Podcasts about mirena iud

In this popular episode, Dr. Talat Uppal, an obstetrician-gynecologist specialising in heavy menstrual bleeding, shares her expertise on a condition affecting one in four women yet rarely discussed openly. This eye-opening conversation sheds light on how women often normalise suffering through periods that drastically impact their quality of life.The discussion reveals shocking statistics: 25% of women experience heavy menstrual bleeding, yet more than half never seek medical help. Dr. Uppal provides clear indicators of abnormal bleeding – passing large clots, changing protection every 1-2 hours, waking at night to change, using multiple protection types simultaneously, and embarrassing "flooding" episodes. These symptoms can lead to iron deficiency, anaemia, and significant quality of life impacts.Learn about the spectrum of treatment options, from medications like Tranexamic Acid to the highly effective Mirena IUD and surgical interventions including endometrial ablation. She emphasises that most women find significant relief once properly treated, with many asking, "Why didn't I have this earlier? Why did I suffer so much?"Perhaps most powerful is the exploration of how heavy bleeding becomes normalised at multiple levels – by women themselves, healthcare providers who don't offer full treatment options, and society that suggests women should simply endure until menopause. This normalisation condemns many to years of unnecessary suffering when effective solutions exist.The conversation offers practical advice for women seeking help, emphasising the importance of advocating for yourself and being knowledgeable about available options. Have you been suffering in silence? This conversation might be the catalyst for transforming your quality of life. Listen, learn, and advocate for your menstrual health.ResourcesWomen's Health Road Clinic - websiteWomen's Health Road - InstagramWomen's Health Road - LinkedinThank you for listening to my show! Join the conversation on Instagram

Endometrial ablation has become a cornerstone procedure in the treatment of abnormal uterine bleeding, but is it the right solution for every patient that meets the indication? In this episode of the BackTable OBGYN Podcast, Dr. Ted Anderson from Vanderbilt University joins host Dr. Mark Hoffman to discuss the evolution of endometrial ablation and its contemporary utilization, including patient selection, technical considerations, and alternative treatments for abnormal uterine bleeding. --- SYNPOSIS Dr. Anderson begins by detailing the history of abnormal uterine bleeding alongside the evolution of the endometrial ablation techniques that have been used to treat it. Shifting focus to current day practice, he then shares his approach to endometrial ablation, covering patient selection and the technical aspects of his approach. Throughout the conversation, Dr. Anderson emphasizes the importance of how we define success in endometrial ablation, explaining that eumenorrhea (normal bleeding that no longer interferes with life events) is the goal, as opposed to the more traditional view that amenorrhea is the target outcome. The episode closes with a discussion on the role of alternative treatments, such as the Mirena IUD and hysterectomy for abnormal uterine bleeding. --- TIMESTAMPS 00:00 - Introduction 09:29 - History of Abnormal Uterine Bleeding and Endometrial Ablation 23:31 - Evolution of Endometrial Ablation Devices/Techniques 31:11 - Selecting the Right Patient for Ablation Success 34:38 - Post-Tubal Sterilization Ablation Syndrome 38:27 - The Role of IUDs in Managing AUB 44:07 - Reevaluating Endometrial Ablation Success Metrics 49:55 - Innovative Ablation Techniques: Cryoablation and Steam 51:48 - Adenomyosis and Fertility-Sparing Treatments 57:28 - Final Thoughts

Kait and I did a fun Q&A session where we dive into all sorts of topics, from weight loss strategies to our personal fitness routines, nighttime eating, and how cortisol plays a role in your progress. We also talk about our fitness routines and share our stories and our plans for the future.In this episode, we discuss: [00:00] Intro[00:29] What's in this episode[01:15] Should hormone tests be done at a certain point in your cycle?[02:06] Kait and Mav's biggest insecurities[06:42] Will the Mirena IUD give false hormone test results?[08:12] Things Mav and Kait can't live without[10:05] Should you focus on fat loss or maintenance first?[14:45] When is the wedding?[15:10] Mav's vasectomy reversal journey and future family plans[20:28] Thoughts on using Berberine to assist with weight loss[21:09] Does cortisol impact weight loss?[23:35] A listener's weight loss journey[24:53] Learning through failure and continuing the journey[27:31] Mav's first meeting with Kait's parents[29:58] Do Mav and Kait work out together?[36:16] Sunday routine and work-life balance[37:22] What would Mav and Kait be if hormones were a personality?[38:30] Does glycemic index of food matter?[40:34] How does lots of sex affect hormones?[42:20] The evolution of Mav's personal style[46:00] Managing nighttime eating[49:42] How is SLAE doing?[54:34] Opinion on WeightWatchers[57:55] The biggest misconceptions around calorie tracking[59:04] What to do if weight loss stalls after months of effort?[1:02:36] Closing remarks ResourcesIf you are ready to lose 25+ lbs. and make the “after” photo last forever, click to learn more about SLAE Online CoachingKait's IG: @kaitannmichelleKait's Youtube: KaitDoesPsychMaverick's Instagram: @maverickonlinecoachingMaverick Online Coaching on Facebook: MOC FREE COMMUNITYSLAE on Instagram: @slaehormonesolutionsWebsite for SLAE Hormone Solution: https://slaehormonesolutions.com/ Website for Maverick Online Coaching: https://maverickonlinecoaching.net/coaching Hosted on Acast. See acast.com/privacy for more information.

Dive deep into the importance of integrative and preventive healthcare with Michele, CEO and co-founder of FemGevity. They tackled systematic barriers to women's health and how the healthcare system often overlooks these needs—particularly in perimenopause and menopause care. Learn actionable tips on balancing hormones, comprehensive health testing, and integrative solutions that can help you live your longest, most vibrant life yet. Tune in to take charge of your health today with confidence and clarity.If you have any questions about this episode or want to get some of the resources we mentioned, head over to LesleyLogan.co/podcast. If you have any comments or questions about the Be It pod shoot us a message at beit@lesleylogan.co. And as always, if you're enjoying the show please share it with someone who you think would enjoy it as well. It is your continued support that will help us continue to help others. Thank you so much! Never miss another show by subscribing at LesleyLogan.co/subscribe.In this episode you will learn about:The necessity of an integrative approach to women's healthcare.FemGevity as an accessible service prioritizing women's health. The importance of comprehensive hormone and microbiome testing.Failures of symptom-based treatments, especially in menopause care.Systematic barriers and the need for innovative healthcare solutions.Why women need community and safe space to discuss vulnerabilities.Episode References/Links:FemGevity InstagramFemGevityFemGevity TIkTokFemGevity LinkedInEve by Cat BohannonGuest Bio:Michele has expertly crafted her career niche within the healthcare sector, accumulating over 18 years as a strategic healthcare executive. Armed with an MBA in Healthcare Management from Northeastern University, Michele excels in aligning women's healthcare services with contemporary needs and expectations. Her contributions have been nothing short of revolutionary, particularly in introducing innovative women's health testing to New York City's leading physicians. Her focus spans molecular genetics, cancer biomarkers, and PCR Testing, making a significant impact in the medical community. Michele's professional journey has seen her in influential roles within Fortune 500 companies like Labcorp and Quest, but her prowess shines brightest in her role in smaller, specialized laboratories. Notably, she achieved remarkable success in expanding her client portfolio to an impressive $40 million in New York City. Michele's leadership extends beyond diagnostics and into innovation. She spearheaded the implementation of the first saliva-based COVID-19 PCR test in the New York Metro area, demonstrating her pioneering spirit. Her entrepreneurial flair is further evidenced by her role as the co-founder and CEO of FLOW Dental, a thriving multimillion-dollar cosmetic dental practice. This multifaceted career showcases Michele's unique blend of strategic vision and entrepreneurial acumen.  If you enjoyed this episode, make sure and give us a five star rating and leave us a review on iTunes, Podcast Addict, Podchaser or Castbox. DEALS! Check out all our Preferred Vendors & Special Deals from Clair Sparrow, Sensate, Lyfefuel BeeKeeper's Naturals, Sauna Space, HigherDose, AG1 and ToeSox Be in the know with all the workshops at OPCBe It Till You See It Podcast SurveyBe a part of Lesley's Pilates MentorshipFREE Ditching Busy Webinar  Resources:Watch the Be It Till You See It podcast on YouTube!Lesley Logan websiteBe It Till You See It PodcastOnline Pilates Classes by Lesley LoganOnline Pilates Classes by Lesley Logan on YouTubeProfitable Pilates Follow Us on Social Media:InstagramFacebookLinkedIn  Episode Transcript:Michele Wispelwey 0:00  You have three options in mind, you need to either accept it, change it, or leave it. And you need to pick your path. And whatever that situation may be, whether it's a fight with a partner, how you feel about your body, if you're having health issues, you have those three distinct options in life. And be very clear which one you choose, accept it, change it, or leave it. I think you change it.Lesley Logan 0:29  Welcome to the Be It Till You See It podcast where we talk about taking messy action, knowing that perfect is boring. I'm Lesley Logan, Pilates instructor and fitness business coach. I've trained thousands of people around the world and the number one thing I see stopping people from achieving anything is self-doubt. My friends, action brings clarity and it's the antidote to fear. Each week, my guest will bring bold, executable, intrinsic and targeted steps that you can use to put yourself first and Be It Till You See It. It's a practice, not a perfect. Let's get started.  Oh my gosh, you guys get ready. This conversation went everywhere, everywhere, ladies, in all the best ways. And to be honest, like, I knew I wanted to have her on the show. But then we got into talking and I was like, oh, we're gonna have a conversation. So we get down and dirty ladies about women's health and holistic health and signs and symptoms that people are getting confused and what doctors are doing and just all about, well just you know how to have ease in existence, right? Like everyone talks about find your purpose, but like sometimes you can know your purpose and it's not easy. And ease of existence can comes from like having really awesome balanced health and wellness. And so Michele Wispelway of FemGevity is our guest today. Get ready, ladies, this is a good one. So here we go. All right, Be It babe. I'm super excited to finally get this interview going because I was so excited when I met Michele Wispelway, our guest today, to talk about what she's just excited to talk with you about. And then you know my life. We all got a little bit busy. And so what's so fun about it happening today is this is the exact day that you should be hearing it. It's the exact day we should be talking about it. So Michele, will you tell everyone who you are and what you rock at? Michele Wispelwey 2:22  Yes. Hi, everyone. I am Michele Wispelway. I am CEO and co founder of FemGevity Health. We are a female longevity medicine and focusing on menopause and perimenopause treatments. I'm also a mom. I'm an aunt, I'm also I'm a sister. I'm lots of other things. But you know, my sole purpose here today is that, CEO of FemGevity. Lesley Logan 2:45  Okay, so that is really cool. Our ears are all perked up at female longevity and all the things. So I guess how did you get into that? Because I don't know, maybe you grew up going I'm going to be in medicine with female longevity, or I don't know, did you stumble upon it? What was the impetus to it?Michele Wispelwey 3:03  Yeah, so I, my background was always, I guess from if you want to kind of go back to just college years, right? And what I want to do, and I really wanted to be on the science back end of like diagnostics, and I love the innovation in medicine, and being able to work with doctors to collaborate different type of treatment plans on how their patients live healthier. And that was, really quickly, I learned that that just wasn't the reality of our healthcare system. It was driven by a payer system. And and there's very limited on what women are offered opportunity wise, especially if you are not, you know, top of the echelon of the income be able to pay out of pocket. And through my journey of with my lab background, I really got to see and dig in deeper on like, what I wanted for myself, and what I think other women would want for themselves. So that's what really long story short led led me here. And I also have a very personal journey where my mom actually was really gaslit for many years on what, she had symptoms, what she was told that were just menopause really, actually they call it go and you're just going through your changes.Lesley Logan 4:23  I do recall my grandma was going through her changes. Michele Wispelwey 4:27  Yeah, isn't that so tacky? You know, it's like when men said oh, she's on the rag. It's like that type of crap.Lesley Logan 4:34  Yeah, it is that type of crap. It's just like, can we just call it what it is? It has a name. Michele Wispelwey 4:39  Yeah, yeah. So my mom actually passed away at 51. Lesley Logan 4:44  Oh, my gosh that's so young. Michele Wispelwey 4:45  Yeah, yeah. She was misdiagnosed for years. And she had a lot of spotting and what appeared that it was her changes and fibroids and that is exactly where we still are today with a lot of doctors, majority of doctors, you know, 80% of them have no training on hormones and perimenopause and menopause and just how it affects women's longevity, ovarian preservation, metabolic, you know, cancer prevention, things like that. So I have a few, you know, caveats that have brought me to where I am today. And I think as a little girl, I was always very, I guess you would say neurotic, where I was always like, nervous and like health conscious and, and stuff about like germs. You know, like, I peed my pants all the time in kindergarten, because I never wanted to sit on the toilet because I didn't want to get germs and probably I'm probably diving into like psychological issues that we don't need to do right now. But my point is, I was very big into health and staying healthy and looking for ways to go down that route. So I think it's always inherently been in me. And just has driven me to here today,Lesley Logan 6:00  Okay, this is, okay, thank you for sharing that. Because yes, I'm, right now, like.Michele Wispelwey 6:04  Just being honest. Lesley Logan 6:05  I love it. Because I know I can already picture some of our listeners, I won't say their names who are, probably, doing the same thing. I'm so sorry to hear about your mom. I have many female family members who were misdiagnosed or just kinda pushed the wayside until it was too bad until it was too late. People just dismissing the symptoms as being oh, you know, like my grandmother, oh, she's just taking too many of her pain meds and she actually had more pain meds leftover than she should every month. So like, that can't be. That's, that's not how math works. So you know, and I, and I don't know that if, she did die of brain cancer. I don't know that finding out sooner would have done anything different for her type. But like also, I think she would have spent the last few months of her life feeling like she was a crazy person. You know, being you know, (inaudible) like, I do think that there's some interesting things I'm currently, I'm sure you've heard the book, Michele, but I'm currently reading the book Eve, the history. Michele Wispelwey 7:01  Oh my God, so am I. It's so good. Did you get to the section yet that men have nipples? (Inaudible) Lesley Logan 7:09  Every man I meet I'm like, you need to read this book, you're gonna learn that you can breastfeed. And so there are no such thing as gender roles, in my opinion. Also like that there has men currently breastfeeding on the planet.Michele Wispelwey 7:23  There is, there was a wave of Homosapiens that they took turns where the woman would breastfeed or if she would go out to gather and hunt and he would nurse. So, it's amazing. And men, if you're listening, you can lactate stuff. We can, we can help you. Lesley Logan 7:39  We can help you. And also apparently, if you got rid of your balls, you could live a longer life. Just another. Michele Wispelwey 7:45  Yes. Lesley Logan 7:47  The first chapter had me like going, oh my gosh, I was like Brad, you have to, every person we meet, like, you must read it. Every pregnant woman I mean, like, hold on, you need to understand there's a first and very important thing is the first few chapters go listen.Michele Wispelwey 8:01  It was amazing. It's a great book. I actually bought it for my co-founder Kristin and I sent it to her last week and she's super excited to read it. We were just talking about the nipple thing today. Lesley Logan 8:09  Yeah, it's so it's so fascinating. If if Cat Bohannon is listening, I would love to have you on the pod. Anyways, I but I loved it because she's doing this like thorough look. And as you mentioned, like you got into this medicine thinking like you could collaborate, and it's just not what happens. Those of you who live in other countries, maybe it's different for you. But if you're currently living in like a system that is like the U.S. it is non-collaborative, you are going to different silo doctors and you're trying to figure out the wrong with you and everyone is kind of trying to give you a pill to cover up symptoms. It is how I feel about it. And I'm not against medicine. I'm not against science, guys, I'm not, so don't put me in that category. But I get really frustrated because I had a massive health issue for 10 years I got exacerbated because no one would actually like work together like no one was actually understand me and like I said, I'm not sleeping very well anymore. And these things it was just terrible. What happened is I had definitely had some stomach issues and I stopped absorbing nutrition. And then I stopped going through sleep cycles, which means I stopped producing stomach acid, which means it's no longer absorbing nutrition and of course you're not sleeping. Michele Wispelwey 9:21  Did you have H. Pylori? Lesley Logan 9:23  No. We did have that. I had that for a little bit then I don't know how long ago that was. But I do remember that one. But yeah, I just like literally finally got someone to listen to me to do a full, full test. Just a full one. Of course this is where money, you have to have money to do this. So was a celebrity in the U.S. in LA., I heard what, who, he used to like gain weight to look like he had done like steroids but not take steroids and I was like who are you doing this with? And he told me about this guy, I was like, I'm gonna go to this guy and this guy looked at my blood and he goes hold on. You have no stomach acid, you're like, no, what is going on? I had no testosterone at that point. Yes, I had that. I mean like, just like I had a ton of (inaudible) there is a metal in my system, it was a whole mess. And I was like, this probably didn't start off this way. But it's gotten to this point because I could not get anyone to actually do an actual panel. And he's like, you don't have any vitamin D? Like you, you know, and I was like, I don't know how it's possible. I'm driving around in a jeep with the top off. I don't understand. So, you know, it took someone like that for me to get to someone who's probably similar to you, who helped me like more holistically and with (inaudible), but to look at the whole picture. So if people are feeling a little bit gaslit, or feeling like a little bit like they're going crazy, what should they be looking for in the medical system? Or how do they find someone like you? Michele Wispelwey 10:40  Yeah, so everything you said is exactly what we do. So what makes us so different is that we take a full integrative approach, we actually take a longevity medicine approach, because a woman's body at a cellular level is all these interconnected systems, the gut talks to your hormone levels, your estrogen affects your cardiovascular system, your gut affects cognitive, your skin, how you absorb nutrients. And I'll tell you a story about me and that situation too. But you need to look for doctors that aren't just spot treating, that aren't treating you just on your symptoms. And that's the problem. And that's the problem with the US health system is that we treat on sick, we don't, we're reactive, we're not preventive. So you need to find a provider, a GYN that is going to, oh you're tired and fatigued, don't just be like oh, well, let's just do a CBC and a thyroid, let's see what else is going on. Because if your gut is going on, you have acid, you have dysbiosis, you're not going to sleep, you're not going to absorb nutrients, you can have like GERD, a lot of different things, you're, a drop in estrogen is going to affect your cholesterol level. So a lot of women end up going to the cardiologist because they're you know, their LDL is through the roof, or they have (inaudible) issues. And that's actually interconnected with your whole hormonal system. It's all a web, it's not this or that it's the whole complex picture together. And if your doctor doesn't do that, then you need to go because this is like, these are the patients that we see everyday that come to us. And like I've seen this doctor, because, you know, I, you know, I've been to my internist. And then she doesn't know what to do. I've been to my GYN and he said, oh, you just have to wait this out. I've been to my cardiologist because I thought I was having, you know, a heart attack because I had a stiff shoulder. But that's one of the menopause symptoms. So, and that's what we do. We test, we do a full comprehensive hormone (inaudible), we do your gut microbiome, your micronutrient level, and even your food allergy levels to see what type of inflammatory markers your body's reactive to with foods. Because if you're fixing your gut, you kind of need to fix what's causing your inflammation from your food first, before you go in and fix your gut. Because that's just gonna cause your gut to just inflame even more or just fire up or not absorb the nutrients and things like that.Lesley Logan 13:00  Yeah, I definitely, I definitely learned that with the stomach, like if you just start to like, take different things for the stomach. The way that the stomach microbiome works, and you can correct me if I'm wrong, it's like what you're eating, you kind of start to crave more of, because that's what your microbiome is actually eating off of. And so if you're used to eating inflammatory foods, you've got a microbiome that's dealing with all of that, and you just go and put medicine on that if you can change the food intake, you get more organisms down there that can help with the situation. Is that right? Michele Wispelwey 13:28  Yeah, yeah, yeah, that's, that's definitely along the lines. And you definitely want you know, things like oregano oil, and a lot of probiotics, Akkermensia, we, I do a lot of things, things like that. But the thing is, and that's the thing with like, personalized medicine is what we are at FemGevity's, I can say, oh, yeah, you should take that. But you shouldn't be taking anything until you have testing to see what your body needs, right? So I could be like, take this oregano oil and take this probiotic and take Akkermensia. Yeah. But if, your your body may not need it, right, you know, you go to your internist and they'll say, take your vitamin D and a multivitamin and omega, well, how do you know what I should be taking? You know, like, you don't know what I'm missing. Lesley Logan 14:13  Right. And also, if your stomach isn't absorbing nutrition, is it getting (inaudible)?Michele Wispelwey 14:20  Flushing it out. You know what's interesting, I was at the pediatrician with my daughter yesterday, she had (inaudible) and she had this like this whatever a gland or not, whatever it is, we're following it and I because I have access to this testing. So my daughter's like, you know, very tired and kind of cranky and stuff like that. So I did a full micronutrient panel on her and she's gonna be a lab bench. Her CoQ10 is low, her vitamin C is low, her zinc is low, and her omega is low. And I'm like, this is why my child is cranky and she's tired and her stomach hurts. But and I just tested the pediatrician yesterday. I said, oh, what do you think we, she's really tired. What do you think we should do? What do you think? She's like well, her CBC and thyroid were fine last year. And she's, she's hormonal, so she's okay. And I'm like, that's exactly why you need a full integrative doctor because I'm listening to her, my child is gonna still continue on this this endless route of feeling worse. Lesley Logan 15:22  Yeah. Also a year ago, my dentist won't let me go more than a year without checking my teeth with an X-ray. Do you know what I mean? I'm like, is this really necessary? Like, well, it's been a year, and I'm like, okay, like, it's my teeth. Like your blood tests, especially on a young child. I think it's amazing that you, I mean good for you. and also like your daughter, so lucky. But it's so interesting, because now it makes me think like, a lot of our people who are listening are parents and like, your child might be cranky, not because they haven't slept enough, but maybe like something is off.Michele Wispelwey 15:54  It's vitamin and she, actually I, then I also did a one step further, I did a gut microbiome and tested her poop. And she had H. Pylori. And that's why her stomach was hurting. So that's why it's like you can't, you know, I have my own theories on uncertain things. But that's why I always need to take it that way, five steps further.Lesley Logan 16:15  When I lived in LA, it felt like so accessible to find someone like you. And now I live in Las Vegas, and I'm sure it exists. I haven't looked because luckily, I can just go to L.A. and see my person but like, but like, but also, can people access someone like you and live in a different part of the country? Like is what you do accessible in a mail order sort of thing? Like, yeah.Michele Wispelwey 16:42  Yeah. Which is great. And I should have mentioned that we are virtual healthcare. Totally telemedicine, convenience of your home. And that's how we're able to keep the costs down. And because we're not a brick-and-mortar, we don't have all this crazy overhead. And we're able to offer this type of concierge care and precision medicine to women all over the country. Lesley Logan 17:02  That's so cool. That is, okay, so that's amazing. So you can telemedicine, people all over the country can access you. And so let's say they do have someone that they trust, or they they want to test their own doctors, like they're not, they're not ready for telemedicine are they testing the doctors to just because I had a doctor that I totally tested. And I got really mad at her. And then I got an email or letter that said she's out of network now, I'm like, thanks, I didn't want to see her anyways. She, I was like, I want to get these things tested on my hormones. And she said, oh, you can't test those they change all day long. And I was (inaudible) and I was like, I'm, these test exists for a reason means you can and if you know how to read them based on where I'm at my cycle, and I do know where I am my cycle, you should know. And she was like, well, I could order it. But it's it's not gonna say anything. And I was like, it's not your money. And I don't want you to have the results. So no, but like, what should people be asking their doctors to see if the doctor they have is someone that they can trust or work with? Who is going to do the whole thing?Michele Wispelwey 18:06  Yeah, so a couple things, I would get all your hormones, progesterone, estrogen, make sure they're looking at your cortisol, your insulin levels, make sure they're looking at your lipids, make sure you look into your DHEA ,your HMH because you want to actually check your ovarian aging levels. If they have access to it, I would order a lot of like heavy metals. See the magnesium, mercury, you do a lot of amino acids and antioxidant testing. Glutathione testing is really good. We're big advocates of testing for that. If gut microbiome testing and make sure they're doing H. Pylori, if you really have to test from the stool, doing bloods is just, for H. Pylori purposes, it's just not because it lives in your intestinal tract and stuff like that. Food allergy testing, but just there's specific labs that do PCR DNA sequencing, too. So you also have to ask them, like, what labs are you using? What's the methodology and I know that's like, not something everyone wants to go into. But at the very least, have them do a very full comprehensive hormone asset, your thyroid your FSH, your LH, prolactin, estradiol, do it all.Lesley Logan 19:16  Wow. Okay, so everyone, don't worry, the show is transcribed, it's on the blog, and you can copy and paste. Michele Wispelwey 19:23  We have a lot of information on our website and blogs. My co-founder does a ton of like, videos where she talks about things a lot hormonal-wise because she does a lot of our medical protocols. And you know, yeah, so that you could find that all there not to be wary but and also women in their 30s, you should be getting your levels tested because you want a baseline, you want to know what you are now. So when you're like in your 40s and your levels are this you could compare them to what they were because even if you're like feeling am I feeling good, am I feeling not? You know you're like able to guide yourself very closely and almost like preventing yourself from symptoms and being able to live symptom-free before it hits.Lesley Logan 20:07  Yeah. And I actually want to chat about that because like one of my girlfriends, you know, she, she's going through the changes. Oh my God, I was going to say, no, so she's you know, she's 10 years older than me and she, you know, was assuming she is premenopausal and was just all these different things were happening. And she was also slowly over time and I was like, I think you might want to just talk with your doctor about like, really, truly like looking into why are you so tired all the time? Why are you having these aches and pains? Why is your hip bothering you? Like you have this? It's, you're, it's not because you're 50. It's not just because you're 50. Right? Like, if you're gonna live to 80, this is early, it's too early to go through all these pain points. So she finally, like really sought something out, like went for it. And then they gave her some hormones because her hormones were off. And she's like, holy moly, Lesley. I was so, like, I feel like I am unstoppable. And I was like, for years, she's been slowly over time managing it, in air quotes, managing it. And I think that we are trained from, I don't know, just society that like, it's, we'll just manage it, we'll just figure it out. We'll just do it later. And like, it's actually okay to demand that you feel really good all the time, especially if you're doing all the things if you're moving your body, if you're trying to sleep, if you're, if you're like trying to drink the clean water, like all the things like you should ideally feel good.Michele Wispelwey 21:34  Yeah, it's been very just highly accepted and overrated, that you just have to kind of deal with it. And it's a part of aging, and you're supposed to be tired, or you're supposed to have an ache or pain. That is not supposed to be how you're supposed to feel. I'm 43 and I feel better now than when I felt in my 30s. And, you know, I actually have more energy, because you're just more aware of how you're supposed to take care of yourself. So, you know, imagine if, like, younger women start understanding how they're supposed to feel and start feeling even more energetic in their 30s. And as you build up and progress, you're just gonna keep feeling better. And, you know, be able to get up from the floor when you're 75 and play with your grandkids.Lesley Logan 22:18  Yeah, and have the energy too, it's not just the strength too, but also all of the things that go with it. Okay, you mentioned something that like piqued my interest. You said someone had a shoulder issue and they were there so and it was perimenopausal, not a heart attack, or whatever. Are there any other symptoms like that that we should be aware of that like we may be perimenopausal but we might think are something else because I or maybe I've just opened up a can of worms because I feel like a like perimenopause. Unfortunately, menopause has not been studied nearly enough. I got really pissed off, did you hear this? There was a daily episode, probably six months ago, where this one scientist was trying to get research money for menopause. And the way he was able to get actual funding from people for his testing that he wanted to do was just to turn the title to like, well, if women stopped turning into men, then their husbands would want them longer. So if we can keep them women longer, and that's how he got the funding, and I was so irritated that that's how money, I was like, (inaudible) you should have been studying this already. So disgusting. So infuriating. He got money for it. And so yay. But also like, unfortunately, we haven't studied this long enough. And so we don't know enough everything I've ever been told that you just have hot flashes, and that you gain weight. But like you just mentioned a (inaudible) I've never heard of before. So like, what are some of those things that might people might be putting off that could actually have to do with like a hormone change happening?Michele Wispelwey 23:49  Yeah, so stiff shoulder like frozen shoulder, itchy ears, a ringing in the ear. Some women become like, like kind of like vertigo, off balanced. There's, I mean, there's 100 plus symptoms (inaudible). Lesley Logan 24:03  That's crazy. Just the ones you listed are like I was like, oh, I trip a lot.Michele Wispelwey 24:09  Yeah. You know, you're and you're like, do I have a brain tumors? You know, like there's some very serious symptoms. You know, women have like weird just like pains that you know, you start pulling things easier just because you have a higher likelihood for bone fractures and osteoporosis. So there's much easier breakage and there's a lot of a lot of women end up like having like a slipped disc or like, you know, like a joint pain or pull like a something in their shoulder. And you hear if you list start paying attention and listening like more women in the 40s 50s and 60s will be like, oh, I went to the chiropractor or the acupuncture, my back's acting up again and you ask them well, what did you do through perimenopause, especially if it's a woman who was in her 60s, I bet you she didn't do anything when she was going through perimenopause and menopause, and now it's catching up to her big time.Lesley Logan 25:03  Oh, okay, so this is interesting, okay, so (inaudible). Michele Wispelwey 25:05  Especially (inaudible) and testosterone is like maintaining your levels of testosterone is huge for women, your body composition is made up of much more testosterone than it is of any other hormone. We just have a smaller formula of it in our body, formula, composition of it. Lesley Logan 25:23  Yeah, that's what, that's the one that like, I'm really, really honest with everyone listening, I have been trying for years to maintain that level. I mean, I lift the heavy weights, I'm now, I'd take a CJC, which is not really for testosterone, but like, it's supposed to help me just feel good. But like, I cannot keep that level up to a number that is anything better than below average. And I'm like, do I just need to actually take testosterone and I'm like, Oh, my God, my grandmother had a beard. So like, I haven't gone down that rabbit hole. (inaudible)Michele Wispelwey 25:53  I mean, unless you're like rubbing it on your, on your, on your (inaudible) and you want a beard, then, you now, hell go for it, whatever, it's 2024. But, you know, you know, I, listen, I'm not the medical provider and the clinician, but there's could be a lot of things for you. Like, who knows what your progesterone level is? I don't know if you're on a Mirena IUD that's causing progestin, and you're getting over an estrogen dominance and and stripping your testosterone so there's like a lot of different things. I think you're probably younger than me. So these are all these factors that are like fully integrated and like a lot of physicians don't understand it, and they don't think about it so if you can't maintain your testosterone levels, there's there's a reason why it just does not because just because like you know you yeah, so just like think about those things they're interesting. Lesley Logan 26:40  I also just I want to just highlight something you're you've done you guys often listen to this every time something has come up she has mentioned that there's more than like, it's not just like this or this. Like there's this and then also there's a few other things that this could be going on. And I think that's so important. You're, anytime we're with a medical provider, they, there needs to be a holistic look at things because otherwise they're putting a bandaid on something or they can make something worse because it's totally off like they could be training you for a heart attack. And (inaudible) did you (inaudible) did you read Halle Berry's doctor mistook her perimenopause for like gonorrhea like a bad case of gonorrhea? (inaudible)Michele Wispelwey 27:25  Imagine, I mean, the poor woman, she probably has such vaginal dryness and like, you know, God only knows what's cool because there's a lot of stuff goes on down there. You know, you lose your atrophy and your collagen in there and it starts thinning out and then you know why? You know why she probably thought that? Because she probably had persistent UTIs because women when they're they start losing their testosterone, they got a lot of vaginal dryness and a lot of reoccurring. UTIs. So he she probably he'd probably get them tested for STDs. And if only he would have given her some bioidentical estrogen, your vagina would have felt a lot better. And the poor thing wouldn't have been accused of gonorrhea. I'm from like, the the lab world, right? So like, doctor's order, you know, urine cultures constantly. Any woman's like, you know, oh, I have a pain or have an itch or something. They're like, oh, do you have a UTI? Or is it (inaudible)? You know, they don't think that like, oh, maybe you have some hormonal thing going on. They don't even test your hormones. Like at your annuals, they don't look at anything. It's not even a part of like the health insurance. You have to do. It's preventative codes. The only thing is preventative is a PAP, not even HPV. That's like considered diagnostics. It's like, it's absurd.Lesley Logan 28:37  (Inaudible) I know, I am too. I'm really excited that this conversation like so okay, because this will just like horrify you. So when I had been (inaudible) on birth control in high school, I went on the patch because I was like, yeah, I'll put this on because I don't have to do a pill at the same time every day. (Inaudible) a badge, it was like you can put it on your arm or on your hip or whatever. Of course, you guys, you guys. I can't wear a BandAid, okay, not longer than a day, I just switched the BandAid out. So of course, like, every time I took this patch off, I had like a red square, super sexy, like everybody wants to be near that. And so I gotta keep moving the patch around. Anyways, I guess like it was but I was like, no, I don't want to be on the pill because I'm gonna have to remember to take anything and we're supposed like low hormone, the whole thing like you won't get a blood clot because it's like, it's like, easy the way that all the things I was told, right? So fast forward two years and I'm in a car accident. I'm on bed rest for a week. I get off bedrest and my leg is super swollen and it's getting hot. And I am it's I'm at work and it's now throbbing. And so I go to an urgent care and I was like, I think I have a blood clot. And he's like, no one was like, I can't sleep because I'm in so much pain. And I watched an infomercial on a blood clot. I think I have one. I have all the symptoms and the guy's like you're too young for blood clot. Kid you're not too young for blood clots, ice and elevate your leg. You were in a car accident a week ago. It's swollen from that. I was like this person doesn't, is not listening to me. And the worst thing I can do is elevate this leg. So I went to work because I had to go back and I, you know, unfortunately, had to pay my own bills. So go to work and it's now getting bigger you guys, like my leg was like twice the size (inaudible). It was I felt maybe it wasn't that big, but it felt that big. So I then went to the emergency room. And I walk in, and I'm like, well limping in because I can barely walk my like, and the nurse goes, oh my god, I think you have a blood clot. And I was like, thank you. I think so too. So sure enough I have a blood clot, (inaudible) and the hospital, I was pulled off of birth control, not by my gynecologist from then, but from a different one who looked at my history and just like, oh, she's like, I think you might be susceptible to clotting based on your family's history. You should not be on these hormones. And so I got on the copper IUD, which of course made my periods the worst thing in the world forever, for fucking ever. So, but anyways, I don't have children. And at the time, I was single. So here we are. So have this copper IUD. And aside from the bad periods, no problems whatsoever, it was pretty easy. Everything was like on time, go to get it removed. And I'd moved. And no one could find it. And they saw I'm at Planned Parenthood, they can't find it. They're like, I'm like, well, it's in there. I'm telling you right now it's there, I know, it's there. I can feel it's there. Right? So you got to like so sure enough, I got my insurance to cover a visit with a gynecologist. And she finds it with what an ultrasound a sonogram, whichever the one is. And it's like in the, I guess it's like in the uterus, and it was like off to the side and turned around. So this, this, the strings were facing the wrong way. So they had to go in with a camera. And this is, will piss you off, even though she could find it that day, my insurance would not let her remove it that day. I had to come back for another visit, to have it removed. And I was and she was like I would do it. But I'm like, can't you just like say I came back another day. Like, I'll just, I'll sign I swear. So anyways, I had that removed, it's now been out for almost two years, best thing I ever did is like have nothing. It's like I'm I'm so cyclical, it's I'm on time, all the time. It's amazing. But it's just the comedy of errors. Like what I would, it's a lot. So you know, I share all that with you. Because like, ladies, if you're listening, it's you're not the only one, even if you are advocating for yourself. And even if you're trying to educate yourself, it can be really difficult to navigate the medical system to get help for yourself. Michele Wispelwey 32:41  It really is, especially the payer system. And it's more difficult now, because a lot of independent physicians are being bought by hospital systems and peer networks because they can't afford to stay in business because, you know, the inflation, right, it's the cost to operate. But the reimbursements are going down. And there's only so many, you know, insurances that you can go to network with. So you're just being it just intertwined or being more caught up in the system. And that's why, you know, we're so adamant on, you know, doing what we do, and so passionate about it, because, you know, being in the lab industry, and Kristin had her own practice for many, many, many years. We know what the payer system is and prevents from women living longer, healthier lives, it just doesn't allow it. So there needs to be companies like FemGevity and, and others to be able to provide these opportunities to live longer and healthier and vibrant and build like an ecosystem and community support where women could be like, vulnerable and talk to each other about these things. Because it's embarrassing, you know, not everyone like where's everything on their sleeve? You know, so. Lesley Logan 33:48  Yeah, I have some girl friends who are like, they're like, I know, I talked about perimenopause all the time, like you should. I don't know anything about it. No one in my life talked about it. So they talked about it after it's over. So I would like I think it's important that we hear these things. I want to go into something so before because like, you've given us so much, but I feel like you are providing something to be unique and to be this different. And to get into the world. You're trying to get through all around all the different obstacles, and there's just all these different things that would probably keep FemGevity from working. How do you have that kind of resilience? How do you stay in line with your purpose? Like, what is it that you practice every day? Because it's, it can't be easy to have this vision and this idea and know what you can do to change women's lives and also know how hard it is for them to get to you.Michele Wispelwey 34:29  Yeah, so, you know, I think the biggest part of me is, you know, I've been through a lot and I'm not afraid of failure and you can't take risks and you can't grow as a person if you're afraid to fail. And, and that's, you know, failure really brings success and it brings it brings a system and you know a person who has been like kind of knocked out of phase his resilience is really like the strongest factor that contributes to a survive level of a system and possibility to really reach your full potential. And I think what's helped me is to really live by like a system right and because it's like a structure and life is a bunch of like interconnected systems like we say with FemGevity right with finding healthcare and, and once you see that it's when harmony and energy truly evolve, and you get closer to your goals. And you really get to this like perpetual state where you get to this like paradox world of having deeper clarity of what you want and to achieve. And I just feel that you know, it, the purpose of it is to like, live with high energy, effortless existence, because at the end, end of the day, you have limited amount of capacity. And it drains, you know, drains you because it's like decision-making, stress, what you're eating, how you're sleeping, and having like an optimized system on how you go about life, the more you're going to get out of it. And there's going to be like, there's going to be dysfunction in life in general. And, like believing that, you know, just because you have dysfunction means it's not possible to be happy. And it just helps you to drive to like more essentialism and making it your own ecosystem. And like a better quality of life. Lesley Logan 36:24  Yeah, before we hit record you were talking about effortless existence, I will say like life can be so hard. And then as we've talked about all the different things that we could control with our health. If everything was imbalanced, I think it'd be so much easier to show up as an effort in effortless existence. I mean, I feel like if you have all these different hormones, but all your you know, happy hormones that are like actually leveled out, like, you probably it'd be probably be easier to show up and, and be in the world.Michele Wispelwey 36:51  Yeah, it's, you know, it's effortless. It's easier to deal with, like the obstacles because you get out of bed and you're hit with your kids or your work and an email and, and just like constant things that can really just like, just set you over the edge over the cliff, you know, where you want to, like, have a nervous breakdown. But if you're balancing your health, that's what's going to keep you on a straight, narrow road, where you're not going to be having huge spikes where it's going to make you want to drop down too far.Lesley Logan 37:19  Yeah, I can totally see how that works out. Because I do have a lot of people who are like, Lesley, I'm doing all the things, I've my dream schedule designed. And I'm like, I've got you know, I'm doing all the things for my business but like these things happen, and I just want to quit, I just want to give up and it's like, well, first of all, there's, as you mentioned, like, gotta get over, gotta get over the failure, can't be afraid of failure, you've got to do that. And I think especially when you're feeling exhausted and tired, you so a failure feels really hard. Michele Wispelwey 37:46  It is, I mean, it really isn't granted, like, you know, running a startup, there's a lot of failures. And you're like, oh my gosh, do I suck at life? Or is it just a bad day? But I'm like, no, I'm going to use this as an opportunity to learn and not make that decision again, you know, and, and it's hard to get in that mindset, especially when you're like, yeah, having a bad day.Lesley Logan 38:11  Yeah. So okay, I do, I may think being okay with failure is what resilience really is. It's like, how did you get good at? How did you get okay with failure? Is it because you practice medicine and medicine is really a practice? Or is it like, were you raised that way? Like, because I feel like so many people, our listeners are super perfectionist, it means, no failure is ever allowed. So how did you get good at being okay with failure?Michele Wispelwey 38:36  I think I once I learned to have confidence in myself, and to trust my own decisions. And, and I think I also started to become more balanced with being intentional and trusting my instincts. And I think once I grew into that, and you know, throughout my, like professional career, it was, it was hard, you had to, you know, grinding it out. It was a very male-dominated industry. And I second-guessed myself a lot. And a lot of those second guesses that I had, where I didn't listen to my gut, I made bad decisions. So I think I know that sounds ridiculous, but I got there from making my mistakes and getting back up. And I just kind of like no mercy I think is also like the way my my dad brought me up. He was very tough. He was, you know, like, if you was in the military and stuff like that. So I think it's the way I grew up and just grown up with like divorced parents and things like that. You're just mentally tough, you know, biking blood.Lesley Logan 39:45  But I think that like thanks for sharing that because I do think that so many people can see maybe they grew up with divorced parents like you or they had all the tough parents or all these things and they don't realize that they have this like superpower of resilience that they can be taking with them into things like you know.Michele Wispelwey 40:00  You know what, that's what it is. You have to find your superpower. And my superpower is resilience and to work under fire. And if you embrace your superpower, and your superpower can be like lying compulsively, who cares? That's your superpower and own it but find to use it in a good way not to like, you know, hurt people. But you know, like Superman. Lesley Logan 40:26  Yeah. Okay. I love that. Michelle, this has been so good, you are amazing. We're to take a brief break and we can find out where people can find you, work with you in FemGevity. All right, Michele, where can people find you and work with you?Michele Wispelwey 40:40  They could find us on femgevityhealth.com our social handle is @femgevity. We are on Instagram, Facebook, TikTok, YouTube, and LinkedIn. And we have live text and chat on our website, too, if ladies have any questions.Lesley Logan 40:59  So good. Okay, you guys. Go check it out. I'm, I'm going to, I'm gonna get down. We're gonna figure out this testosterone thing. Michele Wispelwey 41:08  We're gonna figure it out. We're gonna figure it out for you.Lesley Logan 41:10  This is the year, this is the year I'm doing it. Okay (inaudible), but could you, could you, can you, can you understand why, why I've delayed it? Right? So long. I'm like, oh, I don't know, my grandmother had like a beard.Michele Wispelwey 41:23  We won't give you a beard. We'll just give you chest hair.Lesley Logan 41:28  Oh, my God. My grandmother was up there going are you, have you lost your mind? Anyways, okay, so you've given us so much already bold, executable, intrinsic or targeted steps people can take to be it till they see it, what do you have for us?Michele Wispelwey 41:44  Okay, you have three options in mind, you need to either accept it, change it, or leave it. And you need to pick your path. And whatever that situation may be, whether it's a fight with a partner, how you feel about your body. If you're having health issues, you have those three distinct options in life. And be very clear which one you choose, accept it, change it, or leave it? I think you change it.Lesley Logan 42:14  Yeah, oh, I love these because that can be everything that's coming up. And also, you can also say, I'm gonna leave it on until this date, and then I'm gonna change it.Michele Wispelwey 42:25  Yeah, those are like your, your rocks, you know, where we actually have company rocks where we set what, each quarter in the beginning of the quarter, we set our goals, personal and professional. And then we go back three, four months later and go and reevaluate them. So you can you can leave it now and change it in three months. But don't ever accept it. Like, your health and what doctors are telling you. Because there's always a way maybe no for now, but not no for later.Lesley Logan 42:58  Yeah. I love that. I love that. No accepting it when it comes to your health you guys. You guys can now reach out to Michelle and FemGevity because what you created for women is so cool. The fact that it can be telemedicine. I'm just so I'm so excited for everyone listening. All right, y'all. How are you going to use these tips in your life? Make sure you tag Michele, make sure you tag the Be It Pod, share this, okay, so here's my action plan for you. The only way women actually can get the help that they want is if they know what they need to ask for. Okay, so if doctors were hearing questions from their patients who actually were like I did the research here are the tests I want, the only way we can get them to change, or at least for you to know that that's not the doctor you need for it. We can I think that women are so powerful that if we rose up together and demanded that professionals take care of us holistically, it's the only way it's gonna change things until then, you can go see Michele. But so share this with your, with a friend who needs to hear it because you're not crazy. There's nothing. It's not, nothing wrong with you. They just haven't figured it out yet. And it's because you (inaudible) holistic look at it. So thank you all so much, Michelle, thank you so much for what you've done here. Michele Wispelwey 44:05  Thank you. It's been so amazing. Lesley Logan 44:06  Yeah, so awesome. All right, loves, until next time, Be It Till You See It. That's all I got for this episode of the Be It Till You See It Podcast. One thing that would help both myself and future listeners is for you to rate the show and leave a review and follow or subscribe for free wherever you listen to your podcast. Also, make sure to introduce yourself over at the Be It Pod on Instagram. I would love to know more about you. Share this episode with whoever you think needs to hear it. Help us and others Be It Till You See It. Have an awesome day. Be It Till You See It is a production of The Bloom Podcast Network. If you want to leave us a message or a question that we might read on another episode, you can text us at +1-310-905-5534 or send a DM on Instagram @BeItPod. Brad Crowell 44:54  It's written, filmed, and recorded by your host, Lesley Logan, and me, Brad Crowell. Lesley Logan 44:58  It is transcribed, produced and edited by the epic team at Disenyo.co. Brad Crowell 45:03  Our theme music is by Ali at Apex Production Music and our branding by designer and artist, Gianfranco Cioffi. Lesley Logan 45:10  Special thanks to Melissa Solomon for creating our visuals. Brad Crowell 45:13  Also to Angelina Herico for adding all of our content to our website. And finally to Meridith Root for keeping us all on point and on time. Transcribed by https://otter.aiSupport this podcast at — https://redcircle.com/be-it-till-you-see-it/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

