Do you have PMOS? What It Might Be Doing to Hormones & Metabolism

If you grew up as a young woman, got your first period, were irregular, maybe suffered with acne, even cystic acne and hair where you didn't want it, and no one actually came to your rescue, there weren't really answers, even though you might've tried something and then tried something else or multiple rounds of antibiotics for the acne, for instance, or maybe you got an oral birth control to finally regulate those irregular and erratic periods that made you concerned. This episode is for you. We're talking about PCOS and its new name, PMOS. Number one, why, what it is, both of them, or, or the one that you will recognize and what it means to you. And it may have you too scratching your head as I was just a little bit, there are a lot of common denominators. And as a woman grows up and grows older and into adulthood and pre-, then perimenopause and menopause, signs and symptoms may come out, may baffle you and physicians because you might be doing everything right but have never known about this underlying thing. My guest today is Dr. Anne Hussein, and she's going to shed some light on this very thing. You're in perimenopause, menopause, or postmenopause, and you're not slowing down. You're just getting started. But the old rules don't apply anymore. The workouts that worked before, they're working against you now. The advice you've been given, incomplete at best. I'm Debra Atkinson, and I'm the founder of Flipping 50, the pioneer in fitness for women in midlife. For more than 40 years, I've been in the trenches with women just like you, and for the last 12, right here on this podcast. And, and the founder of Flipping 50: The Stronger Way app and membership. Welcome to Flipping 50: The Stronger Way, where science meets strength, where you'll find the tools, research, and real talk to build the body and the life you want in your second half. Each week you'll get evidence-based exercise and nutrition strategies, conversations with leading experts, and honest answers to the questions your doctor didn't get answers to in medical school and doesn't have time to answer in an appointment. This is your show. Let's get stronger. Hey, welcome or welcome back. I'm so glad you're here. And this is for any of you who are suffering from PCOS, PMOS, the new name now. What you need to know about your hormones and metabolism in midlife and may never have known while you were there. You may be feeling midlife is, is kind of slipping through and you're very much post-menopause. This is for you too. My guest today is so articulate. We're really talking about perimenopause and her interest in it and where it came from, but I want to backtrack. And I talk a little bit in this episode about a private client that I worked with and who is really diving deep into PCOS. It's one of her 3 specialties, people who she sees the most of, primarily women. And she is such an expert on this, on what it means, what it looks like, what signs and symptoms are, how you might know that you have it, when you get diagnosed, what the criteria are, and what you can do about it. So because of the nuances, there's a lot to unpack here. This is a little bit longer episode, which I think is fantastic. So you can strap on your shoes, tie them up, and head out for a walk. My guest today is Dr. Anne Husain. She's a naturopathic doctor, Menopause Society certified practitioner, TEDx speaker, author of The Period Literacy Handbook and co-creator of the Perimenopause Summit. Her passion to empower and support women with evidence-based care through every stage of their hormonal lives stems from her own PMOS, previously known as PCOS, and lack of reproductive health education growing up in Pakistan. Anne runs a hybrid clinical practice in Ontario, Canada. She hosts Phase to Phase, the Hormone Health Show, trains clinicians and collaborates with menstrual equity organizations. She believes that developing agency over your health is not only a personal act, but also a powerful political tool for shaping a healthier world. And you'll hear a little bit about her and I sharing our views on the health of midlife women and the power. that you wield as a midlife woman. I hope you love this episode. Look forward to hearing from you if you do. The doctor is in the house. Dr. Anne Hussain, thanks so much for joining me.

Thank you for having me.

All right, we're going to unpack something that there's definitely a need because I know in our audience, in our— in private clients I've worked with, really in the inner circle, There are women who may have had this, not known they've had this, although all these symptoms and this cluster of things confusing to them. So I want to unpack it all, and we have some alphabet soup we have to unpack as well. So it's commonly referred to, or has been, as PCOS. But even for anyone who is kind of, yes, I've heard that, I don't though know exactly what it is, can we unpack The PCOS and the name change to PMOS and why that occurred. So let's just—I'll let you kind of undo it all.

