Your Brain on Birth Control [Podcast] - PCOS Diva
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Your Brain on Birth Control [Podcast]

PCOS Podcast: Your Brain on Birth Control“The take away here, is that the effects of the pill on the brain go far beyond what’s happening with your ovaries. Far beyond the “mood related side effect” that our doctor will sometimes talk to us about. Instead, it influences the day to day operations of what your brain is doing and because of this, it touches almost every aspect of psychological functioning in women’s lives.” – Dr. Sarah E. Hill

It is so important for all women to understand the benefits and risks (beyond nutrient deficiencies and blood clots) of the birth control pill. This tiny tablet that has the potential to empower us in many ways is often prescribed without an explanation of the effect on your brain. The research is clear- the pill changes women. Though women go on the pill for a handful of targeted reasons—such as pregnancy prevention and clearer skin—sex hormones don’t work that way. Sex hormones impact the activities of billions of cells in the body at once, many of which are in the brain. As a result, the pill affects sex, hunger, friendships, aggression, learning, and more. Dr. Sarah E. Hill, a leading researcher in evolutionary psychology, provides women with an even-handed, science-based understanding of how their bodies and brains work on and off the pill. She recognizes how instrumental the pill has been in helping women advance in the workplace and society. Dr. Hill credits the pill to her own ability to achieve a doctorate and career success. In turn, she’s not anti-birth control. She’s pro-woman. Listen in (or read the transcript) as we discuss how the pill impacts:

  • Sexual desire
  • Stress response
  • Mental health
  • Level of achievement

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Mentioned in this podcast:

Complete Transcript:

Amy Medling:                    So welcome to another edition of the PCOS Diva Podcast. I often browse Amazon Books looking for new and interesting books that would relate to PCOS in some way. And I stumbled upon this book about a month ago. It’s by Dr. Sarah Hill. It’s called, This is Your Brain on Birth Control. And if you’ve been following the PCOS Diva Podcast for a while, you know that we have covered different angles of the birth control pill and this just sounded really interesting to me. So, I approached the book and started reading it, thinking that a majority of the book was going to be about mood. Anxiety, depression, and how the birth control pill may affect your brain in that way. But I was really surprised at all of the different way the pill impacts a women’s health.

Amy Medling:                    So, I begged Dr. Sarah to come on the PCOS Diva Podcast and she graciously agreed. And here she is, welcome to the podcast.

Dr. Sarah Hill:                     Thank you so much for having me.

Amy Medling:                    So, Dr. Sarah Hill is the author of, as I said, this fantastic new book, This is Your Brain on Birth Control. She is a leading researcher in the expanding field of evolutionary psychology. She completed her PhD at UT Austin, and she’s now a professor at TCU. So the first thing I have to ask you is, what is evolutionary psychology?

Dr. Sarah Hill:                     So evolutionary psychology is just an approach to asking research questions in the general field of psychology. So my background training was actually in evolutionary biology. And this is a set of theoretical principles that is grounded in the idea that most traits serve a function in terms of helping to promote survival and reproduction, just because otherwise the traits wouldn’t have been inherited. So we tend to look at the different types of psychological features that humans have in terms of whether or not they might serve some sort of an adaptive function. So the traits that we have, have to promote specific challenges that are associated with survival and with reproduction, and so it’s really just an approach to research questions, so I take these theoretical tools from the evolutionary sciences and I have been applying them to understanding human psychology. And the things that I’ve been most interested in with my research and that I’ve spent most of my time studying, have been women’s sexual psychology and relationship psychology health, usually again with the focus on women and also hormones, and their role in terms of coordinating women’s motivations.

Amy Medling:                    So, I think that gives us such a unique approach to this idea of your brain on birth control, and I would love for you to share why you decided to write this book because you talk about it in the book and it’s really an interesting chapter.

