Clearly Hormonal

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Perimenopause is often missed because the most common symptom is vague (“I just don’t feel like myself”) and hormone tests can look normal. In this episode of Clearly Hormonal, Dr. Komal Patil-Sisodia walks through how perimenopause is actually recognized: from your age, your menstrual pattern, and your symptoms over time.

This is Episode 1 of our Menopause Awareness Month series.

In this episode you will learn

• Why a normal hormone result does not rule out perimenopause
• The three things Dr. Komal focuses on: age, periods, and symptoms
• How cycles differ in early and late perimenopause, using the STRAW+10 framework
• What can make perimenopause harder to recognize: birth control, hysterectomy, and PMOS (formerly PCOS)
• Why FSH and estradiol are a snapshot, and when blood tests do help
• Why pregnancy testing should be one of the first tests if you miss a period
• Four symptom groups: sleep, mood and thinking, physical comfort, and sexual and urinary health
• Other conditions to rule out: thyroid disease, anemia, sleep apnea or insomnia, medication effects, and worsening anxiety or depression
• What a useful perimenopause appointment includes, and how to prepare for it

Timestamps
00:00 | Could This Be Perimenopause?
01:06 | Why Labs Miss It
02:16 | Three Diagnosis Clues
03:45 | Cycle Changes Explained
04:49 | Early vs. Late Transition
06:36 | When Cycles Mislead
07:32 | Hormone Testing Myths
08:50 | When Bloodwork Helps
10:12 | Symptom Categories
11:53 | Rule Out Other Causes
13:02 | Differences Across Women
15:38 | What a Good Visit Includes
16:52 | Three Key Takeaways
17:26 | Prep for Your Appointment
18:17 | Series Wrap and Course Announcement

Course announcement
The PMOS Conversation You Deserve is Dr. Komal’s patient course on understanding PMOS and advocating for yourself in the doctor’s office. It includes three months of access plus a monthly live Q&A webinar with Dr. Komal. Introductory pricing runs through October 13, with regular pricing beginning October 14. Monthly webinar calls begin October 21, 2026. 

Details and enrollment: The Perimenopause Conversation You Deserve

Connect

• Instagram and TikTok: @drpatilsisodia
• Website: eastsidemm.com
• Questions about the course: send a message through the website or DM on social

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

About one in eight women lives with PMOS, polyendocrine metabolic ovarian syndrome, formerly called PCOS. It is one of the most common hormone conditions there is, and still one of the most misunderstood, by patients and by many clinicians.

In this final episode of September PMOS Awareness Month, Dr. Komal Patil-Sisodia explains why the name changed, why the condition is about far more than ovarian cysts, and why the metabolic and cardiovascular pieces so often get missed when a visit stays focused on periods, acne, or hair growth. She also shares what the data shows about diagnosis delays and disparities, and a piece of her own story.

Then she moves from the science to the practical: what to ask, what to track, and what to do when you raise a reasonable concern and do not get a useful answer. She introduces her new six-module course, The PMOS Conversation You Deserve, built to help you walk into your next appointment better informed and better prepared.

IN THIS EPISODE

• Why PMOS stands for polyendocrine metabolic ovarian syndrome, and why the change from PCOS was more than a rebrand
• How PMOS can show up across the lifespan, from adolescence through the reproductive years, perimenopause, and beyond
• The metabolic side of PMOS: insulin resistance, blood sugar, cholesterol, blood pressure, and long-term cardiovascular risk
• What one large international study found about diagnostic delays: about one in three women waited more than two years, and nearly half saw at least three healthcare professionals
• Disparities in who gets diagnosed, including findings in a safety net health system study for Black women and patients on Medicaid or charity care
• Why knowing the science is not the same as knowing how to use it in an appointment
• A first look at The PMOS Conversation You Deserve, including the pushback module, the workbook, and three months of live Q&A

TIMESTAMPS

00:00  Welcome to Clearly Hormonal

01:08  PMOS: Why It Matters

02:22  PMOS Name Change Explained

02:57  Symptoms and Lifespan Impact

04:04  Diagnosis Delays and Disparities

05:51  Turning Knowledge Into Care

07:17  Course: The Conversation You Deserve

08:53  Enrollment Dates and Details

09:45  Final Takeaways and Wrap Up

COURSE DATES

• Pre-order opens: October 7
• Introductory pricing through: October 13
• Regular price begins: October 14
• First live Q&A: October 21

