My guest this week is Dr. Jolene Brighten, a functional naturopathic medical doctor and nutritional biochemist with a focus in 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. Brighten is the author of ‘Beyond the Pill: A 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill’. She is 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.
In this episode, Dr. Brighten and I discuss the physical and mental health risks of hormonal birth control and the importance of informed consent before taking it. Side effects can vary from anxiety and depression to increased risk for stroke, heart attack, thyroid and adrenal disorders. Dr. Brighten provides us with a careful approach to the pill and how to monitor and maintain one’s health while on the pill. Teenage girls specifically are 80% percent more likely to develop depression when taking the combination pill of estrogen and progestin. Those who are on “the pill” have a double risk of suicide after one year of taking it. Learn more about Dr. Brighten here.
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The Benefits of Having a Menstrual Cycle
- The menstrual cycle the 5th vital sign which helps to determine your specific and unique bodily function
- A menstrual cycle can help determine numerous health issues such as hypothyroidism, poor liver detoxification, iron-deficiency anemia or the making of the wrong type of metabolites.
- Symptoms from your menstrual cycle are your bodies way of communicating to you
- This is an opportunity to discover the root cause of many different physical or mental health issues that may be occurring
Why Young Girls Are Being Prescribed Hormonal Birth Control – “The Pill”
- For symptom management alone before ever giving their body the time to adapt to the new routine in their body
- Types of symptoms include: irregular periods, menstrual pain, acne, migraines, mood issues like anxiety and depression
- 60% of women go on the pill for symptom management which can result in major side effects and risks
- The pill puts you at higher risk for strokes, heart attacks, clots, autoimmune disorders, thyroid and adrenal disorders
Mental Health Risks While Taking The Pill
- Women taking birth control are 23% more likely to also be prescribed an antidepressant
- Women prescribed progestin are 34% more likely to be prescribed an antidepressant
- Progestin is a synthetic hormone, progesterone is a natural hormone
- Teenage girls specifically are 80% percent more likely to develop depression when taking the combination pill of estrogen and progestin
- Teens who are taking progestin exclusively, commonly called the mini pill, have two-fold increased risk of depression
- Young women have 3 times the risk of committing suicide while on the pill
- Teens have a double risk of suicide after one year of taking the pill
- The pill is easier to get now more than ever
- BE AWARE of your daughters’ signs and symptoms;
- Lack of motivation, withdrawals from social activity, raging emotions
- These are can be normal symptoms of a teen but mixed with the pill they are at a much higher risk of harming themselves
What to Do Before Starting The Pill
- Before starting the pill, try to spend at least one or more full menstrual cycles documenting your symptoms for each day both physically and emotionally in order to understand your baseline
- If you can also attain lab testing (thyroid panel, CBC, homocysteine test) before starting that will also allow you to have record of that baseline to refer to should other health issues arise
- Look into your family health history
- If your family has a history of inflammatory bowel disease or Crohn’s disease use caution
- A Harvard study found that 5 years on the pill with a family history of Crohn’s meant a 300% risk of developing it
How to Maintain Your Health While Taking The Pill
- Eat a diet filled with whole food
- Be sure to take a prenatal or multivitamin to help with nutrient depletion
- Consider taking a probiotics
- Effects of the pill can strongly affect your microbiome
- Taking the pill has been shown to have similar effects of an antibiotic
Episode Intro … 00:00:30
Benefits of Having A Menstrual Cycle … 00:03:40
Why Girls Are Being Prescribed The Pill … 00:11:43
The Pill and Mental Health Risks … 00:17:47
Before Starting Birth Control … 00:27:22
Maintaining Your Health While on The Pill … 00:29:24
Episode Wrap Up … 00:33:35
Dr. Nicole Beurkens:
Hi everyone, welcome to the show, I’m Dr. Nicole and today’s show is for those of you who are parenting or working with girls or young women, specifically the pre-teen, teen, young adult years.
