WORLD’S TOP OBGYN Dr. Aliabadi: The #1 Hormone Problem Affecting Millions of Women (And The 4 Changes That Can Reverse It)

For many women, the real challenge isn’t just unexplained health problems, it’s being heard when they seek help. Jay sits down with Dr. Thaïs Aliabadi, or "Dr. A", to unpack a silent crisis affecting millions of women around the world: undiagnosed PCOS and endometriosis. This isn’t just a discussion about fertility, but a masterclass on hormones, inflammation, mental health, and the painful reality of medical gaslighting. PCOS, a condition shaped by insulin resistance, hormonal imbalance, chronic inflammation, and neurological disruption, is often overlooked, leaving women struggling with anxiety, depression, weight gain, irregular periods, and infertility without answers. Dr. A shares how insulin resistance acts as the “first domino,” triggering a domino effect that impacts everything from ovulation to mood, and emphasizes that true healing requires addressing all four pillars, not just masking symptoms with birth control. Dr. A challenges the outdated belief that painful periods are “normal,” explaining that severe pain, painful sex, chronic bloating, bladder symptoms, and bowel discomfort are signs something deeper may be wrong. She reveals that diagnosis takes an average of 9–11 years, and that many women are told their pain is psychological before they’re ever taken seriously. Through both science and lived clinical experience, she makes it clear: when inflammation and hormones are out of balance, mental health suffers too. Anxiety, depression, brain fog, and eating disorders are not personal failings, they are often physiological signals that something deeper is happening in the body. In this interview, you'll learn: How to Recognize the Signs of PCOS Early How to Reduce Insulin Resistance Naturally How to Tell if Your Period Pain Is “Normal” How to Protect Your Fertility in Your 20s and 30s How to Balance Hormones Beyond Birth Control How to Spot Hidden Symptoms of Endometriosis How to Lower Inflammation Through Lifestyle Changes If there’s one thing to take away from this conversation, it’s this: your body is not working against you, it’s communicating with you. Pain is not weakness. It is a signal and you deserve to have those signals taken seriously. To learn more about Dr. A’s advocacy on women’s health, check out: https://www.shemdpodcast.com/ With Love and Gratitude, Jay Shetty JAY’S DAILY WISDOM DELIVERED STRAIGHT TO YOUR INBOX Join 900,000+ readers discovering how small daily shifts create big life change with my free newsletter. Subscribe here: https://news.jayshetty.me/subscribe Check out our Apple subscription to unlock bonus content of On Purpose! https://lnk.to/JayShettyPodcast What We Discuss: 00:00 Intro 02:58 Are We Facing a Fertility Crisis? 03:58 What Is PCOS? 07:13 Why PCOS Often Goes Undiagnosed 09:15 The Impact of Insulin Resistance 15:06 Making PCOS Patients Insulin-Sensitive 19:37 The Nutritional Effects of GLP-1 Medications 22:14 High Androgens and Chronic Inflammation 25:39 How Hormonal Imbalances Affect the Brain 29:25 Why Birth Control Alone Isn’t Enough 31:23 How to Know If You Have PCOS 35:01 Painful Periods Are Not Normal 36:47 What Is Endometriosis? 46:07 The Most Effective Treatment Approach for Endometriosis 49:20 The Risks of Ignoring Endometriosis 53:09 How to Use Birth Control Strategically 56:04 What to Do If Egg Freezing Isn’t an Option 57:53 The Link Between Endometriosis and Leaky Gut 01:00:33 Potential IVF Complications Explained 01:04:38 A Scientific Approach to Infertility 01:10:01 What to Do If You’re Not Getting Pregnant Episode Resources: Website: https://ovii.com/ Website: https://www.draliabadi.com/ YouTube: https://www.youtube.com/channel/UCrej0PO97bg8GRMogtcKbbA Facebook: https://www.facebook.com/ThaisAliabadiMd Instagram: https://www.instagram.com/drthaisaliabadi/ See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:00Jay Shetty?

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• 0:45Jay Shetty?

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• 1:24Jay Shetty?

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• 2:07Jay Shetty?

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• 2:20Speaker 01

  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.