LINKS AND RESOURCES

• The PMOS Conversation You Deserve (pre-order opens October 7): Sign up here to get on the list.
• Eastside Menopause & Metabolism: eastsidemm.com
• Follow Dr. Patil-Sisodia on Instagram and TikTok: @drpatilsisodia

DISCLAIMER

This podcast is for education and is not personalized medical advice. Please discuss what resonates with your own healthcare team.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

In the final episode of PMOS Awareness Month, I focus on something that does not get talked about enough: the mental health toll of PMOS and the harm caused by waiting years for a diagnosis. We walk through what weight-matched studies show about depression, anxiety, and eating disorders, why so many people carry these burdens long before anyone connects them to PMOS, and what real care should look like.

In this episode

• Why people with PMOS are about four times more likely to have depression and more than five times more likely to have anxiety
• Why a PMOS diagnosis often comes before a new diagnosis of depression, anxiety, or sleep problems
• How eating disorder risk rises with PMOS, and why it is not limited to larger bodies
• How years of scattered symptoms and "it is just stress" responses make things worse
• Why body image distress from visible symptoms is a real pathway to disordered eating
• What good care includes: screening at diagnosis, CBT as a first step, careful medication choices, treating physical symptoms, and mind-body approaches

Timestamps
00:00 Welcome to Clearly Hormonal

01:01 PMOS Series Finale Setup

02:04 Mental Health Stats in PMOS

03:24 Eating Disorders and PMOS

04:00 Why Diagnosis Takes Years

05:37 Body Image and Visible Symptoms

06:56 What Good Care Looks Like

08:50 What This Means for You

09:51 Series Wrap Up and Resources

11:02 PMOS Mini Course Announcement

Key numbers from the episode

• About 4 times more likely to have depression with PMOS, in weight-matched studies
• More than 5 times more likely to have anxiety with PMOS
• About 1 in 3 people with PMOS have moderate to severe depression; more than 4 in 10 have real anxiety symptoms; well under 15 percent without PMOS
• About 1.5 times more likely to have an eating disorder, with the biggest increases in binge eating disorder and bulimia

The full PMOS Awareness Month series

• Episode 1: What happens in PMOS after your childbearing years
• Episode 2: Why PMOS gets missed in people with a normal BMI (lean PMOS)
• Episode 3: Where GLP-1 medications fit into PMOS treatment
• Episode 4: PMOS and mental health (this episode)

A note on support

If anything in this episode brought up something personal for you, especially around food, body image, or how you have been feeling emotionally, please do not sit with that alone. Talk to your doctor or a mental health professional. If you are in crisis in the US, you can call or text 988 at any time.

Connect

• Instagram and TikTok: @drpatilsisodia
• eastsidemm.com

This episode is for education and is not a substitute for individual medical advice.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

Dr. Komal Patil-Sisodia, obesity advocate Michael Donnelly-Boylen, and Dr. Matthea Rentea explain why they withdrew from a planned ADA-hosted webinar in support of a broader boycott, after an ADA Scientific Sessions keynote by a MAHA representative and the removal of peacefully protesting scientists were followed by an organizational response the three of them found unsatisfying.

They still share the content they had planned to present: integrating peer and lived experience into obesity care, to address a trust gap driven by weight stigma, shaming language, and oversimplified messaging that can delay or derail care, including preventive screening and procedures. They talk through curiosity, person-first language, motivational interviewing, and acknowledging medical trauma, along with practical solutions such as moderated peer support groups, credible online resources, and comprehensive programs that combine lifestyle foundations, medications, bariatric pathways, and clinic infrastructure shaped by patient input.

Timestamps

00:00  Why This Episode Changed

00:47  ADA Boycott Context

02:15  Meet The Panel

03:26  Inside The Keynote Fallout

06:41  Protest And Conference Mood

10:01  Choosing To Withdraw

11:18  Webinar Topic And Roadmap

13:47  Trust Gap And Weight Stigma

18:37  Language That Builds Safety

23:23  Peer Support And Community

25:09  Social Media And Group Coaching

27:19  Why I Started Posting

28:43  Building a Comprehensive Program

30:32  Three Pathways of Care

33:32  Designing for Real Bodies

35:54  Practical Clinician Changes

37:48  Mountain Dew Lesson

41:30  Trauma and Safe Spaces

42:25  Peer Support Communities

44:20  Insurance and Advocacy

46:27  Fighting Wellness Misinformation

47:55  How to Build Support Groups

50:53  Wrap Up and Where to Find Us

Connect

Dr. Komal Patil-Sisodia: Instagram and TikTok @drpatilsisodia. Podcast: Clearly Hormonal.

