Weight Gain During Menopause With Dr. Komal Patil-Sisodia, MD

Dr. Komal Patil-Sisodia is a triple board certified endocrinologist & women's health specialist based out of Washington state.

Website: eastsidemm.com
Instagram: @drpatilsisodia
TikTok: @dr-komal-patil-sisodia

Menopause symptom questionnaire: Greene Climacteric Scale 

Menopause is a single moment on the calendar, but the real story is the long runway leading up to it and the way your whole body can change while your lab work still looks “fine.” We sit down with triple board certified endocrinologist and women’s health specialist Dr. Komal Patil-Sisodia to define menopause, perimenopause, and post-menopause in plain language, then connect the dots to what so many women actually feel: unpredictable cycles, shifting mood, sleep problems, brain fog, palpitations, vaginal dryness, recurrent UTIs, and even joint and muscle changes that can show up in midlife.

We also tackle the elephant in the room: why hormone replacement therapy became so controversial after the Women’s Health Initiative and how the headlines shaped two decades of care. Instead of absolutes, we focus on nuance and shared decision making, including why symptom relief is the primary goal, how to think about risk, and why the route of estrogen matters when discussing blood clot concerns.

Finally, we get practical about metabolic health and weight management. HRT is not a weight loss drug, but it may help body composition in some women and there’s emerging research on pairing menopause hormone therapy with GLP-1 medications like tirzepatide for improved outcomes. If you’re navigating PCOS, prediabetes, diabetes, or obesity in perimenopause, you’ll hear why individualized care beats blanket advice and how to advocate for the support you deserve.

Subscribe, share this with a friend who needs it, and leave a review so more women can find evidence-based menopause and metabolic health guidance.

👩🏼‍⚕️ Live in Missouri? Want to be my patient?
Telehealth clinic: https://missourimetabolichealth.com

🥑 Have questions you want answered on the podcast? Email support@missourimetabolichealth.com

✨Freebies✨
Anti-Obesity Medication Options
How To Prevent Diabetes
Healthy Habits Workbook
Preventative Health Checklist

🤗 Socials:
Instagram: https://www.instagram.com/dr.lindsayogle/
TikTok: https://www.tiktok.com/@dr..lindsay.ogle?_t=8prC4VUQZ5i&_r=1

YouTube: https://www.youtube.com/channel/UCMV0X6U0JLZgRMiNwGtmpeg

Transcript

Dr. Lindsay Ogle, MD 0:00

Welcome

Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD 0:01

to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Olge, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. Welcome to Metabolic Health with Dr. Lindsay Olgill. I am so excited about my guest today. I have already learned so much from her. She has a podcast, Reset Recharge, which covers all things women's health. Today I'm talking to Dr. Komal Patil Sasodia. She's a triple board certified endocrinologist and women's health specialist based in the state of Washington. Today we're going to discuss menopause and what it is and how it impacts weight management. So welcome, Dr. Patil Sasodia.

Speaker 1:18

Thank you so much, Dr. Ogle, for having me. This has been, I've just really truly enjoyed getting to know you. And I really appreciate you being on my podcast several months ago and you reaching out for that. I think it's great to cultivate a community of physicians who are invested in helping patients with overweight and obesity. You know that I have an obesity medicine background as well. And then this next step in my work towards helping women as they hit that midlife struggle of hormones and potentially have their metabolic disease worsen has been a passion project of mine. So I just really appreciate the time today to chat with you and your listeners.

Dr. Lindsay Ogle, MD 1:57

Yeah, thank you for being here. And it's been so fun to collaborate with other health professionals and different fields and aspects of medicine and learn from each other so we can better serve our patients. So I appreciate you sharing your knowledge as well. But let's go ahead and get

What Menopause Really Means

Dr. Lindsay Ogle, MD 2:13

started. What is the definition of menopause and what's actually happening hormonally?

