The Best Podcast for Women of All Ages, 10-60 Years | Dr Anjali Kumar, India's Top Gynaecologist

Summary

Highlights

• Dr. Kumar emphasizes how modern lifestyle changes have increased the prevalence of PCOS among women 📈.
• Stress and lack of sleep are significant contributors to hormonal imbalances, particularly in women 👩‍⚕️.
• Managing PCOS requires a holistic approach, including diet changes, exercise, and stress management 🏋️‍♀️.
• Dr. Kumar encourages women to actively manage their health and take control of their healthcare decisions 💪.
• Menopause is discussed as a natural part of aging that should be embraced and managed positively 🌼.

Key Takeaways

• PCOS is now a common issue among women due to lifestyle changes, emphasizing the need for awareness and personal health management 🤔.
• Stress significantly impacts hormonal balance and can contribute to PCOS and other health issues 😰.
• Sleep and diet are crucial in managing PCOS and maintaining hormonal balance 💤🍏.
• Infertility can be tackled with a holistic approach combining medical treatment and lifestyle changes 🚼.
• Menopause should not be feared; it’s a natural transition that can be managed with a healthy lifestyle 🌺.

Overview

Chapters

• 00:00 - 00:30: Introduction and Changes in Gynecology Practice The chapter titled 'Introduction and Changes in Gynecology Practice' discusses the evolution of gynecological issues that practitioners encounter. It highlights a significant change in the types of conditions that are prevalent in modern times compared to the past. Currently, half of the gynecological outpatient department (OPD) cases consist of polycystic ovarian disease (PCOD) and endometriosis. Historically, issues such as heavy periods and fibroids were more common. This shift indicates a change in the health challenges faced by women today, with statistics indicating that one in every three to five women globally experiences some form of these modern manifestations.
• 00:30 - 02:30: Impact of Stress and Lifestyle on PCOS The chapter discusses the impact of stress and lifestyle choices, such as social media pressure and smoking, on Polycystic Ovary Syndrome (PCOS). It highlights how significant stress can lead to hormonal imbalances, which in turn affect menstrual cycles. The societal pressure to maintain a certain image and lifestyle exacerbates the stress, further disturbing hormonal functioning.
• 02:30 - 04:00: Insulin's Role in Hormonal Issues This chapter discusses the role of insulin in hormonal issues, particularly focusing on the effects of insulin resistance. It highlights the misconception surrounding the treatment of Polycystic Ovary Syndrome (PCOS), emphasizing that solutions like metformin or contraceptive tablets are not cures. Instead, it advocates for personal control and lifestyle changes as key to managing and possibly reversing PCOS. The discussion also touches on societal norms and expectations regarding pregnancy and menopause, noting that early 20s is considered the ideal age for pregnancy, while menopause commonly occurs before 40 in modern times.
• 04:00 - 05:00: Normal Menstrual Cycle Explained The chapter begins with an emphasis on the importance of self-care for women, highlighting that it is crucial for every woman to prioritize her well-being. Dr. Angeli is introduced as a guest, expressing her gratitude and honor for being invited to the show. The host acknowledges Dr. Angeli's commendable work in educating women, both online and offline.
• 05:00 - 07:00: HPO Axis and its Impact on Menstrual Cycle In this chapter, the conversation aims to draw on the expertise of the speaker regarding the HPO axis and its impact on the menstrual cycle. The discussion begins with a focus on the speaker's experience practicing as a gastroenterologist in California, where there is an observable gender difference in patients presenting with fatty liver disease, with a noticeable number of female patients.
• 07:00 - 09:00: Changing Trends in Gynecology The chapter explores the topic of changing trends in gynecology, with a focus on conditions like fatty liver and its relation to hormonal syndromes such as Polycystic Ovary Syndrome (PCOS). It emphasizes that PCOS is not a disease but a syndrome characterized by hormonal imbalances, which can manifest in various symptoms. This sets the stage for understanding how gynecological conditions are interconnected with broader health issues.
• 09:00 - 10:40: Understanding the Menstrual Cycle Phases The chapter begins by addressing a common misconception that hormonal imbalances are solely responsible for menstrual-related issues. Instead, it is suggested that insulin may play a crucial role. The chapter aims to first educate the audience about a normal menstrual cycle, including the key hormones involved, setting the stage for understanding how insulin could be a contributing factor to menstrual health concerns.
• 10:40 - 12:00: Challenges Modern Women Face This chapter discusses the challenges that modern women face regarding their menstrual cycles. It highlights the misconception of the 'right' or 'perfect' menstrual cycle, emphasizing that it varies from person to person and there is no standard 28-day cycle. The chapter aims to educate women about understanding their menstrual health and recognizes the individual nature of menstrual cycles.
• 12:00 - 16:00: Connection Between Stress and PCOS The chapter discusses the typical range for menstrual cycles and flow duration, noting that normal cycles can vary between 22 to 35 days, and flow can last between 2 to 7 days. It highlights that significant deviations from a person's usual cycle length, such as a change from a 22-day cycle to a 32-day cycle, could indicate an underlying issue. Similarly, changes from a long cycle (e.g., 40 days) to a much shorter one (e.g., 20 days) may also signify a problem. The chapter also emphasizes that menstrual periods should not be excessively painful.
• 16:00 - 20:00: Role of Gut Health in PCOS The chapter titled 'Role of Gut Health in PCOS' discusses the normalcy related to menstrual cycles and what symptoms may indicate potential issues. It emphasizes that while occasional pain is not unusual for women, frequent pain requiring multiple painkillers daily is a cause for concern and may signal underlying problems. The chapter further clarifies that bleeding between periods, post-intercourse bleeding, and post-menopausal bleeding are not considered normal. These insights set the framework for understanding normal menstrual cycles in the context of gut health and PCOS.
• 20:00 - 25:00: Managing Infertility and Lifestyle Changes The chapter discusses the process of menstruation, starting from the brain and involving a series of hormonal signals that ultimately lead to ovulation and menstruation. It explains that the process begins in the hypothalamus in the brain, which sends signals to the pituitary gland. The pituitary gland then sends hormones to the ovaries, which finally act on the uterus to initiate menstruation. This highlights the complexity of the menstrual cycle and emphasizes that it is a multi-step process involving various organs and hormones. The chapter may include an exploration of how this understanding can impact the management of infertility and lifestyle changes.
• 25:00 - 29:00: Hyperandrogenism and PCOS Manifestations This chapter discusses hyperandrogenism and its connection with Polycystic Ovary Syndrome (PCOS) manifestations, focusing on the role of the hypothalamic-pituitary-adrenal (HPA) axis. It highlights how disturbances in this axis, often due to stress, can lead to changes in menstrual cycles. The chapter specifically notes that stressors, such as exams, can disrupt the normal periodic patterns, indicating the sensitivity of the menstrual cycle to bodily and psychological stress.
• 29:00 - 35:00: Impact of Diet on Hormonal Balance and Gut Health The chapter delves into the significant effects of diet on hormonal balance and gut health, highlighting how stress can adversely impact menstrual cycles. The speaker, presumably a gynecologist, emphasizes the prevalence of conditions such as PCOD (Polycystic Ovary Disease) and endometriosis in modern medical practice. This observation signals a shift from previous times where these issues were less common. The chapter provides insights into how the field of Gynecology has evolved, with dietary factors playing a crucial role in the health of today's women.
• 35:00 - 40:00: Benefits of Yoga and Multidisciplinary Approach The chapter discusses the evolving health issues faced by modern women, particularly focusing on the rise of infertility, PCOS, weight gain, and hypothyroidism. In the past, issues like heavy periods and fibroids were more common, but today, infertility has become a prominent concern. The narrative highlights the proliferation of IVF centers in metro cities as an indicator of changing physiology affecting modern women.
• 40:00 - 45:30: Lean PCOS and the Importance of Muscle Mass The chapter discusses the evolution of how conditions like PCOS (Polycystic Ovary Syndrome) are perceived in the medical field, particularly highlighting the past focus on fibroids in gynecology. It points out that PCOS was once considered a rare condition and was often overlooked during medical studies in the early 90s. The importance of understanding PCOS and its implications on muscle mass, especially in individuals with lean PCOS (those not exhibiting typical symptoms of obesity), is emphasized. The chapter implies a narrative of changing medical paradigms and the growing recognition of PCOS as a significant area of study.
• 45:30 - 54:00: Fertility Treatments and Egg Freezing This chapter discusses the widespread prevalence of PCOS (Polycystic Ovary Syndrome), noting it as a 'gynecological epidemic' affecting one in three to five women globally. It highlights the hormonal imbalance in the hypothalamic-pituitary-ovarian axis as a key factor manifesting in the condition.
• 54:00 - 64:00: Menopause: Transition and Health Considerations The chapter explores the concept of menopause, emphasizing the changes and health considerations involved in the transition. It begins with a discussion on the improper secretion of reproductive hormones as a potential indicator of perimenopause, a phase leading up to menopause. The initial overview of a typical 28-day menstrual cycle is presented, describing the shedding of the endometrium in the first five days as the body's preparation for a new cycle. This physiological context helps ground the subsequent discussions on the implications of menopause on women's health.
• 64:00 - 67:00: Importance of Mental Health at Menopause The chapter discusses the importance of mental health during menopause. It begins by explaining the menstrual cycle phases and their relevance to mental health. Initially, the endometrium is shed within the first five days, marking the start of the menstrual cycle. Following this, during the follicular phase (day six to day 14), the follicle-stimulating hormone stimulates the ovarian follicles to develop. This biological process is foundational to understanding the hormonal changes women experience, which can significantly impact mental health during menopause. The interplay between these hormones and their effects on mood, mental clarity, and emotional stability are critical during the menopausal transition.
• 67:00 - 76:00: Contraception and Reproductive Decision Making The chapter titled 'Contraception and Reproductive Decision Making' discusses the physiological process of the menstrual cycle, specifically focusing on the role of hormones like leutinizing hormone (LH). It explains that ovulation occurs around the 14th day of the cycle when LH levels surge. If an ovum (egg) released at this time is fertilized by sperm, pregnancy can occur. If the ovum is not fertilized, it disintegrates within 10-14 days, leading to the shedding of the endometrium, marking the start of menstruation.
• 76:00 - 83:00: Cervical Cancer Screening and Prevention The chapter on Cervical Cancer Screening and Prevention discusses the initial stages of follicle development in the ovaries, where multiple tiny follicles begin to grow but only one becomes dominant. This dominant follicle secretes estrogen, which plays a key role in preparing the endometrium. While the transcript provided is brief and seems out of context regarding cervical cancer, the content may link to broader reproductive health and preventive measures.
• 83:00 - 85:00: Conclusion and Reflections The conclusion and reflections discuss the hormonal processes involved in ovulation and the limited time frame for fertilization. Specifically, it focuses on the role of estrogen levels reaching a triggering point that initiates ovulation through a positive feedback loop. Post-ovulation, the viability of the egg is limited to approximately 48 hours, during which fertilization must occur. If fertilization is successful within this window, the egg remains viable, indicating the importance of timing in the reproductive process.

