Transcript for Feb 9, 2016
Topics include: (See the video page for the Q&A)
- Elevated LH
- The difference between a birth control withdrawal bleed and a real period
- Hormonal acne
- Ovulation pain
- Severe pain can be a sign of endometriosis
- Best dose of zinc
- The effect of the copper IUD on zinc
- Restore intestinal and vaginal bacteria after coming off the Pill
- Low libido after coming off the pill
- Restoring periods postpartum
- Premenstrual night sweats
- Are agave and honey as bad as sugar?
- Unwanted hair growth and hirsutism
- What is Post-Pill PCOS?
- What to do about “life-destroying” periods?
- Premenstrual spotting
Lara: Hi everyone and welcome. My name is Lara Briden. I’m the author of Period Repair Manual. And we’re here tonight for a live question and answer session and hosting us is Holly Grigg-Spall who many of you may know, the author of Sweetening the Pill. And she’s also representing tonight an exciting toy, I think. It’s called Daysy. It’s a contraceptive device. So I might just let Holly tell you about that.
Holly: Hi everybody. So yeah, as Lara said I’m Holly Grigg-Spall. I’m going to be helping bring the questions to Lara this evening. I am the author of Sweetening the Pill which is this book. You may have seen it around. And I’m also here in my ambassador for Daysy capacity. Now, Daysy is a little fertility computer toy as Lara said. It’s a basal body thermometer that you use to track your fertility. And it can help you understand how to achieve or prevent pregnancy with a 99.3% accuracy.
So I am here as an ambassador for them as well. We’ll be talking about that a little bit at the end of the broadcast, including the discount code that I have to provide. But otherwise, most of this is going to be about your questions and queries. And if you have any questions that you want to ask live, then you should be able to type them into the question box. You should be able to see that if you’re watching this. Otherwise, we’ll also be going to the Facebook event page to take the questions from there that have been posted previously.
Lara: Great. Okay. Thank you. So should we get started with the first question?
Holly: Yeah, that’s good. Let’s start with the first question. I’ll take one from the live questions to begin with. And this is from Dutoi and she says “I’m 20 years old. I’ve never had a regular period. I’ve tested fibroid and the only problem is that my LH luteinizing hormone is high. I used to have two periods a month, now it’s one with brown bleeding between with cervical mucus. What does this indicate and what should I do?”
Lara: Okay. So first of all, I should say that I can’t get too specific in my answers in an online forum like this. I can’t tell people exactly what to take. I can only so to speak in general terms. So this question about the elevated LH is quite a good question. I think there’s a couple of other people who asked this in the lead up, was the question they left in the lead up for today.
So LH is a pituitary hormone that is normally – should normally be low throughout the cycle and it only spikes up just before ovulation. Its job is to stimulate the ovaries to release the egg. But it’s a common pattern for LH to be high kind of what they call a baseline high level of LH and you usually detect that by testing on day 3. And it can – it’s often part of the pattern of PCOS or polycystic ovarian syndrome. Not always but that’s a common pattern because LH when it’s high all the time stimulates the ovaries to make too many androgens or male type hormones. So it can – LH can be high for a few different reasons. If there’s an underlying problem with insulin for example or inflammation or sometimes coming off the birth control pill LH can be high.
So with my patients I try to – the first thing I do is try to look for any of those underlying conditions and correct that. And then after that there are a number of herbal medicines that have – basically have an LH-lowering effect. And that’s what I discuss in my book, in chapter 7 is a herbal combination called Peony and Licorice which works quite well for the – the herbal medicine black cohosh has also been shown to have LH-lowering properties. And I gave instructions of how to use Peony and Licorice in my book.
Holly: Okay. Great. The other thing I was going to say is if you want to ask your questions on Twitter instead of on the question panel here in Google Hangouts, you can just do it by using the #periodrepair and just go ahead and ask your questions there because I’ll be monitoring that as well if you want to go to that platform instead.
So we’re going to go now to a question from the Facebook event that someone posted previously. Which I think is a really really great question and it’s one that I actually I’ve been told many times I didn’t go into enough detail with in my book, so for the next round of publication there. But it’s from Lana and this is “Can you explain the difference between a hormonal birth control withdrawal bleed or what some people call I guess fake period and a real period?”
Lara: Yes. That’s such a great question. I hope Lana is out there listening and I hope one day we can all meet in person and discuss this a bit more but this is the – what I call the emperor’s new clothes. This myth that I think perpetuates the continued use of hormonal birth control well beyond for reasons that it shouldn’t be used for.
So we have this idea, this delusion that the pill withdrawal bleed is the same as the period bleed but in fact they are very different. The only thing that is similar about them is the shedding of the uterine lining. But if you think about that why do we – why does that matter? I mean we don’t really need – if we’re building up a lining yes, we eventually need to shed it but the real purpose of a period, of a natural cycle is to make estrogen first, estradiol, a very beneficial hormone in the first part of the cycle and then come in with a nice dose of progesterone in the second half of the cycle. And that’s where the benefits of natural cycling come from. It’s from the hormones and from the ovulation that makes hormones. And the steroid drugs that are in hormonal birth control are not the same molecules, they’re not the same hormones, they don’t have the same benefits. In fact, very often their effects are opposite to our own natural hormones’.
So it’s by having this – and also I guess the bleed, a pill bleed is just a drug-induced bleed. It doesn’t really say anything at all about what the body would be capable of doing with its own hormones. In fact, because the hormonal birth control shuts down women’s hormones and replaces them with these drugs that don’t have the same benefits.