Speaker 2:19

Yeah, that's a great question. So menopause is defined as your last menstrual period, meaning the last one that you will ever have. And a lot of times, women, if they once they stop cycling, we've traditionally defined it that you don't have a menstrual cycle for a year, right? And sometimes as you're going into menopause, they can kind of come in fits and bursts at the end, like three months apart, then six months apart, then nothing for nine months, then another one, right? And it's kind of that area where people get a little bit confused. But what's really interesting is the time period that starts before that, which is perimenopause. And that is where the body is just kind of going into hormonal chaos. So in a female body, females are born with a set number of eggs in their ovaries, right? So when we are conceived, we have millions of eggs in our ovaries. By the time we're born, it's down to a million. By the time we hit puberty, it's down to half a million. By the time we're ready to have kids, it's down to like two, three hundred thousand, depending on the person, right? There are some people who are uh what we call super fertile and they can have babies well into their 40s and even their 50s, but the most of us, the average amount of us, will see our fertility tract start to decline somewhere between 35 and 40, right? And if you think about how the ovaries function, when they release an egg, they are also being signaled by the brain to release estrogen and progesterone in order to prepare the uterine lining in case an egg gets fertilized and it can attach. And then if a fertilized egg doesn't attach, how to clean out the uterine lining so it doesn't just build up over time, right? And the cleaning out of that uterine lining is the menstrual period. So when you hit that period five to 10 years before your final menstrual period, which is menopause, you are in the state called perimenopause. And that is where the levels of your hormones are kind of doing this erratically, but still kind of on the decline. And that's because you're running out of eggs, right? And the ovaries are desperate to try and biologically put out as many possible for you to potentially get pregnant. So I think one of the things that women don't realize is during that time period you can also get pregnant. And it is um chaotic at best. I think that's what people are calling it now hormonal chaos. And so that that's how I define menopause. And then the period before it is perimenopause. And a year after you've had your final period, you're officially into post-menopause.

Dr. Lindsay Ogle, MD 4:45

Yeah, thank you for going over that in those distinct periods. Well, I guess they're not necessarily distinct because there's a lot, it's a transition period. And I really have noticed a lot more attention being played to that perimenopause portion of that transition. And I would just love kind of your insight on how us as a medical community and even society have changed our approach and our thought of perimenopause and menopause, um, just I guess what it is and how we should approach treatment and managing the symptoms that come with it.

