Master Your Menstrual Cycle & Hormonal Health with Lisa Hendrickson-Jack

Krati: Let’s start from the very basics. Let’s talk about what menstrual cycle is like for a healthy human being.

What are the primary hormones involved and how it affects your physical and mental well being.

Lisa: Sure. I mean, it’s a great place to start. So a healthy menstrual cycle, I think when I talk about that and bring that topic up, often people think, Oh, it’s just my period or whatever the case.

So we can go through the whole cycle. So when I talk about the menstrual cycle, I’m talking about from the first day of your true menstrual bleed. So some women may experience some spotting leading up to when they actually start to flow. But we would be talking about the first day of that true flow all the way up until the day before the next one. So in a healthy woman, that cycle length averages at about 29 days or so with a range of about 24 to 35 days. So typically a healthy cycle would fall within about that range.

When we start at the beginning of the cycle, it’s really common for women to experience period issues. So a lot of women experience pain with their period or excessive bleeding or excessively light bleeding, but it is helpful to define what a healthy period would look like.

So, you know, a healthy period typically lasts about three to seven days. Average is about five days or so and it should start moderate to heavy and then gradually taper off. So I always say a period, a healthy period should be like a sentence. It should have a beginning, a middle and an end and then be over. So it shouldn’t be trailing on and on and it shouldn’t be kind of stopping and starting all the time in the sense that during the time that you’re bleeding, it should be when you bleed for the cycle. You shouldn’t, in a healthy cycle, expect to be bleeding again around ovulation and again, before your period. We would expect the bleeding to be during the actual menstruation.

And in terms of the bleeding, healthy bleeding typically falls anywhere between about 25 and 80 millilitres. So somewhere between, let’s say, 2 to 4 ounces-ish. The conversion might be a little rusty, so my apologies to the Americans but about 25 to 80 mils. So, when we look at the research, there are plenty of women who bleed more than that, but when the bleeding is consistently higher, we want to actually be looking at if it could be related to fibroids or polyps, or any of the other kind of issues that could be related to heavier bleeding.

One of the things I found, when I’m working with clients or when I do group sessions and we talk about this, I’ll often do a demonstration, I’ll have a menstrual cup and kind of show what this normal bleeding looks like. As a woman, you see your own period, you experience your own cycle. So you kind of just think everyone’s like yours. So sometimes it’s like there are women who bleed within the normal range, but lighter where maybe during their whole period, they only fill, you know, five pads the whole time, right or the equivalent of that. There are other women who would be filling five pads a day for several days, right? So it is helpful to know that there is a range and to know that there is such a thing as a too light period, too heavy.

And although, I feel like it’s somewhat controversial, but maybe getting less, although it’s very common for women to experience pain with menstruation, I wouldn’t say that it’s optimal. So that’s one of the things where if you’re experiencing pain on a regular basis to the point that you need to use medication, I would suggest that we should be looking at it. It doesn’t always indicate a serious problem, but it can because women who have really serious and severe pain, that can be a sign of endometriosis which is associated with fertility issues.

And although many women with pain are dismissed when they go to the doctor and, they’re not really taken seriously. I think that plays into why we’re not really that concerned about it, but it is a sign of endometriosis, high inflammation. And we could talk about that more if you want. So that’s just the period.

Now, if we continue, once your period is over, we are in the pre-ovulatory phase of the cycle. So, in a healthy cycle, we would expect to see several days of cervical fluid leading up to ovulation. We produce cervical fluid towards the beginning of that cycle, as we’re preparing for ovulation as our follicle is developing. So, a follicle is basically the fluid filled sac that holds the egg. So as that follicle is developing, it’s making estrogen.

One of your questions was about the hormones that we produce during the cycle. So it’s estrogen. We are under the influence of estrogen in that pre ovulatory phase. And as that follicle develops, it’s making estrogen and that estrogen is triggering the production of our cervical fluid. And so we experience that as like a creamy white hand lotion in our underwear. Sometimes we might see something that looks like raw, stretchy, clear egg whites. In a healthy cycle, we would expect to see some version of that for about two to seven days leading up to ovulation with at least one day where we see the clear, stretchy fluid.

And sometimes you might just find that you’re going to the bathroom, you wipe, it feels really slippery, or maybe you wipe and it’s like, you have to wipe several times. Because there’s something there, right? I didn’t know what that was when I was a teenager. I remember going to my mom and like, you know, what is this stuff that’s wet in my underwear? And she just said, oh, wear a panty liner. She didn’t really know either.

But if you’re not on hormonal contraceptives, that is your cervical fluid and that’s a sign of fertility. So when you have that cervical fluid, it means that you are in your fertile window. It means that if you were to have unprotected sex, the sperm can survive in there up to five days when you have this fluid.

And it means that you are approaching ovulation, typically in a normal healthy cycle. So once you ovulate and you release that egg, that follicle then turns into something called the corpus luteum, which is a temporary endocrine gland, you could say, because it starts to produce progesterone. So we only produce progesterone in significant amounts after we’ve ovulated, and the progesterone then has a completely different effect than the estrogen did.

So the estrogen was stimulating the mucus, the progesterone shuts that down. So in a healthy cycle, after ovulation, you expect the cervical mucus to go away, and that corpus luteum survives for about two weeks. So a healthy cycle after ovulation, we would expect about 12 to 14 days of that second half of the cycle that we call the post ovulatory or luteal phase. And so during that cycle, I mean, the second half of the cycle, in an unhealthy situation with hormone imbalance is associated with increased rates of PMS. A lot of women experience things like bloating or anxiety or depression or a variety of different things. And some women experience bleeding, as I had mentioned, leading up to their period.

But in a healthy cycle, we would actually expect any PMS type symptoms to be fairly mild. And we’d expect that luteal phase to be long enough, and then your period would come at the end of that. So that was a lot of information, but that’s kind of the breakdown of what’s happening in our menstrual cycle.

