Interview with Dr. Thaïs Aliabadi, OB-GYN: Ask Dr. A About Ozempic, Oral Sex and Antidepressants

What does being our own health advocate actually look like?

Dr. Thais Aliabadi and Mary Alice Haney discuss being an advocate for your own health. We start by taking symptoms seriously. If pain keeps us out of school, sends us to the emergency room, or makes everyday life impossible, we should not accept “nothing is wrong” as the end of the conversation. We need an explanation that fits what is happening in our bodies.

That does not mean assuming every doctor is wrong. Medicine takes a team, and we depend on each other’s expertise. But when the symptoms and the test results do not line up, we can question the interpretation, request another opinion, and keep investigating.

Our goal is to bring better questions into the exam room, not to diagnose ourselves. Everything we discuss here is educational. Medication choices, screening schedules, procedures, and pregnancy planning belong in a conversation with our own medical team.

Table of Contents

• Severe Period Pain and the Importance of Another Opinion
• HPV, Pap Tests and Cervical Cancer Prevention
• Birth Control, Endometriosis and Recurrent Vaginal Symptoms
• PCOS, Pregnancy and Fertility Planning
• Menopause, Joint Pain and Weight Management
• Inherited Cancer Risk, Supplements and Mental Health

Severe Period Pain and the Importance of Another Opinion

Can a “normal” report still miss the reason for debilitating period pain?

Absolutely. We discussed a 14-year-old patient who had experienced excruciating pain since her periods began. She was doubled over, missing school, and repeatedly ending up in the emergency room. Her family had already consulted five OB-GYNs.

Her original MRI interpretation described an ovarian cyst and a pelvic kidney, meaning a kidney located lower in the pelvis rather than in its usual position. But that explanation did not account for the severity of her symptoms.

When we reassessed her abdominal ultrasound, the pelvic structures looked abnormal. Rather than relying only on the written MRI report, we requested the actual images and arranged another radiology review at Cedars-Sinai. That review identified a uterine developmental abnormality.

One side of her uterus connected to the normal menstrual outflow pathway. The other uterine horn did not. Each month, blood accumulated in that obstructed portion without a route through the cervix and vagina. The right fallopian tube became distended with blood, and blood was also entering the pelvic cavity. Endometriosis was present as well.

Because the new interpretation differed so dramatically from the first, we obtained a third opinion. The two Cedars-Sinai interpretations agreed, and surgery confirmed the anatomy they described.

We removed the disconnected uterine portion, the affected right fallopian tube, and the endometriosis. The lesson is not that every teenager with painful periods has this rare condition. The lesson is that severe symptoms deserve an explanation, even when the first report seems reassuring.

What should we do when the explanation still does not feel right?

We can ask whether the actual imaging has been reviewed, whether a specialist should reassess it, and whether the findings explain the symptoms. A report is useful, but it is not the same as an unquestionable answer.

In this case, the additional review also helped us prepare properly for surgery and discuss the anticipated procedure with the family. Some related uterine abnormalities can involve a vaginal septum, a wall dividing the vagina, although that was not the procedure performed here.

We should not have to become medical detectives to receive care. Still, when something remains unresolved, persistence matters. Parents, partners, and other support people can help us keep asking until there is a clear plan.

HPV, Pap Tests and Cervical Cancer Prevention

We have been diagnosed with HPV. What is the first thing to understand?

First, HPV is human papillomavirus. It is not herpes. They are different viruses, and mixing them up creates unnecessary confusion.

HPV is extremely common. Many of us will encounter it during our lifetimes, and a positive result does not mean we have cancer. Different HPV types carry different risks. Some affect the genital area, and certain high-risk types can cause cervical cell changes.

We pay particular attention to HPV 16 and 18 because they account for a large share of cervical cancers. When a high-risk HPV result is positive, we want to understand whether the laboratory has identified those types.

Most infections become undetectable or are suppressed by the immune system over time. Persistent infection is what requires careful follow-up. We can find more background in our guide to HPV, screening, and treatment.

Why are HPV vaccination and screening both so important?

We are enthusiastic about HPV vaccination because it offers an important opportunity to prevent infection with vaccine-covered types and reduce the risk of related cancers. This conversation belongs in childhood preventive care for both girls and boys.

HPV can pass between partners in either direction. Vaccinating only girls leaves out a major part of prevention. We encourage families to discuss the vaccination schedule with their child’s clinician rather than decline it because the topic feels uncomfortable.

