In modern medicine, the oral contraceptive pill (OCP) has become the panacea for virtually all forms of women's health issues. We are now over 60 years and several generations of women in to OCP use as a primary method of contraception and we're only beginning to unravel the long term health consequences.
Today we're joined by women's health expert, Lara Briden, who shares with us why she describes the pill as reversible chemical castration and why she is so passionate about empowering women to make better, informed decisions about their contraceptive options. Lara talks us through why shutting down ovulation is undesirable and what current and future options are out there to help couples manage their fertility choices. She also takes us through the herbal and nutritional interventions she employs in the management of 'post-pill syndrome'.
Covered in this episode
[00:40] Welcoming back Lara Briden
[02:10] Women's cycles have been left out of research
[04:29] Oral Contraceptive Pill: Chemical castration?
[07:55] How does the OCP impact women's hormonal health?
[11:22] Do we know the long term side effects of OCP use?
[13:38] Contraceptive options: efficacy
[17:42] When is the OCP used to treat disease?
[19:52] Current and future contraceptive options
[28:28] Managing post-pill syndrome
[36:43] The Period Repair Manual
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.
Joining us on the line from Christchurch in New Zealand is Lara Briden who's a Sydney naturopath with more than 20 years experience. She first trained as a naturopathic doctor in Canada and then moved to Sydney back in 2001.
Lara is a passionate communicator about women's health and alternatives to hormonal birth control. Her book, The Period Repair Manual, published by Pan Macmillan, and now in its second edition, is a manifesto of natural treatment for better hormones and better periods, and provides practical solutions using nutrition, supplements, and natural hormones. I'd like to warmly welcome you to FX Medicine. How are you, Lara?
Lara: Hi, Andrew. Thank you for having me.
Andrew: Now, we've spoken with Kira [Sutherland] before about researching women in athletic performance and things like that, which is an absolute travesty in itself. Firstly, women, hormones, exercise and health." Tell us a little bit about that.
Lara: The political issue of the fact that women have not been studied in almost every corner of medicine, especially nutritional medicine, especially sports nutrition. Women have been left out of the studies because our menstrual cycle makes us trickier to study. And so, what scientists decided to do is just study men and then apply those findings to women. And what we're seeing from more recent research is that wasn't good enough. You know, that doesn't work, and that's why many diets fail women.
Andrew: And just take us through a little bit of why women are so different, apart from the obvious.
Lara: Yes.
Andrew: But what makes women so, A, different, so hard for the scientist to control for, and why don't they? Like, what's the big issue?
Lara: Yeah. You know, I like to kind of flip the script on that and say that women are normal, women are just fine. Men are different.
But a woman's body, which I like to say is a standard, normal version of the human physiology, works on a monthly basis. So we have something called ovulation which is a very important event, not just for making a baby, not just for periods, but for health. It's how we make our main hormones, oestradiol and progesterone. And those hormones are equally important for general health for women as, say, testosterone is for men.
So, you know, men are different because they make their testosterone every day in a nice, little, predictable pattern. But, as women, we have this unique, I call it, you know, superpower that we make our hormones in a big surge, kind of around the middle parts of the cycle and, you know, the second half of the cycle make progesterone. So that requires a different way of looking at things, a different way of studying. And even Kira and I make the point, potentially, just a different way of doing things, maybe even eating differently in different halves of the menstrual cycle. And then having a whole rethink of everything after menopause because, again, that's another completely different situation. So, you know, it's a level of complexity, but it's one that we embrace.
Andrew: Not to split hairs but, you know, if we wanted to sort of go down that track about cycles, well, we all have circadian rhythms as well. So, isn't that a confounder to even male research?
Lara: Of course.
Andrew: So, you know, I don't get why it's such a big issue. Is it because they just want this control? It's got to be the same.
Lara: Yeah, it's just about trying to minimise the statistical, you know, variables. You make a very good point about circadian rhythm. That's true, and scientists have not been possibly accounting for that as much as they should.
Andrew: Yeah.
Lara: So, yeah, there are lots of variables. And one sad thing, is that to get around the problem of this variable of the menstrual phase, what a lot of scientists like to do is to put women on the pill, which is today's topic…
Andrew: Are, right.
