208. Dr. Thais Aliabadi: PCOS & Endometriosis—The Symptoms Women Should Never Ignore

What if the painful periods, irregular cycles, unexplained weight gain, acne, and fertility struggles so many women experience aren't something they should simply learn to live with? Too often, women are told their symptoms are normal, their lab results look fine, or they're just stressed. But conditions like PCOS (polycystic ovary syndrome) and endometriosis can go unrecognized for years, leaving women without answers while their symptoms continue to affect their health and quality of life. In this episode, I'm joined by Dr. Thais Aliabadi, her patients call her Dr. A, an OB-GYN with decades of experience in women's health, for an eye-opening conversation about two of the most commonly misunderstood conditions affecting women's hormones, metabolism, and reproductive health. We break down the signs of PCOS and endometriosis, why these conditions are frequently overlooked, and how earlier recognition and individualized treatment can make a meaningful difference. In this episode, you'll learn: The warning signs of PCOS, including irregular periods, acne, facial hair, and unexplained weight changes Why women can have PCOS even if they're lean or don't have ovarian cysts How insulin resistance, testosterone, and inflammation are connected to PCOS Why severe menstrual cramps and chronic pelvic pain deserve further investigation for endometriosis How PCOS and endometriosis can affect ovulation, fertility, and ovarian health What AMH testing can—and cannot—tell you about ovarian reserve The roles of birth control, metformin, GLP-1 medications, and lifestyle changes in PCOS management How endometriosis is evaluated and the treatment options available, from hormonal therapies to surgery We also explore the connection between hormone health and mental well-being, the challenges women face when seeking a diagnosis, and why listening to patients is one of the most important parts of preventative medicine. Your symptoms deserve to be taken seriously. Whether you're struggling with painful periods, irregular cycles, infertility, or unexplained hormonal changes, this conversation will help you better understand what may be happening in your body—and what questions to bring to your healthcare provider. Learn more about Dr. Shah: Website: drshah.com https://drshah.com Clinic: next-health.com https://next-health.com Instagram: @darshanshahmd and @extend_podcast Learn more about Dr. Thais Aliabadi: Website: draliabadi.com https://www.draliabadi.com Instagram: @drthaisaliabadi Thank You to Our Sponsor! Momentous: Head to livemomentous.com https://livemomentous.com and use my code DRSHAH at checkout for up to 35% off.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Welcome back to Extend. Today, I'm going to be diving deep into women's health longevity and our broken healthcare system when it comes to women's health. I'm going to be with the preeminent OB-GYN to the Stars here in Los Angeles, Dr. Tais Ali Abadi. Dr. A has spent over 30 years transforming OB-GYN, delivering thousands of babies, building a powerhouse preventive practice, and championing the voices of dismissed women everywhere. She's a renowned media personality, having appeared on national platforms like Dr. Phil. And she hosts her incredible podcast called SheMD, dedicated to educating and empowering women. In this episode, Dr. A shares her incredible journey

• 1:33Dr. Darshan Shah?

  from growing up during the Iranian Revolution to becoming a trusted physician for a high-profile clientele, while unpacking critical underdiagnosed conditions like PMOS and endometriosis. If you've ever felt gaslit by the medical establishment or struggled to get answers about your hormones, this is an episode you cannot afford to miss. Let's dive in with Dr. A.

• 2:00Dr. Darshan Shah?

  Dr. A, thank you for coming on Extend. Really appreciate you being here.

• 2:04Speaker 01

  I'm so excited to be here.

• 2:05Dr. Darshan Shah?

  I know. I knew I had to have you on after you had me on your podcast. Thank you so much for having me. And, you know, I was just like talking to you afterwards, and there's so many topics that you're such an expert in. And you are the preeminent GYN here in Los Angeles to the Stars, many famous clientele, and they all trust you because of your depth of knowledge, but also your ability to explain, some of the times, these complex topics to people in a way that's easy, understandable, and actionable.

• 2:33Speaker 01

  I love doing it. Thank you for having me here.

• 2:36Dr. Darshan Shah?

  So how did you end up in Los Angeles and becoming the OB-GYN to the Stars? Tell me your story.

• 2:43Speaker 01

  Oh, my God. So, you know, I grew up in Iran. And after the revolution, they took my dad's passport away. So I got stuck with my family. I grew up in war, so I had a lot of trauma growing up, you know, in a suppressed country. You know, my mom grew up with mini skirts and her hair down, freedom for women to, like, you know, when I was growing up, cover your hair. We couldn't go outside the house. And, you know, our voices were shot. So I think part of who I am today is because of everything that happened to me in my teenage years. So they took my dad's passport away, so we couldn't leave the country. Until when I was 17, you know, when I was eight, we applied for our green card. When I was almost 18, we got our green card.

• 3:27Speaker 01

  And my second language was French, growing up. So I was planning to go to France and study, you know, medicine. I was going to follow my sister. And when we got our green card and we came to just, you know, to this country for the first time, I remember my sister got out of the plane, and she's like, "I'm never going back. I'm not going anywhere." And this is really, this country changed my life. I love, that's where my journey started.

• 3:51Dr. Darshan Shah?

  Were you a physician when you came here?

• 3:53Speaker 01

  No, I was 17.

• 3:54Dr. Darshan Shah?

  Oh, you were 17 years old?

• 3:56Speaker 01

  17, yes, exactly. So I went to, I didn't speak a word of English. I went to high school. I took every ESL class on the planet. Then I went to junior college, because I was late to apply to college, obviously. And from there, I transferred to Berkeley, and that's where I met my husband. And that journey changed my life forever. So I've been so grateful, you know. Then I went to Georgetown. I got my master's degree. Then I went to medical school at Georgetown. And then I came back to LA County USC, which at the time was the second-best program in the nation.

• 4:31Dr. Darshan Shah?

  Yeah.

• 4:31Speaker 01

  But mostly because of my husband, not because he was the second-best program. And when people used to ask me, you know, "What do you want to do?" I think part of the trauma of growing up during the revolution, Islamic revolution in Iran, and women losing their voice. I, every time someone asked me, "What do you want to do?" I would say, "I want to do something where men would not walk into my office." So I was left with maybe peds or OB-GYN, and that's why I picked OB-GYN, because I just wanted to surround myself with women, and I really didn't want any men. I think that was part of my trauma of my childhood. So there's no, you know, amazing, like, I was inspired. No, I just wanted to be surrounded. I wanted to surround myself with women.

• 5:14Speaker 01

  And I feel like I have this female energy around me. I have three daughters of my own, and then I adopted a fourth daughter. So I have four daughters. It's just female energy. I love what I do. I love my patients. I love being surrounded with women every single day. I'm the one person who wants to live in a Barbie world. And so that's how I became really an OB-GYN. And it's the best thing I've done for myself, the best thing after marrying my husband.

• 5:44Dr. Darshan Shah?

  Yeah. Oh, that's amazing. Is your husband a physician as well?

• 5:47Speaker 01

  Oh, God, no.

• 5:47Dr. Darshan Shah?

  No.

• 5:48Speaker 01

  I think my kids would be a foster kid.

• 5:50Dr. Darshan Shah?

  Right, exactly.

• 5:52Speaker 01

  You know, with OB, when they call, I've done probably 8,500 to 9,000 deliveries. And when they call, you drop whatever you're doing, and you just walk out.

• 6:00Dr. Darshan Shah?

  Yeah.

• 6:01Speaker 01

  So I can't even imagine having like two OB-GYNs under, like, who takes care of these children?

• 6:07Dr. Darshan Shah?

  Four kids.

• 6:07Speaker 01

  Yeah. And my fourth daughter, I don't know if you know this, I delivered her, actually.

• 6:12Dr. Darshan Shah?

  No.

• 6:12Speaker 01

  I went on Dr. Phil to talk about drug use in pregnancy, and her mom was a guest on that show. And she was struggling at the time, and I offered to just take care of her for free. She moved to LA because she was homeless at the time. And I took care of her. I delivered my daughter, Coco. I didn't know I was going to take her home, but she had nowhere to go. And I volunteered to foster her. It's a long story.

• 6:39Dr. Darshan Shah?

  Wow.

• 6:40Speaker 01

  But I fostered her, and she never left. So she's my fourth, my fourth daughter, she's now, and this was peak of COVID.

• 6:46Dr. Darshan Shah?

  Yeah.

• 6:47Speaker 01

  So I'm 55. My husband's 55, and we have a five-and-a-half-year-old as our fourth daughter.

• 6:54Dr. Darshan Shah?

  That's amazing. What a beautiful story.

• 6:56Speaker 01

  Oh, she's the best. It's the best thing that, but my point is, people are like, "How come you didn't adopt a boy?" First of all, I wasn't planning on adopting. But, you know, I would take all the girls on the planet. I'm just, I was made to be surrounded by women.

