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

21 days 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:

I am doing some research on PCOS supplements. Would love to get your anonymous opinion on them in a quick 2 min survey:

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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

How is your January going? This month can be both busy and empowering, or a bit low and confusing. Wherever you are, I hope you are taking life as it comes and surrendering to what comes your way. I am personally very deep into labour research and getting myself ready to give birth. I will share more towards the end of February, but the little girl is coming in early March.

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Today, we discuss a popular compound in PCOS supplementation: Chromium. This little substance has quite a bit of research on it and some very positive results.

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What is Chromium?

Chromium is a trace element found naturally in foods like meat, whole grains, vegetables and grapes. In the body, it exists mainly as trivalent chromium (Cr³⁺), the form involved in glucose metabolism.

We don’t fully understand its mechanism, but we do understand enough to move beyond vague “blood sugar support” claims.

At a cellular level, chromium seems to:

• Enhance insulin signalling

• Improve how responsive insulin receptors are

• Amplify downstream signalling once insulin binds

Importantly, chromium does not act like insulin. It makes existing insulin work better.

One proposed mechanism is the formation of chromodulin, a chromium-binding oligopeptide that enhances insulin receptor activity and glucose uptake. Chromium may also inhibit negative regulators of insulin signalling, essentially removing some of the “brakes” on insulin action.

That’s why chromium works better in people with moderate insulin resistance and often does nothing in metabolically healthy individuals and is less effective in advanced diabetes. This is why, when people take supplements that don’t work, it might be the case that you don’t have insulin resistance. I was convinced for a long time that I had it despite nothing showing up on CGM or other tests. You can have PCOS without insulin resistance.

What does research say?

Interest in chromium really took off after a landmark 1997 RCT showed that 1,000 μg/day reduced fasting glucose and HbA1c in people with type 2 diabetes over four months.

Since then, results have been mixed, with some trials showing improvements in fasting glucose, HbA1c, triglycerides, and HDL, while others show very small or statistically insignificant effects. There is a reason for it; not everyone responds, and the response is dependent on your starting point. People with worse insulin sensitivity, higher fasting glucose, and higher HbA1c were far more likely to respond, whereas those with relatively normal insulin sensitivity often saw no effect. In one study, baseline insulin sensitivity accounted for ~40% of the variation in response to chromium. This makes a lot of sense, if there is no problem to begin with, of course it won’t work.

What about for PCOS specifically?

Across multiple RCTs and meta-analyses, chromium supplementation (usually as chromium picolinate) has been associated with reduced fasting insulin, improved glucose metabolism, and some improvements in cholesterol levels. It has also shown benefits for inflammation, acne and hirsutism scores in some trials. I think Chromium deserves a place in the PCOS management tool-kit for those with confirmed insulin resistance.

However, it’s important to note that just because it improves some of these markers, it doesn’t mean it will improve symptoms so let’s see how it does on ovulation.

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What about the effect on ovulation?

A nice 6-month trial with 1,000 μg chromium picolinate saw that ovulation became more common after 5 months and 6 months compared to placebo. This is why you need to take these supplements for much longer than expected to see a difference. They are not medications, so they work much more slowly. This was also confirmed by a meta-analysis published in 2025.

What doesn’t it help with?

Chromium does not significantly affect other reproductive hormones, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), or sex hormone-binding globulin (SHBG), and it has shown mixed results for testosterone levels.

How much do I need to take?

Clinical trials in PCOS have utilised chromium picolinate dosages ranging from 200 to 1,000 μg per day, with intervention durations from 8 weeks to 6 months. The most commonly studied and recommended dosage is 200 μg daily, which has demonstrated efficacy in multiple randomised controlled trials. I would be careful with 1,000 ug/per day and take them under the supervision of a nutritionist.

Safety

Chromium supplementation is contraindicated in individuals with kidney or liver disease, as these organs may have increased susceptibility to chromium-induced toxicity. Chromium can enhance insulin's blood glucose-lowering effects, needing caution in individuals taking sulfonylureas or insulin to prevent hypoglycemia.