Okay, so PCOS stands for polycystic ovary syndrome, and the name was changed recently. So in May of 2026, so super recently, to PMOS standing for polyendocrine metabolic ovarian syndrome. Say that ten times. This name change had been discussed in PCOS circles for a very long time, and like taking a step back, not all conditions are named for what they are, right? Like not like most conditions aren't exactly describing what's going on in a condition, but in the case of polycystic ovary syndrome, it was quite a reductive name because it had the term polycystic ovary. In it, and so if we unpack just that part of the name, polycystic ovaries, when you think about it and break down the words, it sort of means many cysts in the ovaries, which is not really the case because an ovarian cyst is something very different than what we refer to as polycystic ovaries, which are actually more accurately described as polyfollicular ovaries, meaning follicles that have eggs in them. They're not maturing properly, so they're clustering in a state of sort of arrested development in the ovary because there's a lot of hormonal dysfunction that's leading to that. And as a result of that, it's either 20 or more follicles in one or both ovaries, or we have an enlarged ovary because there used to be polycystic ovaries in there or polyfollicles in there. So that's what the poly— cystic part referred to, but it was really confused with like, oh, I've had an ovarian cyst in the past, or I've had multiple ovarian cysts in the past. Not only that, when we start menstruating— so if you're like 10 to 12 to 13, 14 years old and you're just starting to get a period, you actually can find polycystic ovaries, like the actual definition of polycystic ovary, as a normal part of our ovaries functioning at that time. So in our adolescence, when our bodies are learning the menstrual way, before we reach reproductive maturity— we reach reproductive maturity around 8 years after our first period ever— finding those, that ovarian morphology where there's like arrested development of your follicles, where there's a lot more follicles gathering, that's actually part of our physiology a little bit. So we don't even use ultrasound as a diagnostic criteria at that point because We normally find that in people who even have regular ovarian function. So that was a confusing part of the polycystic ovarian syndrome. And not just that, you don't have to have polycystic ovaries at all to be diagnosed with PCOS. So this is what created a lot of confusion, and it also reduced the condition to an ovarian syndrome. Syndrome is just a clustering of symptoms. So now if we take a— so now I'm going to describe like why PMOS is a better name and why it changed, because I think that's a We'll do a better job that way. So polyendocrine, meaning multiple hormones, loosely speaking. Metabolic, so pertaining to your metabolism and how you consume, utilize, and store and expend energy. Ovarian, so we still have the menstrual cycle and ovarian involvement. And then syndrome, so clustering of symptoms. Because what PCOS is, it's a lifelong complex multifaceted, multihormonal condition that you have for life. So the polycystic ovary sort of also meant it's only pertaining to reproduction when it's not. It's more than reproduction. There's insulin resistance often involved. Your brain is involved, your ovaries are involved, your metabolic hormones are involved. There's so many other things to that. So part of the name change, the beautiful thing that it does is shine this really bright spotlight onto the condition. So now more practitioners and more people know that, oh my goodness, it's not just about the polycystic ovaries, about all these other things. And also it helps us move some of the treatment strategies and how we talk to patients, hopefully not right this second, but hopefully as time goes on to give us better care. Because oftentimes people would go in, especially youngsters, adolescents would go in and they would hear the words, well, come back when you wanna get pregnant. Or just go lose weight, right? Or here's a pill. And there's a time and place for some of those conversations, maybe not in such a reductive way, but there are times and place for us to have those conversations. But it's not just as simple as that, because even how we got to have this condition, it wasn't one thing. When we look at chronic, complex, multifaceted conditions, there's a few different things going on simultaneously. It's your genetics. It's your epigenetics. So how those genes were expressed while you were in the womb, as you got older, your upbringing, childhood trauma, the exposures you had, lifestyle, all of it starts to play a role together like a complex web. And it's not one thing that led you to having it. I have PCOS, PMOS. I'm going to probably switch between PCOS and PMOS in this conversation because I've said it daily for like a decade of my life, at the very least. Wow. So, so yeah, that's kind of where the name change came from. It was to describe better what was happening in the condition itself, to also have cohesion in the medical space, in the insurance space, in the treatment space, and all of it. Because now that we have the word even metabolic in it, we can now expand into metabolic sort of therapies to help patients out, which we've already been doing, right? Like if you treat PCOS or PMOS, Fundamentally, nothing has changed for us because we already knew it was multifaceted. We already knew it was complex. We already knew that we had to look at all of those pieces. But for those people, especially our primary care doctors, our family doctors, they have a lot on their plate. They're generalists at the end of the day. So even getting referrals, even getting care on that front, I think it's gonna trickle down. It might just take a little bit of time.

