Should You Know Your PCOS Type? [Podcast with Dr. Rashmi Kudesia] - PCOS Diva
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Should You Know Your PCOS Type? [Podcast with Dr. Rashmi Kudesia]

PCOS Podcast 145 - Your PCOS Type

As women with PCOS, we want to be empowered with choices and not just take prescriptions without really understanding why we’re taking them.” – Dr. Rashmi Kudesia

If you Google “PCOS” you may or may not connect with the first set of symptoms described. PCOS is experienced in many ways. This has led the PCOS community to begin to describe “types” or phenotypes of PCOS. I asked renowned reproductive endocrinologist, Dr. Rashmi Kudesia to help us make sense of the types of PCOS which are being discussed and the relative pros and cons of labeling the differences. Listen in (or read the transcript) as we discuss:

  • Getting the right diagnosis & conditions which mimic PCOS
  • Types of PCOS and what makes each unique
  • Why your PCOS type may change over time
  • The critical reason to understand and track your cycle whether or not you are TTC
  • Why there is so much hope for women with PCOS

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Mentioned in this podcast:

Complete Transcript:

Amy Medling:

One of the questions that I receive most often these days from PCOS Divas is, “What type of PCOS do I have, and why doesn’t my doctor recognize my type of PCOS?” Well, the first time I heard this concept of types of PCOS was in the book, The Period Repair Manual by Dr. Lara Briden. And I had her on the podcast several years ago. It’s actually podcast number 48, if you want to listen to it. And we talk about the types of PCOS that she has found in her practice. I think there’s four of them. And recently, Dr. Andrea Dunaif, she was also a podcast guest back on episode 6. She was the lead researcher of a study sponsored by the National Institute of Health. And she found in her study that there may be at least two different subtypes of PCOS.

While we certainly know that there is no one-size-fits-all approach to PCOS, I’m finding it confusing now that a lot of PCOS bloggers are now sort of definitively referring to specific types of PCOS, from classic to lean to adrenal to hidden-cause to post-pill, inflammatory type of PCOS and more. I think it’s especially confusing when speaking to your doctor since there really isn’t any hard or fast rules, and no real major medical body has recognized these sort of types of PCOS.

So, I’ve invited Dr. Rashmi Kudesia, She’s one of my go-to PCOS experts, to today’s podcast to weigh in and help us make sense of it all. So, welcome, Dr. Kudesia.

Dr. Rashmi Kudesia:

Thank you so much, Amy Medling. It’s always a pleasure to join you.

Amy Medling:

So, you are a board-certified reproductive endocrinologist and infertility specialist. You work out of Houston, Texas for CCRM Fertility Clinics. You used to work in New York City, where you were named a New York Super Doctor Rising Star for two years in a row. You are a really acclaimed reproductive endocrinologist and one of the stars of my guest experts. So, thank you so much for joining us again to talk about this topic.

Dr. Rashmi Kudesia:

Yeah, my pleasure. I guess it’s a sign that I’ve been at this for a while because down here in Houston now, I’m just a super doc. Not a rising star anymore. So, yeah. So, guess I’m gaining some more experience under my belt, which always feels good.

Amy Medling:

So, my question is, do you have patients that come to you saying, “Gee, I think I have this type of PCOS.” What do you think?”

Dr. Rashmi Kudesia:

Yeah. So, I love that we’re talking about this because I think oftentimes there is a disconnect between the language that people might see on social media or in certain books or in certain blogs and the scientific literature or sort of the guideline consensus statements that we have. And a lot of times, there is a little bit of trying to figure out, “Okay, well, what is somebody trying to communicate to me?” And yeah, people have come in and using certain… or certain terminology, excuse me, that I wasn’t immediately familiar with, and so it’s definitely interesting.

And I do think with PCOS, it’s so true and it’s such a real phenomenon because not only are people… they’re trying to make sense of the fact that if you just Google “PCOS,” you may not look like whatever the first Google result you get is, whether your symptoms are different or how you experience it or the impacts of it on you can be so variable. And so, I think it’s particularly a condition where there’s just this drive to want to categorize people within it because there’s so many ways it can show up. And so, for sure, people are coming in all the time, trying to figure out how they fit within the larger rubric of having a PCOS diagnosis.

