July 21, 2025 • 23 mins
Send us a message with this link, we would love to hear from you. Standard message rates may apply.
PCOS affects approximately one in ten women of reproductive age, creating a cascade of symptoms from irregular periods to fertility challenges. This common hormonal and metabolic condition has implications for long-term health beyond just reproductive concerns, including increased risk for diabetes, heart disease, and mental health issues.
• PCOS is characterized by elevated androgens and insulin resistance
• Symptoms include irregular periods, acne, unwanted hair growth, and weight management challenges
• Diagnosis requires meeting at least two of three Rotterdam criteria: irregular periods, high androgens, and polycystic ovaries
• Having ovarian cysts alone does not mean someone has PCOS
• PCOS increases risk for type 2 diabetes, high blood pressure, sleep apnea, and even endometrial cancer
• First-line treatment involves lifestyle modifications including diet and regular exercise
• Even modest weight loss (5-10%) can significantly improve symptoms
• Mental health support is crucial as PCOS is associated with higher rates of anxiety and depression
• Medication options include birth control pills, metformin, fertility medications, and anti-androgen treatments
• Free resources like the Ask PCOS app and online support groups can provide additional help
Share this episode with someone who might benefit from understanding PCOS better. Send us your thoughts at yourcheckuppod@gmail.com.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Dolesky, a familymedicine doctor in the
Philadelphia area, and I'mNicola Rufo.
I'm a nurse and we are soexcited you were able to join us
here again today.
What did you think of the wecooked at home this week?
(00:30):
We don't have any special likeout meal to discuss with you all
, but what did you think aboutthe chicken?
Speaker 2 (00:38):
The chicken?
Oh, the curry chicken.
Yeah, that was delicious.
I don't think we have any moreof that, do we?
Speaker 1 (00:49):
No, I ate all of that .
Speaker 2 (00:50):
Yeah, that was really good.
I think that was the first timeyou made something like that.
Speaker 1 (00:55):
It is Lots of different ingredients that I
didn't realize would cometogether and collect together.
This was a week ago, by thetime anyone's listening to this,
that I came up with the idea tobroaden my horizons and go into
the store every Monday, kind ofplanning out the meals for the
week, and curry chicken was onthe list.
It was a nice recipe.
(01:16):
I wish I read the commentsbefore and we were able to pull
it back from the brink ofdisappointment when we talked
about adding the lemon at theend.
That was a scary moment.
There's really not a lot ofways you can.
Well, I guess there's a fewways you can come back from
adding too much lemon.
Go ahead.
Speaker 2 (01:33):
Well, yeah, it was also like the end of the recipe
called for like juice of half alemon and we didn't have a lemon
.
But then I was like, oh, wehave like a thing of lemon juice
in the fridge, just use that.
So here's, eddie, glug, glug,glug, glug, glug, glug, glug,
with the lemon juice into thepot.
Speaker 1 (01:51):
I erred.
This is what happens when youcook with your heart and that's
it was a mistake and turns outneeded a lot more salt than what
we put in Because I mean ittasted fine.
You more salt than what we putin because I mean it tasted fine
.
You know you were eating itstraight out the pot but like
that was, a lot of salt wouldhave been helpful in this, this
(02:14):
dish I mean, it turned out greatoh, I was happy with it.
I was.
I thought it was delicious,served over rice.
And then earlier in the weekyou had some pollock cavatelli,
which need.
I mean pollock, true cavatellidefinitely yeah, what is that
pasta called?
Speaker 2 (02:30):
do you know?
Speaker 1 (02:31):
oh well, right now, we're just no, I don't, we're
just this new twirly pasta.
Speaker 2 (02:35):
You've been getting at whole foods or wegmans,
wegmans yeah, it's nice, it'sentertaining.
Speaker 1 (02:41):
We actually still have some um.
Yeah, but that was also good.
That was put as a possibilityfor a special dinner, which I'm
very honored by to have one ofmy own dishes be put in the
running for a special dinner.
Speaker 2 (02:55):
Oh, my God.
Speaker 1 (02:57):
And let's see.
We booked our honeymoon, whichwe're very excited about.
We did Collectively, did a lotof research together to come up
on a location and we are soexcited to be doing this.
We're going to do a traditionalhoneymoon right after the
wedding, which is going to beawesome.
Take all the excitement fromthe day.
Speaker 2 (03:15):
Put it into a 31-hour travel day.
Speaker 1 (03:18):
That's going to be crazy.
Maybe take a couple guessesabout where we're going to go.
We said 31 hours.
Where do you think we might begoing?
Reach out to us in the fan mail, we'll find out.
We're listening to some travelmedicine stuff to try to figure
out.
Speaker 2 (03:33):
Yeah, it turns out we should probably get a couple of
vaccines before we go.
Yeah, we should Some not sogreat things are endemic in the
country we're going to.
So yeah, yeah, not so greatthings are endemic in the
country we're going to.
So yeah, yeah, yes you know,visit a travel medicine clinic,
(03:54):
get a couple jabs.
Speaker 1 (03:55):
Yeah, and we'll need to go get taken care of, take a
couple medicines to make sure wedon't get, like you know,
malaria.
Speaker 2 (04:01):
Yeah, that would suck .
