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Speaker 1: me tell women what they deserve to know. If you

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Speaker 1: take PCOS, seventy five percent of these women are not diagnosed.

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Speaker 1: If you take endometriosis, over ninety percent of these women

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Speaker 1: are not diagnosed. Wow, endometriosis with PCOS, they're the leading

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Speaker 1: cause of infertility on this planet.

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Speaker 2: Hey, everyone, welcome back to on Purpose, the place you

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Speaker 2: come to become happier, healthier, and more healed. Today's guest

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Speaker 2: is someone that I'm extremely excited to talk to because

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Speaker 2: it's a subject matter that so many of you have

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Speaker 2: been asking me about. If you have questions about PCOS,

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Speaker 2: this episode is for you. If you have any questions

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Speaker 2: about endometriosis, this episode is for you. And if you're

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Speaker 2: someone out there who has friends or family that are

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Speaker 2: struggling with fertility, this episode is for you. I'm speaking

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Speaker 2: to the one and only Dr A, who is an

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Speaker 2: authority in the space, someone who has helped so many

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Speaker 2: people go through their fertility journey. Please, welcome to on Purpose,

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Speaker 2: Doctor A. Doctor. It's great to have you here.

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Speaker 1: Jay. I'm so excited. I'm so excited for you to

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Speaker 1: give me this mic and I'll tell you why I'm

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Speaker 1: so excited to be here. You know, I've always listened

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Speaker 1: to you, and you speak so amazingly to these women,

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Speaker 1: to your listeners, basically talking to them about calmness and

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Speaker 1: how to get to that calm, about mental health, about meditation,

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Speaker 1: And one thing I want the world to know is

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Speaker 1: that there are millions of women out there that cannot

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Speaker 1: get to this calm space. Not because they're not trying

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Speaker 1: hard enough, not because they're spiritually weak. They can't get

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Speaker 1: there because they have an underlying condition like PCOS and

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Speaker 1: endometriosis that affects their hormones, their inflammatory pathway, and their

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Speaker 1: nervous system. And that's why they can't find that calm.

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Speaker 1: I sit with women all day long. These are women

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Speaker 1: who've struggled for years with endemytriosis and PCOS, debilitating pain

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Speaker 1: that they can't even you know, stand up straight, and

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Speaker 1: just because no one ever believed them, no one, and

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Speaker 1: they dismiss their symptoms. You know, you have these thirteen

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Speaker 1: year olds who are literally on the bathroom floor with

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Speaker 1: every period, thinking this is normal life and that's life

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Speaker 1: for them and they can't really complain about it. Or

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Speaker 1: they have women who are ashamed of their body, and

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Speaker 1: they go to the doctor and all they hear is

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Speaker 1: will just eat less, exercise more, but no one really

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Speaker 1: addresses the underlying condition. And I've done this for decades,

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Speaker 1: and I reached a point in my life that I

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Speaker 1: said enough, enough is enough enough dismissing women enough, normalizing

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Speaker 1: their pain, normalizing their symptoms, and telling them it's they're

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Speaker 1: in their head, they're crazy, they're anxious. It's none of that, really,

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Speaker 1: and it's time to really start listening to these women

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Speaker 1: and dealing with these underlying conditions. And that's why. You know,

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Speaker 1: millions of women are affected by PCOSN and the metriosis,

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Speaker 1: and majority of them are never diagnosed. So that's why

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Speaker 1: I'm so excited to be here to take at least

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Speaker 1: this hour to bring some awareness to these two conditions.

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Speaker 1: So thank you for having me.

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Speaker 2: Let's dive in, because, like I said, my audience really

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Speaker 2: wants the answer to these questions. I really want to

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Speaker 2: shed light on this topic. I really want people to

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Speaker 2: feel seen, heard and understood as they're navigating this. But

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Speaker 2: you've actually said that we're in the middle of a

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Speaker 2: fertility crisis. What does that mean?

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Speaker 1: So when you know, let's say you take one hundred

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Speaker 1: couples and you have them go try to get pregnant.

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Speaker 1: You tell them have sex three to four times a week,

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Speaker 1: and then come back in a year. Fifty percent of

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Speaker 1: them on average get pregnant in the first six months,

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Speaker 1: ninety percent of them are pregnant within a year, and

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Speaker 1: ten percent don't get pregnant. Well, in that ten percent category,

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Speaker 1: if you take male fertility out, majority of those patients

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Speaker 1: have PCOS and endometriosis. The problem is if you take PCOS,

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Speaker 1: seventy five percent of these women are not diagnosed. If

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Speaker 1: you take endometriosis, I think over ninety percent of these

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Speaker 1: women are not diagnosed, so they fall under this unexplained

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Speaker 1: infertility because doctors are not diagnosing these underlying conditions.

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Speaker 2: What is PCOS? Define it for us.

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Speaker 1: So PCOS is a chronic hormonal, metabolic, inflammatory, and neurological

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Speaker 1: condition that affects fifteen percent of women in this country.

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Speaker 1: If you go to countries like India, that number can

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Speaker 1: go north of twenty percent. The problem with it is

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Speaker 1: that seventy five percent of these women are never diagnosed

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Speaker 1: and they go through life not getting a diagnosis. In

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Speaker 1: order to diagnose PCOS, it's very simple. You neque to

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Speaker 1: meet two out of the three. Criteria. Number one is

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Speaker 1: basically ovarian or ovulation dysfunction. These are women who have

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Speaker 1: irregular periods. They get their periods not every twenty eight days,

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Speaker 1: they get it like every thirty five days, thirty seven days,

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Speaker 1: or they get less than eight periods per year. So

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Speaker 1: that's criteria number one. Criteria number two is PCOS looking

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Speaker 1: over is on ultrasound, So PCOS is not Polycystic ovary

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Speaker 1: syndrome is not cyst To this day, doctors say, oh,

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Speaker 1: you don't have assist on your ovary, so you don't

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Speaker 1: have PCOS. Polycystic ovary syndrome is a group of follericles.

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Speaker 1: It's a specific finding on ultrasound. These are ovaries that

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Speaker 1: are enlarged with at least twenty Foller coles and it's

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Speaker 1: a specific finding on ultrasound. Again, a lot of doctors

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Speaker 1: don't know what to look for. So that's the second criteria.

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Speaker 1: And recently for this criteria they added high account or

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Speaker 1: high AMH to this criteria. Be for women who can

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Speaker 1: have access to ultrasound or they don't you know, or

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Speaker 1: their doctor's this ovarian morphology on ultrasound, so elevated account

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Speaker 1: also counts as this second criteria, and the third criteria

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Speaker 1: is elevated testosterone or androgen symptoms. What are these symptoms?

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Speaker 1: Facial hair, body hair, facial acne, body acne, oily skin,

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Speaker 1: male pattern, hair thinning, or hair loss. You don't have

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Speaker 1: to have all of these symptoms, you have to have one.

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Speaker 1: So this is the third criteria, and you need to

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Speaker 1: meet two out of these three criteria. PCOS patients, for

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Speaker 1: reasons I'm going to go into details, struggle with anxiety

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Speaker 1: and depression. They have mood disorder, they're moody people. They

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Speaker 1: have really bad PMS. They usually have someone in their

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Speaker 1: family who's PCOS diabetic, overweight, insulin resistant. A lot of

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Speaker 1: them have an eating disorder or disordered eating, and they

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Speaker 1: end up in these eating disorder centers because their PCOS

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Speaker 1: is not being diagnosed. It's the leading cause, with endometriosis,

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Speaker 1: leading cause of infertility on this planet. Seventy five percent

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Speaker 1: of these patients gain weight even though they're eating exactly

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Speaker 1: what you and I are eating, exercising exactly the same,

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Speaker 1: but they cannot lose a pound. Twenty five percent of

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Speaker 1: them are lean, lean PCOS patients. Even these lean PCOS

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Speaker 1: patients have eating disorders. So imagine, take this young girl

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Speaker 1: who's gaining weight, is in high school, let's say, gaining weight, acne,

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Speaker 1: facial hair, can't lose her weight, She's moody, she's anxious,

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Speaker 1: she has really bad PMS, and she goes to the

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Speaker 1: doctor and the doctor says, there's nothing wrong with you.

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Speaker 1: You're probably eating too much.

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Speaker 2: So wait, you would know as early as then.

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Speaker 1: Oh my god, yes, teenagers, that's you know what I

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Speaker 1: always say. If you want, if you go knock on

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Speaker 1: the doors of these eating disorder centers, your PCOS patients

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Speaker 1: are sitting behind those doors.

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Speaker 2: So why is it not getting correctly diagnosed? If it's

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Speaker 2: such a big issue, it's affecting so many people, and

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Speaker 2: there's so many symptoms through which you can measure it,

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Speaker 2: why is it not diagnosed?

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Speaker 1: So I think it's multiple reasons. Number one, doctors don't

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Speaker 1: consider you know, they don't know enough about PCOS and

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Speaker 1: PCOS presents in different morphologies. Once we talk about it,

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Speaker 1: you understand why you don't have to have irregular period

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Speaker 1: to have PCOS. Some there's a morphology of PCOS patients

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Speaker 1: who don't have any elevated testosterone symptoms. They just have

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Speaker 1: the irregular period and the PCOS. So remember I said

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Speaker 1: two out of the three criteria. You have different combination

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Speaker 1: of these symptoms and different presentations of these patients. Some

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Speaker 1: are leans, some are overweight, some have irregular periods, some

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Speaker 1: have acnes, some have hair loss, some have facial hair

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Speaker 1: and body hair. They present differently, so it's very confusing

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Speaker 1: to doctors. That's why I'm here to tell you you

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Speaker 1: only need to meet two out of the three criteria.

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Speaker 1: And if you meet those criteria, then you look for

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Speaker 1: the anxiety and the depression and the eating disorder, and

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Speaker 1: the weight issues and the insulin resistance and the fertility issues,

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Speaker 1: and you put this picture together and you can your

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Speaker 1: PCOS patients. I always say, you don't need a doctor

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Speaker 1: to really diagnose you. If you listen to this podcast

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Speaker 1: from home, you can self diagnose. I'm giving you the

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Speaker 1: tools to diagnose yourself. But because PCOS has these underlying

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Speaker 1: pillars that affect their entire, their whole body. So it's

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Speaker 1: not just a fertility issue, it's not just the period issue.

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Speaker 1: Is a total body issue. It affects your mental health,

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Speaker 1: it affects your reproductive health. It affects you metabolically, it

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Speaker 1: affects your hormones. And until you address every single underlying

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Speaker 1: pillar of the driver of these symptoms, you can make

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Speaker 1: these patients feel better.

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Speaker 2: So if a woman is listening to this right now

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Speaker 2: and feel she has PCOS, what's the next thing she

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Speaker 2: should do?

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Speaker 1: Very good question. So the domino, imagine, the first domino

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Speaker 1: of this PCOS storm is insulin resistance. You have to

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Speaker 1: understand insulin resistance. What is it? Sulin resistance. When we

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Speaker 1: eat carbohydrates, bread, pati, pizza, chocolate, ice cream, our body

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Speaker 1: breaks it down into glucose. Glucose stimulates our pancreas to

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Speaker 1: release a hormone called insulin. The job of insulin is

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Speaker 1: it goes at a cellular level, opens up the receptors

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Speaker 1: on our cells. The receptors grab the sugar and put

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Speaker 1: it inside the cell where it turns into energy. This

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Speaker 1: is what's supposed to happen. But PCOS patients genetically have

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Speaker 1: insulin resistance, So when they eat carbohydrates and their body

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Speaker 1: releases insulin, their cells are insulin resistant. So these channels

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Speaker 1: don't open for the sugar to go into the cell

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Speaker 1: and turn into energy. So the sugar bounces in the

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Speaker 1: blood and pushes the insulin to go up. Insulin is

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Speaker 1: a fat storage hormone. It's an inflammatory hormone. You don't

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Speaker 1: want your insulin to go up. So what happens when

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Speaker 1: this insulin goes up? Few things happen. Number One, insulin

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Speaker 1: tells your liver the cells are not taking up this

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Speaker 1: sugar to turn it into energy. Take this sugar and

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Speaker 1: store it as fat. The problem is the fat that

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Speaker 1: gets stored with insulin resistance is not the good old

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Speaker 1: fat under our skin. It's the visceral fat around our

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Speaker 1: organs liver and our inner abdominal organs. That's highly, highly inflammatory,

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Speaker 1: and we'll get into it later. So one, the high

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Speaker 1: insulin tells your body, take this sugar and store it

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Speaker 1: into this inflammatory fat. One two, high insulin stimulates their

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Speaker 1: ovaries to secrete androgens. So, and this is the first domino.

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Speaker 1: Why because when the ovary starts secreting androgens, our menstrual

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Speaker 1: cycle completely goes out of whack. I want to take

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Speaker 1: a minute to tell you what a normal menstrual cycle

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Speaker 1: look like and what it looks like for these poor

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Speaker 1: PCOS patients. So, in a normal menstrual cycle, our brain,

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Speaker 1: our hypothalamus releases GnRH, which is a hormone that affects

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Speaker 1: the pituitary gland, an other gland in our brain that

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Speaker 1: releases two hormones FSH and LH. When this GnRH is

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Speaker 1: being released slowly, the pituitary gland releases a hormone called FSH.

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Speaker 1: FSH effect stimulates our ovaries, the follicles in the ovaries

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Speaker 1: to start growing for that cycle, and these follicles, as

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Speaker 1: they grow, they start releasing estrogen. The estrogen they release,

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Speaker 1: it gets the lining of the uterus ready for pregnancy,

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Speaker 1: because that's the job of the ovaries helping us get

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Speaker 1: pregnant every month. So these ovaries basically release these follicles

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Speaker 1: release these estrogens, and the estrogen stimulates the lining of

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Speaker 1: the uterus. While these estrogen is being released, it has

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Speaker 1: a negative feedback on our brain. When the estrogen levels

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Speaker 1: hit a very high level, it actually stimulates this GnRH

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Speaker 1: secretions from the hypothalamus to go faster. And when the

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Speaker 1: GnRH starts firing faster, the FSH slows down and the

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Speaker 1: LH surge comes. And LH is a hormone that is

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Speaker 1: a lutinizing hormone and it causes the ovulation, so it

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Speaker 1: pushes one follicle out, and that's when the egg gets released.

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Speaker 1: And if we're trying for pregnancy, the sperm comes up,

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Speaker 1: the embryo forms, and now the lining of the uterus

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Speaker 1: is nice and juicy, and the embryo implants and the

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Speaker 1: pregnancy happens. What happens with PCOS patients, remember the insulin resistance.

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Speaker 1: That first domino starts stimulating the THIKA cells in the

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Speaker 1: ovary to release androgens. When you start having androgens in

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Speaker 1: the ovary, it freezes these follicles and doesn't let them

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Speaker 1: grow normally, so then the estrogen starts becoming erratic and

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Speaker 1: you have and when your androgen levels go up, the

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Speaker 1: androgens stimulate the GnRH to go faster, and then the

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Speaker 1: LH starts going faster, and the LH constantly stimulates these

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Speaker 1: ovarian tissues, the THEKA cells to release more androgens. So

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Speaker 1: you start in PCOS patients, you start getting this environment

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Speaker 1: of high androgens and these irregular estrogen secretions that not

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Speaker 1: only block ovulation, block implantation, affects our causes irregular periods,

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Speaker 1: but it starts affecting our brain because the androgens affect

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Speaker 1: our mental health, and we can go over that later.

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Speaker 1: But this is what happens, and this is why seventy

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Speaker 1: to eighty percent of PCOS patients don't ovulate. Of the

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Speaker 1: twenty thirty percent of them who ovulate, they ovulate sometimes

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Speaker 1: even the ones who have regular periods. They're regular periods.

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Speaker 1: It's not because necessarily they're ovulating. It's because they're getting

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Speaker 1: withdrawals from this estrogen. It gets very complicated. But the

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Speaker 1: human the women's hormonal system is so beautiful when you

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Speaker 1: really understand and it. It becomes very complicated with these

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Speaker 1: PCOS patients, and that is why it becomes a vicious cycle. Right, So,

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Speaker 1: the insulin resistance starts reproducing androgens in the ovary. The

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Speaker 1: androgens affect the brain to release more LH. The LAH

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Speaker 1: affects the ovaries to secrete more androgens out and this

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Speaker 1: becomes a vicious cycle that doesn't stop. And so the

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Speaker 1: first underlying condition is this insulin resistance. The second underlying

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Speaker 1: pillar is this androgen being it.

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Speaker 2: Is there anything women can do about that insulin resistance?

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Speaker 1: Absolutely?

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Speaker 2: What do they do. Let's focus on that one and

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Speaker 2: then we'll move to the others.

