Speaker 1: I want to scream in this mic and say, let
Speaker 1: me tell women what they deserve to know. If you
Speaker 1: take PCOS, seventy five percent of these women are not diagnosed.
Speaker 1: If you take endometriosis, over ninety percent of these women
Speaker 1: are not diagnosed. Wow, endometriosis with PCOS, they're the leading
Speaker 1: cause of infertility on this planet.
Speaker 2: Hey, everyone, welcome back to on Purpose, the place you
Speaker 2: come to become happier, healthier, and more healed. Today's guest
Speaker 2: is someone that I'm extremely excited to talk to because
Speaker 2: it's a subject matter that so many of you have
Speaker 2: been asking me about. If you have questions about PCOS,
Speaker 2: this episode is for you. If you have any questions
Speaker 2: about endometriosis, this episode is for you. And if you're
Speaker 2: someone out there who has friends or family that are
Speaker 2: struggling with fertility, this episode is for you. I'm speaking
Speaker 2: to the one and only Dr A, who is an
Speaker 2: authority in the space, someone who has helped so many
Speaker 2: people go through their fertility journey. Please, welcome to on Purpose,
Speaker 2: Doctor A. Doctor. It's great to have you here.
Speaker 1: Jay. I'm so excited. I'm so excited for you to
Speaker 1: give me this mic and I'll tell you why I'm
Speaker 1: so excited to be here. You know, I've always listened
Speaker 1: to you, and you speak so amazingly to these women,
Speaker 1: to your listeners, basically talking to them about calmness and
Speaker 1: how to get to that calm, about mental health, about meditation,
Speaker 1: And one thing I want the world to know is
Speaker 1: that there are millions of women out there that cannot
Speaker 1: get to this calm space. Not because they're not trying
Speaker 1: hard enough, not because they're spiritually weak. They can't get
Speaker 1: there because they have an underlying condition like PCOS and
Speaker 1: endometriosis that affects their hormones, their inflammatory pathway, and their
Speaker 1: nervous system. And that's why they can't find that calm.
Speaker 1: I sit with women all day long. These are women
Speaker 1: who've struggled for years with endemytriosis and PCOS, debilitating pain
Speaker 1: that they can't even you know, stand up straight, and
Speaker 1: just because no one ever believed them, no one, and
Speaker 1: they dismiss their symptoms. You know, you have these thirteen
Speaker 1: year olds who are literally on the bathroom floor with
Speaker 1: every period, thinking this is normal life and that's life
Speaker 1: for them and they can't really complain about it. Or
Speaker 1: they have women who are ashamed of their body, and
Speaker 1: they go to the doctor and all they hear is
Speaker 1: will just eat less, exercise more, but no one really
Speaker 1: addresses the underlying condition. And I've done this for decades,
Speaker 1: and I reached a point in my life that I
Speaker 1: said enough, enough is enough enough dismissing women enough, normalizing
Speaker 1: their pain, normalizing their symptoms, and telling them it's they're
Speaker 1: in their head, they're crazy, they're anxious. It's none of that, really,
Speaker 1: and it's time to really start listening to these women
Speaker 1: and dealing with these underlying conditions. And that's why. You know,
Speaker 1: millions of women are affected by PCOSN and the metriosis,
Speaker 1: and majority of them are never diagnosed. So that's why
Speaker 1: I'm so excited to be here to take at least
Speaker 1: this hour to bring some awareness to these two conditions.
Speaker 1: So thank you for having me.
Speaker 2: Let's dive in, because, like I said, my audience really
Speaker 2: wants the answer to these questions. I really want to
Speaker 2: shed light on this topic. I really want people to
Speaker 2: feel seen, heard and understood as they're navigating this. But
Speaker 2: you've actually said that we're in the middle of a
Speaker 2: fertility crisis. What does that mean?
Speaker 1: So when you know, let's say you take one hundred
Speaker 1: couples and you have them go try to get pregnant.
Speaker 1: You tell them have sex three to four times a week,
Speaker 1: and then come back in a year. Fifty percent of
Speaker 1: them on average get pregnant in the first six months,
Speaker 1: ninety percent of them are pregnant within a year, and
Speaker 1: ten percent don't get pregnant. Well, in that ten percent category,
Speaker 1: if you take male fertility out, majority of those patients
Speaker 1: have PCOS and endometriosis. The problem is if you take PCOS,
Speaker 1: seventy five percent of these women are not diagnosed. If
Speaker 1: you take endometriosis, I think over ninety percent of these
Speaker 1: women are not diagnosed, so they fall under this unexplained
Speaker 1: infertility because doctors are not diagnosing these underlying conditions.
Speaker 2: What is PCOS? Define it for us.
Speaker 1: So PCOS is a chronic hormonal, metabolic, inflammatory, and neurological
Speaker 1: condition that affects fifteen percent of women in this country.
Speaker 1: If you go to countries like India, that number can
Speaker 1: go north of twenty percent. The problem with it is
Speaker 1: that seventy five percent of these women are never diagnosed
Speaker 1: and they go through life not getting a diagnosis. In
Speaker 1: order to diagnose PCOS, it's very simple. You neque to
Speaker 1: meet two out of the three. Criteria. Number one is
Speaker 1: basically ovarian or ovulation dysfunction. These are women who have
Speaker 1: irregular periods. They get their periods not every twenty eight days,
Speaker 1: they get it like every thirty five days, thirty seven days,
Speaker 1: or they get less than eight periods per year. So
Speaker 1: that's criteria number one. Criteria number two is PCOS looking
Speaker 1: over is on ultrasound, So PCOS is not Polycystic ovary
Speaker 1: syndrome is not cyst To this day, doctors say, oh,
Speaker 1: you don't have assist on your ovary, so you don't
Speaker 1: have PCOS. Polycystic ovary syndrome is a group of follericles.
Speaker 1: It's a specific finding on ultrasound. These are ovaries that
Speaker 1: are enlarged with at least twenty Foller coles and it's
Speaker 1: a specific finding on ultrasound. Again, a lot of doctors
Speaker 1: don't know what to look for. So that's the second criteria.
Speaker 1: And recently for this criteria they added high account or
Speaker 1: high AMH to this criteria. Be for women who can
Speaker 1: have access to ultrasound or they don't you know, or
Speaker 1: their doctor's this ovarian morphology on ultrasound, so elevated account
Speaker 1: also counts as this second criteria, and the third criteria
Speaker 1: is elevated testosterone or androgen symptoms. What are these symptoms?
Speaker 1: Facial hair, body hair, facial acne, body acne, oily skin,
Speaker 1: male pattern, hair thinning, or hair loss. You don't have
Speaker 1: to have all of these symptoms, you have to have one.
Speaker 1: So this is the third criteria, and you need to
Speaker 1: meet two out of these three criteria. PCOS patients, for
Speaker 1: reasons I'm going to go into details, struggle with anxiety
Speaker 1: and depression. They have mood disorder, they're moody people. They
Speaker 1: have really bad PMS. They usually have someone in their
Speaker 1: family who's PCOS diabetic, overweight, insulin resistant. A lot of
Speaker 1: them have an eating disorder or disordered eating, and they
Speaker 1: end up in these eating disorder centers because their PCOS
Speaker 1: is not being diagnosed. It's the leading cause, with endometriosis,
Speaker 1: leading cause of infertility on this planet. Seventy five percent
Speaker 1: of these patients gain weight even though they're eating exactly
Speaker 1: what you and I are eating, exercising exactly the same,
Speaker 1: but they cannot lose a pound. Twenty five percent of
Speaker 1: them are lean, lean PCOS patients. Even these lean PCOS
Speaker 1: patients have eating disorders. So imagine, take this young girl
Speaker 1: who's gaining weight, is in high school, let's say, gaining weight, acne,
Speaker 1: facial hair, can't lose her weight, She's moody, she's anxious,
Speaker 1: she has really bad PMS, and she goes to the
Speaker 1: doctor and the doctor says, there's nothing wrong with you.
Speaker 1: You're probably eating too much.
Speaker 2: So wait, you would know as early as then.
Speaker 1: Oh my god, yes, teenagers, that's you know what I
Speaker 1: always say. If you want, if you go knock on
Speaker 1: the doors of these eating disorder centers, your PCOS patients
Speaker 1: are sitting behind those doors.
Speaker 2: So why is it not getting correctly diagnosed? If it's
Speaker 2: such a big issue, it's affecting so many people, and
Speaker 2: there's so many symptoms through which you can measure it,
Speaker 2: why is it not diagnosed?
Speaker 1: So I think it's multiple reasons. Number one, doctors don't
Speaker 1: consider you know, they don't know enough about PCOS and
Speaker 1: PCOS presents in different morphologies. Once we talk about it,
Speaker 1: you understand why you don't have to have irregular period
Speaker 1: to have PCOS. Some there's a morphology of PCOS patients
Speaker 1: who don't have any elevated testosterone symptoms. They just have
Speaker 1: the irregular period and the PCOS. So remember I said
Speaker 1: two out of the three criteria. You have different combination
Speaker 1: of these symptoms and different presentations of these patients. Some
Speaker 1: are leans, some are overweight, some have irregular periods, some
Speaker 1: have acnes, some have hair loss, some have facial hair
Speaker 1: and body hair. They present differently, so it's very confusing
Speaker 1: to doctors. That's why I'm here to tell you you
Speaker 1: only need to meet two out of the three criteria.
Speaker 1: And if you meet those criteria, then you look for
Speaker 1: the anxiety and the depression and the eating disorder, and
Speaker 1: the weight issues and the insulin resistance and the fertility issues,
Speaker 1: and you put this picture together and you can your
Speaker 1: PCOS patients. I always say, you don't need a doctor
Speaker 1: to really diagnose you. If you listen to this podcast
Speaker 1: from home, you can self diagnose. I'm giving you the
Speaker 1: tools to diagnose yourself. But because PCOS has these underlying
Speaker 1: pillars that affect their entire, their whole body. So it's
Speaker 1: not just a fertility issue, it's not just the period issue.
Speaker 1: Is a total body issue. It affects your mental health,
Speaker 1: it affects your reproductive health. It affects you metabolically, it
Speaker 1: affects your hormones. And until you address every single underlying
Speaker 1: pillar of the driver of these symptoms, you can make
Speaker 1: these patients feel better.
Speaker 2: So if a woman is listening to this right now
Speaker 2: and feel she has PCOS, what's the next thing she
Speaker 2: should do?
