Have you ever considered egg freezing?

Today I am bringing you Tatyana, who froze her eggs because she wanted to have control over her fertility. In this podcast, we go through why she did it, what nobody told her about the process, and what she’d do differently.

What is egg freezing actually like — the decision, the process, and what happens after?

This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below.

I share snippets from our conversation and short-form content on Instagram. Follow us there:

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Why egg freezing?

“I always knew I wanted children, but I never knew when and how, and I kind of didn’t feel like the timing was ever right. I was building my career, then I was moving to another country, then I was building a business, and I want to have all those things and have children at the same time, but I just don’t think we can be good at many things at once necessarily. So just making sure that I can get back to that topic when the timing is better for me made me look into it.”

The moment that actually made her decide:

“My final decision was made when I listened to a podcast — one female practitioner was saying it’s not just having children later in life, there are also cases when your child gets sick, you know, at the age of 12, and unfortunately then you lose the child, or something happens and you have a new family and another man in your life, and you still wish to have children with this other man, but maybe age-wise you’re not in the bracket anymore. So there are so many life situations where you wish you had your eggs frozen and you didn’t. It wasn’t necessarily ‘hey, I’m running out of time now,’ but more like ‘hey, I don’t even know what’s going to happen in 10 years, so I want to make sure that I am as flexible as I can be.’”

On the two clocks that don’t match:

“I was in the middle of running my company, fundraising, potentially growing it into a multi-million dollar business. And I felt like my children, whoever I give birth to at the time, would not have the attention they need — because I have another baby, which is my business.”

The process — and the key events that didn’t go to plan

On the timeline:

“For me the process was probably longer than for a regular person simply because I was busy. The moment that I decided to do it was October 2024, and I’ve done it in July, August 2025... from that point onward when I decided until it was completely done, it was probably around three weeks, so it’s not that long.”

On how little she was told before starting:

“I’ve got to say that no one explains very well how to do these injections. I came home with a box and I opened it and it’s like a big syringe with some lances that you can replace, but ultimately no one told me how to do it. I had to watch probably like three YouTube videos.”

On realising egg collection was actual surgery:

“What I didn’t realise is that it’s still a surgery, because everyone is just saying ‘collection.’ I definitely did not imagine on that day that I’m going to have full body anesthesia and I’m going to be in a clinical ward... No one kind of explained this to me. I thought that I’m going to be awake, but actually they sedate you completely.”

On the numbers dropping at every stage:

“I was seeing 23-24 eggs for both ovaries, which was really good, and I asked her, is it good? She was like, yeah, yeah, yeah, it’s really good. But then even when they collected seven eggs, they told me it was really good, which I Googled, and it wasn’t right. So the question is, what is the purpose there?... I don’t even know if I had done something wrong... I don’t really know if I could have changed the outcome had I done more research prior.”

On the doctor swap on the day of the procedure:

“They changed the doctor that I was actually supervised by — on the day of the procedure she just went on holiday, and they replaced the surgeon on that day to the woman that I’ve never met in my entire life. I know that the person that I trusted my eggs with wasn’t even there on that day.”

On what recovery actually felt like:

“I truly thought I’m going to go home and go work out. I booked a Pilates class, and on my way to Pilates I realised I can barely move, the bloating was getting so hard... I took a flight to another country because I was already booked on holidays, which was another mistake — for seven days on an island I was basically laying in bed drinking electrolytes with a mix of all of the GI issues you can possibly have. I think for me that was another learning — you need to give yourself some time off after a procedure like that. I want everybody to know that you need to book a week of light, at-home activities for yourself.”

What she wishes for the future

On doing it again:

“I’m definitely going to do it again. I’m going to do some more research about the place. I already got new recommendations for another practice... I’m also going to see how can I make this process better for myself and perhaps for others — I’m thinking about doing some little blog about it, or maybe just posting some article online for other women, maybe even in Berlin, to not follow the same footsteps and mistakes that I’ve made in my first attempt.”

On employer-paid egg freezing as a benefit:

“I just paid six grand out of pocket, and I wish my employer — who incidentally is me — would offer it as a benefit. There’s so many women that feel it’s pressure on them to keep their job and not choose their family, and how can one be pressured into not having a family if they want one? For me it’s just giving you an option. I really don’t get it how it can be seen as something negative. People should really just stop spiralling and think about this — it’s just an option. You don’t have to take it, but it’s an amazing option to have for the future.”

A personal note

What struck me most in this conversation wasn’t the medical detail it was how often Tatyana used the word “intransparent.” Not painful, not scary, just quietly under-explained at almost every stage. That’s a pattern I hear again and again from women navigating their own health decisions, and it’s exactly why I wanted to share this conversation in full rather than just a summary. If you’re considering egg freezing, I’d treat this as a starting list of questions to ask your own clinic upfront, not a reason to be put off.

If you’d like to hear the full conversation, including more detail on the clinic search and the questions worth asking before you start, the episode is linked above.

See you next Sunday, Francesca

Disclaimer: We are all unique in our own ways, so this information is for educational purposes only. This issue reflects one person’s personal experience and is not medical or clinical guidance. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs.

Today I bring you a lovely conversation with Registered Dietitian about a well-known myth:

“Losing weight is the only way to manage PCOS.”

If you’ve ever sat in a doctor’s office with PCOS, you’ve likely heard some version of this. At least I did.

In this episode, we go through:

1. Is weight loss necessary for PCOS management?

2. The type of fat that is problematic for PCOS

3. The psychological impact of wanting to lose weight

This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below.

I share snippets from our conversation and short-form content on Instagram. Follow us there:

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————-

It’s ok to want lose weight

For many women, this is the very first thing they hear after diagnosis. Before sleep is discussed, before insulin resistance is explained, before lifestyle, stress, or muscle mass are explored, the focus immediately shifts to the scale. The message is often delivered as if it is straightforward and universally applicable.

However, as we unpacked in the conversation, this issue is far more nuanced than it is often presented.

Before even touching the science, Tara made an important point about the emotional weight of the topic itself.

Body weight is not a neutral subject for women. It carries years of cultural messaging, moral judgment, family expectations, and medical dismissal.

When weight becomes the centrepiece of PCOS management, it is not simply interpreted as a metabolic suggestion. It often feels personal, loaded, and at times shaming.

At the same time, it’s important to acknowledge that it is not inherently wrong to want to lose weight. There is a growing narrative online suggesting that weight loss should never be a goal, which can also feel invalidating to women who genuinely feel uncomfortable in their bodies. Two things can be true at once. A woman can want to feel different in her body, and the culture around weight loss can still be deeply unhealthy.

Is weight loss necessary for PCOS management?

From a physiological perspective, there is evidence showing that even modest weight loss can improve insulin resistance and androgen levels in some women with PCOS. Insulin resistance is a central driver of the condition for many people, and improving metabolic health can lead to more regular cycles and symptom improvement. That part of the conversation should not be ignored.

However, what is often missed is that weight itself is not the root cause of PCOS. Insulin resistance and metabolic dysfunction are key players, and those do not map perfectly onto body weight alone. Body composition matters. Visceral fat, which surrounds internal organs and is metabolically active, contributes more significantly to inflammation and hormonal disruption than subcutaneous fat. Two women can weigh the same and have very different metabolic profiles. Equally, a woman with a higher BMI can have stable markers, while someone in a lower BMI range may struggle with insulin resistance.

This is where the blanket advice to “just lose weight” becomes problematic. It collapses a complex metabolic condition into a single external outcome and ignores the underlying mechanisms driving symptoms.

The psychological impact of wanting to lose weight

We also discussed the psychological impact of focusing exclusively on the scale. Tara shared that she often advises clients to put the scale away, not because progress does not matter, but because the number can eclipse every other sign of improvement. A woman can be sleeping better, lifting heavier weights, feeling more energised, experiencing fewer cravings, and cycling more regularly. If the scale does not move, or even increases slightly due to muscle gain, all of that progress can feel erased in an instant.

When weight becomes the sole marker of success, it can drive women toward increasingly aggressive strategies. Severe calorie restriction, excessive cardio, and chronic dieting often follow. In the context of PCOS, where stress and metabolic regulation are already sensitive, those strategies can backfire. Undereating and overexercising can elevate stress hormones, disrupt hunger cues, and make long-term adherence nearly impossible.

One of the most powerful themes that emerged from this part of the conversation was that you cannot hate yourself into health. If weight loss is pursued from a place of shame or self-loathing, it rarely leads to sustainable change. In fact, that internal stress can compound the physiological stress already present in PCOS.

The goal, then, cannot simply be to make the body smaller. The focus needs to shift toward improving insulin sensitivity, supporting muscle mass, reducing inflammation, improving sleep, and managing stress. When those foundations are addressed, weight may change as a byproduct. Sometimes it does, sometimes it does not, and sometimes the changes are slower than expected. But the primary aim becomes metabolic health rather than aesthetic transformation.

Our conclusion

In the end, we concluded that the statement “losing weight is the only way to manage PCOS” is neither fully true nor fully false. For some women, modest weight loss may improve certain markers. For others, focusing on weight can distract from more meaningful interventions. The key lies in understanding individual biochemistry, lifestyle, and stress load, rather than applying a universal prescription.

PCOS is not a condition that can be reduced to a single instruction. It is metabolic, hormonal, psychological, and environmental. When weight becomes the only lens through which it is viewed, important pieces of the puzzle are missed.

Health is not defined solely by a number on the scale, and PCOS management requires far more nuance than that.

See you Sunday,

Francesca

This is a review of all the deep dives from the last 3 months. You might find some answers in some of these articles.

Can you believe we are halfway through the year? July is here. I am not sure where the time is rushing to, but I would like it to slow down.

It’s been a crazy 3 months for me. Lina, my daughter, is 4 months old this week. I am building Leya and working on a PCOS education platform when she naps. I am trying to figure out what this new version of me is and keeping up with all the insightful articles on here.

Let’s see what we were up to:

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1. The pill, PCOS & the cycle we’re not talking about

Me and break down the pill, what it does for PMOS and how to think about it as part of your care.

2. Birth story and meeting my daughter

A personal story about my birth and meeting Lina.

3. The Government just released a new Women’s Health strategy

The revised Women’s Health strategy in the UK.

4. Kayla’s PCOS story

What happens when you stop fighting PCOS. The story of ’s journey to connecting with her body.

5. What intuitive eating looks like for PCOS

The amazing joined us to discuss intuitive eating, where to start with eating well with PMOS

6. The new name for our condition: PMOS

What does it mean, why was it changed and what I think about it

7. Is weight a good measure for health?

An incredible conversation with on the best way to handle weight loss advive and how can we focus more on biology and less on a number on the scale.

8. Laproscopic ovarin drilling - a surgery for PMOS

There is a surgery to help induce ovulation and a company in the US is innovating on it.

I hope some of these insights have helped you gurther your understanding of PMOS and connect to you body.

The next 3 months will also bring some exciting things. We will have:

1. with a deep dive into weight loss medications, GLP1s

2. A story from a dear friend on her egg freezing journey

3. Deep dives into insulin resistance and metabolism

4. A story from on her PCOS journey, her love for running and the pressure she received to conceive

And many more.

If you’d like me to cover something specific to your PMOS situation, please don’t hesitate to send me a message here on Substack or emails me at francesca.abalasei@gmail.com

See you next Sunday,

Francesca

Is there a surgery that could fix my PMOS?

Trying to ovulate with our condition is challenging. There are multiple medication options to try, but if they fail, the current guidelines recommend ovarian drilling. Did you know this was an option?

I have been meaning to write about ovarian drilling for a long time, as a company is currently developing and conducting a clinical trial in the US for an innovative version of this surgery.

Ovarian drilling was, in 1984, one of the only treatments available for what we now call PMOS, and then it quietly disappeared from the conversation, but it’s still available today. I must admit, they should find a nicer name for it because having my ovaries drilled sounds scary.

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What is ovarian drilling?

Laparoscopic ovarian drilling (LOD) is a minor surgical procedure performed under general anaesthetic. A surgeon makes a small incision in the abdomen, inserts a thin camera (a laparoscope), and uses either heat or laser energy to create small punctures across the surface of each ovary.

It sounds more dramatic than it is. It is done as day surgery and most women go home the same day.

This technique is not new. It evolved from a much older procedure called ovarian wedge resection, first described by Stein and Leventhal in 1935, which involved surgically removing a wedge of ovarian tissue via open abdominal surgery. It was effective at restoring ovulation, but carried a significant risk of scarring inside the pelvis and was largely abandoned once clomiphene citrate (a fertility tablet) became available in the 1960s. Laparoscopic ovarian drilling was first described in 1984 as a minimally invasive alternative: the same physiological rationale, achieved with a far less traumatic approach.

What I find interesting is that for decades it fell largely out of favour — not because it stopped working, but because fertility drugs became easier to prescribe. It is only now, as researchers take a harder look at the long-term data, that it is being reconsidered more seriously.

How does it work?

To understand the mechanism, it helps to revisit what is actually happening in the PMOS ovary.

As we have covered in previous issues, a defining feature of PMOS is excess androgen production within the ovary itself. This disrupts the relationship between LH (luteinising hormone) and FSH (follicle-stimulating hormone), the two signals the brain sends to the ovaries to coordinate ovulation.

When androgens are too high, LH dominates, FSH is suppressed, and follicles stall. They begin to develop but never fully mature or release an egg.

I want to be honest here about what is and is not known, because the mechanism of LOD is more uncertain than it is often presented.

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The most supported hypothesis works as follows:

→ the thermal energy from the drilling needle destroys a portion of the androgen-producing tissue inside the ovary.

→ this produces a local inflammatory response and leads to drainage of what researchers describe as “toxic” follicular fluid — the fluid surrounding those stalled, immature follicles.

