Transcript for June 4, 2015
Topics: (See the video page for the Q&A)
- 06:36 Black Cohosh
- 10:00 Dang Gui
- 11:18 Side effects of herbal medicines
- 12:23 What is the link between hypothyroidism and irregular periods?
- 14:05 Gap in your period (stop and start bleeding)
- 15:45 Flooding and alternating levels of menstrual pain
- 18:49 How to know if you’re ovulating
- 23:03 Is it important to have regular periods?
- 26:35 Brown spotting
- 28:08 Post-pill PCOS – Polycystic Ovarian Syndrome
- 35:24 Is there an alternative to the Pill for controlling symptoms?
- 39:02 Intense mood instability during the luteal phase
- 41:40 Evening primrose oil combined with magnesium, supplements for PMS
- 43:33 Acne on and off the Pill
- 46:33 Supplements for perimenopause
- 49:45 Using Vitex and Tribulus
- 51:19 How do you know if the supplements you’re taking are okay?
- 54:37 Can you do period-repair with just food?
Lara: Welcome everybody, my name is Dr. Lara Briden and we’re here for my second Question and Answer session where I’m going to take your questions about period health and answer also any questions that you have about my book, Period Repair Manual. And today we’re being hosted by Holly Grigg-Spall. She is here to facilitate your questions and help us out with this process. And it’s very exciting to have Holly here today because she has something of her own happening: a new project.
Hi Holly, can you tell us about what’s happening with you?
Holly: Yeah. Absolutely. So I wrote a book called Sweetening the Pill and that book is actually the inspiration for a documentary project that is currently on Kickstarter. It’s going to be, well, it is exactly produced by Ricki Lake and going to be directed by Abby Epstein. And basically we spent the last year, or well, they spent the last year looking at the traditional roots for funding. And because it’s, you know what we talking about which is the birth control pill’s side effects, alternatives to that. It’s kind of a controversial topic in the US at least at the moment. So it’s actually quite difficult to get funding from especially companies that get lot of corporate sponsorship.
So that means that we’ve kind of, we decided to make it a grass root effort. And that’s really how my book started. It started as a blog and a lot of women e-mailing me through that blog and so really it’s about making all those women’s voices heard through this project. And anybody who feels hormonal birth control hasn’t worked for them, they haven’t been supported in finding a non-hormonal method they like or relevant to this Q & A, they want natural alternative treatments for issues that the pill is usually prescribed for. Perhaps it hasn’t worked for them, they’ve come off and their problems have returned.
Anybody who has found themselves switching from method to method and really found themselves having to settle in the end for something that hasn’t worked for them really and has caused some problems. And wants really a brighter future for birth control for women. The hashtag is #BetterBirthControl.
So yeah, that’s on Kickstarter right now, it was launched yesterday, it’s doing pretty well already, we’re really pleased and yeah, it would just be wonderful for everybody to check out. And I know we’re not – I understand that everybody can’t contribute, although the smallest amount really makes a big difference with a project like this. Because it’s a vote as well. So when you’ve got a topic like this, if somebody gives a small amount, the backer number goes up. And it’s just great because it shows how many people want to see this film.
Lara: Yes. Even 5 dollars. That’s I mean that would be worth something, wouldn’t it?
Holly: It absolutely does. It’s just the more backers, the better. And it just goes such a long way. And if you can’t even do that, then a share is just brilliant because you’re sending this great video out that we’ve got, that really encapsulates what we want to do and getting the message out there, letting women know that there are alternatives. We’re giving them something to think about and showing them our support and then we validate their experiences which is – we really just want to make space for the community that you and I know so well which is people that are just often not served properly by the medical establishment.
Lara: Absolutely. And I’ve backed the campaign. I’m really really excited about it because I think it’s not just about better birth control, it’s about better women’s health. My intuition is, your book and this film if it gets made –which I pray it does– is going to be a turning point in the history of women’s health. I’ve said for many years actually I’ve just known that future generations are going to look back at the way we gave the pill so casually to women for 50 years and future generations won’t be able to believe but that’s what we did. And I hope that we’re seeing the beginning of the end of that.
Holly: Yeah. And I think the link is actually on the Facebook event page, so if anybody wants to check it out and doesn’t want to just search Sweetening the Pill in the Kickstarter search books, then it’s there for you, too.
Lara: And if you want to maybe just also at some point type the link into the Google Hangouts page as well.
Holly: Oh, yes, definitely. I’ll do that. Okay. So let’s move on to the Q & A that we’re doing here. What we’re going to do is take some questions that we’ve already had come in and we’re also going to look for our questions. We’re going to go for about an hour. So hopefully we’re going to have time to get around to all of them.
You can actually ask your questions through, you’ve got the Facebook event page, you’ve got quite lot of options: Facebook event page, the Google event page, below the YouTube video where we’re screening live or you can Tweet it with the hashtag PeriodRepair. I’m going to try and keep track of everything but I believe if we miss something, Lara might be able to find the time to follow up with you at a later point.
Also if you have asked a question, you’ve been confirmed to enter into to a draw for a free print copy of the book and if you want to be entered and you don’t want to ask a question, then just go on one of those pages and give your name and just shout out “please enter me” and we’ll just contact – Lara will contact the winner in a few days taken from the pool of names that we get there.
