Hot Smart Rich with Maggie Sellers Reum - Women's Health Expert: Doctors Told Women This Was Normal (They Were Wrong!) with Dr. Thaïs Aliabadi

Starting point is 00:00:00 If men had a condition that would put them down for a week every month, do you think they would be dismissed this way? Never. Yet, majority of women are not being treated correctly. You are a world-renowned women's health advocate, trusted by Rihanna, Chloe Kardashian, and Haley Bieber. You're going to learn so much. Girl, pouring my heart out for you. Oh, my God.

Starting point is 00:00:22 It's all about getting hotter, smarter, and richer. And that was very hard for me growing up, because I had things that were working against me biologically. This is highly emotional for me. Because what I'm struggling to understand is how this took me till I was 30. Oh my God. Just start listening to women. They're very in tune with their body.

Starting point is 00:00:41 You don't need a doctor to validate you. Advocate for yourself because the world is not doing it for you. What should every single woman do as next step? People have a hard time to believe this. I was treating my patients with GLP-1s. When Ozempic blew up, were like, oh my God, I used Ozmpic and I got pregnant. Why do you think? And this is just the tip of the iceberg. This episode discusses women's health, fertility, and medical treatment. It is for

Starting point is 00:01:10 general information only and should not replace professional medical advice. Please consult a qualified health care professional for any medical concerns. In case you missed it, you're allowed to be hot, smart, and rich. So let's get into it. Dr. Tais, Ali Abadi. Are you ready to get hot, smart rich i am i do think this is probably going to be a very highly emotional episode for me after my journey going through misdiagnosis not being believed having a challenging experience being diagnosed with pmOS and endometriosis so bear with me if it at times gets tough but for someone that's just clicked into this conversation what do you want them to know about what they'll learn and why they should stay to listen to what we're going to talk about.

Starting point is 00:02:08 I would say PMOS and endometriosis are the leading causes of infertility. Majority of endometriosis patients are never diagnosed, even when they end up in a fertility clinic. It takes doctors in this country nine to 11 years to diagnose an endometriosis patients. Most of them go through life with no diagnosis. PMOS and endometriosis affects, in my opinion, north of 20% of women. So the literature is wrong about the 10%. When we talk about PMOS, it affects 15% of women. 75% to 80% of these women go through life.

Starting point is 00:02:44 They bounce from doctor to doctor and they're never diagnosed. So I say if you're in your reproductive age, if you're a mom of daughters, if you have sisters, if your wife wants to get pregnant, you need to listen to this episode. because it's going to be a wake-up call for a lot of people listening to this. So I want to start there, actually, because I think, you know, the show Hot, Smart, Rich, right? It's all about getting hotter, smarter, and richer. And that was very hard for me growing up because I had things that were working against me biologically that I didn't even understand because it was not the surface level. It was the root cause.

Starting point is 00:03:23 Do you believe it's possible to get hotter, smarter, and richer? If you're doing everything right, but you have an underliebally. lying undiagnosed condition like PMOS or endometriosis? I think it'll make it very challenging. Why? Because PMOS is not just irregular periods and weight gain and endometriosis is not just painful periods. Both of them are a whole body condition. It affects your mental health. It affects your confidence. It affects your social life. It affects your sex life. It affects your friendships. It affects your all of it. So if you don't address these underlying condition. It's hard. I mean, I've done this. I've been in women's health

Starting point is 00:04:06 for 30 years and I've been an advocate for back then. It was PCOS. Now it's PMOS and endometriosis for at least a big advocate for 20 years. Just this year, just this year, I've realized that doctors in my town besides me are starting to diagnose endometriosis and or PMOS for that matter. And it's heartbreaking because I'm so traumatized from my patients, you know, being dismissed for years. Their trauma has become my trauma. So I would say the trauma is so real. I feel like they fight inside because so many, you know, these patients bounce from doctor to doctor. They're told you're normal. There's nothing wrong with you. It's stress. It's in your head. It's normal. So after they see five, six, eight, ten doctors, they start believing that they're crazy. And that needs to

Starting point is 00:05:01 stop. And to this day, I live, my practice was at Cedars. I was in private practice from day one. Now I moved to Beverly Hills. Once every few months, there's a doctor who diagnoses a patient with endo or PCOS or PMOS. Isn't that sad? I'm talking about the leading causes of infertility on the planet. If men had a condition, let's take endometriosis that would put them down for a week every month that would make their penis hurt every time they had sex, that would make them feel bloated, conic pelvic pain, anxiety, inflamed, leaky gut, all of these symptoms, low sperm count. Do you think majority of them would go through life getting dismissed this way?

Starting point is 00:05:51 Never. So why is it? But you know what? I'll tell you something. And it's not like because male doctors are doing this to women. female doctors have done it for years to women. I'm telling you because in Los Angeles, no one was diagnosing these patients until a few months ago.

Starting point is 00:06:11 How about that? Well, that's actually where I wanted to start because as a 33-year-old that just had surgery for endo two weeks ago, had PMOS diagnosed at 30, I have gone through my entire life with not having what is a normal period. So I want to start there. what does a normal period look like? What should it be like? Once a month, every 28 days, you get, you're bleeding, you're not hemorrhaging out, you're not staying in bed, you're not calling your mom to pick you up from school, you're not planning your vacations around your period. Your social calendar doesn't change whether you're on your period or not. So it should just come regularly. It should be some mild pain. Maybe you take a couple of Advils, maybe you don't, but you go on with your life. So I always say if you end up in the doctor's office complaining of painful periods, if you're bringing it up, if you change your plans around your period, if you call your mom or your daughter, you have to go pick her up from school, or if you end up in the urgent care or emergency room, none of it is normal. If I could print a T-shirt that said painful periods are not normal, I would have done it. For my 50th birthday, I wanted to get billboards on the 405 that said painful periods are not normal.

Starting point is 00:07:30 That's what I wanted. I told my husband, you want to buy me a gift? Get 10 billboards for me. And then my eldest daughter walked up to me. She's like, okay. So now you tell these people that painful period is not normal. Hashtag endometriosis. Then they go to their doctor.

Starting point is 00:07:43 What happens? The doctor says there's nothing wrong with you. So I'm like, maybe the next billboard after that would say, you know, go look up this website. And then my daughter's like, okay, great. Then you have to educate them as they're driving down 405. And it didn't make sense. But that's how bad it is. There are millions and millions of women with your story.

Starting point is 00:08:05 Yesterday, I had a patient from Miami, two patients from Texas, one from Arizona, one from Chicago. What do you mean? Every time I walk into the room, easy PMOS endometriosis diagnosis. My MAs are, their diagnosis is at 99%. and accuracy with these patients. Isn't it unfair that they have to fly to come and see me? Isn't that crazy? Doesn't that make you upset?

Starting point is 00:08:32 Yeah. It makes me want to vomit. So if someone's listening to this and they're like, I have symptoms, what would you say are the most common symptoms of let's start with PMOS now? When I talk about PMOS, for patients to understand it, I break it down into four pillars, Okay. And these four pillars interact with one another at different levels, and that's why PMOS patients all look different, right? PMOS affects 15% of women. It's the most common endocrine disorder in women of reproductive age, right? The reason they changed the name from PCOS because it's not polycystic ovary. For years, these doctors thought, if you don't have cyst, then you don't have polycystic ovary syndrome. Now, luckily, thankfully, they changed their name to PMOS.

Starting point is 00:09:27 Polyendocrine, multiple hormones, metabolic, ovarian, right, syndrome. So why is this important? Because these pillars are important. So patients don't get dismissed. So when we want to diagnose a PMOS patient, it's very simple. You don't need a fancy doctor to diagnose you. You need to meet two out of the three criteria. One, history of irregular cycles.

Starting point is 00:09:55 These are patients who can pinpoint, they never know when their periods are coming, right? Completely irregular. They might have less than eight periods per year or their periods can be longer than 35 days, completely irregular. Two is PCOS ovaries on ultrasound. Polys cystic is not cyst on the ovaries. You need to do a transvaginal ultrasound to look at PCHOS ovaries. And this is like a grouping of follicles. I call it string of pearl.