Krati: Can we quickly list the phases?

Lisa: Sure. So, we have the menstrual phase, follicular phase.

Krati: That’s the fertility one? The one where you’re at your most fertile, I’m guessing.

Lisa: Yeah, that’s the pre-ovulatory phase, when you’re kind of leading into ovulation. So you could say the ovulatory phase, which is really just the day that we ovulate. And then we could say the luteal phase or the post ovulatory phase. So, there’s four phases. Menstrual phase, follicular, ovulatory, luteal.

Krati: I think you’re very right that if you’re experiencing too much pain, it’s just something to be concerned about. Although my source of information are the women I know, myself, and it’s not a big sample size, so can’t exactly base findings on it, but for me personally, if I’m exercising consistently, I have very little pain, and it’s very quickly over within the first day itself.

So to me it makes sense. So let’s talk more about that. I want to know, for a healthy individual, someone who is taking care of themselves, these phases, we hear like a variety of things on discussion forums, online on YouTube, everywhere. There are people who talk about how they have no focus during certain phases of their cycle. And again, we’re talking about like a 29 day cycle, as you pointed out. Some days when they are really able to lift weights and do like mad exercise. And then there are times when they are barely able to move. So talk to me about the different phases and how they affect your performance.

Lisa: Yeah, absolutely. I mean, the way that I describe the phases is from that scientific lens, right, looking at the menstrual, follicular, ovulatory, luteal. I think it was Alisa Vitti, author of ‘In the Flow’, she really popularised this idea of cycle syncing, right?

And so these days, and it’s funny because I’ve been in the field for a really long time, so it’s funny to see that now everyone’s really focused on it. I think it’s great, but one of the ways that I talk about the menstrual cycle in my first book, the fifth vital sign is the concept of the seasons of the cycle.

And I think that’s easier to digest. It also lends itself to more of the emotional experience that we have in our bodies during the course of our cycle. So that menstrual phase, when we’re bleeding, we can think of that as the inner winter. And this is again, a topic that was popularised by Shani Hugo Wurlitzer and Alexander Pope, authors of a book called, ‘Wild Power’.

So I just like to kind of put that out there. So the menstrual phase, we can think of that as our inner winter. That follicular phase, as the egg is developing, it’s very much like spring. If you think about what’s happening on the trees, the buds are forming, right? So, that’s our inner spring. And then ovulation is the summer.

That’s when, you know, everything is coming into full bloom, obviously, that’s when ovulation is taking place. Then, that stage leading up to our period is that inner autumn, or fall, when the leaves are starting to kind of come off the trees. So when I paint the picture that way, then it’s a lot more tangible and easier for us to kind of understand. If I think about it that way, there’s times when I might be naturally more inclined to have more energy due to those hormonal changes and times when I’m inclined to have less. Once you have it laid out in this way, it’s like it all makes sense.

So with that in mind, you know, obviously during the menstrual phase now…. Everyone can do whatever they want. So, I’m just going to talk in general terms here. If you want to go and run a marathon when you’re bleeding, do your thing. Generally speaking, when you are actively bleeding, a lot of us don’t actually feel like going out there and doing all the things, you know, it’s a time of rest. Some of us experience some degree of pain or just the feeling, even if your periods are really healthy and you don’t have any actual pain, you often feel a little bit less energetic.

I’ve had many conversations with very active and very, you know, I don’t even know the word I’m thinking of, but a lot of women who are just really, you know, they’re exercising, they’re doing trainings and all this. And sometimes I’ll say, you know, it’s okay to take off for like a day or two when you’re bleeding. And I’ll often hear like, Oh, I never thought about it that way. Right? This is kind of due to that we live in a world that’s very kind of male dominated, right? And men don’t have a menstrual cycle over the course of a month. So a lot of our activities we design over the course of a 24 hour day and so, when you’re a menstruating woman, you are living in this kind of cycle where every 24 hours isn’t the same. So instead of thinking about, you know, just day by day, you might want to think about arranging things based on your menstrual cycle at some point.

Back to that inner winter when you’re bleeding, that tends to be the time when you want to take that rest. Now, as we go into that inner spring, for many women, this is when they find that they have more energy. They feel more outgoing. They kind of want to be out there. Maybe ideas are flowing. Maybe just the workouts are happening. Maybe things are easier, you know, all the things and around the ovulation stage as well.

Now that phase is dominated by estrogen and a lot of women find that that’s when, you know, your skin looks better and all the things and we could even go further. I mean, there’s research on how during that phase, when you’re making your cervical fluid, you smell better to men. They’ve done these studies where they say that they like the sound of your voice better when you’re around ovulation.

I think one of the most famous studies is the stripper study. I don’t know if you’ve heard of the stripper study. So, it’s a literal study though. It was actual science, but they literally had women who were strippers. So it’s a little controversial. Just go with me for a second here. And they measured their tips based on their menstrual cycle. So they had one group who was cycling normally and they had women who were on birth control. So they weren’t cycling. And the women who were cycling normally, they actually made more money around their ovulation and less money around their menstruation compared to the women who were on birth control, but overall, they made more and it was specific, like 83 more or something like that. Overall, there was like a quantifiable difference between the menstruating women.

So anyway, the point I’m making though, is that many women then find that that is the time when they feel more outgoing. Also, there’s a part of that that you can’t control, because you might find yourself getting more attention from men or from your partner around that time, but it’s not anything that you’re necessarily doing, it’s just those hormonal changes.

So then, once you move past ovulation, and you move into that inner autumn, you kind of start that decline. So you kind of get to the point where maybe you have less energy for things. Maybe you feel a little bit less outgoing. Now again, broad generalisations here, I’ve had clients, one client that comes to mind, she was working in a really interesting industry and she was able to kind of change the type of work that she would do based on her cycle. So she found that she would want to schedule her meetings and her presentations during that you know, follicular, ovulatory phase. And in the luteal, she found that she really liked to do some of that administrative work and all the things that require that kind of brain space, but didn’t require her to be so out there.