Lara: To flatline hormones and therefore erase that variable.
Andrew: Got you. So now, you mentioned it before, today's topic is the female oral contraceptive pill, really, female castration. This is a bit topical.
Lara: I know, oh, yeah. So I think I said that to you maybe last time we chatted?
Andrew: Yeah, yeah. Is it?
Lara: That's a strong way to put it.
Andrew: Yeah, maybe.
Lara: But, I mean, I use that word because the drugs, I call them steroid drugs. I don't use the word hormone to refer to what's used in ‘hormonal birth control’. They're drugs.
Andrew: Yeah, they're drugs.
Lara: And they work by shutting down ovarian function, which is essentially, you know, a type of chemical castration. Reversible castration.
Andrew: Let's just delve a little bit into the history. We don't want to go into a, you know, sort of free 1960s... What was it? The burning of the bra and all that sort of thing. Women's lib, where women's lib started. But give us a brief history of the OCP, where it started. What were sort of the dreams for OCP and what are the realities that it's really led to?
Lara: Well, I think it's fair to say that the dream was effective contraception for women. And, you know, I think it delivered on that.
So, you know, the interesting thing about the history, the part that always gets me is because when they first tried to introduce the drugs in the late '50s and early '60s, it was not legal to take something to prevent pregnancy, which, of course, now seems very strange to us. You know, 60 years later that just seems barbaric that, you know, women weren't allowed to have access to it for that reason.
So what they did with the early pills, and the marketing, and the legislation though, the regulations around the pill is that it was to "regulate cycles." It was to, you know, "fix periods," or for period problems. And what that really meant was, "Wink, wink," you know, "give you a bleed and you're not pregnant."
Andrew: Yep.
Lara: That was an interesting thing because I'm sure, at the time, the doctors back then knew it wasn't fixing periods in any way. But now, a lot of us seem to think that it does. That somehow what started as just a cover story or a smokescreen became established as something that a lot of people seemed to believe? You know, I sort of think of it as like "The Emperor's New Clothes" situation, you know, that story. You know, we're walking around with this idea that the pill fixes periods, regulates the periods, and a few of us are pointing at it and going, "Actually, no, it doesn't do any of those things. It never did."
Andrew: And the evolution of the, you know, the different types of pill. There is the minipill, the high-dose pill, and we can talk a little bit about their uses.
Lara: You know, I think evolution is a, you know, not really an accurate term. Certainly the drugs have changed. There's new… they call them generations, which I think is a strange word to use. It's really just different drugs. Actually, some of the modern progestin drugs are actually more dangerous, have a higher blood clot risk than some of the original ones. So, there isn't as much progress as the word ‘generation’ makes it sound like there is.
And so, you know, we have different types, whether you combine it with the synthetic, you know, it was called ethinyloestradiol. It's not actual oestrogen, or and one of various number of progestin drugs. Or you can use progestin drugs on their own. You can now, of course, you know, have an injection or a ring, but those are all really just different delivery methods for the same drugs.
Andrew: And what does the OCP do to a woman's hormonal signaling, both short and long-term?
Lara: It shuts down hormones. It shuts them down. Like, it suppresses ovarian function, suppresses the communication between the brain and the ovaries. And my main issue with it, of course, you know, there is blood clot risk, there's breast cancer risk, that we know now there's a depression risk associated with those drugs. But my biggest concern as a clinician, and a human being, and looking at, you know, all of my sister women in the world is that it robs women of the hormones, specifically progesterone that women need for long-term health.
There's a reproductive endocrinologist out of Canada, out of the University of British Columbia in Canada who, Doctor Professor Jerilynn Prior. She helped me with my book, Period Repair Manual, and she's been a champion of progesterone. She's a scientist, and a researcher, as well as a clinician. And she makes a statement, and I'm willing to believe her, you know, I'm following her lead on this that thirty years of natural cycling… so thirty years of ovulation and progesterone through our lifetime is valuable, because all of that progesterone helps to prevent cardiovascular disease, prevent dementia, potentially prevent breast cancer. She has some documents where she lists all those potential long-term benefits.
