Hormonal Birth Control Side Effects and Informed Consent (Episode 430)

Full Transcript: Episode 430

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

Today I’m sharing a brand new episode with Mike Gaskins. If you’re not familiar with Mike Gaskins, he is the author of In the Name of the Pill and he was a guest on the show back in episode 316 where we really went into his book and essentially in his book he talks about the common side effects that we often talk about with contraceptives but he also talks about some side effects that aren’t so common knowledge, things that you wouldn’t necessarily know, such as the connection between contraceptives and autoimmune conditions, things like lupus, that you wouldn’t necessarily hear because I think the most common things we hear are depression, low libido, sexual side effects, nutrient deficiencies, and there’s a whole host of others. But Mike has really done his research and shared with us some of the more far-reaching side effects that we don’t often hear about. So in today’s episode, we dive into some of those similar side effects and we talk about some of the issues similar issues to what we’ve talked about before on the podcast related to contraception. And I think one of the overarching themes is, as always, informed consent is key. When you’re taking a medication that is known to have certain side effects, I believe it’s really important for women to know what those side effects are so that you can know what the symptoms are if you need to be concerned. It’s kind of like giving a heads up. There are certain things that we get into, for example, like the issue with blood clots and stroke. And if you know what some of those potential side effects are or some of those warning signs in case something’s going awry. So for example having migraines and in particular migraines with aura and knowing that if you’re on contraceptives and you have migraines with aura you’re at a greater risk of having a stroke and things like that where when most of the women I’ve spoken to over the years get their prescription from their doctors they are not being provided with an explanation or discussion around some of these side effects and even just a brief 30 second conversation that although it’s very rare, there are some serious side effects associated with contraceptives. If you ever experience these symptoms, then it would be really important for you to connect with me, make an appointment so we can talk about what’s happening and potentially look to moving you to a different medication. You know, it would just take a second in my opinion. So before I give it all away, I’ll just go ahead and take a moment to introduce Mike. So Mike is a women’s health advocate and author who spent much of the past decade exploring the risks of birth control. He recently completed work on an expanded audio version of his shocking book in the name of the pill. The new version continues his investigation into the dubious nature of both the history and science of birth control. It features new content on modern devices and some of the little discussed dangers scientists have linked to the various forms of birth control. So without further ado, let’s go ahead and jump into today’s episode.

So I’m excited to be here once again with Mike Gaskins. Welcome to the show, Mike.

Mike Gaskins: Thanks, Lisa. It’s great to be on again.

Lisa: Well, thank you for joining me again. I know in our first episode together, which I will link in the show notes page, we dove really deep into your book in the name of the pill. And so today we’re going to continue our discussion essentially on hormonal contraceptives. I want to congratulate you on the release of your new audiobook. So maybe we can start just by sharing just a little bit about the audiobook, what prompted you to do that now. And for the listeners that haven’t heard our first episode together, maybe just share kind of like a brief introduction of how did you, a man, a father, end up writing this book about the pill?

Mike: Sure. So yeah, when we spoke two years ago, I was thinking I would probably do a second book and I had started on it and COVID kind of threw everything out of whack on that. But yeah, to take you back to the beginning, I had essentially been at a medical conference with a man who’s known as the father of autoimmune disease, was the keynote speaker, Dr. Noel Rose. And in his speech where he was kind of giving broad brush strokes to all these doctors of different specialties about autoimmune disease and what triggered it, he started talking about how T cells are the soldier of the immune system. And when our natural estrogen attaches to it, the soldier’s armed and has its marching orders. But when chemicals get in our body and mimic natural estrogen, they attach to those receptor cells. And now the soldier’s armed, but it doesn’t know what to attack because it’s not our natural estrogen and then it starts attacking healthy tissue and that precipitates in all these different diseases. And so as he was talking, I thought, well, he has to be talking about birth control. I didn’t know about endocrine disruptors at the time and so I just — it was the only thing I could think of that mimicked natural estrogen. I mean, it’s designed to mimic natural estrogen. And so as he was talking I googled rise of autoimmune disease and I saw that many of the diseases have skyrocketed since the early 70s. And I thought, wow, he’s talking like this is a pretty well known thing, but I’ve never heard of it before. And so I went up to him after the show and was talking to him and I said, so exactly what role does birth control play in all this? And he said, oh, none at all. And I was baffled. And the conversation didn’t really advance and I trusted him because he’s the world renowned expert, you know. But still it was like this makes no sense. It’s completely counterintuitive to everything he was just saying. So I got back to my hotel room that night and I was still thinking about it and I just picked lupus and I googled lupus plus oral contraceptives and I found this study that showed that women who take birth control are 50% more likely to be diagnosed with lupus and it was a relatively new study. So I thought maybe Dr. Rose hasn’t heard about this. I’ll find him tomorrow at the conference and tell him about it. But I get further down the article, there’s a quote from him from Dr. Rose saying this study doesn’t mean women should stop taking birth control. And so I felt gaslit. I was like, why would he lie to me? What was going on? And so I think in the book I say, you know, maybe he thought I was a simpleton and it was easier just to say no. But that certainly triggered me to keep digging deeper and deeper and look at different diseases and all these things that have been linked to it and ultimately led to the book, which came out a couple of years ago. And when the book came out, I was overwhelmed with feedback from women asking me to write about the IUD and Depo and the implant and all of these other things that I hadn’t written about specifically. And so that’s kind of what prompted me to start writing more. And then this has always been kind of a passion project for me. So when COVID hit and really affected my revenue because I do live events which dried up, I felt like I couldn’t afford to spend time on anything that wasn’t generating money and kind of went away from my writing. But I still felt passionate about it and felt like I need to do something. It’s probably not going to lead to another full book. So that’s kind of how I decided — I’ll just add some of this content I’ve discovered and I’ll just release it as an expanded audiobook. So that’s kind of how the audiobook came about.

Lisa: I remember that story and it’s so interesting. I think that a person’s perspective and experience and even their field that they practice in makes a difference in terms of how they can interpret information and categorize it. That’s just my opinion because it does seem like if you have a different perspective, you can look at certain types of information and look at it and interpret it a bit differently. So like the fact that you said that there was this 50% increase in lupus, I think that people could look at that in a different way and potentially downplay it. But it was interesting that you mentioned you felt gaslit because it was the actual individual that had led that conference that was writing in the paper that you had. And I feel like, you know, just for all the women who are listening, women feel gaslit by medical professionals a lot. So it’s not like a rare kind of experience. So I know for you, one of the important things for you is informed consent, as it is for me. And all of the information that I provide essentially goes back to that, because so many women are taking these medications, they don’t know the full side effect profile. They don’t know the full kind of risk of variety of symptoms that could be related. They’re often not informed by their practitioners. And furthermore, they often don’t know how this birth control is even operating, like how it prevents pregnancy. They don’t know any of those basic informations. So maybe share a little bit about your perspective on why women are not necessarily being advised by their healthcare practitioners the full side effect profile of these drugs.

