Podcast Summary: Dr. 50 Something - S1 E5

Episode Title: PCOS: The Most Underdiagnosed and Undertreated Disease in Women
Host: Nicole Norris MD
Release Date: April 11, 2025

Episode Overview

Dr. Nicole Norris dedicates this episode to unraveling the widespread, yet highly underdiagnosed hormonal disorder: Polycystic Ovarian Syndrome (PCOS). Drawing from her expertise in family practice, preventative and aesthetic medicine, she emphasizes PCOS not just as a gynecologic issue but a pervasive, systemic disease that deserves more attention from both the public and the medical community. Backed by personal family stories, the episode educates listeners about symptoms, diagnosis, consequences of missed treatment, and modern management strategies for PCOS, urging women (and those who care about them) to advocate for better understanding and care.

Key Discussion Points & Insights

1. Personal Story: The Impact of Missed Diagnosis

• Dr. Norris’ Family Experience
  • Shares story of diagnosing her mother (at 75) and herself with PCOS (02:00)
    • Mother's history: Difficulty getting pregnant, miscarriage, irregular and heavy cycles, severe PMS, lifelong sugar cravings and weight struggles. Diagnosed with borderline blood sugar in 40s, Type 2 diabetes in 50s, breast cancer in 50s, uterine cancer at 70.
    • Developed nearly every symptom of PCOS except ovarian cysts, coarse facial hair, or significant acne.
    • "She is now finally, at 75 years old, being treated appropriately for her PCOS... she feels the best she has in 50 years." (06:00)
    • Key message: Early diagnosis could have prevented decades of health issues.
  • Dr. Norris' realization of likely inheriting PCOS from her mother.

"I believe that most of her health issues and struggles could have been prevented if doctors were just taught more about PCOS in medical school." — Nicole Norris MD (08:40)

2. Lack of Medical Education & Specialization on PCOS

• PCOS mentioned "a grand total of two or three times" in all of medical school, about the same in residency (09:10)
  • Focus only on visible symptoms (ovarian cysts, full beard).
• No specialty truly understands or treats PCOS as a whole-body disorder.

3. How Common Is PCOS? Underrecognition

• Prevalence: Cited rates range from 10%–30% of women, depending on criteria and country (11:00)
  • In Dr. Norris’ hormone optimization practice, 75% of women show at least one telling sign when tested.
  • Many have lab abnormalities with few symptoms.

4. Naming is Misleading: Not All Have Cysts

• Only 50% or less with PCOS have cysts present on ovarian ultrasound (13:00)
• Not all women with ovarian cysts have PCOS.
  • “I would really like someone to rename this disorder… in my practice it stands for ‘progesterone deficiency causing oodles of side effects.’” (13:40)

5. Pathophysiology and Consequences of PCOS

• Progesterone Deficiency is Key:
  • Women with PCOS ovulate irregularly → insufficient progesterone → increased miscarriage risk (~40%) and premature delivery risk.
  • Higher lifetime risks: Breast cancer (3x) and uterine cancer (5x) vs general population due to chronic low progesterone (15:10)
  • Symptoms: Irregular, heavy, and/or painful cycles; severe PMS; postpartum depression.
• Thyroid and Metabolism Connection:
  • Many with PCOS have “thyroid resistance” (thyroid hormone produced but not effective) (17:00)
  • Explains why women can have normal labs but remain overweight, insulin resistant, and unable to lose weight.
  • Contributes to diabetes, sleep apnea, heart disease.
• Testosterone & "Male" Symptoms:
  • Low Sex Hormone Binding Globulin (SHBG) leads to elevated free testosterone: acne, facial/body hair.
  • But these are not seen in all cases — "I was missing about 90% of PCOS patients by thinking they all had to have full beards." (19:00)
• Weight Spectrum:
  • About 50% of PCOS patients are not obese; 25% are slim but carry hidden (visceral) fat that elevates risks.

