#195 | Your Menstrual Cycle & Its Vital Role in Health Explained with Author Lara Briden

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

So there's been this faulty assumption that it's fine to just switch off women's actual hormones and replace them with these drugs and that that's going to be good enough. That was the assumption that was the hope, it was wishful thinking. But if you one of the analogies I use if you think about that, for men, like just think about it for a minute, if you were to say, look, men only need testicular function, when they're ready to make a baby. So in the meantime, we're going to routinely switch off testicular function switch off testosterone, because why did they need it, and we're going to replace it with this contraceptive, this version, you know, synthetic version of testosterone that's kind of like testosterone, but also quite a bit like estrogen and quite different. And so therefore, they're going to have altered brain structure. And they're going to have, you know, mood problems, and they're going to have suppressed libido, but it's fine, because that's what we do. That's the paradigm.

Hi, everyone, I'm Laura Briden. I'm a naturopathic doctor and the author of a couple of books, peer to peer manual, and hormone repair manual. And they're both books about how to have healthier periods and hormones without the use of hormonal birth control. And I wrote these books for my patients, they came out of, at that time, about 20 years of Monday to Friday, nine to five, working with women trying to find alternatives to hormonal birth control. And then I wrote these books to help my patients and then I discovered that women all over the world also wanted that help. So I've since then had an opportunity to connect with women and doctors all over the world and be part of this conversation, which I'd say it's a revolution about. It's the revolution of treating the menstrual cycle as something important and not something to be routinely switched off.

There's an author out there, and I can't remember who it is off the top of my head who wrote a book called The period is the fifth vital sign. Yes. And I think that's so important that we treat it that way and think of it that way. Because it really is a sign of our overall health and well being if our cycles are not right, then there is something off in our body. And it is as important as the vital sign.

Absolutely. So actually an ACOG are the American College of Obstetricians and Gynecologists in 2016 came up with what I would call a rather radical statement, I actually cried a little when I read it back then stating just that, that the menstrual cycle be treated as a vital sign they recommend that doctors should ask girls and young women to chart their cycles. I'm just like, wow, my mind was blown that they were saying that. And obviously we're talking about natural cycles, because there's no point in charting a pill bleed because it doesn't mean anything. But as you say, the ability to be healthy enough to ovulate approximately monthly, says a lot about the body that everything is going right that you're eating enough that you're not too stressed that there's nothing else happening like, you know, thyroid problem or anything else or nutrient deficiency that could be impairing your cycle. And so, yeah, a regular menstrual cycle is both an indicator of health and importantly, a creator of health. And this is where some of my work comes in. I had the help of an amazing scientist and clinician Professor Prior at the University of British Columbia. I'm on the Scientific Advisory Board of her organization called the Center for menstrual cycle and ovulation resource research. And that statement about the menstrual cycle being a creator of health comes from her. She's published dozens like over 100 papers on a lot on progesterone, which is the hormone we make after ovulation. And she's been building the case for decades that we need progesterone as much as we need estrogen. And importantly, progesterone is not the same as the predestines of hormonal birth control. This is one of my key points is to understand the difference between progesterone and progesterone. It's a little confusing because estrogen is a generic term, which can refer to our body's own esterday Oh, that's my main estrogen as the term estrogen can accurately refer to the ethanol estradiol that's in most types of hormonal birth control. It's a synthetic estrogen. But progesterone is not a generic term. Progesterone is one molecule. It's the molecule we make. After ovulation. It's the molecule. It's the hormone we make with pregnancy. And also it is possible to take natural progesterone, but not in the form of birth control.

Let's just emphasize two that our period health and our hormones estrogen and progesterone are not just about fertility, and pregnancy. These hormones impact our brain, they impact our mood, they impact our energy, they impact and influence our metabolism and are influenced by our metabolism and our blood sugar and our everything in our overall health. Why don't we have you explain the hormone cycle and the process through over the average 28 day cycle.

