Birth Control and Gallbladder Disease (Episode 435)

Full Transcript: Episode 435

Lisa Hendrickson-Jack: Welcome to the Fertility Friday Podcast, your source for information about the Fertility Awareness Method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Charting Journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I teach women’s health professionals how to utilize the menstrual cycle as a vital sign in their practices and I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys. I know I’m a busy girl but I managed to fit it all in. This podcast is designed to empower you to take full control of your cycles, your fertility and your overall health and I’m so excited that you’re here with me today.

Today I’m sharing a brand new episode in the Pill Reality Series. I’m sharing my interview with Barbara and she is sharing her experience with gallbladder disease. So ironically, this is not the first podcast episode in the Pill Reality Series with this particular issue, but one of the lesser known side effects of oral contraceptives is the gallbladder issue. And so Barbara shares with us her experience of identifying this issue with her gallbladder, having it removed, and then what the fallout has been since. And if this is a new topic for you, or if you yourself have experienced this before, there is a previous episode of the Pill Reality Series with Lucy Fink, episode 369, where she shares her experience with hormonal birth control and gallbladder issues, and she shares her story of having to have her gallbladder removed and what that was like. So those two episodes, today’s episode and episode 369, are a good combo to listen to, especially if this is a topic that interests you. So without further ado, let’s go ahead and jump into today’s episode.

So I’m excited to be here today with Barbara. Barbara is a member of my Fertility Friday community. And as so often happens with these episodes, I think I had posted something about the NuvaRing and comments come in and occasionally I see one and I’m just thinking to myself, wow, I should connect with her. So thank you so much for coming on the show. I’m thrilled to have you.

Barbara: Thanks, Lisa. I’m really happy to be here.

Lisa: Well, so let’s just kind of jump right in. So my favorite question to ask with these interviews to open everything out, how old were you when you had your first period and what was that like? And kind of let us know what led you to use hormonal contraceptives and, you know, how that all went.

Barbara: Okay, so I got my first period. I remember it was Labor Day and it was 1995, so I was almost 12. My birthday’s in October. So I was 11 years old and I remember it being like a surprise and it was painless and there was just a little bit of blood and that was it. And talking about periods in my house was pretty taboo. So I was basically shown where all of the pads and things were and told to say whenever I needed anything and that was kind of it. So I didn’t — I think my mom taught me how to track on a calendar but as an 11 year old I did a really bad job like I didn’t keep track very well. And so I just have like spotty memories of like do I need a pad at school, do I change it at school. And then I was on the swim team my sophomore year of high school and I remember like trying to think through like how I negotiate that swim team. But it never seemed to be like a major problem like we also didn’t have tampons. So like I didn’t bleed swimming and it just didn’t seem to be an issue even though I was anxious about it. Yeah, that brings me through like 1999 so like age 16. And it was age 17 when I started to use contraception and I used condoms because I think I’ve heard you say like I grew up in the era where like condoms were like totally normal and recommended and my mom and family weren’t really into birth control so I didn’t have any exposure to that. Later in college I did try birth control and NuvaRing. But at first I just tried condoms and that seemed to work. As an aside, it was like this crazy thing, the culture around sex at that time was like oh my God, don’t get pregnant as a young woman, your whole life will be over. So like there was that chunk of time in my life where it was just like don’t get pregnant, don’t get pregnant. Like there’s no education but don’t get pregnant. So condoms it was and like even the people I was with were also like terrified to impregnate me.

Lisa: Oh, this is so interesting. So you and I are probably around the same age, I think.

Barbara: Perhaps.

Lisa: And yeah, pretty close. That’s so interesting that you said that because I obviously have talked about this a lot on the show, but I never thought about the other angle, which is so true when you said that the other person was also really interested in not getting you pregnant. That was also a characteristic of this age group. And I think that’s one of the reasons why I can’t understand why it seems that so many men don’t want to wear condoms because back in that time, it was like, if you have sex, you’ll get AIDS and die, you’ll get pregnant, right? And so everyone — I was scared of AIDS. They used to — I feel like the ’90s, everything was so severe. Do you remember those commercials, like this is your brain, this is your brain on drugs? Like they used to take an egg and like fry it.

Barbara: Yeah, and all those campaigns. I remember going to the big city because I grew up in a small town so I was going to the big city and I can’t remember much but I remember being in this room, it was like a movie theater, and they showed all these people getting into car accidents and these mangled people and whatever. It was like, I feel like the ’90s was so extra with all of the public — yeah, like scare tactics for sure.

Lisa: And it worked.

Barbara: It did.

Lisa: Well, so just to take a couple of things I wanted to ask about. So you got your period when you were 11. I mean, that’s kind of young. I know it’s pretty average. I know like a lot of girls get their periods around that time. But it’s just so interesting how you described it — that it wasn’t really something that was talked about a lot, it was kind of like you just have to take care of it. Obviously a big deal wasn’t made about it. But yeah, like at that age, was it okay? Like, were you kind of the first of your friends? Were you expecting it? Was it a surprise?

