Jamie Martin

Welcome to Life Time Talks and our series on performance and longevity with MIORA. I’m Jamie Martin here with Jim LaValle, my colleague and friend. He is a clinical pharmacist, the co-chair of the American Academy of Anti-Aging Medicine, the chair of the International Peptide Society, and the Chief Science Officer at Life Time. Hey Jim.

Jim LaValle

How you doing today?

Jamie Martin

I’m good. I’m ready to dive into this. We’re just jumping right in because we got a lot to talk about. Let’s go.

So recently there was a shift in the name of a condition that’s pretty common, one that people have heard about. Polycystic ovarian syndrome was renamed, essentially, as polyendocrine metabolic ovarian syndrome. It’s a condition that affects one in eight women worldwide. We really want to talk about what is behind this change, and why that change in the name matters. I’m going to have you jump right in.

Jim LaValle

Sure. I think it’s just a more accurate depiction of what’s going on in a woman’s body. At my institute in Ohio, Maureen Pelletier wrote The Idiot’s Guide to Menopause, and one of our big verticals within our institute was women’s health: preconception care, managing hormones, postconception care, and other conditions.

One in eight women will now have PMOS, and I think the new name just depicts things more accurately. It’s not just about the ovaries, where you have multiple follicles that are underdeveloped. It’s really about the whole body. In a lot of previous episodes I talk about patterns and about how your body is a system of systems. Well, it turns out when you have PMOS, formerly PCOS, 50 to 70 percent of those women are insulin resistant, which makes them four times more likely to develop diabetes and heart disease. They have heightened risk of ovarian and endometrial cancers. They have fatty liver. They have weight gain.

Being obese also makes you more prone to PMOS. It can lead to things like sleep apnea. There are a lot of metabolic issues around PMOS. It’s not just about the ovaries. It’s a global situation where hormones have shifted, lipids have shifted, energy efficiency has shifted.

I think the name change was a better depiction. I don’t think we learned anything new about what goes on in a woman’s body. It’s still diagnosed the same way. But I think it’s important because one in eight isn’t a small statistic. And many times, at least from what I found working with Dr. Pelletier, people are on a journey with their health, and sometimes the earlier they can understand what’s happening to them, the better they can intercede with powerful lifestyle tools and nutrients. Just understanding, “Wait, this is a condition I have,” is incredibly important. So I do think the naming convention change mattered because it put far more relevance on everything that’s going wrong in that woman’s body.

Jamie Martin

We should probably take a step back for a second and say, what exactly is PMOS, or polyendocrine metabolic ovarian syndrome? What is it by definition? And what are some signs or symptoms people should be paying attention to?

Jim LaValle

Basically, the ovaries are making follicles that can’t mature. Polycystic ovarian syndrome means the way your hormones are signaling is not allowing for a mature egg, not allowing for a normal menstrual cycle of buildup and breakdown.

That happens because of insulin resistance, or high insulin, and too many androgens. Typically you look at DHT (dihydrotestosterone) and testosterone as the big players. DHT doesn’t allow for follicle maturation, and insulin plays a role in that issue as well.

Because of the shift in hormones, all these different things start to occur: inappropriate hair growth, weight gain, elevated lipids. Once again, insulin is high, and glucose and insulin regulation are at the center of the universe for human beings. It’s the same thing here.

For women with PMOS, insulin resistance creates all these downstream effects. There is genetic susceptibility. There are environmental factors. And then there is the lifestyle side: weight gain, obesity, making more androgens from fat tissue, which then influences ovarian function.

This is a difficult situation for a lot of women. They get acne, inappropriate hair growth, weight gain, and irregular cycles. Mental health is actually a big aspect of PMOS. People get anxious and depressed. I’ve literally worked with hundreds of cases of PMOS over the years, and what’s interesting is when they start to get relief, it’s almost as if you see a different person walking into the office. Their skin’s clearing up, they’re losing weight, their cycles become regular. They no longer have those erratic moods.

I say this with all love and care: I know from interviewing many women that when their mood changes during their cycle and they get anxious or angry, they carry real regret about how they behaved with their children or their spouse. Being able to get back to the normal flow of how your body should be working is critical. It’s a big deal.

Jamie Martin

It really is. So let’s talk a little bit about the shift in framing. The new name really does move this away from being purely a gynecological or reproductive issue and toward something more metabolic and endocrine in nature. Talk about that piece of it, because it feels like when you frame it around reproductive health and fertility, it becomes tied to a specific stage of life.

