Dr. Jen gunter celebrating the release of blood the science medicine mythology of. Dr. Is an internationally bestselling author. Gynecologist with more than three decades of experience. Her New York Times best selling books, vagina bible and the menopause manifesto been translated into 25 languages. She is the host of gen splaining, a cbc, amazon prime series that highlights the impact of misinformation on women and her 2020 tedx talk. Why cant we talk about periods . More than 2 million views in its first six months, leading to the launch of her podcast on the tedx Audio Collective body self with dr. Jen gunter, dr. Gunter will be in conversation. Dr. Michele harper. Dr. Is an Award Winning physician. New york times selling author and nationally recognized speaker whose work centers on individual healing social justice. Her debut, the beauty and breaking, was a New York Times book. So now, please me in welcoming to politics and prose dr. Jen gunter and dr. Michele harper. Hello, everybody my interest is like open up and talk about it and hello now which which microphone do you all want to see for this . Both oh, okay. Yeah. Lets keep our own show here. Thats wonderful. I take it on the road as well. Lovely to be here with you to meet in person and to be here with all of you as well. Jen you know, i think im going to start with an open question. When you were thinking about this book on blood , an excellent resource for, all of us, when it comes to the reasons why we bleed the reasons why we would have painful how to control the bleeding all the way to contraception and abortion. What inspired you to write this book so . Ill be honest. First of all, i decided to book deals, so i had to have a second book just full disclosure. But when i was on tour actually for the vagina bible. I noticed in the audience once we started talking about vaginas, people started asking questions about menopause. So i thought vaginas the last taboo, but apparently menopause. And so that is what inspired me to write the menopause manifesto. And then when i was on my virtual tour for menopause manifesto, i was really paying a lot of attention to what was going on online because, you know, youre on social media or youre promoting stuff you. And i really started to notice and this was during a pandemic that there was this uptick in conspiracy and disinformation about cycle and whether this a Natural Evolution or has come from, you know, false fears about fertility with the vaccines and a lot of fears about the Birth Control pill. And so i thought, you know i think theres really something to that and then i thought a lot about the first two books and how both times my editors had said you know i dont really understand what youre talking about with the cycle. You explain that in more detail and you know, here like, you know, these are like top editors and, you know, publishing houses and they are thinking that i need to explain all of the science because they didnt get it. So then i started to put all those kind of pieces together and i thought, you know, i bet more People Graduate High School knowing more about frog biology than, you know, their uterus works and. Im going to try to fix that next line and i think about this book. You know, itd be easy to say this book is for Health Providers or this book is for young women, want to learn more about their bodies, but do you how do you feel . Who do you envision audience to be . Well, i think this book is for everybody. And im not just saying that someone anybody to buy it, but they should. So first of all, if you have a uterus ovaries, you should know how it all works. These are your body parts and. If you dont know how it works, its very difficult to know when things are going wrong. And i give my own example in book about how having i had to terribly heavy periods as a teen and i didnt know they were heavy because nobody about what a normal period was. I mean knew they existed because of judy blume and because i read some stuff. 17 magazine, you know, back in the day. But apart from that, i didnt know anything about like the actual and so people should know that people, should know that so they can advocate in the doctors, so they can be aware of the snake oil that they might see online. But even people who should learn about it. You know what . Every Single Person is here in this room because someone had a cycle, right every Single Person is here because of that. And you probably love someone who has a cycle or have a child has a cycle or a friend. And if you want even take it a step further. We are here evolutionarily because of the cycle. This was an important and saying that gave us these big brains we have so you know we owe all to the cycle and so i think everybody should know about it because its also cool. Okay. And so you mentioned some of it earlier, some of the pressing concerns people have. And you practice clinically. And im just wondering, what are some of the common questions you get . And im also because youre very active on social media, very popular. Youre a great source of information there to is there overlap between what you receive the what you see posted on social media versus what you hear in clinic thats . A really great question. So let me lets go to the second one first. So absolutely i think that the questions that i get in the office are very similar to the stuff that i see online. I dont think theres much difference to it. And in fact, think, as most of my patients know, im pretty active online. You know, they actually i think maybe i get asked about some of those things sooner because they think i might have heard about it. So so theres that that the common questions that come up are the idea. Is it harmful to not have your period. And this is often comes up in that context of hormonal contraception and you know that thinking really reflects a lack of understanding the cycle because its totally fine if youre on hormonal to not have a period. However theres always a kernel of truth to everything. So if youre not on hormonal contraception, it is concerning. If youre not having a period, right . So you could see how the two could be conflate it because you dont have a period that could be a sign several different medical conditions. It could be a sign of an early menopause. Theres a lot of to know about. So those things kind of get confused and often the confusion is on purpose from people, of course, selling you a supplement to fix your cycle. But yeah, so that i would say thats a really common one. And i think a lot of people also have a hard time wrapping their head around the concept that its fine to not have a period on hormonal contraception means theres nothing there. Theres nothing building up thats not like, you know, its waiting for some, you know, avalanche to come at the most inopportune moments, like, you know, when that plane is taking off or something, right . That happened to me actually. So yeah, i thought, i was done. I was like eight months from my last period. So i was like, yeah, i was going to europe a trip. I didnt pack any pads or. Were taking off from san francisco. The seatbelt light is still on and. Its just like cause of course i couldnt have timed it any worse. So yeah, so. But its totally fine if youre on hormonal contraception. Yeah and when you mentioned periods and that being a common question about if its safe to not have one that makes me think of the apps that have come and period trackers which are relatively new right yeah well they this this sort of evolution absolute but you know when i started practicing medicine every obgyn had little branded card. Theres people here nodding. They probably had those cards and it had like three months of calendars on and you hand it, i was like Business Card but with that calendar, which is actually a really good idea because people come in and