Questions to ask about hormones and food

Most people leave a consultation with a piece of paper and a diagnosis, and the questions arrive afterwards — in the car, or at night, or when somebody asks "so what exactly did they say?".

This article is a set of questions worth asking in a consultation about hormones and food. Not in order to doubt anybody, but because these answers are what determine the shape of the plan, and most of them do not get said unprompted because time is short.

Dr Rana says a consultation sometimes goes by with the patient's whole attention on one question: "what do I eat and what is forbidden to me?" — "when there are far more important questions that could help her understand her own condition."

These are the four she wishes she were asked:

The rest of this article takes those four into a hormonal consultation in particular.

Ask about the diagnosis itself: how was it made?

This is the first and most important question, and the one least often asked.

Polycystic ovary syndrome is diagnosed by a set of criteria rather than by any single finding: disrupted or absent ovulation, signs of raised androgens (clinical or on tests), and the appearance of the ovary on ultrasound. And diagnosis requires excluding other conditions with overlapping symptoms — thyroid problems and raised prolactin among them.

So an ultrasound alone is not a diagnosis. That is a very practical piece of information, because "your ovaries look polycystic on the scan" is a sentence said often, and it turns into a lifelong label.

The international evidence-based guideline for the assessment and management of PCOS, in its 2023 update, takes the point further: it recommends against using ultrasound for diagnosis in the first years after menarche, because ovarian appearance at that age is naturally variable and overlaps with the appearance treated as a sign. And it treats anti-Müllerian hormone as a possible alternative to ultrasound in adults.

So the question to ask is: what exactly was the diagnosis built on? And were the other conditions excluded?

Ask about the tests: what was done, and why?

"Your tests are fine" is a sentence whose meaning depends entirely on what was tested.

Ask for the list of tests themselves, not the summary. And ask, of each: what does it measure, what was the number, and what was the range?

Ask whether anything is sitting near an edge. This is not fussing — it is a legitimate clinical question, and a result at an edge is interpreted alongside symptoms rather than alone.

And if the complaint includes persistent exhaustion, there is a separate article about what "normal" means on a lab report: my results are normal and I am still exhausted.

Ask about the mechanism: what is actually happening in my body?

This looks theoretical and is intensely practical: somebody who understands why she is doing something carries on with it longer than somebody who has memorised that she must.

The central idea in a large proportion of PCOS is insulin resistance. Insulin is a hormone secreted by the pancreas after eating, and its job is to make cells take glucose out of the blood. In insulin resistance the cells respond less efficiently, so the pancreas secretes more to reach the same result, and circulating insulin stays higher than usual.

And the part that connects this to hormones: insulin does not act only on glucose. Raised levels affect the ovary and the production of androgens, and excess androgens are associated with symptoms such as unwanted hair growth, acne and disrupted ovulation.

So ask: is there insulin resistance in my case? How was that established? And how does the change you are proposing act on it?

Ask what else gets checked alongside

PCOS is not only a matter of periods and hair. The international guideline treats it as a condition with metabolic and psychological dimensions as well, recommending attention to markers such as blood glucose, lipids and blood pressure, and asking about mood and anxiety.

That psychological part is always left out, and it is not a detail: a chronic condition affecting appearance and fertility, diagnosed young, has a real effect, and the guideline says so explicitly.

So ask: is there anything else that should be followed over time? And how often?

And ask about the periods themselves

If periods are heavy or irregular, that is information with a direct bearing on food from a direction that is not obvious: repeated blood loss depletes the iron store, and the iron store falls before haemoglobin is affected.

So ask: do my periods have any bearing on my iron stores? And has that been assessed?

Ask about the goal: what exactly are we treating?

This changes the plan more than anything else, and is usually left out.

Somebody who has come about her periods is not somebody who has come about fertility is not somebody who has come about unwanted hair growth is not somebody who has come about glucose markers. Those goals are not in conflict, but they are not the same plan, not the same priority and not the same timescale.

So ask: what is this plan aiming at first? And if I have more than one goal, which is addressed first?

And if the goal is pregnancy, ask specifically: what changes in the ordering of priorities, and what comes before what? That answer differs from case to case, which is exactly why it is a question to ask in the room rather than a fact to read in an article.

And a useful sub-question: how is that goal measured? How will we know we have got there? A goal with no marker attached remains a feeling, and feelings move with mood.

Ask about medication and food together

If something has been prescribed, ask: how does it work? How long before its effect shows? Is there anything in food that affects its timing or its absorption? Are there side effects related to food or to the stomach?

