Reversing PCOS Using Mira + CGM with Rose Mackenzie and Dr. Basma Faris

Three women who've spent years inside the PCOS conversation — one as a clinician, one as a hormone tracking specialist, one as a board-certified OBGYN and culinary medicine physician — and they still said, out loud, that nobody has all the answers. That alone makes this episode worth your time.

Today Dr. Susan Fox is joined by Rose McKenzie, clinical manager at Mira, and Dr. Basma Faris, founder of her namesake practice and creator of the Adopt a Mediterranean Diet for PCOS course, for a conversation about what it actually looks like to track, understand, and act on your own hormonal and metabolic data — especially when you have PCOS.

Mira is a medical-grade at-home hormone monitor tracking four hormones using fluorescent technology. A CGM — continuous glucose monitor — shows you in real time how your blood sugar responds to food, stress, sleep, and where you are in your cycle. Together, these tools are changing what it means for a woman with PCOS to know her own body.

You'll learn 

• why PCOS is a metabolic disorder on a spectrum — and why where you are on that spectrum is not where you have to stay
• what a 2023 University of Toronto study revealed about how glucose levels shift between the follicular and luteal phases — and what that means if you have insulin resistance
• why 70% of people with PCOS have insulin resistance — and why the other 30% matters just as much
• how high insulin drives testosterone production, how testosterone impairs insulin sensitivity, and why breaking that cycle requires interrupting it at multiple points simultaneously
• what Mira hormone data actually looks like in a postpartum breastfeeding woman with PCOS — and why this population is almost always missed
• why elevated fasting glucose and elevated post-meal glucose are two different problems pointing to two different root causes
• how long to use a CGM before you've learned what you need to know, and 
• what "glucorexia" is — and why more data isn't always better.

This episode is for you if you have PCOS and feel like every protocol you've tried was designed for someone else;, you're postpartum and nobody has looked closely at your hormones; you're tired of being told what to eat without being monitored when you follow the rules; you want to understand the insulin-testosterone feedback loop in plain language; you're a provider curious about integrating hormone and metabolic

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Transcript

SPEAKER_03 1:25

Hello and welcome to today's episode of Health University, where we talk all things fertility, pregnancy and postpartum, and the pre-perimenopausal phase before it's time for HRT. And today we're going to focus on something that is actually all inclusive of these walks across the bridge of life, and that is the importance of knowing our blood sugar stability, monitoring and tracking our blood sugar stability, especially insofar as it relates to the polycystic ovarian syndrome person. So I'm delighted to have as my guests two brilliant women. Rose McKenzie is clinical manager at MERA, where she assists healthcare professionals like myself and providers to successfully use MIRA with their patients. With more than 10 years' experience as a natural family planning specialist, she has extensive experience in assisting women using the MIRA monitor for home hormone monitoring and health promotion, including women tracking their hormones in regular cycles, irregular cycles, like the PCOS person, postpartum amenorrhea, chemo-induced menopause, and perimenopause. And Dr. Bosma Ferris is a board-certified OBGYN and certified culinary medicine specialist, and I think that that's important for this conversation. She began her career in healthcare as a registered dietitian and is a published researcher on the impact of lifestyle intervention on pregnancy outcomes, especially in obese pregnant women. She developed a seven-day online patient course called Adopt a Mediterranean Diet for PCOS with Dr. Ferris. She's founder of Polypref and Polypref ND and welcome Rose and Dr. Ferris. Thank you so much for joining us. Really important conversation that oftentimes just gets uh relegated to September, PCOS Awareness Month, and it's happening all the time. So I'm so grateful that you're here to talk with us today. And I'm I'm going to begin just by asking what is your definition of PCOS? We know it's more than a reproductive health issue, it's a metabolic lifestyle issue. So take the floor.

SPEAKER_01 3:42

Okay, I'll start. I think thank you so much for that great introduction. Um I uh I think what's important to mention straight off the bat about PCOS is recognizing that it is a chronic medical condition that impacts people, women with o women and people with ovaries from adolescents through even post-menopause, right? Oftentimes when we see the definition, it's seen as a disorder of reproductive age women. It's it doesn't it's not limited to that, okay? And also, as you mentioned, it's not just a reproductive disorder, it's a hormonal disorder that impacts the reproductive system, the metabolic system, and many other organ systems as well. Um so it affects the nervous system, it affects um, you know, the cardiovascular system, dermatologic system. So it really is a full-body chronic disease that is often only framed in the context of periods or fertility, and it's so much more than that.