So, her key message, and also mine, is that ovulation and ovarian function is not just to make a baby, but for the general long-term health of the woman. Let's regard women and hormones, our bodies, because of evolution, yes, are calibrated to have that oestradiol and progesterone, those real actual hormones present. They signal mitochondria, they are very active in the brain, you know, they have all these downstream effects on the body. Because the body expects to have them there.
Andrew: Yeah.
Lara: The body did not expect to have them just shut off and replaced with a drug called levonorgestrel for 30 years, for example.
Andrew: What about direct nutrient depletions as well?
Lara: Yeah, look, you know, there's all sorts of downstream effects. Because hormones are powerful, therefore, these steroid drugs, analogue… hormone analogues are powerful, they have different effects on the body compared to our own hormones that's going to ultimately affect lots of things.
Like, for example, the steroid drugs affect the microbiome, quite dramatically, I believe. And I think that's one of the reasons why nutrient absorption is impaired with the oral contraceptive pill. But, you know, there's other things with the hair loss. Hair loss is one of the ones that I think causes the most distress, actually. So the American Hair Loss Association issued a statement less than 10 years ago stating... Women need to know this; Especially anyone with a family history of hair loss needs to know that the main types of hormonal birth control are steroid drugs that are really more similar to testosterone than they are to progesterone, and so, therefore, cause hair loss. And sometimes, you know, if you are on the pill for a number of years, that hair loss will be slow and gradual.
Andrew: Yeah.
Lara: And it, basically, sometimes, well, many times cannot be reversed. So that is, for many women, a heavy cost to pay.
Andrew: Yeah.
Lara: Especially if they're weren't told of that, right?
Andrew: No.
Lara: You know, it would be different if they went into, they're thinking of...
Andrew: They never talked about that little chestnut. That's amazing. Okay, so some of these side effects. I just have this issue now, and, like, I am in favour of choice.
Lara: Me too. Yes.
Andrew: And informed choice.
Lara: Yes.
Andrew: And this is my issue, "Why aren't women informed?" It seems there's a little bit of clandestine stuff going on here that, "Oh, don't tell them that because it might decrease sales. Don't worry about the health effects." You know? "Unless it kills them, because that's a legal issue. So we've got to protect ourselves against that, but hair loss is okay. Don't worry about it."
What other sort of long-term effects do women run into when they're on the pill for longer than a certain period?
Lara: Well, we don't really know. I mean, no one is researching long-term effects on dementia, for example, or things like that.
Andrew: Wow.
Lara: You know, we have some long-term mortality studies, very roughly. But I don't think scientists have really been asking those questions.
You know, as to why women haven't been told this whole story, I'm sure there's lots of factors. I think part of the issue... I think there's a couple of things. I think many people just genuinely want women to have access to effective contraception, and I can understand that. And that's why there's this sort of backlash whenever anybody questions the pill. It's like, "Oh," but, you know, teen pregnancy or unwanted pregnancy is kind of anything but that. It's this attitude that, "It doesn't matter what women are suffering. Anything is better than unwanted pregnancies." The thing is, the problem with that argument is there are other ways to prevent unwanted pregnancies. The pill is not the only method of contraception.
I share a little story in my book which is a conversation which I've had, I'm sure, hundreds of times where I used to say to my patient, "What do you use for birth control?" And then I'd get the answer, "Oh, I don't use birth control. I use condoms." And I was like, "Oh, actually, that's a type of birth control." Like, that's valid. You're doing something.
Andrew: Yeah.
Lara: But now I rephrase and say, "How do you avoid pregnancy?" And, of course, there are lots of different ways to do that.
Andrew: Yeah.
Lara: So I just don't think that argument that, you know, "Women, this is the only option or we're going to have all these unwanted pregnancies." That doesn't hold water.
Andrew: Yeah. And then you've got issues, though, with various types of contraception, hence the OCP was relied upon as being the most effective form of contraception. You know, condoms, had a lesser one, dams and things like that. Gel… I'm not sure we have gels as well.
Lara: No, no one uses those anymore. On its own, it's not very effective at all. But here's the thing, Andrew. The pill isn't even...it's not the most effective. It's got a typical used failure rate of 9%, which is actually pretty high.
