Thanks for joining us for episode 88 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show.

Today we are very excited to be interviewing Dr. Lara Briden!

Dr. Lara Briden is a Naturopathic Doctor with nearly 20 years of experience. She runs a busy hormone clinic in Sydney, Australia and is the author of the book Period Repair Manual: A Natural Treatment for Better Hormones and Better Periods. You can find her, and her great blog and website at LaraBriden.com.

The topic of women’s hormones has become one shrouded in mystery, complexity, and confusion. Countless women with ongoing hormonal health conditions are testimonies to the lack of understanding by healthcare practitioners and women themselves about hormonal health.

Our guest today brings good news that it doesn’t have to be that complicated! Be sure to join us as Dr. Lara Briden clears up misconceptions, provides fresh insight into women’s hormones, and reveals how women can learn what their bodies need.

We definitely had some ah-ha moments that you don’t want to miss!

Here are some of the questions we discussed with Dr. Lara Briden:

• Can you define amenorrhea and talk a little about the different symptoms of either amenorrhea or menstrual cycle irregularities?
• For women who may not know all the signs of ovulation, what kind of things would you be looking for?
• Are there benefits to tracking your ovulation cycles or knowing if ovulation is even happening?
• Can you can still have a menstrual cycle if you’re not ovulating?
• What are some of the major things that you find are contributing to amenorrhea and what kind of factors should we be looking at when looking to get our cycles back?
• What are your thoughts about carbohydrates?
• Many women are developing either amenorrhea or PCOS type symptoms from under-eating. Do you see a lot of that kind of PCOS type patient?
• Can you describe what kind of symptoms might come up when somebody stops taking birth control and how to know if they are actually dealing with post birth control syndrome?
• Is there anything that can be done about hormonal acne?
• What are the best options for natural birth control?
• How do you know if your premenstrual symptoms are PMS or something more severe such as PMDD?
• Can irregular periods or menstrual cycle issues in general be caused only by emotional and mental stress?

Links Discussed:

• This episode is sponsored by Pure Indian Foods
• Find Dr. Lara Briden on Facebook, Twitter, and Instagram
• Dr. Briden’s book: Period Repair Manual: Natural Treatment For Better Hormones and Better Periods
• Dr. Briden’s animation “Why Birth  Control Can Never Regulate Periods”
• Dr. Briden’s blog posts “How to Prevent and Treat Post Pill Acne” and “Road Map to Progesterone”
• Daysy fertility calculator and contraceptive device
• “Premenstrual Dysphoric Disorder: Epidemiology and Treatment”
• Danish birth control depression study:  “Association of Hormonal Contraception With Depression”
• Fertility awareness websites

TRANSCRIPT:

Kelsey: Hi everyone. Welcome to episode 88 of The Ancestral RDs. I’m Kelsey Kinney and with me as always is Laura Schoenfeld.

Laura: Hey everybody.

Kelsey: Today we have a really awesome guest and we are very, very excited for you guys to hear this interview, so we’re going to skip our usually updates. But this is a topic that Laura and I are really interested in. It’s such a fascinating conversation that we have with our guest today and I’m sure most of you will really, really enjoy what we’re going to talk about, and that’s just women’s hormones in general. We’ll talk a little more specifically about amenorrhea in our conversation as well.

But I hope that you guys enjoy it as much as we do. I think Laura and I are a little bit invested in our personal questions as well because it’s a topic that every woman deals with. Nobody has it all totally figured out. Certainly Laura and I don’t have it totally figured out. It’s a really fun thing for us to get to talk about because not only does it affect us, but it affects the majority of our clients as well.

Laura: Yeah and I think it’s important to remember that a lot of the topics like amenorrhea, and under-eating, and that kind of thing that we’re going to cover today, I don’t have that issue. Kelsey, I assume you don’t have that issue as well.

Kelsey: No.

Laura: But that said, there are some things that Kelsey and I have struggled with that we definitely cover today, things like hormonal imbalances, PMS, contraceptive options, that kind of thing. We were super stoked to be able to talk to this guest. I got all fan girly. I hope that you all enjoy this as much as we did because if you do, then we know you’re going to like this episode.

Kelsey: For sure. Before we get into the interview today, here is a word from our sponsor:

Today’s episode is brought to you by Pure Indian Foods, a top producer of grass fed, organic ghee products and one of our favorite sources of healthy cooking fats. If you’ve never tried ghee before, it’s a delicious and simple way to get the nutritional benefits of dairy in an easy to tolerate form. The production process removes casein and lactose making a great choice for those who are sensitive to dairy. Pure Indian Foods is your trusted source of homemade grass fed, organic ghee products. The family’s been in the ghee business for five generations and makes their golden ghee with milk from grass fed cows during the spring and fall. Try it today by visiting PureIndianFoods.com.

Laura: We have a really exciting guest with us today. It’s somebody that I know I’ve been wanting to talk to for a while and I definitely reference her work a lot with my work with clients. She has a great book that I’ve been sending a lot of people to. We’re so excited to have Lara Briden with us. She is a Naturopathic Doctor with nearly 20 years of experience. She runs a busy hormone clinic in Sidney, Australia and is the author of the book Period Repair Manual: A Natural Treatment for Better Hormones and Better Periods. You can find her and her great blog and website at LaraBriden.com. We’re going to be talking all about women’s hormones today. Welcome Lara.

Dr. Lara Briden: Hi Laura. Thanks so much.

Laura: Like I said earlier, I know that your work is something I send a lot of my clients to whether that be your blog or your book. I think it’s a great resource and it’s been super helpful to have that just to explain things to people and also to give them another perspective. It’s always nice to have someone who’s on the same page to say look, this is what this person’s saying too. How did you get started in the field of women’s hormones?

Dr. Lara Briden: Great question. It was just based on the patients that were coming to me. In the early years I started out in general practice and I started seeing a lot of women. I started finding that women’s problems, sort of period problems, and thyroid, and those kind of issues respond incredibly well to diet, and lifestyle, and herbal medicine. It just slowly, slowly became my focus.

Laura: Yeah, I found the same thing and that’s probably why I’ve kind of focused on that topic as well is that being a dietician we have a little bit of limitations on what we’re able to do with clients and anything that responds super well to diet and lifestyle is always a nice thing to focus on. I can definitely see why that would be something you would want to be focusing in on. It was mostly on who was seeing you? It wasn’t necessarily any personal history of hormonal issues?

Dr. Lara Briden:  No, actually I’ve always had fairly uneventful, easy periods. But I was certainly worked with thousands of clients and patients who haven’t. But the other thing to say here is that the other I think reason this became my focus is because women, we’re just not getting any answers from conventional medicine at all.

Laura: Mm hmm.

Dr. Lara Briden: We’re in quite a strange time with conventional medicine where there’s just really no tools, no way to help women effectively. Nutrition and natural medicine can step in to fill quite a big gap.

Laura: It’s always funny when they talk about women’s health as a specialty topic because if you think about it, it’s 50% of the population. I don’t know how special that is, but definitely women have issues with hormones and stuff that men don’t experience so there’s lots of complexity there that can be specialized in.

I think what we’re going to talk about today is mostly the kind of hormonal issues that women of childbearing age deal with. Obviously there’s lots of time in the life where you can either have issues with your menstrual cycle, or you’re having kind of that perimenopause stuff, or post-menopausal issues. We’re mostly going to be focusing on pre-menopause today.

