The Liz Moody Podcast - The Hidden Root Cause of Aging Faster, PCOS, & Endometriosis (+ Exactly What To Do About It)

Starting point is 00:00:00 What is the biggest myth that women believe about aging and their ovaries? Overees are just for babies and that menopause is just about hot flashes. The ovary communicates with virtually every single cell in their body. Menopause and perimenopause is about a lot more than just hot flashes. There is this biological factor that is changing in their bodies and by understanding the impact they can navigate and help their bodies be healthier. There are conditions that mimic perimenopause earlier in life. So women who have polycystic ovary syndrome, and this is a big percentage of women, like 10% of women have PCOS.

Starting point is 00:00:35 This is a condition that in many ways looks a lot like perimenopause. What do you think about GLP-1s and other things that might impact metabolic health? I'm super excited about the impact that GLP-1s are going to have. Just a few weeks ago, somebody told me that their 47-year-old friend accidentally got pregnant after she had started GLP-1s because her ovaries just kept back on again. When you can get the metabolism under control, a lot of women have, relief from their PCOS symptoms. Do we know why certain people get PCOS or endometriosis and other people don't? My name is Dr. Pirae, your touchbeim. I'm a PhD scientist and innovator. I have

Starting point is 00:01:11 been researching women's health for over 25 years. So most people know that ovaries are important for babies, but what they don't realize is that the ovary is really what I call central command. So it communicates with virtually every single cell in their body. And I think a lot of women don't associate their ovary with anything other than babies. And when we think about perimenopause, which is when the ovary really starts to decline and function quickly, and when we think about menopause, which is when the ovary stops working altogether, people usually associate that with hot flashes. Hot flashes can be very debilitating and I don't want to minimize that. But it turns out that menopause and perimenopause is about a lot more than

Starting point is 00:01:53 just hot flashes. And it can be really empowering for women to understand. that there is this biological factor that is changing in their bodies. And by understanding the impact that's having on their bodies, they can navigate and help their bodies be healthier, not just while they're going through that, but also later in life. You say that our ovaries are a command center for our entire bodies. What do you mean by that? The ovary, people know that the ovary makes estrogen, it makes progesterone. People are increasingly understanding as well, that it makes testosterone, that testosterone isn't just a male hormone, but it's a gonadal hormone. Ovaries and testes are gonads. But what a lot of people don't realize is it also makes insulin

Starting point is 00:02:34 growth factor. It also requires melatonin, which is the sleep hormone, to function. So the ovary sits at the center of signaling with molecules to virtually every cell. So it communicates with your bones, with your brain, with your muscles, with your immune system, with your hair follicles. That seems like bad design to have something that communicates with all of these different things in your body and then it just stops working at a certain point when you have many years of life left. Why would that be the case? It's one of my favorite questions because we call it natural when menopause happens. But in reality, if we look back and we think about our evolution as a species, we evolved to live until about our 20s, maybe our 30s. And so we spent about half of our

Starting point is 00:03:20 life growing and about half of our life fruiting. I think of it a little bit like a tree. It grows for a while, then it fruits for a while. And that was about our lifespan too, about 30 years. So we would go through. I thought that there was like a thing where we thought our lifespan was short, but then we realized if we took like childhood death out of it, we actually lived longer than we thought in the old days. Am I wrong? I think it's not true. I think that this is something that people do often push back and say, no, people lived for a very long time. There certainly were outliers. But the reality is we evolved in a world where most people died because of infectious disease or trauma, like from an accident or from childbirth. And we have, in the last hundred years, doubled our lifespan,

Starting point is 00:04:03 not just by eliminating childhood illnesses, but by really eliminating the most prevalent causes of mortality that were with us for millennia. So when we think about menopause and we call it natural, and we think, well, why were we designed to have our ovaries stop functioning? I challenge that. I would say that the data is actually counter to that, that we evolved to always have a functioning gonad, and that menopause or the end of ovarian function is something that's called iatrogenic. So it's a new disease that has happened as a result of us solving a different disease.

Starting point is 00:04:40 Which was aging? Yes, we've been able to tackle infectious disease. We've been able to tackle dying in childbirth. We've been able to introduce things like surgery to solve a number of things that would have killed us earlier in our life. So because we now can treat so many things, now we're getting to a place where the ovary, in my view, is the final frontier to really enable women to age in a healthy way. Because the ovary today for modern women, so these are women who on average are living until their 80s, not until their early 40s, which is what the average was, at least in the U.S. 100 years ago. in places like India, the average life expectancy 100 years ago was late 20s. So we've gone from people living until somewhere between their late 20s to early 40s to people in average now living

Starting point is 00:05:26 from their mid 70s to mid 80s. And one of the biggest consequences now that we have to deal with is that the ovary got left behind. Is there any evidence that extending ovarian lifespan will extend health span or overall lifespan? Yes, both. We can look at this from a number of different angles. So one is we can look at people who experience the end of their ovarian function earlier in life. So these are women who either go through premature menopause, which is before the age of 40, or women who go through early menopause, which is before the age of 45. And what we see in virtually every study is that those women have a much higher disease burden for really significant morbidities, diabetes, osteoporosis, heart disease, autoimmune disorders,

Starting point is 00:06:14 So women are surviving things like cancer, which can sometimes cost them their ovaries, but they then are getting other conditions as a result of not having a functioning gonad. And we also know that some women genetically are wired to go into menopause earlier. And those women also have a similar increased risk for multimorbidity. That means multiple chronic conditions like the ones that I mentioned earlier in life before the age of 70. We can look at the other side of the coin, which is to look at women who go into menopause after 50. So the average age is 50, 51. Women who go into menopause later in their mid-40s, et cetera, really push off and have a much lower risk for things like Alzheimer's, osteoporosis, heart disease is a big one. That ovarian function is definitely protective for those things.

Starting point is 00:07:02 We are a podcast about action steps and empowering people. For somebody listening who's like, oh, shoot, I had cancer, I had to have my ovaries removed, I went through early menopause. is it about awareness and then checking and preventing those types of issues or what should they be doing? So knowledge is power. And one of the reasons that I love to talk about this is first of all, this is not intended to be the bad news podcast. This is intended to be the empowering knowledge podcast here. And the message is I cannot sugarcoat the data that when the ovary stops working, it has catastrophic effects on health. I cannot sugarcoat that. But there are things we can do to mitigate. And people have. have tools. So first of all, if we know that people are at increased risk for things, they can be diagnosed with those potential conditions and or can take preventative measures earlier. So we all know we should do the fundamentals, sleep well, eat well, exercise, manage stress,

Starting point is 00:08:02 be part of a thriving community and have a great, you know, intimate partnership. We've all heard it, right? But where do you put your eggs? Because you can't put all the eggs in the basket. It's just too much to try to do all of the lifestyle factors all the time. Is this like pun intended? Yeah, exactly. It's our actual eggs. It's your actual eggs. I find it overwhelming.

Starting point is 00:08:22 I know a lot of women find it overwhelming. They ask me, okay, what are the things I can do to mitigate the things that you're talking about? The list is very long. And so it can end up feeling very overwhelming. But I think generally the health recommendations that we get can feel very overwhelming, especially for women who already have the disproportionate unpaid labor at home, etc. So what I tell women is it's important, first of all, to know what the risk factors are in your family. So if you have hereditary cancers in your family, then you would benefit from closer screening.

Starting point is 00:08:54 If you have heart disease in your family, if you have Alzheimer's in your family. So the first, again, knowledge is power is first understanding for people who I am genetically related to and for people who have grown up in my environment, what are the chronic diseases that run in my family or in my community? I think that's really important for people to understand. And, and And then if somebody is experiencing ovarian issues early in life, or generally as they start to go through this, these are the people who should have cardiac screens earlier, should have bone density screens earlier, should be watching their cognitive function, are they getting brain fog, are they forgetting things, are they having significant sleep disruptions?

Starting point is 00:09:33 The problem is, and you hear this when you talk to physicians who are trained and now have become very passionate, advocates about menopause care that often women's complaints get dismissed. They get called whiny women or hypochondriacs or they're overreacting. If you know that your ovary stopped working earlier or now that you're going through perimenopause or menopause, you can go advocate for yourself and you can say, I really want preventative care because I want to stay on top of it. You can stay on top of your cholesterol. There's a lot of things that are actionable for you. if you know that you're at risk. What's the specific list of things that ovaries directly impact? I know you kind of mentioned them earlier, but let's start with what role do ovaries play in brain health?

Starting point is 00:10:18 Ovaries play a humongous role in brain health. So I mentioned that it's central command. The ovary is talking to every organ in your body pretty much. The loudest conversation that it's having is with the brain. And when that conversation gets disrupted, it has impacts on the brain and impacts on the ovary. So when the brain is disrupted, it can impact the ovary, and when the ovary is disrupted, it impacts the brain. One of the big mechanisms that impacts the brain when the ovaries that function correctly is actually through metabolic pathways. So the brain is one of our most energy-hungry organs, and it really needs a steady supply of energy. That energy comes from our bloodstream. And so there's the systemic metabolism that's happening in our body, but we also have metabolization.

