Good Hormone Health Podcast
Dr. Friedman has a unique practice. He is an experienced, board-certified endocrinologist and researcher. He has the capabilities to diagnose and treat even the most difficult hormonal problems. He is compassionate, a good listener and willing to “think outside the box”.
Good Hormone Health Podcast
PCOS Is Now PMOS? New Name Explained + Best Treatments, Labs & Weight Loss
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PCOS has officially been renamed PMOS (Polyendocrine Metabolic Ovarian Syndrome). In this webinar, endocrinologist Dr. Theodore C. Friedman explains why the name changed, what it means for patients, and how the latest understanding of this condition affects diagnosis and treatment.
In this webinar you'll learn:
• Why PCOS is now called PMOS
• The biggest symptoms of PMOS and hormone imbalance
• How insulin resistance affects weight gain and metabolism
• Which laboratory tests Dr. Friedman recommends, including testosterone, DHEAS, SHBG, fasting insulin, HbA1c, LH, FSH, prolactin, and more
• The role of pelvic ultrasound and AMH in diagnosis
• The best medications for PMOS, including metformin, spironolactone, GLP-1 medications, progesterone, and other treatment options
• Evidence-based supplements including myo-inositol, NAC, berberine, probiotics, vitamin D, fish oil, resveratrol, and more
• The best diet for improving insulin resistance and metabolic health
• Fertility, irregular periods, acne, hair loss, hirsutism, and long-term health risks associated with PMOS
Whether you've recently been diagnosed with PCOS, are struggling with weight loss, irregular periods, fertility, high testosterone, or insulin resistance, this webinar explains the newest science and practical treatment options available.
Learn more:
https://goodhormonehealth.com
So good afternoon, everybody, or good evening, depending on where you are in the country. Today's good hormone health webinar is entitled PMOS, formerly PCOS, What's Behind the New Name Change? Our hotline today is why was the disease formerly called polycystal ovarian syndrome or PCOS, now called polyendrocrine metabolic ovarian syndrome or PMOS? How is that consistent with my approach to the condition? How is POMS diagnosed? What labs are needed to diagnose and follow PMOS? What medicines can be used for PMOS? Is there a PMOS diet? What supplements can be used for PMOS and why is some what is Symmetria and why is it appropriate for PMOS? So PMS is common. Some of the slides do still have the old term of PCOS on it, but they are somewhat interchangeable. Doctors that understand it are not that common. It's thought that sort of one out of eight women in the United States have PCOS or PMOS. And many of them, about 70%, are underdiagnosed or not diagnosed. And there's more than 7 million women. That's more than the number of people diagnosed with breast cancer, rheumatoid arthritis, multiple sclerosis, and lupus combined. PMS is a hormone imbalance in women that affects about one in eight women. PLMS probably has several etiologies, ovarian, uh adrenal pituitary hypothalamus. This is what I learned when I was a fellow at the NLAs in the 90s, and I still think it's true. And has gradients from mild to severe. So this is a picture, again, some of this older picture that uses PCLS, but we're using PLMS now. Head dandruff, male pattern involvedness, depression, extra hair growth, coarse hair growth, masculine features, skin, dry, dark patches, cystic acne, abdomen weight gain, pelvis thickening to the wall, the uterus, polycystral ovaries, multiple cysts, irregular vent season fertility. The causes include the hypothalamus. I mentioned it's a high could be a hypothalamic disorder due to increased GNRH. Their LH and FSH are abnormal, often the LH to FSH ratio is high. This can lead to insulin, high insulin levels, insulin resistance, weight gain, skin changes, and fungal infections. The ovaries occur because have abnormalities in the ovaries. The follicles do not mature. You don't get ovulation. This leads to the adrenals making DHES, the adrenal hormone, which is underappreciated. They get increased conversion from estrogen to testosterone, giving you increased acne, facial hair, male part male pattern baldness, and masculine features. So common signs in PMOS include no periods or irregular periods. Other symptoms include pelvic pain, waking, trouble losing weight, acne, thick skin with dark patches. Half of the women with PMS will experience waking, and many experience issues with fatigue and difficulty sleeping. Hair loss is quite common. Additionally, many women experience mood changes because of PMOS. In May 2026, there was a consensus process with many stakeholders that they decided to change the name to PMS, which more accurately characterizing the diseases affects on multiple endocrine systems, and to move away from the misleading emphasis on polycystic ovaries, which I've always been felt that they weren't really a key part of this syndrome. And many people with POS did not have polycystic ovaries. So I think it's a good move that they changed the name. Patients with POS are at a risk of adverse metabolic, reproductive, and long-term cardiovascular health risks, making proper identification and management of PMS essential for improving your health outcomes. Neither biochemical testing nor ultrasonic imaging is required, according to this consensus statement, to make clinical diagnosis of POS. Although, as an endocrinologist, I use frequently laboratory tests, including androgen levels, and I actually think they're essential. The main features of POMS would be according to this consensus statement of ovulatory dysfunction, irregular, infrequent, or absent menstrual bleeding, hyperangrocin. They can be either clinical or biochemical, but I'm a big emphasis, uh advocate of measuring hormones, making sure it's biochemically confirmed. This includes fursitism, male pattern, hair loss, and acne. And then you can have the polycystovarium morphology, which is done on ultrasound, or you can have an elevated antimalarian hormone level. And this actually can be used as an alternative. And I think more and more doctors are moving away from the ultrasound and doing more biochemical testing. The to diagnose PMOS, you have to exclude other etiologies of androgen excess andor regular periods. Most common of these is Cushing