As a pediatrician, I was not asking enough questions about my patients’ periods. We ask when the last one was. We rarely go deeper than that. And after this conversation, I will never approach it the same way again.

I sat down with my friend and colleague Dr. Natalie Crawford, reproductive endocrinologist, fertility specialist, and author of The Fertility Formula. Here is what I want every parent raising a girl to understand: the menstrual cycle is not just a monthly inconvenience. It is one of the most important windows into your daughter’s hormonal health, her long-term fertility, and her overall wellbeing. And the symptoms we keep brushing off as “just puberty” or “just a bad period” are often the first clues to conditions that will matter deeply later in life.

In this episode, we cover:

• Why the menstrual cycle is a vital sign and what that means for the girls in your life

• The warning signs parents and pediatricians too often dismiss as normal

• What a first period should actually look like, and when irregular cycles need to be taken seriously

• Hypothalamic amenorrhea: the condition linked to over-exercising, under-eating, and chronic stress that silently affects estrogen during some of the most critical years of development

• PCOS in teens: why it does not always look the way doctors expect, and why so many girls get missed

• Thyroid disease and how it shows up in the menstrual cycle before anything else

• Endometriosis in adolescents: when period pain is not normal and what to do about it

• Why birth control is sometimes the right treatment but not always the full answer

• How to advocate for your daughter when you feel dismissed at the doctor’s office

• The referral path from pediatrician to OB to specialist, and when to push for more

Connect with Dr. Natalie Crawford on Instagram @nataliecrawfordmd, visit her site ⁠https://www.nataliecrawfordmd.com/⁠ and buy her new book (paid link)⁠

00:00:00 The Paternalistic History of Women’s Health

00:01:19 Introducing Dr. Natalie Crawford & The Fertility Formula

00:02:56 The Stigma of Cycle Tracking and Menstrual Shame

00:04:53 Dr. Mona’s Personal Battle with Secondary Infertility

00:06:00 Overcoming the Unknown and Paternalism in Medicine

00:08:11 Empowering Younger Women to Advocate for Their Bodies

00:10:27 Raising Children to Trust Their Physical Cues

00:11:32 Dr. Crawford’s Personal Experience with Pregnancy Loss

00:13:13 Shifting Medical Research Toward Natural Fertility

00:16:33 Cultivating Fast Vulnerability in Doctor-Patient Bonds

00:18:15 The Ovarian Vault and the Biology of Puberty

00:20:25 The Brain-Ovary Dance: Follicular vs. Luteal Phases

00:21:59 Static on the Walkie-Talkie: Environmental Disruptors

00:23:40 Red Flags: School Refusal and Endometriosis Risk

00:26:03 Beyond the Basics: Upgrading Pediatric Screening Questions

00:30:11 Deep Dive into Hypothalamic Amenorrhea

00:33:14 The Metabolic Realities of Living with PCOS

00:41:43 The Diagnostic Criteria for PCOS and Clinical Workups

00:44:16 Thyroid Disease and Its Impact on Reproductive Hormones

00:48:15 Long-Term Health Risks Linked to Untreated Infertility

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00;00;00;00 – 00;00;26;05

Dr. Natalie Crawford

You know, women’s health in general has just been historically very paternalistic, where patients are told what to do, they’re not given an explanation. And when they ask questions or say they search something on the internet, it’s immediately dismissed. Or a doctor takes a lot of offense to it. The experience of not trusting your body and not knowing what’s happening in the unknown is just so overwhelming that we don’t even have the compass to say, is this normal?

 

00;00;26;05 – 00;00;34;25

Dr. Natalie Crawford

Right? Is this the right thing? Or how do I advocate for something else?

 

00;00;34;28 – 00;00;57;02

Dr. Mona

Welcome back to the show Doctor Mona here, your online pediatrician mom friend, I hope, combined into one here to support you through every twist and turn of parenting. You’re listening to the Doctor’s podcast, where I have honest conversations to help you feel informed and capable and confident. All the positive things as a parent, because we know it’s not always easy.

 

00;00;57;04 – 00;01;19;21

Dr. Mona

Don’t forget to subscribe and download your favorite episodes so more families can find us. So remember, you like this conversation? Awesome! Download it! But when you download all the episodes, the entire bank of conversations, it really helps the show. Did you deal with fertility issues as an adult? Did you have period pain or irregular cycles dismissed when you were younger?

 

00;01;19;22 – 00;01;42;15

Dr. Mona

Did you even know your period is a vital sign? When was the last time anyone actually taught you how your daughter’s body and menstrual cycle and hormones work? Not just, oh, she’ll get her period soon, but the whole picture. What’s normal, what’s not, and what gets missed for years until it can become a fertility problem. Because most of us didn’t learn any of this.

 

00;01;42;17 – 00;02;08;24

Dr. Mona

Today’s guest Natalie Crawford, double board certified in ob gyn and reproductive endocrinology, has spoken on national stages and on the national news. Host of the As a Woman podcast with over 5 million downloads and author of the fertility formula. But what makes her different isn’t just the credentials, it’s that she actually teaches you how your fertility works. This is a conversation important for you and your daughter.

 

00;02;09;01 – 00;02;30;28

Dr. Mona

Let’s get into it. And remember, if you learned something or think this message is important. Share our episode and our post on social and make sure to tag us at PedsDocTalk at the PedsDocTalk podcast, and at Natalie Crawford, MD. Let’s get into this very important conversation.

 

00;02;31;00 – 00;02;37;15

Dr. Mona

Thank you so much for joining me. I cannot wait to chat with you. And congratulations on this amazing book that’s out there right now.

 

00;02;37;17 – 00;02;56;07

Dr. Natalie Crawford

Thank you so much, Mona. It’s an honor to be sitting with you, and I love this topic so much. It’s something I’m very passionate about. And, you know, I know how hard it is. My my daughter’s about to turn 12, so we’re at that stage where I’m talking about, you know, periods, a menstrual cycle and puberty with her and all of her friends.

 

00;02;56;09 – 00;03;15;10

Dr. Natalie Crawford

But one thing that’s really interesting is in the promotion of this book. I’ve talked to probably 60 plus female podcast hosts, and one thing I’ve asked all of them is, when did you learn to track your cycle or track your ovulation? And I’ve not had anybody who’s told me they ever learn to track it until they were trying to get pregnant.

 

00;03;15;12 – 00;03;34;09

Dr. Natalie Crawford

And yet, if we sit here and say your period is telling you about your hormones, your underlying state of health and we’re never taught how to listen to that or what, it could be a sign of if things are not working normally. It’s really hard to advocate for yourself. And we know women’s health starts when routines, you know, pre-teens and teens, we go through puberty.

 

00;03;34;11 – 00;03;50;07

Dr. Natalie Crawford

It’s really tough because oftentimes you see a pediatrician, do you see an Gyn? It can be hard to get your questions answered. And just in general, there’s a lot of stigma and shame when it comes to menstrual problems. That makes it really hard to use our voice, whether it’s for ourselves or our child.

 

00;03;50;10 – 00;04;11;16

Dr. Mona

Yeah. And, you know, as a pediatrician, I see those issues early on. So when I was a trainee, right. So let’s say medical school even, you know, as an undergrad, when I would volunteer at hospitals, there was a lot of dismissal of period pain or irregular periods. And then I became a pediatrician, and even a lot of my mentors would say, okay, well, that’s pretty normal.

 

00;04;11;16 – 00;04;34;21

Dr. Mona

And I was like, okay, I guess it’s normal. And then I just started seeing a lot of my friends, you know, my my peers in their 20s, 30s who are trying to get pregnant, who had late diagnosis, PCOS or gender ptosis. I got diagnosed later. And so when you talk about this vital sign, when you talk about it being a clue to our health, you know, a lot of times in pediatric pediatrician offices, we will say, when was your last menstrual cycle?

 

00;04;34;21 – 00;04;53;09

Dr. Mona

But we don’t talk about anything beyond that, you know, and I want this to be something where pediatricians read a pediatricians listen to this conversation. Parents are listening so that they know that if they’re not getting asked these questions and their daughters are struggling with certain issues, that they get the help and awareness they need. So, thank you.

 

00;04;53;09 – 00;05;09;13

Dr. Mona

And just a side note, because unrelated to the menstrual cycle being a vital sign, Natalie is very important to me, and I’m going to try not to get emotional because I tend to want to get emotional on podcast. But I went through secondary infertility and it was more of my issues were related for a lot of our listeners.

 

00;05;09;13 – 00;05;28;14

Dr. Mona

I think you know this from traumatic issues with my first delivery and when I was going through secondary infertility was a very lonely place. It’s very isolating, even though, you know, other people going through it. And Natalie, because she was a friend, I would message her not for medical advice, but more so, like protocol. Does this make sense?

 

00;05;28;14 – 00;05;49;19

Dr. Mona

Like, here’s what I’m doing, here’s what’s going on. And honestly, the just the reassurance, calming tone, the, you know, feedback you gave not only personally, but what you do online on your YouTube podcast, social the world needs you have a book out. So thank you so much for doing all the work you do. But finally, putting out in book form.

 

00;05;49;19 – 00;06;00;08

Dr. Mona

And what made you decide to write the fertility formula? Having done all of the other things, and how does your concept shift the way we should think about fertility and reproductive health overall?

 

00;06;00;11 – 00;06;20;29

Dr. Natalie Crawford

Mona, thank you for that. That’s I’m going to get emotional because when you start putting information online, I think we tend to think of it as hypothetical. Hypothetically, I can help somebody who’s going through something because I’ve seen the patients who sit across from me struggling. But when you hear that, it really does help, you know, an individual in a moment who you did not clinically care for, nor could you because you can’t see so many people.