Okay, well, and the very first question that I wanted to ask, and I think you've kind of covered that, is, In a sense, what I got is it's complex. There's no one reason why someone gets it and someone else doesn't. I want to ask you this though: Why is it, and are we going to see this less and less now? In in part, is that helped by the renaming? But why is it there might be a woman in her early sixties who was never told this is why these things happen to you? It's It is a syndrome. It's not you're crazy. It's not that you just got a bad deck of cards here, but will that dissipate? We're gonna see doctors now have a better way of knowing this is it. Okay. I know what we're dealing with now. Can you unpack that? Seeing multiple doctors and taking a variety of labs, it can be hard to track my health status collectively. But not anymore. I'm using AI to organize, analyze, and interpret collective results and give me suggestions in real time. On MasterClass, there's a full class worth of insights just like that one, plus 200 more across every area of your life, like business, writing, cooking, creativity, wellness, and more. With plans starting at just $10 a month, billed annually. Audio mode turns your commute or your workout into a classroom. Download lessons for offline access. Learn on your own terms. I listen to lessons while I'm cooking or walking, depending on the class. You could stay ahead of the learning curve with a suite of classes on AI, including the one I'm using, how to use AI to pull your health records together. With AI and Medicine: Your Secret to Better Health. Or look and feel better with courses on gut health, brain health, and skin health. MasterClass keeps adding new classes, so there's never been a better time to get in. Right now, as a listener of this show, you get at least 15% off any annual membership at masterclass.com/Flipping50. That's 15% off at masterclass.com/Flipping50. Head to masterclass.com/Flipping50 to see the latest offer.

So PCOS or PMOS is also a diagnosis of exclusion. So we have to rule out things that look like PCOS or PMOS. So that could include a thyroid disorder, it could include adrenal disorders, usually congenital adrenal disorders. It could look like prolactinoma, so a growth in your brain essentially, where which is secreting a hormone called prolactin, which can disturb menstrual cycles. It's sometimes often confused or conflated with hypothalamic amenorrhea, which is a loss of periods because we're under-resourced in some capacity. So the so we have to rule out other things for sure, and then we have to use the ruling in criteria for it as well. And in adolescence, I will say partly because of the polycystic ovaries, partly because when we're our bodies are learning the menstrual way, there can be some irregularities in menstrual cycles. To begin with in the first couple of years, right? And then oftentimes people are then put on the pill, which may which is a treatment for many of the things associated with PCOS. So let's take a step back and look at what it usually looks like: irregular periods or anovulatory cycles or missing periods entirely. It looks like acne on the especially on the face, but it could be also on the body. Hair growth where we typically don't want it. On the body and the face, and then hair loss where we don't want it on the head, or we have elevated androgens like testosterone or DHEA on blood work. So first 2 criteria are most important, and then the 3rd criteria only applies if you are past that adolescence phase, so 8 years post-menarche or first period ever, which is either you have polycystic ovaries, ovarian morphology on ultrasound, or an elevated AMH, which is— Anti-Müllerian hormone, oftentimes used in fertility settings.

Yeah.