I have seen a major trend in the last decade or so, I would say of more and more girls and young women being prescribed hormonal birth control, whether it’s birth control pills or hormonal IUDs — for everything from regulating periods to managing PMS symptoms, to dealing with mood issues, anxiety — kind of all over the board, and I am a big proponent of women having options when it comes to birth control and medication, but my concern is that most parents and teens are not really being educated about what these medications are, how they work, and potential problems that can come up.
And I have seen many patients here at the clinic over the past decade or so who had had major side effects and issues, particularly in the realm of mental health that have stemmed from hormonal birth control. So I think that these are things that are not being talked about enough, and that’s why I am thrilled that my guest today is my good friend and colleague, Dr. Jolene Brighten. She is an expert on all the issues surrounding hormonal birth control, and I can’t think of anybody better to delve into this topic with. Let me tell you a little bit about Jolene.
She is a functional naturopathic medical doctor, a nutritional biochemist with a focus on women’s endocrine health. She is recognized as a leading expert in post-birth control symptoms and the long-term side effects associated with hormonal contraceptives. 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. She is 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. Jolene, welcome to the show.
Dr. Jolene Brighten:
Hey there! Thanks so much for having me. I’m excited for this conversation today!
Dr. Nicole Beurkens:
It’s going to be awesome and this is something that so many parents, when I see them at the clinic, if they’ve got girls or young women that they’re parenting — we start talking about things like what kinds of birth control their daughter might be on, or what options have been presented and really — they don’t have any awareness or aren’t being given any knowledge of what these things really are, what’s even going on with their period? What are these medications? How can they be helpful? But also, what are some of the side-effects and the problems that come up? So I’m excited for us to delve into that.
Dr. Jolene Brighten:
Yeah, exactly! And that’s why I set out to write ‘Beyond the Pill’. You know, I did the pill for a decade. Absolutely a tool that I used to make my period problems go away, and also become a doctor. It’s a great tool for women to be able to have access to, but really what I saw was missing in my own health journey and with so many of my patients was that true informed consent of understanding, what happens when you take this pill? What can you do to monitor these symptoms, to stay safe on it and what are the individual recommendations that we could be making?
Dr. Nicole Beurkens:
Let’s jump in, I want to set the stage for this conversation a bit by having you talk briefly about how the menstrual cycle works and what’s the benefit of having a menstrual cycle, of getting a period. Because I think one of the things that’s really appealing, especially to girls now, is this idea that: Oh, I can go on this pill and then I don’t need to deal with the period at all. So let’s just talk about some of the basics of that.
Dr. Jolene Brighten:
Yeah, and I love that you bring this up because really, the question of whether or not to have a period really didn’t enter until we had new iterations of birth control where we could be on them continuously. And it’s something where, in medicine, doctors would say there is this story where you don’t need a period, you don’t need to have a menstrual cycle, it’s not necessary — while at the same time, The American College for Obstetricians and Gynecologists in 2015, deemed the menstrual cycle and your period and the signs and symptoms that come with that the 5th vital sign, which is up there with blood pressure and temperature, like how we know if you’re sick or going to die — like these kinds of things!
So it is something that is very interesting and I definitely don’t judge anybody for this. I thought I was pretty clever for two years of just skipping periods whenever I wanted, until that little voice was like, “Wait a minute! This isn’t what your body is designed to do!” Now, with a menstrual cycle, I would say — this is something that I set out to write my book and really help women understand is: How does your menstrual cycle work?
What’s up with your hormones? What do they do for you? Because I didn’t know this until I got into my first year of medical school, and that’s ridiculous! You shouldn’t have to go to medical school to understand how your menstrual cycle works. And sadly, that was also after college physiology classes.
So here’s the thing: Day 1 is the first day that we see blood, where we experience a flow. And we measure the menstrual cycle, we start on day 1. On day 1, what has happened is your hormones have dropped. So your progesterone, estrogen have dropped — that way you shed the endometrial lining.
So that’s the lining of your uterus. Now — if you’re seeing clots, if it’s heavy, if it’s brown discharge, these can all mean different things in terms of your health. Like it can be a sign of iron deficiency anemia, hypothyroidism, poor liver detoxification and making the wrong metabolites — which those metabolites over a lifetime can stimulate and may very well contribute to cancer progression. So this is pretty valuable information to have.
