Shedding Light On Women's Health: Hormones, Periods, PCOS & Endometriosis | Dr. Lara Briden

Hi there.

Welcome to Women to Women Podcast. Everything hormone, adrenals, trauma, and weight. Today I have someone, um, that I think you'll really find exciting. Her name is Dr. Lara Bryden. She's actually a naturopathic doctor and author of the bestselling books, Periods Repair Manual. And Hormone Repair Manual, which I love because a lot of times when we talk about periods, we're talking about the despair people have around them and problems they have. So she has 25 years experience in women's health and sits on several scientific advisory committees, including the Center for Ovulation and Menstrual Research at the University of British Columbia. She currently has consulting rooms in Christchurch in New Zealand, where she treats women with PCOS, PMS, endometriosis, perimenopause, and many other hormone and period-related health problems. So welcome today, Lara. I'm so excited to talk with you about this incredibly important topic. And I would love to begin by having an interesting conversation about menstrual cycles and menses and periods and cramps, because very few really talk about it. And so many people have issues in regards to either lack of periods, too many periods, too much cramping, uh, diagnosis of PCOS or even endometriosis. So let's dig into some of this. So with regards to— let's just start with something very simple. You know, can your diet impact the quality of your periods and also how much cramping you have?

Yes, 100%. In fact, one of my— I sometimes share this story— one of my favorite Amazon reviews that I ever got on my book, Period Repair Manual, was someone saying, oh my goodness, I had no idea that what you eat can affect your periods. So which makes sense, right? Because our periods, one thing to say is they're not separate from the rest of our health. They're an expression of our health, which is why I refer to them as our monthly report card. So pain is that— that's our first topic, I guess. Yeah. I mean, as period pain is common, but I would say it's not technically normal. I mean, it's okay to have a little bit of pain. We all have. And I certainly did back when I was still having periods. Back in the day. I do miss my period. I've been menopausal for about 2 years now. I do kind of miss my periods. But yeah, but big picture through my lens anyway, as a naturopathic doctor, there's no reason that periods should be painful per se. They often are. But I think often with many of my patients, with the right, you know, anti-inflammatory diet and reduced stress and, you know, pelvic floor. There's a lot going on with, like, as you probably know, I'm sure you know, like pelvic floor and muscles and lots, lots going on in the pelvis. If all of that can be balanced, and, and then the period should just arrive. I love when my patients say, oh my God, oh my goodness, my period just arrived. I didn't even feel it. Like, I didn't have any PMS. It just came. I just flowed for, you know, 4 or 5 days and it was over. And that's really what it should be like. And of course, I do understand that some people have endometriosis or adenomyosis or other more serious things going on, but just sticking for the moment with someone who doesn't have those diseases or those conditions, just who just has run-of-the-mill period pain that is caused by prostaglandins, sort of an immune compound, part of an inflammatory response. What I find— I'll give you my top tips and then maybe you share yours, we can compare notes. Um, what I find, especially with young women, is my first go-to is just obviously reduce junk food or get off junk food and take a zinc supplement because zinc— there's actually at least one clinical trial about zinc for period pain, and they find it reduces prostaglandins. They find it— in this one study, they found it works as well as the pill for period pain, which is amazing. And then my other little tip is, um, to change the kind of dairy that you have because a lot— I read about this in my book, and actually both books, um, normal cow's dairy for some people, not everyone, but for some people can be quite inflammatory. And for women, that can manifest as heavier, more painful periods. So it's an easy thing for a young woman to try, for a teenager to try, you know, get off normal dairy for a few months, take a zinc supplement, and then see where she lands and see how much pain is even left after all of that before looking at more complicated treatments.

Oh, I couldn't agree with you more. I mean, there's enough research and data now to show that doing a combination of fish oil And using also things like borage oil together can be as effective as using any NSAIDs as well. And I do the same thing. I have people stop dairy and many times say, well, why don't you do goat cheese or sheep cheese? Because that is problematic. Or if you can't stand it, at least do organic, because then we know that it doesn't quite have the same things in it.