Holly: Yeah, I think that’s something that a lot of women don’t realize is that you’re not regulating your natural hormones or the hormones your body produces. You’re overriding it and replacing it which I think is something that a lot of people don’t realize.
So we have a live question from Nora which is about acne. She says “I can always tell when I’m ovulating or I’m PMSing because my face is a signal for all hormone-related changes. I struggle with breakouts along my chin area which I’ve been told is a hormonal-related problem.” So she has tried many herbs including doctor-prescribed progesterone, so I see supplementation and she wants to know what your suggestions might be.
Lara: Yes. I thought that was a good way that she phrased it that the skin is signaling the hormonal changes. But that’s because the skin is quite sensitive to our estrogen levels, as our estrogen levels as they go up and down. That doesn’t mean that our estrogen is the cause of skin breakouts. There’s almost always – and I explain this in my book – there’s almost always an underlying problem with either blood sugar or insulin problem or dairy sensitivity or zinc deficiency. There’s some fundamental things that need to happen for the skin and then it can stop reacting so much to the normal ups and downs of estrogen.
That’s it. There is another aspect to hormonal breakouts and often very – I mean the term hormonal acne is when it relates to elevated testosterone or androgens, male hormones. So if those – if – and this goes back to earlier talking about polycystic ovarian syndrome which someone can have even if they have fairly regular cycles, they still might have elevated androgens in which case it’s worth testing for that, knowing that you have that and then using some treatment to try to reduce the androgens.
But just really on the ground clinic day to day what works for breakouts and acne in almost every case, every person is stopping dairy at least for a while, trying it for a few – it has to be for a few months. All dairy, including yogurt and cheese. And there has been some research to back that up that women who consume dairy are far more likely to experience breakouts. Women and men.
And stopping sugary foods, desserts and just stopping them completely for a few months. And that – and together often with – I often give zinc. It’s such a helpful mineral. That combination is quite powerful for skin, regardless of whether they flare up before – regardless of whether the skin flares up before ovulation or before periods. I don’t – that’s interesting but that’s not the whole problem, if that makes sense.
Holly: Yeah, and I guess the other problem is it does not necessarily – it’s not like you have dairy or sugar and then the next day you have breakouts, is it…
Holly: That’s why I think maybe I would make the connection and of course we all assume it’s more like hormonal because that’s what we’ve been told. But I suppose if you have a lot of dairy one week, then I guess it can take some time for that impact to show on your face, I would think.
Lara: That’s a great clarification. Yeah because we can see that hormonal fluctuation more quickly. It’s like yeah, the skin will change throughout the month but yes, the longer acting problems of dairy and sugar and zinc deficiency will, it takes months for that. A few months for that to really notice the difference. It’s very unusual that you could stop dairy and then the next week noticed your skin clears up. And the other thing about hormonal acne is when often patients say to me it’s like “Well, it must be hormonal because it clears up on the pill.”
The synthetic estrogen that’s in the pills is called ethinylestradiol and is in a high dose. It’s a strong estrogen. It’s not the same as our body’s own estrogen. It dries up skin oils and basically just prevents any acne from any cause. So no matter what else is happening with you, with dairy or sugar or zinc deficiency, the pill will dry out skin oils and prevent acne. But that doesn’t mean that there was a deficiency of ethinylestradiol, it wasn’t deficiency of the pill.
Holly: No. And also when you come off as I did after 10 years. You know, I had beautiful skin on the pill but I came off and I had acne like I’d never experienced prior to not being on the pill when I was a teenager. It’s just like insanity, really.
Holly: So that’s the thing and at some point you’re always going to have to come off, right? Whatever it is; because you want to have a baby, or just because you get older or – and then, you know, not everybody deals with that but some people really do.
Lara: Just say again Holly, how soon after coming off the pill was your skin at its worst?
Holly: Probably to 6 months.
Lara: Okay. Interesting.
Lara: It’s usually about 3 to – well, 3 to 5, maybe I guess 6 months after coming off the pill. And that is almost always. That’s the way the human brain works when you think “I’ll give it a few months, I’ll come off the pill for a few months to try out.” And they basically they get to the 3 month point and their skin is so bad that they go back on. And that’s one of the most common stories I hear.
Holly: Yeah. I certainly thought about it but by that point I was so interested in the blog. I was like I can’t possibly. That would be the end of my entire thing.
Lara: That’s funny.
Holly: I trapped myself. Actually it was so funny, I was talking to somebody the other day it was interesting and they just started reading my book. They were like “In the early part of the book you really sell that pill. You know, you say it makes your skin really clear and you’re really skinny and like…” – it’s like I didn’t mean to sell it. It also made me depressed and anxious and I had panic attacks and felt miserable. Just keep reading and then you’ll see.
But we have a live question here from Sabrina. Oh, yes, from Sabrina but this has also been asked over at the Facebook event page by 3 separate people previously which is “What causes – and I see how can you prevent pain around ovulation or what is called Mittelschmerz, isn’t it a German word?”
Lara: Yeah. Okay. Let’s – well, first of all let’s define what is normal. Okay. The normal ovarian pain is just a twinge. It would really only be for a couple of hours. And it’s not – it’s like – you noticed it’s like a little pinching almost in the lower pelvis. It’s not pain that requires a pain killer or that interferes with functioning with your day in any way.