Now around day 3, your brain starts talking to your ovaries and says let’s get a follicle ready so we can ovulate. That’s FSH picks up. Follicle-Stimulating Hormone, and it stimulates the ovaries to get an egg ready, which is going to be ovulated approximately somewhere in the middle of the cycle.
Maybe it’s day 10, maybe it’s day 14 for you. Understand women, that a 28-day cycle is an average and it looks different for every woman. It’s also why the method of, oh just split your cycle in half and that’s when you ovulate, avoid sex then — that doesn’t work. You’re hearing it here first — no you’ve probably heard it somewhere else too. So right you ovulate though you’re going to see an optic.
Estrogen is going to rise, and as is testosterone. And testosterone is going to cause a libido increase, and then what you will see is that the fertile cervical mucus gets started. And so that is totally normal. I would say I have had women in my practice that were put on the pill at like 14 and then they’re in their 40s and they come off them, and for the first time in their lives, they are like what is this goop in my underwear? That is fertile cervical mucus, 100% normal, 100% should not be anything you’re ashamed of.
Now, once you are getting to that ‘I’m about to ovulate’ phase, that’s when you’re going to notice there is going to a surge of LH — Luteinizing Hormone, Estrogen will peak, you will ovulate. Ovulation is so very important, because when you ovulate, what is left behind is the corpus luteum. So in the first half of what I just described, that’s the follicular phase. Some people you’ll see will divide the menstrual cycle into 4 phases, saying your period is separate, but understand that even while you are bleeding, you are getting a follicle ready. So that’s why in medicine, we call it all the follicular phase, because what is the point of that? The point of it isn’t the period, get that egg ready — come into ovulation. Following the ovulation, that’s when we come into the luteal phase.
Now, the luteal phase is where progesterone is the main player — it makes you feel chilled out and calm, you get better sleep at night. I love — I think estrogen and progesterone are wonderful hormones, but when they are out of balance, they are an absolute nightmare to deal with. So at the end of this, if there is no pregnancy, those hormones drop again, your period comes back.
Now even at luteal phase, let’s say you want to scream at people, you’re having anxiety, I mean you’ve seen this where women get put on anti-anxiety medication and some of them are even told, “Just take this anxiety medication a week before your period.” Because that’s when it’s an issue. And the issue is not that you have a deficiency in this medication, although it can help — the root cause of it is really that you don’t have enough progesterone. Is that because you’re stressed? Is that because you have an infection going on?
Do you have a luteal phase defect where that corpus luteum can’t do its job? Are you deficient in vitamin C? Are you not getting enough time with your girlfriends? All of these things can impact what’s going on. And I say all of this because I think the biggest misconception in women’s medicine, and there’s a lot actually, is that your symptoms are your body’s way of betraying you.
And the story of being a woman is inherently awful — so just suppress your hormones, suppress your period and go on your merry way. When in reality, your symptoms are your body’s way of communicating to you — it’s an opportunity to unearth that root cause and in our young girls, this is the time to act now, not when it really comes to a head in our 30s and our 40s. So I had a period that was 7+ days, incredibly painful. So if you are a woman who is hearing that and is like, but I really don’t want these symptoms — I feel you. And if you do choose to use birth control, that doesn’t mean you don’t keep investigating.
Dr. Nicole Beurkens:
I think that that’s such a great point, that these are signs, like red flags that our body waves at us. That something that might be out of whack here, so if you’re seeing in your daughters or in yourself that wow — really, really terrible PMS symptoms, really huge mood shifts, can’t sleep.
If your daughter is really thrown off by different cycles throughout the month, different phases throughout the month, that’s an indication that there’s probably some actionable things there that we should be looking at, right? So what you’re saying is, instead of just sort of putting a bandaid on it and making those go away by using hormonal birth control, that really — we can start digging into what some of those underlying issues are.
Dr. Jolene Brighten:
Yeah, and you know — it’s 100% your right to use birth control for symptom management, but it’s also 100% your right to have that root cause investigation. And this is something that becomes problematic for… so young girls, it’s not uncommon to have irregular periods when you are getting started here, like your brain and ovaries are figuring out how to dance together.
