Hypothalamic Amenorrhea: Causes, Hormones, and Recovery (Episode 428)

Full Transcript: Episode 428

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 the third episode — I wanted to play a few episodes together on the topic of PCOS, especially following a couple of episodes ago where I shared, in detail, the difference between PCOS and HA. And I feel like this episode today, my episode with Lara Briden, it really kind of brings it together. In this episode we actually went through the difference again and kind of defined the two and described how they’re different and went through some of the characteristics and then we kind of move on from there and talk about some of the tenets of achieving hormonal health whether it’s with PCOS or HA. So it’s a really nice conversation where we kind of get into a whole bunch of different topics but the overall theme is maintaining overall hormonal health, menstrual cycle health, and really restoring that menstrual cycle back to what it needs to be. Because whether we’re talking about PCOS or HA, the common theme is disrupted menstrual cycle, of course, to a different degree, depending on the condition that you’re dealing with. But ultimately, the goal for both of these conditions is to restore normal cycling. So without further ado, let’s jump into my episode with Lara Briden.

Dr. Lara Briden: Hi, Lisa. Thank you so much for having me.

Lisa: Well, thank you so much for coming back on the show. I just wanted to congratulate you on the success of your book. I know when we recorded our episode, you were kind of just in the process of releasing it and launching it, and it’s been like a year and a half. I’d love for you to introduce yourself to the listeners and maybe talk a little bit about what motivated you to write your book.

Lara: Yeah. Okay. Good question. So my book is called Period Repair Manual. And it’s basically a compilation of everything that I’ve found in my 20 years of practice to work for periods. I tried to focus in on the diet changes and the nutritional supplements and herbal medicines that give the best results amongst my own patients.

Lisa: Well, as I was reading through the book, you know, it’s very detailed, specific, action-oriented. I feel like it really gives the reader what they need to know, like to really drill down. And I love the last part where you gave the specific questions to ask your doctor. It’s probably a lot of angry doctors because of you.

Lara: I don’t think — I know it’s funny. That’s a good way to say it. But I actually hoped that it wouldn’t make doctors angry, but it would more just bring women and doctors onto the same page so they could have a conversation about what they’re trying to accomplish. It was my little section on doctor speak, you know, how to say the kinds of things that your doctor can respond to.

Lisa: Yes, no, absolutely. And I’m just — that’s tongue in cheek, really. I’m sure that, well, the thing is it absolutely would help open that conversation. But I think doctors can find it frustrating because they’re the doctor, they know everything.

Lara: Yeah, I’ve had it. It’s one of my favorite Amazon reviews that I receive. And I’ll just say to your listeners, I read every review I receive — not just for the praise, but actually just for the feedback, you know, to hear what people — which parts of it — what people, what the book meant to them. One of my favorite reviews was someone that said I, you know, I’ve had a couple of people that gave a copy to my doctor. I used to imagine that might be a time when a doctor is less than thrilled when a patient walks in and plunks down a whole book. Please read.

Lisa: That’s a good idea. Maybe I should give one to my doctor. I don’t — it wouldn’t go very well, but that’s a story for another day. Bless his heart, my doctor. Oh my goodness. I’d love to get into the topic of the day. So like I had mentioned, you know, I have had a lot of listeners ask about hypothalamic amenorrhea, which is a super big mouthful. So maybe we could start with what the heck is it?

Lara: Yeah. Defining that because it does sound like a big fancy word. When really, as I say in my book, it’s kind of a diagnosis of exclusion, which means that other things have been ruled out. So there can be, to start with, there could be lots of reasons that you’re not getting periods. It could be, for example, a common one — a problem with your thyroid. It could be menopause. It could be that you’re pregnant. So the doctor needs to work through — it could be a side effect of a medication you’re taking. So the doctor needs to work through all those different possibilities. And then it might be something called polycystic ovarian syndrome, which is quite somewhat similar to hypothalamic amenorrhea. But at the end of the day, after all those other things have been ruled out, then that’s the diagnosis that’s left. And it really means that your hypothalamus, which is the hormone command center in your brain, has decided that it’s not a good time to make a baby.

I mean, and this applies even for women that don’t want to make a baby. Ultimately, that’s what our healthy period is about — ovulation. So it’s about your body deciding it’s healthy enough, well enough to reproduce and then ovulating and then having a period. So if you’re not — for example, a common thing — if you’re not eating enough or you’re under stress, or you’ve got another illness of some kind, then your hypothalamus makes kind of a smart decision, which is: this is not a good time.

Lisa: You know, it’s so interesting that this kind of theme has come up again. As I had briefly mentioned to you, I just recorded an interview with Dr. Dan Kalish, which would have then been released two weeks ago. And we talked exactly about this, which is that your body is kind of doing something for it — it doesn’t feel positive in the moment when you’re trying to get pregnant, but your body is going to reproduce when it — when you’re healthy. That’s the whole point.

