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    113: The Truth About A Healthy Life Beyond The Pill w/ Dr. Jolene Brighten

    Taking the hormonal birth control pill might be preventing unwanted pregnancy, but it could also be masking, or even causing, a whole host of chronic health conditions.Dr. Jolene Brighten, the author of Beyond the Pill, is here today, along with my daughter, Amanda, to talk about the effects of the pill on our bodies and what alternative birth control methods are available.

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    Jolene is an expert in women’s health, nutrition, contraception, and hormone imbalances. She works with women to reclaim their natural health, cycle, and rhythm. Having been on the birth control pill for 10 years when she was younger, she knows how it can devastate your body’s natural health, though she isn’t completely anti-pill. Jolene just wants to help you find the best healthcare for you.

    Many doctors will put young women on the pill to help manage painful or long periods, amongst other things, but those symptoms could actually be caused by a chronic condition such as PCOS. Jolene explains why we shouldn’t try to just mask these symptoms but should endeavor to find the route cause of them. 

    The effects of being on the birth control pill long-term can also last long into menopause! And did you know that your gut health can actually impact your period? If you have extremely painful periods, it could be due to food intolerance, like dairy, or poor gut health, like leaky gut or SIBO. Plus, there are so many links between the pill and cancer.

    So what do you to prevent pregnancy when you don’t want to risk using the pill? There are so many other non-hormonal contraceptive methods out there. Jolene also talks about the benefits of the barrier method, both male and female condoms, and you might be surprised that they’re not just to prevent pregnancy! 

    The most important thing to understand is that what works for you might not work for the other women in your family. Birth control is personal to you, so figure out what method is best for you, your circumstances, and your health.

    Do you have painful periods? How comfortable are you with your current method of birth control? Are you entering menopause in the healthiest way possible for you?

     

    In This Episode:

    • How birth control can impact so many other medical conditions
    • Why you should reconsider using the birth control pill to manage chronic diseases
    • How you can support your entrance to menopause in a more healthy way
    • Why our gut health can impact the pain of our period
    • What the relationship between the birth control pill and cancer is
    • What other methods of birth control you can use that aren’t the pill
    • Why what’s normal for you won’t necessarily be right for other women in your family
    • Why you should still use a barrier method of contraception 

    Subscribe to Couch Talk w/ Dr. Anna Cabeca on Youtube

    Quotes:

    “Women should have all the information they need to make the best decision for themselves about the birth control pill.” (3:59)

    “Birth control was designed for a healthy, young female patient who didn’t want to have a baby - yet - it was never designed to be this indefinite thing that we’re just left on, never to ovulate, never to have a natural cycle. And it was never designed for the management of chronic disease.” (9:16)

    “Once women start to understand what is going on in their natural cycle, they can see where there’s issues and where there never was issues.” (25:04)

    “How can a woman ever have a boundary if she’s never been given permission by society to have a boundary? One way we can do that, that serves us as well, is by having our own boundaries and not apologize for taking what we need and leaving what we don’t.” (35:42)

     

    Links

    Buy Beyond the Pill now!

    Find Dr. Jolene Brighten Online

    Find Dr. Jolene Brighten onInstagram |Facebook |Pinterest |YouTube

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    BuyThe Hormone Fix

     

    Transcript 

    Dr. Jolene:
    What I want you to walk away with is anything that you start, you know what is normal in your body and you know what's not normal and you deserve to be heard. If something doesn't work for you, that's what's true for you. Whether it was true for your mom, your sister, your best friend, doesn't matter. What's true for you is what's most important.

    Dr. Anna:
    Hello, everyone. Dr. Anna Cabeca here. Today we're going to talk about the birth control pill. What is a menopausal woman wanting to talk about the birth control pill for? Because let me tell you, I will tell you why: The effects of birth control can last well into our menopause and post-menopause and really create some hormone disruption that honestly has been undercover and hasn't been talked about, although the research has been evident for decades.

    Dr. Anna:
    Today, I have a special guest, Dr. Jolene Brighten, who is a functional naturopathic medical doctor, a dear friend of mine, and someone I think very highly of. I've socialized with her on many occasions and have been inspired by her intellectually as well as her passion for this topic as well as helping women heal naturally. She is a recognized leader in birth control, post-birth control syndrome, which is what we're going to talk about today and also, the longterm side effects associated with hormonal contraceptives.

    Dr. Anna:
    Jolene has published a book called Beyond the Pill, which is a 30-day plan to support women on birth control and help them transition off, just like menopausal women going cold turkey on our hormones is not a good idea. In fact, it indicates that there are other deficits that are going on. We always have to get to the root of the problem. But where this comes in with sexual freedom and reproductive freedom is a whole nother issue, so I am looking forward to talking with Dr. Jolene Brighten today. I know you'll love her.