• 2:48Jay Shetty?

  Hey, everyone. Welcome back to On Purpose, 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, 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 On Purpose, Dr. A. Dr. A, it's great to have you here.

• 3:30Speaker 01

  Jay, I'm so excited. I'm so excited for you to give me this mic, and I'll tell you why I'm so excited to be here. You know, 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 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

• 4:12Speaker 01

  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.

• 4:30Speaker 01

  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 thirteen year 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.

• 5:11Speaker 01

  Enough is enough, enough dismissing women, enough normalizing their pain, normalizing their symptoms. And telling them it's 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, 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.

• 5:45Jay Shetty?

  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?

• 6:01Speaker 01

  So when, you know, let's say you take hundred 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. Fifty percent of them on average get pregnant in the first six months. Ninety percent of them are pregnant within a year and ten percent don't get pregnant. Where in that ten percent category, if you take male fertility out, majority of those patients have PCOS and endometriosis. The problem is if you take PCOS, seventy five percent of these women are not diagnosed. If you take endometriosis, I think over ninety percent of these women are not diagnosed. So they fall under this unexplained infertility because doctors are not diagnosing these underlying conditions.

• 6:45Jay Shetty?

  What is PCOS? Define it for us.

• 6:48Speaker 01

  So PCOS is a chronic hormonal metabolic inflammatory and neurological condition that affects fifteen percent of women in this country. If you go to countries like India, that number can go north of twenty percent. The problem with it is that seventy-five percent 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 ovarian or ovulation dysfunction. These are women who have irregular periods. They get their periods not every twenty-eight days. They get it like every thirty-five days, thirty-seven days,

• 7:32Speaker 01

  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 ovaries, 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 twenty follicles and 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

• 8:14Speaker 01

  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, 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 reasons I'm gonna go into details. Struggle with anxiety and depression. They have mood disorder.

• 8:58Speaker 01

  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. Seventy-five percent 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. Twenty-five percent of them are lean, lean PCOS patients. Even these lean PCOS patients have eating disorders.

• 9:41Speaker 01

  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.

• 10:00Jay Shetty?

  So wait, you would know as early as then?

• 10:02Speaker 01

  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.

• 10:13Jay Shetty?

  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?

• 10:22Speaker 01

  So I think it's multiple reasons. Number one, doctors don't consider that, 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 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.

• 11:05Speaker 01

  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 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. It's a total body issue. It affects your mental health. It affects your reproductive health.

• 11:49Speaker 01

  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.

• 12:02Jay Shetty?

  So if a woman is listening to this right now and feels she has PCOS, what's the next thing she should do?

• 12:09Speaker 01

  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.

• 12:53Speaker 01

  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

• 13:34Speaker 01

  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. So, and this is the first domino. Why? Because when the ovaries start secreting 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 GnRH,

• 14:19Speaker 01

  which is a hormone that affects the pituitary gland, another gland in our brain that releases two hormones, FSH and LH. When this GnRH is being released slowly, the pituitary gland releases a hormone called FSH. FSH 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 this estrogen is being released,

• 15:04Speaker 01

  it has a negative feedback on our brain. When the estrogen levels hit a very high level, it actually stimulates this GnRH secretions from the hypothalamus to go faster. And when the GnRH 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?

• 15:47Speaker 01

  Remember the insulin resistance that first domino starts stimulating the theca 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 GnRH to go faster. And then the LH starts going faster. And the LH constantly stimulates these ovarian tissue, the theca cells, to release more androgens. So you start in PCOS patients, you start getting this environment of high androgens.

• 16:29Speaker 01

  And these irregular estrogen sequections 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 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.

• 17:14Speaker 01

  It gets very complicated, but the human, the woman'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 secreted.

• 17:54Jay Shetty?

  Is there anything women can do about that insulin resistance?

• 17:57Speaker 01

  Absolutely.

• 17:58Jay Shetty?

  What do they do? Let's focus on that one and then we'll move to the others.

• 18:01Speaker 01

  Absolutely. So for this pillar of insulin resistance, you want to make patients insulin sensitive, right? So it is, there are many supplements that can make patients insulin sensitive. And that's why, I don't know if you know, I have an 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.

