Are Hormone Balance Diets BS!? Dr. Natalie Crawford Breaks Down the Key to Women’s Fertility & Hormone Health

Here’s a run down of what we discussed in today’s episode: What Does “Hormone Balance” Actually Mean? Can You Test if Your Hormones Are “Balanced”? Signs of Hormone Imbalance (Premenopausal Women) How Doctors Diagnose & Treat Hormone Issues Understanding the Menstrual Cycle (Hormones 101) Cycle Syncing: Helpful or Overhyped? “Estrogen Dominance” & Detox Myths Explained Why Fertility Isn’t Just “Hormone Imbalance” How Dieting & Undereating Impact Hormones & Fertility Advocating for Better Hormone & Fertility Care Check in with today’s amazing guest: Dr. Natalie Crawford Website: www.nataliecrawfordmd.com Tiktok: tiktok.com/@nataliecrawfordmd Instagram: instagram.com/nataliecrawfordmd Youtube: youtube.com/c/NatalieCrawfordMD Book: The Fertility Formula: Take Control of Your Reproductive Future References: https://link.springer.com/article/10.1007/s00737-021-01156-x https://www.nationaleatingdisorders.org/statistics/ Disclaimer: The content in this episode is for educational and entertainment purposes only and is never a substitute for medical advice. If you’re struggling with with your mental or physical health, please work one on one with a health care provider. If you have heard yourself in our discussion today, and are looking for support, contact the free NEDIC helpline at 1-866-NEDIC-20 or go to eatingdisorderhope.com. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✨ Reach Your Weight & Health Goals — Without Dieting! Pre-order The Hunger Crushing Combo Method, Abbey’s revolutionary additive approach to eating well. Learn how to boost satiety, stabilize blood sugars, reduce disease risk, and improve your relationship with food — all while getting the best nutrient bang for your caloric buck. With 400+ research citations, cheat sheets, evidence-based actionable tips, meal plans, and adaptable recipes, The Hunger Crushing Combo Method is the only nutrition bible you’ll ever need. 👉 Pre-order today! 🛒 Where to Purchase: Amazon Barnes & Noble Amazon Kindle Apple Books Google Play Kobo Apple Books (Audiobook) Audible abbeyskitchen.com/hunger-crushing-combo • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✉️ Subscribe to My Newsletters: Abbey’s Kitchen Newsletter 📘 Check out my FREE E-Books: Hunger Crushing Combo™ E-Book Protein 101 E-Book 👋 Follow me! Instagram: @abbeyskitchen TikTok: @abbeyskitchen YouTube: @AbbeysKitchen Blog: abbeyskitchen.com Book: The Mindful Glow Cookbook • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 🎧 Don’t forget to subscribe on Apple Podcasts, Spotify, or wherever you listen — and leave us a review! It really helps support the show ❤️ 💬 If you liked this podcast, please like, follow, and leave a review — and let me know who you’d love to hear about next! ⭐ ⭐ ⭐⭐ ⭐ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Speaker 00

  This episode is brought to you by State Farm. Football has a play for just about everything. You can go deep, keep it on the ground, or draw up something nobody sees coming. And whether you want to run a flea flicker or the tush push, you need a plan to fit your unique situation. That's why State Farm takes the time to get to know you so they can help personalize coverage for your life and budget. Now that's a solid game plan. Like a good neighbor, State Farm is there.

• 0:29Speaker 01

  If we know we need 200 or 300 more calories in the luteal phase, 30 minutes or an hour more of sleep, well then, we're allowed to make those changes without guilt or thinking bad about ourselves.

• 0:43Abbey Sharp?

  Welcome to another episode of Bite Back with Abby Sharp, where I dismantle diet culture rules, call out the charlatans spinning the pseudoscience, and help you achieve food freedom for good. You know, there are a handful of medical and health terms that honestly have become so overused, so stretched, and so misapplied in our everyday language that I feel like they've basically lost all meaning. And as you may know, when that happens, they become a magnet for snake oil, misinformation, and a whole lot of confusion. And I think I speak for a lot of healthcare providers and dieticians when I say that the term hormone balancing is currently one of our worst offenders.

• 1:26Abbey Sharp?

  It is right up there with inflammation and toxins and "resetting" literally anything. From health coaches pushing adaptogenic cocktails to "balance your hormones", to wellness influencers framing seed oils, gluten, or dairy as endocrine poison, to everyone and their grandma freaking out about their cortisol curve. We have become obsessed with "optimizing" our body's natural rhythm. But is there anything we can do, take, or eat that will actually move the needle to improve women's hormonal health? And what does that mean for women who are navigating...

• 2:10Abbey Sharp?

  ...their fertility and pregnancy journeys. Today, I'll be diving into the ubiquitous world of women's hormones and fertility with double board certified OB-GYN, Dr. Natalie Crawford. Natalie is the host of Ask a Woman podcast. She's the author of the new book, The Fertility Formula, and she's the founder of Fora, a boutique fertility clinic based in Austin, Texas. Now, a quick note that the information in this episode is certainly not a replacement for personalized healthcare, so always speak to your doctor about your unique needs. Also, I would really love if you would subscribe to this podcast wherever you are listening right now and just like leave me a little review or a little comment because it really truly does help me out.

