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    112: How To Take Control Of Your Reproductive Health w/ Lisa Hendrickson-Jack

    Your menstrual cycle gives you more indication into your body’s overall health than just whether you have a regular period or not. As  Lisa Hendrickson-Jack shares, by charting your menstrual cycle, you can not only track your fertility, you can also uncover other health problems you might not be aware of. 

     Or listen & subscribe for free on Apple Podcasts | Android

    Lisa is a holistic reproductive health practitioner, the author ofThe Fifth Vital Sign, blogger and podcast host at Fertility Friday, and has been using fertility awareness for 20 years as her primary birth control. On this podcast, Lisa explains what aspects of your menstrual cycle you should notice and track, from the color of your period blood to the length of your bleed to how your cervical mucus changes throughout your cycle.

    Did you know that having pain during menstruation is actually a sign that your body isn’t at optimal health? We’re taught that women experiencing cramps is normal during our pre-menstrual time, but when is pain ever something normal? Pain is a sign that something is wrong in our body.

    Lisa explains how over our menstrual years, our cycle will change. When we first get our period, our cycles might be longer than what’s considered normal (24-35 days). But as long as your cycle falls inside these normal parameters as an adult, you probably don’t have anything to worry about, at least on this front.

    Ovulating regularly, and, in turn, having a regular period, is important for the entire health of your body. Regular ovulation helps regulate your hormone levels, especially progesterone, as this hormone is incredibly important for our overall health. This is one of the reasons why hormonal birth control can negatively impact our health - the pill essentially takes us into false menopause, disrupting the natural rhythm of our hormones.

    Lisa shares some more natural birth control methods, including fertility awareness and non-hormonal birth control. She explains exactly how long we’re fertile for during our cycle (10 days!) and why you should take extra precautions during this time to prevent pregnancy.

    Do you have a regular menstrual cycle? Have you ever charted your cycle changes? Do you experience painful cramping at the start of your period?


    In This Episode:

    • How charting your menstrual cycle can indicate other health problems
    • What aspects of your menstrual cycle you should notice
    • How much pain is normal during your menstrual cycle
    • How your menstrual cycle will change as you age
    • What role ovulation has for the health of your entire body
    • How hormonal birth control negatively affects your health
    • What some natural birth control methods are
    • How long are you fertile for in your cycle

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

    Quotes:

    “As women, we have this amazing gift to be able to track our health just by paying attention to our cycles.” (6:05)

    “Having healthy menstrual cycles, regular ovulatory cycles, ovulating, and producing progesterone is really important for us to achieve optimal health.” (19:54)

    “If you were to draw the blood of 6,000 women who are on the pill, they’re all going to have up to 60% lower testosterone than a woman who’s not on the pill.” (26:04)



    Links

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    Find Lisa Hendrickson-Jack Online

    Find Lisa Hendrickson-Jack on  Instagram |Facebook |Twitter

     

    Transcript

    Lisa:
    The most important part of this conversation comes down to informed consent. Many women don't even think of the pill as a medication. So when their doctor says like, what medications are you on? Many women don't even say the pill because they don't even think of it as a medicine. They don't think of it as a hormone. You know, you could call it hormone replacement therapy, you could call it something else, but we don't even think of it that way. And so I think that it's important, as women, for us to know what the side effects are.

    Dr. Anna:
    Hello everyone and welcome to Couch Talk. This is Dr. Anna Cabeca and I am talking about periods, fertility, your menstrual cycle, and how that can affect you and what that can tell you about yourself. So whether you're desiring fertility, whether you're curious about your menstruation or whether you're in perimenopause or menopause, I know you're going to love this episode. My guest today is Lisa Hendrickson-Jack and she wrote this amazing book called The Fifth Vital Sign. And she comes with a huge amount of experience in being a fertility master, let's say. She is a fertility awareness educator, and holistic reproductive health practitioner and has been teaching women to chart their menstrual cycles for what it can tell them about natural birth control, conception, monitoring their overall health. She is incredibly intelligent and energetic and I know you will enjoy this episode. So I'm going to introduce you to Lisa Hendrickson-Jack.

    Dr. Anna:
    I know again before we get started that menstrual issues are a conundrum for many of us. So please share your questions that you have below and I can address those in a future episode and hopefully we've addressed those in this episode. So check this out.