It's time for another Q&A episode. I'm answering listener questions about bioidentical HRT, the risks associated with oral estrogens, and so much more. Additionally, we'll discuss the Mirena IUD's impact on hormone levels, address concerns about loose skin after weight loss, and weigh the pros and cons of different HRT methods for women experiencing premature ovarian deficiency. I'll also provide my insight on the role of diet, thyroid function, and even probiotics in managing HRT side effects. In this episode: Why some women experience quick benefits from bioidentical HRT, while others need more adjustments. The risks associated with oral estrogens, especially for those with the factor V genetic variant. Why transdermal estrogen is a safer alternative to oral forms. How the Mirena IUD affects hormone levels and natural progesterone production. The long-term health implications of synthetic progestins, plus strategies for integrating natural bioidentical progesterone. Concerns about loose skin after weight loss, along with solutions like muscle-building exercises. The pros and cons of different HRT methods for women with premature ovarian deficiency. Why achieving therapeutic hormone levels is crucial for protecting against health risks. How to manage weight gain concerns related to HRT, including adjusting dosages and supporting detoxification pathways. The role of diet, thyroid function, and probiotics in managing HRT side effects. Why a balanced intake of carbohydrates is important for metabolic health. The potential influence of COVID-19 and its vaccine on menstrual health. The necessity and effectiveness of probiotics for gut health. Strategies for improving sleep and managing HRT side effects like headaches and hair growth. How to identify the culprit hormone causing weight gain and swelling by adjusting doses. The efficacy of calcium D-glucarate and N-acetylcysteine in managing estrogen-related weight gain. The importance of monitoring hormone levels despite a doctor's refusal to conduct lab tests. How tirzepatide affects weight loss beyond appetite suppression.   LMNT: Order your LMNT electrolytes today and get a FREE 8 pack of samples! Plus try it risk free, they have a no-questions-asked refund policy – you don't even have to send it back! www.drinklmnt.com/KarenMartel Timeline is offering 10% off your first order of Mitopure. Go to www.timeline.com/KARENMARTEL and use code HORMONE to get 10% off your order. Apollo https://apolloneuro.com/karen you can get 15% off your apollo wearable. Interested in joining our NEW Peptide Weight Loss Program? Join today and get the details here. Join our Women's Group Coaching Program OnTrack TODAY! Karen Martel, Certified Hormone Specialist & Transformational Nutrition Coach and weight loss expert. Visit https://karenmartel.com/ Karen's Facebook Karen's Instagram

On today's coach confessional, we take a look at the complexities surrounding birth control. Le and I peel back the layers of our own experiences with contraceptives, including the highs and lows of our journey with the Mirena IUD.    Together with our special guest, Alex de Oliveira, we confront the troubling trend of medical gaslighting and the societal pressures that can distort women's health decisions. We emphasize the transformative power of a knowledgeable health advocate—someone who can bridge the gap between women and the personalized care they deserve.   As we unravel the impact of misinformation, we advocate for a world where every woman's health choice is met with respect and understanding, devoid of undue judgment. Check out of concierge program: https://fasterwayconcierge.com/   Don't forget to check out our merch, supplements and other great deals: https://fasterwayshop.com/   Subscribe: youtube.com/FASTerWaytoFatLoss   Follow us on Instagram: Amanda Tress: https://www.instagram.com/amandatress Le Bergin: https://www.instagram.com/le_bergin FASTer Way to Fat Loss: https://www.instagram.com/fasterwaytofatloss  

Dr. Crawford answers voicemails called in specifically about ovarian reserve and AMH. Questions answered: Does having a light (2-3 days) period mean you have low ovarian reserve? Also, is their a safe way to do HRT with factor five leiden during menopause? I got my AMH tested the week after I got my Mirena IUD out. Could that have impacted my AMH level? What does an elevated AMH with no other symptoms of PCOS mean? I am 31 diagnoses with premature ovarian failure and early menopause. Would you recommend going straight to egg donor? We have moved Fertility In The News to the weekly newsletter in order to keep the podcast more evergreen. If you want to sign up go to nataliecrawfordmd.com/newsletter to sign up! Don't forget to ask your questions on Instagram for next week's For Fertility's Sake segment when you see the question box on Natalie's page @nataliecrawfordmd. You can also ask a question by calling in and leaving a voicemail. Call 657–229–3672 and ask your fertility question today!      Thanks to our amazing sponsors! Check out these deals just for you: Apostrophe- Get your first visit for only five dollars at Apostrophe.com/AAW or use the code AAW at checkout. Quince- Go to Quince.com/aaw for free shipping on your order and 365-day returns Ritual-Go to ritual.com/AAW to start Ritual or add Essential For Women 18+ to your subscription today. If you haven't already, please rate, review, and follow the podcast to be notified of new episodes every Sunday. Plus, be sure to follow along on Instagram @nataliecrawfordmd, check out Natalie's YouTube channel Natalie Crawford MD, and if you're interested in becoming a patient, check out Fora Fertility. Learn more about your ad choices. Visit megaphone.fm/adchoices

Crystal Nightingale is The Mama Coach. Her mission is “to guide families through every stage of their parenting journey by providing evidence-informed education infused with nonjudgmental support, compassion, and empathy.” Crystal chats with Meagan today about some of the many resources available to women who are in the postpartum stages of motherhood. While we spend a lot of time preparing for our births, we sometimes don't know how to really prepare for postpartum. Crystal talks about how to recognize postpartum depression, preparing for going back to work, tips on birth control after a baby, and lactation advice. We are so thankful for the work Crystal does to help families thrive with their new babies!Additional LinksCrystal's Website - The Mama CoachPostpartum Support InternationalThe Lactation NetworkNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, hello you guys. You are listening to The VBAC Link and I am with my friend today, Crystal. Crystal Nightingale is with The Mama Coach. Right? I'm saying that correctly. She's amazing. I feel like we connected on social media and I just madly fell in love with her. I feel like I could talk to her for hours postpartum and just the journey of what things look like after we have our babies. It's a topic that we don't talk about enough in today's world and honestly, it's a topic that isn't focused on. It's not only not talked about, but it's not focused on, in my opinion, enough. We have babies and are told to come back six weeks later but a whole load of things happen in that six-week period. There are things from recovering from birth and sometimes we have different types of birth. Maybe we had an easy birth and that's super great, but sometimes we have a C-section or a vaginal or an assisted vaginal and we have extra tearing. Maybe we're having a really hard lactation journey and feeding our babies emotionally. There is so much that is packed into postpartum and we just don't put enough focus on it, in my opinion, in the medical world. So today's episode is with Crystal and she's going to be talking more about postpartum. What does it look like? What to expect? All of the things. We're diving deep into it. We're going to be talking about baby blues and postpartum and mood disorders and hormonal dips and lactation and when it's okay to not be okay and when it's okay to ask for help. Just all of the things, so stick with us today. It's going to be a really, really great episode learning more about what to expect in that postpartum experience. Review of the WeekWe have a Review of the Week as usual. Just a reminder if you guys have not had a chance to leave a review, we would love for you to do so. You can do that on Apple Podcasts. You can do that– I actually don't know if you can do it on Spotify but we are on Spotify. You can do it on Google. Just Google “The VBAC Link”. Find us and leave a review there. Wherever you leave a review, we would just love it and you never know, it might be read next on the podcast. Today's review is actually from Google and it's from Elizabeth Garcia. She says, “As a birth doula and mom, I am always referring clients for information to The VBAC Link. For incredible VBAC stories to lift my VBAC clients up and make them know that there are others who have successfully VBAC'd and for advice, information, and statistics, I always turn to The VBAC Link.”Thank you, Elizabeth or Beth, if you go by Beth, for your sweet review. Again, as always, we love your reviews and would appreciate them on any platform that you want to leave them on. Crystal NightingaleMeagan: Okay, cute Crystal. Hi. Welcome to the show. Crystal: Hi Meagan. Thanks for having me. I'm excited to be here. Meagan: Oh my gosh. I'm excited for you to be here. Like I was saying in the intro, you probably know more than I do. We don't talk about this. There are so many things that I didn't even know about in postpartum, how our hormones shift and what to look for and I've had three kids. Truly, I have not even been informed and I have had three kids so I'm really excited to dive into this with you today. Crystal: Yes, awesome. I know. Like you said, we have all of this attention during the pregnancy and we have all of these appointments and all of this kind of stuff, all of this information and resources, but then when you have your baby, it's like, “Okay, bye. Take care of yourself and your baby. Make sure you sleep.” Meagan: Yeah. Make sure you sleep. You're like, “How do I do that again when I have a baby waking up every 2-4 hours?” Crystal: Yeah and then most women don't have their first postpartum appointment until six weeks and it's like, oh my gosh. Where is the support for those first six weeks or even beyond? Because postpartum doesn't last just six weeks. I've read somewhere– I can't state the source because I don't remember, but it can last up to a year after giving birth. The way I look at it is, okay. You've been pregnant for about 9-10 months or so and all of that time, your hormones were increasing and your body was changing. In my opinion, it will take at least that long to fully recover as well. Meagan: Absolutely. It's kind of interesting that you say that because with my first, my oldest daughter who just turned 12. I'm thinking of when this episode is coming out. She'll be 12 in a week. Crystal: Oh my gosh. Meagan: I know. It's so crazy to me. But I was 11 months postpartum with her. I had gone back to work when she was 3 months old. I had been working and things were pretty good, then I had some struggle with my lactation with my supply and was doing things to try and get it back. I just felt a shift in my whole self. I went in at 11 months postop because my husband was like, “I think you should talk to somebody.” I didn't really know anyone to talk to so I just went to my OB. My OB said, “You have postpartum depression.” I said, “No, I don't. I am really far out from postpartum now,” because, in my head, almost a year was really far out. He said, “No. You have postpartum depression. This is postpartum depression.” I literally looked at him and my jaw opened and I said, “I think you're crazy.” He said, “Nope. This is postpartum depression.” We talked about it and I was like, “What?” So I called my husband and I said, “Hon, even though I am almost a year, he said I could still have this. I have this. These are the things we talked about on how to work through it.” I just could not in my mind believe him. I really could not believe that I had postpartum depression. I think one, I didn't want to admit it. We have a negative stigma around the word “depression”.Crystal: There's a stigma, yeah. Meagan: With just depression, it's like, “No, no. I'm not depressed. Don't say that. Don't put that diagnosis on me.” Truly, I was scared of that and didn't want to admit it, but then I was like, “No. I am not a few months after birth. I am almost a year out.” So it's interesting that you just said that because I was actually told that at 11 months postpartum. Crystal: Yeah. It's crazy. Like I said, with all of the hormones running rampant during pregnancy, then it's the same afterward. There's a hormonal shift right after delivery, during breastfeeding, and if you stop breastfeeding, there's a hormonal shift as well. Then going back to work has all of these different emotions. It's just an emotional rollercoaster. Meagan: It really is. I think that is what was happening. I was shifting a little bit within my milk and then I was maybe deciding on not working, then there was a lot of pressure on where my daughter was. There was so much going on. I had those hormonal shifts, but I didn't realize they were happening. I didn't recognize them. So yeah. Let's just dive into that. Postpartum– things to expect as a postpartum mom both physically and emotionally. What are things that we could just automatically expect to happen? Crystal: All the emotions. Meagan: All the emotions. Crystal: There is a big drop of estrogen after you deliver and that increases prolactin hormones which help with milk supply and then there is just the initial recovery. So if you delivered vaginally, you may or may not have had any tears and there are different degrees of tears. I know you are more familiar with that kind of stuff and how to prevent it with perineal massage and things like that. It's funny because some people think, “Oh, I'm going to have a big baby,” or whatever they tell you that your baby is going to be big or small, but there is a misconception that if your baby is big, then you're going to tear. You're just going to tear, but some women don't tear and they have 10 pounds but other women tear and they have a 6-pound baby. Meagan: Yep. Crystal: It can happen to anyone. It doesn't matter how big or small your baby is. That's the immediate recovery from any tears. Of course, you want to to sitz baths. They have the dermaplast spray to help with pain and things like that. Bleeding, if you had a C-section, you will still bleed. Maybe not as long as a vaginal delivery, but bleeding can last anywhere from a few weeks up to 8 weeks so that's totally normal. Some women are like, “Oh my gosh. Why am I bleeding still?” It's totally normal for all of that. Meagan: Yeah. The wound of our placenta, we have that on our uterus so we can bleed. We can bleed shorter sometimes or longer sometimes. Crystal: Right. Yeah, and it is a wound which is why it's not recommended to have any sexual intercourse until at least six weeks. Even when your doctor “clears you”, you still may not be ready. You're exhausted. You feel touched out, so it's totally okay to be open with your partner on how you're feeling in regards to that, but you definitely want to wait at least six weeks for sexual intercourse. And then of course, have a plan for birth control because you are most likely more fertile right after you've given birth. Speaking of breastfeeding, there is a family planning method called Lactational Amenorrhea Method and there are three criteria to this. You should be less than six months postpartum. You should be exclusively breastfeeding and not have started your period. With those three combined, you can usually use exclusive breastfeeding as a type of birth control. It's just crazy. You do have to be exclusively breastfeeding though. That's the really big key thing. If you're giving bottles here and there, I believe the CDC I think it was said, “If you're exclusively breastfeeding and not going more than four hours in between feedings, it's a good family planning method.”Meagan: I've never even heard of this. When I saw it on the list, I was like, “What is that?” I had no idea. Crystal: Yeah. Yeah, it's crazy. It's just because while you're breastfeeding, a particular hormone is lower than usual. It suppresses ovulation and that's why a lot of women who are exclusively breastfeeding don't even have their periods until months down the line. Meagan: Yeah, we had a question like that on one of the Thursday questions. When is it normal for people to have their period return? I'm like, “It really just depends. It totally depends.” Crystal: Yeah. Yeah. It could be a couple of months after birth, or like I said, if you are exclusively breastfeeding, it could take a little bit longer. Meagan: Yeah, so talking about hormones and all of this, I have been blown away to see recently that we have providers– if you're in Utah anyway, this is happening– that literally right after birth, they are saying, “Hey, we can put your Mirena IUD in right now.” Crystal: Oh my gosh. Meagan: What?! My mind was blown. I was like, “Hold on.” They left and I was like, “Let's talk about this. Let's talk about placing a Mirena IUD the second you have your baby.” Crystal: I know. Meagan: What? No. I mean, for me, I was passionate about it because my IUD was actually placed too early with my second. My cervix hadn't completely “hardened”. It hadn't recovered completely and so it was too soft. It ended up floating up and protruding through my uterus going towards my lung. Crystal: Oh my gosh. Meagan: I was specifically told, “It's because you got it too early.” I'm like, okay. So that was one thing. But hormonally, why are we giving birth control hours and days after we have a baby? So that is something that is happening. Have you ever seen that? Crystal: That is so crazy to me too, yeah. I have. I have. Meagan: Like what? Crystal: Yeah. Literally right after the placenta is expelled–Meagan: “Well, let's place your IUD right now.” Crystal: Yeah, we'll just place it. I'm like, first of all, that's a big wound. Why are you putting something in there? It needs to recover and two, like you said, the hormone stuff. I mean, yes. Mirena or progestin-only birth control is the recommended birth control to use if you are breastfeeding, but still, this is a very vulnerable time. Meagan: Very. Crystal: I say, if you can, wait until you establish your milk supply so that way you have an abundant, well-established supply because you may experience a dip in your milk supply with any type of birth control. It will be easier to bounce back if your milk supply is established. Make sure you are knowledgeable and know what to do and you are informed and educated on it, but yes. I have seen that many, many, many times. I cringe when I see it. I'm like, “Oh my gosh.” But you know, what can you do? The OB offers it. Moms feel like, “Oh yeah. Let's just do it. Might as well,” but they are not given all of the facts and are not informed. It's so crazy.Meagan: I know. I just couldn't believe it. I could not believe it when I saw that. Also too, we want to know who we are and where we are. We're already dealing with so many hormonal shifts emotionally and then getting breastfeeding established and things like that. Why are we adding? I don't know. It wasn't my thing, but I was just shocked to see that. I was shocked to see that that was happening. Like you said, it can impact the milk supply. By the way, listeners, Crystal is also with The Lactation Network, our sponsor, which is super exciting to find out about. She is really skilled in lactation and things like that. Is that something that can impact our milk before we even establish our milk?Crystal: Yeah, it can. I can't say always, right? But yes. I've definitely seen it impacted. It can take a little bit longer for milk supply to be established if you've got the Mirena or started the birth control early on. Like I said, the recommended hormonal birth control is something with progestin-only or progesterone only and no estrogen. But I have seen some women's milk supply impacted by the recommended one. I always say, of course, birth control, yes, is there and it's good but if you do plan to breastfeed, at least know that it may be impacted. Be educated on how you can, I guess, counteract that dip. Frequent and effective removal of milk, staying hydrated, having good nutrition, and eating lots of leafy greens and protein and iron are going to help with that. Meagan: I agree. If we can't get it in through food and nutrients, it's okay to supplement and get vitamins and things like that. We highly suggest Needed but getting the nutrients your body needs and understanding that you're going through a lot so if you can't eat that, supplement with that so your body can still have those nutrients. Crystal: Yeah, for sure. I mean, we are recovering ourselves as well as trying to take care of a new baby and maybe even breastfeeding that baby if you're planning to breastfeed so for sure. You lose some blood during delivery whether it's vaginal or C-section and you know, maybe there's even a complication where you hemorrhaged so now you've lost a lot of blood and you need some iron supplements. So a prenatal vitamin for sure especially if you're breastfeeding and then like you said, if you're unable to eat– most of us, at least I can speak for myself, don't get all of the nutrients that I need through food. Meagan: We don't. We don't. It's so hard. Crystal: It is. It's very hard. Either you're on one side of the spectrum. You're either famished because you're breastfeeding and you want to eat all of the time or you have a lack of appetite. I always recommend for moms if they have a loss of appetite, maybe do a smoothie or a protein shake or something like that. Little snacks throughout the day or a protein bar, nuts, seeds, and things like that. A lack of appetite is a sign of postpartum depression or a postpartum mood disorder. Baby blues versus postpartum depression is pretty similar. Baby blues is basically a temporary, short feeling of that initial postpartum period where you're exhausted. You're stressed. You're anxious. “Am I doing this right for my baby? Is my baby getting enough? I'm tired. Oh my gosh. We've got a new routine going on.” Those are baby blues. It's short, maybe a week or two and you're able to move on. But if it lasts longer than that and includes other signs such as a lack of appetite, excessive worrying, lack of sleep– I mean, of course. New mothers are already sleep-deprived but if you are just so–Meagan: Really unable. Crystal: Unable and you can't sleep even when the baby is sleeping, then those are definitely signs of postpartum depression and you for sure want to reach out to your OB at the least or whatever psychiatric resources your insurance plan has, you want to reach out to them. Of course, online there is a lot of stuff and resources for that. Like you said, it can show up at 11 months postpartum so always be aware of that. And then for the partners, just make sure that they are aware of those things because they may see it first before you realize it yourself. Meagan: Yeah. Exactly. That's what I was just going to say. Yeah, at 11 months is when I really willingly addressed it and recognized it deeper myself, but looking back, I think that it started way further. It just kept getting deeper so going back to baby blues, maybe I was like, “Oh, these are baby blues.” Nursing was really hard for me. I didn't have the opportunity to have as skilled of an IBCLC. As we know, insurance doesn't cover that a lot. We were young and didn't have the best jobs in the world so we didn't really have things like The Lactation Network to work with our insurance and support. Crystal: Right. Right. You couldn't afford it.Meagan: So it was really just trying to figure it out. I had the IBCLC in the hospital and things like that, but not on a deeper level so that was really hard for me. Then it was the stress of work and the thought of how I was going to juggle it all. Then it was back to work. Then I was really struggling when my mother-in-law accidentally spilled over my hard-work-pumped milk for my baby for that day. If I look back at all of the things, I actually had a lot of these signs, but I didn't really chalk it up to anything other than, “I'm a new mom.” I think that's where we can go wrong. There are so many times where it's like, “Of course I'm tired. I have a baby that wakes up every couple of hours. Of course I'm sore. It's because I just had a C-section. Of course I'm this. Of course I'm stressed,” but like you said, if this is continuing, that's where we need to reach out. Crystal: Yeah, and there are a lot of resources out there. Like I said, the first thing would be to reach out to your own provider whether it's your general practitioner or your OB. Someone who can point you in the right direction or give you some of the resources for that. Yeah, so speaking of that, our own maternal struggles, also the partner struggles. I talk to dads and a lot of the time, they're like, “Oh my god, I feel bad. She's trying so hard and I'm trying to do what I can.” It's stressful for the partners as well. Meagan: Absolutely. Crystal: Seeing your other half struggle because they really want to breastfeed or struggling with postpartum depression. Partners will ask me, “How can I help?” so I give them tips like, okay. If mom is breastfeeding or doing newborn care or anything like that, try to make the meal for her. Help with the other kids or say, “Hey, why don't you go take a bath?” because as moms, we just neglect ourselves. I always say, “Make sure she has snacks.” Of course, water and food are probably the biggest things especially immediately postpartum for recovery for ourselves and to nourish our body so we can nourish the baby. But yeah, we should acknowledge that and like I said, obviously, I can't speak for all moms, but for me, I didn't realize and acknowledge all of the things that my partner was doing. The partners can also experience some postpartum anxiety and postpartum depression. Meagan: They really can. I was just going to say that I didn't have the mental space to recognize what my husband was and wasn't doing and where he was emotionally. It wasn't until I wanted to VBAC with my second, my VBAC after two C-sections, that I realized that he had some trauma and some things that he had been dealing with based on things that he had said. It was like, “Oh, okay.” So it's kind of interesting, but I wasn't in that space because I was so focused on my baby that I couldn't even focus on myself or my husband. Crystal: Of course. Right, yeah. Yeah. As mothers, it's instinctual. Of course, we have our baby. We have to protect it and we have to do everything for it but then also we neglect ourselves and inadvertently everyone else around us. But it's good to acknowledge and even just a “thank you” to the partner like, “Hey, I'm so sorry. I'm just really tired. Blah blah blah. Thank you for what you're doing and supporting our family.” Meagan: And coming up with a plan. I think communication is really big and it's really hard for us to say, “I'm not okay,” but it's okay to not be okay or feel okay. There would be times where I would just be tearful. I didn't even know why. He would be like, “What's wrong?” I would be like, “I don't know. I don't know. I don't have anything where I can say this or that.” It got to the point where you have to communicate and say, “I'm not okay” or “I need help today” or “What can I do for you today? I'm feeling really good. You seem like you're stressed. What can I do for you today?” Right? It's hard because again, we're not in that space. We're already taking care of a baby. We can't take care of another human, but they are taking care of the other kids and the dinners and they're still trying to help so sometimes just asking, “Hey, I'm doing good today. I'm just doing a quick check-in. How are you? If you're not okay, how can I help you?” or “Hey, “I'm not doing well today. Is there any way I can get help with this?” Or if they can't do it because they are tapped out, talk about it. Come up with a plan. Maybe it's lactation help. Maybe it's going to a therapist. Maybe it's having a cleaner come in and clean your house because looking at it is creating anxiety for everything that's going on. We don't want a dirty house with a new baby and all of these things. So communicating and really having that full openness is going to impact our postpartum and the way things are with our spouse and our loved ones. Crystal: Yes. I totally agree. Communication is key. I really believe that preparing for the postpartum period before we get there is key too. Meagan: 100%. Crystal: Yes. That well-known saying, “It takes a village,” I say, try to start forming your village before you deliver. Look up different mom groups if you don't have family. Of course, family and friends that are near you will be the best because you feel more comfortable asking. It's pretty hard for us to ask for help. Meagan: It is. Crystal: But it should hopefully be easier with family and close friends so if you can establish that village beforehand before it gets really bad, then you have those resources already. Or, like I said, if you don't have family or friends close by– like for me, I was in the military and I had my second baby while I was away from all of my family– try to find resources in your county or your community or even online mom groups like The VBAC Link and support groups like that where you can even just vent and type out, “I'm so tired.” Whatever you are feeling, there are just so many supportive women, not only women but supportive people out there who are willing to be an ear or try to put you in the right direction or even point out things like, “Hey, it sounds like you maybe need to reach out to somebody. Please do,” and this kind of stuff. Meagan: Absolutely. We've been talking about that a lot lately how we're doing so much to prep for the birth and during pregnancy and all of these things, but then we do forget about the postpartum and really, during our prep for birth, we also need to be prepping for that postpartum period. Crystal: For sure. Meagan: That includes finding your village and getting a meal train organized. Truly, meal trains are amazing. If you want to breastfeed or whatever, I would think even if you are not planning on breastfeeding, it's good to talk to a lactation consultant. Get in touch with The Lactation Network beforehand. Understand your resources and your groups. PSI, postpartum support international, is really great. Resources as well– being familiar with those pages, going and looking at those professionals, understanding, and having a relationship so it doesn't come to five weeks postpartum and think you need help but now it feels really overwhelming to find that village. Crystal: Yes. Right, right. Meagan: Right? It's very overwhelming so if we can just have our village in play, then they're available. We have them on our list. “Oh, here's my lactation help. Here's my postpartum help. Here's my favorite group to vent and get it out because I know I'm going to be validated and feel love in this group.” Crystal: Yes.Meagan: Whatever it may be, do it beforehand. Do it before. Crystal: Yes, yes. I wish I did that before too with my older kids because like you were saying earlier, we were young. I didn't know. I was naive. I was 20 and I'm just like, “Okay. I don't know what I'm doing.”Meagan: I'm just going to have a baby. That's what people do. They show up and have babies then they go off. They know how to nurse and they know how to help. They understand what is going on with their body and how to recover and get those nutrients and fuel our brains. No. Guess what? I didn't know any of that, you guys. Crystal: I didn't either. I did not either. Meagan: I wish I did. I wish I did and that's why we're here talking to you today. Even if it's baby number two and you didn't do it with your first, it's not too late to create your village beforehand for birth and postpartum. Crystal: Totally. Meagan: Those might be two different villages, just fyi. Crystal: True. That's a good point. Yeah. Yeah, for sure. Speaking of postpartum, parents need to also keep in mind that things can change. We have our birth plan. Okay, we're going to breastfeed. We're just going to pump or however you choose to feed your baby but unfortunately, things can happen that are unexpected things. Complications or issues with milk supply or baby not even wanting to take a bottle, having a bottle refusal or breast strike so just being flexible and like you said, knowing where you can turn to for help like, “Okay. I'm having this issue. I'm going to reach out to my lactation consultant” or “I need some extra help with meals or cleaning.” Like you said, now that I know everything that I know, I wish somebody would have told me– you know how we do our birth registry– that we don't need a lot of those things that we put on there. What we need are meal trains and if you have family or friends, someone who can take turns once a week to come in and cool a meal for you or just help you clean up or even a postpartum doula. Meagan: Yes. Crystal: Money for that would be great. Way back when, we didn't have all of this different equipment for the babies and we did just fine without it. Meagan: Yep. Yep. Yeah. There are so many details to figure out. If you really think about it, it's why it makes so much sense to do it beforehand because we're tired. We're sore. We're recovering. We're overwhelmed already. You guys, I don't know. This is my personality. If I'm overwhelmed, I'll just ignore it. I'm like, “I'll just get to it later.” Then it never happens and I suffer because I never did it. Crystal: Yep, exactly. Meagan: Honestly, you guys, if it's overwhelming– say that right now you're listening and you're 3 months postpartum and you're like, “Oh gosh. Yep. Everything these guys are saying, I need help,” delegate. That's okay. Tell someone. Tell your mom or your friend, “Hey. I need help. This is where I'm at. Is there any way you can help me find these resources?” In the show notes below, we are going to have some resources. We'll have The Mama Coach. We'll have The Lactation Network. We're going to have PSI. We're going to make it easy for you right here too, but it's okay to delegate and say, “Hey, I'm not in a space that I can find this.” Wish you woulda, shoulda, coulda, you can't go back and dwell on it. Let's get help now. Delegate someone to find you or even send them this resource and say, “Can you reach out to these links?” Crystal: Yeah, because that's a lot of time too going through these different resources and contacting them or navigating their websites to find the specific information you need. It takes a lot of time and the next thing you know, an hour goes by and you're like, “Oh my gosh, I could have taken a nap. Now the baby's up.”Meagan: Exactly, yeah. Send them this podcast. There will be all of the links in the show notes for all of the things that we are talking about including nutrients that your body needs and resources so we can hopefully try to make it easier for you. Crystal: Yes, for sure. Yes. As a Mama Coach, we have Mama Coaches all around the U.S. and even all around the world. Most of us do provide postpartum hourly care similar to a postpartum doula. We could do it even virtually, virtual postpartum care. If you need help with how to birth your newborn or just with help around the house. If you need someone to watch your baby while you take a nap, the Mama Coach has a lot of services as well. Like you said, it will be in the show notes but definitely reach out. If I can't help you, I can definitely point you in the right direction or connect you with another Mama Coach or resource, whatever that can hopefully help support you. Meagan: Yeah. Do you know what I wish I had you for? Helping me know how to return to work. Crystal: Ah, yes. That's a big one. Meagan: It was a really big, daunting task. I remember just trying to look online, how to figure out, what a good schedule is, if I wanted to pump, what a good schedule for pumping was based off of my specific work schedule, and things like that. Crystal: Yeah. Meagan: I know you guys can help with that. Just a few tips that you can give our listeners if they are planning on returning to work. Crystal: Yes. I always say to try to start planning for your return to work at least a month before you plan to return to work. If you are breastfeeding, say you are postpartum and going along, you are exclusively breastfeeding and now you're going back to work, if you're going to be bottle feeding, don't wait until the last minute to introduce a bottle. There have been a lot of babies who have refused the bottle and just want the breast so for sure, you don't have to give them a bottle every time, but I always say that at least once a week or so starting off a month prior to going back to work, start to introduce it if you haven't already. Yes, definitely you need a plan because there is that separation anxiety too. You've just been home with your baby for 6 weeks, 8 weeks, 3 months, 6 months. You've been home taking care of your baby and now you have to pass him or her off to either a daycare provider or a family member or your husband. The husbands do a lot of stuff, but of course, as a mother, we just are that nurturing type and it's like, “Okay. Are you going to take care of the baby as well as I do?” Meagan: Yeah. I wanted to micromanage my husband. I was like, “I know you're going to do it great.” I kind of was that way with everyone. “I know you're going to do a really good job, but you're not me.” It's so hard. Crystal: Exactly. It's just different. It's definitely hard. There is that separation anxiety so prepare mentally too. Like you said, open communication with whoever is going to be the caregiver while you are away for work whether it's your partner, a family member, a friend, or a daycare provider, be open with them. “Hey, I am breastfeeding and bottle feeding. Paced bottle feeding. Can we talk about that? If you don't know how to do it, I can send you a video on how to do it.” If they are starting solids, what kinds of foods? There are a lot of different things so you definitely need to come up with a plan. I think that the biggest thing is coming up with a plan and being flexible because you just never know what your baby is going to want to take. Meagan: I know. Crystal: I've heard of babies not even eating while they are away from their mom and then they are nursing all throughout the night and now moms are tired and they have to go to work tired. It is a lot so I mean, I think the few tips I have is to get prepared at least a month in advance and open communication with whoever the caregiver is going to be. Reach out for help. Meagan: And reach out for help. Absolutely. Women of Strength, it's okay to reach out for help. It's okay to feel like you need help. We don't want you to have to feel like you need help. We want you to be prepared and feel confident along the way, but it's more likely to need help than to not need help so know that if you do need help, you're not alone. There are a ton of amazing resources that just want to do nothing but help you. Crystal: Yes, definitely. Meagan: Awesome. Well, thank you so much. We'll definitely have to have you on again. I know that we have just brushed the surface. Crystal: Yes. No, I would love to be on here again. Thank you for having me. I love this platform. You guys give a great amount of information and resources and things like that, so thank you for having this platform. Meagan: Yes, thank you. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