The Best Podcast for Women of All Ages, 10-60 Years | Dr Anjali Kumar, India's Top Gynaecologist Transcription

• 00:00 - 00:30 that today Gynecology practice has changed completely today half of my OPD is filled with pcod and endometriosis what were you seeing before so earlier people were having you know problems like heavy periods and um you know fibroids and other things but today these are the problems which are affecting modern women I mean the statistics say that one in every 3 to five women across the globe is suffering from some kind of of manifestation of
• 00:30 - 01:00 how significant stress is affecting the PCOS if there is something wrong here now the periods are bound to be getting Disturbed you know Instagram you have to be there you to be watching the latest Netflix your DP has to look good you need to look good so there's so much of pressure and on top of that hormones are not functioning the way they should so that's the biggest problem are you seeing women smoking a lot
• 01:00 - 01:30 [Music] smoking is one of the major reasons for the premature over and insufficient people at least should be made to aware that the solution to pcus is not a metformin or a contraceptive tablet if you want to reverse your pcus then you need to take control of the entire thing in your hands what is the ideal time to be pregnant early 20s what is the common menopausal age these days any woman who gets a menopause because earlier than 40
• 01:30 - 02:00 years we again say it's for every woman who's watching this they must be selfish when it comes to their self selfcare it's very important hi Dr Angeli thank you for coming thank you very much for inviting me it's my pleasure and my honor to be here on your show oh so so good to see you in person so good to see you um you're doing wonderful job online and photos to you to educating all the women
• 02:00 - 02:30 so we wanted your expertise and then this hour is to extract all the knowledge from you as much as possible so right off the bat getting into the discussion is that so you know um in California while I'm practicing as a gastrologist I see a lot of patients with fatty liver okay lot of patients and the recently I've been seeing noticing a gender difference with a lot of women
• 02:30 - 03:00 mhm coming in with fatty liver yeah and uh underlying thing for every every woman for a common denominator is PCS yeah right PCS and as you as you all been talking in your channel is PCS is not uh disease uh it's basically a symptom uh it's like a syndrome of hormonal problems um so people think as you mentioned people think that there is hormonal imbalance all over um so in PC
• 03:00 - 03:30 overs um the underlying problem is as you have mentioned multiple times in the videos is maybe not the actual hormones that is causing the problems it is actually the insulin which is the main reason for all those issues so before discussing about why that could be if you can teach us and the audience in terms of what a normal menstrual cycle is and how which are the hormones that we should look for so that we can uh
• 03:30 - 04:00 understand how this whole thing works and we can talk about the treatment options eventually okay so I um it's very important for every woman to know what is the so-called the right menstrual cycle so I would like to say that there's nothing called the perfect or the right menstrual cycle it varies from one person to another person so there's nothing called as a 28 day cycle a normal menstrual cycle could vary
• 04:00 - 04:30 anything between let's say 22 to 35 days and the flow also could vary anything between 2 to 7 days but in case the variation occurs more than 8 days now that is abnormal which means earlier if your period was 22 days and now it's coming to 32 days now this is a problem in case your earlier period was 40 days and now it is coming at 20 days now that is a problem that could be indicative of some other problem and obviously the period should not be be really painful
• 04:30 - 05:00 once in a while little bit of pain is fine for every woman but it should not be like a woman has to take three four painkillers every day so that's also not normal and it could be indicative of an underlying problem uh there should be no bleeding in between the periods there should be no bleeding after the Intercourse there should be no bleeding after a woman has gone into menopause so this is what is the definition of a normal menstrual cycle now uh um the
• 05:00 - 05:30 periods don't just happen at the uterus and the ovary now it starts at the level of the brain the entire story of the period starts at the level of the brain so from a brain so we have a gland called hypothalamus then a pitutary gland so from there certain hormones have released from the hypothalamus then it acts on the pitutary from the pituitary then it acts on the ovary and then finally it acts on the uterus for the final periods to happen so medically
• 05:30 - 06:00 you also know this is known as hpo AIS which is hypothalamic pitutary a and axis so in case if there is something wrong here now the periods are bound to be getting Disturbed so um you know that's why when a woman is stressed you know she has an exams you know she has any kind of a stress which is bothering her there the pids are the first first
• 06:00 - 06:30 thing which will get affected so that's why you know any kind of stress will affect your period is it common you see in your practice very common very common in fact the modern uh day women in fact the modern opid today uh you know I tell my juniors also I'm a postgraduate teacher that today Gynecology practice has changed completely today half of my OPD is filled with pcod and endometriosis it's like you know what we read in our times has completely changed what were you seeing before so earlier
• 06:30 - 07:00 people were having you know problems like heavy periods and um you know fibroids and other things but today infertility PCOS weight gain hypothyroidism these are the problems which are affecting modern women I'm 20 years back hardly there were any I IVF centers today in modern Metro cities every nuke and corner has a IVF Center so you know that's how the entire physiology of this HBO aess has changed
• 07:00 - 07:30 in modern times it's amazing it's amazing I remember when I was in medical school um the when you do the Gynecology rotations right so the only thing that they keep on talking about uh is fibroid it was only fibroids only fibroids PC over you know they'll say it's a very rare disease so when I did my postgraduation of course that was way back in 91 so PCS was a small chapter in our books and we never used to read that chapter thinking that nobody body is going to ask this question in the final
• 07:30 - 08:00 exam and today I mean the statistics say that one in every three to five women across the globe is suffering from some kind of manifestation of pcus it's it's like a gynecological epidemic it's it's huge like one in every third woman is suffering from this wow wow so um if my understanding is Right hypothalamic pit hypothalamic pitutary ovarian axis if there is a disturbance in this
• 08:00 - 08:30 connection the reproductive hormones are not secreted properly correct and that could be an initial manifestation of what we call P yes um so I'm going to tell you what my understanding of menual cycle is okay I'm going to refresh my gynecology thing here okay okay so let's take a 28 day menstrual cycle the first five days is the shedding of the endometrium which is a lining of the uterus and it starts bleeding because the uterus is ready for getting ready
• 08:30 - 09:00 for consumption getting ready for possible fertilization okay let me see how much of ganic quality do you remember then ICT so first five days the endometrium is shut off yes the next is a folicular phase where day six to day 14 your uh follicle stimulating hormone is stimulating the ovarian follicles to develop absolutely correct and there is an ovam inside it's it's waiting to come
• 09:00 - 09:30 out yes at the day 14 around 14 day that's where the another sech happens called leutinizing hormone LH then after that let's say that oam is released if it gets fertilized by a sperm then pregnancy happens correct if a sperm is not there then it stays for like 10 14 days then it disintegrates and then the endometrium shuts am I right by
• 09:30 - 10:00 by large so basically what happens is on day one or day two itself you know a bunch of cohort of the uh tiny follicles they start to grow in the OV out of that only one follicle gets selected this is known as dominant follicle now when that follicle is growing it is secreting a hormone called estrogen so now that estrogen starts to stimulate the endometrium in the anticipation of the
• 10:00 - 10:30 pregnancy so when the estrogen levels they reach a particular point now uh you know this triggers a process of ovulation so this is known as a positive feedback loop and uh then the ovulation happens after the ovulation the egg is live inside only for about 48 hours in case the fertilization happens in this window great otherwise everything goes waste uh so supposing if the fertilizer ation happens now the egg stays live the
• 10:30 - 11:00 levels of estrogen are there the progesterone also comes in and then finally the periods don't happen because there is no withdrawal but in case the pregnancy does not happen the estrogen levels come down the egg dies the progesterone also come Downs now endometrium has no support so it sheds in for period now today most of the women have lot of I would not say most but many of the women suffer from what is known as anov ulation so the Cycles
• 11:00 - 11:30 are not ovulating I mean I always say why is the dam OV not ovulating it's like the the the primary function of the ovary is to ovulate but why is the ovary ovulation not happening because of multiple factors because of disturbance at the level of the HBO axis because of insuline resistance I mean we have lot of theories now coming up high insulin levels High cortisol levels less melatonin LS melatonin is very good for
• 11:30 - 12:00 ovaries you know the imbalanced cortisol and melatonin affects the ovary doesn't let the ovulation to happen then of course you know obesity bad diet hypothyroidism autoimmune all these things they disturb the ovulation that's the reason women are not able to conceive you know so multiple problems happening because the modern day life lifestyle lify in fact I tell this to everyone that we are actually paying the price for being modern in our lifestyles right right of course so the the
• 12:00 - 12:30 underlying problem is the ovam needs to be coming out of that dominant follicle correct correct that needs to happen ovulation needs to happen at the right time and after that also see for the pregnancy it's not just the egg and the sperm there are a lot of things which happen around these two guys to make the right things happen so you know we need to have the right Lal phase the optimum level of the progesterone in
• 12:30 - 13:00 case the ovulation is not synchronizing with the endometrium then you know ovulation might happen early the endometrium is not ready so all that the problem is basically is the hormones are not functioning the way they should so that's the biggest problem today among the estrogen and progesterone um which is the hormone that you think that is very important both of them both of them both of them I both of them they have their own
• 13:00 - 13:30 function you know um yeah I mean can't be one favorite both you need both to be working 100% quality yes and both are under the control of this hpoa access yes by and large by and large by and large so when there is any disturbances then let's say the discussion that we had in the first 14 days let's say there is any disturbance maybe the estrogen is not Secret red properly uh or even after
• 13:30 - 14:00 uh at the time of ovulation maybe the hormones are not secreted properly so I'll give you you know uh an example for example pcus you know in pcus what happens as the name suggests polycystic OVI which means that you have multiple tiny tiny cyst in the OVI now these are not really cyst these are bunch of those small follicles which they are developing but none of them is good enough to finally develop into a
• 14:00 - 14:30 dominant follicle and ovulate but all of them are secreting tits bits of estrogen so there is so much of estrogen lot of them are developing but none of them finally ovulates so the multiple things which happen wrong in case uh you know a hormonal profile is not not not optimal not optimal not optimal so if you say that let's say if this hpoa axis is acting super h no problem at all then
• 14:30 - 15:00 all this issues will come down so you know we as doctors we know that everything is interconnected you know it's not we cannot say just the hypothalamus and pitutary for example somebody's obese you know somebody who has a uh you know lot of stress and she'll have lot of cortisol she'll you know she's not sleeping purly she'll have less melatonin so even if things for some time are fine at this Place
• 15:00 - 15:30 probably the end result may not be the right thing so there multiple things like hormonal system is not just about hypothalamus and pitutary there is a thyroid there is adrenal so you know everything has its own role they all interconnected so in in let's say a patient P overs how how significant stress is affecting the PCOS my experience says that stress is a
• 15:30 - 16:00 very big you know reason very big reason in fact you know we are actually in the process of writing a paper on this four years back I always used to see that women who are working in a BP sector they have more pcus you know it was a very small observation then I started reading I started researching the literature and we found out that there is a connection between sleep and PCOS you know and this was a clinical experience of a
• 16:00 - 16:30 gynecologist that women who are not sleeping are not sleeping adequately not sleeping according to their day and night Rhythm tend to have more of pcus so uh stress also in fact there's another observation which I have seen in my clinical practice that the story of pcus starts when a girl is in class 10th or 11th you know this is the time when there is so much of pressure of studies she has to go for her tution classes the parents are after them you know you have