Lara: Exactly. Your hypothalamus hasn’t just decided to be mean. It’s trying to help you — preserve your general health. And obviously making a baby is a big deal for the body and requires enough food and enough nutrients and the right safe environment. And so it’s waiting until that happens. And that’s not to say — I don’t want to make this sound like people who are suffering hypothalamic amenorrhea are necessarily doing something wrong. It’s a lot of complex signals that are going to the hypothalamus. So we just — you know, with my own patients, I just try to untangle that all and figure out what aspect of what you’re doing, what’s happening in your body, even if it’s not something you’re doing consciously, is of concern to your hypothalamus.

Lisa: And what does it look like? So if a person has hypothalamic amenorrhea, is it that they just don’t have their period at all, or is it —

Lara: Pretty much, yes. I think it’s defined as — and we’re talking about secondary amenorrhea. So amenorrhea means no periods, and it has to be happening for at least six months, I think, to reach the diagnosis. So it’s not enough if you’ve just missed a couple of periods — that’s different. Typically, hypothalamic amenorrhea is no periods for some months, like more than six months or up to some years. The other diagnosis, which is polycystic ovarian syndrome, it’s much more likely to be infrequent periods — like maybe three or four periods per year.

Lisa: And do you think that for the woman who just recently came off the pill and is like trying to figure out what’s happening, you know, when her periods come back, do you think that it’s ever kind of mistaken for hypothalamic amenorrhea? Is it different if a woman goes off the pill and then doesn’t get her period for six months?

Lara: That is such a good question. So there is a bit of science on this — which I have this research paper, which you can put in the show notes if you want later on — that hormonal contraception, hormonal birth control, impairs — well, certainly we know it impairs recovery from hypothalamic amenorrhea. So it’s not great for the condition. So if someone was perhaps tending to that anyway, had a sort of a super sensitive hypothalamus for some reason or other things going on, then time on the pill is not going to help things. Because if you think about it, the condition is a suppression of activity of what’s called the hypothalamic pituitary ovarian axis — that communication between those three glands. The pill works by shutting down that communication completely.

It’s not surprising really that hormonal birth control would make it worse because that’s what it does. To me, it just seems kind of obvious that if you actively shut down that communication, that communication might be more likely to stay shut down.

Lisa: Well, and maybe to go dial it back a little bit for the listeners so they’re not like, “What the heck are they talking about?” — going into the science lesson here and obviously not sciencey terms. So in order for the ovaries to ovulate, basically the brain has to talk to the ovaries. So maybe you could just walk us through what’s supposed to happen and then why the pill would make that worse and what that has to do with hypothalamic amenorrhea.

Lara: Yeah. Great. So the first step is the hypothalamus, which is this part in our brain, the command center, and it sends a little hormonal message to the next commander down — the pituitary. And then the pituitary sends out the final message to the eggs, basically waiting in the ovary, to get up and do what you need to do and make some hormones and ovulate. So in hypothalamic amenorrhea, the problem is starting at the hypothalamus. It’s not — what they say in the science is it’s not kind of pulsing. It’s not sending out these little hormonal signals at the right — does that — yeah. No, it totally does. And so then when a woman’s on the pill, there’s great reasons why it works. I would say there’s three great reasons why it works. And one of them is that it stops the communication. It’s like, shut up, hypothalamus.

Lisa: Yes. And then it also does other things. So yeah, that’s really interesting. Because I thought, as we were talking, that if a woman then comes off the pill and then her period doesn’t come back, she might think, oh my gosh, I have hypothalamic amenorrhea — but it’s not necessarily the case. It could just be her body figuring out what’s going on after that communication being disrupted for a while.

Lara: Yeah. And if you read the fine print in the pill, they say it can take up to two years to get your hypothalamic pituitary ovarian communication going again after the pill. So of course, many women, their periods come back straight away, and so we see that. We think, oh, that must be the normal. But it’s actually pretty common to have a delayed — like to take a while to get your periods going off the pill. And whether that meets the criteria of diagnosis for hypothalamic amenorrhea, it’s — like many things actually in health, the term itself — the diagnosis of hypothalamic amenorrhea — is really just a description of the lack of periods. Like I said, it can happen for a few different reasons. I don’t treat that diagnosis anyway. I treat — I go deeper and say, when did — what’s the context of when this — how you know — why this is happening. And is it post-pill? Because that informs the kind of treatment choices that I might make.

Lisa: I think that’s the interesting — another interesting aspect of your book — because I mean, we can call all these illnesses different things. There’s a lot of themes when you talk about how to treat various period-related issues. They come up over and over again. And I’m pretty sure that that’s been your experience with the practitioner, which is that we’re really looking at the whole woman and figuring out what’s going on with her health. So maybe we could talk a little bit about some of the things that you touched on — several of the reasons why women might lose her period. But what are some of the kind of themes that you see when a woman does experience hypothalamic amenorrhea?

Lara: Yeah, great question. Okay, well, first of all, just — I have a few boxes that I like to tick when I’m working with my own patients because they may be — their doctor may have said, this is what you have, hypothalamic amenorrhea. But my first question would be, were there some other things that should have been tested such as thyroid? Thyroid is a common one. It’s a common reason to miss periods and have funny periods. And if thyroid is the reason for — a problem with thyroid is the reason for lack of periods — then technically it’s not really hypothalamic amenorrhea, but it might have been called that. So I look deeper. So test for thyroid. I’d always test for gluten, because gluten — a strong gluten sensitivity, whether even if it’s not full-blown celiac disease — can shut down periods. So that’s — in that case, it’s really more of a gluten issue and possibly doesn’t even deserve, again, the diagnosis of hypothalamic amenorrhea. And then I look for key nutrient deficiencies that might be impairing the ovaries’ response and even that communication. So a big one is zinc. So deficiency of zinc — vitamin D — in my experience can make ovulation very difficult to do.