    Dr. Anna:
    Well, hello Lisa. It's great to have you here on my Couch Talk. You know, I always tell my listeners this is a place for intimate conversation, shamelessly and guiltlessly and you never know where we're going to go. Right.

    Lisa:
    Well, thank you for having me, Dr. Anna.

    Dr. Anna:
    Well, it is a pleasure. Tell us, our audience, a little bit about your background and what brought you to this book. And I have it right here, The Fifth Vital Sign. And when I saw the title, I mean that totally struck a chord with me, because how often we neglect the signals of our own body, and it's certainly one that we can monitor on a regular basis that tells us so much.

    Dr. Anna:
    So I'm happy. I'm just thrilled to introduce The Fifth Vital Sign to my audience. And this, I have to really give you compliments on this and lots of kudos. Having written my book myself, and just seeing how much detail you put into it, the thousands of, I mean a tremendous number of citations. It's tremendous, and the science you've backed it with but made it really understandable and comprehensive, whether we're seeking fertility or not, to really be able to hone into what our body's telling us and to enhance it.

    Lisa:
    Thank you so much for that. That's a huge compliment. And of course, that was my intention with the book. I mean it's something I've been teaching for nearly 20 years, so I am comfortable talking about it and I have a lot of practice breaking down the complex science in to just a regular way that you would explain to somebody. So I really appreciate you saying that. And I mean, in terms of my background and what brought me to this point here, I discovered fertility awareness when I was really young.

    Lisa:
    I was just out of high school. I joke that it was my post-high school feminist phase. I was just at university. We had an amazing women's center on our campus and we would often have these really interesting speakers that would come and just talk about different feminist topics. So somewhere in there I went to a talk, a woman was reading some excerpts from her book, and at some point she just shared that as a woman you're not fertile every day of your cycle, that there's only a small window of fertility that you can identify by paying attention to your cervical position, and your cervical mucus and your basal body temperature.

    Lisa:
    My first introduction into fertility awareness was just like, wow, I could use this for birth control. I don't need to rely on hormones and how empowering I can actually monitor my own body signs and figure out what's going on. And of course, it was in direct opposition to what I had been taught in my junior high sex-ed class. Because I had been taught that I could get pregnant every single day of my cycle. There were no safe days, and it just left me feeling pretty terrified that I would get pregnant at any single point of having sex. But very early on in my own journey, I discovered that you know, the menstrual cycle is not just about getting pregnant. So you know, I'm tracking my cycles, I'm really excited and I was in this kind of phase, I was still quite young and my cycles were not falling into the normal parameters.

    Lisa:
    So on average, my cycles were say 38 days, 40 days. And I remember thinking like, Oh well, you know, it was just a myth that the cycle has to be 28 days. So my cycle is just long kind of like, hi, I'm Lisa and I have long cycles. But fortunately for me, I learned to chart in an environment where the women who I was learning with had been trained in charting. And so that was where I was first introduced to the idea that the menstrual cycle is a vital sign. So my charting instructor took a look at my charts and she said, "Yeah, Lisa, you know, your cycles are too long, your temperatures are too low, I think you need to just go get your thyroid screened." I'm like the early twenties and it turns out that I did have hyperthyroid and it was very, very subtle.

    Lisa:
    It was caught very early. So I didn't have any outward signs. I didn't, there was nothing that was necessarily out of whack yet. But because of charting, I was able to catch it based on just the subtle signs that I was seeing in my chart. So very early on, and I started charting and then I took a training program and started teaching women, and I've been immersed in this field in one way or another for nearly 20 years now. But it was those early experiences where it really helped me to get it, really early on, that the menstrual cycle, if someone can look at my chart and suggest I might have a certain issue or just... That is mind-blowing. But it's also when you learn about the menstrual cycle, it makes perfect sense. So as women, we have this amazing gift to be able to track our health just by paying attention to our cycles.

    Dr. Anna:
    I want to honor you for like that awareness and bringing that awareness to your work and your passion. But it's so true. Menstrual irregularity can be an early symptom of thyroid disease, hormone imbalance, estrogen, hormone disruptors, toxins, mold, candida, I mean really so much the color, the consistency, the duration, the cycle length, all of those things are powerful. So I want, would love for you to teach our audience about what their menstrual cycle may be telling them about themselves, whether they're having a cycle now or even to think back to when we did have a period. Right.