And also just to mention if you have read the book and you have enjoyed it and perhaps you have some follow-up questions, do consider going on Amazon and giving it a little review because it really makes a huge difference, those Amazon reviews. Because if someone’s searching on there and looking for something, if they see that somebody else has got something great out of the book, they’re much more likely to purchase it and then also get something great out of it themselves.
[06:36 Black Cohosh]
So yes, so let’s move on to your questions, so let’s have a look. The first one that we have is about the herbal medicine black cohosh. I think I pronounced that right. Both Haley and Jacky want to know if it’s a good herb for period health. And Jacky has said “I’ve seen a lot of products advertised lately containing black cohosh. What does it do and is it safe?”
Lara: Yes, interesting question. That seems to be in the news a lot lately, too, this herbal medicine. Before I get into the questions, I’ll also say I’m going to – this will be available as a recording and also there will be a written transcript which I’m going to try to break down by question by minute so you can scroll to the question you want and then you can know what minute in the video presentation we talk about that.
So black cohosh, also called Actaea is its scientific name is its been traditionally been used for menopause symptoms for primarily for hot flashes. It’s shown some good clinical studies for that. But more recently it’s been used as a treatment for PCOS or polycystic ovarian syndrome. And that’s something that I have prescribed it for. There’s actually a fairly new — in the last couple of years — clinical trial using black cohosh supplements for PCOS.
And the way it works is it works by lowering the pituitary hormone called LH or luteinizing hormone. And or women with PCOS that can enhance their ability to ovulate. So it’s quite a great herb. It did go through, like many herbal medicines it went through a couple of questions around its safety. One was, the first one was more of a theoretical idea that because it might be estrogenic that it might be a risk for people with a history of breast cancer. But as it turns out with further research, that concern was not warranted. Its mechanism of action has nothing to do with estrogen actually. It works as I said before by lowering LH. So the consensus seems to be now that it’s safe for women even with a history or family history of breast cancer.
And the other concern that has been raised about black cohosh is that there have been a few cases where it perhaps seemed to have caused problem with liver health. And again I think it has possibly been overstated. There have been thousands, hundreds of thousands of women have used the herb and its –- the liver reactions are very uncommon.
That said, when I prescribe it I do often, just as a safety check ask for a blood test like a liver function test usually within about three months of starting the herb.
[09:20 Black Cohosh For 66 Year Old Woman]
Holly: Great, so let’s move on to the next one. Rachel is actually a naturopath herself and she wants to know – this is a kind of a follow-up question – if she can use black cohosh with a 66 year old woman still having hot flashes and is it safe for liver health?
Lara: Yeah, exactly. So those are two questions. We have those together because those are related. Yes, it does help hot flushes. We call them hot flushes in Australia.
Lara: Yeah, hot flushes down here, hot flashes in North America.
Holly: I thought we call them hot flashes in England.
Lara: Oh they’re hot flashes?
Holly: Usually the Australian and the English slang is the same.
[10:00 Dang Gui]
Holly: Okay, so another herb question then. Dania wants to know about Dang Gui, a really – we’ll need to get a translation.
Lara: Dang Gui, yeah.
Holly: Dang Gui for PMS.
Lara: The other name for that is Angelica. It has a beautiful name.
Holly: Oh, that’s easier to say.
Lara: Okay, I do prescribe the herb. It’s not my first choice for PMS or premenstrual syndrome. But it does work for other period problems. Like it can help with period pain or to make a flow, the actual bleeding easier. For a lot of these herbs we don’t know the exact mechanism of action. But with Dang Gui it seems to regulate what is called prostate glands in the body which are a type of inflammation that is essentially involved with period pain and having an easy period flow.
So it’s the kind of herb that you should combine with other herbs in the same formula and it’s typically prescribed – you take it throughout the whole month for a few months and then progressively cycle by cycle you should have easier periods, less pain.
[11:18 Side effects of herbal medicines]
Holly: I might have a quick follow-up question to that actually I’d be curious to know. I know herbs can be – I mean obviously they’re very powerful and they have a lot of, you know, strong effects. And I was wondering, do you have to be careful with side effects with herbs like you do with pharmaceuticals?
Lara: A good question. Well, you certainly have to be aware of potential side effects. I think with some of herbal medicines you need to be aware of their interactions with pharmaceuticals. For example actually – well, the example that comes to mind is, one of the trickiest herbs to use is a herb called St John’s wort because it can interfere with the levels of other medications in the body including – this is kind of topical for us today, it can affect levels of the synthetic estrogens and synthetic hormones in the birth control pill. So it can sometimes render the birth control pill non-effective if taken together with that herb. So certainly yes, I do think that women need to be just conscious and thoughtful about what herbal medicines they decide to use.
Holly: Okay, thanks for that. Next question from Samantha who is also a health coach and she asks “what is the link between hypothyroidism and irregular periods?”
Lara: Yes, that’s something I talk about in my book. I can’t remember how many times I mention thyroid in my book. Probably at least five or six because it’s – so thyroid is a gland that sits right here, right there on the throat. It’s a very important gland, it makes what’s called thyroid hormone which is essentially our energy hormone. It’s kind of the like the ignition switch for the whole body. So it affects, it turns up metabolism in the whole body; in the brain, in the muscles and everywhere including the ovaries.
So if you think of it that way then it’s quite easy to understand what a profound effect thyroid hormone can have on periods. Because the ovaries have very high metabolism, probably higher than many other tissues. And if they’re not getting, if their ignition switch is not turned on, then they’re not going to do what they need to do. So there’s not…. With inadequate or with under-active production of thyroid hormone, it can interfere with ovulation.