Starting point is 00:11:06 within the brain as well. And so anytime the metabolism our body is compromised, it's going to put more pressure on metabolism in the brain. And so what we know is women who are starting to have some of the metabolic issues associated with perimenopause and menopause, that can actually cause the brain to shrink. It's actually being starved of energy. And so one of the things that I started doing when I entered perimenopause about five years ago is I started wearing a continuous glucose monitor. And people that I was overreacting at the time because now it's become much more popular and there are wonderful apps like January AI and levels that make it easier for people to start tracking. I think ORA ring just introduced one as well. When I got started, people said, well, do you have diabetes? I remember I talked to an

Starting point is 00:11:52 endocrinologist and she was like, well, this one blood measurement that we took of your glucose is fine, so you don't really need a continuous glucose monitor. But I shared with her the research that we were doing and what we were finding about how important glucose levels were. And I had started to have hot flashes. So based on the research we were doing, I made a hypothesis, which is if I can control my glucose. So in my case, it wasn't that my glucose levels were going too high. So that's what they were looking for. And they said, oh, your glucose levels are so low. This is great. The reality was once I started wearing a continuous glucose monitor, I was able to correlate that times in my sleep when I became hypoglycemic because I had not managed my metabolism well in the day before

Starting point is 00:12:40 were the times that I was waking up with hot flashes. And so by managing my blood sugar during the day and eating the right things, especially at night, I was able to stay in the green and not go into the red on my glucose at night and I was able to sleep through the night and I didn't have hot flashes. So since I started wearing a continuous glucose monitor, I have barely had any hot flashes that I have struggled with, and this has been five years going now. Do you view symptoms like hot flashes as always almost like a warning light of something going on deeper in our body? So it's like, we don't want to just address the symptom. We want to figure out what it's signaling and address what's happening deeper. Absolutely. I think understandably for women who are having hot flashes,

Starting point is 00:13:26 they just want them to go away. They're really debilitating. They're embarrassing. They can happen, they're correlated sometimes with stressful events. So it's a way of really announcing to the world that you're stressed out. Zoe Saldania, she like had one on the red carpet. And I'm like, ooh, that would be awful. But she used it as an opportunity to like say I'm having a hot flash, which was like a cool use of the press on the carpet. A hundred percent. Yeah. I think we have to normalize it. We have to have a conversation. And then we have to say a brain that is having a hot flash is a brain that is not okay right now. One way to mitigate hot flashes is, by estrogen therapy. So for women to go and find out, is this happening because my estrogen

Starting point is 00:14:08 levels are inadequate? Estrogen is important for your brain's metabolism. So circling back to metabolism, you need estrogen in your brain for your brain to be able to make use of the glucose that comes into your brain. And so it's really hand in hand. It's about managing the metabolic state in your body, but your brain has to have access to estrogen to make use of the glucose that's coming in. And so for some women, they have an adequate estrogen. And so that is partly what is driving their hot flashes. There is a new class of medications that has come out that effectively goes after the thermostat and triggers the thermostat. So instead of adding estrogen back into the brain, it basically just goes and says, stop generating this hot flash. I worry about that because

Starting point is 00:14:56 if your house is on fire and you turn off the fire alarm so you can go back to sleep, that's not necessarily great. Now, I'm not anti these drugs, but I really think for women who are given these drugs to mitigate the hot flashes, we have to give them other tools too. We can't just turn the fire alarm off. What do you think about GLP-1s and other things that might impact metabolic health and interrupting this whole ovary brain metabolic health cycle? I'm super excited about the the glp ones are going to have on ovarian health. We know I mentioned the metabolic piece is really important and as we go through perimenopause, our metabolic health and our ovarian health become very, very critical to kind of co-regulate both. I want to take a step back and say

Starting point is 00:15:46 a lot of women think about ovarian health and ovarian function as they're going through perimenopause or because of menopause. But there are conditions that mimic perimic. menopause earlier in life. So women who have polycystic ovary syndrome, and this is a big percentage of women, like 10% of women have PCOS. Not all of them know that they have PCOS, but 10% of women have PCOS. This is a condition that in many ways looks a lot like perimenopause. You have too little of some hormones. You have too much of some hormones. You don't have a regular cycle. You often have a block where you are not producing eggs all the way to the finish line. You're and ovulatory is what they call it. Sometimes you have a really heavy period. Sometimes you don't

Starting point is 00:16:29 have a period at all for a period of time. So some women experience that during perimenopause. Some women have had that as their reality since their puberty began. We know in those women that managing their metabolism, so for example, women who have PCOS, who have the metabolic aspects of PCOS, often are prescribed metformin to manage it. What's interesting, is when you can get the metabolism under control, a lot of women have relief from their PCOS symptoms. And what has been interesting to me is that the community has not said, well, here's a set of protocols that helps women who have these ovarian health issues early in life. Why don't we also repurpose these protocols later in life? The GLP ones are driving that conversation because

Starting point is 00:17:15 oftentimes people have metabolic issues also have obesity. And so women who are in their early years, often who also have PCOS, who have diabetes or prediabetes or obesity and are prescribed the GLP ones. One of the really, one of the first things that we noticed as a medical community was like, oh, they've started ovulating and having natural cycles again. These women who were told they would have to use IVF to get pregnant, we're getting pregnant on their own. But what's amazing to me is as older women, women who are perimenopausal, they're in their 40s and into their 50s are starting to take these GLP ones too. Just a few weeks ago, somebody told me that their 47-year-old friend accidentally got pregnant after she had started GLP-1s because her ovaries just keep back on again.

Starting point is 00:18:05 Wait, so I've heard so many stories of like GLP-1s are increasing pregnancy rates and we're not quite sure why, and you think it's because of this metabolic ovarian function situation? Definitively, definitely. Wait, can you explain that just like a little bit more in depth? Yeah, so my research group has been focused on this for many years. And what we've been really focused on is trying to understand when we talk about ovarian function, what does that mean on a molecular level? What are the molecules that are really important for an ovary to function correctly? And when an ovary is in a state of PCOS versus not PCOS, what's different about that

Starting point is 00:18:42 PCOS ovary? What's different about that PCOS body? What's different about the genetics of that individual who ended up with a body that is experiencing PCOS? And what was fascinating to us was that the molecules we were discovering were not unique. They were molecules that were disrupted in autoimmune disorders, cardiovascular disease, diabetes. So the GLP1 pathway came up as very, very critical for ovarian function very early in our research. And later when the GLP once came out as drugs, it was not surprising to us that all of these ovarian benefits were coming to light because it made sense from the data.

Starting point is 00:19:18 Is the data robust enough that you would say, even if you don't necessarily want to experience weight loss, you should be like microdosing GLP-1s if you have PCOS or if you're entering perimenopause? So I don't want to go out as far on a limb to say that GLP1 should be a fertility drug, but I want to go out as far as to say there's enough anecdotal evidence that we should be studying that because it could end up being an incredible new. We haven't had a real breakthrough in fertility medicine in decades. Since the invention of IVF, we have not had something that is truly a breakthrough. And I think with all of the glimmers we see with GLP-1s, I think we absolutely should be studying it in populations where ovarian health is really critical within the infertility population. And that's women who are trying to have babies when they're a little older and struggling

Starting point is 00:20:07 and women with PCOS. I absolutely think those studies have to be done. I've also seen anecdotally, like on Reddit and TikTok, women who are saying that they're taking GLP-1s and experiencing a lot of symptom relief with things like PCOS and endometriosis and their speculation, like, is it because of lowered inflammation levels? What do you think is happening there? It's all intertwined. Endometriosis is a great example. I'm the chair of the Endometriosis Foundation of America. I have endometriosis.

Starting point is 00:20:33 So this is a topic that's very close to my heart. We have known for years that modifying diet, So taking metabolic interventions or dietary interventions can really impact the course of endometriosis as well. So PCOS and endometriosis are two conditions that impact the ovary that are in part caused by a malfunctioning ovary. And metabolism is a big part of both of them. I'm mentioning metabolism in the context of inflammation because metabolic disturbances can also then lead to immune dysfunction and can lead to chronic inflammation, and the chronic inflammation can circle back and impact metabolism. These are not siloed processes in the body. They're all in communication with each other. So it's really

Starting point is 00:21:23 about trying to get the body back into balance in using the tools that you have. The tools that you have are, again, to recap, sleep, stress management. Let's talk about stress for a second. Cortisol is another one of these molecules. So your stress response is intertwined with your inflammatory response is intertwined with your metabolic function. So let's talk about sleep for a second, melatonin signaling. So when you think of sleep, you think of the restorative aspects of sleep. Sleeping is an endocrine event. When you sleep, when you are in the darkness, you make a hormone called melatonin. Melatonin has anti-inflammatory action and it goes to the ovary. If you want to get a rodent to stop ovulating, all you have to do is stick it in the dark for.