Barbara: So I wasn’t expecting it. I had had some like very brief education in school. We grew up pretty religious and then my parents would actually send in notes to like avoid sex education. So there was a lot that I sort of had to piece together on my own. And I think my parents also knew that about me — that I just figured stuff out. So like the communication was not really great partly because everyone was embarrassed, but also partly because I think they’re just like, here are the pads, figure it out. And like I did. You know it was not fun, but I was the oldest child of three girls and two boys and so I didn’t have any role models. And like I think I had one best friend and like we did talk about it but it wasn’t like we compared notes. I was just like, oh I have my period, the end. So it wasn’t like — I mean we’re in the Northeast in Connecticut and maybe that’s part of the culture too, like being a bit closed, a bit colder, like only letting a few people in.

Lisa: Well I mean I feel like I can relate to that because as much as I talk about, you know, vaginas and periods and cervical fluids and things all day long, it’s when I was — I distinctly remember that when I was a teenager, it’s kind of exactly what you said. You would kind of know like when a girl got their period, they would kind of tell like if they wanted to, and so you kind of knew who had gotten their period. I had my period when I was 14 so I was a little bit on the later end. I was ready, I was you know, waiting like when is it going to come, right? I think that was the extent of it. Yeah, and no one really talked about — I mean maybe a little bit, you know, who used tampons. Because everyone didn’t use tampons. So maybe there was a couple people who used tampons and like misused stories. Like I had one friend who was like, I had the applicator in and I rode my bike and everyone was like, no, you know, like terrible things like that. But like that happened.

Barbara: Well even that, they didn’t know. I don’t think I would have — I don’t think that would have been something that my friends would have. Yeah, that would not have. Yeah.

Lisa: Well, and I mean it wasn’t until I feel like I was an adult, like legally an adult, that my girlfriends and I started having more conversations around it. And I remember in university that was more of the time when I was getting into the fertility awareness stuff. And that’s when I was learning about alternative menstrual products. And I feel like that was more of the time when we started talking about sex and sex positivity and all that kind of stuff.

Barbara: Right, right. So yeah, I can really relate to your story.

Lisa: So in your case then, it sounds like you had a pretty typical cycle — there’s nothing that you’re remembering or sharing that was problematic. And when that is the case, typically it means you had a cycle pretty regular-ish and not a lot of problems.

Barbara: Yeah. Not very memorable and not a lot of problems.

Lisa: And so then you were using condoms initially and then you decided to try hormonal contraceptives. So share a little bit about that and kind of what brought that up, like what made you jump in.

Barbara: Okay. So when I started college, I had access to the healthcare there and that was actually better for me than access at home. And so I’m not actually sure what prompted me but I knew that I was interested in trying it. I started Ortho Tri-Cyclen in my freshman year and I remember not liking it and I remember moodiness but not really terrible. And then when my relationship ended I ended it because I was like I don’t need this so I don’t want to deal with it. But I don’t remember it being like terrible. I was pretty good about taking it at the same time that I needed to every day. I don’t remember that it like changed me in any sort of real way. Maybe some acne. As I look back there’s a lot that I realized like looking back that I connect the dots.

So and that’s kind of what happened with NuvaRing. Like it took me into — I know I’m jumping ahead, but it took me down like memory lane and I was like, okay.

Lisa: Well, in your case, you had something to compare it to as well. Like you had — that’s a significant period of time. I’m guessing you’re now in your 18, 19, 20-ish age. So that’s a good eight, nine years of regular cycling from age 11. So you have, in your case, you had something to compare it to.

Barbara: Right. Right. Where it’s like it wasn’t really a problem and then birth control.

So that relationship ended in basically a year and a half and then I went off of it because I didn’t want to be on Ortho Tri-Cyclen. And then after that I just used condoms if I was with somebody. And I started a new relationship but then I studied abroad for a year. And so I didn’t start any birth control then because it was a brand new relationship. So I was okay with using condoms, he was okay with using condoms, it was working for us. And we also didn’t see each other that much because it was like the summer and then I studied abroad and I was doing a lot of working. So I had like another year of just being naturally cycling.

And then when I came back from that I was like, all right, we’re home all the time. My friend — I have a few close friends and one of them suggested NuvaRing because she had started it and she liked it. She liked that it wasn’t a pill. And I think she even said like oh you can just put the other one in and skip your bleed week or something like that, which I wasn’t comfortable with. But anyways so I started the NuvaRing and so I’m now on like the later side of the college years.