Andrew: Whoa, I didn't know it was 9%. I thought it was 2%. Really?
Lara: No, I think the perfect use is less than 1%.
Andrew: Right.
Lara: What they call typical use... Every method has a typical use or perfect use. Typical use just means if you forget to take some pills, there will be an unwanted pregnancy. Women do fall pregnant on the pill.
Andrew: Yeah.
Lara: Absolutely. I mean, it's not a guarantee.
The methods that have the highest efficacy rate are the IUDs or the intrauterine devices, of which there are, of course, two types, the hormonal ones. Which is sort of in the category of what we're talking about today. Although, I do think the hormonal IUD is arguably a bit better, but for reasons we can go into. But then there is the copper IUD, which is non-hormonal.
Andrew: Yep.
Lara: And the two have similar, I think, effectiveness rates, you know, very, very high.
Andrew: Yeah. So you said, "Let's discuss it." Let's go into it.
Lara: Okay. The way it's different is that unlike, literally, almost all other methods of hormonal birth control, the hormonal IUD does not work primarily by suppressing ovulation. So, it does potentially permit ovulation, and the making of hormones, and the making of progesterone, which, remember I said is important for long-term health according to Professor Jerilynn Prior. We need those monthly doses of progesterone for general health. Potentially, some women can still get that on the hormonal IUD.
The research seems do suggest that the hormonal IUD inadvertently does shut down ovulation for the first 12 months while the dose of the levonorgestrel drug is highest, and then over the next few years the dose is lower and ovulation can be permitted. It doesn't work by suppressing ovulation. It works by just locally preventing the buildup of uterine lining and changing the typical mucus, so the cervical fluid.
So, one thing I like about to say about the hormonal IUD is that... And I don't want to imply that I'm just a huge fan of it. I actually think there's way better methods than that. I mean, just on the topic of the hormonal IUD, I say this; So on the pill, you bleed but don't cycle, and on the hormonal IUD, you cycle but don't bleed.
Andrew: Right.
Lara: And what I mean by that is those bleeds that one gets on the pill are not real periods. They have nothing to do with an actual hormonal cycle or ovulation. They're meaningless, actually. There's no reason to bleed monthly on the pill. But in the case of the IUD, it's kind of the opposite. You may see no bleed, but you're still getting that cycling going on in the background.
And also, I mean, on the topic of the hormonal IUD, just before we leave the topic, it reduces menstrual flow a lot, by about 90%. And so, of course, that can give great relief. It can give some relief for endometriosis as well.
So it’s, and again, I don't want to sound like I love it. Because the hormonal IUD fared the worst in the big study of Denmark where they tracked 1.1 million women and established a pretty clear link between all methods of hormonal birth control and depression and anxiety. And of all the methods, actually, the progestin-only methods like the IUD actually had the strongest correlation. So it's not without issues. It is solely levonorgestrel, the drug that is testosterone-like, so potentially can still cause skin breakouts, and mood, and things like that. But it is still, in my thinking, different than other types.
Andrew: Yeah, yeah. Going back to the oral contraceptive pill, when is the OCP used to treat disease states?
Lara: It's used for everything, Andrew. It's basically, as far as I can tell... I mean, I shouldn't laugh, I don't know why I'm laughing. It's like this one size fits all.
Andrew: I think there's a little bit of frustration in that laugh there, Lara?
Lara: Yes, and I've just been having the craziest conversations with patients lately. Like, you know, when they're relaying what their doctor said to them. It's like, almost no matter what is going on, what subtle thing or differences, almost no matter what is going on with a woman's cycle, the existing mainstream solution is the pill.
And, I mean, why doctors like it? I can't really blame them for this, is that it erases symptoms, pretty much. Because, of course, because it shuts down the whole system. It's like if you're having trouble with your car...
Andrew: Don't drive it.
Lara: You just shut it all down and you drag it with a horse or something. It's like, you know, "We can't fix it, it's too complicated." It's just, "No, gone."
Andrew: Yep.
Lara: That's what the pill does. And to me, of course, as a naturopath, that just does not make sense. Because the problems haven't gone away.
Andrew: No.