So so one of my messages is that regular ovulation is how women make hormones. So on the way to ovulation, we make estradiol which is amazing hormone, it's our main estrogen. It as you say, it builds metabolic reserve. So it's beneficial for us while we have it. And then also, big picture because my my second book is about menopause. So I can speak to that as well like big picture, what we want is to have had 35 to 40 years of amazing, you know, production of estrogen, as you say, for our brain, bones, muscles, heart, everything, it's very beneficial. And then estrogen is the hormone we make on the way to ovulation. And then progesterone is the hormone we make only after ovulation. And then of course, during pregnancy, Pregnancy is a time of very high hormone production, which I would argue is quite good for women. So progesterone, it has lots of benefits as well, like it's also good for bones, it's potentially very good for the brain. One thing about progesterone is its immune modulating, so what that means is it's anti-inflammatory. And actually, we know that during times in a woman's life when she might have quite a dramatic drop in progesterone such as postpartum such as perimenopause, for example. There's an increased risk of autoimmune diseases, which is the sort of It's a whole new set of conditions. And thyroid is the most common one where your immune system attacks the body. And so progesterone to some degree helps to protect against that. And we need exposure to both of those throughout reproductive years.

That hormone progesterone and its immune modulating effect is also the reason that prior to getting your period or in the PMs week, a lot of people will have flare ups of any type of autoimmune condition that they have or skin rash, or, or anything where the immune system is a little bit compromised. And that's because of the lower progesterone that happens. The drop in progesterone that happened exactly 40 Min straight, is that correct? It's the progesterone withdrawal. Yeah, so we all go through every month. quite a profound progesterone withdrawal. Some of us feel that more than others. Yeah, it can affect the immune system, it can definitely affect mood, as well, because progesterone is intact, it's quite interesting without getting too detailed. It interacts with the GABA system in the brain. The GABA system is the main sort of tranquilizing or calming system in the brain that certain medications act on the alcohol axon GABA system, not in a good way. But progesterone does that. And so that's one of the ways that progesterone actually changes the shape of the brain is this amazing research coming out about brain structure? Like, you can actually see it on scans changes in the brain throughout a natural menstrual cycle versus brain structure and women who take hormonal birth control when of course, the menstrual cycle is suppressed. And so women, there's some evidence to suggest that women's brains look different when they're on hormonal birth control, which is, yeah, very interesting. And of note, yeah, progesterone, GABA effect on the brain, none of the predestines that are used in hormonal birth control have that effect. None of them convert to what's called a neurosteroid that acts and interacts with the GABA receptors, which is quite an important detail. I think we're 70 years into the pill. I've seen quotes from scientists saying, Wait, what, why are we just discovering this? Now? This seems kind of important.

Laura, this is the first time this year is the first time I've started to learn as much as I'm learning about these topics. The first big observation I made from reading your book, and the first key thing I felt I was learning was this, that women have had a history of never understanding their cycles, never been taught anything about their cycles. You either have your period or you don't have your period like you basically have it for a week and then you don't have it for three weeks and you have it for a week and you don't ever for three weeks and then Doctors have a really big role in I think, a not understanding or appreciating women's cycles and be treating women in a way that doesn't recognize that the cycles are happening. I mean, I guess what I'm trying to say is, I think you put it well, you've said that it's we've always heard like a period when you're on the pill is a fake period. And I didn't quite understand what that meant. Even when we interviewed Abby Epstein, a few months ago, after making the movie, the business of birth control, which is, which is just so fantastic that they made that movie. I didn't understand it even then. But after reading your book, I think I started to, it's that the period you get when you're on the pill is a guest shedding of the uterine lining. But it's not precipitated by the it's not triggered by the hormones.

So everyone got distracted by the bleed. Right? So the bleed is a secondary event in the menstrual cycle. ovulation is the main event. ovulation is how women make hormones. Yes, confusingly, we have just come through a few generations, it's not that many, when you think about it, big picture, it's only you know, 60 or 70 years, it feels like forever, but it's a few generations, when it was has been assumed it's fine to just switch off with Aryan function basically, on the Combine pill. If you were to measure, for example, here to try to measure estradiol and progesterone with a blood test, who are women on the combined pill, you would see none like you would see menopausal levels of those hormones, and the hormones are replaced. The idea is, well, they're replaced by the pedestrian and ethanol estradiol and to be fair, the synthetic estrogen is, has benefits, it's somewhat closer to our own estrogen and progesterone is predestined to our to our own progesterone. So there's been this faulty assumption that it's fine to just switch off women's actual hormones and replace them with these drugs and that that's going to be good enough. That was the assumption that was the hope is wishful thinking. But if you one of the analogies I use if you think about that for men, like just think about it for a minute. If you were to say, look, men only need testicular function when they're ready to make a baby. So in the meantime, we're going to routinely switch off testicular function switch off testosterone, because why did they need it? And we're going to replace it with this contraceptive, this version, you know, synthetic version of testosterone that's kinda like testosterone, but also quite a bit like estrogen and quite different. And so therefore, they're going to have altered brain structure, and they're going to have, you know, mood problems, and they're going to have suppressed libido, but it's fine, because that's what we do. That's the paradigm.

