Jay Shetty PodcastWORLDS TOP OBGYN: #1 Hormone Problem Impacting MILLIONS of Women (This is How You REVERSE it!)
Jay Shetty and Dr. Thaïs Aliabadi on oBGYN explains PCOS and endometriosis causes, symptoms, and solutions today.
In this episode of Jay Shetty Podcast, featuring Dr. Thaïs Aliabadi and Jay Shetty, WORLDS TOP OBGYN: #1 Hormone Problem Impacting MILLIONS of Women (This is How You REVERSE it!) explores oBGYN explains PCOS and endometriosis causes, symptoms, and solutions today Dr. Aliabadi frames a “fertility crisis” in which many cases labeled unexplained infertility are actually undiagnosed PCOS or endometriosis.
At a glance
WHAT IT’S REALLY ABOUT
OBGYN explains PCOS and endometriosis causes, symptoms, and solutions today
- Dr. Aliabadi frames a “fertility crisis” in which many cases labeled unexplained infertility are actually undiagnosed PCOS or endometriosis.
- She defines PCOS as a hormonal-metabolic-inflammatory-neurologic condition and teaches the diagnostic rule of meeting two of three criteria: ovulatory dysfunction, characteristic ovarian morphology/high AMH, and hyperandrogenism symptoms.
- PCOS management is presented as addressing four pillars—insulin resistance, hormonal/androgen imbalance, chronic inflammation, and brain effects—using lifestyle changes, insulin-sensitizing tools (e.g., metformin/GLP-1s), and selective hormonal therapy rather than birth control alone.
- She defines endometriosis as a chronic inflammatory neuroimmune disorder causing debilitating pain and central nervous system sensitization, emphasizing it can be diagnosed clinically and treated first with hormonal suppression and, when needed, expert excision surgery.
- Actionable fertility guidance includes early symptom recognition, AMH/ultrasound-based screening, partner semen analysis, targeted workups (HSG/anatomy), and proactive suppression/egg-freezing considerations to protect ovarian reserve.
IDEAS WORTH REMEMBERING
5 ideasMany “unexplained infertility” cases may be missed PCOS or endometriosis.
Aliabadi claims large proportions of PCOS (≈75%) and endometriosis (≈90%+) go undiagnosed, pushing patients into the unexplained category when the underlying drivers are treatable or manageable.
PCOS diagnosis is pattern-based: you only need 2 of 3 criteria.
She stresses irregular/absent ovulation, PCOS ovarian morphology (or high egg count/AMH), and hyperandrogen signs (acne, hirsutism, hair loss) can combine in multiple ways—so “no cysts/no high testosterone/no irregular periods” doesn’t rule it out.
Insulin resistance is positioned as the core PCOS “first domino.”
She explains that insulin resistance raises insulin, promotes visceral fat/inflammation, and stimulates ovarian androgen production—creating a feedback loop that disrupts ovulation and mood/energy.
Small, consistent behavior changes can meaningfully improve insulin sensitivity.
Her practical baseline includes lowering carb load and taking a 10–20 minute walk after meals to help muscles pull glucose from blood, alongside regular cardio and broader exercise.
Medications for metabolic PCOS should be planned for sustainability, not quick weight loss.
She describes GLP-1s as useful for PCOS because they improve insulin regulation and weight, but warns that stopping without ongoing insulin-resistance support (e.g., metformin and lifestyle) often leads to rebound weight gain.
WORDS WORTH SAVING
5 quotesI want to scream in this mic and say, "Doctors, healthcare providers, listen to your patients."
— Dr. Thaïs Aliabadi
You know, your genetics load the gun, but your lifestyle pulls the trigger.
— Dr. Thaïs Aliabadi
Painful periods are not normal.
— Dr. Thaïs Aliabadi
Will you believe me if I told you that every single patient, when I diagnose them in my clinic with endometriosis or when I wake them up from surgery and I tell them the stage of their endometriosis, the first thing they do, they cry and they say, "I feel validated"?
— Dr. Thaïs Aliabadi
People grab that mic for nonsense. Give me that mic for 20 minutes only. Let me tell women what they deserve to know.
— Dr. Thaïs Aliabadi
QUESTIONS ANSWERED IN THIS EPISODE
5 questionsYou described four PCOS pillars—what labs or measurements best track improvement in each pillar over time (insulin resistance, androgens, inflammation, neurologic effects)?
Dr. Aliabadi frames a “fertility crisis” in which many cases labeled unexplained infertility are actually undiagnosed PCOS or endometriosis.
For someone with regular cycles but acne/hirsutism and suspected PCOS, what’s your recommended step-by-step diagnostic pathway (including AMH/ultrasound and which testosterone tests)?
She defines PCOS as a hormonal-metabolic-inflammatory-neurologic condition and teaches the diagnostic rule of meeting two of three criteria: ovulatory dysfunction, characteristic ovarian morphology/high AMH, and hyperandrogenism symptoms.
You recommend post-meal walking for insulin sensitivity—does it matter if it’s after every meal vs. just the highest-carb meal, and what intensity is “enough”?
PCOS management is presented as addressing four pillars—insulin resistance, hormonal/androgen imbalance, chronic inflammation, and brain effects—using lifestyle changes, insulin-sensitizing tools (e.g., metformin/GLP-1s), and selective hormonal therapy rather than birth control alone.
What’s your clinical decision rule for choosing metformin vs. GLP-1s vs. combining them, and how do you manage nutritional risk when appetite drops on GLP-1s?
