PMOS vs. NCCAH: Same Symptoms, Different Cause
Now that we’re all primed for PMOS, it’s time to go a little deeper into the medical rabbit hole.
Let’s talk about NCCAH — non-classic congenital adrenal hyperplasia — a condition that can look very similar to PMOS.
Both can show up with androgen-related symptoms. Both can involve irregular cycles, acne, unwanted hair growth, fertility concerns, and elevated androgens.
But the source can be different.
What is NCCAH?
NCCAH is an inherited adrenal condition that affects the way the body makes certain hormones.
The adrenal glands sit above the kidneys and play a major role in hormone production. In NCCAH, an enzyme pathway does not work as efficiently as expected. This can shift hormone production toward higher androgen levels.
That androgen excess can create a pattern that looks very similar to PMOS.
Why does NCCAH get mistaken for PMOS?
Because the symptoms can overlap.
Someone may have irregular cycles, acne, hair growth, elevated androgens, or fertility concerns and assume the answer is PMOS. Sometimes that is correct. But sometimes the signal is coming from somewhere else.
That matters because symptoms are not the diagnosis.
A pattern can point us in a direction, but the workup helps clarify the source.
PMOS vs. NCCAH: what is the difference?
PMOS is often connected to ovarian dysfunction, metabolic signaling, insulin resistance, and androgen excess.
NCCAH begins in the adrenal hormone pathway.
That difference changes the clinical conversation.
It can change which labs matter, which medications may be appropriate, whether specialty referral is needed, and what should be considered for fertility planning or long-term care.
Why medical evaluation matters
This is where medical care matters.
A wellness protocol may recognize that hormones are “off,” but a true medical workup asks a deeper question:
Where is the signal coming from?
Is it ovarian? Adrenal? Thyroid? Pituitary? Medication-related? Metabolic? Something else?
The goal is not to label the pattern and hand someone a supplement stack.
The goal is to understand the cause, build an appropriate treatment plan, and refer out when needed.
The takeaway
Not everything that looks like PMOS is PMOS.
PMOS and NCCAH can have similar symptoms, but they do not always come from the same source.
Same symptoms. Different cause. Different workup.
At FunctNP Functional Medicine, we help women move beyond assumptions and toward answers.
Sadie Nicole Carlsen, FNP
Provider & Founder
FunctNP Functional Medicine
Functional Medicine Is Having a Moment — But What Is It Actually Doing Differently?
By Sadie Nicole Carlsen, FNP-C
Founder of FunctNP Functional Medicine in Meridian, Idaho
Functional medicine is no longer sitting quietly on the edge of healthcare.
More patients are asking for deeper labs, longer visits, root-cause answers, and a provider who can connect symptoms that often get treated separately. Women especially are paying attention — not because they are chasing trends, but because many have spent years being told their labs are “normal” while still feeling exhausted, inflamed, hormonally off, metabolically stuck, or disconnected from their own bodies.
But with all the buzz, one question matters:
What is functional medicine actually doing differently?
Functional medicine starts with the story
Conventional medicine is excellent at many things: urgent care, emergencies, imaging, infections, prescriptions, diagnosis, surgery, and managing advanced disease.
But many patients are not walking in with one simple problem.
They are walking in saying:
“I’m tired all the time.”
“My labs are normal, but I don’t feel normal.”
“My hormones feel off.”
“I can’t lose weight like I used to.”
“My cycle changed.”
“I’m anxious, inflamed, bloated, or puffy.”
“I know something is wrong, but no one is connecting it.”
Functional medicine starts by taking the whole story seriously.
Not just the chief complaint. Not just the diagnosis. Not just the lab value that finally crossed out of range.
The story matters because symptoms often begin before disease fully declares itself.
Conventional medicine asks one question. Functional medicine asks another.
Conventional medicine often asks:
What disease is present?
Functional medicine also cares about diagnosis. But it asks another question too:
What pattern is developing?
That pattern might involve thyroid function, iron storage, insulin resistance, inflammation, cortisol rhythm, hormone shifts, gut health, nutrient depletion, sleep disruption, stress load, postpartum depletion, perimenopause, or medication effects.
One symptom rarely tells the whole story.
Fatigue might involve thyroid, ferritin, B12, vitamin D, sleep, insulin, cortisol, inflammation, or a combination of all of them.
Weight resistance might involve blood sugar, stress physiology, estrogen shifts, thyroid patterns, sleep, inflammation, medications, or metabolic adaptation.
Brain fog might involve glucose swings, low iron stores, low B vitamins, inflammation, poor sleep, hormone changes, or gut issues.
Functional medicine is not about guessing. It is about pattern recognition.
“Normal” labs do not always mean optimal function
One of the biggest differences in functional medicine is how labs are interpreted.
A lab can be technically “normal” and still not tell the whole story.
For example:
Ferritin may be in range, but a woman may still have low iron stores for her symptoms, hair shedding, exercise tolerance, or preconception goals.