    Dr. Anna:
    Here we go. Dr Jolene Brighten. It is great to see you here. Thanks for joining me today.

    Dr. Jolene:
    Yeah, thanks so much for having me. Always a pleasure to see you and to chat with you.

    Dr. Anna:
    Well, I want to surprise you with a surprise guest that we have today. I have my daughter, Amanda Bivens, here with me today. Tell you a little bit about, because we're going to talk about birth control pill, and to bring in the perspective, the mother-daughter conversation around birth control, I think is really, really valuable.

    Dr. Anna:
    Also, the challenges that our youth are facing and how they're being dealt the whole conversation about birth control, how safe it is versus the reality of the situation. Again, just having a great way to just talk about it real-time. You're helping me out, in other words, Jolene.

    Dr. Jolene:
    Well, good to see you again, Amanda. We actually met at a conference and if you remember, I was sampling someone's liposomal B vitamins and they were like, "It's going to be great," and it was the worst thing in my mouth. Now, it did make me feel great. I do acknowledge it's great technology in supplements, but if it wasn't for the Mighty Maca booth, yeah. You guys were right there and I'm like, "Mighty Maca, please, I need to get this flavor out of my mouth right now." It's good to see you. I won't be making any weird faces or grimacing. Well, we'll see. I don't know. Maybe I shouldn't make that promise.

    Dr. Anna:
    Well, we may, we may. Jolene, share with us your story. What brought you to be so passionate about the birth control pill and this whole topic in women's health?

    Dr. Jolene:
    Yeah, well, I used the pill for 10 years. I'm a first-generation college student, so I'm really grateful for that technology and for us to have access to birth control. I always advocated for birth control and now that I raise the issues of informed consent, what we should be talking about, I think people think that now I'm anti-birth control. Still advocate for access to birth control, but with the lens that women should have all the information they need to make the best decision for themselves.

    Dr. Jolene:
    I did 10 years on the pill, yay, graduated college, yay, became a doctor. But I also struggled in a lot of ways, in ways that I thought were completely unique to me.

    Dr. Jolene:
    It wasn't until I was in medical school that I got the information that you ovulate once a month and you're really only fertile like one day out of the month. There is a bigger window than that due to the survival of sperm, but when that hit me I was like, "Wait a minute. So, I'm taking a medication every single day to suppress my fertility and yet I can't get pregnant every single day?"

    Dr. Jolene:
    At that point, I wasn't sexually active and I decided to make the transition off of birth control. When I did, I developed cystic acne for the first time in my life. My period had gone missing, so I developed post-pill amenorrhea, which is part of post-birth control syndrome, and once again saw that this was unique to me, something was going on with me. My doctor was really good to reinforce that none of this is related to birth control.

    Dr. Jolene:
    It was really through working with patients, listening to their stories, getting the reputation of the doctor who believed women's birth control stories, I came to see that there's a lot of us experiencing side effects. As I got into the research, there is a lot of research talking about these side effects, talking about these issues, and talking about what can happen when you come off of birth control.

    Dr. Jolene:
    That's really where I got passionate about this. Right before then, I had actually said to my husband when I was starting my clinical practice: "After two years working in a homeless youth clinic and prescribing lots of birth control, I don't want to talk about birth control anymore. I'll let the gynecologist do that. I'm going to do my thing over here."

    Dr. Jolene:
    Except that my autoimmune patients were on birth control and couldn't get better, my CBO patients were on birth control and couldn't get better, the leaky gut phenomenon and food sensitivities. There it was that I had to talk about birth control, but just in a different way.

    Dr. Anna:
    That's powerful because understanding what's underlying the issue of what the birth control pill has done. Again, I'm a gynecologist. I prescribe birth control. It's one of the first prescriptions we write, right? There's a time and a place, the reasons, like: What's the duration? When do we need it? When are we allowing it to work with our bodies versus working against our body?

    Dr. Anna:
    You're absolutely right: informed consent. We need to know this because we need to know what it's like to come off birth control. We need to know what vitamin deficiencies birth control is causing and clearly understand what it's doing to our hormonal balance. I'm glad you've brought up these topics, but the deeper issue here is what is the birth control pill doing to our gut, to our thyroid, to our sex drive?

    Dr. Jolene:
    Yeah, and that was the thing that was so eyeopening to me. I went through my twenties on birth control, no libido, and that that was normal. That was a normal state of being. You don't need any research, you just need the women who've been on birth control who are like, "My libido is completely gone."

    Dr. Jolene:
    We see these mechanisms at play where birth control actually alters the liver at both genetic and structural level, so we can develop more tumors, benign tumors, but also liver cancer as well. We see the elevation of sex hormone-binding globulin and that grabs on to testosterone while birth control is down-regulating the production of testosterone so that itself can lend to libido issues.

