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There’s this catch-22 when you live with conditions like PCOS or endometriosis: your symptoms are often dismissed as “just anxiety” even though anxiety and depression are well-documented consequences of the conditions themselves.

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Studies show women with PCOS are 3x more likely to experience depression and five times more likely to experience anxiety than those without the condition (Source). Endometriosis carries similar risks: one study found that over 60% of people with endo experience moderate to severe anxiety and/or depression — often linked to chronic pain, inflammation, and medical trauma (Source). The cycle isn’t just hormonal. It’s physical, emotional, systemic.

And then there’s PMDD, premenstrual dysphoric disorder, a condition affecting up to 5–8% of menstruating people, marked by severe mood symptoms in the luteal phase. Emerging research shows a possible link between PCOS and PMDD. The overlap is still under-researched, but the lived experience of our community tells us the connection is real.

As someone with PCOS, I can tell you that my anxiety and depression–I call it ‘spiraling’-- is extremely unproductive and at times ruins a whole day. This was especially true when I had irregular cycles of 45+ days. It felt like my luteal phase, the week before your period, would be endless because it was 2+ weeks! One thing I did swear by was cycle synching my caffeine intake.

Even without a diagnosis, the hormonal shifts of menstruation can make us second-guess our mental health. How often have you asked yourself, “Is this PMS or am I actually not okay?” Some members have shared that they feel relief once their period starts — while others say it brings deeper waves of sadness or anxiety. There’s no one-size-fits-all.

For those with endo, the mind-body connection can feel even more fraught. We’ve heard members describe how their bodies “remember” pain—even years after excision surgery—triggering anxiety before a period, or even around food.

There’s also growing recognition of how immune dysregulation may factor into both conditions and into mood. Endometriosis has been linked to autoimmune diseases like lupus and hypothyroidism (source), both of which carry higher mental health risks. PCOS, too, is associated with systemic inflammation and insulin resistance — both increasingly tied to depression through gut-brain pathways (source).

More recently, I’ve been wondering: If PCOS increases our risk of anxiety and depression, does it also elevate the likelihood of prenatal or postpartum depression?

The research suggests yes. A study found that women with PCOS had a higher risk of postpartum depression, and an even higher risk of prenatal depression, which is often underecognized (source). Looking back, I realized I went through a version of prenatal depression myself, which I discuss more in my Founder Health Update. I hadn’t felt it during my two egg freezing cycles, so I assumed I’d be fine. But the mood swings during my first trimester hit hard. I even asked my OB if antidepressants were safe.

So let’s say it is your hormones. Or your diagnosis. Or chronic pain. Or trauma from years of being dismissed. What then?

That’s the harder question—because treatment is often presented as a binary: medication on one side (often surrounded by stigma), and a lifestyle overhaul on the other (which is expensive, exhausting, and hard to sustain when you’re already depleted).

We’ve been discussing a few options in our PCOS and Pregnancy & Postpartum subchannels:

Medication, with nuance: For some, SSRIs or other medications offer much-needed relief, especially during severe episodes or major transitions like pregnancy or postpartum.
Cycle-informed therapy: Working with a therapist trained in PMDD, trauma, or reproductive mental health can make a world of difference, especially if they’re open to syncing therapy around your cycle patterns or flare-ups.
Nervous system regulation: This includes things like somatic therapy, EMDR, vagus nerve stimulation, or even cold exposure and breathwork. These can be helpful tools for those whose anxiety is rooted in a constantly “on” stress response.
Community support: Sometimes the most healing thing isn’t a treatment. It’s talking to someone who gets it.
Low-lift habits: We often hear “try meditation!” as if it’s a cure-all. But a 3-minute voice note to yourself, 10 minutes of sunlight in the morning, or logging your mood through your cycle might be more manageable, and meaningful, than a full routine overhaul.
Nutrition and movement as regulation, not restriction: Instead of treating food or fitness like medicine with a rigid prescription, some find relief by viewing it through a gentler lens, supporting blood sugar, lowering inflammation, or just feeling more like themselves.
Acupuncture and integrative care: There’s growing evidence for acupuncture’s role in managing mood symptoms, especially for those with endo or PCOS-related hormone disruption. But the same goes for B12 levels, thyroid testing, and gut health—all often overlooked.

How do you work through your cycle and mental health? Is there anything you’ve white knuckled through? What did reaching out for help look like for you?

Join us on WhatsApp and share your thoughts.

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MyAdvo community news: New Application to Join MyAdvo!
Founder Health Update: First Trimester Thoughts…
Women’s health in politics: Supreme court decisions & massive bill in congress about to pass
MyAdvo monthly reads

We shortened our intake questionnaire and automated welcome emails for approval, so you can get the WhatsApp invite link right away based on your responses (ie, your location, condition, agreeing to our guidelines, and whether you were referred by another member).