→ the downstream effects are a reduction in androgen levels, a fall in LH, and a normalisation of the hypothalamic-pituitary-ovarian (HPO) axis, the communication loop between the brain and the ovaries.

→ with less androgens, FSH signalling can resume and normal follicular recruitment restarts.

This is what they think is happening, but it is not clear.

What does it do for PMOS/PCOS?

Studies report spontaneous ovulation rates ranging from 30% to 90% and cumulative pregnancy rates from 13% to 88%. These ranges are huge, which makes me question the quality of evidence.

The most rigorous assessment of LOD we have is a 2020 systematic review that pooled 38 randomised controlled trials involving over 3,300 women. Here is what it actually found:

• With low-quality evidence, LOD may slightly lower live birth rates compared to medical ovulation. To put numbers to that: if medication alone gives a 42% live birth rate, LOD gives you somewhere in the region of 28–40%. That sounds like a meaningful gap. But here is the thing — when the researchers zoomed in on only the trials with the most rigorous methodology, that difference disappeared completely. The honest conclusion from the best available evidence is that we genuinely do not know whether LOD is better, worse, or the same as medication when it comes to live birth rates.

• It can reduce the risk of multiple pregnancy, twins or more. Injectable fertility medications stimulate multiple follicles at once, which is where that risk comes from. LOD tends to induce one egg at a time, and the evidence is for a meaningfully lower multiple pregnancy rate.

• LOD may also reduce the risk of ovarian hyperstimulation syndrome (OHSS), a potentially serious side effect of hormonal stimulation.

Overall, the authors rated the evidence as very low to moderate quality. The main issues are inconsistent surgical techniques across studies and poor reporting of how patients were assigned to groups.

This is where it gets particularly relevant for those of us in the UK.

LOD is not fringe or experimental. It is listed in NICE’s fertility guidelines as one of three recommended second-line treatments for people with PMOS who have not responded to first-line medication, specifically those who are resistant to clomifene citrate (a common ovulation-inducing drug). The three options NICE recommends at this stage are:

• Laparoscopic ovarian drilling

• Combined clomifene citrate and metformin (if not already tried)

• Gonadotrophins (hormone injections)

The choice between these depends on clinical circumstances and individual preference. So if you have tried first-line treatment without success, LOD is a legitimate conversation to have with a reproductive specialist and one the NHS is mandated to offer.

The practical reality, as with many NHS services, is that availability and waiting times vary significantly by trust. But knowing it exists on the pathway is the first step to being able to ask for it.

A small detail to bear in mind

There is something to consider:

AMH (anti-Müllerian hormone) is a marker for ovarian reserve, a measure of how many follicles remain. In women with PMOS, AMH is typically elevated, often two to three times higher than average, which reflects the large pool of small, stalled follicles.

After ovarian drilling, AMH levels drop. In most cases, this appears to represent a normalisation, coming down from an abnormally elevated level toward a healthier range. However, some studies have found more significant reductions, raising questions about whether aggressive or repeated drilling could affect long-term egg supply. A 2017 meta-analysis on this topic confirmed that LOD reduces AMH and antral follicle count, though the clinical significance is stil a bit in the air

What May Health is building on top of this

A California-based company called May Health is developing what they call the Anavi procedure, a modern iteration of ovarian drilling that does not require traditional laparoscopic surgery. Their approach uses targeted ovarian ablation in an outpatient setting, without the need for a general anaesthetic and the surgical infrastructure that currently comes with LOD.

The device has already received CE Mark certification in Europe, meaning it has cleared the regulatory bar for safety and performance here. They are currently running a clinical trial in the United States, the REBALANCE Study, seeking FDA approval.

The underlying biology is identical to that of traditional ovarian drilling: reduce androgen production at the ovarian level, restore hormonal feedback, and allow ovulation to resume. What May Health is attempting is to make that mechanism accessible without the barriers of general anaesthetic, operating theatre time, and surgical recovery. Whether the Anavi procedure achieves equivalent outcomes to traditional LOD is what their trial is designed to establish, and we do not have that data yet.

But the direction of travel is interesting. If the results hold, this could eventually become a far more accessible intervention relevant even for women who would not currently qualify for, or want, traditional surgery.

So, is this relevant to you?

Ovarian drilling is most likely to be considered if:

• You have been diagnosed with PMOS and are not ovulating

• You have not responded to first-line medications such as letrozole or clomiphene citrate

• You are pursuing pregnancy and want to explore options before or instead of IVF

• You are particularly motivated to find a hormone-free approach

It is not a lifestyle intervention and it is not a cure for PMOS in the broader sense, it does not address insulin resistance, inflammation, or the underlying genetic and metabolic drivers we have discussed before. But for the specific problem of anovulation, the evidence is accumulating and the field is moving.

What I keep coming back to is how quietly this procedure has been sitting in the evidence base since 1984, available on the NHS and yet how rarely it seems to come up in the conversations women with PMOS have with their doctors. It’s worth keeping an eye out for it.

See you next Sunday,
Francesca

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Disclaimer: We are all unique in our own ways, so this information is for educational purposes only. In my communications, I summarise research data and bring my experience. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs.

Today I bring you , a Registered Nutritionist (ANutr) and Chartered Health Psychologist (HCPC).

This conversation is for those who don’t want their worth measured by a number on a scale and who know they deserve care beyond their weight.

Olivia has worked with hundreds of women across weight management services, community eating disorder teams, and the NHS. She developed and delivers an intervention that helps individuals restore their relationship with food and eating, enabling them to manage their health without focusing on weight.

She now works in clinical health psychology within the NHS and independently researches the acceptability of weight-neutral interventions, both for individuals and within healthcare systems.

Through all of this work, Olivia has reached one clear conclusion:

We need to stop telling people that they need to lose weight to be healthy

Women with PCOS are told to lose weight at pretty much every appointment they go to, so this conversation is a valuable exploration of biology, psychology, public health systems, culture, and, unfortunately, stigma.

We are detaching the equation of Weight = Health.

*Although the term ‘obesity; is referenced in this conversation, Olivia does not typically use this language in her own practice. She recognises its utility in systemic and policy contexts, but in her work with individuals, she takes a weight-neutral, health-centred approach.

We cover:

1. The problem with “lose weight” as a prescription

2. Should weight be ignored completely?

3. The importance of addressing the underlying biology

4. Why does healthcare continue to focus so heavily on weight?

5. The role of behaviour change in health

6. What should women do when they hear “lose weight”

This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below.

If you want to see some of the snippets from these conversations on Instagram, give us a follow:

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Why are women with PCOS so often told to lose weight before they receive treatment?

Because weight has become a shortcut for health.

It is easy to measure, inexpensive to track, and simple to report in public health systems that are under pressure to show outcomes. You can step on a scale and produce a number within seconds. That number then becomes the focus.

But PCOS is not simple.

When someone, particularly a teenage girl, walks into a GP’s office with irregular cycles, acne or weight gain and is told that no further investigation will happen until she loses weight, the message she hears is that her symptoms are not valid yet.

She hears that her body must change before she deserves care.

The deeper problem is that weight gain in PCOS is often a symptom of underlying hormonal disruption. Insulin resistance, altered androgen levels, sleep disruption, stress physiology and genetics all sit upstream of body composition. When we focus exclusively on weight, we risk targeting the visible outcome rather than the mechanism driving it.

Should weight be ignored completely?

No. There is evidence that higher adiposity levels are associated with an increased risk of certain conditions. That relationship exists.

But association does not mean that weight itself is the primary driver in every case, nor does it mean that shrinking the body is always the most effective intervention.

If insulin resistance is present, then insulin resistance is what needs addressing. If cortisol is elevated due to chronic stress or stigma, that needs to be regulated. If hunger signalling is altered, that needs a biological understanding.

Weight may shift as those mechanisms improve. It may not shift dramatically. But it should not be the gatekeeper to care.

What I am advocating for is a biology-first approach. What is happening in someone’s body that is leading to all of these symptoms and how can we address that?

Can behaviour override biology?

We often ask people to change their behaviour in ways that directly conflict with their biology. If fat cells shrink, hunger hormones increase. If energy intake drops significantly, metabolic rate adapts. If someone already has altered appetite regulation due to insulin resistance, simply telling them to eat less ignores the biological reality.

That does not mean behaviour is irrelevant. It means behaviour must support biology rather than attempt to overpower it.

Improving sleep can reduce cortisol. Adjusting the macronutrient balance can stabilise blood glucose levels. Reducing chronic stress can positively affect metabolic regulation. Behaviour change absolutely matters, but it needs to be informed by physiology.

Trying to restrict your way out of a hormonally driven condition is unlikely to succeed long-term.

Why does healthcare continue to focus so heavily on weight?

Partly because of measurement and partly because of culture.

BMI is simple. It is inexpensive. It can be tracked at scale. Hormonal panels, continuous glucose monitoring and comprehensive metabolic assessments are more complex and more costly.

But complexity should not be an excuse for oversimplification.

We do have other measurable health markers. In diabetes care, for example, we routinely monitor blood glucose, kidney function, eye health and blood pressure. It is entirely possible to measure health without centring weight as the primary outcome.

The issue is that we remain embedded in a weight-centric health paradigm. It feels familiar. It feels efficient. It feels objective. But it often misses nuance.

What is the psychological impact of framing everything around weight?

When someone has spent years being told they lack discipline, that their body is the problem, or that they simply need more willpower, that messaging does not disappear when they attempt to improve their health.

Shame increases stress. Stress increases cortisol. Cortisol influences insulin sensitivity and fat storage. The framing of the problem can actively worsen the physiology we are trying to improve.

Sustainable behaviour change requires self-efficacy, the belief that change is possible and that one is capable of making it. That belief does not grow in environments of blame.

What should the focus be instead?

The focus should be on improving measurable health outcomes and reducing symptoms.

Are cycles becoming more regular?
Is blood glucose stabilising?
Is energy improving?
Are androgen-related symptoms reducing?
Is blood pressure within range?

These are meaningful markers of health. They reflect physiology rather than appearance.

Weight may change as those processes improve. But shrinking the body should not be a prerequisite for investigation, treatment or compassion.

What should someone do if they are told to “just lose weight”?

Ask for clarity. Ask which mechanism is being targeted. Ask which symptom is expected to improve. Ask whether there are biological interventions that can begin immediately.

If every path leads back to weight without explanation, seeking a second opinion is reasonable. Healthcare should feel collaborative and grounded in physiology, not centred on appearance.

PCOS is complex. It involves endocrine signalling, metabolic regulation and communication between the brain and ovaries. It cannot be reduced to a number on a scale and neither can you.

You can find at her Substack:

Olivia Palmer

Health Psychologist (HCPC), Registered Nutritionist (ANutr) and Behavioural Scientist. Challenging weight-centric health. I share real stories, tools & insights on shifting health from weight-focused to behaviourally informed.

See you Sunday,

Francesca

Today I bring you a lovely conversation with Registered Dietitian about HIIT workouts and how they impact PCOS.

Among PTs and fitness influencers, HIIT is praised as the ultimate solution for weight loss. Short bursts. Maximum burn. Efficient and powerful.

On the other side, women with PCOS are told that HIIT is “too stressful,” that it spikes cortisol, that it ruins hormones, and that we should avoid it altogether.

As usual, the truth sits somewhere in between. In this episode, we go through:

1. HIIT and cortisol - is it true that it messes with your hormones?

2. Should HIIT be off-limits?

3. What type of exercise is best for PCOS?

This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below.

I share snippets from our conversation and short-form content on Instagram. Follow us there:

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The problem with absolutes

One of the first things Tara said was that anyone speaking in absolutes is usually a red flag. Whether they have credentials or not. I couldn’t agree more with this.

“Women with PCOS should never do HIIT” is just as problematic as “HIIT is the only way to exercise with PCOS.”

Research shows that HIIT can improve insulin sensitivity and metabolic markers in women with PCOS. From a purely metabolic standpoint, HIIT can be beneficial. The issue is how and when it’s being done.

Exercise is a stressor, but not all stress is bad

We spoke about something that often gets oversimplified on social media: cortisol.

Exercise raises cortisol, but only temporarily. It is an acute stressor. And when you are well-rested and properly fuelled, your body adapts positively to that stress. That’s how we build cardiovascular fitness, build resilience and improve insulin sensitivity. The good time of stress.

The problem arises when HIIT is layered on top of chronic stress:

• When you’re sleeping five hours a night.

• When you’re under-eating.

• When you’re in a calorie deficit trying to lose weight.

• When work is overwhelming.

• When your nervous system already feels on edge.

I was that person: doing HIIT on an empty stomach, in a calorie deficit, on top of a stressful job.

By 3pm, I was ravenous. Cravings were intense. I felt out of control around food and blamed myself for lacking discipline.

Guess what? My PCOS was not happy, and my period was nowhere to be seen. I wasn't losing weight either, so it all felt a bit like a scam.

The body does not prioritise reproduction during perceived stress. If your system senses that resources are scarce or recovery is inadequate, ovulation is not at the top of the list, because realistically, you should not get pregnant in times of high stress, as it’s likely to not lead to a healthy baby.

In addition to the stress element, doing HIIT underfed puts your muscle mass at risk. Muscle is one of our most powerful tools in PCOS. It acts as a glucose reservoir. The more metabolically active muscle we have, the better our bodies manage blood sugar.

Again, the problem is not HIIT itself. It is the context in which we do HIIT.

Should HIIT be off-limits?

No, HIIT has evidence for PCOS specifically. If you love HIIT, feel energised by it, recover well, and your labs and symptoms are improving, there is no reason to remove it purely because someone online told you it’s “bad for PCOS.”

On the other hand, if you hate it, dread it, and are forcing yourself to do it because you think it burns the most calories, that’s a different conversation.

Consistency matters more than intensity, and variety matters too.