SPEAKER_03 4:50

Absolutely, absolutely, yes. Rose, would you like to add something to this?

SPEAKER_02 4:54

Yeah, I think Dr. Ferris explained it really well, really drawing attention to that it's been mislabeled for too long. When I try to explain it to someone, you know, I think we all agree that we wish it wasn't called PCOS because polycystic, many women don't have the ovaries uh that have the cysts in them. So then they think, oh, I don't have it, and then they find out they do and they're confused. Um, so I really when I try to describe it to people, I say it's a metabolic disorder. So if we think about it as a metabolic disorder, that's a spectrum, and there's a lot of different variations within that spectrum. Um, then it helps people to understand that yes, it's a chronic disorder, but they don't have to stay where they are. So if they're, you know, if it's goes from let's say zero to ten, and the dysfunction that they're currently in is 10 out of 10, um, it's really severe that they don't have menstrual periods for months on end, that doesn't mean they stay there. We really want to move you as far to zero as possible. And, you know, I'll call it out right now. Some people have a much more uphill battle to get to zero than other people. Um, but we never want to just be complacent and say, this is just what you have, or for the person to think, I'm stuck with this. Um, you know, there is a lot we can do to move you from the 10 as far down that scale as we can get you.

SPEAKER_03 6:09

Brilliant. I really I couldn't agree more. We we tend to get a diagnosis and think that that label is our our sentence, if you will. And so therefore, this is what we must live with. But I will always argue, because I'm an argumentative kind of person, you know, how did you get there? Like you didn't, you did not, you you are not your diagnosis. You you got a diagnosis that describes a pattern that has has occurred. And so, therefore, oftentimes, not always, but oftentimes, and I do think in particular with PCOS, it can be reversed because it because it was created by a series of variables, including, and then I'm going to ask you to elaborate on this, yes, there's a genetic component, yes, there's sort of a setup, if you will, in utero. However, there is a switch that gets flipped on at some point in a person's life that says, okay, here comes the PCOS dilemma. What would you say is that sort of maybe perfect storm or singular event that would switch that flip to say, uh-oh, here comes PCOS.

SPEAKER_01 7:18

So, in the spirit of being argumentative, yay. Um I I don't know that you can say that there's one switch. So, yes, people with the PCOS have a predisposition to it, right? Whether it's genetic, epigenetic, and then I think it's often a series of different things. It's not just one thing. And if we try to distill it down to one thing, I think we miss um on really sort of getting people to that, you know, close to that zero as as Rose described it. Um, and so I think there's often usually maybe two or three systems at play that are interacting, and we may be able to identify what that switch was, right? That set that whole cycle in motion. Um but oftentimes we can't, right? Oftentimes even we think back as far as we can and we think about how things were when they were better. Um, you know, so we try because that helps us. Um, if we can sort of identify, was there one point in time where things were better? Um, and you know, so was there sort of a switch that flipped? But oftentimes it's a series of different things, or you know, it's things that are compounded. So, you know, as much as I would love to say that yes, it is easy if we just take a good history and we do enough lab work, we can unidentify the like the one woo cause, I don't think that that's fair. Um, or I think that sometimes gives us part of the story, um, but maybe leave some things out.

SPEAKER_03 8:51

Okay. So uh and Rose, I want to I want your two cents on this as well. So you so what are some of those things that you said you know, a few things that may be occurring in perhaps a perfect storm that uh that will uh set us up?

SPEAKER_01 9:07

Well, you know, there's different scenarios that we see, and I'm sure Rose, you probably see some of these same stories, right? And they kind of come, you know, in themes. So there might be the person who um, you know, was fine all along, but then all of a sudden um there were a lot of big life changes, like uh becoming partnered in a long-term relationship and and moving in together and all the lifestyle changes that happen. Or maybe it's a a work change where now sleep is being disrupted and people are you know, or people who are working from home and they're sort of their whole right inadvertently, their movement has decreased, but also they're not getting outside in the morning, and maybe they're staying up late because their work is really stressful. So it may be like a whole bunch of things that happen with one big life change. Um, I see uh in sort of younger women oftentimes um like college athletes that now they graduate college and they're in a nine to five situation and their physical activity has decreased a lot because they used to be an athlete. So they were able to sort of compensate for something that they didn't even know that they had, but now they're relatively sedentary, and now maybe their life is a lot more stressful because now they have a full-time job. And so is it the full-time job stress? Is it the decrease in physical activity? So it's a life change that results in many different changes in their overall sort of day-to-day, and so sometimes that's what I'm saying. It's maybe not the one thing, maybe it's it's multiple things at once. So sometimes it's identifying what was that stage or like what shifted in your life. Um, and then we can, you know, it gives us some clues.