But let’s talk a little bit about what amenorrhea actually is. Can you define that for us and maybe just talk a little about the different symptoms of either amenorrhea or menstrual cycle irregularities for the listeners that don’t really know what they should be looking for?

Dr. Lara Briden: Yeah, okay. Amenorrhea just is Latin for lack of periods, no periods, and it can happen for lots of different reasons. What most people are talking about is something called secondary amenorrhea where they used to have periods and then they stopped for some reason. Some extension of that is to have irregular periods which would be defined as having a cycle come that is not….A normal cycle should come 21 to 35 days. That’s the parameter that I use. Why that’s important is because within that range of regularity, it’s usually a good sign that ovulation is occurring.

Laura: Okay. As far as how frequently the period either has to be missed or off that, did you say 21 to 35 days?

Dr. Lara Briden: Yeah, so a normal cycle would be 21 to 35 days. Missing a couple periods or skipping a couple cycles is not a problem. It’s quite common with stress, or dieting, or something like that. The diagnosis of amenorrhea would not be given until I think at least 6 months of lack of periods.

Laura: Okay. As far as irregular periods are concerned, I know a lot of my clients who are dealing with that, their doctors have said that they should be getting it every 28 days. Do you find that if people are going shorter maybe in like the 23 to 25 or longer that that would be still something you’d consider normal?

Dr. Lara Briden: I consider that normal.

Laura: Okay.

Dr. Lara Briden: It comes back to my mantra in my book and in my blog. I think I’m just constantly bringing it back to the question of do you ovulate? That’s what it all comes down to for women’s health is do you ovulate? Which is not just the releasing of an egg to make a baby. That’s just one small part of it. Ovulation is how we make our hormones.

Laura: Okay.

Dr. Lara Briden: When I’m assessing what’s happening with a women’s cycle, almost regardless of the length, that’s my first question.

Laura: For those women, myself included, who may not know all the signs of ovulation, what kind of things would you be looking for?

Dr. Lara Briden: I actually think I’m at the point where I think all young women, teenagers should be taught about ovulation, should learn body literacy or just fertility awareness just to know what’s happening with their body to track to have a sense of an ovulation occurs. There are a couple of key signs. There’s a kind of vaginal discharge or what’s called fertile mucus, or cervical fluid, or cervical mucus that looks like quite different than discharge than we see on other days. It looks like raw egg whites and there can be quite a lot of it. I just mention it because your listeners, they’re probably seeing that, they may not know what that is. That’s quite a useful sign. That is a sign that ovulation is probably going to occur. It’s not a guarantee of ovulation, but it’s a good predictor.

Then some women will get a little twinge in kind of their lower pelvis, a little ovulation twinge, a mild pain. Then another way to know is to track with temperatures because we get this really interesting half a degree rise in basal body temperature in the second half of our cycle. Anyone can do that whether they’re using that for avoiding pregnancy, or achieving pregnancy, or just to know what’s happening with their body. It’s worth doing even just for a couple of cycles just to check in with that.

Laura: Yeah, I think the ovulation piece can be difficult. I know a lot of doctors will suggest the ovulation test. Is it luteinizing hormone that they’re testing or follicle stimulating? You might know better than I do.

Dr. Lara Briden: It’s luteinizing hormone. It’s a urine test for LH, luteinizing hormone. It can be helpful, but the problem is it’s not an accurate test for anyone that has a condition called PCOS or polycystic ovarian syndrome because they have kind of chronically elevated luteinizing hormone, so that can be a very confusing test to try to do.

Laura: Okay. As far as knowing when ovulation happens, I think for most women they would understand the benefits if you’re either trying to get pregnant or avoid pregnancy, but is there any other benefit to tracking your ovulation cycles or knowing if ovulation is even happening?

Dr. Lara Briden: There’s every other benefit, every other benefit. Men make hormones every day. Men make testosterone every day. Their testes make it every day. That’s sort of their cornerstone of hormonal health.

We have a totally different situation. We make hormones in monthly pattern. We make hormones, they peak during sort of the middle of our cycle around ovulation, and this is with ovulation. Ovulation is how we make hormones. We need those hormones. Both estrogen and progesterone have multiple benefits, too many benefits to even discuss today, but they’re beneficial for mood, for bone health, for insulin sensitivity, for metabolism, for muscle health, for sleep, for microbiome, for example.

Laura: Mm hmm.

Dr. Lara Briden: Estrogen and progesterone interact with all those systems.

Laura: Wow. When it comes to ovulation, is that something if you’re not ovulating you can still have a menstrual cycle?

Dr. Lara Briden: I would say no. You can bleed, there’s something called an anovulatory cycle and that’s quite common for example in women with irregular cycles or PCOS. They get this kind of random bleeding. That’s not a real period. A real period is defined as one in which a cycle in which ovulation has occurred.

Laura: Okay.

Dr. Lara Briden: And we’ve made both estrogen and progesterone.

Laura: Are there potentially women out there who are having these anovulatory cycles that think that they’re having a normal menstrual cycle, but aren’t’?

Dr. Lara Briden: Yes.

Laura: Is that common?

Dr. Lara Briden: Well, that’s a very interesting question. We haven’t really looked at this, as in the collective we, as in it’s not something that researchers have looked at very much. Except there is a fascinating researcher endocrinologist in Vancouver, Canada, Dr. Jerilynn Prior. She put out a study a couple years ago that found that a lot of women, I think it’s like women who have been having regular cycles, about a third of time those cycles are anovulatory. This is young women. It was quite an interesting discovery. I think it’s going to vary a lot with stress, and diet, and things like that that can effect and impair ovulation.

Kelsey: Would the timing of that anovulatory period be the same timing as if you were having a normal period where ovulation has occurred? Or does it tend to be at a different time than you would expect it?

Dr. Lara Briden: That’s a great question, Kelsey. Even a couple years ago I would have said that what I was saying earlier that a cycle between 21 to 35 days is a pretty strong suggestion that ovulation has occurred. That’s pretty typical for an ovulatory cycle. A cycle that’s shorter than 21 days or longer than 35 days is I think likely to anovulatory. But that said, Dr. Prior’s research found that some women with 28 cycles were having anovulatory cycles at least some of the time.

Kelsey: Wow.

Laura: Well, it sounds like it’s safe to say that even if you’re not worried about the pregnancy piece that tracking your cycles and ensuring that ovulation is happening would be a good thing for all women to get familiar with. Is that right?

Dr. Lara Briden: I agree.

Laura: Yeah, and it’s funny because I feel like when you’re not concerned about fertility from an actual pregnancy perspective, it’s really easy think about this stuff. I know that for me, I’m not married, and I won’t be married until June, and I haven’t really had to worry about knowing if I’m ovulating or not, but it is something that I am definitely interested in. As my marriage is impending, I definitely have been thinking about it a lot more. I didn’t realize that there would be so many benefits to tracking this stuff even if pregnancy is not something that’s a concern. It’s definitely I think a good topic for all of our female listeners to be hearing today especially if they are in that kind of childbearing years as they like call them.

Let’s talk a little bit about amenorrhea because that’s something that a lot of our clients and “Paleo Rehab” participants deal with simply because we have a lot of under-eating, stressed out, over exercising, kind of typical pattern amenorrhea, but there’s lots of different causes obviously. What are some of the major things that you find are contributing to amenorrhea and what kind of factors should we be looking at when looking to get our cycles back if there are women that are amenorrheic right now?