So yeah, I think it’s if women are experiencing something different then it can be for different reasons. First of all, I mean I think if it’s recurring, if it’s every month, I think it’s worth speaking to the doctor because it can be a symptom. The doctor will probably want to rule out infection or ovarian cyst or some other things that are going on in the pelvis.
Once that’s been ruled out then there’s a couple of options. One thing – I’ll say one thing that – ovulation can be a bit more painful when it’s been a long time since you ovulated. And that would be the case for people coming off the pill because their ovaries are just quiet and dormant for possibly years.
So those first couple of times when the egg has to break through the side of the ovary that can cause more pain that once the ovaries have done that a few times it shouldn’t continue. The other thing I guess what I see clinically or what I would do with my patients is just look for signs of chronic inflammation. And I don’t necessarily mean like an infection or endometriosis or something kind of more serious, that kind of inflammation but even just for example having just too much dairy in the diet just creates some congestion or inflammation in the pelvis that – I think it has a lot to do with the health of the intestinal bacteria and therefore the health of the immune system and whether the immune system is generating inflammatory compounds or what they call inflammatory cytokines in the pelvis. And I think when the ovaries are in an inflammatory situation then ovulation can become more painful.
And the other thing that I look at that seems to relieve ovulation pain is correcting an iodine deficiency. Because the ovaries really love iodine and it just seems to make them ovulate better and behave better. And finally about this question I’ll just confirm; we’re talking about ovulation pain but it’s important that women track their ovulation, know when they ovulate. So you’re not just guessing.
Mid-cycle pain could be lots of – if it’s just pain between periods that could be lots of different things. But if it’s actually occurring at ovulation – and that’s where I think of all the take-home messages for women, I think one of the most powerful thing to do is to properly track ovulation. Which you can do with something like temperatures, which you can do with something like Daysy or just a basal body temperature thermometer, an ovulation thermometer and look for the temperature rise and know when you ovulate so that you can really look at symptoms and know whether they’re happening at ovulation or after, whether you have a proper ovulation and therefore what they call a luteal phase, the second part of the cycle. So it’s a few questions, a few answers to that one.
Holly: Yeah, I know. I think that’s really important because it does depend when you’re experiencing things, what the treatment would be or the cause is, right? And then a lot of things happen because you’re not ovulating regularly. So you know that’s something that you might think “Well, I’m having my period so I assume I’m ovulating or my cycle is irregular so I assume that or I’m having ovulation pain which I actually get sometimes which is such a weird sensation.”
But yeah, it’s – I think it’s very true. And I think if you – that’s kind of like key to being able to figure things out. And I know you said before that it’s really helpful if you have charts to share them, then you can share them with like a doctor or your healthcare provider to be able to like get to really dig deep on what’s going on.
Lara: I ask to see my patient’s charts all the time. So these days they just print it off from their app or…
Lara: …they just send it to me straight from their app or email it to me.
Holly: Yeah. So easy.
Lara: They take a screenshot.
Holly: It’s wonderful because we hear so much these days about how women don’t get quality healthcare and they are not treated in the same way as men who visit the doctor if they’re experiencing pain or reproductive health problems and a lot of things you just – that are always just in your head. So it’s great that these tools are there to be able to help women to go to their healthcare provider and be like I actually have data hear that you can look at and help me.
Lara: And let’s talk about pain for a minute. When you’re talking to a doctor it’s important to tell the doctor exactly how much pain, how many painkillers you’re using and that just to try to explain it a bit better because the doctor may not understand that you’re – if you’re using a box of you know like 8 Tylenol per day, that’s different than if you just get a little bit of pain.
And one of the most common causes of pain between periods is a condition called endometriosis which we’ve talked about in our previous Q&As and I have a blog post about it and I talk about it in my book. I would just encourage anyone experiencing pain to know what that condition is and ask the doctor if that’s been ruled out.
Holly: Yeah. Definitely. Okay. So let me bring another question from the live section here. One was about zinc deficiency from Christine. She just wants to know – hopefully quite an easy one to answer – what kind of dosage do you think should women be taking and how long do they take it for is it – is it indefinitely or for a period of time?
Lara: That’s a good question about zinc. I often – I start by doing a blood test for zinc. The one I order is called “plasma zinc” and you don’t have to be fasting. You can just do any time of the day and your doctor might be willing to order it for you. Because zinc deficiency is very common in women – it’s particularly common in anyone who is vegetarian. So that’s a consideration that your doctor would need to know about. And it’s depleted by hormonal birth control. So after many years on hormonal birth control women are commonly deficient in zinc.
So I like to get baseline just so like I can kind of maybe know where we’re aiming with the dose. I dose anywhere between maybe 15 to 50 milligrams. 50 is a high dose. I might do 40 or 50 just for a few months if someone has for example got bad acne or breakouts and they just want some rapid relief with that, it can work very well.
And then yeah, I wouldn’t do zinc, I wouldn’t do it forever. No. I would probably – depending on the dose I might do it for between 3 to 6 months and then retest. Stop the zinc for a day or two and then retest and just see if we’ve – you know, if we’re in the middle of the range or if we’re getting too high in the range of normal, then I would stop the zinc for a while. Because it’s important – I mean zinc is in balance with another mineral called copper so we don’t want to take too much zinc long term. And – oh, and zinc must be taken after food, directly after food or it will cause nausea.