Strength training has strong evidence in PCOS for improving insulin resistance. Lower-intensity cardio supports cardiovascular health. Restorative movement helps regulate the nervous system. Yoga, pilates and pretty much all forms of movement have evidence to help improve PCOS symptoms.

Rather than asking “Is HIIT good or bad?” a better question might be:

What form of exercise can I do for a year straight and not hate it?

Because exercise does not exist in isolation from the rest of your life.

The bigger picture

One of the underlying themes in this conversation and honestly in all of our conversations, is that we often major in the minors.

We obsess over whether HIIT is allowed.
Whether cardio is harmful.
Whether yoga is better.
Whether we should only walk.

Meanwhile, the foundations are sometimes shaky.

Are you eating enough whole foods?
Are you consuming adequate protein?
Are you sleeping?
Are you managing psychological stress?
Are you moving your body enough?

Most of the meaningful change in PCOS comes from these fundamentals.

HIIT can absolutely be part of that. It is not the villain. It is not the saviour. It is a tool, and like any tool, its impact depends entirely on how, when, and why it’s used. The internet loves extremes, but your hormones will respond to consistency.

See you on Sunday,

Francesca

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You probably have heard rumours that PCOS is getting a new name. Well, it’s finally here:

If before you were a woman diagnosed with PCOS, from today onwards, you are acquiring a new name, PMOS. If you have made this condition your identity (guilty ME), this rebrand might feel odd, like you are changing your last name when you marry. Jokes aside, this new name has the potential to really advance this condition.

It is not a treatment. It is something that might, if handled well, change the way PCOS is understood, funded, and managed for the next generation of women going through diagnosis.

Let’s dive into it.

A Health Policy paper published today, 12 May 2026, in The Lancet has confirmed that polycystic ovary syndrome has a new name: polyendocrine metabolic ovarian syndrome, or PMOS. This was agreed through an unprecedented, multi-year global consensus process, and is now published with a full implementation strategy. Some serious work has gone into this name change behind the scenes.

What does the new name actually mean

Polyendocrine — the “poly” prefix acknowledges that this is not a single hormonal disruption. PMOS involves multiple interacting endocrine mechanisms: elevated testosterone (from both the ovaries and often the adrenal glands), FSH/LH signalling to the ovaries, and insulin resistance.

Metabolic — insulin resistance affects approximately 85% of people with PMOS, including 75% of lean women with a BMI of 25 or below. Calling it "metabolic" acknowledges that there are issues with how we process energy and how that affects our health.

Ovarian — ovarian dysfunction continues to be a defining feature, including irregular periods, arrested follicles (the cysts) and failed ovulation.

As you notice, the cysts are dropped from the name for a good reason. The “cysts” in the old name were always arrested follicles, not cysts in any clinical sense, and it often made it look like a purely reproductive issue.

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My thoughts and concerns

I think this is genuinely significant. The process was rigorous, the scale of engagement was big and thought through, and the name makes a lot of sense. A lot of work went into it, and I really hope it generates the impact it deserves.

For those of us who have spent years being bounced between departments, had our metabolic or psychological features ignored, or been told PCOS was a fertility problem and nothing else, I hope this name brings better care.

But I have two things I want to say honestly.

Will metabolic = just lose weight?

This is the one I feel more strongly about, and I want to be direct. If PMOS is widely understood as a “metabolic condition,” there is a real risk that clinical and public perception defaults to weight as both the cause and the solution.

I worry about people being made to feel that it is their fault because they ate too much or didn’t move enough, so they ended up with a “metabolic” disease.

“Metabolic” does not mean “caused by excess weight.” It means relating to the complex biochemical systems that govern energy, hormones, inflammation, androgen signalling, and insulin sensitivity, systems that are dysregulated in PMOS across a wide range of body types, and not simply resolved by weight loss.

The condition that has historically been dismissed as “just a gynaecological thing” should not become a condition dismissed as “just a weight thing.” That would be a different kind of failure, and one we will need to push back on clearly if the narrative goes that way.

Will we get more research?

A name change is a necessary but not sufficient step. What people with PMOS need urgently is investment in understanding the different phenotypes: why two people with the same diagnosis can have almost nothing in common clinically, and what that means for what will work for each person. We still do not have a clear, phenotype-specific evidence base for management. The name change needs to be a door that opens into accelerated, better-funded, phenotype-aware research. I will be watching carefully to see whether research funding actually diversifies, or whether “metabolic” simply becomes a new label on the same reproductive-focused evidence base.

Why PMOS? How the name was chosen

The preferred terms that emerged consistently from the surveys were polyendocrine, metabolic, and ovarian. “Metabolic endocrine reproductive syndrome” was excluded because its acronym duplicated that of Middle East respiratory syndrome. “Endocrine metabolic ovulatory syndrome” (EMOS) initially ranked at the top but was found to overlap with a youth subculture, and “ovulatory” was considered too narrow, irrelevant beyond the reproductive years, and insufficient to capture the full ovarian picture.

Survey B in January 2026 asked participants to rate finalised combinations. Polyendocrine metabolic ovarian syndrome received 66% support from patients and 57% from health professionals as the top-ranked name.

The new acronym PMOS retains visual similarity to PCOS, a deliberate choice. The implementation approach was framed as evolutionary rebranding, updating, not replacing, to make the transition more feasible in practice.

Who is behind it

Previous attempts to rename PCOS have failed. Calls to change the name date back to 1995. The NIH recommended renaming in 2012. Experts, patient groups, and researchers have been making the case for decades, and every attempt has stalled, largely because there was no coordinated global process, no agreed-upon alternative name, and no implementation strategy.

The process was led by Monash University’s Centre for Research Excellence in Women’s Health in Reproductive Life, the Androgen Excess and PCOS Society, and Verity, the UK patient charity that reinvigorated the renaming initiative in 2023. It was funded by the Australian National Health and Medical Research Council, which matters because it meant there were real resources behind the process, not just goodwill.

The methodology used was a multistep combination of global Delphi surveys, Nominal Group Technique workshops, and a professional marketing and communication analysis. This is a rigorous, structured consensus approach, the same kind of framework used in major international health policy decisions. It was designed to be transparent, globally representative, and grounded in both scientific evidence and lived experience.

The process ran from 2024 to February 2026.

How big was the effort?

Building on 7,708 survey responses from prior phases in 2015 and 2023, this new process generated a further 14,360 responses — from 10,411 people with PCOS and 3,949 health professionals from all world regions. 56 leading academic, clinical, and patient organisations were engaged.

Two global surveys were run. Two international consensus workshops were held,one in November 2025 and one in February 2026, with approximately 90 representatives from multiple world regions in each, co-chaired by people with PCOS and health professionals alike, with independent observers overseeing the process.

The surveys were available in English, Chinese, German, Persian, and Malaysian. Every stage, governance, survey design, workshop recruitment, interpretation of results, and the implementation strategy included people with PCOS as active contributors with shared power, not as a token consultation.

On the core question of approach, 86% of people with PCOS and 71% of health professionals voted for an accurate, symptom-based new name rather than retaining the PCOS acronym with different words, or adopting a generic umbrella name.

What might practically change

Referral pathways. A name that signals endocrinology and metabolic medicine creates a legitimate basis for earlier referrals to endocrinologists and for multidisciplinary care to be expected rather than exceptional. The default route through gynaecology has never served women whose metabolic, psychological, or cardiovascular manifestations were the most significant part of their experience.

Research funding. The paper notes PCOS research has been “largely restricted to reproductive schemes,” which has constrained the entire evidence base. A condition classified as polyendocrine-metabolic can legitimately compete for endocrinology, cardiovascular, and metabolic disease funding - hopefully a much bigger pocket.

Medical education. PCOS is currently absent from pregnancy textbooks and midwifery and obstetrics education programmes. If PMOS is coded within endocrinology and metabolic medicine in the ICD, which the implementation strategy specifically plans to pursue, there is a meaningful basis for it appearing across specialities, not just in gynaecology.

Diagnosis. Up to 70% of affected individuals are thought to remain undiagnosed. Confusion around the current name has contributed to this — both because patients don’t connect their symptoms to an “ovary” problem, and because clinicians outside gynaecology may not think of PCOS as within their remit.

The implementation strategy is an eight-stage plan covering: academic dissemination; multilingual resource development; global communication; integration into electronic health records and SNOMED coding; engagement with research funders and journal editors; formal engagement with WHO and the ICD; a managed three-year transition period; and integration into the 2028 update of the International Guidelines, currently used in 195 countries.

During the transition, the condition will be referred to as “the condition formerly known as PCOS.” Your GP, research databases, and patient resources will likely still say PCOS for some time, and that’s expected and planned for.

Conclusion

This is one of the more significant developments in this space in a long time. The condition affects one in ten women globally. It has been misnamed, miscategorised, underfunded, and underdiagnosed for decades. An imperfect name isn’t the only reason for that, but it has been a structural one.

I will continue to cover this here as the implementation unfolds with the ICD coding changes, the International Guidelines update in 2028, and as the research landscape hopefully begins to shift.

As always, I would love to hear your thoughts. Does the new name feel right to you? Does it change anything about how you understand your own diagnosis?

See you next Sunday,

Francesca

1

Today, I bring you the lovely from PCOS Health with Intuitive Eating. I absolutely loved this conversation with Julie, and I think you will too.

Julie is a Registered Dietitian who spent over 25 years helping women with PCOS heal their relationship with food and find peace within their bodies. Her book Find your food voice can be found here.

Over these years, she kept seeing the same pattern: women with PCOS being harmed by the very advice that was meant to “fix” them. Not because PCOS causes eating disorders directly, but because of how early restriction starts for so many of us.

Being told, often in adolescence, that we are “too big” or that we must lose weight to control our hormones does something subtle but powerful. It teaches us that our bodies cannot be trusted.

Personally, this is my mission in the work I do: help women connect to their bodies, even when PCOS is present, which is why this specific conversation was so special to me.

In this episode, we cover:

1. What is intuitive eating?

2. Is intuitive eating suitable for someone with PCOS?

3. How did we lose the connection to our body?

4. What are some baby steps we can take to start intuitive eating?

5. What does “good” look like?

This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below.

I share snippets from our conversation and short-form content on Instagram. Follow us there:

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What is intuitive eating?

Julie described intuitive eating as a non-diet framework for learning how to live with food. Not to control it. Not to master it. Not to optimise it to perfection. But to live with it.

At its core, it means making peace with food and giving yourself unconditional permission to eat. You are allowed to eat. You are allowed to decide what you do with your body.

Intuitive eating is often simplified to “eat whatever you want.” In practice, it relies heavily on hunger and fullness cues—and not everyone feels them clearly. Especially not women with PCOS. Especially not women who have dieted for years. If hunger cues are unreliable, we don’t abandon structure entirely. We can use other signals. The clock. Fatigue. Mood. Cravings.

Fatigue and cravings, in particular, are strong signals in PCOS. They are not character flaws. They are not weaknesses. They are data.

She mentioned something interesting from her clinical work: when someone could not stop eating cereal or peanut butter, it was often a sign they weren’t eating enough overall. The body was looking for quick carbohydrates and micronutrients. It was not a discipline issue. It was survival.

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Do we focus on eating enough, or eating “better”?

Julie always starts with enough. If the body is not getting enough total energy, it stays in a state of deprivation. In that state, it cannot regulate properly. It cannot stabilise blood sugar effectively. It cannot be repaired, and most importantly, it can’t eat intuitively because it’s always fighting.

Trying to optimise food composition while under-eating is like trying to design the perfect house while the foundation is cracking.

She has worked with many women who had both PCOS and anorexia, more than the literature often suggests, and she saw repeatedly that once energy intake stabilised, several things improved before any micronutrient optimisation was introduced: sleep, focus, emotional regulation, and overall energy.

Only when the body feels safe does it allow you to think clearly enough to refine composition.

And this connects to something we discussed — the “overhaul” phase. That moment after diagnosis when fear drives you to change everything at once. Cut everything. Count everything. Fix everything.

Fear does not create sustainable behaviour change. It creates short bursts of control followed by burnout.

When the panic fades, meaningful work can begin.

How much of the disconnection with our bodies is PCOS, and how much is dieting?

PCOS does bring physiological differences — fatigue, cravings, altered insulin signalling. But Julie was very clear that diet culture amplifies the disconnection.

We live in a world where we are told how we should look, how we should eat, and that our bodies are projects to manage. Over time, external noise becomes louder than internal signals.

Many women with PCOS have also been traumatised in medical settings. Repeated weight-centred conversations create shame and hypervigilance. Trauma increases stress. Stress worsens inflammation and insulin resistance. The cycle feeds itself.

When fear is used as motivation — whether for heart disease, diabetes risk, or PCOS — it does not last. It may create compliance temporarily, but not stability.

Grace works better than panic.

What are some of the baby steps to make with intuitive eating?

If intuitive eating feels abstract or even slightly frustrating, the baby steps are far less dramatic than we imagine. It does not start with throwing away all structure or suddenly “trusting yourself.” It often starts with something much more grounded: eating consistently. Three meals a day. Not skipping lunch even if you are “not that hungry.” Noticing when fatigue or irritability might actually mean you need food. It can look like adding rather than removing — adding protein to a meal, adding a snack before you get overly hungry, adding awareness to why you are reaching for something. It is also about gently observing without judgement. Instead of asking, “Why did I eat that?” asking, “What was I needing in that moment?” Hunger, comfort, stimulation, rest? Intuitive eating begins with curiosity, not control. And over time, that curiosity becomes trust.

What does “good” look like?

Before making changes, list the PCOS symptoms that are actually disrupting your life. Not what you think should bother you. Not what social media emphasises. What genuinely affects your day-to-day.

Is it fatigue?
Cravings?
Irregular cycles?
Sleep?

Those become your markers.

“Good” does not mean perfection. It means those symptoms are becoming less intrusive.