And the reverse question matters as much: does this eating plan have any effect on the medication?

The international guideline treats medications as part of management depending on the case and the goal, and choosing between them is a clinical decision. What is not acceptable is somebody stopping a prescribed treatment on the strength of a post.

Ask about the timescale and the point of reassessment

Two questions that prevent wasted months:

When should I expect to see a change? The answer differs by goal — a marker on a test moves on a different schedule from periods, which move on a different schedule from hair.

And when do we sit down and review if nothing has changed? A plan with no review point continues by inertia.

Ask about the things with no evidence behind them

Ask directly about anything you have heard: that supplement, that diet, cutting out dairy, cutting out gluten.

And the useful answer is neither "that is nonsense" nor "try it, it will not hurt". The useful answer is: how strong is the evidence, does the international guideline say anything about it, is there potential harm, and will it take time away from something that would work better?

There is an article on how to judge those claims: PCOS and food — how to judge a claim.

And ask the question nobody asks: what do I do if something happens?

A plan with no instructions for the bad day is incomplete.

If there is dizziness, severe exhaustion, or a new symptom, what do I do? Who do I contact? Is there anything I should stop immediately?

And if the plan involves a large change in eating while I am taking something that affects glucose: are there precautions? That question matters particularly for anybody on treatment related to blood sugar, because changing food without a corresponding adjustment is the thing that causes problems.

The myth: "asking means I do not trust my doctor"

This keeps a great many people silent, and it is wrong in two ways.

First: a question is not doubt, it is completion. A consultation carries a lot of information said quickly, and memory after an appointment containing a new diagnosis is not at its best. A question fixes the information in place.

Second: a plan somebody understands gets followed better than a plan somebody has memorised. That is not a pleasantry — it is the difference between somebody who knows why she is doing something and somebody doing it until she is tired of it.

The myth spreads because the relationship between patient and doctor in our culture carries deference, and deference is fine but should not prevent a question.

And the myth beside it: "the doctor will not have time". That is sometimes true, which is exactly why the questions should be written down and ordered. Three written questions take less time than ten arriving piecemeal, and come away with more.

In the Egyptian context

Consultations here are usually short, clinics are crowded, and time is compressed. That is a reality that will not change by wishing, and the way to deal with it is to arrive with the questions written down and ordered by importance.

And another thing: a great deal gets said about PCOS within the family. "Your aunt had it and lost weight and it went", "it goes when you marry", "it goes with pregnancy". Those sentences arrive in good faith and create real pressure. What is worth knowing is that PCOS is a condition that is managed and differs between women, and that a relative's experience is not a plan.

Pharmacies dispense a great many supplements without prescription, including things sold specifically for PCOS. Those should be mentioned in the consultation even if they seem trivial.

And ask "why?"

Dr Rana says this is the question she likes to hear: "Why are you asking me to change this meal? Why did we add something or reduce something? Why is this plan the right one for me?"

Because carrying out instructions is not the point: "My aim is not for you to follow instructions and that's that. I want you to understand your body and to know why we are making these changes, so that over time you can make better decisions even without the plan in front of you."

And there is no embarrassing question

There are questions a great many people are too shy to ask, particularly when it concerns periods, appetite, changes in weight, or personal symptoms.

To anybody stopped at that point, Dr Rana says: "There is no embarrassing question here. If something is happening in your body that worries you, or that affects how you eat and how you live, say it."

And anything said has three possible endings, all of them better than silence: "It may be very important information for us; it may be something normal and we reassure you about it; and it may be something we need to go back to a specialist for."

"And most importantly: don't leave the session with a question still in your head because you thought it was too small or too embarrassing."

And finally: ask for the summary in writing. Two lines on the prescription pad — the diagnosis, the goal, the next step — save a month of argument later, and become a reference for anybody else who sees the case.

Worth remembering

Her four first: does my case actually need a change in how I eat? Are there tests to review? Could my symptoms have more than one cause? And what can nutrition help with, versus what belongs with the doctor?

Then the detail: how the diagnosis was made, what was tested, what we are aiming at first, how the medication works, when we review, and what has no evidence behind it.

Write them down before the appointment. Questions kept in your head are forgotten; questions on paper get asked.

As Dr Rana puts it: "The session is not an exam, and there is no 'wrong' question. The more I understand about you, the better the plan we can build for you."

If you want a consultation these questions are part of: PCOS and hormonal nutrition or book an appointment.