Your Period- the 5th Vital Sign [Podcast] - PCOS Diva
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Your Period- the 5th Vital Sign [Podcast]

PCOS Podcast No. 101 - Your Period: The 5th vital sign“When you think of your menstrual cycle as a vital sign, then you recognize that when you’re having this cycle that falls way outside of the parameters, it’s a sign of an underlying issue. If you were in your house and your fire alarm started going off because there’s a grease fire in the kitchen, your solution wouldn’t be to take the battery out and then go about your day.”

– Lisa Hendrickson-Jack


Like any other vital sign, your menstrual cycle is an indicator of your overall health. If your cycle is falling outside of normal parameters on a regular, consistent basis, then that is a sign of something very specific happening health wise. Tracking my cycles was actually how I found out that I had PCOS. Lisa Hendrickson-Jack, certified fertility educator and holistic reproductive health practitioner, explains how to monitor this critical vital sign and what your pattern might be telling you. Listen in (or read the transcript) as we discuss:

  • The menstrual cycle as a diagnostic tool
  • What a “normal cycle” looks like
  • How thyroid issues affect your cycle
  • What you should know if you’re on the pill
  • Light exposure’s impact on your cycle
  • The lowdown on toxicity and menstrual products

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Full Transcript:

Amy:                     You are in for a special treat today on the PCOS Diva podcast. I’m so excited to have Lisa Hendrickson-Jack on my show. She is the host of the Fertility Friday podcast, and I was an honored guest on her podcast. I’m so glad she’s here to talk to us today. She has a brand new book out. I read it over the last couple of days and it is fantastic and is really a great resource and tool for you to help sort of hack your menstrual cycle and help you enhance your fertility. It’s not just for women that are trying to get pregnant. It’s really for every woman, with or without PCOS. So, just to give you a little bit of Lisa’s background, she is a certified fertility educator and holistic reproductive health practitioner, who teaches women to chart their menstrual cycles for natural birth control, conception, and monitoring overall health. Her new book, The Fifth Vital Sign, it debunks the myth that regular ovulation is only important when you want children by recognizing the menstrual cycle as a vital sign.

Drawing heavily from the current scientific literature, Lisa presents an evidence-based approach to fertility awareness and menstrual cycle optimization. So, welcome to the podcast Lisa. So happy to have you.

Lisa:                       Thank you so much for having me, Amy. I’m so excited to be here.

Amy:                     Well, as I said, I’m really excited about your book. It was excellent, and I’m just excited to dive into it and share some of my “a-ha’s” from the book, and I think the first thing to do is to talk about your menstrual cycle as a vital sign. We think of vital signs as maybe your heart rate, your pulse. Why do you consider your menstrual cycle a fifth vital sign?

Lisa:                       Well, it’s really interesting about vital signs. As you mentioned, heart rate or blood pressure or body temperature, these are bodily signs that respond in real time to how our body is functioning. For instance, if you’re sick or something like that, then you would expect your temperature, like if you had a fever, that’s a sign that your body’s fighting off an infection. So, there’s this very, kind of real time measure of what’s happening and when you track your menstrual cycle, and you have a sense of what is normal, for instance, with any vital sign, there are a set of normal parameters that we would expect it to fall into if everything is fine. So, with the menstrual cycle, in the same way, when it starts falling out of those parameters, it’s linked very specifically to what’s happening in your body and your health. I think for many women who start charting, that’s one of the things that’s most surprising.

So, for instance, it doesn’t always mean a serious health issue. You could be under stress at work or stuff that could happen. Whether it’s positive or negative, you could be traveling, going on a vacation, and I think a lot of women are really surprised by how much their cycle responds directly in real time, even just to things like that, just travel and stress. But, when you have chronic issues, for example, if your cycle is falling outside of the parameters on a regular, consistent basis, then that again is a sign and it often is telling us something very specific about what’s happening health wise. If we looked into it, similar to the vital signs, then you could actually get a lot of answers, whereas if you weren’t tracking it, you wouldn’t even know necessarily.

