What are the common symptoms of PCOS, and how is it diagnosed?

PCOS symptoms include signs of high testosterone (facial/body hair, acne, oily skin, male pattern hair thinning), irregular periods (ovulation dysfunction), and PCOS-looking ovaries on ultrasound or elevated AMH. Diagnosis requires meeting two out of these three criteria. Mood disorders and weight gain are also common.

Why is a high AMH level not always good for PCOS patients?

In PCOS, a high AMH (Anti-Müllerian Hormone) can be misleading. While it indicates a large number of follicles, these follicles are often frozen, fail to ovulate, and may produce lower-quality eggs. Therefore, high AMH in PCOS doesn't necessarily mean good egg quality for fertility.

How does insulin resistance contribute to PCOS symptoms?

80% of PCOS patients have insulin resistance, which is partially driven by elevated androgens. When cells resist insulin, glucose and insulin levels rise. High insulin stimulates ovaries to produce more androgens, blocks ovulation, decreases sex hormone binding globulin (increasing free testosterone), and promotes visceral fat, creating a vicious cycle of inflammation and worsened symptoms.

What are the first steps to treat PCOS, even before medication?

First steps include lifestyle adjustments: regular exercise (e.g., 10-15 minute walk after meals), sufficient sleep, stress reduction, and a healthy, low-inflammatory diet, minimizing processed and high-carbohydrate foods. Over-the-counter supplements like Inositol and Vitamin D can also significantly improve insulin sensitivity.

What are the key signs and symptoms of endometriosis?

Endometriosis symptoms include painful periods that disrupt daily life, painful deep penetration during sex, chronic bloating (all month), painful bowel movements, and recurrent UTI-like bladder symptoms with negative cultures. A normal ultrasound or MRI does not rule out endometriosis.

How does endometriosis affect fertility and pregnancy outcomes?

Endometriosis is a leading cause of infertility. It causes inflammation and scarring in the pelvis, which can block fallopian tubes, reduce egg count and quality, create a hostile environment for sperm and embryos, and increase the risk of ectopic pregnancies and miscarriages. Adenomyosis, a related condition, also contributes to these issues.

What is the importance of a pelvic ultrasound for women's health?

A pelvic ultrasound is crucial for early detection of conditions like PCOS, fibroids, ovarian cysts, and uterine septa, which can cause infertility and other complications. Despite its importance, it is often not a routine part of a well-woman exam.

What should a comprehensive well-woman exam include?

Beyond a Pap smear and STD check, a complete exam should assess fertility, screen for PCOS and endometriosis based on symptoms, include a pelvic ultrasound, check egg count (AMH), and evaluate genetic and lifetime risk for conditions like breast cancer. It should also address mental health and lifestyle factors.

Is gestational age or pregnancy itself protective against PCOS and endometriosis?

Pregnancy temporarily puts endometriosis 'at bay,' reducing pain. However, it does not cure it, and symptoms often return postpartum. There's no clear evidence that pregnancy itself offers long-term protection against PCOS or endometriosis.

What is PMDD, and how can it be treated effectively?

PMDD (Premenstrual Dysphoric Disorder) is a severe form of PMS characterized by extreme emotional and physical symptoms (depression, crying, unmotivation) occurring 10-14 days before a period. It's an extreme brain reaction to normal hormonal changes. Treatment can involve pulsatile SSRIs (e.g., Prozac or Zoloft for 10-14 days a month) or hormone replacement for perimenopausal women.

How can women assess their breast cancer risk and what should they do if it's high?

Women should calculate their lifetime breast cancer risk using tools like the Tyra Cusk Risk Assessment (available on GMD.com). If the risk is 20% or more, they should request earlier breast imaging (as early as age 30), including ultrasound and MRI, in addition to mammograms. Genetic testing is also recommended for those with suspicious family histories.