A1c may look normal, but fasting insulin may show the body is working harder than it should to keep blood sugar stable.
TSH may be within range, but thyroid antibodies, free T3, free T4, medication history, and symptoms may tell a more complete story.
Vitamin D may not be dangerously low, but it may still be insufficient for immune, metabolic, mood, or hormone support.
Functional medicine does not ignore reference ranges. It adds context.
The goal is not to diagnose every person with a problem. The goal is to understand whether the body is showing early signs of strain.
Functional medicine testing is targeted, not random
There is a misconception that functional medicine means ordering every lab possible.
That is not the goal.
The goal is to choose testing based on the person in front of you.
For women, this may include a deeper look at:
Thyroid function
Iron and ferritin
Vitamin D
B12, folate, and homocysteine
Fasting glucose and fasting insulin
A1c
Lipids, triglycerides, and ApoB
Inflammation markers such as hs-CRP
Hormones such as estradiol, progesterone, testosterone, DHEA-S, FSH, LH, or prolactin when appropriate
Cortisol patterns when stress physiology is clinically relevant
Gut or stool testing when symptoms suggest it
Specialty hormone testing such as DUTCH testing when it fits the clinical question
The difference is not just the test itself.
The difference is knowing why the test is being ordered and what decision it will help guide.
Functional medicine is not anti-medicine
Functional medicine should not be framed as conventional medicine versus natural medicine.
That is too simplistic.
A good functional medicine provider knows when medication is appropriate, when imaging is needed, when a referral matters, when urgent care is necessary, and when a patient needs conventional evaluation.
Functional medicine is not a replacement for medical care.
It is a deeper lens inside medical care.
It asks:
What is driving this pattern?
What is being missed?
What does this patient’s timeline tell us?
What can we address before things progress?
What support does the body need to function better?
At FunctNP Functional Medicine, that may include labs, medication review, nutrition, lifestyle, nervous system support, supplements when appropriate, medical weight loss, hormone evaluation, metabolic care, or referral when needed.
It is not “either/or.”
It is more complete care.
Why women are paying attention
Women are often the first to notice when something shifts.
They notice when their cycle changes.
They notice when their body stops responding to workouts.
They notice when fatigue becomes their baseline.
They notice when their mood, libido, sleep, skin, hair, digestion, or weight changes.
They notice when they feel like a different version of themselves.
But many women are told to wait until things are worse.
Wait until the labs are abnormal.
Wait until the symptoms are severe.
Wait until the disease is obvious.
Functional medicine offers a different approach.
It says: let’s look earlier. Let’s look deeper. Let’s connect the dots before your body has to scream.
The rise of the functional nurse practitioner
Nurse practitioners are uniquely positioned for this moment in healthcare.
We are trained to diagnose and treat. We understand conventional medicine, medications, labs, referrals, and clinical safety. But many of us also come from nursing backgrounds where the patient’s story, environment, stress, family system, habits, and lived experience have always mattered.
That combination is powerful.
A functional nurse practitioner can sit between worlds:
Medical and holistic.
Clinical and relational.
Lab-based and story-based.
Evidence-informed and patient-centered.
That is the space FunctNP was built from.
The future of healthcare will not be one-size-fits-all. Patients are asking for care that is more personal, more preventive, more connected, and more honest about how the body actually functions.
Functional medicine is part of that shift.
What FunctNP does differently
At FunctNP Functional Medicine in Meridian, Idaho, care begins with the belief that women deserve to be heard before they are dismissed.
That means taking time to understand the full picture:
Symptoms
Timeline
Health history
Stress load
Sleep
Nutrition
Medications
Supplements
Hormones
Metabolism
Thyroid
Gut health
Postpartum, fertility, perimenopause, or menopause stage
Lab patterns
Real-life capacity
From there, the goal is to build a practical plan.
Not twenty supplements at once.
Not vague wellness advice.
Not “everything is normal, see you next year.”
The goal is clarity.
What is the pattern?
What matters most right now?
What can be addressed first?
What needs monitoring?
What needs referral?
What can change over the next 30, 60, or 90 days?
Functional medicine works best when it is grounded, phased, and realistic.
Functional medicine is having a moment because patients are asking better questions
Patients are no longer satisfied with being told that symptoms are normal just because they are common.
Common fatigue is not the same as normal energy.
Common PMS is not the same as optimal hormone function.
Common weight resistance is not the same as healthy metabolism.
Common burnout is not the same as resilience.
Functional medicine is having a moment because patients are asking for a different kind of conversation.
They want to understand their bodies.
They want data that makes sense.
They want a plan that respects their life.
They want prevention, not just reaction.
They want a provider who can connect the dots.
That is what functional medicine is doing differently.
It is looking at the story behind the symptoms.
Ready to look deeper?
