How Your Hormones Affect Everything — From the Gym to Egg Freezing & Relationships | Dr Hazel Wallace

0:00I went into Reddit and I wanted to see like what are women talking about right now when it comes to female health. A young woman shared her experience of getting an IUD and she talked openly about the pain and the bleeding. My other intern friend pulled me aside at my lunch break and she said that I should not share anything to do with women's health or periods with men. It is uncomfortable for them and for me. The only way that we change that narrative is by normalising those conversations between men and women. I think we reduce our menstrual cycles to pure fertility, but it's impacting so much more than that.

0:31You're sitting here as a qualified medical doctor, also a nutritionist, but also somebody who now has had a deep focus on women's health. A really interesting study on PMS, premenstrual syndrome, and they did just single therapy with the person that was experiencing PMS, and then they did couples therapy in another arm of the study with the partner of the person who was experiencing PMS. and they found that actually couples therapy was more effective at reducing symptoms. But what do you think about training during your menstrual cycle? There was an interesting study done on female footballers and they perceived that they performed worse during their period.

1:05Actually when they did objective measures of how they performed their reaction times and other measures were better. So they actually performed better during that time. It's really about becoming more aware about how your hormones impact you and that includes fertility as well. I went through egg freezing last year and it was really hard because I came out of a very big relationship that was quite traumatizing and I remember all I had in my brain was I have to do this but the pressure of it was so much. I have to say like when I finished the last injections and had the egg retrieval that's when I felt low.

1:38It was the dip afterwards. I was the same. No one prepares you for that. What's the one thing that you want people to leave today's conversation with. If you are a regular listener to the show or live well, be well, or this is your first episode you're listening to, I really want to ask just a very small quick favor. If you could please hit the subscribe button or leave a review, this helps the show more than you can imagine. It means the world to help growing this show. And you all know that I have a huge thing to want to hit 100 ,000 on YouTube this year. And I can't do that without your support.

2:12I really aim to bring you the best guests possible out there and I pride myself in doing that for the show because it's so important. But to keep the guests coming, to get them to be bigger and to bring more helpful information to your ears and your eyes, I really would love to ask you to subscribe to the show. Thank you. First of all, congratulations. Thank you. On your fourth book, which is called Not Just a Period. It's such a great title. Thank you. And I kind of want to start, I'm trying to, I want to start with more of a curious question, because I think we reduce our menstrual cycles to pure fertility, but it's impacting so much more than that.

2:52So I wanted to ask you, and I think so many women listening to this, which is, what do you wish that more women understood about what's really happening in their body, especially during their menstrual cycle? It's a really great question and it's one of the reasons why I call the book Not Just a Period because when we think about menstrual cycles we just think about the bleeding phase a period when so much more happens across that 23 or so other days outside of the bleeding phase menstruation and every single day is different in terms of a hormonal profile so that means that it's impacting us in a different way every day, which is something so unique to females that men don't experience that.

3:38And I think the hormonal fluctuations like estrogen and progesterone that occur across the menstrual cycle, oftentimes we think about them from a fertility perspective or ovulation, but those hormones impact everything, every single part of our body, every single organ system from our brain, our gut, our mood, how we sleep, our cravings, our metabolism, how our gut functions. And having that knowledge, I think, is so incredibly important for women because it's really empowering. It helps us feel less and dark about our bodies. And if we are struggling with any of those things, be that sleep or breakouts or cravings, we can be proactive when we really fully understand our hormones and our cycle.

4:25When was that moment, I guess, because it's interesting. I think it's so fascinating. You're sitting here as a qualified medical doctor, also a nutritionist, but also somebody who now has had a deep focus on women's health. And, you know, I've spoken a lot on here about women's health and we've had so many varying conversations when it comes to it. And I've learned a lot. And it's interesting that, you know, for you, you've shifted your focus into this being a woman. So you kind of had that lived experience and then you're learning it along the way. What's been one of the most interesting things that you've learned personally during this journey about hormonal and female health?

