Full Transcript 0:00 One of the major risks here is endometrial cancer, which we haven't really talked about much on these podcasts. 0:08 It affects about one in 30 women in the U.S. 0:14 who do not have PMOS, but that goes up to about 1 in 11 women who have P.M.O.s. 0:22 And that is probably a result of chronic unopposed estrogen on the lining of the uterus, the endometrium, and it's a very significant condition that may 0:34 lead to the death of Hello and welcome. 0:56 Today we're going to be talking about the most frequent hormonal problems seen in women. 1:02 It was previously called polycystic ovarian syndrome, and now it's called poliendocrine metabolic ovariant syndrome or PMOS instead of PCOS. 1:15 That's a change that was recently initiated in order to reflect our better understanding of the causes and effects of this condition. 1:25 And as adolescents and reproductive age women, people who have PCOS or PMOS, women that is, experienced irregular cycles typically, 1:39 oftentimes hair growth on their face or body, hair loss on the upper parts of their temples and the top of the heads, and were often known to have cysts 1:55 on the ovary, which were actually small, undeveloped egg follicles that hadn't ruptured in a timely fashion, and people would have irregular periods. 2:08 And sometimes, at times, these young women and girls would periods lasting many, many days or even months, or they might go for months without having a period. 2:20 So this was a classic situation with polycystic ovarian syndrome, which is now PMOS. 2:27 So a few years back I did a podcast about the natural history of PCOS, Which is what happens as we transition through our menopause and what What typically 2:43 happens with women with PMOS is that their cycles will become more regular if irregular cycles were an issue before. 2:52 They often still have overweight or obesity. 2:56 Hair growth and hair loss become a little bit less of a problem but don't go away entirely. 3:04 And these women experience menopause a little bit later than usual, typically about two years later, than the average woman with more regular cycles who 3:15 did not have PMOS. 3:18 The good news here is that once people go through their menoppause, their bone density seems to be preserved at a higher rate. 3:27 than the people who did not have a history of PMOS in their earlier reproductive years. 3:35 A couple other features of PCOS slash PMO was infertility. 3:42 And as a fertility practitioner, I saw many, many of these young women who had such irregular cycles that they had no idea when they could get pregnant 3:54 or they just were not having any luck with that and we would treat them. 3:59 Another aspect of this was a fair amount of psychological issues including depression and anxiety and basically poor quality of life. 4:10 In my early days as a fertility and reproductive medicine practitioner, we had vague ideas only about the cause of what we then called PCOS. 4:22 And over the ensuing years, a number of studies have helped to elucidate this. 4:30 And it's a complex environmental slash genetic interchange that causes a young girl or young woman to have PMOS. 4:42 And the manifestations run through much of the body, starting up with the brain and the pituitary gland. 4:50 the ovaries, the insulin, and the pancreas, peripheral fat in our bodies and so on. 4:58 And this is quite complex and our focus today is not going to be to go through all of this. 5:03 Some of it is genetic. 5:05 There's many, many genes that seem to experienced in women who have PMOS and some is environmental so that exposures even as early as in prenatal life 5:18 when the young female is gestating in her mom's womb, those even may have an impact. 5:26 And then such things as inactivity, obesity, dietary choices, and so on, stress, may all impact on the risk of developing the full clinical picture of 5:38 the irregular cycles, heavy bleeding, hair changes, the cysts on ovaries. 5:45 Earlier this year, a group of clinicians and scientists renamed polycystic ovarian syndrome to PMOS, polyendocrine metabolic ovariant syndrome, 5:58 to reflect our better understanding of the causes and the impacts of this condition. 6:04 And part of this new naming situation has brought to the fore the concept that this syndrome doesn't end when a woman goes through menopause and her menses end. 6:18 In fact, with our understanding of how the syndrome is basically impacting multiple body systems, we have a much better understanding the issues are for 6:34 a menopausal woman, and that's what I thought we should talk about today. 6:38 Obesity and overweight are certainly a big piece of this, as we'll come back at the end and talk what one might do about that. 6:48 Management of obesity, of course, has changed so much in the last 10 or 15 years that that a wedge that many people might wish to exercise to try to reduce 7:01 the risk of some of the downstream syndromes that occur in women with PMOS. 7:08 The main things that we've noted, even in reproductive age women, is an increased risk abnormal cholesterol and triglycerides, 7:19 elevated risk of diabetes, and even an elevated of major adverse cardiovascular events, as we call it, which includes many kinds of heart conditions and stroke. 