So, this is a choose your own adventure. I just want to say there’s no right way to do it. Everybody doesn’t need to do the same thing. Some women have different issues. Let’s say women who have who are really sensitive to histamines. Sometimes they might not feel the greatest around ovulation because high estrogen levels in women who are sensitive to histamines can be associated just with certain symptoms.

So it doesn’t mean across the board, everyone’s exactly the same. These are just general trends, but it is really interesting to think about it that way. So for a lot of women who’ve never thought about any of this stuff and when they hear it, it’s like, Oh, this actually makes sense. And they start paying attention to when they have their energy and when they don’t, it does give you an opportunity to change your outlook, to change your schedule.

Sometimes it doesn’t mean it’s always going to be perfect, but for a lot of women, it’s a game changer because then they take the pressure off themselves to do some of those activities during the time that they just don’t feel able to do it. They are able to better structure their days so that they can overall have more productivity or achieve whatever goals they’re trying to achieve.

Krati: Yes, this knowledge is 100 percent a gift. I really hope all women know this, but I know that’s not true. I know a lot of women don’t know this and they get frustrated. I know because I used to do that to myself when I quit my 9-5. It’s so true what you said about the masculine energy, because up to that point, till I was in the 9-5, before that I was doing my master’s in economics, which meant I was doing 14 hours worth of classes every day. So, you just have to work. You have to work.

Lisa: Every day is the same.

Krati: Yeah, exactly. But the moment that I got off that treadmill, quit my nine to five and had more room to be creative, more room for flexibility. My responsibilities grew. That is when I would get frustrated at certain points. I was like, why can’t I focus? And I would get so mad at myself and that emotion would spin onto the energy for the remaining month. It was when I started doing the podcast, I had a podcast guest on. We were discussing something else entirely. She was the one who pointed out, do you not study your cycle? Are you not doing this work? I’m like, what do you mean study my cycle? I’m not one of those people who make everything about the fact that their hormones are off. I’m not one of those people. I have got control. She’s like, no, that’s not what I mean. It just, you are more creative during certain days and for some days your focus is shot to hell. You need to cut yourself some slack or do work that doesn’t require as much focus.

And, Oh my God! Life changed completely after that. What you have just shared, this knowledge is a gift. I mean that very seriously and I really hope my listeners really work on it.

Okay, so we understand now the phases. We understand that there are periods of the month when we are going to be more productive.Periods of the month when  the mood is going to be more even, more balanced. And of course, as you said, it’s not the same for everyone, but when you study your cycle, trends will emerge, trends specific to you.

That is so amazing. Now, I want to know how the cycle is affected by lifestyle choices, because that’s something else the gravity of which I think a lot of us miss.

Lisa: It’s certainly a huge topic. So in terms of lifestyle factors, there are many. We could talk about even exposure to chemicals, you know. As women, everything that is manufactured for us, whether we like it or not, if it’s lotion or hair stuff or makeup or whatever, unless you’re specifically looking at non toxic brands, it all has all kinds of chemicals.

And my latest book, Real food for fertility, my co-author and I, Lily, she wrote a whole chapter on toxins and just really gets into the weeds on our exposure to Phthalates and just all, whether it’s pesticides, it just goes on and on. So that’s something to think about. One example of that, we don’t always think about our menstrual products.

So one of the first things that I learned on my journey down the rabbit hole of all things menstrual was about the menstrual products themselves. When you are just using the regular stuff, you know, if you’re just using like Playtex or whatever, not to name drop, but here we are, you know, a lot of those products, they’re not made with organic cottons and things like that.

So you don’t even know what you’re being exposed to, whether it be the plastics or the pesticides that they use to grow the cotton. So there are some women who have, let’s say some issues with period pain or hormonal imbalances, who switch from the typical products to organic products, or they use menstrual cup or whatever it is, but they’re just reducing their toxin exposure. If you think about it, the pad that is non organic, it’s on your vagina. It’s like on the vulva, so it’s probably the worst place to be exposed. Some women find even just an improvement by reducing their exposure to xenoestrogens, and the menstrual products are one part of it, but you can think about cleaning supplies. You can think about what you use to wash your clothes, all the scents, the plug-ins in your house. It’s a whole conversation.

So for any of your listeners who haven’t really gotten attuned to that, it is a big topic. It can feel really overwhelming. Typically my recommendation is just to start gaining an awareness of it. Start looking at and thinking about the scents and all the different things. Your lotions, if you smell like mangoes and strawberries, you know, those contain endocrine disrupting chemicals and if this is a new topic for anybody, the reason why these chemicals are problematic is because many of these chemicals, these scents, all the things that are in everything we use, they have a chemical structure, many of them, that is similar to estrogen.

So that’s why we call them often xenoestrogens. And that means that they’re similar enough in structure that they can kind of trigger estrogenic-like responses in your body, but they’re not actually your natural estrogen. So for many women, it can kind of trigger all these different responses, throw off hormones.

You can have various hormonal imbalance symptoms. And when you actually just work on gradually cleaning up your routines and your products and all of that stuff, it can have a good improvement. So that just deserves an honorary mention. And of course, FYI, the biggest hormonal disruptor, contraceptives, would be the pill and other hormonal contraceptives. So you can’t talk about the toxins and the lotions and all of that and then pretend as though hormonal contraceptives don’t also disrupt our natural hormones. So just a PSA, public service announcement there.

There’s a lot of other lifestyle factors also. We could talk about sleep, diet, nutrition, so there’s a lot of different things, and I think what is interesting when you start tracking your cycles and paying attention, you can start to see how your actions can impact your cycle.

