Shailene Woodley & Exercise and Its Effects on Fertility

Dr. Amber Klimczak and Dr. Beverly Reed discuss Shailene Woodley’s comments on how exercise affected her menstrual cycle. They discuss the pros and cons of exercise and how it can affect fertility in both positive and negative ways.

Transcript

0:06

Hi, I am Dr. Beverly Reed. And I'm Dr. Amber k Clack. And we are two, two peaks in a pod. Well, welcome back everybody. So I did not have a celebrity story for today, but I Do you, can you come up with something for me? Well, I have a celebrity and I'm just. Really excited that I know who the celebrity is. Okay.'cause I feel like she's like a young, hot celebrity to me. Oh, okay. Good. Good. I dunno, does that mean I'm not gonna Who It's, well, I just, I think she's a really phenomenal actress. Okay. She's, she's not a reality star. Then I'm probably not gonna know her. All I watch is reality tv, but I really like some of her work that she's done. I think she's really impressive. Um, okay. But I think a lot of our listeners out there have probably heard of Shalene Woodley. She, I think she is like Alister. Mm-hmm. You know, movie star actress. She's lovely. Um, and one of her shows that she did was. Really, really good big little lies. If you've, um, if anyone out there listening has ever watched, that was an HBO kind of kinda like a mini series. You know how HBO does that? Yeah. And they're so good. They're such good quality, but she's a phenomenal actress. Yeah. Um, but I think we all kind of understand that sometimes celebrities have to go through really intense. Training. Mm-hmm. For certain roles. Yeah. You know, um, either they bulk up, right? Yeah. They're doing a ton of exercise, putting on a lot of muscle or losing weight mm-hmm. Really rapidly and having to do a lot of exercise. And she actually shared, I think, because it's part of just being an actress to her mm-hmm. It's really important that she gets into her role, that sometimes she ends up over training for roles and she actually would end up, um, losing her menstrual cycle. Her menstrual cycles would actually stop. Over training and dieting for some of her roles. And she shared that. And I think that that's like something really transparent Yeah. For listeners to understand that that can happen, you know? Yeah. And I thought it was a good topic we can talk about. Yeah. You know, I think exercise and fertility is a very complex relationship. My patients so true are always from me. Dr. Hay, you told me exercise you told me, don't exercise. That changes throughout our time with. Yes. Um, and so there are certain times when I think it's, you know, a good thing and yeah. When used appropriately is really positive. There's other times where it can be detrimental or we don't want you to exercise at all. So I thought we could kind of walk through Yeah. How, how exercise and fertility are interrelated. Amazing. Okay. I have to tell you why this might be a little bit of a sensitive topic for me. Okay. So the last time that I really got into an in-depth conversation with the patient about exercise. She said, why would I take advice from an gosh overweight doctor? Oh gosh. Okay. So that's, it's kind of a sensitive topic for me because I think it's an important topic, but what I have learned sometimes is when you're kind of sharing your experiences, you know, everybody kind of takes that a little bit differently. And it is hard when, you know, some of us, even as doctors are struggling with trying to optimize their own health, you know. So, of course I want to eat healthy and exercise every day, but you know what? I'm really busy and sometimes I don't always prioritize my health. Um, but I remember that was a real. Kind of upsetting conversation for me at the time when I'm just trying to do my best and relay my best advice. And then to have somebody who kind of came back at me like that and I was like, oh goodness. But I think it's important that that happened, and then I went through that. So I can just understand that. This is a very sensitive topic overall for many people. Yeah. Mm-hmm. I hate that that happens to you. I know. It was the worst. Yeah. Now I'm almost afraid to talk to people about it because I'm like, oh no, are they gonna call me overweight again? Well, I admit to people all the time that I don't exercise, like, and you know, it really comes out now because there's all these new exercises that people do. Yeah. Yeah. And I just. Stare at them blank faced when they explain to me what they're doing. Yes. And I'm like, okay, what is that? I don't exercise. You don't have to tell me what this regimen is. Have you seen my dumbbells that I keep in my office? No. This is proof that she exercises. They're under my desk. I haven't used them yet, but I, and also we kind of like throughout the day, I'm kind of like, can we work in some lunges, some planks or so. You know, I'm in my mid forties and it is really important for women in my age range to actually work on strength training. We tend to lose a lot of muscle around my age, and so I do do need to be able to incorporate, um, some strength training through my busy days. Yeah. So don't be surprised if you see me lunging through the hallway. I am totally supportive of, and it's, I mean, for our listeners, that's not just important. For, you know, people Dr. Reed's age, right? Even our younger women in our