PCOS Basics: This Syndrome is More Common Than You Think

Polycystic Ovary Syndrome (now PMOS) is a wildly common endocrine condition among women. We explain why, and cover PCOS symptoms, diagnosis, its impact on ovulation and fertility, and break down the process of getting treatment.

We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.

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This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.

TRANSCRIPT

* Since we recorded this episode, PCOS has gotten a new name poly endocrine metabolic syndrome or PMOS.

00:00 Intro

01:35 What is PCOS?

10:29 PCOS Diagnosis and Symptoms

19:25 Genetics and the Menfolk

23:45 PCOS and Pregnancy

26:32 Treatment Options

34:37 Which Doctor?

40:57 Outro

Erin Stein: Hi everyone, it's Erin and my cat if you're watching on YouTube. We didn't expect to have breaking news so early on in our podcast life, but this episode is all about PCOS and we talk a lot about the name and how problematic it is and apparently we manifested a name change because today we saw news that PCOS is getting a new name: polyendocrine metabolic syndrome or PMOS. Gillian's busy with patients today, so I'm just here to add that we saw this news. Several different medical organizations were involved, such as the Endocrine Society and the American College of Obstetricians and Gynecologists. As you will see the goal was to get cystic out of the name and to convey this condition involves much more than just your reproductive system. It involves metabolic changes. We're already manifesting things. I think this is amazing, more to come to confirm this is an official name change. the news just came out today on May 12th, 2026. Enjoy the episode.

Erin Stein: Welcome to this episode of the Savvy Patient. And I just wanted to say at the beginning, we are laying down a lot of information on you in these first couple episodes. We're teaching you a lot of stuff, but we wanted to get some of these basic one-oh-one facts down, for you so you can always refer back to them. So just bear with us while we get you a lot of info upfront, and then we'll start diving deeper into stuff. So today we're going to lay some groundwork about PCOS.

Gillian Goddard: That is right.

Erin Stein: I don't have that.

Gillian Goddard: Neither do I, but many, many women do. It's one of the most common causes of infertility and it's an incredibly common syndrome of the female reproductive system.

Erin Stein: Yes, and I had a friend who was dealing with it and I sent her to Gillian. And Gillian was very helpful.

Gillian Goddard: That is correct. The other thing I would say is just how common it is. Some estimates suggest that upwards of 15 % of women have PCOS. That's a lot. A disease is considered common when more than 1 % of the population has it. And so when 15 % of the population has something, that's a lot. And what we do know is very much tied to how it affects fertility.

Erin Stein: How long have we even been looking at it?

Gillian Goddard: I mean, the best descriptions of PCOS really weren't published until the 1990s.

Erin Stein: And does that mean people didn't have it before?

Gillian Goddard: Of course not. There's actually a description in the literature of someone describing an infertile woman whose ovaries had sort of what we would now call a PCOS morphology in the 1700s. How he was looking at those ovaries, I don't know, because it wasn't with an ultrasound. My guess is it was postmortem.

Erin Stein: So there you go. Yeah, best not to think about that too much. So I guess let's start with the name.

Gillian Goddard: Yeah, it's terrible. It's descriptive, but it's not descriptive of the actual syndrome. So, let's talk a little bit about that. Polycystic ovary syndrome. So, it sounds like you've got these cysts in the ovaries and they're doing something. And it's a syndrome. So what's a syndrome? A syndrome is just a constellation of symptoms that commonly go together for which we do not have an understanding of the cause. And the reason PCOS is such a terrible name is because not every woman with PCOS has cysts and not every woman with cysts has PCOS. So it's incredibly confusing.

Erin Stein: Yes, the name would imply that cysts are definitely involved.

Gillian Goddard: It would, it would. And yet they're not definitely involved. Some women do have cysts. And this is my all-time favorite. Some women have cysts sometimes and not other times, depending on how well they're treating their symptoms and what different treatments they've been using. And we'll get into some of that stuff a little bit later.

