WORLDS TOP OBGYN: #1 Hormone Problem Impacting MILLIONS of Women (This is How You REVERSE it!)

Key Takeaway

PCOS and endometriosis affect millions of women, yet 75% of PCOS cases and over 90% go undiagnosed. These conditions are the leading causes of infertility, but more importantly, they create a cascade of hormonal, metabolic, inflammatory, and neurological symptoms that make it nearly impossible to achieve mental calm or metabolic health. The single most actionable step: Address insulin resistance first through low-carb eating, 10-20 minute walks after each meal, and supplements that improve insulin sensitivity—this one change triggers improvements across all symptoms.

Episode Overview

Dr. A provides a comprehensive breakdown of PCOS (Polycystic Ovary Syndrome) and endometriosis, two widely underdiagnosed conditions affecting women's hormonal health, fertility, and mental wellbeing. The episode covers the four underlying pillars of PCOS: insulin resistance, hormonal imbalance (elevated androgens), chronic inflammation, and neurological dysfunction. Dr. A explains how these pillars create a vicious cycle affecting everything from weight management to anxiety and depression. She emphasizes that painful periods are NOT normal and provides specific, actionable protocols including dietary changes, exercise timing, supplements (like her OV supplement containing wild mulberry leaf), medications (metformin, GLP-1s), and lifestyle modifications. The conversation challenges the healthcare system's tendency to dismiss women's symptoms and empowers listeners to become their own health advocates through education and self-diagnosis tools.

Full Transcript

Transcript of WORLDS TOP OBGYN: #1 Hormone Problem Impacting MILLIONS of Women (This is How You REVERSE it!) from On Purpose. Auto-generated from episode audio; may contain minor errors.

I want to scream in this mic and say, "Let me tell women what they deserve to know." If you take PCOS, 75% of these women are not diagnosed. If you take endometriosis, over 90% of these women are not diagnosed. Wow. Endometriosis with PCOS, they're the leading cause of infertility on this planet. Hey everyone, welcome back to OnPurpose, the place you come to become happier, healthier, and more healed. Today's guest is someone that I'm extremely excited to talk to because it's a subject matter that so many of you have been asking me about.

If you have questions about PCOS, this episode is for you. If you have any questions about endometriosis, endometriosis, endometriosis, this episode is for you. And if you're someone out there who has friends or family that are struggling with fertility, this episode is for you. I'm speaking to the one and only Dr. A, who is an authority in this space, someone who has helped so many people go through their fertility journey. Please welcome to OnPurpose, Dr. A. Dr. A, it's great to have you here. Jay, I'm so excited.

I'm so excited to for you to give me this mic and I'll tell you why I'm so excited to be here. you know, um I've always listened to you and you speak so amazingly to these women, to your listeners, basically talking to them about calmness and how to get to that calm, about mental health, about meditation. And I one thing I want the world to know is that there are millions of women out there that cannot get to this calm space. Not because they're not trying hard enough, not because they're spiritually weak.

They can't get there because they have an underlying condition like PCOS and endometriosis that affects their hormones, their inflammatory pathway, and their nervous system. And that's why they can't find that calm. I sit with women all day long. These are women who've struggled for years with endometriosis and PCOS debilitating pain that they can't even, you know, stand up straight and just because no one ever believed them. No one and they dismissed their symptoms. You know, you have these 13year-olds who are literally on the bathroom floor with every period thinking this is normal life and that's life for them and they can't really complain about it.

Or they have women who are ashamed of their body and they go to the doctor and all they hear is, "Well, just eat less, exercise more, but no one really addresses the underlying condition." And I've done this for decades. And I reached a point in my life that I said enough. Enough is enough. Enough dismissing women. Enough normalizing their pain, normalizing their symptoms, and telling them it's their in their head. They're crazy. they're anxious. It's none of that really. And it's time to really start listening to these women and dealing with these underlying conditions.

And that's why, you know, uh millions of women are affected by PCOS and endometriosis and majority of them are never diagnosed. So that's why I'm so excited to be here to take at least this hour to bring some awareness to these two conditions. So thank you for having me. having me. having me. Let's dive in because like I said, my audience really wants the answer to these questions. I really want to shed light on this topic. I really want people to feel seen, heard, and understood as they're navigating this.

But you've actually said that we're in the middle of a fertility crisis. What does that mean? So, when you know, let's say you take 100 couples and you have them go try to get pregnant. You tell them have sex three to four times a week and then come back in a year. 50% of them on average get pregnant in the first 6 months. 90% of them are pregnant within a year and 10% don't get pregnant. Well, in that 10% category, if you take male fertility out, majority of those patients have PCOS and endometriosis.

The problem is if you take PCOS, 75% of these women are not diagnosed. If you take endometriosis, I think over 90% of these women are not diagnosed. So they fall under this unexplained infertility because doctors are not diagnosing these underlying conditions. underlying conditions. underlying conditions. What is PCOS? Define it for us. So PCOS is a chronic hormonal, metabolic, inflammatory and neurological condition that affects 15% of women in this country. If you go to countries like India, that number can go north of 20%. The problem with with it is that 75% of these women are never diagnosed and they go through life not getting a diagnosis.

In order to diagnose PCOS, it's very simple. You need to meet two out of the three criteria. Number one is basically uh ovarian or ovulation dysfunction. These are women who have irregular periods. They get their periods not every 28 days. They get it like every 35 days, 37 days or they get less than eight periods per year. So that's criteria number one. Criteria number two is PCOS looking ovaries on ultrasound. So PCOS is not polycystic ovary syndrome is not cyst. To this day doctors say oh you don't have a cyst on your ovary so you don't have PCOS.

Polycystic ovary syndrome is a group of follicles. It's a specific finding on ultrasound. These are ovaries that are enlarged with at least 20 follicles and um it's it's a specific finding on ultrasound. Again, a lot of doctors don't know what to look for. So that's the second criteria. And recently for this criteria, they added high egg count or high AMH to this criteria for women who can't have access to ultrasound or they don't you know or their doctors miss this ovarian morphology on ultrasound. So elevated egg count also counts as the second criteria.

And the third criteria is elevated testosterone or androgen symptoms. What are these symptoms? Facial hair, body hair, facial acne, body acne, uh oily skin, male pattern, hair thinning or hair loss. You don't have to have all of these symptoms. You have to have one. So this is the third criteria and you need to meet two out of these three criteria. PCOS patients for uh reasons I'm going to go into details struggle with anxiety and depression. They have mood disorder. They're moody people. They have really bad PMS.

They usually have someone in their family who's PCOS, diabetic, overweight, insulin resistant. A lot of them have an eating disorder or disordered eating and they end up in these eating disorder centers because their PCOS is not being diagnosed. It's the leading cause with endometriosis. leading cause of infertility on this planet. 75% of these patients gain weight even though they're eating exactly what you and I are eating, exercising exactly the same, but they cannot lose a pound. 25% of them are lean lean PCOS patients. Even these lean PCOS patients have eating disorders.

So imagine, take this young girl who's gaining weight, is in high school, let's say, gaining weight, acne, facial hair, can't lose her weight, she's moody, she's anxious, she has really bad PMS, and she goes to the doctor and the doctor says there's nothing wrong with you. You're probably eating too much. So wait, you would know as early as then? then? then? Oh my god. Yes. Teenagers. That's You know what I always say? If you want if you go knock on the doors of these eating disorder centers your PCOS patients are sitting behind those doors.

So why is it not getting correctly diagnosed? If it's such a big issue, it's affecting so many people and there's so many symptoms through which you can measure it. Why is it not diagnosed? diagnosed? diagnosed? So I think it's multiple reasons. Number one, doctors don't consider, you know, they don't know enough about PCOS and PCOS presents in different morphologies. Once we talk about it, you understand why you don't have to have irregular period to have PCOS. Some there's a morphology of PCOS patients who don't have any elevated testosterone symptoms.

