Birth Control and Gallbladder Disease (Episode 439)

Full Transcript: Episode 439

Lisa: Today I’m sharing a brand new episode in this year’s FAMM Practitioner series. I’m sharing my interview with Rose, one of the FAMM practitioners in the class of 2022. And one of the topics that we focus on in today’s episode is birth control side effects. And so this will be the third episode, I believe, of the Fertility Friday back catalog, where I’ve had somebody share their experience of their birth control causing gallbladder issues. And so for anyone who wants to jump on me for saying the word cause in this example, know that it is one of the listed side effects. If you have taken birth control pills before, if you are currently taking birth control pills, I would encourage you to do a quick search on the internet for the brand that you were taking and the words prescribing information, and that will lead you to the PDF where it has the actual information related to the side effects, and you might be surprised to find that it actually says on many of these contraceptives gallbladder disease.

And so in today’s episode Rose shares her experience with being on the pill, having these gallbladder attacks — which again, what I’ll do is I’ll link the previous episodes that talked about gallbladder issues to today’s in case you haven’t heard them. It might be interesting to listen to all three of them together to hear how similar the stories are. So she shares her experience having these gallbladder attacks, what she did afterwards, how she chose to manage them, and then eventually how she put the pieces together and discovered the connection.

And you know, with all of these stories, the gallbladder thing is definitely not the first side effect that comes to mind. I know it’s not for me when I think about birth control, but it is common enough and enough women are experiencing it. It makes you wonder whether or not the practitioners are really made aware of all the different possible side effects related to contraception. But either way, one of the threads that tends to be common with all of these different birth control stories is the idea of informed consent and how it’s really important that we all have that. And it raises the question of how are we really getting informed consent when we’re taking various medications? How many of you listening, if you are listening and you have ever taken contraceptives — so I’m raising my hand, I have taken contraceptives — did anyone tell you about all of these possible side effects? Did you even know that it was possible that the pill could be associated with gallbladder issues?

So yeah, it’s a really interesting conversation. That’s not all we talk about, but that does represent a big part of what we’re talking about today. So yeah, I think you’ll find today’s episode really interesting and informative. And of course, then Rose shares how she found her way to fertility awareness and how she’s planning to utilize it in her practice now.

So before we jump into today’s episode, I’ll just take a moment to tell you a little bit about Rose. Rose Constantine Smith is a registered AFN nutritionist specializing in women’s health. Using nutrition, lifestyle, and now menstrual cycle charting, Rose supports women to meet their health goals whilst helping them to understand and appreciate their bodies beyond their physical appearance. She works with women of all ages with issues including menstrual health, digestion, preparing for pregnancy, supporting energy, postnatal recovery, and health postmenopause. Now with her knowledge of fertility awareness, which helped her through her own journey, where she was left with very little support after the birth of her daughter, she is on a mission to provide women with the information and support they deserve to navigate their health and hormones smoothly throughout their life. So without further ado, let’s go ahead and jump into my interview with Rose.

And I’m really excited to be here today with Rose. Rose is a member of the current 2022 FAMM program. And as with most of these episodes, we’re recording it toward the end of the official program. So the program officially ends at the end of September and we’re recording this right around that time. So we’ve had about nine months together and we’ve gotten to know each other quite well. So I’m really looking forward to our interview today. So welcome to the show, Rose.

Rose: Thank you.

Lisa: Well, I’m glad to have you and yeah, I think a great place to start would be to just dive in. Maybe let us know a little bit about what you do, like your professional designation, and then maybe you can just take us through what brought you to this point. So one of my favorite questions is, you know, how old were you when you had your first period and let us know what happened there. Birth control experiences if you’ve used hormonal contraceptives and what led you to fertility awareness.

Rose: Yeah, so I’m a registered nutritionist. I did my degree in nutrition. It was a light bulb moment in terms of my career, which is awesome. But yeah, so in terms of my journey, my period started, I think around 13. I was thinking about it, I was like, when was it? But I think it was about then. And I think it was pretty uneventful for the most part. I know my sisters had a lot more issues than I did. So I always felt quite lucky. Yeah, so other than the normal teenage hormones, a little bit of period pain, it was fine. But then at 16, I had my first boyfriend, and my mum suggested going on the pill, which I thought was amazing. Because obviously, everybody around that age was going on the pill. And I was told I might get bigger boobs, which I thought was great, because I was the only one out of all my sisters who had small boobs. I was like, finally — that didn’t happen.

But otherwise, again, like being on the pill was pretty, pretty uneventful, like it was fine. I thought it was all good. And yeah, so I went on that at 16. And then I was au pairing in Spain, and had got really, really poorly, ended up having an ultrasound on my stomach. And all of the doctors started laughing. And I think, why are they laughing? And one of them sort of said in English, that, oh, well, you’ve got these two really big gallstones. But, you know, if they’re not causing you any problem, then, you know, they’re fine, they can stay there. And it’s the first I’d ever heard of gallstones and like, well, I yeah, I don’t think that’s the issue. That’s not why I’m ill. So I’ll just leave them there.

And then I think probably within the next year when I was back at home, I had my first gallbladder attack, which was pretty horrendous. And I vaguely remember when I was in A&E, they asked like, are you on the pill? Amongst many other questions. And I really didn’t think much of it. I thought like, maybe they think I’m pregnant. Didn’t think anything else other than that. And then, you know, the attacks kept happening. We had to push quite hard to have my gallbladder removed because at the time I felt like that was my only option to stop this pain. And obviously I had to go on a really low fat diet. So I was losing a lot of weight and wasn’t very healthy. So finally had it removed, then continued to have these attacks. I didn’t really know why.

