Welcome to Episode 5 of Season 6 of The PCOS Revolution Podcast:
What Every Woman Must Know About The Pill With Dr. Jolene Brighten
Birth control can be very helpful but is often misunderstand and over-prescribed for PCOS. On top of that, many women with PCOS don’t have a full understanding of birth control, side effects and all that goes along with it. In this episode, we shed light on birth control and the impact it can have on your body.
This week on PCOS Revolution Podcast, I am having a conversation with Dr. Jolene Brighten. Dr. Brighten is a functional naturopathic medical doctor and nutritional biochemist with a focus on women’s endocrine health. She is recognized as a leading expert in post birth control syndrome and the long term side effects associated with hormonal contraceptives. Dr. Jolene Brighten is a speaker, women’s health advocate, author and medical advisor.
In this episode, Dr. Brighten and I talk about her book and what inspired her book, birth control and the purposes for using it and tips for those on birth control experiencing symptoms. We dive into the difference between symptom management and root cause work, how birth control can impact mood and how to become educated and remove the fear many women have around birth control.
READ the entire transcript here:
Farrar Duro 0:02
Hello everyone and welcome back to the PCOS Revolution podcast. Today I have a very special guest. Her name is Dr. Jolene Brighten, she’s a functional naturopathic medical doctor and nutritional biochemist with a focus on women’s endocrine health. She’s recognized as a leading expert in post-birth control syndrome, and the long term side effects associated with hormonal contraceptives. This is a subject I’ve really been excited about delving into. Dr. Brighten is the author of “Beyond the Pill: A 30-Day Plan to Support Women on Birth Control, Help Them Transition Off and Eliminate Symptoms of Post-birth Control Syndrome” And we’re going to speak about that during this podcast today. She’s a speaker, women’s health advocate and a medical advisor for one of the first data driven apps to offer women personalized birth control recommendations. I’m so glad to have you here. Welcome. Dr. Brighten.
Dr. Jolene Brighten 0:54
Thank you so much for having me.
Farrar Duro 0:57
Tell us a little bit about what inspired you to write this book. First of all, I’ve actually been listening to your audio book, and I think that is very important. A lot of people don’t know about this condition. Could you tell us a little bit about what inspired you to work with this?
Dr. Jolene Brighten 1:12
The funny thing is that when I started my private practice, I swore never work with birth control again, which my husband reminds me, it’s like, and then you wrote a whole book on this. I have a personal journey with birth control. I spent 10 years on the pill, certainly glad to have that tool, because I’m a first generation college student, and was able to accumulate degrees and become a doctor because I had this tool to control my reproductive health which is very important for people to understand that I’m not in any way anti-birth control. This is more about what I wish I would have been told, and what I found in the research from working with my patients. The whole reason why I swore off birth control is that I spent two years doing clinical rotations in a homeless youth clinic. These are women who are at high risk of sexual assault, but they also are disproportionately impacted by the tampon taxes, the pink tax, so to speak, and mental inequality really impacts them. For them in particular, it’s really important to have access to birth control. We prescribed a lot of Depo-Provera shots and various forms of contraceptives to help them with where they were at in their journey.
Dr. Jolene Brighten 2:25
And after that, I was a little bit fatigued, I was so sick of talking through birth control and talking through all of this. And it was really when I got into private practice that I got the reputation of being the doctor who believes women’s birth control stories. It really went like this, women would go to their doctor complaining of heavy periods, painful periods, endometriosis, polycystic ovarian syndrome, or not even having a diagnosis. Going to their doctor saying, “I have irregular periods, I have acne, I have headaches,” and all they’re really met with is birth control. Then they start birth control and they develop other symptoms to which their doctor says things like, “Oh, you’re having mood symptoms, I have a mood altering medication.” “Oh, your thyroid’s tanking now? Here’s something for your thyroid.” “Oh, you have autoimmune disease, let’s get you over to the rheumatologist.” And yet, they were very much questioning…”I started birth control, then the symptoms developed. Is there any correlation with that?” In a lot of conventional practices, they’re being told no. The story really that we’re taught in medicine is no, birth control impacts your reproductive system. And yes, women report these other symptoms, but there’s no strong studies showing causation.
Dr. Jolene Brighten 3:38
And they’re still not strong studies showing causation when it comes to things like depression. However, with the way I practice, it’s all about believing the woman’s story and really listening into that story for clues. I came to get the reputation that I listened when women had these side effects and these symptoms with birth control, and when they came off, it wasn’t all sunshine and rainbows and unicorns, as we’re told, like, “Oh, you’ll just be able to get pregnant right away.” We’ll talk today about why that’s not a good idea. But also that’s such a short sighted…like, Oh, great, that’s the only thing we’re concerned about, what about everything else? What about the fact that birth control impacts every single system in our body? With that, it was really my patients who trusted me with their story, I dove in, I’m a big nerd, I dove into research. I really started to connect a lot of dots, and what happened in my health as well, in my journey, my story with birth control. And that’s what really propelled me to write this book is, I want women to have the full story and want them to have that informed consent. I want them to choose what’s best for them. And I want them to feel supported, wherever they are in that journey.
Dr. Jolene Brighten 4:47
If you choose that you want to use birth control, because you just can’t hang with your acne or you’re getting married soon, you shouldn’t enter into that blindly, you should have all the information you need, you should feel supported because there are ways to maintain your health, and stay safe while your on birth control. But there’s also things you need to look out for and need to know when is it time to contact your doctor. And really why the book is called Beyond the Pill is that all these patients who were just having their symptoms managed with birth control, I really want women to understand there is another way, we have solutions beyond birth control, to help manage heavy periods, painful periods, mood swings, anxiety, depression, you know what’s coming up as part of PMS. You really need to know how to navigate the medical system and talk to your doctor and advocate for the right labs. It gives you root cause solutions for the common hormone imbalance symptoms, it helps you understand what is going on in your body, how to work with your body. It fills in all the gaps that sex ed just skipped over and didn’t tell us about what happens with our menstrual cycle and our hormones. It also empowers you to have a more informed education. Basically, a more informed education platform for you to launch from to go into these medical visits, and really get the most out of your visit with your doctor.