So all of those aside, then if we’re getting back to just really the situation where — yeah, it’s the hypo — everything else is fine, there’s the right nutrients, there’s no other disease process going on — it’s just that the hypothalamus has decided not to do it. The two biggest reasons really are stress and undereating. And that may or may not meet the full criteria for eating disorder, but it sometimes does. And it’s not being fully nourished in some way.

Lisa: Well, that’s interesting. I’d love to delve into the undereating a little bit. Because is it — do you find that it’s like you’re eating regularly and you know, but you’re just not eating what you’re supposed — or not supposed to, but eating foods that would say support hormonal health, let’s say — or is it more that kind of related to dietary restrictions and that type of thing?

Lara: Okay, not fully nourished. So it might be that it’s not enough calories. Because my experience with some of my patients is that sometimes I think women underestimate how much food they need. Like you can’t — honestly, you can’t get by on a green smoothie and a salad, and you know, women need food, and there needs to be quite a quantity. And so I — and a lot of women know that, but I think some women maybe are struggling with that. So that’s one thing.

It could also be missing macronutrients. So not getting enough protein, fat, or in some cases, not getting enough starch. And that’s kind of a controversial topic because I know a low-carb diet is becoming very popular — at least where I live, I don’t know what it’s like there — but a low-carb diet can be helpful for some women, but it can also cause periods to disappear. And I have a blog post called that called, “Have you lost your period to a low-carb diet?”

Lisa: Well, we’ll link to that blog post. I think it’s really interesting. For me, I always think that it comes back to that awareness of your body and getting to the point where you can kind of understand how you feel and how food is affecting you. But I think the reality is so many women are so far away from that — that, I mean, you go from eating like a typical North American diet where you’re drinking pop and eating chocolate bars all the time. And then you like, okay, I’m gonna go paleo or whatever. And then you go like the total opposite. And then like eat only vegetables and like no carbohydrates. And that’s — I know that I can’t function without some sort of carbohydrate. And I don’t even mean unhealthy ones, but like I even if I eat say protein and fat like I eat breakfast with like sardines and avocado, like if I go hard one morning or whatever, I need an orange. I need sugar. So maybe I don’t know, maybe you could deepen into that a little bit. Why we actually need carbohydrates to some degree.

Lara: Yeah. Okay. So that’s a question for a scientist to do, which hasn’t been — no, I’ll just say — which I’m inviting anyone out there because no one has looked at this. Like basically no one’s, as far as I can tell, asked the question, why do women need more starch than men in general? And we need it for reproduction, which is — aka have a period — even if you don’t want to reproduce. This is the thing I’m trying to not — you know, I think we need to — it’s not about actually whether you make a baby or not. It’s about having a body that is capable of making a baby and therefore making hormones. And I don’t know the mechanism for why women need more starch than men in general, but it’s very true. And I’ve talked to lots of other doctors and clinicians who find the same thing. And I’ve treated hundreds of women who have recently lost their periods to a low-carb diet. And it doesn’t have to be sugar, but you give back a bit of potato or rice with the meals and they feel a lot better and they sleep better and they stop losing their hair and they get their periods back.

Lisa: Yeah, that’s a whole other topic. I feel like that’s — I really get curious about that. And I would just love to hear — because I feel like, okay, let me try to spit it out. I feel like when, as women, when we’re looking for information about our health, we end up — the majority of health information is sometimes put out by men. I mean, I think that that’s probably a fair statement. So then we try to fit ourselves into the same box. You listen to some dude talk about how he lost all this weight and what his crazy diet is and how little carbs he eats, but that doesn’t necessarily apply. I feel like there’s a lot of information out there that doesn’t necessarily apply to a woman who wants to have a baby.

Lara: I think you’re right. And I’ll just say I first read a book about the paleo diet in 1997. And I have a background in evolutionary biology, and so to me it always made sense. It’s like, yeah, it kind of makes sense that we should be eating kind of more what our ancestors did. But the modern popularized parts of it — at least some of the more visible parts of it, the paleo movement over the last few years — to me, just even as a woman, not necessarily as a doctor, but just looking at that, my feeling was, “Oh, that’s by men, for men. That doesn’t apply to me. That’s for those guys.” So I just kind of walked away from — I mean, I mention paleo diet a little bit in my book. It’s just a source of — you know, the principles of eating whole foods, and that all makes sense. But as a movement, as a kind of philosophy, it let women down.

Lisa: Well, and how do you — so I eventually — I’m going to pull it back, but I’m still going there — because I’m like, how do you, if you don’t have a really positive, healthy association with food, and you’ve always kind of had this thing in the back of your head where you’re trying to eat to maintain weight or lose weight — not just eat to nourish your body — then because what you’re saying then is you have clients who are eating this way where they’re eating like lots of protein, fat, not very much carbohydrates. They’re obviously doing that for a reason and they don’t feel good, but it doesn’t clue in. So there’s so much disconnection that even though you don’t feel good, and then you add in the carbs and you feel better. That’s a whole like — what do you do with that? You’re not a psychologist. How do you handle this?