Starting point is 00:22:09 two weeks. Because it disrupt our circadian rhythm so much? Yes, you either put it in all light or all dark. But if you disrupt the circadian rhythm of a mouse or a rat for two weeks, the ovary completely shuts down, it becomes insulin resistant, the ovaries become cystic, it starts to gain weight, it starts to have perimenopausal symptoms or PCOS symptoms, however you want to frame it. But basically, we don't think about when we say, oh, you need to get better sleep. You need melatonin. You cannot produce gonadal hormones without melanchol. And so when you don't get enough sleep, you're not sending enough indocrine signal from the brain to the ovary for it to then make the signals it needs to make to send those signals back out

Starting point is 00:22:52 to the brain, to the immune system, to the metabolic system. That's when you start to get inflammation that doesn't resolve. That's when you start to get mental health changes, brain fog, hot flashes. It's all interconnected. I very rarely get genuinely excited about skincare, but this is one of the most innovative products that I have come across in years, and I'm so obsessed with it. I've been telling all of my friends to get it, so now I need to tell you guys. Here's some science first. Your skin isn't just getting older. It's being actively broken down by something called senescent cells. These are cells that

Starting point is 00:23:26 have stopped functioning but refuse to die. They sit there releasing inflammatory signals, breaking down your collagen, degrading your skin barrier, and accelerating every visible sign of aging. Scientists call them zombie cells, and as they accumulate, they are one of the primary drivers of how old your skin looks and feels. The team at one skin,

Starting point is 00:23:47 a group of female longevity researchers and PhDs, spent five years testing over 900 peptides to figure out how to help reduce the accumulation of senescent cells. And they finally landed on it. OSO1, the first peptides, peptide scientifically studied to reduce skin's biological age at the molecular level. OSO1 goes in and it clears out the senescent cells so it helps skin function like healthier, younger looking skin. It is not masking the signs of aging. It's not targeting one thing. It is

Starting point is 00:24:18 actually rolling the clock back at a cellular level. I've been using the face moisturizer for almost six months now and I love it so much. It feels amazing. It goes on really smoothly. it's not tacky at all. And I actually see a difference, which I just feel like is never the case with skincare. You want to always like see a real difference. And you're kind of like, do, do I? Do I? And this I genuinely do. Because it's clearing the senescent cells, it doesn't just target one thing. So my skin looks firmer. It looks glower. The texture feels dramatically smoother. And I feel like you can see that too. I also love the body moisturizer. It dries down really quickly, which is always a pet peeve of mine with moisturizers. I hate that like sticky feeling when you go to put your clothes on. This does not do that. But it does moisturize

Starting point is 00:25:03 really, really well. And then again, I'm reducing my skin's biological age. I am not making it just look younger. I am making it actually younger. One Skin has four peer reviewed clinical studies and over 10,000 five-star reviews. The data backs everything up for a limited time. Get 15% off with code Liz at oneskin.co slash Liz. Again, that's 15% off at oneskin.co with code Liz. When you think about strength and resilience, like your ability to feel energized, to recover well, to stay strong as you get older, what do you think that actually comes from? Most people say working out or good nutrition, and yes, of course that matters.

Starting point is 00:25:47 But there is a biological foundation underneath all of that that most people are completely overlooking. I have been diving deep into this lately with the team at timeline and what I've learned has genuinely shifted how I think about my own health. Every single movement that your body makes, every step, every workout, every muscle contraction depends on energy produced at the cellular level. And at the center of that is your mitochondria. Here's the thing that nobody tells you, certainly nobody told me, starting around age 30,

Starting point is 00:26:16 our mitochondria naturally become less efficient. More get damaged, more become sluggish, and over time that impacts your energy, your strength, your recovery, and your resilience. Most of us respond by pushing more. we're like noticing these things and we're adding in more protein. We're trying to fix it with more supplements. We're trying to do harder workouts. And those things do help. But timelines research suggests that we also need to be supporting the cellular machinery underneath. And that is exactly what their supplement mitopure does. It contains urolithin A, which helps your body clear out damage mitochondria

Starting point is 00:26:51 and support healthier ones so that your cells can produce energy more efficiently. Because this is happening to your cells, it's going to impact your entire body, your immune system, your muscles. One study found that taking mitochondria increased muscle strength by 12% in four months with no change in exercise routine, it's going to impact your energy, your sleep, your skin, your cell health impacts all of this, and urolithinae keeps your cells healthy. Timeline has done over 15 years of research and testing on this one product, urolithin A, which, by the way, most of us lack the gut bacteria to synthesize naturally. that's why many of us need to supplement it to get the benefits. This has become a staple supplement

Starting point is 00:27:31 for me. It is my top way to support how I want to look and feel as I age. Support yourselves and how you age with mitopure gummies from Timeline. Visit Timeline.com slash Liz and save up to 39% on your mitopier gummies. That is timeline.com slash Liz. The mattress that you sleep on is one of the highest exposures that you have. Like if it's off gassing, you're breathing that in for basically a third of your life. and most conventional mattresses are loaded with synthetic foams, flame retardants, microplastics, and more. Plus, if it's not comfy, you're going to be tossing and turning, you're going to be really hot, and sleep is the foundation of health.

Starting point is 00:28:10 It is so important. Because of all of this, if I were not going to invest in any other part of my house, no other things in my house, I would invest in my mattress. And in fact, I have four years well before I had much money to spend on any of these things because it is such a big needle mover. The birch mattress is incredible. It is made with organic cotton, natural latex, and ethically sourced wool. So it has literally no off-gassing.

Starting point is 00:28:36 You can not smell anything right when you unbox it. It has no microplastics, no synthetic foams or flame retardants. And the wool makes it so breathable, which if you've listened to this podcast for more than five minutes, you know that I run very, very hot, like I am a furnace. Zach has basically accepted that sleepy next to me is like sleeping next to like a little fire. And the birch mattress has been a game changer for that. It's made me sleep so much better. Like I can see my sleep score going up because I'm not hot all night long. It's also hypoallergenic, which is really worth paying attention to if you find yourself waking up stuffy or congested.

Starting point is 00:29:12 Dust mites in a conventional mattress can actually impact your breathing and your sleep quality without you even realizing it. And again, we need to be able to breathe to get good sleep and getting good sleep is the foundation of our health. And then comfort-wise, Zach sleeps on his back and then I sleep on my side and my stomach. So we have two completely different sleep styles. And we both wake up feeling really good, no aches and pains. CNN actually named the Birch mattress, the best mattress for side sleepers. And Wired named it the best organic mattress period. So there you go. Burch has options for every kind of sleeper in your household. They have three firmness layers. I like the Lux Natural, which is the medium one.

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Starting point is 00:30:17 And you're going to get 20% off. birchliving.com slash Liz Moody. Do we know why certain people get PCOS or endometriosis and other people don't? We have the beginning of understanding why. A lot more research needs to go into this. But we know that there is definitely a genetic component and an environmental component. And so what we say is genetics is it is destiny sometimes, but rarely. So I'll try to plot it for you.

Starting point is 00:30:46 On this axis here, let's say is the prevalence of a genetic factor in a population. Okay, so this over here means it's very rare and this over here means it's very prevalent. And then this is the impact of the genetics. So the higher this is, it means if you have these genetics, you're definitely going to get that thing. What would be an example of that? So an example of that would be cystic fibrosis. Okay. So there are genetic factors that are very rare.

Starting point is 00:31:09 Okay. But you can diagnose them prenatally and you can with confidence tell the parents your child is going to have cystic fibrosis because they have these factors. Those are very rare. So most genetics tracks in this line. So we have a few things that are very rare and very high effect and a lot of things that are very prevalent and very low effect. The curve kind of looks like this. Okay, there's a long tail.

Starting point is 00:31:36 Some people have quite high effect PCOS risk factors and endometriosis risk factors. Not quite as high as cystic fibrosis. We can't tell anyone based on their genetics. You will definitely get endometriosis. But we can tell some people you have a three or four times higher risk of getting endometriosis or PCOS than the average person. That's a pretty colossal risk, actually. And that would be like from a DNA test that I could take on the open market. There's like genes that are correlated with this.

Starting point is 00:32:03 Or is it like looking at your mom or your grandma? So I founded a company called Cellmatics back in 2009. And that was one of the first products we actually developed was a test where you could go test. For a variety of reasons, mostly it's just very hard to fund anything in the FemTech space. You're working to change. I'm working to change it. What I will tell you is I got to take that test when it was on the market. And I have endometriosis.

