https://docs.google.com/document/d/1-9g-rqbvk_Y20NgTYdGhTYQJZ0YCNnbyD3lDAYgaXBg/edit?usp=drivesdk

This week I want to start the next GOATGETheR health lane with endometriosis, because there is a lesson here that goes way beyond endometriosis: Women can normalize symptoms for years because nobody ever gave them a reference point for what deserves investigation. What Endometriosis affects an estimated 190 million reproductive-age women worldwide—roughly 10%. It can involve severe menstrual pain, chronic pelvic pain, heavy bleeding, infertility, painful sex, bowel or urinary symptoms, bloating, nausea, and mental-health effects. It can also occur outside the pelvis. But here’s something women need to hear: Severe period pain that disrupts normal life should not automatically be dismissed as “just a bad period.” The UK’s National Institute for Health and Care Excellence says endometriosis should be considered when period-related pain affects daily activities and quality of life, or when someone experiences chronic pelvic pain, deep pain during/after sex, cyclical bowel or urinary symptoms, or infertility alongside these symptoms. Why Endometriosis involves tissue similar to the uterine lining growing outside the uterus, with inflammation and other biological processes contributing to symptoms. But symptom severity isn’t a simple measurement of how much disease exists. That’s important because women sometimes think: “Maybe I’m exaggerating because someone else has worse endometriosis than me.” Pain is not a competition. NICE specifically recommends treating according to a woman’s symptoms, preferences and priorities rather than simply the disease stage. So what Here’s today’s reflection: What have I normalized simply because I’ve experienced it for a long time? Maybe: “My periods have always been horrible.” “I always miss work the first day.” “Sex has always hurt sometimes.” “I always get bowel pain around my period.” “I’ve always needed painkillers just to function.” “My mom had horrible periods too, so I assumed this was normal.” None of those statements diagnoses endometriosis.

If your cycle, sleep, mood, energy, hot flashes, brain fog, or other symptoms have started changing, this tracker is designed to help you spot patterns instead of relying on memory. This 30-day tracker is informed by Mayo Clinic guidance on what women may want to track during perimenopause and menopause, including: • Period and bleeding changes • Hot flashes + night sweats • Sleep disruption • Mood changes • Brain fog • Fatigue and energy • Vaginal + urinary symptoms • What makes symptoms better or worse • How symptoms are affecting everyday life It also includes a cycle history section, symptom dashboard, and an appointment-prep page so you can organize what you’ve noticed before talking with your healthcare provider. This is not a diagnostic tool. It’s a way to collect better evidence about your own body and make those healthcare conversations more useful. Download it below, save your own copy, and start tracking. 🖤

Ever hear: “If you have PCOS, just lose weight.” That advice misses a huge part of the picture. PCOS can involve insulin resistance, irregular ovulation, higher androgen activity, fertility challenges, sleep problems, psychological symptoms, and metabolic risk. And not every woman with PCOS is overweight. So today I want to talk about something that matters even when the number on the scale doesn’t move: Exercise. 🟢 WHAT WE KNOW WITH THE MOST CONFIDENCE The 2023 International Evidence-Based PCOS Guideline, endorsed by dozens of professional organizations, recommends lifestyle intervention—including exercise—for women with PCOS to improve metabolic health. And one line really matters: There are benefits to a healthy lifestyle even without weight loss . That changes the conversation. Exercise doesn’t only “work” if you become smaller. 🔬 NEWER RESEARCH A 2025 systematic review and meta-analysis included 15 randomized controlled trials examining exercise in women with PCOS. Compared with controls, exercise improved: - Insulin resistance - Fasting insulin - Waist-to-hip ratio - LDL cholesterol - Cardiorespiratory fitness - Quality of life But researchers did not find a significant overall improvement in reproductive function. Another meta-analysis examining 10 randomized trials involving 382 women found aerobic exercise improved several metabolic measures, while resistance exercise improved lean body mass and body-fat percentage. Hormonal results were more inconsistent. Evidence tier: 🟢 MODERATE–HIGH Exercise clearly belongs in PCOS management. What is much less certain is: Which exact form of exercise is “best” for PCOS? Current guidelines do not support one magical PCOS workout. 🧠 IN PLAIN ENGLISH Think of insulin like someone knocking on a cell’s door saying: “Hey, glucose is here. Let it inside.” When insulin sensitivity is lower, the body may need to send a louder signal—more insulin—to get the same job done. Muscle contraction gives glucose another route into working muscle and repeated exercise can improve metabolic function.

This week’s question is a good one because it connects directly to what we’re building with “What Is My Body Trying to Tell Me?” Question “Why am I starving before my period? Does my body actually need more food, or am I just craving things?” First: the science in plain English What: There is credible evidence that food intake can increase during the luteal phase—the portion of the cycle after ovulation and before the next period. A 2025 systematic review and meta-analysis in Nutrition Reviews analyzed 15 datasets involving 330 women. Average energy intake was about 168 calories/day higher during the luteal phase than the follicular phase. Why: Estrogen and progesterone fluctuate considerably across the cycle and may influence appetite, energy expenditure, food reward and other systems involved in energy balance. But the research does not support reducing this to something like “progesterone makes you hungry.” Think of appetite more like a mixing board than an on/off switch. Hormones are one slider. Sleep is another. Training is another. Stress, calorie restriction, food composition and individual biology are others. So what: If hunger consistently increases before a period, that experience may be physiologically meaningful rather than simply a failure of discipline. But—and this is important—the meta-analysis included a relatively small and narrow population: participants were 18–45, generally BMI 18.5–25, without disordered eating, and the researchers identified methodological inconsistencies between studies. So 168 calories isn’t a prescription. It is a group average. Your increase could be larger, smaller or nonexistent. What now: Instead of automatically fighting increased hunger, collect evidence. For 2–3 cycles, track: cycle timing + hunger + sleep + stress + training + symptoms Then ask: “Does my hunger actually rise repeatedly during the same part of my cycle—or does it track more closely with sleep, training or stress?” That’s much more useful than assuming every woman needs a predetermined “luteal-phase diet.”