• 7:10Dr. Darshan Shah?

  Yeah, yeah. And also giving women a voice and helping them get good information. Your podcast is amazing, and you're just spreading so much incredible information out there for women in a way that's easy and understandable that they can actually use and feel empowered by.

• 7:26Speaker 01

  I mean, if you, you know, if you've been around women, you'll know that when women go to the doctor, their symptoms are, first of all, 50% of counties in this country do not have an OB-GYN. Let's start there.

• 7:39Dr. Darshan Shah?

  Really?

• 7:40Speaker 01

  Five, zero, 50%.

• 7:42Dr. Darshan Shah?

  In the United States?

• 7:43Speaker 01

  In the United States.

• 7:44Dr. Darshan Shah?

  Have no OB-GYN?

• 7:45Speaker 01

  No OB-GYN.

• 7:45Dr. Darshan Shah?

  Oh, my God.

• 7:46Speaker 01

  So these women have to travel six hours to see someone, right? It takes months, sometimes a year, to get an appointment. I had a patient who traveled from, I think, New Mexico to see me, and she said she had an appointment. She makes an appointment with her OB-GYN. The appointment was a year later. The day of, they cancel her. They give her another appointment eight months later. Then they cancel that. And then she finally traveled to come and see me. So that's the reality of women's health right now. And then, when this same patient, after waiting a year or six months to get into an appointment, goes to that doctor's office, the first thing that happens to them, their symptoms are dismissed.

• 8:26Dr. Darshan Shah?

  Uh huh.

• 8:26Speaker 01

  Right? Their symptoms are minimized. They're told that it's in their head that they're crazy, there's nothing wrong with them, that their labs are normal, and they're probably stressed. It's probably because of anxiety. And everything gets dismissed, and they go home.

• 8:42Dr. Darshan Shah?

  That's true.

• 8:42Speaker 01

  And unfortunately, you know, I've been in women's health for 30 years, and it didn't take much for me to realize how much women get dismissed. And you know what's so scary? Women... Don't know that they're being dismissed.

• 8:56Dr. Darshan Shah?

  Right. That's even the worst.

• 8:57Speaker 01

  I'm sure you know, cause you're in the longevity world of it. So you see what happens to women. Or men too, for that reason, but my experience has been with women. And it's really scary. So one, they don't have access. Two, when they have access, their symptoms are getting dismissed, right? And even when their symptoms are not getting dismissed, they probably can't afford the the treatment. Right? So there's so many ways where, you know, they don't get the care they deserve.

• 9:27Dr. Darshan Shah?

  Yeah, absolutely. It's so true.

• 9:29Speaker 01

  And that's why I started my podcast, Shyam D, because I wanted to empower women. Because in order to be your own health advocate, you have to have the knowledge. You have to be educated on that topic. And thanks to your podcast, my podcast, all these other podcasts out there. Women are becoming more and more educated. And once you get educated about a topic, you can advocate for yourself. Otherwise, in this healthcare system, you have no chance. And I always say, some people think it's rude, but it's my personal experience. And I can honestly say that the care women receive in this country is in the sewer system.

• 10:07Dr. Darshan Shah?

  Hmm, yeah.

• 10:08Speaker 01

  That's the only way I can describe it. It's not even at ground level, it's below. So then anything we can do to lift this, it'll make a huge difference. I've practiced for 25 years. I've never lost a patient under my care to cancer. But I do things, you know, I have, the reason my office blew up, it's not because I don't even know half celebrities. Cause I don't watch TV, I don't really listen to music, I don't know who people are, right? But they come to my office, not because I'm some, I'm doing something crazy. I just practice preventative care, which is what you're doing, right?

• 10:45Dr. Darshan Shah?

  Absolutely.

• 10:46Speaker 01

  So, so I prevent the disease before it comes. I try to prevent the cancer before it comes. If someone's at risk, I want to know. If you're at risk of a heart disease, I know. If you're at risk for dementia, I know. If you're at risk for losing your ovarian reserve early, I know. If you're at risk for infertility, I know. If you're at risk of having early miscarriages, I know. If you're at risk of autoimmune, I know. I look for things before they happen. And that's how I built my practice. And for me, it doesn't matter if you're a celebrity, if you're a billionaire, or if you don't have a penny to your name. I actually like taking care of women who don't have a penny to their name. Because if all of us get dismissed, the, you know, underprivileged women are more likely,

• 11:30Speaker 01

  or women of color are more likely to get dismissed in this healthcare system.

• 11:34Dr. Darshan Shah?

  Yeah, it's so true. It's, you know, I see a lot of women that come to Next Health. And many of them have never even heard of some of the things I want to talk to you about today. Like PCOS, endometriosis, no one's even talked to them about it. Even though they've had the symptoms for sometimes a decade. And it's really sad because to your point, you know, when they go to their regular doctor, they're just like, oh, you know, it's probably just your hormones. And they just send them on their way, like it's something normal, right? Yes, it's the hormones. Well, we need to do something about it, right? And so they, they end up very frustrated. There's a lot of like gaslighting going on as well to where they're made to feel bad for their symptoms. And I think a lot of women just give up and they don't get the care they need.

• 12:16Speaker 01

  And not only they give up, they start thinking that, they start believing that they're crazy. Because the doctors are telling them, the message they're getting is, well, you have all these symptoms, but you're fine. Cause your hormones, your labs are normal. So obviously you're okay. And we know that's not true. And they start believing that, and that's how they get so depressed. Literally, they have PTSD. And after 30 years of treating them, I have PTSD. I call my office the Office of Dismissed Women. Because people fly from all over the country for me just to validate them. Nine out of 10, they come sit in the chair, they already know what's wrong, right? Because of ChatGPT, because of Claude, because of podcasts, because of social media, because of all of this.

• 13:00Speaker 01

  But they still need an MD to say, you're right, this is endometriosis. Yes, yes, this is PMOS. They just need validation. And that's what's so heartbreaking about this.

• 13:12Dr. Darshan Shah?

  Right, right. And, you know, I think you said you know, preventatively, you want to know when people have a risk of cancer, a risk of hormone issues, et cetera, PMOS. And you're probably doing a lot of preventative testing that they don't normally get when they come to your office in the first time, right?

• 13:29Speaker 01

  I do all of it. You name it, I run it. It's starting with a young girl. I mean, let's talk about PMOS and endometriosis. I would love to talk about that.

• 13:40Dr. Darshan Shah?

  I think those are two very, not often talked about topics. And like, you know, like you said, women get dismissed because their symptoms are sometimes a little bit vague. And so they don't, they don't really get the level of work up they deserve.

• 13:52Speaker 01

  Absolutely. So, you know, let's start with PM. First of all, PMOS and endometriosis, leading causes of infertility in women, right? So how can we, how can we not know about it? How can we not di- like, it doesn't even make sense, right? Majority of endometriosis patients, majority of PMOS patients are never diagnosed. They go through life without any diagnosis. So let's start there. So if we start with PMOS, it affects 15% of women. But when you go to countries in the Middle East, if you go to India, that number is north of 20, 23% in this woman, in these women. So it's very common.

• 14:29Dr. Darshan Shah?

  And Dr. Aegis Rooka, don't interrupt you, but for the audience that don't even know what PMOS is, because the name recently changed, right?

• 14:36Speaker 01

  Change. I'm going for all of that. Yes, absolutely. So it used to be called polycystic ovary syndrome. And then they, thank God, they changed it to polyandocrine metabolic ovarian syndrome. So PMOS is a syndrome. It's a, it's a group of symptoms that can vary from patient to patient. Like I said, 15 to 20% of women have it, depending on, you know, where you're located or what your ethnicity is. And 75% of these women go through life and they're never diagnosed. In order to diagnose PMOS, it's very simple. You need to meet two out of the three criteria. One is history of irregular cycles. These are women who can never know when they're getting their periods.

• 15:20Speaker 01

  They can have it every two months, every three months, and it varies, right? Number two, it's PCOS ovaries on ultrasound. Now, polycystic, thank God they changed their name. People, patients would go to the doctor, the doctors would do an ultrasound and say, you don't have a cyst on your ovaries. You don't have PCOS. It's false, right? Polycystic was a bad name because these are not cysts on the ovary. This is a group of follicles. We call it string of pearl. These are follicles that are frozen in the ovary and they have a specific finding on ultrasound. Again, it gets missed, even if you give a probe to a lot of doctors, they will miss that PCOS looking ovary on ultrasound.