• 2:55Abbey Sharp?

  Also, please don't forget to check out my brand new book, The Hunger Crushing Combo Method. Honestly, folks, the reviews are in and they are overwhelmingly positive. So I just know that this is helping so many of you reach your health goals and improve your relationship with food. And on that note, let's get into it.

• 3:21Abbey Sharp?

  All right. Thank you so much, Natalie, for joining me. I'm very excited about this conversation.

• 3:25Speaker 01

  Thank you so much for having me. It's such an honor to be here.

• 3:28Abbey Sharp?

  I have so many questions and I'm sure my audience is just like chomping at the bit with this conversation, but I wanted to just kind of dive into something that I feel irks me a lot and I'm dying to hear your thoughts. Hormone balancing. I mean, we see all of these tips and tinctures and protocols and diets promising to kind of quote, quote, "balance hormones." From a clinical perspective, what does it actually mean to have quote, quote, "balanced hormones"?

• 3:57Speaker 01

  Abby, such a good question. And the reality is, two things can be true at one time. The message that I think is really important is to understand that hormones are a communication system between your body. I like to think about them as text messages that your organs are sending to each other. And so your brain, for example, doesn't know what's happening into your ovary until it gets a hormonal signal telling it what is going on. That means that your hormones are dynamic. They change in response to each other. And they are meant to and supposed to vary time of day, day of the month, in relation to eating, exercise, stress, et cetera. So many different hormones have different functions and they are meant to change. This makes it really hard to just go into your doctor and say, I want to get my hormones checked.

• 4:42Speaker 01

  Or have a big hormone panel done, especially by somebody who doesn't understand them. With all of that said, because that leads to a lot of confusion, you can definitely have hormonal problems. And that is a representation of, in an essence, your hormones not being balanced. I don't love the balanced word because it acts like there's a perfection that you should be at all times. Instead of understanding, are my hormones functioning normally? Because you can truly have an abnormal response where the brain is sending out a signal and the ovary is not responding appropriately. And understanding our body and starting to be able to be a good advocate in our voice for our own healthcare

• 5:22Speaker 01

  allows us to really get to the bottom of when are things not working normally or not functioning normally? Because that's the problem right now is things aren't working normally. Women don't feel right. They don't feel like themselves. They go to their doctor and the only words they may have to advocate for themselves are those they saw on social media, which says, I'm worried my hormones aren't balanced, or can I get hormones checked? And it's not speaking the same language. So one of the goals I know you and I are going to cover today is how do we give women the language to be able to adequately advocate for themselves and really understanding that hormones do change? And I've had people get hormones drawn by somebody who doesn't understand them and prescribe the exact opposite thing that they need.

• 6:06Speaker 01

  So it's really a lot more complex than just this balancing hormones idea.

• 6:11Abbey Sharp?

  Hundred percent. I think so many women can relate to what you just described. Is there any validated way to know if your hormones are quote unquote balanced?

• 6:22Speaker 01

  One of the best things that we can do, or at least when it comes to our reproductive hormones, because there's so many different hormone systems. We've got, you know, our thyroid or adrenal And we've got our ovaries, but let's focus on the ovarian hormone axis here.

• 6:34Abbey Sharp?

  Yes.

• 6:34Speaker 01

  Though for women, the body is meant to give you clues and signs through your menstrual cycle. And there's a variety of different reasons why that's difficult. When did you learn how to track your cycle?

• 6:44Abbey Sharp?

  Oh, like when I was thirty, I don't know, when I was trying to get pregnant, really.

• 6:48Speaker 01

  Well, yeah, for for me, when I was failing to get pregnant, when I was having trouble.

• 6:53Abbey Sharp?

  Yeah.

• 6:53Speaker 01

  And that is the story for most women. Yet I'm going to tell you right now that your menstrual cycle is the number one way that your body is giving you an outward sign of if your hormones are functioning normally. Yet we don't learn how to track it. We miss the red flags. We don't learn about it until we're having problems. And then to to double down on it, which it's not that hormonal contraception is bad. But when we spend our early reproductive years on hormonal contraception, we lose the opportunity to even know what our baseline or our normal is. Because one of those clues that something is off is a change from normal.

• 7:33Speaker 01

  But what is your normal? When we don't know, we just lack that agency right there. And one thing I think is really important is the statistic right now that if you're using an app, so you get an app on your phone and you mark your cycle day one, or the day you start bleeding, which is what majority of women do. It is going to use a method, just a calculated method called the calendar formula, to predict when your ovulation will be. And that is based on population averages, has nothing to do with you and your body. That formula only accurately predicts ovulation 20% of the time, meaning 80% of apps that are just using this calendar method are

• 8:13Speaker 01

  wrong. And that leads to a bigger point, that learning to track your cycle is much more than just knowing when you're bleeding, or marking when you're bleeding. What I mean by that, and what our body means by that, is knowing when we are ovulating. Because I think it's important to say, if this is the normal ovulatory cycle, which we should go through. The first stages of abnormality, you still have a regular cycle. So you have two different phases. And when you start to see shortening and lengthening of a cycle phase, you're still gonna have a regular cycle. It may be different than what it was at baseline. So if you know that, that can help. But if your doctor just says, is your cycle regular? And you say, yeah, you're gonna miss all of these little red flags.