syndrome, and many people do come to see me because of Cushing syndrome. People can have irregular periods due to prolactinomas. They can be perimenopausal and menopausal, although they usually don't have androgen excess from that. They can have androgen secreting tumors, and they can have congenital adrenal hyperplasia, specifically late-onset congenital adrenal hyperplasia that is, uh can look very similar to PCOS. And again, the fishal diagnosis is made by, um, according to this, the statement, uh, made by irregular menses and clinical or laboratory evidence of hyperangen with the exclusion of other causes. Um, adults with irregular menses or hyperangium should get a pelvic ultrasound. If they only have one of them, um, they can get a pelvic ultrasound. And the diagnosis can be made in general. I work on mostly laboratory evidence, and I don't get pelvic ultrasounds. Um, then your chronologists like me make the diagnosis primarily based on high antigen levels, testosterone and DHCS. And I follow them, I diagnose this and I use them for treatment. Insulin resistance is important, especially with the PM and OS. Gynecologists use the ultrasound more frequently, although, again, I think it's becoming less. They look for the string of referrals on the ultrasound. Some gynecologists don't even measure testosterone, although I think that's again changing. I think more and more people are measuring testosterone levels. And POMS has several etiologies, ovarian adrenal, pituitary, and hypothalamic, and has gradients from mild to severe. Um, the guidelines don't recommend pelvic ultrasound except in limited circumstances, especially in women that have either hyperangism or regular periods been on both. And you would look for the having 20 or more follicles at this two to nine millimeter size. Some of the symptoms we talked about earlier, but using spatial hair, acne, infertility, can't lose weight, hair loss, and balding. It's very important to recognize that PMS is part of the metabolic syndrome, which includes insulin resistance, abnormal lipid measurements, obesity, and high blood pressure. It may be harder to lose weight if you have PMOS, but the weight loss and healthy diet are crucial in PMOS. Um therefore it's a difficult disease because you have both inability to lose weight, but you need to lose weight. And PMS is associated with increased cardiovascular disease, more heart disease is associated actually more even a little bit, more kidney disease can be associated with it. So this new name change really uh ties in metabolic syndrome with PMOS. Um, this is always part of my treatment. The treatment should address metabolic issues, including insulin resistance, high testosterone. And we'll talk about my supplement I'm working on Symmetra, is really designed to address the metabolic issues. Some of the long-term health consequences of PMS include hyperinsulinism, insulin resistance, some people have impaired beta cell function, increased risk for type 2 diabetes, obesity, hyperlipidemia, and general increased cardiovascular risk and the risk of endometrial cancer if you're not having periods. Some of the reproductive impact includes increased prevalence of menstrual disorders, hyperangiism, reduced response to ovulation induction, requirement for a higher dose, making the infertility much harder to treat. There's a higher rate of miscarriages and a higher rate of pregnancy complications, including gestational diabetes. So the laboratory test I use to diagnose PMOS is the uh mostly the total and bioavailable testosterone with the SHBG. And I'll talk about why that is so important. DHES is high in adrenal PMOS. I usually can get a day three LHFSH and estradiol to look at perimenopause. We do cushioning tests including 24-hour URF cortisols and solidary cortisols. We can I usually measure prolactin level, 17 hydroxy progesterone, it's green for congenital adrenal hyperplasia, hemoglobin A1C, fasting insulin, and glucose. And the main test I do is the bioavailable testosterone, SHBG, and DHES, and I usually follow them with treatment. Now, the SHBG is a very important hormone, sex hormonal binding global. It's a protein that binds both testosterone and estradiol. Its amount can vary widely in patients, and the FSCF's HBG is either low or high. The amount of active biovel testosterone can vary widely. Therefore, it's very important to measure SHBG in all patients being evaluated for the polycystrovarian syndrome. The assay for free testosterone women is often inaccurate. I used to use that in less. Um, but you can measure the total uh testosterone SHBT and do the biovel testosterone, and it's quite accurate in all the labs, but lab core quests, uh, esoterics. The biovel testosterone includes the free testosterone, but what is loosely bound to album is basically what is the active amount of testosterone. This acid for biovel testosterone is accurate. It's warm bioid quest, lab core, and esoteric. Um, the bioavailable testosterone determines how much active testosterone the patient actually sees. The patient may have a normal testosterone but a low SHBG and therefore have high biovel testosterone. And they may have signs and symptoms of androgen excess, such as herstitism or acne. The doctors say their testosterone is normal, but it's the biovel testosterone that's not normal. On the other hand, the patient may have a high total testosterone and a high SHBG, but a normal biovel testosterone, and then they don't have the androgen excess. SHBG is reduced in insulin resistance and obesity, and actually is a good marker for insulin resistance. So patients say, oh, my SHBG is high, and I tell them it's good news. When the SHBG is low, it's more consistent with PCOS. Anyone with PCOS or PMOS have a high normal or even a normal total testosterone, but have a low SHBG because they have insulin resistance. Therefore, the biovol testosterone is off on the high side. And I use a cutoff of seven to diagnose PMOS. If you're above that, I think the PMS is likely. If you're below that, it's less likely. On the other hand, birth control pills or other forms of oral estrogen raise the SHBE and give a higher total testosterone than FSHBE is normal. These patients often have a normal or low biovol testosterone. And a study found that birth control pills can raise SHBD, and even after stopping it for at least a year, the