Your Checkup: Health Conversations for Motivated Patients
Ever leave the doctor’s office more confused than when you walked in? Your Checkup: Health Conversations for Motivated Patients is your health ally in a world full of fast appointments and even faster Google searches. Each week, a board certified family medicine physician and a pediatric nurse sit down to answer the questions your doctor didn’t have time to.
From understanding diabetes and depression to navigating obesity, high blood pressure, and everyday wellness—we make complex health topics simple, human, and actually useful. Whether you’re managing a condition, supporting a loved one, or just curious about your body, this podcast helps you get smart about your health without needing a medical degree.
Because better understanding leads to better care—and you deserve both.
Your Checkup: Health Conversations for Motivated Patients
PCOS: Symptoms, Diagnosis, and Treatment Options for Patients
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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
Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Dolesky, a family medicine doctor in the Philadelphia area, and I'm Nicola Rufo. I'm a nurse and we are so excited you were able to join us here again today. What did you think of the we cooked at home this week? We don't have any special like out meal to discuss with you all, but what did you think about the chicken?
Speaker 2:The chicken? Oh, the curry chicken. Yeah, that was delicious. I don't think we have any more of that, do we?
Speaker 1:No, I ate all of that.
Speaker 2:Yeah, that was really good. I think that was the first time you made something like that.
Speaker 1:It is Lots of different ingredients that I didn't realize would come together and collect together. This was a week ago, by the time anyone's listening to this, that I came up with the idea to broaden my horizons and go into the store every Monday, kind of planning out the meals for the week, and curry chicken was on the list. It was a nice recipe. I wish I read the comments before and we were able to pull it back from the brink of disappointment when we talked about adding the lemon at the end. That was a scary moment. There's really not a lot of ways you can. Well, I guess there's a few ways you can come back from adding too much lemon. Go ahead.
Speaker 2:Well, yeah, it was also like the end of the recipe called for like juice of half a lemon and we didn't have a lemon. But then I was like, oh, we have 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 the pot.
Speaker 1:I erred. This is what happens when you cook with your heart and that's it was a mistake and turns out needed a lot more salt than what we put in Because I mean it tasted fine. You more salt than what we put in because I mean it tasted fine. You know you were eating it straight out the pot but like that was, a lot of salt would have been helpful in this, this dish I mean, it turned out great oh, I was happy with it.
Speaker 1:I was. I thought it was delicious, served over rice. And then earlier in the week you had some pollock cavatelli, which need. I mean pollock, true cavatelli definitely yeah, what is that pasta called?
Speaker 2:do you know?
Speaker 1:oh well, right now, we're just no, I don't, we're just this new twirly pasta.
Speaker 2:You've been getting at whole foods or wegmans, wegmans yeah, it's nice, it's entertaining.
Speaker 1:We actually still have some um. Yeah, but that was also good. That was put as a possibility for a special dinner, which I'm very honored by to have one of my own dishes be put in the running for a special dinner.
Speaker 2:Oh, my God.
Speaker 1:And let's see. We booked our honeymoon, which we're very excited about. We did Collectively, did a lot of research together to come up on a location and we are so excited to be doing this. We're going to do a traditional honeymoon right after the wedding, which is going to be awesome. Take all the excitement from the day.
Speaker 2:Put it into a 31-hour travel day.
Speaker 1:That's going to be crazy. Maybe take a couple guesses about where we're going to go. We said 31 hours. Where do you think we might be going? Reach out to us in the fan mail, we'll find out. We're listening to some travel medicine stuff to try to figure out.
Speaker 2:Yeah, it turns out we should probably get a couple of vaccines before we go. Yeah, we should Some not so great things are endemic in the country we're going to. So yeah, yeah, not so great things are endemic in the country we're going to. So yeah, yeah, yes you know, visit a travel medicine clinic, get a couple jabs.
Speaker 1:Yeah, and we'll need to go get taken care of, take a couple medicines to make sure we don't get, like you know, malaria.
Speaker 2:Yeah, that would suck.
Speaker 1: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 lot of time. I don't know if I would have been able to do that. I mean, it took days for me to wrap my head around, like things and like when you look somewhere where you've never been before, you're trying to figure out what's a good way to go and I'm proud, I'm proud of how we did it, and I'm very excited and I can't wait your favorite day ever, october 11th when the wedding's over all right.
