Jay Shetty PodcastWORLDS TOP OBGYN: #1 Hormone Problem Impacting MILLIONS of Women (This is How You REVERSE it!)
CHAPTERS
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.
- •Most PCOS cases (she says ~75%) and endometriosis cases (~90%+) go undiagnosed
- •Dismissal leads to years of unmanaged pain, anxiety, depression, and disordered eating
- •Both conditions can prevent women from reaching a “calm” state because hormones/inflammation affect the nervous system
- •Painful periods and debilitating symptoms are frequently normalized
- •Endometriosis + PCOS are positioned as leading infertility causes
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.
- •Typical conception distribution: ~50% in 6 months, ~90% in a year, ~10% not pregnant
- •After male factor is considered, many remaining cases are PCOS/endometriosis
- •Underdiagnosis drives the ‘unexplained’ category
- •Earlier screening could prevent years of failed attempts
- •Fertility workups should prioritize identifying PCOS and endometriosis sooner
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.
- •PCOS affects ~15% (higher in some regions) and is often not recognized
- •Diagnosis: any 2 of 3—(1) ovulatory dysfunction/irregular periods, (2) polycystic ovarian morphology or high AMH/egg count, (3) hyperandrogenism (labs or symptoms)
- •‘Polycystic’ refers to many follicles, not ovarian cysts
- •Symptoms can include acne, hirsutism, hair thinning, oily skin, mood issues, weight changes
- •PCOS can show up in teens; some patients are ‘lean PCOS’
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.
- •Not all PCOS patients have irregular periods; not all have androgen symptoms
- •Some clinicians incorrectly require cysts, high lab testosterone, or classic appearance
- •PCOS is a whole-body condition: reproductive + metabolic + inflammatory + neurologic
- •Many patients are told to “eat less, exercise more,” intensifying shame and eating disorders
- •Self-education can help patients advocate for proper evaluation
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.
- •Carbs → glucose → insulin; in insulin resistance, cells don’t respond effectively
- •High insulin promotes visceral (inflammatory) fat storage and systemic inflammation
- •Insulin stimulates ovaries to produce androgens, disrupting follicle development and ovulation
- •Hormone loop: higher androgens influence GnRH/LH patterns, which further increases ovarian androgen output
- •Many PCOS patients don’t ovulate regularly, even if bleeding appears ‘regular’
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.
- •Lifestyle: reduce carbs; walk 10–20 minutes after meals; cardio/exercise multiple times weekly
- •Supplements can support insulin sensitivity (she references her OVI/Ovaa product)
- •Metformin: common GI side effects; she notes ~1500 mg/day as a typical effective threshold
- •GLP-1s (Ozempic/Wegovy/tirzepatide): improve insulin sensitivity and can help weight and cycle regulation
- •Reported benefits include improved cravings, clearer thinking, more regular periods, and higher chance of conception (via metabolic improvement)
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.
- •GLP-1s are positioned as appropriate for metabolically unhealthy PCOS patients, not minor weight loss
- •Duration depends on weight/metabolic severity; some may need long-term therapy
- •Stopping GLP-1 without addressing insulin resistance often leads to rebound weight gain
- •Strategy: start lifestyle + supplement, add metformin, then taper GLP-1 while maintaining supports
- •Goal is sustained insulin sensitivity rather than short-term appetite suppression
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.
- •High LH and androgens create a vicious cycle that blocks ovulation and fuels symptoms
- •Inflammation worsens insulin resistance and androgen production; stress/sleep/gut issues contribute
- •Neuro effects: unstable estrogen + low progesterone + high androgens/inflammation → anxiety, depression, irritability, brain fog, low motivation
- •Anti-inflammatory diet, stress reduction, sleep, and exercise are central to breaking the cycle
- •Birth control can help acne/hair/bleeding patterns but doesn’t fix insulin resistance or inflammation
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.
- •Use the 2-of-3 criteria framework plus associated symptoms (mood, weight, cravings, fertility)
- •Seek labs/ultrasound and comprehensive assessment beyond a single testosterone reading
- •She references a free online PCOS likelihood calculator (OVII/OVI platform)
- •Common barrier: being denied metformin because it’s viewed only as a diabetes drug
- •Core message: informed patients can better demand proper diagnosis and treatment
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.
- •Normal cramps shouldn’t cause missed school/work, ER visits, vomiting, or being on the floor in pain
- •Red flags: deep dyspareunia, painful bowel movements, bladder symptoms with negative cultures, chronic pelvic pain and bloating
- •Endometriosis + PCOS are framed as major infertility drivers
- •Cultural and clinical normalization of pain delays diagnosis
- •Earlier recognition can protect fertility and quality of life
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.
- •Prevalence stated as ~10–20% globally; “you know someone” is likely true
- •Implants can occur on ovaries, tubes, bladder, bowel, diaphragm; rarely lungs/brain
- •Monthly estrogen stimulation drives implant activity and bleeding outside the uterus
- •Immune dysfunction may allow retrograde menstrual cells to implant and persist
- •Chronic pain can rewire the nervous system, increasing anxiety, depression, and fear responses
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.
- •She asserts endometriosis can be diagnosed clinically with high accuracy based on symptoms
- •First-line: progesterone therapies (pills/IUDs) to suppress implants and reduce pain
- •Next options: GnRH agonists/antagonists (e.g., Orilissa/Myfembree) that lower estrogen but may cause menopausal-like side effects
- •Surgery: excision requires specialized expertise; lesions vary (purple glandular vs subtle white stromal) and are often missed
- •Post-op suppression is critical to reduce recurrence and repeat surgeries
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.
- •Inflammation can reduce egg count/quality; endometriomas increase risk
- •AMH is highlighted as a simple ovarian reserve test; low AMH signals urgency
- •Early egg freezing can help but is often financially inaccessible
- •Ignoring symptoms can lead to painful sex, missed relationships, opioid exposure, and long-term mental health effects
- •She advocates earlier baseline reserve awareness (e.g., around late teens/early adulthood)
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.
- •Myth: birth control causes infertility; her view: untreated endometriosis is the bigger fertility threat
- •Progesterone methods can reduce pain and help patients maintain relationships and function
- •She suggests monitoring ovarian reserve during prolonged pill use (mentions ~7 years as a checkpoint)
- •If reserve appears suppressed, stopping pills may allow recovery; consider progesterone IUD alternatives
- •After excision surgery, immediate suppression helps ‘lock in’ surgical gains and reduce recurrence
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.”
- •She claims many endometriosis patients have SIBO/leaky gut; inflammation can drive brain fog, bloating, fatigue
- •Treat sequence: address endometriosis (surgery/suppression) then target persistent SIBO symptoms
- •Autoimmune overlap: having one autoimmune condition raises risk for others; screen when symptoms suggest it
- •IVF can ‘unmask’ endometriosis/autoimmune tendencies due to hormone stimulation rather than ‘causing’ disease
- •Infertility buckets: female hormones/reserve, male semen analysis, anatomy (ultrasound/HSG), endometriosis, PCOS/metabolic, autoimmune causes (e.g., antiphospholipid)