Yeah. I'll share with your viewers. I mean, I don't know how much this is on the radar in the States, but so there's The problem with normal cow's dairy is something called A1 casein. It's a very particular protein. And what's interesting is that not all breeds of cattle, dairy cows, make that. Like traditionally, actually historically, thousands of years ago, most people were not eating or consuming A1 casein. It's quite new in our agriculture, and only certain countries ever really had cows with this inflammatory casein, including North America. England, Australia, New Zealand, like Southern Europe, typically my understanding is didn't— never had cows with A1 casein. So their dairy has always been less inflammatory. So it is starting to become more common to have access to dairy that does not contain the inflammatory protein. So as you say, goat or sheep, that's why they're not inflammatory in the same way. And also Jersey cows in general don't have A1 casein. And also more and more we're starting to see just what's called A2 milk. So it's just dairy. There's still the Holstein cows, but they've been bred to not make that protein. So dairy is becoming quite a better place, safer place. I mean, 25 years ago when I started practicing and I asked my patients to come off dairy, they were just like, what? What? How do I even do that? And now Especially where I am in New Zealand, I can say, oh, it's easy, just choose the A2 dairy.

So yeah, absolutely. So what I love about what you're saying that I've said for years, because I started my practice in 1985, a very long time ago, is that nutrition plays a huge part of our cycles and also can normalize things. Well, let's dig a little deeper into things like endometriosis or adenomyosis, which is actually endometriosis in the muscle. For people that don't know, let's talk about about that because I, I think that we can also intervene in a way that can make a big difference for these people as well. So what are your thoughts on endometriosis and adenomyosis?

Yeah, I have some thoughts actually. Marcelle, we could have, we could have a full 1-hour conversation just about endo, but we won't do that. We'll keep it a little shorter so we can get to some of the other topics. But I guess the first thing to say is all the trickiness around diagnosis. So there's actually a lot going on there. Like, you know, the story that like a lot of women will have years, like sometimes like a decade of severe debilitating pain and never, never know that they have endometriosis. So that's one part of it. And I guess one thing to say in this on that topic is debilitating pain is never normal. So as I was saying a few minutes ago, even mild pain is technically not normal but common. But often my little algorithm with my patients is let's try the basic stuff that works for normal normal period pain. And then if there's still debilitating pain, then something else is usually going on. So that's part of it. And then I guess the other side, which has just come onto my radar a little more recently— I will, I'm going to name drop another gynecologist, an Australian gynecologist who you might want to have on your podcast one time. Her name is Dr. Peta Wright in Australia from Brisbane. She's just amazing. And so she's surgeon. She's been working with endometriosis for years and years, and she has recently been doing some presentations around— it's quite interesting, actually, how just the presence of those— okay, so backing up, as we know, endometriosis is this presence of this endometrial-like tissue or uterine-like tissue that is found, can be found anywhere throughout the pelvis, and it's not really supposed to be there. It's supposed to be only inside the uterus, and that creates these lesions, these inflammatory lesions. So Dr. Peter Wright has sort of presented the research and kind of pointed out that just the mere presence of those lesions doesn't necessarily mean that's the cause of pain. And this has been very interesting for me to like have her explain that and like look at all that, because actually, as it turns out, a lot of women without pain, if you open them up for surgery for some other reason, they have endometriosis lesions, but it hasn't been causing them any pain. And conversely, a lot of women who have pain have surgery, the lesions are removed, but they still have pain. So this is important to understand. There's like much broader things going on. This is where I talked about pelvic floor. And there's like— so not to— I guess it's just to put endometriosis in some perspective. But certainly, just like endometriosis is, even if it's present, is not always the cause of pain. I guess that's the short version of what I'm trying to say. But when it is the cause of pain, then there's different approaches. And as I've just referred to, it can be removed surgically and that can be helpful. Not always, but it can be helpful. But from a natural health perspective, the way I approach it, and again, I'm curious to hear how that compares to how you approach it. My understanding of the disease now, based on a lot of the recent science, is that it is an immune— it's a disease of immune dysfunction. It's not actually a hormonal problem, although hormones affected, of course, but it's not really— in that way, it's not actually a period problem. I mean, it is, but it's much bigger than a period problem. It's kind of more similar to autoimmune inflammatory diseases like rheumatoid arthritis and things like that. I put it in that category when I'm thinking about it for my patients. It often responds to some of the same things that those kind of more hardcore inflammatory diseases do. So that's obviously quite a different approach than just how you treat kind of normal prostaglandin period pain.

