Welcome to another section of DocScopy, let us walk through the life and professional journey of Dr. Mitali Rathod. MedBound Times (Parul Soni and Darshana Rane) were in luck to get an opportunity to have an educational and enlightening conversation with Dr. Uterus as she is popularly known. She looks like a young and delicate person but in a short span of her career, she has conducted 5000 plus safe childbirths. As we say "Good things come in small packages", Dr. Mitali Rathod is exactly that!

Dr. Mitali Rathod has consulted thousands of women across the world with gynecological problems. She is an Educator on women's health on Youtube and Instagram with a following of young women. Here we discuss the health problems of young women and how to deal with them.

Dr. Mitali Rathod is an Obstetrician and Gynecologist in Kalol, Gandhinagar, Gujarat, India. and has an experience of 8 years in these fields. Dr. Mitali Rathod practices at Kuldeep Maternity and Surgical Hospital in Kalol, Gandhinagar.

Darshana Rane: Kindly give a brief introduction of yourself to our readers.

Dr. Mitali Rathod: Hello everyone. My name is Dr Mitali Rathod. I am a Consultant Obstetrician and Gynaecologist. Also, I am passionate about women’s health, hormones, reproductive health, contraception, etc. After completing my Post Graduation, I felt there was a lot of miscommunication and misinformation that has been floating around. Especially in terms of contraception, reproductive health, pregnancy, menarche in short anything and everything that starts from menarche to menopause. We are surrounded by myths rather than basic information. So, for that purpose I started creating content and the rest is history.

Parul Soni: Please tell us about your life and professional journey so far?

Dr. Mitali Rathod: I have been raised in a family where my parents are doctors. They have been practicing for 30 years. My mother is a Gynecologist & Obstetrician and my father is a General Surgeon. My father is from a family of farmers, my grandparents were farmers. They raised my dad with utmost difficulties.

Eventually they moved to a small town from a village for better education to their only son and 4 daughters. Initially, it was very difficult for my parents to stay with us. The high requirements of a private hospital led us to set up home in the hospital itself. The labor room was next to my room. Hence, I have grown up to babies crying and women in labor.

As a child during schooling, I would study with my mother. My mother consulted with patients. I would sit and study beside her. I loved reading and often spent time doing so. I used to look up to my mother a lot, to how devoted she is to the patients. It was never for money but for passion and devotion. Their motive was to serve their patients in a better way. I have grown up looking up to them.

In highschool, I was stressed and eventually passed with flying colors because I was very clear about my goals towards MBBS. In middle school, I wanted to be an ophthalmologist and then an endocrinologist, due to my interest in hormones. But permanently I had an interest in gynecology.

In my MBBS second-year posting, I had my first OBGYN posting where I saw my first delivery. I remember it was chaos with 25 to 35 students from our batch, 5 to 10 doctors, 1 or 2 seniors, and 5 to 6 nurses with other helping staff. My first experience was an interesting one. I completed both graduation and post-graduation from NHL Medical College, Ahmedabad, India; just like my mother. Exposure and experience really helped a lot in shaping me as a woman, doctor, and a better human.

After MBBS, I took a year drop and studied very hard well for entrance and finally got OBGYN. Since 2015 I have been a part of Gynaecology.

Parul Soni: You have a huge following on YouTube. How did that journey start? What motivated you to start a Youtube Channel?

Dr. Mitali Rathod: After postgraduation, I started meeting a lot of patients everyday. On average, I saw around 50 to 200 women in the outpatient department. These are all rural people. There were taboos on untouchability during menstruation, postnatal bleeding, etc.

The post-natal period is where women face many restrictions, especially during Lochia. The mother was confined to a room with the baby, there was no assistance given to them with feeding or household work. When I came across these things, I decided to start something which can be viewed by the people across the nation. I started with YouTube because it was a bigger platform and served people in a better way. I started Instagram too when I came to know many young girls needed guidance. Topics like Menarche, Premenstrual syndrome and period hacks needed attention. Also, there was a lot of misinformation floating around because of "Fitness Influencers". It has been 6 to 7 months since I started YouTube.

Parul Soni: You got instant attention from all ages of women. I have read comments, they are all over the place.

Parul Soni: So many of the girls are not aware of the basic period care. So, tell us about the challenges faced as a health influencer.  

Dr. Mitali Rathod: I don't consider myself as a Health Influencer. I think of myself as an Educator. I have merely extended my services to online consulting. I enjoy educating the audience on a big platform.

Now, talking about offline consulting and seeing patients in a clinic. There are certain communities, and certain people who have built up rigid walls around their minds. No matter what I do for awareness I can’t get in their head. If they have a "Pooja" (ritual), or a wedding ceremony. If they want to visit a temple on an auspicious day. The women in the family come to us so that we can prescribe pills to delay their periods. They have fear and misinformation, and misunderstanding that they can take medicine to delay their periods for 2 months or more. Generally, this is seen in all communities.

In the postnatal period, when a woman has to go through bleeding, postpartum weakness, breastfeeding,etc . She is in the most vulnerable situation and needs support in every form. During that time, they follow the customs and norms about untouchability, not helping her or her baby.