She defines endometriosis as a chronic inflammatory neuroimmune disorder causing debilitating pain and central nervous system sensitization, emphasizing it can be diagnosed clinically and treated first with hormonal suppression and, when needed, expert excision surgery.
You said endometriosis can be diagnosed clinically—what symptom patterns most reliably distinguish it from GI disorders like IBS/SIBO before imaging or surgery?
Actionable fertility guidance includes early symptom recognition, AMH/ultrasound-based screening, partner semen analysis, targeted workups (HSG/anatomy), and proactive suppression/egg-freezing considerations to protect ovarian reserve.
Chapter Breakdown
Women’s symptoms dismissed: why PCOS & endometriosis stay invisible
Dr. Thaïs Aliabadi opens with a forceful critique of how often women’s pain, mood changes, and metabolic symptoms are minimized or psychologized. She frames PCOS and endometriosis as common, underdiagnosed drivers of suffering that also disrupt fertility and mental health.
Are we in a fertility crisis? The ‘unexplained infertility’ gap
Jay asks what a fertility crisis means; Dr. Aliabadi explains conception rates and how the remaining infertile group often includes undiagnosed PCOS/endometriosis. She argues many people are labeled “unexplained infertility” due to missed underlying conditions.
What PCOS is—and the simple 2-of-3 diagnostic criteria
Dr. Aliabadi defines PCOS as a chronic hormonal, metabolic, inflammatory, and neurological condition. She details the three diagnostic criteria and emphasizes that patients present in multiple “types,” which contributes to confusion and missed diagnoses.
Why PCOS is missed: variable presentation and narrow doctor checklists
She explains PCOS is frequently overlooked because clinicians over-rely on single signs (like cysts or high blood testosterone). She encourages women to connect symptoms across reproductive, metabolic, and mental health domains to recognize the pattern.
PCOS Pillar #1: Insulin resistance—the ‘first domino’
Dr. Aliabadi describes insulin resistance as the primary driver that elevates insulin, increases visceral fat, and stimulates ovarian androgen production. She walks through how this disrupts ovulation and creates a self-perpetuating cycle between insulin, androgens, and brain hormone signaling.
Making PCOS patients insulin-sensitive: diet, movement, supplements, metformin, GLP-1s
She outlines a stepwise approach to improving insulin sensitivity, emphasizing low-carb strategy and walking after meals. She discusses supplements, metformin dosing basics, and GLP-1 medications—framing them as especially helpful for PCOS-related metabolic dysfunction and cycle regularity.
GLP-1s and nutrition: who they’re for and how to prevent rebound
Jay raises concerns about nutrient deficits when appetite is suppressed. Dr. Aliabadi distinguishes PCOS patients with significant insulin resistance/obesity from cosmetic weight loss use, and stresses maintaining a long-term plan (metformin/supplements/lifestyle) to avoid weight regain after stopping GLP-1s.
PCOS Pillars #2–#4: Androgens, chronic inflammation, and the brain
She connects the hormonal pillar (high androgens/LH patterns) and inflammatory pillar (visceral fat, cortisol, sleep issues, gut dysbiosis, ovarian factors) to a neurologic pillar affecting mood, motivation, and cognition. She explains why birth control alone can improve outward symptoms but still leave root drivers untreated.
How to know if you have PCOS: self-advocacy and screening tools
Dr. Aliabadi emphasizes that women can identify likely PCOS by matching criteria and symptom clusters, then asking for the appropriate workup. She references an online risk calculator and stresses that education equips patients to push back against dismissal.
Painful periods are not normal: red flags that point to endometriosis
Transitioning to endometriosis, Dr. Aliabadi draws a line between manageable cramps and life-disrupting pain. She lists hallmark symptoms that should trigger evaluation, including painful sex, bladder/bowel pain, and chronic pelvic inflammation.
What endometriosis is: inflammatory, neuroimmune disease and pain sensitization
She defines endometriosis as uterine-like tissue outside the uterus that bleeds and inflames surrounding organs, creating adhesions and nerve growth. She describes immune dysfunction theories, nerve fiber proliferation, and central nervous system sensitization that amplifies pain over time.
Treating endometriosis: hormonal suppression first, surgery when needed—and why skill matters
Dr. Aliabadi argues endometriosis is often diagnosable clinically and that surgery should be for treatment after hormonal options fail or for fertility goals. She outlines progesterone options, GnRH medications, and the challenges of finding surgeons who can reliably identify and excise varied lesion types.
The cost of ignoring endometriosis: fertility loss, chronic pain, and life disruption
She describes fertility as the most devastating consequence, citing inflammation’s impact on egg quantity and quality and the risk of endometriomas. She recommends AMH testing for ovarian reserve, early egg freezing when possible, and aggressive suppression/treatment to preserve reproductive potential.
Birth control clarified: preserving fertility, strategic monitoring, and suppression plans
Addressing misconceptions, she defends birth control as protective for many endometriosis patients by lowering inflammation and preserving ovarian reserve until ready to conceive. She also notes the importance of monitoring ovarian reserve during long-term suppression and using IUDs/medical therapy strategically, especially post-surgery.
Gut, autoimmunity, IVF, and the ‘full infertility checklist’
She links endometriosis to GI issues like SIBO/leaky gut and explains how treating the underlying pelvic inflammation is necessary before GI symptoms fully resolve. She also discusses autoimmunity overlap and offers a practical multi-bucket infertility workup, emphasizing proactive imaging, labs, and advocacy to avoid “unexplained infertility.”
EVERY SPOKEN WORD
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