Amy:                     So, for women that haven’t really heard the term “tracking your cycle,” I know it’s probably pretty basic at this point for women that have PCOS and are looking to enhance their fertility, but why don’t you just define what you mean by that.

Lisa:                       Well, when it comes to the menstrual cycle, what we’re usually taught is that you have your period and then you have another one, and no one really knows what happens in between periods. So, when I say tracking your cycle, I just mean we break down what happens in the cycle. The three main signs that a women would track if she’s actually, for instance, using fertility awareness, would be her cervical mucous patterns, her basal body temperature, and then some women also check their cervical position.

Basically, you have your period, you would typically have a couple of days before you start observing cervical mucous. Then you would have this cervical fluid, looks like lotion or raw egg whites. Stretchy. Many women have seen it, but maybe didn’t know what it was. So, you typically have that as you approach ovulation and then after you ovulate, that mucous typically goes away. If you’re tracking your temperatures, they go up and then they would stay up for about 12 to 14 days until your next period. So, that simply would be … and some women would do it kind of officially on a chart, on an app. Other women have just an idea of it and they’ll kind of notice when they have mucous and kind of just have that awareness of it. But, that’s all I mean by tracking. Just having a sense of what those menstrual cycle events are and actually paying attention throughout your cycle to where you’re at.

Amy:                     Well, one of your chapters, you talk about the menstrual cycle as a diagnostic tool and I’ve shared this on the podcast before that tracking my cycles was actually how I found out that I had PCOS and I was using the NaPro model, or the Creighton method of fertility tracking, which is basically tracking your cervical mucous, and the facilitator that was helping me and teaching me the method, she noticed that my cycle had multiple patches of cervical mucous. It would kind of get sort of fertile and then it would go back and it would be fertile again, but I never really ovulated, or I just had these really long cycles. She was the one that said, “Gosh, have you ever heard of PCOS and has anybody diagnosed you with PCOS?” So, for me, it was really the missing link, and it was a diagnostic tool to get me the diagnosis that it took 15 years to get.

So, tell us a little bit more about using your menstrual cycle as a diagnostic tool.

Lisa:                       Yes, absolutely. You know, it gives me chills when you say 15 years. I’ve worked with a number of clients who were looking at the chart and, similar to what you’re saying, were seeing these patterns and to me, it’s quite obvious. But, because it’s so obvious to me, it’s really hard for me to understand it could take medical providers so long to pick up on this. So, just in the sense of using the menstrual cycle as a diagnostic tool, I mean, the first thing to recognize is that there is a normal parameter of what we would expect to see. So, in overall length, which is only one of the parameters, a healthy cycle falls somewhere between 24 and 35 days, and that’s from the first day of your period until the last day before your next one.

But, within that, we have your period, which we would expect to fall somewhere between three to seven days. So, some women may have a really scant amount of bleeding, which would be something to look at, and some women have bleeding that lasts for a lot longer than seven days, which is also something to look at. Then, we would expect … so, within that 35 day cycle, we would expect ovulation to happen at some point between day 10 and 23. You’ll notice I didn’t say day 14, because there’re natural variations. Most women don’t ovulate on day 14 every single time, and variation is the one thing all women have in common. So, in a typical cycle then, we would expect to see, like a healthy cycle, we would expect to see your period and then a few dry days, but then we would expect to see mucous kind of leading to ovulation. So, it’s like a sentence. Eventually the sentence comes to an end. You ovulate and then you go into the next phase.

Then, we would expect that second half of the cycle to be about 12 to 14 days. So, we have overall this kind of general sense of what is normal. For women with PCOS, as you mentioned, what we’re typically seeing is a delayed ovulation and so women with PCOS, one of the signs kind of most obvious of PCOS is this lengthened cycle, typically falling over 35 days much of the time. Many women with PCOS maybe will find that they have fewer than nine cycles a year because overall their cycle is averaging so long. So, what you described Amy, is what is this kind of pattern where your ovaries are trying to ovulate. As you approach ovulation, your follicles are developing and producing estrogen, and that estrogen is what triggers our cervical mucous. In order for us to ovulate, that estrogen has to get high enough to send that trigger back to our pituitary gland to actually release luteinizing hormone and cause ovulation to happen.

