Exploring, Understanding, and Treating Endometriosis in Teen Girls

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show. I am Dr. Nicole and today’s episode is focused on an increasingly common health condition that teen girls and young women are facing: Endometriosis. This condition can cause intensely painful periods and other problematic symptoms related to the menstrual cycle, and young women with this condition are at a greater risk for mental health issues, like anxiety, depression, other kinds of psychiatric disorders. Certainly it’s something that my colleagues and I are seeing more in practice with the young women we’re working with. So if you’re the parent, a young woman struggling with intense period-related symptoms that are impacting physical and mental health, you’re definitely going to want to listen to what my friend and colleague, Dr. Jessica Drummond is going to share with us today.

Let me tell you a little bit about her. Dr. Jessica Drummond is a physical therapist and doctor of nutrition. She’s the founder and CEO of the Integrative Women’s Health Institute and is passionate about caring for and empowering women who struggle with women and pelvic health conditions. She’s equally passionate about educating and supporting clinicians confidently and safely, using integrative women’s and pelvic health care. Having two decades of experience in women’s and pelvic health as a physical therapist and functional nutritionist, plus owning a private women’s health clinical nutrition and coaching practice gives her a unique perspective on the integrated conservative options for pelvic pain management, hormone balance, pre-conception and fertility support, postpartum recovery and chronic pain and fatigue management in active and athletic women. She regularly lectures on topics such as integrated pelvic pain management, natural fertility options, optimal hormone health, female athletes and functional and integrated nutrition for rehabilitation, nutrition, wellness, fitness and medical professionals. It’s such a pleasure to have you on the show today, Jessica, welcome.   

Dr. Jessica Drummond:

Hi! So glad to be here!

Dr. Nicole Beurkens: 

So, I like to start out by having people share a little bit of their story of how they came to be doing the work that they’re doing. How did your career and your personal and professional experience lead you to work with so many women with these kinds of issues? 

Dr. Jessica Drummond:

Well, I was an athlete in high school and I was good at science, and unlike, we were just talking about we both have teenagers, unlike how it is now, there wasn’t as much sort of “What do you want to do with your life?” It was just sort of, “Hey, you’re good at science and you’re an athlete, maybe you should be a physical therapist.” And I’m like, “Okay!” So that was the path that I took and it was great, and I thought I would always work in sports medicine, which I did, initially, but then I started working with orthopedic injuries specific to women’s health conditions. So, for example, if people had had breast cancer surgery and then had a shoulder-related issue or had back pain related to pregnancy. So pretty early in my career, I kind of went down a path of specializing in women’s health, which is really sort of — when it comes from a physical therapy perspective, it’s still orthopedics and muscular-skeletal issues related to women’s health related things. So incontinence, pelvic pain — so I became more and more specialized and sort of broad in women’s health. And then after my oldest daughter was born, I had my own personal hormonal crash, which now I recognize was likely due a reactivation of the Epstein-Barr virus, which I had had a couple of times in high school, I had mono. And really, at the time, we didn’t understand that these viruses sort of hang around and then can come back in vulnerable times, but what it did to me was actually give me about four years of really vague but challenging symptoms. Extreme fatigue, insomnia, panic attacks, a lot of anxiety, I was getting every chronic cold and flu and because I had just had a baby, well, initially. Then I had a toddler and then I had a four year-old and everyone was always like, “Oh, well, that’s what happens when you have a new baby”, or “It’s normal to get sick every week when you have a toddler,” or “You’re probably just tired, take a nap, here are some antidepressants.” 

I kind of got stuck in that thing even though I was a clinician, I was working at great hospitals in several different places in the US, but you know, that’s the standard of care, really, it’s just — maybe you need to rest, it’s normal to get a sinus infection every couple of months when you have a baby, this kind of thing is so common that it’s sort of dismissed. So fortunately, that was how I found functional medicine. One of the physicians that I had referred, we sort of referred our challenging, difficult patients to right when I was working in the women’s hospital, I was like, I am definitely one of those people right now. So I took myself to her and she was a very early functional medicine physician. She started practicing functional medicine in the 80’s and every once in a while we still run into each other at functional medicine conferences, which is lovely. She’s still practicing and so Dr. Nellie Grose in Houston, Texas kind of showed me how my lifestyle was contributing and how nutrition was contributing. And she knew some, but because her training was a little different, a little Chinese medicine-focused and it was very early, she wasn’t really deep into nutrition. So she gave me what she could and then I took that further and I realized that once — if I could balance my hormones, essentially, by changing my nutrition and lifestyle — because she didn’t give me a ton of supplements or a ton of medications. There were a few things that were supportive in the beginning. I was actually pretty shocked coming from a Western training background. I was like, “What? This works?”