twenties, you're already getting to the point where you're gonna reach your peak bone density. And so you really have to work at a younger age, um, doing resistance training. I think females love to do aerobic exercise, run, run, run, walk on the treadmill, all those things. But we're not so into weightlifting and resistance training, which is really important for your bone health. Yeah. And, um, reaching as high of a. Peak bone density as possible at a younger age really can help you for the rest of your life. Yes. And I will say, like for me, cardio is so much fun. I love cardio. I dunno about that. Yeah, I love it. But weightlifting is boring, so I, I do feel like I even struggle with that'cause you just wanna do what you really enjoy. But, but yeah, you've gotta, you've definitely gotta incorporate the strength training too. So, yeah. Yeah. Um, okay. Well, I wanna just comment on why I think exercise is so confusing when it comes to fertility. And here's the thing is, I think as patients we just wanna hear one answer, should I exercise or not? How much should I exercise? But what I found when I did my deep dive through the literature is it depends on your overall situation. And it largely depends on your BMI, your body mass index. And so what I found is in patients who are overweight or I call it elevated body mass index, um, if, if they're overweight or above. Any level of exercise is beneficial for your fertility. Any level. So this could be a little bit of exercise. A lot of exercise, it doesn't matter. It's helpful because when you have that elevated body mass index. Your body is usually in a state of inflammation. And um, the amazing thing about exercise is, um, maybe not in the very beginning, but over time it's anti-inflammatory. And they actually say, out of all the supplements that you can take, exercise is the most powerful antioxidant that you could possibly take. That's amazing. Very interesting. Amazing. Yeah, and this is what I have to remind myself too. I saw a study that they said, not exercising is as dangerous as smoking is. That's crazy. I'm like, oh my gosh. Right. So that's a good way to like scare myself into. And so I think that's where you'll really heal, hear from both of us. Um, especially in patients, for example, that have polycystic OV syndrome. We know that is a group of patients that are more likely to have difficulty with weight loss and everything, and that is a group of patients that I think would highly benefit from incorporating exercise. Right. Absolutely. I talk a lot with my PCOS patients mm-hmm. About their lifestyle and what exercise they can incorporate, and really just movement throughout the day is really important for them as well. We kind of talk about what can you reasonably do, right. If, if you choose something that you're not gonna stick to for a long period of time. Right. Yeah. It's probably not gonna be beneficial to you because tell them PCOS isn't going anywhere. It's gonna be with you, right? Yeah. And so a lot of Americans, you know, will hit our 20 minutes of cardio in the morning, check dinner, exercise, and then we go and we sit throughout the day. Mm-hmm. Um, so I always counsel my patients. It's really important to get up and move around after meals. So I like them to take short little brisk. Walks after each meal to try and also lower their insulin and blood sugar levels. So that's one of the ways that exercise specifically for PCOS women can really be beneficial.'cause you wanna try and keep those insulin levels as low as possible.'cause it, it can directly affect your egg quality. Right? Which is already something that's kind of being hit by PCOS. Right, and I think that when we're thinking about, gosh, I'm so busy, how do I work this into my day? I think that's such a great way to do it. These can be little spur. You have to ask yourself, do I have 10 minutes? You know, and then you kind of figure out, how can I work 10 minutes in a day? And maybe over time you can build it. But I think what was so impressive is even just walking a brisk walk can give you a helpful burst, you know? And um, and so I think it's, you know, just good to know maybe the people who benefit from it the most. And, and just to know, look, you don't have to be doing two hours of working out a day or something to, to see the benefit. The benefit is even for short little periods of time too. Yeah, absolutely. Yeah. So, um, what's your recommendation just for women who are trying to get pregnant? Mm-hmm. Not necessarily, you know, seeing us as patients. Yeah. But what fertility, um, exer, fertility friendly exercise do you recommend to them? I, I will say the biggest thing I do, um, recommend is walking and I'll, so let me actually kind of circle back to when I was talking about the, the weight mm-hmm. And how that mm-hmm. Kind of controls exercise. Okay. So, in normal weight, women or underweight women, when I looked at the studies, it actually showed that if those patients did a moderate or severe intensity of exercise, it lowered their chances of getting pregnant. And I thought, oh my gosh. And this is so counterintuitive to what we hear all the time. We always hear exercise is good for you, exercise is healthy, you need to be exercising. Right. Well, for some women they may be do overdoing it and why would that cause an issue? Well, I. I think about to when we were all cave women a long time