 

00;06;21;01 – 00;06;40;17

Dr. Natalie Crawford

It really drives home how, regardless of our education, you know what we’re doing, what we know, the experience of not trusting your body and not knowing what’s happening in the unknown is just so overwhelming that we don’t even have the compass to say, is this normal? Right? Is this the right thing? Or how do I advocate for something else?

 

00;06;40;20 – 00;07;03;00

Dr. Natalie Crawford

I always wanted to write a book, and part of it is because when I first became a fertility doctor, a lot of this field, you know, women’s health in general has just been historically very paternalistic, where patients are told what to do, they’re not given an explanation. And when they ask questions or say they search something on the internet, it’s immediately dismissed.

 

00;07;03;00 – 00;07;21;19

Dr. Natalie Crawford

Or a doctor takes a lot of offense to it. And I always felt that there’s a lot you can gain from trying to understand what’s normal. How do you how do you question things if your doctor can’t gauge it? But these patients knew nothing, so they had no way to advocate for themselves and for something that we don’t learn well enough.

 

00;07;21;22 – 00;07;53;00

Dr. Natalie Crawford

I thought a graduate would approach. Right. Let’s learn about hormones and the menstrual cycle and egg count and then abnormal cycles. And how do you track a cycle, then? How do you get pregnant and navigate infertility and the lifestyle factors that knowledge builds off itself like we like we learned in medicine but social media so great. But I would be saying the same things over and over, and I know you know this or I have talked about PCOS nearly a million times, yet somebody will come to my page today and for the first time and they’ll say, can you talk about PCOS?

 

00;07;53;02 – 00;07;53;14

Dr. Mona

Right?

 

00;07;53;16 – 00;08;11;29

Dr. Natalie Crawford

Right. Because it they’re brand new to it. And I think that fueled long form content to start and why I have a YouTube and a podcast. But really thinking, gosh, somebody who really wants to take ownership over their health, it’s more than you’re even going to get in a 20 or 30 minute conversation. You want to give them the place to dive in and then go back to a reference later.

 

00;08;11;29 – 00;08;45;06

Dr. Natalie Crawford

So I would say the perfect person for my book. You can leverage it at any place, but I would love for younger women to get it before they ever need to get pregnant or have any desire for pregnancy. Just the whole first half is learning about your body and then you can use it as a guide when you want to get pregnant, or you have infertility, or you have questions that we have the established fund of knowledge to be able to trust your body and show up and advocate for yourself with confidence, saying, no, I know it’s not normal to bleed through my clothes, or I know it’s not normal to have spotting for, you

 

00;08;45;06 – 00;09;16;14

Dr. Natalie Crawford

know, two weeks or to have such bad pain that I’m canceling my plans or not going to school because instead so many women tell me I’m just sensitive. That’s just the way I am. I don’t tolerate it as well as other people because they’ve been dismissed as young women. They create this identity where they never get their problem looked into, and instead it’s a true medical issue that then we’re only finding out about when we’re behind the game and failing to achieve something.

 

00;09;16;14 – 00;09;32;06

Dr. Natalie Crawford

That’s a life goal to us. So I think your first question was, you know, why the book and what do I want to do with it? I would say I my big picture goal, Mona, is that we totally change how we talk about fertility right now. Yeah, infertility is a failure. You try to get pregnant for a year, you’re not able to achieve it.

 

00;09;32;09 – 00;09;51;01

Dr. Natalie Crawford

Then, and only then do we do testing to try to see what is going on. And I don’t think that serves people, especially not women. Instead of say like, let’s learn about normal, let’s get earlier testing and treatment when things are not normal or before we want to get pregnant, so we can intervene sooner and feel confident in the decisions that we’re making.

 

00;09;51;02 – 00;10;08;00

Dr. Mona

I love it, and I already love how you mentioned how like people come to your page and they’re like, do you have that content? Like that happens every day? And I’m like, what can I do to make you guys? I have it on my website. You can search it online. I mean, there’s a real life size page and now you’ll be like, do I have a solution for you?

 

00;10;08;00 – 00;10;27;17

Dr. Mona

Oh yes I do. And you put up the book. I love that and I and that’s exactly why I’m writing my book as well. I could write many different books, and I’m sure you can. And you’re focusing on this, taking control of the future. And when me and you are chatting about what to talk about, obviously there’s so many things in this book that go beyond, you know, what we’re chatting about today is the menstrual cycle being a vital sign.

 

00;10;27;19 – 00;10;50;12

Dr. Mona

But I felt like it was just so important for my audience. Right. Parents, people who care for children, and I think that concept that you mentioned of not feeling like you can trust your own body just really resonates to me because that’s my entire platform. Like, how do we raise our children to know themselves, love themselves, trust their body, their hunger cues, their fullness cues, their sleep needs, their emotions.

 

00;10;50;12 – 00;11;08;20

Dr. Mona

And part of that is being able to advocate yourself for yourself. When something’s not going right in a menstrual cycle or in your, you know, female health, which it doesn’t help that the system doesn’t support it. So you’re you’re a pioneer. I love it when, you know, I say that in a not like your old way, but it’s like you’re changing the game way.

 

00;11;08;20 – 00;11;26;08

Dr. Mona

You know, we all we all are in some way, I think, on social media. But I also know that you’re a fertility physician and I don’t know if many people are aware of this, but you’ve also experienced infertility and pregnancy loss yourself. How did that personal experience, which, by the way, thank you so much for being vocal about that on your page.

 

00;11;26;10 – 00;11;32;04

Dr. Mona

How did that shape the way you approach reproductive health, patient care and also this book as well.

 

00;11;32;06 – 00;11;49;23

Dr. Natalie Crawford

Oh, such a great question. And you know, it’s easy for me in a way, I think, to share about my experience now because I’m on the other side of it. And I just do want to acknowledge that the people who are sharing in the moment, when they’re in the trenches, are truly changing the narrative for helping people not feel alone and infertility.

 

00;11;49;25 – 00;12;08;28

Dr. Natalie Crawford

And that wasn’t my story. I didn’t tell anybody. I felt so isolated when I went through it. But I had four pregnancy losses before my children. I was told I didn’t have enough losses to get testing done. You know, after two losses, I had to go lose another pregnancy first. When all my testing was normal, I was told, just do IVF.

 

00;12;09;01 – 00;12;32;02

Dr. Natalie Crawford

I was told nothing in my lifestyle could make any difference in IVF, and not that I was ever opposed to getting testing or to doing IVF. I just felt like despite being an Gyn, the questions I got asked were so quickly dismissed. Yet physiologically, did it make sense? It changed my whole career. I also I just want to like I was so unprepared.

 

00;12;32;05 – 00;12;54;08

Dr. Natalie Crawford

How? Experiencing infertility. As a fertility doctor I was in training. It made me professionally doubt myself to it felt in this personal bubble for a while, but in my head, if I can’t get myself pregnant, how to get other people pregnant? So I felt like a professional failure that just took me by surprise. And, and I think a lot of, you know, Type-A or successful women start to feel that way.

 

00;12;54;08 – 00;13;12;24

Dr. Natalie Crawford

We’re used to achieving our goals. This was a goal we’re not. And then we kind of lose control of of what’s happening. And it feels, you know, hurtful on so many different levels. We’ll just say that for me in fellowship. So four years of O.B. two, I ended three years of RPI. A year and a half of it is research.

 

00;13;13;00 – 00;13;38;00

Dr. Natalie Crawford

Most RPI fellows do an IVF lab project because they’re easier to control basic science. You have to publish a thesis and defend it at your oral board. So you have to have a project of merit. And I did not want to do that. I had done lab research for years and I went to my fellowship director said, I want to study natural fertility, period cycle tracking, ovulation, ovarian reserve, hormone levels, vitamin levels, endocrine disrupting chemicals.

 

00;13;38;07 – 00;13;59;28

Dr. Natalie Crawford

Those are the questions I have and I want answers to them. I’m very lucky I was at UNC, they have a huge school of public health and my fellowship said, well, if you want to do that, we’ll pay for you to get a master’s in clinical research because you’ll need that understanding in order to defend this thesis. So I got that master’s degree while I was in fellowship, and I studied the above mentioned things.

 

00;13;59;28 – 00;14;11;29

Dr. Natalie Crawford

And it really just changed my entire approach. And I love that the world is catching up now. But when I was talking about diet and inflammation and endocrine disruptors ten years ago, people called it, you know, fear mongering.

 

00;14;11;29 – 00;14;13;16

Dr. Mona

Yeah, you’re scaring people.

 

00;14;13;17 – 00;14;36;00

Dr. Natalie Crawford

You’re blaming them. And I felt as somebody who went through it, and I know you cannot control everything, but knowing that I was controlling what I could felt so empowering to me on my own infertility journey. Right. I don’t need to worry about this because I’m doing the best I can. I know what to do. It’s the unknown that is the scariest in my opinion.

 

00;14;36;03 – 00;15;02;08

Dr. Natalie Crawford

So that really propelled me on how I educate online, how I’ve always said my focus. Even though I do IVF every single day, I would love to need fewer patients. I would love for more people to have information to either get started early or get testing early, or have some of that knowledge. And really, the thing that I felt and I heard so often that propelled me more was had I known this information sooner, I would have done something different, right?