Speaker 1:Well, should we get started?
Speaker 2:you don't want to talk about your day yesterday.
Speaker 1:Well, I guess we could talk about my little ditty.
Speaker 2:We talked about it a lot yesterday I did.
Speaker 1:I did, but you know well, I was invited to the arufo family crabbing trip, which is only like a male event, which was not true, but it was in honor of a family member who had since passed um and it was a really nice idea and I had a blast. I mean, if there is someone who could like sit in the pouring rain not like vertical pouring rain, like slanted pouring rain on a crabbing boat and have a smile on his face at nine in the morning, completely drenched, it's me I wish someone took a picture of that yeah, it was like, I mean, I had the smiling on the bay in the rain
Speaker 1:you just gotta make. It was a lemonade day and everyone had a great attitude about it. Your family's awesome. It was a whole like branch of your family I had never met before and they are just a complete delight. They were were all like, are you ready to meet the crazies? And they weren't at all. They were this is lovely people who were so extroverted and welcoming and it was awesome. And I mean right here, like right in New Jersey, close to home to all this fun stuff, but you're out in that Bay it feels like you're not there.
Speaker 1:Got a couple of crabs, nothing spectacular. I Got a couple crabs, nothing spectacular. I'm not even sure we kept them. The other boat did really well Caught something like 60 and then threw, quote, unquote, 20 back or so to end up with a bigger haul. But it was awesome and I love that. They do it every year. But that rain was incredible and the guy at the marina was like, oh yeah, it's going to lighten up, it's going to lighten up, it's gonna lighten up. And then you pull out your iphone, you open up the weather app and you like, see, like now they give you, like you know, heavy rain for the next 15 minutes. It was 10 o'clock and they're like heavy rain expected for the next two hours. And then one of them made an executive decision to just end it and he was able to get a free you know free trip out of the guy afterwards, not for that day, but, you know, a return trip, gotta keep business going cool.
Speaker 1:Yeah, you feel good about that, yeah. Yeah, that was nice, I feel that was. I was really happy to have been invited and to go. All right, what are we gonna talk about today?
Speaker 2:Today we're talking about PCOS.
Speaker 1:Yep and for today's episode, we are pulling information from the 2023 International Evidence-Based Guidelines for PCOS. They were developed by the Endocrine Society. We're taking information from the American Society of Reproductive Medicine, the European Society of Endocrinology, of Reproductive Medicine, the European Society of Endocrinology and some different insights from the Lancet Human Reproduction and the 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:I can. Pcos stands for polycystic ovarian syndrome and it's actually a lot more common than people realize. It affects about one in 10 women of reproductive age, which is a lot, that's a lot. So it's actually affecting millions of people dealing with symptoms which really we'll talk more about, but irregular periods, skin changes, unwanted hair growth and trouble getting pregnant.
Speaker 1:And so what makes PCOS especially important is that it's not just all about fertility.
Speaker 2:It's a hormonal and metabolic condition as well, and so it can have implications on long-term health, things like diabetes, heart disease and sometimes even mental health implications, right but the good news is there are a lot of things that you can do after you've been diagnosed with this to manage it with different lifestyle modifications and medications.
Speaker 1:Great, and so if you are living with PCOS or you're just curious about it, this one's for you.
Speaker 1:So what is PCOS?
Speaker 1:At its core, it's a condition where your body makes more androgen, and these are typically called male hormones.
Speaker 1:It makes more of these than it should, and so it also comes with problems how your body uses insulin and, like we've talked about previously, but just as a reminder, it's the hormone that helps your body manage blood sugar, and so that combination elevated androgens and some insulin resistance really creates this cascade of symptoms that you might notice that you mentioned earlier irregular or absent periods, acne or oily 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 the tricky thing with this is that not everyone has the same symptoms.
Speaker 1:I mean, what's easy is that if you measure someone's blood pressure and the blood pressure is elevated in a certain number of times in a certain setting high blood pressure, increased blood sugar or elevated blood sugar, not too hard, diabetes but with this one, the constellation of symptoms is a little tricky. Some people just have mild irregular periods and they wouldn't know that they have PCOS until they were trying to get pregnant. Others have more visible symptoms that show up when they're a teenager, and so in this sense, pcos could be described as a spectrum, and that's why the part of the diagnosis and the treatment can be really personal and tailored to you individually.
