Pauline (00:00)

Welcome to our podcast, What No Mom Told You, where the rarely spoken truths finally get loud.

Megan (00:10)

I'm Megan Nelson.

Pauline (00:12)

And I'm Pauline Walfisch and this is a therapist-led podcast where we talk about the things no one warned you about, the truths that are often kept quiet.

Megan(00:23)

We're naming the messy parts of life, motherhood, fertility, loss, grief, and joy, and everything in between, without judgment.

Pauline (00:31)

because the rarely spoken truths need to be said out loud, and because no one should feel alone.

Pauline (00:38)

Welcome to What No Mom Told You.

Pauline (00:41)

Welcome back everybody. My name is Pauline Walfisch. I'm a clinical social worker here with two of my wonderful colleagues. Megan Nelson, my co-host, who's also a social worker and therapist at HHP.

Megan introduce you to our guest today.

Megan (00:58)

Yeah, today we're so lucky we have Dr. Ashley Davis Ford Graham. She is a licensed mental health counselor with diagnostic privileges, licensed in both New York and New Jersey, certified mental health counselor, certified in perinatal mental health. She holds a doctorate in mental health counseling. She's an advocate for polycystic ovarian syndrome, and as well as for black maternal mental health and is also a therapist at Helping Hand Psychotherapy. Welcome!

Dr. Ashley J.D. Ford-Graham (01:30)

Thanks for having me! I'm so excited to be here!

Pauline (01:34)

We are so excited to have you Dr. Ashley or Dr. DFG as I've been known to call you, the doctor with many names.

Dr. Ashley J.D. Ford-Graham (01:39)

Yes. Love it. Love it. ⁓

That is me.

Pauline (01:46)

It is great to have you here with us today.

Dr. Ashley J.D. Ford-Graham (01:48)

Yes, I'm excited. We're going to get into some good stuff.

Pauline (01:51)

Yeah, so you know this podcast is really about the things that we all learn the hard way.

⁓ and that nobody told us these things were gonna happen. And so, you know, we've gotten to work together for a while and I know some of the bumps along the way that you have encountered just like all of us have. So what is your thing that nobody prepared you for?

Dr. Ashley J.D. Ford-Graham (02:17)

Yeah.

well, as Megan mentioned when she beautifully introduced me, ⁓ I am an advocate for PCOS or polycystic ovarian syndrome, ⁓ for a long time. So I myself have PCOS and I've dealt with it the majority of my life. and yeah, of course. So there's a lot to it.

Pauline (02:31)

Yeah, and you've been for a while.

Megan (02:42)

Can you explain what PCOS is? ⁓

Dr. Ashley J.D. Ford-Graham (02:49)

Depending on who you talk to in terms of providers, you might get a different answer because it impacts a lot of different areas of the body. So it's partially an endocrine disorder, partially a reproductive disorder. Some individuals experience cysts on their actual ovaries, but that's not required to have PCOS. ⁓

Pauline (03:11)

PCOS actually stands for something.

Dr. Ashley J.D. Ford-Graham (03:14)

Yeah, so polycystic ovarian syndrome. So the other thing too is I'm a mom. So that's a big part of my identity. We'll talk about that a lot. But for me with PCOS, throughout my life I was often always told like fertility is going to be an issue. This is a really big thing that you'll have to worry about. And that really stressed me out because ever since I could remember I wanted to be a mom and I knew that. So when I was like 14 is when I was preliminarily diagnosed. Yeah, yeah, it was very early. Which I learned as I got older that when I was very young, I want to say like nine or 10, I got my very first menstrual cycle.

Pauline (03:48)

That's early.

Dr. Ashley J.D. Ford-Graham (04:00)

And it was very inconsistent after that. And I learned that within the black community, especially black women and girls get their menstrual cycles a lot earlier. And then that can often impact a whole host of other things, including mood, functioning, all of these other disorders. And so, yeah.

Megan (04:21)

Would you say that getting thisbdiagnosis at 14 was early for how people normally get a diagnosis for this?

