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The Long Road to Diagnosis: PMOS and Mental Health · Clearly Hormonal

• 0:00
  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.
• 0:08
  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.
• 0:20
  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.
• 0:36
  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: 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.
• 0:55
  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.
• 1:03
  Dr. Komal Patil-Sisodia: This is the fourth and last episode for PMOS Awareness Month.
• 1:08
  Dr. Komal Patil-Sisodia: It's been wonderful being able to deep dive into PMOS over this month, and hopefully provide you all with some good information that is helping you get answers towards getting a better diagnosis or knowing what to do once you have a diagnosis.
• 1:22
  Dr. Komal Patil-Sisodia: We've covered what happens in PMOS after your childbearing years.
• 1:27
  Dr. Komal Patil-Sisodia: We've covered why PMOS gets missed in people who have a normal BMI.
• 1:32
  Dr. Komal Patil-Sisodia: Last week, we talked about where GLP-1 medications fit into treatment, and today, we're ending the series with something that doesn't get talked about enough, the mental health toll of PMOS and the toll of waiting years just to get a diagnosis.
• 1:48
  Dr. Komal Patil-Sisodia: This isn't a small side issue.
• 1:50
  Dr. Komal Patil-Sisodia: The research on this is clear and honestly a little startling.
• 1:54
  Dr. Komal Patil-Sisodia: Today, we'll walk through what the data shows, why the long wait for diagnosis makes things worse, and what real care should look like.
• 2:04
  Dr. Komal Patil-Sisodia: Let's start with how common this is, really, because the numbers are bigger than most people expect.
• 2:10
  Dr. Komal Patil-Sisodia: Studies compare people with PMOS to people without it, matching them by weight, so weight itself doesn't skew the results.
• 2:19
  Dr. Komal Patil-Sisodia: These studies find that people with PMOS are about four times more likely to have depression and more than five times more likely to have anxiety.
• 2:29
  Dr. Komal Patil-Sisodia: In plain terms, that's about one in three women with PMOS has moderate to severe depression.
• 2:36
  Dr. Komal Patil-Sisodia: In plain terms, about one in three people with PMOS have moderate to severe depression, and more than four in ten have real anxiety symptoms.
• 2:47
  Dr. Komal Patil-Sisodia: In patients without PMOS, those numbers are much lower, well under fifteen percent.
• 2:53
  Dr. Komal Patil-Sisodia: And here's the thing, this isn't just an adult problem.
• 2:56
  Dr. Komal Patil-Sisodia: Teenagers with PMOS also show higher rates of depression than their peers.
• 3:02
  Dr. Komal Patil-Sisodia: One large study found something important.
• 3:05
  Dr. Komal Patil-Sisodia: A PMOS diagnosis usually comes before a new diagnosis of depression, anxiety, or sleep problems, not after.
• 3:15
  Dr. Komal Patil-Sisodia: This tells us PMOS itself is likely part of the cause and not just something that happens to show up alongside of it.
• 3:24
  Dr. Komal Patil-Sisodia: Eating disorders also follow a similar pattern.
• 3:27
  Dr. Komal Patil-Sisodia: Patients with PMOS are about one and a half times more likely to have an eating disorder.
• 3:32
  Dr. Komal Patil-Sisodia: This number goes up depending on which PMOS symptoms are present.
• 3:37
  Dr. Komal Patil-Sisodia: The biggest increases show up in binge eating disorders and bulimia, but not anorexia.
• 3:43
  Dr. Komal Patil-Sisodia: Here's a detail worth remembering.
• 3:45
  Dr. Komal Patil-Sisodia: In one large study, patients who were underweight actually had the highest odds of an eating disorder among PMOS patients.
• 3:54
  Dr. Komal Patil-Sisodia: Disordered eating in PMOS doesn't only show up in larger bodies.
• 4:00
  Dr. Komal Patil-Sisodia: Now let's talk a bit about why the diagnosis takes so long.
• 4:05
  Dr. Komal Patil-Sisodia: The delay itself is part of the mental health story.