Speaker 1 (04:04):
You know other things , so we're so excited.
You know all the planning.
A trip can be a big thing.
I'm grateful that I have a lotof time.
I don't know if I would havebeen able to do that.
I mean, it took days for me towrap my head around, like things
and like when you looksomewhere where you've never
been before, you're trying tofigure out what's a good way to
go and I'm proud, I'm proud ofhow we did it, and I'm very
(04:28):
excited and I can't wait yourfavorite day ever, october 11th
when the wedding's over allright.
Well, should we get started?
Speaker 2 (04:41):
you don't want to talk about your day yesterday.
Speaker 1 (04:43):
Well, I guess we could talk about my little ditty
.
Speaker 2 (04:46):
We talked about it a lot yesterday I did.
Speaker 1 (04:49):
I did, but you know well, I was invited to the arufo
family crabbing trip, which isonly like a male event, which
was not true, but it was inhonor of a family member who had
since passed um and it was areally nice idea and I had a
blast.
I mean, if there is someone whocould like sit in the pouring
(05:12):
rain not like vertical pouringrain, like slanted pouring rain
on a crabbing boat and have asmile on his face at nine in the
morning, completely drenched,it's me I wish someone took a
picture of that yeah, it waslike, I mean, I had the smiling
on the bay in the rainyou just gotta make.
It was a lemonade day andeveryone had a great attitude
(05:33):
about it.
Your family's awesome.
It was a whole like branch ofyour family I had never met
before and they are just acomplete delight.
They were were all like, areyou ready to meet the crazies?
And they weren't at all.
They were this is lovely peoplewho were so extroverted and
welcoming and it was awesome.
And I mean right here, likeright in New Jersey, close to
(05:55):
home to all this fun stuff, butyou're out in that Bay it feels
like you're not there.
Got a couple of crabs, nothingspectacular.
I Got a couple crabs, nothingspectacular.
I'm not even sure we kept them.
The other boat did really wellCaught something like 60 and
then threw, quote, unquote, 20back or so to end up with a
bigger haul.
But it was awesome and I lovethat.
(06:16):
They do it every year.
But that rain was incredibleand the guy at the marina was
like, oh yeah, it's going tolighten up, it's going to
lighten up, it's gonna lightenup.
And then you pull out youriphone, you open up the weather
app and you like, see, like nowthey give you, like you know,
heavy rain for the next 15minutes.
It was 10 o'clock and they'relike heavy rain expected for the
next two hours.
And then one of them made anexecutive decision to just end
(06:41):
it and he was able to get a freeyou know free trip out of the
guy afterwards, not for that day, but, you know, a return trip,
gotta keep business going cool.
Yeah, you feel good about that,yeah.
Yeah, that was nice, I feelthat was.
I was really happy to have beeninvited and to go.
All right, what are we gonnatalk about today?
Speaker 2 (07:03):
Today we're talking about PCOS.
Speaker 1 (07:06):
Yep and for today's episode, we are pulling
information from the 2023International Evidence-Based
Guidelines for PCOS.
They were developed by theEndocrine Society.
We're taking information fromthe American Society of
Reproductive Medicine, theEuropean Society of
Endocrinology, of ReproductiveMedicine, the European Society
(07:26):
of Endocrinology and somedifferent insights from the
Lancet Human Reproduction andthe New England Journal of
Medicine and, last but not least, the American Family Physician.
For today's information,without further ado.
Yes, we are talking about PCOS,so can you tell us a little bit
more about PCOS?
Speaker 2 (07:42):
I can.
Pcos stands for polycysticovarian syndrome and it's
actually a lot more common thanpeople realize.
It affects about one in 10women of reproductive age, which
is a lot, that's a lot.
So it's actually affectingmillions of people dealing with
symptoms which really we'll talkmore about, but irregular
(08:02):
periods, skin changes, unwantedhair growth and trouble getting
pregnant.
Speaker 1 (08:09):
And so what makes PCOS especially important is
that it's not just all aboutfertility.
Speaker 2 (08:14):
It's a hormonal and metabolic condition as well, and
so it can have implications onlong-term health, things like
diabetes, heart disease andsometimes even mental health
implications, right but the goodnews is there are a lot of
things that you can do afteryou've been diagnosed with this
to manage it with differentlifestyle modifications and
(08:34):
medications.
Speaker 1 (08:35):
Great, and so if you are living with PCOS or you're
just curious about it, thisone's for you.
So what is PCOS?
At its core, it's a conditionwhere your body makes more
androgen, and these aretypically called male hormones.
It makes more of these than itshould, and so it also comes
(08:58):
with problems how your body usesinsulin and, like we've talked
about previously, but just as areminder, it's the hormone that
helps your body manage bloodsugar, and so that combination
elevated androgens and someinsulin resistance really
creates this cascade of symptomsthat you might notice that you
mentioned earlier irregular orabsent periods, acne or oily
(09:23):
skin, extra hair growth,particularly on the face, the
chest or sometimes the stomach,trouble, losing weight or
gaining weight really easily,and, for some people, difficulty
getting pregnant, and so thetricky thing with this is that
not everyone has the samesymptoms.
