Rethinking PCOS in Young Women: When a Diagnosis May Not Be the Whole Story

  

Not every young woman with irregular periods and multiple ovarian follicles has PCOS.

 In recent years, more young women have been told they have Polycystic Ovarian Syndrome (PCOS)—often after a single ultrasound or a brief evaluation. For many, the diagnosis comes with fear. A quick online search brings up infertility, insulin resistance, weight gain, and increased risk of diabetes.

 According to Steven R. Goldstein, a leading Gynecologist in NYC, this fear is frequently unnecessary. In his clinical experience, a growing number of young women diagnosed with PCOS do not actually meet the full criteria for the condition. Instead, they are experiencing a normal stage of reproductive maturation.  Let’s unpack what’s happening—and why careful evaluation matters.

 Why So Many Young Women Are Being Told They Have PCOS

Dr. Goldstein has seen numerous teenage girls and women in their early twenties come into his office distressed after being told they have PCOS. The typical scenario goes something like this:

 A young woman has slightly irregular periods.

• An ultrasound is performed.
• The ultrasound shows multiple small follicles in the ovaries.
• She is told she has “polycystic ovaries.”
• The diagnosis quickly becomes Polycystic Ovarian Syndrome.

 But here’s the critical point: polycystic ovaries on ultrasound do not automatically equal PCOS.

 Many adolescents and young adults naturally have multiple small follicles in their ovaries. This can be a completely normal finding during the years when the menstrual cycle is still maturing.

Understanding the Hypothalamic-Pituitary-Ovarian (HPO) Axis

To understand why irregular periods are common in teens and young women, we need to briefly review how the reproductive system matures.

The menstrual cycle is regulated by a hormonal communication system called the hypothalamic-pituitary-ovarian (HPO) axis. This axis involves:

 The hypothalamus (in the brain)

• The pituitary gland
• The ovaries

 In adolescence, this system is still developing. It takes time for the hormonal signaling patterns to become consistent and cyclical. During this maturation process, irregular periods are extremely common—and often completely normal.

 Slight cycle irregularity in a 17-, 18-, or even 21-year-old is not automatically pathological. In many cases, it is simply biology at work.

 The Rotterdam Criteria: Where Confusion Can Begin

Much of the over-diagnosis issue stems from how PCOS is defined.

According to the internationally recognized Rotterdam Criteria, a woman may be diagnosed with PCOS if she has two out of three of the following:

 1.    Irregular menstrual cycles

2.    Elevated androgens (either clinically or on blood tests)

3.    More than 12 follicles in one ovary on ultrasound

On the surface, this seems straightforward. However, modern clinical realities complicate the picture.

 Issue #1: Irregular Cycles in Adolescence

As mentioned, irregular cycles are common in younger women because the HPO axis has not fully matured.

 Issue #2: Ultrasound Technology Has Improved

Today’s high-resolution transvaginal ultrasounds are far more sensitive than those available when the Rotterdam Criteria were first established. As a result:

• Many completely healthy women have more than 12 follicles.
• Studies suggest that up to 50% of normal women may meet the follicle threshold using modern imaging.

 This means a young woman with slight cycle irregularity and multiple follicles on a sensitive ultrasound may technically meet “two out of three” criteria—even if she has no hormonal abnormalities. And that is where mislabeling can occur.

 What True PCOS Typically Looks Like

Dr. Goldstein, a top NYC Gyn, emphasizes that classical PCOS usually presents with additional, more specific findings. Traditionally, women with PCOS often have:

 

• Obesity or significant weight challenges
• Male-pattern hair growth (especially on the chin or face)
• Elevated androgen levels (such as testosterone or DHEA-S) on bloodwork
• Persistent ovulatory dysfunction

 

PCOS is fundamentally a hormonal disorder characterized by androgen excess and ovulatory dysfunction—not simply the presence of multiple follicles.

 In contrast, many of the young women seen by Dr. Goldstein:

• Are not obese
• Have no clinical signs of androgen excess
• Have normal androgen levels on laboratory testing
• Are otherwise extremely healthy

 These women do not fit the classic PCOS profile.

 

“Multicystic Ovaries” vs. Polycystic Ovarian Syndrome

Dr. Goldstein uses a helpful distinction: many of these patients have what he refers to as multicystic ovaries, not Polycystic Ovarian Syndrome.

This distinction is important.