SHBT remains high. Because the SHPG is high, often the biovol or after form of testosterone is low. The female patient often has low libido when all an estrogen and even being offered for a period of time. And again, it takes a while for this to return to normal. SHBD is not affected by transdermal estrogen such as estrogel or oral estradiol patch. It appears that progesterone such as prometrium or proverum may also raise the SHVG slightly, but this is usually to a lesser extent than oral estrogen. So I'm always having my patients trying to figure out what they have wrong with them. Is it hypopertuitism with growth hormone deficiency, polycystric PMOS or Cushing syndrome, PMOS, and Cushing syndrome can both have acting hercitism? However, the testosterone is high in the PMOS syndrome, especially the biolostosterone, what's usually low in Cushing syndrome or hypopertuitism. I published a paper about 15 years ago or so looking at testosterone levels above 31. Then desoterix is more indicative of PMOS, and less than that is more indicative of Cushing's disease. A very high testosterone greater than 100 or a DHS level greater than 500 could indicate in either an ovarian or adrenal tumor and worthy of an ovarian ultrasound or an adrenal CTRL of I. Other hormones that are helpful, the high LH FSH ratio is often seen in PMOS. It's often higher than 3.3 to 1. Estral can be low, normal, or high in PMOS. High LH and FSH and low estradiol are consistent with perimenopause or menopause. Hyprolactin is consistent with prolactinoma. High 17 hydroxy progesterone is seen in congenital adrenal hyperplasia. And high DHES is usually high in PMS and doesn't require any additional workup. It doesn't require looking for congenital adrenal hyperplasia with that DHES elevated. Amenhusion just requires treatment to lower it. Okay, and then DHES versus testosterone. DHES is the adrenal androgen that is often high in POS. Glucocorticoids like dexamethasone can, in theory, lower DHES, but they have too many side effects for use. Prescription medicines are really not that effective at lowering DHES. So the supplements are quite good. We'll talk about the medicines and the supplements shortly, but I think it's very important to recognize this role of DHES. And many providers don't recognize that. And it's a culprit in POS as well as the testosterone. Okay, so what are some of the treatments for PMOS? Um the first one is birth control pills. The Energy Society recommends birth control pills as a first-line treatment for PMOS. The advantage of birth control pills is lowers but biovel testosterone by lowering LH and FSH. It raises the SHVG, so the biovel testosterone is lower, total testosterone is high, but it also doesn't matter. And you have a you usually have a regular period. It helps prevent endometrial buildup and helps prevent uterine cancer. And I would say it's a good choice in a young woman who wants contraception, but it does not have a good choice in an older woman, a woman that wants to get pregnant. The disadvantage of birth control pills is they don't improve insulin resistance. They can lead to waking. It's hard to follow the course of PMOS, as you were originally looking for the um, you know, whether the period will return on its own, and then you're given birth control pills. And so it really sort of masks the underlying cause, which is the insulin resistance and elevated testosterone. Birth control pills affect various liver functions, including the SHBG, cortisol binding globulin, thyroid binding globulin. So a lot of patients on birth control pills have a very high cortisol. They think they have cushions, but it's really because their cortisol binding global is elevate, raising their total cortisol, but not the pre-cortisol. Some birth control pills have a lot of androgenic properties, which means they act like testosterone. Birth control pills lower estrogen, or and these women with BMOS are often low in estrogen. This may lead to menopausal-like symptoms. Birth control pills can affect um factors that can lead to blood clotting. So I think as a woman gets older, I'm less reluctant to give birth control pills. Birth control pills lower IgF-1, which makes the patient growth hormone deficient, which a lot of my patients are trying to treat them with growth hormone. Um, and then uh birth control pills you can't try to conceive. So if you're trying to conceive, it doesn't make any sense to take birth control pills. Some reproductive endocrinologists try to manipulate the system a little bit and they give it first to raise the SHPG and then stop it. But it's very tricky to do that. I think it's better if somebody's trying to conceive to give them something else. The next treatment for PMOS is metformin. Metformin improves insulin resistance, helps with weight loss, but only a little bit, helps prevent several types of cancers, it lowers testosterone and DGS a bit, but not that much. Disadvantage is it doesn't work too well. It has a lot of GI side effects, including nauseousness, bloating, gas, and diarrhea. If you take a low-carb diet or you're taking the metformin extended release, side effects are often less, can lead to B12 deficiency. A typical dose I use is 500 to 1,000 milligrams once or uh twice a day for the uh uh metformin. You can work up a little bit on the dose. Another medicine I use frequently for PMOS is sprotolactone. It lowers testosterone and also blocks aldosterone, it also blocks testosterone. So it decreases both the secretion and blocks of the receptor. So you get sort of a double effect. Um it blocks aldosterone, so it's also a diuretic. Um, it helps with heart and kidney disease, it works pretty well. The disadvantages it blocks aldosterone. So somebody with low blood pressure, they can get worse, get dizzy on standing, dehydrated, it can raise potassium. Um, this usually doesn't happen in younger people, it does happen a lot in older people where you with also kidney disease or diabetes. Um, it rarely raises liver tests that are reversible. I like to sort of keep an eye on the liver test every three months. You should not take while pregnant, uh, but you can take up until pregnancy. It's not that dangerous to take if you get pregnant, but you should try to stop it. Typical dose is 50 milligrams twice a day. In the older patient, I would probably use less. And um a younger person, we