They just have the irregular period and the PCOS. So remember I said two out of the three criteria. You have different combination of these symptoms and different uh presentations of these patients. Some are lean, some are overweight, some have irregular periods, some have acne, some have hair loss, some have facial hair and body hair. they present differently. So, it's very confusing to doctors. That's why I'm here to tell you, you only need to meet two out of the three criteria. And if you meet those criteria, then you look for the anxiety and the depression and the eating disorder and the weight issues and the insulin resistance and the fertility issues and you put this picture together and you can find your PCOS patients.

I always say you don't need a doctor to really diagnose you. If you listen to this podcast from home, you can self diagnose. I'm giving you the tools to diagnose yourself. But because PCOS has uh these underlying pillars that affect their entire their whole body. So it's not just a fertility issue. It's not just a period issue is a total body issue. It affects your mental health. It affects your reproductive health. It affects you metabolically. It affects your hormones. And until you address every single underlying pillar of the driver of these symptoms, you can't make these patients feel better.

So if a woman is listening to this right now and feel she has PCOS, what's the next thing she should do? Very good question. So the domino, imagine the first domino of this PCOS storm is insulin resistance. You have to understand insulin resistance. What is insulin resistance? When we eat carbohydrates, bread, pasta, pizza, chocolate, ice cream, our body breaks it down into glucose. Glucose stimulates our pancreas to release a hormone called insulin. The job of insulin is it goes at a cellular level, opens up the receptors on our cells.

The receptors grab the sugar and put it inside the cell where it turns into energy. This is what's supposed to happen. But PCOS patients genetically have insulin resistance. So when they eat carbohydrates and their body releases insulin, their cells are insulin resistant. So these channels don't open for the sugar to go into the cell and turn into energy. So the sugar bounces in the blood and pushes the insulin to go up. Insulin is a fat storage hormone. It's an inflammatory hormone. You don't want your insulin to go up.

So what happens when this insulin goes up? Few things happen. Number one, insulin tells your liver, the cells are not taking up this sugar to turn it into energy. Take this sugar and store it as fat. The problem is the fat that gets stored with insulin resistance is not the good old fat under our skin. It's the visceral fat around our organs, liver, and our inner abdominal organs. That's highly, highly inflammatory, and we'll get into it later. So one the high insulin tells your body take this sugar and store it into this inflammatory fat.

One two high insulin stimulates their ovaries to secrete androgens. secrete androgens. secrete androgens. So and this is the first domino. Why? Because when the ovaries start secretreting androgens, our menstrual cycle completely goes out of whack. I want to take a minute to tell you what a normal menstrual cycle look like and what it looks like for these poor PCOS patients. So in a normal menstrual cycle, our brain, our hypothalamus releases G&RH, which is a hormone that affects the pituitary gland, another gland in our brain that releases two hormones, FSH and LH.

When this G&R is being released slowly, the pituitary gland releases um a hormone called FSH. FSH affect stimulates our ovaries, the follicles in the ovaries to start growing for that cycle. And these follicles as they grow, they start releasing estrogen. The estrogen they release, it gets the lining of the uterus ready for pregnancy because that's the job of the ovaries helping us get pregnant every month. So these ovaries basically release these follicles release these estrogens and the estrogen stimulates the lining of the uterus. While these estrogen is being released, it has a negative feedback on our brain.

When the estrogen levels hit a very high level, it actually stimulates this G&R secretions from the hypothalamus to go faster. And when the G&R starts firing faster, the FSH slows down and the LH surge comes. And LH is a hormone that is a luteinizing hormone and it causes the ovulation. So it pushes one follicle out and that's when the egg gets released and if we're trying for pregnancy, the sperm comes up, the embryo forms and now the lining of the uterus is nice and juicy and the embryo implants and the pregnancy happens.

What happens with PCOS patients? Remember the insulin resistance that first domino starts stimulating the the cells in the ovary to release androgens. When you start having androgens in the ovary, it freezes these follicles and doesn't let them grow normally. So then the estrogen starts becoming erratic and you have and when your androgen levels go up, the androgens stimulate the G&R to go faster and then the LH starts going faster and the LH constantly stimulates these ovarian tissue, the theta cells to release more androgens. So you start in PCOS patients, you start getting this environment of high androgens and these irregular estrogen uh secretions that not only block ovulation, block implantation, affects our it causes irregular periods but it starts affecting our brain because the androgens affect our mental health and we can go over that uh later.

So, but this is what happens and this is why 70 to 80% of PCOS patients don't ovulate. Of the 20 30% of them who ovulate, they ovulate sometimes. Even the ones who have regular periods, their regular periods, it's not because necessarily they're ovulating. It's because they're getting withdrawals from this estrogen. It gets very complicated. But the human the women's hormonal system is so beautiful when you really understand it. It becomes very complicated with these PCOS patients and that is why it becomes a vicious cycle. Right?

So the insulin resistance starts producing androgens in the ovary. The androgens affect the brain to release more LH. The LH affects the ovaries to secrete more androgens out. And this becomes a vicious cycle that doesn't stop. And so the first underlying condition is this insulin resistance. The second underlying pillar is this androgen being before is there anything women can do about that insulin resistance? Absolutely. Absolutely. Absolutely. What do they do? Let's focus on that one and then we'll move to the others. Absolutely. So for this pillar of insulin resistance, you want to make patients insulin sensitive, right?

So it there are many supplements that can make patients insulin uh sensitive and that's why I don't know if you know I have a OV platform and I have a supplement PCOS is actually one of those conditions that supplements actually play a huge role in it. Why? Because by making a you want to reduce for this insulin resistance pillar a you want to reduce the glucose in the blood right so you tell the patients decrease your carbohydrates if you're eating carbohydrates go for a walk 10 minutes 20 minutes after each meal when we walk we actually wake up these insulin receptors and they start grabbing sugar out of the blood so we lower the sugar so low carb diet simply by having a 10-minute walk after eating after each meal.

So eat less carbohydrate, walk 10, 20 minutes after each meal. Exercise makes a huge difference obviously in addition to the walking after each meal. Then we go to supplements. There are supplements like my OV supplement. These supplements work at a cellular level to make open up these channels and pull the sugar in. The my OV supplement also has wild malberry leaf in it. And what that does if you take it before your heaviest meal, if you take the supplement before your heaviest meal, it actually blocks the absorption of carbohydrate in that meal by 40%.

So now you're decreasing the load of sugar. You're also and whatever gets absorbed, you're pushing it, you're opening these channels and pushing it into the cell. So you're clearing that sugar out of the blood. By doing that, what happens? Your insulin goes down. When insulin goes down, your fat storage goes down. Your weight man uh management becomes easier. When insulin goes down, your ovaries are not secretreting as much androgens. Your androgens go down. Androgens go down, what happens? Your ovulation becomes more regular. The inflammation goes down.

So that's how the supplements work. And the OV has a lot of anti-inflammatory supplements. But there's prescription medication, metformin. What does metformin do? Metformin makes us insulin sensitive. Anything that makes you insulin sensitive again lowers that insulin. Are there any side effects to either of them? them? them? So the supplements don't have any side effects. Metformin does have side effects, but patients get used to it. Uh the most common side effect with metformin is nausea or diarrhea, but most patients do really really well. Um the uh next thing patients can do are GLP1s.

I'm sure you've heard of the Ozmpics and the WGO and the tozepatites. So in 2014, I started treating my PCOS patients with GLP-1. So almost 12 years ago, so none of these medications are new, but back then I had trulicity. GLP1s, why do PCOS patients love GLP-1s? I started treating them and one thing I realized is not only they're losing a lot of weight but GLP1s regulates their insulin and makes them insulin sensitive by doing that they that's why patients say oh when I take I don't know metformin or when I take OVI or when I take um when I use these um GLP1s I get brain clarity I get pregnant my periods are becoming more regular because at its core you're fixing this insulin resistance ance.

