How to Get Your Doctor to Listen (Episode 471)

Full Transcript: Episode 471

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 training workbook. I’m a certified fertility awareness educator and holistic reproductive health practitioner with over 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormone health and optimizing the menstrual cycle without hormones. I have been consistently outspoken about hormonal birth control over the past two decades 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 and a brand new baby girl. 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.

In today’s episode we are focusing on an important topic, how to get the support you need from your healthcare practitioners. This is a topic that comes up in virtually all of my client work, when I’m working with practitioners in the FAM program, and it’s really an essential part of advocating for the care that you need, especially when you start to take control of your health and you start charting your cycles and you start to have a much deeper awareness about the connection between your cycle and overall health, it can just become very difficult to get practitioners to take you seriously. And it can be difficult to find the right words to convey in a way that they will understand when you’re having an issue. And so today’s episode really highlights some of those specific strategies from finding language to convey the issues that you’re having in a way that your practitioners will understand so that they’re more likely to take you seriously to encouragement and again strategies for what to do when you’re not being taken seriously. Before we dive into today’s episode I want to take a moment to share a little bit about our guest Dr. Jolene Brighton. She is a hormone expert, nutrition scientist, and thought leader in women’s medicine. She is board certified in naturopathic endocrinology and trained in clinical sexology. Dr. Brighton is the author of Is This Normal, a non-judgmental guide to creating hormone balance, eliminating unwanted symptoms, and building the sexual desire you crave. A fierce patient, advocate, and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighton empowers women worldwide to take control of their health and their hormones through her website and social media channels. Dr. Brighton is an international speaker, clinical educator, and medical advisor within the tech community. So without further ado, let’s go ahead and jump into today’s episode with Dr. Brighton.

I’m excited to be here once again with Dr. Jolene Brighton. Welcome to the show.

Dr. Jolene Brighten: Yeah. Thank you so much for having me. I’m super excited to be back here with you and all of your awesome people to be chatting.

Lisa: Awesome. Awesome. Well, congratulations on your new book. Is this normal? We were just talking about that. It’s been a while since we talked and it’s like, oh, what have you been up to? Well, I just had a baby and read a book and got a new certification, you know the usual. So maybe fill us in, let us know. I guess my question out of curiosity is why this book now. So tell us a little bit about how it came to be.

Dr. Brighten: I feel like this is the prequel that I needed to be on the pill because I explained so much in Beyond the Pill. And then I realized it was through people’s questions that I was like, there’s just so much that we have not been taught about our bodies. And so I set out to write the book that I think we all should have been given as a manual, like you get your period or before you get your period even better. And like here is a manual that can ride with you for life because things are going to change and things are going to come up and then you’ll be able to access this and have the information that you need. And as I was sharing with you, so I started writing this book during the pandemic. I actually, so I got COVID really bad. I spent four months on oxygen. I had long haulers and was in bed. And it really gave me an opportunity to, ’cause I just wasn’t interacting much. I was like, I just need to heal and what the hell is happening in the world kind of situation. But at just observing, I think it really amplified during the pandemic, how much women didn’t know about their bodies and just how bad gaslighting is in medicine. So we saw, I wrote about the pandemic periods in my book. We saw all of these women saying, my period, I either got COVID or I got the vaccine and something’s wrong with my period. And then we saw all of the medical experts who also suddenly took off all over social media, coming on and being like, that’s not a thing. And like, you’re just hysterical. Oh, did they just say hysteria? Yeah, they’re just, they’re implying that you’re hysterical. And I was like, no, of course, it’s a thing. Of course, it’s a thing. Like, if you got the flu, that can throw off your cycle. Like, that can affect ovulation. That’s the other thing. I was seeing these providers just talking about the period and not talking about the fact that, like, it throws off ovulation. And that’s what’s going on. And that we know that the uterus has some interactions with the immune system. Like when there is failure to implants during pregnancy, one of those main reasons can be because of the immune system activation in the uterus. So if you get really sick, something might be happening in your uterus, but we don’t study that because it’s just a baby container. We just take it out if you don’t need it. We think you don’t need it, right? And so I saw all of this happening. And it just really struck me of how misinformed even medical providers are about the female body because they lack so much humility in listening to women because after, you know, I think it was 50,000 women, all of that was collected, 50,000 women said no, it definitely affected my period. Then they were like, oh, okay, we didn’t study menstrual cycles when developed the vaccine. It’s fair. We thought people were going to die, and many people were dying, and we were trying to rush a vaccine. And I get that, that perspective of, okay, we don’t want to take the extra cycle to study women. But we really should have that. And I wasn’t part of any of that. But medicine as a whole really should have asked that question. And then it turned out that all these women, in fact, knew their bodies. And so that was a big reason of setting out, like ignited the fire even more, where it was like, forget this, I am putting the medicine in women’s hands, because they know they’re normal, they know their body, and all of the things that prevent you from chronic disease and chronic issues, and from ever having to go to the doctor’s office is what you do at home. So why don’t I just give that to you?