    Dr. Jolene:
    But those same mechanisms that cause the sex hormone-binding globulin to go up, they also, we see the cortisol-binding globulin and thyroid-binding globulin, so now we're binding cortisol, now we're binding thyroid. We're having nutrient depletions like magnesium, zinc, selenium, B vitamins, many B vitamins. We know how important folate is because everybody talks about it in case you get pregnant or you are pregnant. However, this is a medication that women do get pregnant on birth control, and yet it's depleting that folate that they need.

    Dr. Jolene:
    There's a lot of ways that birth control impacts our body. As we now enter into the era of understanding the microbiome more and seeing that this daily medication actually decreases microbial diversity, for everyone listening, you want a diverse microbiome, that is one of the things we've been pointed can help prevent chronic disease and help with health and longevity.

    Dr. Jolene:
    At the same time, birth control can trigger autoimmunity specifically in the gut. We can also see intestinal hyperpermeability or what's called "leaky gut."

    Dr. Jolene:
    This is what's mind-boggling to me, is that only in the last handful of years have we started to ask the question, "What happens to the female brain when we leave women on birth control for decades on end?" I know you work with a lot of perimenopause and menopausal women and this is something that really concerns me, is that the majority of the Alzheimer's population are women. Over 66% are women.

    Dr. Jolene:
    Yet we know this is a complex, I'm not saying birth control is the cause, but it's one more drop in the bucket and we're not discussing it. With that age demographic, I'm always a bit, I think, horrified, maybe I am going to make those grimaces now, oh, my gosh, when a perimenopausal woman is being offered birth control for hot flashes and things along those lines because that's not what it was actually designed for.

    Dr. Jolene:
    For everybody listening: Birth control was designed for a healthy, young female patient who didn't want to have a baby yet and to space pregnancies. It was never designed to be this indefinite thing that we're just left on, never to ovulate, never to have a natural cycle, and it certainly wasn't designed for the management of chronic disease, yet we are now seeing it come in for PCOS, for PMS, for things that have a root cause.

    Dr. Jolene:
    It's 100% your right to use whatever tools are available to feel your best and you should never feel ashamed about that, but if there is a root cause and your doctor's not asking that, they're just prescribing the pill, we've got a big problem there because that's a disservice to your health and a disservice to women everywhere.

    Dr. Anna:
    I think this is a huge point because, in these transition phases where hormones are fluctuating greatly, it's a common prescription that's written. That's something, too, that I saw so often is that perimenopause birth control prescription, even if they've already taken care of birth control, right? Husband's had a vasectomy or they've had their tubes tied or they have an IUD, that just, "Let's just knock out the symptoms this way. Eventually, comes 50-something, we can take you off of it so we can monitor your symptoms."

    Dr. Anna:
    Then let's just go into full-blown menopause because you have no reserve at that point and try to juggle and struggle, maybe for months, if not longer, if not years in trying to balance your natural hormones. That's a critical point.

    Dr. Anna:
    Again, just in my clinical experience as with yours, Jolene, is that when we detox the body, when we support ourselves nutritionally, that hormonal transition gets better, right? The menopause is mandatory, suffering is optional.

    Dr. Jolene:
    Absolutely. That's exactly what I talk about in my book, is if you're going to make that transition as successful as possible, then you need to take care of your gut, your liver, the nutrients that you're bringing into your body, your adrenal glands, your thyroid, and these are all areas that hormonal birth control definitely does a disservice to the body on.

    Dr. Anna:
    Yeah, and the other big thing, too, which I thought was so interesting early on, I don't know, lately, over the past few years, saw the Accutane lawsuits. "If you were on Accutane and you have IBS, irritable bowel syndrome, call me," right? But it's birth control pill and Accutane, right? It was both of those that women were typically on for acne, but is it the gut dysbiosis causing the acne in the first place, right? The underlying issue, the gut issue is part of that problem, too.

    Dr. Anna:
    Early, I've seen clients 12, 13, 14 come into my office on birth control pills and infuriates me. It's typically for acne. "I don't want her to have acne scarring," says the mom. Or, "Her periods are really crampy and this will just shut them down." I'm like, "Well, let's just resolve the issue why we're having crampy periods because it's not how we're designed. It's part of a bigger problem." How do you address that, too?

    Dr. Jolene:
    Yeah. Well, in chapter four of my book, I go through the common period problems that we face and what can be the root cause of that, what you should talk to your doctor about, what lab testing to ask for, and what you can do right now.

    Dr. Jolene:
    I actually was really grateful to have access to birth control because I was bleeding more than seven days every month, I would vomit because of period pain, I would be on the ground, hot water. Well, heating pad, actually; this was heating pad days. Electrical heating pad over my female organs, I don't even want to think about that.

