Latest / Clearly Hormonal / Ep 13: PCOS & Perimenopause with Dr. Sonia Hans

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Ep 13: PCOS & Perimenopause with Dr. Sonia Hans · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Bhatia Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist.
• 0:11
  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health And recharge the conversations you are having with your health care providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
• 0:26
  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:30
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your health care provider at your next visit.
• 0:39
  Dr. Komal Patil-Sisodia: Hi, everyone.
• 0:40
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:42
  Dr. Komal Patil-Sisodia: I'm really excited to have a special guest today.
• 0:44
  Dr. Komal Patil-Sisodia: Her name is Dr.
• 0:45
  Dr. Komal Patil-Sisodia: Sonia Hans.
• 0:47
  Dr. Komal Patil-Sisodia: She is my partner and is a triple board certified physician in endocrinology diabetes and metabolism, as well as obesity medicine and internal medicine.
• 0:56
  Dr. Komal Patil-Sisodia: We've been working together for how many years now?
• 0:59
  Dr. Sonia Hans: Gosh, I think we hit our like anniversary next year.
• 1:01
  Dr. Sonia Hans: It's like six years.
• 1:03
  Dr. Sonia Hans: Gosh, time flies.
• 1:04
  Dr. Sonia Hans: It does.
• 1:06
  Dr. Sonia Hans: It does.
• 1:08
  Dr. Komal Patil-Sisodia: And when I met Dr.
• 1:10
  Dr. Komal Patil-Sisodia: Hans, I'm going to call you Sonia for the rest of this, because I think it's just going to be hard to go back and forth.
• 1:14
  Dr. Komal Patil-Sisodia: When I first met Sonia, I remember walking into her interview thinking, Oh my gosh, you remind me of my sister in law.
• 1:21
  Dr. Komal Patil-Sisodia: And it was like, A kinship that started from the beginning and it's been an amazing partnership.
• 1:27
  Dr. Komal Patil-Sisodia: I'm so lucky to work with you.
• 1:29
  Dr. Komal Patil-Sisodia: I want to take a minute and have you tell our listeners about you and your background, what motivated you to go into these things and yeah, I'll hand it over to you.
• 1:39
  Dr. Sonia Hans: All right.
• 1:39
  Dr. Sonia Hans: Thank you for welcoming.
• 1:40
  Dr. Sonia Hans: And likewise, I feel extremely grateful and blessed to have had the serendipitous event to be able to work with you as well.
• 1:48
  Dr. Sonia Hans: And it's been an amazing, yeah, like six years of just like gone.
• 1:52
  Dr. Sonia Hans: And the future looks amazing.
• 1:54
  Dr. Sonia Hans: So, um, little bit about myself.
• 1:56
  Dr. Sonia Hans: I attended medical school at the American University of Antigua College of Medicine in New York.
• 2:01
  Dr. Sonia Hans: I completed my internship and residency at MedStar Union Memorial Hospital in Baltimore, Maryland, and I did my fellowship in Louisiana at LSU School of Medicine in Shreveport.
• 2:12
  Dr. Sonia Hans: I now, live here in Washington, and I've been practicing at Evergreen Health since 2019 as well as I helped to co create and implement the evergreen health, weight loss and bariatric clinic for the non surgical program.
• 2:26
  Dr. Sonia Hans: And I'm the medical director of the obesity medicine program overlooking for the entire system.
• 2:31
  Dr. Sonia Hans: I also, you know, being an endocrinologist loves PCOS polycystic ovarian syndrome has been a passion of mine because metabolism and Diseases related to metabolism are a great passion of mine.
• 2:48
  Dr. Sonia Hans: And often I, feel like my path was forged to always end up in OPC medicine, metabolic management.
• 2:56
  Dr. Sonia Hans: Because I've loved that since undergrad, since biochemistry days and throughout my medical school education in residency.
• 3:04
  Dr. Sonia Hans: I had a great passion for metabolism and really, it was interesting.
• 3:08
  Dr. Sonia Hans: It was diabetes, and then it followed into metabolism.
• 3:11
  Dr. Sonia Hans: Anything that has to do with metabolic function and disease and the comorbidities related to that is a great love for me.
• 3:20
  Dr. Komal Patil-Sisodia: Again, we're so lucky to have you at work and I want to give you a shout out because our obesity medicine program is one of the first 25 in the country to get center of excellence designation and that's because of you and your expertise.
• 3:36
  Dr. Komal Patil-Sisodia: So you didn't mention that, but I'm going to throw that in here as a shout out.
• 3:40
  Dr. Komal Patil-Sisodia: I appreciate all the, all the credit there.
• 3:44
  Dr. Komal Patil-Sisodia: So you know, we wanted to do, gosh, I have so many podcast episodes that I want you on, but today we're going to talk about polycystic ovarian syndrome, right?
• 3:53
  Dr. Komal Patil-Sisodia: Because this is kind of the big red herring mystery and it's oftentimes what we call a diagnosis of exclusion, meaning you have to be ruled out for a ton of stuff before this even hits anybody's radar.
• 4:04
  Dr. Komal Patil-Sisodia: But I think it's so much more common than we give it credit for in young women.
• 4:10
  Dr. Komal Patil-Sisodia: And, tell us in your words, so that the general audience that's listening understands what exactly is polycystic ovarian syndrome.
• 4:21
  Dr. Sonia Hans: A very simplified sentence is it's, A disordered regulation of the female hormone reproductive system.
• 4:30
  Dr. Sonia Hans: So each endocrine system in the body, it has a, function from the master gland and the brain, the pituitary gland.
• 4:37
  Dr. Sonia Hans: And in this situation in females, It's our pituitary gland to our ovaries and then our ovaries, to our uterus and et cetera for the estrogen progesterone, our body.
• 4:47
  Dr. Sonia Hans: And so there's a dysregulation going on.
• 4:50
  Dr. Sonia Hans: And the root issue that we're seeing is that there's an imbalance between.
• 4:54
  Dr. Sonia Hans: Our superpower hormone, which, you know, I'm such a feminist, it's estrogen.
• 5:00
  Dr. Sonia Hans: So there's an imbalance between estrogen and testosterone in the body.
• 5:04
  Dr. Sonia Hans: And when we look at where is this coming from, there's a underlying Glucose metabolism dysregulation that's happening at the ovary level, and it also has to pair in with disordered fat metabolism in the body.
• 5:20
  Dr. Sonia Hans: And so, unfortunately, what happens when you have these couple of dysregulated systems, it's causing a stress on the female hormone.
• 5:30
  Dr. Sonia Hans: production system resulting in the body not able to, properly function, which means not ovulating properly.
• 5:38
  Dr. Sonia Hans: And therefore leading to symptoms of inability to have regular periods or irregular periods.
• 5:44
  Dr. Sonia Hans: And then there's an array of symptoms that people feel when.
• 5:48
  Dr. Sonia Hans: The testosterone symptoms are too much.
• 5:51
  Dr. Sonia Hans: And it's sad because you're right.
• 5:52
  Dr. Sonia Hans: It's a disease of exclusion, but it really shouldn't be because it's very common and it's affecting a lot of young women for prolonged periods of time, they suffer until they're trying to have children and that's when they get diagnosed, which I think is too late in the game.
• 6:08
  Dr. Sonia Hans: That's sort of like the basis.
• 6:09
  Dr. Sonia Hans: It's a dysregulated female reproductive hormone system.
• 6:13
  Dr. Komal Patil-Sisodia: Okay, so the signaling from the pituitary is off.
