Let talk about pills, baby


[00:00:00] Let's talk about pills. I, I can do everything to, let's talk about sex, by the way. Let's talk about pills, baby. Okay, so we're gonna talk about birth control pills. Why a, I don't think I've talked about birth control pills exclusively for a while. I can't cover everything today, but we'll talk about what I can in my 15 minute allotment here, and B, because on social media this. 

Week there was a certain account that tends to look at a women's cycle in a much more holistic manner, which by the way, I am all four. For those of you who don't know, I actually did a semi masters in integrative health a couple years ago, and I loved it and it's fascinating and I don't fully understand it, but I am very open and on board to a combination of integrative modalities with Western. 

That said, um, this particular count made some pretty widespread, um, sweeping statements about birth control pills and how damaging they are for women. Full stop. and I have a real problem [00:01:00] with that and luckily many of my sisters in medicine who are far more just, I don't know, on the ball on social media than I am really, um, went for it on this account and somehow the account got taken down. 

And I don't know if that was because there was enough controversy that, that they felt like they had to, which I'm glad about because here's the thing, as western doctors, we should not behave as if, you know, medicine is the only thing that can. Because medicine has downsides. Like when I say medicine, I don't mean the medical field. 

I mean, actual medicine has some risks and downsides and is not always perfect. Similarly, the eastern world should not say they can heal everything in the world through only eastern modalities. And when I say Eastern, I'm using that as a sweeping statement for anything that we don't consider allopathic medicine, meaning medical doctor medicine. 

So whether it's herbs or nutrition or. Acupuncture or traditional Chinese medicine, all these other modalities that I think are amazing. I love them. I've used them. When I went through chemo, [00:02:00] I was glad to have my toxic chemotherapy and I did acupuncture. I did all kinds of other things. Some which were really kind of kooky, but they helped me feel better. 

And I think they actually helped me in certain ways. And I think part of it might have been placebo effect, and I think a combination is the way we should approach it. I think for either side to be dogmatic, which of course we know they are, is. Wise, but I think many people who are, um, against Western medicine are able to make, again, sweeping generalizations. 

And because they do not have the same malpractice that we have, they're not held to the same standard. They're very easily willing to kind of push people away from things that we know have had scientific evidence proving their validity. The pill is an example. Now let me pre. I don't profit from the pill. 

I don't care if someone takes a pill. I don't care if someone uses any of these birth controls. I just want you guys to know your choices. Okay. And I am the first to say, but just like any other medication, the pill [00:03:00] has some bad side effects for specific people. But that doesn't mean it's all bad. Nothing is all bad, nothing is all good. 

Remember, all my sayings are always about things being both and, okay? So please remember that as I say this. This is not to say that everyone should be on the pill. There's many different types of birth control, and if you're the type who wants to do this all naturally, balance your hormones, take care of your contraception. 

Everything natural. God bless you have at it. It's not easy, but you can do it. But that doesn't mean that everyone needs to do it or should do it or can do it. That's what's important. Okay, so the birth control pill, by and large, here's my little lesson. The majority of combined birth control pills are estrogen and progesterone, and what you should know is that the estrogen is the same in every single brand. 

It's ethanol, estradiol, it's the same estrogen, the progesterone. Is what is different in each proprietary brand, the estrogen's dose might alter. So depending on what brand you use, you'll have different [00:04:00] doses of estrogen, but it's the same chemical formulation. The progesterone will be different depending on the brand. 

One brand, for example, named ya, you might have heard of, uses Dr. Perone, another brand named Ortho Cycline uses nor decimate. So they have different formulations of est, of progesterone, so that's one. Nugget for you guys to know that many people don't know. Second is that there's also alternative birth control pills, which are progesterone only, and there's actually only two. 

There's Noone and then there's a newer one. Sperone. They're progesterone only. I'm not gonna talk about those as much just because there's only two, but those are great for women who have either had migraines with aura, women who are nursing, women who have worse headaches in general on the combined birth control pills. 