    Dr. Anna:
    And I'm going to have my daughters listen into this too because it's so important because it's nice when they hear it from someone else. But I'll never forget the first time listening to, I was already a trained gynecologist-obstetrician and I was in a conversation with a Chinese medicine practitioner and we were discussing menses, and certainly, we were talking about my menses and clients. And the question was, well, what's the color of red? You know, how dark, how light, is it clotting? Is it not clotting? Is it, you know, I mean that whole concept of bright versus dark blood. I mean to a very in-depth degree was like, Oh wait, let me look into this. How does this make sense and exactly what is it telling me? But I was already trained OBGYN when I figured that one out.

    Lisa:
    Everything you said is so important. And I, when I talk about the menstrual cycle as a vital sign, what tends to happen is of course immediately we think it's just the period. So we can talk about the period. As you know in Chinese medicine they focus on the period as well. So we can talk about the period for the whole time that we're together today. But we also want to expand upon that and talk about what happens throughout the course of the whole cycle. So you know, when I talk about the menstrual cycle with regular ovulation as a vital sign, sometimes it's helpful to think about what are the commonly accepted vital signs that we are all aware of. And especially you as an OB. So you know, the most commonly accepted vital signs, heart rate, body temperature, respiratory rate, and blood pressure.

    Lisa:
    We all have a general sense that when you go to your doctor if they're taking your vitals, we have an established set of what is normal. So we have a range. And then if, say if your blood pressure is too high, not only does that inform the doctor that something's going on, but it also provides a bit of a roadmap. So if it's too high, it could be this, it could be that, you know, there's a few things that could be specifically related. And so with the menstrual cycle, it's the same way. If you were working with someone who is trained in this understanding, then they can look at your menstrual cycle and not only tell that there's something going on, but they might have a specific idea of, okay, it could be related to these couple of factors. And so to take your audience through the menstrual cycle, you know, the first day of the menstrual cycle is the first day of your menses, the first day of your true flow.

    Lisa:
    So some women may experience some spotting before their period actually starts. So we're actually talking about the first day that the flow starts, and you have to do something to catch your flow. And so in a menstrual cycle, you'd have your period. And a healthy cycle it would last anywhere from about three to seven days, and then after your period is done. And I always like to say like the period should have a beginning, a middle and an end and then it should be over. So it shouldn't just go on and on and on. The bleeding and your cycle should be during your period only, ideally. And as you mentioned, we can look at the color and if the color is really dark, like black, really clotty I think as women we generally have a sense of, this looks kind of awkward, you know, I don't think this is normal, but we often don't talk about it.

    Lisa:
    So, it should be a variant of red. It can vary. Sometimes it is more like red wine or like a bright red, but if it is really clotty, really dark in color, we'd want to look at that because that can indicate that it's more oxidized. And it could even be an indication of what's happening hormonally. Because your period is a result of your estrogen and your pre-ovulatory phase, building up the lining and then after ovulation your progesterone helping the uterine lining to mature, and prepare for a fertilized egg in the second half. The one thing I like to say about periods as well is that although it's very, very common for women to experience moderate to severe pain with menstruation, that's not what we would consider being optimal or normal because outside of the uterus, pain is typically considered to be a problem.

    Lisa:
    It seems like when it's a menstrual pain, society says it's totally fine for women to be in pain. But outside of that example, I can't really think of another example where we would actually look at pain as being completely normal. So I think, pain is a sign of inflammation and in some cases, it's an early indication of a more serious condition like endometriosis or... So we should be actually paying attention to if it's really painful on a regular basis. But just moving away from the periods. So after your period stops, you would expect to have a few days before you start to see your cervical fluid. So for women who aren't familiar with their cervical fluid, it can look like clear, stretchy, raw egg whites. So you know, if you stretch it between your fingers, that'll form a thread. It can look like creamy white hand lotion kind of between your fingers.