Dr. Sarah Hill:                     Yeah so I am, as I noted, a psychologist and I’ve spent my career studying women and studying hormones and studying sex and motivation, and all the while that I was studying all of these things and understanding the role that our biology plays in terms of shaping who we are and even shaping who we are, and even the role that women sex hormones play in terms of directing their motivation and behavior, all this while I was on the birth control pill. And I never thought twice about it. I never thought, gosh, given that women’s sex hormones play such an important role in how they think, feel and behave, maybe changing my sex hormones by taking the birth control pill might be changing me in some fundamental way. I had a complete disconnect between those things and then I want off of the birth control pill and I just felt very different. I felt like I woke up from a nap, that I didn’t even know that I was taking. And so it was after I noticed these changes in myself, that I started to do some research into the psychology and neuroscience literature to find out more about the role of female sex hormone involvement in how women think, feel and behave and then how all of that changes in the birth control pill.

And I was really surprised to learn that this is something that has been studied now, in some cases for several decades by researchers, that is just not something that most women are aware of. Most women aren’t ever given this information or told this information. I didn’t have this information and I’m a psychologist who studies this stuff, and I was on the pill, and so I felt an obligation to start this conversation with women so that way, all of us, when we’re making decisions about our health, can do so with our eyes wide open, knowing what the trade-offs are that we’re making and when we choose to be one or off of the birth control pill. And then also to allow us to be able to better shape our birth control pill choices if we choose to be on the birth control pill and know what to be looking out for in terms of the types of issues that we know that the birth control pill can cause in terms of psychological functioning.

Amy Medling:                    So, as a lot of women that are listening know, the birth control pill is used as a type of therapy for women with PCOS and I think we’re often told, actually a lot of women aren’t told, but women with PCOS have an increased risk of blood clots or the birth control pill may cause nutrient deficiencies, or increased insulin resistance. But some of the ways that the pill can actually affect our brains and our hormones, we’re not told and that’s really why I wanted you to come on the show today, not to say that birth control pill is bad per se, but to give us the information that we need, to make an informed decision. So, I was wondering if you could go… there’s just so much in your book so we can’t tackle it all in this short podcast, and I really encourage women to pick up a copy of it, it’s on Amazon. But maybe we could go through some of them… why don’t you just go through and mention the different areas in your book that you talk about, how the pill impacts a woman’s health.

Dr. Sarah Hill:                     Right so, women’s sex hormones have a really pervasive role in orchestrating the activities of the brain. And one of the big reasons for this, of course, is that we were shaped by the process of evolution by selection and that is a process and selects for traits that help to promote successful reproduction. And because of this, because reproduction is at the heart of the evolutionary process, sex hormones have a hand in a lot of what our brain is doing. They influence so many different process and there’s hormone receptors all over the place in the brain. And because of this, the impact of the birth control pill on how women think, feel and behave end up being a lot more broad than more women probably have ever taken into consideration and just to give some ideas about some of the areas that the birth control pill has either been shown to have an impact on psychological function and some areas where, the research isn’t out there yet, but there’s every reason to believe that the birth control pill influences women’s psychological functioning just because we know that women’s sex hormones influence functioning in these areas.

I talk about in the book that there is a lot of research now, indicating that the birth control pill can influence who we are attracted to, so research finds, for example, that women who are on the birth control pill, tend to prefer somewhat less masculine male faces than women who are not on the birth control pill. And the reason for this is that women’s levels of estrogen when they’re on the birth control pill are kept very low. And estrogen presence is actually found to increase the preference that women, or the priority that women place on cues to testosterone presence in men. So when estrogen levels are relatively high, and women heighten preference for cues to testosterone presence. And this is something that is believed to function to help women identify partners who have, quote unquote, good genes because we know that testosterone is a cue of immunocompetence, of good health, just because it’s immunosuppressive and so only men whose bodies are healthy enough to be able to produce high levels of testosterone despite the cost that it inflicts on the immune system, have it.