 

00;15;02;08 – 00;15;22;16

Dr. Natalie Crawford

I heard that phrase so often, I felt that in my soul every time a woman said it, because I felt that same way in my own journey and that, you know, really was the driving force behind this book. What is the information I just wish people could have earlier on to support them throughout this. But it all comes from my own journey as well.

 

00;15;22;18 – 00;15;30;23

Dr. Mona

Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show.

 

00;15;30;26 – 00;15;47;18

Dr. Mona

And I love that. Thank you for being so transparent. I love that you mentioned you’re on the other side because I have done the same thing as, you know, with my own fertility journey. I’m very vocal about that traumatic deliveries that I’ve had, postpartum complications. I’m obviously now three years out of the last, my last child being born.

 

00;15;47;18 – 00;16;05;13

Dr. Mona

I’m not having any more kids because I can’t physically. And we decided not to, expand our family, because we are content with what we have. But it’s so important to remember that perspective. But thank you for using that and saying so beautifully how it made you doubt yourself. I don’t think people realize that, especially about doctors.

 

00;16;05;13 – 00;16;28;04

Dr. Mona

Right. And I, I really enjoy having other fellow doctors, especially women doctors on social media with me sharing the humanity of us being human beings and doctors. Second, you know, because sometimes people forget that. Like, it’s like when I share parenting woes, right? They’re like, oh, you go through that too. And I’m like, yeah, because although I know what to do, my parents, my kids still do kid things because.

 

00;16;28;07 – 00;16;29;06

Dr. Natalie Crawford

They’re still children.

 

00;16;29;11 – 00;16;33;09

Dr. Mona

Yeah. I really appreciate that. You know, that’s such a good point.

 

00;16;33;09 – 00;16;53;25

Dr. Natalie Crawford

And I will say, especially in infertility, I sit across from people. I’m really lucky. I own my practice. We have 60 minute consults. I really get to know you, but I ask a patient to open up their deepest, darkest fears. They’re sharing very intimate details about their life. And for the people who follow me online, like the bond is faster.

 

00;16;53;25 – 00;17;12;09

Dr. Natalie Crawford

They know I’ve been through things. They they’ve heard me talk before. And I do think that that makes a big difference in helping that relationship strengthen, because it’s not so one sided. Right? I’m just this doctor in a white coat and you or somebody baring your soul to me, they see me more as somebody who really is invested in helping them, trying to get to this outcome.

 

00;17;12;09 – 00;17;30;01

Dr. Natalie Crawford

So I have found that being open and vulnerable, despite getting a lot of negative feedback originally. Right, I got on social media ten years ago, and there were a lot of people saying, you should have. You shouldn’t be on social that, you know, patients are kind of like, all the negative things like, yeah, all heard that. We’ve seen it to actually just be the opposite.

 

00;17;30;05 – 00;17;45;15

Dr. Mona

Yeah. And I love that. That’s been the story. And hopefully we can can continue to do that doing this. And I always say like if not the permanency of a book is like an amazing legacy, right? I tell my husband I’m like, yeah, like, this is amazing that now that I’m writing my own book, like to that even if social media dies out and.

 

00;17;45;17 – 00;17;46;27

Dr. Natalie Crawford

Instagram could go away tomorrow.

 

00;17;46;27 – 00;18;11;01

Dr. Mona

Yeah, right. You have the permanency of your beautiful book and I, I do want to get into this menstrual cycle being a vital sign. Right? And like I said, for many of us, whether it’s parents, clinicians who are used to thinking about height, weight, blood pressure as health markers and vital signs during adolescence, what symptoms around periods tend to get brushed off as normal?

 

00;18;11;02 – 00;18;15;03

Dr. Mona

Or it’s okay that you actually think you should have a closer look.

 

00;18;15;05 – 00;18;33;23

Dr. Natalie Crawford

I love it. I would love to give a quick kind of my very fast explanation of the menstrual cycle for somebody who’s maybe kind and wonderful. Yeah, they don’t even understand because I really think that we can all understand this and it’s going to help us know what’s normal. So what’s abnormal? First thing I want to say, women are born with all the eggs I ever going to have.

 

00;18;33;23 – 00;18;49;15

Dr. Natalie Crawford

I think most women have now heard this by this point, but I like to imagine them as stored in a vault inside your ovary. And every month a group of eggs is coming out of that vault no matter what. When more eggs are inside or the vault is crowded, more come out. And as the vault starts to get emptier, fewer come out.

 

00;18;49;17 – 00;19;06;07

Dr. Natalie Crawford

And each, I guess, microscopic, but grows in a fluid filled sac called a follicle. This concept’s really important to start with, because you may have heard that women, have their highest account when they’re a five month old baby inside their mother’s womb. They have 6 to 7 million by the time they’re born, they have 1 to 2 million.

 

00;19;06;08 – 00;19;23;28

Dr. Natalie Crawford

Biggest drop we have, because when we have more, we lose more. Next biggest drop happens between birth and your first period. What you’ll lose and you’ll get down to about half a million. So we have lost a majority of our eggs before we’ve ever ovulated a single egg. So what I want people are thinking about is that that means the ovaries are doing things this entire time.

 

00;19;23;28 – 00;19;43;26

Dr. Natalie Crawford

Puberty is not the activation of the ovary, it’s the activation of the brain. So in puberty, the brain turns on and starts being able to send out the signals from the pituitary gland, FSH and LH, which then eventually drive ovulation. It first turns on and we send out a fish follicle stimulating hormone, which is well named. It gets an egg to grow.

 

00;19;43;29 – 00;20;01;06

Dr. Natalie Crawford

That egg is going to grow and make estrogen. It actually takes about two years for the brain to be able to recognize and estrogen maturity. So this is why we think about puberty. We have those first couple of years of estrogen only exposure where we tend to think about breast growth development. We see, you know, axillary pubic hair.

 

00;20;01;06 – 00;20;25;22

Dr. Natalie Crawford

And we see our growth spurt before the period actually starts. Once estrogen has achieved that high level in the brain can sense it. It’ll then kick over into the ovulatory process. So all of these other months, a group of egg comes out never reaches maturity. They all die the next month. Another group, once we have full brain maturation, one of those eggs, when it gets to its peak, that high estrogen will have the brain send out a surge of LH.

 

00;20;25;22 – 00;20;48;03

Dr. Natalie Crawford

LH is luteinizing hormone, which allows the follicle that grew the egg to rupture. It’s a cyst assist is a fluid filled structure that’s just bursts. The egg is released. That’s our violation. And then that cyst reforms itself and becomes something known as the corpus luteum. This is called the follicular phase. The first part of a cycle from day one of bleeding until ovulation, where a follicle is growing.

 

00;20;48;05 – 00;21;09;20

Dr. Natalie Crawford

Estrogen only phase. There’s no progesterone after ovulation. That corpus sodium makes both estrogen and progesterone. This is called the luteal phase stimulated by LH from the brain, and this usually lasts about two weeks at most. Because the corpus luteum can only survive for about that long unless you get pregnant. So the corpus luteum will die. Progesterone will drop.

 

00;21;09;22 – 00;21;32;07

Dr. Natalie Crawford

It is that withdrawal of progesterone that gets the physical outward symptom of a menstrual bleed, and the process starts over. So it’s a really beautiful, coordinated dance between the brain and the ovaries to be able to have ovulation occur. And a few different things that I think are really important for people, women, but also parents who might be thinking about this for their child to understand.

 

00;21;32;10 – 00;21;59;25

Dr. Natalie Crawford

The brain has no idea what the ovaries are doing. This idea that our brain is, you know, omnipresent and just understands our body is so false. It’s really sending its interpreting messages. Let’s imagine the brain and the ovary are on walkie talkie. It’s waiting to be told that estrogen is high enough. It’s just waiting. And this means that you can have static interference on the radio from a variety of different things that interfere with the brain’s interpretation and how it responds.

 

00;21;59;27 – 00;22;23;07

Dr. Natalie Crawford

This can present with abnormal puberty, early puberty, late puberty, and irregularity and cycles. And a lot of this can be driven from excess weight gain because fat cells can make estrogen. So if we go back to the original concept, if we have excess estrogen earlier, we’re increasing that total estrogen and kind of turning on the brain activation earlier than we otherwise would have.

 

00;22;23;09 – 00;22;44;29

Dr. Natalie Crawford

And then we also can see from chronic inflammation or insulin resistance, which kids can have driven from some of our food. And the food choices we’re making, especially ultra processed foods, are very frequent eating intervals, not sleeping enough, chronic stress and stress a lot of times can come from family situations as well. Can all interfere with part of this brain ovary communication.

 

00;22;45;01 – 00;23;05;06

Dr. Natalie Crawford

So when we start to think about the period being a vital sign, we have to know, like the period is just one aspect of it, the bleeding, the entire menstrual cycle is really helpful and telling us what’s underlying. And when we think about normal, we want it to be regular and predictable. We want to be able to not know when we’re bleeding.

 

00;23;05;11 – 00;23;23;12

Dr. Natalie Crawford

Bleeding should. Typically, heavy bleeding is common for the first day or two, should not usually last more than a week. Five days would be average. It should get lighter as you go. It may end with spotting a day. A spotting before the heavy bleeding starts can be common, but more spotting than that can be a sign that something has abnormal.

 

00;23;23;14 – 00;23;40;19

Dr. Natalie Crawford

And there’s many girls will have like a week plus of spotting. And that’s definitely telling us that something might be going on and then bleeding through your clothes should be almost a never the exception might be if you’re sleeping right in your period first starts, but we shouldn’t be chronically bleeding through our clothes when we have pads or tampons.