Lara: It’s complex. Okay, here’s a simple — just because I have to, I’m on the ground, you know, with patients day to day, trying to help them connect with what it feels to be nourished and what they need. And so one of the questions I find myself asking — it’s not like I said I’m going to ask every patient this question, but I certainly find myself asking it a lot — is: do you feel like you’re getting enough to eat generally? Like yesterday, say for example, did you feel satisfied with your food? And I like the question because it also sends the message that you deserve to have enough to eat. This is our goal.

Lisa: That’s a good way to start the conversation. And to really take a moment and get out of your head and stop and actually think about that. So I think that’s a really great way. Okay, so undereating — back to the whole topic at hand, which is hypothalamic amenorrhea. One of the other things that you mentioned as well is stress. And I feel like that theme keeps coming up as well. So maybe you could talk a little bit about the relationship that you see between stress and losing your period.

Lara: Very direct relationship. It comes back to the hypothalamus again — it’s receiving. So it’s communicating not just with your ovaries, but with your stress glands and with your thyroid. It’s communicating with all the big players in your hormonal system, and it’s getting all that information back and integrating that in. So when it receives signals from the stress glands, from the adrenal glands, and it’s like, wow, there is a lot of stress right now — I’m going to dial back, dial down ovarian function. I think it’s almost as simple as that. I mean, of course, there’s other sort of mechanisms involved, but it’s pretty simple.

Lisa: And then when you’re working with clients — so I’m your client, I’m in there. We’ve talked and we’ve identified that I have XYZ stressors, like big stressors, work stressors. Maybe I’m not getting enough sleep, and I don’t know, have an addiction to sugar. So then how does that conversation go? Because I feel like stress is something that isn’t easy. It’s much easier to go and fill your vitamin D supplement.

Lara: I try to bring it back to self-care, to make time, because there’s no one magic herb or vitamin pill that can solve the problem. Some things can help, but ultimately it’s about having more downtime. It’s kind of, you know, boring. So I might prescribe something like this. This is actually a common thing I’d say to someone: okay, I’d like to invite you to schedule two hours per week to do kind of nothing. Like it has to be just really unstructured time. Like it’s not exercise. It’s not shopping. It’s not even maybe time with a friend. It could be maybe time, but it’s not time with your kids — although of course I know you want to spend time with your kids. So that’s a different time. This is time where you’re just going to flake out somewhere on a park bench and read a book, or even just do something as unrefined as walking around and trying on clothes — just something — and bring it all down and just be in your own body for a couple hours a week.

Lisa: That brought up a bunch of different thoughts in my head, and one of them is, like, how sad is that, that you go to your doctor and they have to prescribe for you to, like, chill the heck out. But it’s so true. I used to do yoga before I had the children — meaning that I had more time to do yoga, or I just made it more of a priority, I guess. And I remember thinking, how ridiculous is it that I’m literally going to a class so that I can listen to an instructor tell me to breathe? Because that’s what it is. I mean, it’s harder than that. I love yoga. I’m not dissing yoga because I really, really love it. But yeah, like it occurred to me. But then I would answer myself being like, well, because you need to, because you’re not breathing on your own, are you?

Lara: And the surprising thing is, I make that prescription. And the surprising thing is, there are a great number of my patients who their initial feedback is they can’t do it. They don’t have time. Like, they actually can’t — or they feel like they can’t do it. So that’s in itself, I think, a sign. That’s you know, a message from your life back to yourself — that something’s got to change. And even if that means I might even say things like, okay, can you please then cut back on work hours or hire someone to help you with some — like, there has to be something. Something has to get — like, there has to be some way that you could carve out that little bit of space.

Lisa: Yeah, that’s a tough one. That’s why I asked that question in terms of, you know, how do you manage that? Because even myself, like, I am no perfect person. And my naturopath has prescribed me to go to sleep before 11 o’clock. Like, my naturopath has literally prescribed me sleep. So I am in this boat with everyone else.

Lara: Yes, me too. I’ll just say I’m not perfect either. My goodness. Yep. Yeah, like literally she’s like, you need to go to sleep, and I was like, oh my goodness, but it’s so hard. So I totally get it. I feel like this is the hardest hurdle because it’s so hard to appreciate how big of an impact that stress can have. Yeah, because it’s tangible but it’s kind of intangible. And if you’re like, say, a 25-year-old woman, 35-year-old woman, 40-year-old woman, you’ve been living this way for a long time. So it’s not easy to just go and take two hours to sit on a park bench and read a book. Which would be lovely. It really would be.

Lisa: So some of the other — I guess that gives us some really interesting ideas in terms of what’s causing hypothalamic amenorrhea, what it is, and what type of an impact it has, and what are some of the other ways that you — I guess other treatments. And so we’ve talked a little bit about the lifestyle changes, but what are some of the other supplementation type of approach things that you do as well?