So for example, if you have a really busy month, and your sleep is totally disrupted. Your diet is really off, whether you’re skipping meals, or you’re just not eating optimal foods. You might notice that your period pain is a little bit more that month, or you might notice that your PMS is like out of control that month, or you might find that if you’re tracking your cycle, you might find your cycle is a little bit longer or shorter, or you have some spotting where you don’t usually have it or whatever.

And so I think what’s often just really shocking to women who jump into the cycle tracking is that we actually have a lot more control over what’s happening hormonally than we think. You might be having some issues. You go to your doctor and you say, look, I’m having this PMS. I don’t know why I’m having this issue with my cycle and my hormones.And they’ll say, well, there’s nothing you could do. You just need to go on the pill. But if you start cleaning up your nutritional routine, your habits, your sleep, your exercise routine, all the things, then you might find that your cycles improve significantly in a way that they just didn’t tell you that you could have any impact on that whatsoever.

Krati: Yeah, this is such a huge factor how you exercise. I’ve been stepping up my exercise intensity in the past few months and I tried running while I was on my period. I wasn’t bleeding yet, so I thought, okay, maybe I have a little time yet. So I’m just gonna go run today because probably tomorrow definitely I’m gonna have my period. And a sharp pain shot up in my leg within the first circle itself and I was like, Oh, what the fuck is that? That has never happened before.  I came back home and I was bleeding. It feels like the body is so fluid when you are on your period, very mattressy like it softens in on itself. I feel like so that makes a huge difference what you’ve just said.

And sleep, I feel like we all know this. We just keep ignoring it. We won’t go too deep into that because I think we adults, we know we’re supposed to sleep, how we’re supposed to sleep, how we’re supposed to eat and all of that. But definitely I want to know about, because, tell me if I’m wrong, considering it’s a 29 day cycle, your period isn’t just about estrogen, it must impact all of your hormones. Isn’t that correct?

Lisa: Your period is essentially a result of what happened over the course of the previous cycle. So, in terms of your period specifically, you alluded to a couple of things that I’ll try to touch on. And one of the questions that I had when I was researching for my first book, The Fifth Vital Sign is what exactly is a period, right?

Like what is actually happening? And so in the period, you’re shedding the functional layer of your endometrial lining, and the period itself is a natural inflammatory process which is really interesting. So is ovulation. Ovulation is also a natural inflammatory process. So, in your period, it’s this natural process where your tissue, your endometrial tissue, is literally dying and being shed.

We have prostaglandins that trigger smooth muscle contractions to help to release of that endometrial fluid. So, in a normal, healthy individual, you have these subtle uterine contractions that just aid and facilitate the shedding of the lining, and they don’t cause you physical pain. It’s just part of this natural process, but what happens when you have a painful situation is when they measure the inflammatory markers in women with period pain. So the prostaglandins, for example, they find that women with period pain have upwards of four times the level of these prostaglandins and the prostaglandins are what’s triggering these contractions.

So these women who are having moderate to severe pain have significantly more contraction. So I would wonder if what you’re feeling when you mentioned, you know, during your period, it feels different. It feels, you know, you’re also actively bleeding at that time. So I think that is something where knowing what that menstruation is and knowing that literally, if you’re literally bleeding, you know, it’s literally shedding, this sliding, and this whole process is happening.

So like I said, everyone can do whatever they want, you know. You want to go run and not you in particular because you didn’t know your period was coming right that day, but you know what I’m saying. It is something to consider that from a physiological standpoint, it actually does make sense to take a little bit of rest.

Especially during those actual days. So anyone who’s had it, period, knows that there’s those couple of days, it’s like the first one, two, or three days where you feel like you’re actively bleeding and you know it. And then once that active bleeding stage is finished, it’s like the wrap up after that.

And once you’re in that wrap up, it’s different. You can do more, like, you know what I mean? But during the stage where you’re actively bleeding, I think it is helpful to think about it that way. And since I’m talking about this topic, there was one interesting fact that I found that really irritated me on the day that I found it, but there was this review paper that I was reading, and they have actually quantified and measured that the pressure, when we’re talking about the uterine contractions, the actual pressure, in the uterus, and they found that, if I remember correctly, the women during their regular menstrual period, they measure it in units called millimetres of mercury.

So the women during their normal periods, I think if I remember correctly, it was like maybe 30 or 40 millimetres of mercury. Women in labor, active labor, giving birth to babies, it was like 90 millimetres of mercury. Women who had active period pain that was moderate to severe, it’s like 400.

Krati: Whoa!

Lisa: And I remember I was irritated that day because in the review paper, the researcher said, so when women say that their period pain is, you know, comparable to labor, maybe there’s some truth to it.

I was just like, what?

Krati: Oh my god!

Lisa: It’s period pain. Contractions are far more severe than some parts of the labor process, which is really interesting to note. So I feel like I’ve gone far away from your original question, but I felt like I wanted to touch on that whole concept of what a period is and how that comes into play.

A lot of women find that exercise and movement throughout their cycle can help to reduce their period pain when they’re having their period. So I think there is something to be said for being active and moving your muscles, increasing the blood flow and the circulation in that area by your movement.

But I think that it’s typically the movement, you know, during the actual menstrual cycle itself, not necessarily, the advice out of that isn’t necessarily to like, go hard and work out while you’re actively bleeding. And then, you had mentioned, the sleep and the diet, because it’s true. Everybody feels like they know what they’re supposed to be doing, but I thought I would point out just a couple things from a hormonal standpoint that are interesting.

So one of the things is that we’ve talked about the hormones in a general sense. So leading up to ovulation, you’re making estrogen and then post ovulation, leading up to your period, you’re making progesterone. And during that time, I’m also thinking about something else that you said, because you said, you know, your period, it should be related to estrogen and progesterone. So during that early part of your cycle, after you have shed that functional layer, it’s the estrogen that actually builds back up that functional layer.

So estrogen is a proliferative hormone. It actually builds back that base of your endometrial lining and then progesterone comes in and helps to mature that lining. So in an optimal cycle, average of about 29 days, you would have about equal-ish exposure to the estrogen and the progesterone and they work together.