• 15:59Speaker 01

  And that's why a few years ago, for non-teenagers, for anyone above age eight, you know, past their teenage years. Now you can add, replace that ultrasound with an elevated AMH. Antimalarian hormone is a hormone secreted by follicles. And a high AMH could replace having a PCOS looking ovary on ultrasound in non-teenagers. And the third one, the third criteria is symptoms of high testosterone. You do not need to have a high testosterone in the blood. If you do, okay, but you don't have to have a high testosterone. You have to have symptoms of high testosterone. Most common symptom, facial hair, body hair. It could also be acne, it could also be hair thinning.

• 16:44Speaker 01

  Different people have different symptoms. So you need to meet two out of the three criteria. So if you have irregular periods and you have facial hair and body hair, you keep lasering it, it comes back, you meet the criteria. If you have regular cycles, but you have PCOS ovaries on ultrasound, and you have elevated testosterone symptoms and or high testosterone in the blood, you get the diagnosis. The problem why these patients, it's so confusing to diagnose these patients, because there's so many variations of this. One has regular period, the other one has irregular period. One has acne, the one on, the other patient has facial hair, body hair. So if you basically go by the two out of three criteria, it makes it very easy to diagnose.

• 17:25Dr. Darshan Shah?

  Right.

• 17:26Speaker 01

  PMOS patients have anxiety and depression, they have mood disorder. They are at higher risk of having PMS, PMDD, they're moody people. And 75% of them gain weight, 25% are lean, and.

• 17:41Dr. Darshan Shah?

  That's important, because I think a lot of people associate PMOS with obesity. And there are many women that have it that are not obese. And those poor women always never get.

• 17:52Speaker 01

  They have no chance. They have no chance of diagnosis.

• 17:55Dr. Darshan Shah?

  Cause I've also noticed a lot of thin women, or, or, you know, just even women of normal body size, don't have a lot of cysts on their ovaries either a lot of times too. So then they even get more dismissed, because it's like they don't just fit the mold, you know?

• 18:09Speaker 01

  Right. Again, go by the criteria. The difference between lean PMOS and regular PMOS where patients gain weight is just that. Is 25% of women don't gain weight, the rest gain weight. That's the only difference.

• 18:23Dr. Darshan Shah?

  So important to know.

• 18:24Speaker 01

  And the other thing that is near and dear to my heart is a lot of these patients have disordered eating or a history of an eating disorder.

• 18:33Dr. Darshan Shah?

  Really?

• 18:34Speaker 01

  I will tell you that if you want to find PMOS patients, go knock on the doors of eating disorder centers.

• 18:43Speaker 01

  These teenagers are sitting behind those doors. But instead of having someone say, wait a minute. This is PMOS. What do they get? They get a psychiatrist. They get a therapist. They're started on, sometimes they have to stay in-house, right? For treatment. I had a patient of mine who came on my podcast, Phoebe. And she was, I think, fourteen in an eating disorder center. And they would put pizza in front of her. And she would say, listen, I will eat this pizza for lunch. But I feel like my body gets poisoned when I eat this. Instead of addressing her PMOS, they would tell her, see? You still have an eating disorder. You're not ready to go home. So what did she do? She would like eat the pizza.

• 19:28Dr. Darshan Shah?

  Oh, no.

• 19:29Speaker 01

  So that's what's happening. And we need to educate, educate, educate. But if I could take one group of physicians or therapists to educate, I would first go to the pediatricians to make sure our pediatricians are not missing these PMOS patients. So if you're a mom listening to this podcast, if you have a sister, if you have a friend, if someone's struggling with an eating disorder, please make sure that you're not missing PMOS in that. So and as we talked about, PMOS is one of the leading causes of infertility. So now you have a woman who's gaining weight. For the life of her, she can't lose weight. Her periods are irregular. She constantly lasers her hair. It comes back. She struggles with acne. Someone puts her on Accutane.

• 20:13Speaker 01

  She has anxiety and depression. She has an eating disorder. And then when she goes to get pregnant, she can't get pregnant. Put yourself in that, the shoe of that patient. And these are patients who bounce from doctor to doctor. And they're told, nothing's wrong with you. Why don't you eat less, exercise more, and you'll be fine? Well, obviously, you're probably eating a lot. It's not true. It's the insulin resistance that's getting to them. It's their hormones. That's why this new name, polyendocrine. It affects your hormones. Metabolic, it's a metabolic dysfunction. Ovarian, it affects your ovaries syndrome. And it's a group of syndrome, and everyone presents differently.

• 20:53Dr. Darshan Shah?

  Right.

• 20:54Speaker 01

  But I would love to explain to your listeners why this happens.

• 20:59Dr. Darshan Shah?

  I was just gonna ask you, what is the etiology of this? And do you believe there's an autoimmune component to it as well?

• 21:04Speaker 01

  So first of all, PCOS, or the new name is PMOS. These patients, seventy percent of them have insulin resistance, right? So when we eat carbohydrates, our body breaks it down into glucose. Glucose stimulates our pancreas to release insulin. The job of insulin is it opens up the receptors on the surface of the cells, takes the sugar from the blood, pushes it into the cell where it turns into energy. This is what's supposed to happen. But PMOS patients have insulin resistance. So when they, when they eat carbohydrates and their body breaks it down into glucose and their pancreas releases insulin, their tissue is insulin resistant. So this sugar doesn't all go into the cell. It bounces in the blood and pushes the insulin to go up. As insulin spikes, several things happen to the body.

• 21:49Speaker 01

  Number one, it tells your liver, take the sugar that the cells are not using, store it as fat. The fat that you store with insulin resistance is visceral fat, is highly inflammatory, is very different than the fat under our skin. And that's the last type of fat you want to store. So these are patients who say, I might have a slice of pizza. I gained weight the next day. My skinny friend eats the whole pizza and she comes in in her skinny jeans the next day. And that's a reality of it because that skinny girl is

• 22:17Dr. Darshan Shah?

  Right.

• 22:18Speaker 01

  processing it, but the PMOS patient is storing it. So high insulin causes visceral fat storage. High insulin, even though these patients are insulin resistant everywhere, their ovaries are insulin sensitive. So this spike in insulin stimulates their ovaries to release testosterone. Testosterone should be, you know, all women have certain level of testosterone. But you can't have testosterone, increase testosterone secretions from the ovary. Testosterone causes an inflammatory environment in the ovary and causes these follicles. Every month, we have a certain number of antral follicles that come to the surface, get stimulated, one matures, ovulates in hopes of getting pregnant.

• 23:03Speaker 01

  What happens when you have testosterone around? These follicles freeze and they don't mature. One of them doesn't mature. So ovulation is blocked, right? So if you don't ovulate, you don't have a period, right? So your periods become all over the place. And this elevation in testosterone secretion causes the facial hair, body hair, acne, you know, hair thinning, different patients have different symptoms. So this insulin spike causes fat storage. Insulin spike causes the ovaries to pump testosterone out, cause all these testosterone symptoms, block ovulation. When you don't ovulate, your progesterone levels go down. And now you have these follicles secreting AMH, the anti-malarian hormone that, you know, starts going up, right? Because you have all these follicles that are stuck.

• 23:48Speaker 01

  And you have them secrete estrogen without following that menstrual, normal menstrual pattern.

• 23:54Dr. Darshan Shah?

  Right.

• 23:54Speaker 01

  So the other thing that insulin spike does, it tells your liver not to produce a hormone, a protein called sex hormone binding globulin. Sex hormone binding globulin binds free testosterone in the blood. So when the levels of the sex hormone binding globulin goes down, your free testosterone goes up, more testosterone symptoms, right? The other thing is, so now you have weight gain. You have all these testosterone symptoms. You're not ovulating. And then this insulin, this visceral fat is also causing a lot of inflammation. And I see that inflammation can cause gut dysbiosis. It can, like a leaky gut. A lot of these PMOS patients complain of GI issues, bloating, fatigue, brain fog.

• 24:39Speaker 01

  So this is a big picture of it. However, then, you know, I want to talk about the mental aspect of PMOS and everything that happens.

• 24:48Dr. Darshan Shah?

  Right. Before you talk about that, can you talk about why people get PMOS? What is the root cause of it?

• 24:54Speaker 01

  So there, so let's say seventy percent have insulin resistance, right? And that's the driver of their PMOS.

• 25:01Dr. Darshan Shah?

  So there's, so insulin resistance leads to PMOS, not the other way around?

• 25:05Speaker 01

  Correct. Or if you start gaining a lot of weight suddenly, it can push you into a

• 25:10Dr. Darshan Shah?

  Insulin resistance.

• 25:11Speaker 01

  Insulin resistance. But, you know, a lot of patients have PCOS. It has a genetic factor. And there are twenty genes that are associated with PMOS that can predispose you genetically to having PMOS. Then chronic inflammation can definitely affect ovulation. Then some ovaries, for whatever reason, are more sensitive to the LH hormone that comes from the brain. So they produce more testosterone. But one of the other drivers of PMOS is this brain-ovary axis, which I don't know if you've heard of. So our hypothalamus releases a hormone called GnRH. GnRH stimulates another part of our brain, the pituitary gland, to release two hormones, FSH and LH.