(09:44):
I mean, what's easy is that ifyou measure someone's blood
pressure and the blood pressureis elevated in a certain number
of times in a certain settinghigh blood pressure, increased
blood sugar or elevated bloodsugar, not too hard, diabetes
but with this one, theconstellation of symptoms is a
little tricky.
Some people just have mildirregular periods and they
(10:07):
wouldn't know that they havePCOS until they were trying to
get pregnant.
Others have more visiblesymptoms that show up when
they're a teenager, and so inthis sense, pcos could be
described as a spectrum, andthat's why the part of the
diagnosis and the treatment canbe really personal and tailored
to you individually.
Speaker 2 (10:26):
So what causes PCOS?
Speaker 1 (10:29):
Great question.
Thank you for asking it.
So we have to bust a little bitof a myth here.
Pcos isn't something thatsomeone does.
It's not something that theythemselves cause.
It's not the result of eatingtoo many carbs or not working
out enough.
Pcos tends to run in families.
So it really tells us thatthere is a strong genetic
(10:50):
component to this and in part,it's influenced by how your body
processes insulin.
So even when people eat verywell and they're active, they
can still have PCOS.
What we do know is that insulinresistance is really common in
PCOS and essentially what thismeans is that your cells aren't
responding well enough to theamount of insulin in your body
(11:13):
to do the job it needs to do.
So your body makes more tocompensate and with that extra
insulin can trigger your ovariesto make more androgens, and
that's part of that interplaythat happens those male hormones
that are increased, ortypically called male hormones.
That feeds into the cycle ofdisrupting normal menstruation
(11:36):
and normal periods to make themmore irregular, leading to some
of these symptoms.
And so, once again, this isn'tsomething that anyone did to
themselves.
We've seen that it's incrediblycommon and it's a medical
condition and, like any, there'streatment for it.
But before we get to treatment,we have to talk about diagnosis
(11:57):
, and so to capture a diagnosisof PCOS, there is something
called the Rotterdam criteria,which is the most common way
that's taught to capture thisdiagnosis.
And so the three you have tohave two out of the following
three by these criteria.
Nikki, can you tell us thethree criteria?
Speaker 2 (12:20):
I can.
The first is irregular ormissed periods, signs of those
high androgens, which would bethings like acne or facial and
body hair, where you typicallyprobably wouldn't have any, and
then on an ultrasound you wouldhave polycystic ovaries which
kind of look like a string ofpearls in there.
Speaker 1 (12:42):
Yep, and here's something important Really, just
having cysts on the ovariesdoes not mean you have PCOS.
I've seen plenty of times wherea patient comes in they've had
an ultrasound for some reason.
They don't have any othersymptoms, but they see the
ovaries and they have cysts onthem probably nothing and
(13:02):
they're like, oh my gosh, I havePCOS.
That is not the case.
It really is about the overallpicture, and so your doctor will
also rule out other conditionsthat mimic PCOS.
That is not the case.
It really is about the overallpicture, and so your doctor will
also rule out other conditionsthat mimic PCOS, things that go
by the names of thyroiddisorders or other hormone
problems that can happen.
And so, at the end of the day,it's not just one blood test,
it's not one ultrasound.
It's about connecting all ofthese dots between your symptoms
(13:25):
, the labs, imaging to reallycapture this diagnosis.
And, like we said earlier, pcoscan be really especially tricky
in teens, because some of thesesymptoms are a part of normal
aging and puberty.
Like a teen isn't going to gettheir period initially every
single month at clockwork, itmay be a little abnormal.
(13:47):
They may have more acne thanthe average person because
they're a teenager, so that'ssomething that's also tricky to
keep in mind.
We talked about earlier thatthere are different health risks
associated with PCOS.
Outside of the fertility andthe obvious symptoms that
someone may be experiencing, canyou list off a couple things
(14:07):
that someone with PCOS mightalso be at increased risk for?
Speaker 2 (14:12):
Yeah, it's a decent amount of things Type 2 diabetes
, high blood pressure and highcholesterol, sleep apnea,
depression and anxiety, and evenendometrial cancer, which would
be like in your uterus.
Speaker 1 (14:28):
Yeah, and that especially happens if the
uterine lining isn't sheddingregularly and going through its
normal processes.
That can happen, and so theserisks are real, but they're
manageable, which is theencouraging thing, and that's
what we're going to talk aboutnext when we talk about the
treatments.
But that's why, when we talkabout PCOS, it's something to
(14:49):
take seriously, especially whenwe catch it early.
It's something that really,like you can even think of, like
asthma or high cholesterol.
So we're going to go back andforth here about some of the
treatments.
Nikki, what are some of thefirst things to think about when
it comes to managing PCOS?
It's like a lot of the otherthings, but why don't we start
(15:13):
even there?
Speaker 2 (15:15):
Okay, I've said it once, I'll say it again Diet and
exercise are our first-linelifestyle modifications to help
treat this.
Speaker 1 (15:25):
Yeah.
So eating patterns that containthey emphasize whole foods,
fiber, healthy fats and lowglycemic carbs can help improve
the insulin levels and hormonebalance.
We have a whole episodededicated to describing insulin.
We have a whole episodededicated to describing insulin
resistance that can be reallyhelpful.
