The Diary of a CEO — Episode Summary
Episode Title: Women’s Fertility & Lifestyle Debate: Dangers Of Not Having A Period! Fasting Can Backfire For Women
Host: Steven Bartlett (DOAC)
Featured Experts:
- Dr. Stacy Sims — Exercise physiology and sports medicine expert
- Dr. Natalie Crawford — Fertility doctor and reproductive endocrinologist
- Dr. Mary Claire Haver — OB/GYN and menopause care specialist
- Dr. Vonda Wright — Orthopedic surgeon, musculoskeletal aging researcher
Overview of Main Theme
This landmark episode tackles the reality of women's health with rare depth and honesty, challenging widespread misconceptions around menstrual cycles, fertility, exercise, birth control, menopause, and lifestyle. Steven Bartlett facilitates a dynamic, multi-disciplinary conversation among top women’s health experts to break down the science, history, myths, and practical advice that every woman—and man—should know. Issues covered include why missing periods are dangerous, how research and medicine systematically neglected women, and why “normal” health metrics often don’t work for women. The discussion is candid and at times deeply personal, making it essential listening (and sharing) for both women and men.
Key Discussion Points & Insights
1. Why Women’s Health Needs Its Own Conversation
- Systemic Neglect: For decades, medicine and research were based on male physiology; women were excluded from studies until 1993 (09:47–10:11).
- Underfunding: Less than 1% of health research funds in the US go to women over 40, despite women comprising the majority of the population and outliving men (06:29–08:05).
- Unique Physiology: Women’s needs are fundamentally different–from cellular level (XX vs XY) to organ systems and disease presentation (11:04–13:12).
Memorable Quote
"Women are 51% of the population. We're not a minority. We're the majority. Yet our healthcare is treated like a niche product." - Vonda [06:29]
2. Menstrual Cycle as a Marker of Health
- Regularity Matters: Irregular cycles are red flags for hormonal or metabolic dysfunction, not just a 'fertility' issue (31:00–32:22).
- Not Just About Babies: Menstrual health is a vital sign for brain, bone, cardiovascular, and even mental health (32:27–33:45, 50:28–50:42).
- Tracking is Key: "Normal" should be personal, but most women are never taught to track their cycles (26:27–32:22).
Notable Quote
"Your body's meant to work like clockwork when it comes to hormones and cycle. If it’s irregular, it’s a major red flag." – Natalie [31:10]
3. Birth Control: Myths, Implications, and Informed Choice
- How It Works: Pills and IUDs often suppress natural hormone production and ovulation (79:16–80:49, 107:09–108:34).
- Critical Bone Years: Missing cycles and low estrogen during ages 15–25 can have lifelong negative effects on bones and the brain (82:11–84:49).
- Informed Consent: Women (and especially teens) must be offered all the facts about consequences, not just “side effects” (96:20–101:19).
- Better Practices: Taking breaks from hormonal suppression, using new forms of contraception, and tracking cycles are advised.
Notable Quotes
"I wish I'd advocated more. When I had my own pregnancy losses... even as somebody in the field, that felt very dismissive." – Natalie [90:45]
"Cycle awareness is one of the few early signs you have of your body's health as a young woman." – Natalie [95:42]
4. Polycystic Ovary Syndrome (PCOS) and Metabolic Health
- What is PCOS: A genetically rooted condition of egg excess, insulin resistance, and systemic inflammation (35:48–39:52).
- You Didn’t Cause It: Lifestyle choices don’t cause PCOS, but can worsen or improve symptoms (39:52–41:08).
- Management: Focus on anti-inflammatory, high-fiber, plant-forward diet, exercise (especially resistance training), managing stress, and sleep (41:52–47:20).