And at that point I didn’t know that this was happening but I was super moody, super anxious. Like I think I tend towards anxiousness but like what really didn’t work for me — there was like this huge dissonance because I just came back from a year of living abroad by myself, speaking a different language, doing all of my admin tasks, like talking to professors, doing projects, presenting in a different language, like traveling all over the place and doing things. And now I couldn’t like walk up to a bank teller and ask them what I needed without like fumbling over my words and stuttering and like I was so anxious that it just didn’t make sense.

So the anxiety — that was like a big one. And then I think you know I was dealing with some major stress because I came back from that year that was so awesome and I had to work a lot because I was not going to take out any more loans. So I was like taking on full-time work at the same time as finishing up my coursework and hanging out with my boyfriend and doing all the things you do. And I remember being just so stressed out and so unable to cope that one day like I was just talking with him about everything and I just started to cry and like threw myself down on the ground in the quad like where people would walk to go to the dining hall to have a meal and I was just like crying like in an adult tantrum and like it was so embarrassing but I didn’t care because I was so overwhelmed. And I did not put any of it together that maybe it was the birth control. Like I know that there were other stress factors but like I was able to cope through very stressful things, you know, like being abroad. So it didn’t make sense to me.

And then the other thing that really bothered me was in the mornings I frequently would have nausea. And it would happen so frequently that I was just like is this what pregnant people feel? This is ridiculous. And I would feel so miserable and my thoughts would just kind of like accelerate and I would just get so angry — angry at people who are probably feeling better — and my thoughts were really scary. And I consider myself a gentle person, kind person, someone who probably puts themselves last too many times, who thinks of the other person. But I was having really scary thoughts. And that was one of the things that just was like, this has got to stop. But I didn’t think of it being the birth control. I just was like something is wrong. But I didn’t do anything about it.

And so after graduation that relationship ended and I went off the ring because I wasn’t going to be with anybody. And now that I’m thinking about it and going through all of it, I was at my maximum weight — the weight had crept on but I wasn’t aware that it was potentially the ring or anything. I definitely had skin issues, more acne. And I remember the last NuvaRing that I had in, I was just like, I was afraid I was pregnant because something was wrong. Like I knew that the cycles weren’t regular even though I was following all the instructions like I should. So like the last NuvaRing went out and I was like, I just need to have a period and know that I’m not pregnant. And I wasn’t. But like I was really afraid that I was, because I was trying to be responsible and avoid pregnancy. Yeah, so that’s when I ended it and I just told myself I wasn’t going to go back on it because of how bad it made me feel. But I didn’t seek any medical attention or anything. I just sort of went on with my life.

And I started a job and I moved in with some of my girlfriends and I started with a new PCP and that was when I was told I had metabolic syndrome and had to lose weight and I was told to try a low-fat diet and so I did that with gusto. But then of course you can’t always do a low-fat diet so then you go out and you have something with fat in it and my gallbladder started up. And I’m like — I was 24 years old and I had an emergency room visit because of gallstones. And then I had another emergency room visit because of gallstones. And then I had a surgical consult. And I went to my primary care doctor and I was like, why does this happen? And she’s like, well you’re female and you’re fair and that can just happen.

Lisa: I can see your face. I’m sorry. Like you’re a white female — that’s the gallstones? It never ceases to amaze me, the nonsense that comes. So this isn’t about throwing doctors under the bus, but it’s about recognizing doctors are people and some of the things they say are not necessarily a result of their degree in education.

Barbara: Or they could say they don’t know, or you know.

Lisa: That would be more appropriate. Perhaps. And accurate.

Barbara: Yeah. So kind of not knowing any better — you can kind of hear my regret in this — I went ahead with a surgery. I went off NuvaRing in October and I was getting my gallbladder removed, it was a laparoscopy, in April of 2008. And it was — I had a C-section with my baby, it was probably worse than the C-section. And my digestion changed forever. So like no one told me that there was going to be side effects from the surgery. Like, oh yeah, you’ll have your gallbladder out and then life will go on.

So I sort of wish now — and like I didn’t have many friends who would try natural methods of healing — but later on I had a friend who was like, yeah I’m just trying to get rid of some gallstones, doing this, doing that. I’m like, wait, there’s a way to do that? There’s a way to know that you have them, and then also manage them potentially. Now I don’t know all the ins and outs of that and how well it worked, but she still has a gallbladder and I don’t.

Lisa: Well so let’s dive into — first of all, thank you for sharing your story.

Barbara: You’re welcome.

Lisa: No, but I mean this is what I mean by like looking back over time and then seeing that there’s like potentially a connection and then realizing, like, oh my God. Yeah. So one of the things I’ve said a couple of times today was there’s a lot of things outside of our control. So one of the things I try to do to maintain sanity is to focus on what’s in our control. So from that bigger picture standpoint, that’s obviously why I do these Pill Reality Series — it’s just a standing part of the podcast. It’s important because you’re not alone. Most women who take contraceptives are not provided with a full side effect profile. And we can — at the end of the day I think that the whole idea that we shouldn’t be sharing that information is totally nonsensical. We’re not so stupid that we can’t understand that everyone who takes the medication doesn’t end up with gallbladder disease. There’s no reason why we can’t just be provided with a full side effect profile.

