Dr. Herman Weiss
Sep 30, 2026
Three papers this week, and they rhyme. One shows that the biggest women's-health transition is nearly invisible in American medical records. Two are about PMOS: one finds a gut-bacteria signature that works in the lab and stumbles in the wild, and one asks women themselves why healthy habits fall apart - and gets an answer every doctor should memorize. Then the week in social media, where testosterone is being sold as a cure-all again.
Paper 1: Menopause barely exists in your medical record. Researchers at the University of Colorado, including Audrey Hendricks and Nanette Santoro, asked a simple question inside the NIH's All of Us Research Program: when a woman goes through menopause, does her chart notice? They analyzed surveys, electronic health records, and genomic data from roughly 396,000 women. Survey responses captured about 193,000 menopause observations. The medical records? About 28,000 diagnoses - seven times fewer. Nearly every woman who had a menopause code in her record also reported the transition in her survey, so the records that exist are accurate. They're just mostly absent. What this means in plain English: if you assume your doctor's system knows where you are in the transition, it probably doesn't. Menopause status shapes how we read your cholesterol, your bone density, your bleeding, your cancer screening - and it's missing from the record most of the time. Until systems catch up, the fix is low-tech: say it out loud at every appointment. "I'm perimenopausal" belongs in the room even if it never makes the chart. Limits: this is one research program's data, it describes documentation rather than care quality, and the authors frame it as groundwork for research design, not a verdict on your clinic. For my PMOS readers, note the timing: your condition is mid-rename from PCOS to PMOS, which means two sets of codes and an even thinner documentation trail. If a transition half of humanity goes through is invisible, a renamed syndrome doesn't stand a chance - carry your history in your own words. (Staples JW, White SL, Giacalone A, Pozdeyev NV, Sammel MD, Stranger BE, Valencia CI, Santoro NF, Hendricks AE. Menopause in the All of Us Research Program: a descriptive summary of electronic health record and survey response across sociodemographic characteristics. Menopause, 2026. Authors' summary: The Conversation, Sep 28, 2026.)
Paper 2: The PMOS gut signature is real - and it doesn't travel. A team led by P. Huang pooled stool metagenomic data from three independent cohorts, 169 women in all, and rebuilt the bacterial world inside them from scratch: 540 reconstructed bacterial genomes, 32 of them apparently new to science. Women with PCOS/PMOS carried fewer species overall, a less interconnected microbial community, and eleven species at different abundance - including higher levels of two common gut residents, Phocaeicola vulgatus and Bacteroides uniformis. The bacterial genomes more common in PMOS were loaded with sugar-import machinery, which fits the insulin-resistance biology at the condition's core. Then the authors did the thing I wish every microbiome paper did: they trained a model to spot PMOS from gut data and tested it on women it had never seen. Within one cohort it worked well (AUC 0.757). Across cohorts it stumbled. Their own conclusion: promising signal, not ready for clinical use, external validation required. So file this under "real biology, no action yet" - no probiotic, no stool test, no gut protocol follows from it today. What you gain: confirmation that the gut is statistically entangled with PMOS, and a BS detector for anyone selling you a microbiome cure. For the menopause side of our community: remember the gut-barrier markers we covered that shift through the menopause transition (post #3) - the gut is turning out to be a character in both of our stories, and women carrying PMOS into perimenopause will hear gut claims aimed at them from both directions. Now you know what "validated" should mean before you believe one. (Huang P, Zhang M, Li Q, Xu H, Shou H. Altered gut microbiota composition and function potential in polycystic ovary syndrome: a multicohort metagenome-assembled genomes study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2026. doi:10.1016/j.ejogrb.2026.115453)
Paper 3: Why the lifestyle advice falls apart - asked the women living it. We tell women with PMOS to eat differently and move more, and then we act surprised when it doesn't stick. A team at Central South University in Changsha sat down with 20 women with PMOS plus 13 doctors and 4 nurses and built, from their interviews, a map of how behavior change actually happens: intention, adoption, maintenance - and disengagement, a state that can swallow you at any point. Intention comes from real concerns: fertility, symptoms, self-esteem. Adoption needs self-efficacy, usable health information, resources, and support. The few who reached maintenance had goal-setting, self-regulation, identity, and positive feedback working for them. Most participants disengaged somewhere along the way - not from weakness, but because, as corresponding author Shujuan Zhu puts it, restraining factors outweighed the supports. Time, cost, complexity, disease burden. Her line deserves to be taped inside every chart: disengagement "should not simply be viewed as a personal failure of willpower." What you gain: if you've started and stopped, you are the norm in this data, not the exception - and the fix is structural (smaller steps, support, stage-matched advice), not more shame. For menopause readers: swap "PMOS" for "perimenopause" and every sentence still holds - the same intention-adoption-maintenance climb, the same cliff. Limits: 37 interviews, one province in China, a framework to be tested elsewhere rather than settled truth. But it matches what the larger PMOS lifestyle meta-analysis told us in Issue 5, and it explains the "why" behind those numbers. (Shen Q, Zhang X, Peng E, Qu J, Zhu S, Lei J. Revealing the complexity of health behavior change among women with polycystic ovary syndrome: a qualitative grounded theory study. Journal of Nutrition Education and Behavior, 2026. doi:10.1016/j.jneb.2026.07.008)
One cross-reference: Sunday's post covered the orforglipron analysis presented at EASD this week - a daily GLP-1 pill with similar weight loss across all three menopausal stages. It's on the site; I won't re-review it here.
What social media is saying. Four currents this week, two on each side of our community. First, testosterone is being sold as a menopause cure-all again. CBC News ran a full investigation (Sep 26): influencers and some physicians tout it for everything from libido to night sweats, off-label use is booming, and the researchers they interviewed pushed back hard - the evidence supports testosterone for one indication, low desire causing distress, and not for mood, cognition, or general vitality. UBC's Jerilynn Prior was blunt: there's no physiological reason for most menopausal women to take it. The grounded part: the FDA's September 17 workshop (covered here as post #4) has opened a formal evaluation, with public comment running into mid-October - regulation is following the hype. Where chatter meets evidence: desire, yes; cure-all, no. Second, muscle. Dr. Gabrielle Lyon's podcast episode "Menopause Is a Muscle Problem" (Sep 24) is everywhere this week: lean mass falls fastest in perimenopause, the slide may start near 35, and no pill or patch rebuilds it - her prescription is resistance training two to three days a week plus protein. That message matches the evidence direction (and Sunday's post made the same muscle point about GLP-1 weight loss). Just clock the commercial layer: the episode funnels to a paid challenge with a discount code. Good advice, sold. Third, the supplement boom has a new flagship: Ritual launched a perimenopause capsule pairing shatavari extract with DIM (Sep 28). Neither ingredient has anything like the trial evidence we require here - compare the chasteberry RCT from post #5, where at least a real trial existed. Marketing is sprinting ahead of data again. Fourth, PMOS has a new kind of voice: Dr. Asima Ahmad, a reproductive endocrinologist, wrote in Women's Health (Sep 28) about diagnosing herself with PMOS in her twenties after years of dismissal - and cites the numbers behind her story: a third of women wait more than two years for diagnosis, nearly half see three or more clinicians first. The rename (14 years of work, 56 organizations, 22,000 survey responses) keeps reaching bigger stages, and now the specialists are telling their own stories. That is how a name actually moves.
That's the week. Bring your doctor the papers, not just the headlines.
Dr. Herman Weiss
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