Speaker 1: Very good question. So the domino, imagine, the first domino
Speaker 1: of this PCOS storm is insulin resistance. You have to
Speaker 1: understand insulin resistance. What is it? Sulin resistance. When we
Speaker 1: eat carbohydrates, bread, pati, pizza, chocolate, ice cream, our body
Speaker 1: breaks it down into glucose. Glucose stimulates our pancreas to
Speaker 1: release a hormone called insulin. The job of insulin is
Speaker 1: it goes at a cellular level, opens up the receptors
Speaker 1: on our cells. The receptors grab the sugar and put
Speaker 1: it inside the cell where it turns into energy. This
Speaker 1: is what's supposed to happen. But PCOS patients genetically have
Speaker 1: insulin resistance, So when they eat carbohydrates and their body
Speaker 1: releases insulin, their cells are insulin resistant. So these channels
Speaker 1: don't open for the sugar to go into the cell
Speaker 1: and turn into energy. So the sugar bounces in the
Speaker 1: blood and pushes the insulin to go up. Insulin is
Speaker 1: a fat storage hormone. It's an inflammatory hormone. You don't
Speaker 1: want your insulin to go up. So what happens when
Speaker 1: this insulin goes up? Few things happen. Number One, insulin
Speaker 1: tells your liver the cells are not taking up this
Speaker 1: sugar to turn it into energy. Take this sugar and
Speaker 1: store it as fat. The problem is the fat that
Speaker 1: gets stored with insulin resistance is not the good old
Speaker 1: fat under our skin. It's the visceral fat around our
Speaker 1: organs liver and our inner abdominal organs. That's highly, highly inflammatory,
Speaker 1: and we'll get into it later. So one, the high
Speaker 1: insulin tells your body, take this sugar and store it
Speaker 1: into this inflammatory fat. One two, high insulin stimulates their
Speaker 1: ovaries to secrete androgens. So, and this is the first domino.
Speaker 1: Why because when the ovary starts secreting androgens, our menstrual
Speaker 1: cycle completely goes out of whack. I want to take
Speaker 1: a minute to tell you what a normal menstrual cycle
Speaker 1: look like and what it looks like for these poor
Speaker 1: PCOS patients. So, in a normal menstrual cycle, our brain,
Speaker 1: our hypothalamus releases GnRH, which is a hormone that affects
Speaker 1: the pituitary gland, an other gland in our brain that
Speaker 1: releases two hormones FSH and LH. When this GnRH is
Speaker 1: being released slowly, the pituitary gland releases a hormone called FSH.
Speaker 1: FSH effect stimulates our ovaries, the follicles in the ovaries
Speaker 1: to start growing for that cycle, and these follicles, as
Speaker 1: they grow, they start releasing estrogen. The estrogen they release,
Speaker 1: it gets the lining of the uterus ready for pregnancy,
Speaker 1: because that's the job of the ovaries helping us get
Speaker 1: pregnant every month. So these ovaries basically release these follicles
Speaker 1: release these estrogens, and the estrogen stimulates the lining of
Speaker 1: the uterus. While these estrogen is being released, it has
Speaker 1: a negative feedback on our brain. When the estrogen levels
Speaker 1: hit a very high level, it actually stimulates this GnRH
Speaker 1: secretions from the hypothalamus to go faster. And when the
Speaker 1: GnRH starts firing faster, the FSH slows down and the
Speaker 1: LH surge comes. And LH is a hormone that is
Speaker 1: a lutinizing hormone and it causes the ovulation, so it
Speaker 1: pushes one follicle out, and that's when the egg gets released.
Speaker 1: And if we're trying for pregnancy, the sperm comes up,
Speaker 1: the embryo forms, and now the lining of the uterus
Speaker 1: is nice and juicy, and the embryo implants and the
Speaker 1: pregnancy happens. What happens with PCOS patients, remember the insulin resistance.
Speaker 1: That first domino starts stimulating the THIKA cells in the
Speaker 1: ovary to release androgens. When you start having androgens in
Speaker 1: the ovary, it freezes these follicles and doesn't let them
Speaker 1: grow normally, so then the estrogen starts becoming erratic and
Speaker 1: you have and when your androgen levels go up, the
Speaker 1: androgens stimulate the GnRH to go faster, and then the
Speaker 1: LH starts going faster, and the LH constantly stimulates these
Speaker 1: ovarian tissues, the THEKA cells to release more androgens. So
Speaker 1: you start in PCOS patients, you start getting this environment
Speaker 1: of high androgens and these irregular estrogen secretions that not
Speaker 1: only block ovulation, block implantation, affects our causes irregular periods,
Speaker 1: but it starts affecting our brain because the androgens affect
Speaker 1: our mental health, and we can go over that later.
Speaker 1: But this is what happens, and this is why seventy
Speaker 1: to eighty percent of PCOS patients don't ovulate. Of the
Speaker 1: twenty thirty percent of them who ovulate, they ovulate sometimes
Speaker 1: even the ones who have regular periods. They're regular periods.
Speaker 1: It's not because necessarily they're ovulating. It's because they're getting
Speaker 1: withdrawals from this estrogen. It gets very complicated. But the
Speaker 1: human the women's hormonal system is so beautiful when you
Speaker 1: really understand and it. It becomes very complicated with these
Speaker 1: PCOS patients, and that is why it becomes a vicious cycle. Right, So,
Speaker 1: the insulin resistance starts reproducing androgens in the ovary. The
Speaker 1: androgens affect the brain to release more LH. The LAH
Speaker 1: affects the ovaries to secrete more androgens out and this
Speaker 1: becomes a vicious cycle that doesn't stop. And so the
Speaker 1: first underlying condition is this insulin resistance. The second underlying
Speaker 1: pillar is this androgen being it.
Speaker 2: Is there anything women can do about that insulin resistance?
Speaker 1: Absolutely?
Speaker 2: What do they do. Let's focus on that one and
Speaker 2: then we'll move to the others.
Speaker 1: Absolutely, So for this pillar of insulin resistance, you want
Speaker 1: to make patients insulin sensitive, right, So there are many
Speaker 1: supplements that can make patients insulin sensitive. And that's why
Speaker 1: I don't know if you know I have an OV
Speaker 1: platform and I have a supplement. PCOS is actually one
Speaker 1: of those conditions that supplements actually play a huge role
Speaker 1: in it. Why because by making a you want to
Speaker 1: reduce for this insulin resistance pillar A, you want to
Speaker 1: reduce the glucose in the blood. Right, So you tell
Speaker 1: the patients decrease your carbohydrates. If you're eating carbohydrates, go
Speaker 1: for a walk ten minutes twenty minutes after each meal.
Speaker 1: When we walk, we actually wake up these insulin receptors
Speaker 1: and they start grabbing sugar out of the blood. So
Speaker 1: we lower the sugar so low carbsize.
Speaker 2: By having a ten minute walk after each after.
Speaker 1: Each meal, so eat less carbohydrate, walk ten twenty minutes
Speaker 1: after each meal. Exercise makes a huge difference, obviously, in
Speaker 1: addition to the walking after each meal. Then we go
Speaker 1: to supplements. There are supplements like my OV supplement. These
Speaker 1: supplements work at a cellular level to open up these
Speaker 1: channels and pull the sugar in my ov supplement also
Speaker 1: has one wild mulberry leaf in it, and what that
Speaker 1: does if you take it before your heaviest meal, If
Speaker 1: you take the supplement before your heaviest meal, it actually
Speaker 1: blocks the absorption of carbohydrate in that meal by forty percent.
Speaker 1: So now you're decreasing the load of sugar you're also
Speaker 1: and whatever gets absorbed, you're pushing it. You're opening these
Speaker 1: channels and pushing it into this cell, so you're clearing
Speaker 1: that sugar out of the blood. By doing that. What happens,
Speaker 1: your insulin goes down. When insulin goes down, your fat
Speaker 1: storage goes down, your weight management becomes easier. When insulin
Speaker 1: goes down, your ovaries are not secreting as much androgens.
Speaker 1: Your androgens go down, androgens go down. What happens your
Speaker 1: ovulation becomes more regular, the inflammation goes down. So that's
Speaker 1: how the supplements work. And the ov has a lot
Speaker 1: of anti inflammatory supplements. But there's prescription medication met forman.
Speaker 1: What does metforman do. Metforman makes us insulin sensitive. Anything
Speaker 1: that makes you insulin sensitive again lowers that insulin.
Speaker 2: Are there any side effects to either of this?
Speaker 1: So the supplements don't have any side effects. Met Foreman
Speaker 1: does have side effects, but patients get used to it.
Speaker 1: The most common side effect with met Foreman is nausea
Speaker 1: or diarrhea, but most patients do really, really well. The
Speaker 1: next thing patients can do are glp ones. I'm sure
Speaker 1: you've heard of the ozempics and the wagovis and the urzeppetites.
Speaker 1: So in twenty fourteen I started treating my PCOS patients
Speaker 1: with GLP one, so almost twelve years ago, so none
Speaker 1: of these medications are new. But back then I had
Speaker 1: trulicity glp ones. Why do PCOS patients love GLP ones?
Speaker 1: I started treating them, and one thing I realize is
Speaker 1: not only they're losing a lot of weight, but glp
Speaker 1: ones regulates their insulin and makes them insulin sensitive. By
Speaker 1: doing that, they that's why patients say, oh when I
Speaker 1: take I don't know met foreman, or when I take oh,
Speaker 1: or when I take. When I use these glp ones,
Speaker 1: I get brain clarity, I get pregnant. My periods are
Speaker 1: becoming more regular because at its core, you're fixing this
Speaker 1: insulin resistance. So for this pillar, this underlying condition, I
Speaker 1: say low carbohydrate diet, walk ten to fifteen minutes after
Speaker 1: each meal, exercise cardio at least four times a week.
Speaker 1: I recommend the OV supplement. It works amazingly well. Take
Speaker 1: ask your doctor for a met form in prescription. The
Speaker 1: minimum dose of met forman to affect insulin resistance is
Speaker 1: fifteen hundred, so you want to start with seven hundred
Speaker 1: and fifty at night. If you have no nausea or
Speaker 1: no diarrhea, you want to increase it to twice a day.
Speaker 1: Then if you have weight issues, if you have a
Speaker 1: hard time losing weight, if your BMI is in the
Speaker 1: obese category, or if you're overweight with high blood pressure
Speaker 1: or high cholesterol, then I recommend the GLP ones. You
Speaker 1: can do the ozempeg, wagov. They all work really really well.
Speaker 2: Talk to me about the nutritional impact of being on
Speaker 2: gop one because the friends that I know that have
Speaker 2: been taking it, they're not getting nutrients because they're not
Speaker 2: eating as much anymore. And that obviously sounds like it
Speaker 2: has terrible effects on the body. I not be able
Speaker 2: to actually.
