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

Dr. Thaïs Aliabadi 0:00 I call my office the Office of Dismissed Women.

Mel Robbins 0:03 Today, on The Mel Robbins Podcast, what every woman needs to know about PMOS, endometriosis, PMDD, fertility, and infertility, with world-renowned OB-GYN, Dr. Thaïs Aliabadi.

Dr. Thaïs Aliabadi 0:18 No one did their egg count. No one diagnosed their endo. No one diagnosed their PMOS. And now they're 40, and they cannot have any children because no one ever told them, no one ever correctly diagnosed them. They're not crazy. They're just misdiagnosed. If you get dismissed, go get a second opinion. If you still get dismissed, go get a third opinion. [upbeat music]

Mel Robbins 0:44 Dr. A, thank you for taking time from your extraordinarily busy clinical practice, from all the speaking that you're doing, and teaching that you're doing, to be here with us. Why did you wanna be here today, and what are we gonna learn from you?

Dr. Thaïs Aliabadi 0:58 In listening to this podcast, I will promise you, it will change your life. I want you to know that majority of women get dismissed in the current healthcare system. Their pain is minimized. They're told it's in their head, they're anxious, they're stressed, they're not sleeping well. They come up with a million reason without truly diagnosing the underlying condition. And I'm here to tell you that you need to become your own health advocate. I'm gonna teach you about the signs and symptoms of PMOS and endometriosis, the leading causes of infertility, and yet majority of these women go through the healthcare system, and they're never diagnosed. I will teach you to learn about fertility, your egg count, so at 38 you're not sitting in a fertility clinic wondering why you're not getting pregnant. I will talk about PMDD. But most importantly, I will teach you to be your own health advocate, and that's the most important thing I can teach you today. If you're-- don't advocate for yourself, you will get dismissed in this healthcare system.

Mel Robbins 2:04 I'm glad that you said that

Mel Robbins 2:06 you're gonna teach us how to be our own advocate because before you were coming here, we polled our audience online, and 77% of them said that they've left a doctor's office explaining symptoms, knowing something's wrong, but felt unheard or dismissed.

Dr. Thaïs Aliabadi 2:29 First of all, I would say that the 77% that are dismissed, the rest of them don't know that they're dismissed. How about that?

Mel Robbins 2:39 Whoa.

Dr. Thaïs Aliabadi 2:41 Let me tell you, first of all, when you go to have a well-woman exam, what do they do? They do a Pap smear. They do maybe a breast exam. They might talk about STD testing, maybe give you birth control, and off you go. That's not a well-woman exam. And if this is what you're getting, then you are getting dismissed. And it's a lot more than 77%, but the rest of them, they just don't know that they're being dismissed. I call my office the Office of Dismissed Women. I feel like their trauma over the years, um, has become my trauma, and I get so emotional because my heart can't take it anymore. I'm tired of crying with my patients in the room. I'm tired of women who were dismissed. No one did their egg count. No one diagnosed their endo. No one diagnosed their PMOS. And now they're 40, and they cannot have any children because no one ever told them, no one ever correctly diagnosed them. I'm tired of it. My patients are my family. It-- I, I cry with them. It breaks my heart. I see 34-year-olds who come to my office, and they have no e- Like, literally, I had this patient walk in at 34. She had zero eggs. 20 years of dismissed endometriosis. She'd just gotten married. She looked at me. She's like, "The only thing I wanted in life was to have a child." Zero eggs. No one ever checked her egg count. No one ever diagnosed her with endo. If she was your daughter, would you not turn this country upside down? It's sad.

Mel Robbins 4:16 It's really sad.

Dr. Thaïs Aliabadi 4:17 But I'm gonna change that. You know, I tell my staff and my children that the standard of care for women's health is in the sewer system. And I want every single woman on this planet, not just here, on this planet, to get the care that I give to every single woman who walks into my office. They deserve it. They deserve it. We are the most incredible-- We're the best, right? My daughter was telling me today. [chuckles] She's like, "Mom, women are the best." We're the best. We multitask. We have the kindest heart. We bring life into this world. We're magic. So why are we not taking care of the women in this country and around the world? Not only we're not taking care of them, we're dismissing them. 50% of counties in America don't have a gynecologist. 50%. Let's start there. So 50% of counties don't have gynecologists, and when the patient finds a gynecologist, waits a year, goes to that appointment, they get dismissed. And even if they don't get dismissed, they can't afford the care, the prescriptions. That's why everyone's sick. That's why women are dying. That's why women stop going to the doctor. Because they're tired of hearing, "There's nothing wrong with you."

Mel Robbins 5:39 Well, there's something very wrong with-

Dr. Thaïs Aliabadi 5:42 You have no idea

Mel Robbins 5:42 ... the healthcare system, and there's something very wrong based on all these statistics.

Dr. Thaïs Aliabadi 5:47 And what you see is the tip of this iceberg. If you come to my office, you see the entire iceberg.

Mel Robbins 5:53 Hmm.

Mel Robbins 5:56 Dr. A, what is PCOS? Or PMOS, right, as it's now known. And why is it so hard for women to get a formal diagnosis?

