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Beyond the Buzz: Where GLP-1s Really Fit in PMOS Care · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to Clearly Hormonal, the podcast where we stop googling our symptoms at midnight and actually start understanding what's going on in our bodies.
• 0:09
  Dr. Komal Patil-Sisodia: I'm Dr.
• 0:09
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, an endocrinologist, internist, obesity medicine specialist, and a Menopause Society Certified Practitioner, which is really just a whole lot of words to say hormones are kind of my jam.
• 0:21
  Dr. Komal Patil-Sisodia: I've spent 17 years watching women try to navigate their hormonal health without ever having been taught the language for what's happening in their own bodies, and then meeting clinicians who want nothing more than to help them figure it out, but are up against 10-minute appointments and a system that just wasn't built for it.
• 0:37
  Dr. Komal Patil-Sisodia: This podcast is my answer to that gap.
• 0:39
  Dr. Komal Patil-Sisodia: We'll cover menopause, metabolism, hormones, and everything in between with real evidence, not trends, and without the overwhelm.
• 0:47
  Dr. Komal Patil-Sisodia: A quick disclaimer.
• 0:48
  Dr. Komal Patil-Sisodia: I'm a physician, but this is education, not personalized medical advice.
• 0:52
  Dr. Komal Patil-Sisodia: Take what resonates and discuss it with your own healthcare team.
• 0:56
  Dr. Komal Patil-Sisodia: Now, let's get into it and talk about what's clearly hormonal and what's not.
• 1:01
  Dr. Komal Patil-Sisodia: Welcome back to Clearly Hormonal and our PMOS Awareness Month series.
• 1:06
  Dr. Komal Patil-Sisodia: This is episode three of four, and so far, we've covered what happens to PMOS after your childbearing years and why PMOS gets missed so often in people who are thin.
• 1:17
  Dr. Komal Patil-Sisodia: Today, we're talking about treatment, specifically where GLP-1 medications and other weight management tools fit into PMOS care.
• 1:26
  Dr. Komal Patil-Sisodia: We talk a lot about metformin and spironolactone and birth control pills and lifestyle foundations as potential treatments for PMOS, but there is emerging data around GLP-1s.
• 1:38
  Dr. Komal Patil-Sisodia: GLP-1s are the medications you probably hear about in the news, drugs like semaglutide and tirzepatide.
• 1:46
  Dr. Komal Patil-Sisodia: They were built to treat diabetes and obesity, and I've used them in that context for years.
• 1:52
  Dr. Komal Patil-Sisodia: But because insulin resistance sits at the center of PMOS for so many patients, these medications have become a part of the conversations for PMOS as well.
• 2:03
  Dr. Komal Patil-Sisodia: I want to walk through what these medications actually do, who they might help, who they're not a fit for, and what they don't replace.
• 2:13
  Dr. Komal Patil-Sisodia: So let's start with the basics in plain language.
• 2:16
  Dr. Komal Patil-Sisodia: GLP-1 stands for a hormone your gut already makes on its own.
• 2:21
  Dr. Komal Patil-Sisodia: It helps control blood sugar and tells your brain when you're full and you're ready to be done with eating.
• 2:27
  Dr. Komal Patil-Sisodia: GLP-1 medications work by copying that hormone at a stronger, steadier level than your body makes naturally, and that will lead to three main effects: better blood sugar control, less hunger, and often weight loss.
• 2:45
  Dr. Komal Patil-Sisodia: For a condition like PMOS, where insulin resistance is often part of the main issue, this matters a lot.
• 2:53
  Dr. Komal Patil-Sisodia: Remember from episode one, insulin resistance means your body doesn't respond well to insulin, So it has to make more of it just to keep blood sugar steady.
• 3:02
  Dr. Komal Patil-Sisodia: Over time, that extra insulin can drive weight gain, worsen cholesterol, and push up androgen hormones, which are the hormones like testosterone and DHEAS that can cause many PMOS symptoms like acne and increased facial hair growth and body hair growth.
• 3:19
  Dr. Komal Patil-Sisodia: If a medication can improve insulin resistance directly, it can actually affect several PMOS symptoms at once, not just one symptom.
• 3:29
  Dr. Komal Patil-Sisodia: So who's actually a good candidate for these medications?
• 3:31
  Dr. Komal Patil-Sisodia: Patients with PMOS who have insulin resistance or a higher body weight are often the clearest fit.
• 3:38
  Dr. Komal Patil-Sisodia: For these patients, GLP-1s can improve blood sugar control, support weight loss, and in some cases, help cycles become more regular again.
• 3:48
  Dr. Komal Patil-Sisodia: The last part surprises people, but it makes sense once you understand the chain of events that's happening in your body.
• 3:55
  Dr. Komal Patil-Sisodia: Less insulin resistance can mean lower androgen levels, and lower androgen levels can mean that ovaries start ovulating more regularly.
• 4:04
  Dr. Komal Patil-Sisodia: People who have tried other options like metformin or lifestyle changes alone and they haven't really seen much of an improvement are another group where GLP-1s often come up.
• 4:15
  Dr. Komal Patil-Sisodia: And these medications aren't usually a first step.
• 4:17
  Dr. Komal Patil-Sisodia: They tend to enter the conversation when insulin resistance is significant and other tools like metformin haven't done enough on their own Now let's talk about who these medications are not built for, because this part gets skipped a lot.
• 4:32
  Dr. Komal Patil-Sisodia: Remember lean PMOS from the last episode, the thin patient with PMOS who may have little or no insulin resistance?
• 4:40
  Dr. Komal Patil-Sisodia: Their PMOS might be driven mostly by hormone patterns that have nothing to do with insulin.