Holly: Yeah, I was just thought – two questions that came up for me when you were talking about that was – one was; is zinc the best taken as a supplement? Is there like a way that you can dietary zinc like from food? That’s a good way of getting it other than supplements. And also when you talked about the copper and zinc balance, I was wondering if somebody has a copper IUD, does that affect zinc production?
Lara: I always get asked about the copper IUD.
Lara: And so…how to say? I have some patients on the copper IUD. I’m not anti-copper IUD, I’ll put it that way. I think for some people it can be the right choice. So I’ve had the opportunity to check their copper and measure their copper before and after. Maybe a few months after or 6 months after. I haven’t seen that it causes elevated copper. But what does cause elevated copper is hormonal birth control because the synthetic estrogen, the ethinyl estradiol causes the body to retain copper. And copper is actually – in excess it is not a very nice mineral. It starts to act more like a toxin at that point.
So that’s the answer for copper and – oh, and food sources of zinc. It’s pretty much meat and things like oysters and animal products. The plant food that has the highest dose of zinc is pumpkin seeds.
Holly: Okay. Great. Okay. I’m going to go back to a question from the event page now. So July asked how can we restore our natural intestinal and vaginal bacteria? So I guess your micro biome or your micro flora after coming off the pill or after taking a lot of antibiotics?
Lara: Yeah. Great. Okay. So there is a – and I did talk about this in the book in chapter 10 and in the book I have a section on vaginal flora, like the good bacteria living in the vagina and the reproductive tract. And they’re really important for menstrual health and just you know, fertility and all kinds of things.
So there are – I think one of the best – the first strategy is to avoid antibiotics as much as possible. I know that’s not always possible. But I work with my patients to have alternative strategies for avoiding for example sinus infections and tract infections and things like that. And then – but if – and then also there is – I think the question suggests there is – hormonal birth control itself causes damages the good bacteria in the reproductive track.
So they often need to be repaired after that. I use – I get good results using a couple of strains of lactobacillus. So that’s a probiotic, that’s a type of good bacteria that you can take orally and that you can also insert or apply to the vagina, to the outside of the vagina. And the strains that I use is in all different brands, so this is in the brand – these are the actual names of the species, there’s lactobacillus rhamnosus GR-1 and lactobacillus reuteri RC-14 and those – on the Facebook page later maybe I can give links to a couple of products that I have those.
And so I can get good results if someone is experiencing yeast infections or bacterial vaginosis or some of those signs of bacterial imbalance, this product can be – like this – I would say a 2 or 3 months course of the probiotic can be really helpful.
Holly: Great. Because there’s so much more research out there these days about the importance of the micro biome, isn’t there? It’s so great to have some practical ways of resolving that. So I go back to the Facebook event for another question. So Cynthia – now, this is an interesting one because we’ll be doing a Tweet chat which I’ll talk about later in the broadcast. We’re going to kind of focus a little bit on this. Asked about what to do about low libido after coming off the pill?
And this is something I find really interesting because when I first started working on my book I found this research that showed that for some women – the way that it affects your testosterone levels means that they never return to pre-pill levels. Now, they never return to pre-pill levels I see without any kind of natural treatment or any intervention as far as the – you know from what the research suggested. So yeah, that seemed to be a problem that a lot of people deal with.
Lara: Okay. Yeah. I saw that research too. That was like more than 10 years ago now that it came out. Now that’s a little bit worrying. The truth is we don’t really know because no one is – hardly anyone is researching the effect of hormonal birth control on libido which is really sad. I don’t – I doubt it’s forever. I think people can recover it. I think for people to – part of the challenge is knowing what’s normal for you. All of us have different sex drive, different libido and what worries me is when someone went on the pill at a very young age, say at 13 or 14 that may be before they ever had a chance to fully gauge what is normal for them which is I think a very strong argument for not putting 13 year olds on the pill, if we needed another argument, many arguments… But our sex drive is important, even for teenagers.
The reason they think the effect, the libido suppression might be long term is that its effect on something called SHBG which is sex hormone binding globulin which is normally binds up estrogen and testosterone in our blood. It’s kind of like a hormone sponge or a hormone regulator and on the pill it can go really high, like triple, triple normal, sometimes I’ve seen.
So if someone has come to me for help with post-pill libido I might start with actually just looking at their SHBG. I wait 3 months after pill and then measure it to see is it still elevated? And then I guess if it is, if it’s elevated and it’s not going down then a couple of considerations – the first is to – the first thing before we say anything else is to get the ovulation happening and normal cycling of estrogen and progesterone because that’s – the estrogen in particularly is very good for libido and duplication and the ability to respond pleasurably and all that.
And then if libido is not improving and SHBG is not going down I’d probably look at the herbal medicine Tribulus. I do talk about it in my book actually in a slightly different context. It can be used to boost estrogen levels but it actually has a libido boosting effect generally. And I think it has a slightly – and like a male hormone boosting effect which inversely will help to reduce SHBG. That’s – and I wouldn’t do that forever but I might do say a 3 month course of something like Tribulus.
Holly: Okay. So I actually have a question from Twitter which is from Linda on Twitter. She says “How long postpartum can it take for your cycle to normalize? 1 or 1.5 year?” she asks.
Lara: Yeah commonly people ask that on the Facebook event page, too. In my understanding is it just varies so much from woman to woman and depending on how much, how frequently she’s breastfeeding. So postpartum I guess that would mean – as long as when – people know this but as long as you’re breastfeeding, you’re making a hormone called prolactin which suppresses – can suppress periods entirely or can just make them less regular.