Starting point is 00:32:25 I tested positive for the highest risk endometriosis genetic factor that's ever been identified. And I inherited it from both my mom and my dad. So I don't have a normal copy of it in my body. Oh, interesting. And that could explain why I was at increased risk. But we know that it's not just genetic. So even though you have a three or four X increased risk over the general population, there still has to be something else that pushes you into that. Then what we have is complex traits. So these are things

Starting point is 00:32:54 where it's not just this one marker that you have. And by the way, that one marker I have is related to my immune function. So it relates to how my body processes inflammation and how it resolves it. So why do we have these markers if they're not great? The reason that we have these markers in the population is probably because my ancestors a long time ago because they had that inflammatory response survived a pandemic somewhere. Oh. Fast forward, now in the era where I might have a vaccine I can access or an antiviral drug or an antibiotic, that isn't that beneficial to me because I have other tools

Starting point is 00:33:31 to manage that. But what is manifesting as in my body is endometriosis. Oh, that's interesting. Whereas millennia ago, it might have been the difference between me surviving to child bearing age or not. And again, you could just die after that. Exactly. And it didn't matter if you had some painful periods.

Starting point is 00:33:47 But now these conditions like PCOS and endometriosis are growing because we have higher BMI than we've ever had before. We have more exposure to these environmental factors. So let's talk about those now. So we talked about the genetics and it kind of makes sense that there are these genetic factors floating around that probably were beneficial millennia ago. But now in the context of the modern lifespan and the modern lifestyle are not beneficial to us. Are the risk factors for things that we now call PCOS or endometriosis? What most people have who have these conditions, is a complicated set of genetic risk factors that each one of them alone is hard to point the finger and say that's why you have PCOS. But you get, everybody gets a deck of cards

Starting point is 00:34:30 genetically from mom and dad. And they got a deck of cards that got shuffled from their mom and dad. So we kind of get this shuffling. And each sibling gets a different shuffling, even though they have the same mom and dad. And the way the genetic risk works in most conditions is that it really is the cards. So one sibling might have gotten, you know, 11 out of the 12 risk factors that they could have gotten for PCOS for mom and dad. The other sibling might have gotten three. And that could explain why one sibling has it and one sibling doesn't. But now let's superimpose environment on that. And so let's say both siblings got the equal shuffling of the cards. One sibling might be really into sports and might have managed their metabolic risk that way through puberty. And so that would

Starting point is 00:35:13 have impacted how their ovary was developing, the other one may have been more into art and not as active. And so the disease may have manifested earlier in them. So one person might actually not even have issues until they're older. Maybe they start to have issues when they become less active. And then suddenly now they're manifesting their PCOS symptoms, but because they were managing their weight and their metabolism through exercising earlier in their life, they didn't realize it until later. It's really the intersection of the environment that we live in, the lifestyle choices that we make, including diet and exercise and sleep, and what our underlying strengths and weaknesses are from a genetic standpoint. Do you view metabolic health as the number one external factor that's kind

Starting point is 00:35:56 of influencing that genetic expression or not? Or do you think there's other things that are having an outsized effect? It depends. Pollution is a really big issue right now. And I consider pollution a lot of different things. Let's just call it toxins in our environment. generally. Some of the pollution is the pollution we can't control. So in some parts of the world, I would say that the biggest driver of ovarian issues is things that are in the air, in the water. Women don't have a lot of control over it. In parts of the world where we have relatively clean air, we have purified water and clean water and we're not exposed to toxins in the water, I would say that we have to look at the products that we're putting on our bodies. So we hear

Starting point is 00:36:35 about endocrine disruptors. These are things that are found in. plastics, microplastics, and in a lot of body products. These are not hormones that we're rubbing on our body, but they are molecules that to our cells look like hormones. And so that's an issue. So for me, when I was navigating my own journey, I had trouble getting pregnant. I had a lot of issues associated with my endometriosis earlier in my late 20s, early 30s. and I struggled with infertility and with miscarriages. And so I took a step back and I really started to try to understand what are the things in my control. And one of the biggest things that I started to change was I got high quality air purifiers because I live in New York City.

Starting point is 00:37:22 And at the time I lived a block away from a highway in New York City. So I was really exposed to a lot of exhaust. The second thing was I really started managing the water that I was consuming. So I'd grab a Fiji bottle from the gym and go. I very rarely drink water that has been sitting in plastic for a long time after I educated myself about the impact of these endocrine disrupting molecules that leach from plastic bottles, especially if they've been sitting in the heat, et cetera. So I started to carry a glass water bottle.

Starting point is 00:37:59 People who know me who have either worked with me or my friends, they know that my signature look is my glass water bottle. And I used to actually give them out to all of our employees at Solmatics when they came, they'd get their official glass water bottle. And so I started being careful about the air I was breathing, the water I was drinking, but also my products. I ended up completely refactoring every single product that I put on my hair, that I put on my skin, my toothpaste. And again, I don't want people to feel like, oh, because I'm using the shampoo, I can't get pregnant, or because I'm using the shampoo, my ovary is going to be disrupted. It's not any one thing. It's about the burden of all of these things that we're doing.

Starting point is 00:38:37 So I would say if somebody is not using air purifiers, is living close to a highway, is not thinking about filtering their water or what they're being exposed to from plastic water bottles, and they haven't taken a step back and looked at what's in their products, they probably can get kind of a big boost in their ovarian health by addressing those things, one by. I want, but it took, it took time. It took me like two, three, four years to transition from where I was in my late 20s, early 30s to how I live my life right now. A lot of dermatologists and cosmetic chemists will say that there's no evidence that these really small amounts of chemicals are disrupting our body or our hormones in any way. Do you have evidence that these chemicals are having a real impact on our ovaries? So what I would say is that there's definitely evidence that microplastics for the first time the study just came out. I put it on my Instagram for anybody who wants to go see it. But for the first time, people have actually done a study and looked at follicular fluid within the ovary.

Starting point is 00:39:41 So the ovary has follicles that the egg grows in. And those follicles are the active component of the ovary that do all of the signal that I'm talking about. It's like a hair follicle, like your hair grows out of the follicle. Those follicles are filled with fluid. And so a study took a look at follicular fluid and found these microplastic. components in the follicular fluid. And people are now correlating the presence of that with different issues. And so what I would say is that anybody who's claiming put whatever you want all over your body and in your body and it's not going to impact your ovary absolutely does not have the data to claim that. So as we mentioned with genetics, some people have a lot of genetic risks, some people have less. So similarly for an environmental factor like that, it may impact someone in a very

Starting point is 00:40:25 big way. It may impact somebody else in a very small way. But when they do the study, they don't have that level of personalization. So what they're looking at is on the aggregate, what is the risk? But to an individual, the risk may be colossal. And so I think that we can't just make a blanket statement that this has no impact on the ovary. Is there anything else that you think we're getting wrong when we're trying to treat PCOS and endometriosis? So I think the number one thing we're getting wrong is that we're not even catching it for 10 years. So the average delayed a diagnosis for PCOS and for endometriosis is 10 years. And these are women who end up going through the diagnostic odyssey and they end up at every other specialist. So they end up at

Starting point is 00:41:08 an endocrinologist, obesity specialist. Typically they end up at a mental health specialist, infertility specialist. They're talking to their OBGYNs. And nobody's putting two and two together that what they actually have is PCOS and what they have is endometriosis. This is in part because we don't have good tests for it. Are they all symptom diagnoses? The PCOS is symptom diagnosed and also diagnosed. It's a checklist. You have to have a certain number of things checked. Okay.

Starting point is 00:41:34 And many of those are symptom based. But ultimately they will look at things in your blood and they will typically do an ultrasound of your ovaries. But it's not like just go in, get a test, a single test. Like, oh, you have PCOS and endometriosis, don't they actually have to like do surgery and see if there's? Yeah. So the only gold standard for endometriosis, believe it or not, is surgery to diagnose it.

Starting point is 00:41:55 To see if the lining is essentially growing outside of your uterus. Indemitriol-like cells are growing outside your uterus. It's really advanced. They're starting getting better at diagnosing it with MRI, but that's for very, very advanced disease. So I think the biggest thing we're getting wrong is we are not talking enough about the symptoms and empowering women to go in and really advocate and say, I'm having a level of pain with my period that causes me to lay on the floor and throw up.

Starting point is 00:42:21 And I couldn't go to volleyball practice because of it. please don't dismiss my pain. And yet, I still had to go to work because I wasn't allowed time off for that kind of thing. Exactly. Similarly, with PCOS, the stories are often similar. A woman, she remembers being a girl and felt great and healthy when she was a girl. And then everything changed around puberty where suddenly she gained weight. She started getting acne.