Starting point is 00:10:24 Is this a string of pearl? Because this is what I'm struggling to understand is how this took me till I was 30. Oh, my God. I'll explain to you why that happens, right? And we'll get to it. You're going to learn so much. Girl, this is why I was like, she needs to come on the show. Pouring my heart out for you.

Starting point is 00:10:43 Oh, my God. So let me tell you. So one was irregular cycles. Two is that. So it's basically zoom into it. It's all those little follicles. You see it's like a pearl necklace. Classic.

Starting point is 00:10:56 Shame on people who miss that, right? The second criteria, you can have an elevated AMH, anti-malarium hormone, which is your ovarian reserve test. So for people who can't get an ultrasound, if you have a very high egg count for your age, then that meets the second criteria. We do not use that elevated AMH for teenagers, because a lot of teenagers can have large egg counts,

Starting point is 00:11:20 so we use it for adults after 18. The third one is symptoms of elevated testosterone. You do not need to have a high testosterone in the blood for the diagnosis. If I had a mic, I would have every doctor repeat after me. So they don't tell their patients, oh, your testosterone's normal. You don't have it. Or your symptoms can't be that bad because your testosterone's normal. You look for symptoms of elevated testosterone.

Starting point is 00:11:44 What are those facial hair, body hair being the most common? acne, facial acne, body acne, or hair thinning. So you need to meet two out of the three criteria to get the diagnosis. PMOS patients struggle with anxiety, depression, and we can talk about all of this, why this happens. But I always say if you want to find PMOS patients, go knock on the doors of eating disorders. They're all sitting behind those doors. Right. Because it's all connected.

Starting point is 00:12:14 75% of PMOS patients gain weight, 25% don't. and it's the leading cause of infertility on the planet, yet majority of these patients go through life and they're never diagnosed. And even when they're diagnosed, they're not being treated correctly because doctors don't understand it. So let's talk about these four pillars now that you have a general overview. The first pillar of PCOS is this brain-overy axis. In our brain we have a hypothalamus and then we have a pituitary gland. The hypolytitis, Pothalamus releases a hormone called GNRH that can, in a pulsatile fashion, and controls the release of two hormones from your pituitary gland. One is LH and one is FSH.

Starting point is 00:13:00 FSH stimulates the follicles in the ovaries to grow every month. A certain number of follicles from the ovary come to the surface, we call it or get recruited every month. And then they grow. One of them grows bigger than the others. and then mid-cycle, we get an LH surge, the second hormone of the pituitary gland, and this LH surge causes an ovulation. And that's how the menstrual cycle happens, because the hormones of the ovary then regulate the lining of the uterus, right?

Starting point is 00:13:31 They get it ready for pregnancy, thick and juicy when you don't get pregnant, the lining shuts, right? This cycle should happen regularly. What we see with PMOS patients is that the hypothalamus, the GNRH, is secreting superfinding, faster than normal, that fast secretion of GNRH flips the hormones in the pituitary gland. So the LH goes up and the FSAH comes lower. Well, when you have LH, LH is supposed to just come mid-cycle and cause ovulation, right? But when you have constant release of LH from the pituitary gland, this constant secretion stimulates the tica cells in the ovary to release testosterone.

Starting point is 00:14:14 So now the brain is not functioning well, the hormones shift and your ovarian tissue start pumping testosterone out. Well, testosterone is toxic to the little follicles that are getting recruited every month. It causes an inflammatory environment for these little follicles so the follicles freeze in the ovary, as they did in yours. And they're not ovulating every month. So the testosterone doesn't let you ovulate. What happens? Your periods become irregular all over. over the place. But then that elevated testosterone, what does it do? It causes patients to get facial

Starting point is 00:14:50 hair, body hair. These are people who keep lasering and they have facial hair they have to shave and they can't keep up with it. Or they have acne at a young age. Someone puts them on acutane without addressing the underlying condition. And it can cause hair thinning. Now, the second pillar is insulin resistance. Insulin resistance is very, very common in PMOS patients. 75% gain weight, 25% are lean. But if you take a lean PMOS patient and compare her to another girl, same height and weight who doesn't have PMOS, the girl with PMOS at tissue level, 60, 70% of them have insulin resistance. How about that? So their biology is already different than the other lean patient, right? What is insulin resistance? which is the second pillar.

Starting point is 00:15:41 When we eat carbohydrates, our body breaks it down into glucose. Glucose stimulates your pancreas to release a hormone called insulin. The job of insulin is it mostly goes to the surface of your muscle cells, opens up the channels. Sugar can go into the cell and turn into energy. PMOS patients, 80% of them have insulin resistance, even the lean ones. So what does that mean? The receptors are insulin resistant. They don't open up.

Starting point is 00:16:08 So because they don't open up at an optimal level, some of the sugar bounces in the blood, right? That sugar that bounces in the blood shoots up their insulin. High insulin starts a cascade of event in the body. Number one, it tells your liver, the cells are not picking up, you know, the sugar. Take this sugar and turn it into fat. That stored fat a lot of times is actually visceral fat. Visceral fat is highly inflammatory. That spike in insulin also tells the liver, don't make as much sex hormone binding

Starting point is 00:16:46 globulin, which is a protein that grabs the testosterone in the blood. So when that goes low, your testosterone levels go up and all your symptoms get worse. But most importantly, that spike in insulin stimulates the tissue in the ovary to release more testosterone. So remember that first pillar. Now this insulin-resistant pillar amplifies and literally works as fuel to fuel more testosterone from the first pillar. That spike in insulin crashes your blood sugar. These are patients who when they have that crash, their cortisol gets secreted after they

Starting point is 00:17:26 have a, you know, carb, a heavy meal. And as that blood sugar crashes, they get. get cravings, they get irritable, they get upset, they want to eat more carbs, and at 2 p.m., what happens to them, they crash. The high insulin, the high testosterone, the visceral fat, all of it, causes an inflammatory process in the body. These are patients who get very inflamed. They start having leaky gut. In my opinion, 40, 50 percent of PMOS patients have leaky gut or gut dysbiosis, where the bacteria because of all these hormonal fluctuations is not balanced. And when you have a leaky gut, what happens? Your body starts absorbing toxins because that layer in your gut that has to

Starting point is 00:18:14 protect your body against toxins suddenly becomes leaky. So as toxins get absorbed, your inflammation goes up. As inflammation goes up, your insulin resistance gets worse. As your insulin resistance gets worse. You have more testosterone being secreted from your oocyll inflammation. and then this vicious cycle happens. So the third pillar, aliabody pillar, I call it, is this inflammation, right? And then the fourth pillar is the mental health part of it. In our brain, we have a limbic system. All your emotions are in this limbic system.

Starting point is 00:18:52 This limbic system is controlled by your prefrontal cortex, which is a break that controls the emotions coming out of this limbic system. For the limbic system, to be calm, you need normal levels of estrogen and progesterone, low androgens, or normal levels of androgens, and low inflammation. What do we have? What did we learn with PMOS? Testosterone's off the chart, right? Inflammations off the chart.

Starting point is 00:19:22 There's no ovulation regularly, so when you don't ovulate, you don't have progesterone, so your progesterone's low. And these little follicles that are stuck in the ovary, they're secretions. treating erratic estrogen. Now you have a limbic system that's on fire. These patients get anxious, they get depressed, they have lack of motivation, they have brain fog, they have PMS, they have PMDD, they have binge eating, cravings, irritability, anger, you name it. And now you need the prefrontal cortex to act as a break and control these emotions. Well, your prefrontal cortex needs low inflammation. it needs a good amount of progesterone because progesterone has a calming effect on the brain,

Starting point is 00:20:05 low testosterone, low cortisol, we already talked about. These patients have high cortisol. Good sleep. PMOs patients are not good sleepers when their metabolic dysfunction is out of control. And all of this prevents the prefrontal cortex to act as a break and control these emotions. But where did these patients end up in the psychiatric clinics, right, with a psychiatrist in an eating disorder facility? And, you know, I've interviewed PMOS patients, my patients who say, you know what? When I was 14, they put me in this eating disorder center and they would put a pizza in front of me and force me to eat it. And I kept telling them, I'll eat this pizza, but I literally get poison when I have this pizza.