So after – I would wait until after weaning, after breastfeeding and then let’s say 3 months after that, if we’re not starting to see – 3 to 6 months after weaning, if we’re not starting to see cycles coming back then I might do some tests look at prolactin and FSH, LH and see what’s happening. So I don’t think there’s an easy simple answer of how long after delivery.
Holly: No. Actually a lot of people who use Daysy – obviously a lot of women originally use it to prevent pregnancy but they use it to get pregnant too and then they use it once they’ve had the baby because it’s a really great device to use when you don’t get very regular sleep or a lot of sleep. So you actually only need 3 hours of consecutive sleep to be able to use it. And that should help you like get some warning ahead of time of when you’re going to get your periods, if you are feeling like just insane because you really don’t know when your period is going to come.
Lara: Yeah. Yeah. I mean someone’s period can balance back right away within a few months but that’s not the standard, yeah.
Holly: Yeah. So let me go back to the Facebook event questions. And you can still ask them there if you’d like to use that as well, I’m keeping an eye on that, too. Michelle asks about night sweats. Why did it occur before ovulation and before your period or at least that’s what they do for her. I think this is interesting because I know also that your hormones can affect your quality of sleep and some people deal with it at different points in their cycle as well which I think is something that might be of interest to people.
Lara: Okay. Great question. Yeah premenstrual time is – insomnia can be, it is a common PMS symptom. That’s because both estrogen and progesterone are beneficial for sleep and when they both drop, starting 3 or 4 days before the bleed and so some women feel more – feel that more, are more sensitive to the drop in hormones. And the solution is to – I’ll talk about the solution and then I’ll come back to the question about the next one – the solution is to try what I call hormonal resilience, so try to stabilize the hormone receptors.
So that drop in hormones isn’t felt as acutely. Because it’s normal for hormones to go up and down. This is the kind of language around PMS that I don’t sort of like is that the hormones themselves are bad. Somehow the hormones are causing havoc. They’re supposed to go up and down.
And on the other side of it, we’re supposed to be able to – like have the underlying health or resiliency to adapt, it’s adapting to that basically. And I just kind of set the bar quite high but I will say that I don’t think PMS is normal. It’s common, even I experience it at times. So there’s going to be some months when you experience it more than others. But it’s, we all of us have the right to just experience the period that just arrives with no mood change, no breast tenderness, no sleep problems. And this is the hormonal resiliency that I talk about in my book.
So the answer about night sweats, I think the mechanism, you know the reason, that’s a common PMS symptom or that it also occurs just before ovulation is because of the drop on estrogen. So estrogen actually peaks about 2 – about 3 days before ovulation and then drops a little bit. Not all the way down but it drops a bit and so that can cause bit of spotting or a bit of flashing sometimes for women and then it calms down again in then what’s called the luteal phase and then together with progesterone they both drop before the period.
So I hope that’s helpful. I’ll just say one of the ways to get resiliency without having to buy my book or anything; magnesium. I don’t want to just always be saying buy my book but magnesium is extremely helpful. It’s the one supplement for PMS. And some scientists think that PMS itself is really a manifestation of magnesium deficiency. And magnesium is difficult to obtain from diet. We get it from leafy green vegetables. So lots of green salads and green juices and things that are providing us with magnesium.
But the problem is that we also lose magnesium very easily with stress, with alcohol, with caffeine, with any of those things. We just dump it out. It’s our nervous system does that intentionally to kind of rev itself up. So unless you – what I say in one of my magnesium blog post, unless you’re a monk, living on a mountain, meditating all the time, you’ll probably need some magnesium. And it’s a quite safe mineral to use as well.
Holly: Yeah, I think that’s such an important point because I think so many women have got used to PMS is just what you’re meant to put up with and expect and you’re meant to have up to a week where you feel really anxious or really angry or really sort of frustrated or have all the other symptoms that people get. And I think it’s really unfair, isn’t it? That we sort of let people to believe that they should feel that badly and yeah, such an effect on lives as well. So if you can know anything, I think knowing that it’s not normal and you don’t have to put up with it and it’s not being hormonal, it’s not necessarily. That’s so important.
Okay. So let’s see what else we’re going to get into here? So how about – oh, that’s a nice one to contribute to that little discussion. Lauren has asked “What would you recommend – herbs or supplement-wise to help increase energy and positive mood during your period? Or I assume you just said magnesium for PMS but what about if you find you don’t feel great when you’re actually experiencing your period?
Lara: Okay. Yeah. Okay. Certainly that can happen, too. I think what Lauren is saying is that during the bleed itself she feels low mood or fatigue. That’s I think – I guess if one of my patients presents me with something like that then I’m looking at a couple of things. I’m looking at depending on how heavy the bleed is and whether with the heavy bleed causing fatigue then what just generally someone could benefit from checking iron status and perhaps looking at iron-rich foods or an iron supplement.
But also that time – like the fatigue during the period can be associated with – again – sort of an underlying level of chronic inflammation that might be coming from like a problem with the intestinal bacteria or foods that are causing an inflammatory reaction like – I’ll just go back to dairy. I think dairy is of all the inflammatory foods – and inflammatory foods being perhaps wheat, sugar, vegetable oil – dairy is the one that seems to hit periods the hardest. Sort of makes them – I think because it partly causes a histamine release and a prostaglandin release.
