Transcript for March 12, 2015
Topics: (See the video page for the Q&A)
- Spotting or breakthrough bleeding
- DHEA— high in PCOS and low in adrenal fatigue
- Teenagers and irregular periods
- Do irregular periods matter? Is it detrimental to health?
- Iodine for fibroids
- Healthy consistency of a period
- What do clots mean?
- How to treat premenstrual migraines?
- How to treat complete lack of periods?
- How soon after coming off the Pill can you use Vitex?
- More about DHEA
- How to reduce testosterone?
Holly: Hi everyone, I’m Holly Grigg-Spall, author of “Sweetening the Pill”, and I am here to host a chat with Dr Lara Briden, who is the author of the new book, “Period Repair Manual”.
“Period Repair Manual” is great. It distills Lara’s twenty years of in clinic real-life experience with women just like you and me. She provides breakdowns of natural treatment protocols focusing on food, supplements, and herbal medicines mainly, for every period related problem from PCOS to PMS.
Personally, I love it because it’s a really great resource for women coming off the pill, my area, and those who want to regain regular healthy cycles.
So we have a number of questions that came in this week already, so we are going to do a little Q & A with Lara now.
So I’m going to pass over to Lara. You’ll just hear me ask the questions, and also if you have questions, and you’re listening in or watching in, you can ask your own on the Facebook event page, here in the Hangout event, or you can tweet it online with the hashtag #PeriodRepair. I will keep an eye on all those windows as best I can.
But we’ll start with questions that have already been posed.
Lara: Okay. I just brought myself onto screen now. Please, go ahead with the first question.
I’m really pleased to be here, and to have you all, all the viewers watching us today.
Holly: Okay. Let me give you the first question I have down here.
So… Heather wants to ask about pre-menstrual spotting and what it could mean for her?
Lara: Okay. That’s a really good question because spotting—which just mean a little bit of light bleeding that comes before the heaviest day of the period—is a really good indicator of period health and of health generally. It can mean a couple of things that I see in clinic. Hormonally, it can mean there’s not enough progesterone coming in on the second half of the cycle, and progesterone is the hormone that we make after ovulation. It helps to hold the uterine lining in preparation for pregnancy, and then if you don’t become pregnant then progesterone drops away at the end of the cycle, but if it drops away too soon you get a bit of spotting coming through.
Spotting can also mean, and something I see a lot… It can indicate a problem with another hormonal system called “thyroid hormone”. We need enough thyroid hormone to essentially hold our progesterone in the second half of the cycle.
Holly: Okay. Thank you. I’ll move on to the next question. Just a quick note here—If we don’t actually get on to everybody’s questions – we’re going to do this again in May. So please sign up for announcements on the book page which is LaraBriden.com
But Lara, yes, you were going to say something?
Lara: Yeah. One more thing about the spotting before we move on to the next question I should mention here, and I speak about this in my book, with the symptom spotting, and also pain, a more severe, more painful than normal periods—I would encourage a lot of women out there to just consider whether or not, or maybe speak to their doctor, about whether or not they have a condition called endometriosis, which I explain in my book. It’s fairly common, it affects about 1 in 10 women and it’s a gynecological condition, and spotting is one of the main symptoms of that.
Not every case of spotting is endometriosis but it is something to always keep in the back of your mind, and to maybe speak to your doctor about.
Holly: Thank you for that clarification. So the next question I have here is from Merritt and Danielle, and they wanted to know about the hormone specifically, the hormone DHEA and how that relates to period health.
Lara: Yes, I saw that question come in. It’s such a good question. It’s actually quite a complicated issue.
The hormone is called D -H- E- A, the four letters all in capital.
It’s a hormone that’s made by our adrenal glands. It’s a type of androgen, or male hormone, and we’re starting to learn, the research which is very new in this area, actually, but we’re just starting to learn that all of the androgens including DHEA have quite a strong effect on the ovaries and the eggs that are developing in the ovaries. At the right dose, DHEA helps to promote ovulation, which is why it’s actually used as fertility treatment. And some of the IVF clinics are trialling it, using DHEA supplements to improve ovulation and egg quality which I think is really fascinating. You certainly wouldn’t want to do that until you’ve first had a blood test for DHEA and confirmed that it was low.