• 4:08
  Dr. Komal Patil-Sisodia: Think back to episode two of this series on Lean PMOS.
• 4:12
  Dr. Komal Patil-Sisodia: We talked about how symptoms get scattered across different doctors.
• 4:17
  Dr. Komal Patil-Sisodia: A period problem here, a skin issue there, hair changes somewhere else.
• 4:21
  Dr. Komal Patil-Sisodia: Nobody is connecting them.
• 4:23
  Dr. Komal Patil-Sisodia: And the same thing happens with mental health.
• 4:26
  Dr. Komal Patil-Sisodia: A patient's anxiety gets treated like its own separate issue.
• 4:30
  Dr. Komal Patil-Sisodia: The patient's body image struggles get chalked up to normal insecurity.
• 4:35
  Dr. Komal Patil-Sisodia: Nobody asks if a hormone condition might be tying it all together.
• 4:41
  Dr. Komal Patil-Sisodia: On top of that, many people spend years being told that their symptoms are just stress, or that they're just part of their personality, or something that they need to manage better on their own.
• 4:52
  Dr. Komal Patil-Sisodia: When you hear that over and over and over, two things tend to happen.
• 4:58
  Dr. Komal Patil-Sisodia: First, you start to believe that something is wrong with you instead of realizing something is wrong with how you're being diagnosed.
• 5:07
  Dr. Komal Patil-Sisodia: Second, your symptoms, both physical and emotional, keep building the whole time nobody is looking for a real cause.
• 5:15
  Dr. Komal Patil-Sisodia: By the time many patients finally get a PMOS diagnosis, they've often been carrying undiagnosed anxiety, depression, or disordered eating for years.
• 5:28
  Dr. Komal Patil-Sisodia: The diagnosis doesn't create the mental health burden.
• 5:32
  Dr. Komal Patil-Sisodia: It usually shows up after the burden has already been building for a long time There's one part of this that deserves its own moment, body image.
• 5:43
  Dr. Komal Patil-Sisodia: PMOS symptoms like acne, extra hair growth, hair thinning, and weight changes are all visible.
• 5:50
  Dr. Komal Patil-Sisodia: They all push against typical beauty standards.
• 5:54
  Dr. Komal Patil-Sisodia: Research shows that body image distress isn't just a side effect of PMOS.
• 6:00
  Dr. Komal Patil-Sisodia: It looks like one of the real paths connecting PMOS to disordered eating.
• 6:05
  Dr. Komal Patil-Sisodia: In other words, it's not just that PMOS causes weight changes and weight changes cause disordered eating, it's that the visible symptoms create real distress about how a person looks, and that distress on its own raises the risk of disordered eating People with PMOS score higher on measures of body dissatisfaction than people without PMOS.
• 6:32
  Dr. Komal Patil-Sisodia: This shows up again and again across studies.
• 6:35
  Dr. Komal Patil-Sisodia: In interviews, some describe feeling like their body has become unrecognizable to them.
• 6:41
  Dr. Komal Patil-Sisodia: Some describe real fear of being judged as abnormal because of symptoms like hair growth or acne.
• 6:48
  Dr. Komal Patil-Sisodia: This isn't vanity.
• 6:50
  Dr. Komal Patil-Sisodia: It's a real measurable pattern that we need to talk about directly, and we need to ask about directly.
• 6:56
  Dr. Komal Patil-Sisodia: We can't just leave these things for patients to bring them up on their own So what does good care actually look like given everything we just covered?
• 7:06
  Dr. Komal Patil-Sisodia: The major guideline on this condition is direct about it.
• 7:10
  Dr. Komal Patil-Sisodia: Every patient should be screened for mental health at the time of diagnosis, not just patients who happen to mention feeling anxious or low.
• 7:20
  Dr. Komal Patil-Sisodia: That means checking for depression and anxiety with standard screening questions.
• 7:24
  Dr. Komal Patil-Sisodia: It also means asking about eating patterns, body image and self-esteem, no matter what a patient weighs.
• 7:33
  Dr. Komal Patil-Sisodia: When something comes up on that screening, therapy is the first recommended step, not medication.