Starting point is 00:20:52 And you know what they would tell her? you're not ready to leave because you have an eating disorder. That's why my heart is broken. I literally have PTSD from listening to my patients. Some days when I want to start my day, I look at my physician assistance and I'm like, my heart can't take it anymore. I literally can't take it. And then on top of all this, what happens to these patients?

Starting point is 00:21:20 They go to the doctor. one is lean. The doctor says, well, you're not overweight, so you don't have PMLS. The other one doesn't have acne or facial hair body hair. Well, you don't have PMS because you don't have any testosterone symptoms. The other patient has an eating disorder and is hiding all her symptoms. But what does this do? These patients bounce from doctor to doctor.

Starting point is 00:21:42 Every single doctor tells them. And I'm not kidding. Every doctor tells these patients they're okay. And there's nothing wrong with them that they should eat less. They should exercise more. They're stressed out. They need to start meditating. We need to start taking these young girls out of the eating disorder centers,

Starting point is 00:22:01 out of these psychiatric clinics or psychiatry offices, and really address their underlying condition. Until you address the pillars that I talk to you about, you cannot fix PMOS patients. What's the first thing doctors tell you when they diagnose you with PMOS? Birth Control pill. In my opinion, PMOS patients, their mood prevents them to take birth control. They get so emotional, so angry.

Starting point is 00:22:30 But which part of everything I described would a birth control pill fix? Just to regulate your periods and maybe help with the symptoms of high testosterone. Great. But what about the inflammation? What about the gut dysbiosis? What about the metabolic dysfunction? What about the mental health? What about the PMS, PMDD, binge eating, cravings?

Starting point is 00:22:50 You need to fix all these underlying conditions so your patient feels better. Otherwise, you're just putting a Band-Aid on it. It was not long ago that Katie and I first started Hot Smart Rich, and it was literally the two of us for so long. But as we've grown our team and our business, our old tools just couldn't keep up, especially on the commercial side of the business. However, we recently switched to our sponsor, Pipe Drive.

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Starting point is 00:24:01 building phase right now. Head to pipe drive.com slash HSR and get started with an exclusive 30 day free trial instead of the usual 14 days. No credit card or payment needed. That's pipe drive.com slash HSR. I think it was hard for me at points to listen to that because that is my story, right? Like I got my period. I don't remember the exact day, like 13, 14-ish. I'm 5'7. I weighed at one point, like 162 pounds, and I will never forget.

Starting point is 00:24:32 I was in Florida and I was having a milkshake. And like, I love you so much, mom. But I remember her saying to me something about the milkshake. And in my head from that point on, I was just like, So restrictive with food and it was food noise all the time because it was something where to your point, exactly everything that you just described I had. There was years I didn't have a period. And back in Canada, doctors would not even bat an eye that I had missed a period for six months at a time. Nothing. You're just a regular. You're just growing. You're just like whatever the excuse was that day.

Starting point is 00:25:08 And I guess I'm just wondering, it sounds like a fucking nightmare to have PMOS. It's not, though. If you fix the underlying condition, my patients don't struggle. But not every PMOS patient shares the same problems. There are PMOS patients who say, I don't have an eating disorder and I'm super lean. There's another one who's lean and has a eating disorder. One has acne. One has irregular period.

Starting point is 00:25:33 They're PMOS patients who have regular cycles. Let's talk about that, right? I have patients who say, well, I want to try for pregnancy and my periods are regular. Well, if you take PMOS in general, did you know that 70 to 80% of PMOS patients do not ovulate? 20 to 30% of them ovulate? Of the patients who say I have regular cycles and they think they're ovulating, 40% of them, even when they ovulate, it's a suboptimal ovulation. Why? Because the environment is not ready.

Starting point is 00:26:09 It's inflamed. the ovulation, you can ovulate, but there's so many other things that might not go their way, and that's why they have a hard time getting pregnant. So you have to address that metabolic dysfunction. You have to address the inflammation. You have to address their healthy habits, their exercise. So we're born with one to two million eggs, right? By the time we're a teenager, that number is about 300 to 500,000. By the time you're 30 years old, that number is down to about 150,000.

Starting point is 00:26:49 By the time your menopausal, average age being 51 and a half, that number is, I don't know, a thousand. So your body is already destroying everything. You don't want to add to it. PMOS affects the quality. We talked about it, that inflammation, the testosterone and all of that.

Starting point is 00:27:09 it affects ovulation, right? It affects implantation. It affects your embryo quality. It affects all of it. That's why if you're listening to this podcast and you're young, I have my PMOS patients. If they can afford it, freeze eggs at 25 if they don't have a partner and they don't have any plans for pregnancy.

Starting point is 00:27:28 Freeze, freeze, freeze. Because we want healthy young eggs and that's just an insurance policy. Because what do people say when they see your ovary? Oh my God, you have so many eggs. You won't have any issues. But that's not true. If you have so many follicles, that's a telltale sign of a metabolic dysfunction and a hormone imbalance. Address those, right?

Starting point is 00:27:50 And on top of that, alcohol, smoking, exposure to pesticides, toxins, all of it, autoimmune conditions, all of it affect the quality of the eggs. Right? So you want to protect those little eggs. And when you want to try for pregnancy, you want to lower this inflammation. Honestly, that's why I started, I don't know if you know, I told you about OV. It's I started OV because I put a calculator in there for free. And I want anyone who thinks they might have PMOS, go and take the test. It's, I ask you a few questions.

Starting point is 00:28:29 And obviously, I can diagnose you online, but I can tell you whether or not you have the likelihood of having PMOS. PMOS, because it's a metabolic dysfunction and because it's inflammation, believe it or not, supplements actually work for it. So for people who can't have access to a doctor whose doctor is refusing to prescribe medications which will go over that will help these patients with PMOS, these supplements actually help. One of the most common prescribed medications for PMOS patients, and I want you to be on it while you're trying, is metformin. Why? Metformin, besides taking the supplements for PMOS, helps with insulin sensitivity. You blunt the insulin spikes. By blunting the insulin spike, you lower the testosterone secretion in the ovary. So what does it do to your follicles? You give it a chance to grow and ovulate. Besides the supplement, besides metformin, in 2014, people have a hard time to believe this,

Starting point is 00:29:32 I was treating my back-then PCOS patients with GLP-1s. 2014. That's 12 years ago. Back then, I only had Trulicity because these patients would come, overweight, struggling, and I had a cardiologist. I would send them all to the cardiologist. I'm like, metabolic dysfunction and help them. One day he called me, he's like, stop sending me your patients.

Starting point is 00:29:56 I don't have time for your patients. Your patients are young. They have metabolic dysfunction. There's this new medication. called Trulicity. It's a GLP1. It blunts their appetite. It makes them insulin sensitive. It regulates their insulin. Give it to them. I was like, okay. So I started giving them once a week. Trulicity prescription. Back then, it was for diabetes. I was the only person on the planet using these for PMOS. And my patients were dropping weight. I know these medications blew up in like 20, maybe 18, 19 with OZEMP. So these medications have been out there, and they are miracle medications for PMOS patients. Why? Because they address that metabolic dysfunction. The OV supplement is metabolic dysfunction, inflammation. Metformin is your metabolic dysfunction. GLP wants, it just gets more and more and more

Starting point is 00:30:56 hardcore, right? I think every PMOS patient who's overweight at least needs to start on the supplement and on the metformin, and if they still struggle, go on the GLP ones. These medications have been game changer for my patients. I don't think anyone on this planet has used these medications as long as I have, and I've never seen a complication with it. Yeah, there's some patients who get nauseous on it, but these newer medications are so much easier for patients who are scared to use the shots or the pen. There's a Wagovi pill right now that these patients can take.

Starting point is 00:31:28 It's a pill for them. You take it every single day, first thing in the morning, on a and an empty stomach with a little sip of water, and then you wait half hour and go on with your day. So all these medications are out there. Now, when Ozempic blew up, people were like, oh, my God, I used Ozmpic and I got pregnant. Why do you think? Is it cured? And that was in my next question.