Dr. Lara Briden: Yeah, you just said it, under-eating I’d say is the biggest one.

Laura: Yeah?

Dr. Lara Briden: Yeah. My first step will be to do some blood test to determine if there is something else. My question is always, I come back to are you ovulating? Obviously with amenorrhea, not ovulating.

Then the question is why is the body not ovulating? It wants to ovulate, so there’s something that’s preventing that. Probably going down the list a common situation is PCOS causes a polycystic ovarian situation which means that insulin and high male hormones are potentially preventing ovulation. There could be other factors like underactive thyroid can prevent ovulation, nutrition deficiency can prevent ovulation. Just a post-pill stalling or a post-pill inhibition of the hypothalamic pituitary ovarian axis can be part of the problem.

But after all of those have been ruled out, then my very next thought is are you eating enough to get a period? Are you eating enough to ovulate? I have a blog post called that,” Are You Eating Enough To Get A Period?” I find that women underestimate how much food we need.

Laura: Oh yeah.

Dr. Lara Briden: I think we have this pervasive message that women have to eat like birds, that’s sort of a good thing, and you have little salads and little smoothies. That’s not enough food to get a period. It might be fine, you might say my friend’s eating like that and she’s getting periods, so what’s the problem? Every woman has a woman what’s called ovarian set point. Our hypothalamic HPO, hypothalamic pituitary ovarian axis is very sensitive to nutrient intake, and that includes calories, and that includes carbohydrates specifically.

Laura: Yeah, it’s definitely something Kelsey and I are familiar with with the work that we do. I can’t even tell you how many women I’ve worked with that the under-eating issue was the root cause of basically the majority of their symptoms.

It’s really pervasive and unfortunately it tends to be pretty common in the Paleo community because one of the benefits of a Paleo diet is it is quite low calorie for the volume and for the amount of food you can eat compared to like a typical western diet. But the downside of that is women who are used to eating maybe more refined foods when they switch over to Paleo, they don’t realize how much of a drop in their calories or their carbohydrate intake that they take in. It’s something that we see a lot and so we are really glad that you are kind of confirming and also that we can talk about that a little bit today.

Tell us a little bit about the carb question because it always amazes me that as much Kelsey and I talk about it, that it still seems to not really be understood very well by a lot of the people that we work with or people that are listening to our podcast. What are your thoughts about carbohydrates in general and do you have any sort of guidelines for either an amount that people should be eating or like a general target that people can think about if they are dealing with any sort of either ovulation issues or amenorrhea?

Dr. Lara Briden: Yeah. There’s a paper which we can link to it’s about LH pulsatility. This is the luteinizing hormone coming from the pituitary and signaled by the hypothalamus. There’s what’s called a LH pulse that helps move us towards ovulation, and that’s very much affected by energy intake, and specifically by carbohydrate intake because there are glucose-sensitive receptors in the hypothalamus that are looking for certain a level of carbohydrate in the diet to trigger ovulation. That’s different for every woman. This is where the idea of ovarian set point comes from. That’s why it’s happening. Low carb causes amenorrhea and I think that’s fairly direct. Stress hormones are involved or maybe a general thyroid suppression is part of it, but I think there’s a direct signaling effect from carbohydrates allowing women to get periods.

Laura: Mm hmm.

Dr. Lara Briden: Of course men aren’t thinking about this because they don’t have the same issue. Their sex hormone signaling works entirely differently. Women are not small men.

Kelsey: Right.

Dr. Lara Briden: We have different requirements. In terms of the amount, that’s a very good question. I don’t know if it’s my laziness, or what it is. I mean I don’t tend to speak a lot in terms of grams. I prefer to not micromanage macronutrients in that way. I talk about the period as our report card.

Laura: Right.

Dr. Lara Briden: The period is the marker. Basically I say that if they’re not getting periods, okay, you have to eat potato, or rice, sweet potato every night for a few months. If you don’t get a period, we’re going to increase the amount basically.

Laura: Mm hmm.

Dr. Lara Briden: It’s important for your listeners to know that it takes three months. It won’t happen before that. They can’t say okay, I’m going to try increasing my carbohydrates for a few weeks or a month, and then if I don’t get a period, then that’s not working. There’s always a time delay, sort of a time lag with the ovarian signaling.

Laura: That’s good to know because I’ve worked with a lot of clients who were a couple months in and they were like well, everything’s going great, but I haven’t gotten my cycle back yet. I’m like let’s just wait, I swear it’s going to come.

Dr. Lara Briden: Yes, just wait. Exactly.

Laura: I think with the carb question, Kelsey and I, like I said we talk about this stuff all the time. But it’ll obviously depend on just overall usage, activity levels, that kind of thing. But it sounds like there’s a possibility that with that ovarian set point, that some women might be able to do a low carb diet and their body can produce enough glucose to keep that ovarian set point happy, whereas other women really do need the dietary carbs to actually activate that. Have you experienced that before?

Dr. Lara Briden: Spot on. I think you said that, you summarized that very well. We have to allow for pathology. Women who have severe insulin resistance are obviously in a different category. I work with a lot of women with PCOS and some of them are pre diabetic. They’re very insulin resistant. Then that becomes a different question. That’s different than just your average young women with amenorrhea. Specifically then I think then we can recruit more of a low carb strategy and they can do quite well with that.

Laura: It’s interesting with the PCOS and amenorrhea connection. Unfortunately I think a lot of the PCOS guidelines that are out there for most people or that are being given to them by their doctors is really more aimed towards that insulin resistant type. Which certainly there’s a lot of that and somebody who is insulin resistant, overweight, that kind of thing, is going to benefit from maybe some reduction of overall food intake, or carb intake, that kind of thing. But unfortunately I think that leaves out a big subset of the population who are developing either the amenorrhea or the PCOS type symptoms from under-eating. Do you see a lot of that kind of thin PCOS type patient?

Dr. Lara Briden: Yeah, I do. The basic problem is that PCOS is not one thing.

Laura: Mm hmm.

Dr. Lara Briden: It’s what’s called an umbrella diagnosis. A lot of women are being under the diagnosis of PCOS, but they’ve come there for completely different reasons. They are talking about renaming the condition. I actually think we need to have it renamed into at least 3 or 4 different conditions. About 70% of women with a PCOS diagnosis have the classic insulin resistant PCOS, which means that insulin resistance essentially caused their PCOS. Then the other 30% are an assortment of they might have high adrenal androgens. They might really in a way not have PCOS, not have androgens at all but just happen to have had polycystic ovaries on a ultrasound, which is not diagnostic. But may have been told they have PCOS when really they have hypothalamic amenorrhea due to under-eating, but they happen to have polycystic ovaries.

Laura: Mm hmm.

Dr. Lara Briden: I’m sure you’ve encountered that situation. That’s the group of women that run into the most problems because they say okay, I’ve got PCOS, therefore I need to reduce my carbs more. They’re basically moving in the opposite direction of where they should be going.

Laura: Right. If somebody has cystic ovaries but they don’t have the insulin resistance type PCOS, do you know what might be causing that cyst development?