    Lisa:
    And for some women, they may not see a lot of it. They may not have an abundance of mucus, but perhaps at some point during their cycle they'll go to the bathroom and notice that it either feels really slippery when they're wiping, or they might feel like, okay, I've got to wipe a couple of times because it feels like there's something there. So any combination of those three is typically how the cervical mucus will present as you approach ovulation. So, in a healthy cycle, we'd expect to see about two to seven days. Meaning you should see some, so you shouldn't see any, but you shouldn't see it every single day. And then it should lead up to ovulation. So then you would ovulate and a healthy cycle. And then after ovulation, you would expect your period to come about 12 to 14 days later.

    Lisa:
    One thing I didn't mention is that a healthy cycle ranges. So the myth is that the cycle always has to be 28 days, but a healthy cycle can range anywhere from about 24 to 35 days. 28 or 29 days is average. And that also means that ovulation doesn't always happen on day 14. So if we have that range of 24 to 35 days, ovulation could happen as early as day 10 or even as late as day 22 or 23 in a cycle that falls within that range. So there's a lot of information that I just threw at you, but I think it's helpful to break it down. So your question about like how would we know if there's something wrong, what would we look for? We would look for signs that fall outside of those normal parameters then.

    Dr. Anna:
    Mm-hmm (affirmative). Yeah, absolutely. And also just knowing what's right for you, like for you, recognizing that you're what Lisa with long cycles, right? You didn't know any different so you didn't know it was abnormal, right? Because we get used to abnormal, we get used to pain, we get used to power through, and we think, well this is my normal but not necessarily. So some indicators of what this is telling us or well what can I do to make this even better, or healthier periods. And so describing a healthy period is certainly beneficial. And again, duration, cycle length, we know various 22 to 42 days, but sometimes there's a hormonal reason for those variations too.

    Lisa:
    Well, and I think it's also helpful to mention that it fluctuates throughout reproductive life. So, I mean there, there's a few studies that are really interesting that, there's one study, in particular, I cited in the book, but this [Alan Treller 00:13:41] and his colleagues, and it was done in the early, I think it was done in either the thirties or the forties so I find that to be a particularly interesting... Or maybe it was the forties and the fifties, but it was done before the pill was a thing. So there's a study where they're taking, I think it was over 25,000 women and it was over a quarter of a million cycles. And they looked at the cycles throughout a woman's reproductive life. And so, I find it interesting because hormonal birth control does change. You know, you have a period of time where you're not cycling normally.

    Lisa:
    And so it kind of... And then there's the transition phase once you come off of it. So it does change, what would happen throughout your reproductive life. And in this study, I mean, when you first start menstruating, so you know, whenever that is, it can happen when you're, you know, 12, 13, 14 or whatever the case says. But when you first start menstruating, what they found was that during those first about three to five years, the menstrual cycle has... So on average then the cycles are longer. So instead of being a range from say 24 to 35 days, it would be more like 21 to 45, in those first few years. So it takes a few years for our cycles to mature and normalize. And they identified a period that they called, I think the middle life period, but they... So once your cycles have matured, then they do stay fairly consistent.

    Lisa:
    So a woman of mid reproductive age from whatever it is, like say age 18 to 22, age 30, 35 what they do find is that that's the most stable period. You know, assuming healthy and not talking about hormonal birth control, and stuff like that. But then when you approach menopause, when you're in that 10 years prior to menopause, that's when we start to see fluctuations again. Some women might find that they start ovulating earlier, and they have shorter cycles. And then as we kind of inched towards the latter years before we stop menstruating altogether, then often we're seeing longer and longer periods between cycles. So, I think, what you mentioned as well, understanding what is normal, but also it changes as we are different ages. So kind of having a general sense. As women, it would be so nice if it was just commonplace for us to be taught about how our cycles could change over time and what to expect as we approach menopause.

    Lisa:
    And that's something, the entire conversation is something that we're not taught, but particularly those how it could differ as we age as well isn't taught.

    Dr. Anna:
    And why important it is to maintain ovulation as long as possible. So let's talk about that, Lisa.

    Lisa:
    Well, I mean ovulation, one of the things that I talk about, kind of like, it's become the headline for the book, which is menstruation isn't just about having babies. What's really interesting in our culture is that we think the menstrual cycle only matters when we're trying to have babies. And then outside of that period of time in our lives when we're trying to procreate, it's kind of like we don't think it matters. So I think the first thing to understand is that ovulation is how we make our main reproductive hormones. It's how, so as we approach ovulation, that's when we're producing our natural estrogens.

