The Diary Of A CEO with Steven Bartlett

Women's Fertility & Lifestyle Debate: Dangers Of Not Having A Period! Fasting Can Backfire For Women

October 16, 2025

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  • Irregular menstrual cycles or the absence of a period (outside of hormonal contraception) are significant red flags indicating underlying systemic health issues and pose harm to long-term health, including brain, mental, and physical health. 
  • Historical and systemic bias in medical research, stemming from the exclusion of female physiology in early studies (not required until 1993), has led to a significant knowledge gap and the mischaracterization of women's health issues, such as labeling heart attack symptoms as 'atypical.' 
  • PCOS is fundamentally a metabolic issue driven by insulin resistance and inflammation, and while not self-inflicted, lifestyle interventions targeting diet, sleep, stress, and exercise are crucial for managing symptoms and mitigating long-term risks like Type 2 diabetes and cardiovascular disease. 
  • Pain that consistently keeps women from their activities of daily living is a warning sign for underlying conditions like endometriosis, adenomyosis, or uterine fibroids, not just a normal period symptom. 
  • Lab reference ranges for ferritin (iron stores) are shifting based on population averages, meaning levels considered 'normal' (e.g., 20 and above) may not be optimal for peak health, often requiring levels of 60 to 100 for optimal function. 
  • Contraceptive methods like the birth control pill and progesterone-only IUDs suppress natural hormone production (estrogen and progesterone), which, while effective for contraception, can have long-term implications for bone density, mental health, and fertility if used during critical developmental years. 
  • Wearable technology algorithms often fail to account for natural hormonal fluctuations in women, leading to potentially misleading recovery data that should not dictate athletic performance decisions. 
  • Fertility is not purely luck; lifestyle factors like sleep, stress management, exercise for muscle building, anti-inflammatory diet, and toxin reduction are crucial non-negotiables that impact both natural conception and IVF success rates. 
  • Perimenopause, which often begins in the mid-to-late 30s to early 40s, is characterized by hormonal shifts and declining ovarian function (loss of eggs/estrogen production) that precede the official definition of menopause and cause symptoms like cognitive changes and reduced resilience. 
  • The medical community's antiquated definition requiring a one-year absence of periods to diagnose menopause causes unnecessary suffering due to the critical, systemic roles estrogen plays in the brain, bones, heart, and muscles. 
  • Hormone therapy, particularly estrogen, during perimenopause can be more effective than SSRIs for treating worsening mental health disorders and mood changes, offering a crucial window of opportunity before periods cease entirely. 
  • Women must advocate for themselves regarding hormone optimization, as the long-term physiological consequences of low estrogen—such as bone density loss, muscle atrophy, and cardiovascular risk—are often undetectable until damage occurs, unlike symptomatic relief. 

Segments

Importance of Women’s Health Conversation
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(00:00:00)
  • Key Takeaway: Lack of research funding disproportionately harms women’s long-term health outcomes.
  • Summary: Less than 1% of research funding is spent on women over 40, yet women live 20% more of their lives with chronic disease or mental health disorders. Conditions like endometriosis take seven to ten years to diagnose despite impacting 50% of unexplained infertility patients. Women often gaslight themselves about pain, viewing high tolerance as a badge, which delays necessary care.
Expert Introductions and Biases
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(00:02:57)
  • Key Takeaway: Experts bring diverse lenses—exercise physiology, fertility, menopause, and orthopedics—to the holistic view of female health.
  • Summary: Dr. Stacy Sims focuses on exercise and nutrition’s impact on stress outcomes for active women. Dr. Natalie Crawford specializes in fertility, aiming to educate women on natural fertility and aging effects. Dr. Mary Claire Haver shifted focus from reproductive organs to long-term health after realizing gaps in menopause education. Dr. Vonda Wright integrates orthopedics and longevity, emphasizing mobility preservation to combat chronic disease.
Physiological Differences Between Sexes
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(00:10:51)
  • Key Takeaway: Fundamental physiological differences exist at the cellular level, meaning research generalized from male bodies is inadequate for women.
  • Summary: Men possess more fast-twitch muscle fibers, while women are born with more endurance fibers, affecting metabolism and blood glucose homeostasis. Women generally have smaller lungs, hearts, and less hemoglobin due to testosterone’s effects. Cellular research shows XX cells are better at making cartilage and muscle, while XY cells excel at making bone, confirming inherent genetic differences.
Medical Bias Against Women’s Symptoms
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(00:15:01)
  • Key Takeaway: Systemic medical bias has historically led to the dismissal of vague female complaints, often labeled pejoratively like ‘whiny woman.’
