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

Quick Overview

Dr. Thaïs Aliabadi asserts that PCOS and endometriosis are the leading causes of infertility globally, with over 90% of cases going undiagnosed because physicians dismiss or normalize women's symptoms like pain, mood changes, and hair thinning, which instead reflect serious underlying health issues requiring specific diagnostic criteria and treatment protocols beyond just birth control.

Key Points: Dr. Aliabati states that the majority of patients with PCOS and endometriosis, the top causes of infertility, are never diagnosed, leading to delayed treatment and potential egg reserve depletion by age 30. PCOS diagnosis requires meeting two out of three criteria: symptoms of high androgens (like facial hair or acne), ovulation dysfunction (irregular periods), and polycystic ovary morphology on ultrasound, though high AMH is a newer third criterion for adults. For teenagers, PCOS diagnosis excludes ultrasound morphology and AMH levels; they must meet criteria for irregular periods and high androgen symptoms to avoid mislabeling young patients. The underlying drivers of PCOS symptoms involve five pillars: a disrupted brain-pituitary-ovary axis leading to an inverted LH/FSH ratio; insulin resistance exacerbating symptoms; chronic inflammation; genetics; and epigenetics (stress, sleep, diet). Insulin resistance, common even in lean PCOS patients, causes cells to resist glucose uptake, leading to high insulin, which stimulates ovaries to produce more androgens and blocks liver production of SHBG, increasing free testosterone. A strong critique is made that many doctors fail to perform pelvic ultrasounds, which Dr. Aliabati believes should be mandatory in a well-woman exam, often misinterpreting PCOS morphology as simply indicating 'many eggs.' If every 20-year-old were screened, Dr. Aliabati suggests she could shut down fertility clinics because many patients end up there due to undiagnosed conditions that could have been resolved early, citing a 14-year-old patient whose egg count matched a 40-year-old's.