The Psychology of your 20s - 447. The psychology of PMOS/PCOS ft. Dr Hazel Wallace

Episode Date: August 17, 2026

I was recently diagnosed with PMOS, and with that came a lot of questions: why is my body like this, what caused it, will I be able to have kids, how can I fix it? There's a lot of information (and misinformation) online, so today I decided to sit down with an expert to ask all my burning questions on this condition.  Watch on Netflix: HERE Dr Hazel Wallace is a medical doctor, registered associate nutritionist, women's health expert, author and founder of the platform, The Food Medic. In this episode, we discuss:  The origins of PMOS/PCOS  Why we had to change the PCOS name  What causes PMOS and whether it's genetic  How PMOS intersects with psychology and mental health The 5 things you should and shouldn't do if you have PMOS  What actually helps  How to deal with medical dismissal and misinformation Happy listening!  Dr Hazel's book HERE Follow Dr Hazel HERE  Follow Jemma on Instagram: @jemmasbeg Follow the podcast on Instagram: @thatpsychologypodcast Subscribe on Substack: @thepsychologyofyour20s For business: [e-mail]  The Psychology of your 20s is not a substitute for professional mental health help. If you are struggling, distressed or require personalised advice, please reach out to your doctor or a licensed psychologist. See omnystudio.com/listener for privacy information.

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Hey, this is Hayes Davenport. And Sean Clements. We host the podcast, Hollywood Handbook. Every episode we're trying to help our guests improve their careers by mainly focusing on how they can help us improve our careers. The show's famously super accessible so you can easily jump into any of our 650 episodes and understand what's going on. We recommend some of our recent episodes with Ben Stiller, Danny McBride, Riz Ahmed, and Mary Steenberg. Listen to Hollywood Handbook on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Nick Terturo. You probably know me from NYPD Blue, the longest yard, or Spike Lease Black Klansman.

And on my new podcast, Delivering Happiness with Nick Tatoro, I deliver pizza to a new guest. I've shared a slice with everyone from Seth Rollins. What are you doing, my belt? To Bill Burr. I don't think I've ever met somebody so exactly out of their mind as I am. And now, we even have more great guests coming up, including the great John Tuturo.

It's called Happiness, Delivering Happiness. And many, many more. Open your free High Heart Radio app. Search Delivering Happiness with Nick Tutro. And listen now. I'm Hoda Kotopi, host of the podcast, Joy 101 with Hoda Kotvey. You know, I'm always searching for inspiration and useful tools to maximize joy. Like when my friend Henry Winkler offered advice to aspiring actors and really anybody hoping to stand out.

You're not hired just to fill time and space. You're hired to fill the space with you. Listen to Joy 101 with Hoda Kotby on the IHeart Radio app, Apple Podcasts, or wherever you get your podcast. Our hometown is not a test tube. 90 miles northeast of Nashville, a battle for the future of America, plays out in one small town. Developers with right-wing ties

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on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Hello everybody. I'm Gemma Spike, and welcome back to the psychology of your 20s, the podcast where we talk through the biggest changes, moments and transitions of our 20s 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 20s. 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. We are talking about the psychology of PCOS, PMOS, as it's now called. Kind of to 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 PMS has on our mental health, our emotional health, as well as the physical symptoms. Something I know would 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 in others are not? So today, we're just going to create that opportunity for others. I have in the studio, Dr. Hazel Wallace. She is a female health specialist, a doctor, a nutritionist, the author of Not Just a Period. 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. Dr. Hazel Wallace, welcome to the psychology of your 20s. Thank you for having me. Do you find the intro is a little bit awkward, 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, so thank you very much. 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's the work that kind of lights your fire? What do people know you as? Or who do people know you as?

So in terms of who I am and how I got into this work, it is quite a long and winding story, but I'll try to summarize it quite short for you. So my backstory is when I was 14, I lost my father to a stroke. And being a 14-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. 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 14 years ago now, which is crazy because I'm like a dinosaur in the industry, called the Food Medic, really trying to like connect medicine and nutrition. And that was what I did for a really long time. 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 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 in raging 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 2020, 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 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 2025 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, 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. I'm just like listening to you being just nodding my head.

Just being 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 like 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 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 what it's like to get help as a woman, I really don't know what is.

Yeah. 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 very recently, like three months ago. Three weeks ago, wow, my gosh, so, so that has happened very recently. Okay, talk us through it. So there are a lot of letters and a lot of words, but I will break it down. So formerly called PCOS, polycystic ovary syndrome, has been renamed to PMOS, which stands for polyendocrine, metabolic ovarian syndrome. Like, breaking down that name in itself, I think is really important.

