This is the second post in a series of three about birth control. It became apparent in Season One of the Fempower Health Podcast that there's a lot of questions and potential controversy about birth control.
I wanted to get an MD perspective, a period expert perspective, and then the last one ends with a new innovation in birth control for you to consider. Here, I talk to Nicole Jardim, who is a Certified Women’s Health Coach and author of Fix Your Period: 6 Weeks to Banish Bloating, Conquer Cramps, Manage Moodiness, and Ignite Lasting Hormone Balance.
Georgie Kovacs: Some experts have stated that if you aren't trying to get pregnant, there's no point in bleeding. Based on what you have researched and seen, please share your thoughts.
Nicole Jardim: The importance of the menstrual cycle to overall health has been generally dismissed by conventional medicine. And that to me, is the biggest underlying cause for this belief that if you're not trying to get pregnant, then there's no point in having a period. What I want to drive home is that ovulation is the star of the show. Not your period. Your period is just sort of an end result of the ovulatory cycle.
Traditionally the menstrual cycle has been viewed as a bodily process that happens solely for reproduction. That viewpoint is changing as more research is published to support the system-wide benefits of having consistent ovulatory menstrual cycles. But at the same time, we still come up against this and that's because it's continually perpetuated.
What's really interesting to me is that there are two sides to this coin. There is the, you know, the American College of Obstetricians and Gynecologists (ACOG) who in 2015 released a report actually acknowledging that menstruation should be recognized as a vital sign in girls and adolescents. I extend that to all the females because your menstrual cycle is a barometer for your overall health, no matter your age.
ACOG said, "Identification of abnormal menstrual patterns in adolescents may improve early identification of potential health concerns for adulthood. It is important for clinicians to have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation and the skill to know how to evaluate the adolescent girl patients. And by including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for patients and caretakers."
This tells us that your menstrual cycle is 100% a reflection of your overall health, whether you're an adolescent, whether you're an adult. And so this is really what I believe we need to be focused on. And when you think about our period as being a vital bodily function, that all women and girls and anyone who is menstruating need to experience regularly, and whether you're interested in having a pregnancy or not, and that ovulation will or does occur on a consistent basis, it's going to be what drives these levels of hormones that are not just for reproduction.
Georgie Kovacs: What role do hormones play in overall health?
Estradiol is the most potent form of estrogen. We're talking about progesterone, we're talking about testosterone and a few other hormones that play a role directly in ovulation. And so these two hormones, particularly estrogen and progesterone, are always referred to as hormones that are only useful for reproduction or your menstrual cycle. And they really shouldn't be because they play so many critical roles in the body, but they've been marginalized. But when you think about your brain health and your cognitive function, there is research to back up all of this.
This is why hormonal birth control, in many cases where it stops ovulation, is tied to major mood disorders. Sleep regulation is also a part of the estrogen-progesterone role. Oftentimes, if we're in a low estrogen state, particularly if we've come off of the pill and we're not ovulating for a long period of time, or we're in menopause, we can't sleep well. Progesterone also supports quality sleep. There's bone density, same as above.
When we are in a low estrogen, low progesterone state like amenorrhea or menopause after being on the pill or we're in like a primary ovarian insufficiency or premature ovarian failure, that there is a serious risk for bone related problems.
I've had many clients in their twenties who have shown up with osteopenia after being on the pill for a long period of time or anovulatory for other reasons like hypothalamic, amenorrhea, and finally heart health, breast, and uterine health. There's multiple bodies of research that show heart disease is tied to low estrogen states, breast and uterine health are protected by progesterone. That is the progesterone that is made by your body.
This is just a snapshot of the ways in which ovulation is vital to our overall health throughout the menstrual life cycles - I mean puberty all the way through perimenopause. So when we're talking about whether we just need to bleed or not like that to me is just a microcosm of the bigger picture.
