How to Minimize Your Risk On the Birth Control Pill [Podcast] - PCOS Diva
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How to Minimize Your Risk On the Birth Control Pill [Podcast]

PCOS Podcast No. 105 - Mimimize Pill RiskIf you are a woman with PCOS and/or you’re using hormonal birth control, listen in (or read the transcript) because this podcast is for you. Dr. Jolene Brighten is the leading expert in post-birth control syndrome and the long-term side effects associated with hormonal contraceptives. She’s also the author of a brand-new book, Beyond the Pill. While we both agree that it is a woman’s right to take the birth control pill, it is also her right to understand how to take care of her body while she takes it, what those potential side effects are, and what she should look out for. Listen in and be educated and empowered!

  • Why doctors fail to connect symptoms like gas, bloating, depression, anxiety, acne, yeast infections, any other number of signs and symptoms to birth control.
  • Nutrients you must supplement to reduce your risk of heart disease and neurological issues
  • Baseline lab tests to have done before, during, and after taking the pill
  • Why we have high rates of gall bladder issues
  • How and when to detox
  • The impact on your gut and how to repair it

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Mentioned in this podcast: Straight Talk About PCOS, The Pill, and Post-Pill Syndrome [Podcast episode 87]

Beyond the Pill– new book from Dr. Brighten

Full Transcript:

Amy:                                     Today, I am thrilled to welcome back Dr. Jolene Brighten. She is a functional medicine doctor, a naturopath. She’s a nutritional biochemist, and she has a focus on women’s endocrine health. She is recognized as the leading expert in post-birth control syndrome and the long-term side effects associated with hormonal contraceptives, and she’s also the author of a brand new book, Beyond the Pill: A 30‑day Plan to Support Women on Birth Control, Help Them Transition Off, and Eliminate Symptoms of Post-Birth Control Syndrome. Welcome back, Dr. Brighten.

Jolene Brighten:               Hey there. Thanks so much for having me. I’m super excited to be back with you chatting about this conversation of birth control and PCOS and how we can support women.

Amy:                                     I do want to just make note that episode 87, we talked about … It was titled Straight Talk About PCOS, The Pill, and Post-Pill Syndrome. In that episode, we talked a lot about what post-pill syndrome is and what we can do about it, testing to have done while on the pill, and often undisclosed risks of the pill. Maybe you could just go over what post-pill syndrome is and those risks briefly before we get started on this podcast, but we also talked about contraceptive alternatives for women with the pill. What I wanted you to talk about today was … Okay. We, after your podcast, we know all of the risk factors of the pill, but if we still choose to be on the birth control pill, because frankly, it really helps whatever the symptom may be for PCOS, and we really don’t want to come off of it. What can we do to sort of help our body detox or manage being on the pill better? That’s really the topic for today, but I would love for you to just kind of go back and review what is post-pill syndrome and some of the undisclosed risks of the pill.

Jolene Brighten:               I am so excited for this topic and for your willingness to hold this conversation, because a lot of people want to talk about hormonal birth control with me, and they’re like, “Let’s say it’s the devil and no woman should take it.” Then, they’re always a little taken back when I’m like, “Okay. It’s not the devil, and also, it’s 100% her choice to take it or not to take it. We need to support her wherever she is at.” To go to your question about post-birth control syndrome, so post-birth control syndrome, as it’s defined in Beyond the Pill, which is my new book that you were talking about, is the signs and symptoms that come up when you stop hormonal birth control. Now, on average, we see these come up about four to six months after stopping birth control, but for some women, it can be sooner. Other women, it’ll be later, and let’s face it, as women, we can have symptoms come up, and then we’re like, “Okay. Let’s just plow through it,” because we got things to do in our life.

Sometimes that means that it isn’t until like a couple years later that we’re like, “Oh. Now this is too much for me to handle,” and that’s what makes it tricky. That’s one of the things that makes it tricky, is that you’ll go to your doctor, and you’re like, “All right. I came off of hormonal birth control. Things were off. Now they’re way worse. It’s been a few years, and then your doctor says, “Well, it’s been so long. If it was birth control, it would have happened immediately,” except that’s not the way it works. The other tricky part is, is that hormonal birth control impacts every single system in your body, and your doctor may be viewing you through the lens that, “Well, there are female problems and period problems, and those go along with birth control, and so if you’re having gas, bloating, depression, anxiety, acne, yeast infections, any other kind of signs and symptoms coming up, that’s not related to birth control, because it’s not strictly female period problems.”

That’s a bit of an issue, because that means that a lot of women … Well, let me say this. If you don’t understand how medicine works, they love to compartmentalize things, because it’s really easy for us to understand, study, and treat, and so it goes like this. If you’ve got a female problem, a period problem, something going on with your fertility, your menstruation, that is something you go to the gynecologist for, yet if you have something going on with insulin or adrenals or thyroid, you go to the endocrinologist for that. If it’s gut related, you go to the gastroenterologist, and we keep just piecing it out and forgetting that it’s all connected. It’s especially true in the case of polycystic ovarian syndrome, or PCOS, because yes, PCOS manifest in all of these, quote, “period problems.” However, it’s very much rooted in insulin dysregulation, inflammation, what’s happening with the adrenals, and certainly, we see thyroid issues, as well, and so it’s really a combination of symptoms.