• 16:30 - 17:00 to study study study prepare for your exams she's constantly sitting in front of the computer not really moving the mother is giving all the goodies to her to eat and you know there are other pressures on on you know Instagram you have to be there you have to be watching the latest Netflix your DP has to look good you need to look good so there's so much of pressure and on top of that wrong di dietary choices lack of exercise and then when you go to the hostel you don't get the right food
• 17:00 - 17:30 Unfortunately today we don't have much avenues for people to go out and you know exercise or move their body at least you know I always tell this to people 20 years back nobody did a yoga class or nobody went to a gym you know our grandmothers they never had pcus so what is it which is going wrong today you know which is making the Modern Woman getting more prone to developing PCOS I mean of course most of us think
• 17:30 - 18:00 that we are eating right most of us think oh 30 minutes of gyming or yoga is good enough but our mothers never did that our grandmothers did not do this but still they did not have PC so probably they never had stress they were Physically Active throughout the day and they never had swiggy and zomato in their life right yeah no I think the point of sleep um the that you mentioned is I think is very critical for every disease that we
• 18:00 - 18:30 talk about because and that's why we talk in my channel as well to keep sticking to the Circadian rhythm absolutely 100% 100% And I tell this to everyone you need a sleep which is adequate which is peaceful which is uninterrupted and which is according to circadian rhythm this is the most important thing uh you know our clinical experience also says that most of PCS patients have high prolactin they have
• 18:30 - 19:00 hypothyroidism now this again proves that it starts from the brain because all these hormones are released from the anterior pitutary so how come that every PC patients in fact 80% of the PC patients have Associated hypothyroidism I would say 50% of them have high hypoprolactinemia so that means there's something going wrong there which is making them prone to this so my theory says that it starts from the stress and lack of sleep and of
• 19:00 - 19:30 course coupled with other things you know bad diet and lack of exercise and all that they contribute but I'm sure the papers would come that it is the stress which actually initiates the pathogenesis of of course of course the also so I'm going to give you a different picture you you might have heard this but I'm just going to tell you from my experience where I think PCOS is also starting from the gut quite possible quite possible I would really love to know your perspective on this
• 19:30 - 20:00 I'll tell you why because all the symptoms that's why we started with PC overs is not a disease it's a syndrome uh it's where um the underlying problem might not be the ovary per it is the hormonal issue yeah it is the poor ovary which is finally bearing the BL of everything so each and every risk factor we're going to go one by one okay and then see how that can be connected so you said stress right so in my
• 20:00 - 20:30 experience what we have seen is you know you have the gut bacteria throughout and whenever there is a disturbance in the gut bacteria you have this increased intestinal permeability where there is more influx of bacteria from the intestine into the blood those bacteria are not supposed to be there in the blood it's supposed to be there in the intestine we have when we did animal studies it's very clear that stress disrupts this barrier oh
• 20:30 - 21:00 there we have it right so the cells kind of like uh divide apart and there is increased intestinal permeability so once it goes over there then your inflammation starts so once inflammation starts then your insulin is not able to reach to the cells then your insulin is high then it is connected to all the other hormones so it is not like uh very we cannot be that unfortunate to have so many disas dises at the same
• 21:00 - 21:30 time it's like I always you know think know we were supposed to be healthy by Design how how come God has made such a faulty machine I mean that you need to you know do this do this and then only you'll be healthy I don't you know of course it's good to exercise I exercise myself I eat healthy and everything but somehow as a whole this Machinery was pretty pretty much sufficient you know to handle a lot of things unless and
• 21:30 - 22:00 until we are grossly wrong so uh you know in case we are not healthy that means there is something wrong something wrong right right course which has been done of course so when the uh one of the most common problem of PC overs is infertility where because the ovam is not being released there is no fertilization so people go through infertility I wanted to ask you a practical question where we say that you know decreases stress sleep more and everything that's the underlying
• 22:00 - 22:30 treatment but while they are going through this process it is a very stressful process very stressful very stressful process very stressful in your experience as a physician we are recommending sleep and decreasing stress but as a patient how are they managing and how do you guide them it's actually uh very unfortunate in the sense that you know in my opid also I spend 15 20 minutes sometimes 30 minutes explaining them how does it
• 22:30 - 23:00 happen and in the end then you know they say doctor and you feel oh my God you know I spend 30 minutes explaining them what it is so I guess you know um probably they are trying at their own end you know I mean you also would agree that weight is a very big problem you know uh it's like it's not easy you know for many people it's very easy for me to say okay you know reduce stress but what is it which
• 23:00 - 23:30 is going on in your life which is making the stress to happen it could be Financial it could be your career it could be relationship or whatever there could be multiple reasons so it's very easy for us as a physician also to say okay reduce stress do this do this do this but in the end people want a solution you know what is to be done in case I'm not conceiving now what is to be done let's uh you know right now talk about infertility PCOS has got many other problem s acne hairfall all those
• 23:30 - 24:00 things but infertility people are really desperate so it has to be a multidisciplinary approach where on one side we are telling them okay you know you need to be taking care of your lifestyle and of course as doctors we are there to help them you know the various medical protocols these days ovulation inductions and iuis and IVF and now egg freezing a lot of things are coming up so I think in today's world both the things need to go side by side
• 24:00 - 24:30 and uh fertility is not the final goal ultimately you need to be healthy to look after the child who's going to come so even if you've conceived by hook or cook but you need to be healthy enough to be looking after the child so I think both the things have to go hand in hand and the same thing applies for every other problem of PC like acne hairall today you've rectified acne by all kind of fancy Dermatology treatment but in case you have not really worked at the
• 24:30 - 25:00 root cause of it the thing is going to come back again so AC because of elevated androgens yes so most of the PC patients actually suffer from hyperandrogenism so which is they get acne which is uh you know this is a cystic bad you know painful acne which typically happens on the jawline they are typically more hairy and that to at wrong places you know like men they have
• 25:00 - 25:30 hair on the face corre and so basically these women they can they tend to get hair at uh you know at the places where men have hair so men typically have less hair on the scalp and more hair on the body so these women complain of scalp hair loss more hair on the body more acne uh mustache andm hutis so they have you know uh hair on the upper lip on the chi even uh you know medically there are
• 25:30 - 26:00 there's a grading system for um the hutis we have something known as Perman Gall score where you can actually score give a score that how bad the hutis is it depends upon you know what is the level of the androgens now hyperandrogenism other than PCOS could be because of various other actually pathological reasons also like adrenal causes and other things but in today's Times you know the the most common reason for all this is PCOS so the first
• 26:00 - 26:30 thing which we have to investigate in fact most of our patients are actually referred to us by the uh you know dermatologist somebody's having acne somebody's having you know hairfall so once they haven't found a cause they come to us and most of the times we invariably find an underlying PCOS and uh also I would want to say that PCOS is not just the PCOS in fact many times on the ultrasounds the over are actually normal normal size ovy so
• 26:30 - 27:00 it's actually the insulin resistance PCOS PCOS is actually one manifestation of insulin resistance PCS is actually just the tip of I Iceberg for which the patients come to a doctor but actually there is so much which is happening in their bodies which probably will manifest little later like obesity truncal obesity you know there's a whole metabolic syndrome which we all no you know diabetes high blood pressure
• 27:00 - 27:30 everything correct do you see increase in belly fat as well absolutely as Indians we all have you know we all are pre-diabetic and we all know this so we need to be even more careful if you see people who are thin also have some bit of belly fat right you know uh so there's a term called I think tofi it's like thin outside fat inside so even if people are I mean even I have to make sure you know this this
• 27:30 - 28:00 fat doesn't come in so it's like we are genetically programmed to have that mesentric fat fat inside so we all have to be very careful and of course I mean you've done so much of work on the insulin resistance that what is it which causes insulin resistance in the first place you know as doctors I've seen people go to an endocrinologist they say oh you have insulin resistance you take Metformin but why the hell is endomet you know insulin resistance happening nobody's talking about that it's very
• 28:00 - 28:30 easy to just put them on a contraceptive pill or maybe just put them on a metformin or whatever but will this solve the problem no I've seen so many times Dr Paul this is so so very unnerving you know a 14year old girl is being put on a oval contraceptive pill that's that's bad that's bad medicine I mean what is the age group that you see PC usually in your practice so theoretically also PC can start even before the onset of minaki and it can go
• 28:30 - 29:00 on till the menopause goes in so because we need to understand it's not just the PCS the problem is insulin resistance so delaying manari as well as a sign of insulin yes yes in case a girl is amoric let's say 16 or 18 years probably you know she could be suffering from some kind of a hormonal imbalance because of which the first period which was supposed to be coming has not coming till now early puberty is a sign of
• 29:00 - 29:30 insulin so we can have various things we can have early puberty also we can have late puberty also I mean just two days back I mean it's um it was so funny there's a mother who comes to me with a daughter who's 120 kgs and she's saying oh my daughter is tasa healthy and my response was healthy totally unhealthy I don't know whether I should have said that or not but then you know as doctors also we feel desperate how do we make
• 29:30 - 30:00 people understand that they they need to take control of their lives to make sure I mean everything is not a doctor's responsibility you need to be doing your own bit to make sure that things happen properly uhuh so um in so early one of the doctor that I talked to they said that previously they used to see early people a puberty around like 11 12 now they are seeing around eight years I mean this is like very very disturbing because at 8 years
• 30:00 - 30:30 the girl is not mentally or emotionally mature to understand the implications of having a period so and also there's a medical problem you know uh when the periods they start they basically signal the closure of epiphysis so the growth or the height also could remain stunted so uh you know um I always ask my uh patients especially their mothers you
• 30:30 - 31:00 know so as mothers it's very important for us to make sure that our daughters actually play you know are they going out 1 hour or two hours to play you know that will let the happy hormones play you know flow that will make sure that you know their muscles joints insulin every damn thing is working properly so the um when childhood obesity is related to early
• 31:00 - 31:30 puberty absolutely 100% 100% early childhood obesity is related to pcus and of course early minari yes absolutely very directly proportional 100% 100% And you are seeing a lot of childhood obesity in your practice a lot of course pediatric patients don't come but after they might yes yes yes like I you know it's like common in Metro cities to see see young girls 14 years old 15 years old you know
• 31:30 - 32:00 100 kg weight 120 it's like it's alarming it's alarming so I I've been after talking to so many doctors in the practice it's very clear that I think everything starts with the diet everything starts with diet and movement and movement and happy state of being Happ being in that initial first 10 years um I think one thing has happened more recently in the last 15 20 years is high
• 32:00 - 32:30 fat diet yep high fat diet right so um in your practice when you you're seeing patients um do you see that they are having increased amount of fats in the early part of absolutely absolutely you know I was comparing this with our childhood we used to get a treat once in 3 months and that was the Samosa at the end of the exams and today when I talk to people that how
• 32:30 - 33:00 many meals in a month you have they say practically every second day they go out and eat I mean it's um I mean this is not done I we know uh you know the kind of stuff which is put outside when you go out eat obviously the processed and packaged food they're all bad so people don't have time and I understand because of their busy schedules because of uh you know they're working late they're in hosts so the problems are also too many
• 33:00 - 33:30 but we need to find out the solutions like I said you know in a like I was coming uh from the airport to Mumbai now in such veins and such a busy City where would you find a park to go out and exercise not many people would be able to afford a gym right how does a common person manage this as you know together we all need to find out solutions to this it's not just PC it's a bigger problem it is affecting you as a doctor
