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The Mel Robbins Podcast

What Your Doctor May Be Missing: The Real Reason for Moodiness, Acne, Weight Gain, and Anxiety

This is the health advice every woman, particularly those in their teens, 20s, 30s, and 40s, needs to hear.

Dr. Thaïs AliabadiguestMel RobbinshostGreat Minds

Nov 14, 202643mWatch on YouTube

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CHAPTERS

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Chapter summaries

Why women feel dismissed in healthcare—and why self-advocacy matters
Dr. Thaïs Aliabadi explains that many women’s symptoms and pain are minimized or attributed to stress and anxiety instead of being properly investigated. She frames the episode around learning to recognize signs of common conditions and becoming a persistent advocate for correct diagnosis and care.
- •Dr. Aliabadi says most women are dismissed in the current healthcare system and their underlying conditions go undiagnosed
- •She describes a “well-woman exam” as often being too limited, leaving bigger issues unaddressed
- •She emphasizes becoming your own health advocate as the most important skill women can learn for navigating care
- •She urges seeking second and third opinions when symptoms are dismissed
The human cost of missed diagnoses: fertility, egg count, and years of being ignored
Dr. Aliabadi shares emotional examples of patients whose endometriosis or PMOS went undiagnosed for years, leading to infertility and heartbreak. She describes how delayed diagnosis and lack of egg-count evaluation can leave patients discovering critical issues too late.
- •She recounts cases where endometriosis and PMOS were missed for years, with patients later unable to have children
- •She describes a patient in her 30s with zero eggs after many years of dismissed symptoms
- •She connects systemic access problems (long waits, lack of specialists) with missed diagnoses and poor outcomes
- •She reiterates that women are “not crazy,” but misdiagnosed—and should keep seeking answers
PMOS explained: the new name for PCOS and why diagnosis is often missed
Mel Robbins asks what PCOS/PMOS is and why women struggle to get diagnosed. Dr. Aliabadi explains the updated name PMOS and outlines how common it is, why it’s misunderstood, and why it’s a major driver of infertility.
- •PMOS is described as a new name for PCOS because the older name is misleading
- •Dr. Aliabadi says PMOS affects many women and is frequently never diagnosed
- •She calls PMOS (along with endometriosis) a leading cause of infertility
- •She sets up how simple criteria can identify PMOS when clinicians look for the right signs
How PMOS is diagnosed: the “two out of three” criteria and common pitfalls
Dr. Aliabadi walks through the diagnostic criteria for PMOS and clarifies misconceptions, including why “normal labs” can still fit the diagnosis. She also addresses how to think about cycle history when someone is using an IUD or birth control.
- •Diagnosis requires meeting two of three criteria, not necessarily all three
- •Ovulatory dysfunction includes irregular cycles and having fewer than eight periods a year
- •The second criterion can involve ultrasound findings or a high egg count; elevated AMH can count in adults
- •The third criterion is symptoms of high testosterone (acne, facial/body hair, hair thinning), even if blood testosterone is normal
- •She explains looking back to pre-birth-control cycle patterns when current bleeding patterns are masked
Insulin resistance as the underlying driver of PMOS and its hormone cascade
Dr. Aliabadi describes insulin resistance as a key underlying issue in PMOS and explains the physiological chain from carbohydrate intake to insulin spikes, inflammation, visceral fat storage, and testosterone production in the ovaries. She connects these processes to blocked ovulation and classic PMOS symptoms.
- •She explains how insulin resistance keeps glucose from entering cells, raising insulin levels
- •High insulin promotes inflammatory visceral fat storage and symptoms like bloating and brain fog
- •She says ovaries remain insulin-sensitive, so high insulin stimulates ovarian testosterone production
- •Excess testosterone disrupts follicle development and ovulation, contributing to irregular periods
- •Symptoms tied to high testosterone include acne, facial/body hair, and hair thinning
PMOS and mental health: anxiety, depression, brain fog, cravings, and misdirected referrals
Dr. Aliabadi links PMOS-related hormone fluctuation and inflammation to mood and cognitive symptoms, describing how low progesterone and erratic estrogen can affect emotional regulation. She argues many patients get routed to dermatology, psychiatry, or weight-loss care without the underlying PMOS being recognized.
- •She describes how hormone balance and inflammation influence emotional regulation in the brain
- •In PMOS she links lack of ovulation to low progesterone and fluctuating estrogen, alongside high inflammation
- •She lists mental and behavioral symptoms she associates with PMOS, including anxiety, depression, PMS/PMDD, cravings, and binge eating
- •She explains how patients often end up treated for acne, anxiety, eating issues, weight gain, or infertility without addressing PMOS
- •She emphasizes metabolic dysfunction as the “first domino” to address
How Dr. Aliabadi treats PMOS: lifestyle changes, supplements, metformin, and GLP-1s
Mel asks what to do if someone suspects PMOS, and Dr. Aliabadi outlines a treatment approach aimed at insulin resistance and inflammation. She discusses diet and exercise strategies, supplements, and medications she uses, including metformin and GLP-1s depending on the patient’s goals and situation.
- •She recommends limiting carbohydrates, processed foods, and inflammatory foods as a starting point
- •She highlights exercise and suggests a 15-minute walk after each meal as an easy option
- •She says certain supplements can help and mentions acetol-based supplements
- •She describes metformin as a medication used for insulin resistance