Lisa: Oh, that’s so good. That’s so, I feel like that’s such a great place to start. There’s just so many thoughts going through my head. I think one of the saddest pieces of what you just shared with us, you know, that whole experience, A, that it took 50,000, like that’s one thing that really irritates me, right? That we need to have this huge number. Even if you, a long time ago, Netflix came out with that documentary, “The Bleeding Edge,” if you remember that one.

Dr. Brighten: I just remember, well.

Lisa: Now I’m like, somebody write that down for me. I need that. We’ll look it up, the bleeding edge, it’s definitely one to watch. It was about medical devices and the side effects and it featured Essure.

Dr. Brighten: Oh yeah, okay, okay, yes, this is familiar. It’s coming back to me now.

Lisa: And there was a Facebook group at the time, and I remember I interviewed the woman, one of the women, Angie from Alino, that name sounds familiar. So I have a past episode with her. But there was a Facebook group with 40,000 women who had had issues with this Essure device. And at the time, the group was called Essure problems. I guess I have a good memory today. And what again, that’s when it makes, like that’s where my mind went. Because again, it took them years to get it pulled off the market. Right. And it took like in that like 40,000. So when you said 50,000 women complained about their menstrual cycle, the gaslighting piece of it. So I mean, I don’t know if you want to speak to that because I feel like where I’m trying to go with this is that what I find to be sad is that so many women doubt their own experience, their own bodies and we look to the medical professionals for validation and it’s like we’re asking is this normal, but deep down we know it’s not. Why are we even asking?

Dr. Brighten: Oh yeah, okay. So I had shared that I had long haulers. So I got COVID very early in 2020, like literally when I’m locked down, trying to figure out how to get COVID, I didn’t even leave the house kind of situation. And then, but I never presented with a cough and I never presented with a fever. I just progressively lost the ability to get oxygen. And so my pulse ox dropped after a week of struggling, like I, the house I’m living in, an elderly man built it, and he put an elevator in it. And I laughed when we moved in, and I was like, why would I need an elevator? I needed an elevator. I was so glad to have an elevator. And my husband’s like, look, you can’t even go the stairs. Like, what is going on? So I ended up going to the ER, and they’re like, your lungs are clearer, but you can’t get oxygen, okay? So at this point, like the doctors who are seeing me, they sent me home, they’re just like, they literally said like, she’s gonna make it in two weeks or she’s not, like get your affairs in order kind of situation because I was dropping down, I mean, sometimes my pulse ox was in the 60s. So people know this is a measure of oxygen in your blood. It should be like 98. That’s like where we want to see that at. So that’s not, that’s bad. That means your organs aren’t getting blood. My symptoms then progressed. So I made it obviously, right? I’m here. I had to be on oxygen. My phone actually just popped up in my stories today showing me like, this was your life three years ago and it’s me in bed with like a nasal cannula. And I’m like, man, that’s a look, that’s a look of a survivor. So I get long haulers. I am getting, so I don’t get better. I am getting wandering, shooting pains. I get trigeminal neuralgia. I get migraines. I haven’t had migraines since back when I was on one formulation of the pill in my 20s. I’m getting shooting pains that wake me up at night. Now I have POTS, so I can’t get up to go to the bathroom without my heart rate jumping over 100. It was so confusing. It was a novel new virus and all of this is going on, we can’t figure it out. And there were doctors online who were saying that I was malingering, which is doctor speak for like you’re just making it up because you want attention. They were saying long-haulers isn’t real. This is not a thing that happens. I mean, how would they know? Like I just got this virus, it hit the U.S. and then I got it like right away. Like how much experience did they have with it? I fell into a group on Facebook and even been on Facebook and here I am in a Facebook group of like 70 something thousand people talking about long haulers and we’re all talking about our symptoms and taking surveys on what are your symptoms and then it’s like popping up and we’re all having this experience and yet there were so many I mean these very very popular doctors that you see on TikTok who like exploded during the pandemic gaslighting. And that was hard because even me as a doctor was like, maybe I am making it up. Maybe it is psychosomatic. And I’m like, and I had to start telling my husband, like, write this down. I’m like, having this, like, write this down so that when my feed would pop up with one of these doctors being like, this is not a thing, I can be like, look at it and be like, no, this is the thing I am experiencing it. This whole Facebook group has experienced it but there it took like hundreds of thousands of people getting really noisy about it for the medical community to shift and then the same people who had been gaslighting all along come out with well of course this could happen I mean we see this with Epstein-Barr virus we see this with other viruses and I’m like look pattern recognition is something I do really well and you have just deviated from your pattern of saying this is not real. Oh, and you took down all your videos about it. Like that’s so interesting to me. So I bring this up because I have the only reason I thought to write it down is because that’s what I’ve been advising patients to do for over a decade. Write it down. Write it down because it’s so hard to gaslight you when somebody says it’s not real and you look and you’re like, no, I wrote it down. I have it here. I am not crazy. But you know, even through that experience, I share that whole thing because here I am as a doctor going through this, knowing what I’m experiencing is real, but being inundated with messages from people all over the internet who are wearing white coats and showing up dancing on social media, but telling me that I’m full of it and questioning myself. And I think if that isn’t a testament to how ingrained this is in our society for women to second-guess themselves. I don’t know what else is because I feel like that was such an extreme, extreme situation.