Jim LaValle

I know. It’s interesting because we talk about hormones as “secondary sex hormones,” which is the traditional term.

Jamie Martin

They’re not secondary.

Jim LaValle

They’re not secondary at all. They’re every bit as important as the others. And I do want to make the point that the diagnostic process hasn’t changed: pelvic exam, ultrasound, labs. That’s still the doctor’s pathway.

The issue is we’re finding out GLP-1s may help people with PMOS. Of course they do, because using insulin more efficiently reduces the pressure of excess insulin creating that change in signaling and morphology of the follicles. This isn’t something you only need to worry about during your most productive years. This is a polyendocrine condition. Multiple organs that make hormones are signaling your tissues, and those signals are causing things like hyperlipidemia. Women with PMOS are more prone to metabolic syndrome, prehypertension, prediabetes, obesity, elevated lipids, and mood changes.

It’s really one rubric, one example of pattern analysis. People in this situation share this pattern: insulin is elevated, lipids are elevated, androgens are elevated, which then inhibits progesterone. So progesterone is typically low, and estrogens typically go up. Your androgens, DHT and testosterone, actually get converted to estrogen. So you become estrogen dominant, you tend to gain more weight, you can’t get a normalized cycle, and you get irregular cycles because of it.

Then there’s luteinizing hormone and follicle stimulating hormone. Luteinizing hormone goes up, follicle stimulating hormone is not in the right ratio with it. Follicle stimulating hormone, as its name implies, stimulates follicles. So you’re not getting the right signal to the ovaries because all these hormones are out of balance.

And then there’s something that I think is one of the most important things, speaking from experience. When a woman has facial acne due to these hormonal imbalances, it’s devastating.

Jamie Martin

It goes back to self-confidence, and all of that trickles back to mental health and well-being as well.

Jim LaValle

A hundred percent. I’m glad we’re at least changing the terminology. I think the information that providers receive related to PMOS hasn’t changed as much as I’d like, but we are creating real awareness around it. I don’t think anybody realized it was one in eight women.

Jamie Martin

Yeah, that’s a big number. Really high.

Jim LaValle

Right. And the risks that come with it. If you’re that one in eight, you’ve got a 50 to 70 percent chance, depending on which data you look at, of being fully insulin resistant. That creates a fourfold increase in the risk of becoming someone with diabetes and heart disease. If we’re interested in longevity and performance aging, diabetes and heart disease are going to take you out of that mix. They accelerate aging and comorbidities very quickly. So it’s incredibly important. And the beautiful thing is, it can be addressed.

Jamie Martin

Okay. On that note, what can we actually do to manage PMOS for those who have it?

Jim LaValle

Well, there are the basic foundations. Definitely, the more you can work on your body composition and regulate your blood sugar, the better. Whether that’s working with a trainer, a dietitian, or learning how to eat in a way that doesn’t feed into the insulin resistance. Now, that’s hard because the hormone profile that woman is in means the cards are kind of stacked against her.

You can certainly improve diet and lifestyle. If you have sleep apnea, if your partner tells you you’re snoring or stopping breathing, you should be assessed for that. You can do that at home now. There are some incredible telemedicine companies doing at-home sleep apnea testing, or you can go to a sleep center.

The classic way PMOS has been treated in the past is often oral contraceptives and metformin, a drug that can help with blood sugar regulation. That can help with symptoms. Sometimes you’ll also hear of using a drug called spironolactone, which helps with the acne issues.

But then there’s the integrative medicine side, which is more oriented toward giving you some bioidentical progesterone to get the progesterone signal back and start to balance estrogen and progesterone. We’d also consider using a GLP-1, since it’s now being utilized clinically, to help address the insulin resistance. That also helps with appetite, shedding weight, and has positive effects on lipids and blood vessels. All things that are comorbidities when you have PMOS.

Then there’s usually work on the gut microbiome, which can have a significant effect on your skin, reduce inflammatory signaling, and help you process your hormones. When your gut microbiome isn’t right, you recirculate your estrogen. If you’re eating a ketogenic diet or a highly refined carb and sugar diet, you make more of an enzyme called beta-glucuronidase. That enzyme cuts the glucuronide handle that was put on your estrogen during phase two detox in the liver, which was put there so your body could carry the estrogen out. Once that handle is cut off, the estrogen gets stuck in your system and creates estrogen dominance.