Amy Medling:

So, let me ask you Dr. Kudesia, do you find that this idea of types, since we know that there isn’t a one-size-fits-all approach, is that helpful for you in working with patients? So, for example, if a patient presents as really having normal androgen levels, but she might have irregular cycles and metabolic issues, she might have polycystic ovaries. Do you sort of, in your mind, categorize her in a certain type? Is that helpful for you?

Dr. Rashmi Kudesia:

It’s definitely helpful. And it’s kind of how I’ve always thought of PCOS to begin with. And I know we’ve talked about this before, I think in our “Quality of Life and PCOS” podcast, but the way that I always think about it is kind of looking at all the different manifestations that PCOS can come with. So, what are the main issues that are coming up at any given time? Is it weight? Is it irregular cycles? Is it infertility? Is it excess androgens showing up as facial or body hair or whatever else? Is it mental health? And then also how are we getting to that diagnosis? Is it a typical case by the oldest set of criteria we have from the National Institutes of Health, where it is somebody that has no ovulation or irregular ovulation and high androgen levels? Or is it somebody that maybe has normal androgen levels, as you said, but has kind of polycystic appearing ovaries on ultrasound and irregular cycles, because these have different kind of consequences, I guess you could say, for how things show up?

So, anytime I meet a new patient that has PCOS, I always start from the beginning and figure out, “How did we get that criteria in the first place?” because people are often misdiagnosed. And then we talk about which are the relevant issues. And then, in my mind, obviously, I’m putting all of these things into different categories to say, “Okay, well, here are the relevant issues. Here are the things we need to be testing for. And here’s the plan that we’re going to make, relevant to what’s going on for you.”

So, I think in doing comprehensive care for women that have PCOS, you kind of are categorizing. You may not be using the same terminology that different people are using, but I think you kind of have to do a little bit of categorization to say, “Okay, these are the predominant issues for any given woman at that given point in time.”

Amy Medling:

So, I think that’s where the confusion comes in, is there isn’t kind of hard and fast names that we can all agree to. But maybe you could go through some different scenarios of types that you’re seeing.

Dr. Rashmi Kudesia:

Yeah, sure. And I mean the other thing I want to say is that I think it’s also really important that people realize that when we have… so, all of the things that you said. If somebody came in and told me, “Okay, well, this is how I got the diagnosis. And these are my symptoms. And here’s the list of all of that.” And that woman would be… I would just be so impressed because actually, it’s difficult to kind of have all of that information.

And oftentimes, people maybe got this diagnosis when they were a teenager, when they were younger and maybe they don’t have the records or they weren’t explained exactly what was done at that time to give them the diagnosis, but there’s a lot of detective work we kind of have to do in terms of, “Okay, well, do you really have PCOS or not?” And so, if somebody really had that level of knowledge about her own body, I mean, that’s just so empowering. So, that’s the other thing. I love what you just said before, when you were asking the question because if you knew that level of detail about yourself, then that I think is really wonderful and is a big part of why, for us at CCRM, we spend so much time with our patients because that’s a lot to talk about. So, that, I think is the biggest thing, is kind of helping people understand how their situation is specific.

So, what that looks like in real life. The first question is, “Okay, well, what criteria are we using to diagnose PCOS? And what does any given woman have?” So, typically we use what’s called the Rotterdam Criteria. Those have been around since the early 2000s. And basically, again, as we’ve talked about before, for that, you have to have some combination, 2 out of 3 at least, of irregular ovulation or no ovulation; or high androgen levels; or ovaries that appear “polycystic” on ultrasound. And so, we look at that. And then we make the diagnosis.