Um, those are the biggest reasons why we would use the progesterone only pill in general. Pills come looking like this. I'm covering this one because this is the only sample I happen to have. I'm not advocating any one brand because what I tell patients is this, when I start on any pill, [00:05:00] this is how my counseling goes. 

Is there a pill you've heard of that your friends or sisters or mothers have used that you'd like me to start you on? And that might sound funny to patients cuz they might be like, uh, I'm not the doctor you are. Why are you asking me? But I'm asking you because there's no one particular brand that I can say like, oh, you've got short hair and you're short and you're kind of chunky and therefore this is the pill for you. 

I can make. Some educated guesses based on some of the data, but anyone who's been on the pill and anyone who's prescribed the pill knows that it doesn't always work that way. How the pill works in vivo in your body is very different than how it's worked in vitro, which is why when you guys come to us with, I've done the research and I've looked into it, and this pill has this side effect, and that pill is not side effect. 

Most of your doctors are internally thinking, okay, I'll go with what you say. But the fact is, until we start you on a. We don't know how your body's gonna react because your body's gonna react differently than other people. Does it seem, anecdotally to me, I don't know if there's any data to support this, that if mom or sister was [00:06:00] on X, Y, Z pill, then you might do well in it. 

Maybe because maybe there is something genetically in how you metabolize that pill. I don't know. But it's as good a place to start, given that we don't have any great alternatives. So I'll first say, is there a pill you've heard of that you like to try? Yes or no? They'll tell me if there's not. My other question is, do you want your period or. 

You do not need a period if you are taking the pill. So nugget number two, how does the pill work? It evens out your hormones and therefore stops ovulation. In a normal woman's cycle, they have this up and down like a sine wave of their hormones, stimulating their lining. Then their body ovulates. Then their lining sheds when ovulation did not produce a pregnancy. 

Now, if it produced a pregnancy, you wouldn't shed your lining. You wouldn't get your period. But when it sheds, which is your period, That means you're not pregnant right now. The pill is evening out, your hormones, no ovulation, which means the lining isn't thickening up as much, which means it doesn't have to shed. 

So when all those mamas out there go, oh, but it's not natural to not [00:07:00] get your period. The answer is, yeah, you're right. But it's also not natural to go on the pill and stop ovulation. So once we've made that leap, the second leap to missing your period is not a big deal. You want your period, take it. You don't. 

You don't need it. Pill makers 50 plus years ago seem to think that women wanted to mimic nature. Had they said to us at the time, we're gonna stopping ovulation, you don't need your period. We would've all grown up going, oh yeah, we don't need our period on the pill either. Okay, so that is up to you. You can decide with your doctor, do you want your period or not? 

But it is safe. Let's talk about the good parts of the pill besides decreasing mood. Acne, pain, ovulation pain, period. Besides decreasing ovarian cancer, uterine cancer, and colon cancer. It also provides birth control 99.7% of the time. If you take it every day, what are the downsides of the pill? Well, all those things that I said, it can improve acne, but it can also make acne worse. 

It can make mood worse. It can make you spot or [00:08:00] bleed more irregularly. It can cause weight. Though a third will gain weight, a third will lose weight, and a third will stay the same weight. And that is actually what I would say we see anecdotally. Those of us who tend to be hungrier and eat more are probably gonna be hungrier on the pill. 

Those of you who are perpetually lean are probably gonna stay lean, maybe a couple pounds of water, weight and bloating. That would be it. The, the downside to the pill when it comes to cancer is that we don't know about the risk of breast cancer. There is some data that it might increase the risk of breast cancer, but the likelihood of that is not high. 

And we also have to think of the other risks like not being on birth control and potentially getting pregnant. And I know some people out there might say, well, you could use a condom, or, well, you could use the rhythm method, but the fact is we also have to be realistic with what people will do on this earth regularly. 