Lara: Yeah, supplementation can be helpful. So we’ll go into that. Actually, I might just take a minute to just follow up one thing, because you used the word perfect, which — it’s funny timing, because I’ve been thinking a lot about perfectionism, and I’m struggling with that myself. And it correlates quite strongly, sometimes, with disordered eating or eating restrictions. And I think which then correlates with hypothalamic amenorrhea — it’s this idea that we’re trying to control everything so nothing goes wrong. So we don’t eat the wrong food. And a lot of it’s about, you know, fear. And so one more prescription for that, I guess, if you’re in the grips of perfectionism like I am often, is to find a way to kind of be gentler with yourself, or to forgive yourself for things, or to love yourself.

And then one final thing about food, because that relates to not fearing food. And some of my patients — I often ask about binge eating. And if that happens — and it’s extremely common, so I want to know about it if that’s happening for someone — it’s not — it doesn’t — binge eating, or eating the wrong food, or eating quite a lot of the wrong food at times, doesn’t mean you’re a bad person at all. And I just invite people to just forgive themselves. It’s like, you were hungry — for whatever reason your hypothalamus decided you were really, really hungry. So that’s okay. You’re allowed to be hungry. You’re a human being. It’s just work to get you nourished. And then you’ll find that the symptom of binging just subsides on its own. You don’t have to force it away. You don’t have to force things. It’s about — it’s a different approach. It’s not forcing, but rather permitting.

Lisa: Yeah. I don’t know. I totally agree. I’m really happy that you brought that up. I see it sometimes in a little bit of a different way. So when I’m working with clients and, you know, we’re learning about charting cycles and going through charts, there’s often this kind of theme again with wanting the chart to look perfect. Because in the fertility awareness books you see this like perfect 28-day chart. But when you have an actual human being who has a variety of challenges, which is usually why they’re seeking out for support because it’s not just so straightforward — you know, you don’t need to have a perfect chart to get pregnant. Absolutely not. You don’t need to eat a perfect diet to get pregnant. No. So yeah, I think that it’s important to know overall like what are some of the ways that we can improve our health? What are some of the things that we can do to address it? And it is important to focus on those things to a certain extent, but it’s not the end of the world if you go off of it. There’s moderation there. Arguably there’s no good or bad food. It’s just like, there’s food. There’s food that’s good for you — there’s food that’s more nourishing than other foods. And it’s about moving away from kind of all-or-nothing thinking and giving a bit of wiggle room.

Lara: I agree. No, absolutely. And I love the point that you made before as well, which is that, like, no one supplement is gonna make all the difference. Because then there’s the supplementation aspect of it, the perfectionist, where you have 32 items on your list. I think a lot of women are confused. It’s like, do I take maca? Do I take vitamin D? Do I take selenium? Do I take magnesium? Like, what the heck am I supposed to take? How much am I supposed to take? And the idea that the supplement is going to give you the period when that’s not the way it works. Like, there are certain supplements that could support your body to have a period if it was needing that. And zinc might be a good example. Like, if you’ve been deficient in zinc, then yes, it can be very helpful. But it doesn’t mean that every woman with hypothalamic amenorrhea needs to take it or that it would even work for everyone.

Lisa: So how do you guide a woman through this supplementation conversation?

Lara: Okay, so one of the first ones I use — and you know from reading my book how much I love magnesium — I love it because it has a lot of actions in the body, beneficial actions. One of its main ones is it calms, or modulates, reduces the stress response. So what’s called the HPA — or the hypothalamic pituitary adrenal hyperactivity. So you can reduce the stress messages going to the hypothalamus. And that can be very helpful. But even then, one thing about supplements — it’s important to understand — even if you’ve done something very good with magnesium, it still might be three or four months until you get a period. It’s not going to be an instant thing. Because first of all, the hypothalamus comes down — you might feel a lot better in terms of sleep and energy right away — but it’ll take a few months for the signals to go to the ovaries. And the eggs in the ovaries take three months to develop, basically. So then they start going, you know, and three or four months later, then you get your period. You kind of get your reward, I guess.

Lisa: Yeah, that’s a big challenge. Because even like a listener of the podcast, you know, you listen to the podcast, you hear it, you’re like, okay, it’ll take three months — even when we talk about the pill, coming off the pill — but then when you’re actually in that situation and you’re waiting for the period and you’re waiting for the ovulation and you’re taking your temperature every day and nothing’s happening, like, so frustrating. How do you support clients who are in that stage where they’re just frustrated by the fact that it does take a while?

Lara: Yeah, I’m curious — as a fertility awareness instructor — when I’ve got someone who isn’t ovulating or hasn’t been ovulating for months and there’s no immediate signs that anything’s really happening, I ask them to not take their temperatures. I wait until they’ve seen some cervical mucus, or get what seems like a first real period, and then do it. Because yeah, it can be very distressing almost to be taking it — then you just get this chatter. Like the chart is just a bunch of chatter, like scattered. That doesn’t make sense.