• 8:58Speaker 01

  So that's why we really have to take agency over what is a normal cycle? When are we ovulating? And how do we learn that ourselves?

• 9:05Abbey Sharp?

  Wow, you've just covered, this is so validating because you know, this is exactly what I experienced in my own infertility journey. Um, I was on the pill from 14 because of irregular cycles, you know? And that was just what we did as, as, as kids. Just if, if the period was irregular, you went on the pill. I was on the pill for over, what? The 12 years, never came off. And then when it was time to come off, guess what? Didn't get a period back for a while. And, um, and so I had nothing to compare myself to. And that was why I kind of had to start IVF and, and kind of reproductive, uh, support. And so I, I think that's, this is, this is exactly what so many women are, are talking about.

• 9:49Abbey Sharp?

  Um, and so I feel like nowadays, there's so many influencers out there, um, who, you know, especially because a lot of folks maybe don't want to go on the pill if that is the kind of way to quote unquote, regulate their cycle. Um, there's a lot of influencers claiming that there's like natural hormone balancing recommendations. And I wanna kind of chat through some of those. Okay, talk to me about this idea of cycle syncing. Uh, we are seeing a lot of people online claiming that, you know, syncing your, um, exercise or diet to your cycle phases is gonna help to balance your hormones and, you know, reduce PMS symptoms. And others do suggest that perhaps it disempowers women

• 10:32Abbey Sharp?

  to train in a way that uniquely feels right to them. What are your thoughts on this concept?

• 10:38Speaker 01

  Okay, I have lots of thoughts because that was a really big question that you asked, and I think maybe to Actually answer it, we should give like a really quick, brief menstrual cycle overview in case people are hearing this, so they understand the different size, times of the cycle, that's going to help us answer this question. So the way I want a woman to think about her cycle is imagine all the eggs you're ever going to have, imagine that they are stored in a vault inside your ovary. So at the start of the month, a group of eggs is sent out of the vault. And just for simplicity's sake, we have more eggs remaining, more come out. And as we get older and have fewer eggs, fewer come out. But you have a group of eggs and each egg grows inside a follicle. The brain is going to send out FSH, or follicle stimulating hormone, which is well named, and it gets one follicle to grow.

• 11:22Speaker 01

  As that one follicle grows, the egg inside matures. This makes estrogen. As it makes estrogen, this is going to grow the lining, talk to the brain. This is the follicular phase by definition. So a follicle is growing, FSH, the hormone from the brain. It is an estrogen dominant phase in everyone, meaning you have estrogen, you do not have progesterone. Estrogen, when it gets to a high enough level, is that hormonal communication back to the brain that you have a mature egg. The brain, again, can't see the ovary, it's waiting for estrogen. And it's so specific. An estrogen level of 200 picograms for 50 hours is a strong and long signal that the

• 12:04Speaker 01

  brain now says, oh, Abby has a mature egg, let me now send out a surge of LH, or luteinizing hormone. LH, when it's first released like that, tells the follicle to rupture. So the cyst, which is the same thing, bursts, the egg is released, this is ovulation. And the egg only lives for 24 hours if you're trying to get pregnant, and that's why we're so picky about trying to time intercourse. Well, that same cyst, that follicle that grew the egg, is then going to reform after ovulation and becomes a cyst known as the corpus luteum. And now the corpus luteum is going to make progesterone. And this progesterone is going to be in response to pulses from the brain.

• 12:46Speaker 01

  So the brain sends out LH pulses, cyst makes pulses of progesterone. Progesterone crucial, opens and closes the implantation window. It is the pro gestational hormone, completely changes how our body is in preparation for pregnancy. So it's going to change your metabolism, slow down, wants you to conserve energy, retain some water, wants you to get ready to grow a baby. Well, the corpus luteum, on average, cannot live longer than two weeks. So if you do not get pregnant, the corpus luteum will die. Progesterone will drop and that will be the trigger to bleed off the lining and the cycle starts back. And this second half is the luteal phase. So it's named after the ovarian state follicular phase, when a follicle is growing, estrogen only.

• 13:31Speaker 01

  Luteal phase, that's when you have a corpus luteum, estrogen and progesterone phase. So when we talk about tracking cycles, to briefly, we don't have to dive into it because it's not your question. But what I recommend people do is learn to track their own, what we call fertility awareness signs. And this is going to be based on these hormones. So one of them is your basal body temperature. And this is because once you make progesterone, your core body temperature rises. So you can detect that. And that's become so much easier with natural cycles and different wearables. We have an Oura ring and Apple Watch, a band that's going to tell you when this happens. Old school used to be a thermometer and it was like very hard to detect.

