[00:00:00] Speaker A: Most of us were never really taught how our cycles actually work, what's normal, what's not, or how those patterns connect to our overall health. But your menstrual cycle is more than just a period every month. It's like a built in report card for your hormones, your nutrition, and even your stress levels. Understanding what the menstrual cycle reveals can offer more powerful insight into fertility hormone balance and overall well being. Welcome to the Fertility Cafe, where we explore the beautiful complexity of modern family building.
I'm your host, Eloise Drain, and this is a space for honest conversations about surrogacy, egg donation and the journey to parenthood. With expert insights and real stories, we're here to guide you through the medical, legal and emotional aspects of third party family building.
We believe that love has no limits and neither should parenthood.
Welcome back to Fertility Cafe. I'm your host, Eloise Drain. In our recent episodes, we've talked a lot about reproductive health, from what happens at your ob gyn visits to what it really means to advocate for yourself in the doctor's office. But today's conversation zooms in even closer to something many of us experience yet really understand in depth, the menstrual cycle itself.
For so many people, the cycle is reduced to one question.
Did you get your period? And that's the end of the conversation. But your cycle actually holds valuable clues about what's happening throughout your body. From hormone shift to thyroid function and even nutrient balance. Learning to interpret those signals can change how you approach your health and fertility altogether. Joining me to unpack this is Lisa Hendrickson Jack, a certified fertility awareness educator, holistic reproductive health practitioner, and founder of the Fertility Awareness Mastery mentorship program.
She's also the author of the Fifth Vital Sign, the Fertility Awareness Mastery Charting workbook, and her newest book, Real Food for Fertility, co authored with Lily Nichols, rdn. Lisa also hosts the podcast Fertility Friday where she explores menstrual health, body literacy, and the science behind fertility awareness. Her work has helped countless women understand their cycles that aren't just about reproduction. They're about overall health.
[00:02:25] Speaker B: Lisa, thank you so much for joining me.
[00:02:27] Speaker A: I appreciate it.
[00:02:28] Speaker C: Thank you for having me.
[00:02:29] Speaker B: So I'm just gonna jump right in because obviously fertility awareness isn't exactly something that most people growing up know about.
What kind of got you into this space?
[00:02:41] Speaker C: My very first period was heavy. It was painful from the start. And I was put on the pill because I wanted to be, because girls talked back then and that was kind of like, oh, you go on the pill. And then you don't have any pain and the periods are easier. And I was like, this is sounds great. I was in ballet. Leotards and heavy bleeding aren't a thing that you want to go together. I was on it for the period stuff, so I wasn't on it for birth control. So I was always a nerd. So I like read the insert and, you know, all that kind of stuff. Although I don't remember reading about the side effects, to be honest with you. But I read about the different things it would say. Every now and then I would just come off of it because I kind of thought, like, I'm fixed because I was a child. So I'm like, these periods are better. So let me just come off of this thing. Now I remember actually my dad used to you still taking those pills?
And so anyway, so I'd come off every now and then, but then my actual period with the heaviness and the pain would always be like, back with a vengeance. And so I didn't have the language that I do now, but I knew that it wasn't the same and it wasn't actually a real period. So now I understand that. So I wouldn't have been able to explain it, But I actually did have that experience that it wasn't the same and it wasn't actually fixing it. So that's kind of the backdrop. So when I then did, you know, need birth control, I decided that I wanted to come off the pill. And I grew up as a child of the 80s and 90s where they told us that the sex ed was if you have sex, you'll get AIDS and die. Right? They were telling us to use condoms. I grew up in the era where they were telling us that they were 98% effective. So I didn't have any, like, issues coming off the pill and deciding, okay, I'm going to use condoms. The reason I decided to come off the pill is because I remember reading the insert and it was like, if you skip a pill, take two, and if you skip two, take three, or whatever it said. I thought that I would always be nervous because I was never good at taking it at the same time every day and all of that. So I felt like I would always be using condoms anyways. I would always be nervous if I was pregnant and didn't know it anyways. So I may as well just come off of it and use condoms. And also because I had this issue with the heavy, painful periods, I felt like it shouldn't be that way. I wanted to see if I could figure it out. So this is what I did. And then it was right around that time that in my first year of university that I discovered charting. I was on my university campus. There was a speaker, and she was, you know, she had written a book, and she read her book, and the book itself wasn't totally about fertility awareness, but she mentioned that she had learned that she wasn't fertile. Every day she could chart her cervical position and, like, all this stuff, and she could figure it out in her talk. So I went to my women's center on campus. I found my way to Tony Weschler's taking charge of your fertility. And at the age of 18, 19, that's when I started charting. And so I was charting on my own for a little bit and obviously really fascinated by it. And it was great because in school, they taught us that we could get pregnant every day, and there was no safe days. But you don't understand anything about your cycle. And with fertility awareness knowledge and learning about how the cycle works, the temperature shifts, the mucus changes, the cervical position changes. For the first time, actually off the pill. With charting and condoms, I felt so much more confident. Like, I didn't feel scared that I would be pregnant and, like, not know I was pregnant or whatever. And I felt like because I could identify the fertile days, I just felt so much more empowered because I knew which days to be extra intent, intentional about using condoms. So then around that time is there was a group of women that were meeting monthly, and there were women who were training to be educators, certified educators, fertility awareness educators that would pop in. It was called the fertility awareness charting circle. And so of course, I started attending. And then within, like, a matter of months, I was like, I was helping with all the different things. And then we ended up, you know, started teaching. And a group of us took a training together. Because we were poor, we couldn't afford to, like, individually take the training. So, like, a group of us pulled together and we pooled our money together and we asked the teacher if she would teach us all as a group. And so in my very early 20s, I took this training, and it was all very grassroots. There was no, like, keep in mind. I graduated from high school in the year 2000. So there was no apps, there was no social media.