https://www.instagram.com/littleraeofhealth/https://podcasts.apple.com/us/podcast/the-little-rae-of-health-podcast/id1675991986Check out Citrine: My favorite, one-stop-shop for all things low-tox skincare and beauty. Save 10% by using code: ashleytaylorwellness (all brands except TheraBody, Vintner's Daughter, and Kypris) Click here0:40 - Mirena IUD lawsuit - copper IUD4:00 - Is the Dutch test worth if you're on hormonal birth control?6:11 - We're never going to be perfect, so bring it to the middle8:51 - Having strong boundaries for your health while traveling, while also being sustainable for you10:45 - Why you may not find your partner attractive if you're on birth control and stop taking it12:30 - Finding the most resilient mate for you14:15 - T4, Thyroid & Synthroid15:10 - D-minder app to track vitamin D levels from the sun16:00 - “Woman Code” book Alisa Viti 16:30 - Thinking of seasons simplifies cycle syncing19:24 - Emily Rae's experience with 75 hard, she did it for 3 weeks and her period came early and was painful21:33 - Never know how good you can feel until you get healthy22:42 - Natural cycles with the Oura ring takes average of the temperature during the night ouraring.com/ashleytaylorwellness24:18 - What trends has Emily noticed with natural cycles27:23 - Things that will help & harm our hormones28:00 - Stress from social media scrolling31:30 - Oura's new feature: stress tracking ouraring.com/ashleytaylorwellness33:20 - Emily does take aligned clients sometimes, so you can dm her to see if it's a great fit. Or, The Balanced Babe Blueprint course, lifetime access.Follow me on Instagram here:https://www.instagram.com/ashleytaylorwellness/https://www.instagram.com/highmaintenancehippiepodcast/Apply for 1:1 Coaching: https://secure.gethealthie.com/appointments/embed_appt?dietitian_id=1270471&require_offering=true&offering_id=133465&hide_package_images=false

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Often in medicine, doctors discover a new use for an old treatment or a treatment that is approved for one use and serendipitously doctors find a new use for a drug or medical device. I have used a specific type of IUD in menopausal women on estradiol to prevent postmenopausal bleeding. The Mirena or Kyla IUD produces progesterone into the uterus to suppress the effects of estrogen on the endometrium, preventing post-menopausal bleeding and growth of fibroids. In the May 2023 Journal of OBG Management the experts have discovered that these special IUDs can be used for more than just birth control.  They don't contain any estrogen, but they deliver the progesterone (progestin) where it is needed to the lining of the uterus for 8 years! The cost of one IUD/8 years vs that of daily progesterone reveals a great cost savings by using a Mirena or Lyetta or Kyla (for uteruses that have not been pregnant) and a time savings for patients who are having difficulty with post-menopausal bleeding while on estradiol pellets, or any form of estrogen after menopause. The way these IUDs work is that the soft plastic material of the IUD has a packet of progestin attached to it that slowly dissolves over 8 years. In general, I don't advise the use of Progestins orally as it increases risk of breast cancer and heart disease ONLY when it is taken orally.  The small dose that circulates locally in the uterus is only beneficial and is not circulated throughout the bloodstream. The Mirena (I will use “Mirena” to represent all IUDs of the same genre because it was the first one FDA approved) is placed in the uterus in the GYN office, and a short string is left to stick out of the cervix to be palpable by the patient or the doctor to show that the IUD has not exited the uterus (which is rare in women not having periods, menopause). Generally the patient is given a week of progesterone to cause her to evacuate the remaining lining of the uterus before the IUD is placed. This will decrease the spotting and bleeding after the procedure. If it is a difficult insertion of the IUD, the GYN will often do a post insertion Ultrasound of the uterus to make sure the IUD is in place.  There are a few menopausal women who cannot have an IUD after menopause.  Those patients who have had an ablation of the lining of the uterus usually has scarring of the uterine lining so that an IUD would not be inserted easily or at all.  A patient with a uterine septum is not a cancidate for an IUD. Patients who have had a perforation of the uterus in the past are not a candidate for this treatment either. Patients with fibroids on the inside of the uterine cavity are not a candidate either, because the IUD may rub against the fibroid and cause it to bleed. However if you have a uterus and are on estradiol or oral estrogen and take progesterone or progestin with it to protect your uterus, and have trouble remembering the progestin or progesterone dose every night or you continue to bleed even on progesterone/progestin, then a Mirena would be a good solution for you! There is a novel treatment for those women who we have been unable to give estrogen to because of uterine bleeding, and the Mirena IUD or one of its sisters is the answer!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog. BioBalance Health® pellets are very safe and not painful to have inserted. They are also the easiest form of hormone replacement a woman can have because the dose is adapted every 4 months and our patients only have to think about their hormones three times a year.   BioBalance Pellet therapy is associated with fewer side effects than any other hormone replacement, and we have a 95% success rate for resolving the symptoms of menopause and testosterone loss. Women's lives are drastically impaired at menopause.  BioBalance, and T pellets improve their quality of life to the level of quality they had before they were 40.   Dosage and pellet side effects are specific to the individual and it may take us a few pellet insertions and blood tests to get the ideal result. Finding your perfect fit is like having a custom suit made: hormone balance requires patience and several fittings, before we determine your maintenance dose, which will direct your dose of E/T for follow up pellet insertions.   We give a handout to each patient when she checks out after her first pellet insertion. We ask patients to follow the instructions given to them verbally and in writing in our office. Risks of pellet insertion procedure, risk of taking estradiol and risk of taking testosterone are rare, but patients are given this handout, so they know what to expect.  These same risks are on their consent that they read and sign before they even come to the office the first time.   Here are the most important instructions for immediate care of the insertion site:   ·      Take the pressure dressing off in 3 HOURS ·      Take the steri-strip off in 3 DAYS ·      Don't traumatize your incisional area ·      If you are allergic to tape please tell us ·      For three days don't submerge in water—hot tubs, bathtubs, the lake, a stream, or the ocean. ·      For three days don't exercise ·      Don't take oral or IV steroids if it is not life-threatening   Please tell us if you are on steroids or take blood thinners so we can alter our treatment plan.   The risks of the pellet insertion procedure include:   ·      Infection ·      Bleeding, ·      Bruising ·      Allergic reactions ·      Swelling ·      Pain ·      Reaction to the lidocaine with epinephrine :shakiness and anxiety, lasts a short period of time, and is not permanent.  Tell us if you have this side effect, and we will use lidocaine without epinephrine the next insertion. ·      Keloid scarring     As is usual for medicine , individual patients have a higher risk based on their medical history. Patients who are at higher risk for complications secondary to the pellet insertion procedure in patients who are:   ·      Diabetic ·      Have an autoimmune disease ·      Take steroids ·      Have a clotting/bleeding disorder ·      Keloid former ·      If you have many allergies ·      If you have orthopedic implants that require antibiotics at the dentist, then you should tell us so we can give you antibiotics.     Risks of taking testosterone pellets with BioBalance Health® in the first few weeks or months and are transient. These side effects usually resolve on their own without treatment.    The transient risks of testosterone treatment include:   ·      Over the top sex drive=Hypersexuality ·      Vaginal itching from increased blood flow—it is not an infection ·      Facial hair and acne (Prevented with Spironolactone preventive treatment) ·      Weight gain from muscle mass and sometimes from conversion of testosterone into estrone which is a genetic risk. ·      Increased muscle mass that is confused with weight gain. ·      Lowered voice is only a problem when you are a singer.  Generally, those who think they have a lowered voice really have reflux and it has nothing to do with testosterone pellets. ·      Clitoral enlargement—this is a reaction to a new testosterone exposure, and generally will go away in the following few months. ·      Thinning of hair at the temples and crown (Prevented with Spironolactone preventive treatment)   Women can take testosterone without estrogen before menopause, and after menopause if requested, however the symptoms of menopause will not be completely resolved with testosterone only pellets.   The risks of estradiol pellets are higher for patients with a uterus, than those women who have had a hysterectomy.   Those women with a uterus have the following risks:   • Uterine bleeding, growth of fibroids: Estradiol of any kind - pellets, pills, patches etc. - can stimulate the uterus to bleed. This can come from a thick lining, adenomyosis (spongy uterus), or fibroids. Prescribing progesterone, optimally sub-lingual progesterone or BLA progesterone from Belmar pharmacy, taken 1-2 times a day, counteracts this. Other treatments are surgical and offered by your Gyn. Your doctor will evaluate you for treatments: uterine wall ablation (80% effective), or a Mirena IUD. Sometimes bleeding will necessitate the choice between a hysterectomy and contin   Risks of estradiol pellets for women with and without a uterus: ·      Vaginal discharge: Estradiol increases the moisture in your vagina. This is a gift to some and a curse to others. This wetness is not an infection, but a normal response of the vagina to estradiol. It needs no treatment, but if it bothers you, then the choice might be that you might have to stop getting estradiol of any kind, or just put up with the wetness, or decrease the estradiol dose with the next insertion. ·       Bloating: This is sometimes caused by too high a dose of estradiol for a particular person, or the conversion of estradiol into estrone, which causes water weight gain. Some women need progesterone to balance the estradiol, to treat bloating. Others require a diuretic, or a low carb diet, thyroid medication, DIM supplementation or more exercise. Most of the time this symptom will resolve itself in a few weeks after it starts, as the body balances itself out. Bloating has many non-hormonal causes as well. ·      Anxiety/Depression: Most women's anxiety decreases as estradiol levels rise, but others feel irritable, and for this occurs only in a small subset of the population. For those patients we add progesterone SL (Sublingual tablets) to their regimen, and they improve. Think about whether you stopped your antidepressant when you started pellets. This is a premature move and can cause women to emotionally crash. Please continue your anti-anxiety medications, or your anti-depressants until 4-6 months has passed, and have the prescribing doctor help you wean off. ·       Breast tenderness: This symptom is usually from a hormone called estrone, and not estradiol, but breasts that have not been exposed to estradiol for years sometimes hurt as they “wake-up”. This is generally limited to a month during the first pellet cycle. The product DIM can alleviate this symptom. Remember that stimulation of the breast can also cause them to swell and hurt! In rare patients, progesterone can cause breast tenderness. ·      Weight Gain: Weight gain occurs for many reasons especially over the Holidays. Other times water weight gain can come from Estradiol. This water weight is self-limited and sometimes requires progesterone balancing, a diuretic, or thyroid replacement, increase of protein and decrease of carbohydrates and alcohol. • Migraine headaches: Estradiol in high levels that increase and decrease drastically destabilize the neurotransmitters and can instigate a migraine headache. Pellets increase very slowly, and decrease very slowly, so either your headache is a tension headache and not a migraine, or has a trigger other than estradiol, such as stress, weather change, or food allergies. Migraines generally improve on Estradiol and Testosterone pellets.    

Welcome to Episode 19! And can you believe it, we've already passed my 6 month explant anniversary!!! If you are joining today's episode because you have been searching for podcasts on the Mirena or other IUDs, feel free to skip to 21:28.  My dogs joining in a couple of times throughout the episode, see if you can pick when Harper and Tillie interrupt. The links that I mention throughout the episode are: Professor Deva's study: https://saferbreastimplants.org/breast-implant-removal/ TGA Adverse Event Report: https://www.tga.gov.au/resources/resource/forms/report-medical-device-adverse-event-medical-device-user#:~:text=Complete%20the%20online%20form%20to,or%20phone%201800%20809%20361.  ACCC phone number 1300 302 502 and link: https://www.accc.gov.au/consumers/problem-with-a-product-or-service-you-bought Be Real Babe Podcast are on Rumble, Apple, Spotify etc if you would like to check out my episode with them. Mirena IUD: https://www.mayoclinic.org/tests-procedures/mirena/about/pac-20391354#:~:text=Mirena%20is%20a%20hormonal%20intrauterine,type%20of%20the%20hormone%20progestin. You can find me on instagram at https://www.instagram.com/coulditbiipodcast/

What is an IUD, how does it work and what does it mean for my body? We're answering all of these questions and more in this episode explore hormonal IUD's. with Reproductive Health Practitioner Chloe Skerlak (https://www.instagram.com/chloeskerlak/). In this episode: - What is a IUD? - How does the Mirena IUD work? - Choosing an educated contraceptive method - Do you really ovulate with an IUD? - What to expect after an IUD insertion? - Side effects of hormonal IUDs - 5 things you need to know about the IUD - The advantages of the IUDs - What to do when coming off the IUD Get the full complete show notes, here: https://www.wellsome.com/podcast/ FREE LOVE YOUR CYCLE DOWNLOAD: https://www.subscribepage.com/love-your-cycle MENSTRUAL CYCLE MEMBERSHIP - WELL WOMAN ACADEMY: https://www.wellsome.com/academy/ LOVE YOUR CYCLE FB COMMUNITY: https://www.facebook.com/groups/loveyourcyclesisterhood/ INSTAGRAM: https://www.instagram.com/wellsome_jemalee/ WEBSITE: https://www.wellsome.com/ HELP US SPREAD OUR PODCAST WINGS This show is a passion project that I produce for the love of spreading menstrual cycle awareness for free. If you enjoy this show, help us reach more menstruators. The most effective way you can help is: 1. Subscribe to the show by clicking “subscribe” in iTunes 2. Write us a review in iTunes 3. Share this show with a friend, right now! 4. Screenshot and share via social media - don't forget to tag me @wellsome_jemalee Simple yes, but you'd be AMAZED at how much it helps this passion project reach more people. iTunes' algorithm uses ratings and review to know who to show our show to in their app. Review here on iTunes. In love & abundance! Jema

Episode 18 is the powerful story of how Ironman athlete, Meghan Newell Davis was given a terminal diagnosis of scleroderma not long after the birth of her son.  At the top of her game, and in perfect health, Meghan chose the Mirena IUD as her method of birth control after giving birth.  Shortly afterwards she began to develop debilitating pain and was losing the ability to pick up her son, change his diaper and even walk.  Doctors dismissed her symptoms and no one knew how to help.  Finally she found a doctor with answers.  And it wasn't good.  There was no cure and it was terminal.  Meghan was devastated. She was sent to Duke University and given the option to have a stem cell transplant.  But there were hurdles to cross, could she qualify for the treatment, would insurance cover it?  And the costs could run up to $300,000.  Meghan activated her warrior spirit and was determined to beat the odds.  The treatment was difficult.  Radiation and chemotherapy were undertaken to kill everything in her body, in order to receive the stem cells back in and pray for a good outcome.  All along, Meghan's mantra was "Austin Davis, Austin Davis, Austin Davis" her son's name.  And, although she was very angry at her faith, she clung to it, listening to Christian music over and over. What Meghan didn't realize was that the transplant was only the first part of the journey.  Leaving the hospital to go home, she had to learn to use her muscles and body all over again.  She had to learn how to walk again and making it to the mailbox was a huge victory. Meghan is doing remarkably well and considered scleroderma free.  She has begun training again for an Ironman, knowing it will take time, but she is fierce in her determination.  Above all else, Meghan fights to be a Mom for her beloved son. Meghan graduated from Radford University with a BS. in Exercise Science Health Education Commercial Corporate Fitness with a minor in Nutrition. After graduating she worked as a Rehab Specialist for a Chiropractor in Northern Virginia. She received her Chiropractic Certificate from Parker University and became a Chiropractic Assistant. She came across the Ideal Protein protocol at her Chiropractic office and had excellent results with weight loss and balancing her hormones. Instantly she knew Ideal Protein would be her passion and became an Ideal Protein Coach and Business Developer for Ideal Body Wellness in Northern Virginia.  She has been with Ideal Protein for over ten years. She moved to Myrtle Beach with her husband 4 years ago and became the Founder and Clinic Director of Ideal Body Myrtle Beach. Ideal Body Myrtle Beach is the first Ideal Protein clinic in the Grand Strand Region. Ideal Protein has become an incredible tool in Meghan's life. Not only did it help balance her hormones but it helped her recover from her Stem Cell Transplant after being diagnosed with Scleroderma after her son was born. She lost over 50 pounds after battling Chemotherapy/Radiation and Steroids for treatments. She utilizes Ideal Protein as her Sports Performance Nutrition when training for her Ironman races. In her spare time, Meghan is an advocate for Scleroderma Awareness and Stem Cell Transplant for Duke Medical University.  If you, or anyone you know, is suffering from scleroderma, please feel free to reach out to Meghan.   Connect with Meghan Newell Davis Follow Meghan on Facebook Follow Meghan on Linkedin Follow Meghan on Instagram Follow Facebook Group Scleroderma Connect with Jennifer Seven Follow Unbreakable Spirit on Facebook Follow Unbreakable Spirit on Instagram Follow Jennifer Seven on LinkedIn 7Company Weight Loss & Wellness  Follow on YouTube Follow Jennifer on Twitter Schedule a Free Consultation with Jennifer Get your copy of the book  right here on Amazon  UnBreakable Spirit The Sisterhood Folios   12 remarkable and courageous women take you through their journeys. They show you the strength of their Spirits and show you how they discovered the greatness within themselves. Let them inspire you to find the Unbreakable Spirit that you possess. #7Company #JenniferSeven #unbreakablespirit #transformation #sclerodermaawareness

On this week's 51%, we discuss the inflammatory condition endometriosis: what it is, what it looks like, and how it's treated. We also speak with Linda Griffith, scientific director of the MIT Center for Gynepathology Research, about how engineers are working to better understand the disease. Guests: Linda Griffith, scientific director and co-founder of the MIT Center for Gynepathology Research; Dr. Kathy Huang, director of the NYU Langone Endometriosis Center; Sarah Digby; Natalie Rudd, learning and education manager at the National Women's Hall of Fame 51% is a national production of WAMC Northeast Public Radio. It's produced by Jesse King. Our executive producer is Dr. Alan Chartock, and our theme is "Lolita" by the Albany-based artist Girl Blue. Follow Along You're listening to 51%, a WAMC production dedicated to women's issues and experiences. Thanks for tuning in, I'm Jesse King. Most of us are aware that it's Women's History Month, but the month of March is also an important time to discuss women's health. It's Endometriosis Awareness Month, a time to read up and spread the news on a condition that impacts roughly 1 in 10 women (or people with uteruses) worldwide. Despite those numbers, endometriosis has historically been written off as a “women's disease,” a taboo topic of conversation, or simply part of being a woman in general (after all, no one enjoys their period) — so there's still a lot we don't know about it. So that's what we're focusing on today. The big questions: what is it, what does it look like, and how is it treated. To use the definition offered by the Endometriosis Foundation of America: endometriosis is when tissue similar to the inner lining of your uterus, called the endometrium, is found outside your uterus — where it shouldn't be. Typically, endometriosis is found on organs like the uterus, the fallopian tubes, ovaries, bladder, etc., but in extreme cases it can advance outside the pelvic cavity to other areas, like your appendix or even your lungs. The problem is that this tissue still acts like the tissue inside your uterus, so it bleeds with your monthly menstrual cycle. This can result in painful inflammation and lesions that contribute to symptoms including: painful and abnormal periods, bowel and urinary issues, neuropathy, infertility, and more. Currently, there is no cure. Our first guest today is Sarah Digby, a 32-year-old former education specialist now living in New York City. Digby grew up in San Antonio, Texas, where she says her access to sex education was extremely limited. Even at home, it wasn't typical for her family to talk about their bodies, so she grew up knowing very little about her own. But the moment she started getting her period at age 12, she knew something was off.  "The way that I was experiencing periods, the way that I was bleeding, and the amount of pain that I was in — it was nothing I had been led to expect I would experience from the pre-teen magazines I'd read, and what cramps would feel like," says Digby. "They would be really bad the first couple days of my period — and I had long periods, they lasted about seven or eight days. They'd kind of abate, and then I'd have some pain towards the end...How could something so painful be so accepted and natural? Even though that's what people were telling me. To be fair, I was a dramatic teenager — but I was also in a lot of pain." Digby says her period caused her to routinely miss school during her high school and college years — but that didn't seem to concern many of the people in her life. She never got used to the pain, but over time, Digby says she basically learned to live around it, or at least, in her words, “shut up about it.” By the time she moved to New York and started seeing a new OB GYN in 2008, and it didn't even occur to her to mention the regular pain she was experiencing. But the cysts started happening. "One of them happened on a plane, right before takeoff, while I was on a layover. I passed out and had to be pulled off the plane by EMTs. Even then, no one could figure out what was wrong," Digby explains. "At the time I was actually a teacher, and one time I had an endometrioma rupture on the subway — didn't know that's what it was — [I] barely made it into the school, and then [I] had to have someone cover my class, because I was down for the whole rest of the day, unable to walk, unable to do anything, and just in excruciating pain. I was quickly becoming pretty disabled." What Digby was experiencing were rupturing endometriomas, blood-filled cysts that typically start on one or both of the ovaries. Endometriosis is currently classified in four official stages according to morphology — basically, how many lesions or cysts you have, and where they are. At the time, the flare-ups around Digby's periods had died down — she was on the IUD, so she stopped getting her period — but over time her lesions had increased in number and gotten deeper, and with the added cysts now bursting multiple times a year, her pain was no longer tied to her menstrual cycle. It could hit at almost any time. A precautionary sonogram by Digby's OB GYN showed an unruptured endometrioma on her right ovary, which then prompted her doctor to schedule a laparoscopy, or diagnostic surgery. At age 26, nearly 15 years after experiencing her first symptoms, Digby finally had her diagnosis: she had Stage 3 endometriosis.  "Finally, some good doctors were able to identify what was going on," she notes. We'll check back with Sarah Digby later on in the show, but before we head on, I feel like it's important to ask — what causes endometriosis in the first place? As I mentioned at the beginning of the show, there's still a lot we don't know about this disease, and although Congress has increased funding for endometriosis research over the past couple of years, it's still largely under-researched and under-funded compared to other conditions. Our next guest is Linda Griffith, a top bio engineer at MIT and co-founder of its Center for Gynepathology Research — currently the only engineering lab in the nation to focus on endometriosis. In some ways, Griffith's story is similar to Digby's: she'd always had painful periods, but it took decades for her to actually get a diagnosis. Even then, she required several surgeries to combat the disease (including a hysterectomy), and in the late 2000s she founder herself watching her niece begin to grapple with the same obstacles and frustrations. So in 2009, Griffith co-founded the CGR with the goal of better understanding endometriosis, so that it can be more quickly diagnosed and more successfully treated.  How does the CGR approach its research on endometriosis? What struck us at the time we started to work together was the incredible diversity of patient presentations of endometriosis: the age of onset, the symptoms that they have, the types of lesions, the geographic locations of lesions, co-morbidities, response or not to drugs that are already available. After we started working together, I got breast cancer, and I was immediately classified on a molecular basis as triple negative. So there were three markers, they were related to the mechanism of cancer, to the prognosis, and to the therapies. Why is there not a molecular classification for endometriosis? It's so prevalent. There's got to be different molecular subtypes. So the approach at the CGR became "How do we start to classify patients by molecular mechanism?" with a hypothesis that patients could be different, sort of like cancer patients are different, and need different therapies and have different prognoses. So that was our starting point, and this was really, really not done at the time we started. In doing that, we published the first two studies describing approaches to molecular classification. They're not definitive, they were small patient samples, but this has sparked other people to be thinking in this way as well. And it's something that we continue to pursue, both by looking at patient samples, but also by building little, what we call "avatars" of the patients. We take their tissues back to the lab, and we make 3D tissue, engineered little mimics of the patients, and then we can start to test whether molecular things we find in our analyses allow us to intervene with drugs that are not currently in the clinic. So it's really this idea, which was novel, and now more people are thinking that we need to classify patients, because we know that they're not all the same, and we need to figure out how new drugs that are not hormones, for example, could work in different groups of patients. Do we know for sure what causes it in the first place? The causes of endometriosis are highly debated and speculated on, and we don't really know if there's one cause. I tend to think there's many causes. It's like if a patient shows up in the emergency room and has a smashed tibia: it could have been a motorcycle accident, it could have been a brick falling on him, it could have been somebody hitting him with a baseball bat, etc. So there could be many things that converge on similar symptoms, and this falls in with our molecular mechanism hypothesis. There's very, very interesting data supporting many hypotheses about developmental defects. Very clear data that's support for some patients that, during development, cells can go out of the way and get the wrong place. There's very clear circumstantial evidence supporting Sampson's Theory. Some people really reject this theory, but it's not been proved wrong, and there are many, many circumstantial supports for it — where most women have reflux of menstrual tissue during their periods, and it goes in the abdominal cavity. Most women will clear it, but it's conceivable that some of that tissue implants and turns into lesions. That theory is not very consistent with onset at the time of monarch — we know that some girls, including myself, including my niece, had symptoms from my very first period, before there was all of this reflux. And so then there's a hybrid around the time that babies are born. In some babies, there's a little bit of bleeding seen coming from the vagina, and it's about 5 percent of babies, tending to be babies born late. So there's a hypothesis that there may be bleeding, shedding of the endometrial lining around the time of birth, because you have a huge fall in progesterone — and maybe that seeds the abdominal cavity with cells that came from the endometrium around the time of birth. And then when hormones surge during puberty, it wakes those cells up and they cause lesions. I think that there's credible evidence in all of those arenas. The interplay between infection/environmental exposure is still very much provocative, and circumstantial and epidemiological data suggests, for example, exposure to dioxin [could cause endometriosis]. Animal studies implicate exposure to environmental chemicals. This may be something that affects your immune system, and now your immune system is unable to clear the tissue that goes into your abdominal cavity. So many theories, and probably many of them are correct. There's probably many causes. Does the location of endometriosis have an impact on what you experience? So there's not a strong correlation between lesion morphology — meaning how big the lesion is and where the lesion is — and symptoms. Some patients can have Stage 4, lot of lesions, big lesions, deep lesions...and have no symptoms. And I know people like that. Other patients can have one tiny lesion and be in crippling, excruciating pain. Now, those patients may also have things going on with adenomyosis, and if you haven't heard about adenomyosis, it's important to bring it up. It is when endometriosis is in the wall of the uterus, in the muscle. And you don't see it during surgery, typically, and you can infer it by doing an ultrasound or MRI of the uterus — but there's no for-sure diagnosis other than hysterectomy and pathology, or some other interventions that involve surgery of the actual uterine wall. So some patients who are told they have Stage 1 [endometriosis] and feel like they have a lot of symptoms may have something else going on in the uterus, that's actually a version of endometriosis that not a lot of doctors look for. We know very little about adenomyosis. Just for calibration, Crohn's disease affects about 1 percent of the U.S. population, and in PubMed, where all the scientific papers are collated, there are listed about 60,000 papers for Crohn's disease — which is great, it's a terrible condition. But if you look up adenomyosis, which may affect about 10 percent of women, so that means about 5 percent of the population, or definitely more than 1 percent of the whole population, there's only about 3,000 papers. That that's for the whole world. So now you've got 5 percent of the number of publications for a disease that afflicts a lot more people. So this just tells you how little, you know, attention has been paid to gynecology at the level of funding agencies. What do you feel are some of the biggest misconceptions about endometriosis? Fortunately, many of the misunderstandings are being addressed through greater awareness and things like this. There is something that is troubling to me as a scientist, and as a patient, that I see on Facebook groups. There's a particular Facebook group, "Nancy's Nook," and there's a rejection of the idea that Sampson's hypothesis, the reflux, menstrual tissue, is valid. A complete rejection of that. And I can understand that we want to highlight that there could be other causes, and I believe there are other causes, but it's unfortunate when you throw out a scientific hypothesis without a basis for throwing it out. And there's a lot of misinformation now being promulgated by patients who feel that they know more than the average patient — but they know far, far less than the informed clinicians and scientists who work in the field, and they're very dangerous, in my view, because they promote patients to go seek care from people who may be promising them things that are not true. So if you promise a patient that excision surgery will cure them, publish the data saying that you cure patients that way, and then then you can say that. So I'd say some of the big misunderstandings rights now are actually misinformation being given to patients about cures that are not backed up by rigorous data. What do you feel about the different treatments that are out there for endometriosis? And do you have hope someday for a cure? As for treatments right now, it really depends on the patient. Some patients respond quite well to hormonal therapies. A lot of patients respond, some patients get great relief from the Mirena IUD, for example. Other patients do need to have surgery, and in the case of surgery, there's a lot of debate about this so called "ablation versus excision." You absolutely need excision if you have lesions that go deep into the underlying tissue. Ablation is simply burning them off — and if they're very superficial, ablation can be sufficient. However, you have to be very sure that what you see as a superficial lesion is not invading deeper into the tissue. And so I think that this is where there, again, is some confusion in the way that certain patients on social media are advocating for certain kinds of treatment when there are nuances. I would highlight surgeons who have done a fellowship supported by the American Association for Gynecologic Laparoscopy, [they] are going to be trained to do the most severe endometriosis excision surgery. People may say they're doing excision, and if they're not trained through a fellowship, then it's a lot less clear that they were trained with all the methods that are accepted by the professional societies to do that surgery. You don't know until the surgery happens, generally, what the patient's going to present with, and a surgeon who is trained to do only ablation, if a patient presents with more severe disease, will typically sew that patient up and refer them to an excision specialist. So I think we need to be cognizant that there's a spectrum of therapies that for today are adequate for a lot of patients, but some patients are still not served by those: either they have no access to appropriate surgeons; their disease has progressed to a very difficult state, even for really good surgeons; and they may have complex pain phenotypes. Changes in the brain can make the pain more severe and persistent, and this is not a fault of the patient, this is a consequence of the disease. And one of the things we're doing is trying to work with pain specialists to start understanding differences in patients who have different kinds of pain processing in their brains. How might learning about endometriosis help us better understand other diseases or vice versa? There's amazing opportunity to learn about other diseases, particularly the other chronic inflammatory diseases such as fibromyalgia or chronic fatigue syndrome. [As well as] some autoimmune diseases, because inherently, endometriosis is a chronic inflammatory disease — something is wrong with the immune system or the body's response to tissue that's displaced. There may be connections to infection, or exposure to certain things, or maybe genetics. And so by understanding the relationships between the immune system and the lesions in patients, we are gaining insights into other chronic diseases. For example, we have just started a chronic Lyme Disease study in collaboration with several others at MIT, and there's some fascinating crossovers between what the Lyme Disease researchers see in the mice, and the potential for there to be uterine phenotypes due to infection. And so there may be, potentially, some links between prior infection and development of disease. We don't know. There's a publication in the field that suggests certain kinds of infections predispose patients to certain kinds of endometriosis, but this is all very early studies. These kinds of studies will inform, in general, our understanding of female immunology — which by the way, is very different. We have in our local area actually started a discussion group that meets every two months called Sex and Immunity, trying to understand the differences between the immunological responses in men and women to infection and to vaccinations. Once Sarah Digby was diagnosed with endometriosis, she eventually found her way to Dr. Kathy Huang, director of NYU Langone's Endometriosis Center. Huang says her office takes a holistic approach to treatment, using MRI scans and ultrasound imaging to get a better sense of each patient's individual case. She says the first-line of treatment includes hormonal suppression (including hormonal contraceptives), painkillers, pelvic floor therapy, mental health support, and even acupuncture. But as Dr. Griffith mentioned earlier, there are some cases where your options are limited: if you're trying to conceive, then hormonal suppression isn't going to be the immediate option for you. If you're a more advanced case, like Digby, then some level of surgery — be it ablation or excision — may be necessary. Huang says she specializes in robot-assisted, fertility-preserving gynecologic surgery.  "All of my endometriosis surgeries are done robotically, which means that it's minimally invasive, it's a small incision, and the patients will go home the same day. And what the MRI helps us with, is if the patient has endometriosis, where are the lesions of the endometriosis, so that if we plan for a surgical excision, we have the right partners in the room to do it, " she explains. "So if the patient has endometriosis on the bladder, we will have a urology partner [in the room]. If the patient has significant bowel endometriosis, we may have a colorectal surgeon partner, so that we can do one surgery for the patient and have complete treatment for the condition, rather than multiple surgeries. There are times that patients come in asking for a hysterectomy, which is the removal of the uterus. And I have seen multiple reports on patients undergoing a hysterectomy to treat endometriosis. And I think it's really important to stress that, by definition, endometriosis is an extra-uterine disease. So removing the uterus itself is not going to help patients with endometriosis, unless the patient also has adenomyosis. That is the only situation where a hysterectomy will actually be helpful for the condition. The other that we talk about in fertility-preserving surgery is also not removing the ovaries. So the ovaries produce the hormones, and endometriosis is a hormone-responsive condition — however, if we're able to preserve the patient's ovaries, we do our best to do that, because it does continue to provide antigens even when the patient enters menopause. So it gives you hormones, it helps with your cardiac health, bone density, sexual health, all of those things. So it's a fine line between doing definitive surgery, and stripping the patient of the ovaries and the uterus, versus symptom relief." Digby credits Huang and her gynecologists in New York for helping her get her life back. Through robotic excision surgery, Huang was able to remove more than a decade's worth of lesions without damaging Digby's pelvic organs, successfully bringing her from Stage 3 of the disease to Stage 0. While it could always come back, Digby says she keeps her endometriosis in check with regular monitoring and multiple forms of birth control (in her case: the arm implant and an IUD). The whole process, from diagnosis to remission, took Digby just a year and a half — but she can't help but wonder about those 15 years prior to her diagnosis. How might she have spent her 20s, if she had received treatment as a teenager? How much grief might she have been spared, if someone at home, her school, her college, or doctor's office had noticed the signs? For Digby, spreading awareness is key to ensuring better treatment for future generations. “Here's something where, I think back, and it's just wild: my mom had endometriosis. Never once did it occur to her, as she saw her daughter struggling with a gynecological disease, that there might be a connection there. Because she had been treated for endometriosis and had the surgery before my brother and I were born, but — and this not to say that this is any of her fault at all, the society's falling — but she only had one or two symptoms, and they weren't related to her menstrual cycle," says Digby. "This is how this keeps happening from generation to generation. We all know what to do when somebody's in diabetic shock: get them blood sugar. We all know what to do, or how to recognize, symptoms of a heart attack. And yet we don't know, as a society, the most common symptoms of a debilitating disease in well over 10 percent of the female population, who could also benefit from that widespread awareness.”  "The one message I always have for women is that pain is not normal. So if your doctor is not taking you seriously, then you need to get a second opinion, because pain is never normal. And it doesn't need to be endometriosis, there are other reasons for pelvic pain. We just did a study for sexual trauma, to see how often are OB GYNs actually asking women the question of, 'If you have pain, is there any history of sexual trauma in your life?'" adds Huang. "I just think we need to talk about all these things more, it's not just a single-lever problem. Even though I am a surgeon by training, I really don't think the answer is surgery alone, and nor is it always the answer. It is only seldom the answer, and even when it is, it is not the entire answer. We still need other specialists to continue to help us, to help the patient. Again, the one message is that pain is not normal. So if your doctor is not hearing you, please seek a second opinion." If you think you might be experiencing symptoms of endometriosis or adenomyosis, Dr. Huang advises that you contact your OB GYN and then a specialist if needed. You can learn more about endometriosis and adenomyosis online. The NYU Langone Endometriosis Center, MIT Center for Gynepathology Research, and the Endometriosis Foundation of America all have info and even webinars on their websites to get you started. As part of her own effort to raise awareness, Sarah Digby has her own collection of easy-to-share diagrams and infographics at her website, endographics.org.  Before we head out, we're celebrating Women's History Month by taking some time each week to recognize prominent women in history. Joining me today is someone who's been on the show before: Natalie Rudd is the learning and engagement manager at the National Women's Hall of Fame in Seneca Falls, New York. More than 290 women, past and present, have been inducted into the Hall since its start in 1969, and Natalie has a couple she'd like to share with us today. Sarah Winnemucca "She was a northern Piute author, actor, and activist. She was alive from 1844-1897, and she was raised by an influential Piute family in Nevada. For her, being American was a really complicated process, especially during the late 19th Century. It was a process of adopting the behaviors and languages of white people, who she had often been taught to distrust, but [she] had to do that to kind of assimilate and survive. She worked as a translator, which then eventually led to her becoming an activist for Native American rights. In 1865, her family was actually attacked by a U.S. cavalry, which killed 29 Piutes, including her mother and several members of her family, which then launched her into her advocacy for Native American rights. So she travelled all across the U.S., basically telling white Americans about the destruction and colonization of native peoples. She eventually worked for the U.S. as a messenger, an interpreter, and as a teacher for imprisoned Native Americans. She ended up publishing a book called Life Among the Piutes: Their Wrongs and Claims. The book is both a memoir and a history of her people during their first 40 years of contact with European Americans. It's considered the first known autobiography written by a Native American woman, and then eventually she returned out west, where she founded a private school for Native American children in Nevada." Aimee Mullins "So Aimee has had a really cool career, in that she's done literally everything. She was born with fibular hemimelia, which basically means she was missing her fibula bones, and as a result she had both of her legs amputated below the knee when she was one year old. She was told that she would probably have to use a wheelchair for most of her life, and probably never walk, but by the age of two, she had already learned to walk with prosthetic legs. Aimee has always been about going above and beyond. She ended up becoming an athlete with her prosthetics. She got a full academic scholarship to Georgetown, and there she ended up pursuing a career at the School of Foreign Service. When she was there, she earned a top secret security clearance with the Pentagon at the age of 17. She worked there as an intelligence analyst as a teenager — which that alone is incredible. But simultaneously, she was running track and field for Georgetown, and went on to compete for the NCAA Division I track and field events. She was the first amputee student to ever compete in an NCAA women's or men's event. She later went on to compete in the Paralympics in 1996 in Atlanta, and she helped with the design of her prosthetic legs, which are designed after the hind legs of a cheetah. So a lot of the prosthetic legs you see now, she was involved with the design process of. So again, that alone would have been amazing. After she retired, she then went on to be a model. Not only doing print, but also runway modeling. She modeled for Alexander McQueen, Kenneth Cole. She was named one of People's 50 most beautiful women in the world. And she's also worked as an actress in both television in film. My favorite role of hers was she played Eleven's mom in Stranger Things." Natalie Rudd is the learning and engagement manager at the National Women's Hall of Fame in Seneca Falls, New York. The Hall will be inducting its next class, including Indra Nooyi, Mia Hamm, Octavia Butler, Michelle Obama, and more, this September. 51% is a national production of WAMC Northeast Public Radio. It's produced by Jesse King. Our executive producer is Dr. Alan Chartock, and our theme is "Lolita" by the Albany-based artist Girl Blue.