Erin Stein: Maybe we should even back up more What's a cyst

Gillian Goddard: A cyst is a fluid-filled sac. in the... Look, I didn't make it up. I'm just relaying the information. Also true, this is a simple sac, meaning there are no walls within it. and in the case of PCOS, when women do have cysts, they have sort of a characteristic appearance.

Erin Stein: Delightful. The human body is a fluid-filled sack.

Gillian Goddard: They are described as being string of pearls. And this is based on what they look like on an ultrasound, not what it looks like if you were to look at the ovary in 3D. And on an ultrasound, it literally looks like a bunch of little white outlined black circles around the edges of the ovary. And they look like they're linked together like a string of pearls. And that's because it's not...You know, a lot of times when we think of ovarian cysts, we think of things that are large. These are all like little tiny cysts and they're peripheral, meaning they're around the edges. And they form, we think, because of dysfunctional dysfunction in the process of maturing and ovulating an egg. But they sort of result from the process. They don't actually cause the process. And so it's really confusing to people, including, by the way, doctors. Doctors get very confused about this diagnosis as well.

Erin Stein: In the case of someone I know, they went to a lot of doctors and weren't getting a lot of help, partly because it is so many symptoms associated with it. And so, you might be on this wild goose chase seeing a different doctor for every different symptom. And that I think is very frustrating for some people.

Gillian Goddard: Of course it is, of course it is.

Erin Stein: Why is it called PCOS? If that really doesn't describe it at all.

Gillian Goddard: Because when… so this happens a lot of times with different diseases. When we first get a description of the disease, we are typically getting the most extreme sort of classic version. then as we learn more about a syndrome like this one, we realize that there are less obvious manifestations of it. And so when we're talking about polycystic ovary syndrome, in the original descriptions from not that long ago, from the 20th century, in the original descriptions, what they were really talking about was a woman who had irregular or absent periods, signs of high androgens, which are hormones typically associated with men like testosterone, so high androgen levels, and cysts the ovaries. And that was sort of where the original diagnostic criteria came from. But remember, we're also talking about when they're describing a syndrome and they haven't yet explored how to manage or treat that syndrome. And so, what happens now is that someone might get a diagnosis or a provisional diagnosis gets started on treatment, then they go to another doctor and the doctor's like, well, I don't see any of these symptoms, but it's because they've been at least partially treated. And so, what ends up happening is women get a lot of conflicting information.

Erin Stein: It actually makes sense though, like, as medical history, the most obvious thing is you would see this, as you said, string of pearls of cysts. So that makes sense that the doctors figuring this out were like, there's this thing here, let's call it that. It must always have that. And then they realized later it does.

Gillian Goddard: Right. And then by then you've got this body of literature that all calls it PCOS. And so, and then for the sake of being consistent, then you keep calling it that. I mean, one of the things that happens a lot in endocrinology is that diseases get named after the people who identify them. And actually, PCOS was originally called Stein-Levinthal syndrome.

Erin Stein: No relation.

Gillian Goddard: No relation. But we've been trying to get away from naming things after people because that's not a very descriptive name. And so it really was in the, as late as the 90s when we started calling it PCOS instead of Stein-Levinthal syndrome.

Erin Stein: And some of us have a hard time remembering names. You know?

Gillian Goddard: Yeah, that's fair. Eponyms are not the most efficient...names.

Erin Stein: I have some complaints about some of our brain structures being labeled after men. Not very helpful.

Gillian Goddard: Fair, fair. Well, and you will not be surprised to hear that Dr. Stein and Dr. Leventhal were, of course, both men.

Erin Stein: Not surprising. Especially in women's medicine.

Gillian Goddard: Well, at the time, in all medicine, really.

Erin Stein: So, Gillian, as far as I know, you were one of the first doctors out there trying to talk about PCOS. I remember you trying to get in the media and trying to write about it even before you started Hot Flash and the Savvy Patient. What were the early, aside from the cysts being assumed to be a part of it, I feel like there were other symptoms people assumed you had to have.