    Lisa:
    And then after ovulation is when we're producing our natural progesterone. And it's really important to recognize that it's not that we only have receptors for estrogen and progesterone in our reproductive tract. We have receptors for these hormones throughout our entire bodies. In our brain, in our bones, and our breasts, and our tissues. And you know, there's a few specific examples that I give in the book for how your menstrual cycle is related to overall health. For example, in the instance of HA hypothalamic amenorrhea. So that's a situation where a woman stops menstruating altogether. So she's in, you know, women of reproductive age and it's characterized by stress, over-exercise, undernutrition. And what happens when a woman stops menstruating is that she begins to rapidly lose bone mass. So it turns out that our bone development as we are, you know, from teenagers to grown women, we eventually reach our peak bone mass.

    Lisa:
    But our bone development is related to our hormone production. It's related to our estrogen and progesterone that we produce throughout the menstrual cycle. So when we stop menstruating, we start rapidly losing bone mass and women who fall into that category have a greater lifetime risk of developing osteoporosis. So it's interesting because when you look at it that way, it would mean that having healthy regular ovulatory cycles is protective, for certain health issues that we wouldn't necessarily even think because it's not related to having babies. And another example is in the case of polycystic ovary syndrome, where you have it characterized by insulin resistance, glucose intolerance, high androgen production. But the way it looks in the menstrual cycle often is that women are having delayed ovulation. So their cycles are really long. So we have cycles that are typically longer than 35 days or we have irregular cycles, which would mean that there's more than eight days between, like in the cycle length.

    Lisa:
    So maybe it's 35 days, one cycle, 45 days, another 28 days, and then it goes back up to 52 days. What's interesting is that when you look at what the research has to say about it, and if you think of it from a hormonal standpoint, so if your cycle is 52 days, it means that you're having a really long phase where you're producing estrogen, and then a shorter phase where you're producing progesterone. So you're overexposed to estrogen in many ways, and it's not balancing out. What we know is that estrogen and progesterone have different effects on the body. Estrogen is proliferative. It causes things to grow. That's why after we have our periods, we have estrogen that helps our uterine lining to grow and develop, but progesterone has a different effect. It causes the cells to mature, it directs the cells, it tells them what to do, and progesterone counters some of those proliferative effects of estrogen.

    Lisa:
    So then when you have your menstrual cycle, it's off. It's outside of the normal parameters. You're having all of these days of estrogen, and you're not having it being balanced out with progesterone, you're at a greater risk for certain types of cancer. When you look at the research, I mean there's a bit of debate as to the role of your menstrual cycle in breast cancer, but there is research to show that progesterone has a protective effect. And so if you have healthy menstrual cycles that are falling into the normal parameters, it can mitigate the risk of certain cancers, endometrial cancer, breast cancer. And so again, that's outside of our ability to reproduce, but very important as women for us to know that having healthy menstrual cycles, regular ovulatory cycles, ovulating, producing our progesterone, is really important for us to achieve optimal health.

    Dr. Anna:
    Yeah, absolutely. And then with hormonal birth controls, I want to talk about the birth control pill for a minute, because it's certainly revealing a lot of problems. The use of birth control pills, infecting hormonal health and reproductive health, breast health, immune health, all of these things. We're looking at the consequences of that right now. And you were mentioning, you know we're looking at estrogen, progesterone, not just being associated with the uterus, but also with all over our bodies, right? Like everywhere. Our brain has progesterone receptors and estrogen receptors, but it's not just not being produced by the ovaries. It's also testosterone and some DHEA as well.

    Dr. Anna:
    And these are being suppressed also by birth control pills, right? Healthy testosterone, healthy libido, healthy testosterone and DHEA, you know, good bones, right? Good brain, good ability to rebuild, and have strength, and cognition, and sharpness, and memory. All of those are critically important. So let's talk about what the research is now revealing with hormonal contraceptives. They saw this as such an issue and it's a dilemma. And for everyone listening, the biggest thing I don't want people to do is to be on birth control pills to prevent the symptoms of menopause, right? We can do something different and I'm a big fan of the Paragard IUD. You still need birth control, right? The pair... Non-hormonal IUD, I mean that's something to consider, but let's talk about this.