 

00;23;40;19 – 00;24;15;15

Dr. Natalie Crawford

N and then you’re pain. You’re you’re it’s normal for the process of having a period. Your uterus is expelling those menstrual contents of the endometrium, and it does cramp to help get things out. It’s usually noticeable, but taking pain medication that’s over-the-counter like Tylenol, Advil, Motrin, Aleve, heating pad, it should be tolerable. And when young girls want to stay home from school, having an adolescent or a teen tell me that their period is so painful that it kept them home from school, has almost a 90% positive predictive value that they have.

 

00;24;15;15 – 00;24;17;25

Dr. Natalie Crawford

Endometriosis as an adult.

 

00;24;17;27 – 00;24;18;07

Dr. Mona

Interested.

 

00;24;18;09 – 00;24;35;00

Dr. Natalie Crawford

Me in that. Crazy. So like when you say not just like I don’t want to go, but the pain is so bad that I do not want to go. That usually we think it’s because we trust ourselves. When we’re a child, we believe that pain, it’s interfering with our lives and we’ll stay home if you have that same pain every month.

 

00;24;35;00 – 00;24;52;18

Dr. Natalie Crawford

Women are so resilient. What are you going to do? You’re going to say, I just don’t tolerate it like my friends. I’ve got to just deal with it. And so we tend to adjust or change our expectations. And these are the women who say I have a poor pain tolerance, etc., when in reality they have huge pain tolerance.

 

00;24;52;20 – 00;25;11;28

Dr. Natalie Crawford

They are just dealt with higher levels of pain because of the nature of endometriosis. So it can take a while. I think one of the hardest things in adolescence, or when you’re first starting a period, is that you’re going to start ovulating. And those first six months or so, you may not have a perfectly regular pattern, right? The brain has just turned on.

 

00;25;11;28 – 00;25;32;12

Dr. Natalie Crawford

It’s just figuring things out. But once we get outside that window, you should have a regular, predictable period. And when you do not, we start worrying about is there some external source that’s interfering that could be at the brain level, could be the thyroid gland. It could be at the ovarian level. It could be, you know, from the external environment that should be looked into.

 

00;25;32;12 – 00;25;57;12

Dr. Natalie Crawford

And certainly a lot of teens will present with menstrual abnormalities. That can be from not eating enough calories from dieting, over exercising, from PCOS, from thyroid disease. These all often get diagnosed because they come in for the period problem way later on versus some of the other symptoms that they’ve been experiencing. And we definitely should talk about extreme dieting and hypothalamic amenorrhea at some point.

 

00;25;57;12 – 00;26;03;20

Dr. Natalie Crawford

It don’t have to be this minute, but I think it’s, undertreated in. Teen girls are not often managed the right way.

 

00;26;03;26 – 00;26;27;07

Dr. Mona

I well, I love all of this, especially what you mentioned about the stats about endometriosis, which I would love to talk about as well. Because I feel like as a pediatrician, because pediatricians are one of the first line people talking to these children, and we are not trained to a level that we should know. So in your dream world, what are some of the questions that my fellow clinicians should be asking families like?

 

00;26;27;07 – 00;26;43;28

Dr. Mona

Is it because, you know, like I mentioned at the beginning, sometimes we’re asking about, you know, when was your last menstrual period, but would you want to talk about heaviness or how often, what other things are we missing in that conversation to kind of cue our brains like, hey, we need to do more. And then my next question will be, what do we do if we’re concerned?

 

00;26;44;00 – 00;26;45;19

Dr. Mona

But I would love to hear that. Yeah.

 

00;26;45;21 – 00;27;03;29

Dr. Natalie Crawford

So I would say it’s not just like when was the last, which we always want to ask to make sure we’re not actively potentially pregnant. But you know, if I gave you a calendar, could you put your finger on when you expect your next period to be and would you be, you know, correct, essentially the regularity of it, a lot of girls will present with what I call irregularly regular period.

 

00;27;03;29 – 00;27;29;04

Dr. Natalie Crawford

Like it’ll come somewhere between a 4 to 7 week interval. So they will declare, they’ll give you a date that makes sense and they’ll say, yeah, it’s normal because that’s normal for them. So instead of that, you know, asking them maybe when was your last one okay. When do you think your next one will be in. Is that at what we would normally expect to be, you know, a 25 to 35 day interval from then or is, oh, they just marked seven weeks on the calendar.

 

00;27;29;04 – 00;27;47;09

Dr. Natalie Crawford

Like, that’s not normal. I should look into that more. Do you have a lot of bleeding in between your periods, so that break through bleeding can be a sign of hormonal issues. Thyroid is a big one that pops up and so is prolactin. High prolactin use can come from a variety of different reasons. I probably saw it most.

 

00;27;47;09 – 00;28;08;27

Dr. Natalie Crawford

I see it a lot now, but I also saw it a lot when I was working in the pediatric endocrinology clinic in fellowship. And a lot of this can be from some mental health medications from ADHD, medications for medications for depression. They can often change in, you know, prolactin secretion from the brain. And high prolactin blunts the brain’s ability to make FSH and LH.

 

00;28;08;27 – 00;28;32;12

Dr. Natalie Crawford

So you tend to see very classic spotting in your periods, shorter cycles, irregular cycles, and then your cycles go away as prolactin levels rise. So what we do about that is depends on the scenario based on the medication they’re on and how important it is, but it can be a clue. High prolactin can also come from a brain mass, so obviously manage very, very differently depending on what’s happening.

 

00;28;32;15 – 00;28;48;18

Dr. Natalie Crawford

Bleeding through clothes when using menstrual products, as we said. And that one’s a little bit tougher because you have to make sure that they know. Are they choosing the right product, how often are they changing it, etc. but really it should not be the normal. Yeah, I always bleed through my clothes. That should not be normal. And that’s a sign.

 

00;28;48;18 – 00;29;09;24

Dr. Natalie Crawford

Could be a sign of a bleeding disorder. You know, which would be more common in the teen or adolescent years, but can also be a sign of, uterine fibroids or an endometrial polyp or PCOS. Kind of another clue that things could be irregular because they’re building up and in the pain. And I think the pain one is hard because a lot of people think, oh, asking about school, nobody wants to go to school.

 

00;29;09;24 – 00;29;25;11

Dr. Natalie Crawford

So if they’re going to like, stay home, what I usually would say is like, hey, when your period starts, if you are going to go to the movie with friends, would you stay home instead? Or if you were going to go to your, you know, what’s your favorite restaurant? Oh, you love sushi. Okay, it’s the day your period starts and your family’s going to sushi.

 

00;29;25;11 – 00;29;39;18

Dr. Natalie Crawford

Would you still want to go? And if a child is going to say no, they don’t want to do an activity that they deem very fun because of their period. That’s a that to me is a big red flag as well.

 

00;29;39;21 – 00;29;47;20

Dr. Mona

Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show.

 

00;29;47;23 – 00;30;02;22

Dr. Mona

I you know, one of the biggest things I love that because yes, you’re right. Like I was just going to say like, how do we differentiate the school refusal of like, yeah, that’s not fun for me. But like knowing that they would not with miss out on things that they would normally want to. That is definitely a red flag in my mind.

 

00;30;02;22 – 00;30;11;20

Dr. Mona

And I love these questions already. I would love to dive into three things the endometriosis, PCOS. And then you mentioned thyroid hypothalamic.

 

00;30;11;23 – 00;30;12;22

Dr. Natalie Crawford

What was.

 

00;30;12;24 – 00;30;13;21

Dr. Mona

Happening?

 

00;30;13;23 – 00;30;37;04

Dr. Natalie Crawford

Yeah. Okay. Let’s dive into them and let’s go backwards first because hypothalamic amenorrhea I think is has the biggest impact and isn’t always managed appropriately. So if you’re a parent or a physician, we might see this girl. Hypothalamic amenorrhea is let’s just say the walkie talkies are now no longer like the brain’s is turned off. The ovaries can tell the brain whatever it wants.

 

00;30;37;06 – 00;30;59;23

Dr. Natalie Crawford

The brain, which is where the hypothalamus is the control center of the brain, is no longer responding or interpreting signals. What that means is that the pituitary gland will not send out FSH or LH. You will not ovulate, you will not make estrogen. And this is so important for girls long term health and development. Because in these early years especially, we’re laying down a lot of our bone from this estrogen.

 

00;30;59;26 – 00;31;23;03

Dr. Natalie Crawford

And so when we see teen girls who have hypothalamic amenorrhea specifically, it’s a chronic low estrogen state. They number one feel terrible. They tend to have headaches. They have trouble concentrating or brain fog, low energy, lack of interest in things. So so they don’t feel like themselves. They don’t feel good. And they don’t have a period because of the hypothalamus is turned off.

 

00;31;23;03 – 00;31;50;07

Dr. Natalie Crawford

They’re not having a period. The top causes in these years is going to be low calorie intake, especially for teens who are dieting, trying to like restrict and lose weight, eating disorders like anorexia or bulimia and over exercising or some of our competitive athletes. We see gymnasts, figure skaters because they have an energy mismatch. It’s worth saying that chronic disease, autoimmune disease can present this way for a first presentation chronic stress in the body or the home.

 

00;31;50;14 – 00;32;13;05

Dr. Natalie Crawford

So if you have a girl who has I used to have I had my periods, but they’ve been gone for a year. She’s jealous off all these symptoms. She might have low estrogen, explaining all of the symptoms. Number one, we do need to make sure it’s not high prolactin, thyroid disease or ovarian failure. You know, I have a handful of girls whose ovaries turned on and then off in their teen years.

