Latest / The Home of Fertility with Liz Walton & Helen Zee / PMOS Explained with Professor Hart from City Fertility

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PMOS Explained with Professor Hart from City Fertility · The Home of Fertility with Liz Walton & Helen Zee

• 0:05
  SPEAKER_00: Welcome back to the Home of Fertility.
• 0:09
  SPEAKER_00: Today's episode is part of the City Fertility Education series on the Home of Fertility.
• 0:17
  SPEAKER_00: And this is created in partnership with City Fertility.
• 0:21
  SPEAKER_00: Together, we are bringing you a series of conversations designed to answer some of the biggest questions people have about their fertility, about IVF, family building, and of course reproductive health.
• 0:35
  SPEAKER_00: So whether you are beginning to explore your options, whether you're already navigating fertility treatment, our hope is that these conversations leave you feeling more informed, more empowered, and knowing you are not alone.
• 0:53
  SPEAKER_00: So now, let's welcome today's guest.
• 1:02
  SPEAKER_00: Hello, good afternoon, good morning, good evening, wherever you are and welcome to the Hunt of Talking Podcast.
• 1:10
  SPEAKER_00: With me, Liz Walker, your host.
• 1:12
  SPEAKER_00: Today I have another amazing gentleman that I am talking to, and it is Professor Hart here, and he is in Perth.
• 1:21
  SPEAKER_00: How are you doing, Professor Hart?
• 1:23
  SPEAKER_01: I'm very well, thank you, Liz.
• 1:24
  SPEAKER_01: Thank you for inviting me to talk today.
• 1:26
  SPEAKER_00: The pleasure is all mine, and to have our doctor speaking on such a very important subject, I am excessively passionate to be able to chat to you.
• 1:36
  SPEAKER_00: So we're talking today about what was polycystic ovaries and how it's changed to PMOS.
• 1:45
  SPEAKER_00: And um this this is our conversation today, which is highly important on the space of fertility or infertility and everybody walking that path.
• 1:55
  SPEAKER_00: And I know for decades we've had you know polycystic ovaries, polycystic ovaries syndrome, one of the most commonly misunderstood conditions for women, roughly 30, 39 and upwards, despite affecting one in eight women, the name has often created confusion.
• 2:12
  SPEAKER_00: It's uh suggesting a condition defined by ovaries and cysts when in reality it actually affects the hormones and metabolism, fertility, and long-term health.
• 2:22
  SPEAKER_00: And look, this year, the global consortium of researchers and clinicians and patient advocacy, you know, it's it's it's been renamed.
• 2:30
  SPEAKER_00: And I know that you know a lot better than myself.
• 2:34
  SPEAKER_00: So tell me about this name change from polycystic ovaries, PCOS to PMOS.
• 2:40
  SPEAKER_00: And I'm a bit worried if I'm going to get the name wrong, polyundrine metabolic ovarian syndrome.
• 2:46
  SPEAKER_00: What does it mean, please, Professor Hard?
• 2:49
  SPEAKER_01: Um, well, thanks, Liz.
• 2:50
  SPEAKER_01: Um, so yeah, so this started in about 2012, uh quite a long time ago.
• 2:55
  SPEAKER_01: A momentum to change the name, which has obviously taken a lot of time because it's taken a lot of people on the journey.
• 3:02
  SPEAKER_01: Um, essentially because polycystic ovary syndrome suggested it is a condition disease of the ovaries.
• 3:12
  SPEAKER_01: And um many women would come along and say, please fix my ovaries, and then the whole thing will sort itself out.
• 3:17
  SPEAKER_01: So it was a condition that was very much focused on the ovaries.
• 3:21
  SPEAKER_01: And for many women, that's probably right.
• 3:23
  SPEAKER_01: That is uh uh main part of their problem is the ovaries.
• 3:27
  SPEAKER_01: But to be fair to all the women who will suffer with the spectrum of disorder, and to also help them understand how it may impact them and their people around them and their clinicians that will be looking after them, it was felt a more descriptive, all-encompassing name change should um should occur to describe the actual condition.
• 3:50
  SPEAKER_01: And so this is being driven by clinicians, but with huge momentum from patient advocates.
• 3:57
  SPEAKER_01: So this, as I said, it's taken many, many years.
• 4:00
  SPEAKER_01: Uh, was published in um the New England Journal earlier this year, um, and that is undergone substantial engagement with um women with this condition.