Vaccination and screening have different jobs. Vaccination helps prevent future infection; cervical screening looks for infection or cell changes that may already be present. Neither should be treated as a reason to forget the other.

We also need to separate treating precancerous cells from treating the virus itself. A procedure can remove abnormal cervical tissue, but it does not directly eliminate HPV.

If our Pap test is normal but high-risk HPV is positive, can we ignore it?

No. A Pap test examines cervical cells, while an HPV test identifies viral infection. They answer related but different questions. A normal Pap result does not erase a positive high-risk HPV result.

In the approach discussed here, HPV 16 or 18 warrants colposcopy even when the Pap test is negative. Other high-risk types may initially be followed with repeat testing, but persistent positivity over about a year deserves further investigation.

We shared a heartbreaking example of a woman whose repeated normal Pap results were treated as reassurance despite ongoing high-risk HPV positivity. She later developed advanced cervical cancer. The point is not to frighten us; it is to make sure the HPV result remains part of the follow-up decision.

Our exact schedule depends on our age, current results, and screening history. We should leave the appointment knowing what gets repeated, when it gets repeated, and what would trigger colposcopy.

What happens during colposcopy, and what do precancer results mean?

Colposcopy is an office examination that lets us inspect the cervix under magnification. We apply an acetic acid solution to help identify suspicious areas, then take biopsies when appropriate. The laboratory determines whether those samples contain abnormal cells.

Cervical precancer is commonly described as CIN 1, CIN 2, or CIN 3. These are grades of cell changes, not stages of invasive cancer. Low-grade changes often resolve, so observation with repeat testing may be appropriate.

Higher-grade changes can require removal of the affected tissue. We discussed LEEP, a procedure that removes abnormal cervical tissue, and the importance of clear margins while preserving as much healthy cervix as appropriate.

Treatment does not end the need for follow-up. We still need to monitor for persistent HPV and recurrent cell changes. Our colposcopy guide explains the examination, biopsy process, and possible next steps in more detail.

Does a new positive HPV result mean a partner has been unfaithful?

We cannot use an HPV result to establish when an infection was acquired. HPV can remain undetectable for a long time and later become detectable again. A positive result years into a relationship does not, by itself, prove a new exposure.

That distinction matters because the emotional reaction can be immediate. We may jump from a laboratory result to an accusation before understanding how the virus behaves.

We also discussed supporting overall health through sleep, nutrition, stress management, and avoiding smoking. Those conversations should complement medical follow-up, not replace it or make us feel responsible for a positive result. The practical priority is understanding the result and following the recommended monitoring plan.

Can oral sex lead to throat cancer, and can male partners get an HPV test?

Oral exposure to HPV can be associated with certain throat cancers. That is a real connection, but exposure does not mean cancer is inevitable. We should approach the subject with information rather than panic.

If we or a partner have a concerning HPV history, we can discuss whether an ear, nose, and throat evaluation makes sense. We do not suggest that everyone needs routine specialist examinations simply because they have had oral sex.

We also highlighted a frustrating limitation: there is no routine HPV screening test for men comparable to cervical HPV testing. That makes vaccination, education, and appropriate clinical evaluation especially important. We should also remember that HPV and herpes remain separate issues, even when both arise in sexual health conversations.

Birth Control, Endometriosis and Recurrent Vaginal Symptoms

Does going on birth control mean we will gain weight?

We do not generally expect low-dose birth control pills to cause significant weight gain. But we should still listen when someone notices a change in appetite or weight after starting a medication.

One important example is PCOS. We may prescribe birth control when hormonal symptoms begin, while underlying insulin resistance is also contributing to weight gain. Because the timing overlaps, the pill gets blamed. Stopping it may not resolve the metabolic issue.

If weight concerns or a history of an eating disorder make the pill feel unsuitable, we can discuss alternatives. We are particularly fond of hormonal IUDs, including the smaller Kyleena IUD. It contains a progestin, has no estrogen, provides contraception for five years, and can make periods much lighter.

Our best choice is the one that fits our health history and feels manageable, not simply the one someone else loves.

Is rectal pain during menstruation normal, or could it be endometriosis?

Mild discomfort may occur around a period, but severe or recurring rectal pain deserves attention. We take it seriously because endometriosis can present in ways that do not look like straightforward menstrual cramps.