But I think one of the questions that came in was a question about high DHEA because it can go the other way too. And high, having too much DHEA is usually associated with a hormonal condition called
Polycystic Ovarian Syndrome (or PCOS) and in that case having too many androgens can impair ovulation or prevent ovulation. It’s one of the features of PCOS. So it’s quite an interesting hormone. There’s basically a sweet spot of just the right amount.
Holly: I think that is really interesting because I think a lot of women when they go and get tested with their doctor, hear about that, and it kind of throws them, so it’s nice to have have a bit more information.
Lara: Finally… Sorry to interrupt you Holly… With anything like that, if you’ve had a blood test that came back with high DHEA, and your doctor has related that to PCOS and you’re concerned about that… I’ll just say, my experience is that all of the hormones of PCOS, but including that one, can normalize quite well with natural treatments. So it’s not that…and this goes with any of the hormones… the hormone that you see on one blood test is not necessarily always the way it’s going to be for you.
Holly: Yeah, I think that’s a really important point. It doesn’t just mean that that’s your lot, does it?
Okay, so let’s have a look at the next question we have here.
Minute 6:38—Teenagers and Irregular Periods
“How would one go about helping a 14 year old athletic girl regulate her periods?”
Lara: Yeah. I see this a lot in my own clinic, so the first question for teenagers is “How regular should they be?”
It’s pretty common, and it’s okay in the first 12 to 24 months of periods, for them to be somewhat irregular.
That’s just the cycles finding their way.
But after a couple of years we do like to see it coming at least every 35 days because that suggests that then the girl is ovulating regularly and that’s the important thing.
The doctors just… If the girl’s periods aren’t regular they often just put them on pill, and I’m just going to take this opportunity to say that (to all the listeners): The pill bleed, the bleed you get on the oral contraceptive pill is not a period. So if the concern is irregular periods then the pill does absolutely nothing to correct that it just pretty much brings an artificial bleed to reassure you and keep you out of the doctor’s office, as far as I can tell.
So for girls like this a lot of it relates to body weight. So, either they’re underweight or they’re overweight.
I think when this question came in, it was mentioned that the girl is not underweight but she was quite athletic, a dancer, and she is quite athletic. So I would just say, even if… Just make sure that there is a body mass index, or BMI, of at least 20. That’s a common body measurement, that you can calculate yourself, and find that calculation online. And even if it’s at the low end of normal that might not be enough to get a period, because the body really does need a certain amount of body fat to have a period, and so girls need to be eating regular meals and certainly and having enough starch and fat and all the nutrients.
So that’s the number one consideration.
On the other side of things, certainly there are teenagers out there who are having irregular periods because their body weight is too high. And that relates back to Polycystic Ovarian Syndrome, that I spoke about before. Having too much body weight, which I know doesn’t relate to this particular question, but I’ll just say: There are teenagers out there that have too much body weight, especially around the middle (around their belly) that can impair ovulation also. Which also means preventing regular periods.
Holly: Okay. Actually on that note, I’m going to segue into Ledah’s question which is quite a broad one but a really important one.
Minute 9:22—Do Irregular Periods Matter?
Is it detrimental to a woman’s long term health to menstruate irregularly, besides encountering fertility issues? Can a woman just live with it, if she chooses- is her question.
Lara: I love that question, so that’s a good question. Like, what’s the big deal? Why do we really need these hormones—
these periods? There, I already gave away the answer.
We need periods, because we need to ovulate, and of course ovulation then leads to a period. A period is the end result of having ovulated. And we need that for our health because of the hormones that gives us—both beneficial estrogen, and progesterone, which is the hormone we make after our ovulation. Both of those hormones have a lot of benefits and I talk about this in the book.
They’re good for mood. They’re good for metabolic rate. They’re good for sleep. They’re good for healthy hair for example. I know hair loss is a condition I treat a lot.
And what the doctors will often say and bring up is that, mainly estrogen, but both estrogen and progesterone are really important for maintaining and gaining healthy bone density. So especially in our 20s and 30s we need to be reaching that maximum bone density. And if you are not having periods and you’re not making estrogen then you are at risk for osteoporosis in the long term.
So that’s a valid concern, and the doctors often give “Well you’re not having your period”, so they want to give you the synthetic estrogen in the pill to make up for it. But I really I don’t, for most I my patients I don’t. That’s just not necessary I think most of the time you can get the periods going.