Labs can help, but they are not the only measure. For some women, medical environments are triggering, and that must be taken seriously. Symptom relief, sleep quality, energy stability — these matter.

Why have we lost connection to our bodies?

Our grandparents did not track macros. They ate what was available. They ate when they were hungry. There was no calorie ledger on the wall.

Modern life is different. Food is engineered. Messaging is constant. We override hunger with rules.

Interestingly, Julie mentioned that connection often becomes easier when we are caring for someone else, for example, during pregnancy. When responsibility extends beyond ourselves, we tune in more carefully. There is research supporting this.

But she also said something important: we deserve nourishment whether we are growing a baby or not.

Connection should not be conditional.

A closing thought

You can add many tools to manage PCOS, but you also deserve grace. If something is not working, it does not mean you failed. It may just mean you do not yet have the right tools, and that is a very different starting point than blame.

You can follow Julie on her own Substack below:

PCOS Health with Intuitive Eating

Stop cutting carbohydrates and get off the PCOS diet roller coaster. Add energy and balanced blood sugar. Leave the rigid food rules and body hate.

By Julie Duffy Dillon

See you Sunday,

Francesca

Today, I bring you who has kindly accepted to share her PCOS journey with the rest of us. Her story resonates deeply with my own, and I think it will with you, too. This is her message to her younger self:

You are not broken. Your body is not broken, and it’s not all your fault. You do not need to white-knuckle it to feel better. You are in complete control and you have the power to change this for yourself!

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Research call

Anna Benzley, an undergraduate at Brigham Young University, is conducting a study on the Lived Experiences of Perimenopausal and Menopausal Women with Polycystic Ovary.

She is looking for women in the United States with PCOS to
participate in an interview about their experiences (Age 45+, English speaking).

If you fit the criteria or know someone who does, please consider participating. We can’t advance PCOS research if we don’t participate. You will also receive a $30 Amazon gift card. You can register your interest here:

Register interest

If you have any questions or concerns regarding this study, please contact Brianna Magnusson, Ph.D., at brianna_magnusson@byu.edu.

Over to Kayla 👇🏻

Hi friends!

I’m so excited to share more about my PCOS journey today. I took the jump to share a bit about my experience in a recent article (These 3 habits changed my life), so I’m going to paraphrase myself here to give more context:

Here’s a little TLDR on my story:

I grew up anxious, overweight, riddled with acne, and struggling (and I mean really struggling) with binge eating. In my teens, my period was irregular or nonexistent. I remember thinking that once I hit my twenties, it would all figure itself out and that this was just a phase. Spoiler: it was not.

To this day, I have literally not gotten one single helpful answer from my doctors. I’m also such a holistic wellness girly that I kept hearing my gut tell me that there has got to be something that I can do on my own (that’s not to say western medicine doesn’t have a place, and I actually hope to create a well-rounded practice that includes both western medicine and holistic habits).

There was a stint in my twenties where I went hardcore (like, 5 times a week emptying the tank hardcore) into high-intensity workouts. I was so desperate to transform my life that I also hacked together a diet that I thought was so good for me - I think I was literally eating 1,200 calories a day at one point (I’m 5’8…).

Looking back, I want to give that girl the biggest hug. I have so much empathy and grace for that past version of me.

I lost 50 pounds. 50! And guess what? I gained it all back. Every single pound. Not to mention that all of my other symptoms persisted, if not worsened. Combined with a job that stressed me the F out and a life that was fueled by go-go-go, safe to say things were not going well.

Diagnosis

To be fair, I’ve never been formally diagnosed with PCOS. In my teens, my OBGYN ran an ultrasound test that came back negative. She told me that I had no cysts on my ovaries, so I was free and clear, and that the only thing to do was to continue birth control (the most disheartening news I had heard). Newsflash: you can have all of the symptoms of PCOS, without ever having cysts on your ovaries. I’d like to formally file a petition to change the name!

In the subsequent years, I repeatedly asked a new OBGYN how to manage my symptoms and whether she thought it was worth a hormone test. I was met with the classic: “Just lose weight. Eat less and exercise more.”

Coming off medication

By this time, I was on Spironolactone and hormonal birth control. The combination was great for my skin and excessive hair growth, but did nothing to regulate my period. And then, something really bad happened. I got a blood clot in my lung. I was 23.

Let me tell you: I do not wish that type of pain on my worst enemy. I was incapacitated for months. There was one period where it got so bad that I literally couldn’t lie down to sleep at night. I slept in a chair.

I am so beyond blessed and grateful to say that I recovered 100% and can now live a full, normal, healthy life. Safe to say, though: this incident got me off of hormonal birth control really, really quick (and honestly? Thank god!).

Something amazing happened when I got off the Spironolactone + birth control mix: my period came back naturally, and more regularly than it ever had before.

This was the first time a lightbulb went off: even though I was dealing with this condition, my body was not totally broken and it could function normally on its own.

Fast forward to February 2025. My 30th birthday was coming up in August, and this year felt like such a pivotal moment. I was feeling so much anticipation and excitement, but also a little sadness about this next chapter because I wasn’t where I wanted to be - health-wise, but also across the board when it came to relationships, career, finance, and home.

The biggest changes which had an impact

My mission this past year has been to feel as good as I can feel using the lowest-hanging fruit. I’m talking the biggest bang for my buck practices that just felt good in my body.

I have really, really dedicated the last year to learning as much as I could about healing PCOS naturally. You can read more about the habits that have had the biggest bang for my buck here. These include most notably: eating breakfast before coffee, switching out afternoon coffee for matcha, and lowering the intensity and volume of my workouts.

I have re-focused a lot of my efforts on addressing the root cause of PCOS - insulin resistance. Making small switches like eating my protein and veggies before my carbohydrates, and walking 10 minutes after meals has gone such a long way.

Note: I keep finding that the simplest, most sustainable habits have been the ones that have shown me the biggest change.

Here’s what I wish I could go back and tell my younger self:

You are not broken. Your body is not broken, and it’s not all your fault. You do not need to white-knuckle it to feel better. You are in complete control and you have the power to change this for yourself!

Go find examples of other women who have 180’ed their PCOS symptoms. Some of my favourites are calliewellness on TikTok and pcos.weightloss on Instagram. Sometimes all it takes is just seeing someone else do it to show you that you can, too.

I’m still a work in progress and learning as I go. But I like to think that everything happens for a reason.

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Fran’s incredible newsletter is allowing us to connect with other women on a deeper level - maybe that’s just the point of it all. And for that I’m grateful.

Kayla

Kayla

Dating stories, health, finance, and business deep dives that from a 30 year old girlie who's figuring it out so you don't have to. The opposite of mansplaining.

The UK government published its Renewed Women’s Health Strategy for England at the beginning of this month and PCOS is mentioned.

It’s a 90-page policy document, and it is not exactly a light Sunday read. But buried in it are some things that are genuinely significant for those of us with PCOS and a few things that made me feel, cautiously, that the tide might be turning.

I want to walk you through the parts that are most relevant to us: what the document acknowledges, what it’s actually committing to, and where the gaps still are.

Want the short version? Follow Leya Health on Instagram.

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In this newsletter:

• Why the NHS has been failing women and what the data actually says

• The specific mentions of PCOS and what’s changing in schools and services

• What the gynaecology waiting list crisis means for you

• The new research funding on women’s health, including PCOS

• The hormones and mental health connection, the strategy finally names

• What I think is worth being cautiously optimistic about

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Why we needed a new strategy

Let’s start with the context, because it matters.

The UK dropped from 20th to 26th place (out of 38 OECD countries) in female life expectancy between 2000 and 2022.

Women in England now spend more of their lives in poor health than men, despite living longer. And more than 8 in 10 women have, at some point, felt unheard by a healthcare professional.

For those of us with PCOS, this will probably feel familiar.

Most of us have a story about a symptom that was dismissed, a GP appointment that left us feeling like the problem was us, not the system. The average time from first seeing a doctor to receiving an official endometriosis diagnosis in the UK is still around 9 years and 4 months, and while PCOS timelines vary, the pattern of delayed diagnosis and normalised symptoms is something many of us share.

The Secretary of State for Health describes the NHS as having:

“a problem with basic, everyday sexism and an appalling culture of medical misogyny.”

Those are strong words in an official government document. And while words alone don’t transform anything, the fact that this framing is now embedded in national policy is meaningful.

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The strategy is an attempt to address it. Here are some top insights:

1. PCOS is now being named in school education, for the first time

The Department for Education published revised statutory guidance on relationships, sex, and health education in schools last year. For the first time, that guidance explicitly includes polycystic ovary syndrome as a topic that should be covered alongside menstrual health, premenstrual syndrome, heavy periods, and endometriosis.

The strategy builds on this by committing an additional £1 million to improve menstrual health education in schools and community settings, so that girls understand what “normal” actually looks like and, importantly, when to seek healthcare. I wish this were around when I was not getting my periods for months on end.

This matters because nobody ever told us that irregular periods, acne, or excess hair growth were anything more than bad luck. Earlier education creates earlier awareness, which leads to earlier diagnosis, which leads to earlier access to support. The compound effect of that, over a lifetime, is significant.

It won’t help those of us already in the system. But it matters for the next generation, and it suggests that PCOS is finally being positioned as a condition worth knowing about before you end up in a doctor’s office trying to explain yourself.

2. New research funding on PCOS

The strategy reveals that, through NIHR (the National Institute for Health and Care Research, the research funding arm of the Department of Health), the government has issued more than 20 new funding calls since July 2024 on women’s health topics. Among those explicitly named are assessments of new therapies for polycystic ovary syndrome.

What that will produce is a bit unclear at this stage. Research funding calls are the beginning of a long pipeline. But they are the beginning, and that is further along than we were.

The strategy also commits to an important structural change: from now on, NIHR will only fund research that appropriately considers sex-based differences. This matters because much of our existing understanding of conditions that affect women, including metabolic risk, cardiovascular disease, and medication effects, was built from trials that either excluded women or didn’t look at the data by sex. That gap in evidence has real consequences for clinical practice. Closing it won’t happen overnight, but the policy direction is clear.

3. FemTech is getting £1.5 million

For someone who has worked in digital health for my entire career, I am equally excited and disappointed in this one. They launching a FemTech healthcare challenge within 2 years with a pot of £1.5 million

On one hand, I am happy to see money allocated specifically to the FemTech founder space, as this creates an opportunity for innovation and an incentive for private investment to put more money into these start-ups.

On the other hand, this is very little money for the reality of VC-backed companies. For reference, a start-up that has been running for 2 years is expected to have £1.5 million in revenue already to access further investment.

from has done a deep dive into this specifically on PCOS which is worth reading if you are interested in the economic side of innovation and PCOS tech.

FutureFemHealth

The PCOS opportunity: a deep dive into this unsolved area of women’s health

After more than a decade of campaigning work spearheaded by the UK charity Verity and Australia’s Monash University, Polycystic Ovary Syndrome is about to be renamed…

Read more

4 months ago · 12 likes · 2 comments · Anna O'Sullivan

In addition, they will launch a new accelerator for female founders with innovations addressing women’s health priorities. Should I apply with Leya Health?

4. The Gynaecology Waiting List

Here’s the less comfortable part of the picture.

There are currently 565,000 women on the gynaecology waiting list in England. The average wait is 15 weeks — up from 6.4 weeks in 2018. Only 57% of gynaecology referrals are being seen within 18 weeks.

For those of us with PCOS navigating the referral system, whether for fertility investigations, ultrasounds, hormonal management, or related conditions, this is the reality we are working with.

The strategy does acknowledge this and has committed to reducing those waiting times. The plan is to shift the majority of gynaecology care out of hospitals and into primary care and community settings, including redesigned clinical pathways for heavy periods and a single point of access for gynaecology referrals. There is no mention of a PCOS-specific pathway, but hopefully we will see one in the near future.

One hypothesis here is that the “hospital or nothing” model has created bottlenecks, and that more women could be managed well and earlier in community settings. That may well be true. What remains to be seen is whether those community services will have the specialist knowledge to appropriately manage complex presentations like PCOS, where symptoms overlap with metabolic, reproductive, and dermatological systems.

The strategy also commits to publishing an equity good practice guide to help NHS systems better understand and reduce inequalities, specifically in heavy periods, a symptom that disproportionately affects women from ethnic minority backgrounds and those in the most deprived areas of England. It’s worth noting that PCOS prevalence and presentation vary by ethnicity, and that ethnic minority women have historically been underserved in this space.

5. The hormones and mental health link is finally mentioned

Something in the “conditions affecting women disproportionately” section caught my eye.

The strategy explicitly acknowledges “increasing recognition of the links between hormones and mental health, such as in conditions like premenstrual dysphoric disorder (PMDD).”

For the PCOS community, this framing matters. We know that the hormonal landscape of PCOS is not just an ovarian thing. It has consequences for mood, anxiety, and energy levels beyond what we can imagine.

The strategy doesn’t say this directly in relation to PCOS, but the acknowledgement that hormones are relevant to mental health is a step towards a more integrated understanding of how reproductive endocrinology and psychological well-being interact. Maybe we will actually see a multi-disciplinary team approach to women’s health in the future (I assume in a lot of years).

Additionally, the strategy commits to improving mental health support for women and girls generally and acknowledges that around 1 in 4 women have a common mental health condition. For those of us with PCOS, where the evidence suggests elevated rates of anxiety and depression compared to the general female population, having mental health support genuinely embedded into women’s health pathways rather than treated as a separate referral would be pretty meaningful.

6. The NHS App and Digital Access

The product manager in me had to include this, as I believe the lack of data access among doctors makes our care so much worse.

The strategy places significant weight on digital transformation, and there are a few things worth knowing.