Dr. Lara Briden: They’re not cysts. It’s a funny word. The word cyst has to be eliminated from the condition completely. They’re follicles. They’re undeveloped follicles, which are eggs. The ovaries are cystic by their very nature. They always have a certain number of cysts or otherwise called eggs, follicles. It really just comes down to like in a normal ovulatory cycle we would have sort of between 8 to 12 cysts I guess if you will, normal cysts, including a dominant follicle which is the one that ovulates. In lots of women, not just women with PCOS, at any one time you could grab any woman off the street and do an ultrasound and one in four times should would display what are classified what are polycystic ovaries, but it doesn’t mean anything. It’s not diagnostic. As a stand-alone finding, it means really nothing.

Laura: Wow.

Dr. Lara Briden: Another thing to understand is that young women, sort of teenagers and women in their early 20’s by definition always, always have more cysts, more follicles in their ovaries than older women. There needs to be an age gradient in that as well. I know they’re trying to revise some of the diagnostic criteria to account for that because teenagers are being misdiagnosed based on just ultrasound finding and then just doctors not really thinking it through.

Laura: Yeah.

Kelsey: That’s so interesting.

Laura: I wouldn’t be surprised if there was lots of malnutrition in those young teenage girls that are either under-eating or maybe just eating a very nutrient poor diet and that could easily be contributing to some of those symptoms that are then misdiagnosed as the typical PCOS.

Gosh, I feel like I’m learning a lot just talking to you about this stuff. Cool. Well, we have some questions from our listeners and we have a lot, definitely this was very popular topic. We’re not going to be able to get through all of the ones that were submitted. We try to group them into some just overall topics that we can cover.

I know that you work a lot with post birth control syndrome. Can you describe what kind of symptoms might come up when somebody stops taking birth control and how to know if they are actually dealing with post birth control syndrome?

Dr. Lara Briden: Yeah, let’s talk about it. But first I’ll say just for your listeners, a lot of women also have easy time coming off the pill. We’re going to talk about some of the bad things that makes it sound quite scary. But there certainly are women who can just stop hormonal birth control and feel better, feel well, and their mood improves. It can go that way as well.

But a common experience especially after pills…there’s certain pills what are called anti androgens, so they have a very strong androgen suppressing effect. That would be like Yasmin, and Yaz, and we call it the Diane. Those are some of the brand names. They have the progestin drospirenone and the other one is cyproterone. Those if a woman has been on those for some months or years potentially and then stops it, there’s going to be a pretty massive androgen surge, which means male hormone surge, which means potentially hair loss, potentially post pill acne, the dreaded post pill acne which starts about 3 months off the pill is usually when it starts. It usually peaks 6 months off the pill and starts to resolve maybe 9 months off the pill.

I like to get that timeline out there because if women don’t understand that that timeline exists, then they reach the 6 months mark and they think this is crazy, I must need the pill, I have to go back on because my skin is just getting worse and worse. But that’s usually the turning point.

Kelsey: Yeah, I wish I had known that. I was on the pill for a long time. I was actually put on it by my doctor when I was quite young for acne and then stayed on it for a number of years. Then towards the end of college, I was like why am I taking this? I should get off of this. I came off of it and it was little while ago at this point, but I think essentially followed that timeline. Boy, had I known that there was that timeline, I would have felt so much more confident getting through that period knowing that it was going to end at some point soon rather than just thinking what the heck is wrong with me? This is worse acne than I had in the first place basically and freaking out about that.

Dr. Lara Briden: Yeah, Kelsey, what you just said, that little story, your personal story is exactly, I’ve heard that from probably 100s, 1,000s of patients, that comment on my blog so often.  It’s almost the classic experience.

I’ll just explain one of the reasons for this withdrawal, the drugs, the hormonal birth control, they’re not real hormones, these steroid drugs. The ones in those anti-androgen methods that I talked about, they bizarrely suppress androgens and suppress skin oils to the level of a child, which is kind of quite frightening because as adults it’s normal for us to have more skin oils. Because they’ve been suppressed so much, the skin sort of up regulates its oil sebum production in response to that and then just really goes into hyperdrive when the drug is removed. It’s kind of drug withdrawal for the skin.

Kelsey: Right. It makes sense that that cycle would kind of happen, that you just need to give your body and your skin some time to get through that process of hyperactivity and then it’ll come back down to normal levels essentially?

Dr. Lara Briden: Yeah, that’s my experience.

Kelsey: Yeah, interesting. I have one other question about acne maybe before we move on here, which is let’s say you kind of gone through that period of probably worse acne than you had previously after you come off of birth control. Let’s say that there is either still some degree of hormonal acne that happens. Or for example, somebody who’s never been on birth control but who still gets some degree of hormonal acne around her period. Is there anything that can be done about that type of acne?

Dr. Lara Briden: Yeah. Skin is affected by female hormones and by male hormones as well. Those are certainly factors. But I think the underlying driving factor affecting skin, or acne, or breakouts is really to do with insulin sensitivity because even a mild degree of insulin resistance, it up regulates the production of what’s called DHT, so the activated androgens.

Removing sugar and dairy from the diet is by far I’d say clinically one of the most critical things to do. By sugar, I mean all high fructose foods including dates, and honey, and maple syrup. I’m sure you debated the idea. I’m sure you’ve had conversations about fructose with other guests, but it certainly for the case of skin, I think the fructose has to be largely removed to get an improvement. That’s my experience.

Kelsey: Interesting.

Dr. Lara Briden: Yeah. Again, there’s going to be a timeline. You can’t just remove it for a few weeks and think my skin is just as bad as ever. You have to give it time. The skin is on a sort of 6 month arch. There has to be some time to allow for that. The other key treatment is zinc.

Laura: Yeah, zinc and vitamin A tend to be those two nutrients that I like to focus on when I have a client with skin issues because they both kind of play into skin turnover and skin immunity, that kind of thing.

Now, real quick question about the fructose and sugar recommendations. Is that primarily for women who have signs of insulin resistance with acne? Or is it any woman that has acne at all?

Dr. Lara Briden: That’s a very good question. I’m going to say certainly if insulin resistance has been demonstrated, then I think a very low fructose diet is a critical part of treatment for that. My clinical experience is that even when with normal insulin sensitivity, normal on blood test, can benefit from removing high fructose foods. I don’t know exactly the mechanism. I think it has something to do with the DHT activation, the androgen activation. That DHT, that activated testosterone is also one of the reasons zinc works so well for skin because it down regulates.

Laura: Cool.

Kelsey: Interesting.

Laura: I feel like I was going to ask another question.

Dr. Lara Briden: About insulin or about fructose?

Laura: No, it was before that. It’s okay. There’s so many questions that come up with this kind of topic that I’m like oh no, I need to remember what I’m going to ask because I mean there’s thousands of things we can talk about.

Oh, now I remember what I was going to say. With the post birth control, something else that I see a lot in clients is post birth control amenorrhea. Can you talk a little bit about what might be causing that?

Dr. Lara Briden: Yeah. Do you know if you read the fine print on hormonal birth control it states in there written very small that it can take up to 2 years to resume ovulation after stopping hormonal birth control?

Laura: Wow!

Kelsey: Wow!

Laura: I didn’t know it was 2 years.

Kelsey: I know.

Dr. Lara Briden: Yeah. Of course there’s some women who bounce back right away and they get a period their very first month they come off. It’s like that’s great, that happens. Again it’s a lot to do with the sensitivity of the ovarian axis.