• 25:56Speaker 01

  The FSH comes during the first part of the menstrual cycle, stimulates those follicles, which we talked about, antral follicles, stimulates them, one becomes dominant. Mid-cycle, you get a surge in LH hormone from the pituitary gland that causes ovulation. So the egg gets released and whatever is left behind forms the corpus luteal cyst, which protects the pregnancy for the first eight to ten weeks of pregnancy. But if we don't get pregnant, the corpus luteal goes away and our uterine lining breaks down and everything comes out and the cycle begins again. What happens in PMOS patients is their GnRH from the hypothalamus is secreting. This GnRH secretes in a postive fashion.

• 26:39Speaker 01

  In PMOS patients, it starts, it starts secreting much, much faster than normal. And it basically shifts the hormones of the pituitary to more LH and less FSH.

• 26:54Dr. Darshan Shah?

  I see.

• 26:54Speaker 01

  LH, which is supposed to come mid-cycle and cause ovulation. When you have it all month, it stimulates the cells, the TCA cells in the ovary to secrete testosterone. And that testosterone then stimulates the GnRH to even go faster. And this becomes a vicious cycle of testosterone. And again, what do you get with testosterone? All those symptoms we talked about. And testosterone is toxic to these follicles. So it blocks ovulation. So that's another pathway that happens in PMOS patients. So different, some, and then we have the adrenal PCOS that we used to talk about. And these are patients who basically have DHEAS secreted

• 27:35Speaker 01

  from their adrenal glands, which mimic the symptoms of high testosterone, right? They have the same testosterone, I'm sorry, they have the same symptoms. But it's actually the source is the adrenal gland, not their ovaries. And these patients are usually the ones who are super stressed and anxious and their cortisol is all over the place.

• 27:55Dr. Darshan Shah?

  Right.

• 27:55Speaker 01

  So going back to everything that happens. So now we have an environment where inflammation is high, testosterone's high, progesterone's low, because there's no ovulation or suboptimal ovulation, and estrogen is erratic. So take this environment and I'll tell you how it affects their brain and why they get to where they are. Why did they end up in an eating disorder center? Our limbic system, am I going too fast?

• 28:23Dr. Darshan Shah?

  No, this is perfect. I love this, yes.

• 28:25Speaker 01

  Sometimes I feel like I'm like

• 28:28Dr. Darshan Shah?

  I'm the one that puts my podcast on one point seven five when I listen to them in the car.

• 28:32Speaker 01

  Oh, really? Okay, so I'm that person.

• 28:34Dr. Darshan Shah?

  You're perfect, yes.

• 28:36Speaker 01

  So basically, in our brain, we have a limbic system. Which is our emotional headquarters. It's our hypothalamus, hippocampus, and amygdala.

• 28:44Dr. Darshan Shah?

  Right.

• 28:45Speaker 01

  This emotional headquarters has all of our emotions in it. For this limbic system to function normally, we need low inflammation. We need normal testosterone. We need normal estrogen and we need high progesterone because progesterone has a calming effect on the brain. What do we have in PMOS? Exact opposites, right? High inflammation, high testosterone, low progesterone, estrogen that's erratic. So now you have a limbic system on fire. These are patients who are anxious, depressed, irritable. They get angry. They're at risk of PMS, PMDD, binge eating, craving, eating disorder, lack of motivation, brain fog, fatigue. They just feel terrible and out of control.

• 29:27Speaker 01

  We have a prefrontal cortex that acts as a brake on our limbic system to calm the limbic system down. Well, the prefrontal cortex needs good progesterone, low inflammation, low stress. These people have high cortisol. They're always stressed out. Good sleep. PMOS patients don't sleep well. So again, you have this limbic system on fire and the brake, that's the prefrontal cortex, is also not working. So you have a car going 100 miles an hour down the street and the brake doesn't work.

• 29:54Dr. Darshan Shah?

  Right.

• 29:55Speaker 01

  So then you have all these emotions come out, right? But where do they end up? With a psychiatrist.

• 30:00Dr. Darshan Shah?

  Yeah.

• 30:01Speaker 01

  With a therapist. Because no one is addressing their metabolic dysfunction.

• 30:05Dr. Darshan Shah?

  Right.

• 30:06Speaker 01

  And the other thing I want to tell you is that it's very important for people to know this. As we talk, so this is the mental health aspect of it, but PMOS is one of the leading causes of infertility, right? One, because we talked about how they're not ovulating. In order to get pregnant, you need to ovulate. There's an inflammatory environment in the uterus and even when they ovulate, it's not optimal ovulation. And usually 70 to 80% of PMOS patients do not ovulate. Of the ones who report regular cycles, they're ovulating, they're sometimes not ovulating.

• 30:43Dr. Darshan Shah?

  Even them, okay.

• 30:44Speaker 01

  And if you take a lean PMOS patient with another woman who doesn't have PMOS, same height, same weight, same everything, the girl with PMOS, the lean PMOS patient, she has a 60% higher chance of having insulin resistance at tissue level compared to the other person.

• 31:05Dr. Darshan Shah?

  Wow.

• 31:05Speaker 01

  Does it make sense?

• 31:06Dr. Darshan Shah?

  Yeah.

• 31:06Speaker 01

  So even she's, even though she's lean.

• 31:09Dr. Darshan Shah?

  Sure.

• 31:09Speaker 01

  She does have insulin resistance at tissue level.

• 31:12Dr. Darshan Shah?

  Right.

• 31:13Speaker 01

  So now that we know all this, it's important, A, to diagnose, which is very easy. I don't know, did I tell you about my platform, OV?

• 31:23Dr. Darshan Shah?

  No.

• 31:24Speaker 01

  Ovi.com.

• 31:25Dr. Darshan Shah?

  Yeah, what is that?

• 31:25Speaker 01

  So it's, I created it for PMOS patients. Basically, I have a calculator on it. It's free.

• 31:31Dr. Darshan Shah?

  Yep.

• 31:32Speaker 01

  You go answer the questions that I want you to answer and I will tell you whether or not you have the likelihood of having PMOS. Obviously, I can diagnose you on my website.

• 31:43Dr. Darshan Shah?

  Right.

• 31:43Speaker 01

  But I can tell you if you have a high likelihood of having it. And if you do, I, basically, PMOS is one of the very few conditions on this planet where supplements make a huge difference.

• 31:56Dr. Darshan Shah?

  Sure.

• 31:57Speaker 01

  Huge.

• 31:57Dr. Darshan Shah?

  Right.

• 31:57Speaker 01

  It's, you know, like, we know the importance of vitamin D and ferritin, but generally speaking, you take vitamins and you don't feel what it does do, right? PMOS, supplements for PMOS actually work to treat the underlying condition. So when it comes to PMOS treatment, number one, we know these patients, we learned that they, they're insulin resistant, 70, 80% of them, so be careful. Low carbohydrate diet is very important. Exercise is very important because when we exercise, walking, you know, 15 minutes after each meal, you will basically clear that sugar out of your blood and lower that insulin spike.

• 32:37Dr. Darshan Shah?

  Sure.

• 32:37Speaker 01

  But sometimes patients eat healthy and exercise and they can't really get to their goal. And for these patients, I would say, making them more insulin sensitive is the goal.

• 32:48Dr. Darshan Shah?

  Right.

• 32:48Speaker 01

  And you can get to that insulin sensitivity several ways. You can do it, I have an OV supplement. In this supplement, I have wild mulberry leaf extract, which if you take it before your heaviest meal, it blocks the absorption of carbohydrates by 42% in that meal. It makes people insulin sensitive. So by making patients insulin sensitive, you clear that sugar out of the blood. And it has a lot of anti-inflammatory supplements in it. So all the aspects, all the pillars of PMOS.

• 33:17Dr. Darshan Shah?

  Right.

• 33:18Speaker 01

  So I always start with the supplement. Next, you can go to metformin. I'm sure you've heard of it. We use it for diabetics, for prediabetics. I've been on it seven years because I'm insulin resistant and I don't have PMOS. And metformin makes patients insulin sensitive and blunts that insulin spike. So when you put these PMOS patients, especially who have insulin resistance, on metformin, you lower their insulin and by lowering their insulin, you lower their visceral fat and you lower the secretion of testosterone in their ovaries. So they, the inflammation goes down, the testosterone in the ovary goes down, so they start ovulating and they get, it helps them get pregnant.

• 33:56Dr. Darshan Shah?

  Right.

