447. The psychology of PMOS/PCOS ft. Dr Hazel Wallace

0:04 Hello everybody, I'm Jemma Spake and welcome back to the Psychology of Your Twenties, the podcast where we talk through the biggest changes, moments, and transitions of our twenties and what they mean for our psychology. Hello everybody, Welcome back to the show. Welcome back to the podcast. It is so great to have you here, back for another episode as we of course break down the psychology of our twenties. Today, we are doing an episode that selfishly, I think I need more than anything right now, and on a topic which I have searched, I have looked, there aren't really or there are very few in depth podcast episodes about it.

0:53 We are talking about the psychology of PCOS PMOS as it's now called. Begin the episode with a little bit of a story time. I was diagnosed with PMOS last year, and I think just since then, I found that the information and the advice and the help I've been looking for has been very, very lacking. And I know I'm not alone in this. It can take years for our symptoms to be recognized, to finally get a diagnosis, and even afterwards, the advice we usually get is come back when you want to get pregnant, go on the pill, do some exercise. What is often not examined is the impact of this dismissal on our psychology and the impact that PMOS has on our mental health, our emotional health, as well as the physical symptoms. Something I know would

1:39 have helped me would have just been sitting down with an expert and just getting to ask a lot of why questions. Why was this happening, Why did this start? Why does my body behave this way? Why are certain treatment options offered and others are not? So today, we're just going to create that opportunity for others. I have in the studio. Doctor Hazel Wallace. She is a female specialist, a doctor, a nutritionist, the author of Not Just a Period.

2:05 She has spent thousands of hours, probably more thinking about studying, examining women's hormones, women's health, women's nutrition, PMOS symptoms. She also has PMOS herself, so she really knows the ups and downs. We are so excited to have her, Doctor Hazel Wallis, Welcome to the Psychology of your twenties.

2:23 Thank you for having me.

2:25 Do you find the intro is a little bit awkward?

2:26 As I was saying, yeah, I always do I always do. It's hard to know how to respond, but I think you captured everything.

2:33 So thank you. Okay, I'm so glad. Well I've done the introduction, but I'm going to let you do your own as well. Who are you? What are you? What's the work that kind of lights your fire? What do people know you as? Or who do people know you as?

2:50 So in terms of who I am and how I got into this work, it is quite a long and winding story. I'll try like summarize it quite short for you. So my backstory is when I was fourteen, I lost my father to a stroke, and being a fourteen year old girl, that was really significant in my life. And I think that moment made me first want to be a doctor, and second of all, it helped me realize that our lifestyle, including nutrition, plays a really big impact on our health. So those two things started to shape what came next. So I went into medicine, and I was really excited to learn everything there is about nutrition.

3:36 Doctors don't learn really anything about nutrition, and I was a bit disappointed by that and also quite shocked because from my own reading, I was understanding that nutrition was hugely impactful on our health and preventing disease. So I started a blog and Instagram page fourteen years ago now, which is crazy because I'm like a dinosaur in the industry called the Food Bat like really trying to like connect medicine and nutrition, and that was what I did for a really long time, and the Food medic page still exists today and I've written books on nutrition. But along my journey as a doctor, I was working through the pandemic as a COVID doctor, which was a really challenging time, and I was living alone, so outside of

4:21 my hospital hours, I spent a lot of time reading, and I was reading a lot about how women were neglected in health and healthcare, how most of the medical research we have is based on men or male cells, male mice, and that a lot of what we know about women is just kind of left up to guesswork, which means women's health is hugely neglected. I found that insane and really enraging as a woman and also as a doctor with many female patients. So I wrote a book on it called The Female Factor, and since then, which was around twenty twenty, I completely pivoted my work into women's health because there is so much work to be done, and I think also, as you mentioned, I also was going through my own diagnosis or diagnosis journey

5:07 with PMOS. Despite being a doctor. It took me two years from first going to my doctor to actually getting the diagnosis because I was told that I just didn't fit the picture. There was no need to kind of progress with further testing, and I think being a junior doctor at the time, I didn't want to. I don't know step on anyone's toes who was more senior than I was in that space. So fast forward to twenty twenty five. Last year, I released my second women's health book, Not Just a Period, and that is basically your encyclopedia to the menstrual cycle in terms of not just the hormones and everything that happens across the phases, but how that impacts your skin, your mood, your nutrition, your exercise,

5:56 even your libido. And for me, that was really a really empowering book to write because I learned so much about myself, but also I feel like it's something that every woman should know.

6:11 I'm just like listening to you being just nodding my head's like yeah, yeah, exactly. What I find so interesting about that story, and there's so many things like you speaking about your dad and how you've had this powerful motivated to change people's lives and completely pivoting. Part of what I found really interesting as well was you talking about how you were a doctor got looking for a diagnosis and it took you two years. Yeah, and if that is not the most insane but also perfect metaphor example for like what it's like to get help as a woman, I really don't know what is.

6:51 Yeah.

6:51 So today we're going to talk about PMOS and you went after your own diagnosis, you got one, and so many other women that I know are currently like at some stage in that process. Can you give us a quick overview of what PMOS is formally PCOS. Maybe also like touching on the significance of that name change, because that happened.

7:14 Very recently, like three weeks ago.

7:16 Three weeks ago, wows So, so that has happened very recently. Okay, talk us through it.

7:23 So there are a lot of letters and a lot of words, but I will break it down. So formally called PCOS, polycystic ovary syndrome has been renamed to PMS, which stands for polyendercrine metabolic ovarian syndrome. Like breaking down that name in itself, I think is really important. Polyendocrine poll means many endocrime means hormones. Many hormones are involved.

7:48 We often talk about testosterone when it comes to PCOS or PMOS, but there's many hormone systems involved. Metabolic signifies that it's not just your ovaries, it's your metabolic So what I mean by that is like your blood sugar balance, insulin resistance, cardiovascular risk. Ovarian highlights that your ovaries and your reproductive system are still involved. They're still a very important part of the diagnosis. And then syndrome means that there's many different symptoms and signs. There's not one cause, so it's kind of like many things together. And the reason why the name change is really important. First of all, it's so rare to change in name in medicine like that in itself is huge, but it came about because

8:33 so many patients and practitioners were like, PCOS is so misleading, and it's confusing because polycystic ovary syndrome kind of focuses just on the ovaries and it makes us assume that you have to have polycystic ovaries to have the condition, which you don't, and also that it's just an ovary problem.

8:53 But now we know it's a full body condition. So this new name change, I think, pivots away from this is just a problem with your ovaries, and actually this is a full body condition. You don't have to have polycystic ovaries to have the condition. Some women do, but it's not essential for the diagnosis. So I think that in itself is really important because a lot of people were only getting the diagnosis if they had kind of that picture on their ultrasound. So by changing it, we're opening up the definition and it means a lot more women are fitting that criteria. And I think, thinking back to my own diagnosis, I was told you don't fit the picture of PCs, so you can't have it because I wasn't fitting that very tight definition that they had

9:43 in their textbook, whereas now we know it's much more than that.