So I brought that back to my clinical practice, which was pretty focused on more complex pelvic pain at that point and just started trying to do this, and I had clients who suddenly were going to have a hysterectomy because that was their last choice for this pelvic pain and found that by stopping dairy, their symptoms were completely gone or things like that. Obviously not every case is that simple. But those were the cases that made me realize that, okay, there is some value to this, let’s see if we can explore this. That’s how my clinical direction went that way.  

Dr. Nicole Beurkens: 

I love it. So many of us, it’s the intersection of our things that we’re dealing with personally either for ourselves, for our children, and then that intersects with our professional work and it leads us to be doing really unique and cutting edge things in the field. So your story certainly fits with that for sure. So let’s dive into endometriosis, because this is sort of a big word, I think a lot of people are maybe vaguely familiar with it, but let’s start out with what is this condition? What are the most common symptoms of this?

Dr. Jessica Drummond:

So, endometriosis is a disease state where cells that are like the lining of the uterus, inside the lining of the uterus grow outside the lining of the uterus, grow outside the uterus in general. And it could be on the outside of the uterus, it can be on the outside of the ovaries, fallopian tubes, but it can also be on the bowel, anywhere in the kind of abdominal pelvic cavity, it’s been found on the lungs, it’s been found in the nose.

Dr. Nicole Beurkens: 

So basically rogue cells! They’re showing up everywhere where they’re not supposed to be!

Dr. Jessica Drummond:

Exactly! And it’s kind of like cancer in that way, but it’s not cancerous. So most of the time, it kind of stops growing at some point, usually past menopause and it’s not exactly the cells that are like the inside of the lining of the uterus, but very similar. So there’s this cancer-like component to it, but it is benign. However, there are a certain percentage of women that there is actually an increased risk that this will convert to a cancer. So it is important to get it under control as early as possible. So that’s what the disease is. How it’s caused is still up for some debate. There is definitely a genetic component, so women who have had painful periods their whole life or just pelvic pain, painful sex, pain with pooping or bowel movements, that maybe was never diagnosed as endo because it’s only a surgical diagnosis, which I’ll talk about in a second. So if you’re a mom of a preteen or teen who kind of had rough periods your whole life, maybe you struggled with infertility or sub fertility or you had secondary infertility. There were times when fertility was difficult, but eventually you had children and now you’re kind of going through menopause and your symptoms have moderated or you just decided to grin and bear it and never really got a diagnosis, that increases the likelihood that your child is likely to have endometriosis.

So there is a genetic component and there is definitely an inflammatory and possibly an autoimmune component, there’s a lot of disagreement about that among my colleagues and I but we all agree it’s inflammatory. So you have these rogue cells and what’s challenging about endometriosis is that the legions can be very superficial, they can be deep and infiltrating, you can have endometrioma’s, it can be very kind of a very pervasive disease state itself or it can be very mild. But if you go in and look at the disease state itself, the specific physical lesions on laparoscopy, that does not directly correlate with how severe the symptoms are. So someone can have quite severe stage 4, again there is debate about staging, but quite severe stage 4 endometriosis and have a milder case, or in some cases, endometriosis is actually silent and women don’t know they have it until they struggle with fertility or they just never know they have it. And you can have what looks like a mild case of endometriosis in terms of where the legions are and how big they are and how many there are, but you could still have very, very severe pain. So it’s the intersection of all these things: Inflammation, where the endometriosis lesions are located, any kind of adhesions related to it?, is it impacting your bowel function?, is it impacting your breathing function?, is it impacting your menstrual cycle? So it’s a very diverse disease, which makes it a little bit tricky to diagnose. 