• 33:56Speaker 01

  And of course, if that fails, we can always go to GLP-1s. I started in 2014 treating PMOS patients with GLP-1s. Back then, it was Trulicity.

• 34:08Dr. Darshan Shah?

  Yeah.

• 34:08Speaker 01

  I think I was the first doctor on the planet to use these for PMOS. It's a miracle drug for these patients.

• 34:13Dr. Darshan Shah?

  It works so well.

• 34:14Speaker 01

  It addresses their insulin sensitivity, it curbs their appetite, it blunts that insulin spike, and the anti-inflammatory aspect of it is just incredible.

• 34:24Dr. Darshan Shah?

  It covers a lot of the bases of PMOS, right?

• 34:26Speaker 01

  Right, a lot of it. And it's, that's why they, you know, it was always interesting to me because patients were talking about Ozempic babies.

• 34:34Dr. Darshan Shah?

  Yeah.

• 34:34Speaker 01

  And in my head, I'm like, of course, all these PMOS patients who are not getting pregnant, they're injecting themselves with Ozempic, their testosterone's going down, they're starting to ovulate, the inflammation's down, and they're getting pregnant, good for them. But that's, I think, majority of these patients had metabolic dysfunction.

• 34:51Dr. Darshan Shah?

  Absolutely.

• 34:52Speaker 01

  And that's how, or high inflammation.

• 34:54Dr. Darshan Shah?

  Yeah. Creatine isn't just the most researched supplement, it's actually proven to deliver results. So whether you want stronger muscles or you want a sharper mind, creatine is the energy source you're gonna need to get there. Momentus just introduced Signature Spec Creatine. It's their highest quality creatine to date. It has 10 times fewer impurities and two to five times stricter heavy metal limits than even other premium creatines. And it's all backed by six stages of testing and certification. Not to mention, the ultrafine micronized powder makes it so easy to mix into your favorite drink or smoothie.

• 35:37Dr. Darshan Shah?

  Try it yourself at livemomentous.com/drsah and you'll get up to 35% off your first order using the code DRSah. You know, the AMH biomarker that you measure too, to me, is becoming more and more, you know, normally it's just measured for women that are trying to get pregnant and have infertility. So infertility clinics use it a lot, but I think more and more it's just an overall marker of a woman's overall health as well, right?

• 36:08Speaker 01

  Absolutely.

• 36:09Dr. Darshan Shah?

  And so we want to start measuring it in all of our female patients.

• 36:12Speaker 01

  Thank you.

• 36:12Dr. Darshan Shah?

  Because it can really be helpful in understanding, first of all, is there a component of PMOS that we're missing, right? And I think that's something important to know as well, but also I think as women age, their AMH levels drastically drop, but some women drop so much faster and so much earlier too. So you can almost tell how someone is aging by their AMH levels too.

• 36:34Speaker 01

  I love that, yes. And I think it should be mandatory.

• 36:38Dr. Darshan Shah?

  Yeah.

• 36:38Speaker 01

  For women to get their AMH baseline checked between 18 to 20. I follow my patients every single year.

• 36:45Dr. Darshan Shah?

  Right.

• 36:46Speaker 01

  There are so many factors. Autoimmune can drop it.

• 36:49Dr. Darshan Shah?

  Right.

• 36:50Speaker 01

  Endometriosis can lower your egg count and quality. PMOS patients have high egg count, but the quality is poor because of that inflammation.

• 36:58Dr. Darshan Shah?

  Right.

• 36:59Speaker 01

  Any condition that increases inflammation can affect the egg count and quality. Chemotherapy, the foods, all the toxins we're exposed to, all of it, our environment, endocrine disruptors, all of it can affect our AMH. You know, we're born with, if you take a 20-week female embryo, that embryo has six to eight million eggs. By the time we're born, that number is about one to two million. By the time you're a teenager, that number drops to three hundred to five hundred thousand eggs. By the time you're thirty, that number is about hundred to hundred fifty thousand. By the time you're thirty-five, that number is twenty-five to fifty thousand.

• 37:41Dr. Darshan Shah?

  Right.

• 37:42Speaker 01

  And at menopause, that number is about a thousand.

• 37:44Dr. Darshan Shah?

  Uh huh.

• 37:45Speaker 01

  So, and you know, we ovulate maybe three hundred times in our life. So the majority of it goes away by atresia. Basically, these eggs are dying.

• 37:54Dr. Darshan Shah?

  Uh huh.

• 37:55Speaker 01

  So, an AMH, I want to make it very clear. It's a, it's a test of ovarian reserve. If it's low, it doesn't mean you're not gonna have a baby.

• 38:03Dr. Darshan Shah?

  Right.

• 38:03Speaker 01

  If it's high, it doesn't mean you're guaranteed to have a pregnancy. But it's the only thing we can check to see what, where the patient is. Just like you said, where are we heading? Am I missing endometriosis? Am I missing an autoimmune? What is going on? Is there a genetic component, component to this? Am I dealing with premature ovarian failure? Why not have that information?

• 38:23Dr. Darshan Shah?

  Absolutely. Yeah, it's like an overall health marker for the ovaries, which is an overall health marker for the women in general. And then you can use this as an indicator to go looking even further and deeper into what's going on. Because, you know, the end of the day, I think the fertility rates in the United States and the Western world are dropping like off a cliff, right? And this is due to many different factors. But each individual woman can know how their personal fertility rate is headed by checking their AMH levels on a yearly basis, to your point.

• 38:52Speaker 01

  So for your longevity patients?

• 38:54Dr. Darshan Shah?

  Yeah.

• 38:55Speaker 01

  You know, it starts at as young as a teenager. When we can talk about, we talked about PMOS. But if you have a teenager with an eating disorder, who's gaining weight, who has acne, don't ignore that patient. Deal with her metabolic dysfunction. When you don't deal with that metabolic dysfunction, that patient is at risk for diabetes, for prediabetes, for heart disease, for stroke. You're, you're setting that patient up. You know, why not diagnose and treat early? You know, and endometriosis is another condition that I would love to cover.

• 39:28Dr. Darshan Shah?

  Yes, I would love to talk about endometriosis as well. But before we do that, because I think it's important in this conversation too. Can we talk a little about birth control pills and how they affect women? And kind of what your advice is for young women or even older women that are on birth control pills? Some women are on, obviously just for birth control, but there's a huge population of women on it for irregular menstrual periods, right? And a lot of these women have PMOS as well.

• 39:51Speaker 01

  Right.

• 39:51Dr. Darshan Shah?

  So is there a better way to get more regularity? And also, especially for the PMOS patient?

• 39:58Speaker 01

  So you know that brain overreacts issue that I was talking about? A lot of patients do well when you put them on birth control pills. I'm not a huge fan because I treat a lot of PMOS. And for all the reasons that I explained, these people are moody, they have anxiety, depression. My experience has been that they don't do well with birth control pills. They get more emotional, they cry more, their PMS gets worse, the PM. So I offer it, you have to pick and choose. I don't have, you know, I was listening to this podcast and a very well-known podcast. And the host asked, so how do you treat PMOS? And the gynecologist said, birth control. And my heart sank because you can't just throw a birth control.

• 40:39Speaker 01

  After everything I told you about inflammation, metabolic dysfunction, you can't just throw a birth control at someone and expect them to feel okay.

• 40:46Dr. Darshan Shah?

  Right.

• 40:46Speaker 01

  Now, if you have a lean PMOS patient who also needs birth control, who has irregular period, who has acne, facial hair, body hair. Yes, a low dose birth control pill is great for them. Why? Because the birth control pills stimulate that sex hormone binding globulin. And it grabs the free testosterone. So all their acne, facial hair, body hair, all of that, it gets better, their periods become more regular. It's a great method of birth control. I have no problem with that. But I would say pick and choose. I also love IUDs, progesterone IUDs. And for women who don't want to take a pill, it's more local for women who have a bad reaction or had a bad experience with birth control pills, then I would go to progesterone IUDs with these patients.

• 41:27Speaker 01

  But I would never dismiss the, the core metabolic dysfunction that affects these patients.

• 41:32Dr. Darshan Shah?

  For sure. That is such a good point. And, you know, I think GLP-1s are definitely a game changer for these patients. But also, whenever I put someone on a GLP-1, I always recommend just kind of relearning and reforming their relationship with food. Like you talk about, these simple habits like going for a walk after a meal. You know, minimizing carbs, but also putting the fiber in the front of the meal, rather than the carbs in the front of the meal. And continuous glucose monitors can also be very helpful in changing some of these habits as well. So I think there's so many treatments and tools available for the PMOS patient. And the earlier you catch it, the better, because it's just gonna be that much more effective, right? Because what I find is it's harder to make progress a lot, like with the visceral fat, with the facial hair, et cetera.