• 6:17
  Dr. Komal Patil-Sisodia: What happens in the ovaries is that they're making more testosterone than estrogen.
• 6:22
  Dr. Komal Patil-Sisodia: And then that's having this whole cascade to how you metabolize your carbs, how your body's processing insulin and et cetera, et cetera.
• 6:31
  Dr. Komal Patil-Sisodia: And, it's interesting because I remember when we learned about it in medical school residency fellowship, even it's not, you know, there's, There's certain diagnostic criteria, but you don't have to have all of them.
• 6:44
  Dr. Komal Patil-Sisodia: And then the name, I think of polycystic ovarian syndrome is confusing too, right?
• 6:50
  Dr. Komal Patil-Sisodia: So how do you go about diagnosing this?
• 6:53
  Dr. Komal Patil-Sisodia: And do you have like any examples of people that, come into your practice and what does that look like?
• 6:58
  Dr. Komal Patil-Sisodia: What is, what goes off in your head that triggers it?
• 7:01
  Dr. Komal Patil-Sisodia: And then how do you go about working through, how you're going to, how you're going to diagnose?
• 7:05
  Dr. Komal Patil-Sisodia: young women who are struggling and showing up in your office.
• 7:09
  Dr. Sonia Hans: Yeah.
• 7:09
  Dr. Sonia Hans: And I think one of the two points that you sort of really stressed upon is there's this excess testosterone and it's coming from two places, depending on what else is going on in your body at the time.
• 7:20
  Dr. Sonia Hans: I often have to tell people PCOS and metabolic disease, which is, the struggle with weight, right, obesity, being overweight, they're like BFF.
• 7:30
  Dr. Sonia Hans: Sometimes they're together, but definitely when one shows up, the other one will likely show up.
• 7:36
  Dr. Sonia Hans: And so you have this testosterone in, in balance from the ovary.
• 7:40
  Dr. Sonia Hans: And also depending off your struggling with weight, you also get the excess testosterone from the fat cells on the body, which then even causes the disease to further, further become, more symptomatic.
• 7:51
  Dr. Sonia Hans: And so what happens often for me and the endocrine clinic, it'll be.
• 7:56
  Dr. Sonia Hans: A referral for, I'm struggling with my cycles.
• 7:59
  Dr. Sonia Hans: I'm not getting my periods on time or my periods are irregular and then we start talking about, okay, so tell me what other things you've been experiencing.
• 8:07
  Dr. Sonia Hans: The red flags to me are, When we're a teenager, our periods are going to be a little irregular just because of puberty.
• 8:15
  Dr. Sonia Hans: And so it's so hard to totally discern that between the ages of 12, 13, when one would get their, menstrual cycles to about 17, you know, 16, 17.
• 8:25
  Dr. Sonia Hans: But when I have a 19 year old who comes in, who says I've got irregular periods, I only get my periods every six to eight weeks, or sometimes 10 to 12 weeks.
• 8:33
  Dr. Sonia Hans: That's my red flag.
• 8:34
  Dr. Sonia Hans: That's not supposed to be happening.
• 8:36
  Dr. Sonia Hans: Number two.
• 8:37
  Dr. Sonia Hans: when they start experiencing what I call testosterone like symptoms.
• 8:41
  Dr. Sonia Hans: Abnormal weight gain excess hair growth or inability to lose weight acne, lots of excess oil symptoms on the skin and hair.
• 8:51
  Dr. Sonia Hans: And hair is a big one, body hair, facial hair, that's outside of your ethnic genetic norms, and
• 8:59
  Dr. Komal Patil-Sisodia: women on this call,
• 9:00
  Dr. Sonia Hans: that's what I'm saying.
• 9:01
  Dr. Sonia Hans: Cause like, when I get like, you know, someone from North Asia or Middle East, I'm going, okay, so what do you look like compared to your family members?
• 9:08
  Dr. Sonia Hans: Then it'll help me discern, but someone who comes in from Sweden, I'm going, okay, what's going on?
• 9:14
  Dr. Sonia Hans: You know, I shouldn't be
• 9:15
  Dr. Komal Patil-Sisodia: having all this excess hair growth.
• 9:17
  Dr. Sonia Hans: No.
• 9:18
  Dr. Sonia Hans: And so those are sort of the red flags that'll team me.
• 9:20
  Dr. Sonia Hans: And you're right about the diagnostic criteria.
• 9:22
  Dr. Sonia Hans: This is still today.
• 9:24
  Dr. Sonia Hans: I feel that there's a definitely a discrepancy between the endocrine world and what we see in the primary care world.
• 9:32
  Dr. Sonia Hans: Primary care says cysts on ovaries.
• 9:34
  Dr. Sonia Hans: That's PCOS.
• 9:35
  Dr. Sonia Hans: That's not true.
• 9:36
  Dr. Sonia Hans: Cysts on ovaries can happen, even in those who struggle with weight without PCOS.
• 9:42
  Dr. Sonia Hans: Cysts are cancer.
• 9:43
  Dr. Sonia Hans: are definitely help to say, Oh yeah, that's, that might be happening in somebody who's got the PCOS syndrome, but it's testosterone.
• 9:51
  Dr. Sonia Hans: It's the driver of this disease.
• 9:53
  Dr. Sonia Hans: So the real diagnostic criteria here is increased testosterone levels in the blood, and it could be total or free.
• 10:01
  Dr. Sonia Hans: And it really depends on your weight because people who are struggling with overweight and obesity, total testosterone levels may look normal, but when you check free levels, They're high.
• 10:13
  Dr. Sonia Hans: And so then you know something's wrong.
• 10:15
  Dr. Sonia Hans: But that's one of the, that for me is actually in our expert panel on the PCOS committee that I serve on.
• 10:21
  Dr. Sonia Hans: That's one of our criterias.
• 10:22
  Dr. Sonia Hans: We are like, if without that access to testosterone, that's not PCO, PCOS.
• 10:27
  Dr. Sonia Hans: So I have a question about that.
• 10:28
  Dr. Komal Patil-Sisodia: I know testosterone comes from the ovaries, but there's some production in the adrenal glands as well.
• 10:33
  Dr. Komal Patil-Sisodia: Are the adrenal glands affected in PCOS?
• 10:36
  Dr. Komal Patil-Sisodia: Or do we can
• 10:37
  Dr. Sonia Hans: be,
• 10:38
  Dr. Komal Patil-Sisodia: they
• 10:38
  Dr. Sonia Hans: can be.
• 10:39
  Dr. Sonia Hans: So that's the thing that we're seeing.
• 10:40
  Dr. Sonia Hans: And actually you can't even really test that level appropriately, but there's one level one could test for, and that's called a DHEA sulfated dihydro.
• 10:51
  Dr. Sonia Hans: Dihydro, uh, andostronine.
• 10:54
  Dr. Sonia Hans: It's really a complicated name, but we abbreviate it as DHEA, but we actually check the sulfated version in blood because it's a stable molecule.
• 11:01
  Dr. Sonia Hans: And so DHES levels can be slightly elevated in those with the ovarian origin of PCOS.
• 11:10
  Dr. Sonia Hans: And they're not supposed to be excessively high.
• 11:12
  Dr. Sonia Hans: They're usually just slightly elevated.
• 11:14
  Dr. Sonia Hans: And so that can be a signal that maybe the adrenals are making a bit.
• 11:17
  Dr. Sonia Hans: So that just tells you there's major testosterone dysregulation going on.
• 11:21
  Dr. Sonia Hans: And the other thing that, we see is obviously adipose tissue.
• 11:26
  Dr. Sonia Hans: So fat tissue in the body also makes testosterone.