Polyendocrine, poly means many, endocrine means hormones, many hormones are involved. 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 health. 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 a name in medicine. Like that in itself is huge. But it came about because so many patients and practitioners were like, PCS 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. 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 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 in their textbook. Whereas now we know it's much more than that. So that is something I did not know, which was that previous. obviously, as you're kind of telling us, only if you had cysts on your ovaries, would they say yes, you can kind of enter the gate? Is that what you were saying? 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 one I'm, am I right in assuming? 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. Oh, okay. One of them is polycystic morphology. 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 ovary 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 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 jaw line, 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 chest, typical male pattern or acne or hair loss from kind of male patterns on the forehead or on the scalp. And the third feature is absent or regular periods.

So you have to have two or 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 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. Or take the pill and that will sort you out. 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, 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. And it's so wild to me because I was given that exact quote, whenever I say it online, where I hear it repeated back to be by thousands of women. I'm not going to lie.

Somebody said that to me last week. I'm not even joking. I had a gynecology appointment. Last week, I had to go private because I'm, I'm 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. And I went and I was like, I have never gone to a private doctor before in Australia. It's very rare. And I was like expecting her. I was like, oh my gosh, I'm so, I was excited. I'm so excited. I feel like she's going to have something for me. And she told me to exercise, which I was like, well, I already do that.

And then was like, oh, but your blood pressure, like your heart rate's really low. You have like brachocardia. And I was like, oh, because I exercise. So we can rule that. Thank you for the advice. We can rule that one out. And then she was like, you have a partner. And I was like, yeah, I do.

And she goes, are you guys trying to have kids? 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, we'd be really worried if you're like trying to get pregnant, but you're not. So we kind of have some time. And I left and I actually was like very teary and very upset about it. 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 to. 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, know from experience, there is like a laundry list 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? 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 haircitism, which is hair growth in unwanted places. And it's typically around like the jaw line 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 resistance

has 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 someone. And just that conversation didn't happen because that carries its own risk factors of future type 2 diabetes, cardiovascular disease, which women with PMOS unfortunately have much higher risk of. 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. Well, yeah, I didn't get any of that, but that's interesting. Maybe I'll ask for a follow-up appointment. Please do. The new Red Bull, Dragonberry and Tropicberry energizers now at McDonald's, made with freeze-dried fruit and an electric burst of flavor. The all-new Red Bull Energizers. Now at McDonald's. This product may not be right for you. High in caffeine, details at McDonald's.ca.

At participating Canadian restaurants, excluding Quebec. Hey, this is Hayes-Davenport. And Sean Clements. We host the podcast, Hollywood Handbook. Every episode we're trying to help our guests improve their careers by mainly focusing on how they can help us improve our careers. The show is famously super accessible, so you can easily jump into any of our 650 episodes

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And you make it on, you make your own. That's great. I call him Terro Reed. It's a good name. They're all named after cast members of American Pie. Yeah. I call, I don't, I never looked up if she was a. in this, but I call him Leachie Sobieski.

I don't think she was an American pie, but I still like that. I haven't looked it up. She was prominent around the same time. Then Mary Steenberg. Why are you guys talking to me? I'm worried. Why are you talking so down to me that you think I don't understand your little

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They feel like they're standing in opposition to an entire administration. Guess you didn't move in on a bunch of dumb hillbillies now, did you? Listen to Our Town on the Iheart radio app, Apple Podcasts, or wherever you get your podcasts. So 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 underdeveloped or overdeveloped follicles, like in the ovary. Yeah.

Is that what it is? Or like, how does this start? Where does it come from? It's a great question. And in terms of what causes PMOS? The short answer is we don't know, but it's likely to be a combination of genetics, environmental, and lifestyle factors. So a 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. 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 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. 80% of women have insulin resistance regardless of their BMI or body weight. Insulin resistance means that our body isn't responding as well to insulin when we have carbohydrates. 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 androgens, testosterone. They can also directly impact the ovaries. 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. 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. We can't neatly categorize them yet, but I suspect that in the future that we'll have very personalized treatments for different types of PMOS because it behaves so differently in different women. 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. I'm 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, this, this. And it would be PMSS is the lack of a period. PMS is this and this. And I was like, but I don't have those things. 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 is 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 like neurological disorders. Is that kind of what you're seeing happening? 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. They may have, you know, the irregular cycles and the acne. Or they may have normal cycles and really bad hearsitism 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 accurate 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 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 are really ladding down women. 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 call 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 even 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 because like there is no consensus on this.

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 healthcare provider, women turn to social media. 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 health professional who also creates content and 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 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 world 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 there is, 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 have a, I work in a clinic and I see a lot of PMS 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, so many different things. 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 something. 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.