they dont know youre talking about having symptoms and youre feeling moody or youre having, you know, pain. Is it in related your cycle . I dont think about it. Heres card start tracking it. So the idea tracking your cycle to understand more about is very old and a good thing. But the apps have taken it to kind a different level and its kind of this quantified self, this idea that we need to track like every single, theres people with continuous glucose monitors who dont have diabetes, theres people monitoring their sleep with like a ring and checking their apps. All the and so what we theres a couple of here so one is we dont the algorithms for these apps so we dont know how accurate they are in we know that if youre just going by your cycle its not actually very active very accurate. And there was a study at women who were using trackers and and when they compared their cycles to what the app told them when their period came at a different they were more likely. Blame their body than blame the app for being incorrect. However when researchers put their data into you know sort of a real sort of real life situation, it was clear that the app was incorrect. So they may be making you less into with your body also. A lot of the apps ask people to record the of their blood and that can be the only explanation had probably in the last five years for people asking if the color through blood matters. Because i dont remember ever being asked that before. And then of course, if you live in a state where abortion is illegal, tracking can be used against you. So whether youre using a tracker or fertility awareness method that uses app, they can subpoena your phone, they can subpoena from the company and they can also just purchase your they can purchase metadata and it takes very amounts of information to pin where people are your phone pinging when youre in planned parenthood its pinging when youre in the pharmacy its so these are real concerns and i would say for someone who is living in a place where abortion is illegal in the book i actually some apps that keep all the information on the phone but its just something for people to be aware of right and that is increasingly important now and it might that it might just be better to use a form that that wouldnt be able to be tracked for safety reasons i would say for people who are just and they dont need that app fertility awareness methods. You can use the calendar on your phone, then no one knows what you know. You can come up with your own system. If you need the algorithm for your awareness method, then thats different and thats going to have to obviously be a trade off. And there are some different ways to make choices. But yeah, if its just because you want to track your period, there isnt really a reason to expose your privacy in that way. You know you mentioned menopause on the on the other side of the spectrum and im hearing more and more about menopause and were speaking about it as its not this kind of secret process that our elders are mothers arent or arent sharing about as much. Are you getting more questions about that . Are people more comfortable speaking about it, wanting to learn about it . Yeah. Yeah, my husband likes to say that. Well, since you wrote your everybodys talking menopause, im like, i dont think its just me, but but yeah, i think that, you know, many of us grew up not knowing much about. Certainly my mother didnt know anything about. It like she when she had her first period, she didnt even know what was going to come and menopause, i think it was probably the same for her and i think same for a lot of women. You know, weve both you know, weve diminished a lot of symptoms, diminished suffering. Weve very little studying about even what happens, the basics in menopause. And so now were seeing know i think some of its related to sort of you know coming of age and we have more People Living their lives online and its a lot easier sometimes talk about something in front of 100,000 strangers than it is to three people in person, which is kind weird. But i guess its its really i mean, you see people doing all these like testimonials on tiktok and and so i think thats the power of social media, but also a lot of snake oil that has recognized that gap in menopause right. And has stepped in with supplement and you know untested and other types of things. So the with every good theres always a bad you just have to be mindful of it. But i its great that were having these conversations mean we have so much ageism in the United States and you know this idea that the women are now just feeling more confident, are going platinum right now, going great. Wow. Its a level up. Yeah. And when you mentioned some of the the myths snake oils, im curious, what are some of the ones would warn people . You might hear about this online as a quick fix something easy and now i am for a holistic so when i ask this its with no shade at all. What are some some of the treatments you might caution people about . What are some ones that you are more likely to advocate . Right. So i think a big is that theres some kind of diet or supplement that can balance your hormones. So hormones dont get balance. Thats not even its even like its not even a good analogy. So there isnt anything you can eat or change that will affect how your ovaries produce estradiol. I mean, thats just not going to happen however eating a healthy a healthy balanced diet is really good for you. So for example, if eat 25 grams of fiber a day or more, have a lower rate of breast cancer, a lower rate of colon cancer, a lower rate of type two diabetes being is really good for your. So we could say indirectly thats very good thing. So focusing eating healthy really good. The idea that supplements can really do anything for you. I mean, i tell people supplements are unstuck, untested pharmaceuticals. The that they are you know, safe giving a mega dose of a vitamin isnt necessarily safe and especially youre looking at products that are designed say, hot flashes or for libido or metabolism boosters. Those are the ones that are more likely to be adultery with actual hormones. In one study that was just it was in jama just a few months ago looking at sport enhancers. There was one one supplement that was centum and with a substance thats never been tested in humans. So, you know, you have to be very mindful about that. Yeah. And, and i would say. And you can tell me if you disagree with me, like when it comes to supplement for example, just like when it comes to any kind of medication, its important where youre getting it from and its important the quality and the source of it. So i would yeah, it, it can be hard because theres, you know, supplements. Theres no theres absolutely no legislation. So you can you can basically do what you want. So, you know, we tell people that, you know, if youre going to take a supplement, you want to get one that maybe has a usb verified label on it because that that its been tested for contaminants and it should contain what it claims. So those are important and it gets confusing because there are some supplements that might be recommended so. For example, if youre vegan, we would recommend you take a b12 supplement because. Youre not getting it from your diet or if youre iron deficient, we would recommend that you take iron. So its that confusion and that sometimes theyre recommended that. Supplement companies are depending upon right there so well if its okay to take one supplement then it must be okay to take my ovary support and also look out for words like support and boost and enhance because theyre using those because they cant actually make a medical claim. So yeah. I know, i know one wants to hear that like a healthy diet, like no one wants to hear that. Yeah. Like i, get it . Its not sexy. It doesnt sell a book and and no one