6. Diagnosis: Testing for PCOS

• Blood tests:
  • Hemoglobin A1c, blood sugar, cholesterol, free thyroid T3 hormone, and the LH/FSH ratio (21:00)
  • High LH relative to FSH (2:1) in menstruating women is typical of PCOS.

7. Modern Treatment Approaches

• Progesterone Replacement (Body-Identical):
  • Oral micronized progesterone (from compounding pharmacies) taken at bedtime is preferred (22:00)
    • More effective/safer than creams, pellets, or synthetic progestins (used in birth control and some menopause treatments).
    • "Synthetic progestins are definitely different... body-identical progesterone can help you sleep amazingly well, and that is its only side effect." (25:30)
• Thyroid Optimization:
  • Desiccated thyroid hormone (provides both free T3 and T4) is used to overcome thyroid resistance.
    • Synthroid/Levothyroxine (only T4) not effective for PCOS-related thyroid issues.
• Insulin Resistance Management:
  • Medications such as GLP-1 agonists, supplements like berberine, Fatty 15, vitamin D, magnesium glycinate.
    • "[We are] very aggressive with treating this with prescription medication… and well-researched supplements." (27:00)

8. Screening Recommendations

• Who: "Everyone with two X chromosomes" — all women should be screened.
• When: At the first sign of any typical symptoms ("any one of the symptoms that my mom Ann had as a young woman — tomorrow!" 29:10)
• Is it ever too late?: “I think my answer was 130. Might be a little late.” (29:40)

Notable Quotes & Memorable Moments

• "After this podcast, about 75% of you are going to have a sneaking suspicion that you might have it." — Nicole Norris MD (02:00)
• "At this time, I don't think there really is is a specialty of medicine that really treats PCOS and truly 100% understands it. It should be treated by all medical specialties because honestly, it can eventually affect every organ system." (08:30)
• "Only 50% or less of women with PCOS in studies actually have cysts found on their ovaries on ultrasound… I would really like someone to rename this disorder." (13:00)
• "The underlying pathophysiology of PCOS is not enough progesterone production." (14:00)
• "Progesterone is critical in maintaining pregnancy… women with PCOS have a 40% miscarriage rate." (15:10)
• "This thyroid resistance is actually what leads to patients with PCOS developing diabetes, sleep apnea, and… increased risk for heart attack and stroke." (17:30)
• “We assume every woman we see has PCOS until proven otherwise. Everyone gets screened.” (28:10)
• “Progesterone deficiency causing oodles of side effects — that's the new name for PCOS.” (13:40)
• "Please, please, please help me spread the word." (30:00)

Timestamps for Key Segments

• [02:00] Introduction and family story — Dr. Norris’ mom’s and her own PCOS
• [08:30] On the lack of provider knowledge and medical education
• [11:00] Prevalence and underdiagnosis: how many women are affected
• [13:00] Misleading name and explanation of PCOS
• [14:00] Progesterone deficiency as the core problem
• [17:00] Thyroid resistance and metabolic impact
• [19:00] Misconceptions about symptoms (not always obese or visibly different)
• [21:00] Lab tests and diagnosis
• [22:00] Modern treatment strategies
• [27:00] Insulin resistance medications and supplements
• [28:10] Screening everyone, early and often
• [30:00] Call to action: spread awareness

Episode Tone

Dr. Norris maintains a passionate, empathetic, and advocacy-driven tone throughout, blending personal anecdotes with clear, actionable medical advice. The episode is educational but approachable, aiming to empower women and their families to question conventional wisdom and seek thorough, ongoing screening and treatment for PCOS.

Bottom line:
PCOS is vastly underdiagnosed and affects far more women than traditionally taught. Many serious health issues can be prevented or mitigated with early recognition and proper, modern treatment focused on progesterone and thyroid optimization. Dr. Norris strongly urges listeners to be proactive in their care or the care of their loved ones and to share this knowledge widely.

For more information or PCOS screening, check the episode show notes and Dr. Norris’ Illinois preventative medicine practice.