So when the estrogen is normal, then your endometrial lining doesn’t get too thick, it gets the thickness that it’s supposed to. And then the progesterone counters that proliferative effect by helping it to mature and to prepare it to be receptive to a fertilized egg. So what happens when the cycle is problematic?

If you have a really long cycle, so delayed ovulation. You end up with double the exposure to estrogen. In terms of the time frame versus progesterone, you could have heavier bleeding because you’re having the estrogen kind of building it, building it, building it, building it, but you’re not necessarily having the progesterone to counter it.

Similarly, if the luteal phase, the second half of the cycle isn’t strong, your progesterone isn’t where it needs to be, then that countering effect might not be as strong. So that’s why kind of going back, it’s like your period is a result or a printout of what was going on for the course of that cycle.

So whatever was going on, if you had healthy hormones, good balance of estrogen and progesterone, then your period is going to be a lot more manageable in terms of the volume, you know, how it all goes. But if the hormones are imbalanced, then that’s when you can have the heavier bleeding, the clotting and all the things that you wouldn’t expect in an optimal healthy cycle.

Krati: Thank you for sharing all of that.

I know I said that we all are aware that if we eat healthy, we sleep well, we operate well, our body operates well. But tell me if there’s anything we can do to regularise estrogen levels, to maintain a healthy balance of it all so that we don’t experience as much pain because what you’ve just pointed out with the, the study, the levels of mercury, that is insane to me.

I remember when the whole conversation, on a global level, it was happening about the paid period leave. My instinct was, no, we don’t need that because periods are never that bad. And then I had conversations with a lot of women and that was a mind fuck because there are women who are hospitalised during those days and I can’t even wrap my head around that.

So anything we can do to help ourselves.

Lisa: Yeah, I mean, you touch on so many important points and the biggest point is obviously it shouldn’t be that painful. That’s not a healthy menstruation when it’s that severe and a woman is hospitalised or she’s vomiting or she’s fainting, passing out because the pain is so bad. I mean, those women with that severe of symptoms are more likely to be suffering from a serious condition, whether it be pelvic inflammatory issues or literally endometriosis, which is the abnormal growth of endometrial like tissue outside of the actual uterus.

Endometriosis is a big condition. It’s a big conversation. And, I think, one of the biggest takeaways I would say is for women who have extreme pain, it’s helpful to know this word endometriosis so that you can start to advocate for yourself. Just to take a little aside, there was a research study that came out many years ago and they looked at, on average, how long it would take for a woman who has endometriosis to receive a diagnosis, a firm diagnosis. One of the challenges with receiving a diagnosis is that it typically requires a laparoscopic procedure because you could have even an MRI or an ultrasound and it’s possible that it could be missed. So, there are times when a person could even go through the trouble of having other types of screening options, but still not have it be confirmed.

So the gold standard for diagnosis still remains this laparoscopic procedure. But what the researchers found was it took an average of 8 to 12 years or so, depending on whether they were in the UK or the US, to actually get that diagnosis, and that’s an average. So a lot of women who have this really severe condition that can impact fertility and be, you know, very debilitating, obviously, are often waiting a decade or more to get an actual diagnosis, going from doctor to doctor who maybe just suggest going on the pill or just this or that and not necessarily getting that full evaluation for their conditions. So the first thing I want to say is – it’s not supposed to hurt that much.If it is, we have to be looking a little bit deeper, but in the general sense, if we go back to, you know, what is a period? And I mentioned this kind of normal inflammatory process then when we are having pain, whether it be mild pain, moderate or severe, it is a sign that that inflammation is too high. It’s out of control. So from the standpoint of like, what can we do about it? We can start looking at some of those lifestyle factors.

We can start looking at our exposure to different chemicals, our exposure to pesticides, even the sources of inflammatory foods. So if you are regularly consuming junk food, whether it’s the sugary stuff or the processed foods, the foods that are really, really high in carbohydrates, like processed carbohydrates.

If you think about the concept of whether it’s white sugar, white flour, you can look at that and you don’t necessarily know where it came from. So, all of those types of foods are highly inflammatory. We can look at the inflammatory oils that you’re consuming and looking at the quality of the foods that you’re consuming.

So one example of that would be the commercial dairy products. You know, a lot of women find, especially if they’re having severe period pain, that if they’re consuming the conventional dairy products, I mean, I could go into a whole lot of information about dairy products. I’m not anti-dairy, I’ll start there.

A lot of people would say, Oh, dairy is bad, but I don’t think dairy is bad, but I think when we learn about how it’s processed, you have these cows that are supposed to be eating grass on a pasture that they’re giving, you know, GMO  corn too, and genetically modified foods are modified so that they can spray them with pesticides.

So that’s the reason they modify it. So if you’re consuming genetically modified foods or food that has consumed genetically modified food, then you are getting a higher level of exposure to pesticides. Most of our dairy products come from cows that have this A1 protein that is also associated with higher rates of inflammation.

So we can have that conversation of what are you actually consuming. A lot of us that are consuming more of a traditional, they call it like the standard American diet, but we’re just exposed to way too many inflammatory oils, we’re exposed to too many pesticides in the food, and we’re not being exposed to those anti inflammatory aspects as much as we should be.

So, the opposite of the inflammatory foods would be our fish and our seafood, high in omega 3 fatty acids. It would be our leafy green vegetables, you know, the anti inflammatory foods. And It would be the meat and dairy products that are not the kind of feedlot, corn fed, GMO scenario, highly inflammatory meats.

It would be the grass fed, locally raised, when possible, types of alternatives. So, there’s a whole lot to be said for that, but I think we can look at some of those factors and start to just educate ourselves about it and then look to ways that we can support the reduction of the inflammation.

