Bite Back with Abbey Sharp - Are Hormone Balance Diets BS!? Dr. Natalie Crawford Breaks Down the Key to Women’s Fertility & Hormone Health

Starting point is 00:00:00 If we know we need 200 or 300 more calories in the ludial 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. Welcome to another episode of Bite Back with Abby Sharp, where I dismantled diet culture rules, haul 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.

Starting point is 00:00:46 And I think I speak for a lot of health care providers and dietitians when I say that the term hormone balancing is currently one of our worst offenders. It is right up there with inflammation and toxins. and quote unquote resetting literally anything. From health coaches pushing adaptogenic cocktails to, quote, 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.

Starting point is 00:01:20 We have become obsessed with, quote, unquote, 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 their fertility and pregnancy journeys? Today I'll be diving into the ubiquitous world of women's hormones and fertility with double board certified OBGYN, Dr. Nadley 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, quick note that the information

Starting point is 00:02:06 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. Also, please don't forget to check out my brand new book, The Hunger Cushing 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. All right, thank you so much Natalie for joining me. I'm very excited about this conversation. Thank you so much

Starting point is 00:02:57 for having me. It's such an honor to be here. 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 unquote balance hormones. From a clinical perspective, what does it actually mean to have quote unquote balance? hormones. 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.

Starting point is 00:03:43 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 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,

Starting point is 00:04:27 in an essence, your hormones not being balanced. I don't love the balance 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 health care, 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 in the only words they may

Starting point is 00:05:07 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. So it's really a lot more complex than just this balancing hormones idea. 100%. I think so many women can relate to what you just described. Is there any validated way to know if your hormones are, quote, balanced?

Starting point is 00:05:53 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 gland, we've got our ovaries. But let's focus on the ovarian hormone axis here. Yes. 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?

Starting point is 00:06:15 Oh, like when I was 30, I don't know. when I was trying to get pregnant, really. Yeah, for me, when I was failing to get pregnant. Right. When I was having trouble. Yeah. 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.

Starting point is 00:06:37 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 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. But what is your normal?

Starting point is 00:07:06 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 are 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

Starting point is 00:07:41 just using this calendar method are 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 going to have a regular cycle. It may be different than what it was at baseline.

Starting point is 00:08:19 So if you know that, that can help. But if your doctor just says, is your cycle regular? And you say, yeah, you're going to miss all of these little red flags. 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? Wow. You've just covered, this is so validating because, you know, this is exactly what I

Starting point is 00:08:41 experienced in my own infertility. journey. I was on the pill from 14 because of irregular cycles, you know, and that was just what we did as kids, just 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 so I had nothing to compare myself to. And that was why I kind of had to start IVF and kind of reproductive support. And so I think that's, this is, this is exactly what so many women are talking about. And so I feel like nowadays there's so many influencers out there who, you know, especially because a lot of folks maybe don't want to go on the pill, if that is the kind

Starting point is 00:09:31 way to quote unquote regulate their cycle. There's a lot of influencers claiming that there's like natural hormone balancing recommendations. And I want to kind of chat through some of those. Okay, talk to me about this idea of cycle sinking. We are seeing a lot of people online claiming that, you know, sinking your exercise or diet to your cycle phases is going to help to balance your hormones and, you know, reduce PMS symptoms. And others do suggest that perhaps it disempowers women to train in a way that uniquely feels right to them. What are your thoughts on this concept. Okay, I have lots of thoughts because that was a really big question that you asked. And I think maybe to adequately answer it, we should give like a really quick brief menstrual cycle overview

Starting point is 00:10:19 in case people are hearing this so they understand the different 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, when 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 FSAH or follicle stimulating hormone, which is well named, and it gets one follicle to grow. As that one follicle grows, the egg inside matures. This makes estrogen. As it makes estrogen,

Starting point is 00:10:59 this is going to grow the lining, talk to the brain. This is the follicular phase by definition. So a follicle is growing. FSA 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 pikograms for 50 hours is a strong and long signal that the brain, now says, oh, Abby has a mature egg, let me now send out a surge of LH or lutinizing hormone. LH, when it's first released like that, tells the follicle to rupture. So the cysts, which is the same thing, bursts. The egg is released.