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Speaker 1: Absolutely, So for this pillar of insulin resistance, you want

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Speaker 1: to make patients insulin sensitive, right, So there are many

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Speaker 1: supplements that can make patients insulin sensitive. And that's why

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Speaker 1: I don't know if you know I have an OV

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Speaker 1: platform and I have a supplement. PCOS is actually one

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Speaker 1: of those conditions that supplements actually play a huge role

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Speaker 1: in it. Why because by making a you want to

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Speaker 1: reduce for this insulin resistance pillar A, you want to

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Speaker 1: reduce the glucose in the blood. Right, So you tell

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Speaker 1: the patients decrease your carbohydrates. If you're eating carbohydrates, go

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Speaker 1: for a walk ten minutes twenty minutes after each meal.

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Speaker 1: When we walk, we actually wake up these insulin receptors

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Speaker 1: and they start grabbing sugar out of the blood. So

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Speaker 1: we lower the sugar so low carbsize.

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Speaker 2: By having a ten minute walk after each after.

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Speaker 1: Each meal, so eat less carbohydrate, walk ten twenty minutes

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Speaker 1: after each meal. Exercise makes a huge difference, obviously, in

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Speaker 1: addition to the walking after each meal. Then we go

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Speaker 1: to supplements. There are supplements like my OV supplement. These

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Speaker 1: supplements work at a cellular level to open up these

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Speaker 1: channels and pull the sugar in my ov supplement also

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Speaker 1: has one wild mulberry leaf in it, and what that

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Speaker 1: does if you take it before your heaviest meal, If

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Speaker 1: you take the supplement before your heaviest meal, it actually

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Speaker 1: blocks the absorption of carbohydrate in that meal by forty percent.

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Speaker 1: So now you're decreasing the load of sugar you're also

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Speaker 1: and whatever gets absorbed, you're pushing it. You're opening these

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Speaker 1: channels and pushing it into this cell, so you're clearing

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Speaker 1: that sugar out of the blood. By doing that. What happens,

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Speaker 1: your insulin goes down. When insulin goes down, your fat

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Speaker 1: storage goes down, your weight management becomes easier. When insulin

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Speaker 1: goes down, your ovaries are not secreting as much androgens.

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Speaker 1: Your androgens go down, androgens go down. What happens your

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Speaker 1: ovulation becomes more regular, the inflammation goes down. So that's

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Speaker 1: how the supplements work. And the ov has a lot

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Speaker 1: of anti inflammatory supplements. But there's prescription medication met forman.

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Speaker 1: What does metforman do. Metforman makes us insulin sensitive. Anything

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Speaker 1: that makes you insulin sensitive again lowers that insulin.

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Speaker 2: Are there any side effects to either of this?

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Speaker 1: So the supplements don't have any side effects. Met Foreman

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Speaker 1: does have side effects, but patients get used to it.

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Speaker 1: The most common side effect with met Foreman is nausea

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Speaker 1: or diarrhea, but most patients do really, really well. The

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Speaker 1: next thing patients can do are glp ones. I'm sure

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Speaker 1: you've heard of the ozempics and the wagovis and the urzeppetites.

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Speaker 1: So in twenty fourteen I started treating my PCOS patients

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Speaker 1: with GLP one, so almost twelve years ago, so none

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Speaker 1: of these medications are new. But back then I had

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Speaker 1: trulicity glp ones. Why do PCOS patients love GLP ones?

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Speaker 1: I started treating them, and one thing I realize is

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Speaker 1: not only they're losing a lot of weight, but glp

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Speaker 1: ones regulates their insulin and makes them insulin sensitive. By

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Speaker 1: doing that, they that's why patients say, oh when I

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Speaker 1: take I don't know met foreman, or when I take oh,

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Speaker 1: or when I take. When I use these glp ones,

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Speaker 1: I get brain clarity, I get pregnant. My periods are

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Speaker 1: becoming more regular because at its core, you're fixing this

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Speaker 1: insulin resistance. So for this pillar, this underlying condition, I

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Speaker 1: say low carbohydrate diet, walk ten to fifteen minutes after

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Speaker 1: each meal, exercise cardio at least four times a week.

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Speaker 1: I recommend the OV supplement. It works amazingly well. Take

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Speaker 1: ask your doctor for a met form in prescription. The

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Speaker 1: minimum dose of met forman to affect insulin resistance is

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Speaker 1: fifteen hundred, so you want to start with seven hundred

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Speaker 1: and fifty at night. If you have no nausea or

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Speaker 1: no diarrhea, you want to increase it to twice a day.

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Speaker 1: Then if you have weight issues, if you have a

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Speaker 1: hard time losing weight, if your BMI is in the

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Speaker 1: obese category, or if you're overweight with high blood pressure

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Speaker 1: or high cholesterol, then I recommend the GLP ones. You

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Speaker 1: can do the ozempeg, wagov. They all work really really well.

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Speaker 2: Talk to me about the nutritional impact of being on

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Speaker 2: gop one because the friends that I know that have

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Speaker 2: been taking it, they're not getting nutrients because they're not

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Speaker 2: eating as much anymore. And that obviously sounds like it

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Speaker 2: has terrible effects on the body. I not be able

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Speaker 2: to actually.

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Speaker 1: Eat, you know, and I.

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Speaker 2: Can use weight, but you're not eating.

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Speaker 1: Yes, But remember we're talking. I'm talking right now about

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Speaker 1: my PCOS patients. I'm not talking about that, you know,

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Speaker 1: perimenopausal woman or someone out there who wants to lose

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Speaker 1: ten pounds five pounds. Patients who are already underweight and

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Speaker 1: they want to lose ten more pounds and you know

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Speaker 1: they're not eating. This is four PCs, this is this

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Speaker 1: is for pcos. I mean twenty fourteen I started using

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Speaker 1: these medications. It's a game long someone to conceive, So

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Speaker 1: it depends, it depends. So for someone who wants to

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Speaker 1: lose one hundred pounds, you know, they might have to

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Speaker 1: stay on it for two two and a half years.

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Speaker 1: And the reality of it is, you know, insulin resistance

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Speaker 1: metabolic health is not a one size fits all. Someone

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Speaker 1: who loses one hundred hundred and fifty pounds with glp

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Speaker 1: ones is probably never going to get off of these mets,

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Speaker 1: you know. But their patients, my PCOS patients who want

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Speaker 1: who I don't know. They lose thirty pounds, forty pounds,

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Speaker 1: fifty pounds on these glp ones. But what I do.

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Speaker 1: I keep them on ov and met foreman after they

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Speaker 1: lose their weight. So if someone has insulin resistance, you

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Speaker 1: give them glp ones and you stop it. What's going

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Speaker 1: to happen? They shoot back up. Right, take a pcos patience.

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Speaker 1: Her insulin resistance is not going away. You give her

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Speaker 1: GLP one, You address her insulin sensitivity, you regulate her insulin.

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Speaker 1: She loses fifty pounds. You stop it. The patient comes

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Speaker 1: back three months later, she's like, doctor, I gain all

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Speaker 1: of my weight back. Why because you did not address

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Speaker 1: the underlying condition. So what I do with my patients

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Speaker 1: if you're starting on glp ones in about three four months,

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Speaker 1: when they get used to the GFP one, that's when

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Speaker 1: I introduce the MET format. And right when I start

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Speaker 1: them on the GLP ones, I have them take the

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Speaker 1: OV supplement. So when I'm ready to stop the golp ones,

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Speaker 1: they're already on the OV supplement, They're already on the

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Speaker 1: MET format. I'm addressing their inflammation, I'm addressing their insulin resistance.

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Speaker 1: I'm decreasing the load of carbohydrate that's being absorbed in

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Speaker 1: their diet. And then I wean them off of the

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Speaker 1: GLP one. You have to address the underlying disorder. If

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Speaker 1: that makes sense.

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Speaker 2: Yeah, So what's the second pillar?

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Speaker 1: So the second pill is the hormone pillar that I

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Speaker 1: was explaining. When the when the insulin resistant stimulates your

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Speaker 1: ovaries to secrete androgen. The androgen actually affects your GnRH secretion.

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Speaker 1: It makes it very rapid. And this rapid secretion of

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Speaker 1: GnRH causes a shift in the LH FSH, So the

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Speaker 1: FSH kind of stays down and the LH chronically stays up.

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Speaker 1: So instead of only going up mid cycle causing ovulation

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Speaker 1: all month, this LAH is firing. What does LH do

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Speaker 1: It stimulates your ovaries to release androgens. So then it

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Speaker 1: becomes a vicious cycle. You have these androgens that block ovulation,

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Speaker 1: and you have these androgens that are free floating in

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Speaker 1: the system causing facial hair, body hair, irregular period acne

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Speaker 1: oily skin. And on top of that, these androgens are

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Speaker 1: affecting your brain, which we'll talk later. So this is

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Speaker 1: the second pillar. And for this pillar, not only you

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Speaker 1: want to deal with the insulin resistance. This is when

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00:24:00,600 --> 00:24:03,480
Speaker 1: we give patients birth control pills, right, and birth control

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00:24:03,840 --> 00:24:10,560
Speaker 1: pills help help regulate this vicious cycle. The third pillar,

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Speaker 1: which is extremely important and nobody talks about, is chronic inflammation.

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Speaker 1: These poor PCOS patients have chronic inflammation in their body.

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Speaker 1: This chronic inflammation, remember I told you with the insulin resistance.

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Speaker 1: The liver takes this sugar and turn it turns it

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Speaker 1: into a visceral fat. Visceral fat is highly inflammatory. Insulin

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Speaker 1: resistant increases this inflammation. PCOS patients are stressed out, they

398
00:24:38,640 --> 00:24:43,359
Speaker 1: have high cortisol. Cortisol increases inflammation. These follicles that I

399
00:24:43,440 --> 00:24:47,000
Speaker 1: tell you freezing the ovaries and they're not ovulating, are

400
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Speaker 1: highly inflammatory. These PCOS patients have sleep disturbances. Sleep disturbance

401
00:24:52,800 --> 00:24:58,040
Speaker 1: causes increase in the inflammatory markers in our body. These

402
00:24:58,040 --> 00:25:02,080
Speaker 1: PCOS patients have got this BioC This increases this inflammation.

403
00:25:02,200 --> 00:25:05,720
Speaker 1: So they have so many reasons for this inflammation to

404
00:25:05,800 --> 00:25:09,520
Speaker 1: go up. As this inflammation goes up, it makes their

405
00:25:09,520 --> 00:25:16,400
Speaker 1: insulin resistance worse. Inflammation stimulates more androgen secretions from the ovaries,

406
00:25:16,760 --> 00:25:21,919
Speaker 1: and inflammation again affects their mental health. So this again,

407
00:25:22,200 --> 00:25:25,640
Speaker 1: this third pillar adds to the first two pillars, just

408
00:25:25,840 --> 00:25:30,560
Speaker 1: pushing androgens out and increasing the inflammatory.

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Speaker 2: What do you suggest for that third pillar?

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Speaker 1: The third pillar, you have to address insulin resistance, which

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Speaker 1: is the key form antioxidants. Anti inflammatory diet is very

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Speaker 1: very important. So there are lifestyle changing, lifestyle changes, exercise,

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Speaker 1: you know, dealing with that visceral fat, blocking that visceral

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Speaker 1: fat lowering, your stress, exercising, sleeping, anti inflammatory diet, that lifestyle,

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Speaker 1: you know, not always. I read this somewhere that you

416
00:26:01,600 --> 00:26:05,240
Speaker 1: know your genetics load the gun, but your lifestyle pulls

417
00:26:05,280 --> 00:26:08,439
Speaker 1: the trigger. And that's exactly what happens with PCOS. If

418
00:26:08,480 --> 00:26:11,520
Speaker 1: you're not sleeping, if you're stressed, if you have a

419
00:26:11,560 --> 00:26:16,120
Speaker 1: poor diet, if you're not exercising, you're pulling that trigger

420
00:26:16,160 --> 00:26:22,240
Speaker 1: and making all these symptoms so much worse. The last pillar,

421
00:26:23,080 --> 00:26:27,520
Speaker 1: which is your pillar, is the pillar is the neurologic

422
00:26:27,600 --> 00:26:34,320
Speaker 1: pillar of PCOS, which is huge. So with the first pillar,

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00:26:34,560 --> 00:26:37,080
Speaker 1: with the second pillar, and with the third pillar, what

424
00:26:37,160 --> 00:26:41,800
Speaker 1: do we have unstable estrogen levels that fluctuate. We have

425
00:26:42,440 --> 00:26:46,920
Speaker 1: high androgens pumping in their blood every single day, and

426
00:26:46,960 --> 00:26:51,199
Speaker 1: we have high high inflammatory markers in a woman with

427
00:26:51,320 --> 00:26:54,840
Speaker 1: a normal menstrual cycle, when the estrogen is normal, when

428
00:26:54,840 --> 00:26:58,480
Speaker 1: the cortisol is leveled, when there's no insulin resistance, when

429
00:26:58,480 --> 00:27:04,280
Speaker 1: the inflammation is down estrogen normal estrogen levels actually are

430
00:27:04,400 --> 00:27:09,000
Speaker 1: calming on the brain. Normal estrogen levels stimulate serotonin in

431
00:27:09,040 --> 00:27:13,560
Speaker 1: our brain, lower anxiety and depression. They regulate our dopaminy

432
00:27:13,720 --> 00:27:18,080
Speaker 1: in the brain, so we're more motivated. Basically, amygdala, which

433
00:27:18,160 --> 00:27:22,120
Speaker 1: is the part of our brain where all the emotions

434
00:27:22,160 --> 00:27:27,720
Speaker 1: are stored. It's regulated and it calms our amygdala down. Estrogen,

435
00:27:27,760 --> 00:27:31,840
Speaker 1: so estrogen has a calming effect. Progesterone has the same

436
00:27:31,880 --> 00:27:35,160
Speaker 1: calming effect. It binds GABA receptors in the brain and

437
00:27:35,200 --> 00:27:38,439
Speaker 1: it calms it down. What happens with pcos there is

438
00:27:38,760 --> 00:27:43,120
Speaker 1: unstable estrogen, there's lack of progesterone, and the androgens are

439
00:27:43,160 --> 00:27:47,280
Speaker 1: going crazy. So if you think of our limbic system,

440
00:27:47,400 --> 00:27:49,600
Speaker 1: which I'm sure you talk about all the time, our

441
00:27:49,680 --> 00:27:54,320
Speaker 1: limbic system is our amygdala, are a hippocampus, and our hypothalamus.

442
00:27:54,800 --> 00:27:58,680
Speaker 1: This is the emotional headquarter of our brain. So all

443
00:27:58,720 --> 00:28:02,240
Speaker 1: the emotions are in these three areas of our brain.

444
00:28:03,000 --> 00:28:07,320
Speaker 1: Estrogen and progesterone calms it down. But when estrogen is unstable,

445
00:28:07,359 --> 00:28:11,560
Speaker 1: when progesterone is low, and when androgens are going crazy,

446
00:28:11,960 --> 00:28:15,800
Speaker 1: serotonin levels go down. As serotonin levels go down, we

447
00:28:15,880 --> 00:28:21,480
Speaker 1: become anxious, depressed, irritable. The dopamine goes crazy, our motivation

448
00:28:21,720 --> 00:28:27,800
Speaker 1: goes down. We feel tired, fatigued, unmotivated. The amygdalah goes crazy,

449
00:28:28,160 --> 00:28:31,920
Speaker 1: and becomes hyperactive. That's our fear center. We get anxious,

450
00:28:31,960 --> 00:28:36,760
Speaker 1: we get scared, we can't control our emotions. And as

451
00:28:36,800 --> 00:28:40,600
Speaker 1: the inflammation goes up in our brain, what happens. We

452
00:28:40,640 --> 00:28:43,080
Speaker 1: start having brain fog. We feel like our brain is

453
00:28:43,120 --> 00:28:46,120
Speaker 1: not functioning, we feel like we're not sharp. So take

454
00:28:46,120 --> 00:28:51,520
Speaker 1: a pcos patients all day long with unstable estrogen progesterone

455
00:28:51,560 --> 00:28:54,840
Speaker 1: that's low, you have this androgens pumping up and this

456
00:28:55,040 --> 00:28:59,680
Speaker 1: inflammatory markers high up in their brain, making them feel

457
00:28:59,680 --> 00:29:03,760
Speaker 1: ankus and sad and depressed and irritable and brain fog

458
00:29:03,960 --> 00:29:07,960
Speaker 1: and all of it. And what happens People tell them,

459
00:29:08,000 --> 00:29:11,960
Speaker 1: you have a personality disorder. You're crazy. Go see a psychiatrist,

460
00:29:12,560 --> 00:29:14,920
Speaker 1: you know. And on top of all this, with the inflammation,

461
00:29:15,080 --> 00:29:19,000
Speaker 1: with all these hormones changing in the brain, with insulin resistance,

462
00:29:19,080 --> 00:29:22,600
Speaker 1: they get food cravings, They binge eat. That's why they

463
00:29:22,640 --> 00:29:26,600
Speaker 1: have eating disorders. So I'm here to say that if

464
00:29:26,640 --> 00:29:30,520
Speaker 1: you're sitting at home, if you have irregular peers, if

465
00:29:30,560 --> 00:29:35,240
Speaker 1: you're gaining weight, if you feel inflamed, if you have acne,

466
00:29:35,320 --> 00:29:37,800
Speaker 1: hair loss, facial hair, body hair, if you're anxious, if

467
00:29:37,840 --> 00:29:41,840
Speaker 1: you're depressed, if you're not motivated, all of these could

468
00:29:41,840 --> 00:29:46,720
Speaker 1: be PCOS. It is probably PCOS. And until you deal

469
00:29:46,760 --> 00:29:50,480
Speaker 1: with these four pillars and address each one of them,

470
00:29:50,920 --> 00:29:54,520
Speaker 1: you can't feel normal. So throwing a birth control pillar

471
00:29:54,520 --> 00:29:57,760
Speaker 1: at these patients that's why they don't feel better. And

472
00:29:57,800 --> 00:30:00,280
Speaker 1: you know, to this day, I listen to podcasts when

473
00:30:00,560 --> 00:30:04,880
Speaker 1: even gynecologists, very well known gynecologists, show up, and when

474
00:30:04,920 --> 00:30:07,640
Speaker 1: they're asked what is the treatment for PCOS? They say

475
00:30:07,680 --> 00:30:08,600
Speaker 1: birth control pill?