First of all, I think we need to give women permission to take 6 months to ovulate and get a period. I don’t see that as a problem. I don’t see that as pathology. That’s just recovering from a strong drug that had completely shut down hormonal function. I mean just to be clear, hormonal birth control, all types expect for the hormonal IUD’s which we can talk about, but all other types of hormonal birth control work by completely shutting down the communication between the hypothalamus, and the pituitary, and the ovaries. It induces essentially a menopausal state. It’s going to take a while to kind of get going again after that.

It’ll take longer if there’s other problems. Certainly if there’s under eating, that’s going to take a lot longer. If there’s zinc deficiency, if there’s anything happening with the thyroid, if there’s a gluten problem. Gluten sensitivity can completely shut down periods. That’s my experience. I’m looking for all of those things. I’m trying to make the body happy. You ask the body, what do you need to ovulate? What is the missing link for you? For every woman it’s a little bit different, but those are I guess where I start.

I guess I also do use the herbal medicine Vitex or chaste tree, or it’s called chasteberry which stimulates that hypothalamic pituitary ovarian axis. But I won’t give it for 3 months because I do want to give a woman just a chance to see what that hormonal communication is going to do.

Laura: Yeah. I know for me I usually like to focus on like you said the under-eating, macronutrient ratios, supporting their calorie needs, and then micronutrient deficiencies which I think can be super not only common in general, but then I know there are some micronutrients that actually get even more deficient when on oral birth control. Those would be ones to be focusing on like B6, zinc, that kind of thing. Then like you said, all the other lifestyle factors that can affect ovulation as well.

At the end of the day, if all of those things are covered, then the time piece sounds like that’s a big factor as well and just being able to be patient and wait until the body is ready to start doing it again. That’s I think a factor that a lot of women don’t remember that it’s not just going to be like a light switch even if all the factors are on board with the way they’re supposed to be.

Dr. Lara Briden: Do you know one of the reasons why there’s a 3 month delay always is that the ovarian follicles, the little developing eggs in the ovaries take 3 months to do their journey all the way from starting to develop and getting the proper stimulation from the pituitary, all the way through until ovulation is three months. That’s why I see a lot of naturopaths and they work with this kind of a 3 month time frame. When you do something, intervention, to help the female hormones you have to allow that time to see the results.

The micronutrients that the ovaries love the most are zinc, and iodine, and vitamin D. A deficiency of any of those alone can cause amenorrhea. I’m just thinking beautifully sometimes it’s that simple. If you can demonstrate a vitamin D deficiency and then give it, that can be enough to bring back periods if everything else is okay.

Laura: It sounds like 3 months from when everything is dealt with.

Dr. Lara Briden: Exactly.

Laura: If you still have some factors that are lingering, that can slow down the process as well. Just from a treatment perspective, if everything is being dealt with, then add 3 months, then that’s the timeline we’re looking at. Is that right?

Dr. Lara Briden: Minimum. You could imagine my reaction when I get a patient who said okay, I’m coming, I’m going to try some natural things. And if I don’t become pregnant in the next 2 months, I’m going to have IVF in 2 months. It’s like well, by definition I can tell you there’s no reason to even try anything because there isn’t enough time.

Laura: Right. Well, you were mentioning that IUDs work differently. That was one of the questions we got was does the pill have the same effect in your body as Mirena which is an IUD option? The other IUD option that’s hormonal that I’m familiar with is Skyla. They’re asking if you should expect your experience post removal to be the same as stopping the pill.

Dr. Lara Briden: They’re quite different than the pill. All the IUDs, and they have different names based on the different dose of the progestin that’s used. It’s given locally in the uterus. They work locally. They don’t work by suppressing ovulation. My experience is it’s a different thing because women potentially should still be cycling, ovulating, and hormonally cycling even when on the hormonal IUDs. Although the research is that that’s not always the case, that some women do stop ovulating especially during the first year of use, but then tend to recover their ovulation after that.

Laura: Okay. That kind of goes into a leading question from another listener. They wanted to know what the best options are for natural birth control. And also to add onto that, do you actually support the use of a hormonal IUD? Or are there other medications or devices that you feel are less problematic than oral birth control that can be used for women who would prefer not to use the family planning method?

Dr. Lara Briden: Okay. Well let’s speak through some birth control methods and then we’ll finish with a discussion about the hormonal IUD. I’m quite a pragmatic, practical person so I always just want the thing that’s going to work best for my patients. My first choice is fertility awareness method of some kind. I’ll say for your listeners, that’s working with the fact that we’re fertile for only 6 days per cycle. Men are fertile every day. Women are fertile 6 days per cycle. If you can identify those 6 days and avoid sex or use awareness methods on those 6 days, it’s an effective method of birth control.

It’s not rocket science. It is possible to figure out those 6 days, but you can’t just use your period app on your phone to guestimate that. You have to use temperature, basal body temperature. You can either do that on your own paper charting it or charting it with a period app making those calculations as to when you’re fertile. To do that you’ll need some kind of training either from a book or from a fertility awareness trainer, which there are many online. I can give you sort of a link at the end that has listed some of best ones. The other method, device that’s out there is the contraceptive device called Daysy. It’s a little computer that does that for you. I’m actually a huge fan of Daysy. I have no financial ties to it.

Kelsey: I actually heard of that the other day.

Dr. Lara Briden: Yeah.

Kelsey: I was like wow, I am surprised that I’ve not seen this before.

Dr. Lara Briden: I love it. I had written a few things for them, but I’m not associated with them or anything. It comes out of Germany. They register it as a medical device, contraceptive device. It’s a little computer thermometer so you take your temperature every morning and it starts to do the calculations. After a few months it starts to confidently give green days, there’s a little green light that comes on when you are in your non fertile days. For most women, that’s going to be the majority of the month, they’ll start to see green days and that means there’s no chance of pregnancy on those days. They claim a 99.4% I think efficacy

Kelsey: I’m looking at it right now. I think it’s 99.3, I believe.

Laura: That’s pretty high for birth control in general.

Kelsey: Yeah.

Dr. Lara Briden: It is. For sure. That’s my first choice. I like it because it doesn’t interfere with the body in any way. It doesn’t interfere with hormones. And also it gives women as we talked about before just a sense of body awareness or body literacy knowing that they are ovulating. One advantage of fertility awarness method or Daysy is that it can alert you to the fact that you’re not ovulating and then might need to make some changes or see your doctor about having some blood tests. I’d like to see every woman do it, use fertility awareness even if that’s not what they rely on solely for birth control. I think it’s still useful way to understand the body.

Laura: Mm hmm.

Dr. Lara Briden: Then after that, there are the barrier methods. There’s condoms of course which are actually I think really great. And there’s some new ones coming out. There’s an unbreakable condom called HEX I believe. It was just released last year. It was crowd source funded. They’re more comfortable and more reliable.

Then there are a couple of barrier methods for women. There’s the cervical cap which is made with natural latex. There’s apparently also a new diaphragm called Caya which I haven’t really looked at yet. I haven’t had a chance to investigate or recommend that yet. They’re inserted over the cervix and kind of held in place by like a gel.