Then I do a whole bunch of other tests as well. So, we want to see, “Okay, well, we’re looking at where’s your overall health? How’s your diet and exercise regimen? Are you showing signs of insulin resistance or even diabetes?” because I diagnose a lot of diabetes, even in 20-something-year-old women. “What’s your family history? Are there other signs of metabolic disease? What are your periods like? What other signs and symptoms do you have of androgen excess, like are you having hirsutism issues, like extra facial or body hair? Are you having male-pattern hair loss?” which is also can be due to high androgen levels. “Are you having acne?” et cetera.

And so, to give a couple of examples, you could say, for example, that oftentimes I get patients that will come in and they may have had a lifelong struggle with their weight, for example. So, they might come in and say maybe, “I want to try to get pregnant.” And sometimes people have had really bad experiences with doctors along the way. I know you’ve talked about this a little bit too, is I just had a patient yesterday who came and told me that she was just told that she couldn’t get pregnant because she was overweight. And she actually used the word “fat,” which I never use that term. And so, that was really sad. And so, we would look at a situation like hers where she would come in and say, “Okay, look, I’ve been struggling with weight. I’ve been told in the past maybe I had prediabetes. My cycles are totally irregular.”

And when we do an ultrasound, we’ll find that their ovaries look polycystic. And when we do the blood work, we’ll find out that she does have signs of high androgen levels. And it’s showing up for her because she’s having extra facial and body hair growth. So, that’s a really classic PCOS case. So, that, if you Google “PCOS,” you might find some of the scenarios or some of the symptoms that I described there. And that kind of management has to take into account the metabolic piece of it, so making sure that you were managing the sugar levels, that somebody is not going to go on to develop full-fledged gestational diabetes or type 2 diabetes.

Compare that to other women that I see all the time that come in and they feel generally healthy, but they just come in and they say, “My cycle’s kind of irregular.” When I’ll ask them about, “Are you having issues with extra body hair or acne or anything like that?” They’ll say, “No, that doesn’t really apply to me.” But then we go do their ultrasound and we see that the ovaries look typical polycystic ovaries. Their blood work will look more or less okay. Sometimes the sugar levels might be trending up, but in general it looks okay.

Both of those women could have PCOS, but it could show up in totally different ways. And so, that first type is kind of more of a metabolic type, if you will, where there’s much more going on and a much higher risk at that moment of developing all of the cardiometabolic issues we worry about. And particularly when a woman is trying to get pregnant, we want to make sure that their health is optimized prior to pregnancy.

The other woman is probably still at a slightly higher risk of cardiometabolic disease than somebody that doesn’t have PCOS at all, but it’s a different risk. And maybe she has more of a sort of reproductive issue where she’s just not ovulating. And, again, if she’s trying to get pregnant or if she’s just frustrated with irregular cycles, that’s kind of the main, predominant issue.

And indeed, in Dr. Dunaif’s paper that you mentioned at the beginning, that was what they ended up finding, that there was sort of a reproductive phenotype and a metabolic phenotype. And so, there were kind of women that had more of one versus another type of cluster of, in their case, genetic signals. And so, that’s kind of one way that it can show up. And the reality is that if we consider all of the issues, all of the different symptoms that I mentioned before, the things that can come into it, whether it’s mental health or dermatologic issues or whatever, ultimately there’s so many ways it can show up. But that’s kind of what I think about.

And one last thing I’ll say is this whole concept of “post-pill PCOS,” I don’t really think of that as true PCOS. The birth control pill is not going to cause you to have PCOS. You may have irregular cycles for a time coming off of the pills, but if you truly have PCOS after coming off the pill, it may be that you may have started at a really young age and you just were never diagnosed with PCOS beforehand, or your health has changed. I think, for many women, some of the symptoms of PCOS don’t really show up until they’re in their 20s and 30s, and so it’s probably more just the passage of time. And so, yeah. I don’t love the post-pill terminology because I think it kind of puts a bunch of people in one bucket, which could be some women that just have irregular cycles as they get used to coming off of birth control and some women that probably always had PCOS, but it was just late diagnosed.

Amy Medling:

Mm-hmm (affirmative). I think that’s a really good point. I wanted to ask you, so there’s this idea of hidden-cause PCOS. And I know that there are other conditions that can sort of mimic PCOS. Maybe you could talk to us about NCAH or non-classic congenital adrenal hyperplasia. I know that’s a fairly common genetic disorder that shares many symptoms with PCOS, and I’m wondering if that might be a hidden-cause factor.