Speaker 5:21

I

Hormone Therapy Fears And The WHI

Speaker 5:22

think that's a great question. And I think it's in process, right? If you look back to the early 2000s, we had the women's health initiative come out. And while that study was extremely well intentioned, it was not particularly done well. And the reason I say that is that when we look at the natural history of aging in women, we see chronic illness start to increase in that perimenopausal period as the hormone levels are declining. In that particular study, what they were looking to prove was whether hormone therapy decreased heart disease. But the average age of women in that study was 63. That's really far outside of that range of 40 to 55, right? Where, in my opinion, as an endocrinologist, if you're going to treat something to try for prevention, younger is probably a little bit better. That has yet to be proven in studies, but logic and all other things kind of lead to that, right? And so if you look at the Women's Health Initiative study, they they um recruited women age 50 to 79 into that study, which is a huge span. And when they initially released the results, there were two arms in the study. There were people who were on estrogen and progesterone, which um makes sense because if you have a uterus, you absolutely need to protect it. You can't give estrogen alone because that increases the risk of endometrial cancer. Um, and then in the women who'd had a hysterectomy, they were on estrogen alone because you can do that and you don't have to take the progesterone. What they saw were the adverse effects were in the estrogen plus progesterone arm of that study. And what they saw was the estrogen-only arm actually showed benefit in women, right? Where there was actually a decreased risk of breast cancer, decreased risk of heart disease, decreased risk of stroke, especially in that age group of 50 to 59 compared to the older women who were like 60 to 79. But unfortunately, initially when the study was released, everybody freaked out about the estrogen plus progesterone arm, and it was like, oh, hormones are bad. No hormones for anybody, hormones cause cancer, heart disease, blah, blah, blah, blah, blah. And I actually did this for one of my podcast episodes. I pulled the media headlines from that time and they're so inflammatory, right? It's like kind of a masterclass study in what media looks like. Well, May of last year, the original investigators of the Women's Health Initiative actually went back and looked at the data and put out a statement that said, you know, we may have been rash in our condemnation of hormones. They didn't say that exactly, but that was my understanding of the subtext. Still shouldn't be used to prevent coronary artery disease, but should be used to treat menopausal symptoms, right? And unfortunately, the way the study was released the first time, we just yanked women off of hormones, right? And it's really sad because you just saw women suffer for two decades. The medical profession as a whole just became a bunch of ostriches, right? Like everybody stuck their heads in and then nobody was paying attention to what was happening around them. And I think now what we're seeing is one, there are more women in medicine. And now having more women in practice in the practice of medicine, a lot of us are hitting middle age and thinking, good lord, this cannot be the best it's ever going to be. There has to be a different answer. We can't continue to suffer through this and then continue to perform and be able to take care of our patients. So I think that that mindset has been shifting uh for some time. Unfortunately, for almost two decades, we had a generation of women just suffer and not be offered anything, right? So I think a lot of us feel a lot of sadness and guilt around the fact that we were not able to help that generation of women, but we're coming out swinging and wanting to shift that approach to women in the future. Now we have to be careful and we have to be a little balanced because there's still not a ton of studies out there for women. Women were not included in medical research since until 1993, right? So even the data we do have is pretty limited to the last 30 years. Um, and I think unfortunately, menopause hormone therapy by some people is being touted as like a silver bullet, a magic cure all. And that's not the case, especially when you are struggling with pre-existing metabolic disease. As an endocrinologist, I see a lot of women who come in to see me and they have PCOS, prediabetes, diabetes, and the way that their bodies shift in menopause and what happens to their metabolic disease is different than the average woman who does not have any of those conditions, right? So I think putting a blanket statement over something is not going to be good for all patients, and we really do have to look at it from a nuanced lens, right? You see a lot of people who struggle with overweight and obesity, which are metabolic diseases, right? And these things have the potential to get worse when women hit that midlife period. Um, and then women who've never had it before have the potential to potentially develop some degree of metabolic disease. So I think the good news is to answer, sorry, that was a long-winded answer. Um in short, we are getting, we are becoming more open to the option of giving women hormones, giving them autonomy over their bodies to make that choice for themselves, right? Um, even now there is conversation around long-term breast cancer survivors and whether they should be able to get hormone therapy for relief of their menopausal symptoms, right? And a lot of times it's just been deny, absolutely not. And I heard somebody say, and I can't, I wish I could remember who it was. In doing no harm, we've inadvertently done a subset of women some harm, right? And that that I think we have to keep at the forefront of our minds is that patients should have the choice to, you know, should be able to choose with a shared decision-making visit with their physician on what is going to be the best thing for them, what are the risks, benefits, when do we pull the plug on something if it's not working and it's actually causing harm. But if we never give women that option, we're not really doing them a whole lot of good.

Dr. Lindsay Ogle, MD 11:31

Yeah. That was a lot of information, but I really do appreciate all of it because I think it's all very important. Because I do think with those like absolutes that were going on prior with menopausal care, that it caused a lot of frustration and confusion too. I think for patients to yeah, be given hormone replacement and then all of a sudden be told, no, it's dangerous, you can't have it, and then now to be offered it again for you know the next generation right now. Um, and then that can cause a lot of mistrust in the medical system. So I think it's really important to explain why those decisions were made and what the thought process was underneath it, and for us to be humble and share that um that experience and what actually happened. Um, and some of that mistrust can lead to a lot of misinformation online. And I think that that's why both of us have taken the time to do videos and podcasts and be on social media to share this information so more people can be aware of the evidence that we have now and the options that are available. And I'm a huge fan of shared decision making with my patients. And I think that that's really important because um what is right for one person is not going to be right for the other. And so having that experience, especially for you being an endocrinologist, obesity medicine, um, women's health specialist with menopause specialists, to bring all of that knowledge to bring in those different aspects of somebody's medical care and then to create an individualized plan for them is so special and so important and powerful and really helping women. So um I do appreciate all of that that you shared.