Gillian Goddard: The way we diagnose PCOS is based on clinical presentation. So that means you come to me, you say I have these symptoms, I say, well gosh, that sounds an awful lot like PCOS, and then I do some tests mostly to rule out other things, and then I say, yeah, you don't have any of these other things. You probably have PCOS and that's how you get a diagnosis. And so there's a list of criteria that you are supposed to meet to be given the diagnosis of PCOS. And those criteria are that you have infrequent or absent periods, that you have either biochemical evidence, so like a blood test, or you have physical evidence of high androgens. physical evidence of high androgens would be acne, especially on the chin and jawline and on the back. Body hair growth on the face, chest, back, and upper part of the abdomen above the belly button. Scalp hair loss, particularly in a quote unquote male pattern, so temples and crown. And then cysts on the ovaries. You only have to have two out of the three hyperandrogenism, irregular periods or cysts on the ovaries to meet the criteria for diagnosis.

Erin Stein: I didn't realize it was that simple. I mean, not that it's simple, but isn't, I feel like it was also assumed that you had weight issues or concerns.

Gillian Goddard: It's that simple. So, in the classic, in the most classic versions of PCOS, people, women would have signs of impaired glucose tolerance, which means when you consume carbohydrate, whether that's like sugar or starch, your body can't process it very well. And they used to, we don't do this nearly as much as we used to because we have simpler tests. But one of the things we used to do as we were thinking about this diagnosis to determine whether someone had impaired glucose tolerance or not was give them a glucose tolerance test, which these days the time when most women encounter a glucose tolerance test is during pregnancy when they're being screened for gestational diabetes. But we used to use glucose tolerance tests much more often to diagnose impaired glucose tolerance, pre-diabetes, and diabetes. And so it was decided fairly early on that impaired glucose tolerance in particular was part of PCOS. Now we know that you can have PCOS in a few different quote unquote phenotypes. So, a few different kinds of pictures of PCOS. And one of them is this classical person with all the symptoms, including impaired glucose tolerance, which leads to increased body weight, especially around the midsection. One of them is a person with PCOS who is quote unquote lean, so doesn't have this kind of impaired glucose tolerance, but you can also have women who have regular periods but high androgens and impaired glucose tolerance, and that's PCOS also.

Erin Stein: Okay. What does it mean when you have PCOS? How is it affecting your body?

Gillian Goddard: Yeah, that's, I think, what matters the most, right? And one of the challenges is that it affects different women differently. So many women will have irregular periods. That usually means they have very long cycles and that their cycles vary in length. The reason they have irregular periods is because they are not ovulating regularly. And so that is sort of the hallmark of the irregular periods is that the periods are not preceded by ovulation all the time. Many women will have acne, hair growth, scalp hair loss. Many women will have weight gain that is not related to their lifestyle or their activity level. And then some women will also have cysts. Some women don't find out they have PCOS actually until they go to try to become pregnant. And because ovulation can be quite infrequent, you can imagine that this could make it more difficult for somebody to get pregnant. And so a lot of times that's the setting in which somebody gets diagnosed because symptoms can ebb and flow over your life. So you might not have symptoms, especially if you don't have the most classic presentation, you might not have symptoms as a teenager or a woman in your 20s, or they might not put together all the pieces and they might be like, you have acne, let's put you on a birth control pill. And then birth control pills do a great job of sort of treating the symptoms of PCOS and then it's not until you go off a birth control pill that you discover that there's something going on.

Erin Stein: So it may, even if you're having these, I don't want to call them superficial symptoms, like acne, hair, that's not an obvious body function symptom, right? So you may not ever know even that you have it because it's really if you're using your ovaries for something that you're going to be paying attention to that function, I would guess. while it may mean more infrequent periods, does it affect your periods? Does it affect perimenopause? Does it affect menopause?