So, as I just mentioned, the diagnosis is surgical. Unfortunately there is no marker that we can do a blood test and say you have endometriosis or do some imaging and say you definitely have endometriosis. Now, sometimes it can be seen on imagine, but imaging does not rule it out. So if you don’t see it on imaging, you might still have it. And there are inflammatory markers to look for that add to that suspicion. So doctors who are very well versed in endometriosis who see a lot of endometriosis who specialise in this kind of disease can definitely make a strongly educated guess about whether or not someone has endometriosis based on their symptoms. In fact, I treated tens of thousands of women with endometriosis, so just even based on the symptom picture and the history, you can get a generally good idea if someone likely has endometriosis but you can’t confirm that diagnosis without a laparoscopic surgery. And again, it has to be done by someone experienced because if someone’s not really looking in the right place because it could be anywhere, you could even miss it on surgery. I think that’s important to know: If you do have a mild physical case but intense symptoms, and someone does kind of look and see in a laparoscopy and they don’t see anything, it doesn’t necessarily mean it’s 100% ruled out. So that can be frustrating too, because it’s like, what is this?

So you asked about symptoms. Symptoms are: Killer cramps. So someone who has painful periods that make them miss work or school, in fact, the number one reason for teenage girls to miss school is period pain, actually. So one, and this is very common, I think that’s another thing that’s underlooked, 1 in 10 women and girls has endometriosis and I emphasize the genetic component because some studies have been done on fetuses that didn’t survive for some reason, and endometriosis is about 10% of the female population and it’s also about 9% of the fetal population, so it’s like it’s already there at birth, but there is definitely a hormonal triggering of the symptoms that starts in prepuberty. So killer cramps is one thing, but in teenagers, what’s challenging and in preteens, because now, puberty starts a little earlier, like roughly age 11, 11 and a half, early 12, is that it’s actually more common to have non-cyclical pelvic pain in teens and preteens and maybe it’s because their cycles are still pretty irregular or they haven’t started yet. So you know, when a girl is, say 6, 7, or 8 years old, just kind of moving towards puberty, it’s very common to have had in the history a lot of stomach aches, a lot of digestive complaints, as you said, anxiety, because the gut microbiome plays a big role in this, we do GI-Map testing, which looks at the composition of the gut microbiome. In almost every case that I work with of endometriosis, because there are bowel symptoms, and those actually start earlier, and anxiety symptoms related, and depression — I actually more commonly see anxiety due to the gut microbiome’s communication with the brain, which is essentially irritated by the endometriosis inflammation. So if you’ve got an inflammatory process just like if you had cancer, the gut microbiome can be changed in a negative way, and then that communicated with the brain, triggering anxiety or depression. 

So it looks like I’ve got a 6, 7, 8, 9 year old girl who seems to be having kind of either consistent or inconsistent stomach aches. One thing I would be kind of looking out for, especially if in the female family history of the family anyone had endometriosis or had really bad periods or have a lot of infertility, endometriosis is one of the very most common causes of infertility, so if that’s a family issue, keep that in mind. And then as they start cycling, exactly what you said: Digestive complaints, anxiety, sometimes depression, pain, really bad pelvic pain and I think we’ve really downplayed this in teenagers. We kind of teach them, oh, it’s normal to have cramps, it’s normal to feel bad during this time of the month, it actually is not normal at all. You really shouldn’t feel bad during your period. Totally normal for one or two days, a little fatigue, mild, mild cramping, but for anyone, it’s actually not normal to have painful periods or to have pain in between in ovulation, painful sex as they get a bit older, pain with bowel movements, pain with gynocolgical exams because sometimes this overlaps with bladder symptoms or vulvodynia, which is pain at the opening of the vagina, so pain is the number one thing, but fatigue, anxiety and digestive complaints are extremely common as well. 

 

Dr. Nicole Beurkens: 

And I think you talked about the genetic component, how often a girl or a young woman who is dealing with this, their mother or other female family members have had this and that does sort of normalize it, right? So I appreciate what you’re saying, like a lot of times, because I’ll see that in my practice, moms will be like, well you know, you just had to take some Midol and push through, this is how periods are, whatever — that’s because that was their experience, but that’s why I think it’s so helpful, what you’re spotlighting here, which is actually that’s not how periods should be. So I think there is a lot of downplaying of that, and I see many young women in my practice who are not overstating the pain, the pain is so severe for them that they can’t function, and what can happen then is that gets funneled into this whole psychological or psychiatric realm, right? Oh you’re overly sensitive, oh you’re overly dramatic, you’re too hyper-vigilant and anxious, you need to approach this from a psychiatric standpoint, and while sometimes that can be helpful, it really does minimize the actual physiological problem that the person is dealing with, it can make them feel a bit crazy, right? Like do I even — am I in touch with what’s going on with my body? Ultimately, it delays them getting the appropriate treatment for it.  