Lisa: Yeah. No, it’s like they’re trying to look for a pattern — there’s no pattern. It’s not — the problem is you haven’t ovulated. Like, you’re not going to see a pattern until you ovulate. So you can just stop doing that for now. Well, yeah. No, I think that’s a really good approach. The thing about temperature is that it has one job. The purpose — the only thing it’s doing is telling you that you have ovulated. It has no predictive value. So if you’re looking at your temperature chart to figure out if you’ve ovulated, it’s a waste of your time. So I’ll give you a perfect example of that because I just had a baby nine months ago and so I’m breastfeeding. And I’m not taking my temperature because what would have been the point of taking my temperature for the last nine months? Exactly. So I check mucus and I record that and that’s how I roll. Until it comes back. And then yeah — you’ll know, because of course you’ve been doing this so long, you know your body. So you’re going to know when you — yeah, it’s usually pretty obvious when it just comes back.

Lara: So magnesium is one of the supplements that really makes a difference, but it takes a little bit of time, obviously, to see the results. Any supplement takes a bit of time. That’s a blanket statement for anything you take — I’d say minimum three or four months. Which is different, right? Because we’re thinking, oh, it’s kind of like the alternative to the pill, which gives you a period — a bleed — which is not a real period. You know, it gives you a pill bleed, kind of on demand, when you get to that part in the packet. It’s like — it’s not the same thing at all. It’s a very different process.

Lisa: Yeah. Well, I’ll take another tangent here because the video that you have — which we’ll link to in the show notes — why birth control can never regulate periods. I loved it. It was so creative and I loved the animation thing. And it’s such an important message. I think that’s why it’s gone so viral. And you’ve had — at this date — like what, 84,000 views or some crazy thing like that. And the important — one of the things that stood out for me that I know, but so many women don’t know — is yeah, there’s no point really to have a bleed on the pill. And the reason they did that was to make women feel comfortable with that whole situation. Because if they just took it away, women in the 60s wouldn’t have been okay with that.

Lara: Yeah. Yeah. There is no medical reason to bleed monthly on birth control. It’s an artifact of a funny story that happened 50, 60 years ago. Not so funny.

Lisa: Yep. And then there’s a whole conversation about, now people say that women don’t need to have a period at all, which is a whole — that’s a topic of a show of itself.

Lara: It is. I’m going to say one thing about it. It’s not that women need periods, it’s that women need hormones. And if you — this is what I care about the most — I’m a cheerleader for estradiol, our main estrogen, and progesterone. And the only way we can make them is to ovulate.

Lisa: Well, go figure. You mean to tell me that a woman comes fully assembled, period included? Like, I love this. I mean, there’s nothing wrong with us as women. We came this way. This is how we were created for a reason that’s bigger than we even will ever understand, to be honest. Our bodies are calibrated to have those hormones. We benefit from them. And to be fair, our ancestors didn’t have as many periods because they were pregnant or breastfeeding a lot more at the time. But when you’re pregnant, you make a huge amount of these hormones. So we were still getting hormones. Just in our modern time, we need to get them sort of — if we’re not having 10 babies, then we need to kind of get them, get our hormone doses monthly. But they’re beneficial.

Lara: Yes, exactly. And I’ll just bring up — if any of the listeners did not have an opportunity to listen to the podcast episode that I did with Dr. Jerilynn Prior — to really get why it’s important for us to ovulate. Because periods are a result of ovulation, and why it’s important then to have that balance of progesterone and estrogen. Definitely have a listen because her work is amazing and it really shows us why it’s not just about fertility.

Lisa: Oh, Lisa, I love Dr. Prior’s work. In fact, I don’t know how I missed listening to that myself, so I’m going to find it. I’m going to write — as soon as I hang up with you, I’m going to listen to that episode. She’s amazing. Okay. One of the supplements that I did want to ask you about — I think a lot of women have questions about vitex because we’ve all heard about vitex and how it impacts our hormone levels. So what can you tell us about vitex?

Lara: It’s a good herb. I like it. I do prescribe it a lot. It works. It has a couple of mechanisms, but one of the things it does is — I guess you could phrase it — it protects the hypothalamus from stress hormones. It kind of convinces, helps to convince the hypothalamus that everything’s okay and just speak to the ovaries again. And that downstream — that’ll look like it can reduce a hormone called prolactin, which can be elevated during stress as well. So it can definitely help to promote ovulation. That’s not to say that every woman needs it or every woman would benefit from it. Because my experience is that some women, if they’re tending at all to kind of a polycystic ovarian syndrome picture, which is a bit of a different thing, then I have found vitex to be sometimes not the right choice. It’s quite a strong medicine. And so yeah, it’s also called chase tree or chase berry. It’s made from the fruit, the berry of a tree. And again, it’ll take a few months to work. It’s not like you take it in the first month and you’re going to necessarily have a period. If that happens, that’s coincidence.

Lisa: I get a lot of comments on my blog saying, I took vitex and a week later I got my period.

Lara: I don’t think so. But you got your period a week later — you ovulated two weeks ago. Exactly. Yeah. Chances are. Well, that’s interesting. I think it’s important to know as well that nothing is necessarily going to work for everyone. Nothing is a magic bullet. And you have to consistently take all of these supplements really for several months before you see the results. If you’re going to try vitex, there’s probably no point in trying it for less than three months. Because I don’t think you’d then have really — unless you for whatever reason are feeling worse on it, then you can stop it, of course. But if your goal is to get a period and you haven’t yet seen a period, you need to keep going for at least three months, three or four months.

