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Ovulation as a sign of health with Katie Morris · Reproductive Health, Mostly

• 0:05
  SPEAKER_02: Welcome to Reproductive Health Mostly, where we talk about health, hormones, and everything in between.
• 0:11
  SPEAKER_00: We're your hosts, Leah and Alex, and we're bringing you honest, approachable conversations with the providers and professionals who care for our patients every day.
• 0:20
  SPEAKER_00: Whether you're a patient, a coworker, or simply someone who wants to understand more about reproductive health, you're in the right place.
• 0:29
  SPEAKER_02: Now let's dive in to reproductive health mostly.
• 0:32
  SPEAKER_02: You go.
• 0:33
  SPEAKER_02: Now it's Hey.
• 0:35
  SPEAKER_02: Hey.
• 0:35
  SPEAKER_02: It's funny you switch spots too on my uh like the order of us, which is funny.
• 0:40
  SPEAKER_04: Oh there we go.
• 0:42
  SPEAKER_04: I'm just gonna put my lights on.
• 0:44
  SPEAKER_04: Oh yeah.
• 0:45
  SPEAKER_04: Alex, where are you again?
• 0:47
  SPEAKER_04: Where are you located?
• 0:48
  SPEAKER_04: I am in Pennsylvania.
• 0:50
  SPEAKER_01: Okay, cool.
• 0:51
  SPEAKER_03: Not too far from us.
• 0:54
  SPEAKER_01: I love it.
• 0:54
  SPEAKER_01: I love how lightly spread out we are.
• 0:56
  SPEAKER_01: And even the patients too.
• 0:57
  SPEAKER_01: I'm always like, what state are you in if I don't like look?
• 1:00
  SPEAKER_01: Like, what state are you in?
• 1:01
  SPEAKER_04: What time zone are you in?
• 1:03
  SPEAKER_04: Yeah, I know, I know.
• 1:05
  SPEAKER_04: Sometimes they like don't say the right one.
• 1:07
  SPEAKER_04: I'm like, hmm, are you sure you're not in Virginia?
• 1:10
  SPEAKER_04: I don't think we were supposed to do this.
• 1:12
  SPEAKER_04: But yeah, everybody's all over the place.
• 1:15
  SPEAKER_02: Yeah.
• 1:15
  SPEAKER_02: Yeah.
• 1:16
  SPEAKER_02: I love that you're like close to us though, because it feels like everybody is very far from the the like few of us in Virginia.
• 1:23
  unknown: Yeah.
• 1:25
  SPEAKER_01: We gotta represent East Coast.
• 1:28
  SPEAKER_04: Yeah, East Coast, baby.
• 1:31
  SPEAKER_04: It is a different experience here.
• 1:33
  SPEAKER_04: I think it's just so I find in the patients it's a little bit different.
• 1:38
  SPEAKER_04: I think even in the staff a little bit.
• 1:40
  SPEAKER_04: Like the culture culturally, I think it's very different.
• 1:43
  SPEAKER_02: Yes.
• 1:43
  SPEAKER_02: Like Alabama and Georgia.
• 1:47
  SPEAKER_02: Yes.
• 1:47
  SPEAKER_04: Yeah.
• 1:48
  SPEAKER_02: Well, I thought that we could I thought we could start with talking about our highs and lows for the week or this season, this month, you know, whatever, whatever kind of time frame.
• 1:58
  SPEAKER_02: Um, so Katie, you wanna hit us with a high or a low?
• 2:03
  SPEAKER_04: Yeah, yes, I will hit you with a high.
• 2:06
  SPEAKER_04: Um, and then I'll do a low, you know.
• 2:08
  SPEAKER_04: We have to start with high.
• 2:10
  SPEAKER_04: Um, I just did a high rock with five other moms.
• 2:14
  SPEAKER_04: So all in our neighborhood.
• 2:16
  SPEAKER_04: Have you guys heard of high rocks before?
• 2:18
  SPEAKER_02: No.
• 2:18
  SPEAKER_02: No.
• 2:19
  SPEAKER_04: Oh, it's not rock climbing.
• 2:21
  SPEAKER_04: A lot of people think that is what it is.
• 2:22
  SPEAKER_04: It's like a you run and then you do you do like events, like lunges or burpees, and then you go to the next event, you run again, and you do another event.
• 2:30
  SPEAKER_04: And there's like a total of eight events.
• 2:32
  SPEAKER_04: Anyway, it's really great to train for because you get kind of you get pretty strong if you have to train for it.
• 2:37
  SPEAKER_04: And we all trained for four or five months, and I just want to shout out all five of those mamas.
• 2:42
  SPEAKER_04: We're all we all live in like the same neighborhood, and we all trained and watched each other's babies to train, and we just did it yesterday, two days ago, and we're all very sore.
• 2:51
  SPEAKER_04: Um, but I felt very proud of us.
• 2:53
  SPEAKER_04: A lot of us were postpartum, so it was like a nice way to like get our little, you know, postpartum exercise routine going again.
• 2:59
  SPEAKER_04: So it's definitely a high.
• 3:00
  SPEAKER_04: And then low, I don't know.
• 3:02
  SPEAKER_04: Um, I guess you guys do highs, and I'll think of them.
• 3:06
  SPEAKER_04: Leah, what was your high for this week?
