Why PCOS got renamed to PMOS and what that means

PCOS has been a familiar label for decades, but the name may have been steering patients and clinicians toward the wrong center of gravity. SWH Podcast host Dr. Holly Thacker sits down with endocrinologist Dr. Ula Abed to unpack the new term PMOS, polyendocrine metabolic ovarian syndrome, and why it better captures what so many people actually struggle with: insulin resistance, weight gain, high cholesterol, fatty liver disease, and long-term cardiovascular risk, alongside cycle changes and fertility concerns.

They talk through what changes when you treat PMOS as a metabolic condition first. That includes how the newest international guidelines push earlier screening and a more realistic, whole-person plan, and why improving metabolic health can sometimes restore ovulation and improve fertility outcomes before jumping straight to expensive interventions.

If this helped you think differently about PMOS, share it with a friend, subscribe so you don’t miss next week, and leave a review to help more people find evidence-based women’s health conversations.

Transcript

Welcome And Meet Dr. Abed

Dr. \ 0:08

Welcome to the Speaking of Women's Health podcast. I'm your host, Dr. Holly Thacker, and I am back in the Sunflower House with a recurrent favorite guest and wonderful colleague of mine. And joining us is endocrinologist Dr. Ula Abed. And she's done prior podcasts with us on thyroid and polycystic ovarian condition. And let me tell you a little bit about her to remind you about her. And today what we're going to talk about is the new term, PMOS. Dr. Abed is an internal medicine physician, and she specializes in endocrinology, metabolism, diabetes, and thyroid disorders. And we're so lucky to have her in our Center for Specialized Women's Health. She sees people in person and also virtually. She is a graduate of the Damascus University School of Medicine in Damascus, Syria. And she just got back from Syria. We're going to talk a little bit about that. She did her internal medicine residency training at the prestigious Emory University Hospitals in Atlanta, Georgia. And then she came to the Cleveland Clinic to do her fellowship in endocrinology, diabetes, and metabolism. And she's got quite a good strong interest and expertise in women's health endocrinologic problems, particularly this condition of this ovarian hyperandrogenism. And she's run our PCOS clinic, both in our now renamed Women's and Children's Institute, as well as the Endocrine and Metabolic Institute for the last eight years. And she's very talented with portrait and landscape photography that we've featured on our speaking of women's health.com. And she's quite an artist. I'm so thrilled to have you back again and join us and share your expertise, Dr. Abed.

SPEAKER_01 2:23

Thank you so much, Dr. Sackert. It's always really nice time to spend it speaking of women's health at the podcast as well as the clinic and see you every Thursday morning. Thank you for the great introduction.

Dr. \ 2:36

Oh, my pleasure. And I'm wearing this beautiful Damascene Brocade that you brought back from Syria. And

Syria Trip And Damascene Brocade

Dr. \ 2:44

I know you have family, and I know it's such a beautiful country. So tell us a little bit about your visit and about this beautiful artwork because I know you have that artist eye and you're still also a scientist. That's a rare combination.

SPEAKER_01 2:58

Thank you. Yes, so um we try every summer to uh me and my husband, you know, have our vacation now in Syria. We take the kids to uh um explore the country and see how things are changing positively over there. And as Dr. Sacker always uh uh know and I always like to share with her, uh there is a lot of culture uh in in in Syria and a lot of different um talents and and and arts that are you know very old, but uh people now are trying to revive them and uh and preserve them as well. One of them is the um making of brocade. The brocade fabric itself is very damasine, is uh originated in Damascus, and uh it's um they make it handmade on the loom. So it's uh really thin silk uh strings that they use very, very delicate on the loom that to make you know different things, of course. So uh this time I really wanted to you know get you something special and I found it to be uh a great uh um uh souvenir from Syria. So uh I'm glad you you enjoy it. You like it.

Dr. \ 4:10

It's it is lovely. And every day I think about you because I open up my jewelry box and you know you made that handmade and it's just so beautiful. I think I showed it on the

Why PCOS Is Now PMOS

Dr. \ 4:20

last podcast that we had you on. And I was so impressed with the recent publication that you and our uh graduated senior fellow, Dr. Nayang Sung, who has been on the podcast, and we tried to recruit her. She's gonna be going to Mayo Clinic in uh Jacksonville, Florida. But she and you and um the esteemed Dr. Tommaso Falcone wrote uh a very important uh article on this polycystic ovary condition that has just right after your publication, all the news hit about how it was decided to rename it. And do you want to talk a little bit about the new name and why that was done and what women need to know?