Lisa: Well, I really appreciate you sharing that with me. I mean, I feel like what I have is the unanswerable question. Obviously, that example is super egregious and just because everything was so crazy with the pandemic stuff. But in the work that I do with the menstrual cycle and charting, it’s a daily thing that I hear from like, it’s daily. So it’s a daily thing I hear from women, whether it’s the period pain, whether it’s they told their doctor that they want to use fertility awareness and literally were laughed at, told that it doesn’t work, whatever it is, it’s a daily thing. So the unanswerable question, like I’m curious to wait, wait, wait, maybe it is answerable. Why is it that doctors are so sure of themselves when they’re like wrong? Like, what is wrong? Legitimately wrong? They were wrong. Like, you know what I mean? And they’re like so, but it’s not like you’re wrong. And you’re so like, like you’re so sure of yourself. And you’re literally just like dead wrong. Yes.

Dr. Brighten: Okay. So firstly, there is very much like doctors are taught, like you need to be confident. And your confidence is what’s going to instill trust. I actually think this is wrong. I think your humility is what instills trust. I think your ability to be wrong and to say I’ve learned new information. I said this thing, it wasn’t right. I’ve been presented with new information and this is correct, that instills trust. I think saying, you know, I don’t know what’s happening here but I very much believe that this is a real experience, let me see who I can refer you to instills more confidence than no, that’s not a thing. I don’t think that’s happening for you. So there’s the one piece of how doctors are taught they’re supposed to be like, like it’s almost like, you know, being an actor of like, this is who you’re supposed to be and how you’re supposed to show up with the patient. And they are taught something. So when we get taught in medical school, we are taught the same thing over and over and over and over and is the repetition that really instills it in our minds. And that is why some doctors have very fixed and unchangeable minds because it’s like, they laid down that neuronal pathway and they’re like, that’s just too much work to like think something new, like forget it. I don’t think they’re having this conscious decision, but they’ll always remember as well the feeling of how their resident made them feel when they brought up fertility awareness method and when they laughed at them and the room laughed at them and the way that they were ostracized and all of that. And the shame that came with that like embedded that this is something really not right or wrong or is not going to work for you. And when you think about it from that perspective, like they’re dealing with their own baggage. Because when you bring that up, here come the emotions that are embedded in their memories surrounding what that was. And oftentimes when we’re talking about fertility awareness method, I mean, I went to naturopathic medical school and they still were like, you know, this is like, you know, potential to get pregnant. Like they really discouraged it as well. Part of that is because of malpractice. Part of that is because if you want to stay safe as a provider, then you can’t be, you know, just saying like, oh, just do fertility awareness method without really doing your due diligence. And if it’s not taught to you, then it’s out of your, it’s out of your scope. I actually had, um, I had this reporter contact me oddly enough, wanting to do a story about fertility awareness method and about fertility awareness educators online. And then she was asking me about how I teach people about it. And I said, I don’t refer them to somebody who does like I will give them here’s the parameters here’s what to know this is like how it works if you want to do this and be successful you should work with an educator because that is the best way to get to know your body and be successful with this so you know just going back to your point I think that there’s just a lot of doctors who get one thing in their mind and that’s what it is forever and that’s I mean we know from the research that even when new research comes out, it can take 17 years before it makes it into somebody’s practice. And even then the doctor might be like, but this is the way I’ve done it all along. So I’m not going to change now.

Lisa: Yeah. I mean, I agree with what you were saying. And the one thing that stuck with me actually, when you describe that kind of hypothetical experience of someone bringing something up and fully actually literally being laughed at by all their peers. So I’m guessing you didn’t bring that up just because it’s hypothetical. Like, is this a real thing? Like, is that how tough it is in med school?