Now, with post-birth control syndrome, you may have started birth control for symptom management, which means that when you come off of birth control, those symptoms will likely come back, but you may have started birth control for contraceptive reasons only, and when you come off, you may find yourself, for the first time, experiencing new symptoms like acne. Me, for instance, I had, every 28 days, I had my period. I feared it, because it left me writhing in pain for seven to eight days out of the month, heavy, heavy periods, carrying a sweatshirt with me … Thank goodness it was the ’90s. It was fashionable to tie a sweatshirt around your waist. That was like a thing to do. … to hide the fact that every single month I bled through my clothes. I bled through my pad. They were horrific periods, and so when I was passed hormonal birth control, I was super, super grateful to have something that would help me manage my periods.

My adult self now is like, “Could I have please had some root cause conversations around that?” I don’t know that I would have chosen anything different, but I at least would have liked to have been in the know. But when I came off of birth control, I found myself wearing a beard of cystic acne for the first time in my life, and my period was completely gone, to which my doctor was like, “You probably had PCOS all along.” I happened to be in naturopathic medical school at the time, so when I countered with, “No. I’m studying PCOS, and this is not what PCOS looks like. I always had regular periods,” he told me, “Well, you are likely misremembering your periods.”

I laugh at this now, because any woman with dysmenorrhea, which is painful periods, or menorrhagia, which is that you bleed more than seven days or you have excessive bleeding altogether, knows when her period is coming, because she counts it down like doomsday, and so understand that sometimes, with PCOS, we get misdiagnosed when we come off of hormonal birth control, which I explain in the Metabolic Mayhem chapter of my book, because of the androgen rebound and the fact that not all of us pick up menstruating just because we stop hormonal birth control. That’s a bit of the overview and talking about post-birth control syndrome. I know we’re going to go in deeper today about how to support women who do choose to use hormonal birth control, which is 100% their right, and I, for one, am grateful that women have this option.

Amy:                                     Yeah. I wanted to make a couple comments. First off, I … There’s sort of this term that’s kind of been bantered around … I think Dr. Lara Briden sort of … She’s the first person that I saw use it. … is this post-pill phenotype of PCOS, which I think is sort of what you’re alluding to with this androgen rebound, where it may not actually be PCOS, but it’s part of this post-pill syndrome.

Jolene Brighten:               Totally.

Amy:                                     I do think that now that PCOS is kind of on the radar screen, the rates of PCOS are increasing, so it’s like now I’m seeing the stat is like 20% of women have PCOS. I’m wondering if this might be what may be happening, and then, to your other point about how kind of in allopathic medicine, they treat the symptom and compartmentalize, I think that’s why 50% of women with PCOS are undiagnosed, that, for one, nobody’s really looking at that root cause. Then, finally, I just wanted to state that I was on the pill for about 10 years, from the time I was 17 until I started trying for kids, like at age 27, and they really did … It really did suppress the androgens. It was helpful, but yet there was no really 100% informed consent. I think if I knew all of the risk factors of the pill and ended up experiencing them to some extent, I don’t know if I would have made the same choice today as I did then.

I think that this conversation, when I’m on the podcast talking to experts about the pill, it’s not that it’s anti-pill, but it’s really I want you to have the informed consent that I really never did. Then, when I tried to go back on the pill after having my two boys and trying to figure out a way of natural … or not natural, but family planning, I could not … My body could no longer tolerate the pill, and really, as a treatment for PCOS, which is what my doctors wanted me to use it for, so I had to find another way. But yeah. Let’s get to some of the nitty-gritty for women that are on the pill. Those 10 years, what should I have been doing, Dr. Brighten?

Jolene Brighten:               Totally, and I do want to say that Dr. Lara Briden, that’s B-R-I-D-E-N, and I’m Dr. Jolene Brighten … I say that because we get confused all the time. We actually got really giddy, probably a few … It was about six months ago. … when we realized that her book and my book would be right next to each other on the bookshelves, and they’re going to be sister books. We’re really excited about that …

Amy:                                     I love that.

Jolene Brighten:               … and she’s quoted in my book, because yes. She is the first doctor that I came across talking about post-pill PCOS, and this is something that I stumbled around with language in my practice of what I was observing until I found her work. I appreciate you bringing that up, because I think it’s really important, and if we all take a moment to reflect that like 50% of women walking around with PCOS not knowing it, 50% of women walking around with thyroid disease and don’t even know it, and why don’t we know it? Why don’t we know? Well, one, our stories aren’t being heard by doctors, and two, they’re not doing appropriate lab testing, which is part of what we need to be doing while women are on hormonal birth control.