Lara: When a woman then stops the pill, her problems are still there, probably often amplified. Most of the time it worsens, actually, by having been on the pill. So she didn't gain anything in that way. And actually, when most of my readers and patients, when they kind of find out that this was just a masking the problem kind of thing, that it actually probably worsened the problem in the long-term, they are not happy about it. There are a lot of pretty angry young women out there right now who sort of are just like, as the penny drops and they think, "What?”
Andrew: Yeah.
Lara: “I'm taking a drug that induces a kind of chemical menopause, and then I'm taking these drugs that are actually more like testosterone than the hormone I'm supposed to have?" Yeah.
Andrew: Yeah.
Lara: Yeah, as to why? It can't be long. I think it really is going to start to shift and change, I hope.
Andrew: Yeah. So what about the alternatives? Now, we've discussed these a little bit, but let's go through them step by step, the dams. The gels aren't used in Australia anymore.
Lara: Okay, so, yeah, the current landscape toward non-hormonal birth-control is, well, there's the copper IUD which I mentioned, which has pros and cons. If it's okay, I'll refer to...I have a blog post called "The Pros and Cons of The Copper IUD," and I think it's pretty balanced. You know, there's obviously good and bad things to that.
Just to say, for any of your listeners who might not know, because the IUD has not been popular the last few decades. Women have kind of lost awareness of what it is. It's a little copper and sort of plastic earring-shaped, earring-size device that the doctor inserts through the cervix. It's not surgery. I just mention that because most of my young patients have no idea, you know. They think it must be a surgical procedure to have it inserted. It's just done in the doctor's office. And it can be removed any time. You know, it's a fairly simple procedure to remove. So just that puts it in a little bit of context, I think. It's certainly something, you know, women could try.
I had one patient say to me that she would like to try the copper IUD, but she then would not want to have to convince her doctor to remove it. I was like, "What?" A lot of my writing comes directly out of conversations with patients like that.
Andrew: Yeah.
Lara: I said to her, "Okay, look, you know, there's no convincing involved. Like, it's your body. If you decide that device is not right for you, you just say to your doctor..."
Andrew: "I want it out."
Lara: "I want this out." Obviously, that's, you know, her choice. So just that could be a message for women as well.
Andrew: Yeah.
Lara: But there's the copper IUD. Then there are condoms which are great. You know, I don't know why... It's a little bit of a grey area. Their effectiveness is better or worse depending on how they're used, and depending on the type of condom as well. Like, the effectiveness of them is going to be greatly increased with better quality condoms. There's a couple on the market now. There's a couple that I mention by name in my book. There's one brand called MyONE fit condoms, male condoms, that come in 60 different sizes. And by having a condom that actually fits, kind of like wearing shoes that actually fit, you decrease the risk of slippage, and breaking, and all those things.
Andrew: Yeah.
Lara: So it's just kind of a no... Like, when I heard about that, I thought, "Why is it 2018 and we're just learning about it, like, having this now? That seems so obvious." And there's other, just a couple of brands that, you know, claim to be unbreakable. So, there's definitely, I think if used properly, they're a valid method.
And then there's the fertility awareness-based methods, it's actually plural because there's lots of different kinds. But where women track their fertility with their temperatures, morning basal body temperatures, or cervical fluid, or cervical mucus, or a combination of the two. And they need to either learn how to do that properly from an instructor, which could be done online a lot of the time these days. Or, there's a couple of devices out there that have a computer algorithm that does the calculations for women. I'll mention them by name because they're in the news a lot, and I think women need to know, and I'm kind of a fan.
Andrew: Yeah.
Lara: So there's one called Daysy, which is, yeah, a little computer built right into the thermometres. So, it kind of does everything. It gives a red, green, or yellow light depending on whether it's safe or not to have unprotected sex on that day. And they claim pretty high. They claim, I think, 99.3%, currently, effective.
Andrew: Wow.
Lara: And then the other one is, that was just in the news... It's been a lot in the news, because it was just approved as contraception in the U.S. It's called Natural Cycles. Their efficacy is a bit lower, I think, than Daysy. I think it's fair to say that. They have different algorithms. So there's that.