Female Hormone Health, PCOS, Endometriosis, Fertility & Breast Cancer | Dr. Thaïs Aliabadi

Andrew Huberman

Science & Technology7 min read188 min video

Nov 24, 2025|162,611 views|4,826|578

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TL;DR

Women's health issues like PCOS, endometriosis, and breast cancer are often dismissed. Early diagnosis and patient advocacy are crucial.

Key Insights

Most female fertility issues stem from undiagnosed PCOS and endometriosis, leading to significant egg count and quality problems.

PCOS is linked to insulin resistance, chronic inflammation, and hormonal imbalances, requiring comprehensive treatment beyond birth control.

Endometriosis involves ectopic uterine tissue causing severe, progressive pain, often misdiagnosed and dismissed for years.

Early screening for PCOS and endometriosis, including AMH levels and pelvic ultrasounds, is vital, especially for teenagers with severe symptoms.

Women need to be their own advocates for health, demanding specific tests and challenging dismissive medical advice.

Calculating lifetime breast cancer risk is crucial for personalized screening, as the standard 'mammogram at 40' is often inadequate for high-risk individuals.

THE SYSTEMIC CRISIS IN WOMEN'S HEALTH DIAGNOSIS

Dr. Thaïs Aliabadi highlights a profound crisis in women's healthcare, asserting that symptoms like pain, hair thinning, and mood changes are frequently dismissed or normalized by medical professionals. She argues that this systemic neglect leads to millions of women suffering from undiagnosed conditions such as PCOS, endometriosis, and chronic pelvic pain, which are leading causes of infertility. Aliabadi emphasizes the urgency of listening to women's complaints, as early intervention could prevent severe health complications and financial burdens associated with late diagnoses, particularly in fertility treatments.

PCOS: DIAGNOSIS, SYMPTOMS, AND MISCONCEPTIONS

Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting approximately 15% of women in the U.S., with over 90% remaining undiagnosed. Diagnosis requires meeting two out of three criteria: symptoms of high androgens (e.g., facial/body hair, acne, male-pattern hair thinning), ovulation dysfunction (irregular periods), and a "PCOS-looking ovary" on ultrasound or elevated AMH levels. A critical misconception is that "polycystic" means ovarian cysts, when it actually refers to numerous small follicles, often misinterpreted as healthy ovaries. Furthermore, normal testosterone levels do not exclude a PCOS diagnosis.

UNDERLYING DRIVERS AND PHENOTYPES OF PCOS

The core drivers of PCOS symptoms are multifaceted: a disrupted brain-pituitary-ovary axis (leading to increased LH and androgen production, blocking ovulation), insulin resistance (affecting 80% of PCOS patients, even lean ones), chronic inflammation (exacerbating insulin resistance and androgen production), genetics (often linked to family history of diabetes or obesity), and epigenetics (lifestyle factors like stress, diet, and sleep). PCOS presents in four phenotypes, making diagnosis complex as not all women exhibit the same symptoms (e.g., some are lean, some have regular periods but still lack ovulation), leading to frequent misdiagnosis or inadequate treatment.

TREATMENT STRATEGIES FOR PCOS AND INSULIN RESISTANCE

Effective PCOS treatment targets the underlying drivers. Lifestyle modifications are crucial, including regular exercise (especially walking after meals), adequate sleep, stress reduction, and a low-inflammatory, limited processed food diet. For insulin resistance, Metformin is often prescribed, with dosages typically starting at 750mg twice daily, up to 1000mg twice daily for those who tolerate it and lack symptom resolution. Dr. Aliabadi also champions supplements like inositol and Vitamin D, which improve insulin sensitivity and can significantly alleviate PCOS symptoms. GLP-1 agonists, initially used for weight loss, have also shown remarkable success in normalizing insulin and reducing inflammation in PCOS patients.