Mike: Well, my thought on that is I think still evolving. I have a tendency, I think, when I speak, a lot of times I paint doctors as being kind of the villains of the story and I don’t mean to do that. I mean, I think I want to believe most doctors are well-intentioned and maybe, you know, because Big Pharma controls so much of the curriculum in the universities and in the continuing medical education, you know, I feel like a lot of them, a lot of the doctors, the practitioners, aren’t even aware. I’ll give you a for instance. Right now I’m finishing up an article on what birth control does to the eyes. And it came out of — I was in a small meeting of glaucoma specialists, and they were talking about certain biomarkers in the diagnosis and treatment of the disease. And I don’t even remember what the biomarker was now, it could have been C-reactive protein, or I don’t even remember, but I remember it sparked in my mind, oh, I should look at glaucoma. I never even thought about it. And so when I got out of the meeting, started doing research, and I found, sure enough, in 2013 there was a pretty big study that found that women who had taken birth control for longer than three years more than doubled the risk of being diagnosed with glaucoma later in life, and started digging further. And you know, it’s just one of those things, and unless you’re listening for it and specifically thinking about it, you might miss the cue. You know, you might miss the clues. But there have been several studies over the last decade that showed that even women who are currently taking birth control in their reproductive years are twice as likely to be diagnosed with glaucoma. It’s still rare. You know, young people don’t typically get the disease. But even at that lower threshold, they’re still doubling their risk. And not only that, but it’s been tied to one of the biggest causes of retinopathy and loss of vision, which is called, I think, retinal venous occlusion, RVO. It’s one of the biggest threats to eyesight and it’s more predominant in women, and they’ve started connecting it more and more to birth control users. So in writing the article, after I wrote the first draft, I sent it to a friend of mine who’s an eye surgeon and she’s been a big supporter and very encouraging in my writing. And so I know she believes in the stuff I’m writing about. And so when I sent her the article, she was blown away. She was like, I had no idea. So here’s somebody who I know cares about women. And when she takes medical history, even if it’s not related to their eyes and she hears something, she will tell them, why don’t you try to stop taking your birth control for a couple of months and see if that gets better. And she’s had patients call her and thank her saying how much better they’re doing because they stopped their birth control. So here’s somebody who I know earnestly wants to help women and cares about it. And even within her field, she had no idea some of these connections to birth control and how they’re affecting the eye. So like I said, I don’t want to paint doctors as the villains, although I think there are some of them that probably aren’t as straightforward as they should be and probably know more than they want to lead on about the damage it’s doing. It’s just, it’s like everything else. There are probably bad seeds, but all in all, I want to believe doctors are good.

Lisa: I feel like that’s a fair assessment. And I know that when I was — I think it was in maybe the last chapter of my book, there’s research that tells us how long it typically takes before science — so the research, the latest research becomes part of standard medical practice, and it was like an average of 20 years. So I feel like there’s certainly a few things going on here. One of the things I think that makes the pill and other hormonal contraceptives a bit unique in a good way is that they have been out since 1960. And so being that we’re recording this in 2022, that’s 62 years since it’s been out. So I think that most people would be floored and flabbergasted at the amount, the sheer volume of research on contraceptives. And so I think that’s kind of the first thing to put out there. So as you mentioned, in terms of how doctors are trained in medical school, I think that it’s common knowledge that pharmacists know a lot more about the drugs, drug interactions, drug side effects than doctors because pharmacists — that’s their job. That’s their whole purpose, their whole purpose and job and role is to know all the things about all the drugs and support people to have a good understanding of what’s happening. So ironically, if you’re prescribed a drug by your physician, if you were to go to your pharmacist, your pharmacist would likely be able to provide you a lot more specific information about the effects of that drug. So I think that’s kind of the first thing to keep in mind along with what you’re saying, which is that doctors don’t — it’s not even like it’s malicious. I think what I’ve learned from interviewing doctors is that the focus of their education around birth control is really about the life-threatening, severe, kind of more common side effects. And the other side effects are kind of downplayed. You know, they’re rare, they’re not common. But unfortunately, that even includes some of the most common effects with like depression and anxiety. Like I feel like even those very, very common but not life-threatening side effects are — well, arguably not life-threatening. I mean, depression is life-threatening, but you know what I’m saying. So, so yeah. That’s something interesting. But on the other hand, like, we have all this research there. So you just did a search and you found this link to glaucoma. So yeah, I feel like it’s kind of a mess. But now I’m curious as to what some of the research you pulled about some of the other contraceptives so we could kind of — it might take a while, but we could kind of go through one by one. If you like, we can start with Depo. So that’s the shot. There’s more than one brand of shot, so you could just put the shot in a category. And so personally I am the least fond of the shot because what I found from my perspective charting and supporting women to chart their cycles is that women who use Depo have a much longer time to a return of normal cycling. It’s just known, it’s the worst offender, basically, in terms of return of cycling, and then has really severe side effect profile. So share with us what you uncovered about Depo.

Mike: Right. Yeah. So Depo — I’ll agree with you. I think Depo is my least favorite form of birth control. And actually, I’m part of a petition right now to try to have it removed from the market. I’ve had a few people kind of get sideways with me because they think it’s an indication that I want to take birth control away from women. It’s not the case. I mean, Depo is clearly so much more dangerous than all of these other options that are available. And women, for the most part, have no idea what they’re walking into. I mean, I know it’s purely anecdotal, but just the women alone who have contacted me to say it ruined their life would be enough for me to say, I never want this anywhere near anyone in my family. And I know it doesn’t happen to every woman. But the only good thing — and I mentioned this in the book, if there is a good thing — the only good thing about Depo is that most women are aware of the weight gain issue of it, and they stay far away from it just from that. And I forget the exact quantities, but I believe it’s something like 25% of women gain at least 5% of their body weight even from a single shot. So the weight gain is a huge issue for a lot of women. But then, I don’t even know where to begin with it. One of the things that we bring up in the petition is it makes women more susceptible to HIV transmission from their partner. And that’s a thing a lot of people don’t recognize. Basically, I’m not capable — it’s above my pay grade to get into the science of it. But essentially, the environment of the uterus changes, the ability of the immune system to fight certain things is altered by the drugs in Depo, and basically makes them less able to resist or fight off the HIV virus.

Lisa: I think from a practical standpoint, one of the concerns from my perspective right off the bat, even before I kind of knew about some of the worst side effects, is the fact that it is an injection. So if you get the shot for the first time, you don’t know how you’re going to react. Some women are obviously okay, and others are not. And so if you read just the package inserts — so I think it’s really important to put out there that there’s nothing we’re saying that is not literally on the package insert, like the drug insert. So type in Depo or whatever brand of shot that you are curious about and prescribing information in your favorite browser and you will find the prescribing information. You should look at it. So some women will have irregular bleeding, meaning if you have a shot and you respond in that way, you could just bleed for three months. And that’s — I mean, just from a practical standpoint, no one wants that. That’s one of the biggest complaints with all contraceptives, that the irregular bleeding and that kind of thing. And so I think one of the big things from a practical standpoint before we even get into all the side effects is that once you get it, you’re committed and you can’t do anything about it. Like if you were to get an IUD and it was really, really bad within the first two weeks, you could theoretically get it removed and then the side effects would start to wane. But with the shot, you literally have to wait it out.

Mike: Right. You can’t just stop taking it.

Lisa: No, because it’s in there for like three months. And you had mentioned, I think before we started recording, the black box warning. So even that is helpful to know that the Depo shot is associated with bone loss — severe. And you mentioned that the black box warning literally on the label says that you shouldn’t use it for more than two years, but there are plenty of women that are put on it for longer than that. So it literally says on the prescribing information that it shouldn’t be used for more than two years because of the severe bone loss that could result.