Speaker 1: Eat, you know, and I.
Speaker 2: Can use weight, but you're not eating.
Speaker 1: Yes, But remember we're talking. I'm talking right now about
Speaker 1: my PCOS patients. I'm not talking about that, you know,
Speaker 1: perimenopausal woman or someone out there who wants to lose
Speaker 1: ten pounds five pounds. Patients who are already underweight and
Speaker 1: they want to lose ten more pounds and you know
Speaker 1: they're not eating. This is four PCs, this is this
Speaker 1: is for pcos. I mean twenty fourteen I started using
Speaker 1: these medications. It's a game long someone to conceive, So
Speaker 1: it depends, it depends. So for someone who wants to
Speaker 1: lose one hundred pounds, you know, they might have to
Speaker 1: stay on it for two two and a half years.
Speaker 1: And the reality of it is, you know, insulin resistance
Speaker 1: metabolic health is not a one size fits all. Someone
Speaker 1: who loses one hundred hundred and fifty pounds with glp
Speaker 1: ones is probably never going to get off of these mets,
Speaker 1: you know. But their patients, my PCOS patients who want
Speaker 1: who I don't know. They lose thirty pounds, forty pounds,
Speaker 1: fifty pounds on these glp ones. But what I do.
Speaker 1: I keep them on ov and met foreman after they
Speaker 1: lose their weight. So if someone has insulin resistance, you
Speaker 1: give them glp ones and you stop it. What's going
Speaker 1: to happen? They shoot back up. Right, take a pcos patience.
Speaker 1: Her insulin resistance is not going away. You give her
Speaker 1: GLP one, You address her insulin sensitivity, you regulate her insulin.
Speaker 1: She loses fifty pounds. You stop it. The patient comes
Speaker 1: back three months later, she's like, doctor, I gain all
Speaker 1: of my weight back. Why because you did not address
Speaker 1: the underlying condition. So what I do with my patients
Speaker 1: if you're starting on glp ones in about three four months,
Speaker 1: when they get used to the GFP one, that's when
Speaker 1: I introduce the MET format. And right when I start
Speaker 1: them on the GLP ones, I have them take the
Speaker 1: OV supplement. So when I'm ready to stop the golp ones,
Speaker 1: they're already on the OV supplement, They're already on the
Speaker 1: MET format. I'm addressing their inflammation, I'm addressing their insulin resistance.
Speaker 1: I'm decreasing the load of carbohydrate that's being absorbed in
Speaker 1: their diet. And then I wean them off of the
Speaker 1: GLP one. You have to address the underlying disorder. If
Speaker 1: that makes sense.
Speaker 2: Yeah, So what's the second pillar?
Speaker 1: So the second pill is the hormone pillar that I
Speaker 1: was explaining. When the when the insulin resistant stimulates your
Speaker 1: ovaries to secrete androgen. The androgen actually affects your GnRH secretion.
Speaker 1: It makes it very rapid. And this rapid secretion of
Speaker 1: GnRH causes a shift in the LH FSH, So the
Speaker 1: FSH kind of stays down and the LH chronically stays up.
Speaker 1: So instead of only going up mid cycle causing ovulation
Speaker 1: all month, this LAH is firing. What does LH do
Speaker 1: It stimulates your ovaries to release androgens. So then it
Speaker 1: becomes a vicious cycle. You have these androgens that block ovulation,
Speaker 1: and you have these androgens that are free floating in
Speaker 1: the system causing facial hair, body hair, irregular period acne
Speaker 1: oily skin. And on top of that, these androgens are
Speaker 1: affecting your brain, which we'll talk later. So this is
Speaker 1: the second pillar. And for this pillar, not only you
Speaker 1: want to deal with the insulin resistance. This is when
Speaker 1: we give patients birth control pills, right, and birth control
Speaker 1: pills help help regulate this vicious cycle. The third pillar,
Speaker 1: which is extremely important and nobody talks about, is chronic inflammation.
Speaker 1: These poor PCOS patients have chronic inflammation in their body.
Speaker 1: This chronic inflammation, remember I told you with the insulin resistance.
Speaker 1: The liver takes this sugar and turn it turns it
Speaker 1: into a visceral fat. Visceral fat is highly inflammatory. Insulin
Speaker 1: resistant increases this inflammation. PCOS patients are stressed out, they
Speaker 1: have high cortisol. Cortisol increases inflammation. These follicles that I
Speaker 1: tell you freezing the ovaries and they're not ovulating, are
Speaker 1: highly inflammatory. These PCOS patients have sleep disturbances. Sleep disturbance
Speaker 1: causes increase in the inflammatory markers in our body. These
Speaker 1: PCOS patients have got this BioC This increases this inflammation.
Speaker 1: So they have so many reasons for this inflammation to
Speaker 1: go up. As this inflammation goes up, it makes their
Speaker 1: insulin resistance worse. Inflammation stimulates more androgen secretions from the ovaries,
Speaker 1: and inflammation again affects their mental health. So this again,
Speaker 1: this third pillar adds to the first two pillars, just
Speaker 1: pushing androgens out and increasing the inflammatory.
Speaker 2: What do you suggest for that third pillar?
Speaker 1: The third pillar, you have to address insulin resistance, which
Speaker 1: is the key form antioxidants. Anti inflammatory diet is very
Speaker 1: very important. So there are lifestyle changing, lifestyle changes, exercise,
Speaker 1: you know, dealing with that visceral fat, blocking that visceral
Speaker 1: fat lowering, your stress, exercising, sleeping, anti inflammatory diet, that lifestyle,
Speaker 1: you know, not always. I read this somewhere that you
Speaker 1: know your genetics load the gun, but your lifestyle pulls
Speaker 1: the trigger. And that's exactly what happens with PCOS. If
Speaker 1: you're not sleeping, if you're stressed, if you have a
Speaker 1: poor diet, if you're not exercising, you're pulling that trigger
Speaker 1: and making all these symptoms so much worse. The last pillar,
Speaker 1: which is your pillar, is the pillar is the neurologic
Speaker 1: pillar of PCOS, which is huge. So with the first pillar,
Speaker 1: with the second pillar, and with the third pillar, what
Speaker 1: do we have unstable estrogen levels that fluctuate. We have
Speaker 1: high androgens pumping in their blood every single day, and
Speaker 1: we have high high inflammatory markers in a woman with
Speaker 1: a normal menstrual cycle, when the estrogen is normal, when
Speaker 1: the cortisol is leveled, when there's no insulin resistance, when
Speaker 1: the inflammation is down estrogen normal estrogen levels actually are
Speaker 1: calming on the brain. Normal estrogen levels stimulate serotonin in
Speaker 1: our brain, lower anxiety and depression. They regulate our dopaminy
Speaker 1: in the brain, so we're more motivated. Basically, amygdala, which
Speaker 1: is the part of our brain where all the emotions
Speaker 1: are stored. It's regulated and it calms our amygdala down. Estrogen,
Speaker 1: so estrogen has a calming effect. Progesterone has the same
Speaker 1: calming effect. It binds GABA receptors in the brain and
Speaker 1: it calms it down. What happens with pcos there is
Speaker 1: unstable estrogen, there's lack of progesterone, and the androgens are
Speaker 1: going crazy. So if you think of our limbic system,
Speaker 1: which I'm sure you talk about all the time, our
Speaker 1: limbic system is our amygdala, are a hippocampus, and our hypothalamus.
Speaker 1: This is the emotional headquarter of our brain. So all
Speaker 1: the emotions are in these three areas of our brain.
Speaker 1: Estrogen and progesterone calms it down. But when estrogen is unstable,
Speaker 1: when progesterone is low, and when androgens are going crazy,
Speaker 1: serotonin levels go down. As serotonin levels go down, we
Speaker 1: become anxious, depressed, irritable. The dopamine goes crazy, our motivation
Speaker 1: goes down. We feel tired, fatigued, unmotivated. The amygdalah goes crazy,
Speaker 1: and becomes hyperactive. That's our fear center. We get anxious,
Speaker 1: we get scared, we can't control our emotions. And as
Speaker 1: the inflammation goes up in our brain, what happens. We
Speaker 1: start having brain fog. We feel like our brain is
Speaker 1: not functioning, we feel like we're not sharp. So take
Speaker 1: a pcos patients all day long with unstable estrogen progesterone
Speaker 1: that's low, you have this androgens pumping up and this
Speaker 1: inflammatory markers high up in their brain, making them feel
Speaker 1: ankus and sad and depressed and irritable and brain fog
Speaker 1: and all of it. And what happens People tell them,
Speaker 1: you have a personality disorder. You're crazy. Go see a psychiatrist,
Speaker 1: you know. And on top of all this, with the inflammation,
Speaker 1: with all these hormones changing in the brain, with insulin resistance,
Speaker 1: they get food cravings, They binge eat. That's why they
Speaker 1: have eating disorders. So I'm here to say that if
Speaker 1: you're sitting at home, if you have irregular peers, if
Speaker 1: you're gaining weight, if you feel inflamed, if you have acne,
Speaker 1: hair loss, facial hair, body hair, if you're anxious, if
Speaker 1: you're depressed, if you're not motivated, all of these could
Speaker 1: be PCOS. It is probably PCOS. And until you deal
Speaker 1: with these four pillars and address each one of them,
Speaker 1: you can't feel normal. So throwing a birth control pillar
Speaker 1: at these patients that's why they don't feel better. And
Speaker 1: you know, to this day, I listen to podcasts when
Speaker 1: even gynecologists, very well known gynecologists, show up, and when
Speaker 1: they're asked what is the treatment for PCOS? They say
Speaker 1: birth control pill?
Speaker 2: That's why I would they suggest that that is? What
Speaker 2: would that do?
Speaker 1: What's the hope to regulate the periods and help stimulate
Speaker 1: the sex hormone binding globulin that's low in the blood
Speaker 1: that causes elevations in the andandrogens. It works with their symptoms,
Speaker 1: It regulates their periods, their acne clears up, their facial hair,
Speaker 1: body hair, hair loss gets better. But you're not addressing
Speaker 1: their inflammation, you're not addressing the core insulin resistance, and
Speaker 1: you're not addressing this neurological effect that PCOS has these
Speaker 1: poor patients. I mean my heart aches. That's why I
Speaker 1: take time out of my office to come and sit
Speaker 1: with you here on a busy day, because I want
Speaker 1: to scream. I want to scream in this mic and say, doctors,
Speaker 1: healthcare providers, listen to your patients. But unfortunately, our healthcare
Speaker 1: system is not built to listen to women. People still say.
Speaker 1: Doctors are still telling these patients, you don't have a
Speaker 1: high testosterone in the blood, so you don't have PCOS.
