Interview with Dr. Thais Aliabadi, Leading OBGYN and PCOS Expert: Unlocking PCOS from Diagnosis to Treatment

What is PCOS, and why is it considered a silent epidemic?

Dr. Thais Aliabdi explains PCOS. Polycystic Ovary Syndrome, or PCOS, is a complex condition affecting roughly 10% to 20% of women during their reproductive years, varying by ethnicity and geography. Despite its prevalence, up to 75% of women with PCOS remain undiagnosed. This underdiagnosis and misunderstanding are why PCOS is often called a silent epidemic—a serious health issue hiding in plain sight that is overlooked in women’s healthcare.

PCOS is not just a hormonal imbalance or a reproductive problem, as traditionally thought. It’s multifactorial, involving genetics, metabolic dysfunction, hormonal disruption, inflammation, and gut health. Women with PCOS experience a range of symptoms that affect their overall well-being, yet too often they are told simplistic solutions like “just lose weight” or “go on birth control,” which dismisses the seriousness and complexity of the syndrome.

Could you break down the causes and nature of PCOS?

PCOS has no single cause; it stems from an interplay of multiple factors:

• Genetics: Family history increases susceptibility.
• Gut microbiome: Imbalances in gut bacteria can drive insulin resistance—a common problem in PCOS—and exacerbate symptoms.
• Metabolic dysfunction: Insulin resistance is at the core of PCOS, affecting weight and hormone balance.
• Hormonal imbalance: Women with PCOS often have elevated testosterone, increased luteinizing hormone (LH), and decreased follicle-stimulating hormone (FSH), leading to disrupted ovulation and irregular cycles.
• Chronic inflammation: Low-grade inflammation may stimulate the ovaries to produce excess testosterone.

This multifaceted nature means that effective treatment must address each of these components rather than focusing on just one symptom or cause.

How is PCOS diagnosed? What criteria do doctors look for?

Diagnosis follows a clinical approach based on at least two out of three key criteria:

1. Irregular menstrual cycles: Women often have unpredictable or absent periods due to disrupted ovulation.
2. PCOS-looking ovaries on ultrasound: Instead of simple cysts, the ovaries typically have numerous small follicles arranged like “strings of pearls.” This is a distinctive imaging finding, but not present in every case.
3. Signs or lab values indicating elevated androgens (male hormones): Symptoms include excess facial or body hair, acne, and hair thinning. Blood tests measuring testosterone can help, although normal testosterone levels do not rule out PCOS.

For women without access to ultrasound, an elevated Anti-Müllerian Hormone (AMH) level—an indicator of follicle count—can substitute the ultrasound criterion, as women with PCOS often have high AMH due to the abundance of follicles.

For teenagers, diagnosis relies more heavily on irregular periods and androgen symptoms because AMH levels are naturally higher in adolescence, which can complicate interpretation.

What symptoms commonly bring women to the doctor, and which are most concerning?

Women typically struggle with symptoms like:

• Irregular or absent menstruation
• Weight gain that’s difficult to lose
• Acne, hair thinning, or unwanted facial and body hair
• Mood changes, anxiety, and depression
• Fertility challenges
• Insulin resistance and metabolic issues

Weight gain, while common, is not a diagnostic criterion, but it remains a substantial source of frustration because it’s often resistant to diet and exercise efforts. Mood disorders are also prevalent and can worsen with hormonal treatments, requiring careful management.

How does insulin resistance relate to PCOS symptoms?

Insulin resistance is the metabolic cornerstone of PCOS. Normally, after consuming carbohydrates, the pancreas releases insulin to help cells absorb glucose and create energy. In PCOS, cells become resistant to insulin, causing glucose to stay in the bloodstream.

This triggers higher insulin levels, which prompt the ovaries to produce more testosterone, driving symptoms like irregular cycles, acne, hair thinning, and excess hair growth. High insulin also promotes fat storage, which explains the persistent weight gain many women experience despite “doing all the right things.”

Addressing insulin resistance is thus a critical part of managing PCOS symptoms.

What are the modern approaches to treating PCOS?