Dr. Jessica Drummond:

Absolutely. I’m actually writing a book right now on endometriosis and we’re focusing on women in their 20s and 30s who are in graduate school, early career, because endometriosis very often sidelines women’s career, about 75% of women say that this has happened to them, because you keep having to miss stuff, not showing up — but women who have endometriosis, in my experience, are queens of powering through. They say exactly those words that you say. “I take handfuls of Ibuprofen, I show up.” What happens, the other problem that happens is they get fueled into medical pain management, so then they get challenged with things like opioids and benzodiazepines and Gabapentin and the other neurologic medications and these are sometimes hard to come off, and they are — it changes the impact of the things that we can use of the more gentle nutritional supplemental tools that we have. Or, as you said, they’re given psych medication, antidepressants, and again, sometimes that does help. I don’t want to completely minimize the value of pain medication for endometriosis, because if you do have a clear diagnosis, you’ve done all the lifestyle medicine and nutrition in a very therapeutic way, you’re not just kind of dabbling. I just didn’t go gluten-free and that’s it, I didn’t heal so this is isn’t going to work. But as you know, there’s kind of a lot to it to really use nutrition and lifestyle medicine in a very therapeutic dose. Doing that though before we use medication is much, much more effective.

Now, Ibuprofen is a little bit of a different story, almost every woman who has come to see me has used a lot of Ibuprofen because it’s like what are you going to do? But the things that change the brain do make it harder. And then, there maybe a place for them, but we want to make sure that we’ve kind of optimized the system. We’ve lowered inflammation as much as possible. We’ve given women tools of empowerment to really understand, lower their symptom load and then be able to fine tune, like okay, “I have to give a big presentation at school today”, or “I have to do the mile run test today.” There are all these things that you are supposed to just show up and be able to do at any time, which is hard for anyone, but definitely someone who has a chronic pain condition. So you’re trying to power through. You’re taking the meds, you’ve got ice all night, you are laying on the heating pad, you’re just — so I think what’s frustrating for women with chronic pain is they’re actually showing up more than everybody else, but they’re being told that, “Eh, it can’t be that bad, you’ll be fine, just push through it.” Then, as you said, the mental health component actually gets worse because there is no support around, okay, sometimes there are going to be some flare up days, let’s think about your team that’s going to help you get through that. What are your tools for that? If medication is the right thing for you, how do we use it? How do you we think about it as a long term vs. a short term thing, and then the other thing that can be really valuable is excision surgery, which is a specific kind of surgery for endometriosis that’s been found to be the gold standard. I prefer, because in my clinical practice, I’ve seen much better results if people who have their excision surgery done by someone who does a lot of endo surgeries. So not just necessarily your local gynecologist, unless they really focus on that. And still, just like if you were going to have a knee surgery, pre-op. 

So you’re going to have all this nutrition first. The more we can lower the inflammatory load before you go into surgery, the better. I say at least three months would be perfect and pelvic physical therapy because again, there’s a lot of muscle tension. So Imagine if you had like severe painful growth on your shoulder, you would have headaches a lot, right? So pelvic physical therapy helps with the muscle tightness and nerve inflammation and local circulation that can help reduce that accessory guarding, which is again, perfectly normal. So if you do that before surgery, have a good surgery and then do that for about six months, generally this whole process takes between 6 and 24 months in my experience, depending on how severe the case is, which I think is important to know, this isn’t forever, but it’s not a magic wand. There really is no one drug, just go on birth control and this is over or just take whatever and this is done, because you’ve got to sort of heal the whole disease state. That takes a multi-disciplinary approach, it takes some time, it takes some learning and understanding of your body, it takes some understanding of how the brain creates pain signaling. So all of that is really important but it is very helpful, and the sooner that you do this process — so if someone finds out that they are likely to have endometriosis when they’re 12, 13, they’re just starting their periods and they do this earlier, it’s much better because the disease process has not progressed as much, their fertility is more likely to be fine, you’re preserving fertility, if you’re 35, it’s just sometimes harder. It’s not impossible, but you’ve now already had — so let’s say you started pre puberty at 9, that’s 26 years!