Symptoms may include bladder discomfort, back pain, leg pain, bloating, or rectal pain. That variety is one reason diagnosis can be delayed for years.

We want to understand when the pain occurs, how severe it becomes, and whether it interferes with everyday activities. We should not dismiss a symptom simply because it happens during menstruation.

For a deeper discussion of endometriosis and advocacy, including the conversation with Olivia Culpo referenced here, we can explore the SHE MD podcast collection.

What should we do about recurring yeast infections or bacterial vaginosis?

We first need to establish what is recurring. Yeast infections and bacterial vaginosis, or BV, are different conditions and need different treatment approaches.

Yeast commonly causes substantial itching and a thick discharge, often without a strong odor. Antibiotic use can precede it. BV more often causes a creamy discharge with a fishy odor. These descriptions help guide the conversation, but persistent symptoms should be evaluated rather than repeatedly treated on assumption.

We also consider other explanations, including a retained tampon when odor is prominent. For confirmed recurrent yeast, clinician-directed antifungal suppression may be an option. We discussed prescription boric acid suppositories and partner-related considerations in selected recurrent cases, but these are not universal self-treatment instructions.

Stress and anxiety also deserve support. We can address emotional wellbeing without assuming that every recurring infection is caused by stress. We need both a confirmed diagnosis and a plan for why symptoms keep returning.

PCOS, Pregnancy and Fertility Planning

Can we have PCOS and anemia, and should low iron be addressed before pregnancy?

We can have both, but anemia is not itself a defining feature of PCOS. We should investigate it separately rather than assume one diagnosis explains everything.

For someone of reproductive age, we start by asking about heavy periods. Depending on the history, evaluation may include pelvic ultrasound to look for fibroids or uterine polyps, hormone assessment, and blood testing for iron stores and other causes of anemia.

We discussed iron, ferritin, and vitamin B12 as parts of that broader assessment. Pregnancy changes blood volume, and anemia can develop during pregnancy, but we would rather identify and address an existing problem beforehand.

Low iron alone does not explain every fertility concern. Our preconception appointment is an opportunity to assess the whole picture.

How should we prepare for pregnancy after birth control or medications such as Accutane and acyclovir?

We need a medication-specific conversation. Acyclovir, used for oral or genital herpes, is a medication we also use during pregnancy. Its role is very different from Accutane, or isotretinoin, which requires careful pregnancy precautions.

We discussed a waiting period after stopping isotretinoin, but the important practical step is confirming the required interval with the prescribing clinician before trying to conceive. We should not use a general answer as clearance for a particular medication history.

After birth control pills, we discussed allowing a couple of months for planning and reassessment. That was a practice preference, not a universal requirement for everyone.

We can use this transition to review cycles, anemia, underlying conditions, and any medication that may need adjustment before pregnancy.

What does AMH tell us about fertility planning?

AMH stands for anti-Müllerian hormone. It is a blood test used to help assess ovarian reserve. We described it conversationally as an “egg count,” but it is not a literal count of every egg, nor a complete answer about whether we can become pregnant.

We care about awareness because younger age does not automatically mean ovarian reserve is high. We discussed young patients whose results prompted earlier fertility-preservation conversations.

The purpose is planning, not panic. Depending on the broader clinical picture, that conversation may include possible endometriosis and future egg freezing.

We should ask what an AMH result means in our situation, what other information is needed, and whether it changes our plans. A single number should begin a thoughtful discussion, not define our entire reproductive future.

How does PCOS change pregnancy and postpartum care?

PCOS does not disappear during pregnancy or after delivery. Insulin resistance remains an important consideration, including an increased concern for gestational diabetes.

In the practice approach discussed here, we screen PCOS patients earlier, around 12 weeks, and repeat screening at the usual 24 to 28 weeks if the earlier test is reassuring. We also discuss food choices with attention to sugars and carbohydrates, while keeping the plan appropriate for pregnancy.

Postpartum, metformin may be part of managing insulin resistance. But we also need to give ourselves a break. Recovery and weight changes do not follow the same timetable for everyone.

We can seek treatment and still enjoy our baby, ask for help, and stop comparing our bodies with someone else’s. Those early months are not a competition.

Can we take Ozempic or metformin while pregnant or breastfeeding?

We need to separate the medications. Ozempic is not a pregnancy treatment, and we advised against its use during pregnancy or breastfeeding in this discussion. Anyone planning pregnancy needs a medication review beforehand.