There are other considerations too: mood, other individual risk factors. But in general, care starts with those foundational pieces. Personally, I’m not as big a fan of oral contraceptives. They deplete so many nutrients, and women end up depressed. Between 19 and 51 percent of studies showed that correlation, because women sensitive to B6 loss would end up not making enough serotonin.

Jamie Martin

So then you end up in more of a depressed state.

Jim LaValle

Depressed, anxious, you go back to the doctor, and now you’re on another medication. I recognize the role oral contraceptives play. But we’re finding out that utilizing bioidentical hormones and working to balance them is a powerful alternative. That’s what we’ve been teaching at the American Academy of Anti-Aging Medicine for the last 25 years. When we were talking about it, it was unpopular, partly because of the Women’s Health Initiative study, which is now being debated and largely reconsidered. But there are thousands of healthcare providers we’ve trained in bioidentical hormones who understand how to use that approach and also look for the other polyendocrine issues to address the full picture.

Jamie Martin

So taking a more holistic approach to the body.

Jim LaValle

Right. That’s our providers at MIORA: our OB-GYNs, our doctors who have been doing bioidentical hormones for women for 20 to 25 years. Their approach is to look at you as a whole person. And honestly, I’d say we’re all living in some version of a polyendocrine metabolic disorder.

Jamie Martin

Okay, say more about that.

Jim LaValle

I mean, I think all of us are in that situation to some degree. Either things are working together or they’re not. And when they’re not, it leads toward obesity, diabetes, thyroid problems, autoimmunity, colitis, all the things. Whole-body metabolism.

I think the step toward recognizing that in conventional medical language is super important, just like when they came out with the term “metaflammation,” or metabolic inflammation. It’s important because it’s moving medicine toward the understanding that all things are connected and signaling each other. How do we create harmony in the body? That’s a very different solution set than saying, “We’re going to suppress your hormones over here because that’ll make the symptoms better.” Instead, let’s get things working the way they’re meant to.

Jamie Martin

That gets back to root cause, right? So when you talk about PMOS, is there a root cause? You mentioned genetics, environment, and lifestyle. Let’s break those up. Genetics, we don’t have a lot of control over, right?

Jim LaValle

But you can have control over the expression of those genes. For example, you might be more genetically prone to making bad estrogen metabolites that trigger more inflammation. You can measure those in urine, and you can take something that helps your body overcome that genetic predisposition. From that standpoint, the same applies to genetic tendencies toward diabetes, for instance.

Jamie Martin

You’ve talked about that for yourself, right? You’ve had those tendencies but have been taking steps for years to address them.

Jim LaValle

I have. Yeah, I’ve got most of the diabetes genes, the majority of the heart disease genes, and the obesity genes. So yes. But I think with genetics, lifestyle will conquer genetic predisposition most of the time.

Then there’s environmental burden. We have a lot of things we’re breathing in, ingesting, and absorbing nowadays. If you look at the EPA website, one of my favorite places to go, you’ll find information on endocrine disruptors. We don’t really know how much is truly being dumped into our environment because the reporting is incomplete. And we don’t know what happens when you combine endocrine disruptors with other things like different kinds of pesticides. What’s the net effect of that combination?

But what we do know is that hundreds of millions of pounds of endocrine disruptors enter our environment each year. Women and men are both affected. I know our topic today is women’s health, but we are certainly seeing a male fertility issue now as well.

Do you have any control over this? It turns out you do. You can do things like use a sauna. When you work out, your lymphatic tissue moves and you can move these things out of your body. You can take things, you can do a detox to clean up your tissues. And the biggest thing, and I know I’ve said this before: when you’re carrying more body fat, you store more of those chemicals. I know from personal experience, my whole family struggled with obesity. My brother was six-four and 476 pounds. I say this without any judgment whatsoever. But when you’re obese, you store more of those chemicals than when you’re not.

Jamie Martin

Yeah, because they tend to be stored in fat tissue.

Jim LaValle

So if you’re obese and it’s hard for you to get the weight off right now, for whatever reason, try to get in a sauna and sweat. Get it out, and try to move when you can. Get the lymph moving. There’s no doubt that environmental burden and endocrine disruptors play a real role.

And then there’s stress. Stress can affect how your hormones are produced, because cortisol triggers a reduction in gonadotropin releasing hormone. So now you’re getting wonky hormone production. You may not be making as much estradiol or testosterone, but because you’re storing more fat, you’re making more androgens in that fat tissue. And when you don’t make estradiol, your adrenal glands, your liver, and your fat tissue step in to make estrone. It’s a complicated, interconnected web.