• 33:30 - 34:00 it is affecting a physician or an endocrinologist all of us are in the same boat where we need to treat these patients so on a bigger scale we need to do something to make sure that people actually end up following a healthy lifestyle Cony City May there is a pathway to walk I don't think so in India we have any you know space for people to walk let alone exercise um I I I'm involved in a research with the gut bacteria and PCs over there and we have figured out that
• 34:00 - 34:30 um high fat diet uh is interfering with the gut barrier and it increases this bacteria called bacteroides bacteroides is a gr negative rod and gram negative anerobic thing and then that gram negative once it goes inside the blood your uh inflammation gets started right that is one way of insul the second way that high fat diet does is it inhibits the bile acids okay and bile acids are necessary to
• 34:30 - 35:00 regulate the cholesterol and bile acids stimulate some il22 inflammatory marker and that increases the folicular Genesis very much possible Right very much possible so nowadays the research is thinking along the lines that can we give il22 H to impr improve the ovarian folc Genesis I am saying that instead of giving I 22 how about decreasing the
• 35:00 - 35:30 fat you know we always love to find out complicated solutions to simple problems it's a fact it's a fact so the other thing that I think is the high fat diet is not your regular oil that's not the case I think it is all the process F Ultra process that is coming in yeah yeah and um simple thing we can if if was my family member who's having a PC overs I think we should just draw a line
• 35:30 - 36:00 and then says that you know no package foots at all uh and then you have seen people resolving their symptoms absolutely so um Dr Paul I'm a I'm myself a yoga person I'm a certified teacher so I learned it because uh yoga helped me a lot and it's a beautiful form of uh taking care of your body and mind both you know when you do those breathing exercises and when you sit in
• 36:00 - 36:30 just quietness not just let's not call it even meditation people find it very difficult even that helps you to settle down so about two years back we actually did a program of uh managing yoga managing pcus with the yoga program three months and we got some amazing results amazing results people lost weight people's inflammatory markers came down so it was such a uh you know
• 36:30 - 37:00 such an eye opener that you know all this happens at the level of the brain and of course you know coupled with the fact that high fat diet and other problems so uh like I said we need to have a multidisciplinary approach where a nutritionist is working where a GI person is working maybe a fitness trainer is working endocrinologist fertility Specialists and these women are actually struggling I mean it's not easy for them I have seen there are people who are literally struggling so
• 37:00 - 37:30 it's uh you know it's difficult for them also but today like I said you know not many solutions are easy like you know I give you one example of an exercise how the hell a normal person who can't afford to go to a gym how does she exercise you know she's staying in a hostel how does she train her hostel Chef to make a good diet she's studying the whole night she has an examed tomorrow morning or a presid presentation to make tomorrow morning how does she manage her life so it's not
• 37:30 - 38:00 easy modern life is like it is not that simple as life was simple for us but uh people at least should be made to aware that the solution to pcus is not a metformin or a contraceptive tablet you know if you want to reverse your pcus then you need to take control of the entire thing in your hands so this people need to understand and of course as doctors you and I are there to help
• 38:00 - 38:30 them correct correct in multiple studies we have I mean I also read that weight loss is the treatment correct absolutely weight loss even 5% of weight loss can bring about changes in all the markers of PC 5% is let's say you 100 kilos five 95 kilos itself 5% weight loss also can bring about significant change so every kg will count so don't get
• 38:30 - 39:00 disheartened oh it is just 2 kgs or 3 kgs or 5 kgs each kg loss is bringing you you know back to recovery and uh talking about the weight there is something known as a lean PCS also I don't know if you know about this or not so once again these are the people who are very thin but they have you know practically all manifestations of PCS they might be having acne they
• 39:00 - 39:30 may be having hairfall they find it difficult to you know conceive so once again the problem of stress comes in so in thin pcus basically the cause is stress and secondly altered fat and muscle ratio in the body so once again even you might be thin from outside but you might be having practically no muscle and lots of fat inside so that concept of tofi comes in of course of course so once again even thin people need to exercise and
• 39:30 - 40:00 another problem which I'm sure you also would have seen that thin people think oh I can eat everything I can have the burger or the pastry or whatever not realizing that this is going to cause you as much damage as it would cause to a person who's on the higher BMI side of course you know in my experience I know including me I was pretty big before I was 100 kilos before Oh my God you should tell your story one on your channel no I I actually I'm very open
• 40:00 - 40:30 about it that I know I lost 30 kilos with the fasting uh but during that I did not exercise I I not do strength training that I lost my muscle so I did a exra scan I found out that even though I'm skinny I'm fat so that we belong to the skinny fat category my body fat percentage was 29 29 you know normal is around like 15 to 17 so I did like a challenge on my uh Channel for 100 days I was able to decrease only
• 40:30 - 41:00 like 5 6% 5 6% I know it was only 24 but I have to put so much effort it was not easy at all easy that's what I'm saying thin people actually I you know I see it amongst the doctors also when we have our parties people are you know gobbling those samosas and burgers thinking oh I'm thin I can't get fat but without realizing that probably it will cause you lot of damage and another thing which uh you know I tell my patients is
• 41:00 - 41:30 um there's something known as sarcopenia you know you also know the muscle loss so every person from the age of 30 years would probably lose 1% of the muscle mass every year unless and until we are very proactive about it you know we need to get into that muscle building exercise we need to do strength training fortunately in olden times there was so much of work in the households that you know people need to pick up grocery bags or you know do a lot of stuff at home
• 41:30 - 42:00 that there was a inbuilt strength training but today with the modern households there's practically no work you know when people say Housewives come and say oh Ma'am I'm very very busy so I do little bit of dusting I do cooking because the maid cuts the vegetable I do just a little bit of you know so I said where's the physical work so we all need to understand as human beings we were designed to move we were
• 42:00 - 42:30 not designed to be sedentary we were designed to use our body I mean this is an old saying you use it or you lose it so in your practice with PC patient the body fed percentage should be high right absolutely you get it done it's 100% even with thin patientsin patient exactly it's like altered fat and muscle ratio so either ways whether you are on the higher side or in the lean PC overs body fat percentage I think I've seen around 35 40% I'm sure fatty liver and
• 42:30 - 43:00 all that also is the prob the probable Genesis is is the same or is it something different I'm telling you everything I think it is boiling down to that intestinal permeability we talked about yeah no matter I'm I I know I'm repeating the same thing again but I have a strong feeling it is because that and the reason for the inter permeability is not only the high fat diet it is also the high carb diet as well uh and in especially in PC overs
• 43:00 - 43:30 excessive Branch chain amino acids Lucin isolus and Bin is known to cause um the intestinal disruption a little bit more I was you know purposefully not talking about this thinking that it will become too technical but I'm glad you you know you started this point so it's very important so for PC overs what I'm thinking is okay so we talked about High fat so we should decrease the fat content and excessive protein is an
• 43:30 - 44:00 issue especially in Western countries yes maybe not over here that much probably no but uh Dr Paul this is the problem you know in pregnancy every patient comes and tells me doctor you don't write a protein powder for me and I said do you have so much of protein in your diet why don't you look inside your kitchen do you take a bowl of Dal with each meal do you take egg whites do you take
• 44:00 - 44:30 paneer or tofu do you do that or you are trying to get a shortcut that I just take two you know scoops of protein powder now this is a big problem probably either you don't have time or you find it absolutely uncool to cook or whatever in fact I tell this to my son also cooking is one skill it's a life saving skill which every person male or female must know this because otherwise you are dependent upon you know other things and like you rightly said you
• 44:30 - 45:00 know this was a concept which was brought to me by my yoga teacher that you don't need so much of proteins especially the extra new protein yes yes you know people who work out they say oh I need lot of protein of course you need proteins but you don't really need to pump yourself with protein so I'm very glad that you spoke about this in fact I I would really want you to explain this to me more you know this is a very New Concept New Concept
• 45:00 - 45:30 very New Concept um excess protein is actually not a great idea especially for PCOS all inflammatory conditions in the body so this branch and amino acids uh stimulates this bacteria called prevotella PR prevotella okay p r e v o t e l l a okay this prevotella is very uh is increas in proportions in the gut and this invariably affects the insulin
• 45:30 - 46:00 resistance by stimulating the mtor pathway Maman Ramin pathway wow so every PC problem has a reason behind it yeah so high fat diet as we talked about it disturbs the B acid thing uh excessive excessive protein BCAA and excessive carb this is the main problem excessive carb is the main problem and in one of the paper with PC overs they said artificial sweetness where you know sacin uh is
• 46:00 - 46:30 known to alter the gut bacteria significantly whenever the gut bacteria is Alter then the hormonal problem is also coming in so what I tell my patient with fatty liver who has PCOS as well is that see listen you have a issue so you need to be conscious and then need to be really proactive and put your foot down and then say that this is I'm going to do this absolutely I'm going to do this if not this is just a vicious cycle that you're not going to come out of it at all so I say decrease fat decrease carb
• 46:30 - 47:00 and normal protein in PC normal protein normal protein in PC overs on the top of it you exactly mentioned about decreasing the stress by using some kind of relaxation techniques yoga has been shown to improve p similia and then sleep is one of the main things primary things primary we did a one there was a study on mice they gave light to the mice H overnight h and this hormonal imbalance that you're talking about happen in 28
• 47:00 - 47:30 days yeah so there was a study which says that in case you are deficient in your sleep for 2 hours between 10 to 4 window which is 10:00 p.m. to 4 a.m. window 25 days in a year if you have deficiency of 2 hours of sleep between 10 p.m. to 4: a.m. 25 days only in a year it classifies you as shift worker and puts you at the risk of all
• 47:30 - 48:00 metabolic consequences which a shift worker has now just think of it it's like only 25 days in a year in case you're not sleeping if you're sleeping at 12:00 the damage is done damage is done yeah I mean then it comes back to the again same the brain axis that we talking about yeah the um low carb diet is that you recommend in your practice so I Dr pal tell people to
• 48:00 - 48:30 follow the natural Indian diet you know this is what we've been also talking that challenge is for me for for an Indian diet it's very difficult to say what is low carb and what is high carb I mean with a Roy and a chowel can you do that it's very difficult so I tell people that each like every meal of your day should have one cereal not the American cereal Indian cereal one lentil
• 48:30 - 49:00 one fruit and one vegetable if you do this by and large you are sorted and all that should be seasonal and local food I mean it should not be you know expensive like avocados or blueberries or which you don't get in India what does an Indian person eat so if you have a Roy subi Dal and a food by and large this is complete and this is my simple funa which I tell to all my patients and and I've seen
• 49:00 - 49:30 this no it's a fact unless you stuffing yourself with five six seven roties otherwise with a normal Bland Roti how can somebody get fat so um in in my what I tell my patients is that um in the first critical the first 3 months so let's say you have PC's patient or fatty Li patient comes into me we know that insulin assistance the first 3 months you have to put that extra effort by
• 49:30 - 50:00 calculating the number of Cs per day see how much you're doing and try to decrease the cars how do you do that let say for an Indian how will you do that H so we have Diet charts and everything right so I say that you know you first thing I tell them to meas get a weighing skill not your weighing skill the food weighing skill a small food weighing skill and then I I I don't ask them to change anything doctor I don't ask them to change anything the first one week I
• 50:00 - 50:30 asked them to just write what they are eating per day that's it wow so if you're eating chavel H you need to know how much chavel that you are eating so you take a small bow and the exact amount of chavel that you are eating just put it on that on the wing skin so they will say okay no 100 G are CS they take a picture and they send it to me H and then I and then they will send the subg they vegetables fruits and everything right so in the whole day