Dr. Brighten: Oh, it can be. Absolutely. I mean, you talked to somebody about residency. There’s a friend of mine, she’s in surgical residency right now when I was chatting with her because she was hospitalized for exhaustion and for all these issues. And I don’t want to say much more about who she is, but how amazing it is for who she is that she is actually a surgical resident. It’s a really big deal, but she is degraded on the daily and is pushed to the point of exhaustion. And so it’s really problematic. Doctors go to school because they want to help people, and then that school beats the empathy and the humanity out of them in some ways. So that absolutely can happen depending on the school, depending on the residency. And so this is all to say that we’ve got a systemic issue. We don’t have an individual issue. We have a systemic issue and it shows up in the individuals. And it can feel as the patient as if our doctor is the worst human on earth, but trust me, they didn’t put themselves through all of that because they didn’t care about people. They absolutely do. I believe they still do. They just went through a system that was really, really hard to maintain your humanity in.

Lisa: Well, one of the comments I get a lot along this topic is, well, I had a woman doctor and I thought it would be so much better. And what I’m really curious to hear what you’re going to say about this, because my experience has been, unfortunately, for anyone who’s going to get upset, get ready. But that women doctors are often worse. But I don’t think it’s because of some inherent issue with women. I think that this is just my opinion. So again, I think that it could possibly be because it’s so male dominated and they have to prove themselves so much more and they end up having to be so much harder and firmer so that they do end up being even less empathetic than male doctors. But what do you think?

Dr. Brighten: I absolutely think that is part of what contributes to all of this. And when you say that, like, I hear this all the time where people will tell a story. And then other people in the comments will be like, oh, tell me about this male doctor as a man. And they’re like, no, as a woman. One of the best gynecologists I’ve ever had in my life for my personal was a man. He took a vacation one time. How dare he? But the story I tell in Beyond the Pill about the doctor that wanted me to cut my pudendal nerve. Yeah, that was his doctor who was filling in and she was a woman and she just met me. It was like, you have pain with sex, let’s cut your pudendal nerve. Never did she say, oh, it’s ’cause you’re on the pill and you have chronic yeast vaginitis and pain with sex comes as a result of chronic yeast vaginitis and like this makes sense. No, she was like, let’s cut the pudendal nerve then you can lay there and your partner can have sex with you. And I was like, this is the worst thing. I was in my early 20s and I was like, this feels wrong. And I don’t like this person. And when I talked to my male gynecologist when he was back, he was so livid. And he was like, absolutely not do not do that to your body that like would be mutilating like that is like experimental. And he was so upset that she even took the liberty to suggest it and how flippant she was about it. And it was definitely a situation that I’ll say, you know, looking back, I’m like, I’m glad I had that experience because it really did open me up so much to what my patients have been experiencing, but you’re absolutely right. I see women say this all the time. What I see as a common statement on social media is, why are female gynecologists such misogynists? I’m like, it could definitely feel that way. I definitely can see that. I have hesitancy in even saying this because, man, I have just so many good friends who are female gynecologists, where I’m like, I see this and I know these people exist, but depending on where you live or what you’ve had access to or even your experiences, it can feel like everybody is just like that.

Lisa: Well, and I feel like it goes back to what you were saying, because you were saying this is a systemic issue. This is an issue with the actual system itself, because it’s churning out this product that is not doing the things. So then getting back to the idea of is this normal and what we do, I think this presents a real problem for all the women out there who have certain challenges, questions, is this normal, I’m seeing this thing, I’m seeing that thing. Because we’ve just established that when you go to your medical professional, you could fully just be gaslighted into the doctor, could fully be confident in what they’re saying, be completely wrong. And tell us a little bit about your take on it, because the question out of it is, what do I do? Because usually, the thing you have to say is, talk to your doctor. We have to say that about everything. Talk to your doctor. Talk to your doctor. Ask your doctor. But then we’ve just established that there’s a problem with medicine. So what do we do?