Starting point is 00:42:47 She had significant mood changes. Hair started to grow in places that she didn't want. to grow. And she just starts thinking, that's my body. She doesn't start thinking, oh, I have a condition called PCOS. And so this is where I think if we, just like we're doing with menopause and perimenopause, which I think is great, as we're saying, oh, those joint pains that you're having might be perimenopause. The brain fog you're having might be perimenopause. You can't enjoy a glass of wine with dinner anymore. It might be perimenopause. I think we have to remember that while every woman who lives long enough is going to start to have those issues of midlife, 10% of women with PCOS have always been dealing

Starting point is 00:43:27 with those issues, but they aren't realizing that it's PCOS. So I think that's one of the biggest things is that we don't tackle it early enough because we don't talk about it and there's not enough awareness, even among physicians of what they're dealing with. The other thing that I think we get wrong is that we don't understand and we are not giving access to people on the things that they can do. So one of the biggest things I ask, So people come to me, given my experience with endometriosis, my work with the foundation, and my work is a researcher, and they say, oh, my neighbor's daughter, my daughter really struggling with extreme period pain. Could it be endometriosis? Is there anything we can do about it?

Starting point is 00:44:07 One of the first things I ask is, do they eat a lot of candy? And I'm not trying to cast blame, and I'm not saying that eating candy gives you endometriosis, but having a high degree of processed sugars in your body does not set you up for. success if you have a pro-inflammatory body genetically. So these are the things that I ask where I say, like, look, you may have to have a conversation with them and say, look, you're going through puberty now. And that extra candy bar that you ate after school today, right around the time you were set to get your period when your body's about to ratchet into this hyper-inflammatory state isn't helping you. Right. And so these are things where it's a really fine line where we don't want to stigmatize and we don't want to shame people based on their dietary choices, but we also want to

Starting point is 00:44:54 empower them to make healthier choices. And it's not all the time. It's not, if you're a teenager who has painful periods, you can't ever have candy bars. That's not what I'm saying. But by tracking your periods and understanding when you are in your late ludial phase and you're getting ready for that menstruation program to kick in and you know your body's going to get ratcheted into this kind of inflammatory state, that's when you want to protect your sleep, say no to the that extra glass of wine, say no to process sugars in your diet, manage stress. You don't have to do it all the time. But if you are able to do it for that couple of days leading up to your period, it can potentially have a huge impact for you. And we don't talk about that enough. That's so

Starting point is 00:45:34 interesting. I've never even heard somebody segmented out to that specific phase of your period. Yes. So I'm very big on this. Since period trackers came out and trackers like I'm wearing my or a ring and I track my basal body temperature. Your temperature is one of the most important vital signs that you can track as a woman because it tells you what is going on with your ovary. And there should be, if your ovary is functioning correctly, there should be spikes and troughs and spikes and troughs and those should be regular. If that's not the pattern you're getting, something isn't right. And the other thing that you, that you, that you, that you, you, that you get out of tracking your temperature is you know exactly where you are. And there are a number

Starting point is 00:46:23 of people who have started to work on this. I know there are apps that are trying to help women optimize their training schedule around where they are in their cycle, et cetera. So I would say that to really optimize your health as a woman, it's really important to understand while your ovary is functioning. So before menopause, really where are you in your follicle development. So what happens is that day over day, these pre-folicles get pulled out of your ovarian reserve. So you're born with all of the follicles you can ever have. And they sit quietly waiting for their turn. And day over day, a certain number of them gets activated, like go, grow, turn into a follicle. And so at different stages of follicle growth and development,

Starting point is 00:47:04 they have a different role. Eventually, a lead follicle emerges. The other follicles who are kind of competing to be the lead follicle are told to die. So they undergo program. cell death in a process called atresia. And then something called the lead follicle emerges. And that is the follicle that will give rise to the egg that gets ovulated. And then to the post-ovulatory structure that produces progesterone and other factors that are important. So that follicle, even after the egg is gone, is still really important for our hormonal and metabolic and other function. So by seeing where you are in your temperature, you can get a sense of by the shape of that curve, are you getting enough estrogen exposure, is your follicle developing correctly? Where do you need to be supporting your

Starting point is 00:47:49 body? Because the way you eat, exercise, and manage your lifestyle while your follicle, your lead follicle is growing and developing is different than what your body needs on the way down to start to get ready for your period. And then also during your period. Wait, so as your temperature is rising, you should behave in a certain way. And then when your temperature spikes, you should behave in a certain way and then your temperature declines, you're kind of behaving a certain way? Yeah, so the here's, it's complicated, but I try to simplify it, which is that if your body temperature's going up, you need to do all the things that feed your ovary correctly. So your, your ovary needs oxygen, it needs energy, it needs to be protected from toxins and protected from stress. So when you are

Starting point is 00:48:34 on your way up, your ovary is in like overdrive, trying to make that follicle. And this is your one shot at your follicle for that cycle. And if we're not tracking temperature, like roughly this is after you're done with your period. If you have regular cycles, this is the starting day three of your period. Okay. When the follicle starts to grow. Okay. Through about day 14 post your period.

Starting point is 00:48:56 Okay. So day three through 14, you do the things that are really important for the growth of your follicle. And give me like three actual specific things. So I really manage carbohydrates and try not to open. overdue carbohydrates. I try to sleep well and I try to get exercise and I'm going to give you a fourth, which is heat. I was trying to think leading up to our conversation, what are some easy things that women can incorporate? Because this can feel overwhelming. The easy hack that I do is whenever

Starting point is 00:49:28 I'm driving my kids anywhere, I'm a total soccer mom and I drive them around. Whenever I drive them anywhere, I turn the seat heater on. Oh, I do that, period. My husband makes fun of me because it can be like 95 degrees outside. But I'm like, it's for my muscles. It's really relaxing. Well, it's for your ovaries too. It's for my ovaries. Okay, why? Yeah. Heat means blood flow. And so what you want to do is you want to increase circulation. Increasing circulation to your ovaries through exercise and through, I mean, you don't want to overheat yourself, but some heat exposure in a sauna, a warm bath, a heating pad, the seat heater in your car. Again, everything could be taken to an extreme. But in moderation, can help stimulate blood flow.

Starting point is 00:50:14 And that blood flow does two things. One, it brings energy, glucose to your ovary at a time when it needs energy, and it's very metabolically active. And it also takes toxins away. So we talk about these microplastics and things that are accumulating in that follicular fluid. You want to really increase the circulation in your ovaries. So we think about increasing circulation into our brain, pushing blood into our brain, into our hearts into our muscles. Just think about your ovary too. It also needs a lot. And so it needs a lot

Starting point is 00:50:41 during that period of time. I thought though, you said that we kind of want to be intense right before our period so that we don't have these symptoms. But you're also saying we want to do all this healthy stuff like when we're leading up to ovulation. So when do we get to like chill out and and have fun? Yeah. So I chill out and have fun. So that's when I might have an extra glass of wine. I might stay up a little too late. Wait, when? So I would see the safest window of time is from day 15 to day, this is for a 28-day cycle. Yeah. From day 15 to day 25.

Starting point is 00:51:18 Okay. You're being like extra healthy to mitigate symptoms of stuff was like literally right before them, like two or three days. Right before your period and the first day three through 14. Like put your eggs in that basket. Okay. Do you know what I mean? Like if you want to plan a bachelorette party with your ladies, like,

Starting point is 00:51:37 Do it those days. And remember, when we think about egg development, so this like pivoting now for women who aren't just thinking about their ovarian health, but are thinking about their egg quality, and because maybe they're going to undergo egg freezing and or they want to get pregnant or they're about to undergo IVF, what most women don't know is it takes over 300 days to make an egg. So that follicle, that lead follicle, has been in that competition, has been growing a little stopping, growing a little stopping, for 330 days. So if you're egg freezing and you're like taking

Starting point is 00:52:14 a supplement to help with your ovarian health or something like that, would you want to, in an ideal world, do it for 300 days before you would? If you want to full effect, yes. Wow. And this is where it's not fair because it only takes 90 days to make a sperm. Yeah. So when men are similarly freezing their sperm, we did our embryos and my husband was so whiny about like not saunine for 90 days. And I'm like, Well, I'm getting hormones shot into my body. Exactly. So again, what I don't want anybody listening to think is, oh, my God, I didn't teetotal for 330 days. It's more to empower you to understand that in the year, approximately year leading up to when you want your optimal egg quality, that's the time to get super healthy.

Starting point is 00:52:54 And by the way, when women are actually pregnant, they're the healthiest of their entire life. That's not what my friends make it sound like. Oh, really? Well, they're like, I'm throwing up every day. They're not feeling. Yeah, yeah, yeah. I mean more women are so disciplined. Typically, they don't drink, they don't smoke.

Starting point is 00:53:12 They're very careful about what they eat. It's often, it's actually, it's a really interesting thing. It's the number one way that most women find wellness, quote unquote. Yes. Which I find really frustrating because it speaks to this idea that women can only take care of themselves when it is for somebody else. Yes. But it is, you know, when people change their lives in that way. Yeah, I'm guilty as well, by the way.