Notable Quotes
"Infertility is a warning sign your body’s giving you that can set you up for many problems down the road." – Natalie [36:16]
"The gut reaction is to starve ourselves. That's the opposite of good for physiologic wholeness." – Vonda [44:40]
"Building and using skeletal muscle is one of the most effective ways to combat insulin resistance." – Natalie [41:52]
5. Fasting, Exercise, Diet: What Works for Women, What Doesn’t
- Fasting Pitfalls: Intermittent fasting, skipping breakfast or fasted training often backfires for women—leads to hormonal disruption, higher stress, poor sleep (45:44–47:20).
- Resilience over Restriction: Focus on strength and muscle gain, fueling, and cycle-tracking for health/performance (45:44–47:20).
- Basic Lifestyle First: Sleep, regular meals, strength training beat any "shiny gadget."
Notable Quote
"We want to build muscle, we want to sleep well, and that requires food." – Stacy [47:20]
6. Endometriosis: The Invisible Disease
- Long Delays in Diagnosis: Women average 7-10 years to diagnosis; pain is dismissed or mistaken for something else (01:02–01:18, 63:33–67:38).
- Severe Impact: It’s not just pain—can devastate fertility, anatomy, and cause lifelong problems.
- Inflammation & Treatment Gaps: Treated as a pill problem, but needs diet, anti-inflammatories, and, when applicable, surgery (69:35–75:21).
Powerful Segment
"She was in pain for 17 years because she did not get a diagnosis." – Stephen, referring to team member Liv's case [66:08]
"If you have pain every single month, you’re going to convince yourself it’s normal... but it can be a predictive marker that you do have endometriosis." – Natalie [72:26]
7. Iron, Anemia, and Why Lab ‘Normals’ Fail Women
- Iron Deficiency is Rampant: 30–50% of women worldwide aged 15–49 are anemic (59:42–61:45).
- Lab Ranges Are Misleading: 'Normal' is getting lower as population gets sicker; optimal is much higher (61:45–63:27).
- Effects: Low iron impairs performance, mood, cognition, sleep, and can be an early red flag (53:07–61:45).
8. Hormones, Mood, and Mental Health
- Dynamic Symphony: Hormones fluctuate throughout the cycle; no 'one test' defines your health (24:29–25:01).
- Mood Swings: Luteal phase drop in estrogen/progesterone triggers premenstrual dysphoria for some; support, vitamin D and iron may help (110:06–113:19).
- Suicidality Peaks: Suicide risk in women peaks between 45–55, coinciding with perimenopause; hormonal shifts are overlooked contributors (179:04–179:59).
Notable Quotes
"The hardest time is when estrogen is changing: high to low is when your brain can’t keep up." – Natalie [153:30]
"Period pain should not keep you home from work or out of activities. That’s a warning sign." – Natalie [57:56]
9. Fertility Realities, Family Planning & Egg Freezing
- Egg Count: Women are born with all their eggs; supply drops sharply long before menopause (124:30–127:23).
- Age & Quality: Fertility declines due to age-related drop in egg quality, not just quantity (127:23–129:29).
- Plan Ahead: Egg freezing best before 32; cost and access are barriers (128:44–141:17).
- IVF is Not a Failure: Reframes narrative that needing assistance is shameful; technology is a tool (135:55–137:39).
Notable Quotes
"The choices made in early reproductive years impact your longevity." – Natalie [84:49]
"Fertility is not just luck. There are things you can do that will harm or support your chances—lifestyle matters." – Natalie [122:39]
"IVF is not a failure. ‘Natural isn’t always better’—sometimes the natural progression of disease is death." – Natalie [135:55]
10. Menopause and Perimenopause: The Grand Transition
- Ovarian Failure: Menopause = all eggs gone, no more estrogen/progesterone from ovaries (163:33–174:41).
- Perimenopause: Lasts 7–10 years before menopause: cycles shorten, hormone chaos, mood, memory and sleep disruptions (163:29–171:36).
- Hormone Therapy: Underused yet highly effective; only 4% of eligible women get it (196:52–197:16).