• 3:09
  SPEAKER_02: My high for this week is that I am the new cycle education director, uh, or director of cycle education here at RHM.
• 3:18
  SPEAKER_02: So starting a new role, which is very exciting.
• 3:21
  SPEAKER_02: Uh yeah, just yeah, very excited to kind of into this new season uh at work.
• 3:26
  SPEAKER_02: So yeah, it's pretty fun.
• 3:28
  SPEAKER_03: That's awesome.
• 3:30
  SPEAKER_02: And then personally, my my family just went to the beach this weekend, so that was really fun.
• 3:35
  SPEAKER_04: Oh, nice.
• 3:36
  SPEAKER_04: What beach did you go to?
• 3:37
  SPEAKER_02: We went to Virginia Beach, so it's very fun.
• 3:40
  SPEAKER_02: There's playgrounds on the beach, mellow mushroom, if you've heard of it, gray pizza.
• 3:47
  SPEAKER_01: They have one in uh North Carolina, in Asheville, North Carolina, a mellow mushroom.
• 3:51
  SPEAKER_02: Yes, so good.
• 3:53
  SPEAKER_02: So that was it, that was my high for the week.
• 3:56
  SPEAKER_01: Yes, that's awesome.
• 3:58
  SPEAKER_02: What about you, Alex?
• 3:59
  SPEAKER_01: One of my highs, I don't know.
• 4:01
  SPEAKER_01: I had a good long run.
• 4:03
  SPEAKER_01: I did what did I do the other day?
• 4:05
  SPEAKER_01: 11.8, which is pretty good.
• 4:08
  SPEAKER_01: It was a long I'm like, there's a half coming up where I am do it, and I'm like, I think I might just do it.
• 4:16
  SPEAKER_01: I don't know.
• 4:16
  SPEAKER_01: I haven't done I haven't done any races in a while, so we'll see.
• 4:20
  SPEAKER_01: I don't feel the need to, I don't know, but I like kind of want to.
• 4:24
  SPEAKER_01: Like, so if I want to do a half, I want to do 13.1, I'm just gonna go do it.
• 4:27
  SPEAKER_01: But I'm feeling like I want some energy with it, you know?
• 4:31
  SPEAKER_01: Yes.
• 4:32
  SPEAKER_01: Yeah, yeah.
• 4:33
  SPEAKER_02: I love you guys.
• 4:35
  SPEAKER_02: You're both like, I'm on my exercise, and I'm like, pizza.
• 4:39
  SPEAKER_04: Yeah, girl, the pizza, mm-hmm, it's so good.
• 4:43
  SPEAKER_04: That's like the best post-workout thing is to go to mushroom.
• 4:48
  SPEAKER_04: But yeah, Alex, you gotta go to a race where like, yeah, there's a lot of hype and adrenaline going.
• 4:52
  SPEAKER_04: You can't go to one of those quiet, like races.
• 4:55
  SPEAKER_01: Yeah, it's there's so much like beauty and peace and running alone, you know.
• 4:59
  SPEAKER_01: So it's that's what I choose to do.
• 5:01
  SPEAKER_01: I don't know.
• 5:03
  SPEAKER_01: That's true.
• 5:03
  SPEAKER_01: That's true.
• 5:04
  SPEAKER_01: Yeah, that's okay.
• 5:06
  SPEAKER_01: You know what I'm saying?
• 5:07
  SPEAKER_01: What am I doing?
• 5:08
  SPEAKER_01: If you just did 11, you got it.
• 5:10
  SPEAKER_01: Oh, like once another, you know, two.
• 5:13
  SPEAKER_04: Yeah, yeah.
• 5:14
  SPEAKER_04: That's nothing.
• 5:16
  SPEAKER_04: Easy peasy.
• 5:17
  SPEAKER_04: It's so crazy.
• 5:18
  SPEAKER_04: Once you get to like that higher mileage, you're just like, oh yeah, just an easy 11.
• 5:22
  SPEAKER_01: Yeah, might as well.
• 5:25
  SPEAKER_01: Right.
• 5:25
  SPEAKER_04: Oh, so fun.
• 5:27
  SPEAKER_01: So cool.
• 5:28
  SPEAKER_01: So, yes, I love it.
• 5:30
  SPEAKER_01: Well, Katie, do you wanna tell us a little a little bit about yourself, like who you are, how you got here, what's your role in RHM?
• 5:38
  SPEAKER_01: We want to hear about you.
• 5:40
  SPEAKER_04: Yes, I would love to.
• 5:41
  SPEAKER_04: Well, thanks for having me on the podcast, guys, and for putting all this together.
• 5:45
  SPEAKER_04: I'm so excited to be able to chat with you guys.
• 5:48
  SPEAKER_04: Um, so I am a wife to a very awesome supportive husband, and we have three little ones.
• 5:55
  SPEAKER_04: Um, and then I'm a women's health nurse practitioner at RHM, gynecology.
• 6:01
  SPEAKER_04: Um, so I'm in the Virginia office, which is in Arlington, Virginia, and we serve DC, Maryland, and Virginia.
• 6:08
  SPEAKER_04: Um, but then I also see some patients in Alabama via telemedicine.
• 6:12
  SPEAKER_04: So yeah.
• 6:14
  SPEAKER_04: Um, and then did you ask how I heard about RHM or how I got here?