Since PCOS has no cure, treatment focuses on managing its multiple symptoms through a holistic approach:

• Diet: Emphasizing low carbohydrate intake to reduce insulin stimulation.
• Exercise: Regular movement, especially walking after meals, helps open insulin receptors on cells and lowers insulin resistance.
• Medications:
  • Metformin: Improves cellular insulin response, lowering insulin and testosterone levels, and helping with weight and hormonal balance.
  • GLP-1 receptor agonists (e.g., Ozempic, Wegovy): These newer medications regulate insulin effects and have been shown to significantly aid weight loss and metabolic health in PCOS patients.
  • Birth control pills: Often used to regulate menstrual cycles and reduce symptoms of high androgens by increasing sex hormone binding globulin (SHBG), which binds free testosterone.
  • Anti-androgens (e.g., spironolactone): To control acne, hair loss, and excessive hair growth.
• Supplements: Certain evidence-based supplements work at a cellular level to improve insulin sensitivity and hormone balance.
• Treating inflammation and gut health: Addressing gut dysbiosis and chronic inflammation is gaining attention since they contribute to insulin resistance and hormone imbalances.
• Symptom-specific therapies: Topical treatments like minoxidil for hair loss and laser hair removal or electrolysis for facial/body hair may be necessary.

This multi-pronged approach allows treatment to be tailored to each patient’s unique symptom profile and medical background.

How do you integrate supplements like OV into the treatment plan?

OV is a supplement Dr. Aliabadi developed based on decades of clinical experience and scientific research to address key aspects of PCOS, including hormone balance, metabolism, and inflammation. Unlike single-function supplements, OV targets the multifactorial nature of PCOS in one daily packet.

It’s especially beneficial when combined with medications like GLP-1 receptor agonists or metformin to help manage side effects and enhance efficacy. OV has become a staple in the treatment regimen for many patients because of its comprehensive support.

Can women take OV alongside metformin or GLP-1 medications?

Absolutely. OV works well alongside these medications. Often, patients start on GLP-1 medications and OV together to address symptoms and mitigate side effects like nausea or digestive discomfort. Metformin may be added later to further improve insulin sensitivity. Combining these treatments can produce strong, synergistic results in managing PCOS symptoms.

What about different patient profiles? How do you treat teenagers, adult women, and menopausal women differently?

Teenagers require careful diagnosis because PCOS symptoms overlap with typical puberty changes like acne and irregular periods. When diagnosed, the focus is on balancing hormones and supporting mental health, often without relying on hormonal birth control initially.

Adults who face fertility issues, weight gain, or significant metabolic disturbances typically receive a more intensive approach, including medications like metformin and GLP-1s, supplements like OV, and sometimes birth control or anti-androgens.

For perimenopausal and menopausal women, fertility concerns lessen, but insulin resistance often worsens. Many experience weight gain and metabolic risks. It’s important to continue monitoring these risks and use treatments such as metformin or GLP-1s as needed. Hormone replacement therapy, including testosterone creams, may be prescribed for low libido and energy. The treatment strategy shifts from lowering testosterone (seen in younger PCOS patients) to supplementing it as levels decline with age.

How does PCOS affect fertility, and when should egg freezing be considered?

Women with PCOS often have a high follicle count and elevated AMH levels, which may give a false sense of security about fertility. However, the quality of eggs declines rapidly after age 30, and many PCOS patients also develop endometriosis, which affects both egg number and quality.

It’s crucial to assess ovarian reserve through AMH testing early, especially if symptoms like painful periods or infertility arise. Teenagers with severe symptoms can also be monitored for egg count and may be candidates for egg freezing from age 16 with parental consent. Egg freezing can preserve fertility for women who need to delay pregnancy.

Why are so many women with PCOS frequently dismissed or undiagnosed?

The high rate of undiagnosed PCOS stems from several issues:

• Dismissal of symptoms: Women are often told their symptoms are “in their head” or due to stress without thorough investigation.
• Lack of a definitive test: PCOS diagnosis relies on symptoms and multiple criteria, not a single test, which can confuse clinicians.
• Varied presentation: Not all women have the same symptoms. Some may be lean and have regular cycles but still have PCOS.
• Overlap with normal teenage changes: In adolescents, distinguishing PCOS from typical puberty symptoms is difficult.

This diagnostic challenge and systemic dismissal mean many women suffer undiagnosed for years, often cycling through multiple doctors without proper care.

What impact does receiving a correct diagnosis and treatment have on women’s lives?

Proper diagnosis and comprehensive treatment profoundly improve quality of life. Patients often experience relief from symptoms like acne, hair loss, excessive hair growth, anxiety, and depression. Beyond physical symptoms, many women report a significant boost in self-esteem, self-confidence, and overall happiness.

For some, receiving validation after years of dismissal is transformative—feeling seen and understood can be as powerful as medical treatment itself. One patient described finally knowing what it was to feel happy and confident after beginning therapy, underscoring the emotional toll this condition takes if untreated.

How does PCOS intersect with eating disorders?

