How Hormonal Birth Control Affects Your Menstrual Cycle (Episode 510)

Full Transcript: Episode 510

Lisa Hendrickson-Jack:

This is the Fertility Friday Podcast, episode number 510.

I’m excited to share a brand new episode in my FAM Research Series today coming off the heels of the release of Real Food for Fertility. And so for those of you who tuned in to last week’s two episodes, Lily and I went deep into the behind-the-scenes. That was a super fun episode that we did together where we talked about the process of bringing this about. I know we had a lot of questions. Worlds colliding, how did this happen? And so we shared a lot of the details behind the scenes. We also shared some of the details regarding the research that went into it and how we approached it and how we are aiming to stay objective, not totally biased, and sharing a little bit about the writing process. And ultimately, for those of you who might have figured this out, when I was starting the FAM Research Series, these are not to say every single paper in the series was something that was covered in the book, but many of these papers are actually covered in the book because this was a way for me to share that research as I was going in and researching various sections of the book. So something to keep in mind as we continue moving forward.

And so in today’s episode, I’m kicking off the first episode in a three-part series where I’m going to delve into this question of hormonal contraceptives and fertility. And I find this topic to be really interesting and also very important. I haven’t really heard a lot of people speak about contraceptives the way that I speak about them, especially coming from the standpoint of menstrual cycle charting and the effect that contraceptives can have on the cycle. And so I decided to break it into three parts because I think that there’s different ways that we can look at how hormonal contraceptives impact fertility. And so one of the ways that we can look at it is how do hormonal contraceptives affect the menstrual cycle. Another way to look at it is how do contraceptives impact the ovaries. And a third way to look at it is how do contraceptives affect your time to pregnancy? Again, when I’m asking these questions, I’m looking to the research and seeing what the research has to say and really letting that then inform the recommendations that come out of it. And so when Lily and I are talking about how to consider your choice of contraceptive in Real Food for Fertility, we’re really looking at what the research is telling us how contraceptives are impacting these different aspects of our fertility. And what we know from looking at the research is that hormonal contraceptives are associated with a temporary period of subfertility post-pill. Obviously, it doesn’t mean that when you come off the pill, you won’t be able to get pregnant because we know that plenty of women come off the pill and get pregnant right away. Some women even get pregnant when they’re still on the pill. But what we also know is that there are many women who come off the pill and don’t get pregnant immediately. And for many of them, there can be a period of time where it could just take a little bit longer. And so that’s essentially what we’re looking at. We’re looking at what’s going on, what does the research have to say about that? And why is it that we’re not being provided with really good strategies overall.

And so over the years, I’ve spoken with many women who — and I always say it this way too — I’ve spoken to many women, not even just a few, who were kind of thinking about this and concerned. You know, I’ve been on the pill for whatever it was, three years, five years, ten years, fifteen years. And I’m finally ready to consider starting a family. You know, let’s say that my boyfriend and I are getting married in the fall. Or I’ve just heard many varieties of these types of stories. You know, my partner and I were planning to start trying at the beginning of the year. Whatever the case, I’ve been on the pill for X number of years, and so I was wondering what I should do. And so I’ve spoken to so many women who, you know, they make a phone call, they book an appointment with their doctor, they take a shower, put on their clothes, drive across town, go to this appointment to kind of seek their doctor’s perspective on what they should be doing. So it’s kind of like, you know, I’m thinking about it, my partner and I are planning to conceive, start trying in a few months. You know, should I come off the pill to get my body a bit of a break? And what I have heard so many times is that these women are told, no, no, no, it’s fine. When you come off the pill, your fertility will resume and it’ll be totally fine. And I always say, like, your intuition was loud enough that you booked an appointment and went to it. You actually got in your car, you took public transit, and you actually went to this appointment because you had this feeling that maybe there’s something going on here. You know, I don’t even know what my normal cycles are like. It’s been so long since I even saw what my normal periods are like. And only to have the doctor tell you, like, ah, it’s fine, it makes no difference. So what I would say in a situation like that, or if you’ve ever felt something like that, I mean, we should be listening to our intuition. What was it that made you think that?