Holly: So let’s move on to another more specific question,
Emma wants to know what she could do to help fibroids? Ok, a fibroid is a benign growth. Essentially it’s a little lump that forms in the uterus muscle. It’s very common in women in their 40s at least one or two small fibroids, but for some women they can grow to a large size up to 10cm which is not very comfortable. That’s one of the main concerns with it, that it takes up a lot of space in the pelvis. It can push on the bladder and one thing (giving you a little background on fibroids) that you need to understand is they will naturally shrink at menopause. They will shrink at least 50% or even more with menopause so if its someone in their 40s or mid 40s or late 40s dealing with fibroids then they will have to try to..if they can get some information in their family history at what age menopause is likely to occur for them, it can be of help, because they will have to hold that for another two or three years for it to reduce on its own.
So your question is natural treatments for fibroids. It’s not going to be easy. I can tell you that with a lot of hormonal conditions in the book and some of them are easier to treat than others are. Natural treatments are effective but just because the nature of the fibroids and the dense growth that it is, it’s not going to disappear overnight. Natural treatment is effective for slowing or stopping the speed of growth and maybe softening them to some degree and start making the pelvis feel a little more comfortable.
I’ll say here, because I wondered if this is what the question is related to, sometimes (in about 10% of the cases) fibroids can (because of where they are situated)can cause heavy bleeding, and very heavy bleeding of course is a concern and natural treatments can work extremely well for heavy bleeding and there is a section about that in my book.
But I will just finish the conversation about fibroids. Even those that aren’t causing heavy bleeding are stimulated by estrogen so it’s really about estrogen.
Being able to have less estrogen exposure which means to be able to detoxify estrogen properly and that’s our own estrogen we are making, being able to detoxify that, and also being able to detoxify what are called xenoestrogens or
foreign estrogens that come at us from pesticides and plastic and all kinds of those sorts of things can have a stimulating effect fibroids. So we need to be able to detoxify those. The liver health is important for that, but—and
I speak about this in my book—in fibroids and any other high estrogen symptoms has a lot to do with having healthy intestinal bacteria because they play a huge role in removing estrogen from our body.
So for that reason I always try to find to ways such as avoiding antibiotics, to eat healthy foods like vegetables that help with the growth of healthy bacteria, so that they can do that job for us. There is another treatment that I rely on so much to treat fibroids and that’s iodine.
Minute 14:27—Iodine for Fibroids and Estrogen
Iodine is a mineral that’s best known for its effect on thyroid. Very important for the production of thyroid hormone, but also hugely important for women’s health and for buffering our estrogen receptors and for preventing overstimulation by estrogen. So in the book I talk about finding a safe dose of iodine: a dose that’s safe for thyroids but can also halt fibroid growth. I think I linked to a reference that suggests that fibroids themselves maybe the result of iodine deficiency.
So I just think that fascinating and that it is just a easy and simple solution.
Holly: Well that’s a wonderfully complete answer, thank you, and I have a few questions coming through on hangout and on Facebook
Minute 15:20—Healthy Consistency
Nicole has asked: is there a healthy consistency for your period? As in the actual what it looks like.
Lara: Yes, good question. It should be fairly fluid, it should be fairly liquid, maybe like milk or a little bit thicker. It’s not water but it should be fairly fluid and I think of course a common problem is clotting where we see some chunks of the uterine lining coming out.
And a couple problems you might run into is a period that is too thick or one that has clots that are too big.
Let me speak about the clots. It’s normal to have a few clots but they shouldn’t be really be any bigger than about the size of a 10 cent piece, I guess, in the U.S. or a dime size.
If you are seeing a lot of clots, that’s a sign that the uterine lining did not, essentially (and this is coming back to what we spoke about with the spotting symptom) there wasn’t enough progesterone to kind of mature and do the final phases of maturation of the uterine lining. So it comes back to progesterone and: Was there enough progesterone? You could try to measure that. And then looking at quality of ovulation and how to enhance progesterone.
With clotting and with consistency I do again have to bring up the condition endometriosis which we spoke about earlier. It is, just keep coming back to it because it is often missed and it’s a common cause of, well, pain is the main symptom, but it can also affect fertility and so I really want to help—as many doctors do who have had a similar conversation—trying to get the message out there to women that it is something they should know about. If they are seeing large clots or a lot of spotting, then they should speak to their doctor about that.