Dr. Rashmi Kudesia:

Totally. And so, yeah. That’s another category I’m a little skeptical of because ultimately, PCOS, when you make the… So, I talked a lot about the diagnostic criteria. Now, that being said, the caveat to that is you have to have certain other things ruled out. And so, honestly, there shouldn’t be a hidden cause. I mean, just to the extent that we know the cause. Either you have truly diagnosable PCOS by the criteria, once these other things have been checked for. And I think what’s confusing is that oftentimes, people haven’t gotten the appropriate workup in the first place. So, you’re totally right.

So, the things that we look for, you mentioned. You totally read my mind. As you were asking that question, that was the first thing I wanted to talk about. So, congenital adrenal hyperplasia is a situation where, for a variety of reasons, there are different number of enzymes that basically help synthesize the progression of all of our steroid hormones. So, basically all of our estrogen, progesterone, testosterone, all of that come from cholesterol as a precursor. And so, there is a series of enzymes and hormonal changes that happen to convert cholesterol into each of those things.

And so, if certain enzymes are missing, then basically what ends up happening is that there are certain shifts in what is actually produced. And so, in this instance, what happens is that our adrenal glands produce a fraction of the androgens that we have as women, and the rest come from the ovaries. And so, when we have adrenal hyperplasia, basically what that means is that there’s a high production of adrenal androgens, specifically DHEAS is the one that we often test for. And so, if you have that really high level, it’s going to cause a lot of the same symptoms that PCOS causes, which is extra facial and body hair growth.

Oftentimes for congenital adrenal hyperplasia, there is a very severe form that can be diagnosed at infancy. So, in that instance, it actually prevents the production of certain hormones that help with regulating your blood pressure, with regulating the salts and electrolytes in your bloodstream. And so, some of these can actually be very serious.

The non-classical piece of it is a milder form that shows up generally around the time of puberty. And so, that’s the one that can oftentimes be confused with PCOS. Now, oftentimes, even in that, women will have more severe symptoms. They might actually get clitoral enlargement as a result of the high androgen levels and they can get a deepening voice. So, there can be other symptoms that go along with it.

But it’s basically driven by a blood test. We just basically check the levels of a hormone called 17-hydroxyprogesterone. And we make sure that it’s not high. And we look at the DHEAS levels. And we look at all of that stuff. And we can kind of rule out somebody from having congenital adrenal hyperplasia. And so, that is one thing that we look at.

Thyroid disease is another thing that can be often confused for PCOS. They’re a little bit different in terms of how they show up, but there’s a huge overlap in the symptoms. And so, I think that’s another thing.

So, in my mind, once the appropriate tests have been done for the things that commonly mimic PCOS, then if you have the symptoms and you don’t have those other things, then you just have PCOS. And that’s kind of how I would view it.

Amy Medling:

I think what you had said about having this idea of type, and patients sort of coming in with a better knowledge of the symptoms that they’re dealing with and maybe even some of previous lab work by the time they come to see you, so that they can kind of say, “Gee, my insulin resistance isn’t that bad, and I’m thin. Maybe I have this lean type of PCOS.” I mean, for me, that could be very empowering, especially I think when there’s, in my experience working with women with PCOS, there are a lot of general practitioners that only sort of identify the classic type or think that you have to be overweight in order to have PCOS and losing your hair and kind of have that classic manifestation of symptoms, so that if you know that there are actually sort of these other manifestations, it really is empowering and it allows you to advocate for yourself. So, I’m just curious, how many women have you diagnosed with lean PCOS? Do you feel like it’s harder for those women to get a diagnosis?