So these are topics that we go into. Like my coauthor, Lily and I, we went into a whole lot of detail in real food for fertility. The book’s called ‘Real Food’ because we’re arguing that you should be eating things that you know what it means. So, when you’re looking at, if you open a package of something, so if you open a chocolate bar, you can’t look at it and be like, it came from this plant or this, like you don’t know what it is.

And that’s one of the aspects of the definition of what is real food. If you pull out an apple or you pull out a piece of chicken, like you know what that is. You know where it came from. So the more of those types of real, true, actual nutrient dense foods that we can incorporate into our body, then nourished and having a higher nutrient intake, micronutrient intake as well as just getting enough protein can help.

Krati: How much can supplementation help here?

Lisa: I mean, that’s such an important question. I think that it depends on your view of supplementation. So when Lily and I address this concept of supplementation in the book, we’re talking about it to supplement. So if you’re eating in a way and living in a way that is not optimal. If your diet is devoid of sufficient protein, if you’re not getting healthy fats. We could talk a little bit about what is necessary, the basic baseline for your hormones to work. So if you have not optimised your diet, your lifestyle factors and you want kind of the easy option, which is just buy all these supplements and it’ll fix everything.

You’re going to have a limited result. The best way to incorporate supplementation is to truly have it to supplement the other things that you’re doing. And the other things are a lot harder It’s a lot harder to make all these different changes and look at what you’re eating and change your exercise routine and all the things.

So one thing I should mention is when we’re looking at what is going to help your cycle to be optimal. I mean, we spent a lot of time talking about estrogen and progesterone. So how do we support our hormone production. So it turns out that we require some foundational, basic dietary things in order to make this work, you’re not going to have a healthy balanced cycle if you are not getting sufficient protein.

And if your diet is devoid of sufficient fat and controversial as it is to say, it’s animal fat that we need to ensure that we’re getting enough of. So I know again, that can be controversial to say, but protein, what I’ve observed in the menstrual cycle, because again, when you’re tracking the menstrual cycle, we can use exercise as a good example as well.

You know, a lot of us, especially in my age category, so I’m in my early 40s now, you know, we start to notice that it’s not as easy to keep off the weight. And so a lot of women in this age range, what we’re trying to do is we’re trying to do all the things that the male influencers are doing. So they’re intermittent fasting, we’re intermittent fasting. They’re skipping breakfast, we’re skipping breakfast. And then our cycles go all haywire. And then the doctors just put us on HRT and then we just keep intermittent fasting and all the things. So what it turns out is if you want to manage your cycle optimally, and you don’t want to necessarily be as reliant on some of those medications, we need to get sufficient protein for our activity level.

You know, as a guideline, it is useful to think if you are an active woman, you should be getting nowhere less than 80 to 100 grams of protein a day, and that might even not be enough depending on what type of activity you’re doing. And a lot of women, unintentionally, under eat in general. So they’re just not eating enough, specifically under eat protein and often limit fat. I grew up in the 80s and 90s. That was like the fat phobia era where we were told not to eat any fat. But when we talk about estrogen and progesterone, it is our body synthesises these hormones, estrogen, progesterone, testosterone, cortisol, it synthesizes them from cholesterol.

So If you think about what that means, we’re making these hormones from cholesterol. So if your diet is devoid of sufficient, it doesn’t mean you have to overdo it. You just have to make sure that you have it in there, that it’s going to be harder for your body to make these hormones. It’s one of the things I love about the work that I do. It’s not about Lisa said so, so I should do it because it’s really your menstrual cycle. So, when I’m working with clients, it’s like we see where their menstrual cycle is starting from, and if they make certain changes, they get to see for themselves if their hormones are better, because they’re going to see the changes in their menstrual cycle.

Krati: That is so huge. I feel like a fraud saying this because I know how much I skip out on the healthy stuff and, you know, just not do the things that I should be doing. But, while I was recovering from depression, this was several years back. I had to build my life from scratch.

So like everything had to be examined and had to be corrected because my body was completely broken and my mind was in a bad place. So I had to figure out what to eat, how to exercise and everything. And once I got to a place where I was doing it perfectly. I had a lot of support, of course.

A lot of people were helping me in that process, so definitely had that. But I got it right for that age. I was, I think, 24, 25 at the time. So, of course, that would be different now, I’m guessing. But when I got it right, oh my god! It’s like you are Thanos with all five gemstones. It’s insane how much power you have, how easy life feels. So what you are saying, there is so much truth there. There’s, I mean, obviously, you know, you are giving us a lot of information that we need to sit with and sift through for it to really impact our choices. But I think we need to figure out what works for us. It’s a lot of hard work, but it is good kind of hard work that will take you to the most wonderful place. So I’m glad you said that about supplementation because a lot of us do use it as a shortcut and you are right. Without supportive lifestyle choices, it’s just not enough. It’s really not.

Lisa: I’m all for supplementation because I’ve also seen what it can do, but it’s the difference. One of the analogies I often use is, you know, picture you’re driving in your car and there’s like a brick on the brake. So how far are you getting with the brake engaged? Right? So when you’re able to combine supplementation with the kind of foundational lifestyle factors that are necessary to optimise those, then instead of just pushing on the gas while the brake is engaged and you’re kind of like puttering along, you get to get the full benefit of putting your foot on the gas.

So the supplements in that case are the gas, you know, but you need to make sure that you kind of get out of your own way. And this could be a reason too, why people take all these supplements and, oh, they don’t work. And then it’s not, you know, I’m not getting the result that I want, but it’s a whole picture that is necessary.

Krati: Yeah, I hope my listeners do this work. It’s so incredibly important. It’s life changing. I do want to ask you this one thing. We talked about endometriosis and I have read some publications from women who have experienced it and they are heartbreaking. It’s heartbreaking to read those.