You ever see anybody figuring out how to dance the first time and they nail it? No, that never happens. So it’s not uncommon to see that. And there’s a researcher, Jerilynn Prior who has talked about how it’s really a 10 year maturation process of that brain-ovarian connection being solidified. But often, young girls will be given birth control for that. Or sometimes that actually can be cause of hypothyroidism for instance, so I’ll have patients in my clinic, I go through a timeline with them, they are like yeah — my period was irregular and then I was like, I always have had dry skin, my weight has always been an issue.
I am someone who just needs to sleep 10-12 hours. And you go through that and things are getting worse and worse in that whole time you are like wow, it sure sounds like you had hypothyroidism, and your period was the first place that presented — and yet you were given birth control, and everybody said, well that’s irregular period, so go on your merry way, except that it’s medication withdrawal bleed — it’s not actually a menstrual cycle.
Dr. Nicole Beurkens:
So you mentioned the irregular cycles and I think that’s one of the reasons that I see of why a lot of girls, young teenagers, teens, young adults are put on the pill. What are some of the other reasons that you see younger girls or even at younger and younger ages now that they’re being put on the pill?
Dr. Jolene Brighten:
Well, menstrual cramps and pain — pain in general. It’s estimated that over 30% of women who are taking the pill, that’s one of their primary reasons. Now to frame that, we used to use birth control to space pregnancies, and then this thing happened when I was about in my early 20s, where it started being marketed as ‘The pill for every female ill’. And so now we see, like you were saying, in the last decade we are seeing that birth control pills are being prescribed more and more.
Now, from the research we have come to understand that almost 60% of women state that their primary reason for going on the pill or using any kind of hormonal contraceptive is for symptom management. So menstrual cramps and pain is #1.
And definitely, nobody wants to be in pain, and so I can understand that, but what is that pain? That pain is often an issue with inflammation, prostaglandins, estrogen, it also can be related to the gut. So again — there is a root cause to all of this.
And for women who are listening who are like — what about endometriosis? It’s interesting because endometriosis is cited as about 4% — so I think that number, the reason that it sounds so low and it’s like — wow, no wait a minute. If you’re saying it’s pain, it should be higher — it’s because when you use the pill to treat symptoms, you often delay diagnosis…. And the longer she stayed on it, you know when she’s put on the pill for pain, the higher the probability that she has endometriosis.
And so I don’t think that’s because — you know there are people out there that are like, ‘That’s because the pill causes endometriosis’. I don’t think we have enough research and evidence to say that, I think it’s more that this girl presented with these painful periods, she was then put on birth control and when she decided to have a baby, that’s when it was uncovered.
Now, why is it uncovered then? Because endometriosis is responsible for about 12% of infertility cases. Now regular periods, that’s also up there with the painful periods. Acne is another one and this is the one that gets me, where — you’re treating her for acne and sometimes, this is for women with polycystic ovarian syndrome. Like irregular periods and acne — but hormonal birth control puts her at a higher risk for stroke, heart attack, having a clot, something that PCOS women are already at a higher risk for.
But in addition to that, when you are treating her for acne, something that nobody dies of, with a medication that people do die of — are you having that discussion? Are you helping her really make that decision and understand what to look out for? So those are some of the top reasons.
Over 10% are unspecified reasons that are related to hormones. So that might be that you are having hair loss, you’re having hair growth on your chin, chest, abdomen, it also can be an issue with headaches, which is very concerning. I actually was having a discussion with a mutual friend of our, Dr. Maya Shetreat about how often we see doctors prescribing the pill for migraines, although we’ve known for a very long time that a migraine with an aura is a contraindication she’s at higher stroke risk, and yet this is still a treatment that is being offered.
Dr. Nicole Beurkens:
That’s a great point and I’ve seen that more often than I should in practice too, or even teenagers who aren’t having any problem — young women who aren’t having any problems around their periods but being put on hormonal birth control because of migraine issues, mood issues are another one that I see often, where it’s like well we’ve had this young woman on SSRI medication for depression and these kinds of things, it’s just not getting better so let’s throw a birth control pill at it and see if that will help manage the mood.