7:33 The biochemical aspect of this is that most or many women with PMOS have elevated bad cholesterol, LDL cholesterol. 7:44 Reduced good cholesterol HDL, cholesterol and elevated glucoses on the basis of insulin resistance. 7:53 And just a quick word on insulin resistant, it's when our downstream tissues fail to react to insulin at a certain level. 8:04 So the insulin has to go up in order to get the glucose to into our muscles. 8:10 Of course, the menopausal transition per se has many elements that dovetail in a negative, unfortunate way with these metabolic risk factors that women 8:23 with PMOS will bring to the game. 8:26 And that is as our estrogen drops, a number of things happen downstream. 8:32 Our muscle mass decreases, and again, muscle masses where most of our glucose goes. 8:38 and our sensitivity to insulin diminishes as well. 8:44 We have increased inflammation as we get older, increased cortisol, which again impacts on our glucose and triglycerides, 8:55 and a number of more subtle changes such as chronic inflammation. 9:00 When one reaches a menopausal age range of course the cardiovascular risks go up dramatically in men and women regardless of their status of PMOS or not 9:14 but the women with PM OS are. 9:17 greatly more increased risk of having adverse cardiac events. 9:23 They're two or three times more likely to develop diabetes, which of course then sets you up for cardiovascular risk. 9:31 There are more like to have liver dysfunction and several other things that are of concern. 9:40 One of the major risks here is endometrial cancer, which we haven't really talked about much on these podcasts. 9:48 It affects about one in 30 women in the U.S. 9:54 who do not have PMOS, but that goes up to about 1 in 11 women who DO have P.M.O.s. 10:02 And that is probably a result of chronic unopposed estrogen on the lining of the uterus, the endometrium, and it's a very significant condition that may 10:14 lead to the death of a woman and certainly requires major intervention to cure it. 10:22 So that's one of things to be aware of. 10:25 So we've listed a bunch of things that are not too wonderful to hear about here, but what is one to do if one has a history of PCOS or PMOS? 10:38 First thing that I would say is know your numbers. 10:42 Stay connected to the medical system. 10:44 Know your cholesterol level. 10:46 know Your blood pressure. 10:48 No, your hemoglobin A1C, which reflects your risk of developing diabetes. 10:55 And if those things need attention medically there's a number of downstream things that can be done starting with lifestyle of course healthy eating is 11:06 always on our list of usual suspects here resistance exercise is huge if one had to choose between aerobic and resistance. 11:16 which one hopefully never would have to choose, but if you were to have choose go for resistance because again muscle mass is where the glucose is going 11:26 to be most effectively transported and that'll keep it down in your circulation and reduce the downstream negative impact on your kidneys and your eyes 11:38 and nerves of having elevated Oh and your heart as well of having elevated glucose so so those are some big ones if hormonal replacement therapy is a consideration 11:53 for you from other symptoms i would certainly. 11:57 not let the PMOS status diminish your openness to using hormone replacement therapy or menopausal hormone therapy, as we call it, 12:08 with bioidentical estrogen and probably progesterone for most people who have an intact uterus. 12:16 Same thing with weight loss. 12:17 If you're considering GLP-1s or even gastric bypass, if things are tipped towards PMOS, your risk of the downstream consequences of your weight are higher 12:32 with PMO-S, then certainly I would be quicker to get onto those GLp-ones, and we don't think that there's any crossover risk that's elevated with PMO-s. 12:46 And again, correcting whatever you can correct even without weight loss is still a valuable thing to do. 12:53 So be active, do your resistance training. 12:58 Sleep is an important one for all of us, but again sleep will keep your cortisol level into a good range and reduce your stress level as well. 13:08 so pay some attention to that and do whatever needs to be done to keep you sleep as healthy as it can be. 13:16 If your hemoglobin A1c is a little bit elevated or your glucose is elevated, certainly there are sensitizers that can improve your insulin sensitivity 13:28 such as metformin and others as well. 13:31 So if this is something that your doc or your practitioners are suggesting for you, you certainly might be open to it or even suggest it to them if they 13:42 might have lost track of your status as someone with PMOS. 13:47 So this is just kind of a list of things that might be impactful to reduce your risk of those cardiac events and developing diabetes and so on and forth. 14:00 So I hope this has been helpful for you, and if it is, please share it with your friends and others who may benefit from this information. 14:09 Thanks so much for being along with me today, Thanks for listening to Women's Health Span Voices. 14:18 If today's episode spoke to you, please recommend this to one of your friends and leave a review. 14:24 It helps more women to find us. 14:27 Thanks
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