• 11:29
  Dr. Komal Patil-Sisodia: Well, that's interesting because we talk a lot about how it also may or how it makes estrogen predominantly.
• 11:35
  Dr. Komal Patil-Sisodia: And so when you were talking about how women who are struggling with overweight and obesity, their testosterone levels can look normal.
• 11:42
  Dr. Komal Patil-Sisodia: My follow up question was going to be, is that because the excess fat mass is making more estrogen too?
• 11:49
  Dr. Komal Patil-Sisodia: But it's interesting that if the fat mass makes testosterone, that it would still be lower.
• 11:53
  Dr. Komal Patil-Sisodia: So I wonder if that, that messes with the ratio, but I don't know.
• 11:57
  Dr. Sonia Hans: No, so it's actually, so it actually has to do with protein binding globulins in the body.
• 12:02
  Dr. Sonia Hans: So, sex hormone binding globulins.
• 12:05
  Dr. Sonia Hans: So all hormones, they're either with a BFF called protein of some type, or they're by themselves free.
• 12:11
  Dr. Sonia Hans: The total testosterone is testosterone that's binded with a protein, but also free, but people who struggle with overweight and obesity have higher binding gobulins.
• 12:22
  Dr. Sonia Hans: So that means less free has bound.
• 12:24
  Dr. Sonia Hans: And therefore the total levels will look normal, but when you check free levels, they're high.
• 12:29
  Dr. Sonia Hans: Oh, that's fascinating.
• 12:30
  Dr. Sonia Hans: That makes sense.
• 12:31
  Dr. Sonia Hans: So it has to do with the protein ratio, which is why, you know, whenever I have an individual who's coming in, I actually check all of it, total levels, free levels.
• 12:39
  Dr. Sonia Hans: And I check that sex hormone binding globulin to see, is that throwing anything off?
• 12:43
  Dr. Sonia Hans: Because that's going to really help me understand how severe the disease is.
• 12:47
  Dr. Komal Patil-Sisodia: Yeah.
• 12:47
  Dr. Komal Patil-Sisodia: Yeah.
• 12:47
  Dr. Komal Patil-Sisodia: And, you talked a little bit about metabolic syndrome and PCOS being BFFs, we have like the five things within metabolic syndrome.
• 12:56
  Dr. Komal Patil-Sisodia: PCOS, we know increases lifetime risk of developing metabolic syndrome.
• 13:02
  Dr. Komal Patil-Sisodia: How often do you see that in the women that you're treating?
• 13:05
  Dr. Komal Patil-Sisodia: Right?
• 13:05
  Dr. Komal Patil-Sisodia: Because there is a subset of women who don't have any of those signs and just have the irregular periods.
• 13:10
  Dr. Komal Patil-Sisodia: But at least in my experience, and maybe it's, You know, I'm biased because we're endocrinologists and we see this coming into the office.
• 13:17
  Dr. Komal Patil-Sisodia: I tend to see the ones with the metabolic syndrome more.
• 13:20
  Dr. Komal Patil-Sisodia: Do you get both in your office or are you predominantly working with the metabolic syndrome?
• 13:24
  Dr. Komal Patil-Sisodia: And then what does that look like, that pairing of the two?
• 13:28
  Dr. Sonia Hans: Similar to you in our endocrine clinic, I will get the cases that are a bit more severe.
• 13:34
  Dr. Sonia Hans: That's really hard because you just feel like, gosh, we dropped the ball because this could have been detected earlier and prevent some of this syndrome.
• 13:41
  Dr. Sonia Hans: In my weight loss clinic where I'm really diagnosing them for the first time, I don't have to see all that.
• 13:47
  Dr. Sonia Hans: I don't get, I don't see as much metabolic syndrome because usually they're coming into me early with something that has to do with the weight stuff.
• 13:54
  Dr. Sonia Hans: And then we figure out, aha, you're having PCOS.
• 13:57
  Dr. Sonia Hans: And so that is actually what I've seen in clinical practice.
• 14:00
  Dr. Sonia Hans: So my endocrine clinic, it's different than what it is in the weight loss clinic for sure.
• 14:04
  Dr. Sonia Hans: And my colleague, Oh, definitely.
• 14:06
  Dr. Sonia Hans: Oh, yeah.
• 14:08
  Dr. Sonia Hans: 100%.
• 14:08
  Dr. Sonia Hans: And ages matter too.
• 14:09
  Dr. Sonia Hans: So younger patients tend to, and it depends, where they are in their sort of weight history too.
• 14:15
  Dr. Sonia Hans: But I've had several young, women who are thin and, or even normal weight, struggling with PCOS.
• 14:22
  Dr. Sonia Hans: And then, you know, my weight loss clinic, naturally I deal with people who've already been struggling with weight.
• 14:26
  Dr. Sonia Hans: So their weights tend to be a little higher and they're a bit more symptomatic.
• 14:30
  Dr. Komal Patil-Sisodia: Yeah.
• 14:30
  Dr. Komal Patil-Sisodia: Now, do you see the weight gain happen early on in these women?
• 14:34
  Dr. Komal Patil-Sisodia: I know you talked about the irregularity of the periods being a trigger, but sometimes I've heard from patients that, they start gaining weight rapidly after puberty.
• 14:44
  Dr. Komal Patil-Sisodia: How frequently do you see that?
• 14:46
  Dr. Komal Patil-Sisodia: And what does that look like?
• 14:47
  Dr. Komal Patil-Sisodia: What are the things that you're looking for when you start talking to people about their weight gain around this?
• 14:52
  Dr. Sonia Hans: This is where we're starting to put this whole metabolic disease picture into play.
• 14:56
  Dr. Sonia Hans: So earlier on, and I'll be honest with you, 10 years ago, it would be somebody who had, it was always typically a PCOS individual that was diagnosed, typically already struggled with weight at the time they're overweight, they're obese, et cetera.
• 15:11
  Dr. Sonia Hans: And then they started developing more symptoms later in life.
• 15:13
  Dr. Sonia Hans: We are seeing a younger group of.
• 15:15
  Dr. Sonia Hans: Of individuals with dysregulated periods, like dysregulated hormones and then, and you're right.
• 15:23
  Dr. Sonia Hans: And then rapidly starting to put on weight, or we're seeing them have the metabolic disease issues where they're putting on a ton of weight and then developing PCOS symptoms, in their early twenties.
• 15:34
  Dr. Sonia Hans: Like the teenagers, and we know this right, obesity is, really affecting our teens, in a huge exponential way.
• 15:41
  Dr. Sonia Hans: And unfortunately it's affecting males and females differently, but females, they're gaining all this weight and then they're getting PCOS, in their early twenties and you're just like, Oh gosh.
• 15:51
  Dr. Sonia Hans: So you know, the chicken and the egg story starts being at play.
• 15:54
  Dr. Sonia Hans: And so that's where, my practice and thinking has really shifted because I recognize my goodness, these BFFs, one before the other, we'll throw the other off, but get one under control, you can get the other one under control,
• 16:06
  Dr. Komal Patil-Sisodia: so it almost sounds like One can cause the other and it doesn't matter where you start you'll converge in the middle,
• 16:14
  Dr. Sonia Hans: always, I have yet to see a PCOS patient, and long term follow up so you know I had a 19 year old and now I see her at 24.
• 16:25
  Dr. Sonia Hans: And now she's struggling, like at 19, we really controlled the PCOS and we worked really hard.
• 16:30
  Dr. Sonia Hans: She got lost to follow up and then came back with weight issues.