Farrar Duro 6:11
That’s great. I think there definitely is a disconnect sometimes, because in the western medical world you’re taught that birth control is a cure for a lot of things, not just for acne, but for prevention of cancer and many things, and it’s all in the textbooks. I think it’s going to take some time and work like this to actually, you know, kind of unravel a little bit of that, and know that not everybody is the same. I mean, personally, I could not take birth control. It just made me extremely ill. And the doctors were like, well, you’re just a freak. That can’t be possible, but I said, Well, I think I’m different. I’m very different than the next person who can take it and they’re totally fine.
Dr. Jolene Brighten 6:54
Well, and that’s what we really need to be looking at. Is that a lot of people have tried to say, “Okay, well, Dr. Brighten, it’s just trying to have no woman be on birth control and shut down access.” And no, I’m trying to raise the conversation and raise the awareness around what happens, because you can get on any social platform, and there are thousands upon thousands of women who have never met each other telling the same stories, and really what it comes down to, is that we don’t have all the answers, to be fair, yes, birth control does lower the risk of certain cancers like ovarian cancer. And right now, if you get diagnosed with ovarian cancer, it doesn’t look good for you. We don’t have early screening, we don’t have great treatments, if you’re at high risk, yes, this might be a great solution to add to the toolkit, and I say it as a tool kit, because it’s going to be more than one thing, right, in preventing cancer…that using just birth control would be short sighted. But we haven’t answered the question of, why is it that one woman can take birth control, and she feels amazing, another woman takes birth control, and it just wrecks her world?
Dr. Jolene Brighten 8:02
The thing we haven’t recognized and really acknowledged is that there’s so much we don’t know about birth control, about long term birth control use, about generational birth control use. A woman who gets on birth control from the second she gets her period, stays on it up until the point that she conceives and then when she has a daughter, her daughter’s born, her daughter goes through the same thing. We don’t actually know what that’s doing. We don’t understand. And we’re only now starting to question all these things like, “What happens to your brain long-term? What happens to your bones long-term?” It’s not black and white, we don’t need to have access to birth control for all with no question, or no birth control for anybody, we really need to just stay curious, stay humble and start asking these questions.
Farrar Duro 8:48
I think they should give your book to everybody who’s starting birth control like “Here it is, whenever you’re ready to get off, there’s some answers for you.”
Dr. Jolene Brighten 8:57
Well, right now, there’s politicians who are advocating birth control for all and I keep getting tagged on social platforms where they’re like, where women are saying that if you’re going to give birth control for all, can you also give them this book, because the book, when it first came out, there was a media blackout, no media wanted to touch me. And a lot of people who didn’t even read the book, I don’t understand this, like, read the book, and then criticize it, good with that. That’s fair, right. But you didn’t even read the book. And you just decided this was the story of Brighten, and that you would tell the story that this woman’s anti-birth control, she’s fear-mongering, she’s pushing women into fear so that nobody uses birth control.
Dr. Jolene Brighten 9:41
I’ve had women reach out and saying, “I read this doctor who wrote about you and said that all you do is you preach fear, you’re trying to keep women off of birth control. Because of you, we’re going to go back to the dark ages of no birth control”, and then I listened to an interview with you. And I was like, “Wait, that’s not what this is about.” And this person just wrote me recently and said, “And then I bought your book. And I was like, this is one of the most empowering women’s health books I’ve ever read and then I went back to that doctor and said, actually, you’re fear mongering, and you’re keeping the medicine out of women’s hands, and you are perpetuating this idea that’s not grounded in facts or reality. You’ve just made your mind up and judged this person. And what you’re doing is actually keeping women from getting access to this information.” And, it’s just been really interesting to see the conversations that are coming about. I think this friction is important. It’s part of the evolution, right? I think about like the analogies of life, good things don’t come out of basically sunshine, rainbows, unicorns, right. It’s through friction, it’s through tension. It’s through these things, that we evolve this conversation so that we can evolve women’s medicine for the better.
Farrar Duro 10:54
Definitely. I think that starting from that, looking at someone that, I think the biggest disservice you can do a woman is to actually keep her on birth control without figuring out why she’s taking it in the first place, if it’s not for contraceptive purposes. That’s what we see working with infertility every single day. You see women going, “I wish I had known that I had endometriosis, that I had PCOS, that I had all these things that I could have been working on instead of just getting off the pill and having everything just wham, come back, and then having to figure it out and taking years to actually work on that.” I think that’s why this is important. It’s because instead of disguising things, and we’re not saying that nobody should ever take birth control. That’s not what we’re saying. I think that what we’re saying is to find out why you need it, first of all, why your doctor was prescribing it, and what your underlying issues are, and work with those. Maybe it’s simultaneously while you’re taking birth control, you can still do a lot of the suggestions that you’re saying, work with nutrition, and get acupuncture and work with your diet. But know that there is a condition that’s underlying, and that it’s not going to go away with birth control.
Dr. Jolene Brighten 12:10
Yes, and I think PCOS women are definitely impacted by this in such a huge way, because you’ve probably seen it on my Instagram where I’ve written and I think I have it on repeat, multiple times, out there. Giving hormonal birth control to women with PCOS with no discussion as to what the root cause is, and no discussion about what else she could be doing is a complete disservice. Giving women birth control for acne, irregular periods, heavy periods, painful periods, all these lady-part problems, is a disservice if you don’t ask why. It is not a disservice if you acknowledge that this is for symptom management, right? That’s really how things should work in medicine. Sometimes people will say, well, you’re a naturopathic physician, therefore, you’re only interested in just root cause work, right?