Dr. Brighten: Okay. So firstly, we’ll say, talk to your doctor all the time. Midwives exist. Nurse practitioners exist. Doctors of nursing practice exist. There are so many other providers out there. I mean, physician assistants as well. So understanding that while in our minds, we’ve, I mean, the American Medical Association’s marketing, like kudos off to them, because they’re like, there is only one provider to see. And that is going to be, if you’ve got lady part problems, you see your OB-GYN. And you’ll see these OB-GYNs even get like super pressed on the internet, if somebody talks about going to their PCP and they’re like, no, but we’re like the expert. It’s something like, you know, some people live in rural areas and they don’t have an OB-GYN. So this is the other thing. There’s other providers out there. And so sometimes you need to get creative. And then it depends on like, what do you have going on? I put all of these checklists in Is This Normal to help you expedite this conversation to a solution with your provider. So for example, period pain, told it’s normal. Well, I mean, what do doctors see all the time? They see people who have problems, people have problems, go to the doctor, and it’s got to be a pretty significant problem in the United States because nobody wants that copay, or maybe they can’t even afford to go to the doctor because, I mean, that’s a whole conversation, right? So what do doctors see? They see day in and day out, they see period pain, they see PMS, they see all of these things. And that starts to become more normal in their world, thinking like this is a sample from the population. Like this must be telling us what everybody’s experience is like. And that in part, along with the fact that they lack sufficient education and things like endometriosis is why we see such long delays. Or you have conditions like PCOS where they’re, “Okay, you have an irregular period. Do you want a baby? No. Okay, we’ll just put you on the pill because that’s what’s the normal practice and that will make you bleed when we say bleed. But like there’s no conversation about the fact that the pill doesn’t fix PCOS and I have to say, you know, I came out with Beyond the Pill I got a lot of backlash from conventional trained docs who are now changing how they’re talking on social media. I don’t know if you’ve noticed and I’m just like you might hate me but I definitely did what I came to do in that now you are saying, no, it doesn’t fix PCOS. And I’m like, that’s what I’ve been asking for is tell, tell the honest truth, because the dysfunction of PCOS in terms of why you don’t get a period is ovulation. And if you are giving the pill, that is so you don’t ovulate. How could that fix the problem? I love your face right now. People can’t see us. We’re like throwing up hands. But this is something that we have to understand ourselves and the patient role, what our symptoms are and what they could potentially be, and that is so lame because that never should be on you. Someone especially who doesn’t feel well, and that’s why I put the checklist in Is This Normal. You can go in and you can take that. Is it endometriosis? Is it PCOS? Is it functional hypothalamic amenorrhea? Why I lost my period. Is it a situation with perimenopause? Like what is going on so that you can have all of that and understand how to articulate to your doctor? So if your doctor’s like, “Well, your period pain is probably fine.” And you’re like, “Yeah, but like I’m vomiting and I can’t go to work.” And you start listing those things out. It wakes them up to these, you know, how significant the condition is. It’s the same thing with heavy periods. How often I hear, I was actually just talking to another physician the other day and she does not, she works in dermatology and she was talking about how she was telling her doctors her periods were getting really heavy, they were really problematic. And her doctor was like, it’s normal, it’s fine. And she’s like, and I started hemorrhaging, like it was that bad. And I ended up having to have a hysterectomy and I had adenomyosis and she’s telling me this whole story. And I’m like, this is what I think people don’t understand is that the system is so messed up that even as doctors, we struggle to get other doctors to listen to us. And as I was talking to her about it, she was like, “If I had Is This Normal, I would have loved to just have gone through the checklist and said to my doctor, here are all the things.”

Lisa: Yeah, that’s such a good point and so like so important, so helpful, so practical. Like this is what we need because what I always try to convey when I’m working with clients is we have to speak in their language. You can’t just be like, “My periods are painful.” You have to really quantify it. You can’t just be like, “My periods are heavy.” You have to really quantify it. So I love the concept of just bringing those checklists to specifics because you really have to speak in their language to get. You have to be persistent. You have to not be discouraged. And I think the hardest thing is we have to trust our intuition. We have to trust what we feel. There was a quote that a long time ago, I remember from Mike Gaskins, who wrote In the Name of the Pill. I can’t remember the whole quote, but what I remember is trust your questions more than their answers. And I feel like that’s where we need to go. That’s one of the biggest things that irritates me to no end. This whole thing of women having symptoms, women experiencing issues. And what I, what I often say is that it’s similar to what you said when you’re like, well, if you’re there and yet you have to like pay for it in the States, like it’s obviously bad enough that you’re there. So what I always say is like you, it wasn’t like it was nothing, like you were in your house and it was bothering you enough to pick up the phone, make an appointment, you know, bathe, put on your clothes, leave your house and go sit in the doctor’s office and no one wants to go to the doctor, right? Like it’s not like it’s the same thing as going for tea with your friend.

Dr. Brighten: No.

Lisa: So how do we end up doubting ourselves so much? Like how did this happen? How are they? Anyways, these are all unanswerable questions but I really love the checklist piece.

Dr. Brighten: Mm-hmm. Well, and that’s the biggest thing is when you have it written down is very hard for them to gaslight you. And then for everybody listening, if they are saying like, “Yeah, I don’t think it is that,” then you ask them, “What have you done to rule this in or rule this out?” Get them to pause. What else is on your differential? That is the other things they think this could be because you do have symptoms, so they should be thinking of other stuff. Get them to answer that. And what have you done to rule that in or rule that out? That can get them to pause and be like, “Okay, hold up. Let me just spend a little more time here.” But again, when you look at it from a systemic issue, they might be stacked with 42 patients in a day. You know, people talk a lot about like the 30 something patients, but you don’t like it’s cold and flu season. Now they’re stacked with like 42 patients in a day, and they don’t even know how they’re going to get lunch. And then they are like already thinking about like, God, who’s going to pick up my kids from school? And like all of these things because they’re a human in this really messed up system but still trying to serve you like they can all be going on and has absolutely nothing to do with you and so being kind and you but firm and using that language can help you get at what you want and then if you’re requesting tests and they’re like I’m not going to do it I say well can you please document I requested these tests and your reasoning for not doing this because I’ll be getting my chart notes at the front so when I get my the second opinion the provider can see why these were not done. It’s a really good way to make someone pause and be like, oh, someone else is gonna check my chart notes. And like, what if I’m wrong? What if I’m wrong?