On this week's 51%, we discuss the inflammatory condition endometriosis: what it is, what it looks like, and how it's treated. We also speak with Linda Griffith, scientific director of the MIT Center for Gynepathology Research, about how engineers are working to better understand the disease. Guests: Linda Griffith, scientific director and co-founder of the MIT Center for Gynepathology Research; Dr. Kathy Huang, director of the NYU Langone Endometriosis Center; Sarah Digby; Natalie Rudd, learning and education manager at the National Women's Hall of Fame 51% is a national production of WAMC Northeast Public Radio. It's produced by Jesse King. Our executive producer is Dr. Alan Chartock, and our theme is "Lolita" by the Albany-based artist Girl Blue. Follow Along You're listening to 51%, a WAMC production dedicated to women's issues and experiences. Thanks for tuning in, I'm Jesse King. Most of us are aware that it's Women's History Month, but the month of March is also an important time to discuss women's health. It's Endometriosis Awareness Month, a time to read up and spread the news on a condition that impacts roughly 1 in 10 women (or people with uteruses) worldwide. Despite those numbers, endometriosis has historically been written off as a “women's disease,” a taboo topic of conversation, or simply part of being a woman in general (after all, no one enjoys their period) — so there's still a lot we don't know about it. So that's what we're focusing on today. The big questions: what is it, what does it look like, and how is it treated. To use the definition offered by the Endometriosis Foundation of America: endometriosis is when tissue similar to the inner lining of your uterus, called the endometrium, is found outside your uterus — where it shouldn't be. Typically, endometriosis is found on organs like the uterus, the fallopian tubes, ovaries, bladder, etc., but in extreme cases it can advance outside the pelvic cavity to other areas, like your appendix or even your lungs. The problem is that this tissue still acts like the tissue inside your uterus, so it bleeds with your monthly menstrual cycle. This can result in painful inflammation and lesions that contribute to symptoms including: painful and abnormal periods, bowel and urinary issues, neuropathy, infertility, and more. Currently, there is no cure. Our first guest today is Sarah Digby, a 32-year-old former education specialist now living in New York City. Digby grew up in San Antonio, Texas, where she says her access to sex education was extremely limited. Even at home, it wasn't typical for her family to talk about their bodies, so she grew up knowing very little about her own. But the moment she started getting her period at age 12, she knew something was off.  "The way that I was experiencing periods, the way that I was bleeding, and the amount of pain that I was in — it was nothing I had been led to expect I would experience from the pre-teen magazines I'd read, and what cramps would feel like," says Digby. "They would be really bad the first couple days of my period — and I had long periods, they lasted about seven or eight days. They'd kind of abate, and then I'd have some pain towards the end...How could something so painful be so accepted and natural? Even though that's what people were telling me. To be fair, I was a dramatic teenager — but I was also in a lot of pain." Digby says her period caused her to routinely miss school during her high school and college years — but that didn't seem to concern many of the people in her life. She never got used to the pain, but over time, Digby says she basically learned to live around it, or at least, in her words, “shut up about it.” By the time she moved to New York and started seeing a new OB GYN in 2008, and it didn't even occur to her to mention the regular pain she was experiencing. But the cysts started happening. "One of them happened on a plane, right before takeoff, while I was on a layover. I passed out and had to be pulled off the plane by EMTs. Even then, no one could figure out what was wrong," Digby explains. "At the time I was actually a teacher, and one time I had an endometrioma rupture on the subway — didn't know that's what it was — [I] barely made it into the school, and then [I] had to have someone cover my class, because I was down for the whole rest of the day, unable to walk, unable to do anything, and just in excruciating pain. I was quickly becoming pretty disabled." What Digby was experiencing were rupturing endometriomas, blood-filled cysts that typically start on one or both of the ovaries. Endometriosis is currently classified in four official stages according to morphology — basically, how many lesions or cysts you have, and where they are. At the time, the flare-ups around Digby's periods had died down — she was on the IUD, so she stopped getting her period — but over time her lesions had increased in number and gotten deeper, and with the added cysts now bursting multiple times a year, her pain was no longer tied to her menstrual cycle. It could hit at almost any time. A precautionary sonogram by Digby's OB GYN showed an unruptured endometrioma on her right ovary, which then prompted her doctor to schedule a laparoscopy, or diagnostic surgery. At age 26, nearly 15 years after experiencing her first symptoms, Digby finally had her diagnosis: she had Stage 3 endometriosis.  "Finally, some good doctors were able to identify what was going on," she notes. We'll check back with Sarah Digby later on in the show, but before we head on, I feel like it's important to ask — what causes endometriosis in the first place? As I mentioned at the beginning of the show, there's still a lot we don't know about this disease, and although Congress has increased funding for endometriosis research over the past couple of years, it's still largely under-researched and under-funded compared to other conditions. Our next guest is Linda Griffith, a top bio engineer at MIT and co-founder of its Center for Gynepathology Research — currently the only engineering lab in the nation to focus on endometriosis. In some ways, Griffith's story is similar to Digby's: she'd always had painful periods, but it took decades for her to actually get a diagnosis. Even then, she required several surgeries to combat the disease (including a hysterectomy), and in the late 2000s she founder herself watching her niece begin to grapple with the same obstacles and frustrations. So in 2009, Griffith co-founded the CGR with the goal of better understanding endometriosis, so that it can be more quickly diagnosed and more successfully treated.  How does the CGR approach its research on endometriosis? What struck us at the time we started to work together was the incredible diversity of patient presentations of endometriosis: the age of onset, the symptoms that they have, the types of lesions, the geographic locations of lesions, co-morbidities, response or not to drugs that are already available. After we started working together, I got breast cancer, and I was immediately classified on a molecular basis as triple negative. So there were three markers, they were related to the mechanism of cancer, to the prognosis, and to the therapies. Why is there not a molecular classification for endometriosis? It's so prevalent. There's got to be different molecular subtypes. So the approach at the CGR became "How do we start to classify patients by molecular mechanism?" with a hypothesis that patients could be different, sort of like cancer patients are different, and need different therapies and have different prognoses. So that was our starting point, and this was really, really not done at the time we started. In doing that, we published the first two studies describing approaches to molecular classification. They're not definitive, they were small patient samples, but this has sparked other people to be thinking in this way as well. And it's something that we continue to pursue, both by looking at patient samples, but also by building little, what we call "avatars" of the patients. We take their tissues back to the lab, and we make 3D tissue, engineered little mimics of the patients, and then we can start to test whether molecular things we find in our analyses allow us to intervene with drugs that are not currently in the clinic. So it's really this idea, which was novel, and now more people are thinking that we need to classify patients, because we know that they're not all the same, and we need to figure out how new drugs that are not hormones, for example, could work in different groups of patients. Do we know for sure what causes it in the first place? The causes of endometriosis are highly debated and speculated on, and we don't really know if there's one cause. I tend to think there's many causes. It's like if a patient shows up in the emergency room and has a smashed tibia: it could have been a motorcycle accident, it could have been a brick falling on him, it could have been somebody hitting him with a baseball bat, etc. So there could be many things that converge on similar symptoms, and this falls in with our molecular mechanism hypothesis. There's very, very interesting data supporting many hypotheses about developmental defects. Very clear data that's support for some patients that, during development, cells can go out of the way and get the wrong place. There's very clear circumstantial evidence supporting Sampson's Theory. Some people really reject this theory, but it's not been proved wrong, and there are many, many circumstantial supports for it — where most women have reflux of menstrual tissue during their periods, and it goes in the abdominal cavity. Most women will clear it, but it's conceivable that some of that tissue implants and turns into lesions. That theory is not very consistent with onset at the time of monarch — we know that some girls, including myself, including my niece, had symptoms from my very first period, before there was all of this reflux. And so then there's a hybrid around the time that babies are born. In some babies, there's a little bit of bleeding seen coming from the vagina, and it's about 5 percent of babies, tending to be babies born late. So there's a hypothesis that there may be bleeding, shedding of the endometrial lining around the time of birth, because you have a huge fall in progesterone — and maybe that seeds the abdominal cavity with cells that came from the endometrium around the time of birth. And then when hormones surge during puberty, it wakes those cells up and they cause lesions. I think that there's credible evidence in all of those arenas. The interplay between infection/environmental exposure is still very much provocative, and circumstantial and epidemiological data suggests, for example, exposure to dioxin [could cause endometriosis]. Animal studies implicate exposure to environmental chemicals. This may be something that affects your immune system, and now your immune system is unable to clear the tissue that goes into your abdominal cavity. So many theories, and probably many of them are correct. There's probably many causes. Does the location of endometriosis have an impact on what you experience? So there's not a strong correlation between lesion morphology — meaning how big the lesion is and where the lesion is — and symptoms. Some patients can have Stage 4, lot of lesions, big lesions, deep lesions...and have no symptoms. And I know people like that. Other patients can have one tiny lesion and be in crippling, excruciating pain. Now, those patients may also have things going on with adenomyosis, and if you haven't heard about adenomyosis, it's important to bring it up. It is when endometriosis is in the wall of the uterus, in the muscle. And you don't see it during surgery, typically, and you can infer it by doing an ultrasound or MRI of the uterus — but there's no for-sure diagnosis other than hysterectomy and pathology, or some other interventions that involve surgery of the actual uterine wall. So some patients who are told they have Stage 1 [endometriosis] and feel like they have a lot of symptoms may have something else going on in the uterus, that's actually a version of endometriosis that not a lot of doctors look for. We know very little about adenomyosis. Just for calibration, Crohn's disease affects about 1 percent of the U.S. population, and in PubMed, where all the scientific papers are collated, there are listed about 60,000 papers for Crohn's disease — which is great, it's a terrible condition. But if you look up adenomyosis, which may affect about 10 percent of women, so that means about 5 percent of the population, or definitely more than 1 percent of the whole population, there's only about 3,000 papers. That that's for the whole world. So now you've got 5 percent of the number of publications for a disease that afflicts a lot more people. So this just tells you how little, you know, attention has been paid to gynecology at the level of funding agencies. What do you feel are some of the biggest misconceptions about endometriosis? Fortunately, many of the misunderstandings are being addressed through greater awareness and things like this. There is something that is troubling to me as a scientist, and as a patient, that I see on Facebook groups. There's a particular Facebook group, "Nancy's Nook," and there's a rejection of the idea that Sampson's hypothesis, the reflux, menstrual tissue, is valid. A complete rejection of that. And I can understand that we want to highlight that there could be other causes, and I believe there are other causes, but it's unfortunate when you throw out a scientific hypothesis without a basis for throwing it out. And there's a lot of misinformation now being promulgated by patients who feel that they know more than the average patient — but they know far, far less than the informed clinicians and scientists who work in the field, and they're very dangerous, in my view, because they promote patients to go seek care from people who may be promising them things that are not true. So if you promise a patient that excision surgery will cure them, publish the data saying that you cure patients that way, and then then you can say that. So I'd say some of the big misunderstandings rights now are actually misinformation being given to patients about cures that are not backed up by rigorous data. What do you feel about the different treatments that are out there for endometriosis? And do you have hope someday for a cure? As for treatments right now, it really depends on the patient. Some patients respond quite well to hormonal therapies. A lot of patients respond, some patients get great relief from the Mirena IUD, for example. Other patients do need to have surgery, and in the case of surgery, there's a lot of debate about this so called "ablation versus excision." You absolutely need excision if you have lesions that go deep into the underlying tissue. Ablation is simply burning them off — and if they're very superficial, ablation can be sufficient. However, you have to be very sure that what you see as a superficial lesion is not invading deeper into the tissue. And so I think that this is where there, again, is some confusion in the way that certain patients on social media are advocating for certain kinds of treatment when there are nuances. I would highlight surgeons who have done a fellowship supported by the American Association for Gynecologic Laparoscopy, [they] are going to be trained to do the most severe endometriosis excision surgery. People may say they're doing excision, and if they're not trained through a fellowship, then it's a lot less clear that they were trained with all the methods that are accepted by the professional societies to do that surgery. You don't know until the surgery happens, generally, what the patient's going to present with, and a surgeon who is trained to do only ablation, if a patient presents with more severe disease, will typically sew that patient up and refer them to an excision specialist. So I think we need to be cognizant that there's a spectrum of therapies that for today are adequate for a lot of patients, but some patients are still not served by those: either they have no access to appropriate surgeons; their disease has progressed to a very difficult state, even for really good surgeons; and they may have complex pain phenotypes. Changes in the brain can make the pain more severe and persistent, and this is not a fault of the patient, this is a consequence of the disease. And one of the things we're doing is trying to work with pain specialists to start understanding differences in patients who have different kinds of pain processing in their brains. How might learning about endometriosis help us better understand other diseases or vice versa? There's amazing opportunity to learn about other diseases, particularly the other chronic inflammatory diseases such as fibromyalgia or chronic fatigue syndrome. [As well as] some autoimmune diseases, because inherently, endometriosis is a chronic inflammatory disease — something is wrong with the immune system or the body's response to tissue that's displaced. There may be connections to infection, or exposure to certain things, or maybe genetics. And so by understanding the relationships between the immune system and the lesions in patients, we are gaining insights into other chronic diseases. For example, we have just started a chronic Lyme Disease study in collaboration with several others at MIT, and there's some fascinating crossovers between what the Lyme Disease researchers see in the mice, and the potential for there to be uterine phenotypes due to infection. And so there may be, potentially, some links between prior infection and development of disease. We don't know. There's a publication in the field that suggests certain kinds of infections predispose patients to certain kinds of endometriosis, but this is all very early studies. These kinds of studies will inform, in general, our understanding of female immunology — which by the way, is very different. We have in our local area actually started a discussion group that meets every two months called Sex and Immunity, trying to understand the differences between the immunological responses in men and women to infection and to vaccinations. Once Sarah Digby was diagnosed with endometriosis, she eventually found her way to Dr. Kathy Huang, director of NYU Langone's Endometriosis Center. Huang says her office takes a holistic approach to treatment, using MRI scans and ultrasound imaging to get a better sense of each patient's individual case. She says the first-line of treatment includes hormonal suppression (including hormonal contraceptives), painkillers, pelvic floor therapy, mental health support, and even acupuncture. But as Dr. Griffith mentioned earlier, there are some cases where your options are limited: if you're trying to conceive, then hormonal suppression isn't going to be the immediate option for you. If you're a more advanced case, like Digby, then some level of surgery — be it ablation or excision — may be necessary. Huang says she specializes in robot-assisted, fertility-preserving gynecologic surgery.  "All of my endometriosis surgeries are done robotically, which means that it's minimally invasive, it's a small incision, and the patients will go home the same day. And what the MRI helps us with, is if the patient has endometriosis, where are the lesions of the endometriosis, so that if we plan for a surgical excision, we have the right partners in the room to do it, " she explains. "So if the patient has endometriosis on the bladder, we will have a urology partner [in the room]. If the patient has significant bowel endometriosis, we may have a colorectal surgeon partner, so that we can do one surgery for the patient and have complete treatment for the condition, rather than multiple surgeries. There are times that patients come in asking for a hysterectomy, which is the removal of the uterus. And I have seen multiple reports on patients undergoing a hysterectomy to treat endometriosis. And I think it's really important to stress that, by definition, endometriosis is an extra-uterine disease. So removing the uterus itself is not going to help patients with endometriosis, unless the patient also has adenomyosis. That is the only situation where a hysterectomy will actually be helpful for the condition. The other that we talk about in fertility-preserving surgery is also not removing the ovaries. So the ovaries produce the hormones, and endometriosis is a hormone-responsive condition — however, if we're able to preserve the patient's ovaries, we do our best to do that, because it does continue to provide antigens even when the patient enters menopause. So it gives you hormones, it helps with your cardiac health, bone density, sexual health, all of those things. So it's a fine line between doing definitive surgery, and stripping the patient of the ovaries and the uterus, versus symptom relief." Digby credits Huang and her gynecologists in New York for helping her get her life back. Through robotic excision surgery, Huang was able to remove more than a decade's worth of lesions without damaging Digby's pelvic organs, successfully bringing her from Stage 3 of the disease to Stage 0. While it could always come back, Digby says she keeps her endometriosis in check with regular monitoring and multiple forms of birth control (in her case: the arm implant and an IUD). The whole process, from diagnosis to remission, took Digby just a year and a half — but she can't help but wonder about those 15 years prior to her diagnosis. How might she have spent her 20s, if she had received treatment as a teenager? How much grief might she have been spared, if someone at home, her school, her college, or doctor's office had noticed the signs? For Digby, spreading awareness is key to ensuring better treatment for future generations. “Here's something where, I think back, and it's just wild: my mom had endometriosis. Never once did it occur to her, as she saw her daughter struggling with a gynecological disease, that there might be a connection there. Because she had been treated for endometriosis and had the surgery before my brother and I were born, but — and this not to say that this is any of her fault at all, the society's falling — but she only had one or two symptoms, and they weren't related to her menstrual cycle," says Digby. "This is how this keeps happening from generation to generation. We all know what to do when somebody's in diabetic shock: get them blood sugar. We all know what to do, or how to recognize, symptoms of a heart attack. And yet we don't know, as a society, the most common symptoms of a debilitating disease in well over 10 percent of the female population, who could also benefit from that widespread awareness.”  "The one message I always have for women is that pain is not normal. So if your doctor is not taking you seriously, then you need to get a second opinion, because pain is never normal. And it doesn't need to be endometriosis, there are other reasons for pelvic pain. We just did a study for sexual trauma, to see how often are OB GYNs actually asking women the question of, 'If you have pain, is there any history of sexual trauma in your life?'" adds Huang. "I just think we need to talk about all these things more, it's not just a single-lever problem. Even though I am a surgeon by training, I really don't think the answer is surgery alone, and nor is it always the answer. It is only seldom the answer, and even when it is, it is not the entire answer. We still need other specialists to continue to help us, to help the patient. Again, the one message is that pain is not normal. So if your doctor is not hearing you, please seek a second opinion." If you think you might be experiencing symptoms of endometriosis or adenomyosis, Dr. Huang advises that you contact your OB GYN and then a specialist if needed. You can learn more about endometriosis and adenomyosis online. The NYU Langone Endometriosis Center, MIT Center for Gynepathology Research, and the Endometriosis Foundation of America all have info and even webinars on their websites to get you started. As part of her own effort to raise awareness, Sarah Digby has her own collection of easy-to-share diagrams and infographics at her website, endographics.org.  Before we head out, we're celebrating Women's History Month by taking some time each week to recognize prominent women in history. Joining me today is someone who's been on the show before: Natalie Rudd is the learning and engagement manager at the National Women's Hall of Fame in Seneca Falls, New York. More than 290 women, past and present, have been inducted into the Hall since its start in 1969, and Natalie has a couple she'd like to share with us today. Sarah Winnemucca "She was a northern Piute author, actor, and activist. She was alive from 1844-1897, and she was raised by an influential Piute family in Nevada. For her, being American was a really complicated process, especially during the late 19th Century. It was a process of adopting the behaviors and languages of white people, who she had often been taught to distrust, but [she] had to do that to kind of assimilate and survive. She worked as a translator, which then eventually led to her becoming an activist for Native American rights. In 1865, her family was actually attacked by a U.S. cavalry, which killed 29 Piutes, including her mother and several members of her family, which then launched her into her advocacy for Native American rights. So she travelled all across the U.S., basically telling white Americans about the destruction and colonization of native peoples. She eventually worked for the U.S. as a messenger, an interpreter, and as a teacher for imprisoned Native Americans. She ended up publishing a book called Life Among the Piutes: Their Wrongs and Claims. The book is both a memoir and a history of her people during their first 40 years of contact with European Americans. It's considered the first known autobiography written by a Native American woman, and then eventually she returned out west, where she founded a private school for Native American children in Nevada." Aimee Mullins "So Aimee has had a really cool career, in that she's done literally everything. She was born with fibular hemimelia, which basically means she was missing her fibula bones, and as a result she had both of her legs amputated below the knee when she was one year old. She was told that she would probably have to use a wheelchair for most of her life, and probably never walk, but by the age of two, she had already learned to walk with prosthetic legs. Aimee has always been about going above and beyond. She ended up becoming an athlete with her prosthetics. She got a full academic scholarship to Georgetown, and there she ended up pursuing a career at the School of Foreign Service. When she was there, she earned a top secret security clearance with the Pentagon at the age of 17. She worked there as an intelligence analyst as a teenager — which that alone is incredible. But simultaneously, she was running track and field for Georgetown, and went on to compete for the NCAA Division I track and field events. She was the first amputee student to ever compete in an NCAA women's or men's event. She later went on to compete in the Paralympics in 1996 in Atlanta, and she helped with the design of her prosthetic legs, which are designed after the hind legs of a cheetah. So a lot of the prosthetic legs you see now, she was involved with the design process of. So again, that alone would have been amazing. After she retired, she then went on to be a model. Not only doing print, but also runway modeling. She modeled for Alexander McQueen, Kenneth Cole. She was named one of People's 50 most beautiful women in the world. And she's also worked as an actress in both television in film. My favorite role of hers was she played Eleven's mom in Stranger Things." Natalie Rudd is the learning and engagement manager at the National Women's Hall of Fame in Seneca Falls, New York. The Hall will be inducting its next class, including Indra Nooyi, Mia Hamm, Octavia Butler, Michelle Obama, and more, this September. 51% is a national production of WAMC Northeast Public Radio. It's produced by Jesse King. Our executive producer is Dr. Alan Chartock, and our theme is "Lolita" by the Albany-based artist Girl Blue.

Doctor, can you check my hormones to see if I'm perimenopausal?  The short answer is "no." But the long answer is "checking hormones" may not give me much information if you're perimenopausal because your hormones are fluctuating...they can be "normal" one day and "abnormal" the next day.In this episode, I discuss:-Hormones that I consider checking like thyroid hormone-Follicle-stimulating Hormone (FSH) and what it does in menopause-Reasons I may consider checking additional hormones:a woman without cycles due to contraception like Mirena IUD or due to hysterectomy or if a woman was placed on testosterone and the importance of monitoring its levels.-The importance of monitoring symptoms instead of just the levels of hormones to see if treatment plan is working.Are you a professional woman of color over 40 who wants to pivot to something new in your career or start a business but feel overwhelmed by menopausal symptoms?Menopause Moguls:The Power of the P.A.U.S.E. Program is my online group coaching program that could be your answer to eliminating those menopausal symptoms using simple integrative strategies so you can level up in your health and become the Mogul you are meant to be! If you need to optimize your health so you can perform with excellence, then join my next group cycle to gain community, support and accountability to help you!  Schedule a Discovery Call to see if you're a good fit and get on the waiting list!Please Subscribe and Share this episode!Join my private Facebook group to surround yourself with other women who share the same experience and provide support through this journey.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/ Do testosterone pellets cause breast cancer? No. Testosterone pellets improve the immune system function so you can fight all types of cancers more easily than before you started treatment. I am a breast cancer survivor: Can I take bio-identical testosterone pellets? Yes.  This is the safest form of hormone replacement and can take the place of estrogen to treat symptoms of estrogen deficiency like hot flashes and painful intercourse.  Testosterone also improves your immune system so you can fight abnormal cells,           pre-cancer and cancer cells, so they don't grow.  Testosterone pellets stimulate the production of T-killer cells that kill cancer cells. Do BioBalance testosterone pellets cause blood clots? No.  Do BioBalance Health estradiol pellets cause blood clots? No. Estrogen that is non-oral does not cause blood clots, however circumstances like long airline flights can cause blood clots in anyone!   If I have used alcohol to excess or drugs like marijuana in the past, will I get the same effect as other women? No.  Both alcohol and marijuana quicken the break-down of testosterone and estradiol. You will likely consume (metabolize) the testosterone pellets more quickly than other people because your liver is hyper-activated to metabolize testosterone with the same enzymes that metabolize alcohol and drugs.  In addition, marijuana increases the production of the hormone prolactin, the hormone that increases breast size in men and women. Prolactin not only decreases your testosterone level but decreases your sex drive, and sexual stamina.  It is your responsibility to tell us about your medical marijuana and alcohol use so we can adjust your testosterone dose.   Can I take birth control pills with testosterone pellets? We strongly suggest that you do not take oral birth control pills, because they dampen the effects of the testosterone pellets.  Instead of oral contraceptives we encourage our patients to get a Mirena IUD or permanent birth control (like a tubal ligation or have their husbands get a vasectomy) instead of taking the pill. Many women who insist on continuing the pill (we are located in the Show-Me state) are disappointed that their symptom resolution is not complete, and they decide to change to a Mirena IUD or a tubal ligation for birth control.  Of course, no birth control is needed after menopause. What other medications inactivate or interact negatively with estradiol and testosterone pellets? We suggest you look for alternative medications for the following drugs: All corticosteroids such as prednisone, Medrol dosepak, tamoxifen, progestins (not progesterone) like Provera, DHEA that is not 7-keto DHEA, other hormones given orally like oral contraceptives, as well as anti-depressants and drugs for schizophrenia and bipolar disorder, which suppress the libido.   We do not suggest you avoid or stop taking these medications, but we do help you find alternatives in certain circumstances.   How do cholesterol-lowering drugs affect my testosterone level? Testosterone is made from cholesterol in the ovaries and testes.  When you take cholesterol-lowering drugs, you decrease the substrate that testosterone is made of, and generally decrease the level of testosterone. In your body if you are making it yourself, not if we are giving you testosterone pellets. We have found that testosterone pellet replacement lowers cholesterol blood levels so that statins are often not needed after treatment.   What can I do about my belly fat that started to increase after I turned 40? First you should replace your estrogen with non-oral estradiol and testosterone in the form of pellets.  This is the only form of hormone replacement that brings the level of estrone back to young healthy levels, and lower estrone decreases the amount of belly fat. If you are having trouble losing belly fat and have already accomplished the above, then take DIM ES 250 mg per day with food, Iodoral (iodine to bump your thyroid activity), eat 6 small meals a day with high protein and low carb, exercise by doing interval training, and always work out your abs by doing sit-ups and core exercises, like Pilates.  As a last resort, after you have achieved your ideal weight and that fat won't budge (small set of cases) from your abdomen, we offer radio frequency treatments called Juvashape and iLipo to dissolve the fat around the waistline.   Under what circumstances would I have to stop BioBalance Health® pellets? About 5 % of our patients are not “cured” for the problems they came to BioBalance Health ® to treat, or they have a side effect from the pellets that does not fit their lifestyle, such as re-igniting their libido when they are unmarried or do not want a sex drive. Patients with Chronic Fatigue are helped by testosterone replacement, but they may not feel the complete resolution of symptoms as quickly as women who do not have that illness. These patients may not feel they are completely treated so they cease pellets. Women who have psychiatric illnesses and are on multiple medications may not feel as healthy as women who do not have those illnesses or take these medications. Lastly, if a patient develops breast cancer, then the estradiol pellets are not continued if they have estrogen receptor positive breast cancer, however testosterone pellets are continued because they are safe and improve the immune system that fights all types of cancer.   What if my genetics make me prone to convert testosterone into estrone (old lady estrogen)? After the first pellets, we find that you are genetically prone to convert testosterone into estrone we prescribe a drug called Arimidex® (anastrazole) which blocks the enzyme that converts testosterone into estrogen (called an aromatase inhibitor).  It is used off -label for this indication, however it was originally intended for prevention and treatment of breast cancer.  We can use anastrazole/testosterone pellets or prescribe anastrazole orally. As an alternative DIM is a supplement that is weaker than the prescription anastrazole, however it works very well for most women. I hope these FAQs can help you decide whether you need bio-identical testosterone pellets. I believe that most women over the age of 40 require testosterone replacement, to lead a healthy and full life, complete with a healthy sex drive and productivity.  Fear of the unknown is the greatest threat to your current quality of life and your future health. I hope answering nagging questions help you decide to replace your missing hormones.