• 16:33
  Dr. Sonia Hans: And I was like, dang it.
• 16:34
  Dr. Sonia Hans: We buckled down on that PCOS and just kept it tightly controlled.
• 16:38
  Dr. Sonia Hans: We might have even prevented the weight issues.
• 16:39
  Dr. Komal Patil-Sisodia: Yeah.
• 16:40
  Dr. Komal Patil-Sisodia: Oh, gosh, that is such a hard thing to diagnose and to live with, right?
• 16:46
  Dr. Komal Patil-Sisodia: Oh,
• 16:47
  Dr. Sonia Hans: yeah.
• 16:47
  Dr. Komal Patil-Sisodia: Yeah.
• 16:47
  Dr. Komal Patil-Sisodia: I feel like so many young women struggle and with everything that we're seeing in the media about how, I think it's gotten better over years, but there was definitely a certain look you had to achieve to be considered whatever.
• 17:02
  Dr. Komal Patil-Sisodia: the media standard of beauty is.
• 17:04
  Dr. Komal Patil-Sisodia: So how do you think that's impacted your patient population?
• 17:08
  Dr. Komal Patil-Sisodia: I
• 17:09
  Dr. Sonia Hans: mean, I tell you, my young population is struggling so hard because they're trying they don't understand why the typical scenarios of just taking care of their weight and exercising eating well isn't enough, and I think that.
• 17:23
  Dr. Sonia Hans: As endocrinologists, and we've really, we've come a long way in diagnosis and education and prevention for PCOS.
• 17:31
  Dr. Sonia Hans: But I think that we're still lagging in sort of our primary care world.
• 17:35
  Dr. Sonia Hans: And so they're suffering because they don't recognize that this hormone dysregulation is not going to make it easy.
• 17:42
  Dr. Sonia Hans: To maintain a weight or lose weight, and it's tough.
• 17:44
  Dr. Sonia Hans: We talk about our type one diabetics when we give them diagnosis at age 12.
• 17:49
  Dr. Sonia Hans: It's a big thing to tell a young person, Hey, guess what?
• 17:53
  Dr. Sonia Hans: You've got this disease and it's not going away anytime soon.
• 17:56
  Dr. Sonia Hans: So let's try figuring it out.
• 17:57
  Dr. Sonia Hans: These chronic diagnosis at such a young age are hard.
• 18:01
  Dr. Sonia Hans: And young women have enough to deal with right now in their early 20s.
• 18:05
  Dr. Sonia Hans: And given the current circumstances we're in, I mean, young women are like, what in the world, how much more am I supposed to take?
• 18:12
  Dr. Sonia Hans: You know, so
• 18:14
  Dr. Komal Patil-Sisodia: it's hard.
• 18:15
  Dr. Komal Patil-Sisodia: Right.
• 18:15
  Dr. Komal Patil-Sisodia: And I think, one of the good things that we've seen Progress over the years has been the body positivity movement, right?
• 18:22
  Dr. Komal Patil-Sisodia: Where we're honoring people in all shapes, sizes, and things like that.
• 18:26
  Dr. Komal Patil-Sisodia: How do you balance that with trying to help them with their metabolic disease?
• 18:34
  Dr. Komal Patil-Sisodia: Because that it's a weight is a sensitive topic.
• 18:36
  Dr. Komal Patil-Sisodia: You're an expert in that.
• 18:37
  Dr. Komal Patil-Sisodia: I'm not an expert in addressing that with people, but that is such a tenuous balance, especially in younger women who are starting to, see either the PCOS causing the weight gain or the weight gain causing the PCOS.
• 18:47
  Dr. Komal Patil-Sisodia: So it's got to be a hard conversation.
• 18:50
  Dr. Sonia Hans: Yeah, when you have to break so it's such a gentle approach with a young woman to let her know you have a chronic disease.
• 18:57
  Dr. Sonia Hans: That unfortunately is not a simple thing.
• 19:00
  Dr. Sonia Hans: Simple.
• 19:01
  Dr. Sonia Hans: Why?
• 19:02
  Dr. Sonia Hans: And the treatments, there's really not a lot of, options out there other than really trying to make your ovaries not work and giving your body a rest so that you have a chance to kind of live, what I call sort of a quality of life.
• 19:15
  Dr. Sonia Hans: Metabolic disease, the weight struggle.
• 19:18
  Dr. Sonia Hans: It is, it's such a complex disease in itself.
• 19:21
  Dr. Sonia Hans: And when I approach it I really have to just one sort of break the news to them that this is what's going on, but then I have to empower them.
• 19:29
  Dr. Sonia Hans: This is how we're going to manage it because there is hope you we're not where we were 15 years ago, where we're just going to say, Hey, this is what you're going to do.
• 19:36
  Dr. Sonia Hans: And then this is your life.
• 19:37
  Dr. Sonia Hans: Just deal with it.
• 19:38
  Dr. Sonia Hans: We're going to have a way to, because today's metabolic disease management is revolutionary where it was 15 years ago.
• 19:45
  Dr. Sonia Hans: And so we have some great options for people who do not need to suffer any longer.
• 19:51
  Dr. Sonia Hans: And so I think for me, it's just empowering them.
• 19:53
  Dr. Sonia Hans: We've got options and it's getting better and better.
• 19:56
  Dr. Sonia Hans: And then really, we have to really talk about lifestyle.
• 19:58
  Dr. Sonia Hans: Style and some of what we call the endocrine disrupting sort of triggers to help make sure that we try to keep them in the best, health and wellness state that they can be in.
• 20:07
  Dr. Sonia Hans: But it's not easy, but I think empowering people, one, when people understand what's going on with them, there's a sigh of, I'm not broken something, not I'm, you know, I'm not screwing my life up.
• 20:18
  Dr. Sonia Hans: I mean, there's something really going on.
• 20:20
  Dr. Sonia Hans: And then you can say, I got some options for you and we're gonna try them together.
• 20:23
  Dr. Sonia Hans: And we're going to figure out what works.
• 20:24
  Dr. Sonia Hans: I think that and I can say it, humbly is my success, being one of the experts of PCOS actually in the Puget Sound, I have a lot of referrals from a lot of providers in the area because that is sort of, the community.
• 20:37
  Dr. Sonia Hans: The area that I focused on.
• 20:38
  Dr. Sonia Hans: And I think I've had a really, really great response and patients and not everything has to be birth control, right?
• 20:44
  Dr. Sonia Hans: Cause that's a big treatment, right?
• 20:45
  Dr. Sonia Hans: I have a lot of young women who want to get pregnant and we, we figure it out and we get there, I think it's about education and empowering women.
• 20:52
  Dr. Sonia Hans: And I think it's about a lot of empathy and I document very well so that other providers read my notes and know how to do this and talk about it with them.
• 21:01
  Dr. Komal Patil-Sisodia: Yeah that's really great.
• 21:03
  Dr. Komal Patil-Sisodia: And so let's talk a little bit about the treatments, right?
• 21:05
  Dr. Komal Patil-Sisodia: So when you're coming to your office you mentioned birth control is one and birth control will help lower those testosterone levels.
• 21:12
  Dr. Komal Patil-Sisodia: What else do you have in your arsenal?
• 21:15
  Dr. Komal Patil-Sisodia: I know you're very, also very big into laying a great lifestyle foundation.
• 21:19
  Dr. Komal Patil-Sisodia: So I want you to talk about that.
• 21:21
  Dr. Sonia Hans: Yeah.