• 7:40
  Dr. Komal Patil-Sisodia: Cognitive behavioral therapy, often called CBT, has real evidence behind it for body image distress, disordered eating and low self-esteem in PMOS specifically, not just for mental health in general.
• 7:54
  Dr. Komal Patil-Sisodia: Medication still has a place when symptoms are more serious or don't improve.
• 8:00
  Dr. Komal Patil-Sisodia: But the guidance is clear that we need to be careful in how we use these medications, because choosing options that cause weight gain can make PMOS symptoms worse.
• 8:11
  Dr. Komal Patil-Sisodia: We have to be really careful about choosing medications that don't promote weight gain.
• 8:17
  Dr. Komal Patil-Sisodia: There's also a real value in treating PMOS itself as part of the mental health plan.
• 8:24
  Dr. Komal Patil-Sisodia: Treating the physical symptoms that fuel body image distress, like excess hair growth or acne, can ease some of the emotional burden too.
• 8:34
  Dr. Komal Patil-Sisodia: And there's growing evidence that mind-body approaches like structured relaxation or mindfulness programs can help reduce depression symptoms in people with PMOS.
• 8:46
  Dr. Komal Patil-Sisodia: Their effect on anxiety is still not clear.
• 8:50
  Dr. Komal Patil-Sisodia: So what does this mean for you?
• 8:52
  Dr. Komal Patil-Sisodia: If you have PMOS and you've been carrying anxiety, low mood, body image struggles, or a hard relationship with food, I want you to hear this.
• 9:02
  Dr. Komal Patil-Sisodia: That is not a personal failing.
• 9:05
  Dr. Komal Patil-Sisodia: It's not something you should have to figure out on your own.
• 9:09
  Dr. Komal Patil-Sisodia: It's a well-documented part of this condition, and it deserves to be treated as seriously as any other PMOS symptom.
• 9:18
  Dr. Komal Patil-Sisodia: If you've been told your symptoms are just stress without anyone connecting it to PMOS, or you've never actually been screened for how you're doing mentally at a PMOS visit, it's completely okay to bring that up directly with your doctor.
• 9:34
  Dr. Komal Patil-Sisodia: You don't need to wait to be asked And if you're a clinician listening to this series, my hope is that we make this a standard of question at every PMOS visit, not just an afterthought.
• 9:46
  Dr. Komal Patil-Sisodia: How are you really doing?
• 9:48
  Dr. Komal Patil-Sisodia: And has anyone ever really screened you for this?
• 9:51
  Dr. Komal Patil-Sisodia: That brings us to the end of our PMOS Awareness Month series.
• 9:56
  Dr. Komal Patil-Sisodia: Over these four episodes, we covered what happens to PMOS at perimenopause and beyond.
• 10:02
  Dr. Komal Patil-Sisodia: We covered why it gets missed so often in people who are lean.
• 10:06
  Dr. Komal Patil-Sisodia: We covered where GLP-1 medications actually fit into treatment, and now the mental health toll that so often goes unaddressed along the way.
• 10:14
  Dr. Komal Patil-Sisodia: If there's one thread running through all four episodes, it's this: PMOS is bigger than any single symptom.
• 10:24
  Dr. Komal Patil-Sisodia: It deserves care that looks at the whole picture for as long as someone is living with it.
• 10:31
  Dr. Komal Patil-Sisodia: Thank you for spending this month with me.
• 10:33
  Dr. Komal Patil-Sisodia: If any of these episodes helped you or someone you know see PMOS more clearly, please share them.
• 10:40
  Dr. Komal Patil-Sisodia: And if anything in this episode brought up something personal for you, especially around food, body image, or how you've been feeling emotionally, please don't sit with that alone.
• 10:52
  Dr. Komal Patil-Sisodia: Talk to your doctor or a mental health professional who can help.
• 10:57
  Dr. Komal Patil-Sisodia: I hope that you all found this series helpful, and I hope to see you on the next episode.
• 11:02
  Dr. Komal Patil-Sisodia: 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.
• 11:08
  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.
• 11:20
  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.