In terms of dosaged the European Food Safety Authority (EFSA) concluded that chromium picolinate can be used safely based on a No Observed Adverse Effect Level (NOAEL) of 2,400 mg/kg body weight/day from long-term National Toxicology Program studies, so the dosages you see in studies are fine.

With any supplementation, I don’t recommed long-term usage and working with someone who has training in this is advisable.

Conclusion

I would say Chromium has enough evidence to make into the PCOS management toolkit if you have insulin resistance and feel like you need support with glucose metabolism. If you don’t, it won’t do much and it will be a waste of money and time.

If you need personalised support for your PCOS, please don’t hesistate to drop me an email at francesca.abalasei@gmail.com. I am a qualified Nutritional Therapist and can help with supplement protocols and support your PCOS management.

See you the following Sunday with another insightful conversation!

Francesca

1

Here we are! 2026 has officially started!

You know I like to talk a lot about behaviour change in January, and this year I am bringing you an interview with Dr Rosie Webster, the person who first taught me about behaviour change in 2021.

PS: The videos I upload here are available as podcasts on Spotify, Apple Podcasts or on YouTube. If you prefer reading, I have summarised the conversation below.

If you have PCOS and feel stuck in cycles of motivation, burnout, and starting over, this episode is for you. We break down why common advice doesn’t work, why weight loss is such a frustrating goal, and how behavioural science can help you build habits that actually support your hormones, health, and long-term life. You’ll leave with a clearer way to think about habits, health, and January resets and a framework you can actually apply to your own life. We answer the following:

1. Why does motivation fade so quickly when we try to change our habits, especially around weight and lifestyle?

2. Why doesn’t “just trying harder” work when it comes to weight loss and behaviour change?

3. How should someone approach lifestyle change in a way that’s realistic and sustainable, rather than all-or-nothing?

4. What role do our environment and daily context play in why weight-related changes feel so hard to stick to?

5. Why does focusing on weight loss often backfire, and what should people focus on instead?

6. How can someone use a fresh start (like January) to actually set up changes that last long term?

Rosie has a PhD in Health Psychology and is a behavioural science consultant and health coach, specialising in how people make and sustain health behaviour change. The perfect person to speak to in January, as we are considering making changes to our lifestyle for PCOS.

If you’d like to get even deeper on the topic, Roise is doing a 7-day free email course called Resolutions Reframed. You can sign up here: www.reframehealth.uk/resolutions-reframed. Otherwise, she is also available on Instagram.

Over to Rosie:

Why is everyone starting fresh in January?

There’s a reason January feels like such a decisive “reset” moment, and it isn’t just cultural, it’s psychological. Research on what’s called the fresh start effect shows that when we hit moments that feel like a new beginning (January, a birthday, even a Monday), we get a temporary spike in motivation. It feels like a clean slate. Past mistakes feel further away, and we feel more optimistic about who we can become.

That motivation is real — but it’s also short-lived. The problem isn’t that people feel motivated in January. The problem is that we expect that motivation to carry us indefinitely, without changing anything else around it.

Why do we run out of motivation?

Most people approach lifestyle change by riding that initial motivation high. They decide they’re going to exercise more, eat differently, or completely overhaul their routine — often all at once. What’s usually missing is any real thought about how those changes fit into their actual life, or what happens when motivation drops, which it inevitably does.

From a behavioural science perspective, behaviour isn’t driven by motivation alone. It’s driven by a combination of motivation, capability, and opportunity. If any one of those is missing, change becomes very hard to sustain. This is the COM-B model.

What is the COM-B model and why is it the only way to change behaviour?

Behaviour is driven by Capability, Opportunity, and Motivation.

Capability

Can I realistically do this?

• Do I have the knowledge or skills?

• Am I mentally overloaded or exhausted?

• Do I know how to do this safely?

Sometimes the blocker isn’t laziness — it’s overwhelm.

Opportunity

Does my environment support this?

• Is it physically easy to do?

• Does my social environment help or hinder me?

• Is it convenient, accessible, and realistic?

If something requires constant friction, it’s unlikely to stick.

Motivation

Do I want to do this — not just feel like I should?