As part of our new welcome series, we built a couple of email flows to make sure folks don’t get lost in the shuffle:

One walks new members through our origin story, how to introduce themselves in the chats, and what our community guidelines are all about.
The other gives a gentle nudge to people who applied but haven’t jumped into WhatsApp yet. Just in case life got in the way!

Our goal is to make it easier to grow our community without compromising the experience of every member while making sure we vet prospective members and onboard them so everyone understands our community guidelines and mission. When we were smaller, I could manually review every single person, set up intro calls or message them one by one. But now that we’re growing (🥹), we’re setting things up to scale by building the groundwork to protect our community’s intimacy and authenticity.

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At first, we tried to trigger all of this via WhatsApp using tools like Wati (yes, we even got a separate MyAdvo business number 😅). But after a lot of troubleshooting, we realized that Meta has restrictions against WhatsApp automations. You can’t automate messages based on user behavior like joining a channel or DMing. The only thing you can automate is a very specific kind of “utility” message within groups. So we decided to keep WhatsApp automation free, which honestly feels right. We’re now using Airtable and Zapier to track applications and trigger welcome and follow-up emails, keeping everything inside the chats human.

👋 We also launched two new sub-channels this month:

Adenomyosis Support
Tri-State Area Members

After interviewing a dozen community members, we heard loud and clear how prevalent adenomyosis is and how often it overlaps with endometriosis (in fact, up to 90% of people with endo also have adeno). Members also told us that as the chats have grown, it’s been harder to follow threads and find local recommendations. These new sub-channels are a way to go deeper, whether that means sharing tips and venting about adenomyosis or connecting with someone nearby to exchange doctor recs or coordinate a meetup.

In our members' WhatsApp chat, we have a few different channels so people can connect more deeply by condition and more recently by health stage like Pregnancy and Postpartum.

Here are a few highlights from our Endo, PCOS, and Pregnancy & Postpartum chats this month:

Are joint/bone aches and soreness endo symptoms or lupron side effects? Can lupron impact bone density? What do you do if your provider refuses to provide a bone density test?
What period relief devices do our members love? Thermie and Myobi came up for relief via tens and heat. Do you have other recs?
How to prep pre-op and post-op for endometriosis surgery, especially when you’re traveling out of state for it? Check out our AdvoKit of community-sourced recommendations here.
How do you handle social situations when you’re depleted due to PCOS? Cycle synching can be super helpful. We’re reading Alisa Vitti’s Women Code right now, actually!
If you’re dreading buying maternity clothes, what alternatives have worked for you? Baby doll and flow tops (Doen has loads), Poshmark, non compression high waisted leggings from Kirkland. Any other recs?

Join the conversation by becoming a MyAdvo member.

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For this founder health update, I wanted to write about my first trimester–what I didn’t expect, and what I’ve learned. I’ll start by saying that I’m pretty sure I was dealing with prenatal depression albeit self-diagnosed. By the second month, I had no resilience to intrusive thoughts. I was breaking down every other day, often spiraling over things like: What if I’m not ready? What if I lose myself in motherhood? Will I still be able to build MyAdvo? Am I the right person to build MyAdvo? What if something’s wrong with the baby and I’m to blame, especially with how depressed I feel?

It felt a lot like my PCOS moods but worse. Even though I was keeping up with weekly acupuncture and had dramatically slowed down my schedule, nothing seemed to lift the weight. I also experienced a kind of social anxiety I’d never felt before. Crowded restaurants, networking events, even casual catch-ups with friends felt overwhelming. All I wanted was to stay home in silence — basically the opposite of life in New York. I kept beating myself up for “changing.”

I started looking into how normal this was and brought it up to my OB a few times. We discussed how certain antidepressants like Zoloft (sertraline) are safe. Just knowing I had the option made me feel more grounded — like if things got worse, I wouldn’t be stuck. I will say that it was like night and day once I crossed into the second trimester, but more on that in next month’s newsletter.

I didn’t have morning sickness, but I did have evening sickness — every day like clockwork around 4pm until I went to sleep. And as someone who genuinely enjoys food, the food aversions were brutal. I could barely tolerate anything except cold fruit. Pineapple and grapes basically became my dinner for a few weeks.

I also had spotting and cramps very early on, which really worried me. My OB reassured me that light spotting in the first trimester is relatively common, especially if it’s not accompanied by pain, heavy bleeding, or clotting. Later, I was diagnosed with a small subchorionic hematoma — a pocket of blood between the placenta and uterine wall — which likely explained it. Because it was small and not near the gestational sac, my OB wasn’t concerned. It resolved by the second trimester. Around the same time, the uterine cramps gave way to round ligament pain, which is apparently also “very normal,” though not at all pleasant.