ago, right? Um, and really our brain had to kind of know when is a good time to be able to get pregnant? And it's almost a protective mechanism where if we are not getting enough calories every day. Our reproduction can actually turn off and we stop ovulating, we stop having periods. And that was a way of protecting our bodies. And then if we started getting a calorie excess, then ovulation comes back, periods come back. Um, and so I think if you kind of think about that for women who are normal or underweight, it could be that when they exercise, they're accidentally putting themselves in a calorie deficit. Gosh, if you go. Run for an hour and lift weights, but you didn't have enough protein and calories and carbs in your meals that day. Your calorie deficit can dip down and your brain sees that, Hey, if I don't have enough calories for me, I don't have enough calories for a baby, and it may affect egg quality. The lining of your uterus are maybe factors that we don't even totally know and understand at this point, right? Definitely. Yeah. Yeah. But what was interesting is even in normal weight and underweight women, what was okay? Still walking. So that's why I say 30 minutes of brisk walking every single day, or not every single day, most days of the week, have been shown to be beneficial across all body weights of women. And we don't wanna leave the guys out. Yes. Even the guys I know. So one of the most common issues that we see for men on their semen analysis at the is that they can have low morphology. And there is some data to show that if men do 30 minutes of brisk walking most days of the week, that can improve their sperm morphology too. Yes. I tell my patient and partners like it's a nice thing to do together. Yeah. Right. Mm-hmm. Like after dinner and Yeah. And, um, they can go for walks together. Yeah. And you know, the other thing that I've seen with my other underweight patients mm-hmm. So I think sometimes people may say, well, I'm normal BMI or maybe you're slightly thin. Yeah. Um, your BMI is slightly low. Yeah. And you're like, I still exercise pretty intensely. But my periods aren't stopping. Mm-hmm. Like shaylene Woodley. Yes. You know? Um, so it just because your periods aren't completely stopping Yeah. Doesn't mean that it's not having an effect on your fertility. Yeah. Um, and in fact, anecdotally I've actually had some of my own patients mm-hmm. Who will cycle, they'll have periods. Mm-hmm. But there, hormonal levels look horrible. Right. Yeah. Yeah. Especially my very, very thin patients. And it's interesting because. These patients are often patients that just report my whole family is really skinny. Yeah. You know, if you see everyone looks just like me, you know, and they're just kind of like living and doing their normal things. Yes, they exercise kind of like everyone else. Um, but that the hormonal level dysfunction is just very prominent in those underweight women. I think that's a really good point too, because oftentimes even when we're training and we're learning, we're certainly taught about women who have eating disorders that have anorexia and how it can be common for them to stop ovulating and not have periods and everything. But I think that is just such a severe version of it, and that is when the patient is intentionally trying to lose weight and stay as thin as possible. But most of the time when I'm. Seeing this, it's not because our patient is trying to be a little skinny minty, it's because she has been taught that exercise is healthy. And good for fertility. She just doesn't know the difference. Um, and also because exercise does feel good for a lot of women. Mm-hmm. Some people say, this is my antidepressant, this is my anti-anxiety. Right. Medication, you know, and so once you're, and I would say, I would almost say it's even an addiction for some people. Mm-hmm. Once they. Have gotten into such a good routine, they don't wanna stop. Absolutely. Mm-hmm. Yeah, I get that. Um, and I think that has been one of the challenges I've had, especially for my runners. Runners love to run. I know. I don't get it. I'll say it's so fun. So I did do this challenge before, it's called streaking. Don't be alarmed. Of course. Streaking in that you, so you get a group of people and you have to run at least a mile every day. And you see who can streak the longest. But you have your clothing on. Yes. Did not. Okay. So I did a drinking challenge and I won the challenge. Really? Okay. I now, granted it was not good for me. I had like horrible hip inflammation. I was like limping around, but I was like, I will not lose. Um, and, and the only reason I want to, because it was a group of ob GYN doctors, is the other doctor who he and I were head to head, got called in for an ectopic and he couldn't run that day and I won. But, um, but anyway, um. With running, once you get into that routine, it, it can feel just so good and just part of your, you know, health, your daily health. And so to tell somebody they have to stop doing it is, is very difficult. In fact, I've even talked to patients before who said. I would rather adopt than stop running if it is affecting my fertility that much. I just don't, I don't wanna do it. And that's fair enough. Yeah. That's okay. Everybody has to kind of prioritize what what is important to'em. Yeah. Um, and I do think it's really important to listen to our patients about that