(15:46):
We also have a whole episodeabout the Mediterranean diet,
which is something that can behelpful in someone who is
experiencing PCOS, and, whilenot yet, we'll have an episode
about the DASH diet, which canalso be helpful.
Physical activity is extremelyimportant.
Even walking 30 minutes a daycan help all of the overall
(16:06):
processes of PCOS can help allof the overall processes of PCOS
.
Resistance training issomething that should be
incorporated, and even losing 5%to 10% of your body weight can
make a noticeable differencewhen it comes to periods,
fertility and insulin resistance.
All that being said, yourhealth is not a scale.
They are not completely linkedto one another, but it's just a
(16:28):
reasonable goal to hit.
Something that we also know isthat people with PCOS may be
more susceptible to mentalhealth concerns.
If you have PCOS and you'vefelt anxious, depressed,
frustrated or you feel like yourbody's working against you, you
really aren't alone.
(16:49):
There's a lot of evidence thatshows that people who have PCOS
have increased rates of anxietyand increased rates of
depression, and I mean thismakes a lot of sense to us.
If you're dealing with thingsthat are so cosmetic and visible
, like acne, hair changes,weight fluctuations, fertility
struggles, I mean it's no wonderthat these things can take a
(17:10):
toll on you.
So that's why we say and wehighlight that emotional support
and being kind to yourself, forbehavioral health can be really
important when it comes to PCOS.
Cbt cognitive behavioral therapyis probably not out of the
realm of possibility for someonewho might be experiencing this,
and so you really have to, andwhat we're trying to do here is
(17:32):
emphasize that we're looking atthe whole person when it comes
to PCOS diet, exercise and theirmental well-being All things
that you can do without amedicine.
I see a lot of people onlinebecause Threads is what we're
most active on.
People are in distress aboutthis.
Speaker 2 (17:53):
Yeah, I would be.
Speaker 1 (17:56):
Yeah, they don't like that.
They feel like there's a lot ofsolutions out there that can
help them without leaping to amedicine.
It seems like they feel reallymisunderstood and I feel like a
lot of people suspect they haveit but they haven't captured the
diagnosis for some reason,which seems like a really
(18:19):
frustrating place to be in.
But with all that frustrationcomes a little glimmer of hope,
and what we're going to talkabout next is different
medications that you might beoffered and why different
medications that you might beoffered and why.
So you know, for a lot ofpeople, lifestyle and these
(18:41):
mental health steps forward mayhelp a lot of people, but there
are a lot of medications outthere that can be helpful.
So birth control pills areoften the first medication used
to help regulate irregularperiods, acne and unwanted hair.
What they do is they helpregulate the cycles and acne and
unwanted hair.
What they do is they helpregulate the cycles and they
lower the androgens in the body.
Second is metformin.
This medication commonly usedfor diabetes, prediabetes.
(19:04):
It helps your body use insulinmore effectively, which also can
help maybe improve cycles andhelp with the underlying
metabolic processes with PCOS,like insulin resistance and
prediabetes.
There are two other medications.
One medicine is a medicine touse when someone's trying to get
(19:24):
pregnant.
It's called letrozole.
It's a fertility medicine andit tends to work a little bit
better than other medications,but it's one that's commonly
used in the fertility world.
And a fourth medicine is calledspironolactone, which is
actually more commonly used inblood pressure and heart failure
worlds, but it can be used herebecause it can help with
(19:48):
stubborn hair growth.
This is specifically ananti-androgen medication, but
it's only safe to use if you'reusing contraception, because
it's not safe during pregnancyit can harm the fetus.
There are some other non-medicalor non-pharmaceutical ways,
like there are laser ormechanical hair removal, which
(20:09):
can be really effective forpeople as well, because that
seems to be one of the mosttroublesome symptoms that people
have, and so the key here isthat the treatment really should
match your goals.
If it's the period symptomsthat you're monitoring, there
might be an option for you.
If it's the fertility concerns,there might be an option for
you.
If it's managing your weight,insulin resistance and possibly
prediabetes, there might be anoption for you layered into all
(20:33):
of the aspects of your life andtreatment altogether.
Can you take us through some ofthe resources that might be out
there for someone with PCOS.
Speaker 2 (20:44):
Yeah, the first one is an app that's actually a
legit, evidence-based app it'scalled Ask PCOS that you can
download and it's free.
There's the endocrine societythat has really great tools and
information and can help likeconnect people who also are
(21:05):
struggling.
Speaker 1 (21:06):
And then there are also a lot of online support
groups out there really for likeevery ailment, but the PCOS
community online is pretty bigyeah, and I mean, like, how
validating might it feel to bein a group of people or at least
have conversations that peoplecan relate to?
(21:27):
So think about it.
I will say a word of caution.
Some of these Facebook groupsare wild, so you can't read or
believe everything you hearonline, especially when it's
coming from some random person.
But some of them have greatintentions, some of them are
well monitored and you might beable to find someone that you
can relate to.
And so we're going to wrap uphere.
To recap, pcos is common, it'smanageable, frustrating and it
(21:52):
deserves way more attention.
And so, whether you've beendiagnosed for years or just
starting to wonder if you mighthave it, remember there is help,
there are treatments andthere's nothing wrong with you.