So for this pillar, this underlying condition, I say low carbohydrate diet, walk 10 to 15 minutes uh after each meal, exercise, cardio at least four times a week. Um I recommend the OB supplement. It works amazingly well. Take ask your doctor for a metformin prescription. The minimum dose of metformin to affect insulin resistance is 1,500. So you want to start with 750 at night. If you have no nausea, no diarrhea, you want to increase it to twice a day. Then if you have weight issues, if you have a hard time losing weight, if your BMI is in the obese category, or if you're overweight with high blood pressure or high cholesterol, then I recommend the GLP1s.

Uh you can do the ompic wagi, they all work really, really well. Talk to me about the nutritional impact of being on GOP1 because the friends that I know that have been taking it, they're not getting nutrients because they're not eating as much anymore. And that obviously sounds like it has terrible effects on the body to not be able to actually eat, actually eat, actually eat, you know, and you lose weight, but you're not eating. Yes. But remember, we're talking I'm talking right now about my PCOS patients.

I'm not talking about that uh you know pmenopausal woman or someone out there who wants to lose 10 pounds, five pounds, patients who are already underweight and they want to lose 10 more pounds and you know they don't they're not eating. This is for PCOS. This is this is for PCOS. I mean 2014 I started using these medications. It's a game changer. game changer. game changer. And how long would someone stay on it to conceive? conceive? conceive? So it depends. It depends. So for someone who wants to lose 100 lbs, you know, you they might have to stay on it for two 2 and 1/2 years.

And the reality of it is um you know, insulin resistance, metabolic health is is not a one-sizefits-all. Someone who loses 150 lbs with uh GLP1s is probably never going to get off of these meds, you know, but there are patients, my PCOS patients who want who I I don't know, they lose 30 lb, 40 lb, 50 lbs on these GLP1s, GLP1s, GLP1s, but what I do, I keep them on OV and metformin after they lose their weight. So if someone has insulin resistance, you give them GLP-1s and you stop it.

What's going to happen? They shoot back up, right? Take a PCOS patients, her insulin resistant is not going away. You give her GLP-1, you address her uh insulin sensitivity, uh you regulate her insulin, she loses 50 lbs, you stop it, the patient comes back 3 months later, she's like, "Doctor, I gain all of my weight back." Why? Because you did not address the underlying condition. So what I do with my patients if you're starting on GLP-1s I in about 3 4 months when they get used to the GLP-1 that's when I uh introduce the metformin and right when I start them on the uh GLP1s I have them take the OB supplement.

So when I'm ready to stop the GLP ones, they're already on the OV supplement. They're already on the metformin. I'm addressing their inflammation. I'm addressing their insulin resistance. I'm decreasing the load of carbohydrate that's being absorbed in their diet. And then I wean them off of the GLP1. You have to address the underlying disorder, disorder, disorder, if that makes sense. Yeah. So what's the second pillar? So the second pillar is the hormone pillar that I was explaining. When the when the insulin resistant stimulates your ovaries to secrete androgen, the androgen actually affects your uh G&RH secretion.

It makes it very rapid and this rapid secretion of G&R causes a shift in the LH FSH. So the FSH kind of stays down and the LH chronically stays up. So instead of only going up midcycle causing ovulation all month this LH is firing. What does LH do? It stimulates your ovaries to release androgens. So then it becomes a vicious cycle. You have these androgens that block ovulation and you have these androgens that are free floating in the system causing facial hair, body hair, irregular period, acne, oily skin and on top of that these androgens are affecting your brain which we'll talk later.

So this is the second pillar and for this pillar not only you want to deal with the insulin resistance this is when we give patients birth control pills right and birth control pills help uh help regulate uh this vicious cycle. The third pillar which is extremely important and nobody talks about is chronic inflammation. These poor PCOS patients have chronic inflammation in their body. this chronic inflammation. Remember I told you with the insulin resistance, the liver takes this sugar and turn it turns it into a visceral fat.

Visceral fat is highly inflammatory. Insulin resistant increases this this inflammation. PCOS patients are stressed out. They have high cortisol. Cortisol increases inflammation. These follicles that I tell you freeze in the ovaries and they're not ovulating are highly inflammatory. These PCOS patients have sleep disturbances. Sleep disturbance causes increase in the inflammatory markers in uh our body. Uh these PCOS patients have gut dispiosis increases this inflammation. So they have so many reasons for this inflammation to go up. As this inflammation goes up, it makes their insulin resistance worse.

Inflammation stimulates more androgen secretions from the ovaries. And inflammation again affects their mental health. So this again this third pillar adds to the first two pillars just pushing androgens out and increasing the inflammatory. inflammatory. inflammatory. What do you suggest for that third pillar? pillar? pillar? The third pillar you have to address insulin resistance which is the key form. Antioxidants form. Antioxidants form. Antioxidants uh anti-inflammatory diet is very very important. important. important. So there are lifestyle changes. lifestyle changes, exercise, you know, dealing with that visceral fat, blocking that visceral visceral fat, lowering your uh stress, exercising, sleeping, anti-inflammatory diet, that lifestyle.

You know, I always I read this somewhere that, you know, your genetics load the gun, but your lifestyle pulls the trigger. And that's exactly what happens with PCOS. If you're not sleeping, if you're stressed, if you have a a poor diet, if you're not exercising, you're pulling that trigger and making all these symptoms so much worse. The last pillar, which is your pillar, is the pillar is the neurologic pillar of PCOS, which is huge. So tell me about it. Yeah. So with the first pillar, with the second pillar, and with the third pillar, what do we have?

Unstable estrogen levels that fluctuate, we have high androgens pumping in their blood every single day. And we have high high inflammatory markers. In a woman with a normal menstrual cycle, when the estrogen is normal, when the cortisol is leveled, when there's no insulin resistance, when the inflammation is down, estrogen, normal estrogen levels actually are calming on the brain. Normal estrogen levels stimulate serotonin in our brain, lower anxiety and depression. They regulate our dopamine in the brain, so we're more motivated. Basically amygdala which is the uh part of our brain where all the emotions are stored.

It's regulated and it calms our amygdala down. Uh estrogen so it estrogen has a calming effect. Progesterone has the same calming effect. It binds GABA receptors in the brain and it calms it down. What happens with PCOS? There's unstable estrogen. There's lack of progesterone and the androgens are going crazy. So if you think of our lyic system, which I'm sure you talk about all the time, our lyic system is our amygdala, our hippocampus, and our hypothalamus. hypothalamus. hypothalamus. This is the emotional headquarter of our brain.

So all the emotions are in these three areas of our brain. Estrogen and progesterone calms it down. But when estrogen is unstable, when progesterone is low and when androgens are going crazy, serotonin levels go down. As serotonin levels go down, we become anxious, depressed, irritable. The dopamine goes crazy. Our motivation goes down. We feel tired, fatigued, unmotivated. unmotivated. unmotivated. The amygdala goes crazy and becomes hyperactive. That's our fear center. We get anxious. We get scared. we uh we can't control our emotions and as the inflammation goes up in our brain what happens we start having brain fog we feel like our brain is not functioning we feel like we're not sharp so take a PCOS patients all day long with unstable estrogen progesterone that's low you have this androgens pumping up and this inflammatory markers high up in their brain making them feel anxious and sad and depressed and irritable and brain fog and all of it.

And what happens? People tell them, "You have a personality disorder. You're crazy. Go see a psychiatrist." Uh, you know, and on top of all this with the inflammation, with all these hormones changing in the brain, with insulin resistance, they get food cravings. They binge eat. That's why they have eating disorders. So, I'm here to say that if you're sitting at home, if you have irregular periods, if you're gaining weight, if you have if you feel inflamed, if you have acne, hair loss, facial hair, body hair, if you're anxious, if you're depressed, if you're not motivated, all of these could be PCOS.

