An Interview With Dr. Caitlin Fiss

Dr. Fiss earned her medical degree from Brown University School of Medicine. She completed her residency in Obstetrics and Gynecology at Mt. Sinai Hospital in New York City. After graduation, she joined the faculty of the Weill Cornell School of Medicine and began her private practice. She returned to Mount Sinai in 2006 and has been in private practice since that time.

What made you want to pursue a career as an OB/GYN?

I chose Ob/Gyn as a specialty because I love taking care of women and female identifying patients. I love the continuity of care of taking care of adolescents, their moms and also their grandmas!  I now take care of some young women whom I delivered as babies --- and I am not that old! 

Have you developed a particular area of interest or expertise within women’s health?

I am passionate about female reproductive care, and the autonomy and equality that comes with the ability to become a parent when you want to become a parent. That is one of the reasons I love to counsel my patients about their reproductive choices, from different options in birth control to egg freezing to IVF, and the full spectrum of obstetrical care, including delivery.

What’s one surprising thing about women’s health that most women are shocked to find out? 

One thing I find surprising is that most young women do not know what a pap smear is or what it tests for. The pap is a screening test for cervical cancer. In countries where women are not able to get pap smears, cervical cancer is one of the leading causes of death for women. Fortunately, in the United States, most insurance companies recognize the importance of this life saving screening tool and will cover the costs of it. It involves a very quick, but slightly uncomfortable, internal exam by a medical practitioner to collect the cells from the cervix. The sample is then sent to a lab for evaluation. It is one part of the annual gynecological/well woman health check up.

What is PCOS and why do you think more people are finding out about it?

This is PolyCystic Ovarian Syndrome or Resistant Ovary Syndrome or Stein Leventhal Syndrome. It is a spectrum of disease, meaning some people have very mild symptoms and some have more severe symptoms. For most people, these symptoms wax and wane throughout their adolescent years and 20's. Surprisingly, it often improves after childbirth!

I believe more people are finding out about PCOS for several reasons:

1. They are able to discuss the symptoms and irregularities of their cycles with their health care provider in a way that women were not able to many years ago.

2. It is easier and less expensive to send basic blood tests to diagnose PCOS so that we can pick up milder cases in women with very few symptoms.

3. More women have ultrasounds in which very specific findings in the ovaries can be linked to PCOS. The diagnosis of PCOS  is made based on history, ultrasound findings and laboratory results. Two of the three of these diagnostic criteria are needed for the diagnosis.

4.  PCOS is a hyper-androgenic state (meaning a hormonal imbalance with too much androgen--male hormones and their precursors). So, other doctors, like dermatologists, sometimes make the diagnosis. 

5. Lastly, there are now multiple ways to treat PCOS so I believe practitioners are more inclined to try to help make the diagnosis and there are now many options for treatment. 

6. You cannot cure PCOS but you certainly can treat the symptoms. One of the most important things is to screen patients for insulin resistance. Likewise, you cannot prevent it....But you can prevent some of the unwanted and more challenging symptoms from arising!

We’re seeing a lot of women with hormone imbalances after being on birth control pills for years. Why is this happening? 

More women are on birth control pills and staying on them for longer periods of time than ever before. Recently the FDA approved an over the counter option for a birth control pill! Given the many new and severe restrictions to abortion in the US, I suspect even more people will start birth control pills this year. I am actually seeing women who will be living or studying in states with severe abortion bans in effect seeking double methods of birth control!

It is perfectly safe to stay on pills for ten years or longer but when you stop taking the pill, it takes a bit longer for your ovaries to rebound and come back on line -- so to speak. The combination (estrogen and progesterone pills) suppress ovarian function and it can take a little while for them to "wake up" from this suppression. However -- sometimes they come back right away! There is literally no way of knowing how your ovaries will react.

Do you have any strong opinions on birth control pills vs an IUD? 

Birth control pills are still extremely popular amongst women of all ages.  But more and more young women are interested in and requesting IUDs. IUDs are even better birth control protection given that less than 1/100,000 women get pregnant on IUDs per year vs 1/100 on the birth control pill. They are safe to use and have been used by women for over 20 years, making them a great option for young women. 

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