There's just somethinghappening to you.
So thank you, as always, forcoming back to another episode
of your Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or a neighbor.
(22:14):
Share this episode with someone.
Send us some fan mail if youwant.
You can email us atyourcheckuppod at gmailcom.
But, most importantly, stayhealthy, my friends.
Until next time.
I'm Ed Dolesky.
I'm Nicola Ruffo.
Thank you, goodbye.
Speaker 2 (22:30):
Bye no-transcript.
Speaker 1 (22:56):
We explicitly disclaim any liability relating
to the information given or itsuse.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Dolesky, a familymedicine doctor in the
Philadelphia area, and I'mNicola Rufo.
I'm a nurse and we are soexcited you were able to join us
here again today.
What did you think of the wecooked at home this week?
(00:30):
We don't have any special likeout meal to discuss with you all
, but what did you think aboutthe chicken?
Speaker 2 (00:38):
The chicken?
Oh, the curry chicken.
Yeah, that was delicious.
I don't think we have any moreof that, do we?
Speaker 1 (00:49):
No, I ate all of that .
Speaker 2 (00:50):
Yeah, that was really good.
I think that was the first timeyou made something like that.
Speaker 1 (00:55):
It is Lots of different ingredients that I
didn't realize would cometogether and collect together.
This was a week ago, by thetime anyone's listening to this,
that I came up with the idea tobroaden my horizons and go into
the store every Monday, kind ofplanning out the meals for the
week, and curry chicken was onthe list.
It was a nice recipe.
(01:16):
I wish I read the commentsbefore and we were able to pull
it back from the brink ofdisappointment when we talked
about adding the lemon at theend.
That was a scary moment.
There's really not a lot ofways you can.
Well, I guess there's a fewways you can come back from
adding too much lemon.
Go ahead.
Speaker 2 (01:33):
Well, yeah, it was also like the end of the recipe
called for like juice of half alemon and we didn't have a lemon
.
But then I was like, oh, wehave like a thing of lemon juice
in the fridge, just use that.
So here's, eddie, glug, glug,glug, glug, glug, glug, glug,
with the lemon juice into thepot.
Speaker 1 (01:51):
I erred.
This is what happens when youcook with your heart and that's
it was a mistake and turns outneeded a lot more salt than what
we put in Because I mean ittasted fine.
You more salt than what we putin because I mean it tasted fine
.
You know you were eating itstraight out the pot but like
that was, a lot of salt wouldhave been helpful in this, this
(02:14):
dish I mean, it turned out greatoh, I was happy with it.
I was.
I thought it was delicious,served over rice.
And then earlier in the weekyou had some pollock cavatelli,
which need.
I mean pollock, true cavatellidefinitely yeah, what is that
pasta called?
Speaker 2 (02:30):
do you know?
Speaker 1 (02:31):
oh well, right now, we're just no, I don't, we're
just this new twirly pasta.
Speaker 2 (02:35):
You've been getting at whole foods or wegmans,
wegmans yeah, it's nice, it'sentertaining.
Speaker 1 (02:41):
We actually still have some um.
Yeah, but that was also good.
That was put as a possibilityfor a special dinner, which I'm
very honored by to have one ofmy own dishes be put in the
running for a special dinner.
Speaker 2 (02:55):
Oh, my God.
Speaker 1 (02:57):
And let's see.
We booked our honeymoon, whichwe're very excited about.
We did Collectively, did a lotof research together to come up
on a location and we are soexcited to be doing this.
We're going to do a traditionalhoneymoon right after the
wedding, which is going to beawesome.
Take all the excitement fromthe day.
Speaker 2 (03:15):
Put it into a 31-hour travel day.
Speaker 1 (03:18):
That's going to be crazy.
Maybe take a couple guessesabout where we're going to go.
We said 31 hours.
Where do you think we might begoing?
Reach out to us in the fan mail, we'll find out.
We're listening to some travelmedicine stuff to try to figure
out.
Speaker 2 (03:33):
Yeah, it turns out we should probably get a couple of
vaccines before we go.
Yeah, we should Some not sogreat things are endemic in the
country we're going to.
So yeah, yeah, not so greatthings are endemic in the
country we're going to.
So yeah, yeah, yes you know,visit a travel medicine clinic,
(03:54):
get a couple jabs.
Speaker 1 (03:55):
Yeah, and we'll need to go get taken care of, take a
couple medicines to make sure wedon't get, like you know,
malaria.
Speaker 2 (04:01):
Yeah, that would suck .
Speaker 1 (04:04):
You know other things , so we're so excited.
You know all the planning.
A trip can be a big thing.
I'm grateful that I have a lotof time.
I don't know if I would havebeen able to do that.
I mean, it took days for me towrap my head around, like things
and like when you looksomewhere where you've never
been before, you're trying tofigure out what's a good way to
go and I'm proud, I'm proud ofhow we did it, and I'm very
(04:28):
excited and I can't wait yourfavorite day ever, october 11th
when the wedding's over allright.
Well, should we get started?
Speaker 2 (04:41):
you don't want to talk about your day yesterday.
Speaker 1 (04:43):
Well, I guess we could talk about my little ditty
.
Speaker 2 (04:46):
We talked about it a lot yesterday I did.