5:02It's been fascinating, to be honest. I feel like writing the book made me learn so much more about my body and feel maybe really validated about what I was experiencing. So I guess my real interest in women's health stemmed from my own experience and that's often the case when people go through their own journey. I was diagnosed with PCOS, polycystic ovary syndrome, in 2018 but I was having symptoms for two years and I was back and forth to the doctor whilst working as a doctor myself at the time and I didn't incline that this is what was happening to me but you need blood tests and an ultrasound to be diagnosed.

5:46Well technically you could be diagnosed without the ultrasound but on this in this situation my GP wasn't convinced that I had PCOS. He felt like I didn't fit the PCOS picture is what he called it and so having to really push and advocate for myself and then finally get that diagnosis made me realize kind of the state of women's health within the UK and across the world. And just how we approach menstrual health is often that, you know, it's just part and parcel of being a woman. Periods are supposed to be irregular, periods are supposed to be heavy, PMS, everyone gets it. Like all of these assumptions that we have when what I was experiencing wasn't normal, what lots of women are experiencing aren't normal, But while they're common, they're not normal and they are fixable.

6:36And so that was kind of my entry into really wanting to understand why we're not serving, why we're not really taking women seriously in that space. and I guess like through my own research when I got my diagnosis I was doing my master's in nutrition so I set out to like figure out what can I do from a nutrition standpoint and supplement standpoint because I was simply told just cook carbs and come back when you're gonna get pregnant and that is just such useless advice but you would like I could literally I would say every second client that I see in my practice will say I was told the same thing it's like almost as if There's a script that everyone's given the same script or the alternative is lose weight, which is something that women are often told.

7:25And so I just don't think that's good enough. But there were no books that you could read. Yes, you can dive into research if you're skilled to do that, if you've got access to that. But not everyone does. and I think realizing how transformative it was for me to really understand my hormones and my cycle because a lot of this stuff isn't taught at medical school. Yes we learn about women's health in general, menstrual health disorders, obstetrics, gynecology but what about the women who which there are 1.9 billion of us who are having a cycle and experiencing that every day and maybe they don't have endometriosis or PCOS but they have really debilitating PMS or they get really bad uncomfortable bloating or cramps during their cycle and they're not given the tools to help support themselves so that was the why really behind the book um because there was such a gap in knowledge and research there is a gap and i think what's really interesting is that i'm so deep in this sphere so i feel very grateful and privileged to be able to speak to so many different people every day and learn and push myself even more to know, you know, the landscape of this.

8:40I'm in a very fortunate position to do that. And obviously, all the female friends I have around me, I'm constantly like relaying all this information. And I'm very vulnerable with what I go through and try and have that interaction with my friends. I actually got a voice note last night from a very good friend of mine, where I had sent her to see somebody because she really suffers with PMDD. and it probably took you know eight months of support and convincing to get her to this person that I thought would really help and with her hormones and she sent me a voice note crying last night saying I don't want to speak too soon it's been the first month but it's been life changing it's been completely life changing and my you know validation back was this is amazing but think how many women are just left feeling like this without the support because it does it is something that's not spoken about regularly.

9:32And when I was like researching this podcast, as well as like reading your book and looking at comments at the moment about what women are talking about, I was like, oh, I think I know where I'll go. Reddit. So I went into Reddit and I wanted to see like what are women talking about right now when it comes to female health. And I thought I'd share something and see what you think. Because it quite broke my heart. It was a young woman shared her experience of experience of getting an IUD and she talked openly about the pain and the bleeding so this is what she said hi I got my IUD yesterday I had to take a day off from my internship to do it and didn't hide the motive when I got into my internship a bunch of co-workers men and women asked me if it was okay and how it went I essentially told everyone the same thing I was in a lot of pain I bled a lot and at first I thought it could take I could take it without anesthetic but then it hurt so much they had to take it.