Dr. Ashley J.D. Ford-Graham (04:30)

I... you know... I'll say yes. What I will also say...

Pauline (04:36)

Or some people don't find out until they're trying to get pregnant and they're having a hard time.

Dr. Ashley J.D. Ford-Graham (04:40)

Exactly, exactly. And so that's why I said yes. But the reason I gave pause is because, and this will go into the original question you asked me, but when I got my menstrual cycle so young, I was a dancer, I was very active. So a lot of my, you know, my pediatrician, my providers, they were like, don't stress it too much. Like, you know, we'll see as you get older.

Um, and then when I got to be around 13, 14, and my cycles still were not consistent, then my pediatrician sent me for blood work. And when my pediatrician sent me for blood work, what came back was, um, my testosterone levels. I believe it was my D H E A sulfate. I am not a medical doctor. I don't know what this stuff really is. Um, but it was a couple of different labs.

Pauline (05:26)

the alphabet soup.

Dr. Ashley J.D. Ford-Graham (05:31)

were off the charts. And when I tell you off the charts, you know, as women, we have both estrogen and testosterone. If, for example, we're only supposed to have like, I don't know, 12 of whatever the measurement is of testosterone, I had like 381. So it was very, very.

Pauline (05:50)

I think a lot of people don't even know that women have testosterone, right? Like, you hear testosterone, you think it's just a man's hormone.

Dr. Ashley J.D. Ford-Graham (05:55)

You know?

Exactly, exactly. And so, this was all new information for myself and my family. And the pediatrician was then like, OK, well, I'm going to send you to a child endocrinologist. when I went to the endocrinologist, they told me that based on my blood levels, I also had, um, I believe it's called heritism. So I had like, um, hair in or more hair like on my chin. I had like a little bunny trail on my stomach. And at 14, I was like starting to get super self-conscious. Like, what is all of this? Um, on top of my cycles. So.

The endocrinologist told me at that point, there's a likelihood that you have PCOS. But that was it, right? Like they were like, there's this likelihood you have this, it's probably gonna impact your fertility. Here are the options at 14. So the options that they gave me were, you can either have hormone replacement therapy, which,

Pauline (06:52)

at 14.

Dr. Ashley J.D. Ford-Graham (07:00)

especially at that time, it was still pretty new. they didn't, know, they as in medical world didn't necessarily know how this would impact PCOS and other things or birth control. And so my mom was like, we don't know what the hell hormone replacement therapy is. You're not doing that. So I guess we're doing birth control. So at 14,

I got on birth control and that was it. Like they never really followed up and gave me any more information, told me other ways in which this was going to affect me ⁓ or how it all went together. So leaving the endocrinologist at 14, the one thing that stuck in my head was them saying like, this is probably going to impact your fertility. But I also really didn't necessarily know what that meant.

Pauline (07:34)

you

Megan (07:49)

know what

Pauline (07:49)

Yeah,

I don't think at fourteen. Yeah.

Megan (07:49)

I'm saying. What does that even mean?

Dr. Ashley J.D. Ford-Graham (07:51)

At 14, like what does that, you know, what does that mean? ⁓ But I went on birth control.

Megan (07:55)

I imagine that the first thought

is like, I'm not going to be able to have kids. Yeah.

Dr. Ashley J.D. Ford-Graham (07:59)

Literally, right? And so now I'm like, but you know what? I'm 14. I can't think about this because I'm not having a kid right now. Um, so that was it. I got on birth control and I went on about my business and it was great. Or so I thought at the time because, um, my cycles regulated a little bit and I was like, okay, I'm consistent now. I can plan. This is great. I feel normal, right? I'm fixed.

Megan (08:05)

Great.

and

Dr. Ashley J.D. Ford-Graham (08:26)

And then I graduated high school, I went to college, and as I was in college, I started experiencing life and stressors more than as a child. And I started noticing I was getting migraines, and it was to the point that I could not sleep or function unless I was in complete darkness. I was very overstimulated. easily. Ended up going back to my gynecologist. And at that time, he had said to me like, you know, it might be because you have been on birth control for all these numbers of years, maybe we need to try a different one, all of these different things. So fast By 2017, I met my now husband.