can go up to 100 milligrams twice a day. Another medicine I like a lot for PLS is called Casidex. It blocks testosterone. It's a very potent drug. It lowers testosterone, it blocks testosterone at the receptor, decreases hair growth very well. It only blocks testosterone at the receptor, it's not, it's it doesn't block aldosterone, unlike spermolactose, so it doesn't give you the low blood pressure. The disadvantage is that it's a prostate cancer medicine, so you're using it off-label. It's not FDA approved for women, um, which isn't that big of a deal. Doctors are allowed to prescribe things off-label. It rarely raises, rarely and reversibly raises liver tests. So you do need to monitor liver tests every three months. If you do um get um elevated liver tests, you can stop it. You should not get pregnant by taking it. Um, and this is a little bit more dangerous in terms of conception um than the serno lactone. So I, you know, I think you should certainly stop it. If you get pregnant, if you're trying to conceive and you're close to conceiving, you might want to stop it. Typical dose is 50 milligrams a day and up to 50 milligrams three times a day. Another medicine I use a lot for PMS is progesterone. It lowers testosterone due to feedback. If you give it every 11, like 11 days a month, like days 15 to 25 of the month, you can offer restore periods. It's good for women to put on birth code pills who want to get off. It has much less side effects. It's biodential compared to birth control pills. Occasionally you get fatigue. I usually give it a night, waking and bloating, but not too often. Um, I prefer the biodential progesterone. It's also the brand is called prometrium over synthetic provera. Um, maybe a provera, digesting it's not biodential, doesn't work as well. I would typically give progesterone 200 milligrams of bedtime days 15 to 25 year cycle, um, if you want to, especially if you want to restore this your cycle. And you can also give it continuously if the patient doesn't want to have a cycle. Another surprisingly good medicine for uh PMS are statin. So these are medicines used to lower cholesterol, and that's the advanced. They also lower cholesterol, but they have a good side effect profile. They lower testosterone also quite well. Um, these are usually pretty well tolerated. Occasionally, people get muscle eggs, rarely you get decreased memory. In general, studies have found that they actually help prevent Alzheimer's disease. There's a slight increase in glycemic parameters like hemoglobin A1C, but it's very insignificant. Um, I use these a lot. With typical dose might be lipidor 40 milligrams at bedtime or crestor 20 milligrams at bedtime. The next category of medicines that is quite helpful for uh PMOS is the GLP1 receptor agonists. These are medicines, semaglutide and trzepatide. Um they lower testosterone. They are often expensive and may not be covered by insurance unless you have diabetes. And they aren't covered for PMOS right now at all. Um, so you know you can't even put a PA in for trying to get it on PMS, they won't be covered. I often use compounded GLP1s, trzepatite and semaglutide for weight loss. They're especially helpful for PMOS, especially the metabolic components. Advantages of them are they lower testosterone, they liquidate weight loss, they improve diabetes parameters, disadvantages they can be expensive, not covered by insurance. The compounded ones are less expensive, but um, they're more expensive than metformin say. Side effects include nauseous volume, abdominal pain, loss of appetite, diarrhea, constipation. A typical dose I would use would be compounded to 2.5 milligrams weekly. You could do microdosing and start with a low dose or work your way up if you need it. So, to summarize treatment for PMOS, you often need to use more than one drug. The drugs may have side effects. And this points to a need for dietary interventions and supplementary interventions. So, what is a healthy PMOS diet? So, first of all, you want to do anti-inflammatory diet, ultra-processed foods, especially high-carb foods, high amounts of carbohydrates, trigulate insulin rise, insulin release, and trigger inflammation. These include cereals, white bread, white rice, baked goods, uh, crackers, cookies, sodas, soft drinks, um, food drinks, all those can lead to inflammation, lead to insulin release. I like this slide. I show this to my obesity patients. You have your corn on the cusp and a corn in a husk, it's minimally processed. The corn in the can is a little bit processed. Um, it's corn cut up, it's basically still corn. The Doritos have a little bit of corn in them, but not too much. It's mostly chemicals and fiber and fillers. They don't have any fiber in them, they don't have any nutrition in them, they have a lot of salt, additives, flavorings, and the grocery stores are full with these type of foods, have a lemon's full of them. So really try to cut down these ultra-processed foods, I would say would be the main sort of diet supplement, diet recommendation for PMOS. So try to have foods containing healthier carbohydrates, whole grains, fruits, vegetables. I like having two servings of vegetables per meal. You can have both of starchy and non-starchy vegetables. Uh, the um the non-starchy ones are really good for you. Even the starchy ones like peas and beans are probably fairly good for you. Legumes are good. Um, so concentrate on these types of foods. So basically, for a healthy PMOS diet, no suitors, no sodas or fruit drinks, start the day with a high protein or vegetable breakfast, eat regular meals and some uh snacks throughout the day. Don't eat too much, include fruit, um, include protein fat and some carbs at each meal. I usually recommend mostly vegetables at each meal with a little bit of these others. Focus on unprocessed whole foods, include a rainbow of fruits and vegetables. Uh, three-quarters of your plate should be fruits and vegetables, grains, starchy vegetables, beans and lentils, things like yogurt and milk are okay to add. And keep your carbs to a quarter of your plate. This is a plate I showed my patients. A lot of fruits and vegetables on the left side, the plant proteins, some pulp grains, a little tea that are plant fats, are okay. This would be what I would recommend for a POS diet. Okay. And then we'll talk about supplements to conclude with. So