Hormonal Contraception Decoded with Sarah E. Hill & Abby Epstein

Welcome to beyond the Cycle, the podcast that's here to help you take control of your hormonal health and feel good every day.

I don't know what this is that's happening to me, but I like it.

No matter where you are in life, whether you are thinking about quitting the pill, navigating a regular cycle, have no cycle at all, or transitioning into menopause, this is the perfect place for honest conversations and expert insight.

I wasn't a low libido person. I was just on the pill.

So get ready for some real talk. This is beyond the Cycle. First, we have Dr. Sarah Hill, an award winning research psychologist and professor. Her expertise lies in women's health and sexual psychology with a focus on how hormonal birth control influences your brain, behavior and overall psychology. You might know her from the book this Is yous Brain on birth control. Joining her is acclaimed film director Abby Epstein. Together with actress and activist Ricki Lake, she co created the award winning documentary, the Business of Birth Control. This film delves into the history, politics and impact of hormonal birth control, highlighting the side effects, risks and societal consequences that are often overlooked in its widespread use.

Welcome.

I'm very excited to have you both here. I have been thinking a lot about birth control. I'm on birth control at the moment, so it's very important to have this conversation for women like me because lots of women are on hormonal birth control. But I think we need to start from the very beginning because I have a serious lack of knowledge. Like many people in our society, I think what are the very basic hormones that run through our body?

We have a lot of different hormones, but when we're talking about hormonal birth control and talking about birth control in general, we're going to be mostly talking about our sex hormones. And women have three sex hormones. They have testosterone just like men. But our two primary sex hormones are the sex hormone estrogen and the sex hormone progesterone. And for a naturally cycling woman, which is what we would call somebody who's not using hormonal birth control, what you get across the cycle is you get an increase in estrogen that occurs as eggs are maturing and getting ready to potentially be released. During ovulation and during this period of egg maturation, this causes a real surge and increase in estrogen levels. And so estrogen rises and rises and rises right until right prior to ovulation, it peaks and then estrogen levels fall. After ovulation, there's an empty egg follicle where that Egg just came from. It actually remodels itself into a temporary endocrine structure called the corpus luteum. And it releases women's second primary sex hormone, which is progesterone. And so progesterone then begins to rise, and it peaks then in the second half of the cycle. And so when we're talking about naturally cycling women, we're about women who are ebbing and flowing between their two primary sex hormones, with the first two weeks of the cycle being dominated by the sex hormone estrogen, and then the second two weeks of the cycle being dominated by the sex hormone progesterone.

Okay, that's very clear. Thank you. Those hormones and those balances are those.

Hormones we're born with, we're born with the capacity. So, yes, you know, we all have hormones. So even men have. Have these same hormones that our bodies produce, but we don't really start producing them in force until after, until pubertal development. And pubertal development is kicked off when the hypothalamus in the brain, which helps regulate things like reproductive drive, when it reaches maturation, it starts to stimulate the ovaries to begin to initiate the process of ovulation. And ovulation is the main process by which we produce sex hormones. And so it's once we start ovulating and cycling that we're really producing high levels of our sex hormones that make us unique for men.

Okay. So from our first menstruation, that's when the cycle starts. I'm a bit hesitant to ask, but what actually happens to our hormones when we take the birth control pill?

Well, the birth control pill tells the hypothalamus in the brain not to stimulate the ovaries. So essentially it prevents egg development. So you don't ovulate. And when you're not ovulating, you're not producing hormones. And so essentially what it does is it flatlines production of women's own sex hormones.

So when we're on the pill, I'm understanding correctly that not ovulating. Yes. Okay. And then all the eggs that we're born with, that I know we're born with all our eggs, what happens to those eggs when we're on the pill?

They just hang out. They're just hanging out. Now, there is some evidence that they may begin. Like sometimes some of the, especially the low dose pills seem to have sufficiently low levels where the egg follicles actually start to get stimulated a little bit. And so what you see is that some women on some formulations, they actually get A little bit of a bump of endogenous, which is internally produced estrogen levels in the first half of the cycle. It's not something that is clinically noticeable, but it's noticeable when we run biological assays on it. And it suggests that some of those egg follicles probably are starting to develop, but then they die the same way that they would during a regular ovulatory cycle.

So, Abby, were you at any phase in your life on birth control? And why.

