by Rebecca Prade | Jul 14, 2026 | WELLBEING
I was recently diagnosed with DSAP, which stands for disseminated superficial actinic porokeratosis.
DSAP is a genetic skin condition linked with UV exposure. It usually shows up as small, dry, rough patches or ring-like lesions, often on sun-exposed areas such as the arms and legs.
For me, the diagnosis makes sense.
I grew up in New Zealand, running around outside on a farm, in the sun, completely unaware that my skin was storing that history. New Zealand’s thinner ozone layer and high UV environment certainly didn’t help.
But I can understand it clinically and still feel upset by it personally.
As a woman, it is hard to be told you have a visible skin condition that is not curable and not especially pretty.
What is DSAP?
DSAP is not contagious. It is not a skincare failure. And it is not something a serum is going to fix.
It is considered a disorder of keratinisation, which means it affects the way skin cells grow and shed. It is often associated with genetic susceptibility and years of UV exposure.
That distinction matters.
DSAP is not just “sun damage”. It is usually genetic susceptibility plus environmental exposure over time.
The predisposition is genetic. The exposure is what helps bring it to the surface.
Why mine became obvious in my mid 40s
What I find interesting is that my DSAP became more obvious in my mid 40s, as my oestrogen was declining.
To be clear, oestrogen did not cause my DSAP.
But oestrogen has a significant role in skin health. As oestrogen falls in perimenopause and menopause, skin can become drier, thinner, less elastic and less resilient. For some women, this is when changes that have been building quietly for years start to show more clearly.
That is exactly why I never look at skin as just surface.
Skin is not separate from the rest of the body. It reflects hormones, gut function, inflammation, immune activity, blood sugar, nutrient status, genetics, environment and time.
Why skin is rarely just one thing
In clinic, I see this pattern constantly.
A woman comes in with skin changes and has usually been told to change her skincare, use a stronger active, or try another topical.
Sometimes that is needed.
But often, the skin is responding to something deeper.
It may be hormone shifts. It may be gut inflammation. It may be blood sugar instability, nutrient insufficiency, immune activation, stress physiology, or accumulated UV exposure.
With DSAP, dermatology matters. Proper diagnosis matters. Sun protection matters. Regular skin checks matter.
But from a functional medicine perspective, I also want to understand the terrain underneath the skin.
How DSAP is managed
Sadly, there is no cure for DSAP, so for me this now means long-term management.
That includes proper sun protection, regular skin checks, and a compounded statin and cholesterol cream.
Not glamorous. Very real.
There is emerging evidence for topical statin treatment, including lovastatin with or without cholesterol, but this is something to discuss with a dermatologist or prescribing clinician. DSAP needs proper medical diagnosis and monitoring, especially because lesions can resemble other skin conditions.
Why I test, not guess
This diagnosis has been another reminder of why I work the way I do.
Skin holds history.
Genetics, hormones, gut function, immune activity, inflammation, blood sugar, environment and UV exposure all leave their mark over time.
That is why I test, not guess.
Because when we understand what the skin is responding to, we can support it properly.
Sometimes skin needs topical treatment. Sometimes it needs internal support. Often, it needs both.
Want to understand what your skin is telling you?
If your skin has changed and you want to understand what may be driving it, from hormones and gut health to inflammation, blood sugar and nutrient status, book a discovery call through the link below.
Together, we can look at the full picture and build a plan based on evidence, not guesswork.
Join my mailing list and get access to my 5 Essential Steps to Optimise Your Health here!
by Rebecca Prade | Jun 26, 2026 | WELLBEING
Most women are taught that oestrogen is about periods and fertility. That it does its job during the reproductive years, then politely bows out at menopause.
That framing is not just incomplete. It’s the reason so much avoidable decline gets written off as “just ageing.”
Oestrogen is a whole-body hormone. It works in your brain, your bones, your blood vessels, your muscles and your metabolism. When it falls, those systems feel it. Understand that, and perimenopause stops looking like an ending and starts looking like a window, one you can do a great deal with.
Where oestrogen actually works
Oestrogen receptors aren’t confined to the reproductive organs. They sit throughout the body, which is why a single hormone has such reach.
In the brain, oestrogen is neuroprotective. It supports healthy connections between neurons, dampens inflammation and helps the brain clear waste proteins. This is part of why brain fog, low mood and memory wobbles arrive so often in perimenopause and why they’re a signal, not a character flaw.