• “I should do this” is weak motivation

• “I want this because it matters to me” is far stronger

When people struggle, it’s rarely because they “lack willpower”. It’s usually because one of these pieces hasn’t been properly thought through.A

An example

Let’s say I want to strength train twice a week.

Capability:
If I don’t know how to lift weights safely, or I feel intimidated, that’s a real barrier.

Opportunity:
If the gym is 20 minutes away, no one I know goes, and it doesn’t fit my schedule — that’s another barrier.

Motivation:
If I’m doing it because my doctor said I should, that motivation will fade.
If I’m doing it because I want to feel strong, independent, and confident as I age — that’s much more powerful.

The key is balancing all three, not forcing one.

Our environment

One thing I think we massively underestimate is how much our environment shapes our behaviour. We live in a world that constantly nudges us towards convenience, food availability, and inactivity. Against that backdrop, we’re often told that our health outcomes are purely about personal responsibility.

When behaviour change doesn’t stick, people tend to blame themselves. But the reality is that many of the forces acting on our behaviour are completely outside our control. Recognising that doesn’t mean giving up — it means being kinder to ourselves and more realistic about what change actually requires.

Rather than asking, “Why can’t I stick to this?”, a more helpful question is, “Given the life and environment I actually have, what’s realistic for me right now?”

Why chasing weight loss usually doesn’t end well

This is where my perspective can sometimes feel uncomfortable, especially for people who’ve been told for years that weight loss is the solution to their health problems.

In most cases, I don’t recommend pursuing weight loss as the primary goal. That’s not because weight never changes — it often does — but because focusing on weight tends to push people into restriction, extremes, and a constant battle with their own body.

When people try to lose weight, they often have to eat less while feeling hungrier, exercise more while feeling more tired, and ignore signals from their body that something isn’t sustainable. Biologically, the body responds by increasing hunger hormones and slowing metabolism, because it’s trying to protect you. That’s why weight loss so often leads to weight regain. It’s not a lack of discipline — it’s physiology.

Instead, I encourage people to focus on behaviours they actually have some control over: how they eat, how they move, how they care for their body day to day. Those changes improve health regardless of whether weight changes, and they’re far more likely to last.

Why All-or-Nothing changes rarely work

Extreme approaches — cutting out entire food groups, rigid rules, dramatic overhauls — can feel appealing because they’re clear. You know exactly what you’re allowed to do and what you’re not. But clarity doesn’t equal sustainability.

What works better, almost every time, is making smaller changes and building on them gradually. Changes that feel good in your body. Changes that don’t require you to constantly fight yourself. Over time, those small shifts add up — not just physically, but in how you relate to your health.

Why change feels so hard

Our brains are designed to rely on habits because habits save energy. Changing behaviour requires conscious effort and self-regulation, and that’s tiring. When that effort runs out, we default back to what’s familiar — not because we’re lazy, but because it’s efficient.

That’s why I often say that when people “fall off the wagon,” it’s because the wagon was never built to last in the first place. The solution isn’t more willpower. It’s better planning, better design, and more compassion.

How to use January in a way that actually helps

January motivation can be incredibly useful — but not if it’s spent trying to do everything at once. I’d much rather see people use that energy to slow down and do the groundwork properly.

That means reflecting on what truly matters to you, what kind of life you want to support, and which behaviours help or hinder that. From there, you can start identifying small, meaningful changes that feel supportive rather than punishing.

It also means making plans that can flex. Life is unpredictable. If one approach doesn’t work on a given day, the goal doesn’t disappear — you just find another way to meet it.

A final thought

Lasting change doesn’t come from forcing yourself into a new identity overnight. It comes from understanding yourself better, designing for the life you actually live, and choosing changes that feel good enough to keep doing.

That’s where real sustainability lives.

Thank you so much to everyone for tuning in.

See you in 2 weeks!

Francesca

Happy New Year! I hope you had a good Christmas. In this article, I want to reflect on The PCOS Newsletter's progress and what’s in store for next year.