And then I was in Australia at the time when I had one of these attacks. And they said, oh, it might be something called sphincter of Oddi or SOD, which apparently can be a fallout from having your gallbladder removed.

Lisa: Okay, great. Come from one thing to another. Can you say what the name of that was again?

Rose: It was sphincter of Oddi, or SOD, I think it’s often called. I went to go and see a specialist in London to try and find out, can I get an official diagnosis? Is there anything I can do? And he said, you can have a camera put down to see what’s going on, but it can actually cause more damage. Judging by your symptoms, you might have type three and we can probably just make the assumption that’s what this is. So the attacks tended to keep happening every few months, whether it was kind of because I’d had a social time, I’d been eating more rich food or something. And I hadn’t literally had not thought at all about the link with the pill.

And then around 24, I decided to come off the pill. I just wanted to kind of get back to my own cycle. But then when I came off, it was also around the time that I was kind of almost about to finish my degree. So stress was high and I don’t know if that added to it, but I just had awful low mood and anxiety. I ended up having to go and see a counselor about it, try and help me to manage these panic attacks. I couldn’t sleep. And I know something instinctively just made me think the thing I’ve changed here is that I’ve stopped taking the pill. And so I thought I’m just, I just need to get through this phase. I’ve got like six months to a year. I just need to get back on the pill and just get out the other side, which I did and yeah, everything went back to normal.

And I think that kind of almost is how I felt the whole time I was on the pill, it’s nearly 10 years. And it was this like, I just felt pretty, I don’t know, flat. Not like, you know, I was happy, but it was just sort of no real highs and lows in that sense. So then, yeah, I came off the pill and went straight onto the Mirena coil around the age of 26 once things had settled down in my life. And again, yeah, that was fine. I didn’t have any period with the Mirena coil. But then around 27 started to think, well, you know, in a few years, I’d like to have a baby. And again, was having this desire to try and get a bit more natural and get used to my cycle. I felt like I was really out of touch with it.

So I came off and a year went by and I had no periods. This is strange, you know, no one said anything about this. They started having lots of different tests done. And nothing was coming up on any of the tests. They said, you know, everything looks fine. And I just remember sitting in the gynecologist’s office and he said, well, you know, looking at all your results, everything’s fine. So I think you just need to wait. And that was it. Like no other advice. And it just doesn’t seem right.

And I started to hear about, you know, how exercise can play a part in your cycles. And within the last few years, I had been doing triathlons and cycled London to Paris and stuff like that. So I was like, okay, you know, maybe I need to start thinking about how much I’m exercising. Obviously, I knew about nutrition. So I started to think, right, okay, I know I’m eating right. So maybe I’m not. And maybe I’m exercising too much and potentially not eating enough for the exercise I’m doing. So I kind of tried to balance that out. And lo and behold, periods started to come back again, but they were like 50 days apart, which wasn’t ideal because then at that time, me and my partner were thinking about, okay, we’d like to start trying for babies.

So we’ve got these very intermittent opportunities to try. I think I had somewhere heard about the fact that you’ve got to wait for the fertile mucus and that it looks like egg whites. So that’s what I was kind of looking for. And after about six months of trying in these random gaps of cycles we conceived. The pregnancy was all fine. And then after I stopped feeding about a year later, my period returned and I was like, okay, this is good. Hopefully this will be more normal. But still I was having really long gaps. And on top of that I was experiencing incredibly low mood. And I was kind of like, this is weird. This is happening in the middle of each cycle.

And I remember saying to Ben, my other half, yeah, there’s definitely something that keeps happening. And then it goes. And I just said to him, I can’t keep feeling like this because it’s just awful. It’s just, I can’t describe it. And now I’m out of it, I look back and I just don’t know how I was getting through the day with a young baby. And I called the doctors and they said, okay, so you think it’s to do with your cycle, you can either go back on the pill, or you can take antidepressants in the middle of your cycle when you feel this low mood. And I said to the nurse, I just don’t feel that’s actually fixing the problem. And I said, also, I’m really enjoying having my periods back. And that’s when she went on to explain that we don’t really need our periods and that actually, you know, back in the day, we didn’t used to have as many periods because we were just constantly pregnant or breastfeeding or whatever. And that just seems like a really simplified way of looking at it.

Anyway, we got off the phone and I think I was just scrolling on Instagram and some audio came up of these two women talking about PMDD and I was like, this is what I’ve got. Like, tick, tick, tick, tick, tick. And then I think shortly after that I found you and learned about seed cycling. And I was like, well, seed cycling is pretty harmless. I’m going to give that a go. And literally within a month, the low mood did go. So like, okay, this is amazing. And just the more that I read about nutrition and its role in women’s health, particularly for cycles and menstrual health, I was like, this is why I’m so angry. Like, why does no one know this? This is fundamental information that can literally change women’s lives. And we’re not being told. We’re just being given this really simple form of take the pill. If you don’t take any kind of contraception, you’re going to get pregnant. And if you’re having low mood, well, it’s probably in your head.

And yeah, just really mad. And I think that’s when I thought, right, this is where I want to be working. This is where people need to be investing time. And here I am now. That’s a very long story. But yeah, that’s how I got here.

Lisa: Wow. Well, thank you for taking us through all that. I always say, I feel like I always say the same things, but you took us through like 20 years of your life, maybe 30 in a very short time. And there’s so many pieces of your story. I think I want to kind of break down some of them and dive into some of them more. I mean, I want to start with the gallbladder thing. Like there’s a lot more to talk about, trust me, but I want to start there. It’s so interesting because to be honest, you know, when I first started the podcast back in the day, I knew about a lot of the side effects. The gallbladder thing wasn’t on the top of my list, right? I just didn’t really know about that. And within the recent few years, now I think you’re the third person on the podcast to share her gallbladder removal story. And yeah, that in a way it blows my mind, but in a way it doesn’t because like, I feel like at this point, it’s not surprising. I’m much more well-versed in a lot of the different side effects of birth control.