In the heart and blood vessels, it keeps vessel walls flexible and supports a healthier cholesterol balance. There’s a well-known clue here: women tend to develop heart disease around a decade later than men. That gap closes after menopause. Oestrogen was doing quiet protective work all along.
In the bones, oestrogen restrains the natural breakdown that bone constantly undergoes. When it drops, that breakdown speeds up. Bone loss accelerates sharply in the years around menopause, which is why this stage is the moment to act on bone, not a decade later.
In muscle and metabolism, oestrogen supports how your body builds and repairs muscle and how it handles blood sugar. Its decline is one reason body composition shifts and the middle becomes harder to manage, even when nothing about your effort has changed.
One hormone. Five systems. That is why losing it is felt everywhere at once.
What perimenopause really is
Perimenopause is not the day your periods stop. It’s the often turbulent years before, when oestrogen and progesterone no longer rise and fall in a predictable rhythm.
I’m 49 and in the middle of it, so I say this as someone living the work, not just describing it. The fluctuations are real. The fatigue, the disrupted sleep, the shorter fuse, none of it is imagined. It is biology.
But here is the reframe I come back to. The decline of oestrogen is not something to dread passively. It is something to respond to deliberately. The symptoms are information. They tell you which systems need support, and they tell you now, while there’s most to gain.
Slowing the curve
You can’t stop your ovaries ageing. You can absolutely influence how steeply the rest of you ages alongside them.
Protect muscle and bone with resistance training. This is non-negotiable in midlife. Lifting weights is the single most evidence-based thing you can do to preserve bone density and muscle, steady blood sugar and support hormonal health. Two or three sessions a week, gradually adding more load over time.
Steady your blood sugar. Stable glucose takes pressure off the whole hormonal system. The shifts that come with falling oestrogen make this more important, not less.
Calm the stress load. Chronic stress and falling oestrogen pull in the same unhelpful direction. Sleep, nervous-system care and genuine recovery aren’t luxuries here, they’re part of the protocol.
Get informed about HRT, properly. Replacing oestrogen is an increasingly well-supported option, and the evidence on timing is striking: the protective effects on heart, brain and bone appear strongest when oestrogen is replaced earlier in the transition rather than years later. So here is what’s worth knowing. The fear most women carry about HRT traces back to one study from the early 2000s, using older oral and synthetic hormones, that was widely misreported and the science has moved a long way since. Modern transdermal oestrogen, absorbed through the skin, carries a lower risk profile than those older oral forms. Knowing this changes the conversation. You walk in able to ask for what you want, rather than hoping it’s offered. This is your body and your decades ahead, and informed is the position of power.
Oestrogen is not a fertility footnote. It is a longevity hormone, and its decline touches your brain, heart, bones and metabolism at the same time.
That sounds daunting until you flip it. Because it means the steps that support one system tend to support them all. Strength, stable blood sugar, real rest, and an informed conversation about your hormones, these compound.
I feel better now than I did ten years ago. Not because the biology paused for me, but because I stopped treating midlife as a slow surrender and started treating it as something to optimise. That option is open to you too.
If you’d like the practical version of all this, how to actually eat, move and support your hormones through perimenopause, that’s what I share with my email list, and you can join below.
And if you want to understand your own hormonal picture rather than guess at it, that’s the work I do with clients directly. Knowing what’s happening is the first step to working with it.
This article is for education, to help you make informed choices about your own body and ask better questions.
Join my mailing list and get access to my 5 Essential Steps to Optimise Your Health here!
by Rebecca Prade | Jun 11, 2026 | WELLBEING
For decades, women were handed a diagnosis that pointed at the wrong organ.
Polycystic ovary syndrome. The name put the spotlight on the ovaries and on “cysts.” Both were misleading. As of this year, that name has officially changed — and the change matters far more than it first appears.
In May 2026, after a global consensus process, the condition previously known as polycystic ovary syndrome was renamed polyendocrine metabolic ovarian syndrome, or PMOS. The new name was published in The Lancet on 12 May 2026, following more than a decade of debate and input from tens of thousands of patients, clinicians and researchers across 56 organisations.
This is not a rebrand. It is a correction. And if you have ever been told you have PCOS, it changes the question you should be asking.
The cysts were never the problem
Here is the detail that undoes the old name. The “cysts” seen on an ultrasound are not pathological cysts at all, they are arrested follicles, eggs that started to develop and stalled. You do not even need them to have the condition.
So the original name described a symptom that isn’t reliably present, on an organ that isn’t the root cause. No wonder it confused everyone, including the women living with it.