If you are a woman with polycystic ovarian syndrome or you’re using hormonal birth control in any way, stay tuned. Keep listening, because we’re going to go through a whole lot of things you need to be doing. Now, I do want to talk about lab testing, but the very first thing I want to say is don’t do what Dr. Brighten did, and that is pop that pill every day and then drive your car up to a fast food window. I like to say that, because I ain’t shaming anybody for their dietary choices, but you have to understand that hormonal birth control is depleting nutrients like crazy, so things like magnesium, selenium, zinc. Just depleting zinc alone can make your acne a whole lot worse, especially when you come off of it. While hormonal birth control can suppress the androgens, which it does very well, so that you don’t have to deal with acne or hair growth, when you come off, that lack of zinc due to nutrient depletions can cause even worse symptoms, especially with the androgen rebound.

With that in mind, you need to be eating a diet that’s rich in these minerals, and one of the easiest, maybe least palatable ways, and I say this because I’m currently talking to you in Paris, France, and like every other block is an oyster bar and seafood, and my son, he’s being like, “Mama, let’s get oysters,” and in my mind, I’m like, “No. They’re the worst,” but they’re actually the best. I’ve committed with my husband. We’re going to go to an oyster bar and do it anyways, because they’re such a rich source of zinc. That idea that oyster are an aphrodisiac, it’s actually true. Because of those zinc levels, they help optimize testosterone so that you don’t get the wrong kind of testosterone. You get the right kind of testosterone.

Now, other nutrients that are being depleted by birth control include folate, B-12, so these things are definitely important for pregnancy, but they’re also important for heart disease, something that PCOS women are at a higher risk for anyways, and for neurological health.

Amy:                                     Yeah, and just … Just-

Jolene Brighten:               Yeah. No. Go for it.

Amy:                                     To interrupt you … I’m sorry. … and I always try to hit this point home, that so many women are also on metformin …

Jolene Brighten:               Oh. Yes.

Amy:                                     … which depletes B vitamins, so it’s like you get a double whammy.

Jolene Brighten:               Yeah. I really appreciate you saying that, because I have found, over the last month, I think like every other day on Instagram, people are asking me, like, “Well, what about metformin? I’m taking the pill, and I started metformin?” Then, I’m like, “Oh lord. Did your doctor talk to you about B-12?” and they’re like, “No. What are you talking about?” I’m like, “Oh my gosh. No, no, no, no.” We know that B-12, and here’s the thing to understand, ladies, is that I talk to doctors. I mentor doctors in this work, and I will have some doctors say to me, “Oh. Well, it’s birth control. Why do you need a supplement? They can just change their diet.” Then, when I … I ask them, like, “Okay. What about metformin? How do you feel about that? Okay. We know it depletes B-12. What would you recommend?” “Oh, that she gets on a sublingual B-12 or she’s taking B-12.” I’m like, “Right.”

You’re talking about one medication that you know depletes a nutrient. We know … Statins is another one. Sometimes, PCOS women get given that because they have higher cholesterol. With statins, same thing. CoQ10. You need to take a supplement of CoQ10. It’s not enough to just do the diet, and so that is something that, whenever I’m talking to doctors about that, I’m like, “Look. If you were going to offer metformin and you would recommend B-12, why is it with hormonal birth control that depletes B-12, folate, magnesium, zinc, selenium, CoQ10, vitamin A, vitamin C, just a lot of nutrients I could keep going with here, that you wouldn’t recommend a multivitamin or prenatal?” They always look at me kind of shocked, like, “Oh. Yeah. I guess that’s something.” I think a lot of it is because so much of the birth control information and knowledge has been passed down as if it’s a woman’s right and we have no right to question it in medicine. It is a woman’s right, but it so is her right to understand how to take care of her body while she takes it and what those potential side effects are and what she should look out for.

I was talking with a colleague of mine who is a conventional medical doctor, and something really interesting he said to me was, is that, “This is the way it goes for us,” is that, like, “If they taught us in medical school and then it was driven into us, residency, then that becomes truth, and it’s going to take a whole lot of studies to change our mind.” He admitted … He was like, “This isn’t the best way to go about it,” but it becomes that level of dogma where we’re like, “No. This is what we were taught about birth control, so I don’t care if you have 10 studies. I don’t care if you have 20 studies. I don’t care if you have 20,000 women. This is what I was taught. This is what it was originally ingrained in me.”

I think that’s a really important thing to acknowledge, is that they planted their roots deep down in the soil around this idea and that it can be a little bit difficult to unroot that and to understand that, like, “Wait. Maybe I didn’t get the whole story in serving my patients,” but I so appreciate you bringing up the double whammy of metformin and how many women are passed metformin and they don’t even have insulin or hemoglobin A1c or fasting glucose or glucose challenge tested. This is the other thing I hear from women, is they’re like, “Well, my doctor said, ‘You have PCOS. Here’s birth control. Here’s metformin,'” and I say, “Well, what did they test?” “Well, I had cysts on my ovaries and irregular periods.” Okay. Yeah. That might be PCOS. It could also be thyroid. It could also be estrogen dominance. We have to look a little bit deeper. Some women, they very much do have the diagnosis of PCOS, but nobody’s getting baseline labs on them to understand how these medical interventions, these pharmaceuticals, are impacting their health. How can you measure change in somebody if you never got that baseline to begin with?

Amy:                                     Yeah, and I think that now, with the birth of some of these patient direct lab companies … I know you and I both like … you can, if your doctor is not willing to do some of these baseline testing for you, like your fasting insulin levels, you can order those yourself really … It’s an affordable.