Multicystic Ovaries:

• Common in adolescents and young women
• Often reflect normal ovarian activity
• Not associated with hormonal abnormalities
• Typically resolve as cycles mature
• Do not inherently increase future health risks

 

PCOS:

• Endocrine disorder
• Associated with androgen excess
• Linked to metabolic risks
• Can affect long-term fertility
• Often requires ongoing medical management

 

By labeling multicystic ovaries as PCOS, we risk medicalizing a normal developmental phase.

 

The Emotional Toll of a Premature Diagnosis

The psychological impact of a PCOS diagnosis in a young woman can be profound.

 Patients often leave their initial appointment believing:

• They may struggle with infertility.
• They are at high risk for diabetes.
• They will gain weight uncontrollably.
• Their health outlook is compromised.

 Dr. Goldstein, a top Gynecologist in Manhattan reports that many of these women arrive at his office distraught. They have spent hours researching worst-case scenarios online. In reality, many of them are completely healthy young women whose bodies are simply still calibrating hormonally.

 A premature diagnosis can create anxiety that lingers for years—especially when it concerns fertility and long-term health.

 

What Happens Over Time?

In Dr. Goldstein’s experience, the overwhelming majority of these young women:

 

• Develop regular menstrual cycles in their mid- to late twenties
• Have normal fertility
• Do not develop insulin resistance
• Do not show increased risk for diabetes

 As the HPO axis matures, cycles stabilize. The ovaries continue functioning normally. The body does what it was biologically designed to do.

Time, in many cases, is the most important “treatment.”

 

Why Proper Evaluation Matters

A thoughtful evaluation for PCOS should include:

 

• Detailed menstrual history
• Assessment of weight and metabolic health
• Clinical evaluation for androgen excess
• Appropriate laboratory testing
• Careful interpretation of ultrasound findings

 

Ultrasound alone should never determine the diagnosis.

In adolescents especially, major medical organizations caution against diagnosing PCOS too early unless clear androgen excess is present and symptoms persist over time. A diagnosis with lifelong implications deserves careful consideration.

 

The Metabolic Component: A Key Differentiator

True PCOS is often associated with insulin resistance. Over time, this can increase the risk for:

• Type 2 diabetes
• Cardiovascular disease
• Metabolic syndrome

 But these risks are typically seen in women who have clear metabolic dysfunction—not in healthy young women with isolated ultrasound findings.

If a patient is lean, metabolically healthy, hormonally normal, and simply has slightly irregular cycles at age 19, the long-term outlook is usually excellent. Context matters.

 

When Should PCOS Be Considered Seriously?

PCOS should be strongly considered when a woman has:

 

• Persistent cycle irregularity well beyond adolescence
• Clear signs of androgen excess
• Elevated androgens on lab testing
• Obesity or insulin resistance
• Difficulty ovulating over time

 

In such cases, early intervention can be beneficial.  But labeling every young woman with multiple follicles as having PCOS dilutes the meaning of the diagnosis.

 

The Importance of a Second Opinion

If you have been told you have PCOS—especially at a young age—and your only findings were irregular cycles and an ultrasound showing multiple follicles, it may be worth seeking further evaluation.

 

A second opinion can clarify:

• Whether androgen levels are truly elevated
• Whether metabolic risk is present
• Whether the menstrual irregularity is simply part of normal maturation

 

An accurate diagnosis provides reassurance when appropriate—and targeted care when necessary.

 

A Reassuring Perspective for Young Women

The key takeaway from Dr. Goldstein’s clinical experience is this:

Many young women diagnosed with PCOS do not, in fact, have the syndrome.

 

They have:

• A developing reproductive system
• Normal hormonal fluctuations
• Multicystic ovaries that are common and benign

 

And most importantly, they have excellent long-term reproductive and metabolic health. Medicine must balance vigilance with restraint. Not every variation from textbook “regularity” represents disease.

 

Final Thoughts

Polycystic Ovarian Syndrome is a real and important condition that deserves proper diagnosis and management. However, over-diagnosis—particularly in adolescents and young adults—can cause unnecessary stress and medicalization.

According to Steven R. Goldstein, a top Obgyn in Manhattan, many young women who have been labeled with PCOS are simply experiencing a normal phase of reproductive development.

 

If you have concerns about a PCOS diagnosis or would like a careful, individualized evaluation, consider consulting an experienced specialist like Dr Steven R. Goldstein. An informed, nuanced approach can provide clarity, reassurance, and peace of mind—without attaching a lifelong label that may not apply.