Dr. Matthea Rentea: Instagram, TikTok, and YouTube. Podcast: The Obesity Guide with Matthea Rentea, MD, at renteaclinic.com.

Michael Donnelly-Boylen: Instagram and TikTok as Mike On A Mission. Podcast: Weight and Measure with Mike and Zach, at weightandmeasurepod.com.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

Dr. Komal Patil-Sisodia continues the PMOS Awareness Month series by walking through where GLP-1 medications, like semaglutide and tirzepatide, fit into PMOS treatment. She explains what GLP-1s actually do in the body, who is likely to benefit, who they are not built for, and why they are never a stand-alone treatment plan for PMOS.

In This Episode

• What a GLP-1 is and the three main effects these medications have on the body
• Why insulin resistance sits at the center of PMOS for so many patients, and how that connects to androgen levels and symptoms like acne and excess hair growth
• Who is the clearest fit for a GLP-1: patients with insulin resistance or higher body weight, and those who haven't seen enough improvement from metformin or lifestyle changes alone
• Who GLP-1s are not built for: lean PMOS patients without insulin resistance, and anyone trying to conceive soon
• Why GLP-1s only work well alongside lifestyle change, and the real risks of low protein and fiber intake while on these medications
• What a GLP-1 does not replace: ongoing metabolic monitoring, fertility treatment, and androgen-targeted treatments like birth control pills or spironolactone
• The four questions Dr. Patil-Sisodia asks herself before recommending a GLP-1 for a PMOS patient

Timestamps

• 00:00 Podcast Intro
• 01:01 Series Setup
• 02:13 GLP-1 Basics
• 02:45 Why It Matters
• 03:28 Who Benefits
• 04:32 Who Should Avoid
• 05:27 Lifestyle and Safety
• 06:15 What GLP-1s Don't Replace
• 07:40 How I Decide
• 08:29 Wrap Up and Next Week
• 09:36 Mini Course Promo

Links Mentioned

• Newsletter sign-up: eastsidemm.com/newsletter
• Follow Dr. Patil-Sisodia: @drpatilsisodia on Instagram and TikTok

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

Many people picture PMOS (polyendocrine metabolic ovarian syndrome, formerly known as PCOS) as a condition tied to weight gain. But the diagnostic criteria never mention body size at all, and a significant number of people with PMOS have a completely normal BMI. In part two of our PMOS Awareness series, Dr. Patil-Sisodia breaks down “lean PMOS”: what it looks like, why it is so often missed, and why the metabolic risk is just as real even when the outside doesn't show it.

In This Episode

• Why PMOS became associated with a specific body type, and why that picture was never the diagnosis itself
• The three actual diagnostic criteria: irregular or anovulatory cycles, elevated androgens (DHEAS, testosterone), and polycystic ovarian morphology on ultrasound
• What lean PMOS symptoms look like: irregular periods, acne, facial and body hair growth, scalp thinning
• “Normal weight obesity”: how insulin resistance and visceral fat can hide behind a normal-looking exterior
• The three-part pattern that causes lean PMOS to slip through the cracks in clinical practice
• Why an undiagnosed lean PMOS patient loses out on cardiometabolic monitoring, not just a menstrual explanation
• What needs to change: for clinicians, dropping body size as a screening filter; for patients, presenting symptoms as a pattern instead of one at a time

Timestamps

00:00 | Welcome to Clearly Hormonal
01:01 | Series Setup: Lean PMOS
02:09 | Why PMOS Has a Body Type
02:42 | Diagnosis Criteria, Not Weight
03:39 | Lean PMOS Symptoms
04:05 | Hidden Insulin Resistance
05:01 | Why Lean PMOS Gets Missed
06:51 | Why Diagnosis Matters
08:05 | What Should Change
09:24 | Wrap Up and Next Week
10:03 | Mini Course Announcement

Coming up next week: Episode three of the series looks at treatment, including where GLP-1 medications and other weight management tools fit into PMOS care, and who they actually make sense for.