Yes, so I was on hormonal birth control. I was on the pill for 10 years, about 10 years in my 20s. And I, like many women, my doctor started me on the pill for non contraceptive reasons. So I was 19 and I had just begun university and my period just sort of stopped. Which has a clinical name, amenorrhea. Is that right?

Yeah, amenorrhea.

Okay, see, I remembered it.

So it's called amenorrhea. And basically, yeah, my period, I just stopped getting my period. And I think looking back on that time, there were probably very many social, emotional reasons that my cycle stopped. One, I was in a dorm, you know, living with strangers. This was the 90s. There was a lot of take back the night marches, a lot of rape on campus, a lot of sexual assault, you know, and I think maybe, like looking back, it was sort of a protective mechanism of my body. But, you know, that was seen as when I went in for my visit. Oh, my God. What do you mean you're not menstruating? Well, we've got to get you going again. So that's when I was put on the pill. And I had a really unbelievably miserable experience in the beginning because I was not warned about any of the emotional side effects. I didn't understand why I was like riding my bicycle to class every morning, sobbing, crying, calling my mother every day. And so finally when I saw my doctor, she switched the brand. And I thought that I was good, but I didn't really know what that meant, you know. So my experience was when I was exposed to this information for the first time, you know, in my 40s, when I read Holly Griggs Ball's book, Sweetening the Pill, and I learned about Sarah's work, this Is yous Brain on Birth Control. And I started to connect these dots and I saw that there were many things that happened to me. I had emotional side effects. I also had physical side effects. I had vaginal dryness, which was pretty extreme. And I didn't understand that. I was like, oh, I guess I'm one of those 25 year olds who needs a lot of lube. I mean, you know, like I, like I didn't, I hadn't had enough sex to understand that I had vaginal dryness. And I also started getting these urinary tract infections, these UTIs, which I would get pretty much regularly from intercourse, which I also learned when I was researching the documentary that that can also be attributed sometimes to taking a birth control pill. So I think that I was really angry. Like I felt like I had suffered a lot, the vaginal dryness. I actually went to my gynecologist about and I was misdiagnosed as having herpes when I knew that I didn't have herpes and he just wouldn't listen to me. But it was dryness. And so I felt like, I don't know, I felt like a whole injustice was done to me. And I just felt that that was one of the reasons I wanted to make this documentary. The business of birth control is I just felt like, you know, women have the right to understand these things if they're 16, if they're 19, you know.

We get prescribed a hormonal contraception. Not just for contraception, for other things as well. What are the main reasons people get given the pill, Sarah?

Oh, well, I mean, people get given the pill for everything, you know, everything. It's like everything. It's like, oh, you know, you're having a bad day. Have you considered hormonal birth control? But no, I mean, really, the primary things that women tend to get prescribed hormonal birth control for are of course contraception, but problems with acne. A lot of times when girls begin to cycle, they have irregular cycles, which is totally normal. And it's what's going on when the brain and the ovaries are learning to communicate with each other. But what doctors will do oftentimes is say, oh, you can't predict your period here, go on the birth control pill. Then you can predict your period or oh, you've got bad cramps here, go on the birth control pill. And so women get given this for all sorts of menstrual related issues, also pcos, pms, endometriosis, pregnancy prevention and so on.

Yeah, Sarah, you've done lots of scientific research on all of this and like you just said, it's not just prescribed for preventing pregnancy. It's so much more than that. The pill also affects our brain, right? Yes. Can you explain that?

Yeah, absolutely. I mean, the way that the pill works, really, it starts in the brain. And because the brain is where ovulation starts because the brain tells the ovaries, like, it's time to ovulate. And the way that the pill shuts down ovulation is by preventing the brain from telling the ovaries to do that. So the pill actually works on the brain foremost, like, more than anywhere else. But it also affects brain regions everywhere. There are hormone receptors on all major regions in the brain. And the reason for this is that our brain is wired to be sensitive to what's going on with our hormones. Because when we are in the period of our cycle, when estrogen is high and conception is possible for sex, our brain needs to do one set of activities. And those are the activities related to attraction and sex and, you know, sussing out good partners. And then during the second half of the cycle, when pregnancy is possible, when implantation can potentially occur and pregnancy can occur, our brain needs to also be wired for those hormones, because the types of things that we need to do when we might be pregnant are very different than the types of things that we need to do when we're. When conception is possible from sex. And so our brain is wired to be super sensitive to variations in sex hormones.