Yeah. So I would add to that, so many people that have endo almost always have systemic Candida and that there's a direct relationship between the gut microbiome. And we know now scientifically, because I teach for the Institute of Functional Medicine and we talk about endometriosis.— yeah, always do the most recent studies— that there's a pretty significant relationship between the microbiome of the uterus. Yep. Microbiome of the vagina and the microbiome of the gut. They're not necessarily the same. So by treating the microbiome of the uterus, you can actually have substantial changes that go on with the menstrual pain too. And also obviously food sensitivities and treating Candida and parasites and anything else that goes on in the gut. And then also, you know, looking at autoimmune immune, because it oftentimes starts around the age of 12, 10, 13. What was going on oftentimes in the family homes, you know, causing the immune system to be somewhat aberrant? I mean, there's so many pieces to the puzzle, and I've had amazing success even including with infertility around these patients, um, treating them from that kind of, you know, holistic, if you want to call it that. Yeah, a term, but from that perspective. But the gut always huge, huge, huge in— with endometriosis, for sure.

Yeah, I couldn't agree more about the gut. And that ties in exactly to some of the science, which I'm sure you're aware of, called the bacterial contamination hypothesis of endometriosis, where they are talking about bacterial translocation either from the gut or from the uterine microbiome, what are called gram-negative bacteria, which are quite inflammatory, coming into the pelvic cavity in women with endometriosis. And they found that to be true. And so this relates to Candida a little bit too. This is any kind of intestinal, what's called dysbiosis, or problems with the microbiome in the gut, in the uterus, exactly as you say. And what they've found is that women with endometriosis have up to 6 times higher levels of gram-negative bacteria in their pelvis, probably from the gut. So yeah, it's great. I mean, I think that's definitely what can move the needle with endometriosis, is that kind of approach, which is very different than just the conventional approach of, okay, let's just switch off your hormones and hope for the best.

Or hysterec— hysterec— whatever, cut it out because I can't stand the pain anymore.

Yeah.

And I think as we begin to learn more and more of the vaginal microbiome and also the uterine microbiome, there's going to be more of a connection and probably related to the gut microbiome. So I think for people, I would say stay tuned because medicine is changing at warp speed when it comes to some of this material. So that's pretty exciting. So the take home, I think, for many people is we can do something. It's not just a matter of just let's take drugs up the wazoo and bear with it. That doesn't have to be, especially if you're someone that has a lot of pain. It can be, um, we can mitigate the pain pretty substantially when we start, start to figure out where it's coming from as well. So it's pretty exciting.

I agree. Yeah.

So let's, um, kind of look at the whole notion of, um, stress and how stress affects our menstrual cycles as well, because it does. Of course.

Well, of course. Well, there's lots of parts to that. I mean, I guess the most— the first thing to talk about is that stress can make you lose your period, and, um, as can under-eating. There's similar mechanisms. So the—

I always—

one of my messages in my work is the body is smart. It knows what to do when it's given the right, like, information and support. Um, so losing your period to stress or under-eating is a perfect example actually of It's not a malfunction. It's the part of your brain called the hypothalamus that's in charge of reproduction and other things. And it's perceiving, oh wait, what? Like there's, there's like, you know, war or famine or something really bad is happening. And so it's not a good time to make a baby because the important thing to understand is having a healthy, regular, natural menstrual cycle it from your body's perspective is about making a baby, even if you don't want a baby. Like, you know, we— women say, well, I don't actually want a baby, I just want a period. Well, that just— that's not how— like, your brain, it's all about having a baby, making a baby. So it will— if you want your brain to conduct your hormonal system to have regular cycles, then your brain needs to think, needs to believe that everything is safe, that there's enough food coming in, that everything as well. So that's one way that stress can affect periods, and not just actually losing your period, but your period going all wobbly and weird, like becoming irregular. And, um, then the other way that really— I mean, there's lots of ways stress can affect periods, but one of the other ways is premenstrual mood symptoms. So there's a huge impact there, and there it's not just the hypothalamus, it's actually the whole interaction between the nervous system generally like the stress response system, including the adrenal glands and, and adrenaline and everything, and, and a hormone called prolactin. And like the whole stress system and the female hormonal system are, as I'm sure you've talked about before on your podcast, are like inter— interlocked. So when we— with a natural menstrual cycle, we have to have the hormonal resilience to go through those ups and downs of progesterone. And they're going to go up and down. That's going to happen. So that's not the problem. Usually it's— the problem is that our, our nervous system, our brain, if it's already stressed and not— doesn't have a lot of bandwidth, it will— you can really feel those premenstrual hormonal changes. So that's one another factor. And actually, I don't know about you, but I find treating premenstrual mood one of my absolute favorite things to treat because it responds So, so it responds so well. You just give a few things, like you give some magnesium, you get women like moving their bodies, getting outside in the day, getting more sleep, maybe cutting alcohol, or, you know, just sort of giving the nervous system what it needs. And then again, that's that same story that I said earlier about women saying, oh my God, my period just arrived and I didn't even know, I didn't get any headaches or anything like that. So Yeah. In answer to your question about stress, that's another way.