Speaker 1: That's not true. You don't have irregular periods, you don't
Speaker 1: have PCOS, that's not true. You don't have cysts on
Speaker 1: your ovaries, so you don't have PCOS. But I want
Speaker 1: I come today to tell you, especially for women listening
Speaker 1: to your podcast with anxiety, with depression, with eating disorders,
Speaker 1: with a lack of motivation, with a hard time getting
Speaker 1: themselves to this beautiful calm, that you can get yourself too.
Speaker 1: You know, it's because their body is on fire, their
Speaker 1: brain is on fire, their hormones are raging, their androgens
Speaker 1: are out of control, and their inflammation and inflammatory mark
Speaker 1: are off the chart, and someone needs to go to
Speaker 1: their rescue. Someone needs to start listening to that.
Speaker 2: Yeah, it's so hard to hear that so many people
Speaker 2: have sadly been given the wrong advice and people are
Speaker 2: struggling and suffering, and is there a checkup that you
Speaker 2: can do to get diagnosed or is it just diagnosed
Speaker 2: based on symptoms? Like is there an actual way of
Speaker 2: knowing and checking?
Speaker 1: Thank you for this question. So I because of years
Speaker 1: of doing this, I actually created a free calculator free
Speaker 1: It's on ovovii dot com Go answer. I ask questions
Speaker 1: that I ask my patients in my office, and with
Speaker 1: a very smart scientist, I figured out an algorithm. Obviously
Speaker 1: I cannot diagnose online, but I can tell patients with
Speaker 1: very high accuracy if they have the likelihood of having PCOS,
Speaker 1: and this calculator does that for them. So if they
Speaker 1: go on ovii dot com answer these questions for free,
Speaker 1: I can tell them whether or not they have pcos.
Speaker 1: And if they have PCOS, I want them to listen
Speaker 1: to this podcast to you know, I created CMD just
Speaker 1: to give women this information because until you make them
Speaker 1: become their own health advocate, they will get dismissed in
Speaker 1: the healthcare system. So by listening to these podcasts, they
Speaker 1: become their own health advocate so they can fight further symptoms.
Speaker 1: For when they go to that obgy and visit, they
Speaker 1: are ready. They've taken they've listened to this podcast, they
Speaker 1: already know they probably have pcos, they go take the
Speaker 1: OV tests. They know, you know, based on the OV
Speaker 1: tests whether or not they have the likelihood of having pcos.
Speaker 1: And if they listen to my podcast, I literally give
Speaker 1: them the bullet points. They can print it out, take
Speaker 1: it to the doctor, and become their own health advocate. Honestly,
Speaker 1: until we have a bet our healthcare system and we
Speaker 1: educate our doctors not to dismiss women, this is what
Speaker 1: we have for now, making women become their own health advocate.
Speaker 2: Yeah. That's a real masterclass on pcos that I think
Speaker 2: is going to help so many people figure it out quickly.
Speaker 2: And I like those steps of being able to understand
Speaker 2: it whether you have it yourself, being able to do
Speaker 2: the test, and then going to your doctor and being
Speaker 2: able to list all the symptoms and have an educated
Speaker 2: conversation seems like an important step absolutely.
Speaker 1: And you know, to this day, I get patients they're like,
Speaker 1: you know, I listened to your podcast. I went to
Speaker 1: my doctor and I said, I have insulin resistance. You
Speaker 1: need to give me met forman And the doctor says, well,
Speaker 1: you're not diabetic. Met formulis for diabetes. Do you know
Speaker 1: what I'm saying? But that's why these podcasts are so important.
Speaker 1: So what I'm trying to tell to your listener is,
Speaker 1: listen to this podcast. You don't need a doctor to
Speaker 1: diagnose you. If you meet two of the three criteria
Speaker 1: that I listed at the beginning, you know you have PCOS. Right,
Speaker 1: learn about it. Learn about all these pillars that I'm
Speaker 1: telling you. I'm literally giving you the tools of what
Speaker 1: you can do at home with diet, with exercise, supplements,
Speaker 1: with lifestyle changes to you know, help yourself, and then
Speaker 1: you can address all these things. You know, sometimes I
Speaker 1: start my patients on the supplement and they come back
Speaker 1: and they're like, doctor, this month, my PMS symptoms were better,
Speaker 1: but they can't figure out why. Why. Because when you
Speaker 1: address that metabolic health issue at its core, the puzzle
Speaker 1: falls into place, The inflammation falls into place, the brain
Speaker 1: health falls into place, the periods, the hormones, everything starts working.
Speaker 2: Let's talk about endometriosis. My first question was around do
Speaker 2: periods have to be painful? Should they be painful?
Speaker 1: No? So painful periods are not normal? So what does
Speaker 1: that mean? It's okay to have cramps? You know, we
Speaker 1: all have cramps. You take a couple of advils, it
Speaker 1: gets better. It doesn't disrupt your life. You don't end
Speaker 1: up in the emergency room. You're not in the urgent care.
Speaker 1: You're not calling your mom to pick you up from school.
Speaker 1: You're not on the bathroom floor vomiting from pain. That's normal.
Speaker 1: But if it starts disrupting your life, then it's not normal.
Speaker 1: If I could print a T shirt that said painful
Speaker 1: periods are not normal, I would do it because to
Speaker 1: this day, unfortunately in our healthcare system, women are told
Speaker 1: that painful periods normal, that it's in their head, that
Speaker 1: they're being dramatic. None of it is true. So if
Speaker 1: moms are listening, if women who are listening are experiencing
Speaker 1: severely painful period that disrupts their life. If they cannot
Speaker 1: have sex, and when they have sex with deep penetration,
Speaker 1: they're having pain. If they have recurrent bladder symptoms, they
Speaker 1: go to the doctor, their urine culture is negative, but
Speaker 1: they keep having bladder symptoms. Burning with your nation. If
Speaker 1: they have painful bowel movements, if they have chronic pelvic pain,
Speaker 1: if they have chronic bloating and they chronically feel inflame,
Speaker 1: that's enemy triosis until proven otherwise, endometriosis with PCOS together,
Speaker 1: they're the leading cause of infertility on this planet. Can
Speaker 1: you imagine, and majority of these women are not being diagnosed.
Speaker 2: So you find endometriosis for me.
Speaker 1: So endometriosis is a chronic inflammatory and neural immune condition
Speaker 1: that affects ten to twenty percent of women on the planet.
Speaker 1: Close your eyes and think of these women, right, so
Speaker 1: you know someone is the point, absolutely single one of us.
Speaker 1: Have someone right with enemytriosis. And basically endometriosis is when
Speaker 1: tissues similar to the lightning of the uterus is outside
Speaker 1: of the uterus, around the tubes, ovaries, on the bladder,
Speaker 1: on the bough, on our diaphragm, and in a very
Speaker 1: in rare cases you can find it in the lungs,
Speaker 1: in the brain. And what happens if you think of
Speaker 1: the menstrual cycle. Every month, our ovaries are trying to
Speaker 1: get us pregnant, so they secrete estrogen to get the
Speaker 1: lining of the uterus ready for pregnancy. And when we
Speaker 1: don't get pregnant at the end of the month, the
Speaker 1: lining comes out well. Once a month. When these ovaries
Speaker 1: are secreting estrogen, these endometriosis implants also get stimulated, and
Speaker 1: as they get stimulated, when we don't get pregnant and
Speaker 1: the lining breaks down, these guys also break down, but
Speaker 1: they break down and bleed outside of the uterus. Blood
Speaker 1: is an irritant and it causes inflammation, bloating, pain, scar
Speaker 1: tissue adhesions. What's interesting about enemytriosis is there are so
Speaker 1: many theories of why so many women have it right,
Speaker 1: and one of the main theories is that when when
Speaker 1: we get our menstrual cycle, as we're bleeding, the blood
Speaker 1: that's shedding, the lining that's breaking, some of those cells
Speaker 1: come from the endometrial cavity into the tubes, out the
Speaker 1: tubes and they implant into the pelvis. In a normal
Speaker 1: immune system, our immune system attacks those cells and clear
Speaker 1: it out. Patients with endometriosis, their immune system is not
Speaker 1: functioning well, so when these cells retrograde, flow from the
Speaker 1: uterine cavity out inside the tube and implant into the pelvis,
Speaker 1: their immune system, instead of getting rid of these cells,
Speaker 1: actually help these cells stick to the walls of the pelvis,
Speaker 1: and once they stick there and there's inflammation around them,
Speaker 1: it's literally like a horror movie. They start grabbing onto
Speaker 1: vessels and they grow nerve fibers, and these nerve fibers
Speaker 1: start causing these pain and depending on where this nerve
Speaker 1: fiber is, it can cause different kind of pains. It
Speaker 1: can cause bladder pain, bow movement pain, sciatic pain, back pain,
Speaker 1: leg pain, pelvic pain. So but the worst part of
Speaker 1: this Eventually, as these nerve fibers start firing and firing
Speaker 1: and firing, our central nervous system becomes sensitized. So what
Speaker 1: happens is their brain starts basically cranking up the volume
Speaker 1: on these pain fibers, so they start experiencing more and
Speaker 1: more and more severe pain. So that's why it's not
Speaker 1: only you know, a pelvic pain issue, a fertility issue,
Speaker 1: a pain issue, but it's a central nervous system issue.
Speaker 1: And chronically, because it takes doctors nine to eleven years
Speaker 1: to diagnose these women, and because majority of these women
Speaker 1: men go undiagnosed, this chronic pain, this chronic inflammation that
Speaker 1: comes from these inflammatory tissue in the pelvis, starts affecting
Speaker 1: their central nervous system. They start becoming anxious, brain fog depression,
Speaker 1: their amygdala, their limbic system is literally on fire twenty
Speaker 1: four to seven to a point that they become so
Speaker 1: fearful and so anxious of these periods, and because doctors
Speaker 1: are not addressing it, what do they do. They start
Speaker 1: taking pain pills, They become addicted to these narcotics. They
Speaker 1: start second guessing themselves because they keep going to the
Speaker 1: doctor saying, I have painful periods, I don't feel well,
Speaker 1: and the doctor says, there's nothing wrong with you, that
Speaker 1: it's in your head, that you're anxious, that you're crazy,
Speaker 1: that you probably need to see a psychist. Do you
Speaker 1: understand what I'm telling you?
Speaker 2: Yeah, it's I mean, it's it's shocking and traumatic.
Speaker 1: That's why they have PTSD. That's why they end up
Speaker 1: in therapy. That's why they end up getting ketymine treatment.