• 18:45Speaker 01

  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.

• 18:53Jay Shetty?

  By having a 10 minute walk after eating.

• 18:55Speaker 01

  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. My OV supplement also has wild mulberry 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.

• 19:36Speaker 01

  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 management becomes easier. When insulin goes down, your ovaries are not secreting 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 Ovi has a lot of anti-inflammatory supplements. But there's prescription medication, metformin. What does metformin do? Metformin makes us insulin sensitive.

• 20:21Speaker 01

  Anything that makes you insulin sensitive, again, lowers that insulin. Are there any side effects to either of the? So the supplements don't have any side effects. Metformin does have side effects, but patients get used to it. The most common side effect with metformin is nausea or diarrhea. But most patients do really, really well. The next thing patients can do are GLP-1s. I'm sure you've heard of the Ozempics and the Wegovy and the Terzepatides. 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. GLP-1s, why do PCOS patients love GLP-1s? I started treating them.

• 21:04Speaker 01

  And one thing I realized is not only they're losing a lot of weight, but GLP-1s regulates their insulin and makes them insulin sensitive. By doing that, that's why patients say, oh, when I take, I don't know, metformin or when I take Ovi or when I take, when I use these GLP-1s, I get brain clarity. I get pregnant. My periods are becoming more regular. Because at its core, you're fixing this insulin resistance. So for this pillar, this underlying condition, I say, low carbohydrate diet. Walk 10 to 15 minutes after each meal. Exercise cardio at least four times a week. I recommend the Ovi supplement.

• 21:49Speaker 01

  It works amazingly well. Take, ask your doctor for a metformin prescription. The minimum dose of metformin. To affect insulin resistance is fifteen hundred. So you want to start with seven hundred fifty 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 GLP ones. You can do the Ozempic, Wegovy, they all work really, really well.

• 22:34Jay Shetty?

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• 23:17Jay Shetty?

  That's indeed.com/podcast. Terms and conditions apply. Need to hire? This is a job for Indeed sponsored jobs.

• 23:26Speaker 02

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• 23:56Jay Shetty?

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• 24:52Jay Shetty?

  Talk to me about the nutritional impact of being on GLP-1 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.

• 25:05Speaker 01

  I know.

• 25:05Jay Shetty?

  To not be able to actually eat.

• 25:07Speaker 01

  You know, and I.

• 25:07Jay Shetty?

  You lose weight, but you're not eating.

• 25:10Speaker 01

  Yes, but remember, we're talking, I'm talking right now about my PCOS patients. I'm not talking about that, you know, perimenopausal woman or someone out there who wants to lose 10 pounds, five pounds. Well, patients who are already underweight and they want to lose 10 more pounds. And, you know, they don't, they're not eating.

• 25:29Jay Shetty?

  This is for PCOS.

• 25:31Speaker 01

  This is for PCOS. I mean, 2014, I started using these medications. It's a game changer.

• 25:37Jay Shetty?

  And how long would someone stay on it to conceive?

• 25:39Speaker 01

  So it depends, it depends. So for someone who wants to lose 100 pounds, you know, they might have to stay on it for two, two and a half years. And the reality of it is, you know, insulin resistance metabolic health is, is not a one size.

• 25:56Speaker 01

  Fits all. Someone who loses hundred, hundred fifty pounds with GLP ones 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 thirty pounds, forty pounds, fifty pounds on these GLP ones. But what I do, I keep them on Ovi and Metformin after they lose their weight. So if someone has insulin resistance, you give them GLP ones and you stop it. What's gonna happen? They shoot back up, right? Take a PCOS patient, her insulin resistance is not going away. You give her GLP one, you address her insulin sensitivity, you regulate her insulin.

• 26:38Speaker 01

  She loses fifty pounds, you stop it, the patient comes back three months later, she's like, doctor, I gained 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 ones, in about three, four months, when they get used to the GLP one, that's when I introduce the Metformin. And right when I start them on the GLP ones, I have them take the Ovi supplement. So when I'm ready to stop the GLP ones, they're already on the Ovi 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 GLP one.