No, absolutely. And one of the things I oftentimes did too is add some progesterone depending on progesterone. And it's just one of the things I love treating. And I actually loved treating PCOS. It was one of my favorites when I was seeing people one-on-one for the same reason, which is that if you make the changes, then people are so incredibly grateful and their metabolic issues come back into balance. So let's go to that. I mean, we're going for the big ones here.

We're just doing it all today.

So, um, polycystic ovarian syndrome is what we're talking about with regards to PCOS. So what, what are some of the things that you say to your people when they are diagnosed with that? Because it's not really a syndrome, it's more of a metabolic issue. But let's, let's talk a little bit about—

yeah, step one is to get the right diagnosis. And again, this— I, I mean, I did talk about this a little bit with endo, but with PCOS it's more important because again, there's both sides of the equation. We have women being— a lot of women, I would argue, and I'll explain why— being told they have PCOS when they don't. And conversely, a lot of women who, who have PCOS, who have insulin resistance and high androgens and anovulatory cycles and all the things and are not— that's not being picked up. So there's both sides. And I guess I'll— and I think it's just very, very important. So I'm going to start with the women who are being told they have PCOS when they don't. And that is a chunk of the women, like a group of women who have lost their periods, under eating, which we just talked about, or have either no period or irregular periods. And the main driving force for that is under eating. And they are— some of them are being mistakenly told they have PCOS. And the way it's happening is all to do with ultrasound. And you can just to preface, I mean, you could think how important this is actually, because as we'll discuss, sometimes part of the treatment for PCOS is to eat less, to maybe reduce carbs or, you know, avoid— well, avoid junk food is good for anyone. But like, you know, the strategy of eating less can be appropriate for PCOS. It's obviously completely inappropriate for women who've already lost their period to undereating. So you can see why this matters. What's happening, and I'm curious to see, you know, what your feedback, but I get a lot of women I see have been mistakenly told PCOS based on an ultrasound. So just to be clear, that finding of so-called polycystic ovaries on ultrasound doesn't really mean anything for this condition, which is not to say that ultrasound is not helpful for diagnosing other conditions. It 100% is. Like, for example, an ultrasound is a good way to pick up an ovarian cyst, which is different than what we're talking about here, right? Like, you can have all different kinds of abnormally large ovarian cysts, and those can cause pain, and that's a different topic. These are— I mean, I don't— I kind of reject the word cyst when it comes to them. These are small undeveloped eggs or follicles, which are normal. It's normal for the ovary to be full of follicles or little kind of sacs. They're eggs. It's all about So with this condition, it's all about did ovulation occur or not? So normally, if women are having regular ovulation and natural menstrual cycles, their ovaries will appear in a certain way. They'll have a dominant follicle, which is quite big, and the other ones will be suppressed, if that's not too technical. And but so all it takes to really get a polycystic appearance or lots of small undeveloped eggs is to not have ovulated. So that can happen under all kinds of circumstances, like even any just woman who's like healthy, actually totally normal, but is having the occasional cycle in the year, throughout the year, which is normal when you don't ovulate. You can pick up polycystic ovaries in her. That doesn't mean anything. You can definitely pick up so-called polycystic ovaries in women who have lost their period to undereating, and that's called hypothalamic amenorrhea. So one of— with my work, a lot of my step one in the kind of flowchart of what to do for PCOS is make sure it's the correct diagnosis. So the condition, by definition, I would say, is, um, high male hormones, high androgens, high testosterone or other male hormones, when all other explanations for that have been ruled out. Plus, usually the situation of, um, having cycles when you don't ovulate are called anovulatory cycles. So these are typically like you— the sign of having a cycle or menstrual cycle when you didn't ovulate, like, common signs would be you bleed for longer than the standard kind of 4 to 5 days. You might like have a 10-day bleed. So often some women with true PCOS will have like— they might have like 4 periods a year and the period goes on for like 2 weeks. Like, that's— that can be caused by other things, obviously, but like, that's a classic. If someone describes that, I'm like, okay, that sounds like PCOS before we maybe examine other possibilities for that. So I hope that's starting to be clear. As— and then the next step in my flowchart of diagnosis, if you're confident that it is PCOS, then the next step is to— in through my lens anyway— is to determine, confirm that whether you have insulin resistance or not. I actually test for that. I think you don't want to just guess, you don't just assume if it's PCOS you do have insulin resistance. Most most women with PCOS do, but not all, which is then why there's these other kind of non-insulin-resistant types of PCOS which need different treatment, I would argue. But for about 70 or 80% of women with legitimate PCOS diagnosis, they also have insulin resistance, which is metabolic syndrome. As you said, it's a metabolic condition, which is in some ways great because it means it responds really well to all the kind of metabolic lifestyle Lifestyle treatments. If this— I'm just not sure if this interview is going to air today. People can pop onto my social media. I've just shared— I'm doing a little survey of my followers on metabolic health and what their understanding of that is and what's going to work for them. But I test for insulin resistance with— I actually do. I'm curious to hear what you used to do with your patients. Like, I, I use— it's what's called a glucose— well, we call down here anyway, glucose tolerance test with insulin. So I'll test glucose and insulin fasting, and then you give the sugar drink, and then you test glucose and insulin again at 1 hour and then again at 2 hours, ideally. And then you get this sense of whether insulin is too high at any of those points. Because just to be clear, it's normal for insulin to go up with food or with glucose. That's a normal response. But so it's not like we don't want— it's sometimes I have to be careful because it's not like we don't— it's not like obviously we don't want zero insulin. Insulin is an important hormone. It just— it should be in this kind of sweet spot, both fasting and then not going too high. So does that match with what you—