By 2028, a Single Patient Record will be accessible through the NHS App, bringing together all medical records. For those of us who have had to repeat our PCOS history, symptoms, and current medications to every new GP we see, which is exhausting and sometimes dangerous, this could reduce that friction meaningfully.

The NHS App will also offer personalised health coaching over time, and eventually integrate genomic risk data. Whether this will be developed in a way that is relevant to complex hormonal conditions like PCOS, rather than focusing solely on weight, remains to be seen.

What is already confirmed is that menstrual health problems will be among the first 9 pathways established in the new virtual hospital, NHS Online, launching in 2027. I am very disappointed PCOS is not explicitly named here, but menstrual disruption is one of its primary presentations, and there is reason to hope that, as these pathways are designed, PCOS will be incorporated into menstrual health workflows rather than siloed.

My thoughts

I want to be honest with you: this strategy is a policy commitment, not a guarantee of change. We’ve had Women’s Health Strategies before that didn’t translate into meaningful improvements in access, waiting times, or care quality. The document itself acknowledges this, describing the 2022 strategy as “set up to fail” because it operated within an outmoded care model. Whether those intentions survive contact with NHS commissioning reality is genuinely uncertain.

What I think is worth holding onto:

1. PCOS is now included in school education. That’s a first. If you know young people who are asking questions about their health, this is a shift in what they are likely to encounter in classrooms.

2. There is active NIHR research funding on PCOS therapies. If you are interested in participating in research, the strategy commits to making it easier to find and join relevant clinical trials through the NHS App. Worth keeping an eye on https://bepartofresearch.nihr.ac.uk/

3. The hormones-mental health connection is explicit. This creates space for those conversations to be treated as medically legitimate rather than subjective. Document it if you feel your mood or mental health is part of your hormonal picture — that framing now has policy backing.

What we still don’t have and what I think we should continue to advocate for is a specific, dedicated PCOS care pathway within the NHS. A condition affecting an estimated 1 in 10 women, with documented implications for metabolic health across the life course, deserves more than being absorbed into a general gynaecology referral queue.

That work isn’t done yet. But understanding the landscape we’re working in is, I think, always a better starting point than working in the dark.

See you next Sunday,

Francesca

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*We are all unique in our own ways so this information is for educational purposes only. In my communications, I summarise research data and bring in my own experience. This shouldn’t be viewed as medical advice at any point. Please further consult your healthcare provider about your health needs.*

Meet Lina, born on the 5th of March, with a grumpy face and a cuteness to match.

Lina, meet this awesome person who opens and reads mummy’s writing each Sunday because they care about their health.

First and foremost, WTF?

Writing this newsletter and deep-diving into the human body often left me speechless at how carefully designed our bodies are. However, nothing prepared me for the shock of actually seeing a human being come out of me. That is absolutely insane that my body made 10 fingers and toes from scrath, not to speak about kidneys, stomach and the rest of it. Absolutely mind-blowing.

Second of all, did you know they just let you leave the hospital after 36h with a newborn just like that?

There are zero instructions, no explanation of how to take care of this little human, just off you go with a person to look after. I must admit I did panic as soon as we got home from the hospital. Thank God, my mum was with us. As much as I love my husband, I think we were both in shock.

Anyhow, the whole experience has been extremely positive, and as I write this (3 weeks postpartum), it is by far the best thing I have experienced in my life. Yes, you don’t sleep, and yes, your whole schedule is upside down, but who cares? It’s totally worth it. Let me get into my birth story and the first few weeks.

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Giving birth

I wrote the following sentence in my pregnancy reflection:

I am still slightly scared (I am sure this is universal), but I feel equipped with the choices and knowledge of how I will navigate birth. I will tell you about it, so we will see if this is a bunch of bull*** I am telling myself. So far, I am planning a vaginal birth and hoping I can cope with the pain to have an unmedicated birth. However, I am VERY OPEN and PREPARED to accept an epidural or a C-section at any point during labour.

I am happy to announce I still feel the same, but I did end up with a planned C-section in the end. Slightly from my own choice, but also out of need. My little Lina turned out to be a big baby. One of our scans estimated her weight at 4.2kg (9.2 pounds) at 38 weeks. Essentially, she had the potential to go to 4.5kg by week 40, and who knows what would have happened if I were overdue. Her weight at birth was 3.970kg (8.75 pounds).

One of my main worries with this was late-onset gestational diabetes. I passed the OGT (oral glucose test) at 28 weeks with very good results, but knowing my PCOS history, I was super worried I would develop it later on and hence her big weight. I tracked my glucose levels for about 4 days before birth, and they were all within limits. Doctors don’t think I developed it, so I think she is naturally a bigger baby. She is in very good health, and nothing has been flagged so far, but I will be keeping a close eye on my glucose levels and on her health (as I would anyway).

For the birth, doctors gave me two options: induction at 39 weeks or a planned C-section. With big babies, they are mainly worried about shoulder dislocation for the baby and, of course, tearing for the mum. There is also an increased chance that with induction, you might end up with a C-section (double the risk, according to some data I had found). I found induction to be extremely invasive and a long process. I was very worried I would end up with my worst-case scenario: be induced, labour for 14 hours, be in a lot of pain, get the epidural and still end up with a C-section. When weighing the options, I found a planned C-section to be the best option for me. I did get a membrane sweep to get things moving naturally, but it didn’t start labour. I was essentially ready to give birth vaginally if Lina decided to come out by herself, but I didn’t want my body to be medically tricked into thinking it was in labour.

Deep down, I was a bit disappointed that I didn’t give birth vaginally. As I was prepping for the C-section, I kept wishing that my body would go into labour. I think it came from this deep connection I felt with my body through pregnancy and wanting to experience birth. Maybe I will get that chance again, or it may stay an unknown experience for me.

As for the C-section, 100% recommended. The actual surgery itself requires just a bit of mental strength to cope with the thoughts as you are on the operating table (nothing a bit of meditation prep beforehand can’t handle). The recovery was super fast; I was out walking to the park on day 4. The pain was very mild with the pain medication, and overall, I found the experience straightforward. I do think the staff members and doctors were very good (all through the NHS). It is also very fast. The whole thing lasted 1h and 30 min, and you were reunited with your baby very quickly.

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First few weeks

I have been pretty lucky, and baby Lina has latched pretty well. She did give me quite a big bruise from the first time she breastfed, but from then on, we managed to exclusively breastfeed.

As for the feeling, it’s freaking amazing. I was worried I won’t experience this rush of emotions people describe, but OMG, it felt amazing. The feeling does fade as weeks progress, but that first week was like I was on a fluffy cloud filled with love. I laughed so much and overall felt like I was on some sort of drug that makes you experience life on another level. I thought progesterone was great in pregnancy, but just wait for oxytocin. This hormone is another level of happiness. Can someone inject me with it for the rest of my life?

I do feel connected to her. Every time I pick her up from the cot, I just smile. No matter how tired I am, seeing her little face just lights me up. The feeling is not as intense as in those first days, but there is a connection that will grow more steadily from here on. I can’t wait for her to start smiling at me, looking me in the eye, talking, and the rest.

As for sleep, it’s nonexistent. However, if you are reading this and feel scared, please don’t. Again, our bodies have designed this in a way that allows us to cope. I don’t think I would ever be capable of putting up with this much little sleep for anything else, but for her, it just happens. I try to take naps, rely on my husband and mum and hope to start pumping in the next month so we can replace one feed with a bottle. I would just like 4 hours of uninterrupted sleep.

My body

If you follow me on Instagram and have read my pregnancy reflection, you know there has been a shift in my relationship with my body over pregnancy. That has evolved even more over the past 3 weeks as I have seen my body give birth and shrink back like I have not just carried a human for 9 months.

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I was worried about my body image post pregnancy, but my newfound love for myself and this body means I respect and love how I look like I have never had in my life. My body has responded extremely well, and I have kept very little weight. For someone who has battled her weight her whole life, this was a shock. If only I had connected with it as a teenager and not seen my weight as an issue, I might have had this level of love for it much earlier. I am looking forward to getting back into the gym and moving my body again with this new mindset.

Conclusion

I will keep you updated on how things progress at 6 months and 1 year, but overall, I want to say this has been an incredible experience, a highlight in life that I wish every woman to experience. I know not everyone is able to, and my heart goes out to you if that’s the case.

Thank you for reading, and I look forward to sharing more of this part of me with you.

Francesca

Today I bring you a lovely conversation with Registered Dietitian on the role of the contraceptive pill in managing PCOS and the importance of the cycle beyond pregnancy.

Tara and I share many of the same principles for managing PCOS, and our conversations are always filled with passion, inspiration, and insights. We got so frustrated about the misinformation shared online about PCOS that this will be a 3-part series where we debunk and discuss some of the most common things we see on social media about PCOS.

Today, we discuss the pill. We walk through:

1. The issues we have with the “just take the pill” approach

2. How the pill works

3. When it’s appropriate to take it

4. Why having a natural cycle is important beyond contraception

This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below.

The pill & the illusion of “fixing” PCOS

When most women are diagnosed with PCOS, the first thing they’re offered is the contraceptive pill. At least that was my experience.

The main issues I had, and I am seeing, is that it is often done without much explanation. Not because doctors are careless, but because it’s the standard first-line treatment. It regulates periods, reduces androgens, improves acne, and creates predictable cycles. On paper, it looks like it’s solving the problem.

However, the pill doesn’t “fix” PCOS. It doesn’t restore ovulation. It doesn’t address insulin resistance. It doesn’t correct the underlying metabolic drivers.

What it does is suppress the communication between your brain and your ovaries. Instead of your body producing its own cyclical hormones, you’re given synthetic ones in a steady, controlled dose. Your natural rhythm is paused.

For some women, that pause can be relief. If you’re dealing with acne, irregular period, emotional overwhelm, or simply need contraception, the pill can be a helpful tool. There is no shame in using medication.

The issue isn’t the pill itself.

The issue is when women aren’t told what it’s actually doing, and that is something we have a bit of an issue with. It’s the false illusion that this will fix everything, which is not true.

How the pill works

In a natural cycle, there’s constant communication between your brain and your ovaries. Hormones rise and fall. Estrogen builds. Ovulation happens. Progesterone rises. Then everything resets and begins again.

When we take the combined oral contraceptive pill, that communication is suppressed.

Instead of your brain and ovaries leading the process, synthetic hormones take over. They flatten the fluctuations. Ovulation is paused. The “bleed” you get each month isn’t a true menstrual period; it’s a withdrawal bleed triggered by the hormone drop in the pill cycle.

So, in PCOS, it gives the illusion of a cycle, and it does help manage some of our most annoying symptoms:

• Increases sex hormone binding globulin (SHBG), which binds free testosterone.

• Lowers circulating androgens.

• Reduces acne and excess hair growth.

• Creates predictable cycle patterns.

The issue is that the underlying drivers have not been addressed, so once women come off it, PCOS returns.

I have a more in-depth article on the mechanism behind the combined oral pill here:

What happens when we come off

Many women assume that after a few years on the pill, their PCOS will be “sorted”, that the break gave their bodies time to recalibrate.

But PCOS is a syndrome. It’s a complex condition influenced by genetics, metabolism, and environment. When you remove the pill, your original physiology returns.

Sometimes symptoms come back stronger.
Sometimes they look different.
Sometimes they were masked for years.

And if no one explained that beforehand, it can feel quite a shock.

A cycle is important beyond just pregnancy

The other issues we have with being on the pill for a very long time are that it assumes that our cycles and hormones produced naturally are not important for other aspects of our lives. That is not true.

Estrogen supports:

• Bone density

• Cardiovascular health

• Brain function

Progesterone supports:

• Mood stability

• Sleep quality

• Nervous system regulation

These functions only touch the tip of the iceberg. Our bodies are highly intelligent machines that have not been designed for any single use.

In PCOS, restoring ovulation isn’t just about getting pregnant. It’s a barometer. It tells you insulin resistance is improving. It tells you the hormonal communication loop is functioning better, and it allows your hormones to do their thing in other parts of your body.

When you suppress that loop, you lose a piece of feedback. That doesn’t automatically mean it’s wrong, but it does mean something important is different.

Tara shared something really powerful - she only truly experienced a natural cycle consistently in her 40s. For much of her life, she was either on hormonal contraception, pregnant, or breastfeeding. When she finally lived with a regular, natural cycle, she started noticing patterns:

• Libido rising before ovulation

• Cervical mucus shifting.

• Mood softening before bleeding.

• Energy surges in the follicular phase.

She described it as if she'd discovered a hidden rhythm she’d never been taught to listen to.

However, we should NOT demonise it

Two truths can exist simultaneously.

Hormonal contraception has given women enormous autonomy. It has reduced unplanned pregnancies. It has allowed educational and career freedom.

And at the same time, it suppresses a complex hormonal system that affects more than reproduction.

If you take it, take it consciously.

If you need it, use it without shame.

But understand:

• It manages symptoms.

• It does not cure PCOS.

• It pauses your natural cycle.

• It doesn’t replace lifestyle and metabolic work if those are relevant.

And perhaps most importantly, have a plan.

Are you using it short-term for symptom relief?
For contraception?
While you stabilise something else in your life?

That’s very different from assuming it has resolved the condition.

Our conclusion

PCOS is complex. It requires time, nuance, and often a multidisciplinary approach.

So the real message isn’t “Don’t take the pill” but know what you’re choosing, what is does and have a plan on how to come off it once you want to.

See you Sunday,

Francesca

We’ve had quite a busy Q1 (as the corporate girlies would say) at The PCOS Newsletter. I gave birth, we launched a new brand, we had amazing guests on The PCOS Podcast, and we grew the newsletter past 1500 of you.