My wishes for you in 2026

I hope you find calm and rhythm in your life. I hope you find love for your body and your health. I wish you to see your PCOS as a source of power to connect with your body and your health and give yourself the patience, time and dedication our bodies truly deserve. I hope you find success in any areas of your life you are focusing on. I also wish that you surrender to the unknown and the beautiful path ahead, and that any hardships that may come your way are gentle.

If changing things in your lifestyle is part of your 2026 plan, I have an incredible conversation coming on the 4th of Jan with a specialist in behaviour change that you will love. I hope you find the time to listen to it so you can approach this condition and yourself with kindness and love for your future.

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The PCOS Newsletter

Update on numbers

It has been 3 years since I started this weekly newsletter. I have not missed a Sunday for 3 years, and we now sit close to 200 articles on the latest research in PCOS, incredible stories from women with PCOS, meal plans and behaviour change content. I am incredibly proud of the work that has gone into this and of the 1450 people who read this newsletter every Sunday. It’s a privilege to hold a spot in your inbox, and I want to thank you for the trust, patience, and dedication.

The paid subscription

2025 was the year I tried to turn the newsletter into a paid product. My hypothesis was that people are willing to pay for high-quality information to manage their condition. I was mostly wrong. I want to thank any of the readers who have purchased a paid subscription, as that has made my heart jump every single time. However, overall, it has not been the success I hoped it would be. As a result, I will be turning paid off for 2026.

I will be transforming paid posts into free ones at different points throughout 2026, especially starting in March, as my baby girl will arrive. For anyone on a paid subscription, auto-renewal will be disabled, so no further payments will be charged after your billing period ends. Thank you so much for your support!

New cadence for 2026

The newsletter will continue to land in your inbox free of charge every other Sunday, compared to the current weekly cadence. I would love to dedicate the time to make the best use of all this wealth of information I have written in the past 3 years. I will switch my focus to building personalised pathways for you to navigate this condition. More on this in January. I hope you choose to tune into the newsletter in 2026 and make progress in managing this condition well.

Personal side

2025 has been a great year overall. I was so worried I would struggle to conceive that most of my time and effort went into preparing my body to have a baby. I am excited to meet our baby girl in March 2026. I am sure my life will be turned upside down in the most beautiful way, and I will become a better, stronger person with it. I am excited to keep you in the loop with how motherhood is going.

I am thankful that all my family and friends have stayed healthy, and we were blessed with a calm year. I thank God every year for the opportunities He has laid before me, and I pray that He continues to show me the path to do good in life. Lessons I have learnt:

1. One of the most important things for my motivation is having inspirational conversations with people - it’s the fuel that puts my heart on fire

2. This is the first year where I don’t have a 5-year plan - letting go of control and surrendering to life in its beauty - I will figure it out

3. Growing in your life and working hard are the things that make us, humans, happy - I honestly think we are designed to want to be better and work hard; they are the cornerstone of our self-esteem.

4. Pregnancy can be beautiful - the Instagram algorithm is a pitfall of how much people like to either over-romanticise or over-dramatise things.

I hope you have a beautiful end of the year. See you on the 4th of Jan with an inspiring newsletter.

Francesca

For anyone planning to conceive in the near future and have PCOS, this is your ultimate guide to fertility and PCOS. We discuss how to prepare, what is important to pay attention to, how to track your ovulation and understand the risk of miscarriage. This series is an honest discussion and is meant to empower you to approach this journey with information, not fear.

They are in video format, but all articles also have a written version if you prefer to read. All episodes are also available on Apple Podcasts and Spotify.

1. Episode 1: How do I know how much time I have left?

2. Episode 2: How can I prepare my body for pregnancy?

3. Episode 3: Your partner’s fertility and optimising for a family

4. Episode 4: Finding ovulation when your cycles are irregular

5. Episode 5: The risk of miscarriage

In some, I am joined by my colleague Daria, who specialises in fertility (and just had a little boy).

If you need any further support with your journey, don’t hesitate to contact me at francesca.abalasei@gmail.com. I am a qualified Nutritional Therapist and offer one-to-one coaching if you need it.

Francesca

Today, I bring you another PCOS story from Dr Laura. She was sent home at 18 years old with a diagnosis of menopause, instead of PCOS and no answers.