And so when we look at what the research has to say, there’s a reason why your intuition is going off, and it’s because of the way that contraceptives work. And a few things to know about contraceptives: when I talk about hormonal contraceptives, there’s a lot of different contraceptives under that umbrella. The most common being the combined oral contraceptive pill. And when I say combined, it just means that there’s a combination of synthetic estrogens and synthetic progestins, and they are not the same as your natural hormones, and so they don’t have the same impact as your natural hormones. The primary function for hormonal contraceptives is to suppress ovulation. So they stop ovulation from happening, and that’s necessary if you’re looking to avoid pregnancy because if you are not ovulating, you can’t get pregnant. So it actually is a useful function when you’re looking to prevent pregnancy. But in order for it to do that, it suppresses the conversation that’s taking place between the hypothalamus, pituitary gland, and ovaries. And you have to think to yourself, you know, if you’re taking hormonal medication, a synthetic hormonal medication that is doing this to the body, and you’re on that medication for sometimes decades, could it possibly have an effect? And so that’s a question that we should not be scared to ask. We should be able to ask that because it’s reasonable to think to yourself, well, you know, it’s been suppressing this for so long, what could be going wrong? And then the two other main modes of action would be to prevent the uterine lining from fully developing so that the uterine lining is, as they say in the research, thin and flat and basically unresponsive to a fertilized egg. And a third response is to actually prevent and suppress the production of fertile-quality cervical fluids so that instead of the sperm being able to kind of freely swim around in your reproductive tract, they are blocked from entrance. And so those are the three main modes of action for hormonal contraceptives. And something like the hormonal IUD doesn’t always fully suppress ovulation, but those other two functions that I mentioned — having the thin endometrial lining that is unreceptive to a fertilized egg and having the cervix blocked with the thick mucus plug because you’re not producing fertile-quality cervical mucus — those become then more of the primary mode of action in those cases.

And so that’s a little bit of background on how the pill is working and also why the pill is not giving you an actual period. So when you’re having a natural menstrual cycle, you are ovulating, and then you’re releasing your natural estrogen and progesterone. So you’re producing significant estrogen as you approach ovulation, you’re producing significant progesterone after ovulation. And those hormones then work to really build up the endometrial lining and prepare the endometrium for fertilization and they give you a true menstrual period. If the egg is not fertilized in that second half, or if the egg is not fertilized at ovulation, then the egg disintegrates within 12 to 24 hours. And without that egg producing HCG to kind of rescue that corpus luteum and keep everything going, then you end up having your period. So when you’re on the pill, it’s not a true period. It’s a withdrawal bleed. And what happens is that when you’re on the pill, these artificial hormones are having this suppressive effect, and then when you come off of them for those few days on your sugar pill week, then the hormones just dramatically drop from your system. You know, you’re taking all of these synthetic hormones and all of a sudden you’re not taking them anymore. And so your body essentially resets itself. That’s where the bleed comes in. And if you were to not continue to take the hormones, at some point ovulation would resume, and then you would continue to have your cycle. But when you’re continuing to take them, you just have this withdrawal bleed, and then you go back on those artificial hormones. So that’s a little bit of background. For many of you, it’s review, and for some of you, this may be the first time that you’ve heard that information.

And I think that it’s helpful as we go into then some of the impacts of the pill on fertility. So as this is the first episode in my three-part series, today we’re going to talk about how the pill impacts the menstrual cycle. There’s a really interesting study that looks at the way that the pill impacts the overall parameters of the cycle, and that’s what we’re going to get into today. The study we’ll be looking at today is called “Cycle Characteristics After Discontinuation of Oral Contraceptives,” and this study is by Gnoth et al., so Gnoth and colleagues. And basically this study looks at this question of how do contraceptives impact fertility in an interesting way, because they’re not looking at the pregnancy questions specifically, but they’re looking at the impact on the menstrual cycle. And so in this study, it says it’s an ongoing prospective study of the use of natural family planning, and they had 175 women who were observed for a total of 3,048 cycles immediately after coming off of the pill. So they were the post-pill group, and those women were compared to a group of 284 women who were observed for a total of 6,251 cycles who had never taken the pill. And so what’s interesting about this study is you have the post-pill group, you have the never-used-contraceptives group. And so you can compare them side by side to see how long it takes for the post-pill women for their cycles to look the same as what I would term virgin cycles — cycles of someone who has not had any hormonal influence.