There was coffee shops, and then at some point there was Facebook. But, like, all of this was happening before all of that stuff. So we were teaching at a grassroots level. And I remember wanting to make a career out of this, but feeling like there was no way, how would I ever get enough clients? How would anybody find me? How would I ever make enough money to actually make this a career? That was my 20s where it was more grassroots and coffee shop by donation. It was definitely not a full time gig. It was more of a passion project and all of that. Enter podcasting, social media, Internet, you know, online marketing. And that was when I decided to. When I started the podcast in 2014, that was when I just thought to put it out there. I was like, you know what, this made a really big difference in my life. I started to notice how a lot of women in my age category were having so much trouble conceiving. And while I had had access to all of this information about how my cycle works and to understand how to use fertility awareness for birth control or to conceive, when my husband and I were ready to start a family, we knew exactly when to do that and we had all this information.
But you know, the average woman still has no idea. So. So that was why I initially started the podcast. Just to kind of put it out there and think, does anyone want to know? And so in 2014, I was the first fertility awareness podcast, period, and one of the first fertility podcasts at all, which is hard to even think about now, cuz there's thousands of them. That's what it was. And I think because I was the first to kind of like start blabbing about it on open air, you know, a lot of people did gravitate to it and there's a lot of people out there now that are aware that the menstrual cycle is a vital sign. But of course, we still have a long way to go.
[00:08:17] Speaker B: If you think about it, it's kind of wild that we're taught very little about something that happens literally every single month. What all you have to go through just to learn about it yourself. And here we are, we are preteens and we start getting our periods. We have no idea what it is, we have no idea how to track it, we have no idea. We just know. We bleed every single month and that's it. That's all we really know. So was there a moment for you when you realized, okay, more people need to know about this. And I mean, I know you started the podcast and all of that, but was there a trigger?
[00:08:52] Speaker C: The specific timing of when I started the podcast would have been after I had my first son. That would have been the trigger. Because something changes when you become a mom. So there was a couple things. From a practical standpoint, I now all of a sudden, my time had value. I've always been a very kind of workaholic type a type of individual. I never had any issues with just working a lot. So when I was in university, I would get two jobs, right, because I wanted to save money for school and whatever I needed. And I was always a good saver and all that. But, you know, I would get a job 9 to 5 during that summer season, and then I would also get a job in the evening. Like I waitressed in the evening. And then I have like a 9 to 5. And there was one year where I actually had a weekend job too. So a lot of those early years, I just was always working a lot. And it was my time that I was spending to earn money.
And when I had my son, I knew that that was over. There was no way I could do days and nights and weekends ever again.
And so there was a practical standpoint of like, you know, I, I, I need something scalable. But there was also the kind of like, now my time has value in a way that it never did before. Now. If you see my face, it's literally because I'm away from my child. So if I'm going to be away from my child, I need to be doing something that I actually believe in. That was one of the reasons why, because that was one of those things that had really transformed my life, my view of just even women's health. That's why the center of my platform is on this idea that the menstrual cycle is a reflection of health, because that was one of the most transformational aspects for me. So when I shared my story, I kind of just shared the bones of it. But like I said, I could go on about the story because one of the things that I found. So I started charting on my own, and I was charting away. I was able to identify my fertile days and all that, but my cycles were on the longer side. So on average, my cycles were kind of like 38 days. Looking back, I think there may have been some insulin resistance. But when I went to went to the group and I'm bringing my charts, one of the instructors looked at my chart and she's like, lisa, your temperatures are super low. Your cycles are really long. You should have your thyroid tested. And I remember just thinking, how did this woman just look at these dots on this paper? Because back then, no apps, so it's legit, like a, you know, an Excel spreadsheet situation here. And so she's looking at this and telling me all this Stuff about my health. And that really transformed because before I thought it was just cool birth control. And so that moment is probably one of the reasons why we're here. So it was a combination of things, as you can see, the practical thing that a lot of women go through when you have children and you're trying to figure out what to do, you know, because feminism told us we should go to work and work all the time and whatever. And then you have a baby and you're like, what is wrong with you people?
And so, so there was that. So then I had to kind of find another way to be in the world. And the other thing too is that, you know, I wanted to do something that, like I said, like, if it's time away from my children, I have to feel like it's worthwhile. Otherwise, I'm quitting.
[00:11:45] Speaker B: Yep. Yeah, yeah, no, I, I, I hear you. When you talk about the cycle being a vital sign, what does that actually mean in English?
Just in plain English.
