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Women's Health OSLoad-Bearing · care operating system
Enter by goal · phenotype · or module

Women's Health OS.

An operating system for a multidisciplinary women's-health practice — verified clinical modules plus the coordination layer that turns them into care: team lanes, action plans, escalation, and a longitudinal timeline. Start with what she came for, or go straight to a module.

Clinical: Anthony Pick, MD, FACE, FACP, CDCES · Coaching: Brianne Lamb · evidence is the arbiter.
Start with a goal · "why are you here?"
The patient-facing entry — patients don't think in ICD codes. Pick a goal to see the modules and team lanes that address it.
Or by phenotype / pathway
Different starting points, different pathways — routed to modules and the care-model timeline.
Menopause axis

Menopause & MHT

Built
2025 FDA labeling change, timing/route MHT & contraindications, non-hormonal VMS, postmenopause risk.
OPEN ↗

GSM

Built
2025 AUA stepped care; local estrogen / DHEA / ospemifene; safety counseling; recurrent UTI.
OPEN ↗
Reproductive-endocrine

PCOS / PMOS

Built
Rotterdam selector, IR↔androgen loop, manage-by-goal, letrozole-first OI.
OPEN ↗

Sexual Health

Built
Biopsychosocial, interactive DSDS, flibanserin/bremelanotide, testosterone protocol.
OPEN ↗

Mood & PMDD

Built
DSM-5-TR PMDD, SSRI/drospirenone ladder, perimenopausal depression; suicidality flags.
OPEN ↗
Systems

CV in Women

Built
Female risk enhancers, INOCA/MINOCA/SCAD, sex-specific presentations.
OPEN ↗

Bone Health

Built
USPSTF-2025 screening & FRAX, treatment threshold, drug ladder, denosumab-rebound caution.
OPEN ↗

Skin, Hair & Nails

Built
FPHL ladder, nails as a systemic window, the biotin-assay trap.
OPEN ↗

Sleep

Built
Phenotype (insomnia/OSA/circadian/RLS), CBT-I first-line, menopause & progesterone/allopregnanolone, OSA-in-women, honest supplements.
OPEN ↗

Cognitive health

Built
Menopause brain fog (usually transient), hormones-are-not-a-cognitive-drug, Lancet 2024 modifiable dementia risk, reversible-cause work-up.
OPEN ↗

Pelvic floor

Built
Incontinence (PFMT first-line), OAB meds (mirabegron over anticholinergics), prolapse, hypertonic floor/pelvic pain — not just Kegels.
OPEN ↗

Breast health

Built
Screening & density (FDA 2024), risk models (Tyrer-Cuzick vs Gail), genetics, chemoprevention, and the honest MHT-and-breast input. Not oncology.
OPEN ↗

Wearables & data

Built
Honest signal-vs-noise: steps & rhythm alerts (validated), sleep stages/HRV (trend only), CGM-in-healthy (hype), orthosomnia.
OPEN ↗
Foundations

Lifestyle Medicine

Built
Midlife inflection; resistance/protein/Mediterranean; disordered-eating screen.
OPEN ↗

Smart Supplementation

Built
Evidence-tiered; creatine, D/Ca; biotin deprescribe; hepatotoxicity cautions.
OPEN ↗

Women's Health Labs

Built
Interactive tool: PCOS/androgen stack, menopause/POI, testosterone, interpretation traps + a report builder that generates a copyable interpretation.
OPEN ↗

Longevity / Healthy aging

Built
Cardiorespiratory fitness (the strongest mortality lever), strength/sarcopenia, nutrition, cancer & bone screening, 2025 immunization, frailty.
OPEN ↗

Measurement & Outcomes

Built
The measure-to-manage layer: validated questionnaires + the DXA / RMR / VO₂max / ABP stack + functional-balance battery, with tracking cadence.
OPEN ↗
Care model & coordination

Care Model

Built
Team lanes (who owns what), action plans (30/90/annual), escalation rules, longitudinal timeline, role-dashboard templates.
OPEN ↗

⚑ Red Flags

Safety
The can't-miss items across every module, consolidated in one screen.
OPEN ↗

Governance

Map
One canonical source per topic; the seams and build queue, honestly.
OPEN ↗
Expanding domains · now built
The six hubs flagged in the care-model review — Sleep, Longevity, Cognitive, Pelvic floor, Breast health, and Wearables — are now built to verified depth and live in the groups above. What remains below is genuinely external: the adjacent Metabolic/Peptides hubs and a planned General Endocrine module.
Detailed tools & adjacent hubs · open separately

Metabolic

Interim
Obesity/GLP-1 (canonical), lipids, DM. Interim in the legacy hub; standalone planned.
INTERIM ↗

Peptides

Interim
Weighing rubric, tiering, regulatory reality, monitoring. Interim in the legacy hub.
INTERIM ↗

General Endocrine

Planned
Thyroid, adrenal, pituitary, detailed Ca/bone-endocrine — referenced where it meets women's health.
PLANNED
Safety

⚑ Critical red flags

The can't-miss items across the women's-health core. Each spoke also carries these in context; this is the consolidated screen.
The single highest-priority miss

Postmenopausal bleeding is endometrial cancer until proven otherwise. Any bleeding >12 months after the final period — or unscheduled/persistent bleeding on MHT — needs evaluation (TVUS ± endometrial biopsy) before it's attributed to atrophy, GSM, or hormones.