 

00;32;13;07 – 00;32;31;09

Dr. Natalie Crawford

They need to be managed very differently. And then we have to have the often have to say this is a diagnosis of exclusion, you know, really asking them about activities, food that they’re eating, medications that are taking, brain MRI, etc. but if it is hypothalamic or yes, the brain is no longer interpreting these young women need hormone replacement.

 

00;32;31;09 – 00;32;54;17

Dr. Natalie Crawford

They need estrogen for sure. And it doesn’t have to be a birth control. But it can we sometimes you give estrogen and we cycle progesterone. You would probably need me to help guide you in what we’re going to do. But the identification that your estrogens low and it shouldn’t be. And the reason why is the brain’s not going to respond as I need to support you with estrogen to feel like yourself.

 

00;32;54;17 – 00;33;13;11

Dr. Natalie Crawford

Have an interest in your activities, protect your brain, protect your bones. Estrogens life changing. And these young women. Just think about the discussion we have right now for women who are in perimenopause, in menopause, how do we know what estrogen is life changing for them? It’s it’s it’s even more so for teens who should be having a really high estrogen level.

 

00;33;13;14 – 00;33;38;12

Dr. Natalie Crawford

And we can diagnose this by a, you know, history. But also on lab work. Right. If FSH and LH are low and estrogen is low, it is hypothalamic amenorrhea. So that is something that needs a very specific treatment for it. PCOS and endometriosis are kind of different, but more common I would say PCOS is in short, the easiest way to think about it is being born with a high number of eggs.

 

00;33;38;15 – 00;33;55;11

Dr. Natalie Crawford

It really becomes a metabolic disease. But if we want to think about it again, the brain doesn’t know what’s happening in the ovary, so it sends out a normal amount of f h. Well, if you have 40 eggs one month instead of the normal, we’ll say is 20. That same FSH signal is getting halved to every single egg.

 

00;33;55;17 – 00;34;13;19

Dr. Natalie Crawford

So it is not a strong enough signal to get an egg to grow and respond and start making estrogen. It can take longer. So if it’s not as strong, it needs more. And so eventually you might catch and start ovulating. But these very long cycles, all those days, you’re not making quite as much a student as you should.

 

00;34;13;19 – 00;34;35;29

Dr. Natalie Crawford

The ovary loves to make hormones, and in this case starts making testosterone because it’s getting some stimulation, just not quite enough. It’s not as detrimental long term because each tiny follicle makes some estrogen. So the difference in having an estrogen level of 20 from 20 follicles and a baseline estrogen of 40 is actually quite different for your long term health.

 

00;34;35;29 – 00;35;00;09

Dr. Natalie Crawford

So you don’t tend to have all the same low estrogen symptoms that somebody with hypothalamic amenorrhea would have because you’re a little bit protected for reference and a normal menstrual cycle when you’re ovulating, your estrogen is closer to 200. So we’re still way under. You’re used to having to function optimally. But that shift in testosterone production causes acne can cause hair growth in places that you don’t want.

 

00;35;00;11 – 00;35;23;21

Dr. Natalie Crawford

It can cause you to have that beer belly right where men distribute that that abdominal fat gain, instead of what we think about as a female like hips and thighs, specifically that lower abdomen fat and this all kind of counters with the metabolic health of having insulin resistance, which is tightly tied to our lifestyle. So even if we didn’t lifestyle our way into it, you’re born with PCOS.

 

00;35;23;24 – 00;35;39;02

Dr. Natalie Crawford

The choices you make, especially for teens, like getting enough sleep, how we help them deal with stress that they encounter, which I do find you. You probably feel strongly about this, that a lot of times parents sometimes are dismissive of children’s stress because it’s so different than parental strikes.

 

00;35;39;05 – 00;35;45;07

Dr. Mona

What do you have to be stressed about? Like you don’t? Your life is so easy. So much. Yes, I do, yeah.

 

00;35;45;09 – 00;36;22;16

Dr. Natalie Crawford

And again, to them and to their body, chronic stress does cause insulin resistance. And so really trying to think about how we are supporting and understanding, how do we manage stress, the foods that we’re providing and how we model good behavior. Fruits and vegetables, fiber, how that decreases insulin resistance and inflammation. So important in anybody but especially in young girls with PCOS and then building muscle, you know, building and using skeletal muscle, of course, as we’re going through, you know, our adolescent and teen years is something that’s not often talked about as much but is so important for PCOS, long term management, because it can decrease inflammation and can really help with this

 

00;36;22;16 – 00;36;44;02

Dr. Natalie Crawford

insulin resistance combating. And then the the plastic use and you probably feel stronger about this than me. You know, I studied PFC so endocrine disrupting chemicals in fertility when I was in fellowship forever ago. I remember coming home and like getting rid of all of our products. And then afterward, having finally getting pregnant, having my daughter and taking her to daycare, I had these fancy glass bottles and they’re like only plastic bottles.

 

00;36;44;04 – 00;37;05;21

Dr. Natalie Crawford

I remember coming home and like, sobbing, right? Like, okay, that these are so bad and they heat them up and just feeling like there’s nothing I could do about it. And you know how overwhelming that can feel as a parent. And what I try to tell people, whether it’s their own journey or their children, is, you know, pay attention to the things you do in your house, like them that your children are exposed to the most.

 

00;37;05;21 – 00;37;29;06

Dr. Natalie Crawford

Those are the things you can control. There’s always going to be external factors, whether it’s at school or a friend’s house or out to eat, that you don’t control those environments. But endocrine disrupting chemicals can cause abnormal ovulation, hormone production, impact, long term fertility, puberty onset, thyroid function, all the things we’ve talked about. And so trying to cultivate a home where we are decreasing those does play a role.

 

00;37;29;08 – 00;37;44;04

Dr. Mona

I agree. And I think, I with plastics and stuff, I take that same mentality like let’s reduce as much as we can without losing sleep over it. Right. Like where what are the small steps that we can take? And I agree with you, I wanted to I had one question before we go into thyroid disorders about the PCOS.

 

00;37;44;04 – 00;38;03;26

Dr. Mona

And to be to be honest, I love I’m loving this because I this is probably one of the I have had this podcast for six years. I am like taking notes for myself as a clinician, and that rarely happens because I feel like I know the stuff in your tracks pretty well. But when you’re coming in, because this matters to my population.

 

00;38;03;26 – 00;38;20;28

Dr. Mona

But I’m like I said, we didn’t get training. So the first thing is my question about PCOS. And you talked about how it’s, when the signal’s not strong enough, it doesn’t, you know, you’re having, it starts making testosterone. Why does it switch to start making more testosterone? Is there a reason why the body is now going into testosterone production?

 

00;38;20;28 – 00;38;24;29

Dr. Mona

More than because there’s no estrogen or, you know, the fish is not there as much?

 

00;38;25;06 – 00;38;42;28

Dr. Natalie Crawford

Yeah. The way I like to explain this to patients is, you know, in in the perfect dance, these hormones are released in tandem, right? Drives an egg growth. Estrogen talks back to the brain. High estrogen levels tell the brain to send out LH. What happens is kind of twofold. One is that estrogen testosterone can go back and forth.

 

00;38;43;04 – 00;39;01;23

Dr. Natalie Crawford

So a little bit higher baseline estrogen predisposes you to make some more testosterone. Second is going to be the fact that this FSH to estrogen pathway is blocked where it’s not communicating well. And so the brain will start to say but LH makes testosterone and that pathway works really well. So it gets some positive feedback to keep that going.

 

00;39;01;28 – 00;39;26;22

Dr. Natalie Crawford

And the estrogen wants to make hormones. But third, and probably most important is that insulin resistance predisposes the ovary to make androgens over estrogen. So we really many different things are leading to the same outcome. And I think patients can start to hear how tied together they are. Which means we have to take a really proactive approach. And unfortunately, a lot of clinicians too will say, oh, well, PCOS just happens in a certain phenotype.

 

00;39;26;22 – 00;39;50;10

Dr. Natalie Crawford

They say, oh, because, you know, PCOS can cause you to be overweight. That that can be true. They will often see young thin girls and they’ll say, you can’t have PCOS, right? And that’s not the case either. Think about it. If you’re born with a lot of eggs, this is probably due to some exposure or something genetic your mom had when she was pregnant with you, because that’s when you were supposed to lose most of your eggs.

 

00;39;50;13 – 00;40;11;19

Dr. Natalie Crawford

Something and that time period probably reprogramed your ovaries to have this mismatch between what the brain’s telling it and how it wants to respond. It’s not that, oh, she was overweight and it caused this. Being overweight can be kind of a symptom of it, but not in everybody. There’s many young women who are lean who have this exact same problem.

 

00;40;11;21 – 00;40;33;16

Dr. Natalie Crawford

And it’s why, though, we can imagine if we kind of understand the disease that. Yeah, but if I lose 5 to 10 pounds and I am overweight, it will lower some of your baseline estrogen and the brain may now be able to communicate clearer. So it can be a treatment strategy for all. But I wish more clinicians would stop just saying, oh, they don’t meet the classic look of it and just assume that it’s not PCOS.

 

00;40;33;18 – 00;40;45;09

Dr. Natalie Crawford

Especially especially in these girls 20 and younger, they definitely can present with period symptoms or acne as the chief complaint, for sure, without having, you know, being overweight.

 

00;40;45;12 – 00;41;01;16

Dr. Mona

Do you feel like the hair growth is a like, you know, Andrew Andrew, genetic hair growth. So like, you know, facial like facial hair in places that women technically not it. Right. Like like the beard, sideburns. Like, do you feel like the hair growth is pretty indicative, or some women can have PCOS without the hair growth, too.