PS: The videos I upload here are available as podcasts on Spotify, Apple Podcasts or on YouTube. If you prefer reading, I have summarised the conversation below.

Dr Laura hosts her own PCOS podcast, Triggered by Testosterone, where she speaks openly about PCOS, hormones, mental health, and the realities of managing this condition in everyday life. Laura holds a PhD in Management Studies, where her work focuses on women’s health in the workplace and how organisations can better support women living with chronic and hormonal conditions. Her academic research is profoundly shaped by her own experience navigating PCOS.

In this video, she mentions a few key episodes from her podcast you might want to listen to:

Ep1 - It started with three periods

Ep6 - Fertility and misunderstandings

Ep8 - Day in the life

What were your symptoms before diagnosis?

Looking back, it still sounds crazy when I say it out loud, but before my diagnosis, I’d only ever had three periods in total. That was across my teenage years. Roughly one a year.

At the time, I genuinely thought that was normal. My dad brought me up. We didn’t really talk about periods or women’s health, and this was about 15 years ago, it just wasn’t a conversation anyone was having. Even now, we don’t talk about it enough.

Alongside that, I was experiencing things like brain fog, hot flushes, and a general cloudiness, but I didn’t connect them to anything hormonal. I wasn’t thinking about babies or fertility or long-term health. I was 18 and living my life.

How did you get diagnosed?

The turning point came when I went to university. I casually mentioned to a friend that I’d only ever had three periods, and the look on her face said everything. She immediately told me that it wasn’t normal and that I needed to get it checked.

I went to the doctor and explained my symptoms. Because my cycle was so long, essentially one period a year, they classified it as post-menopausal. They took the brain fog and hot flushes and concluded I was showing signs of perimenopause.

I was 18.

They didn’t do any scans. No blood tests. No deep investigation. I was handed a leaflet, told it was unusual but possible, and sent on my way.

At that point, I hadn’t even heard of menopause. I didn’t know what it really meant, but I very quickly understood the implications. The idea that I might not be able to have children hit me hard, even though I wasn’t thinking about that stage of life yet.

Something didn’t sit right. So I started researching myself. I had to push for further testing - really push. Eventually, they agreed.

That’s when I was diagnosed with PCOS. But even then, I was told I was a “special case.” I wasn’t obese, I had no cysts on my ovaries, and the main thing that showed up was elevated testosterone. Later, it also became clear that I was insulin-resistant.

How have your symptoms evolved since?

After the diagnosis, there really wasn’t much support. I was put on the contraceptive pill, the phrase used was “kill two birds with one stone”, and that was basically it.

Every six months, I’d go back to get my prescription renewed. They’d weigh me, check my blood pressure, tell me I was overweight or obese, and send me on my way. That was the extent of my medical care.

Everything else I’ve done has been self-taught. Trial and error. Some things worked, some didn’t. Mentally, it was exhausting.

I struggled a lot with anxiety, especially in the mornings. I’d wake up with this awful, sick feeling in my stomach for no obvious reason, what I’d call a PCOS flare-up.

For a long time, I also had a very negative mindset. I convinced myself I’d never lose weight, that PCOS meant my body was broken, and I used it almost as a reason to give up.

COVID was a turning point. I was at my highest weight and genuinely scared for my health. That’s when I started taking things seriously — not perfectly, but consistently.

What has worked the most for your PCOS?

I’ve tried everything.

Extreme calorie restriction. Cutting out food groups. Keto. HIIT. Doing workouts I hated because I thought I “should” be doing them. None of that was sustainable for me.

What finally worked was changing my mindset.

I got a coach who took a non-judgmental, structured approach and worked with me long-term. I started strength training, boxing, and eventually running, which I was terrified of at first because of everything you read about cortisol and PCOS.

Running has honestly changed my life. It helps my mental health more than anything else I’ve tried. I don’t wake up with that crippling anxiety anymore. I run two to three times a week, lift weights, and box, and I do it because I enjoy it.

With food, I stopped punishing myself. I still eat pizza. I still eat chocolate. I prioritise protein, I focus on feeling full, and I pay attention to how food makes me feel rather than labelling it “good” or “bad”.