• 42:16Dr. Darshan Shah?

  If someone has been living with it for ten, fifteen, twenty years, it just takes longer. Not to say that it's not gonna work, it's still gonna work.

• 42:23Speaker 01

  Right.

• 42:23Dr. Darshan Shah?

  I just think the earlier you get it, the better.

• 42:25Speaker 01

  Yeah, and you know, for patients, I mean, I use spironolactone for acne. I use oral minoxidil for their hair. I mean, there are different, different medications, prescriptions, supplements that we can use, like I said, to help these patients.

• 42:40Dr. Darshan Shah?

  Yeah, yeah, absolutely. And then as far as like, you know, one of the things I've talked about earlier today too, was methylation pathways. And how, you know, testing and making sure that if someone's methylating correctly. I found that can also be very, very helpful for the PMOS patient.

• 42:54Speaker 01

  And you know, when I check high sensitivity CRP, I check homocysteine on my endo and PMOS patients. And you'd be surprised, sometimes these numbers are off the chart. And when you address that metabolic dysfunction and lower their inflammation, if it's endometriosis, when you lower that inflammation, you see these inflammatory markers going down.

• 43:15Dr. Darshan Shah?

  Absolutely.

• 43:16Speaker 01

  It's all connected.

• 43:17Dr. Darshan Shah?

  It's all connected. It has to all be addressed at once, but also checked for at once.

• 43:21Speaker 01

  Yes.

• 43:21Dr. Darshan Shah?

  Yep. Okay, so let's talk about endometriosis.

• 43:24Speaker 01

  Near and dear to my heart.

• 43:26Dr. Darshan Shah?

  Yes, yes, I know you see a lot of patients with this, and I think this is also very underappreciated.

• 43:31Speaker 01

  If you want your heart broken, forget about PMOS patients, go to the endo patients. Literally, I always say, if you spend a day with me in my office, you will go home with a broken heart. Because the devastation that this condition has on women, yet majority of them go through life and they're never diagnosed. They're told they're crazy, it's in their head, and they, they start believing it. And they have such PTSD from it. And over the years, their trauma has become my trauma. I went on Jay Shetty and I started crying when I talked about my endometriosis patients. Because I can write a book this thick about my, the trauma of these endometriosis patients. Endometriosis, by the way, six, in my practice, because I have so many years of data, sixty-one percent of my PMOS patients have endometriosis.

• 44:16Dr. Darshan Shah?

  Sixty-one percent?

• 44:18Speaker 01

  Sixty-one. If you look at the literature, they're like ten percent are like false, false. There's a high association, and I have tissue pathology to prove it. Endometriosis is a condition, they say ten percent, again, I don't believe it. It's probably twenty to twenty-five percent of women have endometriosis. Isn't that significant?

• 44:35Dr. Darshan Shah?

  That's a lot of people, right?

• 44:36Speaker 01

  Leading cause up there with PMOS for infertility. It takes doctors in this country nine to eleven years to diagnose these patients. Average age is thirty-two, because these patients can either not get pregnant at that point, or they're bouncing from doctor to doctor to get pregnant. So the devast, it's just devastating. And it affects everything in their body. It's not just about having painful periods. It affects their gut, it affects their mental health, their inflammation is off the chart. It's, it scars their pelvis, they have a hard time getting pregnant, it destroys their egg count, their egg quality. And yet they bounce from doctor to doctor, doctor to doctor. One of the most common symptom of an endometriosis patient is period pain.

• 45:21Speaker 01

  If I had, if I was able to print a T-shirt that said painful periods are not normal, I would have every single woman wear it and walk around. I wanted to get billboards on the four oh five that said painful periods are not normal, hashtag endo. Because at some point, I was just devastated. And when I turned fifty, I went to my husband, I'm like, for my fiftieth birthday, I want you to buy these, these billboards for me. And then my daughter was like, okay, so now you tell them painful periods are not normal, hashtag endometriosis. They go to their gynecologist, and the gynecologist will say, there's nothing wrong with you.

• 45:53Dr. Darshan Shah?

  Yeah.

• 45:54Speaker 01

  Then what are you gonna do? I'm like, huh, so that's why I didn't do my, she like literally popped my, my.

• 46:00Dr. Darshan Shah?

  You need your phone number into that.

• 46:02Speaker 01

  I know, right? No, I don't want that. And that's how I started my GMD podcast. I'm like, that's a better way to educate these patients. But basically, endometriosis, if you think about it, every month, our ovaries secrete a hormone, estrogen and progesterone, to get the lining inside the uterus, endometrium, ready for pregnancy. When we don't get pregnant, the lining comes out as a form of period at the end of the month. This happens month after month, year after year. The hypothesis is that when we have our menstrual period, some of these cells, instead of coming out of the cervix into the vagina, they actually go up out the tubes into our pelvis. And normal immune system will get rid of those cells, right? And but unfortunately, in endometriosis patients, their immune system does the opposite.

• 46:45Speaker 01

  Takes those cells and sticks it to the wall of the bowel, bladder, pelvis, ovary tubes. And this, each one of these implants, we'd call them endometriosis implants, they need estrogen to grow. So eventually, they start expressing their own aromatase enzyme and they start making their own estrogen. They become their own island. They grab blood vessels, they grow nerve fibers, and they start making their own estrogen. And it's like an alien movie, really. They become these individual islands. And depending on where that nerve fiber goes, that's where the patient feels the pain. It could be pain with period, it could be pain with intercourse, with deep penetration. It could be pain with bowel movements, it could be pain with urination.

• 47:30Speaker 01

  These are patients who bounce from doctor to doctor with UTI. Doctor, I get bladder infections 10 times a year. No, that's not a UTI.

• 47:38Dr. Darshan Shah?

  Yeah.

• 47:39Speaker 01

  And my cultures are negative. That's endometriosis, until proven otherwise.

• 47:43Dr. Darshan Shah?

  So this is the endometrium?

• 47:44Speaker 01

  And these are cells similar to the lining of the uterus that are outside of the uterus growing, causing an inflammatory process.

• 47:51Dr. Darshan Shah?

  Right.

• 47:51Speaker 01

  And because these patients go dismissed, their pain is minimized and dismissed. This condition grows, grows, grows, until the pain becomes debilitating or their tubes are blocked, their ovarian reserve is completely gone and they can't get pregnant.

• 48:08Dr. Darshan Shah?

  Do these cells divide in their new location?

• 48:10Speaker 01

  No, they just, they just larger. It's like, and they go deeper, they infiltrate deeper. And they cut, because of that inflammation, they can cause scar tissue. But one of the most important things that happen with these patients, eventually, they get central sensitization. So their brain gets rewired to perceive that pain at a higher level than it actually is. So if I perceive that pain in my brain as a 2 out of 10, an endo patient's brain will feel that pain as 10 out of 10.

• 48:41Dr. Darshan Shah?

  Oh.

• 48:42Speaker 01

  That's why they end up in the ER. And you know, we stage it into four stages. But really, the degree of pain has nothing to do with the stage. There are patients with stage four disease that have 4 out of 5, 4 out of 10 pain. And then there are patients with stage one who are in the ER every single month. I had a patient last week who said, I always rupture cysts and I always end up in the ER. Ruptured cysts, that's blood in your pelvis from your endometriosis. You don't rupture cysts every single month. There's no such thing. You might rupture cysts a couple of times in your lifetime. That, and you know, you might end up in the ER because of that pain. But you don't just rupture cysts and go to the ER. That's endometriosis until proven otherwise.

• 49:25Dr. Darshan Shah?

  Right. And so what you're saying there is people are getting misdiagnosed by these

• 49:28Speaker 01

  All the time.

• 49:29Dr. Darshan Shah?

  Ultrasounds that are done in the emergency room showing some fluid and pain. And they just get told it's a ruptured cyst.

• 49:35Speaker 01

  Or PID.

• 49:36Dr. Darshan Shah?

  Yeah, or PID, right?

• 49:37Speaker 01

  And they go home.

• 49:38Dr. Darshan Shah?

  And then they go home. So, you know, I'm sure there's women listening to this that have had this happen to them. And they need to go look at, look for someone like you that will help them understand if they have endometriosis or not.

• 49:50Speaker 01

  It's so, so important. And this is when self advocacy comes into play. If you're listening to this podcast, if you have a loved one, if yourself, if, you know, I always say, you have to call your parents to pick you up from school. If you have to, if you end up in the urgent care with your period, if you plan your social life around your periods, if you skip school, skip work because you're on your period, none of that is normal. That's endometriosis until proven otherwise. The problem is, A, remember I said the counties don't have OB-GYNs? B, these patients, after a year, go to that healthcare provider, they're told there's nothing wrong with them. And C, the worst part of it is, even when they get diagnosed, A, they're not being treated correctly.