9:48 So that is something I did not know, which was that previously as you were kind of telling us only if you had cysts on your ovaries, would they say, yes, you can kind of enter the gate, And if you didn't, they were like, well, something else is wrong with you? And I'm going to assume they weren't going to look any further. Is that what I'm am?

10:07 I right, Yeah, you're right in saying that I mean to be diagnosed with PMOS or PCOS. There are three criteria and you need to have two of three.

10:15 Oh okay.

10:16 One of them is polycystic morphologies. So these cysts on your ovaries. They're different to the cysts that we talk about when we say you've got a cyst on your over and it's ruptured. These are immature follicles that have not kind of developed fully and they look what we call like a string of pearls on your ovary. So having one of those is can be diagnostic. The other two features are having raised testosterone, and this can be on a blood test or it can be clinical features of it. So clinical features of raised testosterone would be excess hair around your jawline, your face, your neck, your test typical male pattern or acne or hair loss from kind of male patterns on the forehead, were on the scalp.

11:01 And the third feature is absent or regular periods. So you have to have two of three of those, So technically you don't need to have the polycystic ovaries, but I think for a lot of people that was an area that was causing confusion. But also even if you've got the diagnosis, so you've been fighting for your diagnosis, you got it, A lot of women were then told we'll just come back when you want to get pregnant because it's just no very problem. So or take the pill and that will suit you. Yet and I'm not saying the pill is a bad solution. I know we're going to talk about that later, but I think the problem is we were completely neglecting that women were really struggling with the fatigue, the difficulty losing weight, the metabolic features,

11:49 the cravings, the blood sugar crashes, the excess hair growth, the cystic acne, and just telling her to go away and come back when she wants to get pregnant. Scene. And it's so weld to me because I was given that exact quote whenever I say it online or I hear it repeated back to be my by thousands of women.

12:10 I'm not gonna lie. Somebody said that to me. Last week. I had it. I'm not even joking. I had a gynecology appointment last week. I had to go private because I like, I'm in the in the UK, but like the waitless was too long. I was having really terrible problems. I couldn't get to go and see a public you know, a GP. Well I have a GP, but they She basically was like the referral process was so difficult. She was like, well, if you have the means, go private, okay, And I went and I was like, I have never gone to a private doctor before in Australia, it's very rare.

12:47 And I was like expecting her. I was like, oh my gosh, I'm so I was excited. I was I'm so excited. I feel like she's going to have something for me. And she showed me to exercise, which I was like, well, I already do that. And then I was like, oh, but your blood pressure, like your heart rates really low. You have like bracka cardia. And I was like, oh, well because I exercise, so we can rule that. Thank you for the advice. We can rule that one out. And then she was like do you have a partner and I was like yeah, I do, and she goes, are you guys trying to have kids?

13:15 And I was like no, no, no, and she kind of looked at me, like why are you here? And then she was like oh well, and then at the end was like, you know, I would we really worried if you like trying to get pregnant, but you're not, so we kind of have some time and I left and I actually was very teary and very upset about it.

13:32 And something that my boyfriend actually said was like that advice is inappropriate, a like just because you should still get treatment, but what if you just didn't want kids? Yes, And I'm sure that's something you see all the time where it's like, wait, so if I don't want children, this isn't going to be dealt with as a bad way of saying but managed. And yet you're saying and I know from experience, I'm sure many women listening to this, and from experience, there is like a laundry less of other stuff that is going on. You've mentioned three, well, actually you've mentioned quite a few, But can you give us some others that might have nothing to do with your period or nothing to do with you know, reproductive health.

14:18 Yeah. I think the most kind of visible ones, and for a lot of people can be almost the most distressing is the visible features, and that is cystic acne and also heir setism, which is hair growth in unwanted places, and that's typically around like the jawline and the cheeks and the neck and the chest, and it can be quite stubborn, and even on fair skinned women who typically wouldn't have dark hair, it can be very dark and difficult to get on top of the other symptoms will be things like gaining weight or difficulty losing weight. Anxiety and depression is very common. There's a higher risk in women who have pmos, so that's something that's often not spoken about. The fertility issues of course, and then insulin

15:08 resistance is a huge trigger for the condition, but also that can cause symptoms in itself with blood sugar crashes, fatigue, and you know, is a really core thing that we need to be focusing on. So I find it really difficult when you tell me that you've gone to see some and just that conversation didn't happen, because that carries its own risk factors of future tattoo, diabetes, cardiovascular disease, which women with PMOS unfortunately have much higher risk of.

15:38 So it's so important that every woman who comes through the door with a new diagnosis of PMOS is being screened. It's in our guidelines. We need to be checking blood sugar, we need to be checking cholesterol, blood pressure. That needs to be done. I would say, like majority of the time, that's not happening from what I'm seeing.

15:56 Well, yeah, I didn't. I didn't get any of that, But that's interesting. Maybe I'll for a follow up appointment.

16:01 Did So.

16:08 What I'm always wanted to know, and something that I feel like nobody's explained to me, is what is actually happening in my body hormonally, on a cellular level, scientifically that is creating this. So you spoke about this kind of for some women, it's like this string of pearl. I'm not sure if you said undeveloped or overdeveloped follicles like in the overar e. Yeah, is that what it is? All?

16:35 Like?

16:35 How does this, how does this start? Where does it come from?

16:39 It's a great question. And in terms of what causes pmls, the short answer is, we don't know, but it's likely to be a combination of genetics, environmental, and lifestyle factors, so combination of things. But what's happening in your body, first of all, can kind of vary from person to person. And the other thing to mention is PMOS and how it presents in a different woman can be so different to the woman next to her. It can kind of appear very differently. But the main thing to say is it's not one single hormone that's causing this, and it's not one single organ. Think of it as like a network problem where the ovaries, the brain, and your metabolism are just not really communicating in the way that they should.

17:25 So all our hormone systems in our bodies do not work in isolation. They all communicate with one another, and when one of them is out of we'll say balance for lack of a better word. But if it's out of sync, it impacts everything downstream. And so in the case of PMOS, there's a few things that can be going on. First of all, the brain can be sending signals to the ovaries, which is normal, but it can be sending too many, which can stimulate the production of androgens, which are male hormones. The one that we often talk about is testosterone. Now, it's normal for women to produce a little bit of testosterone. That's good. Lots of testosterone can be problematic because it can interfere with ovulation, which

18:10 means the follicles which are going to be eggs don't fully mature, and that's why women with pmos don't ovulate every month and have long cycles. So that's the first thing. Now, the other big component is insulin resistance. Eighty percent of women have insulin resistance, regardless of their BMI or body weight.

18:32 Insulin resistance means that our body isn't responding as well to insulin when we have carbhydrates, and so it has to produce more insulin. High levels of insulin and dysregulated blood sugar have a knock on effect by also increasing things like androgen's testosterone. They can also directly impact the ovaries.