• 50:30 - 51:00 they're not even eating unhealthy they're eating healthy in the healthy part itself the carbohydrate content is 300 gram per day wow 300 G per day and Studies have shown that insulin resistance will not be able to handle 300 G of Cs so it needs to be somewhere around 150 or something like that how much does one Roy has how many carbs does it have so normal average average size Roti depending on the size of the
• 51:00 - 51:30 Roti so it you'll be surprised that uh let's say a Ry will be around 8 to 10 grams of carbs based if it a small size it can actually go up to 15 to 20 15 20 so for example I'm from South I eat dosa right so one Dosa is easily 18 to 20 grams of Cups okay even though it is made with rice and D yes yes exactly wow exactly that is the problem Indian
• 51:30 - 52:00 food is very healthy extremely healthy Health very healthy if there is no mix of adulteration with processed foods packaged Foods Western Foods if you're eating only Indian foods right from the start I don't think they will end up with VC over to start with exactly to start with but when there is an adulterated contaminated food with process and package then the Indian food efficacy doesn't work yeah doesn't work at all yeah so I am damn sure is that if the PC patient can go down on the carobs
• 52:00 - 52:30 as low as 100 G of Cs per day or even lower and they can continue and sustain it for like 6 months to a year we can close all the IVF centers 100% you you tell a person to lose weight she will start spontaneous ovulations yes so many times Dr pal it's so common that IVF also fails you know three Cycles IVF fobia it fails and then
• 52:30 - 53:00 after weight loss she spontaneously conceives so that means inherently inside there was no problem once that you know that hormonal imbalance has been rectified the ovulations happen spontaneously and people conceive spontaneously it's so very common it's just that you know how come in only in metros people are facing the problem of infertility why in Villages or why in olden times our mothers or grandmothers never suffered
• 53:00 - 53:30 from infertility you know so the ovies were nicely oating and they were happy so let's say there was no processed food and no stress and uh of course of course I mean we were playing a lot I remember my mother had to pull me from the park to get into the house and and then sleep by 10:00 and up by 5:00 that was the nor in our days so so you will say simple measures will
• 53:30 - 54:00 actually going back to simple measures will help 100% 200% 200% but yes in case you are not able to do all that because of XY Z reason then of course you need to take help I mean it's not like you know you're you're getting diabetes you're getting high cholesterol and still you're sitting at home N I will do it like this you have to you know you have to go to the doctor and follow both the paths all along with along with all along um
• 54:00 - 54:30 so in your practice uh how many patients are actually being referred to infertility centers very common very common very common very common in fact the statistics I think say the incidence of any kind of infertility is about 17 to 18% this is the quoted incidents and so what is infertility infertility is uh when a couple is not
• 54:30 - 55:00 able to get pregnant after one year of unprotected intercourse that is another problem that today after 2 or 3 months people come to us you know it's like P four five years I'm not going to do it but the day I've decided next month it better happens now if this has not happened I must go to the doctor that's also another problem and if I tell people no you must wait they said no doctor I'm turning 35 I said suddenly you've not turned 35 you
• 55:00 - 55:30 would have thought about it before so it's like people are having uh you know a sword hanging on their heads that today I've turned 35 now I better get pregnant one month and now something has to be done so so the the um it has to be one year one year one year the book says one year of unprotected intercourse in case the pregnancy doesn't happen now is the time to investigate but people come to us much much much before that one month two months and
• 55:30 - 56:00 they are at the doctor's chamber do chamber it's okay by uh nowadays we say post 35 you should not be waiting for very long because as it is the oen reserve also comes down what is the ideal time to be pregnant according to you this is you know if I say this um people will go into a shock as a gynecologist what is the ideal time to get early 20s early 20s early 20s that's when a girl
• 56:00 - 56:30 gets pregnant easily has a easy pregnancy uncomplicated pregnancy with the most successful pregnancy outcomes but today because of various reasons you know career and not being able to find the right partner people are getting married Beyond 30s and then after that you know you're waiting 3 4 years to plan a pregnancy and then Suddenly at 35 you wake oh I have turned 35 I know so
• 56:30 - 57:00 the 35 is because pregnancy Beyond 35 has an increased risk of complications correct or not really uh number one is that chances of getting pregnant easily uh you know that decreases so we have proper statistics which say that age is one single most important variable when it comes to getting pregnant so there's an exponent ential decline with Rising age so it's not 35
• 57:00 - 57:30 34 33 whatever the age is one single important variable and today we are seeing a very disturbing phenomena which is called premature AAR and failure so women are losing their eggs faster so there are so many times people come to us with a Mist period and you get their pregnancy test done it's negative you get their amh and FSH done it's high amh is low and Fs is high it's it's it's so
• 57:30 - 58:00 disappointing what age 32 33 my God I mean I had uh few days back a patient who was a WEP in one of the cor rates she says now I'm settled in my career and now I want to plan a pregnancy and she came to us with a M period we did a pregnancy test it was negative we did the complete hormonal profile and we found out that amh was just 0.1 which is like almost almost this is known as premature
• 58:00 - 58:30 where failure or we don't like to use the word failure we say as doctors aaren insufficiency insufficiency yeah yeah exactly so insufficiency yeah so um number one ovarian reserve is a genetic uh you know can you tell us about the ovarian reserve okay so every girl child is born with fixed number of eggs in her o now this is controlled genetically you know that's why in olden times the age
• 58:30 - 59:00 of menopause was decided by for example if a mother had an early menopause probably you will also have an early menopause if your mother had late you probably also will have a late menopause now when a girl child is born she probably has millions of eggs in her ovary but then slowly and slowly the eggs they come down by the time she has her puberty probably the eggs in her ovy are only three lakhs for Millions it comes like that and when she is you know planning her egg you know planning her
• 59:00 - 59:30 pregnancy by about 25 or whatever the egg probably could have me just 40,000 or 50,000 so the age causes you know exponential Decline and also for every year there's decline in the ovam and also every month if there's one egg ovulating there are 10 eggs which are developing at the same time but out of that only one lucky egg develops and OV so there's a lot of egg wastage which happens every cycle and nowadays because
• 59:30 - 60:00 of multiple environmental factors like pollution in the air herbicides pesticides bad food women are losing smoking alcohol women are losing their eggs very fast I mean it's very common very common and that's why you know these days we talk about uh egg freezing you know we tell people that in case because of whatever reason you are planning to delay your pregnancy at
• 60:00 - 60:30 least go to the doctor when you are in 25 you know you're 25 or 26 get your amh test done get your eggs frozen so that later on you know you may plan 35 40 whatever at least you have some backup because the quality of the egg is much better yes so people generally ask ma'am when should I do it at 25 so the answer to that is earlier the better because earlier we get a better cohort of eggs better number better
• 60:30 - 61:00 quality and how long so this is the new Gynecology like I was telling in in olden times we never face this problem infertility premature awaran insufficiency was not there so as the I'm just going to summarize what you said as the age advances the number of ovan follicles can also go down number of O goes down so you're saying that earlier the better chance of pregnancy chance of pregnancy but if you delaying uh because of your career growth or some any other reasons they call it as cryo
• 61:00 - 61:30 preservation or what do they yeah so it's called oite freezing oite freezing oite freezing is more technical but egg freezing is common lay Manish nowadays we also do what is known as embryo freezing so in case you know that this is the partner and as a couple you want to delay your pregnancy then you can get your embryo Frozen and embryo Frozen uh sorry you know pregnancy after Frozen embryos is much better than oite
• 61:30 - 62:00 freezing because many Ides might not get fertilized so here you you've already made the embryo and Frozen it so that carries better pregnancy rates as the years Advance is the uh prognosis of that embryo turning into a successful pregnancy what is the prognosis is it good not really you know that eggs and the embryo can be stored till Infinity
• 62:00 - 62:30 till Infinity so that's what is the future artificial reproductive technology and it has its own uh ethical and emotional dilemas God forbid the parents are not there and the embryo is still Al right so so lot of legal and ethical and emotional problems are there so so the Frozen embryos can survive until Infinity but let's say we unfreeze it we thaw it and then implant there's always a
• 62:30 - 63:00 wastage you know when when you thw them in case there's any problem in the thawing or you know even a minor variation here and there it can you know spoil the EMB but you know we assume that the IVF centers are doing a good job job so the successful pregnancy is a is definitely a possibility absolutely absolutely seen so people do go for the couples nowadays go for the embryo freezing and uh you know I'm going to
• 63:00 - 63:30 ask you a very practical question this is all new right new techniques how do we know the increased risk of you know chromosomal abnormality yeah yeah so whatever the data says till now yeah till now whatever babies have been born through the F which is the frozen embryo transfer we've not seen any statistical difference in the uh chromosomal or any kind of birth anomalies in these babies but like you
• 63:30 - 64:00 rightly said time will tell lot of things lot of it's all new yeah it's all new but uh but so far the data is yeah so far the data seems very promising so um I always tell this to patients that in case you are planning your pregnancy to be little later at least go to the doctor discuss your options and you know see where do you stand today for example if your AMS today is very low and you are just 27 or 28 better go for egg
• 64:00 - 64:30 freezing quickly you know in case your amh is still okay you can still take some time am is a testing that they can come and check with you yes so amh is a very simple blood test it's called antimullerian hormone so it's a marker for uh testing your ovarian reserve so let's say I am a 30-year old female I have finished my masters I'm doing my software engineering and and um I am want to grow in my career I have not find the right partner yet um but at the
• 64:30 - 65:00 same time I'm reading about you know getting pregnant after 30 35 there's increase of complications I don't want to do it based on this discussion maybe it is time to consider your oite egg freezing how do they do it so most important is I would say please go to a gynecologist meet talk about your concerns with the gynecologist now the gynecologist based on your history your
• 65:00 - 65:30 family history your own medical history will advise you all the test to find out you know what is your overall medical condition supposing you're a diabetic supposing you're obes supposing you have you better control all these things before you start to become pregnant so first of all pay a visit to a doctor and get yourself thoroughly examined and investigated so nowadays we have a very we spoke about a test called um amh it's called antim malarian hormone so it's a
• 65:30 - 66:00 very easy way to find out your ovan reserve of course there are other tests also like we can do a FSH on day two of the cycle we can do an ultrasound on third day of the cycle to find out what is known as the AFC antral follicle count so it's the budding follicles in OV we can actually measure them on the ultrasound to see like how much of egg reserved do you you have now supposing if you have good Reserve is there a number to it yeah yeah yeah so generally
• 66:00 - 66:30 you know on an average BC about 7 to eight good anal follicles each side ovary per cycle right but in you know PC the this number could go up to 15 20 25 but nothing will work but none of these follicles are good enough to finally develop into a dominant follicle and finally ovulate so this is what is PCOS so number one is meet a doctor get these basic tests done and in case you feel
• 66:30 - 67:00 that the pregnancy is quite a time away then do discuss with your doctor the option of egg freezing so egg freezing nowadays with the modern a you know coming in it's it's a very simple thing you know you know we give certain medicines to stimulate the OVI so that we have multiple eggs which are developing in a in a cycle and then when the time comes when the these eggs are mature there's a very small you know procedure by which we aspirate these eggs and immediately they are frozen
• 67:00 - 67:30 it's as simple as to the vagina uterus yes so through the vagina through the ultrasound guided we just aspirate those eggs and we freeze them it's as simple as that now uh you know how many eggs do you freeze yeah so that's another thing now it again depends upon your ovarian reserve in one cycle we might just get 15 eggs or maybe just good five or six eggs eggs on an average most of the IVF Specialists they agree on this that we