So, when you’re having these really long cycles, essentially what’s happening is the follicles are kind of trying to ovulate, doing something, but then something is happening to prevent that from … something is basically happening so the ovaries are not ovulating. So, you see this pattern, for many women, it’s either just a long delayed, but some women will see cervical mucous and then they’ll stop and then they’ll see cervical mucous and then they’ll stop and then eventually they’ll ovulate. But, it can be really frustrating on both fronts.

So, for women who are trying to conceive, it’s really frustrating because then it’s hard. It’s kind of like if you’re running a race and it never ends. You kind of start to feel like, “What’s the point of this?” For instance, if you’re trying to conceive, you need to time sex with mucous because mucous is what tells you that you’re approaching ovulation and that’s what keeps the sperm alive and all that. But, if you have multiple patches of mucous, then obviously that becomes a challenge because you think, “Okay, this is the time,” but then it’s not. So it’s like, “Okay, now this is the time,” then it’s not.

Similarly, for women who may be trying to avoid pregnancy, then they have this long, long phase that they have to consider themselves potentially fertile. So, that is one of the most obvious signs that women would show if they have PCOS. Then, it just depends. Many women with PCOS, because you have this long stretch of estrogen essentially, unopposed by progesterone, because you only produce progesterone after ovulation in significant quantities, and estrogen and progesterone play different role in developing the uterine lining. So, for instance, women with PCOS are having kind of unopposed estrogen for these long stretches of time in your menstrual cycle and for some women, that might result in changes in their menstrual cycle.

So, for some women, they might find that their periods are actually heavier because estrogen is what causes the lining to proliferate and grow, whereas progesterone is what helps the lining to mature. So, let me know if that kind of answers the question about how to use the menstrual cycle as a diagnostic tool, but essentially what you have in PCOS is very, often, this very obvious pattern that falls way beyond what we would consider to be normal and healthy.

Amy:                     Yeah, and we won’t get into it right now, but in your book you also talk about thyroid issues and how you can see that in your cycle and you write about that in detail in your book.

Lisa:                       And I suppose one thing for anyone who is kind of like, “What do you see?” I think one of the most obvious things is the lower temperatures. I mean, as soon as you’re charting your basal body temperature, you see these low temperatures. But, thyroid disorders are one of the most common reasons for menstrual cycle disruptions, whether we have delayed ovulation or issues with menstruation, so heavier periods or too light periods, shorter luteal phase because thyroid interferes with your overall hormone production and what you’re seeing in your menstrual cycle is a direct result of your hormonal profile.

Amy:                     So, something that I did want to have you address, and you go into really wonderful detail about it, is hormonal intervention and birth control, the pill or other contraceptive devices that introduce artificial hormones, that they really can be very disruptive for our health, and I think that for a lot of women with PCOS, that when we have these really long, irregular cycles that when we’re given the pill now we have what I think we think of as sort of the perfect cycle. We bleed every month and it’s easy and predictable. But, could you sort of give us some insight why that can be problematic and it’s really not the cure?

Lisa:                       Yeah, that’s such a great question. I think it takes us back to when we spoke about the fifth vital sign at the beginning of the call, which is when you think of your menstrual cycle as an actual vital sign, then what happens is you recognize that when you’re having this cycle that falls way outside of the parameters, it’s actually a sign of a deeper underlying issue, and the example that I give in my book is if you were in your house and your fire alarm starts going off because there’s a grease fire in the kitchen, your solution wouldn’t be to take the battery out and then go about your day.