Mike: Right. And it’s not necessarily reversible. It may be reversible to a certain extent. It’s not fully reversible necessarily. And yeah, it’s in big bold letters with a thick rectangle around it to draw your attention to it. And yeah, I’ve had that conversation with some women who will say, well, I’ve been taking Depo for 12 years. It’s like, oh my gosh, you know, you’re not supposed to — has your doctor mentioned this? And it blows me away the number of women — a lot of women have brought it up to their doctor when they hear about it, you know, they say, oh, I heard you’re not supposed to take this longer than two years. And some doctors will say, well, it’s okay, just take a calcium supplement and you’ll be okay. And I don’t know, my response is I try not to get indignant, but it’s like, well, it doesn’t say that in the FDA warning. There’s nothing about just take a calcium supplement and you’ll be okay. There’s nothing in the FDA warning that says take it for two years and take a year off and then come back and take it two more years. That’s not the way this works. Those responses from doctors are the ones that make me less likely to think that it’s a well-intentioned doctor, because that’s just — I don’t know — it’s borderline criminal to ignore a black box warning or to come up with your own set of rules for how you can mitigate a black box warning by just taking a calcium supplement. Seems totally wrong to me.

Lisa: Well, and I mean, if there’s — I’m not for this idea just to put that out there — but if there is research to suggest, so for example, there is research showing this link between the rapid depletion of B vitamins and depression in birth control pills. So there are studies that say that have tested giving a higher dose of vitamin B6 for women who suffer depression on contraceptives and shows that in many cases it can reduce the symptoms. So, you know, there are situations where it would make sense to make a similar type of recommendation, but I would say, well, where’s the evidence to show that that could offset it? Is this something that has been studied? So yeah, and I feel like it’s interesting that you mentioned that you’re part of a petition to try to get it taken away and how that can, you know, people want to paint it like you’re anti-birth control. And I think it’s possible to be really critical of a certain type of hormonal contraceptive. So in general I’m not the biggest fan of hormonal contraceptives. I think that’s pretty obvious. But at the same time, I took the pill when I was a teenager and I do recognize that for many women, it is — some version of hormonal contraceptives are the best option for a period of time in their lives. So there’s nothing about my — I don’t have a desire to take away contraceptives as an option for people. But I’m the least fan of the shots because of the side effects. And I feel like there are some women who do take it for a period of time and report having lasting side effects from it. And so I feel like if anything, if there was one to get rid of, I would be okay with that one. And I feel like all of the medication, we should really be sharing the side effect profile. So women should know if they’re taking it that it does have one of the harshest side effect profiles. And it certainly has one of the strongest effects on the return of fertility, where it’s literally always — if you look at studies that compare different methods, literally always the last. Whereas with the pill, it can take an average of nine to 12 cycles for the cycles to return completely normally — not to return, but to regulate and to be kind of normal again. But with Depo, we’re talking 18 months to two years minimum for a lot of women coming off of it for their cycles to return normally.

Mike: Yeah, and I’m — I have no idea what the incidence is, what kind of — how often it happens — but I’ve met a number of women who were injured after one shot. I mean, they only got one shot, and it’s been years, and they still have not recovered from it. You know, I’ve never heard of that happening with a combo pill or really any other form that I can think of. It’s just, yeah, it’s something you can’t just undo, unfortunately.

Lisa: Yeah. So if you have a bad reaction, you can’t necessarily undo it. So now that we’ve thrown Depo under the bus, let’s move on. So one of the things actually that you were mentioning too is the IUD. So maybe if you wanted to talk a little bit about — because you know the two main categories of IUD are the hormonal versus the non-hormonal. So maybe share a little bit about what you dug up in your research about the IUDs.

Mike: Yeah, so this was another one where, you know, just when you think you’ve kind of uncovered everything and nothing’s going to surprise you anymore. You know, when the book came out, I guess I had probably been researching pretty in-depth birth control for six years, seven years, something like that. And felt like I had a pretty good grasp of all the risks and dangers. But when the book came out, I was contacted by many, many women asking me if I would start writing about the IUD or if I would write some articles about the IUD. And it really caught me off guard. And in thinking about it, I think I probably made the same mistake a lot of women make in their birth control journeys when they have trouble with — they try a few different pills and they have issues or whatever. And, you know, I think there’s this natural assumption that the copper IUD is probably safer because it doesn’t carry any hormones with it. It doesn’t have a drug attached to it. And I had kind of made that assumption. I was shocked to learn that a lot of women have had many issues with it, that a lot of the side effects are similar, you know, the depression and anxiety and things like that that I had never even considered. And then kind of stacked on top of that, you have the idea that it’s this medical device that’s placed in your body. And I had started a birth control group several years ago. And one of the women shared in it recently that she had had her IUD removed and the doctor, when he pulled it out, said, oh — in one piece. And she was like — that reaction told her everything she knew about it. Like, it was rare for the thing to come out in one piece. I guess one of the biggest things I tell women who are who ask me about the IUD and they’re thinking about getting it — I think one of the most important conversations that you need to have with your doctor before you get it is if I have any issues, how willing are you to remove it? And what’s the cost going to be? Because that seems to be the two of the biggest shock factors for women after they get it and they don’t like it and they want to get it out. The doctor refuses to remove it oftentimes. Oftentimes they’ll schedule you for six or eight months down the road to remove it or the cost will be inordinately high. So I say get those things out front. If I don’t like this thing, what’s it going to be like to get it removed? Because I think those are kind of the most unexpected hurdles women face after they get an IUD.

Lisa: Yeah, it’s super paternalistic to have a doctor decide that you can’t get it out, you know. So that’s certainly a big problem. I think that — and the other thing is when you start looking at the side effect profile, so the hormonal IUD — in many ways, it takes care of some of the issues that women have with the copper IUD, like some of the things that they would complain to their doctor about specifically. So with the copper IUD, it’s well known that the most common side effects are that you may bleed heavier and or you may have stronger cramps. This is pretty well known. It’s pretty consistent, pretty common. So most women who use it do report an increase in the level of their bleeding and then potentially the pain. And so I think it’s important to point out that for women who are trying to live their best lives, trying to prevent pregnancy, the copper IUD is an important option obviously because it is non-hormonal. So it’s not actively putting hormones in your body, although it can disrupt the hormonal balance to some degree, but it’s still like a great option. So for women who it works for, I think it’s great. Because there are a percentage of women who use it, they don’t really have any problems with it. They love it. And women who love it, they really love it. And I think the challenge obviously is that there is a percentage of women who just do not have a good time with it — whether it’s the heavy bleeding, the pain, or some of the other side effects that you wouldn’t expect from non-hormonal, having it affect your moods. I just released an interview with a client who shared her experience with PMDD — the bigger, badder version of PMS. And in her case, the copper IUD significantly exacerbated her symptoms because it really significantly exacerbated the imbalance of estrogen and progesterone. So it really lowered her progesterone. And so she had the severe PMDD while on it that was kind of worsened by it. And then when she came off of it, it improved. And you wouldn’t think that the copper IUD would have anything to do with emotions or hormones. But because of the mode of action of localized inflammation of the uterine lining and then also releasing copper ions, people react differently. And like you said, having a foreign item in your body. So the only other thing I always say when I talk about it — so my audience is kind of waiting for me to say it — is the painful insertion. That’s something that’s a really big deal. I didn’t realize it was as bad as it was until I started interviewing women. And now it’s a standard. Like if I’m interviewing someone, I’ll just ask them if they mentioned they use the IUD, I’ll ask them about that. Because yeah, it’s a problem. Many women find it very, very painful. And the doctors either don’t acknowledge that it’s painful, and certainly are not on — some of them offer pain relief, but it’s quite rare. I guess it’s not the norm for the doctors to offer women pain relief.

Mike: Yeah. I guess for me, the just the copper IUD was where I focus most, probably just because the way it hit me — whereas that was the most shocking kind of revelation of, oh wow, you know, I was way off base in assuming that it was going to be a safer better option. And not to say it’s not — like you said, there are some women where it probably is the better thing. But it certainly wasn’t as innocent as I had pictured.