And I knew when I met him, I was like, I'ma marry you. So in my head, yeah, I was like, yeah. So in my head I was like, okay, yeah. Like this is what's happening. And one thing I loved about our relationship, we were very transparent. So he knew about my PCOS, how I felt about wanting to be a mom. And I was so grateful because he was very supportive and really encouraging of like, okay, well.

Megan (09:20)

Just you know, I picked you.

Dr. Ashley J.D. Ford-Graham (09:42)

why don't we try and figure out holistic ways or like other things to understand what's going on with your body because at that point I still really did not have a lot of information. ⁓ He was so involved and I was like, I love you. And the other thing I will say is,

Pauline (09:55)

I love that he was like involved and wanting to understand and helping you.

Dr. Ashley J.D. Ford-Graham (10:04)

Shout out to my husband, but he was so great because he was like, I love you and I just want to be with you. So whether we can, you know, biologically have children or not, like that doesn't matter to me. And that was very helpful because I think that alleviated a lot of stress, but it also empowered me because I was like, I appreciate that, but I also want and need to know what's going on with me so that I can understand. And so.

as the world would have it and the universe and everything, 2020 COVID hit and I went to my gynecologist because I was still dealing with all of these migraines and things and they had suggested that they were going to change the birth control that I was on. And this literally happened a week before the world shut down. So, right, so I'm like, okay, so I get this new birth control.

and then I'm reading up on it. And as I'm reading up on the birth control, it's saying that, you know, it's going to limit or decrease my cycle even more than I was already experiencing. And I was like, well, I don't want that.

Dr. Ashley J.D. Ford-Graham (11:09)

so between 2017 and 2020, when I had met my husband, I was starting to do a lot more research on my own in terms of what is polycystic ovarian syndrome? What does this actually mean? How does this affect me and come up? And it was at that point that I learned that it was both an endocrine and a reproductive disorder and that it can impact your mood.

you're functioning and all of these other things outside of fertility. And how birth control was not actually a fix, but it was like a bandaid. And it was really just kind of masking all of the other symptoms associated with it, but not getting to the root cause. So then, you know, my husband is like, yeah, you know, whether it's more exercise, eating, whatever the case, like put the fertility stuff to the side.

Megan (11:50)

Thank

Dr. Ashley J.D. Ford-Graham (11:59)

Let's just get your self-regulated, your body right, all these things. That holistic approach. 2020 comes

Pauline (12:04)

that holistic approach, right?

Dr. Ashley J.D. Ford-Graham (12:08)

there wasn't a whole lot that we could do because I couldn't get in with a doctor. So at that point, we just collectively made the decision to have me go off birth control completely. And that was the first time in like 10 or 11 years I had not been on birth control. And I took matters into my own hands. And in doing that, I found

Megan (12:27)

you

Dr. Ashley J.D. Ford-Graham (12:33)

an endocrinologist that was a black woman that listened to me, that sat with me and explained things to me and got me onto a different holistic treatment regimen. I did take medication and I still do as well. I take metformin, which is not specifically for PCOS, but it helps with PCOS symptoms. Yeah, yeah.

Megan (12:55)

It's like an off label. Yeah.

Dr. Ashley J.D. Ford-Graham (12:57)

And it's really for like diabetes and things of that nature. But that really helped me. It helped my weight. It helped my mood. It helped my functioning. And then it helped me get pregnant per my doctors because I got pregnant naturally and I had my daughter and everything was great. My pregnancy was great. And then I had my daughter and my birthing experience did not go the way I planned or anticipated.

And nobody, you know, like what? nobody told me that all of my PCOS symptoms that I thought I managed and controlled and learned about were going to then be exacerbated with my own PMADS and all of the other postpartum mood things that I had to deal with. And so then I had to learn how to

Pauline (13:24)

⁓ so surprising. That happens so often.

Dr. Ashley J.D. Ford-Graham (13:49)

re-engage my body and my lifestyle and everything with PCOS as a mom. So yeah. As a postpartum mom, right, a freshly postpartum mom.