476
00:30:08,840 --> 00:30:11,400
Speaker 2: That's why I would they suggest that that is? What

477
00:30:11,440 --> 00:30:11,960
Speaker 2: would that do?

478
00:30:12,080 --> 00:30:16,800
Speaker 1: What's the hope to regulate the periods and help stimulate

479
00:30:16,840 --> 00:30:19,760
Speaker 1: the sex hormone binding globulin that's low in the blood

480
00:30:20,160 --> 00:30:25,240
Speaker 1: that causes elevations in the andandrogens. It works with their symptoms,

481
00:30:25,280 --> 00:30:28,400
Speaker 1: It regulates their periods, their acne clears up, their facial hair,

482
00:30:28,400 --> 00:30:31,760
Speaker 1: body hair, hair loss gets better. But you're not addressing

483
00:30:31,760 --> 00:30:36,440
Speaker 1: their inflammation, you're not addressing the core insulin resistance, and

484
00:30:36,520 --> 00:30:42,160
Speaker 1: you're not addressing this neurological effect that PCOS has these

485
00:30:42,200 --> 00:30:47,160
Speaker 1: poor patients. I mean my heart aches. That's why I

486
00:30:47,240 --> 00:30:49,600
Speaker 1: take time out of my office to come and sit

487
00:30:49,640 --> 00:30:52,920
Speaker 1: with you here on a busy day, because I want

488
00:30:52,960 --> 00:30:58,160
Speaker 1: to scream. I want to scream in this mic and say, doctors,

489
00:30:58,320 --> 00:31:04,160
Speaker 1: healthcare providers, listen to your patients. But unfortunately, our healthcare

490
00:31:04,240 --> 00:31:08,480
Speaker 1: system is not built to listen to women. People still say.

491
00:31:08,520 --> 00:31:11,280
Speaker 1: Doctors are still telling these patients, you don't have a

492
00:31:11,320 --> 00:31:14,480
Speaker 1: high testosterone in the blood, so you don't have PCOS.

493
00:31:14,880 --> 00:31:19,440
Speaker 1: That's not true. You don't have irregular periods, you don't

494
00:31:19,480 --> 00:31:22,400
Speaker 1: have PCOS, that's not true. You don't have cysts on

495
00:31:22,440 --> 00:31:26,040
Speaker 1: your ovaries, so you don't have PCOS. But I want

496
00:31:26,400 --> 00:31:30,200
Speaker 1: I come today to tell you, especially for women listening

497
00:31:30,200 --> 00:31:35,080
Speaker 1: to your podcast with anxiety, with depression, with eating disorders,

498
00:31:35,120 --> 00:31:38,840
Speaker 1: with a lack of motivation, with a hard time getting

499
00:31:38,880 --> 00:31:44,280
Speaker 1: themselves to this beautiful calm, that you can get yourself too.

500
00:31:45,040 --> 00:31:49,320
Speaker 1: You know, it's because their body is on fire, their

501
00:31:49,400 --> 00:31:53,920
Speaker 1: brain is on fire, their hormones are raging, their androgens

502
00:31:54,000 --> 00:31:59,920
Speaker 1: are out of control, and their inflammation and inflammatory mark

503
00:32:00,200 --> 00:32:03,400
Speaker 1: are off the chart, and someone needs to go to

504
00:32:03,520 --> 00:32:06,440
Speaker 1: their rescue. Someone needs to start listening to that.

505
00:32:06,600 --> 00:32:09,200
Speaker 2: Yeah, it's so hard to hear that so many people

506
00:32:09,280 --> 00:32:11,880
Speaker 2: have sadly been given the wrong advice and people are

507
00:32:11,920 --> 00:32:14,920
Speaker 2: struggling and suffering, and is there a checkup that you

508
00:32:14,960 --> 00:32:17,160
Speaker 2: can do to get diagnosed or is it just diagnosed

509
00:32:17,160 --> 00:32:19,959
Speaker 2: based on symptoms? Like is there an actual way of

510
00:32:20,040 --> 00:32:20,880
Speaker 2: knowing and checking?

511
00:32:21,080 --> 00:32:24,760
Speaker 1: Thank you for this question. So I because of years

512
00:32:24,760 --> 00:32:28,840
Speaker 1: of doing this, I actually created a free calculator free

513
00:32:29,840 --> 00:32:34,760
Speaker 1: It's on ovovii dot com Go answer. I ask questions

514
00:32:34,760 --> 00:32:38,840
Speaker 1: that I ask my patients in my office, and with

515
00:32:38,920 --> 00:32:44,400
Speaker 1: a very smart scientist, I figured out an algorithm. Obviously

516
00:32:44,480 --> 00:32:48,560
Speaker 1: I cannot diagnose online, but I can tell patients with

517
00:32:49,280 --> 00:32:54,160
Speaker 1: very high accuracy if they have the likelihood of having PCOS,

518
00:32:54,640 --> 00:32:58,280
Speaker 1: and this calculator does that for them. So if they

519
00:32:58,320 --> 00:33:02,600
Speaker 1: go on ovii dot com answer these questions for free,

520
00:33:02,920 --> 00:33:05,680
Speaker 1: I can tell them whether or not they have pcos.

521
00:33:05,920 --> 00:33:09,160
Speaker 1: And if they have PCOS, I want them to listen

522
00:33:09,200 --> 00:33:13,240
Speaker 1: to this podcast to you know, I created CMD just

523
00:33:13,360 --> 00:33:18,040
Speaker 1: to give women this information because until you make them

524
00:33:18,080 --> 00:33:20,920
Speaker 1: become their own health advocate, they will get dismissed in

525
00:33:20,920 --> 00:33:24,600
Speaker 1: the healthcare system. So by listening to these podcasts, they

526
00:33:24,680 --> 00:33:28,520
Speaker 1: become their own health advocate so they can fight further symptoms.

527
00:33:28,560 --> 00:33:31,800
Speaker 1: For when they go to that obgy and visit, they

528
00:33:32,040 --> 00:33:35,760
Speaker 1: are ready. They've taken they've listened to this podcast, they

529
00:33:35,800 --> 00:33:38,800
Speaker 1: already know they probably have pcos, they go take the

530
00:33:38,840 --> 00:33:42,560
Speaker 1: OV tests. They know, you know, based on the OV

531
00:33:42,680 --> 00:33:45,960
Speaker 1: tests whether or not they have the likelihood of having pcos.

532
00:33:46,360 --> 00:33:49,240
Speaker 1: And if they listen to my podcast, I literally give

533
00:33:49,320 --> 00:33:52,800
Speaker 1: them the bullet points. They can print it out, take

534
00:33:52,840 --> 00:33:57,320
Speaker 1: it to the doctor, and become their own health advocate. Honestly,

535
00:33:58,040 --> 00:34:01,560
Speaker 1: until we have a bet our healthcare system and we

536
00:34:01,760 --> 00:34:05,360
Speaker 1: educate our doctors not to dismiss women, this is what

537
00:34:05,400 --> 00:34:09,160
Speaker 1: we have for now, making women become their own health advocate.

538
00:34:09,239 --> 00:34:12,560
Speaker 2: Yeah. That's a real masterclass on pcos that I think

539
00:34:12,640 --> 00:34:15,279
Speaker 2: is going to help so many people figure it out quickly.

540
00:34:15,360 --> 00:34:18,200
Speaker 2: And I like those steps of being able to understand

541
00:34:18,239 --> 00:34:20,200
Speaker 2: it whether you have it yourself, being able to do

542
00:34:20,280 --> 00:34:22,319
Speaker 2: the test, and then going to your doctor and being

543
00:34:22,320 --> 00:34:24,480
Speaker 2: able to list all the symptoms and have an educated

544
00:34:24,480 --> 00:34:28,000
Speaker 2: conversation seems like an important step absolutely.

545
00:34:28,120 --> 00:34:30,600
Speaker 1: And you know, to this day, I get patients they're like,

546
00:34:30,760 --> 00:34:32,440
Speaker 1: you know, I listened to your podcast. I went to

547
00:34:32,440 --> 00:34:35,120
Speaker 1: my doctor and I said, I have insulin resistance. You

548
00:34:35,160 --> 00:34:38,319
Speaker 1: need to give me met forman And the doctor says, well,

549
00:34:38,360 --> 00:34:41,319
Speaker 1: you're not diabetic. Met formulis for diabetes. Do you know

550
00:34:41,360 --> 00:34:45,400
Speaker 1: what I'm saying? But that's why these podcasts are so important.

551
00:34:45,680 --> 00:34:48,200
Speaker 1: So what I'm trying to tell to your listener is,

552
00:34:48,640 --> 00:34:51,200
Speaker 1: listen to this podcast. You don't need a doctor to

553
00:34:51,239 --> 00:34:54,520
Speaker 1: diagnose you. If you meet two of the three criteria

554
00:34:54,560 --> 00:34:58,400
Speaker 1: that I listed at the beginning, you know you have PCOS. Right,

555
00:34:59,200 --> 00:35:02,239
Speaker 1: learn about it. Learn about all these pillars that I'm

556
00:35:02,239 --> 00:35:04,719
Speaker 1: telling you. I'm literally giving you the tools of what

557
00:35:04,760 --> 00:35:11,080
Speaker 1: you can do at home with diet, with exercise, supplements,

558
00:35:12,120 --> 00:35:17,279
Speaker 1: with lifestyle changes to you know, help yourself, and then

559
00:35:17,520 --> 00:35:20,120
Speaker 1: you can address all these things. You know, sometimes I

560
00:35:20,160 --> 00:35:22,759
Speaker 1: start my patients on the supplement and they come back

561
00:35:22,800 --> 00:35:26,480
Speaker 1: and they're like, doctor, this month, my PMS symptoms were better,

562
00:35:26,960 --> 00:35:30,359
Speaker 1: but they can't figure out why. Why. Because when you

563
00:35:30,400 --> 00:35:36,160
Speaker 1: address that metabolic health issue at its core, the puzzle

564
00:35:36,239 --> 00:35:40,360
Speaker 1: falls into place, The inflammation falls into place, the brain

565
00:35:40,440 --> 00:35:44,640
Speaker 1: health falls into place, the periods, the hormones, everything starts working.

566
00:35:44,960 --> 00:35:48,880
Speaker 2: Let's talk about endometriosis. My first question was around do

567
00:35:49,040 --> 00:35:51,880
Speaker 2: periods have to be painful? Should they be painful?

568
00:35:52,040 --> 00:35:55,919
Speaker 1: No? So painful periods are not normal? So what does

569
00:35:55,960 --> 00:36:00,279
Speaker 1: that mean? It's okay to have cramps? You know, we

570
00:36:00,360 --> 00:36:02,799
Speaker 1: all have cramps. You take a couple of advils, it

571
00:36:02,800 --> 00:36:05,040
Speaker 1: gets better. It doesn't disrupt your life. You don't end

572
00:36:05,080 --> 00:36:07,120
Speaker 1: up in the emergency room. You're not in the urgent care.

573
00:36:07,160 --> 00:36:09,560
Speaker 1: You're not calling your mom to pick you up from school.

574
00:36:09,560 --> 00:36:13,760
Speaker 1: You're not on the bathroom floor vomiting from pain. That's normal.

575
00:36:14,320 --> 00:36:19,040
Speaker 1: But if it starts disrupting your life, then it's not normal.

576
00:36:19,400 --> 00:36:21,560
Speaker 1: If I could print a T shirt that said painful

577
00:36:21,600 --> 00:36:26,440
Speaker 1: periods are not normal, I would do it because to

578
00:36:26,520 --> 00:36:31,120
Speaker 1: this day, unfortunately in our healthcare system, women are told

579
00:36:31,360 --> 00:36:35,520
Speaker 1: that painful periods normal, that it's in their head, that

580
00:36:35,560 --> 00:36:39,920
Speaker 1: they're being dramatic. None of it is true. So if

581
00:36:40,200 --> 00:36:44,880
Speaker 1: moms are listening, if women who are listening are experiencing

582
00:36:45,239 --> 00:36:50,920
Speaker 1: severely painful period that disrupts their life. If they cannot

583
00:36:50,960 --> 00:36:53,960
Speaker 1: have sex, and when they have sex with deep penetration,

584
00:36:54,120 --> 00:36:58,600
Speaker 1: they're having pain. If they have recurrent bladder symptoms, they

585
00:36:58,640 --> 00:37:01,160
Speaker 1: go to the doctor, their urine culture is negative, but

586
00:37:01,200 --> 00:37:05,399
Speaker 1: they keep having bladder symptoms. Burning with your nation. If

587
00:37:05,440 --> 00:37:09,919
Speaker 1: they have painful bowel movements, if they have chronic pelvic pain,

588
00:37:10,320 --> 00:37:15,080
Speaker 1: if they have chronic bloating and they chronically feel inflame,

589
00:37:15,520 --> 00:37:21,480
Speaker 1: that's enemy triosis until proven otherwise, endometriosis with PCOS together,

590
00:37:21,640 --> 00:37:26,680
Speaker 1: they're the leading cause of infertility on this planet. Can

591
00:37:26,719 --> 00:37:30,600
Speaker 1: you imagine, and majority of these women are not being diagnosed.

592
00:37:30,560 --> 00:37:32,360
Speaker 2: So you find endometriosis for me.

593
00:37:32,800 --> 00:37:39,760
Speaker 1: So endometriosis is a chronic inflammatory and neural immune condition

594
00:37:40,000 --> 00:37:44,040
Speaker 1: that affects ten to twenty percent of women on the planet.

595
00:37:44,360 --> 00:37:47,480
Speaker 1: Close your eyes and think of these women, right, so

596
00:37:47,560 --> 00:37:51,839
Speaker 1: you know someone is the point, absolutely single one of us.