And so, the idea is that women, when estrogen is high, which is something that typically occurs in the cycle when conception is possible. That this increases women’s attunement to cues associated with high genetic quality, including cues to testosterone presence and also, cues to genetic compatibility, which is something that women are able to determine via cue that are based on body scent. So, there’s research also indicating that women who are on the birth control pill, aren’t able to detect some of these scent-based cues of genetic compatibility that we know can direct mate choice in naturally-cycled women and particularly when they’re at high fertility across the cycle. What all this means is that women who are choosing their partners when they’re on the birth control pill might be prioritizing different types of cues or traits compared to what women would choose if they were the naturally cycling version of themselves. And this is something, of course, that’s pretty provocative because it suggests that this could, of course, influence women’s relationship quality if they eventually go off of the birth control pill.

We know that it can influence attraction, it can influence… it, of course, influences sexual motivation. There’s a ton of research linking women’s hormonal contraceptive use and sexual disfunction so that they tend to be less interested in sex. If your sexual fantasy is they have more problems with sexual functioning, there’s research linking birth control pill use to issues with the stress response and less of an ability to cope with and respond to stressors in an effective way. There’s research linking birth control pill use to issue with self-regulation. So we have a paper right now that’s about to get published, showing that women who are on the birth control pill have a harder time exercising self-control that’s required to do things that they don’t want to be doing. And this is also consistent with some of the structural base differences that we see in the brains of women who are using the birth control pill compared to not.

We know that it influences mood, anxiety levels, I could go on and on and on. But there’s, given that relatively short time that I have to talk to you all, I don’t know which of these types of findings you’d like me to elaborate on, if any. But the effects, the take away here, is that the effects of the pill on the brain go far beyond what’s happening with your ovaries. Far beyond the, quote unquote, mood related side effect that our doctor will sometimes talk to us about. Instead, it influences the day to day operations of what your brain is doing and because of this, it touches almost every aspect of psychological functioning in women’s lives.

Amy Medling:                    So, in your book, you tell some stories about women who, I’m thinking in particular, Olivia and Annalise from Chapter Five. And how, maybe you could tell us a little bit about their story, how things… the way they viewed their partners changed when they came off the pill. I thought that was fascinating.

Dr. Sarah Hill:                     Yeah. So it is really fascinating. One of the stories that, as I was doing the research for my book and I, of course in addition to going in the research literature and reporting the results of these scientific studies of large samples of women, I also talked to a lot of women about their experiences of birth control pill. And did some qualitative research, and so in the book, I provide these composite snapshots, I create these composite characters, it’s really multiple women’s stories all wrapped into one. That way I’m not compromising anybody’s anonymity. But one story that comes up over and over again, when you talk to women who were on the birth control pill and then went off of the birth control pill, is this issue of no longer feeling attracted to their partner. And sometimes, this takes the form of no longer being attractive to their partners because they don’t like the way that he smells. Because all of a sudden, the birth control pill, one thing that we know that it does, is that is prevents this monthly surge in estrogen and it keeps estrogen levels very low across the cycle.

And estrogen is like Miracle Grow in your brain. It causes new dendritic spines to pop up all over the place in the brain and it makes you more sensitive to your environment. And so when women are on the pill, they’re not experiencing these changes in sensory acuity that would allow them to detect fine brain differences between men, including scent-based cues. And so I’ve heard from women talking about, they no longer like the smell of their partner, and it’s part of this general increase in sensory acuity that generally goes on. A lot of women report, after they go off of the birth control pill, that they notice all smells more than they used to. And they become more bothered by them and in so, I’ve heard from women who, they don’t like the scent of their partner. I’ve just heard from women who just don’t really feel so much attraction to their partner as they used to and I’ve also heard from women who, it’s not that they feel less attraction to their partner than the used to, but instead is that all of a sudden, they’re experiencing intense sexual attraction toward other men.