too. I, I, I think that's fair. Yeah. Um, well, I, um, I think the other place that I see this,'cause this actually has happened to me, is, oh, I think a lot of the, the exercise programs Yeah. That people use. Mm-hmm. Are trying to make money. Right? And so they try and evoke in you, right? Yeah. That like you have a seven day streak, let's keep going. Right? And you get like five notifications on that eighth, eighth day that you're about to miss. Yeah. Um, and, you know, I just ignore them, but I can understand how you don't wanna miss, you know, Peloton is kind of notorious for this. Like, there's Pat, there's people that have not missed a day on Peloton. Yes. Well, guilty. I'm on my six week streak. Are you, are you a Peloton? I'm a Peloton now. I, my streak is, I've been doing one one hour bootcamp once a week. But I'm on a streak of, I've done it for six weeks now. This is part of my like New Year's resolution, so it is true. I'm like, I can't miss my streak. So, yeah. Well you'll appreciate this'cause a one hour bootcamp is really hard. Okay. I do the like grandma workouts that are, that are like low impact. 15 minutes, low impact, 10 minutes. And it's, it's like fit, fit grandma with the handles letter on it with me in the morning. I'm like, oh, this is so embarrassing. That's so funny. Oh my gosh. How hilarious. Well, you know, I know you drink out of your granny glass and now I know you do your granny workouts. You are just an old soul. Well, it, to me, it's less intimidating to do like really short. Period of exercise. Yeah. Like, okay, I can do this. Yeah. And, and my girls will do it with me. So, um, okay. So one of the things I'll talk to my runners about is, you know, some of the real life cases I've had, and I just remember, um, I had this patient, um, this was many years ago actually, even just when I was an ob, GYN, not even a fertility doctor yet. She couldn't figure out why she was having trouble getting pregnant. And when I was trying to help her figure it all out,'cause I checked her hormones and I'm like, why are hormones looking a little funny and everything? And I had asked her, do you run a lot? And she said no. Okay. So then I'm still trying to figure out what's going on with her. It's not making sense. And then I just said, well. How much do you run? She said, oh, well maybe about five miles a day. Maybe like on the weekend. 12 miles. Oh my gosh. And I'm like, okay. So remember when I asked you, do you run a lot? And she's like, do you think that's a. And she's like, oh, I don't really think it's that much. And I'm like, my gosh. Oh my goodness. So I'm like, this is probably what's happening. So I did. I said, Hey, would you consider stopping to just, you know, see what happens? And she didn't want to, of course she said, I get periods. You know, that whole argument? Mm-hmm. It is not that I get periods every month. So, um, but we had her stop and she got pregnant the next month. I say that because I think it's very helpful to know that when you stop, it really doesn't take that long. To see a positive effect. So I would've thought maybe before, if you stop, it might take six months or something like that. And sure, maybe in some people that may be the case. Um, but certainly, maybe if it is even a more mild case, you can just stop and try that. Just stop. And just kind of see, hey, do things kind of get back to normal? Yeah. Yeah. And at the end of that, you can always resume course know. Course. I think it's like people have this fear of stopping. Yeah. And they'll never get back into it, you know? Right. So we're not saying that, you know, you have to stop forever, but, right, right. Yeah. Um, and then, um, I, you know, I have another patient, so let's say she's, so she's been running, running. She's not gonna stop running. And I said, okay, well I get that, but maybe we could try coming at it from a different angle. Remember, we think it might be due to a caloric deficit. Just an accidental caloric deficit if you really feel like you need to keep exercising. What if we try to make sure you're getting a surplus of calories every day too, right? Mm-hmm. That might be another way of trying to correct that negative energy balance too. So I think you could try to come at it from different directions, but part of it may just. Be to see how your body responds.'cause that's one thing I really found. Yeah. Kind of back to that first example I gave too. I remember her saying, look, I'm not super skinny. Mm-hmm. I'm normal weight. This couldn't be happening to me. Right. Because again, we think of that classic picture of somebody who's just super tiny and, um, but no, like for all of us, we may have a different set point. For our weight that our brain keeps. And that can make it very confusing for people.'cause she might say, well, my friend can do this. Mm-hmm. And it's not happening to her, but it might be happening to you. Definitely. Yeah. Yeah. Yeah. Absolutely. Mm-hmm. Mm-hmm. So are there any other types of exercise that you ever caution your patients against? I have a few. Yeah. Okay. Okay. Tell me, um, so hot yoga mm-hmm. Yes. Any heated type of exercise? Yeah. I really caution my patients not to do. Yeah. Um, you know, for several reasons. Mm-hmm. You know, I do think it puts a lot of stress on the body, but at any given time, we're hoping that our patients are pregnant. Yeah. And so we don't want