Dr. Lara Briden, author of Period Repair Manual, is a naturopathic doctor and the period revolutionary—leading the change to better periods. She has helped thousands of women find relief for period problems such as PCOS, PMS, endometriosis, and perimenopause. She shares her expertise in honor of National Period Day.
Lara Briden 01:54
Hi, Georgie. Thanks for having me.
Georgie Kovacs 01:56
So please introduce yourself.
Lara Briden 01:58
Absolutely. So I'm a naturopathic doctor, and the author of the book Period Repair Manual. I'm Canadian, as you can probably hear from my accent, but I live in New Zealand. And I spent nearly 20 years practicing in Sydney, Australia. So I have three I call three countries home. And I've spent the last nearly 25 years of clinical practice on the ground, pretty much nine to five, Monday to Friday, helping women have better periods with diet supplements, herbal medicines.
So I've had an opportunity, which I'm very grateful for, to learn what works and what doesn't work with thousands of women every day to the point about five or six years ago where I thought I really need to share this information with not just my own patients, but women out there. So that's how the book came into being the first edition. So it's in its second edition now and came out early 2015.
Okay, so I don't remember 2015. But I have to mention it because that was the year of the period. That was the first time there was a lot of kind of mainstream media, where they were actually using the word period. For the first time, women were talking about it openly in sports. And that's only five years ago, it's been a lot. The world is changing very quickly. But even five years ago, even back then, when I in 2014, when I was getting ready to release my book, I had a number a few people tell me say to me, “I don't know if you should put the word period in the title of the book, because it's kind of off putting. So we've come a long way. Now, in 2020, that seems pretty normal to have to say that word period. That's not a not taboo anymore.
The problem is if you are on hormonal birth control on the pill. We're in this weird situation where there's no ovulation so no hormone production, and the contraceptive drugs are not as good as our own hormones.
Georgie Kovacs 03:43
Did you write the book before that happened? So it's just amazing timing.
Lara Briden 03:50
Yeah, my book came out in February 2015, and by the end of that year, it was declared the year of the period, not because of my book, I don't think, but just because of what was happening in the world.
Georgie Kovacs 03:59
Let's talk about periods now that we're so comfortable using that word. What myths do women have about periods?
Lara Briden 04:13
I want to start with one of my key messages about periods - ovulation is the main event of the menstrual cycle, and the bleed itself is just a secondary downstream effect. The reason I start with that is because I think we put so much focus on the bleeding. From a health perspective, it's not about that.
We want the bleeding to be as easy and symptom free as possible, but the value of a menstrual cycle for women is ovulation, not just to be able to make a baby. Of course, that's part of it, but also because ovulation is how women make hormones. Men make hormones every day, they have quite a flat pattern with their hormone production, we have this monthly pattern of hormone production. But that has been treated as sort of a liability in some ways.
I like to flip the script and reclaim that it's an asset. We make hormones in this monthly pattern, but we need those hormones. Both estrogen and progesterone have many benefits. Beyond just making a baby, for example, there was just in the research mid-September, there was some new bit of research about how having more years of ovulatory cycles in reproductive years is beneficial for reducing the risk of cardiovascular disease after menopause.
Ovulation every menstrual cycle is like a deposit into the bank account of long term health. It's building what's called a metabolic reserve. And most people would know that estrogen makes bones stronger. Progesterone makes bones stronger. Both hormones are good for the heart, both hormones are good for the brain, they affect the microbiome, or the gut. They're beneficial for us, just as testosterone is beneficial for men.
So this is, this is what it all hinges on. And the thing about this is you can see it's not about the bleed. The problem is if you are on hormonal birth control on the pill. We're in this weird situation where there's no ovulation so no hormone production, and the contraceptive drugs are not as good as our own hormones. Then we have this monthly induced bleed, which doesn't mean anything. So there's no reason to have a monthly drug induced bleed, which is why we get these headlines, these crazy headlines saying things like women don't need periods. They are, what that's referring to, is women don't need a monthly drug induced bleed from the pill, which we totally don't like there's no there's no reason to bleed per se, if you're not, if it's not part of a cycle with ovulation and making hormones.
Georgie Kovacs 07:14
I love that you flip the switch. What I've been observing in women's health is when it comes to ovulation, people tie it so much to getting pregnant and even the apps they're referred to as fertility tracking apps. I wish that the whole conversation would change to just reproductive health or even women's health because when you say reproductive health, people automatically think baby, and it all runs together. I created this podcast because I want women to understand these things like it is women's health is not period, ovulation, as you mentioned, get pregnant, you have menopause. it's a whole system that is magical.