• 6:17
  SPEAKER_01: How did you get here?
• 6:18
  SPEAKER_01: Like what got you into the um women's health in general and and how'd you find RHM?
• 6:23
  SPEAKER_04: Yeah, so I started in like cardiac as a nurse.
• 6:28
  SPEAKER_04: I really loved the cardiac and I figured like if I can do the heart, I can do anything else after that.
• 6:34
  SPEAKER_04: And so I really loved doing like postcardiac surgery care and I did a lot of travel nursing.
• 6:38
  SPEAKER_04: But in that time, I just had this real pull towards women's health and I didn't really know what that meant.
• 6:44
  SPEAKER_04: Like, did I want to deliver babies or did I want to work with infertility patients or just regular gynecology?
• 6:49
  SPEAKER_04: I didn't know, but I just wanted most of my patients to be women.
• 6:52
  SPEAKER_04: So I um like non-specific, but I also like had a uh feeling like I wanted to be a nurse practitioner too.
• 7:01
  SPEAKER_04: So I found a great program at Georgetown for women's health nurse practitioner.
• 7:06
  SPEAKER_04: And it's like you really once you graduate from that, you are serving women over the age of 13 and like no men, you know, it's really specialized care, and I loved that.
• 7:16
  SPEAKER_04: I wanted to get really good at one thing.
• 7:18
  SPEAKER_04: So really loved the program.
• 7:19
  SPEAKER_04: And during the program, I had a friend who was working at RHM as a nurse, and she reached out um and she was just telling me about how much she loved working there.
• 7:29
  SPEAKER_04: And um, I was in school full time, and so I was just like really busy and they needed more nurses, and but so I couldn't like apply for that position at the time.
• 7:37
  SPEAKER_04: But she was like, hey, you know, once you graduate, you should look at becoming a provider there.
• 7:41
  SPEAKER_04: Um they have a fellowship program, and I had really wanted to do a fellowship.
• 7:46
  SPEAKER_04: It's pretty rare to find as a nurse practitioner or a PA, um, but it's basically like a six to 12 month-long training, and they really help you get good at your job before you're independently seeing patients.
• 7:59
  SPEAKER_04: And I I loved that.
• 8:00
  SPEAKER_04: I really wanted to give women good care and I wanted to train under some really awesome providers.
• 8:04
  SPEAKER_04: Um, and so then I became a little bit obsessed with RHM through my program.
• 8:09
  SPEAKER_04: I was like, I looked at their website and and just the care that they were giving women, and then I started to run into more and more women that had been patients at RHM because I was living in Georgia at the time and they were serving women in Georgia, and just like they had the most wonderful experience.
• 8:25
  SPEAKER_04: They felt like they were very heard by the providers.
• 8:28
  SPEAKER_04: They felt like the admin and billing team and the nurses were just so responsive.
• 8:33
  SPEAKER_04: And I just was like, there's just like this feeling of love surrounding this clinic.
• 8:39
  SPEAKER_04: And I had never been a patient there, so I hadn't experienced it personally, but just kind of like this aura of RHM of like, what is this clinic about?
• 8:47
  SPEAKER_04: Like, why is it so good, you know?
• 8:49
  SPEAKER_04: Um, but the root cause too, like the fact that they wanted to treat all of these women's health symptoms without suppressing normal function of a woman's body was like really intriguing to me.
• 9:04
  SPEAKER_04: I was like, how do they do that?
• 9:06
  SPEAKER_04: Because that's not what I was learning in school.
• 9:08
  SPEAKER_04: Um, and I wasn't finding in my clinicals I had really wonderful preceptors, but I wasn't finding like alternative ways to treat women other than like, let's just shut everything down so that she's not in pain or that her PMS isn't terrible, or you know, a number of things, but let's just shut it down.
• 9:25
  SPEAKER_04: So I was really intrigued by okay, we're not gonna shut things down.
• 9:28
  SPEAKER_04: And so then applied for the fellowship.
• 9:30
  SPEAKER_04: I got the fellowship shortly after um graduating and I was able to do that program and then started seeing my own patients in like 2023.
• 9:39
  SPEAKER_04: So it's been a great, a great job.
• 9:42
  SPEAKER_04: It's my dream job.
• 9:43
  SPEAKER_02: And we're so glad you're here.
• 9:46
  SPEAKER_02: All the Virginia patients love you.
• 9:48
  SPEAKER_03: Oh, wow.
• 9:49
  SPEAKER_03: We included them.
• 9:51
  SPEAKER_02: Um but but that brings us to a good point.
• 9:53
  SPEAKER_02: Like you kind of said that at RHM it just seemed special and different, and like this approach was much different than you were learning in school.
• 10:01
  SPEAKER_02: So can you elaborate now that you know you've been a provider for a few years at the practice?
• 10:06
  SPEAKER_02: Like, what do we do here at RHM and and what does make it different?
• 10:10
  SPEAKER_02: Like what kind of is special about this approach?
• 10:13
  SPEAKER_04: Yes.
• 10:14
  SPEAKER_04: So I'm not saying that other providers don't do this, but I do think we we really focus as soon as a woman comes to us, we focus on a really good history taking.
• 10:24
  SPEAKER_04: So, first we want to know about like not only her medical history, but what is her lifestyle like?
