In this episode 69 protocols
▶ 7:25 Screen for Endometriosis Behaviors “You need to know at a very young age, every girl on this planet needs to be screened for endometriosis, for PCOS, and they need to know their egg count.” ▷ 7:25 Screen for PCOS Behaviors “You need to know at a very young age, every girl on this planet needs to be screened for endometriosis, for PCOS, and they need to know their egg count.” ▷ 7:38 AMH Test Behaviors “Egg count, AMH, anti-malarian hormone, is a simple blood test. It's covered by most insurances. It needs to be offered.” ▷ 8:14 Egg Freezing Behaviors “Because for these patients, sometimes by age 16, I freeze their eggs.” ▷ 23:42 Hormone Panel Behaviors “So what I do with these patients, I do a hormone panel.” ▷ 24:17 GLP-1 Agonists Supplements “And, you know, in 2014, I started using GLP-1s on my patients for weight loss, for PCOS. 2014, 11 years ago.” ▷ 25:13 Pelvic Ultrasound Behaviors “A, a lot of gynecologists don't do a pelvic ultrasound, which I want to change that in this country. It needs to be part of a well-woman exam.” ▷ 1:04:00 Birth Control Pills Supplements “Birth control pills stimulate that sex hormone binding globulin that starts grabbing the testosterone and helps with their symptoms. That's why if you go to the doctor and you say I have acne, they're like birth control.” ▷ 1:04:25 Slynd Supplements “or there's a progesterone-only birth control pill now called Slend that helps with, it's very anti-androgenic that I try for PCOS patients who don't want to, you know, need a method of birth control.” ▷ 1:04:50 Walking After Meals Behaviors “We talked about the epigenetics that always start with that exercise, walking after each meal, you know, walk for 10, 15 minutes.” ▷ 1:05:02 Moderate Low-Carbohydrate, Whole-Foods Diet Diet “Make sure your diet is healthy. You're not eating inflammatory foods.” ▷ 1:05:02 Sleep Optimization Behaviors “Make sure you're sleeping well. Make sure your diet is healthy.” ▷ 1:06:16 Metformin Supplements “I start with 750 at night. And if they tolerate it, I add the 750 in the morning. And for patients who are tolerating it and they still are not ovulating, their periods are still not regulating, and they still have symptoms, I might up it to 1,000 twice a day.” ▷ 1:08:01 Inositol Supplements “I'm sure you've heard of inacetol, different forms of inacetol that work to increase sensitivity to insulin. And that's why these patients, when they take it, they say, oh, my periods became regular or I took it and I got pregnant because it does address that.” ▷ 1:08:26 Vitamin D Supplements “But what I like to do, I like to start them on supplements that has inacetol in it and vitamin D. Did you know that low vitamin D makes you insulin resistant?” ▷ 1:09:52 Stress Reduction Behaviors “So whether it's metformin or supplements or exercise or low-carbohydrate diet or lowering your stress and lowering your cortisol, all of that, all of this system.” ▷ 1:12:20 Resistance Training Behaviors “As long as people still engage in the right behaviors, maintaining muscle through resistance training, and people still need to take great care of themselves, eat properly, exercise, sleep, et cetera.” ▷ 1:13:07 Chromium Supplements “you know, like you mentioned, vitamin D, curcumin, chromium, inacetol. Acetol. There's so many things we can do to increase that insulin sensitivity, lower the inflammation in the body.” ▷ 1:13:07 Curcumin Supplements “you know, like you mentioned, vitamin D, curcumin, chromium, inacetol. Acetol. There's so many things we can do to increase that insulin sensitivity, lower the inflammation in the body.” ▷ 1:13:18 Berberine Supplements “I don't usually give berberine long term, but it definitely short term, you can use it as pulse treatment for these patients.” ▷ 1:20:06 Try Naturally Before Fertility Escalation Behaviors “What I usually do, I have them try on their own for six months to a year, depending on their age. If they're above 35, I say six months” ▷ 1:20:24 Have Sex Three to Four Times Per Week When Trying to Conceive Behaviors “if you take 100 couples, regardless of age, and you have them have sex, I don't know, three to four times a week, 50% of them get pregnant in the