wants to hear. Its like, you know, and my other thing is, whats the best thing . Exercise, you know, whenever people ask me whats the best thing you can do in menopause, its exercise. Its aerobic exercise and resistance training. Dont you know, dont shoot the messenger i mean, its its it really is. I would say like an exercise where a pill wed all be clamoring to take it, you know, reduces your risk of heart disease. Type two diabetes dementia, osteoporosis, fractures. I mean, it goes on and on and on. So yeah, i that its helpful for every system and if its accessible you know if you have the blessing and the privilege of having the time to be able to do it if you if you live in an environment where, its safe for you to exercise it a blessing. Thats something that is seemingly as simple as exercise can benefit your whole body. Yeah. Would say like i take it i try to take a walk every lunch and its it honestly its life changing like when i go if i dont get out at lunch in afternoon, i find it so much harder. And when i go out, i just, you know, for 30 minutes, i mean, sometimes im just like around the block a couple of times its okay if you go a walk, you can have a latte. So you know, a little treats. You, i mean, even mental health. I know it is. Im very pavlovian. I get my coffee that works that well. We all have these little tricks. But yeah its and its hard because you especially a lot of women, especially, you know, when you have a, you know, a busy job, may have other responsibilities and, you know, even, you know, at work, women are more likely to take on emotional labor. Right. So theres all other layers that can make it difficult. And sometimes at the end of the day, youre just like, i just, you know, i just want to sit down. And so it can be it can be hard. It is it is a blessing and its also a privilege to have the time to be able to do it. That is that is, you know, and im thinking about we were about this a little bit. Workers in to writing a book just the massive project that it is to write a book to get a book published and timing this book coming out post jobs during an election year. I mean certainly, you couldnt have timed it this way. I mean, who can given given all the factors that go into but do you think that that somehow kind of heightens the the relevance of all these topics right at this particular historical. Yeah. I mean, i hope that that i help a lot people who are speaking up rights to have more language to be able discuss it, to be able to have the science to have the conversations. I mean it was was just last week that there was i think politician in wisconsin talking like how he knew about the reproductive cycle because hes a vet and im like were not cattle or i mean on and you know do you know the difference between actual cycle and the cycle i bet not. I hope hes watching. And i mean, that idea that that that in 2024 a human being would stand up and say, well, because i knew about animals, im. Like, what are you even talking about this of theres so much ignorance masquerading as knowledge. You know, people attach to it and they think that they everything and its really at this juncture time, i think it is so important for people to know all of the facts mean its important anyway because its your body and you should know how it works and youre the person who might get sick and youre the person who might 400 times, right . So should know. But you should also know how wrong so many of those politicians are, you know, and theres power in that and youre able to then talk to friends, talk to advocates, talk to you political leaders, and to be able to say, you know you should really know about this now, honestly, my own my own belief is a lot of them dont care. You know, its about power. You know, with the patriarchy factor or irrelevant, right . Its about power. But there is theres benefit in you having the power of knowledge because then can speak up. So yeah, i do think its i think its really important time and thats also when i, you know, i expanded the chapter on abortion in here because first of all, abortions, just management really thats really all it is. And i wanted to normalize it because im aware that there will be people hopefully who are 14 or even 15, 15, 14, maybe 13 year olds reading this. They should know about it. Im hopeful that people will leave the book on the coffee table and maybe, you know, a son or a dad or a brother or just a guy whos in the house will read it and look at it and leave through. And i think when we can normalize these and say words without shame, not use euphemisms, thats a way that we can, you know, its its seems a minor act, but i think its actually revolutionary in a lot of ways. So im hopeful that were going to get more education on the subject and means that will be more people will be to have louder voices. Yeah. And when we talk about people louder voices, im always curious, you know, as Health Care Providers, whether its as physicians or nurses, physician, assistant do you see theres role for us in in addressing these issues, whether or not its Economic Justice and specifically period poverty around reproductive rights or bodily autonomy. General, is there a role specifically for Health Care Providers and is there a duty . What do you think . Yeah, so i is a great question. You know, sometimes i get a lot saying, well, you shouldnt be talking about it because. Youre a doctor. Im like a okay, like health is political. I didnt make it political. I didnt design this system, but i got dumped in it. And, you know, the idea that cant afford their medications how is that not medicine that i have people cant take the medication i prescribe people who cant take a day off work to come in for surgery. How is that not medicine. How is someone who is being beaten by her who cant get into a shelter . Hows that . Not medicine or the law that puts him back onto the street the next day. How is that not medicine . How is that backup of rape kits that you know, we spent our time collecting . Never, you know, how is that not medicine . These poor people who cant their day in court because of the political system because of the legal system, because of how things are so stacked them. And then when you look at women who are the half of the population are more likely to have a lower financial status, to have less know social clout and power, it becomes even more important. You know im not the one who took away right for abortion. So i think that until we have complete and were living in some kind star trek utopia right. You know, i love that scene in the movie where they come back to with the whales and and, you know, mccoys like youre on dialysis. Is that so barbaric . You know until were you know and he just like gives her a scan and her kidney failure goes away, you know. So until yeah i know but so until we live in that kind of utopia and even then i think like, you know, bones was, you know, kind of political too. So until were in some kind of utopia like that, i think that doctors have a duty to speak up. I mean, you, you, you have people that suffering and why why wouldnt want to alleviate suffering isnt that why you went into medicine . Yeah i mean, i agree with you. I know its contentious at times and its its befuddling truly. It is. But i agree that if we have a duty to patients, then we have a duty to our patients inside the clinic and take hospital and outside and to that kind canaux. And to say that can entail certainly does entail speaking up and trying to affect access and legislation as well. Well, especially when we have the least educated people making laws this subject right i mean usually hearing some kind of like dystopia yeah i mean i give the example i when i used to live in kansas, they passed a law to make it to do abortions at the university of kansas hospital where i worked. It was part