Dr. Jolene Brighten 13:03
I want everybody to feel better like yesterday, while we also work on the root cause. And yes, sometimes birth control can be a tool for that. I have women who write me, “I’m going to get married, and I know that my acne is going to take time to clear but I don’t want to have acne in my wedding photos.” I acknowledge wedding photos are forever, so if you want to use birth control short term, to shut down your acne, and it works for you that’s 100% your decision. Now let’s talk about what you can do to support your body through that. If you’re a woman with polycystic ovarian syndrome, and you’re like, “I just want this hair growth on my chin to stop and I want this acne to stop. And I know we need to do root cause work. I know we need to heal my gut, I need to deal with inflammation, my blood sugar, all of these things. But for right now, can I just get some relief?”
Dr. Jolene Brighten 13:55
That’s 100% your choice. That’s the thing that I really advocate for is that we acknowledge when we’re treating symptoms, we acknowledge when we’re working on the root cause, and we acknowledge when we don’t know what is going on, and we’re offering you the best solutions we have. If your doctor is offering you birth control, it’s not because they’re bad, it’s not because they’re trying to dismiss you or do a disservice. It’s because that’s the tools they have right now for you. The problem, though, is that we do see so many women who get put on birth control for irregular periods, or they’re having painful periods. And no one discusses why that might be. And then they decide like, well, I want to have a baby, but I don’t want to have a baby until like, I’m 35.
Dr. Jolene Brighten 14:40
And they come off of birth control at 35 thinking they’re going to get pregnant right away. Yet there’s been this root cause all along, and now they’re infertile, they’re unable to get pregnant, which leads a lot of people to say, birth control caused infertility. But in reality what was really going on is that birth control masked your symptoms so there was no investigation that took place. And that is really what was going on is what was underlying that birth control that led to that infertility. This is why we can use birth control. But we still need to ask why. And in Beyond the Pill, I give a list of labs that can help your doctor really ask why. What is going on for you so that you can understand what is happening in your body. Yes, birth control can help some women with period pain and heavy periods with endometriosis. But it doesn’t treat the root cause of endometriosis. And it doesn’t mean the disease won’t progress.
Farrar Duro 15:32
Right! Tell us a little bit about what post-birth control syndrome is for those listeners that have not read your book yet.
Dr. Jolene Brighten 15:40
Post-birth control syndrome is a collection of signs and symptoms that come up, on average, about four to six months after stopping birth control. For some women, they can come on a lot sooner, for other women the symptoms are there, but you’re pushing through. And it isn’t until like a year or two later that you’re like I can’t handle anymore, I need to go to my doctor. Because birth control can impact every single system in your body, it can show up in a right wide array of systems. I’ll hear people say, well post-birth control syndrome, if it was truly because of birth control, it would only impact the reproductive system. That’s a nice idea, right? Because the drug was designed that way. But in reality, our natural hormones impact every single system in our body. And you can take a stroll through PubMed and find that birth control can impact your neurological system. Perhaps you come off birth control, and now you’ll have brain fog, maybe anxiety, depression, new onset of headaches or migraines. It also impacts our gut health, it leads to intestinal hyper permeability, now also known as leaky gut, and can impact your microbiome, it can lead to yeast overgrowth. So sometimes women come off and now they’re having digestive symptoms. We can see that gallbladder issues can arise.
Dr. Jolene Brighten 16:57
And people often will say like, “Well, that doesn’t make any sense. How can birth control be related to that?” And I want to acknowledge that we don’t have studies to say causation, we have these correlations, and if you use just a little bit of critical thinking on how natural physiology works, it’s not hard to see the correlation in these things. So how does it impact gallbladder, for example? Well, the gallbladder, we know that excess levels of estrogen can lead to gallbladder dysfunction. When you come off of birth control, you may not reestablish a brain-ovarian communication that leads to ovulation. On average, a woman who had a normal menstrual cycle that was predictable before going on birth control, she’ll spend about three months getting her period back, getting her ovulatory cycles back. A PCOS woman will probably spend about six months in that, what does that mean? Estrogen is left unchallenged, because without ovulation, we don’t have progesterone.
Dr. Jolene Brighten 17:55
And now that estrogen can go and impact your gallbladder, for example. There’s a lot of ways that post-birth control syndrome can show up. It’s really my hope in naming this, and bringing attention to this, that we start studying it. Then in 20 years time, the term is obsolete, because now we’ve really refined the language because our understanding of what’s going on is so much better. Some people will experience a resurgence of symptoms that they had before, and those symptoms can come back with a vengeance. And that’s when we can work to get to that diagnosis, maybe it was PCOS all along, although there is Post-pill PCOS. Where it looks like PCOS, but it ain’t actually PCOS, and I write about this in the Reversing Metabolic Mayhem chapter of my book. And with that, for some women, it’s brand new symptoms that they’ve never experienced before.
Dr. Jolene Brighten 18:47
I have seen people out there say, well, post-birth control syndrome is just the return of symptoms in the conditions you already had. Not necessarily. I was someone who had clockwork periods, and yet I didn’t have period when I came off of birth control. I developed cystic acne for the first time in my life. And my doctor thought I had PCOS. He actually told me I was misremembering my periods, and I actually had PCOS all along. Through all of my research, I’m like, there’s this androgen rebound, there’s all these things. And it was Dr. Laura Briden, who sounds a lot like Brighten, and wrote “The Period Repair Manual” that I got in a conversation with her. And she’s like, I call that post-pill PCOS. And I’m like, that is brilliant.
Dr. Jolene Brighten 19:28
That is what it is. That collection of signs and symptoms, that’s what it can show up as. Post-birth control syndrome can be complicated. And really, what it comes down to is we have to figure out your hormone imbalance, we have to repair your gut, we have to reverse the metabolic mayhem, the insulin resistance and inflammation caused by hormonal birth control, plus the high blood pressure and the cholesterol issues and all these things that I certainly was never taught or told about before I started birth control or the entire time I was on it. We also have to look at the nutrients that have been depleted. How do we replenish those and making sure that we’re working on you as a human, as a complex biological system and really understanding that every single system interacts. I mean, that’s really what gets us into so much trouble in women’s medicine, is that we compartmentalize everything. Well, we don’t, not in the naturopathic or functional medicine arena. But more in that conventional paradigm, which is great. People are like, Oh, this is a really big problem. It is a problem when you need a holistic approach. When someone says, your period problems have nothing to do with your gut. But if you have gut issues send you to the gastroenterologist. The gastroenterologist would say “I don’t want to hear about your lady parts, that’s not my jam, that’s not my arena.”