  • Summary: Medical training often included dismissive terminology for middle-aged women presenting with vague symptoms like weight gain, low mood, and rising blood pressure. This bias echoes historical concepts like ‘hysteria’ and the ‘wandering uterus,’ leading women to downplay their pain and delay seeking care. This lack of curiosity extends across medical subspecialties, failing to investigate symptoms beyond surface-level assumptions.
Understanding Hormones and the Menstrual Cycle
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(00:21:54)
  • Key Takeaway: Hormones are the body’s dynamic communication system, and the menstrual cycle reflects whole-body health, not just reproductive function.
  • Summary: Estrogen receptors are found almost everywhere in the body—brain, bones, muscle, and gut—highlighting the systemic role of sex hormones. A normal cycle requires predictable timing (25 to 35 days) as it signals proper hormonal communication. The cycle consists of the estrogen-dominant follicular phase followed by the luteal phase, where progesterone prepares the body for potential pregnancy.
PCOS: Metabolic Roots and Management
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(00:33:45)
  • Key Takeaway: PCOS is primarily a symptom of underlying insulin resistance and inflammation, not solely an ovarian issue, which predisposes women to future chronic disease.
  • Summary: PCOS is often caused by a genetic predisposition leading to excess eggs and subsequent insulin resistance, where cells stop responding effectively to insulin signals. Infertility in PCOS is a warning sign that, if uncorrected, increases the risk of heart attack, metabolic syndrome, and early death. Management focuses on combating inflammation and insulin resistance through whole foods, fiber, adequate sleep, stress reduction, and building skeletal muscle.
Lifestyle Choices vs. Medical Treatment for PCOS
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(00:47:47)
  • Key Takeaway: Traditional medical management for PCOS often overlooks crucial lifestyle factors, while restrictive dieting and overtraining can worsen hormonal imbalance.
  • Summary: Historically, PCOS treatment focused only on birth control pills or Clomid, neglecting nutrition and exercise advice. Starving oneself or overtraining increases stress hormones like cortisol, which elevates hunger signals and can disrupt hormone pulses, leading to poor sleep and carbohydrate cravings. Optimal management requires a plant-forward diet, avoiding ultra-processed foods, and utilizing exercise to build muscle, which is highly effective against insulin resistance.
Period Health: Absence, Lightness, and Pain
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(00:49:59)
  • Key Takeaway: Having a period during reproductive years (unless using hormonal contraception) is essential for long-term health, as its absence signals harmful low estrogen levels.
  • Summary: Losing a period (amenorrhea) results in hypoestrogenic time, which is detrimental to bone health and overall systemic function, despite some athletes viewing it as a sign of peak performance. Any consistent change from baseline—whether too light, too heavy, or accompanied by excruciating pain—warrants investigation beyond simply accepting it as normal menstrual discomfort.
Abnormal Period Pain Warning Signs
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(00:58:25)
  • Key Takeaway: Pain that consistently forces cancellation of daily activities signals potential underlying issues like endometriosis or fibroids.
  • Summary: Pain should not routinely cause a person to call in sick or cancel social engagements; consistent monthly disruption is a warning sign. Conditions such as endometriosis, adenomyosis, and uterine fibroids can be the cause of severe, recurring menstrual pain. This highlights the need to take severe period pain seriously as a potential indicator of pathology.
Iron Deficiency and Ferritin Levels
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(00:58:53)
  • Key Takeaway: Ferritin levels below 60 to 100 are considered suboptimal for optimal functioning in women, despite clinical norms often accepting much lower values.
  • Summary: Iron is critical for hemoglobin structure and oxygen-carrying capacity in red blood cells, stored primarily as ferritin. Menstruating women are often iron deficient, and chronic inflammation can inhibit iron storage, lowering ferritin levels. Optimal ferritin levels for peak performance are cited as 60 to 100, significantly higher than the baseline used by labs to avoid diagnosing anemia.
Endometriosis Diagnosis and Impact
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(01:03:27)
  • Key Takeaway: Endometriosis is a chronic inflammatory and autoimmune-like disease where endometrial-like tissue outside the uterus causes severe inflammation, scarring, and often leads to a 7-10 year diagnostic delay.
  • Summary: Endometriosis involves the body attacking endometrial cells that escape the fallopian tubes, leading to implants that worsen with estrogen exposure and cause extensive organ scarring. The disease severely impacts fertility, with stage three or four disease resulting in less than a 20% chance of natural conception. Diagnosis is typically surgical, and GI symptoms like IBS are a major red flag due to implants on the bowel.
