Interview with Sasha Pieterse Sheaffer, actress, podcaster, and advocate on PCOS, hormones, and Hollywood

Table of Contents

• Conversation highlights
• About our guest
• Interview (Q&A)
• How we approach PCOS in our practice
• Real talk about hormones
• When it comes to contraception and IUDs
• Talking about mental health and body image
• Resources and next steps
• FAQ
• Final words from Sasha and Dr. A

Conversation highlights

Dr. Thais Aliabadi and Mary Alice Haney sit down with Sasha Pieterse Sheaffer to unpack a deeply personal story that has become a public lesson: living with polycystic ovary syndrome, navigating fertility, and surviving the scrutiny that comes with growing up in the spotlight. Sasha’s story is candid, heartbreaking at times, and ultimately empowering. Alongside her, Dr. Thais Aliabadi offers clinical insight into diagnosis, treatment, and practical strategies women can use to advocate for their own health.

About our guest

Sasha Pieterse Sheaffer is an actress best known for her role on Pretty Little Liars. She is also a mom, the host of the podcast Women in the Nude, an entrepreneur, and a vocal advocate for women’s health awareness. Her experiences with sudden weight gain, irregular cycles, and later a diagnosis of PCOS have led her to speak openly so other women don’t have to suffer in silence.

Interview (Q&A)

Mary Alice: Sasha, you grew up in front of the camera. When did you first notice something was wrong with your health?

We started very young—Sasha began acting at four and joined Pretty Little Liars at 12. As she moved through adolescence into her late teens, things shifted. She remembers getting her period at 10 and never experiencing regular cycles through her teens and early twenties. At 17, she gained 70 pounds in one year. For someone whose image was part of her career, that sudden change felt seismic.

Sasha explains that the weight gain and irregular periods were paired with seizures she’d been diagnosed with at 15. No one had connected the dots at first. She went to many doctors, felt dismissed, and was told she must be eating too much or not exercising enough, even though she was following the standard advice.

Dr. A: What finally led to a diagnosis?

Dr. Thais describes a turning point: a specialist—an endocrinologist—who listened. A careful history, a few tests, and finally a name: polycystic ovary syndrome, or PCOS. For Sasha, getting the diagnosis was validating. She was not “doing something wrong”; her symptoms were the result of an underlying condition with metabolic and hormonal roots.

Mary Alice: What does a PCOS diagnosis mean in practical terms?

Dr. Thais breaks down the diagnostic criteria we rely on. A person generally meets diagnostic criteria if they have at least two of the following three features:

• Irregular menstrual cycles or a history of irregular periods
• PCOS-appearing ovaries on ultrasound, which often means many small follicles rather than true cysts
• Clinical signs or laboratory evidence of high androgens—things like acne, facial or body hair, hair thinning, or elevated testosterone on blood tests

Not every test is required for every person. A careful history and physical often point the way, which is important because many women are dismissed long before they reach a specialist.

Mary Alice: Sasha, how did that diagnosis change your approach?

Getting a name allowed Sasha to stop blaming herself and begin experimenting with approaches that addressed PCOS specifically. Her main strategy was dietary—moving away from low-fat, high-carb assumptions and toward higher protein and lower refined carbohydrates. She combined that with Pilates and weight training, and gradually the weight came down.

Sasha also took metformin for a period, which she credits with helping regulate her cycles and improving ovulation. After pregnancy, her cycles regulated further, and she felt more in control. But she is clear: progress wasn’t linear. It was trial and error, with setbacks and progress over years.

Dr. A: How does insulin resistance tie into PCOS?

Dr. Thais explains that insulin resistance is central to many PCOS cases. When cells resist insulin, the pancreas produces more insulin to compensate. Elevated insulin stimulates ovarian androgen production, which can cause irregular cycles, acne, and hair changes. Tackling insulin resistance is therefore a primary target.

Strategies that help insulin sensitivity include:

• Dietary changes focused on lower refined carbohydrate intake and balanced protein and fats
• Consistent physical activity and resistance training
• Simple behavioral tactics like walking 10 minutes after meals to blunt post-meal glucose spikes
• Medications such as metformin, when lifestyle measures alone are insufficient

Mary Alice: You mentioned supplements like OV. How should supplements fit into a treatment plan?

Supplements can be helpful as part of a multi-pronged approach. Sasha and Dr. A discuss OV, a supplement formulated for hormone balance, metabolic support, and beauty from within. Dr. Thais points out that lowering insulin through diet, exercise, medications like metformin, and potentially targeted supplements will often help reduce testosterone, regulate cycles, and improve skin and hair symptoms.

Supplements should not replace evidence-based medical care but can complement it. We emphasize checking with a clinician before starting new supplements, especially when trying to conceive or during pregnancy.

Mary Alice: What about fertility? Sasha, you worried about infertility—what happened when you tried to conceive?

Sasha and her partner decided to try early, anticipating possible difficulty. Despite long stretches without menstruation, she did ovulate sometimes, and they were fortunate to conceive on the first month of trying. That outcome is a reminder that irregular cycles do not equate to guaranteed infertility, but they can make conception less predictable.