Amanda is scheduled every first show of the month. Today we chat about her new Mirena IUD. She just got a new one so why not have a sex education bit. Also the news you need to know!!Simple Blasphemy info: -----------------------------------

Thank you Newsstand Studio at 1 Rockefeller Plaza for providing a place for me to record this episode for y'all! No more Brooklyn closet recording!!!   Welcome to the TRC Remix Series #3. If you're not sure what this series is click here for more info!   I am so excited to be chatting with my soul sister Kate Eskuri today! This episode we're talking all about PERIODS. Ladies (and gentleman), you're going to learn so much more about your period than you ever did in health class. Kate is a registered nurse, holistic health junkie, and the voice behind The Foundation Blog. Since recording this episode, she is officially a DNP aka a Doctor of Nursing Practice. She is passionate about helping women maximize their health with simple and foundational health practices. Our hope is that this conversation will empower you to do research and make informed decisions for that time of the month.   Finding The Balance Kate took a year off from being a nurse in the Mayo Clinic to work on her sister Jenna Kutcher's Goal Digger Podcast. During this time, she realized her passion for integrative health.   "What are you doing when you're putting off something else?" She knows that areas of Western medicine need improvement, but also recognizes that this medicine is the reason we are alive today after seeing it in action in the ICU. However, chronic conditions that plague our country prove a need for a shift toward the holistic. We need to look at sleep, stress, and diet. "I feel very at home in this spot in the middle."     Becoming A Woman   "Everything in my life was very natural but yet I was still controlling this really natural and beautiful cycle." Kate never felt any shame around her period. "I just felt honored and excited about it." Her periods were regular but were more frequent than they should have been. "It takes a while to normalize your cycle."   Wanting to prevent this near constant bleeding, she tried the NuvaRing but ultimately settled on the Mirena IUD which allowed her to continue ovulating.   Cons of Hormonal Contraceptive   "I completely trust my fellow woman to make the choice that is best for her. There is an option that is right for everybody."   The hormones in contraceptives are not the exact hormones your body would make. Hormonal contraception often suppresses ovulation and ultimately suppresses hormones that are natural and have important benefits.   "You're inhibiting a very natural process that goes a lot deeper than just your period." The Phases Of Your Cycle Ladies + Gents--the below is just an overview...you gotta listen to the whole episode to get the goods of each phase of your cycle!   Menstruation/Winter Day 1: shedding the uterine lining. You're maybe feeling moody or withdrawn, experiencing cramps, and a need to slow down. It's like the 'winter' season of the cycle.   Follicular/Spring Day 3 or 4: Follicle stimulating hormone is working on the dominant egg. More energy in this phase, almost like stepping back into your skin. This time is good for creative projects and you'll experience clear thinking.   "You feel energetic and attractive... it's just a really vibrant time."     Ovulation/Summer Body releases egg as the pituitary gland signals for it to release.   "You can't kind of ovulate—you either ovulate or you don't."   High energy, high sex drive, you feel attractive. Your hormones even make you more attractive to those around you. There is a study that shows a correlation between a woman's scent during ovulation and a man's attraction to her.   Luteal/Fall Progesterone—can make you moody and somber, but it's really important.   "It is the yin to estrogen's yang."   Progesterone is calming, helps sleep, reduces inflammation, + builds muscles.   "The shift from being so estrogen dominant at parts of your cycle to progesterone dominant causes an influx of emotion—what we see as PMS."     Getting To Know Your Period   "Your period health says a lot about your overall health."   Track Your Cycle! Kate journals every morning and will write about how she is feeling on the previous day of her cycle. A few key words is all you need—nothing flashy! Kate uses the Ava app and Kat uses the My Flo app.   "Your period story does not have to be suffering every month."     Books To Read: The Period Repair Manual by Laura Briden (textbook info in novel format) Hormonal by Martie Haselton (quick + easy relatable read)   Thoughts On Period Products Thoughts on tampons? "Invest in organic—it does matter." Regular tampons are covered in toxins. Thoughts on menstrual cups? Tampons are single use and create waste so this is a great alternative. Kate uses OrganiCup and LOVES it. "I can't believe I lived for so long without using it." It's easy to clean—simply boil between cycles. It may not be for everybody—some women say they experience more cramps using a cup. Thoughts on Thinx? Kate hasn't tried them, but Kat has some friends that swear by them and only use them during their periods.   "Whatever makes you feel most at home and comfortable with your period… I say go for it." “It all comes back to the base of introducing small integrative habits into your day to live your most balanced and vibrant life."   Resources: Grab the organic menstrual cup I use here. Keep up with Kate on Instagram at @kate.eskuri Check out Kate's website, thefoundationblog.com Read Kate's blog post about using acupressure for periods! Sign up for Kate's email list to get access to exclusive content. I'm an avid reader and always have at least 3 books going at once. Anyone else love getting lost in a good fiction book? I just got a new book I'm super excited about called The Lost and Found Bookshop by Susan Wiggs. This NYT Bestseller now in paperback is the perfect feel-good summer read for a beach read or your book club. Grab your copy anywhere books are sold or find more at SusanWiggs.com. I have become very invested in taking care of my skin— I just wish I had started earlier! Swedish skincare company Foreo strives to turn daily routines into vibrant rituals and celebrate aging gracefully. They bundled their most popular products into a bundle that is sold exclusively on Amazon. Go to Amazon.com and use coupon code REFINEDC50 to grab the set for $199 (it is valued at over $300!)

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/ Q: Why do I have to take Progesterone every night? Post-menopausal bleeding is one of the side effects of any estrogen replacement therapy, including estradiol pellets. We can prevent break-through or postmenopausal bleeding by treating all women who have a uterus with bio-identical progesterone (BLA Progesterone, or Prometrium®) orally or with sublingual (under the tongue) progesterone. Progesterone prevents overgrowth of the uterine lining, uterine bleeding and uterine (endometrial cancer). You must take progesterone if you want to be treated with estradiol after menopause and you have not had either a hysterectomy, a successful uterine ablation, have a Mirena IUD, or if you can't take progesterone undergo a uterine ultrasound and biopsy of the uterine endometrium yearly.   Q: What should I do first if I start bleeding? Take AirBorne®, one tablet in water every day for a week.  If that doesn't stop the bleeding add Vitamin K 100 mcg 1-3 pills per day for a week, to the Airborne®.  If that doesn't stop it, then double your progesterone dose for 2 weeks and if that doesn't stop it then you'll have to go to your gynecologist for a diagnosis and treatment of this unusual bleeding.  Most of our patients stop bleeding.   Q: I've bled once or twice in the first 4 months after starting estrogen pellets, what should I do? Bleeding in the first 4 months after starting your first round of pellets is common and is usually something that will not happen again if you're taking your progesterone every night before bed.    Q: What should I do If I forget my progesterone? If you forget your progesterone for one or more nights, take it as soon as you remember, but you may spot or bleed for up to 2 weeks.  If your bleeding is heavy then take 2 progesterone pills at bedtime for 2 weeks and then try going back to 1 every night.   If the bleeding doesn't stop, then go off the progesterone for 2 weeks and restart one every night again.  If bleeding starts again then we will ask you to see your gynecologist to make sure you don't have a polyp or fibroid causing the bleeding.   Q:  What if I have a thick lining in my uterus, polyps or fibroids? What's next? Your gynecologist will do an ultrasound and may decide to do a D&C, a uterine biopsy, or a hysteroscopy to remove the lining and the polyp or fibroid. In some circumstances you might have to choose between stopping your estradiol or having a hysterectomy.   Q: I've bled over and over during my treatment and have already tried doubling my progesterone but keep bleeding, what should I do? Recurrent bleeding can be from a thick uterine lining, a very thin lining, or a uterine polyp or fibroid.  For us to know how to treat you, we need to know what is making you bleed.  This requires an ultrasound of the uterus done through the vagina.  We can order a pelvic ultrasound at Metro Imaging, or you can go to your GYN to have it done at his or her office.   Q: I had my ultrasound and I have a (thick lining/or polyp), what do I do now?  Your GYN will have to biopsy the lining of your uterus to make sure it is benign.  If you have a polyp then you will need a D&C and a hysteroscopy to remove it.  Your GYN will do this because that is their job. Please call them for an appointment and tell their receptionist what the problem is.   Q: I had my ultrasound and I have a very thin lining, what can I do to stop my bleeding? A thin lining means that your estradiol is low, and you should be given more estradiol, and or less progesterone.  We will take care of that by adjusting your dose of Estradiol when we give you your next pellets. In the meantime, if the bleeding is bothering you, we can prescribe an estrogen patch for you to wear until your next pellet insertion.   Q: I have one of the following symptoms: hair loss, swelling, pelvic pain, water retention, high blood pressure, fainting, chest pain, etc., all of which are symptoms that are not from to Estradiol or Testosterone.  Should I continue to take my pellets? My doctor said your treatment caused my disease/problem/complications.   There are a few side effects of Testosterone and, or Estradiol pellet therapy but these symptoms are not side effects of our pellet treatment.  You should go to your PCP and be evaluated for your symptoms and be diagnosed and treated for the real cause and what the problem really is. Don't just stop your pellets because your doctor doesn't understand that this form of hormone replacement doesn't cause these complaints.  Encourage her or him to find the real problem.   Q: What can I do if I cannot take Progesterone in any form because I have (melasma, nausea, swelling, headaches, bleeding) on Progesterone?  There are other options if you cannot tolerate natural progesterone to balance your estradiol.  You can ask your GYN for a uterine ablation of the uterus which would burn out the lining of the uterus and stop all bleeding, avoiding   any need for progesterone. Or you can get a Mirena IUD placed which will keep the lining thin and avoid bleeding for 5 years. The Mirena takes the place of oral BLA progesterone.   Q: What can I do if neither of these options for not taking progesterone are appropriate for me?   In very few cases a woman has a fibroid or a spongy uterus (Adenomyosis) that bleeds every time it is exposed to progesterone and the IUD or Ablation options are not possible. In these cases, we have a few other options No progesterone, but receive a vaginal ultrasound yearly and if your uterine lining is thick, you will need a D&C to clean out the uterus or an endometrial biopsy Get a Mirena IUD that lasts 5 years+ Stop all estrogen, but you can still take testosterone pellets and then there won't be a need for progesterone Have a hysterectomy, is the last and most drastic choice These are the answers to the questions we give our patients when they call or email our RN or Nurse Practitioners. These options for treatment and prevention are effective for most patients.  It is our goal at BioBalance Health to stop all bleeding in women on estradiol pellets who are menopausal.    Please subscribe to You Tube BioBalance Health Healthcasts to see this information in video format.

Dr. Jessica Drummond, DCN, CNS, PT, NBC-HWC Founder and CEO of the Integrative Women’s Health Institute is passionate about caring for and empowering women who struggle with women’s and pelvic health conditions. She is equally passionate about educating and supporting clinicians in confidently and safely using integrative tools to transform women’s and pelvic healthcare. Having two decades of experience in women’s and pelvic health as a physical therapist and functional nutritionist, plus owning a private women’s health clinical nutrition and coaching practice, gives her a unique perspective on the integrative, conservative options for pelvic pain management, hormone balance, preconception and fertility support, postpartum recovery, and chronic pain and fatigue management in active and athletic women. She regularly lectures on topics such as integrative pelvic pain management, natural fertility options, optimal hormone health, female athletes, and functional and integrative nutrition for rehabilitation, nutrition, wellness, fitness, and medical professionals. Dr. Drummond was educated at the University of Virginia, Emory University, Duke Integrative Medicine, and Maryland University of Integrative Health. Questions that were asked about birth control and fertility: Does coming off the birth control pill lead to missing periods? Can I conceive?/How soon can I conceive after going off BC/does BC affect my fertility long term? Is there anything that I can be doing to help conceive quicker after birth control? Should I be doing anything before I get off of birth control in preparation for pregnancy? How will my body react/what are the changes in my body/lasting effects/side effects after going off BC? What are the side effects of using the Mirena IUD? Are there any nutritional deficiencies associated with using an IUD? Find out more of Dr Drummond's work at the Integrative Women's Health Institute: https://integrativewomenshealthinstitute.com/ Outsmart Endometriosis: https://www.amazon.com/Outsmart-Endometriosis-Relieve-Symptoms-Career/dp/1950367509 Instagram: https://www.instagram.com/integrativewomenshealth/ Episode with Lisa Hendrickson-Jack on the 5th vital sign: https://open.spotify.com/episode/5uGcgNuZKUzidcZYWOF7Dr --- Support this podcast: https://anchor.fm/nourishmel/support

Birth control can be intimidating. There’s so many different shapes, sizes, and forms of use, not to mention the horror stories you hear through WebMD or your friends. Whether you see them as a pesky chore or a form of empowerment, it’s an essential part of many of our lives. Today we tackle our experiences with different types of birth control, any side effects we’ve experienced, and the involvement of our male partners in our BC journey! Follow us on IG @eatyourcrustpod

Your Workout Too Stressful? We're back with a full episode dedicated to your questions! We covered several hormonal questions including what it means when your testosterone is LOW but you have unwanted, coarse hair growth, what to expect coming off the Mirena IUD when in perimenopause and how to know how your hormones are faring with that workout you just love. Sponsoring this show is NED that amazing full spectrum hemp oil we love so much. Use code BETTEREVERYDAY at checkout to save save 15%. Be sure you connect with us in our FREE PRIVATE Facebook group where we're already hanging out with other amazing, like minded women like YOU! Join us! And we can't wait to see you all in person! Our spring retreat was postponed to fall which means you can still register! Get signed up for our retreat to be held in Chico, CA October 15-18, 2020 and you save $100 with code EARLYBIRD20 at checkout.