Lisa: Well, you kind of expect it to be the panacea. Like, this is like we’ve found it. This is the non-hormonal option. It’s got one of the highest effectiveness profiles and it’s even used — it can be used as an emergency contraceptive. So they’re saying like this is really effective. But I mean, I think women should be aware of the side effects. So one of the side effects potentially of a copper IUD is pregnancy, because there’s no method that’s 100% effective. And if you do become pregnant with the copper IUD or an IUD in, it’s more likely to be ectopic. And so I interviewed a woman who she had the copper IUD and she had it for a long time — I don’t remember how long, three to five years. And then she had this intense pain in her abdomen. The thing is that she had taken care of the birth control — that had been checked off. So it doesn’t occur to her that it could even — like, there’s no ectopic pregnancy possibility even in her mind. So she’s just confused as to why she’s in so much pain. And when the doctor tells her she’s pregnant, like the pregnancy test came positive, she still can’t process that. And so yeah — I think when it comes back to our conversation around contraceptives, I think it’s important. It would be like — wouldn’t it be basic to have a handout? Even like, if you’re a doctor, you’re busy, you don’t necessarily have time to like go through every side effect. Like you could use the prescribing information in the package. Like that could also work. But couldn’t you just have like a handout for all of these different hormonal contraceptives or the copper IUD so that you could list — and then the serious effects that could kill you at the top — just say these are rare, because they are. It’s not like so common that women have ectopic pregnancies when they have the copper IUD, but it can happen. But you say if you ever have severe abdominal pain, go to the hospital, because it could be an ectopic pregnancy. Or like with the hormonal birth control options, if you have a severe headache, loss of vision, pain, etc., go to the hospital. Although rare — I’ll get off my soapbox now — but I feel like it’s not that complicated. They could do this and make it more accessible to women so that when they take these hormonal birth control or other type of birth control options, that they at least have a list of what could happen so that if something does occur, they have a heads up kind of thing.

Mike: Yeah, actually, that’s great information for me because one of the things, you know, obviously I’ve done all this research and my mind goes to I want to raise awareness. I want women to go into this with their eyes wide open. And so if a woman shares something about being on a combo pill and suffering migraines, I feel like it’s my place to tell her — again, within like the Facebook group or whatever, not in, I’m not going to interrupt somebody’s conversation — but I feel like it’s my place to kind of warn her. Hey, if you probably shouldn’t be on estrogen if you’re having migraines. They just shouldn’t go together. You shouldn’t be looking for a secondary medicine to help you with a migraine. You should just be avoiding synthetic estrogens altogether. But with that tendency, I also try not to jump in enough where it looks like I’m just fear-mongering, because that’s not my intention either. I want women to know about the dangers. I want them to know about the risk. But I’m not trying to scare them into making a decision that I want them to make.

Lisa: Well, I think that for me personally — because I do this series on my podcast, the Pill Reality Series — and because I’ve interviewed all these women, and I also have clients on my podcast, and many of them share their experiences with contraceptives and things like that. So I’ve spoken to a number of women who have experienced strokes, pulmonary embolisms, and ectopic pregnancies that resulted in surgery and the removal of their tubes. And in many of those scenarios, these are women who are experiencing severe pain. So the one woman with the pulmonary embolism, she experienced severe pain like in her chest. She even went to the emerge. And what I always say is — if you put your clothes on and your shoes and get in your car and go to the emerge, no one does that. Like no one wakes up and just goes to the emerge. So I feel like women were gaslit so much that even that is understated. No, no, no — you left your house, put on your clothes, and went to the emerge. People don’t just do that. You were really scared. You knew something was wrong. That’s why you went to the emerge. And this woman went to the emerge and the doctor — and she had Googled it. So she was like, am I having a pulmonary embolism? Oh, did you Dr. Google? Did it? You’re too young. And so they sent her home. And then she collapsed in her house. And fortunately her boyfriend was there. They called the ambulance, and then obviously she survived. So they found out that it was a pulmonary embolism. Gave her blood thinners and now she has to potentially be on medication for the rest of her life. So I feel like in terms of your question, like this isn’t about fear-mongering, although it can feel that way. My hope — like if I ran the world, what I would want is a very basic kind of — so I live in Canada. I don’t know how it is everywhere in the world. I don’t smoke, but if I did, I would go to the convenience store and on the pack of cigarettes there’s like rotten teeth, like the gum disease. There’s like a picture of black lungs. There’s like a picture. Like there’s all this stuff on it. So when I go — if I don’t smoke, but if I did smoke and I went and I bought the thing, I’m seeing the lungs. Like, I know. Your eyes are wide open. And the thing about it is, like, people still smoke. It’s a choice. We all have the choice. So if I wanted to smoke I could smoke and I’m not trying to diss smokers. My point is to say that a person who smokes is making a conscious decision and they know the risks. It’s not like they don’t know. But when you take your medication, I feel like we should have that same opportunity. Certainly the argument is that it’s going to dissuade people. But I would argue that there’s literally black lungs on the cigarette carton and it doesn’t. So I’m saying like, I think we need to treat women like adults. And what that means is you just tell them. And it’s not like they don’t really know. I think most women do know. They don’t think it’s ever going to happen to them. But we know that it could cause blood clots and strokes. Like we know this. So I think that just my basic example of — if we had just a handout that listed some of the life-threatening stuff and saying like it’s rare, it’s not something that happens to most people, but I just want you to know, like if you ever experience like a shortness of breath or this or that or whatever, like you need to understand that that could be serious and I want you to call me or come in to see me. And if it’s really severe, go to the emerge. Literally 30 seconds of your life, warn the person and go about your day. How is this a problem?

Mike: Yeah, it’s — it shouldn’t be. And I got goosebumps as you were talking about the one woman. I mean, I’ve met two more families this month who lost daughters to birth control. And at some point, you know, you just — you get tired of hearing those stories. I mean, I want to hear the stories, but you just get tired of it happening. You want it to end somehow. You want to do whatever you can to not have it happen again. But one of the women was — she was a 25-year-old mother of two, started having shortness of breath, started having the symptoms, recognized it, went to the emergency room. They didn’t act like they thought it was a big deal. She sat in the waiting room for several hours and decided they don’t think it’s a big deal, it must not be a big deal, and went back home without being seen and collapsed, went into cardiac arrest, and died at 25.

Lisa: Yeah, I hear stories like that and it’s like — yeah, it’s not fear-mongering. It’s just women need to know the facts. And unfortunately, even when they do recognize what’s happening to them, oftentimes the medical system lets them down still.

Mike: Well, I would say it’s hard. It’s hard. All I’m saying is like, however potentially difficult or uncomfortable — if you imagine going back to this person and saying, hey, look, I saw the study — you know, like trying to correct the professional. So add times that to a hundred or a thousand, and that’s how it feels as a woman when you’re in a doctor’s office and you have a problem that the doctor tells you that it’s in your head. It’s common. It’s fine. It’s normal. Like, that’s what it’s like. And so it’s really hard to actually fight because I think women were socialized to be nice. We’re socialized. We don’t want conflict. I mean, I know I’m using stereotypes here. But I’m not comfortable. I don’t want to pick a fight with my doctor, right? You know, like if your doctor tells you like, oh, did you Dr. Google this? Do you want to then continue to pursue that because that could lead to a negative interaction? So all I’m saying is it’s really hard. And I think what I hope to do, and I’m sure what you hope to do with your work, is to empower women with the knowledge. It’s still hard even if you have the knowledge. But at least if you have the knowledge when you’re gaslighted in that way — and you’re sharing a story of this woman who they didn’t take it seriously and she ended up going home — and I can share with you stories. I shared the story of the woman who literally was sent home. And there are several experiences like that that I’ve heard, where you literally are having a health problem, but because of how you look, you’re too young, you’re too skinny, whatever, you’re basically dismissed. And so it’s hard. And I think the hardest thing is that in order to get the care that you deserve, for all the women listening, sometimes you have to be willing to kind of fight through that nonsense and be very persistent. And the only way to build up the courage to do that is to be armed with knowledge so that at least you don’t doubt yourself. Like, no, no, I’m having shortness of breath. I’ve read that this — like, you need to check me. But it’s not fair to put that responsibility on these women that are just trying to seek support.