any high heat exposure to that early embryo or early unborn, um, fetus. Yeah. And so I explain to patients that it's really important to just kind of be normal temperature when you're exercising. Yeah. Um. Apparently hot yoga is really, really popular. I think it was a, yeah, I've done it. Have you done it? Yeah. Um, I left in the middle of the class. It was one of my worst days. Why did you leave? I felt like I was gonna die. I panicked and I. Okay. It was so hot. Hot. Yoga's not pretty. It was so hot. It's so hot. I'm like, I, I, I mean, I know that people out there listening are like, it's not that bad. But I, I don't know, like I went into like panic modes too much. Oh no. It does kind of be like you can have trouble breathing almost. Yeah. Because it gets very humid and stuffy. Yes. So I do think that could be, yeah. Pretty, pretty stressful. But yeah, I've, I've done it like a couple times, but Yeah. Yeah. And then, you know, similar sort of thing, any type of exercise where there's contact or you could fall off of or onto something. Mm-hmm. Or injure yourself. I kind of caution my patients against too, because I, you know, we work so hard Yeah. To get them, um, pregnant. Yeah. And so I try, you know. Yeah, anything like that, that's what I can recommend against. Sure. Well, I think the other part of it too is where the patient is in their treatment. Mm-hmm. Um, so whenever you know a patient is about to do her IVF egg retrieval. Her ovaries are really swollen, like our ovaries are usually the size of golf balls, but right before your ture goal, or even right after, they're the size of grapefruits. So imagine you've got these two grapefruits down here. In those cases, I really don't want anybody running. I. Jumping, um, anything kind of active, because I worry those grapefruits are gonna be bouncing around in the air and you don't wanna cause yourself a complication. So, for example, rarely your ovary can twist. It's called no bearing torsion, which is a surgical emergency. Um, and so during those times they say, gosh, really just again, just walking. Or maybe some gentle yoga, but not hot yoga. Yeah. Yeah. I tell my patients no exercise while they're doing the IVF stimulation. Mm-hmm. And it's hard. Yeah. Like they're, they're messaging me like after every day, after their retrieval, when can I start exercising again? Yes. I know. It kind of reminds me of one of my patients who every single appointment she'd be like, can I exercise? Can I exercise? You know, and I was so cautious in her because, you know, she just had a. Long history and she recently messaged us and she said, I deliver my meetings. I'm like, okay, you can exercise after postpartum. Yeah. Um, but, but yeah, I know, I know. It's really hard. Again, when it's just part of the Yeah. And again,'cause we've counseled our patients a lot about hip hair. Sure. Daily exercise that we recommend. So again, it's that. Yes, exercise, don't exercise back and forth. So you really have to kind of pay attention to where you are in your treatment cycle. Yeah, I think the other time I get a little bit worried about it, although it may not necessarily be backed up by studies, is when somebody's pregnant and they're having some bleeding, um, you know, bleeding unfortunately can happen whenever you're, um, early on pregnant. And of course we always worry, what if you end up having a miscarriage or something like that? So during those times I say, you know what, let's just take it easy. I don't know that it would necessarily change the overall outcome, but I do feel like sometimes running might even just shake a little blood clot loose or something and then it comes out and then you stress and I stress, we all stress together, like, you know. So in those cases, if I know somebody has had some bleeding, I say, you know what? Let's just be a little bit more of a couch potato for now until this all ends due. Mm-hmm. Yeah. There's very few times that your doctor's gonna tell you not to exercise. Yeah. I would love for my doctor to tell me not to. So I'm like, just enjoy it. Yeah, right. Exactly. Yeah. Yeah, yeah. Um, okay. Anything else about exercise that comes to mind that we wanted to talk about? I think those are the most common ones. Yeah. And I think, you know, after you're successfully pregnant, I think it cannot be underestimated that exercise is actually extremely important during pregnancy as well. Mm-hmm. Um, you know, you have increased. Um, likelihood of having insulin resistance during pregnancy, and that's why they always test you for gestational diabetes. And so we really do try and set our patients up for success with that, especially our PCOS patients who are at slightly increased risk of that happening. So continue your walking regimen, your moderate exercise routine, um, throughout the pregnancy really is a positive thing. Yes, absolutely. Okay, well, we'll wrap it up for the week. Thank you guys so much for listening. By the way, did you see our email message? We have had our podcast downloaded 7,500 times. It's crazy. Yay. So it makes us feel good to know. We're just helping people all over the world. If you would be so kind to leave us a positive review on our Peak fertility website, um, or excuse me, peak Fertility Google website, um, or our podcast pages or anything like that, we definitely appreciate any encouragement you wanna get. Alright, have a good week.