Dr. Thais stresses the reality: PCOS is one of the leading causes of infertility because of anovulation. Some people with PCOS have many eggs but fewer ovulatory cycles; others have suboptimal ovulation even if bleeding seems regular. Interventions like metformin, lifestyle changes, and ovulation induction can improve the odds.

Dr. A: How do medicines like metformin and others fit in?

Metformin improves insulin sensitivity at a cellular level and can restore more regular ovulation for many people. It played a role in Sasha’s path to pregnancy. Beyond metformin, Dr. Thais references the use of GLP-1 receptor agonists in PCOS patients who struggle with weight and insulin resistance—an approach she has used in clinical practice for years.

Important medication notes:

• Metformin can be continued until pregnancy is confirmed, but may be stopped in pregnancy to avoid masking gestational diabetes in some cases. Clinicians often screen earlier and more frequently for gestational diabetes in people with PCOS.
• Spironolactone is an anti-androgen used for acne and hair loss, but it is teratogenic and must be stopped before trying to conceive.
• Hormone therapies and birth control pills can have variable effects on mood and metabolic parameters; those with PCOS may have heightened sensitivity to systemic hormones.

Mary Alice: Sasha, you also have epilepsy. How does that fit into this story?

Sasha was diagnosed with seizures as a teen, and only recently did she and her team connect seizure timing to her cycles. Dr. Thais explains a clinical observation: painful periods and pelvic inflammation can trigger vasovagal episodes or other neurologic responses in some patients. There are documented cases where treating endometriosis relieved seizure-like episodes.

Because PCOS can co-occur with endometriosis in a significant minority of patients, it’s important to evaluate persistent pelvic pain. If painful periods are present, we should take them seriously and consider referral for gynecologic evaluation and potential treatment of endometriosis.

Mary Alice: You mentioned an overlap between PCOS and endometriosis. Can someone have both?

Yes. About 40 percent of people with PCOS may also have endometriosis. The two conditions have different mechanisms, but they can coexist. Painful periods are not normal. Unrelenting pain that worsens, extends beyond the period, or causes pain with sex or bowel/bladder symptoms warrants evaluation.

Treatments for endometriosis can include hormonal suppression, surgical excision, or a progesterone IUD like the Mirena to reduce symptoms. A copper IUD can worsen pain for those with endometriosis and should be chosen with caution.

Mary Alice: You have a podcast called Women in the Nude. Why that name?

Sasha named the podcast Women in the Nude to reflect candid, unvarnished conversations—bearing truth without filters. The title is intentionally provocative to invite honest talk about taboo or stigmatized topics like infertility, endometriosis, and body image. The platform aims to create community and normalize stories that many women hold privately.

Mary Alice: Sasha, navigating Hollywood’s expectations must have been brutal. How did public scrutiny affect you?

Sasha recalls harsh public commentary starting in her mid-teens: tabloids labeling her “pregnant” from momentary bloating, designers refusing to make costumes in her size, and industry attitudes that celebrated thinness and criticized any deviation. That external pressure fed internal body shame and, at times, disordered eating patterns, even though those behaviors did not change the underlying physiology.

Her coping strategies included quieting exposure to social commentary when possible, building a strong circle of friends outside the industry, and eventually channeling her experience into advocacy so others could feel less alone.

Dr. A: What’s the single most important thing you want women to take away from Sasha’s story?

Advocate for yourself. Many women with PCOS report seeing multiple clinicians before receiving a diagnosis. Your body knowledge matters. If you feel dismissed, seek second opinions, ask for specific tests, and insist on being heard. Tracking cycles, pain, and symptoms can help you build a medical record that makes a diagnosis more likely. And remember that PCOS is common—medical providers should be familiar with it, but sadly, many are not.

Mary Alice: For readers wondering what to do next, what practical steps can they take?

Here are concrete actions we recommend for anyone suspecting PCOS or wanting better management:

1. Document symptoms: irregular periods, acne, hair thinning or excess hair, sudden weight changes, mood shifts, and painful periods.
2. Request a focused evaluation that may include pelvic ultrasound and hormone labs when appropriate.
3. Start with lifestyle changes: prioritize protein, minimize refined carbohydrates, and include resistance training and daily activity. Even a 10-minute walk after meals helps.
4. Ask about insulin-sensitizing options such as metformin if lifestyle measures are insufficient.
5. Discuss fertility planning early if you are considering pregnancy, because timing and egg quality matter with age.
6. If you have painful periods, pursue evaluation for endometriosis. Pain is not normal and deserves attention.
7. Advocate for appropriate contraceptive choices if you are using an IUD: progesterone-releasing devices are generally better tolerated for those with pelvic pain than copper devices.

How we approach PCOS in our practice

We view PCOS as a metabolic and endocrine disorder with reproductive implications. Management is individualized, but these principles guide our care:

• Start with affirming the patient’s experience and building a symptom timeline.
• Target insulin resistance first when present—lifestyle, metformin, GLP-1 agonists, and in select cases, weight-loss medications or procedures.
• Treat symptoms such as acne or hair loss with appropriate medications, but consider reproductive plans before prescribing teratogenic drugs like spironolactone.
• Screen for mood disorders and support mental health—PCOS commonly coincides with anxiety, depression, and body image concerns.
• Coordinate care with endocrinologists, dermatologists, and fertility specialists as needed.