• 21:21
  Dr. Sonia Hans: If there's a patient with PCOS who is struggling also with metabolic disease, which is, overweight and obesity we focus on the three pillars of weight loss, which is a foundation that I use even in my weight loss clinic nutrition.
• 21:34
  Dr. Sonia Hans: We talk about, really following a low carbohydrate because the data on PCOS says this, there's a glucose metabolism problem.
• 21:40
  Dr. Sonia Hans: It's almost, and then the, what do I mean insulin resistance.
• 21:44
  Dr. Sonia Hans: There's an insulin resistance problem, which another layman term for people to understand is it's almost like pre diabetes, not full diabetes.
• 21:51
  Dr. Sonia Hans: Some are, but there's a problem with, the insulin and sugar in the body.
• 21:55
  Dr. Sonia Hans: So we focus on a low carbohydrate, high protein nutrition plan.
• 21:59
  Dr. Sonia Hans: We focus on, movement because the body needs endorphins.
• 22:03
  Dr. Sonia Hans: It needs to feel great.
• 22:05
  Dr. Sonia Hans: And it needs to move and it's really helpful for inflammation and overall well being and guess what?
• 22:11
  Dr. Sonia Hans: Glucose metabolism, which is something that we're battling with, right?
• 22:15
  Dr. Sonia Hans: And then the third is wellness.
• 22:17
  Dr. Sonia Hans: So you know, the number one thing that we've seen overall with these chronic diseases is that emotional wellbeing, mental health and good sleep are essential to our body's immune system, sort of calming down and allowing our body heal and deal with a chronic disease.
• 22:36
  Dr. Sonia Hans: And so we talk about those three sort of pillars being important.
• 22:39
  Dr. Sonia Hans: And then when it comes to medical therapy, there's two pathways that I always ask my patient, what's our goal?
• 22:45
  Dr. Sonia Hans: Are you trying to just focus on, getting this disease under control and losing weight or, or do you want to get this disease under control, lose some weight and get pregnant?
• 22:56
  Dr. Sonia Hans: And when do you want to get pregnant?
• 22:57
  Dr. Sonia Hans: Because those two pathways are totally different.
• 23:00
  Dr. Sonia Hans: If the patient has no desire for pregnancy, you know, the next Two, three years, we will say, okay, let's shut down the ovaries for a minute and give your body a break from all this chaos signaling with a birth control pill.
• 23:12
  Dr. Sonia Hans: That's currently the guideline base.
• 23:14
  Dr. Sonia Hans: If they have symptoms of the excess testosterone, in terms of inability to lose weight, the facial hair, the acne, the excess oil, then you know, we talk about sper lactone, which is a testosterone receptor blocker.
• 23:27
  Dr. Sonia Hans: We can always add that in the mix.
• 23:29
  Dr. Sonia Hans: And the other thing that I think is very important and it's being utilized beautifully all over providers is let's attack that insulin resistance.
• 23:38
  Dr. Sonia Hans: So we've got to get on an insulin sensitizer.
• 23:41
  Dr. Sonia Hans: And, before it was always a medication that was used in pre diabetes and diabetes called metformin.
• 23:47
  Dr. Sonia Hans: Right.
• 23:47
  Dr. Sonia Hans: And it was a pill.
• 23:49
  Dr. Sonia Hans: It has some GI side effects, so not everyone loves it, but there's actually now new guidelines showing that inositol, which is a supplement, works as an excellent insulin sensitizer.
• 24:00
  Dr. Sonia Hans: Patients have a couple of choices to use either that or, the supplement.
• 24:04
  Dr. Sonia Hans: And then.
• 24:05
  Dr. Sonia Hans: Yeah.
• 24:05
  Dr. Sonia Hans: We have to follow closely.
• 24:07
  Dr. Sonia Hans: Hormones take three to four months to adjust.
• 24:09
  Dr. Sonia Hans: So that's usually my, like every three to four months, we're going to check in and make sure that is everything working, do we have to adjust doses?
• 24:17
  Dr. Sonia Hans: People with really severe disease.
• 24:19
  Dr. Sonia Hans: And I'm talking about more of the abnormal hair growth and that kind of acne.
• 24:24
  Dr. Sonia Hans: We might even have to step it up to some of our big guns, like finesse stride and things like that, to help block the testosterone effects.
• 24:32
  Dr. Sonia Hans: But that's the pathway for people who don't want to get pregnant, the ones who want to get pregnant, no birth control.
• 24:38
  Dr. Sonia Hans: I mean, I know they want to get pregnant, so you know what I mean?
• 24:40
  Dr. Sonia Hans: And so, you know, and also, sorry, I forgot to mention my off label use, which is being very, I forgot it.
• 24:50
  Dr. Sonia Hans: I was like, Oh, cause I use it in both pathways.
• 24:52
  Dr. Sonia Hans: Um, yeah.
• 24:53
  Dr. Sonia Hans: So I'll save that last one for last one for the last thing, cause they can be used in both.
• 24:57
  Dr. Sonia Hans: But for people who want to get pregnant, we've buckled down.
• 25:00
  Dr. Sonia Hans: We do the insulin sensitizer.
• 25:02
  Dr. Sonia Hans: Um, we do not do the spironolactone because it's absolutely contraindicated in anybody who wants to get pregnant or gets pregnant on it.
• 25:09
  Dr. Sonia Hans: And then we really focus in on those three pillars of weight loss.
• 25:12
  Dr. Sonia Hans: And then my favorite, which is both, Both groups, the GLP one receptor agonist if I could describe, I remember doing a it was, it was on my audition rotation for residency and I got to speak this in front of the entire internal medicine group, and it was about GLPs and I said, it's going to change the world because there's more to it than diabetes, and so I use that and you're being the oracle for GLP.
• 25:38
  Dr. Sonia Hans: I know, I know, I swear, like, I think that people often ask me, like, what's the one thing in your medical life, you know, career that you felt like was the greatest change.
• 25:47
  Dr. Sonia Hans: It's not cancer meds.
• 25:48
  Dr. Sonia Hans: It's not this.
• 25:49
  Dr. Sonia Hans: No, it was the metabolic disease drug, GLP one receptor agonist.
• 25:54
  Dr. Sonia Hans: And now there's more drugs coming out, but it changed the link.
• 25:58
  Dr. Komal Patil-Sisodia: semaglutide, the terzapatide.
• 26:00
  Dr. Komal Patil-Sisodia: Yeah,
• 26:01
  Dr. Sonia Hans: liraglutide.
• 26:02
  Dr. Sonia Hans: Exactly.
• 26:03
  Dr. Sonia Hans: Brand names.
• 26:04
  Dr. Sonia Hans: I don't know if we can say that on here, but Ozempic is using diabetes.
• 26:08
  Dr. Sonia Hans: We'll go via weight loss, Manjaro and diabetes, Zepfound and weight loss.
• 26:13
  Dr. Sonia Hans: You have Victoza on diabetes, succenda on weight loss.
• 26:17
  Dr. Sonia Hans: That GLP 1 receptor agonist, and honestly, the PCOS research is just underway.
• 26:22
  Dr. Sonia Hans: We know it helps with glucose metabolism and sensitivity.
• 26:26
  Dr. Sonia Hans: We know it helps with metabolic disease.
• 26:28
  Dr. Sonia Hans: So aiding in weight loss, there's going to be a lot of data coming out to show some anti inflammatory, endocrine disrupting blocking ability of it, because there's this balance that starts happening.
• 26:42
  Dr. Komal Patil-Sisodia: And I use it a lot.
• 26:43
  Dr. Komal Patil-Sisodia: I was talking to some rheumatology colleagues, too, and they were telling me that they're seeing an improvement in autoimmune disease as well, and they wonder if it's tied to some insulin resistance, right?