- Stigma: Women suffer due to outdated definitions and lack of education around HRT ([189:50–191:58], [176:58–179:04]).
Notable Quotes
"We are making women suffer to get that diagnosis. Being low estrogen is hugely impactful at any age." – Natalie [177:01] "We celebrate men taking testosterone, but stigmatize women using estrogen. That’s got to change." – Vonda [190:46]
11. Sex, Love, and Relationships Through Menopause
- GSM (Genitourinary Syndrome of Menopause): Atrophy, dryness, and pain are common; local vaginal estrogen is critical, underprescribed (205:00–207:51).
- Testosterone for Women: Can boost libido, muscle mass, and quality of life (201:00–205:00).
- Empowerment: Menopause can signal a new era of authenticity, strength, and positive relationships ([192:23–194:10]).
Notable Quotes
"I have better relationships, better sex—everything now is better. Menopause gave me permission to cut out the crap and focus on what’s important." – Mary [192:24] "If sex hurts or you bleed, that’s not something to hide—local estrogen can fix it, and there’s no age limit." – Vonda [207:01]
12. Workplace, Society & What Needs to Change
- Structural Change: Women need workplace flexibility, better leave policies, emergency childcare, and understanding of monthly/hormonal variations (155:58–161:44).
- Self-Advocacy: Women must demand the same curiosity and standards for their own health as they would for their children ([212:58]).
Timestamps for Key Segments
- Why women’s health must be singled out – [06:22–10:51], [14:41–16:15]
- Difference in male/female physiology – [11:04–14:50]
- Personal stories of dismissal & bias in medicine – [15:12–19:57]
- Cycle tracking and what’s “normal” – [25:53–32:22]
- PCOS & metabolic health links – [35:07–44:39]
- Fasting, exercise, and stress effects – [44:40–47:20]
- Birth control pros/cons – [79:16–86:10], [101:19–108:34]
- Endometriosis case & inflammation – [63:27–75:21]
- Fertility, egg reserve, and planning – [124:30–141:49]
- How lifestyle influences hormonal health – [143:31–144:54], [209:43–210:51]
- Menopause, hormone therapy, and stigma – [163:29–191:58]
- Sex and relationship after 50 – [201:00–207:51]
- Empowering next generations, self-advocacy – [210:51–213:31]
Notable Quotes & Moments
- “Women gaslight themselves. It takes so long to seek care, because they fear not being taken seriously.” – Natalie [19:14]
- “If pain is keeping you from daily life, that’s not normal—endometriosis, adenomyosis, fibroids should be investigated.” – Natalie [57:56]
- “To those who say, 'I want to do this naturally,' brain fog, night sweats, and mood swings aren't the only thing going on. You can't feel bones crumbling.” – Vonda [199:49]
- “I want every woman to approach her midlife with the same energy and curiosity she would have for her sick child. Don't take no for an answer.” – Vonda [212:58]
Tone and Language
- Direct, scientific, often passionate
- Candid and personal stories—no sugarcoating
- Accessible even when discussing complex science
- Empowering but never patronizing
Conclusion
The episode busts pervasive myths and shows that women's health is not a mystery—just misunderstood and systematically neglected. Tracking your cycle, building muscle, anti-inflammatory diets, demanding better care, and informed choices on contraception and hormone therapy can literally change—and extend—women’s lives. Every listener is urged to question norms and advocate for themselves or the women they care about.
A must-listen episode for women of all ages, anyone who loves a woman, and anyone working in health, sport, or wellness.
Resources Mentioned
- My New Book: link
- Dr. Sims’ research on exercise physiology and cycle
- Dr. Crawford’s fertility guides
- Dr. Haver's programs for menopause
- Dr. Wright's resources on longevity
Listen, share, and—most importantly—advocate.
Episode aired: October 16, 2025
Podcast: The Diary of a CEO with Steven Bartlett
This summary skips advertisements, intros, and outros.