some complicated rider to get the University Hospital out of the you know the purchasing agreement with the government like some financial thing and of course know the dean said oh dont worry, were going to fight that. And of course they didnt. And you know, abortion guys, you know, and so two weeks later or three weeks later, a month later, i get a call from someone about their very sick patient who needs an abortion. And im like well, i didnt see at the meetings about it, so yeah. So i cant help. Sorry. And eventually what happened was . You know, i spoke to the politician who wrote the law to get permission, and ive never this. And i was sitting in my basement in johnson county, kansas, and i had i had read every single thing on this complicated medical condition like i was prepared for like an oral boarding. I read every paper and all the quotes. I had it all laid like i was doing some kind of, like, game analysis. And so started to explain. And im not kidding. I maybe got five words out. And what he said was, oh, do whatever you is best doctor. Thats well, if whatever i thought was best was what we should do, why we have a law, because its about power and its about, you know, weaponizing womens gets votes, it raises funds. And until it doesnt raise funds and it doesnt get votes that the Political Parties are, you know, thats going become an issue. So that really opened my eyes how little the people who make these laws actually care right right because he didnt even want to hear about the personhood law was affecting. Oh whenever you think oh sorry to bother you, sir. You know, and i was like, you. I wanted to say something. And my then husbands like, no no, no, no, dont stop. So, you know. Thats probably the only piece of advice he ever gave me. You know, i think about when Health Care Providers are the issue when we are part of the ones causing barriers to our patients, when we think about structural inequity, i wanted to drill down on that part for a bit. Certainly an area thats gotten a of attention and and rightfully so is infant Maternal Mortality for example although we can see it with many Health Matters where, people of color for example, have disparate treatment and then worse outcomes where risk factor isnt the of one skin, but the way theyre the risk factor is the bias, the racism that we bring. Medicine, study after study shows that whats advice that you would have to Health Care Providers . What can we do to change that . Well i think we need a lot more education about know about the bias that we all have because thats the thing about bias is you dont maybe realize that you have it. So i think we need a lot of that. I think i think thats the kind of thing that should be incorporated into, you know, the rounds that have our educational rounds are you know, whenever you have we have these conferences, we talk about cases that go poorly that needs to be part of that. And you know i think that we need to to have a lot more resources in these areas as well, because i think that when when the the kind education thats needed is sort of pushed off as sort of like a box that has to be as opposed to an actual important thing that we need to learn because peoples lives depend on it. So i think it needs the funding because that also one, so we can have better training but we all associate importance with the amount of money thats into something. Right. And i think that that will also be helpful. I mean, were seeing also all these, you know, devastating of closing, you know, county departments and clinics with the rise. I just read about, you know, how the syphilis rates are rising and, you know, were just having all kinds of issues that that, you know, are due to the inequities in our system related to endemic related to poverty lack access to health care and yet theres nothing else to say except shocking and its awful and we all need to be part of the solution. I think theyve made some a little bit of headway in california, had a really active Maternal Mortality task force. And i think theyve started to sort of turn turn the boat. Theyre not anywhere where they need be. But i think it takes kind of like state level attention and, you know, from the top all the way down from hospital administrators, from, you know, individual physicians, from nurses, you know, all the way, you know, to the top politically and, its true. And with all of these matters. Whether its like were talking the disparate treatment when it comes to Health Equity or, an Economic Justice, there is the part about education and then, like you mentioned, the politicians, the part about caring as well and if its important and if were willing to invest in it, not just fund, but also time and also to do introspection on because its an integral clearly integral part of we are as humans and Health Care Delivery in this nation so i agree yeah i mean when you think about the the lives lost and the suffering thats happened because of just these inequities in the Health Care System not related to your genetics that gave you cancer or anything that, you know, the things that we thought we mentioned that went medical school right to treat that related to social issues that shouldnt exist its really staggering when you think about all of all of the that the trauma and the suffering that comes from that and then when you look at, for example, armor or Maternal Mortality rates here, say, canada or the u. K. And, you know, youre thinking how how how are we so much different . And and and while we are and, its its a problem. So i think i think we need to make this an every persons problem. And i agree agree. And, you know beyond this, what are some of the other we were having an interesting chat about. Some of the barriers the other barriers we face medicine and external influence as to delivering care, for example, affects and influences of private equity. How are you seeing that manifest your practice . Well, it hasnt touched practice. Yeah, right. You lucky you are like. No, it hasnt touched my practice, but i but from colleagues the things that ive heard are just awful. Basically its in ten years time there may not be gynecology covered by you know, you may not be able to find a gynecologist, because the big secret is Office Gynecology pays very little pays very little. And so Health Equity firms have very so they buy these practices and what they do is they get rid of all the gynecology and, expand the obstetrics, because thats what makes money. Right. You know, its buying up a hospital, whether its all these Health Startups with funds. You know, i always say if medicine were that profitable. Nobody would need go to vcs for money. Right. But vcs want like what, like five fold tenfold back. I mean, i dont know what health vcs want, but you know, if you could ten i mean tenfold the profit Office Gynecology you need that help and so its really a problem. You know ive ive heard from quite a few colleagues the last few months whove had their offices who you know or cant afford to take, you know, insurances anymore because of the cost of the private equity. I mean, its i dont think prepared for how this is going to have an impact. And we were also about there was a report that was just released about, you know, i think it was effects. It was a difference in mortality or some kind of negative Health Outcome associated with being hospitalized in a private hospital. And i you know, Management Serves to keep management having jobs right. I mean not that i know much managing things but yeah its a big problem. And i dont think that our politicians are taking this seriously enough. I think that were going to be faced with a lot of issues, you know . I think so. And i think that as we speak about these matters, because i wasnt even aware of it till fairly recently, i mean, i think is newer information for us. So i think