It is probably PCOS. And until you deal with these four pillars and address each one of them, you can't feel normal. So throwing a birth control pill at these patients, that's why they don't feel better. And you know, to this day, I listen to podcasts when even gynecologists, very well-known gynecologists show up and when they're asked, "What is the treatment for PCOS?" They say birth control pill. That's one. Why would they suggest that? What's that? What is What would that do? What's the hope? to regulate the periods and help uh stimulate the sex hormone binding globbulin that's low in the blood that uh causes elevations in these androgens.

It works with their symptoms. It regulates their periods. Their acne clears up. Their facial hair, body hair, hair loss gets better, but you're not addressing their inflammation. You're not addressing the core insulin resistance. And you're not addressing this uh neurological effect that PCOS has. these poor patients. I mean, my heart aches. That's why I take time out of my office to come and sit with you here on a busy day because I want to scream. I want to scream in this mic and say, "Doctors, health care providers, listen to your patients." But unfortunately, our health care system is not built to listen to women.

People still say, doctors are still telling these patients, you don't have a high testosterone in the blood, so you don't have PCOS. That's not true. You don't have irregular period, so you don't have PCOS. That's not true. You don't have cyst on your ovaries, so you don't have PCOS. But I want I come today to tell you especially for women listening to your podcast with anxiety, with depression, with eating disorders, with a lack of motivation, with a hard time getting themselves to this beautiful calm that you can get yourself to.

You know, it's because their body is on fire, their brain is on fire, their hormones are raging, their androgens are out of control. Uh, and their inflammation and inflammatory markers are off the chart and someone needs to go to their rescue. Someone needs to start listening to that. Yeah, it's it's so hard to hear that so many people have sadly been given the wrong advice and people are struggling and suffering and is there a checkup that you can do to get diagnosed or is it just diagnosed based on symptoms?

Like is there an actual way of knowing and checking? Thank you for this question. So I because of years of doing this I actually created a free calculator free. It's on ovi.com. Go answer. I ask questions that I ask my patients in my office and uh with a very smart scientist I figured out an algorithm. Obviously I cannot diagnose online but I can tell patients with very high accuracy if they have the likelihood of having PCOS and this calculator does that for them. So if they go on ovi.com, answer these questions for free, I can tell them whether or not they have PCOS.

And if they have PCOS, I want them to listen to this podcast to, you know, I created CMD just to give women this information because until you make them become their own health advocate, they will get dismissed in the health care system. So by listening to these podcasts, they become their own health advocate. so they can fight for their symptoms for when they go to that OB/GYN visit. They are ready they've taken they've listened to this podcast. They already know they probably have PCOS. They go take the OV test.

They know, you know, based on the OV test whether or not they have the likelihood of having PCOS. And if they listen to my podcast, I literally give them the bullet points. they can print it out, take it to the doctor and become their own health advocate. Honestly, until we have a better health care system and we educate our doctors not to dismiss women, this is what we have for now. Making women become their own health advocate. Yeah, that's a real masterass on PCOS that I think is going to help so many people figure it out quickly.

And I like those steps of being able to understand it, whether you have it yourself, being able to do the test, and then going to your doctor and being able to list all the symptoms and have an educated conversation. Seems like an important step. step. step. Absolutely. And you know, to this day, I get patients, they're like, you know, I listen to your podcast. I went to my doctor and I said, I have insulin resistance. You need to give me metformin. Uh, and the doctor says, well, you're not diabetic.

Metformin is for diabetes. Do you know what I'm saying? But that's why these podcasts are so important. So what I'm trying to tell to your listener is listen to this podcast. You don't need a doctor to diagnose you. If you meet one of two of the three criteria that I listed at the beginning, you know you have PCOS, right? Learn about it. Learn about all these pillars that I'm telling you. I'm literally giving you the tools of what you can do at home uh with diet, with exercise, with uh supplements, uh with lifestyle changes to, you know, help yourself and then you can address all these things.

You know, sometimes I start my patients on the supplement and they come back and they're like, "Doctor, this month my P PMS symptoms were better." But they can't figure out why. Why? Because when you address that metabolic health issue at its core. The puzzle falls into place, the inflammation falls into place, the brain health falls into place, the periods, the hormones, everything starts working. working. working. Let's talk about endometriosis. My first question was around do periods have to be painful? Should they be painful? No. So, painful periods are not normal.

So, what does that mean? Uh, it's okay to have cramps. You know, we all have cramps. You take a couple of Advils, it gets better. It doesn't disrupt your life. You don't end up in the emergency room. You're not in the urgent care. You're not calling your mom to pick you up from school. You're not on the bathroom floor vomiting from pain. That's normal. But if it starts disrupting your life, then it's not normal. If I could print a t-shirt that said painful periods are not normal, I would do it.

Uh because to this day, unfortunately, in our health care system, women are told that painful periods normal, that it's in their head, uh that they're being dramatic, none of it is true. So I if moms are listening, if uh women who are listening are experiencing severely painful period that disrupts their life, if they cannot have sex and when they have sex with deep penetration, they're having pain. If they have recurrent bladder symptoms, they go to the doctor, their urine culture is negative, but they keep having bladder symptoms, burning with urination.

If they have painful bowel movements, if they have chronic pelvic pain, if they have chronic bloating and they chronically feel inflamed, that's endometriosis until proven otherwise. Endometriosis with PCOS together, they're the leading cause of infertility on this planet. Can you imagine? And majority of these women are not being diagnosed. So diagnosed. So diagnosed. So define endometriosis for me. So endometriosis is a chronic inflammatory and neuroimmune and neuroimmune and neuroimmune condition that affects 10 to 20% of women on the planet. Close your eyes and think of these women, right?

women, right? women, right? So you know someone is the point. Absolutely. Every single one of us have someone right with endometriosis. And basically endometriosis is when tissues similar to the lining of the uterus is outside of the uterus around the tubes, ovaries, on the bladder, on the bowel, uh on our diaphragm and in a very in rare cases you can find it in the lungs, in the brain. And what happens if you think of the menstrual cycle, every month our ovaries are trying to get us pregnant.

So they secrete estrogen to get the lining of the uh uterus ready for pregnancy. And when we don't get pregnant, at the end of the month, the lining comes out. Well, once a month when these ovaries are secretreting estrogen, these endometriosis implants also get stimulated. And as they get stimulated, when we don't get pregnant and the lining breaks down, these guys also break down, but they break down and bleed outside of the uterus. Blood is an irritant and it causes inflammation, bloating, pain, scar tissue, adhesions.

What's interesting about endometriosis is there are so many theories of why so many women have it, right? And one of the main theories is that when we get our menstrual cycle, uh the as we're bleeding, the blood that's shedding, the lining that's breaking, some of those cells come from the endometrial cavity into the tubes, out the tubes, and they implant into the pelvis. In a normal immune system, our immune system attacks those cells and clear it out. Patients with endometriosis, with endometriosis, with endometriosis, their immune system is not functioning well.

So when these cells retrograde flow from the uterine cavity out inside the tube and implant into the pelvis, their immune system instead of getting rid of these cells actually help these cells stick to the walls of the pelvis. And at once they stick there and there's inflammation around them, it's literally like a horror movie, they start um grabbing onto vessels and they grow nerve fibers and these nerve fibers start causing these pains and depending on where this nerve fiber is, it can cause different kind of pains.

It can cause bladder pain, bowel movement pain, sciatic pain, back pain, leg pain, pelvic pain. So, but the worst part of this eventually as these nerve fibers start firing and firing and firing, our central nervous system becomes sensitized. So, what happens is our their brain starts basically cranking up the volume on these pain fibers. So they start experiencing start experiencing start experiencing more and more and more severe pain. So that's why it's not only you know a pelvic pain issue, a fertility issue, a pain issue, but it's a central nervous system issue.