• 14:11Speaker 01

  We also have cervical mucus because as estrogen rises and gets to those peak levels, it changes the cervical mucus to become sticky, stretchy and egg white so sperm can get through. So detecting that can clue you into ovulation. And you can also measure these hormones directly in the urine. So urinary based hormone monitoring, whether it's what we call an OPK, an ovulation predictor kit, or a more complex urinary system, we can measure the urinary metabolites of them. So these are ways where we can really find out, when are we ovulating? How long is our luteal phase? How long is our follicular phase? Because the luteal phase is typically the first thing to go. So it'll start to get short as the first sign of ovulation disorder. So if you're not ovulating perfectly, you're still ovulating, but there's some miscommunication.

• 14:57Speaker 01

  That luteal phase will be less than 11 days. Now, you're still gonna have a cycle, you're still ovulating, but it's gonna be probably harder to get pregnant and you might start to feel off because of that miscommunication. And then we're gonna start to have a longer follicular phase, where it's taking the brain a long time to get the ovary to respond, or even a shorter follicular phase where it responds too soon. So again, a little bit of a misfire. And then we start to see this irregularity, not having cycles, really spacing out into amenorrhea or no cycle at all. So the thing I love about cycle syncing, to your actual question, is that it forces you, by definition, to know when you're ovulating. So in general, if you're going to sync your cycle, you have to know when you're in follicular

• 15:41Speaker 01

  and when you're in luteal phase. And that overall is great, because you have more cycle awareness, you're more in tune with your own hormones, you can detect these abnormalities. Wow, my luteal phase is only nine days. Maybe I should get that checked out. And I had a doctor message me today that said she saw a patient who came in with a short luteal phase trying to get pregnant, and because she'd heard me talk on some other podcasts, she was able to ask more questions, not just, are your periods regular? That, do you track each phase? And this patient ended up having hyperlactin, one of the hormones from the brain was the direct cause. Okay? So had we just asked, are your periods regular? They would have missed this, and instead she got treated and got pregnant.

• 16:25Speaker 01

  So really important for us as providers, of course, to ask the right questions. But as a woman, it's nobody's journey but your own. And so if you sit in front of somebody who's maybe moving on, we have to know how to come in and say like, well, actually, my luteal phase is short, or I have a lot of spotting, or my follicular phase has gotten longer than it used to be. And we have to really take that ownership. So I love that cycle syncing, by definition, you have to know when you ovulate to know what phase of the cycle you're in. Yes. I also think that there's some truths to this one as well, and then some misnomers. Because when you are, we'll just say like, working with your body, really learning to listen to it,

• 17:08Speaker 01

  we're going to, for the most part, feel better most of the time, because we're really starting to listen to our own body's clues about when we're hungrier. If we know we need 200 or 300 more calories in the luteal phase, because making progesterone takes more energy. If we know that we tend to need thirty minutes or an hour more of sleep in the luteal phase, well, then we're allowed to make those changes without guilt or thinking bad about ourselves, because that's one thing that a lot of my patients and a lot of women in general, we tend to stick to this one regimen, and I need to eat this many calories a day, or I need to get this much sleep, or I need to do this training plan. And if I say you can achieve your personal best much easier in the follicular than the luteal phase,

• 17:50Speaker 01

  you need longer recovery intervals. And then you're following an exercise plan from a man, and you know, you're week three or four into it, and you're not progressing as you should, you're going to internalize that back on yourself sometimes and say, well, I just can't do it. I'm, I'm a failure. So I think that there's benefit when we look at things and we say, okay, we, by definition, as being women, we're cycling and our hormones are different, and we're meant to do different things. And giving ourselves the grace in those moments, that it doesn't have to look the same every single day, is going to make you feel better and make you happier. If you say, okay, well, I'm actually not going to increase weights this week, because I'm in my luteal phase, I'm not going to be able

• 18:32Speaker 01

  to achieve a personal best, so I'm going to work on maintenance. Where I think the cycle thinking narrative goes wrong and can harm people, is when we don't ever, we'll use exercise as a good example, we're never able to make a gain because we're totally switching what we do. What we know for hormone health and hormone balance, the number one thing that's going to disrupt this, that's from an external force, is chronic inflammation and insulin resistance. Meaning, we can have a thyroid abnormality or a prolactin, but from externally, we, chronic inflammation disrupts ovulation. And so, we want to lower inflammation levels as much as we can. And one of the strongest tools we have is going to be some of these lifestyle modifications. So getting enough sleep, how we manage chronic

• 19:17Speaker 01

  stress, but also building and using skeletal muscle. So from an exercise standpoint, I say that all women need weights and resistance training three times a week at all phases of your cycle, at all stages of life. So where I don't love the cycle thinking narrative is when it's like, oh, lift weights in these two weeks, and only do yoga in these two weeks, because it's very hard to progressively build the muscle you need if that is your game plan. But if we use that mentality to our advantage and say, okay, I'm gonna lift three times a week. And when I'm in my follicular phase, I'm gonna up the weights or up the reps. And when I'm in my luteal phase, I'm just gonna maybe stay where I where I went up to. Now, we're using cycle syncing to our advantage to help balance our hormones,

• 20:00Speaker 01

  but in a way that's setting us up for success.