Dr. Jolene Brighten 20:44
But these specialists are really, really important. If you have ulcerative colitis, that gastroenterologist is awesome. If you have Crohn’s disease, that gastroenterologist is awesome. If you need an endometrial biopsy, then that gynecologist is awesome. But if you need somebody to put all those puzzle pieces together, that’s not going to be the team member that does it. Does that mean you ditch them? No, they’re still a really important part of your healthcare team, but you’re going to need somebody who can understand that every single system interacts together, and that none of these systems are separate from each other. And I always make this joke about…you know who doesn’t care at the end of the day about the compartmentalization that’s done in medicine? Your body. Your body doesn’t care how you want to look at it, it’s still going to operate the way it’s designed to operate.
Farrar Duro 21:31
That’s so true. I just jotted down a list from some concerns that our patients had about birth control. I was speaking with you earlier, and I was actually really surprised at how fast the suggestions came on. And when I just mentioned I was speaking with you, and I said, “Do you have any questions about birth control?” Actually, we have a staff member who’s on birth control. And she said, “Yes, I do. And I have these questions.” She’s in her early 20s, she’s experiencing a lot of side effects of birth control. And what she’s been told is this is normal, like mid-cycle spotting. I think that we also work with a lot of women who are concerned about that in the Jewish community, too, who cannot have staining during the month, that sort of thing, and that’s interesting to me, because a lot of people go on birth control to control bleeding, right. And so now they’re told it’s normal to have this mid-cycle spotting when you’re supposed to be ovulating, mood changes, no libido, concerns about fertility afterwards, acne on birth control, abnormal breast distension and pain, too much appetite, more risk of infections, and also pain in the lower abdomen. Do have any suggestions for women who are currently on birth control that might be experiencing some of these? is there just a matter of okay, just keep trying different brands?
Dr. Jolene Brighten 23:08
So firstly, mid cycle bleeding should not be considered normal. If it’s less than a tablespoon, and your ovulating, that could be what’s going on, but you’re on birth control, so you shouldn’t be ovulating. I would not consider mid-cycle spotting to be normal. And if you want to stay on birth control, have a conversation with your doctor. You likely need to just switch forms of birth control, that’s one thing. The other thing too is that like mid-cycle bleeding can sometimes be a sign of more concerning issues. In a 20-something year old female, less likely. But still, anytime you feel concerned about a symptom, it’s good idea to talk with your doctor. And in chapter 4 of Beyond the Pill, I actually give you, you have this period problem, this is what it might be,this so you can talk to your doctor about these things. This is what to do right now. So changing your diet and lifestyle practices. And then here’s what labs to be testing. So we’ve got the abnormal uterine bleeding, and I actually have an article on www.drbrighten.com all about that. And what causes heavy periods and what’s normal and what’s not normal, So guys, definitely check that out: www.drbrighten.com. I had lots and lots of readers say it is the Google of women’s medicine, and they’re like, I don’t even Google stuff anymore. I just go to your website. I search it there. Definitely check that out. Now, the missing libido 100%, that’s how birth control really works, is that you don’t even want to have sex.
Dr. Jolene Brighten 24:41
It’s not the mechanism of action of birth control, although it is very, very common. This is why birth control gets used in women with PCOS. And you have to decide, are you willing to trade off and have your acne go away? That oily skin, the back acne as well? Acne can really show up anywhere when it’s the excess androgens, and are you willing to trade that for no or low libido, for possible increased risk of stroke, of heart attack given your individualized risk factors. And that’s where talking with your doctor, knowing your family history, paying attention to your body can be so helpful in navigating that conversation. But what happens is that birth control can reduce ovarian production of testosterone by up to 50%. And then it increases sex hormone binding globulin that’s made in the liver. And it does this by actually altering the genetic expression. So hear that women. I want you to understand, birth control actually alters the genetics of your livers that it increases sex hormone binding globulin, and grabs on to any testosterone you can produce. So that’s why you will see the low libido. In addition, we see vaginal dryness can increase on birth control, pain with intercourse, you can also have pain with orgasm. If you are able to achieve orgasm you may have an inability to orgasm.
Dr. Jolene Brighten 26:02
All of that comes into play, and I talk about that in the libido and fertility chapter in my book, everybody’s like why is libido and fertility together? Guess what, you have to have both. If you want to achieve getting pregnant, you need to have a libido, you gotta you gotta want to have sex. That’s the way that works. Unless you’re going IUI or IVF or have a same-sex partner and you’re going a different route. I do want to acknowledge that there are those variables, and at the same time, if you want to have a healthy libido in your fertile years, you need to be fertile because that is about getting those hormones balanced. So, missing libido is something that you’re not going to get it back until you come off of birth control. You can try to switch birth control. If you’re already having breakthrough bleeding and your libido is low, try switching your contraceptives.
Dr. Jolene Brighten 26:51
Some women go from using the birth control pill to an IUD. There’s hormonal and non-hormonal IUDs that you can look at. Hormonal IUDs like Merina, Skylak, Kyleena…spotting, breakthrough bleeding, all of that. If your concern is that “I need to only bleed once a month and that’s it”, there is a risk with those that you can have that kind of intermittent bleeding. Okay, so we hit the spotting, the low libido. Fertility concerns after birth control…there is no research to show that birth control has a long term impact on your fertility. It can cause a delay in ovulation and your ability to conceive, that’s important to acknowledge, that we can have that delay. That means that if you want to have a baby at 38, coming off at 38 is not the approach. You’re going to want to come off earlier, definitely address anything that might be going on and replenish your nutrient stores. With hormonal birth control they’re nutrient depletion and nutrient deficiencies that come up. That can impact fertility, it’s not that birth control caused that, it’s that you need to get your nutrient status up. The birth control didn’t cause your fertility struggles, but in lowering Coq10, for example, and then being advanced age where your Coq10 production is lower, that can impact the quality of your eggs. What we really see, and I’ve written about this at www.drbrighten.com and have videos on YouTube about it, is that one, birth control is being used for symptom management, which means a lot of these women who struggle with fertility afterwards, it’s because they had a pre-existing condition that was never addressed, and that’s heartbreaking. So polycystic ovarian syndrome, endometriosis, even fibroid disease, right?