18:52 All of this is like a huge cascade of things that cause us to have longer cycle length, higher testosterone which impacts things like ovulation, but also those symptoms we mentioned acne, hair growth, and the insulin resistance is impacting first of all our risk of those future illnesses that I mentioned conditions, but also our blood sugar balance, our cravings, our ability to lose weight. So it's multiple things happening at once, which is really confusing and hard to disentangle.

19:25 And some women will be more impacted by one part of that pathway than others, So you might find that you actually don't really get terrible androgenic those kind of acne hair related symptoms, but you're impacted by other things. And so we treat all women with PMOS the same. But I think what we're starting to see in the research is that there's probably different types of PMOS going on.

19:53 We can't neatly categorize them yet, but I suspect that in the future that we will have very personal life treatments for different types of PMOS because it behaves so differently in different women.

20:07 That is so interesting because and again I keep relating this back to my personal experience, but again at the top of the episode, I'll let them know. I told them, like, I'm here just to ask you questions for my own sake in a way, but I would go online and be like, okay, PMS. Back then, when I was really looking for it was pcos, like pmos, like really heavy period PMS like I've had my period for like four months TMI to the gang listen, but like you know, pmos like this is this, and it would be PMS is the lack of a period, PMS, is this and this, and I was like, but I don't have those things.

20:43 And a big thing that really confused me was I was like, but I don't have acne and I don't really grow hair in other places, and I don't I get I have the opposite problem, Like I like, my period doesn't cease. And what you're saying is as the research progressing, you think that we're going to start categorizing it, maybe the same way that we like categorize diabetes in some ways, or maybe the same way that we even categorize certain neurological disorders. Is that kind of what you're saying, Yeah, happening.

21:13 Yeah, I think like we can. If you think of it like a then diagram. This is how I see it in my head, with like four circles and in the in the middle there's like where they all overlap. And someone might have all of these features and that's one type, and then someone might have two of those features.

21:29 They may have, you know, the irregular cycles and the acne, or they may have normal cycles and really bad heir citism and acne, or they might just have fertility struggles and they've only realized that they've got PMOS because they've been on that journey. So it seems that there is different phenotypes or types of PMOS. The reason I'm really cautious with this is I've seen that idea kind of being captured and spat out on social media in various different forms, and it's not always act curate. So I think, like, at this point, if someone's telling you you need this specific type of treatment for this specific type of PMOS, we don't. We clinically don't use that terminology yet, but I think it will be. I think it's really useful

22:17 for women who have PMOS to understand what are what is their problematic features, what is really concerning for them, so they can articulate that when they're speaking to their doctor and ask for support in those areas, because I think that's where maybe we're really leading down women.

22:39 I really want to touch on something you just said, which is you see this idea online a lot. Yes, this idea of the four different phenotypes categories, strains whatever you want to pull it. And I've seen that and I was going to ask you. I was like, what are the four different types? And it's so interesting because I think this is a pattern with a lot of health conditions that primarily, if not exclusively, impact women. You're not getting the information from probably your GP. You're not getting the information from the specialist that you need, and so you turn online, turn to like online resources. And this is a whole different conversation, but the amount of misinformation you're saying is kind of spreading through those channels

23:23 because there is no consensus on this.

23:26 Yeah, that's it, and I think that's so reflective of every area of women's health. If you feel like you aren't getting the help from your normal health care provider, women turn to social media. Yeah, and if you see someone who has something similar to you, then you're going to see what are you doing that's helping you. Or you see someone who's got a stethoscope around their neck and they're on social media and they've got a page, you're going to listen to them. And I mean, I am a health professional who also creates content and how it has done for years, but I really I think you have to approach anyone who's giving healthcare advice on a specific condition with a lot of skepticism, because just

24:11 because someone has a doctor title or healthcare title doesn't mean that they're a specialist in that area. And I guess that's the world wild West of social media. Because it can be amazing to connect communities, it can be amazing to sometimes get support, and I think that's great, but also it's just so unfortunate that it's a very muddy place to get health information and it's never going to be personalized to you. And I guess what I'm trying to say is that when it comes to PMOS and I work in a clinic and I see a lot of PMOS women, and I would say, no, two women are getting the same pieces of advice. You know, everyone's getting such specific advice based on their goals, based on their symptoms, based on their diets, based on you know,

24:59 so many different things.

25:00 Yeah, I relate to this. I've spent many a night on a Reddit thread and I've also spent a lot of time on social media being like, well, this person looks like they know what they're talking about. And as somebody who also operates in that space, I think a big red flag is if somebody does not at some stage say this is general advice, or doesn't it some stage say I am not your doctor, I am not your therapist go and this is where you can go and find it. And that's like a big thing that I always try and do is we have it in every single episode description. We say at the top of every single episode, you know, like I cannot provide you with individual kind of feedback or help. And I think that's a big red flag. If you have somebody who's like,

25:46 I'm going to give you the cure. All, yes, I'm going to tell you the final secret on this, It's going to fix your life.

25:52 It's like, no, No, that's so true. I think you're looking for disclaimers and caveats and no one's selling you this because they just don't exist, Like unfortunately they don't.

26:04 And you're looking for research. Yes, if somebody sites, make sure they're starting sources and check the sources, because sometimes somebody will be I actually had this happening the other day where I was like, well, this source is amazing, and it was like a blog post written by the person who was doing a video, and I was like, I just got tubed. I was like, I was like, that is such great advice, and I was like, oh, that's an opinion, that's like not even real. Anyways, I kind of want to circle back to something because I flew over it too quickly. Which is you mentioned the increased chances of a likelihood or prevalence I guess of anxiety and depression and a myriad of other mental health concerns in women and people with pmos. Why is that?

26:49 Is it purely because they are experiencing a medical issue that is being dismissed. So is it contextual? Is it environmental or biological?

27:00 Social?

27:01 Why do you think it is?

27:03 I think with anxiety and depression, it's usually multifactorial, and that's the case in PMS. Anyone with a chronic health condition typically has a higher risk of anxiety and depression. We also know that women with pmos have more issues with body image and the higher rates of eating disorders, and a lot of that is from what we know is at least in part relates to the fact that there is a nutritional component. And if you're told that the only way that you're going to get better is if you lose weight, if you cut carbs and all of the pressures put on you, that can create very troubled relationships with food. So I think it's a component of this likely that kind of hormonal systems are probably

27:56 at play here in impacting women. We know that the hormones of your menstrual cycle that are impacted here are not just sex hormones. They impact everything. You know, You've got estrogen receptors on your brain, so it's likely hormones are play. But the kind of experience of being a woman with PMOS is just hugely stressful in itself and living with that, and it's not just you know, it's not something that's curable. From what we know, you may get to a point where you are living mostly asymptomatic, and that would be amazing, but for a lot of women, they really struggle to get there and there's just such little support. And from what we spoke about earlier, you know, physical manifestations can be really hard for women fertility problems.

28:40 There's I guess there's what I'm trying to say. There's so many things that could be contributing.