Yes. And I think that's a big red flag if you have somebody who's like, 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. 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 magic bullet because

they just don't exist. Like, unfortunately, they don't. And you're looking for research. Yes. If somebody's, make sure they're starting sources. Yeah. And check the sources. Absolutely.

Sometimes somebody we, I actually had this happening the day where I was like, 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 chipped. 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 or 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? Is it purely because they are experiencing a medical issue that is being dismissed? So is it contextual? Is it environmental? Or is it biological or social? Why do you think it is? I think with anxiety and depression, it's usually multifactorial. And that's the case in PMOS. 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 higher rates of eating disorders. And a lot of that is,

from what we know, is it at least in part related 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 the kind of hormonal systems are probably at play here and 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. There's, I guess there's what I'm trying to say, there's so many things that could be contributing. Yeah. And I like that you have said that rather than just being, 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. And you're like, wait, but I, what? am I meant to do? Do I feel it so deeply that this is impacting me, but maybe I don't have it.

A doctor took a while to diagnose me. Now they're saying, come back 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. Yeah. I think, I mean, it's massive and it goes for so many women's health conditions beyond PMOS, you know, endometriosis takes eight years to be diagnosed. Wait, eight years? Yeah, eight years on average, like globally. Oh, I didn't even know.

That is insane. It's insane. And the UK, there was a report in the UK not too long ago, which there was this fact from it, which was so shocking that on average women had gone to their doctor more than 10 times, their GP more than 10 times before a referral for investigations, which is, you is just wild. So I think PMOS slightly shorter time to diagnosis largely because different ways that we diagnose it's less invasive. But I think having PMS 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 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. 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 you and being like, oh my God, thank you for listening to me.

Thank you for just like letting me say that. And I'm sure like the stress levels plummet immediately, probably. And like just this tension that you're like you're holding is 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, don't be stressed, but like this condition 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 of those things on the systems of somebody with PMS?

Yes. Stress is hugely impacted. it. 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 cortisol that we often talk about. And that can impact our ovarian access. So the hormones that are released from our brain that tell our ovaries to produce hormones. Cortisol can basically downregulate that. So it can switch off those signals 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 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 dieting, 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 androgens, testosterone. And there's an association with PMOS where women may have higher levels of cortisol who have PMS. So baseline levels are slightly higher. And then if you're kind of more stressed,

you're kind of increasing that even further. So it's not great. So stress management is a huge part of the picture when it comes to helping improve PMOS symptoms. Now, I think when it comes to stress management, often the advice is just stress less. Like, don't be a stress. And goodbye. Have you tried meditation? Yeah. 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 is 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 10 hour days? I'm, you know, moving house, moving country, whatever it might be. 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 you experience. And that might be that for the first 30 minutes of your day, you're not going straight in your phone because cortisol is highest in the morning. If you get up and you're looking at your phone, looking at your emails, you're just increasing that 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 fan of fasted exercise because we're increasing cortisol when we don't need to do that. So it's those little things. 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, 10 minutes a day.

but stress management for every single woman with PMOS is very important. 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 actually doing everything right. You know, I'm according to like this information I was given, you know, I'm like doing so good with like not eating processed carbs. and 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. Yes. Do you know what I mean? It's almost like it's like the alcohol or like the cigarette of like the emotional states. Yeah. Where it's like, but I need my stress. I need my stress to like get stuff done and I need my stress to like be successful. And then it's, you eventually get to a point where you're like, but also I, I, I.

I need to be healthy. And we don't really consider it until you exit a period of that. 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 going to 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?

you go to a GP's office, if you go to a doctor's office, what should you are, 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, you know, that will get people paying attention? How do you advocate for yourself just very quickly before we go into? 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 PMOS, 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 10 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 earlier for getting the diagnosis are those that criteria so two of three and that's the same even though we've changed the name the criteria for diagnosis is the same so irregular cycles evidence of raised 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 you could be diagnosed with just that because you're meeting 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 um beyond that we should also be just doing our due diligence checking things like your blood sugar balance or what we do we use a different test in the UK, called HBA1C, 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. Okay. That's good to know because 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. Yes. Dragonberry and Tropicberry Energizers, now at McDonald's. Made with freeze-dried fruit and an electric burst of flavor. The all-new Red Bull Energizers, now at McDonald's.