Holly: Great. We have a question here on Facebook from Angela which is a pretty important question. She says that she has pre-period migraines. She says they start the week before and go on a few days into her period. Apparently she has tried magnesium but still needs pain killers.
From the rest of her question I can assume that she is on the pill. Yes: “Will it resolve with the repletion of nutrients or will I need to go off the pill?” I know migraines and pill taking is really crucial so let’s go into that?
Lara: Ok, so the general consensus is that the pills causes headache, worsens migraine or causes them. Of course there is always going to be exceptions to that rule like anything in medicine it’s not always the way. But that’s generally and that’s even what I get from family doctors and that’s kind of the understanding.
So the first thing with migraines is did you have migraines when you weren’t taking the pill? If not, then yes I think that it’s the pill that is the primary cause of migraines.
But for those people who have migraines anyway and the pill didn’t seem to make it any worse, I still think it’s important to get off the pill and I will tell you why. Because the best hormone to treat migraines—to help migraines—
is progesterone. We come back to this again. This is the hormone we can only make after ovulation.
When you are on the pill you cannot, you will not ever make progesterone, and the artificial progestin, it’s called, whatever chemical they have got you on that’s taking the place of progesterone is not the same as progesterone and will not relieve migraine in the same way as progesterone will.
I’ll give you a quick tally, because I have been doing this a long time. I’ve worked with a lot of women with migraines and kind of know what works and what doesn’t work. I can tell you that magnesium works.
Sometimes it’s not enough on its own.
Progesterone works; either your own progesterone that make or that you take and that is called natural progesterone cream and that can be really helpful for migraines.
B vitamins can be helpful for migraines, especially something called vitamin B2 or riboflavin. That’s been clinically trialled for migraine and I am talking about prevention of migraine.
Once the full migraine has hit these medicines are probably not enough to stop it. But this is about prevention—reducing the frequency, reducing severity and the other thing with migraines because it is an inflammatory condition affected by hormones. It’s an inflammatory condition of the nervous system, really, we are starting to understand, and the food that can make that worse is gluten or wheat products. So certainly there are some people out there, migraine sufferers who need to avoid gluten. Not every migraine sufferer, but many of them. And finally I will say about migraines.
I’m trying to give a very complete answer here.
It’s often the case of getting everything to line up correctly so it might be you might need magnesium but it’s not enough on its own. You might also have to get off gluten and maybe also look at taking some progesterone.
That’s an example of three treatments that might have to line up. And it is worth pursuing—persevering with treatments, because I know migraines are a terrible symptom to have.
Holly: Definitely. Hopefully that can help you Angela.
Minute 21:01—Lack of Periods
I have a question here on Facebook again from Sudha, she wants to talk about lack of periods in women in their late 30s early 40s matched with low energy and depressive symptoms.
I believe she is medical practitioner from her question. She says she has a patient who also has suffered from anorexia unfortunately in her teens but she seems to be better now so she is wondering I know you have written a little bit about eating disorders in the book. Yeah. I think she is wondering what to do with the patient is not having regular periods.
Lara: Ok good, I may have to separate those out. Eating disorders—anorexia, bulimia—it is the underweight. It stops periods So that is kind of a large topic and in my book I do encourage referral out.
Treating eating disorders requires a lot of different things to come together. So I definitely encourage women to reach out for help and in many countries there are eating disorder associations are able to help them—referral networks.
But back to the question about irregular periods, obviously without knowing all the details about that hypothetical case, I cannot say specifically but I can say one of the things I look at with irregular period, and I have blogged about this and it is in the book, is thyroid and a possible thyroid disease and diagnosis of thyroid disease that’s been missed by the standard blood testing.
The thyroid is a gland that sit right here on the throat, it produces a hormone called the thyroid hormone which is the little ignition switch for every cell in our body including our ovaries. And period and irregularities and period problems are a classic marker of a thyroid problem, so in the book I talked through different just looking beyond the standard
blood testing and doing a couple you know hopefully in cooperation with your doctor doing a bit of additional testing for thyroid assessment.
Because if it’s thyroid and then you fix your thyroid, you fixed your period. It’s that simple—you know—it doesn’t
really involve anything else. The reason I brought this up in an answer to this question is the fatigue, because the fatigue another common symptom of thyroid disease– under-active thyroid.
Holly: Ok we have a really quick question here that I think a lot of people might have, from Sophie.