28:45 Yeah, And I like that you have said that rather than just being like, that's just a hormonal thing. Yeah, because I do think a large part of it as well is dismissal and the fact that you are staring down at like the barrel of a diagnosis that, as you said, doesn't have a cure. But then also you can't find a way to manage it. And then there's probably somebody being like, I don't know if you have that or not. You're like, wait, but what am I meant to do? I do? I? I feel it so deeply that this is impacting me. But there maybe I don't have it. A doctor took a while to diagnose me.

29:19 Now they're saying, come back when and when you get pregnant? What is the impact of that on our psyche, like in your patients or the people that you see. You know, how much of the mental distress is nobody believes me or nobody can help me?

29:34 Yeah, I think. I mean it's it's massive, and it goes for so many women's health conditions beyond PMS, you know, and demetriosis takes eight years to be diagnosed. Wait eight years, yeah, eight years on average like globally and.

29:50 I didn't even know that is insane.

29:52 It's insane. And the UK there is a report in the UK not too long ago which there's this fact from it which was so shocking that on average, women had gone to their doctor more than ten times. They're GP more than ten times before referral for investigations, which is just wild. So I think PMOS slightly shorter time to diagnose this, largely because different ways that we diagnose it's less invasive. But I think having PMOS myself, I'm probably more empathetic to it than someone else, and it's just having consultations with women who have maybe been waiting for a really long time, or they have the diagnosis but they've been sent away because there's not really anything that they've been offered. Just being able to speak to

30:45 someone who understands the condition, they will be hugely emotional and I think they find that hugely therapeutic because no one explained to them what it is or what that means for their fertility or their future health, or what they can do outside of pills or having babies. And I think, you know, even from a public health perspective, there's not much knowledge out there. There's not more kind of there's maybe one charity in the UK that supports PMOS, but there's not much being done in the way of like public health messaging supporting women who have that beyond go see a private doctor and you know from your experience or from other people's experience. That's not even always a great experience.

31:34 No, it wasn't. It wasn't a great experience. But I think that I like that you've pointed to this something, you said, this amazing point, which is the benefit of like catharsis, of somebody coming to and being like, oh my god, thank you for listening to me, thank you for just like letting me say that. I'm sure like the stress levels plummet immediately, probably and like just this this tension that you're like you're holding finally released. And what's interesting to me is the role of stress in PMOS, which I want to ask you about and how significant it is, and the process of getting diagnosed, the process of getting help, the process of maybe pursuing like your fertility journey is so stressful. It's kind of like, wait,

32:17 don't be stressed, but like this conditions is so uniquely stressful that it's like almost impossible. Maybe I should have asked you this earlier, But can you talk about the role of yeah, stress and all those things on the systems of somebody with PMOS.

32:31 Yes, stress is hugely impacted. Stress is hugely impactful on our hormones in general, and our sex hormones, and that goes for all women. So there are multiple different types of stress hormones, but the main one is cort isol that we often talk about and that can impact our or variant access. So the hormones that are released from our brain that tell our ovaries to produce hormones, Cortisol can basically downregulate that, so so it can switch off those signals in when you're going through chronic stress. And a really good example of this is when we were going through the pandemic, so many women found that their cycles had skipped a month or their cycles were really long, like globally because we were all going through this insanely

33:17 stressful event. Now, that can happen in PMOS, and it can also happen when women are going through kind of physical stress, be that they're extreme diety and doing a lot of exercise, going through anything that's physically demanding your body basically is switching off signals because right now it's not a safe time to have a baby. In PMOS, that can happen. But also cortisol may increase the production of things like androgen's testosterone, and there's an association with PMOS where women may have higher levels of of pmos, so baseline levels are slightly higher, and then if you're kind of more stressed, you're kind of increasing that and further.

34:00 So it's not great. So stress management is a huge part of the picture when it comes to helping improve PMS symptoms. Now, I think when it comes to stress management, often the advice is just stress less, like, yeah, don't don't be a stress and goodbye. Have you tried meditation? And I think also for a lot of people, it naturally falls to the bottom of the pile of the things that we're going to prioritize, like you know, supplements isn't far more tangible. I can take a pill, I can get on what my day? How do I manage my stress when I'm working like ten hour days, I'm you know, moving house, moving country, whatever it might be.

34:43 So I think how I speak to my clients about it is integrating kind of stress management buckets in your day where you can like dial down the amount of stress to experience. And that might be that for the first thirty minutes of your day, you're not going straight in your phone because cortsols highest in the morning if you get up and you're looking at your phone, looking at your emails. You're just increasing enough further if you're getting up doing fasted exercise, that's also quite a big stress with PMOS. With women in general, I'm not a huge amount of fasted exercise because we're increasing cortisol when we don't need to do that. So it's those little things.

35:17 It doesn't need to be like huge hours of journaling or hours of meditation. It could be downloading a meditation app and doing five minutes ten minutes a day. But stress management for every single woman with PMOS is is very important.

35:34 And I found this when I when I moved countries at the start of the year, was like when my symptoms were the worst, and I remember saying to my mom, actually, I was like, I don't understand like I'm doing. I'm actually doing everything right. You know, I've according to like this information I was given. You know, I'm I'm like doing so good with like not eating process cubs and like I'm eating my three meals a day and I'm hitting my protein goal. And I think that is the invisible factor of like stress feels like a necessity for so many things that it's sometimes like the last thing we want to cut out, do you know what I mean?

36:09 It's almost like it's like the alcohol or like the cigarette, of like the emotional states where it's like, oh, but I need my stress. I need my stress to like get stuff done, and I need my stress to be successful. And then it's you eventually get to a point where you're like, but also I need to be healthy, and we don't really consider it until you exit a period of that, or like you accidentally have a period where you're not as stressed and you're like, wow, my body functions so much better, so much better. I'm gonna ask you some questions now about what actually works with pmos actually before I do that, I don't want to skip over this, which is getting diagnosed and if you've been had what does that actually look like? If you go

36:56 to a GP's office, if you go to a doctor's office, what should you I don't know if you're allowed to do this in the UK, but what should you ask for? What should you mention that you know that will get people paying attention? How do you advocate for yourself? Just very quickly before we go into.

37:11 Yeah, great question. I think first of all, your cycle length is an important factor. Now, if you have regular cycles, that doesn't mean that you don't have PMS, but it can be a really big feature. So first of all, if you're not tracking your cycle, I would really do that so you can have at least three cycles worth of like this is what's happening. I would also list the symptoms that you're experiencing, because first of all, you have them to hand. It's easy to forget things when you're in a ten minute appointment and you're feeling pressure with like a doctor staring down at you and asking you to kind of hurry up, and it just helps you to kind of know what are the patterns with my symptoms as well. The main things, as we mentioned

37:53 earlier forgetting the diagnosis are those that criteria so two of three and that's the same even though we changed the name. The criteria for diagnosis is the same, so irregular cycles, evidence of race testosterone or polycystic ovaries on a scan. So to get diagnosed, we want to know your symptoms, so that's what you're going to bring. We'll do a blood test to see if you've got raised testosterone, and sometimes you don't have to go further than that.