The next three months will be even more exciting. Here are some things to look forward to:

1. An insightful conversation on the pill, HIIT workout and weight loss with

2. A PCOS story with

3. A deep dive into intuitive eating with

4. A story on egg freezing and the journey to fertility

A lot more to come, but in the meantime, let’s see what we were up to in the past months:

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1. A Behavioural Scientist’s view on your goals - beyond motivation

We had the incredible Dr Rosie Webster, a behavioural scientist, give us the framework that will help you achieve your goals. If your 2026 start did not go as you expected, this is the time to review your goals and put in place the right way to tackle them.

2. Chromium in PCOS: who it helps (and who it won’t)

A deep dive research review of a popular PCOS supplement.

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3. A Conversation on Heart Health and PCOS with a Cardiac Surgeon

There are a few conversation that suprises me in this space, but this was one of them. Women are twice as likely to die from a heart incident than man. The reason for it is not because there is something wrong with us, it’s because we ignore it. A must listen if you care about your heart health.

4. The 5 changes that made the biggest difference to my PCOS

This seems to have been a huge hit with all of you. I hope you find some ideas on how to approach your PCOS in these 5 things that have helped me the most.

5. Do women with PCOS have a slower metabolism?

A question that’s on a lot of our minds. This is an insightful conversation with on her latest research paper that compared Resting Energy Expenditure of women with and without PCOS.

6. Happy Women’s Day

We celebrated Women’s Day on the 8th of March. In this article, I share the stories of my mum and grandmother. Two women who have taught me courage, self-respect and love.

7. My Pregnancy Experience

A raw story about my pregnancy. I go through the relationship with my body, my symptoms, thoughts on my career and my husband. I walk you through my worries about connecting with my baby and giving birth.

8. Who is Leya Health?

Introducing the latest brand: Leya Health. Here to empower women to deeply understand their bodies through honest science, curiosity and long-term thinking.

9. Understanding your PCOS through data

Finally, we had Kate, VP Medical from the Ultrahuman team, deep diving into how to track ovulation and your cycle when you have PCOS. With this insightful conversation comes 10% off the Ultrahuman rings with code “PCOS”.

I think these were incredible 3 months to start 2026 with, and I really hope at least one of these publications has brought you value. Please share the newsletter with anyone who has PCOS and follow us on Instagram.

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See you next Sunday,

Francesca

Having PCOS makes it hard to understand what is going on with our body. The unpredictability. The irregular cycles. The “Am I ovulating?” The constant second-guessing.

In this episode of The PCOS Podcast, I sat down with Kate, Vice President of Medical for Women’s Health at Ultrahuman. With over 30 years of experience across gynaecology, menopause and fertility, she now works at the intersection of clinical medicine and health technology.

We go through Ultrahumans' cycle-tracking algorithm (the only medical device-grade algorithm for temperature tracking), how it helps women with PCOS and the impact it can have on your health.

If you are considering investing in a ring to help you track your cycle and ovulation alongside your other markers, I would recommend listening to this episode. You can get 10% of using this link, or with the promo code “PCOS”.

Disclosure: This product was gifted, and I receive a small affiliate commission if you purchase using my link.

This episode can be listened to on all major platforms, including Spotify, Apple and YouTube. If you prefer reading, I have summarised it below.

If you want to see some of the snippets from these conversations on Instagram, give us a follow:

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Tell us a bit more about Ultrahuman. What do you do there?

Ultrahuman is a health-tech ecosystem designed to provide deeply personalised insights into your body.

Most people know us for the ring, but we offer much more than that. We integrate continuous glucose monitoring (CGM), blood biomarker tracking via Blood Vision, home environment monitoring, and advanced sleep and recovery data.

The key idea is layering information. We don’t just look at one metric in isolation. We look at heart rate, sleep quality, recovery, metabolic markers, temperature patterns, blood results and bring them together to create a personalised picture.

For women with PCOS, that’s incredibly powerful because PCOS doesn’t affect just one system. It impacts hormones, metabolism, sleep, fertility and long-term cardiovascular health. You need a layered approach to really understand what’s happening.

Ultrahuman acquired OvuSense. Why was that such an important move in women’s health?

When UltraHuman acquired VO Health Tech — the makers of OvuSense — we brought in what I genuinely consider a gold-standard ovulation detection algorithm.

What makes it different is that it’s a medical device. That means it has gone through regulatory validation. It’s not simply estimating ovulation based on averages or calendar predictions.

The vision wasn’t to isolate cycle tracking as a standalone feature. It was to integrate reproductive health into the broader ecosystem of data — sleep, recovery, metabolic health and blood biomarkers.

Women’s health doesn’t exist in isolation. Your cycle is connected to everything else happening in your body.

Is the algorithm actually designed to work for women with PCOS?

Yes, absolutely.

The algorithm is designed to handle both regular and irregular cycles. It can detect ovulation, long cycles, anovulatory cycles and patterns that are suggestive of PCOS.

We also have cycle flags that can indicate patterns suggestive of increased miscarriage risk or early perimenopause.

It’s not a one-size-fits-all system. It adapts to your data. That’s particularly important in PCOS, where irregularity is common and traditional tracking often falls short.

Temperature tracking can be unreliable in PCOS. Can the ring really help?
If you are ovulating — even with PCOS — the ring will detect it.

Now, for women with very long or highly irregular cycles, sometimes more granular data can be helpful. That’s where the vaginal sensor (OvuSense) comes in. It measures core body temperature every five minutes overnight, which gives extremely detailed insight.

But my recommendation would usually be to start with the ring. You’re getting far more than just ovulation prediction — you’re getting sleep, recovery, metabolic data and more.

If you later feel you need deeper fertility-specific insight, then the vaginal sensor may be appropriate. It’s about personal choice and understanding your own cycle complexity.

What type of research is Ultrahuman involved in?

We’ve always been research-driven. We collaborate with universities and IVF clinics and have published multiple scientific papers. We’re currently running studies on embryo implantation timing, progesterone correlations, exercise and the menstrual cycle, and early pregnancy monitoring.

But on an individual level, the platform allows women to observe patterns over time.

If you improve your sleep, change your training routine, alter your diet, you can see how your recovery, metabolic data and cycle respond.

That feedback loop is incredibly empowering. Instead of guessing whether something is working, you can observe it.

What’s one thing you wish more women with PCOS understood about their bodies?

Can I give you two?

First, most women with PCOS will ovulate at some point during the year.

When a test shows “not ovulating,” many women assume they never ovulate. That’s rarely true unless PCOS is extremely severe. Some women may only ovulate two or three times per year, but those ovulations matter.

If you can track and identify when they happen, you can optimise around them.

Second, PCOS is manageable.

Yes, it’s long-term. Yes, insulin resistance plays a central role. But there is so much you can do.

We’ve learned that type 2 diabetes — once thought irreversible — can be put into remission through lifestyle changes. PCOS is intrinsically linked to insulin resistance. The same principles apply.

You may not erase PCOS entirely, but you can control it. You can restore ovulation. You can improve metabolic health. You can optimise fertility.

The idea that there’s nothing you can do is simply not true.

Looking ahead — what excites you most about the future of women’s health?

Kate:
We’re finally talking about women’s health properly.

We’re talking about menopause. We’re talking about PCOS. We’re addressing stigma.

At the same time, female health tech is evolving rapidly. Within UltraHuman, we’re developing new “power plugs” and expanding what’s possible in women’s health monitoring.

In five years’ time, women will understand their bodies in ways we can barely imagine today.

And that’s incredibly exciting.

If you’ve ever felt disconnected from your body because of PCOS, I hope this conversation leaves you with something important:

Your body is not broken.
It is complex.
And complexity can be understood.

With the right data and the right mindset, you can start working with your body rather than against it.

See you next Sunday,
Francesca

You probably have noticed the colours of The PCOS Newsletter changing a bit over the past few posts. This is because it’s getting a new house: Leya Health.

Introducing Leya Health

Leya exists because too many women have stopped trusting their bodies and themselves. Over the past 3 years, this has been my mission with the newsletter: to empower you to understand your body, learn to love it and give it the grace that it deserves.

Leya is the brand that will house The PCOS Newsletter, The PCOS Podcast and future projects for PCOS and women’s health. Nothing changes with the newsletter or its value. Nothing changes with the mission either, but I wanted a bigger house to express myself beyond the written format.

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Who is Leya built for?

I have a clear picture of the person who reads this newsletter regularly. I wrote it down a few years ago:

She is smart, intelligent and thinks for herself.

She is not chasing quick wins; she wants to understand how her body truly works.

She is rational but connects deeply to her emotions.

She feels angry with society and craves a deeper connection with her body and herself.

She honours the struggle without becoming defined by it, choosing to channel her energy into action.

She knows herself and actively invests her time in becoming a better version of herself.

Do you recognise yourself in any of these?

What should you expect from Leya?

For those who have been reading this newsletter for a long time, you already know what I stand for. For anyone else who is a bit newer:

• You should expect nuance.

  • We don’t speak in absolutes

  • We hold respect for science and its limitations

  • We understand some things work for certain people but not others

• You should expect depth.

  • We talk about mechanisms

  • We translate research

  • We acknowledge uncertainty.

• You should expect respect

  • We assume you are intelligent.

  • We assume you can tolerate conditional answers.

  • We assume you want understanding, not instructions.

• You should expect a challenge

  • We will create an intellectual stretch

  • A reframing of ideas you may have absorbed from wellness culture

  • An invitation to think differently.

Your support

I am currently building our social channels, so following us on Instagram and subscribing to our YouTube channel will help us a lot.

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I am always looking to speak to people with PCOS to better understand their needs. If you’d be willing to speak to me for 30 min about the PCOS journey and give feedback on some of the things I am building, I would truly appreciate the help. If this is of interest, kindly drop your email below:

Help build Leya

More things will come in the second part of the year, and it highly depends on how I am navigating motherhood. As you are reading this, our little girl might already be here.

Thank you for opening this newsletter, thank you for reading and thank you for investing in your PCOS.

See you soon,

Francesca

Today, I am bringing you my raw pregnancy experience. Over the past 3 years, this newsletter has been my outlet for getting to know my body and my condition, and for exploring the women’s health space together. It is only fair that I reflect on my pregnancy here.

I also want to say that this won’t be everyone’s experience, and I am aware that some women live pregnancy very differently. This is a positive pregnancy experience, so if you are in any way worried about the process, I think it will help you feel at ease. I go through the relationship with my body, my symptoms, thoughts on my career and my husband. I walk you through my worries about connecting with my baby and giving birth.

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A pivotal shift in my relationship with my body

All throughout my teenage years and 20’s, I never trusted my body. My periods weren’t coming, I had a lot of body image issues, and my body was not responsive to exercise or diets. I somehow felt at war with it because it was unpredictable. I would say the relationship with it has improved over the past 5 years, but I would lie if I said I fully trusted my body. Hence, I prepared for pregnancy as I would for a marathon. Read all the books, took all the supplements, did all the work. To my surprise, getting pregnant was easy, and all throughout the 9 months I have been pregnant, I have been in awe of what this body is capable of. Early on, I was just waiting for the miscarriage or for the 12-week scan to tell us something was wrong. However, as we progressed, things fell into place, and I somehow felt that everything was ok with her. I have this deep feeling that she will be a healthy baby and that somehow things will work out for the best.

If you are there thinking, “Oh, that must be nice, I am an overthinker”, trust me! I was, and still am, a very nervous, agitated person who overthinks and overprepares for everything. This came as a surprise.

This made me think that pregnancy is such an inward experience. For the first time, whatever goes inside you is more important than what is happening around you. This is where I realised we become disconnected from our inner selves as we go about our busy schedules, careers, social lives, and hobbies. Pregnancy makes you stop and look inwards; it makes you connect with a deep evolutionary reason for being alive. It made me connect with being a woman and a central part of creating life. I am not saying every woman’s purpose on earth is to have babies, but you can’t deny nature. I don’t know if this sounds too spiritual or weird, but this experience has been a beautiful way to connect with myself. I don’t know how I would feel if things got complicated, but I can only imagine the hurt that women feel when they miscarry because of this deep-rooted connection to creating life. I send you a warm hug.

It wasn’t all smooth sailing

I don’t want to paint this picture of perfection and being on a cloud whilst growing a baby inside me. I am sure the taxi driver who had to take his car for cleaning after my vomiting episode saw a different version of my pregnancy.

I had a lot of transitional weeks. I can only look back and describe it as times throughout ALL trimesters where I did not feel good. I vomited, I felt sad, I cried, and I was very tired. However, they lasted for 4-5 days, and they came around every month. It was not a constant bad experience. My guess is that she was going through her own growth milestones that required more of my body’s energy, both physical and emotional. I am currently going through one of those moments (34 weeks pregnant). I cried because the dog stole and ripped one of the baby’s mittens and had a meltdown over my husband's snoring. Not my best week.

I am a half-full cup type of person, and I do believe that changes a lot of my perception of this experience. One big mindset shift is that these episodes are normal and mean your baby is growing. Most of the time, we experience discomfort or pain, which comes with worry about worst-case scenarios, but only at this moment in our lives is it actually our body accommodating to another life.

Body image

I have always had a body image problem. Growing up in Eastern Europe does a lot of tricks on your mind, and for most of my life, I was at war with how I looked. Over the past 5 years, I have invested considerable time in improving this relationship, and I have reached a point where I love how I look and feel in my own body. However, for anyone who has experienced this war with their ownselves, knows that the fear of losing it is always there. Pregnancy was certainly one of those worries where I felt like I would put on 25kg and not like what I see in the mirror.

My body surprised me again; I have gained weight, but my face and body have not changed much. I am one of those people who stayed the same but with a bump. I am in complete shock. It just shows me how much at war I was with my body, how much I expected it to act at its worst, as I was not expecting that. I don’t know how I will feel postpartum, and I will definetely let you know, but my goals for this year are to approach it from a place of love and respect for my body. My plan is to make space to keep this relationship and this trust with my body, and no matter what it will look like post-partum, to learn to love it.