How soon after coming off the pill do you recommend trying a herbal medicine like Vitex to get your periods to regulate?
Lara: Yes ok, thank you Sophie! The mistakes I see sometimes…. I love Vitex—the herbal medicine called Vitex or Chaste tree. It is a herbal medicine with a long history of use. It stimulates—it works on—communication between the pituitary, which is a hormone gland in our brain, and our ovaries and it helps to stimulate ovulation and it can work really well to get periods going.
But the mistake—and I have seen this over 20 years with my patients—the mistake is using too soon after coming off the pill. I ask patients to wait at least three months because—it’s just a really simple thing—you just want to give your pituitary and ovaries a chance to find their way and figure out whether, you might ovulate on your own and don’t really need Vitex.
In which case I think that Vitex kind of throws a spanner into the works and confuses things a little bit, so yes, that’s the answer.
Holly: Ok, I’m just going to take one off the Google hangout now actually.
Minute 24:55—More about DHEA
There is a couple similar, in fact, and so: how does high DHEA affect your cycle? Does it affect fertility and weight loss?
Lara: So we are kind of going back to our question that we did earlier on but a little bit more on that.
Yes, we spoke about about high DHEA being a feature of some types of Polycystic Ovarian Syndrome.
I will say high DHEA is not associated with the overweight of PCOS which shouldn’t be a problem for weight and I don’t want to spend too much time on this because we spoke about it earlier. But its sometimes high DHEA is more of a marker than a full cause. I think my experience with DHEA is women, PCOS sufferers that have high DHEA are also showing, in my assessment, signs of other inflammation and possibly environmental toxicity that is interfering with their ovulation.
So the body make DHEA responds to stress—and that can be emotional stress or physical stress. So I see the DHEA more as a marker rather than the whole story. Does that make sense?
Holly: Ok, another related last final question, and just so everybody knows if we didn’t get to your question Lara is going to go on the Facebook event page tonight give you some notes there on any questions you may have asked there. Or the Hangouts, and again as I said we will be doing this again in May so check it out at LaraBriden.com for that, and as I said before our final question: If you want to enter the contest for a free book please check in on the Facebook event page and tweet the hashtag #PeriodRepair there, and you will be entered into the draw.
So I am going to ask the final question and then we’ll wrap up.
Minute 27:00—How to Lower Testosterone
So that is: Do you have any advice—this is from Sarah—advice for lowering testosterone levels naturally?
Lara: That’s good. This relates to Polycystic Ovarian Syndrome again and PCOS. I want to find the right words to say this.
PCOS is a very confusing diagnosis, because it is essentially not a diagnosis.
It is a description of….probably, and it can…. mean lots of different things. Androgens can be high for lots of different reasons so in my experience the best way to lower androgens or testosterone, which is male type hormones, is to address the underlying reason why they are being made. And that falls under the PCOS diagnostic umbrella. I don’t want to get too complicated here.
I know we’ve only got a few more minutes but I say in a nutshell the most common reason for high androgens is a problem with insulin; a condition called insulin resistance.
And the treatment—and I blogged about this a couple times—it’s in my book. The treatment is to give up all sugar. All of it! Desserts and any sweet drinks or fruit juices. And there are a couple of supplements that can work to normalize insulin and to normalize blood sugar control. And that by far works better to lower androgens than any other treatment that I have come across. So it’s the whole body approach.
I was just going to say if you people want to sign up, we are going to do this again May cause it really is fun getting these questions coming in. So if you want to know about that follow me on Facebook or Twitter, and I just set up a it’s on the book page of my blog the little email subscription, you can just submit your name and email and I will add you to the list to receive notifications for future Q&A or any other events that we do like this.
Holly: So yes. And also, this will be recorded and Lara will then be posting that on her blog larabriden.com so if you know anybody who could benefit from hearing her responses or if you just want to look back and hear your own answer again, which I’m sure some of you will, then you can just go to that and watch what you need to watch again.
Then finally just a reminder. If you do want to be entered into the contest for a free book,—A free copy of Period Repair Manual!—Just go to the Facebook event page and mention it or go to Twitter at #Period Repair and your name will be put into a draw and then Lara will announce the winner though social media and her blog. Thank you everybody for joining us.
Lara: And thank you Holly for hosting us. It was really good. It was fun to have you, and thank you everyone. We will talk to you again soon