[00:11:57] Speaker C: When we think about the vital signs, the common vital signs that our, you know, medical providers are looking at, we're thinking about things like our body temperature, we're thinking about things like our heart rate or our respiratory rate or our blood pressure. If you think about any of those vital signs, if you go to the doctor and he checks your blood pressure, if the blood pressure is too high or too low, it does provide general information that there's something going on. But your doctor would know of some of the common reasons why it would be high specifically. And so that would provide a bit of a roadmap for, okay, it's high. We're going to follow these kind of like testing or whatever we need to do to determine what that might be about and, you know, ways to treat that. And so with the menstrual cycle, it's the same kind of idea. And when we talk about the menstrual cycle as a vital sign, one of the questions that I used to get a lot people think I'm talking about just the period, but when I mentioned the menstrual cycles of vital sign, I'm actually talking about the whole thing. So from your first day of your first period all the way until the day before your next one, and if we break the cycle down into its parts, we do have the period and then we have the pre ovulatory phase. So from, you know, when your period is done, we have until you're ovulating, and then we have from ovulation until the next part of the cycle. And in all of those phases, there are a variety of different things we can pay attention to to identify what's normal, what's optimal, and what could be a sign that there's something wrong. And so if I give a couple basic examples of that, if you look at the period on its own, you could look at how long is it lasting, and is the bleeding happening during the menstrual. Menstrual time, or is it happening all throughout the cycle? Right. So we could be looking at those kinds of things. What does a normal period look like? Is it painful? All of those. If we know what's normal, then we can identify that. If it's outside of that, there could be something wrong if we're looking at even something as basic as cervical fluid patterns. So in the menstrual cycle after your period, you know, that's when your estrogen starts rising, as your follicles start developing because they are preparing for ovulation. And as that estrogen rises, that's what stimulates our cervix to produce cervical fluid. And so that looks like either the creamy white hand lotion or the clear, stretchy, raw egg white type cervical fluid. And when we know what's normal, we know that we, you know, should expect to have mucus anywhere from two to seven days leading up to ovulation, and then it should stop or largely decline. But if we're seeing discharge every single day, then that gives us information. Maybe it's an infection. Maybe, you know, there's a different issue going on there. And even the length and duration of the cycle, so. So knowing that healthy cycle averages about 29 days and 24 to 35 days, if we're seeing that, you know, the cycle's always 45 days or 50 days, or you lost your cycle altogether and you're of reproductive age. So that in general tells us that there's something going on. But if it's long and irregular, that could be a sign of PCOS or something like that, where we have insulin resistance and glucose intolerance. You know, in a lot of different cases, if you lose your cycle altogether, that could be a sign that you're exercising too much, not getting enough nutrition. If that goes on for several years, you are at a lifetime greater risk of osteoporosis. Like, the more you get into it, you realize, oh, wow. So as a woman of reproductive age, you actually should have a cycle. It should be within these normal parameters, and everything isn't fine. So a lot of women have had the experience where they go to Their practitioners. And why are my cycles irregular? Why am I having this bleeding? Why am I having this pain? And it's like, go on the pill. Go on the pill is not like, this is why you're having this. We're not looking at the cycle, and we're also giving the impression that you can't normalize it, that there's nothing you can do, or that we just don't know why it's like that. That's nonsense. So that's kind of at the heart of this concept that the menstrual cycle is a vital sign. Because if you can get your head around the fact that if your body is functioning normally, your cycle will fall into those parameters. And if the cycle is not falling into those parameters, there's a reason. And if we figure out that reason and figure like, you know, sort that out, your cycle will go back into that parameter. I think the whole world would be.
[00:16:00] Speaker B: Different for women, 100%. And I'm being educated right now. And I've been in this space for a long time, so, you know, there's that. So walk us through what is going on with our bodies leading up to ovulation and then what happens afterward.
[00:16:14] Speaker C: The first day of the true flow. I would identify that as the first day of your cycle. So during your period, you're shedding the functional layer of the endometrium that build up the cycle before. During that time, you're shedding the lining as you move into that first phase. Like I said, what's happening is your body's preparing for ovulation. And so within your ovaries are groups of follicles. A little pool of follicles is. Is there and developing. And one of those follicles is chosen essentially by your body to. To grow into the dominant follicle. And so it grows up to 20 times its size. And as that follicle is growing, so basically an egg inside of a little. A little sac, which is the follicle. So as that is growing, it is producing significant estrogen. And it's the estrogen then that has a variety of different effects on the cycle. One of the things that estrogen is doing is that it's stimulating the growth.
So it's growing back that functional layer of the endometrium. I mentioned that it stimulates the cervix to produce the cervical fluid. I remember when I was a teenager that I just started feeling like, this wetness in my underwear sometimes. I remember asking my mom about it, and, you know, she was just like, well, just wear panty liners. So I started wearing pan lighters. That was like the end of the conversation. I was like, thanks, Mom. Okay, so we're gonna do penny liners. But anyone who experienced that, you know, there's some women, unfortunately, who none of us are really taught about this. So you might end up at your doctor's office getting a prescription for an infection you don't have because you have cervical fluid that's normal. And this is a real thing. And I'm sure at least one person who's listening has had that experience. So as you move closer to ovulation, we produce a cervical fluid. And it is important because it facilitates our fertility. You know, I always call it like a, a home away from home for the sperm. So we produce this fluid leading up to ovulation, and it has the capacity to keep sperm alive for up to about five days or so. And so during the time that you have the cervical fluid before ovulation, those would be your fertile days. That would be your fertile window. You know, I think what a lot of women have in their mind is that we have to figure out which day I'm ovulating on, and that's the day I'm fertile. But no, it's the window. If you had sex on Monday and the sperm, and you have cervical fluid, the sperm can hang out. And your cervix. So in the cervix itself are these little crypts that are legit, like little hotels for sperm. It is wild to learn about how our body works. So our cervical fluid draws the sperm into the crypts and they actually hang out there. They can hang out there for several days during this five day period where this, the mucus can keep it alive. And then we produce a different type of mucus the day or so before ovulation happens. And then it kind of pushes them into the, the reproductive tract of the fallopian tube. You know, the way our body is designed is really just incredible. So in addition to the kind of drawing the sperm in, the cervical fluid also filters out sperm of poor morphology.
And if the sperm has poor motility, it won't really have the gusto to be able to kind of swim through. So it's also like a collection filtration system so that, you know, once you have sex, if you're trying to conceive, it's only like the good guys that make it through. So all that's going on once your estrogen reaches to a certain level. So once that follicle gets to that Place where it's like juicy, it's, you know, ready. The egg is finally ready to ovulate. The estrogen rises to a certain point, and that is what triggers ovulation. Ultimately, you know, we have a feedback system where once the estrogen reaches a certain point, our pituitary then releases lh luteinizing hormone. That's what the ovulation predictor kits test for. And that is ultimately what triggers ovulation. So all of that is going on before you ovulate. And then once you ovulate, then that same follicle that had been growing and held the egg, it bursts open and the egg is released. It turns into what's called the corpus luteum, which is kind of like a temporary endocrine gland. And that's when we start producing progesterone. So we don't really produce significant progesterone until after ovulation. And then progesterone has different effects. So estrogen was stimulating the production of mucus, progesterone shuts it down. Estrogen was building up that uterine lining and proliferating it, progesterone matures it. So progesterone comes in, stabilizes the uterine lining, and it also is necessary to make the endometrial lining. It basically makes it ready to accept the fertilized egg. So it changes the lining so that it's able to do that. So in addition to that, progesterone raises our body temperature, it raises our metabolism. So that's why we check temperature. And that's why once the temperature increases, the thermogenic effect to progesterone does increase our metabolism. And so therefore we can actually confirm ovulation by taking our temperature each day. All that good stuff. I mean, ob. I can go into the weeds here, so I'm going into a lot of detail, but you did ask.