first six months and 90% of them get pregnant in the first year.” ▷ 1:23:50 Start Supplements Before Metformin Behaviors “And start with supplements first if your symptoms are not bad.” ▷ 1:24:06 Ask for Metformin Behaviors “But if it doesn't work, ask for metformin.” ▷ 1:24:09 Ask for GLP-1s Behaviors “If it doesn't work and you're having a hard time losing weight, ask for GLP-1s.” ▷ 1:24:13 Ask for Letrozole Behaviors “Ask your doctor for Clomid if you're trying to get pregnant. Ask your doctor for Letrozole. Letrozole first, Clomid second.” ▷ 1:24:13 Ask for Clomid Behaviors “Ask your doctor for Clomid if you're trying to get pregnant. Ask your doctor for Letrozole. Letrozole first, Clomid second.” ▷ 1:24:55 L-Carnitine Supplements “I've seen a few papers that suggest that coenzyme Q10 and L-carnitine might be beneficial for egg quality. Yes.” ▷ 1:24:55 Coenzyme Q10 Supplements “I've seen a few papers that suggest that coenzyme Q10 and L-carnitine might be beneficial for egg quality. Yes.” ▷ 1:39:18 Treat Painful Periods as Abnormal Behaviors “The first thing I want to teach your listeners is painful periods are not normal.” ▷ 1:40:54 Treat Painful Sex With Deep Penetration as Abnormal Behaviors “If sex with deep penetration hurts, that's not normal.” ▷ 1:40:58 Treat Persistent Bloating as Abnormal Behaviors “If you're constantly bloated, even during the month when your periods are painful and after your periods you eat and you're constantly bloated, that's not normal.” ▷ 1:41:08 Treat Painful Bowel Movements as Abnormal Behaviors “If when you have a bowel movement, your bowel movement hurts, that's not normal.” ▷ 1:41:11 Treat Recurrent UTI-Like Symptoms With Negative Cultures as Endometriosis Until Proven Otherwise Behaviors “If you constantly end up in your GYN or primary care's office complaining of UTI or bladder symptoms, recurrent bladder symptoms, and you're getting antibiotics three, four, five times, six times, 10 times a year with a negative culture, that's endometriosis until proven otherwise.” ▷ 1:51:52 Take Advil for Mild Menstrual Cramps Supplements “Now, it's common for patients to have some cramps. They might take a couple of Advils and it's fine.” ▷ 2:01:35 Laparoscopic Resection of Endometriosis Behaviors “The gold standard way of treating this is laparoscopic resection of endometriosis. Surgery.” ▷ 2:01:57 Excise Endometriosis Lesions Rather Than Burn Them Behaviors “We used to burn them, but as of like for the past 15 years, we've learned that you really need to cut them. You don't want to burn them, right? Because burning them is just a band-aid and the pain comes back.” ▷ 2:17:28 Progesterone-Only Birth Control Pills for Endometriosis Supplements “Then there's nothing wrong with prescribing them some form of birth control or hormonal suppression that will suppress their symptoms of endometriosis. What do I mean by that? You can use progesterone-only birth control pills” ▷ 2:18:01 Avoid Estrogen Birth Control Pills in Endometriosis Behaviors “Would you recommend against estrogen birth control pills? I do.” ▷ 2:19:20 Mirena IUD Tools “one of the methods that I use to suppress endometriosis is actually a progesterone IUD, like Chilina or Mirena IUD.” ▷ 2:19:47 Kyleena IUD Tools “For young girls who haven't had children, I tend to go with the smaller IUD because Mirena IUD is slightly larger than the Kylina IUD. So I love the Kylina IUD” ▷ 2:20:27 GnRH Antagonists Supplements “Then we have GnRH antagonists. I don't know if you've heard of these pills, Oralisa or Myfembri.” ▷ 2:21:38 Limit GnRH Antagonist Use to Two Years Behaviors “The problem with these pills are because of the effect on the bone and the bone loss it causes, you can take them up to two years. So you can't take them beyond two years.” ▷ 2:21:55 Post-Surgery Progesterone IUD for Endometriosis Behaviors “during surgery, I resect the endometriosis, I cut all the adhesions if they have it, and then I put a progesterone IUD and I send them home.” ▷ 2:22:04 Post-Surgery GnRH Antagonists for Severe Endometriosis Behaviors “For patients during surgery who have severe disease, stage three or four, then I also add these GnRH antagonists after surgery, depending on their stage or