So, you know, in terms of your story, when did you make that connection that the gallbladder having to have that removed likely was a direct result of taking the pill?

Rose: So it was definitely after I had it removed. And I think I must have read it somewhere, whether, you know, I’m one of those people that like, I read, I like to know all the details and understand things. And so I must have been looking at a study or something and it came up and it was, yeah, like that oh my God moment, because two of my friends had also within that two year period had their gallbladders removed and they were on the same pill. And so I was like, oh my God, what is going on? Like, this is actually happening, this is real evidence here that this is causing it for people and no doctor is asking about it. Yeah, so I can’t remember exactly when it was, it must have been maybe when I was 24, 25. Yeah, to start having the pill, the gallbladder removed, I think that’s probably when I realized and that was probably around the time then I was thinking I want to get off this but it just wasn’t good timing in terms of my degree and things.

Lisa: Well, which pill was it?

Rose: It was the Microgynon.

Lisa: Just for everyone, you know, let’s call it out for everyone. So that name, I’ve definitely heard it, like I’ve heard of the Microgynon. I wonder if it’s, because you’re based in the UK, so I wonder if it was more common there.

Rose: Yeah, possibly. I know a lot of the girls when I was at school, like they were all taking it. It’s obviously a combined oral contraceptive.

Lisa: Yeah, and then you had mentioned briefly that when you were having one of those gallbladder attacks — and that’s something actually I’d like if you wanted to talk us through what that is like. But you had mentioned you were in the A&E and they had kind of, it was one of the various questions that they asked. But maybe take us through what is that like? What is a gallbladder attack like?

Rose: It’s not pleasant. I would actually say, I’m trying to think, I almost feel it’s as bad as labor in terms of the contraction. Because it is literally like a contraction. It’s as though all of your internal muscles in around your rib cage are just squeezing. And I’m squeezing my hands — it’s literally like, yeah, I felt like I was having a heart attack. I didn’t obviously know what that feels like but it was just as though everything — and I remember the pain used to start in my back and I was like, okay, something’s happening. And it would come in waves. So again, like labor, that kind of contraction. I couldn’t stand, lying down, I couldn’t lie down, every position was uncomfortable. And it felt like you couldn’t breathe. And one of the times I was on holiday with my other half, and I passed out on a sun lounger, just before they started.

And then we were on this remote area — I’m just going to try to wait this out because normally you would end up going to hospital but I was like, there’s no way we’re going to get there. I’m just going to have to wait for it to pass. I know it will pass. And I was throwing up, it was just, yeah, the pain — that’s how I describe it. It’s a contraction and comes in these waves and it’s just as though everything around all your organs are just squeezing. It’s kind of how I describe the pain. It was horrible.

Lisa: Yeah, it sounds horrible.

Rose: Yeah, it was kind of, because obviously it holds the acid and then as you eat foods that need to be broken down, it releases the acid into your stomach to help with that digestive process. So when I was eating richer foods, like when you’re on holiday, or yeah, alcohol, spicy foods, fatty foods, rich foods, red meats, things like that, that just require a little bit more work. If I had a lot of those in quick succession, that’s kind of often when I could, I’d know I would be on the line. But really interestingly, and I’m touching wood, since I’ve been off the pill, I haven’t had any. And by that, I’m talking about the SOD, because I did continue to have these flare-ups after having my gallbladder removed. And that apparently is because of the sphincter, like as it gets blocked because there’s this constant acid now dripping into my tummy because I don’t have a gallbladder to hold it. And so when you then eat the rich stuff, it causes a similar sensation. But since being off the pill and not having any coils or anything, it hasn’t actually happened again, which is really interesting. And I don’t know a huge amount about it, but it’s just an observation.

Lisa: That is really interesting. And so the, because you would think that if the gallbladder was causing a problem that once you took it out, you wouldn’t have it. So the attacks that you can continue to have afterwards that you said were related to the sphincter, so the SOD, were they about the same in terms of intensity and sensation?

Rose: Yeah, because that was the one that happened when I was in Australia. And so I think that’s what was really confusing. So it’s like, what’s going on? And it was only when I was in Australia that the doctor said, this could be SOD. And that was the first time anyone had said to me, oh, yeah, you could actually still have attacks, because I thought you remove the gallbladder, you remove the problem, you’re fine. That’s why I had it removed. But obviously, that wasn’t quite the case. There’s so many questions like, well, if you still had them, then was it the gallbladder? And if it wasn’t, then if I had gone off the pill, would they have stopped? And these are questions we’ll never have answers to.

Lisa: I know, sadly. Unless someone’s listening and had a similar experience and went off the pill before taking out the gallbladder. And like, it’s so interesting. Because again, I just feel like unless you listen to a podcast like this one or read the actual insert and saw the gallbladder thing, who would think that their stomach issues would have anything to do with the pill? Like, who would that occur to?

Rose: No, no, it’s just there’s just no link is there, because unless somebody tells you, you just wouldn’t think it.

Lisa: Yeah, I mean, for the record, it is on the prescribing information. So if you’re currently on a hormonal contraceptive, do an internet search for the label and the words prescribing information and read the PDF. You know, it’s there. But other than that, I just feel like this is one of the things that you just would not think. And it’s unfortunate that the doctors don’t necessarily make those connections either because that would be the opportunity to really make that connection when you’re in the A&E.