• 26:55
  Dr. Komal Patil-Sisodia: For example, psoriasis, we know, is linked very closely with obesity and with insulin resistance in general.
• 27:02
  Dr. Komal Patil-Sisodia: They are seeing some improvements in other spaces.
• 27:05
  Dr. Komal Patil-Sisodia: We already have indications for the heart disease, for the liver disease.
• 27:08
  Dr. Komal Patil-Sisodia: I'm very excited to see, do you think we will get an indication for those for PCOS?
• 27:12
  Dr. Komal Patil-Sisodia: I know right now you can get.
• 27:14
  Dr. Komal Patil-Sisodia: By with doing it based off of BMI, because there are certain cutoffs for BMI.
• 27:18
  Dr. Komal Patil-Sisodia: So if patients fall into the category of overweight or obese or overweight with complications or comorbidities or obesity, you can get them those medications provided their insurance covers it.
• 27:29
  Dr. Komal Patil-Sisodia: But do you think we'll see one for PCOS fingers crossed?
• 27:34
  Dr. Sonia Hans: So, you know, I, I like it's a woman's health.
• 27:37
  Dr. Sonia Hans: Um, I think the number one thing first off, right?
• 27:40
  Dr. Sonia Hans: Number two, the number of PCOS cases that have gone up exponentially just in the last five years warrants the FDA to look at this.
• 27:47
  Dr. Sonia Hans: I think if the big pharma were actually to do some clinical trials to show the benefit, we could get the indication.
• 27:56
  Dr. Sonia Hans: I'm trying to be optimistic, but the truth of the matter is that they don't put a ton of money into something that's just going to be one disease only.
• 28:04
  Dr. Sonia Hans: And it can affect one type of population.
• 28:05
  Dr. Sonia Hans: And we've seen, women's health is finally being pushed forward.
• 28:08
  Dr. Sonia Hans: But I think if we don't get a randomized clinical trial, I don't think we're going to get that FDA approval.
• 28:12
  Dr. Sonia Hans: So we're going to have to wait for it to be generic and that's off label use.
• 28:16
  Dr. Sonia Hans: You know, and so because liver right now, yeah, the heart disease is going to take diagnoses.
• 28:22
  Dr. Sonia Hans: Liver disease is going to get approved.
• 28:23
  Dr. Sonia Hans: It got approved for some and it's going to expand further.
• 28:26
  Dr. Sonia Hans: The next big gun is actually kidney disease.
• 28:29
  Dr. Sonia Hans: And so anything that can be general population is going to get the first one.
• 28:33
  Dr. Sonia Hans: But I like to say it very candidly.
• 28:36
  Dr. Sonia Hans: If there was something that was going to help testosterone in men.
• 28:39
  Dr. Sonia Hans: Oh yeah.
• 28:39
  Dr. Sonia Hans: It would get approved tomorrow.
• 28:43
  Dr. Komal Patil-Sisodia: I did a podcast episode with a friend and colleague, Dr.
• 28:48
  Dr. Komal Patil-Sisodia: Naomi Bush, and she runs Seattle menopause medicine.
• 28:51
  Dr. Komal Patil-Sisodia: And she said the same thing about a testosterone product for women.
• 28:56
  Dr. Komal Patil-Sisodia: We just don't have one that's FDA approved anymore.
• 28:59
  Dr. Komal Patil-Sisodia: And her, I think her brother in law or somebody in her family works for the FDA.
• 29:03
  Dr. Komal Patil-Sisodia: And it was just like, yeah, don't hold your breath.
• 29:05
  Dr. Komal Patil-Sisodia: It's there.
• 29:05
  Dr. Komal Patil-Sisodia: It's too much money and not enough of the population being affected for them to do it, which is a sad statement, but you know, that's why we're doing this podcast.
• 29:13
  Dr. Komal Patil-Sisodia: So women get good.
• 29:15
  Dr. Sonia Hans: That's what I'm saying.
• 29:15
  Dr. Sonia Hans: Yeah, exactly.
• 29:16
  Dr. Sonia Hans: And honestly,
• 29:17
  Dr. Komal Patil-Sisodia: Yeah,
• 29:18
  Dr. Sonia Hans: we got to advocate more just like today.
• 29:20
  Dr. Sonia Hans: We have more things available for women in terms of perimenopausal menopausal treatments than we've ever had in our women's lifetime.
• 29:27
  Dr. Sonia Hans: Again, I think it's interesting that the FDA is like, Oh, there's just not enough.
• 29:31
  Dr. Sonia Hans: Y'all there's plenty of women.
• 29:32
  Dr. Sonia Hans: Let me tell you.
• 29:34
  Dr. Komal Patil-Sisodia: We're like 51 percent of the population.
• 29:35
  Dr. Komal Patil-Sisodia: Thank
• 29:36
  Dr. Sonia Hans: you.
• 29:37
  Dr. Sonia Hans: So there's plenty of women.
• 29:38
  Dr. Sonia Hans: And let me tell you, I think there's a lot of, male, family members, partners, siblings, friends who would support a woman feeling pretty darn good because it's, when you see someone you love struggle, you want the best for them.
• 29:52
  Dr. Sonia Hans: And so, yeah, so that's my stitch.
• 29:54
  Dr. Sonia Hans: I just think that
• 29:55
  Dr. Komal Patil-Sisodia: you and me both.
• 29:56
  Dr. Komal Patil-Sisodia: And that's why we get along so well.
• 29:58
  Dr. Komal Patil-Sisodia: Yes.
• 29:59
  Dr. Komal Patil-Sisodia: So let's talk a little bit about, PCOS we know starts.
• 30:03
  Dr. Komal Patil-Sisodia: Can start pretty young affects those key reproductive years, right?
• 30:07
  Dr. Komal Patil-Sisodia: But how does it start transitioning when women hit perimenopause?
• 30:10
  Dr. Komal Patil-Sisodia: Because I know what I see, but I would love for you to tell our listeners what it is you see from your perspective and what are the things that we need to be doing?
• 30:19
  Dr. Komal Patil-Sisodia: Because oftentimes, right?
• 30:20
  Dr. Komal Patil-Sisodia: One, we don't complain women.
• 30:23
  Dr. Komal Patil-Sisodia: Complain.
• 30:23
  Dr. Komal Patil-Sisodia: Unfortunately, they've been gaslit in the medical system to not speak up.
• 30:28
  Dr. Komal Patil-Sisodia: But then when you have a family or you get busy in your career, you're not going to the doctor as frequently.
• 30:33
  Dr. Komal Patil-Sisodia: So when they're hitting that perimenopause transition.
• 30:37
  Dr. Komal Patil-Sisodia: I, I'd love to hear from you what you see PCOS doing in that population.
• 30:42
  Dr. Sonia Hans: Oh, yeah.
• 30:43
  Dr. Sonia Hans: I mean, ask me, where do I see it the most in the weight loss clinic?
• 30:46
  Dr. Sonia Hans: Sadly, not in my endocrine clinic, right?
• 30:49
  Dr. Sonia Hans: The weight loss clinic.
• 30:50
  Dr. Sonia Hans: So some of them have, you know, and, and the, there's two stories.
• 30:53
  Dr. Sonia Hans: They've had children and then they're struggling right afterwards, or they've had that.
• 30:57
  Dr. Sonia Hans: Horrible history of infertility, failed IVFs, or maybe even IVFs.
• 31:01
  Dr. Sonia Hans: I'm thankful for that, but it's just sad because I see, it's 40 plus, right?