SPEAKER_01 5:04

Yeah, absolutely. I mean, working on the article itself for the Cleveland Clinic Journal was uh was absolutely uh enjoyable for me because we what we tried to do is to update the article that they had many years ago, and it was really amazing to see how much we know now compared to the past, about 10 or 12 years ago, about PCOS. For a long, long time, we used to think that PCOS is this disease that causes irregular periods and infertility, and that's it. But now we understand that there is a huge metabolic impact, a huge metabolic part of PCOS that almost never you see a PCOS patient without a metabolic problem. Um, so so we reviewed the literature and most importantly, we included the new international guidelines that were uh adopted by the ACOG, the American College of Gynecology recently. So that basically, these new guidelines really change the way physicians, primary care physicians, family practice, OBGYN as well as endocrinology, how we understand the disease itself, how we see the metabolic part uh more and and and before we think about the other issues that happens that happens sometimes later, like fertility and um and and anovulation. So so yeah, shortly after we published that article, the um the the the everybody heard the news about changing the name, and I'm very happy and excited about the name changing because now it really includes the metabolic, as I said, part and makes um patients as well as physicians aware of of um of the syndrome, the whole syndrome itself. And honestly, it it gives us also a relief as physicians that you know patients now um when they complain about the metabolic part, the weight gain, the you know, high cholesterol, the um um, you know, the later on the cardiovascular risk, uh we we are recognizing it, we are familiar with it. It's you know, so so so everybody hopefully come on the same page on that. Um in terms of patients, I mean I I see these patients every day and I really feel for them, like their struggle, their um um on not only on you know a period or a fertility issue, that's far too fit, but I see their struggle with all the metabolic factors that play a role in the pathophysiology and pathology of PCWAS. So finally, finally, and and this is only the start. This is only the start that we're changing the name. Hopefully, next will come better, you know, medication coverage, better recognition of treating the metabolic part and how it's it really has a positive impact on the whole syndrome itself. So this is only the beginning.

Dr. \ 7:52

So the new term PMOS, it doesn't flow off the tongue like PCOS, I guess maybe because for 30 plus years that's what I've been saying. But that stands for polyendocrine metabolic ovarian syndrome. And it really puts the focus, like you said, on not just cyst and not just the ovary, even though the ovary is key, but all these other uh systems are as well. And so it has reproductive effects, which is why a lot of REI and OBGYNs get involved. But importantly, and long term, it has these metabolic and psychological consequences that your article in March of 2026, and I imagine you could just Google Cleveland Clinic Journal of Medicine, March of 2026, um, and put in P uh COS or PMOS. And uh, you know, we have a lot of physician and clinician listeners as well as you know, very smart and sophisticated people around the world that like to listen to this podcast. And so I think that uh looking at it from a holistic lifestyle, as well as pharmacologic, in the past we just focused on pregnancy and menstrual irregularities or some of the dermatologic manifestations of hair thinning, and we've got six podcasts on hair thinning because women really, of course, care about their hair,

Metabolic Risks Beyond Periods

Dr. \ 9:15

as well as you know, chin whiskers or hair sutism. We've had podcasts on lasers, and sometimes medically that's covered if there is hair sutism. One of the things I wanted to go into with you that I was excited about and that every single patient is asking about are um the GIP, um the peptide one receptor agonist and uh their role. And I I I imagine you probably have a lot to say about that.