Rose: Yeah, well, I think this could be related because we have seen it before. I just wonder how many physicians have seen these things in young women, but don’t actually either know or don’t make that connection, even though it’s written. Well, I know when I spoke to some people before, and they said, you know, around the time that I was diagnosed with it, they said, oh, you know, I’m sure that’s more of a — I think they described it as “fair, fat, and forty” is like what they classify as somebody who would have gallstones.

Lisa: And so kind of thinking about what you’re saying about doctors, it’s like, well, she’s not 40. She’s not fat. She’s fair. But I don’t know. I feel like I recently did an interview where I don’t remember — it’s all kind of running together. I don’t remember exactly what the issue was, but it was a similar thing where she was like, yeah, I was told that this is happening because I’m a white person. And I’m like, what?

Rose: Yeah.

Lisa: How does this — is this the state? Like the degrees cost like 80 grand. Do you need to tell me who took 80 grand to tell me that this is happening because I’m a white person?

Rose: Yeah, well, exactly. It’s just ridiculous. So there you go, that’s what we’re dealing with.

Lisa: Yeah, this is the state. I feel like this is something that comes up a lot in our work, in the program too, because this is what we’re dealing with. This is the state of it. This is what many of our clients are constantly having to deal with, which is basically that when you’re a woman and you have health issues, we’re just not really given proper answers. So that’s a whole other topic, but no, that is really interesting and I think it’s clear that the reason that I kind of ask those questions to get you to talk a little bit more in depth about it is I think it is helpful to hear what the symptoms really are, what it’s really like, especially for someone who might be experiencing those things and isn’t really making those connections and potentially their health professionals aren’t making those connections either.

You mentioned something else that was really interesting because your experience emotionally while on the pill sounds like it was quote fine, right? Like you didn’t really, there wasn’t any real changes that you noticed. And for anyone who’s listened to my Pill Reality series or all of the different opportunities for women to share their own experiences on this podcast, obviously, there’s a percentage of women who do experience these dramatic emotional changes and changes to libido and all this kind of stuff. And in your case, it was the opposite. You came off the pill and then you started to experience these emotional ups and downs. So knowing what you know now, what do you make of that?

Rose: Well, I think the one thing I’d say is that I felt normal. I can now look back and be like, I was normal, but I was just — it was too normal, if you know what I mean. It was almost like being on, I don’t know if it’s too strong to say, but antidepressants, in that you’re just fine. And I was, you know, silly things like I feel like I tolerated so much more than I do now, you know, almost to the point where you’re a bit of a pushover just because you’re just like, it’s fine, it’s fine. And then coming off the pill, which obviously for my other half, he has experienced me on the pill for probably like six years of our relationship. And then I came off and he’s like, he’ll openly say, yeah, you’re different. Because I am more reactive. But I feel more like me, if that makes sense.

But yeah, I’ve, you know, those emotions I was feeling when I came off the pill that first time and why that might have been happening. And I know about how you were saying within our course that if you go on the pill before your period has actually had a chance to mature when you’re much younger, then that can mean when you come off it’s actually still got some maturing to do. And so I wanted, you know, is that going on, or potentially was it a sign that at that time in my life there were nutrient deficiencies or something that was potentially causing the extreme moods that I was feeling. And yeah, I have lots of questions about why that was the way it was, because I think when I did come off the next time, I went straight onto the Mirena coil, did that dampen it? I don’t know. Yeah, I wish I could understand it more, but that’s kind of the observations I’ve made from that time.

Lisa: Well, and a question, so when you went off at that time you mentioned you were still in university and I think you were almost finished. Did you get a period?

Rose: Oh, that’s a really good question. I don’t think I did while I was off it. I had a withdrawal bleed but I don’t think — I really can’t remember.

Lisa: Well I asked because then when you did get the coil out you said that it was a year and then that was when you kind of had to make that connection between the exercise and — you know, so that’s, I mean, I don’t have an answer either, but I would imagine that if you come off the pill and there’s just nothing going on or very little going on in terms of hormones, that would feel really unbalanced to be thrown into that, you know, after having this artificial stabilization hormone.

Rose: Yeah, it felt like cold turkey. Like, yeah, it wasn’t, again, not a nice experience, especially when there’s so much external stress going on in your life, which probably was also not helping it.

Lisa: Well, and your comments about how you felt different, it’s hard to explain. I can hear it when you’re talking about it because this is not something that’s easily explainable because you’re talking about feelings here and that sense. But it’s interesting because again, for anyone who has listened to a bunch of the Pill Reality series, or I included a bunch of women’s stories in The Fifth Vital Sign in the pill chapter — but if you want to feel angry today, read this chapter. But this sentiment of I felt flat, I felt kind of — you didn’t say numb, but I’m just kind of putting out some of the similar things that people say. But that kind of feeling of being stable, but like too stable. And yeah, feeling like yourself, like feeling like you don’t feel the high highs or the low lows, you just kind of feel, you know, so you’re not really feeling the true depths of happiness or depths of sadness or whatever. That is hard to describe, obviously, but that’s a very, very common thing that women say.

And I just want to point out that during the time you were on it, I would imagine that if anyone was like, hey, you know, I heard the pill causes you to have all these emotions, you’d probably say, I’m fine, right? Because you were. But this is often what I hear. Because in, you know, they’re off of it now, they’re charting their cycles and that’s when you’re reflecting on it and in retrospect you’re kind of like, yeah, I kind of was a little — so whenever I hear the like it’s totally fine or whatever. I mean, yeah, sure. It’s a blessing that you didn’t have any side effects, right? Like any. Yeah. Well, that’s not true. Let me — yeah. Well, I mean, any emotional side effects. You had your gallbladder removed — like that’s a clear side effect. But you know what I mean. It was a blessing that you didn’t have the emotional side effects, the depression, that kind of thing that so many women experience. But it’s so interesting, right? Like to think about how it can be affecting you in ways that you really can’t know until you come off.