And so there's certain decisions we would make in certain phases of our cycle that we wouldn't make in other parts of the cycle.

So the way to think about hormones and the way that they affect the brain and the way that they affect the way that we feel and the way that they affect motivation and behavior is that it tends to nudge us in certain types of directions, right? So it's not like you're going to feel like a vastly different person during one phase of your menstrual cycle compared to another. But instead, it'll kind of nudge you, for example, during the estrogenic follicular phase and periovulatory phase phase, which is the time in which sex can lead to conception, it will nudge you toward being more sexually aroused and more flirtatious and more interested in men, and you're sort of more cued into the quality of men. And this is something that research has been showing for a long time. And it's not that it makes you a totally different person. It just sort of, you know, sort of nudges your attention and your behaviors, you know, toward this specific set of goals which have to do with conception. And then, you know, during the second half of the cycle, it sort of nudges you out of that, right, where you feel less sexual arousal and less sexual desire. And Instead you feel sleepier and you feel hungrier. Women are more motivated to eat and less motivated to move. And all of this is because progesterone is very expensive and it increases your metabolism, so your energy needs are higher. And it's also preparing your body for the possibility of pregnancy.

If we would go off the pill, how long would it take to get that cycle back?

Most women resume within a cycle and a half, so usually about six weeks in and women will start cycling again by three months. It was about 99% of our sample had gotten their periods back and recycling again. But they were still at the three month point when we discontinued because we just followed them over the course of three months. We still did have some women who weren't cycling yet. And so it can be very variable with, you know, most women starting to cycle right away. And what we found with our research is once women start cycling, they feel normal, like they start to feel like themselves again. And sometimes there can be other sorts of, you know, where they'll have acne for a little while and some other kinds of side effects like that, but for the most part they feel very much kind of like themselves, I found. So I was on it for almost 12 years, more or less nonstop. And for me it was about, I remember still, like, I remember like it was yesterday when I went off of. It was about three months later where I was like, like I, like I feel different. Like I have more energy. Like I'm going to the gym again. Like I was, I was realized that I'd been having a lot more sex than I'd been having before. And I was just like. So it was about three months in that I really started to feel like, oh, this feels good. Like I don't know what this is that's happening to me, but I like it.

Well, it's kind of interesting because like one of the things that Sarah was talking about with the way that, you know, the cycle influences your behavior in your brain, one of the things that they've studied is how it affects partner attraction. And that's a really interesting piece to look at. And Sarah has a bunch of the studies in her book, but that was one of my, my first, like awakenings is that I actually had a huge change when I went off in partner attraction, which wasn't great because I was in a very committed long term relationship, which I had met this man on the pill. So, you know, then when I went off, yeah, I found that I had a completely different level of libido. Like I thought I was a low libido person. I wasn't a low libido person. I was just on the pill. On the pill, yeah. And I was actually a high libido person. I was suddenly, like, attracted to other people and not my partner. And it does make sense. I feel like I'm almost like a textbook example of the research. Because, like, Sarah's research shows that when on the pill, a lot of women prefer more of, like, for lack of a better word, maybe like a more brotherly type man, sometimes more even, like, feminized features. And that is sort of who I was with. Like, I literally was with someone who was unbelievably, gorgeously handsome in a pretty way, and also kind of looked like my brother. And I also found my personality changes that were just kind of interesting. Cause I started reading. When I started reading the research, I read that it can also sort of make you function more, like, in a masculine way in the world, and you can lose a bit of your compassion, in a sense. And I did sort of feel that, like, looking back, I was such a ball buster. I just remembered some situations with actors where actors. And I was like, why is he so sensitive? Why is he so offended? You know? But I do think that it changed my brain in that way that I wasn't as. You know, I was much more about, like, eyes on the prize. Eyes on the prize, you know, and don't let anyone get in my way. And I noticed that change when I went off.

I've had the same experience. It's like when a lot of people, we go on it when we're pretty young and you're still forming your idea about yourself. And so many of us have, like, created a narrative of ourselves that's, like, not really who we are. It's who we are in the birth control.

Yeah.