And that's the future, Andrew. I mean, I think those methods are just going to continue to improve and become more of them. And just to clarify, that is not the rhythm method. I mean, the rhythm method is a very old-school, old-style version of this.
Andrew: Yeah.
Lara: These are scientific in that they use objective measures the fertility, including temperature. So, most experts and scientists agree that when they're done properly, you know, there's efficacy behind them.
And then just going down the list, there's a new diaphragm which can be used without spermicide, which is nice. It doesn't have the toxic effect. It has a gel that it's used with, it's called Caya. I believe it's available in Australia. And then, you know, there is withdrawal. Which...I just mention because a lot of women are still doing it. There's a couple who are using that. So I talk about some of the nuances and, you know, things to consider with withdrawal in my book. I'll let listeners just refer to that, maybe.
And then there is a company coming called Vasalgel, which I think is going to be a game-changer. I'm holding out for this. They are being developed by a nonprofit organisation in Berkeley, in California. And it's a reversible, non-hormonal birth control contraceptive for men. It’s a one-time injection of gel into the vas deferens which is the tube that connects, you know, puts the sperm into the semen. So they block that, and then it can be reversed with another injection when a man is ready to have a baby.
And I just feel like something like that is so much more modern. And, I mean, just, you know, if it can be proven to be safe and effective, and obviously it doesn't affect men's hormones, you know, that could be a game-changer. Because suddenly we're trying to avoid teenage pregnancies. You can say, "Right. Well, let's just give the boys this safe procedure."
Andrew: One of the biggest risks, if you like, for unwanted pregnancies, the spur-of-the-moment action with no other method of birth control, condoms have their issues for males. You know, there's some males don't like the feeling of them and things like that. So...
Lara: Although to that, I would just say, "Tough."
Andrew: Yeah, get used to it.
Lara: Just keep going. Let's keep going, yeah. Yeah. One thing about, you know, contraception for men, here's just a little factoid to consider. Men are fertile every day. Women are fertile only six days per month. So, you know, from that angle, why are women shouldering all the burden of contraception?
Andrew: Well, we'll go back to the 1960s and '50s. So, you know, there's the whole cultural thing of what men's and women's expectations were in society, where it started. And it just seems to have flowed from there. I seriously, I just think, "Wow, what a fantastic thing if we can get a male contraceptive device," pill, not a pill, you know, the injection. If that comes to fruition, wow, what a level of control that will give to society.
Lara: I think so too. I think it will certainly address that issue, you know, that concern about...just for those, I guess, people who, for whatever reason, don't have to wherewithal to either use a condom or take a pill daily. Because taking a pill daily is something to remember as well.
And just on the topic of male contraception, I would not be a fan of using some kind of hormonal method that suppressed men's own testosterone and then replaced it with... I mean, that's what they're looking at, some drugs like that for men. And I just feel like I would be hypocritical to say that's fine for men, but it's not okay for women. So, you know, I'd like to see non-hormonal methods for both sexes.
Andrew: Yeah. I think it would be interesting, though, to see if there is a lot more investigation into potential side effects into men, male hormonal issues than there was for women? Hormonal side effects, adverse events, and things like that.
Lara: Yeah. That got a lot of press actually, last year when there was a trial where they were giving a progestin drug, so, you know, it’s to suppress a testicular function. And then the synthetic testosterone replacement, it's kind of similar, basically the same as what we do for women.
Andrew: Yep.
Lara: And there were a lot of side effects. This is what got press. They cancelled the trial due to the headaches, and weight gain, and depression that the participants suffered.
Andrew: Really?
Lara: And, of course, all on social media. That got a lot of traction, saying, "Okay..."
Andrew: But women just suck it up. Yeah.
Lara: Yeah.
Andrew: What about moving away from the OCP? If it's already an established strategy for couples, or women on their own, how do you get them to move away? How do you get them to regain their personal power, and also their health, and their normal cycles?
Lara: It depends on what their challenges are going to be. So if I have no reason to think there are going to be any specific period problems, and the main challenge is just finding alternative contraception, then that's usually just a conversation about which of those methods that I just mentioned a woman, you know, wants to use? A lot of my patients are using Daysy, the little computer fertility awareness method device. Some get copper IUDs. You know, just a variety depending on preference.