Starting point is 00:53:31 That was totally means. Like, I did not think about any of these things until I had trouble getting priestly. and then suddenly it completely turned everything around. So what I argued a woman is, look, when you're pregnant, there's no question you're going to make these changes. Why not make them the 300 days before so that you're giving your offspring the best possible egg when you do get pregnant? Because what we know is that if that egg is not optimal, you can do everything right

Starting point is 00:54:00 during your pregnancy, but your child will still be at risk for certain things. So I think that's another thing we get wrong is we don't really empower women in the lead-up to trying to get pregnant. I think once they are trying to get pregnant and they're struggling and or they're pregnant, then we suddenly throw all these tools and all this information at them and they take it on board. Why not educate them that their egg quality, it's a 330-day process leading up to the point that the egg is fertilized. Okay, going back to the endo PCOS conversation, especially if you are having symptoms that like, three to five day window before is really, really important. And then this other time, this lead up to when your temperature is rising, that's more important for if you're trying to kind of like go the extra mile and take care of your ovarian health, correct? Yes. Okay. Is there anything else that you

Starting point is 00:54:47 would say to somebody who is dealing with PCOS or endometriosis? One question I have is what do you think about hysterectomies and other sort of surgically based treatments? I think women have to follow medical advice, first and foremost, and there are women who are at risk for certain types of cancers, women who are experiencing difficult fibroids, for example, that can't be treated or very heavy bleeding that impacts them in other ways. So what I don't want to do is say, don't listen to your doctor. But having said that, hysterectomy is the most common surgery that women undergo. We routinely remove this organ, the uterus from the body. And medical texts, I love collecting old medical texts. When I go into antique bookstores, I always look for a hundred-year-old medical books.

Starting point is 00:55:34 And one thing is common throughout these medical textbooks, which is, you know, the womb is only for babies and not for anything else. So endometrium is that really active lining that is where the baby implants and embryo implants and where the baby grows, but also is what comes out when you menstruate. Turns out indometrium, that tissue has other functions other than just growing a baby. And we're just at the beginning of understanding what those functions are because I would say that the uterus is probably even more neglected than the ovary. It is not as vital of an organ. You cannot compare the uterus to a gonad. However, I want to hold on to mind for as long as possible. And what we shouldn't do is rush to say to women, oh, you've already had kids, you don't need them. It's not just a uterus that we say that to women, not me, but physicians often will say, while I'm in there, should I just, take your ovaries out. I can't tell you how many women have had that offered, but certainly a much larger percentage of women who go and talk to their gynecologists in the first conversation where they're saying, hey, I'm having some issues. So many gynecologists are so quick to say, well, let's just do a hysterectomy. And so I probably get, just through my network of, you know, for a second, third

Starting point is 00:56:48 degree, friends and acquaintances, I probably get a call a week from a woman in my extended network saying this is the organ that the physician wants to remove from my body, what do you think? And sometimes they go through with it, but they go through with it at least empowered with what the risk factors are that they're taking on by doing that and balancing that with what they're mitigating. But oftentimes they have the tools to go back to their doctor and push back and say, well, we haven't tried these other things. I'm not ready to let go of my organ yet. And that's something that generally I find very frustrating that women's health and how we manage the health of women is at a place where so often women lose their body parts. One of the things that I do

Starting point is 00:57:31 when I give talks now is I start off by saying, raise your hand if you know a woman who has lost a body part surgically. And virtually every hand in the room goes up. I'd raise my hand. Yeah. I've lost some. And this could be breasts. It could be ovaries, fallopian tubes, uterus, you name it. And then I say, okay, now keep your hand up if you know a man who has lost the body part surgically and very few hands stay up. That's a problem. I'm genuinely confused how master class gets literally the absolute top people in every single field to teach every single one of their classes.

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Starting point is 01:03:34 That is branch basics.com and use code Liz Moody. What about eating gluten or dairy free or are there any other like little tweaks for somebody listening who's dealing with Endo, dealing with PCOS that like you found has an outst? size difference. So again, it has to be personalized. I deal very well with gluten. I come from Turkey originally, Mesopotamia. We invented wheat. Just kidding. But agriculture started in the part of the world that I'm from genetically. My body tolerates gluten very well. There are friends of mine, often this is friends who come from northern European areas, et cetera. They don't deal well with gluten. So what I would say is that you need to understand what your triggers are from an

Starting point is 01:04:19 inflammation standpoint. For me, my kryptonite is sugar. It's the worst for me. I gain weight. I have very painful periods. I have all sorts of things that happen and go wrong with me. If I eat, you know, if I take my kids to the cinema a bunch and eat candy and if I basically live like a child for a couple of weeks, my body starts to fall apart. So I try to educate my children to not live that way, but I certainly at my age cannot consume those things. So for me, it's sugar, but I'm fine with dairy. I'm fine with gluten. For other people, they absolutely cannot have dairy. They absolutely cannot have gluten. And so I'm not going to tell somebody that they should or should not be gluten-free. What I will caution them is what are they replacing the gluten

Starting point is 01:05:04 with? And this is not, people who have celiac disease, that's a different, that's actually medical is you cannot be exposed to gluten. I'm talking about people of gluten sensitivities or who have figured out that they get inflamed. What they need to be careful about is, okay, so you're taking the gluten out of your diet, but a lot of these gluten-free products or dairy-free products then have other ultra-processed additives. So you compare a homemade loaf of bread that came from whole wheat where there was very little processing to a gluten-free product that might be ultra-processed. And you're not necessarily, you might be trading the anti-inflammatory aspects of managing gluten with suddenly all these pro-inflammatory molecules you're putting in your body because you're eating ultra-processed food.

Starting point is 01:05:47 So I think you just have to be careful when you're navigating those food sensitivities. Does taking the birth control pill or being on an IUD doing something that prevents ovulation, does that extend our ovarian health? Unfortunately, it doesn't. Why not? What's happening there? Folliculogenesis, let's talk about that process again. So 330-day process.

Starting point is 01:06:09 The final step of it is what is blocked by birth control and the IUD. So birth control and the IUD, in fact, every medication that we have that exists on Earth today can only impact the last 30 days of folliculogenesis. We don't have any medication that can accelerate or slow down the earlier or fixer impact kind of early folliculogenesis, with the exception of the emerging modality. with GLP-1s and metform and things like that for people who have PCOS. But what that means is just because you're stopping the process here doesn't mean that that recruitment of early follicles, which is how you deplete your ovarian reserve, stops. So you're just preventing the lead follicle

Starting point is 01:06:53 from emerging and ovulating. You are not stopping the decline in ovarian aging. What about pregnancy? Does pregnancy put a pause on it? Yeah. No, it's the same. You get an ovulatory block That's annoying, but it doesn't put a pause on it. The only things you can do to extend your ovarian age is to fully manifest your full ovarian potential. That's it. So that means not taking away from your ovarian age. What takes away from your ovarian age? Smoking, exposure to pollutants, environmental toxins, like we were talking about,

Starting point is 01:07:27 microplastics, things like that, having chronic inflammation. One of the things that happens to ovaries as they get older or ovaries that, have PCOS is fibrosis. So fibrosis is like scar tissue. So when we talk about follicular development, you actually have these cells that have to expand and grow. And then you have this tiny little organ, which is the size of an almond. And it has to grow this like pretty big kind of extension on it. So if your organ is getting fibroatic, if it's starting to develop scar like tissue and it's not as flexible anymore. It's harder for those follicles to break out. And as the ovary stiffens, either because you have a condition like PCOS early in life or as your ovary starts to harden as

Starting point is 01:08:13 you get older, it just disrupts the whole thing. And so anything that promotes inflammation, promotes fibrosis and accelerates that aspect of the aging as well. What about things like IVF or freezing eggs or embryos or things where you're hyper-stimulating your ovaries? Is that going to have an impact on ovarian health? No. So good news, bad news. Those drugs also only impact the last 30 days. Okay. So we really, whatever we're doing, whether we think we're getting more eggs, we're not, what we're doing with those fertility drugs is we're just saying, you can all grow. So what I was saying is that the ovary sends a signal to the other follicles saying we have a lead follicle, we're good. We're handled for this month. All of you follicles die now. Those fertility drugs bypass that and say,

Starting point is 01:08:55 no, no, 12 of you can live. It's fine. You can all become the lead follicle. but it doesn't do anything about that early process. And so you're still continuing to decline. So going back to the things that our ovaries are impacting that we're not talking about. We talked about brain health. We've talked about metabolic health a lot. They also impact our bone health, correct? For sure.