why take supplements? So the supplements are often quite effective. They improve the labs, they help you for insulin, they help your cholesterol triglycerides, they improve ovulation. Many of these have been studied extensively. Double blind studies, they improve the egg quality, they lower testosterone, especially, they lower DHES, which is hard to do with some of the medicines. They help deficiencies in your diet. If you have malabsorption, you have gastric bypass, you may help low levels of some of these hormones, some of these supplements, these vitamins. And people that are vegan don't get enough B12. So it's important maybe to supplement that. And it's important to optimize your nutrition, nutrient levels. In general, I advocate, you know, a balanced diet and try to get most of your nutrients from food. But some people may need to add some of these supplements. Only supplements can be used to lower your testosterone levels, for example, DHS levels. So metformin can give you low B12 levels. It's quite common. It's progressive. It depends on the dose response. And you can get macrocytic anemia, neuropathy, nerve damage, mental changes. And I like to keep the level of B12 above 400. It's a you know simple medicine to take. You don't have to do fancy tests. Um, and I'd say patients on bed pharma should get their B12 channel at least twice a year, maybe more. You want to keep again the level above 400. There's ex Amazon B12 gummies that are two gummies for 3000 micrograms. So you can take one gummy, it's easy to take and cheap, tastes pretty good. Um, usually a thousand micrograms a day is a good choice. Um, so the high, there's several studies on this. Um, a hard study in PL PLS1 show the um the higher um lutose of metformin, the more deficient in B12 people are. Um, and it's the same in people with uh type 2 diabetes and PMOS. Um, and this can lead to um low levels of B12, both long term and short term. Um, in some women taking uh metformin, uh it lowers um B12 levels um in patients with PMOS. This was studying us in 2013. So definitely looking at your B12 level and recruit placing, it would be a good choice. Now, these two supplements are very helpful for PMOS, um, myanocitol and Dchironacitol. These are also the B complex vitamins. They're found in foods, fruit, beans, cereals, buckwheat. The inocitol phosphoglycine, glycant, IPG, are secondary messengers, and they regulate activities of hormones, including FSH and insulin. They're quite useful in insulin resistance, um, they can help with uh lipid issues, and they lower your antigens, they help with infertility, they help with high blood pressure, they lead to a little bit of weight loss. Can everybody mute themselves? They reduce gestational diabetes risk, improve a quality, and lower your TPO antibody. So they have quite a lot, which is in Hashimoto's. I recommend 2,000 milligrams of myo and 50 nanograms of DCI, that's 40 to 10. Um, and I recommend taking it with meals. I like this brand of omnibiotics on um Amazon Myanocetol Plus, and this is going to be my the main ingredient in Symmetra. Side effects would be hypoglycemia. There was uh here's a study in European Review of Medical Pharmacal Sciences in 2009. Uh randomized controlled trial, increased insulin sensitivity, decreased triglycerides, decreased cholesterol, decreased testosterone. You know, testosterone was almost cut in half. It's quite impressive. In fact, decreased systolic and diastolic blood pressure. Um, and 69% of the women started ovulating. Um, another study by um also in European Review of Medical Pharmacological Science in 2007 showed myonosinal improved ovulation uh compared to control, simply increased HDL, your glucose, or reduced your body weight, and 70% of women establish a normal varying circadian rhythm. So these are quite helpful. Um, myonocidal improves egg quality better than DCI. It's important to have a good ratio of them. Uh myonocy, there was one study, again, a European review of medical pharmacological science that showed uh myonositol is more effective than Dchironositol. Um and taking too high of a DCI dose made actually your egg reserve worse. So it's important to do get a good ratio of the myonocitol to DCI. Another supplement that's very good for PMS is NAC and acidl-cysteine. It's an antioxidant and amino acid, acid of Lightcysteine, a precursor of glutathione. Its advantages are improved insulin resistance, infertility, dyslipidemia, inflammation, and gerizin lowering. Uh, it helps with oxidative stress, helps with bronchitis, and it's immune support. It's fairly expensive. And there are other things that have a similar name to you. You need to make sure you're getting the an acetylcysteine and not something else. Um, it's also hard to sort of put in supplements, so it's not going to be in Symmetra, um, but you can get it separately. Sort of a dose of about three grams is needed to be effective. There's NAC from now on Amazon, that's quite good. And it has uh GI issues and fatigue as it's side effects. Um there's uh eight randomized trials with nine or ten women and general NAC improved BMI, total testosterone, insulin, lipid levels that had improved in rates of pregnancy and improved ovulation risk rate compared to placebo. And it was as good as metformin for improving pregnancy rates, spontaneous ovulations, menstrual regularities in insulin resistance, and cholesterol. Resferatol is what's in red wine. It's been found in grapes, berries, and peanuts, also. It's an antioxidant, anti-aging, anti-cancer, and has cardiovasprotective properties. So it really is an excellent supplement to take. 30 patients with PMS were randomly given in the resveratol or placebo. The resverotol group had a 23% reduction in their total testosterone, a 22% reduction in their DHCS, the past insulin levels dropped. Um, the advantages are it does reduce total testosterone levels and DHES levels. And disadvantages are some GI side effects of it, but not too much. Um, I often recommend doctors vest transferotol or nutrient neutrovene premium respheritol. Fish oil is another good supplement. It reduces inflammation, helps with depression, supports healthy pregnancies, improves triglyceride levels, helps with um fatty liver disease, fertility, sex, uh, skin and hair health. Um, it probably helps with dementia. Um, there's little disadvantages. Um sometimes it does it