The cost of that confusion was real. Diagnostic delay affected up to 70% of people with the condition, and care was often fragmented across specialists who each saw only their corner of it. You can’t treat a whole-body condition one symptom at a time.
What PMOS actually means
The new name does something useful. It names the mechanism Polyendocrine, many hormones are involved, not one. Insulin, androgens like testosterone, and the brain’s signalling hormones all interact. Metabolic, this is, at its core, a condition of how your body handles energy. Ovarian, the ovaries are affected, but they are downstream, not the origin.
In other words: PMOS is a metabolic and hormonal condition that happens to show up in the ovaries. It is not a gynaecological problem with metabolic side effects. The order matters, because it tells you where to intervene.
The thread that runs through it: insulin
In clinic, I see the same pattern again and again. A woman has been told her irregular cycles, her acne, the stubborn weight around her middle, the unwanted hair growth, these are separate problems. They are not. They are usually the visible end of one process: insulin resistance.
When cells stop responding well to insulin, the body produces more of it. High insulin drives the ovaries to make more testosterone. Excess testosterone disrupts ovulation, alters the skin and hair, and the cycle becomes erratic. The weight gain isn’t a willpower failure. It is a hormonal signal.
This is why two women can both have PMOS and look completely different. One is slim with regular-ish cycles and high androgens. Another carries weight and has stopped ovulating altogether. Same underlying driver, different presentation. Insulin resistance, by the way, is common even in women who are not overweight, which is exactly why the old “lose weight and come back” advice failed so many.
Why your blood tests came back “normal”
This is the part that frustrates my clients most. They’ve been to the GP. The standard bloods looked fine. They were sent away reassured, still exhausted, still not ovulating, still not themselves.
A standard panel measures a single moment. It rarely captures how testosterone is being produced and cleared, how insulin is behaving across a day, or how the stress response is feeding into the whole picture. “Your results are normal” and “your hormones are working well” are not the same sentence. They never were.
This is where functional testing earns its place. Mapping androgens, insulin and cortisol together, rather than glancing at one number in isolation, is what turns a vague label into a specific, workable plan.
The genuinely hopeful part
Here is what I want you to take from the name change. PMOS is metabolic. And metabolic processes respond.
This is not a fixed sentence written into your genes. It is a pattern you can shift, through the way you eat to steady blood sugar, the way you train to improve insulin sensitivity, the way you manage the stress that quietly pushes the whole system in the wrong direction.
Resistance training in particular does more for insulin sensitivity than almost anything else, and it costs nothing but consistency.
I won’t pretend it is effortless. But “workable” is the honest word, and it is a far better word than the resignation so many women were handed alongside the old diagnosis.
The renaming of PCOS to PMOS is, in the end, an invitation. An invitation to stop chasing isolated symptoms and start asking a better question: what is driving all of this at once?
That is the question worth answering.
If you’d like the deeper guide to steadying blood sugar and supporting your hormones day to day, it’s the kind of thing I share with my email community, you can join below.
And if you suspect PMOS is part of your picture and you’re tired of being told you’re fine, this is exactly the work I do with clients one to one. Mapping the full hormonal and metabolic picture is where we start. Book a discovery call
This article is for education and isn’t a substitute for personalised medical care.
Join my mailing list and get access to my 5 Essential Steps to Optimise Your Health here!
by Rebecca Prade | Apr 13, 2026 | WELLBEING
Cortisol is often blamed for everything, but in clinic it is rarely that simple.
What I see far more often is a pattern. People who are doing a lot right with their health, eating well, exercising regularly, but still not feeling quite right.
Low energy. Poor sleep. Digestive issues. Skin changes. Weight gain in the wrong places.
These are often early signs that the stress response is being activated too frequently, even if it does not feel like “stress” in the traditional sense.
This is where understanding cortisol properly becomes useful.
What are the silent signs your cortisol is too high?
High cortisol does not always feel like stress.
It often shows up as subtle shifts in the body:
• waking in the night, particularly around 2–4am
• feeling tired but unable to switch off
• increased abdominal fat
• relying heavily on caffeine to function
• changes in digestion
• fluctuations in blood glucose levels
These are early signals that the body is relying on the stress response more than it should.
What everyday habits are raising cortisol without you realising?
In most cases, it is not one big stressor. It is daily habits.
Skipping meals, especially breakfast, is a common one. It forces the body to rely on stress hormones to maintain blood sugar.