SPEAKER_03 11:02

Okay, great. Rose, I have a question for you because I see in my practice oftentimes that someone has been, would have possibly been diagnosed as a PCOS person in in early menarchy and has irregular menstruation and that and she's you know, she's a tween, so she's she's pasta bageling pizzaing her way through the day, um, and which is which is again another layer of of setup. And she's put on birth control to help regulate her cycles. So what what do we do like how I mean, what I'll just say, what do we do about that? Because that person's coming to us perhaps, you know, 15, 20 years later. And so what do you see, Rose? And what do you do about what you see?

SPEAKER_02 11:51

Sure. Well, I think we have to admit that we can't change anything about someone who had difficulties in their adolescent and they got put on birth control as their solution. That is what's the phrase, water under the bridge at this point. Exactly. Um, but now what can we do now to support you? So again, you may have had a di this dysfunction that you didn't know was happening because when you got put on birth control, it made the cycles regular. So we don't know if you would have kept having irregular cycles or not. Um, because we do have to admit, when women start getting their periods, they are usually abnormal. They are irregular, might be heavy, light, and variable. So that in and of itself is not usually um a red flag, at least yet. Um, I'm always that person like I have to give a small caveat. If you are someone hemorrhaging, please go get help. Don't think, oh, I just have to get through this. This will happen a couple of times. But generally, there's irregular cycles as women reach menarchy. And so this person who has now been on birth control for let's say 10, 15 years, we start working with them right where they're at. So let's get off the birth control, start tracking your hormones, see what hormones you have, and what is that pattern, and now what can we do to support those hormones? And so I'm always encouraging women to understand like optimal health here. What we're trying to get you to is balanced hormones with a regular menstrual cycle with that are ovulatory, and then of course the menstrual bleed itself is within the normal ranges as well. So that's what I'm always shooting for people to get to, whether they be someone who's coming off birth control, someone who's um in a new situation like new onset PCOS. You know, there's a lot of scenarios when Dr. Ferris was just mentioning situations where PCOS might start to show itself. Um, one example that I think is a little bit shocking to people is after having a baby.

SPEAKER_03 13:43

Yes. Oh, that's okay. Please, let's talk about that.

SPEAKER_02 13:46

So, you know, what's challenging about this time frame is these women have a baby. If they're breastfeeding, we don't expect them to be getting periods for, you know, a potentially a long time, anywhere from eight weeks to two years is what I usually tell someone. If you are actively breastfeeding, we're okay with you not having a period. But this is one thing where uh hormone testing with Mirror is beautiful because if I'm evaluating someone's chart, and like what I expect to see is suppression. So low LH, low estrogen, no progesterone because you're not ovulating. So a pretty much kind of flatlining pattern. But when I start seeing abnormalities like LH that's maybe surging multiple times, but no ovulation happens, or I see um LH all the time elevated, I'm like, that's not what I expect to see. And I think you should get a workup. And so I um we have a couple of chart examples of patients who were able to proactively get a workup, got diagnosed with PCS while they were postpartum breastfeeding. And I think those people usually would be told, well, I'm okay that you don't have a period because you're breastfeeding. So they wouldn't get a workup done. But these women have data to stand on and say, No, I'm concerned because this isn't what it's supposed to look like.

SPEAKER_03 14:58

I think that's brilliant. And that is something that we do overlook far too often is that postpartum period, postpartum time frame. Um, and and I and let let's, if if you don't mind, so so we've got the mirror, you know, kind of testing and saying, uh oh, something's we're seeing LH, you know, spiking and and and surging, and we don't expect a uh you know, we don't expect that. How does the continuous glucose monitor then come into play in helping to, and and and maybe I'm getting ahead of myself here, but how might that come into play in concert with the Mira hormone tracking?

SPEAKER_02 15:33

Oh, I think they work beautifully together in all situations. Um, but I'll just throw out one idea and then I'll uh pass it off to Dr. Ferrets. But what I really like for people to understand is let's give an example of a regular cycling woman right now, so not the postpartum scenario. And someone is able to see when they're ovulating, so they know they've moved from a pre-ovulatory state when their estrogen is high, and then they move to a post-ovulatory state when their progesterone is high. So we have two different hormone patterns going, and their glucose levels actually can change within the cycle be based on these two hormone shifts. And when they understand this, they can understand that one, their body might respond differently to the same meal before they ovulate and after they ovulate. So it's not always, you know, um, what do I want to say? They they're like, oh, I can't eat that. Yeah, so it's not maybe the food, it's the phase of the cycle that they're in and how they respond to it. And it also helps them to realize like, I think a lot of women get discouraged in their after-ovulation time because they're they tend to be more hungry based on the caloric need change that most women are not aware of.