Lisa: Those are real stealth techniques that you wouldn’t really know unless you’re part of, you know, the medical profession to actually kind of put them on blast like that. So I really appreciate that, even to dig into it a little bit further. I always find it interesting when you speak to somebody, this is a current pet peeve of mine. I’ve got lots, but we’ll just pick this one. So, the PCOS piece. So, PCOS is like candy. They just give it out to everybody, regardless of whether or not they meet the criteria. It’s a total, it’s just something that really hurts you. And then women with PCOS, if they don’t present in the way that they’re anticipating, particularly if they’re not overweight.

Dr. Brighten: Yeah, exactly.

Lisa: Right? So, we give out all the candy to everybody except you who actually has it.

Dr. Brighten: Yeah. So what you’re saying is really useful and like, I really love it because what I always get to is like, well, like, they just look to you like, right, you have this appointment. It’s like 10 minutes long, they have five minutes long, they just look at you and they just tell you, they just spit out this information. But like, where’s the testing? So yeah, I mean, I feel like you spoke to it with the checklist. So I feel like now everyone needs to grab a copy of your book so that we have, so that we’re armed with this information because it could just be so discouraging. One of the questions I get all the time is like, well, where do I find a good doctor? Or like, where do I go to get support? Or what do I do? And I feel like we’ve gone through a lot of that. But yeah, I guess I’m just excited for. I would love to see this turn the corner because this is honestly one of, I feel like the biggest issues with our medical system. And like one of the challenges I also find just in the work that I do is when I load up my clients with all this incredible information about how to chart their cycles and how to interpret what’s going on and start to see how different things affect their hormonal health, like now they have the data, like when you were saying to write it down, right? So now they actually have the evidence that when I stay up all night for a week straight, it kind of messes with my hormones or like when I go off track and eat all the like, right. Like, and we can, like, you can see like, drinking that bachelorette party. Exactly. Like binge drinking, like whatever, like you can see how it affects it. And then you go, like, so I find that, you know, I’m like setting these women up for like failure, because like, you’re so excited about all this amazing information. And then you’re like, you go to the doctor with your chart and you’re like, I’m doing this really cool thing. And I just want to check about my hormones and they’re like, get that out of my face. That’s stupid. And like, just completely pop your puzzle, Bob. It’s pop your bubble. Bubble? Like, oh, disease or not disease, but there is an optimal range, like there is a more optimal function, or they didn’t do the right test, or they need to do more tests, or you know what, your body’s thinking about disease, but it hasn’t gotten there yet. And maybe that’s where it’s heading. So let’s head it off at the past.

So, you know, back to your point about what you were saying with PCOS, it is a situation with PCOS where the diagnosis can be made clinically. You have made clinically. You have irregular cycles, which we need anovulatory cycles. Here’s the thing, why is it with PCOS doctors can put it together that like, oh, it’s anovulation that leads to the missing periods, the irregular periods, but they can’t get to the next step of like, we need to restore ovulation as a metric for us actually correcting this condition. I don’t understand that. And the other thing is the excess androgen symptoms. So if you have, you know, your hair follicles are getting really thin, you’re losing hair, you have oily skin, you have acne, like if you have hirsutism, you’re presenting with these things, we can make the clinical diagnosis of PCOS. We don’t have to do an ultrasound. I think it is worth doing testing to look at thyroid, or excuse me, testosterone. I do think everybody should have their thyroid screen, by the way, because sometimes these conditions ride together. Or what’s really going on with PCOS is that you’ve also got hypothyroidism, and that’s causing you to have anovulatory cycles as well, and so we can do all the things right for that. But if your thyroid isn’t corrected, then that’s going to be problematic as well. But to the point, you can make some of these diagnoses just based on looking at someone, just based on their history altogether. But I do think when it comes to PCOS, doctors are really missing the mark in not getting a cholesterol panel, looking at inflammation, looking at all these other things because you might get this diagnosis at 18. And they’re like, well, you know, we’ll worry about cholesterol testing when you’re in your 30s, except that you’re already at higher risk for heart disease. So why don’t we figure out what your baseline is? And maybe you say like, Hey, at 25, I want to make sure I’ve got this baseline down that we know where that’s at so that when you’re in your 30s, we know if there’s any changes, we’re going to screen again.