10:28My other intern friend pulled me aside at my lunch break and she said I felt like you were being inappropriate towards the male colleagues. She said that talking openly about getting an IUD was going to put the image of me naked in their minds and that saying I bled a lot or was in pain was too much. She said that it was practically like I was harassing them and that I should not share anything to do with women's health or periods with men and is uncomfortable for them and for me. She also said that she had been meaning to tell me this for a while because she also felt very annoyed when I openly shared about having menstrual cramps.

11:01And this girl ended it with saying, now I'm spiraling a lot. And it's just, I mean, that was a really recent Reddit post that I read. And there was 43 lots of comments underneath. And it just made me kind of step back and think for a moment of where we kind of, I guess, disassociated from having these conversations around women's health. And what made me sad about that was it was another woman speaking to another woman in this situation and scenario. Is this something that you see a lot? Is this maybe why that you felt the need to write this book? And you're also incredibly open on your content and social media about your own journey.

11:45Like, how do you see the landscape of women's health conversations changing or do you think they're not? I think they are. Um, within like the menopause, we have a lot more conversations about that now. And that's, wasn't always the case. I think people like Davina McCall really like paved the way for that. But I do think that anything related to menstrual health and the menstrual cycle is completely lagging behind and there's still such taboo shrouded around women's bodies because I think some people still believe that periods and menstrual cycles should be discussed in like hushed tones just for women you know hiding your tampon up your sleeve not having those conversations not speaking up in school if you're struggling not taking days off work if you're in really bad pain.

12:38And I think the only way that we change that narrative is by normalising those conversations between men and women, because this is a completely normal bodily function. And no one, when someone shares their pregnancy story, and sometimes there is bodily fluids there, people don't say that, like, don't talk about that, that's horrible. I guess, when I talk about this as well, I get some women say, well, I don't want to talk openly with my male friends or my male partners about my cycle or my period. And that's absolutely fine. I'm not asking you to. But there are some women who are completely struggling in silence and they've got no one to speak to.

13:21And actually by opening up to their partner, they get the support that they need. And we see that even in the research, like we see that with those, there was a really interesting study on PMS, premenstrual syndrome, and they did just single therapy with the person that was experiencing PMS. And then they did couples therapy in another arm of the study with the partner of the person who was experiencing PMS. And they found that actually couples therapy was more effective at reducing symptoms. And it's when you, it's kind of like a problem shared as a problem half, like when you include someone in what you're experiencing it.

13:57they can help support you through that. But also it really normalizes it. You know, I think back to my own relationship and at the start of our relationship, maybe our conversations weren't so open around my cycle and my PCOS, but now it's as if we're talking about a headache. Like it's no different to any other part of my body or any other experience. And he's so equipped to know what to do that I don't feel like I need to really overthink it in my head and like really psych myself up to have that conversation it's so normalized and for some women that can be really difficult within their relationship for some women they have great partners who are willing to talk about it so I think it's it really is taking time to change that narrative but I think the more we talk openly about it the more podcasts like this hopefully more books like mine will just put menstrual health back on the map like any other part like mental health, like gut health.

14:57It's just another organ. It is. I think, you know, I believe that not talking about it is silencing the diagnosis of things like PCOS, PMDD, which I think many people even five years ago didn't know that was. People might be listening to this and going, well, what is that? It's kind of the next extreme of PMS where it's so debilitating for people to cope. Endometriosis, which you just mentioned, even missing periods. You know, I've had some times when my friends have mentioned that they've not had a period for 10 months, but they've not really acknowledged it because there's shame there. And so I think having those open conversations is actually really important in this context.

15:36And I love that you mentioned PMS because we had, I don't know if you know her, the neuroscientist, Dr. Sarah McKay, on the show. She was amazing. And it was really blew my mind because I always come on and go, well, I feel like I know a lot about PMS now because so many people have come on and spoken about it. And something that she said was, yes, there is so much about the biology and the hormonal side that do affect PMS. But there's also so many other things, like the cultural messages that we're given. And she said in a really interesting stat that in France, 12 % of women compared to 90 % of women in Iran are affected by PMS.