A few surprises during the first three months:

Skin breakouts: I was really hoping for clear skin—or at least for my acne to disappear like it did for my mom. Instead, my chin broke out worse than usual, and I had to stop using my prescription retinoid. I swapped in sulfur-based spot treatments and so far, it’s been a decent alternative.
Measles immunity scare: Routine blood work showed I’d lost my immunity to measles — despite getting both doses as a kid. I panicked a bit, especially with the recent outbreaks and anti-vaccine rhetoric gaining steam. Since the MMR vaccine is live, I can’t get it while pregnant. My OB said we’ll get it done right after delivery (likely in the hospital) and in the meantime, recommended avoiding sick kids and masking when traveling.
NIPT: We opted to do the MaterniT21 PLUS test, a non-invasive prenatal test (NIPT) that screens for chromosomal abnormalities and fetal sex. Thankfully everything looked good. I was really happy to hear that the test that is usually up to $799 could be discounted to $299 after taking a survey (similar to the genetic testing that we did earlier this year)! Very helpful in an expensive healthcare year…

Overall, I’m super relieved to be able to share my pregnancy and am now trying to relish in the second trimester. I’ll share more soon about how I’m navigating doula options, newborn care planning (it’s a whole underground network of DMs and recs), and how we’re monitoring my fibroids throughout pregnancy.

If you’ve been through any of this, or have resources that helped you, I’d love to hear from you — just reply or shoot me a note at esther@hellomyadvo.com.

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There’s a lot going on right now as the Supreme Court prepares to go into its summer recess and the House and Senate try to push through the “One Big Beautiful Bill.” It’s generally been hard to keep up with the news…everything is breaking news, so I like writing this section to digest what’s happened and what’s in play for women’s health. I hope you find it helpful too.

Just last week, the Court ruled 6–3 in Medina v. Planned Parenthood South Atlantic to give states more control over which providers qualify for Medicaid reimbursement. In this specific ruling, it means that, “Patients who receive Medicaid in South Carolina cannot choose Planned Parenthood as a provider and denies them the dignity to choose where they want to go for care they need,” as quoted by CEO of Planned Parenthood, Alexis McGill Johnson. This isn’t just about abortion care. It also excludes women who depend on clinics like Planned Parenthood for STI testing, birth control, wellness exams, cancer screenings. In fact, medicaid isn’t even used for abortions at Planned Parenthood in South Carolina except in case of rape, incest, or save life of mother. The decision sets precedent to remove patients’ provider choices.

The Court also weighed in on religious liberty this month when it comes to private insurance. In Catholic Charities v. New York Department of Financial Services, the Court issued an unanimous decision via GVR order (grant, vacate, and remand) telling New York courts to revisit a state rule that requires employer-sponsored health insurance plans to cover abortion. Catholic Charities, a faith-based employer, had argued the mandate violated its First Amendment rights. While the Supreme Court didn’t decide whether the rule itself is unconstitutional, it threw out the lower court’s ruling and sent the case back for reconsideration using more recent religious liberty rulings. This is the latest in a series of legal shifts that could allow more employers to opt out of covering essential reproductive care and also indicates that even blue states can’t full protect their residents from limited reproductive rights.

In a rare moment of reassurance, the Court also ruled this month to uphold the Affordable Care Act’s preventive care mandate. In Kennedy v. Braidwood Management, Inc., a 6–3 decision preserved the ACA requirement that most insurance plans cover preventive health services at no cost to patients. That includes everything from contraception and breast cancer screenings to HIV prevention and STI testing—services that are especially critical to women, LGBTQ+ individuals, and those managing chronic conditions.

Faith-based employers had challenged the mandate, arguing that offering coverage for certain services (like PrEP and birth control) violated their religious beliefs. The Court rejected that broader claim and left the ACA’s preventive services protections in place.

The “One Big Beautiful Bill Act” passed the House on May 22 by a single vote (215–214) and cleared a key procedural hurdle in the Senate this week. This bill is basically a tradeoff between healthcare access, particularly for low-income women and families, in order to fund the military spending, immigration enforcement as well as tax breaks for the wealthy..

G2G’s newsletter provided the below summary (full report here) The House version would:

Increase the deficit by $3.8 trillion through 2034
Raise the debt ceiling by $4 trillion
Cut SNAP (food assistance) by $300 billion
Cut Medicare by $500 billion
Cut Medicaid by $700 billion
Slash Affordable Care Act programs by $358 billion
Slightly expand the Childcare Tax Credit by $500
Increase the cap on employer-provided childcare benefits to $500,000

The Senate version proposes even deeper Medicaid cuts. It also lowers state and local tax deductions, limits penalties on foreign investors, and makes a range of business tax breaks permanent—breaks that the House version only extended through 2029.