That’s one way, like many things in the hormonal system there are overlapping, there are other things happening to — having not enough thyroid hormone actually stimulates the pituitary to make too much of a hormone called prolactin which can also suppress periods or cause period problems.
So female health and thyroid health are very closely related.
[14:05 Gap in Your Period]
Holly: Great. I’m going to take a question from the side here because I believe it was also posted on the Facebook event page. And it’s from Betty Bake blog but I don’t know specifically. And what is happening if there is a gap in your period? So you start menstruating for two days and you stop for two days and then you continue again for four or five days.
Lara: Yeah, good question. That’s a common experience and of course it’s something that women are trying to understand about their periods, what that could mean.
Well, the first thing I’d to say is depending on how heavy the first couple of days are, the first thing to consider is whether it’s just spotting, a bit of pre-menstrual spotting which is not uncommon to get a bit of essentially breakthrough bleeding. So that would be one explanation and then the real period starts a couple of days later.
Alternatively if you truly have a period that’s kind of stop and start, then that suggests like any sort of abnormal kind of flow whether it’s clots or stop and start bleeding or bleeding that goes on, drags on for too long. That usually suggests that there isn’t, hasn’t been enough progesterone coming in in the second half of the cycle.
So progesterone, one of the most important – well, it does many things for us as I discuss in my book but when it comes to the lining of the uterus, progesterone helps to mature it and thin it and kind of get it ready to have other – you’ll have a baby or if not a baby then have a very smooth expulsion or smooth flow.
[15:45 Flooding and alternating levels of menstrual pain]
Holly: Okay. Yeah I think that’s when I asked around quite a bit. I’ve got another question here, two of them very similar. So Joanne wants to know what causes flooding. And then I’ve got another question from Christine which is similar which is why some days she has periods that are just terrible but other days it’s perfectly fine? I guess maybe one cycle it might be terrible and then one cycle it might be fine.
Lara: Yeah I’m thinking she means one cycle they’re bad. I’ll speak about the flooding question first. Flooding is a type of heavy bleeding that can be very heavy and quite frightening and it can be the kind of bleeding that where you bleed through your clothes and can’t leave the house. And it’s more common in our forties during perimenopause. And the official consensus is we don’t know exactly why it happens, this kind of standard hormonal flooding. I think it always needs investigation by a doctor because there can be other medical reasons why it happens. So once the doctor has rules out anything medical then they’ll say: “Well, it’s just a hormonal issue.” Again it comes back to progesterone. And not having enough progesterone in the second half of the cycle to mature and thin the uterine lining. So instead of coming out in just a nice, smooth, easy flow for four or five days, it will kind of build up and come out in big gushes.
So that’s the flooding question and then as to why the period pain during some cycles rather than others, like I’ll answer it that way. I hope that’s what Christine was asking. Well, first of all there is not going to be a period pain if someone’s had what’s called an anovulatory cycle. So that’s something I describe in my book. It is possible to have a bleed and usually it happens not regularly but sort of a random bleed that comes every six to eight weeks or longer. That is, in which your body has not gone through the steps of ovulation and then making progesterone. So there’s actually been no progesterone. Nothing like that’s happened and it’s just a random shedding of bleeding at a certain point. And that doesn’t usually have pain associated with it.
But the other reason why there might be some cycles that have more pain than others – it’s what I talk about in my book Holly that our period is our monthly report card. That’s our little sign. So if we’ve eaten some inflammatory foods, whether it’s dairy or too much sugar, or too much alcohol, or I hope you’re not but you know, smoking, anything like that or stress or… Then end result of that can be later that cycle, even weeks later period pain.
[18:49 How to Know If You’re Ovulating]
Holly: I kind of have my own follow-up question for that because I’ve been interested to learn that you can bleed but have an anovulatory cycle. And so I’m wondering, you’ve just said that there has to be a regular – if a woman has very regular cycles and has a period, is that enough to know that that person’s ovulating? Or do they need to do more to figure out whether they are or not?
Lara: That’s a great question. And I think there’s a question coming up later, I think it was Christine wondering about progesterone, how to know if you’re making enough progesterone in the second half of the cycle. That’s kind of the same question. Like how to know if you ovulated or if you’re just having a non-ovulatory, non-progesterone cycle or bleed.
Okay, I think a regular cycle, a very regular cycle, like if its coming within a few days, like whether it’s a 28 day cycle, or a 35 day cycle but it comes roughly every 35 days for a person, it strongly suggests that they are ovulatory cycles but no, to answer your question no, it’s not a guarantee. It could be that you just get fairly regular anovulatory bleed.
So I encourage all women to… this is about body literacy, which I’ve heard is a term that’s used and I love that phrase. It’s about learning our bodies. And we have so many tools at our disposal to do that. So I think it’s very important for women to learn to know if they’ve ovulated that cycle. And certainly one way of doing that is to have a blood test or a saliva test for progesterone to confirm that. But not everyone wants to run off to the doctor every month to test that so fortunately there are other ways we can – well, there’s a couple of ways we can be certain that we have ovulated but I’ll jump to the first.