Dr. Thaïs Aliabadi 6:08 Ooh, my favorite topic on the planet. Um, so PMOS is a new name for PCOS. PCOS was polycystic ovary syndrome. Completely wrong because there are no cysts on the ovaries, so that was misleading, that was confusing. And the new name describes the condition really well. It's polyendocrine metabolic ovarian syndrome, and I'll explain why. PMOS affects 15% of women. It takes doctors, uh, years to diagnose these patients. 75% of women go through life and they're never diagnosed, and PMOS is the leading cause of infertility in women, together with endometriosis. PMOS patients, these are patients who have irregular period. They can have acne, facial hair, body hair, hair thinning. 75% of them gain weight and they have a really hard time losing it. They tend to be moody, anxious. They suffer more from PMS, PMDD. It's so easy to diagnose. Why? You need to meet two out of the three criteria for diagnosis. One is ovulatory dysfunction. These are patients who have irregular period. Their periods are 35 days, 37 days, 40 days. They don't come regularly every 28 days, and they usually have less than eight periods a year.

Mel Robbins 7:28 Okay. And how would you know if you have an irregular period if, let's say, you have an IUD or you're on-

Dr. Thaïs Aliabadi 7:33 And because-

Mel Robbins 7:34 ... birth control or-

Dr. Thaïs Aliabadi 7:34 Because I go back to before your birth control pill. How did you have your periods? Were they regular? Oh, no, they were irregular, you know? And you need to meet two out of the three criteria. A lot of women have three out of three.

Mel Robbins 7:47 Okay.

Dr. Thaïs Aliabadi 7:47 So even if they don't have the irregular period, they still qualify. Number two is MOS ovary on ultrasound or having a high egg count. So this finding should be done on ultrasound. But then again, these patients go have an ultrasound, and the technician doing the ultrasound or the gynecologist doing the ultrasound looks at the PCOS ovary and says, "Nah, it looks normal," or they tell the patient, "Oh my God, you have so many eggs. You're good. Don't worry about anything." In this second criteria, because not every woman has access to an ultrasound, having an elevated AMH, anti-Müllerian hormone, which is a blood test we do for egg count, also counts as the second criteria in women who are 18 and above. And the third criteria is having symptoms of high testosterone. What are those symptoms? Acne, facial hair, body hair, hair thinning. These are the most common. Facial hair and body hair is probably the most common. These are women who say, "I always go laser and the hair comes back. I'm 30 years old and I'm still dealing with acne," right?

Mel Robbins 8:57 Yeah.

Dr. Thaïs Aliabadi 8:57 "I don't know why I have hair thinning." And you need to meet two out of the cr- three criteria. You do not need to have a high testosterone in your blood to get the diagnosis. A lot of doctors tell their patients, "Well, your hormones were normal."

Mel Robbins 9:09 This just happened to my daughter, who was diagnosed with PCOS when she was in her teens and had all the criteria you're talking about. It was probably higher testosterone, you know, kind of-

Dr. Thaïs Aliabadi 9:20 Yeah

Mel Robbins 9:21 ... hair thinning-

Dr. Thaïs Aliabadi 9:21 Yeah

Mel Robbins 9:22 ... whatever, couldn't lose weight, irregular period. And she recently went in to get another test and was told her labs are normal.

Dr. Thaïs Aliabadi 9:29 Good. Then I'm glad we're talking about this. Tell your daughter to listen to this podcast.

Mel Robbins 9:33 I will. What is the treatment

Mel Robbins 9:35 for PMOS?

Dr. Thaïs Aliabadi 9:35 So let's talk about it. One of the underlying conditions for PMOS is insulin resistance. A lot of women walk around with insulin resistant. As we get older, we become more insulin resistant. However, PMOS patients are genetically predisposed to this. When we eat carbohydrates, our body breaks it down into glucose. Glucose stimulates our pancreas to release insulin. The job of insulin is it goes to the cells in the body, opens up the receptors on the surface of the cells to push the sugar into the cell to turn it into energy. This is what's supposed to happen when you have a sandwich, when you have bread, when you have pasta. But what happens to these poor patients when they eat carbohydrates and their body re- breaks it down into glucose and glucose stimulates their pancreas to release insulin, their tissue, their cells are insulin resistant. The cells are not listening to the insulin. So the receptors don't open up, so the sugar cannot go into the cell to turn into energy. It bounces in the blood.

Mel Robbins 10:35 Hmm.

Dr. Thaïs Aliabadi 10:36 As sugar bounces in the blood, it pushes your insulin to go up. This high insulin causes a cascade of event in their body. Number one, it tells your liver, the cells are not using the sugar, take the sugar and store it as fat. The fat that you store, however, is a visceral fat. It's different than the fat under your skin. It's highly inflammatory.

Mel Robbins 10:59 Ah.

Dr. Thaïs Aliabadi 11:00 These patients start feeling inflamed. They feel bloated. They have brain fog. They gain weight. They don't feel good. That high insulin does one more thing. Even though these women are completely insulin resistant everywhere, their ovaries are insulin sensitive. So the high insulin stimulates these cells in the ovary called the theca cells to release testosterone. We all need some level of testosterone, but when your cells start pumping testosterone in the ovary, testosterone is toxic to these little follicles.