Not a single experience was an easy one. It’s a heartbreaking journey. So anything like that, anything problematic with your body or anything that needs attention, I know that your cycle is a major indicator. If you’re having too much pain, like you pointed out, it could be a sign that your body needs help. But like you said, endometriosis cannot be diagnosed as easily without a laparoscopic procedure. Anything that can help us spot hormonal imbalances in our body or just any methods that you can recommend so we can track all of this and actually get to a good place.

Lisa: Yeah, absolutely. I mean, the concept that I’m sharing when we talk about the menstrual cycle, the title of my first book, the fifth vital sign is my take on this. I mean, this concept of the menstrual cycle is biosign, I did not create that. It’s something that is gaining more prominence and there are a variety of doctors and, you know, medical institutions that are acknowledging that we should be looking at it that way.

So, if we think about it from that standpoint, it’s great, like, we have this in our bodies, this, this menstrual cycle that we can track and pay attention to that is always reflecting back what’s happening in our bodies in real time. It’s, it’s really fascinating field to be in, to be able to see what happens where you make certain changes.

It doesn’t mean that you’re going to go from a really highly problematic cycle to everything’s great cycle number two, but you can see these shifts and changes. So if you have some issues going on related to low progesterone and you start to make some changes and you start to support your body, get enough protein, get enough sleep, all the things that you need in order to support that, then you may see that luteal phase increase by a couple days or the spotting decrease by a couple days in that cycle number two.

And for a lot of women, this is the motivation. This is, I have [00:47:00] found, from the work that I do with clients that I don’t know what else could be as motivating to be able to see in real time? Oh my goodness. Like I can actually have a positive impact on what’s going on. So in terms of your question of what can you do, what can you track?

So, you know, every single woman on earth isn’t necessarily going to gravitate to detailed cycle tracking. But if you are listening to this today, , watching this today and your curiosity is peaked. I mean, you could start as simply as just paying attention to when your period’s coming. You know, that’s sometimes the first step just to, to, and many of you already have that.

You already have your app, your period tracker, and you just kind of pay attention to that. And if you want to take it a step further, you know, if you’re not taking Um, hormonal contraceptives, because you wouldn’t see a cycle, so if, even though you have bleeding, , regularly, if you’re taking hormonal contraceptives, it’s not an actual true period.

In order to have a true period, you have to ovulate, and you’re not ovulating. With most hormonal methods, some, you may still [00:48:00] ovulate, but most hormonal methods are, you are not. So, If you are not using contraceptives, you’re tracking your period, you may want to start paying attention to cervical mucus. You don’t necessarily have to do anything, but you can start to notice it, and you can start to notice when you’re having it, and you might be able to start, you know, identifying when you’re ovulating.

And that can be, again, a first step. So your question about how do I determine if I might have hormonal imbalances? So earlier in this, uh, episode, we talked about what a normal healthy cycle looks like. So essentially, if you’re not falling into those ranges, If your cycle is way longer than 35 days on a regular basis.

If you start seeing your cervical mucus, but you have it every single day for like two weeks straight. If you bleed all the time, , and you bleed between periods and through, you know, you bleed every two weeks. Like, but none of those things are falling into the normal range. So I think just by our conversation, um, even if you have like the wild PMS symptoms that are again, mild changes in mood are, are [00:49:00] actually quite normal.

We are cyclical beings. And so there is something to be said for just having changes in energy throughout our cycle, but when they become problematic and we start to call it shark week and like, You know, get everyone away from me. And you’re, you’re bawling in your bedroom for three days at a time because the depression that you feel every time you’re period, like that is not normal.

So we have to be able to, first of all, identify it. No, it’s not in your head. We have to empower ourselves with information. If your physician practitioner. It does not take you seriously, isn’t listening to you. You need to find another one and talk to someone else. You may have to have someone else on your care team.

You may have to consider working with, whether it’s a coach, working with a functional medicine doctor, finding a naturopath, finding someone who’s actually looking at your hormones in a more holistic way. So we still need our doctors. But if your doctor isn’t great, find another one. , but you may need someone else on your team to actually focus on some of these other issues.

So I feel like that would be the place to start, because I find that with a lot of women who are new to [00:50:00] this knowledge and information, They still think they are going to go to their medical doctor and ask about hormones as if the doctor is going to recommend lifestyle changes. The doctors are not trained to do that.

They’re trained to prescribe medication. And so it’s like going to my classic example. It’s like going to McDonald’s and asking for an oil change and being pissed off. Like you’re legit standing in the front of McDonald’s and you’re just like, why aren’t you changing my oil? Like, this is what it’s like going to your classically trained m. D. and expecting them to really dive deep into the hormones and all that and lifestyle. They’re not trained in nutrition. They’re not trained in lifestyle changes. So they’re not the ones to ask about that type of information.

Krati: Okay. Uh, I want to know about the birth control. We, we know that, you know, this is an area of concern. Women who are on birth control, and now as women are having babies a lot later in life, they’re on birth control for a long time.

What we have all of this in news now, right now, This is something that’s trending. Women are losing their fertility, uh, to a [00:51:00] large extent, like they’re struggling to have babies as and when they do decide to have babies because they don’t have normal periods. Their periods completely disappear. What is the alternative here?

What is the solution for them? Anything that you can offer?

Lisa: I mean, it’s a, it’s a definitely a big question. I think there’s a lot to unpack. So when it comes to birth control, we could talk about birth control for an entire 60 minute session. So I’ll share a few things to, to consider. So one of the things to consider is that birth control has I would say the research does not suggest that birth control has a permanent negative effect on fertility that’s lasting.

What the research suggests is that the pill and other contraceptives are associated with a temporary period of subfertility when you come off. So essentially, if you’ve been taking the pill for the long term, when you come off, there is a temporary period where your fertility is suppressed. Now, that doesn’t mean that you cannot get [00:52:00] pregnant.