The best way to know for certain that you’ve ovulated apart from a blood test is to do a basal body temperature reading. So we’re looking for… if it’s a basal body temperature…. it’s taking your temperature first thing in the morning before you’ve moved your muscles and generated any heat that way and it’s your resting body temperature. And that should be lower in the first part of your cycle and then after ovulation it goes up about half a degree. Which doesn’t seem like very much, it’s about a third of a degree Celsius and a bit more than a degree in Fahrenheit but it’s detectable. And it happens because progesterone stimulates –- this is interesting…. it ties back to our question before about thyroid. Progesterone stimulates more thyroid production. Hormone production of the thyroid hormone. So that turns on the ignition switches in your body and revs up metabolism. So you can measure that with a temperature. It’s really obvious.
So that’s the one way, there are other things you can learn to look for which is changes to cervical mucus or vaginal discharge and also the physical position of the cervix which is actually pretty easy to do and there are lots of resources that can help you learn to do that.
Holly: Just to remind people of the Kickstarter again, one of their reward was actually giving backers the chance to have a Wink which is Kindara’s new Bluetooth basal body temperature thermometer. And it actually syncs your data to the app so when you wake up in the morning – because you have to take it first thing in the morning, right? Before you even move or anything. When you wake up you don’t have to struggle to do that. You can just take it and it goes to your app. So that’s going to make things…
Lara: I love it.
Holly: Yeah. I think it’s going to make it much easier for people and more effective but it’s really great. So that’s one of the rewards they’re offering actually. As well as a class which is to learn more about what Lara’s discussing which is fertility awareness.
[23:03 Is Regularity Important?]
Okay so now let’s see, we have actually a related question which is Laura wants to know about regularity in periods. She says that she actually tracks it via an app and she finds that hers are between 27 to 35 days apart. But her naturopath that she sees actually has asked her if she can work to have them more regimented. So her naturopath has said if they were every 28 days then they should be every 28 days and if its 31 days, it should be every 31 days. And she wants to know what you think about that, is that important?
Lara: Yes, that’s a great question actually. I think – well, I guess the short answer is I think it’s normal to have a period that fluctuates a little bit. I don’t think it has to be regimented. I don’t think it’s abnormal if it’s not coming perfectly. Chances are even if it’s not coming exactly every 32 days or whatever, chances are there’s still ovulation happening and that’s what matters.
I’ll just come back to –- and I speak about this in my book –- what really matters is that you’ve had ovulation. That you’ve ovulated because that’s how you make your hormones. Which is what you need for your health.
But I guess to be fair, yeah, I think her naturopath is right in that it can be a better sign for health if the periods are fairly regular. And that goes back to our period as our monthly report card. I think if everything’s lined up in terms of less stress and the right diet and the right nutritional status, it will start to naturally on its own become a little bit more like clockwork.
So I guess it’s a yes and no kind of answer. I think it doesn’t have to be like that. Certainly if you’ve had a stressful month and then your period is a few days later, that makes sense and you know why it’s like that. And so it’s not something that you should be concerned about.
Holly: Yeah I remember when I was first learning about ovulation, I realized that I was taking antibiotics and I took them for a UTI and I was one them for about 5 or 7 days. And I was supposed to ovulate around that time but it delayed until the day after I stopped taking antibiotics, like magic which was quite amazing to me at the time.
Lara: I just want to follow up – I’m so glad you brought that up about antibiotics. I’m just going to follow up about that for a minute. Antibiotics have a profound effect on period health. Such a common thing what you just said to have a shift in your cycle in some way and also the other thing I see after antibiotics all the time is it might not happen in that month, it might be a month or two later is a sudden worsening of pre-menstrual syndrome and of PMS symptoms.
And I know there’s probably a few mechanisms, reasons why that happens but one thing is that antibiotics obviously have a huge impact on our good bacteria, our intestinal bacteria and that in turn has a huge effect on period health because our bacteria are what – one of their big jobs that they do for us is to help to detoxify and clear and maintain a normal level of estrogen. So what you’ll see is it’s kind of wash out effect the month you have antibiotics and for other reasons, too suddenly symptoms like PMS will get a lot worse.
[26:35 Brownish Spotting]
Holly: Okay, I’ve got a question from Twitter actually if that’s okay. Someone on Twitter has explained that she has brownish spotting for two days and before she has her full flow of her period which isn’t very heavy and it doesn’t last longer than three days. She wants to know if that’s okay and she came off the pill in 2014 April so over a year ago.
Lara: A little bit of spotting like that pre-menstrual spotting is extremely common. So it almost never means something is really wrong. It usually goes back to – it’s come up a few times today but – progesterone levels. Because progesterone is what holds the uterine lining. With a good progesterone level it should, the lining should just be intact and healthy and holding until progesterone actually drops down you know, the day before your period and then it just all starts flowing quite easily.
So I interpret spotting to usually mean something happening with progesterone. Spotting can also indicate a problem with thyroid and I suspect that relates back to what we said before about how thyroid’s very important for all these relations. But it’s one of those clinical signs that I look for in my patients and I describe a patient’s story in the book, the only thing that really worked for spotting was to get the right kind of nutritional thyroid support in place.
Holly: I had another follow-up question for me that’s sort of an after coming off the pill question, too. Which is that you hear a bit about this idea of post pill PCOS – Polycystic Ovarian Syndrome. And how does a woman know that she’s experiencing PCOS? Actually that she had it before she went on the pill or that she just hasn’t got her period back after the pill or are those all the same thing? Because I find that very confusing.