Dr. Nicole Beurkens: 

Right. And I think that focus on getting to it early and the foundations of that are so important because what I see is even 15-20 year olds coming in now with, as you said, just a really complicated case, right? They’re sent to our clinic because they’re having severe anxiety and panic attacks, mood disorder, their life is just not really working well. They’re on birth control, they’re on multiple psych meds, as you mentioned maybe even some pain meds, the picture is just really complicated and I think the mental health things get worse over time, for anybody, as you feel like nothing’s getting better, right? It’s like okay, I’m going to all these doctors appointments, I’m still having all these symptoms, I’m taking everything they’re giving me, this is never going to get better, oh and guess what? Every 3-4 weeks, I get to look forward to basically having an entire week of my life that is completely dysfunctional. And so, I think it’s pretty normal in those types of situations to have some amount of depression, to have anxiety. But I think that focus on getting to the root of what’s actually going on there and getting to that as early as possible and putting those foundations in place is so important. So you’ve talked about kind of the typical trajectory of treatments, various kinds of medications, birth control, surgery, those kinds of things, let’s get into the functional nutrition part because I think this is really something unique that you’re talking about and focusing on, and I’ve seen first hand in some patients that you and I have shared together just the profound effect that this has had on their life. So talk through why the functional nutrition piece is important for healing this disease state.

 

Dr. Jessica Drummond:

Well, the first thing that we can do is anti-inflammatory nutrition because I think it’s really underestimated how much nutrition contributes to inflammation. Especially in kids and teenagers, right? I mean I’m no nutritionist and I still have a hard time getting my teenagers to eat an anti-inflammatory food plan all the time, right? Because life is about cupcakes and pizza when you’re that age, right? But that’s extremely inflammatory. Not to mention just the environment is more inflammatory and more estrogenic. 

So not all endometriosis is driven by estrogen. We used to think that, but there was an interesting paper that came out in 2018 that showed that some of these lesions have more progesterone receptors, some have both estrogen and progesterone receptors, some have neither, which is probably why hormonal birth control, which suppresses estrogen doesn’t always work. And there are other drugs that are used in endometriosis that suppress estrogen and again, doesn’t always work and gives a lot of side effects because estrogen, of course, is used in the brain and in the bones and in the heart and so it helps balance blood sugar. So that’s the reason that’s not always ideal.

But there are a lot of cases that are more estrogenic, so of course, what is the nutrition that helps to lower inflammation and optimize hormone metabolism? Lots of vegetables, 8-10 servings a day is what we aim for, sometimes we have to go slowly depending on if there’s also SIBO or bloating, dysbiosis of the small intestine, dysbiosis of the large intestine. The gut bacteria plays a huge role here, especially in that connection between the brain and the gut because both pain signaling and anxiety and depression essentially play in both the brain and the gut-brain, which has a lot of communication with the gut microbiome. So what helps feed a health balance microbiome — Things like fiber, vegetables, prebiotics, and then some times probiotic foods and certain probiotics, I don’t start there but we usually get to that at some point. And then hydration is underestimated, especially for people that have bladder symptoms too, they tend to fluid restrict, which actually makes the urine more concentrated and more irritating to the bladder. 

We think about healthy fats and proteins, your cleanse sources of proteins. It doesn’t have to be a more vegan diet. It’s sort of a both — it depends on the person, so it can be more vegan/vegetarian, sort of as we would think of cancer, less meat. But I do see that women with endometriosis do well with animal protein, that’s from the cleanest possible sources for two reasons. One: Their physical tissues are in better shape. There’s just more stability, and the surgeons have actually told me the same thing, that internally, the tissues are just more strong and flexible because you’ve got that animal protein and collagen and more amino acids which help build up structural tissues, but also because the brain really needs amino acids for balancing those neurotransmitters. So another key problem is that women or girls have not enough stomach acid because maybe they’ve had heartburn and bloating and things related to their endometriosis and so they’ve been on proton pump inhibitors or other acid-suppressing drugs, which make it really hard to absorb the components of protein that we need to build our brain and then just optimizing digestive function because as I said, sometimes there is pain with diarrhea or constipation that can go along with endo because sometimes those growths are right on the bowel. So the more, the less inflammation in the bowels. So the things we’re taking out are common foods for kids and teenagers. Sugar and processed grain and trans fats and processed foods in general and really just shifting to a more anti-inflammatory diet makes a huge difference. And then there are some specific supplements that work really well. There are some studies going on right now in fish oil — I was talking to one of the researchers who is working on a multi-site study in England and he was like, “Yeah, we’re trying to get this through, but they won’t let us study it until we show efficacy.” And we’re like, “Well this is what the study is for!” And so they’ve done some pilots, but clinically and in the small research studies that we do have, fish oil is really good, so I definitely have my patients eating fish and taking a good quality fish oil that’s not rancid. 