Because your follicles, and in PCOS we have a lot of follicles gathering, remember, those are the ones that make AMH. So it's a false elevation of your ovarian reserve. It's not really actually your ovarian reserve. It's telling you that you have a bunch of follicles in your ovaries. So that's the diagnostic criteria that we use. And then there can be like metabolic change, so high cholesterol or insulin resistance and diabetes. That might show up more for people in pregnancy. It can look like fertility problems. It can look like pregnancy loss. It can look like in perimenopause, your cardiometabolic risk is increasing more rapidly than you think. The problem— so going back to actually answering your question now, we didn't used to diagnose it as much as before. So I've been practicing for almost 12 years now, and I used to diagnose PCOS more earlier on in my practice, and now I would say sometimes I'm correcting a misdiagnosis, or patients are already coming in after being diagnosed. So that's actually a beautiful change that has happened just in the last like ten years, which is awesome. So that's one thing. So if you're in your fifties and sixties, you probably weren't diagnosed at all because we didn't know much about it. We didn't talk about periods that much. Most people, most of us grew up not knowing about what a menstrual cycle and regular menstrual cycle was in the first place. I remember. My periods used to come every like 45 to 60 to 90 days, and that was my normal. I grew up in Pakistan where I'd never learned about periods, so I just thought that was normal. I didn't think to even talk to anyone about it not being normal. It wasn't until I started realizing and getting some menstrual cycle information that, oh, this is not normal to not go, not have a period for that long. And then when I went back to my mom, She also has a history there, and now she has some cardiometabolic disease, and we can see that okay, that was probably an extension of what was happening. And then there's also a strong family history, right? Not just of PCOS, but also of type two diabetes and hypertension and things like that. So that's part of the picture that we a didn't know have enough menstrual education to understand. B it was earlier on, so our just general awareness in the medical system also was. Poor. Then number 3, if we're giving you oral contraceptives, for example, to regulate your menstrual cycle, then what's happening is that it's decreasing some of the symptoms associated with PCOS, like acne and hair loss, for example. And then it's also giving you a regular bleed. So then you think that, okay, I'm having a regular bleed. And most of us didn't know when we were growing up that what the pill is doing, it's suppressing ovulation entirely, giving you a constant dose of hormones. And then when you take those hormones away, you shed a lining, and that's not really a period. That's a withdrawal bleed because we took away the hormone, right? So you think that you have a regular menstrual cycle, and then when you come off it, you're like, oh, I have fertility issues, which is not always the case. Some people can easily get pregnant with PCOS. There's a wide range of like, there's a spectrum here. But, but that's also why. And then I wanna talk about something we don't talk enough about, which is the age-related normalization that can happen in menstrual cycles because our hormones change as we age. Your menstrual cycles can actually become more regular as a product of that. Or you've changed your lifestyle, so you're actually managing some of your PCOS or PMOS in the background because you're eating more fruits and vegetables and getting more fiber. You're exercising more regularly because you're trying to take care of your body and take care of yourself. So and those all of those start to then have an impact. And I have lots of patients who are like, "Well, I had PCOS and now I don't," which is not how we think about it. We call it you have well-managed PCOS because you. Improved your muscle mass, you decreased your fat mass, and you've changed your whole diet and lifestyle, and you're taking better care of yourself. So those are some of the reasons why we've missed it. And then because we don't really go into the history of someone's menstrual cycles if they're in their 50s or 60s— like, I have the luxury of time with patients, but family doctors— I'm in Canada— family doctors in Canada have like 7 minutes with their, uh, per appointment. Oh my gosh. Period of time. That's the average. Oh my gosh! That's the average per appointment, and there's only so much you can go into the history, especially if you don't—you haven't seen that doctor for a long time, right? So there's that missing component that can sometimes happen as well. But if you have gesta—you had gestational diabetes, if you had gestational hypertension, if you have a history of irregular menstrual cycles, if you had acne or acne that was treatment resistant or acne that needed like multiple rounds of Accutane for. These are things that I'm looking for in my patients to be like, oh, are we looking at possibly PCOS that has like normalized with age? Or now that we don't have a period, we still need to consider, especially from a long-term risk standpoint.

You have me wondering if I have PCOS. I've— because— and I'm so glad you unraveled it without me asking, but that would have been my question for so many of us. And I don't know how common this is still, but I, like you, was regularly irregular, or the opposite, like, you know, every 3 or 4 months. So it was kind of regular, but it was kind of like that. And, you know, talking in the locker room with other girlfriends, I knew that that's not how everybody had it. But I did go on oral birth control to regulate it. So I am one of those people, and maybe one of the lucky ones who you know got pregnant easily coming off of it. But you know there are some common denominators there. So coming back to dig in, is it actually? I mean, we've we've we rule things out, but there is no you can't take a test and say okay you have it. It's a matter of we come to a conclusion based on other things. Is that so? Yeah, it's a good question.

So we the diagnostic criteria is the Rotterdam criteria. That's the that's the standard that we use. So you have to meet two out of the three criteria. One criteria is you have or one criterion if we're being technical is anovulatory cycles or irregular cycles, and the definition of that changes. But if you're in your prime reproductive years, that usually looks like somewhere between 24, beyond the 24 to 38 day mark. So that's criterion number 1. It's different when you're younger, and it's different obviously when you're in perimenopause, right? Because like those are transition phases in our lives. So that's number 1, you have to meet that criterion. Number 2, the criterion is the hyperandrogenism or hyperandrogenemia, which is either you have clinical signs, and the clinical signs are enough, you don't need to testosterone or DHEA or androstenedione in someone who has cystic nodular acne, moderate to severe hair loss on the head and/or hirsutism or facial and body hair growth. So that's number 2. Or some people don't have those symptoms but their androgens are still elevated in blood work. So that's where the testing is important. And then the criteria number 3 is if we're doing an ultrasound, we're seeing polycystic ovarian morphology or elevated AMH, which is the anti-Müllerian hormone. And there some cutoffs that are more recent. That AMH inclusion is recent from the 2023 guidelines on PCOS. So you have to meet 2 out of 3 criteria. For adolescents, it's the first 2. The 3rd criterion doesn't matter. And sometimes we just give it a provisional diagnosis at the time, like if we suspect it. There's also like metabolic change, like a young menstruator is gaining significant abdominal weight, for example. Like those sorts of things that we can give also based on that, a provisional diagnosis. Along with those criteria being met, we have to then rule out, um, to your point, the other things that look kind of like PCOS but— and maybe contributing to some of the symptoms. Because like I said, irregular cycles, it could be you're under-resourced, you're over-exercising and not eating enough for that, or you went through a concussion and you lost a period because of a concussion, or you have a thyroid disorder, or You have a high prolactin or something else. And then, so like, that's how we paint the full picture of what's happening. And then we start gathering a little bit of other history too, right? Like, what else is happening in your life and your health? Family history, because that can start to give us clues that, oh, you have a family history of strokes and heart attacks and/or type 2 diabetes, right? Like, these start— this starts to paint the picture of, okay, this is what we're looking at.