SPEAKER_01 9:43

Absolutely, yes, yes, for sure. So we we, I mean, we all of us, we we are entering or probably already entered a new era of medicine. And it's the era of of uh inflammatory diseases, and I'm not talking about autoimmune inflammatory diseases like Crohn's disease or although they are still connected, but I'm talking about diseases that get gets worse with inflammation. Um, and and all the metabolic diseases, to be honest with you, whether it's PMOS, uh diabetes, any other um um um metabolic disease, it gets worse with inflammation. So now we have this agent that is basically touching the lives of many patients. So it started as a diabetes medication for sure, but later on throughout the studies, we start learning how it's affecting not only the blood sugar but also the weight. It also affects the heart health, and now it's recommended. Uh honestly, I think all the new GLP ones, all the weaky ones, got the the cardiovascular data, so they do decrease the risk of heart attacks, they do decrease the risk of heart failure, and not only that, also the kidneys, so they do decrease decrease the progression of kidney disease, they do uh decrease the risk of you know acute kidney injury as well as chronic kidney disease, liver, um fatty liver, or you know, muscle, uh, or or you know, liver steatosis. It's the best medication that you can give it to liver patients. It doesn't only halt the progression of uh liver disease, it also reverse and help the liver cells regenerate. And this is only yeah.

Dr. \ 11:29

Tell us the generic and brand name of the medicines that you're talking about.

SPEAKER_01 11:33

So sure. I mean, we we started out um by the very first one that got approved um back in the early 90s via and and then Victosa, and now we have um we have the that was from the saliva of the Gia Monster, is that right? Yes, yes, yes. And I made it as a joke uh in one of my talks, like, do you know why they use that reptile? And one of the and one of the audiences was like,

GLP-1 Drugs And Whole-Body Benefits

SPEAKER_01 12:05

oh, maybe they the their like the scientist's son had it as a pet. I was like, that's that's a good that's a good answer though. But because because the the reason why is because we do have in our bodies in our intestine, we have GLP1, but it only lasts for uh a minute or two. That's it, that's the half-life for it. So the one that comes from the Gilla Monster, it actually lasts for 12 hours, and that was what how Baera came as like a twice-a-day medication, because it was uh straight from the Gilla Monster, the GLP1 that would last um 12 hours, and then we had Victosa, which is once a day. We had Sixenda approved for weight loss, which is uh double dose Vectosa, it's a daily medication as well, and then we had the Trulicity, Ozempic, all the way until Minjaro, and we are gonna have uh more coming in the pipeline soon. So all these medications, um we call them GLP ones, um, they every every day we are learning more about the benefits and more organs are getting involved and more diseases are getting better with these medications. Now, I I the other day I was reading about a study that compared patients who had obesity-related cancers. So those are cancer survivors, okay, of obesity-related cancers. We're talking about breast cancer, colon cancer, and and other cancers that are related to, again, inflammation and uh and obesity. How GLP1 decreased the rate of recurrence of cancer. So these people have longer survival and less likelihood to, you know, get a recurrence of cancer when they were on GLP1. So this is new, it's still not in the guidelines, but it will come to the guidelines.

Dr. \ 13:51

And uh this is only, you know, this is only how much of that is just from the reduction of obesity, because we know obesity is associated with cancer. We also know that a lot of tumors feed off of sugar and there's no essential carbohydrate, or there are essential proteins and fats, which, you know, there's definitely a push in terms of rechanging the food pyramid and getting rid of or minimizing these simple carbohydrates. So, how much of it's from the actual peptide, do you think, or is it from just simply the weight reduction?

SPEAKER_01 14:26

It's even before the the weight reduction. That your question is absolutely legitimate. So it's basically because it prevents the insulin surge, and basically that um the every time we get insulin high, that basically induce inflammation in our bodies. So when we prevent that surge of insulin and and and we prevent um the inflammation factors, interleukins and TNF and all the the bad stuff, the bad guys, then we are decreasing the risk. As I said, I mean not I'm not a cancer doctor, but this is how it works. So you're decreasing inflammation, you're uh decreasing the risk of progression for cancer. And same thing applies to the other diseases we were just talking about, as well as the um the PMOS. So we'll talk more about PMOS and the GLP1 best, but the the data so far is very promising in every aspect, not only in PMOS.