SPEAKER_03 16:47

And so they're disappointed in themselves that they these I think are such important pearls. And I I learned this from you both about the the tendency toward insulin you know resistance or sensitivity in the luteal phase. So if you don't mind us rolling up our sleeves, because I think this is something that many, many people don't know, and I'd really like them for them to get a better understanding of what does that mean.

unknown 17:16

Dr.

SPEAKER_01 17:17

Ferris, do you want me to um you can yeah, you can go start, yeah, and I'll fill in if there's anything else I want to ask.

SPEAKER_02 17:23

Please. Um, so if we're okay rolling up our sleeves and going all the way back, I'll explain a study that happened out of the University of Toronto. It was the summer of 2023. So that publication you can find online. Um, but the researchers set out to see do glucose levels change within the menstrual cycle? And they admitted that prior to this, there were some studies that said it did, some said that it didn't. And they alluded to or said some of the issues was women were being asked what your cycles are like. So a historical recollection of how regular their cycles are, when was your last period? And that's how we tracked where they are in the menstrual cycle. Another challenge was the infrequent glucose checks. So they were doing usually blood draws for these. And so those two incomplete data set really made the conclusions of the study not always match each other. And so the researchers set out now that we have advances in technology, they used all 49 participants used Mira to detect what phase of the cycle they were in. They used Fitbit to track other metrics, and then they were on a continuous glucometer, a CGM. And at the end of the study, their conclusion was there's a strong correlation between how women respond or what their glucose levels are based on the phases of the cycle, which, as I was just describing before, the lead up to ovulation is a higher estrogen state, and the after ovulation state is a higher progesterone state. And so knowing that those two phases, the woman responds differently, is really important. And so that again study really shows to us what we've kind of known and suspected in clinical practice and out in the world, but now we can say we can stand on this and now preach it to women that they should understand how their body is different between the two phases.

SPEAKER_03 19:11

Dr. Ferris, would you like to add?

SPEAKER_01 19:13

Yeah, so let's now let's put this in context of PCOS because that study really was done in normal, healthy people. So, number one, um, I just want to say that if somebody does not have objective markers of insulin resistance, they should not be concerned that they're a little bit less sensitive in their gluteal phase, right? That's not they shouldn't be worried about that. So I don't want people to think that that's a problem. But let's put it into the context of PCOS, where 70% of people with PCOS have insulin resistance, not all, right? Just a little bit more than two-thirds. So about one third don't have insulin resistance, which is also important for people to know about themselves. Um so when somebody has insulin resistance and maybe they even have pre-diabetes, we may see these shifts to be even more exaggerated. So that may be more of you know of more concern. If now in the luteal phase their blood sugars are getting really into a pre-diabetic range, that's something that we would want to pay attention to because that um you know we can get into why having uh insulin resistance and having high insulin um is impactful for PCOS. Um we did though, so um when I was working with a company Aspect Health, um no longer with them, but when I was, we completed this little um pilot study together with Mira, and it was interesting to see that some um people did have this uh luteal phase increase in their in their blood glucose, indicating that their insulin sensitivity was compromised. Um but you know, we also have to remember that in some people with PCOS they have these high testosterone levels. And when we factor that in as well, testosterone, which may be higher in the later follicular phase before ovulation, um, in people who are ovulating, that also may impair their insulin sensitivity. So we may see a slightly different pattern in people with PCOS, um, depending on sort of their degree of um, you know, their their androgens um and sort of how severe their insulin resistance is. So it's really interesting, and I think it's important for people to know for themselves so they can recognize their own patterns. It doesn't necessarily mean that we apply, you know, what we know about the normal healthy cycle onto people with BCUS, but that we understand for them what is going to work for them. And that's why using personalized tools you know helps people to individualize uh their own care.