• 27:23Speaker 01

  Right. You have to address the underlying 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 resistance stimulates your ovaries to secrete androgen, the androgen actually affects your GnRH secretion, it makes it very rapid. And this rapid secretion of GnRH causes a shift in the LHFSH. So the FSH kind of stays down and the LH chronically stays up. So instead of only going up mid-cycle causing ovulation, all month this LH is firing. What does LH do? It stimulates your ovaries to release androgens.

• 28:06Speaker 01

  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 wanna deal with the insulin resistance, this is when we give patients birth control pills, right? And birth control pills help regulate 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.

• 28:52Speaker 01

  This chronic inflammation, remember I told you with the insulin resistance, the liver takes this sugar and turns it into a visceral fat. Visceral fat is highly inflammatory. Insulin resistance increases 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 our body. These PCOS patients have gut dysbiosis, increases this inflammation. So they have so many reasons for this inflammation to go up.

• 29:37Speaker 01

  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.

• 30:01Jay Shetty?

  What do you suggest for that third pillar?

• 30:03Speaker 01

  The third pillar, you have to address insulin resistance, which is the key form. Antioxidants, anti-inflammatory diet is very, very important. So there are lifestyle changes. Lifestyle changes, exercise, you know, dealing with that visceral fat, blocking that visceral fat, lowering your 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 poor diet, if you're not exercising,

• 30:46Speaker 01

  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. 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,

• 31:27Speaker 01

  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 part of our brain where all the emotions are stored, it's regulated and it calms our amygdala down. Estrogen, so 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 is unstable estrogen, there's lack of progesterone.

• 32:13Speaker 01

  And the androgens are going crazy. So if you think of our limbic system, which I'm sure you talk about all the time. Our limbic system is our amygdala, our hippocampus and our hypothalamus. This is the emotional headquarters 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.

• 32:57Speaker 01

  The amygdala goes crazy and becomes hyperactive. That's our fear center. We get anxious, we get scared, we 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 patient 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.

• 33:41Speaker 01

  Go see a psychiatrist. 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.

• 34:23Speaker 01

  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.

• 34:40Jay Shetty?

  Why would they suggest that? What's that? What is, what would that do? What's the hope?

• 34:44Speaker 01

  To regulate the periods and help stimulate the sex hormone binding globulin that's low in the blood that 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 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,

• 35:28Speaker 01

  doctors, healthcare providers, listen to your patients. But unfortunately, our healthcare 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 periods, so you don't have PCOS. That's not true. You don't have cysts 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,

• 36:08Speaker 01

  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.

• 36:28Speaker 01

  And their inflammation and inflammatory markers are off the chart.

• 36:33Speaker 01

  Someone needs to go to the rescue. Someone needs to start listening to that.

• 36:37Jay Shetty?

  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?

• 36:52Speaker 01

  Thank you for this question. So I, because of years of doing this, I actually created a free calculator, free. It's on OV, OVII.com. Go answer, I ask questions that I ask my patients in my office. And 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 OVII.com, answer these questions for free. I can tell them whether or not they have PCOS.

• 37:37Speaker 01

  And if they have PCOS, I want them to listen to this podcast to, you know, I created GMD just to give women this information. Because until you make them become their own health advocate, they will get dismissed in the healthcare 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.

• 38:22Speaker 01

  They can print it out, take it to the doctor and become their own health advocate. Honestly, until we have a better healthcare system and we educate our doctors not to dismiss women, this is what we have for now, making women become their own health advocate.

• 38:40Jay Shetty?

  Yeah, that's a real masterclass 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 that educated conversation seems like an important step.

• 38:58Speaker 01

  Absolutely. And you know, to this day, I get patients, they're like, you know, I listened to your podcast, I went to my doctor and I said, I have insulin resistance. You need to give me metformin. 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 or 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 with diet, with exercise, with supplements,

• 39:43Speaker 01

  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 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.

• 40:16Jay Shetty?

  Let's talk about endometriosis. My first question was around, do periods have to be painful? Should they be painful?

• 40:23Speaker 01

  No, so painful periods are not normal. So what does that mean?

• 40:29Speaker 01

  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 healthcare 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.