And so I had the. I had a very similar experience where it was like, I thought that, like, sex, like, my. Because I remember when I was like, a teen, like an early teen, I had a really high sex drive. And then I thought that I just outgrew it. You know what I mean? And I was like. I was, like, 19, and I'm like, I've just outgrown. I just outgrown sex, you know, it's like, I'm just like, that's just not something I'm into. And the ball buster thing, where it was just like, yeah, eyes on the prize. Like, I don't need any of this. I felt almost like a worker aunt, you know what I mean? Just like a Drone aunt. And I also had a narrative about myself as being somebody who was kind of anxious and depressed, like a little anxious and depressed. And so I'd always thought that these things were all true of me. And it wasn't until years after I went off of it where I'm like, I'm not anxious and depressed at all. The sex thing I picked up on quicker. I was like, oh, no, I did not have gross sex. I was just like, I just had no interest. Women have the same experience of they're forming their. Who they are and their sense of self, and it's not actually who they are.

It's true, it's true. And it's one of the reasons that I saw, like, so, you know, because I'm part of what's like sort of generation X here, right. Which is like women who are born from, I think, 1965 to 1980. So we're that generation in a way. And, you know, I think for that generation, like, I know my film was very hard for them to accept. Very hard. Lot of defensiveness around feminism. And the pill is the holy grail and the great equalizer because as we're both saying, it does equalize you in the workforce. Absolutely. But that's why I think, you know, when you go down now, like Millennials and Gen Z, they were much more open about this movie and also much more interested in their lived hormonal experience. And I saw that time and time again making the film. They are not jumping on the pill at 19, 20. I mean, I was meeting, you know, 22 year olds who were using a copper IUD, you know, to avoid hormonal birth control. I mean, that's very. That would have been unheard of.

Oh, really? Right.

To ask for that. So I think there is an awakening to, like, you know, what Sarah's talking about. There's an awakening now to women saying, like, hmm, you know, have we been lied to or have we been sold a bill of goods? And do we wanna be these worker aunts? Right. Or do we wanna be, like, more in touch with our intuitive feminine energy, our sex drive, Even if that makes our life more chaotic? Because there is also an embrace now. Right?

Yeah.

Of this kind of, you know, the roller coaster of the cycle. Right. And cycle syncing I'm sure you've heard of.

How does that work? It's fascinating.

Well, I mean, it's just this idea that during different phases of your cycle, that your body and your brain are optimized to do different things.

You sync your life with Your cycle, your life.

Exactly. And there's even some companies that have started giving literally like menstrual days. So like day one or day two of your cycle, when you're on your period, you actually like can work from home or don't have to come into work because that's all a part of this cycle sinking. That's saying that, you know, when you're in, let's say your luteal phase, like, that's when you might want to like, do your taxes or like have a nap. Yeah. Clean your room, you know, like organize. Like you're a little more homebody, maybe a little less social. So yeah, that. The syncing of ideas, you sort of calendar map your workouts, that's another big thing. Because now they're saying that you shouldn't do like the same workout every part of your cycle.

Okay, right. So depending on your cycle, you change.

Exactly. So like luteal, you might want to do more yoga and stretching. And then ovulatory, you might want to do more high impact intensity, you know.

Yeah. And there's some, there's good research data behind that. So for example, there's evidence showing that women build more muscle mass during the ovulatory phase and in the follicular phase than they do in the luteal phase because progesterone is actually catabolic and it breaks proteins down and so it's not as good for muscle building. And so there's science behind that. And our calorie needs are higher, so our metabolic rate increases by almost 11%. And so it's like our daily calorie needs increase. If you eat 250 or like, what is it, 2,000 calories a day, your calorie needs increase by up to like 200 calories a day, which is a lot. And we are, you know, most women, we've all been given a one size fits all set of, you know, nutritional guidelines. And so cycle syncing in a lot of ways is taking that back and saying, wait a minute, like we're not one size fits all. And so we can't be making, you know, what we need to be doing here isn't the same as what we should be doing there. And so it's trying to bring some of that back.

And it's bringing a real, I think, feminist perspective to the idea that we're not men. So we're not on this hormonal stasis where every day is kind of the same. Right?

Yes.

That our cyclic nature can be used to optimize right for benefit and that we shouldn't live and work the way that men do.

The driving force behind this podcast is Good Woman. Good Woman is your trusted source for hormonal health support, offering education, expert guidance and supplements. From day one, they've been more than just products. They've created a community where women can openly discuss personal and often taboo questions. I'm glad we touched on the cycle sinkings. I thought, I think that's a fable that it meant women who live together single their cycles. Well, that happens too. Is that a thing or is that a fable or do we not know? Maybe there's lack of research.