Jamie Martin

It really is. Considering what you just said about the rising environmental burden, have we seen rates of PMOS rise in recent years, or has that one-in-eight figure been pretty steady?

Jim LaValle

It’s been reported as pretty steady, but I’ll tell you from 41 years in practice and being around OB-GYNs and doctors who specialize in hormones: it’s definitely gone up. And it’s not just in women who would previously be thought of as obese. You’re seeing it in women of pretty much normal weight too. Being overweight or obese is a big risk factor, but there are women who have all the criteria and are not overweight. I think we’re seeing more of PMOS overall. I don’t have that data right off the top of my head, but anecdotally from years in practice, it’s increasing.

Jamie Martin

Yes, from what you’ve experienced in practice over the years. Okay. So we know there’s a lot we can address: lowering inflammation, balancing blood sugar, addressing nutrient deficiencies, avoiding disruptive chemicals, lowering cortisol. This all comes back to the things we do have control over. You mentioned sauna, exercise, moving the body, nutrition. What else?

Jim LaValle

Well, first of all, saunas have gotten pretty affordable. You can get pretty good saunas, whether steam or infrared, at a reasonable cost. It’s possible to have one at home. And if you’re a Life Time member, take advantage: you have access to both steam and sauna there.

Massage also helps move the lymphatic system. Food choices matter. Watch the chemicals you’re bringing into your home. I’d recommend checking out the Environmental Working Group at ewg.org. You can look up makeup, shampoos, everything you put on or in your body, and make sure you’re limiting those disruptors.

And then there’s a very simple practice I do and have taught a lot of people: box breathing. Just a few minutes a day to reset your nervous system. A couple minutes before lunch, a couple minutes before dinner, maybe before you walk back into the house after a long day. Get recentered. And a few minutes before bed.

I think intention matters, especially with PMOS, since anxiety is a regular companion of this condition. It’s not always a pill. Maybe you take a nutrient like theanine. Inositol, specifically myo-inositol, is a well-studied nutrient that helps regulate the ovarian cycle. Bioidentical hormones are another option to get more proactive.

Yes, there are things you can do on your own. But this is why people benefit from coming into a MIORA and getting a full workup. It’s why I developed the Metabolic Code: to help people clearly see where the system of systems is broken.

Jamie Martin

Right. And to identify which one to address first.

Jim LaValle

Exactly. Which one do you need to address so you can move your health forward, managing all of these things not as isolated body parts, but as one symphony of wellness and vitality.

Jamie Martin

I love that. Okay. So while we know the name change is shifting focus away from purely fertility and reproduction, we can’t forget about those aspects. Why is it important to make sure we’re not leaving them behind?

Jim LaValle

By default, the way hormones are expressed in PMOS, you can’t get a mature egg. And because of the progesterone deficiency, even if you were to get pregnant, it’s very difficult in a low-progesterone environment for a fertilized egg to survive. So you have irregular cycles, you’re not creating mature eggs, and that creates a real risk of infertility.

Remember, that’s a two-way street. Because of many of the issues we talked about, men are now being assessed for sperm count and sperm fragmentation as well. As a couple, it can become very difficult. So it’s really important for women to understand that even though PMOS has moved to this broader metabolic and endocrine framing, fertility is still a core concern. It’s just that all these other factors are now being recognized as the things putting pressure on that fertility.

Jamie Martin

Right. And that pressure creates more stress and anxiety, which creates even more downstream effects. We don’t want to overlook that. Last question for you. For someone who may have previously been diagnosed with PCOS, are there any shifts you’d suggest they consider or ask their healthcare provider about, given what we now know with the updated name and understanding of PMOS?

Jim LaValle

Yes. I would suggest learning a lot about your condition, because more information is coming out. Ask your provider what else can be done for your lipids. Is a titrated GLP-1 an option to help you? What other resources do you have to help manage your situation, beyond just two medications and being sent on your way?

In general, I really think doctors are becoming more aware and engaged, and are looking for other options for their patients. Don’t be afraid to talk to your doctor and ask: “Do you have any other options to help me with my insulin resistance? My hyperlipidemia? My weight? My snoring? Can we get assessed for sleep apnea?” All of that.

Just be aware, and don’t be afraid to ask. Because if you don’t ask, you can never find out.

Jamie Martin

Right. Be your own best advocate. Always. All right, Jim. Another interesting topic today. Thank you so much for always bringing such good insights. There’s always an aha moment in every episode. Thank you for always bringing that.

Jim LaValle

It’s my pleasure.