This product may not be right for you. High in caffeine, details on McDonald's.ca. At participating Canadian restaurants, excluding Quebec. Hey, this is Hayes Davenport. And Sean Clements. We host the podcast, Hollywood Handbook. Every episode we're trying to help our guests improve their careers by mainly focusing on how they can help

us improve our careers. The show is famously super accessible so you can easily jump into any of our 650 episodes and understand what's going on. We recommend some of our recent episodes with Ben Stillard. The definition of what is a movie has kind of changed anywhere too, right? What do you think it is now? It's images and words being spoken, captured by some sort of technology. Danny McBride. Oh, that's fantastic.

And you make it on, you make your own. That's great. I call him Tarot Reed. It's a good name. They're all named after cast members of American Pie. Yeah. Oh, gotcha. I call, I don't, I never looked up if she was in this, but I call him Leachie Sobieski.

Yeah. I don't think she was an American Pie, but I still like that. Haven't looked it up. She was prominent around the same time. Yeah. Then Mary Steenbergin. Why are you guys talking to me? I'm worried.

I'm worried. Why are you talking so down to me that you think I don't understand your little play, play game? I just really. I get it. I'm trying to set you up for success here. Listen to Hollywood. handbook on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Nick Totoro.

You probably know me from NYPD Blue, the longest yard, or Spike Lee's Black Klansman. But I'm also from Queens, which means I know pizza. And on my new podcast, delivering happiness with Nick Totoro, I deliver pizza from Prince Street pizza to a new guest. Are you delivering pizza now? Then we sit down for a real conversation. I've shared a slice with everyone from Seth Rollins. What are you doing, my belt?

To Alex Rodriguez. Just to let you people know. We're talking to one of the goats here. To Bill Burr. I don't think I've ever met somebody so exactly out of their mind as I am. And now we even have more great guests coming up, including the great John Tuturo.

It's called Happiness. Delivering Happiness. Mariano Rivera. Oh, my God. And many, many more. Open your free High Heart Radio app. Search Delivering Happiness with Nick Totoro. And listen now.

I'm Hoda Kotbi, host of the podcast, Joy 101 with Hoda Kotby. If you know me, you know, I'm always searching for inspiration and useful tools to maximize joy. So this podcast lets us uncover those things together through meaningful conversations with fascinating people. Like when my friend Henry Winkler offered advice to aspiring actors and really anybody hoping to stand out. You're not hired just to fill time and space. You're hired to fill the space with you. You have something in your guts. You go with it.

And Sean Johnson recalled the moment she realized her now husband, Andrew, was the one. He was just so unapologetically himself and knew nothing of Hollywood. He hadn't been on a plane before without his family. It was so pure. Listen to Joy 101 with Hoda Kotby on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. Our town is small taters by most standards, right? But to the people who grew up here, it's every. What happens when a quiet Tennessee town becomes the front line in a battle over the future of America?

Developers with right-wing ties have purchased hundreds of acres of land in the area. The first thing you see when it pops up is pioneers in Appalachia. But they weren't just planning houses. We need cities on a shining hill that exemplify and embody the Christian way of life. Stop right there. Is that normal? A podcast about what happens when a small town becomes the site of a site of a Christian way of a Christian way of life. a social experiment. God need men to rule.

Great. And decides to fight back. Do not use my hard work to sell your bull. They're not just opposing what's being planned for here. Our hometown is not a test tube. They feel like they're standing in opposition to an entire administration. Guess you didn't move in on a bunch of dumb hillbillies now, did you? Listen to our town on the IHeart radio app, Apple Podcasts, or wherever you get your podcasts.

This is a nice segue into what's. 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 10 and then maybe go into some things that aren't on the list. Okay. So I spent, as I said, I spent a lot of time online on Reddit. Not 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 PMS might help, might not help. You ready? Yes.

Okay, the pill. Oh, this is such a big one to start with. So I won't give you a quick fire answer, but I'm going to 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 28 days they're having a bleed. If you have very irregular cycles, and I mean like three to six a year, so not very many, it's really important that we're protecting your womb lining because if you don't bleed regularly, that builds 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 hercetism, 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 option for you. And also, I think, you know, some women experience side effects from the pill that they really don't like. And that can vary, whether that's mood, libido, 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. And this is the combined pill. What about a progesterone? How do you pronounce that? Progesterone. I always struggle with it. Is that different? Would you're waiting for that be different? Yeah. 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 progesterone methods of contraception can sometimes worsen acne symptoms and that's not always spoken about so if your doctor

knows that you have PMOS and suffer with acne they shouldn't really be kind of looking at those progesterone methods I feel like that's not something that's like commonly spoken about yeah I've never heard of that that we go 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 I was just thinking that's the right word for it 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. It's really helpful. That's great. I know it's really great.