smells fishy depending on the brand you get. Um, but in general, it's a reasonably uh safe and good supplement. You have to check the milligrams. Um you do want to take at least a thousand milligrams a day, perfectly twice a day. Nature's bounty fish oil has a thousand milligrams, and there's nature-made fish oil with 1200 milligrams. Berberine is another medicine that I supplement I use a lot. It's a Chinese herb, and the dose is usually 600 milligrams twice a day. It's very good for prediabetes and diabetes. It was found to reduce testosterone, uh, lipids, insulin levels, and give weight loss and improved fertility. It reduces testosterone, lipids, and insulin levels, and it gives weight loss, approves fertility, and reduces fatty liver. There's some nauseousness and constipation. Reasonable brands would be um premium berber HCL by Smart Nutri Labs and Toplex Burberry Supplements. And you have to be careful, the bat the bottle usually says um 1200 to 1800 milligrams is the dose, but each that's for three pills, two or three pills. Each pill is usually 600 milligrams. They usually recommend 600 milligrams twice a day. Um, there was a 2022 retrospective randomized control trial with women with PMOS looking at myositol, berberine, and metformin. All groups improved cholesterol and triglycerides, but berberine showed the greatest benefit, leading to larger decreases in total cholesterol, LDL, and triglycerides, the biggest increase in HDL compared to metformin and myonocitol. All treatments reduce weight and DMI, but berberine led to the largest drop in waste size and waist hip to hip ratio, showing a stronger effect on essential weight loss than metformin and myonocitol. And these findings suggest that berberine may be a great option for women with PLS that are focused on cardiovascular health and weight loss. They help decrease fasting insulin and glucose levels and improve trahoma IR score, which is insulin resistance. They lead to a significant increase in SHBG and decrease in total testosterone levels, and the free androgen index, which reduce symptoms like curcitism and acne. They reduce inflammation. POS is associated with low-grade inflammation. Probiotics can lower inflammatory markers like highly sensitive CRP. Probiotics may manage, help manage cholesterol and triglyceride levels, helping reduce the cardiovascular risk associated with PMOS. While it's not a direct weight loss tool, they have been associated with modest weight loss, weight reduction, improved body composition when combined with dietary and lifestyle modifications. I think the best POS supplement is caramentia, and you can take one pill a day. Vitamin D has also been found to be helpful. This dose had 100,000 units a month in a couple of journals, Complimentary Therapeutic Clinic Practice and a Taiwanese journal of Obstetrics and Gynecology. They found that vitamin D improved follicles, helped with menstrual regularity, and they were the vitamin D plus metformin is better than metformin alone. In fertile women with PMOS who endroit cloma stimulation had more follicles and were more likely to get pregnant when they had higher the vitamin D levels. And in vitamin D, deficient women, vitamin D supplementation lowers the abnormally elevated AMH levels, which is probably a helpful thing, but may or may not be. So this led us to Symmetra. Symmetra is a blend of supplements that separately have been shown to improve PMOS. This is going to be available shortly. We just got the final product. We're working on the label now. It's a powder. The flavor is called mixed berry and contains myonocitol, dechironocitol, resferatol, echemuncia, mucinophilia, the probiotic, B6, selenium, zinc, and chromium. It does not contain NACN, it does not contain berberine because they didn't taste good and we couldn't really get the dose in them. So people can get those separately. That's gluten-free, soy free, dairy-free. It's called N-L-E-A, which means all the ingredients listed are present. I recommend one scoop for PMOS and two scoops for more severe PMOS. I think it's likely to be better than any supplement on the market. We expect it to be available in a couple months, but we're going to use the website Symmetra PMOS.com, reflecting this new name change. This is what the label is going to look like. At the end of it, it's going to be one scoop, 30 servings per scoop. I think we're going to charge around $49 for it. And it has the B6, zinc, selenium, chromium, and myonositosferatol, echromancia, mucophilia, and Dchyro andositol. So the label cannot, according to the FDA, say it can't used to treat BMOS or PCOS. So we're trying to figure out how the best way to get around it. This is what we came up with so far, but we may change it a little bit. Symmetria is a doctor-formulated dietary supplement designed to support healthy hormone balance and metabolic wellness. It contains a blend of nutrients and probiotics selected to help maintain normal endocrine function and overall reproductive health. One woman may use symmetry to support healthy anterior metabolism, balanced ovarian and adrenal hormone activity, metabolic health and healthy glucose processing, and overall reproductive system wellness. So overall, I think I have a unique approach to PMS combining medicines, supplements, and diets. I think there's rarely you can find a provider that does all those. Some people do supplements, some people do medicines, some people do the diet, but I think I uniquely combined all of them. If you're struggling with PMS, and again, I think this is a hard disease to treat, it's misdiagnosed and mistreated. Please make an appointment to see me at goodhormonehealth.com. Stralacterin, progesterone, cassid XGLP1s are all good options often together. Anti-inflammatory foods, sensual portions, and uh low carbs helps. Supplements when added to healthy diet and life strike can offer health benefits and aid in improving ovulation. I think symmetrical will be a likely breakthrough in the treatment. In the meantime, there'll be uh you know, I have my PMS article on goodhormonehealth.com if it's an excellent article. It has links, and you can get your supplements on Amazon separately. So this will be posted in a couple days. It'll be available on my uh YouTube channel, Spotify podcast channels. Uh it's available on Facebook. If you have any questions, please let us know.