Menopause / MHT

Menopause spoke
  • Postmenopausal bleeding → evaluate for endometrial cancer.
  • MHT absolute contraindications: unexplained bleeding, current/prior breast cancer/estrogen-dependent cancer, active/prior VTE or thrombophilia, active/recent MI/stroke, active liver disease.
  • Never give systemic estrogen without a progestogen to a woman with a uterus.
  • Neuro deficit / chest pain / leg swelling on MHT → stop, evaluate; prefer transdermal to lower VTE/stroke.
  • Fezolinetant & elinzanetant → baseline/periodic LFTs; elinzanetant contraindicated in pregnancy.

GSM

GSM spoke
  • Postmenopausal bleeding is not GSM until malignancy is excluded.
  • Persistent vulvar itch/plaque/ulcer → biopsy for lichen sclerosus / VIN / carcinoma, don't keep treating "dryness."
  • Vaginal estrogen on an aromatase inhibitor → shared oncology decision.

Sexual Health

Sexual Health spoke
  • Flibanserin + alcohol (≥3 drinks) → hypotension/syncope; contraindicated with CYP3A4 inhibitors & hepatic impairment.
  • Bremelanotide → avoid in uncontrolled HTN / known CVD.
  • Testosterone only for postmenopausal HSDD; total T ≤ premenopausal range; not for energy/mood/bone.

PCOS / PMOS

PCOS spoke
  • Anti-androgens (spironolactone, finasteride) teratogenic → contraception required.
  • Chronic unopposed estrogen / oligomenorrhea → endometrial hyperplasia risk.
  • Rapid virilization / very high T → rule out androgen-secreting tumor, nonclassic CAH, Cushing's.

Skin, Hair & Nails

FPHL spoke
  • Biotin → assay interference: falsely low TSH/high free T4 (mimics Graves), falsely low troponin. Hold ≥48–72 h before labs.
  • Spironolactone / finasteride / dutasteride teratogenic (Cat X).
  • Melanonychia + Hutchinson sign → subungual melanoma; refer/biopsy.

CV in Women

CV spoke
  • SCAD (young/peripartum ACS) → often conservative; don't reflexively PCI.
  • INOCA/MINOCA — nonobstructive coronaries is not "all clear."
  • Female enhancers (early menopause, HDP history, PCOS) — don't under-treat.

Cross-cutting (external modules)

Lifestyle · Bone · Supplements
  • Bone: never stop denosumab without a bisphosphonate (rebound fractures); romosozumab CV cap; fragility fracture = treat.
  • Supplements: biotin assay interference; hepatotoxic botanicals (turmeric/green-tea/ashwagandha/red-yeast-rice) — DILI, avoid in liver disease.
  • Lifestyle: disordered-eating screen before precise diet/exercise targets.

Cross-cutting (pregnancy & cancer)

All spokes
  • Teratogens: spironolactone, finasteride, dutasteride, elinzanetant, bisphosphonates; flibanserin caution.
  • Breast-cancer survivors: systemic MHT generally avoided; coordinate GSM / vaginal-estrogen / testosterone with oncology.
Decision aids, not a substitute for individualised judgement or full guideline text. Several items shifted with the 2025 FDA menopausal-hormone-therapy labeling change and the 2025 AUA GSM guideline — see the Menopause and GSM spokes. Verify contraindications and labeling against current prescribing information before clinical use.
Governance

One source per topic — no duplicates

Every topic lives in exactly one file; everything else links to it. Core spokes embed inline; cross-cutting modules are external. This is what keeps the hub from drifting.
TopicCanonical homeType
Menopause / MHT · postmenopauseMenopause spokeCore (embedded)
GSM · local vaginal therapyGSM spokeCore (embedded)
HSDD · desire pharmacology · testosterone protocolSexual Health spokeCore (embedded)
PCOS / androgen excessPCOS spokeCore (embedded)
FPHL · hirsutism · nailsSkin, Hair & Nails spokeCore (embedded)
Sex-specific CV riskCV-in-Women spokeCore (embedded)
Exercise · nutrition · sleepLifestyle MedicineExternal (linked)
Osteoporosis screening & drug ladderBone HealthExternal (linked)
Supplements (evidence tiers)Smart SupplementationExternal (linked)
Obesity/GLP-1 · lipids · DMMetabolic (interim: legacy hub)External (future)
Labs & interpretation · PeptidesLabs / Peptides (interim: legacy hub)External (future)
Thyroid · adrenal · pituitary · Ca/bone-endocrineGeneral EndocrineExternal (future)
Honest read — the seams
  • No duplicates: the legacy Sexual Health copy was removed from the 3.8 MB hub; each core topic now lives in one file only.
  • External modules are the interim link target: Metabolic / Labs / Peptides still live inside the legacy hub until their standalone versions are built — that's a build queue, not a duplication.
  • Retire when ready: the old platform "master trunk" and the legacy mega-hub are superseded by this hub + the standalone modules; keep the legacy hub only as the interim source for the not-yet-extracted foundations.
  • Brand: older "True Health" source assets vs the "Load-Bearing" modules — reconcile before anything goes public.
Scope & caveats. A navigation and decision-support layer for a licensed clinician and care team — not a substitute for individualised judgement or full guideline text. Each module carries its own scope notes and verification ledger. Testosterone in women is off-label in the US; spironolactone/finasteride/dutasteride are off-label for FPHL and teratogenic; breast-cancer decisions require oncology input; coaching-lane items support but never replace clinical decisions. Verify dosing and labeling before prescribing. Hub assembled July 2026.