ENDOMETRIOSIS: THE DEVASTATING SILENT EPIDEMIC

Endometriosis affects over 20% of women, though often dismissed and misdiagnosed for 9 to 11 years on average. It involves tissue similar to the uterine lining growing outside the uterus, bleeding internally with each menstrual cycle and causing severe inflammation, scarring, and nerve growth. Symptoms include debilitating painful periods that disrupt daily life, painful deep penetration during sex, chronic bloating, painful bowel movements, and recurrent UTI-like symptoms with negative cultures. Despite its prevalence and severe impact on fertility and quality of life, there is no simple blood test for endometriosis; diagnosis often relies on patient history and, definitively, via laparoscopic surgery.

ETIOLOGY AND IMPACT OF ENDOMETRIOSIS ON FERTILITY

While the exact cause of endometriosis is unknown, leading theories include retrograde menstruation (menstrual blood flowing into the pelvis, implanting tissue), immune system dysfunction (failing to clear ectopic tissue), and cellular metaplasia (embryonic cells forming in distant sites). This inflammatory process damages egg quality and count, scars fallopian tubes, and creates a hostile uterine environment for embryo implantation, contributing significantly to infertility and increased miscarriage risk. Dr. Aliabadi postulates a high comorbidity between PCOS and endometriosis, suggesting that chronic inflammation in PCOS patients may fuel endometriosis.

DIAGNOSIS AND HOLISTIC MANAGEMENT OF ENDOMETRIOSIS

Early diagnosis is crucial, based on listening to patient symptoms as painful periods that disrupt life are never normal. While ultrasound can detect advanced cases (like endometriomas), it often misses superficial or stromal lesions. Surgical excision via laparoscopy is the gold standard for diagnosis and treatment, though many gynecologists lack the specialized training for full resection, often leading to missed lesions and symptom recurrence. Post-surgery, hormonal suppression (e.g., progesterone-only birth control, IUDs like Kylina/Mirena, or GnRH antagonists) is essential to prevent recurrence, as untreated implants grow back with estrogen.

THE IMPORTANCE OF EARLY EGG COUNT AND QUALITY PRESERVATION

Dr. Aliabadi stresses the critical importance of early egg count (AMH) checks, even for teenagers with severe pain, as endometriosis can drastically deplete ovarian reserve prematurely. While PCOS patients often have high AMH, indicating many follicles, their egg quality may be poor, necessitating egg freezing by age 28-30. For endometriosis, which severely impacts both count and quality, early freezing is even more urgent. Supplements like CoQ10 and L-carnitine are also suggested for improving egg quality.

CHALLENGES IN WOMEN'S MEDICAL TRAINING AND ACCESS

The medical system is failing women due to inadequate training among many OB/GYNs in diagnosing complex conditions like PCOS and endometriosis, exacerbated by time constraints (10-minute appointments). Dr. Aliabadi advocates for mandatory pelvic ultrasounds as part of annual well-woman exams and suggests separating obstetrics from gynecology. This would allow gynecologists to specialize, dedicate more time to complex cases, and improve diagnostic and surgical skills, such as advanced laparoscopic surgery for fibroids or hysterectomies, which currently few physicians can perform minimally invasively.

ABANDONING THE 'UNEXPLAINED' INFERTILITY DIAGNOSIS

Dr. Aliabadi breaks down infertility into actionable 'buckets': female factor (hormonal, egg count, STDs), male factor (sperm quality, lifestyle), anatomical factor (fibroids, septum, blocked tubes), endometriosis, PCOS, and autoimmune conditions. She argues that "unexplained infertility" is often a result of doctors failing to thoroughly investigate these areas, particularly undiagnosed endometriosis or PCOS, or not considering autoimmune panels. Patients are encouraged to systematically address each bucket and advocate for comprehensive testing and diagnosis.