Sign up for the newsletter at eastsidemm.com/newsletter, and follow along on Instagram or TikTok @drpatilsisodia.

This podcast is for education, not personalized medical advice. Please discuss anything you hear here with your own healthcare team.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

PMOS Awareness Month kicks off with a reframe: PMOS is not a condition that resolves once your cycles regulate or once you're done having kids. It is a lifelong cardiometabolic condition that happens to announce itself first through reproductive symptoms. Dr. Komal Patil-Sisodia walks through the three diagnostic criteria (irregular periods, high androgens, and polycystic ovarian morphology) and explains why the biology underneath, insulin resistance, visceral fat, and unfavorable cholesterol, persists even when periods look normal. She unpacks what worsens in perimenopause, the clinical blind spot that causes PMOS histories to get dropped from the chart, and what she actually changes in her own practice: earlier and trend-based lab monitoring, a shift in treatment goals from fertility to long-term metabolic and heart protection, and more individualized hormone therapy decisions.

In This Episode

• Why the three PMOS diagnostic criteria are not the whole disease
• The underlying biology: insulin resistance, visceral fat, and cholesterol changes that often start in the teenage years
• What worsens at perimenopause: insulin resistance, LDL and triglycerides, and belly fat
• The missed clinical question that keeps PMOS histories from shaping midlife care
• Why 20+ years of a less favorable metabolic starting point matters for heart disease risk
• What changes in practice: trend-based monitoring, shifting treatment goals, and individualized hormone therapy
• A preview of the rest of the PMOS Awareness Month series

Timestamps

• 00:00 — Welcome to Clearly Hormonal
• 01:03 — PMOS Beyond Fertility
• 02:14 — PMOS Is Lifelong
• 04:05 — Perimenopause Metabolic Shifts
• 06:17 — The Missed Clinical Question
• 07:52 — Heart Risk Over Decades
• 09:38 — What To Do In Practice
• 11:34 — Key Takeaways & Next Episodes
• 12:46 — Mini Course Invitation

Coming Up in This Series

• Episode 2 — Lean PMOS (sometimes called "skinny PMOS") and why it gets missed
• Episode 3 — Where GLP-1s and other weight management tools fit into PMOS care
• Episode 4 — The long road to diagnosis and its toll on mental health

Links

• Join the email list for the PMOS mini-course: eastsidemm.com/newsletter

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

On Women's Equality Day, host Dr. Komal Patil-Sisodia revisits an idea from an early episode of Clearly Hormonal: the menopause penalty, the disproportionate income loss, leadership attrition, and career disruption that midlife women face. This episode goes past the data to ask what it actually feels like to lead through sleep disruption, cognitive overload, and hormonal change while carrying the weight of an executive role.

Guest Dr. Brooke Buckley traces her path from a punishing early surgical practice through hospital operations, an MBA negotiated into her first CMO contract, and a system-level leadership role she stepped into during the pandemic. She speaks candidly about infertility and loss, being the only woman in her surgical residency class, and the coaching and community that carried her through. The conversation moves into trauma-informed leadership, why physiology cannot be negotiated away, and the hard pivot Buckley made in walking away from the operating room to protect her own health.

00:00  Why Equality Still Lags

01:48  The Menopause Penalty

02:34  Meet Dr. Brooke Buckley

04:04  From Surgeon to Executive

07:32  Lessons From Organized Medicine

11:44  Midlife Friction and Storytelling

15:13  Boundaries as Superpower

18:07  Leading Through the Pandemic

21:29  Community, Coaching, and Accountability

27:20  Trauma-Informed Leadership

32:07  AI, Physiology, and the Future of Work

35:05  Hard Pivots and Closing Takeaways

Dr. Brooke Buckley is a board-certified general surgeon and physician executive, board-certified in lifestyle medicine, and currently serves as System Vice President of Medical Affairs for Henry Ford Health. She previously served as chief medical officer and holds an MBA from Johns Hopkins. She has held national leadership roles with the American Hospital Association and The Joint Commission and is a widely followed voice on physician wellness, trauma-informed leadership, and healthcare system transformation.

Instagram: play_your_story

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

Two women get the same diagnosis, PMOS (formerly known as PCOS), and end up with completely different symptoms. One has irregular periods, acne, and high androgens. The other has none of that, just an ultrasound finding. How can that be the same condition?