Starting point is 01:09:13 What's the mechanism of action there? So, again, none of these things are perfectly studied. And typically when they are studied, they're studied through the lens of estrogen. And so what we know is that, first of all, our bones are breaking down all the time and being rebuilt all the time. It's a constant process. and osteoporosis and bone fractures, things like that, start to accumulate when that process becomes out of balance where the breaking down of the bone overpasses the rebuilding of the bone. Estrogen is a key signal for that and estrogen is a key genital hormone.

Starting point is 01:09:46 And so if you are not producing enough estrogen, then it disrupts the balance of the bone being rebuilt as it's being broken down. And so when you're going through perimenopause and your estrogen levels are kind of all over the place and your body is adjusting to that, you lose like 10% of your bone density in the last five years of perimenopause on average. So it's something that women have to really regulate and what can they do? They can have more calcium in their diets. That's really important. And dietary calcium is more effective than taking like a calcium. Yeah, I've heard mixed reviews on calcium supplements. I don't take them. I don't recommend them because they can have other issues.

Starting point is 01:10:26 they can calcium is also it forms those you know those blood clots that break off and cause strokes and stuff they have oftentimes they have calcium in them and so I think it's a little I really think getting it through yogurt um you know I say yogurt or cheese because it's like it's like really concentrated down milk basically so it's it's a denser form you have more calcium and something like a yogurt or a milk that's denser or yogurt or a cheese rather than just drinking milk also people like being told to eat cheese. Yes, eat more cheese. But if you can't have dairy, there's other sources so you can get it from certain fruits and vegetables. So having calcium is important, but also weight-bearing exercise and jumping. So I love dancing and running. These types of things where

Starting point is 01:11:14 you're kind of pounding your bones and or lifting heavy things. So people, you know, chivalry isn't dead. There's still guys out there who will offer to carry a heavy thing for me. My two boys, being among them. And whenever people ask to carry something heavy, what I say to them is, no, I'm staving off osteoporosis. Thank you so much. That's my part of trying to normalize the conversation. But take advantage of every opportunity to carry something heavy. Now, don't tweak your back in the process, but don't avoid, again, like we were saying, put the seat heater on, carry the groceries in from the car. It's important. It's weight-bearing. You can't get to the gym. that's fine. Find other things that are weight-bearing. Are there tests that we can take to know how

Starting point is 01:11:59 healthy our ovaries are at any given moment? Yes. So there are a number of things you can do. One, you can track your basal body temperature that you can do pretty much for free. If you have a thermometer and a notebook, you can track it. And that we're just looking for the pattern of like rising and falling. You should see a regularity in that. It might not be a perfect 28-day cycle for everybody. That's fine. I wouldn't worry about that. But what you want to worry about is when you don't see a regular pattern of rising and falling. So that's one measure of ovarian health. The other is you can look at your anti-mularyin hormone levels. Antimularyan hormone is a key ovarian hormone that is produced by growing follicles. And so there's a regulatory loop where growing follicles, the ones that are

Starting point is 01:12:47 competing to be the lead follicle, they produce antimularyan hormone, AM8. And then as levels get high, AMH actually circles back, puts the brakes on that process and says, we have enough follicles right now. Thank you. So it's a circle. When your follicular reserve, those cells that you're born with, when that starts to get lower, your AMH levels get lower too because you have fewer follicles that are developing and you don't have to put the brakes on as hard to keep it under control. And so tracking your AMH levels is actually really important. You have to be a little careful in your 20s. When your ovaries very active, your AMH can kind of go up and down. It's more about tracking it over a couple of years and getting a baseline, but if you have very high AMH or you have very low AMH, that could be an issue. If you have very high AMH, that could be a sign that you have PCOS, and that would be something that would accelerate the conversation with the physician. If you have very low AMH, that could be a sign that you're at risk for early menopause. And what is low and high mean? Do you agree with like the cutoffs? Yeah, the cutoffs. Generally, if you are below a one,

Starting point is 01:13:51 for AMH or above a six, you probably need to have a conversation with a physician. Okay. Those are like the main test. Are there any other tests that we would? You can look with ultrasound, but you typically have to go to a fertility specialist, and then they can count how many of those growing follicles can be visualized, because once they get big enough, you can actually see them. And so an ideal ovary has between, you know, two and 12 of those. If you have much more than that, you may have PCOS. if you have younger than that, then you may be at risk for early menopause. Are there other more out there things that you are doing on your own perimenopause journey

Starting point is 01:14:30 based on the research that you've conducted? Yes. I'm not ready to talk about them yet, but I will tell you that I was really struggling with some aspects of perimenopause. I did not ovulate for four months. and my son sadly had a ruptured appendix and I was in the hospital with him for two weeks and I was sitting there just looking at the fact that my ovary had flatlined and I thought you know my my Instagram handle was boss ovary and I thought I literally am like boss ovary I am

Starting point is 01:15:05 I've been researching this stuff for my whole career am I just going to go down without a fight and so I have implemented a protocol and I've been having normal 28 day cycles since I implemented that protocol. I'm not ready to talk about it yet. Can you give us, you got to give us something. Like, you don't have to give us the whole thing, but you got to give us something. It is back to the piece about the metabolic control. So I did something more extreme than just a diet to implement some metabolic changes and it has reactivated my ovary for now. The reason that I want to, I don't want to talk about it is it is really cutting edge. I was at a medical conference in my field saying, you know, what inspired me to try to work on this is that I have been researching

Starting point is 01:15:45 ways to extend ovarian function throughout the lifespan pharmacologically, so creating drugs that would keep the ovary from dying during our modern lifespan. But people would ask, well, are those going to benefit you? Are they going to benefit people my age? And I would say if you're under 33, it'll probably benefit you, thinking about how long it takes to bring a drug to market. If you're over 33, you're going to go into menopause. There's other companies that are working on stem cell treatments, which might be a hope for those of us who are older. But I pretty much just said I'm doing this for my daughter. But then I was staring down the barrel of an ovary that wasn't working anymore. And I was sitting in this hospital room and there's a crash cart. And these crash carts are like when the heart stops working and

Starting point is 01:16:25 you know, you push a button and they run in with paddles and things like that. And I thought, is there anything we can do for a perimenopausal ovary that has just stopped for a minute? Can we kind of put the equivalent of the paddles on it? And so I went to this medical conference around that time when I started to implement this protocol. And I started to ask people, like, these are the top experts in the field. What would you do to jumpstart a perimenopausal ovary that was just on the doorstep of menopause? And they were like, they didn't know how to answer the question. Yeah.

Starting point is 01:16:57 So I finally was one expert, I said, if I locked you in this, it was Paris. And there were no air conditioners in any of the restaurants in Paris. And it was like so hot. It was like a sweat lodge in this restaurant. And I said, if I locked you in this restaurant with this temperature and did not let you leave until you told me how you would jumpstart the ovary. What would you do? And he said, well, I would try to figure out a way to just really push a lot of blood into the ovary. And we think about things like PRP injections, have been helping some women get pregnant who weren't able to produce

Starting point is 01:17:26 follicles prior to that. So it's early days in trying to understand. But what was fasting to me, the reason I'm telling you this is that no one is working on this. And so for me, I have my end of one in my own body. And I do, if this does continue and I'm able to maintain. healthy cycles, then it is something that I do want to have a study and let's do this at scale and make sure that the benefit. And you'll come back and tell us. And I will come back and we'll do round two, I promise. Okay, so you can't recommend your secret protocol. But knowing what you know, with all of the research that you've done, what do you think we're missing in terms of how we are approaching perimenopause? I think what I have had to learn the hard way is that we cannot eat in

Starting point is 01:18:09 perimenopause and beyond the way we ate up until perimenopause. And this goes for everything. This goes for alcohol. This goes for anything you put in your body. If you were someone who is used to going out with your friends and having a couple of margaritas, maybe you have a soda or two, you have a high degree of carbs. You're not really getting a lot of fiber. You're not eating enough protein. You are going to accumulate significant issues. It is going to be a potentially rough. I mean, you might have one of the genetic lottery and you might be able to throw everything at your body and you're just fine. But if you're the average woman and you're eating and drinking the way you in your 40s, the way you did in your 20s, most likely you're going to have a plethora of issues in

Starting point is 01:18:56 perimenopause, you won't necessarily connect it to that. But I would say the earlier you start, the better because we talk a lot about why women need hormone therapy after menopause when their ovary is not working and they don't have estrogen and enough estrogen in their body and they don't have enough testosterone and progesterone, et cetera. And the risk of that, what we don't talk enough about is just the roller coaster that the body goes through during perimenopause is itself a disease that leaves a long lasting mark. So if you're having all these issues in perimenopause and you are not figuring out a way to get them under control for your organs to be going through that swing, one of the things that we say in the healthcare field is you're only as