And so to put the conclusion right up front, what the researchers found was that there were cycle disturbances — very notable cycle disturbances — that continued till at least the nine-month mark. And so they made a distinction. They said that cycle disturbances after discontinuing oral contraceptives were reversible, but the time of regeneration as they termed it took up to nine months for significant disruptions, or even longer if we’re counting what they would term non-significant disruptions. And so out of that, you may have heard me say — if you’ve listened to the podcast a lot or if you’ve heard me here and there — you may have heard me talk about how on average we found that it takes anywhere from 9 to 12 cycles or more for everything to normalize post-pill. And what they’re looking at in particular — so the things that they noted that were most significant, the changes or the disruptions — were the length of the overall cycle, so essentially delayed ovulation. So when you’re looking at women coming off the pill, there’s several commonalities, to the point that when I’m working with my FAM practitioners, we are looking at that time — that post-pill transition phase — as a specific category for clients, because we know that there’s certain trends and just certain characteristics that women in this phase share that we should be looking out for and that we should be particularly supporting.

So I mentioned one, which is the delayed ovulation. So it’s not uncommon for some of those first few cycles — whether it takes a bit of time for you to have your very first ovulation and menstrual period, or whether those first few cycles are a bit more on the longer end. So while the average cycle is about 29 days in length, it’s not uncommon for those first few cycles post-pill to be a bit longer because ovulation may be delayed for a bit of time, again due to that disruptive effect of the synthetic hormones. Another really common impact is on the luteal phase — so the period of time between ovulation and your next period. And so what they found in the study was that for the post-pill group, the first several cycles, it was quite common for these women to have a shorter luteal phase. And interestingly, in the study they looked at a lot of different factors. So they weren’t just looking at one specific thing. They weren’t just looking at cycle length or anything like that. I’ll read a few things that they were looking at here, but they were looking at the cycle length, the first day of the temperature rise, the length of the follicular phase — so how long did it take before ovulation took place — they’re looking at the length of the luteal phase, so how long did it take between ovulation and the start of the next cycle, the last day of highly fertile cervical mucus, first day of mucus. So they actually were looking at some of those mucus characteristics to see if they were falling into normal range, and they were kind of just determining between a lot of these factors whether these disruptions were considered significant or less significant.

So they had their own way of looking at things. The participants in the study had a range of how long they had used contraceptives. So an interesting fact that many people aren’t aware of is that I’ve seen a number of studies that consider use of contraceptives of two years or more to be long-term. So there’s a study that we’ll be talking about in one of our upcoming episodes in this series where they actually define long-term as two years or more of use. So in this particular study, the duration of use ranged from a few months to 13 years, and the average duration of use was three and a half years. So I think that’s interesting as well, because in today’s day and age when women are using contraceptives, it’s often more on the long-term side. It’s not uncommon to see women who are using contraceptives for five years or ten years or eight years or fifteen years, even twenty years or more, and I’ve had a number of clients who have continuously used some form of contraceptives for twenty years or more.

So what I find interesting about this study is that they can literally line up the cycle characteristics of the women who were in the post-pill group and compare that to the control group. And when you do that, you do see that — so there are some more significant cycle disruptions and there are some lesser ones — so you can kind of see that by between months 9 and 12 there’s much less of a disruption in the cycle, but you still see that it takes up to that 12th cycle before the parameters are virtually indistinguishable. And this is of course on average. And so what that tells us is that there is a period of subfertility, there is this period of cycle normalization that is taking place. Now whether that means you will or will not conceive is a separate question, and that’s why we’re addressing it in a separate study. But I think that it is useful information. So what we’re aiming to do — to take it back to Real Food for Fertility for a moment — is to give you as the woman, whether you are preparing for your first pregnancy and your first baby or whether you already have children and you’re preparing for baby number two or three or four, we’re wanting to give you those tools and information so that you can make these decisions for yourself. So essentially in the book we’re arguing two things. One is that when you know that you’re planning to conceive in the near future, we are encouraging you to consider taking a period of time before you’re ready to actively start trying where you can come off the pill and let your hormones normalize a little bit, and then also give your body time to kind of recover. And I would also add to give you time to see where you’re at. As I had mentioned in one of the previous examples, if you’ve been on the pill for X number of years and you don’t know what your normal cycles look like anymore, it gives you the opportunity before you’re actively trying to actually see what’s going on with your cycles so that you can see if there’s potentially an issue there. Because if you come off immediately when you’re starting to try and then there’s an issue, it just causes a lot more stress than if you give yourself a bit of a buffer period. And what the study tells us is that it actually does take a bit of time for the cycles to normalize.