• 31:06
  Dr. Sonia Hans: That I'm seeing these group of women and and really I get aggressive.
• 31:10
  Dr. Sonia Hans: I'm like, all right, we're kind of late to the game.
• 31:12
  Dr. Sonia Hans: So these women all have to be on GLPs.
• 31:15
  Dr. Sonia Hans: Because I know what their number one issue is that they're starting to experience the metabolic changes of metabolism slowing down and body composition changing from muscle mass to fat.
• 31:26
  Dr. Sonia Hans: And so I know what's ahead five years from now.
• 31:29
  Dr. Sonia Hans: And so I get really aggressive.
• 31:31
  Dr. Sonia Hans: I check all the levels on them as well.
• 31:34
  Dr. Sonia Hans: Most of these women have elevated free testosterone levels.
• 31:37
  Dr. Sonia Hans: Most are struggling with adipo excess adipose in their body.
• 31:42
  Dr. Sonia Hans: Cause I don't use a weight necessarily to define somebody's health status.
• 31:45
  Dr. Sonia Hans: I look at body fat percentage.
• 31:47
  Dr. Sonia Hans: And,
• 31:48
  Dr. Komal Patil-Sisodia: so You guys specifically, your in body machine looks at the visceral fat, right?
• 31:52
  Dr. Komal Patil-Sisodia: Yep, we look at both visceral
• 31:54
  Dr. Sonia Hans: fat, body fat percentage and skeletal muscle mass because those things matter that ratio matters, especially when you're trending what's happening to someone.
• 32:02
  Dr. Sonia Hans: In fact, I think every single clinic needs an in body so people can start seeing how their body changes over time.
• 32:09
  Dr. Sonia Hans: Like if every woman at 30 And then again, you know, a few years later, 35, and then 40 got to see how their body's changing.
• 32:16
  Dr. Sonia Hans: They would believe that my goodness, there really is something hormonal going on.
• 32:20
  Dr. Sonia Hans: You know what I mean?
• 32:21
  Dr. Sonia Hans: And
• 32:21
  Dr. Komal Patil-Sisodia: the saddest story that we hear is that I haven't changed anything.
• 32:25
  Dr. Komal Patil-Sisodia: I'm still working out and moving as much as I was.
• 32:29
  Dr. Komal Patil-Sisodia: I haven't changed my diet.
• 32:30
  Dr. Komal Patil-Sisodia: I'm not doing anything crazy.
• 32:32
  Dr. Komal Patil-Sisodia: Why is my body changing like this?
• 32:34
  Dr. Komal Patil-Sisodia: Right.
• 32:34
  Dr. Komal Patil-Sisodia: And I feel like it just gets fueled by that metabolic disease.
• 32:37
  Dr. Komal Patil-Sisodia: And just for our listeners.
• 32:38
  Dr. Komal Patil-Sisodia: To break down a few of the terms, adipose tissue is just the fat tissue you carry in your, sorry, visceral fat is what we have inside our abdominal cavity versus the fat that sits under our skin.
• 32:50
  Dr. Komal Patil-Sisodia: That we call subcutaneous fat, but all of it matters, but the visceral fat is really what's driving that metabolic disease to some degree.
• 32:57
  Dr. Komal Patil-Sisodia: Right.
• 32:58
  Dr. Sonia Hans: Yes.
• 32:59
  Dr. Sonia Hans: And visceral fat.
• 32:59
  Dr. Sonia Hans: So like overall body fat is never a great thing for us.
• 33:03
  Dr. Sonia Hans: So that's the body fat percentage.
• 33:04
  Dr. Sonia Hans: The visceral fat is the one that's associated with those diseases like insulin resistance.
• 33:11
  Dr. Sonia Hans: So pre diabetes, diabetes, cholesterol issues, heart disease, liver, fatty liver.
• 33:17
  Dr. Sonia Hans: I know so many women who are like, I've been told I have a fatty liver.
• 33:19
  Dr. Sonia Hans: And I was like, well, cause you're struggling with a lot of visceral fat, you know?
• 33:22
  Dr. Sonia Hans: And honestly, we even see gut dysregulation.
• 33:25
  Dr. Sonia Hans: Right.
• 33:26
  Dr. Sonia Hans: And to describe it to page to our listeners, it's the belly fat.
• 33:30
  Dr. Sonia Hans: Like that's what it comes down to.
• 33:32
  Dr. Sonia Hans: Visceral fat is your belly fat.
• 33:34
  Dr. Sonia Hans: And the more of a belly fat, that we have, the more of the struggle is for us and the higher risk we have for developing other diseases.
• 33:41
  Dr. Sonia Hans: And so that's a real sort of specific area that I really try to hone in on patients because I'm like, all right, we got to get this down.
• 33:47
  Dr. Sonia Hans: And GLPs do that.
• 33:51
  Dr. Sonia Hans: So that's why I'm aggressive about it.
• 33:53
  Dr. Sonia Hans: And my, my perimenopausal women.
• 33:55
  Dr. Sonia Hans: And so many of them tell me, like, just with even a GLP.
• 33:58
  Dr. Sonia Hans: So no birth control.
• 33:59
  Dr. Sonia Hans: No spironolactone.
• 34:01
  Dr. Sonia Hans: Not even a metformin or acetal.
• 34:03
  Dr. Sonia Hans: They get on a GLP and they're like, tell me why I'm regulated.
• 34:06
  Dr. Sonia Hans: Tell me how my periods are regulated.
• 34:08
  Dr. Sonia Hans: Yeah, because you've been suffering, my friend.
• 34:10
  Dr. Sonia Hans: You know?
• 34:11
  Dr. Sonia Hans: It's definitely something that I use in my arsenal and it's one of my first line drugs because I know what the next 10 years looks like for them.
• 34:19
  Dr. Komal Patil-Sisodia: Yeah, it's it is amazing how much we've seen it improve the regulation of the menstrual cycles and then fertility too.
• 34:25
  Dr. Komal Patil-Sisodia: I know we've had some oops, babies with patients on the bed a lot.
• 34:31
  Dr. Komal Patil-Sisodia: Okay, well, a lot.
• 34:33
  Dr. Komal Patil-Sisodia: And it's such a happy thing because most of them are excited to be finally to finally be getting pregnant, right?
• 34:39
  Dr. Sonia Hans: So true.
• 34:40
  Dr. Sonia Hans: So true.
• 34:42
  Dr. Komal Patil-Sisodia: So In
• 34:43
  Dr. Sonia Hans: fact, like, my patients laugh at me because, you know, I, I feel bad because I feel like I'm like this doctor getting like, you know, sex education, but I have to tell them, like, listen, I need you to know, you're about to, you're about to lose some weight, and you're about to get regular, and you're going to ovulate, and you had no idea, you thought you, you missed four periods, and you're about to enter menopause, no, no, get ready.
• 35:06
  Dr. Sonia Hans: Yes.
• 35:06
  Dr. Sonia Hans: So, Please remember, this is the oops baby time.
• 35:09
  Dr. Sonia Hans: This is when the, you know, this is when the love babies happen.
• 35:14
  Dr. Komal Patil-Sisodia: Exactly.
• 35:14
  Dr. Komal Patil-Sisodia: Right.
• 35:15
  Dr. Komal Patil-Sisodia: And then you throw on top of that, the fact that, the ovaries are spitting out more eggs at once.
• 35:20
  Dr. Komal Patil-Sisodia: There's more multiples as well.
• 35:22
  Dr. Komal Patil-Sisodia: And that 40 plus age range.