Rose: Yeah, exactly. I think, and when you’ve been on it for such a long time, what you’re feeling becomes normal. So you don’t have this — I was so much younger when I went on it, and life’s changed so much, and you change as a person. And so how do you compare when you’re in it? You can only really see it when you’re on the other side. Yeah, but I definitely feel very strongly about not encouraging people to go on them now, if they don’t have to.

Lisa: Well, and with that said, I feel like if I was a skeptical person who was really pro pill, you know, because there’s two sides of this story, right? Like, you were using it to not have an unplanned pregnancy and you did not have one, right? And you were busy, you were in school, you were doing all these things and it was fairly convenient. I mean, those are the selling points, right? So it’s interesting because this is a nuanced conversation. Yeah, and it has to be. But at the end of the day, I feel like this part of the conversation has to be discussed. It can’t just be, let’s just pretend it’s all wonderful and butterflies and roses or whatever when you have serious medical issues that some women have as a direct result of taking this medication. Like we have to be able to talk about these things. Was it worth your gallbladder?

Rose: Yeah. Well, this is the thing, and with my own little girl now and thinking about what conversations I’ll be having with her when she gets to that age. Yeah, it’s thought provoking. And you think, you know, I know that my mum at the time was doing, to the best of her knowledge, what was the right thing. And arguably it was. I just wish I had had more information going into it. And you know, I just think, I’m sure, I know you’ve said many times before, it’s just having that education at a younger age around all the stuff that we’ve learned through the course, that you just feel like should be part of school curriculum. You know, we should all know this stuff, but for some reason it just hasn’t made the cut.

Lisa: Yeah. Well, I feel like in many ways it can provoke a different kind of discussion, which is about the kind of pressure that we feel to do procedures. And at the time, like I don’t, I honestly, this is outside my area of specialization. I’m not going to say don’t get the gallbladder out or get the gallbladder out. But at the time, you weren’t really presented with any other solutions or even a possible reason why it was happening. And so those things could have affected that decision, whether it would have delayed that choice, whether you would have taken a little bit more time. I feel like it’s not just the pill, but it’s the whole overarching thing. And this is one of the challenges I feel like, again, with our clients — like with all women, anyone who bleeds here, these are the issues that we have when we’re trying to decide what course of action to take. And it’s very complicated. There’s no one right answer for everybody. And always hindsight is 20/20. And we think, okay, we would have done this differently. So we, you did the best that you could with what you knew. And I feel like you did the best possible things that you could have for yourself. Like everything, every choice that you made was for your best interest at the time, based on what you knew.

Rose: Yeah, absolutely.

Lisa: All right. So I’m literally going down my list because I’m like, we’re still unpacking. I love it. One of the things that we talk about a ton, obviously, it’s kind of the whole purpose of the program, the FAMM program, is to utilize the menstrual cycle as a vital sign. So even before you were charting in this way, you figured that out on your own because you came off your — you had your IUD removed and then there was no period to be had. And through trial and error, you found out how to bring your period back. Obviously it wasn’t perfect right off the bat because you mentioned that the cycles were about 50 days apart, but they still came back.

So maybe we can — I do have, before we move on to my next question though, I do want to ask about your IUD insertion. This is becoming a theme.

Rose: Yeah, so the insertion was fine. Okay. I remember going home, taking some painkillers. I think they told me to take some before and spent the afternoon on the sofa and just had like tummy ache, but kind of just like I’d have potentially like period cramps. That was fine. When I went to have it removed, they said, “Ah, yes, your cervix likes to move away from me, so I’m going to have to clip it to pull it back so that I can get to it and get it out.” So, okay, I mean, I don’t really feel like I have a choice here because I need to get it out. So they literally clipped my cervix to hold it so it wouldn’t move away to then remove it.

Lisa: Not an enjoyable experience and to be kind of manhandled in that way. So scale of zero to 10, you know, zero being no pain on the beach enjoying yourself and 10 being horrific or like the crowning ring of fire in labor, where did that fall?

Rose: It was a high level of pain, but it lasted for like 20 seconds. So I think it was, yeah, it was painful, but I think because it was such a short period of time it felt manageable.

Lisa: And are you willing to give us a number for that 20 seconds?

Rose: I would say maybe a seven or eight. I think if it lasted a long time, it would have felt more like a 10. But because it was such a quick procedure, it was probably more like a seven or an eight, if that makes sense.

Lisa: Well, and I just, you know, all the listeners just hear the hesitation of Rose giving it. I feel like we always — not singling you out, I do the same thing. But I feel like we all kind of minimize and we all know like there’s women out there that have it worse than us and whatever. But like, I just feel like that’s not okay. Like, you know what I mean? There has to be a better way. All right, well, we’re not going to go down that rabbit hole, but I am making a point of asking because every time I ask, I hear like — I feel like we’ll just take it as anecdotal data. We’ll just leave it at that.

Well, so then back to the question. Before, you had that taste of, okay, my cycle — well, lack of cycle — is related to what I’m doing, and I changed what I’m doing and now the period came back, you were able to conceive. And then, I know we had a number of conversations about how your cycle was looking postpartum, and kind of some of the irregularities there and the questions. So maybe share with us then how fertility awareness and charting came into your life and what made you decide to jump into the FAMM program, and then maybe you can kind of share a little bit about how it’s changing your practice in a positive way.