• 10:29
  SPEAKER_04: What is her cycle like?
• 10:31
  SPEAKER_04: Is she charting ovulation?
• 10:33
  SPEAKER_04: What exactly is happening with her period?
• 10:36
  SPEAKER_04: And and throughout that entire month, what does that look like for her?
• 10:40
  SPEAKER_04: We want to know things about how she feels her body, how she exercises, what stress is like, what's her job like?
• 10:46
  SPEAKER_04: So we really get into the nitty-gritty of um a woman's life, which I think is helpful because we are holistic people, right?
• 10:54
  SPEAKER_04: We're body, mind, spirit.
• 10:56
  SPEAKER_04: We we are multifaceted and we shouldn't just be looked at in this one lens.
• 11:01
  SPEAKER_04: And so I really appreciate that at RHM, especially with the initial visit, like we'd spend a lot of time with patients, um 30 to 45 minutes, getting a lot of history, a lot of personal information, really getting to know our patients.
• 11:14
  SPEAKER_04: And then from there, we do a really great workup to figure out exactly what's causing some of the symptoms they're having, or some women are just curious as to what's going on in their body, even if they're not having like life-altering symptoms.
• 11:27
  SPEAKER_04: Um, and so at that point, we do a very large lab panel.
• 11:33
  SPEAKER_04: So we are um looking at a huge hormonal panel, we're looking at, and that's not just reproductive hormones, we're looking also at the thyroid, we're looking at insulin and glucose levels, um, we're looking at hormones that are impacted by the thyroid and insulin and glucose, we're looking at the adrenal glands, kidney, liver function.
• 11:54
  SPEAKER_04: Um, we want to see um hormones that come from the brain that can also impact reproductive health.
• 12:01
  SPEAKER_04: So we're getting a really good picture with the labs, not just about her reproductive health, but about overall health and the whole endocrine system.
• 12:09
  SPEAKER_04: So reproductive endocrinology is that facet, I would say.
• 12:13
  SPEAKER_04: And um, we also do some reproductive immunology testing so that that in the initial labs we order, we can kind of identify whether there's some inflammation going on or some immune response going on, and then we can order more if we need to or investigate further because a lot of um symptoms and a lot of infertility can caught can be caused by immune disorders.
• 12:38
  SPEAKER_04: And then we also look at um, you know, structural causes of different women's health issues, so infertility or just complex GYN issues.
• 12:49
  SPEAKER_04: So we can order imaging.
• 12:51
  SPEAKER_04: Um, and then on top of all of that, all of our patients do learn how to chart their cycle if they haven't already, because that's really great information for us to have at every single visit to know, okay, you know, do you know if you're ovulating?
• 13:06
  SPEAKER_04: Are you having all the signs you're supposed to?
• 13:08
  SPEAKER_04: And if you're not, how are we addressing that?
• 13:10
  SPEAKER_04: And if you are, is it changing month to month?
• 13:13
  SPEAKER_04: Or um is it staying great and the same, you know?
• 13:17
  SPEAKER_04: So that piece of information is so important because um that's a woman, she knows her body best.
• 13:24
  SPEAKER_04: She knows her body, she sees it in and out, and she can give us that information.
• 13:29
  SPEAKER_04: And our patients are so good at it.
• 13:31
  SPEAKER_04: Oh my gosh, they bring the information, they're so in tune, and they're like, girl, I know something's off because this, this, and this.
• 13:38
  SPEAKER_04: And I'm like, okay, let's figure it out together.
• 13:42
  SPEAKER_02: Right.
• 13:42
  SPEAKER_02: So I get this question.
• 13:43
  SPEAKER_02: I'm curious, Alex, if you have too with our psycho education patients a lot of why why is this important?
• 13:50
  SPEAKER_02: What is this going to tell the provider?
• 13:53
  SPEAKER_02: What is she going to do with it?
• 13:55
  SPEAKER_02: So obviously, I have an answer for that, but I'd love to hear, like, you know, if a patient asks you that, like what is your response if if they're wondering why is it important?
• 14:05
  SPEAKER_02: Why is ovulation important?
• 14:07
  SPEAKER_02: Why do I need to chart my cycle?
• 14:10
  SPEAKER_04: Yeah.
• 14:11
  SPEAKER_04: Um, so ovulation is pretty miraculous, I would say.
• 14:16
  SPEAKER_04: It's pretty amazing that we are able to release an egg every single month.
• 14:21
  SPEAKER_04: And every woman who is of reproductive age, so she's gone through puberty, um, and you know, she's not in perimenopause or menopause, should be ovulating every single month.
• 14:32
  SPEAKER_04: And in order for that egg to come out of the ovary, it's a very complex conversation that has to happen between our ovaries and our brain.
• 14:43
  SPEAKER_04: So it's amazing that it even happens.
• 14:46
  SPEAKER_04: Like those things are very far apart from each other.
• 14:49
  SPEAKER_04: Um, and so the the ovaries, the brain starts the conversation, the ovaries respond and recruit a follicle, which is an egg, and it starts growing as the egg grows, it talks back to the brain, the brain's like, oh, okay, I'm gonna keep helping you with more hormones.
• 15:04
  SPEAKER_04: So these these hormones are being released.
• 15:07
  SPEAKER_04: There's multiple hormones being released.