Mel Robbins 11:37 Oh.

Dr. Thaïs Aliabadi 11:38 So every month we have a certain number of follicles, we call them antral follicles, come to the surface. One becomes the dominant follicle. We ovulate that mid-cycle. The egg gets released in hopes of getting pregnant, and then this cycle happens. And then if we get pregnant, there's a cascade of event that happens. If we don't, this cycle repeats itself after-

Mel Robbins 12:02 Hmm

Dr. Thaïs Aliabadi 12:02 ... we get our period. But when you have a lot of testosterone in this environment- The little follicles freeze halfway. As they freeze, they give this string of pearl look-

Mel Robbins 12:14 Yeah

Dr. Thaïs Aliabadi 12:14 ... in the ovary-

Mel Robbins 12:15 Yeah

Dr. Thaïs Aliabadi 12:15 ... because of that inflammation. So ovulation gets blocked, right? That's why if you don't ovulate, you don't get your periods, right?

Mel Robbins 12:26 Yeah.

Dr. Thaïs Aliabadi 12:26 That's why the periods become irregular. They get a lot of inflammation in the pelvis, right? And that high testosterone causes what? Facial hair, body hair, acne, hair thinning, and these are patients who end up in the dermatologist and th- they end up going on Accutane. They're constantly lasering their face, and no one's addressing their underlying metabolic dysfunction. So that insulin spike also tells your liver not to produce this protein called sex hormone-binding globulin, which basically grabs the free testosterone in your blood. When the level of this protein goes down, your free testosterone levels go up, so your symptoms get worse.

Mel Robbins 13:09 Hmm.

Dr. Thaïs Aliabadi 13:09 Right? But all of

Dr. Thaïs Aliabadi 13:11 this affects your mental health, and this is the part I want every single person to listen to me, okay? In our brain, we have a limbic system. It's your emotional headquarter. All your emotions are in your limbic system. And then you have a prefrontal cortex that acts as a brake on that limbic system and controls these emotions that come out of your limbic system. For the limbic system to function and be calm, you need normal estrogen, normal testosterone, low inflammation, and high progesterone. Progesterone has a calming effect on the brain. What happens in PMOS? These follicles that are frozen secrete estrogen erratically, so it fluctuates. There's no ovulation, so progesterone's down. Inflammation is off the charts, so now these patients have a limbic system on fire, anxiety, depression, PMS, PMDD, binge eating, craving, motivation issues, brain fog. They just don't feel like themselves, right? They are tired. They just don't feel good. And then we have a prefrontal cortex that has to control these emotions. Well, that prefrontal cortex needs normal testosterone. They don't have it. Needs low cortisol. PMOS patients are very stressed out. Their cortisol is high because of that insulin resistance. They need good sleep. PMOS patients are not good sleepers. They need normal estrogen. They need low inflammation. You have a car going 100 miles an hour down the street, and the brake doesn't work. Where do these patients end up?

Mel Robbins 14:40 Psychiatrists.

Dr. Thaïs Aliabadi 14:40 With a psychiatrist.

Mel Robbins 14:41 If they can afford one.

Dr. Thaïs Aliabadi 14:42 What did they, what did they start them on? Anti-anxiety medication. Where is the underlying condition? What was that first domino that fell? Metabolic dysfunction. You're insulin resistant. So what happens to these patients? They end up with a dermatologist because they have acne. They end up with a psychiatrist because they have an eating disorder. They end up with a psychiatrist because they have anxiety and depression.

Mel Robbins 15:07 Oh.

Dr. Thaïs Aliabadi 15:07 They end up with a primary care because they're gaining weight. They end up in a fertility clinic because they're not getting pregnant. But what is the underlying diagnosis? It's PMOS. It's a group of syndrome. If you address their metabolic dysfunction, you lift that first puzzle, and the domino gets fixed. Do you know, Mel, if I had another Dr. Aliabadi sitting next to me, I would have her go knock on the doors of all these eating disorder centers where the teenagers are sitting. That's where PMOS patients are. What do they get as a teenager? A psychiatrist. These are teenagers who say, "I can't lose weight," right? Especially right now with social media, body image issues, everything they're going through. You take two sisters. One is like a toothpick. The other sister is eating the same thing in that household, doing the same exercises, same everything, right? But she cannot lose it. That's why not only that messes with their brain, messes with their confidence, with their body image issue, but really, that metabolic dysfunction causes binge eating, cravings, affects your mental health.

Mel Robbins 16:27 Huh.

Dr. Thaïs Aliabadi 16:27 It breaks my heart 'cause I think of millions of girls with eating disorders, but no one's addressing their underlying PMOS diagnosis. They're just misdiagnosed. When the patient finds a gynecologist, waits a year, goes to that appointment, they get dismissed, and even if they don't get dismissed, they can't afford the care, the prescriptions. That's why everyone's sick. That's why women are dying. That's why women stop going to the doctor because they're tired of hearing, "There's nothing wrong with you."

Mel Robbins 17:02 What exactly

Mel Robbins 17:03 do you do if you suspect that you have PMOS?

Dr. Thaïs Aliabadi 17:06 A, start with a healthy diet.