SPEAKER_03 21:54

So I've put together a free 28-day detox masterclass that you can access by clicking on the link below. And now let's go back to our show. I really love that because I do think that the PCOS person oftentimes is um almost ashamed that her like her, why is her body not, and I'll I'll use the the pronoun her, but why is her not body not working the way her, you know, sister is and or best friend is, and it is and it is not a a fault of yourself, and yet there are things one can do to improve and correct those insulin um sensitivity patterns so that it doesn't become amplified, exaggerated, because it can, if you'll if if I'm correct, um worsen over time and it can become more of an inflammatory and then and then almost stuck, stagnant situation that becomes even more difficult to unravel, would you say?

SPEAKER_01 22:54

Yeah, because you have to remember, right? So let's just, you know, if we take it back a step, right? Um, the reason why insulin resistance is a problem for people with PCOS is that when you have insulin resistance, if you are consuming, you know, more carbohydrates than your body can utilize at once, then you will produce more insulin um necessarily than you need. And high levels of insulin do a few things, they stimulate the ovaries to produce. More testosterone. They stimulate the adrenal glands to produce more androgens. And it actually changes that signal that's coming from the brain that generates the cycle. So Rose mentioned before having elevated levels of LH that also can be exacerbated by higher levels of insulin. And so, you know, for that it is important. Also, testosterone, right? So now you've got insulin telling the ovary to produce more testosterone. Testosterone actually impairs insulin sensitivity. So it's this vicious cycle that we have to interrupt, you know, at many different places so that we can sort of unwind that as you, you know, um, you know, as you say. Um otherwise it just sort of becomes this vicious cycle that you get stuck in. And so we have to figure out where we can interrupt that.

SPEAKER_03 24:15

Yeah, the snowball rolling downhill becomes the avalanche, yeah. Right. Wow. So how when do we begin to interrupt? And and I bet I know the answer is going to be right now, wherever you are. But but but the how. So so what can someone listening right now who has either been diagnosed with PTOS, suspect PTOS, or insulin resistance, or just wants to make sure that their, you know, their their metabolic longevity is is as primed as it can be? Because wouldn't it be lovely if these tools were just preventative and not intended just to you know help uh interrupt a problem. So, how would someone begin to use Mira and the CGM uh today?

SPEAKER_02 25:09

I can I can speak about the hormone testing first. So um Mira hormone testing is an at-home solution, so you can decide to go purchase it right now. We do have about 4,000 providers who use this as well. So if you happen to have a provider who's already set up with us, then you can receive a discount from them. Or if you want your provider to understand the mirror data, then of course have them meet with our clinical team and get set up. But the value that Mirror is going to give you is you can identify where you're at right now. So are you in a state of ovulatory cycles that may be long? Or are you having long durations in between your periods? But when you do get a period, it wasn't actually ovulatory. So it was you know breakthrough bleeding that you were experiencing. So identifying where you're at, and then as you start making these adjustments, you can see your hormone patterns actually shift. And it's very empowering to see the hard work you're doing pay off instead of just waiting until that next period. You know, if your periods were six days apart and you're like, well, this one was only 50, so I've made progress. Um, you know, that's helpful to see, but actually seeing the hormone patterns shift, you're like, I'm making true progress, I'm changing your metabolic state. Um, and and that is we cannot overestimate the power that patients, users understanding their data and making action on it. Um, it's going to change everything else about you.

SPEAKER_03 26:32

Absolutely. So I just want to restate you do not have to begin on cycle day one. You do not have to wait for your cycle day one. You can begin now and then start making the changes. And again, combining it with CGM. Is that what you would say for for for someone? Or just or just begin with Mira? I mean, my I I've got my own bias of of that more is better, especially if if you've got long cycles, Dr. Ferris?