Jolene Brighten:               Yeah, and I so appreciate that, because you deserve to know your data, and you deserve to have access to that. If your doctor won’t order it and you keep going round and round trying to find someone who will, getting those baseline numbers, I mean, even if you don’t totally understand them, you have them. I think a lot of doctors will say, “Well, I’m not going to order these labs, because you don’t really have the symptoms to warrant it,” and that is like old-school medicine that needs to go away, because if you feel awesome right now, get your labs done. Understand what they look like when you feel awesome, so if you don’t feel awesome and then you have changes and you go to your doctor, and they’re like, “Eh. They’re kind of off,” you can compare them and say, “No. They’re really off for me,” because we’re moving more and more forward to this individualized medicine and understanding that each of us … There’s variations in the human population about what is optimal, and certainly, I …

I’m going to call you out, New York, these states that do not allow patients to have direct access to your labs. I’m sorry, but you’re a state. You are not a human. You have no right to tell this woman that she can’t access her data and understand what’s going on with her body, all because you have a bunch of legislators passing laws who have no medical education whatsoever who think they know better on a woman’s body. It’s 2019. I have zero patience for that.

Amy:                                     I know. I know. It does seem so antiquated, doesn’t it?

Jolene Brighten:               Well, it’s just … I just don’t understand why, in this day and age, that people without any medical training whatsoever get to pass laws about a woman’s body, and then you … You hear these things where some of the politicians are like … I mean, they just, they say these things where you’re like, “Okay. We never even taught that in sex ed in, like, grammar school or high school, so how did you make that up in your mind? How did you get so far off on the basic physiological understanding of how the human body works? Now, you think you’ve got to pass a law based on misinformation?” That’s a huge problem in women’s medicine. I mean, we will record an entire podcast about the disservice done to polycystic ovarian syndrome women …

Amy:                                     Oh gosh. I know.

Jolene Brighten:               … in terms of research, in terms of politicians, in terms of insurance. It needs to go away, and that’s so much of the work that you and I are doing, is making sure that women are so educated, so empowered that, at the end of the day, they know they made the best decision for themselves and they can go advocate for their own health and create the change that needs to happen in women’s medicine.

Amy:                                     Yeah, and just a quick shout out to PCOS Advocacy Day on Capitol Hill. That’s sponsored by PCOS Challenge every year. It’s really a great opportunity to kind of get in the front lines and advocate with your legislators. I did it last year, and I’m going to do it again this year. The National Institute of Health only appropriates like 0.01% of their budget for PCOS research, and that needs to change. You have a voice, and you can use it on that PCOS Advocacy Day, so thanks for that.

Jolene Brighten:               No. No, and that … It’s kind of ridiculous, though, how little research goes to PCOS, how little research goes into endometriosis, how little research goes into actually measuring the statements your doctor is making about birth control. Meanwhile, we dump buckets, boatloads of money into heart disease, diabetes, all these things. Oh. Wait. Heart disease? Diabetes? You mean that thing that’s preventable in a PCOS woman, but that she has set the stage for to develop should you not intervene early enough? I’m on a little bit of a soapbox right now, but you can tell I get fired up about this.

Amy:                                     I know. I know. It’s good. We talked about … I’m just going to point people to my labs guide at, and I know that you talk about that in your new book, as well, the Beyond the Pill, which is brand new and is available really anywhere books are sold, so you can … You can also go listen to podcast 87, where you go into detail about the different tests to have done while you’re on the pill.

Jolene Brighten:               Mm-hmm (affirmative).

Amy:                                     Let’s go on to your next tip for us. If we’re on the pill, what should we do?

Jolene Brighten:               Well, I think this dovetails really nicely, because if you’re on hormonal birth control, you should continue to monitor your labs. Now, estrogen, progesterone, testosterone, those should be squashed while you’re on hormonal birth control, but we know that hormonal birth control can, and does, increase the risk of diabetes through insulin dysregulation and glucose issues. With that, if you’re a woman with polycystic ovarian syndrome, you need to be monitoring your labs, and not just your hemoglobin A1c, which is what your blood sugars look like over the last three months, your fasting insulin, and your glucose, but you also need to be looking at things like c-reactive protein.

Hormonal birth control is inherently inflammatory, and that’s a big problem, because with polycystic ovarian syndrome, inflammation is driving a lot of these issues, and so measuring your CRP, your c-reactive protein, is very important, having regular screening of your comp metabolic panel. Now, that’s … The acronym is CMP. That’ll tell you about your sodium and your potassium ratio. This is especially important in a PCOS woman, because she is more likely to be given progestin derivatives that help … They do very well in squashing that testosterone trouble that can be made, but it’s also potassium-sparing, which can increase the risk of having a stroke, having a blood clot, or having a cardiovascular event like a heart attack, and so monitoring that can help you understand further.