Dr. \ 15:26

Fascinating. You've been listening to the Speaking of Women's Health podcast. I am your host, Dr. Holly Thacker, the executive director of Speaking of Women's Health. I'm in the Sunflower House with endocrinologist and women's health expert, Dr. Ula Abed. And we were talking about this PMOS, polyglandular metabolic ovarian syndrome. And I was so fascinated with your Cleveland Clinic Journal of Medicine article that uh there's a strong genetic component. My son, Stetson Thacker, no relation, who's a geneticist, has been on our podcast. And every day he's always talking about how genetics just affect so many things. And you were referencing a study of um mothers and sisters, and then the twin study showing that if you're identical monozygotic, it's a much higher concordance than dizygotic or fraternal twins, and how GUAS, these genome-wide associations, have shown several different risk uh loci, revealing associations with a ganatotropin action, insulin signaling, and andergen biosynthesis. And what really blew me away was that uh this syndrome can affect men even though they don't have an ovary. I didn't realize that male relatives of affected women have earlier onset male-patterned androgenic alopecia

Insulin Surges And Inflammation

Dr. \ 16:55

and the metabolic abnormalities. So I wondered if you wanted to talk about that.

SPEAKER_01 17:00

Yeah, yeah. So the everything we you mentioned is absolutely correct. And um however, I would like to emphasize that PCOS is not solely a genetic disease. There is no sole gene that is responsible for this. If you have it or your cousin had it, uh, it doesn't mean that it will run in the family the way people think about it. Um it's more, it's very, it's really multifactorial. So the genes are absolutely involved in, as you said, uh, the way they um um uh respond to insulin surges um and and so forth. But there are a lot of other environmental factors that are playing a huge role, not only in causing the problem, but but in making it a pandemic itself. So we surely we surely now see more PCUS than before, not only because we diagnose it more and it was ignored before, you know, underdiagnosed, but because it's more prevalent. In my clinic, Dr. Thakur, this is a very common scenario. I see the patient coming with her mother, and the mother is you know in her 50s, 60s, no sign or symptom of PCUS had her children, you know, with no problem, fertility problems whatsoever, no diabetes, you know, but the daughter have all the syndromes very clear, very clear. So why would that be? Um, and then you ask about family history, maybe yes, maybe no, it's not clear. This should make us think about a lot of environmental factors that are playing a role in this. In terms of men, same thing. Like, you know, if uh if we know that it's not a single gene or sing or a wreath or a thing that is only affecting women and it's more of a metabolic problem, then yeah, of course it will affect men and women. Um we may not be able to recognize it as well in men, um, because they have no periods. Because they have no periods, and if they get facial hair, so what, right? But right, right.

Dr. \ 19:06

They're more masculine looking.

SPEAKER_01 19:08

Yeah. Yes, but uh we definitely we definitely um uh can see the metabolic uh part of it, the you know, the metabolic syndrome, hyperlyphodemia, cholesterol, um diabetes as well as obesity.

Dr. \ 19:21

So these yeah these environmental issues you think are what causes this epigenetic alteration. So things in the environment can actually, and prenatal as well as post-delivery environmental influences can actually affect the genetic expression. And so it's very you know interlinked. And I guess there's

Genetics And Why Men Are Affected

Dr. \ 19:45

been animal models that uh show how being exposed to elevated active testosterone in perinatal life can induce more of these changes, leading to kind of more DNA methylation affecting the genes that are involved in both reproduction and metabolic pathways.

SPEAKER_01 20:07

Yes, and there is a couple of things that I would like to mention. So in in that regard, so in utero exposure to some antibiotics, so you know how to Which ones, which ones? I like the wide spectrum ones. I really have to you know go back and but like the white, like we have wide spectrum everything now, right? So they they cover like a wide range of bacteria and and probably 30 years ago or 40 years ago, humans were trying to you know invent all these antibiotics and and and uh um uh develop them so they can fight bacteria. Nowadays we we realize that come on, I mean, the these medications are not 100% safe. Yeah, and they affect the gut microbiome as well. So in utero during pregnancy, if you get you know uh certain exposure, like a you know prolonged exposure to antibiotics in certain amounts, and and as I said, wide spectrum antibiotics, you may be able, you may be changing the metabolism in the fetus and in the fetus gut and and and changing the bacteria spectrum in the baby gut and maybe exposing to insulin resistance and everything related to it. That's number one. Number two, some antidepressants as well that we know about right now, um, can play an antibiotic role on the gut. I mean, they are not used as an you know antibacterial medications, right? But they are commonly used for for many other reasons anxiety, depression. Again, exposure in the uterine, and I can send you these references, can play an antibiotic effect on the fetus gut as well. And may, I mean, all these are still, you know, um studies on um like uh in in the lab, so nothing in humans yet, but it's very interesting to see like what. When they say environmental factors, what does that mean? How would a pregnant woman get exposed to testosterone or androgens? I mean, pregnant women they take very good care of themselves, they have very good, you know, um uh medical um uh follow-up and all that. So, how would they get exposed to all these things? Well, sometimes things can happen and they get exposed to some medications that could cause a problem. In addition, of course, to all the stuff that we talk about in diet um and and lack of physical activity and and uh you know the other environmental factors. But I really wanted to mention, you know, new studies and where things are leading, especially the gut microbiome. We'll learn a lot in the next few years about how these things are linked to metabolic diseases.

