Common doesn't mean normal

Hi —

Welcome to the first issue.

If you've found your way here, you already know the premise: I went to medical school so you didn't have to. This is where I put the things there isn't time to explain in a fifteen-minute visit.

One issue a month, first Wednesday. Four sections, every time.

1. This month: PCOS

September is PCOS Awareness Month. It's also Ovarian Cancer Awareness Month — more on that below.

Polycystic ovary syndrome affects roughly one in ten women of reproductive age. Most spend years being told their symptoms are separate problems: irregular periods, acne, weight that won't move, hair growth, trouble conceiving. Each one gets addressed on its own. Nobody connects them.

What it actually is: a hormonal and metabolic condition, not just an ovary problem. The name is genuinely misleading — you don't need cysts to have it, and having them doesn't mean you do.

How it's diagnosed: by pattern, not a single test. Irregular or absent ovulation, signs of excess androgens, and ovarian appearance on ultrasound. Two of the three, with other causes ruled out.

What often gets missed: PCOS isn't only a fertility issue. It carries long-term metabolic and cardiovascular risk that matters whether or not you ever want to be pregnant. If your care has only ever been framed around conception, you've had half a conversation.

What to ask for: a real hormonal workup rather than a birth control prescription and a shrug. Ask whether you've been screened for insulin resistance. Ask what your long-term risk looks like. Ask what changes if you're not trying to conceive right now.

The earliest sign is almost always the cycle. Irregular, absent, or unpredictable periods are the thing that shows up first and gets dismissed longest.

Go deeper The full PCOS article, with the actual diagnostic criteria →

2. On Instagram this month

Perinatal mental health and medications. Someone told me she stopped her anxiety medication in pregnancy — not because a doctor advised it, but because she read online that it could cause withdrawal in her baby. Some medications can cause neonatal adaptation: a few days of jitteriness or irritability, usually mild and self-limited. What gets discussed far less is that untreated depression and anxiety in pregnancy are not the safe option. Mental health conditions account for more than 23% of pregnancy-related deaths in this country. The real comparison isn't medication versus nothing. It's medication versus an illness that carries its own serious risk.

Don't stop a medication on your own. Bring it to your next visit and ask three questions: What are the risks? What are the benefits? What happens if I don't take it?

Your cycle is a vital sign. We check blood pressure, heart rate, temperature. Your cycle belongs on that list — it reflects your hormones, your thyroid, your weight, your stress, your fertility. A normal cycle comes every 24–38 days, bleeding typically lasts up to 8 days, and cycles are generally predictable even if they're not identical month to month. When yours changes, that's information.

Trying to conceive. The rule most people haven't heard: twelve months of trying if you're under 35, six months if you're 35 or older, and don't wait at all if your cycles are irregular, you have known endometriosis, you've had pelvic surgery, or you've had a miscarriage. And the part that gets skipped — your partner gets evaluated too, from the start. Male factor accounts for roughly half of cases.

Go deeper Take the Postpartum Mood Check-In → Real fertility workup timelines and next steps →

3. What's new in women's health

Postmenopausal bleeding: a meaningful change. ACOG updated its guidance this year and now recommends both transvaginal ultrasound and endometrial tissue sampling at the initial evaluation for most patients with bleeding after menopause. Previously, ultrasound alone was often considered sufficient. The change exists because ultrasound can falsely reassure — particularly for Black women, who face higher risk of aggressive endometrial cancers that may not produce visible ultrasound findings.

What this means for you: any bleeding after menopause needs evaluation, and a normal ultrasound alone may not be the end of the workup. It's reasonable to ask whether sampling was done.

Ovarian cancer prevention. In August, ACOG strengthened its recommendations supporting removal of the fallopian tubes as a strategy to reduce ovarian cancer risk. Much of what we call ovarian cancer appears to originate in the tubes. For anyone already planning pelvic surgery — including permanent contraception — this is worth raising with your surgeon, because it may change what procedure makes sense.

Ovarian cancer symptoms are vague by nature: bloating, feeling full quickly, pelvic pressure, urinary changes. Persistent and new is what matters, not dramatic.

4. Question of the month

Roughly how many women of reproductive age have PCOS?

A. 1 in 100
B. 1 in 50
C. 1 in 10
D. 1 in 8

Answer in October's issue.

Coming next month Perimenopause — why it starts earlier than most people expect, and what to do about it.

Thanks for reading. If something here was useful, forward it to someone who needs it.

Dr. Angel Marquez — OB/GYN
Arte & Cera · Education is care

If you're struggling with your mental health: 988 (Suicide & Crisis Lifeline). Postpartum Support International: 1-800-944-4773.