Dr. Jolene Brighten 28:45
That’s why we need to be looking at the root cause of these things, and understanding that we could counsel women different. You might need to say to a woman, if you know you want to have a baby in this lifetime, get it in before 30, that’s really where we want to aim, don’t just go along your way thinking, because you’ll see so often that so many experts are like, it’s a myth that birth control will impact your fertility. Now, it is a slippery slope in that women will hear that and then think possibly, “Oh, well, then I’ll just come after birth off of birth control after age 35.” And now, advanced age, we know is correlated with infertility as well. That’s another reason why we may see women come off of birth control and say, birth control caused infertility, when in reality, it’s our age, and that we delayed fertility for so long. That’s another consideration in this, and then, the other piece that I said I would speak to at the very beginning of this conversation is that we don’t want to get pregnant within six months of coming off of birth control. There was a small study, this is just the tip of the iceberg. And we need to dig a lot deeper, showing that if you get pregnant within six months of coming off of birth control, babies have a mild increased risk of childhood cancers. That was very eye-opening for a lot of us, and that was not a question that had been asked or answered in all of these years of birth control being available, like since the 1960s. If you are a woman who did get pregnant, within that six-month window, you didn’t know, I didn’t know, your doctor didn’t know, don’t judge yourself in any way.
Dr. Jolene Brighten 30:19
But knowing this, we can do a lot better. And I go through this in my fertility chapter where I talk about six months is the minimum. It takes 90 days for the egg that you actually get pregnant with to mature. We really want to be thinking about a year to two years in advance with a very different way of thinking about things, conventionally speaking, and the way we’re told to think about things is, start a prenatal when you decide to try just get off birth control, you could be pregnant the next month, could be or it could take you a good 18 months, there are definitely studies to show that.
Dr. Jolene Brighten 30:51
We definitely want to understand a little bit better about this woman’s individualized factors. But also what are her goals in terms of when does she want to become pregnant? What’s your family history look like? what if you have a woman that has a family history of early menopause? And her mom went into menopause at 39 and her grandma at 40? if that’s what’s going on, we need to counsel her differently, right? Okay, well, we might actually want to consider coming off a birth control much earlier and trying to conceive much earlier, because giving your individualized factors, it may be more difficult for you. It is something that it is commonly said that birth control leads to infertility, but we just don’t have any research to back that up. I hope I demonstrated all the things that really could be contributing to that infertility that you can start investigating now.
Farrar Duro 31:54
It’s interesting, because when I hear it, I think, oh, estrogen dominance, she probably has already estrogen dominance, then we have more estrogen on top of that, because of the breast tenderness. And all the symptoms here, you know, but there’s no way to really test hormones when you’re on birth control very accurately. One of them was, you know, mood changes, like we mentioned, breast pain, and very tired in general and more acne.
Dr. Jolene Brighten 32:21
Yeah, so some women do get more acne when they start birth control. Some women get hair loss when they start birth control. And those things don’t necessarily go away when they stop. If it’s true for you, that you developed acne, good idea to talk with your doctor, possibly kick birth control, and start the protocols that are in the on the pill, acne is always the last thing to heal. It’s super, super frustrating, although, as I say that there are women who’ve been using the protocols and beyond the pill, and they are seeing improvement within two to three weeks of starting those protocols, which is not the average, usually it’s going to be like my mood gets better, my periods get better, and then my acne gets better. So with acne that’s usually rooted in gut health, inflammation, nutrient depletion. So vitamin A and Zinc, for example, really beneficial for acne depleted by hormonal birth control. This is why I recommend every woman who’s on hormonal birth control, be on a multivitamin or prenatal, it also depletes folic, and you need folic when you get pregnant before you ever knew you’re pregnant.
Dr. Jolene Brighten 33:27
We want to make sure that we’re on that, 9 out of 100, women using birth control will get pregnant at 91% efficacy rate, w that in mind, you want to be on folic plus B12, magnesium, selenium, all these other things, birth control is depleting. Breast tenderness, breast swelling, very common with hormonal birth control, it is stimulating those tissues. And you’re right, you can’t test estrogen, progesterone, testosterone while you’re on birth control, because you won’t have an adequate reading, it’s shutting down ovarian function, so you’re not getting those hormones. And likely, if you were having symptoms of estrogen dominance before going on birth control, and that drove you on it. You’re having heavy periods, irritability, extreme PMS, you’re probably making the wrong metabolites.
Dr. Jolene Brighten 34:10
That means that your liver is processing that estrogen and putting it into more like four hydroxy, 16, hydroxy estrone. These estrogen metabolites that lead to a lot of problems, symptoms, yes, but also, it’s been shown in studies that women with a history of these estrogen-positive cancers, they actually had a history of elevated 16-hydroxy estrone, that’s in the birth control detox chapter in my book, which some people get confused and think that I when I wrote that chapter what it means is that you can’t detox these hormones, or that when you come off of birth control, you have to somehow push your body to detox the synthetic hormones out. That’s not what that chapter is about. When you get into it. What you read is: How does your liver process these hormones? How did these hormones affect your liver? I just really wanted to call it the liver chapter. How do your hormones impact your liver, your ability to detoxify, and when you come off of birth control, why is your liver so important in getting your hormones back into balance? That is definitely important. It’s a nerdy read, but it’s an important read for every woman. I’ve actually had gynecologists write me and say, “Oh, my God, thank you so much for explaining the liver-gut component of women’s hormonal health. Because now I’m actually implementing this in my practice, and I’m having women eat broccoli sprouts”, always winning in the research, on birth control, off birth control, everybody, can we eat some broccoli sprouts, and eat them weekly, because they’re so protected because of how they help us process our estrogen.