Mike: No, it’s not. And okay, this is something I need to look into because every time I have this type of discussion, I always think how expensive is the D-dimer test and how effective is it? I mean, is that something that could a woman just say — could she stand up and say, just give me the D-dimer test and see — test me for blood clots? And the D-dimer — can you explain that a little?

Lisa: So that’s — if you have blood clots or if you’re — you’re right. The D-dimer apparently is the test at the emergency room they use to determine whether you’re experiencing clots, whether, you know, pulmonary embolism or whatever. And several of the parents — and this is why I say I need to look into it, maybe I shouldn’t have even brought it up here — but several of the parents who I’ve gotten to know whose daughters died from birth control have talked about the D-dimer. And when they talk to women who may be experiencing symptoms, they throw it out as, you know, go and have a D-dimer done and see. So it seems like a ubiquitous thing among the people who have lived through this experience that they know that that’s what you need to get. So I guess my thought is, you know, how expensive is it? How easy would it be for a woman to just go into an emergency room situation and if she’s being ignored, just kind of demanding, I really need to have this done for my peace of mind. If you think I’m crazy, then do this for my peace of mind.

Yeah, it’s hard, I think. So I mean, I have not specifically related to the D-dimer, but I have conversations with my clients on a regular like daily weekly basis regarding how to get your doctor to do the test you need. And from a general practical standpoint, you need to talk their language. Like, you have to figure that out, because even if a test is warranted, it’s just unfortunate. There’s a certain bias and a certain level of gaslighting that is inherent in the system. And I can’t explain why it just — it really is. And all you would have to do is gather 10 women together or 20 women and get them all to just share experiences that they’ve had with medical professionals, and you will see for yourself. So generally speaking, you want to talk in their language. Like if you think — if you want like an iron test because you think your iron might be low, sometimes you have to like express your symptoms. Like, I’ve been very tired lately. Like you have to share the symptom profile to justify the test. And when it comes to menstrual cycle problems, a lot of women — oh, I have heavy periods. Well, the doctor is like — I hear this every day. But if you go in there and you say, I’m filling 10 pads every day for the first four days of my period — 10. And I did my math and that amounts to 180 milliliters over the course of my period. Like I’m losing like a ton of blood. So if you quantify it, then that doctor might take notice and say, well, that’s actually quite a bit higher than what is normal. Because the doctors are trained, they’re smart, they know all this information, but you kind of have to talk their language. I would imagine it would be useful to not try to tell them what to do to the job. But like, if you think you have these symptoms, you’re probably Googling it anyways. So look at the how it presents and look at how many symptoms that you have of that. And when you’re talking to the doctor, you say, I have shortness of breath that started at this time, it’s consistently getting worse. And like, just try to very clearly define your symptoms and then ask for the D-dimer. You know what I mean? Because you have to make your case. Like if you’re in a court of law, you got to make a case. And the doctors hear a lot, they see a lot of patients, and they do have a percentage of patients for better or for worse — probably for worse — that probably come in there and try to say things to get medication and stuff like that. We all know that there’s issue with opiates and things like that. So doctors do legitimately see the general public, many of them. And so they’re like — there’s a reason why they don’t jump for every case. I think it’s like what you said — like if you treat them like people. So if we want to get something, then we have to do our best to make our case. And then as a woman, if you can, you probably want to go in with somebody.

Mike: Preferably male, but you probably want to go in with somebody, really.

Lisa: I would say so. Okay, see, that still blows me away. And I think we got into that a little bit the last time I was on with you too. That was another one of the things that the women who were contacting me to ask me to write about the IUD — I heard several times, was maybe coming from a man they’ll listen.

No, it’s legit, because even men get gaslit. So this is like an overall problem. But at the same time, like if you are the dad and you go in with your daughter and she has these symptoms, for better or for worse, if the man is speaking, it’s probably gonna get looked at quicker. And this is controversial. I’m sure someone’s rolling their eyes or, you know, but I think the majority of people would agree. As a woman, I’ve — I’m almost 40. I’ve lived as a woman for 40 years. And I can tell you, like people take you more seriously when there’s a dude in the room.

Mike: Well, I don’t know what to tell you. Yeah, no, I believe you, which is — I’m stunned.

Lisa: And so I guess like we can move on from this point, but I think it’s important. I think that when you’re dealing with a serious health issue and even just in general — like I had this conversation with Dr. Aviva Rahm. Like, we were talking about this and she was sharing some of her suggestions as well. And having someone in the room is helpful. Because we get nervous sometimes. You know, you have this medical problem. You maybe don’t feel well. You’re already kind of nervous. A lot of us get nervous in the doctor’s office. Plenty of people can’t even get their blood pressure taken at the doctor’s office because they legit is too high because they’re legitimately stressed out. We know this. These are things we know. And so if you end up having a not so positive interaction, then it’s more common for women to kind of freeze up and not object. It’s not everybody’s reaction, but this is just how it is. And so again — this was something that I’ve — so I think what I’ll do is I’ll link a few podcast episodes below. I had a really interesting conversation with Kimberly Ann Johnson, Mega Mama, and we talked about this specific issue and how women respond, kind of like that fight, flight, or freeze type of response. And how yes, there are plenty of us who if we have a specific request or a specific concern, it can be helpful to have someone. And then the unfortunate thing is that now that we’re in these times in the 2020s, there might be restrictions on how many people you can even come with you. So that might make it even more difficult, not being able to have somebody. But you could still — because I’ve done this with my parents because they live across the country — you can still in some cases FaceTime or have someone on the phone even if they’re not allowed to come in. So I feel because at the end of the day, what do I want? I want the woman not to die in the waiting room. Right. So I want to just do as much as I can to help her, encourage her, find ways, strategies to talk about the language of the medical care providers, to get support if you need it, to help you, especially if you are saying things and you start to get fatigued because they’re not listening to you, to have another person there. These are just strategies because for some, in some situations, it is life and death. And so we need to make sure that we have as much strategy as possible to get our voices heard.

Mike: Yeah. Wow. Sad, right? That we have to come up with all the strategy just to get someone to listen to us. But this is how it is, unfortunately. Yeah, yeah. I’m sure it’s compounded, but doctors have so little time per patient anyway. And what you’re saying makes great sense. If you have your case ready and you’re able to speak in the language that they’re looking for, you’re probably a lot more likely to get the kind of attention you need, I guess.