Blood clots, heart attack. Are risks, but are rare. Can a young woman who is healthy, who doesn't smoke, get a blood clot? Yes, but it's [00:09:00] much less likely than if she is over 35 and smoking. Those women cannot take the birth control pill again, that has estrogen in it. Is it something that I would say, you should be so fearful that you shouldn't be on the pill? 

The answer is no. I think that, again, the risks of the pill are far less than the benefits. So in individual, You have to make that decision as to whether or not it's worth it. Do we, do we have patients who after years on the pill, notice that their vagina gets more atrophic, meaning less elastic and dry? 

Yes. Can it affect your libido? Yes. Are there things about the pill that I wish didn't occur? Of course, in a though, it's like anything else. Pros, cons. Each individual has to weigh it. So let's not generally malign something that has actually created a huge amount of benefits for women at large, because without it, women were not able to plan their pregnancies and plan not to have pregnancies. 

And an archaic view of saying just don't have sex is just not the way our world works anymore. Now, when it comes to the [00:10:00] pill, the most important thing is taking it every day, ideally at the same time, every day. Not to the minute, but within an hour or two, because these pills nowadays are also low. That if you're taking it at like 26 hour intervals routinely, your body might start to think, ah, am I in my placebo week? 

Let me release that lining and bleed. And then you start to kind of spot or bleed and it's frustrating. A typical pill pack will look somewhat like this. It will have three weeks of regular active hormones and anywhere from four to seven days of different color pills, which are placebos, meaning they have no hormone in them, and that's where your brain is going. 

I'm in the placebo week, no hormone. Let me release that lining. That again, doesn't really need to be released, but you can have it if you want. It comes with these stickers so that the first day of your period, you can put the sticker over the top so that then from then on, you know, like if you get your period on a Monday, you can start on a Monday. 

In the old days, we used to tell people to do a Sunday start, but that's a little archaic and old fashioned. You don't need to do that, and you don't even [00:11:00] need to wait for your period. You just need to make sure you're not pregnant, so you could actually start whatever day of your cycle you want. But then you have to look at the package insert for them to tell you when it would actually be effective as far as birth control. 

Can you still get STIs when you're taking a pill? Hell yeah. This is just birth control. This is just hormone regulation. This is not gonna stop you from hiv, hepatitis, syphilis, herpes, gonorrhea, chlamydia, none of them. So you still need to take precautions, which means condoms if you are with more than one partner, or if you think your partner might be with. 

Condoms. Condoms. Condoms. Condoms. Okay. What else can I tell you about the pill? Again, in general, I think that it is not something that everyone should be on and not, so not something that everyone shouldn't be on. Every individual young woman has to make a decision with herself and her doctor to decide whether or not this is something that works for her instead of the pill. 

If young women want to do this naturally and holistically and use the rhythm method and [00:12:00] really understand their cycle, I. They should, but that doesn't just mean, oh, I'm gonna pull out, or, oh, I'm just gonna count my days. Because just counting what days you're, you are getting your period is not gonna be enough to no ovulation cuz it can fluctuate each month. 

So just understand that if you wanna do these things on your own holistically, it is wonderful to try that. But it's a big endeavor and it can be really challenging and it's not something that you should just do kind of will. . Um, the other things that I really wanna just, again, make really, really clear about the pill is that overall the safety has really been around now for about 50 years. 

I have patients who start when they're in their forties, like 41, 42, because of perimenopausal symptoms like bleeding and mood. They can stay on it as long as they're not smoking. Until anywhere from 50 51, 52, 53, and somewhere in that range, I'll have a conversation with them about, you know, you're probably going through menopause. 

You've probably gone through menopause. Let's go ahead and take you off and see. So it really can be very safe. Individual cases have to change things, meaning if your blood [00:13:00] pressure went up or you all of a sudden had a stronger family history than we knew of a stroke or a heart attack, than we might tell you to go off of it. 

But ultimately it is very safe and the doses are really low. Okay. I hope that helps my.