Female Hormone Health, PCOS, Endometriosis, Fertility & Breast Cancer | Dr. Thaïs Aliabadi
In this episode of the Huberman Lab podcast, Dr. Thaïs Aliabadi and Andrew Huberman explore several key women's health conditions that affect millions. They discuss Polycystic Ovary Syndrome (PCOS), examining its symptoms, underlying causes, and treatment approaches, as well as endometriosis, detailing the challenges of diagnosis and current treatment options.
The conversation also covers breast cancer risk assessment and screening protocols, including the use of the Tyrer-Cuzick model for risk calculation. Aliabadi and Huberman address the broader issue of women's health conditions being overlooked in medicine, discussing how the healthcare system's constraints can impact proper diagnosis and treatment, while offering insights on how women can advocate for appropriate medical care.
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1-Page Summary
PCOS: Symptoms, Diagnosis, Underlying Causes, and Treatments
According to Thaïs Aliabadi, Polycystic Ovary Syndrome (PCOS) affects 15-20% of women of reproductive age, making it the most common hormonal disorder among women. Diagnosis requires two of three criteria: high androgens (causing acne, facial hair, or male-pattern hair loss), ovulation dysfunction (irregular periods), and polycystic ovaries visible on ultrasound.
Aliabadi explains that PCOS stems from multiple factors, including disrupted brain-ovary feedback, [restricted term] resistance, inflammation, and genetic factors. Despite its prevalence, over 90% of cases remain undiagnosed or improperly treated. Treatment typically involves managing [restricted term] resistance through lifestyle changes, medications like [restricted term], and supplements such as inositol. For women trying to conceive, fertility medications like [restricted term] or [restricted term] can help stimulate ovulation.
Endometriosis: Symptoms, Diagnosis, and Treatments
Dr. Aliabadi describes endometriosis as an autoimmune inflammatory condition where uterine-like tissue grows outside the uterus. Diagnosis typically takes 9-11 years and multiple doctor visits, with patients usually diagnosed around age 32. Common symptoms include painful periods, painful sex, chronic pelvic pain, bowel/bladder issues, and potential infertility.
Treatment options include hormonal suppression, pain management, and surgical excision. Aliabadi notes that there's a shortage of doctors trained in surgical removal of endometriosis, which is considered the gold standard for treatment.
Breast Cancer Risk Assessment and Screening
Dr. Aliabadi emphasizes the importance of the Tyrer-Cuzick model for calculating breast cancer risk. This model considers factors like age, weight, breast density, and family history. Women with a lifetime risk of 20% or higher should begin annual screenings at age 30, rather than the standard age of 40.
For high-risk women (over 35% risk), Aliabadi outlines several management options, including regular imaging, medication like [restricted term], or preventive mastectomy.
Women's Health Underdiagnosis and Dismissal by Medicine
Dr. Aliabadi and Andrew Huberman discuss the systematic dismissal of women's health issues in medicine. They note that doctors often overlook proper testing for conditions like PCOS and endometriosis, sometimes dismissing symptoms entirely. The current healthcare system's time constraints can lead to generic treatments without thorough investigation.
Aliabadi proposes separating obstetrics from gynecology to allow for better specialized care. Both experts emphasize the importance of women self-advocating and insisting on proper testing when experiencing unexplained symptoms.
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Actionables
- Create a personal health diary to track symptoms and patterns that could indicate PCOS or endometriosis. Note down any irregularities in your menstrual cycle, instances of unusual pain, or any other symptoms mentioned. This record can be invaluable when discussing your health with a doctor and can help push for a more thorough investigation.
- Research and compile a list of specialized women's health clinics and practitioners in your area. Having a list ready can save time and ensure you have access to healthcare professionals who may be more knowledgeable about conditions like PCOS and endometriosis, especially if you feel your concerns are not being taken seriously.
- Educate yourself on the Tyrer-Cuzick model and other risk assessment tools for breast cancer. Use online resources to understand these models better and consider discussing them with your healthcare provider to determine if you should have an earlier or more frequent screening based on your personal risk factors.
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Pcos: Symptoms, Diagnosis, Underlying Causes, and Treatments
Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting 15-20% of women, with higher prevalence in certain regions. Thaïs Aliabadi and other experts delve into the various aspects of this condition, including symptoms, causes, and treatments.