Now, as I talk about in Beyond the Pill, there’s some very special and specific genetic markers, so if you are a woman who’s using hormonal birth control, if I did my job right and be on the pill, you will not feel afraid about being on it, because you will know exactly what to test and what to look out for. I actually take you through, what does a heart attack look like, what does a stroke look like? A heart attack for a woman looks very different from a man. In fact, if you walk into a hospital having a heart attack and you walk in at the same time as a man, the man is more likely to get treatment, and you’re more likely to be sent home and told that your symptoms are likely in your head or you’re having a panic attack, and then you die. That is super lame in women’s medicine, and it’s all because you present differently.

It’s also a situation where so many of us will be like, “Oh. I kind of have … I’m tired. I have flu-like symptoms. I don’t want to bother anybody,” and as it turns out, you’re having a cardiovascular event, so these are important things to look out for. A few screenings you can do to understand your risk. One is MTHFR, which is an enzyme that helps us utilize our folate. You can measure that, and you get a homocysteine and understand how are you using your folate and your B-12. You might put on metformin and the pill and then be given something like cyanocobalamin and folic acid, and you can’t actually use those, so you need a different supplement with that. Understand that with MTHFR, you start the pill, and you are at higher risk of stroke and heart attack.

Same with factor V Leiden. Factor V Leiden is one I cover in my book in the Metabolic Mayhem chapter, because … When it comes to genes, there are two copies. If one factor V Leiden copy is off, so that means you don’t process things correctly, are at a higher risk of forming clots, you have a 35-fold increased risk of developing a clot. That is no joke, and this is something where doctors will say, “Well, the stroke, clot, heart attack risk, that’s really minimal.” Sure. It’s minimal until you step away from the general study that cherry-picked a population and you look at the nuances of the individual.

These are things that you definitely want to be monitoring, and then, for as long as you’re on hormonal birth control, you need to be checking your cholesterol, as well, so hormonal birth control, being inflammatory, and then its impact on the liver can raise cholesterol. Cholesterol, alone, is not going to cause heart issues, but cholesterol that meets inflammation and immune system dysregulation can absolutely lead to long-term cardiovascular risk. This is something PCOS women are already at risk for, so getting your cholesterol checked. If your cholesterol is going high, check your thyroid and consider transitioning off of hormonal birth control, because it’s hitting your liver a little too hard.

If it’s a situation where you’re like, “I am really concerned about these cardiovascular risks. We have heart attacks in my family before age 50,” getting things tested like an MPO, which is an enzyme that tells you about your immune system activity in your epithelial tissue, so specifically the cardiovascular system, and an Lp-PLA2, that will tell you about are you forming plaques, what’s going on in your heart, and what’s going on in your cardiovascular system. These are all really important labs for women with PCOS to be testing, but absolutely if they are on hormonal birth control, so I appreciate that you have a resource for your people to be able to get lab testing done. I know yourlabwork does offer the Lp-PLA2, which is something that not a lot of labs offer, but it’s highly, highly insightful.

If you’re going to stay on hormonal birth control, you need to get this lab testing done. The other nice thing about the comp metabolic panel, that CMP, that is also going to tell you about liver enzymes and your gallbladder function. These are impacted by hormonal birth control, and with women with PCOS, because they typically have … Well, they do have anovulatory cycles, but they typically have lower progesterone that can lead to an estrogen dominant state. These are women that are at higher risk of losing their gallbladder altogether, because estrogen has a big impact on gallbladder health. Taking hormonal birth control is just one more drop in the bucket on that.

Amy:                                     Yeah. I’m so glad that you mentioned about the blood clotting factors. I mean, women with PCOS … As you mentioned, the risk is still low, but we’re at two times the risk of blood clots while on hormonal birth control. Then, the gallbladder issues, I can’t tell you how many women I hear from that have had their gallbladders out or have … with PCOS or have compromised gallbladder function, so thank you for bringing that to light.

Jolene Brighten:               Yeah, and with gallbladder, the interesting thing … I write about this in my book, and I’m like, “Look. This is an acronym. Please don’t judge me, but it is something that like … ” The acronym goes is that if you’re fertile, you’re fat, you’re 40, you have fair skin, these put you at higher risk for gallbladder disease, and so fat is just a way that doctors are able to memorize acronyms, but what fat really means is increased adiposity, so fat cells are more abundant. That can happen in certain types of polycystic ovarian syndrome, and, as we talked about in our previous podcast together when we were talking more about fertility, is that PCOS women, they tend to be more fertile later in life compared to the non-PCOS woman, and so you may very well be entering 40. You may have fair skin. You may be overweight, and that’s when you start ovulating.

Now, you’re at higher risk of gallbladder disease, but what’s really going on there is that estrogen metabolism, which I talk all about in my liver chapter within the book, which is the birth control detox chapter, apparently saying, like, liver love was not sexy enough. They were like, “Nobody wants to talk about the liver.” I’m like, “Everybody … When you read this chapter, you’re going to know everybody wants to talk about the liver, because that’s how we metabolize our estrogen, and really, the liver is doing everything from blood sugar metabolism to sex hormone binding globulin, which keeps estrogen and testosterone in check, to helping with your immune system.” The liver’s involved in just about everything.

Amy:                                     Yeah, and that’s why I really love my Sparkle Cleanse, which I do three times a year just to kind of love up my liver.