Lisa: Yeah, it’s, there’s so much. If we ran the system, I feel like it would just be so different. Um, I mean, we’ve covered a lot of ground. Maybe this would be a good opportunity. Share with us some of, like if we’ve talked about a lot of it, but share with us some of the things that were really on your list to talk about in your book. So some of the things like that isn’t normal things? Like what are some of the common things I guess even that prompted you to go there?

Dr. Brighten: Oh you know I actually just saw this doctor the other day putting on social media and they were like people who talk about hormone imbalances they talk about the most vague symptoms like fatigue everyone has fatigue I don’t worry if my patients say they’re fatigued and I was like you know worry if your patient has fatigue that could be iron deficiency anemia. It’s very common. I don’t know if you know this. Like it could be hypothyroidism. It could be that they don’t understand sleep hygiene and how to get proper sleep. It could be depression. Like it could be so many things and you’re just like, yeah, don’t worry about if it’s fatigue because everybody has it. And I’m like, I don’t. If my toddler sleeps, I’m fine. And if I have fatigue, I’m like, you’re doing something wrong. Like something’s wrong with your health here or you’re doing something wrong lifestyle wise. So that was part of it in the book is taking the common symptoms that you experience as an individual that you would bring to your doctor, that you have concerns about things like brain fog, weight gain, anxiety, like things where you don’t want to just be past a prescription, always an option, great to have options, or being told like just eat less and exercise ’cause that also doesn’t work and I’m so sick of that too. But all of these things that can show up as hormone imbalances and helping you understand what that could be for you and what you can do with nutrition, lifestyle and supplementation to help reverse that, turn it around, feel better. And then I also give you suggestions of when to see your doctor. Like this is, you know, if you’ve also got this and this going on, you need to see your provider. And so I normalize what’s normal. I help you understand what your normal is. And then I help you understand what’s not normal, because there are things that are not normal and we should definitely go to the doctor for those things. But in the book, I also talk about some of the cycle myths. So myths like everybody’s cycle is 28 days. I mean, how many doctors do you see say that where they’re like, yeah, well, your cycle should be 28 days. I’m like, that’s a great framework for teaching, love it for teaching, ’cause then we like split it and we say 14 days and then people are like, oh, well, everybody ovulates on day 14 always. And I’m like, that’s fun. No, let’s talk about that more. And it’s a lot of the stuff that I think that you talk about as well, like you can’t get pregnant every day of the month going on to that cycle education. And then that’s like really the center of the book is all of the hormone stuff. And the front of the book is all of the sex stuff that people are too uncomfortable to bring to their provider, that when I open up and say this is anonymous, people flood in with questions and they’re like, I’ve got so much I want to ask you about that. And the top thing is, is my libido normal. I think that is a huge one that comes up. And so I have a whole chapter on libido and I talk about what we know from a psychological perspective, what can be going on. And I talk about what we know from a hormonal perspective. And I think there are, you know, there’s a lot of confusion around all of this where people think, if you don’t want sex, your hormones are broken. Or people are like, if you don’t want sex, forget the hormones, it’s something psychological. And the answer is, it’s usually put it all in a pot. And it’s all of these things. And I help people dissect that out and understand what is really going on for them. What’s true for them, what their normal is, and then how to get their libido or their relationship to sex at a place that they’d prefer it to be.

Lisa: I mean, I’d love to hang out the libido topic for a little bit. I feel like with libido, because I’m always on top of this pill stuff and it relates to like, right? Like one of the things that really irritates me about the libido conversation is that that aspect of it, the pill’s role. Obviously, that’s not the only reason why a person could have a libido. So we’re not going there. But it could contribute for a lot of people because a lot of women have been on the pill. A lot of women have been on the pill from when they were young before they potentially were even sexually active. And so that’s, I feel, it’s so interesting how it’s this huge hole in the conversation. And the other thing I just want to say on that is that it seems to be often just thought to be like all emotional, like kind of like what you were saying, like it’s just all emotional. It’s not normal to just not have a libido at all. And it doesn’t have like, yeah, anyway. So those are the kind of the two big pieces for me that, because what happens is these women, it’s like another opportunity for gaslighting. Like it’s either like, well, it’s in your head and you just have to like do therapy when really you’re in pain sometimes.