    Dr. Jolene:
    I actually had developed gastritis, that's inflammation of my stomach. I had an H pylori infection, but I also had to take ibuprofen for my period pain to the point where I wouldn't even use that drug anymore.

    Dr. Jolene:
    When I was given the pill I was like, "Yes. I can shut it all down. I don't have to deal with this. This is so nice." I was all signed on to the story that goes that "Periods are just inconvenient and messy and you should hate them."

    Dr. Jolene:
    Yet I look back and I'm like, "What was likely going on is I had elevated prostaglandins," these hormone-like substances that are great for making your uterus contract to get a baby out or to shed uterine lining and are also impacted greatly by your diet. Adding some magnesium and some omega-3 rich foods probably could have helped me get out of that period pain along with taking care of my gut because the gut, yes, it is everything in health but it's so crucial in our hormones. I'm like, "I had all these gut issues and I had painful periods." Something was going on in my gut. With period pain, we have to look at why is that?

    Dr. Jolene:
    In some instances, there's been studies to show that the younger you're put on birth control and the longer you're on it for period pain, the more likely you are to be found to have endometriosis. Well, that should definitely be investigated, should be part of the conversation.

    Dr. Jolene:
    When it comes to acne, acne is one of those that sometimes it gets better with birth control, sometimes it gets worse, sometimes it gets way worse when you come off as part of post-birth control syndrome, and sometimes you get the new onset of acne when you come off of birth control.

    Dr. Jolene:
    This is something where we have to ask the question: What are the trade-offs here? Because maybe you're giving her birth control for her acne, but it's really due to polycystic ovarian syndrome, and a woman with PCOS is at higher risk for cardiovascular events, high cholesterol, a high blood pressure, diabetes, all of these things that birth control raises the risk on in your average, no-issues woman.

    Dr. Jolene:
    With that, we may be treating the acne, but are you trading acne for potential cardiovascular events like stroke, blood clot, heart attack? I don't say that to scare anybody, I definitely don't want anyone to feel afraid, but it's the kind of conversation that has to be had: Why do you have acne? You don't have acne because you have some kind of absence of synthetic hormones. You make progesterone, you don't make progestin, that's the synthetic progesterone version you find in birth control.

    Dr. Jolene:
    When women have acne, it's exactly what you said, usually rooted in gut dysbiosis, so an imbalance in gut flora. Birth control, I've already stated causes an imbalance in gut flora. There's also going to be nutrient depletion issues, so zinc, vitamin A, for example, really important for skin health, really important for the immune system modulation, that can also be contributing to acne. Birth control depletes those as well.

    Dr. Jolene:
    We haven't even begun to explore the skin microbiome, so if anything disrupts your gut microbiome, it has the potential to disrupt the skin, the respiratory, the vagina. I mean, you've got these ecosystems all over your body and they're all in communication with each other.

    Dr. Jolene:
    Then the other piece of acne that I always just giggle is when I hear doctors say, "There's no evidence that diet does anything for acne." Well, you talk to women who, for example, dairy's their trigger and they're like, "I eat dairy, I get acne. I don't eat dairy, I don't get acne." There's something going on there. Is it that dairy is just not going to work for them forever? Yeah, maybe. Or maybe they have intestinal hyperpermeability and we have to go deeper on that level and start to heal there.

    Dr. Anna:
    I have definitely found that dairy is a big trigger. Certainly, for me, that was one of my food sensitivities. It was probably a big problem why I had acne growing up. Dairy, there's a definite correlation there for so many women and men and boys and girls, I think just has to be eliminated when we're dealing with acne and in most situations.

    Dr. Anna:
    The breast cancer question about birth control pills, when girls are started on birth control pills before age 16 and the effects on our genetics on our detoxification pathways, what have you found out about this?

    Dr. Jolene:
    It was really interesting and I'm sure you saw this as well, when the newer versions of birth control came out, they said that the cancer risk was lower because the pill now had less estrogen. We hear a lot that, "This is the low-dose pill that I'm on," or, "The birth control is low dose, so I don't need to worry about this," when in reality it's low dose compared to what the first iterations are.

    Dr. Jolene:
    When the research came out, although we were saying forever that, "The new birth control, the breast cancer risk is much lower," we actually found out it wasn't true. Now, there's about a 20% increased risk in breast cancer compared to women who have never used hormonal birth control. Statistically speaking, that is a moderately increased risk.

