A quick note: This episode was recorded just days before PCOS was officially renamed PMOS, polyendocrine metabolic ovarian syndrome, in a global consensus published in The Lancet in June. You'll hear us use PCOS throughout the conversation. Same condition, new name, and funny enough, we spend part of the episode talking about how much the old one never quite fit.

PCOS, now PMOS, affects 10 to 13 percent of women, roughly 1 in 8. It is the most common endocrine condition in women, and it is still underdiagnosed and often misunderstood.

Dr. Madeline Kaye is a board-certified OBGYN whose grandfather trained under Dr. Irving Stein, one of the two physicians PCOS was originally named after (Stein-Leventhal syndrome). Generations later, Dr. Kaye is doing the careful, comprehensive work this condition requires.

We cover:

• The renaming of PCOS to PMOS and what it reflects about the science
• What PMOS is and how it is diagnosed
• Why insulin resistance sits at the center of so many symptoms
• The hormonal dance of a normal menstrual cycle and what goes wrong in PMOS
• Irregular periods, acne, unwanted hair growth, hair loss, weight, sleep apnea, and mood disorders
• Why women with PMOS carry a higher premenopausal risk for endometrial cancer, and how to protect against it
• Birth control: band-aid or true treatment
• Lifestyle as the foundation: nutrition, exercise, sleep, and stress
• Supplements: what do we think about inositol (dose, ratio, what to expect), vitamin D, berberine, and spearmint tea?
• Metformin, GLP-1s, and the new oral options changing the game
• Fertility considerations and how to optimize before conception
• Spironolactone and the androgen symptom toolkit

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The average woman with vulvar lichen sclerosus waits 5 to 15 years for a correct diagnosis. Most see three or more providers along the way. One in three women lives with a vulvar condition at some point in her life, and uncommonly is told what is really happening to the skin of the most sensitive area of her body.

Dr. Melissa Mauskar is a board-certified dermatologist at UT Southwestern, a leading vulvar disease researcher, and the founder of one of the few specialty clinics in the country dedicated to vulvar dermatology. She has built her career around finding the answers women have been told do not exist, and her work is changing what these women can expect from medicine.

We cover:

• Why the vulva is its own organ and behaves differently than skin anywhere else on the body
• Lichen sclerosus: who gets it, what it actually is, and the 1 to 3 percent prevalence that doesn't get spoken about enough
• The autoimmune debate and what the research is showing now
• Lichen planus, eczema, psoriasis, and Crohn's on the vulva
• Why the diagnostic delay is so long, and what is being done to close it
• Topical steroids: how to use them correctly, and the myth that they thin the skin when there is disease present
• Compounded and emerging treatments, including JAK inhibitors and the international clinical trial Dr. Mauskar is leading
• The vulvar microbiome and hormone research that may rewrite how we treat these conditions
• Surgical considerations and when to optimize before any procedure
• Vulvar irritants, allergens, and the over-the-counter products doing more harm than good
• Diet, irritants and allergens connection
• Vulvar cancer surveillance and what women need to know
• The new clinical trials and research consortium reshaping the field

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Find Dr. Mauskar's work at melissamauskar.com

Autoimmune diseases affect roughly 5 to 10 percent of the U.S. population, and women carry about 80 percent of the burden. The science is clear that chronic stress and adverse childhood experiences raise the risk in a dose-dependent way, with each additional ACE increasing autoimmune disease prevalence by about 10 percent. A large Swedish cohort found a 36 percent higher risk of autoimmune disease in adults with stress-related disorders, rising to 46 percent for those with PTSD.

That's what the science says. Sara Hirsh Bordo went further. Filmmaker, founder of Women Rising, and author of Autoimmunity & The Good Girls, she funded the first survey at the intersection of female empowerment and autoimmunity in 1,000 American women and found a striking pattern: more than 6 in 10 with autoimmune disease were the eldest or only daughter, and more than half were raised as the family caretaker.

Her thesis: a self compromised creates immunity compromised.

We cover:

• The eldest daughter, only daughter, lifelong caretaker pattern
• How chronic self-betrayal correlated with Sara's own diagnoses and relapses
• Reframing self-prioritization as foreign, not wrong
• The little-T trauma of being raised to fear disappointing others
• Practicing safe disappointment as a muscle to rebuild
• The body speaks story, not just science
• Raising daughters who can fall, get dirty, and get back up
• Imperfection as the path forward
• Readiness, healing, and what it takes to live differently

Autoimmunity & The Good Girls is available now wherever books are sold. A portion of Sara's proceeds benefit the Society for Women's Health Research.

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