Dr. \ 22:45

Oh, it's just uh amazing and expanding, and it's really an exciting time to be in medicine. Um one of the questions that will I get every every single day is you know, everybody wants to know about these medications in terms of being on medications for weight loss. And I'm like, you know, we have to go to the basics, and we've had a lot of podcasts on exercise and diet. One of the things that I wondered about is do you think this reverse ratios of the omega-3s to the omega-6s, where the omega-6s are a lot of vegetable oils and petroleum type products basically are driving obesity and weight gain and affecting metabolic and hormonal health, because I have never seen so much metabolic liver disease. Women with no history of alcohol or any other liver toxins having to get liver transplants uh because of the inflammation and scarring in their liver. And um, pretty much most people that I check their omega ratios, they're they're they're not very good. They're very, very inflammatory.

SPEAKER_01 23:55

Yeah. Oh yes, yes, I I believe you. I believe you. I I see it in young ladies with uh PMOS every day, and we check the labs and their liver function tests are elevated, and they are they are very young, and they are not you know on any estrogen or anything like that. But and then you you check their fibro scan, which is like a new way to to check the fibrosis and give you a score of the liver, and uh and sometimes it's I mean it's reflective and it's indicative of of um uh steatosis or what we call mastold. So, yes, I agree 100%. Things have changed quite a bit. Um gut microbiota is very important

Epigenetics Antibiotics And Gut Microbiome

SPEAKER_01 24:35

to think about. There are ways to um improve that uh in in diet as well as medications for sure.

Dr. \ 24:42

Um so you're talking about more fermented type foods. Oh, yes. I feel like eating pickles and kimchi like right away. Listening to this. Yes, lifting weights, you know, doing some deep squats.

SPEAKER_01 24:56

Yes, and and you know, we we I mean you have good bacteria in yogurt as well. Like many people really underestimate how how like the importance of yogurt. Um, and as as you said, like the pickles, good like homemade pickles, like sold low-soled pickles, have a lot of you know, good bacteria.

Dr. \ 25:14

So these things I just I just had some pickles today. Our administrative assistant, uh Brenda, who's so great, who's gotta be on this podcast soon about making appointments. She made homemade pickles. She gave me all the supplies to help my granddaughters make homemade pickles. And I really do think, yeah, the the fermented foods and the yogurt for those that don't have allergies or intolerances is so important.

SPEAKER_01 25:37

Yes, yes, yes. I mean, people will like and when you make it a habit, you will notice that you know, the bloating that you get, that um, you know, people complain about, the IBS, irregular bowel movements and all that will get better. I mean, you're really supporting the gut. And who who doesn't get an antibiotic here or there every few years for this infection or that infection? Remember, every time you get the antibiotic, yes, it's very helpful and it's a great invention. Get rid of the infection, it gets rid of the good bacteria as well. As well. Yeah, yeah. Good bacteria now, it sounds like they are doing way more than just being a bacteria. They are a hormonal organ.