And what I see is a lot of young women who have been on hormonal birth control for various symptoms for a while, and they’re coming in because those problems still aren’t solved. It’s like I’m taking all these medications including birth control, and still I’m having all these issues.
And you made a great point about how the pill can mask important physical symptoms and things, and I look at that too that it can mask important emotional things and traumas and things that people are experiencing, that young girls and young adult women are experiencing that need to be dealt with and not just shoved under the rug and said well, you’re having hormone issues, you’re feeling down or anxious or whatever because of this, let’s put you on the pill.
Sometimes what I find then is that this makes it so that these young women are not getting the help that they need for maybe things that are going on in their life that somebody needs to look at and address or learning coping skills, things like that — so I think these are red flags both for physical and emotional issues and we can use the pill as a bandaid, but really what we want to do is get to the root issues that are causing these things.
Dr. Jolene Brighten:
Yeah, and like you were saying, I think hypothyroidism is… we’re seeing this more and more in young women. Do you remember the time where it was hypothyroidism — it was something that women in the 40s get, not women in their 30s.
Now we’re seeing 8 year olds with hypothyroidism. What is going on? The canary in the coal mine is what’s going on. That alone is something that can present with anxiety or depression or alternating. And it’s interesting to me that you talk to psychologists and psychiatrists and they will say, “Well if that medication didn’t work, you should definitely be looking at thyroid.” And then we’ll hear from primary care physicians who are just prescribing mood-altering medications over and over, and not investigating that.
I think it’s really interesting that people who have the training in mental health recognize thyroid and then there is this disconnect within the conventional medicine paradigm on that.
Dr. Nicole Beurkens:
Yeah, excellent point. I want to delve into mental health risks for our preteen girls, our teen girls, our young adult girls because I have yet to have a patient come in who has received any information from their prescriber around this, and I really think that it’s important that you are talking about it. So what do we know about mental health risks for teenage or younger girls who are on hormonal birth control?
Dr. Jolene Brighten:
Yeah, let me say this too, for every woman listening — odds are, you’ve been dismissed at some point with something that you’ve brought to the doctor, because medical gender bias is well recognized and documented. And what’s interesting to me, like you were saying, doctors will say okay, you are having your hormones fluctuating and your menstrual cycle are causing your mood symptoms, so I will put you on hormonal birth control.
Then when you say they’re worse, they’ll say well that could never have an effect because there is no study on that — but just use a little bit of logic there, you just used this medication, these synthetic hormones, which by the way, your gut has never seen before, your brain doesn’t know, we didn’t evolve with synthetic progestin. That’s just not the reality of the human body.
So I think it is something that is important for women to recognize, it’s on the package insert, it’s something women have complained about since the introduction of the pill and yet, it is one of the most commonly dismissed side effects. And even when we say a study come out of over a million women in 2016 — think — hey, if you get prescribed birth control, you are also 23% more likely to also get prescribed an antidepressant because you go on to develop depression.
And yet, scientists and doctors lined up to dismiss this. And I’m like, when you dismiss that — you are dismissing a woman’s story, okay? And I get that maybe the research wasn’t done exactly the way that you want to see it and we’re not in a place where we can say causation.
We can only say correlation based on a relatively new scientific method of researching the human body and in medicine, and that’s the other thing that we can come to understand — is that all this evidence-based medicine, it’s fairly new on the scene as well, and I don’t think it’s out of place to really understand the complex nature of being a woman. We are not as biologically simple as men.
And why would we be? We make humans, we grow them in our body. So for our teen girls, what was really the most concerning coming out of that is that they were 80% more likely to develop depression when taking the combination pill, so that’s estrogen and progestin — and let me just say: Progestin is made in a lab, progesterone is made in nature, they are not the same thing.
If you understand that, you are way ahead of most experts in this arena. Now, there are people who were then like oh, well — it’s probably the estrogen. And then when we came to find out it’s not, if you are on the progestin-only pill, you’re 34% more likely to be prescribed an antidepressant. That was higher than the combination pill which was 23%. Teens taking progestin only, which is commonly called the mini pill, had two-fold increased risk of depression.
