There are no cysts in polycystic ovary syndrome. That is not a technicality. The name is one of the reasons a condition that affects one in eight women goes undiagnosed in 70 percent of them. Yemi Famuyiwa, MD is an OB/GYN and fertility specialist. Her argument is that the old name did something specific and harmful: it told everyone which organ to look at. Here is what actually happens. Follicles in the ovary move along what she describes as a conveyor belt. Your brain wakes up a batch, carries them through to maturity, one releases, the belt keeps moving. In this condition somebody jams the belt. A monkey wrench goes in and everything behind it backs up. So on an ultrasound you see a lot of small fluid filled structures pushed out toward the edge of the ovary. Radiologists call it a string of pearls. It is not a field of cysts. Cyst just means fluid filled. Those are completely ordinary follicles that got stuck in traffic, and the picture is a consequence, not the diagnosis. Now follow the patient instead of the ovary. The acne goes to dermatology, which treats the skin and stops at the skin. The hair loss goes to the same place. The rising insulin and the abnormal glucose go to an internist. The abnormal liver enzymes go to whoever handles the liver. The anxiety goes to a psychiatrist. The irregular or absent periods go to a gynecologist, and unless she is trying to get pregnant she may not reach a reproductive endocrinologist at all. Three or four specialists. Each doing their own little thing, in her words. None of them cross talking. Famuyiwa's word for it is silos, and she says the whole entity should be speaking to itself. One trap for anyone reading their own labs: AMH is now part of the diagnosis, and it runs on an age curve. A high value reads like a signal of unusual fertility. It can mean the opposite. That number needs a clinician, not a search bar. Her actual ask is not diagnostic. She says plainly that she does not expect patients to diagnose themselves. She wants the constellation brought to one appointment and one sentence said out loud: can someone put this together for me? And the take home, for anyone with irregular cycles and a pile of unrelated referrals: the right diagnosis is what points you to the right treatment. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. If you diagnose or manage this, which piece of the constellation is the one that walks in first most often? #PCOS #ThePodcastbyKevinMD