I just want to make the point. So everybody understands that. Yeah. People realize that birth control and taking birth control. It's not, it prevents pregnancy by suppressing ovulation. I think a lot of people don't even understand that. They're eliminating their ovulation that, you know, that is what birth control does.

I know you're gonna laugh when I asked this question, because I'm so uninformed on this. But if you go years on the pale and you're not releasing an egg, doesn't that radically mean you're going to be fertile for like, an extra 20 years and going to

be where you're going with this? I get this question all the time. Well, this is another you'll have to have me back for a conversation about menopause because we've got a whole other Sure. Sort of confusion in the background here, which is this idea that it's not exactly that whole, you know, analogy of menopause is running out of eggs that's not quite accurate. Like we have a blueprint for simplified. It totally ever simplifies. I mean, are without let's not go down that path too much. But no, the pill does not taking the pill and suppressing ovulation for decades. Does not delay menopause. Absolutely not.

I'm just wondering why not? I mean, I know that doesn't happen with women, but why not?

We're basically it's in our genetic blueprint to stop ovulating around, you know, 45 to 55 is just gonna happen.

Lots of other hormones that influence it other than just quantity of eggs. I just wanted to make sure that people understand that yeah, just preventing pregnancy by some, you know, unknown, no, to sperm getting in and creating a baby, but they are literally suppressing ovulation, which suppresses all of the natural production of the hormones so we can keep which suppresses women's hormones. Yeah, right. So let's keep talking about how that's the detriments of that and how these replacement hormones that are synthetic don't mimic that they don't work in the same way. And what the detriments and dangers of that are.

Yeah, we'll talk about that. And then I'll say a word I'll do I'll answer that question. And then I'll say we're just about birth control more broadly, because of course, birth control, like the phrase itself can refer to the copper IUD or to be fair, and I'll just say as a little teaser, like, the hormonal IUD actually does allow ovulation. So it's a little different. So not every we're mainly talking about the combined estrogen pill, the patch, the ring, they work, and a lot of the progesterone only methods, but not all of them. Suppress ovulation is one of their main mechanisms. So what that means is that when you say hormone replacement, or because we're also and when you have me back to discuss menopause, if you want to, we can go into how actually we've reached this great place where what's happening for menopausal women is there's been this shift, which is awesome, to using hormones that are identical that are actual estradiol and progesterone. And we know it took a few decades to get to this point. But the research says yes, that's a safer thing to do. For example, progesterone is a lot safer for the breasts than projects done. That's true and menopausal women. And that's true in young women. So we're in this weird, I've had a few social media conversations where people are going, wait, what? So we're all convinced that it's safer for menopausal women to be on these real hormones, but it's fine to give high dose not real hormones, to young women. I'm like, Yeah, that's where we're at. Unfortunately, young women don't even get the same. Like don't even get the attention that menopausal women now get. But to be fair, for us to be all they have all the information, there's no real way to use natural hormones to suppress ovulation and prevent pregnancy. So it's not like, you know, we're just withholding that from young women, there are some pills actually that have body identical estradiol now, which is good. That's that's a step up, but all of them still use progestin. So and yeah, as you say, that has consequences. And we're just starting to see that in the research. Now, here's an excerpt. So there's consequences on bone health, because contraceptive drugs are not as good for bones as real estradiol and progesterone. There's potentially long term consequences on longevity to some extent, there's an interesting study, we can put in the show notes. It's quite early in the morning here in New Zealand, for me, so I don't have the exact title of that study and in my head, but I'll give it to you. But the other one of the other studies, and we can put this in the show notes, was one of the ones that worries me the most actually, as a clinician is a study where they looked at the risk of depression and anxiety after the pill now, so there has been some a big study, the big Lancet study came out in around 2016, showing there is an increased risk of anxiety and depression for women who are currently taking contraceptive drugs. But, you know, that should stop what that risk should we do is when they come off them, but there was a very interesting study where they tracked basically, women who took hormonal birth control while they were teenagers go on to have an increased risk of anxiety and depression later in their life, even when they don't aren't taking the drugs. And they The researchers say, well, it's only correlation. They acknowledged that it's not proven causation. But they say that biologically plausible, because the brain is very plastic and very responsive to hormones, especially during the teenage years. And if you take away the progesterone that has such a huge brain effect, and you put back progestin that acts differently on the brain to a teenage girl, you can't be surprised if she ends up having mood or nervous system side effects from that.