Mel Robbins 17:08 Okay.

Dr. Thaïs Aliabadi 17:09 Limit your carbohydrates, limit your processed food, limit inflammatory foods. Two, exercise. Exercise makes a huge difference for these patients. One of the things you- they can do, which is easy, is go for a 15-minute walk after each meal. Third, acetol-based supplements work really well.

Mel Robbins 17:26 Okay.

Dr. Thaïs Aliabadi 17:27 Metformin. Have you heard of metformin? We give it to diabetics, right?

Mel Robbins 17:31 I-

Dr. Thaïs Aliabadi 17:31 We give it to women-

Mel Robbins 17:32 ... think so, yeah

Dr. Thaïs Aliabadi 17:32 ... who are insulin resistant, and basically, metformin works to help with that insulin sensitivity. And In 2014, I know you guys just learned about GLP-1s a few years ago, but in 2014, I was treating my PMOS patients with GLP-1s. It was a miracle medication for these patients because GLP-1s address that insulin resistance-

Mel Robbins 18:00 Huh

Dr. Thaïs Aliabadi 18:00 ... that regulate your insulin. As a side effect, it curbs your appetite, but what it's really doing is addressing that insulin resistance in these patients. So it depends on the patient. I would say the diet, exercise, supplement anyone can do. And for patients who need to lose weight and they have, you know, their BMIs are high, I absolutely recommend, uh, doing a GLP-1 trial. For patients who want to lose weight, patients who want to get pregnant, metformin is a great option. I don't know if you remember, but they called it Ozempic babies. They're like, "Oh my God, Ozempic is a miracle drug. Everyone who's using it is now getting pregnant." Why do you think?

Mel Robbins 18:39 Because it's helping balance your-

Dr. Thaïs Aliabadi 18:41 The insulin

Mel Robbins 18:41 ... metabolic and your hormone balance.

Dr. Thaïs Aliabadi 18:43 And then when you lower that insulin spike, you lower the testosterone getting secreted from the ovary, the inflammation in the ovary goes down, you start ovulating, and you start getting pregnant.

Mel Robbins 18:57 Let's talk about endometriosis.

Dr. Thaïs Aliabadi 18:59 Uh, the literature says that 10% of women have endometriosis. I think that's an understatement because these women are not diagnosed. I think it affects probably 20, if not more, percent of women. Um, and it takes doctors nine to 11 years to diagnose endometriosis, and majority of these patients go through life, they're never diagnosed. And, um, one of the most common symptoms of endometriosis is painful period, painful sex w- especially with deep penetration, chronic pelvic pain, pain with bowel movement, pain with urination. So it's around pain, right? It's if I say if you're listening to this podcast and, um, you have, uh, pain and you're young and you don't know why your periods are painful, you need to think about endometriosis. Can I bring my uterus model out?

Mel Robbins 19:55 Yeah. What actually is it? What is endometriosis?

Dr. Thaïs Aliabadi 19:58 So every month, our ovaries secrete hormones-

Mel Robbins 20:02 Mm-hmm

Dr. Thaïs Aliabadi 20:02 ... estrogen and progesterone to get the lining of the uterus ready for pregnancy. When we don't get pregnant, the lining comes out as a period, and this happens month after month, year after year. When we have our period, one of the hypothesis is that some of the cells, endometrial cells, go out the tube into the pelvis. In a normal immune system, y- the endometriosis in, these endometrial cells that are floating, they get removed and they go away until next cycle. In endometriosis patients, these cells actually stick to the wall of the uterus, so it has to involve an immune dysregulation, right? It's not an autoimmune, it's not classified under autoimmune, but the immune system of these patients take these floating cells and sticks it to the wall of the bladder, pelvis, tube, ovary, behind the uterus, on the bowel. It can go all the way up to the diaphragm.

Mel Robbins 20:56 Huh.

Dr. Thaïs Aliabadi 20:56 Right? Each one of these implants becomes inflammatory, and these implants grow with estrogen. They need estrogen to grow. So they start expressing their own enzyme, aromatase, that starts making estrogen for them. And as they grow, they grab blood vessels, they grow nerve fibers, and depending on where that nerve fiber goes, that's where the pain is. One person might have pain on the right. One person might have pain on the left. One person might have pain with deep penetration. The other one might have pain when she empties her bladder. These are patients who end up at the doctor's office with UTIs. "Oh, I have a UTI, I have a bladder infection," every single month. You don't get a bladder infection every single month. Make sure it's not endometriosis, especially if y- your urine culture keeps coming back negative. It's another underlying condition. So all of this, these implants cause an inflammatory environment in the pelvis, and that inflammation lowers your egg count, lowers your egg quality, causes scar formation, blocks your tubes, causes adhesions. Your bowel can stick to your ovary, your ovary can stick to the pelvic side wall, and that can eventually develop into chronic pelvic pain. But one other thing that happens with these patients, remember these nerve fibers firing-

Mel Robbins 22:16 Mm-hmm

Dr. Thaïs Aliabadi 22:16 ... every single month-

Mel Robbins 22:17 Mm-hmm

Dr. Thaïs Aliabadi 22:17 ... and eventually throughout the month? Eventually, something happens in the brain that your brain and your spinal cord start perceiving that pain at a higher volume. It's like cranking up the volume on that pain, and a rewiring of your brain happens that we call central sensitization. So if it's a pain that I experience and I would rate as 2 out of 10, in the endo patient, that pain becomes 10 out of 10.