So I can’t stand here and say definitely the NuvaRing caused all these problems. But if you do a search for NuvaRing prescribing information — which anybody can do right now in a PDF if you want — all of these drug companies are required to provide the prescribing information. In order to come up with prescribing information, what that means is they had to hold clinical trials and they are required to report all of the side effects. And so when you read these documents, it’s very interesting because it’s right there in black and white. And so generally speaking with these contraceptives, the stuff that they’re telling you is mood changes, depression, anxiety, weight gain, irregular bleeding, acne, nausea — they’re telling you all of these things. The gallbladder thing seems so random if you’ve never heard this before. But then when you pull the prescribing information and see that it is written on the thing, it means that when they did their clinical trials there were women who took the drug as directed and then got gallbladder disease. That’s what it means.

Barbara: Yeah, yeah.

Lisa: So tell us a little bit about the fallout, because this is one of the challenges. The topic of advocating for yourself and taking time has come up on a few podcasts. Again, you’re not the only one. When you go to a doctor and there’s a legitimate health issue, of course from the medical perspective they’re going to say, okay well you need to get this gallbladder out and we need to do it sooner than later. And there’s always this push to do everything now. And unfortunately many of us don’t even realize that we could just wait a month or two or six.

Barbara: Right, right. It doesn’t — because they’re telling us and it’s a doctor and it’s serious we need to do this now. And they couldn’t even grade it for me like, you have gallstones but there’s an imminent rupture. It always seems like an emergency and you have to make a decision right now. And it seems to me — obviously I’m not a specialist in gallbladder issues — but it seems to me that they talk about the gallbladder as if it’s vestigial or basically that it’s not something that we need, we can live without it, it’s sort of like casual — like you’re going to be okay without it. And you won’t die without a gallbladder, but it does change your quality of life because the gallbladder helps us to process fat. So it obviously will forever change the way that you digest food.

So going to the doctor — I mean I was having gallstone attacks and they were really painful. And they would give me something in the emergency room. I remember getting an ultrasound once and they confirmed there was gallstones. And then they gave me a Valium I think to go home with. And I would just like lay in bed and cry and try to sleep. And so I was like, I can’t live like this, this has to stop. But the only option offered to me was surgery. I didn’t think to ask. I was young and I was just putting my faith in the professionals that were in front of me. There were my friend’s doctors, I liked my friends, I respected them and their choices. And honestly I didn’t have great relationships with doctors growing up. And then you know when I met with the surgeon, the surgeon was like all positivity. I have friends who are surgeons so I’m not going to bash them, but that’s what they do. Surgeons want to do surgery. And so he was really reassuring, really charming — like we’re going to solve your problem and it’s going to be laparoscopic, it’s going to leave very little scarring and you can just be on your way. And so I mean I knew it was going to be a healing process and I knew there was going to be pain, he did tell me that. But I didn’t know about like digestive problems afterwards.

And like I think too I was probably also eating like a standard American diet plus whatever I had learned about nutrition in college — you know, like you should eat low fat, you should eat lots more fruits and vegetables and grains. My family culture, like the first meal that I got after my surgery was like a fast food meal. And I was thankful that they were taking care of me but I had to immediately run to the bathroom and it was really hard because I was wearing a belly band because you couldn’t laugh without crying because you had abdominal surgery. And so having to go to the bathroom immediately after eating — I had diarrhea. It was embarrassing and I was like, okay, why? It wasn’t digesting the fats and it was causing things to just leave immediately. And honestly if I’m not careful today it still happens. It’s just way more controlled and I know a lot more about my diet but it’s been 14 years.

But I do wonder about like fat-soluble vitamins and other things and absorption. And I’m still kind of on a journey of figuring out if I’m deficient in some of those things and if there’s like any sort of other effects. And I’m also learning that the gut is also connected to the rest of your body but like the gut microbiome is important and it impacts your periods too. And I think that inflammation from there has really been a problem for me over the years. And I’ve been vitamin D deficient constantly. I also had to have my parathyroid out in 2014 and I have no idea what that’s from. But I basically feel like ever since my gallbladder came out nothing was right and I’ve been sort of correcting since then. Like it’s been harder to keep weight off, harder to know what to eat, what works. Funny things set my digestion off like raw vegetables. Harder to digest. And I also noticed that I’m really, really sensitive to processed oils — like anything with canola, sunflower, cottonseed oils — those do not work for my stomach.