• 20:03Abbey Sharp?

  Right, yeah, absolutely.

• 20:17Abbey Sharp?

  And you mentioned earlier, when you were kind of describing the natural cycle of our women's hormones, this idea of estrogen dominance, which obviously is, happens at a specific phase of our cycle. But in wellness speak, we hear a lot about estrogen dominance being kind of framed as the root cause of everything. PMS, weight gain, bloating, acne, anxiety, fatigue, basically everything. And then, you know, naturally, this is followed by like an estrogen kind of detox protocol. Is estrogen dominance an actual diagnosis? And can you detox your estrogen down?

• 20:57Speaker 01

  Estrogen dominance is either a normal cycle phase. So let me give an example. If I draw your labs and you are in your follicular phase, you will be estrogen dominant. I have had a patient, I've actually had multiple patients who go somewhere else and they go to, we'll say, a quote, hormone expert and they get their labs drawn. They are clearly in the follicular phase, but they are diagnosed with estrogen dominance and they are put on daily progesterone to counter it. And let me just say this in case any of your listeners hear that. Daily progesterone is a birth control, no matter what, because progesterone opens and closes that implantation window. And in fact, if you're taking it just based on cycle days and not tracking ovulation, you can be making it so that you don't have the appropriate implantation window to get pregnant.

• 21:42Speaker 01

  So I take it really seriously when we throw it around as a diagnosis. To me, estrogen dominance is either a normal cycle phase or it is a symptom. It's a symptom of not ovulating. So let's use PCOS, which is the most common condition that women get diagnosed as estrogen dominant. What happens in PCOS, for the most part, is that you have a high number of eggs, which isn't necessarily a bad thing. PCOS combines, becomes a metabolic disorder because what happens? High number of eggs inside the vault, so a high number come out. And I like just using simple math to make it make sense. If I say for a 30 year old, 20 eggs outside the vault is normal, then the brain is sending out enough FSH to get one out of 20 to grow.

• 22:27Speaker 01

  Well, if you have 40 eggs out of the vault because you have PCOS, each egg is only getting half as much FSH, and it's not a strong enough signal to grow with that reliable predictable interval that the body wants. So two things start happening, or three actually. One is that sometimes it takes just a longer signal of that FSH to get one to grow. So really long or irregular cycles can be what women with PCOS see, and that's a long follicular phase. Now, sometimes it's too many and that whole egg group dies, and the next month you have another group come out, and there's some natural variation in your cycle. So now it's 32 eggs. And well, now that FSH is a strong enough signal. So you get stuck in this follicular phase.

• 23:10Speaker 01

  The other thing to note is that every follicle makes a small amount of estrogen. So if I say a mature egg makes 200 picograms, let's say an immature one makes one picogram. So that girl who's got 20 follicles outside the vault at baseline, they're not doing much, she's making about 20 picograms of estrogen at baseline. Essentially not much at all. But the person with PCOS, well, her baseline estrogen might be 40 or 50. So it's a little higher than normal. This estrogen is going to confuse the brain because it also thinks, "An egg must be growing. It must be on the path because I have a 40 to 50." So that's why the brain doesn't get that stimulus to send out a stronger signal of FSH, and you get stuck right there. And if you draw a line, somebody might say, "Oh, look, estrogen's over that baseline threshold.

• 23:55Speaker 01

  Therefore, it's estrogen dominant, but it's really just a symptom of PCOS." The third and fourth thing that happened is that the ovary loves to make hormones. Like it loves it, it's its favorite job. Really wants to make estrogen, it's its most favorite hormone. But when it can't, because it's stuck in this PCOS pathway. The signal from the brain to make testosterone becomes really easy. So LH testosterone. So the ovary goes, fine, if you won't let me make estrogen, I'll make testosterone. And we start making testosterone, which then changes the entire metabolic environment of the ovary, makes it more insulin resistant. We put on visceral fat, we get acne and hair growth and fatigue. And so there's also an idea that PCOS is only associated with obesity, and that is not the case.

• 24:39Speaker 01

  We can see PCOS in all body sizes. It's an ovarian disorder. The end. So what happens though is we can kind of hear this and say, oh goodness. Well, if I check blood work on the majority of days and a woman with PCOS who's not ovulating, she will be estrogen dominant. And it's not that treating her with progesterone is wrong or trying to lower her estrogen, but understanding that you're going to have a lot of eggs. You're gonna have a higher baseline estrogen. Trying to detox that out isn't really getting to the root cause. And this is where, I mean, I love functional medicine and wellness, but this is where they're selling you kind of a book of goods that doesn't make sense in this context.