that as providers are aware and as the public is aware and were seeing and Health Care Outcomes whether its deaths in the hospital or infections which are all being documented now that doing studies about it, i think that as you said, we will be more empowered with information, speak up and demand better. Yeah, its you know, i really probably found out about i kind of understood maybe i heard somebody mention it but maybe like the last year or two. And i think its like many things right when they first when it first starts, you hear it like once or twice. So you dont hear it again for a while and youre like, oh, thats just a problem in that or in that city. But then it starts you start to hear more chatter and more chatter, and then it starts to happen to people, you know, then you start seeing studies about it. So you know, i, i dont understand all the legality of it and all that kind of stuff, but, but i havent heard one positive thing about it, ill say that, you know. So yeah from the public, possibly from the making money from yeah yeah possibly possibly now but not for i havent heard a physician say oh my god im so that is so amazing. We are bought out by private equity. I mean, i heard that i may have heard like for anything, right . You know, i dont know anything about any other people, but it just doesnt sound. It just, you know it sounds problematic. And i had an this is an interesting sort of add on is people are often really surprised to hear that Office Gynecology is paid so little. Well, you know, were only looking after women, right . So you know, theres all kinds of with reimbursement. If i do a vulva biopsy and a urologist does scrotal biopsy, its the same equipment those same little biopsy tools came out same injection and embryo logically, its the same tissue. Right. The urologist gets paid more money. Oh right. So you know just things like that. So in some places, if a urologist as a hysterectomy, my understanding is some of them do, some of them are trained to do it. And they do. They do sort of your gynecology fellowships. So i they call them something different, but as the same gynecologists can, and i believe in some places they have higher reimbursement than. A gynecologist doing it. Well, you know, gynecologists are mostly women. Right. So so its a problem. So if you think about what we are saying that care is worth very little right. And thats a really awful message. And then if that care is worth very little and it can bill very little, then when you have a private equity firm come in, theyre just like, you know, sorry, bye. Because its not making any money. So its its a problem and now because we have so many great tools treating abnormal bleeding, right . We have not just the Birth Control pill, we have a hormonal we have endometrial ablation, we have other medications, tranexamic, acid we have all these things to treat heavy bleeding. When i was a resident, it was the Birth Control pill or a hysterectomy like that was it . Thats what we had. But so the money is made. The surgery not in seeing the patient, the office and doing the counseling about, well, lets try this this medication. Lets try medication. Right. So the downstream is that you know, you may be operating less but you know, putting an iud is far less reimbursement than than doing a hysterectomy. So, you know, so there theres all these downstream effects. I think were really prepared for. Right. And my last brief question before we open it up, this Rich Resource that is your book, what is your hope that people take away from it . How do you how do you envision people using this tool . Well, i hope everybody well, first of all, i love seeing this cover everywhere. Like i that i love seeing the word blood out there. Im so done with euphemisms about the female genital track like we call them what they are a. Its a valve, its a vagina. Its no different than saying elbow. Its really not. So the first thing is id like to get rid of any sort of related chain that would be like my first thing. And so i hope to see this book and i love all these independent bookstores gone to have all had the book out prominently, proudly, and thats fantastic. But i want people to know their body works. I dont want to be like some weird black box that they dont know and like referred to obliquely as the or Something Like, you know, so i, you know, i people to know how their body is this really awful to think like theres something broken with you and its really awful to like not know like you should know its your body, right . I mean, you know, and its a its an intrusive bodily function, right . Like you dont really think about your liver. It just talks along like it. But if you were leaking bile every 30 days, you might say, id like to know more about my liver. Thank you very. So, you know, i think the that we have this like intrusiveness, we should know more about it and the fact that its been weaponized against us since the beginning of time. I think its really time to take that reclaim it and talk about it as it should be. And as i say in the book, the is the wheel that drives humanity and we should treat it that way. Know so you and now were happy to take questions questions. So that was all very interesting. Im a physician among other things, and you dont talk much history in the book. And this is not history of , but its been a cultural, a deep cultural thing ever since there have been humans. Because if there was no. Of course, there would no humans. But do you think or do write about the fact that im one hand has been a shameful thing and women were used to be sent off and still in some places sent off when theyre unclean or they have to go to a bath something. And on the other hand, fertility is highly prized and fertility and are the same thing if you dont , you cant have children. So how how what . First of all, how long did it take before science realized that these two things were connected . Or had they always understood that theyre connected and how did how how can you have this contradiction where is but fertility is good . Well, thats the patriarchy right so you know, to be woman is to be on the edge of a life. Right. Veer too far. In one direction or the other and its barely a. Mm and youre a problem, right. So, you know, its you know its that is that Casey Musgraves song. Right. You know youre know youre either a you know, youre youre a drunk or a prude. Theres no no in between ever. Right. So, you know, i would say that i do talk a lot about the history in the book. I talk about the history of that shame has been there, you know, since the beginning of time and its really interesting really dedicated you know phds have looked at actual from women from like the 1800s and they dont even talk about their periods. Right. Like so much of the shame even in your private writing, there really isnt much about almost everything that we we know about. Was written men right so it you know kind of the original right like, you know, you what your periods like its like, oh, okay. Well let me write down i really think that meant right. So theres a lot of that but yeah i did that is the dichotomy we there clearly known about that connection between fertility because the ancient greeks were very obsessed with you know having a regular cycle and so there was you know thats why there were all these recipes putting stuff in the vagina to bring on a period. And so im im sure they some type of understanding about that but not in the way that we do they clearly knew that know thats when people became pregnancy capable once they you know once they. So they would have had that, but not in the way that we know but yeah thats think that thats the thing about oppression you cant explain it right if you were barren women were you know i mean thats if you were using, you know, common sense you would say, well, yeah, it