BREAST CANCER RISK ASSESSMENT AND SCREENING

Dr. Aliabadi insists that every woman must know her lifetime risk of breast cancer using tools like the Tyrer-Cuzick calculator (available on sheMD.com). This is crucial because mammograms starting at 40 are insufficient for high-risk individuals. Women with a lifetime risk of 20% or more should begin breast imaging (mammograms, ultrasounds, and potentially MRIs) as early as age 30. Genetic testing (e.g., via Myriad) is also recommended for those with a family history of various cancers, as it can reveal elevated risk scores (e.g., from tiny, individually minor genetic markers) that demand more aggressive screening or preventative measures like Tamoxifen or prophylactic mastectomy.

PREMENSTRUAL DYSPHORIC DISORDER (PMDD) AND MENOPAUSE

PMDD, a severe form of PMS, involves extreme emotional and psychological responses to normal hormonal changes, leading to debilitating depression, anxiety, and relationship issues for two weeks each month. It can be treated with birth control (like Yas) or, effectively, with pulsed SSRIs taken 10-14 days before a period. Postpartum depression is on the rise, often affecting women with pre-existing anxiety, depression, or PMDD. Menopause and perimenopause, often dismissed, bring a new wave of challenges including mood swings, hot flashes, brain fog, and other physical changes, highlighting a continuous cycle of unaddressed medical issues throughout a woman's life.

EMPOWERMENT AS THE PATH TO BETTER HEALTH OUTCOMES

Dr. Aliabadi's overarching message is the absolute necessity for women to become their own informed and empowered health advocates. By understanding their symptoms, utilizing available zero-cost resources like her OV and sheMD platforms, and demanding comprehensive diagnostic tests (e.g., AMH, pelvic ultrasound, and specific breast cancer risk assessments), women can navigate a medical system that often fails them. This self-advocacy, coupled with open communication with clinicians and peer support, is the strongest force for improving women's health outcomes and ensuring their voices are heard and validated.

Mentioned in This Episode

●Supplements

●Products

●Software & Apps

●Tools

●Companies

●People Referenced

Female Hormone Health & Gynecological Conditions: Actionable Steps

Practical takeaways from this episode

Do This

Assess your likelihood of PCOS using the free OV platform (ovi.com)

Prioritize insulin sensitivity through diet (low carbohydrate/processed foods), exercise (10-15 min walk after meals), sleep, and stress reduction

Consider supplements like Inositol, Vitamin D, CoQ10, and L-Carnitine for insulin sensitivity and egg quality

If you have PCOS or endometriosis, know your AMH (egg count) early, especially if under 20 with severe pain

If trying to conceive with PCOS, try Metformin, Letrozole, or Clomid (under doctor guidance) before fertility clinics

Consider egg freezing before age 30, or even later if PCOS, aiming for 20-40 eggs

Listen to your body: painful periods, painful sex, chronic bloating, recurrent UTIs with negative cultures are NOT normal - advocate for further investigation

Insist on a pelvic ultrasound as part of your annual well-woman exam for early detection of issues like fibroids, cysts, or uterine septum

Calculate your lifetime risk of breast cancer using tools like Tyra Cusk formula (on GMD.com) and discuss imaging (ultrasound, MRI) with your doctor if risk is >20%

If you have family history of breast, ovarian, pancreatic, or prostate cancer, ask for genetic cancer testing (e.g., Myriad)

For PMDD, consider pulsatile SSRI treatment (e.g., Prozac 10-14 days before period) or Zoloft daily, and refer to a psychiatrist

For menopausal hair thinning, consider oral minoxidil (0.5mg-2.5mg daily) early on for best results

Avoid This

Do NOT dismiss or normalize painful periods, painful sex, or chronic pelvic pain - they are often signs of underlying conditions

Do NOT rely solely on high AMH or regular periods as indicators of good fertility, especially with PCOS, as egg quality can be low

Do NOT allow doctors to dismiss your symptoms or label you as 'crazy' or 'anxious' without proper investigation

Do NOT assume a normal ultrasound or MRI rules out endometriosis, especially superficial or stromal types