16:09So she's like, wait, is this biological? Is it environmental? Is it cultural? Like there must be other things. So it makes so much sense when you say, well, if your partner kind of shares the problem and can see you and can support you and can use positive language and not dismiss you and validate you, then it would seem to make more of a supportive environment to be able to cope with PMS. Yeah, 100%. So it's interesting. I try and think about how we've all grown up around like what are those messages and like how were we treated at school? I mean, I remember getting my period at school and I decided that I was sick and wanted to go home.

16:43I remember first getting it and going in and pretending that I was really ill to go home because I was so embarrassed yeah I mean if no one's prepared you or maybe you've had like one lesson on it and it was very brief and you know you're an 11 year old girl who just started her period for the first time it can be pretty terrifying if you don't have the information that you need so I'm really not surprised that that was your experience and I think you know my experience wasn't too dissimilar. I have an older sister, so my mum just kind of hushed me into a room with her and she told me what to do.

17:21And that was really the only conversation that we had. But I think because I had older sisters, I'd seen them have hot water bottles. I seen them moan about having painful periods. So I just assumed this is what's coming. Painful periods, sometimes taking time off school not exercising during that time or not doing PE I was a really sporty girl so I found that like really like I wasn't really sure how to navigate that should I not exercise should I exercise my mom didn't really tell me otherwise and so I would love that the girls coming up behind us or even my own daughter if I ever have one that their experience is completely different and they feel so well equipped about what to do around their cycles not just the bleeding phase.

18:07And when it comes, it's not like complete panic and it's not something that's like shrouded in shame or embarrassment or you can't speak up if you are the girl who's vomiting because your pain is so severe or you're soaking through your uniform. Because a lot of girls do not speak up about that because they're so embarrassed. Iron is one of the most common deficiencies that I see in clinic, especially in women. And it's not just about feeling tired. Low iron can impact your energy, your focus, your mood, and even your immune system. It's something we really need to be aware of because if left untreated, iron deficiency can become very serious.

18:50Now, UK data shows that around 20 to 35 % of women aged 18 to 50 do not need the recommended dietary guidelines for iron intake. And if you're pregnant, menstruating or following a vegetarian or vegan diet your needs are even higher and therefore you're more at risk. So that's why I often recommend Spartone. Now this is a naturally sourced iron-rich water that comes from the Welsh hills. It contains ferrous iron, the most absorbable form with studies showing up to 40 % absorption so your body can actually use what it takes in. Now it's also incredibly gentle. It's one natural ingredient, there's no harsh tablets and there's no digestive issues.

19:30I use it myself and it is my go-to in clinic. You can pick up Spartone at Boots and if you've been feeling low in energy it's absolutely worth checking in on your iron with your doctor or GP. That was me and I think it was really interesting because I know that you try to not talk down about the pill you have a very balanced view about it but the solution for me at that time was, well, just go on the pill because it's so much easier. And then it was great because it stopped my periods. And then I started modeling. So for me, I was like, well, this is brilliant. I haven't got to think about it.

20:04And then 10 years later, I had this moment where I was like, wait, I don't, I have no idea how my cycle is. And I had to, I've had to reframe my own narrative with my menstrual cycle because now I feel very empowered by it and I feel very lucky and very grateful to have it. and one of my friends has something really interesting she said you know I kind of feel sorry for men because we have this amazing moment in a month where we can just allow ourselves to let everything just go and we can cry and we can kind of reset ourselves yeah and she was like I feel quite sorry for my partner that doesn't he doesn't really get that he doesn't really get that card in the months and I was like that's such a positive way of looking at it yeah so look at it and it takes me back to a question which I get a lot and I'm sure you get overwhelmed with but a lot of people say well what does a normal period look like what is a normal period and how do I know if I'm not because some people say well I come on every 21 days and someone else might say well I come on every 34 days so like how do we define what a normal period is and how can we then be aware of when maybe not falling into the remits of what that could look like.