Dr. Jolene Brighten 35:45
So, we talked about the…we’ve hit libido, the breast size, we’ve hit fertility. Moods, that’s where we got to go next. With moods, we see so many women who report this. I personally went through this is well. I was on one form of birth control, I had debilitating depression, talking about, couldn’t even get out of the shower, would just be crying all the time. My doctor was like, “it’s probably not the birth control pill. But let’s go ahead and switch it.” And lo and behold, we switch the formulation. And there I was feeling like myself again. So, this is where we really need to ask, why does this happen? A study came out in 2016, showing that if you start hormonal birth control, you’re 23% more likely to be prescribed an antidepressant, this is a correlation. This is not saying birth control caused depression, I mean, explain the mechanism of what we understand currently. With that, I just want women to understand progestin only didn’t do better in any of the research study. Women will say, this is just the pilll, this is a pill problem. No, when I’m talking about these hormonal birth control problems, every single form of hormonal birth control is on the table, because they all contain progestin, which is synthetic progesterone. The research gets it long wrong often. If you read that progesterone causes cancer, that you get into the methods and they were actually using progestin it is not the same in any way.
Dr. Jolene Brighten 37:10
Only you make progesterone, chemists make progestin. And when it comes to the mood studies and brain health, progestin doesn’t do you any favors, and in fact, it’s correlated with higher rates of depression. I really want you to understand IUD, ring, patch, shot, pill, whatever it is, all these run the risk because our brain and neurological health are so dependent on our natural hormones. They build our myelin sheath, they help with neuroplasticity or ability to learn new things. Please understand: all birth control is on the table when it comes to mood alterations. Now we can’t say causation, why is that? Because it’s not that you take birth control and it directly just pushes your serotonin or pushes your dopamine or pushes these neurotransmitters into causing depression, causing anxiety, causing panic attacks. But what I was really happy to see is that once that Danish study came out, there were researchers who said “Okay, well let’s explore this. Let’s try to answer this question. Why could this be? Why are we seeing this correlation?” Hormonal birth control is inflammatory. There’s really two working theories of depression. One is cytokine theory, this is inflammation, the other is serotonin theory, and it really doesn’t matter which one you subscribe to, I’m going to describe them both to you so you can understand, but if your providers are like “I believe in the serotonin theory of depression,” recognize that’s a belief. Belief doesn’t really belong in science. There’s things that we believe to be true. But we have to be open to the possibility that we are wrong in these things. If your provider says that, let’s talk about how all of this work.
Dr. Jolene Brighten 38:45
Hormonal birth control depletes B vitamins and minerals that are essential to forming serotonin. There has been research to show that your tryptophan pathway is actually altered while you’re on hormonal birth control. Tryptophan is an amino acid for which we build serotonin from, maybe you’ve been told if you’re depressed to take tryptophan or 5-HTP. Now, you don’t really want to take tryptophan because what’s happening on birth control is that there’s alterations in this pathway that throws that tryptophan into neurotoxin production. So you actually make neurotoxins, brain toxins while you’re on birth control, 5-HTP doesn’t go down that same pathway. I just want to be clear, 5-HTP is not a root cause solution for what is going on here, you’re on a medication that’s actually altering this pathway, but it may prove to be beneficial along with taking things like complete B complex, and magnesium as well. Having those helpful minerals in play. It impacts how you actually make serotonin, and instead of making neuro-nourishing chemicals, we actually make neuro-toxic chemicals. Now, birth control is inflammatory, so this lends to the cytokine theory of depression, and that inflammation actually disrupts our ability to make these neurotransmitters.
Dr. Jolene Brighten 39:59
But also, inflammation on the brain is bad. We can get brain fog, we can be anxious, we can have depression, we can have panic attacks. There’s a lot of things that go on with that. Being on birth control, there have been studies that show that they can measure C-reactive protein, a marker of inflammation. They measure it, they put you on birth control, and now it’s elevated. Well, that marker of inflammation is telling us that you have systemic inflammation. That means you also have inflammation in your brain as well. So if you’re on birth control right now, understand that turmeric and ginger and EPA, which is an omega three fatty acid, are not necessarily a root cause solution to the inflammation because the inflammation is being driven by a medication. Likely, it’s how it interacts with your gut. The majority of your immune system lives in your gut, which the immune system is how we make inflammation. So with that, really what is the root cause? That we’re on the medication that’s disrupting all these things. However, we can’t say birth control caused that directly because really birth control set off a cascade and all these other things developed.
Dr. Jolene Brighten 41:03
Now, the other thing I just want to throw out there is that we know that from the gut-brain research that’s coming out…I’ve been in the health and wellness arena for over 20 years now, and I remember a time where the gut bugs were called a bunch of freeloaders. “Oh they make a little bit of B12…Well, maybe vitamin K, but other than that they’re worthless.” And, anybody who was giving probiotics was called crazy or a quack. Anyone who thought like, this old saying of all disease begins in the gut was a crazy person. Turns out, it’s true. And all of that was really the story that was being told. If you said it leaky gut, what’s known as intestinal hyper-permeability, even there’s still people now who are like “you’re quack if you’re talking about that.”
Dr. Jolene Brighten 41:44
There’s lots of research on PubMed on this. But in reality, now, we understand that if you have gut bacteria, viral, yeast, parasite imbalances that can impact your mood. That if your gut is leaky, it’s hyper-permeable, and proteins are getting through and your immune systems lighting up. That can affect your mood. Understand that we’ve got nutrient depletions, we’ve got inflammation, we’ve got alterations in tryptophan pathway, and we’ve got these gut impacts that can contribute to mood. So birth control didn’t directly cause your mood symptoms, but it played a hand in all of these other things, which is why it’s correlated with these changes, right now. We need different studies to be able to say causation. Can you say birth control caused my mood symptoms? 100%.