    Lisa:
    It's a huge topic and in the book, I have two chapters related to the birth control pill and other types of hormonal birth control, but I focus on the combined oral contraceptive pill. But, I think that in order for us to understand how the pill could affect so many different areas of our lives, when you look at the side effects associated with birth control, depression, low libido, painful sex, nutrient depletion, and increased risk of liver cancer, cervical cancer, there's a lot of different side effects that you have to understand. First of all, that your menstrual cycles, the vital sign, that ovulation plays a crucial role in overall health, that our main ovarian hormones, estrogen, and progesterone play a role in our body beyond reproduction. I think, when you can understand that, then you can appreciate how the pill could have these effects. So I think it's helpful to know how the pill works.

    Lisa:
    So all hormonal birth control doesn't work in the exact same way. But there's three main things that all hormonal birth control methods do to some extent. So one is suppressing ovulation. So when you mentioned suppressing the production of estrogen and progesterone and testosterone, the birth control pill, and especially combined contraceptives that have synthetic versions of estrogen and progestin, and it's important to point out that they're synthetic versions, they're not the same as the hormones that we produce. Because often as women we're told, Oh, the pill has estrogen and progesterone, and it makes us think that we're having the same hormones that we naturally produce, but these hormones are made in a lab. They're not even found in nature, because you can't sell things if you don't patent them. Right. You have to make them different enough so that you can sell them. So when you're taking hormonal birth control, first and foremost, one of the main reasons that it works is because it suppresses ovulation.

    Lisa:
    Often women are told these white lies about the pill. Oh, it's tricking your body into thinking that you're pregnant. Oh, it's regulating your cycle. But what it's doing, is it's suppressing ovulation so you're not ovulating anymore. That means you're not producing sufficient quantities of your natural estrogen, progesterone, and testosterone. If you were to compare the hormone, like the natural hormone levels of a woman who is on birth control, it would more closely resemble the hormonal patterns of a woman in menopause. Because when you're in menopause, you are not ovulating and you may still be some degree of the hormone, but it's a lot less than what you would be when you're cycling. And so, obviously, it's not good for business to call it like, let's put you in temporary early chemical menopause so that you can prevent pregnancy.

    Lisa:
    But I think it's helpful to understand that one of the reasons why the pill causes problems for some women who have, who experienced negative side effects is because it is suppressing your natural hormone production. That's one mode, one reason why it works or one of the main functions, the pill also thins the uterine lining to prevent implantation. If an egg were to poke its way through somehow and also fills the cervix with a thick mucus plug to prevent the sperm from being able to access. So, I think first and foremost we have to understand how it works, and obviously it needs to do those things. That's why it's effective, right? So I think that is helpful. So when it comes to testosterone and the negative impacts that can have on our sexual function, our libido, even our moods, contributing to the chance of feeling anxious or depressed. When women are on the pill, often we think about side effects, and side effects being some women experience side effects, and some women don't.

    Lisa:
    When you look at how the pill works, it's important to know that the pill suppresses ovulation, right? And all women who are on it have a dramatic decrease in their natural testosterone production. And they also have a dramatic increase in their sex hormone-binding globulin SHBG levels. So SHBG binds to your free testosterone, kind of like iron, like iron filings and a magnet and takes it out of circulation. So some women may experience lower libido, some women may experience painful sex because our vulva or tissues are very sensitive to testosterone.

    Lisa:
    And when you have that dramatic decrease in testosterone, it can thin the vaginal tissues. There's research that suggests that it shrinks the clitoris, thins the vaginal tissues, and makes women more susceptible to painful sex, particularly if they start using the pill at a younger age. So women who start using it younger are at a greater risk for those types of effects. So, I think it doesn't present the same way in all women, but it's helpful to understand that when you take... If you were to draw the blood of 6,000 women who are on the pill, they're all going to have up to 60% lower testosterone than a woman who's not on the pill. So I'll just pause there. Because there's more to say.