And then when it comes to vitex — how long can a woman take it? And if she gets pregnant, should she stop taking it?

I say yes. That’s controversial. Certainly, I know some herbalists who give it during pregnancy. I don’t, because I don’t know if we have all the safety data on that. So I say stop it when pregnant, but it’s safe when you’re trying. And I think I usually don’t like women to just keep — okay, my concern is, based on some — it’s not a lot of research to say one way or the other — but I think after many months, or like a year of taking it, I think potentially there’s a chance that its effect will attenuate. As in, the way it’s — what it’s doing at the hypothalamus and pituitary will kind of lessen. So I have women take — not take it every day. I always take a break during the month and not take it just continuously. I might say, if they really like it — a lot of women use it for PMS — so if it’s really helping them, then I might say, okay, that’s great, but maybe take one month off and then you can go back on and use it for that reason.

Lisa: Yeah, I think that kind of speaks to the idea that it’s important to work with somebody who knows what they’re doing. Because as much as you can get information online, from the podcast, from websites, from blogs, from books — the information out there is geared to women as general information, not necessarily geared to you. And so that’s something that I think, especially in this kind of world of fertility awareness, there’s so much information out there about it. And a lot of women end up feeling confused because you’re not getting the information tailored to you — based on your hormone levels, based on your situation, based on your diagnosis, quote unquote, or whatever the case is for you. So I think that’s really important.

Lara: I agree. And actually, one other thing I’ll say about herbal medicines in particular and vitex in particular is — unfortunately there are quite a few products on the market that are not delivering possibly an active dose of the herb. So there are definitely people out there who say, “Oh, I’ve tried it, it did nothing.” That might actually be because it wasn’t a good product. And to be fair, I get a lot of my readers saying which brand do I recommend. The brands I use with my own patients in Australia — but in terms of a comprehensive review of which brands are good and which aren’t, I haven’t yet done that.

Lisa: So just as we’re kind of coming close to the end, there’s a few questions I want to ask. So as I was reading through the book, there were a couple of different sections where you kind of talked about alcohol and how it would impact this or it would impact that. So generally when you’re working with women who are having hormonal dysregulation, how does alcohol impact our hormones?

Lara: It increases estrogen. That’s one of its big effects. And it does that via the intestinal bacteria. It impairs — it affects the bacteria so that they potentially kind of release — they interfere with the detoxification of estrogen and push a lot of active estrogen back into the body. And that’s why it’s linked with a breast cancer risk, I think. That’s why potentially it contributes to certain kinds of PMS, premenstrual symptoms. Yeah. Even year by year, I’m just realizing — we need to — women really shouldn’t be drinking very much at all, if any.

Lisa: Well, I remember years ago learning about that connection. And there’s, I’m sure, so much more to it. Like, I really want to do a show kind of just on alcohol. So I’ll have to look into that. And how it impacts because obviously the liver is playing a key role in detoxifying estrogens from your body.

Lara: Absolutely. And another theme in your book was the xenoestrogen issue, or the environmental toxins that we’re exposed to. So alcohol — your body considers alcohol a poison, right?

Lisa: It is a poison, yeah, absolutely. So when you drink it, the body kind of shuts down all the other detoxification that it’s doing. Right, yeah — it impairs the detoxification of things generally. So potentially then you’re being exposed for longer to some of the phthalates and plastic estrogens that we’re exposed to. I think there’s a multi-factorial effect of alcohol. My understanding has always been — like you drink alcohol and your body’s like, wait a minute, stop everything. We need to get rid of the alcohol. So then alcohol takes precedence. And your liver is just never stop — it’s 24 hours a day, just working for you. Our livers — we should all take a moment to put our hand on our abdomen. Thank you, liver. So we don’t even know what the heck it’s doing, but when you drink alcohol, whatever it was doing, it’s not doing anymore. Because now it’s rushing to get that alcohol out of our bodies so we don’t die.

Lara: Yes, ode to liver, thank you. Well, is there anything else based on our discussion today that stood out to you that you wanted to kind of share with our listeners?

Lisa: No. I think just — I don’t know if we had a chance to say this one in my podcast last year with you or a couple of years ago — this just kind of sums up our conversation about how the period is an expression of our health. You know, our fertility basically is an expression of our health. And so in that way I view our periods as our monthly report cards. And it’s a good thing. So if you’re getting bad marks on your report card, you can change that. You know, it doesn’t mean you’re a bad person. It just means something needs to change.

Lara: I love that. I think — yeah, I love that. I’ll just throw in there — a healthy body is a fertile body. I think that’s a hard thing to say for women who are struggling with infertility though, because then it makes them feel like there’s something that they’re doing wrong, which is not.

Lisa: Absolutely. Well, I just want to point out to your listeners — I’m sure you’ve hopefully had someone talking about male infertility — because it’s close to 50 percent of the problem is men. And it’s — this is actually a big issue. And it’s not just naturopaths saying this. Everyone — like, these women are getting treatments, sitting in the doctor’s rooms, getting tests, getting going to fertility treatments. And the whole time it’s the man who is the problem. And so I just — I experienced that in my own practice and it really upsets me actually. I’m just getting to the point where we have got to, as a society, look at this a bit more closely. And not to blame men, but it’s just like, if you don’t know why you’re not falling pregnant, it might actually be not you at all.