Dr. Jolene Brighten 42:35
As a doctor, I can’t say causation. But I can explain to you what are our working theories are right now, and how it maybe altering your mood. And really, we need to stop bickering, whether or not this is true, whether or not women are telling the truth about their mood, that one, quite frankly, just pisses me off when you’ll see people say, “Oh, this research study is saying this, but these women, they’re probably mis-remembering or it’s their lifestyle, or it’s this or that, and they’re not reporting, they’re not telling the truth.” And it’s like, okay, we need to believe women, we don’t need a study to believe women. And these stories that get told by women who don’t even know each other, and yet, they’re all the same. They should be lighting us up for curiosity to be linked. “Hmm, I wonder what that is, I wonder what’s going on there. Let’s explore that a little bit more.”
Dr. Jolene Brighten 43:19
Rather than, some people who meet it with, “Birth control has been proven to be great for all women and questioning it means we might lose it.” I understand where that fear comes from, because we very much did have to fight to have access to this. When birth control was first introduced, you had to be married to get that prescription, like, what is that even about? I get that, and I’m grateful to have access. And I do advocate for access for all women to have access to birth control, but I also want to advocate for them to have all the information. We can’t….in my mind, we can’t afford to lose another woman to a birth control-related side effect, when we could have screened for it ahead of time. We could have understood ahead of time that she was at a higher risk for stroke, she was a higher risk for a clot, she already had a family history of early cardiovascular events. We need to be screening for these things, and helping her understand what to look out for. Because women sometimes, when they die from birth control, because yes, women can die from birth control, it’s also because they delayed getting help. We do this thing in our head is women. I do this too. “Is this really an issue? I mean, is it is it real? Do I really need to go the doctor? Am I going to be a pain if I go to the doctor? Are they gonna laugh at me if I go to the doctor? And we kind of go through this, “Should I really go?” I have women who write me and they’re like, “Am I just being silly that I’m bleeding for eight days, and I think I need to go the doctor for that? And I’m afraid my doctor is going to laugh at me or dismiss me or just tell me it’s normal.” If you’re concerned about it, you need to go to the doctor. And if your doctor isn’t concerned about it, ask why. Maybe it is something that it’s like “Yeah, okay, this does happen because of X, Y, and Z,” so that you don’t have to live in that place of fear.
Farrar Duro 45:06
My cousin actually suffered a stroke while on birth control. I think of what if, in a perfect world, we could actually screen for the ones who are supposed to be on birth control, and the ones that maybe they need another option, like the diaphragm or, many others. But now, I think that it’s just not right for everyone. There are people out there that, like you said, just sail through. But what if you could do a Dutch test or some sort of hormone panel or a cardiovascular risk assessment before telling someone, “You’re going to be on birth control for 20 years, maybe we do need to do a little bit of an assessment first.”
Dr. Jolene Brighten 45:44
I talked about this in “Beyond the Pill”, and I break it down in chapter eight, of like, we need to screen for MTHFR, we need to screen for Factor 5 Leiden, and we need to be looking at this woman’s individualized factors or family history, before giving her that prescription. We need to monitor her if she starts birth control. She really should get lab testing six months later to understand what is going on, or when she has symptoms. Often women are just dismissed, and I actually have a video on YouTube of me interviewing a woman who three people in her social circle had strokes under the age of 30, while on birth control, and she went to her doctor and was very afraid, because she’s like, “I’m afraid. This is supposed to be rare, yet I know three people have died.” And her doctor laughed at her and was like, “Well, you’re not going to look cute with a pregnant belly so you should just stay on it.”
Dr. Jolene Brighten 46:36
And this is the thing that I always laugh about when anybody tries to accuse me of perpetuating fear. I’m like, the fear is already there. Women already have this fear, they already have this fear of going on birth control, coming off of birth control, being on birth control. And what I really set out to do in Beyond the Pill is take away that fear so that you make decisions based on what’s best for you not decisions based on fear. A lot of women, myself included, in my 20’s I just kind of ignored things because I was like “I don’t even want to know about the scary things,” and all I knew about then was blood clots and heart attacks.
Dr. Jolene Brighten 47:18
I don’t even think it really clicked for me that you could have a heart attack while on birth control. And yet, there was just so much that I was really actually afraid of these things. I was afraid to come off of birth control. I hear this from so many women, and the thing is that not everybody is at risk for these cardiovascular events. And you can screen and know and you can test if you’re concerned and in “Beyond The Pill” I even gave you what a heart attack looks like in a woman because it’s not the same as a man. You can screen for that as well. You don’t have to pop that pill every morning and just bury your head in the sand like an ostrich and think you’re not going to get eaten. And it’s the same thing. You can’t just bury your head in the sand about, “I don’t even want to know about the side effects.”
Dr. Jolene Brighten 48:16
And then think that it won’t happen to you. It’s something that, when it comes to breast cancer risk, there is this mild, increased risk, and a lot of docs and experts out there are quick to dismiss it. And they’re like, “Well, it’s mild increase, don’t even worry about. It’s not even worth discussing, because it’s not statistically significant enough for us to be educating every woman about” And there’s this story of like, don’t tell women the side effects of birth control, because then they would choose not to take it, nobody would take it. Well, okay, but that doesn’t excuse not giving her all the information. And you as a doctor don’t get to make that choice for her. You don’t get to choose what information she can and can’t have because you’re trying to influence the outcome, that’s manipulative. That’s a manipulative practice in medicine, and it’s just not right.
Dr. Jolene Brighten 49:06
Instead, give her the information. And with breast cancer, the thing that I pose is that, yeah, I educate women on “Okay, what is the increased risk of breast cancer? What is what does this mean for you? Are you living in a very polluted area? Are you living somewhere near a Superfund site? Are you living somewhere where pesticides are sprayed regularly? Do you eat organic? Are you not eating organic? What is your family history? What’s your detox capacity? What are you putting on your skin every day? We have to look at it very holistically of “Okay, this is the risk now.” Is birth control a mild increased risk for you? Or is it one more drop in the bucket of a lifestyle that’s setting you up for cancer and you already have these risk factors. That’s the discussion that we need to be having. And if she chooses, and I do have patients that choose to use birth control. And with that I say, “Okay, great, we need six to nine servings of vegetables every day, we all need that. But we know this always wins in the research.”