One of the biggest … and I’m sure you’ve talked about this quite a bit on your podcast, is that women with PCOS are at an increased risk for a number of cardiovascular risk factors. They’re like at a 50% higher chance of developing diabetes in their lives and there’s the cardiovascular risk factors go up. So, because the ovaries are involved, it seems as though the medical establishment has decided that it only really matters when she’s trying to have kids. So, it’s like, “Okay, if your cycle is really long and irregular, we’re just going to put you on the pill and then you know what, when you want to have babies later on, you just come back to me and we’ll just give you some drugs that are going to make you ovulate.” That seems to be the general way that PCOS is often treated by medicine.

The problem is that if a woman has these signs, it’s also a sign of a health issue that she needs to be aware of. Women with PCOS are much more likely to have issues with insulin resistance, glucose intolerance, that was just one of the many issues that are kind of there and present. So really, what I would like to see is that our healthcare, just the way we look at the menstrual cycle, instead of trying to just create this fake menstrual cycle with the birth control pill, to actually address the underlying issue. Because, if we address the underlying issue, the menstrual cycle will normalize and then you will have a healthier woman.

So, what the hormonal birth control, what it does, is it doesn’t actually give you a menstrual cycle. So, that idea that it regulates the cycle, that’s just incorrect. That’s not what it’s actually doing. So, in order to have a menstrual cycle, you would actually have to produce your natural estrogens and then you’d have to ovulate and then you’d have to produce your natural progesterone and then you would have an actual period. So, a true menstrual period can only happen after ovulation and that’s because your uterine lining then is affected by the estrogen and the progesterone and that is what a true period represents.

When you’re on hormonal birth control, most types of hormonal birth control, especially the types that combine synthetic estrogens and progesterone, most of them prevent ovulation. So, they actually stop you from ovulating, which is one of the main ways that it works. So, what you’re experiencing then every 28 days is not a true menstruation. What you’re experiencing is this withdrawal bleed. So you’re getting these synthetic hormones that are not the same as the hormones that your body produces and those hormones then suppress your natural cycle. So, your ovaries are still producing tiny amounts of your own natural estrogen, and possibly even progesterone, but one of the things we share as women is “Okay, when you’re on the pill your body thinks you’re pregnant.” There’s just all of these ideas about what the pill is doing, but if you were to measure the hormone levels of a woman on birth control, they would more closely resemble the hormone levels of a woman in menopause, like her natural hormones.

So, that’s important to recognize so when you take the little break from the pill pack or when you pull out the ring or take off the patch or whatever the case is, and you start to bleed, what you’re having is a withdrawal bleed. It’s not an actual period. The whole time, your cycle is just put to a halt. Then, there’s a whole host of side effects that are associated with hormonal birth control. Not all women experience them in the same way. I’ve heard a lot of women say, “I was on the pill and I was totally fine,” but what I talk about in the book are basically the effects that every woman experiences. For instance, the pills dramatically suppresses your testosterone levels and it dramatically, as we talked about, suppresses your natural estrogen and progesterone levels. You’re really not producing your natural hormones to the same effect. That’s something that happens to every woman on hormonal birth control.

What’s different is how women experience it. So, some women are going to experience depression, anxiety, low energy. Some women are going to notice a dramatic reduction in their libido and an increase in how painful sex is or difficulty with orgasm because testosterone is really important for all that. Whereas other women won’t really notice those same effects. But especially for women with PCOS as well, the pill is known to kind of increase insulin resistance. So, there’s just a lot of negative effects. Instead of one problem, you’re getting another and at the end of the day, you’re not actually addressing the underlying issue whatsoever and you’re putting a Band-Aid over it. Then, when you come off of the pill, you still have to address those issues because even though you weren’t seeing them, those issues were still happening in the background.

Amy:                     Yeah, I received an email, I think two days ago, from a PCOS Diva and she said to me, “Just wondering why you think birth control is so bad. I’m on it now, and it’s currently saving my life. It’s okay if you don’t like it, but it’s risky to spread around misinformation to desperate women. Hormonal treatment already has a stigma and why are you adding to it?”