• 41:09Speaker 01

  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,

• 41:52Speaker 01

  they're the leading cause of infertility on this planet. Can you imagine? And majority of these women are not being diagnosed. So

• 42:02Jay Shetty?

  Do you find endometriosis for me?

• 42:04Speaker 01

  So endometriosis is a chronic inflammatory and neuroimmune condition that affects ten to twenty percent of women on the planet. Close your eyes and think of these women, right?

• 42:18Jay Shetty?

  So you know someone is the point?

• 42:20Speaker 01

  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 secreting estrogen, these endometriosis

• 43:03Speaker 01

  Plants 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, 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.

• 43:48Speaker 01

  In a normal immune system, our immune system attacks those cells and clear it out. Patients 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 grabbing onto vessels and they grow nerve fibers. And these nerve fibers start causing these pains.

• 44:31Speaker 01

  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 more and more and more severe pain. So that's why it's

• 45:13Speaker 01

  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 nine to eleven years to diagnose these women.

• 45:29Jay Shetty?

  Why?

• 45:29Speaker 01

  And because majority of these women go undiagnosed, this chronic pain, this chronic inflammation that comes from these inflammatory tissue in the pelvis starts affecting their central nervous system. They start becoming anxious, brain fog, depression. Their amygdala, their limbic system is literally on fire twenty-four seven. 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.

• 46:13Speaker 01

  They become addicted to these narcotics. They start second guessing 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?

• 46:34Jay Shetty?

  Yeah, it's, I mean, it's shocking and traumatic.

• 46:38Speaker 01

  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, on Fridays I operate, majority of the patients I operate on are endometriosis. I mean, I have endo, endo, endo, it's a lineup of endometriosis patients. Will 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,

• 47:21Speaker 01

  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.

• 47:41Speaker 01

  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 changing your social calendar. You plan your trips around your periods. That's endometriosis until proven otherwise. If you have painful 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.

• 48:26Speaker 01

  And all we need to do is our healthcare providers to start listening to these patients. You need to listen for five 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

• 49:10Speaker 01

  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 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 I IUDs, Kyliena, Morena, Lyleta,

• 49:54Speaker 01

  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 GnRH agonists or antagonists. These are medications like Oralissa, Myfembry, 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,

• 50:38Speaker 01

  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 resect 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.

• 51:09Jay Shetty?

  And what counts as an advanced disease? How long?

• 51:11Speaker 01

  In deep infiltrated 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.

• 51:22Jay Shetty?

  So you're saying there's no cure, it's more hormonal balance?

• 51:25Speaker 01

  Hormonal balance in surgery makes a huge difference. It's still gold standard to treat these patients. But because these patients don't have access to surgeons who are familiar with endometriosis surgery, it's always best to start with hormonal suppression first. And if they need surgery and they still having painful sex and they still have experiencing pain with their periods, then I would recommend searching for an endometriosis surgeon.

• 51:54Jay Shetty?

  How long does hormonal suppression take? Like to actually have an effect?

• 51:57Speaker 01

  At least four months, at least four months. Because your body is not a light switch. You can't say on, off, on, off.

• 52:11Jay Shetty?

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• 53:38Jay Shetty?

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• 54:20Jay Shetty?

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• 54:36Jay Shetty?

  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 that people are just managing it?

• 54:47Speaker 01

  So 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 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, hundred laparoscopes and say, go operate, half of them will wake the patient up and say, you didn't have endometriosis.

• 55:28Jay Shetty?

  Wow, how's that possible?

• 55:30Speaker 01

  I know, 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 stromal endometriosis, from the stroma, the connective tissue around the gland. These, when you look for them, don't have that typical purple spot.

• 56:13Speaker 01

  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 laparostomy. 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.

• 56:41Speaker 01

  Average age of diagnosis is thirty two, nine to eleven 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.

• 56:54Jay Shetty?

  It's crazy.

• 56:54Speaker 01

  Talk about gaslighting.

• 56:56Jay Shetty?

  Yeah, it's crazy.

• 56:56Speaker 01

  Put yourself in that girl's shoes. And to make the matters worse, in my opinion, more than fifty percent of PCOS patients have endometriosis.