597
00:37:51,960 --> 00:37:57,959
Speaker 1: Have someone right with enemytriosis. And basically endometriosis is when

598
00:37:58,239 --> 00:38:01,520
Speaker 1: tissues similar to the lightning of the uterus is outside

599
00:38:01,560 --> 00:38:04,720
Speaker 1: of the uterus, around the tubes, ovaries, on the bladder,

600
00:38:04,800 --> 00:38:08,799
Speaker 1: on the bough, on our diaphragm, and in a very

601
00:38:08,840 --> 00:38:11,000
Speaker 1: in rare cases you can find it in the lungs,

602
00:38:11,000 --> 00:38:14,359
Speaker 1: in the brain. And what happens if you think of

603
00:38:14,400 --> 00:38:17,440
Speaker 1: the menstrual cycle. Every month, our ovaries are trying to

604
00:38:17,440 --> 00:38:19,800
Speaker 1: get us pregnant, so they secrete estrogen to get the

605
00:38:19,880 --> 00:38:23,319
Speaker 1: lining of the uterus ready for pregnancy. And when we

606
00:38:23,360 --> 00:38:25,080
Speaker 1: don't get pregnant at the end of the month, the

607
00:38:25,120 --> 00:38:28,520
Speaker 1: lining comes out well. Once a month. When these ovaries

608
00:38:28,520 --> 00:38:34,319
Speaker 1: are secreting estrogen, these endometriosis implants also get stimulated, and

609
00:38:34,400 --> 00:38:37,520
Speaker 1: as they get stimulated, when we don't get pregnant and

610
00:38:37,560 --> 00:38:40,719
Speaker 1: the lining breaks down, these guys also break down, but

611
00:38:40,760 --> 00:38:43,360
Speaker 1: they break down and bleed outside of the uterus. Blood

612
00:38:43,400 --> 00:38:47,560
Speaker 1: is an irritant and it causes inflammation, bloating, pain, scar

613
00:38:47,640 --> 00:38:53,400
Speaker 1: tissue adhesions. What's interesting about enemytriosis is there are so

614
00:38:53,520 --> 00:38:57,200
Speaker 1: many theories of why so many women have it right,

615
00:38:57,760 --> 00:39:00,120
Speaker 1: and one of the main theories is that when when

616
00:39:00,160 --> 00:39:05,760
Speaker 1: we get our menstrual cycle, as we're bleeding, the blood

617
00:39:05,800 --> 00:39:09,080
Speaker 1: that's shedding, the lining that's breaking, some of those cells

618
00:39:09,360 --> 00:39:13,799
Speaker 1: come from the endometrial cavity into the tubes, out the

619
00:39:13,840 --> 00:39:17,960
Speaker 1: tubes and they implant into the pelvis. In a normal

620
00:39:18,520 --> 00:39:22,520
Speaker 1: immune system, our immune system attacks those cells and clear

621
00:39:22,560 --> 00:39:27,160
Speaker 1: it out. Patients with endometriosis, their immune system is not

622
00:39:27,280 --> 00:39:31,480
Speaker 1: functioning well, so when these cells retrograde, flow from the

623
00:39:31,680 --> 00:39:35,560
Speaker 1: uterine cavity out inside the tube and implant into the pelvis,

624
00:39:36,080 --> 00:39:39,120
Speaker 1: their immune system, instead of getting rid of these cells,

625
00:39:39,480 --> 00:39:43,080
Speaker 1: actually help these cells stick to the walls of the pelvis,

626
00:39:43,800 --> 00:39:47,839
Speaker 1: and once they stick there and there's inflammation around them,

627
00:39:48,239 --> 00:39:53,160
Speaker 1: it's literally like a horror movie. They start grabbing onto

628
00:39:53,360 --> 00:39:58,359
Speaker 1: vessels and they grow nerve fibers, and these nerve fibers

629
00:39:58,480 --> 00:40:02,720
Speaker 1: start causing these pain and depending on where this nerve

630
00:40:02,760 --> 00:40:05,600
Speaker 1: fiber is, it can cause different kind of pains. It

631
00:40:05,600 --> 00:40:10,680
Speaker 1: can cause bladder pain, bow movement pain, sciatic pain, back pain,

632
00:40:10,880 --> 00:40:15,839
Speaker 1: leg pain, pelvic pain. So but the worst part of

633
00:40:15,880 --> 00:40:20,880
Speaker 1: this Eventually, as these nerve fibers start firing and firing

634
00:40:20,960 --> 00:40:27,080
Speaker 1: and firing, our central nervous system becomes sensitized. So what

635
00:40:27,320 --> 00:40:32,520
Speaker 1: happens is their brain starts basically cranking up the volume

636
00:40:32,760 --> 00:40:37,920
Speaker 1: on these pain fibers, so they start experiencing more and

637
00:40:38,040 --> 00:40:42,160
Speaker 1: more and more severe pain. So that's why it's not

638
00:40:42,440 --> 00:40:47,320
Speaker 1: only you know, a pelvic pain issue, a fertility issue,

639
00:40:47,760 --> 00:40:51,680
Speaker 1: a pain issue, but it's a central nervous system issue.

640
00:40:52,080 --> 00:40:56,280
Speaker 1: And chronically, because it takes doctors nine to eleven years

641
00:40:56,280 --> 00:40:59,960
Speaker 1: to diagnose these women, and because majority of these women

642
00:41:00,080 --> 00:41:06,279
Speaker 1: men go undiagnosed, this chronic pain, this chronic inflammation that

643
00:41:06,400 --> 00:41:12,480
Speaker 1: comes from these inflammatory tissue in the pelvis, starts affecting

644
00:41:12,520 --> 00:41:18,440
Speaker 1: their central nervous system. They start becoming anxious, brain fog depression,

645
00:41:19,160 --> 00:41:26,360
Speaker 1: their amygdala, their limbic system is literally on fire twenty

646
00:41:26,440 --> 00:41:29,880
Speaker 1: four to seven to a point that they become so

647
00:41:30,320 --> 00:41:36,440
Speaker 1: fearful and so anxious of these periods, and because doctors

648
00:41:36,440 --> 00:41:39,680
Speaker 1: are not addressing it, what do they do. They start

649
00:41:39,760 --> 00:41:45,279
Speaker 1: taking pain pills, They become addicted to these narcotics. They

650
00:41:45,360 --> 00:41:48,360
Speaker 1: start second guessing themselves because they keep going to the

651
00:41:48,400 --> 00:41:51,720
Speaker 1: doctor saying, I have painful periods, I don't feel well,

652
00:41:52,040 --> 00:41:54,880
Speaker 1: and the doctor says, there's nothing wrong with you, that

653
00:41:55,000 --> 00:41:58,200
Speaker 1: it's in your head, that you're anxious, that you're crazy,

654
00:41:58,280 --> 00:42:01,160
Speaker 1: that you probably need to see a psychist. Do you

655
00:42:01,360 --> 00:42:03,000
Speaker 1: understand what I'm telling you?

656
00:42:03,080 --> 00:42:07,000
Speaker 2: Yeah, it's I mean, it's it's shocking and traumatic.

657
00:42:07,160 --> 00:42:10,600
Speaker 1: That's why they have PTSD. That's why they end up

658
00:42:11,040 --> 00:42:14,680
Speaker 1: in therapy. That's why they end up getting ketymine treatment.

659
00:42:15,200 --> 00:42:20,280
Speaker 1: That's why they end up using MDMA psilocybin, because doctors

660
00:42:20,280 --> 00:42:25,919
Speaker 1: are not addressing this and they literally feel crazy. Can

661
00:42:25,960 --> 00:42:29,279
Speaker 1: I tell you on Fridays I operate, majority of the

662
00:42:29,320 --> 00:42:32,200
Speaker 1: patients I operate on are enemytriosis. I mean, I have

663
00:42:32,400 --> 00:42:36,439
Speaker 1: endo endo endo. It's a lineup of enemeytriosis patients. Will

664
00:42:36,440 --> 00:42:40,080
Speaker 1: you believe me if I told you that every single

665
00:42:40,680 --> 00:42:44,680
Speaker 1: patient when I diagnose them in my clinic with endometriosis,

666
00:42:44,920 --> 00:42:47,360
Speaker 1: or when I wake them up from surgery and I

667
00:42:47,480 --> 00:42:50,719
Speaker 1: tell them the stage of their endometriosis. The first thing

668
00:42:50,760 --> 00:42:53,440
Speaker 1: they do, they cry and they say, I feel validated.

669
00:42:53,920 --> 00:42:57,920
Speaker 1: The problem with enemy triosis is the same doctors who

670
00:42:57,960 --> 00:43:01,520
Speaker 1: are dismissing these patients are telling these patients that the

671
00:43:01,560 --> 00:43:05,839
Speaker 1: only way to diagnose enemy triosis is surgery. That's an

672
00:43:05,960 --> 00:43:11,520
Speaker 1: old school way of thinking about enemytriosis. I'm here to

673
00:43:11,719 --> 00:43:16,520
Speaker 1: let your listeners know that endometriosis is a clinical diagnosis,

674
00:43:16,840 --> 00:43:20,959
Speaker 1: and yes, the patient can self diagnose at home. If

675
00:43:21,040 --> 00:43:26,640
Speaker 1: you have debilitating pain with your periods, that's disrupting your life.

676
00:43:26,960 --> 00:43:30,720
Speaker 1: You're missing school, you're not going to work, you're changing

677
00:43:30,760 --> 00:43:35,000
Speaker 1: your social calendar. You plan your trips around your periods,

678
00:43:35,360 --> 00:43:39,400
Speaker 1: that's endometriosis until proven otherwise. If you have painful uh

679
00:43:40,080 --> 00:43:43,719
Speaker 1: sex with deep penetration, if you can't have sex, that's

680
00:43:43,840 --> 00:43:48,600
Speaker 1: endometriosis until proven otherwise. If you have chronic inflammation, BOUD

681
00:43:48,680 --> 00:43:53,239
Speaker 1: movement with pain, your bladder pain, these are all telltale

682
00:43:53,280 --> 00:43:57,440
Speaker 1: signs of endemetriosis. And all we need to do is

683
00:43:57,440 --> 00:44:02,080
Speaker 1: our healthcare providers to start listening to these patients. You

684
00:44:02,200 --> 00:44:06,640
Speaker 1: need to listen for five minutes to diagnose endometriosis with

685
00:44:07,280 --> 00:44:14,120
Speaker 1: over ninety percent accuracy. Surgery is not to diagnose. Surgery

686
00:44:14,360 --> 00:44:21,560
Speaker 1: is to treat only if hormonal suppression fails. Why endometriosis implants?

687
00:44:21,719 --> 00:44:26,160
Speaker 1: These tissues in the pelvis are highly inflammatory, and what

688
00:44:26,280 --> 00:44:30,640
Speaker 1: they do. They're estrogen dependent, but they don't depend on

689
00:44:30,760 --> 00:44:35,960
Speaker 1: the estrogen from the ovary. That inflammation actually stimulates this

690
00:44:36,640 --> 00:44:41,799
Speaker 1: enzyme aromatase in the tissue that starts producing estrogen. So

691
00:44:41,880 --> 00:44:45,359
Speaker 1: they become self sufficient. They make their own estrogen, They

692
00:44:45,400 --> 00:44:48,760
Speaker 1: cause their own inflammation, They have their own blood vessel,

693
00:44:49,000 --> 00:44:52,720
Speaker 1: and they have their own nerve fibers that's constantly firing

694
00:44:53,120 --> 00:44:57,759
Speaker 1: and until this central nervous system becomes sensitized. So what

695
00:44:57,920 --> 00:45:01,879
Speaker 1: happens to these implants. They love estrogen, so you don't

696
00:45:01,920 --> 00:45:06,160
Speaker 1: want to give it estrogen, and they become very progesterone resistant.

697
00:45:06,840 --> 00:45:10,680
Speaker 1: So one of the ways to treat them hormonally is

698
00:45:10,719 --> 00:45:14,280
Speaker 1: to either give them progesterone or take the estrogen away.

699
00:45:14,840 --> 00:45:18,680
Speaker 1: How do you give these implants progesterone? Progesterone birth control pails,

700
00:45:18,960 --> 00:45:23,960
Speaker 1: progesterone IUDs, Kylina morena like letta, they're different forms of

701
00:45:23,960 --> 00:45:29,799
Speaker 1: progesterone IUDs work amazingly well for these patients. However, sometimes

702
00:45:29,840 --> 00:45:33,759
Speaker 1: patients with the progesterone IUDs are still having pain. Why

703
00:45:33,840 --> 00:45:37,880
Speaker 1: because these implants are progesterone resistant. So if you start

704
00:45:37,880 --> 00:45:41,760
Speaker 1: with a progesterone birth control progesterone IUD and you're still

705
00:45:41,800 --> 00:45:47,759
Speaker 1: having pain, you can actually take medications that are GnRH

706
00:45:47,840 --> 00:45:52,360
Speaker 1: agonists or antagonists. These are medications like or Lyssa my

707
00:45:52,600 --> 00:45:57,280
Speaker 1: femor that. What they do they actually take that estrogen away,

708
00:45:57,680 --> 00:46:01,160
Speaker 1: and by taking that estrogen away, they calm down these

709
00:46:01,280 --> 00:46:05,399
Speaker 1: endometriosis implants. The problem with this group of medications are

710
00:46:05,800 --> 00:46:09,080
Speaker 1: because they take the estrogen away, they can cause hot flashes,

711
00:46:09,560 --> 00:46:12,760
Speaker 1: night sweats, mood changes, and these patients are already anxious

712
00:46:12,800 --> 00:46:16,120
Speaker 1: and depressed, so sometimes they don't tolerate it well. But

713
00:46:16,360 --> 00:46:22,800
Speaker 1: if all fails, then you do laparoscopic surgery to resect endometriosis.

714
00:46:23,520 --> 00:46:28,000
Speaker 1: But here's the problem with laparoscopic surgery. I honestly can

715
00:46:28,080 --> 00:46:31,240
Speaker 1: sit here and tell you that less than one percent

716
00:46:32,120 --> 00:46:37,440
Speaker 1: of GYNs can operate on endometriosis with advanced disease.

717
00:46:37,800 --> 00:46:40,440
Speaker 2: And what comes as an advanced disease how long.

718
00:46:40,360 --> 00:46:45,600
Speaker 1: In deep infiltrated implants in vowel in bladder. You know,

719
00:46:45,719 --> 00:46:49,000
Speaker 1: endometriosis causes a lot of adhesions, so you have to

720
00:46:49,000 --> 00:46:50,920
Speaker 1: be able to know to operate on that.

721
00:46:51,200 --> 00:46:54,240
Speaker 2: So you're saying there's no cure, it's more hormonal balance.

722
00:46:54,440 --> 00:46:57,640
Speaker 1: Hormonal balance and surgery makes a huge difference. It's still

723
00:46:57,719 --> 00:47:01,520
Speaker 1: gold standard to treat these patients, but because these patients

724
00:47:01,560 --> 00:47:06,960
Speaker 1: don't have access to surgeons who are familiar with endometriosis surgery,

725
00:47:07,760 --> 00:47:11,680
Speaker 1: it's always best to start with hormonal suppression first. And

726
00:47:11,880 --> 00:47:15,640
Speaker 1: if they need surgery and they still having painful sex,

727
00:47:15,680 --> 00:47:19,040
Speaker 1: and they still have experiencing pain with their periods, then

728
00:47:19,160 --> 00:47:22,760
Speaker 1: I would recommend searching for an endometriosis surgeon.

729
00:47:22,920 --> 00:47:25,920
Speaker 2: How long does the hormonal suppression take like that at

730
00:47:26,000 --> 00:47:27,120
Speaker 2: least four months?

731
00:47:27,440 --> 00:47:29,759
Speaker 1: At least four months, Because your body is not a

732
00:47:29,800 --> 00:47:32,200
Speaker 1: light switch, you can't say on off, on off.

733
00:47:48,800 --> 00:47:51,840
Speaker 2: Have you seen success with people coming to you and

734
00:47:51,880 --> 00:47:55,480
Speaker 2: taking your advice? Are you seeing people cure and recover

735
00:47:55,960 --> 00:47:58,120
Speaker 2: and feel completely different or is it more that you're

736
00:47:58,560 --> 00:48:01,120
Speaker 2: that people are just managing there's no cure.

737
00:48:01,600 --> 00:48:05,880
Speaker 1: But in my practice, it's extremely rare for me to

738
00:48:05,960 --> 00:48:09,120
Speaker 1: have a patient with chronic pain. I fix everyone. I

739
00:48:09,239 --> 00:48:14,160
Speaker 1: always start with hormonal suppression if that fails, or if

740
00:48:14,200 --> 00:48:17,560
Speaker 1: they're actively trying for pregnancy and they can't get pregnant,

741
00:48:17,840 --> 00:48:23,040
Speaker 1: then I do laparoscopic surgery. Here the points with laparoscopic

742
00:48:23,120 --> 00:48:28,279
Speaker 1: surgery A you need a laparoscopic surgeon who's done endometriosis surgery. B.

743
00:48:28,840 --> 00:48:34,560
Speaker 1: In my opinion, if you give hundred gynecologists hundred laparoscopes

744
00:48:34,680 --> 00:48:38,319
Speaker 1: and say go operate, half of them will wake the

745
00:48:38,400 --> 00:48:41,120
Speaker 1: patient up and say, you didn't have nymetriosis.

746
00:48:41,440 --> 00:48:42,880
Speaker 2: Wow, how's that PoCA?