Dr. \ 26:18

Yes. Yes, so an endocrine organ, yeah. Yeah, so uh the endocrinology fellowships and other fellowships are gonna have to expand to include being a gut microbiome expert, I believe, not just to the field of GI. And for our listeners, if if you haven't heard of our prior podcast on fatty liver, on irritable bowel syndrome, we're gonna have one in the future on fiber maxing, which is kind of like pretty popular. Um, but getting back to the peptides, and we had um a very interesting podcast with a functional medicine and obesity expert that uh posted a while back with um Dr. Tuma, and he um talked a lot about peptides. And one of the questions that I have with these compounded peptides, you know, because people in the past had a lot of trouble affording some of these medications, even if they needed it for diabetes or sleep apnea or obesity or PMOS, um, would go to these online compounded things. And I always worry about, well, if they're just adding B12, maybe that's okay. But if they're adding other things, and I almost wonder if they're adding other peptides as well, because I have some patients who say they're on these and they have like no joint pain or inflammation. And then other people still still do, or I'm wondering, maybe some people are better at fixing their diet than others. And now that some of the cost of these medicines through direct cost, I know that trumprx.gov, which is the government website to link people to infertility medicines, which are quite expensive, as well as some of these um uh GLPs. Um so I just was curious about your opinion. Has that really helped enough people? Do you want to just treat them metabolically before you recommend they get expensive? IVF and infertility, and are you discouraging your patients with compounding? But if that's the only way they can afford it, I'm just curious about um how you advise people.

SPEAKER_01 28:18

Yeah, absolutely. Absolutely. Well, uh I mean the thing is um uh I really still don't feel comfortable prescribing compound, and I I don't prescribe compound. Like I don't even know their dosing. Every place that makes compound GLP ones, they have their own dosing. And unfortunately, I'm gonna say this, Dr. Thacker. They abuse the their customers, meaning they yes, true, they this is how it works. So that yes, they sell for less, like you know, monthly, say, you know, half the brand price. However, I think what they're doing, and this is what I see in my patients, they microdose it quite a bit so they you know get you hooked up on the medicine for longer and paying more um on the longer term because I don't see the same benefit I see with the brand. And I'm really I nobody paid me, no brand paid me here. But this is an observation in my clinic that I see these patients, they tell me I am on like 0.1, 0.2, and I don't understand the dosing, I don't do it. But they are over like six months, they don't lose as much weight as the what you expect with someone on you know a very strong GLP1. So be careful. Like, yes, they might sell you something on the monthly rate, might be less, but it might not be as effective. They are really trying to microdose it to last longer, so you stay with them longer. And at the end of the day, you may be just paying the same amount that you would have paid for the brand. So I still like to say, and and the other good news that this is what I'm telling my patients this year, I am very happy and and excited um that now we have many options, and all these companies that make these medications have a self-pay option now for a quite reduced um uh amount. So, for instance, like with the instead of the pen, they offer a vial, which is still as good. It's a one-dose, uh, you know, uh one dose per vial, and it's very easy to administer, so but just you know, the technology of the pen, you know, it costs them more, so why not? Um we have now the the oral GLP ones. I mean, the oral GLP ones got approved January 2026, and they are priced very, very well and very reasonable for um for I would say many patients, for many, many patients. Yes, they are not great to hear. Yeah, they are not as strong or as effective as the injections. However, I tell many patients, you know, we can start with the pills. The study that got got the orals approved showed 11 to 15% weight loss. So we can start with them, get the most out of them, and then

Fermented Foods And Building Muscle

SPEAKER_01 30:55

switch to the injections that to get you 20-25% weight uh weight loss off. So that way you save some money being on the orals and then you switch to the injections. So that's a way to do it and get you know the brand and get the benefit, the most benefit out of the GLP one for sure. Uh you asked me about like something else. Um about uh what was the other thing about not the uh the infertility drugs.

Dr. \ 31:21

Like, isn't it better to try to treat the metabolic problem before just trying to treat the ovulatory problem for our infertility patients?

SPEAKER_01 31:28

Absolutely. So even in the international guidelines, as I said, they they stated clearly that you know treat these patients metabolically first, treat the obesity or the overweight first before doing any fertility, because we know now that you know getting the weight down, getting the periods regularly again, getting the PMOS under control have very positive um results. These patients, first of all, might become pregnant spontaneously. If not, they may need less medications, if not, they will have higher successful rate with IBF or other renal interventions. So, yes, some other countries they have a BMI cut off to refer the patient to the PMOS specialist before doing any fertility treatments. Oh, interesting. We don't in the US for many reasons, but but that's okay. Still, you know, our fertility doctors at the Cleveland Clinic, they do, you know, refer the patients to the PMOS clinic that we have at Women's Health to help these patients because to save them money as well. I mean, these treatments are very expensive, as you said. So it would be wise to wait six to twelve months, work on the um on the metabolic part, and then if needed, refer back to fertility.