Lara Briden 08:10
Absolutely, so one way of talking about it might be to speak about ovarian hormones because they are beneficial for general health. Just as testosterone, or testicular, hormones are important for general health for men. Testosterone is not just for making a baby. It seems so obvious when you say it about men, but unfortunately, when it comes to women's health, there is kind of this idea of “If you're not going to make a baby, do you even really need any of that?” Well, that's, that's definitely what's going on with hormonal birth control because it shuts them down.
Georgie Kovacs 08:49
I recently spoke with the Ovarian Cancer Research Alliance, one of the questions that I had asked them is this very tough position that women seem to be in with birth control, because apparently, with ovarian cancer, having children is helpful in preventing it, but also being on birth control.
Lara Briden 09:15
Anything that puts the ovaries into dormancy is going to reduce the number of cell divisions happening in that tissue. So I thought about this a lot. So yes, hormonal birth control decreases the risk of ovarian cancer, just as chemical castration of men would probably reduce the risk of testicular cancer. But the thing is, in terms of that question, depending on your history could be a very strong history of ovarian cancer. That's obviously a different conversation, a conversation to have with your doctor.
Let's say your average woman has no risk factors, specifically for ovarian cancer. It's quite a rare cancer compared to other health events for which the risk is reduced by having ovulation so having active ovaries having regular ovulatory cycles, menstrual cycles, reduces the risk of a number of diseases. I'm going to quote my colleague, Professor Jerilynn Prior, who is a reproductive endocrinologist. She is in Vancouver and helped me with my book. There's a quote from her that I've used several times. She says quite boldly, that 35 to 40 years of ovulatory menstrual cycles, regular natural menstruation helps to prevent osteoporosis, dementia, heart disease, and breast cancer. And she puts breast cancer in there. Because progesterone, the real progesterone we make after ovulation, has an anti-breast cancer effect. This is a perfect example because the progestin drugs in hormonal birth control are called progesterone, but unfortunately, they're not. Progestins increase the risk of breast cancer. So progesterone lowers the risk of breast cancer and increases of breast cancer. So if we're talking about it, the cost benefit analysis of having regular ovulatory cycles throughout your life? The beneficial side is reduced risk of all those things, including breast cancer, which is obviously a lot more common than ovarian cancer. So that's kind of my short answer to, “Does the pill reduce the risk of ovarian cancer?” Yes, but big picture, this lot there.
Georgie Kovacs 11:56
Help our listeners to understand more about the impact of birth control, because I know that even in your book, you reference certain types, whether you really need them, and for certain cases they are better than for others.
Lara Briden 12:14
Okay, well, let's start with the hormonal IUD, please, as I guess I would say a better option. So we'll start with the positive rather than just bashing the pill.
Georgie Kovacs 12:24
To be clear for everyone, it's not like Dr. Briden said birth control is the worst thing you can ever take. You had definitely strong suggestions around precautions. And so this is about creating awareness so that women have freedom of choice.
Lara Briden 12:44
Let's start with, arguably through my lens, why the hormonal IUD is a bit better. So just to clarify, for any of your listeners, I'm sure people, depending what generation you're in, that an IUD is just an intrauterine little plastic device that's inserted in the doctor's consulting rooms. It's not a surgery to have that just inserted up the cervix, and it stays in there for a number of years, between three to five years depending on the type. There's a nonhormonal type as well, which will leave out of this conversation.
The hormonal IUD contains levonorgestrel - it's a drug to similar to progesterone, but also actually quite similar to testosterone. So there could be some effects from that. But the advantage of it is that it will lighten periods quite dramatically. So that can be very welcome effect - it thins the uterine lining, and licensed periods by up to 90%. It prevents pregnancy, but it does not routinely switch off ovulation. So you can kind of see why from my lens, I prefer that.
I just spent the first 10 minutes talking about how important ovulation is for women for making hormones for building long term health. The hormonal IUD is quite unique in that it doesn't switch off ovulation. Sometimes, it does suppress ovulation to some extent, especially during the first year when the dose of the drug is higher. But that's not how it works. It's working locally in the uterus.