Speaker 1: That's why they end up using MDMA psilocybin, because doctors
Speaker 1: are not addressing this and they literally feel crazy. Can
Speaker 1: I tell you on Fridays I operate, majority of the
Speaker 1: patients I operate on are enemytriosis. I mean, I have
Speaker 1: endo endo endo. It's a lineup of enemeytriosis patients. Will
Speaker 1: you believe me if I told you that every single
Speaker 1: patient when I diagnose them in my clinic with endometriosis,
Speaker 1: or when I wake them up from surgery and I
Speaker 1: tell them the stage of their endometriosis. The first thing
Speaker 1: they do, they cry and they say, I feel validated.
Speaker 1: The problem with enemy triosis is the same doctors who
Speaker 1: are dismissing these patients are telling these patients that the
Speaker 1: only way to diagnose enemy triosis is surgery. That's an
Speaker 1: old school way of thinking about enemytriosis. I'm here to
Speaker 1: let your listeners know that endometriosis is a clinical diagnosis,
Speaker 1: and yes, the patient can self diagnose at home. If
Speaker 1: you have debilitating pain with your periods, that's disrupting your life.
Speaker 1: You're missing school, you're not going to work, you're changing
Speaker 1: your social calendar. You plan your trips around your periods,
Speaker 1: that's endometriosis until proven otherwise. If you have painful uh
Speaker 1: sex with deep penetration, if you can't have sex, that's
Speaker 1: endometriosis until proven otherwise. If you have chronic inflammation, BOUD
Speaker 1: movement with pain, your bladder pain, these are all telltale
Speaker 1: signs of endemetriosis. And all we need to do is
Speaker 1: our healthcare providers to start listening to these patients. You
Speaker 1: need to listen for five minutes to diagnose endometriosis with
Speaker 1: over ninety percent accuracy. Surgery is not to diagnose. Surgery
Speaker 1: is to treat only if hormonal suppression fails. Why endometriosis implants?
Speaker 1: These tissues in the pelvis are highly inflammatory, and what
Speaker 1: they do. They're estrogen dependent, but they don't depend on
Speaker 1: the estrogen from the ovary. That inflammation actually stimulates this
Speaker 1: enzyme aromatase in the tissue that starts producing estrogen. So
Speaker 1: they become self sufficient. They make their own estrogen, They
Speaker 1: cause their own inflammation, They have their own blood vessel,
Speaker 1: and they have their own nerve fibers that's constantly firing
Speaker 1: and until this central nervous system becomes sensitized. So what
Speaker 1: happens to these implants. They love estrogen, so you don't
Speaker 1: want to give it estrogen, and they become very progesterone resistant.
Speaker 1: So one of the ways to treat them hormonally is
Speaker 1: to either give them progesterone or take the estrogen away.
Speaker 1: How do you give these implants progesterone? Progesterone birth control pails,
Speaker 1: progesterone IUDs, Kylina morena like letta, they're different forms of
Speaker 1: progesterone IUDs work amazingly well for these patients. However, sometimes
Speaker 1: patients with the progesterone IUDs are still having pain. Why
Speaker 1: because these implants are progesterone resistant. So if you start
Speaker 1: with a progesterone birth control progesterone IUD and you're still
Speaker 1: having pain, you can actually take medications that are GnRH
Speaker 1: agonists or antagonists. These are medications like or Lyssa my
Speaker 1: femor that. What they do they actually take that estrogen away,
Speaker 1: and by taking that estrogen away, they calm down these
Speaker 1: endometriosis implants. The problem with this group of medications are
Speaker 1: because they take the estrogen away, they can cause hot flashes,
Speaker 1: night sweats, mood changes, and these patients are already anxious
Speaker 1: and depressed, so sometimes they don't tolerate it well. But
Speaker 1: if all fails, then you do laparoscopic surgery to resect endometriosis.
Speaker 1: But here's the problem with laparoscopic surgery. I honestly can
Speaker 1: sit here and tell you that less than one percent
Speaker 1: of GYNs can operate on endometriosis with advanced disease.
Speaker 2: And what comes as an advanced disease how long.
Speaker 1: In deep infiltrated implants in vowel in bladder. You know,
Speaker 1: endometriosis causes a lot of adhesions, so you have to
Speaker 1: be able to know to operate on that.
Speaker 2: So you're saying there's no cure, it's more hormonal balance.
Speaker 1: Hormonal balance and surgery makes a huge difference. It's still
Speaker 1: gold standard to treat these patients, but because these patients
Speaker 1: don't have access to surgeons who are familiar with endometriosis surgery,
Speaker 1: it's always best to start with hormonal suppression first. And
Speaker 1: if they need surgery and they still having painful sex,
Speaker 1: and they still have experiencing pain with their periods, then
Speaker 1: I would recommend searching for an endometriosis surgeon.
Speaker 2: How long does the hormonal suppression take like that at
Speaker 2: least four months?
Speaker 1: At least four months, Because your body is not a
Speaker 1: light switch, you can't say on off, on off.
Speaker 2: Have you seen success with people coming to you and
Speaker 2: taking your advice? Are you seeing people cure and recover
Speaker 2: and feel completely different or is it more that you're
Speaker 2: that people are just managing there's no cure.
Speaker 1: But in my practice, it's extremely rare for me to
Speaker 1: have a patient with chronic pain. I fix everyone. I
Speaker 1: always start with hormonal suppression if that fails, or if
Speaker 1: they're actively trying for pregnancy and they can't get pregnant,
Speaker 1: then I do laparoscopic surgery. Here the points with laparoscopic
Speaker 1: surgery A you need a laparoscopic surgeon who's done endometriosis surgery. B.
Speaker 1: In my opinion, if you give hundred gynecologists hundred laparoscopes
Speaker 1: and say go operate, half of them will wake the
Speaker 1: patient up and say, you didn't have nymetriosis.
Speaker 2: Wow, how's that PoCA?
Speaker 1: I know. I swear to God, I want to cry
Speaker 1: when I talk about these things because I see these
Speaker 1: patients in my office. Why Because endometriosis implants can be
Speaker 1: glandular where they're purple. You know, there are these purple
Speaker 1: spots in the pelvis. You have to look for them
Speaker 1: to find them. You can't quickly scan the pelvis and
Speaker 1: say it's not there. Sometimes it takes me ten minutes
Speaker 1: to find them. They're tiny, but they're very inflammatory and painful,
Speaker 1: so you have to be patient. You have to know
Speaker 1: what they look like. But there's a type of endometriosis
Speaker 1: that stromo endometriosis from the stroma of the connective tissue
Speaker 1: around the gland. These when you look for them, don't
Speaker 1: have that typical purple spot. They're just these fine white lines.
Speaker 1: In my opinion, these stromo endometriosis implants are more inflammatory
Speaker 1: and more painful and have more debilitating pain. But ninety
Speaker 1: percent of the time they get mis during laparoscope. So
Speaker 1: these are patients that already people are telling them they're crazy.
Speaker 1: It's that painful periods are normal, that it's in their head.
Speaker 1: They on average see ten doctors. Average age of diagnosis
Speaker 1: is thirty two nine to eleven years. They wait to
Speaker 1: finally for someone to say you might have endometriosis, and
Speaker 1: then they take them to surgery, wake them up and
Speaker 1: say you didn't have it.
Speaker 2: It's crazy.
Speaker 1: Talk about gas lighting, it's crazy. Put yourself in that
Speaker 1: girl's shoes. And to make the matters worse. In my opinion,
Speaker 1: more than fifty percent of PCOS patients have endometriosis.
Speaker 2: So what's the cost of ignoring this? Like if someone's
Speaker 2: listening right now and they've been kind of feeling all
Speaker 2: this but you kind of just let it go, what's
Speaker 2: the cost every year of not diagnosing.
Speaker 1: The most devastating part for endometriosis is fertility because endometriosis
Speaker 1: is a highly inflammatory condition and it destroys the account
Speaker 1: in quality. I set it on Huberman podcast that I
Speaker 1: have a fourteen year old with an account of a
Speaker 1: forty year old, and yes, I do check account in
Speaker 1: a fourteen year old with debilitating pain. It's whenever. I'm
Speaker 1: not saying every single girl on this planet at fourteen
Speaker 1: needs to know her account. But I think until doctors
Speaker 1: start diagnosing endometriosis, we need to have a baseline account
Speaker 1: at eighteen. I absolutely fight for that every single day.
Speaker 1: I every single day in my practice, I see someone
Speaker 1: in her twenties or thirties ready for pregnancy with an
Speaker 1: account of zero because of years of pain, dismissed by
Speaker 1: the healthcare system. So no, I would so to answer
Speaker 1: your question, fertility is the biggest price they pay. So
Speaker 1: if you have painful, debilitating periods, absolutely check your account.
Speaker 1: It's a simple black test. It's called AMH. AMH tells
Speaker 1: us about the ovarian reserve. A low AMH doesn't mean
Speaker 1: you're not going to have a baby. A LOWIMH means
Speaker 1: your reserve is down. Be careful. So if you can
Speaker 1: afford eg freezing freeze early. That's why you know, I
Speaker 1: wish egg freezing was free. I wish you know it
Speaker 1: wasn't this expensive. I always say, when you're young and
Speaker 1: your eggs are healthy and you want to freeze them,
Speaker 1: you don't have the money. When you're old and your
Speaker 1: account is down and the qualities down, that's when you
Speaker 1: have money to freeze eggs. To the endometriosis patients, I say,
Speaker 1: check your account absolutely, if your account is low and
Speaker 1: you can afford it, freeze eggs. If your account is low,
Speaker 1: immediately do hormonal suppression and decrease the inflammation in the pelvis.
Speaker 1: If you can find an endometriosis surgeon with debilitating pain,
Speaker 1: excite those endometriosis implants. By doing that, you bring down
Speaker 1: the inflammation in the pelvis, specially patients with endometriomas. These
Speaker 1: are chocolate saysts in the ovary. Those are the ones
Speaker 1: at most at the highest risk of losing other agccount
Speaker 1: and quality. So that's the biggest price they pay. Painful sex.
Speaker 1: There's so many women who can have sex. Imagine these
Speaker 1: are young girls who either don't get married because they
Speaker 1: can't have a relationship because they can't have sex. So
Speaker 1: that's debilitating chronic pain causes severe anxiety and depression and
Speaker 1: lack of motivation. A lot of them unfortunately become addicted
Speaker 1: to these pain meds, so these are long term side
Speaker 1: effects of it. So it affects their mental health, their
Speaker 1: nervous system, their inflammation in the body, their fertility. It's
Speaker 1: just devastating. There's no words for it. I mean I
Speaker 1: can sit here, you guys, and I mean I can
Speaker 1: talk for another ten hours. I'm touching the tip of
Speaker 1: the iceberg. I'm traumatized from years of seeing these patients.