Dr. \ 32:44

Yeah, and any women listening who think that they want a half a family, ovarian aging happens fast. And if you think you've got any metabolic problems, um it's better to get it taken care of sooner rather than later, even if you're not planning pregnancy, but really our fertility rates in the United States around the country have really just fallen off a cliff. And I mean, my family's trying to do their part. I'm expecting my sixth grandchild, my fourth granddaughter, in just a few weeks. I'm so excited by that. Um and I um in terms of though preventing pregnancy for people that are wanting to prevent pregnancy, is it true that it's just with uh terzepatide that has the warning of decreased oral uh hormonal contraceptive effects because of delayed gastric emptying, but the others don't have that warning? Is that right?

SPEAKER_01 33:38

Yes. So terzepatide is the only one that's got that warning. However, I still tell my patients on c magalotite, same thing. I mean, just because, you know. So so the patient should be aware of uh of that warning and should use some other way of birth control. So they don't have to start with film.

Dr. \ 33:57

IUD or maybe switching to like the once-a-year vaginal ring or patch that doesn't go through the gut and just gets right in the bloodstream. Right, yes, yes, because it's all at a stomach emptying level.

SPEAKER_01 34:11

Yes, yes. So, as we all know, you know, absorption of birth control is really time dependent. You have to take the pill at the same time. So if it's uh delayed absorption, ovulation could happen, and therefore pregnancy could happen. So, yes, we always talk about, you know, was it or using other physical barriers like condoms, stuff like that.

Dr. \ 34:30

So yes, absolutely. And uh I had a patient who I thought would be a really good candidate, and I was going to refer to endocrine metabolic weight management uh for chip

Compounded GLP-1 Concerns

Dr. \ 34:40

treatment, but she said that she had already talked about it, and since she had a father who had uh an anaplastic thyroid cancer, there, even though he was at advanced age, so there wasn't really anything else in the family history to suggest an inherited MEN syndrome, they just kind of summarily told her no.

SPEAKER_01 34:58

Yeah, absolutely. That's a great question. So the only cancer that we really need to worry about, or you know, the family history of a cancer is medullary thyroid cancer. And medullary thyroid cancer is special. So the cases of you know um just sporadic medullary thyroid cancer are rare. Mostly it comes in like a familial syndrome, as you said, Dr. Sacker. So these families they know they have a history, family history of medullary thyroid cancer. And that patient, I would be very, very, very careful in starting a GLP one on. By the way, medullary thyroid cancer is not the most common type of thyroid cancer. The most common type of thyroid cancer is papillary or follicular thyroid cancer. Most people who get thyroid cancer are their you know, parents or you know, siblings or cousins got thyroid cancer, it's mostly papillary or follicular, it's always good to check. These types of cancer has nothing have nothing to do with uh with GLP1. It's only the medullary thyroid cancer that I would be careful with. And careful doesn't necessarily mean you know an absolute no. It's a contraindication, yes, but these families, some of them, you know, they they are hooked up to cancer centers, they get screenings every year, they have you know special special uh treatment, but that doesn't apply to everybody else with, as I said, with the papillary or follicular. And then remember that study is about 20 uh years old. It was noted in rats that these medications can stimulate the medullary thyroid cancer in in people who are or in you know um uh lab uh animals that are that that carry the gene for medullary thyroid cancer, not in general population. So this is the only group of patients that I would be very careful with, but not the general population. For the your patient who had a father with amplastic, that doesn't apply. So she can take it. That's what I thought.

Dr. \ 36:58

That's why I sent her back for another opinion. What about these reports of vision loss, non-achemic vision loss with this class of medicines?