But then it's another situation if a woman expects or maybe has tried to stop the pill before, and then had post-pill acne. That's a really common one. Or had pain come back which, you know, if it's endometriosis, that's another situation. Or, you know, stopped the pill and periods didn't come. And then there was that whole aspect.
Andrew: And that's called the post-pill syndrome. Is that right?
Lara: Yeah. So, some people call it that as a broad term for all those different possibilities. I tend to look at it more kind of focused on which of those different problems it is, that's basically just a problem that is reemerging after being masked by the pill. It's not specifically caused by stopping the pill. Although there can be a temporary PCOS situation which I did describe at the PCOS Symposium.
Yeah, I am certainly seeing women who possibly had normal cycles before, then went on the pill for 10 years, and then come off and find they're in this situation of not bleeding, not having their regular menstruation, and then having these high levels of male hormones that basically, immediately qualifies them for a diagnosis of PCOS. And yet, at least for some of those women, that could just be a temporary situation as they transition back into their own cycles.
Andrew: And how do you help women along with, say, nutrition herbs, maybe acupuncture? What other methods do you use in your armamentarium to help normalise cycles?
Lara: Yeah. Yep. So my practice is I use some pretty simple things. I think mainly because I put some fairly simple things in my book. I really wanted these treatments to be ones that are available to, you know, most women out there, not expensive, not complicated. But, for example, let's use post-pill acne as the example.
Andrew: Yeah, yeah.
Lara: If I know, because it's common, that's a really common reason for women to be trapped on the pill basically, not be able to go off it because every time they try, they get this, just, explosion of skin breakouts like they've never seen before, even if they had skin problems before.
That's a withdrawal from some of the other drugs called drospirenone and some of the kind of anti-testosterone types of drugs that are used in certain types of birth control. And that typically, not in everyone, but typically can have this skin adaptation kind of withdrawal phase. Which the skin is usually at its worst about three to six months off the pill, so not immediately. But six months later, they might be thinking, "Oh my goodness, this is how it is now. You know, I really must need the pill," and so they retreat back to it.
So if that's already happened, then I make a strategy while they're still on the pill. So it's best if they see me before they come off the next time, because then we do some simple anti-acne strategies. Such as no cow’s dairy, less/dramatically reduce sugar, take zinc, and sometimes I look at a couple of other nutritional supplements. But zinc is the big one. I'm mentioning zinc first and almost foremost because I don't like people to lose sight of zinc when pursuing some of the other ones.
Andrew: Yeah.
Lara: And then we keep that in place. And I reassure. I say, "Yep, this should, you know, reduce it quite substantially. You're probably still going to get some breakouts that can't be avoided, part of the post-pill process. But know that, at about the six-month mark, that's pretty much as bad as it's going to get. And you're going to start to then just improve anyway."
And even just that reassurance can be quite helpful for women, because they have some sense of control, like, some sense that they know what's going to happen.
Andrew: And do you tend to use, you know, like zinc, B6, magnesium together or do you just go zinc on its own? I guess where I'm thinking is, you know, the transferases, and the dehydrogenases, the flow of the hormones, that sort of thing?
Lara: Yeah, look, those three nutrients are a powerful combination, I will grant you that. And, yes, I think very often my patients are on a combination of magnesium, zinc, and vitamin B6. It's just a mechanism.
Andrew: They're just so simple. They're so simple, so cheap.
Lara: Simple, exactly. And this separate mechanism is why that's all working.
I think zinc, just specifically for the skin, you know, has a natural anti-androgen effect, anti-microbial, you know, helps the immune system, it dries up skin oils, it reduces keratin. Like it just has quite a nice... And there's been a number, a few, anyway, not a huge number, but some clinical trials of using highish-dose zinc to treat skin problems, also to treat period pain, actually. There was a study a couple of years ago published in The Australian Journal of Obstetrics and Gynecology where they used, I think it was like 40-milligram zinc, which was around the dose I would probably often give. And they concluded that it was as effective for period pain as the pill.
Andrew: Wow.