Endometriosis Treatment Limitations
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(01:09:17)
  • Key Takeaway: Current treatments for endometriosis often focus on halting the ovulatory cycle to reduce estrogen feeding the lesions, but this can negatively impact mental health, relationships, and fertility.
  • Summary: The lack of a cure stems from insufficient research and the difficulty of treating a condition fed by estrogen, as removing estrogen has its own health implications. Birth control pills offer symptomatic relief but do not reverse the disease, though they can slow progression. Surgical removal of cysts, like endometriomas, directly decreases ovarian reserve and egg count.
Anti-Inflammatory Strategies for Endometriosis
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(01:15:22)
  • Key Takeaway: Pilot data suggests that regular, timed cold water exposure (around 10°C/50°F) can dampen inflammation and improve endometriosis symptoms by inducing a learned parasympathetic immune response.
  • Summary: Decreasing inflammation is key to managing endometriosis symptoms, similar to PCOS management. Cold water exposure, specifically cold submerged (not ice baths which are too stressful), can create a protective immune cascade that reduces inflammation and stress. Athletes can time this exposure in the 10-14 days before their period to reduce the expected inflammatory burden.
Contraceptive Pill Effects on Hormones
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(01:19:09)
  • Key Takeaway: The birth control pill suppresses the brain’s signal (FSH/LH) to the ovaries, halting natural production of estradiol and progesterone, which differs significantly from natural hormone function.
  • Summary: The pill uses synthetic estrogen (ethinyl estradiol, 300x more potent than natural estradiol) and progestin to trick the brain into thinking hormones are present, thus preventing ovulation. This suppression means the ovaries stop making natural estradiol, progesterone, and testosterone. While useful for conditions like PCOS or preventing hemorrhagic cysts, this synthetic suppression impacts tissues differently than natural hormones.
Hormonal Impact on Young Athletes and Bone Health
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(01:21:27)
  • Key Takeaway: Suppression of natural testosterone via birth control in young, high-performing female athletes can negatively impact athletic performance and critical bone-building years (ages 15-25).
  • Summary: Inflammatory cytokines (like IL-6) and lack of natural estrogen/testosterone during peak bone development years (15-25) halt bone growth. Decisions made regarding hormonal suppression in youth directly impact longevity, as low bone density achieved then is compounded by perimenopausal loss later. Educating young women on the importance of maintaining natural hormones for muscle and bone mass is crucial.
Contraception Choices and Long-Term Effects
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(01:35:14)
  • Key Takeaway: Women should be given all information regarding contraceptive options, as choosing methods like the pill or IUD without understanding their impact on natural hormone cycles can lead to missing signs of underlying health issues.
  • Summary: My eldest daughter chose an IUD for contraception, but her body expelled it due to severe cramping, highlighting that not all methods suit everyone. Progesterone-only IUDs can suppress ovulation, leading to low estrogen states that are often dismissed as a normal ‘side effect’ rather than a health concern. Stopping hormonal contraception to track cycles is vital for establishing a baseline understanding of one’s natural hormonal health.
Luteal Phase Mood Swings and Management
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(01:50:18)
  • Key Takeaway: Mood changes before a period (luteal phase dysphoria) are linked to the sharp drop in estrogen and progesterone, which affects neurotransmitters like GABA, serotonin, and dopamine.
  • Summary: The luteal phase involves high estrogen followed by a drop in both estrogen and progesterone, which can profoundly affect mood, sleep, and libido, sometimes leading to PMDD. Traditional treatment often involves short-term SSRIs, but treating the root cause with low-dose estrogen during this phase can alleviate symptoms without suppressing ovulation. Low iron and Vitamin D are also significant contributors to luteal phase mood disturbances.
Wearables and Female Physiology Mismatch
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(01:57:36)
  • Key Takeaway: Wearable technology algorithms are primarily designed around male physiology, causing them to misinterpret natural luteal phase changes (increased respiratory rate, decreased HRV) as poor recovery or high stress.
  • Summary: After ovulation, progesterone naturally increases respiratory rate and resting heart rate while causing HRV to plummet, leading to poor recovery scores on wearables five days before a period. This mismatch means wearables often fail to capture true stress resilience in women unless comparisons are made between follicular and luteal phases separately. Athletes should be cautious using wearables during peak performance times due to this inherent bias.
Wearables and Hormonal Data
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(01:58:03)
  • Key Takeaway: Wearable data algorithms must segregate populations and create new norms for women to accurately reflect hormonal phase changes like those induced by progesterone.