Speaker 1: I swear to God, they come to my office, they cry.
Speaker 1: I cry them because I can't take it anymore.
Speaker 2: I'm glad that you're able today as we're talking to
Speaker 2: give people the help that they need I've got. I
Speaker 2: wanted to ask you about how there's a lot of
Speaker 2: mixed information about birth control pills and then when you're
Speaker 2: off them, whether they block you from conceiving. What's your
Speaker 2: take on that.
Speaker 1: So, first of all, see I got emotional talking about
Speaker 1: these girls. It's my trauma. Literally, their trauma is my trauma. Anyways,
Speaker 1: I love birth control. So birth control pills for endemetriosis
Speaker 1: patients is the difference of having children and no children
Speaker 1: for some patients. Why so, because birth control pills, especially
Speaker 1: if you're on progesterone only birth control pills, what they
Speaker 1: do they suppress these implants. Remember I talked about inflammation
Speaker 1: destroying the egg, destroying the egg quality. So by putting
Speaker 1: these patients on these progesterone birth control pills, what you're doing,
Speaker 1: you're bringing down the inflammation. You're hopefully suppressing these inflat
Speaker 1: aim endometriosis tissues outside of the uterus, and by doing that,
Speaker 1: you're preserving some of their ovarian reserve. So that's number one.
Speaker 1: Number two. When you give these patients birth control pills
Speaker 1: and you can or progester on IUDs, what you're doing,
Speaker 1: you're helping their pain so they can start having sex,
Speaker 1: they can start having relationships. So the answer to the
Speaker 1: question of birth control pill is absolutely wrong. You know,
Speaker 1: there are a lot of moms or grandmas who tell patients,
Speaker 1: don't take birth control pills, you're going to be infertile. No,
Speaker 1: you're going to be infertile if you're not taking birth
Speaker 1: control pills. You want to be suppressed on these birth
Speaker 1: control pills until you're ready to have children.
Speaker 2: But then why do people struggle?
Speaker 1: Then?
Speaker 2: When they do that.
Speaker 1: So one thing to remember is there are many women
Speaker 1: who stay on birth control pills past seven years. There's
Speaker 1: a small percentage of women when they take birth control
Speaker 1: pills that chronically suppresses their ovulations. When they stop it,
Speaker 1: their ovarian reserve never recovers. So for that reason, it's
Speaker 1: important to you know, I always say, after seven years
Speaker 1: of suppression, make sure you're checking your account, make sure
Speaker 1: you're checking that ovarian reserve, and if it's you know,
Speaker 1: suppressed and you've been on birth control for so many years,
Speaker 1: stop the birth control pill. Maybe go to a progesterone
Speaker 1: IUDA at that point. I've seen this numerous times when
Speaker 1: patients come and they're like, my ovarian reserve is really low.
Speaker 1: I've been on birth control pills, yes, And when you
Speaker 1: stop their birth control pills, their ovarian reserve recovers. So
Speaker 1: that's why I'm such a big advocate of checking doing
Speaker 1: a pelvic ultrasound, which should be mandatory for every single
Speaker 1: girl who's sexually active and goes for a well woman exam,
Speaker 1: check a PUBLC ultrasound, check the foticular account, check their
Speaker 1: ovarian reserve. If you can't just do a simple AMH
Speaker 1: blood just to see what that reserve is, specially for
Speaker 1: endometriosis patients.
Speaker 2: If someone can't afford to freeze their eggs right now, yes,
Speaker 2: what are there other options?
Speaker 1: Suppress? Suppress, suppress suppress, Put a progesteron our udea, take
Speaker 1: a progesterone birth control pill, take my femburi or alyssa,
Speaker 1: go have laparoscopic surgery. But here's the problem with laparoscopic surgery.
Speaker 1: Do you know how a patient once in my office
Speaker 1: who came in, She's like, I'm here for my twelfth
Speaker 1: laparoscopic surgery. Every year she checks herself in for a
Speaker 1: laparoscopic surgery. That's madness.
Speaker 2: You do not scar.
Speaker 1: That's so scary and you do not need that. The
Speaker 1: reason these patients keep having surgeries is because no one's
Speaker 1: suppressing them. Imagine someone has colon cancer and you go
Speaker 1: in and you resect their colon cancer. Do you ever
Speaker 1: tell them, Okay, sir, go home, I'll see you in
Speaker 1: six months. No, they're gonna come back in six months
Speaker 1: with cancer everywhere.
Speaker 2: What do you do?
Speaker 1: You give them chemo and demetriosis is not cancer. But
Speaker 1: that's exactly what you need to do for these patients
Speaker 1: when you do laparoscopic surgery, and first you want to
Speaker 1: resect all the implants. Once you do that, you want
Speaker 1: to suppress immediately. In my case, almost every single patient
Speaker 1: I take to surgery, unless they're actively trying for pregnancy,
Speaker 1: I put a progester on IUD at the same time
Speaker 1: because I want to freeze the pelvis the way I'm
Speaker 1: leaving it. And as soon as they start having pain again,
Speaker 1: then in addition to surgery and the IUD, if they
Speaker 1: have more pain after surgery, if they have advanced stage,
Speaker 1: I put them on these GnRH antagonists like or Alyssa
Speaker 1: and my fambri to just completely kill it. That's why
Speaker 1: my patients it's very rare for me to operate for
Speaker 1: the second time on my patients unless they have advanced disease.
Speaker 2: How much is all of this affecting other functions in
Speaker 2: the body, whether it's the microbiome in the god, whether
Speaker 2: it's oh.
Speaker 1: Thank you for asking that. In my opinion, ninety percent
Speaker 1: of endometriosis patients suffer from leaky gut. They have CIBO
Speaker 1: ninety percent. What's leaky gut? Basically, you know, they get
Speaker 1: disruption in the lining of their gut, so harmful substances
Speaker 1: start getting absorbed. As harmful substances get absorbed, what goes
Speaker 1: up inflammation. When inflammation goes up, it becomes a vicious cycle. Right.
Speaker 1: They get brain fogged, they get bloated, they get tired,
Speaker 1: they get insulin resistant if they have PCOS, and they
Speaker 1: just feel terrible. And on top of that, they start
Speaker 1: gaining weight. So but I always say, and these are
Speaker 1: patients who end up having colonoscopies, having endoscopies, have seeing
Speaker 1: GI doctors, bouncing from doctor to doctor, and no one
Speaker 1: stops to tell them, are your periods painful? And why
Speaker 1: unless you treat eat the underlying condition, which is endometriosis,
Speaker 1: you cannot get rid of their the he goat. They
Speaker 1: keep having these symptoms of bloating and fatigue and inflammation.
Speaker 1: So what I do in my practice is, once I
Speaker 1: operate on them and I suppress them with IUT, I
Speaker 1: have them monitored their symptoms of bloating. And if they
Speaker 1: come back in a month, in two months and they say, doctor,
Speaker 1: you know what, my pain is so much better, which
Speaker 1: is usually the case, but I'm still bloated when I eat,
Speaker 1: then I treat their sebo. Do you understand, and that's
Speaker 1: how it works now. Patients with advanced disease, patients who
Speaker 1: go through years of pain and central sensitization of their
Speaker 1: nervous system being ignored. Sometimes when you operate, when you
Speaker 1: suppress and you treat their sebow, they still have pain,
Speaker 1: they're still anxious, they're still depressed because they're brain is
Speaker 1: rewired after all these years of pain. For those patients,
Speaker 1: one thing you can do is use neural modulators like
Speaker 1: medications like Effects or Symbalta, Gabba penton Lyrica, because once
Speaker 1: you address their pathology, it takes sometimes time to rewire
Speaker 1: that brain and calm their nervous system down. And you
Speaker 1: tell them to listen to your calm by the way,
Speaker 1: I listen to it every night. But do you understand, yes.
Speaker 2: Yes, yes, that's helpful. Yeah, I'm glad I asked that
Speaker 2: because I'm always yeah, I'm always intrigued as to the
Speaker 2: side effects. And when you're trying to it fills up
Speaker 2: with the body. Sometimes, especially with traditional medicine, you're trying
Speaker 2: to solve one thing and you negatively kick off something else,
Speaker 2: and there's all these things happening back and forth that
Speaker 2: people don't usually think about because doctors are just trying
Speaker 2: to solve one thing. And we'll talk about IVF in
Speaker 2: a second. But I know a friend who is going
Speaker 2: through IDF, but then something that we taking to make
Speaker 2: that more successful triggered their autoimmune and then you know,
Speaker 2: now you're dealing with that, and then that's effect to
Speaker 2: So it's like I'm always just in treatis to the correlation.
Speaker 1: Talk about that. That's so important. First of all, Number one,
Speaker 1: like you said, every doctor is treating what they know
Speaker 1: they're treating, right, a GI doctor is only treating the cebo.
Speaker 1: In my opinion, every GI doctor needs to know about
Speaker 1: nimytriosis because enemeytriosis is causing this leaky guy. So if
Speaker 1: you're missing animeytriosis, you can never treat your cebol patient
Speaker 1: number one. So we have to start treating patients holistically.
Speaker 1: I'm a gynecologist. I check everything metabolically. Let's say, in
Speaker 1: my PCOS patients, I check their A PO E, I
Speaker 1: checked their APO B, I checked their lipoprotein little A.
Speaker 1: I checked their hemoglobin A one CEE. I check for
Speaker 1: pre diabetes. And I'm a gynecologist. I screen for anxiety.
Speaker 1: I screen for depression, I check for fertility. I do
Speaker 1: my part, and I do everybody else's part too, because
Speaker 1: because doctors are not having this holistic approach to patient.
Speaker 1: So that's extremely, extremely important. And the second thing I
Speaker 1: want to talk about. You're absolutely right. Let's take endometriosis.
Speaker 1: In endometriosis, your own immune system is attacking your own tissue, right,
Speaker 1: So it is a form of autoimmune. When you have
Speaker 1: one autoimmune condition, you have a thirty percent chance of
Speaker 1: having another autoimmune condition. So in my practice, if I
Speaker 1: see someone with endometriosis, I immediately think to myself, am
Speaker 1: I missing lupus? Am I missing antiphospholipid syndrome, am I
Speaker 1: missing chogrins in them? Am I missing psoriasis? And I
Speaker 1: start asking questions and believe it or not, when they
Speaker 1: start trying for pregnancy, if they have any other symptoms,
Speaker 1: if they complain of a little bit of a draining pain,
Speaker 1: a little bit of a mailer lash, any symptom of
Speaker 1: any kind of autoimmune disorder, I do a full autoimmune
Speaker 1: lab on them. So this friend of yours who's in
Speaker 1: IVF right, I'm assuming this because I see this every
Speaker 1: single day, and I've done it for decades. She might
Speaker 1: have an endometriosis that was undiagnosed, right, So what happens
Speaker 1: during IVF treatment they blast her with estrogen. When they
Speaker 1: blast her with estrogen, they stimulate her endometriosis. So the
Speaker 1: pain sometimes gets really hard for these patients during IVF.