SPEAKER_01 26:59

So, you know, I do um I use CGMs with my patients. Um, I don't use them for long periods of time because um, you know, unless somebody really, really wants to, but they are a really great way to learn about your body. And so you can learn. Do you have like when are your challenging times? Do you have, you know, are your fastings high? Are certain meals causing you to have, you know, really high post-meal blood glucose? Do you does your body take a long time to return to baseline? There's a lot of patterns that can be learned, and using a CGM with somebody who knows how to interpret them is really important. Um, and so that people can really learn about their bodies. Um, and then usually once they sort of learn what works for them, they can just continue to you know continue on with those habits if they're finding because they're not, you know, unfortunately they're not covered for people with PCOS. So it's a out of it's another out-of-pocket cost. Um, and so if people want to, you know, determine where to put their dollars and you know, use a mirror test, that you know, may be more worthwhile depending on what their goals are. And so, you know, but I do like to use them um really as a learning tool as a diagnostic tool because I like the CGM instead of using a uh like a glucose challenge test. It's more of a you know, a real world um situation. So I feel like that's just easier, and you know, people don't particularly like the glucose challenge test, it's unpleasant. But um, so I do like to use them for a period of like four to eight weeks typically to really get people to learn about their bodies, and then once they're able to establish those habits, then you know they don't need them because I do see people sometimes get a bit obsessive with their um with their CGMs and their you know and the data that they're with all their gadgets, right? With all their gadgets, you know, there's a term um that uh somebody coined, I don't know, glucorexia, which really is this sort of like you know obsessive managing of of your blood glucose beyond which is you know beyond which is clinically sort of relevant and then now potentially you know anxiety provoking and distressing. So we're trading sort of one, right? We're you know, we're we may be improving your blood glucose on one hand, but if we're causing you more anxiety, you know, and maybe some disordered behaviors on the other hand, we have to be cognizant of that as well. So to balance it. Um so but yeah, having these tools is so incredible, especially when people don't always have access, right? Either they don't have access because they can't find somebody locally that is going to listen to them and and you know, and really help identify if they're having ovulatory cycles, inovulatory cycles. There's so many tools people now have to be able to manage themselves at home, you know, which is really so remarkable.

SPEAKER_03 29:53

Yeah, that's fabulous. And there will be links to to Mira in the show notes. Is there a particular CGM that you like that you find works well with? Um, I mean, people tend in in my side of the of the of the pond tend to use the CLO, but I didn't know if that was, and I think it's because it's more cost effective than others. Um with um it really depends.

SPEAKER_01 30:17

What I tell people is like just go talk to your local pharmacist and find out what your out-of-pocket cost is. Um if I because I can prescribe the um, you know, the prescription, like the non-over-the-counter ones, and they won't the insurance won't pay for them, but their out-of-pocket cost is maybe less than the Stello or the Lingo. Um, so sometimes I will, you know, prescribe a freestyle Libra three. I think that's the least expensive prescription one. And if it ends up being, you know, less uh costly than the over-the-counter one, sometimes people will choose uh that one. It has had some, I think some, you know, there were some recalls a few months back. Um so I sort of shifted away for it. But you know, hopefully they've addressed those issues that they were having. So no, it really depends. Whatever somebody wants to use. Um, some people like to use, you know, whatever if they if they're using a wearable like an aura, they like the stello because it, you know, it syncs with their with the app. And it's always nicer to use as as few apps as possible. I agree.

SPEAKER_03 31:19

Let's let's not increase our exposure when that's as a result of trying to be healthier. Rose, would you agree that the the eight do you do you find that that you're also suggesting it an eight-week-ish time frame of syncing uh Mira with it a CGM? And do you do you make recommendations for a period of time using Mira that has you know sort of an end date, if you will?

SPEAKER_02 31:43

Sure, sure. So for the CGM, you know, it really depends on if they can get their hands on one. If they can only get their hands on one single, so it's going to be let's say 14 days, and they are having any cycles, then I try to have them time it for so they have it on a week before they ovulate and a week after they ovulate, because then they do get to experience both hormone states. And as Dr. Furris said, if if it's someone with um maybe an unmanaged PCOS plan, the CGM data may not follow that traditional pattern, like I just said. Um, but still, then they are in sense a two different hormone patterns. We can see how they're um responding to the different um insulin sensitivities in glucose. So that's my minimal plan. Yeah, someone can get their hands on it longer, of course. Um, I I agree with Dr. Furith that six to eight weeks is really sufficient to learn a lot about yourself. Some people will do a month and then they'll do their interventions and then they'll recheck it again, you know, two or three months later. Yes. If they respond differently now. So yeah, don't do it the whole three months. But and Mira can be done the same way. It can be um one month. You see, okay, this is where I'm at. Now I'm gonna do all the interventions that my provider recommended, and then I'm gonna bring it back out in two to three months and see where I'm at now. Some people, of course, test continuously through the three months of treatment and see how they're progressing. That's really up to the user. Those that want to see longitudinal data, but they're like, I'm really on a tight budget. Then I just encourage them to limit their testing maybe to every other day throughout the cycle. I don't like to go much more than every three days because then you might completely miss the LH surge and you might miss, you know, the the oh, your estrogen just changed. Yes. And and then you obviously, so you know you kind of missed it. Um so every other day though is fine or uh one cycle and then wait um until your follow-up. So it's very flexible, honestly. That's one of the things I love about these direct-to-consumer options. Um, if you can get your hands on a CGM and let's say you're gonna do both of them, do them both together. Yes. And then, you know, decide what you're gonna do next.