• 4:11
  SPEAKER_01: Um, so um, so yes, so it's about and eight women, about 170 million worldwide.
• 4:16
  SPEAKER_01: Um so it the name is polyendocrine, meaning poly meaning lots of, nothing to do with parrots.
• 4:22
  SPEAKER_01: Um endocrine meaning um several different organ involvement, so maybe things like the pancreas, which can affect blood sugars, um, and yes, the ovaries, um, but also the pituitary gland.
• 4:33
  SPEAKER_01: So there's polyendocrine.
• 4:35
  SPEAKER_01: Um, and an underlining um momentum of this um condition is that it that we need to be informing women that later in life they may suffer the metabolic consequences, so hence the metabolic.
• 4:53
  SPEAKER_01: So for many women who have passed their reproductive years, and many women who are still in the reproductive years, the metabolic component is the overriding um um disorder.
• 5:01
  SPEAKER_01: And yes, um, ovari is there because obviously for some women it leads to ovulatory problems and syndrome.
• 5:08
  SPEAKER_01: Syndrome is always a collection um of signs, uh, signs um and and and um that a patient may have symptoms and signs that they can make complain of.
• 5:17
  SPEAKER_01: So there you go.
• 5:18
  SPEAKER_01: You've got polyum endocrine, lots of endocrine, metabolic ovarian syndrome.
• 5:23
  SPEAKER_01: So that's the name change.
• 5:25
  SPEAKER_01: So um, so that's that is what the description is.
• 5:28
  SPEAKER_01: Um, and when we talk you you in your description, you you were um slightly misleading as well.
• 5:35
  SPEAKER_01: You talk polyum um uh these cysts in the ovaries, you polycystic ovaries.
• 5:40
  SPEAKER_01: So that's so that is a description of something.
• 5:42
  SPEAKER_01: When we say polycystic ovary, that's a pure description of what the ovary looks like.
• 5:48
  SPEAKER_01: And you're right, many of these women may have that.
• 5:50
  SPEAKER_01: But many women may go to their grave and never knew they had lots of little cysts in the ovaries, and it never did them any harm, and it was never any problem.
• 5:58
  SPEAKER_01: In fact, one in four women have multiple cysts in their ovaries.
• 6:02
  SPEAKER_01: It's only when the woman is displaying these other signs and symptoms that you call it a syndrome.
• 6:08
  SPEAKER_01: Um, so do you see what I mean?
• 6:10
  SPEAKER_01: It's like uh something under the water that nobody sees, but something like an iceberg that now appears above the water, then it's like she complains of some symptoms.
• 6:18
  SPEAKER_01: So let's take you on a journey of how it evolved.
• 6:22
  SPEAKER_00: So thank you.
• 6:24
  SPEAKER_01: Yeah, but um, so so basically, you know, people say, How did I catch it?
• 6:28
  SPEAKER_01: You know, my sister's got it, my mom's got it, you know.
• 6:30
  SPEAKER_01: It was it because we shared the same same kitchen.
• 6:33
  SPEAKER_01: No, um, it's probably underlying genetics.
• 6:36
  SPEAKER_01: There are some genetic things.
• 6:37
  SPEAKER_01: So, therefore, you could imagine sometimes there may be some genes that dad may pass on down, which actually may predispose to the metabolic component.
• 6:45
  SPEAKER_01: So there's certainly some genetic components to that.
• 6:49
  SPEAKER_01: Um and um so so so basically the first sort of signs that a uh that a girl may be about to develop this um is is that her periods may be slightly erratic.
• 7:01
  SPEAKER_01: It's generally believed eight to nine percent, um nine, sorry, eighty to ninety percent of girls will have regular menstrual cycles um after about two years of the onset of puberty, that's called menarchy in the first period.
• 7:14
  SPEAKER_01: Um, vast majority are regular after two years.
• 7:17
  SPEAKER_01: The first couple of years, as you imagine, are not ovulatory.
• 7:20
  SPEAKER_01: After about two years, they do become ovulatory and the cycles become regular.
• 7:25
  SPEAKER_01: And so, interestingly, most of those girls where they're not regular after a couple of years, there's probably a very high number will actually be developing polyendocrine metabolic disorder, we'll call PMOS today.
• 7:38
  SPEAKER_01: Um, so that's the first sort of science.
• 7:40
  SPEAKER_01: So, what will she complain of?