[00:20:44] Speaker B: So you had alluded to a range of when your cycle can come on. And when I was young, it was always the rule is 28 days for your cycle. And if it wasn't in that 28 days, then, you know, is it really normal? So how much variation is really actually normal?
[00:21:03] Speaker C: The 28 day thing is a whole conversation. But when we look at cycle data, there's lots of research, there's a lot of studies that have looked at a collection of hundreds of thousands, thousands even of menstrual cycles. So for women of reproductive age, the average length of the cycle is about 29 days. And then what's considered to be normal fluctuation is if the cycle is fewer than eight days of fluctuation from cycle to cycle. So for example, what that means is that if you had a 27 day cycle and then you had a 32 day cycle, and then you had like a 29 day cycle and then you had like a 33 day cycle, we wouldn't consider that to be irregular, we would just consider that to be normal fluctuation.
Because we're not robots, we are humans. And so there is some degree of normal fluctuation. And any woman who has tracked her cycle, whether it's through fertility awareness methods or just paid attention to her periods, because you hear a lot of women saying, I'm like clockwork and I'm every, you know, but if you actually track it and you actually write it down for an entire year, no, you didn't ovulate, didn't ovulate on day 14 every single time. And you didn't, you know, have a 28 day cycle every single time. Actually if you did go buy a lottery ticket. But no, it's just, it's just not a thing. And this is why it's helpful to know what's normal and what's not. Because then if you think that anything other than 28 days is abnormal, you could be making problems where there isn't any.
So it's really helpful to understand that normal, there's some degree of normal fluctuation, that's all right. And when we do consider it to be an issue is when the fluctuation is happening more than eight days from cycle to cycle. One thing I should mention, so I took you through the cycle, talked about ovulation, talked a little bit about progesterone. So what's interesting is after we ovulate and that follicle, you know, transforms into the corpus ludium, it actually has a bit of a lifespan. So the healthy luteal phase, so the healthy second half of your cycle, post ovulatory or luteal phase, you can use those terms interchangeably, is about 12 to 14 days. If you think about that. If we're thinking about cycle, that's 28 or 29 days. So ovulation does not always happen on day 14. So in a healthy cycle, in order for it to fall, I think I mentioned that the, the range for a healthy cycle could be somewhere between 24 and 35 days. 35's kind of like the upper limit. But if your cycle's somewhere in there pretty consistently, then that falls into normal range. In order for that to happen, ovulation Typically has to occur somewhere between days 10 and days 22. So interestingly, you know, there is some leeway there. There's a lot of women who are trying to get pregnant and they'll just have sex on day 14 religiously. Maybe they ovulate on day 19. So tracking is really helpful. I do a program for women's health professionals and it's a very practical program. So the women in the program who are of reproductive age and cycling, part of the program is that it's a mentorship. So part of the program is to actually chart and to go through those charts in class. And then we have a pract component where they're sharing their clients charts with permission, anonymously and all those kinds of things. And one of our practitioners brought a chart from a client that was really interesting. So this client cycles were like 28 days. And so she assumed that she was ovulating on day 14, if I remember correctly. I think she was trying to conceive or something like that. I don't remember all the details right off the top of my head, but basically she was using an app and the app tracked her periods only. So she was assuming when ovulation was based on what the app was telling her. And what was interesting is when she actually started tracking her mucus and her temperature, she was ovulating. I think it was like day 19 or 20. And so her luteal phase was like really, really short. And so everything she was timing was just totally wrong, even though her cycle was 28 days. So that's just an example of we have to kind of learn how our bodies actually work instead of whatever nonsense we've been told about 28 days cycle ovulation, day 14. Like we have to really elevate our education so that we can understand how our bodies really work.
[00:24:35] Speaker B: But I think that that is the problem is that there's nobody really out there educating any regular folks. Right? There's no one really educating anybody. That's the whole thing. And why I felt it was important to get you on the podcast, because we're not talking about it, we're not educating anybody about it. It's definitely not anything that's taught in schools, quite honestly. I mean, we're half ass taught sex education, we're definitely not taught reproductive health. And nowhere in there is there any fertility awareness whatsoever.
So, you know, it is a very important conversation to be having and for us to be taking the onus on, we have to be able to start having these conversations. Because if we're trying to help the next generation, or my daughter's generation or my granddaughter's generation, or what have you, and them knowing this information ahead of time, how much we could really empower them to be able to be ready and whenever it's their time to want to have children. So even if they don't want to have children, and that's fine too, but.
[00:25:37] Speaker A: At least still knowing your body and.
[00:25:38] Speaker B: The signs of that, there could be something completely off with just from your cycle. So if somebody's cycle is bouncing around, it's short one month, it's long one month. Is that an indication that there's something worth looking into? Like, there is something wrong? Or it could just be that that is your body and it's not this textbook thing that everybody says it's supposed to be.
[00:26:01] Speaker C: That's such a great question. It made me think of a few different things.
So one of the things that made me think of was when I started charting, as I mentioned, my. My cycles were on the longer end. And I remember when I was reading through, you know, one of the books on charting, there were these examples of different cycles. The short cycle, the, you know, regular cycle, and then the long cycle. And I remember thinking like, oh, I just have long cycles. That's just how I am.