 

Menopause, Osteoporosis, and the Path to Strong Bones

 

 

 For many women, menopause is framed as a period defined by hot flashes, night sweats, and changes in mood or sleep. While these symptoms can certainly affect quality of life, they are only part of a much larger physiological transition. One of the most significant—and often underappreciated—health concerns associated with menopause is its impact on bone health. Osteoporosis, along with its precursor states and related muscle loss, represents a serious but largely preventable threat to long-term independence and healthy aging.

 

Dr. Steven R. Goldstein is a Menopause Specialist NYC. He is a Certified Menopause Practitioner and a past President of both The Menopause Society and the International Menopause Society. He is also a former Co Directory of Bone Densitometry and Body Composition at NYU Langone Medical Center.

 

Dr Goldstein has spent decades caring for women in perimenopause and menopause, with a particular focus on the profound relationship between hormonal changes and skeletal health. His work emphasizes that bone health is not a niche concern, but a central pillar of longevity, mobility, and overall wellbeing.

 

Understanding Bone Health in Menopause

Bone is not a static structure. Throughout life, it is continuously remodeled through a balance of bone formation and bone resorption. In healthy younger women, these processes are tightly regulated and generally remain in equilibrium. In women, Estrogen plays a crucial role in this balance by slowing the breakdown of bone.

 

During menopause, ovarian production of estrogen declines sharply. Without estrogen’s protective effect, bone resorption accelerates, tipping the balance toward bone loss. This process can occur rapidly, particularly in the first several years after menopause, placing women at increased risk for weakened bones and fractures.

Because women today are living longer than ever before, the consequences of postmenopausal bone loss extend over decades. Many women will spend 40 percent or more of their lives in a low-estrogen state. This makes early awareness and proactive management of bone health essential, rather than optional.

 

Osteopenia and Osteoporosis: What’s the Difference?

Bone loss exists along a spectrum. Osteopenia is often described as a midpoint between normal bone density and osteoporosis. While the term is commonly used, it can be misleading when considered in isolation. Two women labeled with osteopenia may have very different fracture risks depending on their actual bone density measurements, rate of bone loss, age, and overall health.

 

Osteoporosis represents more advanced bone thinning and structural weakness. At this stage, bones are fragile and prone to fractures, even from minor falls or everyday activities. Fractures of the hip, spine, and wrist are especially common and can be life-altering.

 

Dr. Goldstein, a Menopause Specialist NYC, emphasizes individualized assessment rather than relying on labels alone. Bone density testing, typically performed with a DEXA scan, provides objective data that can guide meaningful discussions about risk and treatment options.

 

Why Bone Health Matters More Than Ever

The medical consequences of osteoporosis extend far beyond broken bones. A hip fracture, for example, is not simply an orthopedic injury. It is a major health event that can permanently alter a woman’s independence and survival. A significant proportion of women who suffer hip fractures are unable to return to independent living, and mortality rates in the year following a fracture remain alarmingly high.

 

As life expectancy increases, the goal is not merely to live longer, but to live well. Strong bones are fundamental to maintaining mobility, balance, and confidence. Preventing bone loss is therefore an essential component of healthy aging, on par with cardiovascular health or cancer prevention.

 

The Overlooked Role of Muscle: Sarcopenia

Bone health does not exist in isolation. Muscle mass and strength play a critical supporting role in protecting the skeleton. Sarcopenia, the age-related loss of muscle mass and function, often progresses quietly alongside bone loss.

 

When low bone density and muscle weakness occur together, the risk of falls and fractures increases dramatically. This combination has a compounding effect, making prevention strategies even more important.

Regular physical activity, particularly strength training and balance exercises, can help preserve muscle mass and coordination. Maintaining muscle strength supports posture, stability, and reaction time, all of which reduce the likelihood of falls. Dr. Goldstein, an Osteoporosis Specialist NYC, encourages his patients to aim not merely for average fitness, but to remain as strong and capable as possible as they age.

 

Risk Factors for Osteoporosis

While menopause is a major driver of bone loss, several additional factors influence a woman’s risk of developing osteoporosis:

 

• Gender: Women are more vulnerable to osteoporosis due to smaller bone size and hormonal changes associated with menopause.
• Age: Bone density naturally declines with age, and the rate of loss can accelerate after menopause.
• Lifestyle factors: Inadequate nutrition, limited physical activity, smoking, and excessive alcohol use can all contribute to weaker bones.
• Medical conditions and medications: Certain health conditions and long-term use of specific medications can adversely affect bone density.