SPEAKER_03 33:49

Yeah, I know that my patients in practice, you know, they're actively trying to conceive and are planning perhaps undergoing an IVF cycle. So they really want to get a handle on their data, not just for the cycle itself, but for pregnancy. And I, you know, I think that that's also an important conversation. It it may it may be a full-on conversation that warns us coming back and having you know a conversation about you know what what to do in the various um trimesters of pregnancy, how things might change. Something, something, uh a little flag popped up with for me, Dr. Ferris, when you were saying that, oh gosh, it just blew right out of my head. Oh darn. Oh darn it. I hate when that happens. It was something along the lines of the that there is a change to one's uh glucose levels, fasting, that was it. So if someone is having normal postprandial but elevated fasting, is that a flag for something for an insulin resistance kind of flag?

SPEAKER_01 34:51

Sure. It may be a sign of more um hepatic or liver insulin resistance, so the liver is not responding to live to um the signals, and so it's continuing to produce and put out glucose. Um, it may be a signal of sort of you know, excess early morning cortisol. It may be indicative of some middle of the night dips in blood glucose that then rebound um in the morning. And so there can be many different reasons for having an elevated fasting glucose, and that's gonna be right. So that's gonna be different than somebody who has a normal fasting but high, you know, post-bill glucose.

SPEAKER_03 35:30

Got it, got it. Okay, I've been pummeling you with questions, and but I don't want to miss any key messaging that you want to be sure to impart. So I'm just gonna zip it for a minute and then hand it over to you to have a little two-way conversation, if you will, about things that you want to make sure that the listeners and viewers uh walk away with.

SPEAKER_02 35:51

Open mic. What are we going to talk about? Well, Dr. Furris and I have presented together a couple of times, and it's always fascinating how we ourselves are continuous learners as well. And so I think I want the audience to understand that um none of us have all of the answers, but we want to assist you with what we know now. And that's something that's um beautiful with our ability to have our hands on you know, the newest technologies and the newest research that's coming out. And so I would just want to encourage you, the listener, to keep learning alongside of us. Because as we learn, you know, we talk about things like here, but um I've I have to say, you know, I've been challenged, like something I thought would work good for PCOS, for example. And you kind of use it as a blanket, like this is good for all PCOS. And we learn, nope, that's not true. It might not be good for all of the types of PCOS. So then, you know, sometimes we have to put our foot in our mouth and say, I'm sorry, I I maybe gave you bad advice for your situation. You may need something different. Right.

SPEAKER_03 37:00

Or advice that was not applicable to you.

SPEAKER_02 37:02

Yeah, not applicable to you.

SPEAKER_01 37:03

Yeah, yeah. So it's okay, I think, to say that like this works for most people who try it and see if it helps you. And if it doesn't, then come back and we'll, you know, we'll restrategize. Right.

SPEAKER_03 37:17

Because there's agency in the trying.

SPEAKER_01 37:19

Yeah, and every person is an individual. And so um, you know, we like like uh Rose said, we're learners too, right? We're life tongue, lifelong learners, and we do it so that we can, you know, advance, advance health and and continue to help the people that we that we care for and we care about. And so, you know, it really does come from a place of caring. Um, but I've learned so much from patients as much as I've learned from other professionals, and I love that. I really love that. Um and so, you know, we can't think that we have all the answers all the time. Um, and you know, when we do, I think that's when we really sort of lose sight of things. But yeah, one size, you know, fits all advice is just lousy. Um, there's a lot of that in the PCOS space. There's a lot of people that have a lot of conviction, but not a lot of knowledge or experience or humility. And those are the things those are the those are the people you have to watch watch out for. Um those absolutes are or people who speak with like really strong conviction that everybody should do this, and every, you know, anybody with should or should never do, right? So any of these absolutes are certainly red flags.

SPEAKER_02 38:32

Well, and it kind of leaves out, but it kind of leaves out those who have, you know, maybe endometriosis and PCOS.

unknown 38:40

Right.

SPEAKER_02 38:41

It's like this, well, then what do you do? Do I follow the p the person that says was what I do for PCOS, or should I do the one that says for endometriosis? So this is really where personalized care matters the most.