So that – so if someone is experiencing difficult periods where they feel fatigued and unwell, I would look for other signs of dairy sensitivity and perhaps ask them to try to avoid it for a few months – it’s not just about avoiding dairy during the period. It’s about avoiding it because everything we do really for the month leading up to the period or even the few months leading up to the period translates into what the period is like. This is why I call periods our monthly report cards. They’re telling a story about something whether it’s iron deficiency or inflammation, commonly.
Holly: I think people might be interested to hear if you don’t or you recommend or I assume you yourself also avoid dairy specifically as a way to avoid the symptoms, does that mean any dairy or are some dairies are worse than others? And if you don’t have dairy, milk, cheese yogurt, do you use anything that is a substitute and what would you recommend as a substitute?
Lara: Okay. Yeah. Great question. So I don’t take normal dairy. Normal dairy being cow’s milk. The problem – there’s a few problems with it. It contains quite a lot of hormones. So I think that’s one of the reasons that it affects periods. But it also – what the likely culprit in dairy, the inflammatory part of dairy is probably the protein. A protein called A1 casein which is not in all milk. It’s only in certain cows. Unfortunately in the Holstein cows that most of the big factory farm dairy comes from. So other animals like goat or sheep do not contain the inflammatory part of milk. Do not contain the inflammatory casein.
So I myself eat a lots of goat and sheep cheese and yogurt and I found that’s okay for me and that’s okay for a number of my patients. And some types of cows as well Jersey cows have – many of them do not contain the A1 casein, the A1 protein. And also high fat like butter and heavy cream because they’re mostly fat, they don’t have the inflammatory protein part of dairy. So those are the kind of recommendations I give to my patients. And like other signs of dairy sensitivity. I’m looking for things like hay fever or chronic sinus or as a child perhaps, like I always ask people that when they were kids did they have recurring tonsillitis or chest infections or anything like that because those are common signs of dairy sensitivity that they had then and that really doesn’t – dairy sensitivity doesn’t go away. It just changes into something else. Maybe they had tonsillitis as a teenager but now they’ve got painful periods or endometriosis or something like that, it just kind of goes deeper. That’s my experience clinically.
Holly: And what about sugar? Now are sugars made the same like agave and honey and stevia and molasses? Like do you have a take on that like when you cut out sugar, do you cut out everything sweet? Or are there some things that you can have?
Lara: Good question. Not – okay, some people need to cut out sugar more desperately than others. So I think some people can get away with a little bit of honey or agave. And it’s just a nice treat and it’s not a problem.
But if someone is insulin resistant, has insulin resistance, then yes. For my patients if I’ve confirmed with the blood test that they have insulin resistance, if they’re having symptoms of insulin resistance such as polycystic ovarian syndrome for example, then – which affects period. Something called PCOS. Then I need them to come off sugar. Like the only way we’re really going to get results is to quit all deserts and that includes honey and agave and dates. Dates are the big one. Dates are the one that kind of get through somehow, they’re considered as a natural food. Stevia is different. Stevia is not – so all of those things, dates, agave, honey, those are all fructose, high concentration of fructose. Not that different from what they call the high fructose corn syrup that kind of everybody knows is bad. Fructose is bad in quantity. Below of a certain threshold, if insulin sensitivity is normal, then a little bit of fructose is fine.
But stevia is a herbal sweetener. It’s totally different. It’s a different molecule. It’s not fructose. So I think – as far as I understand, stevia is safe. I do recommend that for my patients.
Holly: Somebody had a quick follow-up question on the live stream here. What about raw milk?
Lara: Okay. The short answer: I don’t know. I think – in my understanding I think probably raw milk is better in some ways. It will not get around the problem of the A1 casein. So I think actually what happens practically is that often farmers that are providing raw milk are providing Jersey cow milk for example which is healthier anyway. Beyond that, like if you’re looking at milk from a Holstein cow that has a lot of A1 casein, I think it’s possible that when it’s raw, unpasteurized, that the casein is a bit easier, less reactive and less of a problem. I don’t – I haven’t seen any research around that. I don’t recommend raw milk to my patients just because I don’t feel confident about it. It’s a kind of a controversial thing to do so it’s not something I have.
Holly: Okay. So I’m going to grab a couple more questions from the live feed. Because they’re coming in pretty fast here.
Holly: Yeah, it’s great. Lana actually she asks again, what about unwanted hair growth? Specifically on the face or chin. Where does that come from? I know sometimes it can come with hair loss in other places which must be so frustrating.
Lara: Yeah. It is.
Holly: Is there anything I know you’ve written a lot on hair loss on your blog and in the book, so…
Lara: Okay. It’s very distressing for some people. Just to put it in perspective it’s not a small issue, depending on the amount of – you know, it’s different. Just the odd hair on your chin or upper lip or something, that’s not the same but yes, there are women, there are young women that are facing a very distressing amount of facial hair and body hair. You might not see that because they’re waxing and – but it’s just stressing for them. And often – that’s called hirsutism. It’s caused by too many androgens or male hormone or testosterone and it’s usually part of PCOS or polycystic ovarian syndrome. Usually. I mean that’s a key kind of symptom of that condition. And high androgens, testosterone can also cause hair loss and can also cause breakouts or acne. But I’ll just say about the hair loss and acne can be caused by other things.
So they’re not synonymous with having high androgens but facial and body hair is almost it is really. If not, if the androgens aren’t measurable and – it’s a common – usually the androgens are measurable on blood test like testosterone and DHEA and another called androstenedione, they’re usually high. And if not, then there’s a problem with hypersensitivity of the androgen receptor.