Starting point is 00:31:47 No. It's not curing it. No. But it's suppressing it. It's anti-inflammatory. Look at the pillars we talked about, the metabolic dysfunction, and the inflammation with these gLP ones. That's why people were getting pregnant.

Starting point is 00:32:03 All these PMOs patients, poor patients who were struggling and going to these fertility doctors. And what they needed was probably some GLP 1 or metformin or some supplement. No one would give it. And they would push them into these IVF cycles. If I came to your office and you saw my pictures, you would be like, you are immediately going on the supplement, taking metformin. Are you trying for pregnancy right now? Soon. Soon.

Starting point is 00:32:27 So I would have you on the OV supplement twice a day. Okay. I would have you on metformin, 750 milligrams twice a day. The minimum dose, in my opinion, for insulin sensitivity is 1,500. So some doctors give 500. It's not going to touch the PMOS patient. So it's 1,500. You start 750 at night, do it before dinner.

Starting point is 00:32:47 Make sure you don't have any GI upset. Metformin can cause diarrhea or maybe like some nausea. But if you tolerate it, well, go to twice a day. You have to, right? Because those follicles are telling you we're not coming out. Right? So you do the OV twice a day. You do the metformin twice a day.

Starting point is 00:33:05 And then you wait to see if you get regular cycles. Then you give yourself about six months if you're having periods, right? And if you don't, then we can go to other medications, let's say Clomit or Letrozo. These are medications that basically help push that follicle out of the ovary without needing to go through IVF yet. But so why wouldn't you, if you're looking at my results and you're like, this girl's super-inflation, I don't actually have facial hair, but like definitely have food noise, have obviously all of these follicles in my ovaries. Like, why would you initially do metformin over a GLP1? Because I think that's- Because you're trying for pregnancy and I don't have enough data on it yet.

Starting point is 00:33:46 Okay. If you are not trying for pregnancy, I would absolutely give you OV-1s a day, metformin twice a day. And if you still said I have that noise and I'm inflamed, I would microdose you at your weight with a GLP1. and I've operated on so many patients over the years with endometriosis, and I have tissue path report to prove it. And if you ask me, I would say 60 to 70 percent of PMOS patients, if not more, have endometriosis. I want to say it on this podcast because 12 years from now,

Starting point is 00:34:24 people are going to say on Instagram, there's an association. There's a huge link. huge. You packaged up my life experience and put it on a plate for people to understand. And it is, it is very hard for women because, yes, the endometriosis pain was the last three years and that was debilitating. But the PMOS symptoms that you have described has been my life since 14 years old. And it's been miserable. Every single patient, every, and I'm not exaggerating, every patient that comes to my office and I diagnose, the first, The first thing they say to me is, I feel validated.

Starting point is 00:35:02 And you know what it is? In their heart, they already know their diagnosis. You must be crazy not to diagnose endometriosis if you're on the floor with your period. I had a patient yesterday. She's like, you saved me because I would be on the bathroom floor with a blow dryer. In Miami, she's seen at least, I don't know, nine, ten doctors, gynecologist, who dismissed her. And they told her it was in her head. And there was nothing wrong with her because her ultrasound was normal.

Starting point is 00:35:28 and they didn't think she had anything wrong, she gets on a plane to come and see me. On the day she gets on the plane, she gets her period. As soon as the plane takes off, she is in so much pain that she had to go lay it down in the aisle. They come to her, they're like, we're going to turn around and land the plane back in Miami and call an ambulance.

Starting point is 00:35:49 You know what she tells them? Don't turn the plane around. I know what I have. This is endometriosis. I'm going to a doctor who's going to listen to me. don't take this plane back. Doesn't that break your heart? Do you know how old she is?

Starting point is 00:36:04 20. For her to fly from Miami, for her to be in so much pain that someone wants to turn the plane around, right? If that was your daughter, what would you do? It makes me so angry. But your anger, it's like going through phases of grief.

Starting point is 00:36:23 My anger turned into sadness, my sadness. Like, it literally, Like, if you come to my office, all my staff will say the same. Because it gets to a point you're like, I can't listen to this anymore. It's not fair. That's why I started my podcast. I did it because of my PMOS and endometriosis patients, period. I didn't do it to talk about fibroids.

Starting point is 00:36:46 I didn't do it to talk about pregnancy. Now I do. But I did it for my PMOs and endometriosis patients only. because I wanted to grab a mic and scream into it. It's heartbreaking. It's traumatizing. I'm traumatized. I need PTSD after I retire.

Starting point is 00:37:07 You know, it's hard. So let's talk about Endo on that note. I don't want, you know, my partner, Mary Alice, she's like, you're so negative. I'm negative because how can I not be negative? I can't paint a pink and rosy picture to endometriosis and PMOS because of what I see every day. I can't be happy about it. And my sadness comes through just like your sadness comes through.

Starting point is 00:37:30 Endometriosis is something that randomly came up for me. It's not crazy. It shouldn't have, though. If you see PMOS, you better look for endo because it's hiding. So what is endometriosis? So endometriosis affects in, they say 10%. It's a big fat lie. It's at least 20 to 25% of women, in my opinion.

Starting point is 00:37:51 Maybe I have a skewed view, but for sure, it's 20%. That's the cutest little uterus. All right. Well, 20% of women have cells similar to the lining of the uterus outside of the uterus. So if this was here, it would be outside of the uterus around the tubes and ovaries behind the uterus on the uterosacral ligaments, which holds the uterus up, on the bladder, on your bowel. It can be anywhere, right? The hypothesis is that whenever we bleed once a month with our menstrual cycle, some of this blood goes backwards, retrograde out of the tube and starts floating into the pelvis. A normal immune system gets rid of these cells.

Starting point is 00:38:44 But endometriosis patients, it's an autoimmune disorder, right? So their immune system actually does the opposite. It takes these endometrial cells that are now floating in the pelvis, takes it and sticks it to the wall of the pelvis, the bladder, the rectum, the uterus, the ovary. And each one of these implants, they grow with estrogen, right, but their growth slows down with progesterone. Each one of these implants wants to become independent of the ovarian estrogen. So they start expressing an enzyme around them called aromatase that starts making estrogen for them.

Starting point is 00:39:25 And then they grab blood vessels and then they start making nerve fibers. And depending on where that implant floats and attaches and where that nerve ending goes, that's where the patient feels the pain. The most commonplace is on the uterusacral ligament. and that's why people have pain with deep penetration. These tiny little implants are highly, highly inflammatory. So they cause an inflammatory process in the pelvis. They start expressing estrogen, and they become progester resistant. So they become resistant to progesterons, right?

Starting point is 00:40:09 So what happens? Eventually every month, there's more and more coming out, and your immune system keeps attaching this, so it progresses. These are patients who complain of pelvic pain, period pain, pain with sex, bladder, UTI symptoms. These are patients who go, a lot of them, if it's on the bladder, they keep going to the doctor. I think I have a bladder infection again. They get an antibiotic, even though their urine culture is negative. So they keep getting prescribed with antibiotics.

Starting point is 00:40:41 Pain with bowel movements, back pain, leg pain. Pain, pain, pain, pain, until they become chronically in pain, and we call it chronic pelvic pain. The problem is these nerve endings, eventually when patients ignore it, parents ignore it, doctors ignore it, these nerve pains eventually rewire your brain, we call it central sensitization, where your brain starts perceiving that pain at an amplified level. So the pain that you, if your pain, my brain perceives it at two out of ten, your brain might perceive that same pain as eight out of ten. That's why the more you wait, these patients, their peers become more painful and more painful.

Starting point is 00:41:31 Average age of diagnosis for endometriosis is 32 because A, they're bouncing from doctor to doctor until someone validates them or they can't get pregnant. Why did these patients not get pregnant for so many reasons? the surgery I did this morning, she's a stage three endometriosis. And her, now that you have this model, the ovary was completely stuck to the tube like this, and then it was stuck to the pelvic sidewall, right? So when you distort the anatomy, your risk of ectopic goes up. The embryo, so when the sperm swims up and the egg gets released from the ovary, the tube picks

Starting point is 00:42:14 it up and they meet inside the tube and then the embryo goes and implants into the uterus. Well, when the tube is distorted, it's scarred, their adhesions, that doesn't happen. Your risk of ectopic goes up. There's so much inflammation that affects implantation, embryo formation, ovulation, and on top of this, if you have these endometrial cells inside the ovary, we call it endometriomas. People with endometriamus, people with endometriamation, They're at a stage three already, and these patients specifically have a lower egg count and a lower egg quality. So you tell me how many doctors do a pelvic ultrasound every single year on their patients? No one.