 

00;41;01;16 – 00;41;02;05

Dr. Mona

Oh.

 

00;41;02;07 – 00;41;15;14

Dr. Natalie Crawford

It’s you know, it’s really tough. And I think this goes both ways. One is that there’s a lot of different ethnic distribution of what our body hair is going to look like, especially here. You know, in the U.S, we tend to think you should have zero body hair, and that’s not really what we’re all predisposed to have.

 

00;41;15;17 – 00;41;17;22

Dr. Mona

And I can tell you that’s true. Yeah.

 

00;41;17;25 – 00;41;43;20

Dr. Natalie Crawford

So I think that, you know, we have to understand like what we have to give grace for, like there’s different levels of what is normal and what’s not normal. And so definitely, I would say not every woman with PCOS has abnormal hair growth, but it can be one of the signs that signs as a clinician, you have to ask, because we have such great hair removal technology now, I will have a lot, I will say Indian parents who struggled immensely with facial hair.

 

00;41;43;23 – 00;42;03;00

Dr. Natalie Crawford

Yeah, like they got it lasered off their daughter at a young age. So if I’m just using my eyeball test like she’s doesn’t have any, but that doesn’t mean it couldn’t have been a sign. So saying like, have you ever had abnormal hair growth? Have you ever needed a treatment for that? Or a medical treatment? That’s an important distinguishing factor too, because just saying, well, I don’t see any.

 

00;42;03;00 – 00;42;19;27

Dr. Natalie Crawford

So it’s not a problem. Same thing with acne. I don’t see it. You know, they may be managing it in another way, but we should also say right. Male pattern baldness can be a sign of high androgens too. So losing hair, especially in kind of what we think about that male pattern area, is also a high androgen sign.

 

00;42;20;03 – 00;42;38;28

Dr. Mona

Yeah. And I think, again, going to all of this kind of encompassing understanding that two different people can look a little different. And that’s exactly you brought up exactly why I saw that concern. I have a lot of leaner Indian women who got misdiagnosed or, you know, underdiagnosed. And then that’s what led to the fertility issues down the line.

 

00;42;39;01 – 00;42;58;17

Dr. Mona

And that is why I’m like, oh, very interested. And a lot of it is for anyone who’s not familiar, including, like you just mentioned, with hypothalamic amenorrhea. A lot of this with PCOS is also lab workup, not necessarily imaging. Right. I know you can do ultrasounds, but that’s usually not the gold standard for diagnosing. It’s more so looking at the clinical picture and labs.

 

00;42;58;20 – 00;43;21;12

Dr. Natalie Crawford

So for PCOS specifically it’s going to be two out of three. And so one would be having irregular or absent periods. So I can ask you those questions. Second is going to be having clinical or lab values of high androgens. So excess hair growth acne that meets the criteria. So would a high testosterone level. And then the third would be polycystic ovaries on ultrasound.

 

00;43;21;14 – 00;43;42;08

Dr. Natalie Crawford

Some places are using a high AMH which is a blood test. But essentially if you sit here and tell me I have terrible acne, my periods are irregular. You meet the criteria to be diagnosed with PCOS and like that isn’t like, oh, you have to force a young woman to go get a vaginal ultrasound or something that might feel really intrusive for a young girl.

 

00;43;42;11 – 00;44;03;21

Dr. Natalie Crawford

We often can get there through clinical kind of work up, and then bloodwork can support it if we’re unsure. Sometimes blood work can be helpful, and I think that that’s kind of a misnomer. Hypothalamic amenorrhea must have blood work to diagnose, and then young girls should have a brain MRI to rule out a brain mass. Depending on how the lab work is coming.

 

00;44;03;27 – 00;44;08;09

Dr. Natalie Crawford

We don’t want to just assume it’s from not eating enough and miss a pituitary mass.

 

00;44;08;11 – 00;44;16;09

Dr. Mona

I’d love to talk about thyroid because that’s another big one. I know there’s also other things. And then after that I have a question follow up that I will ask you about all of these combined.

 

00;44;16;09 – 00;44;37;06

Dr. Natalie Crawford

Yeah, thyroid disease is so tied together. And this is something that I think people really understand about your thyroid is a butterfly shaped gland in your neck, and it makes thyroid hormone call it T3 and T4. So essentially these are your thyroid hormones. And your thyroid hormones work throughout your entire body. They control temperature growth, metabolism. They come back and they talk to your brain.

 

00;44;37;06 – 00;44;58;14

Dr. Natalie Crawford

They’re important for brain health. Your brain interprets your levels and then is also going to talk through the same process hypothalamus to the pituitary gland to the thyroid gland, to make more or less one of the hormones from the pituitary gland that gets sent out is called TSH, or thyroid stimulating hormone. The reason why this is so important and impactful is if I use my cup.

 

00;44;58;14 – 00;45;17;15

Dr. Natalie Crawford

The pituitary is so interesting because it’s mapped. There’s different areas on the pituitary gland that make a solo hormone, the gonadotropin or FSH and LH, the hormones that come from the pituitary gland that work on the go down to the ovaries are the furthest away from the blood supply, but they’re also close to a lot of different hormones.

 

00;45;17;15 – 00;45;40;16

Dr. Natalie Crawford

So for TSH, if the thyroid gland is low. So thyroid hormones are not being made enough, the brain interprets there’s not enough. It tells the pituitary, please make more thyroid hormone and we see a lot of attention. Go to the area in the pituitary where TSH is being made. And that is going to suppress the release of FSH and LH, because now our blood supply is going to this thyroid specific center.

 

00;45;40;19 – 00;46;05;18

Dr. Natalie Crawford

Thyroid then is diagnosed by a high TSH and low circulating thyroid hormones T3 and T4, but often can present with period abnormalities in both states. So hypothyroid is those low thyroid hormones. Hypothyroid is going to be having an overprotective thyroid gland. Both of these can come from autoimmune disease but not always are there. So it’s really important to look.

 

00;46;05;18 – 00;46;28;00

Dr. Natalie Crawford

And if you have family history of autoimmune disease at all, autoimmune hypothyroidism or Hashimoto’s is going to be one of the top causes of autoimmune disease that we tend to see. These girls can have extreme. So when your thyroid hormone is extremely making nothing or a lot, you can get very, very sick. You can end up, you know, in the hospital, you know, it can cause huge disruption because it’s so important for the brain and for your whole body functioning.

 

00;46;28;07 – 00;46;47;05

Dr. Natalie Crawford

So trying to capture somebody much earlier in the process is so important. So whenever you have in your regular cycle at all thyroid, a full thyroid panel should always be part of the part of the paradigm of what we are checking. And so we should never tell a young girl. My period is irregular and we say, oh, that is normal.

 

00;46;47;11 – 00;47;09;21

Dr. Natalie Crawford

We should say, oh, let’s make sure that it’s not. And the thyroid labs should be checked as a part of this. Treating hypothyroidism is so easy, relatively we can replace with thyroid hormone. There’s of course more nuance to that. But that thyroid gland is important for growth and development throughout all all of your time. If it’s hypothyroid is it’s actually a little bit more complicated to treat it.

 

00;47;09;21 – 00;47;15;14

Dr. Natalie Crawford

But the earlier we know about it and we can intervene, the better it will be.

 

00;47;15;17 – 00;47;36;25

Dr. Mona

Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show. Oh, and that was the exact question. That was my follow up that I said I had a follow up. Right. We’re talking about all these three major things the hypothalamic amenorrhea, PCOS, thyroid disease. You already mentioned that when we know about these things, we can hopefully manage it.

 

00;47;36;29 – 00;47;56;00

Dr. Mona

And the goal of that is that that can perhaps reduce the fertility issues down the line. Correct. Exactly. And you know. Yeah. Like maybe explain why like obviously you just mentioned that if you can manage the thyroid disease, then of course then we have the FSA and that can probably start working on board again to get the follicles working, menstruation back on track, all of that.

 

00;47;56;06 – 00;48;15;02

Dr. Natalie Crawford

So each disease is a little bit different. But like in in overall if we we gonna put everything together. Well one thing we can say is that having infertility let’s go from the back and come forward. Yeah. Not being able to get pregnant for 12 months is associated with later health risks, notably metabolic syndrome, heart attack, stroke, earlier death, cancer.

 

00;48;15;09 – 00;48;34;29

Dr. Natalie Crawford

That’s a huge scary statistics. But why is that? Is that by the time you’re trying to get pregnant, have infertility, there’s underlying cellular metabolic dysfunction that has gone on so long, you’re at a point where some damage has been done. Of course, if we’re diagnosing it at the infertility stage, we want to modify, get it on a different health trajectory there forward.

 

00;48;35;01 – 00;48;51;22

Dr. Natalie Crawford

But especially for women. And we think about your eggs inside your body your whole life. We think some of these statistics and how scary they are, if we can mitigate these factors even earlier, huge impact for long term health and for fertility as well. We think about things like the thyroid gland. I’ll walk through a couple of the thyroid gland.

 

00;48;51;22 – 00;49;15;15

Dr. Natalie Crawford

Right. It it it has so much it has to do when it has to work over time longer it will poop out and do nothing. It’s going to be much easier for your long term health if your thyroid gland still functions. And we’re supplementing it with some additional thyroid hormone support, versus if it is completely and a failure and can’t do anything, your risks long term are different in those two scenarios for PCOS.