• 15:09
  SPEAKER_04: There's four main ones, right?
• 15:10
  SPEAKER_04: And they're like super complex, and they have to be released at the right time and in the right amounts for this ovulation to happen.
• 15:17
  SPEAKER_04: And so if that's happening, you're pretty darn healthy because that's amazing that your body was able to talk to its itself, right?
• 15:27
  SPEAKER_04: Now, if it's not happening, that's okay.
• 15:30
  SPEAKER_04: We can restore that conversation, um, but we need to figure out what where the disconnect is.
• 15:36
  SPEAKER_04: What is cutting that phone line between the ovaries and the brain?
• 15:40
  SPEAKER_04: Um, and so that can be thyroid disorders, that can be insulin and glucose um issues, right?
• 15:46
  SPEAKER_04: That can be um an imbalance of hormones in other places like the adrenal glands.
• 15:50
  SPEAKER_04: So that kind of like prompts conversation.
• 15:52
  SPEAKER_04: So if a woman is getting all of the signs that those hormones are fluctuating and she can observe those signs, which is so cool too.
• 16:00
  SPEAKER_04: We have a lot of ways to observe those signs, then she's getting all the signs every month and they're kind of happening around the same time every month.
• 16:06
  SPEAKER_04: We're pretty sure she's releasing an egg and ovulating.
• 16:10
  SPEAKER_04: Um, so I'm sure Leah, you could talk more about like all the signs if we're talking about that today.
• 16:14
  SPEAKER_04: But it is really cool that like you can learn like very basic signs or like really complex signs and know whether you're having a good ovulation each month.
• 16:24
  SPEAKER_02: Yeah.
• 16:25
  SPEAKER_02: Yeah, Alex, do you do you find that our new when you find new patients at RHM, they are often confused by this or curious?
• 16:33
  SPEAKER_01: Yeah, they always ask.
• 16:35
  SPEAKER_01: They always ask.
• 16:36
  SPEAKER_01: And I tell them, I'm like, ovulation is a sign of health.
• 16:41
  SPEAKER_01: So I that's typically how I lead lead that conversation.
• 16:45
  SPEAKER_01: And then I do a deep dive too into, you know, what's your life look like?
• 16:49
  SPEAKER_01: You know, I literally told a patient today, I said, if because there was stress, right?
• 16:54
  SPEAKER_01: She's getting married soon.
• 16:55
  SPEAKER_01: She's like, I am so stressed.
• 16:57
  SPEAKER_01: And I'm like, well, that makes sense, you know, like you're experiencing shorter cycles.
• 17:01
  SPEAKER_01: Like, we're gonna see that play out in your reproductive hormones, like we're gonna see that play out in your biomarkers, you know.
• 17:08
  SPEAKER_02: I always like to tell our patients, uh, yeah, like if you're stressed or you're sick, think about to think about yourself kind of on a biological level, right?
• 17:17
  SPEAKER_02: And your body is not gonna be like, now it's the time for a baby when you are very ill or you are very like, you know, your body is very stressed, like biologically, like an animal is not gonna lay an egg when it's running from a cheetah or whatever.
• 17:33
  SPEAKER_02: Yeah.
• 17:33
  SPEAKER_02: So we have to think about ourselves that way of yeah, it's protecting you.
• 17:37
  SPEAKER_01: Yeah.
• 17:38
  SPEAKER_01: And I always explain too, like, uh, you know, the reason, like, why do why do I need to do this as a patient?
• 17:44
  SPEAKER_01: Like, why is this important?
• 17:46
  SPEAKER_01: I always explain it like this gives the providers that we have at RHM better information, right?
• 17:54
  SPEAKER_01: Like more information, more data on you so that they can better help you, you know, and like and I explain it like we're a whole team, like we're all working together for your health and your goals, you know.
• 18:07
  SPEAKER_04: Yeah, yeah, no, for sure.
• 18:10
  SPEAKER_04: And I we use a lot of the protocols from the Reproductive Health Research Institute, which created FEM charting.
• 18:17
  SPEAKER_04: Um, and I feel like they they always say like ovulation is a vital sign of health.
• 18:24
  SPEAKER_04: So just like you go to the doctor and you get your blood pressure and your heart rate and your oxygen drawn, really every woman after puberty should be asked whether she's ovulating every month.
• 18:33
  SPEAKER_04: Like that should just be a normal check-in because if she's having all these signs, we're like, all right, we're doing pretty darn good.
• 18:40
  SPEAKER_04: Um, but yeah, I I love that it's like they consider it a sixth vital sign.
• 18:45
  SPEAKER_04: And I I think at all of our offices, like we're asking that every visit too.
• 18:49
  SPEAKER_04: Um, we're we're always like working with the patient.
• 18:52
  SPEAKER_04: It's not there's no pressure to know.
• 18:54
  SPEAKER_04: Like if you're still learning and you have no idea how to track your ovulation, that's totally fine.
• 18:58
  SPEAKER_04: But we're gonna work with you so that once you've been working with us for a little bit, you're like, yes, I can answer that question.
• 19:04
  SPEAKER_04: Um, so I think that's also really empowering for for women to have that knowledge about their bodies.
• 19:10
  SPEAKER_02: Yeah.