Tahnee is joined by Nicole Jardim on the Women's Series today to wax lyrical on all things menstrual. Nicole is a Certified Women’s Health Coach and the creator of Fix Your Period, a series of programs that empower women to reclaim their hormone health. Nicole's passion for women’s health arose in response to her own hormonal journey and negative experience using hormonal birth control in her early twenties.  Nicole takes a holistic approach, placing her focus on identifying and addressing the root cause of dis-ease within the bodies and minds of her female clients. Nicole believes that the fundamentals to healing any hormonal imbalance lie in an approach that addresses the unique physiology of every woman, and that this is essential to reclaiming and maintaining optimal health and vitality at any age. We say amen to that sister! Tahnee and Nicole discuss: Nicole's period journey - how the traditional medical model failed to connect the dots between her oral contraceptive use and the myriad of undesirable health complications she experienced as a result. The lack of education and female body literacy in our society. The fact that menstrual disharmony is generally considered normal. The horrific side effects synthetic birth control can cause. The menstrual cycle and female empowerment. What a normal menstrual cycle looks/feels like. The sensitivity of the female organism, how this aids our fertility and serves as a defense mechanism at the physiological level. "We are exquisitely sensitive to stressors and it is a good thing." -  Nicole Jardim The impact of diet culture and "health" fads on female reproductive health. Nutrition - the power of mastering the basics. Self observation as simple yet profound tool in health and healing. Nicole's take on hormone testing.   Who is Nicole Jardim? Nicole Jardim is a Certified Women’s Health Coach, writer, speaker, mentor, and the creator of Fix Your Period, a series of programs that empower women to reclaim their hormone health using a method that combines evidence-based information with simplicity and sass. Nicole's work has impacted the lives of tens of thousands of women around the world in effectively addressing a wide variety of period problems, including PMS, irregular periods, PCOS, painful & heavy periods, missing periods and many more. Rather than treating problems or symptoms, Nicole treats women by addressing the root cause of what’s really going on in their bodies and minds. She passionately believes that the fundamentals to healing any hormonal imbalance lie in an approach that addresses the unique physiology of every woman. This is essential to reclaiming and maintaining optimal health and vitality at any age. Nicole is the author of Fix Your Period: 6 Weeks to Banish Bloating, Conquer Cramps, Manage Moodiness, and Ignite Lasting Hormone Balance, and the co-author of The Happy Balance, a recipe book filled with over 80 hormone balancing recipes. Finally, Nicole is the co-host of The Period Party, a top-rated podcast on iTunes—be sure to tune into that if you want to learn more about how to fix your period—and has been called on as a women’s health expert for sites such as The Guardian, Well+Good, mindbodygreen and Healthline.     Resources: Nicoles Website Nicole's Programs Nicole's Podcast Nicole's Book Nicole's Instagram Nicole's Facebook Nicole's Twitter Nicole's Period Quiz       Q: How Can I Support The SuperFeast Podcast?   A: Tell all your friends and family and share online! We’d also love it if you could subscribe and review this podcast on iTunes. Or  check us out on Stitcher :)! Plus  we're on Spotify!   Check Out The Transcript Here:   Tahnee:   (00:01) Hi everybody and welcome to the SuperFeast Podcast. Today I'm joined by Nicole Jardim who's a Nicole is a Certified Women's Health Coach, writer, speaker, mentor and the creator of Fix Your Period, a series of programmes that empower women to reclaim their hormone health using a method that combines evidence-based information with a lot of simplicity and sass.   Tahnee:  (00:23) Her work has impacted lives of tens of thousands of women around the world and effectively addressing a wide variety of period problems including PMS, irregular periods, PCOS, painful and heavy periods, missing periods, and much, much more.   Tahnee:  (00:38) And Rather than treating problems or symptoms, Nicole treats women by addressing the root cause of what's really going on in their bodies and minds. She passionately believes that the fundamentals to healing any hormonal imbalance lie in an approach that addresses the unique physiology of every woman. We are so behind that at SuperFeast Podcast. And this is so essential just to reclaiming and maintaining optimal health and vitality at any age.   Tahnee:  (01:02) Nicole is also the author of Fix Your Period: Six Weeks to Banishing Bloating, Conquering Cramps, Manage Moodiness, and Ignite Lasting Hormone Balance, and she's the co-author of The Happy Balance, a recipe book filled with over 80 hormone balancing recipes.   Tahnee:  (01:16) And finally, she's the cohost of The Period Party, a top rated podcast on iTunes, which is with Nat K. I believe, a friend of ours. So be sure to tune in to that if you want to learn more about how to fix your period.   Tahnee:  (01:29) She's also been on The Guardian, Well and Good, Mind Body Green, Healthline and she has an awesome Instagram and a really great website. We're so stoked to have you here today, Nicole. Thanks for joining us.   Nicole Jardim:   (01:39) Thank you so much Tahnee. It's so great to be here. I'm thrilled to be joining you on your podcast.   Tahnee:  (01:44) Yay. We're so stoked to have you as part of the women's series because we've been covering all this different perspectives on women's health and the underlying theme is really that women are having to take responsibility for their own menstrual health, to really change their own cycles, to seek out the individualised care that every woman needs and deserves.   Tahnee:  (02:06) I'm really curious about your own journey because obviously you're here and you've got your business and you're really passionate about educating women around periods, but you must have had your own process to get there, so where did your passion come from? How did you get to be where you are today?   Nicole Jardim:  (02:20) Oh girl. Was it ever a process? Let me tell you. Just feel like I landed in this role accidentally. It was one of those kinds of careers, because my whole teenage years, I was dead set on being in film production, and I was going to be a producer, and do all kinds of fun things, and it was going to be so glamorous, all of that.   Nicole Jardim:  (02:42) And that's actually sort of what happened, but then life got interrupted by period problems and I started exploring different options, and then suddenly I became so passionate about it, I decided to change careers. So yeah, it goes all the way back to being a teenager and I was the quintessential period problems girl.   Nicole Jardim:  (03:03) I had really heavy periods, the kind that you've got to have a towel on your bed when you go to sleep at night, and you're terrified to go to school the next day because you know that it's probably going to leak through all the protection and the clothes. And it was super painful as well. I definitely remember missing days of school at a time, almost every month.   Nicole Jardim:  (03:25) And then something weird happened, over time, I started noticing that my period was coming less and less and I wasn't really a big tracker or anything like that. I really didn't know anything about my body or my periods. Andn I always laugh because I was totally that girl who would think I had a yeast infection or something every month because of my cervical fluid would change, and I was like, "What's going on here?" To this, totally body illiterate.   Tahnee:  (03:50) Very cute.   Nicole Jardim:  (03:51) Anyway. Yeah, I know. Right? Hilarious. Fast forward, a few years and I thought, okay, it's coming every three or four months now, this is getting ridiculous because when it would come it just came and all hell would break loose. So finally, I went to my gynaecologist and she really didn't ask me any questions. She just got out her prescription pad and wrote a prescription for the pill.   Nicole Jardim:  (04:16) And I was thrilled because I was finally joining the ranks of all the cool period popping, pill popping friends of mine and I was psyched because I was now going to have this sort of like period panacea. It was a silver bullet as far as I was concerned. And that's really what happened actually.   Nicole Jardim:  (04:34) All the symptoms that I had, the super heavy periods, that irregularity, the horrible pain, the crazy mood swings, the horrible bloating, all of these symptoms I was experiencing pretty much completely disappeared. And I thought, sweet, I have definitely found the answer. And then I fast forward a few years and unfortunately I started to notice all of these other symptoms that didn't really seem related and they just seemed like really arbitrary symptoms, and I thought, oh, okay, whatever. I guess I'll just deal.   Nicole Jardim:  (05:05) And eventually they got to the point where it was just unbearable. I had chronic urinary tract infections, I was terrified to have sex, chronic yeast infections. I was always in and out of my gynecologist's office, and I also started noticing like terrible gut health issues, like just chronically constipated. It was just terrible. I'd go a week, those kinds of... So fun.   Nicole Jardim:  (05:30) Anyway, and then I started having joint pain, and my hair was falling out. I had melasma all over my face. The dermatologist was like, "Oh, that's so strange. You're only 21. This usually happens to women when they're pregnant." I'm like, "Oh great, that makes me feel awesome." And then I did a colonoscopy with a gastroenterologist and they were like, "Oh, you're fine."   Nicole Jardim:  (05:49) And I went to a rheumatologist for my joint pain because my mum has rheumatoid arthritis, so they thought maybe I might have it. I was the poster child not only for period problems but now for pill side effects, and nobody connected the dots. I went to all of these different doctors and no one could really say what had happened or what was going on with me.   Nicole Jardim:  (06:12) On a whim I went to my friend's acupuncturists because I kind of given up hope on modern medicine and they were just not able to give me any definitive answers. And he immediately said, "Are you on the birth control pill?" And that opened this... It was like a light bulb went off and it was like the flood gates basically because then he started explaining how it all worked and I just thought, oh, okay, well nobody's ever said this to me before. Interesting. Okay. And that really was the catalyst for this whole career.   Nicole Jardim:  (06:45) I was in my early 20s, I just was finishing up university. I just spent four years getting a degree in film production and digital media, and now I was getting into health and wellness, and trying to figure out my hormones. It was hilarious. And that like I said, it really got the ball rolling and by the time I was 30 I switched careers and did a whole tonne of training around women's hormonal health, I became a health coach and just knew that... It's hilarious.   Nicole Jardim:  (07:13) I remember distinctly thinking this, if I could just help one woman not go through what I went through, my work would be done here.   Tahnee:  (07:19) It's your small vision..   Nicole Jardim:  (07:21) And here I am.   Tahnee:  (07:21) ... For such a huge achievement.   Nicole Jardim:  (07:25) Yes. I know. My goals have clearly changed a little bit, but yes, that was the original trajectory.   Tahnee:  (07:33) It's such a common story like this whole... I guess what I'm really hearing and it always devastates me, but I understand it's the way it is, but it's like the lack of education around these medications that we're given as young women and how your role is to become an educator really it's to fill in that gap I suppose between the person who's seeking treatment and then the kind of medical institution which is like, "Hey this fixes everything. Just go take it. It has no possible side effects."   Tahnee:  (08:04) I remember being told by a university lecturer because I studied medicine... Oh, not medicine but like biochemistry and a whole bunch of the prerequisites for medicine at uni and they were like-   Nicole Jardim:  (08:15) Yes.   Tahnee:  (08:16) ... "Take the pill every day, don't bleed. That's what the indigenous women do, they have less breast cancer and all this stuff because they're constantly pregnant and you just like..." And you know as an 18 year old you're going, "Oh well, this is like what a really impressive-   Nicole Jardim:  (08:29) Makes sense.   Tahnee:  (08:30) ... PhD researcher a guy is telling me." And yeah. The me now is like, "What the actual fuck?" That's a terrible thing to do, but-   Nicole Jardim:  (08:40) Yes.   Tahnee:  (08:40) ... my 18 year old meas was like, "Oh wow. Yeah. Okay, great." And I don't have to have my period. Like,   Nicole Jardim:  (08:45) Yeah.   Tahnee:  (08:45) ... "this is such a sort of...   Nicole Jardim:  (08:48) Sign me the hell up. Yes. Exactly.   Tahnee:  (08:50) Yeah. And I think it came with me [crosstalk 00:08:52]-   Nicole Jardim:  (08:52) I can still relate.   Tahnee:  (08:54) ... like there's no kind of at school, even within a lot of families, like culturally there's just such a lack of conversation, and even reverence for bleeding and talking about what's going on beyond, like demonising periods because everyone I know talks about periods as almost being a negative. It's sort of shifting in the last, I think four to five years, and I'm sure you've seen that too in your work.   Nicole Jardim:  (09:20) Yes.   Tahnee:  (09:20) But like, "Bad periods." It's just like what people expect is the joke amongst men is like, "Oh, she's on her period," or whatever.   Nicole Jardim:  (09:29) Yeah.   Tahnee:  (09:29) Statistically crazy normal, but one of your big passions is to explain that this is biologically not normal. Like what's going on? Why are we so prone to these kinds of problems? I know this is a big question but I'm curious as to see your take on it.   Nicole Jardim:  (09:44) Oh man, I know. There's so many things that I want to say in response to what you were saying and just with regards-   Tahnee:  (09:51) Go!   Nicole Jardim:  (09:51) ... our culture. I know, right? It's so hard. I know there's... you want to say all the things. I'm like, "Oh I could just read my whole book to your audience here because that's basically what I'm talking about, this idea that culturally we don't know how to deal with periods. We really don't.   Nicole Jardim:  (10:09) And it's so interesting because girl's self esteem plummets if puberty, which is not surprising at all considering that we live in a culture of misunderstanding and fair when it comes to how female bodies function. And in my opinion, I think so many hormonal imbalances and subsequent period problems are tied to a girl's experience in puberty to some degree because we really don't have a like a formal initiation into womanhood in our culture.   Nicole Jardim:  (10:43) And I just think that's so unfortunate and I believe that's why we really need to have or implement education, and be able to give the tools that these girls need to go into this phase of their lives with more respect for their bodies and valuing their menstrual cycles and the gifts that their cycle can give them.   Nicole Jardim:  (11:05) And I'm sure there's a few women who are rolling their eyes when I say that, but it really is true. Your period and your entire menstrual cycle is a barometer for your overall health. It's going to tell you pretty much every time you get it or don't get it, what is going on with your health.   Nicole Jardim:  (11:24) And there's now so much scientific evidence pointing us to the fact that your period is... or your ovulation is a sign of health. Your menstrual cycle is also a sign of health and it will definitely tell you that there's something deeper happening. And the problem is that we don't know how to read these signs. We don't know how to interpret the signals that our body is sending us or the way our body is speaking to us and its own language.   Nicole Jardim:  (11:56) We speak English or whatever language we speak. We don't speak our body's language and really needs to happen from a much younger age. That's really what I'm going for in my work because like you said, this idea of period problems being statistically normal and not biologically normal.   Nicole Jardim:  (12:17) There's so much I can say about that because I really think that we have been led to believe that these problems are basically our lot in life. This is what we've got and we just have to deal with it. Like, "My doctor told me that this runs in my family and so I've got this." Or, "My mum has this, and my grandmother has this, and now I have it." Or, "I have to be on the pill to regulate my periods," or, "I have to be on the pill if my heavy periods," or, "I'm now on a Mirena IUD because my period was super heavy and my doctor says it lightens periods."   Nicole Jardim:  (12:52) We are never ever searching any deeper than the surface to find the clues that will lead us to a resolution., like an actual resolution of the problem.   Tahnee:  (13:03) Yeah. That isn't like medicalised or some kind of-   Nicole Jardim:  (13:07) Yeah.   Tahnee:  (13:09) Form of alternative... This is the thing I think with these synthetic hormones as well as is the effect they have on the liver, the toxicity that builds up over time and we see so many people coming off the pill that are just having horrendous symptoms, and I had that experience coming off. It was just like-   Nicole Jardim:  (13:27) You did?   Tahnee:  (13:28) ... crazy ance.. Yeah. I'd never really had a pimple growing up. I'd get like one or two [crosstalk 00:13:34] really. And then I came off the pill at 26 or seven and I just had insane acne and I ended up going through a whole bunch of liver support and dah, dah, dah. I cleared it all up naturally, but it was just like one of those things.   Tahnee:  (13:47) It was a great experience for me, it's like I can't ok I learned a lot, but I was like, "This is insane." It's just never told [crosstalk 00:13:56], and we learn so much through our own suffering I suppose. But yeah, I suppose.   Nicole Jardim:  (14:01) Sure.   Tahnee:  (14:02) If someone else cannot have that experience, wouldn't that be great? [crosstalk 00:14:05]... Yeah. People take a lot of these medications thinking they've been studied and researched and it's like, "No, we're literally the Guinea pigs of, I think it's now like a 40..? Are a 60 years into the pill?" 1960s, right?   Nicole Jardim:  (14:20) Yeah.   Tahnee:  (14:21) It's like we've seen the generational issues, we've seen that it's creating issues with fertility and all of this stuff, and it's still just being given out like candy.   Nicole Jardim:  (14:31) I'm so happy you've brought this up because I could not agree with you more. I'm getting all fiery and annoyed, but I just feel like... Because first of all, it's interesting, I'll just preface this by saying that I did this Instagram series because I wrote a blog post on the Mirena IUD and the side effects and whatnot.   Nicole Jardim:  (14:54) On one of the posts in the series, I probably had like maybe 115 comments or something like that, and probably about 99 of them were women describing horrible experience with this form of birth control. And granted, I know that when it comes to medicine, there are going to be people who don't respond well to it, understand that. But I was talking about this with a man on our podcast whose daughter died of a blood clot after being on the pill.   Nicole Jardim:  (15:29) And I just feel so strongly that there are just some people who are collateral damage as far as the pharmaceutical industry is concerned and that's just the nature of this work. And I feel like there's systematic denial or even suppression of this information. There are so many people having side effects and in fact, I think there are more than we are even led to believe because they're not reporting this to their doctor in many cases or maybe their doctor isn't reporting their patients side effects. I don't really know.   Nicole Jardim:  (16:05) This has been my work, and I know this is your work too, so you're obviously, and I'm obviously seeing a lot of the negative impact of these medications or these forms of hormonal birth control that are just so detrimental to women's lives. I mean I had one woman tell me that their IUD perforated her uterus and travelled all over pelvic cavity, and she lost her ovaries because of it, and she's 27. That's just craziness.   Nicole Jardim:  (16:34) And again, I just keep coming back to the fact that there is an easier way we can actually learn to figure out our signs of fertility. It's not that hard, and use that as birth control, and we don't have to have foreign objects implanted in our arms, or in our uteruses, or be cycling through synthetic hormones every single day of our lives for fertility that really only lasts for 24 to 48 hours really at the most.   Nicole Jardim:  (17:08) I get really fired up for this because I just feel like there's something seriously wrong with this situation.   Tahnee:  (17:14) Yeah. All right. Look, I completely agree. I speak to people a lot that are in different circumstances and I understand that there's always nuance around this conversation, but to me just taking that time to get to know your body on that level has... For me it's built such self-respect, and such self love, and kind of appreciation for just the complexity of my body and... It's just been such like a wow.   Tahnee:  (17:42) Like a wonder kind of experience that I have this incredible capacity to create life and I can choose whether or not I engage with that. That's such a privilege I think, and it's almost like an act of feminism to say, "No, I'm going to be responsible and just become the master of this domain I've been born into."   Tahnee:  (18:10) Even if you still aren't sure, whatever, to start trying to get to know, there's so many resources now and fertility awareness is I think becoming more and more popular. There's all the tracking apps, like I use one called Flo and I've been using it for, I think now close to six or seven years. I used a different one for a while and then I've moved over to Flo, but there's so many resources now that people and-   Nicole Jardim:  (18:32) Certainly.   Tahnee:  (18:32) And I saw on your website you've got some conversations around that, right? Or do you [crosstalk 00:18:38]-   Nicole Jardim:  (18:37) Yes.   Tahnee:  (18:37) ... or?   Nicole Jardim:  (18:39) Tonnes, yes. I have a blog post on the apps that I've used over the years that I would recommend or that clients have suggested that I've checked out. I'm a bit of a tech junkie, so I really love all of these devices. I have probably like 12 apps on my phone currently that I've tried over the years and I also I'm a big fan of these different fertility monitors because there's a number on the market now and I feel like there are different types that are suitable for people's differing needs.   Nicole Jardim:  (19:15) Like I use the Daysy fertility tracker, but I also practise the fertility awareness method as well because I always have. I started when, I'll never forget when I got my first iPhone, which feels like a really long time ago at this point. They had this very generic app on there, it had a really crappy menstrual cycle tracker and I was thrilled, so I use that.   Nicole Jardim:  (19:38) That was probably like 12 or 13 years ago now, it's probably 2007 maybe I think. And yeah, wow. And so I feel like we've really come a long way ladies, so you have no excuses whatsoever. I was using a calendar on a wall [crosstalk 00:19:51]-   Tahnee:  (19:51) They're very pretty and interesting now.   Nicole Jardim:  (19:53) Are they? I know. We really are so lucky, so spoiled. Then there's the Ava Fertility Bracelet, which is so cool. I joke that it's like the Fitbit of fertility and it really is. You wear it on your wrist and you sleep with it. It takes your temperature, but it also measures various parameters that change, either are different before you ovulate and they change after ovulation. So in addition to your temperature, it measures your heart rate variability, it measures your pulse and a couple other things.   Nicole Jardim:  (20:25) And so it's very cool to see the changes, and it can really pinpoint your fertile hour window. It's amazing. And then there's other things too, like the Mira Fertility Tracker. It's not really a tracker so much as it's a device that you can pee on these little sticks and then you insert the stick into their device and it'll tell you what's going on with your hormones. It's sort of, again, pinpointing your fertile window.   Nicole Jardim:  (20:50) So these aren't necessarily used to prevent pregnancy. I know people do and I don't advise that if you have never done this before, but it's fascinating to be able to read this information and know exactly what your body's doing. I've been able to predict the exact day my period is coming now for 12 years. It's pretty impressive for someone who used to think she had a yeast infection every month. So if I can do it, you can do it too. That's exactly. Oh my gosh.   Tahnee:  (21:20) Yeah, I think it's such empowering, I don't know. I feel like it's just such an empowering thing. And I think when you look at how... Because people have been preventing children for a really long time as well, like way before-   Nicole Jardim:  (21:32) That's true.   Tahnee:  (21:33) ... technology and way before, so we can just without any add ons get really in tune with our body and our cycles. I find from my partner, he's a lot more confident with us using I guess the fertility awareness method when I'm able to show him like, "Hey, this is my cycle and this is when I'm fertile, and this is what I'm not." And so I use the app to help him feel okay because he's like-   Nicole Jardim:  (21:58) Yeah.   Tahnee:  (21:59) ... "I don't want any more babies right now?"   Nicole Jardim:  (22:00) No, yeah. Exactly.   Tahnee:  (22:02) So it's great to have a resource as well. But yeah, I feel like I've got to this point where I'm super like, yeah I can actually feel when I'm ovulating a lot of the time, and I feel like when my period's about to come and stuff. And just this idea of not being in pain all the time. I know people that are suffering like three weeks out of the four, like they're.. [crosstalk 00:22:24]-   Nicole Jardim:  (22:23) I do too..   Tahnee:  (22:24) ... their cycle. Yeah, they're in pain, or they've got symptoms, or something's going on with their bodies. And I think-   Nicole Jardim:  (22:30) Yes.   Tahnee:  (22:31) Can you explain to us what a healthy period looks like versus what most people deal with, I guess?   Nicole Jardim:  (22:37) Oh my gosh, I would love to. Yes. I get this question often, "What's my parents supposed to be like, Nicole?" And I also get a lot of questions around what's normal and what's not, like how big should my clots be? Should I even have clots? What colour should my period be in? How long should it last? And all of this stuff.   Nicole Jardim:  (23:00) Again, this comes back to this lack of education, this lack of body literacy in our society. And so I think that the first thing that everyone should know is the difference between what a period is and what a menstrual cycle is because I do get that question often enough that I felt I needed to actually put it in the book.   Nicole Jardim:  (23:21) So for anyone who doesn't know, your period is the days that you are bleeding during your menstrual cycle, which are the first day of bleeding all the way through to the last day before your next period. So the menstrual cycle is a long one, the period is a short one. And when I talk about a period, I'm talking roughly about three to seven days of bleeding. That's the window I like to see, and this is always followed by ovulation because if you're not ovulating, you're technically not having a period.   Nicole Jardim:  (23:56) So I think it's important for people to understand that because a lot of women go on the pill to quote, unquote "regulate their cycles." And I'm like, "You're no longer ovulating on the pill so technically you're just having a withdrawal bleed." So just so everyone knows that. And I also get a lot of questions about whether you should have a period or not because there is a lot of messaging in the mainstream media and from conventional medicine around whether it's necessary to have a period or not, and most people you'd say the consensus was that you don't need a period.   Nicole Jardim:  (24:30) I'll never forget there was a cosmopolitan article I saw last year that was saying something like "You can just say goodbye to that shit," or whatever. And I was like, "Wait, what? What is happening right now? This is not saying goodbye to a bad boyfriend, this is a fundamental aspect of your health.   Tahnee:  (24:45) I've actually met that a lot from like the row vegan community beCause they have a tendency to get [inaudible 00:24:50] on account of the diet and then they're like, "No, no-   Nicole Jardim:  (24:52) Yes.   Tahnee:  (24:53) ... it's because I'm so healthy." I'm like, "Noooo."   Nicole Jardim:  (24:56) Yes, it's real crazy. I saw that recently. I saw someone post about this and there was probably a hundred comments under her post agreeing-   Tahnee:  (25:04) I know. More like [crosstalk 00:25:04]-   Nicole Jardim:  (25:04) ... agreeing with her.   Tahnee:  (25:05) ... "I want to be like you." It's like no.   Nicole Jardim:  (25:08) I was really stunned. I could not believe it. I was just stunned. Anyway, it is what it is. Everyone's got their thing. So when it comes to like the length of a menstrual cycle, I really like to see somewhere between 25 and 35 days. The average length of a cycle according to the studies that I've seen is about 29 days long, which is funny because the moon cycle is 29 and a half days, living for the moon. A girl can hope.   Nicole Jardim:  (25:38) But anyway, the point is that I love to see that 25 to 35 day cycle, and the reason I say that is because I find that when you have cycles that are under 25 days, what I see a lot of is a short luteal phase and that's the second half of your cycle after you ovulate. And when you have a shorter luteal phase, there are multiple issues; one of the biggest ones is that it can potentially impair your fertility, meaning that a fertilised egg needs time to travel through the fallopian tube and implant in your uterine lining.   Nicole Jardim:  (26:11) And so if your luteal phase is too short and that uterine lining starts to disintegrate before that little fertilised egg gets there, then you have a problem, it can't implant. And so that's what I tend to see a lot of. I see the short luteal phase or I see ovulation happening really early in the cycle, so you have a shorter follicular phase or I see this accompanied with really heavy, painful, long clotty periods.   Nicole Jardim:  (26:39) So again, 25 days and up is really where I like to see things. And then over 35 days, that's an issue too because what it means is that you're just not ovulating earlier in your cycle, in that window that I like to see. I like to see somewhere between like days 10 and 21, somewhere around there. And what I find is that on those longer cycles, it just means that ovulation is being delayed, so something's going on in your life that is causing you to ovulate later in your cycle.   Nicole Jardim:  (27:10) And what I also find too is that when you have cycles that are over 35 days, you tend to have a lot of irregularity in your cycles. So like one cycle is 36 days, and another one is 47 days, and then you go back down to 35 days. There's a lot of fluctuation, which to me again indicates that there's too much stress, there's not enough fat in your diet, maybe not enough fat on your body, you're not eating enough calories. You have the specific nutrient deficiencies.   Nicole Jardim:  (27:41) There's some gut health issues happening. Maybe celiac disease even because that's definitely connected to period issues. So there are multiple problems that could be happening if your cycles are longer and a little irregular. So I think it's important for us to be cognizant of that fact.   Nicole Jardim:  (27:58) And I think that even within the 25 to 35 day window, I think there shouldn't be a lot of fluctuation in there either. Like I said, I feel like if there is a lot of fluctuation, that just means something's up. I like to see very little fluctuation, so by like two, three, maybe four days. Like one month you have a 27 day cycle, the next month it's 30 days, the next month it's 29 days, so there's not a whole wide range going to 25, to 35 back to 25 because again, that to me indicates something's up.   Nicole Jardim:  (28:33) So that's just something that I think that we can be aware of, and also if you have you irregularity, don't freak out. I don't want you to go digging through your life's calendar or whatever to figure out what the hell happened last month or the month before because again, it could be stressors in that month, in that cycle or it could be something that's been going on for a long time and it's just now manifesting.   Nicole Jardim:  (28:59) So it's just important to be cognizant of the fact that this is not really that normal, and if it's happening to you, you can start to pay attention and do something about it. And then-   Tahnee:  (29:10) I think looking more for trends over time as opposed to like one or two random events, because I know when I try to-   Nicole Jardim:  (29:15) Random months, yes.   Tahnee:  (29:16) ... I'll get like a delayed or an early period if I've done like a couple of timezones or something.   Nicole Jardim:  (29:22) Oh yeah. I know.   Tahnee:  (29:23) [inaudible 00:29:23] my body, yeah, and it's like, "Okay, I'm just really sensitive to that," and I just try and take it easy and eventually it's back to normal next month.   Nicole Jardim:  (29:33) I think that's so great and it's a really good point to bring up the fact that we are really sensitive. I think that we sort believe that we can just be like guys and go through life, pushing, pushing, pushing and there are going to be no repercussions. And that unfortunately is just not the case because our bodies are cyclical in nature. We very much are more attuned to the stressors that exist in our lives.   Nicole Jardim:  (30:03) In all honesty, our bodies are more sensitive to stress than, or not as resilient to stress as men's and that's really because of our menstrual cycles, and our fertility, and our ability to reproduce. Our bodies are using that as a protection mechanism and we have viewed it mostly in our society as a weakness, which is so unfortunate.   Nicole Jardim:  (30:25) Because really what it is, it's your body is sensitive to stress because you procreate and it's going to do whatever it can to protect your growing foetus and protect your resources as well. So just keep that in mind as well everyone who is listening that you really have to be aware of that.   Nicole Jardim:  (30:44) Like if you're pushing yourself super hard and you're seeing all of these health issues, trust that that is the reason why. And it takes time. There's short term changes one can make and then there's longterm big changes. So just always be aware of the fact that we are exquisitely sensitive to stressors and it is a good thing.   Tahnee:  (31:05) Yeah. I feel like you've been talking about of it being like a report card. We often talk about how fertility is a sign of health, so it's like if your body's in a state of readiness to reproduce, even if you don't want to take advantage of that, it means that you're really in a harmonious and healthy state because biologically you're only going to be there if all conditions are right to reproduce.   Tahnee:  (31:30) And I think people really take that for granted when they do too much exercise or they eat really extreme diets and they lose their period or they have all these hormonal issues. It's like that's your body telling you it's time to make a change to find that window of fertility again. And we see it in men and women, but given we're talking about ladies here.   Nicole Jardim:  (31:54) Definitely.   Tahnee:  (31:55) Like this culture of fitness and stuff is such interesting one and-   Nicole Jardim:  (31:59) Mm-hmm (affirmative).   Tahnee:  (32:02) ... I just think like-   Nicole Jardim:  (32:03) Oh.   Tahnee:  (32:04) ... the wellness industry actually has a lot to do with this too, but anyway, that's really-   Nicole Jardim:  (32:09) It does.   Tahnee:  (32:10) ... a conversation [crosstalk 00:32:10]-   Nicole Jardim:  (32:10) Overall should we go there? Oh my. Yeah.   Tahnee:  (32:13) Maybe we [crosstalk 00:32:13]-   Nicole Jardim:  (32:13) I know, right?   Tahnee:  (32:14) I sometimes feel like... I'm like, "Oh man, I don't know if I like being a part of the scene," because there's so much pressure on women to cleanse, and to fast, and to do all the things, and all the exercise, and then to be a career woman. And it's like, "Man, we were not built for that." And it sounds like [crosstalk 00:32:32]-   Nicole Jardim:  (32:31) No kidding.   Tahnee:  (32:33) ... And it sounds anti feminist in some ways, but I feel like it's this real act to really embrace your feminine essence. I don't know, I think that's a really powerful statement I suppose.   Nicole Jardim:  (32:47) I would agree with that. I know. I think about this a lot and I definitely address this in the book and I've always talked about this in my programmes because I really think there is no one right way to eat or to take care of your health. There's your unique way to do that. And I feel like this sort of modern day approach to nutrition has left a lot of people feeling very confused.   Nicole Jardim:  (33:14) It's a lot of noise and I just think that all of the diets are like, "Yeah, this is the one and you've got to do this because this is going to help you do X, Y, Z." And what I found in all of my research is that food actually impacts people differently. Surprise! I quoted this actually the study that where... There was a study where researchers fed people an identical meal and then they tested their blood sugar and so many people reacted differently.   Nicole Jardim:  (33:47) I'm like, "Again, wow, that's not surprising." And so it's really about how you can figure out what works for you. And if we're talking about body literacy and really understanding your menstrual cycle and just your health in general or what you respond to and what works for you, you'll really start to see a pattern and you will be able to meet your body where it's at when making changes to your diet and whatnot.   Nicole Jardim:  (34:18) And so I think that it's so much about tuning back into our bodies and its wisdom, and for women and I think that we have been led so far astray and we have moved really far away from what feels right for us and that our bodies are actually telling us. So we really have to check back in, I think with our bodies on a consistent basis.   Nicole Jardim:  (34:42) And part of that is in tracking your cycle and paying attention to how you feel after you eat. Like how do you actually feel after you eat breakfast? I think we just reach for a huge mug of coffee and we don't even think that the meal we ate is possibly making us feel like we want to crash at 10:00 AM.   Nicole Jardim:  (35:01) It's become so normal. I know we can talk about hormonal imbalances and stuff, but to me that's a beginning sign of a hormonal imbalance. We think of period problems, but that's later on down the line actually. There's other signs of hormonal imbalance.   Tahnee:  (35:17) That's always something I think people... The things my partner talks about, which I love is, he's like, "This is affecting you 20, 40, 60 years down the track. You've got to think that long term." And a lot of the time I see people, especially all these health trends at the moment and there is like the celery juice, [crosstalk 00:35:37] and What the Health just came out.   Tahnee:  (35:39) I've been meeting all these vegans, I'm kind of like-   Nicole Jardim:  (35:42) Oh yes.   Tahnee:  (35:42) And I know for some people that can be a really powerful transition for sure. My opinion is that it's a really catabolic, cleansing diets so a lot of people benefit in the short term from it, but longterm not so much.   Nicole Jardim:  (35:59) Yes.   Tahnee:  (35:59) I have-   Nicole Jardim:  (36:01) I would agree with that.   Tahnee:  (36:02) Yeah. And I have strong opinions around that we should probably be eating as close to nature as possible and that involves things like animal . Anyway.   Nicole Jardim:  (36:11) I know. I do, I have strong opinions about that too [inaudible 00:36:14].   Tahnee:  (36:14) Especially [crosstalk 00:36:14]-   Nicole Jardim:  (36:14) It's gotten me a lot of trouble. Yes.   Tahnee:  (36:18) It's not popular, but it's like we need fat, like you said, about even having body weight. I was very skinny and I wasn't getting my period, and it's like, if I want to have my period, which is a sign of health, I need to have a few more kilos on me, and that's just the way it is. It's like this weird... We're trying to have both sides of it and it's like you need [crosstalk 00:36:40]. You just can't, the body has what it needs and we have to honour that.   Tahnee:  (36:44) I don't know, how do you-   Nicole Jardim:  (36:46) Yes.   Tahnee:  (36:48) I guess when people are trying to work out what's right for them, there's so much conflicting information and even nutrition is not a perfect science by any stretch.   Nicole Jardim:  (36:56) Yeah.   Tahnee:  (36:56) You can't just feed someone the same food for five years and see what happens to them. There's ethics involved in all this kind of stuff. And some-   Nicole Jardim:  (37:05) Very true.   Tahnee:  (37:06) ... studies are really flawed and like you look at some of the most popular studies cited by media, even the food pyramid, all that stuff around Ancel Keys and around the grain industry lobby and all that stuff. It's certainly interesting-   Nicole Jardim:  (37:19) And low fat lobby, and-   Tahnee:  (37:21) Yeah.   Nicole Jardim:  (37:21) ... the great.   Tahnee:  (37:23) And how many processed foods, if you look at what processed food marketing, basically just stay away from that stuff.   Nicole Jardim:  (37:30) Yes.   Tahnee:  (37:31) But yeah, I think it's just a really... I feel like people get so confused, and conflicted, and they don't even know what would feeling good if you were going... All right, I'm trying to help you understand what's working for you.   Tahnee:  (37:42) Is it smooth digestion, no bloating, stable energy because a lot of people seem to get addicted to that like hit from coffee in the morning and they do these fasting things and like, "Yeah, I'm just surviving on coffee all morning." And I'm like, "Oh, I don't feel like that's so great for your hormones, but hey, that's my opinion." Can you speak to any of that or is that just like we need [crosstalk 00:38:04]-   Nicole Jardim:  (38:04) Totally.   Tahnee:  (38:04) ... [inaudible 00:38:04].   Nicole Jardim:  (38:06) Oh my gosh. Yes, I really can. I feel like we're kindred spirits. We're totally in agreement on so much of this. I feel like anything that seems extreme and is too good to be true, it's usually too good to be true. Just saying. It's funny because I really have always kept it relatively basic in my programmes and in my work with women.   Nicole Jardim:  (38:31) And if there's a requirement for the keto diet or something, extreme low carb for whatever reason, I usually work with someone else in conjunction with this person because I just want to make sure that this is done in the right way because I'm not a dietician and I'm a health coach. I'm not a trained, registered dietician or nutritionist, and I have nutrition training, but I think that it's so important to start with the basics.   Nicole Jardim:  (39:03) I find that what has happened is that these recommendations, and the diets, and everything have become more and more complicated and sort of convoluted actually over the years. And I think that we're all at like step number six when really many of us should just be at step number one still. The most basic of the basic things for me is can you make your plate? Like here's how you make your plate, this is what you arrange on your plate.   Nicole Jardim:  (39:36) So my whole thing is that I really like to see, first of all, I like for people to not just cut out entire food groups. I just don't know that that makes a whole lot of sense when you are in a state of hormonal imbalance, especially when the hormones that are triggering that imbalance are usually the stress hormones like cortisol, and epinephrine, and whatnot.   Nicole Jardim:  (40:03) And then the other hormone that triggers imbalances, I think are insulin, which is your blood sugar balancing hormone. So what we were saying earlier right about the morning time when someone wakes up and they're fasting or then they're drinking all this coffee and whatever, and they're crashing, or they just feel like they really need coffee, like to me, that's your first sign of hormonal imbalance.   Nicole Jardim:  (40:27) If you are getting a full night of sleep, and you get up, and you can't function without caffeine or you're eating a little bit later on and you find that you're crashing where you're... It's like 10:00 in the morning and you're craving sugar or you eat breakfast and your blood sugar crashes and you've got like within an hour, you're just starving again.   Nicole Jardim:  (40:55) There's mid-afternoon sugar cravings, and then there's the wine or alcohol craving later on in the afternoon, and or you can't fall asleep when it's time to go to sleep at night, or you're up until 1:00 or 2:00 in the morning, or you wake up and throughout the night. These are all signs of imbalanced cortisol, and melatonin, and blood sugar/insulin.   Nicole Jardim:  (41:16) And that to me is the beginning stages of a hormonal imbalance, but the problem is that we have so normalised all of these symptoms, right? Oh my gosh. Have we ever?   Tahnee:  (41:27) We celebrate them. [crosstalk 00:41:27] I've been at the risk of-   Nicole Jardim:  (41:29) Me too.   Tahnee:  (41:29) ... sounding really obnoxious, that's literally what a culture celebrates. It's like, "look at me, I work 500 hours a day, and I got no sleep, and I don't need food cause I drink coffee and fat." It's like, "Oh my God."   Nicole Jardim:  (41:43) Oh wow. It's so true. I feel like we need three more podcasts episodes to talk about this stuff, it's unbelievable. Yes, I agree completely. We really do and it's not okay. I'm always really cautious of something, even something like intermittent fasting, man, if that was the popular kid in school, that would be it right now, and we're [keto 00:42:09]... Don't get me wrong, I've done IF, I get it, it's fine.   Nicole Jardim:  (42:15) It works for me because I feel like I've gotten my hormones under control, but it doesn't work for everyone. And what I've found is it's really problematic for women who are so depleted and their hormones are a mess, and there are blood sugar's all over the place and I'm just like, "Can we just start with like a blood sugar balancing breakfast?" Can we just [crosstalk 00:42:36]-   Tahnee:  (42:35) ...Like three meals a day, keep it easy.   Nicole Jardim:  (42:38) Right. Can we just start with the basics seriously? And so when we're talking about that, like I talk about this idea of making your plate and really all I'm saying to you is that you've got to just sort of reimagine your plate like half of your plate is veggies, a quarter is fat and a quarter is protein.   Nicole Jardim:  (42:52) And veggies can include some carbohydrate, heavier veggies too, and if you want to have some rice, or potatoes, or something like that, stick it all into that hash there of the plate and see how you feel. Literally, I ask women to remove the judgement and approach your meals, and the way you're eating, and how you're feeling with curiosity, and in a sense of experimentation to see how you respond because literally nobody is going to fix you, you have to fix yourself.   Nicole Jardim:  (43:26) And the only way to do that is to literally know that yourself, know what it is that your body is doing when you're eating a certain type of food, or you're eating a meal, or you're drinking alcohol, or you're drinking caffeine. There is no way to know unless you are paying attention.   Tahnee:  (43:47) If someone's really struggling... I speak to people that are just like, "I just don't know how my body feels." And I'm a yoga teacher as well, so it's often something I observe in students is they're just like... You're like, "Relax." And they're like, "I don't know how to." Or, "How do you feel?" It's like, "I don't know. How should I feel?" It's like, "No, no, no. How do you feel?"   Tahnee:  (44:09) We just sometimes are so used to having people tell us what to do or giving our power away, and that's a whole complex conversation in and of itself. But if someone does have food allergies or suspects that they might have something like that going on, do you recommend people get testing, or do you recommend like elimination diets, or do you have a.. I saw on your site that you've got some links? Should people just go have a look at that or?   Nicole Jardim:  (44:35) Yeah. I love this question about not knowing how to feel or not knowing how you feel. I think that paying attention to your symptoms is a way for you to know how you feel. For instance, if you drink coffee, do you feel anxious at any point in the day? Seriously. Do you feel anxious after you drink it? Do you have anxiety later on in the day? Do you have problems falling asleep at night? Do you feel tired but wired kind of thing? Or do you wake up in the middle of the night?   Nicole Jardim:  (45:03) Those are really good symptoms of too much caffeine and they will definitely tell you how you feel. And then I think the other thing is when you wake up in the morning, how do you feel? Because we have been so programmed to believe that you hit the snooze button five times and you go back to sleep a couple of times more, and then you just drag yourself out of bed and you drink a coffee or whatever. Or you take a shower and you wake up, and then you haul ass to work or whatever.   Nicole Jardim:  (45:37) If you knew that you were actually not supposed to feel that way, would you pay attention and see how you actually are feeling? And so I'm always curious about how you feel in the morning, how you feel at night in the lead up to going to bed, and how you feel after eating meals emotionally. Do you get angry or upset too easily after you've eaten sugar, for instance? That means that something's happening.   Nicole Jardim:  (46:01) So really tuning into those physical and emotional symptoms I think can really help you know how you feel without having to do too much work to try and like really figure that out.   Tahnee:  (46:18) I think that's so helpful for people just to have those little points in the day where they pay attention and it sort of builds the capacity I think to become more self aware and tune into your feeling state or whatever it is.   Nicole Jardim:  (46:34) Feeling state, I love that.   Tahnee:  (46:35) That's something I say a lot in yoga, I'm like, "Maybe that would apply." The other thing I think is hard for people is when they are in those periods of transition like from when you're a young woman, like you were saying, first getting your period, it's such a confusing time anyway. Being in high school and all of the madness that comes with that, and then you suddenly having to deal with this really biological thing, but culturally you have not been prepared for.   Tahnee:  (47:03) And then similarly, we've got postpartum, we've got perimenopause, and so that beginning of the menopause process. So many women I know really struggle in those transitory times and I think... It's obviously a great time to reach out for help and support, but I wonder if you have any thoughts on when... or even if there's just a lot of stress in your life, is it just a matter of pairing back for you and being a lot more mindful of having regular meals, and being really kind to yourself, and taking space? Or do you recommend-   Nicole Jardim:  (47:34) Or is it more?   Tahnee:  (47:36) Yeah, like seek more medical helpful or?   Nicole Jardim:  (47:40) I really like this because again, this builds on the fact that we tend not to reach out for help in our society, another wonderful trait of modern humans. We don't do that and it is very much to our detriment. I know you'd asked about testing and that kind of thing. Maybe I'll talk about that for a second.   Nicole Jardim:  (48:02) I do really like testing, but I do also want to... I feel like it comes with a bit of a warning that you can go down a rabbit hole because what you look for, you will find, just so you know, and it can be very expensive, and it can also not necessarily tell you accurately what's going on with your particular cycle. Not all testing can do that.   Nicole Jardim:  (48:27) However, it can give you a baseline and it can certainly help you to create a roadmap for healing. I'm certainly a fan of testing, I just think that it can get out of control. And I also really like to encourage women to really tune back into what that little voice is telling them and what's going on and tracking their cycles so that they can really see what symptoms are happening, and where they're happening in their cycle. And that can tell us a lot about what their hormones are doing too.   Nicole Jardim:  (48:59) With that said, I really like the DUTCH test and I know you've had Carrie Jones on your Podcast and you've talked all about, so I won't go down that road too much, but it's just excellent for really seeing on a multilayered way or in a multilayered way what is happening with your hormones on so many levels.   Nicole Jardim:  (49:19) So I think that's really great, but if you don't have access to that, which I know the majority of people do not I would say, asking for your doctor to pass just the following hormones. So you want to be thinking about estradiol, which is the most potent oestrogen. It's the most prevalent oestrogen when you are still cycling.   Nicole Jardim:  (49:39) Progesterone, and testosterone, and DHEA. And then some other tests you can do, especially if you're looking at fertility, would be FSH and LH, which is Follicle-stimulating hormone and Luteinizing hormone. And those two hormones are quite dominant in the first half of your cycle as you lead up to ovulation.   Nicole Jardim:  (50:01) And then estradiol can also be tested with FSH and LH between days two and four of your cycle. And those are really going to tell you what's going on with your fertility for the most part, again, because they're involved in the ovulation process and kicking that off.   Nicole Jardim:  (50:18) So I think the other thing that's really critical for everyone to understand is that you can't just test these hormones in any old time in your cycle. If you're getting a period and you're ovulating, you actually have to test them about five to seven days after you've ovulated. And I can't tell you how many people have come to me and said, "Oh yeah, I tested on, I don't know. I don't even know what day, Nicole. Maybe day 12 in February."   Nicole Jardim:  (50:42) I'm like, "Oh great. Okay. That does not help us because your hormones fluctuate people, so you have to make sure that you're testing after you've ovulated so you can get an accurate reading on your progesterone levels." And so I would say, that's a good baseline. And of course tracking your cycle as well, and knowing what the symptoms are or what your symptoms are so that you can see if they correlate with the test results.   Tahnee:  (51:09) A lot of the stuff we've discussed today is in your book anyway, for people that are interested, it's coming out in April. Like I said, I've seen on your site you've got links to all the different tests you recommend and so much content on your website.   Nicole Jardim:  (51:24) Oh thanks.   Tahnee:  (51:24) I was just like, "Wow. She's really put a lot of work into this..   Nicole Jardim:  (51:26) I know. I've been busy. I don't value my spare time clearly.   Tahnee:  (51:32) Because I really love like you got the period quiz, which I think is a really great way for people who are unsure just to get a bit of an idea of maybe where to focus their attention and energy because I think sometimes it can just be like, "Oh my God, is there something wrong with me?" And it's like, well, maybe it's just that these couple of things need to be addressed or this is a good place to start. Or maybe it's just a few tweaks to lifestyle.   Tahnee:  (51:58) But are there any other ways people can connect with you? I know you're on Instagram as well.   Nicole Jardim:  (52:04) Yes. Obviously, on my website there are bonuses if you purchase the book. You just go to fixyourperiod.com, pretty easy and straight forward and you'll get a whole period toolkit. And then yes, I'm on Instagram, Nicole M like Madeline, Jardim. And I'm also on my own podcast, The Period Party.   Nicole Jardim:  (52:23) So there are lots of ways to connect with me and I do... I just share an obscene amount of content. It's kinda crazy, but I really just want everyone to have this information so that they can make more empowered and educated decisions about their health and their bodies.   Tahnee:  (52:41) Just feel how passionate you are about it and it's really amazing, and such a great contribution I think to women's health.   Nicole Jardim:  (52:47) Thank you.   Tahnee:  (52:49) Can people actually work with you as a coach or are you pretty full up with that?   Nicole Jardim:  (52:52) I am not taking private clients at the moment because life is a little intense. However, I do have live group programs that I do throughout the year that people can do with me. Yes.   Tahnee:  (53:04) And they're promoted through your site, right?   Nicole Jardim:  (53:07) Yes. They are promoted through my sites, so you can sign up for... You basically take the quiz or you can sign up for my mailing list directly on my site.   Tahnee:  (53:15) What I wanted to say is well, a couple of the girls in the office have used your work to really get to the bottom of some of their stuff. They will sit on the DUTCH test and a few things, but it's been really beautiful speaking to them about how much your work helped them. So I just wanted to say thank you from the team at SuperFeast as well because it was really nice to have you on the show and just to hear your thoughts. I feel like we could have a really great hang.   Nicole Jardim:  (53:42) I know, we really could if only we lived not like a million miles away from each other, seriously.   Tahnee:  (53:47) I know.   Nicole Jardim:  (53:47) I know.   Tahnee:  (53:47) [inaudible 00:53:47]-   Nicole Jardim:  (53:47) Thank you so much [inaudible 00:53:53] literally.   Tahnee:  (53:55) I know. We had a chat earlier before we came on about whether your book could be available to Australian's on launch in April. We're not sure, but we will try and find out and we will let everyone know. I reckon we might be able to get it through book depository or Kindle maybe. But otherwise it'll be coming out in October in the UK, which should reach us in Australia as well.   Tahnee:  (54:14) And so yeah, it's such a great book. I've had a chance to read quite a lot of it and I am really excited that we can recommend it to people, and you've done so much work and you should be really proud of what an achievement it is. So Thank you so much [crosstalk 00:54:29]-   Nicole Jardim:  (54:29) Thank you so much. I was so thrilled to be on you podcast, and really happy to hear that some of the girls in your office have utilised my work and that just thrills me. So thank you.   Tahnee:  (54:40) Big fans. Have a good day and we will hopefully have again one day soon.   Nicole Jardim:  (54:46) Sounds great, thank you.   Tahnee:  (54:47) Bye Nicole.   Nicole Jardim:  (54:49) Bye.

Words from Erin:. “Just because [the Doctor's] tests come back normal, doesn't mean you're going crazy. If you feel like something's not right, you need to keep looking for the answers.” In this episode, we talk about: Erin's personal health journey and how she overcame chronic fatigue and illness  Physical and emotional symptoms of not listening to your intuition What Kundalini yoga is all about The difference between supermarket, health food shop and practitioner supplements  How liquid herbs work Using herbs to support weaning off antidepressants  The Mirena IUD vs Copper IUD Using herbal medicine to help with fertility and menopause The connection between gut health, periods and menopause Erin's recommended cow's milk alternatives that aren't yuck Resources:   The Longevity Diet by Dr. Valter Longo, P.h.D   Where to find Erin: Learn more: https://goldenyogi.co.nz/ Instagram: @goldenyogistudio

Holistic health coach, certified sex educator, and sex and intimacy coach Jess Brassington joins Amanda for a conversation about birth control and what synthetic hormones are really doing to our bodies. After Amanda spoke up on social media about having her Mirena IUD removed, the response was overwhelming. Hundreds of women told of their experiences—stories about the negative effects of hormonal IUDs—after being told by their doctors that it was completely safe. Jess helps us understand what’s really happening in our bodies and what we can do about it.   For more information about the FASTer Way program, please visit our website at fasterwaytofatloss.com; and be sure to get your free gift by visiting fasterwaytofatloss.com/freegift.