Caffeine on an empty stomach has a similar effect.
Poor sleep timing, late-night screen exposure, and very intense training without adequate recovery can also keep cortisol elevated.
It is the accumulation of these inputs over time that tends to drive the issue.
Why do people feel “tired but wired”?
This is one of the most common patterns I see.
It is usually a mismatch between cortisol and the nervous system.
Cortisol may be elevated at the wrong times of day, particularly in the evening, while energy production at a cellular level is actually low.
So you feel exhausted, but your system is still switched on.
Fluctuations in blood glucose levels often play a role here as well, keeping the body in a more alert state than it should be.
What does chronic stress do to your body over time?
Over time, chronic stress affects multiple systems.
It can shift fat storage, often increasing it around the abdomen, and affect skin quality through inflammation and reduced collagen production.
It also disrupts sleep, digestion, and hormone signalling.
From a visual perspective, people often notice duller skin, increased breakouts, and a more tired appearance.
Internally, it places ongoing pressure on the body’s ability to regulate itself properly.
Is “cortisol face” actually a thing?
The term has become popular online, but there is some physiological basis behind it.
Elevated cortisol can influence fluid retention, inflammation, and fat distribution, which may lead to a slightly puffier appearance in the face.
That said, it is rarely just cortisol alone.
Sleep, diet, alcohol intake, and overall stress load all contribute.
It is more accurate to see it as a reflection of overall physiological stress rather than one hormone in isolation.
How stress affects your skin
Stress has a direct impact on skin health.
It increases inflammation and can influence oil production indirectly through its effects on insulin and androgen activity.
This is why breakouts often worsen during periods of pressure.
Stress acne vs hormonal acne
Stress-related acne tends to be:
• more inflammatory
• less predictable
• linked to periods of pressure
Hormonal acne is usually:
• cyclical
• more predictable
• often located around the lower face
In reality, the two often overlap, but the pattern gives useful clues.
Why jawline acne often flares during stress
The jawline tends to be more sensitive to androgens.
These can be influenced by both stress and blood sugar regulation.
Cortisol increases inflammation and can affect oil production indirectly through its effects on insulin and androgen activity.
So while jawline acne is often labelled as hormonal, stress is frequently a contributing factor, particularly when breakouts flare during busy or pressured periods.
Can stress trigger eczema, rosacea or psoriasis?
Yes.
Stress is a well-recognised trigger for inflammatory skin conditions.
It affects the immune system and increases inflammatory signalling in the body, which can worsen conditions like eczema, rosacea, and psoriasis.
It does not cause them in isolation, but it often exacerbates underlying susceptibility.
Simple ways to lower stress in real time
You do not need complex routines to support the nervous system.
Simple, consistent inputs tend to work best.
Techniques like the physiological sigh, a double inhale followed by a long exhale, can quickly reduce stress in real time.
Box breathing, where you inhale for four, hold for four, exhale for four, and hold again for four, can calm the system within a few minutes.
A short walk outdoors, particularly in natural light, helps support a healthier cortisol rhythm and regulate circadian rhythm.
Even stepping away from screens and allowing a few minutes of quiet can lower the overall load on the system.
Consistency matters far more than intensity.
Foods that support a healthier stress response
There is no single food that lowers cortisol in isolation.
What matters is the overall pattern.
Protein-rich meals help stabilise blood sugar and reduce reliance on stress hormones for energy.
Magnesium-rich foods such as leafy greens and nuts support nervous system regulation.
Omega-3 fats, found in oily fish, help modulate inflammation and support the body’s response to stress.
It is the combination of these that makes the difference.
Burnout vs stress: what is the difference?
Stress is typically short-term.
Burnout develops when that stress becomes chronic and unresolved.
With burnout, people often feel more depleted, less resilient, and less able to recover, even with rest.
In some cases, after long-term stress, the cortisol rhythm can become dysregulated, with a flatter or lower daily pattern rather than the normal rise and fall seen across the day.
This can leave people feeling exhausted throughout the day, less motivated, and less able to cope.
It is not just feeling busy or overwhelmed. It reflects longer-term strain on the nervous system and energy production.
Final thought
Most people do not have a cortisol problem in isolation.
What I see more often is a system that has been under pressure for too long without the right support.
When you start to stabilise blood sugar, improve sleep timing, and reduce overall load on the nervous system, things tend to shift more quickly than expected.
Not through extremes. Through consistency.
