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[@hubermanlab] Female Hormone Health, PCOS, Endometriosis, Fertility & Breast Cancer | Dr. Thaïs Aliabadi

· 6 min read
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@hubermanlab - "Female Hormone Health, PCOS, Endometriosis, Fertility & Breast Cancer | Dr. Thaïs Aliabadi"

Link: https://youtu.be/hMzfGZnaPN8

Short Summary​

This podcast episode with Dr. Tais Aliabati explores critical, often overlooked aspects of women's reproductive and general health, including PCOS, endometriosis, breast cancer screening, and perimenopause. She argues that many women are dismissed and misdiagnosed, leading to unnecessary suffering and fertility issues, and offers actionable steps for women to become their own health advocates by understanding symptoms, requesting necessary tests, and seeking appropriate treatment. Dr. Aliabati also underscores the importance of knowing one's lifetime risk of breast cancer and seeking timely screening and intervention.

Key Quotes​

Here are five direct quotes extracted from the transcript that capture valuable insights:

  1. "If every 20-year-old in this country would go through my office once at age 20, I would shut down these fertility clinics. Because where do these patients end up? In fertility clinics. That's why these doctors are so busy. And that's why these patients go bankrupt, selling their homes, selling everything they have to pay for an IVF cycle that could have been completely blocked had they been diagnosed correctly and treated at a very young age."

  2. "PCOS patients, their egg count is falsely high because of that, you know, these tiny follicles that are frozen in the ovaries that never got to ovulate, they do secrete AMH. So these patients that's why in 2023 they changed that second criteria the PCOS ovaries to elevated or elevated AMH."

  3. "If men, think about this, had a condition that would cause them to have severe pain during sex. It would scar their scrotums. It would lower their sperm count. It would be the top cause of their fertil infertility that they would stay home 2, three days out of the month in bed. They would end up in emergency rooms few times a year, right? They would get bloated, anxious, depressed from the pain. Do you think majority of them would go undiagnosed?"

  4. "I strongly believe that over 50% of PCOS patients also have endometriosis."

  5. "Stromal endometriosis doesn't have the glandular uh lesions with it. It's just these fibers that have nerve endings and the the nerves get squeezed and actually patients with stromal endometriosis tend to have more bloating, more inflammation and more deeper pain. But when you put a laposcope, you only see these thin lines."

Detailed Summary​

Here is a detailed summary of the YouTube video transcript, presented in bullet points:

Key Topics:

  • Women's Health: Focus on PCOS, Endometriosis, Breast Cancer, Pmenopause, and Menopause.
  • Infertility: Causes, Diagnosis, and Potential Prevention.
  • Importance of Early Diagnosis and Intervention.
  • Need for Improved Women's Health Education and Awareness.
  • Criticism of current medical practices and the dismissal of women's symptoms.

Arguments:

  • Women's health symptoms are often dismissed, minimized, or ignored by medical professionals.
  • PCOS and endometriosis are significantly underdiagnosed, leading to infertility and other health problems.
  • Textbook pictures of fertility as a function of age are often inaccurate due to the exclusion of PCOS and endometriosis.
  • Early screening and diagnosis of PCOS and endometriosis in young women (even teenagers) are crucial for preserving fertility and preventing long-term complications.
  • Many doctors are unaware of the telltale markers of PCOS and endometriosis and/or lack the time and tools to diagnose properly.
  • Visceral fat is a dangerous form of fat due to the inflammatory factors it releases, increasing insulin resistance and stimulating androgen production.
  • The current well-woman exam is often inadequate and should include pelvic ultrasound as a mandatory element.
  • There is a need to separate Obstetrics from Gynecology as physicians are often burnt out, which lead to misdiagnosis and dismissal of women's issues.

Information Discussed:

  • PCOS (Polycystic Ovary Syndrome):
    • Most common hormone disorder in women of reproductive age (affects 15% in US, higher in Middle Eastern countries).
    • Majority (over 90%) are undiagnosed.
    • Diagnosis requires meeting 2 out of 3 criteria:
      • Symptoms of high testosterone/androgens (facial hair, body hair, acne, oily skin, male pattern hair thinning).
      • Ovulation dysfunction (irregular periods, infrequent periods).
      • PCOS-looking ovaries on ultrasound (multiple follicles, "string of pearls" appearance) OR Elevated AMH.
    • High AMH does NOT necessarily mean good quality eggs, but it is an indicator for PCOS.
    • Four phenotypes of PCOS exist, making diagnosis complex: Classic PCOS, non-PCOS ovaries, regular cycles, etc.
    • Insulin resistance is a key factor driving PCOS symptoms.
    • PCOS is characterized by high insulin, leading to more androgen production, decreased Sex Hormone Binding Globulin (SHBG), visceral fat storage, and inflammation.
    • Four Underlying Pillars that Drive PCOS:
    • Brain-Pituitary-Ovary access.
    • Insulin resistance.
    • Chronic inflammation.
    • Genetics.
    • Epigenetics.
    • Treatments include: Lifestyle changes (exercise, diet, sleep), supplements (inositol, vitamin D, mulberry leaf), metformin, GLP-1 agonists, and/or hormonal birth control.
  • Endometriosis:
    • Tissue similar to the lining of the uterus grows outside the uterus (around tubes, ovaries, bladder, bowel, etc.).
    • It takes an average of 9-11 years to diagnose endometriosis.
    • Diagnosis is often delayed due to the dismissal of women's pain.
    • Painful periods are NOT normal.
    • Other symptoms include: painful sex, bloating, painful bowel movements, recurrent UTI-like symptoms with negative cultures.
    • Endometriosis can impact egg count, quality, and cause inflammation.
    • Gold standard treatment is laparoscopic resection of endometriosis. It must be paired with continued hormone suppression to be effective.
    • Hormonal birth control helps suppress endometriosis in order to preserve fertility.
    • Stromal endometriosis can be easily missed on laparoscopy.
    • Pregnancy at a younger age can be protective against endometriosis.
    • Treatments include: Lifestyle changes, progesterone IUDs (Kylina, Merina), GNRH antagonists, and Laparoscopic resections.
  • Egg Count and Freezing:
    • Egg count (AMH) should be checked in young women with severe pain.
    • For PCOS patients, egg count can be falsely high and quality might not be good.
    • Egg freezing is recommended before age 30, even with high egg count in PCOS.
    • AMH is a useful indicator (0.1 AMH units averages 1 follicle).
  • Well-Woman Exam:
    • Current well-woman exam is often inadequate.
    • Should include: Comprehensive hormone and metabolic health assessment, pelvic ultrasound, discussion about breast cancer risk, and screening for mental health disorders.
  • Ov Women Platform:
    • A free platform where women can take a quiz to assess their likelihood of having PCOS.
    • Provides a supplement, OV, designed to address insulin sensitivity and inflammation in PCOS.
  • Breast Cancer:
    • Women need to know their lifetime risk of breast cancer.
    • Tyra Cusk is a formula to assess lifetime breast cancer risk.
    • If lifetime risk is 20% or more, breast imaging should start at age 30.
    • Genetic testing should be done for those with family history.
    • High risk patients may consider medication or double mastectomy.
  • PMDD (Premenstrual Dysphoric Disorder):
    • A severe form of PMS.
    • Treatment can include SSRIs such as prozac and sertraline.