So, a lot of these women’s stories take a very similar form, and the form is of this. It’s of a woman who, she’s with her partner and thinks that she doesn’t have much of a sex drive, right. So she thinks that, I’m just one of these women who doesn’t think about sex very often, and I’ll have sex with my partner sometimes and that’s fine, but it’s not all that important to me. And then they go off of the birth control pill, and they are still feeling the same way about their current partner, but now all of a sudden, flash forward a few months after going off the birth control pill, and they’re starting to notice men that they actually are, what I would call, chemically attracted to. Or men who, they’re just intensely sexually attracted to. And they’re sexual desire is reawakened and they’re finding that the target of this sexual desire isn’t necessarily their partner. Because this isn’t somebody that they chose during a period in their life when those here the types of qualities that they were prioritizing.

And so, I’ve talked to several women who have experienced romantic breakups or were engaged in extra-pair relationships because of some of these issues where they either didn’t feel attraction to their partner or they were finding that they’re low level attraction that they had to their partner was being almost totally overwhelmed by this newly awakened desire that they had that seemed to be directing them toward other men.

Amy Medling:                    And then you also tell a story about a 22-year-old, named Katie, that’s on the flip side. She goes on the pill after being in a relationship, while being off of it, and things change. Maybe you could tell us about that.

Dr. Sarah Hill:                     Yeah, so this is another story that I also heard echoed in a number of women’s accounts of their experiences with the birth control pill and how it influences sex and attraction. And this is a case where a woman in a relationship with a man and she feels like she has no sex drive at all. And she just doesn’t even think about it and isn’t really feeling all that attracted to her partner and just really isn’t into it. And in this story with Katie that I tell in the book, she was in her 20s and she went and saw her doctor about this saying, I’m really concerned about the fact that I don’t seem to have any sexual motivation at all, and then her doctor told her that, it was something that was normal. That once you’re in a long-term relationship that you should expect sexual desire to plateau and that she just needed to soldier on and eventually she and her boyfriend ended up breaking up in part because they had this intense friction that was caused by the fact that, she never really felt like having sex and it was making him feel undesirable and it was causing conflict in their relationship.

And then after they broke up, she went off the pill. And because she wasn’t having sex with anybody anymore, and then she encountered her ex-boyfriend at a Starbucks and just was intensely attracted to him and she just couldn’t understand how it was that she could ever have not been attractive to him because she just felt so intensely attracted to him, and they ended up getting back together and she was on the non-hormonal contraception and she noted, and a lot of women that I talk to, and this is something that I think is really important for women because I think that we have a tendency to downplay the role that our sexuality and sexual behavior can contribute to relationship satisfaction but one thing that she has said and that many women have said is that it is amazing how much of a difference it makes to a quality of a relationship, to be having sex with your partner and being attracted to your partner and having that closeness and so you hear the opposite story too. All of these things point in the direction that the birth control pill can influence our relationship and sexual psychology in some pretty important and life chancing ways.

And it’s really important, I think, that women have this information, not to care them away from the birth control pill, because I think that there’s still a definite place in the world for the pill, but just rather so that way they know what to look out for and they can strategize within the context of choosing relationships but also inhabiting the relationships that they’re in and understanding whether or not they’re on a birth control pill that’s working for them.

Amy Medling:                    Yeah, I mean it just creates a real level of awareness, so if you are having issues in your relationship and things have changed, you can pinpoint it to going on or off the pill.

Dr. Sarah Hill:                     Right, and another really important point to make with all of this, is that there’s also several tons of women who report no such issues on the birth control pill, and so it’s really about the pill that’s going to work right for you because clearly this isn’t something that’s always going to happen to every woman on every pill. And so, if you know what to look out for, the hope is that if things seem not to working for you, that you can go and try a new birth control pill.