38:22 You could be diagnosed with just that because you're meaning two of three criteria. In some cases, if you don't, then you'll be referred for an ultrasound scan, and that is a transvaginal scan, so they kind of basically put the probe inside your vagina and look at your ovaries. Beyond that, we should also be just doing our due diligence, checking things like your blood sugar balance or what we do.

38:46 We use a different test in the UK called a HbA one C and checking risk factors, so making sure your blood pressure is okay and cholesterol levels and asking you a little bit about your family history. That's the main things for PMOS.

38:59 Okay, that's good to know because I wasn't. I didn't do a testosterone test until like this year recently, which is like so interesting that that would have been nice to avoid the third option that you gave. This is a nice segue into what happens next you get the diagnosis. I would say that's a cause for celebration. Some people might feel very daunted by it, but I think it's a good thing to just know what are some things. Well, I was going to ask you what are some things that actually help? But I'm going to give you a list of some things that I've heard about, and I want you to kind of rate them out of ten and then maybe go into some things that aren't on the list. So I spent as I said, I spent

39:49 a lot of time online. I read it ready, just on Instagram as well, and sometimes on TikTok if I really want my sources. No, but just like looking things up online, going to forums and websites and all this stuff. I've got eight things here, okay that are factors in PMOS. Might help, might not help. Are you ready?

40:09 Yes? Okay?

40:10 The pill.

40:12 Oh this is such a big one to start with, so I won't give you a quick fire answer, but I'm gonna give you maybe a six out of ten. Okay, maybe a seven. So the answer really is it depends. Now. There's so much pill fear mongering going on right now. In general, I don't think the pill is suitable for everyone, and it also is not a cure for PMOS. So sometimes people will say, oh, the pill regulates your cycles, not necessarily it gives you a regular bleed, because it gives you a false bleed. So for some women with PMOS who have really irregular cycles, that's quite reassuring because every twenty eight days they're having a bleed. If you have very irregular cycles, and I mean like three to six years, so not very many, it's really important that

41:07 we're protecting your womb lining because if you don't bleed regularly, that bills up and it increases the risk of something called endometrial hyperplasia, which can increase the risk of endometrial cancer. So in some women with very irregular cycles, the pill is actually protective because it means that we're kind of losing that extra endometrial lining every month. So it's helpful for some women they take the pill with PMOS because the combined pill is anti androgenic, so it blocks the acne symptoms, the heir setism, the hair loss, and it's really beneficial. So for those women, fantastic. If they're not issues for you, or for some reason you can't take the pill because there are contraindications, then it's not an

41:58 option for you. And also, I think you know, some women experienced side effects from the pill that they really don't like, and that can vary whether that's mood, libid or whatever it is. So I'm going to give it a six out of ten, because for some women it can be like a nine out of ten. For some women it's a one out of ten, So it really depends.

42:15 And this is the combined pill. What about a progesterone? How do you pronounce that progesterone? First? Progesterone? I always like, I always struggle with it. Is that different? Would you're waiting for that being? Yeah?

42:25 Well, the progesterone pill can be used as well, and sometimes women are given a progesterone type pill to just have a withdrawal bleed every few months, so you don't take it all month, you just take it to help you have a bleed, and some women prefer that. The thing with progesterone is that it can actually the progesteroney methods of contraception can sometimes worsen acne symptoms, and that's not always spoken about. So if your doctrine knows that you have PMS and suffer it with acne, they shouldn't really be kind of looking at those progester and any methods.

43:02 I feel like that's nothing something that's like commonly spoken about.

43:06 Yeah, I've never heard of that.

43:07 But again, for some women, they can't have the combined pills, so progester might be the only option. It's it is a minefield.

43:12 I was just thinking that's the right word for it.

43:14 It's such a minefield. I do kind of really go into great detail about this in my book. But there's also a great platform. It's called The Lowdown and it's kind of like a trip advisor for contraceptives, and it's run by doctors. Okay, I really rate it, So before you go into the doctor, have a read of that because you can like compare different options, see the side effects.

43:39 It's really helpful. That's great, I know.

43:42 Link to that.

43:42 Yeah, anostole, anocetol. I really rate this, so I'm going to give it an eight out of ten.

43:50 Oh my god, that's high. That's a high score.

43:53 So innocetol is like a type of sugar compound and the body. We can get some from food, but it's really really needs to be taken in supplements to get the high dose where we see benefits. And the most kind of evidence back to form is myonocetol, or a combination of myostol and dechiro inocetol. And this kind of works by improving your insulin sensitivity, so it helps with blood sugar, but it also improves ovulation. And I think probably the biggest win that women experience is that if you've got irregular cycles, you tend to find your cycle lenth starts to shorten, and you know, it's a fantastic supplement.

44:35 It's well evidence backed, very low side effects. I don't really hear much from people who take it, but it's also not a magic bullet. And for some women it's fantastic and they get results amazing and they just think, oh my god, I could never be off this. And other women try it and they're like, it actually doesn't do very much for me, And that might be because we're seeing different types of PMS and we don't fully understand that.

44:59 Se responded really well to it, because I read a couple of studies about it last year and shout out to Grace Beverly Shreddy PMS.

45:08 You find it beneficial.

45:10 I have life changing and I but I also have just taken my own nose at all on its own anyways. But that's just my experience. But yeah, I like that you gave that a note kind of confirm something for me. I'm like, oh, it's working, okay, great, low carb diet.

45:27 I'm going to give it like a three out of ten. So that's not because there's no evidence for low carb diets. There is, but there's nothing to say that it's better than like a moderate carb intake, so like forty five percent of your diet. Also, a lot of the low carb studies are actually pretty high carb. Like they're not like, well not high carb, but they actually have quite a lot of carbs. They're not like ketogenic in that they're like ten percent of your calories. So in these studies where women are on low carb diets, they're still eating quite a lot of carbohydrates. I generally like to keep carb hydrates in the diet because they're really great source of fiber, b vitamins, and other nutrients. Carbs are also

46:06 important for thyroid hormone production. If they become low, that can impact your cycle. And also it's just more enjoyable, like why could I carbs if you don't need to. So in my practice, I always include carbohydrates in the diet, and we just focus on the quality of carbohydrates, so low glycimic index, so carbohydrates that aren't giving you big spikes and glucose and that means, you know, we're choosing those that are full of fiber, your whole grains, your brown rice is that kind of thing. So yeah, I really don't rate a low carb diet.

46:39 Okay, what about high protein diet?

46:41 Yes, big fan of that. I think protein in the diet can be hugely satiating and also really important for kind of body composition. But also high protein diets have good evidence in pens.

46:54 Seven hours of slight.

46:56 I'm going to give a seven out of ten. I would love seven to nine, like if you can go even more cautious saying that because some women are like, I'm struggling to get seven. I have kids, I have demanding work life, all of that. So I think on the days you can get more, go for more. But seven as a minimum. As a minimum, sleep is so important for pmos.

47:17 What would you give nine? Hypothetically if I had said nine, knowing that it's not always accessible.