Gillian Goddard: Right. Right. Right. Yeah, so I think that's a really good question. And yes, we know that it has effects on all of those things. So let's talk a little bit about sort of a little bit more about that. So women with PCOS not only will have infrequent periods, but when they do have periods, they can be very heavy sometimes. You can have a few periods very close together and then and then not have a period for six months. So they can be very unpredictable. And along with that and sort of the hormonal fluctuations with that, those hormonal changes can have a lot of an impact on mood. So women with PCOS are more likely to have anxiety and depression. And women with PCOS can develop not just impaired glucose tolerance, but even pre-diabetes and diabetes at a relatively young age and while not leading a particularly unhealthful lifestyle. As you get into perimenopause, a lot of times women with PCOS actually find that their cycles become more regular, which is kind of a funny thing. And I've had patients who struggled to get pregnant in their late 20s or 30s get pregnant by accident in their 40s ⁓ because all of a sudden, they're having actually more regular ovulation in the latter part of their reproductive life. And women with PCOS actually have menopause later on average than women who do not have PCOS. So, they might have menopause in their 50s, late 50s instead of in their early 50s. The other thing is that PCOS does carry along with it other health risks. So we already talked about the risk for pre-diabetes and diabetes, but women with PCOS are also more likely to develop cardiovascular disease, so heart disease and stroke, but if we diagnose you and we know that you're at risk for these things, we can manage that risk and hopefully help you avoid those things completely.

Erin Stein: Yeah. Talk a little bit more about it being a syndrome versus like, like I get the idea that a syndrome is a potential constellation of symptoms, but is that different from a disease

Gillian Goddard: A syndrome is just a constellation of symptoms that go together. A disease is a specific pathophysiologic process that causes symptoms. And so, the reason it is PCOS and not PCOD, which every once in a while, people will use that terminology, but that's not terminology that's used in the medical literature. The reason it's PCOS is because we don't fully understand the pathologic, the like pathophysiologic process that leads to PCOS. However, there have been some really interesting developments in the last, few years around the genetics of PCOS. So, it turns out probably PCOS is genetic. It's probably not a single gene. It's probably a bunch of different genes. And how you experience PCOS is probably related to how those different genes are turned on and turned off. And many of those genes probably get turned on and turned off in utero in response to the uterine environment of the mother. So, the mom might have PCOS and that is both in her genes, but then she also has a slightly different uterine environment that is more likely to turn those genes on or off and then lead to PCOS in her kids.

Erin Stein: I already hear the response like what do I do to keep my uterine environment free from PCOS?

Gillian Goddard: I mean, we don't understand the details of that. What we're talking about when we're talking about genes being turned on and turned off, particularly in utero, is something called epigenetics. So sort of like above the genes or with, you know, or on top of the genes. And it's an area of medicine that we're really just barely have scratched the surface on as far as understanding how to manipulate turning certain genes on and off. So stay tuned on that one. Probably a lot of this comes from the insulin resistance piece of things. managing your glucose metabolism, how your body is processing sugar and carbohydrates, managing those things both before and during pregnancy is probably quite important.

Erin Stein: So does that mean don't eat sugar?

Gillian Goddard: I like to steer clear of absolutes when it comes to just about everything, including diet. But women with PCOS do better with a lower carbohydrate diet and they do better when they avoid very simple carbohydrates, simple sugar and very processed flours. It's also really helpful for women with PCOS, when they do eat carbohydrates to consume them with proteins and or healthy fats. Because when you consume a carbohydrate with a protein or a healthy fat, it changes how your body absorbs the sugar and allows your body to process it better.

Erin Stein: My brain is like, “meat and potatoes.” You should eat them together.

Gillian Goddard: I usually say things more like apple and peanut butter or avocado toast on whole grain bread.

Erin Stein: Yeah, well, you're the doctor. Do men get PCOS?

Gillian Goddard: So this is another thing that has been in the literature much more recently and the answer is that the men who have these same genes that in women manifest as PCOS, in men they manifest a little differently but they're still there, those genes are still there and they can still be turned on and turned off. So men with the PCOS genes are more likely to experience baldness. They're more likely to have diabetes, type 2 diabetes, and they're at higher risk for cardiovascular disease. So yes, they can. It just looks a little different because they don't have periods.

Erin Stein: Right. And how would a man know that he would be at risk or I mean is it even worth him getting a diagnosis.