Speaker 13:26

And I think it's I know it's a lot of backstory in context, but I think people need to hear it. Otherwise, it's just like little silos of information, right?

Symptoms From Head To Toe

Dr. Lindsay Ogle, MD 13:37

Right, right, absolutely. And I do want to touch on, I guess, why one of the main reasons we use hormone replacement, right? It's not everybody doesn't need it. Correct. The goal of it is to control symptoms of peripheropause and postmenopause. So what sorts of symptoms should women or can women expect during this period? And what may be helped with hormone replacement therapy?

Speaker 14:07

That's a great question. So, first and foremost, I want to say that 80% of women will have symptoms related to menopause, right? So that is a big chunk of the female population, right? There are 20% of women who barely feel anything, and I'm so happy for them, right? That group may not necessarily need it, or they may not be educated that they're actually having symptoms, right? Because we traditionally talk about the ones that are in the media, the hot flashes, the night sweats, the mood changes, the genito-urinary syndrome, even that has not really been played up as well. But, you know, pain with sex, vaginal dryness, increased frequency of UTIs, those are the major ones that get touted. But we have estrogen receptors everywhere in our body from head to toe, right? So if you just go organ system by organ system, you will find symptoms that pop up, like the brain fog, the um issues with memory, the um just feeling fatigued and tired, right? Like those are all neurotype symptoms. There can also be paresthesias in the body where you get numbness and tingling or parts of your body are going numb, um, especially your hands and feet. I've had a few women tell me that their skin changes, right? It gets dry, they get itching all over or itching in their ears. I mean, there are so many little nuanced symptoms, palpitations. The number of patients that our cardiologists see that are middle-aged women who go in with palpitations, it's it's a pretty big amount, right? And then you think of the psychological impact of these, uh, this lack of hormones. So underlying anxiety and depression can get worse, the mood changes and the irritability can be there, women can start having panic attacks. You feel kind of like you're just coming unglued, right? And that is a really hard thing to deal with. Um, Dr. Vonda Wright also wrote this amazing paper last year, I think it came out, called The Musculoskeletal Syndrome of Menopause, where she talks about the impact on the joints and on the muscles. And uh, you know, frozen shoulder is a common thing that women struggle with in midlife. They were just told, oh, yeah, there's no fix for it, go to PT. A lot of times it can get better with HRT if that is truly what the cause is, right? And sleep apnea, difficulty with sleeping, um, all of these things can contribute to symptoms. And it may not be the most obvious because, again, we're so genetically diverse, right? Your menopause is not going to look like my menopause, it's not gonna look like the menopause of the next lady walking down the street because our genetic backgrounds are different. And one of the things that I've observed as an endocrinologist is that when women start hitting midlife, whatever is coded in their genetics starts coming out medically, right? You can do all the lifestyle things and optimize everything you can, but at some point we reach a point where we can't necessarily outrun our genetics and things will start to manifest, right? And you and I as physicians know that that's why we have science, that's why we have medicine, that's why we have all of these life-saving treatments. Because if we just let things go quote unquote naturally, everybody would eventually get sick with hypertension, high cholesterol, prediabetes, heart disease, stroke, right? These are that's kind of like the natural selection order of these things. But if we have all of these tools at our disposal, we should be using them in a goal-directed way to help patients get better, right? So again, the symptoms can be varied. There is a great tool online, uh, it's the only validated tool we really have right now for assessment of menopause symptoms. It's called the Green Climacteric Skill. And it is 21 questions that go through a variety of different symptoms that are divided up into like uh psychological, vasomotor, physical, and then there's one question at the end about libido for sexual health. And for each of those questions, you answer none, mild, moderate, or severe, and you get zero, one, two, or three points, right? So it's graded out of 63. And if you have a score of 12 to 15 in that range over 63, you're symptomatic from perimenopause or menopause, right? And you can talk to your doctor to talk about whether treatment would be helpful. And the thing I like about the scale is that after you start somebody on hormone therapy, you can use it to reassess, see what gets better and what doesn't, right? And what doesn't get better may not be due to menopause and may require some additional investigation or may just require a dose adjustment, right? So these are the conversations and the shared decision making that you have to keep having with patients. But to answer your question, there I think there are a total of 80 symptoms of menopause, right? How are we ever going to track that, right? And so many women, when they go in and they're like, well, I want my hormones checked, your hormones are gonna be normal for as long as you're cycling. It's not until a year after menopause that they're actually low enough for us to call it menopause. And that makes it much harder, right? Because women will go and say, Hi, I want to get my labs done, get their labs done, labs will look normal, they're still having all these symptoms, but they're told they're fine and to go on their way. So this is one of those conditions in medicine where the numbers in that perimenopause period don't matter as much as the symptoms do, which is kind of a paradox for how we practice, right? Like when I think about treating thyroid disease, I'm looking at lab tests and my patient's symptoms, but also to make sure the lab tests are in a range that's been justified by studies. We don't have that for women in perimenopause.