747
00:48:43,640 --> 00:48:45,480
Speaker 1: I know. I swear to God, I want to cry

748
00:48:45,520 --> 00:48:48,080
Speaker 1: when I talk about these things because I see these

749
00:48:48,080 --> 00:48:52,520
Speaker 1: patients in my office. Why Because endometriosis implants can be

750
00:48:53,200 --> 00:48:56,840
Speaker 1: glandular where they're purple. You know, there are these purple

751
00:48:56,880 --> 00:48:59,640
Speaker 1: spots in the pelvis. You have to look for them

752
00:48:59,640 --> 00:49:02,360
Speaker 1: to find them. You can't quickly scan the pelvis and

753
00:49:02,400 --> 00:49:05,040
Speaker 1: say it's not there. Sometimes it takes me ten minutes

754
00:49:05,080 --> 00:49:09,480
Speaker 1: to find them. They're tiny, but they're very inflammatory and painful,

755
00:49:09,840 --> 00:49:11,880
Speaker 1: so you have to be patient. You have to know

756
00:49:11,920 --> 00:49:15,240
Speaker 1: what they look like. But there's a type of endometriosis

757
00:49:15,360 --> 00:49:19,720
Speaker 1: that stromo endometriosis from the stroma of the connective tissue

758
00:49:19,760 --> 00:49:23,640
Speaker 1: around the gland. These when you look for them, don't

759
00:49:23,680 --> 00:49:28,560
Speaker 1: have that typical purple spot. They're just these fine white lines.

760
00:49:29,280 --> 00:49:33,960
Speaker 1: In my opinion, these stromo endometriosis implants are more inflammatory

761
00:49:34,320 --> 00:49:39,600
Speaker 1: and more painful and have more debilitating pain. But ninety

762
00:49:39,760 --> 00:49:42,920
Speaker 1: percent of the time they get mis during laparoscope. So

763
00:49:42,960 --> 00:49:47,360
Speaker 1: these are patients that already people are telling them they're crazy.

764
00:49:47,440 --> 00:49:50,000
Speaker 1: It's that painful periods are normal, that it's in their head.

765
00:49:50,440 --> 00:49:55,759
Speaker 1: They on average see ten doctors. Average age of diagnosis

766
00:49:55,800 --> 00:49:59,680
Speaker 1: is thirty two nine to eleven years. They wait to

767
00:50:00,040 --> 00:50:03,560
Speaker 1: finally for someone to say you might have endometriosis, and

768
00:50:03,600 --> 00:50:05,680
Speaker 1: then they take them to surgery, wake them up and

769
00:50:05,719 --> 00:50:06,759
Speaker 1: say you didn't have it.

770
00:50:06,760 --> 00:50:07,360
Speaker 2: It's crazy.

771
00:50:07,480 --> 00:50:10,960
Speaker 1: Talk about gas lighting, it's crazy. Put yourself in that

772
00:50:11,120 --> 00:50:15,640
Speaker 1: girl's shoes. And to make the matters worse. In my opinion,

773
00:50:16,200 --> 00:50:20,160
Speaker 1: more than fifty percent of PCOS patients have endometriosis.

774
00:50:20,400 --> 00:50:23,040
Speaker 2: So what's the cost of ignoring this? Like if someone's

775
00:50:23,040 --> 00:50:24,719
Speaker 2: listening right now and they've been kind of feeling all

776
00:50:24,760 --> 00:50:26,799
Speaker 2: this but you kind of just let it go, what's

777
00:50:26,840 --> 00:50:29,480
Speaker 2: the cost every year of not diagnosing.

778
00:50:29,840 --> 00:50:36,480
Speaker 1: The most devastating part for endometriosis is fertility because endometriosis

779
00:50:36,640 --> 00:50:41,240
Speaker 1: is a highly inflammatory condition and it destroys the account

780
00:50:41,280 --> 00:50:45,680
Speaker 1: in quality. I set it on Huberman podcast that I

781
00:50:45,719 --> 00:50:48,120
Speaker 1: have a fourteen year old with an account of a

782
00:50:48,160 --> 00:50:51,920
Speaker 1: forty year old, and yes, I do check account in

783
00:50:52,000 --> 00:50:56,040
Speaker 1: a fourteen year old with debilitating pain. It's whenever. I'm

784
00:50:56,080 --> 00:50:59,160
Speaker 1: not saying every single girl on this planet at fourteen

785
00:50:59,239 --> 00:51:02,840
Speaker 1: needs to know her account. But I think until doctors

786
00:51:02,840 --> 00:51:07,640
Speaker 1: start diagnosing endometriosis, we need to have a baseline account

787
00:51:07,680 --> 00:51:12,160
Speaker 1: at eighteen. I absolutely fight for that every single day.

788
00:51:12,840 --> 00:51:16,600
Speaker 1: I every single day in my practice, I see someone

789
00:51:16,640 --> 00:51:19,920
Speaker 1: in her twenties or thirties ready for pregnancy with an

790
00:51:20,000 --> 00:51:25,600
Speaker 1: account of zero because of years of pain, dismissed by

791
00:51:25,600 --> 00:51:29,280
Speaker 1: the healthcare system. So no, I would so to answer

792
00:51:29,360 --> 00:51:33,440
Speaker 1: your question, fertility is the biggest price they pay. So

793
00:51:33,640 --> 00:51:40,000
Speaker 1: if you have painful, debilitating periods, absolutely check your account.

794
00:51:40,040 --> 00:51:44,840
Speaker 1: It's a simple black test. It's called AMH. AMH tells

795
00:51:44,960 --> 00:51:49,080
Speaker 1: us about the ovarian reserve. A low AMH doesn't mean

796
00:51:49,080 --> 00:51:51,959
Speaker 1: you're not going to have a baby. A LOWIMH means

797
00:51:52,000 --> 00:51:55,399
Speaker 1: your reserve is down. Be careful. So if you can

798
00:51:55,480 --> 00:51:59,880
Speaker 1: afford eg freezing freeze early. That's why you know, I

799
00:52:00,120 --> 00:52:03,640
Speaker 1: wish egg freezing was free. I wish you know it

800
00:52:03,719 --> 00:52:06,799
Speaker 1: wasn't this expensive. I always say, when you're young and

801
00:52:06,840 --> 00:52:09,719
Speaker 1: your eggs are healthy and you want to freeze them,

802
00:52:09,760 --> 00:52:11,719
Speaker 1: you don't have the money. When you're old and your

803
00:52:11,760 --> 00:52:14,120
Speaker 1: account is down and the qualities down, that's when you

804
00:52:14,160 --> 00:52:17,960
Speaker 1: have money to freeze eggs. To the endometriosis patients, I say,

805
00:52:18,200 --> 00:52:22,040
Speaker 1: check your account absolutely, if your account is low and

806
00:52:22,040 --> 00:52:26,560
Speaker 1: you can afford it, freeze eggs. If your account is low,

807
00:52:26,960 --> 00:52:34,160
Speaker 1: immediately do hormonal suppression and decrease the inflammation in the pelvis.

808
00:52:34,560 --> 00:52:38,520
Speaker 1: If you can find an endometriosis surgeon with debilitating pain,

809
00:52:38,960 --> 00:52:42,719
Speaker 1: excite those endometriosis implants. By doing that, you bring down

810
00:52:42,760 --> 00:52:48,080
Speaker 1: the inflammation in the pelvis, specially patients with endometriomas. These

811
00:52:48,120 --> 00:52:51,280
Speaker 1: are chocolate saysts in the ovary. Those are the ones

812
00:52:51,360 --> 00:52:54,960
Speaker 1: at most at the highest risk of losing other agccount

813
00:52:55,040 --> 00:53:01,440
Speaker 1: and quality. So that's the biggest price they pay. Painful sex.

814
00:53:01,920 --> 00:53:04,960
Speaker 1: There's so many women who can have sex. Imagine these

815
00:53:04,960 --> 00:53:07,879
Speaker 1: are young girls who either don't get married because they

816
00:53:07,880 --> 00:53:11,399
Speaker 1: can't have a relationship because they can't have sex. So

817
00:53:11,480 --> 00:53:18,560
Speaker 1: that's debilitating chronic pain causes severe anxiety and depression and

818
00:53:18,680 --> 00:53:25,120
Speaker 1: lack of motivation. A lot of them unfortunately become addicted

819
00:53:25,160 --> 00:53:29,719
Speaker 1: to these pain meds, so these are long term side

820
00:53:29,760 --> 00:53:33,640
Speaker 1: effects of it. So it affects their mental health, their

821
00:53:33,680 --> 00:53:39,439
Speaker 1: nervous system, their inflammation in the body, their fertility. It's

822
00:53:39,480 --> 00:53:43,839
Speaker 1: just devastating. There's no words for it. I mean I

823
00:53:43,880 --> 00:53:46,399
Speaker 1: can sit here, you guys, and I mean I can

824
00:53:46,520 --> 00:53:51,200
Speaker 1: talk for another ten hours. I'm touching the tip of

825
00:53:51,239 --> 00:53:56,520
Speaker 1: the iceberg. I'm traumatized from years of seeing these patients.

826
00:53:57,160 --> 00:53:59,480
Speaker 1: I swear to God, they come to my office, they cry.

827
00:53:59,520 --> 00:54:02,840
Speaker 1: I cry them because I can't take it anymore.

828
00:54:03,800 --> 00:54:06,279
Speaker 2: I'm glad that you're able today as we're talking to

829
00:54:06,320 --> 00:54:08,719
Speaker 2: give people the help that they need I've got. I

830
00:54:08,719 --> 00:54:10,600
Speaker 2: wanted to ask you about how there's a lot of

831
00:54:10,640 --> 00:54:13,719
Speaker 2: mixed information about birth control pills and then when you're

832
00:54:13,760 --> 00:54:16,680
Speaker 2: off them, whether they block you from conceiving. What's your

833
00:54:16,719 --> 00:54:17,160
Speaker 2: take on that.

834
00:54:17,840 --> 00:54:21,440
Speaker 1: So, first of all, see I got emotional talking about

835
00:54:21,480 --> 00:54:27,040
Speaker 1: these girls. It's my trauma. Literally, their trauma is my trauma. Anyways,

836
00:54:27,239 --> 00:54:32,280
Speaker 1: I love birth control. So birth control pills for endemetriosis

837
00:54:32,360 --> 00:54:36,360
Speaker 1: patients is the difference of having children and no children

838
00:54:36,400 --> 00:54:41,600
Speaker 1: for some patients. Why so, because birth control pills, especially

839
00:54:41,600 --> 00:54:44,520
Speaker 1: if you're on progesterone only birth control pills, what they

840
00:54:44,600 --> 00:54:48,480
Speaker 1: do they suppress these implants. Remember I talked about inflammation

841
00:54:48,640 --> 00:54:51,800
Speaker 1: destroying the egg, destroying the egg quality. So by putting

842
00:54:51,800 --> 00:54:55,120
Speaker 1: these patients on these progesterone birth control pills, what you're doing,

843
00:54:55,160 --> 00:54:59,960
Speaker 1: you're bringing down the inflammation. You're hopefully suppressing these inflat

844
00:55:00,000 --> 00:55:04,919
Speaker 1: aim endometriosis tissues outside of the uterus, and by doing that,

845
00:55:05,200 --> 00:55:09,640
Speaker 1: you're preserving some of their ovarian reserve. So that's number one.

846
00:55:09,800 --> 00:55:12,600
Speaker 1: Number two. When you give these patients birth control pills

847
00:55:12,800 --> 00:55:16,760
Speaker 1: and you can or progester on IUDs, what you're doing,

848
00:55:17,000 --> 00:55:20,040
Speaker 1: you're helping their pain so they can start having sex,

849
00:55:20,239 --> 00:55:23,719
Speaker 1: they can start having relationships. So the answer to the

850
00:55:23,920 --> 00:55:26,840
Speaker 1: question of birth control pill is absolutely wrong. You know,

851
00:55:26,880 --> 00:55:31,080
Speaker 1: there are a lot of moms or grandmas who tell patients,

852
00:55:31,120 --> 00:55:34,359
Speaker 1: don't take birth control pills, you're going to be infertile. No,

853
00:55:34,760 --> 00:55:37,160
Speaker 1: you're going to be infertile if you're not taking birth

854
00:55:37,200 --> 00:55:40,120
Speaker 1: control pills. You want to be suppressed on these birth

855
00:55:40,160 --> 00:55:42,680
Speaker 1: control pills until you're ready to have children.

856
00:55:42,719 --> 00:55:43,840
Speaker 2: But then why do people struggle?

857
00:55:44,000 --> 00:55:44,239
Speaker 1: Then?

858
00:55:44,320 --> 00:55:44,920
Speaker 2: When they do that.

859
00:55:45,200 --> 00:55:49,000
Speaker 1: So one thing to remember is there are many women

860
00:55:49,320 --> 00:55:52,959
Speaker 1: who stay on birth control pills past seven years. There's

861
00:55:53,000 --> 00:55:57,080
Speaker 1: a small percentage of women when they take birth control

862
00:55:57,239 --> 00:56:03,160
Speaker 1: pills that chronically suppresses their ovulations. When they stop it,

863
00:56:03,440 --> 00:56:07,960
Speaker 1: their ovarian reserve never recovers. So for that reason, it's

864
00:56:08,040 --> 00:56:11,839
Speaker 1: important to you know, I always say, after seven years

865
00:56:11,840 --> 00:56:15,480
Speaker 1: of suppression, make sure you're checking your account, make sure

866
00:56:15,480 --> 00:56:18,759
Speaker 1: you're checking that ovarian reserve, and if it's you know,

867
00:56:19,719 --> 00:56:22,480
Speaker 1: suppressed and you've been on birth control for so many years,

868
00:56:22,800 --> 00:56:25,920
Speaker 1: stop the birth control pill. Maybe go to a progesterone

869
00:56:25,960 --> 00:56:29,960
Speaker 1: IUDA at that point. I've seen this numerous times when

870
00:56:29,960 --> 00:56:32,640
Speaker 1: patients come and they're like, my ovarian reserve is really low.

871
00:56:32,880 --> 00:56:35,000
Speaker 1: I've been on birth control pills, yes, And when you

872
00:56:35,040 --> 00:56:38,880
Speaker 1: stop their birth control pills, their ovarian reserve recovers. So

873
00:56:39,160 --> 00:56:43,520
Speaker 1: that's why I'm such a big advocate of checking doing

874
00:56:43,560 --> 00:56:47,360
Speaker 1: a pelvic ultrasound, which should be mandatory for every single

875
00:56:47,680 --> 00:56:50,600
Speaker 1: girl who's sexually active and goes for a well woman exam,

876
00:56:50,760 --> 00:56:54,680
Speaker 1: check a PUBLC ultrasound, check the foticular account, check their

877
00:56:54,680 --> 00:56:58,600
Speaker 1: ovarian reserve. If you can't just do a simple AMH

878
00:56:58,719 --> 00:57:02,400
Speaker 1: blood just to see what that reserve is, specially for

879
00:57:02,520 --> 00:57:03,880
Speaker 1: endometriosis patients.

880
00:57:04,360 --> 00:57:08,320
Speaker 2: If someone can't afford to freeze their eggs right now, yes,

881
00:57:08,560 --> 00:57:09,760
Speaker 2: what are there other options?

882
00:57:10,200 --> 00:57:15,560
Speaker 1: Suppress? Suppress, suppress suppress, Put a progesteron our udea, take

883
00:57:15,560 --> 00:57:20,680
Speaker 1: a progesterone birth control pill, take my femburi or alyssa,

884
00:57:21,240 --> 00:57:25,240
Speaker 1: go have laparoscopic surgery. But here's the problem with laparoscopic surgery.

885
00:57:25,480 --> 00:57:27,200
Speaker 1: Do you know how a patient once in my office

886
00:57:27,240 --> 00:57:29,440
Speaker 1: who came in, She's like, I'm here for my twelfth

887
00:57:29,480 --> 00:57:33,120
Speaker 1: laparoscopic surgery. Every year she checks herself in for a

888
00:57:33,160 --> 00:57:35,560
Speaker 1: laparoscopic surgery. That's madness.

889
00:57:36,040 --> 00:57:37,640
Speaker 2: You do not scar.

890
00:57:37,960 --> 00:57:40,640
Speaker 1: That's so scary and you do not need that. The

891
00:57:40,760 --> 00:57:44,120
Speaker 1: reason these patients keep having surgeries is because no one's

892
00:57:44,120 --> 00:57:48,320
Speaker 1: suppressing them. Imagine someone has colon cancer and you go

893
00:57:48,440 --> 00:57:51,560
Speaker 1: in and you resect their colon cancer. Do you ever

894
00:57:51,800 --> 00:57:55,160
Speaker 1: tell them, Okay, sir, go home, I'll see you in

895
00:57:55,200 --> 00:57:58,120
Speaker 1: six months. No, they're gonna come back in six months

896
00:57:58,160 --> 00:57:59,320
Speaker 1: with cancer everywhere.

897
00:57:59,480 --> 00:57:59,920
Speaker 2: What do you do?