Dr. Rashmi Kudesia:

I think you’re totally right. I think that that group is often underdiagnosed. And I think that the other thing that happens is that there’s a little bit of cognitive dissonance, again, when somebody that feels like that describes them and then they Google just “PCOS” and they hear all these things and they’re like, “But I don’t have these things. I have not really struggled with my weight,” or, “I’ve not had hirsutism,” or other things. And so, I think that that is oftentimes… they come in and they’ll say, “Do you think I really have PCOS, because I’ve tried to look it up and I just felt like that didn’t really describe me?” And so, I think there’s two aspects to it.

But there’s no doubt that it’s underdiagnosed in that patient population and then oftentimes in general. And so, yeah, I totally agree with that.

Amy Medling:

And then what about this idea that some women’s PCOS can be sort of adrenal-driven rather than kind of ovary-driven?

Dr. Rashmi Kudesia:


Amy Medling:

Yeah. Can you tell us about that.

Dr. Rashmi Kudesia:

Yeah. So, it kind of goes back to the different kinds of androgen levels. So, androgens are just a category of the hormones that we often think of as “male hormones,” but we all have them. And so, the main ones that we will look at would be testosterone, which primarily comes from the ovary; and then the DHEAS, which primarily comes from the adrenal glands.

And I think that oftentimes this “adrenal PCOS,” the way it shows up is… So, the adrenal glands also produce our stress hormones like cortisol. And so, I think that the connection there is that women that have adrenal PCOS oftentimes have symptoms of kind of high cortisol levels or of high sort of stress levels. And the way that that can manifest is kind of a particular way that we sort of put on weight. So, some of the symptoms of high cortisol or high stress levels can be sort of, again, the body distribution of how we put on fat, of actually feeling stressed is one thing. And then if it’s uncontrolled, can actually lead to high blood pressure and other kinds of complications that way. And then people often talk about, I think you have talked about too in some of your materials, about adrenal fatigue and people often feeling like they’re… sort of when they feel most awake versus kind of depleted of energy, and things like that can sometimes feel a little bit off.

So, there are a number of symptoms that seem to correlate with this “adrenal PCOS.” It’s not something that is clearly defined in the scientific literature, but essentially kind of applies most to the women whose, I guess, criteria of having what we would call high androgen levels primarily comes from having high adrenal androgen hormones, like the DHEAS, rather than having a high testosterone level. So, I think that’s kind of how we would categorize it, but then some of the symptoms that show up oftentimes, or people associate with those symptoms, are some of the things that I just mentioned.

Amy Medling:

It seems to me that the medical literature, is slow to catch up with what practitioners are seeing in practice.

Dr. Rashmi Kudesia:

Yeah. I mean, I think that the tough thing is that… So, on the one hand if we were doing a research study, what would be ideal would be to have all of that data. Exactly how did somebody meet the diagnosis? What are their symptoms? What are their lab tests, et cetera? But unfortunately, unless it’s some sort of prospective, randomized, controlled trial where you can sort of request all that information ahead of time, oftentimes research just doesn’t have access to all of that information. And so, you’re right, it’s kind of limited in the sense that in many studies, all women that have PCOS are just kind of lumped as one category.

And we would probably find richer answers if we were able to kind of divide them out. And so, the larger, bigger studies do do that. I think people clearly realize that. And certainly, in clinical practice, there is a lot of mismanagement I see too, of women that have PCOS. So, I wouldn’t say it’s just a research issue, but I think yes, that there are definitely different phenotypes. And we are still trying to figure out the best way to help people sort of self-identify that these are their active issues, and then also make sure that we have the correct treatment plan for each of those women.

And I think the other thing that’s important, which is why I’m a little reluctant to kind of tell somebody, “Hey, you have ‘this kind of PCOS,'” because it may change over time. I don’t think it’s fair to say or that we can say for sure that if somebody doesn’t have metabolic PCOS or whatever, one kind of PCOS, when they’re 23, it doesn’t mean that by the time they’re 43 things will be exactly the same; or if they have inflammatory signs or if they don’t, that that will not change at all over the course of their life. I think things can change. So, I think even if you find a classification system that works well for you, I think I would caution every woman to be open-minded to recognizing if it seems like things are changing because I see that all the time. People come in and they say, “Well, this wasn’t an issue before, but now it is.” And so, we kind of have to think about that too.