  • Summary: Wearables can misinterpret natural progesterone-induced changes in respiratory and heart rate as poor stress resilience, leading athletes to distrust their true performance capacity. Data masters need to establish new norms for women, comparing follicular phase data to follicular phase data, rather than mixing cycle phases. Relying solely on current wearable data without proper context can cause women to self-limit based on improper algorithmic readings.
Fertility Non-Negotiables
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(02:02:35)
  • Key Takeaway: Achieving fertility requires active management across five non-negotiables, even when undergoing treatments like IVF, as lifestyle choices inherently harm hormonal health.
  • Summary: The five fertility non-negotiables include getting adequate sleep, actively decreasing chronic stress through boundary setting and light exposure, exercising to build muscle, eating an anti-inflammatory, high-fiber diet, and reducing environmental toxins. Chronic stress negatively impacts both natural fertility and IVF success rates. These lifestyle factors must be addressed concurrently with fertility treatments.
Egg Count and Aging
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(02:04:24)
  • Key Takeaway: Women are born with their entire lifetime supply of eggs, losing the majority before birth and puberty, and fertility decline with age is due to both chromosomal damage and decreased mitochondrial metabolic function in the remaining eggs.
  • Summary: Women lose millions of eggs between five months gestation and puberty, long before reproductive years begin. As eggs age, chromosomal abnormalities increase, leading to difficulty conceiving and higher miscarriage rates. Poor metabolic health and inflammation accelerate mitochondrial dysfunction in eggs, further impacting quality alongside the unavoidable effects of time.
Egg Freezing Advice
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(02:07:24)
  • Key Takeaway: Freezing eggs is a smart game plan for women delaying childbearing, offering an opportunity that time would otherwise eliminate, especially before age 32.
  • Summary: Egg freezing is not an insurance plan but a smart strategy when delaying conception, as IVF success is still limited by age-related egg quality and quantity issues. The optimal time for freezing is in the 20s or early 30s, though financial barriers often cause delays until later. Factors like endometriosis, surgery, and smoking can also negatively impact egg count.
Male Fertility Factors
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(02:25:55)
  • Key Takeaway: Male fertility is significantly impacted by modifiable lifestyle factors, as sperm health regenerates every 90 days, making changes like avoiding heat and cannabis use highly effective.
  • Summary: Men should avoid heat sources like hot tubs and saunas, prolonged cycling, and cannabis use, as these directly impair sperm production, motility, and DNA integrity. Marijuana use specifically disrupts the brain signals (FSH and LH) necessary for sperm production and is linked to higher rates of pregnancy loss in partners. Because sperm lifespan is 90 days, a singular health change can yield a noticeable improvement in sperm quality relatively quickly.
Pregnancy Loss Stigma and Support
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(02:28:47)
  • Key Takeaway: Pregnancy loss is common, affecting one in four pregnancies, yet it remains a taboo subject, and employers must offer grace and flexibility, recognizing the profound physiological and psychological impact on women.
  • Summary: The physiological impact of pregnancy loss or birth involves a massive hormone crash (estrogen and progesterone dropping rapidly from peak levels), which causes significant emotional instability. Employers should offer flexibility and support structures, such as emergency childcare, as the traditional nine-to-five structure does not accommodate the realities of motherhood or loss. The identity shift following pregnancy or loss, combined with hormonal changes, contributes significantly to postpartum anxiety and lack of control.
Perimenopause Onset and Symptoms
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(02:41:44)
  • Key Takeaway: Perimenopause begins years before the final menstrual period (menopause at age 51-52) when the ovary becomes stubborn and less predictable, often starting in the mid-to-late 30s, causing symptoms before cycles become irregular.
  • Summary: Perimenopause is the transition period where the ovary’s declining egg count causes it to become stubborn, requiring the brain to send stronger signals (higher FSH) to stimulate hormone production, leading to unpredictable fluctuations. Symptoms like feeling ’not like myself,’ sleep disruption, and cognitive changes (word salad, memory loss) can appear while cycles are still regular, often before age 45. Knowing a mother’s age of menopause is crucial, as early menopause in a first-degree relative increases the likelihood sixfold.
Antiquated Menopause Diagnosis
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(02:56:46)
  • Key Takeaway: The one-year waiting period for menopause diagnosis forces women to suffer from estrogen deficiency’s systemic effects.
  • Summary: Medical training mandates waiting one year without a period to confirm menopause, ignoring estrogen’s vital roles outside reproduction for the brain, heart, and bones. This antiquated definition forces women to prove ovarian failure, leading to unnecessary suffering from low estrogen states. There is currently no single medical specialty ‘in charge’ of women’s health after reproduction ends.
Menopause and Mental Health Crisis
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(02:59:04)
  • Key Takeaway: The peak time for female suicide (ages 45-55) correlates directly with the perimenopausal transition, where mental health disorders increase by 40%.