And then, like I told you, my charting instructor was like, actually, no, that's not how you are. So to answer your question, I would say that we want to understand what the normal range is. Like, you're human, so we all have the same normal range. So imagine if you're like a zookeeper and you know that elephants have a certain gestational period when they're pregnant, right? It's not like you're going to be like, well, no, Sally the elephant has a different gestational period than the like, no, I can go on with different examples. One example could be period volume. One of the exercises that we do in our programs is just like, this is what's normal. And then we do like a blood demo to show the range. There's a range of what falls under normal, but to show what is light, medium and heavy so that you can see. Because of course, there are women who have really, really heavy periods where they're bleeding, you know, through a super pad or a super tampon every hour. And maybe it's always been like that for them. So they're like, no, no, no, this is just how I. No, it's not like, no, it's not. And this is why it's so important to understand what normal parameters are so that we can identify when you're outside of those normal parameters. So to go back to your example, if you, if you have a woman who's saying, oh, I bleed every two weeks, that's not something we can say is normal because again, you're a human. So we know what's normal. And from the charting perspective, the first thing I want to know is what's really going on. Whenever someone tells me that they're bleeding every two weeks, there could be something else going on. I don't necessarily always believe on its face that you could be ovulating and have a bleed every two weeks. So we want to establish is it ovulatory? Is that bleed representative of a true menstruation? A true menstruation would be defined as bleeding that does take place after like confirmed ovulatory event. So I described the cycle and if you ovulate a healthy cycle, your period, if you are not pregnant will come about 12 to 14 days after. But of course the luteal phase can be very short and that would indicate a problem. So I've seen women and I've seen cycles who, where the, the luteal phase is like seven days, that is never okay. And there's always reasons why it's so short. It's often related to exercise or undernutrition or something like that. And those activities are preventing your body from producing sufficient progesterone to give you a luteal phase that's within the normal length. So if we're seeing that kind of beyond eight days fluctuation from cycle to cycle, there's definitely something going on.
[00:28:37] Speaker B: Well, that's, that's definitely interesting now. And you had talked about you being on birth control in the beginning. Right. And how does the birth control work in all of this? And then the kind of, there's a two part question, how does it work with all of this? Because I think that people don't understand.
You think like it's birth control is just preventing me from having, getting pregnant. Yeah, but there's a lot more to it. And then what happens when someone comes off birth control? Because a lot of women are surprised when their cycles don't immediately fall back into place where it was before.
[00:29:14] Speaker C: The first piece of your question is how it works. And I'm not sure what's going around these days. It's been a while since I was in high school, but I remember when I was younger they would say, oh, it's, it tricks your body into thinking that it's pregnant. That's what they would say. I just talked about how the cycle works. There's different types of hormonal birth control. So I think the most common are the combined oral contraceptive. And that means the combination of synthetic estrogens and synthetic progestins. But there are, you know, methods that are progestin only and things like that. The majority of what I'll talk about is related to the regular, like the pill, the patch formulations that have the combination of synthetic estrogen and progestin. The primary mode of action for that, that type of birth control is to suppress ovulation. So they work by interfering with that natural communication that is happening between your hypothalamus, your pituitary gland and your ovaries. And so ovulation is suppressed. If there's no egg, there's no baby. So that's one of the reasons why it can be so effective. One of the secondary modes of. Because that's not the only function. So another mode of action of birth control is to prevent your cervix from making that fertile quality cervical mucus that we talked about. So when you're on the pill, theoretically, you know, because it's suppressing your natural production of estrogen, it's giving you the synthetic version instead. So it's giving you synthetic estrogen and synthetic progestin. So your natural hormones are very, very low. And so that causes the cervix then to just fill with a thick gelatinous mucus plug, like what would happen outside of the fertile window. And so women on the pill are, you know, not seeing fertile quality mucus. And so therefore the sperm can't get in there. And then the third main mode of action would be that it prevents the uterine lining from getting thick enough to support a pregnancy. That progesterone makes the uterine lining receptive to the fertilized egg. And so when you're on hormonal birth control, then the uterine lining is very thin. So it's not thick enough to actually support a pregnancy. Those are the main modes of action. And then if you look at the progestin releasing iud, that is an example of a hormonal method that doesn't always suppress ovulation. So sometimes ovulation is fully suppressed, sometimes it's partially suppressed. You know, sometimes women continue ovulating cyclically, even with that progestin releasing IUD in. But then its mode of action would be to thin that uterine lining and to prevent the sperm from having that thick mucus plug to Prevent the sperm from having access, even that is useful to think about. So when they say, oh, it's like you're tricking your body to thinking it's pregnant, I would say, like, no, false. Because if you were to look at a woman's natural hormone profile while she's on the pill, so the little bit of hormone that she's actually making, it's more comparable to a woman in menopause.
What's interesting about that is then if you think about the side effect profile, low libido, painful sex, vaginal dryness, it's like, oh, it all makes sense now, right? The one thing that's interesting about this is that when you talk about this information, it's better now. But when I first started, there was more of a, like, you're being anti feminist. You can't call this out. If you tell women this kind of stuff, then you're going to dissuade them from using the pill. And that's bad. But I think that at the end of the day, it is what it is. Like, it works, how it works. You can look up the papers. I go through them in great detail in my book. So you can read, you know, if you want to go and find the notes and pull the papers and read them. So I'm just sharing how it works, and there's no reason why we shouldn't learn how it works. That's something to consider. If ovulation and our menstrual cycles were only related to conception, if that was the only thing that they did in the body, then shutting them off would only prevent you from getting pregnant. It wouldn't also be associated with all of the side effects. Some of the most common side effects associated with birth control include things like depression and anxiety. And I mentioned low libido and, you know, painful sex. And it is associated with nutrient deficiencies, a whole host of them, including things like folate and B12 and, you know, zinc. It kind of offsets the zinc copper balance. Like, why? Well, because our menstrual cycle is a central part of the body and our whole system as women of reproductive age. So when we shut it down, it's not like, you know, I'd often give the example of like, a car. Like, a car is a machine. So if I decide to pull out the air conditioner, the car will still run and it's fine because it's a machine. So these things are totally separate from each other. But as a human, it is not separate. They are connected.