    Dr. Anna:
    That's huge, right. No, that's huge. And we look at that and we think, of course, it does, right? Of course, it would. Right? Of course. You know, if we think of the natural functions of testosterone, DHEA, estrogen, progesterone, the receptors in the vaginal and vulvar tissues as well. I mean we have plenty of receptor sites there. So why wouldn't it cause clitoral atrophy? Why wouldn't it cause thinning, and why are we surprised when we're having really huge numbers of women, younger and younger, that are having these problems, dryness, pain, discomfort, and incontinence. I mean the list goes on, we're affecting our body's natural rhythm. So what do you suggest Lisa? Like what's the solution here?

    Dr. Anna:
    Like, let's talk about it. Because you know, I'm a big proponent of natural hormones. The other thing to say about the pill, I mean we're giving estrogen and progestin and artificial progesterone, not at a biogenical. So that's also creating negative cardiovascular impact. Negative vascular impact can affect our breast, heart, bones, muscles negatively, right? And sometimes it's a necessary evil when everything else has failed. But it definitely should not be used as a first-line. Or if we are using it for a very short duration, as safely as possible with supplementation, with drug holidays and things like that that we can do. So, it's really important to bring this up and to bring this to awareness because it's not that easy. We can't bandaid the issue any longer.

    Lisa:
    Well, and with the pill it's, it's always a delicate conversation as I'm sure you appreciate it because I can come across as very anti-pill. I wouldn't want the audience to think that my stance is that no one should ever use the pill. The reason that I shared this information, and I think it's important to share the science, first of all, you know, when I was writing the pill chapters, there was no shortage of research. There was plenty of research. So if you have the question of like, why do some women experience painful sex? Or why is it that some women experience depression and anxiety? The research is there and there's a lot of specific ways that the pill interferes with nutrient absorption and hormone production, that it's very clear why it would be associated with these effects. I think that the most important part of this conversation comes down to informed consent.

    Lisa:
    Many women don't even think of the pill as a medication. So when their doctor says like, what medications are you on? Many women don't even say the pill, because they don't even think of it as a medicine. They don't think of it as a hormone. You know, you can call it hormone replacement therapy, you could call it something else. But we don't even think of it that way. And so, I think that it's important, as women, for us to know what the side effects are. Not because no one should ever use it, because I think women fall into three categories. You know, if you know all these side effects then some women are going to say, that sounds like it's not for me.

    Lisa:
    Some women are going to say, you know what, thank you, I'm so glad I know about the side effects. I'm going to take it. But then if I experience painful sex or if I experience depression or low libido or you know, if I start to have panic attacks, if I start to have recurrent yeast infections, then at least I know. Like, someone told me, you know the pill could be related to that. So then you can at least know, you could try to switch to a different one or you could go on something different for a while. I always talk about this when I talk about the pill because I would want to be very clear that this is about impact. The solutions, you know, what do you do when, especially because we know that some women just can't use the pill. So there are some women like they go on it and they have immediate negative reactions, their moods change so much and they just can't be on it.

    Lisa:
    So you mentioned the copper IUD. So, I mean all types of birth control have their own risks and side effects. And again, it's about informed consent. So you know, for many women the copper IUD is a fantastic option. For some women, it might contribute to heavier bleeding, or some additional cramping, and things like that. So they might not be able to use it. But I mean looking for non-hormonal options that work for you it's... With the copper IUD, some of the benefits of that, for example, are that you can continue cycling. Most women who are using the copper IUD continue ovulating and continue menstruating. So the copper IUD is localized as causing some degree of local inflammation. It's preventing, you know, it's slightly spermicidal and there's reasons why it works and why it prevents pregnancy in most cases.

    Lisa:
    But at the same time, you're still... Like you can still keep ovulating, you can still experience your natural hormones, and you can still have your menstrual cycle. So, of course, for me, I teach fertility readiness. I'm a certified fertility awareness instructor. So I mean first and foremost, fertility awareness. We spoke about it a little bit, but it's having that awareness of your cycle, learning. If you're using it for birth control, then we're taking it to another level.

    Lisa:
    You're learning about your three main fertile signs, cervical mucus, cervical position, basal body temperature. So, you'd be checking for your cervical mucus on a day to day basis. You would be checking your temperature when you get up in the morning. Cervical position is an optional sign, so some women would also be checking internally, checking their cervix each day, and with those three signs you can identify the short window of your cycle, where you're fertile, and then you have to modify your behavior. So you have to organize how you're going to have sex, or if you're going to have sex during your fertile window. So either using barrier methods, abstaining from sex or engaging in alternative sex that doesn't involve penis and vagina intercourse. You're basically organizing your behavior during the time of your cycle where you're fertile.