And chronically because it takes doctors 9 to 11 years to diagnose these women. And because majority of these women go undiagnosed, this chronic pain, this chronic inflammation that comes from these inflam inflammatory inflam inflammatory inflam inflammatory tissue in the pelvis starts affecting their central nervous system. They start becoming anxious, brain fog, depression. Their amygdala, their lyic system is literally on fire 24/7. to a point that they become so fearful and so anxious of these periods and because doctors are not addressing it. What do they do?

They start taking pain pills. They become addicted to these narcotics. They start secondguessing themselves because they keep going to the doctor saying, "I have painful periods. I don't feel well." And the doctor says there's nothing wrong with you. that it's in your head that you're anxious, that you're crazy, that you probably need to see a psychiatrist. Do you understand what I'm telling you? Yeah. It's it's I mean, it's it's shocking and traumatic. That's why they have PTSD. That's why they end up in therapy. That's why they end up getting ketamine treatment.

That's why they end up using MDMA, psilocybin, because doctors are not addressing this. and they literally feel crazy. Can I tell you my on Fridays I operate majority of the patients I operate on are endometriosis. I mean I have endoendo endo. It's a lineup of endometriosis patients. Would you believe me if I told you that every single patient when I diagnose them in my clinic with endometriosis or when I wake them up from surgery and I tell them the stage of their endometriosis, the first thing they do, they cry and they say, "I feel validated." The problem with endometriosis is the same doctors who are dismissing these patients are telling these patients that the only way to diagnose endometriosis is surgery.

That's an old school way of thinking about endometriosis. The I'm here to let your listeners know that endometriosis is a clinical diagnosis and yes, the patient can self diagnose at home. If you have debilitating pain with your periods that's disrupting your life, you're missing school, you're not going to work, you're uh changing your social calendar, you plan your trips around your periods, that's endometriosis until proven otherwise. If you have painful uh sex with deep penetration, if you can't have sex, that's endometriosis until proven otherwise. If you have chronic inflammation, bowel movement with pain, your bladder pain, these are all telltale signs of endometriosis.

And all we need to do is our health care providers to start listening to these patients. You need to listen for 5 minutes to diagnose endometriosis with over 90% accuracy. Surgery is not to diagnose. surgery is to treat only if hormonal suppression fails. Why? Endometriosis implants, these tissues in the pelvis are highly inflammatory. And what they do, they're estrogen dependent, but they don't depend on the estrogen from the ovary. That inflammation actually stimulates this enzyme aromatase in the tissue that starts producing estrogen. So they become self-sufficient.

They make their own estrogen. They cause their own inflammation. They have their own blood vessel. And they have their own nerve fibers that's constantly firing and until the central nervous system becomes uh sensitized. So what happens to these implants? They love estrogen. So you don't want to give it estrogen. And they become very progesterone resistant. So, one of the ways to treat them hormonally is to either give them progesterone or take the estrogen away. How do you give these implants progesterone? Progesterone birth control pills, progesterone IUDs, kylina, merina, letta, there are different forms of progesterone IUDs work amazingly well for these patients.

However, sometimes patients with the progesterone IUDs are still having pain. Why? Because these implants are progesterone resistant. So if you start with a progesterone birth control, progesterone IUD, and you're still having pain, you can actually take medications that are uh G&R agonist or antagonist. These are medications like Oralissa, my Femry that what they do, they actually take that estrogen away. And by taking that estrogen away, they calm down these endometriosis implants. The problem with this group of medications are because they take the estrogen away, they can cause hot flashes, night sweats, mood changes, and these patients are already anxious and depressed.

So sometimes they don't tolerate it well. But if all fails, then you do laparoscopic surgery to reect endometriosis. endometriosis. endometriosis. But here's the problem with laparoscopic surgery. I honestly can sit here and tell you that less than 1% of gyns can operate on endometriosis with advanced disease. And what counts as an advanced disease? How long How long How long in deep infiltrated uh implants in bowel in bladder you know endometriosis causes a lot of adhesions. So you have to be able to know to operate on that.

So you're saying there's no cure. It's more hormonal balance. hormonal balance in surgery makes a huge difference. It's still gold standard to treat these patients, but because we these patients don't have access to surgeons who are familiar with endometriosis surgery, uh it's always best to start with hormonal suppression first. And if they c if they need surgery and they still having painful sex and they still have experiencing pain with their periods, then I would recommend uh searching for an endometriosis surgeon. How long does hormonal suppression take?

Like to actually actually actually at least 4 months. At least 4 months. Because your body is not a light switch. You can't say on, off, on, off. Have you seen success with with people coming to you and taking your advice? Are you seeing people cure and recover and feel completely different or is it more that you're m that people are just managing? managing? managing? There's no cure, but in my practice, it's extremely rare for me to have a patient with chronic pain. I fix everyone. I always start with hormonal suppression.

If that fails or if they're actively trying for pregnancy and they can't get pregnant, then I do laparoscopic uh surgery. Here the points with laparoscopic surgery. A, you need a laparoscopic surgeon who's done endometriosis surgery. B. In my opinion, if you give hundred gynecologists, 100 laparoscopes and say go operate, half of them will wake the patient up and say you didn't have endometriosis. Wow. How's that possible? I know. I I swear to God, I want to cry when I talk about these things because I see these patients in my office.

Why? Because endometriosis implants can be glandular where they're purple. You know, there are these purple spots in the pelvis. You have to look for them to find them. You can't quickly scan the pelvis and say, "It's not there." Sometimes it takes me 10 minutes to find them. They're tiny, but they're very inflammatory and painful. So, you have to be patient. You have to know what they look like. But there's a type of endometriosis that's stromoal endometriosis from the stroma, the connective tissue around the gland. These when you look for them don't have that typical purple spot.

They're just these fine white lines. In my opinion, these stromal endometriosis implants are more inflammatory and more painful and have more debilitating pain, but 90% of the time they get missed during laparoscopy. So these are patients that already people are telling them they're crazy. It's that painful periods are normal, that it's in their head. They on average see 10 doctors. Average age of diagnosis is 32. 9 to 11 years they wait to finally for someone to say you might have endometriosis and then they take them to surgery, wake them up and say you didn't have it.

It's crazy. It's crazy. It's crazy. Talk about gaslighting. It's crazy. It's crazy. It's crazy. Put yourself in that girl's shoes. And to make the matters worse, in my opinion, more than 50% of PCOS patients have endometriosis. have endometriosis. have endometriosis. So what's the cost of ignoring this? Like if someone's listening right now and they've been kind of feeling all this, but you kind of just let it go. What's the cost every year of not diagnosing? The most devastating uh part for endometriosis is fertility because uh endometriosis is a highly inflammatory condition and it destroys the egg count and quality.

Uh I said it on a on Huberman podcast that I have a 14year-old with an egg count of a 40-year-old. And yes, I do check egg counts in a 14year-old with debilitating pain. It's whenever I'm not saying every single girl on this planet at 14 needs to know her egg count, but I think until doctors start diagnosing endometriosis, we need to have a baseline egg count at 18. I absolutely fight for that every single day. I every single day in my practice I see someone in her 20s or 30s ready for pregnancy with an egg count of zero because of years of pain dismissed by the health care system.

So no uh I would so to answer your question uh fertility is the biggest price they pay. So if you have painful debilitating periods absolutely check your egg count. It's a simple blood test. It's called AMH. AMH tells us about the ovarian reserve. A low AMH doesn't mean you're not going to have a baby. A low AMH means your reserve is down. Be careful. So, if you can afford egg freezing, freeze early. That's why, you know, I wish egg freezing was free. I wish, you know, it wasn't this expensive.

I always say when you're young and your uh eggs are healthy and you want to freeze them, you don't have the money. When you're old and your egg count is down and the quality is down, that's when you have money to freeze eggs. To the endometriosis patients, I say check your egg count. Absolutely. If your egg count is low and you can afford it, freeze eggs. If your egg count is low, immediately do hormonal suppression uh and decrease the inflammation in the pelvis. If you can find an endometriosis surgeon with debilitating pain, excise those endometriosis implants.