Then there’s the copper IUD which I think is reasonable method for women. There’s no hormones. It doesn’t interfere with hormonal balance in any way. It doesn’t suppress ovulation. It just works locally in the uterus. The copper ions impair sperm and the device impairs implantation. It’s good for 10 years or more. They once a doctor inserts it, it can just stay there and it has a very high efficacy rate. I think one of the highest of any method. To be clear for your listeners, it’s just a quick in-office insertion. It kind of feels like a strong menstrual cramp. It’s not surgery. A lot of young women I’ve talked to have sort of weird ideas about what IUDs are. You can just put it in and it can be removed at any time just by pulling it out.

Those are the sort of all the non-hormonal methods. Do you have any questions about those before I go on to the hormonal IUD?

Laura: I think I’m familiar with most of those. The Daysy is something I’ve seen. I feel like because of the technology on Facebook, I see that one a lot because I’ve been doing research about family planning methods and also reading your blog and it just starts to come up a lot on my newsfeeds. I’ve seen that product as an option.

Then with copper IUD, I think in general I’ve heard some really good reviews from women who are using that. I have had at least 2 women not do well with the copper IUD. One women recently that was having some pretty significant I guess emotional response. We basically believe she was having some copper toxicity symptoms because she was having some hair loss and like I said some issues with depression while on the copper IUD that basically went away very quickly right after removing it. I don’t know if you’ve had that experience before with clients on the copper IUD.

Dr. Lara Briden: With my own clients, no, but I’ve certainly read that online and hear that women are reporting that. I’m keeping an eye on it. There was a study that came out of Mexico a few years ago where they did assess women’s copper levels and found that women with copper IUD do have higher levels of copper than women who don’t use one. It’s a tiny amount of copper really, so I don’t know that that’s necessarily the whole story with it. I think some women get anxiety with both types of IUD. I do sometimes wonder if there’s in some women kind of almost like a physical reflex to having something in the uterus that their nervous system doesn’t like. To me that seems like the most obvious explanation.

Laura: Okay.

Kelsey: I feel like one thing kind of heard about, and this could completely wrong so I hope you’ll correct me, about the Paragard is that sort of the way that it works is almost by causing local inflammation. You were talking about the copper ions inhibiting sperm. Is there any role of localized inflammation in how that works at all?

Dr. Lara Briden: My understanding is not. I used to kind of think that too, but I’ve sort of seen that debunked recently. It’s not. No there’s no significant amount of inflammation that I’m aware of with the current research.

Kelsey: Yeah.

Dr. Lara Briden: But yeah, we have to acknowledge that some women feel well on it. But with the copper IUD, I think there’s some hyperbole online about it. Some of the people who have had a bad experience become very vocal. I do want to make a point of all the methods including all hormonal methods and every other method, it has the highest rated user satisfaction of any method. I do know that some of my naturopathic doctor colleagues, that the copper IUD is the method they personal use. I think it’s important that women have maybe more of a sort of balanced understanding of it.

It does also make periods heavier. It makes periods 50% heavier which means however heavy they are now, half of that much again. Sometimes that’ll sort of settle down after the first year. But that’s just important to know. If a woman is tending toward iron deficiency for example, she needs to really think about whether a copper IUD is the right choice.

Kelsey: Right.

Dr. Lara Briden: Another just consideration is that very often women might be changing from they might have been on a hormonal birth control and then go straight to a copper IUD, like just very first month or two. Then they have to consider whether any symptoms they encounter are actually pill withdrawal symptoms. There could be a synthetic estrogen withdrawal coming off hormonal birth control too that can cause anxiety. I’m always kind of looking for what the factors might be.

Laura: Mm hmm. Now let’s talk real quick about the hormonal IUD since it sounded like that might not be quite as problematic as the oral birth control, but maybe not your top choice.

Dr. Lara Briden: When I support the use of it is when, again, when there’s pathology, when there’s women with endometriosis which is quite a serious condition. Often sufferers of endometriosis are forced into some kind of hormonal control, not always. Sometimes the condition can be managed without it. But in that case, I see Mirena as the lesser evil if you will, the least sort of harmful of all the types of hormonal birth control. I might support it in that case.

The other times when Mirena I think can be helpful is for perimenopausal women or women in their 40s that are having really heavy, severely heavy periods. Then the way I see it is potentially having Mirena means, or having the hormonal IUD means they don’t have to have a hysterectomy which is obviously a preferred choice.

Kelsey: Right.

Laura: Right. Is that kind of the only time you’re recommending the use of the hormonal ones? Or are there any other reasons why the hormonal IUDs would be, not preferred, but at least a reasonable choice?

Dr. Lara Briden: Obviously I want women to have the autonomy to choose what is right for them. I think sometimes it can be a reasonable method of birth control. But the problem is, just keep in mind it does deliver the steroid drug Levonorgestrel. And even though it’s supposed to be working locally in the uterus, we know from the research that it does have systemic effects. I think that’s one of the reasons that Levonorgestrel is a steroid that causes anxiety.

I think that’s one of the reasons why actually the hormonal IUD did quite badly in the recent Danish study. If you‘re aware of this huge study that came out of Denmark this year where they tracked 1.4 million women and they strongly associated hormonal birth control with depression and anxiety, which makes sense to me because hormones affect the brain, and the synthetic drug steroids affect the brain, and Levonorgestrel in particular is bad for mood. So there’s that.

Also Levonorgestrel is one of the progestins, one of the hormonal birth control drugs that has what’s called a high androgen effect. It’s very testosterone like. That’s why it can cause acne, and breakouts, and hair loss. Hormonal birth control induced hair loss is another problem that I see a lot and I find very distressing because very often women will have had suffered it for years and the doctor never explaining that it’s from the birth control that they’re using.

Laura: It’s amazing. I feel like all this information…I’ve talked to an OBGYN about the potential of those kind of options and I’m like wow, none of this came up in that conversation! It’s like one of those things where you’re like alright, well maybe my thoughts about what I was going to go with are not what I’m actually going to choose. This is all at least for me super helpful. Hopefully it’s helpful for our listeners.

Now, one quick question I have, I don’t know if you actually know, is there any difference that you’ve seen between the Mirena and the Skyla because I know the Skyla is a lower dose hormone. I don’t know if you’ve seen that work better because it’s not quite as much hormone, or if it doesn’t seem to make a difference.

Dr. Lara Briden: Yeah, it’s a good question. I don’t actually know. I haven’t had a lot of patients on Skyla. In theory because it’s a lower dose, that should mean that’s there’s less of the drug getting into the bloodstream which should hopefully mean that there’s less likelihood to develop those side effects that I just talked about, the anxiety, the hair loss, the skin.

Laura: Mm hmm.

Dr. Lara Briden: But I guess that remains to be seen. I like to empower my patients to consider some of the non-hormonal methods. I think it’s just about becoming familiar with idea and sort of understanding that they are real options for most women.

There’s another method which I want to mention here because I’m pretty excited about it. It’s not available yet, but it’s supposed to be in clinical trials and I think it might be coming by 2018. They keep pushing the year, pushing the date. But it’s for men. It’s called Vasalgel and it’s a gel that’s injected. It’s again not surgery, but a needle into the vas deferens which are the tubes that connect where the sperm enters the seminal fluid, and so it blocks sperm. It’s reversible. The idea is the man has an injection and then however many years later he decides he wants to have children, he has a second injection to wash that away.