So this one is one where what women say and what science says are like two totally different things. But I'm gonna tell you this, I don't think that it's been studied well. I just, I don't. I think it's incredibly complicated. And so what you tend. So there's. Yeah. The other sort of cycle thinking is when women are living together, that they will, their periods will kind of converge and that they're all ovulating around the same time and they're all having their periods around the same. And I know I've experienced this. I'm sure you've probably had the experience. Most women I know have experienced this, but science has not been able to capture it. But again, I don't think that it's been studied very well because it's very difficult to try to get that in converge. And I also think there's probably interesting dynamics with it where it's like, I think that subordinate women cycle sync to a dominant woman because that's been high. I have people in my lab who've been forming different hypotheses about all of this. And whoever the, like the top female is in the lab, like they all tend to cycle. And this has been something that's happened for a while. So anyway, I think it's more complicated than what we like than the way it's been studied.

So we need more research probably to back all those things. Is it because we're still. Science is still a male dominated world?

Yeah, yeah, yeah. And I think that for, you know, I think there's a variety of reasons for that. It started just that everybody studied men because men are easier to study because they, you know, don't have any hormonal variation. So it makes them really easy to study. But then I also think that some of these political issues that Abby was kind of talking about with, with our generation, like Gen X and then before that where it's like the idea of cycling and hormones and everything has been something that's been seen to be like a dirty word. And so everybody's trying tried to downplay the importance of them. Like, oh, no, no, no, we're rational and can do what men can do because our hormones don't matter. And so there was this big push. And so science has been really slow to want to even kind of tiptoe into these issues because there is a fear that if you make people aware of how important hormones are, that this all of a sudden is going to call into question whether or not women are suitable for things like the presidency, for example. And so there's been sort of a movement of those kinds of issues for that reason as well.

Yeah. And that's probably the generation that gave you pushback on your documentary as well.

We had pushback from the medical community, but to be fair, I would say only the medical community who had financial ties to self delivery, birth control platforms, or, you know, big voices in the medical community who were like, you know, have big books or Instagram accounts and are very pro pharma, are paid by pharma, are very pro medical. Those were a lot of the voices that I felt like had to shoot us down first because they didn't want anyone talking about fertility awareness methods. But when we would go on talk shows, radio shows, you know, it was the opposite where, like, the anchor of the news desk would look at us and say, I'm so happy you're making this, because I was on the pill for two years and it was the worst two years of my life and no one told me. And we found there was this collective rage around women and they weren't afraid to say it on air. These products stink. They're not good. I felt terrible on them. Why aren't there more options?

Where?

In the birthing world, it was almost like you can't complain about your birth because if your baby came out alive, even if they had to put 20 stitches in you and cut you open, you're not allowed to complain. Like, you're not allowed to say, oh, I wish I had, you know, this beautiful water birth, then it's like, you're an ungrateful mother. So women were very silenced around complaining about their birth experiences. But with birth control, it was like they were much more open. Right. The frustrating thing in all of these conversations is, so then what do we use?

Yes, what do we use? What are the other options? Avoiding the trauma of abortion.

Right, right. So, I mean, I'll give you my hot take on this. I'd love your hot take on this. I mean, fertility awareness method is great, right? And this is where you keep track of your cycle. And then during the fertile phase of your cycle, which you can identify by measuring body temperature and cervical mut mucus. And during that time then you either abstain from sex or you use a barrier method like a condom. The thing about fertility awareness method is that especially for young girls who are the ones that we really want to avoid pregnancy from, they're oftentimes not very good at being able to be reliable at anything, let alone managing their own fertility. And the other issue with fertility awareness that makes it sort of tricky is that, well, there's two things. So one, the time that women want sex the most is during the fertile window, right? So abstaining from sex is not realistic oftentimes for women when they're in the fertile window. And then if condoms are not readily available or some other form of barrier method, the brain is really good at telling you stories to get you to want to have sex when you shouldn't have sex. And your brain will tell you, oh, it's fine, like it's gonna be okay.

He's gonna pull out.