Amy Medling:                    Yeah, I want to talk about that in a minute but before we get into that, well I thought you did a great job with breaking down the different types of pills and the generation of pills, which I want you to talk about but I just want to comment on one follow-up piece on this sexual attraction piece of the pill. And you talk about research suggests that the impact of pill on things related to sex must cut both ways, potentially making men less interested with you when you’re on the pill and maybe you can talk about that, I thought that was really fascinating.

Dr. Sarah Hill:                     Yeah, so because we and also men, so men and women, our psychology’s been honed by the process of evolution by selection to do things that are going to help promote gene transmission. Just because traits that get passed down from one generation to the next tend to persist, and traits that don’t, don’t. And so because of this, men have been… their mating psychology has been honed by natural selection to be really sensitive to cues associated with conception risk in women. Because over the course of evolution history, men who were tuned in to cues of estrogen presence, and then chose those women as partners and have sex with them, they would have likely passed down a great number of genes than men that were not sensitive to those cues.

And this is my way of just saying that we know that men are really wired to be maximally attracted to women when they exhibit cues to estrogen presence. And there’s a great deal of research indicating that this is the case, that men prefer the scent of women, at times in the cycle when estrogen is dominant. They prefer the appearance of women when estrogen is dominant. Women feel sexy themselves and so are behaving in a more sexy, flirtatious way when estrogen is dominant. Estrogen, it attracts men and whether we want this to be true or not, there’s a lot of research indicating that this is the case. And so what this means, of course, is that when women are on the birth control pill, and estrogen is being kept very low, that women aren’t enjoying these same benefits that come from estrogen presence in terms of how attractive they are to partners. And there’s research that suggests that this is the case, that men do find women maximally desirable across every modality you can imagine. Their appearance, their scent, their level of engagement, in terms of flirtatiousness, when estrogen is high compared to when it is low. And when it estrogen is high compared to when women are on the birth control pill.

And so, part of women’s sexual mojo comes from estrogen, and in fact, I would say a large portion of sexual mojo is fueled by estrogen presence and for women who naturally cycling, if you keep track of how you’re feeling and how people are responding to you at high and low level of fertility across the cycle, you can see this for yourself. Most women feel attuned to the world, I’ve heard women describe it as being a sexual tigress when estrogen is high compared to when it’s low. So, when you are masking this variability, even though it’s amazing a preventing pregnancy, it also prevents women from being able to capitalize on what is perhaps the greatest tool in our arsenal in terms of what makes us desirable to partners. And again, this isn’t to say that this is something that should be of interest to all women but a lot of women care about this. And so this is something, again, that’s worth knowing as you’re strategizing your use of the birth control pill, is that it’s going to rob you of this mid-cycle sexiness boost that you get, that comes from high levels of estrogen presence.

Amy Medling:                    I just find that so interesting. But let’s…

Dr. Sarah Hill:                     It’s so, it’s so…

Amy Medling:                    I know. But I want to switch to the different types of hormonal contraceptives, and you have two fantastic charts in your book. You have one that lists out all of the different brands of hormonal birth control and how and what generation is it, and then how much progestin is it, how much estrogen. And this was like, when I looked at it, it was a huge aha moment for me because in my 20s, I was on Loestrin, which I did really well on. I mean, I felt good on it, it worked for me. But then after having one child and trying to get back on to it. My doctor said, okay, since you have PCOS, you need to be on Yasmin. And I tried to go on Yasmin, and I felt horrible. But the increase in progestin, it’s like two milligrams over the Loestrin, and I’m sure that that has something to do with why I couldn’t tolerate it, but I had no idea that I should be trying to figure out the right one for me and my doctor never told me that.

And then the other chart that’s fantastic, and we’re not going to probably get a chance to dive into the mood related issues and the pill but you have a great chart about the increased risk of depression on different pills and it was really interesting. But why don’t you just explain to us the different generations of pills, what that means and maybe how to go about troubleshooting is one pill doesn’t work for you.