Wow. Okay, so there's so much here. So In terms of treatment, are you kind of playing whack-a-mole and you have to go like symptom to symptom? Because of what you've just described, like the symptoms someone has also in the phase of life they are— a woman in perimenopause, as you described, okay, now insulin resistance is probably a factor because of that too. It's how do you determine What is the, what is the ideal treatment? Or are you starting even with somebody younger to be preventative? And, and are the lifestyle mostly changes, or is there something more?

Okay, so this is a huge question. Yeah, because we're— what we're trying to not do is play whack-a-mole. Yeah, we have some, we have some great—

Thank you, thank you. We like to hear that from our doctors.

We're trying to go systematically. There's always a role for lifestyle, especially when we're looking at prevention, when we're looking at even treatment of cardiometabolic disease, right? Like regardless of what other tool or intervention that we're using, lifestyle is always part of the picture. And the younger we start, the longer the runway. And that's what I really want people to focus on. Wherever you are right now, this is the soonest you can start, right? So let's start right Right this second, and then we have other tools. So that could be supplements, that could be herbs, that could be medications, and there's a variety in there. But I always like to focus on the lifestyle because it is always important, and there's so much we can do, especially if patients are young. So I work with a lot of adolescents, especially who have PCOS because I have PCOS, and I have moms who have PCOS and they want to be proactive about their daughters. My primary patient populations are PCOS endometriosis. Perimenopause, right? Like, those are the 3 primary, um, populations I work with. And perimenopause, as you mentioned, like, there's already an element of increased insulin resistance, and then PCOS, like, adds this layer of insulin resistance on top of that and increased cardiometabolic risk. So from a lifestyle standpoint, it really is following a heart-healthy lifestyle. So that's gonna be like a plant-forward diet with, you know, lots of fiber, lots of potassium, not too much sodium. It's going to look like exercise of all kinds. Strength training— muscle can improve insulin resistance and your glucose metabolism independent of insulin too, right? So we want to build muscle young. And the nice thing about building muscle, or starting to build muscle young, is that you also improve your bone density over the long run, right? Like, we don't think about bones until we're like all the way over there in perimenopause. So lifestyle has lots of important roles. And then when we— and then we go in with other interventions depending on what's happening. So to your point, if someone has irregularity in their menstrual cycles or if someone's missing periods for 3 to 4 months, then what we want to do is actually regulate, not just for the sake of regulation, it's also to decrease the risk of endometrial hyperplasia, which is overgrowth or abnormal growth of that uterine lining that we normally shed during a period. In PCOS or PMOS, That lining is still building up in the background to some degree, and there is an increased risk of uterine cancer. Small risk, but there is an increased risk if that lining goes unchecked. So we do want to have a bleed every three to four months, whether that is through a medication or through something natural. So inositol are the typical supplement that we will use. Those are insulin sensitizers. They improve menstrual cycle regularity. The sort of equivalent pharmacologically would be metformin, but birth control pill also serves a purpose in there. And I always really like talking about the oral contraceptive, not because, you know, I love it, it's because it's a tool. And really, that's how I look at all the tools. I look at all the tools very neutrally and see where the patient is at. But if you're like 18 and you need contraception, And you have acne perhaps, and irregular cycles, perhaps an oral contraceptive is a great fit for you at this time of life for a short period of time at the very least, so that when you're in school and you have no time to like do other things, or as you're implementing lifestyle changes, you have like the contraception piece also, because you could be irregularly ovulating and you just don't know when and where that's happening.

Can I interrupt you there? And, and I don't want you to lose train of thought, but I think that's tricky. Like saying, you know, an oral contraceptive at this time of life for a short time would be— you know, I went on it at 18, 19, and I was on it until I was 53, you know, because I think once you're on it and you've got this regular thing, it's easy. And so it would have been a, like, a why would I want to stop this kind of And, and I think now maybe we are educating and there is a reason people will understand better. Maybe long-term this is not the ideal thing to do, but we didn't, right? It was just great. This is awesome. It's easy. Yeah.