Pcos: Common Hormonal Disorder Affecting 15-20% of Women
Pcos: Irregular Periods, High Androgens (Acne, Facial Hair, Male-Pattern Hair Loss), Polycystic Ovaries on Ultrasound
The diagnosis of PCOS requires two of the following three criteria: high androgens, ovulation dysfunction, and polycystic ovaries on ultrasound. High androgens are indicated by acne, facial hair, or male-pattern hair thinning, while ovulation dysfunction is characterized by irregular periods. On ultrasound, a polycystic appearance is often a "string of pearls" with 20 or more follicles.
Causes of Pcos: Disrupted Brain-Ovary Feedback, [restricted term] Resistance, Inflammation, Genetic/Epigenetic Factors
Aliabadi highlights disrupted brain-ovary feedback, [restricted term] resistance, inflammation, and genetic/epigenetic factors as underlying causes. [restricted term] resistance, in particular, drives many symptoms of PCOS, including difficulty losing weight and mood disorders.
Pcos: Over 90% Undiagnosed or Improperly Treated
Despite its prevalence, over 90% of women with PCOS remain undiagnosed or improperly treated. Misconceptions and lack of awareness contribute to the misdiagnosis and mistreatment of this condition.
Pcos Treatments: Lifestyle, Supplements, Medications, [restricted term] Resistance
Treatment begins with managing [restricted term] resistance through lifestyle changes and can include medication such as [restricted term]. Supplements like inositol and a balanced diet are also crucial. Hormonal treatments such as birth control can help manage symptoms like acne and facial hair.
Aliabadi stresses the importance of addressing PCOS holistically, considering not just symptoms but also underlying causes. Lifestyle plays a crucial role in managing PCOS, with emphasis on exercise, diet, stress reduction, and adequate sleep.
For women trying to conceive, fertility medications such as [restricted term] or [restricted term] can stimulate ovulation. Aliabadi suggests that women with symptoms of high [restricted term] likely are not ovulating, which underscores the need for fertility assessment and treatment tailored to the individual's hormonal profile.
Addressing the underlying condition is key to managing PCOS effectively. Treatments for PCOS are multi-faceted and should be individualized to target both the metabolic and hormonal imbalances associated with the disorder.
Moreover, for long-term managemen ...
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Pcos: Symptoms, Diagnosis, Underlying Causes, and Treatments
Additional Materials
Actionables
- You can track your menstrual cycle using a smartphone app to identify irregularities that may indicate ovulation dysfunction. By logging your period start and end dates, flow intensity, and any associated symptoms like cramping or mood changes, you'll have a detailed record to discuss with a healthcare provider if you suspect PCOS.
- Create a simple home exercise routine to manage [restricted term] resistance, which could include bodyweight exercises, yoga, or brisk walking for at least 30 minutes a day. This habit not only supports [restricted term] management but also promotes overall well-being and can be easily integrated into your daily life without the need for a gym membership or equipment.
- Start a food diary to monitor your dietary patterns and identify areas where you can mak ...
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Endometriosis: Symptoms, Diagnosis, and Treatments
Dr. Thaïs Aliabadi delves into the multifaceted aspects of endometriosis, underscoring the commonality of the condition, its misdiagnosis, and the various treatment methods. Endometriosis is characterized as an often overlooked autoimmune inflammatory condition where uterine-like tissue grows outside of the uterus, leading to pain and infertility.
Endometriosis: A Common, Overlooked Condition With Uterine-Like Tissue Growing Outside the Uterus, Causing Pain and Infertility
Endometriosis Often Misdiagnosed, Requiring 5-10 Doctor Visits Over 9-11 Years For Diagnosis
Thaïs Aliabadi reveals that endometriosis affects a significant portion of women, many of whom remain undiagnosed. On average, it takes nine to eleven years for doctors in the United States to diagnose the condition with patients seeing an average of five to ten doctors, and some have seen up to fifty. The age of diagnosis is typically around 32 after a long journey of chronic pelvic pain or infertility issues.
Symptoms: Painful Periods, Painful Sex, Chronic Pelvic Pain, Bowel/Bladder Issues, Infertility
Aliabadi details the symptoms of endometriosis, including painful periods, painful sex with deep penetration, GI pain, bloating, chronic pelvic pain, leg pain, and potential infertility. As the disease progresses, patients may also experience worsening premenstrual and postmenstrual pain that can disrupt daily activities. Painful periods that increasingly impact life suggest endometriosis until proven otherwise.