  • Summary: The most likely time for a woman to commit suicide is between 45 and 55, strongly linked to menopause. Mental health disorders increase by about 40% across the transition, leading to a doubling of SSRI prescriptions. Giving low-dose estrogen during perimenopause can treat mental health disorders and cognition issues more effectively than SSRIs alone, before periods fully stop.
Hormone Therapy in Perimenopause
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(03:00:51)
  • Key Takeaway: Low-dose estradiol during perimenopause stabilizes the brain and alleviates mood swings without suppressing natural ovulation.
  • Summary: Menopausal-dosed hormone therapy, often via a patch for a steady state, can be used in low doses during perimenopause to calm the brain’s fluctuations without stopping ovulation. This stabilization addresses the ‘delta chaos’ of fluctuating hormones that causes distress. Post-menopause, hormone levels stabilize, and women tend to respond better to SSRIs for new onset anxiety.
Defining Menopause and Postmenopause
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(03:03:23)
  • Key Takeaway: Medically, menopause is defined as a single day after the final period, but postmenopause is the permanent new biological state following this transition.
  • Summary: Menopause is medically defined as one day exactly after the final menstrual period, a definition considered antiquated due to factors like IUD use. Postmenopause is the subsequent, permanent biological state where hormone levels stabilize, though bone deterioration continues. Research is exploring ways to extend ovarian function to slow down osteoporosis and heart disease without inducing pregnancy.
Holistic Approach to Midlife Health
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(03:05:12)
  • Key Takeaway: Hormone optimization is one critical building block, but it must be combined with lifestyle factors like nutrition, fitness, stress detox, and sleep for a great life.
  • Summary: The five non-negotiables for fertility—protein/anti-inflammatory nutrition, cardiovascular fitness, lifting, stress detox, and sleep—are the same foundational tools needed for rebuilding life post-perimenopause. Women must use all available tools, as relying on just one, including hormones, is insufficient for optimal health span. Agency is crucial, allowing women to make informed decisions rather than being passive recipients of care.
Personal Journey and Hormone Use
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(03:06:51)
  • Key Takeaway: One expert transitioned from high-capacity health to severe symptoms like heart palpitations and total body pain due to perimenopause, necessitating a multi-tool approach including optimized hormones.
  • Summary: An expert researcher experienced a rapid decline around age 47, suffering from night sweats, brain fog, heart palpitations, and arthralgia due to the inflammatory response of low estrogen. She chose to use all tools: diet, heavy lifting, cardio changes, strict sleep hygiene, and optimized hormones (estradiol, progesterone, and low-dose testosterone) to feel like herself again. This comprehensive approach is necessary because hormone decisions alone are not a cure.
Stigma of Menopause and HRT
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(03:09:50)
  • Key Takeaway: There is a significant stigma surrounding menopause and taking HRT, contrasting sharply with the celebration of men taking testosterone for longevity and virility.
  • Summary: Women often feel emotional about starting HRT, viewing it as marking an end, unlike men who are celebrated for seeking testosterone for low energy. Media often frames female longevity as superficial ‘anti-aging’ rather than celebrating wisdom, leading to the stigma that women ‘age out of the game’ after reproduction ends. The goal is to pivot this narrative to focus on improving health span, similar to how matriarchal whales gain seniority.
Sex Life and Genitourinary Syndrome
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(03:21:02)
  • Key Takeaway: Testosterone can improve libido, but low estrogen causes genitourinary syndrome of menopause, making sex painful due to vaginal atrophy, which requires local estrogen treatment.
  • Summary: Testosterone can increase desire and initiation for women experiencing low libido, and improved communication and relationship dynamics often follow midlife changes. Low estrogen causes genitourinary syndrome, leading to vaginal atrophy, dryness, and pain during sex, which men often misunderstand as rejection. The root cause solution is local vaginal estrogen, which is not systemic and also prevents UTIs and pelvic floor prolapse.
Empowerment Over Gaslighting
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(03:29:39)
  • Key Takeaway: Women must control their health narrative by understanding inflammation and insulin resistance, refusing to accept the historical gaslighting that led to past generations being prescribed sedatives for menopausal symptoms.
  • Summary: Inflammation and insulin resistance are controllable factors that can worsen hormone changes, meaning women are not entirely without control over their situation. Past generations were often prescribed sedatives like ButaSol (a barbiturate derivative) as ‘mother’s little helper’ instead of receiving proper care for menopausal symptoms. Women must demand the same vigorous advocacy for their midlife health that they would for their children, refusing to be blown off by medical advice.