Speaker 1: But because they have other they're at risk of having
Speaker 1: other autoimmune disorders. The IVF did not cause the autoimmune
Speaker 1: The IVF pushed it out, just like pregnancy pushes it out.
Speaker 1: But if we know that endometriosis is in autoimmune condition,
Speaker 1: a diagnose it correctly, don't dismiss these patients. And when
Speaker 1: you diagnose it, look for other autoimmune disorders. You will
Speaker 1: not be surprised with patients like got it here.
Speaker 2: Yeah, I think that's the point, right, Look, I appreciate that. Well,
Speaker 2: you said that, Hey, we're going to look at everything,
Speaker 2: and that makes sense because the body's so connected. It
Speaker 2: makes no sense to be like, we're going to treat
Speaker 2: this in a silo and hope it doesn't affect anything else,
Speaker 2: when of course it's going to affect your entire body
Speaker 2: in mind, and I feel like a lot of patients
Speaker 2: just get thrown around different departments going, oh, well, now
Speaker 2: you're going to have to sort that out, and now
Speaker 2: you're going to have to sort that out, and it
Speaker 2: doesn't add up for them, like it's a painful process
Speaker 2: to go through bingo. Yeah, it's terrible. And I've seen
Speaker 2: it happen with so many friends where they're constantly running
Speaker 2: around trying to solve another problem now that was triggered
Speaker 2: by something else they were trying to solve. I wanted
Speaker 2: to ask you if a woman in a mid to
Speaker 2: late there is wants to conceive, what should she be
Speaker 2: doing and thinking about if she hadn't frozen her eggs previously.
Speaker 1: You come to my office, you're thirty five, You show
Speaker 1: up to my office for a while, woman exam, I
Speaker 1: love this question. Number one, take a good history. I
Speaker 1: want to rule that enemeytriosis because no one's diagnosed it.
Speaker 1: I want to rule at pcos. These are the top
Speaker 1: leading causes of infertility. They need to be ruled out.
Speaker 1: On that visit Three, I do a pelvic ultrasound. I
Speaker 1: look at her anatomy, I look at her ovaries. I
Speaker 1: look for pcos looking ovaries on ultrasound, I look to
Speaker 1: make sure she doesn't have chocolate cysts. I look to
Speaker 1: make sure she doesn't have any abnormalcis on the ovary.
Speaker 1: Then I go to the uterus. I make sure she
Speaker 1: doesn't have any fibroids, because fibroids, when they come closer
Speaker 1: to the lining of the uterus, they can cause heavy periods,
Speaker 1: painful periods, or they can cause fertility issues and miscarriages.
Speaker 1: I look for polyps in the lining of the uterus.
Speaker 1: PCOS patients specially because of that hormonal changes. They have
Speaker 1: a lot of polyps in the lining of their uterus,
Speaker 1: so that can block them from getting pregnant, so I
Speaker 1: look for that. I do a three D image of
Speaker 1: their uterus on my pelvic ultrasound to make sure they
Speaker 1: don't have a septum. You'll be surprised of how many
Speaker 1: patients go through fertility clinics. Do idf embryo, gets transfer,
Speaker 1: or they don't get pregnant. They end up in my
Speaker 1: clinic and I'm like, you have a large septum. So
Speaker 1: these are all the things that I do. Then after
Speaker 1: I'm done taking a good history doing a pelvic ultrasound,
Speaker 1: I send them to my lap. I check all their hormones,
Speaker 1: I check their thyroid hormones. I check for thyroid antibodies.
Speaker 1: I check for prolactin. These are hormones that can affect ovulation.
Speaker 1: I check their testosterone levels. If I'm suspecting PCOS in them,
Speaker 1: I check DHAS, which can go up. It's we call
Speaker 1: it adrenal pcos. And everyone's stressed out in LA where
Speaker 1: I live. So adrenal PCOS is a real condition where
Speaker 1: they start secreting androgens and they have symptoms very similar
Speaker 1: to PCOS. So I screen for DHAS in their blood,
Speaker 1: and I check testosterone free and total, and I do
Speaker 1: a full SDD panel. But the most important thing I
Speaker 1: do in a thirty five year old, I also check
Speaker 1: her account, so that account is very important for me.
Speaker 1: Once I do all of this, then I tell her
Speaker 1: to go get pregnant. How how did they try for pregnancy? Basically,
Speaker 1: I recommend having them start prenatal vitamins usually three months prior.
Speaker 1: If they have a progesterone IUD because there have been
Speaker 1: my patient, I pull that IUD. If they have PCOS,
Speaker 1: I treat them with every single thing we talked about
Speaker 1: before they start trying. Because met Foreman the ov supplement.
Speaker 1: These things stimulate ovulation. Help with the ovulation and lowers
Speaker 1: their inflammation. I encourage a healthy diet, a good exercise,
Speaker 1: stopping smoking, stopping alcohol, and then I tell them to
Speaker 1: go try to have sex three to four times. For
Speaker 1: patients younger than thirty five, I usually give them a
Speaker 1: year to try. For patients who are older thirty five
Speaker 1: and older, I tell them go try for six months
Speaker 1: and come back. I screen for their partner's health. I
Speaker 1: ask the age, I ask if they use any drugs,
Speaker 1: if they smoke weed, if they've had any fertility issues,
Speaker 1: if there's any concern. I sometimes get a semen analysis
Speaker 1: because I don't want my patients to try at thirty
Speaker 1: five for six months and then find out that the
Speaker 1: semen is not bad and thirty percent of fertility issues
Speaker 1: are male related, and then you know, I have them
Speaker 1: try for pregnancy. One thing I don't have them do
Speaker 1: is check their ovulation, check their temperature, get an ov
Speaker 1: you kit, because the more you think about it and
Speaker 1: the more you stress, the more cortisol you release and
Speaker 1: your hormones go off balance. So I tell them go
Speaker 1: try for six months, go try for a year, and
Speaker 1: if you're not pregnant, come back. But one thing that
Speaker 1: I do in my office, I've already done ninety percent
Speaker 1: of the screening for that patient. So it's rare for
Speaker 1: me to have a patient show up to my office
Speaker 1: under my care that she's tried for a year and
Speaker 1: she's not getting pregnant. If they're under my care, I've
Speaker 1: already ruled out everything. And if they've had pcos, I've
Speaker 1: addressed it. If they've had any meteorosism, I've addressed it.
Speaker 1: If they've had autoimmune I've already addressed it. If they've
Speaker 1: had a septum, I've resected it. If they've had polyps,
Speaker 1: I've dealt with it. Do you know what I'm saying?
Speaker 1: So when I let them go, I maximize that time
Speaker 1: this is not being done. One thing I want to
Speaker 1: do for women in the healthcare system, I want to
Speaker 1: make pelvic ultrasounds mandatory at a well woman exam. Just
Speaker 1: by doing a bimanual exam, you can't screen for these things.
Speaker 1: If you come to my office and you tell me
Speaker 1: you can't do a pelvic ultrasound, then I will tell
Speaker 1: you to leave, probably because it's just like taking someone's
Speaker 1: glasses away and telling them to read. I see so
Speaker 1: much with my ultrasound. I can't even imagine women going
Speaker 1: once a year to their doctor and not having an
Speaker 1: ultras out.
Speaker 2: I think for a long time at least these things
Speaker 2: weren't talked about, and so people thought having kids was
Speaker 2: just like you turn up, you have kids, and things
Speaker 2: work out that way. And I think everyone realizes all
Speaker 2: of a sudden, like I was saying, you start talking
Speaker 2: to all your friends and like, hey, I had a miscarriage. Hey, hey,
Speaker 2: we've been trying for six months, nothing's happened. Now we're
Speaker 2: going to go get checked. Hey, you know. And so
Speaker 2: it's fascinating that this wasn't talked about for so long
Speaker 2: that now when people are finally coming to the point
Speaker 2: of wanting to conceive, wherever they are in their life,
Speaker 2: they think that there's something wrong with them, or they
Speaker 2: think there's something that's not working out, or now they're
Speaker 2: figuring out a health issue because of the reactive approach
Speaker 2: as opposed to, Hey, having a kid's not easy no
Speaker 2: matter what age you are, because there could be a
Speaker 2: million different things going on, as we've discussed today, and
Speaker 2: so whether you're in your twenties and you don't want
Speaker 2: to have a kid, told you with that is, there's
Speaker 2: still things you can do. There's still steps you can
Speaker 2: take now that are probably going to help you, even
Speaker 2: if it's that far away.
Speaker 1: If you've tried for a year and you've had sex
Speaker 1: three to four times every week and you haven't gotten
Speaker 1: pregnant at the end of the year, here's what you
Speaker 1: can do. Number one bucket is the female factor. Right,
Speaker 1: it's the woman. Check your hormones. I listed those hormones,
Speaker 1: thyroid panel, prolactin, testosterone, free testosterone, dhgas. Make sure those
Speaker 1: are normal. Do an SCD check, check for gonarrhea, chlamydia,
Speaker 1: check your AMH anti malarian hormone. Is egg count Basically
Speaker 1: it tells us what that ovarian reserve is for the woman.
Speaker 1: That's number one, So that's female factor. Second, you want
Speaker 1: to make sure the agcount is good and the hormones
Speaker 1: are good. Second bucket is the male factor. Make sure
Speaker 1: the semen analysis is normal. If your partner go to
Speaker 1: any fertility clinic, do a sman analysis. It takes two
Speaker 1: minutes to do that. Number three I call it the
Speaker 1: anatomy bucket. Right, get a pelvic ultrasound because doctors are
Speaker 1: not doing it. Make sure you don't have fibroids. Make
Speaker 1: sure in the lining of the cavity you don't have
Speaker 1: any polyps. Make sure you don't have any septum. Ask
Speaker 1: your doctor for an HSG. Histrosapingogram is a very simple
Speaker 1: procedure done by radiologists. They basically inject die into the
Speaker 1: uterus and they flush the tubes. Not only it flushes
Speaker 1: the tubes and helps you get pregnant, it tells us
Speaker 1: whether or not there's any blockage of the tubes. A
Speaker 1: lot of patients with endometriosis with scar tissue can have
Speaker 1: block tubes and that's why they're not getting pregnant. So
Speaker 1: that's the third bucket. My fourth bucket is the bucket
Speaker 1: of endometriosis. Have you had painful periods? Do you have
Speaker 1: painful sex? Do you get really bloated? Have you had
Speaker 1: recurrent bladder infections? With negative culture? Is bound movements painful?