oh, totally. I mean, if I, if I have somebody that I think is insulin resistant, then that's— and even when I don't, if I think somebody has PCOS, I always check their insulin levels. Yeah. Um, because there's a huge relationship between those as well.

Yes.

And I think, you know, for me, in the culture that I'm in, it was probably undiagnosed than overdiagnosed.

Okay.

Yes. I don't know that I've ever seen somebody that was diagnosed with it that I didn't then confirm that diagnosis.

So, oh good.

Okay. Yeah. My experience, which is fine. Yeah, it's great.

Um, well, I think there's trends. I think there's a trend to undereating, which maybe has been in the last 5 to 10 years, which I don't remember. I don't remember seeing 20 years ago, like not this, not to the same degree. Um, for some of the population.

Yeah. Yeah. No question. Well, the beauty for me about PCOS, though, is when they do the lifestyle changes and they do cut back on carbohydrates and they get their insulin stabilized, then what you see is a huge change in their disposition. They certainly lose weight like crazy, and they just feel, oh my God, I'm finally back to normal. This isn't me.

And the periods come back. The periods regulate.

I was going to say that without drugs. Yeah, it's pretty amazing to do that for sure. So what I love about really what we're talking about today is this whole notion that there is more that we have control over than we don't have control over. Even with endometriosis, it's starting to understand for that particular person, what's the culprit? What's the cause of the cause? Where did it start? How did it begin? So that, that gives a lot of credence for people to think, you know, I can do something about this.

Yes.

It's not out of my control, which is pretty exciting for especially listeners that have cramps with their periods or are having PMS or or even, you know, even worse, PMDD, which is a little bit more drastic for people. So it's— we're giving people hope, which is what we're hoping to be able to do, is we just need to figure out for that person what is it that's going on and how do we direct them in terms of how did they feel much better.

So yeah, exactly.

So if people wanted to learn more about you and kind of follow you a little bit more, I know you're kind of far away for us, but this is the part of the world that I grew up in and, and love. Even though I don't have that accent.

Yeah, I was delighted to hear you were Australian. Yeah, I know, by birth.

By birth. Well, I didn't come to America until I was 11, actually, and I spent much of my— I grew up in Bundino, which is outside of Cronulla, and in the outback. I mean, we didn't have cars, we didn't have street lights, we didn't have— it was a very different time. Outhouse, you know, the whole bit.

Wow.

Yes.

Yeah. Well, I'm actually Canadian. You can hear, so I have my accent. If people are wondering, this, this accent is Canadian. Uh, lived there till I was like 31, then about almost 15 years— well, and whatever adds up to 12 or so years in Australia, and then I've been 8 years in, um, New Zealand. So it's kind of a mixed accent, but I think the accent you have, like, obviously the Canadian accent will never leave me. Um, no. So yeah, I'm easy to find. So everything really is from my blog, which is laurabriden.com. And there you can link to— I've got a community forum, I've got a podcast, I've got my two books, Period Repair Manual and Hormone Repair Manual. And I'm working on my third book currently. And all my social media is @laurabriden. So I'd love— yeah, people can ask me questions there.

Right over. Awesome. Yeah, thank you so much. I appreciate it, and, um, thank you for being my part of the world.

Thanks for having me.

Yeah, okay, have a great day.