My husband

I am so privileged to have an incredible man by my side. The love he has shown me throughout these 9 months has been incredible, and my trust in him has increased considerably. We are very vulnerable whilst pregnant, so our senses are even more attuned to seeking validation and safety. Having someone who shows you that will change the experience of pregnancy considerably. Letting your partner know how your brain works is very important, as this experience is new to them as well. They might need to make a bigger effort to make you feel safe.

I believe it’s crazy that we meet someone randomly, be with them for a few years, and then create a human being from scratch together. That blows my mind, and with that comes a lot of insecurities about making the right choice. For me, this time has confirmed that I made the right choice, and I am excited to share this chapter with him.

My career

I have been working in Health Tech for close to 8 years now. Being a Nutritional Therapist has been my side gig for the past 4-5 years. I still have a full-time job, and I love it because I get to create digital products (mainly apps) to help people stay healthier. I have never felt the need to leave my full-time job because it aligns with what I love: helping people get healthier. I also associate a lot of my worth with my job and success. It’s also part of the Eastern European hyper-achieving mentality I grew up with, but I love it and don’t want to change it. Going into maternity leave and taking a step back from “achieving” and “progressing” scares me. I am a bit scared about losing my identity and my trajectory of success. However, part of the inward connection I described earlier also makes me feel that things will be all right. I really want to take my PCOS business to the next level and make this my next successful chapter in my career. We will see how that goes with motherhood, but my plan is to work on products that can help women navigate this condition more effectively, so your feedback will be an incredible support.

Giving birth

Well, well, well… she has to come out somehow, and there are only two ways.

I did not think about birth at all till I was about 28-30 weeks pregnant, and then I started panicking a bit because I had NO CLUE how to give birth to a baby. In this process, I actually recognised a strength in my character: I prepare, and I figure things out. I rarely sit in panic or sadness. Guess what I did? I started reading all the books under the sun and preparing: meditation, breathing, yoga, TENS machine, perineal massage, and I can keep going…Maybe I go overboard sometimes, but my way of coping with uncertainty is to prepare and understand the science and the truth. Do you see why I write this newsletter? I am sure you, who are reading this, share the same mindset, as you wouldn’t be reading this newsletter otherwise.

There are A LOT of traumatic labour stories out there, and selective hearing is probably a good idea. I am still slightly scared (I am sure this is universal), but I feel equipped with the choices and knowledge of how I will navigate birth. I will tell you about it, so we will see if this is a bunch of bull*** I am telling myself. So far, I am planning a vaginal birth and hoping I can cope with the pain to have an unmedicated birth. However, I am VERY OPEN and PREPARED to accept an epidural or a C-section at any point during labour. I don’t care much for having a perfectly natural birth, as I believe in medicine and its advancement. Whilst I hope this connection with my body allows me to do this as God intended, I am also perfectly aware that things go wrong, and we now have tools to make life easier.

I had the pleasure of speaking with a few women who loved their labour experiences, and one in particular echoes in my mind all the time. She said:

I would love to experinece labour and the first 2 months of my baby’s life. I have never felt more powerful as a women than when I was giving birth.

Connection to my baby

This is where I don’t know what is normal. I feel this deep connection to something, but I don’t talk to her or see her as a person yet. I somehow have more visions of her being a teenager than a baby. I am not a child person. I do not find them cute or interesting, even though I have noticed I find them a bit cuter in recent months. I don’t have negative feelings towards children, but I also don’t seek their company. Both my husband and I will be in the furthest corner possible at a kid’s party. This slightly worries me about how I will connect with her. Coming back to this intuition and trust, I think it will be an instinct to love her and feel connected to her, so whilst there is a worry, I am not overly concerned. I have already briefed my husband on postpartum depression symptoms, just in case I experience them.

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I think this is it. I really hope this has resonated with some of your worries or thoughts. Overall, I don’t think pregnancy should be such a scary experience that women have to go through. I look forward to writing my birth story, and I hope it is as positive as this article.

Francesca

Happy Women’s Day! Today, we celebrate the beauty of being a woman, our courage and the beauty of our intuition. Today we celebrate YOU!

My wish for you is that you connect inwards and recognise the power you hold, the resilience within you and the beauty you carry.

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I had the pleasure of being raised, mentored, and surrounded by strong women who do NOT accept the status quo.

My grandmother raised me and my dad without knowing how to read or write to be caring, intelligent and respectful people. She divorced her husband, who had an affair in the 1950’s, in the middle of communism, with 0 money to her name. She did not accept being second or being treated as unworthy in a time when women did not leave their husbands regardless of what they did. That taught me to recognise my worth and never rely on someone else to love me, respect me, or provide for me. I will cherish her love for me and her strength forever and hope to pass it down to my daughter. My grandma passed away almost 10 years ago.

My mum left Romania when I was only 4 years old because she knew she wanted a better future for her family. She left alone and travelled to Italy without knowing the language, where she was going, or how she would survive. She spent 3 years waking up to her pillow wet from crying every night as she couldn’t be next to her daughter or family. I did not see her for 3 years when I was a child. She taught me the power of love and sacrifice, and the strength it takes to care for your family and provide them with a better future. I am sitting here writing in English in a beautiful flat in London because of her courage, determination and sacrifice. I wish I can be at least half the woman she is for my daughter.

As I am writing this, I have tears in my eyes because I am realising - how did we get scammed into thinking we are the weaker sex? Women do incredible things every single day, and somehow still feel they are not worthy, need to change their bodies and make themselves small?

Let’s stop doing that and connect to our inward power!

I hope you have a lovely day filled with joy, and you celebrate yourself and the women in your life.

Francesca

I am so excited to bring you on the pod . We are deep diving into the metabolism of women with PCOS. Georgia has recently co-authored a research paper that aimed to answer the burning question of:

Do women with PCOS have a slower metabolism?

Georgia is a Registered Nutritionist and Trainee Counsellor & Psychotherapist and works in fat loss and PCOS. You can find her here on Substack at or on Instagram. For anyone interested in the paper itself, you can find the abstract here. It’s still going through peer review, but should be fully out soon.

This episode is available on Apple and Spotify. If you prefer reading, I have summarised the conversation down below.

In this conversation we go through:

1. Why was answering this question important to you?

2. Do women with PCOS have slower metabolism?

3. How is metabolism defined in research?

4. What was the methodology of this research paper?

5. If metabolism is not to blame, what makes it challenging for women with PCOS to lose weight?

6. What surprised you in this research?

Why was answering this question important to you?

It actually started with frustration. There’s this very persistent idea that women with PCOS have a “slow metabolism,” and I kept seeing how disempowering that was in practice, women being told to eat less, restrict more, and assume their bodies were somehow broken.

A few years ago, some science-focused people in the fitness space put out a paper questioning that idea. My partner (who’s an academic) and I read it and thought, this is exciting, but it deserves proper research. So we decided to take that question seriously and look at the evidence properly.

At its core, the motivation was simple: is PCOS actually causing a metabolic disadvantage, or are we building advice on outdated and poor-quality research? If the assumption is wrong, the way we support women needs to change.

Do women with PCOS have slower metabolism?

The main finding was actually very clear: women with PCOS do not have a meaningfully slower metabolism.

When we pooled all the best available studies together, the average difference in resting energy expenditure between women with PCOS and those without was about 30 calories per day, which is essentially nothing. It’s a couple of bites of food. Clinically, that’s not enough to explain weight gain or difficulty losing fat.

So the idea that PCOS causes a metabolic disadvantage just doesn’t hold up when you look at the data properly. The body isn’t broken. The challenges people experience with PCOS come from other factors, not a fundamentally slower metabolism.

How is metabolism defined in research?

We look at resting energy expenditure, the energy your body needs just to keep you alive: breathing, pumping blood, thinking, maintaining body temperature. That alone makes up about 60–70% of the energy you use in a day.

Then on top of that, you have the energy used for movement, digestion, and everything else you do.

So when we talk about metabolism in research, we’re usually talking about that baseline: how much energy your body needs at rest. And that’s the part people assume is lower in PCOS — but the evidence shows it really isn’t.

What was the methodology of this research?

We conducted a systematic review and meta-analysis, which is essentially research on all the existing research.

We searched major scientific databases and pulled together every study we could find that had directly measured resting energy expenditure in women with PCOS, going back to the 1990s. Importantly, we only included studies that actually measured energy expenditure properly — a lot of papers use indirect or estimated methods, which aren’t very reliable.

Once we had those studies, we analysed them together to see what the overall picture looked like, rather than relying on one small or isolated study.

What stood out was how much of the existing research was poor quality or inconsistent, which is part of why this myth has stuck around. But when you only look at the stronger data and put it all together, the answer becomes much clearer.

If metabolism is not to blame, what makes it challenging for women with PCOS to lose weight?

Insulin resistance
Insulin resistance changes how the body handles energy. Instead of glucose being easily taken up by muscles and used, more of it gets stored as fat. This doesn’t mean weight loss is impossible, but it does mean the body is more biased toward storage, especially when insulin levels are high. Supporting insulin sensitivity often makes everything else feel less uphill.

Appetite dysregulation
Many women with PCOS experience stronger hunger, feel less satisfied from the same meals, and have more frequent cravings. This isn’t imagined — it’s physiological. That’s why jumping straight into intuitive eating can feel impossible at first. When appetite signals are disrupted, “listening to your body” can just mean feeling hungry all the time until those signals are stabilised.

Fatigue
Fatigue is incredibly common in PCOS. When you’re tired, you naturally move less and gravitate toward quick-energy foods, often higher in carbohydrates. That combination feeds back into insulin resistance. It’s not a motivation problem — it’s a tired nervous system doing what it can to cope.

Low mood, anxiety and depression
Women with PCOS are more likely to experience low mood and anxiety, which affects how food is used emotionally. Food can become comfort, relief, or a way to regulate feelings. That doesn’t mean anything is “wrong” psychologically — it means emotional and metabolic health are deeply connected.

Sleep disruption
Poor sleep worsens insulin resistance, increases hunger hormones, and increases cravings for high-energy foods. After a bad night, almost nobody wakes up wanting a salad and a workout. Sleep quietly but powerfully shapes eating behaviour and energy use.

Body image and visible symptoms
Things like weight changes, acne, or facial hair can affect how someone feels in their body. That relationship with the body matters. When you feel disconnected or frustrated with your body, it’s much harder to care for it consistently.

So when you zoom out, weight loss in PCOS isn’t about calories alone. It’s about managing a cluster of metabolic, hormonal and psychological factors that all interact. That’s why one-size-fits-all diets fail and why working with the body changes everything.

What surprised you in this research?

Two things really stood out.

First, how little evidence there actually is to support the idea of a slower metabolism in PCOS and yet how strong and persistent that myth is. When you read the data carefully, most studies don’t show a meaningful difference at all, but that message has somehow turned into “fact” online.

Second, I was surprised by how inconsistent the research is. Different studies use different diagnostic criteria for PCOS, so sometimes you’re not even comparing like with like. That makes it really hard to draw clean conclusions and it explains why confusion sticks around.

Overall, it was striking to see such a gap between what the evidence actually says and what women are being told every day.

Your closing thought

My main message is that your body isn’t broken. PCOS doesn’t mean doom and gloom, it just means there are a few extra considerations to work with.

Once you take metabolism off the table, it becomes much more empowering. You can stop fighting your body and start understanding what it actually needs. And interestingly, there are even things that can work in your favour with PCOS, like a slightly greater ability to build muscle.

So it’s really about saying: these are the cards I’ve been dealt, how do I play them well? When you work with your body rather than against it, everything becomes more sustainable and far less punishing.

See you next Sunday,

Francesca

Today I bring you a past paid post on the things that have been the most impactful for my PCOS in the past 12 years.

I do want to make a caveat and say that these might not work for everyone. The nature of this condition is that it is multifaceted, and you need to find what works for you.

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Number 1: Switching from HIIT to strength training

Like many of us, I was the woman with two spin classes on an empty stomach on a Sunday morning. I used to think that if my heart rate wasn’t hitting the 180s during a workout, it was a waste of time. Over time, I changed that.

Muscle is one of the most essential things for PCOS, as muscle is the best place to store excess glucose, which gets used up quickly when you move. The bigger the muscle, the more glucose it uses, even when you are just walking or resting. HIIT, especially when done on an empty stomach, can break down your muscles. I have still kept HIIT as part of my workout regime, but not on an empty stomach and not as often. I tend to do 3 strength training sessions, 1 HIIT and 1 spin class a week (this is, of course, before I fell pregnant).

From a research perspective, there isn’t actually one exercise type that has been proven to be superior for PCOS but muscle remains important to manage our condition and longevity.

Number 2: Not working out on an empty stomach

Women’s bodies are especially sensitive to the stress of fasted exercise. When you exercise without eating, it can cause your cortisol levels to stay elevated for longer. Chronically high cortisol can interfere with our hormones. Additionally, HIIT prefers glucose as a form of energy; therefore, fat is actually used more in moderate exercise efforts. It was always making me so hungry that I would overeat throughout the day to compensate. Terrible idea. It might work for some women, and if it does, please don’t change it, but if your hunger is exaggerated throughout the day, it may be a good idea to try to eat beforehand. Some more in depth information on this in the article below.

Number 3: Switch from a sweet breakfast to savoury

I was a sweet breakfast person for a long time. I loved oats, yoghurt and jam in the morning. This left me on a blood sugar rollercoaster for the rest of the day, as my body was craving protein to be able to support my muscles and activities throughout the day. Once I switched to eggs in the morning, my energy was so much more stable, my food choices were more nutritious, and I was less hungry throughout the day.