Megan (13:56)

And that's like a full-time job.

Pauline (13:56)

as a postpartum mom.

Megan (14:02)

And it becomes like another job, right? It's like monitoring, learning what you need for, you know, your mood, what you need for nutrition, for exercise. It's...

Dr. Ashley J.D. Ford-Graham (14:04)

Absolutely. Absolutely.

Everything. Yeah. Yeah.

And I, you know, it was also really hard because especially being an advocate for, you know, Black maternal health, PCOS, all of these things, I, you know, I knew a lot about advocating for myself and, you know, the different things that could come up and...

I tried really hard to do that throughout my pregnancy and my birthing experience. I had planned to give birth at a birthing center, all of these things. I had a midwife, a doula, and things still didn't go according to

Pauline (14:46)

and you are somebody who is educated, who is in the field, you know all about PMADS, you know all about PCOS, you advocated for yourself, had all you had an entire team, all the things that we know people to do and it's still surprised you.

Dr. Ashley J.D. Ford-Graham (14:51)

I'm in the field.

Yup.

Megan (15:02)

You have a list of people that you can call. Yeah.

Dr. Ashley J.D. Ford-Graham (15:02)

Yup. Yup.

And still,

yeah. And you know, the other thing too is that I didn't know, nobody told me how PTOs was going to affect my pregnancy And because I was really trying to be intentional about my birth,

and wanting to be at a birthing center, the requirements were that you're not on any medication. So then it was a conversation with my midwives and my OBs about, do I continue taking this metformin that has been so helpful for me these last three, four years and has helped me regulate my weight and, you know, a lot of my symptoms and all these things so that I can have the birthing experience that I want, or should I keep doing this?

And it was a really, really stressful and big decision because I wanted to make the right decision, right?

Pauline (15:57)

I don't get

it. I don't get it. Why would you not be able to take mid-formin and deliver at a birthing center? Like, did they tell you that? Why?

Dr. Ashley J.D. Ford-Graham (16:07)

So I guess they still know. They didn't tell me specific why, but it was any medication. Like there were no medications that this particular birthing center allowed patients to take. And I had spoken with a bunch of people. had done a lot of the research on my own and I knew that it was safe to take metformin during pregnancy. And I did for the first like 16 weeks.

⁓ and then after that, I stopped it with the anticipation and then I didn't even get to give birth there. right. So like, but the, I, I tell you this story, I tell you this story though, because it impacted the way that I was able to trust myself because I made this decision to go off of metformin, not knowing how my PCOS symptoms were going to show up.

Pauline (16:40)

This is plan.

Dr. Ashley J.D. Ford-Graham (16:57)

during pregnancy and freshly And then I gained way more weight than I planned. So then my body image was out the window and I was like, this shit is really hard. Like, why did I decide to do this? Because this sucks. So yeah. But I got my girl and she was safe and healthy and I was safe and healthy and.

Now it's just like nobody told me I was gonna have to figure out how to do this for a third time with PCOS. And it's completely different than the other times I've had to navigate this.

Pauline (17:33)

and you say third

time, you mean postpartum.

Dr. Ashley J.D. Ford-Graham (17:35)

⁓ No, mean like, well, postpartum is the third time because when I first got diagnosed was ⁓ me trying to figure it out. And then when I kind of took matters into my own hands and got off birth control and then, you know, once I was pregnant and now postpartum with a daughter that sees me day to day and sees, you know, my mood fluctuations still at times or

when I am having really, really painful cycles because that was, another thing with the PCOS. And so trying to navigate how I explain this to her and teach her while also figuring it out myself.

Pauline (18:17)

As parents, we're always thinking about how we're going to change the experience for our kids.

Dr. Ashley J.D. Ford-Graham (18:17)

Yeah.

Exactly. Yeah. Yeah.

Pauline (18:24)

I

want to get back to something that you said though, because I think you have another hidden, like what nobody told me in there. We might have to have you come back, but you were talking about your pregnancy, something that you wanted clearly since you were a teenager. And you said, this sucks.