• 67:30 - 68:00 should have at least 10 to 15 eggs good quality eggs with us so that we can have some decent carry home baby rate so there is something called as a pregnancy rate then there is carry home baby rate so we should have at least 15 eggs in our kitty to freeze now some women may require one cycle or two cycle or three cycles of stimulation to get us that number so nowadays we have another thing which is coming up which is called embryo freezing so what happens there is
• 68:00 - 68:30 in case uh you know uh a woman is already married or she's in a committed relationship and she knows for sure that this is the partner final partner we can take the egg from the mother the sperm from the father we fertilize them in the laboratory and when the embryo is made we freeze the embryo and we can get two or three embryos Frozen so embryo freezing always gives us better pregnancy rates as compared to egg freezing because many of the eggs which we have Frozen may not finally end up
• 68:30 - 69:00 fertilizing so in case you are sure but all these things you know what is the probability success of oite developing into an embryo Frozen egg converting into an embryo when at the time of the need let's say it's very diff like 40 50% huh I would say yeah this is the but definitely not 100% not 100% because it all develops all depends also upon the quality of the egg and uh also the
• 69:00 - 69:30 quality of the sperm later on nobody talks about that yeah nobody talks about that we indans always love to not talk about not talk about right not at all in your practice yes even till today you know after one year of Investigation after multiple probing hband okay it's a very common thing but the the the iology of the infertility could be from the man's side as well yes
• 69:30 - 70:00 so in fact it is said that 40% the cause is of female infertility 40% male infertility 40% 10% both 10% no cause found idiopathic infertility so men are an equal culprit when it comes to producing a so for then it's the sperm count yeah sperm count the morality of the sperms
• 70:00 - 70:30 and also the appearance of the sperm the morphology of the sperms many times the sperm could be having multiple defects at the head tail so when we do a seen analysis there are properly defined wh uh parameters so when we issue a seen analysis report all this is taken out of course nowadays we have more advanced test uh there's something known as DFI DNA fragmentation index so higher the
• 70:30 - 71:00 DFI goes that means the more is the damage which is happening to the sperms smoking is a big smok is a big thing big big culit smoking in women as well absolutely smoking is one of the major reasons for the premature ovarian insufficiency major reason and that's another problem today you know I mean it's in your practice you are you seeing women smoking a lot a lot a lot that's not the case before it was not the case
• 71:00 - 71:30 but today A lot of people do people do lot of things to look and feel cool huh is it vaping or smoking both both both both it's it's actually it's actually very sad you know alcohol we still understand I still can't understand the psychology of a person who's smoking what is it which you know gives you a high knowing fully well that smoking affects every cell in the body every cell in the body top to bottom so I tell
• 71:30 - 72:00 my patient is that you know if you want to quit smoking or alcohol if you want to quit only one quit smoking yes absolutely smoking has a direct I mean it it causes such a high free radical damage yes of course and smoking decreases the sperm count and motility as well 100% like no doubt on this yeah and then Ed ereal dysfunction is one of the most common side effects smoking I mean again you know uh people don't talk about Ed I mean it's such a common problem I mean we
• 72:00 - 72:30 investigate we don't find any cause and then little bit you know somebody say oh you know this is a problem and then you go in a different direction but that should be the first thing that should be the first thing people don't talk about this so uh you know I'm happy at least with the internet coming in you know your platform my platform we encourage people to talk about you know let's be open I mean there's nothing wrong nothing wrong with it nothing wrong any infertility
• 72:30 - 73:00 discussion should be both both husband and wife absolutely but people don't come to us they don't come to you it's so strange uh Dr Paul just two days back this yesterday yesterday so I was asking uh I had three people in my op husband wife and the Mother-in-law the sasuma right and then you know my standard questionin husband no husband's mom hb's so my standard question you know I I take a detailed history and I ask uh
• 73:00 - 73:30 does any one of you smoke then immediately the Mother-in-law Pops in oh my son smokes you know he has lot of pressure and stress in his life he works in IT doctor I hope you understand I said oh my God I this is like you know as if the mother's trying to justify why does my son smokes now just think of the psychology and I said Mom mom at least on this you should not be taking your son's sign and you're trying to justify I mean you
• 73:30 - 74:00 don't even know what kind of stress do as we work as doctors your son works in an IT department you're saying oh he has lot of stress and that's why he smokes wow so we have multiple types of problems when it comes to us as doctors I would you would say so many things right so many things you know I remember when I was in obgy in rotation when we dealing with infertility um I mean the family invariably uh creates a victim card for
• 74:00 - 74:30 the women yeah is that still happening or see here in case just think of it Dr pal in case the woman said I'm smoking what response bu sasuma no then the mother then the son will start smoking because that's a to mon stress oh my God you know a very you know it's very
• 74:30 - 75:00 difficult to understand the psychology of people I I I still fail to understand the psychology of a person who is in the first place smoking and now there's another person who is his mom trying to justify why is he smoking and the poor woman who is being affected the most is keeping quiet not able to say anything that's the plight of today Modern Woman Who is is even educated it's it's so sad so very sad so very sad so very sad Family Support is
• 75:00 - 75:30 one of the main thing that you very yeah we talked about the stress and the emotional component yeah so uh you know abnormal seman parameters not only can cause infertility it can cause abortions it can cause birth defects it can cause multiple problems you know the carry home birth rate yeah I want you to educate the audience there's a very slight Nuance over there because every pregnancy is not a successful delivery
• 75:30 - 76:00 absolutely carry home baby rate at home you carry a baby so that is very different from just getting pregnant pregnant yeah so in fact the abortion rates could be as high as 10 to 15% so 10 to 15 person pregnancies may get lost now to to you it may seem such a big number but lot of pregnancies end up in abortion especially in the first trimester in case there is something wrong with the pregnancy it's a Nature's
• 76:00 - 76:30 rule the nature would never want an abnormal embryo to develop so the nature whats the pregnancy now we've seen women who are sorry uh you know couples who are smoking the abortion rates could be much higher so um yes of course there is there is a difference between getting pregnant and then finally taking your baby back home back home and that is why in in I think I've read somewhere that the environment where the embryo is
• 76:30 - 77:00 being formed is extremely important which means the women should be healthier at the time of conception to get a successful outcome absolutely that's why I said you know in case you are you know not planning to get pregnant in your future at least use this time to make sure that you your body is healthy you work keep working on yourself so that when you finally make a decision of becoming pregnant your BMI is in order your sugars your blood pressure
• 77:00 - 77:30 your every parameter is in place place you know in place so moving from the pregnancy and the part from 20 to 40 the most important thing that I get questions on is the menopausal period between around you know 45 to 55 what is the common menopausal age these days okay so here once again the menopause is not a definite thing is not a fixed thing for every woman any woman
• 77:30 - 78:00 who gets a menopause earlier than 40 years we again say it's premature menopause and uh any menopause which happens after 40 Years is supposed to be a normal thing but it all depends upon your genetic makeup uh you know uh some women might get a menopause at 42 while another woman might go up to 58 also it depends upon your a and reserve and how well are you keeping taking care of your eggs which means once again you know
• 78:00 - 78:30 eating good food making sure that you're you're not suffering from any lifestyle diseases there are few things which are beyond our control know somebody's diagnosed with a malignancy and you know this is something which is beyond anybody's by and large you know control but uh it's important to look after yourself and um I also said that women are these days losing their eggs faster because of multiple environmental
• 78:30 - 79:00 factors all around us now if there's pollution you can't help it I mean you have to breathe in that air can't help it you so uh I mean if there's a there's a vegetable coming to you however much you wash it you can't be really sure that it is completely free from the pesticide or the herbicide uh you can do whatever you can from your side yeah but there are lot of factors which are beyond your control I mean uh you can control your smoking alcohol making sure
• 79:00 - 79:30 that your diet Bine large is good taking care of your stress factors but still there would be some factors so uh menopause I tell people is that number One never get scared I mean it's a it's a it's a natural transition of your uh age and uh I take it like this it's a it's a wonderful phase you should celebrate the kind of wisdom you have acquired for so many years and you know the very fact that you raised a family
• 79:30 - 80:00 you've brought up your children you've come this far with a single or multiple partners or whatever but it's it's it's a time to you know take pride and look back so never get scared but this is the time when women should be even more careful of their health the biggest thing which a woman faces at actually are two things one is a risk of osteoporosis and second is a cardiovascular risk so the estrogen is a
• 80:00 - 80:30 hormone which protects your heart and it protects your bone so strength training is once again a very very important thing for every woman number one training increases estrogen helps in s training no no no no no no once you go into menopause you need to be strengthening your bones because now there EST estrogen to protect your bone and of course when you do a good strength training you have good muscles
• 80:30 - 81:00 you have good uh you know joints your heart is good so you benefit everywhere so I always tell this to my patients that you know it's important for a woman in 45 age group to exercise more than a woman when she's 25 of course Every Woman must exercise but now you need to be even more proactive make sure that your diet has vitamin D has calcium and you know make sure that you have less inflammation in the body
• 81:00 - 81:30 by reducing your stress reducing your cortisol we know you know inflammation or high cortisol can cause bone loss so there's everything is interconnected and once again you know it comes to you know move your body eat little less and be happy so you recommend most in training around the age of 45 when they absolutely and Dr Paul I started strength training 10 years back wow like I'm now
• 81:30 - 82:00 nearing 60 and I will be you don't look like you're 60 he look so young I'm nearing 60 I have so but it's been uh for me the menopause has been the best phase of my life I've done the best in my life after my menopause I've been at the best stage of my fitness after my menopause so and I'm not just saying it I wish some people get motivated by listening to this that never give an
• 82:00 - 82:30 excuse that why can't I do this I mean all of us have our own excuses you know as doctors also you know we working late this that but never give an excuse because when you give an excuse you're actually fooling yourself because your health is your responsibility it's nobody else's of course what kind of sing that you do so I do it with baits bands bands so I like I'm a yoga teacher so I do practice 4 days yoga and I do three days of strength training too so I
• 82:30 - 83:00 practice I miss only if I'm stuck up in a hospital oh my God so you are a busy surgeon busy obgy and clinical practice you are active in YouTube social media and you find time to do St training no this is like an attempt to make sure that my body is in place and I and uh I think every woman must realize this that you need to do it for yourself I mean in my family everybody knows that that one hour they can't disturb me I mean I've
• 83:00 - 83:30 set those boundaries that you need to do this and for every woman who's watching this they must be selfish when it comes to their selfcare it's very important very very important and why not I mean why a man can go to exercise why can't a woman do this of course of course and they been working a lot more family yes absolutely so it's uh very very important and like I said eat simple eat less we you don't need that
• 83:30 - 84:00 much you don't your body doesn't need that much exactly and unfortunately we all eat much more than what we are supposed to eat then on top of that we eat wrong things then on top of that we eat at at wrong times so body the body's going to collapse so I mean you are doing yoga you're doing s training you look much younger than your age for sure of course um that is the living testimonial that
• 84:00 - 84:30 you know people can follow you uh and then you know have a very good menopause of Life yeah so I would say fortunately or unfortunately I had an early menopause and I was 41 so it's been now 17 18 years and I've been surviving yeah what the hot flashes that comes around menopause right is there a common thing that affects everybody it does so it's once again it's not um I would say you