Gillian Goddard: I mean because it's genetic, the other men in your family are also going to be at high risk for cardiovascular disease and such and so that risk is already going to be sort of calculated into your personal situation based on your family history.

Erin Stein: That makes sense. But if you have PCOS, tell your brothers.

Gillian Goddard: Yeah, absolutely, because having a sister with PCOS puts you at increased risk for these, these sort of chronic diseases.

Erin Stein: If you're trying to have a baby and you're having trouble because you then find out you have PCOS, what do you do?

Gillian Goddard: It really depends. So one of the things I will say is not all women with PCOS experience infertility and you definitely cannot think of PCOS as an effective form of contraception. Meaning you can't rely on the fact that you have PCOS to not get pregnant. You still should use contraception if you do not want to be pregnant.

Erin Stein: I think that's a very important PSA.

Gillian Goddard: All women should use contraception if they do not want to be pregnant, regardless of whether they have PCOS or not.

Erin Stein: Unless you've had the relevant organs removed.

Gillian Goddard: Well, that's still kind of contraception. It's just surgical. So not all women experience the fertility issues associated with PCOS and the degree to which fertility is affected not only varies from woman to woman, but within one woman across her reproductive life. you might have difficulty getting pregnant at one point and not at another point in your reproductive life. You might have a sister that has trouble getting pregnant because she has PCOS and you have PCOS and you don't have trouble getting pregnant. We don't have a great way to predict who will struggle to get pregnant and who will not. Although in my clinical experience, the more regular your periods are, the less likely you are to struggle to get pregnant, but that is a generalization and there are exceptions to that.

The key with PCOS often is to induce ovulation. And we have medicines and protocols for doing this. Typically, if you are not having regular periods, you would want to go fairly early on to see a fertility specialist, a reproductive endocrinologist, because they can monitor cycles. And oftentimes you can even do what's called ovulation induction just with timed intercourse. Not all women with PCOS need more involved assisted reproductive technology to conceive. And so it really can run the gamut. But typically, that's what they will start with is trying ovulation induction to get you to ovulate when you know you're ovulating so that you can, so that sperm can meet egg at the right time.

Erin Stein: It’s a meet cute. 

Gillian Goddard: I don't know that I've ever heard that term used in that setting.

Erin Stein: That's what I'm bringing to the conversation. Okay, so if you're not trying to get pregnant, do you still treat your symptoms by inducting ovulation or not so much?

Gillian Goddard: No, not so much. Well, maybe indirectly. When we think about treating PCOS, I always say the number one thing we should be doing is treating the symptoms that are bothering you the most. And different treatments manage different symptoms, better or worse. So classically, we have used three different treatments for PCOS. And then we'll talk a little bit about a fourth one that is becoming more common. Typically, to regulate periods and to reduce androgen levels, we will use a birth control pill. Birth control pills regulate periods by essentially shutting down ovulation completely, which is why they work as contraception, and then giving you the estrogen and progesterone that your body needs. When you give someone that estrogen and progesterone, it can be really helpful for acne and hair symptoms in addition to regulating periods. So that is often a great place to start.

You do have to be a little bit careful with birth control pills. They're not all created equal and some pills are better for PCOS than others. And so, you really want to be working with a doctor to select a pill that is kind of targeted toward treating these types of symptoms. And then if a birth control pill alone doesn't get the job done or if someone doesn't want to take a birth control pill for some reason, we use a medicine called spironolactone, which is a mouthful. Spironolactone actually blocks the androgen receptors in the hair and skin follicles so that the androgens can't act to cause acne and hair loss or body hair growth. It works really, really well for the acne. It works less well for the hair symptoms, but it can be a nice adjunct to other treatments. And one of the things about PCOS is we often have people on multiple treatments to get at different symptoms effectively. The other thing that we will use is an old diabetes medicine called Metformin. Metformin has been around for 70 years. It's only been used for diabetes since the 1990s. It was actually originally developed as an anti-malarial. Metformin works differently. It's not affecting the testosterone side of things; it's affecting the blood sugar metabolism side of things. So, metformin stabilizes blood sugar so that if you have impaired glucose tolerance, you often also have very spiky blood sugar. And metformin stabilizes blood sugar and improves insulin sensitivity. So, it improves how your body responds to the insulin that your pancreas is making so that you can better process sugar. When you do that in women with PCOS, sometimes it also leads them to ovulate more regularly. So when we improve insulin sensitivity, we improve how frequently and how regularly someone ovulates. But it can also help with any symptoms that women are having related to blood sugar and in the past was really our best option for helping women with PCOS to manage their weight. It's not great at weight loss. It can be quite helpful for helping women to maintain their weight. And it's been shown to reduce your risk of progressing from impaired glucose tolerance to pre-diabetes to diabetes. And so it can manage those risks as well, which is good.