Speaker 1 (04:49):
I did, but you know well, I was invited to the arufo
family crabbing trip, which isonly like a male event, which
was not true, but it was inhonor of a family member who had
since passed um and it was areally nice idea and I had a
blast.
I mean, if there is someone whocould like sit in the pouring
(05:12):
rain not like vertical pouringrain, like slanted pouring rain
on a crabbing boat and have asmile on his face at nine in the
morning, completely drenched,it's me I wish someone took a
picture of that yeah, it waslike, I mean, I had the smiling
on the bay in the rainyou just gotta make.
It was a lemonade day andeveryone had a great attitude
(05:33):
about it.
Your family's awesome.
It was a whole like branch ofyour family I had never met
before and they are just acomplete delight.
They were were all like, areyou ready to meet the crazies?
And they weren't at all.
They were this is lovely peoplewho were so extroverted and
welcoming and it was awesome.
And I mean right here, likeright in New Jersey, close to
(05:55):
home to all this fun stuff, butyou're out in that Bay it feels
like you're not there.
Got a couple of crabs, nothingspectacular.
I Got a couple crabs, nothingspectacular.
I'm not even sure we kept them.
The other boat did really wellCaught something like 60 and
then threw, quote, unquote, 20back or so to end up with a
bigger haul.
But it was awesome and I lovethat.
(06:16):
They do it every year.
But that rain was incredibleand the guy at the marina was
like, oh yeah, it's going tolighten up, it's going to
lighten up, it's gonna lightenup.
And then you pull out youriphone, you open up the weather
app and you like, see, like nowthey give you, like you know,
heavy rain for the next 15minutes.
It was 10 o'clock and they'relike heavy rain expected for the
next two hours.
And then one of them made anexecutive decision to just end
(06:41):
it and he was able to get a freeyou know free trip out of the
guy afterwards, not for that day, but, you know, a return trip,
gotta keep business going cool.
Yeah, you feel good about that,yeah.
Yeah, that was nice, I feelthat was.
I was really happy to have beeninvited and to go.
All right, what are we gonnatalk about today?
Speaker 2 (07:03):
Today we're talking about PCOS.
Speaker 1 (07:06):
Yep and for today's episode, we are pulling
information from the 2023International Evidence-Based
Guidelines for PCOS.
They were developed by theEndocrine Society.
We're taking information fromthe American Society of
Reproductive Medicine, theEuropean Society of
Endocrinology, of ReproductiveMedicine, the European Society
(07:26):
of Endocrinology and somedifferent insights from the
Lancet Human Reproduction andthe New England Journal of
Medicine and, last but not least, the American Family Physician.
For today's information,without further ado.
Yes, we are talking about PCOS,so can you tell us a little bit
more about PCOS?
Speaker 2 (07:42):
I can.
Pcos stands for polycysticovarian syndrome and it's
actually a lot more common thanpeople realize.
It affects about one in 10women of reproductive age, which
is a lot, that's a lot.
So it's actually affectingmillions of people dealing with
symptoms which really we'll talkmore about, but irregular
(08:02):
periods, skin changes, unwantedhair growth and trouble getting
pregnant.
Speaker 1 (08:09):
And so what makes PCOS especially important is
that it's not just all aboutfertility.
Speaker 2 (08:14):
It's a hormonal and metabolic condition as well, and
so it can have implications onlong-term health, things like
diabetes, heart disease andsometimes even mental health
implications, right but the goodnews is there are a lot of
things that you can do afteryou've been diagnosed with this
to manage it with differentlifestyle modifications and
(08:34):
medications.
Speaker 1 (08:35):
Great, and so if you are living with PCOS or you're
just curious about it, thisone's for you.
So what is PCOS?
At its core, it's a conditionwhere your body makes more
androgen, and these aretypically called male hormones.
It makes more of these than itshould, and so it also comes
(08:58):
with problems how your body usesinsulin and, like we've talked
about previously, but just as areminder, it's the hormone that
helps your body manage bloodsugar, and so that combination
elevated androgens and someinsulin resistance really
creates this cascade of symptomsthat you might notice that you
mentioned earlier irregular orabsent periods, acne or oily
(09:23):
skin, extra hair growth,particularly on the face, the
chest or sometimes the stomach,trouble, losing weight or
gaining weight really easily,and, for some people, difficulty
getting pregnant, and so thetricky thing with this is that
not everyone has the samesymptoms.
(09:44):
I mean, what's easy is that ifyou measure someone's blood
pressure and the blood pressureis elevated in a certain number
of times in a certain settinghigh blood pressure, increased
blood sugar or elevated bloodsugar, not too hard, diabetes
but with this one, theconstellation of symptoms is a
little tricky.
Some people just have mildirregular periods and they
(10:07):
wouldn't know that they havePCOS until they were trying to
get pregnant.
Others have more visiblesymptoms that show up when
they're a teenager, and so inthis sense, pcos could be
described as a spectrum, andthat's why the part of the
diagnosis and the treatment canbe really personal and tailored
to you individually.
Speaker 2 (10:26):
So what causes PCOS?
Speaker 1 (10:29):
Great question.
Thank you for asking it.
So we have to bust a little bitof a myth here.