Dr. Ashley J.D. Ford-Graham (18:32)

Sure.

Yeah. Yeah. I had my daughter and I was thrilled. And I was like, this is great. I loved her so much. And there was that part. But there was also the part of me trying to navigate processing a birthing experience that was traumatic and did not go.

any way that I thought it was going to be. It was also me working to accept a c-section that I didn't want, I didn't plan for, was very scary. And then the recovery was horrible. It was really bad. And I am so grateful because I have a wonderful support system.

And so I had a lot of people that showed up and that were here to help take care of me and help take care of my baby and my family. But I remember even past, you know, Baby Blue's state standpoint, which is different from PMADS but for another episode. But I remember saying to my mom, like, I don't like this at all. Like this, I don't know why I decided to do this because I am, I am

really struggling. And it was like that for, I can't even tell you how long. And to be honest, are still very often days and times that that comes up, you know, to your point.

Megan (20:07)

One.

Pauline (20:08)

23 years postpartum, still comes up. It will happen.

Dr. Ashley J.D. Ford-Graham (20:10)

You know what saying?

Megan (20:11)

Yeah, I was just like 13.

Dr. Ashley J.D. Ford-Graham (20:13)

I'm like, this is crazy. and, and, again, I'm like, why did I choose to do this? also I love it. Right. But to your point, everything's coexisting. Absolutely. Absolutely.

Megan (20:14)

I'm 13 and I'm like, hmm. So that was a choice.

Mm-hmm. So it's that duality that we always talk about. You can feel more than one thing. Yeah.

Pauline (20:31)

as a birthing person who has lived with PCOS your most of your life. What what was something that was really helpful to you?

Dr. Ashley J.D. Ford-Graham (20:37)

Yeah. Yeah.

Pauline (20:43)

Or what was the one thing that you would want people to know?

Dr. Ashley J.D. Ford-Graham (20:47)

taking my health into my own hands. ⁓ And by that I mean like, yeah, being my own advocate, finding provi- like not stopping until I found providers that aligned with me, leaning on the supports.

Pauline (20:52)

being your own.

No, no,

Yeah,

you can go see more than one provider.

Megan (21:07)

Right.

Dr. Ashley J.D. Ford-Graham (21:07)

Yeah,

identifying what I valued, what was important to me from like a provider standpoint, from, know, my diet and nutrition and the holistic aspect of things. And really leaning on advocating not only for me, but for the joy that came with

being able to advocate for other people. And then being able to advocate for Black women who get cycles earlier, are not diagnosed as much, like all of the things that align with me, because had I known any of the things that I mentioned to y'all today that I didn't know, that's not to say I would do things differently, but I think I would have been more informed.

to make more informed decisions.

The thing that nobody told me is that PCOS affects mood and fertility and postpartum and birth and it's gonna suck sometimes but there are ways to navigate it. And there, I said it. And you figure it out. So yeah.

Megan (22:11)

Hmm.

Yeah, I'm gonna

Pauline (22:15)

Right.

Megan (22:15)

have this

beautiful full life even with people less complicated. Yeah.

Dr. Ashley J.D. Ford-Graham (22:18)

Yeah, exactly. Thank you.

All of their things. All of the things.

Megan (22:24)

You are always inspiring and a joy to be around. And we'll definitely ask you back.

Dr. Ashley J.D. Ford-Graham (22:29)

I appreciate you guys. Thanks for having me.

Pauline (22:34)

Thank you, Dr.

DFG.

Dr. Ashley J.D. Ford-Graham (22:36)

No problem!

Well, I appreciate you. Thank you.

Pauline (22:40)

Thank you. And you said it.

Dr. Ashley J.D. Ford-Graham (22:42)

Bye!

speaker-0 (22:43)

Thanks for spending this time with us. If you found yourself nodding along or saying, same, that's kind of the point.

speaker-1 (22:52)

We hope you leave today feeling a little less alone. This is what no mom told you. And yeah, there's more where that came from.