Speaker 2:So what causes PCOS?
Speaker 1:Great question. Thank you for asking it. So we have to bust a little bit of a myth here. Pcos isn't something that someone does. It's not something that they themselves cause. It's not the result of eating too many carbs or not working out enough. Pcos tends to run in families. So it really tells us that there is a strong genetic component to this and in part, it's influenced by how your body processes insulin. So even when people eat very well and they're active, they can still have PCOS.
Speaker 1:What we do know is that insulin resistance is really common in PCOS and essentially what this means is that your cells aren't responding well enough to the amount of insulin in your body to do the job it needs to do. So your body makes more to compensate and with that extra insulin can trigger your ovaries to make more androgens, and that's part of that interplay that happens those male hormones that are increased, or typically called male hormones. That feeds into the cycle of disrupting normal menstruation and normal periods to make them more irregular, leading to some of these symptoms. And so, once again, this isn't something that anyone did to themselves. We've seen that it's incredibly common and it's a medical condition and, like any, there's treatment for it. But before we get to treatment, we have to talk about diagnosis, and so to capture a diagnosis of PCOS, there is something called the Rotterdam criteria, which is the most common way that's taught to capture this diagnosis. And so the three you have to have two out of the following three by these criteria. Nikki, can you tell us the three criteria?
Speaker 2:I can. The first is irregular or missed periods, signs of those high androgens, which would be things like acne or facial and body hair, where you typically probably wouldn't have any, and then on an ultrasound you would have polycystic ovaries which kind of look like a string of pearls in there.
Speaker 1:Yep, and here's something important Really, just having cysts on the ovaries does not mean you have PCOS. I've seen plenty of times where a patient comes in they've had an ultrasound for some reason. They don't have any other symptoms, but they see the ovaries and they have cysts on them probably nothing and they're like, oh my gosh, I have PCOS. That is not the case. It really is about the overall picture, and so your doctor will also rule out other conditions that mimic PCOS. That is not the case. It really is about the overall picture, and so your doctor will also rule out other conditions that mimic PCOS, things that go by the names of thyroid disorders 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 of these dots between your symptoms, the labs, imaging to really capture this diagnosis.
Speaker 1:And, like we said earlier, pcos can be really especially tricky in teens, because some of these symptoms are a part of normal aging and puberty. Like a teen isn't going to get their period initially every single month at clockwork, it may be a little abnormal. They may have more acne than the average person because they're a teenager, so that's something that's also tricky to keep in mind. We talked about earlier that there are different health risks associated with PCOS. Outside of the fertility and the obvious symptoms that someone may be experiencing, can you list off a couple things that someone with PCOS might also be at increased risk for?
Speaker 2:Yeah, it's a decent amount of things Type 2 diabetes, high blood pressure and high cholesterol, sleep apnea, depression and anxiety, and even endometrial cancer, which would be like in your uterus.
Speaker 1:Yeah, and that especially happens if the uterine lining isn't shedding regularly and going through its normal processes. That can happen, and so these risks are real, but they're manageable, which is the encouraging thing, and that's what we're going to talk about next when we talk about the treatments. But that's why, when we talk about PCOS, it's something to take seriously, especially when we 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 and forth here about some of the treatments. Nikki, what are some of the first things to think about when it comes to managing PCOS? It's like a lot of the other things, but why don't we start even there?
Speaker 2:Okay, I've said it once, I'll say it again Diet and exercise are our first-line lifestyle modifications to help treat this.
Speaker 1:Yeah. So eating patterns that contain they emphasize whole foods, fiber, healthy fats and low glycemic carbs can help improve the insulin levels and hormone balance. We have a whole episode dedicated to describing insulin. We have a whole episode dedicated to describing insulin resistance that can be really helpful. We also have a whole episode about the Mediterranean diet, which is something that can be helpful in someone who is experiencing PCOS, and, while not yet, we'll have an episode about the DASH diet, which can also be helpful.
Speaker 1:Physical activity is extremely important. Even walking 30 minutes a day can help all of the overall processes of PCOS can help all of the overall processes of PCOS. Resistance training is something that should be incorporated, and even losing 5% to 10% of your body weight can make a noticeable difference when it comes to periods, fertility and insulin resistance. All that being said, your health is not a scale. They are not completely linked to one another, but it's just a reasonable goal to hit.