So, and there's something to be said about ease too, right? But what I want is for you to make an informed decision, whatever that is, and then you And you revisit it. If it's still the appropriate tool for you, great, carry on. And if you're like, okay, now I wanna come off it because I wanna start thinking about a family in 2 years, or I just wanna see what my body does 'cause I'm curious, I think all of it is good as long as we're going in with our eyes open. And that really is the goal with any kind of treatment plan is you go in with your eyes open, you know what you're getting into. Obviously there's always gonna be unknowns. Plans go out the window all the time, but we do our best to, you know, lay out a buffet of options and pick the right thing for you at this point in time. Like, where we are in Canada, birth control pill, in many of our provinces, they're subsidized. It's also a free option when you don't have a lot of disposable income when you're younger, right? So there's something to be said about all of the tools, but that's not the only tool that you have available to you. You have acne, then you can go into your symptomatic stuff. Like, if you have acne or if you have hair loss, there's There's medications for that. There's also herbs and supplements for that. Oftentimes, unfortunately, because I am a naturopathic doctor, some of our tools aren't as well studied. But I will say in the PCOS and PMOS world, some of our top tools are quite well studied actually, like the inositols, the NAC or N-acetylcysteine, the berberine. But like when and where we use them is not the same for everybody. It really depends on what also is happening metabolically. And this is where blood testing does come really in. Right? Like checking your cholesterol, checking your blood sugar, like all of those things, they start to matter a lot more. And then as we age, what worked for you before might just not work for you now, and that's totally fine too. Bodies will change. If there's one thing I can guarantee in life, it is that the bodies will change. And your priorities might change, your values might change. And the goal with a treatment plan always is to have lifestyle components And B is to meet you where you're at and have very real conversations, right? Like I have conversations even though I can't prescribe statins. I sometimes talk about statins because if your cholesterol is going up, up, up, up, up in perimenopause or postmenopause, we care because it increases the risk of a heart attack, right? Like I'm not trying to push a pill on you. I'm trying to help you manage your risk, especially if you have like this really strong genetic predisposition. There's so many people who can do it with diet and lifestyle, which is awesome. I love it. But there's some people who need a tool, and a tool is just that, a tool, you know? And we need to find the right tool that helps you achieve what we're hoping to accomplish. Did I answer your question?

Yes. Oh gosh, and then some. So good. So you— this is your niche actually, and specialty, because it's got personal meaning Yeah, yeah.

So I have, I have PCOS now, PMOS. It runs in my family. And my mom, we didn't identify it or really like look at it until later. And my mom didn't know my cycles were so irregular, partially because we never really talked about menstrual cycles so, so much. But also, guess what? Her normal was also irregular.

Wow.

So she didn't make much of it. She's like, oh, I was irregular too. You're irregular. That like one plus one equals two, right? So and it's it's fascinating to me. She had severe cystic nodular acne. It runs in her family. And now that we look at a little bit of that side of the family, I'm like, oh, there's like a lot going on here in that regard, right? So yeah, I have a personal history there, and that's why I care so much about it. I love having conversations with my patients about. PCOS, PMOS, and really I think that's the power of longer appointments. So I get to spend—I sit outside of the public system in Canada, so I get to spend a little bit of time extra time with patients, which I think is where a lot of the the therapeutic value of an appointment also lives—is in asking the questions. It is in busting some of the myths. And now we have like this huge amount of information at our fingertips, which in so many ways is so awesome. I think. You know, menstrual cycle literacy, body literacy, even where we are in the perimenopause world. Like, all of that is the power of sharing and community and the internet. But then there's, you know, always the bad actors and the marketing and the corporation, you know what I mean? Like, there's like all of that, um, noise out there that we have to sift through. And I find that, um, marketers really know how to pull on those, um, heartstrings of especially of of women who are already just shouldering such a high burden of responsibility.

So vulnerable. So agree. And so you, you also mentioned perimenopause, and I think, I think right now what is happening is it's just being elevated that, you know, we don't, we don't wanna just target menopause and wait until, oh, there you are. Okay. You know, but we wanna look at, there's actually an on-ramp here. And so as you're on this on-ramp, if you're more proactive and you're learning as much as possible, you know, and of course if we catch them way back here and we can get them to do the right things, even better. But their journey is going to be a little less bumpy if we liken it to a plane. It'll be more smooth. And you are a part of an upcoming summit. And I think This you just demonstrated today makes that so very important because it's deep. You know, it is not just, oh, perimenopause, and there are certain symptoms and, and the hot flashes in the night sweats and things, but there's literally, you know, very serious things happening that actually we can unpack from clues in your youth that also come along for the ride here. That if you can get to all of it earlier, you know, before you hit your 50s and your 60s, when now you have that compounding, your estrogen decline is kind of layering another piece of that. I think it's fascinating. Tell me a little bit about the decision, because I've hosted Summit, and that is not for the faint-hearted. It's, you know, just so that everybody understands, I mean, you don't go lightly into This—it's a—it's like you just took on another part-time job, and you're a physician. You know, or I'm running a company. It's like a passion of the heart. So talk to me about your decision to host, and—and what does it mean to you?