And then my periods were pretty difficult after that. It’s only been within the last five years that I’ve gotten to less painful periods, less heavy periods, more regular periods. I had been seeking care for PMS difficulties and was put on Vitex a while back and that was really, really helpful. And basically it just took me a really long time to get my periods and my cycles back to like healthy normal because I always had something like this digestive issue in my body as one of those stress factors on my body. I also had an ovarian cyst that I think ruptured and that was very painful. I had that happen a year into my marriage, at which point I had been off the NuvaRing for about a year and a half. So from 2009 through 2012 I was still trying to figure out my periods. And then like even later when I found your podcast and I’d gone to a naturopath and seen other people and talked to friends about things — yeah, it took a really long time. Maybe 2017 was when I was like, all right, things are good.

Lisa: Yeah, that’s so tough, especially when you’re not provided with the background information. Because you basically — it’s kind of similar to the way that your family dealt with your periods. Here you go, we’re going to take out your gallbladder, figure it out.

Barbara: Yeah. Very much the same.

Lisa: Well, and so share with us when you made that connection. It sounds like your doctor didn’t make that connection even though it’s written on the prescribing information. And this also points out an important point for everyone to always remember — pharmacy and medicine are two separate modalities. And so often the pharmacist knows more about the medication that the doctor is prescribing than the doctor. So if you really do have questions about the medication, you could go to your doctor and ask them to explain the side effects. Listen to the doctor’s answer. And then when you go to fill a prescription, ask the pharmacist to go through the side effects with you and the profile and just see the difference yourself. Because the pharmacist is going to be the one who knows potentially more about the nutrient deficiencies that can be caused by certain medications, the side effect profile, and how they could interact with other medications. So how did you put those two together?

Barbara: Honestly, I don’t really know when it was. It was not with a medical professional. I think it might have been a mixture of like those infomercials. And then the fallout from this is now I am very critical of all of my healthcare providers. And getting critical, asking more questions — I didn’t figure it out with them. I think it was infomercials, like reading all of the side effects that come up there and kind of caustically making fun of them like, oh this, this, and this. And just always questioning whether or not any pharmaceutical is actually going to help people when there’s all those side effects listed.

Lisa: Well, I mean, I’m in Canada. So in Canada, they can’t advertise like that on the TV.

Barbara: Yeah, it’s everywhere right now. All the time.

Lisa: We get American TV though. So it’s so weird, from as a Canadian, it’s so weird to see — diarrhea, constipation, heart disease. Your face might fall off. I think I saw one of those for NuvaRing and like the svelte young happy woman living her life wonderfully and gallbladder disease. I think I saw that and I was like, okay. And then and then your post honestly — like it’s not then that it first hit me, but it might have. And when it sunk in and when I was like thinking like, oh yeah, that time, and then this, and then this, and then this — and I was like, oh my God.

Barbara: So like it’s really in retrospect that all of those things like kind of come together. And I think honestly, like maybe it’s being a woman, maybe it’s society, maybe it’s all those things, but like you think you’re the one who’s got to fix it. It’s your problem. I was moody, I needed to cope better. I didn’t think, yeah, it just didn’t occur to me. Except there was something intuitively about your body that’s like, I don’t like this anymore. So it’s like your head and your body are doing different things if that makes sense.

Lisa: Well, when you were describing that scenario when you were on the campus and you were crying — you were legitimately stressed out but your response was just so much more than it seemed necessary, given that you’d experienced stressors before. And that’s something that I’ve heard a lot. I’ve heard a number of different women over the years say, you know, it wasn’t that there wasn’t a legitimate stressor here, but it’s just that my response was so far outside of what you would think was reasonable.

Barbara: Yeah. Yeah. Like, you’re again — you’re not alone.

Lisa: That’s like the third time I’ve said that. And this is why these conversations are necessary. So now that we know, it’s like, okay, if I’m to be put on a medication, I should look it up. I should see if I can find information about it. Maybe I’ll talk to my pharmacist. Maybe I’ll see if there’s prescribing information available online. Maybe I’ll press my doctor a little bit more. Or for example, if you have gallbladder disease, in retrospect, I wish I would have looked into it and found out if there was a way — because there might not have been a way for you — but there might have been a way to cope with it or to minimize the symptoms or minimize the frequency of the gallbladder attacks. And then also it might have been useful to have that actual conversation about what life is like after gallbladder disease. Now we have YouTube, so you can find people who’ve had gallbladder issues and find out what they’re saying. There’s a lot of things but we just don’t think of those things in the moment.

Barbara: Right. And in 2008 we weren’t thinking about them.

Lisa: There was no — 2008, that was like the year after Facebook came out. And now it really irritates me that Google doesn’t work anymore. And I honestly wonder if the younger generation actually thinks — when I say it doesn’t work, what I mean is that they have literally destroyed the algorithm and whatever they want comes up and nothing else. There could be something legitimate from a university that you’ll find on like the 11th page. And we think that we have more access to information than ever, but we have more access to curated information than ever.

Barbara: You put that in a very interesting way.