Rose: Yeah, so I started charting. I was using, I can’t remember what the app was now. I think it’s got “OV” — some sort of fertility app where you track your cycle and it helps you know when’s the best time to try. So I’d say I probably started tracking then, which was at some point before I conceived. And then after that, I obviously was waiting for my period to come back and when it did, I just wanted to start tracking again, I think because it was so irregular. But at that point, I was only really tracking when my period started. And then so I had just the length. I didn’t really have much more information.

And I think it was doing that classic thing of predicting when I ovulated, which obviously in my situation was completely inaccurate because my cycles were so long and it probably wasn’t expecting that. So then when my cycle came back, I started charting again and I was aware of the fertile mucus and then started seed cycling, but it was — okay, now I need to know more accurate timings for when I’ve ovulated. And I think that’s when I came across you and the fertility awareness method as a method of charting. And that’s when everything sort of really fell together and really unlocked the mystery of cervical mucus, which is just amazing. That’s really been a massive eye opener to me. And that was like the cervical position and basal body temperature. That’s what I was doing before, basal body temperature. That’s what I was using to try to predict ovulation or when ovulation had happened.

So I was doing that — just that. So introducing the cervical mucus and the cervical position has just been mind blowing. And just the more I was learning, the more, yeah, there were just like oh my God moments. And I came across your course and I was really hesitant about doing it because I had got to this position where I’d just been made redundant and I was thinking, right, what’s my next step? I want to continue practicing but I feel like I need direction. I was so fed up of working with people just talking about weight because that’s not the only measure for health and particularly for women, it’s not a good measure of your health. It’s one, but I wouldn’t say the main one. In fact, I would say that your cycle is probably the one that’s really telling you what’s going on. And I think that was so refreshing to look at people’s health that way.

And so I eventually decided to do it. I was listening to lots of your previous podcasts with other people who have done it. I just thought, yeah, you know, this really seems to be what I need. And it’s just given me so much direction and it’s given me confidence again in practicing. And, you know, I think other people have said it, but it’s given me structure to how to kind of work better with clients. So even beyond the fact that you’ve got all this new resource at your fingertips to help people, it’s actually just the practical stuff as well for how to go about, keep taking information, and literally each session, how best to approach it.

So now when women come to me and they might not even be coming to me about their cycle initially, but then once I start talking to them and I start asking questions about their cycle, they’re like, oh yeah, that’s really interesting that you say that because I’ve been to doctors, but they said that that’s just normal. But actually, and often there’ll be a link between the thing they’re coming to me for and what’s going on with their cycle. And so then I can introduce it as a concept to them, because I think especially in the UK, fertility awareness doesn’t seem to be that well known. And so when you do start talking about it, they think, well, no, that’s okay, I’m not trying to get pregnant. It’s like, no, no, the name doesn’t really, you know, it’s more than that.

And it’s just so rewarding because every time you have that moment with the client and they get the light bulb and they’re like, no one’s ever talked to me like this. And I had a client recently who just sent an email afterwards and said, I’m really empowered after feeling so on my own with what I was feeling for so long, just from having that initial conversation with you about how I could help. And that’s just so rewarding because that’s at the end of the day, when you’re working in this kind of field and supporting women, it’s an investment in time and obviously money, but I definitely feel it was worth it. It’s just given me a whole new direction for my work. And yeah, I now just want to continue to learn and grow and progress the business.

Lisa: So interesting to hear what your experience has been like with it and how it’s been integrating it in. I always feel like I’m a bit biased because this is what I do all the time. So I always see those connections to the cycle. Just before our call today, I had a conversation where a client was asking about an anovulatory cycle, something we’ve talked about a lot in class. I was describing what that would look like, where you don’t really have an ovulatory pattern, no temp shift, but then you have a bleed and it’s like what’s going on. We’re just talking about this in general because she was asking this question. Then I’m like, okay, well, are you talking about a specific client? And then she says yes. And then she’s like, I just don’t know why it happened. And of course, me with all the questions, well, did anything happen? It’s like, oh, well, I moved into a different house and I started a new job. Right? Like it’s always the same kind of stuff.

So that’s just the tip of the iceberg. But it makes me think about what you said earlier, which you said that you were having these issues that were taking place mid-cycle. And your doctor said, go on the pill or take antidepressants. So I feel like now after having gone through the FAMM program, I mean, I’m curious to hear what your response is to that, you know, given what you know now about how you can support somebody who is having cycle-related changes of any kind, or cycle-related mood changes.

Rose: Yeah, well, it’s like, you know, you’ve said before, either of those things is putting a plaster over the problem, it’s not actually fixing it. And so, yeah, any woman who is going through what they think might be what I was experiencing with the PMDD is just, yeah, get help from somebody who can help. While I definitely think there is absolutely a place for medical care and not dismissing that at all, I just feel as though this area of women’s health is just a little unknown in some areas of healthcare. And that, yeah, I think in looking for those alternatives, alternative support, and working on those foundational factors, which is what I did to sort mine out, and seeing the huge change that came from just a few simple changes, and to think that I could have gone down the route of either going on the pill or taking antidepressants.

Yeah, I think it is just that thing. I guess the message that I would give to other people, if they were in the same situation, is just look at the foundational factors first. Because that is your bare bones, that’s your structure. That is what’s going to impact everything else. And if they’re not right, then you’re kind of almost jumping the gun, if that makes sense, by going to these more extreme measures if there is another way that you can actually get over it.