898
00:58:00,120 --> 00:58:03,240
Speaker 1: You give them chemo and demetriosis is not cancer. But

899
00:58:03,320 --> 00:58:05,600
Speaker 1: that's exactly what you need to do for these patients

900
00:58:05,960 --> 00:58:09,440
Speaker 1: when you do laparoscopic surgery, and first you want to

901
00:58:09,480 --> 00:58:12,640
Speaker 1: resect all the implants. Once you do that, you want

902
00:58:12,640 --> 00:58:16,800
Speaker 1: to suppress immediately. In my case, almost every single patient

903
00:58:16,840 --> 00:58:20,120
Speaker 1: I take to surgery, unless they're actively trying for pregnancy,

904
00:58:20,400 --> 00:58:22,439
Speaker 1: I put a progester on IUD at the same time

905
00:58:22,680 --> 00:58:24,640
Speaker 1: because I want to freeze the pelvis the way I'm

906
00:58:24,720 --> 00:58:28,320
Speaker 1: leaving it. And as soon as they start having pain again,

907
00:58:28,640 --> 00:58:33,040
Speaker 1: then in addition to surgery and the IUD, if they

908
00:58:33,080 --> 00:58:37,040
Speaker 1: have more pain after surgery, if they have advanced stage,

909
00:58:37,320 --> 00:58:41,560
Speaker 1: I put them on these GnRH antagonists like or Alyssa

910
00:58:41,680 --> 00:58:45,880
Speaker 1: and my fambri to just completely kill it. That's why

911
00:58:45,920 --> 00:58:49,480
Speaker 1: my patients it's very rare for me to operate for

912
00:58:49,520 --> 00:58:52,520
Speaker 1: the second time on my patients unless they have advanced disease.

913
00:58:52,680 --> 00:58:55,080
Speaker 2: How much is all of this affecting other functions in

914
00:58:55,120 --> 00:58:57,800
Speaker 2: the body, whether it's the microbiome in the god, whether

915
00:58:57,880 --> 00:58:58,760
Speaker 2: it's oh.

916
00:58:58,520 --> 00:59:03,320
Speaker 1: Thank you for asking that. In my opinion, ninety percent

917
00:59:03,480 --> 00:59:07,960
Speaker 1: of endometriosis patients suffer from leaky gut. They have CIBO

918
00:59:08,520 --> 00:59:15,160
Speaker 1: ninety percent. What's leaky gut? Basically, you know, they get

919
00:59:15,160 --> 00:59:20,080
Speaker 1: disruption in the lining of their gut, so harmful substances

920
00:59:20,120 --> 00:59:24,280
Speaker 1: start getting absorbed. As harmful substances get absorbed, what goes

921
00:59:24,360 --> 00:59:30,040
Speaker 1: up inflammation. When inflammation goes up, it becomes a vicious cycle. Right.

922
00:59:30,120 --> 00:59:33,440
Speaker 1: They get brain fogged, they get bloated, they get tired,

923
00:59:33,560 --> 00:59:38,080
Speaker 1: they get insulin resistant if they have PCOS, and they

924
00:59:38,200 --> 00:59:41,520
Speaker 1: just feel terrible. And on top of that, they start

925
00:59:41,560 --> 00:59:45,520
Speaker 1: gaining weight. So but I always say, and these are

926
00:59:45,600 --> 00:59:49,760
Speaker 1: patients who end up having colonoscopies, having endoscopies, have seeing

927
00:59:49,800 --> 00:59:53,840
Speaker 1: GI doctors, bouncing from doctor to doctor, and no one

928
00:59:53,920 --> 00:59:57,800
Speaker 1: stops to tell them, are your periods painful? And why

929
00:59:58,400 --> 01:00:03,360
Speaker 1: unless you treat eat the underlying condition, which is endometriosis,

930
01:00:03,560 --> 01:00:06,320
Speaker 1: you cannot get rid of their the he goat. They

931
01:00:06,440 --> 01:00:10,720
Speaker 1: keep having these symptoms of bloating and fatigue and inflammation.

932
01:00:11,280 --> 01:00:14,520
Speaker 1: So what I do in my practice is, once I

933
01:00:14,640 --> 01:00:18,160
Speaker 1: operate on them and I suppress them with IUT, I

934
01:00:18,320 --> 01:00:22,360
Speaker 1: have them monitored their symptoms of bloating. And if they

935
01:00:22,400 --> 01:00:25,040
Speaker 1: come back in a month, in two months and they say, doctor,

936
01:00:25,080 --> 01:00:27,160
Speaker 1: you know what, my pain is so much better, which

937
01:00:27,200 --> 01:00:31,240
Speaker 1: is usually the case, but I'm still bloated when I eat,

938
01:00:31,720 --> 01:00:35,800
Speaker 1: then I treat their sebo. Do you understand, and that's

939
01:00:35,800 --> 01:00:40,439
Speaker 1: how it works now. Patients with advanced disease, patients who

940
01:00:40,480 --> 01:00:45,760
Speaker 1: go through years of pain and central sensitization of their

941
01:00:45,800 --> 01:00:50,880
Speaker 1: nervous system being ignored. Sometimes when you operate, when you

942
01:00:50,920 --> 01:00:55,240
Speaker 1: suppress and you treat their sebow, they still have pain,

943
01:00:55,400 --> 01:01:00,920
Speaker 1: they're still anxious, they're still depressed because they're brain is

944
01:01:01,080 --> 01:01:06,320
Speaker 1: rewired after all these years of pain. For those patients,

945
01:01:06,720 --> 01:01:10,320
Speaker 1: one thing you can do is use neural modulators like

946
01:01:10,400 --> 01:01:17,640
Speaker 1: medications like Effects or Symbalta, Gabba penton Lyrica, because once

947
01:01:17,680 --> 01:01:23,440
Speaker 1: you address their pathology, it takes sometimes time to rewire

948
01:01:23,560 --> 01:01:27,240
Speaker 1: that brain and calm their nervous system down. And you

949
01:01:27,320 --> 01:01:29,440
Speaker 1: tell them to listen to your calm by the way,

950
01:01:29,480 --> 01:01:33,960
Speaker 1: I listen to it every night. But do you understand, yes.

951
01:01:33,800 --> 01:01:35,800
Speaker 2: Yes, yes, that's helpful. Yeah, I'm glad I asked that

952
01:01:35,880 --> 01:01:39,200
Speaker 2: because I'm always yeah, I'm always intrigued as to the

953
01:01:39,240 --> 01:01:41,120
Speaker 2: side effects. And when you're trying to it fills up

954
01:01:41,120 --> 01:01:43,480
Speaker 2: with the body. Sometimes, especially with traditional medicine, you're trying

955
01:01:43,520 --> 01:01:46,440
Speaker 2: to solve one thing and you negatively kick off something else,

956
01:01:46,960 --> 01:01:49,960
Speaker 2: and there's all these things happening back and forth that

957
01:01:49,960 --> 01:01:52,120
Speaker 2: people don't usually think about because doctors are just trying

958
01:01:52,160 --> 01:01:55,320
Speaker 2: to solve one thing. And we'll talk about IVF in

959
01:01:55,320 --> 01:01:58,320
Speaker 2: a second. But I know a friend who is going

960
01:01:58,360 --> 01:02:00,680
Speaker 2: through IDF, but then something that we taking to make

961
01:02:00,720 --> 01:02:04,120
Speaker 2: that more successful triggered their autoimmune and then you know,

962
01:02:04,160 --> 01:02:05,960
Speaker 2: now you're dealing with that, and then that's effect to

963
01:02:06,000 --> 01:02:08,600
Speaker 2: So it's like I'm always just in treatis to the correlation.

964
01:02:08,760 --> 01:02:13,120
Speaker 1: Talk about that. That's so important. First of all, Number one,

965
01:02:13,400 --> 01:02:16,520
Speaker 1: like you said, every doctor is treating what they know

966
01:02:16,600 --> 01:02:20,120
Speaker 1: they're treating, right, a GI doctor is only treating the cebo.

967
01:02:20,680 --> 01:02:23,760
Speaker 1: In my opinion, every GI doctor needs to know about

968
01:02:23,840 --> 01:02:27,720
Speaker 1: nimytriosis because enemeytriosis is causing this leaky guy. So if

969
01:02:27,760 --> 01:02:30,880
Speaker 1: you're missing animeytriosis, you can never treat your cebol patient

970
01:02:31,240 --> 01:02:35,960
Speaker 1: number one. So we have to start treating patients holistically.

971
01:02:36,360 --> 01:02:41,080
Speaker 1: I'm a gynecologist. I check everything metabolically. Let's say, in

972
01:02:41,080 --> 01:02:43,920
Speaker 1: my PCOS patients, I check their A PO E, I

973
01:02:44,000 --> 01:02:46,840
Speaker 1: checked their APO B, I checked their lipoprotein little A.

974
01:02:47,000 --> 01:02:49,120
Speaker 1: I checked their hemoglobin A one CEE. I check for

975
01:02:49,240 --> 01:02:53,240
Speaker 1: pre diabetes. And I'm a gynecologist. I screen for anxiety.

976
01:02:53,280 --> 01:02:57,160
Speaker 1: I screen for depression, I check for fertility. I do

977
01:02:57,360 --> 01:03:00,880
Speaker 1: my part, and I do everybody else's part too, because

978
01:03:01,120 --> 01:03:05,080
Speaker 1: because doctors are not having this holistic approach to patient.

979
01:03:05,560 --> 01:03:09,880
Speaker 1: So that's extremely, extremely important. And the second thing I

980
01:03:09,920 --> 01:03:14,400
Speaker 1: want to talk about. You're absolutely right. Let's take endometriosis.

981
01:03:14,960 --> 01:03:20,280
Speaker 1: In endometriosis, your own immune system is attacking your own tissue, right,

982
01:03:20,600 --> 01:03:23,840
Speaker 1: So it is a form of autoimmune. When you have

983
01:03:23,960 --> 01:03:27,800
Speaker 1: one autoimmune condition, you have a thirty percent chance of

984
01:03:27,840 --> 01:03:31,440
Speaker 1: having another autoimmune condition. So in my practice, if I

985
01:03:31,520 --> 01:03:36,160
Speaker 1: see someone with endometriosis, I immediately think to myself, am

986
01:03:36,160 --> 01:03:40,920
Speaker 1: I missing lupus? Am I missing antiphospholipid syndrome, am I

987
01:03:41,080 --> 01:03:45,160
Speaker 1: missing chogrins in them? Am I missing psoriasis? And I

988
01:03:45,320 --> 01:03:49,320
Speaker 1: start asking questions and believe it or not, when they

989
01:03:49,400 --> 01:03:53,160
Speaker 1: start trying for pregnancy, if they have any other symptoms,

990
01:03:53,160 --> 01:03:55,200
Speaker 1: if they complain of a little bit of a draining pain,

991
01:03:55,680 --> 01:04:00,560
Speaker 1: a little bit of a mailer lash, any symptom of

992
01:04:00,680 --> 01:04:03,880
Speaker 1: any kind of autoimmune disorder, I do a full autoimmune

993
01:04:03,960 --> 01:04:07,120
Speaker 1: lab on them. So this friend of yours who's in

994
01:04:07,240 --> 01:04:11,840
Speaker 1: IVF right, I'm assuming this because I see this every

995
01:04:11,880 --> 01:04:15,919
Speaker 1: single day, and I've done it for decades. She might

996
01:04:16,000 --> 01:04:21,880
Speaker 1: have an endometriosis that was undiagnosed, right, So what happens

997
01:04:22,000 --> 01:04:25,800
Speaker 1: during IVF treatment they blast her with estrogen. When they

998
01:04:25,840 --> 01:04:29,480
Speaker 1: blast her with estrogen, they stimulate her endometriosis. So the

999
01:04:29,520 --> 01:04:32,480
Speaker 1: pain sometimes gets really hard for these patients during IVF.

1000
01:04:33,320 --> 01:04:37,040
Speaker 1: But because they have other they're at risk of having

1001
01:04:37,120 --> 01:04:41,680
Speaker 1: other autoimmune disorders. The IVF did not cause the autoimmune

1002
01:04:42,000 --> 01:04:46,720
Speaker 1: The IVF pushed it out, just like pregnancy pushes it out.

1003
01:04:46,920 --> 01:04:51,520
Speaker 1: But if we know that endometriosis is in autoimmune condition,

1004
01:04:52,120 --> 01:04:55,840
Speaker 1: a diagnose it correctly, don't dismiss these patients. And when

1005
01:04:55,840 --> 01:04:59,240
Speaker 1: you diagnose it, look for other autoimmune disorders. You will

1006
01:04:59,240 --> 01:05:01,520
Speaker 1: not be surprised with patients like got it here.

1007
01:05:01,640 --> 01:05:04,640
Speaker 2: Yeah, I think that's the point, right, Look, I appreciate that. Well,

1008
01:05:04,680 --> 01:05:06,760
Speaker 2: you said that, Hey, we're going to look at everything,

1009
01:05:07,040 --> 01:05:10,040
Speaker 2: and that makes sense because the body's so connected. It

1010
01:05:10,120 --> 01:05:11,920
Speaker 2: makes no sense to be like, we're going to treat

1011
01:05:11,960 --> 01:05:14,880
Speaker 2: this in a silo and hope it doesn't affect anything else,

1012
01:05:14,880 --> 01:05:17,400
Speaker 2: when of course it's going to affect your entire body

1013
01:05:17,440 --> 01:05:19,520
Speaker 2: in mind, and I feel like a lot of patients

1014
01:05:19,560 --> 01:05:22,440
Speaker 2: just get thrown around different departments going, oh, well, now

1015
01:05:22,440 --> 01:05:23,720
Speaker 2: you're going to have to sort that out, and now

1016
01:05:23,760 --> 01:05:25,280
Speaker 2: you're going to have to sort that out, and it

1017
01:05:25,360 --> 01:05:27,400
Speaker 2: doesn't add up for them, like it's a painful process

1018
01:05:27,440 --> 01:05:30,640
Speaker 2: to go through bingo. Yeah, it's terrible. And I've seen

1019
01:05:30,640 --> 01:05:33,440
Speaker 2: it happen with so many friends where they're constantly running

1020
01:05:33,440 --> 01:05:36,320
Speaker 2: around trying to solve another problem now that was triggered

1021
01:05:36,320 --> 01:05:39,120
Speaker 2: by something else they were trying to solve. I wanted

1022
01:05:39,120 --> 01:05:41,440
Speaker 2: to ask you if a woman in a mid to

1023
01:05:41,480 --> 01:05:44,480
Speaker 2: late there is wants to conceive, what should she be

1024
01:05:44,520 --> 01:05:47,680
Speaker 2: doing and thinking about if she hadn't frozen her eggs previously.

1025
01:05:47,800 --> 01:05:51,200
Speaker 1: You come to my office, you're thirty five, You show

1026
01:05:51,280 --> 01:05:53,240
Speaker 1: up to my office for a while, woman exam, I

1027
01:05:53,280 --> 01:05:56,920
Speaker 1: love this question. Number one, take a good history. I

1028
01:05:56,960 --> 01:05:59,680
Speaker 1: want to rule that enemeytriosis because no one's diagnosed it.

1029
01:06:00,040 --> 01:06:02,360
Speaker 1: I want to rule at pcos. These are the top

1030
01:06:02,440 --> 01:06:05,479
Speaker 1: leading causes of infertility. They need to be ruled out.

1031
01:06:05,800 --> 01:06:09,800
Speaker 1: On that visit Three, I do a pelvic ultrasound. I

1032
01:06:09,880 --> 01:06:12,360
Speaker 1: look at her anatomy, I look at her ovaries. I

1033
01:06:12,400 --> 01:06:15,640
Speaker 1: look for pcos looking ovaries on ultrasound, I look to

1034
01:06:15,640 --> 01:06:18,360
Speaker 1: make sure she doesn't have chocolate cysts. I look to

1035
01:06:18,400 --> 01:06:20,880
Speaker 1: make sure she doesn't have any abnormalcis on the ovary.

1036
01:06:21,240 --> 01:06:23,440
Speaker 1: Then I go to the uterus. I make sure she

1037
01:06:23,480 --> 01:06:27,040
Speaker 1: doesn't have any fibroids, because fibroids, when they come closer

1038
01:06:27,080 --> 01:06:30,120
Speaker 1: to the lining of the uterus, they can cause heavy periods,

1039
01:06:30,120 --> 01:06:35,040
Speaker 1: painful periods, or they can cause fertility issues and miscarriages.

1040
01:06:35,360 --> 01:06:37,840
Speaker 1: I look for polyps in the lining of the uterus.