Jolene Brighten:               Yeah. Well, I mean, in this modern day, we all need a good liver. Let me say this. If you’re skeptical right now and being like, eye roll, “Liver cleanse. Did someone just say that?” I hear you and I feel you, because one is you might have this idea that you’re drinking swamp water and restricting calories and doing horrible things. No. That’s not what supporting your liver should look like, but I used to be really skeptical of like, “Why do people need to do a liver detox? Your body naturally detoxifies. It does that all on its own.” Then, you start getting into the research about environmental toxins, about what the current state is, estrogens. I mean, when you start looking into all of that, it’s very easy to see why so many of us benefit from doing a liver detox, and what do we mean when we say that? It’s supporting and enhancing what your body is meant to do naturally, but helping it overcome the excess burden that we experience in modern day life.

Now, if you’re a woman on hormonal birth control, this is … You’ll read this and be on the pill. This is absolutely something I recommend, is that every three to four months, you should be putting yourself through a two-day liver detox. Maybe you’re going to need supplements. Not every woman in my practice elects to use the supplements, although that is like rocket fuel to the experience. You ever want to have skin that glows and have tremendous energy, add the supplements to that, but you …

It’s very much just being mindful, focusing on how are you breathing, how are you pooping, are you eating liver detoxifying foods, are you practicing good blood sugar balance, how are you moving your body, are you sweating often enough. While these things seem really simple and, likely, you’ve heard them before, we always have to stand back and be like, “Well, how well am I doing them, and how often am I doing them?” which is why a mindful commitment of every three months of putting yourself through this process can really help mitigate the side effects of hormonal birth control, enhance your health overall, and make it so when you transition off of birth control, it’s easy rather than those horrific horror stories that you can read on the internet.

Amy:                                     Mm-hmm (affirmative). We’ve talked about looking at those nutrient deficiencies that hormonal birth control causes. We looked at the labs that we really need to advocate for and keep track of, and then making sure that our livers are loved three to four times a year. As we get to the end of our podcast, is there anything else that you want to share with us about managing being on the pill and having as optimal health as we can?

Jolene Brighten:               Your microbiome is everything. Understand this. Hormonal birth control has been compared to antibiotics in terms of how it decimates your microbiome. Now, take a moment, let that sink in, and then think about the last person you met that spent 10, 20, 30 years on antibiotics. That doesn’t happen. This is something that was very startling to me, when I came into the research that said the impact that birth control has on the microbiome, so those good gut bugs, and decreasing microbial diversity is like that of being on antibiotics. I took a huge pause, because we are on this for a very long time. I did 10 years. You did 10 years. These were things that were instrumental to our health and our life, so we can be grateful for it, but at the same time, I wish someone would have told me …

Well, okay. Let me say this. I wish someone would have told me to take some probiotics and to eat a little differently, but at the same time, back when I was on the pill, that’s when we believed that these gut bugs were freeloaders, they did nothing for your health overall, that anyone who recommended probiotics or probiotic-rich foods was a quack or a crazy person. Ladies, we can all take a minute to respect how far medicine has come and that any time medicine starts dismissing things or calling you or anything else crazy, it’s usually because we’re about to make a big discovery. If we understand that hormonal birth control impacts the microbiome in such a negative way and that research is starting to hypothesize that part of why we develop polycystic ovarian syndrome is due to abnormalities in the microbiome, we can certainly come to understand that loving up our gut, like loving up our liver, is going to be a really important part of staying on hormonal birth control.

Now, the other piece is that if you’re popping that pill every day, that can actually lead to intestinal hyperpermeability, what is more commonly known as leaky gut. I hate to break it to you, but if your food sensitivities are escalating or you cannot clear gut infections, that means you got to say bye-bye to hormonal birth control, because that’s at the root cause of what your issues are, and your body just can’t handle that daily burden of hormonal birth control. That’s not to say that you can’t support your body, that that means you’re going to have no birth control or that you have to suffer with acne or hair loss or any of that business. No, and Beyond the Pill has you covered in a whole lot of solutions.

But right now, if you are on hormonal birth control, you have to be taking a probiotic, and I actually recommend that women start with a spore-based probiotic, move through that for a good three to four months, and then start rotating other species. The reason for that is because spore-based probiotics survive the stomach acid. They actually reinoculate the gut, so they actually grow there. Now, that doesn’t mean that your other species like lactobacillus, Bifido, or even Saccharomyces boulardii are bad or not beneficial. They are, but they’re not going to repopulate your gut. We once believed that, but the reality is, is that they participate in positive cellular signaling, tell your immune system all is well, reset the terrain so the good gut bugs do want to grow there.

Now, you got to feed them, too. It’s not enough, often, to just take probiotics, but I also recommend that women include a variety of fiber in their diet. If you’re seed cycling, which I think is excellent … You’ll read about that in Beyond the Pill. … for PCOS women, that’s going to get you fiber. If you’re eating plenty of plants, you’re going to get lots of fiber, and then start thinking about including things that you wouldn’t normally eat, so tiger nuts or burdock root or having some … like actually grating turmeric straight into your food, not just having the powder, and getting a variety of fiber. Our microbiome loves variety, and variety and showing it lots of different things is actually how you help balance the whole ecology.