Potentially I think things like this, that could be a game changer. It’s like can we have a world where women don’t carry the full burden of contraception? And where something like this that is so relatively noninvasive, doesn’t affect men’s hormones, hopefully is safe, and doesn’t cause side effects, then that could be something that as a society we embrace more. I’m hopeful that there are going to be other new methods that we haven’t thought about it yet that are still to come.

Laura: Yeah, I think I’ve heard that product being tested. We shall see once it comes out if the men of the world are willing to take the effort that the women have had to be doing for so long. I’m hopeful for that. I think all of these options are great examples for people to check out and there’s some that I wasn’t familiar with so I’ll have to add that to my Google search list for next week or so.

We have a couple more questions and I want to try to see if we can get some in before we let you go for the day. We had some question about PMS and PMDD. Two questions in particular that kind of probably overlap. One is “I’d love to know if Lara has any advice for addressing heavy periods and hormonal headaches.” The second one is, “How do you know if you’re premenstrual symptoms are run of the mill PMS or something more severe such as PMDD? I have horrible depression, mood swings, and insomnia in the week before my period as well as very bad fatigue. For example, a routine workout leaves me completely exhausted. I don’t know if this is just PMS or if I have a more severe hormonal imbalance.”

Let’s just talk about PMS, PMDD, what’s is normal, what’s not, how do you fix it.

Dr. Lara Briden: Okay. I’ve got a paper which I can share with you in the links…we’ll have lots of links at the end of this…about some of the sort of underlying mechanisms of PMDD, which is just a more severe version of some of the mood changes associated with PMS or premenstrual syndrome. It really resonated with me because it made a lot of sense. It talks about one of the main sort of factors is general…the neurotransmitter called GABA. It’s sort of having enough GABA in the body generally. There’s different nutritional ways to support that such as magnesium and B6 which is probably why that duo of magnesium and B6 is the most powerful treatment for PMS.

Then they talked about sort of progesterone levels and how a rapid decline in progesterone towards the end of the cycle seems to be a major trigger for women. Progesterone is a beneficial hormone. It interacts with the GABA receptors. It’s quite a calming, soothing hormone. But when it leaves the body, when it drops way too quickly at the end of the cycle, that makes sense that that’s going to cause an anxiety or sort of mood problem. Nutritionally and naturally there are ways we can support progesterone to last a bit longer through the cycle.

The other couple things they mentioned in the paper were to do with estrogen receptor sensitivity and how women, we just genetically have different types of estrogen receptors. And also I’ll say the estrogen receptor is quite sensitive to nutritional things such as chronic inflammation and iodine deficiency. Chronic inflammation makes the estrogen receptor more sensitive, more sensitive to the ups and downs of estrogen which is where a lot of PMS and PMDD symptoms come from. They actually go so far to talk about chronic inflammation in the paper and how a lot of people are starting to think now of PMS as an inflammatory condition that by reducing the level of chronic inflammation can really sort of relieve symptoms even though the hormone levels on blood tests remain the same.

It’s not a hormonal condition so much as a sensitivity to your own hormones. That’s the way I see it, and what can we do to stabilize the hormone receptors and maximize and sort of promote progesterone through all of the cycle.

Laura: Sure. Just to go off of that, we had a question about increasing progesterone naturally. What might be some techniques to make sure that the progesterone isn’t dropping off so significantly?

Dr. Lara Briden: Progesterone comes from ovulation, and that comes from a healthy ovarian follicle. Remember that takes 100 days or 3 months to make. So there’s a bit of a journey towards that which is why for example someone might get bad PMS or kind of a lower progesterone cycle 2 to 3 months after something like a stress, or a flu, or dieting, or antibiotics, that’s a common one that interfere with the development of the ovarian follicle. If someone’s had kind of a bad PMS month, I might say count back and say what was happening 2 or 3 months before?

Boosting progesterone is a longer term project, if that makes sense. It’s what can we do to support those follicles through all of their journey? It’s a whole body effect. I mean they need total nutrition. They need reduced chronic inflammation. Those ovarian follicles certainly need enough thyroid hormone. Underactive thyroid is a common reason for progesterone deficiency and other period problems. That’s something I think every women, if you’re doctor hasn’t looked for it, have a look and just check out optimal reference ranges and really think through this possibility that under-active is a factor.

Laura: I’m so glad you mentioned that issue with the 3 months between something happening and then getting a bad period. And this is maybe TMI, but let’s just talk about it.

Dr. Lara Briden: Yeah.

Laura: The last period I had, I had pretty much I would say the worst cramps I’ve had ever in my entire life to the point where I was taking lots of Advil just to sleep because it was waking me up it was so bad. I was trying to think like what did I do? I don’t think I was that stressed. It doesn’t make sense why the last month…I had no explanation for why that happened. Now that you mention that, I was like going back in my calendar and like what was 3 months before that? I was just looking that period of time and for me, I gotten really sick and I also got engaged over the same weekend. I’m like alright, well maybe that was the reason for being so ill the last cycle that I had because I was thinking it would have been something within the last month that had knocked that off. But looking back 3 months, I’m like yeah, I’d say that was a pretty stressful weekend for both bad and good reasons.

I’ll have to keep that mind next time. I mean I don’t get bad PMS often, but I’ll get it occasionally. Like I said, the most recent was really, really severe and I just couldn’t figure out for the life of me what had happened. Now it all kind of makes sense and I’m glad that you mentioned that just for personal reasons.

Dr. Lara Briden: I would say I think that’s an accurate analysis of what happened for you. I see that a lot. One thing I say in my book is that our periods are our monthly report cards. In that way they’re quite useful. I mean and none of us are going to always to have every month a perfect period because we can’t because we have life events, and as you say we get sick, we have to sometimes take antibiotics, or whatever it is. That’s going to show up in our periods.

It’s more just information and also a sense of understanding and control. Because otherwise if we’re not able think through what’s actually happening, that there’s a logic to what the body is doing and the symptoms that are coming out, then women’s hormones and periods can start to feel like a real wildcard is like out of control, kind of in the too hard basket, which is to be honest how they’re treated by conventional medicine. It’s like we don’t know how to do anything else, so let’s just shut it all down with hormonal birth control because it’s just really too complicated. It’s not that complicated.

Dr. Lara Briden: That’s a message in my book, is it’s not that complicated.

Laura: Yeah.

Dr. Lara Briden: You can try and learn what your body needs.

Laura: It probably just is complicated enough that the conventional medical system can’t deal with it the way it needs to be dealt with based on just the shortness of the appointments and the tools that they have to work with. I think just knowing that it is a symptom of something else going on, that’s usually the reason that I give to my clients who question whether they should go on birth control or not, or they have a OBGYN saying you’re not having your cycle or whatever is going on, let’s just go on birth control because that will fix the problem.

For me, I’m like even if it technically fixed the not having a period problem, it seems like first of all that’s not actually fixing the root problem. Second of all, I find that a lack of a cycle or irregular cycles is actually a really helpful just indicator of whether there’s diet or lifestyle issues. If there are issues there, then it’s like okay, let’s try to figure out what’s going on because if everything was going well, more times than not you’d be having a normal cycle.