Lara: I know, it’s such a good question. Well, I think it’s a whole book in itself actually, this post pill lack of periods which is very common; PCOS which is very common, there is a lot of overlap. I guess the easiest way to answer that question is that PCOS – the problem with it at the moment is it’s not a very clear diagnosis. It can mean lots of different things. And it’s very – essentially it just means someone who is not having regular periods or not having any periods. And who may or may not show something called polycystic ovaries in ultrasound and may or may not have high testosterone on a blood test. It’s very nebulous — it’s a syndrome. A lot of different people with quite different things happening are getting slotted under the same diagnosis of what I call an umbrella diagnosis which means it encompasses – it’s a word that’s attached to a lot of different people.
And in particular – and I speak about this in my book. I would just caution women if you’ve been given the diagnosis of PCOS, just to confirm that it wasn’t given purely based on the ultrasound finding because that’s a very common finding and doesn’t necessarily mean you have the syndrome. And it’s actually a very common finding after the pill. So I know it’s not entirely answering your question but I guess what I see in my clinic are women who – the period didn’t come back straight away when they stopped the pill. And during that time possibly all they needed was just a bit more time to get ovulation going again which is a very common experience. But during that time, six months or whatever it is, they happen to have an ultrasound and they happen to get this diagnosis and I don’t think it’s always a relevant diagnosis.
And also – sorry, I just keep going with this question, it’s such a huge question. Yes, many women possibly had polycystic ovarian syndrome before they started the pill. But they didn’t realize that they weren’t given this diagnosis, it wasn’t being diagnosed as much as say 10 or 15 years ago but maybe their periods weren’t regular and rather than having a diagnosis they were just told “okay, we’re going to put you on the pill now, it’s your so called regulate your cycles” which is a very confusing thing to happen because the monthly bleeds that the pill produces are not periods. They’re not real periods in any sense of the word. They don’t happen, they don’t follow ovulation, they don’t follow the production of progesterone which are all the normal elements of a normal cycle.
So what a lot of women have had is maybe ten or more years of thinking they had regular periods when they didn’t really, they were just pill bleeds. And then finding when they stop the pill there’s no bleeds and then not really being able to remember thinking back “how regular were my periods before and what was happening before?”
Holly: I actually was going to mention that you wrote a piece recently, didn’t you? — for I think it was for the Hormones Matter site about: Are Pill Bleeds Real Periods? — I think it was titled, but it was really a popular piece and I know a lot of people talked about it on the Sweetening the Pill Facebook page and got shared a lot.
And I found that very interesting because I commented when I shared it myself that it seems like a really, you know, the doctors say the pill regulates your periods, we’ll put you on it to regulate your periods. Especially if you’re a teenager it seems like a small kind of statement, like well… And a lot of women just accept it as what it is but I think it’s a quite insidious little lie in a way. And when I discuss it with women it’s interesting how even if you try and explain but it’s not regulating your cycle. They still feel very keen on holding on to that.
And it’s funny because it’s something that in the Kickstarter campaign video we have, we have a host, a holistic health doctor in there talking about exactly this and how it’s kind of the start of where we get a lot of misinformation about the pill.
Lara: Absolutely. Holly, it’s not a little lie. The fact that it regulates – I’m catching your phrasing here that it’s a little lie that we keep telling ourselves – or doctors tell themselves. I mean, it’s like everyone believes it that pill bleeds are somehow equivalent to women’s cycles. You know, I guess – and this is in my book but I’ll just say it again here. I think this is the crux of the whole matter. I think this is what the film Sweetening the Pill is going to blow this out of the water. It’s this.. this is like… the emperor’s new clothes situation. You know we’ve all been going around for some reason saying this is fine, this is fine, this is normal. This is kind of just equivalent to what women’s hormones normally do, and it’s the complete opposite.
So I honestly can’t imagine how doctors can say that or think that. It’s like a kindergarten kid could understand this almost. It’s they’re not real periods, they’re not real hormones. I’m getting so emotional when I talk about this.
Holly: I know I think it makes a lot of us really angry because it’s kind of where it starts, you know and it’s so insidious, isn’t it?
Lara: And especially – I’ll just go back to teenagers. I mean to put a 13 or 14 – this is crazy, I don’t know why I’m feeling so emotional about this….. I just feel that maybe we’re at a real turning point for this. I think it’s yeah, these girls, because I see them then 10 years later. And if they went on the pill at 13, it’s not easy for them to get going again after that. Get their own periods going again. It can happen, you know I call my book, Period Repair – it can happen but it didn’t have to be that way. They don’t have to be put on the pill for minor symptoms.
[35:24 Is There An Alternative to the Pill?]
Holly: I think there would be an interesting follow-up to that question actually it’s something that I get asked a lot and a lot of people come to me to tell me. Are their any hormonal health problems for which the pill is the only option or that is absolutely needed and there’s very little alternative, there’s very little else a woman can do. Because if somebody has endometriosis and who has friends with endometriosis who suffer really painful periods and it’s something that I hear talked about a lot. And the moment you say “I think we need to move beyond [inaudible 36:06] birth control” people do want to say well, for some people it seems as though it’s essential. Would you agree with that or not?
