When women come to me frustrated and exhausted — low energy, reduced libido, a quiet but persistent sense of flatness that sleep and self-care haven't touched — and when their estrogen and progesterone levels have been addressed without fully resolving the picture, the conversation I find myself having, again and again, is about testosterone.

On May 12, 2026, a landmark paper published in The Lancet announced that polycystic ovary syndrome — PCOS — will be officially renamed polyendocrine metabolic ovarian syndrome, or PMOS. This was not a cosmetic adjustment. It was the culmination of a 14-year global consensus process involving 56 leading academic, clinical, and patient organizations, and informed by surveys gathering input from more than 14,300 people living with the condition and health professionals from every region of the world.

Infertility affects approximately one in six people of reproductive age globally, according to the World Health Organization. And yet the information landscape around fertility — when conception is possible, what causes infertility, what treatment actually offers, and what options exist beyond IVF — remains remarkably distorted by myths that circulate as confidently as facts.

You deserve a provider who treats this decade of your life as the significant and consequential medical transition it actually is.

Most women know that estrogen is a reproductive hormone. What far fewer women know is that estrogen has been functioning as a powerful anti-inflammatory agent throughout their reproductive years — quietly modulating the immune system, regulating inflammatory pathways, and protecting tissues from the kind of chronic, low-grade inflammation that drives so many of the diseases we most want to avoid.

This protective role doesn't get much attention while estrogen is present, because its effects are largely invisible. What makes them visible is their absence. When estrogen declines during perimenopause and menopause, the inflammatory landscape of the body shifts — measurably, consequentially, and in ways that help explain a wide range of the symptoms and health changes women experience during this transition.

For many women, alcohol has been a relatively unremarkable part of adult social life for decades — a glass of wine with dinner, a drink at a social event, a ritual that has fit comfortably into daily life without obvious consequence. The menopause transition doesn't change the behavior, but it does change the context in which that behavior occurs. And the gap between the old context and the new one is larger than most women realize.

This is not an emerging or experimental therapy. Vaginal estrogen has been studied for decades. Its safety and efficacy are well established in the medical literature. Major professional organizations — including The Menopause Society and the American Urological Association — endorse it as a first-line treatment for genitourinary syndrome of menopause. And yet a large proportion of women who would benefit from it have never had it offered, explained, or recommended.

When most people think about longevity, they think about the heart, the brain, or the gut. Muscle rarely makes that list — and that is one of the most consequential oversights in how we think about women's long-term health.

One of the most important things I want every woman to understand is this: perimenopause is not a brief prelude to menopause. It is not simply "the year or two before your periods stop." It is a hormonal transition that can begin as early as the mid-to-late thirties and unfold over the better part of a decade — and during that entire window, the symptoms a woman experiences are very often real, physiologically driven, and treatable, even while her menstrual cycle still looks essentially normal.

For a long time, a woman's pregnancy complications, her age at menopause, and conditions like endometriosis or PCOS were treated as separate, contained chapters of her medical history — relevant to reproductive health, perhaps, but not formally connected to her future cardiovascular risk. That framework has changed. Major cardiovascular guideline bodies have now formally incorporated specific elements of a woman's reproductive history into cardiovascular and stroke risk assessment. This is not a fringe opinion. It reflects a substantial body of research, and it is now reflected in the guidance issued by some of the largest cardiovascular professional organizations in the country.