I’ve also learned to treat my body like an experiment — noticing patterns without shame. That’s been far more powerful than any rigid plan.

A closing message for women with PCOS

You are not alone.

There is no one-size-fits-all solution for PCOS, and anyone who tells you otherwise is oversimplifying something incredibly complex. Trust your gut. Try things. If they don’t work, that doesn’t mean you’ve failed.

Medication is okay. Doing it “naturally” isn’t a moral badge of honour. We all live real lives with real pressures.

Ignore as much of the noise as you can, take what’s useful, and leave the rest. It will be okay — even if it doesn’t feel like it right now.

Thank you, Dr Laura, and thank you for reading or listening.

See you next Sunday,

Francesca

Today I bring you the summary of a new research study published at the end of October 2025. New findings reveal types of PCOS beyond the standard ones we hear about.

What does this research mean for me?

I wanted to bring this up at the beginning of the article as I think this is where research has to become relevant to the everyday person navigating this condition.

What I love about this research is that it brings a bit more nuance and blood testing to help us understand more deeply what drives our condition. This can help us create more targeted interventions and work on specific hormones. With this in mind, this study suggests that LH, SHGB, fasting insulin/fasting glucose, and DHTS can surface new insights about this condition. They might be good additions to your next blood test panel.

If you are going for IVF, making sure you bring this research with you is super important, as testing for some of the parameters can help you understand your odds and approach this journey from a data-driven place.

Whilst this research has some positives, it also adds complexity to the condition. I hope this complexity is taken into consideration by doctors and future research.

Let’s see what it uncovered.

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What is showed

For this, they used data from 11,908 women with PCOS across multiple geographical areas, including Europe, China, the USA, Brazil and Singapore. They discovered 4 distinctive groups of women with PCOS:

1. HA-PCOS (25%) - The hyperandrogenic subtype was characterised by high testosterone–dehydroepiandrosterone sulfate (DHEA-S), along with mild metabolic disorders

2. OB-PCOS, 26% - The subtype with obesity was characterised by higher body mass index (BMI), fasting glucose and fasting insulin level, with the highest prevalence of T2DM (7.9%), high cholesterol levels (75.3%) and hypertension (28.7%)

3. SHBG-PCOS, 26% - The high-sex hormone-binding globulin subtype had the highest sex hormone-binding globulin (SHBG) level and lowest BMI among four subtypes, primarily manifested as lower luteinizing hormone (LH) and testosterone levels.

4. LH-PCOS (23%) - The high-LH–AMH subtype was distinguished by elevated levels of LH, follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH).

Past articles that will help you understand this better:

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6-year follow-up results

Out of the 11,908 women with PCOS, 5,065 were followed up around 6.5 years later, either via phone or physical consultation, to check how their PCOS was evolving. Here is what they found:

1. Women who still displayed the same level of PCOS

HA-PCOS: 67.2%

OB-PCOS: 50.9%

SHBG-PCOS: 52.8%

LH-PCOS: 74.8%

• LH-PCOS showed the lowest remission.

• OB-PCOS + SHBG-PCOS showed the highest remission.

This is super interesting as LH-driven PCOS is probably the hardest to influence through the conventional treatments and is most likely the one driven mostly by genetic changes.

2. Those in the SHBG-PCOS group had the best ovulation recovery and the fewest polycystic ovaries.

I guess this is the most gentle PCOS type, as lower BMI and lower testosterone levels characterise it due to the high SHBG levels.

3. OB-PCOS, unfortunately, displayed the highest level of complication

We know that extra weight, specifically the one around the waist, increases the risk of disease, as this was also confirmed by this study, where women in this group displayed higher levels of type 2 diabetes, hypertension, high cholesterol and MASLD (Metabolically Associated Steatotic Liver Disease- fatty liver).

The good news is that this the type of PCOS that can go into remission the most as it’s the one that is most responsive to lifestyle changes and treatments.

IVF-outcomes specific outcomes

5,418 women with PCOS received IVF treatment in this study. That’s a significant number.

Here are some findings:

1. HA-PCOS - High pregnancy rates but significant pregnancy loss, hypertension risks, PROM risks, and benefits strongly from frozen embryo transfer over fresh.