And so when you suppress ovulation for that time, it does have these other effects, which is really interesting.
[00:33:41] Speaker B: So ovulation, that is not just about, not just getting a period. Like there's actual key signs of health pieces to your body for that.
[00:33:50] Speaker C: Well, ovulation is how we make our hormones. Like that's how we make estrogen and progesterone. And they're not only related to the ovaries and the endometrial lining. For example, women who are put on birth control really young, it's suppressing their natural estrogen and progesterone production and it has the potential to interfere with their lifetime development of bone density. It's well established in the research. Like if a woman of reproductive age, if she stops having a period. So I kind of mentioned that for the example of HA hypothalamic amenorrhea, if she's exercising too much or under eating or whatever and she stops getting her period altogether. The lack of your natural estrogen and progesterone flowing through your veins is associated, especially over the long term, six months or more, with a lifetime reduction in your bone density. Women who have HA for an extended period of time are more likely to develop osteoporosis. There are women in their 20s with osteoporosis because they went years without having a period. Yeah. Our hormones are related to more than just whether or not you want to have a baby. Mm.
[00:34:54] Speaker B: So why do you think they push.
[00:34:56] Speaker C: Between like a 25 and 30 billion dollar a year industry is hormonal contraceptives with a B.
[00:35:02] Speaker B: And I do know people that were on various birth control or whatever and it wasn't the pill or an iud. There's other ones out there that they were on it for these shots for an extended period of time. And now experiencing osteoporosis.
[00:35:18] Speaker C: I can be friendly and cordial with the other, like some of the other methods, but when it comes to the shot, I feel like it's all hands. I am not a fan. If we look at the research, it's certainly associated with a really high side effect profile and also a very long post contraceptive transition phase. So there was another part of your question, which is a whole other situation, but the other part of your question was around coming off and what happens. So in my research I've looked at there's a temporary period of subfertility post pill. That does not mean that pregnancy is not possible. It just means that there's a temporary period of subfertility while your body bounces back.
So as I mentioned, one of the primary modes of action for most hormonal contraceptive methods is to suppress ovulation. You know, if you're suppressing ovulation, what happens? A few different ways to look at this phenomenon. And one of the interesting lines of study is to see the impact of the pill on ovarian reserve parameters. So, you know, if you're trying to conceive and it's not happening, you're gonna go and get a bunch of fertility tests done. And that's when they're testing those ovarian reserve parameters. And that's things like your AMH levels, anti mullerian hormone, your antral follicle count, and even your ovarian volume. When you're on the pill, it's suppressing ovulation. So your ovaries are dormant. And those studies are kind of scary because they show that the ovarian volume, the size of your ovaries, it reduces by 50%, meaning the ovaries shrink a little because, again, they're dormant. And then the ovarian reserve parameters, like the AMH levels, are quite a bit lower. Like, how could they not be? The ovaries are dormant. This is one way that we know that there's this temporary suppression. And then there's some of the studies that I've shared in my different writings. There was one study that was really interesting because they looked at a group of women who were wanting to have fertility preservation done. And so fertility preservation is like when you're young and you pay all this money to have them take out your eggs, right, and freeze them. What they found was that if a woman was on the pill and she came off the pill and then immediately got the procedure done, she would have not as great results. Like, so when they gave her the stimulation drugs, you know, she wouldn't have as many eggs. You know, the pill suppresses those ovarian reserve parameters. So she would have a lower antral follicle count, she'd have a lower AMH level. And. And these are two factors that are associated. If those levels are good and you do IVF stimulation, then those numbers are associated with better results in terms of how many eggs they're going to retrieve. And again, it makes sense because the ovaries are dormant. So in the same group, they had the test group, they would test their ovarian reserve parameters monthly. And so they did that for about half a year, six to seven months, if I remember correctly. And so by month six and seven, those ovarian reserve parameters, they normalized. They were in the Normal range. And so the, the researchers came to this conclusion that if a woman wants to have fertility preservation done, they should consider coming off the pill several months earlier so that they would have to give their parameters a bit of time to rebound so that there would be a better result. Right. They would stimulate better and they would get more eggs, more bang for the buck. Yet that logic is never applied to women who are trying to conceive naturally.
Interesting.
So there's other lines of study that would support what I'm saying about this temporary period of sub fertility. One of the ways, like some studies just look at cycle parameters. So I just kind of went through the cycle, you know, and I Talked about average 29 days, you know, got your period and then you got your mucus, you ovulate, you got the different phases of the cycle. So there's some studies that just look at. Okay, so you have women who've never taken the pill. There's a study that I've talked about a lot. And so they had, you know, between like 200 to 250 women who never use the pill, had them track their cycles. And they're tracking not just the overall length, but they're tracking the pre and post ovulatory phases. So you can actually see the length of that post ovulatory phase versus the pre ovulatory phase, et cetera, and even mucus they were looking at. So women who had never used the pill, and then women who would use the pill two years or more and they came off. And so they basically tracked them cycle over cycle until to see how long it would take before their parameters normalized. So the women off the pill, the first cycles tended to be a little bit longer because sometimes it can take a little bit of time before you ovulate. The first time, the pre ovulatory phase, like the time between period to ovulation, that phase was longer for a period of time. And the post ovulatory phase, especially within the first two to three cycles off the pill, tended to be a lot shorter. And like, when you look at the data, because they kind of compare it side by side, it took about nine to 12 cycles before the women who had used the pill before, their parameters were pretty much indistinguishable from the women who had never used it. I just want to stress, like, this study was not testing if they could get pregnant or not. So.