• 50:35Speaker 01

  Or if someone says, oh, you need surgery, and they take these patients to surgery. My experience has been that 50% of those patients, the surgeon wakes them up and says, there's nothing wrong. I didn't find endo.

• 50:46Dr. Darshan Shah?

  Yeah.

• 50:47Speaker 01

  And talk about gaslighting.

• 50:48Dr. Darshan Shah?

  Yeah.

• 50:49Speaker 01

  At that point, they really think they're crazy, right? And remember that limbic system and the prefrontal cortex?

• 50:56Dr. Darshan Shah?

  Sure.

• 50:57Speaker 01

  Endometriosis is a progesterone resistant condition, because these implants become progesterone resistant. Estrogen dominant, remember, they're, and high inflammation. So again, you have a limbic system that's on fire, prefrontal cortex that doesn't work. The chronic pain that adds to it, that just destroys these patients' mental health. Anxiety, depression, PTSD. I had a patient who said, she's been to 100 emergency rooms, 100. She said she knows the, she knows every emergency room in every country she's ever visited.

• 51:31Dr. Darshan Shah?

  Oh my gosh.

• 51:31Speaker 01

  At 50, I diagnosed her with endo. She never got married, never had kids, never, because she couldn't have sex. Sex was always too painful for her. I mean, these are so sad. And I always say, if you send every 20-year-old through my office once at age 20, I would bankrupt these fertility clinics.

• 51:50Dr. Darshan Shah?

  Yeah, yeah, absolutely.

• 51:52Speaker 01

  Because all of this is preventable.

• 51:53Dr. Darshan Shah?

  It's all preventable. How do you make the diagnosis of endometriosis?

• 51:56Speaker 01

  You listen to them.

• 51:57Dr. Darshan Shah?

  Uh huh.

• 51:58Speaker 01

  You know, right now, as of like a few weeks ago, there is a blood test, HER resolve, that's approved in this country. And basically, they use some biomarkers in the blood, plus some AI algorithm. And they can diagnose eight out of 10 women with endometriosis with a simple blood test. So I like this test because all those women who are getting dismissed can take this blood test now. It's not readily available, but it'll soon, everyone will have access to it. But it's a simple blood test and it takes, you know, I think a couple of weeks to get the results.

• 52:34Dr. Darshan Shah?

  And what are they measuring?

• 52:35Speaker 01

  They measure biomarkers in the blood, plus they have an AI algorithm. So I don't, I don't know.

• 52:42Dr. Darshan Shah?

  Is it like a regular biomarkers that you and I would test normally, or is it a?

• 52:45Speaker 01

  They're RNA, they're microRNAs that they're, they're evaluating.

• 52:50Dr. Darshan Shah?

  That's such an incredible technology because, you know, the more, we're discovering so much floats around in our blood. Like analogy to that is like the Gallery Grill tumor test, which measures for circulating.

• 53:00Speaker 01

  Liquid biopsy, yeah.

• 53:01Dr. Darshan Shah?

  Liquid biopsy. So they're finding actual RNA in the blood that is coming from endometrial implants, which is incredible.

• 53:08Speaker 01

  It's incredible, right? So the, the good thing with this test is it picks up, if it's positive, then it's very reassuring.

• 53:15Dr. Darshan Shah?

  Yeah.

• 53:15Speaker 01

  But if it's negative, it doesn't mean you don't have endometriosis.

• 53:19Dr. Darshan Shah?

  Sure.

• 53:19Speaker 01

  And my argument has always been, if you listen to women, my diagnosis, I'm 99.5% accurate with my diagnosis. And because I operate on these patients and I always find endo. If you listen to them, you don't need a fancy test.

• 53:34Dr. Darshan Shah?

  Sure.

• 53:34Speaker 01

  Women are telling you, just listen to them.

• 53:37Dr. Darshan Shah?

  Yeah.

• 53:38Speaker 01

  There's no reason, we don't need these fancy tests. We just need them because patients get dismissed. So bless their heart for creating these tests. But if you listen to women, it's so easy to diagnose them. Chronic pelvic pain is endometriosis in a woman until proven otherwise. The other issue is in this country, women do not get an ultrasound. It should be mandatory for every single woman, every well woman exam to get a pelvic ultrasound. Because you can't be surprised at age 30 that you miss fibroids, that you missed a septum, that you missed the paw lip, that you missed endometriosis. Because endometriosis, you can't see it on ultrasound. But if you have chocolate cysts in the ovary, those you can pick it up in two seconds on ultrasound. And actually, endometriomas destroy the account and quality. You don't want to miss those.

• 54:22Speaker 01

  But do a pelvic ultrasound. It takes me one minute to do a pelvic ultrasound on someone. Why so much resistance in doing a pelvic ultrasound in these women? It should be mandatory. If there's one thing I would change, I would make it mandatory for women to get a pelvic ultrasound every year. That's why I never lose a patient. If I see an ovarian mass in a postmenopausal woman, I'm having her in the OR the next week.

• 54:44Dr. Darshan Shah?

  Right, right.

• 54:45Speaker 01

  That's why I don't lose patients to ovarian cancer. Do you know what I'm saying? So it's just, again, it goes back to prevent, there's no preventative care. And, you know, when you talk about well woman exam in this country, what is it? It's a pap smear, it's a by manual exam of the bra, I mean, I'm sorry, a by manual exam of the pelvis, a breast exam, maybe an STD check, maybe a talk about birth control pills, and off you go.

• 55:09Dr. Darshan Shah?

  It's all stuck in 1980s medicine. I always say that medicine has not evolved at the real, like, front line since 1980.

• 55:16Speaker 01

  Nothing has changed.

• 55:17Dr. Darshan Shah?

  Even though we have incredible technology, like you said, ultrasound is so good now and it's so easy. You have to have a skilled person doing it, but why would you not do that? Right. There's no radiation, there's no downside.

• 55:28Speaker 01

  You have nothing to lose and so much to gain.

• 55:30Dr. Darshan Shah?

  So much to gain.

• 55:31Speaker 01

  But that's why women have to ask for it, right? I'm telling you today, if you're listening to this podcast, ask for a pelvic ultrasound. Ask for your hormones. If you have a teenage daughter, make sure you're not missing PMOS. Make sure you're not missing endometriosis. If you have an eighteen, twenty year old, make sure you have a baseline egg count. Don't dismiss their symptoms. Do you know, then perimenopause, menopause, that's a whole different like. At every step, a woman gets dismissed in this healthcare system. And, you know, but going back to that endometriosis, sorry, I sidetracked. You know, as we talked about, it's an estrogen dominant progesterone resistant condition. Gold standard treatment, so you do these blood tests. There's a saliva test right now in the UK that's only available there.

• 56:14Speaker 01

  But that's the specificity and sensitivity of that test is a little higher. But again, nothing is like listening to the patient as far as diagnosing endometriosis. But when it comes to treatment, birth control pills actually help these patients a lot. I love progesterone only birth control pills because it suppresses these implants. A lot of endometriosis patients, I love using progesterone IUDs like Kailena or Marina IUD for these patients. They do really well with it. But gold standard is always to do laparoscopic surgery. It's minimally invasive. You go in three tiny little incisions, you cut all the endometriosis out. And what I do with my patients is while they're under anesthesia, I just put a progesterone IUD in there.

• 56:58Speaker 01

  And then that will make all the difference for them.

• 57:01Dr. Darshan Shah?

  And when you're doing these surgeries on women and, you know, I remember just from when I was a surgeon, when you see endometriosis. Some women, it's all over the place. It's very easy to see and find. Other women, you have to go really searching for it, right? And so is it, there's definite like skill of surgery involved here, right?

• 57:20Speaker 01

  Hundred percent. And you know, have you heard of stromal endometriosis?

• 57:23Dr. Darshan Shah?

  Tell us about that. Yes, I've heard of it.

• 57:25Speaker 01

  So endometriosis, you know, when we talked about self similar to the lining of the uterus, you have the gland and then you have the stromal tissue around it. The gland ones, it's very easy to see on laparoscopy. They're purple, they're ugly, they're, they like jump at you when you go in with a laparoscope. But the stromal ones, you really have to search for them. They tend to be these like clear, light yellowish, almost like ulcerated lesions. You have to go really close to find them. Those tend to be more inflammatory and more progesterone resistant. And I tell you, ninety five percent of them get missed. Those are the patients where the surgeon wakes them up and say, you didn't have it.

• 58:03Dr. Darshan Shah?

  Yeah.