Pcos isn't something thatsomeone does.
It's not something that theythemselves cause.
It's not the result of eatingtoo many carbs or not working
out enough.
Pcos tends to run in families.
So it really tells us thatthere is a strong genetic
(10:50):
component to this and in part,it's influenced by how your body
processes insulin.
So even when people eat verywell and they're active, they
can still have PCOS.
What we do know is that insulinresistance is really common in
PCOS and essentially what thismeans is that your cells aren't
responding well enough to theamount of insulin in your body
(11:13):
to do the job it needs to do.
So your body makes more tocompensate and with that extra
insulin can trigger your ovariesto make more androgens, and
that's part of that interplaythat happens those male hormones
that are increased, ortypically called male hormones.
That feeds into the cycle ofdisrupting normal menstruation
(11:36):
and normal periods to make themmore irregular, leading to some
of these symptoms.
And so, once again, this isn'tsomething that anyone did to
themselves.
We've seen that it's incrediblycommon and it's a medical
condition and, like any, there'streatment for it.
But before we get to treatment,we have to talk about diagnosis
(11:57):
, and so to capture a diagnosisof PCOS, there is something
called the Rotterdam criteria,which is the most common way
that's taught to capture thisdiagnosis.
And so the three you have tohave two out of the following
three by these criteria.
Nikki, can you tell us thethree criteria?
Speaker 2 (12:20):
I can.
The first is irregular ormissed periods, signs of those
high androgens, which would bethings like acne or facial and
body hair, where you typicallyprobably wouldn't have any, and
then on an ultrasound you wouldhave polycystic ovaries which
kind of look like a string ofpearls in there.
Speaker 1 (12:42):
Yep, and here's something important Really, just
having cysts on the ovariesdoes not mean you have PCOS.
I've seen plenty of times wherea patient comes in they've had
an ultrasound for some reason.
They don't have any othersymptoms, but they see the
ovaries and they have cysts onthem probably nothing and
(13:02):
they're like, oh my gosh, I havePCOS.
That is not the case.
It really is about the overallpicture, and so your doctor will
also rule out other conditionsthat mimic PCOS.
That is not the case.
It really is about the overallpicture, and so your doctor will
also rule out other conditionsthat mimic PCOS, things that go
by the names of thyroiddisorders or other hormone
problems that can happen.
And so, at the end of the day,it's not just one blood test,
it's not one ultrasound.
It's about connecting all ofthese dots between your symptoms
(13:25):
, the labs, imaging to reallycapture this diagnosis.
And, like we said earlier, pcoscan be really especially tricky
in teens, because some of thesesymptoms are a part of normal
aging and puberty.
Like a teen isn't going to gettheir period initially every
single month at clockwork, itmay be a little abnormal.
(13:47):
They may have more acne thanthe average person because
they're a teenager, so that'ssomething that's also tricky to
keep in mind.
We talked about earlier thatthere are different health risks
associated with PCOS.
Outside of the fertility andthe obvious symptoms that
someone may be experiencing, canyou list off a couple things
(14:07):
that someone with PCOS mightalso be at increased risk for?
Speaker 2 (14:12):
Yeah, it's a decent amount of things Type 2 diabetes
, high blood pressure and highcholesterol, sleep apnea,
depression and anxiety, and evenendometrial cancer, which would
be like in your uterus.
Speaker 1 (14:28):
Yeah, and that especially happens if the
uterine lining isn't sheddingregularly and going through its
normal processes.
That can happen, and so theserisks are real, but they're
manageable, which is theencouraging thing, and that's
what we're going to talk aboutnext when we talk about the
treatments.
But that's why, when we talkabout PCOS, it's something to
(14:49):
take seriously, especially whenwe catch it early.
It's something that really,like you can even think of, like
asthma or high cholesterol.
So we're going to go back andforth here about some of the
treatments.
Nikki, what are some of thefirst things to think about when
it comes to managing PCOS?
It's like a lot of the otherthings, but why don't we start
(15:13):
even there?
Speaker 2 (15:15):
Okay, I've said it once, I'll say it again Diet and
exercise are our first-linelifestyle modifications to help
treat this.
Speaker 1 (15:25):
Yeah.
So eating patterns that containthey emphasize whole foods,
fiber, healthy fats and lowglycemic carbs can help improve
the insulin levels and hormonebalance.
We have a whole episodededicated to describing insulin.
We have a whole episodededicated to describing insulin
resistance that can be reallyhelpful.
(15:46):
We also have a whole episodeabout the Mediterranean diet,
which is something that can behelpful in someone who is
experiencing PCOS, and, whilenot yet, we'll have an episode
about the DASH diet, which canalso be helpful.
Physical activity is extremelyimportant.
Even walking 30 minutes a daycan help all of the overall
(16:06):
processes of PCOS can help allof the overall processes of PCOS
.
Resistance training issomething that should be
incorporated, and even losing 5%to 10% of your body weight can
make a noticeable differencewhen it comes to periods,
fertility and insulin resistance.
All that being said, yourhealth is not a scale.
They are not completely linkedto one another, but it's just a
(16:28):
reasonable goal to hit.
Something that we also know isthat people with PCOS may be
more susceptible to mentalhealth concerns.
