Episode 11.13 PMOS, PCOS, and the Metabolic Truth

Howard and guest hose Sivani Aluru unpack why the new PMOS name matters, how PCOS got tied to “cysts,” and what the evidence actually says about diagnosis, metabolic risk, and treatment. We also challenge a few habits we have all inherited, from pre-op antibiotic dosing to the way we talk about hormones, weight, and fertility with patients. • the evidence gap behind 2 g vs 3 g cefazolin in obese cesarean patients and how practice inertia forms • why PMOS shifts attention toward insulin resistance, metabolic screening, and multidisciplinary care • how NIH, Rotterdam, and androgen excess criteria shape who gets diagnosed and who gets missed • SHBG and free testosterone as a practical way to explain symptoms when total testosterone looks normal • why ovarian follicles are not the same as painful ovarian cysts and why ultrasound can mislead • patient frustration with “just take birth control” and how we explain progesterone protection for the endometrium • lean PMOS, weight-focused bias, and realistic conversations about lifestyle change, GLP-1s, and bariatric surgery • fertility takeaways from PPCOS II, metformin limitations, and what lifestyle trials suggest preconception Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram.0:00 Welcome And Guest Introduction2:01 The 3-Gram Ancef Habit12:02 PCOS Becomes PMOS12:55 How The Criteria Got Complicated22:00 Insulin Resistance And Free Testosterone30:40 Hormone Panels And TikTok Myths32:30 Ovarian Follicles Are Not “Cysts”36:03 Treating Symptoms Without Dismissing People46:12 Fertility Trials And Lifestyle Results57:27 ACOG At 75 And Why JoinFollow us on Instagram @thinkingaboutobgyn.