should be prized, but but not common sense. Its about power and control. So you want to make every aspect of it problematic, right . So, you know, and then once youve finished reproducing. Then of course, you even less value in that patriarchy model. But you know, we now know thats not true. Oh, yeah. Okay. Of for your pregnant patients, do you recommend the Covid Vaccine . And are you going to recommend the upcoming rna flu vaccine . So recommend Covid Vaccination in pregnancy. The impact reducing severe illness is dramatic the impact on infant mortality. And you know, the stillbirths were seeing from covid versus, you know, when people are vaccinated. So there really is absolutely no reason to have any concern about getting vaccinated against covid pregnancy. And i think many vaccines are fantastic. This is incredible technology. And i think a lot of people think its very new. But the research has been there for a long time. Theyve done so much about, you know, back story to this. So when covid came out, they were able use all of that to, you know, to basically move things ahead. And i think that gave people the idea that maybe it was done quickly, but it wasnt it was someone had done their homework, basically. Thats what it is. And you know, when youve done all the pre work, its a lot easier to do the work. So and it also shows what happens when you throw a of money and smart people at things. So thats what i think about when i think about all the things that we dont know about cycle. So in january 2020 the you know, the genome of covid 19 was sequenced and by december of 2020 we had i think three, three candidate vaccines. So thats what happens when you have money and interest in people and you people putting their big smart brains that are there because of the cycle on on to on to a task and. So i just think about things that we know so little about like and polycystic ovarian syndrome. What would happen if we had that same kind of funding and that same kind of brain, you know, so so yes, im yes, all the vaccines take all the vaccines. Ill take any vaccine i can get and and and we just need more funding. Is there any correlation or maybe even a predictive correlation between length of a womans cycle and how soon she reach menopause . For example, if someone has a 24 day cycle, are they more likely to hit early menopause at 44 than someone with 48 day cycle . So thats a great question. You know, cycle length, predictive and it doesnt seem to to any great extent. However a shorter cycle is linked with with a several medical conditions. Endometriosis one of them. But but and people often also ask an earlier, you know, if start your period early or is that linked with an earlier menopause and it isnt the things trigger your periods starting Different Things its a different system for triggering your period to end. So there doesnt seem to be to be any correlation there so isnt anything that will really predict when a woman will hit menopause. So know that theyve done that they did actually a fascinating study looking at a sister dyads and mother daughter dyads living in the same to see you know are you more likely to have menopause that matches with your sister or my more likely to have menopause that matches with your mother . Its a really interesting idea because you share 50 of your dna, right . Youre 50 with your sister, 50 with your mother and your sister. Age of menopause was more predictive. Your mothers. And the reason for that, they believe is its environmental right. So your mother grew up 20, 30, 35 years, 40 years even, sometimes you and in a different environment in a different house and your sister grew up in the same house. So it seems that has a has probably a bigger impact than genetics. But admittedly theres a lot we dont know. Thank you you. Hello. Thank you for being here. This is its really neat to see you. I have a friend of mine who experiences extremely painful. The week before her period and i was if thats something thats common if thats something thats a bad yeah it sounds bad but is that something to be very worried about and what could potentially cause like Something Like that that level of pain. Yeah. So pain with is almost related to pelvic floor muscle spasm because when you have an , its the elevator muscles that are contracting are big muscles that kind of wrap around the vagina there. If you were going to do a cable to squeeze your pelvic floor to stop, you know, stuff, urine, those are the muscles contracting. And so those are the muscles that contract with. So when people have pain with , its almost always because of that many people. When you inquire further know sometimes have pain with sex as well. So they have some other things that might you too that we can certainly usually tell with an exam if the muscles are tight and we know that changing levels of hormones can affect pain thresholds, you know, so theres probably, you know, related for that person for how theyre changing hormone levels or affecting their pain threshold, perhaps the sort of the threshold of spasm in their muscles kind of in the same way, you know, some people get migraines right that it can be cyclically related. So if a patient like that came in the offset, obviously do an exam first. But id be calling up, you know, pelvic floor, physical and also making a referral. Okay, great. And is that something from like muscles being like because she said that they referred or to like cagle exercises and im like is that is not the problem yes you are very intuitive absolutely the worst thing you can do when you have tight pelvic is to learn to tighten them more like so you know people always say well dont tight muscles work well and know so if i clench my fist and make fist, its not really good for me to write it, right . Its not very functional. So trying to clench it more isnt going to teach me to learn to open my fist. Right . So and so a lot of people who maybe dont know as much about the pelvic floor will mistake that that for being strong or other things. So no, actually the exercises are to actually learn to relax the pelvic floor and theres internal home exercises dilator is and a cool tool called the crystal wand for people to do so so yeah so i have a lot on that in my book the vagina bible. Thank you. I thank you for being here. Im a huge fan of your work i love following you on substack and like dr. Harper, im also really into holistic lifestyle. So i try. Notice my defenses go up every time you talk about the supplements and the aveda and everything like that, which i love. But i also really appreciate it. Like thank you for for demystifying some of that stuff and giving the actual science information. What im interested in knowing and. Im only about 50 through the book, so i dont know if you talk about it, but, you know, exercise, Healthy Eating great things like but theyre not a pill and everybody wants the quick fix. Im really curious about cortisol and stress and chronic stress and that effect on the whole system and how that might affect the cycle if at or not. I like stress release strategies and things like that. That might be helpful. So i think weve seen the most there with aces, right . So exposure to Adverse Childhood Experiences for who dont know what that stands for. And thats like chronic toxic stress. So you know, having a parent whos an alcohol like having a parent who living in poverty, you know, things like that, once you start to accumulate aces increases your risk of many other medical problems. Theres a link with earlier menopause with aces. The idea is that this sort of chronic of the stress response is, you know, chronic release of, you know, and probably not just cortisol. All inflammatory change that they have an impact. So definitely. From that standpoint, its understudied with with regards to other things, although theres