Lisa: Yeah, so from a practical aspect, I think one of the questions that a lot of the practitioners, or practitioners who are thinking about jumping into the program ask — and some of the, I think most of the participants in the program are still figuring this out — but from a practical standpoint, how have you found incorporating that FAMM process with the charting and the instruction with your nutrition practice? Like how has that been from a practical standpoint for you?

Rose: It’s a good question. So I think for me it might be easier than some of the other people who are on the course because it’s so food related, everything to do with charting your cycle and looking at what might be going on with it. So much of it is to do with what you’re eating and that actually links in really nicely. And I’ve sort of been offering it as a — so if somebody comes to me and I feel like they’re the right age and demographic to be looking at this specific area, then I would introduce it to them in that initial session and the option that they could incorporate it. And I’ll explain why it actually would help me to give a more targeted approach to their progress, because by looking at their chart, we’re able to actually identify if there’s a nutrient deficiency. And when you talk to women through that, they are kind of like, “Oh, wow, this is an amazing resource we’ve got that I didn’t even know I could use.”

So it’s actually been quite straightforward, I think, for me in that sense. It’s just kind of been an added tool that I’ve been able to use alongside what I currently do. And yeah, I think there are obviously some people who come to me, they might not be cycling anymore, and in that situation obviously I wouldn’t use it. However, I’ve obviously feel like I’ve gained information and tools that I can still use for them, but it might not be the actual keep going through the charting process. But a lot of the younger women who come through, who are still cycling, they’re quite keen to use it as a tool. It’s just obviously there is more of a commitment. So I think that’s the main thing for them, is that they feel, okay, if I’m going to do this with you, it’s not just going to be six weeks of sessions. It’s going to be five to six months of sessions. So I think that’s the big thing for them. But no, to answer your question, it’s been okay to integrate it and it’s felt very natural.

Lisa: Yeah, I mean, it’s interesting to see how everyone incorporates it. One of the ways that I look at it is that if you already have an existing practice, every client isn’t now going to become a charting client, but you now have this information. And even if your client isn’t devoted to that whole process, because it’s obviously its own thing, you still have that additional — like your brain is still working in their cycles and you can still ask them general questions and get a better picture of how it all ties in together. So I feel like that’s really interesting.

Rose: Yeah, absolutely. That’s a really good point actually. Because I do definitely think, like I’ve had a lady recently who she was really interested in doing the charting but decided just to stick for the time being on just the nutrition. But I’m looking at her food diaries so differently and thinking about that chart side of it, knowing that in the future she would want to have children. These are the things we need to think about. She’s told me already about the issues she’s got with her period. So even though we’re not charting, I’m using what I’ve learned to actually just apply it to the advice I’m giving, because there’s definitely been some enlightening moments in the content that we’ve gone through where I’m like, ah, that’s an update from what I learned on my degree. So that felt really good just to feel I actually have got more tools to help women specifically in these areas.

Lisa: Well, and of course I’m biased, but I feel like it’s one of those things that pretty much every woman I ever talk to — I don’t go around telling people what I do, like when I meet people on a one-to-one basis or whatever. But if they ask, I’ll obviously mention it. And there’s barely a time that I share what I do, that I don’t get the full dump of like, well, this is happening with my cycle. Right? Like, so there’s very concrete information, tools, and whatever. It’s such a big part of when you’re a woman of reproductive age. It’s such a big part of your life because not only is it managing your period or managing your fertility, so every woman who’s sexually active with someone of the opposite sex has to manage this thing. It’s this huge thing that we have to manage and it really does take up a lot of your life and your thought process and your emotions and whatever, even if you don’t think about it. Even if you’ve chosen to do a set it and forget it, you know, like an IUD or an implant or whatever. You still had to go get it and you still know it’s there all the time. It’s a big part of your life. I mean, I could go on, but I really feel like it’s such a central part of our lives. But we don’t necessarily have that opportunity to learn more about it, which is what we are trying to do.

Rose: Yeah, one uterus at a time.

Lisa: Yeah. One last question along these lines, so for the practitioner who is listening and she’s thinking about jumping into this class, it sounds like it would be a good fit for her, but she’s still hesitant. What, if anything, would you want her to know?

Rose: It’s worth it. It’s hard work, but it’s good hard work. I feel like everything that we’ve done has been related. Nothing’s felt like wasted information, if that makes sense. Yeah, I would just say go for it. If you’re one of those, if like me you’ve been thinking this is the area I want to move into and I just want more information so that I can support clients better, then this is what the course does. It gives you this structure, it gives you all the information you need to know about a uterus and a cycle and hormones. I sort of feel really well equipped now and I think I said earlier, it’s just given me the confidence to feel like I can really support women in this field, and that’s worth every penny. Because I think, you know, as a practitioner you always want to feel like you’re doing the best you can for them. So yeah, I’d just say, if that’s how you’re feeling, and this is the area you want to be working in, then it’s a bit of a no brainer, really. It’s worth doing.

Lisa: Well, thank you for that. I’m still kind of thinking about what you said earlier. So I was taking notes when you were talking. So the note on this one says, “Doctor said go on the pill or antidepressants mid-cycle.” Wow, that’s my note. But your doctor also said that whole thing. So I wanted to get into that whole thing of we don’t need periods. This whole idea, because it’s out there, a lot of women have heard it. You can search it. There was a pretty well-known researcher, I think, who wrote a paper on why we don’t need periods anymore. And that’s its own rabbit hole, but I just wanted to touch on that because we have just spent so much time talking about how much insight we can get into our health by paying attention to our cycles. How personally you were able to come to a nice equilibrium with regards to your nutrition, your exercise routine, improving your moods, and all of those things just by paying attention to your cycle. You mentioned seed cycling.