Lisa: Well, I mean, this conversation has been really fun, really informative, really eye-opening in a lot of ways. So the gallbladder disease issue has not come up a ton on the podcast yet. Although I did do an interview with Lucy Fink — she was my first gallbladder episode I guess you could say. So this is a thing. And I think the same comment that I have about this is similar to the comment that I have about some of the more serious issues like the blood clot, stroke, pulmonary embolism kind of thing. Because again, it’s a real thing. It really does happen. 21-year-olds really do have strokes. Of course, we know that not everyone who takes the pill ends up with something like this. But it does happen. And so this is the important part of having these conversations, which is just to acknowledge that it does happen.

And so I always go back to the same thing, which is with informed consent there are three categories. Someone’s listening to this and they’re like, oh I was thinking about NuvaRing, and then they listen to this episode and they’re like, well this is way more than I bargained for. For that person there are still three options. Some people are going to say, well, good thing I know, and they’re going to do their research, and maybe they’ll look at the statistical probability. It’s not like it’s huge — it’s not like one in every five women who use NuvaRing have gallbladder disease. We know that everyone isn’t going to have it. So some women are going to say, okay, I’m glad I know, and so I’m going to use it for maybe a shorter period of time. Some other women are going to say, nope, that’s too scary for me, that’s too much, too many moving parts, I’m going to skip it. And then other women will just use it for as long as they were going to use it anyways. And the key is that when we give the information, then she gets to make that choice. And that’s all I want in life. That’s it. That’s all I want.

And then I want for her to know that if she’s crying in the middle of her university atrium, that someone told her that your mood issues could be related to your contraception. So instead of her having to find a random late-afternoon commercial on television — and these companies are not voluntarily providing this information. Someone had to sue the pants off of them to make a piece of legislation to force them to provide this. So the obvious question is why isn’t my doctor telling us? Like, can we just acknowledge that the doctors don’t provide the full side effect profile most of the time? Even with the gallbladder disease, your surgeon did not provide you with a full profile of life after gallbladder disease. So we have to accept that our medical system is not the be-all and end-all.

Barbara: Yeah. It certainly isn’t the end-all be-all, right? Like there’s room for alternative. It doesn’t mean it’s not good, but doctors are really good at — exactly what you said — surgeons do surgery. They don’t do holistic lifestyle and dietary change post-op. And I definitely didn’t have any issues with my wounds, like my scar was okay.

Lisa: I bet you have a really small scar. Everything he promised you was delivered on schedule and as directed. But this is, again — it’s not fair. It’s really not. We shouldn’t have to be the ones to be doing the research, doing the legwork. We should be provided with informed consent. We should be provided with all this information. But we have to live in the real world. And so unfortunately, episodes like this are just to empower us. So it means being that annoying patient asking all the questions and being difficult and delaying the surgery or whatever.

So my takeaway for the audience members is that we do have the right to ask for more information. We have the right to take more time. We have the right to say I’m going to go home and think about it. Have your canned responses ready: I don’t make any serious health decisions unless I talk to my husband, sister, mother, father, brother, best friend. But legitimately say, I’m going to take some time to think about it, I’m going to get back to you. Unless you’re literally about to die bleeding out on the table, you can delay the surgery by a day, a week, a month, two months, three months, six months, a year. I’m not encouraging you to ignore your medical professional, but we can usually take a couple of weeks or a month or more if necessary to look up these things, get a second opinion, have a second doctor or surgeon. Find out how urgent it is.

Barbara: Well, and also in addition to the surgeon, you could potentially go to a functional medical practitioner and naturopath just for a second opinion. It doesn’t mean again like the surgery or the surgical option is still there. But sometimes as women I feel like we need permission. Like someone needs to give us permission to go against the patriarchal father-figure doctor. We’re supposed to be nice. We’re supposed to be polite. Just listen. We know what’s best for you. But sometimes it’s not easy. It’s really hard advocating for yourself. It’s real out there. But hopefully that’s the takeaway.

Lisa: Yeah. And it definitely did like just set me along a path of just continuing my own education, not being like bitterly critical of healthcare providers, but really just taking my time in my pregnancy, advocating more for myself, choosing a provider. It’ll be nice if we had that information at the start.

Lisa: Well, I mean, we do the best we can with what we know. At the end of the day, you made that decision to take care of yourself. That’s why you made that decision. It’s not fun to have gallbladder attacks. You were doing the best you can with what you knew at the time. And so yeah, I feel like I’m just grateful that you were able to share your experience, grateful that you found a way to manage with it. Obviously it wasn’t ideal and you’ve had other challenges as a result of it. So we can’t go back and change it, but ultimately this is what it is. This is real life. This is how this stuff turns out sometimes. And this is the part that they don’t want to talk about.

Barbara: Yeah. I’m not the one on that wonderful video. Like you can’t have salads. Like this is the part. And all of these decisions that are just, oh just come back and do the surgery this afternoon.