So what to do? Yeah, it’s about lowering androgens which is about correcting PCOS which is about identifying the underlying cause of PCOS for you. Like for that one person is different, certainly different for everybody. The most common underlying cause is insulin resistance. But an underlying cause can also be inflammation or could also be just a temporary post-pill situation that’s happening.
So this ties back – tie back – this was the first question about elevated LH. That’s the LH hormone from the pituitary. That’s another symptom or sign of PCOS.
Holly: Yeah, I think – I found it really interesting when you talked about post-pill syndrome as something that people can suffer with. And often you get diagnosed I guess with PCOS but not specifically as a post-pill syndrome, when periods don’t return right away. I also found it really interesting what you said in our Q&A yesterday about how it’s not when you come off the pill so much about getting rid of the synthetic hormones, is about balancing your own body’s hormones. Because I think a lot of people think, well, I have to detox my hormones.
Lara: I know. I never really – I don’t use that phrase with my patients. I just focus on restoring ovarian function and activity. And I’ll just respond to the post-pill – so there is definitely a time – it can happen – it’s just sort of a temporary elevation of LH. And even androgens creeping up into the upper end of normal of normal, that occurs post-pill before ovulation has been re-established. This is kind of how it looks on the blood test. And the person might also have had an ultrasound that shows that the ovaries have a polycystic appearance.
But and if it’s – I don’t – if I see someone – if one of my patients comes to me and says “I’ve been off the pill for 4 months and this is what this is showing and therefore I have PCOS”, I don’t take that at face value. I might say did you or your periods before you went off the pill? And let’s first just try to get your period going. And then retest and then we find out 5 or 6 months later that it’s all normal. And their ovaries look normal on ultrasound and it’s just where they were at with their hormones and ovaries during that time before they started working normally again post-pill.
But that’s not to say that every – some woman do have PCOS and have a long-standing problem with elevated androgens. I don’t like it the way anyone with a slight androgen or problem is all lumped together under one diagnosis. It’s very confusing for people. And yeah – so I just try to think of it more functionally in terms of what are the ovaries doing, what’s happening right now and – yeah.
Holly: Yeah. I think that’s great. There are a couple of ladies who asked on the Facebook event about having really bad menstrual cramps and there’s one lady – which is really sad to hear – she just has what she calls life destroying periods. And both of them were not getting much help from their regular doctor about it, just basically telling them that it’s something that you have to put up with and that they should just go on the pill to get rid of it. I’m sure that this is if you do come off the pill some women do struggle with it and it’s very difficult for them. And it’s really sad to hear that it can be that severe. What kind of recommendations do you have for that?
Lara: Okay. First thing, if the pain is life destroying, the doctor needs to know about that. Don’t accept – okay, I’ll speak again about endometriosis. Of course I can’t say whether this is – what the person who asked the question specifically has because without all the information I couldn’t know. But anytime there is that much pain, the doctor needs to understand. And the doctor just says “That’s just how you are. That’s just some women have more pain than others.” Don’t accept that. Basically I would get a second opinion. There’s an inflammatory condition, a very painful condition called endometriosis which affects 1 in 10 women which typically takes 10 years to diagnose. Because of exactly what you’re saying, people just – they go to the doctor and doctor is like “Oh, it’s just you’ve got painful periods and take the pill and…” which the pill can actually somewhat mask or somewhat improve it. But the underlying condition just marches on.
So that anytime someone tries to come off the pill, then they get these terrible periods back again. I think it needs some investigation. So there aren’t easy ways to diagnose endometriosis unfortunately. The doctor can try with an ultrasound to see something. A good gynecologist could sort of do a physical exam and perhaps be able to kind of feel something.
So endometriosis are these little inflammatory lesions that can go throughout the pelvis. I mean it’s a benign condition as it is not – I mean it really just causes pain. That’s the primary issue. It can affect fertility as well. And then sometimes the doctor might suggest having surgery to investigate it. And I often support that with my patients. I know that’s not very naturopathic or natural but I think if it has reached that point and the doctor wants to have a look for endometriosis, I think it worth doing it. I really hope one day soon we’re going to have a blood test for the condition because that would just make things so much easier, so much better.
Holly: Yeah. It’s interesting. Just to interject there my sister has really bad endometriosis and she has had everything, including acupuncture in the UK and lots of different things. And actually when I came off the pill about 2 years later I had a lump that I couldn’t explain. It was like this painful lump in my belly button. And I had it for ages and I really didn’t know what it was. This is something I haven’t talked too much about because it’s kind of strange but it’s interesting. I went to the doctor and she said “It could just be a benign cyst or I really don’t know.” And eventually they said that we could do outpatient surgery, just minor surgery and remove it and see what it is. And they did and they tested it and it was endometrial tissue.
So essentially that meant that I have endometriosis as far as I’m concerned. So I had the internal examination and everything and they said “Well, yeah, you have endometriosis.” But I have none of the symptoms of endometriosis. My doctor told me “Well, do you want to try to having a baby?” and I said “Well, no, I don’t want to have a baby in the near future.” And she said “Well, come back when you do.” That was literally – and she is a lovely person like an absolutely lovely doctor, a very sweet person. But she was like if you’re okay, you’re okay but you do have it, you know?