• 7:41
  SPEAKER_01: Well, it's fairly obvious if a woman's not got regular ovulation, she's going to have disordered development of the lining of the uterus, because that's produced by Easterine.
• 7:51
  SPEAKER_01: She's a young girl, obviously, she's developed, so she's got lots of Easter and her ego is working.
• 7:55
  SPEAKER_01: So the lining of the uterus will get thick and she'll have probably heavy but completely unpredictable periods.
• 8:02
  SPEAKER_01: So the adolescent girl complains of irregular, heavy periods, completely unpredictable, interfering with schoolwork, social life, sporting activities.
• 8:12
  SPEAKER_01: So she would probably be wise maybe to consider the conceptual pill, not for contraception, but to regulate her menstrual cycles.
• 8:19
  SPEAKER_01: Um, so so that is great.
• 8:22
  SPEAKER_01: Also, maybe manifesting is what many of us suffer with in adolescence is a tendency a bit of greasier skin.
• 8:28
  SPEAKER_01: Um, interestingly, our insulin is a bit activated in adolescence.
• 8:32
  SPEAKER_01: Um, but somebody that's predisposed to PMOS may also produce more androgens.
• 8:38
  SPEAKER_01: So here we've got the adrenal gland raising its head now.
• 8:41
  SPEAKER_01: There's another endocrine organ.
• 8:44
  SPEAKER_01: So often some women with PMOS may have overactive androgen production.
• 8:49
  SPEAKER_01: Androgens are male hormones, um, and so they may be slightly raised.
• 8:54
  SPEAKER_01: What will the poor girl, woman, experience?
• 8:57
  SPEAKER_01: Potentially greasier skin and sometimes some excess body hair, which may um obviously um negatively impact her her mental health or body, um, body image and ideas and things like that.
• 9:08
  SPEAKER_01: So and um, and unfortunately, in the absolute extreme, I'm digressing a little bit here, there can be some poor women where they we call that hyperandrogenism, excessive androgen production can um lead to things like substantial hair loss, alopecia, which could obviously be very, very distressing for many women.
• 9:24
  SPEAKER_01: So, so you can see how now we're obviously linking in potentially the risk of um body image, mental health disorder, those sort of things.
• 9:33
  SPEAKER_01: So let's circle back to where we started.
• 9:35
  SPEAKER_01: We talk about the adolescent girl.
• 9:36
  SPEAKER_01: So, as I say, many of us will predispose to greasier skin and things like that.
• 9:40
  SPEAKER_01: That's as often fundamental with the insulin resistance of adolescents, but it may be accentuated in the a um um a younger girl at risk of PMOS.
• 9:52
  SPEAKER_01: So she complains of greasier skin.
• 9:54
  SPEAKER_01: And interestingly, again, the contraceptive pill is very good at addressing that.
• 9:58
  SPEAKER_01: There are also some other strategies um too limited time to go into, but often because that stops that excessive androgen production.
• 10:05
  SPEAKER_01: So again, that may be something useful.
• 10:07
  SPEAKER_01: So you can see now we've got two things.
• 10:09
  SPEAKER_01: We've got the ovary coming in, irregular cycles and um heavy, unpredictable periods.
• 10:15
  SPEAKER_01: We've got the adrenal gland, excessive androgen production, greasier skin, and um things that she may not like.
• 10:21
  SPEAKER_01: Um the pill may, for vast majority, may well be great relief.
• 10:25
  SPEAKER_01: And she'll probably be on those until early 20s.
• 10:28
  SPEAKER_01: And we find in the 20s when uh our adrenal gland sort of tends to slow down anyway, uh, our insulin resistance comes down a little bit, um, many women will come off it and go, Oh, marvelous.
• 10:38
  SPEAKER_01: Um, everything is all um back to what I'd like to think it is.
• 10:42
  SPEAKER_01: And that would be great for some, but obviously some it will not, and they'll probably think that they'll have to go back on the pill.
• 10:47
  SPEAKER_01: But interestingly, those who where they did have um those symptoms, perhaps if they go through light, which happens to us all, we may accrue some weight around our waist.
• 10:58
  SPEAKER_01: We um, you know, we tend to put a little bit of weight on.
• 11:00
  SPEAKER_01: And weight is another integral factor in this.
• 11:04
  SPEAKER_01: Weight, um um, when we try um um when we um when we try to get that weight around our waist down, we're actually improving our insulin resistance.