21:13Yeah. There's no like real such definition of a healthy menstrual cycle, but there are what I like to call green flags or what fall into that like healthy signs that your cycle's working as it should. And so in terms of how often it's coming, we want something to fall between 21 to 35 days which is quite a big variation but textbooks will say like a 28 day cycle is is what most women have but actually a lot of the research shows that not many women do have a 28 day cycle so it's okay if you're falling either side of that now another thing that I often find isn't common knowledge is how to track the days of your cycle so day one is the first day of your bleeding and the last day of your cycle so say that is 28 will be the last day before your next bleed.

22:08So that's your full cycle length. Then in terms of the bleeding phase which is typically the first five to seven days, bleeding for three to five days is considered normal. If you're bleeding up to seven days and it's quite heavy that's a bit of a red flag so we'd want to speak to your doctor about that. But heaviness and pain is very subjective. So we can measure how much fluid or blood is too much to lose. But I don't know about you, but not many people are measuring that. So what I think is a better definition is it's too much for you to manage. So if you're soaking through at night, every night, if you're having to wear two products all the time, if every hour you're like clock watching and you need to like get in and change and similar with pain if you're clock watching because you want to stay on top of painkillers every four hours because otherwise the pain's too severe or you're someone who vomits because of the pain or what I hear a lot of the girls with endometriosis tell me is lying on the floor because it's really cold and that's the only way to get relief when they're you know experiencing painful periods or really heavy periods during the night.

23:17So they would be red flags and then not bleeding between your period. Sometimes it's okay to spot. So sometimes after sex you might spot, sometimes after extreme exercise you might spot. But if it's happening all the time or you're finding it's happening frequently across your cycle, that's also a red flag. So those would be the main things. And the other thing that I'd add in, which we've already kind of talked about, is any severe mood symptoms in that late luteal phase, so the week or so before your period. Anything that's causing disruption in your everyday life, whether that's work, your relationships, your activity, the things that you love, that's a red flag for me.

24:02And so the one thing you mentioned there, which I think every woman will relate to, and if you don't, I'm incredibly jealous. Painful periods. So you said something earlier, you know, and very similar, I had an older sister and a mum that would always have hot water bottles around that time, and warm baths, and, you know, gentle yoga moves. But I always remember being like, oh, gosh, and I would be terrified of my period coming because the pain, is there anything we can do, just thinking actively around having painful periods, like, obviously, there's going to be symptoms of maybe why, like endometriosis, like you just mentioned, and other key drivers but general period pain like what advice can you give to people who are listening who suffer yeah it's really it's it's really tricky if you fall into that category and most women will experience some pain it's unrealistic to have no cramping at all because our body is essentially cramping in order to shed the womb lining so we have to expect a little bit of discomfort but severe pain that's interfering with your day-to-day is is not normal if you fall into that I get some cramping but I'm able to carry on with my day-to-day it's not interfering with like my physical activity or my relationships then there are a few things that you can do as much as it feels like an old wives tale hot water bottles heat patches that you can get the pharmacy or any heat tool is actually can be effective and we have some research to back that up so if you do have a hot water bottle that's fun or you can get those heat pads as well have a warm bath they're good methods um certain yoga poses can be helpful in here i've got some in the book hang on let me find i've honestly read this batch back and i remember seeing this and thinking this is something that i'm definitely going to be doing here we go i'll show it for anyone watching on YouTube.

25:55We're gonna show there's different exercises here. There we go. How many have we got? Eight. And I've just pulled a few from... The boat pose. Yeah. That feels like it would cramp my stomach. Maybe it would, but this is a sequence that I've taken from a research study. So, yeah. And they seem to be the same movements that show up in most of the research studies. But again, And no two women are the same. So if you find that uncomfortable, I wouldn't recommend it. There's a lot of people who say, you know, yogis who will say, I've been told not to do inversions during my period. There's actually no evidence to say that you can't.