By doing that, you bring down the inflammation in the pelvis. Especially patients with endometrioma. endometrioma. endometrioma. These are chocolate cysts in the ovary. Those are the ones at most at the highest risk of losing other egg count and quality. and quality. and quality. So, um that's the biggest price they pay. Painful sex. There's so many women who can't have sex. Imagine these are young girls who either don't get married because they can't have a relationship because they can't have sex. So that's debilitating. Um chronic pain causes severe anxiety and depression and lack of motivation.

of motivation. of motivation. Uh a lot of them unfortunately uh become addicted to these pain meds. So these are long-term uh side effects of it. So it affects their mental health, their nervous system, their inflammation in the body, their fertility. their fertility. their fertility. Yeah. Yeah. Yeah. It's just devastating. It's it's there's no words for it. I mean, I can sit here, you guys, and I I mean, I can talk for another 10 hours. I'm touching the tip of the iceberg. I'm traumatized from years of seeing these patients.

I swear to God, they come to my office, they cry. I cry with them cuz I can't I can't take it anymore. Well, I'm glad that you're able today as we're talking to give people the help that they need. I've got I wanted to ask you about how there's a lot of mixed information about birth control pills and then when you're off them, whether they block you from conceiving. What's your take on that? So, first of see, I I I got emotional talking about these girls.

It's my trauma. Literally, their trauma is my trauma. Anyways, I love birth control. So birth control pills for endometriosis patients is the difference of having children and no children for some patients. Why? So because birth control pills, especially if you're on progesterone only birth control pills, what they do, they suppress these implants. Remember I talked about inflammation destroying the egg, destroying the egg quality. So by putting these patients on these progesterone birth control pills, what you're doing, you're bringing down the inflammation. you're hopefully suppressing these inflamed endometriosis tissues outside of the uterus and by doing that you're preserving some of their ovarian reserve.

So that's number one. Number two, when you give these patients birth control pills and you can or I progesterone IUDs, what you're doing, you're helping their pain so they can start having sex, they can start having relationships. So the answer to the question of birth control pill is absolutely wrong. You know, there are a lot of uh moms or grandmas who tell patients, "Don't take birth control pills. You're going to be infertile." No, you're going to be infertile if you're not taking birth control pills. You want to be suppressed on these birth control pills until you're ready to have children.

children. children. But then why do people struggle then when they do that? So, one thing to remember is there are many women who stay on birth control pills past seven years. There's a small percentage of women when they take birth control pills that chronically suppresses their ovulations, when they stop it, their ovarian reserve never recovers. So, for that reason, it's important to, you know, I always say after 7 years of suppression, make sure you're checking your egg count. Make sure you're checking that ovarian reserve. And if it's, you know, uh, suppressed and you've been on birth control for so many years, stop the birth control pill, maybe go to a progesterone IUD at that point.

I've seen this numerous times when patients come and they're like, "My ovarian reserve is really low. I've been on birth control pills." Yes. and when you stop their birth control pills, their ovarian reserve recovers. So that's why I'm such a big advocate of checking um doing a pelvic ultrasound, which should be mandatory for every single girl who's sexually active and goes for a wellwoman exam. Check a pelvic ultrasound, check the follicular account, check their ovarian reserve. If you can't just do a simple AMH blood just to see what that reserve is, especially for endometriosis patients.

patients. patients. If someone can't afford to freeze their eggs right now, yes. yes. yes. What are their other options? Suppress, suppress, suppress, suppress, put a progesterone IUD in, take a progesterone birth control pill, take my fee or um or Alyssa, go have laparoscopic surgery. But here's the problem with laparoscopic surgery. Do you know I had a patient once in my office who came in, she's like, "I'm here for my 12th laparoscopic surgery." Every year she checks herself in for a laparoscopic surgery. That's madness. You do not need scary.

That's so scary. And you do not need that. The reason these patients keep having surgeries is because no one's suppressing them. suppressing them. suppressing them. Imagine someone has colon cancer and you go in and you resect their colon cancer. Do you ever tell them, "Uh, okay sir, go home. I'll see you in six months. No, you they're they're going to come back in six months with cancer everywhere. What do you do? You give them chemo. Endometriosis is not cancer, but that's exactly what you need to do for these patients.

When you do laparoscopic surgery, and you first you want to resect all the implants. Once you do that, you want to suppress immediately. In my case, almost every single patient I take to surgery, unless they're actively trying for pregnancy, I put a progesterone IUD at the same time because I want to freeze the pelvis. the way I'm leaving it. And as soon as they start having pain again, then in addition to surgery and uh the IUD, if they have more pain after surgery, if they have advanced stage, I put them on these uh G&R antagonist like oralysisa and my femri to just completely kill it.

That's why my patients, it's very rare for me to operate for the second time on my patients unless they have advanced disease. How much is all of this affecting other functions in the body? Whether it's the microbiome in the gut, whether it's whether it's whether it's Oh, thank you for asking that. In my opinion, 90% of endometriosis patients suffer from leaky gut. They have SIBO. 90%. 90%. 90%. What's uh leaky gut? Basically um you know they get disruption in the lining of their uh gut. So harmful substances start getting absorbed.

As harmful substances get absorbed, what goes up? Inflammation. When inflammation goes up, it becomes a vicious cycle, right? They get brain fog, they get bloated, they get tired, they get insulin resistant if they have PCOS. And uh they just feel terrible and on top of that they start gaining weight. So um but I always say and these are patients who end up call having colonoscopies, having endoscopies, have seeing GI doctors, bouncing from doctor to doctor and no one stops to tell them are your periods painful and why unless you treat the underlying condition which is endometriosis, you cannot get rid of their leaky gut.

They keep having these symptoms of bloating and fatigue and inflammation. So what I do in my practice is once I operate on them and I suppress them with IUD, I have them monitor their symptoms of bloating. And if they come back in a month, in two months, and they say, "Doctor, you know what? My pain is so much better," which is usually the case, but I'm still bloated when I eat, then I treat their SIBO. SIBO. SIBO. Do you understand? And that's how it works. Now, patients with advanced disease, patients who go through years of pain and central sensitization of their nervous system being ignored.

Sometimes when you operate, when you suppress and you treat their SIBO, they still have pain. They're still anxious. They're still depressed because their brain is rewired after all these years of pain. For those patients, one thing you can do is use neurom modulators like medications like aexer, symbalta, gabapentin, lica because once you address their pathology, you it takes sometimes time to rewire that brain and calm their nervous system down and you tell them to listen to your calm. By the way, I listen to it every night.

night. night. But do you understand? Yes. Yes. Yes. Yes. That's helpful. Yeah, I'm glad I asked that because I'm always Yeah, I'm always intrigued as to the side effects and when you're trying to it fills up with the body sometimes, especially with traditional medicine, you're trying to solve one thing and you negatively kick off something else and there's all these things happening back and forth that people don't usually think about because doctors are just trying to solve one thing. Like I know someone and we'll talk about IVF in a second, but I know I know a friend who was going through IVF, but then something they were taking to make that more successful triggered their autoimmune and then you know now you're dealing with that and then that's affected.

So it's like I'm always just intrigued as to the correlation. Let's talk about that. That's so important. First of all, number one, like you said, every doctor is treating what they know they're treating, right? A GI doctor is only treating the SIBO. In my opinion, every GI doctor needs to know about endometriosis because endometriosis is causing this leaky gut. So if you're missing endometriosis, you can never treat your SIBO patient. Number one. So we have to start treating patients holistically. I'm a gynecologist. I check everything metabolically.

Let's say in my PCOS patients, I check their ApoE. I check their Apo B. I check their lipoprotein little A. I check their hemoglobin A1C. I check for pre-diabetes and I'm a gynecologist. I screen for anxiety. I screen for depression. I check for fertility. I do my part and I do everybody else's part too because because doctors are not having this holistic approach to patient. So that's extremely extremely important. And the second thing I want to uh talk about you're absolutely right. Let's take endometriosis. In endometriosis, your own immune system is attacking your own tissue, right?