It's gonna be just fine. Like I'm not actually in the fertil, like I'm probably not even ovulating right now. And your brain will tell you all of these stories because it's desperate for you to get pregnant. Because our brain, you know, we've inherited through this evolutionary process that rewards reproduction. And so that can make that tricky. It's a really great, I mean, it's been how I've been regulating my fertility for a very long time now. But I'm a grown ass woman and so it works for me. For younger girls who are not so great at remembering things, you know, there is the copper iud, which is still a little bit barbaric when you get it put in, especially when your cervix is completely closed like it is with young girls who haven't had babies, it can be really painful to put in. But that being said, you know, my teenage daughter who is not sexually active right now, so she's not using any method, but if she, when, when she becomes sexually active, that's going to be the first thing that we try.

My, my take is always sort of like, you know, condoms and vasectomies. Hello. You know, I mean, first of all, for married women, I just, I just can't believe that, you know, the amount of Men that refuse to have vasectomies, you know, after their wife has delivered several children and then has to go, like, back on a birth control, it's to me, it's like that is the simple, you know, for a married or monogamous or committed couple, I mean, it is like a two minute nothing procedure and you're done. So I feel like vasectomy needs to be free on the street, you know, and it's reversible.

I mean, it's like easily reversible. It's not like barbaric.

Yes. I have a teenage son and, you know, he doesn't go near anyone without a condom ever, ever, ever, ever, ever. And we have these conversations all the time. And he is very well trained that I'm, you know, like, I don't care what birth control she says she's on. I don't care. You know, this is your life. You want to be a teenage dad, it's not going to be an easy ride, you know, and this is your only thing you have to do. And the diseases that you can get can stay with you for your entire life. Forget about pregnancy.

There are more than that.

Yes. Other gifts that can stay with you for your whole life. And, you know, so I really have these conversations and I think that it's unfortunate that people with penises have been like, removed from the burden of this equation. That's another big shift that needs to happen.

It's a lot. It's a big responsibility. Yeah. Because we know that the natural method is 99% effective only if it's done correctly. Any tips for younger people listening? Like, how could they achieve that 99%?

You know, from what I've learned from the fertility awareness educators is that you are really not only tracking your cycle with your basal body temperature, so you are tracking basal body temperature so that you know when you're ovulating. You are also checking fluids. Right. Cervical mucus, you are even checking cervical position. Like, you actually need to take a fertility awareness class. This is just what I've heard from the fertility awareness educators that I respect. They really feel like this is something that needs to be taught. And I would say it's something that every girl should learn because then you would just learn your cycle. Even if you don't wanna use fertility awareness as your birth control method, think about what you would learn about your body and your cycle. And that's what they're saying, that if you really understand it and know how to track things and get kind of good with it and the apps have made it easy, right? Cause now they have a wearable thermometer. You know, things that you're not waking up in the morning and putting a thermometer in your mouth. You know, like, there's things where it's just going straight into your phone. They're saying that you can pick up other issues. So you can pick up other hormonal imbalances and potentially serious health issues, cancers. I mean, really, like, you can pick these things up by understanding when your cycle is off or irregular.

Okay, that's so interesting. So it's so much more. It's a whole. It's a whole thing.

Here we are putting these young girls on something that's preventing their own hormone release and providing them with this daily synthetic. And there's just no way that it doesn't affect brain development. It would actually require a miracle to occur for this not to be affecting the trajectory of brain development. And so, because these young brains are very sensitive to hormonal involvement, Just because they're primed for that, because they're in puberty and still in that post pubertal brain growth period, that's likely what's responsible for the greater increased risk of depression. And it's also likely what's responsible for the increased risk of depression that lingers long after these girls develop into women and are off of hormonal birth control. Because now there's evidence showing that girls who go on hormonal birth control when they're teenagers, that they continue having an exaggerated risk of developing major depressive disorder across their lifetime. And this doesn't go away. And the sad thing about this is, it's only really recently that anybody's even asked this at all. There's only a handful of studies that I seen that have even looked at adolescent use of hormonal birth control and how that affects brain development, despite the fact that we've known that hormones affect brain development forever. I mean, this is like, you know, textbook. Like Endocrinology 101 is about the role of sex hormones in brain development during puberty. And yet nobody's asked that question. And so we have these girls who are being put on the pill, and they're working experiment. They're just like a walking experiment that they didn't even know that they were in to try to see how this affects brain development.

So doctors might not know all these side effects.

