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

Overview

This episode dives deep into women's health, focusing on the often-overlooked conditions of Polycystic Ovary Syndrome (PCOS) and endometriosis, their symptoms, underlying causes, and treatments. Dr. Thaïs Aliabadi emphasizes the importance of early diagnosis, actionable steps for managing these conditions, and empowering women to advocate for their health. The discussion also covers breast cancer risk assessment, fertility preservation, and the challenges women face throughout their reproductive and hormonal health journeys.

Notable Quotes

- If every 20-year-old in this country would go through my office once at age 20, I would shut down these fertility clinics. – Dr. Thaïs Aliabadi, on the importance of early diagnosis for PCOS and endometriosis.

- Painful periods are not normal. – Dr. Thaïs Aliabadi, highlighting the need to take endometriosis symptoms seriously.

- Your genes load the gun, your environment pulls the trigger. – Dr. Thaïs Aliabadi, on the interplay of genetics and lifestyle in women's health.

🩺 PCOS: Symptoms, Diagnosis, and Treatment

- PCOS is the most common hormonal disorder in women of reproductive age, affecting 15-20% of women, with over 90% undiagnosed.

- Symptoms include irregular periods, acne, hair thinning, weight gain, mood disorders, and infertility.

- Diagnosis requires meeting two of three criteria: high androgen symptoms, ovulation dysfunction, or PCOS-like ovaries on ultrasound.

- Treatment focuses on addressing insulin resistance (e.g., metformin, inositol supplements), reducing inflammation, and lifestyle changes like exercise and a low-inflammatory diet.

- Dr. Aliabadi developed a free online PCOS risk calculator (OVII) and a supplement targeting insulin sensitivity and inflammation.

🩸 Endometriosis: Misdiagnosis and Management

- Endometriosis affects 10-20% of women, often taking 9-11 years and multiple doctors to diagnose.

- Symptoms include painful periods, painful sex, chronic pelvic pain, bloating, and infertility.

- Diagnosis is primarily clinical, with laparoscopic surgery as the gold standard. Imaging like ultrasounds and MRIs can help but often miss early-stage disease.

- Treatment includes hormonal suppression (e.g., progesterone IUDs, GnRH antagonists) and, in severe cases, laparoscopic excision surgery.

- Dr. Aliabadi emphasizes that painful periods are never normal and should be investigated.

🧬 Fertility Preservation and Egg Quality

- Women with PCOS or endometriosis should monitor their egg count (AMH levels) early, as these conditions can deplete egg quality and quantity.

- Freezing eggs by age 28-30 is recommended for women with PCOS or endometriosis to preserve fertility.

- Supplements like CoQ10 and L-carnitine can improve egg quality, alongside managing inflammation and insulin resistance.

- Misconceptions about AMH and egg count can lead to false reassurance; high AMH in PCOS may indicate poor egg quality.

🎗️ Breast Cancer Risk and Screening

- Women should calculate their lifetime breast cancer risk using the Tyrer-Cuzick model, especially if they have family history or dense breast tissue.

- A lifetime risk above 20% warrants earlier imaging (starting at age 30) and additional screenings like breast MRIs.

- Dr. Aliabadi advocates for genetic testing for women with family histories of breast, ovarian, or related cancers.

- She shares her personal story of detecting breast cancer through proactive risk assessment and surgery, underscoring the importance of vigilance.

💡 Empowering Women to Advocate for Their Health

- Women must advocate for themselves by requesting specific tests (e.g., AMH, pelvic ultrasounds) and challenging dismissive medical opinions.

- Education about conditions like PCOS, endometriosis, and menopause should be mandatory in schools to empower young women.

- Dr. Aliabadi calls for systemic changes in women's healthcare, including separating obstetrics from gynecology to improve care quality.

- She emphasizes the need for comprehensive well-woman exams that go beyond basic screenings to include hormone testing, ultrasounds, and fertility assessments.