Endometriosis: Inflammatory, Autoimmune Condition Damaging Reproductive Organs
Endometriosis leads to internal bleeding outside the uterus and it can cause scarring in the pelvis, affect the quality of a woman's eggs, and create a hostile environment for sperm, eggs, and embryos, which increases the risk of infertility, ectopic pregnancy, and miscarriage. Adenomyosis, a sister condition to endometriosis, is also common among these patients and contributes to heavy periods and painful sex. Patients with endometriosis may have autoimmune conditions, making it advisable to ask for a full autoimmune panel.
Endometriosis Treat ...
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Endometriosis: Symptoms, Diagnosis, and Treatments
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Actionables
- Create a symptom diary to track patterns and triggers, noting down instances of pelvic pain, bloating, and other related symptoms daily. This can help you identify trends and provide concrete evidence to healthcare providers, potentially shortening the time to diagnosis. For example, use a simple notebook or a digital app to log your symptoms, their severity, and any activities or foods that seem to correlate with flare-ups.
- Research and compile a list of specialists in endometriosis and surgical excision before you need them, so you're prepared if you or someone you know requires expert care. Look for doctors with positive reviews from endometriosis support groups and forums, and keep this list accessible. This proactive approach can save valuable time if a diagnosis is made or if you're seeking a second opinion.
- Educate yourself on t ...
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Breast Cancer Risk Assessment and Screening
As discussed by Thaïs Aliabadi, understanding one's risk for breast cancer involves more nuanced guidelines and methods for early screening and prevention.
Breast Cancer Affects 1 In 8: Screening Guidelines Inadequate
Thaïs Aliabadi sheds light on the Tyrer-Cuzick model, also known as the breast cancer risk calculator, which assesses a woman's lifetime risk of developing breast cancer.
Calculate Breast Cancer Risk Using Tyrer-Cuzick Model
The model factors in a range of personal details, including age, height, weight, breast density, family history, and genetic predispositions. Breast density information, crucial for the risk assessment, can be sourced from mammograms or MRIs.
High-Risk Women to Start Annual Breast Screenings By 30
Aliabadi underscores the inadequacy of current screening guidelines, revealing that her own lifetime breast cancer risk was calculated at 37% using the Tyrer-Cuzick model. Women with a lifetime risk of 20% or higher should start annual screenings for breast cancer at the age of 30—ten years earlier than the often-advised age of 40.
Consider Genetic Testing For Cancer Mutations in Women With Family Histories
Drawing from her experience, Aliabadi explains the crucial nature of early diagnosis and treatment, particularly for those with significant family histories of cancer. The podcast stresses the importance of considering family history as part of breast cancer risk assessment, as any histor ...
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Breast Cancer Risk Assessment and Screening
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Counterarguments
- The Tyrer-Cuzick model, while comprehensive, may not account for all risk factors, and different models may provide different risk assessments.
- Relying solely on breast density from mammograms or MRIs may not capture the full picture of an individual's breast cancer risk.
- The recommendation to start screening at age 30 for high-risk women may not be universally accepted, as different health organizations have varying guidelines based on their interpretation of the evidence.
- Genetic testing can have psychological impacts and may not be necessary or beneficial for all women with a family history of cancer.
- The effectiveness of [restricted term] in reducing breast cancer risk may vary among individuals, and the medication comes with potential side effects that need to be considered.
- Elective double mastectomy is a drastic measure that may not be the most appropriate choice for all high-risk women, and the psychological and physical impacts of su ...
Actionables
- Create a personalized breast cancer risk profile by gathering your medical history, including any known genetic predispositions, and discussing it with your healthcare provider to determine if you should use models like the Tyrer-Cuzick for a more accurate assessment. This conversation can lead to a tailored screening plan based on your specific risk factors.
- Develop a family health tree that details the history of cancer and other diseases in your family, which can be a visual tool to understand and communicate your genetic risk factors when consulting with a genetic counselor or healthcare professional.
- Advocate for your health by researching and preparing a list of questions about breast cancer s ...
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Women's Health Underdiagnosis and Dismissal by Medicine
Women face significant challenges in the medical field, with critical health issues like polycystic ovary syndrome (PCOS) and endometriosis often encountering dismissal and delayed diagnoses by doctors. Personal advocacies and changes in medical practices are needed to address this pervasive issue.