Speaker 1:Something that we also know is that people with PCOS may be more susceptible to mental health concerns. If you have PCOS and you've felt anxious, depressed, frustrated or you feel like your body's working against you, you really aren't alone. There's a lot of evidence that shows that people who have PCOS have increased rates of anxiety and increased rates of depression, and I mean this makes a lot of sense to us. If you're dealing with things that are so cosmetic and visible, like acne, hair changes, weight fluctuations, fertility struggles, I mean it's no wonder that these things can take a toll on you. So that's why we say and we highlight that emotional support and being kind to yourself, for behavioral health can be really important when it comes to PCOS.
Speaker 1:Cbt cognitive behavioral therapy is probably not out of the realm of possibility for someone who might be experiencing this, and so you really have to, and what we're trying to do here is emphasize that we're looking at the whole person when it comes to PCOS diet, exercise and their mental well-being All things that you can do without a medicine. I see a lot of people online because Threads is what we're most active on. People are in distress about this.
Speaker 2:Yeah, I would be.
Speaker 1:Yeah, they don't like that. They feel like there's a lot of solutions out there that can help them without leaping to a medicine. It seems like they feel really misunderstood and I feel like a lot of people suspect they have it but they haven't captured the diagnosis for some reason, which seems like a really frustrating place to be in. But with all that frustration comes a little glimmer of hope, and what we're going to talk about next is different medications that you might be offered and why different medications that you might be offered and why. So you know, for a lot of people, lifestyle and these mental health steps forward may help a lot of people, but there are a lot of medications out there that can be helpful. So birth control pills are often the first medication used to help regulate irregular periods, acne and unwanted hair. What they do is they help regulate the cycles and acne and unwanted hair. What they do is they help regulate the cycles and they lower the androgens in the body. Second is metformin. This medication commonly used for diabetes, prediabetes. It helps your body use insulin more effectively, which also can help maybe improve cycles and help with the underlying metabolic processes with PCOS, like insulin resistance and prediabetes.
Speaker 1:There are two other medications. One medicine is a medicine to use when someone's trying to get pregnant. It's called letrozole. It's a fertility medicine and it 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 called spironolactone, which is actually more commonly used in blood pressure and heart failure worlds, but it can be used here because it can help with stubborn hair growth. This is specifically an anti-androgen medication, but it's only safe to use if you're using contraception, because it's not safe during pregnancy it can harm the fetus.
Speaker 1:There are some other non-medical or non-pharmaceutical ways, like there are laser or mechanical hair removal, which can be really effective for people as well, because that seems to be one of the most troublesome symptoms that people have, and so the key here is that the treatment really should match your goals. If it's the period symptoms that 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 an option for you layered into all of the aspects of your life and treatment altogether. Can you take us through some of the resources that might be out there for someone with PCOS.
Speaker 2:Yeah, the first one is an app that's actually a legit, evidence-based app it's called Ask PCOS that you can download and it's free. There's the endocrine society that has really great tools and information and can help like connect people who also are struggling.
Speaker 1:And then there are also a lot of online support groups out there really for like every ailment, but the PCOS community online is pretty big yeah, and I mean, like, how validating might it feel to be in a group of people or at least have conversations that people can relate to? So think about it. I will say a word of caution. Some of these Facebook groups are wild, so you can't read or believe everything you hear online, especially when it's coming from some random person. But some of them have great intentions, some of them are well monitored and you might be able to find someone that you can relate to. And so we're going to wrap up here.
Speaker 1:To recap, pcos is common, it's manageable, frustrating and it deserves way more attention. And so, whether you've been diagnosed for years or just starting to wonder if you might have it, remember there is help, there are treatments and there's nothing wrong with you. There's just something happening to you. So thank you, as always, for coming back to another episode of your Checkup. Hopefully you were able to learn something for yourself, a loved one or a neighbor. Share this episode with someone. Send us some fan mail if you want. You can email us at yourcheckuppod at gmailcom. But, most importantly, stay healthy, my friends. Until next time. I'm Ed Dolesky. I'm Nicola Ruffo. Thank you, goodbye.
Speaker 2:Bye no-transcript.
Speaker 1:We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider 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 checkup with your own personal doctor.