Mel Robbins 22:45 Because it's chronic.

Dr. Thaïs Aliabadi 22:46 That's why they end up in the hospital.

Mel Robbins 22:48 Huh.

Dr. Thaïs Aliabadi 22:48 And we stage it with superficial, mild, moderate to severe form, and this is a surgical staging. Sometimes stage one patients are in the ER. They leave work, they leave the office, they can't go to work. They're staying in bed, uh, during their period, and they only have stage one. And you have stage four patients would report 3 out of 10 pain, but they can't get pregnant. Generally speaking, this is endometriosis.

Mel Robbins 23:13 When it's pieces of the uterine lining that are going out through your tubes and getting into, like, other parts of your body, and if you don't have endometriosis, there is a way for your body to clear out these floating, you know, pieces of the, the uterine-

Dr. Thaïs Aliabadi 23:35 Endometrium

Mel Robbins 23:36 ... lining.

Dr. Thaïs Aliabadi 23:36 Yes.

Mel Robbins 23:36 And if you do have endometriosis, your body's not cleaning these up, so they're attaching themselves in and around in other areas and then growing nerves and expanding and inflaming, and that's why the pain is happening.

Dr. Thaïs Aliabadi 23:51 Correct.

Mel Robbins 23:52 Okay. That is the first time I have ever understood this. I always thought- It was something wrong with the lining inside. Like, that the lining and something in here, I had no idea, it was, like, spreading-

Dr. Thaïs Aliabadi 24:07 Going outside

Mel Robbins 24:08 ... all over your body. Basically, I now understand what you're saying, that the cells that make up the lining of the uterus are in places in your body where they shouldn't be.

Dr. Thaïs Aliabadi 24:19 Correct.

Mel Robbins 24:20 Whoa.

Dr. Thaïs Aliabadi 24:20 And the gold standard treatment, right, is to excise these laparoscopically. Going one by one, we grab these implants, cut them. If they have scar tissue or adhesions, we release it. And you have to be super careful looking at these. The problem is not only these patients get dismissed when they go to the doctor's office, they're not diagnosed, majority of gynecologists are not trained to operate laparoscopically. And I would s- honestly tell you that less than 1% of gynecologists know how to operate on advanced endometriosis or even diagnose it. From my experience, I can tell you if you give 100 laparoscopes to 100 gynecologists, at least 40% of them will wake the patient up and say, "You didn't have it," because it's sometimes hard to find these tiny little lesions.

Mel Robbins 25:19 So I'm hearing you wanna go to a specialist if this is what-

Dr. Thaïs Aliabadi 25:21 100%. A million percent. And so surgical resection is one option, is gold standard. The second thing is giving ... I love using progesterone IUDs. Progesterone IUDs lower the amount of bleeding. It helps with inflammation and pain in the pelvis. But for patients with advanced stage, remember I told you these implants grow with estrogen-

Mel Robbins 25:45 Mm-hmm

Dr. Thaïs Aliabadi 25:45 ... and they love estrogen.

Mel Robbins 25:46 Mm-hmm.

Dr. Thaïs Aliabadi 25:46 So you want to take that estrogen away. And there are pills that do that. Uh, we call them GnRH antagonists. These are medications like Orilissa or nafemothri that patients take daily for up to two years. And we, uh, we can literally suppress the inflammation and the pain that they experience. And usually by two months, we can get these patients pain-free. It does have a side effect of hot flashes, 'cause it kind of puts you in a temporary menopause, maybe-

Mel Robbins 26:12 Mm. Mm-hmm

Dr. Thaïs Aliabadi 26:12 ... symptoms, so vaginal dryness, low libido, hot flashes, night sweats are some of the symptoms of it.

Mel Robbins 26:19 So let's say you're listening right now, and your mom sent you this, or your sister sent you this episode, and now you're thinking, "Wait a minute, do I have endometriosis?" What is the test I am walking into my doctor's office and asking for?

Dr. Thaïs Aliabadi 26:34 That's a very good question. First of all, the first thing you need to do is listen to the patient. If you're staying home when you get your period, if someone needs to pick you up from school, from work, if you have to change your social planning, your trips, your vacations around your period, if you're planning everything in your life around your period, that's not normal. If you're ending up in the urgent care with period pain, if you're constantly having UTIs and getting antibiotics and your cultures are negative, if you're young and when you have a bowel movement you have a lot of pain, that's not normal. Two, do an ultrasound. Always do a pelvic ultrasound. Endometriosis in the ovary, we call it chocolate cyst. It has a specific finding on ultrasound. You cannot miss it. If yous have an endometrioma, you're already advanced stage. I can tell you that. And your egg count and quality has been affected, so be careful. Number three, as of recently, few offices in this country have a blood test called HerResolve. I love it. Now, it picks up about 80% of women with endometriosis. Ask for this blood test. Hopefully soon it will be available to all women. You get the results within a week, and it tells you whether the patient has endometriosis. If the test is positive, it means you have it. If the test comes back negative, it doesn't mean you don't have it.