• 25:21Speaker 01

  Because if we're trying to get to the root cause of a not diagnosis, you're not getting the treatment for the real diagnosis you have. And instead of being empowered that you actually have PCOS, really the key to this is gonna be, can we decrease and reverse the insulin resistance? Because once that environment starts in the ovary, it is so much harder to then become ovulatory. Can we decrease chronic inflammation? Can we help you ovulate? Because ovulating is gonna get to the root cause of what's happening. And I just want to say this because we mentioned it earlier and I think it's important is that birth control is not inherently bad, and for women with PCOS especially. It can suit certain life goals, it might treat your symptoms. But what is wrong is what you described, Abby, which is being put on a medication without knowing why.

• 26:04Speaker 01

  And I'm sure your doctor said, oh, this young girl has irregular cycles. Maybe she has PCOS, or maybe she has this. But instead of any evaluation, any blood work, or even giving you the opportunity to live 15 years of your life thinking, okay, when I get off the pill, I'm probably gonna have my irregularity come back and I need to do that well enough in advance, or I need to start learning about PCOS myself. Or I don't know that you have PCOS, I'm using that as an example. But just you lost that opportunity of all of those years to cultivate a life that was going to be more conducive for a chronic disease like PCOS. So estrogen dominance, having high estrogen, low progesterone labs can be perfectly normal depending on your

• 26:48Speaker 01

  cycle phase. So again, bringing that to the table to advocate, or it can be a symptom of something else going on.

• 26:54Abbey Sharp?

  Yeah. Oh, I'm so glad that you mentioned that. And also that idea, you know, that unfortunately, wellness grifters have really co-opted this language of treat the root cause. When, you know, often just kind of blaming estrogen dominance for everything that ails you, just kind of, like you said, overlooks or hides that that root cause that we should be really addressing before we just kind of slap a hormone or a detox protocol on top. I want to kind of talk a bit more about diet here because a lot of my listeners are coming from, you know, a strong dieting history, disordered eating backgrounds. And I myself, you know, suffered from an eating disorder in my late teens, only to later face fertility

• 27:37Abbey Sharp?

  issues. So I want to talk about under fueling, especially because right now we're in this kind of skinny talk meets Ozempic era. Can you talk about how rapid fat loss or under fueling or over exercising can impact our overall health and fertility?

• 27:53Speaker 01

  You know, women and men are different on this. And I want to expand upon what you said, and I'm going to address it. But just to say, because this comes into the fasting narrative as well. Women's bodies are constantly looking to see, are you at a state where you can carry a child, whether you want to carry one or not? Your menstrual cycle is only going to work perfectly when you are at a state that you can. So yes, we can have external disease states, but if you are not at a caloric need, if you are losing weight, if you are overtraining, you're going to be at a place where your brain is going to protect you first and foremost. That's how we are made. And if we think evolutionary, that's because if you were in a famine or migrating to a new area, it would not be a good time to

• 28:36Speaker 01

  have a baby and have to be breastfeeding and providing nutrients for that baby if you're not getting what you need. So I agree with you. This is interesting because five years ago, I wasn't seeing it as much. Now I'm seeing this come back, you know, how it goes in cycles. Your hypothalamus is the control center for your brain. And I always like to tell people it is constantly the one that's interpreting those different hormone signals, putting it all together, stress hormone, estrogen, progesterone, inflammation, insulin, and deciding, how is Abby doing right now? And it needs all these signals to be at a place where it feels confident to send out the right signals to the pituitary gland, which sends out so many other hormones to us. So what we know is that when we are at the, at the most severe end of it, we have hypothalamic

• 29:19Speaker 01

  amenorrhea, and this is when our brain has just said, no, I'm going to shut down commonly from an eating disorder, low calorie intake, overtraining, or the combo of those together. And right now, the combo of those together, I'm actually seeing more. It's not somebody who's an elite gymnast, or somebody who's, you know, has a true, we'll say, eating disorder, but we're in the middle. We're potentially on a GLP-1, we are losing weight rapidly, we're not taking many calories, and we're also running and training every day. And the combination together is what you said, underfueling for overtraining. And that's the signal to the brain that like, I'm not sure that we're at a good metabolic state.

• 30:01Speaker 01

  I don't know that we can support an additional pregnancy right now. And so it is going to change how it sends out the brain hormones. And the hypothalamus isn't always an on off switch, it's like a dimmer switch. So we'll start to see these menstrual cycle changes, and we can start to see it have severe consequences when it is turned off. What I do want women to know is it can take years to recover. And what that means is even once you have restored that deficit from a calorie or training standpoint, the brain will be very fearful it will come back. And if we think just evolutionary, if there was a famine, it's like, I gotta really prove that there's not going to be another one. So it takes often years to have the brain turn fully back on.

• 30:46Speaker 01

  So many women do have to go to fertility treatments if they're trying to conceive when they find this out. But also, it speaks to trying to prevent it from turning off as so, so, so important, because when it's off, You will be estrogen low, not just like minimal, but low. There will be no estrogen signal and being hypoestrogenic. We hear about it in the menopause and the perimenopause sphere and how bad it can be for you, but it can be even more profoundly impactful on your life when you're in your reproductive years because all of your tissues need estrogen and needs it at those high levels. And it can cause osteopenia, you know, thinning bones, osteoporosis, mental health issues, heart issues. So estrogen is so, so, so important for your body.