• 84:30 - 85:00 know it's not a very uniform thing that every woman will have hot flushes uh it varies from person to person and uh why does that happen is because the lower uh estrogen levels somehow disturb the therat which is present in our I see hypothal regulation yeah so uh for some people it could be uh you know really bad that they are not able to work and
• 85:00 - 85:30 they're constantly with a fan and you know there is something known as a night sweats so you know people wake up in the middle of the night so just sweating I had a patient she has to remove the whole t-shirt because she just completely so uh you know some people have it more some people have it less but I would say I always tell my people is my patients is that first of all don't get worried nobody dies because of her hot flash so don't get worried oh
• 85:30 - 86:00 doctor you know this is I understand it's a problem but typically we've seen within 2 three years of starting the menopause now the body gets used to lower levels of uh estrogen and sort of makes space with it I can't get more estrogen than this let me be happy with it so till that time you know do whatever makes you comfortable it could be wearing your clothes and lay and making sure that you exercise follow a good diet and in case nothing works there is a small subset of
• 86:00 - 86:30 people where in we might need to put them on HRT for some time there are proper guidelines for putting a patient on HRT so hormone replacement therapy hormone replacement therapy so uh you know there are proper guidelines like who should be put on so uh so doctor will decide yeah let the doctor decide please don't ever take a medicine just because my friend is taking or my sister is taking HRT comes with its own risks
• 86:30 - 87:00 including risk for the endometrial and the breast cancers so it is a decision which you must take after talking with your doctor is HRT available in the pharmacy that anybody can buy here in India unfortunately in India in case you have your fence prescription with you you can take your fence prescription buy an HRT by HRT huh which is uh sad so here uh you know you have your friendly chemist and a friendly pharmacist who is
• 87:00 - 87:30 ready to oblige you wow because it causes blood cloth sometimes right yes yes yes of course the so that's why I said there are lot uh the decision for HRT has to be taken after a detailed discussion with your doctor because the doctor is going to evaluate your medical condition if you're obese if you're a smoker if you're a diabetic if you're at a risk of any form of DVT of course that may not be a good option for you exactly so uh there are multiple things which
• 87:30 - 88:00 can be done uh you know for hot flashes and in case nothing works HRT is there we can put you on a uh you know guided uh HRT with a proper monitoring this is very important so don't just take an HRT because somebody else you know takes this spill on own never do that the other problem in this menopausal group is the osteoporosis and you said that estrogen is the key thing to maintain
• 88:00 - 88:30 the muscle mass and Bone everything and since after menopause estrogen has gone down so you are at increased risk of bone loss do you recommend dexa scan or something 100% 100% every woman must undergo a dexa scan fortunately these days you know with the uh era of preventive Health investigations so a lot of people are now uh doing that so with the blood investigation ation you get a dexa also done a mamogram also done so it's a good idea please uh that
• 88:30 - 89:00 how often should we get it annually every year every year after 40 after menopause H after 40 years an annual Health examination is required and in case your dexa scan is showing osteopenia it's important to be in a regular touch with your gynecologist and orthopedician to make sure that in case the scan is to be done even more frequently then it should be done so it all depends upon where your parameters
• 89:00 - 89:30 are and there is a proper uh you know recommendation protocol protocol you know there are a lot of drugs which we give in case we find that the person is grossly uh you know you give calcium vitamin D supplements all that that is very B you know then of course we have lot of other drugs like bis phosphonates and other things also so uh but then uh I want to say the names so that people should not just think oh this is a drug I should buy so let that decision be taken by a
• 89:30 - 90:00 doctor course but understand that osteoporosis is reality is reality it's much more commoner than what we think and uh unfortunately in our country I don't know what happens in us it is diagnosed when a woman has a fracture and she comes you know with a fracture and then a Dexter scan or a SC you know x-ray says oh she's grossly osteopenic so please look after yourself and uh smoking is one reason which causes
• 90:00 - 90:30 osteoporosis I'll tell you an example in the US um where there are two patients had one patient had a hip fracture uh and the other patient had a knee strain or something both had osteopenia osteoporosis um one of the patient is from a Indian immigrant came from India after 20 years uh and the other one was a white female who was there uh both had same age same menopausal symptoms but
• 90:30 - 91:00 the white female got recovered much faster and from a knee sprain same kind of fall okay then I was telling that I was involved because of fatty liver and everything I was telling the person from the Indian Community is that see the the problem is that she the other patient had a muscle mass protecting the knee yes in your case you were 4 six you know we didn't focus on the muscle mass at that time by strength training let's say you would have done strength training
• 91:00 - 91:30 build some muscle mass from 35 to 45 the recovery rate might have been much easier s so it's like um once again it comes to this please move your body movement big time Big Time ah big time and hip fracture is the main thing correct elderly yeah yeah facture neck FEMA facture FEMA neck FEMA neck of Fe and it can be very debilitating debilitating very debilitating it has a very very tmy course also so um make sure that you
• 91:30 - 92:00 don't reach that place in the first place hopefully hopefully you know audience will listen to this do some kind of s training and we will not end up in that situation the other thing very important in this field is bleeding after menopause that should not be any bleeding if there is bleeding you should seek a medical attention right away absolutely so any bleeding post menopause is not normal so first of all what is menopause so which means for one
• 92:00 - 92:30 year you haven't had your periods now we officially declare you've gone into menopause after that any bleeding is abnormal and should be immediately reported to the doctor because of fear of malignancy malignancy it's endometrial cancer yes endometrial cancer a possibility yeah yeah even cervical Cancers and everything cervical cancer of course all these things can happen in a premenopausal age group also but
• 92:30 - 93:00 postmenopause any bleeding please report to the doctor and these days going for a preventive Health checkup is a good idea many times we pick up a increased endometrial thickness on an ultrasound in a postmenopausal woman so in case you know before she has a bleeding episode we pick it up then and there only so if you can afford it please go for an annual Health checkup ah and you biopsy the endometrium yes so supposing in case uh
• 93:00 - 93:30 you know postmenopausal bleeding is an indication of a hysteroscopy hysteroscopy and endometrial sampling and uh in case on the ultrasound something is coming which means that you know your ET looks thick or in case we see something some growth inside the endometrium inside the uterus of course we do the hysteroscopy and the endometrial sampling of the other thing I want to touch upon is breast cancer breast cancer recommendation is mamogram
• 93:30 - 94:00 at the age of 40 or 45 40 40 annual screening mammograms every year every year every year so a lot of people have this misconception that mamogram itself will cause cancer so no it's not like that the kind the risk of getting a cancer from a mamogram is much much much much lesser than missing a diagnosis of a cancer so broadly it is said that before 40 ultrasounds annually after 40
• 94:00 - 94:30 annual mammograms but again it depends upon your history supposing somebody has a very strong family history that your mother your sister everyone had a you know um breast cancer history then of course we do uh you know more intensive and more frequent screening for that woman you've been practicing for more than 30 years now you think the breast cancer rate is increasing decreasing it's so common so common so very common at what age usually what is the earliest
• 94:30 - 95:00 age that You' have seen 24 years and that too in a woman who was pregnant it was like I will never forget that patient she just came she was 6 months pregnant and she said I can you know feel a lump in the breast and then you know the first thing is it might be just a milk duct or whatever and then I palpated I said no this doesn't look nice and then of course we got a scan done they said no this is doubtful we biopsied it was proven it was an
• 95:00 - 95:30 introductive CA and then of course you know we put the patient because we couldn't deliver the patient earlier we put her on some kind of a chemo therapy which could sort of control the growth of the cancer we delivered her at 32 weeks and then you know mastectomy was done and all that pregnancy is supposed to protect from B no not uh I'm sorry so it's a very broad thing it's a very broad thing it is said that women who breastfeed their babies uh breastfeeding
• 95:30 - 96:00 has a protective effect women who have no children are at a higher risk of getting breast cancer women who've never breastfed are at a higher risk women who have a family history at are at a higher risk but Dr Paul you'll be surprised women who have who are diagnosed with breast cancer many many times have no family history they have two children they have breastfed so there's practically no reason why they have got
• 96:00 - 96:30 breast cancer so it's not that simple that you know I have a child I have breast fed so I'm protected no it's not like that though of course these are you know sort of the predisposing factors but sometimes a woman may just get a breast cancer just like that so once again it's important that you go and get your annual Health checkups done it's very there something called self breast exam right what do they self breast
• 96:30 - 97:00 examination is a good idea but nowadays we don't use this term like a self- breast examination we say it's important to be breast aware how does your breast feel if you have to choose between not doing anything and doing a breast examination it's a good idea Every Woman must do this but we have to understand by doing a self- bre examination you can pick up Lums only who are which are more than one or two cm and that to If a woman is very careful you know but you
• 97:00 - 97:30 know a breast cancer in case it is detected at a stage where the lesion is just about 1 cm or so the prognosis is much better much better so great you do the self- rest examination uh but it does not it is exclude the possibility of not going to a doctor because even a doctor when I do a best examination I can miss lesions which are less than a centimeter and how can you feel with a hand if a woman is
• 97:30 - 98:00 obese correct you are likely to miss it but a good Imaging will pick it up and obesity increases a risk of breast cancer obesity once again uh you know smoking exposure to hormonal you know that's why at 14 years you give her birth control pills what are we doing rather than educating her and the mom we are constant we are trying to make her completely dependent on an ocp forever
• 98:00 - 98:30 for her life this is not fair birth control pills does put you at an increase risk of pre cancer slightly not a lot again having said that we need to understand birth control pills are a great invention they have revolutionized the way women have regained the control of their reproductive destiny it's very important but we need to understand that putting a patient on an ocp will not cure her of PCOS once in a
• 98:30 - 99:00 while I also put my patient on an ocp in case a person is bleeding she has lot of bad heroism to let the you know situation get back to a point of a control we can put that but then telling her let you take this and your pcus will go away that's the wrong notion right so we need to ocps are not bad I mean this generally people say oh you know taking a birth control pill even for a contraception is bad it's wrong birth control pills are very safe
• 99:00 - 99:30 once again they are taken on a if they are taken on a doctor's prescription not on your friend's prescription it's important that you talk to a doctor because today we have more than 100 types of a pill and the doctor decides which pill is good for you and then puts you on that kind of a pill of course while we on the topic just wanted to touch base upon on the most common contraceptive method that people are adopting right now is it intra utrine device no no no it's not
• 99:30 - 100:00 like that it's like we have to understand that there is no contraceptive method which is the best contraceptive method the day somebody invents the best contraceptive method that person will get a Nobel Prize more than a Nobel Prize so every contraceptive method starting from a barrier method it could be a male or a female condom or or a birth control pill or an IUD or a finally sterilization and rings and peses and so many everything
• 100:00 - 100:30 has its own pros and cons and the doctor decides that what is good for you of course taking into account your consideration your medical history so once again never take a pill just like that of course for an IUD you need to go to a doctor condom of course you can decide to use it but once again make sure that you use it responsibly you know use it carefully use it the right way it's a great thing to do it prevents a un pregnancy unwanted STD is a very
• 100:30 - 101:00 big thing it is one of the best things which can be done to prevent an estd so be responsible educate yourself in fact when we started me one purpose was this ke it's important to take control of your health in your own hand you know educate yourself and educate yourself from the right sources not because XYZ influencer who's not even a credible source is telling you I mean with due