Amy Medling:

Yeah. That’s a great point. So, with these types, I think it is helpful because it’s helping get to the root factors. That we all know that there is no one-size-fits-all approach to PCOS in general. And even if you have sort of classified yourself into one of these kind of “types,” it doesn’t mean that the treatment plan is necessarily going to work for you.

And I think it’s really comes down to trial and error, in my experience, managing my own PCOS. And I think you’re right. As I’ve aged, that has changed. What worked for me in my 20s is not really… Now, that I’m in perimenopause and gosh, I’m going to be 50 next year, it’s not… things are changing. I have to work a little bit harder to keep the belly fat off. And it’s not the same as it used to be.

So, I’m really curious. Where do you think that this is going to go, this idea of types and phenotypes? And I know that as we get more information about different genetics, do you think that we’re going to really be able to create more customized plans based on a woman’s genetics and factors of PCOS? Do you see that happening down the road?

Dr. Rashmi Kudesia:

I definitely see that happening. So, I think that the genetic studies are really interesting because obviously, those genetics are there from the moment you’re born. And so, that’s not to say that genetics is everything because people can have very similar genes and have totally different health profiles. There’s sort of the whole epigenetic phenomenon of kind of fetal… or genetic programming that happens while we’re in utero. So, there are a lot of subtleties and nuance to it, no doubt. But there I think is a lot of interest in the idea of, “Okay, can we help somebody identify ahead of time?” And this is particularly relevant for me as a fertility physician because if people can identify in their earlier years, “Well, these are the things that seem like they’re showing up as risk factors for me,” then can we potentially take steps to address them preemptively rather than waiting for them to show up?

And what I mean by that is that I’m very passionate about sort of appropriate, full sexual education and fertility counseling for adolescents in the sense of, “You need to understand what your menstrual cycle is telling you.” And that is the one thing, if I could tell every girl and every woman, that would be the one message I have. And so, what that means is that if you could know on top of, “Okay, well, here are the signs and symptoms my period’s telling me because it’s kind of irregular, and I’m 15, and I got my period two years ago, and it’s still irregular.” And now, maybe you have a blood test that can sort of, even though clinically, we might hesitate to label somebody as PCOS because I don’t think that’s really appropriate to give most 15-year-olds a diagnosis like that, but if it could tell you, “Look, you are at risk for these metabolic issues, which are present and based on your blood work,” and so on and so forth, that could help a 15-year-old make important life choices that will have such a huge impact when you’re that young, or if you’re 25, whatever.

And so, I think that it’s really, I think, very empowering in theory to be able to identify ahead of time the risks that people are at because the treatment for most of these things is just a healthy lifestyle. I would be much more nervous about it if it meant that you had to put somebody on medication, but it isn’t about medication. It’s about really helping people emphasize that they’re at risk for these things and that if you’re an average… Let’s say you’re going off to college, if you… I have patients talk to me about this all the time, that they kind of look around and they’re like, “Well, I don’t know. I was doing the same thing as all my friends, but then all of a sudden I put on 50 pounds.” And I think that is a hard thing for a woman to go through. And it feels like your body’s fighting against you. And so, if you contrast that to the possibility of, “Maybe I could know ahead of time that this is a risk factor and learn at a young age how to be my healthiest self,” you could avoid or reduce the risk of a lot of these complications.

And so, I definitely think that there is so much of an interest in personalized medicine, in patient-centered medicine, in genetics, genomics, the whole nine yards. So, I do see that coming, but I think we’re still a ways away.

Amy Medling:

I love that, what you’re telling your young patients. I have a daughter who’s 11. And she’s kind of putting her hands over her ears when we… I’m trying to have that period talk with her, but… I’m determined to do it before the end of the summer. But anyway, one of the things that I want to teach her is how to track her cycles when the time comes because you’re right, there’s just so much information and it does… You need to know what your body’s doing.