Dr. Lara Briden: I have to respond to what you just said there about how by giving a pill bleed, that technically birth control will have fixed the problem of no period. It hasn’t. Because a pill bleed or a drug withdrawal bleed, which is what pill bleeds are, is not a real period even remotely. Did you see my little animation that I made about that called “Pill Bleeds: Why The Pill Can Never Regulate Periods” or why pill bleeds are not real periods? It’s just a fundamental sort of weird misconception that we’re living in right now somehow that these pill bleeds are in any way similar or mimicking our real periods.

We don’t have to bleed monthly on hormonal birth control. We don’t actually have to bleed at all. That induction of a monthly bleed is purely just to reassure women I guess and reassure doctors. The fact that any doctor could say that the pill regulates periods to me is crazy. It really just shows kind of the depth of the lack of understanding of women’s hormones.

Laura: Yikes! I don’t disagree with you, but those are some fighting words. I like it though.

Dr. Lara Briden: Yeah, I know.

Laura: It’s good though because I think a lot of women need to hear this because they’re getting a lot of conflicting messages. As a dietician, I feel comfortable suggesting let’s give your body a chance before you jump straight on the pill. But to say don’t do that, I don’t feel like that’s within my scope of practice to say don’t take the medication that your doctor is offering. But I do like people to remember that there are other options and that we can try other things first. Knowing all this timing stuff is really helpful because that’ll give me more confidence when I have a client who’s like we’ve been working on this for 3 months, and I’m like it’s okay! Everything’s going fine!

Dr. Lara Briden: Keep going!

Laura: Yeah. It’s one of those things that just knowing this is the way it works is going to help at least allay some of the fears that women have that things are not going to be fixed and they start to get desperate and then the recommendations by their doctor starts to sound like their only option. I think this is all really good to know.

I guess we can fit one more question in if you have a minute or two to go over this. This might be something, I mean Kelsey and I talk about stress all the time and we definitely cover it in our “Paleo Rehab” program pretty extensively. But some people were wondering if hypothalamic amenorrhea, or let’s just say irregular periods or menstrual cycle issues in general can be caused only by emotional and mental stress?

And somebody else was saying that they are school psychologist. They tend to only get their period in the summer when they’re off or sometimes after a vacation. They’ve been doing everything from eating more calories, more carbs, doing talk therapy, cutting out on their workout intensity. Is there anything else that they should be doing at this point, or is it really just a stress issue?

Dr. Lara Briden: That’s an interesting question about the holidays. The short answer is yes. I think stress alone could be a reason that a women doesn’t get periods. Absolutely. Then the solution is to modulate or try to support the stress response, which I’ll give you my sort of few bullet points of what I use for that.

But the woman who said she only gets a period during school holidays, my other question too would be around vitamin D because I talked about how important vitamin D is for ovulation. It might also be, I’d be testing that at least to see if sort of sun exposure is a factor in her case.

The stress response is sort of regulated as by you know by the hypothalamic pituitary axis. There’s another too which is the hippocampus in the brain. This has sort of recently come to my radar of how important that is to kind of support nutritionally, the cortisol receptors and the health of the hippocampus. That’s very much affected by my duo for modulating the stress axis is magnesium and zinc. The hippocampus has high requirement for zinc, which is one of the reasons I think zinc is so helpful for mood and reducing anxiety. Magnesium blocks the glutamate receptors. It has a very strong kind of anti-stress effects. Those are kind of the staples of my supplements. I often say if you’re going to take one supplement, let it be magnesium because of its modulating effect on the stress response.

Obviously I also try to just get women to make some boundaries around their work requirements, and say no to things, make some time for personal space because we’re all sort of rushing around. Especially for women who have children, it’s like everything, if they’re not working or doing their volunteer work, or writing their book, or whatever, and they feel like any extra time should be spent on child care. Then I will say to them well, where in the week, when do you just have a bit of down time for yourself? For some reason a lot of us find that difficult to give ourselves permission to do that.

Part of my job is giving permission saying you need to minimum, sort of I’ll recommend 2 hours per week have a little date with yourself, a little bit of unstructured time where you just go and putter around the shop. Do something nonproductive. Is that similar to the kinds of things you do with your adrenal fatigue patients?

Laura: Yeah, definitely. I mean I know the “me time” prescription is something I give to a lot of my clients because it’s one of those things that unless it’s scheduled, it doesn’t happen. It can be a little odd to say I’m going to schedule painting my nails, or I’m going to schedule a bath, or something like that.

Dr. Lara Briden: Yeah, exactly.

Laura: I feel like the way that women especially live their lives these days it’s like every minute of their day is filled up with taking care of the needs of others. Then when it comes to taking care of themselves, they either just don’t prioritize it or they even have that guilt associated with doing things for themselves. Breaking that barrier is definitely a big part of the work that we do. Kelsey, do you have anything that you focus on in addition?

Kelsey: Oh gosh, that’s the most important thing I think honestly. It’s like one of the hardest things for people too. I think that’s why it’s so important. This is for women especially I think it’s just so easy to think that unless they’re constantly being productive that the world will just crash and burn around them. It’s really hard to just take time to focus on themselves and really give them time to relax and recuperate. But I think that because it’s so hard for people to do, I think that’s why it’s so important that it needs to be done.

Dr. Lara Briden: Yeah.

Laura: Well, this has been really helpful for me, for Kelsey, hopefully for the listeners that were interested in this topic. I feel like I could talk to you for another hour about this stuff.

Kelsey: I know. There’s so much.

Laura: We certainly got enough questions that we could have gone for at least another hour. Hopefully the ones that we picked are the ones that people wanted to hear about and people found it helpful. Where can our listeners find you, Lara?

Dr. Lara Briden: I’m at LaraBriden.com, it’s my blog. And on Instagram, and Twitter, and Facebook I’m just @LaraBriden. Then of course my book, which is available on Amazon, and I think a lot of the online bookstores, and iTunes, and the usual places.

Laura: Yeah, we’ll link to that for sure because like I said it’s a reference that I like to share with not only my clients but also with people who are just looking for a little help and they don’t necessarily need quite the depth of analysis of a one on one consultation. But your book has been really helpful for a lot of people. You’re such a wealth of information. When we posted that we were going to be interviewing you, we got a bunch of people saying I don’t have a question, I just want her to know that she’s amazing and I love her work.

Dr. Lara Briden: Aww, sweet.

Laura: They wanted to share the love with you. As a practitioner I know I definitely appreciate having your work to reference because I feel like there is so much misinformation on women’s health out there even from the medical field, from alternative health blogs, and I just find that the work that you do is so balanced and really well researched. It just makes me feel very comfortable sending people your way because I feel like you’ve done the research, you have the clinical experience, you also have a very balanced perspective and your goal is always to support people whatever is going to work best for them even if it doesn’t go along with the “everything all natural” approach. I just really, really appreciate the work that you do.

Dr. Lara Briden: Thank you.

Laura: Great! Thank you so much for your time. Oh did you have something to add?

Dr. Lara Briden: I was just going to say I’ll put together a list of some of those papers and things that I referenced today. I’ll try to do it now while it’s still fresh in my brain.

Laura: Yeah, absolutely.

Dr. Lara Briden: I really enjoyed speaking with both of you. It’s been a great conversation.

Kelsey: It was awesome to have you.

Laura: Awesome. We may have to have you on again in the future to get some of these other questions answered.

Dr. Lara Briden: Sounds good.

Laura: Thank you so much for your time and we’ll be looking forward to seeing everyone here next week.