quite a lot in here about stress and, the regularity of the cycle because if you think about it, if a lot of you know, we have be able to tolerate some stress because i always think like what about the first person that like experienced right . Like youre into Northern Europe and all of a sudden this white stuff is falling. I mean id be like, you know, retreating. But but you know, were like, youre b you have to build a shelter and youre migrate ing during ice ages like those pretty stressful things right . So obviously the cycle has to tolerate some stress, but if theres too much stress, then thats not good time to have a baby, right . Because know there might be a famine or Something Like that so. So it seems that some stress is tolerated but that there is a level where it becomes more and that seems to be more related to chronic stress as opposed to like an acute single which you know, which would make sense. And i think that, you know, its an open area of research and you know, stress is bad for us on so many levels that learning how to, you know, to lower levels isnt just important. You know, from a medical standpoint. Its also good just so you dont feel so aggravated. Right . So yeah. So its its an important area of research and im all about things that can make an individual person feel less stressed, less stressful. Thank you. Thank you. Hi. Im a fellow vegetarian and i just want to say i feel in terms of like your education and disinformation, social justice, and also just that diversity, you know, issues with Health Disparity and also the pay. How how like we receive less funding, less pay. And that affects like our ability offer as much care. Im also like really huge like a huge interest i have a huge interest in like dispelling disinformation and i know that thats like big thing for you. And there, and theres and my question is how do you what advice do you have for those of us who are sort coming up in this area and wanting to like make a change and make a difference and out there like what are good to start up in terms of offering like Free Education outside of just like the clinical direct patient interactions, right . So i think theres lots different ways to kind of get involved, you know, somewhat. I was at a book event yesterday and someone said, oh, we should talk about this at girl scouts. You like. So there you can start with you know, if you have any local groups to get involved with to talk to people are always looking for speakers like once you start saying youre willing to go out and talk like youre schedule will be full. So you think about it, you have to think about what age interests you to talk to. Like, are you more interested in . Going out and talking to High Schoolers are . You more interested in, you know, talking with know the age of your practice because your practices all kind of sort of age with us, you know, and also feels like a fit for you. So some people dont mind being out public and talking about a lot of things other people say, to me, i couldnt handle the kind of trolls that you got. So how can i do it in a way thats, you know, less. Yeah, so i know im like i, you know, i can i swear on cspan. Yeah, i can. I dont care. Like, im sorry. Go back your bridge like i like i only what what . You know, people who have something of value to say, you know i have today i was like, did i hear you personally . Ive nothing to apologize for the fact that, you know, you to attack me. You know, thats i go back to your basement like thats, you know, so but everybodys different, right . Some people that really gets to them and. I just it just doesnt. So you figure out what youre willing to do and start with baby steps and just see what feels comfortable. You know, think about pamphlets. You can for your office. Think about, you know, expanding if you, you know, expanding content on, you know, on your website. These are the kind of questions that i get asked, you know, and then Pay Attention to questions your patients are asking because theyre almost related in some, while not almost always, but a lot of times theyre related to, you know, misinformation that theyve heard somewhere, you know, just passed down, you know, like we used to get it the Old Fashioned way or like know in like Readers Digest when they tell you to sleep with a sock, like an onion in your sock words or Something Like that, you know, was a big one id forgotten about. So but so you know, where where are they getting it from . And ask, you know, when i have somebody in my office, i they really just im trouble sort of taking the next step without saying it. So it sounds like you might have heard Something Else from some. Ah, why dont you tell me about it . I think acknowledging that people are going online validates, that they have interest in their medical condition and everybody should have access online. And you know what is not fault that people who are snake oil are better at Search Engine optimized optimized. I think. Im curious to hear a little bit more the connection between like parents and, children and periods like if a mother has really periods, is her daughter more likely to, you know, end to end dimitrios this if a mom has it is the daughter more likely to have it. Yeah so there definitely is a genetic component to endometriosis. There definitely a higher incidence, but its not a guarantee. And so thats why Family History is important as it is for many conditions. Right. So, so want to say knows your mother have endometriosis. You know, we also see that with polycystic ovarian that theres a genetic component to it so its important but its just one factor and and and the more we learn about genetics im sure were going to learn so many things that we didnt believe were genetic were i . Its just, you know, we have all this like undiscovered with genetics. So so definitely its a risk factor. Its not a definite. And were making new advances and new therapies all the time. And so but definitely there there is a genetic component, but its not in sense that if a mother has, then for sure her daughter. Well, so its not like a, you know, passing on an autism or dominance gene, you know, like i have brown eyes. My kids going to have brown eyes. Its not a definite, but its definitely a risk factor in. We have three more questions. I think we can get through the next. Okay. All right. We can do it. Mm. Hello. Thank you for taking question. My question is what are some recommendation or things you would implement at the workplace and the reason i ask this is because the workplace is basically made by men 8 hours stay in the office or now return to office and theres talk about 32 hour workweeks. But im just talking about some of my who have very painful periods and cramps. They cant even consent but they cant leave either. So i just want to know, what are things, practical things you would implement in the workplace to make it more woman or female friendly. Right. Great question. So first of all, id make products, right . Like you shouldnt caught unawares like nobody cares. Toilet paper is free, right . Like so i would make natural products. I think that says a lot to people and i would have them all bathrooms for all genders. The second thing is i would look at my insurance that im giving my employees almost always, people who are getting the short shrift. So, you know, from age of sort of like 18 to 40, you have clergy system that the population doesnt have. So you have cramps that are expensive. You have to buy medications for them or you have to go to doctors visits or you have to get ultrasounds or you have to have surgeries. You have all these things. So workplaces should be making insurance equitable. They should be taking that into consideration also if you need to miss work of pain, you should be talking to a doctor because that to find out that we need to talk about