• 11:13
  SPEAKER_01: Our insulin comes down.
• 11:15
  SPEAKER_01: So the pancreas is coming now, the pancreas.
• 11:18
  SPEAKER_01: So, but unfortunately, that girl in the 20s that sort of says, Oh, I'm feeling marvelous now, um, as she maybe put a little bit of weight on, her insulin goes up.
• 11:26
  SPEAKER_01: And insulin drives the adrenal gland as well to make more androgens.
• 11:31
  SPEAKER_01: And therefore she says, Oh, the skin's come back, back.
• 11:34
  SPEAKER_01: Oh, it's actually interfering with my menstrual cycle.
• 11:37
  SPEAKER_01: So basically, if she put a bit of weight on, perhaps in the later 20s, perhaps she's not doing as much exercise as she was when she was early 20s, um, then her symptoms come back, the irregular menstrual cycles, the maybe the skin complaints.
• 11:50
  SPEAKER_01: And interestingly, that um um that is really the weight side of things will often control it.
• 11:57
  SPEAKER_01: Um as the weight goes up, those symptoms get worse.
• 12:01
  SPEAKER_01: Um, and then again, you might have some negative mental health consequences of that, because there is some very important research which shows unfortunately, women with PMOS do have a tendency to accrue weight.
• 12:14
  SPEAKER_01: Um, their ability to lose weight is um is impaired compared to the friend who does exactly the same thing without PMOS.
• 12:23
  SPEAKER_01: So it's uh so there's that as well, which again will have negative consequences.
• 12:27
  SPEAKER_01: So here we've got now the metabolic thing coming in.
• 12:30
  SPEAKER_01: That's where the metabolic side of things comes in.
• 12:32
  SPEAKER_01: Because as we all know, um, you know, who is at greater risk of heart disease and diabetes?
• 12:38
  SPEAKER_01: We could all draw a picture of a cartoonist to who we think, and it's somebody, probably normally a middle-aged bloke, um, but with a big gut.
• 12:44
  SPEAKER_01: Um, and that is nothing to, it's not alcohol, but yes, that makes it worse.
• 12:49
  SPEAKER_01: But it's not, it's that gut.
• 12:50
  SPEAKER_01: It's that fat around the waist, which is not good.
• 12:53
  SPEAKER_01: Butter can thigh fat is not too adverse in terms of metabolic disorder, but a rate around the waist is.
• 13:00
  SPEAKER_01: Um that is a that is a constant leads to consequences later in life with increased risk of metabolic disorder, um, diabetes, and potentially when she gets pregnant, getting gestational diabetes, blood pressure problems in pregnancy.
• 13:16
  SPEAKER_01: So um, so there you go.
• 13:18
  SPEAKER_01: That's where the metabolic side of things comes in.
• 13:20
  SPEAKER_01: And as I've said, often her cycles are being irregular because the environment and the ovary has predisposed to not ovulate on a regular basis.
• 13:30
  SPEAKER_01: And and I hear on a weekly basis GPs who will tell patients, oh, you've got PMOS, or you won't get pregnant.
• 13:38
  SPEAKER_01: And I just drives me mad.
• 13:40
  SPEAKER_01: I start twitching when I hear that.
• 13:42
  SPEAKER_01: I never want to hear a patient say that because of all the patients to get pregnant, PMOS are generally one of the easiest to do that in safe hands.
• 13:52
  SPEAKER_01: It's not IVM.
• 13:54
  SPEAKER_01: What we just need to do is prod her ovary to release that egg.
• 13:57
  SPEAKER_01: Yeah, you know, if you think about it, it's incredibly, it's amazing how any woman ovulates, you know.
• 14:03
  SPEAKER_01: So you've got a whole bunch of follicles in the ovary.
• 14:06
  SPEAKER_01: Um, obviously, one with PMOS tends to have a few more than most.
• 14:09
  SPEAKER_01: She's got a lot of follicles, but how does she select that one?
• 14:11
  SPEAKER_01: It's like you walking into a classroom, Freddie's been really naughty, and you want to grab Freddie out without telling anybody else and drag him off to be told off by the headmaster.
• 14:19
  SPEAKER_01: That is what a woman does on a monthly basis, just releases one.
• 14:22
  SPEAKER_01: Our friends in the animal kingdom don't do that, do they?