    Dr. Jolene:
    However, we really have to view it through the lens of not just family history, but what might be going on in terms of her diet or where is she living in the country. What other risk factors are there for cancer? To be fair, with the pill, yes, breast, cervical, liver, and brain cancer risks all go up. That's really important to know. At the same time, cancers like ovarian cancer or endometrial cancer, those go down while on birth control. I always try to be fair in this and that yes, there can be an increase in some cancers, other cancers, there's a reduction in risk.

    Dr. Jolene:
    The one thing I really think that we should all understand and I talk about in my book is that when it comes to cancer prevention, yes, the pill can be one form of cancer prevention for ovarian cancer. However, there are other things that we can be doing. I'll often hear this argument where it's like this whole anti-food-is-medicine movement, which blows my mind because I'm like, "What you eat and assimilate becomes every single cell in your body. How is that not powerful?" But with that, just seeing this conversation of, "Diet doesn't prevent cancer. You can't just do one thing and expect to prevent cancer, but birth control, you can just do the one thing and expect to prevent cancer."

    Dr. Jolene:
    I think it's a slippery slope because you can use birth control to help prevent ovarian cancer, but that doesn't mean you don't pay attention to diet, lifestyle, inflammation, all these other factors that we know can contribute to that. That's just to say that like you don't have to throw the baby out with the bathwater and as a modern woman, you have access to these things that you can pick and choose the tools that are going to serve you best.

    Dr. Anna:
    Yeah, that's well-said. Well, let's bring in our young millennial here, Amanda Claire. What questions do you have about birth control, birth control pills?

    Amanda Claire B:
    Well, what would you recommend to use instead of birth control, then?

    Dr. Jolene:
    I knew you're going to ask that. You know how I know that? Because everybody asks that because they're like, "Oh, god, if it does this, then what do I use?" There is no one-size-fits-all when it comes to birth control. It's really about counseling the individual, where they're at in their life. If you can't get pregnant, then you need to be confident in the method that you're using, taking a look at family history and taking a look at can you pop a pill every day? For some women, that's a no, so maybe it's an IUD instead.

    Dr. Jolene:
    With that, in Beyond the Pill, I go through birth control pills, I go through looking at progestin, that's the shot. You're going to find progestins and in all of the contraceptives, the hormonal contraceptives, but they stand alone.

    Dr. Jolene:
    And IUD, we've got different versions of IUDs, where Mirena works for one woman but it doesn't work for another woman but then Skyla works for her. It's about really understanding what is true for you and that [inaudible 00:20:58] can certainly have copper IUDs, doesn't work for everyone. If you have painful periods, heavy periods, endometriosis, probably not the best option for you.

    Dr. Jolene:
    We also, we have barrier methods which it's something I think is really important, especially as we send women off to college and they often get, "Here's your birth control prescription. Study hard. Do good work," but we also have to educate that that's not going to protect against a sexually transmitted infection. Barrier methods are usually part of the conversation with women as it is: condoms, whether it's a female condom or the male condom.

    Dr. Jolene:
    We also have other barriers like cervical cap. I'm not a huge fan of those if you do not want a baby; they have a higher failure rate, so you have to really evaluate where you're at and what is going to be the best choice for you.

    Dr. Jolene:
    Now, before any intervention is done, what I recommend, and yes, these are all medical interventions when we start modulating our fertility, I recommend that women track their cycles. Three months is ideal, but if you can at least track for one month so you know what your baseline is and get some baseline lab testing, simple lab testing, like are you anemic? Because if you're anemic, you have iron deficiency anemia and we give you a copper IUD and you start bleeding more heavily, you're going to have a problem, so looking at baseline lab testing, employ the medical intervention, and then come back six months later, rerun some tests, track your cycles.

    Dr. Jolene:
    If anything changes for you that's unfavorable after having a medical intervention, that warrants a discussion with your doctor. One method that can be effective in preventing pregnancy, which also allows you to get a lot of data about your body and track your cycle, is fertility awareness method. What I advocate for is the use of basal body temperature, so you wake up first thing in the morning, thermometer under your tongue. There are apps these days that you can plug it into that'll do the math for you or you can get a paper chart, do it yourself.

    Dr. Jolene:
    Do you track your symptoms? Are you in the mood a little bit more? You're probably going to ovulate soon. Is there fertile cervical mucus? I'm looking at these as data points. Whether or not women want to use this to prevent babies, totally their call, but it's a great way to get to know your body and you can use that to track where you're at.

    Dr. Jolene:
    Then you decided to get an IUD or you decide to start the pill. This is the other thing: There are many pills out there. For some women, one pill works well, though this one doesn't work for this woman, so we switch her to a different one. It's really important to recognize that for a very long time the conversation of medicine has been that estrogen was the devil and that progestin was going to save you.

    Dr. Jolene:
    Now what we've come to understand in the research is that progestin, the synthetic stuff in birth control, does not give the same benefits as progesterone. In fact, especially in young women, we see higher incidences of depression and suicidal ideation is what it's called, so women are at higher risk of suicide.