Understand that we have lots of research on the microbiome, but we are very early in understanding it. What that means is that you’ve got to go back to what we have always done, ancestrally speaking, and instead of jumping on the newest rage of like, “Hey, there’s this new coconut kefir … ” Probably good. We can try that. We can add that in, but we’re going to need to also fall back on, what would our ancestors do? They would eat all the things in the environment that they came across, which include things like tuber vegetables, and some people will say, like, “Oh. Well, potatoes are really bad because of their glycemic index,” or, “You shouldn’t eat things like turnips because of how they have goitrogens,” but okay. Those things, there’s very little concern when you eat them in a moderate amount. The problem is that why we say those things is because … well, the goitrogens aside. The goitrogens is more about, like, if you have iodine deficiency. Honestly, don’t worry about goitrogens. Who eats raw turnips? No one. Eat them cooked.

But in terms of what is going on with potatoes and sweet potatoes and those starches, eat a smaller amount. We’re not saying eat a whole baked potato, and if you look at why a potato’s been vilified, well, because most Americans are like, “Let me just eat all the french fries, and that’s how I’m going to get potatoes in.” But you can incorporate them in your diet in different ways, and those starches are not bad. Yes, they can spike your blood sugar, but partnered with fat and healthy proteins, that’s going to be less of an issue and is part of looking at your plate, of like, “How can I get as much variety to be feeding my microbiome?” That’s a very different conversation to be had. You have to have that diet dialed in when you’re on hormonal birth control, as we already talked about, and part of that consideration is making sure that we are feeding our microbiome, we’re keeping up healthy gut motility, and that we’re eating those fibers, because those fibers will also help you and your gallbladder carry the fat-soluble toxins out and make sure that your estrogen gets out of your body, as well.

Amy:                                     Such great information. I love that common sense advice about potatoes. I can’t tell you how many women vilify potatoes with PCOS, but they’re in my meal plans in a combination with fat and protein. I don’t think … For most women with PCOS, in small amounts, it’s not a problem, so …

Jolene Brighten:               Totally. I just had a whole conversation about this, because people are … You know, it’s … You and I, right now, everybody that’s listening, we’re talking in January. This will come out a little bit later, but with that, so many people have been reaching out to me, and they’re like, “What about this diet? What about that diet? In Beyond the Pill, are you going to have rules?” I’m like, “I get a visceral response to rules about food.” Okay, so like, “I am an ENTP if you follow Myers-Briggs. I’m an A Type personality. That means if you give me rules, I will follow those rules, and I will be diligent about those rules until they make me crazy. It doesn’t serve me. It doesn’t serve anyone.” But this idea that we have to have rules around eating … You have children. I have children. How many rules do you have to put on them? Not many. You put food in front of them. You put whole foods in front of them, and they will select the food that serves them best.

Right now, my son, his working diagnosis is PANDAS, so this is a neurological psychiatric disorder that’s rooted in an autoimmune condition. He has inflammation in his brain, and they … These kids stop eating, and people are like, “They stop eating. This is really, really bad for them.” Had I not gone through a traumatic brain injury myself and recognized from that experience that, actually, I would fast for periods out of the month, and then I would make these tremendous gains in my neurological rehab because the ketones spiked, and so I watched this with my kid, where he’s like … He eats … He’ll eat where he minimizes his food, and then he eats a ketogenic diet. It’s not because I’m putting ketogenic foods in front of him and being like, “You’re just going to eat a bunch of fat and leafy greens and that’s it.” I put all the food in front of him, and he selects what he needs.

It blows me away how I just watch and I observe this, where I’m like, “Okay, so he doesn’t want to eat these certain things, but he’s gravitating towards really high fat and leafy greens and restricting calories,” and he’ll do that for five to seven days, which kind of freaks me out. But at the same time, I can respect through the research, like Valter Longo’s research, is that he’s speaking his ketones. He’s actually repairing his brain. He’s fueling himself with fat. I say all of this so that you, who is listening, can recognize that everything you need to know about how to eat, about how to take care of your body, you know this. It’s inherent to you, and the idea that we have to put rules around food, I don’t know who came up with that, but I’m going to guess the diet industry, and … because it doesn’t serve us.

Sometimes, you’re going to want more sweet potatoes and more potatoes in general. When is that going to be? Most likely before your period because of fluctuations in dopamine, serotonin, what’s going on with your progesterone, how that’s changing your metabolism, and then other times, you’re going to gravitate to where you’re like, “Yeah. I just want to eat fat, vegetables, protein, and that’s all I want to do.” Odds are, that’s going to be as you roll out of your menstrual cycle and as you enter into that ovulation phase, and, you know, if you are an ovulating female or your body is trying to get to that. To understand that food rules don’t really serve, especially in the context of a cycling female, because we ebb and flow every single day, every hour of the day, and all throughout our cycle.