Dr. Brighten: Like, you know, the whole concept around like women are not interested in sex, they’re not sexual creatures, they don’t have a libido. I mean, this is a narrative that has really served the male counterpart. And this is not an all men kind of conversation. Like I’m, I cohabitate with a man, I married a man, I birthed two men, like I’m raising them. I do not believe this is a, you know, all men situation. But even when we look through psychology, when we look through medicine, when it was all dominated by men, we very much had these narratives and those narratives. And I talk about all of this in the book and they still continue until today. And what’s interesting, just, you know, this kind of clicked for me as you were saying this with like the whole libido and the gaslighting and birth control is that that narrative has also lent itself to dismissing the side effect of birth control. Like women are not really sexual creatures as it is. Really? So why did we need birth control? Why did we need the pill? I don’t understand. Like if I didn’t want to have sex without the risk of getting pregnant, like why did we invent all of these things? Like that is and you will hear self-proclaimed feminists say these things. And I’m like, so what you’re saying is that birth control was invented so that men could have sex with women who didn’t want to have babies, and that this wasn’t for them. This wasn’t in fact for them. So it is a well-known side effect. SSRIs are another one, and yet both have a time and a place, right? It’s not something that I would ever advocate for just jumping off an SSRI because you’re like, “Well, I can’t have an orgasm.” That is one of the known side effects, and that really, really sucks. I do talk about saffron being something that’s been shown in the research to overcome that. So that’s one little tidbit from the book that you can tuck away for later. But it’s the same thing with birth control. And birth control can be kind of a double-edged sword because there is the fear of unintended pregnancy that will completely put you out of the mood or stop you from getting it. You’re like already aroused. Now you’re like, I can’t be aroused anymore ’cause I just thought, what if I’m ovulating? What if something happens? And so then you go on something that you feel is reliable, which, you know, most prescribers are going to give you the pill. And then at that point, you’re like, well, I’m not interested in sex anymore. And then your provider’s like, well, that sounds like a you issue, or that’s just how it is, or have some wine. And I’m not saying all providers do this. I mean, obviously, I don’t do this, but it does happen enough that we hear about it, right? And when you see something show up on social media over and over again, and then you see doctors take to like name-calling or trying to put them in like a different camp to be like us versus them. If they even question birth control, like they’re the bad guys. And just by being over here, you’re obviously smarter than these dumb women who are talking about the low libido stuff. Like when you see that, you’re like, there’s definitely something here and it is really putting salt in a wound right now that like people don’t want us talking about it so I and I just laugh I’m like my name’s Brighton I just feel like when and stuff’s like that I’m like let’s shine the light on it let’s make it a little brighter like so we can all see it because if you can see it and you can name it and you can talk about it we can move past it and we can heal from it and we can we can forge a better way and when it comes to the libido conversation. There’s been research for a very long time documenting that the pill specifically raises sex hormone binding globulin and that’s going to gobble up your testosterone and it’s also going to suppress testosterone production from the ovaries. And so as I talk about, so I have a whole book called Beyond the Pill. So if you’re on the pill or you want to come off of it, that’s the book for you. If you’re wanting this big libido conversation over on, I talk about in Is This Normal about the role of testosterone. Everybody’s like testosterone, libido, yes. Okay, that’s part of it. But in women, estrogen is really important as well. In fact, it’s when estrogen is up that we find that we, so this is the phase of the cycle for everybody who does chart. It is the sexual phase of your cycle. This is what I love. The research I came across that was like the sexual phase. As soon as I read the abstract and it said the sexual phase, I was like, oh, we’re talking about ovulation. But I love that if you don’t want a baby or you’re past your baby making years, or you like maybe you’ve been infertile and you’ve had loss, we don’t have to center the conversation of ovulation. I still think everybody should understand this part of their cycle. But if you just want to talk about sex, we can call it the sexual phase because research has well recognized that is estrogen ramps up and that LH spikes, I mean, basically you get like five, six days and it’s based on how quickly do those ovaries respond because once they respond and they ovulate to that LH surge, progesterone comes in and it’s a wah wah trumpet sound, but it’s not estrogen rising, right? Testosterone’s up at that time as well, but estrogen rising affects the brain and that can get us fantasizing about sex a lot more. We’re much more in tune to all of the sexual stimuli in our environment. So I love that we talk about the testosterone component so much, but I think we really miss the part of the conversation about what is happening with estrogen, with insulin, with cortisol, with thyroid. All of these hormones are really important when it comes to our sexual health and they can all be affected by birth control and other medications which I list and talk about in the book as well.

Lisa: I mean, I feel like we’ve scratched the surface because there’s so much amazing, I mean, there’s so many amazing topics that you’ve covered in the book. So I think this is like a really nice teaser for the listeners to go and grab your book. So as we start wrapping up today, I mean, tell us for anyone who doesn’t know, tell us all the places where we can find you, where we can find your book, where you’re hanging out these days on the socials, all the things.

Dr. Brighten: My main hub is drbrighten.com, d-r-b-r-i-g-h-t-e-n.com. And then you can find me on Instagram.