    Dr. Jolene:
    It's really important for women to understand because you may be thinking, "Well, the combination pill of the estrogen and progestin is the problem, so I'll just start with the progestin-only," what I want you to walk away with is, Amanda, anything that you start, you know what is normal in your body and you know what's not normal and you deserve to be heard. If something doesn't work for you, that's what's true for you. Whether it was true for your mom, your sister, your best friend, doesn't matter. What's true for you is what's most important.

    Dr. Anna:
    I love this, Jolene, because it's just about the awareness of what your body is doing normally: What is normal for you? How do we make it better and when is something off-track? Like you said, make sure that you're heard because so many times can come in and say, "You know what? This doesn't feel right." You need to be heard. I think that's really true.

    Dr. Anna:
    Having that data, that information is good. I mean, cervical mucus is like another vital sign that tells us when our body is ovulating, we're doing well. Getting familiar with your body's natural cycle will help you connect the dots a lot, too, don't you think? Like of: How's my mood? How's my energy? How's my sex drive?

    Dr. Jolene:
    I take women through. I just basically, I have a whole sex-ed section in my book of this is a normal menstrual cycle, this is what it looks like, this is what's going on. What I find so often in my clinic is once women start to understand what is going on in their natural cycle, they can identify where there's issues and where there never were issues.

    Dr. Jolene:
    Sometimes women are like, "I'm fatigued before my period. I think that's a problem." "What does that look like?" "A couple of days before my period, I'm not as social. I can't get as much done at work. I just feel like I need to rest." It's like, "Well, that's not really a problem. You're about to shed your uterine lining. Are you not getting out of bed?" "No, I get out of bed. It's just I don't have the edge that a male counterpart might." I'm like, "Well, they're non-cyclical creatures."

    Dr. Jolene:
    The other thing is that you can also understand which hormones are at play with your acne. If you are having acne flares that are cyclical or headaches that are cyclical, you can start to dial that in. Yes, we [inaudible 00:25:49] every single day of your cycle. There are tests out there that that try to do that, but you can do that very inexpensive at home just by tracking all of that data.

    Dr. Anna:
    Yeah, no, that's really good. I want to touch on the importance of barrier protection, too, because whether we're...

    Dr. Jolene:
    "Well, because my daughter is here right now."

    Dr. Anna:
    Because my daughter is here right now, and we've like had the abstinence discussion, the barrier discussion, let's keep this going here. But the barrier, just because of autoimmunity, right? It's like we are exposed to antigens with semen and sperm and it's not just we worry about STD, something an antibiotic will heal or pregnancy or HIV, human immunodeficiency virus, I mean, we're worried about the viruses and what else we're being exposed to.

    Dr. Anna:
    As women, as vessels, we need to add on extra layers of protection and we have to really stand for that and the importance of that and that it can affect our health 10, 20, 30 years down the road.

    Dr. Jolene:
    Yeah, absolutely. You know what's interesting? In the research with birth control and HPV, they've speculated that being on the pill there might be something special about it that puts you at increased risk of contracting HPV when sexually active. Now, HPV, human papillomavirus, is the number one sexually transmitted infection. There a handful of strains that can lead to cervical cancer, which is why, and then the others that lead to warts. Okay, nobody wants any of that.

    Dr. Jolene:
    But in that is very interesting when you look at the research and one hypothesis is that it's actually changing the mucosal tissue and the cervix. Another is that birth control does alter your immune system function. Looking at these things as well, that's one of the most common sexually transmitted infections you're going to pick up, so everybody gets really worried about it.

    Dr. Jolene:
    Yet we don't see the conversation happening or the science moving forward of what role does birth control play in our ability to contract that virus, so at this point, we can't say, "Birth control causes you to catch HPV." We can't say that. We need more research on that. That's another reason why barrier methods are so important.

    Dr. Jolene:
    There's things like herpes. We think cold sores, now think cold sores on your vagina, nobody wants that because it's incredibly painful, it's really easy to spread. I'm freaking out Amanda right now. She's like, "What is this? What is this? Stop," but these are the kind of candid conversations that we need to be having with women as a whole.

    Dr. Jolene:
    I love that you mentioned abstinence because if you do choose to go to the abstinence route, that's 100% your choice, but it doesn't mean you shouldn't have all the information about what the other options are and what is possible out there. Sex doesn't have to be this big scary thing, but when you step into the unknown and you're not educated, it can feel scary.

    Dr. Anna:
    Well-said. Well-said, Jolene. Thank you. Amanda, what do you think about all this?