Lara: Well, yeah. And then the women are also like taking the vitex and eating the healthy and doing the thing and exercising and the yoga and the meditation. And he needs to be doing some of that too. Seriously though. But yeah, so if you’re partnered and you have a male partner and he has the cell phone by his gonads and he’s got the laptop on top of his lap all the time and stuff, and he drinks beer all the time and maybe never eats anything green — then we’re going to have to deal with that too.

Lisa: It’s true. You know what — two more things about that. It’s not enough for the doctor to have said sperm is fine. You know, you have a semen analysis — they have a pretty low bar for what is fine. It’s like, oh yeah, there’s millions there, so I’m sure there’s one good one. But sperm quality matters a lot. And sperm quality is the quality of the DNA. It’s affected by a man’s nutritional status. It’s affected by whether he smokes or not. It’s affected by microbiome, which is the bacterial — so there’s a microbiome of the seminal fluid. So there’s a microbiome around sperm, and that affects their quality as well.

Lara: Yeah, well, and I remember in one of the interviews that I did too, it was learning that some of the genetic abnormality then comes from the male. And the male could be the reason that you have the miscarriage. Absolutely — 100 percent. That research is out there and it’s very clear.

Lisa: And I don’t know any woman who has a miscarriage who thinks it was him. It’s not about — please don’t take me the wrong way. I’m not saying it was him, blaming him. But I’m saying like, there’s a factor. It’s two people that come together. Like we do the heavy lifting. But I mean, my kids came out looking exactly like my husband. Like, it’s really a significant contribution. We can’t keep blaming ourselves and taking all of that on. And it’s not about blaming anybody. Because none of us can put our hand up and say, “I’m perfectly healthy. I do everything right.” It’s not about that. It’s just about trying to do the detective work and think about what realistic changes we could make without beating ourselves up. Perfection is annoying. We could just go with — improved from last week.

Lara: Perhaps good enough. A little bit improved. Better than last week.

Lisa: All right, well, a few final questions to tie up the show. What would you say is the biggest myth about fertility that you would like to see corrected?

Lara: Oh, well, I think it has to be what I just said — that it’s a woman’s issue.

Lisa: All right. What advice, if any, would you give to a couple who’s struggling to conceive?

Lara: I guess it’s that it’s not you personally failing. You know, that it’s your bodies — both of your men and women body — that need some kind of support that you haven’t been giving it.

Lisa: Well, and a question that I just thought of on the fly, based on something that you said earlier about why we should care about our periods even if we’re not trying to have a baby. So maybe you could just speak to that. Why should women care about the health of her hormones and her periods if she never wants to have a baby?

Lara: Exactly. This goes back to Dr. Prior’s podcast, I’m sure, which I’m going to listen to. The reason we should care, the reason it matters, the reason ovulation matters, is because that’s how we make estradiol and progesterone. That’s the only way we make those hormones. And we need them for brain health, for mood, for metabolism, for thyroid, for bone health, for libido, for gut health, for immune health. Those hormones are essential. And if we shut it all down with hormonal birth control, we don’t have any of that.

Lisa: Yes, I love that. And final question of the day — for a woman who’s currently on the pill and doesn’t want to get pregnant now, but she’s thinking about it within the next couple of years, what advice, if any, would you give to her?

Lara: My patients come off the pill, usually. I strongly suggest that they come off — barring, you know, there may be some circumstances where I feel like maybe if they’ve got severe endometriosis or something like that, then I’m cautious and wouldn’t just. But as long as we can organize an alternative contraception — you know, fertility awareness method is my first choice. If a woman can feel comfortable and transition to something else, then I want her to get off so we can actually do something for her health.

Lisa: I think those are brilliant words to end on. So I’d like to thank you so much, Lara, for coming back on the show. I had so much fun talking to you and I know that I could pick your brain for the next like three hours. I go through every chapter in detail. I totally would. But where can our listeners go to find out more information about you?

Lara: Yeah. Okay. I’m at my blog — it’s larabriden.com. And my Facebook is Lara Briden’s Healthy Hormone Blog, and I’m on Twitter at LaraBriden, and Instagram, same. Awesome. Well, all those links will be in the show notes page. Thank you so much for coming on the show.

Lisa: Thanks, Lara. 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/428. I hope that you enjoyed today’s episode with Lara Briden. Fun fact — Lara was one of my very first interviews. She was actually in interview number seven. So if you’re wanting to go back and listen to it, it’s not available on the podcast player because I believe they only hold 300 episodes at a time. You can go to Fertility Friday on YouTube — all of the episodes are actually there. So if you’re wanting to listen to the very first episode with Lara Briden, you can do that, or you can head over to fertilityfriday.com/episodes. That is the collection of all of the episodes. You can search L-A-R-A, Lara, and find episode seven. It’s really interesting — we talked about the pill and actually quoted from that interview in the fifth vital sign. But either way, I hope that you enjoyed today’s episode and I hope that 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.