Lisa: Yeah. Well, I’ll share an example, because I think it’s ridiculous. So I had heavy periods all my life and I actually had low iron for basically all of my 20s. My iron was always low. And so I regularly had it tested and I was doing my best. I didn’t need as much liver back then — like, if I only knew, because I’ve solved it now. But anyway, so this is the background. So imagine I’m seven months pregnant with my first son, I have a history of low iron, heavy periods all my life. And I go to my doctor. Can you test my iron? He says, well, we tested it at the beginning of your pregnancy. I’m sure it’s fine. I literally have to build a case. I was like, I literally have had low iron my entire life. Yes, it was high then, but now, you know, I’m in my seventh trimester. And, you know, I have a thyroid issue as well. So I need to know if I’m tired because of my thyroid or if it’s my iron. Like I had to make this whole case. And then he said, well, that makes sense. Let’s do the test. But can you imagine having to justify getting your iron tested at seven months pregnant when you have a history of low iron? And so is it a cost thing for him? Is it a time thing? I wonder. Or is it just — we already tested it in January? Anyways, so hopefully that example — because that’s a very simple, ridiculous, like not life-threatening type of basic. So if I have to come up with a full justification for getting an iron test at seven months — and it was low. That’s the other thing. So when he did test and it was low and I was like, oh wow, I didn’t think it would be that low. And I ended up increasing my liver consumption within — you know, for anyone who’s concerned that I said liver and pregnancy — within a normal decent range. But my point — because it’s like he didn’t want to even test it, and then it was low. So hopefully this just gives — I always just hope that this gives courage. Sometimes we just need permission and we need that little bit of extra push so that we can have the courage to advocate for ourselves, because it’s really hard. It’s so hard.

Mike: Yeah, yeah. That’s the kind of feedback that makes me feel like, yeah, okay, I’ve accomplished what I’m trying to. I’ve gotten that kind of thing, you know, in emails or whatever from women of — for the first time I feel empowered. I don’t feel like I just had — you know, I understand why I was feeling this and why I need to stand up for it and not just accept the doctor telling me no, move on. I’ve never heard of that happening before, so it’s impossible or whatever. So yeah, empowering women to stand up for themselves and to know what the actual risks are — that’s, if we can accomplish that, I guess we’ve done our job.

Lisa: So to switch gears a little bit, I know one of the topics that you were talking about in your book, and this is something that I really haven’t heard anybody else talk about, is basically the potential change in the blood plasma of women who are using contraceptives. So you referred to it as the green plasma mystery. And yeah, so I’m curious. So maybe just take us from the top — like, what the heck is green plasma? Why is it a mystery? And what does it have to do with the pill?

Mike: Okay, so yeah, this story gets deep fast. So when I was first writing the book, I had one chapter I wasn’t happy with. I felt like it was weak, it didn’t kind of belong with everything else. And I went back through and I was reading Barbara Seaman’s letter to Senator Gaylord Nelson, which ultimately led to the Nelson Pill Hearings in 1970 — that were kind of the first real look, the U.S. Senate look into whether the pill had ever been proven safe. And so that whole set of hearings plays a big part in the book as well. And Barbara Seaman was a feminist who had written a book called The Doctor’s Case Against the Pill, where she outlined a lot of anecdotal stories of women along with doctors who were not feeling very good about what the pill was doing. So she wrote a six-page letter to Senator Nelson trying to get him to look at birth control. And so I went back and revisited it, and one thing jumped out at me that I really hadn’t noticed before was — as almost an afterthought at the end of her letter, she said, and what about this green plasma thing? We still don’t know what it means. And doctors at Stanford have just said, you know, we’ll ignore it and we’re going to go ahead and include it in the blood supplies and everything. And so I was like, green plasma? What could she be talking about? And started researching. And so I found these doctors at the University of Pennsylvania who were in the operating room in 2008. And a unit of plasma came in from a donation, and it had a striking green color. And plasma is usually kind of straw yellow. And so the anesthesiologist had never seen anything like it before. And none of the doctors in the room had. And so they took pictures of it and they sent it back to the blood bank saying they didn’t want to use it. And they showed the pictures around to all the clinicians in the hospital and nobody had seen anything like it. And so they were baffled, and they started doing research. And they found a number of studies on green plasma dating back to the late 60s, but also found that nobody had done any research, any subsequent research, for the past 40 years. And so they became immediately curious about what could be causing it. And in looking at the studies that Barbara Seaman had referred to in her letter, they found out that researchers at the time had kind of narrowed down what could be causing this green plasma. It was happening in young women who were taking birth control. They were suddenly seeing it. They had never seen it before. They were suddenly seeing it in all these young women taking birth control. They isolated it and realized it was an elevated level of ceruloplasmin, which is a protein that carries copper throughout the body. So the estrogens in birth control can cause you to absorb more copper. Estrogen and copper kind of directly correlated with each other. So as your estrogen levels rise, your copper levels rise. Well, the ceruloplasmin is kind of a bluish protein that carries the copper. Once the copper adjusts it, it takes on this green color. So their levels were so high that their plasma was actually turning green. At first they dismissed it and said, we’ll just kind of ignore it. No big deal. That’s probably nothing. But then later on, the American Red Cross came out with visual guidelines — so an actual chart to show you what is visually acceptable in plasma donations. And by doing that, they kind of weeded out all the green plasma. So, you know, the fact that these doctors had never seen green plasma doesn’t mean it’s gone away. It just means it’s been kind of removed from the system. And so they were trying to figure out — these doctors — okay, so we’ve identified that because of these visual guidelines, that’s why we haven’t seen it before. But then they also were trying to figure out what kind of effects it could have. What is what’s going on? And in studies, you see that there have been studies over the past 40 years on elevated ceruloplasmin levels and the effects they have. And it’s pretty similar to the side effects of birth control. You know, it’s been linked to anxiety, depression, higher incidence of diabetes, breast cancer, things like that. And it’s really fascinating that you also get into trying to figure out what kind of role it’s played, how it’s been removed. Well, in 1992, the first case of TRALI was diagnosed — and TRALI is transfusion-related acute lung injury. So they started noticing in the early 90s it became the leading cause of death among transfusion patients. People were dying from an alloimmune response. So their immune system was responding to something from outside their system, and they knew it had to do with these blood transfusions or plasma transfusions. And they identified it was mostly happening with female donors. And so the kind of the story they came out with that was in the media at the time was that their theory was that maybe women who had been pregnant in their life had formed antibodies to the husband’s sperm and to the baby. And so those antibodies were somehow affecting the blood that they were donating and causing them to — there was one headline that read something to the effect of blood from pregnant women killing men in transfusions or something like that. But what they didn’t look at, and what they ignored, was the fact that taking birth control also increases antibodies. That’s why it contributes to so many autoimmune diseases. I mean, you can’t develop an autoimmune disease if you don’t have certain types of antibodies causing it. So, you know, I guess conveniently for them, the researchers never looked into the connection between taking hormonal birth control and developing these antibodies and then donating blood in the plasma. But here’s something that I found really fascinating. In 2003, the United Kingdom became the first country to move to what they called a male predominant policy when it came to blood transfusion. So they tried to move toward literally only taking plasma from men for donations, because they felt like it was just too dangerous to take plasma from women. And while the media was kind of trying to paint it as pregnant women were the danger or the threat, these doctors from the University of Pennsylvania, when they wrote their paper at the end, said basically, we need to find a solution for this because if we eliminate all women who have ever been pregnant or who are taking birth control, we won’t have enough supply to meet the demand. So those doctors recognized that women taking birth control were an issue. And so for me, it was just kind of a fascinating rabbit hole. And it ended up being the last chapter I wrote just before we published the book. And I think it ended up being my favorite chapter just because it’s just so fascinating to look at how the medical industry — the way they treat women’s health is not about a woman’s health at all. It’s about how do we cover up, how do we keep the public from figuring this out? And even there was one team of researchers who looked at why don’t we take the green plasma and reintroduce it back into the system and use it for patients who are at threat of bleeding out. So they recognize that women who have these elevated ceruloplasmin levels have blood that has a higher hypercoagulability. So it clots easier. But nobody’s ever done research to say, hey, let’s look at the women who have these elevated levels and see if they’re at more risk for blood clots. Because I think they would be afraid of just how many women have elevated risks, and you don’t want to have to give that warning to women that that many women might be susceptible to clots.