• 19:12
  SPEAKER_02: How do you feel like this differs from what you saw, kind of like you said, in school or in your clinicals, just like the or like the typical approach to women's health?
• 19:22
  SPEAKER_02: Because I had never been asked, was I ovulating before I became a patient at RHM?
• 19:29
  SPEAKER_02: Um, so I I'm curious, yeah, your your take on that.
• 19:33
  SPEAKER_04: I do think the conversation is centered around the patient.
• 19:38
  SPEAKER_04: So the person when we're having a visit, I think most of our providers see uh the patient as the one with the most knowledge um in that visit because and and then it's very individualized.
• 19:53
  SPEAKER_04: Like this care is for each woman.
• 19:56
  SPEAKER_04: I can give examples of like what typically happens and how we typically treat things, but really we have like a case-by-case basis for each patient because they're an individual with their own signs and symptoms and their own um data, and then we analyze from there.
• 20:14
  SPEAKER_04: So I would say like that is truly, I think, a patient-centered approach.
• 20:19
  SPEAKER_04: Like they are coming with the information, we're receiving it, and then we're gonna say, okay, in our experience, like these are the options for how we can treat this.
• 20:28
  SPEAKER_04: Um, and then they get to decide from that point what option fits best with their life.
• 20:34
  SPEAKER_04: It's not you must do this supplement or you must have this lifestyle or you must have this medication in order to fix everything, right?
• 20:43
  SPEAKER_04: We know more, just trust us.
• 20:45
  SPEAKER_04: Of course, we're gonna say, hey, I've seen this really work, but you know, we're we could try it, right?
• 20:50
  SPEAKER_04: And so it's always, I really appreciate Dr.
• 20:52
  SPEAKER_04: Kangwasa, who started the practice.
• 20:55
  SPEAKER_04: He always has a very uh patient-centered approach.
• 20:58
  SPEAKER_04: Ask her what she wants.
• 21:00
  SPEAKER_04: Sometimes we're like, what do we do about this patient?
• 21:02
  SPEAKER_04: He's like, have you asked her what she would like to do first?
• 21:05
  SPEAKER_04: And I think that is a really good way of um of doing care because then you're always going to, I think, find more answers because the patient does like then they have more time to speak.
• 21:16
  SPEAKER_04: They have more time to kind of give their insight into what they've been observing since the last visit.
• 21:22
  SPEAKER_04: I think that's why it's a little bit different from make maybe other practices.
• 21:27
  SPEAKER_01: Yes, yes.
• 21:28
  SPEAKER_01: I'm over here like I don't I don't work for other practices, I work for this one.
• 21:33
  SPEAKER_01: Yeah, no, I mean, even I mean, Leah, I'd love to hear your thoughts too.
• 21:37
  SPEAKER_01: Like, from my perspective, and I've worked with many providers and practices doing you know, doing other things, but this is truly what sets RHM apart.
• 21:46
  SPEAKER_01: Like it is patient-centered.
• 21:48
  SPEAKER_02: Um I agree, and I I was a patient at RHM first uh since 2020, and I have seen Katie many times since we we moved to the same area, and I always appreciate i tell them like Katie always says what do you want to do what like what what do you think um which is yeah not something that I think most providers ever ask it's do this you know and then if you push back there's a conversation but the conversation is the most important part I think at RHM most of the time.
• 22:21
  SPEAKER_04: Yeah I think also the approach of um you know some sometimes people are like I don't want my provider to ask me that question because I don't know I'm not gonna go to I didn't I don't want to know that so there is like you have to feel it out for sure and it's not like we're just we're gonna give you options and kind of see what what seems to be resonating with where you're at um but I also think the best part about giving this kind of care is that we're always trying to restore a woman's natural physiologic function, right?
• 22:52
  SPEAKER_04: So how was this person created and what is her body supposed to be doing let's make sure that's happening instead of suppressing any of that.
• 23:02
  SPEAKER_04: We want all of the parts and pieces to be working well and so that is that's really um rewarding as a provider to pre to be able to provide that type of medical care where it's like okay how was this person supposed to function right and and how can we try and get her back to that if she you know if she used to have it and and has does not does no longer you know have it.
• 23:26
  SPEAKER_04: So um yeah but that kind of goes with like a lot of the complex gynecology so PCOS endometriosis PMS pelvic pain um and then it also really lends well to infertility and um and and recurrent miscarriage too.
• 23:44
  SPEAKER_04: So those are all things that we are able to treat it's so good.
• 23:53
  SPEAKER_02: It's so good.
• 23:53
  SPEAKER_02: I mean I and I think people often when they hear about RHM it's often in the kind of latter context of infertility or recurrent loss.
• 24:06
  SPEAKER_02: But what would what would your plug be like to to all the other women or single women or you know whatnot that are kind of like oh I don't I don't need to see a provider that that way um because I'm fine and I'm not worried about having a baby.
• 24:21
  SPEAKER_02: Like is that what we centered on here?
• 24:24
  SPEAKER_04: You know or obviously I know the answer is no but I'd love to hear like what would you say to someone who's who's more hesitant because they aren't at all focused on that yes I think usually a patient's gonna make an appointment because there is something that's impacting their life that's not great to deal with right so it's like okay every single month I am having to skip work because I'm in that much pain or um yeah the PMDD which is um premenstrual dysphoric disorder like before your period is so bad or um I'm having like trouble losing weight even though I've never had that before or like abnormal weight gain or I'm losing too much weight or my periods are coming too close together or too far apart.