Do NOT take unmonitored or insufficient doses of medications like Metformin (e.g., 500mg once daily is often ineffective for PCOS)

Do NOT stop birth control pills for endometriosis prematurely, as they are crucial for hormonal suppression after surgery

Do NOT take estrogen-only hormone replacement post-menopause if you have endometriosis; always include progesterone to prevent stimulating implants

Do NOT rely on general mammogram guidelines (starting at 40) if you have high breast cancer risk (≥20%); push for earlier screening (age 30) and additional imaging

Common Questions

Women's symptoms are frequently dismissed, minimized, or normalized by healthcare providers, leading to millions suffering without proper diagnosis. Many doctors lack sufficient training or time during consultations, and standard well-woman exams often omit crucial diagnostic steps like pelvic ultrasounds.

Topics

Female Fertility Hormone Health Chronic Inflammation Breast Cancer Screening PMDD Women's Health Advocacy Pelvic Ultrasound Metformin

Mentioned in this video

supplementL-Carnitine

A supplement that may be beneficial for improving egg quality, possibly due to its anti-inflammatory effects.

supplementInositol

A supplement (different forms mentioned) that significantly helps increase insulin sensitivity, thereby improving PCOS symptoms and fertility outcomes.

drugLetrozole

An ovulation-inducing medication that helps regulate the hypothalamus-pituitary-ovarian axis, pushing patients to ovulate; often recommended before Clomid for PCOS patients trying to get pregnant.

companyMyriad Genetic Testing

A company specialized in genetic cancer testing, checking for cancer-causing genes and also calculating the Tyra Cusk score, adding tiny markers from DNA to give a comprehensive risk score.

toolKylena IUD

A smaller progesterone-only IUD used for hormonal suppression of endometriosis, particularly recommended for young girls who haven't had children.

drugMyfembree

A G&RH antagonist medication that takes away estrogen to treat endometriosis, effective for painful sex and periods, but can cause pseudo-menopausal symptoms and is limited to two years of use due to bone loss risk.

drugTamoxifen

A medication that reduces the risk of breast cancer by 50% over 10 years, offered to patients with a very high lifetime risk (north of 35%).

personDr. Corandi

A cardiologist who introduced Dr. Aliabadi to the benefits of Trulicity for weight loss and metabolic improvements in PCOS patients in 2014.

supplementWild Mulberry Leaf

An ingredient in the OV supplement that can block the absorption of carbohydrates in meals by 40%, benefiting PCOS patients by addressing insulin resistance.

drugGLP-1s (Trulicity, Ozempic)

A class of medications (like Trulicity and Ozempic) used by Dr. Aliabadi since 2014 for PCOS patients to regulate insulin, reduce weight, inflammation, and improve mood, often micro-dosed to avoid side effects.

drugClomid

An ovulation-inducing medication that helps regulate the hypothalamus-pituitary-ovarian axis, pushing patients to ovulate; often recommended for PCOS patients trying to get pregnant.

drugOrilissa

drugMinoxidil (Rogaine)

A medication used to treat hair thinning in menopause, available as topical Rogaine or oral minoxidil (0.5mg-2.5mg daily), with results typically seen in 6 months to 2 years.

productOur Place Always Pan Pro (Titanium)

A non-toxic, non-stick pan made with pure titanium, free of PFAS and other harmful chemicals, praised for its durability, easy cleaning, and cooking performance.

softwareTyra Cusk Risk Assessment Tool

A free formula available on GMD (Dr. Aliabadi's platform) that calculates a woman's lifetime risk of breast cancer based on factors like age, height, weight, breast density, family history, and genetic mutations.

drugAccutane

A prescription medication for acne, often used by young women who may actually have underlying PCOS.

toolMirena IUD

The most common progesterone-only IUD used for hormonal suppression of endometriosis, also offering contraception and heavy period management.

drugYaz

A birth control pill form that helps with PMDD symptoms.

supplementMetformin

supplementSpironolactone