Understanding these risk factors allows for earlier screening and targeted prevention strategies.

 

Silent Progression and the Importance of Screening

One of the most challenging aspects of osteoporosis is that it often progresses without noticeable symptoms. Many women are unaware they have low bone density until a fracture occurs. By that point, significant bone loss may have already taken place.

 

As osteoporosis advances, signs may include back pain, loss of height, stooped posture, or fractures occurring with minimal trauma. However, relying on symptoms alone is insufficient. Proactive screening during perimenopause and menopause is essential to identify bone loss early, when interventions are most effective.

 

A Comprehensive Approach to Bone Health

Protecting bone health during and after menopause requires a multifaceted approach. This includes appropriate screening, lifestyle modifications, and individualized medical management when necessary.

 

Nutrition plays a foundational role. Adequate intake of calcium, vitamin D, and other nutrients supports bone remodeling. Physical activity, particularly weight-bearing and resistance exercises, strengthens both bones and muscles. Avoiding smoking and limiting alcohol further reduces risk.

 

 For some women, lifestyle measures alone may not be sufficient. In these cases, medical therapies can help slow bone loss or improve bone density. Decisions regarding treatment should be made in consultation with an experienced clinician who understands the complex interplay between hormones, bone biology, and individual risk factors.

 

Partnering for Long-Term Bone Health

Menopause represents a critical window of opportunity to protect skeletal health for decades to come. With proper evaluation and personalized care, many women can significantly reduce their risk of osteoporosis-related fractures.

 Dr. Steven R. Goldstein’s long-standing focus on bone health reflects his commitment to helping women age with strength, independence, and confidence. Through education, screening, and individualized guidance, women can take meaningful steps to preserve their bones and their quality of life well beyond menopause.

 

Bone health is not just about preventing fractures—it is about preserving freedom, mobility, and the ability to fully engage in life at every stage.

If you are Menopausal, approaching menopause or postmenopausal and are concerned about your bone health, then a consultation with Dr Steven R. Goldstein, a Menopause, Osteoporosis and Perimenopause Specialist NYC may be in order.

 

The Importance of Annual Pap Smear Exams: Early Detection, Prevention, and Peace of Mind

 

 

 Cervical cancer is one of the most preventable forms of cancer affecting women today, largely due to one simple, routine screening: the Pap smear. Despite its proven effectiveness, many women delay or skip this exam, often because they feel well, are busy, or are anxious about what the test might reveal. According to Dr. Steven R. Goldstein, a leading gynecologist in Manhattan, annual Pap smear exams remain one of the most powerful tools in protecting women’s long-term gynecologic health.

 

Dr. Goldstein strongly recommends that women have a Pap smear performed every year to help detect cervical cancer cells early—often before symptoms develop—and to prevent the need for aggressive or invasive treatment later on. This routine, painless examination is performed during a standard pelvic exam and plays a crucial role in identifying abnormal, pre-cancerous, or cancerous changes in cervical cells.

 

Why Pap Smears Matter

The Pap smear is designed to detect changes in the cells of the cervix, the lower part of the uterus that opens into the vagina. These cellular changes often occur slowly and silently over time, long before cancer develops. By identifying abnormalities early, physicians can monitor or treat them before they progress into invasive cervical cancer.

 

Dr. Goldstein feels strongly that the benefits of Pap smears far outweigh any inconvenience associated with the exam. Catching cervical cancer early—or preventing it altogether—is the goal, and annual testing remains the most reliable way to achieve that.

 

In fact, the dramatic decline in invasive cervical cancer cases in the United States over the past sixty years is largely attributed to the widespread use of Pap smear screening. This single test has saved countless lives by allowing early intervention and preventing the progression of disease.

 

A Simple, Painless, Routine Exam

One of the most common misconceptions about Pap smears is that they are painful or complicated. In reality, the test is quick, straightforward, and typically completed during a routine pelvic exam. Dr. Goldstein, a top gynecologist in Manhattan performs the Pap smear by gently collecting a small sample of cells from the cervix, which are then sent to a laboratory for evaluation.