Let's talk about Endometriosis... On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Anila Ricks-Cord, a wife, mother of 3 hilarious children and a board-certified obstetrician-gynecologist. She is a motivational speaker, a 2-time bestselling author of The New Laws of Mommyhood & Marriage: From A New School Mom With An Old School Hustle and the co-author of The Making of a Medical Mogul. She is a media personality whose passion is to encourage women to address their health care concerns and fears, giving them a voice and empowering their best lives, mind, body, and spirit. This week she is on the show to talk about endometriosis, a disease that affects 11% of women, can responsible for painful menstrual cycles and even infertility. Listen to how Dr. Ricks-Cord has to deal with this problem in her current practice. Text LUNCHLEARNPOD to 44222 to join the mailing list. Remember to subscribe to the podcast and share the episode with a friend or family member. Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify Sponsors: Lunch and Learn Community Online Store (code Empower10) Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you) Dr. Pierre's Resources – These are some of the tools I use to become successful using social media My Amazon Store – Check out all of the book recommendations you heard in the episode Links/Resources: Facebook Instagram Twitter Social Links: Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/ If you are looking to help the show out Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod Download Episode 132 Download the MP3 Audio file, listen to the episode however you like. Episode 132 Transcript... Episode 132 Transcript...  Introduction   Dr. Berry:  Welcome to another episode of the Lunch and Learn with Dr. Berry. I’m your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of DrBerrypierre.com as well as Pierre Medical Consulting. Helping you empower yourself with better health with the number one podcast, for patient advocacy. Today I get to bring you a special guest today Dr. Anila Ricks-Cord which is a good friend of mine and an expert in women's health and what she calls vagina land. She is hilarious, first of all. But she is really an expert because you guys know I'm not the biggest women's health discussion, right? Because there was a reason why I went into medicine but so I figured. Let's bring someone on who can kind of help me, kind of grasp what is knowledge and I really kind of avoid it when I was a medical student in medical resident. So today we're gonna be talking about endometriosis which depending on when you listen to gets its entire month of awareness March is Endometriosis Awareness Month. So I figured if a disease gets a whole entire month, it has to be important. And if it has to be important let's bring an important guest on. So I just want to talk. I'm just gonna give a little bit of a bio just so you can kind of understand exactly the person we gonna talking to. First of all she’s hilariously funny. You definitely gonna enjoy today's episode. Dr. Anila Ricks-Cord is a wife, mother three hilarious children. She's a board certified obstetrician gynecologist. She's a motivational speaker. She's a two time bestselling author.  She's a media personality whose passion is to encourage women to address their health care concerns and fears giving them a voice in empowering their lives, mind, body and spirit. Can you know the theme: Empower yourself a Better Health. She currently resides in Texas where for loving spouse, three children and two lizards. She attended college at Indiana University. While there she performed research and published articles on rats in order to help curb alcohol behaviors in humans which is absolutely hilarious. She did move to Baltimore to perform research and publish articles at John Hopkins University. This time investigating acute respiratory distress random at the molecular level. She attended graduate school at Johns Hopkins and pursue a master's degree in biotechnology. She was accepted at the University of College Medicine. Experience significantly shaped how she practice medicine culminating her receipt of the Leroy Week's Award for Outstanding clinical skilled bedside manner and commitment to service.  Again, she is absolutely amazing and I get again especially from my fellows who are probably not sure this is a podcast. I listen to this is a disease process that could affect your mom, could affect your sister, it could affect your cousins. So this is something you may well listen to just be able to kind of pass it on, right? Especially if you have a female friend or spouse or a wife or a sister who has these very vague complaints and no one seems to know what's wrong with her. And then you start kind of attributing it to maybe in her head. This is a disease process that may make you think different right. So sit back for another great episode again if you have not had a chance, make sure you subscribe to the podcast. Leave a five star review for the podcast. So we are on the radar of everybody so everyone can be empowered for better health. So again thank you. Let's listen to another amazing episode this week with Dr. Dr. Anila Ricks-Cord. Episode   Dr. Berry: All right. Lunch and Learn community. So you heard that amazing intro with Dr. Anila and we're gonna, you know, really let her speak and introduce yourself to the community. And of course, you know guys, I've said this before, I am not no women's health expert. One of the reasons why I went and turned on medicine is because I kept getting kicked out of their rooms when I was a medical student, right? So I figured if we're going to be talking about women's health, especially disease course like endometriosis, right? I figure let's get the expert to talk and I'm just going to sit here and listen. So really, I'm actually going to be listening along with you guys and you know this, this expert kind of expand her knowledge on this and tell us what endometriosis in the show. But first and foremost, Dr. Anila, please again, thank you for coming to the Lunch and Learn with Dr. Berry. Dr. Anila Ricks-Cord Thank you Dr. Berry so much for allowing me to be able to be graced by your presence and share a little bit of knowledge. Dr. Berry: Just the feeling is, oh, a hundred percent mine. I've told Dr. Anila, a friend of mine and I told her, I said, I'm gonna get you on a podcast. Like you can't be given all that amazing information out to the community on Facebook and everywhere else and not give it to Lunch and Learn community. So I already, I had already pre-warn she would be on the show. Dr. Anila Ricks-Cord That’s you did, that’s you did. And I'm honored to be here. So. Dr. Berry: For those who may not know, you may not be following you, you give a little bit, you know, outside of the bio, little bit about yourself. Tell us why you do what you do and you know, kinda how you got to where you at now. Dr. Anila Ricks-Cord Sure. So I am a board certified obstetrician/gynecologist. I'm a wife of 22, going on 23 years. Praise God, Lord willing. I’m a mother of three awesome kids and I'm a two time best-selling author and a speaker. So through my books, my patient care, and my coaching programs, I encourage women to address their health care concerns and fears, giving them a voice and empowering them to live their best lives, mind, body, and spirit. So I'm originally east coast native. I'm the eldest of three children and a big science geek. I openly where their pin. I attended school in Indiana University, Purdue University at Indianapolis. And that was where I met my love and my biggest cheerleader perform research at Hopkins before having the privilege of attending Howard University College of Medicine and then completed my residency at WellSpan York, Pennsylvania. So I was inspired to practice medicine and led to become an obstetrician gynecologist secondary to the death of my mom. She was last 22 years old. She was misdiagnosed with the flu and subsequently died of Septicemia. For those who don't know what that is, it's essentially a bacterial infection in the blood, which basically causes massive organ failure and death. So this is why I do what it is I do. So. Dr. Berry: I love it. And you know, thank you for sharing that story with us because I think a lot of times people outside of in fact very, you know, full disclosure, we're actually recording this on like, you know, national doctor's Day, right? And I love this day. Because a lot of times physicians really aren't getting a lot of the fanfare and the good light that they should be getting. Right? You know, a lot of times there's a lot of misconceptions of why we became physicians. For some reason people think it's all about the money. I keep trying to tell you, trust me. (Most assuredly is not. Fannie Mae, Sallie Mae, she visits me on a regular). Can you chat and tell folks that, and it's really the love of wanting to see that next person get better. Right? And understanding that is, you know what, I wasn't there. I wasn't able to maybe make the steps I wanted to. It's like for my mom. Right? But maybe I can do for someone else. Right. And I, I'm, you know, I'm totally feeling that because I remember being a second year medical student and getting a phone call that my father was in the hospital and again, I'm a second year medical student. I didn't even know my dad had like medical problems. But you know, that's a whole another discussion. They don't, you know, patient guys don't like to talk about nothing. Right? And you know, subsequently from that he passed away and I said, you know what, there's no way that I'm not going to let people know, like, hey I only, I’m physician but I can't help you right from that day forth, I just kind of took that man once again, thank you for kind of taking your mantle and kind of really running with it. Dr. Anila Ricks-Cord It is what I was called to do. I feel like knowledge is power and my angelus says, when you know better, you do better. And my goal is to make it so that people know better so they can do better. Dr. Berry: I love it. So the topic at hand today is endometriosis. And I could tell you from a, I'll be honest, I'm an internist. I take care of patients than I used to take care of patients outpatient where I knew a little bit about it. But once I went inside the hospital, you know, my knowledge of it was very, very weak. Right? So I know that again in March where it's actually National Endometriosis Month, right? So any disease process that gets a whole month is one that I feel like the Lunch and Learn community needs  to know. Dr. Anila Ricks-Cord So I happily, I will tell you about endometriosis. So before I can tell you what it is, allowing me to describe what's normal. First told you I'm a big fan of that Geek and women who become their menstrual cycles every month. The body attempts to get itself ready for the possibility of pregnancy. So I like to describe it as your brain calls her ovaries and says, hey girl, we're trying to get pregnant this month. Under the influence of your brain. Your ovaries make estrogen and progesterone, which causes the lining of your uterus to get nice and thick and fluffy, and it causes you to ovulate. The thickness of this lining. This thing happens every single month where every month we get nice and thick and fluffy, so we actually do get pregnant. There's a nice and nourishing space for a fertilized egg to implant and grow. If you don't get pregnant, that lining dies and peels off. And that peel, that lining is actually your menstrual blood, and so if you don't get pregnant, it starts all over again. Better luck next month. Maybe it'll work out next month. Exactly. Just like we bleed out of our uteruses and out of our vaginas and owns or whatever, you know, products you used. There's also something called the theory of retrograde flow where we actually need backwards too. So if you imagine that this uterus has like this cavity on the inside, and whenever I talked about my lives, whenever I do them, I use my face as the uterus and I take my laps and I separate and pull them up to the side and said this is the fallopian tubes. You bleed backwards into the uterus are actually from the uterus into the fallopian tubes and into the pelvis. You know, this is where it's an issue and some of us, that tissue, that lining, endometrial lining, the supposed to regenerate itself every month. Some of that tissue takes residents actually in your pelvis and your abdomen and so come next cycle, the tissue does what it does and it sickens to try and make a lining where it is, but it's in the wrong place.  Yes, exactly right. Right. So you've got this out of bounds, bleeding going on, which triggers inflammation. Kind of like if you hit your elbow, you hit your knee and it swelled up. Right. Nice. And is sore. Your body responds to this perceived injury and your immune system kicks in and gets involved. And this is where scarring happens. So what is endometriosis is when you have your period in places other than in your uterus. And these endometrial cells, once they get access to your pelvis, they can then travel to other places and get access to your blood vessels and your root system and go outside your covas, to other places. So it is primarily a disease of your pelvis, but because they don't have any limitations and they don't know down, they can go other places too.  Dr. Berry: So once that I retrograde bleeding happens. There's really like, oh all fair in love and war pretty much. Dr. Anila Ricks-Cord Yes. For some of us, we all do it. Not all of us, we all have this, this retrograde flow, but not all of us have tissue that are like boundaries. I don't know things like no boundaries. And so there's a, there's a thought that there's a genetic predisposition where there's a subset of people who have tissue that decides, Oh yeah, I'm going to be a topic, I'm going to grow wherever it is I wanted to go. Maybe, maybe it's like living in a large city, you need to get to some places not so highly populated. So you decide, a lot of people live like on the pelvic. The actual prevalence of endometriosis is not exactly known. So they say that you see it in between 25 to 38% of adolescents that have chronic pelvic pain and in 10 to 15% of women that are reproductive age. And so there's a substance and we talk about this theory of retrograde flow and then there's also a thought process to or told you big baggy claim. I apologize. I put disclaimer on it. Dr. Berry: We trust. We're just, we're all here for this. I'm sitting there, I'm listening. I'm like, okay. Okay. All right. All right. Dr. Anila Ricks-Cord Cool beans. So from an embryo logic perspective, I know you remember, you don't tucked it back in the rule that dig somewhere because it doesn't serve you anymore. But those of us who are women, when we actually go about being formed in our mother's womb, we have got a fallopian tube and a uterus and another fallopian tube and a uterus. And what happens is these two halves come together to make a hole. The center hollows out. And you've got, if you're lucky, you have one normal functional cavity. There's a subset of people who have what are called Mullerian anomalies where the two little pieces and uterus don't get together where they're supposed to. It doesn't hollow out the center and become one. And so these people are also a set up for endometriosis because they have topic endometrial tissue that ends up in other places. And so about 40% of these children that have these genital check defects will have issues with individuals. As they say, 50% of women that have infertility's had endometriosis and 70% of women and adolescents that have pelvic pain actually have endometriosis. Dr. Berry: And because we don't know the true figures, do you feel like the figures maybe higher than what we're even picking up? Dr. Anila Ricks-Cord I would say so because unfortunately it takes about nine years to diagnose endometriosis because it's a disease of exclusion. And so when people present, so you have a patient that will come and see you in and they've got these vague multitude of symptoms. So like in women in grownups, people who are not adolescents and adolescents have defined 10 to 19 years old. So reproductive age women, you can have a lady that comes to see you with a complaint of pelvic pain either with her periods or with sex. And so if it's pelvic pain with her periods and call a dysmenorrhea, which is this dull crampy pelvic pain, that might start about two days before your cycle starts last. The entire length of cycle might occur a couple of days afterwards. Or if it's chronic, we're, it's been present for more than six months. It can be dull or throbbing or sharp or even in one of my patients, she has a burning sensation every month on her cycle shows up. She's got a spot in her left lower quadrant or her anterior abdominal wall where it's like a hot poker. That's how hers that she has pain all the time, but when her period's shows up, it just burns in this one little spot. So that's what cycle you're paying with your period. If you have pain with sex, you will have patients that have complaints of pain with penetration, particularly deep penetration, and so when you go see your Ob-Gyn, one of the ways that you can kind of mimic this is the thought is when you get these endometrial implants in such a personal space, you can get these. It starts off as a microscopic disease and you can get nodules or uterus has got this support system inside our pelvis is kind of like the ladies who wear bras, kind of like a bra strap. So you've got the same call, uterine staples that supported on the inside of your pelvis. You can take your fingers in a lady who has endometriosis, put them in the back part of her vagina, separate them like a peace sign and stroke and practically make her leap off the table because she has nodular implants in the back. So you can simulate this, this pain with sex when you stroke on these easier to cycles on the back issues that nodules implanted inside. Ladies who present with infertility and so infertility technically is defined is a chick, is less than 35 years old, has been trying for a year to have, has been having regular sex for a year and trying to get pregnant and hasn't. If you're over 35 is six months essentially, but they say the 30 to 50% of women who have infertility had endometriosis. If you have a lady that presents and she has an incidental finding on ultrasound which has got some pain and you do an ultrasound, she's got a mass on her ovaries, there's a particular. Endometriosis implants can actually implant anywhere inside your pelvis, on your bow, on your bladder, inside the wall of the uterus to, and I'll come back to that one. And inside the ovary you can get what it called Endometrioma where when you look at them on an ultrasound where essentially the equivalent of blood clots inside the ovary, a lady that's got an ovarian mass and is an Endometrioma, if you have a high index of suspicion that she has endometriosis, you know, also present in ladies and have bladder issues. Like if you have a feeling like when you do not have a UTI but you feel like you go into the bathroom all the time or you feel like you've got to go right now or you have pain when you go to the bathroom. That could be a sign of endometrial implants in your bladder. If you have bowel issues where you have issues with diarrhea or waxing and waning diarrhea and constipation or pain when you desiccate or colicky bow, that can be a sign of endometrial implants in your bow. There is a version of endometriosis called adenomyosis. Which is what Actually Gabrielle Union had. Heavy menstrual bleeding is is a possible sign of endometriosis and by heavy menstrual bleeding. Allow me to clarify. A regular period is supposed to be no more than 80 cc's so in simple terms in an English Dr. Berry: Talk to the men. I hear. Dr. Anila Ricks-Cord Right. I'm about to say so. A normal period is for hotel bottles of lotion. That’s 2.7 fluid ounces or it's about a third cup. That Mixing Cup that you have in the kitchen when you make us up on one third cup size, that's ATC seats. Anybody who has more than that and some of the patients that don't have had that have had heavy menstrual bleeding, they making crosses and ease and the underpants they've got multiple two, three second. I'm like mattresses. Or they're use tampons. If you can use a super plus tampon and that thing falls out in an hour or two you have heavy menstrual bleeding. For Gabrielle Union. When she was talking about her fertility struggles, what she suggested was that she was in it to her doctor with heavy menstrual bleeding. Traditionally put her on OCP is birth control pills in order to be able to regulate her flow.  She subsequently was found after having her struggles with fertility so she could, she had gone through some ivs cycles. She got pregnant a couple of, actually, she’s pregnant more than a couple of times. I think she suggested maybe nine times. She got pregnant, something along those lines, seven to nine times. But with her, she has endometriosis in the walls of her uterus. And so you've got this glandular tissue that's supposed to do right and be nice and fluffy like a comfort in the winter time for this egg that's on fertilizer on the wall. But it has a place where it's supposed to be. It's only supposed to be on the lining of the inside of the shoe is not deep with them. A muscle for people who have the endometriosis inside the wall of the uterus or the Adenomyosis. They actually have bleeding that occurs within the muscle itself. And this leads to inflammation and issues with fertilization and implantation and being able to carry a pregnancy. So again, heavy menstrual bleeding was also a sign as well as irregular menstrual bleeding. Endometriosis can also make itself manifest in the form of low back pain or chronic fatigue. This is why it's so nondescript and it takes forever to diagnose. Dr. Berry: That’s I think about. Nine years? Dr. Anila Ricks-Cord Nine years. Yeah. In adolescence, which is that group between ages 10 to 19 and there had been some documented cases of little girls who didn't have Mullerian anomalies I talked about what you just didn't come together. Right. They had the babies that have been documented to have endometriosis as young as eight and a half years old. Those little girls will have symptoms that are, that can be cyclic, like only a time with your pain and not having anything to do a period. But they can get pain that gives worsening and more severe when they actually start having periods and they can have rectal pain, they can have constipation, they can have pain with defecation when they go to the bathroom associated with their cycle. Rectal bleeding, pain with urination, and even blood in the urine or that need to go right now and so is so nondescript. You can see how a physician would run through a litany of tests before finally getting to the point where you even considered endometriosis at all. Dr. Berry: Nine year seems so long. (It is). Should it not be like more ahead of the line or do you really have to kind of rule out some big stuff first before you can say like, okay, let me let's think about endometriosis inside of them. No, cross my t's of everything else. Dr. Anila Ricks-Cord So I think that because it was a diagnosis of exclusion for the longest time to truly diagnose it, you need a tissue staff and so the thought process, (Tissue it's in the muscle. How do you get, wow, okay). Right and endometriosis, you only get, if you have a uterus of the path lab, that's how you diagnose that otherwise is I take you to the operating room. I do a diagnostic laparoscopy where I poke a hole inside your belly button, do you up the carbon dioxide, took another two holes inside your belly in order to be able to get camera inside there and some graspers to move around and look to see if I can see signs of disease. And it's not four stages to what you could have minimal disease, which is microscopic, and you don't see nothing to stage four disease where you have everything stuck like chuck on the inside. But ideally if you get to the point where you have to do laparoscopy, then you go inside and you biopsy this different parts of the pelvic sidewall underneath the uterus cycles. If it's on the ovary where ever you see there'll be, sometimes it looks chocolate, sometimes it looks white, and so any abnormalities you see you're biopsying them in order to be able to confirm the presence of disease and that's part of it. A lot of us who are conservative would want to try. I think old school thought was if you had endometriosis, let me try all these other things to make sure it's not that before I'd used last resort and take you to the operating room. (Which is operating room. When I talked to some people and say operating room, what? ). Exactly and yes, just when you think about that, if at any time you poke a hole inside anybody, anytime you performed surgery, there's a risk of it. It’s a disease thereafter and so it's a risk versus benefits kind of thing. But I think that the thought process, I think more people are becoming more aware about how much of a big deal this is. Because you think about how often do when you were seeing patients that were women, you joked that you got put out of the room all the time, that it's a comfort level that's got to exist between you and your physician and I'm sure you've seen the commercials talking about the meds and the chick the study have had endometriosis. When people don't feel comfortable talking about what's going on with their period, how much they bleed. Like you'd be surprised the number of women that have gotten Menorrhagia or heavy menstrual bleeding where they practically write their name on the floor in blood and cursing every time their period shows up and they think it's normal and they ask anybody about anything.  Dr. Berry: Wow. Have you have trouble in the past and tried to even pull that type of information out of your patients? Dr. Anila Ricks-Cord You know, I think for me I'm fortunate in that I laugh and joke with my patients and then because I have also had issues with Menorrhagia like so black people are real good at making fibroids. Sidebar, I have a fibroid. Uterus is about the size of a 12 week pregnancy. And as a consequence, I think God has got a funny sense of humor cause at the Ob-Gyn, if somebody thinks that I have experienced it, I can relate to with my patients. And having been one of those chicks that has been a Menorrhagia without, not that people want to know what my contraceptive option is, but I use a Mirena IUD in order to control my Menorrhagia. Without my Mirena IUD, I can use a super plus tampon and it falls out every two hours. And I could write my name on the floor of blood curse using a regular tampon. Using a regular tampon, about Mirena. I don’t know what that was.  And so I use humor in what are the bridge the gap in order to be able to ask those kinds of questions. So tell me about your menstrual cycle. How long does it last? What products do you use, how often do you change them? Because a large number of these people who have, who should have hemoglobin hematocrit of six. They eyeball rolling because they believe, they think that's absolutely normal. They think that's absolutely normal. And then because it's, it's your period and you're not comfortable talking about that stuff anyway. It's a don't ask, don't tell, unless you have the kind of relationship with your physician where you feel like you can talk about.  Dr. Berry: Can you talk about it and if you can't, if I want to say you can't take their relationship isn't there to talk to it with your OB, you definitely not talking to the hospitalist. Dr. Anila Ricks-Cord Of course not. If the person see it on the bottom, you can to the physician. Why talk to people that you are not close? Exactly.  Dr. Berry: Okay. All right. All right. So let's see. So you mentioned liking me and I told you I was going to get some learning today. I already let her know, oh we're going to do some learning today. Cause again this is, I'm taking those right along, which I'll be going again. I've experienced in taking care of patients with this disorder. But of course you know me, I'm referring out to the OB clinic when I, well I think is what you got. Go ahead. See my OB friends, see if that's the case. So definitely. Wow. Okay. So what about, so we talked about it. I, I hear somebody, you know, some of the signs and symptoms kind of really associated with it. Now, is there anything that these patients are doing that may have attributed to getting any endometriosis? I mean because I guess they have to have a menstrual cycle, right? So it's not all about the retrograde bleeding, but is there… Dr. Anila Ricks-Cord Well in theory, remember there are some babies eight and a half and haven't had periods that have issues with the document in endometriosis. Wow. The vast majority of us have this menstrual, heavy menstrual cycle related signs and symptoms. We were, we're cycling and we've got this retrograde flow, but you don't necessarily have to have a period. You can have these, these girls. So when you're talking about risk factors for it in the materials, as we talked again about the, the developmental conditions that predispose you to basically having your belly tampered with endometrial tissue. We talked also about the fact that there are some people who are believed to have the genetic predisposition. So if you have a first degree relative that has endometriosis and by first degree relative is either your mom or your sister or your children, if you have a first degree relative that has endometriosis, you have an increased likelihood of having it too. And there's a thought process that, and these people who have a genetic predisposition for endometriosis, there's something about the way their cells signal that they don't respect boundaries and go from one place to another. Like tutors, I'm going to the pelvic. And then there's also a thought to that if you started your period early, like 10 or less that you're an increased risk for endometriosis. And then it has unfortunately has awful side effects too. Awful side effects. Dr. Berry: Now are, those are the, especially because we would kind of lean on, they're kind of starting to period early. So of course, you know, we're talking about like kids and then obviously this is an issue that a dose deal with as well. But I'm always kind of fascinated, especially as I'm an internist, I really only see 18 and up, you know, as an OB, you know, you're seeing all kinds of ranges. Do the complications associated with it? Like are they much worse off in the child than adult or is it still kind of tight? I gets bad either way. Like we know the rectal bleeding, we know the urinated, we know all this. But like if you, if you had to I guess choose, right? Like when would you rather start dealing with these problems? Would you rather deal with it as you know, in, in the younger age or more of that old, they're 35 40? Dr. Anila Ricks-Cord Well, oh, sorry. That's interesting. Thank you for reminding me. I forgot about that. One might tell you a little sidebar about that one. So in theory with children, the thought process is again, 40 days, 40% of adolescents with general tract anomalies, 50% of them have issues with infertility and 70% of women and adolescents with pelvic pain, it's got it. But the thought is that you've got longer in, would it be repetitive or your belly with these things? And so as a child, outside of the symptoms that we discussed beforehand, okay, the issue is think about all the years particularly undiagnosed, that you've got your belly, your abdomen, and your pelvis, your bowel, your bladder being peppered by these implants inside your personal space that then may not reflect or respect boundaries. Hop a ride on your vasculature or in your lymph system and go to other places. You can actually have endometriosis implants in your chest. Dr. Berry: The chest wall? Dr. Anila Ricks-Cord Yes, you can actually, it's this thing with, with so you know, cells and how they're supposed to respect boundaries and go to confluence and owning by protein signaling. Endometriosis implants can end up inside your lungs. You can actually get a collapsed lung as a consequence of endometrial implants. You can actually have Hemolysis when you cough blood for people don't know where that is. Yes. Or you can actually have, what is the other one is there's the collapsed lung, this coughing up of blood. And there's one other, I'm gonna circle back. When you talked about the difference between adults and children from the standpoint of what it is they have, you think about you have longer to be able to develop the side effects which are infertility. And if he's a disease which distorts the tubes and the ovaries, you have inflammation which is going to cause scarring and you've got pain and so you've got a longer time in order to be able to do this. So yeah, it can give you chest pain, collapsed lung, a blood in the lungs and coughing up few months. And then also with endometriosis, which I'm a sidebar in people who don't have one, you talked about the difference between adult versus children. You can be a perfectly normal lady who went to go have a C section. And as a consequence of having a c section because the uterine lining was disrupted, you can get into endometriosis impulse anywhere along that incision line. So where when I do C section, so we, after the scan we cut that we cut through the Fascia, separate the muscles cut. So the organs are online with this peritoneum is what he's got his own thought casing. Your bladder sits on top of your uterus and there's this thing called the physical uterine peritoneum that you cut your, put some letter out of the way you cut inside the uterus, you deliver the humans, you close uterus one layer and then folded back on itself. You can get into the endometriosis implants from the opening of that uterus being out in the abdomen, in the Fascia, in the anterior abdominal wall, and in the incision site. In my residency program, we had a lady who had a complaints of pain every single time her periods showed up. And actually when we imaged her, you found what looked like a small little one meter hole and it was actually much larger when you got inside her and started dissecting out where it could be. Endometrial lining had implanted in her incision and every single time she had a period it would bleed in her anterior wall and that incision site. I had a lady who when she was a child she had, I can't remember what her particular condition was. She had some kind of condition where she ended up having anomalies with her legs. One was rotated backwards, the other was rotated in a strange way and so she ended up having to have one of an amputated and was a compromise. Actually had that, she had booked a mandated bilateral amputees and there was something going on with her belly when she had some kind of surgery or maybe there was a challenge or something that was playing. She presented with complaints of belly button pain at one point in time and on further inquiry when you talked to her, she said that she could milk her belly button around the time of her period, showed up and get a round discharge to come out. And sure enough she had endometrial implants in her belly wall were when she started cycling because she had surgery when she was a child. It was enough to disrupt stuff and literally she blown through her interior wall where there was a defect of a wall with the implants would bleed right inside there. She'd get a little know what’s inside. Another chick who came to office, same kind of thing, complaints of just barely walk. She had an endometrial coma in her anterior wall as well. And so you, you go to the treatment modalities for endometriosis cause she's got endometriosis. And then outside of what it does from a standpoint of being a child and you having all this time to pepper your belly and being able to get it being a normal chick who just had a c section or a disruption in the lining of the uterus. Now you have it causes all kinds of pregnancy complications. We causes miscarriage, increased restricts topic pregnancy. You can get bleeding during pregnancy and hemorrhage afterwards sets you up for Preeclampsia. You can have a Placenta Previa where ideally placement of the placenta is hanging from the top of the readers like a chandelier. It increases your risk for a preview where it covers the opening of your cervic for a c section, such your upper preterm labor and delivery, a c section and low birth weight babies. So it's just all unpleasant. (Oh Wow. Okay).  And the thought is that because you have got these ectopic implants, this endometrial tissue inside your pelvis within triggers an inflammatory response. As women when we get pregnant. So we have relations, the sperm travels up of vagina for the rest of, it's through our uterus, Fallopian to define the egg, fertilizes the egg, and then the Fallopian tube pulls the egg, desperate lives towards itself. And then in the tube you got these hairs, these silly or that kind of push the egg through the tube and into the wall of the uterus. It is a thought process that with people who have endometriosis, that'd be inflammatory. Mediators are chemicals and their pelvis are so high that it's toxic to sperm. And that's part of the compromise with your fertility too, that this from getting sad then go. Dr. Berry: It's just not the place for me. Right? Dr. Anila Ricks-Cord No, I can't work on these conditions. I cannot be. So, no, it's crazy. Dr. Berry: That's and I guess the question is like, especially in your stance, like how, what's the likelihood that you're going to, you know, you see a young who is complaining of a lot of these issues and say, you know what, let me let, let's open you up and see. Right? Like let's do a laparotomy, right? Like is that, does that also ate into it as well that you know maybe the surgeons aren't likely to open them up to check because of like I don't want to put a surgeon. I don't want to put a kid through that. Dr. Anila Ricks-Cord And you think about the fact that if it's a child, some of us are comfortable with adolescents, some of us are not. There is a branch of gynecology that is specific to pediatrics and so you think about asking about whether or not people are even listening to what the complaints are. How many people with a child who complains of having constipation would ever think that has endometriosis and that you just eat too much junk or you need to drink some more water. I think that there's such a vague complaints that unless the child has been complaining about them the entire time and you've done a complete workup and I can't tell you the number of times where we'd endometriosis, it comes down to the gastroenterologist and the Ob-Gyn they've been sent and would it be able to get a colonoscopy in order to be able to be assessed to see what's going on with this presumed abdominal pain that once they ruled them not that is not GI in origin. Then it becomes, well the only other thing you got left down there is your reproductive organs. So it's either your guts or your uterus, which is where the attachments to it. Dr. Berry: I'm scared, scared for you. I don't have any of those issues with it being clearly, clearly this is why the disease process like this needs whole month. Right? Because it average nine years to like that, we got to move this out, right? We got to move this up quickly. That should not be the case. I'm sorry. I'm so sorry for you. Dr. Anila Ricks-Cord I think things are getting better. Again, we used to treat it like it was a zebra and you go through everything before you, and even from the same point of you ask about what's the like of somebody performing surgery. So ideally the founder to do laparoscopic surgery, but you think about people who manage conservatively, they would put you on everything first. Exactly. Birth control down to see what exactly you would. You would go through all the other conservative options before definitively going to surgery and, and the data suggests that even if you do surgery alone and that’s it, there are people who have defended over get relief with surgery, particularly if you have adhesions where you imagine that you've got with a good example of an adhesions? Where you have an abnormal connection of one thing to another. Maybe like imagine a ribbon and not inside your uterus but still if you had a connection between your uterus and your bowel or your uterus was stuck to your anterior abdominal wall because this inflammation causes this scarring and this is music disease that take place. If you want surgery, you just… Dr. Berry: Almost like a fly trap where like it's like it's stuck to that. Dr. Anila Ricks-Cord Yes. That’s a good analogy. Yes. Minus the dead flies. Exactly. Well you have things sticking from one point to another and it causes for the people who have chronic pelvic pain and have that disease, just going to the bathroom causes them problems. If they have issues with constipation and near bowel is stuck to the anterior abdominal wall or stuck to their uterus. A contorted in some way, shape or form. Can you think about how though the bow has got this motion where kind of squeezes fecal matter from one point to another? Just being constipated is enough to cause you wicked pain. And so people who have chronic pelvic pain secondary to disease, secondary to endometriosis, have to do things to alter their lifestyle to make it so the consistency of their stool is more like saucers. So the bowel doesn't get over distended and pissed off and cause pain. Dr. Berry: Wow. So we didn't scared Lunch and Learn community enough. They want to hear now. Like all right, you scared us. We believe you. We notice issue. Please tell me how to treat it or at least prevent it, right? Because I guess that's a two part question, right? Is this a way? Again, little kids is getting even before there, you know, they're menstruating, right? Is there an actual way that you could do anything about this? And if there is like how do I treat it? Like I, I know we've mentioned a little bit about the oral contraceptives, which again, I'm an internist. I don't know none of those things.   Dr. Anila Ricks-Cord Oh that's hilarious. So I'm trying to be really, really good. But all I could hear you say…Nope, and I don't do that. So treatment options and prevention, unfortunately at this point, because we understand its mechanism of action, but we don't really understand what causes it. So because we don't really understand what causes it, we've seen the clusters of people that look like this and clusters of people that look like that, we don't know how to prevent it. And so the thought now is with treatment options, there are a couple. They thought ideally as you want to decrease your inflammation, and initially I didn't mean to scare anyone. Knowledge is power. I wouldn’t scaring anybody at all.  Dr. Berry: Lunch and Learn community knows that you know, we're going to talk about a lot of disease courses. That you know what, if you're not, if it's not taken care of, it can cause a lot of problems. Yes, yes. Yeah. Take care of the problem. If you don't know that the problem is out there. Dr. Anila Ricks-Cord This is true. You're absolutely correct. And so with treatment, so ideally, first line is nonsteroidal anti-inflammatories, Ibuprofen and Naproxen. Back in the day we used to give people for chronic pelvic pain narcotics. And unfortunately we turned them into crack heads. So ideally the goal is to stay away from opioids. You want to do what you can do to increase, decrease, I'm sorry, inflammation. That's first one. Second is you use hormones. So you either have a couple of choices. You can either use birth control for non-birth control reasons. If you're not sexually active and you just have wicked pain or you get a two for trying to decrease your pain and make it said that you don't get any unplanned babies. The thought as you can use birth control pills, you can use injectable, which would be depot, you can use the implant, which is the next one on the ring. Do you either use them continuously when you get on a method and you stay on a method or use it cyclically in order to be able to make them. Dr. Berry: And from a, you know, from a non OB, I'll even talk about the guy on the guy's perspective, right? When y'all take birth control pills, so that it bleed less? So, yeah. Dr. Anila Ricks-Cord So yes. Ok I got you. Thank you for asking. In my case, I can write my name on the floor in blood and curse if mine is definitely about, not having or bleeding less. And so earlier when we talked before about how the brain calls the ovaries and tells the ovaries, we tried to have a baby and the ovaries go about thickening of the lining of the uterus and making it so you ovulate. Your body doesn't care how the hormones are made. You can either make them or take them. Your body just wants them to be present. And so the thought with the use of birth control pills or contraception, depending on which condom use is to thin the lining of the uterus. So you don't have a nice fluffy learning for an egg to implant. And some of them that modalities actually shut your ovaries down so you don't ovulate. In this case, the goal is to be able to thin the lining of the uterus and if you're using it continuously to shut down those ovaries so that that you don't have that tissue, that's another places. It's getting nice and thick and then after it gets nice and thick, it dies and you've got all this inflammation. You're trying to stop that process. Just shut it down. Thank you very much. Where you, you're in these other locations. Yes. Where you're living, where you've traveled abroad with this issue… Dr. Berry: We trying to starve those areas off. (That is exactly right). All right. All right guys, trust me guys. I got, y'all are here. I know. This is a woman's cell phone. Trust me. Dr. Anila Ricks-Cord Yes. From the standpoint of endometriosis, the goal is to starve that estrogen sensitive tissue that sitting out in the periphery. So you can either use hormones in the form of birth control or they're another batch of medicines you can use called GNRH agonist. I'm not going to have moment over this cause this term too much. But old school, there was a medicine called Lupron, which was a shot that you could get. New school, is this the one that you've seen on TV called Orilissa. They're both GRNH agonist and what they do is they cause the equivalent of a medical menopause. They shut you down, allow the implants to starve and die. But they can only be used short term, like the Orilissa. Depending on what your symptoms off, you can only use a six months to 24 months. And the same with Lupron because there's some side effects that go with it because it puts you into a medical menopause. It can actually decrease your bone mineral density and make it like a little old lady. The snap. Exactly. So those are treatments and if you do hormones that thought as if you do hormones, you do insets to so hormones and insets. And the goal was if you use the hormones when the same one of the contraception, the goal is to trick your body into this sort of false pregnancy state. Shut down your ovaries and make the implants die or go into a coma and decrease that inflammation. The next option would be surgery. Like we talked about laparoscopic. Laparoscopic surgery where you fill the belly up with carbon dioxide, drop the camera on the inside, put in some graspers in order to move things around. See if you can find some tissue to biopsy to confirm the diagnosis. If there adhesions, you disconnect those adhesions. And then if there are lesions that you can see, you do what's called ablation, you literally go and you burn these adhesions on the inside of the belly. Now, the lovely thing about surgery, but the bad thing about surgery is that anytime you have surgery, God makes all of our organs have their own organ case to them. Even your belly, it's got aligning cause like the inside of your mouth, anytime you pop inside somebody's belly, you risk the possibility of causing them adhesions as a consequence of the surgery. And if the surgery alone… Dr. Berry: With a c section? Dr. Anila Ricks-Cord Yes. Well, the endometriosis actually tracks. So all of these layers that you put together, it actually tracks into all of these. So imagine anywhere your nice touch, your skin fat Fascia, peritoneum, the endometrial cells can be in any of that line. From the inside of the uterus all the way out from the incision site in the uterus to the peritoneum, to the Fascia and the muscle wall in the back, all the way through in the skin itself, all the way through. And the lady I was talking about in residency, she had a tiny little lesion in her skin. But when you went to go dissect this thing out, it was huge. And it was in her Fascia. So it was like a mountain top. You just saw the top of the mountain. And when he got up on the news, right, you saw the rest of this mountain down inside, they were like icebergs. Now that…so. Dr. Berry: I'm not gonna lie, I might not wish endometriosis as my enemy. That's what I'm hearing. Dr. Anila Ricks-Cord It’s not a pretty thing to have at all. And the problem with surgery is that if you just do surgery here within a year, you've got symptoms that returned. Yeah, definitive treatment for endometriosis once you have done having your baby. So ideally for ladies who are reproductive age, the goal is to shut you down so you're ready to get pregnant, you get pregnant, then we shut it back down again. And then when you're done, depending on the severity of your disease process, some people respond well to hormones, some people don't. And definitive treatment for endometriosis is removing your uterus, tubes and ovaries being without hormone for a period of time to allow the implants to die off. And then restarting the hormones afterwards because you really need to be on hormones. Still menopause up in this country and average age is 52 otherwise you look like a man about to blood vessels and you snap crackle, pop in, all kinds of stuff. So outside of that, there's a thought process that there are some alternative medicine options that may or may not work. Now traditional data says it doesn't work. But you have to bear in mind that we are unique individuals. We have bio individuality. And so what works for one person may not work for somebody else but may work for the person that's using it. So this on is that acupuncture, herbal remedies and homeopathic May. I worked for some people outside of that. From the standpoint of you asked if there's anything you can do to prevent it. No. The thought process is to try and make yourself as healthy as you can be and to have coping mechanisms for the pain. So exercise. Dr. Berry: Health wise, you're talking about food or? Dr. Anila Ricks-Cord Right. We talking about food. We talking about balanced diet with very little processed food in it. We thought, I'm like getting enough sleep because you feel yourself when you sleep at night. We're talking about exercise and what it be able to decrease inflammation and meditation in order to be able to help cope with the pain. There's also in the DDA goes a suggestion to they're people who have endometriosis are deficient in vitamin D and so when we talk about how this tissue response and how we can say, Oh, you have to say the curb, but I'm going to go outside the boundaries and do other stuff. And these people who have endometriosis and are found to have vitamin D deficiencies. Folks believe this supplementation of vitamin D you might make a difference in any woman who is of reproductive age needs 800 international units of vitamin D a Day. Anyway, some of US Brown people don't spend a whole lot of time in the sun and don't generate the vitamin D and I'll give you an example. A lot of people who drink milk, they get milk and eat cheese. Drink milk and eat cheese. They get all the calcium and vitamins they need, I don't drink milk because I'm lactose intolerant. The last time I had my labs on, I'll tell you my vitamin D level with 17.  I'm the surprised Dr. Berry laughing at me. Normal is considered to be normal to be 30 and in Vagina land as the OB Gyn. We lasted to be around 6. And so vitamin comes supplement outside of of finding that people who have endometriosis are deficient in vitamin D. There's also a thought process that vitamin D and depression have a role with deficiencies in vitamin D and colon cancer. There are deficiencies in vitamin D, so just bone up on your vitamin D. Dr. Berry: Get your Vitamin D. Right. Like I say that again. I kind of scoffed at first. I was like, what is this little thing had his own month? This ain't heart disease. This ain't, you know, verbally like, okay, all right. Dr. Anila Ricks-Cord It affects quality of life. Talked about seriousness of disease. The reality is the endometriosis isn't going to kill anybody at all. There's a thought process that when I talked earlier about the ovarian masses that you can get the Endometriomas. The endometrial tissue that invades into the ovary and obviously takes residents can actually give you so with ladies who held a Sidebar, I'm making a correlation. I apologize, I coming back. For the Ovarian Syndrome who don't have regular menstrual cycles are at increased risk range and mutual cancer because at lining become can become atypical and find it. That same kind of thing can happen in the ovary where the endometrial tissue that is implanted in the ovary this now cause this chocolate fiscal of blood, which is the endometriomas. He can take on abnormal qualities just like the lining of the uterus when it is a typical he ladies are at PCOS.  They haven't found words actually become for lung cancer, but it has the capability to change cause it's inter-mutual tissue crazy stuff. Right. The bad thing about endometriosis is, like I said, if you, if you have it, it's everything. Unfortunately it can cause infertility. It can dictate whether or not you can move your house and function without pain. The patients that I have had that have had chronic pelvic pain secondary to endometriosis sometimes have to be selective about the kind of jobs that they take. Because if you have a pain syndrome that's present, say 21 days out of the month where you might have eight had a 10 pound most days. But maybe you get a break in on some other days, you've got five out of 10 pain interferes with your ability to be able to live. If you can’t get up to bed and get functioning because your belly is his feels like his demonically possessed and it's telling you all kinds of things from a pain standpoint and you can't function.  Pain was, and how can you hold a decent job? There are people who, because they have issues with endometriosis and the pelvic pain is exacerbated when they have relations. If you are single and not all of you in an intimate relationship, you have a difficulty with engaging in relationships and if you're married, it can interfere with your ability to be able to have an intimate relationship with your spouse. And then that over time leads to depression because is a chronic pain syndrome. Intimacy is a huge part of having relations or we're having a relationship and imagine not being able to be intimately associated with the person that you've vowed to spend the rest of your life with because it hurts so bad you can't stand it, but it's like having a nails in the back of your personal space and so you'd much rather that than have an intimate relationship. Dr. Berry: Wow. Okay. All right. You and Endometriosis. Before we let you go. Right. I got a couple more questions are, you know, but more on a, on a lighter note, right. Because endometriosis is scary. Again, I might have to tell my residents like hey, that patient who comes in for this vague abdominal pain. We might've needed to move it up a couple notches on the differential. Now can you talk about how what you do can help women take just take better control? Not necessarily just for this show, but it's just in general. Right? And this is a question I like to ask. I just want to, and I want to kind of get my guesses thoughts on like what do they do to help people empower, especially in your world, women empower themselves for better health.  Dr. Anila Ricks-Cord Sure. So what I like to do with all of my encounters be an individually as a patient, either in the hospital or in coaching or when I was in private practice in private practice is I encouraged them to be their own healthcare advocate. When you're looking for a physician, the purpose is to find somebody that you can partner with, with the ultimate goal of optimizing your health. Medicine is no different than customer service. It actually is like customer services for women. For those of us who like to drop some coins every now and then in places like say Nordstrom. Nordstrom is pricey as all get out, but the one thing that you can bank on with Nordstrom is they have customer service on luck. You know, they're rumored to have taken back a tire from somebody who said that they bought it there even though they don't feel tight. Medicine is no different than that. If you don't have a relationship with someone who listens to you and is genuinely vested in you being successful, you being healthy and your money someplace else, this also puts the onus of your health care on you. So I think when I think about my patients and they come and they talk to me, they say that nobody has listened to them and I think that's crucial. I think that you have to bear in mind that however old you are, you have had that body and know how that body works for however many years God has allowed you to live on the face of the earth.  Dr. Berry: No one gonna knows better than you. Dr. Anila Ricks-Cord Right. You are your own healthcare advocate. You got this on lock. If you go see somebody and you were trying to talk to them about what you're experiencing and then listen to what it is you say, go ahead and pick up and walk right on out the door and take you off your money and your insurance card with you. Because you wouldn't take bad customer service at a restaurant. You wouldn't take bad customer service in a product that you purchased. (Nope). So why would you take it with your health care, which is more important and lasting than product you going to buy, meal that you eat and pass on through it. Dr. Berry: Please tell Lunch and Learn how can they find you? Right? Because I know some people are probably energized right now. You know, and I kind of alluded to your Facebook, like give them all the ditails because I need people to be able to kind of track you. Dr. Anila Ricks-Cord Sure. On the sly, I'm a firm believer that food is medicine that tells the body what to do. And so I have invested in becoming a health coach. So in addition to being an Ob-Gyn, I'm a health coach. And with that said, I love answering questions that Dr. Berry's alluded to. So on Wednesday evening, 7:00 PM CST cause I'm in Texas, I do Facebook live on women's health topics and you can find me across all social media At D R A N I L A O B Gyn, that’s Doctor Anila OB Gyn. You can also find more information on my website, which is also www.drnilaobgyn.com. That's D R A N I L A O B G Y N.com. And if you tune into any of my lodge will find that I love answering questions. I think that as I alluded to earlier, my mom died because there was nobody there to advocate for her. And at 22 years old I didn't know the questions to ask. My goal as a health provider is to make it so that you know what I know. So your arm to take better care of yourself. Dr. Berry: I love it. Absolutely love it. And of course Lunch and Learn community, like always, if you're running out, you're in the car, you're driving, wherever you doing, you don't have to worry. All the, all of her information will be in the show notes. So you we will make sure and, and you really just got to watch one of her Facebook lives because she gets very animated, right? Like she really make like, okay, yeah, this one was health really is, that's why I say that, you know, you're going to be on my show because I need someone animated to educate me. A women's health to really educate y'all. So again, she is always, which she seems to be when you listen to her and you could just tell the love that's there. I like that and have everything right. You could just tell the love that is there to educate, to help you. Right? Get to where you need to be. And that's what I love about her. Right. She's absolutely amazing. Again, we're going to make sure she will be a repeat regular on this show, especially again at ya'll. Y'all ask me a lot about women's health stuff and I'd be like, I'd be like, hey they, and this, I know what I know and I know that I don't know. Once I realized I know what I don't know. That's when I get the console. Dr. Anila Ricks-Cord It has been my privilege and it would most assuredly be my pleasure for wherever it is you'd like for me to talk about from vagina land cause I have it on low. Dr. Berry: All right. Again, I appreciate everything that you do for your community. Appreciate everything you do for just the world and allowing you to take your amazing talents outside of the clinic and outside of the one on one and being able to talk to the master. So again, thank you Dr. Anila for coming on the show this week. Dr. Anila Ricks-Cord Thank you so very much Dr. Berry. I appreciate it.