So, it is a form of autoimmune. When you have one autoimmune condition, you have a 30% chance of having another autoimmune condition. So, in my practice, if I see someone with endometriosis, I immediately think to myself, am I missing lupus? Am I missing antifhospholippid syndrome? Am I missing shogans in them? Am I missing psoriasis? And I start asking questions. And believe it or not, when they start trying for pregnancy, if they have any other symptoms, if they complain of a little bit of a joint pain, a little bit of a malear lash, a any any uh symptom of any kind of autoimmune disorder, I do a full autoimmune lab on them.

So, this friend of yours who's in IVF, right, I'm assuming this because I see this every single day and I've done it for decades. She might have an endometriosis that was undiagnosed, right? So, what happens during IVF treatment, they blast her with estrogen. When they blast her with estrogen, they stimulate her endometriosis. So, the pain sometimes gets really hard for these patients during IVF. But because they have other they're at risk of having other autoimmune disorders, the IVF did not cause the autoimmune. The IVF pushed it out just like pregnancy pushes it out.

But if we know that endometriosis is an autoimmune condition, a diagnose it correctly. Don't dismiss these patients. And when you diagnose it, look for other autoimmune disorders. You will not be surprised with patients like Got it. Your friend. Yeah, I think that's the point, right? Like I appreciate that what you said that, hey, we're going to look at everything and that makes sense because the body's so connected. It makes no sense to be like, we're going to treat this in a silo and hope it doesn't affect anything else when of course it's going to affect your entire body and mind.

And I feel like a lot of patients just get thrown around different departments going, "Oh, well, now you're going to have to sort that out and now you're going to have to sort that out and it it doesn't add up for them." Like, it's a painful process to go through. go through. go through. Bingo. Bingo. Bingo. Yeah. It's it's terrible. And I've seen it happen to so many friends where they're constantly running around trying to solve another problem now that was triggered by something else they were trying to solve.

I I I wanted to ask you if if a woman in her mid to late 30s wants to conceive, what should she be doing and thinking about if she hadn't frozen her eggs previously? You come to my office, you're 35, u you show up to my office for a wellwoman exam. I love this question. Number one, take a good history. I want to rule out endometriosis because no one's diagnosed it. I want to rule out PCOS. These are the top leading causes of infertility. They need to be ruled out on that visit.

Three, I do a pelvic ultrasound. I look at her anatomy. I look at her ovaries. I look for PCOS looking ovaries on ultrasound. I look to make sure she doesn't have chocolate cyst. I look to make sure she doesn't have any abnormal cysts on the ovary. Then I go to the uterus. I make sure she doesn't have any fibroids because fibroids when they come closer to the lining of the uterus, they can cause heavy periods, painful periods or they can cause um fertility issues and miscarriages.

I look for polyp in the lining of the uterus. PCOS patients especially because of that hormonal changes, they have a lot of polyp in the lining of their uterus. So that can block them from getting pregnant. So I look for that. I do a 3D image of their uterus on my pelvic ultrasound to make sure they don't have a septum. You'll be surprised of how many patients go through fertility clinics, do IF embryo gets transferred, they don't get pregnant, they end up in my clinic and I'm like, you have a large septum.

So these are all the things that I do. Then after I'm done taking a good history, doing a pelvic ultrasound, I send them to my lab. I check all their hormones. I check their thyroid hormones. I check for thyroid antibodies. I check for prolactin. These are hormones that can affect ovulation. I check their testosterone levels if I'm suspecting PCOS in them. I check DHEAS which can go up. It's uh we call it adrenal PCOS. And everyone's stressed out in LA where I live. So adrenal PCOS is a real condition where they start secretreting androgens and they have symptoms very similar to PCOS.

So I screen for DHEAS in their blood and um I check testosterone free and total and I do a full STD panel but the most important thing I do in a 35year-old I also check her egg count. Um so that egg count is very important for me. Once I do all of this then I tell her to go get pregnant. How do they how do they try for pregnancy? Uh, basically I recommend having them start prenatal vitamins usually three months prior. If they have a progesterone IUD because they've been my patient, I pull that IUD.

If um they have PCOS, I treat them with every single thing we talked about uh before they start trying because metformin, the OV supplement, these things uh stimulate ovula, it help with the ovulation and lowers their inflammation. Um, I encourage a healthy diet, a good exercise, stopping smoking, stopping alcohol, and then I tell them to go try to have sex three to four times. Uh, for patients younger than 35, I usually give them a year to try. For patients who are older, 35 and older, I tell them go try for uh 6 months and come back.

I screen for their partner's health. I ask the age. I ask if they use any drugs, if they smoke weed. uh if they've had any fertility issues, if there's any concern, uh I sometimes get a semen analysis because I don't want my patients to try at 35 for six months and then find out that the semen is not bad and 30% of uh fertility issues uh are you know male related and then um you know I have them try for pregnancy. One thing I don't have them do is check their ovulation, check their temperature, get an ov kit because the more you think about it and the more you stress, the more cortisol you release and your hormones go off balance.

So I tell them, go try for 6 months, go try for a year, and if you're not uh pregnant, come back. But one thing that I do in my office, I've already done 90% of the screening for that patient. So, it's rare for me to have a patient show up to my office under my care that she's tried for a year and she's not getting pregnant. If they're under my care, I've already ruled out everything. And if they've had PCOS, I've addressed it. If they've had endometriosis, I've addressed it.

If they've had autoimmune, I've already addressed it. If they've had a septum, I've reected it. If they've had polyp, I've dealt with it. Do you know what I'm saying? So when I let them go, I maximize that time. This is not being done. One thing I want to do for women in the health care system, I want to make pelvic ultrasounds mandatory at a wellwoman exam. Just by doing a bmanual exam, you can't screen for these things. If you come to my office and you tell me you can't do a pelvic ultrasound, uh, then I will tell you to leave probably because it's just like taking someone's glasses away and telling them to read.

Yeah. Yeah. Yeah. I see so much with my ultrasound. I can't even imagine women going once a year to their doctor and not having an ultrasound. ultrasound. ultrasound. I think for a long time at least, these things weren't talked about. And so people thought having kids was just like you turn up, you have kids, and things work out. And I think everyone realizes all of a sudden, like I was saying, you start talking to all your friends and like, "Hey, I had a miscarriage. Hey, I um hey, we've been trying for six months, nothing's happened.

Now we're going to go get checked. Hey, you know, and so it's fascinating that this wasn't talked about for so long that now when people are finally coming to the point of wanting to conceive wherever they are in their life, they think that there's something wrong with them or they think there's something that's not working out or now they're figuring out a health issue because of the reactive approach as opposed to, hey, having a kid's not easy no matter what age you are because there could be a million different things going on as we've discussed today.

And so whether you're in your 20s and you don't want to have a kid till your 30s, there's still things you can do. There's still steps you can take now that are probably going to help you even if it's that far away. If you've tried for a year and you've you've had sex three to four times um every week and you haven't gotten pregnant at the end of the year, here's what you can do. Number one bucket is the female factor, right? It's the woman. Check your hormones.

I listed those hormones. thyroid panel, prolactin, testosterone, free testosterone, DHEAS. Make sure those are normal. Do an STD check. Check for gorrhea, chlamydia. Check your AMH, antimmalarian hormone is egg count. Basically, it it tells us what that ovarian reserve is for the woman. That's number one. So, that's female factor. Second, you want to make sure the egg count is good and the hormones are good. Second bucket is the male factor. Make sure the semen analysis is normal. Have your partner go to any fertility clinic, do a semen analysis.

It takes 2 minutes to do that. Number three, I call it the anatomy anatomy anatomy uh bucket, right? Get a pelvic ultrasound cuz doctors are not doing it. Make sure you don't have fibroids. Make sure in the lining of the cavity you don't have any polyp. Make sure you don't have any septum. Ask your doctor for an HSG. Hyro sapingoggram is a very simple procedure done by radiologists. They basically inject dye into the uterus and they flush the tubes. Not only it flushes the tubes and helps you get pregnant.