 

Most women experience little to no discomfort, and the exam usually takes only a few minutes. When weighed against the potential benefits—early detection, reduced treatment intensity, and peace of mind—the Pap smear is one of the most valuable preventive health measures available.

 

Understanding Abnormal Pap Smear Results

Receiving news of an abnormal Pap smear can be alarming, but Dr. Goldstein emphasizes that patients should not jump to conclusions. An abnormal result does not automatically mean cervical cancer or even pre-cancer.

 

An abnormal Pap smear simply indicates that there has been a change in the cervical cells. These changes can occur for a variety of reasons, many of which are not serious. Common causes include:

• Infections
• Inflammation
• Hormonal changes related to the menstrual cycle
• Temporary cellular changes that resolve on their own

 

In some cases, abnormal results may indicate pre-cancerous or cancerous cells, but further evaluation is always required before making that determination. The Pap smear is a screening test, not a diagnosis.

 

Follow-Up Testing After an Abnormal Pap Smear

When a Pap smear shows abnormal findings, Dr. Goldstein carefully evaluates each patient’s situation and may recommend additional testing to better understand the nature of the cellular changes. These follow-up tests are designed to determine whether abnormal cells are benign, pre-cancerous, or cancerous.

 

Some of the diagnostic procedures Dr. Goldstein may recommend include:

 

Endocervical Curettage (ECC)

Endocervical curettage involves collecting a sample of cells from the endocervical canal using a small, spoon-shaped instrument called a curette. This procedure is typically performed in an outpatient setting or hospital.

The patient is given medication to minimize discomfort, and Dr. Goldstein gently scrapes a thin layer of tissue from the cervical canal. The tissue sample is then sent to a laboratory for analysis to determine whether cancerous or pre-cancerous cells are present.

 

Colposcopy

A colposcopy allows for a more detailed examination of the cervix and vaginal tissues. During this procedure, Dr. Goldstein uses a colposcope—a specialized lighted microscope that magnifies cervical and vaginal cells—to closely inspect the area for abnormalities.

 

If any suspicious areas are identified, Dr. Goldstein may take a biopsy. These tissue samples are then examined under a microscope to determine whether abnormal, pre-cancerous, or cancerous cells are present. Colposcopy provides valuable information and helps guide appropriate treatment decisions.

 

Treatment Options for Abnormal Cervical Cells

If further testing shows that abnormal cervical cells require treatment, Dr. Goldstein, and experienced gynecologist in Manhattan may recommend one of several effective options. The choice of treatment depends on the severity of the abnormality, the patient’s age, overall health, and reproductive plans.

 

Cryotherapy

Cryotherapy destroys abnormal tissue by freezing it. A cold chemical is applied directly to the affected area of the cervix, freezing and eliminating abnormal cells. This procedure is commonly used for pre-cancerous changes and is typically quick and well tolerated.

 

Laser Therapy

Laser therapy uses a narrow beam of intense light to destroy or remove abnormal cervical cells. This precise technique allows targeted treatment while preserving healthy surrounding tissue.

 

Conization

Conization involves removing a cone-shaped piece of cervical tissue that contains abnormal cells. This can be done using a surgical knife, laser, or the LEEP (loop electrosurgical excision procedure) technique. Conization is often used when abnormal cells extend deeper into cervical tissue or when more detailed examination is needed.

 

Perspective and Reassurance

Dr. Goldstein emphasizes the importance of perspective when dealing with abnormal Pap smear results. As stated earlier, an abnormal Pap smear does not automatically mean cancer or even pre-cancer of the cervix. In many cases, the changes are temporary and related to inflammation, infection, or hormonal fluctuations.

 

The key is timely follow-up and expert evaluation. With proper screening, monitoring, and treatment when necessary, cervical cancer is often preventable and highly manageable when detected early.

 

Taking a Proactive Approach to Women’s Health

Annual Pap smear exams are not just about detecting disease—they are about empowerment and prevention. By staying consistent with screenings, women take an active role in protecting their health and reducing the risk of serious illness.

 

If you are in the New York City area and have questions about Pap smears, abnormal results, or cervical health, a consultation with Dr. Steven R. Goldstein, MD, a highly experienced obgyn in Manhattan, may be an important next step. His patient-centered approach emphasizes education, reassurance, and evidence-based care, helping women navigate their health decisions with confidence.

 Routine screening saves lives. An annual Pap smear is a small investment of time that can make a lifelong difference.