If you have PCOS and you'vefelt anxious, depressed,
frustrated or you feel like yourbody's working against you, you
really aren't alone.
(16:49):
There's a lot of evidence thatshows that people who have PCOS
have increased rates of anxietyand increased rates of
depression, and I mean thismakes a lot of sense to us.
If you're dealing with thingsthat are so cosmetic and visible
, like acne, hair changes,weight fluctuations, fertility
struggles, I mean it's no wonderthat these things can take a
(17:10):
toll on you.
So that's why we say and wehighlight that emotional support
and being kind to yourself, forbehavioral health can be really
important when it comes to PCOS.
Cbt cognitive behavioral therapyis probably not out of the
realm of possibility for someonewho might be experiencing this,
and so you really have to, andwhat we're trying to do here is
(17:32):
emphasize that we're looking atthe whole person when it comes
to PCOS diet, exercise and theirmental well-being All things
that you can do without amedicine.
I see a lot of people onlinebecause Threads is what we're
most active on.
People are in distress aboutthis.
Speaker 2 (17:53):
Yeah, I would be.
Speaker 1 (17:56):
Yeah, they don't like that.
They feel like there's a lot ofsolutions out there that can
help them without leaping to amedicine.
It seems like they feel reallymisunderstood and I feel like a
lot of people suspect they haveit but they haven't captured the
diagnosis for some reason,which seems like a really
(18:19):
frustrating place to be in.
But with all that frustrationcomes a little glimmer of hope,
and what we're going to talkabout next is different
medications that you might beoffered and why different
medications that you might beoffered and why.
So you know, for a lot ofpeople, lifestyle and these
(18:41):
mental health steps forward mayhelp a lot of people, but there
are a lot of medications outthere that can be helpful.
So birth control pills areoften the first medication used
to help regulate irregularperiods, acne and unwanted hair.
What they do is they helpregulate the cycles and acne and
unwanted hair.
What they do is they helpregulate the cycles and they
lower the androgens in the body.
Second is metformin.
This medication commonly usedfor diabetes, prediabetes.
(19:04):
It helps your body use insulinmore effectively, which also can
help maybe improve cycles andhelp with the underlying
metabolic processes with PCOS,like insulin resistance and
prediabetes.
There are two other medications.
One medicine is a medicine touse when someone's trying to get
(19:24):
pregnant.
It's called letrozole.
It's a fertility medicine andit tends to work a little bit
better than other medications,but it's one that's commonly
used in the fertility world.
And a fourth medicine is calledspironolactone, which is
actually more commonly used inblood pressure and heart failure
worlds, but it can be used herebecause it can help with
(19:48):
stubborn hair growth.
This is specifically ananti-androgen medication, but
it's only safe to use if you'reusing contraception, because
it's not safe during pregnancyit can harm the fetus.
There are some other non-medicalor non-pharmaceutical ways,
like there are laser ormechanical hair removal, which
(20:09):
can be really effective forpeople as well, because that
seems to be one of the mosttroublesome symptoms that people
have, and so the key here isthat the treatment really should
match your goals.
If it's the period symptomsthat you're monitoring, there
might be an option for you.
If it's the fertility concerns,there might be an option for
you.
If it's managing your weight,insulin resistance and possibly
prediabetes, there might be anoption for you layered into all
(20:33):
of the aspects of your life andtreatment altogether.
Can you take us through some ofthe resources that might be out
there for someone with PCOS.
Speaker 2 (20:44):
Yeah, the first one is an app that's actually a
legit, evidence-based app it'scalled Ask PCOS that you can
download and it's free.
There's the endocrine societythat has really great tools and
information and can help likeconnect people who also are
(21:05):
struggling.
Speaker 1 (21:06):
And then there are also a lot of online support
groups out there really for likeevery ailment, but the PCOS
community online is pretty bigyeah, and I mean, like, how
validating might it feel to bein a group of people or at least
have conversations that peoplecan relate to?
(21:27):
So think about it.
I will say a word of caution.
Some of these Facebook groupsare wild, so you can't read or
believe everything you hearonline, especially when it's
coming from some random person.
But some of them have greatintentions, some of them are
well monitored and you might beable to find someone that you
can relate to.
And so we're going to wrap uphere.
To recap, pcos is common, it'smanageable, frustrating and it
(21:52):
deserves way more attention.
And so, whether you've beendiagnosed for years or just
starting to wonder if you mighthave it, remember there is help,
there are treatments andthere's nothing wrong with you.
There's just somethinghappening to you.
So thank you, as always, forcoming back to another episode
of your Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or a neighbor.
(22:14):
Share this episode with someone.
Send us some fan mail if youwant.
You can email us atyourcheckuppod at gmailcom.
But, most importantly, stayhealthy, my friends.
Until next time.
I'm Ed Dolesky.
I'm Nicola Ruffo.
Thank you, goodbye.
Speaker 2 (22:30):
Bye no-transcript.
Speaker 1 (22:56):
We explicitly disclaim any liability relating
to the information given or itsuse.
This content doesn't endorseany treatments or medications
for a specific patient.
Always talk to your healthcareprovider for complete
information tailored to you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy, Jess Hilarious, And Charlamagne Tha God!