Metformin has different considerations. We discussed its use during breastfeeding and explained that pregnancy decisions depend on why it is prescribed and how blood glucose will be monitored.

The practice approach described here involves reassessing metformin after pregnancy begins and arranging gestational diabetes testing. That is not an instruction for us to stop a prescription on our own.

If gestational diabetes develops, care may involve dietary changes and medication when needed. We should make medication changes with the clinician managing our pregnancy, not from a general Q&A.

Does Ozempic affect egg freezing?

We do not have a confident answer about a direct effect on egg freezing. We acknowledged the need for more research rather than pretending the question is settled.

There is a separate discussion about improving metabolic health before fertility treatment. In some patients with PCOS, weight management may help cycles become more regular and support preparation for pregnancy or fertility care.

But those possible benefits do not establish a direct effect on eggs. We should coordinate with both the prescribing clinician and the fertility team so everyone understands the treatment plan and reproductive timeline.

What should a workup include after multiple miscarriages or an ectopic pregnancy?

We need a structured evaluation, not an automatic label of “unexplained.” A previous ectopic pregnancy raises questions about the fallopian tubes, including possible inflammation or scarring, but it does not establish endometriosis by itself.

We discussed several areas to assess:

• Ovarian and hormonal factors: ovarian reserve and hormone function.
• Male factors: semen analysis rather than assuming infertility is exclusively a female issue.
• Tubal and uterine anatomy: whether tubes are open and whether polyps, fibroids, or adenomyosis are present.
• Endometriosis and PCOS: whether either condition contributes to the reproductive history.
• Selected autoimmune factors: conditions such as antiphospholipid syndrome when clinically appropriate.

Treatment depends on what we find. Blood thinners were discussed for particular diagnoses, not as a general solution for every miscarriage. We deserve an investigation that considers the whole reproductive picture.

Menopause, Joint Pain and Weight Management

Can joint pain be hormonal, and what about frozen shoulder?

Age and timing matter. Joint pain in a younger patient should not automatically be attributed to reproductive hormones. Persistent symptoms may need a rheumatology evaluation.

Around menopause, joint discomfort and shoulder symptoms can occur, but arthritis and other musculoskeletal problems remain possible. We should not replace “it is nothing” with “it is definitely menopause.” Both shortcuts can miss something.

We discussed nighttime shoulder pain and the possibility of orthopedic assessment, treatment, and imaging when symptoms persist. The useful takeaway is that chronic pain deserves evaluation. Hormonal changes may be part of the conversation without being the entire explanation.

Should every woman take hormone replacement therapy after menopause?

No. We cannot treat every woman the same. We have moved between broad enthusiasm for hormones and broad avoidance, but the better approach is to listen to the person in front of us.

We ask what needs treatment: hot flashes, night sweats, mood symptoms, sleep disruption, or bone health concerns. Then we review medical history and risk factors.

Personal cancer history can fundamentally change the decision. We specifically discussed estrogen receptor-positive breast cancer as a reason systemic HRT may not be appropriate.

Genetic and family history questions also arose, including APOE4 and dementia risk. We should not turn that discussion into a promise that HRT prevents Alzheimer’s disease. Our central point remains individualized care, with a clear understanding of what we are treating and why.

How do we choose estrogen and progesterone doses, and can we take too much?

We aim for the lowest dose that adequately manages symptoms. More is not automatically better, and adding extra patches without medical guidance is not a solution.

Whether we have a uterus matters. With systemic estrogen, progesterone is generally added for someone with a uterus to protect the uterine lining from excessive stimulation. Without a uterus, that particular reason for progesterone usually does not apply.

We discussed a preference for estrogen patches in appropriate patients, especially when considering blood clot risk associated with oral estrogen. Patch schedules and progesterone regimens vary.

Instead of copying a sample dose, we should ask how the prescribed regimen fits our symptoms and history, when it will be reassessed, and what to do if relief is inadequate.

What is our perspective on Ozempic and other weight-loss medications during perimenopause?

We are enthusiastic about the role these medications can play for appropriately selected patients. Weight gain around perimenopause can be deeply frustrating, particularly when PCOS, insulin resistance, or a family history of diabetes is part of the picture.

We discussed years of experience with medications such as Trulicity, Victoza, Saxenda, Ozempic, Wegovy, Mounjaro, and Zepbound. The options have evolved, and medical weight management can make a meaningful difference.

