WORLD’S TOP OBGYN Dr. Aliabadi: The #1 Hormone Problem Affecting Millions of Women (And The 4 Changes That Can Reverse It)

Summary of WORLD’S TOP OBGYN Dr. Aliabadi: The #1 Hormone Problem Affecting Millions of Women (And The 4 Changes That Can Reverse It)

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1h 24m•March 11, 2026
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Overview of WORLD’S TOP OBGYN Dr. Aliabadi: The #1 Hormone Problem Affecting Millions of Women (And The 4 Changes That Can Reverse It)

This episode of On Purpose (hosted by Jay Shetty) features Dr. A (Dr. Aliabadi), an OBGYN and women’s-health advocate, explaining why PCOS and endometriosis are massively underdiagnosed, how they drive a modern “fertility crisis,” and what concrete, evidence-informed steps women can take to diagnose and treat these conditions. The conversation focuses on the biological mechanisms (especially insulin resistance), the four core “pillars” that sustain PCOS, diagnostic tests to demand, treatment options (from lifestyle to meds and surgery), and practical next steps for anyone concerned about cycles, pain, mood, or fertility.

Key takeaways

  • PCOS and endometriosis are common and commonly missed: PCOS affects ~15% of women (higher in some countries); Dr. A estimates ~75% of PCOS and >90% of endometriosis cases are undiagnosed or dismissed.
  • The primary metabolic driver in many PCOS patients is insulin resistance — treating it often improves androgen levels, ovulation, mood, and weight.
  • PCOS is multi-system: metabolic, hormonal, inflammatory, and neurologic — so single-mode treatment (e.g., only birth control) often fails.
  • Endometriosis is a chronic inflammatory, neuroimmune disease that can sensitize the central nervous system; painful periods that disrupt life are not “normal.”
  • Practical, high-impact actions exist: low-carb and post-meal walking, exercise, specific supplements and medications (metformin, GLP‑1s in select cases), hormonal suppression for endometriosis, targeted surgery when needed, and full fertility workups.

Why Dr. A calls this a “fertility crisis”

  • Typical statistics: ~50% of couples conceive within 6 months, ~90% within a year. The remaining ~10% includes many women with undiagnosed PCOS and endometriosis.
  • PCOS and endometriosis are leading causes of infertility worldwide; late or missed diagnoses cost years of health and fertility potential.

What is PCOS — definition & diagnosis

  • Definition (Dr. A): a chronic hormonal, metabolic, inflammatory, and neurologic condition.
  • Diagnostic rule (Rotterdam-based, as described): meet 2 of 3 criteria
    1. Ovulatory dysfunction (irregular periods, <8 periods/year, very long cycles)
    2. Polycystic ovarian morphology on ultrasound (≥20 follicles per ovary) or elevated AMH (when ultrasound unavailable)
    3. Clinical or biochemical hyperandrogenism (facial/body hair, acne, oily skin, male-pattern hair thinning, or elevated testosterone)
  • Presentations vary: lean vs. overweight, variable combinations of symptoms — that variability contributes to missed diagnoses.
  • Common associated problems: anxiety/depression, severe PMS, eating disorders, insulin resistance, difficulty losing weight.

The 4 pillars of PCOS — what they are and how to address them

1) Insulin resistance (the “first domino”)

  • Mechanism: insulin resistance → high circulating insulin → visceral fat, inflammation, ovarian theca cell stimulation → increased androgens → disrupted ovulation.
  • Interventions:
    • Diet: lower carbohydrate intake (reduce glucose load).
    • Simple behavioural: 10–20 minute walk after each meal to increase cellular glucose uptake.
    • Exercise: regular cardio (Dr. A suggests ~4x/week).
    • Supplements: Dr. A’s OV supplement (contains agents like mulberry leaf) to reduce carb absorption and help cellular glucose uptake.
    • Medications: Metformin (minimum effective total dose ~1500 mg/day) and GLP‑1 agonists (e.g., semaglutide, tirzepatide) for selected patients with obesity/insulin resistance — used with a plan to transition to long-term metabolic maintenance (metformin + supplements).
    • Note: Metformin can cause GI side effects; supplements generally have fewer side effects per Dr. A.

2) Androgen/hormonal pillar

  • Mechanism: insulin-driven androgen production → irregular GnRH/LH dynamics → chronic LH stimulation → more ovarian androgens.
  • Interventions:
    • Hormonal regulation: combined or progestin-containing birth control to suppress androgen effects and regulate bleeding.
    • For fertility goals: address insulin resistance first, use ovulation induction as needed.

3) Chronic inflammation

  • Sources: visceral fat, cortisol/stress, sleep disturbance, gut dysbiosis, inflammatory ovarian/frozen follicles.
  • Interventions:
    • Anti-inflammatory diet, antioxidants, better sleep, stress reduction, exercise.
    • Treat gut issues (SIBO or dysbiosis) when present — improving gut health reduces systemic inflammation.
    • Address visceral fat via metabolic interventions (see insulin-resistance actions).

4) Neurologic/brain (mental health and central sensitization)

  • Mechanism: unstable estrogen/progesterone, high androgens, and inflammation lower serotonin and dysregulate limbic circuits → anxiety, depression, brain fog, binge eating.
  • Interventions:
    • Treat underlying metabolic/hormonal/inflammatory drivers to help restore neurotransmitter balance.
    • Psychotherapy, meditation, and behavioral strategies (Dr. A praises calm/meditation content).
    • When needed, neuromodulators (e.g., SNRIs like venlafaxine/effexor, duloxetine/cymbalta; gabapentin/pregabalin) for central sensitization and pain/anxiety symptoms — under medical supervision.