• 58:04Speaker 01

  And sometimes, you know, at first glance, I'm like, oh, did I make a mistake? And I do this, I've done this for like twenty five years and I'm almost never wrong. But every time I go in and it's a stromal for one second, I'm like, oh my God, is this the time I'm wrong? But then I'm like, I know this patient has nine out of ten pain, I'm gonna find it. And I always find it. But sometimes it takes me five minutes.

• 58:25Dr. Darshan Shah?

  Yeah.

• 58:25Speaker 01

  Lift the ovary, go on the bladder, go behind, go check the bowel, go on the diaphragm, go on the abdominal side, pelvis side. Look everywhere.

• 58:34Dr. Darshan Shah?

  Sure, sure.

• 58:34Speaker 01

  Uterosacral ligaments, you have to look everywhere, but you'll find it.

• 58:39Dr. Darshan Shah?

  And laparoscopy is a game changer for this too, because you can really look really well and make sure you get all of it. And is there any new technologies coming out for finding these sometimes? I mean, I.

• 58:50Speaker 01

  I'm sure it will. And you know, I look forward to the day when robots can do surgery. Cause right now, to be honest with you, one percent of gynecologists operate for like advanced disease. I mean, I do a hysterectomy, let's say the size of the fibroid is the size of a watermelon, let's say. You know, ninety five percent of doctors are still doing a vertical incision from the belly button down. But these, I do them laparoscopically outpatient, the patient goes home the same day. So we need robots to operate on women. And when I say that, people get so upset, but it's the truth. A robot.

• 59:26Dr. Darshan Shah?

  There's not enough access to this.

• 59:27Speaker 01

  No, and robots won't dismiss. If you tell a robot, my periods are painful, the robot won't call you crazy. If you say, I can't lose weight and I have acne and my periods are irregular, the robot will not say, go eat less and exercise more. You're gonna get correctly diagnosed. And I look forward to the day where robots can actually operate. And I think that day is coming.

• 59:47Dr. Darshan Shah?

  Yeah.

• 59:47Speaker 01

  I think they just did a, didn't they do four gallbladder surgery, skin to skin?

• 59:52Dr. Darshan Shah?

  Yep, yep. I just, just happened literally a few weeks ago where they had unsupervised, well supervised, but no human behind the robot. The robot did the surgery by itself, which is massive. And you know, like the, the, I remember doing some of these surgeries for endometriosis. It's so dependent on the skill of the surgeon. And some surgeons don't do enough of these to where they get good at it. And unfortunately, they, they leave a lot of endometriosis behind. And then the woman ends up having a surgical procedure, then another one, and then another one. And it becomes a kind of a mess.

• 1:00:23Speaker 01

  And you know, I wanna add this, if you operate on endo patients, and that's my personal opinion, and I'm very like black and white about this. If you operate and don't suppress, it will come back. Six months to two years, it'll come back. I had a patient once from Northern California, she came to my office, she's like, I'm here for my twelfth laparoscopy. I was like, excuse me? She's like, yeah, I, around this time in September, I always check in for my laparoscopic endosurgery.

• 1:00:51Dr. Darshan Shah?

  Oh my gosh.

• 1:00:51Speaker 01

  I was like, wait, what? It goes, and I always use the example, if you have someone with colon cancer and you respect part of their colon, you never tell them, all right, sir, I'll see you in six months. The cancer will come back, you have to give him chemo. Endo is not cancer, but you operate and you suppress. If you suppress, you don't have to go in circles.

• 1:01:09Dr. Darshan Shah?

  Right, right, absolutely. I think, yeah, that's a very important point. And also, you know, to your earlier point, the, are there treatments for endo that are not involving surgery?

• 1:01:20Speaker 01

  Yes, so I always.

• 1:01:22Dr. Darshan Shah?

  Who's the candidate for non-surgical treatments, my question?

• 1:01:24Speaker 01

  So if you have someone who's tried for pregnancy, who hasn't gotten pregnant and really wants to get pregnant and doesn't wanna do IVF. If you have a patient who has debilitating pain, if you have a patient who cannot have sex, if you have a patient who's constantly in the ER. If you have someone with low egg reserve and you need to bring down that inflammation. If you have someone who's tried non-invasive options and hasn't gotten anywhere, then, you know, I operate. But I always, so let's say I have a teenager, right? Who comes in and has really painful periods, I put them on a progesterone birth control. If they're sexually active, I might offer a progesterone IUD to them. I watch them. If they're not better, I always bring them back in four months. Your body is not a light switch.

• 1:02:08Speaker 01

  It takes three to four months for anything to start working. But if in four months with suppression, they still have pain, if their ovarian reserve is good, you have the option. I love surgery because you just knock it out, you suppress and they go live their life. But if someone absolutely is not a good surgical candidate, does not wanna do surgery, cannot afford surgery, then they're a GnRH antagonist. That basically, remember I told you these implants love estrogen, but they, their growth slows down with progesterone. So you're giving it progesterone, but they're still in pain, you can take that estrogen away. And you can do that by, with medications like oralis or myofemri. These are daily pills, you can take up to two years. The reason we say two years, the bone loss after two years is, could be, you know, irreversible.

• 1:02:53Speaker 01

  But up to two years is very, very safe. But it does cause some mood changes, some hot flashes, some vaginal dryness. So it's not, you know, some patients have side effects to it. I reserve those pills, especially for patients with advanced disease. So if I do a laparoscopy and put a progesterone IUD and respect all your endo, but you have stage three, four endometriosis, I will suppress you. In addition to surgery and IUD with these medications. So again, every patient is different.

• 1:03:21Dr. Darshan Shah?

  Yeah.

• 1:03:22Speaker 01

  And the other thing I wanna touch on is that endometriosis patients have a slightly, slightly higher risk of ovarian cancer after menopause. So these are, again, do pelvic ultrasounds every single year. If you have endometriosis, your hormone replacement should always be with progesterone. Because unopposed estrogen after menopause can stimulate these implants again, which you don't wanna do.

• 1:03:43Dr. Darshan Shah?

  No, no. Is there a certain percentage of endometriosis patients that it goes away?

• 1:03:49Speaker 01

  Usually you'd need to suppress them. After menopause, they're good, right? When you, when that source of estrogen is gone, these patients do really, really well. But I would say up to, you know, during their reproductive age, they need to be suppressed.

• 1:04:03Dr. Darshan Shah?

  They need to be suppressed until, until they get to menopause and then they don't need it. Wow, that was a masterclass in endometriosis and PMOS. Thank you so much.

• 1:04:11Speaker 01

  Thank you for having me.

• 1:04:13Dr. Darshan Shah?

  You know, if anyone is listening to this podcast that knows someone with endometriosis or PMOS, this is definitely one to listen to. This tells you everything you need to know. And quite frankly, like, you know, I think people are struggling with this. They don't have a doctor like you available. And putting out information like this is so useful, so beneficial.

• 1:04:33Speaker 01

  And honestly, I say, if you think you have PMOS, go take the calcul, use the calculator.

• 1:04:38Dr. Darshan Shah?

  Yes, what's the website of that?

• 1:04:39Speaker 01

  OV.com, OVII.com. And if you have the high likelihood, try the supplement. It really works. It helps with inflammation, it lowers your appetite, it helps with your mood, it helps with insulin sensitivity, it helps patients lose weight. It does help these patients. And if you have any questions on, if you don't understand a topic in women's health, I would say go on SheMD Podcast. I literally do this for patients, for women.

• 1:05:04Dr. Darshan Shah?

  Yep, yep. It's like, you and I were talking about this, one of the biggest reasons we started these podcasts is because we say the same things to patients over and over and over again. And they love the information. And the podcast is just a way to, those things that we say every day to patients, just tell it to everybody.

• 1:05:18Speaker 01

  Better awareness, yeah.

• 1:05:19Dr. Darshan Shah?

  Exactly, yeah. Well, thank you so much.

• 1:05:21Speaker 01

  Thank you.

• 1:05:22Dr. Darshan Shah?

  Dr. A for being on the pod.

• 1:05:23Speaker 01

  Thank you for having me.

• 1:05:25Dr. Darshan Shah?

  Such a pleasure, can't wait to have you back in the future.

• 1:05:27Speaker 01

  You're amazing and your next health clinic is, I wanna come back and be a patient in that clinic.

• 1:05:32Dr. Darshan Shah?

  Let's do it, one hundred percent. You're amazing.

• 1:05:35Speaker 01

  Take care.

• 1:05:35Dr. Darshan Shah?

  Where can people find you on social?

• 1:05:37Speaker 01

  I would say SheMD Podcast is my baby. I, you know, I pour my heart out in my podcast for women.

• 1:05:44Dr. Darshan Shah?

  That's the best place to hear from you. Thank you.

• 1:05:47Speaker 01

  Thank you.

• 1:05:50Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also wanna remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today. Especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.