Dr. Sarah Hill:                     Right, so this is really important and I actually, just to let your listeners know, I have a really cool article about this called, How to Choose the Least Worst Birth Control, that talks about this issue of troubleshooting, and it’s on my website.

Amy Medling:                    And we’ll link to that in the show notes.

Dr. Sarah Hill:                     Yeah, but a lot of times, a doctor, they just put us on a pill and they tell us, okay I think this is the one that’s going to work for you and we don’t really know a whole lot about what we’re being given and we don’t know what else is out there, and we don’t know why we’re being given what we’re given. And so in the book, in This is Your Brain on Birth Control, I provide a chart that lists all the major brands of the pill that are out there, the most frequently used ones in the US, and tell the reader, hey, this is what is in your pill and this is the generation or progestin that’s in it and here’s how much estrogen is in it.

And I also provide a chart giving the differences between the different types of progestins. Because there’s four different types of progestins out there. They’re called four different generations just because they came out in serial order. The first group, they called those the first generation, second generation and so on. And they’re different from one another, and they simulate different receptors in the brain, because most of them, these progestins, which is the synthetic progesterone that is in these types of birth control, they aren’t made out of progesterone, they’re made from something else and in a lot of cases, they’re made from testosterone and they’re just structurally modified in ways that cause them to also simulate progesterone receptors, which is how they prevent ovulation from occurring. But because they’re different from one another, they’re going to do different things in the body.

I mean, one of the big takeaways from the book, is that hormones influence what the brain does and so we take that thesis seriously, which I recommend that people so because it’s absolutely true. That means that these different formulation of the pill, which differ not only in the types of progestins that are used, which means it’s going to be stimulating different receptors in your brain, they also differ in the ratios in the progestins relative to the estrogens. And so, the specific combination that you’re put on is going to influence you in different ways than if you go on a different formulation of it.

And this means that it can be really idiosyncratic and it can be really hard to predict, and because the science isn’t yet in a place where we can make really solid predictions about who’s going to respond what way to which pill, a lot of times women end up having to troubleshoot. And so I offer in the book this list to at least let women know hey, here’s the generation of progestin in what you’re on and here’s the dosage of it relative to the synthetic estrogen in there. So if you’re on something and it doesn’t feel right to you, when you go to your doctor and you try something else, and you can even say, I see that this is a… because you went on guess, they’d put you on fourth generation progestin, right, which is made out of something completely different then the Loestrin, which I think is a third generation progestin.

Amy Medling:                    I think on your chart, I think it says, first.

Dr. Sarah Hill:                     Oh it is a first? Well, my chart’s right. My chart has been intensely researched and triple checked, triple fact-checked, so you were on two totally hormonal, I mean, you had two totally different hormonal profile, one versus the other one. And so, it’s going to make you feel different and so, if you are on one that works and you know that you tolerate a first generation progestin really well, then if you’re going on something different, I would try to stay in that same space, or…

Amy Medling:                    Exactly, I know.

Dr. Sarah Hill:                     Go ahead.

Amy Medling:                    That chart is worth its weight in gold I think for a lot of women that feel like that need to be on the pill but are really struggling with getting the right one for them.

Dr. Sarah Hill:                     Right. That was my hope is that, that chart and just the information about the different progestins will really allow women to take the bull by the horns when it comes to their birth control prescription because the birth control pill, for all of the things that it does psychologically, it’s still the best thing on the market right now for many of us. And women should have as much information as possible to be able to troubleshoot their options, because the good news is that there’s almost 100 different formulations of hormonal combinations that are out there, and so if women want to be on it, I mean it seems overwhelming but it’s shouldn’t be if you troubleshoot using the chart that I offer in the book. Women should be able to find something that allows them to feel at home in their own bodies, that they troubleshoot.

Amy Medling:                    So, you close out the book with a letter to your daughter. I have a daughter who’s almost 11. I know, when you were writing the book, your daughter was 11. And my daughter may have PCOS. There is a study that just came out that I read today that women with PCOS have a five times more likely chance of passing it on to their daughters so…

Dr. Sarah Hill:                     Oh wow.