That would be like taking away testosterone from a teenage boy. Can we just make it clear to that by taking the synthetic progestin it's blocking your own innate progesterone and that progesterone has that calming effect on the brain. So that's sort of the assumption. That's why anxiety and depression are worse. Is that correct?

That's one of the believed mechanisms. I mean, this. To be fair, this I just don't know all the different mechanisms of what's going on. It's not just that progesterone is calming to the brain, it actually creates what's called neuroplasticity, like it actually changes the brain. So is that why it doesn't get better when she comes off the pill later? I'm trying to understand why it doesn't get better later when she is off of it. Is it because the brain was changed? And she actually yes and get back to that place? That's like, this is this is unbelievable, I know permanently changed even after coming off of it. Potentially. That's the potential interpretation of this study. And the the authors are cautious that it does make sense biologically, if they say it's biologically plausible. Yeah, I mean that even if that's a remote possibility, this is something we should take seriously when you consider how many millions of women are on the pill and how many preteen girls are put on the pill before they even get their first period without understanding the impact of Oh, you have acne. All right, let's put you on the pill. Oh, you have irregular periods. Let's put you on the pill. And one thing that really stood out in your book is like where it said, not trying to get pregnant, go on the pill trying to get pregnant, take fertility drugs, like choose, rather than let like learning about our cycle, eating and taking the supplements that support a healthy cycle, so that every stage of life fertility, menopause is as comfortable and thriving as possible. And the fact that all of this affects the brain as much as like way beyond the reproductive conversation. It like I said, it's extraordinary.

It is extraordinary.

Can we just well, this, we've already talked about a little bit about the whole fake period versus real sherried thing. But as you said, girls are put on the pill to regulate their cycle. Now, this is one of my key messages. The pill cannot do that. Like it's been a very unfortunate. I mean, just phrasing I guess it came from the you know, originally in the 60s, I don't think any of the scientists or doctors really believed that the pill would regulate the cycle. They just had to kind of it was marketing. They had to sort of portray it that way for different reasons for infomercial love to do is sort of getting the pill legal and getting the Catholic Church to okay, it is the result of this whole backstory. But then 60 to 70 years later, we're left with this Emperor's New Clothes situation where it's been reinforced, it's like, well, the pill can regulate your cycle. It can't because as we said, it switches off the cycle, it switches off ovarian function, and it replaces it with these induced bleeds, which are arbitrary. Now there's just to be clear, like there's no medical reason to bleed monthly on the pill. If you're going to take the combined pill, you might as well just not have a bleed or have a bleed. What usually ends up happening is you have to have a bleed a few times a year otherwise you start to get a lot of breakthrough bleeding, but there's no monthly anything going on with the pill that's not required for any part of it because the ovaries are flatlined. We chatted a little bit off air about this, but in my experience now 25 years of clinical experience talking with my patients, talking with my readers talking with my followers online. That information that the pill cannot actually regulate the cycle is the number one thing that women react to that when they find that out. Sadly, and I don't like that this is what's happening but when they find that out a lot of women then start to question everything that they've been told and I, you know, I want women to work with their doctors, I don't want women to reject medical care in any way, shape or form. I think it's important to work with the doctor to get diagnosis to get, you know, appropriate treatment. But you can understand where some of this in a rebellion is coming from women are like, Wait, every time I go to my doctor, they just tell me to take the pill to regulate my cycle. And now I know it can't do that. So what else are they saying? That's not true?