It tells us whether or not there's any blockage of the tubes. A lot of patients with endometriosis with scar tissue can have blocked tubes and that's why they're not getting pregnant. So that's the third bucket. My fourth bucket is the bucket of endometriosis. Have you had painful periods? Do you have painful sex? Do you get really bloated? Have you had recurrent bladder infections with negative culture? Is bowel movements painful? If you think you have endometriosis, endometriosis can cause infertility in several ways. A, that inflammatory environment that we talked about destroys the egg.

Doesn't let the egg go to the tube. the tubes are scarred. Even when you make an embryo and the embryo wants to implant into the uterus, a lot of these patients have adenomiiosis, which we didn't talk about. It's a it's a sister diagnosis to endometriosis. A lot of times they go hand in hand when the walls of the uterus are so glandular. And when you have that, your risk of miscarriage goes up. So this bucket is an extremely important bucket. And if you think you have endometriosis and your doctor is telling you you don't have it, go find another doctor.

Go find an endometriosis specialist. You have to be your own health advocate in this specific bucket because it will get dismissed. Okay? And the next bucket is the bucket of PCOS which we spent all this time. If you have irregular periods, if you have acne, hair loss, facial hair, body hair, if you have gain, if you gain weight and you can't lose it, if you've struggled with weight most of your life, if you're anxious, depressed, history of eating disorder, these are all telltale signs of a PCOS issue.

And PCOS patients when they want to get pregnant, I would a million% I swear not because it's my supplement, because it works. Take the OV supplement. Ask your doctor for metformin. Believe it or not, women in this bucket who are lean and they go to the doctor and the doctor says, "Well, your hemoglobin A1C is normal. You don't have insulin resistant." That lean woman also has insulin resistance at his tissue level. You can't see it in the blood, but she has it at her tissue level.

And putting them on the supplement and giving them metformin will help them ovulate and get pregnant. That's how you pull these patients out of the hands of the fertility doctors. So that's my what are we fifth bucket and my sixth bucket is my autoimmune bucket. This bucket is always also dismissed in women. This is your friend with the autoimmune condition. These are patients that when you have an autoimmune, let's say if you have psoriasis, yeah, psoriasis doesn't affect your fertility, but if you have psoriasis, you might have another autoimmune condition that does affect your uh uh fertility.

Why am I saying this? Let's take antifhospholippid syndrome. These are patients who might not have any symptoms, right? But in their labs, their antifphospholipid syndrome is positive. These patients make clot easily in pregnancy. Pregnancy is a hypercoagulable state and patients in this bucket when they get pregnant, they make blood clots in their placenta. They get recurrent miscarriages. Uh sometimes I have my medical assistant present a patient to me. We have a new patient. She's had five miscarriages. She's seen all these doctors. She's pregnant right now.

She's five weeks. Even before going in, I'm like, "Give her blood thinners." I don't even need to see the patient. I can tell you she needs blood thinners because she's in this dismissed sixth bucket. For me, in my practice, it's extremely rare, extremely rare that I find someone unexplained infertility. Do you know that if you look at the literature they say 30% of infertility is female related 30% is male related and 30% is uh unexplained or mixed like no one knows I know I know I know really really really you know why because those are my poor endometriosis and PCOS women the autoimmune women that no one is addressing them I always say if you send every 20-year-old to my office once.

Actually, if I could take him, I would probably take him at 18. Every 18year-old to my office once, I would shut down a lot of these fertility centers because I would not dismiss a woman with endometriosis. I would not dismiss a woman with PCOS. Now that you learned all this, I want you to imagine this patient, and I've seen thousands of them. Imagine a 34year-old girl who's had irregular period who's overweight since she was in high school. She had an eating disorder because her sister was very thin.

Her mom was very thin. And at a very young age, her mom kept telling her, "Honey, why are you you probably eating unhealthy? That's why you're overweight. Eat less. She gets anxiety. She gets depression. By the time she's 16, she has an eating disorder. She has acne. Her mom takes her to the dermatologist. They start her on Accutane. She is very depressed. Uh she goes to a psychiatrist. They put her on a anti-depressant. Uh she bounces from psychiatry office to psychiatry office. She's doubled over in pain.

When she's at school, she uh the nurse calls for her mom to come and pick her up. Um, she goes to goes to goes to 10, 20, 50 doctors from state to state, country to country, and everyone tells her that she needs to eat less, exercise more, that she's stressed out, that she was born anxious and depressed, that her medications need to be changed. And by the time she gets to me, she's 34 years old. I do her AMH and she has no eggs left. Yeah.

Yeah. This is my broken heart. This is my trauma. This is every single patient I see in my office. Do you understand? understand? understand? And I don't take insurance. My office is expensive. Not because I want to torture patients, because I just can't see patients anymore. I've done this 30 years and I'm at their trauma is my trauma and that's why I started my podcast, podcast, podcast, my CHMD podcast. I literally take these, we don't talk about men. Men are not allowed. It's a safe place for women and I literally take every single condition, endo, PCOS, fibroids, STDs, one by one.

I teach them. I empower them to become their own health advocate. So if you're 25 and you go to an office and you're being dismissed, those that needs to stop. stop. stop. I'm here today because I want to change this health care system. I swear to God, I feel like this is my calling. I feel like I was placed on this planet to change this. I feel like I got breast cancer because I was, you know, do you know how many people called me crazy with my breast cancer journey?

And if as a women's health advocate, people call me crazy. Do you think women have a chance in this healthcare system? That's so painful. It's so painful and tragic to hear. It's so painful. You don't understand the depth of this pain that these women go through. go through. go through. You don't understand it. The gaslighting is toxic. I want to scream. That's why I say I want the president of United States to give me the mic. People grab that mic for nonsense. Give me that mic for 20 minutes only.

Let me tell women what they deserve to know. You don't have to be 35 years old to find out you don't have any eggs left. You don't have to be 35 to learn that you have giant fibroids, that you have endometriosis, that you have PCOS, that you have an autoimmune condition, that your lifetime risk of breast cancer is high and no one diagnosed it and now you have stage four breast cancer. Enough. Enough is enough. That's it. I can talk for another 10 hours. hours. hours.

Dr. Trey, I want to thank you Dr. Trey, I want to thank you for showing up and to have such a clear, conscious, powerful message delivered that emphatically by you to everyone who's listening right now. Everyone who's listening or watching right now, please go and subscribe to CHMD. It's free. It's a podcast by Dr. A where you can get deeper insights. You can get the extra 10 hours of conversations around any of these areas you're struggling with. And of course, pass this episode on to a friend.

I think there's going to be someone in your life who you know struggling silently, who you know suffering in the background, who you know is not aware of what they're going through. I hope you'll share this episode with them as a way of sparking a conversation and starting their journey and empowering yourself through your health journey. Dr. A, thank you for enlightening us, inspiring us, and giving us such a so sweet powerful message. Truly, I I learned so much today, more than I ever have truly on this subject.

And even more than that, I appreciate your directness, just your conviction in how important this is because you're absolutely right. I mean, women's health has been ignored for a long time. It's been depprioritized for a long time. It is at the core of how we exist as humans. So, for us to not understand it is there is no excuse for it. it. it. There's no excuse for it. And I'm just really thankful that you came on today and shed so much light on it. So, I'm very grateful for you.

You're so sweet. Thank you for giving me this mic. this mic. this mic. Yeah, I mean it. Well, hopefully you get the get the get the president's mic, too. That's that definitely. But thank you for your time and energy. Thank you. Thank you for having me. If you enjoyed this podcast, you're going to love my conversation with Michelle Obama where she opens up on how to stay with your partner when they're changing. If you're going through something right now with your partner, this is the episode for you.

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