QC: Facts Of PCOS with Dr. Sadikah Behbehani

Confused about PCOS and endometriosis? You’re not alone—and you might’ve been misdiagnosed. In this essential episode, Dr. Sadikah Behbehani, a double-fellowship trained reproductive endocrinologist and minimally invasive surgeon, sets the record straight.

She breaks down the real differences between Polycystic Ovary Syndrome (PCOS) and endometriosis, explains how they can coexist without causing each other, and outlines the actual diagnostic criteria for PCOS. This conversation is critical for teens, adults, and parents trying to make sense of irregular periods, hormonal changes, or conflicting diagnoses.

What you’ll learn:
 • Why PCOS and endometriosis are often confused but are very different
 • How misdiagnosis happens—and how to avoid it
 • What the Rotterdam criteria are, and why they matter
• Why polycystic-appearing ovaries alone are not enough for a PCOS diagnosis
• The truth about irregular cycles in teens and when to be concerned
• When PCOS should be diagnosed—and when it shouldn’t
• How endometriosis and PCOS can impact fertility and treatment

Whether you're newly diagnosed or searching for answers after years of symptoms, this episode will give you science-backed clarity and validation.

Listen now to get empowered with accurate information and practical next steps.

Have a question for a future episode? Submit it through the link in the description, email contact@endobattery.com, or visit www.endobattery.com/contact.

#PCOS #Endometriosis #HormonalHealth #PCOSAwareness #EndometriosisAwareness #Misdiagnosis #RotterdamCriteria #WomenHealthPodcast #ChronicIllness #PelvicPain #PCOSInTeens #DrBehbehani #EndoBatteryPodcast

Chapters

• 0:00 Introduction to Quick Connect
• 0:51 Dr. Bebehani's Expert Background
• 1:29 PCOS and Endometriosis Connection Explained
• 3:22 Rotterdam Criteria for PCOS Diagnosis
• 5:46 Episode Wrap-Up

Transcript

Speaker 1: 0:03

Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect time to connect.

Speaker 1: 0:51

Today I'm excited to have Dr Sadiqa Bebehani, a double fellowship-trained OBGYN specializing in reproductive endocrinology and infertility, as well as minimally invasive gynecological surgery. Dr Bebehani completed a second fellowship at the prestigious Mayo Clinic, where she mastered complex pelvic surgery using both laparoscopy and robotics. As an associate professor at the University of California Riverside School of Medicine, she is also deeply involved in medical research and publications. With her rare combination of training in surgery and infertility, dr Babiani is uniquely equipped to treat complex gynecologic conditions such as endometriosis and fibroids that affect fertility. Let's jump in and be empowered with knowledge. There tends to be a lot of crossover between endometriosis and PCOS. Can you tell us a little bit more about the PCOS piece of it and what it is, how it kind of responds in the body, and just give us that overview?

Speaker 2: 1:46

Yes, I'm glad that you bring this up because this is a question we get asked often in clinical practice is how are endometriosis and PCOS related? We have to remember that endometriosis occurs in about 15% of the population. So, not looking at pelvic pain or fertility patients, just in the general population, about 15% of women will have endometriosis and 5% to 15% of the population will have PCOS. So they may not necessarily be caused by the same cause, like in utero, or the same manifestation that created the disease. But because they are both prevalent and common, it is definitely possible for women to have both endometriosis and PCOS. So I often get asked is the endo causing PCOS? Is the PCOS causing endo? No, there are no studies to show that one causes the other. It's just because they're both prevalent. It is absolutely possible for both diseases to co-occur in someone. Now, what is PCOS? You asked me what PCOS was. Pcos, for those of you who don't know, stands for polycystic ovarian syndrome and it is often misdiagnosed. So a large proportion of women will come see me and say oh well, my doctor diagnosed me with PCOS 5, 10, 15 years ago. The first question I ask them is how was the diagnosis established? And most of the time they're not able to provide the evidence or the results that led to the diagnosis of PCOS. So PCOS is often misdiagnosed and sometimes is overdiagnosed.

Speaker 2: 3:17

But when we are correctly diagnosing PCOS we diagnose it based on a criteria called the Rotterdam criteria. So that's the scientific way of diagnosing PCOS. What the Rotterdam criteria looks at is to see if women have irregular periods or no periods. So that's one of the criteria. Number two is elevated male-type hormones called androgens testosterone, dhea, 17-hydroxyprogesterone. Those fall in the category of androgens or clinical findings of elevated androgens, like having increased facial hair, acne, sometimes male pattern baldness. Those are all called clinical findings of elevated androgens or elevated male-type hormones. And then number three is the appearance of polycystic ovaries on ultrasound. So you need two out of those three things to be diagnosed with PCOS, and the reason why this is important is because many women will have an ultrasound to show multiple follicles or cysts on their ovaries and be automatically told that they have PCOS.

Speaker 2: 4:22

You cannot diagnose PCOS based on just one of the three things. You cannot just have polycystic appearing ovaries and have PCOS. You need to have polycystic appearing ovaries plus one of the other two things on the criteria, which are either irregular periods or absent periods or clinical or lab findings of elevated androgens. So you need two out of three to diagnose PCOS. And then you can't be really young and diagnose PCOS.

Speaker 2: 4:48

You need to wait a certain number of years after you start your period. So you can't have a 15-year-old who started her periods two years ago, see a GYN and be told she has PCOS. She's too young to be diagnosed with PCOS. You need at least six to eight years of regular menstrual cycle. So from the start of the first period we wait six to eight years before you re-evaluate the situation to see if they have PCOS or not, because it takes this long for the brain to stimulate the ovaries to produce hormones on a regular basis. So it's very common for girls in the first six to eight years of starting a period to have irregular periods, elevated androgens and polycystic appearing ovaries on ultrasound. But they will not have PCOS if you just give them time to regulate their own hormones. So that's another important thing to remember is you need to give your body time to adjust to having periods before you're able to diagnose PCOS.

Speaker 1: 5:46

To hear more about the connection of endometriosis and PCOS from Dr Bebehani, check out episode 91. That's a wrap for this Quick Connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming. Send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.