What do you hope happens? Mm-hmm. So my producer and I are co-created the Perimenopause Summit coming up on September 21st to 24th. 4th of 2026. It's virtual, it's free for you to attend, and there's also a chance for you to have longer access to it and access to some incredible resources. And Debra is part of our summits, so graciously contributed your time and your expertise to talk about exercise and perimenopause, which is so important. I, I always say I love women I love women. I love talking to women. And selfishly, I got to talk to some incredible practitioners, clinicians, and experts, which was really, really fun. And also, the goal is to empower women. My mission started very early. I knew I wanted to help people. And part of that comes from my own personal history of not growing up with any menstrual education and then learning and and discovering, like so many women do, as I got older and older about, oh my gosh, there's this, and then there's this, and then, oh my gosh, here's another thing that I never learned about. And then in perimenopause, learned nothing, not much in school even, right? Like, and I have had the immense privilege of having formal training, um, and still not learning so many things. When I wrote my book, one of the best things that came out of it wasn't like reaching the end, it was the process. There were so many questions That I got to answer for myself and had the time to dive in. And that's where I find like the summit shines also, like expanding the boundaries of perimenopause a little bit, but also getting into the nooks and crannies of all the things that people experience and then chalk up to XYZ. And as women, I think we could just get so much messaging from out in the world from a very young age that we need to do things a particular way. And look a particular way and say things a particular way and hold our anger in and not get, quote, emotional, unquote, right? Like, there's so many things that come to the surface during perimenopause, and I'm there for it. I want women to take this opportunity to really pay more attention on themselves because we usually also just give our time and our effort and our love and nurturing away to everyone in our lives. That's also something that we learn, but also I think that's something within a lot of us in many different ways. And we shoulder a lot of responsibility, and this is a time where your body starts to send you some signals. And there's a spectrum, right? And I think that's also what I wanted to highlight with the, with the summit, is that there's not one way to go through perimenopause. You could have zero symptoms, but the changes in the background are still happening. You're still losing a little bit of bone. It happens silently. You're still at risk for cardiometabolic disease. You're not going to feel plaque building up in your arteries. The cognitive changes, all of that, it's to validate. So women are being like, okay, I thought I was just imagining this, and you're not. That's part of it. Part of it is to not blame everything on hormones because you could have very real things happening alongside perimenopause, and we need to address those. Part of it, I talk about iron deficiency like way too much in, in most of our talks because iron deficiency is just just so prevalent in women, and people know it and still don't take their iron. And I want you to take your iron.

Right.

And then I think it is an opportunity to set yourself up for right now and also the future, because when patients land in my practice, the thing that they want to say— and I know with people who work with you— they want to age well, they want to have their independence, they want to do all the things that they love to do, they want to have peace of mind, right? Like, all of those things come from putting in the work now, and it It's work. I won't lie, getting healthcare is work because only you can figure out what's happening in your body and then relay that to someone who can help you, right? So it does require a lot of work, but I think it is worth it for sure. And like I said, there's the symptom part of it, which can be really debilitating, but there's also the background part of it that's going to happen regardless of whether you have a lot of outwardly signs and symptoms. Or not, and I really wanted to also address some of the noise that's out in the world because perimenopause right now is quite understudied scientifically. The science is going to follow, and then I think we're going to get stratifications between like different populations and demographics, and also age by age. But the most important parts where there is accelerated cardiometabolic and bone change is in the two years on either side of your final period, right? So. So to what you were saying, the sooner we start, the more we can help ourselves set ourselves up for the future. And also screening earlier. In Canada, we have a public system, so we have a lot more rules around screening, even when we test cholesterol and when we do bone density. And I think we in the summit had the conversation about how we screen too late. And I wouldn't even call it screening because by And in Canada, we only do a bone mineral density scan when you're 65 or 70, and the guidelines have changed. And by that time, guess what? Bone loss has already been established.

We're watching what happened. Yes.

Yeah. And I also don't want us to miss the forest for the trees, right? So I want us to focus on the things that are going to move the needle for you the most. And what might work for you might not work for me, might not work someone else. There's elements that we all can probably implement, but then like the sprinkling on top, whether that's hormone therapy or herbs or supplements or the one particular exercise that you need, all of that can change. But the foundations is where we start. So that was a long-winded way of me saying like I care about women and I want us to age well and I want us to do, um, all the things that we want to do. And also like secretly— not so secretly actually— I want I want women to show up as leaders in the best capacity possible because I think we— not I think, I know we can change the world to be a much better place than it is right now.