Join my mailing list and get access to my 5 Essential Steps to Optimise Your Health here!
by Rebecca Prade | Feb 20, 2026 | WELLBEING
A Functional Medicine Approach To Building Habits That Actually Fit Your Life
Women are being hit with more health advice than ever before. Protein goals. Step counts. Circadian rhythm hacks. Cold plunges. Strength training. Meditation. Saunas. Fasting. Sunlight exposure. The list grows every week, and for many women it feels like a full-time job just trying to keep up.
As a functional medicine practitioner, I see this every day. Women want better energy, steadier hormones, less stress, clearer skin, better digestion, and a stronger metabolism. Yet the sheer volume of wellness content online makes it confusing to know where to start. And when your daily schedule is already stretched, even helpful advice can feel impossible to integrate.
This blog is designed to cut through that noise. No trends. No pressure. Just evidence-based, realistic steps that genuinely support your biology.
Why Modern Wellness Feels So Overwhelming
Spend a few minutes on social media and you will hear the same message over and over: do more. Track everything. Optimise everything. Fit more in. And while many of these tools have merit, they often forget the most important part of women’s health: your capacity.
Most women are managing work, families, households, relationships, stress, emotional load, and the invisible admin that keeps life functioning. Adding twelve wellness habits on top rarely leads to better health. More often, it creates guilt, burnout, or the sense that everyone else is coping better than you are.
Real functional medicine is not about doing everything. It is about doing the right things for your body in a way that is sustainable.
The Foundation of Women’s Health: Start Small, Start Now
You do not need extremes to feel better. You need consistency and habits that support your hormones, gut, sleep, metabolism, and stress response.
Here are the core areas worth focusing on, backed by research and easy to fold into daily life.
1. Protein: The Most Underrated Women’s Health Strategy
Adequate protein intake is one of the biggest drivers of energy, blood sugar balance, muscle retention, cravings, mood stability, and hormone regulation.
A useful benchmark is thirty to forty grams of protein at each meal.
Practical ways to increase protein without changing your entire diet:
- Add a scoop of high-quality protein powder to oats, yoghurt, or smoothies
- Add beans, lentils, cottage cheese, tofu, or extra chicken to meals
- Remember that one large egg contains only six grams protein
- Pair snacks with protein to stabilise glucose
When women increase their protein intake, they often notice improvements in energy, appetite control, metabolic health, sleep and strength within weeks.
2. Walking: Low Stress, High Impact
Walking is one of the most effective and overlooked tools for women’s health. It supports metabolic function, gut motility, cardiovascular health, insulin sensitivity, and stress regulation.
Simple ways to increase steps without adding pressure:
- Walk during kids’ activities
- Walk while on the phone or listening to a podcast
- Use a walking pad during calls or while watching a show
- Walk to break up long sitting periods
This is functional movement, not another task. It supports every system of the body.
3. Morning Light: The Real Circadian Reset
Light exposure is a key driver of hormonal rhythm, cortisol balance, sleep quality, and metabolic function.
Your circadian rhythm needs a daily reset and the easiest way to do that is light.
Try:
- Opening a window or stepping outside for five to ten minutes
- Pairing your morning drink with natural light
- A short walk if time allows
This simple signal strengthens your energy, focus, mood, and sleep timing.
4. An Evening Routine That Actually Works
Women often struggle with sleep because evenings are overstimulating. Bright screens, overhead lighting, stress, and rushed tasks all reduce melatonin production and keep the stress response high.
Support your sleep and hormone balance by:
- Dimming lights at least an hour before bed
- Swapping scrolling for reading, stretching, or a warm bath
- Preparing one or two things for the next day to lower morning stress
- Sleeping in total darkness or using a sleep mask
Deep, restorative sleep is one of the most powerful investments in hormone health, metabolism, immunity, and emotional resilience.
5. Progress Counts, Even When It’s Small
Women often assume they need major overhauls to see results. Functional medicine says the opposite. Small, consistent shifts regulate the system more effectively than extreme routines.
Some days you will manage more. Some days you will manage less. But if you consistently:
- eat more protein
- walk a little more
- get morning light
- protect your evenings
You create real biological change.
You are not behind. You are not doing it wrong. You are living a full life and building habits that support your long-term health.
Final Thoughts
Women’s wellness does not need to be complicated or overwhelming. Your body responds best to clarity, simplicity, and consistency. Start with the habits that fit your real life. Build from there. Your biology will meet you where you are.
Join my mailing list and get access to my 5 Essential Steps to Optimise Your Health here!
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