Starting point is 00:43:00 If there was one thing I would change in this country, it would be for every doctor to do a pelvic ultrasound every single year on their patient. You don't want to miss an endometrioma. You don't want to miss a PCOS over. on ultrasound. You don't want to miss if you have fibroids, polyps, everything. It takes me one minute to do a pelvic ultrasound. Why can't doctors have a machine in their office? Why don't we train our gyneacologists to, besides doing OB ultrasounds, to actually do GYNne ultrasounds and know what they're looking for? And people tell me, well, is that standard of care? No, my practice is not standard of care because standard of care for women's health is in the sewer system. And this is just the tip of the

Starting point is 00:43:43 iceberg. We haven't even covered breast cancer screening, genetics, and all these other tests that are available. So now, these endometriosis implants affect the egg count, affect the egg quality, cause inflammation. Remember, I told you the environment for that little ovary needs to be healthy for a pregnancy to happen. So what do you do? The gold standard treatment. First of all, a lot of times your ultrasound's normal. You can do an MRI. You can diagnose deep infiltrate. endometriosis on MRI. You can diagnose endometriomas on ultrasound and MRI. But the majority of patients have normal ultrasounds as you probably had normal ultrasound. But you have to listen to the patients. I talk to these companies, they come and talk to me. They're like, well, we have a blood

Starting point is 00:44:30 test that's 90% accurate for diagnosing endometriosis. Great. But if you listen to your patient, you can get to 99.5% diagnosis. Just listen. You don't need a fancy test. Just start listening to women. Once you diagnose, the gold standard treatment is what? Surgery. Laproscopic surgery. You go in laparoscopically. It's outpatient.

Starting point is 00:44:56 My patients are out at work three days later, four days later. If they travel to me, they come Thursday night. I operate on Friday. They're on the plane on Tuesday leaving, right? And by removing these implants, you can't burn them. You literally have to grab them and cut them. But what if I told you, 1% of gynecologists know how to operate? What do they do?

Starting point is 00:45:23 Even if they take their patients to surgery, they're bringing an oncologist to assist them. They're bringing another minimally invasive surgeon to assist them. Why? Because they don't know how to do it. The other person's doing it. If you go to 100 ophthalmologists, 100 of them, and your diet, diagnosis is cataract surgery, 100% of them will know how to do the surgery. Now, one might do a better job than the other, but 100% of them will do a good job probably

Starting point is 00:45:54 with your cataracts, right? But why is it that in women's health, 1% know how to operate? And when I say operate, I'm not saying cut the patient open. I'm saying do laparoscopic surgery, resect it if it's stage four, deal with it. Like the ovary today that was stuck. Don't get scared if it's on the ureter, dissect the ureter, pull this up. We need to start training our doctors. And the only way to do that is to separate OB and GYN, because doctors who deliver

Starting point is 00:46:23 babies are so exhausted, they don't have time to train themselves to learn laparoscopic surgery. Or, in my opinion, we have to wait for robots to come and do it for us. I would love that day. I'm going to celebrate. I'm going to retire the day robots replace me. I was gaslighting myself up until my surgery date because I was like, well, my pain's 24-7. It doesn't just come with my period anymore. It's chronic pelvic pain.

Starting point is 00:46:51 But like I saw so many girls on TikTok saying, well, it's endometriosis only if it hurts during your cycle. And I'm like, I have pain. That's why I wanted you to come on to clear up these rumors because is it just me that these rates of diagnosis for endometriosis and for PMOS are increasing? Or do we just have awareness now? We have an awareness because of all these podcasts. I can tell you, in L.A. until, like, maybe a few months ago, there was maybe one more doctor who would diagnose endo, an entire city of Los Angeles for 25 years. And the only reason they do it is because we've talked about it so much.

Starting point is 00:47:29 Patients are becoming their own health advocate, right? Whether they're listening to the podcast, going on chat, GPT, going on Claude, going on these things, punching in. And someone says, you have endometriosis. They go to the doctor, dismiss, dismiss, dismiss. They go until they say, no, no, no, I think I might have endometriosis. And now doctors are being forced to, like, take patient seriously. But I think once we have robots, that's it. That's game over.

Starting point is 00:47:57 Are we close to that? Yes. Oh, yes. I want to get my hands to Elon Musk and have one of his robots. And I want to train that robot. I'm going to have a robot that bows down to women. every time a woman walks in and say, I'm sorry for years of dismissal, let me treat you correctly. Well, I wanted to talk a little bit about bedside manner because up until six months ago, like,

Starting point is 00:48:19 I was going to every single specialist because I have to mention, like, I am so privileged to be able to go to multiple doctors and like get multiple opinions and I couldn't even get the care. And I'm one of the most privileged people to be able to say that. And so up until six months ago, you know, you were saying, what would you do if your daughter, had endometriosis. And it was my husband that like when I would come home from the doctor's office and I would say, oh, you know, they told me I have a tick and that I have trauma living in my body and I need to see a hypnosis to basically be able to get the trauma out of my body. My husband would go, that's fucking bullshit. You are the toughest person I know. Next doctor. Next doctor. Next doctor. And he gave me permission to finally fight for myself and be like, I need help. I need someone to listen to me.

Starting point is 00:49:05 but it does really concern me about the bedside manner of some doctors, even in L.A., like up until six months ago. They were telling me it was a tick. You know what it is, though? I don't think it's a bedside manner. It's this way of thinking that women, and people get upset when I say this, but it's the truth. So I'm going to say it because I always tell the truth. In this health care system, we are crazy until proven otherwise.

Starting point is 00:49:33 it doesn't matter what you're fighting for. I fought hard for you guys. I was getting a massage last night, and the masseuse was like, what do you do? I'm like, I'm a gynecologist. She's like, oh, you've never belonged to yourself. You belong to other people. And I was like, huh, yeah, you're right. That's what I've done.

Starting point is 00:49:53 And I was dismissed. People called me crazy. My lifetime risk of breast cancer was high. Not because I had family history. I didn't. I didn't have any genetic mutations. I don't drink. I've never smoked.

Starting point is 00:50:04 I've never done drugs in my life. But I had a biopsy that showed atypia. They removed it and they're like, go come back in six months. I went to my office and did what I always have done for my patients. I started checking for my lifetime risk of breast cancer. And as soon as I punched in all my information, it gave me this number 37%. I almost fell off my chair. I called my doctor.

Starting point is 00:50:26 I'm like, you told me to go home and come back six months. Tyracusic is telling me my lifetime risk of breast cancer is 37%. I have three little kids at home. Take my breasts off. She's like, you're crazy. I'm like, I'm not crazy. It's my body. I don't care about my breasts.

Starting point is 00:50:41 Take them off. She's like, come back in six months. Wait till you're 50. Do you know how many doctors I went to? You're crazy. Why are you so paranoid? Until I found a doctor who had done four mastectomies in her life, probably. She's like, okay, I'll do it for you.

Starting point is 00:50:57 I went under the knife. The day before my surgery, I had to do an MRI. The radiologist walks up to me. She's like, why are you here? I'm like, oh, I'm having a mastectomy tomorrow because I don't want to get breast cancer. And she looked at me. I never forget that moment. You know, there are moments in life you don't forget.