symptoms from six months up to two years.” ▷ 2:24:30 Postpartum Progesterone IUD in Endometriosis Behaviors “What I do for these patients, as soon as they deliver, I put a progesterone IUD in them. When they come postpartum, six weeks postpartum, and they're discussing birth control, I always recommend a progesterone birth control.” ▷ 2:38:12 Tyler-Cuzick Breast Cancer Risk Assessment Behaviors “if you know your first name, your last name, and your date of birth, you need to know your lifetime risk of breast cancer. It's mandatory.” ▷ 2:39:52 Start Breast Imaging at Age 30 if Lifetime Breast Cancer Risk Is 20% or Higher Behaviors “If your lifetime risk of breast cancer is 20% or more, you can start breast imaging at 30, not 40.” ▷ 2:42:10 Breast Ultrasound Behaviors “Patients who fall into the high-risk category, 20% or more, in addition to mammogram, if they have dense breast tissue, they need to ask for ultrasound of the breast.” ▷ 2:42:23 Breast MRI Behaviors “And for high-risk patients, 20% or more, in addition to mammogram and ultrasound, they need to ask for a breast MRI.” ▷ 2:43:00 Genetic Cancer Testing Behaviors “For any woman with family history of breast cancer, ovarian cancer, pancreatic cancer, prostate cancer, and the list goes on and on, they can ask their doctor to see if they qualify for genetic cancer testing.” ▷ 2:44:19 Alternating Breast Imaging Every Six Months Behaviors “those patients have the choice of either doing imaging every six months, alternating mammogram ultrasound with MRI” ▷ 2:44:19 Double Mastectomy Behaviors “for patients who fall into the very high risk category, north of 35%, those patients have the choice of either doing imaging every six months... or ask for a double mastectomy” ▷ 2:44:19 Tamoxifen Supplements “for patients who fall into the very high risk category, north of 35%, those patients have the choice of either doing imaging every six months... or asking their doctor for a medication called tamoxifen. Estrogen receptor blocker. that reduces the risk of breast cancer by 50% in the next 10 years of their life” ▷ 2:48:44 APOB Test Behaviors “If you have PCOS, if you're young, I'm checking your APOB.” ▷ 2:48:46 Lipoprotein(a) Test Behaviors “I'm checking your lipoprotein little A status.” ▷ 2:48:52 APOE4 Testing Behaviors “If you're perimenopausal, I'm checking your APOE4 to see if that increases your risk of dementia.” ▷ 2:48:56 Discuss Hormone Replacement Early in Perimenopause Behaviors “I talk about hormone replacement early during perimenopause.” ▷ 2:48:59 Bone Density Screening Behaviors “I talk about bone density.” ▷ 2:49:00 Colonoscopy Behaviors “I talk about colonoscopy.” ▷ 2:52:01 Full Autoimmune Panel Behaviors “if you have endometriosis and you're trying to get pregnant or if you've had a miscarriage, ask your doctor for a full autoimmune panel.” ▷ 2:52:36 Hormone Replacement Therapy Supplements “So by replacing, by giving these patients hormone replacement, they feel like, oh my God, I'm alive again. I can see again. I can think again.” ▷ 2:54:47 Yaz Supplements “If you want to use birth control, there's one form of birth control. Yaz, I don't usually go to it. It helps with the symptoms of PMDD.” ▷ 2:54:56 SSRIs for PMDD Supplements “But these patients, actually, they do really well if you put them on SSRIs or antidepressants just 10 days during the month.” ▷ 2:55:33 Psychiatry Referral for PMDD Behaviors “PMDD patients, you do want to make sure they don't have a chronic underlying anxiety depressive disorder. So I always refer them to a psychiatrist” ▷ 2:57:34 Minoxidil Supplements “So for that reason, I would say, you know, I usually treat these patients with minoxidil... but hit it early, and it's not the estrogen patch.” ▷ 3:00:05 Progesterone With Estrogen in Menopausal Endometriosis Behaviors “In patients with endometriosis, even when they undergo a hysterectomy and they're using estrogen patches, you always want to give them the progesterone.” ▷ 3:01:10 Micronized Progesterone Supplements “for perimenopausal women, then you need to prescribe them the micronized progesterone.” ▷ 3:01:34 Exercise Behaviors “your diet, your exercise, your sleep, your stress, all of that will affect it long term.”