Mel Robbins 28:04 Ah.

Dr. Thaïs Aliabadi 28:04 Do you understand?

Mel Robbins 28:05 I do understand.

Dr. Thaïs Aliabadi 28:06 So it only helps if it's positive. And it's so good because I can't wait for this test to be available because women won't get dismissed. So if someone has all these symptoms, she can go to the doctor and the doctor says, "No, you don't have it," she can say, "I want this blood test." But I want to say today, if the test is negative, it doesn't mean you don't have it.

Mel Robbins 28:27 And how do you treat it if it's a positive? You have to have surgery?

Dr. Thaïs Aliabadi 28:30 Not at all. You start always, you can start with a low-dose birth control pill. You can start with progestin IUDs. You can do the pills that I was talking to you about-

Mel Robbins 28:41 Mm-hmm

Dr. Thaïs Aliabadi 28:41 ... the GnRH antagonist. For patients, we used to give Lupron, which is a GnRH agonist. That puts you in, like, menopause, and we moved away-

Mel Robbins 28:50 Yeah, no one

Dr. Thaïs Aliabadi 28:50 ... from that 'cause nobody wants to go through that. You can't put these young patients through that. But gold standard

Dr. Thaïs Aliabadi 28:55 is still laparoscopic surgery.

Mel Robbins 28:57 Dr. A, what is PMDD?

Dr. Thaïs Aliabadi 28:59 I love you for asking me all these questions. PMDD. Have you heard of PMS?

Mel Robbins 29:07 Mm-hmm.

Dr. Thaïs Aliabadi 29:08 PMDD is a severe form of PMS. It affects 3 to 5% of women. These are women, for 10 to 14 days out of the month, they crash in their mood. They're anxious. They, they're depressed. They can't get out of bed. They feel worthless. They have brain fog. They're tired. They're exhausted. They start getting angry, irritable. And as soon as their period comes, by day three- Suddenly they're back to themselves. They're completely normal. They do great. They spend the next two weeks trying to, you know, fix all the damage that they created during-

Mel Robbins 29:53 Hmm

Dr. Thaïs Aliabadi 29:53 ... their previous two weeks, and then that vicious cycle happens over and over again. These are patients, not because they have abnormal hormone levels, these patients, their brain reacts differently to the normal fluctuations of the hormones of the menstrual cycle. And it happens after ovulation. So one thing you can do with these patients to treat them... First of all, these patients are never diagnosed, right? They end up, their suicide rate is really high. I mean, when I tell you there's a shift overnight in their personality, you don't even recognize your own child.

Mel Robbins 30:29 Huh.

Dr. Thaïs Aliabadi 30:30 And i- it's really heartbreaking because they go to the doctor, and again, because when they feel good, the doctor's like, "But you look great. You don't look anxious to me." Well, it's in the two weeks, you know, right after her period-

Mel Robbins 30:42 Yeah

Dr. Thaïs Aliabadi 30:42 ... she's gonna crash again. One of the things, one of the easiest things to do with these patients is to stop them from ovulating. One of the best birth control pills to use is the birth control pill Yaz.

Mel Robbins 30:54 Yaz.

Dr. Thaïs Aliabadi 30:54 It works amazing.

Mel Robbins 30:56 Okay.

Dr. Thaïs Aliabadi 30:56 The progestin in it helps with their mood. You block their ovulation, so you stop this fluctuation in the hormones. And a lot of times when they get used to taking it, I even skip the last four placebo pills where they menstruate, and I give it to them continuously. That's number one. Number two, you can treat these patients with SSRIs. So we have a lot of data on SSRIs and PMDD. These are patients that you don't actually need to treat all month. You can if they have an underlying anxiety, depression.

Mel Robbins 31:28 Yep.

Dr. Thaïs Aliabadi 31:29 But if they only dip 10 days before their period, you can actually just treat them with SSRIs, with antidepressants during that window. So for 10 to 14 days before their period, let's say it's day 18 to 28 or day f- 15 to 28 every single month, you start these patients on Prozac, 20 milligrams, one a day. You take it for 10 days, two weeks, then you stop. You can also give them Zoloft, 25 milligrams.

Mel Robbins 31:59 But don't you have to ti- titrate up on Zoloft?

Dr. Thaïs Aliabadi 32:01 No, 'cause you only keep it on a low dose.

Mel Robbins 32:03 Got it.

Dr. Thaïs Aliabadi 32:03 The brain, the PMDD brain is extremely responsive to SSRIs-

Mel Robbins 32:09 Huh

Dr. Thaïs Aliabadi 32:09 ... during that window. So you don't need to over-treat, and you only basically give them a boost of SSRI 10 days to 14 days out of the month, and that's it. But I always start these patients on Yaz. Think about this.

Mel Robbins 32:24 The birth control Yaz.