One of the things that can happen when you don't have a period for an extended period of time and you're not like on a birth control pill or have an IUD is that the uterine lining can build up and it gives the uterine, the cells that make the uterine lining can mutate. And so not if it happens once, but if you go a reproductive lifetime, not having a period at least every 90 days or so, it actually increases your risk for endometrial cancer later in life. And so one of the reasons we like birth control pills in women with PCOS is because it can manage this buildup of uterine lining and reduce the likelihood that the uterine lining is going to mutate. And if needed, it can also cause a withdrawal bleed. It can cause the uterine lining to slough off appropriately so that we can make sure that a woman is not setting herself up to be at higher risk for endometrial cancer later in life.

Erin Stein: So, if you're on a birth control pill continuously, it sounds like you need to shed what's in there at some point.

Gillian Goddard: When you stop the pill, anytime, so whether you take the sugar pills every month, every three months, whatever, when you stop the pill, you will slough off that lining. But when you're taking a birth control pill, you don't build up as much lining, so the fact that the estrogen and the progesterone come together in the pill, which is different than how it works when your body is cycling on its own, you don't actually build up much lining. because you don't build it up, there's not really so much to slough off. And because it's not building up and growing, there's less opportunity for mutation. Taking birth control is one of the times when it's okay not to get a period when it's not okay to not have a period as if you're not taking birth control and your body is not cycling on its own.

Erin Stein: Did we cover three treatments and now there's a fourth one?

Gillian Goddard: So now, yes, that's exactly right. So in recent years, in the last 10 years or so, endocrinologists like myself have become interested in how GLP-1 receptor agonists might affect women's experience of PCOS because like metformin, GLP-1 receptor agonists work by improving how the body is processing sugar. And makes the body more sensitive to insulin. it turns out that women with PCOS actually do very well with GLP-1 receptor agonists. They do help women reduce their blood sugars, reduce their carbohydrate cravings. When people have impaired glucose tolerance, they often have pretty significant carb cravings, sugar cravings, which of course is super counterproductive, right? Because it makes you want to eat the thing that your body can't really process all that well. So GLP-1 receptor agonists can be super helpful with that. They can deal with some of the metabolic problems that come along with impaired glucose tolerance, like high cholesterol, high blood sugar. And of course, they can be helpful with weight loss as well. Although that's not often my main goal in using them. you may have heard that people were suddenly getting pregnant when they started taking GLP-1 receptor agonists and the thinking is that when you improve insulin sensitivity, you improve ovulatory frequency. so GLP-1 receptor agonists may also be helpful from that point of view. It's a little tricky because GLP-1-RAs have never been tested in pregnant women. They're almost certainly never going to be because we're not going to give weight loss drugs to pregnant women. However, we have registry data that shows that women who have accidentally gotten pregnant, taking them and then stop them, their pregnancies were healthy and fine. But the current guidelines tell us actually that you should stop your GLP-1 receptor agonist before trying to conceive. And so, we're really looking to get some data on using these medications in women who are trying to conceive. So, stay tuned. I'm hoping that it won't be too long before we have some data around that.