Amy Medling:                    This topic of the birth control pill I’m sure is going to come up at some point for my daughter. I will tell you, Dr. Sarah, that there are a lot of girls with PCOS that are getting prescribed the pill at age 15, 16, which is really concerning to me. But I would love for you to just leave us with a little… just synopsis of that chapter. What would you tell your daughter?

Dr. Sarah Hill:                     Yeah. I mean, I will say this that especially with young girls, when their brains are still developing. So 19 and younger. My conversation with my daughter would be, if you are not having sex and you want to go on the birth control pill for other reasons, or you’re not managing something like PCOS, or you’re just trying to have fewer periods or lighter periods, or manage a skin related issue, my recommendation would be to try to avoid going on hormonal contraception as long as possible until after your brain is done developing. And the reason for this is just that, there is almost no research out there telling us what happens when you take the birth control pill when the brain is still developing. I actually just read a study showing that taking the pill prior to age 19 actually seems to now be associated with an increased vulnerability to depression in adulthood, even among women who aren’t on the pill anymore.

And so, there’s every reason to believe, given the role that sex hormones play in terms of post-pubertal brain development, to believe that going on the pill during the pubertal transition into adulthood is going to influence the way that the brain is structured. And because that’s… hormones play a role in terms of determining the structure of the brain. And so, my recommendation would be that we try to keep our daughters off of hormonal birth control up until they’re older than 19 if possible. If they’re not doing it for really important reasons. Now all of this being said, if my daughter, for example, is 16 and sexually active and let’s say we tried the non-hormonal copper IUD, which would be my probably first line of defense with her to try to prevent pregnancy. If she didn’t tolerate that well, because some women don’t, they don’t like it, it’s physically uncomfortable or causes profuse bleeding, I would put her on the birth control pill, if she was sexually active and not likely to be effective using barrier methods which, of course, have a higher failure rate just because they aren’t always used every time, right.

Teenagers tend to be irresponsible, as we all know. So it’s one of these things where it’s like there’s never going a cut and dry answer because it’s always going to be a situation where you are going to want to manage the risk relative to the benefits. And so, I mean I would just say that the risk, and we know from the research that the risk of suicide risk and increased our risk of depression is much higher in women who are 19 and younger and put on the pill. Managing that risk against the benefit, I think, is really important for parents to think about when they’re talking with their daughters and just understanding that if you put your daughter on the birth control pill while her brain is still developing, there is a little bit of a question mark there. Now I don’t think that it’s dangerous and terrible, and as I write in the book, I was on the birth control pill when I was 18. So my brain was still developing, and I don’t think that it’s done anything terrible to me. I have no idea what the alternative would be but I’m not afraid of the birth control pill with younger girls, I’m just more cautious with it with younger girls.

Amy Medling:                    And it’s good to know about the associated risks of depression and what to look for if your daughter is on it.

Dr. Sarah Hill:                     Yeah, absolutely.

Amy Medling:                    Well, I just want to thank you for writing this book. You could tell that it was a labor of love and it’s just so important for us to understand the risks outside of nutrient deficiencies and blood clots, like I mentioned earlier. So you can purchase the book on Amazon and I would love to know how we can learn more about your work Dr. Sarah.

Dr. Sarah Hill:                     Yeah, follow me on social media. I’m on all the platforms, probably most active on Instagram. And my handle is @sarahehillphd, and that’s Sarah with an H.

Amy Medling:                    Great and you have a blog. We will definitely link to that article that you had mentioned earlier in the podcast. So, check out Dr. Sarah’s blog as well. So thank you again for so coming on.

Dr. Sarah Hill:                     Yeah, thank you so much for having me.

Amy Medling:                    And thank you everyone for listening, I look forward to being with you again soon.

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