• 57:07Jay Shetty?

  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?

• 57:17Speaker 01

  The most devastating part for endometriosis is fertility. Because endometriosis is a highly inflammatory condition and it destroys the egg count and quality. I said it on a, on Huberman podcast that I have a fourteen year old with an egg count of a forty year old. And yes, I do check egg counts in a fourteen year old with debilitating pain. It's whenever, I'm not saying every single girl on this planet at fourteen needs to know her egg count. But I think until doctors start diagnosing endometriosis, we need to have a baseline egg count at eighteen. I absolutely fight for that every single day.

• 58:00Speaker 01

  I, every single day in my practice, I see someone in her twenties or thirties, ready for pregnancy with an egg count of zero because of years of pain dismissed by the healthcare system. So no, I would, so to answer your question, 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.

• 58:45Speaker 01

  That's why, you know, I wish egg freezing was free. I wish, you know, it wasn't this. It's expensive. I always say when you're young and your 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 and decrease the inflammation in the pelvis. If you can find an endometriosis surgeon with debilitating pain,

• 59:26Speaker 01

  excise those endometriosis implants. By doing that, you bring down the inflammation in the pelvis, especially patients with endometriomas. These are chocolate cysts in the ovary. Those are the ones at most, at the highest risk of losing other egg count and quality. So that's the biggest price they pay. Painful sex. There are 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. Chronic pain causes severe anxiety and depression and lack of motivation.

• 1:00:08Speaker 01

  A lot of them unfortunately become addicted to these pain meds. So these are long-term side effects of it. So it affects their mental health, their nervous system, their inflammation in the body, their fertility. 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. Cause I can't, I can't take it anymore.

• 1:00:51Jay Shetty?

  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?

• 1:01:05Speaker 01

  So first, you see, 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.

• 1:01:44Speaker 01

  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 IUD, 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 moms or grandmas who tell patients, don't take birth control pills, you're gonna be infertile. No, you're gonna be infertile if you're not taking birth control pills.

• 1:02:25Speaker 01

  You wanna be suppressed on these birth control pills until you're ready to have 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 seven 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, suppressed and you've been on birth control for so many years,

• 1:03:10Speaker 01

  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, doing a pelvic ultrasound, which should be mandatory for every single girl who's sexually active and goes for a well woman exam. Check a pelvic ultrasound, check the follicular count, 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.

• 1:03:51Jay Shetty?

  If someone can't afford to freeze their eggs right now.

• 1:03:55Speaker 01

  Yes.

• 1:03:55Jay Shetty?

  What are their other options?

• 1:03:57Speaker 01

  Suppress, suppress, suppress, suppress. Put a progesterone IUD. Take a progesterone birth control pill. Take my Phambray or Alissa. 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.

• 1:04:24Jay Shetty?

  That's so scary.

• 1:04:25Speaker 01

  That's so scary and you do not need that. The reason these patients keep having surgeries is because no one's suppressing them. Imagine someone has colon cancer and you go in and you resect their colon cancer. Do you ever tell them, okay, sir, go home, I'll see you in six months? No, 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 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,

• 1:05:07Speaker 01

  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 the IUD, if they have more pain after surgery, if they have advanced stage. Put them on these uh GnRH antagonists like Oralisa and Mifembril 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.

• 1:05:40Jay Shetty?

  How much is all of this affecting other functions in the body, whether it's the microbiome in the gut, whether it's?

• 1:05:45Speaker 01

  Oh, thank you for asking that. In my opinion, ninety percent of endometriosis patients suffer from leaky gut. They have SIBO, ninety percent. 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.

• 1:06:30Speaker 01

  So um but I always say, and these are patients who end up 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.

• 1:07:15Speaker 01

  But I'm still bloated when I eat, then I treat their 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.

• 1:07:34Speaker 01

  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 neuromodulators, like medications like Effexor, Cymbalta, Gabapentin, Lyrica. Because once you address their pathology, 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.

• 1:08:19Speaker 01

  But do you understand?

• 1:08:21Jay Shetty?

  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 is 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.