Number 4: Switching to a micronutrient mindset

I was the kid who asked my grandma to sieve the vegetables from a soup so I wouldn’t see them. I tried aubergine for the first time when I was 20, having a phobia of anything green. I know, I know, a nutritionist who hated vegetables. However, once I learnt the power of these little monsters, I just had to get on board. Once you make the switch, your body needs them. I had to learn how to cook them and implement them in my day-to-day. My morning green smoothie made a big difference. It packs loads of vegetables in one go. I find myself wanting broccoli these days, and my new favourite is asparagus. The micronutrients that these legumes pack will make a world of difference to your body. The moment I understood that our muscles don’t contract without Calcium, our energy production needs Magnesium, and our brain runs on Omega 3, it all makes sense—a switch from macro focus to packing as many micronutrients as I can.

Number 5: A switch from weight loss to health

I became obsessed with being thin from the age of 15. I look back at the pictures from when I was 15 and realise what a mind f** up this was. The girl in this picture thought she was fat.

The behaviours we engage in when we want to lose weight are pretty detrimental to our health. We try to eat less so we lose weight. If our foundational food is not nutritious, we are giving our body less energy and fewer nutrients. This leaves us hungrier than ever. We cut carbs, making us even hungrier. We overexercise, further making us hungrier. The results? No nutrients, no energy and your brain panics and we eat everything we see. Hormones are panicking because why would we prioritise a period when we can barely survive? Then you feel like you have no discipline, and you always fail, only to jump on the cycle all over again. I have been there and done it countless times.

An insightful conversation with a behavioural scientist can shine a bit more light on what I am saying above:

When we start eating right, our weight settles at what our body feels comfortable. It might not be the weight you see in magazines, or the one you want, but your body is happy. You are not hungry or skinny; you look healthy. You have muscle, your face is radiating, and your period is back. We were meant to eat food, not starve.

The result?

A healthy period, fewer PCOS symptoms and a happier and stronger self.

If you are struggling with weight, these two articles still stand true and give an insight into the relationship between weight and PCOS and my weight loss principles:

Supplements

I want to include this a bit separately as I don’t think supplements is what we should be leading our PCOS management with. However we can’t deny that there is solid evidence for some PCOS supplements out there. I have been taken Inositol for years, Chromium, Omega 3 and Vitamin D. This regime might not be suitable to the PCOS type you have so I recommend you work with a nutrionist to find the best combination for you. Supplements might not be necessary at all and you can save those money and invest them in professional help.

I hope you will find these empowering. I am sure you already do some of them, and I hope you find your five most impactful lifestyle changes.

See you next Sunday,

Francesca

Today I have the pleasure of introducing you to Dr Lily Kruse, a cardiac surgeon with a Yale medical degree and a deep passion for prevention. We discuss the risk of cardiovascular disease in women and how it differs from men, why women are twice as likely to die of a heart attack compared to men (it’s not what you think) and why women with PCOS have a higher risk of CVD.

A deep conversation that will show you how to take care of your heart early so we can live a long, fulfilling life. We answer:

• What are the differences between men and women in CVD?

• Women are twice as likely to die of a heart attack compared to man. Why is that?

• What symptoms should I take seriously as a women?

• How does each hormonal stage in a women’s life impact our CVD risk?

• How can I protect my cardiovascular health?

• What is your view on PCOS in relation to CVD?

Lily is also the founder of HealthCaters, where she has dedicated the past 4 years to building preventive health check-ups to help people avoid coming to her operating table.

This conversation is available to listen to on: Apple and Spotify.

If you prefer reading, I have summarised the most important parts below:

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What are the differences between men and women in CVD?

The first difference is anatomical.
When I was in medical school, we were taught that a heart is a heart, whether it belongs to a man or a woman. In practice, that’s not really true. Women’s hearts are physically smaller, even when you account for body size, and the coronary arteries that supply blood to the heart are also narrower. This matters because the same amount of plaque or the same degree of constriction will limit blood flow more in a smaller vessel. So disease can present differently in women, and it’s also one of the reasons why it can be harder to see on scans, because women often have involvement of smaller vessels rather than the large, obvious blockages we tend to look for first.

The second difference is hormonal.
Hormones, and particularly estrogen, play a very important role in cardiovascular health. Estrogen acts as a protective factor for the blood vessels: it helps keep them flexible, it influences inflammation, and it even affects how cholesterol interacts with the vessel wall. That’s one of the reasons why, before menopause, women tend to have a lower cardiovascular risk compared to men. Men’s risk is more stable across life, whereas women’s risk is much more shaped by hormonal changes. As estrogen levels start to decline, especially in the years leading up to menopause, that protective effect fades, and women begin to catch up to men in terms of cardiovascular risk.

Women are twice as likely to die of a heart attack compared to man.

Yes, women do tend to have worse outcomes after cardiovascular events, even though the overall risk of having one can be similar. They are twice as likely to die of a heart attack compared to man. This is why:

If you look at the data globally, women still have heart attacks and other cardiovascular events, and when they do, their outcomes are often worse compared to men. This pattern holds even when you account for age and even when women receive the same interventions.

There are several reasons for this. One is that women tend to present later. By the time they come into the healthcare system, they often already have more accompanying conditions, such as high blood pressure or diabetes, alongside the acute cardiovascular event. That combination makes recovery more complex.

Another reason is how cardiovascular events present in women. Symptoms are often less typical, more vague, and easier to dismiss. In women, heart attacks frequently don’t look like the classic picture most people have in mind. Instead of severe chest pain and left arm pain, symptoms can include shortness of breath, nausea, vomiting, jaw tightness, unusual fatigue, or a general sense that something is wrong.

Because of this, heart attacks in women are very often confused with panic attacks. If you see a woman who is sweaty, clammy, breathing quickly and distressed, the first assumption — by bystanders and sometimes by healthcare professionals — is often anxiety rather than a cardiac event. That assumption creates the first delay. A second delay can happen because women are then less likely to arrive by ambulance. If you think you’re having a panic attack, you’re more likely to wait, try to calm yourself, or come to the emergency room later and under your own steam.

And even once women are in the emergency department, delays can continue. If a woman is still sitting upright, talking, and appears relatively stable, it can be easier to underestimate the seriousness of what is happening. On top of that, diagnostic tests can be less straightforward in women, because the disease often affects smaller vessels or involves constriction rather than a clear blockage, which is not always obvious on initial scans.

All of this means that women are more likely to receive care later in the course of the event, when the situation is already more complex. This is a major reason why outcomes tend to be worse — not because women are inherently at higher risk, but because recognition and timing are different.

Even once women are in the system, diagnosis can be more challenging. Women are more likely to have disease affecting smaller blood vessels, or vessel constriction rather than a clear blockage, which may not show up as obviously on scans. As a result, disease can be underestimated or recognised later than it should be.

So when we see worse outcomes in women, it’s not because women are inherently at higher risk or weaker. It’s a combination of biology, presentation, and how the healthcare system is currently structured and trained to recognise cardiovascular disease.

What symptoms should I take seriously as a women?

The most important thing to understand is that cardiovascular symptoms in women are often subtle and non-specific. That means they’re easy to explain away as stress, anxiety, exhaustion, or “just one of those days”.

Symptoms that deserve to be taken seriously are not necessarily dramatic, but unusual for you, persistent, or out of proportion to what’s happening around you.

That can include:

1. A feeling of shortness of breath that comes on without a clear reason, especially if it feels different from anxiety or exertion.

2. A sense of pressure, tightness, or discomfort in the chest that doesn’t quite feel like pain, but also doesn’t feel normal.

3. Pain or discomfort in places you might not associate with the heart, such as the jaw, neck, upper back, shoulders, or between the shoulder blades.

4. Unusual nausea, vomiting, light-headedness, or breaking out in a cold sweat, particularly if it comes on suddenly.

5. A sudden, overwhelming fatigue — the kind where something feels “off”, rather than just tiredness after a long day.

How does each hormonal stage in a women’s life impact our CVD risk?

Each major hormonal stage in a woman’s life changes how the cardiovascular system behaves, and those changes matter for long-term health.

Adolescence is where a lot of the groundwork is laid.
This is a period of major hormonal shifts, and those shifts affect many systems at once. Fat distribution changes, insulin sensitivity changes, lipid profiles start to evolve. For some women, this is also when PCOS first becomes apparent.

At the same time, adolescence is when habits begin to form — how someone eats, moves, sleeps, copes with stress. Those patterns often track into adulthood. From a cardiovascular perspective, this stage can already give us early signals about future risk, even though the person is young and generally considered “healthy”.

The problem is that we tend to underestimate this stage. There’s often very little education or early prevention offered, even though this period is actually very influential for long-term cardiovascular health.

Pregnancy is one of the most demanding stages for the cardiovascular system.
Physiologically, pregnancy places a significant load on the heart. Blood volume increases, cardiac output rises, the heart works harder, and blood vessels have to adapt quickly.

Because of this, pregnancy can unmask risks that were already present but silent. Conditions such as gestational diabetes, high blood pressure in pregnancy, or pre-eclampsia are now recognised as important signals for future cardiovascular risk — even if everything appears to return to normal after delivery.

I don’t see pregnancy complications as isolated events. I see them as information. They tell us how the cardiovascular system responds under stress, and that information is valuable if it’s followed up properly.

Menopause represents a major shift because of estrogen.
Estrogen has a protective role in cardiovascular health. It helps maintain flexibility of blood vessels, influences inflammation, and affects how cholesterol interacts with the vessel wall.

For much of a woman’s life, this protection is present in the background. As estrogen levels decline — and this starts years before menopause itself — that protective effect gradually fades. This is why women tend to “catch up” to men in terms of cardiovascular risk later in life.

What’s important to understand is that this change doesn’t happen overnight. It’s gradual, which means there is time to respond. But it does mean that menopause is a key transition point where cardiovascular health deserves more attention, not less.

Overall, I see hormonal stages as windows of insight, not moments of danger.
Adolescence, pregnancy and menopause are not problems in themselves. They are periods where the body is adapting, and those adaptations tell us something about long-term cardiovascular health.

The earlier we pay attention to those signals, the more calmly and effectively we can support the system over time.

How can I protect my cardiovascular health?

When I think about preventing cardiovascular disease, I think much less about doing something extreme, and much more about doing simple things consistently over time.

From a clinical perspective, most cardiovascular disease does not appear suddenly. It develops quietly, over many years. That’s why prevention works best when it starts early and stays relatively unremarkable.

The foundations matter most. Regular movement is one of the strongest protective factors we have. This doesn’t need to mean intense exercise. In fact, consistent, moderate activity — something like walking regularly over long periods of time — is often more protective than sporadic bursts of high-intensity exercise that aren’t sustained.

Sleep is another core pillar. Chronic sleep deprivation affects blood pressure, insulin sensitivity and inflammation, all of which feed into cardiovascular risk. Good sleep is not a luxury for heart health; it’s part of the baseline.

Nutrition matters too, but not in an extreme or restrictive way. From a cardiovascular perspective, what I look for is whether someone’s diet supports stable blood sugar, healthy lipid levels and overall metabolic health over time. It’s not about perfection, supplements or trends, but about patterns that the body can maintain.

One marker I pay particular attention to is blood pressure. Blood pressure is powerful precisely because it’s simple. It’s easy to measure, accessible, and gives us a lot of information about how the cardiovascular system is responding over time. You don’t need very sophisticated tools to notice early shifts and noticing those shifts early makes a real difference.

What I try to emphasise is that prevention is not something you start once symptoms appear. By then, the process has often been unfolding for a long time. The earlier you begin supporting the system — ideally in adolescence, early adulthood, or after key life stages like pregnancy — the better the long-term outcomes tend to be.

And finally, prevention should not feel like fear management. It should feel like care. Cardiovascular health responds well to steady, consistent support. Most of the time, it doesn’t require doing more, it requires doing less, but doing it for longer.

What is your view on PCOS in relation to CVD?

PCOS is often discussed as a reproductive condition — about periods, fertility, hair growth — but from a cardiovascular perspective, that’s only a small part of the picture.

What matters more to me is that PCOS affects multiple systems at the same time. Women with PCOS, on average, tend to have higher blood pressure, less favourable lipid profiles, and higher rates of insulin resistance and diabetes. All of these are established cardiovascular risk factors, and over time they interact with each other.

Because of this, women with PCOS do have a higher long-term risk of cardiovascular disease compared to women without PCOS. That can include conditions such as heart attacks, strokes, and also rhythm disturbances. But I think it’s very important how this information is framed.

PCOS is not a single cause of cardiovascular disease. It creates a different metabolic and hormonal environment over time, and that environment can increase risk if it’s not recognised and supported properly.

What I find reassuring — and what I think is often under-emphasised — is that this risk is not fixed. Studies show that when PCOS is well managed, cardiovascular risk can reduce significantly, in some cases approaching that of women without PCOS. From a clinical perspective, this is a key point.

So my view is not that PCOS should be seen as something frightening in relation to the heart, but as something informative. It gives us an earlier signal that cardiovascular prevention may need to start sooner and be taken a bit more seriously. And when that happens, outcomes can be very good.

PCOS, in that sense, is not a prediction, it’s an opportunity for earlier, calmer prevention.

My main closing thought is that cardiovascular health is a long-term process.
It’s not something you should only start thinking about once symptoms appear. By that point, a lot of the process has already been unfolding quietly in the background.

The earlier you start paying attention, the better the outcome tends to be. And I don’t say that to scare anyone. I think it’s actually reassuring, because it means there is a lot we can do ourselves, outside of the medical system.

Most of what protects the heart is very straightforward. It’s about consistent movement, sleep, nutrition, and paying attention to simple signals over time. When you know that you have a certain risk — whether because of PCOS or other factors — that knowledge doesn’t have to be heavy. It can simply guide you to take care of yourself a bit earlier and a bit more intentionally.

So my hope is that women with PCOS are aware that this risk exists, but also confident that they can meaningfully reduce it. A lot of it really is in our own hands.

See you next Sunday,

Francesca