Dr. Lindsay Ogle, MD 19:47

Yeah, I think that's such an important point to titrate the dosing and whether you are even on medication or not based on your symptoms. That is our absolute goal rather than that lab number. And it's definitely not something that we need to continue to repeat those labs and monitor and see how they're responding. We want to know how you're feeling um on the treatment. So it's really important. So thank you for sharing that. Oh, of course. Yeah, and I'll include um a link to um a copy of that checklist so people can read.

Speaker 20:21

Yeah, I'll send it over to you.

Dr. Lindsay Ogle, MD 20:22

Oh, thank you so much.

Speaker 20:23

Yeah.

Dr. Lindsay Ogle, MD 20:24

Um,

HRT And Weight Loss Reality

Dr. Lindsay Ogle, MD 20:25

I know a lot of people are going to be wondering will hormone replacement therapy, HRT, help with weight management or weight loss? What are your thoughts?

Speaker 20:35

So I think the data is pretty clear on this, right? They have looked at menopause hormone therapy in women who struggle with overweight and obesity as an intervention by itself. And while it may help with body recomposition, it does not result in substantial weight loss, right? And I think it's important for women to understand that in that period where your hormone levels are declining, your body is trying to produce estrogen itself. And it does so by having you gain fat mass because fat tissue produces estrogen. And as the ovaries are decreasing their production, the body's like, hey, we still want estrogen. And like, how do we make that happen? It's by it's by holding on to fat, right? And as the estrogen from the ovaries is declining, it also makes it harder for us to hold on to muscle mass. So you get this shift in body composition. What menopause hormone therapy can do is it's shown modest improvements in that body composition where you hold on to your muscle a little bit better. You may not gain as much visceral fat, but it doesn't result in weight loss per se, right? And I don't think there are studies yet that show that it impacts metabolic disease. There was one that was going around for a little bit talking about, oh, well, you know, prediabetes is reduced in progression to type 2 diabetes by 30% if women are put on hormone therapy. And that's a great claim. And I was like, I don't even have meds that that do. That for diabetes, I went and I read the study. The majority of women that it worked for were BMI less than 25 Caucasian women. Does not address the rest of our high-risk ethnicities who are at a higher BMI, right? And so you can't take a study like that and apply it blanket statement to all these women, right? In a certain subset of women, it can help, but it's not going to help everybody. And so I think that that's important to note and have that, again, have that conversation. But there's interesting data now that shows menopause hormone therapy when it's given with a GLP1 agonist. I think the most recent study that came out was in turzepitide, actually shows improved weight loss compared to terzepatite alone. And that to me is very, very interesting because for the longest time, women who struggle with overweight and obesity have been denied hormones because they're like, oh, they're going to cause blood clots for you. Well, we have options that don't do that. Transdermal estrogen compared to oral estrogen does not increase the risk of blood clots. Oral estrogen does because it gets processed through the liver. The transdermal does not. So there was a world menopause society. Um, oh my gosh, I'm I'm blanking on the name of it. There was a uh conference where they talked about this ad nauseum for for like three or four different lectures. And the consensus was you have to treat the overweight and obesity, and you have to treat the menopause in order for women to have to hit their weight loss goals. And so, you know, I I think menopause hormone therapy by itself, mild benefit combined with a GLP one, it's much better.