Women's Health Issues Like Pcos and Endometriosis Often Face Dismissal and Delayed Diagnoses by Doctors
Doctors May Overlook Testing For Pcos and Endometriosis, Dismissing Women's Symptom Reports
Dr. Thaïs Aliabadi and Andrew Huberman address the problem of underdiagnosis or dismissal of conditions like endometriosis and PCOS, suggesting a profound gap in the medical system's handling of these women's health issues. For instance, doctors often misunderstand PCOS as merely a presence of cysts, despite it being an ultrasound finding, and endometriosis patients face devastating side effects because physicians do not take the time to listen. Aliabadi recounts that patients with severe period pain or suspected endometriosis are sometimes told they are too young to have fertility issues. Additionally, Aliabadi points out that PCOS-looking ovaries might be dismissed by doctors without properly examining or understanding the condition, even offering mistaken reassurances regarding fertility.
Dr. Aliabadi highlights that non-typical PCOS presentations, including patients who are thin or without overt symptoms, contribute to the condition's misdiagnosis, further complicated by varied phenotypes of PCOS. Further, pelvic MRI and ultrasounds are mentioned as crucial but often overlooked tests, and Aliabadi contends that a normal result does not mean a person does not have endometriosis.
Medical System Limits Doctor-Patient Time For Complex Women's Health Issues
Doctors with constrained schedules may default to providing generic treatments, such as birth control, without conducting a thorough investigation. Dr. Aliabadi criticizes the healthcare system for only allowing 10 minutes with a doctor, which can result in insufficient diagnosis and treatment. The structure, including handling of insurance, could pressure physicians into a "conveyor belt" type of practice, limiting the time they can devote to complex health issues such as endometriosis.
Separating Obstetrics and Gynecology Empowers Gynecologists to Focus On Pcos and Endometriosis
Dr. Aliabadi proposes separating obstetrics from gynecology, enabling gynecologists to be better trained in recognizing conditions like PCOS and endometriosis. She envisions that specializ ...
Here’s what you’ll find in our full summary
Women's Health Underdiagnosis and Dismissal by Medicine
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Clarifications
- Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. It causes enlarged ovaries with small cysts on the outer edges and can lead to irregular menstrual cycles, excess hair growth, acne, and weight gain. PCOS is also linked to [restricted term] resistance, increasing the risk of type 2 diabetes. The exact cause is unknown, but it involves a combination of genetic and environmental factors.
- Endometriosis is a condition where tissue similar to the lining inside the uterus grows outside it. This misplaced tissue causes pain, inflammation, and sometimes fertility problems. It can affect organs like the ovaries, fallopian tubes, and pelvic lining. Symptoms often include severe menstrual cramps, chronic pelvic pain, and pain during intercourse.
- In the context of PCOS, "phenotypes" refer to the different ways the condition can present in individuals, with varying symptoms and severity. These variations can include differences in hormone levels, presence of cysts, menstrual irregularities, and metabolic issues. Recognizing these phenotypes is important because not all patients show the classic signs, making diagnosis more complex. Understanding phenotypes helps doctors tailor treatment to each patient's specific condition.
- Pelvic MRI and ultrasounds help visualize internal organs and detect abnormalities linked to endometriosis, such as cysts or lesions. These imaging tests can identify deep or complex endometriosis that physical exams might miss. However, they cannot detect all endometriosis cases, especially superficial implants. Therefore, imaging complements but does not replace clinical evaluation and sometimes surgical diagnosis.
- Obstetrics focuses on pregnancy, childbirth, and postpartum care. Gynecology deals with the health of the female reproductive system outside of pregnancy. Both are medical specialties often combined but involve different patient needs. Separating them allows gynecologists to specialize more deeply in non-pregnancy-related conditions.
- Non-typical PCOS presentations refer to cases where individuals have PCOS but do not show the common signs like obesity or visible cysts on ovaries. These patients might have normal weight, irregular symptoms, or subtle hormonal imbalances. This variation makes diagnosis harder because doctors often expect classic symptoms. Understanding these diverse presentations helps ensure more accurate and timely diagnosis.
- Calculating lifetime risk of breast cancer estimates the probability a woman will develop breast cancer over her life. This helps identify those at higher risk who may benefit from earlier or more frequent screening. It can guide decisions about preventive measures, such as lifestyle changes or genetic testing. Tools like the Gail model use personal and family history to provide this risk assessment.
- Genetic cancer testing analyzes a person's DNA to identify inherited mutations that increase cancer risk. It is recommended for individuals with a strong family history of cancer or early-onset cancers. The results help guide personalized prevention, screening, and treatment strategies. Testing is usually done through a blood or saliva sample.
- Birth control is often prescribed as a generic treatment because it can regulate menstrual cycles, reduce pain, and manage hormone levels. It is a quick, broad approach that may temporarily alleviate symptoms without diagnosing the underlying cause. Doctors may choose it due to limited appointment time and the complexity of ...
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