• 31:29Speaker 01

  And even if you're not trying to get pregnant and your period goes away, you might be somebody who needs estrogen replacement. So just kind of putting that in a nutshell.

• 31:39Speaker 01

  It's a balance. I have, I live in Austin. I have a lot of people who are runners, hardcore runners, marathoners. And maybe they want to be pregnant, but they don't really want to give up their sport. And what we notice is that, you know, over 50% of runners will have a luteal phase defect. And that is because of this hypothalamic dysfunction. So everything else is normal. It's just this training to fueling mismatch. One is, you know, don't be afraid to fuel your body with calories. Okay. Quality of calories matters immensely. Two is going to be for those people specifically I'll speak to. You know, we titrate to luteal phase, meaning we track our cycles. If your luteal phase is getting short, you are training too much. This is the red flag before things shut off. So we've got to cut back on our miles, cut back on the number of runs.

• 32:24Speaker 01

  We can trade in with weight training to try to kind of balance that out. And that's a tool that if we learn to leverage, if you are somebody who is, you know, training for a goal, we can be in a place to try to get that where we want to go. Or at least get your cycle in the positive direction and not have the switch totally turn off. But it is scary right now in the era of GLP-1. I'm seeing a lot of people rapidly lose weight. We are seeing, you know, severe caloric restriction as how these medications can work. And even though medications can Be life changing for many I've seen PCOS patients and endometriosis, chronic inflammatory disease, obesity. So I think that

• 33:08Speaker 01

  there's a lot of places where they're beneficial, but we also have to understand what the potential risks are so that we can look out for them and track our cycles ourselves. So long winded to say this is something that is real. It can have lasting consequences and it speaks to the importance of what we started with, like tracking your cycles and knowing your body is going to help you target that or be aware. Oh, maybe I'm losing weight too rapidly or something like that.

• 33:36Abbey Sharp?

  I think that's really helpful, you know, especially because you know, you're right. There's, there's a lot of folks out there who for various reasons, including the use of GLP-1s, they, they are quickly losing weight and may also be wanting to get pregnant at the same time. And, and so it's really important to kind of keep those things in mind as you're kind of going through your fertility journeys.

• 34:09Abbey Sharp?

  I want to end here with an appreciation for what you're doing here because I think so often women's health concerns just get swept under the rug and it's very hard to find evidence-based support when you feel like something's not right with your hormones, hormones for whatever reason. I mean, for years, just from my own experience, I dealt with chronic mid-cycle spotting, basically for two weeks of the, of the month. And, you know, I couldn't get a doctor to figure out what was going on. They test my hormones, be like, oh yeah, you're in the range and just that was it. So if you feel like something is not right and, you know, aside from having that data for tracking your cycle, understanding when you're ovulating,

• 34:53Abbey Sharp?

  what are some things that we can do to advocate for better care with our healthcare provider? What tests should we be asking for? What support should we be asking for?

• 35:03Speaker 01

  That is a great question, and I do want to say, you know, in my new book, The Fertility Formula, I'm breaking it down by what the problem is because I think that's key to, to knowing. But a couple, you know, commonalities, no matter what. As a physician, I sit across from patients every day and I make decisions about the tests we will order and what we will do based on the story you are telling me. So I do think it's so important to be a good storyteller. And I don't mean that in like a mean way, but you might be surprised how often when we finally get on with our doctor, we're emotional, we feel overwhelmed, we forget. And if I tell somebody, well, please, you know, tell me what's going on, how often we stumble through that story and it's hard. So give yourself that space

• 35:47Speaker 01

  first. Okay, this is a problem. So how long has it been going on? If you know what things used to be, how did it used to be? When did it change? Are there things that make it worse? Things that make it better? What are you most concerned about? So being prepared and write it down if you need to, or make some bullet points that you can reference. So be prepared for that opening question. What brings you in today? Or tell me how you're doing. If you have to write it down and pull it out, I have patients say, okay, hold on, I wrote it down. And they read it and that's great. I love it because I can, I can only start by wherever you tell me and then we're going to jump from there. So know your own story, be prepared to walk your doctor through that. I also think it's really, really, really

• 36:28Speaker 01

  important to clarify at the end of the visit, what the next steps are. And I try to do this with my patients. I say, okay, next up, number one, you're going to come in for an ultrasound. Number two, but I know everybody's different and doctors are different. So you should never leave a visit saying, I don't even know what to do next. So make sure that doesn't happen to you. If they don't tell you, or they tell you, and they have a hundred other things they're saying, you know, clarify and write it down. Okay, I just want to be clear on what I need to do next, you know? I need to call the office and schedule an appointment after my period starts. I need to go to the lab and get blood work drawn. And when that comes back, you'll message me, you'll call me, I'll schedule a follow-up.