Lara: I do agree and I’m glad you brought it up. I think I wouldn’t want this conversation or this kind of discussion to belittle or in any way dismiss the suffering that someone has with conditions exactly as you said: endometriosis or severe heavy bleeding, or large fibroids. You know, certainly the pill in those situations can be medicine if it’s controlling symptoms that are debilitating. And I support that. Certainly in my own practice even, every week I’ll have some patients where I say “look, this is now not a good time to come off the pill. I’m concerned about what your periods might be like if you do. I’m concerned about the pain, I’m concerned about the heavy bleeding. So instead what we’ll do is we’ll work on some of the underlying causes while you’re still on the pill and then revisit the idea of coming off at some point in the future.”
So there’s that. But also, I’ll interject, I’ll mention here that there’s another technology which is called Mirena which is a small dose intrauterine device. It releases a small amount of synthetic hormone called levonorgestrel which is the hormone that’s also used in a lot of the pills and it’s not my favorite hormone…But as I say in my book I feel like Mirena is…. especially for women that you have just described that are having a lot of pretty serious symptoms…. it’s a reasonable compromise because they’re not getting the whole — it’s such a small dose–it doesn’t give them the whole body hormonal shut down that the pill does but it still helps control the symptoms in the uterus itself.
Holly: That’s something that I’ve heard, too. Actually a friend of mine does use that for her really serious endometriosis symptoms.
I actually have two pieces coming up in the Telegraph later this month about the Mirena and the whole IUD and what we can say about it being like an alternative for the pill and the kind of benefits and the drawbacks of it as well. So those should be out in a couple of weeks I think.
Lara: Also, before we actually leave the topic of Mirena – and I’m looking forward to see your pieces on it– I might just say one thing and I say this in the book as well. The thing that I prefer is that it does permit… even having the Mirena in place…some women do ovulate at least some of the time. So they’re at least getting some of the benefits of ovulation and their own hormones.
Holly: Okay, let’s move on to a topic that a lot of women are definitely going to be interested to hear about which is PMS. We’ve had several questions come in about PMS. So let’s start with the first one which is Lynn’s who wants to know why she’s having really intense mood instability during the luteal phase. So she feels depressed and irritable. And she just says she wishes there was something that she could do or change or take to stop having that and she says she already takes Magnesium but she’s not sure if she’s been taking it for a long enough time for it to be effective.
Lara: Magnesium should work almost in the first cycle. So that’s one of the things I like about it. It’s calming, it delivers some benefits within the first month of using it. But certainly there’s lots of other things that can be done. Chapter 8 of my book is all about the PMS solution and looking at it kind of from the ground level up, all the changes that we can make to remove some of the contributing causes of premenstrual syndrome.
There’s a few factors involved. I think it’s—a lot of it has to do with the fact that the two hormones, estrogen is quite a stimulating hormone, very stimulating actually. It stimulates serotonin and dopamine, it hypes us up. And progesterone is the calming hormone that stimulates something called GABA which is our chill neurotransmitter. So we need enough of both. We need enough of both, it comes back to progesterone again. We need enough progesterone to be made in the second half of the cycle to give its calming effect.
And also there’s another concept that I describe in the book called inflammation or a problem with chronic inflammation which contributes to pre-menstrual symptoms because essentially inflammation in our body… which could be coming from food, or our digestive system or smoking or stress. Inflammation can interfere with hormone receptors and also with the function of some of our neurotransmitters. There’s actually a study – I think I quote it in the book — that found that women who do suffer PMS have measurably higher levels of inflammation in their bodies. They can measure that on a blood test.
So I think relieving PMS symptoms is very possible for most women.
[41:40 Evening Primrose Oil Combined With Magnesium, Supplements For PMS]
Holly: So let’s just get into that a little bit then. Katie actually asks about she is using evening primrose oil and she wants to know whether it can be combined with the Magnesium. And we’ve also got Susan asking specifically about supplements for PMS.
Lara: Certainly evening primrose oil can be combined with Magnesium. I don’t use evening primrose oil a lot, I know it was pretty popular a couple of decades ago but it’s not one of the PMS supplements that I find most effective. I guess the two – so the top three supplements for PMS is Magnesium, which we already spoke about which works in the body a lot of different ways but particularly it’s a calming mineral. The second one is vitamin B6 which I would say is almost like a magic pill for PMS. It works long term, it also works – it’s the kind of thing you could take when you’re premenstrual, just take it that morning and feel a bit better, you know an hour or two later. And it helps with – I think one of the reasons it works so quickly is it helps with the production of GABA which is our calming neurotransmitter. Those other things, too. And the third supplement to think about PMS is a very popular supplement these days called Vitex or chaste tree and it’s been clinically tried for relieving pre-menstrual symptoms. It helps with the production of progesterone. And it also – it’s an interesting herb actually because it has some, it works like a mild opiate in the body. Kind of like a mild, well.. narcotic is a strong word.. but it’s a bit calming herb, too. So it’s quite a nice herb.
Holly: Great, top three. That’s so easy to remember. That’s very simple. Okay, let’s move on to another very – a topic that I think a lot of people like to hear about. Which is acne. Katie wants to know why it is that some women’s acne get worse on the birth control pill. I think kind of the other side of that coin actually from a lot of what I hear on my end is women who find that that acne gets – they suddenly get acne or that acne gets worse after they come off the birth control pill. So what’s going on there?