And it only gets scarier, because if you are using hormonal birth control as a teenager you have 3 times the risk of committing suicide, which really peaks in the — and let me say, no that was young women. Teens are actually at double the risk of suicide after one year on the pill and they were 30% at a higher risk for 7 years on hormonal birth control. Now, the suicide risk peaks in the first few months. And I really want to highlight this and spend a little time here because we are in an age where a girl can go get the pill and her mom never knows about it, her family never knows about it. I would never advocate for women not to have access to that, I was in a super religious family, there is no way I would have been able to ever be given permission to start birth control.
However, if you notice your child is not motivated, they don’t want to talk to their friends, they’re starting to cry all the time, they are raging out like the hulk — because everybody always thinks depression is like you’re just sad — and like no, it shows in a lot of way, but if you as a parent notice anything is not normal, and you have a teen that possibly did go start the pill, like this is something to give pause and pay attention to and something that I am really concerned about, because I think that if a doctor going to pass a girl the pill — and when I say girl, I mean any woman, there should be this conversation of what could be the impact on your mood.
But especially with these teenage girls, if they are going and their parents are not aware of their contraceptive choices — that should really be a dialogue that the doctor has, and should say — your bestie should keep an eye on you for the next 6 months and I actually want to check in with you in 6 weeks.
I want to check in with you again in 12 weeks and see how you’re doing, and do a mini mental health screening because these girls are really, really high risk. Being a teenage gal, I mean you cry enough as it is. I think back to my teenage self, I went through a pill that I remember when I started it with my doctor, I remember I would get in the shower and I would just cry and I would be immobilized, like I couldn’t get out of the shower, and I remember when I went to him and said the only thing that’s changed is birth control, maybe it’s this — he was like “No. But I’ll put you on a different pill.” And then everything changed.
And how many women have you talked to that that’s happened? If your daughter.. if something is going on, don’t assume it’s a bad breakup with a boyfriend, don’t do what most of society has done, which is like brush it off and say it’s something else. Definitely take a moment to pause and say, could this possibly be involved?
Because this is a real risk. To think that these days you can get it in the mail and never talk to a doctor. To think that you can get this medication, you can start this and no one ever told you, “Hey, this could be impacting your mood.” And then the next thing you know, you could be having suicidal ideation, you’re thinking about taking your own life.
Dr. Nicole Beurkens:
So important. The statistic are really staggering, actually. And just so vital for us as parents to understand, and I’ve had several moms over the years come into clinic who have raised with their child’s prescriber — like, “Gosh, things seem to be worse”, and they were told exactly what you were saying — no, it’s not the pill.
Or — we can change the type of pill. And I think where it becomes even more complicated, and for those of you who are listening who have daughters who already have a history of things like depressions or things like mood disorders or anxiety, those types of things and they’ve been put on the pill — either for contraception or to manage cycles or as part of their treatment for those mental health issues, the picture gets really complicated, right?
Because it’s like my kid already had some of these issues, now what’s causing an increase in it? But I think any time you start your daughter on something, even birth control. Even an antibiotic, anything — and we tend to think, oh that’s not related to their mental health stuff: it’s all related.
And what I hear you saying is, this is all interconnected and absolutely hormonal birth control can have an impact on either initiating mental health problems that weren’t there before or worsening them, and that we need to really be aware of that, we need to be watching for ourselves and our daughters and advocating that for them with their prescribers that something doesn’t seem right there.
Dr. Jolene Brighten:
Yeah. And as I go into… I have a whole mood chapter in my book. So at this point, I think we need to stop debating: Does hormonal birth control impact women’s mood? There are enough women who have said this, they’ve said yes and raised their hand — I don’t care if we can say causation, correlation, whatever.
Can we just start believing women’s stories and instead take the approach of ‘Why her and not her’? Why has it happened to this person but not this other person? Because we all have somebody in our lives that has been impacted — you’ll hear women say, “I can’t do hormonal birth control, it makes me a crazy person.” Why? Why did it affect her in that way? And I really respect that a study came out and researchers were like, we’re not going to sit here and debated causation.