• 101:00 - 101:30 respect to everyone it's like uh you know um of course you need to be sure like what you are falling is it really true or not I mean you would agree to this on Internet it's full of information but is that information really correct it's most of the times very filous and very trash so uh be very sure make sure that you educate yourself make sure that you find the right kind of a health care provider and once you have found the right healthare provider
• 101:30 - 102:00 trust the doctor thect wholeheartedly that's very important no second opinion no second opinions I know we this is the problem which you and I face as a doctor every doctor is facing this so take time to find your doctor and once you found out your doctor trust the doctor wholeheartedly my uh my nephew is a doctor and he saw a patient he he wrote his recommendations and then that patient is a friend of mine since me what do you think about
• 102:00 - 102:30 this but I this this might be a very uh sensitive question but I just wanted to ask you I'm very curious uh usually what happens is after the second baby uh if the second baby is a C-section people actually consider doing a tubber liation no not really not really not really it all depends I mean it's a Stay Stay what do I say it's a it's a time of reproductive autonomy everybody has decid has decides if the
• 102:30 - 103:00 if the family decides that you know they don't want any more kids yeah yeah a lot of people do get it done a lot of people do not also get it done it's completely their decision but doing a sterilization at the time of a second ceran is a great idea a great idea if you are very sure that come what may I don't want a third pregnancy we can do a recanalization surgery but then the success rates of a recanalization are not that great so
• 103:00 - 103:30 it's important to take a informed decision when you a permanent method H the point I was very interested was vasectomy is it being done recommended I mean is it being adopted as a possible very Less in very less once again you know there is such a strong bias which is you know um against a woman that you know you know a man should not
• 103:30 - 104:00 get this procedure done exactly so vasectomy rates are very very poor very poor it even in upper class like I deal with uh you know women from the upper educated Strat of society they also nobody talks about that not that much yeah even if they talk they'll say n NE I'm getting a Sian done I will get it done it's like so I but let's say normal normal vaginal delivery so two babies normal vaginal delivery then the options are open uh immediately post uh no what I'm
• 104:00 - 104:30 saying is uh family huh two kids they decided we don't want any more kids huh okay and the contraceptive method that is uh recommended is tubal liation I mean not recommended they let's say they are choosing tubal liation this is what happened to my friend that's so uh what we do is like in case uh after normal delivery they want a sterilization immediately we can do it it's called
• 104:30 - 105:00 postpartum uh sterilization wherein we need to give a very small cut otherwise we do a laparoscopic sterilization 3 months later because by that time the uterus is iMed and gone back to the pelvis yeah what I'm trying to say is 3 months later right so this is not a C-section the patient is not there so it is not an easy option of yeah yeah she has to get admitted again get aded it's a Sur it's a procedure and it's a it's a much more uh bigger surgery than a vasectomy it's a proper
• 105:00 - 105:30 surgery proper surgery so my point is I think we should open up for vasectomy a lot more because the women is going through a lot more invasive procedure there are so many good and bad things in US mostly bad things but but one good thing is vasectomy is very common very common there very here the vasectomy weights are very poor very poor women will say I'm not doing it you do it my urology doctor you should say he
• 105:30 - 106:00 has practiced both in India and us now he's saying that you know vasam is extremely common I think it's something very easy as well relatively it it should be I think uh as men they need to be educated about this that it's a very small thing the recovery is going to be very small it's in all publicity an OP procedure and um it's a very easy thing yes yes very easy thing as well one last thing before we wrap up is cervical cancer okay papsmear is something that
• 106:00 - 106:30 we recommend where we uh take scrape the cervical epithelium when should we start just for the education yeah early so cervical cancer screening should be done from the age of 21 years onwards whether a woman is sexually active or not and after that it should be done every three yearly in case we are combining an HPV screening along with that 5 years yeah and it's it's a test which is very easy to do
• 106:30 - 107:00 hardly takes 2 minutes to do it's not painful it's not expensive at least in India and uh uh it's a very easy thing to do once again India has a very high cervical cancer rates so um once again here women who are you know having a single partner they also get this so uh even if you know the risk factors could be multiple sexual partners and STDs but
• 107:00 - 107:30 I've seen Housewives who've been into a mutually faithful relationship also getting a cervical cancer so probably because in India we are not proactive in our screenings women come to us very late when the cancer has already into stage two or stage three so a regular papsmear can actually pick up a cancer 7 eight years before the actual cancer develops so cervical cancer has a very long history so something known as C1
• 107:30 - 108:00 cn2 so these are all pre-cancerous stages by doing a paps we can pick up women in these precancerous stages where by just a simple local treatment excision or a cryotherapy or an electrotherapy can cure a patient completely completely once again you need to get the test done and today we have cervical uh cancer vaccinations HPV vaccinations so if you can afford the vaccine please take the vaccine it's around age 12 or 13 right when should we
• 108:00 - 108:30 get so the vaccine in India it is 9 years onwards now uh hopefully it should come it should now become part of the national immunization program since it's a little costly vaccine the government is working on producing an indigenous brand for the HPV vaccine once that happens hopefully it should come into the national immunization program but but 9 years onwards it is recommended the best time to take this is 9 to 26 years after 26 to 45 years it is known
• 108:30 - 109:00 as rescue vaccination and Beyond 45 years it's useless yeah because the idea is by that time you probably would have been exposed to HPV on your own H this happens in my uh neighborhood a lot sometimes I've have done this mistake as well where um during menal periods right um I know I know the menstrual cycle a little bit lot more because I recommend fasting and during fasting around the
• 109:00 - 109:30 menstrual period they are craving for cups because of the progesterone um sometimes what happens is what I'm feeling is that mental health issues are not being addressed seriously in women because people are thinking that it is that time of the month ah this is correct oh she must be PMSing ah PMSing how common is that yeah it is common so women
• 109:30 - 110:00 unfortunately face a bias at every stage you know biologically also there is so much they have to handle and uh even as a society you know they handle so much so unfortunately that's a reality but now women uh women are standing up for their rights and talking to them look this is not a problem which I'm making it up it is not uh it is a real thing it it happens because somehow those
• 110:00 - 110:30 hormonal changes they interact with the neurochemistry and causing some changes there which make you more sensitive in your mood and you know your anger and all those things so it's a real thing it's not you're making it up and it's a proper entity needs a proper treatment and it can be treated pretty well so in case it needs medical attention yes of course so there are various uh you know
• 110:30 - 111:00 grades to this it could be premenstrual syndrome it could be you know proper dysphoric disorder where the woman is having lot of mental issues so in case you feel that it is affecting you up to that level do not wait meet a doctor we can put you on lot of supplements lot of hormonal medicines to tide over that crisis and once again uh all those problems like uh you know premenstrual syndrome pmdd they have U some bit of
• 111:00 - 111:30 psychological uh I would say conation to it that women who have these issues tend to you know face these kind of problems more like for example postpartum depression will happen more in a woman who probably had a PMS so underlying some neur lability you know
• 111:30 - 112:00 exists but having said that it is not something which a person is making it up out of their own own thing own thing it is a proper thing which varies from person to person and needs a proper medical attention beautiful it's a wonderful discussion amazing I know for gastroenterologist lot of you know new things all I know is stomach and colon that's so nice of you you're doing a wonderful job you you are opening up a my three uh online platform for women
• 112:00 - 112:30 yeah huh what is that about so um so I started mat three um about 3 years plus and I started this simply as an experiment to see you know uh let's see how does it go and then you know fortunately lot of people responded and uh my only uh motivation was to create a good content which is scientific which is evidence-backed but given in a manner which is easy to understand and uh
• 112:30 - 113:00 recently we got picked up by wh as the me is a voice you can trust so U that was the greatest validation which I got so we are part of the wh Network now beautiful and uh we are now you know planning to scale it up and make it into a big platform where you know pan India and hopefully later on also you know women can actually access the authentic sources you know authentic
• 113:00 - 113:30 doctors authentic care providers everything which is like you know ethical credible authentic so um you know hopefully uh we should be reaching there you will of course you will you will um I really you know we really want to help women to empower them to take their health in their own hands you know so that they
• 113:30 - 114:00 are able to take the decisions so that they are able to ask their care providers the right questions unless you know what is correct how would you ask the doctor what I want correct and you know once again we hope to create metri a platform where you find the right answers to your questions the medically correct answers latest answers so uh you know at matri we would never discourage you beautiful that's wonderful what does MRI stand for okay
• 114:00 - 114:30 so metri is a Hindi word and metri means friendship so I wanted to create a friend which is going to be your friend and guide in the matters of your health and uh I don't know if you've seen the logo I wanted to give a Indian connotation to this if you see there is a bindii there red Bindy which denotes the Indian connection and U it's a power of the strength of a woman so that's how
• 114:30 - 115:00 we made this and uh today um it makes me feel very very happy that um you know globally uh I think more than in 41 countries people follow M three and um uh there was a very um I would say a heartwarming moment for me we recently got an email from a group of women in Middle least they said that they get together in a kitty party to watch our videos so where women are not allowed to even talk about these taboo subjects you
• 115:00 - 115:30 know there you know mat is coming them and helping them and make empowering them to take their own decisions when it comes to their health so at me3 we talk about not only the periods and fertility we talk about contraceptions safe sex breast health basically anything and everything which a woman must know about her own health I know we still have a long way to go uh it's a very big
• 115:30 - 116:00 subject and um we hope to continue working in this direction and um hope to make the women more you know independent and empowered to take their own decisions that's the motto of mat beautiful beautiful I'm sure you'll do it and you have done already a lot uh hopefully I wish you best everything what you're do and thank you very much Dr PA it was really insightful for me also I'm waiting for those papers please send them to me actually we'll put that in
• 116:00 - 116:30 the description and we'll show that any guest who's coming in I'm going to connect them with the gut anyways that's when you're no it was a very very um good discussion and I'm very very happy that I came despite the rains and everything it was worth all the effort so thank you very much for even considering me to be part of your show so you thank you so much thank you thank you that was a wonderful session I'm sure you learned
• 116:30 - 117:00 something at least from the podcast as usual I'm going to ask you to write down in the comment section in terms of what you exactly learned it is extremely critical this is a health podcast it is not just a one-off podcast it is just not for entertainment I want this to be an infotainment where you actually learn something absorb it and then implement it on your daily lifestyle so this is the goal of this whole Health podcast so for that to happen all the points that you might have learned today or you
• 117:00 - 117:30 might have at least exposed something new I want you to write down this New Concept in the comment section so that you will get registered in your mind so that the thought gets registered in your mind and you will not forget and that is how usually learning process happen so please let me know your thoughts on the podcast session as well so we have two more new YouTube channels gut feeling with Dr pal shorts gut feeling with Dr pal Clips both these channels will be releasing videos in a shorter format of that 1H hour long podcast series highlighting the salian futures of it so
• 117:30 - 118:00 please consider subscribing to that channel as well if you are an audio person please check us out in gut feeling with Dr pal on Spotify while you're commuting while you're driving this will be a wonderful infotainment for you again remember one belly at a time it is absolutely important I'll see you in the next video