[00:39:52] Speaker B: Right.
[00:39:52] Speaker C: You know, I'm not saying these women couldn't get pregnant, but I'm saying there's different ways we can look at, is there a temporary suppression of fertility? Is there an effect on fertility? I've been working with women for many years and in this capacity of cycle tracking, teaching them to chart their cycles for birth control or conception. I've worked with, with I don't even know how many women at this point, hundreds who've come off birth control. So you see that the first couple cycles like they're longer, they're not as stable, luteal phase is shorter, mucus production, abnormal, often not very much mucus for several cycles until it starts to rebound again. And that is interesting cuz it lines up with the study on the ovarian reserve parameters. Like you're seeing the ovaries kind of like revive and come back to life and like you're seeing those hormones like finally kind of get like back into the groove.
One other line of study that I find to be really interesting and hard to find though. So there's a lot of studies out there that look at the time to pregnancy post pill. And so what I found is that a lot of the studies, they'll give you one number, they'll look at a group of women and they'll say at the 12 month mark, you know, 70 blank percent of women conceived and therefore the pill is a reversible contraceptive method and there's no effect on fertility, but they give you the 12 month mark. If you look at the fine print, if you pull out the study and read it, anybody who had any cycle irregularities, any type of problems are excluded from the study. Just so that you know how many women are put on birth control because of cycle issues, cycle irregularities, hormonal imbalances, anything. Right, but all of you guys are excluded from that study. So they're telling you, you know, up to 80% of you guys are just going to conceive within a year, no problem. But by the way, you weren't included in the study. Okay, so then the other thing is that they're staying at the 12 month mark. So there was a study that I've shared quite a bit about one of the rare ones that actually broke it down month over month. So they had women who were using condoms, obviously non hormonal method, you just take off the condom versus the combined oral contraceptive versus a shot versus the hormonal iud. So they had several hormonal methods that they were comparing to condoms. The non hormonal method. What was really interesting is that they define long term use as two or more years. In that study, if you use the pill for two years or more that is considered long term use. So for those long term users, on average it took twice as long for conception. So the women who were using condoms and stopped on average conceived within four months on average. The women who came off of the combined oral contraceptive, on average it was eight months. Months. The shot on average was 15 to 18 months for long term use and the IUD was about twice, it was about eight months as well. This is where I always feel like, because I've read all these papers and then you know, they'll want to say like, you don't want to scare women.
I don't have the patience. We have been taught for our entire lives that we could get pregnant any day. I have not met a 20 year old who's like not like married and trying to have a baby, who's not absolutely terrified, just terrified. When she comes off the pill, she's okay for like two months. But when she's not pregnant, even in month three and four, she's already freaking out a little bit and thinking that there's something wrong with her. Nobody told her about this transition phase. Nobody told her that the take home message or like the conclusion is, you know, I'm not here to scare anybody. I'm just literally like reporting on the data. Like that's all I'm doing. What my recommendation in general is if you're thinking about conceiving in the future, you want to start thinking ahead. You want to come off, if possible, come off the hormonal method, I would say a minimum of a year before you're ready. And that means that you're coming off when you're still scared, you're coming off when you're actually avoiding still. But you're an adult, you can have a conversation with your partner, you can figure out a non hormonal method. Condoms are up to 98% effective. You can pull up a YouTube video and learn how to use them. Because most of the younger generation doesn't seem to know because our health system is just so interesting. I've had this conversation, you know, over the years where my generation I mentioned was like the AIDS and die use condoms generation. But the younger generation is like, if you're not on birth control, you're definitely pregnant. You're pregnant right now, get on the pill. What I've observed is that that younger generation, they're so petrified of coming off the pill because they basically think that if they're not on it, they won't be able to get pregnant. And I Also think that that generation, somehow the men have this entitlement and expectation that the women are going to be on the pill. So you have all these, these young people that are having sex and they've literally never had a conversation. They literally have never had the conversation was, yet I'm on the pill. And there's never ever been any responsibility that he's had to take. And so I think a lot of these younger women are terrified because they've never had the conversation.
[00:44:28] Speaker B: Yeah. And I think that it's, it's, it's about time.
[00:44:32] Speaker C: My recommendation would be come off before you're ready, use protection, let your body normalize so that when you're ready to conceive and chart your cycle, you know, if this has intrigued you, start charting, start learning about fertility awareness. Start charting, start learning about how to tell when you're ovulating, all of that. And do it while you're avoiding. So you're avoiding. I know you're scared. Learn about it though. Education helps to quell the fear and be responsible. You're an adult. You can figure this out. Done more complicated things in your life. Right. So there's that piece of it. Because what I've seen in, in my practice is like when women come off the pill and they're ready to conceive right now versus when women come off the pill, but they're avoiding and they're learning to chart for birth control and they're using a non hormonal method. Their bodies are going through the same thing, except for the woman who's trying to conceive. She's also stressed because maybe she didn't get pregnant as soon as she wanted to. Maybe her mucus is weird. Maybe it took an extra, you know, six weeks for her first period. Like she's so stressed about the same exact things that are happening to the other woman.
[00:45:28] Speaker B: And, you know, and the thing about it is, it's also up to us, I guess, to reframe the idea of fertility. And it's not just about getting pregnant or not getting pregnant. It's also about learning how your body is functioning, functioning overall.
[00:45:40] Speaker C: Well, an understanding that part of having a healthy body, just like part of having healthy blood pressure or a good respiratory rate, like part of being a healthy adult female is having a menstrual cycle that is within normal range. That is an expectation. And when that is the case, you're gonna feel better.