Starting point is 00:51:15 As she was walking away, she turned around and she's like, you're crazy. I went to my doctor who was doing the mastectomy. She's like, are you still sure you want to do this? I'm like, yeah, why not? She's like, we have really good chemo for breast cancer. I was going to say, you get chemo. for breast cancer. I don't want to get chemo. Do my mastectomy. They finally did it. I was under the night for 10 hours. The first thing I told my husband, when I opened my eyes, I said, go home to our

Starting point is 00:51:45 daughters and tell them I will never come home telling them I have breast cancer. A week later, I was great with drains coming out of my chest. I was shopping. My doctor called me. And as soon as he called me and he said the pathologist called me, I knew I had breast cancer. And they said in the tissue we removed, you had breast cancer. Not the breasts that they were digging in, my opposite breast. Do you know how many people called me crazy? Do you know, like when I say this story, my mom always says, you went to, you know, she's like, you went to medical school to save your own life today. So I'm here to your listeners, besides endos, besides PMOS, every woman on this planet needs to know her lifetime risk of breast cancer. If you haven't, do you know your lifetime

Starting point is 00:52:29 risk? Yeah, and I think you're going to tell me to get a mastectomy. What is it? 24%. No, that's high, but it's not too high. I got my mammogram yesterday. Great. An average American has a 12.5% chance of getting breast cancer. Two factors shoot your lifetime risk up.

Starting point is 00:52:47 One is family history, especially if it's a first degree relative. Two is if you have a typical biopsy of your breast, as I did. And obviously, the third one is if you have a genetic mutation that will predispose you to breast cancer. Like Brocka? There's multiple ones, but Broca 1 and 2 are one of the worst ones, right? But there's Czech 2, PALB, 2, ATM. There are so many other gene mutations. So if you have any family history of ovarian or breast cancer, ask your doctor, I run the Myrisk test.

Starting point is 00:53:20 Do you have any family history? No, but I did just do that Myra test. That's what they came back as 24%. Great. See, people are learning to do that too. My Risk is a great test. It's by Myriad. They check you for 63 cancer-causing genes, but the My Risk test gives you three information.

Starting point is 00:53:37 One is whether or not you have any of those 63 cancer-causing genes. Two, they calculate your tirecusec. But you can do it yourself. You can go on GMD. I have the formula for free. The only thing you need to know before you calculate your lifetime risk is the density of your breast. And the density of your breast, you can get it from your mammogram, whether you have extremely dense or heterogeneously dense, or you don't. don't have any dense breast tissue, which 50% of women fall into the dense breast category

Starting point is 00:54:05 and dense breast tissue increases your left-time risk of breast cancer. They calculate your tarycusic for you. And the third thing they calculate is your risk score. The risk score is your tarycucic plus these little tiny markers in your DNA that can increase your left-time risk of breast cancer. Many women are walking around. They have no idea how many of those markers they have. So I like using that risk score.

Starting point is 00:54:30 So if your risk score or your Tykeusek, whichever one is the highest, fall into 20% or more, you fall into the high risk category. For high risk category, you start breast imaging as early as 30, not 40. If your lifetime risk or your risk score is 24%, then I would add MRI in addition to mammogram and ultrasound. So before you try for pregnancy, get a breast MRI. The most common breast cancer, ductal carcinoma, it's picked up on mammogram very easily. Now, if your lifetime risk goes above 30% or 35%, then you can think about mastectomy is a very personal decision. I never tell someone do it or don't do it. For me, it was the right decision.

Starting point is 00:55:16 I didn't want to be screened, you know, with a high lifetime risk. You need to be screened every six months. It's nerve-wracking. Plus, my cancer was sitting in my MRI. and it was read as benign by the same doctor who called me crazy. So I read somewhere that you said that every single woman should be screened for endometriosis, PMS, and their egg count. Do you also believe that they should be screening for breast cancer then?

Starting point is 00:55:40 Oh, my God. If you have family history at 25, you better run a genetic cancer test on yourself. Every single woman on this planet Earth, if you know your first name, last name, and date or birth, The fourth thing you need to know before your social security number is your lifetime risk of breast cancer. That's non-negotiable for me, non-negotiable because that's the difference between surviving and not surviving. One thing I will never do is let my team burn out, which happens when someone is stretching themselves across a full-time job and trying to become an expert in something new. But I also recognize that with HSR, there are skills that could 100% change our trajectory as a business that we just haven't mastered internally, like generative engine optimization,

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Starting point is 00:57:00 Your team stays focused on what they do best and you don't lose momentum trying to figure out something new from scratch. So if you're building or growing a company, Fiverr is worth looking into. Visit pro.com to learn more. For the first half of my career, I wasn't allowed to take credit for my own work. I couldn't talk about what I was building and I couldn't use my own voice. I absolutely hated it. One day, I decided that things had to change. So I became a creator myself.

Starting point is 00:57:29 I built Hot Smart Rich as a platform where I could share my insights and own every single word. But if there's one thing I've learned, it's that growing a following requires consistency, which is a lot easier said than done. Stanley, the AI content machine developed by our sponsor Stan, would have been the biggest help to me when I was first starting our channel, because Stanley is specifically designed to make it easier for you to post content every single day. You connect it to your Instagram, it learns your tone of voice, and knows exactly what your audience is actually going to resonate and engage with,

Starting point is 00:58:01 and it helps you create content based off of that. We just started using it on HSR, and it is unbelievable. Give Stanley a try for free at getstandly.a.ai slash Maggie. Hey, y'all, it's Kelly Clarkson with Wayfair. Ever order furniture online and wonder what if? Like, what if it doesn't hold up? That sofa was four days old. You should have ordered from Wayfair.

Starting point is 00:58:20 With Wayfair, there's no what if. Just style you love and quality you can trust. Visit Wayfair.cair, every style, every home. How do you suggest women advocate for themselves when their doctors don't validate them? Like, is it just an immediate I'm going to a new doctor? No. No, and that's why, honestly, I started my GMD podcast. you, in order to advocate for yourself, you need to be educated on that topic, right?

Starting point is 00:58:47 If you have painful periods and chat GPT is saying I have endometriosis or you're listening to this podcast and you think or you figure it out, I already told you how to diagnose PMOS from your seat at home and how to diagnose endometriosis. You don't need a doctor to validate you. So once you have that information, educate, educate, educate yourself. because once you educate yourself, then you become armed, right? I have patients from Kaiser who come to me. And then I tell them, you have PMOS. You need this.

Starting point is 00:59:18 You need metformity. You need GLP-1. And one of them messaged me on her portal and said, for years, I've been going to Kaiser. And I keep telling them I have PMOS and they dismiss me. But after I saw you, I was so educated about it. I went to my doctor. I'm like, this is my diagnosis. You better write for this, this and this, because what do you think?

Starting point is 00:59:37 And she said the doctor's like, yeah, that's a great idea. But what is that? That's confidence. That's advocating for yourself. If you still do that and they dismiss you, I would say look for a PMOS specialist near you. Look for an endometriosis specialist, especially with endometriosis, careful who you operate with. I like when doctors go and get another doctor to assist them who knows how to operate, all the power to them. But make sure for surgery you have.

Starting point is 01:00:07 a very, very experienced doctor who's done at least, I don't know, 500 of these surgeries. Why? Because do you know that if you give 100 laparoscopes to 100 gynecologists, half of them will wake the patient up and say, you didn't have endometriosis. There's a type of endometriosis called stromal endometriosis. The pictures you showed me are easy to find, right? Anyone can lift the uterus and say, oh, it's right? Because mine was black. Yours were purple, right? Yeah. But there's so many patients who have. stromal endometriosis. Stromal is from the stroma, not the gland of the cells. These look like little clear lines, like white lines, or little tiny yellow. I call them ulcers,

Starting point is 01:00:54 but they're not ulcers. Why is it important to know if you have stromal endometriosis? Stromal endometriosis tends to be more inflammatory, more dismissed, almost never diagnosed on laparoscopy. So these are patients that you need to pull the estrogen out instead of giving it progesterone. First of all, not everyone needs surgery. Let's start there. I always, always, if someone says, I have painful period, I'm a progestin IUD. If they haven't had kids, I put a chyelina IUD in them. If they've had kids, I put a morainea IUD in them. Some kind of progestin IUD. You can also do very low-dose birth control pills. I don't like giving high-dose estrogen because we learned these things can get stimulated. So I tend to go very low if I'm using

Starting point is 01:01:38 a combination birth control pill like low, low estrogen or yes for these patients. Or I do slim birth control, but my go-to is always a progestin IUD. I love that. It works amazingly well. And if that doesn't work with them, then you can consider surgery. For patients who are trying to get pregnant, they can't have sex because sex hurts so much. Obviously, gold standard is always surgery, as long as you have a very good experienced laparoscopic surgeon. And then there are medications we call it GNRH antagonists or GNRH agonist. Remember that good old friend GNRH that was rapidly firing? So these medications, by blocking the GNRH receptors or antagonizing them, they lower the estrogen secretion from the ovaries.