Real talk about hormones

Fear of hormones is understandable, given conflicting messages. But hormones are powerful tools when used appropriately. Hormone therapies can restore cycles, reduce pelvic pain, and improve quality of life. We caution that systemic hormones can have different effects in different people, and those with mood sensitivity may respond differently. Progesterone IUDs are localized and often better tolerated than systemic hormonal pills for people with PCOS and pelvic pain.

We also address a common misconception: PCOS does not automatically mean too much estrogen. Fat tissue produces estrogen, so body composition, timing of testing, and individual physiology determine hormone levels. Accurate diagnosis and tailored treatment matter far more than blanket assumptions.

When it comes to contraception and IUDs

Not all IUDs are the same for someone with PCOS or pelvic pain.

• Copper IUDs can increase menstrual flow and pain; in people with endometriosis, copper IUDs may worsen symptoms and feel like “pouring acid on an open wound.”
• Progesterone IUDs such as Mirena or Kyleena provide local hormone suppression and often relieve endometriosis-related pain for many years.
• After insertion, confirm placement with ultrasound immediately and again after the first period to ensure the IUD has not shifted or been expelled.

Talking about mental health and body image

Sasha’s story illustrates the emotional toll of untreated or misunderstood conditions. The repeated dismissal by clinicians and public shaming compounded anxiety and body dysmorphia.

We recommend integrating mental health care into PCOS management. Cognitive-behavioral therapy, support groups, and trauma-informed therapy can help process medical trauma and rebuild self-advocacy skills. Peer communities and podcasts like Women in the Nude create safe spaces to share and learn from others living similar experiences.

Resources and next steps

For people who suspect they have PCOS or want better care, practical resources include:

• Keeping a symptom and cycle journal
• Searching for clinicians who specialize in reproductive endocrinology or high-volume gynecology practices
• Asking for specific labs: fasting glucose, insulin, lipid panel, free testosterone, and pelvic ultrasound when indicated
• Seeking second opinions if dismissed
• Using community resources and podcasts to find support and up-to-date information

FAQs

What are the most common PCOS symptoms to look for?

Irregular or absent periods, sudden weight gain or difficulty losing weight, acne, facial or body hair growth, hair thinning on the scalp, and mood changes. Painful periods may indicate a coexisting condition like endometriosis and should be evaluated.

Can you have regular periods but still have PCOS?

Yes. Some people have regular bleeding but suboptimal ovulation. They may have symptoms of high androgens or ultrasound findings consistent with PCOS. If fertility is a concern, further evaluation of ovulation quality may be necessary.

How does metformin help with PCOS?

Metformin improves insulin sensitivity at a cellular level. By lowering circulating insulin, it can reduce ovarian androgen production, leading to more regular ovulation, improved menstrual cycles, and sometimes weight stabilization.

Are supplements useful for PCOS?

Supplements can complement lifestyle and medical interventions. Some are formulated to support hormone balance and metabolic health. They should be used under the guidance of a clinician, especially when trying to conceive or during pregnancy.

What should I do if my doctor dismisses my symptoms?

Advocate for yourself: document symptoms, request specific tests, seek a second opinion, and consider seeing a specialist like a reproductive endocrinologist. Persistent symptoms deserve answers.

Can PCOS cause seizures or neurological symptoms?

PCOS itself does not directly cause epilepsy, but hormonal fluctuations and pelvic pain from conditions like endometriosis can trigger vasovagal responses or seizure-like episodes in some patients. If seizures cluster around cycles, discuss this pattern with both neurology and gynecology teams.

Which IUD is best if I have painful periods?

A progesterone IUD is often better for those with painful periods or endometriosis because it suppresses the lining locally and can reduce pain. Copper IUDs may increase pain and bleeding in those with endometriosis and should be used cautiously.

Final words from Sasha and Dr. A

Sasha’s message is simple and powerful: you are not your condition, and you deserve to be heard. Dr. Thais reminds us that medical knowledge is available and treatments can make a real difference—but only if we ask for help and push for answers.

We believe the most transformative step any woman can take is to become her own advocate. Track your symptoms, ask specific questions, and seek care from clinicians who listen. When we combine lived experience with evidence-based medicine, real change happens.

Where to learn more

• Consider reputable sources such as reproductive endocrinology clinics, national PCOS advocacy groups, and academic medical centers for up-to-date guidance.
• Podcasts and community platforms hosted by women living with these conditions can provide practical tips and emotional support.
• If fertility is a concern, consult a specialist early so you can make informed decisions about timing and treatment.

We are grateful to Sasha for sharing her story and to Dr. Thais for translating clinical realities into practical advice. If anything in this conversation resonates, take a step today: document, ask, and advocate. Your body deserves answers, and you deserve care that listens.

This article was created from the video Sasha Pieterse Sheaffer’s Journey With PCOS Hormones & Hollywood | SHE MD for Dr. Thais Aliabadi’s website.