In this episode, Dr. Komal Patil-Sisodia breaks down the Rotterdam criteria, the three features used to diagnose PMOS, and explains why you only need two of the three to qualify. That single fact is the reason PMOS shows up as four distinct phenotypes (A, B, C, and D), each with its own symptom pattern and metabolic risk profile.

You'll learn:

• What hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology actually mean (without the jargon)
• The four PMOS phenotypes and which one carries the highest, and lowest, metabolic risk
• Why insulin resistance, not BMI, may be the real driver of your risk
• Why phenotype D ("the mild one") still deserves your attention
• Three questions to bring to your next appointment to get more personalized care

Whether you were diagnosed years ago or are newly navigating a PMOS diagnosis, this episode gives you language to better understand your own body, and better questions to ask the people caring for it.

Audio Stamps:

00:00 Welcome to Clearly Hormonal
01:03 Why PMOS Looks Different
02:43 Rotterdam Criteria Explained
05:15 Phenotype A: Full House
06:03 Phenotypes B Through D
08:27 Why Phenotype Matters
11:00 Phenotype D Still Counts
12:44 Three Takeaways and Next Steps
14:39 Recap and Final Message

This podcast is for educational purposes only and is not a substitute for personalized medical advice. Please discuss your own care with your healthcare team.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.

📱 Send Us a Text Message! We’d love to hear from you! Please include your name and email address so we can reply. Don’t worry — this won’t sign you up for our email list. We’ll only use your info to respond to your question.

Perimenopause is having a cultural moment, and endocrinologist Dr. Komal Patil-Sisodia is glad it is, but in this launch episode of Clearly Hormonal, she pushes back on social media's habit of attributing nearly any midlife symptom to hormones. She defines perimenopause as the years leading up to menopause (recognized after 12 months without a period, average age ~51) and explains that it's marked by hormonal variability, not simply “low estrogen,” with menstrual-cycle changes serving as an important clinical clue.

She walks through why most women don't need single-point hormone testing, since levels fluctuate day to day, per current ACOG guidance. Using a composite patient example (“Jen”), she shows how fatigue, sleep issues, hair loss, and weight gain may reflect iron deficiency, thyroid disease, sleep apnea, nutrition, stress, medications, or life changes, not hormones by default.

She closes with a four-question framework for sorting it out: where you are in the reproductive transition, whether a symptom is plausibly related to it, what else could explain it, and whether treating perimenopause would actually help. Taking symptoms seriously, she argues, requires evidence and continued curiosity, not a single convenient explanation.

Timestamps

00:00  Welcome to Clearly Hormonal

01:03  Perimenopause Everywhere

01:32  Why Nuance Matters

03:24  How Social Media Shaped It

05:22  Defining Perimenopause

07:51  Hormone Testing Reality

09:29  Patient Example: Jen

11:51  Fatigue and Weight Gain

13:58  Brain Fog and Mood

15:35  Hair, Sleep, Libido, Joints

18:54  When “It's Just Perimenopause” Becomes a Problem

21:38  The Four-Question Framework

23:33  Key Takeaways and Invite

25:26  Quick Question: 3 AM Wakeups

Key Takeaways

• Perimenopause is hormonal variability, not simply low estrogen: levels fluctuate rather than steadily decline in the early transition.
• Menopause is recognized after 12 consecutive months without a period; average age in the U.S. is around 51.
• Most women don't need a single hormone test to identify perimenopause: age, symptoms, and menstrual changes usually tell us more (ACOG).
• Common midlife symptoms (fatigue, weight change, hair loss, brain fog, mood shifts, low libido, joint pain) can have multiple causes beyond hormones.
• The four-question framework: (1) Where am I in the reproductive transition? (2) Is this symptom plausibly related to perimenopause? (3) Is there another explanation to consider? (4) Would treating perimenopause actually improve it?
• Taking a symptom seriously and attributing it to hormones by default are not the same thing.

Resources & Links

• ACOG: Do I need to have testing of my hormone levels during perimenopause? (acog.org)
• Follow along: Instagram & TikTok @drpatilsisodia
• Got a question for “Is This Actually Hormonal?”: DM @drpatilsisodia or send a note through the show's fan mail link.

Thanks for listening. Find more info about Clearly Hormonal on the website or Instagram.