1041
01:06:38,000 --> 01:06:42,200
Speaker 1: PCOS patients specially because of that hormonal changes. They have

1042
01:06:42,280 --> 01:06:44,600
Speaker 1: a lot of polyps in the lining of their uterus,

1043
01:06:44,920 --> 01:06:47,840
Speaker 1: so that can block them from getting pregnant, so I

1044
01:06:47,880 --> 01:06:50,200
Speaker 1: look for that. I do a three D image of

1045
01:06:50,240 --> 01:06:52,720
Speaker 1: their uterus on my pelvic ultrasound to make sure they

1046
01:06:52,720 --> 01:06:55,680
Speaker 1: don't have a septum. You'll be surprised of how many

1047
01:06:55,720 --> 01:07:00,000
Speaker 1: patients go through fertility clinics. Do idf embryo, gets transfer,

1048
01:07:00,080 --> 01:07:01,720
Speaker 1: or they don't get pregnant. They end up in my

1049
01:07:01,760 --> 01:07:04,400
Speaker 1: clinic and I'm like, you have a large septum. So

1050
01:07:04,680 --> 01:07:08,840
Speaker 1: these are all the things that I do. Then after

1051
01:07:08,920 --> 01:07:12,040
Speaker 1: I'm done taking a good history doing a pelvic ultrasound,

1052
01:07:12,560 --> 01:07:15,440
Speaker 1: I send them to my lap. I check all their hormones,

1053
01:07:15,480 --> 01:07:18,720
Speaker 1: I check their thyroid hormones. I check for thyroid antibodies.

1054
01:07:18,920 --> 01:07:22,560
Speaker 1: I check for prolactin. These are hormones that can affect ovulation.

1055
01:07:23,160 --> 01:07:27,840
Speaker 1: I check their testosterone levels. If I'm suspecting PCOS in them,

1056
01:07:28,160 --> 01:07:32,040
Speaker 1: I check DHAS, which can go up. It's we call

1057
01:07:32,120 --> 01:07:36,120
Speaker 1: it adrenal pcos. And everyone's stressed out in LA where

1058
01:07:36,160 --> 01:07:39,919
Speaker 1: I live. So adrenal PCOS is a real condition where

1059
01:07:39,960 --> 01:07:44,000
Speaker 1: they start secreting androgens and they have symptoms very similar

1060
01:07:44,040 --> 01:07:47,040
Speaker 1: to PCOS. So I screen for DHAS in their blood,

1061
01:07:47,600 --> 01:07:52,360
Speaker 1: and I check testosterone free and total, and I do

1062
01:07:52,440 --> 01:07:55,720
Speaker 1: a full SDD panel. But the most important thing I

1063
01:07:55,760 --> 01:07:57,840
Speaker 1: do in a thirty five year old, I also check

1064
01:07:57,880 --> 01:08:01,920
Speaker 1: her account, so that account is very important for me.

1065
01:08:02,360 --> 01:08:06,680
Speaker 1: Once I do all of this, then I tell her

1066
01:08:06,720 --> 01:08:11,680
Speaker 1: to go get pregnant. How how did they try for pregnancy? Basically,

1067
01:08:11,840 --> 01:08:16,599
Speaker 1: I recommend having them start prenatal vitamins usually three months prior.

1068
01:08:16,880 --> 01:08:19,080
Speaker 1: If they have a progesterone IUD because there have been

1069
01:08:19,080 --> 01:08:23,720
Speaker 1: my patient, I pull that IUD. If they have PCOS,

1070
01:08:23,880 --> 01:08:27,280
Speaker 1: I treat them with every single thing we talked about

1071
01:08:28,120 --> 01:08:31,400
Speaker 1: before they start trying. Because met Foreman the ov supplement.

1072
01:08:31,800 --> 01:08:36,360
Speaker 1: These things stimulate ovulation. Help with the ovulation and lowers

1073
01:08:36,400 --> 01:08:41,920
Speaker 1: their inflammation. I encourage a healthy diet, a good exercise,

1074
01:08:41,920 --> 01:08:45,320
Speaker 1: stopping smoking, stopping alcohol, and then I tell them to

1075
01:08:45,360 --> 01:08:48,680
Speaker 1: go try to have sex three to four times. For

1076
01:08:48,840 --> 01:08:52,040
Speaker 1: patients younger than thirty five, I usually give them a

1077
01:08:52,120 --> 01:08:55,519
Speaker 1: year to try. For patients who are older thirty five

1078
01:08:55,560 --> 01:08:58,719
Speaker 1: and older, I tell them go try for six months

1079
01:08:58,760 --> 01:09:02,680
Speaker 1: and come back. I screen for their partner's health. I

1080
01:09:02,760 --> 01:09:05,520
Speaker 1: ask the age, I ask if they use any drugs,

1081
01:09:05,560 --> 01:09:09,360
Speaker 1: if they smoke weed, if they've had any fertility issues,

1082
01:09:09,400 --> 01:09:13,480
Speaker 1: if there's any concern. I sometimes get a semen analysis

1083
01:09:13,520 --> 01:09:15,639
Speaker 1: because I don't want my patients to try at thirty

1084
01:09:15,640 --> 01:09:17,479
Speaker 1: five for six months and then find out that the

1085
01:09:17,520 --> 01:09:21,240
Speaker 1: semen is not bad and thirty percent of fertility issues

1086
01:09:21,720 --> 01:09:26,639
Speaker 1: are male related, and then you know, I have them

1087
01:09:26,720 --> 01:09:30,040
Speaker 1: try for pregnancy. One thing I don't have them do

1088
01:09:30,280 --> 01:09:33,200
Speaker 1: is check their ovulation, check their temperature, get an ov

1089
01:09:33,200 --> 01:09:35,240
Speaker 1: you kit, because the more you think about it and

1090
01:09:35,280 --> 01:09:38,000
Speaker 1: the more you stress, the more cortisol you release and

1091
01:09:38,120 --> 01:09:41,439
Speaker 1: your hormones go off balance. So I tell them go

1092
01:09:41,520 --> 01:09:43,640
Speaker 1: try for six months, go try for a year, and

1093
01:09:43,680 --> 01:09:47,120
Speaker 1: if you're not pregnant, come back. But one thing that

1094
01:09:47,320 --> 01:09:51,919
Speaker 1: I do in my office, I've already done ninety percent

1095
01:09:52,000 --> 01:09:55,240
Speaker 1: of the screening for that patient. So it's rare for

1096
01:09:55,280 --> 01:09:57,160
Speaker 1: me to have a patient show up to my office

1097
01:09:57,360 --> 01:10:00,840
Speaker 1: under my care that she's tried for a year and

1098
01:10:00,880 --> 01:10:05,040
Speaker 1: she's not getting pregnant. If they're under my care, I've

1099
01:10:05,080 --> 01:10:08,439
Speaker 1: already ruled out everything. And if they've had pcos, I've

1100
01:10:08,439 --> 01:10:11,400
Speaker 1: addressed it. If they've had any meteorosism, I've addressed it.

1101
01:10:11,960 --> 01:10:15,360
Speaker 1: If they've had autoimmune I've already addressed it. If they've

1102
01:10:15,360 --> 01:10:18,480
Speaker 1: had a septum, I've resected it. If they've had polyps,

1103
01:10:18,479 --> 01:10:20,679
Speaker 1: I've dealt with it. Do you know what I'm saying?

1104
01:10:20,760 --> 01:10:24,400
Speaker 1: So when I let them go, I maximize that time

1105
01:10:24,800 --> 01:10:28,040
Speaker 1: this is not being done. One thing I want to

1106
01:10:28,080 --> 01:10:30,920
Speaker 1: do for women in the healthcare system, I want to

1107
01:10:31,040 --> 01:10:35,559
Speaker 1: make pelvic ultrasounds mandatory at a well woman exam. Just

1108
01:10:35,680 --> 01:10:39,920
Speaker 1: by doing a bimanual exam, you can't screen for these things.

1109
01:10:40,120 --> 01:10:41,760
Speaker 1: If you come to my office and you tell me

1110
01:10:41,760 --> 01:10:45,320
Speaker 1: you can't do a pelvic ultrasound, then I will tell

1111
01:10:45,360 --> 01:10:49,120
Speaker 1: you to leave, probably because it's just like taking someone's

1112
01:10:49,160 --> 01:10:52,880
Speaker 1: glasses away and telling them to read. I see so

1113
01:10:53,120 --> 01:10:56,920
Speaker 1: much with my ultrasound. I can't even imagine women going

1114
01:10:57,200 --> 01:10:59,559
Speaker 1: once a year to their doctor and not having an

1115
01:10:59,600 --> 01:11:00,240
Speaker 1: ultras out.

1116
01:11:16,920 --> 01:11:18,840
Speaker 2: I think for a long time at least these things

1117
01:11:18,840 --> 01:11:21,559
Speaker 2: weren't talked about, and so people thought having kids was

1118
01:11:21,640 --> 01:11:24,080
Speaker 2: just like you turn up, you have kids, and things

1119
01:11:24,120 --> 01:11:26,160
Speaker 2: work out that way. And I think everyone realizes all

1120
01:11:26,160 --> 01:11:28,160
Speaker 2: of a sudden, like I was saying, you start talking

1121
01:11:28,200 --> 01:11:31,920
Speaker 2: to all your friends and like, hey, I had a miscarriage. Hey, hey,

1122
01:11:31,920 --> 01:11:34,519
Speaker 2: we've been trying for six months, nothing's happened. Now we're

1123
01:11:34,560 --> 01:11:36,160
Speaker 2: going to go get checked. Hey, you know. And so

1124
01:11:36,680 --> 01:11:39,400
Speaker 2: it's fascinating that this wasn't talked about for so long

1125
01:11:39,840 --> 01:11:42,120
Speaker 2: that now when people are finally coming to the point

1126
01:11:42,120 --> 01:11:44,320
Speaker 2: of wanting to conceive, wherever they are in their life,

1127
01:11:44,720 --> 01:11:46,599
Speaker 2: they think that there's something wrong with them, or they

1128
01:11:46,680 --> 01:11:49,760
Speaker 2: think there's something that's not working out, or now they're

1129
01:11:49,800 --> 01:11:53,120
Speaker 2: figuring out a health issue because of the reactive approach

1130
01:11:53,200 --> 01:11:55,720
Speaker 2: as opposed to, Hey, having a kid's not easy no

1131
01:11:55,720 --> 01:11:57,200
Speaker 2: matter what age you are, because there could be a

1132
01:11:57,240 --> 01:12:00,640
Speaker 2: million different things going on, as we've discussed today, and

1133
01:12:00,680 --> 01:12:02,760
Speaker 2: so whether you're in your twenties and you don't want

1134
01:12:02,800 --> 01:12:04,479
Speaker 2: to have a kid, told you with that is, there's

1135
01:12:04,479 --> 01:12:06,439
Speaker 2: still things you can do. There's still steps you can

1136
01:12:06,439 --> 01:12:08,880
Speaker 2: take now that are probably going to help you, even

1137
01:12:08,920 --> 01:12:09,960
Speaker 2: if it's that far away.

1138
01:12:10,120 --> 01:12:12,920
Speaker 1: If you've tried for a year and you've had sex

1139
01:12:13,280 --> 01:12:17,439
Speaker 1: three to four times every week and you haven't gotten

1140
01:12:17,439 --> 01:12:20,200
Speaker 1: pregnant at the end of the year, here's what you

1141
01:12:20,240 --> 01:12:25,000
Speaker 1: can do. Number one bucket is the female factor. Right,

1142
01:12:25,120 --> 01:12:29,160
Speaker 1: it's the woman. Check your hormones. I listed those hormones,

1143
01:12:29,439 --> 01:12:34,160
Speaker 1: thyroid panel, prolactin, testosterone, free testosterone, dhgas. Make sure those

1144
01:12:34,200 --> 01:12:37,400
Speaker 1: are normal. Do an SCD check, check for gonarrhea, chlamydia,

1145
01:12:38,160 --> 01:12:43,599
Speaker 1: check your AMH anti malarian hormone. Is egg count Basically

1146
01:12:44,360 --> 01:12:47,679
Speaker 1: it tells us what that ovarian reserve is for the woman.

1147
01:12:47,960 --> 01:12:52,240
Speaker 1: That's number one, So that's female factor. Second, you want

1148
01:12:52,280 --> 01:12:54,240
Speaker 1: to make sure the agcount is good and the hormones

1149
01:12:54,280 --> 01:12:57,639
Speaker 1: are good. Second bucket is the male factor. Make sure

1150
01:12:57,760 --> 01:13:01,000
Speaker 1: the semen analysis is normal. If your partner go to

1151
01:13:01,040 --> 01:13:04,679
Speaker 1: any fertility clinic, do a sman analysis. It takes two

1152
01:13:04,760 --> 01:13:08,120
Speaker 1: minutes to do that. Number three I call it the

1153
01:13:08,200 --> 01:13:13,439
Speaker 1: anatomy bucket. Right, get a pelvic ultrasound because doctors are

1154
01:13:13,479 --> 01:13:16,320
Speaker 1: not doing it. Make sure you don't have fibroids. Make

1155
01:13:16,360 --> 01:13:18,960
Speaker 1: sure in the lining of the cavity you don't have

1156
01:13:19,000 --> 01:13:22,759
Speaker 1: any polyps. Make sure you don't have any septum. Ask

1157
01:13:22,880 --> 01:13:28,320
Speaker 1: your doctor for an HSG. Histrosapingogram is a very simple

1158
01:13:28,360 --> 01:13:32,120
Speaker 1: procedure done by radiologists. They basically inject die into the

1159
01:13:32,200 --> 01:13:36,160
Speaker 1: uterus and they flush the tubes. Not only it flushes

1160
01:13:36,160 --> 01:13:38,720
Speaker 1: the tubes and helps you get pregnant, it tells us

1161
01:13:38,760 --> 01:13:41,200
Speaker 1: whether or not there's any blockage of the tubes. A

1162
01:13:41,200 --> 01:13:44,120
Speaker 1: lot of patients with endometriosis with scar tissue can have

1163
01:13:44,160 --> 01:13:47,080
Speaker 1: block tubes and that's why they're not getting pregnant. So

1164
01:13:47,240 --> 01:13:51,160
Speaker 1: that's the third bucket. My fourth bucket is the bucket

1165
01:13:51,200 --> 01:13:55,360
Speaker 1: of endometriosis. Have you had painful periods? Do you have

1166
01:13:55,479 --> 01:13:58,360
Speaker 1: painful sex? Do you get really bloated? Have you had

1167
01:13:58,360 --> 01:14:02,760
Speaker 1: recurrent bladder infections? With negative culture? Is bound movements painful?

1168
01:14:03,240 --> 01:14:08,200
Speaker 1: If you think you have endometriosis. Endometriosis can cause infertility

1169
01:14:08,320 --> 01:14:13,280
Speaker 1: in several ways. A that inflammatory environment that we talked

1170
01:14:13,280 --> 01:14:16,760
Speaker 1: about destroys the egg, doesn't let the egg go to

1171
01:14:16,840 --> 01:14:19,800
Speaker 1: the tube. The tubes are scarred. Even when you make

1172
01:14:19,840 --> 01:14:23,440
Speaker 1: an embryo and the embryo wants to implant into the uterus.

1173
01:14:23,520 --> 01:14:26,880
Speaker 1: A lot of these patients have adenomiosis, which we didn't

1174
01:14:26,880 --> 01:14:30,680
Speaker 1: talk about. It's a sister diagnosis to endometriosis. A lot

1175
01:14:30,720 --> 01:14:33,000
Speaker 1: of times they go hand in hand when the walls

1176
01:14:33,000 --> 01:14:36,960
Speaker 1: of the uterus are so glandular, and when you have that,

1177
01:14:37,000 --> 01:14:40,880
Speaker 1: your risk of miscarriage goes up. So this bucket is

1178
01:14:40,960 --> 01:14:44,760
Speaker 1: an extremely important bucket. And if you think you have

1179
01:14:44,920 --> 01:14:48,000
Speaker 1: endometriosis and your doctor is telling you you don't have it,

1180
01:14:48,439 --> 01:14:52,320
Speaker 1: go find another doctor, Go find an endometriosis specialist. You

1181
01:14:52,520 --> 01:14:55,840
Speaker 1: have to be your own health advocate in this specific

1182
01:14:56,040 --> 01:15:00,920
Speaker 1: bucket because it will get dismissed. Okay. And the next

1183
01:15:01,000 --> 01:15:04,360
Speaker 1: bucket is the bucket of PCOS, which we spend all

1184
01:15:04,400 --> 01:15:07,919
Speaker 1: this time. If you have irregular period, if you have acne,

1185
01:15:07,960 --> 01:15:11,160
Speaker 1: hair lost, facial hair, body hair, if you have gain,

1186
01:15:11,280 --> 01:15:13,519
Speaker 1: if you gain weight and you can't lose it, if

1187
01:15:13,560 --> 01:15:17,120
Speaker 1: you've struggled with weight most of your life, if you're anxious, depressed,

1188
01:15:17,520 --> 01:15:20,840
Speaker 1: history of eating disorder, these are all telltale signs of

1189
01:15:20,840 --> 01:15:24,439
Speaker 1: a PCOS issue. And PCOS patients when they want to

1190
01:15:24,479 --> 01:15:28,320
Speaker 1: get pregnant, I would have a million percent I swear

1191
01:15:28,360 --> 01:15:31,439
Speaker 1: not because it's my supplement because it works. Take the

1192
01:15:31,520 --> 01:15:35,600
Speaker 1: ov supplement. Ask your doctor for met Foreman. Believe it

1193
01:15:35,720 --> 01:15:39,600
Speaker 1: or not. Women in this bucket who are lean and

1194
01:15:39,680 --> 01:15:41,599
Speaker 1: they go to the doctor and the doctor says, well,

1195
01:15:41,600 --> 01:15:43,760
Speaker 1: your hemoglobin A one c is normal. You don't have

1196
01:15:43,840 --> 01:15:49,439
Speaker 1: insulin resistance. That lean woman also has insulin resistance at

1197
01:15:49,479 --> 01:15:52,479
Speaker 1: his tissue level. You can't see it in the blood,

1198
01:15:52,520 --> 01:15:55,040
Speaker 1: but she has it at her tissue level. And putting

1199
01:15:55,040 --> 01:15:58,280
Speaker 1: them on the supplement and giving them met Foreman will

1200
01:15:58,360 --> 01:16:02,320
Speaker 1: help them ovulate and get pregnant. That's how you pull

1201
01:16:02,400 --> 01:16:05,040
Speaker 1: these patients out of the hands of the fertility doctors.