• 1:08:55Speaker 01

  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 ApoB, I check their lipoprotein little A, I check their hemoglobin A1C, I check for prediabetes, and I'm a gynecologist.

• 1:09:39Speaker 01

  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 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 thirty percent chance of having another autoimmune condition. So in my practice, if I see someone with endometriosis,

• 1:10:21Speaker 01

  I immediately think to myself, am I missing lupus? Am I missing antiphospholipid syndrome? Am I missing Sjogren's 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 Meilar lash, or any, any 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.

• 1:11:02Speaker 01

  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.

• 1:11:46Speaker 01

  You will not be surprised with patients like.

• 1:11:48Jay Shetty?

  Got it, yeah. I think that's the point, right? Like, I appreciate that. Well, you said that, hey, we're gonna look at everything. And that makes sense, because the body is so connected. It makes no sense to be like, we're gonna treat this in a silo and hope it doesn't affect anything else, when of course it's gonna 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 gonna have to sort that out, and now you're gonna have to sort that out. And it, it doesn't add up for them. Like, it's a painful process to go through.

• 1:12:15Speaker 01

  Bingo.

• 1:12:16Jay Shetty?

  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 thirties wants to conceive, what should she be doing and thinking about if she hadn't frozen her eggs previously?

• 1:12:35Speaker 01

  You come to my office, you're thirty five. Uh, you show up to my office for a well woman exam. I love this question. Number one, take a good history. I wanna rule out endometriosis, because no one's diagnosed it. I wanna 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 cysts. 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,

• 1:13:18Speaker 01

  or they can cause fertility issues and miscarriages. I look for polyps in the lining of the uterus. PCOS patients especially, because of that hormonal changes, they have a lot of polyps in the lining of their uterus. So that can block them from getting pregnant. So I look for that. I do a three D 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 I D F, 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.

• 1:13:58Speaker 01

  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 secreting 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.

• 1:14:38Speaker 01

  And I do a full SDD panel, but the most important thing I do in a thirty five year old, I also check her egg count. 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? 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 pulled that IUD. If um, they have PCOS, I treat them with every single thing we talked about. Before they start trying, because metformin, the OV supplement, these things stimulate ovula, it helps with the ovulation

• 1:15:23Speaker 01

  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. For patients at younger than thirty five, I usually give them a year to try. For patients who are older, thirty five and older, I tell them go try for uh, six 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, 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 it thirty five for six months and then find out that the semen is not bad. And thirty percent of uh, fertility issues.

• 1:16:08Speaker 01

  Are you know male related? And then, 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 ovu 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 six months, go try for a year. And if you're not pregnant, come back. But one thing that I do in my office, I've already done ninety percent 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.

• 1:16:50Speaker 01

  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 resected it. If they've had polyps, 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 healthcare system, I want to make pelvic ultrasounds mandatory at a well woman exam. Just by doing a by manual 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,

• 1:17:31Speaker 01

  then I will tell you to leave probably because it's just like taking someone's glasses away and telling them to read.

• 1:17:38Jay Shetty?

  Yeah.

• 1:17:39Speaker 01

  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.

• 1:17:55Jay Shetty?

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• 1:18:39Jay Shetty?

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• 1:19:42Jay Shetty?

  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 you're like, hey, I had a miscarriage. Hey, I, um, hey, we've been trying for six months, nothing's happened. Now we're gonna 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.

• 1:20:23Speaker 01

  A million different things.

• 1:20:25Jay Shetty?

  And so whether you're in your twenties and you don't want to have a kid till your thirties, 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.

• 1:20:35Speaker 01

  If you've tried for a year and you've you've had sex three to four times

• 1:20:41Speaker 01

  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 gonorrhea, chlamydia. Check your AMH, anti-malarian hormone is egg count. Basically, 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.

• 1:21:25Speaker 01

  Have your partner go to any fertility clinic, do a semen analysis. It takes two minutes to do that. Number three, I call it the anatomy bucket, right? Get a pelvic ultrasound because 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 polyps. Make sure you don't have any septum. Ask your doctor for an HSG, histosapingogram. 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

• 1:22:10Speaker 01

  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 adenomyosis, which we didn't talk about. It's a sister diagnosis to endometriosis.