 

00;49;15;15 – 00;49;37;07

Dr. Natalie Crawford

Well, knowing this earlier teaching young women how to reduce insulin resistance, how to cultivate a life where they have less chronic inflammation, understanding what this can mean when they want to get pregnant, meaning a no fault of your own. You might have to do ovulation induction. You might need some medical treatment earlier intervention. Just knowing that can change how they approach their health.

 

00;49;37;07 – 00;49;56;26

Dr. Natalie Crawford

And a lot of these really critical years where we’re establishing the foundation for our metabolic health. And I, I have nothing. I love birth control like I didn’t get just there’s so many positives that it does. It gives you a reproductive freedom. It can be a great treatment for disease. But we have to acknowledge the world we live in where a girl has acne and irregular cycles.

 

00;49;56;26 – 00;50;18;19

Dr. Natalie Crawford

A doctor might say here, this birth control pill will treat it. That’s not necessarily wrong, but what’s wrong is saying, hey, this is from PCOS. One of the treatments we can do is the birth control pill. This is why it’s going to help, but it’s not changing any of this. Insulin resistance is metabolic health. And when you start working on this and when we stop it, these symptoms will come back.

 

00;50;18;19 – 00;50;34;29

Dr. Natalie Crawford

So we need a game plan when you want to come off of it. So just that simple thing, even if it’s not the wrong treatment, how we’ve been giving it as treatment is wrong without any autonomy and understanding. There’s an underlying disease and starting to give people the opportunity to make changes for that.

 

00;50;35;03 – 00;50;54;13

Dr. Mona

And I love that as a, you know, encompassing what we had said earlier about we need better education. And this is why I’m like literally like taking notes, not only because I want it for like, you know, the when we promo the episode. But for myself, I think this is so important because I knew about PCOS, I knew about thyroid disease, and I was testing blood work for, you know, FSH.

 

00;50;54;15 – 00;51;10;05

Dr. Mona

But then the just the name of having hypothalamic amenorrhea in my head, I needed that reminder. And so like I said, I’m learning so much and I can’t wait to dive into your book to be even a better advocate for my patients to be like, hey, this is what we need to do. And I love the point you made about the birth control.

 

00;51;10;05 – 00;51;29;03

Dr. Mona

I also agree that hormonal therapy, like birth control, can be extremely valuable, but I do believe that it’s thrown like a kitchen sink without getting into the underlying. It’s like it’s like for me, in my world, it’s like when people give melatonin for sleep, okay? Issues that why you’re not sleeping, like there’s definitely something else going on. Maybe it is that you have jet lag.

 

00;51;29;10 – 00;51;33;09

Dr. Natalie Crawford

Like it’s not wrong, but it’s not ness. Right. And how it’s being recognized.

 

00;51;33;09 – 00;51;59;28

Dr. Mona

And I think that’s a very valid point. And I love this because again, our goal and my goal, your role as well is to like, have have women have the best chance of expanding their family. That’s what they want, right? And I think when we don’t do that and ask these questions and get the curiosity going on like, hey, this is a vital sign what’s going on, and just throw the kitchen sink or not really walk them through what we can do for them is we’re doing a huge disservice to our families and our patients.

 

00;52;00;03 – 00;52;17;00

Dr. Natalie Crawford

Absolutely. You know, women deserve more tools in the toolbox. Yeah. So you shouldn’t deserve to know what’s what’s out there. But a lot of these tools are, you know, come from where we started this conversation. Like understanding what’s supposed to happen normally so you can navigate when it doesn’t in an easier way.

 

00;52;17;02 – 00;52;28;18

Dr. Mona

Is there anything else that we missed about menstrual health in the adolescent years that you wish we would know you already went through, like the regularity, the things that you talked about, but is there anything else high yield that you want to share today?

 

00;52;28;20 – 00;52;45;20

Dr. Natalie Crawford

I guess I guess we can like a couple of the points really, really fast because I said them like in a sentence, but we could drive them home. Yeah. You know, young women can, you know, you should start puberty, you should start your period within two years of breast development, and you should have a period by age 16, you know, at the latest.

 

00;52;45;20 – 00;53;13;09

Dr. Natalie Crawford

And if you are not, please go to a doctor for an evaluation. And I have diagnosed young woman with ovarian failure for a variety of different reasons. They sometimes need puberty initiation with estrogen. They do not need puberty initiation with a birth control pill that will absolutely change their breast development if they won’t reach their max height. So we need to very systematically approach how we initiate puberty in them and if they’ve gone into ovarian failure, they need hormone replacement therapy.

 

00;53;13;09 – 00;53;40;10

Dr. Natalie Crawford

It’s not optional. It’s mandatory for them, or they will have much higher health risks later on in life. Number two for endometriosis, if we think somebody has endometriosis, which is usually a pain basin syndrome, it can be really tough in adolescence because it’s a surgical diagnosis. We don’t always want to put young girls through surgery, but putting a young woman through surgery whose life is impacted by her period can change her life and give her knowledge she needs.

 

00;53;40;12 – 00;54;00;18

Dr. Natalie Crawford

Talking to those patients is typically about decreasing inflammation. And Demetrios, this is an inflammatory disorder. So lifestyle mitigation of inflammation is extra important because their baseline levels are already a little bit higher. But also if we try a medication, this is another circumstance where people are given the birth control pill because it can suppress endo. It can help with some of the pain.

 

00;54;00;20 – 00;54;17;09

Dr. Natalie Crawford

It’s not wrong, but we need to do it from a place of I’m worried you have endometriosis. This gets progressively worse with every ovulatory cycle. We’re going to try to stop you from ovulating and seeing if it gets better. These lifestyle changes to decrease inflammation are equally important. If this doesn’t help, we won’t have a discussion about surgery.

 

00;54;17;12 – 00;54;37;25

Dr. Natalie Crawford

This can impact your fertility. So when you’re at that place, we need to talk about checking your account in your 20s. Should we freeze our eggs? These simple phrases, said to a young girl by a pediatrician in her teen years, will make them approach how they think about their reproductive health in their 20s and 30s, completely different. So even if you’re not doing it now, you’re not putting them to surgery.

 

00;54;37;25 – 00;54;52;11

Dr. Natalie Crawford

You’re not putting in the referral, just telling them, I’m worried you might have this. We’re going investigate it. When you’re older, you should keep this in mind or these are things to look out for. That is so powerful for how we develop that health literacy for our own journey.

 

00;54;52;17 – 00;55;11;00

Dr. Mona

And part of my role is always being able to make diagnosis, make parents feel seen, patients feel seen. Obviously, when we do the workup or if someone’s listening to this and be like, hey, my pediatrician, I’ve expressed concerns. I don’t feel like they’re listening. Who would be that next person for a parent of a teenager that they should be talking to?

 

00;55;11;00 – 00;55;20;09

Dr. Mona

Is it an OB? Do you think they should be going to an RBI? Obviously who’s someone who has more advanced experience and fertility? Who is that next point person to get themselves heard?

 

00;55;20;11 – 00;55;38;03

Dr. Natalie Crawford

It’s a good question. You know, most of my, adolescent teen patients come to me through their OB, so usually they’ll go pediatrician to ob gyn, who typically will do some of the initial testing. I always view, if this is, if you’re a pediatrician listening in, which I know a lot of your audience is or you’re a parent, the goal from the pediatrician is to get to the next step, right?

 

00;55;38;03 – 00;55;59;08

Dr. Natalie Crawford

Just for them to not say, hey, yeah, that’s normal, right? We want to say, okay, this is not normal. You’re going to go somewhere else. If you’re already established with an OB, which used to happen earlier when PAP smears were younger. And, you know, birth control was kind of exclusively tied to getting your pap smear. Younger women were seeing an ob gyn earlier, but a lot of them in their teen years never see an ob gyn.

 

00;55;59;11 – 00;56;20;13

Dr. Natalie Crawford

So this would be the good opportunity. If you’re a mom, like to schedule your daughter with your ob gyn and say, hey, like I’m worried about puberty, periods, etc. and they can start the work up to get them in with us. It’s not wrong to see a reproductive endocrinologist, but we do see a lot of infertility. Our wait times can be longer and your your pediatrician or your ob gyn can probably expedite that.

 

00;56;20;13 – 00;56;40;10

Dr. Natalie Crawford

Like if you called me and said, I have a young girl who hasn’t gone through puberty and she’s 17, what labs do you want? Right? I help my community navigate, draw the send her to me, let me get her in faster. So as a parent, we’ll say specifically helping your child get to that next level, it is just part of the, you know, squeaky wheel approach.

 

00;56;40;10 – 00;56;44;05

Dr. Natalie Crawford

Sometimes of like, no, I need this worked up more. Who can we get to?

 

00;56;44;07 – 00;57;11;27

Dr. Mona

I always like to be self-critical of our profession and what I do. What I say by this is that like in my world, right to child development, there’s some pediatricians who are still not understanding or aware of autism and when to refer or say, you know, let’s watch for weight. Do you feel in this day and age, as we speak in 2026, that most OBS in the world are being more aware of patients pain, being more respectful, like, you know, we at the beginning of this, we talked about like the paternalistic nature that has kind of made it so.

 

00;57;11;27 – 00;57;22;05

Dr. Mona

But or do you feel like things are changing where there’s more ability to advocate and people being heard of, for their concerns in all these fertility, painful periods, all these issues that we’re talking about.

 

00;57;22;07 – 00;57;50;11

Dr. Natalie Crawford

I think both things can be true. I also think there’s a lot, a lot of good doctors and bad systems. And my my biggest piece of advice here is especially in the OB world, is that an annual exam is not a problem visit. And a lot of patients don’t understand the language of navigating the health system. So if you have a problem, you’re bleeding through your clothes or your periods are painful or they’re irregular, you can schedule a problem specific visit where that is all you talk about.