• 14:25
  SPEAKER_01: They release them all and they have a litter.
• 14:27
  SPEAKER_01: But how on earth can you just from a whole bunch of follicles select one to ovulate on a reliable basis?
• 14:34
  SPEAKER_01: It's amazing how it happens.
• 14:36
  SPEAKER_01: So, understandably, it doesn't take much to just shove it out a little bit, a little minor perturbation in the woman's environment, and she doesn't ovulate regularly.
• 14:45
  SPEAKER_01: And all the doctor has to do is just gently prod the ovary, I mean, metaphorically, not physically.
• 14:52
  SPEAKER_01: Yeah.
• 14:52
  SPEAKER_01: And to release that one egg.
• 14:54
  SPEAKER_01: Time, to course appropriately, maybe sometimes give us some progesterone to help, but they are generally one of the easiest women to help to get pregnant.
• 15:02
  SPEAKER_01: So I don't want every woman thinking I've got PMOS, I need IVF, it's gonna be miserable.
• 15:07
  SPEAKER_01: It's not at all.
• 15:08
  SPEAKER_01: It's called ovulation induction.
• 15:09
  SPEAKER_01: We just need to induce one follicle to be released.
• 15:13
  SPEAKER_01: Yes, sometimes for the doctor it can be a bit challenging.
• 15:16
  SPEAKER_01: We want to minimize the risk of twins, but in good, competent hands, it's relatively straightforward.
• 15:24
  SPEAKER_00: This episode is part of the City Fertility Education Series on the HOMA fertility in partnership with City Fertility.
• 15:34
  SPEAKER_00: You may know it as PCOS, but in this conversation, we're exploring PMOS, known as polyendocrine metabolic ovarian syndrome, and what the name change now means.
• 15:50
  SPEAKER_00: The condition goes far beyond the ovaries.
• 15:53
  SPEAKER_00: It can affect the hormones, metabolism, fertility, and longer-term health, which is why understanding the whole picture is so important.
• 16:03
  SPEAKER_00: For people who have already been diagnosed or those wondering whether their symptoms could be connected, having the right information can help you have an informed and correct conversations with your healthcare team.
• 16:20
  SPEAKER_00: City Fertility provides specialist fertility care for people experiencing a wide range of reproductive health conditions.
• 16:29
  SPEAKER_00: To learn more, please go visit cityfertility.com.au.
• 16:34
  SPEAKER_00: Now, let's get back to today's conversation.
• 16:41
  SPEAKER_01: Compared to things like bad sperm or block fallopian tubes or being a lot older, that is the risk that the challenges for the doctor is much less.
• 16:52
  SPEAKER_01: Yes, in pregnancy, we have to be very vigilant.
• 16:54
  SPEAKER_01: We have to make sure her weight's good, not too much weight gain, minimize the risk of diabetes.
• 16:59
  SPEAKER_01: We have to be vigilant for that and pre-eclampsia.
• 17:01
  SPEAKER_01: So um, so that's the sort of the challenge that she goes through the 20s with ovulation, um, you know, irregular ovulation, she remained ovulation, definitely get her pregnant.
• 17:10
  SPEAKER_01: We've talked about pregnancy, she has a slightly higher risk of these in pregnancy.
• 17:13
  SPEAKER_01: But then she's sort of had her family.
• 17:15
  SPEAKER_01: Um that's great, and she's really happy that that's uh that that that epoch of her life is over.
• 17:21
  SPEAKER_01: And we're entering into the post um post-reproductive years.
• 17:25
  SPEAKER_01: Um, and to be fair to that woman again, as I've said, she will accrue more body fat than her friend, who's exactly the same in any other ways without PMOS.
• 17:35
  SPEAKER_01: So, as we all know, as we go through life, it is more challenging to keep that weight under control.
• 17:40
  SPEAKER_01: We've got busy lives, we've got family to feed, um, and um we tend to look after ourselves um least, less.
• 17:46
  SPEAKER_01: But but she unfortunately will have to focus more on that because she will tend to accrue more weight than her friends.
• 17:53
  SPEAKER_01: Um, and and and as we all know as we get older, there's greater risk of things like heart disease and diabetes.
• 18:00
  SPEAKER_01: And that's where the metabolic thing comes back again, and the um endocrine with the pancreas diabetes, she's at greater risk of these things.
• 18:08
  SPEAKER_01: So her GP should be vigilant.