Lara: And then, but get this, Andrew. What they said in that same paper was, they're like, "Well, therefore, we should look at this as treatment because it's cheaper than the pill." That was their angle on it. I'm like, "Yeah, okay, it's cheaper than the pill." Also, it's heaps better than the pill because it doesn't, you know, shut down a woman's hormonal system.
Andrew: Yeah.
Lara: So there's that as well.
Andrew: What about certain vitamins? Like, for instance, I think thiamine. Now, this was more to do with dysmenorrhea not cycling and things like that. There's one large trial on it.
Lara: Yeah, I've heard that vitamin B1 for period pain. I haven't personally, like, as a clinician, I haven't used that a lot, but not because I don't believe that it works. It actually sounds great. It's just, I have other things that also really work, so I tend to... so period pain, I tend to go, again, the no cow's dairy, it's kind of a repetitive thing here, and zinc, and magnesium, and vitamin B6. Yeah, it does sound a little bit repetitive here.
But, I mean, it could be simple. I think, yeah, vitamin B1, definitely. It wouldn't surprise me if, actually, yeah, if there were some formulas out there, period pain formulas that have all of those nutrients combined.
Andrew: Any commonly used herbs there, any ones that you tend to lean towards in your repertoire?
Lara: Herbal medicines, or nutritional supplements?
Andrew: Yeah. Oh, both.
Lara: Both. I do do a lot of kind of single dosing of zinc, like a nice kind of 30-milligram zinc capsule or in liquid zinc. I use all the variety of magnesium powders.
As far as herbal medicine goes, I guess the main one for this type of work is I do look at some of the...especially in the market now, at least three good ones amongst the practitioner-only brands of peony and licorice combination for PCOS.
Andrew: Got you, yep.
Lara: And it has an androgen-lowering effect to promote ovulation. It really is a nice combination. So I tend to give that in tablet form, but that, I mean, certainly, the naturopaths are already giving it in liquid form, which arguably would be even more potent. So...
Andrew: And, of course, you cover all of this in your book, "Period Repair Manual."
Lara: Yes.
Andrew: Which I've got to say, like it's seminal. It should be a text in all naturopathic courses.
Lara: Aww, thank you. Yeah.
Andrew: Well, it's important. It's written from an expert angle who cares. And somebody who's got a lot of expertise in finding out not just what does work, but what doesn't work, but also the sort of issues that prop up along the way for women and how you can get around that, you know, i.e. when things go wrong. And that's what you effectively do. I really do take my hat off to your work. You've done a lot for not just women, but couples, and along, their babies I would say as well.
Lara: Yeah. No, thank you. Yeah, I wrote "Period Repair Manual" for laypeople, well, for women, just ordinary women around the world. But it has been great to see how useful it is for clinicians as well, and naturopaths, and also doctors. Like, I'll say I actually had a few doctors too.
Just, what it gives for a lot of clinicians, I think, is a framework to start to think about things and then they can still slot in other treatments and, you know, other expertise that they have. They can slot that under some of these ideas. So, for example, like, one of the main ideas in my book is that ovulation is important. You know, that when we're putting on our detective hat to work out almost any kind of period problem, we need to be thinking about, "Okay, what are the obstacles to ovulation here?" So that's just, you know, a good start starting place for a lot of different clinical thinking.
Andrew: Yeah, Lara, thank you so much for taking us through this very political, very hot issue. Or, it's a constant hot issue, but along with anything that goes with women's hormones, it's sort of like shoved under the carpet.
Lara: A recent interview that I did, the interviewer said, "Oh, well, you know, I guess it's all very complicated." And my response was, "Nope, nope, it's not. It's not that complicated." This is my key message. It's actually quite simple.
Andrew: Andrew.
Lara: Lots of aspects of this are actually quite simple. This is a disservice that we've done to women to think that women's health is mysterious, and complicated, and in the too-hard basket, and only for the gynecologist to understand. You know, my key message is that women can understand their own bodies. And certainly, natural clinicians can step in and help them to do that as well. We have to, because they're not getting that from most doctors, and women deserve better.
Andrew: Thanks for joining us on FX Medicine, Lara.
Lara: Great, thank you.
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.
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