Lisa: Yeah, it’s so interesting. I mean, there’s a lot of words thrown around and a lot of information, but I feel like if we dial it down to the basic level — it sounds like what you’re saying is that there’s research that used to be done that is kind of no longer being done, that would indicate that women on birth control, their actual blood plasma might be different. And there’s interesting pieces to the story I think, because you mentioned that the ceruloplasmin, if I’m saying that correctly, carries copper. So we know that women on contraceptives, it depletes zinc. And many women who’ve used contraceptives for a long time have elevated copper levels. So often we think about like copper elevated copper levels associated with copper IUD, which is also a thing. But with the birth control pill, you end up having a similar issue where you have elevated copper and low zinc. And so that’s interesting because it correlates with what we already know about the fact that, you know, women on contraceptives for a period of time tend to have a higher level of copper. So I feel like this is an interesting kind of correlatory, if you will, piece of information. And the fact that what you’re saying is that it’s been found that women who are on contraceptives, they have this higher level of ceruloplasmin and carrying copper, but then also higher level of blood coagulation — meaning a higher rate of blood clots. Ironically, that’s well studied in the sense of maybe not the specific relationship to the plasma itself, but estrogen-containing contraceptives are well known to increase the risk of blood clots and stroke and pulmonary embolism and thrombosis and those kinds of things. So I feel like this is another piece of the puzzle to explain the phenomenon that we already see with contraceptives.

Mike: Yeah, it certainly feels like — and I guess part of the mystery that I write about in the book is you think about medical researchers. And just for me as a layperson reading, I mean, it opens up all sorts of questions. And I know you have to have funding to conduct a real study, but there has to be curious investigators out there who would want to study — okay, what exactly is the relationship between all of these things, an elevated ceruloplasmin level and whether she could develop blood clots. And not only that, you know, when you move further down the road, and all of a sudden you realize these women who are taking birth control are not only at risk themselves, but if they donate blood and their plasma is taken out and given to another person, whether it’s a man or a woman, that person can suddenly develop this disease, you know, and a lung injury because their immune system is reacting to the elevated level of antibodies. So it feels like a lot of things they probably don’t want to find the connections, or they don’t want to see what’s happening. So instead, they just start using a male predominant blood supply, which is fascinating. And they didn’t want to make a big media ordeal out of that because they were afraid women would stop donating altogether.

Lisa: Yeah, it’s — I mean, these are things that I have never considered. You know, like, does taking the birth control pill change your bloodstream? I mean, we would know that it adds in those additional synthetic hormones, but yeah, these are questions that we don’t necessarily have answers to. And I suppose there’s the question of — because at the end of the day, there’s always this discussion around contraceptives. There’s a lot of opinions and sides and perspectives. And you could say that somebody on the other side of it would say, well, so what? I don’t think that that’s the answer. But like, to kind of say — so what are you saying? Like, women should just not take contraceptives? Or they should not allow women who take contraceptives to donate blood? But it sounds like what you’re saying is that there should be research into this because there seems to be a problem. And it seems like for whatever reason, they kind of stopped looking into it — maybe because they had the solution to screen it out by how it looks.

Mike: Yeah, it’s interesting because in Barbara Seaman’s letter, her next to the last question was this question about the green plasma. But then her final question was, why are so many researchers who are doing very important work suddenly finding their funds slashed? So maybe it’s not coincidence that right at that same time, all of the green plasma studies just ended, because it sounds like funding was being taken away from anything that was looking into just how dangerous the dangers ran with these birth control pills.

Lisa: Well, I suppose like if it would be really bad PR if there was actually evidence to suggest that it was like tainting the blood — that wouldn’t be like a good media moment. That would be an immediate disaster, I think.

Mike: Yeah, absolutely. And that would make it seem like a much bigger thing than just — I mean, when I talk about birth control, in one of the interviews I did with Dr. Miranda Naylor, I remember she said — she’s a doctor, so she was sharing her experience in med school — and she was saying, you know, the pill is presented as a totally benign thing that everyone just takes. And you know, she thought of it like a vitamin. And one of the things that I’ve said many times, and I personally experienced when I was on the pill, is because the pill is so normalized, even if you go to a medical doctor’s office or some situation where you have to list the current medications that you’re taking, many women don’t even list it. Like, they forget to mention it because it’s not — they almost think of it like a vitamin. Like it’s not an actual — it’s not even in their mind considered like actual medication. So there’s plenty of women on the pill who’ve had this experience or on other contraceptives where they’re asked, so what medications are you taking? And they say none, because they don’t even like consider the pill medication. So I feel like these questions, even though we don’t have answers to them, kind of present like — no, it is a medication. Obviously it’s strong enough to prevent you from conceiving. So it has to be doing something in there. And with all of the years since it’s been released into the market, we have a lot of data on it. And I think this also highlights what we don’t know. We have a lot of data on it, but we really still don’t know everything.

Lisa: And so I feel like with the blood plasma thing, it’s kind of a hard wrap-up to the conversation because it’s like — what is the message? Like, what do you think? Like, someone hearing this — this is exactly kind of what the doctors argue when they say, well, if we just provide all of this information, then we’re going to scare women off. They’re not going to want to use it. And there was a research paper that I quoted in my book, where they studied — I’ve complained about it before — but the research study was aimed at studying the women who complained about contraception. In the study, 50% of the participants had an issue with the contraceptive, from sexual side effects to emotional, etc. So half of the participants had an issue. And of course, instead of the researchers saying, wow, that’s a high amount, maybe there’s something for the medication, maybe there are things we can do to improve it and improve the user experience — no. It was like, okay, who complained? And let’s find out why. And so the researchers concluded that it was hard for doctors to recommend the most effective birth control methods without unduly discouraging the women from taking it. So they were sympathizing and saying it’s so hard for doctors because how are they supposed to get women on these pills and inform them about all the problems without discouraging them from taking it? And this was like the big concern in this research paper. And this is basically where we’re at. So if you think about everything we talked about today, we’ve been very critical about hormonal contraceptives and their effects, and very critical about the medical system that doesn’t necessarily fully inform their patients, and even at times not necessarily even aware of some of those side effects that cause additional problems if women are seeking support. What do we take from this?

Mike: Well, there’s so many things to be taken. I think one thing is, I think more men need to get involved with this conversation and be concerned with this conversation. Again, not to take over, but to be concerned. Because when it comes down to it, it is not just a woman’s issue. Sure, we should be concerned about women’s health and actual women’s health, not what it’s come to be defined as. But this affects all of us. If there is a link between this blood plasma and people dying — the leading cause of death from transfusions — that’s affecting men. It’s not just a woman’s issue. It’s ridiculous to think that just the person who’s taking this pill is going to be affected by it. If you think about 15 million women in the United States taking some sort of hormonal birth control every day, and it has to resist degradation in her stomach to be effective, so then she’s flushing it into the sewage system, and our sewage systems don’t remove these pollutants. So it’s affecting the fish, it’s affecting the wildlife. This drug is affecting everything. So we do need to be looking at it seriously. We do need to be spending money on the research to see all of the effects it’s having, not just on the women who are taking it, but the so-called secondhand smoke, if you will, those people beyond her who are being affected by this. It affects all of us. It’s an important conversation, and we need to all be looking at the side effects that extend on a macro level.