Lara: That second situation is the more common, that it’s worse when you come off the pill. I’ll answer the first question though. That’s not a common thing for it to get worse on the pill. I guess I might question what pill it was, if it was a mini pill, if it was a progesterone-only pill, then I would expect that. But if it’s a combined pill with synthetic estrogen then that usually works to dry up skin oils and suppress acne. It’s really just a bandaid though. Because the problem is – it’s a cruel thing, another cruel thing about the pill: that because it dries up skin oils, it essentially, you know, your skin is trying to compensate for that. So in a way your skin starts up-regulating its production because it’s being suppressed, its skin oils are being suppressed.
So what happens is it’s almost universal. I mean if you have any tendency to acne at all, then what happens is when you come off the pill, it will probably be worse than it was when you went on. Or if a person who kind of never had acne before was on the pill for a while and then came off, you get this, it’s a withdrawal, like an estrogen withdrawal that happens in the skin. And this acne is usually worse after three months of coming off the pill which is unfortunately exactly the amount of time I think that women allow themselves to come off the pill. So it’s like “okay, I’ll come off for a few months” and they hit the three month mark and it’s like “this is crazy, I’ve got so many breakouts, I must need it” and they go back on just to the point when they might have started to turn it around.
Holly: Yeah, I think that’s definitely, I think acne post pill is almost like a built in problem to make you go back on the pill. It always seems so mean and so cruel…
Holly: And you almost can’t believe it’s not a conspiracy.
Lara: It’s an addiction, it’s an estrogen addiction, yeah. You almost couldn’t have designed it any better to keep women on it for that reason.
Holly: Yeah, I mean people have been victimized sometimes but acne is so – it can be so depressing and can cause so much anxiety that it’s really, I think it’s such an important issue.
Okay, let’s – actually we’ve got one about a topic that I know a lot of people have heard the term but a lot of us won’t know much about it. Which is perimenopause and – perimenopause, sorry, I don’t know why I said it like that. The question is from Susan and “what types of supplements or other recommendations do you have specifically for women that are currently in perimenopause?”
Lara: So perimenopause is anywhere between sort of five up to ten years before menopause. Before periods stop. So it’s happening in our forties. For some women late thirties, early forties. You start to notice periods becoming less regular, maybe new sort of premenstrual or heavy period symptoms that you didn’t have before.
And it’s happening, essentially it’s happening because during perimenopause we ovulate less regularly than we were before. I’ll just say one thing actually. Of course we want ovulation every cycle. We talked about something called anovulatory cycles where you don’t ovulate but you still have a bleed. That can happen to anyone at any age. And one or two of those doesn’t mean anything bad necessarily. That can happen with stress or for lots of different reasons. But it starts to happen more often in our forties. And so the end result is we’re not making as much progesterone.
So I guess in terms of how to manage that, what supplements, it’s a lot of the things I talk about in my book. Supplements to help promote a healthy ovulation. Which could be a herb like Vitex. It could also be just some of the nutrients that the ovary needs like Zinc or Selenium or there’s another nutrient called Coenzyme Q10 which helps promote ovulation in older women. Older women – I say older – but in our forties. And then on the other side of things sometimes women in their forties have quite high levels of estrogen. So it’s about using some of the supplements, this one’s called DIM, it’s a broccoli extract that helps your body to naturally detoxify and eliminate estrogen.
But the other thing to keep in mind, the other thing that’s really important for removal of estrogen is a healthy intestinal bacteria. Which we talked about that before when we talked about antibiotics. And it makes sense you know, as we get on in life, our digestion might be not as healthy as it was when we were younger for whatever reason. It may be more antibiotics or other medications that can affect digestion. So I think women in perimenopause are also at risk for some other underlying issues. And also just to tie it all together, possibly at risk for thyroid disease around that age as well. So even if your thyroid was tested and found to be normal maybe five years ago and if you’re finding new symptoms with your period now, it’s definitely worth getting a retest for thyroid and testing it a bit more carefully with some of the methods that I discuss in my book.
[49:45 Vitex and Tribulus]
Holly: Great so you mentioned Vitex there and we have a question about that. So Reagan wanted to know about combining two of the herbal medicines that you actually mention in the book which is Vitex and Tribulus.
Lara: Yeah. So Tribulus is a herb, quite a strongly estrogenic herb that can actually be used to stimulate ovulation, stimulate what’s called FSH and stimulate the production of estrogen from our ovaries. So I often use it in women, well, I mention it briefly in the book briefly as a way for women who truly have low estrogen can look at using that herb. Theoretically yes, it can be combined with Vitex. And it’s an interesting question because I know some of my colleagues do that. At cycling the combination of Vitex and Tribulus can sometimes be a strong enough treatment to stimulate ovulation in women that might not have had a period for a long time. But I’ll caution – this is one of the situations where I would actually not – I would prefer if people would speak to a herbalist or a holistic doctor about it before they try it because it is quite a strong treatment.
And actually both herbs; Vitex and Tribulus stimulate the ovaries so strongly that they definitely should not be combined with fertility medication or like an IVF cycle, or Clomid or anything like that. It has quite a real effect.
[51:19 How do you know if what you’re taking is okay?]
Holly: That’s actually something I wanted to ask you about as well. This idea of using supplements. I know some people feel like it seems like you’re swapping the pill or one kind of tablet that you’re taking every day for a bunch of other stuff that you have to take every day.