It just means that when we look at statistical averages, on average, it can take women a bit longer to conceive. So, you know, several months more immediately off contraceptives. Now, if you think about what contraceptives are doing, the typical most common, you know, birth control pill, the combined synthetic estrogen progestin formulation, it works by three main modes of action.

So it’s suppressing ovulation. So when you’re Cycling normally, you’re ovulating, you know, on average, like once a month, right? But on the pill, you’re not ovulating. So think about what that means to take something that just stops, suppresses ovulation for years. Imagine your car, you just put it in the garage for years, it doesn’t work.

So that has an impact. And when you come off that contraceptive, it does take some time for those. ovarian reserve parameters. So just the ovarian volume, the AMH levels, [00:53:00] like it takes time for that ovary to kind of kick back in, get back into the groove and start putting out the optimal amount of hormones that it would in under normal circumstances.

And there’s studies that suggest that it seems to take anywhere from six months to a year before those hormones fully normalize post pill. So that’s something to consider where if you have somebody who’s taking contraceptives for a long time, the other thing that’s happening is they’re getting older.

So that’s not because of the pill, but if you’re on the pill for 15 years and you started at 20, you are now 35. So in addition, you know, we know that our fertility changes with age. And then I mentioned that there’s also this temporary delay in the return of fertility. So those two factors together, we should be considering.

So my, I don’t know if it’s controversial, um, take on it is that if you do have it in your mind to have children someday, that when you start getting [00:54:00] into your late 20s. early 30s that you should start reconsidering your choice of birth control. And if it’s possible for you, you may want to consider switching to a non hormonal method.

I mean, often, not always, but often when we’re in our early 20s, sexually active, you can’t conceive of anything that would give you any chance of an unplanned pregnancy, right? So, you know, hormones, whatever you need to do. But as you get older, I’ve heard a lot of women say like, I was too irresponsible in my early twenties.

Like, I don’t believe that I think you can do whatever you need to do. I charted from when I was young. Um, I was in my late teens when I started charting. But the point that I’m making is that often we don’t reconsider. We never take time to reconsider that choice of birth control. So you might’ve made a choice when you were 19 or 16 or 21 and now you’re 30 and you’re still doing the same thing you did then, but you haven’t.

Like you haven’t sat down to think, okay, in 2025, this, what type of birth control should I use? So I’m suggesting that we just stop, pause, and just think about it and re [00:55:00] evaluate. So if you are thinking, I want children in the next year, two years, three years, five years, and you’re, maybe you’re in a stable relationship now, maybe you’re not even in a relationship, but you can, I encourage you to just.

Think about this, because if you choose a non hormonal method, I mean, fertility awareness charting is not necessarily for everybody, but it is as effective as many of the hormonal methods with a perfect use rate of effectiveness of over 99 percent and the typical use that ranges depending on the type that you are using, but still very high.

There’s also, you know, condoms and the diaphragm and, you know, the, the, the methods that have fallen out of, uh, favor and I mean, for women for whom the copper IUD is a bit controversial because it doesn’t work for everybody, some women have, you know, it causes additional inflammation, heavier bleeding, , but there are women who love it and it works really well for them, women who, maybe whose periods were not, particularly heavy to begin with, who love it.

So what I’m saying is there are non hormonal options. And so I think that it is useful to have a [00:56:00] conversation about this. And if you are planning to get pregnant within the next few years, although your medical provider might tell you, ah, it doesn’t matter. Just, you know, as soon as you go off of it, she’ll get pregnant anyways.

What the research tells us is that we do have this temporary period of subfertility. So it is a really useful and important conversation to have just to, to think about what are my options here. And as terrified as you are of coming off that birth control, the chance that you might get pregnant, um, have you thought how you would feel if you, you know, were ready to have children and it took six months longer than you wanted or 12 months longer than you wanted or 18 months longer than you wanted.

So I think we really, and that might not happen, but it’s like insurance. Like I don’t expect to get an accident, but I have to have car insurance. So like you don’t expect to have fertility issues, but you probably should start thinking about planning ahead for that so that you minimise the chance of that happening.

Krati: Yeah, true. Okay, because there’s so much wonderful information in this episode, there’s going to be a very clean transcript of this. I’m going to make sure the link to that transcript is in the episode description for my listeners. So for the last question, any other resource that you really love, that you would want to point my audience to that could really help them with this.

Lisa: Sure, absolutely and first of all, thank you so much for having me. You asked such great questions. I mean, we could talk for like 16 hours. We totally could. We may have to do a part two.

Krati: You can’t see my list. My list is ginormous.

Lisa: Well, I mean, when you’ve written a couple of books, there’s gone into a lot of depth. Obviously, I’ve done a lot of research in this area. I’m still fascinated by it. I’ve been working in this field for the the last two decades. I think it shows, and I’m still not bored. I’m still always interested in these topics, and they truly are life changing.

I mean, I know the difference it made for me, and so I’m happy to share as much as I can, because ultimately, if we wait until our, you know, educators decide to put this into our curriculum at school, we’ll be waiting until we’re dead. We’re just going to be 150 years old and they’re still not going to be in the standard system.

So in terms of resources the two books that I mentioned. You can grab the first chapter for free. So, you can head over to realfoodforfertility.com and grab the first chapter for free. So we include our forward, and the first chapter has tons of information. So there’s lots of really great information that you can read right away. Of course, if you want to go ahead and buy it, it’s available on Amazon. We also have the audio book version. Everything that we talked about today is in immense detail in those resources. If this conversation was interesting to you, you can find me on the Fertility Friday podcast. So, you know, take a search for that.

There’s like someone else that recently, called their podcast, Fertility Friday, but if you search like Fertility Friday radio, you should find me. My stuff is kind of pink. So I feel like you’ll see me. On brand, right?

My podcast is in its 10th year. We’ve released over 500 episodes, so lots and lots to dig into over there.

And I hang out on Instagram primarily at Fertility Friday if you want to connect on the socials.

Krati: Perfect. All of these links will be in the episode description.