Lara: It’s an interesting condition. It can be – someone can have quite extensive endometriosis, these lesions throughout the pelvis and have almost no symptoms. In which case it doesn’t always – and some people can have just a tiny bit and have a lot of pain. I think it ultimately comes down to the amount of inflammation in the body because it’s an inflammatory condition. So people regardless of kind of the quantity, depending on if they have more – if it’s more inflamed it’s going to cause more symptoms.
So hopefully in your case that means it’s relatively un-inflamed and is not causing damage or – because the problem – what they’re worried about with fertility is that in theory it can cause scar tissue and impair future fertility. Although not in every case. I met a woman who had endometriosis and then go on to have no problems at all. So it’s a complex – it’s an interesting condition but I love treating it because it’s one of the things that I respond the most dramatically to natural treatment.
Holly: Well, the interesting thing is that I don’t have symptoms but since I came off the pill I’ve been vegan and a variation of vegan and vegetarian. And I was actually at a conference recently with somebody who is a representative of the Endometriosis Society and she was just starting a vegan diet and she said it was the only thing that gave her dietary-wise alleviation of symptoms. And a several people have said to me well, I don’t know, maybe it’s because you don’t eat a lot of dairy.
Lara: It’s dairy. I’ll say it’s dairy. I mean I think beef – I think certain animal products are a little bit more inflammatory for endometriosis but…
Holly: I don’t eat red meat at all so it’s…
Lara: I don’t ask my endometriosis patients to become vegan but I take them off dairy. And I test for gluten sensitivity and look at anti-inflammatory treatments.
So yeah, we should maybe have a future Q&A just about endometriosis. I think it’s endometriosis month coming up in March in a number of different countries. So it’s an important – I guarantee almost everyone out there knows somebody. If they don’t have endometriosis themselves, they know somebody who has it. It’s pretty common.
Just going back to the question about the life destroying periods. I mean it might be something like this, if it’s more of a premenstrual – it might just be kind of a severe PMS as well which like I said can improve with magnesium and other strategies to improve hormonal resilience.
Holly: Yeah. I guess we have time for maybe one more question.
Lara: I know the hour went so quickly.
Holly: We should probably wrap up. Okay, so I’ll take one from the live feed here from Amy. “Can you talk more about options for spotting between periods?” She says she tried Vitex for 4 months since at one point she was tested for low progesterone but she now bleeds usually 10 days before her period.
Lara: Oh, gosh. That’s a lot of spotting. Yeah, okay. So spotting between periods can mean different things. So it can mean like the little bit of natural kind of ovulation spotting which is benign and it’s not a problem. If it’s happening throughout the luteal phase or the second half – okay, so spotting can also mean ovarian cyst or endometriosis. Just on the topic of endometriosis. Spotting can mean infection so it’s worth checking with the doctor and the doctor might then say, okay, it’s just a hormonal thing which is this luteal phase leading up to the period spotting. That’s primarily to do with progesterone levels but also thyroid.
And I give patient’s story in my book; I think it’s Rachel who was one of my patients who had this spotting that wouldn’t improve with anything. Like she tried progesterone cream, everything. And it just wasn’t – wouldn’t improve until we finally picked up on the fact that she had an underactive thyroid. And then she treated that and then 3 months later the spotting was gone. It was one of the more genetic cases I’ve seen.
But so spotting – because lots of different things affect progesterone production. It’s not just Vitex for progesterone. This is kind of one of the messages that I want to get out there. Progesterone is ultimately – when I say our periods are our monthly report cards it’s largely that progesterone is our monthly report card. We need – if we are vital in the 3 months leading up to ovulation and the follicles have everything they need. All the nutrients, no inflammation, they are happy, healthy, enough thyroid hormone, then we’ll make progesterone. So I hope that clarifies a little bit, explains it. We’ve only got a few more minutes.
Holly: Yeah. Only a few more minutes. So if you’d wrap up with a few things. First on Twitter on Thursday this week at 4 pm PST so that’s 7 pm EST we’ll be doing tweet chat and to join in all you need to do is use the #periodrepair, just to ask your questions. We’re going to try and make it like one sort of Valentine’s Day theme to talk about like these issues of libido and sex and sexual issues. And then the other thing that I wanted to provide is this discount code for Daysy. So if you are interested, we have a discount code. You just use PERIODREPAIR, all one word capitals as your code when you go to the checkout. It’s going to be available to use on purchasing the Daysy until the 17th of February. So you’ve got a week to use it if you do want to use it. And so that’s PERIODREPAIR, you just type that into the code when you go to checkout and you’ll get your discount there.
Lara: That’s great. And I’m giving away something too. I’ll just show you. I talked about it a few times but I’m giving away 2 copies of Period Repair Manual today. So well, I mean in the next couple of days I’m going to look at everyone, compile all the names of anyone who asked a question or sort of checked in on the Facebook event page and draw 2 names out of that group and send you – and then I’ll message you and then I’ll send you a print copy of the book. And if you already have my book, then you could just – this is a print copy that you could give to someone else who might need it.
Holly: It’s a great idea.
Lara: Thank you so much Holly for hosting it. It was a great as usual.
Holly: Thank you for taking the time to do it and I hope you’ll be able to do it again in the future at some point.
Lara: I hope in the coming months we’ll do it again. I’ll just go on social media and take some more questions.
Holly: Yeah. Great. Thank you. Thanks everybody for joining in.
Lara: All right. Thanks everyone. Yeah. Bye.