Oh, I'm going to leave a link to that below. Anositol. Anositol. I really rate this, so I'm going to give it an 8 out of 10. Oh my God, that's a high score. Enositol is like a type of sugar compound in the body. We can get some from food, but it really needs to be taken in supplements to get the high dose where we see benefits. And the most kind of evidence-backed form is myoanositol, or a combination of myoanositol and de-chiroinocetol.

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 length starts to shorten and it you know it's it's a fantastic supplement it's well evidence backed very low side effects I don't really hear much from 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 PMOS and we don't fully understand that. There we go. See, I responded really well to it because I read a couple of studies about it last year. And shout out to Grace Beverly Shreddy PMOS. You found it beneficial. Life-changing. Amazing.

But I also have just taken my own osatol on its own. Anyways, but that's just my experience. But yeah, I like that you gave that a night. Kind of confirm something for me. I'm like, oh, it's working. Okay, great. Low carb diet. 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 45% of your diet. Also, a lot of the low Carb studies are actually pretty high carb. Oh, like they're not like, not high carb, but they actually have quite a lot of carbs. They're not like ketogenic in that they're like 10% 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 carbohydrates in the diet because they're really great source of fiber,

B vitamins and other nutrients. Carbs are also important for thyroid hormone production. If they become low, that can impact your cycle. and also it's just more enjoyable like why cut out carbs if you don't need to yeah um so in my practice I always include carbohydrates in the diet and we just focus on the quality of carbohydrates

so low glycemic index so carbohydrates that aren't giving you big spikes in 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 um so yeah I really don't rate a low carb diet Okay. What about high protein diet? 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 PMS. Seven hours of sleep. I'm going to give a seven out of ten. I would love seven to nine. Like if you can go even more. Cosh is 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. What would you give nine hypothetically if I had said nine, knowing that it's not always accessible, but if it's in the perfect world. I would think nine out of ten. Okay. Red light therapy.

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. But right now I'm going to say two out of ten. Like, don't waste your time. Okay. Focus on the other things.

It's not a big thing right now. 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 worsen 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 knock on effects on your sleep, on your stress, everything else. So it's not great. But if you have the all glass of wine here and there, I don't think it's going to cause much harm. Yeah. You don't need to get too stressed about it. No. 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.

Yeah. 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, Wittebix, the cereal? Yeah. Yeah, I think Wiedabix is Australian.

Okay. Or is that just something that everybody claims, probably. Yeah, maybe. It sounds British, not going to lie. Yeah, we have weight fix. 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 with 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 henshing 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 Pilates do count because I always get asked that. Like people say like does Pilates count? Some forms do. But the reformer Pilates would be like more resistance because you're actually using a lot of resistance there. Whereas if you're doing mat platas 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 Pilates. But I'm just saying I love when women use weights because then they're

adding more of a stimulus to building muscle. So there's. 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, 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? 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 bans, if that's reformer, that's going to. to be muscle strengthening. So if we want to build more muscle and build strength, we need to have progressive overload. So we need to increase the amount that we're doing. So if you're, you know, 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 kilogram

weights and sometimes those one kilogram weights can be really heavy if you're doing lots of reps 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 20 reps and you're not breaking a sweat you're not lifting heavy enough. 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. So I see your peppermint tea and I raise you spearmint tea because spearmint tea is that what's in gum? The spearmint flavor? Is that what I'm thinking? Yeah. Okay, okay, yeah. It's actually hard, it's quite hard to get your hands on like

pure spearmint tea, but there's evidence that spearmint tea can reduce androgen, so testosterone, two cups a day. try it for three months. There is some research for it. Pepper mint tea less so, but it's good for the IBS Gerties. Oh, okay. There we go, girls. Knowing your ratings there, oh, you didn't give it, what would you give spearmint tea, sorry? I'm going to give it a five out of ten. Okay. Pepperment tea would be less. Yeah, not for PMOS. We'll give it two out of ten. Okay. If you got loading, it might be helpful. Okay, great. The hard rock bat casino app is here, Ontario. It's safe, secure, and crystal. clear with fast payouts and 24-7 local support.

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And Sean Clements. We host the podcast Hollywood Handbook. Every episode we're trying to help our game. guests improve their careers by mainly focusing on how they can help us improve our careers. The show is famously super accessible so you can easily jump into any of our 650 episodes and understand what's going on. We recommend some of our recent episodes with Ben Stillard. The definition of what is a movie has kind of changed anywhere too, right?

What do you think it is now? It's images and words being spoken, captured by some sort of technology. Danny McBride. He loves over. Oh, that's fantastic. And you make it on, you make your own. That's great. I call him Terro Reed.

It's a good name. They're all named after cast members of American Pie. Yeah. I call, I don't, I never looked up if she was in this, but I call him Leachie Sobieski. Yeah, I don't think she was an American Pie, but I still like that. Haven't looked it up. She was prominent around the same time. Yeah.