So let me just make sure I'm explaining this to the people who don't understand this easily as I don't. Because this is new to me that it doesn't regulate the cycle, it definitely creates the illusion of regulating a cycle, because it's, it provides this regular quote, period every month. Yeah, but what you're saying is, it's doing nothing to regulate any of the hormones, it can't do that it is capable of that it's suppressing them entirely. It's kind of what I said in the beginning, that most of us spend our lives like, oh, I have my period for about a week and no period for about three weeks on a period for about a week. And so their only understanding of their cycle is having a period for about a week. So when women go on the pill, and they get that quote, period for a week, they're like, oh, yeah, it's so reliable and so regular, and they don't understand and appreciate all the hormones that are happening every day of our lives playing a role in our cycle, those are being completely suppressed.

Exactly. Because the bleed is not the main event. So inducing a blade doesn't, doesn't accomplish anything.

It's amazing. Yeah, incredible. It has been a bit of a wild ride. And we're in the middle of it. We're starting it now there's a paradigm shift coming around women's health. And yeah, I'm excited to have been part of it. I think it's future generations are going to thank us for these kinds of conversations because better things are coming. for women's health, I believe including methods that don't suppress ovulation. I'll just talk about the hormonal IUD just briefly. Because it's popular, and I get it, I get the shift to that I mean it, it still does release a contraceptive drug. It's a progestin it's not real progesterone. But the difference, for example, with the hormonal IUD is it's quite a low dose, it mostly works locally, although not entirely, unfortunately. But it can in many women permit them to cycle naturally and still make the estradiol and progesterone their own hormones, which is almost like having the best of both worlds, then you get like your own your hormone cycling, which is the main event. Plus, you might get very little menstrual bleeds, so you don't have to have a lot of bleeding. So I mean, I think there are pros and cons to the hormonal IUD, and I don't want people to think oh, that's definitely the answer for everyone. But I'm just acknowledging there's already some changes happening away from the combined pill, which is mostly what we've been talking about.

So I think, as far as the progesterone, I progesterone releasing IUDs. Justin, I think, yes, thank you the progesterone IUDs. Yeah. The newer ones are maybe releasing, have less progesterone, yes, and are allowing it but lower dose, some of the older ones, definitely, many women would completely suppress their periods, it would at least get what's present. And usually after six months to a year, they would no longer be having a period at all. It will get let's talk about let's just talk about this. Because suppressing you can now it's quite interesting because the hormonal like a D is a unusual situation where you can have ovulated, but not bleed. That almost that almost never happens in any other situation. So weirdly, there's a compare and contrast in here, which you might your listeners might find helpful. With the combined pill. you bleed, but don't cycle like you bleed but don't ovulate, which as I've said means nothing is zero point in doing that. With the lower dose as you say hormonal IUDs especially especially in the later like after a year or so of use, the dose is lower and especially older women can start to ovulate. With the hormonal IUD you can weirdly ovulate but not bleed. So with the combined pale you bleed, but don't cycle with the hormonal IUD, you can cycle but not bleed. So they're they're actually extremely different in that way. And again, it takes the emphasis off the bleed and put it back on ovulation, which is where it belongs. Because that's what that's all about.

That's what we want to protect. So right yeah, endometrium is not the important part of it. Yeah. Then there's the copper IUD, which Yeah, also, it allows ovulation, there's no influence over the hormones. Yeah, that's, that's a great option. Can we talk a little bit about what happens when you come off these synthetic hormones and how fertility might be impacted?