Georgie Kovacs: What is the role of birth control and cancer prevention? We agree the woman's body is made to create babies, whether or not you want to have them. Yet there is evidence of tribes where women are getting pregnant and breastfeeding often and thus not having as many menstrual cycles. They don’t get endometrial cancer and ovarian cancer, yet we have them in Western society. Is it as black and white as your risk of cancer ties to how many babies you have, which impacts how often you get your period?
Nicole Jardim: I think it's really interesting. There really needs to be a nuanced approach to this because obviously human bodies are that way. One person might respond to something differently to another person. Some women have really challenging pregnancies and it leaves them in a state of complete depletion and their bodies don't function well afterwards and they need a lot of rehabilitation, whereas others do great with multiple pregnancies and they're fine.
There are multiple factors to consider here. The first is, "What else in Western culture is contributing to cancer rates?” We can't just look at one aspect of our life or health. We can't isolate that one thing. In Western culture, we're set up for chronic illness or degenerative illness. I don't fundamentally believe that turning off ovulation on a consistent basis with a hormonal birth control of some kind is the answer to solving the cancers that women develop. I am not a medical doctor. I'm not a scientist, but that's the way I choose to live my life and the way I choose to educate my clients.
Ultimately, what I understand of consistent ovulation and consistent ovulatory cycles is that these, these hormones that we create are protective. There's a caveat though, and there's so much nuance.
There is testing that is just not at all really accepted in the mainstream or just doesn't exist as an option in mainstream medicine. When you look at something like a DUTCH test, for instance, this is a Dried Urine Test for Comprehensive Hormones. What you will see on that is a breakdown of your hormones such as estradiol, estriol, estrone, which are the main estrogens in the family of estrogens. What you'll see from there is the breakdown from those three estrogens after phase one of liver detoxification into metabolites, and then a further breakdown after phase two of detoxification.
The same goes for progesterone, testosterone, and other hormones.
You may have perfectly normal estradiol and your estrogen metabolites. So your estradiol breaks down, like I said, and so those metabolites might be too high or too low causing symptoms.
When we look at those kinds of tests, you can clearly see that if, for instance, 4-O-H-1 (a metabolite of your estrogen). is going down that pathway, there is a higher chance of you developing certain types of cancers. If you correct that pathway and push it down a different or more protective one like the 2-O-H, then you will effectively be helping yourself avoid certain cancers. I can't say that that's the case for everyone, obviously. It really is so dependent on so many factors. All I'm trying to say here is that, ultimately, we have a lot of tools to help us prevent certain cancers.
Georgie Kovacs: What are more tools women can leverage to understand and promote better health?
Nicole Jardim: There's lots of screening. There is testing. There's the diet lifestyle component. There is stress, there's sleep, there's environmental chemicals that are driving our estrogen to levels that we've never seen before. So many of these are extra xenoestrogen and they cause this estrogen dominant situation in our bodies, which I'm constantly working with clients, asking them to remove as much of this from their environment as possible. So it's a multifaceted approach. And I just don't believe that this one size fits all approach is the answer.
Georgie Kovacs : I'd read Dr. Lara Briden's book, Period Repair Manual, and highlighted much of that as well. And I was fortunate enough to have her on the podcast last year in 2020. This was where I first heard about the different types of PCOS, as an example, where one of them is birth control pill induced PCOS. Does birth control induce PCOS?
Nicole Jardim: Yes, the synthetic hormones can be out of your system in three days. However, the questions I want to ask are:
How long were you on the pill for - 10 years, 15 years?
What did you go on it for? Was it because you had heavy periods, period pain, migraines, irregular cycles, and/or PCOS?
Do you have heavy periods because you have a bleeding disorder that could be life-threatening if you were to have a hemorrhage during childbirth and you didn't know about it?
Again, this is a really nuanced conversation that requires a significant amount of investigation and question asking. As is evidenced by my work and Laura's and everyone else in our field, this is clearly not the case for a significant amount of people.
Why are we not asking more questions about what is causing these problems?