    Amanda Claire B:
    It's very good information and I'm very grateful. It's not spoken about. We are just told to take a pill or not have sex, so it's very good to hear more of the information and the long-term effects. Yeah, I had a list of questions, but you answered everything, so that was awesome.

    Dr. Jolene:
    Well, that's awesome. I will say, for women who are listening, there's a lot of talk about abstinence-only as if it's a matter of self-control. I know you're well-versed in how hormones override your brain, but just, I don't want anyone to feel like if they try the abstinence-only and they failed because they found themselves in a situation where their biology override, our hormones will override us, especially, I think, when we're younger. Before age 25, the brain's not fully developed. We're very susceptible to what hormones can do. I'm giggling in my head about my mood swing teenage self.

    Dr. Jolene:
    But in all of that, your biology, your actual physical chemicals that meet your brain can override this. If you were like, "This was the method I was going to use and it didn't work out," not to feel ashamed about that.

    Dr. Jolene:
    Same with if you, I've heard doctors say, "You failed the pill." Well, you didn't fail it. Your body was like, "That's not for me." That's something that we don't have to feel shame in this conversation and we don't have to feel ashamed of the choices we make. It's something that I really encourage women to make the best decision for you. Not the decision that anyone else thinks that you should make, but what's the best decision for you? If I could tell my younger self anything, that's definitely in the top 10.

    Dr. Anna:
    I think, Jolene, it stands into standing up for ourselves. It's advocating, is using our voice to say, "This is what I want, this is what I accept, this is what I don't want, this is what I don't accept," versus the going with the flow and being persuaded maybe into doing something we don't want to do, whether it's from our lover or it's from our doctor or it's from our peer pressure, whatever it is, standing into that state of, "This is right for me and I will accept this, not this." What do you recommend to help girls, especially navigating teens and peer pressure?

    Dr. Jolene:
    Well, one thing I will say is if you write things down... I think about this a lot, about how young women keep journals, right? They have their diary. When we grow up, we call it a journal. When we're little girls, we call it a diary.

    Dr. Anna:
    Yes, exactly.

    Dr. Jolene:
    That's actually really funny. I've never thought about that. But tracking your data and tracking what is true for you, if you track your data and you have that, you go to the doctor and the doctor's like, "No, you're misremembering," you can actually look. Now, these days we have iPhones and all kinds of technology to do this, but I'm still a paper-and-pen person. You can always look and say, "No, that's not true for me."

    Dr. Jolene:
    When it comes to being in situations with peer pressure, and that peer pressure is real, taking time to journal and reflect is really powerful, especially not making any decisions until you've taken some time to separate yourself.

    Dr. Jolene:
    I mean, I can still remember being on the bleachers in high school and my friends were all smoking and I didn't want to smoke. That peer pressure that happened and how much it was and then you know what I did? I finally was like, "I'm just going to pretend to smoke so they leave me alone," so I took a puff but didn't inhale and then they all made fun of me. It was actually way worse, then they made more fun of me.

    Dr. Jolene:
    But I still was like, "This doesn't feel right to me." I've definitely been there. But something of removing yourself from the situation and trying to take some time to get some clarity because all of that is just noise, it's just static, and you have to check-in.

    Dr. Jolene:
    One tool that I recommend and I have all my patients do is just asking, "Is this in affinity with me?" or is this in "alignment" with you? Whatever word jives with you, but using that as often as possible. You're going to open up the fridge and you want to eat something: "Is this in affinity with me?"

    Dr. Jolene:
    Is that because we've got to overthink food? No, it's about honing that tool of, "Is this for me? Is this really what I want?" It's like a muscle. These are neuronal pathways that you have to work at and you have to build so you can actually set up your brain to go down this pathway just by doing this little practice with like, be little neurotic about it at first and do it with everything.

    Dr. Jolene:
    Then what you'll find is you are in these situations and you just ask the question, "Is this true for me?" and your body will give you that message. Your body will say, "Shut it down. Get out of this situation." But it only works if you honor that. It only works if you honor the message.

    Dr. Jolene:
    This is back to my 14-year-old, what would I tell you? "Do not even try to fake smoking that cigarette just so that they'll leave you alone." Really, I was like, "I just want them to shut up. I'm a fake smoke this cigarette" Instead, it wasn't true for me.

    Dr. Jolene:
    That is something that I ended up shedding those friends. I didn't want to be friends with them anymore because I came to a place where, and I had older mentors who said wonderful things like, "Do you really want to be friends with people who are practicing knowingly unhealthy lifestyle practices and wanting to pressure you into it because it makes them feel better if you come with them but they could care less about your health?"

    Dr. Jolene:
    That was a big, the camera's like... "Yeah, what kind of friends am I keeping that they don't care about me?" They're teenagers at that time, so we can hold grace for teenagers.