Yeah, so the whole like, When will you be fertile again, there is a delay coming off contraceptive drugs for obvious reasons. I mean, ovulation has to return. So there's been a bit of more study around that. But I might just speak to to the symptoms coming off the pill because are coming off hormonal birth control because that's a big part of this as well. And I guess The simplest way to explain this, there's no one recipe for what you need to do to transition off hormonal birth control, because the way to think about it is to zoom way out and think remember, wait, okay, so what were my real cycles like, before I suppressed everything with contraceptive drugs, because it's, those symptoms have very likely not gone away. That's, that was my starting point. And then these induced pill blades have really only masked the situations. So for example, if there was, if skin like if breakouts, acne was the main concern that's coming back, especially if you've been using as a couple of particular projects, the Yazmin group of pills like the josper now and they coming up those can cause a post pill acne that is really brutal. Actually, I've written about that a few times, I have a podcast about that. But or, for example, were periods irregular, because they're still going to be like, that hasn't gone away. Nothing's changed as the pill has the combined pill could could not and has not done anything to regulate the underlying, you know, problem with ovulation. So if you weren't ovulating regularly before, then you're not likely to be doing so now. And so a lot of women will phrase it well, my periods became irregular when I went off the pill. It's like, did they or did you just unmask what was always there? Or if the problem was severe premenstrual mood symptoms, or if the problem was pain, whatever it was, you have to kind of go back to the drawing board and think what was my actual diagnosis? What was causing the actual problem before I masked it with the pill and then treat that and that's how you can transition to symptomless natural menstrual cycles. This is my mission statement. This is my goal for my follow up my readers, my patients is to achieve symptomless Yeah, regular natural, natural menstrual cycles and therefore gain the benefits of those for long term health.

What is what's a good takeaway, Laura, for women who are listening who are still in the years of, you know, either planning their first pregnancy or they're not finished having their last baby? What are the takeaways for those women? And then separately, I would like to ask you what the key points are that you would provide to the women who are finished having their babies and they have the perimenopause years, not too far off. That which you said can last two to 12 years. So it's a very long period. Yeah. Pause meaning around menopause, it can be the decade leading up to menopause. What are the key points or Takeaways you have for the women in those two different categories?

Ovulate while you can build that metabolic reserve make progesterone ovulate while you can if at all possible and I do have to acknowledge because there's going to be some people listening thinking I can tabulate you know, I've got endometriosis or I've got whatever terrible symptom It is then okay, like there's always there are, you know, there's some nuance to it, but for a lot of us ovulate while you can. That's true when you're younger and still in your reproductive years. It's true into perimenopause and for what it's worth, you can still have a baby during the early years of perimenopause. It's they're not, you know, totally separate. Yeah, a cycle while you can eventually with perimenopause, ovulation or cycling becomes harder and harder to do. That's nothing you've done wrong. That's just our we evolved to do that to go through menopause. I'm an evolutionary biologist, which might be interesting for any of your listeners. That was my first career. So I see everything through the lens of evolution. And, yeah, we meant we're meant to go through menopause and then live for decades beyond but we make estrogen first because we can't ovulate yet very well. When we're still 1314. We're still trying to learn how to do the body's trying to learn how to do that. That's what periods can be heavier in first puberty. And then progesterone kicks in because your body learns how to ovulate. It's like, wow, we're gonna make this progesterone lightened flow. And then hopefully we have, you know, 35 to 40 years of regular cycles, but making progesterone that way making tons of progesterone with pregnancy, and that if we decide to have a pregnancy, and then in perimenopause, the first hormone to leave is progesterone and then we're left with only estrogen like we had in our first puberty so second, perimenopause, a second puberty, high estrogen compared to low progesterone in perimenopause is also a source of heavy periods in our 40s, an answer to your question, cycle, while you can ovulate if you can, and then troubleshoot your symptoms and find there's almost always a solution for pain or you know, premenstrual mood or whatever it is lack of ovulation. It's about troubleshooting, that you have to have a detective hat like you have to figure out what are the underlying factors, and they're often often factors from your general health that are creating these symptoms. So that you can achieve symptomless natural cycling.

So Laura, if you had to give young women one piece of advice on how to have healthy ovulation every month, what would it be? I'll just first say that for me. I believe that diet and blood sugar management so diet and exercise that combination of lifestyle has a very big influence over our ovulation and keep managing our blood sugar can help us ovulate when we're not ovulating. But what would it be for you?

The way to achieve regular ovulation is to give your body what it needs. What does it need? What is the obstacle to ovulation? Is it some sort of illness? Is it another medication you're taking? The address or a very common one is are you not eating enough? Very common for young women to lose their populations to under-eating. What women need to understand is your body wants to do this, it wants to ovulate, it's not broken. And so another one of my key messages is to trust your body. Women's Health is not as mysterious or complicated as we've been led to believe.

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