• 1:22:55Speaker 01

  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 gained, if you gain weight and you can't lose it, if you've struggled with weight most of your life,

• 1:23:41Speaker 01

  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 percent, 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 resistance. 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.

• 1:24:26Speaker 01

  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.

• 1:24:38Speaker 01

  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 fertility. Why am I saying this? Let's take antiphospholipid syndrome. These are patients who might not have any symptoms, right? But in their labs, their antiphospholipid syndrome is positive. These patients may 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.

• 1:25:23Speaker 01

  They get recurrent miscarriages. 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 thirty percent of infertility is female related.

• 1:26:05Speaker 01

  Thirty percent is male related and thirty percent is unexplained or mixed, like no one knows.

• 1:26:13Jay Shetty?

  Really?

• 1:26:13Speaker 01

  I know.

• 1:26:15Jay Shetty?

  Really?

• 1:26:15Speaker 01

  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 twenty year old to my office once, actually, if I could take him, I would probably take him at eighteen. Every eighteen year 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've learned all this, I want you to imagine this patient, and I've seen thousands of them.

• 1:26:56Speaker 01

  Imagine a thirty four year 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're probably eating unhealthy. That's why you're overweight. Eat less. She gets anxiety. She gets depression. By the time she's sixteen, she has an eating disorder. She has acne. Her mom takes her to the dermatologist. They start her on Accutane. She is very depressed. She goes to a psychiatrist. They put her on an antidepressant. She bounces from psychiatry office to psychiatry office.

• 1:27:40Speaker 01

  She's doubled over in pain. When she's at school, she, the nurse calls for her mom to come and pick her up. She goes to ten, twenty, fifty 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 thirty four years old. I do her AMH and she has no eggs left.

• 1:28:22Speaker 01

  Yeah. This is my broken heart. This is my trauma. This is every single patient I see in my office. Do you 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 thirty years. And I'm, their trauma is my trauma. And that's why I started my podcast. My SheMD 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.

• 1:29:05Speaker 01

  Endo, PCOS, fibroids, STDs, one by one. I teach them, I empower them to become their own health advocate. So if you're twenty five and you go to an office and you're being dismissed, those, that needs to stop. I'm here today because I want to change this healthcare 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,

• 1:29:50Speaker 01

  do you think women have a chance in this healthcare system?

• 1:29:54Jay Shetty?

  So painful, it's so painful and tragic to hear.

• 1:29:56Speaker 01

  It's so painful, you don't understand the depth of this pain that these women 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 twenty minutes only. Let me tell women what they deserve to know. You don't have to be thirty five years old to find out you don't have any eggs left. You don't have to be thirty five to learn that you have giant fibroids, that you have endometriosis, that you have PCOS, that you have an autoimmune condition,

• 1:30:41Speaker 01

  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 ten hours.

• 1:30:53Jay Shetty?

  Dr. Ray, I wanna, I wanna 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 SheMD, it's free, it's a podcast by Dr. A where you can get deeper insights, you can get the extra ten 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 is struggling silently, who you know is 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.

• 1:31:38Jay Shetty?

  Dr. Ray, thank you for enlightening us, inspiring us and giving us such a

• 1:31:43Speaker 01

  You're so sweet.

• 1:31:44Jay Shetty?

  Powerful message. Truly, 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 deprioritized 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.

• 1:32:09Speaker 01

  There's no excuse for it.

• 1:32:10Jay Shetty?

  And I'm just really thankful that you came on today and shed so much light on it. So I'm very grateful to you.

• 1:32:14Speaker 01

  You're so sweet. Thank you for giving me this mic.

• 1:32:17Jay Shetty?

  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.

• 1:32:24Speaker 01

  Thank you. Thank you for having me.

• 1:32:26Jay Shetty?

  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.

• 1:32:40Speaker 04

  The world won't always like you, but you can't count on the world to like you.

• 1:32:47Speaker 05

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• 1:33:16Speaker 06

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• 1:33:46Speaker 08

  Ugh, I hate Mondays.

• 1:33:48Speaker 06

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• 1:34:01Speaker 06

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