Parul Soni: What response did you get while doing online consultations and YouTube?

Dr. Mitali Rathod: In online consultation, people were open to talking and easy. It started during the initial period of my YouTube journey, the response wasn’t skyrocketing. It eventually took time. However, the YouTube community happened over several months. I miraculously got close to 85k followers in 15 days. Despite all this, in the community, 99% are a mix of well-educated women and young girls from various communities and financial statuses. They are willing to understand and listen to the knowledge I impart. 1 % are trolls are bad but I am learning to keep up.

Parul Soni: A pattern is often seen in women in general, where they tend to ignore their health completely. What can you say about that aspect?

Dr. Mitali Rathod: The one thing I have often noticed sin1ce childhood till today is that, as women we tend to be over-giving. Since childhood, we have been taught that you will have to get married, go to somebody’s house and take care of them. Someday you have to be a mother. You are taught everything from how to look, speak or behave. When there is onset of menarche, the ever-growing responsibility of these beliefs is overwhelming. It becomes so massive that women tend to become over givers. And with this chaos, she tends to ignore herself to an unimaginable extent. So, the message is to fill your cup first and then when your cup is full then only you can help other people.

Parul Soni: What were the memorable moments so far? If you can recount one or two for us?

Dr. Mitali Rathod: I started with the online consultation around two years ago. A case of a young girl who was 22 at that time came to me after online consultation. She could only speak Marwari ( regional Indian language). Her husband communicated with me. She had a painful and irregular cycle. The patient was diagnosed with PCOS based on her hormonal reports. Within 3 months of following the plan, she conceived. This was miraculous! I never did ovulation induction or tracked her cycles. We just took care of the basics. After 9 months of treatment, I delivered her son.

So, with social media great things happen, there are good people who create informative content and some who spread misinformation. So, in all this PCOS has been given a fearful environment especially about infertility and forced to conceive faster. The husband of this patient also thought the same. But after a positive pregnancy test things changed for them. The fear of miscarriage was there but we overcame that.

With offline consultation it can be overwhelming but 99 percent of the time when I am holding a baby, my heart just says ‘Thank you’. It is part of my existence. I am happy inside out for doing what I get to do every day!

Parul Soni: There are doctors who are quite conventional and rigid protocols, whereas you are very dynamic. Is there a difference in the treatment of conditions like PCOS?

Dr. Mitali Rathod: I have my own story of birth control pills. In 2015 I had severe dysmenorrhea. Every month I took a Dynapar injection prior to scrubbing into surgery. The entire department knew about my painful periods. For my condition, I got investigations done and got diagnosed with a simple cyst in the right ovary of 5 cm. My parents thought of so many possibilities suspecting of endometritis, fibroids, etc.

My senior doctor prescribed me with a birth control pill for 3 cycles, which is a conventional treatment. Almost everyone ends up prescribing oral contraceptive pills or weight loss. This is gaslighting. They couldn’t prescribe me weight loss as I was already underweight and my genetics are like this.

I started consuming the pill from 4^th day of my cycle. This pill got me so emotionally cranky, had food aversions, insomnia and nausea. During Diwali (Indian festival), when I was still on pill, I came home and I felt like a completely different person. I didn’t speak to anyone for hours, didn’t eat or felt like smiling. I was clueless. At this point, I had only taken the pill for 10 to 12 days. My parents asked me to stop consuming.

Prior to prescribing the patients I consider 100 times. I am not against the birth control pill but it is not for everyone. I never prescribe before informed consent and information. Sadly, many doctors neglect this fact.

Also, you asked about the generational gap. Just like the generational gap between parents there is a gap between doctors. Just like in PCOS there are all senior doctors prescribing Metformin. As they usually think of the case of classical PCOS with insulin resistance presence, so metformin is prescribed for weight loss.

But by the research there are 4 types of PCOS, if given Oral Contraceptive pill for 6 months the person might develop post-pill type PCOS. We have to plan treatment for every single patient in a different manner. We need to consider differential diagnosis as every patient requires a different mode of treatment. It's not okay to medically gaslight patients.

The worst are those crash diets and exercises that make you end up with underline nutrition deficiencies. They often crash your metabolism overnight and recovery is very difficult.

The doctors are also very stubborn and sometimes they are not ready to listen to patients. In such cases, the patient has to decide which doctor to choose. Don’t go after doctors who are famous just for clinical experience. Or from where their degree is from. Rather go for a doctor who has knowledge, understanding, compassion, and empathy.  

Parul Soni: Many women go through infertility, PCOS, etc where the periods are irregular and sometimes planning a pregnancy doesn’t work. What do you have to say to such women?

Dr. Mitali Rathod: When it comes to PCOS there are four types. We have to determine whether it is insulin resistant or Adrenal or post-pill or inflammatory PCOS. It starts with a correct diagnosis. Some people have a 35 days cycle and the practitioner considers it as PCOS. No that’s not true. The cycle of 25 to 35 days is really acceptable.