Lisa: I think I’ve shared on the podcast a number of times the time when I was ovulating but my doctor thought I was having an appendicitis. And he was like, come back at four and get surgery. And my mom was like, whoa — and so she took me to my pediatrician. She got a second opinion who was like, yeah, she’s ovulating. So they would have taken out my appendix. Like this is serious stuff, right? We have to remember that. Doctors are people like you and I, and people are not perfect. And that’s the end of it. If you take nothing else from this whole podcast — 400 whatever episodes — if you take nothing else: doctors are people like you and I. Backcheck them, get a second opinion, don’t rush, take time.

All right, well, we went off the NuvaRing. Now you mentioned that you have an 18-month-old but you didn’t come off the NuvaRing and just immediately start having kids. So in somewhere between there there had to be some birth control. So maybe we can kind of wrap up with that. Especially you and I being of a similar age, coming from a similar time — it sounds like you and I are not in that camp of like, well if I’m off birth control it’s just a matter of time until I get pregnant. So maybe share from that perspective how you managed it.

Barbara: Yeah. So I actually — when that relationship ended and I went off of the NuvaRing, my sexual ethic also changed and my next partner was my husband and we abstained until we got married. So that made that part easy. But then when we did, we practiced withdrawal and it was pretty much perfect use withdrawal. And 2009 to 2020 didn’t get pregnant, no scares, nothing. Condoms sometimes. And as the years went by and I was actually tracking for fertile cervical mucus and I could tell, and as my ovulation got more regular and I got really in tune with my body, I was like we should probably be really careful right now but no problem. So withdrawal, condoms sometimes. And that’s still what we use even after my baby. I’m 18 months postpartum. So I’m sort of proud of that because it’s so much easier and it feels really healthy and I’m so happy to be so connected with my body. And every time it doesn’t happen I’m like there’s another cycle where I know a little bit more about myself and it works.

Lisa: And to the point where, like I said earlier, when I went to my OB-GYN and I was like, I think we’re going to start trying, he was like, all right, well you’re this age, it hasn’t happened yet. You know, if it doesn’t happen, maybe the reproductive endocrinologist is the way to go for you. So I think the provider was anticipating that I might have infertility.

Barbara: They thought you were using protection, yeah. That actually adds a little bit of context to your story because they’re thinking, well, they’re not really using protection and they’re not getting pregnant, so they’re probably not going to conceive. Right. And I remember in the hospital because this was 2020 they automatically added birth control to my list of discharge prescriptions and I said, um, can you take that off? I don’t need that. And they were like, oh yeah, but we always do this. And I talked to my midwife and she’s like, oh yeah, we’ll take it off for you. But it still ended up on there like it was a constant thing that was automatically pushed. And I didn’t know what kind it was. There was no brand name or anything, no discussion. So I could have gone home with a pill pack of something.

Lisa: Yeah. Yeah, no, this is one of the things. So whenever I talk about withdrawal, I feel like withdrawal is like the dirty little secret that people don’t talk about. In the real world, when I’m having conversations with clients over the years, there’s a good percentage of couples who use withdrawal. It’s a thing. It happens. People do it. And many couples use it successfully with no pregnancies. So I can’t say all couples are successful with withdrawal. But I would say the majority of people who use it — I know people who’ve used it for like a decade or more with no scares. And I guess the part that no one wants to talk about is that it actually is a method of birth control. Obviously, like any method of birth control, there are failure rates to it. So officially the perfect use statistic is 96 percent. And the only issue is that some men potentially could have sperm in their pre-ejaculatory fluid.

But just to kind of validate what you said — I’m not here saying do it or don’t or whatever. I’m very neutral on this topic because I know that it works for people and works for many couples and it doesn’t work for others. But why can’t we have these conversations? Because the professionals are either trained or maybe through just their own experience to have this sort of negative opinion — like, they’re always going to fail, or here’s a more realistic thing that will help you really succeed because you can’t do it on your own. That’s sort of the impression that I get.

I mean I can link a couple of episodes to this podcast here, but when you’re talking to doctors, it’s like some of them when you ask them how they’re trained in medical school they’ll tell you that there is a specific bias. And it goes even beyond the birth control pill. They’re kind of trained to, when possible, push birth control options that require no user participation. So that would be the IUD and potentially the implant or the shot. They’re looking to make it kind of user-proof so that you can’t even miss a pill. And so those are considered the highest tier for efficacy. Whether it’s your personal health or your personal comfort or whatever, the efficacy is kind of put at the top. And the irony is that you can have high efficacy without hormonal methods. It is possible. Yes, it depends on the person and whether or not they’re willing to go that route, but it obviously is actually possible to be highly effective without hormones.