• 25:10
  SPEAKER_04: So there's something usually that's like triggering I need to get this checked out.
• 25:14
  SPEAKER_04: So usually that's like a motivation to then get hormones tested and kind of get to the root cause of what is what are these outward symptoms coming from.
• 25:22
  SPEAKER_04: And we really want to provide relief too that's the thing like root cause care takes more time right it is taking a little bit more time to figure out what's causing that issue right and I'm always like hold tight with us.
• 25:36
  SPEAKER_04: We're gonna figure it out we're not gonna just like try a couple things and be like sorry we didn't figure it out like we're gonna keep trying we're gonna walk with you um but also we realize that time is of the essence like usually women are gonna their periods in two weeks and they don't want to miss work again and they need to figure this out now or they don't want to miss school we have a lot of teens we have a lot of college students um a lot of women in their 20s and 30s and 40s and they just want to live their life well and they are like they know in their brain exactly when that symptom's about to show up right or they have prom and acne is terrible.
• 26:11
  SPEAKER_04: So we're also going to be solution focused pretty early on too and we're not gonna just be like oh well give us a couple months and we'll figure it out we do usually want to provide some sort of solution especially for those more urgent needs and so we have really good um pain control for example um interventions that we can do we can do a lot for acne we can do a lot for abnormal hair growth we can help restore those cycles to a more regular period of time while we're still finding the root cause so I think that's great.
• 26:39
  SPEAKER_04: And then if you're not having symptoms right I do think it's really important every single year to just check in because sometimes labs do reveal things that we weren't aware of.
• 26:53
  SPEAKER_04: So I do think an annual hormone panel is great for anybody even if you're not having like really overt signs and symptoms and especially if you're not charting your cycle.
• 27:03
  SPEAKER_04: So sometimes labs don't need to be done especially if you're like super in tune with your body and you know that your cycles are regular and you're not having any symptoms I'm like okay you don't need to do labs because you're probably just fine but if you're not charting your cycle and you don't know whether you're ovulating every single month like it would be a good time to just at least get a hormone panel and kind of see what's going on.
• 27:23
  SPEAKER_04: And I always plug it I'm like I wish I did this when I was in my 20s.
• 27:29
  SPEAKER_04: I didn't get my first hormone panel done until I was like post baby first baby you know in my 30s so it's just nice I think to just have that information and it's great to have information for later in life so you have something to compare it to this is my baseline when I'm really healthy for example.
• 27:47
  SPEAKER_04: Okay so now I'm having trouble trying to conceive when I'm 35 okay let's go back what was my baseline and now I can kind of compare those things um so I think it it is beneficial for everybody to kind of do a check-in kind of like an annual visit yeah how do you how do you decide whether a treatment is actually addressing the underlying problem oh that's such a good question I love that okay so primarily it's gonna be symptom based right so we're gonna we meet very frequently with our patients we do a lot of follow-up okay and when we work with patients you know to be able to do that realistically um so kind of like month to month when you're first working with us we want to see you and we want to follow you closely to know that things are working or not working we're not gonna be like okay see you in six months like have fun you know we're like okay let's see you in three to four weeks and like see if these interventions are working and how you're how things are going.
• 28:42
  SPEAKER_04: So the mainly is like patient history taking we want them to be really tracking their symptoms from the time you know we meet with them and they start implementing things to the time we meet with them again.
• 28:54
  SPEAKER_04: And then you know charting is part of that right especially for more complex cases of infertility recurrent loss um PCOS like we're trying to get those that ovulation back to where it needs to be we are going to do labs typically every two to three months at first until we start to see a really great improvement.
• 29:14
  SPEAKER_04: So I always joke I'm like I can tell when someone's been working with um a restorative reproductive medicine provider for a bit because and that's alright Chem, there's a lot of wonderful providers in the US that do this type of care because I see that hormone panel start to like get into all those beautiful ranges and our ranges are not what you would see on LabCore or Quest or even in like a general textbook.
• 29:42
  SPEAKER_04: We have very specific ranges from the protocols we follow that's something the fellows learn during their fellowship.
• 29:49
  SPEAKER_04: And so if Chat GPT says it's normal it's probably wrong right you know probably chat GPT is pretty good for like other things but um yeah I would say no I would a lot of my patients are like oh well it said this you know the reference range that they can see and I totally understand that but we've tailored it to peak reproductive age women and there are these very the tight windows we want those hormones in to know that ovulation is actually as healthy as it can be and the cycle in general is as healthy as it can be.
• 30:25
  SPEAKER_04: So that's kind of cool to be able to see their labs like start to get exactly where you want them to be and then usually symptoms are resolving as well because inflammation is going down hormones are in in order again um so that's like the most rewarding thing is when people just start to feel a lot better.
• 30:42
  SPEAKER_04: And sometimes have a baby sometimes we're like and now you're pregnant and they usually want want to be so would you say I I feel like would the difference be what's normal versus what's optimal is that kind of what we're striving for here yes yes yeah so there's really optimal levels of hormones um and yeah it does give a tighter window for where we want all these hormones to fall in but it's because once we get those hormones optimized we usually then see a great improvement like I said in ovulation in symptoms and in fertility.
