The Ovaries Are The Overlooked Key To Women's Longevity – A Fertility Doctor Explains
When you think about your ovaries, what comes to mind? Babies, right? Fertility? Maybe a ticking clock.
That's what most of are taught, but that framing is way too narrow. I recently sat down with fertility doctor Natalie Crawford, M.D. on the mindbodygreen podcast, who explained to me why the importance of ovaries for women's health goes way beyond reproduction.
Your ovaries are churning out estrogen, progesterone, and testosterone every single day. They're a hormone-producing powerhouse, and their function is a window into your overall health and longevity, whether you want children or not.
This conversation changed how I think about women's health. Here's what you need to know.
Why your ovarian health predicts your overall health
The magic of an ovary isn't actually in the egg itself, Crawford says. It's in the the cells that surround each egg inside its follicle, which are called granulosa cells1. These cells are responsible for hormone production, and when they're functioning well, your whole body benefits. When they're not, the consequences extend far beyond fertility.
Dr. Crawford shared that women who have metabolic diseases, such as cardiovascular disease, heart attack, stroke, and cancer, are more likely to struggle with getting pregnant.
But, it's critical to remember that it's not the infertility itself causing these outcomes. It's the underlying conditions that drive chronic disease: chronic inflammation and insulin resistance.
Another example of how ovarian health predicts healthspan has to do with menopause. When you go into menopause early, you have a higher risk of a heart attack and a higher risk of osteoporosis, Crawford says. The longer your ovaries function well, the more protected you are against a lot of these factors.
The vault analogy — how your egg reserve actually works
To understand ovarian health, you need to understand how your egg reserve works. Crawford describes all your eggs as being kept in a vault inside your ovary. Here is the timeline she laid out:
Here's the timeline:
- At 5 months in utero: You have about 6-7 million eggs. You hit your peak number before you're even born.
- At birth: 1-2 million eggs remain
- By puberty: Less than 500,000 eggs remain.
Every month since you were a baby inside your mother, a group of eggs has been released from the vault. Before you hit puberty and begin menstruating, nothing happens. The eggs just die. After puberty, one egg is selected to ovulate each month, and the rest die too.
What most people don't realize is that the number of eggs released each month is proportional to how many are inside the vault. Crawford puts it simply:
"The vault's really crowded, the door opens and more exit because it's so crowded. And then as it starts to get emptier, there's fewer inside and fewer exit."
This is why two women doing IVF can have wildly different results. It's not about effort or luck, it's about how many eggs you were born with and your individual rate of decline.
Your ovarian reserve, an important metric in fertility, is calculated through tests like AMH (anti-Müllerian hormone) or a follicle count. These tests measure the eggs outside the vault, that are available that month.
The puberty misconception
Many people think that, if you start your period earlier, you'll run out of eggs faster. But Crawford says this is a major misconception.
She explained that the truth is you are losing eggs your whole life, starting before your born. When you start menstruating doesn't change the rate of egg loss at all.
What happens during puberty is a new form of brain activation. When the brain matures enough, it sends out FSH (follicle-stimulating hormone), which triggers egg growth and eventually ovulation.
But, early puberty is a red flag, just not for the reason you might think.
Girls who go through puberty earlier tend to have higher rates of insulin resistance, more inflammation in their body, and greater exposure to certain chemicals. These factors can signal to the brain that it is more mature than it actually is. Crawford says, and decides to turn on early.
"Starting your period sooner didn't change the rate of loss of eggs at all. But it is a red flag that metabolic health is not ideal," Crawford says.
The same factors that trigger early puberty also predispose you to health risks later in life, including earlier menopause.
Chronic inflammation — the hidden driver
Inflammation gets a bad rap, but normal levels of inflammation are essential. Our body uses inflammation to help us heal a cut, and in the process of ovulation. The problems arise when you have chronic inflammation.
"Chronic inflammation can get inside the vault," Crawford says. She lays out the different ways inflammation can impact your reproductive system:
- At the brain: It interferes with hormone signaling, causing the brain to misfire.
- At the ovary: It changes how the ovary responds to signals.
- Inside the vault: It can directly drop your egg count.
- Egg quality: It impacts both genetic normalcy and metabolic function.
- Long-term: It can cause fibrosis (scarring) in the ovary.
The lifestyle pillars that protect your ovaries
In Crawford's new book, The Fertility Formula, she dives deep into the lifestyle factors that impact ovarian function. Some of the most important pillars include:
- Sleep: Chronic sleep deprivation drives inflammation and insulin resistance.
- Stress management: Chronic stress increases inflammatory burden.
- Diet: Focus on whole foods, fiber, and antioxidants. Minimize ultra-processed foods.
- Toxin reduction: Limit exposure to endocrine disruptors (found in food packaging, plastics, and many cleaning and personal products).
- Exercise: Movement supports metabolic health.
Remember, these aren't just fertility tips, they're longevity strategies. The same factors that protect your ovarian function protect you from health risks down the line. You can even begin ingraining these habits in your daughters, if you are worried about their ovarian health.
The takeaway
Crawford makes it clear: the conversation about women's health shouldn't start at menopause. It should start now, with a proactive approach to understanding and protecting your ovarian function.
Whether you want children or not, you have more agency over your ovaries than you might think.