1202
01:16:05,600 --> 01:16:09,200
Speaker 1: So that's my what are we fifth bucket? And my

1203
01:16:09,600 --> 01:16:15,080
Speaker 1: sixth bucket is my autoimmune bucket. This bucket is always

1204
01:16:15,120 --> 01:16:18,200
Speaker 1: also dismissed in woman, this is your friend with the

1205
01:16:18,240 --> 01:16:22,280
Speaker 1: autoimmune condition. These are patients that when you have an

1206
01:16:22,320 --> 01:16:25,840
Speaker 1: autoimmune Let's say, if you have psoriasis, Yeah, sooriasis doesn't

1207
01:16:25,840 --> 01:16:29,280
Speaker 1: affect your fertility. But if you have psoriasis, you might

1208
01:16:29,320 --> 01:16:34,000
Speaker 1: have another autoimmune condition that does affect your fertility. Why

1209
01:16:34,040 --> 01:16:38,360
Speaker 1: am I saying this. Let's take ANTIFOSPHILIPD syndrome. These are

1210
01:16:38,439 --> 01:16:43,120
Speaker 1: patients who might not have any symptoms right, but in

1211
01:16:43,200 --> 01:16:47,720
Speaker 1: their labs their antifossilipid syndrome is positive. These patients make

1212
01:16:47,760 --> 01:16:52,160
Speaker 1: clot easily in pregnancy. Pregnancy is a hypercoagulable state, and

1213
01:16:52,320 --> 01:16:55,920
Speaker 1: patients in this bucket when they get pregnant, they make

1214
01:16:56,000 --> 01:17:00,639
Speaker 1: blood clots in their placenta. They get recurrent miscarriages. Sometimes

1215
01:17:00,640 --> 01:17:02,960
Speaker 1: I have my medical assistant present a patient to me.

1216
01:17:03,520 --> 01:17:07,760
Speaker 1: We have a new patient. She's had five miscarriages, she's

1217
01:17:07,800 --> 01:17:11,920
Speaker 1: seen all these doctors. She's pregnant right now, she's five weeks.

1218
01:17:12,240 --> 01:17:15,799
Speaker 1: Even before going in, I'm like, give her blood thinners.

1219
01:17:16,000 --> 01:17:17,800
Speaker 1: I don't even need to see the patient. I can

1220
01:17:17,840 --> 01:17:20,599
Speaker 1: tell you she needs butt thinners because she's in this

1221
01:17:21,200 --> 01:17:28,200
Speaker 1: dismissed sixth bucket. For me, in my practice, it's extremely rare,

1222
01:17:28,920 --> 01:17:33,680
Speaker 1: extremely rare that I find someone unexplained infertility. Do you

1223
01:17:33,760 --> 01:17:36,599
Speaker 1: know that if you look at the literature, they say

1224
01:17:36,680 --> 01:17:41,400
Speaker 1: thirty percent of infertility is female related, thirty percent is

1225
01:17:41,439 --> 01:17:47,479
Speaker 1: male related, and thirty percent is unexplained or mixed. Like

1226
01:17:47,560 --> 01:17:52,240
Speaker 1: no one knows really, I know, really know why because

1227
01:17:52,560 --> 01:17:56,920
Speaker 1: those are my poor endometriosis and PCOS women, the auto

1228
01:17:57,000 --> 01:18:01,280
Speaker 1: immune woman that no one is addressing, them. I always say,

1229
01:18:01,280 --> 01:18:05,800
Speaker 1: if you send every twenty year old to my office once, Actually,

1230
01:18:05,840 --> 01:18:07,320
Speaker 1: if I could take him, I would probably take him

1231
01:18:07,360 --> 01:18:10,799
Speaker 1: at eighteen, every eighteen year old to my office once.

1232
01:18:11,720 --> 01:18:15,000
Speaker 1: I would shut down a lot of these fertility centers

1233
01:18:15,280 --> 01:18:18,800
Speaker 1: because I would not dismiss a woman with a demetriosis.

1234
01:18:18,840 --> 01:18:22,640
Speaker 1: I would not dismiss a woman with PCOS. Now that

1235
01:18:22,760 --> 01:18:27,559
Speaker 1: you learned all this, I want you to imagine this patient,

1236
01:18:28,040 --> 01:18:32,720
Speaker 1: and I've seen thousands of them. Imagine a thirty four

1237
01:18:32,800 --> 01:18:38,479
Speaker 1: year old girl who's had irregular period, who's overweight since

1238
01:18:38,520 --> 01:18:40,959
Speaker 1: she was in high school. She had an eating disorder

1239
01:18:41,000 --> 01:18:44,639
Speaker 1: because her sister was very thin, her mom was very thin,

1240
01:18:44,960 --> 01:18:48,240
Speaker 1: and at a very young age, her mom kept telling her, honey,

1241
01:18:48,280 --> 01:18:51,320
Speaker 1: why are you You probably eating unhealthy, that's why you're overweight,

1242
01:18:51,439 --> 01:18:55,800
Speaker 1: eat less. She gets anxiety, she gets depression. By the

1243
01:18:55,840 --> 01:19:00,000
Speaker 1: time she's sixteen, she has an eating disorder. She has acne.

1244
01:19:00,160 --> 01:19:02,559
Speaker 1: Her mom takes her to the dermatologist. They start her

1245
01:19:02,560 --> 01:19:09,160
Speaker 1: on acutane. She is very depressed. She goes to a psychiatrist.

1246
01:19:09,240 --> 01:19:13,680
Speaker 1: They put her on an antidepressant. She bounces from psychiatry

1247
01:19:13,720 --> 01:19:17,400
Speaker 1: office to psychiatry office. She's doubled over in pain. When

1248
01:19:17,439 --> 01:19:20,200
Speaker 1: she's at school, the nurse calls for her mom to

1249
01:19:20,240 --> 01:19:26,799
Speaker 1: come and pick her up. She goes to ten twenty

1250
01:19:27,479 --> 01:19:33,439
Speaker 1: fifty doctors from state to state, country to country, and

1251
01:19:33,520 --> 01:19:38,040
Speaker 1: everyone tells her that she needs to eat less, exercise more,

1252
01:19:38,439 --> 01:19:42,640
Speaker 1: that she's stressed out, that she was born anxious and depressed,

1253
01:19:43,160 --> 01:19:46,800
Speaker 1: that her medications need to be changed. And by the

1254
01:19:46,920 --> 01:19:49,840
Speaker 1: time she gets to me, she's thirty four years old.

1255
01:19:50,439 --> 01:19:52,880
Speaker 1: I do her amah and she has no eggs left.

1256
01:19:57,760 --> 01:20:01,880
Speaker 1: This is my broken heart. This is my trauma. This

1257
01:20:02,120 --> 01:20:06,080
Speaker 1: is every single patient I see in my office. Do

1258
01:20:06,120 --> 01:20:12,760
Speaker 1: you understand? And I don't take insurance. My office is expensive,

1259
01:20:13,320 --> 01:20:16,400
Speaker 1: not because I want to torture patients, because I just

1260
01:20:16,560 --> 01:20:20,880
Speaker 1: can't see patients anymore. I've done this thirty years and

1261
01:20:21,120 --> 01:20:24,679
Speaker 1: I'm at Their trauma is my trauma. And that's why

1262
01:20:24,720 --> 01:20:29,519
Speaker 1: I started my podcast, my CMD podcast. I literally take

1263
01:20:29,600 --> 01:20:33,200
Speaker 1: these we don't talk about men. Men are not allowed.

1264
01:20:34,200 --> 01:20:37,599
Speaker 1: It's a safe place for women. And I literally take

1265
01:20:37,920 --> 01:20:45,479
Speaker 1: every single condition ENDO, pcos, fibroids, SDDS, one by one.

1266
01:20:46,439 --> 01:20:50,439
Speaker 1: I teach them. I empower them to become their own

1267
01:20:50,479 --> 01:20:53,840
Speaker 1: health advocate. So if you're twenty five and you go

1268
01:20:53,920 --> 01:20:57,960
Speaker 1: to an office and you're being dismissed. Those that needs

1269
01:20:58,040 --> 01:21:02,479
Speaker 1: to stop. I'm here today because I want to change

1270
01:21:02,479 --> 01:21:06,000
Speaker 1: this healthcare system. I swear to God. I feel like

1271
01:21:06,120 --> 01:21:09,599
Speaker 1: this is my calling. I feel like I was placed

1272
01:21:09,640 --> 01:21:13,240
Speaker 1: on this planet to change this. I feel like I

1273
01:21:13,280 --> 01:21:17,400
Speaker 1: got breast cancer because I was You know, do you

1274
01:21:17,400 --> 01:21:19,400
Speaker 1: know how many people called me crazy with my breast

1275
01:21:19,400 --> 01:21:24,479
Speaker 1: cancer journey? And if as a women's health advocate people

1276
01:21:24,560 --> 01:21:27,120
Speaker 1: call me crazy? Do you think women have a chance

1277
01:21:27,160 --> 01:21:28,880
Speaker 1: in this healthcare system?

1278
01:21:29,040 --> 01:21:31,320
Speaker 2: That's so painful? It's so painful, and try.

1279
01:21:31,160 --> 01:21:34,719
Speaker 1: To get it so painful. You don't understand the depth

1280
01:21:34,800 --> 01:21:38,960
Speaker 1: of this pain that these women go through. You don't

1281
01:21:39,120 --> 01:21:45,840
Speaker 1: understand it. The gas lighting is toxic. I want to scream.

1282
01:21:46,280 --> 01:21:48,320
Speaker 1: That's why I say I want the President of the

1283
01:21:48,439 --> 01:21:52,439
Speaker 1: United States to give me the mic. People grab that

1284
01:21:52,560 --> 01:21:57,120
Speaker 1: mic for nonsense. Give me that mic for twenty minutes only.

1285
01:21:58,080 --> 01:22:02,360
Speaker 1: Let me tell women what they deserve to know. You

1286
01:22:02,439 --> 01:22:05,439
Speaker 1: don't have to be thirty five years old to find

1287
01:22:05,439 --> 01:22:07,800
Speaker 1: out you don't have any eggs left. You don't have

1288
01:22:07,880 --> 01:22:11,240
Speaker 1: to be thirty five to learn that you have giant fibroids,

1289
01:22:11,280 --> 01:22:14,680
Speaker 1: that you have endometriosis, that you have pcos that you

1290
01:22:14,760 --> 01:22:17,960
Speaker 1: have an audioimmune condition, that your lifetime risk of breast

1291
01:22:17,960 --> 01:22:20,200
Speaker 1: cancer is high and no one diagnosed it, and now

1292
01:22:20,200 --> 01:22:24,400
Speaker 1: you have stage four breast cancer. Enough, enough is enough.

1293
01:22:24,880 --> 01:22:27,760
Speaker 1: That's it. I can talk for another ten hours.

1294
01:22:28,439 --> 01:22:31,640
Speaker 2: Doctor Ray. I want to thank you for showing up

1295
01:22:31,680 --> 01:22:36,080
Speaker 2: and to have such a clear, conscious, powerful message delivered

1296
01:22:36,280 --> 01:22:39,360
Speaker 2: that emphatically by you to everyone who's listening right now.

1297
01:22:39,920 --> 01:22:42,880
Speaker 2: Everyone who's listening or watching right now, please go and

1298
01:22:42,880 --> 01:22:46,240
Speaker 2: subscribe to SHEMD. It's free. It's a podcast by doctor

1299
01:22:46,280 --> 01:22:49,320
Speaker 2: a where you can get deeper insights. You can get

1300
01:22:49,320 --> 01:22:52,280
Speaker 2: the extra ten hours of conversations around any of these

1301
01:22:52,320 --> 01:22:55,000
Speaker 2: areas you're struggling with, and of course, past this episode

1302
01:22:55,000 --> 01:22:56,559
Speaker 2: onto a friend. I think there's going to be someone

1303
01:22:56,560 --> 01:22:59,479
Speaker 2: in your life who you know is struggling silently, who

1304
01:22:59,520 --> 01:23:01,519
Speaker 2: you know so offering in the background, who you know

1305
01:23:01,720 --> 01:23:04,800
Speaker 2: is not aware of what they're going through. I hope

1306
01:23:04,800 --> 01:23:07,000
Speaker 2: you'll share this episode with them as a way of

1307
01:23:07,560 --> 01:23:12,360
Speaker 2: sparking a conversation and starting their journey and empowering yourself

1308
01:23:12,400 --> 01:23:15,519
Speaker 2: through your health journey. Doctor thank you for enlightening us,

1309
01:23:15,880 --> 01:23:18,880
Speaker 2: inspiring us, and giving us such a no so sweet,

1310
01:23:18,920 --> 01:23:21,920
Speaker 2: powerful message. Truly I learned so much today, more than

1311
01:23:21,920 --> 01:23:24,559
Speaker 2: I ever have truly on this subject. And even more

1312
01:23:24,600 --> 01:23:29,920
Speaker 2: than that, I appreciate your directness, just your conviction in

1313
01:23:30,040 --> 01:23:32,960
Speaker 2: how important this is, because you're absolutely right. I mean,

1314
01:23:33,240 --> 01:23:35,639
Speaker 2: women's health has been ignored for a long time. It's

1315
01:23:35,680 --> 01:23:38,200
Speaker 2: been deprioritized for a long time. It is at the

1316
01:23:38,240 --> 01:23:41,080
Speaker 2: core of how we exist as humans. So for us

1317
01:23:41,120 --> 01:23:43,880
Speaker 2: to not understand it is there is no excuse for it,

1318
01:23:44,040 --> 01:23:46,519
Speaker 2: just no excuse. And I'm just really thankful that you

1319
01:23:46,600 --> 01:23:48,320
Speaker 2: came on today and shed so much light on it.

1320
01:23:48,360 --> 01:23:49,000
Speaker 2: So I'm very great for.

1321
01:23:49,040 --> 01:23:51,639
Speaker 1: Your sweet for giving me this mic.

1322
01:23:51,840 --> 01:23:54,959
Speaker 2: Yeah, I mean it. Well, hopefully you get the the

1323
01:23:54,960 --> 01:23:58,040
Speaker 2: the President's mic too, that's that definitely. But thank you

1324
01:23:58,040 --> 01:23:58,840
Speaker 2: for your time and energy.

1325
01:23:58,840 --> 01:24:00,640
Speaker 1: Thank you, thank you, thank you for having me.

1326
01:24:01,080 --> 01:24:03,880
Speaker 2: If you enjoyed this podcast, you're going to love my

1327
01:24:04,000 --> 01:24:08,280
Speaker 2: conversation with Michelle Obama where she opens up on how

1328
01:24:08,320 --> 01:24:11,400
Speaker 2: to stay with your partner when they're changing. If you're

1329
01:24:11,439 --> 01:24:14,240
Speaker 2: going through something right now with your partner, this is

1330
01:24:14,280 --> 01:24:15,200
Speaker 2: the episode for you.

1331
01:24:15,320 --> 01:24:19,320
Speaker 1: The world won't always like you, but you can't count

1332
01:24:19,360 --> 01:24:20,800
Speaker 1: on the world to like you.