Sadie Nicole Carlsen, FNP-C, is the founder of FunctNP Functional Medicine in Meridian, Idaho. FunctNP provides functional medicine care for women in Meridian, Boise, Eagle, the Treasure Valley, and across Idaho in person and telehealth.
If you have been told your labs are normal but you still do not feel like yourself, functional medicine may help you understand what your body has been trying to communicate.
Why Your Vitamin D Is Still Low (Even If You’re Taking It)
By Sadie, NP — Functional Primary Care at FunctNP Functional Medicine/ Idaho Functional Care
Vitamin D is one of the most commonly checked labs in primary care — and one of the most commonly low. Most people assume low vitamin D means one thing:
“You’re not taking enough.”
But that’s not the full story.
As a functional primary care provider, I routinely see people who do supplement with vitamin D… and their levels are still low.
Here’s why — and what your labs may actually be trying to tell you.
What Vitamin D Actually Does
Vitamin D isn’t just a “bone health” vitamin. It functions more like a regulatory hormone, affecting:
Immune balance
Inflammation control
Mood and energy
Nervous system support
Hormone regulation
Muscle recovery
Your body uses vitamin D constantly — and sometimes, faster than you can replenish it.
Symptoms of Low Vitamin D
People may experience:
Fatigue
Low mood
Musculoskeletal aches
Frequent colds or slow recovery
Poor stress tolerance
Increased inflammation markers
But the real key is why the level is low — not just that it’s low.
Why Vitamin D Stays Low Even When You Supplement
1. Your Body Is Using It Faster Than You’re Taking It
This is the part almost nobody talks about:
Vitamin D levels reflect demand — not just intake.
If your immune system is activated or you have low-grade inflammation, your body uses vitamin D at a significantly higher rate. Vitamin D helps regulate inflammatory pathways, so in an inflamed state, it gets burned through quickly.
This is why your labs can show:
Low vitamin D
Elevated CRP, ESR, or immune-driven patterns on CBC
…even when you’re taking supplements consistently.
2. Low-Grade Inflammation Often Goes Undetected
You do not need to feel “sick” to have inflammation.
It can come from:
Metabolic dysfunction
Chronic stress
Viral aftermath
Autoimmune activation
Musculoskeletal pain
Gut or food-related inflammation
Vitamin D is a major player in calming these pathways.
When those pathways are active → Vitamin D drops.
3. Most Primary Care Doesn’t Connect the Dots
In traditional primary care, vitamin D is treated as:
Low = take more.
But functional primary care asks a better question:
Why is your body using so much vitamin D in the first place?
By looking at:
Vitamin D
CRP
ESR
CBC with differential
Symptoms
Immune patterns
…we can identify the real driver of the drop.
Functional Primary Care Helps You Understand the “Why”
At FunctNP Functional Medicine, we don’t rely on expensive specialty testing to understand your vitamin D story.
We start with simple, insurance-covered labs and interpret them through a functional lens.
Because when you understand the story behind your labs, you can actually fix the problem — not just treat the number.
What You Can Do If Your Vitamin D Is Still Low
✔ Check for inflammation
Even mild elevations in CRP or ESR matter.
✔ Look for immune activation patterns
Neutrophils, lymphocytes, eosinophils — all tell a story.
✔ Support your body’s demand
Supplementation is still important, but the amount you need depends on what your body is fighting.
✔ Find and address the source
This is where functional primary care makes the difference.
The Bottom Line
If your vitamin D levels are persistently low, it may not mean you’re “not taking enough.”
It may mean your body is using more than you’re replenishing — a clue worth paying attention to.
Vitamin D is dynamic, not static.
Once you identify what’s increasing demand, your levels improve… and so does how you feel.
FDA To Remove Black Box Warning for HRT. Advancing Women’s Health.
Recently, the FDA announced plans to remove black box warnings from HRT replacement therapy for women: estrogen/progestin. This black box label has been in place since 2003 after a research study published by the Women’s Health Initiative (WHI) indicated increased risk for breast cancer, cardiovascular events and stroke among women receiving combined HRT.
However, the WHI study faced significant critique. Researchers and clinicians have identified several flaws and limitations, those of which included: age of participants, timing of therapy initiation, types and routes of hormone formulations used and baseline health status.Despite these limitations, the WHI findings became the foundation for decades of restrictive guidance on hormone therapy. These variables are critical to consider before generalizing outcomes to all women.
It’s also important to remember that hormone replacement therapy extends beyond symptom management. Estrogen acts as a powerful neurosteroid, supporting brain health and cognitive function (women are nearly twice as likely as men to develop Alzheimer’s disease). It also helps preserve bone density, which declines sharply after menopause, and protects cardiovascular health by maintaining vascular flexibility and lipid balance.
Functional practitioners have long understood the benefits of HRT replacement for women beyond just managing hot flashes but to preserve heart bone health to enhance longevity.
It is both refreshing and exciting to see that reflection in the broader healthcare landscape. I am looking forward to publications in the future that support the health benefits HRT replacement for women that we have known.