Dr. Jolene Brighten 50:03
When it comes to cancer, we need cruciferous vegetables coming at you. You need regular screening, that’s something else we need to tell women is you need to check your breasts every month yourself, and then you need to make sure you have an annual exam. No, you don’t need to have an annual pap depending on, some women do, but some women don’t. But that doesn’t mean you don’t need to check in with your doctor once a year and have a breast exam and things like that. And so it’s really about we need to be dispelling the fear in women’s medicine. Birth control is not the devil, it’s not evil, but you need all the information so that when you’re entering into it, its eyes open, its head out of the sand. And so that you know to get help sooner than later. It’s a very interesting thing when it comes to the nutrient deficiencies that birth control causes, how often on social media, I have clinicians or PhD docs who write and they’ll leave comments and be like, “You need to cite all your research studies on this.” And I’m like the hundreds of research studies on this? The deficiencies caused by birth control…there are things when you’re presenting new stuff and it’s not this commonly accepted idea. Yes, bringing up studies is helpful. Nutrient deficiencies is nothing new.
Farrar Duro 50:45
It has been around a long time. But yes, I don’t understand why it’s always rejected.
Dr. Jolene Brighten 51:25
There’s a drug handbook right behind me right now that talks about the nutrient deficiencies introduced by birth control. The American Association of Family Physicians has that published on there. It was taught to me in my Clinical Nutrition training while I was getting my bachelor’s, and the registered dietitians are educated about this as part of their curriculum. There are multiple books out there published that are medical textbooks to train physicians that talk about the nutrient deficiencies of birth control.
Dr. Jolene Brighten 52:00
It’s something that is not controversial, yet, it seems that anything we talk about with birth control, there’s people out there that meet it with controversy. And really where that’s coming from is a place of fear…that you have this fear that if we tell the truth to women, that somehow women are going to start rejecting birth control. And then we’re going to have unintended pregnancies and things like that, which really, when you get in Beyond The Pill, and what so many women have appreciated is that I won’t present you a problem without immediately following up on a solution. And the majority of the solutions in the book are diet and lifestyle therapies. They are, what do you eat? How do you talk to yourself? How do you move your body, these things that take place outside the doctor’s office, and then it gives you all the tools to have a better educated discussion with your doctor as well. But nutrient depletion and deficiencies is why every woman needs to be on a multivitamin or prenatal while she’s on birth control, and she has to have her diet dialed in. And the funny thing is that there are people who criticize this and will say like, there’s no reason that women even need folate while they’re on birth control, except they made a form of birth control, there was a pill that also had folic acid in it.
Dr. Jolene Brighten 53:13
And because the pharmaceutical companies know this. Also, these things I’m talking about that people are like “These are so controversial, where are they coming from?” Package inserts of the actual drugs that are being dispensed. That’s where a lot of this starts, right? They list the side effects in there. They’re well-recognized side effects. There’s nothing I’m talking about, that the pharmaceutical companies aren’t disclosing to you in those package inserts. And it’s also a funny thing, because I’ve had people say, well, you’re anti-pharma, you’re obviously anti-pharmaceuticals. And especially because you’re a naturopathic physician, I just laugh. I have Hashimoto’s hypothyroidism, I take Nature Throid every day, that’s the form of medication that works for me. I take a pharmaceutical everyday myself. I prescribe pharmaceuticals to patients. It’s something where I am all about every single tool in the toolkit and deciding what is best for that person. Sometimes it is a drug, sometimes it is a surgery, sometimes it’s these things that people feel are not natural. But thank God, we have these interventions. Thank God, we have all of these tools. The example that I use, or the analogy is that if you are in need of a hammer, and you need a hammer to build a deck, but you decide you don’t like hammers, are you going to use a saw, because you decided you like saws and you don’t like hammers, that’s a lot like medicine. You decided you don’t like conventional medicine, but you need it. You need to have a surgery, just because you don’t like it doesn’t change the fact that that’s the tool that you need right now. And really the discussion needs to be, what is this person sitting right in front of you right now need to get one, out of pain, out of these symptoms that are like keeping them from living their life, but two to also get to the root cause.
Farrar Duro 55:11
True. I really hope that each and every one of you guys listening to this, check out this book, because it’s going to actually bring a lot of it home to as far as your individual situation about what your goals are, your long term plan of taking birth control, or maybe it’s a short term one, of getting off of it, of what happens when you want to try to plan a family and that sort of thing. I really do feel strongly that everybody needs to have this book. Like it should be in every gynecology office, I think when they write that prescription for birth control, because this is the information that’s been left out. I really want to thank you, Dr. Brighten, for being here today. I know that each and every one of you guys have just have so much that’s going to come out of this and you might have questions. I want you visit her blog, we are going to link to it in the show notes. I really think that this is such an powerful book as well. So thank you for writing it.
Dr. Jolene Brighten 56:09
Thank you. Yes, and if you guys want some help on dialing in your diet and supporting your body on or off of birth control, go to www.drbrighten.com/pbcsdiet and you can grab a free guide there and it will have lots of foods that you can start incorporating to optimize your hormonal health.
Farrar Duro 56:29
Awesome. Great. Well, thank you so much. Thank you guys for listening and I’ll see you next week. Take care of yourself.
- What inspired Dr. Brighten to write her book (0:58)
- There’s so much we don’t know about birth control (8:09)
- Understanding symptom management vs root cause work (13:00)
- What post birth control syndrome is (15:37)
- Tips for those on birth control experiencing symptoms (23:03)
- Fertility concerns after birth control (27:22)
- Birth control as symptom management (28:26)
- Impact on moods (35:56)
- Access to birth control and having all the information (43:55)
- Fear of birth control & removing the fear (46:48)
Resources Mentioned In This Episode:
- Learn more about Dr. Jolene at drbrighten.com
- Read Dr. Jolene’s book Beyond The Pill
- Grab a free guide for foods to optimize hormonal health at drbrighten.com
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