Female Hormone Health: Undiagnosed PCOS, Endometriosis, Fertility, and Systemic Failures in Women's Healthcare

The episode features Dr. Tais Aliabadi, an OBGYN, discussing critical issues in women's reproductive and general health, primarily focusing on Polycystic Ovary Syndrome (PCOS) and endometriosis. A central theme is the widespread dismissal and normalization of women's symptoms by medical professionals, leading to a staggering rate of undiagnosed cases for these conditions, which are the leading causes of infertility globally. Dr. Aliabadi highlights how common complaints like pain, hair thinning, and mood changes are often brushed aside as "normal" aspects of being a woman, obscuring underlying health problems that can severely impact fertility and overall well-being.

Dr. Aliabadi meticulously breaks down the diagnostic criteria for PCOS, emphasizing that it's the most common hormone disorder in reproductive-age women, affecting 15-20% of the population, yet over 90% remain undiagnosed. She clarifies that PCOS diagnosis requires meeting two out of three criteria: symptoms of high androgens (e.g., acne, facial hair, hair thinning), ovulation dysfunction (irregular periods), or specific "PCOS-looking" ovaries on ultrasound, or elevated AMH levels. She stresses that a normal blood testosterone level does not rule out PCOS and that the term "polycystic" refers to follicles, not cysts, a common point of confusion for doctors. She also outlines four distinct phenotypes of PCOS, further complicating diagnosis.

The discussion extends to endometriosis, another major contributor to infertility, where patients often suffer from severe pain dismissed as normal. Dr. Aliabadi reveals alarming cases of young women, even teenagers, experiencing rapid depletion of their ovarian reserve due to undiagnosed endometriosis, leading to egg counts typical of much older women. She argues that early screening, including AMH blood tests, should be mandatory for young women, especially those with severe symptoms, to prevent the need for costly and often avoidable fertility treatments like IVF later in life.

Practical insights include the need for mandatory education on PCOS and endometriosis from a young age, the importance of pelvic ultrasounds as a standard part of well-woman exams, and a more holistic approach to treatment beyond just birth control. Dr. Aliabadi advocates for patient self-advocacy, empowering women to recognize symptoms and seek appropriate care, even suggesting that "robotic doctors" might be better at diagnosing due to their unbiased approach. The episode underscores a systemic failure in women's healthcare and calls for a paradigm shift towards proactive diagnosis and comprehensive management of these prevalent conditions.

Women's health is very different than other fields of medicine. It's very it's a different monster.

Women's symptoms get dismissed, minimized, or completely ignored, right? It's normalized.

Behind these dismissals are millions and millions of women suffering undiagnosed PCOS, endometriosis, chronic pelvic pain, infertility...

If every 20-year-old in this country would go through my office once at age 20, I would shut down these fertility clinics.

The textbook picture is a false picture of fertility as a function of age.

You don't need a doctor to diagnose you. If you listen to this podcast, by the time you and I are done, whoever is listening... you're going to be able to diagnose these conditions...

Polycystic ovary syndrome does not mean cyst. That's a bad name.

I always say, if you're twer than 25 and you're struggling with acne and you come to my office and you're asking for sperolactone and Accutane, something's not right.

70 to 80% of PCOS patients don't ovulate even when they have regular cycles.

Pelvic ultrasound should be mandatory. That's another topic I want to cover with the what wellwoman exam should look like versus what women get when they go to their doctor's office.