Endometriosis — definition, signs, diagnosis, treatment

  • Definition: estrogen‑dependent, chronic inflammatory and neuroimmune disease in which tissue similar to uterine lining implants outside the uterus (ovaries, tubes, bladder, bowel, diaphragm, rarely lungs/brain).
  • Key clinical signs (classic): debilitating period pain that disrupts life (not “normal” cramps), deep dyspareunia (painful sex), chronic pelvic pain, painful bowel movements, bladder pain with negative cultures, chronic bloating.
  • Important pathophysiology points:
    • Retrograde menstruation + immune dysfunction allows implants to survive and cause inflammation and scar tissue.
    • Implants grow nerves and blood vessels; chronic nociception leads to central sensitization (brain amplifies pain).
  • Diagnosis: endometriosis can be a clinical diagnosis (history + exam + imaging), not always requiring surgery for diagnosis. Dr. A emphasizes listening carefully to symptoms.
  • Treatment hierarchy:
    1. Hormonal suppression (combined or progestin-only contraceptives; progesterone IUDs such as Mirena/Kyleena work well).
    2. GnRH agonists/antagonists (e.g., elagolix/Orilissa, relugolix/Myfembree) to suppress ovarian estrogen when indicated — useful if progesterone fails.
    3. Laparoscopic excision by an experienced endometriosis surgeon when hormonal therapy fails or if fertility requires it. Dr. A stresses that many surgeons miss subtle implants; choose a specialist skilled in endometriosis excision.
    4. Post-operative suppression (IUD or meds) to prevent recurrence.
  • Time to response: allow at least ~4 months for hormonal suppression to work.
  • Impact: major cause of infertility (inflammatory damage to eggs/tubes/implantation environment), high prevalence of gut issues (leaky gut, SIBO) and mental health burden.

Practical diagnostic tests and fertility roadmap

  • Self-check: PCOS criteria (2 of 3) and endometriosis symptom checklist (pain, dyspareunia, bowel/bladder symptoms).
  • Free resource Dr. A mentions: ovii.com — a questionnaire-based calculator to estimate PCOS likelihood.
  • Tests to ask for:
    • AMH (anti-Müllerian hormone) — ovarian reserve/egg count
    • Transvaginal pelvic ultrasound (evaluate ovarian morphology, follicles, endometriomas, fibroids, polyps, and 3D uterine anatomy)
    • Blood work: TSH and thyroid antibodies, prolactin, estradiol/testosterone/DHEA-S, fasting glucose/HbA1c, lipids
    • Semen analysis for partner (male factor ≈30% of infertility)
    • HSG (hysterosalpingogram) to check tubal patency and flush tubes
    • Autoimmune panel if signs/suspicion (antiphospholipid antibodies, lupus markers) — especially with recurrent miscarriage
  • Fertility timeline guidance:
    • Under 35: try for 1 year before full fertility workup.
    • 35 and over: try for 6 months then evaluate (but get baseline testing earlier: AMH, ultrasound).
  • If AMH is low and fertility is a priority: consider egg freezing early (preserve options).

Concrete, prioritized action plan for listeners (what to do next)

  1. Self-screen: note irregular cycles, excessive acne/hirsutism, debilitating period pain, painful sex, and mood/eating disorder history.
  2. Use ovii.com or consult resources (SheMD podcast) to learn and prepare notes for a clinician.
  3. Get basic tests: AMH, pelvic ultrasound, thyroid panel, prolactin, testosterone/DHEA-S, HbA1c/glucose, partner semen analysis.
  4. Lifestyle first: reduce refined carbs, walk 10–20 minutes after meals, regular exercise, improve sleep and stress management, anti-inflammatory diet.
  5. Medical therapies to discuss with a clinician:
    • For insulin resistance/PCOS: metformin (titrate to ~1500 mg/day), consider GLP‑1 agents if indicated (obesity or severe metabolic disease), targeted supplements (as advised).
    • For hyperandrogenism/irregular bleeding: hormonal contraceptives or progesterone IUD.
    • For endometriosis pain: trial of progesterone methods → GnRH antagonists if needed → skilled excisional surgery if refractory or fertility-focused.
  6. If trying to conceive: evaluate fertility buckets (female hormones/reserve, male factor, anatomy, endometriosis, PCOS, autoimmune) and follow suggested timelines.
  7. If pain or repeated dismissals: seek an endometriosis specialist (laparoscopic excision experience matters).
  8. Advocate and document: print symptom list and test requests for clinicians; be persistent — Dr. A stresses educating oneself is essential because many providers still dismiss symptoms.

Notable quotes & messages

  • “Painful periods are not normal.” (Repeated emphasis.)
  • “You don’t need a doctor to diagnose you — if you meet two of the three PCOS criteria, educate yourself and become your own health advocate.”
  • “Your genetics load the gun, your lifestyle pulls the trigger.” (On how modifiable factors interact with predisposition.)
  • Call to action: check AMH if you have severe period pain; consider early fertility preservation if egg count is low.

Resources mentioned

  • ovii.com — free PCOS likelihood calculator (Dr. A’s tool)
  • SheMD — Dr. A’s podcast for deeper episodes on women’s health
  • Discussed medications and interventions: metformin, GLP‑1s (Ozempic/Wegovy etc.), progesterone IUDs (Mirena/Kyleena), GnRH antagonists (Orilissa/ Myfembree), neuromodulators when needed.

Final note

Dr. A’s central message: PCOS and endometriosis are multi-system conditions that require a multi-pronged approach — metabolic, hormonal, inflammatory, and neurologic. Early recognition, targeted metabolic interventions (especially addressing insulin resistance), appropriate hormonal suppression, and specialist surgical care when indicated can dramatically change outcomes for pain, mental health, and fertility. Become informed, keep clear records, and press for the tests and specialists you need.