And as you were talking, you think about all of these young women, girls that are put on the birth control pill because they don’t really understand their cycles. And yeah, they’re sort of sporadic, but that can be quite normal in adolescents. But they’re put on the birth control pill. And then 10 years down the road, they’re diagnosed with post-pill type of PCOS, which if they were given sort of… to be empowered, to take control of their cycles, they may have made different decisions, especially if you can combine that with lab work that shows that they might have higher inflammatory markers or androgen levels or their insulin is a little bit off. They can make a more informed decision about how to move forward.

And I think that’s really what it’s all about. We really, as women with PCOS, we want to be empowered with choices, and not just take prescriptions and not really understanding why we’re taking them.

Dr. Rashmi Kudesia:

Yeah. I mean, I couldn’t agree with that more. And I think that is the main issue when people talk about sort of the backlash of birth control. I think part of the issue with that is that people are often not explained things properly before being put on it. And so, I think it’s oftentimes easier if somebody comes in, girl, woman, whatever, and say, “Well, I think my periods are irregular.” “Okay. Here’s an answer: prescription for birth control.” Rather than diving into, “Well, why do you say that? What is irregular about your cycle? Let’s talk about what a normal cycle is, what it tells you. And if it is truly irregular, what are the tests we need to do to figure out why? And if you have a diagnosis, then what do we do about that?” Instead, I think people often turn to the pill as a band aid without figuring out what’s underneath it. And so, I think that that is precisely the wrong approach, unfortunately, and results in women coming to see me.

I mean, I’ve lost track of how many women have started crying in my office because they were told however many years ago that they would never get pregnant or that it would be very hard for them to get pregnant. And I’m telling them, “Actually, it will probably be pretty easy,” or, “Relatively young, we’re going to do some ovulation induction. And the success rates are about as high as it gets if you’re relatively young.” And so, it’s just amazing to me how many people are out there getting horrible information.

And so, I would make a big plug for people to consider seeing either a reproductive endocrinologist or a medical endocrinologist or an OB-GYN, but somebody that really is passionate about PCOS because there’s just a lot of very poor patient counseling I think that happens and a lot of incorrect diagnoses and not as much of a focus on, “How do you maintain your health despite this diagnosis? And how do you maintain your fertility or understand what’s coming about that?”

Amy Medling:

Yeah. And I was one of those girls at 17 in my college clinic, being told that they would have to jump through hoops one day to get me pregnant if I ever did get pregnant.

Dr. Rashmi Kudesia:

Yeah, you told me that.

Amy Medling:

Yeah. And thank goodness I found some good medical care, and I have three beautiful children. But I find it so refreshing to talk to you, Dr. Kudesia, because you really are kind of a trailblazer in the way that women with PCOS are cared for and treated. And I really recommend everybody listening to don’t take talking to a doctor who tells you, “Here, take this Metformin and birth control. And if you want to get pregnant, come back and talk to me. I’ll do the best that I can.” Women deserve better care than that. And I just want to underline what you said about women, there’s so much hope for women with PCOS that want to get pregnant.

So, tell us how we can find out more about your work, and if you are accepting new patients, and how we can get in touch with you.

Dr. Rashmi Kudesia:

Yeah. So, as you mentioned, I’m based in Houston. And so, Texas is obviously a big state, so we take care of a lot of people from all over the area, to be honest. And we do, obviously, in-person consultations and telehealth as well. My focus is primarily on fertility, but I do lots of non-fertility PCOS as well.

And I am on Instagram. I know we can link the handle there. But I will be doing a ton of stuff next month, or I should say in September, for PCOS Awareness Month, so I’ll be putting out a lot of specific PCOS content. But I share most of the stuff that I do through my Instagram, so that’s probably the best way to find me, or on Facebook. I share a bunch of stuff there as well.

Amy Medling:

Yeah. And if you’re listening on iTunes or another podcast platform, just come back to for all of the show notes and the transcript of this podcast. So, I want to thank you again for clarifying some things for us, Dr. Kudesia. It’s been a great conversation. And I just want to thank everyone for listening again, and I look forward to being with you again very soon. Bye-bye.

Dr. Rashmi Kudesia:

Thank you. Bye.

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