It can be awful if you had no idea that this was a thing and you were just told that everything would be just great right off the bat. To come off the pill and have it take maybe a month or two or three before you get your first ovulation in and your first period — that can be just so alarming, especially if you had no idea that this is actually normal. It’s not normal in the overall sense, but within this particular phase — the post-pill transition phase — it’s actually quite common to see a delay in ovulation and to see this pattern of longer cycles, delayed ovulation, for those first several cycles off the pill.

Clearly you can’t convince me of anything else, because I’ve seen this pattern time after time over all the years I’ve been running group programs and working with clients individually. When I’m working with clients who come off the pill, it doesn’t mean that everybody’s cycle is super delayed — it doesn’t mean that — but what’s consistent is that it can take longer for that cycle to return. And some women do start ovulating like two weeks after they came off the pill, but there’s a range. And I would say within the kind of more typical range that I see, it could be anywhere from 2 weeks to 4 months. And then there are some women for whom it takes a lot longer, and in those cases there would have been an underlying issue that is preventing their ovulation. Because the pill by itself is not just going to prevent you from ovulating for a year. But in a case like that — if it’s six months to a year or more that a person’s cycle isn’t returning — it’s likely that the pill was masking an underlying issue, whether it be something like PCOS, or some sort of underlying inflammatory condition, or something like HA where you have the overexercise, under-nutrition kind of scenario. But either way, that’s information that you would need to know in order to make your decision. And when you’re able to give yourself a bit of a buffer period before coming off the pill — giving yourself some time between coming off the pill and actively starting to try — then that’s arguably giving you a better chance.

One of the other things that we suggest in the book is that we make a distinction between women whose cycles were relatively normal. So if your cycle was relatively normal, you went on the pill for birth control — for example, you didn’t go on the pill because of cycle issues or irregular periods or painful periods or anything — you just went on the pill when you needed birth control, and you can’t really remember any issues with your cycle, then you are in a category that’s more likely to have just a normal resumption of your cycling. And so in that situation, we would recommend for you to consider coming off the pill anywhere from 6 to 12 months ahead of time, just to give your body the chance to normalize and just to go through those phases. But we wouldn’t be anticipating any extreme delay in the return of your ovulation or anything like that, provided that you’re healthy and it’s just the effects of the pill.

Now if you fell into a different category — if you had been put on contraceptives specifically because you had menstrual cycle issues, because you had irregular periods, because you had severe pain or other concerns, hormonal imbalances, severe PMS or PMDD, or something like that — then we would recommend for you to consider, if possible, coming off even earlier. So in a case where you did have irregular cycles or there are some potential flags there, I would encourage you to consider coming off, if possible, 18 months to 2 years. And I feel like when I say that it sounds so out there, because it’s not what you’re hearing from most of your practitioners. But the way I look at it is the same reason why I have insurance for my car. You know, I don’t buy car insurance because I assume I’m going to have an accident, but I buy it because if something happens, then it’s there and I can have that peace of mind. So if you knew already that you had some issues, then it’s worthwhile just to consider it. It doesn’t have to be even that long, but my recommendation for someone who knew — it’s like, oh, I never knew when my cycles were coming, I would have a cycle every like three, four months — I would absolutely recommend that you consider coming off 18 months to two years ahead of time.

During that time, coming off before you’re ready to start trying, you’d have to find an alternate birth control method, because one of the things to say is that just because we’re acknowledging that there’s this temporary period of subfertility, it doesn’t mean you can’t get pregnant. It means that we are wanting to make sure that we are giving you a buffer so that if there were any issues, you would have time to replenish nutrient stores, allow your hormones to normalize, and really give your baby the best chance. But that means that during that time you’d have to be actively avoiding pregnancy and you need to have an alternative birth control method. So this is just to get you thinking. And the reason is because some women in a situation like that — when they had this history of irregular cycles or other period issues — these women are more likely to experience a more delayed return of ovulation and things like that. And if that’s you and it took six months for you to have your first period because your periods were always irregular and you didn’t know what was going on, and then after that you have this underlying issue that was never addressed and you’re going 45 days between periods — it actually takes that 18 months to two years to give you the time that you would need to really dial down, see the health professionals you need to see, get some answers about what’s going on, without simultaneously having the pressure of actively trying to conceive. And of course, we’re hoping that you don’t have any issues at all — we’re hoping that your ovulation just comes back two weeks later and then your cycles are super regular right off the bat. But if you fall into one of those risk categories, then it’s more likely that you could have an issue.

