Educate yourself about your body and potential conditions, then prepare specific questions and requests for your doctor. This empowers you to seek appropriate care and ensures your symptoms are taken seriously, especially given widespread dismissal of women’s health concerns.
Utilize the free OVII.com platform to answer questions and assess your likelihood of having PCOS. This zero-cost tool provides initial feedback on a common, often undiagnosed, hormonal disorder.
Recognize that PCOS is diagnosed by meeting two out of three criteria: symptoms of high androgens (acne, hair thinning, facial/body hair), irregular periods (over 35 days or <8 per year), or PCOS-looking ovaries on ultrasound/elevated AMH. Do not dismiss a potential diagnosis based on normal blood testosterone or lack of cysts alone.
Be aware that painful periods that disrupt daily life, painful deep penetration during sex, chronic bloating, painful bowel movements during menstruation, or recurrent UTIs with negative cultures are not normal and strongly indicate endometriosis. These symptoms require thorough investigation, as they are often dismissed.
Request a pelvic ultrasound as a mandatory part of your annual well-woman exam, regardless of symptoms. This can help identify issues like PCOS-looking ovaries, endometriomas, fibroids, or uterine septums that are often missed.
Request an AMH (anti-Müllerian hormone) blood test to understand your ovarian reserve, especially if you are young and considering future family planning, or if you have symptoms of PCOS or endometriosis. Understand that a very high AMH can indicate PCOS and potential egg quality issues, not just high quantity.
If diagnosed with PCOS or endometriosis, consider freezing eggs at a younger age (e.g., by 16 if severe, or before 30 generally) to preserve egg quality, even if quantity is high. This proactive step can mitigate future fertility challenges caused by these conditions.
Actively work to improve insulin sensitivity through lifestyle changes: walk 10-15 minutes after each meal, prioritize 7-9 hours of quality sleep, reduce stress, and adopt a healthy, low-inflammatory diet avoiding processed foods. This is a foundational step for managing PCOS and overall metabolic health.
Explore supplements like inositol (myo and d-chiro), vitamin D, curcumin, chromium, and wild mulberry leaf (taken before heavy meals to block carb absorption by 40%) to enhance insulin sensitivity and reduce inflammation. These can significantly improve PCOS symptoms and overall well-being.
If lifestyle and supplements are insufficient for managing insulin resistance in PCOS, discuss metformin with your doctor. Ensure the dosage is adequate (e.g., 750mg twice daily, potentially up to 1000mg twice daily) for effective treatment.
If other treatments for insulin resistance and weight management are not effective, discuss GLP-1 medications (e.g., Ozempic, Trulicity) with your doctor. These can regulate insulin, improve sensitivity, reduce inflammation, and may quiet constant food cravings.
If trying to conceive with PCOS, ask your doctor about ovulation-inducing medications like Letrozole (often preferred) or Clomid. These can help regulate the brain-pituitary-ovary axis to promote ovulation.
Following laparoscopic surgery for endometriosis, ensure you receive hormonal suppression therapy to prevent recurrence of the disease. This is a critical step, as endometriosis often returns without it.
Discuss progesterone-based treatments, such as progesterone-only birth control pills (e.g., Slend) or progesterone IUDs (e.g., Kyleena or Mirena), with your doctor for endometriosis and adenomyosis suppression. These locally act to reduce lesion growth and pain, especially if mood disorders are a concern with estrogen-containing pills.
If experiencing severe endometriosis pain, particularly painful sex, discuss GnRH antagonists (e.g., Oralisa, Myfembry) with your doctor. These medications rapidly suppress estrogen, offering significant relief, but are typically limited to two years of use due to potential bone loss.
If you have a history of endometriosis and are post-menopausal, ensure any hormone replacement therapy you receive includes progesterone, even if you’ve had a hysterectomy. This prevents stimulating any remaining endometriosis implants with unopposed estrogen.
If experiencing PMDD (severe PMS), discuss with your doctor the option of taking SSRIs like Prozac (20mg) or Zoloft (25mg) for only 10-14 days before your period, stopping at its onset. This pulsatile treatment can significantly alleviate severe mood symptoms.
If you notice hair thinning during perimenopause or menopause, start treatment with minoxidil (topical Rogaine or oral minoxidil, starting at 0.5mg daily) early. This can significantly improve hair density over time, with results typically visible in six months to two years.
Mandatorily calculate your lifetime risk of breast cancer using tools like the free Tyrer-Cuzick Risk Assessment Tool (available on SheMD.com). This crucial step informs personalized screening and prevention strategies.
If your calculated lifetime breast cancer risk is 20% or higher, begin breast imaging (mammogram) as early as age 30, not 40, and advocate for this with your doctor. Standard screening guidelines are for very low-risk individuals.
For high-risk patients (20%+ lifetime breast cancer risk), request a breast ultrasound in addition to mammogram, especially if you have dense breast tissue. If risk is very high (35%+), also request a breast MRI, ensuring your doctor notes your high-risk status for insurance coverage.
If you have a family history of breast, ovarian, pancreatic, or prostate cancer, ask your doctor about genetic cancer testing (e.g., Marriott panel). This can identify specific mutations or markers that significantly increase your cancer risk.
If your breast cancer risk is very high (35%+), discuss preventative options with your doctor: alternating imaging every six months (mammogram/ultrasound with MRI), medication like tamoxifen (reduces risk by 50%), or prophylactic double mastectomy. These are critical choices for high-risk individuals.
Systematically assess all ‘buckets’ of fertility: female factors (hormones, AMH, STDs), male factors (sperm analysis), tubal/anatomical factors (ultrasound for fibroids, septum, open tubes), endometriosis, PCOS, and autoimmune conditions. This comprehensive approach helps identify underlying issues often missed.
If experiencing recurrent miscarriages, have endometriosis, or a family history of autoimmune conditions, request a full autoimmune panel. Undiagnosed autoimmune disorders can significantly impact fertility and pregnancy outcomes.