Dr. Thaïs Aliabadi 32:25 The birth control pill. You address their symptoms of PMOS if they have it. You stimulate that sex hormone-binding globulin so their acne, hair loss, facial hair, body hair gets better. If they have endometriosis, you're addressing the, uh, pain associated with endometriosis. You're making their periods super light. It becomes pain-free. And if they have PMDD, you're blocking their ovulation and you're addressing their mood. So it's a good medication for someone who has all three. But for PMDD alone, Yaz is a great option, but I would absolutely also recommend, um, the SSRIs. Now, if you have a patient with long history of anxiety and depression, and let's say your patient comes and says, "I take Zoloft every single day, 25 milligrams, but I still dip two weeks-

Mel Robbins 33:09 Yeah

Dr. Thaïs Aliabadi 33:09 ... before," you can up your Zoloft, bump it up to 50 milligrams during those two weeks, and then bump it back

Dr. Thaïs Aliabadi 33:16 down.

Mel Robbins 33:16 You know, there's a lot of misinformation online right now about birth control and this huge fear that birth control and the pill causes infertility.

Dr. Thaïs Aliabadi 33:24 So let's talk about that.

Mel Robbins 33:25 I'd like to hear your thoughts on that.

Dr. Thaïs Aliabadi 33:27 Now that you know all this, if you ask me, what's the treatment for PMOS, and I told you birth control pill, what would you say?

Mel Robbins 33:33 Well, now that I know all this, and I know the insulin-resistant aspect of this, I think it would depend on the, uh, the hormone, like-

Dr. Thaïs Aliabadi 33:47 The metabolic, yes

Mel Robbins 33:48 ... profile of the person because if you have very low or erratic estrogen levels, it would throw everything about your hormone panel out of whack.

Dr. Thaïs Aliabadi 33:58 If you have-

Mel Robbins 33:58 Right?

Dr. Thaïs Aliabadi 33:58 Yeah. If you're, if you're insulin resistant and you have metabolic dysfunction that's affecting-

Mel Robbins 34:04 Yes

Dr. Thaïs Aliabadi 34:04 ... testosterone secretion from your ovary, birth control pills help PMOS patients. Why? Because PMOS patients have irregular periods, so birth control pill will regulate that. But remember I told you about that sex hormone-binding globulin-

Mel Robbins 34:18 Mm-hmm

Dr. Thaïs Aliabadi 34:18 ... that goes down with PMOS patients? Guess what combination birth control pills do? Ups the sex hormone-binding globulin. That's why their acne gets better, their facial hair gets better, their hair loss gets better, their periods become regular. And then they stay on it for years because they started it for acne, for irregular period, for a painful period, and they do great on it. And then when you take them off, they don't get pregnant. They blame the birth control pill. Well, it's not the birth control pill because no one ever diagnosed you with that underlying condition. I was on birth control for nine years. I stopped, and I got pregnant the first month.

Mel Robbins 34:53 This is what's driving me crazy because I see so much fear and misinformation directed at one of the safest medications that's been studied for women that's also the first-line intervention for PMOS and endometriosis. And then when-

Dr. Thaïs Aliabadi 35:12 People are scared to take it

Mel Robbins 35:12 ... all these young women go off it, and now all of a sudden they have acne, and all of a sudden they have weight gain or this and that, and now they're taking Accutane-

Dr. Thaïs Aliabadi 35:21 Yep

Mel Robbins 35:21 ... and they're doing all this stuff.

Dr. Thaïs Aliabadi 35:22 Yep.

Mel Robbins 35:22 And I'm speaking about this from personal experience-

Dr. Thaïs Aliabadi 35:25 Yeah

Mel Robbins 35:25 ... 'cause they wanna clean out their body.

Dr. Thaïs Aliabadi 35:27 Yes. Well, sometimes when you come off of the birth control, you might have a transition period.

Mel Robbins 35:31 For how long?

Dr. Thaïs Aliabadi 35:32 But if you go back for maybe three months, you know? But m- max four or five months, in my opinion.

Mel Robbins 35:39 I wanna highlight this because of this trend of Women in their 20s, you know, letting myself, like clean myself out from the birth control, and I really want to make sure that the birth control's not gonna make me infertile, and I need to like-

Dr. Thaïs Aliabadi 35:57 It's the opposite

Mel Robbins 35:57 ... get this out of my system. Say that again?

Dr. Thaïs Aliabadi 36:00 It's the opposite. So a lot of these patients, they're willing to have painful periods. They're willing to have endometriosis destroy their pelvises because they don't want to take a birth control pill. Now, I will say, if you have mood disorder, if you take birth control pill and you get anxious, you get depressed because of other underlying metabolic issues, let's say with PMOS, sometimes PMOS patients don't do well with birth control pills because of the limbic system and everything-

Mel Robbins 36:26 Uh-huh

Dr. Thaïs Aliabadi 36:26 ... I told you about. Use a progestin IUD. Use a Kyleena IUD. Use a Mirena IUD.

Mel Robbins 36:32 I just want to be very clear. Does the birth control pill cause infertility?

Dr. Thaïs Aliabadi 36:36 No.

Mel Robbins 36:37 You keep mentioning egg count.

