I think I don't know how genetically determine the age of puberty is certainly there's a lot of environmental influences like toxins can affect it but pregnancy the age at which you start to go through perimenopause menopause many of those have a genetic component so with pregnancy I mean you can certainly think the shape of the pelvis your ability to have a vaginal birth some of that is genetically determined you
know in my family for instance we have no cesarean sections so everyone goes through this process of a relatively easy vaginal birth I was a forceps baby but you know for the most part you can find out about that and then there's certain female conditions that have a very strong component genetically most of which run in my family so that includes endometriosis fibroids I just had a hysterectomy I added 50 plus fibroids and polycystic ovarian syndrome and of those three uh how frequent are those and maybe I can constrain the question a little bit by saying um today's discussion I imagine is going to be heard by men and women of all sorts of Ages so I uh maybe I'll direct the question a little bit toward you know at what age should these discussions start um you know we always imagine that women in their 30s and 40s and 50s and onward should be getting certain tests and addressing things like uh ovarian reserve and and other sorts of things