Dr. Lindsay Ogle, MD 23:40

Thank you for going over that.

Speaker 23:42

Yeah.

Dr. Lindsay Ogle, MD 23:43

And I can't even tell you how much gold is in this conversation. I learned a lot, and I know a lot of people are going to love this conversation and probably are going to have follow-up questions or want to learn more from you. Um I would love to hear if you have any last comments. And then how can people find you if they want to learn more or if they're in Washington, if they would like you to be their doctor?

Finding Care And Advocating For Yourself

Speaker 24:10

Oh, well, thank you. Yes. So I I just want to put out there that as kind of some last comments to women, do not ignore your symptoms, right? We've spent the last two decades being told by the medical system that there's nothing wrong when really truly there is. And it was because of that study that, you know, unfortunately drew some conclusions that were not in the benefit of women, right? Um, so don't hesitate to speak up. If you are feeling like you're not being heard by a physician or healthcare provider, it's okay to go seek help elsewhere, right? There, if you look on menopause.org, there are a bunch of healthcare providers who are certified in menopause care, and you can find somebody in your area. So menopause.org is a really great resource. Um, I am located in Redmond, Washington. I have a practice called Eastside Menopause and Metabolism, where this is kind of my uh sole purpose, I feel, to help women navigate that period of metabolic disease getting worse in perimenopause and menopause, and trying to give them the best quality and disease-free years that we can going into the future because all of us deserve to have a good quality of life. Um, for me, it's very personal because when I was in high school, my mom had, I think it was my senior year of high school, she had an 80% blockage in her uh coronary artery and could not get diagnosed. There's so many layers to it. But one of the things I found out later when I started to hit perimenopause was my mom actually had a hysterectomy in her 30s and nobody ever checked up on her after. And Southeast Asian women will go through perimenopause and menopause on order like five years earlier than other ethnicities. And when you layer that with a hysterectomy, um, a hysterectomy, even if you leave the ovaries behind, will put you into menopause earlier as well. I can't shake the thought in my head that the two are probably related and how that one event of having to have open heart surgery at 42 has changed the trajectory of her life and the quality of her life. And I wish there had been somebody to advocate. So, my goal is to be that advocate for women and make sure that they're getting the help that they need because I want everybody to be enjoying all of the things that they've worked hard for, right? Family events, um, being able to go on the trips that you want to go on, just being able to live. We are given such a short time on this earth, it shouldn't be spent in suffering. So that's that's my that's about me and my practice. And you can find more information on my website at esidemm.com. I also have a podcast on Apple Podcasts and Spotify called Reset Recharge, which I think you mentioned at the beginning. And uh that also has ways to to get in touch with me. But thank you so much again, Dr. Ogle. This was such a pleasure.

Dr. Lindsay Ogle, MD 27:12

Yeah, well, thank you so much for being here and sharing all of your wonderful knowledge and your personal story. I really appreciate it. And I definitely recommend checking out everyone should follow your podcast, follow you on Instagram, TikToks. You share so much great information on there.

Speaker 27:30

Thank you.

Dr. Lindsay Ogle, MD 27:31

Um, I like I said, I've learned a lot um from you, and I just appreciate the time that you've taken today. So thanks again. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.