47:22 But yeah, world, I would think nine out of ten.

47:25 Okay, red light therapy.

47:29 Like two out of ten because there's not really any research on red light therapy. From the top of my head, I think I've seen one study and it was an in vitro or mouse study on that and PMOS. I'm seeing more of it in the fertility space, so I don't want to eat my words. No, but right now I'm going to say two out of ten, like, don't waste your time, okay, folks.

47:50 On the other thing, it's not a big thing right now.

47:52 Drinking alcohol zero out of ten. Okay, Well, like, do you know what it's fine to drink. There's nothing to say that moderate consumption is going to ruin your symptoms or worse than your symptoms, but it's not going to be helpful. Alcohol is very pro inflammatory. PMOS is a pro inflammatory condition, so we want to reduce inflammation. Drinking a lot isn't going to help. It's also going to have knocking to effects in your sleep, on your stress, everything else. So it's not great. But if you have the odd glass of one here and there, I don't think it's going to cause much harm.

48:27 You don't need to get too stressed about it.

48:29 Yeah. Yeah, Lifting weights probably like one of my favorites. I'm going to say nine out of ten because I don't really see many drawbacks. Obviously, it requires effort. Yah, yeah, it requires effort, so that's the only drawback. But we want to build muscle, and as pmos, it's really important that we've got muscle mass because muscle is like a sugar sponge. So I've seen someone use this analogy of like do you know what the bis the cereal? Are you? Yeah?

49:01 I think we to mix is Australian okay? Or is that just something that everybody claims Probably.

49:06 Yeah, it sounds British. Yeah. Yeah. So if that's your muscle and then you pour milk on it and then it soaks up all that milk, that's kind of what your muscles are doing. What blood sugar? Okay, So the more muscle you have, the more insulin sensitive you are. So it's really beneficial to be building muscle. And that doesn't mean that you have to like be so hench and like have loads of muscle. But it's good to lift weights and do resistance training. So that doesn't include like small weights on your ankles when you go for a walk. I mean like actually lifting weights. Some form of plattates do count, because I always get asked that, like people say, like does platates count? Some forms do, but the reformer platates would be like more resistance because

49:48 you're actually using a lot of resistance there, whereas if you're doing Matte Platti's and you're not doing a huge amount, you may not be using as much stimulus. It's not to say it's redundant. I love blatties, but I'm just saying I love all women use weights because then they're adding more of a stimulus to building muscle.

50:05 So this is something I'm sure a lot of women have heard, which is like, you need to be lifting heavy? What does that mean? When somebody says, oh, you need to be lifting heavy. I'm a big fan, but I remember hearing that and being like, I don't like something over my head, or like when I first started, I was like do I push something? Or what does that mean?

50:24 It is a very vague phrase, and I think it's all relative. But moving any form of resistance I think is beneficial. So if that's weights, if that's bands, if that's reformer, that's going to be muscle strengthening. So if we want to build more muscle and build strength, we need to have progressive overloads, So we need to increase the amount that we're doing. So if you're you know you've go to the if you go to the gym and for the first four weeks you're lifting let's just say two kilogram dumbbells. In the next couple of weeks, I want you to increase that because you need to increase the stimulus to build strength. And that's just what we mean because I think typically, and this is very much like generalizing. You know, women use these tiny one

51:10 kilogram weights, and sometimes there's one kilogram weights can be really heavy if you're doing lots of raps. But if you're using the big muscles of your body, so that's like your quads, your glutes, your hamstrings, your back, we can lift a lot more. And so we want to be kind of pushing ourselves. If you're able to do twenty reps and you're not breaking a sweat, you're not lifting heavy enough.

51:36 I like that. I like that as a rule. Okay, I've got one more, and I just threw this one on because it was a nice, fun one, which is peppermint tea.

51:45 So I see your peppermint tea, and I raise you spearmint tea because spear mint tea?

51:50 Is that not in gum? Is that what I think?

51:53 Yeah? Okay, okay, yeah, it's actually hard. It's quite hard to get your hands on like pure sperminty. But there's evidence that spearmin tea can reduce androgen. So testosterone two cups a day, try it for three months. There is some research for it. Peppermint T less so, but it's good for the ibs scurties.

52:12 Oh okay, there you go, girls, knowing your ratings there. Oh you didn't give it. What would you give spearmint.

52:21 I'm going to give it a five out of ten.

52:22 Okay, peppermint T would be less.

52:25 Yeah. Not for pmos. We'll give it two out of ten. So if you get bload in it might be helpful.

52:29 Okay, great, I walk into your office, I go doctor Hazel, help me, and I give you my symptoms. If you have to give like a top four, what would you say to a woman who's experiencing PMS to start doing or to start trying or to stop doing.

52:48 So? I'm gonna leave eddy medication chat to your doctor because there are some options beyond the pill that you can discuss and also will depend on whether you are actually trying to conceive or have any risk factors. What you can start doing today. Nutrition is going to be a huge part of it. First and foremost. Now, there's no specific diet, there's no single diet that will kind of cure PMOS. But nutrition is so powerful, Like I can't tell you enough. I feel like it transformed my symptoms and it's what I do every day in my practice.

53:28 The best way to kind of like summarize what you need to do from a food perspective for PMOS is following a Mediterranean style dietary pattern. I know that we bang on about this diet for everything, and that's because it does a lot of things, but because it's a dietary pattern, so it's not a specific foods that you need to consume it to not have two almonds a day or anything. It's a pattern, which is good news because it means that it's flexible to you. And what I mean by that is we want to have lots of colorful fruits and veg, whole grains, fish and nuts and seeds, moderate intake of dairy less red meat, processed food, and alcohol and sugar. Within that. When it comes to the macro nutrients, the key macros are the three are protein, carbs,

54:17 and fats. We already talked talked about carbohydrates, but we want to have them in the diet to make up around forty percent of your overall calorine take, so present at every meal, but the high fiber, low glycimic carbohydrates glycemic. When we say that word, we mean blood sugar, and adding fiber to your meal reduces that glycemic impact, but also pairing carbs with fat and protein further reduces it.

54:48 So if you're having a slice of toast and you add some smashed avocado and maybe a poached egg on top, you're getting carbohydrates, fats, and protein, so that blood sugar response will be less than if you had a slice of sour dough with some strawberry gem on top or banana. And that's not to say that you can never have a single carb on its own, because they have their place, like around exercise. We want those fast acting carbs. I run a lot. I'm having bananas before I run. I'm having toast with honey on it. That is absolutely fine if you've got pmos, but if you're sitting at your desk or you're about to go to work, we want steady energy levels and it's going to be those balanced meals that give us those steady energy Now I mentioned

55:33 inflammation earlier, and the only the things that help reduce inflammation in the diet are all that colorful fruits and veg and so we want as much of that in there. We want nuts and seeds, we want our oily fish. Oilyfish specifically is a really great source of amiga threes, and we can get omega threes from other sources like cheese, seeds and walnuts and plant based foods, but our body has to convert it, and that conversion is not We're just not great at it. So if you don't have oily fish, and I'm not saying you have to, but if you don't, I would think about adding an omega three supplement and still prioritizing those sources because omega three is hugely beneficial in PMOS. You've got lots of good

56:17 evidence behind that. That's really darting and nutshell. We kind of said we mentioned alcohol. Ideally limit it as much as you can. Limit as much processed food as you can. But if you're traveling for work and you're in an airport and the only thing that you can get is a processed snack, one day of kind of processed foods is not going to derail you. It's what you do eighty percent of the time that will impact you the most, not what you do twenty percent of the time. So that's nutrition and then supplementation. Annoying answer, but it does depend.