• 18:11
  SPEAKER_01: Sometimes the patient has to be the advocate for themselves, making sure they go to see their GP every year, making sure her blood sugars are fine, checking her blood pressure, um, sometimes a liver if she's a little bit overweight, um, sometimes at risk of fatty, fatty liver.
• 18:26
  SPEAKER_01: Um, she may be at increased risk of sleep apnea.
• 18:29
  SPEAKER_01: So waking up, um, sleeping, feeling very groggy in the morning, or at risk, you know, in a long traffic jam at work, is finding a spine and not off.
• 18:38
  SPEAKER_01: That is probably that poor individual has uh has got sleep apnea.
• 18:42
  SPEAKER_01: So we're not sleeping deeply and we're just jolting ourselves up at night without actually being conscious of that and not getting into our deep sleep.
• 18:50
  SPEAKER_01: So sleep apnea, so often the partner will say that they keep jolting or things like that.
• 18:55
  SPEAKER_01: And getting a sleep study by the general practitioner is important.
• 18:58
  SPEAKER_01: That's got long-term impact for the health.
• 19:01
  SPEAKER_01: So you can see, you can see why just calling it an ovarian condition um is rather um rather unfair.
• 19:08
  SPEAKER_01: And um, and and and it really doesn't help the woman understand and the people around her and the clinicians, but actually it impacts the whole the whole body.
• 19:18
  SPEAKER_01: Um so um so yeah, and often the woman later in life will have some increased menstrual problems because any woman in the mid-30s onwards, the peers tend to get a bit heavier.
• 19:27
  SPEAKER_01: Um, the uterus postnatally tends to be a bit bigger, understandably, therefore the lining is bigger because there's more of a uterus.
• 19:34
  SPEAKER_01: So any woman's peers get heavier.
• 19:36
  SPEAKER_01: Um and the because she's perhaps not ovulating with that reliable, predictable progesterone in the luteal phase, which is good to keep the lining thin, she's actually at increased risk of a disordered endometrium called endometral hyperplasia or endometral cancer.
• 19:53
  SPEAKER_01: So there's very good evidence that she's at greater risk of that because she's not got that regular ovulation and progesterone protecting her lining.
• 20:01
  SPEAKER_01: So there is this marvelous thing called the Myrene IUCD, which is a progesterone-releasing device that many general practitioners are very comfortable inserting.
• 20:11
  SPEAKER_01: And it can stay for seven years.
• 20:13
  SPEAKER_01: It thins the lining of the uterus.
• 20:16
  SPEAKER_01: Vast majority of women don't get any appearance at all.
• 20:19
  SPEAKER_01: She cannot get endometral cancer, if it was clear before she started, because you're protecting the lining of the uterus.
• 20:26
  SPEAKER_01: So it removes that completely unpredictable, often very heavy and sometimes very protracted bleeding that she will get.
• 20:33
  SPEAKER_01: Um, so that's um that will see her into the um to the to the um menopause.
• 20:39
  SPEAKER_01: Um and um evidence which she yes, she similar sort of time to her friend, so that's not an issue.
• 20:44
  SPEAKER_01: But um, so that's the sort of the stages of a life.
• 20:47
  SPEAKER_01: Um, so you know, people say, How would you go about dealing with PMS?
• 20:50
  SPEAKER_01: Well, it depends.
• 20:51
  SPEAKER_01: You know, you've got to live, you listen, telling my junior doctors, you listen to the patient.
• 20:56
  SPEAKER_01: What is it they're complaining of?
• 20:57
  SPEAKER_01: What are their aspirations now?
• 20:59
  SPEAKER_01: Because we would describe the adolescent.
• 21:01
  SPEAKER_01: We've talked to a young girl in her early 20s, she's not interested in fertility then, but maybe contraception.
• 21:07
  SPEAKER_01: We talked about a woman who's a bit later.
• 21:08
  SPEAKER_01: Obviously, she's really worried about the reproductive side of things.
• 21:11
  SPEAKER_01: Then she's busy in her late life, um, you know, heavy periods, exhausting and interfere with her life.
• 21:18
  SPEAKER_01: The Myrena IUCD will be appropriate.
• 21:21
  SPEAKER_01: And obviously, we need to focus on pregnancy, being vigilant at that time.
• 21:24
  SPEAKER_01: So, depending on where they are in the stage of the lives, um, that's when the doctor should focus and treat um what she's complaining of at that particular time.