Starting point is 01:19:42 healthy as your least healthy organ. And what women in perimenopause need to understand is whatever you thought was your least healthy organ, it is now your ovary. What do you think about hormone replacement therapy? I think it is vital. Do you think people should be approaching it any differently, starting it earlier? After menopause, all women definitively don't have enough of these factors in their body. So replacing them make sense. The challenge with perimenopause is, again, it has to be personalized. For some women, the issues they're having during perimenopause, why they're having these symptoms is because they don't have enough of these hormones. For some women, they have too much of these hormones because their ovary is kind of overproducing,

Starting point is 01:20:20 underproducing, overproducing. And so some of them actually have to be put on blockers. So some women need to be on testosterone blockers, things like that. So what I would say is that is really important to get to a menopause specialist as somebody who really can work in that nuanced way. So there's not a one-size-fits-all, like every woman should be on HRT earlier. The other thing I will say is that estrogen is a misnomer. There are at least six estrogens. And they rise and fall. One of my favorite new estrogens just came on the market in Europe. It's called E4. It is a fetal estrogen that now is synthesized. They don't, they don't derive it from fetuses, but it is one that the fetal liver produces this. We don't understand what makes this special,

Starting point is 01:21:04 but what we do know is it doesn't go to the breast and it doesn't get metabolized by the liver. And a lot of the issues that women have side effects with birth control and with hormone replacement, which is pretty much the same drug at different doses, is because of what the liver does with this. And also they're worried about breast cancer. So what's really exciting is they've just launched E4 as a contraceptive estrogen in Europe, and they're going to launch it as a hormone replacement. So I'm very excited to see the data accumulate around that. But the big thing is that if you're having symptoms, they're not just symptoms. They're indications that something is going on with your body on an organ level

Starting point is 01:21:40 and you should seek treatment for those things. Yes, and you should have at least the hormones that we do know how to manage and balance. You should have a conversation about that. But remember, when you're thinking about hormonal balance, include insulin and melatonin on that list. So there's estrogen, progesterone, testosterone, thyroid on that list, thyroid hormone. So when you're having these issues, you really should find a menopause specialist who's going to check your thyroid function, who's going to check your insulin resistance and how you're doing with your metabolism, who's going to ask you questions about sleep. You can't just, unfortunately, the melatonin you buy at the grocery store is not as good as the melatonin that your brain makes when you're able to protect your sleep.

Starting point is 01:22:22 But what I'm saying is that remember that there are a number of hormones that are becoming dysregulated, cortisol, your stress hormone. So make sure that you get to a menopause specialist who's going to have a long conversation with you about all of the factors that you need to start to manage. And it might not just be adding more of these hormones. It might be suppressing. So for example, if your testosterone is too high, that might be causing some of your issues. What's one piece of advice that you would give to parents of children who are maybe going through puberty or about to enter puberty who want to help protect their ovaries and maybe help prevent things like PCOS and endometriosis? So I think the number one thing is to track the data. Every girl, eventually every woman, has to become an expert on her own data. So get her the tools. There are many different ways to do it now to track her basal body temperature. I think that that is key. With knowledge comes power. Once you know what your cycles look like, you can more quickly identify if you have PCOS if your cycles are looking really irregular, et cetera. And also you can really control when you should. be more disciplined about your diet, things like that. So I think that's probably the simplest thing

Starting point is 01:23:35 that you could do that would make a big difference. It's surprising how few women still, even though we have these tools and these apps, actually track their cycles. One piece of advice for somebody who is going to get pregnant or maybe struggling with their fertility. So one piece of advice for someone who's trying to get pregnant and struggling with their fertility is you are going to get there. I know that that feels really tough to hear when you're not there yet. But what I will say is I have been helping people navigate this. And there are so many different journeys to parenthood. And I say that because I often think that people start to run out of their emotional credit

Starting point is 01:24:08 card before they run out of their financial credit card. And I think it's really important for people to have faith that I'm going to get there. My journey is going to be unique. Now, to help maybe make your journey less frictionful, but also remembering that sometimes you can do all the right things and it still doesn't work, I really, I'm going to circle back to diet and sleep. I think the biggest thing you can do to give yourself the best shot at having the least bumpy fertility journey is really to eat better than you've ever eaten in your life, sleep better than you've ever slept in your life.

Starting point is 01:24:38 What about pregnant women? For pregnant women, I think all the things that we talked about inflammation are just as important during pregnancy. There are conditions like preclampsia, gestational diabetes, etc. So I know that pregnant women struggle with, you know, they often have difficult. eating early in pregnancy, then they have difficulty controlling eating later in pregnancy when they're having cravings. You really have to be disciplined about what you're putting in your body. It's not just about your baby. It's about protecting your heart health. It's about protecting your own brain health, et cetera. The other thing that I will do is put in a plug for ovarian

Starting point is 01:25:12 health. If you don't know if you're having a boy or girl, or if you know you are having a girl, the most important window of time for her ovarian health is between week 14 and week 16 of the pregnancy. So for me personally, when I found out I had a daughter, I was in complete lockdown. I did not travel. I made sure that I could control what I was putting in my body and what I was exposed to during that two weeks. Some people may say that that's extreme or fear mongering, but that is a period of time when

Starting point is 01:25:38 that little fetal ovary is getting set up. And so your daughter's age of menopause, all these things we've talked about, might be impacted by the decisions you make between week 14 and 16. Women in their 30s. Women in their 30s, I think, overestimate how much time they have left. And this isn't to worry people, but it is kind of to worry people. I talk to so many women who are in their mid to late 30s who still feel like they have a lot of time. From a fertility standpoint, they don't.

Starting point is 01:26:05 And so to the extent that they want the option of having families later, they really need to be talking to somebody and being proactive and freezing their eggs. And they have to start implementing some of these lifestyle factors. Because remember, when I decide to go into complete lockdown on my health, it still took me three, four, five years to really build those habits. your health and midlife really is impacted by the decisions you're making in your 30s. Women in perimenopause actively. Women in perimenopause actively, I think, should really track their glucose.

Starting point is 01:26:33 I think that has been the biggest hack for me. Understanding what impacts my glucose. And trying to avoid the spikes in the falls. Yes, and it's not just about the spikes. That's the thing. People don't think about the hypoglycemia. And sometimes it happens in your sleep. And you cannot detect that if you're going into the doctor

Starting point is 01:26:48 and just getting a single sugar test as part of, of an endocrine workout or as part of an annual exam. We're a glucose monitor for a couple of weeks and see what's going on with your body. Check back in again in a couple of months, years. But understand how your metabolic health is tracking because that is, I think, the biggest tool that you have control over as you're going through perimenopause. And then postmenopausal women. Postmenopausal women, hope is not lost.

Starting point is 01:27:16 What you need to realize is that when you don't have the ovary as the conductor of the orchestra that's helping to regulate and facilitate communication across your organs, you have to do the extra work for it. So that means you have to really protect your sleep, you have to really be disciplined about exercise, your bone health, all of those tips that you get told. If you mitigate those things, you are protecting your body from chronic disease, you are, and definitely seek out hormonal therapy.

Starting point is 01:27:46 I think that that's a no-brainer for women after menopause. I think they have to at least go have the conversation. And there's a small subset of women that maybe are at risk if they go on HRT. But I'd say 99% of women, it is just a definitive positive for them. They should go and have a conversation with their physician. Priya, this was absolutely fascinating. Can you leave us with one final message, some shift that you want us all to have in the way that we think about our health and the way that we think about our ovaries? Yes, I think we just need to see them as a vital organ and that there's nothing natural about menopause.

Starting point is 01:28:17 And we have to fight on a policy level. We have to do more research. We have to have more solutions. And we have to really care about trying to get the maximum lifespan that we can until innovation catches up and gives us tools to go beyond. It's not a nice to have organ. It is a vital, vital organ. And I want people to love their ovaries and take good care of their ovaries and talk about

Starting point is 01:28:39 it more. Thank you so much for the research that you're doing and for all of the information you shared with us today. Thank you so much. Thank you so much for tuning into this episode of the Liz Moody podcast. If you enjoyed the episode, go ahead and follow on Apple or Spotify or subscribe on YouTube and hit that notification bell so you never miss a new episode. And if there's somebody in your life you think would benefit from this episode, send them a quick link. It is the best way to support the podcast, and it is so, so appreciated.

Starting point is 01:29:06 And if you're watching this, drop me a comment. I would love to hear your thoughts and what resonated most with you. Thanks again for being here. I feel so lucky that I get to grow and learn and share with you. And I will see you on the next episode of the Liz Moody podcast. Oh, just one more thing. It's the legal language. This podcast is presented solely for educational and entertainment purposes.

Starting point is 01:29:28 It is not intended as a substitute for the advice of a physician, a psychotherapist, or any other qualified professional.

The Liz Moody Podcast - The Hidden Root Cause of Aging Faster, PCOS, & Endometriosis (+ Exactly What To Do About It)

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