Starting point is 00:11:52 This is ovulation. And the egg only lives for 24 hours if you are trying to get pregnant, and that's why we're so picky about trying to time intercourse. Well, that same cyst, that's 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. So the brain sends out LH pulses. Cist makes pulses a progesterone. Progesterone crucial opens and closes the implantation window. It is the progestational hormone completely changes how our body is in preparation

Starting point is 00:12:31 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.

Starting point is 00:12:57 So it's named after the ovarian state. Follicular phase, when a follicle is growing, estrogen only. Luteal phase. That's when you have a corpus luteum. estrogen and progesterone phase. So when we talk about tracking cycles, 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

Starting point is 00:13:27 rises. So you can detect that. And that's become so much easier with natural cycles and different wearables. We have an aura ringing up. 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. 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

Starting point is 00:14:09 these are ways where we can really find out when are we ovulating? How long is our ludial phase? How long is our follicular phase? Because the ludial 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. That luteal phase will be less than 11 days. now you're still going to have a cycle, you're still ovulating, but it's going to be probably harder to get pregnant and you might start to feel off because of that miscommunication. And then we're going to 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,

Starting point is 00:14:50 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, 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 sink your cycle, you have to know when you're in follicular and when you're in ludial 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 ludial 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

Starting point is 00:15:35 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. 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 to 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

Starting point is 00:16:18 we have to really take that ownership. So I love that cycle sinking 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 misnomer's because when you are, we'll just say like working with your body, really learning to listen to it. 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 30 minutes or an hour more of sleep in the luteal phase, well then we're allowed to make those changes without guilt or

Starting point is 00:17:04 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, 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.

Starting point is 00:17:38 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 ludial phase. I'm not going to be able to achieve a personal best, so I'm going to work on maintenance. Where I think the cycle sinking narrative goes wrong and can harm people is when we don't ever, we'll use exercise as a

Starting point is 00:18:13 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 prolactin, but from externally, 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 modification. So getting enough sleep, how we manage chronic.

Starting point is 00:18:48 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-sinking 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 a muscle you need if that is your game plan. But if we use that mentality to our advantage of say, okay, I'm going to lift three times a week. And when I'm in my follicular phase, I'm going to up the weights or up the reps. And when I'm in my leoial phase, I'm just going to maybe stay where I went up to. Now we're using cycles syncing to our advantage to help balance our hormones, but in a way

Starting point is 00:19:32 that's setting us up for success. Right. Yeah, absolutely. 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 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, you know, Strogen dominance an actual diagnosis, and can you detox your estrogen down? Estrogen dominance is either a normal cycle phase. So let me give an example. If I draw your

Starting point is 00:20:34 labs and you are in your follicular phase, you will be estrogen dominant. I have had a patient, I actually have 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

Starting point is 00:21:13 pregnant. So I take it really seriously when we throw it around as a diagnosis. To me, estrogen dominant 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 FSA to get one out of 20 to grow.

Starting point is 00:21:58 Well, if you have 40 eggs out of the vault because you have PCOS, each egg is only getting half as much FSAH and it's not a strong enough signal to grow with that reliable, predictable interval of the body once. So two things start happening, or three actually. One is that sometimes it takes just a longer signal of that FSA to get one to grow. So really long or irregular cycles can be what women with PCOSC, 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 FSAH is a strong enough signal.

Starting point is 00:22:38 So you get stuck at this follicular phase. The other thing to note is that every follicle makes a small amount of estrogen. So if I say a mature egg makes 200 p grams, let's say an imbalt. mature 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 picagrams 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

Starting point is 00:23:17 to send out a stronger signal of FSA and you get stuck right there. And if you draw a lab, somebody might say, oh, look, estrogen's over that baseline threshold. 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 most favorite hormone.

Starting point is 00:23:40 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 to testosterone. So the ovary goes fine. If you won't let me make estrogen, I'll make testosterone. We start making testosterone, which then changes the entire metabolic environment of the ovary, makes it more insulin resistance. We put on visceral fat.