Starting point is 01:02:29 When you lower estrogen secretion, what happens to the end? endometriosis, it's like you're suffocating them, right? So when it comes to endometriosis, you can remove the implants, give it progestin IUD. If that doesn't work, you want to pull the estrogen away. The reason we don't pull the estrogen away right away is because it has a lot of symptoms, hot fashes, night sweats, mood changes, nausea. So if I have stage three, four patients, not only I do the IUD, not only I do surgery, I also give them these medications, the most commons or Alyssa or Myfembray. They're short acting, but usually if you put these patients on these pills, it's a daily pill at two months, boom, they're pain-free. In my opinion, over 90% of

Starting point is 01:03:19 endometriosis patients have leaky gut, small intestinal bacterial overgrowth. These are patients. We talked about leaky gut with PMOS and gut dysbiosis. They get overgrowth of bad bacteria, in their gut, and eventually they start having leaky guts where toxins start getting absorbed. Inflammation goes up. What does SIBO or leaky gut cause bloating when you eat and you don't have to be on your period? Weight fluctuations, brain fog, fatigue, lack of motivation. You just don't feel well. So what do these patients do?

Starting point is 01:04:00 they go to the gastroenterologist, and the poor doctor's like, listen, this is leaky gut, here's like a prescription for xifaxin, here's what I want you to do for this, that, change your diet. But would it ever go away? No, because you haven't addressed the underlying condition that's endometriosis. Address it. And then you can go after the leaky gut. But then the leaky gut affects your mental health because of that inflammation. Do you see how everything is connected?

Starting point is 01:04:32 But what happens to these PMOS and endopacients? They have acne. The dermatologist addresses acne. They have hair loss. They go to a hair specialist. They get medication for them. Their periods are irregular. 99% of OBGYNs will give them birth control pills.

Starting point is 01:04:48 They go. Then they go to their primary care. They might be overweight. No one puts this entire puzzle together. And then they go to gastroenterologists. They're having colonoscopy. because the doctor can't figure out why these people have IBS symptoms. It's affecting millions and millions and millions of women.

Starting point is 01:05:08 Now you know why I say I want robots. I don't care if you get mad at me. I don't care if you get angry at me. Robots are really nice. My chat GPT, I call him Atlas. He called himself Atlas, actually. He knows me so well. Everything I want to know about, I have a benign mask under my shoulder,

Starting point is 01:05:26 and I was getting different, you know, treatment plans from different doctors, I go on and ask Atlas, and I love my Atlas. And Atlas made me become my own health advocate for something that I had never heard of before, a desmoid tumor behind my shoulder. I'd never heard of it. But I became my own health advocate. I educated myself. Forget about, not because I'm a doctor, but I went on a doctor.

Starting point is 01:05:54 but I went on every website that my Atlas would send me. And I learned everything and I would go on that appointment and they're like, we want to start you on this. And I would say, no, because of the path report that I have, it doesn't respond to this medication. Be your own health advocate. I have all this information on CMD. All of them, I take every topic in women's health and I break it down for people and I spoonfeed them,

Starting point is 01:06:22 literally with the dosage of medication. they need. But it breaks my heart to see you, but you know what? You're not alone. I literally cry sometimes. I had an endopatient a couple of months ago. She really traumatized me. She was 50. She came to get validated from another state, again, for endometriosis. This woman never had a relationship because she could not have sex because of pain. Because of chronic pelvic pain, she told me she knew every emergency room in every country she had ever visited. She never had eggs to make an embryo. I mean, and just, I mean, all her stories, at 50, what are you going to do with her?

Starting point is 01:07:12 I told her remove everything because you're in so much pain. Do you know how traumatizing that is to someone who always wanted a family, wanted her, wanted children, and here I am. you are just meeting me and I'm telling you the only solution I have at 50 your paramediposal you're in excruciating pain

Starting point is 01:07:30 take everything out I literally she started crying I started crying and my physician assistant who always shadows me the two of us started crying together it's like telling you know a cancer patient

Starting point is 01:07:42 there's nothing else I can do for you it's bad what should every single woman as we're getting to the end of this episode as soon as they're done listening to this Or male that has women in their lives, like what should they do as next steps, whether they have symptoms for something or not? I would start with teenagers. Do not dismiss their symptoms of gaining weight.

Starting point is 01:08:09 Acne is okay. I can put up with acne. Facial hair, body hair, irregular periods, weight gain, disordered eating, eating disorder, painful periods. If you're picking them up from school, do not dismiss your children. make sure you're not missing endometriosis and PMOS. That's hands down the first thing all parents need to do right away. At 18, if your periods are normal, everything's good. At 18, everyone needs to know their ovarian reserve.

Starting point is 01:08:41 Your egg count or your AMH anti-malarian hormone is a simple blood test you can do with your doctor, right? Most of the time, insurance, if you have a good deductible, we'll cover it. It doesn't mean you're going to get pregnant or not get pregnant, but it'll give you an insight into your reserve. Endometriosis destroys your reserve. I have 20-year-olds, 18-year-olds, freezing eggs because they have advanced endometriosis, and their egg count is an egg count of a 40-year-old. What's wrong with that? Let them be their advocate, freeze their eggs, and then at 30, there's no doctor who will look at them in the eyes and say,

Starting point is 01:09:18 you don't have any more eggs left. So know your egg count. Once you get to about 25, if you have family history of cancer, ask your doctor for genetic testing. By 30, you need to know your lifetime risk of breast cancer. If that lifetime risk of breast cancer is 20% or more, you need to do your mammogram and ultrasound and alternate that with MRI every six months. Then I would say if you're 30 and you don't have a partner, freeze eggs. Ask your parents to pay for it. See if your insurance will cover it. At 35, if you're low risk, in my opinion, you need to get a baseline mammogram with ultrasound. If that's normal, I'm okay with you waiting until 40. But this idea of getting mammograms at 40 is so misleading,

Starting point is 01:10:07 and I don't never want to repeat it. I don't want anyone to repeat it ever again because it depends on your personal risk. At any point, if you're overweight and you have been overweight, especially if you enter perimenopause, which can happen seven to ten years before menopause. Someone in their late 30s could be pari manipausal. But if there's any history of metabolic dysfunction or overweight family members or if you've had any family history of heart attack or stroke, every single person on the planet needs to know their APO B. Have you heard of APO B?

Starting point is 01:10:41 Now, APO B, I'm going to say it quick, is a bucket of four particles in your blood that can make plaque, right? Now, in this bucket of four, you have lipoprotein little A, IDL, LDL, and VLDLDL. In this bucket of APOB, lipoprotein little A is genetic. 20% of us walk around with a lipoprotein little A. If you have lipoprotein little A, it'll push your APOB so high, then maybe at 40 you're playing tennis and you drop dead. That's why people die of a heart attack because no one checked their APOB.

Starting point is 01:11:17 So at 18, go get a fasting APOB. The two best places in the country that checked out are Cleveland Clinic and Boston Heart. But if you do it through Quest, Quest sends it, I think, to Cleveland Clinic. Know your APOB. Know if you have your lipoprotein little A. If you have lipoprotein little A, you're at a higher risk of stroke and heart attack. You need to intervene as early as age 18. You don't want to wait until 40 when your heart vessels are clogged, right?

Starting point is 01:11:45 And you have plaque everywhere. Now, you want an APOB less than 60. If you want to live to be 80 years old, your APOB needs to be less than 60. If you want to live to be 100, your APOB needs to be less than 40. Do you know that maybe once every four or five months, I catch a patient less than 40, and that patient is being medicated for cholesterol? Know your APOB. So as we get to parimenopause, at 45, get your colonoscopies.