So it’s all — we have just spent so much time talking about how useful the cycle can be in helping us to achieve health. And then the doctor says we don’t need periods. So I just, yeah, that’s something that I find really interesting. It’s certainly a myth that I’d love to have removed. And when you were talking about it, that whole idea of, okay, well, so-called evolutionarily. I think it’s really interesting because if you look at what they’re saying, they’re saying that back in the day, women had more babies and that would mean that we were pregnant more. Nowhere in that does it say women were on artificial hormones to suppress ovulation for extended periods of time. So that is an interesting comment that they’re making that, okay, yes, sure, I’ll give you that. However, every single woman back in those times didn’t have all these kids — that’s the average, right? So there were plenty of women who probably didn’t have kids.

Rose: Yeah.

Lisa: But the women who didn’t have as many periods did have more kids. But during those times they were either pregnant or breastfeeding, which are two natural states of the body. So this whole concept is flawed. I just felt the need to touch on that.

Rose: Well, yeah, and I think what you’re saying is absolutely right. And also, as far as I know, being pregnant and breastfeeding doesn’t cause things to shrink and all of the other side effects that can also come from being on the pill or some of the other oral contraceptives. I don’t think that they do that. So I don’t really feel like they can compare the two because one is a natural process and the other is not and also has these different side effects on our fertility and functioning of our female organs.

Lisa: Yeah, I think sometimes because there are potential pregnancy complications that people go through, sometimes women have preeclampsia, high blood pressure, there’s a variety of different complications that can occur with pregnancy. And I think that incorrectly, in my opinion, they’re saying, well, you know, comparing them as if — the pregnancy has a purpose and you end up with a baby. It’s obviously a whole thing. I just went through that process. So you’re growing a human. So yes, things happen. But I feel like it’s not an appropriate comparison. But I just wanted to say that because for anyone who’s listening who’s heard that before, this whole idea that because women didn’t used to have that many periods, now we don’t need to have periods because we can just go on — like, I feel like we’re comparing apples and oranges to say that a woman should then be on hormonal contraceptives her whole life, because historically women used to have more kids. These are not the same things. And being on the contraceptive is not the same as being pregnant or breastfeeding. Even if they tell you that, it’s not the same thing.

So and I guess just to kind of wrap that up. As we have been talking about this whole time, it is possible to create a women’s health practice where the cycle is a central part of how you identify potential health issues and an incredible tool that you can use to help support her and improve it. And all the while helping her to get in better touch with her body and definitely a sense of empowerment. It doesn’t solve every problem. You can’t necessarily make a diagnosis unless you’re a physician. But it’s an incredible tool that you can really rally your practice around to support women. So to your doctor, if your doctor is listening, yes, we do need periods. Thank you very much.

Rose: Yeah, I’m very pleased that I didn’t just fall down that route and sort of looked for alternatives.

Lisa: Yes, for sure. Well, as we wrap up today, I would love to take a moment to give you the floor. Let us know where you are in the world. We know you’re in the UK, but maybe be more specific for some of the listeners who might be in your area. And so let us know the name of your practice, website, socials, whatever information you’d like us to know for how to get in touch with you.

Rose: Yeah, so I’m based in Suffolk in England, but I also provide online support to all my clients, so I can help anybody anywhere. On Instagram, I’m @Rose.C.Smith. My website is www.RoseConstantineSmith.co.uk. And I work from a clinic in an area called Southwold, but as I say, I’m also online, so that’s probably the best place to find me.

Lisa: Awesome. Well, I will make sure to link all of those places on the show notes page. And if you’re listening on your phone, you can just look at the notes in the podcast player itself and click on those links if you want to jump in. And I just want to thank you so much for being here. This conversation has been so great. This is why I love doing these episodes because even though we had talked so many times, it really flushes out — like I feel like I have such a better idea of your story now. So thank you so much.

Rose: It’s a pleasure, thanks for having me.

Lisa: 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/439. I hope that you enjoyed today’s episode with Rose. I really appreciated her for coming on the show and sharing her experience. And it’s always fascinating to me to find out how people discover fertility awareness, how that works, and particularly in the practitioner training program, what it is that kind of led up to them wanting to incorporate it into their practice. It’s not always a personal story, but it’s often a personal story, whether it is you yourself who went through something and discovered charting because of that thing and then started to see the connection between your health and your cycle. I feel like that’s often one of the ways that we find ourselves in this particular field because it’s one thing to hear about it and read about it, but it’s another thing to apply it into your own life and see how it can help you, how intimately the cycle can be connected with what’s going on in your life and how it can really force you to address some of those issues maybe that you weren’t ready to before, or maybe you underestimated how significantly it could affect you.

And so Rose’s story is interesting because she did have the unfortunate serious side effect of the gallbladder issue, but what’s interesting is what led her then to start charting, which was her own cycle — having the IUD removed and not having a cycle and then having to figure out how to bring on the cycle and how to normalize it. That’s a really powerful experience when you chart through something like that. I feel like it really changes your perspective on your cycle and on charting because it shows that it’s all connected. It’s one thing for me to talk about it all the time — it’s connected, it’s connected to your health. I think it’s a really interesting idea and I feel like a lot of us gravitate to that. But when you actually see it in motion and in action, I feel like it really has a profound effect on us. It’s sometimes really humbling to see, especially when you think everything’s good, you’re healthy, it’s all great, to start charting and to actually see that there are areas of improvement or sometimes actual issues. So I know that can be really humbling for practitioners in the program and in general for anyone who’s ever charted.

So I hope you enjoyed today’s episode with Rose. If you know somebody who you think could benefit from hearing this episode, the share link once again is fertilityfriday.com/439. And I hope you have a wonderful week, weekend, whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.