According to the nonpartisan Congressional Budget Office, roughly 7.6 million people would lose Medicaid coverage under these changes. Medicaid and CHIP currently cover close to 80 million Americans, the majority of whom are women and children.

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Last year’s Idaho v. United States ruling punted the question of whether EMTALA — the federal law requiring hospitals to stabilize patients in emergency situations — applies to abortion care in states with bans. Some thought this was a win because the case was dismissed on procedural grounds, but it really just left hospitals to navigate conflicting laws on their own.

That ambiguity deepened in March, when the Justice Department dropped its EMTALA lawsuit and signaled it would no longer defend the idea that federal law guarantees abortion access in medical emergencies. This was also seen as a potential win, but then in June, the Trump administration formally rescinded the Obama-era guidance that required hospitals to provide emergency abortion care, arguing the previous interpretation overstepped federal authority.

So what does this mean in practice? EMTALA itself hasn’t changed, but without clear federal guardrails, the responsibility now falls to individual providers who must weigh legal risk against medical urgency. For patients, it means whether you receive life-saving abortion care in a crisis may come down to where you live and which hospital you visit.

That disconnect was on full display this month when Republican Congresswoman Kat Cammack of Florida shared that she experienced an ectopic pregnancy, a non-viable, life-threatening condition where the embryo implants outside the uterus. She said doctors at her Florida hospital hesitated to give her the necessary medication because of the state’s six-week abortion ban. It wasn’t until she pulled up the law on her phone that treatment moved forward.

Florida’s six-week abortion ban includes exceptions for life-threatening pregnancies, but it fails to clearly define what counts as an emergency, leaving doctors unsure how to proceed in cases like ectopic pregnancy. While state officials later clarified that treating ectopic pregnancies is permitted, the law’s vague wording caused real delays in care, even for a sitting Congresswoman.

Without clear state guidance and with federal EMTALA protections no longer enforced providers are forced to make high-stakes medical decisions under legal uncertainty. The risk for getting it “wrong” is massive: felony charges, jail time, loss of a medical license, or steep civil fines.

So when Rep. Cammack later went on Fox News and accused Democrats of “fearmongering” about abortion bans, she overlooked the very situation she experienced: a confusing legal landscape where even life-saving care can be delayed. Not because doctors don’t know what to do — but because the law makes them afraid to do it.

In a post-Roe world, politicians are writing medical laws without understanding medicine — and patients are left to deal with the fallout

The EMTALA issue is likely to return to the Supreme Court after the 9th Circuit rules, potentially in 2026 or 2027. Until then, providers and patients are left with dangerous uncertainty and uneven protections across state lines (tbh…this is what makes me hesitate about traveling to certain states while pregnant).

June 24th was also the 2-year anniversary of the Supreme Court overturning Roe v. Wade, ending the federal protection for abortion rights. Since, thirteen states, including Texas, Louisiana, and Idaho, have fully enforced total abortion bans, while four others, such as Georgia and South Carolina, have implemented 6-week bans, often before many people even realize they’re pregnant (I can attest to this!).

Despite these restrictions, people are still finding ways to access care (Source: Guttmacher Institute):

Medication abortion now accounts for 63% of all U.S. abortions — up 10 percentage points from 2020.
Out-of-state travel for abortion care has doubled since 2020.

Meanwhile, protective states like Colorado, New York, and Washington have passed new laws codifying emergency abortion care and expanding provider capacity to meet growing demand from people traveling across state lines. New York’s 2025 legislative session, specifically, delivered the below key wins (Source: Planned Parenthood of Greater NY):

$25M in new grant funding to support access to medication abortion and care later in pregnancy.
$15M in capital and security funding for reproductive health providers.
$4M in additional funding to support provider training.
Ending mandatory abortion reporting.
- Passed the NY Health Information Privacy Act, which bans the sale of New Yorkers’ electronic health data and strengthens consent, deletion, and data minimization requirements.
Enshrining important federal EMTALA protections in our state law.
Strengthened legal protections for gender-affirming and reproductive care, shielding patients, providers, and helpers from out-of-state legal threats.
Passed the Hospital Transparency Act, requiring hospitals to disclose whether they offer services like abortion and gender-affirming care so patients can make informed choices.
Legalized medical aid in dying for terminally ill, mentally capable adults, affirming bodily autonomy and compassionate end-of-life options.