Well, and psychologists don't know. Like, my mother is a psychologist, and when she saw my documentary, she was like, oh, my God. I mean, I'm gonna Completely add this into my practice, you know, of, like, asking that question, you know, have you recently removed or inserted an iud? Are you on a hormonal birth control? I mean, psychologists, we. Ricky and I did a podcast with, like, Psychology Today, and he was like, like, I've been doing. I've been in this field for 25 years. He goes, I didn't know any of this. How is it possible that I have been. You know, it's. And like, Sarah's saying, it's like, nobody thought to study this. And my little personal take on this, right, is that when you have a blockbuster drug that's not only making billions of dollars, but is also solving a problem, a big problem in society, right?

How.

Where's the motivation?

Right? Yeah. It's like we all have a blind spot. And it's like a. And it's like a willful ignorance, you know, where it's like, we have this problem that's solved. We're not going to ask any questions, you know, and it is. It is a total blind spot. I mean, I had the same experience. So I was on birth control for, like, 12 years. I'd been publishing research papers, looking at the effects of estradiol on women's motivational states and looking at estradiol across a normal cycle. So I'm a woman, I'm on hormonal birth control. I'm studying and publishing research papers on the effects of hormones on the brain. I never put two and two together. I never thought, oh, you know, changing my hormones is then going to change what my brain is doing. And it never even occurred to me, and what a stupid thing not to have thought of.

No 100%. And I think that that's the other thing that, you know, the block, in a sense, to people knowing about the non hormonal IUD is that when they go into a doctor's office, if they talk about an iud, unless they specifically advocate and say, I would like the paraguard, you know, I would like the copper iud, whatever it's called, they will get a hormonal one and they will probably not know that there were two.

Right? And they'll also not know that with the hormonal one that most of them are going to have ovulation suppressed because it does have that effect on the brain. And what ends up happening because the levels of synthetic hormone are really low, and then their own hormone production is stopped is their levels of hormones are so low that they feel crazy. And like. So a lot of women who go on the IUD feel much worse than they would if they were on something with a higher dose of synthetics. Because being in a low hormonal state is just not normal for women. It's just not natural for us. Like, our brain does not feel like itself when hormones are super low for a really long time.

And then what's happening to a lot of women. One of the women I'm working with now is that, you know, because the IUD stays in for so many years, they actually are going into their perimenopausal, menopausal transition without knowing it. So just like we're medicating sort of puberty, we're now medicating menopause. So, like this one woman I'm working with, you know, when she was 47, her doctor was like, well, I think we could take the IUD out now. Like, I think you're okay, you know, you're probably not gonna get pregnant. Took it out and she couldn't get out of bed. I mean, she had a complete hormonal crash because while that IUD was in her own hormonal production, must have been menopause. So she went from like 100 to zero overnight and then had to go on the journey of learning what happened and getting on HRT and took her like a year to kind of get her life back in a way. And so all of these things are connected. It's like all of these choices are connected because, you know, you are fertile like well up into your mid-40s, you know, and, and beyond even. I mean, I have friends who've gotten pregnant even over 45. So I mean, fertility is a huge window and it's something you've gotta deal with for most of your adult life. And so all of these choices that you make. Which leads me right back to vasectomy, 47 year old man not getting a vasectomy.

That's a lot of very, very wonderful information to process. If I'm wondering like now, what. What advice would you give to listeners who want to stop taking the pill, or parents with teenage daughters or sons.