Yeah, I so agree. I think that's such a great extension of our tagline or it's our overarching message. There's no more powerful health influencer in the world than a midlife woman. And that the reason this is so important is no longer just a matter of, I want arms to go sleeveless. It's, it's, this is the vehicle that you have to take that feminine leadership that the world is so craving right now. Yeah. So agree. I love that. I want to ask you one question from what you said, and this is like very granular, but you mentioned bone testing not actually happening until 65 or 70. Can someone choose to do it and pay out of pocket and access it? And is that like an exorbitant amount, or is that not necessarily— I mean, how accessible is that to someone?

Yeah, the accessibility piece is, is a question mark. There are private places pay clinics where you can get DEXA scans. So those are the typical scans you're getting for bone mineral density.

Yeah.

You can get some like adjacent scans that will roughly approximate but not give you like a T-score or a Z-score. When you're younger, you get a Z-score. When you're older, you get a T-score to determine like what your bone density is. But in Canada, you can pay out of pocket to get it earlier. And there are some exceptions to that in the sense of if you're younger younger than 65, if you meet the criteria, yeah, exactly, you can. But yeah, I just, I had this conversation on one of the sessions. I wish we, we actually screened, right? Like screening test is trying to be proactive and preventatively looking at a particular issue or parameter that is common in that demographic. That's why we do mammograms. So mammograms in Canada we do at 50, but at 40 you can request it from your family doctor, but you have to request it between 40 and 50, and you only get Mm-hmm. Sooner if you have like a strong family history or personal history of another type of cancer, for example. And then that's why we do cholesterol screening because it starts to change in midlife and we do wanna at the very least get a baseline blood pressure, right? Like all of these are screening tests that are very important and move sort of bringing this back to the PCOS, PMOS conversation. In midlife, there is increased cardiometabolic risk. Period across the board, whether you have PCOS or not. If you have PCOS or PMOS, that is higher, and we do see a higher incidence of heart attacks and strokes in people with PMOS down the road once they're post-menopause. So we're trying to actually decrease events that are transformative to your life later on, and the sooner we can get some screening done and address it because cardiovascular. Disease happens in the background for years, decades over time. And then the other one is sleep apnea. So women with PCOS are at higher risk of sleep apnea even at a younger age. And in midlife, we already see an increase of obstructive sleep apnea, and women with a history of PCOS or PMOS are at higher risk as well. But if we can manage sooner, if we can— and sometimes that looks like prevention of weight gain, not necessarily weight loss. Sometimes that means like giving you something Um, or really working on lifestyle to improve muscle mass and insulin sensitivity. Some of— some, right, like there's lots of tools available, but the, the key is not to just push through it and push it aside and not push yourself aside and to really start wherever you are and put the steps slowly over time.

Yeah, I so love that. So much goodness here, and thank you really for I think painting the picture of where we are at this moment of time is kind of a state of the union about perimenopause awareness right now, and so valuable. So thank you for all of you who are listening. And we do have a lot of Canadian listeners, so it was one of the reasons I specifically wanted to ask that question about DEXA. But for those of you who are here and this resonated, and I would be hard-pressed to find anybody I think who it doesn't, either for yourself or for daughters, daughter-in-laws, and, you know, who's coming down the line, and can we do better by them. I want you to go to flipping50.com/theperimenopause, just the perimenopause, no spaces between, and that will be a link for you to attend the free summit that we were discussing And so much good information there. And I just want you to think back on the conversation you had with your mother, and how much did you actually learn about getting your period? And you know, how often did that come up? Or was there any discussion about menopause? And thinking about, you know, it starts with you and I if we're going to change it. You know, and so looking at, okay, how are we doing it different? And I think by learning and getting information ourselves, we have an excuse now to talk about it. Maybe you bring in a daughter or daughter-in-law to it as well. So I'll leave that as food for thought. Dr. Anne, thank you so much for being here.

Thank you so much for having me and all the work you're doing.

The information All information shared on Flipping 50: The Stronger Way is for educational and informational purposes only and not intended as a substitute for medical advice, diagnosis, or treatment. Always consult your physician or qualified healthcare provider before beginning any exercise program, making changes to your diet, or adjusting any medications or supplements. Individual results may vary. Debra Atkinson and Flipping 50 are not responsible for any injury or adverse outcomes resulting from information presented on this podcast.