Starting point is 00:24:02 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. We can see PCOS in all body size. 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,

Starting point is 00:24:35 but understanding that you're going to have a lot of eggs, you're going to 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. 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 going to 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 going to get to the

Starting point is 00:25:18 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. And I'm sure your doctor said, oh, this young girl has irregular cycles. Maybe she has PCOS or maybe she has this. But in 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 going to have your regularity come back and I need to do that well enough in advance or I need to start learning about PCOS myself

Starting point is 00:25:58 or I don't know that you have PCS. 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 progesterine, labs can be perfectly normal depending on your cycle phase. So again, bringing that to the table to advocate, or it can be a symptom of something else going on. Yeah. Oh, I'm so glad that you mentioned that. And also that idea, you know, that unfortunately wellness scripters 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 root cause that we should be really addressing

Starting point is 00:26:46 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 issues. So I want to talk about underage. fueling, especially because right now we're in this kind of skinny talk meets OZembeck era. Can you talk about how rapid fat loss or underfueling or over-exercising can impact our overall health and fertility? You know, women and men are different on this.

Starting point is 00:27:26 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 have a baby

Starting point is 00:28:07 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 from 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 most severe end of it, we have hypothalamic 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.

Starting point is 00:29:06 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 GLP1. 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, under fueling for overtraining. And that's the signal to the brain that like I'm not sure that we're at a good metabolic state. I don't know that we can support an additional pregnancy right now.

Starting point is 00:29:37 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

Starting point is 00:30:09 just evolutionary, if there was a famine, it's like, I got to really prove that there's not going to be another one. So it takes often years to have the brain turn fully back on. 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 parabenopause 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

Starting point is 00:30:47 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. 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. It's a balance. 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.

Starting point is 00:31:19 And what we notice is that, you know, over 50% of runners will have a ludial 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 ludial phase, meaning we track our cycles. If your ludial 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. 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,

Starting point is 00:32:03 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-1s. 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 from any, I've seen PCOS patients, endometriosis, chronic inflammatory disease, obesity. So I think that 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

Starting point is 00:32:52 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. 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 ones, they are quickly losing weight and may also be wanting to get pregnant at the same time. And so it's really important to kind of keep those things in mind as you're kind of going through your fertility journeys. 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

Starting point is 00:33:50 find evidence-based support when you feel like something's not right with your 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 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, what are some things that we can do to advocate for better care with our health care provider? What test should we be asking for? What support should we be asking for. That is a great question. And I do want to say, you know, in my new book, The F fragility

Starting point is 00:34:38 formula, I'm breaking it down by what's the problem is because I think that's key 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, 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 first. Okay, this is a problem. So how long has it been going on? If you know what things used to be,

Starting point is 00:35:24 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 a patient say, okay, hold on. I wrote it down. And they read it. And that's great. I love it because I can only start by wherever you tell me and then we're going to jump for there. So know your own story. Be prepared to walk your doctor through that. I also think it's really, really, really important to clarify at the end of the visit what the next steps are. And I try to do

Starting point is 00:36:04 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 not 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, 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.

Starting point is 00:36:39 I'll schedule a follow up. 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

Starting point is 00:37:10 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 comes to cycle abnormalities or women's health. 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.

Starting point is 00:37:48 So I will use the example. 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 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 question, so you should know how to get them answered. That is incredibly helpful for so many people. Thank you so much, Natalie.

Starting point is 00:38:30 I'm going to be living 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, you know, and this is not just for folks who are specifically trying to conceive at this moment, so important for your own, um, to. 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 hormonal rollercoaster. So thank you so much for joining us. Thank you, Abby.

Starting point is 00:39:06 And yes, you know, fertility is a marker of your overall health. We talked to 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. 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 in fertility circles.

Starting point is 00:39:51 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. 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.

Starting point is 00:40:39 When the health care 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. 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 overlaught.

Starting point is 00:41:21 with disordered eating patterns. You know, eating disorders are actually not that uncommon. So it's estimated about 9% of the U.S. population will have an eating disorder in their lifetime. And when we look specifically at fertility care, one systematic review found among women pursuing fertility treatment, up to 17% met the criteria for an active ED, up to 28% had a history of an ED and nearly have 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's this fear that if you don't

Starting point is 00:42:07 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, 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.

Starting point is 00:43:02 But signing off now with science and SaaS, I'm Abby Sharp. Thanks for listening.

Bite Back with Abbey Sharp - Are Hormone Balance Diets BS!? Dr. Natalie Crawford Breaks Down the Key to Women’s Fertility & Hormone Health

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