• 35:24
  Dr. Komal Patil-Sisodia: So, Yeah.
• 35:26
  Dr. Komal Patil-Sisodia: So what are your recommendations, for women who feel like they might be struggling with this?
• 35:32
  Dr. Komal Patil-Sisodia: Like if you could tell somebody to evaluate themselves from head to toe, what would be the things that you would, that they would be experiencing that you would encourage them to go seek out help?
• 35:44
  Dr. Komal Patil-Sisodia: Cause a lot of times we just ignore ourselves.
• 35:47
  Dr. Sonia Hans: And I, I really think the first thing I want to say to women is your thirties, you felt great.
• 35:52
  Dr. Sonia Hans: And you thought at 40, you're just aging.
• 35:54
  Dr. Sonia Hans: No, something's changing.
• 35:57
  Dr. Sonia Hans: As soon as you start feeling a little bit more fatigue, a little bit more difficulty keeping your health in check.
• 36:05
  Dr. Sonia Hans: Boom, that's a signal.
• 36:06
  Dr. Sonia Hans: We got to get checked out.
• 36:07
  Dr. Sonia Hans: Because there is a dysregulation that's happening.
• 36:10
  Dr. Sonia Hans: So disturbed sleep, changes in energy level, and even just a slight change in weight or ability to keep the weight in check.
• 36:19
  Dr. Sonia Hans: That is your red flag.
• 36:21
  Dr. Sonia Hans: It's time to go see the doc.
• 36:22
  Dr. Sonia Hans: Something's changing.
• 36:23
  Dr. Sonia Hans: And if you've already been struggling with weight, you're going to notice I'm rapidly kind of putting on weight.
• 36:28
  Dr. Sonia Hans: So you got to get in, sooner to get established with a provider who manages not only hormones, but also get into a provider who helps to manage weight, because that's going to be the big thing.
• 36:41
  Dr. Sonia Hans: That's going to help you through the course of this stuff because weight loss medication, for example, the GLPs have been the most efficacious in this group of women.
• 36:49
  Dr. Sonia Hans: And then being, with a provider who knows how to manage hormones or even like perimenopausal hormones, they coupled with your weight doc will help to ensure those next few years are as smooth as possible and successful for them.
• 37:02
  Dr. Komal Patil-Sisodia: Yeah.
• 37:03
  Dr. Komal Patil-Sisodia: Yeah.
• 37:03
  Dr. Komal Patil-Sisodia: I think that's great.
• 37:04
  Dr. Komal Patil-Sisodia: Really what we want to do is see women being able to prevent all of those metabolic complications like heart disease, stroke, diabetes, things that are going to impair your quality of life and maybe hasten complications and other bad things happening.
• 37:22
  Dr. Sonia Hans: Yeah.
• 37:23
  Dr. Sonia Hans: And I think you've spoken about it in some of your other podcasts too.
• 37:26
  Dr. Sonia Hans: Or in the series is that as soon as the woman's estrogen start coming down, yeah, all of a sudden your sugars are rising.
• 37:33
  Dr. Sonia Hans: All of a sudden your cholesterol is rising, but you're still working out five days a week.
• 37:36
  Dr. Sonia Hans: You're still eating the healthy nutrition plan.
• 37:37
  Dr. Sonia Hans: So you're like, well, what happened to
• 37:39
  Dr. Komal Patil-Sisodia: me?
• 37:39
  Dr. Komal Patil-Sisodia: I know we've talked about it, but yeah,
• 37:43
  Dr. Sonia Hans: no, and it's true.
• 37:44
  Dr. Sonia Hans: And it's, so those are also little clues like, uh, you know, this is not a normal aging thing.
• 37:50
  Dr. Sonia Hans: This is your body saying, help me.
• 37:53
  Dr. Sonia Hans: Because you're still an active woman living in an amazing active life.
• 37:57
  Dr. Sonia Hans: And we got to get this in check.
• 37:59
  Dr. Komal Patil-Sisodia: Absolutely.
• 38:00
  Dr. Komal Patil-Sisodia: Life is too short to go through it, feeling crummy all the time.
• 38:03
  Dr. Sonia Hans: I agree.
• 38:03
  Dr. Sonia Hans: I agree.
• 38:04
  Dr. Sonia Hans: And you know, I will say like one of the first things on like, especially in my weight loss clinic, when I see a consult and I have a woman who's struggling possibly with her hormones, one of the first things I will say is, Hey, we got to get this hormone thing in check because it's going to dictate weight loss journey.
• 38:20
  Dr. Sonia Hans: Yeah.
• 38:20
  Dr. Sonia Hans: And so often I'm having them see a provider who manages hormonal placement therapy or even, symptom management.
• 38:28
  Dr. Sonia Hans: And then we start getting more aggressive with the weight loss because I have not yet, seen a patient who's struggling with perimenopause symptoms.
• 38:35
  Dr. Sonia Hans: Yeah.
• 38:36
  Dr. Sonia Hans: So how successful weight loss just by itself, like we have to pair it together a little bit.
• 38:41
  Dr. Komal Patil-Sisodia: Yeah.
• 38:42
  Dr. Komal Patil-Sisodia: And it has to be that comprehensive approach.
• 38:44
  Dr. Komal Patil-Sisodia: I'm so grateful to work with you and, have you be part of our community.
• 38:48
  Dr. Komal Patil-Sisodia: I think what people who get in to see you are incredibly lucky.
• 38:52
  Dr. Komal Patil-Sisodia: Where can our listeners find you?
• 38:55
  Dr. Sonia Hans: Yes, so I work at Evergreen Health, endocrinology, diabetes and metabolism clinic.
• 39:00
  Dr. Sonia Hans: And so if patients are interested specifically in PCOS and they have a diagnosis and they need optimization, that's the best clinic to see me in for PCOS management.
• 39:09
  Dr. Sonia Hans: In terms of metabolic disease, which is a big issue, Big portion of what I actually serve for.
• 39:15
  Dr. Sonia Hans: We have our evergreen health, weight loss and bariatric care clinic, and we're always accepting referrals.
• 39:19
  Dr. Sonia Hans: And it's a great space for those women, especially in perimenopause to come to, because that's a great way to kind of get yourself established, set yourself up for success.
• 39:30
  Dr. Sonia Hans: As we work with another provider to help with the hormones and symptoms.
• 39:33
  Dr. Sonia Hans: So you can find me there and yes, I'm accepting consults.
• 39:37
  Dr. Komal Patil-Sisodia: Okay.
• 39:37
  Dr. Komal Patil-Sisodia: Wonderful.
• 39:38
  Dr. Komal Patil-Sisodia: Wonderful.
• 39:39
  Dr. Komal Patil-Sisodia: Thank you so much for being on today.
• 39:41
  Dr. Komal Patil-Sisodia: I, we're going to bring you back for talking about obesity management specifically.
• 39:47
  Dr. Komal Patil-Sisodia: But thank you so much for giving the listeners insight into PCOS and how complicated it can be and how earlier the intervention is the better chance they have at getting things under control.
• 39:59
  Dr. Komal Patil-Sisodia: So thank you.
• 40:00
  Dr. Komal Patil-Sisodia: Thank you.
• 40:00
  Dr. Komal Patil-Sisodia: I appreciate you.
• 40:01
  Dr. Komal Patil-Sisodia: You're
• 40:01
  Dr. Sonia Hans: welcome.
• 40:02
  Dr. Sonia Hans: All right.
• 40:03
  Dr. Sonia Hans: You're welcome.
• 40:04
  Dr. Sonia Hans: Thank you.