• 21:36
  SPEAKER_00: Wow, that has given me such a deep understanding of PMOS, why the name change, understanding exactly what it means to a woman, to a woman, and and the needs of our body.
• 21:53
  SPEAKER_00: Um, so I don't think I've ever heard it been explained in in such a wonderful way.
• 21:59
  SPEAKER_00: And also Going through the body and our ages and what we need to do.
• 22:03
  SPEAKER_00: My sister-in-law suffers quite a lot and has suffered and also had to have IVF with PMOS.
• 22:11
  SPEAKER_00: And I'm going to let her know about the marine, which I I just think it's gum smacking.
• 22:16
  SPEAKER_00: I that is awesome about how you can support a woman through the latter stages and support their body with the thinning of the line.
• 22:28
  SPEAKER_01: No, absolutely.
• 22:30
  SPEAKER_01: It's because it because unfortunately endometrial cancer, because I know progesterone for most women is really annoying.
• 22:37
  SPEAKER_01: That's this hormone that's produced after a woman ovulates.
• 22:40
  SPEAKER_01: It can often produce some side effects we call the um the um the luteal phase symptoms, some phenomenal cause significant um negative impact of fluid retention, breast tenderness, mood alterations, some really significant symptoms.
• 22:57
  SPEAKER_01: But that progesterone is actually protecting the lining of the uterus.
• 23:00
  SPEAKER_01: Because Easterine, as you know, is a good hormone, but it stimulates the endometrium, which in an uncontrolled fashion, without the progesterone restraining it, it just gets thicker and thicker and thicker.
• 23:10
  SPEAKER_01: And she's at risk of endometrial um early, which you call hyperplasia, the precursor of the endometrial cancer.
• 23:16
  SPEAKER_01: I think just while, you know, if we just sort of to focus on one thing that um another thing that I'd like to women to go away with, because maybe with your uh interest and focus of your podcast is is fertility.
• 23:30
  SPEAKER_01: So um, so absolutely, some women with PMOS um will unfortunately be their partner will have poor sperm, um, or she may unfortunately have perhaps had some maybe endometrosis or an ectopic pregnancy, and unfortunately she's now got fallopian tube damage.
• 23:46
  SPEAKER_01: So she does need IVF.
• 23:47
  SPEAKER_01: So some women with PMOS do need IVF.
• 23:50
  SPEAKER_01: Um but I really would encourage the women to try to ask them, ensure their doctor is trying to focus on ovulation induction.
• 23:56
  SPEAKER_01: Um, and certainly by all means look at my work we've published in the literature about it, about ovulation induction.
• 24:02
  SPEAKER_01: But some women will, and they will have heard some dreadful stories, and unfortunately, some of them are true.
• 24:07
  SPEAKER_01: She's at major risk of a condition called ovarian hyperstimulation syndrome, which I describe as a bit like smoking a cigarette in the wheat belt in in um in Perth um in um in February.
• 24:19
  SPEAKER_01: Um you tap your cigarette outside, which you should never do, um, and and that is what he's he's at risk of.
• 24:26
  SPEAKER_01: Because remember, remember, she has often got lots of follicles in the ovary.
• 24:32
  SPEAKER_01: And so genital stimulation with what we give with IBF is follicle stimulating or with FSH.
• 24:38
  SPEAKER_01: That's what it says on the packet.
• 24:40
  SPEAKER_01: Doctors be simple people, um, so so it stimulates the follicles.
• 24:44
  SPEAKER_01: So she's going to a friendle to get seven or eight, but she'll go bad.
• 24:48
  SPEAKER_01: So so she has to be managed very carefully to make sure she's um not at risk of that.
• 24:54
  SPEAKER_01: There are many strategies, too detailed to go into during this podcast, to try to limit that excessive response.
• 25:01
  SPEAKER_01: Um, there are conditions and um uh dealing with this, and we have something we've pioneered um in Perth as well, is in vitromaturation of her sites, where um where what we do is we only give a few days of stimulation.
• 25:15
  SPEAKER_01: So rather than give the woman the drugs, we actually take those eggs out very early in her cycle, and we will give the drugs to her eggs.
• 25:22
  SPEAKER_01: So she's um heading off home um into the into the country um while we've got her eggs, and we're for giving the FSH to the drugs in the to the eggs in the laboratory.
