Understanding PCOS: What You Need to Know Before You Worry

 

 

If you’ve recently been told you might have Polycystic Ovarian Syndrome (PCOS), it’s completely understandable to feel concerned. You may have gone online and read about the risks of infertility, insulin resistance, or even diabetes later in life. For many young women, hearing “PCOS” can feel like a life-changing diagnosis. But the truth is, sometimes this label is applied too quickly—or even incorrectly.

 

Dr. Steven R. Goldstein, MD, a leading gynecologist in NYC, has seen this all too often. Young women, usually in their teens or early twenties, come into his office deeply worried after being told they have PCOS. But after a full evaluation, Dr. Goldstein finds that many of these patients do not actually meet the medical criteria for this diagnosis.

 

Let’s break down what’s really going on—and why you may not need to worry.

 

What Is PCOS?

 

Polycystic Ovarian Syndrome is a hormonal condition that affects how a woman's ovaries work. True PCOS is typically characterized by three key features:

 

1.    Irregular or absent menstrual periods

2.    High levels of androgens (male hormones such as testosterone), either in blood tests or seen as symptoms like facial hair growth (especially on the chin), severe acne, or hair thinning

3.    Ovaries that appear “polycystic” on ultrasound, meaning they contain 12 or more small follicles

 

According to the Rotterdam Criteria, a widely accepted guideline, a woman must have at least two of these three characteristics to be diagnosed with PCOS.

  

What’s Actually Happening in Many Young Women

 

Dr. Goldstein points out that many young women who have been labeled with PCOS don’t actually meet these criteria. Here’s what he’s seeing:

 

• Their periods are a little irregular—but that’s common and even expected during late adolescence and early adulthood. Your menstrual cycle is governed by a complex interaction between your brain (hypothalamus and pituitary gland) and your ovaries, and it often takes time—sometimes until your mid-twenties—for this system to fully mature.
  
  
• An ultrasound may show “multiple small follicles” in the ovaries. This can sound alarming if you're told it looks “polycystic.” But here’s the key insight: this appearance is completely normal in many healthy young women. In fact, with today’s high-resolution ultrasound machines, up to 50% of women may show more than 12 follicles per ovary—making this finding far less meaningful than it used to be.
  
  
• These patients are usually not obese, do not have elevated testosterone or DHEA-S levels, and do not have symptoms like excess facial hair or acne. In short, they are healthy.
  
  

Dr. Goldstein prefers to use the term “multicystic ovaries” to describe what he sees in these cases. It simply refers to the presence of multiple follicles, which is often a normal part of the menstrual cycle in younger women and not a disease. It’s not the same thing as PCOS—and it doesn’t mean you’ll have trouble with fertility or develop diabetes later in life.

The Importance of a Proper Diagnosis

Getting a PCOS diagnosis can have real implications—not just emotionally, but also in terms of how your health is managed. If you’re told you have PCOS when you actually don’t, you might be started on treatments you don’t need, or live in fear of problems that may never arise.

 

That’s why Dr. Goldstein gynecologist in NYC stresses the importance of taking a careful, individualized approach. Instead of rushing to label every irregular period or follicle-rich ovary as PCOS, it’s important to look at the whole picture—your symptoms, hormone levels, body composition, and overall health.

 

There’s Good News

If you’re a young woman with slightly irregular periods and an ultrasound that shows multiple follicles—but you don’t have elevated androgens or other symptoms—you’re most likely just going through a natural phase of reproductive development. According to Dr. Goldstein’s experience, the overwhelming majority of women in this situation go on to have normal menstrual cycles, normal fertility, and no increased risk of insulin resistance or diabetes.

 

When to Seek a Second Opinion

If you’ve been told you have PCOS and you’re unsure if the diagnosis is accurate, consider seeking a second opinion. A thoughtful, experienced gynecologist like Dr. Steven R. Goldstein can help you understand what’s truly going on in your body and whether any treatment is actually necessary.

 

You deserve clarity, reassurance, and care based on the latest medical understanding—not outdated criteria or hasty conclusions.

 

Ready to Feel Confident About Your Health?

Dr. Steven R. Goldstein, MD, is a top NYC Gyn with decades of experience helping women understand and manage their reproductive health. If you're unsure about a PCOS diagnosis or simply want to learn more about your body, Dr. Goldstein can provide the insight and support you need.

 

Schedule your consultation today and get the answers—and peace of mind—you deserve.

 

THE LATEST ON HORMONE REPLACEMENT THERAPY

 

 

Dr Steven R. Goldstein MD is a past President of the International Menopause Society, a past President of The Menopause Society, and a Certified Menopause Practitioner. A Past Chairman of the American College of Obstetrics and Gynecology (ACOG), Dr Goldstein was the author of their practice guidelines on SERMs (Selective Estrogen Receptor Modulators), a form of hormone replacement therapy (HRT). In private practice for over 35 years as a Menopause Specialist in NYC, Dr Goldstein has helped thousands of patients combat the symptoms of Menopause by using SERMs.

Here is a summary of what these SERMs are in HRT and how they can be used by women to alleviate the symptoms of Menopause while protecting other organs.