SPEAKER_00All right, thank you, Dr. Freeman. Um can start with some Facebook questions and get into the Zoom questions. Um, I have one call ask, is there a benefit from taking both NAC and MYO, or is that overkill?
SPEAKER_01No, there's a benefit. They are some um synergistic, both of them are helpful. And generally, I recommend six supplements if you can um afford them and tolerate them. They're not that expensive. But the myonocitol, dechironocitol, which is called myonocitol plus, and then respferatol, NAC, omega-3s, probiotics, and berberine are all good choices, and you can combine them together.
SPEAKER_00Okay, a follow-up to that. Do you have a favorite PM PMOS birth control for those that sorry, for those that want to do contraception? And what okay, I guess we could answer that first.
SPEAKER_01Right. So there used to be one called desigen. I think it's harder to get it, may not be available at a low android level. I think Yaz and Yasmin are good choices. And then they have these progesterone-only ones, um, such as SLInd, um, nor which is called norothindron. Um, they work okay, but they're low, you know, they have they don't have any estrogen in them. So you're sort of blocking your own estrogen.
SPEAKER_00What level of DHEA might you be concerned of of adrenal etiology rather than PMOS?
SPEAKER_01Yeah, so I would still say PMOS is adrenal, also. So I wouldn't say it's a separate disease. You have an adrenal variant and ovarian variant. And you know, now the term doesn't have ovarian in it, really. So, you know, it's a metabolic condition. Um, but in general, if the DHES is above the range for the age, I'm more concerned it's really an adrenal etiology, especially if um um the testosterone is more normal, the bivalve testosterone is more normal.
SPEAKER_00All right, thanks for your presentation, Dr. Freeman. You talk so fast. Can you post this so I can read later? We speak slowly in Texas. Don't worry, we're gonna post it. Okay. Um why would someone with stage four endometriosis develop hair steucism, acne fluid filled yeah, acne-filled fluid cyst that had been drained before suspicion of adrenal insufficiency and later develop a hemorrhohagic endrometosis. Gosh, that's a lot, and ovarian cyst after diagnosed, polyendom broken, um cortisols monitored and later diagnosed with adrenal insufficiency. Menstrual cycles were stopped before and after suspicion of adrenal insufficiency despite severe endromatosis. Mentral cycles always on time. Is this related to VMOS? I was emaciated in 82 pounds.
SPEAKER_01Um, so again, that's a sort of a long question. In general, endometriosis is a separate condition. It's usually dealt with gynecological by your gynecologist. Uh, it's usually due to topic uh uh uterine tissue outside of the uterus. Um, and it's very hard to treat. Um, so I would see a gynecologist or a specialist for that. People with um BMOS can also have endometriosis. It should be addressed similarly. Most people with PMS are overweight, but not all of them. Some of them can be quite thin. And I would work on optimizing your DHES and testosterone hormones.
SPEAKER_00How common is it how common is it to have all three? PMOS, AGHD, and Cushing's disease.
SPEAKER_01Um, you know, they are again separate conditions that you can have all three of them. I did my paper that we looked at uh the androgen levels in general and cookings versus PMOS. And POMS, the androgen levels are higher and cushions are lower often. But you couldn't have all of them to have them all together.
SPEAKER_00Okay. Another question from Facebook um is PCOS, PMOS a um disease that lasts a lifetime or is it curable?
SPEAKER_01Um so I would say it's treatable, and you know, losing weight, eating healthy, taking supplements can often reverse it. Also, you know, usually women as they age, they go through menopause, their testosterone levels decline. So it can also be cured because the people can sort of age out of it. It's usually a condition in 15 to uh 45 or 50 or so. So um people can age out of it.
SPEAKER_00Okay, and then a follow-up on your birth control slides. Do you think taking birth control makes getting P PMOS more likely?
SPEAKER_01No, birth control pills does help treat PMOS. It does help lower your testosterone and raise your SHBG and low SHBG is one of the issues. It lowers your biovil testosterone and raising your total. So it doesn't make it worse, but it does can have side effects and it can be used as an effective treatment for PMOS.
SPEAKER_00Okay. I am menopause now with stage four endometriosis, and endometriosis flares up despite a menopause. And I was told this is the pituitary signaling and happens in women with severe endometriosis. How does this happen?
SPEAKER_01Yeah, so I'm I'm not familiar with showing that endometriosis is a pituitary condition. Um, it's usually due to um, you know, sort of these ectopic uterine tissues in the places outside the uterus. Um and it's usually treated with uh by gynecologists offering surgically as a separate condition.
SPEAKER_00Okay. Another Facebook question. Um, women can live with PMOS and not be aware of it.
SPEAKER_01Um women can have PMOS and be not aware of it is true. Um they usually have symptoms of androgen excess, facial hair acne, the inability to lose weight at irregular periods.