 

00;57;50;13 – 00;58;06;10

Dr. Natalie Crawford

And that’s going to give your doctor the best opportunity to have all of that time just to focus on the problem. And you. Because so often I see patients say, oh yeah, I have this. I’ll bring it up to my OB at my annual visit. But at your annual visit, I’m sure you feel the same way about Well-child check.

 

00;58;06;10 – 00;58;08;14

Dr. Natalie Crawford

So you have a list of things to do.

 

00;58;08;17 – 00;58;09;16

Dr. Mona

You have to check off.

 

00;58;09;16 – 00;58;24;27

Dr. Natalie Crawford

You have to talk about it, etc. but if you have a problem, schedule a problem focused visit. Same rules apply with an ob gyn. I think a lot of people just try to say I’ll bring that up when I’m there, then there’s not time to dress with it and they’re left feeling very unsupported with what the problem is.

 

00;58;25;04 – 00;58;48;11

Dr. Natalie Crawford

So we also have to use a health care system that’s not very patient centric, at least to the best that it can function, and to really try to see. And if you’re getting dismissed, that’s not the doctor for you. We should never feel married to a doctor or to a system, and we should feel empowered to say, I deserve to have somebody who’s helping me with my care, who understands me, makes me feel seen and heard and validated and listened to.

 

00;58;48;13 – 00;58;53;13

Dr. Natalie Crawford

Because that is often what we can control when it comes to our patients experience.

 

00;58;53;15 – 00;59;08;23

Dr. Mona

Yeah, I appreciate that. Because I see that as well. And I love what you said there just a lot of good doctors in a bad system. And then there is just a lot of not so great doctors. But I would say the prior is more true, that there’s just a lot of doctors who just can’t do their art and what they love to do right now.

 

00;59;09;00 – 00;59;27;09

Dr. Mona

And people might be saying, well, why don’t we talk about it? Like, why are they not talking about the well, Vas it has a lot to do with the time. Like, I don’t think people realize, like you said, for me and my I’m sure my OB colleagues. Right, who see multiple patients, I have to see so many patients in a short period of time because of insurance reimbursement.

 

00;59;27;09 – 00;59;56;25

Dr. Mona

And you know how the practice is running. In my dream world, I would also love to have 60 minutes like yourself to talk about general pediatrician stuff. Right? But we don’t what? And if I honestly believe that if OBS like general OBS and pediatricians had the 60 minutes or whatever be totally different, it would be totally different. Like, wow, I just like I just think about all the things I can change in the world, like, and how people would not necessarily need me anymore because I would be able to give so much anticipatory guidance, so much education.

 

00;59;56;25 – 01;00;12;16

Dr. Mona

So thank you for bringing that point, because I always like to drive that home when I speak to fellow clinicians on my show about, we are trying our best to do what we can in a system that doesn’t support us. So I appreciate that. Absolutely. Last question for all of my authors, is what is your favorite chapter in this book?

 

01;00;12;16 – 01;00;14;25

Dr. Mona

It’s like choosing a favorite kid, but what is it? Which one?

 

01;00;14;25 – 01;00;43;12

Dr. Natalie Crawford

Oh, that’s such a good question. You know, it’s the first chapter. The first one is called How Inflammation is Hijacking Your Fertility wasn’t. You’re writing a book, so you’re going get this wasn’t originally slated to be the first chapter. But after, you know, many discussions with the editor back and forth felt like it really laid the groundwork for why understanding how everything works opposed to during the day, both within and without and not within our control, really do impact how our body is functioning and why that’s so important for framing it.

 

01;00;43;12 – 01;01;01;14

Dr. Natalie Crawford

And I think that that is something I’ve been passionate about on my own journey with pregnancy loss, what I talk to patients about, and I think it gives patients the most agency because we can’t rewind the clock, we can’t be younger, we can’t go back and change the past. But understanding how decisions today forward impact our health to that is empowering in my opinion.

 

01;01;01;17 – 01;01;18;12

Dr. Mona

I cannot wait for everyone to have this book I’ve learned a lot and like I said, I don’t say that to all my my guests guys. Like if I learn something new, I am very admit I always admit that and I’m just like, wow, this is so helpful for me. Like I said, as a pediatrician who treats patients and always wants to be better for my patients.

 

01;01;18;12 – 01;01;29;16

Dr. Mona

So thank you so much. Where can everyone go to get the book? Stay connected. I know you’re not only writing books, but you have a platform as well, sharing educational information. So give us all the deets.

 

01;01;29;16 – 01;01;42;14

Dr. Natalie Crawford

Yeah. Thank you. The book is the fertility formula. You can buy it anywhere. Books are sold. It’s everywhere. You can learn more about it on my website at Natalie Crawford md.com/book. And I’m on Instagram and the other social platforms at Natalie Crawford, MD.

 

01;01;42;17 – 01;01;52;10

Dr. Mona

And I will be attaching all of those things. My very last question, Natalie, what is giving you joy right now in your life? It doesn’t have to be about the book, but in general, what is giving you happy?

 

01;01;52;10 – 01;02;08;01

Dr. Natalie Crawford

Yes, it will be, because my mantra as I’ve been in this season, you write it, we just talked about it’s a book. It’s about two years from you get the deal until when it’s out in the world. Weirdly, it’s written by about that first year and then you start marketing it almost nine months early before it’s release, which is so wild.

 

01;02;08;04 – 01;02;25;26

Dr. Natalie Crawford

You since we started marketing it, my mantra has been must be present to win, which sounds like an overachiever mantra, but what I really have learned through it is saying your present, both in your time and your energy when you give it to other people, will give you the most back you. You will get the most joy from that when you can go into those conversations.

 

01;02;25;26 – 01;02;59;29

Dr. Natalie Crawford

So there’s opportunities to connect with people in person and virtually and see us and stand on stages and go to events and just connect with an audience and other colleagues. It the reward is so high and so really just kind of keeping that in mind, say like, must be present to when experiencing the gift of your presence and then receiving it from other people and not trying to be overwhelmed with all the things that are happening, but like just absorbing that gift being received back has brought me so much joy in this season where the the book is been, you know, years of work to finally come into existence.

 

01;03;00;03 – 01;03;15;04

Dr. Mona

Well, everyone, a labor of love. We talk about that with all books. The fertility formula is out now, so definitely get it. And I will be linking all of that information to the show notes, and you just gave me a lot of motivation with that final statement as well, not only just in my book journey, but also just in life.

 

01;03;15;04 – 01;03;26;16

Dr. Mona

So, Natalie, always a pleasure. I know I just saw you at the conference as well. The Pinnacle Conference. You are wearing many hats. And thank you for all you do for us and for women in medicine as well.

 

01;03;26;19 – 01;03;31;03

Dr. Natalie Crawford

Thanks, Mona. You’re amazing.

 

01;03;31;05 – 01;03;47;18

Dr. Mona

I told you it would be amazing. Natalie is just such a great speaker. And by the way, she is a friend of mine. I didn’t mention that in the intro, but you probably heard that in the conversation. She is a powerhouse in the field of fertility medicine and an advocate for women in medicine in general, and I love that.

 

01;03;47;21 – 01;04;08;06

Dr. Mona

If there’s one thing I hope you carry from this episode, it’s that your daughters period is information and your period can be information pane that keeps your child home cycles that come whenever they feel like it. Bleeding through her clothes. None of that is just the way it is. It’s her body asking for attention. And now you know what questions to ask.

 

01;04;08;09 – 01;04;31;00

Dr. Mona

And I’ll be honest with you, this one was personal for me. I have watched friends struggle with fertility issues as adults, and when you trace it back, so many of them had symptoms that were dismissed when they were younger. Painful periods, irregular cycles, told it was normal, told to push through. And so many of those women ended up having PCOS, endometriosis and I have just seen the same thing in my patients.

 

01;04;31;00 – 01;04;52;25

Dr. Mona

Girls whose concerns got brushed off by other clinicians whose pain got minimized, and who grew into women who didn’t trust their own bodies because no one ever validated what they were feeling. And this is not okay. Female reproductive health has been dismissed for too long, and conversations like this one are how we start to change that. What stuck with me most was that stat about missing school.

 

01;04;52;27 – 01;05;10;25

Dr. Mona

If pain is bad enough that she would skip something she loves or anything that was important, that is a red flag worth following up on. That’s the kind of detail that could change the next 20 years of her fertility, health. But I want to hear from you. What was something in today’s conversation that surprised you the most? Come find me on social.

 

01;05;10;28 – 01;05;31;13

Dr. Mona

Drop a comment on our latest post about this episode and share. Share share share share tag at PedsDocTalk at the PedsDocTalk podcast at Natalie Crawford, MD. Because you never know which parent in your circle needed to hear this today. And to grab the fertility formula and learn more about Doctor Natalie Crawford, head to Natalie Crawford, md.com/book.

 

01;05;31;17 – 01;05;51;17

Dr. Mona

It’s also in our show notes. Thank you again for being here, for staying curious, and for being such an important part of this community. And if you have not yet seen it, go check out our new look on YouTube for our podcast videos. They are stellar. And maybe, just maybe, you may want to watch the conversations now instead of listening.

 

01;05;51;20 – 01;05;59;15

Dr. Mona

Don’t forget to subscribe and download your favorite episodes so we can keep growing together. Stay informed, stay educated, stay loved, and stay well.