Erin Stein: PCOS is often categorized as a gynecological issue, like it's related to your period and getting pregnant and it's about your hormones, yada yada yada. But this conversation has suggested to me that it is just as much about your insulin than your reproductive hormones…

Gillian Goddard: 100%. For most women, the insulin piece of things is a huge part of the picture. And that is at least part of the reason why it really actually falls under the purview of endocrinologists. Some gynecologists are very well versed in PCOS and very capable of helping women manage their PCOS. But classically, PCOS is an endocrine problem. And most of the research comes from endocrinologists.

Erin Stein: This is why we have an endocrinologist talking about it here today. that misconception can lead people to frustration and difficulty talking to doctors, knowing which doctor to talk to. So, I guess I would say if you suspect you have it. And I'm not even sure that would be a scenario, right? Because you're probably having one symptom that you want to look at. But I think the thing is if you're having a couple of these symptoms, maybe consider that this is what might be going on. But even so, what do you do? Where do you go? What questions do you ask? What doctors do you talk to?

Gillian Goddard: Yeah, I mean, I would start with your gynecologist just because that's probably a doctor you already have in your health care arsenal. But if you're not satisfied with their sort of response and their workup, then it's always reasonable to ask for a referral to an endocrinologist. You might have to wait a little while,

Erin Stein: because they're busy.

Gillian Goddard: because there's 9,000 of us in the country.

Erin Stein: Yeah. So you just might have to wait to get your appointment,

Gillian Goddard: but it might be worthwhile rather than bouncing around to other types of doctors who may not be as well-versed in PCOS.

Erin Stein: You still may end up just doing this treatment for the hair thing or this treatment for the acne, but at least you know if there's something bigger you should be concerned about. So, if you do have PCOS, what is the one risk you need to be really looking at?

Gillian Goddard: The one risk you need to be looking at when you're young is this idea that if you're going more than 90 days without having a period over and over and over again across several years, that that increases your risk for endometrial cancer. And so we just really want to make sure that we're managing that.

Erin Stein: And to clarify, that is not the same as being on birth control and having withdrawal bleeds, which are not periods. I'm learning. Listen to our Lady Cycles episode. Cause that's where I learned it. So, okay. Is there anything else we should be talking about with PCOS?

Gillian Goddard: I think that the point that I try to drive home to my patients is that your goal in treating PCOS is we don't know what's causing it. There's not a treatment that gets at the underlying cause because I think sometimes patients think that these treatments are masking what's the root cause. We don't know what the root cause is of PCOS. And so the goal of treatment is really minimizing risk and managing the symptoms that are bothering you. And so if you are minimizing your risk and managing the symptoms that are bothering you, you are doing the best that you can do managing your PCOS right now.

Erin Stein: And I think that's our message to women in general. If you have symptoms that are bothering you, do something about it.

Gillian Goddard: Yeah, and if you get ignored...

Erin Stein: Go to somebody else. Don't give up. Unfortunately, a lot of women have this experience if they go to the doctor and the doctor is dismissive, right? In multiple ways that that can happen. And you shouldn't take that for an answer. we have this misconception that all doctors are...not amazing, but that doctors are wonderful people and they've studied and they know everything. They're an authority and they are, but not all doctors are made equal. Some doctors are nicer to patients than others. Some doctors are keeping up with the research and some are not. Some have had specialties for a long time and some have not. It is not one-stop shopping, is what I'm trying to say with a doctor. You can very much and very well may need to see several doctors to find the one that's going to help you and that sucks. It's definitely annoying, but you should keep trying. get a recommendation. I mean, the best doctors generally are the ones your friends recommend to you. So ask around. Go in local Facebook groups and ask. I've seen people do that. it's a lot easier now at least to find people recommending someone that does listen and will help you figure it out.

Gillian Goddard: The other good way to go is if you have a doctor that you like, whose practice style you like and who you feel like listens to you, ask them for recommendations. Because I won't send someone to a doctor who I don't think is going to give them that courtesy.

Erin Stein: Once you find one good doctor, you can ask them for other good doctors. Yes. Very good point. that covers PCOS. For the basics at least, if you have questions about it or a very specific experience you want to share and questions about that, please send it in.