56:52 I think nostol is a great one for most women with PMOS. Give it a go for three months. Anyway, in the UK, vitamin D is a big one because we don't get much sunlight. Low levels of vitamin D are quite common in PMOS and if you've got low levels, that may worsen symptoms. So I tend to look at supplementation, but always look at people's blood tests first, and then on top of that it's really variable. So like I mentioned omega three, if you're getting two portions of oily fish in your diet, there's no point in me adding omega three into your diet supplementation. There are other supplementations supplements that people try, and that can be magnesium, burberine, chromium, copper, loads of different ones. They are varying amounts of evidence.

57:41 You'd probably be surprised at how little I prescribe supplements because yeah, I think if you can get it from your diet, I really don't want to be giving you loads of supplements. The supplement industry is so poorly regulated as well, and I think nothing's better than a food first approach. Yeah, and outside of food, exercise, sleep and stress management are the other things. So exercise, there's no single best form of exercise when it comes to PMOS.

58:10 A lot of people say, only do low intensity. That's not true.

58:14 That was going to be one of my questions. I always see people being like, don't do hit workouts? Yes, but I love I have this one class I talk about on this podcast all the time called sculpt that is just like a hit workout in like a sauna basically, And I'm always like, should I be doing that? What's your take on? Yeah, on hit workouts.

58:34 So I've really wanted to talk about this because I find it really surprising that this is a big thing, Like it's big myth, because the research shows the opposite. There's like good research to say high intensity exercise improves PMOS symptoms. And when we pull together all the different exercise studies in PMOS, there's no superior type that's like best for women with PS. It's kind of a combination of both. The caveat to that is And this is where I think because some people I speak to say, well, actually, I know high intensity exercise or running made my symptoms worse.

59:16 And then when we kind of get into the grains of salt or whatever the phrase is, grains of rice, we're getting to the right. What I realize is it's actually, it's not the high intensity exercise that's the problem. It's the fact that you're doing loads of exercise fasted, and you're doing a ton of exercise, and you're not making time for recovery, and your sleep is off. So we're underfueling and we're under recovering, and we're doing too much exercise.

59:48 And actually, if we bring down the intensity of how much you're doing, so instead of doing seven back to back barriers classes every week, we're doing three hit workouts and two strength sessions per week. We're fueling before we go to the gym or for hit sessions. We're making sure we're optimizing our recovery afterwards, we're resting. No longer do we see those issues. So, and that goes for every woman with or with that PMOS. It is not bad for you. It doesn't harm your hormones. But if it's all you do. You're not recovering and you're underfueling, you're gonna have issues.

1:00:27 I like the caveat let's finish that an optimistic pathway. What are some of the promising things that you are seeing in the research right now that you're excited about.

1:00:45 I think, well, I guess first of all, the fact that PMOS has had a name change, I think is going to open up more opportunity for researchers because it means that we're shifting our focus, which is so important because means more research means better guidelines, more treatment options for women. But across the board, we are seeing a lot of advances in diagnostics for women's health, especially when it comes to conditions like enometriosis, where it typically our diagnostic techniques are quite invasive where we have to look inside your tummy through surgery. And there's a lot of research looking at kind of on the spot diagnostic for enometriosis, which would be amazing. So I think that's fantastic. I

1:01:35 think when it comes to PMOS specifically, there's no specific thing that's on my radar that's going to transform things. But if we can fully establish these different types of PMOS, I think that will change how we treat women. I'm really hoping that this new name change means that when women go to their doctors, they will start to feel like they're actually heard, that the symptoms that they're feeling outside of the reproductive system matters, because I think for a long time that was kind of dismissed as it's just not relevant to the conversation.

1:02:15 Yeah, no, for sure.

1:02:19 I know.

1:02:20 I said we're going to end on a positive note, and we are because I'm going to ask you this question that I think is kind of strange. But it was inspired by this article I saw that was like this is so strange, but it's like people with endometriosis are like rated is more attractive. And I know this has been debunked, but I remember reading it and being like that that's so funny that they're like, here's a consolation prize.

1:02:44 Yeah, they actually retracted that article because there are so many issues with it, but I'm also like to publish a paper. First of all, there was like multiple authors on that, so they all sat around and agreed that this was a great idea, and then they went and got you know, ethical approval for it. So other people had to approve it that it went through a whole publishing peer review and no one was like this is absurd.

1:03:08 That also it's completely irrelevant and also irrelevant. Yeah, like this is April feels like wild.

1:03:17 Also so funny that you couldn't have the emotional intelligence to realize women's health funding is so limited. They got money to do that study that could have been spent on like a million other things, and they were like, are these women hot or not?

1:03:35 Yes? Hot or not?

1:03:37 They were like, can you pay us to play hot or not with a bunch of people who are like experiencing like a life changing illness. Yeah? Please?

1:03:44 No, It's how crazy is It's so crazy? And there's there's been other studies like within endomitrisis, and it's like the impact of endometriosis on patients, on the male partners patients, the impact of sex life. That's what I was like, No one cares.

1:04:04 Also, yeah, go away, leave her alone, like she's gone through something like that's just insane that it's like that we have all this limited money and we're gonna be like, here is the patient and then it's like they shift. I can almost imagine like they're looking at her and then they're like their gaze like kind of grows out of focus and they like look behind her and they're like you, They're like, how do you feel? And it's like what hello?

1:04:28 Like?

1:04:29 And this is gonna sound so ironic because I'm gonna ask you, like, obviously, I'm yeah, are women with pmost more attractive? Doctor Hazel, what's your opinion? But you mentioned things of like, oh, women with pmos may have more testosterone androgens x y Z. Is there anything beneficial or not beneficial? But just like any silver linings for pmos, anything that you're like, great, at least I'm maybe better at that. At least I have a lawer risk factor for this. Anything that's like again a consolate.

1:05:00 Prize, so potentially may be able to build some more muscle, which is beneficial for many things because you might go through the menopause slightly later. I think it's like two years an average later, which is a beneficial thing. And I think something I've been personally thinking about in my own journey is and I don't think i've been I've never articulated it publicly because it could go in or two ways, but I think for me personally, it was while I didn't cause my PMOS. The lifestyle I was living wasn't helping. And I think going through the diagnosis made me, for the first time in my life, actually start putting me first and caring about my sleep, my boundaries, my nutrition, exercise, like a lot of things that I

1:05:55 really enjoy, but I always put other things first. So I think it's helped me to, yeah, put myself first and actually prioritize my health. And while I'm not grateful to have PMOS, I'm grateful for that because I believe that I'm actually a much healthier person than the person I was when I first got my diagnosis. And I don't really experience the day to day symptoms of PMOS after, you know, I was diagnosed in twenty eighteen. After eight years of going through this, I have regular cycles. I ovulate, and I see that I can help women achieve that, and I think that's a really positive thing. It's not you know, we talk about all of these risk factors.