PCOS and eating disorders often coexist, particularly because the metabolic imbalances and symptoms of PCOS (weight gain, insulin resistance) can trigger harmful behaviors in vulnerable individuals. Many women with PCOS struggle with severe eating disorders like bulimia and anorexia, frequently exacerbated by frustration over weight gain and body image issues.

It’s important to rule out PCOS when assessing eating disorders because addressing the underlying hormonal and metabolic issues can be crucial to effective treatment. Sadly, many teens are sent to eating disorder centers without thorough hormonal evaluations, prolonging suffering and complicating the path to recovery.

What are the misconceptions around PCOS and weight?

Many still believe that PCOS only affects overweight women, but about 25% of PCOS patients are lean. These “lean PCOS” patients exhibit classic symptoms despite normal or low body weight. Weight gain is not a diagnostic criterion for PCOS, and women who are underweight or of average weight can definitely have PCOS. This misconception leads to missed diagnoses.

What advice do you have for women suspecting they have PCOS?

Women who suspect PCOS should educate themselves and seek a healthcare provider who listens deeply to their symptoms. A thorough history alone can be sufficient for diagnosis in many cases. For a first step, tools like the OVII PCOS Quiz online can help assess the likelihood of PCOS and guide next steps.

It’s essential to become your own health advocate by requesting appropriate tests like AMH, insulin levels, and hormonal profiles, and demanding a comprehensive treatment plan. Remember, PCOS is multi-dimensional and requires an approach that addresses hormones, metabolism, inflammation, and lifestyle.

What’s your message to women living with PCOS?

We see you, we hear you, and you are definitely not alone. PCOS is real, common, and complex, but advances in understanding and treatment mean better outcomes are possible. The era when women’s health concerns are dismissed must end. Seek care, empower yourself with knowledge, and know that through the right interventions, lives change dramatically.

Treatment is not a quick fix but a journey requiring patience, self-compassion, and persistence. Celebrate every improvement, from better skin to more stable moods and regular cycles. Most importantly, prioritize your mental health and self-esteem—they are central to overall wellness.

Table of Contents

• Frequently Asked Questions

Frequently Asked Questions

What exactly causes PCOS?

PCOS has no single cause. It results from a combination of genetics, hormonal imbalances, insulin resistance, chronic inflammation, and gut microbiome imbalances. This multifactorial origin makes diagnosis and treatment complex.

Can PCOS be diagnosed with a blood test?

No single blood test can diagnose PCOS. Diagnosis is based on having at least two of three criteria: irregular periods, elevated androgens or symptoms of high testosterone, and PCOS-looking ovaries on ultrasound or elevated AMH levels.

Is weight gain required to have PCOS?

No. While weight gain and insulin resistance are common in PCOS, about 25% of women with PCOS have a normal or low body weight, known as lean PCOS.

How does insulin resistance affect PCOS?

Insulin resistance causes higher insulin levels, which stimulate the ovaries to produce excess testosterone. This worsens symptoms like irregular periods, acne, hair thinning, and weight gain.

What treatments are available for PCOS?

Treatment includes lifestyle changes (diet and exercise), medications such as metformin and GLP-1 receptor agonists, hormonal treatments like birth control or anti-androgens, and supplements like OV. Treatment is tailored to individual symptom profiles and aims to improve hormonal and metabolic imbalances.

Can teenagers be diagnosed with PCOS?

Yes, though diagnosis can be challenging because symptoms overlap with normal puberty changes. Diagnosis in teens typically requires irregular periods and signs of androgen excess, but not necessarily ultrasound or AMH criteria.

Does PCOS go away after menopause?

PCOS is a lifelong condition. While some symptoms like irregular periods resolve after menopause, insulin resistance often worsens, increasing risks for diabetes and cardiovascular disease. Management continues through menopause with a shift in treatment focus.

How can women with PCOS prepare for fertility?

Monitoring ovarian reserve with AMH blood tests and considering egg freezing early, especially if symptoms like painful periods or infertility appear, can help preserve fertility. PCOS patients often have many eggs but declining quality with age, plus risks from coexisting conditions like endometriosis.

Are supplements effective for PCOS?

Evidence-based supplements like OV can support hormone balance, metabolism, and inflammation, complementing other treatments. They are often used alongside medications like metformin and GLP-1s for better results.

Why is awareness about PCOS important?

Because PCOS affects so many women yet remains underdiagnosed and often dismissed, increasing awareness empowers women to seek proper diagnosis and comprehensive care. Early recognition and treatment can dramatically improve quality of life and long-term health.

This article was created from the video The PCOS Masterclass | Unlocking PCOS: From Diagnosis to Treatment with Dr. Thais Aliabadi | SHE MD for Dr. Thais Aliabadi’s website.