• 4:46
  Dr. Komal Patil-Sisodia: And for them, a medication built to fix insulin resistance and drive weight loss may not address their main problem at all, and it could cause unwanted weight loss in someone who doesn't need it.
• 4:59
  Dr. Komal Patil-Sisodia: These medications are also not the right choice for anyone who's trying to get pregnant soon.
• 5:04
  Dr. Komal Patil-Sisodia: GLP-1 medications need to be stopped before conception based on current safety guidance, so timing matters a lot if fertility is a goal.
• 5:15
  Dr. Komal Patil-Sisodia: I can say in my practice, I've seen people get pregnant unintentionally because they were aware of how much a GLP-1 would improve their fertility These medications are also not a good fit for somebody who's looking for a fast fix without doing the other work, the other changes, the lifestyle changes that we need in order for these medications to work.
• 5:41
  Dr. Komal Patil-Sisodia: GLP-1s work best when you are actively looking at your lifestyle and changing your eating habits and moving your body more.
• 5:50
  Dr. Komal Patil-Sisodia: It's not a replacement for those things.
• 5:52
  Dr. Komal Patil-Sisodia: And there can actually be quite a bit of harm done if you're not getting in enough protein or fiber and you're taking these medications.
• 6:00
  Dr. Komal Patil-Sisodia: I see patients develop really significant muscle loss or significant constipation, and you really want to be getting treatment with these medications by someone who knows what they're doing with them and knows how to anticipate these side effects.
• 6:16
  Dr. Komal Patil-Sisodia: Now let's talk about what these medications don't replace.
• 6:19
  Dr. Komal Patil-Sisodia: This is the part that I want every listener to really hear, because it's really easy to treat a medication like a whole treatment plan on its own, but that's not true of mostly any medication.
• 6:31
  Dr. Komal Patil-Sisodia: GLP-1s can improve insulin resistance and support weight loss, but they don't erase a PMOS diagnosis or the monitoring that comes with it.
• 6:42
  Dr. Komal Patil-Sisodia: A patient on a GLP-1 medication still needs their cholesterol checked.
• 6:46
  Dr. Komal Patil-Sisodia: They still need their blood sugar and metabolic markers followed over time, the same way we talked about in episode one.
• 6:54
  Dr. Komal Patil-Sisodia: Starting a medication is not a reason to stop watching for the long-term heart and metabolic risks that come with PMOS.
• 7:03
  Dr. Komal Patil-Sisodia: GLP-1s also don't replace other PMOS treatments when those treatments are doing a different job.
• 7:12
  Dr. Komal Patil-Sisodia: Someone focused on fertility still may need ovulation-inducing medication.
• 7:17
  Dr. Komal Patil-Sisodia: Someone who is dealing with unwanted hair growth or acne may still need a treatment aimed specifically at androgen hormones, like birth control pills or spironolactone.
• 7:29
  Dr. Komal Patil-Sisodia: A GLP-1 can work alongside these treatments, but it's rarely a stand-in for all of them So let's talk a little bit about how I think about this with patients.
• 7:40
  Dr. Komal Patil-Sisodia: When I'm deciding whether a GLP-1 makes sense for a patient with PMOS, I'm asking a few questions.
• 7:47
  Dr. Komal Patil-Sisodia: Is insulin resistance actually a driver of their symptoms, or is something else driving them?
• 7:54
  Dr. Komal Patil-Sisodia: Is the patient trying to get pregnant soon, or is that not a near-term goal?
• 8:00
  Dr. Komal Patil-Sisodia: Have they already tried other tools, and how much have they helped?
• 8:05
  Dr. Komal Patil-Sisodia: And are they looking for one part of a bigger plan or hoping this one medication solves everything on its own?
• 8:13
  Dr. Komal Patil-Sisodia: The answers to those questions matter more than whether GLP-1s are the, quote,"new thing everyone's on." The right treatment for PMOS always depends on which version of PMOS a patient actually has and what they're trying to achieve.
• 8:30
  Dr. Komal Patil-Sisodia: So that's it.
• 8:30
  Dr. Komal Patil-Sisodia: That's episode three.
• 8:32
  Dr. Komal Patil-Sisodia: The main point today, GLP-1 medications can be a real tool for the right patient with PMOS, especially when there's insulin resistance that's driving their symptoms.
• 8:44
  Dr. Komal Patil-Sisodia: But they're not a fit for everyone, they're not a replacement for monitoring, and they're not a stand-in for every other treatment PMOS might call for.
• 8:54
  Dr. Komal Patil-Sisodia: Next week, when we close out the series with episode four, we'll talk about It's really important to discuss treatment options with your doctor and pick the right one for you based on your situation.
• 9:08
  Dr. Komal Patil-Sisodia: Next week, we close out the series with the last episode in our PMOS awareness series, and that's episode four.
• 9:16
  Dr. Komal Patil-Sisodia: We'll talk about the long road to diagnosis so many patients face and the toll that delay takes on mental health.
• 9:23
  Dr. Komal Patil-Sisodia: Thanks for listening, and if this episode helped you think about treatment differently, share it with someone who needs to hear it.
• 9:31
  Dr. Komal Patil-Sisodia: I'll see you next week for the last episode in our PMOS awareness series Before you sign off, I wanted to tell you about a project that I have that's coming up that I'm very excited about.
• 9:41
  Dr. Komal Patil-Sisodia: I'm putting out a PMOS mini course to help you get a better understanding of your PMOS phenotype and how to advocate for yourself when you go into a doctor's office and you're not getting answers or help.
• 9:53
  Dr. Komal Patil-Sisodia: If you want more information, sign up for my newsletter, which you can find at eastsidemm.com/newsletter or follow me on social@drpatilsisodia on Instagram or TikTok.