    Dr. Anna:
    Yeah. I think that's exactly true. I like how you said, "What is true for me? What resonates truth? Is this health? Is this going to bring me more health? Is this good for me?" I like that: "What is true for me?" Because we start exercising that muscle, that intuitive muscle, that reading the energy of something, too, whether we're grocery shopping, "What's better for me? What's not?" Right? In our life and in our relationships, that inner voice, trusting that intuition, exercising that really is a powerful tool.

    Dr. Jolene:
    I will say, Amanda, observe women over 40 because when I started my practice, the gifts of wisdom that women over 40, there is something magical about 40 where, just, they batten down the hatches with the boundaries. I've always said, "In my 30s, I aspire to be like [inaudible 00:35:10] who was her best and who recognized what was serving her, what wasn't and no apologies for loving herself fiercely."

    Dr. Jolene:
    That is something my patients absolutely taught me. The more you exert your boundaries, the stronger they become, the stronger your resolve becomes. But also, it gives permission to other women to also have those boundaries. It not only serves us, but it serves our community in a big way, and I mean, with men as well, but we're in the lady parts business over here.

    Dr. Jolene:
    In this, how can a woman ever have a boundary if she's never given permission by society to have a boundary? One way that we can do that that serves us as well is to have our own boundaries and not apologize for taking what we need and leaving what we don't.

    Dr. Anna:
    Yes, that's well-said. Never apologize for having your own boundaries and for just fiercely standing up for yourself and protecting yourself and always. I hear you on that. It's definitely something that I've transitioned to over the years. It is liberating. It's liberating when you know your no is no and your yes is yes and you know what's good for you and you're able to better make those decisions. Man, I wish that was all the time, though.

    Dr. Jolene:
    Yeah, right?

    Dr. Anna:
    Maybe when I'm over 60.

    Dr. Jolene:
    Yeah, we like to learn the hard way. I mean, that's the thing. Whenever I'll hear from patients or women who've read my book and they write to me and they say, "You're just so smart," they say all these wonderful things that I'm really grateful for, but I always have to reflect to them that it's like, no, it's just that I did dumb for a really long time. I'm a little further on the road ahead. I fell in all the potholes and now I can look back and say, "Don't step there. It's really bad. I've been there."

    Dr. Jolene:
    That's it. That's really what it is, is more life, more experience, wisdom that we can pass on, but recognizing that we'll never be done learning.

    Dr. Anna:
    Excellent. Well-said. Amanda, any questions before we let you go?

    Amanda Claire B:
    I think everything was answered. Thank you so much. It was a pleasure being a part of this.

    Dr. Anna:
    Oh, thanks for joining us.

    Dr. Jolene:
    Yeah. Well, I appreciate you being here, Amanda, and being a part of the conversation. I think it's really important.

    Dr. Anna:
    She's going to be a functional medicine health coach, so learning from the best right here. Dr. Jolene Brighten, tell our viewers where they get more of you.

    Dr. Jolene:
    Yeah, you can find me at drbrighten.com. I spell my last name a little tricky, it's D-R-B-R-I-G-H-T-E-N dot com. I'm also on Instagram, YouTube as well, because I know we all learn differently.

    Dr. Jolene:
    If you pick up Beyond the Pill, I want to give you some gifts to really say thank you for being part of the movement to change women's medicine for the better and you can find those at beyondthepillbook.com, which we've got videos, we've got recipes, we've got all kinds of things to support you on your journey.

    Dr. Anna:
    Excellent. I want to thank all our viewers for being with us today and listeners and thank you guys for listening to this podcast. I know this is one that you have got to share, share with your friends, families, daughters, their friends, and spread the word about this.

    Dr. Anna:
    Again, just being educated and understanding what is true for you and being really clear, what are the risks and benefits of what we're being offered and weigh that individually. No judgment, no shame. Dr. Brighten was really clear on that. That is really, I think, so important.

    Dr. Anna:
    We make the best decision we can make for ourselves with the information that we are given at that time, right? Listen to that inner voice so that we are acting with our truth and start exercising that muscle even more on a regular basis.

    Dr. Anna:
    I want to thank all of you for being here. Please, I love your reviews and your rating of this podcast, so please share those with me and keep posting and sharing. Again, thank you, Dr. Brighten, for being with us today.

    Dr. Anna Cabeca

    Dr. Anna Cabeca

    Dr. Anna is a Triple Board Certified OB/GYN, Anti-Aging Medicine expert, and author of the best selling book, The Hormone Fix.

    Dr. Anna helps women heal the 9 most dreadful symptoms of menopause with natural, safe solutions. Follow her for content on hormonal imbalances, vaginal dryness, menopause (and more) that are medically backed, and created to empower women — not just treat them.