Speaker 1: If you think you have endometriosis. Endometriosis can cause infertility
Speaker 1: in several ways. A that inflammatory environment that we talked
Speaker 1: about destroys the egg, doesn't let the egg go to
Speaker 1: the tube. The tubes are scarred. Even when you make
Speaker 1: an embryo and the embryo wants to implant into the uterus.
Speaker 1: A lot of these patients have adenomiosis, which we didn't
Speaker 1: talk about. It's a sister diagnosis to endometriosis. A lot
Speaker 1: of times they go hand in hand when the walls
Speaker 1: of the uterus are so glandular, and when you have that,
Speaker 1: your risk of miscarriage goes up. So this bucket is
Speaker 1: an extremely important bucket. And if you think you have
Speaker 1: endometriosis and your doctor is telling you you don't have it,
Speaker 1: go find another doctor, Go find an endometriosis specialist. You
Speaker 1: have to be your own health advocate in this specific
Speaker 1: bucket because it will get dismissed. Okay. And the next
Speaker 1: bucket is the bucket of PCOS, which we spend all
Speaker 1: this time. If you have irregular period, if you have acne,
Speaker 1: hair lost, facial hair, body hair, if you have gain,
Speaker 1: if you gain weight and you can't lose it, if
Speaker 1: you've struggled with weight most of your life, if you're anxious, depressed,
Speaker 1: history of eating disorder, these are all telltale signs of
Speaker 1: a PCOS issue. And PCOS patients when they want to
Speaker 1: get pregnant, I would have a million percent I swear
Speaker 1: not because it's my supplement because it works. Take the
Speaker 1: ov supplement. Ask your doctor for met Foreman. Believe it
Speaker 1: or not. Women in this bucket who are lean and
Speaker 1: they go to the doctor and the doctor says, well,
Speaker 1: your hemoglobin A one c is normal. You don't have
Speaker 1: insulin resistance. That lean woman also has insulin resistance at
Speaker 1: his tissue level. You can't see it in the blood,
Speaker 1: but she has it at her tissue level. And putting
Speaker 1: them on the supplement and giving them met Foreman will
Speaker 1: help them ovulate and get pregnant. That's how you pull
Speaker 1: these patients out of the hands of the fertility doctors.
Speaker 1: So that's my what are we fifth bucket? And my
Speaker 1: sixth bucket is my autoimmune bucket. This bucket is always
Speaker 1: also dismissed in woman, this is your friend with the
Speaker 1: autoimmune condition. These are patients that when you have an
Speaker 1: autoimmune Let's say, if you have psoriasis, Yeah, sooriasis doesn't
Speaker 1: affect your fertility. But if you have psoriasis, you might
Speaker 1: have another autoimmune condition that does affect your fertility. Why
Speaker 1: am I saying this. Let's take ANTIFOSPHILIPD syndrome. These are
Speaker 1: patients who might not have any symptoms right, but in
Speaker 1: their labs their antifossilipid syndrome is positive. These patients make
Speaker 1: clot easily in pregnancy. Pregnancy is a hypercoagulable state, and
Speaker 1: patients in this bucket when they get pregnant, they make
Speaker 1: blood clots in their placenta. They get recurrent miscarriages. Sometimes
Speaker 1: I have my medical assistant present a patient to me.
Speaker 1: We have a new patient. She's had five miscarriages, she's
Speaker 1: seen all these doctors. She's pregnant right now, she's five weeks.
Speaker 1: Even before going in, I'm like, give her blood thinners.
Speaker 1: I don't even need to see the patient. I can
Speaker 1: tell you she needs butt thinners because she's in this
Speaker 1: dismissed sixth bucket. For me, in my practice, it's extremely rare,
Speaker 1: extremely rare that I find someone unexplained infertility. Do you
Speaker 1: know that if you look at the literature, they say
Speaker 1: thirty percent of infertility is female related, thirty percent is
Speaker 1: male related, and thirty percent is unexplained or mixed. Like
Speaker 1: no one knows really, I know, really know why because
Speaker 1: those are my poor endometriosis and PCOS women, the auto
Speaker 1: immune woman that no one is addressing, them. I always say,
Speaker 1: if you send every twenty year old to my office once, Actually,
Speaker 1: if I could take him, I would probably take him
Speaker 1: at eighteen, every eighteen year old to my office once.
Speaker 1: I would shut down a lot of these fertility centers
Speaker 1: because I would not dismiss a woman with a demetriosis.
Speaker 1: I would not dismiss a woman with PCOS. Now that
Speaker 1: you learned all this, I want you to imagine this patient,
Speaker 1: and I've seen thousands of them. Imagine a thirty four
Speaker 1: year old girl who's had irregular period, who's overweight since
Speaker 1: she was in high school. She had an eating disorder
Speaker 1: because her sister was very thin, her mom was very thin,
Speaker 1: and at a very young age, her mom kept telling her, honey,
Speaker 1: why are you You probably eating unhealthy, that's why you're overweight,
Speaker 1: eat less. She gets anxiety, she gets depression. By the
Speaker 1: time she's sixteen, she has an eating disorder. She has acne.
Speaker 1: Her mom takes her to the dermatologist. They start her
Speaker 1: on acutane. She is very depressed. She goes to a psychiatrist.
Speaker 1: They put her on an antidepressant. She bounces from psychiatry
Speaker 1: office to psychiatry office. She's doubled over in pain. When
Speaker 1: she's at school, the nurse calls for her mom to
Speaker 1: come and pick her up. She goes to ten twenty
Speaker 1: fifty doctors from state to state, country to country, and
Speaker 1: everyone tells her that she needs to eat less, exercise more,
Speaker 1: that she's stressed out, that she was born anxious and depressed,
Speaker 1: that her medications need to be changed. And by the
Speaker 1: time she gets to me, she's thirty four years old.
Speaker 1: I do her amah and she has no eggs left.
Speaker 1: This is my broken heart. This is my trauma. This
Speaker 1: is every single patient I see in my office. Do
Speaker 1: you understand? And I don't take insurance. My office is expensive,
Speaker 1: not because I want to torture patients, because I just
Speaker 1: can't see patients anymore. I've done this thirty years and
Speaker 1: I'm at Their trauma is my trauma. And that's why
Speaker 1: I started my podcast, my CMD podcast. I literally take
Speaker 1: these we don't talk about men. Men are not allowed.
Speaker 1: It's a safe place for women. And I literally take
Speaker 1: every single condition ENDO, pcos, fibroids, SDDS, one by one.
Speaker 1: I teach them. I empower them to become their own
Speaker 1: health advocate. So if you're twenty five and you go
Speaker 1: to an office and you're being dismissed. Those that needs
Speaker 1: to stop. I'm here today because I want to change
Speaker 1: this healthcare system. I swear to God. I feel like
Speaker 1: this is my calling. I feel like I was placed
Speaker 1: on this planet to change this. I feel like I
Speaker 1: got breast cancer because I was You know, do you
Speaker 1: know how many people called me crazy with my breast
Speaker 1: cancer journey? And if as a women's health advocate people
Speaker 1: call me crazy? Do you think women have a chance
Speaker 1: in this healthcare system?
Speaker 2: That's so painful? It's so painful, and try.
Speaker 1: To get it so painful. You don't understand the depth
Speaker 1: of this pain that these women go through. You don't
Speaker 1: understand it. The gas lighting is toxic. I want to scream.
Speaker 1: That's why I say I want the President of the
Speaker 1: United States to give me the mic. People grab that
Speaker 1: mic for nonsense. Give me that mic for twenty minutes only.
Speaker 1: Let me tell women what they deserve to know. You
Speaker 1: don't have to be thirty five years old to find
Speaker 1: out you don't have any eggs left. You don't have
Speaker 1: to be thirty five to learn that you have giant fibroids,
Speaker 1: that you have endometriosis, that you have pcos that you
Speaker 1: have an audioimmune condition, that your lifetime risk of breast
Speaker 1: cancer is high and no one diagnosed it, and now
Speaker 1: you have stage four breast cancer. Enough, enough is enough.
Speaker 1: That's it. I can talk for another ten hours.
Speaker 2: Doctor Ray. I want to thank you for showing up
Speaker 2: and to have such a clear, conscious, powerful message delivered
Speaker 2: that emphatically by you to everyone who's listening right now.
Speaker 2: Everyone who's listening or watching right now, please go and
Speaker 2: subscribe to SHEMD. It's free. It's a podcast by doctor
Speaker 2: a where you can get deeper insights. You can get
Speaker 2: the extra ten hours of conversations around any of these
Speaker 2: areas you're struggling with, and of course, past this episode
Speaker 2: onto a friend. I think there's going to be someone
Speaker 2: in your life who you know is struggling silently, who
Speaker 2: you know so offering in the background, who you know
Speaker 2: is not aware of what they're going through. I hope
Speaker 2: you'll share this episode with them as a way of
Speaker 2: sparking a conversation and starting their journey and empowering yourself
Speaker 2: through your health journey. Doctor thank you for enlightening us,
Speaker 2: inspiring us, and giving us such a no so sweet,
Speaker 2: powerful message. Truly I learned so much today, more than
Speaker 2: I ever have truly on this subject. And even more
Speaker 2: than that, I appreciate your directness, just your conviction in
Speaker 2: how important this is, because you're absolutely right. I mean,
Speaker 2: women's health has been ignored for a long time. It's
Speaker 2: been deprioritized for a long time. It is at the
Speaker 2: core of how we exist as humans. So for us
Speaker 2: to not understand it is there is no excuse for it,
Speaker 2: just no excuse. And I'm just really thankful that you
Speaker 2: came on today and shed so much light on it.
Speaker 2: So I'm very great for.
Speaker 1: Your sweet for giving me this mic.
Speaker 2: Yeah, I mean it. Well, hopefully you get the the
Speaker 2: the President's mic too, that's that definitely. But thank you
Speaker 2: for your time and energy.
Speaker 1: Thank you, thank you, thank you for having me.
Speaker 2: If you enjoyed this podcast, you're going to love my
Speaker 2: conversation with Michelle Obama where she opens up on how
Speaker 2: to stay with your partner when they're changing. If you're
Speaker 2: going through something right now with your partner, this is
Speaker 2: the episode for you.
Speaker 1: The world won't always like you, but you can't count
Speaker 1: on the world to like you.