We just want to understand what’s the possible mechanism of action to this. And one thing they found is that the inflammatory effects of hormonal birth control, the way it affects the female brain led to an increase in neurotoxins being produced in the brain.
So when you’re on it you actually make toxins in your brain. So I’ve had doctors who kind of push back on this, and ask them — if you subscribe to the serotonin theory of depression and you believe that it’s a deficiency in serotonin, then can you understand that if you are on a medication that depletes the nutrients you need to synthesize serotonin how that might play a role?
It’s usually a moment where a light bulb goes off for them, because this is something we’ve been taught in school — that is: If you are deficient in serotonin, then you are going to have depression. And so research has been showing for decades, you need more tryptophan if you’re on hormonal birth control. Well, that’s a precursor to serotonin! Problem is if you look at the cytokine theory of depression, what you do with that tryptophan is what becomes problematic. And so no matter what you subscribe to — there is logic.
There is basic physiology that you can look to and have the answers, that we don’t have to wait decades for a study to come out, for someone to fund the study, and then for doctors to hear the study and then believe the study for us to start believing women.
Dr. Nicole Beurkens:
So true. Absolutely. So we’ve talked some, you talked about getting to the root cause issues. So that may be a reason that some parents opt to not use hormonal birth control for their daughters, because they want to delve into root causes and investigating that with appropriate medical professionals who can help them do that. Let’s talk here before we have to end, what about for parents and young women and teens who do choose to use the pill for whatever reason, whether it’s regulating cycles or for mood issues or whatever — what can they do, what should they know about how they can better maintain their health while using hormonal birth control?
Dr. Jolene Brighten:
That’s a great question because it’s not up for us to decide what a woman does with her body and I have a boy, and I still have fear of teenage pregnancy. That fear is real, and so definitely parents reach out to me — they’re like I feel like the pill is the thing my daughter is going to be most successful with. Well, somebody needs to talk to her about how she uses it, because it’s not perfect to use — it’s only 91% effective. And so keep that in mind as well.
Now, if you choose to go that route, then the first thing I recommend is to at least spend one — more is even better, but at least one menstrual cycle documenting all your symptoms. Going through, just as we explained in the very beginning, so go back listen to the beginning of this again and go through what’s day 1 like for you? What’s day 2? Go through both the physical and emotional symptoms — everything you go through so you know your baseline. I also think it’s important to get lab testing.
There are doctors out there who are like — we just test if there’s something wrong. Why are you waiting so long to get someone’s baseline. How would you know they’re normal if you are only basing it on when they get sick. And so getting a thyroid panel, getting a CBC, looking at a homocysteine so you know right now what are you doing with your B vitamins? And I go through all kinds of labs in my book. They can get those baseline labs.
Then when you start hormonal birth control, you need to be on a prenatal or a multivitamin because it’s very hard to out diet these nutrient depletions. You still need to eat a whole foods diet, but you know — when I was a teenager, I thought crumb doughnuts were an acceptable lunch.
So I’m like let’s be realistic of what might go down, because I think we all have to do these moments of what I call the metabolic obscenities, cursing at your body with your food. So with that, getting a good prenatal or multivitamin onboard, so that way you can safeguard against nutrient depletions.
As much as we can get our teens eating fibers and nourishing their microbiome, awesome. But probiotic is going to be a good idea as well. Hormonal birth control really hits the microbiome about as hard as an antibiotic does. When I read the paper that was like, ‘The effects of hormonal birth control, the pill specifically, is similar to that of an antibiotic’, I was like whoa — well who spends ten years on an antibiotic! So that’s what it’s been liken to it causes intestinal hyperpermeability as well, which is leaky gut and sets the stage for potential autoimmunity.
So the other thing you should know is, if you have a family history of inflammatory bowel disease or Crohn’s disease, you’re going to want to give pause before you start that. Because a Harvard study found that 5 years on the pill and a family history of Crohn’s, you were 300% more likely to develop it.