26:37I think maybe hypothetically, some people are worried it might cause something called retrograde menstruation, which is a theory related to endometriosis. But we've got nothing to say that. if it's not causing you any discomfort you can absolutely do it it's not harmful it's more of a ancient recommendation not to do that and so if that's part of your practice and you don't do it for that reason then don't do it but if you've always been doing those inversions during your period and it's fine then continue to do so but for people who don't practice yoga all forms of movement can be beneficial during exercise during your period because exercise is anti-inflammatory and it can produce antioxidants so it's really beneficial for us.

27:25I know a lot of people don't feel like doing much during that time but it doesn't have to be severe. It could be a yoga class, it could be going for a long walk, it could be a lightweight session, it could be a Pilates session, whatever works or feels good for you. But generally trying to move as opposed to complete rest tends to be more beneficial. I know I've seen you talk about it a lot on the show. We've had Dr. Stacey Sims on here a lot speaking about the importance of, you know, resistance exercise and training for women's health. But what do you think about training during your menstrual cycle?

28:00Because there's a lot of different conversations around this now on, you know, you should ramp it up for the two weeks when like pre-ovulation and then once you've ovulated you should be slowing it down what's your because you're also really into your training so what do you do and what does the research say in that in that kind of sector so the research is definitely growing in this space but there's not a huge amount of studies there on training around the menstrual cycle or recovery around the menstrual cycle or muscle building potential around the menstrual cycle and of the ones that we have, there is a lot of conflicting evidence or inconclusive results.

28:42From the systematic reviews where we pool all the research together, it seems that there may be a small dip in performance during your period. And I think for a lot of people that is not really a surprise, but it's such a small dip, like very insignificant that some women won't experience it. the other caveat to that is there's other studies that found otherwise and when I was writing this book I really wanted to pull this apart because I find personally that my cycle really impacts my energy, my motivation to train and also how strong I feel and I wanted to find out if that was a real perceived effect like from objective measures and there was an interesting study done on athletes, I think they were female footballers, and they perceived that they performed worse during the period.

29:34But actually, when they did objective measures of how they performed, their reaction times and other measures were better. So they actually performed better during that time. And I think what this tells us is, it's not that it's all in your head that you're having a terrible day or having a hard period, but we can still perform well during our period and during different parts of our cycle and I found that actually really empowering at the time I was writing the book I was doing Paris Marathon and it was day three of my cycle and so having that knowledge of my brain yes it might practically be really annoying but I'm still going to do well I'm still going to perform well I think is it's an important message to tell yourself so kind of what does the research say maybe a small dip around your period and maybe kind of in that late luteal phase potentially there's more muscle building potential around ovulation in that kind of like pre-ovulatory phase when estrogen is high because estrogen is known to really prime us for strength motivation endurance training so you might feel stronger during that time if you do amazing and there's been a handful of studies i think five now where they've compared basing most of your training in that follicular phase so the first part of your cycle versus the luteal phase or versus spreading it out across the entire cycle and they found that maybe there's a benefit of actually front loading your training in the follicular phase there may be some benefits there but I think for most women who are not athletes who kind of are trying to go to the gym around their you know working schedule maybe picking the kids up from school it's not practical to swap and change their workouts around based on their cycle and I don't think the benefits are great enough to make that big shift so I think for most women use your cycle as a guide but it shouldn't dictate whether you rest or move it can't like use it to influence how you train in the sense of like take each day as it comes.

31:45So if you wake up during your period and you feel really uncomfortable, then maybe today's not the day to put a barbell across your hips and do hip thrusts. But maybe doing a Matt Pilates class actually feels really good for you. So it's just about taking, I think what the conclusion I've come to is while we're waiting to gather more research, you are your best piece of evidence. So start tracking your cycles, start feeling how you feel across your cycle and your training program and see how you need to change things. For me personally, as I said, I feel the effects of my cycle on my training, but I don't follow a cookie cutter approach and say during my letheal phase, I only do low intensity exercise.