Also a good supplement studied well in this population is tumeric. So therapeutic doses of turmeric, which also have been shown to help with depression. So the good thing about the tools that we use here help with everything. It helps with digestive function, it helps with brain health, anemia is a common problem if there is a lot of bleeding or if they have difficulty absorbing iron because of the gut, so making sure they have adequate iron but not too much because that can be a bit inflammatory, so really, it’s an anti-inflammatory plan that feeds a healthy gut microbiome and nourishes a healthy brain. Then we can sort of lower the symptom low, then we think about what else these women and girls are dealing with. So mindfulness, meditation, good psychotherapy, good behavioral therapy, good acceptance and commitment therapy has been shown to work well in pain populations in general, but also just having a web of support. 

If you know this is going to take some time to unwind, that you’re going to be on a path that both, you have to have a strong, solid anti-inflammatory lifestyle, but potential have surgery, potentially use medications, depending on your goals and how old you are — having that support person at work, having the school nurse really understand what’s going on with you. Being able to time certain things so that you can do them, especially if your pain is cyclical and you can predict it, even if it becomes less severe, it may still occur, so being able to work your school work or your work work around that, depending on what your role is. And I think having a better conversation about that in schools and at work, and especially schools where this can be identified. There was a movie called EndoWhat? And the non-profit organization who created that movie does also have training programs available for school nurses. So I strongly suggest kind of looking at that and obviously we teach a lot to nurses and traditional practitioners about endometriosis, but being able to identify this and then support it is really key in terms of using functional nutrition as a therapeutic tool that’s just as powerful and in my opinion, more so than the medication because you’re actually healing the inflammation issue. We’re not just masking it short-term or trying to change the brain’s response to pain on a symptomatic. 

Dr. Nicole Beurkens: 

Right. I think in general, nutrition is such an underestimated tool for impacting health, right? So helpful for you to share your experience with really how profound the shifts can be. And even in situations where that’s not the total answer, it provides a foundation then that allows other things to work better. I want to circle back to the point you made about the psychosocial supports and the school piece because for the young women and the girls that I see that are struggling with these issues, it is really important that we work with the school because that can be a huge source of anxiety for girls in school, to make sure that school understands what’s going on, so if these girls know that they’re not going to be penalized, that we have support plans in place, often it just takes a medical letter that I’ll write for families to inform the school about what’s happening and what kinds of accommodations are needed, but I think just for parents to be aware that those are all options and possibilities and that those kinds of supports whether it’s through the family support, through school, through friends are so important for following just those mental health pieces of feeling isolated, feeling depressed, feeling anxious, and then that helps healing happen much more effectively too. 

Dr. Jessica Drummond:

Absolutely. 

Dr. Nicole Beurkens: 

So let’s wrap up here. You’ve provided so much great information, and I think really given people a roadmap for what’s possible and the kinds of things they can do. What would your overall message be? To moms who are listening, parents who are listening or professionals who are listening too who are working with this. Parents who have kids and they’re thinking, “Ah, I think this is going on.” What message would you want to give them?

Dr. Jessica Drummond:

I would just say be aware that the earlier we get good diagnosis or at least a high level of suspicion that this can be an issue, don’t just write it off. It’s not normal for menstrual cycles to be painful at all, ever. And the sooner you get your child’s treatment, the faster this can resolve and the less of a long term impact it will have. The disease isn’t really gone, but it’s much better managed and the goal would be to have 1 or 0 surgeries ever. Maybe 2, not 12 throughout the life that I’ve seen and not to start a complex drug cocktail until you have gotten those nutrition and lifestyle foundations in place, including everything you are talking about psychosocially at school and at home, because once we get that foundation in place, we don’t have to have girls just falling off their life path, their career path, their goals. 

Dr. Nicole Beurkens: 

Awesome. So valuable. Where can people find more information from you? I know you’ve got so much available online. What’s the best place for people to find you?

Dr. Jessica Drummond:

Well, our main website is integrativewomenshealthinstitute.com and then probably a lot of information is on Instagram @integrativewomenshealth. 

 

Dr. Nicole Beurkens: 

Awesome. I highly encourage listeners to check that out, such great resources, Jessica, thank you so much for taking the time to be with us on the show today. 

Dr. Jessica Drummond:

Thanks so much for having me, Nicole. Great to be here. 

Dr. Nicole Beurkens: 

And thanks to all of you for listening to this episode. We’ll see you next time on the Better Behavior Show.