And so this is — if you think about this — this is just sound advice. It makes so much sense after you hear it. Oh, well, duh, of course that makes sense. I should give myself some time. I should plan ahead. I should have an alternative method of birth control in case my cycle comes back and everything’s great, but if that’s not the case and I’m doing this ahead of time, then by the time my partner and I are ready to try to conceive, I actually have all this time ahead of me that I’ve worked charting my cycle. My period has come back, even if it took a little bit longer than I had thought it would. I was able to look into what was going on with me a little bit more, and I have a better understanding. And if you take that time, you’re able to take some measures to ensure optimal nutrition, and so you’re really prepared. And this is the goal, this is the ideal, and this is where it comes from. So that you can see that in this particular study, just of these women who had been on the pill, there was this consistent pattern where it did take some time for everything to normalize post-pill.

A couple of other interesting pieces from the study, and also I want to touch on cervical mucus briefly, because what I’ve observed over the years is that women who are coming off of hormonal contraceptives, there is this period of subfertility where it’s not uncommon to see abnormal cervical mucus patterns. So even if a woman — I’ve also had clients who come off the pill and ovulation happens 14 days after, like clockwork. That’s not necessarily the norm, but I have had a number of clients with that. So a couple of things about that, to kind of even allude back to what I was just talking about. When you’re in that category that I would recommend waiting a little longer, a couple of things — characteristics of women whose cycles come back right away even after long-term pill use, just for your information. So I’ve had clients in that category who tend to be clients who were put on the pill because of birth control and not super young. So for example, maybe you had your first period at the average age of 13 and then you started having sex at 18 or 17 or whatever, and so you actually had four, five years of normal cycling — nothing really came up, you couldn’t really remember anything that was really off — and so your cycles had had an opportunity to mature. And then you were put on the pill not for cycle issues. And what I’ve found is that women whose cycles had the opportunity to kind of mature — so throwback to puberty for anyone who wants to dial back into those archives — I can remember growing breast buds. It’s not like I woke up one day and I just had breasts. It was a process that took a couple of years from breast bud to full breast. And similarly, our menstrual cycles take a few years to normalize. When we look at studies that look at the average parameters of those first few years of cycling, it shows that there’s quite a bit more cycle irregularity. So instead of — when you’re in what this one study terms as the middle life phase, after your cycle has grown up and is robust — that’s where we get that average length of the menstrual cycle, about 29 days, and 24 to 35 days as that kind of average length. For a woman within the first couple of years of her menarche, the average cycle ranges from 21 to 45 days. There’s a lot more variability during that time, and one of the reasons for that is that it just takes a little bit of time for the cycles to mature, for the communication between the hypothalamus, pituitary gland, and ovaries to get established and be robust and all those things.

And so that’s something to think about as well, because if your body had the ability to just kind of mature and you took the pill after that maturation process had completed, and you didn’t necessarily have issues with your cycle — I mean, that would make you an ideal candidate for birth control. And to take it even a step further, many women don’t necessarily know the history of birth control, so I might save that for another podcast. Today’s podcast isn’t so long to go into all of that detail. But when the pill was first designed, they tested on — many women who would have been a little bit older, they wouldn’t have had prior pill use closer to their menarche. So the women who were in those first pill trials, they had already had established menstrual cycles. They weren’t in their teens, and they were likely married because this was in the 60s, and it was a different time. And so even just considering that piece of it, what I’ve seen is that when women are taking the pill really early — like if they’re taking it a year after their first period or less, or two years after their first period — their cycles arguably didn’t have the chance to fully finish maturing. And so it can take a little bit of time for all of those parameters to normalize, versus the woman who’s had many years of cycling under her belt before she ever took that first pill.

Okay, so that’s an interesting piece of information. And also the cervical mucus patterns that I mentioned before. So it’s not uncommon for women to come off the pill and see less cervical mucus, whether it’s — I’ve had clients who come off the pill and for the first two, three cycles, they have zero mucus. We call them dry cycles. But they’re still ovulating, and we’re checking their temperature, and so we know that we can confirm ovulation. But there’s no mucus to speak of. So that’s a small percentage of women that have zero mucus, but it is a thing and some women do experience that. And what I see more commonly is just kind of more scant mucus. So instead of having these days where you’re observing lots of cervical fluid that you can pick up between your fingers and stretch like that raw egg white type cervical mucus, it’s a little bit more scant. You know, it’s fewer and far between. And it takes — I’ve observed — several months. So when we get into that 9 to 12 cycles post-pill, for many women, that’s when they’re starting to see a more robust cervical fluid production. And that would also coincide with better hormone production as their ovaries have normalized, their hormone production has started to normalize, and everything has started to reestablish. And this study shows this same result.