I think I like to bring on guests that give us … sort of really explain the risk factors because I don’t think mainstream medical does. You know, you get a prescription for the pill and you’re not given all of the risk factors and the real, I guess, details of what’s it’s doing to you physiologically. So, that’s why I think it’s really important. Your book is very important because it gives women the information they need to make an educated choice. I’m not saying that it’s not helpful to some women who are really experiencing difficult symptoms, but as you said Lisa, it’s a Band-Aid and it’s not getting to the root cause, and when you get off of it, once you can’t be on it forever, you’re still going to have to deal with those issues that you had before the pill, and maybe even more.

Lisa:                       Well, I think one of my goals was to not only talk about it, because everyone’s talking about it, but I really wanted to connect women with the science so that you can feel more informed and educated. It’s sometimes hard when you have a perspective that is different than the modern, mainstream medical perspective and you really feel like you don’t have a leg to stand on. So, I wanted to really provide that. I think that’s an important comment. We’ve come a long way. The pill came out in 1960. That was a long time ago. When it came out, it was associated with a whole different, just a different time, a different era. So, for many women of that era, it represented this freedom because it was the first time that many women were able to have that agency, in terms of making that decision of whether or not they were going to have babies.

So, my goal isn’t to completely ignore the significance of that and pretend like that wasn’t a big deal. But, my whole point, as you mentioned Amy, is to really … at the end of the day, this is about informed consent. Because, the pill is not harmless. There’s so much research to verify all the different ways that they pill can affect the body, and so my opinion about it, and I’ve also used the pill, so when I was a teenager, I had horribly painful periods and I used the pill because I didn’t know how else to do it. I was really active. I was involved in all these sports and I just needed something to help me and I didn’t know of any other way. So, at that time, it was the solution. But, looking back, I did experience some effects. I had no idea at the time. Like I had migraines and I never had them outside of that window of time. I also have a lot of anxiety and crazy behavior.

So, looking back I’m like, “Okay, I’m sure it affected me.” But, the whole purpose of this isn’t to say women shouldn’t use it. It’s to say that if we all knew about the effects, there’s a couple things that would happen. I believe that some women would just use it in the exact same way that they’re using it now, and that’s completely fine because they’re informed of the risks. I believe that some women would use it, but potentially use it for a period of time, so maybe you’re in college and like, “I can’t handle all of this menstrual cycle stuff right now,” but with that knowledge they might not use it for as long. Then some women would choose not to use it because they would know that there are other alternatives.

I just want to highlight a couple, kind of some of the more jarring side effects associated with hormonal birth control. I did mention the testosterone. The pill seriously depletes testosterone. It’s quite significant and there are studies that have examined women over time, so even women who have come off of hormonal birth control, there was one study where a year later the women who had taken it still had lower testosterone. I found one study of women with PCOS and they actually studied these women 10 years off of hormonal birth control and at the five year mark they still had statistically significantly lower testosterone. Even at the 10 year mark, it was no longer statistically significant, but you could look at the actual numbers and see that they were still slightly higher. So, I feel like that’s something important and testosterone is associated with the sexual side effects, as we talked about. Low libido is really, really common. It’s one of the most common side effects.

Many women don’t know that because of course they’re not being informed that this could happen. So, for many women who experience low libido or painful sex or even just reduced sensation, those types of things, they often just believe it’s them and maybe I’m just not that sexual of a person and really again, about the informed consent piece, at least if somebody told you this could happen, then if you experience those affects you have the opportunity to say, “okay, my doctor said this could happen, so I’m just going to go off of these for a couple of months, just to see if it could be related.”

When we don’t tell women what the effects are, we don’t even give them the opportunity to do that because they don’t even know that this could be affecting it. One really jarring statistic, there was a study where they followed these women for three months on combined hormonal birth control, so the pill and then I believe it was the ring, and they measured the clitoral volume. They measured the thickness of the vulva tissues. So for instance, around the vaginal opening, they measured the thickness of the skin, the tissues, and all of the women experienced a decrease in their clitoral volume, meaning their clit shrank, and the average shrinkage was 20%. Many of these women also experienced a thinning out of the vaginal opening.