2. OB-PCOS - Consistently the poorest reproductive outcomes: lowest pregnancy + live birth rates, highest pregnancy loss, highest T2DM/GDM risk, highest LGA babies, and should avoid HRT preparation.

3. SHBG-PCOS - The strongest IVF performers overall: highest live birth, lowest pregnancy loss, best neonatal outcomes, and metabolically safest profile.

4. LH-PCOS High pregnancy success but the highest Ovarian Hyperstimulation Syndrome risk and poorer outcomes with HRT preparation; benefits from standard stimulation but requires careful OHSS prevention.

A significant limitation with PCOS studies is that the recruitment of patients happens within fertility assistance institutions. It’s the easiest way to get clean data in substantial amounts. For this reason, I think a lot of the types represented are pretty severe. From my experience working with women with PCOS and speaking to 1000s, there are also milder PCOS types that don’t display as many of the risks and symptoms. Nonetheless, it’s essential to catch all types and personalise their care.

In the meantime, if you want to work on your PCOS and dig a bit deeper into your condition, you can email me at francesca.abalasei@gmail.com, and I can help guide your next steps.

Have a good Sunday,

Francesca

1

I can’t believe we are saying bye to November and entering December. This year went by relatively fast, but it has been filled with self-discovery.

My life learning this month:

Living from a place of abudance. The more open you are to opportunities, the more the universe will show you the way. I am quite spiritual but over the past year I was too stuck in my ways. This month I opened myself to embrace a more uncertain future with the faith that they way will be shown to me. Maybe pregnancy forces you to let go of control.

Small announcement

Eva Okunieff from Brandeis University in Waltham, MA, is writing her undergraduate thesis on the experience of women with PCOS, after she was herself diagnosed with COVID. She would love to conduct interviews with some of the lovely people subscribed to The PCOS Newsletter. If you are interested, send her a quick email at evaokunieff@brandeis.edu. The more research we have, the better we understand this condition, and better treatments will emerge.

November in review

We were busy doing some supplement reviews and listening to some great stories this month:

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1. Tara’s view on PCOS mindset

We started the month strong by sharing her most important mindset shifts women with PCOS need to go through to manage this condition

2. Hair loss and hair thinning

We deep dived into why women with PCOS might experience hair loss and what causes it, including the nutritional deficiencies and genetic components

3. Vitamin D with K2

Should you take Vitamin D with K2, or just by itself?

4. Magnesium

Magnesium is another popular supplement, but what type does what? We review six different magnesium types.

5. Caroline’s fertility journey

Learn from Caroline’s 10-year fertility journey. There is a lot to gain from listening to this episode, as Caroline shares what led to her figuring out a 3.5-year struggle to conceive her first child and how she approached conceiving her second.

As we step into December, we will discuss a new research paper that was published last month, and we will touch on the holiday season and slow down to enjoy the holidays.

I hope you find the newsletter useful and look forward to your next one.

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See you Sunday,

Francesca

Caroline’s 10 years learning regarding her fertility and PCOS were so touching. Listening to her has made me feel angry, hopeful and determined. Sharing these insights will help so many women avoid the pain of having to try for 3 years before conceiving.

This episode is also dear to me because it showcases how tools such as ovulation trackers, knowledge and advocating for yourself can help women navigate this challenging time that some of us have to go through.

Weather you are just starting your conceiving journey, have been in it for a while or want to know what tools to use once the times comes, this episode is for you.

Ultrahuman gifted me their product for review; this interview is part of that collaboration.

Caroline goes through her realisation that she had a short luteal phase using the OvuSense vaginal temperature tracker and how she had to fight for ovulation medication due to her weight. A story of resilience, perseverance and love.

Caroline is part of the Ultrahuman team, who have recently acquired viO HealthTech company who produces the OvuSense temperature trackers. She left her job at a police department to join this team because of how much she believes in advocating for women with PCOS.

The Ultrahuman team has a 30% discount on their ring who has an advanced temperature tracking module. I don’t gain any monetary value from sharing this.

Have a good Sunday,

Francesca