    Dr. Anna:
    I'd stop there a second because I want to just talk about the duration of fertility, right? Like the total duration of our fertility during an average menstrual cycle is somewhere between six to nine days, what is it?

    Lisa:
    Well, from a scientific perspective, there are six days of your cycle where you are fertile, where pregnancy can result. So from the scientific perspective, the reason that we say that is because when you are approaching ovulation, and you're producing estrogen, and you're producing your cervical fluid that we talked about, your cervical fluid has been shown... It can keeps from alive for up to five days. So then when you have sex, when you have your cervical fluid, you could have sex on Monday, you could ovulate on Friday, and then you can get pregnant on Friday because you had sex on Monday because the sperm is still alive. And then ovulation only happens on one day of the cycle. So we have six days. When you're practicing a fertility awareness-based method, then we do have to add additional days around that as a buffer period, so that the method works. So then you know, on average in a typical cycle there'd be at least seven to nine, possibly even 10 days that you would have to consider fertile in your menstrual cycle.

    Dr. Anna:
    Yeah, no, that's perfect. And that helps clear it up, you know, because I think that's where we're like, ah, [inaudible 00:33:06] I was doing natural family planning and surprise, it gets a little tougher in the perimenopause, and we're not so sure when our, you know, when we're ovulating, but these signs can really help. So I think that makes a difference. All right, Lisa, what do you want to leave our listeners with today? And I know you have a three video series that's really great on fertility, so share about that and how our listeners can catch up with you.

    Lisa:
    Well, thank you for that. So for the listeners who are intrigued and want to learn more about fertility, I do have a free three-part video series that takes you through these three main fertile signs. So your mucus, your temperature, and your cervical position and you can grab that at fertility Friday dot com slash fam one Oh one of course. The book is The Fifth Vital Sign, lots and lots of information about fertility awareness, and information about why we should be looking at the menstrual cycle as a vital sign. And also just some of the very specific connections between the menstrual cycle and overall health that we're not typically taught of. So that's available on Amazon in paperback, ebook, and audiobook formats. And I've been podcasting for about five years now, so over 250 episodes related to fertility and fertility awareness over at the fertility Friday podcast. So thank you so much for that opportunity, Dr. Anna.

    Dr. Anna:
    Thank you for joining us. Tell us, leave our listeners with one thing they can do on a daily basis to enhance their fertility.

    Lisa:
    Ooh, this might feel very anti-climatic, but to be honest with you, the very first thing that came to my mind was sleep. So if I can leave you with one thing that you can do, and because I monitor cycles, I could tell you that it really does make a big difference. Get to bed early, sleep in the dark. So in your bedroom, if you don't have blackout lines, figure it out so that you can make your room completely dark. And that has been shown to boost progesterone levels and it can really improve your overall cycle. So if that's the one thing I can leave you with, that's what I'm going to suggest.

    Dr. Anna:
    I think that we can never talk about sleep enough, you know, they say it's just like sex. Everyone's talking about it and not getting enough of it. So we got to do that. So, Lisa, I want to thank you and honor you for your time today, and I definitely love The Fifth Vital Sign. And also the intro, the forward was by another dear colleague of mine, Dr. Lara Briden, who I highly admire. She wrote The Period Repair Manual, another great resource. So I want to encourage our listeners to comment below, to share a little bit of their stories, or their struggles, and to check out your resources as well. Because the more we understand about what's happening, even if we're in the perimenopause menopause, like, what is it, you know, how can we help those around us understand it, and maybe helps bring to light why we may have struggled at some stage of our life as well.

    Dr. Anna:
    But the longer we can maintain healthy ovulation, the better that is. And it takes a very integrated approach. And I encourage all of you to do that and thanking our guest again, Lisa, for being on our show today, and thanking all of you, my listeners, I have been reading your praise and I appreciate all those reviews. I read every single one of them, and I want to encourage you, thank you. Share this episode with your friends, and if you haven't left a review yet, Oh my gosh, please leave a review. I love hearing from you, and also what you want to hear next. So I will see you next week on Couch Talk. Thank you all.

    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.