SPEAKER_03 38:52

Absolutely. And so if if I'm gonna I'm just gonna step on that soapbox as well to say, you know, there are a lot of perhaps even well-intended, well-meaning people who aren't well educated on this, uh, on this conversation, on this information, and can be leading you sideways. You know, you it so in time often, again, with this population is of the essence. They don't have three, six, twelve months to, you know, to figure out later that, oh, that wasn't my my protocol that was determined by someone, some influencer to be the very the very protocol. So finding a true expert, someone who has really dedicated the time uh and invested time and often money as well into this lifelong learning is going to get you your your best results soonest. And then toward that end, resources, you know, you you are lifelong learners, and I imagine your websites or blogs or newsletters or such such and such would have continuing education or information that people can access. So I'll be sure to put that into the show notes as well. But if there's anything you'd like to highlight and say, oh, well, in that case, make sure you pay attention to X, Y, or Z.

SPEAKER_01 40:16

Well, I want to say, I want to add one thing before we before we finish, because I think Rose made a very good point is that sometimes people have more than one concern, right? But instead of us deciding what is important, we need to listen to our patients and figure out what their goals are. And that is what, right? What is bothering you the most? What are you trying to accomplish? It's not for me to decide for you, right? And so, um, and I think so. I, you know, I really just want to lead with that. And so sometimes we can't do all the things that we can prioritize, but we should be prioritizing based on what people want for themselves. Um, as far as resources go, you can go to my website. I actually did rebrand my practice from polyprep to just Dr. Bassima Farris a lot easier. So D-R-B-A-S-M-A-F-A-R-I-S.com is my website. You can sign up for my newsletter. It's a monthly newsletter. I share recipes, I share research articles, um, lots of different resources for patients and for healthcare professionals as well. Um and then I'm on I'm on sort of all the platforms. Um, I'm on Instagram, on I'm on TikTok, both as Dr. Bessma Farris. Um, and I also just started a YouTube channel. So, and wherever it is that you like to view, um, you know, video content, short content, longer content, um, you can find me. So excellent.

SPEAKER_03 41:48

I'll be sure to have all those links in as well. And Rose, how about over at Mira? Is uh is there a uh you know a blogs page, a resources page, or is or do you have your own that is uh outside of Mira that we should be highlighting?

SPEAKER_02 42:01

Yeah, so for users, you just go to MiraCare.com. That's where you purchase your items. Um, if you want to get connected with a clinician who uses or understands how to interpret Mira data, then please consult our directory. So if you again want someone who fits all the boxes, they understand Mira, there's someone who's um trained in fertility and they have, let's say, a PCS specialty, then you'd be able to find a clinician that's a good fit for you. Um at Mira, we like to say we empower patients to understand what their hormones are doing, but I always like to take that step further and say you understanding it is one thing, but having someone to help interpret it with you and make those recommendations and changes is that next step further. So don't feel like you have to figure all this out on your own. I really actually wouldn't recommend against that. I'd encourage you to learn what you can from your own hormone data, but then meet with a trained clinician who can help you take those next steps. So for any providers who may be listening, Mira provides extensive resources. So you can hop on an onboarding call with our team, learn what Mira is, see if it's a good fit for your practice, and then we offer monthly webinars, we have documents to support you, live Q ⁇ A's with hormone experts like Dr. Carrie Jones, Dr. Sarah Peterson, and we want to support you on this journey of using Mira in your practice so you can help your patient population. So those are the two places to go, mirrorcare.com for users. And if you're a clinician, we'll have a link in the chat where you can book a call with our team and learn more.

SPEAKER_03 43:38

Beautiful. That's beautiful. And what what I what I can add is uh here in the West Coast in the San Francisco Bay Area, my patients, when they come in, they're already using Mira. So I've got it easy. They're already in the system, that you know, they're coming up with their here's my last two months of data. And it really does help make my work with them easier. And to your point, to to kind of restate your point, it gives them the agency to say, I know something about my body. I am not, I am not just at the effect of someone else's diagnosis and prescription. Again, especially in that in that short, seemingly short window of trying to conceive, it can feel pretty desperate. Uh, and I'd really, really love to have people who are you know planning their family to know that they've got some some agency over how they how they plan not only that positive pregnancy test, but their pregnancy. So yeah. Well, I could chat with you forever, and I think we're gonna actually come. I I I just that really was a flashing flashing light saying, let's do something on the three trimesters and postpartum because I think that would be really, really valuable. So until next time, we'll just wrap this up here so that the viewers and listeners can get on with their day, and you can get on with your day, and viewers and listeners, thank you. We know that you have many places you could be spending your time, and we really appreciate you spending this with us, and we hope and trust that you found this to be useful. So until next time, we will say, take good care.