SPEAKER_01 37:08

Yeah, yes, this is very important. It came with Ozempic, to be honest with you, and it's extremely rare, so but it happens, and and and and it's uh it's very scary. Um, so I don't want this uh neon thing, it's called N-E-O-N-S or whatever, to you know, scare people of all the or make them shy away from all the great benefits of GLP1. It's extremely rare, extremely rare, and it only is reported with with uh semaglutide, with semaglutide. Nothing with their zepatite so far.

Dr. \ 37:42

So but yes, but I I do think the point that nothing is risk-free. And I just see so many women who still want their wine at night and they like to go out to eat, and they're maybe getting too many carbs,

Treat Metabolism Before Fertility Care

Dr. \ 37:55

and they still like to do their aerobics, but not do the weight training to build their muscle. And they're not reducing calories that you have to do with age because we all have a slower metabolism, and they just want that quick fix because their friends are on it. And so I think people with serious metabolic problems, bad genetic history, truly, you know, um, the metabolic, you know, derangements that have to be treated because they're high risk. They just haven't yet been diagnosed with heart disease or cancer, but all that stuff is percolating. That's a lot different than just the cosmesis aspect of it. And again, you know, adults can do what they want, you know, with their body. And I have lots of patients who want to have a lot of plastic surgery or other things that they don't have to necessarily have. Um, although some plastic surgery, like, you know, somebody reminded me, you know, you have to take the lift the skin up off the eyelids if you can't keep your eyes open. So I don't mean to minimize that. And we have great plastic surgeons who do incredible work, and I don't minimize the importance of people wanting to look good as well as feel good, but it is our responsibility as physicians to counsel and to know about all the risk-benefits. And usually anything that's just too simple is not necessarily, you know, no pain, no gain some of the time. So thank you so much for being on this podcast. Tell us how patients, if women, you know, reproductive age have PMOS, they're concerned about possible future fertility, but not, you know, and or thyroid disorders. How can people, um, women come see you?

SPEAKER_01 39:29

Yes, so I uh as you said, Dr. Sakar, I am uh available at the PCOS clinic or PMOS clinic, and it's purely just solely for PMOS patients. So I don't see any other endocrine uh problems in that clinic. It's dedicated for these women. We have a great program, great support. We have a um like a dietitian support, and we we created the PCOS diet book uh for

Contraception Thyroid And Vision Safety

SPEAKER_01 39:55

for um just for my patients. So when they see the dietitian, they go over the book itself and they get a copy of the book. We do have a Cleveland Clinic Exercise Physiology program, so we have great resources. We created this program to help these women, um, in addition to the medications for sure, to help them achieve their goals and get the PMOS under control. One last thing I want to mention when you said about you know taking it and not worrying about anything else, this is very dangerous, and we are trying to raise awareness that listen, GLP1 is not a you know an injection or a pill you take and you don't have to do anything about it. There is a huge amount of muscle loss that has been reported with these medications that we really need to talk about and address and and prevent and prevent. So it's not you really need to see a healthcare provider to to help you with these medications. Please don't get it over, you know, a um uh what they call it, anything spa. Spa, yeah, yeah, yeah. Online market, gray market, yeah. Yes, yes, beauty spa or whatever. Please see a healthcare uh personnel who can help you and guide you how to eat, how to exercise, not only to lose weight, but also to preserve your muscle mass. It's very important to prevent muscle mass.

Dr. \ 41:13

I understand that there's some trials with like some muscle uh inhibitors going on as well.

SPEAKER_01 41:19

Yes, yes. Very it's still not approved. I I read those studies. Very exciting. There's still a lot of side effects to these medications, but the results are very exciting. So for now, the only thing we know is eating enough protein and doing enough muscle strength exercise to prevent muscle loss will definitely keep you in the safe side.

Dr. \ 41:39

Well,

PMOS Clinic Support And Closing

Dr. \ 41:40

I'm gonna definitely take off this beautiful brocade, get in my exercise clothes and go lift some weights and have some fermented foods. This has been so great to talk to you. Thank you so much. And thanks to our listeners. If you enjoyed this, be sure to give us a five-star rating. Um, and if you don't already subscribe, hit the follow or collect button on your uh podcast app. And be sure to join us next week for another edition of Speaking of Women's Health. Remember, be strong, be healthy, and be in charge.