That is really something to give pause. So going through your family history before you start it and then continuing to monitor your symptoms through the lens of your personal and family history. And I will say this, especially with mood — you start to get a little anxious, you start to get a little weepy, you feel a little bit angry. If it’s even a little bit, you need to talk to your doctor because what happens is that it starts out subtle, because your body is so adaptable and super, super smart, keeping you safe. But then what happens is a year later, you can’t handle it anymore. Adaptation is failing and at that point, your doctor say, well if it was birth control, it would have happened by now. But it’s been too long, so it’s something else.
And really, the reality is that the female body, in particular, is really amazing at pushing through pain and discomfort and dealing with a lot of it — it’s why there are humans here. There wouldn’t be humans if we didn’t have that capacity. So getting your diet dialed in as best as possible, trying to get all the broccoli and cruciferous vegetables to support liver or liver detoxification, bringing on probiotic-rich foods or even taking probiotics and then getting that prenatal and multivitamin.
That is all really helpful, but one of the best things you can do is continue to ask: What is true for you? And monitor your symptoms throughout. And you know, I’m sure that you are aware of this as most female medical professionals are, that women have been dying of heart attacks at a higher rate than men. We are more likely to be dismissed with chronic pain and significant conditions than men are. And it is something that has hurt us.
So in ‘Beyond the Pill’, I go through — what does it look like to have a heart attack for a woman? What should you be aware of? And I have heard from so many doctors who were like, “Oh the stroke risk is so low, clots are so low — why would you even worry about it?” And I go through specific lab testing that you can have done to know, is that true for you and to understand that.
And I’ve also had 19 year olds — I’ve had 20-somethings come into my office after having a stroke on the pill and then being told, “Well just do the NuvaRing, or just do the patch or do something else.” And some of them, the doctors are like, “Nope — this is a deal breaker.” There are really, really great doctors, but it may not be within their wheelhouse with what you’re dealing with to be able to hear and understand that. So those are the big things, and I can not iterate enough that you live in your body and so you know what normal is, and if you feel like it’s not normal for you, it doesn’t matter what your doctor says. Doctors will say, “This is your new normal.” I’m on a medication that created this new normal — maybe we should pause and question it.
Dr. Nicole Beurkens:
Awesome. Such great practical things that parents and girls can be thinking about in terms of what they can do. And I love that message about being in touch with what is true for you and lot just letting people dismiss. And for parents and for young girls and young women to feel empowered to advocate for themselves and to keep searching if you need to, to find the provider that is going to listen and going to look at what’s really going on for you and not just dismiss that. I think that’s such a powerful message. The book is ‘Beyond the Pill’, it’s out now. Tell us, where can people go to get the book, where can they go to find out more about you and what you’re doing in the world?
Dr. Jolene Brighten:
Yeah, so you can find me at drbrighten.com, that’s my main hub. I also play on Instagram — @drjolenebrighten and I have a YouTube channel where I seek to educate people in a different way, because not everybody wants to read big articles like you and I do. We all learn differently, right?
And you can pick up ‘Beyond the Pill’ anywhere they sell books. If you grab it, I’ve got some gratitude gifts for you at beyondthepillbook.com. You can go over, grab some exclusive interviews, some recipes, lab guide that you can check out. So you can start supporting yourself now, whether you’re on birth control or off of it.
And the book is called Beyond the Pill because I knew from my years of practice that you can go to your doctor with any lady parts problem and they will offer you the pill, I wanted to give women a solution beyond birth control, but also provide them support if they decide to do it and when they’re ready to transition off.
Dr. Nicole Beurkens:
Awesome. Such an important book, and we’ve been recommending it so much here at the clinic. For us to use as moms for ourselves, for our girls, our daughters, our friends — all of that. Just an amazing book, so I highly encourage people to check that out and certainly to follow you on Instagram and everywhere else. So thank you so much. Really important, really informative interview — I learned a ton, so thank you for that! And we appreciate you spending time with us.
Dr. Jolene Brighten:
Thanks so much for having me and for all the work you do. We need a lot more docs like you.
Dr. Nicole Beurkens:
Thank you! Alright, everybody, that’s it for this episode, we will see you next time for the next episode of The Better Behavior Show!