And a lot of my clients would use two methods. When you know where you are in your cycle, you know the days where conception is possible. So that is great motivation to be even more cautious. Moral of the story is, it’s up to you. And no, your doctor may not be super supportive or understanding. And that’s not really their fault, you know, it’s not part of their training. You go to McDonald’s, they give you hamburgers. You go to a surgeon, they do surgery. You go to a doctor, they give you medication. This is just how it works. But yeah, without going down the rabbit hole of informed consent again, at the end of the day it’s unfortunate that we have to be the ones to advocate for ourselves.

Barbara: Yeah. It seems like too, like with hormonal birth control, there seems to be this like stereotype of side effects. But then like gallbladder disease is like not in the same category — even though it’s there on the prescribing information. But like a doctor thinking about hormones and an endocrinologist and OB-GYN — they’re not necessarily thinking about my digestion or my gallbladder. Yeah, they’re taught in medical school like about the whole body but they’re thinking about one system. So it kind of feels like there’s no one to catch that. Like that’s why nobody would have said to me, oh, maybe there’s a connection between your birth control and your gallbladder.

Lisa: Yeah. I mean, the last thing I’ll say on that is at some point — I think it was when I was writing The Fifth Vital Sign — I found an informational package about birth control for doctors. And it’s very interesting how it read because it focused on the life-threatening side effects, which is important. But the way that it was presented is that okay, we’ve got the stroke, we’ve got the blood clots, we’ve got the pulmonary embolism, but the risk factors are being over 35 and smoking and being overweight or whatever. And so what that does is it really typecasts — so that if you have a 21-year-old experiencing symptoms specifically about pulmonary embolism and stroke, they’re thinking to themselves, well, no, they don’t have the risk factors. They’re not over 35. So again at this point, there’s so much out of my control. I can’t control how doctors are trained in medical school. I can’t control why these hundreds of millions — they say 100 million women are taking birth control. So I can’t control the fact that at very few of those appointments the woman is being provided with a full side effect profile. So all I can do is keep going on this podcast and give women the opportunity to share their stories so that one by one we can just at least put it out there. Because again, we can’t prevent all the bad things, but at least if you are listening and you were like, wow, I was getting gallbladder attacks — you can piece it together sooner. Or wow, I was having these mood swings and I thought it was just me. It’s not just me.

Barbara: It’s really not.

Lisa: Well, thank you so much for coming on the show. If there’s a woman who’s thinking about coming off of contraceptives but she’s scared to, or having side effects and kind of skeptical — like, could it really be related — what, if anything, would you want to say to her?

Barbara: I would just encourage her to do more thinking on her own, do more searching on her own, talk with other people, talk with other providers, read some books, just get yourself informed. And things will make sense when you actually hear about people who have experienced what you’re experiencing. And I’d say especially if they’re afraid about the contraceptive aspect — there are ways to avoid pregnancy without hormones and you might have to figure it out, but it’s worth doing.

Lisa: Amazing words. Thank you so much for being here Barbara. This was such a great conversation — honestly, I’ve been having such a good time. We could have just kept on talking.

Barbara: Thank you. I owe a lot to you. I appreciate your work and your book and just your consistent effort on women’s behalf. So thank you.

Lisa: Well, thank you. That’s such a sweet thing.

Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/435. I hope that you enjoyed today’s episode with Barbara. I was fascinated by this conversation, again talking about a side effect that does happen but it’s a little bit lesser known, less well known.

And just in general, outside of this specific kind of pill side effect aspect of it, to really touch on that issue that has been a common thread of many of the past episodes, which is that when you receive a diagnosis or some information from your doctor with this very kind of rushed and we need to do the surgery now and we need to take out this body part now, it’s always a reminder — hopefully the takeaway from this episode isn’t that we never need medical treatment because we often do in certain situations — but just take a minute.

So a few things to always remember: it’s your right to get a second opinion. So whenever you’re provided with any type of information, diagnosis, given a directive that you have to go and get this procedure right away, unless you’re literally about to die, you do have the right to get a second opinion and it’s a good idea to do so. That could be a second opinion from another medical doctor, or from a specialist in that particular area, or a person who is a functional doctor coming from a functional perspective, to give you a different perspective. Is there anything I can do to treat this? Is there anything I could do to minimize it? Do I need to go ahead and get this procedure done right now? Is this something that could wait a week, a month, six months? Is this a situation where we could take a wait-and-see approach?

I think it’s always really helpful just to keep that in mind because over the years I’ve just spoken to so many women who have felt pressured to do something right away before they could even think. Before we have the ability to really inform ourselves about the situation, we’re already going ahead and having these procedures. And then often in retrospect, we look back and think, okay, well, maybe if I would have known this or that, I would have delayed it or I would have tried this or I would have done something different. And so we do have the right to do that.

So hopefully that is the takeaway from today’s episode: it’s always within your right to get a second opinion. And even if you do end up going ahead with whatever the procedure is, at least you’ll have known that you did everything you could to look into it, and that you were the one that made that decision, not that you were pressured into doing it.

So with that said, I hope you have a wonderful weekend whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.