One thing I’ll say about interpreting research is that it is helpful to read a number of papers and start to identify why one paper might say this thing and another paper might say another thing. And so often when you’re looking at research papers that are specifically talking about hormonal contraceptives, whether it’s talking about the cycle parameters and characteristics or whether it’s talking about the return of fertility, many papers don’t necessarily break down results by cycle by cycle or month by month. Many papers will look at the one-year mark and that’s it. They’ll just say at the one-year mark X number of women had such and such, and so that means that it’s a reversible method. So when you read a lot of papers too, you start to see kind of like a consensus. I hesitate to use the word consensus, but you start to see that there’s certain words that the researchers will use on a regular basis. And one of the terms that is frequently used when talking about hormonal contraceptives is that it’s a reversible contraceptive method, which is true. It is a reversible contraceptive method. And so the researchers here acknowledge that as well. They say that cycle disturbances after discontinuation of oral contraceptives are reversible, but the time of regeneration of the hypothalamic-pituitary-ovarian axis takes up to nine months. Interestingly, they say months, because in their study they were looking at cycles. So they numbered the cycles post-pill and they presented their information — cycle one post-pill, cycle two post-pill, cycle three post-pill — but here they say months. So they say regeneration of the HPO axis takes up to nine months or even longer, and menstrual cycle disturbances — whether that being long cycles or short, long total cycles or short luteal phases, or issues with temperature and cervical mucus — must be expected up to the seventh cycle. However, just under 60% of all first cycles after discontinuation were ovulatory.

So they’re summing it up by saying that this method is reversible, but we are seeing some cycle disruptions most significantly up to seven months, they’re saying. But if you look at the data, the cycles really take anywhere from 9 to 12 before they normalize. And I always stress that it was 9 to 12 cycles — that’s how long it took. It wasn’t 9 to 12 months. If you come off the pill and your first cycle is 60 days, 60 days from when you first came off the pill until you start your first true period — not just the withdrawal bleed, but your first true period — nine cycles could be a year. So I don’t say this to discourage, and I definitely don’t say these things to alarm, but it’s just something to be aware of. We want to be aware that when you come off the pill, there’s this period of transition that your body needs to go through. Whether you are emotionally prepared for it or not, whether you’ve planned for it or not, whether you’ve put that time in your conception timeframe or not, that’s how long it just takes for your body to fully normalize.

And so that’s what informs our suggestion to really consider — and it’s pretty basic stuff — just consider coming off a bit earlier, give yourself a bit of time. Best case scenario, if you fall into one of those I would say low-risk categories where your cycles had normalized, you had gone on the pill not immediately after you had your first period, you didn’t really have any cycle issues of note that you can remember, you primarily used the pill for birth control, it wasn’t really to balance hormones or any of that kind of stuff, then yeah, it would make sense for you to consider 6 to 12 months. But if you fall into one of those higher risk categories — maybe you were put on the pill within the first year or two that you used it, maybe you had some cycle irregularities or issues or hormonal imbalances, things like that — then that would put you into the other category and we would recommend anywhere from 18 months to 2 years. And again, not because we’re assuming there’s going to be a problem, but more so because we want to be your insurance policy and make sure that we give yourself enough time in case there are any issues, since if you fall into one of those higher risk categories, it would be more statistically likely that you could have more of a delay in the return of your first ovulation or the return of normal cycling.

So with that said, I think I’m going to wrap there. I hope that you enjoyed today’s episode. I hope that was enlightening for you. And if you’re wanting to take a peek at the research, feel free to head over to the show notes page, which you’ll find at fertilityfriday.com/510. And we will link out to the paper that we were going through. And as I mentioned, this is going to be a three-part series. So this is part one in a three-part series. We’re going to be getting into the effect of the pill on the ovaries in our next episode next week. So stay tuned for that. And then in our third episode, we are going to be talking about the specific impact of the pill on time to pregnancy. So lots more to discuss in our FAM Research Series. I hope you have a wonderful week — whenever you’re tuning into the show — and of course, as always, until next time, be well and happy charting.