Lisa: Well, and when we’re going this deeply into the basically criticism of hormonal contraceptives, then certainly it comes to mind — so what are we supposed to do? You know, are we advocating for women never to take it? And I mean, I know I’m not. I had a woman say to me once — because she learned about all the side effects of contraceptives — and she said, how could you ever be okay with someone taking this after everything? And I said, well, people do like crack and stuff. Like people do heroin. I’m not comparing it to that, but I’m just saying like people drink alcohol and do all like — we, you know, I mean, I drink wine, but I’m saying like, we all do things. And for me, it always comes back to informed consent and making those choices. When it comes to birth control, I always say that I feel that women fall into three categories if we are given informed consent. There are some women who are going to hear all this stuff about the pill and they’re just going to be like, wow, I didn’t know. I’m not comfortable with it. There’s a lot of women who are just kind of like, I’m not comfortable putting that stuff in my body. So that’s fine. There’s another group of women who say, well, okay, I’m glad that you told me, so at least I know what to look out for. But there’s certain periods of my life where I’m going to take it. So I would say with informed consent, there’s another group of women who will take it, but they’ll take it a bit more judiciously potentially. So maybe they’ll modify it. Maybe they won’t take it for instead of 15 years, they take it for eight. So you know, I feel like there’s that category. And then I feel that there’s a third category of women who they’re like, thank you, I’m glad that you’ve told me, but I’ve always done well on contraceptives and I don’t have a problem with them. They work really good for me. And so I feel like the third category will just take it for as long as they would have. And I think all three categories are still happy that they have informed consent.

Mike: Yeah. And I mean, that’s the world that I would like to go to. And I do agree that additional research would be useful because of these potential implications. But I’m sure that there’s some listeners that are wondering, so Mike, are you saying that like no one should take it? Because like now you’re talking about the fish and the ocean. Like are you saying that we need to get rid of it? No. I feel like I’ll go back — I said secondhand smoke. So I’ll go back to that analogy. I don’t think cigarettes should necessarily be outlawed. It’s not like I’m going to go and say cigarettes need to be taken off the market, even though I think they’re causing a lot of harm and everything. But like you said, I mean, you have the pictures. Everybody — anybody who enters into that habit knows what they’re walking into. They know what the risks are. They’ve been informed. They can’t deny being informed. We all know the risks and dangers. But at the same time, I am thankful that, you know, like in my area, you’re not allowed to smoke within 85 feet of the front door of an establishment, or you go to restaurants and nobody’s allowed to smoke in there. So there are certain things to protect me as somebody who would be inhaling secondhand smoke. I can live my life and avoid it most of the time. I’m thankful for those. I think we need to find whatever the equivalent of that is for hormonal birth control, because if it is being flushed into our sewage system and it is changing the fish population to the point where we have to have fish hatcheries just to keep a population alive because all the male fish are disappearing downstream from sewage plants — which has been shown — then I feel like we need to find a solution where that’s not happening. If it’s altering the woman’s blood plasma to a point — I mean, they are trying to do that. They’ve pretty much stopped using women’s plasma as much as they can to try to prevent it from injuring people beyond her. So I think we just need to keep looking for — okay, establishing these connections. And if there are dangers, how do we prevent them from kind of trickling out and minimize the damage? Because like you said, some people are going to hear all the risks and they’re still going to say, okay, I’m willing to live with that risk.

Lisa: Well, I think that that makes a lot of sense. I feel like if we just close our eyes and like, oh, this is crazy, I don’t want to talk about it — that’s a problem too. I think that, you know, there are potentially very practical solutions to this, like water treatment. Somehow hormones are small, so it’s harder, but there’s more smart population. They’re doing all kinds of interesting things around the world with engineering. I’m pretty sure that we could figure this out. So I feel you. And I feel like it’s reasonable to say, okay, well, can we look at this? Like, it seems like it has happened. And I would just throw in there too that hormonal contraceptives are definitely one of the factors, but I think when it comes to the oceans and the fish, there’s also the onslaught of chemicals that are acting as estrogens, xenoestrogens, and things like that, to contribute to it and make it all worse. So I think there’s more than one factor that’s contributing to this problem. And obviously, it’s affecting all of us. It’s affecting men and women. And there’s an argument — I talk about sperm all the time. So there’s certainly an argument to be made for all of the kind of pollution and estrogenic chemicals and things like that and how it can affect sperm quality and rates and testosterone levels and things like that. So there’s certainly a conversation that needs to be had about all of this. And I think for that, I think it’s a little bigger than birth control. But I do recognize that it’s legitimately like in the water supply. And so it is useful to ask — to have somebody who cares about it to say, look, can we just measure — what are we doing about this? Can we have honest conversations? One of the researchers said that, you know, to get a sense of how potent these things are, if you took a pinch of salt and dropped it in an Olympic-sized pool, that’s how much synthetic estrogen it takes to start having an effect on vertebrate animals, including us. So think about that quantity. Because estrogen is powerful. It’s a very strong, powerful hormone. Women produce significantly less estrogen in terms of quantity compared to progesterone, because estrogen is very potent. And essentially, we tend to think of pollutants in terms of parts per billion or parts per million. But when it comes to estrogen, you have to think in parts per trillion. And that’s something that we haven’t really come to yet. Our ability to measure it — it can already be affecting us when we haven’t even reached levels where we can measure it in the water supply yet.

Well, as we wrap up, I feel like we covered so much ground. Like I feel like this conversation went in a lot of really interesting directions. We covered a lot of different types of hormonal contraceptives and talked about some really interesting information that I feel like we don’t really get anywhere else. So I think we’re all thankful for your resourcefulness and we’re glad that you have taken the time to dive into this research. So could you share with us where the listeners can go to buy your book In the Name of the Pill and also the new audiobook to learn more about you and to connect with you if they have any questions, because I’m sure you’ve piqued some interests today.

Mike: Sure. I cut social media way back during COVID as well, so I’m pretty much just on Facebook at Mike Gaskins. I’ll occasionally post on Instagram at In the Name of the Pill. And that’s the name of the book — In the Name of the Pill. It’s available on Amazon or Audible.

Lisa: Awesome. Well, we will put all the links for everyone to find you below in the show notes page. So thank you again for coming back on the show.

Mike: Thank you. And yeah, you mentioned people. I’m very open to people reaching out to me. You know, if you have a short story to share or insight you want me to look into or anything, I’m happy to hear from people on their thoughts or their experiences with birth control.

Lisa: Awesome. Well, we’ll see — maybe that next full book is in the future at some point. We’ll wait and see. Thank you so much, Mike.

Mike: Thanks, Lisa. I really enjoy talking to you.

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/430. I hope that you enjoyed today’s episode with Mike. I think one of my favorite parts of this episode was just that detailed dive into the history of birth control and all of the things that happened around that time. And I just feel like it’s really enlightening. And I know I did some research into the history and I often talk about the history of the pill itself and the role of the doctors who came up with it and how they came up with the 28-day formulation. Long story short, it was because when they put the women on a continuous pill and they lost their periods all together back in the 60s, that didn’t fly because they just didn’t understand what was happening. They didn’t know if they were pregnant. They didn’t know what’s going on. And it was confusing for them. And so the 20-day cycle, for example, was put in to mimic a woman’s natural menstrual cycle so that she would have that reassurance every month that she wasn’t pregnant. And basically it was a marketing ploy to get women to accept that the pill shuts down their ovulation and they don’t have a cycle. So replacing it with kind of like a synthetic version — I would say fake cycle, to be honest. But either way, that was the part of the history that I focused on. So I found it really interesting to delve deeper into some of the other aspects of the pill and especially the controversy around the side effects and the link between the pill and being the reason that we actually have drug inserts in our medication today that are intended to provide informed consent for us. So it’s really interesting to see how the pill really interplayed into the history of medicine. So with that said, 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.