I am so excited to be chatting with my soul sister Kate Eskuri today! This episode we’re talking all about PERIODS. Ladies, you’re going to learn so much more than you ever did in health class. Kate is a registered nurse, holistic health junkie, and the voice behind The Foundation Blog. She is currently getting her doctorate degree in integrative health and healing and is passionate about helping women maximize their health by simple and foundational health practices. Our hope is that this conversation will empower you to do research and make informed decisions for that time of the month. Finding The Balance Kate took a year off from being a nurse in the Mayo Clinic to work on her sister Jenna Kutcher's Goal Digger Podcast. During this time, she realized her passion for integrative health. “What are you doing when you’re putting off something else?” She knows that areas of Western medicine need improvement, but also recognizes that this medicine is the reason we are alive today after seeing it in action in the ICU. However, chronic conditions that plague our country prove a need for a shift toward the holistic. We need to look at sleep, stress, and diet. “I feel very at home in this spot in the middle.” Becoming A Woman “Everything in my life was very natural but yet I was still controlling this really natural and beautiful cycle.” Kate never felt any shame around her period. “I just felt honored and excited about it.” Her periods were regular but were more frequent than they should have been. “It takes a while to normalize your cycle.” Wanting to prevent this near constant bleeding, she tried the NuvaRing but ultimately settled on the Mirena IUD which allowed her to continue ovulating. Cons of Hormonal Contraceptive “I completely trust my fellow woman to make the choice that is best for her. There is an option that is right for everybody.” The hormones in contraceptives are not the exact hormones your body would make.  Hormonal contraception often suppress ovulation and ultimately suppress hormones that are natural and have important benefits. “You’re inhibiting a very natural process that goes a lot deeper than just your period.” The Phases Of Your Cycle Ladies + Gents--the below is just an overview...you gotta listen to the whole episode to get the goods of each phase of your cycle! 1. Menstruation/Winter Day 1: shedding the uterine lining. You’re maybe feeling moody or withdrawn, experiencing cramps, and a need to slow down. It’s like the ‘winter’ season of the cycle. Follicular/Spring Day 3 or 4: Follicle stimulating hormone is working on the dominant egg. More energy in this phase, almost like stepping back into your skin. This time is good for creative projects and you’ll experience clear thinking. “You feel energetic and attractive... it’s just a really vibrant time.” Ovulation/Summer Body releases egg as the pituitary gland signals for it to release. “You can’t kind of ovulate—you either ovulate or you don’t.” High energy, high sex drive, you feel attractive. Your hormones even make you more attractive to those around you. There is a study that shows a correlation between a woman’s scent during ovulation and a man’s attraction to her. Luteal/Fall Progesterone—can make you moody and somber, but it’s really important. “It is the yin to estrogen’s yang.” Progesterone is calming, helps sleep, reduces inflammation, + builds muscles. “The shift from being so estrogen dominant at parts of your cycle to progesterone dominant causes an influx of emotion—what we see as PMS.” Getting To Know Your Period “Your period health says a lot about your overall health.” Track Your Cycle! Kate journals every morning and will write about how she is feeling on the previous day of her cycle. A few key words is all you need—nothing flashy! Kate uses the Ava app and Kat uses the My Flo app.  “Your period story does not have to be suffering every month.” Books To Read: The Period Repair Manual by Laura Briden (textbook info in novel format) Hormonal by Martie Haselton (quick + easy relatable read)  Thoughts On Period Products Thoughts on tampons? “Invest in organic—it does matter.” Regular tampons are covered in toxins. Thoughts on menstrual cups? Tampons are single use and create waste so this is a great alternative. Kate uses OrganiCup and LOVES it. “I can’t believe I lived for so long without using it.” It’s easy to clean—simply boil between cycles. It may not be for everybody—some women say they experience more cramps using a cup. Thoughts on Thinx? Kate hasn’t tried them, but Kat has some friends that swear by them and only use them during their periods.  “Whatever makes you feel most at home and comfortable with your period… I say go for it.” You can keep up with Kate on Instagram at @kate.eskuri or at her website thefoundationblog.com. She shares everything from safe ways to grow out your eyelashes to yummy recipes. She has a post specifically about acupressure for periods too! “It all comes back to the base of introducing small integrative habits into your day to live your most balanced and vibrant life.” You can sign up for her email list to get secret special content that nobody else sees! If you join now you can see her evening rituals for better sleep and her all-natural grocery shopping guide.  If you like the podcast, I want to invite you to subscribe to the podcast and leave a rating and review. It helps us to get the episode out to more people and means the world to us! We’d love to hear your reactions to this specific episode and what topics you want to hear more of! Hey, single ladies— are you frustrated by the dating world? This episode is brought to you by my free guide called “6 Tips to Activate Your Dating Life with Intention and Clarity.” These resources helped propel me from sitting on the couch to out on a date. Head over to Bit.ly/trwdating to check it out! With you on the journey. XO, Kat 

EP12: Soulfull Living w/ Raina Dyanne In this episode, I interview the beautiful Raina all about how she has created a soulful life while healing from endometriosis. She shares valuable AF information on endometriosis that I haven’t been hearing many people talk about, you definitely want to listen if you have or have had the Mirena IUD!!! She’s grounded, inspiring, beautiful, & lives life from her soul, y’all don’t miss this beautiful conversation! We talk all things: ⚡️Endometriosis ⚡️Mirena IUD, birth control, hormones ⚡️Natural Healing ⚡️Doing what you can ⚡️Eating/Living for your soul ⚡️Listening to your body ⚡️Blogging, cooking, & creating from the soul ⚡️And SO MUCH MORE!! Links from the show: Find Raina in all the places

Today on the podcast I'm taking you through the good, the bad and the ugly crying that has happened in the last month since getting my IUD out. Things haven't been as picture-perfect as I was expecting, but there have been some amazing things that my body has already healed in the past 4 weeks! Listen in below! Blog:www.justjessieblog.com  Facebook Group: www.facebook.com/groups/chronicallyhealing/

Hello friends! Today's episode is a little background into my journey with hormonal birth control over the last 15 years and why I decided it was time to stop. I chat about all things Mirena IUD, the book Beyond the Pill by Dr. Jolene Brighten and some of the symptoms I'm hoping to relieve by getting off birth control!   Blog: www.justjessieblog.com Instagram: www.instagram.com/jessiedeschane Beautycounter: www.beautycounter.com/jessiedeschane Dr. Jolene Brighten: https://drbrighten.com "Beyond the Pill": https://shopstyle.it/l/ZeHh

You may or may not have noticed that last week it was a little quiet on the How to Be Selfish front -- this was due to a series of migraines that I was experiencing from the Mirena Crash. In today's episode, I want to talk through my experience with the Mirena IUD. The good, the bad and the downright ugly.  If you or anyone you know has, or is thinking about getting, the Mirena, please pass this episode along to them. The more knowledge you have, the more empowered decision you can make for yourself.  *Note: I am not a doctor. This episode outlines my personal experience with the Mirena. This episode is intended for awareness -- I am not suggesting you do or do not do anything with your body. 

Vince Pitstick has been in the health and wellness field for over 15 years. Beginning in personal training, competition dieting, and nutrition programs in Chicago. He began a functional medicine journey ten years ago working under various Functional Medicine physicians learning how to take nutrition and lifestyle change and use it as a treatment for disease. Working as a Functional Medicine Consultant for Metagenics INC., he helps hundreds of Physicians in Ohio, Kentucky, and Indiana bring natural based programs to their office with the latest in natural technology and coaching to help their patients. In an endeavor to create a place where client centered care was the priority of the care center heopened Nutrition Dynamic in 2012. Vince and his team of coaches now cover everything from top of the line sports performance programing to disease management programs across the U.S. Ange has been working with Vince over the past few months to help balance her hormones & improve digestion.  Today's episode is from one of their recent coaching calls where we talk about how Ange has been feeling after removing the Mirena IUD. We also discuss improving insulin sensitivity. Connect with Vince https://www.nutritiondynamic.com/

  Vince Pitstick has been in the health and wellness field for over 15 years.  Beginning in personal training, competition dieting, and nutrition programs in Chicago.  He began a functional medicine journey ten years ago working under various Functional Medicine physicians learning how to take nutrition and lifestyle change and use it as a treatment for disease.  Working as a Functional Medicine Consultant for Metagenics INC., he help hundreds of Physicians in Ohio, Kentucky, and Indiana bring natural based programs to their office with the latest in natural technology and coaching to help their patients. In an endeavor to create a place where client centered care was the priority of the care center he opened Nutrition Dynamic in 2012.  Vince and his team of coaches now cover everything from top of the line sports performance programing to disease management programs across the U.S. In today's episode:- What is a Ovarian Adrenal Thyroid Axis Imbalance? - The relationship between stress, thyroid and hormones- Signs and symptoms of a hormone imbalance- The do's + dont's of optimizing the OAT axis- Which herbs and supplements can help support the OAT axis- How the MIRENA IUD can really fuck up your hormones- How contest prep affects your ability to have children- The negative side effects of contest prep on your hormones- Which bloodwork and tests should you have done to find out what's going on with your hormones Vince Pitstick; Nutritional Therapist, HC, FLT, CPTOwner/Founder Nutrition DynamicCOO Nuethix FormulationsYou can connect with Vince on INSTAGRAM - @NUTRITION_DYNAMIC or @AESTHETIC_DYNAMIChttps://www.nutritiondynamic.com/------All about Nutrition Dynamic: Nutrition Dynamic is a multi-location; full service health and wellness company.  They specialize in online nutrition programs and Functional Medicine health coaching.  The Dynamic process is designed to work alongside of you to reach your goals whether its weight loss or fighting disease. Specializing in weight loss, auto immune conditions, diabetes, genetic disorders, IBS or digestive issues, fatigue and sleep issues, and much more. One of their elite coaches will meet with you in person or online and get to know you.  Build out a program with diet, workouts, supplement schedule, and lifestyle change. You will have biweekly live sessions with your coach with weekly online check-ins.  The accountability and individualization of the program is second to none.  Locations: Cincinnati; 441 vine st. 100LL, Cincinnati Oh 45202Dayton Location; Machine Shop:  547 Miamisburg Centerville rd. Centerville Oh

In today’s Pill Reality Series episode, Allie shares her experience using the Mirena IUD. Today's episode is sponsored by Steamy Chick. Learn the ancient practice of vaginal steaming to improve menstrual cycle health and fertility. Become a Vaginal Steam Facilitator for only $194 online. Today's episode is also sponsored by my 10 Week Fertility Awareness Mastery Group Program. The next session begins in July 2018! You are invited to join us in the Fertility Awareness Mastery program! You'll have an opportunity to master Fertility Awareness, take a deep dive into your cycles, gain confidence charting your cycles, and gain deep insights into the connection between your health, your fertility, and your cycles. Click here to apply now! Topics discussed in today's episode: What side effects did Allie experience while using the Mirena IUD Anxiety, sleep disturbances, and other neurological symptoms How long it took for Allie's symptoms to go away after having her IUD removed Why Allie's doctor did not consider that the IUD could be causing her symptoms Transitioning from using IUDs to using fertility awareness for birth control How does the IUD prevent pregnancy? Connect with Lisa: You can connect with Lisa on her Website, on Facebook, and on Twitter. Resources mentioned: Fertility Awareness 101 FREE Video Series Fertility Friday Programs Fertility Friday Facebook Group Related podcasts & blog posts: Pill Reality Series Episodes | Fertility Friday Fertility Awareness Episodes | Fertility Friday FFP 161 | Are IUDs Safer Than The Pill? | Hormonal IUDs vs Copper IUDs | Dr. Steve Gangemi FFP 021 | What Hormonal Contraceptives Really do to Women | Sweetening the Pill | Holly Grigg-Spall FFP 202 | Vaginal Steaming for Period Problems | Steamy Chick | Keli Garza FFP 073 | Copper Toxicity, IUDs and the Birth Control Pill | Julie Casper Join the community! Find us in the Fertility Friday Facebook Group Subscribe to the Fertility Friday Podcast in Apple Podcasts! Music Credit: Intro/Outro music Produced by J-Gantic A Special Thank You to Our Show Sponsors: Steamy Chick | Vaginal Steam Facilitator Certification This episode is sponsored by Steamy Chick. Learn the ancient practice of vaginal steaming to improve menstrual cycle health and fertility. Become a Vaginal Steam Facilitator for only $194 online and begin offering this service that is quickly growing in demand as women revive this advanced form of women's health. Head over to steamychick.com and click certification for more information. Fertility Friday | 10 Week Fertility Awareness Mastery Group Program This episode is sponsored by my 10 Week Fertility Awareness Mastery Group Program! Master Fertility Awareness and take a deep dive into your cycles and how they relate to your overall health! Click here to apply now!

In this episode, we are discussing the #metoo movement from the perspective of healing. With us is Gail Foss, RN and Licensed Alcohol and Drug Abuse Counselor, we talk about how she helps women and men heal after experiencing sexual violence. In the interview, Gail opens up about her own experience and tells us a little bit about what needs to be done to change our culture so this doesn't continue to happen. In the "Ask Mabel" segment we learn about the Mirena IUD.

If you are interested in the low-carb, moderate protein, high-fat, ketogenic diet, then this is the podcast for you. We zero in exclusively on all the questions people have about how being in a state of nutritional ketosis and the effects it has on your health. There are a lot of myths about keto floating around out there and our two amazing co-hosts are shooting them down one at a time. Keto Talk is co-hosted by 10-year veteran health podcaster and international bestselling author Jimmy Moore from “Livin’ La Vida Low-Carb” and Pittsburgh, PA functional medicine practitioner Dr. Will Cole from DrWillCole.com who thoroughly share from their wealth of experience on the ketogenic lifestyle each and every Thursday. We love hearing from our fabulous Ketonian listeners with new questions–send an email to Jimmy at livinlowcarbman@charter.net. And if you’re not already subscribed to the podcast on iTunes and listened to the past episodes, then you can do that and leave a review HERE. Listen in today as Jimmy and Dr. Will Cole answer all your keto questions in Episode 99.   BECOME A NUTRITIONAL THERAPY PRACTITIONER   Sign up by February 2018 for the 9-month program NOTICE OF DISCLOSURE: Paid sponsorship       HERE’S WHAT JIMMY AND WILL TALKED ABOUT IN EPISODE 99:   – Be ketotic . . . but only sometime   – The Keto Diet is Having a Moment, but Its Legitimacy is Up for Debate   – The keto diet: Pros and cons   – What Are Ketone Strips—And Can They Help You Lose Weight?   – American meat consumption set to break records in 2018   GET A $39 BOTTLE OF OLIVE OIL FOR JUST A BUCK       GET YOUR $39 BOTTLE FOR JUST $1 NOTICE OF DISCLOSURE: Paid sponsorship   – Why am I waking up in the middle of the night and struggling to get back to sleep? What can I do?   Hi Keto Talk,   I understand sleep is an important component of ketosis and overall health, but it’s a big problem for me. For the past three years I wake up between 3:15-3:30AM and struggle to get back to sleep. A few months ago my doctor prescribed Silenor. It seemed to help in the beginning but it is helping much less now. I believe this medication might be interfering with my pursuit of ketosis and fat loss. I know I have high cortisol levels, but my doctor is unconcerned since I don’t display any of the typical symptoms. I’ve tried melatonin and valerian, but they both give me horrendous nightmares. Most sleep herbs are designed for falling asleep, but that’s not my issue. Do you have any suggestions for me?   Thanks,   Laura   – STUDY: Study Links Low-Carb Diets to Brain and Spinal Cord Problems in Babies         NOTICE OF DISCLOSURE: Paid sponsorship   1. How do I deal with this low progesterone to optimize and complement my ketogenic nutrition?   Dear Jimmy and Dr. Cole,   I have learned so much from both of you on my health journey! I have lost 50 pounds since last May using keto and intermittent fasting, implementing much of your advice, and I am now very close to my weight goal. I hit the occasional plateau along the way and at those times I noticed I would need to shift my focus from losing weight to understanding the big picture of my overall health. In that regard, my Mirena IUD (which releases synthetic progesterone teaching my body to make less of its own progesterone) began to seem relevant. I had it implanted in November 2012 and replaced in November 2017. When I had it replaced, I was weighing daily so it was easy to notice a six pound weight jump overnight for no apparent reason.This happened three days after I got the new device and it led me to do some research.   I concluded that I really need to get that thing removed which I did in mid-December 2017 over the pushback from my doctor. I got my period back almost immediately and it lasted about a week, but since then (40 days) I have not had my period again. More disturbingly, I am now experiencing other symptoms like itchy skin, shakiness, dizziness, fatigue, brain fog, mood swings, and weakness. I considered electrolyte balance and treated for that with extra salt and magnesium (which always works for me during fasting)—but no effect. I tested my blood sugar when feeling extra shaky and weak—it really felt like hypoglycemia—and it was 83 preprandial (my A1C in November was 4.7).   Based on my research, my symptoms suggest low progesterone; if that is the case, how should I proceed? Should I tough it out and wait for my body to ramp its own progesterone production back up? Should I take bioidentical progesterone, or would that throw off my overall hormone balance? Should I look instead to adaptogens like Maca? Is there anything I can focus on nutritionally to encourage a return to optimal hormone balance? I had been feeling so amazing up until recently so these symptoms are hard to miss and are definitely discouraging.   Thank you for the wonderful podcast, I look forward to it every week!   Kind regards,   Stacey   2. Is eating high-protein long-term like eating high-carb? Are very low triglycerides a health problem?   Hi guys,   Can five plus years of eating high protein be just as damaging to someone’s metabolism and insulin levels as eating five years worth of carbage? It seems like right now I am just maintaining weight and body fat levels after the initial water weight loss. I have been in nutritional ketosis for the past five weeks with blood ketone levels ranging from .6-1.3 in the morning. My fasting morning blood glucose readings are 85-102. Also, does having super low triglycerides (below 45) show a sign of any health issues? My triglycerides have been that low for years, way before keto.   Thank you so much guys. I have literally been listening to your shows on repeat ever since I discovered them a few weeks ago! You have so much information and explain things in a very fact of the matter way which I really appreciate!   Thank you!   Laura   YOUR NEW KETO DIET ALLY   NOTICE OF DISCLOSURE: Paid sponsorship   “.” – Jimmy Moore   3. Is it typical for keto to produce out of whack energy metabolism markers on an organic acid test?   Hi Jimmy and Will,   I recently did an organic acid test to see the effects keto was having and my energy metabolism markers were completely out of whack. In fact, the people who ran the test took extra long because they repeated it a few times just to be sure there wasn’t a lab error. I’m pretty freaked out by the results and don’t know if there is something problematic going on or if this might be typical of someone on keto.   Much appreciated!   Robin   MAKE KETO EASIER WITH FBOMB       NOTICE OF DISCLOSURE: Paid sponsorship   KETO TALK MAILBOX   – What is the major difference between burning fat and burning ketones for fuel?   Dear Jimmy and Dr. Cole,   People sometimes talk about burning fat and burning ketones in the same breath as though they were more or less the same thing, but don't think that's quite the case, is it? Let me describe what I think is roughly going on and then please correct me where I am wrong: Assuming blood insulin levels are low enough, fat can be released from the adipose cells. It was in the adipose cells in the form of triglycerides and after release, it is converted into free fatty acids and then the glycerol part is converted into glucose. The free fatty acids go via the blood and can be used in the muscles directly as fuel, for example. Some of the free fatty acids make it to the liver and can be converted to ketones, some of which are used to fuel the brain, and probably can also fuel the muscles and other parts of the body. Now, in some descriptions, I see ketones being described as byproducts of fat metabolism which I assume means that first the fatty acids are burned for fuel and then ketones result as a byproduct of this metabolism. Is that correct, and if so, can those ketones also be used as fuel? If so, it implies that fat is indeed a super fuel because it can be used twice so to speak. So then what is the biochemical result of burning ketones? Keep in mind that I am seeking, if possible, a reply that is understandable to a layperson like myself but also one which does not oversimplify the science if that’s humanly possible.   Many thanks in advance,   Mike   THE PERFECT KETO SUPPLEMENT USE COUPON CODE LLVLC FOR 15% OFF NOTICE OF DISCLOSURE: Paid sponsorship   LINKS MENTIONED IN EPISODE 99   – SUPPORT OUR SPONSOR: Staying in ketosis just got easier – Your new keto-diet ally (Enter MOORE15 at checkout for fifteen percent off your first order.) – SUPPORT OUR SPONSOR: Drop an FBOMB for the freshest, high-quality fats from JimmyLovesFBomb.com (Get 10% off your first food order with coupon code “JIMMYLOVESFBOMB”) – SUPPORT OUR SPONSOR: Jump start your ketogenic diet with PerfectKeto.com/Jimmy (USE PROMO CODE LLVLC FOR 15% OFF) – SUPPORT OUR SPONSOR: Become A Nutritional Therapy Practitioner – SUPPORT OUR SPONSOR: The perfect keto-friendly snack with 85% FAT (Use coupon code JIMMY to get 15% off your order of Gra-POW!)   – Be ketotic . . . but only sometime   – The Keto Diet is Having a Moment, but Its Legitimacy is Up for Debate   – The keto diet: Pros and cons   – What Are Ketone Strips—And Can They Help You Lose Weight?   – American meat consumption set to break records in 2018   – STUDY: Study Links Low-Carb Diets to Brain and Spinal Cord Problems in Babies – Jimmy Moore from “Livin’ La Vida Low-Carb” – DR. Will Cole D.C. from DrWillCole.com

Chattin’ about the Change! It has been a challenge to learn how to podcast and new ways to Google things! Julia’s been finishing up the movie project she’s been working on and remarks upon the young people she’s working with and the things they DON’T UNDERSTAND because of the age difference. We talk about the radio we used to listen to back in the 70s on Maui. We talk about the rate of change in the past 20 years. Like when Sarah’s kids were born (1999 and 2003) she still took photos on film and had to have them printed to share. It was so different from having the luxury of digital photography and being able to take dozens of shots to get a good one and then just delete the bad ones. Sarah resigned from her volunteer position this week, and while some people are disappointed in her, she ceases to have any fucks to give anymore. We talk about seeing the movie Fried Green Tomatoes, since Kathy Bates’ character has the classic line: “I’m older and I have more insurance!” It’s Fall in LA, but that doesn’t mean it will be cold. And hey - are you the Pumpkin Spice type or not?? Bible Study: Chapter 9 - Sex in Menopause: Myths and Reality (the Sex Chapter!) from Dr. Christiane Northrup’s book The Wisdom of Menopause. While we would not say we are prudes, we are also not really exhibitionists, either, so we have been a bit reticent to talk about our sex lives. It does seem that people in their 60s, 70s etc. can be sexually active, which is good to know. Since we are both married, we discuss how there can be routines and unspoken rules in a marriage, but during menopause, as women are changing or evolving - as we know that we are - that has to affect the relationship, even if our partners haven’t changed. And then add in kids to a marriage and it has to alter your sex life. Julia says Menopause + Kids at home = Sex Life Challenging. Sarah brings up all the things you can do or try - but it really comes down to what you want to do and how badly you want to do it. Julia brings up balance - that if things in your life are out of balance, then your relationship will be affected for sure. Dr. Northrup says in the chapter that sexual energy is also like Lust for Life, which we love the sound of. We were fans of Dr. Phil back in the day, and the opening for his show included a clip of him telling someone “I want you to get excited about your life,” which Sarah still thinks about and wants that for her kids - and for herself, her husband, friends. Everyone should have that! Julia has been married for 16 years and she’s noticed that they had a “routine” for sex when they were dating and then married, before kids, and then when they had their daughter, of course it meant change, but okay - you adjust and adapt - but the times you can have sex are limited because of the kids - and then life happens and work hours are long and things get very complicated - so routines have to adapt again. And dealing with the day to day life is not only tiring but less sexy, so it becomes more of a job to make sex happen. We recall Dr. Phil talking about how sex and foreplay work in a marriage with kids - that’s it’s very different and you have to learn to deal with it. And there was a sex therapist who was on Oprah who contended that women and men get to intimacy levels differently: women want the cuddling and preparation and the build-up, while men need the physical act first in order to get to that place of being able to give us what we want. At the time, Sarah felt like this was a load of horse shit, but gave it a try. She had sex with her husband one night and the next morning he woke up and did a household task for her that made her day a little easier, especially with little kids at home - something that meant a lot to her and that she felt he did as a gesture to her after they had made love - because he felt closer to her at that point. Sarah was astonished and happy to know she was wrong. Sarah also shared a story about how to get over a dry patch with your spouse: have sex every night for a week in order to get to know each other’s bodies again. But of course sex after you and your partner have kids is totally different. Not like when you first met a sexual partner and you had all day to lounge around and have sex. Sarah tells the story of how the Mirena IUD was marketed to Moms as a way to have sex safely and at a moment’s notice - because as a Mom, that’s all the time you’re going to have. Julia talks about the IUD she had, called the Paraguard T380-A, which we decided sounded like a weapon - and we guess it kind of is. The chapter has a list of ways to rebuild intimacy and get to know your partner again: 10 Steps to Rekindling Libido - and Julia quoted one of them: “ #3 Intimacy - Take time to make the personal connection. There is nothing more conducive to a good sex life than the ability to share one’s thoughts and feelings with one’s partner on a regular basis. ** One of the really nice things about midlife is that we often have more time to spend with our partners than ever before.”** Julia was struck by how little that applies to her life right now because she has a 5 year old. And obviously not for everyone. Sarah loved the story in the chapter about the woman who had been diagnosed with a disease, but who had also just met someone - and the affair helped change her outlook on life and helped her heal. Sarah tells about when Dr. Northrup was on Oprah years ago and talked about how midlife women may find sex unappealing with their partners and may look to have an affair. She said that women reported improved sex lives with new partners but that she felt WE should become that new partner, not go out and have an affair. That we should do our evolving and bring that newness to our current relationship. It’s a challenge, though. Julia has been working on her big life plans - and asking the big questions - like where we will we live, what do we want to do with our lives - and for the first time wondered “Do I want to die in this house?” She feels like she hasn’t been in this place before and that so many of these kind of things are coming up for her. And for many of us in midlife. Ties into so many issues around aging and where do we want to end up? Time to do research! Issues come up with Julia’s Mom, who’s 75 and in great shape, but at some point they may need to live nearby each other and what would that look like? And wondering how did we get here - and what can I still make happen in my life at this stage? Sarah feels like a couple of years ago she may have been feeling trapped by her life and didn’t have a great lust for life or great feeling of what might be coming in her future, but feels in a much better place now. The college application year was very stressful for her family and maybe now that it’s done it’s been a release, plus since her son is in college, she can see her empty nest coming - maybe that has been a catalyst for change? Not sure… Julia talks about the toddler years and how daunting they can be. She is not really a sit-on-the-floor-and-play-for-an-hour kind of a mom. She’s more of a Let’s-go-do-something-mom. Sarah loves toddlers, but of course, from afar. But it all relates to sex because of course that’s how we get the kids in the first place. The chapter talks about Viagra (for men) and the issues relating to being connected to your heart and maybe not needing it so much, and masturbation (for everyone) plus we bring up romance novels and erotic fiction, aka “cliterature.” Of course some women need help with vaginal dryness and there are great lubes out there. So we feel the Lust for Life is the best takeaway. Modern Menopause issue: where to store the lube or sex toys that the kids can’t find. We wish each other good luck! How Hot was Your Flash: Sarah had none and Julia had a few warm ones, but otherwise -- all good.

Natasha Cecere, self-advocacy hero    "You are allowed to be demanding and annoying about your health"    Self- Advocacy: This is a topic near and dear to my heart. Probably because it saved my life. I have always said that I am my own primary care-taker and everyone else is supplemental—including doctors. Someone I agree with once said, “the days of doctor knows best are OVER.” For the first episode of 2018, I chose to bring on Natasha Cecere a knowledgeable and fierce self-advocate. It’s the resolution time of year, many of you are grabbing life by the balls—taking control where you’ve regrettably released the reins. As far as I’m concerned life= HEALTH. Take your health into your own hands, don’t simply surrender your most precious self to the “white coats in charge.” In this episode, you’ll learn some easy self-advocacy tips and hopefully feel inspired to take control of your health. Natasha Cecere: After facing her own mortality due to a rare reaction to Hepatitis A, Natasha began educating herself on health and has since learned so much about her body and medicine that it is one of her great life passions. Her interest is especially strong in women's health. Natasha is an East-Coast transplant, living in Hollywood. She is an actor, storyteller, singer, and body and sex advocate. You can find her on Instagram @funnygal83   Listen to this Episode if you are Especially Interested IN: What info to give your doctor and what it’s safe to withhold Antibiotic misconceptions (and different tips for taking them) Women's health and how to make the most out of gyno. appointments Mirena IUD complications and how to advocate for removal Who is safe to use Mireana IUD and who shouldn’t Why it’s worth it to look silly at the doctors office Why you can’t care what others think Listening to your body above all else How to learn about your body Quick and easy ways to advocate for yourself at doctor's offices, in hospitals and at home.   Reminder: We are not doctors, and we highly suggest everyone see a doctor that they trust and respect. While we suggest you push for what you think is right for your own body, we also suggest getting multiple opinions from multiple doctors before making any rash decisions.  Happy Listening! xo    

  Topics: hypothalamic amenorrhea, exercise and getting your period back pros and cons of the IUD/IUS common misconceptions about PCOS and how to "treat" it how we became functional dietitians with a private practice  Links:  http://rootforfood.net  http://diehardfoodie.net https://www.nourishingmindsnutrition.com   theme music provided by bensound.com Disclaimer: Remember, the information in the podcast in intended for general audience only and is not invented to diagnose, treat, or replace professional medical opinion.

Topics:  the Mirena IUD  practical tips to transition into intuitive eating how to determine food sensitivities and foods that make you feel good     signs to know that your metabolism is increasing  cod liver oil brand recommendations  cycle syncing with an irregular cycle  Links:  http://rootforfood.net  http://diehardfoodie.net https://www.nourishingmindsnutrition.com   theme music provided by bensound.com Disclaimer: Remember, the information in the podcast in intended for general audience only and is not invented to diagnose, treat, or replace professional medical opinion.  

225 - Ask Dr. Angela - Side Effects With My Mirena IUD. What's Normal? - The Ask Dr. Angela Podcast. Dr. Angela Jones, Board Certified OB/GYN answers all your personal health questions with quick humorous answers. Ask your own question at www.AskDrAngela.com