• 37:09Speaker 01

  What will be my next step? So knowing your story and knowing your next steps, no matter what the middle ground problem is, that's going to help you navigate the health system better. Because the reality is, There's many good doctors too who are in bad systems and unless we set things up to be in a way that's favorable for us, you may just get lost in the shuffle and nobody deserves to be lost in the shuffle. And you know, there's many of us who've left more traditional systems and have our own so that we can control the patient outcome. And I would say that too, if you feel like your doctor's not answering your questions, if you feel dismissed or gaslit, those are universal experiences that women experience, especially when it

• 37:51Speaker 01

  comes to cycle abnormalities or women's health, get a new, get a new doctor. I know that's easier for me to say than always to do, but you can always get a second opinion. It is that important to have somebody walk this journey with you, especially if it is your fertility. You need to trust that you're a team and that you can get your questions answered. And I'll make that my last point. Every clinic, every doctor's office communicates differently. So I will use the example, or if I'm a patient, I go to a doctor's office and they call me with all my results or what to do. That is going to be highly incompatible with how I live my life, which is never answering the phone because I will always miss the call. It's just going to be very hard for me to get the information I need. So maybe

• 38:36Speaker 01

  that's not you, but you should know, do we email? Do we have a portal? Do we call? Like, how do we communicate? Who is my point person? Is it a nurse? Is it a doctor? Because that's just going to help you understand what the relationship will be like because you will have questions. So you should know how to get them answered.

• 38:54Abbey Sharp?

  That is incredibly helpful for so many people. Thank you so much, Natalie. I'm going to be leaving links in the show notes below to your podcast, Ask a Woman. And absolutely, folks, to check out your brand new book, Fertility Formula. It is, I mean, this is so key. This, look at that beautiful, oh, you know, and this is not just for folks who are specifically trying to conceive at this moment. So important for your own, to be your own advocate in your, you know, hormone and fertility journey today. And, you know, as we go through the next phases in our kind of hormone Monocentric roller coaster. So thank you so much for joining us.

• 39:35Speaker 01

  Thank you, Abby. And yes, you know, fertility is a marker of your overall health. We talked the whole time about your menstrual cycle and how important it is. So no matter what reproductive life stage you are at, you deserve to understand your body and your health and your hormones, what's a warning and what you can be doing to make them better. So I appreciate spending this time and talking with you.

• 39:54Abbey Sharp?

  Oh, this is the kind of conversation that I really, really wish I had access to when I was sitting in that infertility clinic every single morning for my 6 a.m. blood draw. And you know, looking back, I now understand why women's hormone health misinformation is so wildly sticky, especially infertility circles. You know, infertility is high stakes, it's emotional, and it's often painfully uncertain. So it makes total sense that people will reach for anything that promises control, clarity, or a sense that they are leaving no stone unturned.

• 40:39Abbey Sharp?

  But that desperation is exactly what the wellness industry exploits. It takes a complicated medical reality and it turns it into a consumer-friendly storyline. Your hormones are off, your body is inflamed, you're not detoxing. And if you just buy the right protocol, you'll unlock the secret to the one thing you want more than anything in the world, which for many of us in the thick of trying to conceive is a baby. When the healthcare system is rushed, dismissive, or hard to access, those simple do A, get B narratives may feel like a huge relief to hear, until of course, they don't work.

• 41:22Abbey Sharp?

  And then they quietly and quickly become a new source of self-blame. You know, they ultimately reduce a situation that is often multifactorial and unpredictable, and in many ways out of our hands, to something that we should be able to easily achieve if we just try hard enough. But here is my take. As an ED survivor and an infertility warrior. This try everything mindset often overlaps with disordered eating patterns. You know, eating disorders are actually not that uncommon. So it's estimated about 9% of the US population will have an eating disorder in their lifetime. And when we look specifically at fertility care, one systematic review found among women

• 42:07Abbey Sharp?

  pursuing fertility treatment, up to 17% met the criteria for an active ED, up to 28% had a history of an ED, and nearly half displayed some disordered eating pathology. That is a huge signal that fertility spaces can be a perfect storm for disordered eating. I mean, there's pressure, there's body scrutiny, there's optimization culture, weight centric messaging, and there is this fear that if you don't follow every single rule, you're jeopardizing your chance at what we have all been told essentially defines our whole lives as women. So if you have ever felt pushed towards rigid diets or protocols,

• 42:50Abbey Sharp?

  you are not crazy or weak. You are human. Evidence-based support gives you options, not ultimatums. So I want you to consider that if you are feeling overwhelmed by your fertility journey, I highly recommend reaching out to a therapist specializing in infertility and to make sure that you are working with a reproductive endocrinologist that is willing to meet you where you are. And on that note, I do want to offer my love, support, and baby dust to my friends who are on their own TTC journey. Please, friends, be kind to yourself. I know this is so incredibly hard.

• 43:31Abbey Sharp?

  But signing off now with science and SAS, I'm Abby Sharp. Thanks for listening.

• 43:47Speaker 00

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