That enthusiasm is not a blanket declaration that every medication is suitable for everyone. We still need individual prescribing, monitoring, and reproductive planning.

We also raised access concerns during medication shortages. Patients with substantial medical need should not be overlooked while others seek treatment for a small cosmetic weight change. We want less shame around treatment and more thoughtful access to care.

What about hair shedding and a slower-feeling metabolism around age 50?

Menopause belongs in the discussion. We would ask about the last menstrual period and whether other symptoms suggest perimenopause or menopause. Hair thinning, hair loss, and weight changes can appear during this transition.

We discussed maintaining attention to movement and nutrition, including reducing excess sugars and considering carbohydrate intake. If weight remains difficult to manage, medication may be part of an individualized plan.

But we should not turn frustration into punishment. The point is not that we must starve ourselves or exercise constantly. We need to recognize the transition, discuss what has changed, and choose care that supports our health.

Inherited Cancer Risk, Supplements and Mental Health

If we are BRCA2-positive, do we necessarily need a preventive mastectomy?

A BRCA2 mutation warrants a serious conversation about inherited cancer risk and prevention. We discussed preventive removal of both breasts as one risk-reduction option, as well as the need to address ovarian cancer risk.

But these are personal decisions. We need counseling that accounts for the specific mutation, family history, age, medical circumstances, and preferences. A single percentage or birthday cannot replace that process.

We shared an example of a patient who rejected the proposed preventive approach. Our job is to educate clearly and discuss the consequences of different choices, while recognizing that the patient makes the decision. Advocacy includes understanding risk well enough to participate in that decision.

What do we think about inositol, berberine and supplements for PCOS?

We discussed interest in inositol for PCOS and insulin resistance, including its planned inclusion in a supplement we were developing. Berberine was not part of that formulation, and we raised concerns about treating it as a straightforward “natural Ozempic.”

We should separate enthusiasm from evidence about a finished product. Our hope that a supplement might offer benefits similar to metformin was a hope, not proof of equivalence.

Metformin can be useful, but nausea and diarrhea make it difficult for some patients to tolerate. That creates understandable interest in alternatives. Still, “natural” does not answer whether something is suitable, effective, or compatible with our medications. We should discuss supplements as part of care, not assume they can replace prescribed treatment.

Which antidepressants are best for PCOS-related anxiety or depression?

There is no single best or worst antidepressant for everyone with PCOS. We first need an accurate mental health assessment, especially when symptoms are substantial or pregnancy is being planned.

We discussed sertraline, commonly known as Zoloft, in pregnancy-planning conversations, and escitalopram, or Lexapro, for some patients with anxiety. These were clinical preferences, not prescriptions for every reader.

Early treatment can sometimes increase anxiety before improvement occurs. A clinician may use gradual dose adjustment to improve tolerability. We should understand that plan before starting, rather than improvise our own pill-splitting schedule.

We also emphasized patience: improvement may take several weeks. If treatment is not helping, we need reassessment, not abrupt changes without guidance.

How are antidepressants different from medications such as Xanax or Ativan?

We discussed the important distinction between longer-term treatment with an SSRI and reliance on benzodiazepines such as Xanax, Ativan, or Valium. Benzodiazepines carry dependence concerns and should not casually become our default ongoing anxiety strategy.

That does not mean changing or stopping any medication on our own. We need the prescribing clinician’s guidance about benefits, risks, and any transition.

For PCOS patients dealing with anxiety, depression, eating concerns, or distress about their bodies, mental health care is not an optional extra. We want a plan that addresses emotional wellbeing alongside hormonal and metabolic health.

What if a 19-year-old goes six months without a period?

We should evaluate it. PCOS belongs near the top of the possibilities, particularly when long gaps between periods occur with acne, facial or body hair, hair loss, or weight changes.

We discussed checking thyroid function, prolactin, testosterone, and the broader hormonal picture. Some cycle irregularity occurs as the reproductive system matures, but that does not mean every prolonged gap should be waved away.

We also need to distinguish patterns. Endometriosis commonly raises concern because of painful periods, while PCOS often raises concern because ovulation and cycle timing are irregular. Symptoms guide the investigation; they do not establish a diagnosis by themselves.

Across all these questions, our message is consistent: we deserve to understand our symptoms, know our follow-up plan, and feel comfortable asking another question. Good advocacy is not having every answer. It is making sure an unanswered concern does not quietly disappear.