other kinds of treatments. And then i think when possible flexible working, right. So i think who has a medical issue should their time for that and you know if someone says, you know, when i have really bad cramps, i can do all this work at home and im okay with it because can get my heating pad and i do that and i want keep working because it takes my mind off of it but its just so much harder to come into the office, you know, so having that kind of flexibility acknowledges that understanding. You know, obviously theres going to be some types of jobs that that just doesnt work for. But there are many that do. And so those would be the three things that that i would implement and i personally, when i hear companies about like equity or menopause and menopausal thing and then i hear from people work there and you tell me about what they have to pay for this prescription or that prescription like vaginal estrogen costs them 300 bucks and it should be like 25. So, you know, so the Companies Need to walk the and make insurance affordable. Okay. Thank thats how high so my questions a little bit more general than everyone elses. I want to ask your thoughts are on premenstrual dysphoric disorder and how it should be treated like culturally and in the medical field. So dont think i can answer that question in the short time i do covered in the book. So so i have a whole chapter on pms and pms and go into all you know, the treatments and and the options that are available. And i think its really important to recognize that as a medical condition because for too long, women have obviously marginalized as being hysterical, problematic and you know, so but yeah. So i have a whole chapter on it and this is our last question, i think, oh, were okay. Were going to get it in and do it. Hi. So also a fellow physician and Womens Health advocate on social so and thank you for everything that you do and for being here. So one thing that keeps coming across my social channels that i dont feel equipped to address but would love to hear your are things like seed and you know already see that you see the reaction to which is it was my sort of gut reaction but just want to hear your thoughts on those types of things so cover nutrition and the cycle in the book and i actually talk about seed cycling which is this idea that you need to eat different. In different weeks of your cycle for Optimal Health really right okay its really good. Only up in the last couple i heard of it in the last like. Yeah, its new. Yeah. Absolutely. So think about it. Everybody around. The world and streets and are amazing omnivores and they have if you look at the diet historical people in iceland for example and compare that with diet of historical people in. Argentina, i bet they look nothing like this idea that everybody would have access to pumpkin seeds and flax seeds, like how did we even reproduce if were so fragile that we need different seeds. And each week its if it sounds witchcraft, its usually. So, so yeah. So it gets talked about because you can sell diets and you can sell stuff and so you know again i talk about it in the book but its not based in any kind of, you know, reality. And thats the problem with undoing baseless things. So you have to take the approach of you talk about it, then youve elevated it sort of being a thing. But if you ignore it, your patients have these questions, you kind of get in this like, you know, this weird inner space. And so i usually explain to people the cycle is not that fragile that if we needed very certain chemicals optimize that our diets have evolved in completely different right we wouldnt be able to like whatever wouldnt be able to eat like you know you know you know theres all i think about, you know, kind of food that grows would grow natively where, you know, i grew up in winnipeg, canada. Nobody gets fresh, like, what are you talking about . Like for half the year. So all this, you know, so the idea that that that would have something and its really so to undo stuff that wasnt put there by science so these things beliefs and you cant undo a belief with facts so thats what makes it really hard if somebody said oh i read an article on seed cycling and then you said well thats in a predatory journal and their methods were terrible, then the person would probably say, oh, okay, i should discount that article because that was put there with what they thought was science. But thats a problem with influencers. You believe they influence you and so and theyre, you know, they have these gorgeous, edited lifestyles. Their hair is spectacular. You know, if you just see these seeds, youre going to, you know, be like them and, you know, and so it gets hard undo and so i what i usually is i take that as a window that i hear you want to talk about nutrition. So lets talk about that and then give my big plug for, you know, if you really want to do something good for your cycle, you want to eat 25 grams of fiber a day. Im like a fiber revamp. Yeah, im just like i am totally into it because its its one of the few things that has many cross system and so many of us for so long have had toxic messages. The food we should avoid and fibers adding something in. Right. How can i add in something . And so you i give people i usually have three or four different recipes. I have a great recipe for lentils on. My website, the agenda. Yeah with aj and you know because theres theres just so many different ways for people to get fiber in and you know we all get stuck in about what we should eat. So talk about high fiber cereals. I talk having more and more more protein from plant because theres data that shows that thats particularly heart healthy for women. I try to pivot and say, i sounds like youre interested in nutrition. Lets talk about what that science tells us. I im a pediatrician. I did my fellowship in adolescent medicine so talk about periods a lot and my practice and i feel like i have an increasing number of parents coming in because their children are starting their periods at a very young age and studies are coming out showing that puberty is starting earlier and earlier and they want to be put on Birth Control. Right. You know, the my child is only ten years old. We cant be dealing with a period in elementary or whatever it might be. So im just your thoughts about starting contraception so soon after menarche and such a young age. For that reason in particular . Right. So my understanding is that the only issue when people are really, really young is that is there a potential for a slight negative effect on growth later on. And so i think in that situation, if somebody was or 11, i might want to with a pediatric endocrinologist just get their take on it. You know, if somebody was, you know, 12, 13, 14, but, you know, i have far less concerns. So i just think that if somebody is really that young, then thats we dont have a lot of data on that. But also, if you have an 11 year old with painful periods, they be suffering. I mean, no, i mean, we also know that untreated pain can change the nervous system. So i think that would be a situation where i think itd worth having a chat with somebody whos a super expert in in hormones would be a pediatric and acknowledge us. So that would be my take. Thank you. And we should all you know, we all talked about how obgyns are not reimbursed. Probably the worst reimbursed field is pediatrician in pediatrics and they do so much work and they are so incredible. So, again, we have to think, you know, how our our Health Care System is structured. So thank you. Coming and thank you for asking your dr. Elizabeth coleman, welcome to afterwords and congratulations on your new book. Im really excited to have this conversation with you today. Thank you so much for having me. Im delighted to. So before we get into your book, i actually wanted to tk