That’s why in Beyond the Pill, we go through 30 days of testing, but you will read and you will understand that I’m like, “We have to understand what’s true for you,” because, well, some women, they can’t do something like dairy. That’s only going to cause acne, cause them problems. There are other women who are like, “Actually, I feel pretty good when I have some cheese. That seems to work for me,” and there are definitely health experts out there that would be like, “Dr. Brighten, did you just say that someone could eat dairy? That’s the worst thing ever.” I’m like, “No. The worst thing ever is acting like we can only eat certain foods.”

Let’s just take a moment to respect that our food supply used to be much more vast than what it is now, and now it is … We have very little variety in terms of our produce. Our meats are coming from the same places. We are losing variety, and then we have this other side that’s putting more and more rules on us so that we cut even more variety. At the end of the day, maybe all that information is true, but is it true for you? That’s what we need to ask, and we need to respect that you know your body, and you know how you feel in it, and you have the power to understand how foods work for you.

Amy:                                     You know, I’ve loved this conversation so much, and I was actually … Before we got on the podcast together, I had gone back to look at what I sent you when I read your book. You gave me a preview copy last year, and I sent you back an email. This is so true, I mean, the … what you’re saying right now, and your … Well, this is what I wrote. I said that, “You have provided such a groundbreaking solution for common hormonal struggles women face both on and off the pill. Your words are uplifting, inspiring, and empower women to honor their body. It’s really a must-read book to help women take control of their hormones naturally.”

Amy:                                     Just listening to you talk today, I love that message of honoring your body and your individual body and that message of empowerment, and I’m just so grateful that you … I know what it’s like to write a book. It’s just a long slog.

Jolene Brighten:               Totally. Right?

Amy:                                     I’m just so grateful that you wrote Beyond the Pill and that you’ve came on my podcast today to share your vast knowledge of women’s hormone health.

Jolene Brighten:               I just want to say, this book would have never come to be without women like you, and so, I want to just take a moment to honor you, because you’ve absolutely supported this book from day one. You’ve also raised so much awareness, created a community of women who are hungry for change, and this is something that I think every woman listening needs to understand, because you can walk into a doctor’s office, and they can leave you with a sense of feeling so disempowered and like you have no hope, but understand this right now. Just being a part of the PCOS Diva community, you are creating change.

For every time a doctor makes you feel hopeless or makes you feel like maybe your symptoms are all in your head, take that energy and channel it, just like Amy has done with the PCOS Diva community, and create some change, because, truly, I think the whole world is going to be in for a really big surprise when every single one of us takes control of our own health, stops subscribing to the dogma, and puts our hormones back into balance. We will be unstoppable, and truly, the change we need in women’s medicine isn’t going to come by any single one of us demanding change. It’s going to come because we create communities, we band together, and we’re part of something bigger. It all really starts with healing yourself and letting that extend outward, so I just want to take … I just want to take, like, months to honor you …

Amy:                                     Oh. You’re so nice.

Jolene Brighten:               … because I think you’ve done such an amazing job in really supporting the PCOS community, and I think that without you, they wouldn’t even be where they’re at today. It is … You have had such an impact on this community, and I hope you recognize this. Ladies who are listening right now, I hope you leave a comment and you show Amy some love, because she works really, really hard at making sure that you guys have access to the best information to support you. Thank you so much for having me, for the work that you do, and for being a change maker in this world.

Amy:                                     Oh. I so appreciate your kind words, Dr. Brighten, and I want … Before we leave, I just want you to let people know where they can find out more about your work. I mean, we talked about Beyond the Pill, but you have lots of other things going on, as well.

Jolene Brighten:               Totally. Here I am gushing on you, and I totally forgot about that part of like, “Oh yeah. You guys, do you want to know who I am?” You can find me at That’s my main hub. It’s D-R-B-R-I-G-H-T-E-N, .com. You can also find me on Instagram. That’s my main playground, so @drjolenebrighten, and then I have a YouTube channel, because I really recognize that we all learn differently. Some of us don’t want to read a long blog post, but we actually just want snippets of video and audio information so that we can get our learn on. You can find me in all of those places, and right now, if you grab Beyond the Pill, I want to show you much love and gratitude. You can go to, and you can get yourself a plethora of resources, including a lab guide, recipes, and five exclusive interviews with experts who will help enhance your journey with Beyond the Pill.

Amy:                                     That’s wonderful. I mean, such great resources for really such little money. I mean, when we put pretty much everything that we know into a book that costs, like, I don’t know, $27 for a hardcover, it really is such a great value, so I really … I encourage women listening to pick up a copy of Beyond the Pill, Amazon, Barnes & Noble, really anywhere books are sold, and thank you, again, for sharing your time with us today, Dr. Brighten. I hope to have you back on the PCOS Diva podcast again soon, because I know we could have gone on and on.

Jolene Brighten:               Yeah. Yeah. We need to have like a political rant session, I think, where we, like, call to arms, like action to happen so that we get the research we need in women’s medicine, but they … That’s an aside. Ladies, stay tuned. That’s another day, but thank you so much for having me, for all of your support. Truly, my work and this book wouldn’t be possible if it wasn’t for women like you, so I’m so grateful.

Amy:                                     Well, I’m happy that everybody tuned in and listened to this podcast today, and I look forward to being with you again very soon. Take care. Buh-bye.

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