• 31:21
  SPEAKER_02: Yeah it's so rewarding yes we're all so thankful for your work okay well to wrap up we have like a fun little true or false game to play with you Katie so um okay so I'll say something you let me know if if you would say it's true or it's false and then we can talk about why so first you should wait 12 cycles or 12 months before you investigate any kind of infertility false okay and why why would you say it's false because I know many women are told this right come back in a year if you're not pregnant.
• 32:02
  SPEAKER_04: Yeah so I think you can investigate as early as you want I actually really encourage preconception um investigating so that you know you know if there's anything going on before you even try to conceive um and that's you know so and then I would also say like it's whenever you kind of discern that you want to get seen you could go the first month of trying and you're like wait we were really spot on with all the things I've already looked up like what that's strange you know you can always get a workup right then and there and we would never ever ever be like why are you here?
• 32:38
  SPEAKER_04: We we love to see you and we want to help you as quickly as possible and we know that every cycle counts so um no we we walk with women from like who have been struggling to conceive for years and years and who have like not even tried to conceive yet.
• 32:56
  SPEAKER_02: And I think so many people appreciate that because yeah this kind of standard answer is just well don't worry about it.
• 33:04
  SPEAKER_01: Yeah it's not a problem until until you've hit that earmark.
• 33:08
  SPEAKER_02: And I I always tell our patients it's very interesting to me that um you know somebody fact check me I guess but uh from what I was always told and what I read that the study that this advice is based around is actually not timed inner course either.
• 33:23
  SPEAKER_02: So like what we're encouraging here at at RHM of charting your cycles timing inner course for ovulation so you can have better chances it's just random.
• 33:33
  SPEAKER_02: So I always tell our patients so if you're timing it it should happen sooner because that is just assuming that you're not doing anything you have no idea and so that feels like always very bad advice to me.
• 33:47
  SPEAKER_04: Yeah and I I wonder if it also came from maybe like oh we don't want like people to stress out like it shouldn't be a stressful process.
• 33:54
  SPEAKER_04: It's a really beautiful thing to be open to life and so um I all of our providers like we're very good at being like hey also relax like also it's gonna be okay and it's gonna happen when it's supposed to happen and like this is in our hands in as like a little bit right we can optimize things we can make you as healthy as possible but there's like there's a lot of other factors at work that's what we all believe.
• 34:20
  SPEAKER_04: And so um that's also very freeing like and I think because we have that approach it's never like this pressure like you also have to try to you have to conceive at this certain amount of time or else then you have to do this intervention.
• 34:33
  SPEAKER_04: No you could try you can do what you discern as a couple is right for as long as you want to do that.
• 34:39
  SPEAKER_04: So there's never really that like pressure conversation um at least we try try not to have that.
• 34:46
  SPEAKER_04: Yeah bringing it back to what does what does she want okay our next true or false we are we already touched on this event but if you are not sexually active then your cycle is not important to track false I think every woman should track her cycle again just so that we know whether all of the that conversation between the brain and ovaries is happening.
• 35:13
  SPEAKER_04: That's so important and if it's not it can point to like a a deeper medical issue and a lot of women thank us for kind of unveiling certain medical issues that they might not have discovered until much later because um they started to tune in and pay attention to their body even more the cycle is yeah is a wealth of knowledge for everyone yeah for everybody yes okay and then last one is that period pain is normal and it should be expected it's just part of being a woman false false false you should not be in pain really like we really really your your uterus is cramping down yes but it should not be very painful if at all painful and so um I know that's hard to believe if you've never experienced that I know it's so hard to believe um I think all of us have probably been there and it's amazing what really good medical care and somebody walking with you can do to help cure period pain.
• 36:22
  SPEAKER_04: And you can be pain free.
• 36:24
  SPEAKER_04: It's crazy yeah do you see that happen do you see that that kind of shock happen with people as you as you treat them if they do have very painful periods and they come to see you or you know whoever and then someday they don't yes yeah so I think it's really cool it's usually because they're like so used to taking ibuprofen or something like right you know the days before their period starts like they just take it routinely because they don't even want to like because once once if you don't get on top of it it's terrible right um so they're used to taking it and then one time they forget and they wake up and they don't have period pain and that is the coolest thing to hear about.
• 37:09
  SPEAKER_04: Yeah that's really awesome.
• 37:13
  SPEAKER_02: Oh my goodness I know all of our patients are so grateful for you and all the providers and thank you for for chatting with us and just sharing more about your work and you guys this was so fun.
• 37:26
  SPEAKER_04: Thank you for having me and thank you for your work that you do educating our women on their cycles that is such a great job and they always come to us and they know like more about cycle than I've ever learned I'm like oh my gosh so shout out to our cycle educators we're all a team working together just trying to give give some ladies good care right yes definitely all right ladies well thanks again for having me yeah you have to come back yes I would love to a huge thank you to our guests for joining us and helping make reproductive health a little easier to understand.
• 38:03
  SPEAKER_02: If you're a patient we hope this conversation gave you something to think about or a question to bring to your next appointment and if you're part of our team we hope you learned something new about the people practices and perspectives that make reproductive healthcare what it is thanks for listening to Reproductive Health mostly we'll see you next time where reproductive health is a topic but the conversation is always bigger