SPEAKER_00Um Do you think taking supplements like are a good preventative cause or not necessarily?
SPEAKER_01Yes. So I think if you are sort of borderline high androgens, you don't have enough to need a medicine, I think the supplements are very helpful for that.
SPEAKER_00Does having thyroid problems correlate to having something like MOS or not necessarily?
SPEAKER_01No, not necessarily. They're I would say they're two different conditions.
SPEAKER_00Okay. Did you create some Metra to help your patients?
SPEAKER_01Yes, of course. And you know, it's um it's difficult for them to buy the you know four or six different supplements. They're not sure which ones to get. So I did want to put them all in one container and um wanted to blend them properly and add some you know different different uh vitamins to it. So I do think it's gonna be a very helpful uh uh product.
SPEAKER_00Right, and a good flavor, and you'll be able to take everything at once, so it'll be much more simple and effective. Right. Um let's see anything. If anyone has any more questions on Facebook or Zoom, you can list them now. Is it typical for people to get PMO or be aware of their PMOS when they're trying to be fertile?
SPEAKER_01Yes. So one of the main symptoms of PMOS is infertility. And that's often sometimes sometimes people get diagnosed the first time they're trying to get pregnant and then they can't, and then their doctor measures a AMH level and it's high, not low, and they measure the testosterone level and it's high.
SPEAKER_00Do doctors usually measure that without you asking?
SPEAKER_01In fertility doctors do.
SPEAKER_00Baby gynecologists might but not a regular just appointment. Okay. Why would SHBG be low with biotests under seven?
SPEAKER_01Um so SHBG is low in PMOS. It's a marker of insulin resistance. And you can have low SHBG and your biobell testosterone can't be, it doesn't have to be elevated. It still indicates that you have some insulin resistance going on.
SPEAKER_00Okay. I was wondering for lean PMOS, is it still metabolical even though all mark all markers are within normal range?
SPEAKER_01Yes. So, you know, to have PMOS, you do have to have either androgen excess or regular periods, basically. And you can have sort of mild condition. Your periods can be irregular and your hormones be okay. Most of my patients have the elevated bioavailable testosterone and or a high elevated DHES level, even if they're lean.
SPEAKER_00Great. Just a nice comment. Thank you, Dr. Freeman, for your very informative Zooms and sharing this information with your patients and others. Many of us are learning so much from you, you may never retire.
SPEAKER_01Thank you so much.
SPEAKER_00How can PMOS cause low AMH?
SPEAKER_01It does, it usually causes high MH AMH, not low. You can have the older, you can have poor A quality, and that can give you a low AMH, but in general, for younger people, AMH is usually high in PMOS.
SPEAKER_00What causes low AMH at a young age?
SPEAKER_01Poor A quality. Poor A quality. And it's a statistical thing. You know, not everybody that has a poor low AMH is going to not be able to get pregnant, but you're less likely to get pregnant if your AMH is low. So if you do have a low AMH, and you want to get pregnant, you should probably see a reproductive endocrinologist.
SPEAKER_00Right. I know that this is probably another reproductive question, but on Facebook they said, do you think taking birth control lowers your chance in getting pregnant and hires your chance in PMOS? I know you kind of answered that.
SPEAKER_01So it's it's very hard to get pregnant if you're all in birth control pills. Against some reproductive endocrinologists, but people are not going to be able to do that.
SPEAKER_00But have I think she's maybe like having I think she's maybe like having in your system for however many years.
SPEAKER_01Probably not. Yeah. And then you could stop it, and some reproductive endocrinologists can try to get you pregnant.
SPEAKER_00Um I guess and another question from um Facebook is um besides the sentence you listed, what are a reason that someone will get PMOS?
SPEAKER_01It's genetic. I think again a lot of it is people women have it, their mothers have it, their grandmothers have it. A lot of it's genetic. I don't think we know all the genes involved, but it seems to be somewhat genetic, somewhat related to, you know, or eating poorly, but not too often. Um obesity makes it more likely.
SPEAKER_00Okay. All right, great. I think we have one more, a couple more questions and we'll call it a day. If I have PMOS, when should I be helping my daughters slash looking for it in them?
SPEAKER_01Yeah, so I think if they're not having, I don't know how old your daughters are, but if they're not having periods, um they're having facial hair acne, I think they should be tested also.
SPEAKER_00And you can get tested at any age.
SPEAKER_01Yeah. Any age, you know, sort of above puberty.
SPEAKER_00Right. And you just ask your doctor, can I what kind of test do you also have?
SPEAKER_01You know, I think I would probably, you could ask your pediatrician, but I would and I would start with the um um the bioveil testosterone and DHCS levels.
SPEAKER_00Um she asks, do you see preteens?
SPEAKER_01Um, usually not. They usually just start seeing people in in puberty. It's not it's not a really disease of preteens, you know, it's mostly uh once they start having their supposed to start having periods.
SPEAKER_00Right. You wouldn't really be diagnosed with something like that before then. Do twins have higher prevalence of PMOS?
SPEAKER_01No. If one twin has it, the other dies, but separately not.
SPEAKER_00Well, they both have to be girls.
SPEAKER_01Right. Okay, so let's um call it a day. Thank you guys so much. It was really interesting. Thank you, everybody. Uh we'll post this very shortly.