Then Mary Steenbergin. Why are you guys talking to me? I'm worried. I'm worried. Why are you talking so down to me that you think I don't understand your little play? Play game. I just really. I get it.

I'm trying to set you up for success here. Listen to Hollywood Handbook on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Nick Totoro. You probably know me from NYPD Blue, the longest yard, or Spike Lee's Black Klansman. But I'm also from Queens, which means I know pizza. And on my new podcast, delivering happiness with Nick Totoro, I deliver pizza from Prince Street pizza to a new guest. Are you delivering pizza now?

Then we sit down for a real conversation. I've shared a slice with everyone from Seth Rollins. What are you doing, my belt? To Alex Rodriguez. Just to let you people know, we're talking to one of the goats here. To Bill Burr. I don't think I've ever met somebody so exactly out of their mind as I am. And now, we even have more great guests coming up, including the great John Tuturo.

It's called Happiness. Delivering Happiness. Mariano Rivera. Oh, my God. And many, many more. Open your free High Heart Radio app. Search Delivering Happiness with Nick Tutro. And listen now.

I'm Hoda Kotbby, host of the podcast, Joy 101 with Hoda Kotbbe. If you know me, you know, I'm always searching for inspiration and useful tools to maximize joy. So this podcast lets us uncover those things together through meaningful conversations with fascinating people. Like when my friend Henry Winkler offered advice to aspiring actors and really anybody hoping to stand out. You're not hired.

Just to fill time and space. You're hired to fill the space with you. You have something in your guts. You go with it. And Sean Johnson recalled the moment she realized her now husband, Andrew, was the one. He was just so unapologetically himself and knew nothing of Hollywood. He hadn't been on a plane before without his family. It was so pure.

Listen to Joy 101 with Hoda Kotby on the IHeart Radio app, Apple Podcasts, or wherever you get your podcast. Our town is small taters by most standards, right? But to the people who grew up here, it's everything. What happens when a quiet Tennessee town becomes the front line in a battle over the future of America? Developers with right-wing ties have purchased hundreds of acres of land in the area. The first thing you see when it pops up is pioneers in Appalachia. But they weren't just planning houses. We need cities on a shining hill that exemplify and embody the Christian way of life.

Stop right there. Is that normal? A podcast about what happens when a small town becomes the site of a social experiment. God need men to rule. Great. And decides to fight back. Do not use my hard work to sell your bull-h-h-h-hue. They're not just opposing what's being planned for here. Our hometown is not a test tube. They feel like they're standing in opposition to an entire administration.

Guess you didn't move in on a bunch of dumb hillbillies now, did you? Listen to our town on the I-Heart Radio. Apple Podcasts or wherever you get your podcasts. I walk into your office. I go, Dr. 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 PMOS to start doing or to start trying or to stop doing? So I'm going to leave any medication to your 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. 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 specific foods that you need to consume. It's 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, nuts and seeds, moderate intake of dairy, less red meat, processed food and alcohol and sugar. Within that, when it comes to the macronutrients, the key macros are, the three are protein carbs and fats.

We already talked about carbohydrates, but we want to have them in the diet to make up around 40% of your overall calorie intake. So present at every meal, but the high fiber, low glycemic 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. 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 sourdough with some strawberry jam 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 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. Oily fish specifically is a really great source of omega-3s. And we can get omega-3s 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-3 supplement and still prioritizing those sources.

because omega 3 is hugely beneficial in PMOS. We've got lots of good evidence behind that. That's really diet in a 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 80% of the time that will impact you the most.

not what you do 20% at the time. So that's nutrition. And then supplementation, annoying answer, but it does depend. I think Nocetal is a great one for most women at 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 PMS. 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-3. If you're getting two portions of oily fish in your diet,

there's no point me adding omega-3 into your diet supplementation. There are other supplements that people try, and that could be magnesium, berberine, chromium, copper, loads of different ones. They have varying amounts of evidence. You'd probably be surprised at how little, I prescribe supplements because 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 PMS. A lot of people say only do low intensity, that's not true. 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've always like, should I be doing that? What's your take on, yeah, on hit workouts? So I've really wanted to talk about this because I find it really surprised. that this is a big thing, like it's a big myth, because the research shows the opposite.

There's like good research to say high intensity exercise improves PMOS symptoms. And when we pool together all the different exercise studies in PMS, there's no superior type that's like best for women with PMS. 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. And then when we kind of get into the grains of salt or whatever the phrases for it. The grains of rise? Grains of rise.