1:06:44 It's not a sentence. This doesn't mean it has to happen.

1:06:47 Yeah, And I think that's really how I wanted to end the episode of like this is you said before, Like you can kind of go into it can be asymptomatic asymptomatic, and I think I read a paper that it can go into remission almost And I think we've spoken a lot today about the difficulties in so many areas of life for someone from an anecdotal point of view, from a clinician point of view, from a research point of view, and so I think ending on this note of like, yes, terrible experience, Yes, hard to have your symptoms recognized. However, like there is hope and there are things that maybe you aren't being offered that will assist to you. And maybe there's not a silver lining, but having any kind of conversation about women's health is helpful.

1:07:35 And having any conversation about your own health, even if if it's maybe not the conversation you want, you're like, maybe don't want to be having just brings an awareness that I think has benefits to it.

1:07:47 Yeah, I completely agree, And I think I was on Grace Beverly's podcast also we talked about PCs at the time, and there's a really there's a sound bite that went really viral, and it was me saying, we say that PCOS can't be cured. It was PC of the time say PMOS can't be heared, but I'm not so sure anymore.

1:08:04 And that clip went really viral because we say it's incurable, but actually I have seen it in myself and other women be completely dormant, where even your ultrasound features improve. And I think I think it's helpful to use that terminology because women need to know that the kind of the state of their PMOS today doesn't mean that it's going to be like that forever, and they need to know that there is a chance for improvement, and there is an absolutely everyone, but the way to get there might be different for another person who has the condition.

1:08:40 And you know, one of the things you mentioned, which we didn't really cover in great detail is the fertility aspect. And it is more difficult to get pregnant if you've got PMOS. That is a fact, but that's largely because you're not ovulating every month. There are medications we can use to help, there are fertility and techniques beyond that.

1:09:00 Before you get pregnant, we can work to restore ovulation through supplementation, through nutrition, through all the things we spoke about. And I think PMOS, compared to a lot of the other women's health conditions. I'm thinking about endemeutrisis is probably the most influenced by our lifestyles. It's so influenced by our lifestyles, which is a good thing and a bad thing, but it's a good thing too.

1:09:22 Yeah, And I really liked that we've also ended on that because I didn't even talk about this. But again I didn't. I didn't want to make the conversation to like fertility dominant, because I know for some women that's just not something they're thinking about, you know, in the early twenties and twenties, or just not something they want.

1:09:38 But I like that you've mentioned that. You know, when I was told I had back in the time, PCOSL like, oh, a third of women can't get pregnant, like dun, don't dun. And I remember really freaking out about it and then just reading and being like, wait, that's where do they even get that number from?

1:09:55 Yeah?

1:09:56 Right, Like that's just this random number. And another thing to say that it's completely separate. Anytime you see a statistic that's like one third, and it's a neat number like twenty five percent or like fifty percent, or it's just such a clean number, you should always be skeptical. Oh my gosh, you always be skeptical, because that's when does that happen? And learning more about like actually, no, like there are so many stories of women who have this condition who never have trouble, do have trouble find you know, these amazing treatments and clinicians who believe them, Like, there is just so much the fact that we're having this conversation, like the momentum towards better days for people

1:10:37 with this condition is on the up, Like the velocity at which we're moving towards a better future for people with PMOS is increasing. So thank you for yeah, confirming that you're so welcome. Yeah, one more question. I'm sorry, and it has nothing to do with what we talked about. It I almost I'm so like enraptured by how you how you're explaining this in a way that it's just like so remarkable that forgot to just do the thing that we do in every episode, which is about your twenties.

1:11:06 Are you still in your twenties?

1:11:07 No, I'm thirty five.

1:11:08 You're thirty five, Okay, I actually think that's a great age to ask this question because you still remember what it's like. But like you're like halfway through your thirties. Now, what is one piece of advice that you wish you had had received in your twenties or you wish you knew in your twenties that our audience should know. Caveat because we love a caveat, as we've spoken about, has nothing to do with what we talked about today.

1:11:33 Okay, can I give two?

1:11:37 Oh? Yes, you can give it four. You are full of information.

1:11:40 You can.

1:11:40 You could just do a whole other episode. We would welcome that.

1:11:44 My first one that I've been thinking about lately is I regret not having more fun in my twenties because I think I took my life very seriously to get to the place I wanted to with my career, and I think I still could have done that and still taken myself less seriously. So I think embrace your twenties because you can still have so much fun in your thirties as well. But if there are things that you want to do in your life, be that like buying a house, haven't started family, things can your responsibilities can rack up, So enjoy kind of the fewer responsibilities of your twenties if you can. The second thing is it's okay to change your mind and to pivot. For a really long time, I was kind of stuck on one

1:12:31 pathway and I thought everyone would judge me if I changed. I left the NHS, which is the national healthcare system in the UK, a couple of years ago, and I was so terrified of judgment, and I'm so much happier for it. And I've dedicated my life now to women's health, which was very different to what I was doing before, was doing nutrition in the hospital. And I think for so long we kind of picture ourselves as this one identity.

1:13:01 But it's okay if that changes, and that might change again, So it's okay to not have it all figured out, and it's okay to change your mind.

1:13:08 I love that advice. What a beautiful way to end the episode. Your book is coming out and payback very very soon.

1:13:14 Yes, in two dates, three days.

1:13:16 Three days that will be would have already happened when people listen to Yes, it's called not just a period.

1:13:22 Yeah.

1:13:23 I just feel like from the conversation we've had today, I'm going to be picking up a copy and I'm going to leave a link in the description for you guys too as well. Because I know it might be somebody who feels awkward and people give you compliments, but the way you've explained that is one of the most remarkable kind of conversations that I've been able to have on the podcast, So thank you so much. Anywhere else that people can find you or where they should go looking for you.

1:13:49 Yes, on social media on Instagram, so my main thing. I also do TikTok, but Instagram and TikTok under my name doctor Hazel Wallace, I talk mostly about women's health. I do a lot of nutrition on there related to women's health as well, and I'm very happy for you to do some medium So.

1:14:08 Yeah and yeah book Instagram. I will also leave like a link to your I guess your website or like your Clinchion page as well so people can can check you out. But again, thank you for coming on the podcast. I hope you the listener has enjoyed. I hope you've learned. If you are whatever way through your PMS PMOS journey, you are sending you a whole lot of love and support and hopefully just the value and the knowledge that other people are going through it as well and that there is a lot to be optimistic about so. Until next time, be safe, be kind, be gentle with yourself.

1:14:45 We will talk very very soon.