You're gonna feel better when you're producing sufficient estrogen and progesterone. You know, you're not gonna feel better when your hormones are off. And we all know this.
You're gonna have more PMS symptoms, less energy. It's all tied in. We, we have this wonderful gift, we have this cycle that reflects what's going on. And for women who chart, they see it in real time. Literally came off of a conversation, because this is what I do all day with women who were learning about how their different patterns of charting. You know, I was having conversations with some clients and it's like, okay, so I've been charting my cycles and I've noticed that when I increase my activity level and I've noticed that when I include the cardio, my luteal phase gets shorter. They're able to kind of like adjust their workouts and figure out what their body actually needs. Or it's like my luteal phase was only eight days. And I know you said it's supposed to be 12 doing all these workouts, and I realized, okay, so I'm gonna have to eat more protein. When you implement that strategy and you start working on balancing how much exercise is right for what your body actually needs. And it's not just about having a 12 day luteal on a piece of paper. It's about having lower PMS symptoms. It's about producing sufficient progesterone so that you have optimal bone density. We don't stop the bone density. It's not that we develop it when we're 12. This bone density conversation goes into our 20s. And so if you're not developing, if you're not having that healthy hormone production into your 20s that could result in a greater. To your, to your point, it is about more than just if you want to have a baby today.
[00:47:23] Speaker B: So final question. For anyone who's in that kind of like that messy middle trying to figure out what their body's doing or feeling discouraged, like, like what's one thing you would want them to hear?
[00:47:35] Speaker C: Like right now I would say, trust your intuition. Don't let anybody gaslight you if you know that something's off. But you, you already did it. You already went to the doctor and they told you it was fine and ignore that. Trust your intuition. And it's hard. You know, I have to have compassion for the medical professionals when we were talking about, you know, this information isn't taught in schools. Like, it's not even taught to this degree in med school.
So the doctors don't know.
Not trying to offend any doctors out there, but you don't.
Different professions, they'll teach you what you need to do the. The job. But then if you as a physician want to specialize in endometriosis, you would have to go to a fellowship to do that. Like, if you were a surgeon and you like, it's like anything. If you're a surgeon and you want to specialize in specific type of surgery, you have to then go do that. So this is one of those areas of specialization that is not a part of the standard medical programs. It's just not. It's really frustrating. So many women have these negative experience with their providers. We do have to have some compassion. They didn't learn this level. So it can be challenging. But if you're dealing with a specific issue, if you're feeling frustrated, the most basic advice I can give is like, trust your intuition. And then once you determine what. What the issue is. Because we do live in a wonderful age of information now. So much information that you have to figure out which information is actually legit. But once you figure out generally what the issue is that you're dealing with, go find a specialist. Go find somebody who does that all day. Find the person who's written the book on the thing who does that all day. All of the patients have the thing. You will have much better results than going to a generalist.
[00:49:13] Speaker B: Yeah.
Lisa, thank you so much for this conversation. It's so needed, and we're not having enough. And quite honestly, we probably could go on for another hour.
Before we wrap up, can you share where listeners can find you, learn more about your work, grab a copy of your books? Obviously, Fertility Friday is your podcast, but yes, share all of the details because there's a whole lot more that people could be learning.
[00:49:40] Speaker C: Well, yes, well, thank you for that. This was so much fun and you asked such good questions and all of the topics that I've talked about today and the different research and all of that and more are in my book. So my first book, the Fifth Vital Sign, is primarily about the idea that the menstrual cycle is a vital sign. And it's available on Amazon and it's, you know, we have the audible version of it, too. Real Food for Fertility is my most recent book that I co authored with Lily Nichols, who's a registered dietitian nutritionist, and her and I share a passion for research. We are weirdos. We had so many citations in the book that we chose to include it as a separate PDF download because it would've added, like 250 pages to the book.
[00:50:18] Speaker B: Oh, my gosh.
[00:50:18] Speaker C: There's over like 2500 notes. Notes. Yeah. It's unreal. But the good thing about it is that while there's so much information, it's written in a way that's really approachable. And the thought behind that book is for anyone who is thinking of conception in the future, this is the book that goes into a lot of detail about nutrition. We didn't talk anything about nutrition today, but there's a lot of evidence based nutritional information in there and all of the things that I talked about as well. So the fertility awareness and we have an entire chapter on timing sex for conception, an entire chapter on supporting egg and sperm quality. It just goes on and on and on. PCOS has its own chapter. Hypothalamic amenorrhea has its own. Like, there's just a lot of information in there. Real food for fertility. Com, you can grab the first chapter free. You mentioned my podcast, Fertility Friday. If you search that in your favorite podcast player, there is now another podcast called Fertility Friday. So look for the pink one. That's me. I'm on Instagram at Fertility Friday. And you can find
[email protected].
[00:51:15] Speaker B: All right, awesome. Lisa, thank you so much for your time.
[00:51:17] Speaker A: I appreciate it.
[00:51:18] Speaker B: And we'll make sure everything is in the show notes with the correct links to the right Fertility Friday.
[00:51:24] Speaker C: Well, and I should mention that I mentioned it a little bit when we were talking about it. I've moved away from, you know, individual programs as much and my real passion now is about training practitioners. So kind of going to what you were talking about, about the difference and getting the word out. I'm at a point in my career where I really realized that the way to get the word out is to train practitioners so that they're able to teach their clients how to chart and then use the cycle as a diagnostic tool and a vital sign. So if you want more information about that, you'll find it on my website as well.
[00:51:55] Speaker B: Awesome. Thank you so much. I appreciate it.
[00:51:58] Speaker A: Thanks so much for listening to Fertility Cafe. If you've enjoyed this episode, be sure to subscribe so you never miss an interview. Leave us a review and connect with us on socials. We're at Fertility Cafe. Until next time. Remember, love has no limits. Neither should parenthood.