So we get into the rise. We're getting to the rise. 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 under fueling and we're under recovering and we're doing too much exercise. And actually, if we bring down the intensity of how much you're doing, so instead of doing seven back-to-back Barry's 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 our hit sessions. We're making sure we're optimizing our recovery afterwards. we're resting. No longer do we see those issues. And that goes for every woman with or without PMS. 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 underfeeling,

you're going to have issues. I like the caveat. The new Red Bull, Dragonberry and Tropicberry Energizers, now at McDonald's, made with freeze-dried fruit and an electric burst of flavor. The all-new Red Bull Energizers. Now at McDonald's. This product may not be right for you.

High in caffeine, details at McDonald's.ca. At participating Canadian restaurants, excluding Quebec. Hey, this is Hayes Davenport. And Sean Clements. We host the podcast, Hollywood Handbook. Every episode we're trying to help our guests improve their careers by mainly focusing on how they can help us improve our careers. The show's famously super accessible so you can easily jump into any of our 650 episodes

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And you make it on, you make your own. That's great. I call him Terro Reed. It's a good name. They're all named after cast members of American Pie. Yeah. I call, I don't, I never looked up if she was a. in this, but I call him Leachie Sobieski.

I don't think she was an American pie, but I still like that. I haven't looked it up. She was prominent around the same time. Then Mary Steenbergin. Why are you guys talking to me? I'm worried. Why are you talking so down to me that you think I don't understand your little

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Our town is small taters by most standards, right? But to the people who grew up here, it's everything. What happens when a quiet Tennessee? town becomes the front line in a battle over the future of America. Developers with right-wing ties have purchased hundreds of acres of land in the area. The first thing you see when it pops up is pioneers in Appalachia. But they weren't just planning houses. We need cities on a shining hill that exemplify and embody the Christian way of life.

Stop right there. Is that normal? A podcast about what happens when a small town becomes the site of a social experiment. God need men to rule. and decides to fight back. Do not use my hard work to sell your bull-h-h-hick. They're not just opposing what's being planned for here. Our hometown is not a test tube. They feel like they're standing in opposition to an entire administration.

Guess you didn't move in on a bunch of dumb hillbillies now, did you? Listen to our town on the IHeart radio app, Apple Podcasts, or wherever you get your podcasts. Let's finish on an optimistic pathway. What are some of the promising things that you are seeing in the research right now that you're excited about? 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 it 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 endometriosis where 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 endometriosis, which would be amazing. So I think that's fantastic.

I think when it comes to PMS 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 PMS, 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 hurt,

that the symptoms that they're feeling outside of their reproductive system matters because I think for a long time that was kind of dismissed as it's just not relevant to the conversation. Yeah, no, for sure. I know 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. They're like, read it is more attractive. And I know this has been debunked, but I remember reading it and being like, that's so funny that they're like, here's a consolation prize. Yeah, they actually retracted that article because there was so many issues with it. But I'm also like,

to publish a paper, first of all, there's, 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. other people had to approve it, that it went through a whole publishing peer review. And no one was like, this is absurd. Also, it's completely irrelevant and also. Irrelevant, yeah. Like, this is April Fools, like, wild. 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. Yeah. And they were like, are these women hot or not? Yes, that was basically. Hot or not? 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. No. How crazy is that? It's so crazy. And there's been other studies at like within endometriosis and it's like the impact of endometriosis on patients, on the male partners of patients. The impact of their sex life.

That's what I was thinking. I'm like, no one cares. Also, yeah, go away. Leave her alone. Like, she's going through something crazy. Like, that's just insane that it's like that we have all this, there's limited money and we're going to 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 point to like, how do you feel? And it's like, what? Hello? Like, and this is going to sound so ironic because I'm going to ask. ask you, like, obviously, I'm not, like, yeah, are women with PMOS more attractive? Dr. Hazel? What's your opinion? No, 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 lower risk factor for this, anything that's like, again, a consolation prize. So potentially may be able to build more muscle, which is beneficial for many things. Because you might go through the menopause slightly later. I think it's like two years and 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 one 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 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 2018. after eight years of 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. It's not a sentence. This doesn't mean it has to happen. Yeah. And I think that's really how I wanted to end the episode of like this is, you said before, like it can kind of go into, it can be asymptomatic.