The content we consume on YouTube or Instagram has created a lot of misinformation and stigma, especially around infertility. The prevalence has increased up to so many folds. Out of 10, 4 to 5 women can experience difficulty in conceiving. Every PCOS is different according to diagnosis. The goal can be short or long-term.

The short-term goal can be to conceive where the work has to be done on the lifestyle, managing stress, balancing meals, add supplementation, correlate with blood work, and within 3 to 4 months the pregnancy is much easier. 

Whereas, in the long term where the woman doesn’t want to conceive immediately then it can start with taking care and getting better gradually. It is important to understand food sensitivity and routine check up. The approach of giving pills should be scrapped off. The first thing is lifestyle modification. Period.

Parul Soni: Young girls suffer from mood swings and premenstrual syndrome. It affects our mental health, How to tackle these things? Give us some general advice if possible.

Dr Mitali Rathod: Prioritize yourself! We all have night shifts. But its important to sleep well. I'm not telling you to sleep at 8 p.m. and wake up at 4 a.m. But try to go to bed early by 9 p.m. or 10 p.m. and get a minimum of 7 hours of sleep. After a long day you don’t need Netflix. We do not require these Dopamine kicks which lead to sleepless nights. The cortisol goes through the roof!

The emotional vacuum and physical pain are a void which we try to fill with junk food. There is no need . If 3 meals cannot be prioritized then at least try one. If homemade lunch and dinner is not possible then try with breakfast. Meal prepping often works. We eat junk when we don’t have meals prepped and get into a guilt trap. To fill that guilt trap then is another pizza coming in which is absolutely wrong.

Parul Soni: What do you have to say about the latest Fad? The gummies for PCOS, weight loss, apple cider and Hair gummies?

Dr. Mitali Rathod: Instagram has a large PCOS marketing which include PCOS gummies, patches, tablets, and what not. There are Ashwagandha tablets, which I am not against but there is no mention of therapeutic dose. There are people wasting money on them. So many follow this approach which don’t mention the list of ingredients, no dose, and the prices are sky rocket high. They falsely claim naturally regulated periods.  They have already challenged the oral contraceptive pill as unnatural. These random gummies are very risky.

Parul Soni: The brands which sell these products with inositol, do they need regulation? Don't we need a prescription?

Dr Mitali Rathod: When it comes to supplementation there is no regulation. If I want to wake up one fine day and make my brand then I can, due to the liberty. That’s the reason for misuse of these drugs. Of course, there are genuine brands.

For example, Myoinositol if given to a woman with PCOS with insulin resistance, the therapeutic dose will work brilliantly. But in a different case like after Post pill PCOS, the body will have a normal amount of blood glucose levels and insulin will be normal too. In this case, myoinositol will not work. Though it has other functions. The root cause will not be resolved.

The hormonal panel has to be done on Day 2 of the cycle. The panel should include FSH, LH, Fasting Insulin, and dehydroepiandrosterone levels. Irregularity can be caused due to anaemia, hypothyroidism, crash diets, insomnia, excess or underline nutrition deficiency. This doesn’t define PCOS. Lifestyle changes can make it better. Correct correlation is important.

Parul Soni: As a physiotherapist myself, I know that we should create awareness about pelvic exercises. Can you tell us the importance of pelvic floor exercises in sexually active, pregnant and post-menopausal women?

Dr Mitali Rathod: Pelvic floor exercises are supremely important. Due to our sedentary lifestyle, we hold a high amount of tension around the pelvis, glutes and muscles. Therefore, it is very important to stretch the respective muscles.  It is often neglected in teenage years and middle aged women.

Younger women with sedentary lifestyle experience period cramps. I highly recommend lower-body yoga. If started in Luteal phase, then it shows tremendous results in terms of relieving cramps. The importance of this in pregnancy phase is often not told.

In Indian households, pregnant women are often told to sweep and mop the floor for normal pregnancy. Mainly to stretch out muscles and to increase the endurance of pelvic floor muscles.

Parul Soni: Now some casual Questions! What do you do in your pastime?

Dr. Mitali Rathod: I love to read and I am very passionate about nutrition.

 Parul Soni:  What is your focus in your life after your work?

Dr. Mitali Rathod: After my 30s, I have taken special care of my health, especially my sleep, I usually sleep by 9:30 p.m. as I never keep any other thing on priority. The second thing is I always take some time for physical exercise. It can be floor exercises, yoga, lifting weights, etc. I often have supplements according to requirements. I do vent out my thoughts by writing, sleeping well, managing stress. I love doing meal preps so I don’t have to plan meals. The focus has changed completely from outside to inside.

Parul Soni: What would be your alternate career?

Dr. Mitali Rathod: Nutritionist for sure. I have studied nutrition for a year after my PG and changed my approach for treatment. It is very important.

Parul Soni: What would be your message for the budding doctors?

Dr. Mitali Rathod: I would say, we have already read the textbook but it is not enough. Along with that, we have to learn and explore.  Experience teaches you. Learn to listen. Every single patient teaches you something so listen to them. If you don’t hear them out then you don't have a right of prescribing. Because of Western medicine, we have lost out understanding about nutrition so just prescribing Iron, calcium and B12 to pregnant women is not enough. High time you study nutrition for better practice.