And obviously as you just said it’s pretty powerful, you’re kind of changing things for the regulation of your period, you’re changing how you experience your period. I think the first part of the question is like should we be worried about that moving from one thing to the other? And secondly I think also, you know there has been a lot in the news about how if you get supplements from big box stores then it’s basically saw dust and house plants. So how do you know if what you’re taking is okay, it’s the right thing?
Lara: Yes, I love that question. I didn’t know that one was coming so that’s good. Holly, what I’ll say is I don’t think any woman – I hope I make this clear in the book and I should make it clear now. So when when I’m talking about some of these supplements to be used to perhaps help promote ovulation and reduce symptoms, almost none of them are intended to be used indefinitely. They’re like catalysts. You take it – either to address a deficiency or promote a change – and once the period symptoms are better, you should be able to maintain that with just healthy diet and managing stress.
So I agree. I don’t think we should be swapping one pill for the other to be going on indefinitely. Like for example Vitex. I don’t think Vitex is a substitute for the pill. It’s quite a different thing. And sometimes I might only prescribe for a few months at a time and then once the periods are going, stop it again.
The other answer I guess I’ll give is that any supplement that’s chosen wisely or that’s used in the right way for the right reason is working to promote something that the body is trying to do anyway which is to ovulate, to have healthy periods.
So in that sense it’s very different from hormonal birth control which is working to shut down one of the body’s own natural processes. So my mantra is to always try to respect what the body is trying to do and support that. Work to support that rather than to interfere with it or change it in any way.
And to answer your question, yeah, some supplements are better quality than others, yeah, absolutely. I’d love to sit here now and give list of brands. I didn’t include brand names in my book. Which I think a lot of people would like to have brand name for things. Let me put it this way, it’s better trying to get a better quality one. One that has fewer additives and excipients and perhaps has some sort of standardized extract of some kind. And if you can work with a nutritionist or a holistic doctor or a herbalist to help you choose the products, then you’re more likely to get something that’s better quality.
[54:37 Food Or Supplements?]
Holly: Okay, that makes sense. I think a little separate question to that is probably a huge question but I know people would be thinking it.
Is that can you do all the things that you want to do to heal your periods and do period repair with just food? Or do we need supplements because our food no longer holds the kind of nutrients that we require for that?
Lara: The short answer? You can do it with just food. I would say you should be able to do it with just food, yes. If you have a whole food diet, I think – at this point I’ll speak about what I think are some key nutrients that you want to make sure you’re getting from food if you’re going to do it that way.
Well, one is zinc which hasn’t come up today. So this is a good time for us to talk about it. It’s a very important mineral for ovulation. It helps, the studies show it helps reduce period pain, it’s good for acne – we didn’t speak about treatments for acne but it’s really a key mineral and a lot of women don’t get enough of it. And it mainly – you can get it from plant foods, certain plant foods, you know, pumpkin seeds and it’s in a low dose in some plant foods. But I’m going to say here that its main source…. it can be helpful to have some animal products in the diet for zinc. Or if a person doesn’t want to eat any animal products then I usually recommend for my vegan patients that they supplement zinc. So that might be a situation where I think a supplement is necessary.
The second nutrient that I think is really important for nutrient health is iodine which can be obtained from fish and sea vegetables and iodized salt. I think it’s really important that women just make sure that they have that in their diet.
And the last key period nutrient is magnesium which we get from leafy greens and nuts and seeds and we can get some of it and the problem is not usually that we are not taking it in but that stress depletes magnesium. Our body has got this weird thing where as soon as it’s under stress – and it might only be stress like not being able to find a parking spot or something stupid, it’s just stresses that we can’t avoid. The body just dumps out, kind of gets rid of magnesium and so it leaves us in this deficient state.
So magnesium is the supplement that I give the most. And I might give magnesium if say one of my patients was quite conservative and didn’t want to take a lot of tablets –- and that’s fine –- I’ll give them some magnesium just because it’s so safe and can be so helpful.
Holly: Okay, I guess we only have a minute left, right?
Lara: Yeah, that went so quickly…
Holly: Yeah that was really fast. Should we just wind up and just remind people of what we were saying before in case anybody checked in late?
Holly: So first of all, please remember if you asked a question then you entered into a prized draw of a print copy of Lara’s book. If you didn’t ask a question, just make yourself known to Lara through the Facebook event page or through any of the other avenues that you’ve got here, the Google event page, etc. that you want to be entered. And she’ll announce a winner in a few days.
And also if you’ve read the book, you’ve liked the book and you have it, this is all just follow-up for you, please go to Amazon and write a review because it’s so important in helping other women find that they need when they’re on there looking for the kind of books that could really help them in the way that this book is helping you hopefully.
And then I also want to say please go to the Kickstarter for Sweetening the Pill, a documentary, the Ricki Lake and Abby Epstein project and show your support with a contribution or a share and just let other like-minded people know about it and pass it on.
Lara: Let me thank you Holly, thank you so much for facilitating us. And everybody, definitely get behind the Kickstarter film project, I couldn’t endorse it more. I’m so excited and also check out Holly’s book, Sweetening the Pill which is – I’ve read it myself a couple of years ago and it’s a great book and I’m sure Holly would like some Amazon reviews for that one, too. And thank you everyone for coming, I’m going to have this – I’ll have a written transcript made and I’ll put the transcript on my website broken down by topics so people can just search for the answers that they need.
Okay, everyone thank you very much.
Holly: Thank you, bye-bye.