- •She discusses using GLP-1s to address insulin resistance and notes ovulation and fertility can improve when insulin and testosterone decrease
Endometriosis: symptoms, why it’s missed, and what’s happening in the body
Mel shifts the discussion to endometriosis, and Dr. Aliabadi explains prevalence, diagnostic delays, and hallmark symptoms centered around pain. She then explains what endometriosis is and how endometrial-like tissue can implant outside the uterus, driving inflammation and pain.
- •She lists common symptoms: painful periods, painful sex (especially with deep penetration), chronic pelvic pain, pain with bowel movements or urination
- •She describes a long diagnostic delay and says many patients are never diagnosed
- •She explains a hypothesis of endometrial cells moving into the pelvis and, in endometriosis, sticking and growing rather than being cleared
- •Implants can attach to pelvic structures and even higher locations, creating inflammation and pain that varies by location
- •She explains central sensitization—chronic pain changing how the brain and spinal cord perceive pain intensity
Endometriosis treatment options: excision surgery, IUDs, and hormone suppression
Dr. Aliabadi describes laparoscopic excision as a gold-standard option and stresses the importance of specialist care. She also outlines non-surgical approaches aimed at reducing bleeding, inflammation, and estrogen-driven implant growth.
- •She describes laparoscopic excision of implants and releasing adhesions as a key treatment option
- •She says many gynecologists are not trained to diagnose or operate on advanced endometriosis and recommends seeing a specialist
- •She discusses progesterone IUDs as a way to reduce bleeding and help with pelvic inflammation and pain
- •She explains that implants grow with estrogen and describes using GnRH antagonist medications to suppress inflammation and pain
- •She notes potential side effects from estrogen suppression such as hot flashes and vaginal dryness
How to pursue diagnosis when you suspect endometriosis: symptoms to report and tests to ask about
Mel asks what someone should request at the doctor’s office, and Dr. Aliabadi emphasizes taking period-related disruption seriously. She outlines evaluation steps including ultrasound, recognition of endometriomas, and a newer blood test that can help confirm endometriosis when positive.
- •She says major life disruption from period pain (missing school/work, changing plans) is not normal
- •She advises pelvic ultrasound and explains that ovarian endometriomas have a specific ultrasound appearance
- •She warns that having an endometrioma suggests more advanced disease and can impact egg count and quality
- •She mentions a blood test called HerResolve that can detect many cases and can help prevent dismissal when positive
- •She clarifies that a negative result does not rule out endometriosis
PMDD vs PMS: recognizing the cycle pattern and core features
Dr. Aliabadi explains PMDD as a severe form of PMS with marked mood and functional impairment for part of the month, followed by a rapid return to baseline after menstruation. She emphasizes that the issue isn’t abnormal hormone levels, but a heightened brain response to normal hormonal fluctuations after ovulation.
- •She describes PMDD as severe symptoms lasting roughly 10–14 days each month with a dramatic mood crash
- •She lists symptoms including anxiety, depression, inability to function, irritability, exhaustion, and brain fog
- •She notes the striking pattern of improvement soon after the period begins and then recurrence each cycle
- •She says PMDD involves the brain reacting differently to normal hormone fluctuations and occurs after ovulation
- •She explains why patients may be dismissed if they appear fine at appointments during their “good” weeks
PMDD treatment strategies: stopping ovulation (Yaz) and targeted SSRI use
Dr. Aliabadi outlines approaches she uses to treat PMDD, including hormonal contraception to stop ovulation and SSRIs used either continuously or only during the symptomatic window. She also discusses adjusting SSRI dose during the two-week premenstrual period for patients already on medication.
- •She describes stopping ovulation as a straightforward way to reduce PMDD hormone-triggered swings
- •She names the birth control pill Yaz as a strong option and describes using it continuously in some cases
- •She explains SSRIs can be used specifically during the 10–14 day premenstrual window for PMDD symptoms
- •She gives examples of SSRI dosing approaches and explains PMDD brains can be very responsive during that window
- •She describes a strategy of temporarily increasing an existing daily SSRI dose during the symptomatic weeks and lowering it afterward
Birth control fears, fertility, and the closing message: don’t accept dismissal
Mel raises concerns about misinformation that birth control causes infertility, and Dr. Aliabadi directly rejects that claim while explaining why symptoms may return after stopping the pill. She then discusses egg count changes with age, how PMOS and endometriosis affect fertility, and ends with a strong call to seek additional opinions and advocate for proper care.
- •She says birth control pills can help PMOS by regulating cycles and increasing sex hormone-binding globulin, improving acne and hair symptoms
- •She explains people may blame birth control for infertility when the underlying condition was never diagnosed
- •She says some people may have a transition period after stopping birth control and mentions progestin IUDs as alternatives for those with mood issues
- •She explains egg count declines with age and describes how inflammation and endometriosis can worsen egg count and quality; she notes PMOS can show a high AMH with lower egg quality
- •She states that many of her PMOS patients also have endometriosis and emphasizes not missing either condition
- •She closes by urging second and third opinions, rejecting normalization of symptoms like acne, irregular periods, weight gain, hair loss, mood changes, and PMDD, and repeating the need for self-advocacy

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