Aisimatic 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 of PMS, 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 you. And maybe, maybe the there's not a silver lining, but having any kind of conversation about women's health is helpful and having any conversation about your own health, even if it's maybe not the conversation

you're like maybe you don't want to be having, just brings an awareness that I think has benefits to it. Yeah, I completely agree. And I think I was on Grace Beverly's podcast also. We talked about PCOS at the time and there's a really, there's a soundbite that went really viral. And it was me saying, we say that PCOS can't be cured. It was PCOS at the time. We say PMOS can't be cured, but I'm not so sure anymore. 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 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. 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 PMS. 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 techniques. Beyond that, before you get pregnant, we can work to restore ovulation through supplementation, through nutrition, through all those things we spoke about. And I think PMOS compared to a lot of the other women's health conditions, I'm thinking about endometriosis, 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. Yeah. And I really like that we've also ended on that because I didn't even talk about this. But again, 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 in their early 20s, mid-20s or just not something they want. But I like that you've mentioned that, you know, when I was told I had back at the time, PCOSL like, oh, a third of women can't get pregnant. Like, dun dun dun. And I remember really freaking out about it. And then just, reading and being like, wait, that's, where did they even get that number from?

Yeah. Right? Like, that's just this random number. And another thing to say that's completely separate, anytime you see a statistic that's like one third and it's a neat number, like 25%, or like 50%, or it's just such a clean number, you should always be skeptical. Oh my gosh. 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 these amazing treatments and clinicians who believe them. Like, there's just so much, the fact that we're having this conversation, like the momentum towards better days for people 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. I'm so like enraptured by how you're, how you're explaining this in a way that it's just like so remarkable that I almost forgot to just do the thing that we do in every episode, which is about your 20s. Are you still in your 20s? No, I'm 35.

You're 35. 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 halfway through your 30s now. what is one piece of advice that you wish you had had received in your 20s or you wish you knew in your 20s 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 okay um can i give two oh yes you can give like four you have full of information you can you could just do a whole other episode we would welcome that I, my first one that I've been thinking about lately is I regret not having more fun in my 20s 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 taking myself less seriously.

So I think embrace your 20s because you can still have so much fun in your 30s as well. But if there are things that you want to do in your life, be that like buying a house, having a starting family, things can your responsibilities can rack up so enjoy kind of the the fewer responsibilities of your 20s 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 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 you know dedicated my life now to women's health which was very different to what I was doing before is doing nutrition in the hospital um

and I think for so long we we kind of picture ourselves as this one identity 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 I love that advice what a beautiful way to end the episode Your book is coming out in paperback very, very soon. Yes, in three days. Three days. That would have already happened when people listen to this. It's called Not Just a Period.

Yeah. 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 you might be somebody who feels awkward when 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? Yes. I'm on social media. On Instagram is my main thing. I also do TikTok, but Instagram and TikTok under my name, Dr. 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 send you DM. Yeah. And yeah, book. Instagram. I will also leave a link to your, I guess, your website or like your clinician page as well so people 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. We will talk very, very soon. Hey, this is Hayes Davenport. And Sean Clements. We host the podcast, Hollywood Handbook. Every episode we're trying to help our guests improve their careers by mainly focusing on how they can help us improve our careers. The show's famously super accessible so you can easily jump into any of our 650 episodes and understand what's going on.

We recommend some of our recent episodes with Ben Stiller, Danny McBride, Riz Ahmed, and and Mary Steenburgeon. Listen to Hollywood Handbook on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Nick Totoro. You probably know me from NYPD Blue, The Longest Yard, or Spike Lease Black Klansman. And on my new podcast, delivering happiness with Nick Tatourl, I deliver pizza to a new guest. I've shared a slice with everyone from Seth Rollins. What are you doing, my belt?

To Bill Burr. I don't think I've ever met somebody so exactly out of their mind as I am. And now, we even have more great guests. coming up, including the great John Tuturo. It's called Happiness. Delivering happiness. And many, many more. Open your free High Heart Radio app.

Search Delivering Happiness with Nick Tutoro. And listen now. I'm Hoda Kotbby, host of the podcast, Joy 101 with Hoda Kotb. You know, I'm always searching for inspiration and useful tools to maximize joy. Like when my friend Henry Winkler offered advice to aspiring actors and really anybody hoping to stand out. You're not hired just to fill time and space. You're hired to fill the space with you.

Listen to Joy 101 with Hoda Kotby on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Our hometown is not a test tube. 90 miles northeast of Nashville, a battle for the future of America, plays out in one small town. Developers with right-wing ties have purchased hundreds of acres of land. We need cities on a shining hill. This is our town. A podcast about what happens when a small town becomes the site of a social experiment and fights back. Guess you didn't move in on a bunch of dumb hillbillies now, did you?

Listen to Our Town on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Nancy Glass, host of the Burden of Guilt Season 3 podcast. This is a story about a horrendous situation that destroyed two families. It's a scorched earth war that shows just how far someone will. go to get what they want. Cindy said I had to choose between the truth and my family, and I had to choose the truth. Listen to

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