I find that the medical gaslighting that occurs is just so shocking, and it's really unfair because it perpetuates this belief that women are going crazy and their bodies don't work properly. If their bodies are not to be trusted, that they're just this mysterious thing that you just have to take a pill for and call it a day. This belief that our bodies are somehow defective is unfortunate. And I am committed to that narrative.
Georgie Kovacs: Another thing that I saw in research is that a large percent, I think a majority, if I'm not mistaken of women, don't go on birth control to prevent pregnancy they're actually going on birth control because there is a problem. Given this, what are the main things a woman should know and consider when choosing the right birth control for them?
Nicole Jardim: Informed consent is so critical in this situation, meaning you're being presented with all of the options for birth control with the pros and cons.
In an ideal world, anyone who wants to go on the pill or ring, for instance, or any of these forms of hormonal contraceptives, that have a higher risk of blood clots be tested. There's a test that can be done to determine whether you have a higher risk of these. Because thousands of women die every year in the United States alone from blood clots caused by their hormonal contraceptive. And I've done multiple interviews now with people who have talked about this and the fact that it's just generally overlooked. And then I heard from women that had almost died. And they came off the pill, but they had no idea.
The information should be presented when we go to the doctor, but also by doing your own research such as reading up on people's experiences.
Ask yourself, “Does this feel like the right decision for you?”
We've been taught for so long to turn off this inner voice, this inner, knowing this intuition, this body wisdom that we all have, because for the longest time we go to the doctor and then go home with whatever it is that they've given us. Yet there isn't really a lot that's done outside of that.
I am not against any kind of birth control. I just want everyone to choose what feels right for them. There's some women yesterday who were telling me all about the Mirena IUD and how amazing it's been for them. And I am so happy about that. I really want us to be able to be happy with what we've found and it actually works for us.
Georgie Kovacs: Thank you for, for your perspective. We could go on and on about this, but your book, Dr. Briden's book and others really talk about the details, the types of hormones, things that might be going on with you that add additional consideration. So I would just encourage people to read that and better understand those details to be able to make the decisions, especially if they're not up for reading a clinical trial, because sometimes those are hard to dive through.
Nicole Jardim: I would say Lisa Hendrickson's book, The Fifth Vital Sign, it's an excellent book. She details a lot about hormonal birth control and her focus as a fertility awareness educator is, is helping people use the fertility awareness based methods as birth control. So I think that that's another great one to consider.
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About Nicole Jardim
Nicole Jardim is a Certified Women’s Health Coach, writer, speaker, mentor, and the creator of Fix Your Period, a series of programs that empower women to reclaim their hormone health using a method that combines evidence-based information with simplicity and sass. Her work has impacted the lives of tens of thousands of women around the world in effectively addressing a wide variety of period problems, including PMS, irregular periods, PCOS, painful & heavy periods, missing periods and many more.
Rather than treating problems or symptoms, Nicole treats women by addressing the root cause of what’s really going on in their bodies and minds. She passionately believes that the fundamentals to healing any hormonal imbalance lie in an approach that addresses the unique physiology of every woman. This is essential to reclaiming and maintaining optimal health and vitality at any age.
Nicole is the author of Fix Your Period: 6 Weeks to Banish Bloating, Conquer Cramps, Manage Moodiness, and Ignite Lasting Hormone Balance, and the co-author of The Happy Balance, a recipe book filled with over 80 hormone balancing recipes. Finally, she’s the co-host of The Period Party, a top-rated podcast on iTunes—be sure to tune into that if you want to learn more about how to fix your period—and has been called on as a women’s health expert for sites such as The Guardian, Well+Good, mindbodygreen and Healthline.
About Fempower Health and Its Founder
Georgie is the founder and host of the Fempower Health podcast, a top 10 women’s health podcast with 5 stars on Apple. She is an advocate leveraging her 20+ years in healthcare and personal fertility journey to transform women’s healthcare, answering your health questions. She brings on top experts in women’s health with the aim of educating women about their bodies to have more empowered (and speedy) health journeys.
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