Yeah, I mean, I agree with Sarah in the sense that I feel like teenagers. If you are looking to hormonal birth control for like acne, painful periods, irregular periods, any kind of cycle issue, or acne, I would say definitely don't just go to the quick fix. It is just a band aid, you know, and it can make things worse. Also, when you go off, your acne can explode. So I would say, you know, there's a lot of other Options and to really try to address the underlying hormonal issues, if you can. Sometimes you can't because we don't have the research. And for endometriosis, you know, there are a lot of conditions where we don't have a lot of solutions, and the pill is the only solution. And if that's the solution, you know, great. And I do think what I tell, like my friends with teenage daughters who are, you know, going to take contraception. This is my little personal hot take. You know, I usually say to stay away from things like, like an implant or something that is really hard to reverse or remove. If you have a bad reaction to the pill, stop. You know what I mean? It's just two seconds. I also tell them that to research what kinds of micronutrient depletions occur when taking the Pill. Cause I think those are fairly well studied and I think those can be supplemented. And, you know, if you're on it, you might as well try to be as healthy as you can on it. And there are, you know, companies that are making actually targeted supplements for women on the pill, or you can just do it yourself. But I would say that. And then I always tell my friends, you know, please be very, very alert for mood changes and have this conversation with your daughter that, you know, if she feels any mood shifts, you know, anything, or the other thing I always say, and this I think should be shouted from the rooftops, is, you know, migraines and migraines with aura, that's extremely dangerous and can actually really be a telltale flag that you might be one of the people that is more inclined to have a blood clot or a stroke. I mean, we haven't talked yet in this podcast about the very serious side effects that can be life threatening. Some of those are shown in the film and they're very difficult to watch. But, you know, blood clots, if you catch the blood clot, right, it can be easily treated and resolved. If you don't catch the blood clot and it moves up to your lungs, it can be life threatening. I've been surprised since I started making the movie of how many women have told me very casually that they did get a blood clot. And, you know, it's just not something that we speak about. And I don't think it's a risk to be swept under the rug. And what I've seen and what we saw in the film is that it doesn't follow that if you just don't smoke and you're not, you know, overweight that you're safe. You know, the women in our film who were. They were young, they were healthy, they were non smokers, and they did experience blood clots which could lead to strokes and pulmonary embolism. So I do think that another thing to look at, which most people do not do this, but I tell my friends and their daughters, when you get pregnant, they check you for clotting disorders. They see if you have factor V Leiden, if you have factor V Leiden, if you have certain clotting disorders in your blood that can make you much more susceptible to a clotting incident on the pill. And that's just a test your medical provider is not gonna suggest or the birth control clinic. So, you know, my overall take is like, I totally understand that there are periods of life and teenage years where, you know, you wanna opt to be on hormonal birth control. And my friends are putting their daughters on it, and I completely understand and support it and support everyone's informed choice. But this is a medication. It's a medication, you know, it is. And it can have systemic effects. And you just really need to research, you know, and understand them.

Yeah, that's the thing. Informed choices.

Informed choice. And I think the problem is a lot of times when we talk about informed choice, like, one of the things we got accused of in our movie was fear mongering. And that to me is such a. Oh, my God. You know, it's such a cheap pushback. Right?

Yeah.

So, okay. Because now we're talking about risk. We're fear mongering. We're trying to scare women off the pill. Well, why would we do that? We don't have. We're not Catholics. We don't have some religious agenda. What would be our agenda of scaring women? So I think, unfortunately, that's what happens is people get nervous when you talk about the more severe risks. But I think all of that is part of this conversation. And one quick antidote that I don't know if this came to your. I'm sure it did. But when they were testing the COVID vaccines, one of the vaccines, the Johnson and Johnson vaccine, they found that there was this very small risk of a fatal blood clot, or I don't know if it was fatal, but like a pretty serious, like, brain blood clot. Right. Like, the risk was, like, enough that they took the Johnson and Johnson COVID vaccine off the market to calm people down. They said, oh, but don't worry, this risk is lower than the risk of having a blood clot or a stroke on the birth control pill. And instead of calming people down, it made women crazy. And it's like, okay, wait a minute. So it's okay for millions of us to be on this medication that has this low but, you know, risk of, you know, strokes, blood clots, death, but now you're pulling a vaccine off the market that has an even lower, you know, and that is so typical. It is so typical of how we treat, treat women's health and how we value women's health, you know, in general.

Thank you so much, really. It's an honor, Abby and Sarah, to be able to talk to you and for, thank you for sharing your insights and your expertise, everyone. All the listeners can find additional information in the show notes or if you have any questions you can. You feel free to reach out to Good Woman, the team. You can find them@goodwoman.com after this episode, you might be wondering whether quitting the pill is the right choice for you and who you really are without it. It's all about educating ourselves. If you're interested in diving deeper into these subjects, we recommend resources like Sarah Hill's book this Is yous Brain on Birth Control, the documentary the Business of Birth Control by Abby Epstein, and the book Decode youe Cycle by Morgan Leighton. Don't forget to tune into our upcoming episodes where where we'll explore related topics such as skin health, nutrition, perimenopause and much more. This podcast was brought to you by Good Woman, produced by the audio collective Velcro, based in Belgium.