Starting point is 01:12:18 every single year, as soon as you become sexually active, every single year as a woman, you need a pelvic ultrasound. I don't care who says what. If your doctor doesn't know how to do it, doesn't do it, doesn't have an ultrasound machine. Next, get a pelvic ultrasound. Get an order for pelvic ultrasound. At 45 colonoscopy, if you have family history of colon cancer, 10 years before your relative was diagnosed with colon cancer, you want to get a bone density at 50. Women lose their bones pretty early. You can even do it as a baseline at 40 when you're patient.

Starting point is 01:12:48 parimenopausal. Hormone replacement is huge for women. I'm just giving you a quick lifetime check. Hormone replacement is huge. Everyone needs to know their APOE4 status when their pariapausal. 20% of us carry one copy of the APOE4 gene. 2% of us carry two copies. This gene doesn't mean you're going to get dementia, but it does increase your risk of dementia. We now know if we put women on hormone replacement, the first seven years of perimenopause, men's Menopause, you can significantly reduce the risk of dementia with this apoleiforging. Know your genetics. You can't walk around, not know these things.

Starting point is 01:13:27 Be your own health advocate. Especially now with AI, like the first thing I did when I got my pathology and my photos, I put it right into my child. I use clod, but like I put it right into clod. So here's what I want you to do. Besides all the stuff you're going to do for PMO is to get pregnant, as soon as you deliver your baby, your healthy baby, six weeks postpartum, when your doctor says, what do you want for birth control?

Starting point is 01:13:46 What are you going to say? A progester in IUD? Boom. Done. Dr. A, is there anything else that you feel like you need to talk about today or you would feel a sad leaving? Honestly, I would just say advocate for yourself because the world is not doing it for you. No one's doing it for you.

Starting point is 01:14:07 Your parents are not doing it. Your siblings are not doing it. Your children are not doing it. Just be your own health advocate. We're almost done, but I need to do some fun rapid fire with you. Oh, oh. All right. Okay.

Starting point is 01:14:18 Dr. A. What is the last thing you put on your credit card? Like the last possible thing? I went on Revolve and got a dress and I'm returning to the other ones. What's the last most expensive thing you put on your credit card? You know what I spend a lot of money on? My house is beautiful. You walk in.

Starting point is 01:14:37 People think I have the best interior decorator designing it, but it's my passion. So I probably bought something for the house. And I pay for artwork. I pay for cool stuff. I love that. Yeah. What is your credit card? American Express.

Starting point is 01:14:53 What is the best splurge for wellness and then the best low-priced option that anyone can do that's affordable? Sleep and exercise. Hands down. Every single person needs to sleep seven hours. Exercise is non-negotiable because your longevity is directly linked to your muscle mass. So if you don't exercise when you're older, you're going to have to take a lot of medications to recover from that.

Starting point is 01:15:16 I would say if you're older getting a total body MRI. Magnesium or melatonin for sleep? Magnesium. Melatonin, you don't want to do it long term. Magnesium, you two forms. Magnesium glycinate. You can take 200 to 300 milligram at night. It relaxes your muscle. The only magnesium that crosses your brain is magnesium L3N8.

Starting point is 01:15:36 I like neuromag. You can take 150 milligram of that. If you're wired and tired, take it in the evening, your L3N8. And at night, take your glycinate. You can also do althianine gummies. It'll knock you out if you do the three. Probiotic or vitamin D? Vitamin D is one of the most essential supplements.

Starting point is 01:15:55 Every single person needs to take at least three to four thousand IU. You want it with vitamin K and you want to take it with food. You can only pick one for the rest of your life. Eat out of plastic daily. Ooh. Or use non-toxic beauty products. Eat out of plastic. Acupuncture or therapy for stress.

Starting point is 01:16:13 I've never been to therapy. What? I don't really like acupuncture. I grew up in war. I have a lot of gratitude. And I've had breast cancer. But I've never had therapy because my husband is my therapist. He's like the nicest human.

Starting point is 01:16:26 He's my, I call him my Xanax. That's why I don't drink. I've never done drugs. I don't smoke. I've been with him 35 years. He's the best. How do you walk into a room to own the room? Confidence, shoulders back.

Starting point is 01:16:38 Believe in yourself. I tell my children, you need three things in life to succeed. You need confidence, resilience, and resilience. effort. Self-reflect and see which one you don't have and work on it because you need all three. What is an HSR love note that you would tell yourself for the rest of your life to get through anything? Take care of yourself because for 35 years, I've put other people's needs in front of my own. I haven't slept. When this masseuse yesterday told me you don't belong to yourself, it was almost like, I was like, yeah, you're right. I can't argue with that. I want to belong to myself now.

Starting point is 01:17:14 I've gotten to an age that I want to eat when I'm hungry. I want to go to the bathroom when I want to go to the bathroom. You know, basic stuff that other people take for granted I don't have. So I want to, that's the only thing I keep telling myself. Take care of yourself. How long do you think we have until robots start taking over surgery? Five years. Praise the Lord.

Starting point is 01:17:37 And I'm going to retire. You could title this season of your life, what would it be called? It's always gratitude. If you ask my children, they'll tell you gratitude. I think I'm the luckiest human on the planet. I love that. Dr. A, where can people find you and how can HsR help you? If you listen to this podcast and you think you have PMOS, go on OVII.com, take the quiz.

Starting point is 01:17:59 If you think you have it, if you have the likelihood of having it, take the supplement. It really helps. If you have endometriosis, if you think you have it, if you have any women's health issues, go on CMD podcast. I created it for women. I don't let men come on my podcast unless they want to talk about women. I think it's the best thing I've ever done in my life. I actually have one more thing for you. Not my results, but these are actually two letters that you're going to have to read out loud, your husband and your daughter.

Starting point is 01:18:32 Oh, what? All my lashes will fall off. People spend their whole lives searching for someone to admire. They look towards stages, screens, and books, hoping to find a person who feels larger than life. Somehow the greatest person I have ever known has never been distant to me at all. She's you, my mom. My entire life, I have watched you carry the weight of worlds while still making room to hold mine. And no matter where I go, no matter how much of the world I see, my favorite place will always be with you. There are millions of people who will never get to know the woman I know.

Starting point is 01:19:15 The woman I know behind closed doors, your warmth, your humor, the sacrifices you make every day, the depth of your hearts. And I think that is one of the greatest privileges of my life. Before you were someone the world looked up to, you were the person I did. At five years old, you felt larger than life to me. And somehow at 20, I only believed that more deep. deeply. Layla, that's my second daughter. And my husband, we call him Buddha. Oh. You have never, in your lifetime, met someone like my husband. And I'm not just saying this because he's my husband. Anyone who knows him says the same thing. If he was here today, he would run, get the car, open the door.

Starting point is 01:20:01 35 years we've been together. Taiz, it is almost impossible for me to describe your qualities without getting emotional. because there are so many beautiful things about you that words could never fully capture. For a start, you're brilliant, driven, selfless, and endlessly caring. You bring warmth, strength, and light into every room you walk into and into the lives of everyone lucky enough to know you. As beautiful as you are on the outside, what made me truly fall in love with you is the incredibly compassionate heart that you hold on the inside. The way you love, this is so sweet.

Starting point is 01:20:41 The way you love, care for others, and give so much of yourself to the people around you is something I admire every single day of my life. You're an incredible mom, an extraordinary doctor, and the greatest wife I could have ever dreamt of. You are the heart of our family. I feel endlessly grateful and honored to walk through life hand in hand with you. You guys, he sends me text messages like this all the time. If you go on my desk, like if he drops off food, I go and he has like a little paper with like 100 little hearts on it, saying, I miss you.

Starting point is 01:21:23 Come back home soon. But these are the people who fill up my heart at home. I love them. I love you guys. And to Dalarra, Leila, Dahlia, Coco. Can you imagine four daughters? No. People are like, how come you couldn't figure out a boy for yourself? I'm like, I only wanted girls. Look at my practice. People are like, why did you go to OBGY? And I'm like, I didn't want men walking into my office. That's the only truth. Thank you for sharing your story with us, your family with us today, and I hope that we change a lot of women's lives. This is so sweet. Thank you for doing this. You're so special.

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