Dr. Thaïs Aliabadi 36:38 Yes. So did you know that we, uh, when we're in utero, at 20 weeks, we have about six to seven million eggs. At birth, that number drops to one to two million eggs. At puberty, that number is about 300 to 500,000. At age 20, it's about 200,000. At age 30, it's about 100 to 150,000. At age 35, that number drops to about 50 to 80,000. At 40, that number is about 10 to 30,000. And by menopause, that number is 1,000. So just by being a woman and aging, you're destroying these eggs. Now, you add inflammation, endometriosis, endometrioma to that, that number crashes, the quality crashes. You add PMOS to it, PMOS patients have a falsely high AMH. Remember that second criteria I told you?

Mel Robbins 37:41 Mm-hmm.

Dr. Thaïs Aliabadi 37:42 Their, their egg count is high, but the quality is low because of all that inflammation in the ovary. And I want to tell you that, and I want you to be careful with your daughters, in my practice, based on my data in my office, 61% of my PMOS patients also have endometriosis.

Mel Robbins 38:01 61%?

Dr. Thaïs Aliabadi 38:02 Yes, 61%. So when you see one, you better not miss the other, because both are leading causes of infertility. One of the most wonderful, sweet, beautiful women I've ever laid my eyes on, at age 30, came to me from another country with 10 years of painful periods. By the time she got to me, her egg count was zero. Zero. If she was your daughter, what would you do? If someone told your daughter at age 30 that you have no more eggs, and your daughter had been to seven, eight doctors, and everyone told her her ultrasound was normal, her blood tests were normal, there's nothing wrong with her, what would you do?

Mel Robbins 38:49 I'd want to murder somebody.

Dr. Thaïs Aliabadi 38:50 Right? That's how I feel every day. I don't want to be negative. I'm just negative because I see negative all day. My heart is broken. My heart is shattered for these patients. Going through these journeys with my patients, listening to them, crying with them, taking care of them, has been more traumatic to me than my own journey with breast cancer.

Mel Robbins 39:13 Dr. A, what are your parting words?

Dr. Thaïs Aliabadi 39:15 If you get dismissed, go get a second opinion. If you still get dismissed, go get a third opinion. No one said you need to be stuck. You deserve the best care on this planet. There's no reason why you should ever be dismissed. Don't let anyone tell you that you're anxious, that you're stressed, that it's in your head, that it's normal for women to have acne, irregular period, weight gain, hair loss, mood changes, PMDD. None of it is normal. Fight for it. Educate yourself. Empower yourself, and become your own health advocate. That's the only way to survive this healthcare system. If you want to advocate for yourself, educate for yourself. I don't expect you to be a doctor, but I do expect you to advocate for yourself, because no one on this planet cares about your body or your health as much as you do. So you need to advocate for yourself.

Mel Robbins 40:17 As you said, Dr. A, no one cares about your health as much as you do, and you deserve the best care on the planet. And I want to thank you on behalf of the tens of millions of women who will listen to this, who will share this with the women in their life. I want to thank you on behalf of the men who love the women in their life, who have educated themselves by listening to this. And I know, there's no doubt in my mind, that based on the information that you shared with us today and the way in which you shared it, there will be people whose lives are saved, and I believe it will be in the millions because every time someone listens, and they take all this information, and they empower themselves to take responsibility for demanding the care that they deserve, you are saving a life, and you're improving it. And so thank you for the extraordinary work that you do.

Dr. Thaïs Aliabadi 41:20 Thank you for sharing this beautiful mic. Thank you for everything you do. Honestly, without your microphone, without everyone's microphone, I'm only a gynecologist in my little office.

Mel Robbins 41:30 Well, I don't see you like that.

Dr. Thaïs Aliabadi 41:31 So thank you. And-

Mel Robbins 41:32 I don't think any of us see you as-

Dr. Thaïs Aliabadi 41:33 Yeah. [laughs]

Mel Robbins 41:33 ... only a gynecologist in your little office. I see you as somebody who is here on this planet to improve the lives of women. And yes, you're doing it one patient at a time, but by expanding your platform and making all of this available to people for free, you're creating massive ripples that turn into tidal waves of positive change as women are equipped with what we need to know so we can advocate for ourselves.

Dr. Thaïs Aliabadi 42:07 Amen.

Mel Robbins 42:08 Amen. Thank you, Dr. A. And thank you. Thank you for listening to something. I know you don't have a lot of time, so thank you for making the time to listen to something that will educate you, and thank you for being extraordinarily generous with this episode. I am going to ask you personally to take a minute and copy the link and text it, email it, send it to every woman you know. This is a free resource with a world-renowned expert who wants you to have the best care on the planet, and having the best care on the planet means educating yourself and advocating for that. And so together, we can support women all over the world, and we can support them in not only advocating for themselves but also in advocating for the women in their lives and the girls in their lives that they know. All righty. In case no one else tells you, as your friend, I'm also gonna remind you that I love you, and I believe in you, and I believe in your ability to create a better life. And at the end of the day, your life depends on your health and your well-being. And thank you for watching all the way to the end here on YouTube. Thank you for spending time with me. I loved being with you. And thank you for sharing this with people in your life that you care about. All righty, I know you want to watch another episode of The Mel Robbins Podcast. You're gonna love this one next, and I'll welcome you in the moment you hit play. [outro music]