A SERM (selective estrogen receptor modulator) is a molecule that combines to the estrogen receptor and produces estrogenic effects in some tissues like bone, vagina, sometimes uterus, while being an estrogen blocker in other tissues – breast, sometimes uterus. There are a number of SERMs, many of which you have heard of and some which you have not. 

 

TAMOXIFEN

The original SERM was tamoxifen. Most of you have heard of this as a breast cancer drug. It binds to estrogen receptors in the breast and acts as an anti-estrogen. It also acts as estrogen in bone metabolism; thus it is good for protection against breast cancer and helps maintain bone health.

Any bleeding whatsoever in a patient on tamoxifen has to be reported immediately and must be evaluated because a very small number of women will develop endometrial cancers and precancers while on it. More women will develop benign endometrial polyps.

 

RALOXIFENE

Originally marketed as Evista but now generic, is a cousin of tamoxifen without the baggage in the uterus. It acts as an anti-estrogen in breast and estrogenic in bone. In 1997, it was approved for prevention and treatment of osteoporosis. So, raloxifene, also known as Evista, is approved for prevention and treatment of osteoporosis and breast cancer prevention. What is also little known is that on average, it will lower cholesterol approximately 20%. It is neutral in the uterus unlike tamoxifen, but it does not improve vaginal dryness or atrophy which are often the causes of painful intercourse in menopause.

 

OSPEMIFENE

Still another SERM is called ospemifene and marketed under the name Osphena. This is estrogenic in the vagina and is approved by the FDA to treat dryness and atrophy of the vagina which results in painful intercourse and discomfort in menopausal women, which simply gets worse the further into menopause a patient gets. Osphena, may have some benefit in bone and breast but the magnitude of that benefit is unstudied. In addition, because it is unstudied, it is not carried in the label. Very, very few healthcare providers are aware that Osphena has any benefit in bone and breast.

 

BAZEDOXIFENE

Bazedoxifene is yet another SERM which gives the best protective effect in the uterus. Pfizer produces a hormone replacement product called Duavee which combines their estrogen Premarin with the SERM bazedoxifene. The bazedoxifene is given for uterine protection. Thus, this is hormone replacement which is progestogen-free.

Hormone Replacement Therapy (HRT) has come a long way. These SERMs are rigorously tested and FDA approved for use. As a leading  HRT Specialist in NYC, Dr Goldstein has worked with pharmaceutical companies in testing these drugs for uterine safety.

 If you are a woman in the Menopause stage of life or are post-menopausal and need help coping with Menopause, then perhaps SERMs may be a course of treatment for you. A consultation with Dr Steven R. Goldstein, a Menopause Specialist in NYC may be in order.

 

ENDOMETRIAL BIOPSY? NOT SO QUICK!

 

 

Dr Steven R. Goldstein is a highly regarded Gynecologist in NYC for abnormal uterine bleeding, Menopause, Perimenopause and more for women’s health. His research in the field of gynecological ultrasound has been ground breaking with much of it being adopted as the standard of care by the American College of Obstetricians and Gynecologists.

Many women who suffer from pelvic pain or irregular bleeding are told to have an “endometrial biopsy” as the first means of diagnosis. If you’ve been told to have an endometrial biopsy, then “not so quick.”

 Blind endometrial biopsies with these tiny plastic devices became very popular in the early 90’s. and became the standard of care after a report said they were 97.5% accurate. Before that, women had Dilatation and Curettage (D&C) or a scraping that was done under anesthesia. Both of these are painful, invasive, procedures that cause women a lot of discomfort and needless pain.

In 1995, a much better study of women with known cancer had a biopsy in the operating room before the hysterectomy. They missed 11 out of 65 of the cancer in those women, which meant that 16% of the time in these women with cancer who had a blind biopsy, the cancer was missed! In all of these cases, it was found that the cancer occupied less than half of the surface area of the uterine cavity. So, unless the cancer or precancer is detected by a blind biopsy, a gynecologist should not consider a blind endometrial biopsy as a stopping point for diagnosis.

Dr Goldstein, a NYC Gyn, says that a better option for diagnosis is a saline infusion sonohysterogram where some fluid is put into the uterus with a much thinner catheter tube. This enables the operator to see the uterine cavity better. The reason ultrasound is such a home run in obstetrics is because the baby is in a bag of water. This is why we get such beautiful images. So, by putting some fluid into the uterus, we can see better and get high resolution images of the entire uterine cavity instead of doing a blind biopsy and only sampling a small portion of the uterine lining for diagnosis.

A sonohysterogram has become the new standard of care in such situations. In the right hands, it is painless, takes a few minutes and is done right in your gynecologist’s office. The clear, high-resolution images produced show minute detail of the ovaries, fallopian tubes, uterus, endometrial lining etc. Such details cannot be obtained with painful, invasive endometrial biopsies that are unfortunately still performed by physicians who are not using up to date methods to diagnose patients.

Either that or, for some women, the use of disposable office hysteroscopes may be appropriate. With these, a physician can see inside the uterus in a matter of minutes painlessly, but the procedure requires more preparation and analgesia.

So, if you, a friend, relative or colleague are told to have an endometrial biopsy, ask first for a saline infusion sonohysterogram. As usual, Dr Goldstein, a leading Gynecologist in NYC is always available for a consultation.