Allison LackoI would like to lead off by recognizing that the past few weeks have quickly become a little overwhelming here in the U.S. due to COVID-19. First and foremost, I encourage everyone to make sure you reach out to check in on family and friends. Next, see what you can do to help the most vulnerable in your community (example, donate money to a food bank online, donate blood if you feel healthy). And if you have quiet time, take it to focus on your mental and physical health. Listen to your body. Use the information in this post (and the presentation linked at the end) to learn more about women’s health specifically.
Over the next few weeks, we can all spread some knowledge, love and a smile. Abrazos!
And on to the article:
It’s women’s history month, and I can think of no better time to talk to you all about my period. Four months ago, I was really excited to get my period. Like, really excited. You see, I started the pill in 2010. At some point, I decided to go off birth control to see how long it would take for my natural period to come back. That was August 2014. So, in November 2019, when my uterus contracted to let me know that it had no more use for the beautiful lining of blood and tissue it had built up, I cried.
I had hypothalamic amenorrhea, which a doctor’s way of saying “your period is missing, and we don’t know why.” I saw many specialists and paid for many copays and many lab tests. All but one doctor recommended that I go back on hormonal birth control to regulate my cycle. But, I thought, aren’t synthetic hormones just a crutch? Isn’t your body relying on external hormones like when you’re in a study group and copy that one smart kid’s answers to the problem set? Sure, you get by, but if you don’t try to get the answers yourself, you’ll never learn. I did what graduate students do best, I put on my citizen scientist hat and dug into my own research to help my body get my period back.
Women’s hormones 101
I have learned so much. And since I’m sure your high school sex ed class was just as boring and uninformative as mine was, I wanted to explain how cool the menstrual cycle is. It’s governed by two hormones, or chemical messengers that travel throughout the body: estrogen and progesterone. I would like to pause and underscore that hormones travel throughout the body, because this means that sex hormones affect every single system. This makes sense – in order for your body to accommodate an entirely new person during pregnancy, every system has to be on board, particularly your nervous, endocrine, digestive and immune systems. This means that every system has receptors for estrogen and progesterone, changing their behavior throughout your menstrual cycle.
During the first half of our cycle, estrogen is the sexy time hormone – it heightens women’s senses, increases synaptic connections in our brains, and drives us to be more social and magnetic. After ovulation, progesterone increases metabolism in case there’s baby-building to be done. Progesterone also creates a state of calm and focus. This cycle of energy is a woman’s infradian rhythm. Men and women have a circadian rhythm every day – and just like we all time how we eat, exercise and do work to line up with our circadian rhythm, women can sync their nutrition, fitness and focus with their infradian rhythm to work with their biology. If you’re a naturally cycling lady and ever wondered why it’s draining to stick to a low-carb diet all month, why completing a workout is easier some weeks than others, or why you found your boyfriend delicious one week and couldn’t be bothered with him the next – don’t beat yourself up (and fellas, don’t be offended). The effects of fluctuating estrogen and progesterone (and testosterone) during our menstrual cycles are why. If your partner is a woman and you know where she is in her cycle, then you can support her by making plans that take into account her changing neurochemistry and physiology (what to cook, type of date, etc).
Be an informed user of birth control
The fact that every system is wired to respond to estrogen and progesterone also means that your reproductive system isn’t the only thing affected by the synthetic hormones in hormonal birth control (HBC). Now, I want to give an immediate disclaimer here: the point of this is not to scare women off birth control. Especially during women’s history month, it’s incredibly important to honor that we stand on the shoulders of giants, like Margaret Sanger, who have fought for women to have control over their reproduction. After the pill became commercially available to all women in the US in the 1970’s, college graduation rates and enrollment in advanced degree programs among women skyrocketed and the rate of unintended pregnancies declined.
Having said that, HBC can have serious side effects. HBC works by using moderate levels of synthetic estrogen and progestin to stop your brain from communicating with your ovaries. In the process, these constant levels of synthetic hormones stress your liver, which works hard to metabolize them. This increases levels of sex hormone-binding globulin (SHBG). However, SHBG also binds testosterone, which leads to low sex drive, and research has found that SBHG remains elevated even after stopping HBC. HBC also induces a state of chronic stress, characterized by elevated cortisol and reduced volume of the hippocampus, a part of the brain important for learning and memory. Most worrisome, HBC has been associated with a 23% increased risk of being prescribed antidepressants compared to nonusers. In adolescents (15-19 years old), this jumps to an 80% increased risk. Another side effect: women on the pill have different preferences for men than women who are naturally cycling, preferring less masculine faces and different smells, which could affect how attractive you find your boyfriend when you go off HBC.
Unfortunately, HBC is commonly prescribed for reasons other than controlling pregnancy and these side effects are under-researched and rarely discussed. It’s often prescribed to regulate periods, but HBC does not regulate your hormones – it switches them off. If you have problems with your cycle and go on HBC without fixing underlying problems with your metabolic, adrenal or gut health, then your irregularity and symptoms will most likely return after you stop using HBC. Heck, my dermatologist prescribed me the pill to treat my acne, and never mentioned possible side effects. And HBC is prescribed at young ages, even to teenagers – when the mental health risks are highest, and before women’s brains have fully formed.
Time to put on your own citizen scientist hat
I have a few takeaways that all come back to one thing: be a good scientist and collect data. If you’re naturally cycling, track where you are in your cycle. Pay attention to energy, sex drive, mood stability, weight changes, and side effects like pain, breakouts or irregular bleeding. Remember, just because symptoms are common does not mean they are normal and that you must suffer through them. And if you’re dating a woman, this is a team effort! Notice when things are off compared to your partner’s cycle and help her be a detective to figure out how to restore healthy hormone levels. The two apps I recommend to help you track are Flo (free) and MyFLO ($2 but it lets you share what you’re logging with other people, like your partner).
If you’re on HBC (or thinking about it or recently coming off of it), there are also things you can do. Pay attention to the same things – your energy, sex drive, mood and weight – on and off the pill. There are about 40 different formulations of HBC, so talk to your doctor about switching if you do experience side effects. Sarah Hill just came out with a book that has a great chart of HBC and the different types of synthetic hormones they use (pdf in google folder linked below). In addition, support your liver (use safe cosmetics and cleaning products and, yes, less alcohol), your adrenals (maintain a regular sleeping and eating schedule; orgasms!) and gut (eat high fiber food and lots of vegetables). You can also supplement the nutrients depleted by your overtaxed liver and chronic stress: vitamin B complex, zinc, magnesium, selenium, CoQ10 and vitamins C and E. Lastly, if you meet your partner on birth control, let your hormones meet him too before you commit.
If you’d like to learn more about a woman’s infradian rhythm or the side effects of HBC, I gave a presentation at Crossfit Chapel Hill about these topics, and the PPT (with a resources slide at the end) can be found in this google folder (along with the pdf from Sarah Hill’s book): bit.ly/cfchwonderwomen. Please read it and please, please share the link. And if you’re a lady on your own hormonal journey and would like to decompress with a long walk and some of Napoli’s dark chocolate sorbet, I got you. My natural period has come back, but it’s been two steps forward and one step tripping backwards and making a wrong turn somewhere. It’s a journey. Email me at amlacko@live.unc.edu.
Peer edited by Yogitha Chareddy