• 25:33
  SPEAKER_01: That's called in vitro fertilizer um maturation of the eggs rather than IVF, which is in in doing it, um um doing it, doing it to the woman.
• 25:43
  SPEAKER_01: So so this is will not get hyperstimulation syndrome.
• 25:46
  SPEAKER_01: So so speak to your doctor about that.
• 25:48
  SPEAKER_01: Unfortunately, if you're not in uh um Perth or in Sydney, then it may not be um somewhere where you can do that, but um, but there are ways to mitigate that because some women really struggle to actually get to egg collection because it's like an all or nothing response.
• 26:02
  SPEAKER_01: She either doesn't respond and then suddenly bang and she gets lots of follicles, which can really negatively impact her health.
• 26:09
  SPEAKER_01: But as I say, there are many strategies now in expert hands to for the doctor trying to minimize that patient experience.
• 26:18
  SPEAKER_01: Yeah.
• 26:20
  SPEAKER_00: My goodness, um extremely fascinating.
• 26:23
  SPEAKER_00: And I what the one thing I really loved was PMOS is one of the easiest issues to support a woman on their fertility path.
• 26:32
  SPEAKER_00: And I thought that was really wonderful to hear.
• 26:35
  SPEAKER_00: So um thank you so much.
• 26:39
  SPEAKER_00: Now, if there was one thing that um you could leave the listeners with if they're on a fertility path and they have POMS, PMOS, what would be the one take-home thing that you would like to leave them with today?
• 26:54
  SPEAKER_01: I'd like to say fantastic.
• 26:56
  SPEAKER_01: We generally the major issue is we just need to prod you into ovulating.
• 27:00
  SPEAKER_01: As I pretty much say to most of my women I see with PMOS, is I what is the other the woman with hardly any follicles in her ovary?
• 27:09
  SPEAKER_01: That unfortunately is for her personally a disaster.
• 27:13
  SPEAKER_01: She's heading to an early menopause.
• 27:15
  SPEAKER_01: This what you have, lots of follicles in your ovary.
• 27:18
  SPEAKER_01: All we've got to do is try to minimize getting them all together.
• 27:21
  SPEAKER_01: So I really like the woman to walk away with a very positive um spin on their journey.
• 27:27
  SPEAKER_01: Some women may have some lifestyle issues they've got to address.
• 27:31
  SPEAKER_01: As I say, these poor women have often got um a tendency to crew weight more than their friends, and sometimes some negative body images and mental health concerns, which are very, very important to address.
• 27:42
  SPEAKER_01: But in terms of the fertility journey, it's often one of the easiest things to do is try to get us to release one egg.
• 27:50
  SPEAKER_01: That's the challenge.
• 27:51
  SPEAKER_01: So it's a very positive thing I'd like her to go away with.
• 27:54
  SPEAKER_00: Yeah, I love that.
• 27:55
  SPEAKER_00: Thank you so much.
• 27:56
  SPEAKER_00: So, um, Professor Roger Hart, thank you so much for your time today and explaining PMOS and the journey and what we as women can do, and also understand that I think this is the easiest issue, then maybe we know.
• 28:13
  SPEAKER_00: So thank you so much for that.
• 28:14
  SPEAKER_00: And I really, really appreciate your time today.
• 28:18
  SPEAKER_01: Thank you, Roger.
• 28:19
  SPEAKER_00: Ah, thank you too.
• 28:24
  SPEAKER_00: Thank you for joining me for another episode of the City Fertility Education series, which is on the home of fertility.
• 28:34
  SPEAKER_00: This is created in partnership with City Fertility.
• 28:38
  SPEAKER_00: I do hope today's conversation has given you something extremely useful to take away.
• 28:44
  SPEAKER_00: Perhaps it's a better understanding of your fertility, maybe it's a new question, or simply more confidence in knowing what your options might be.
• 28:54
  SPEAKER_00: Because sometimes one conversation can be the thread that leads you to the information, support, or next step that's right for you.
• 29:04
  SPEAKER_00: If you'd like to learn more about City Fertility and the services that they offer, please visit cityfertility.com.au.
• 29:14
  SPEAKER_00: And if today's episode could help someone you know, please share it with them and follow the home of Fertility wherever you listen on your podcast.
• 29:25
  SPEAKER_00: I'm Liz Walton.
• 29:27
  SPEAKER_00: Thank you so much for listening, and I'll see you back here for our next conversation.