So it's quite unique in that sense, and the hormonal IUD is one of the one of the only times when you can ovulate or cycle, but not bleed, which is very interesting. It is actually the complete opposite of what happens on the pill, which is that you bleed but don't ovulate or cycle. So there are very different sorts of things.
I have a blog post called the Pros and Cons of the Hormonal IUD, which I've been told is quite balanced so people can look there and look at all the different pluses and minuses of that technology. In terms of the other types of hormonal birth control, they all share in common the fact that they do suppress ovulation definitely any combined pill like an estrogen - progestin pill works by suppressing ovulation, the progestin only methods like the implants, the mini pill, the while the injection, I really don't recommend the Depot injection for reasons we can get into if you want, but I would say not that. The other ones, the progestin only ones don't, they don't always suppress ovulation, but they usually do. So that's through my lens.
Then there's the side effects of the contraceptive drugs themselves, which varies depending on which drug it is. They've been linked to hair loss and mood problems. So we kind of had the layer of, okay, you're being robbed of you're on hormones and the benefits of ovulation. And then on top of that, you've got potentially the side effects of the progestin drugs.
I was just actually last night having a discussion with my husband about this very topic - is the pill safe? I think an answer to that, you'd have to define safe. Is it safe in terms of severe side effects, arguably, big picture, yes. Although, some women do die of blood clots from hormonal birth control. That's a reality. But big picture, most women do not get anything sinister from hormonal birth controls. From that sense, it's safe.
On the other side of things, what we're starting to now understand that a number of women experienced mood changes, if you will, or mood symptoms from contraceptive drugs, potentially can contribute to hair loss, depending on the type. It alters metabolic function; it changes the shape of the brain. So these are things we know and are just learning about. They had no idea of any of that back when the pill was approved.
Georgie Kovacs 17:28
Lara Briden 17:32
It's a more nuanced answer. It's been used by hundreds of millions of women over the years. But not that long - 50 or 60 years. And in other ways, we've got women who've experienced, for example, depression from the pill. But we're not heard when they said that's what was happening, right?
That's the other part of this conversation. For generations, women have been saying, “Oh, this pill affects my mood.” And then sometimes the message back to them is, “You're just imagining things. That's not a thing.” But it is a thing.
So now we do have some research. There was a big Danish study in 2016. It was a correlational only, so it didn't prove causation. But they proved a definite link between all types of hormonal birth control, including the hormonal IUD, and negative mood outcomes. The authors of that study said that was probably an underestimate of the problem, because they were only measuring women who actually went on to take antidepressants, not women who just quietly stopped taking it. They weren't even counted. So is the woman who kept taking it and then ended up on an antidepressant.
And that's something I see quite often with younger patients, like teenagers. I'm looking at her list of medications, and she's on Yasmin and then on an antidepressant. I ask, “What order did those come in?”
Georgie Kovacs 19:03
That's a good question.
Lara Briden 19:05
Yeah, the Yasmin at 15. And then about nine months later, and antidepressant. Wow, I've heard that story before.
Georgie Kovacs 19:16
It’s really interesting to just hear how the OB GYNs are trained. And it does seem like birth control is such a solution. For those of you listening, I wanted to bring this up because I know this is National Period Day, but I wanted to make sure we talked about birth control, because a lot of what we think about is the period and ovulation and controlling the cycle.
Lara Briden 20:00
This semantics, right? And I know that just words and words but words are part of the problem here. Two words that we need to sort out, please.
1-The phrase that the pill can regulate is the word that I'm taking issue with. “Regulate the menstrual cycle” is wrong.
Like it, the contraceptive drugs do not regulate anything. They switch off ovarian function and replace it with contraceptive drugs that replace hormones with contraceptive drugs, that then, because of their dosing, induce a drug withdrawal bleed. So that is not regulated if the menstrual cycle is an arbitrary menstrual cycle where you make estrogen and progesterone. And the pill works by completely shutting that down and inducing basically chemical menopause. That's not regulating, right?
I think if they spoke to women in terms of what's actually happening, it would start to change the whole conversation like, “Okay, I'm going to give you this.” More accurately, it will be, “These contraceptive drugs are hopefully going to relieve your symptoms.” Okay, so that, yeah, maybe something we can work with.
And by shutting off your ovaries, something like that. I mean, that sounds bad, but that's what some women might say, “Okay, I understand what that means that I still want to do it.” And that's fair.
Keeping in mind that just circling back briefly to the hormonal IUD works differently. So it does lighten periods without switching off the ovaries. So that's a different conversation.