So, for women who experience painful sex, and that’s often pain around that area, like pain around the penetration aspect of it, because it’s around the opening of the vagina, again, this is something where women are having therapy and talking about all of the … you know what I’m saying? This is often thought of as psychosomatic, as a psychosomatic issue, and again, about informed consent, just knowing that it could be related. Of course, every woman doesn’t experience these side effects, but many women do, and if we’re not telling them about it, then how would they even know that it could be related to it?

Amy:                     Yeah, and another side effect too that I think women really need to know, because 60% of women with PCOS have some mood related disorder, anxiety, depression, bipolar even, and the pill can contribute to those feelings of anxiety and depression as well.

Lisa:                       Well, one kind of compelling … so, the testosterone kind of contributes to that if it’s lower. So, women with lower testosterone are prone to depression, but the effect on the nutrient, the micronutrients, particularly B vitamins, is also quite jarring. So, what the research shows is that women on birth control, they metabolize B vitamins differently and for instance, folate, vitamin B12, over time, especially because time compounds this effect, this increases with time. So, you’re more likely to be deficient if you’re not supplementing with those. But, vitamin B6 in particular, the amount of disruption is so incredible that in order to maintain a normal B6 level while on hormonal birth control, you have to take almost 40 times the recommended daily allowance.

Amy:                     Wow.

Lisa:                       So, vitamin B6, I highlight that because vitamin B6 is critical for our serotonin production. It impairs … the deficiency of vitamin B6 impairs our tryptophan metabolism and that is related to how we produce serotonin and serotonin is associated with mood. So, when you’re talking about mood disorders, anxiety, depression, bipolar, if a woman is on hormonal birth control and she’s experiencing depressive symptoms, in many cases she ends up on antidepressants. Again, this is a physiological thing that happens to women on the pill.

So, how women experience that is going to be different. Some women may experience depression. Some women may experience anxiety. I just want to mention that not all women go on the pill and immediately have depression/anxiety. I interviewed this one woman who was on the pill for eight years and at the eight year point she started having panic attacks. So, keep in mind again, these nutritional deficiencies, they kind of happen and are compounded with time. So, that makes it even more complicated because if you start to develop depressive and anxiety symptoms years after you started taking it, if you didn’t even know that it could be related, are you even going to make the connection? How long is it going to take you to make the connection.

So, I feel like it’s just so important to recognize this isn’t to say no one should ever take the pill, but again, it’s all about informed consent. If you know about these factors, then if they happen, you can at least know, “Okay, I remember someone told me that it could be related so instead of thinking I’m crazy, I’m just going to actually come off of this for a little bit and see if it could be related to that.”

Amy:                     Well, I also wanted to mention that if you’re listening and you’re thinking, “Well gee, maybe I want to come off the pill,” I think your book has some excellent guidance in how to do that as well.

Lisa:                       Well, one of the things, especially if you consider the nutrient deficiencies and things like that, I know a lot of women are concerned to come off it, and you’ve probably encountered this too. There’s a lot of reasons why women are afraid to come off of it. So, one of the reasons of course is the pregnancy aspect. If you’re not ready to get pregnant then there’s a lot of fear around it and a lot of that comes from what we’re taught about our bodies. So, when I was growing up, I was taught that as a women I could get pregnant on any day of my cycle and there were no safe days and that made it really terrifying, the thought, because you really believed that any time you had sex with your partner you’re going to get pregnant.

But, when you learn that there’s only a small window of time where pregnancy is possible, and you can learn how to identify that, that really helps just to kind of settle some of those anxieties, once you actually realize that there’s a small window of fertility that you can identify. But, in addition to that, a lot of women are on birth control for specific reasons. Women with PCOS, perhaps your cycles were so irregular and you just really felt like you weren’t in control. You had no idea when your period was coming and things like that. So, I think it’s really important to acknowledge that. Many women have painful, hard periods and they go on it for that too. So, in terms of planning to come off of it, I feel like there are a few things that you can do.

In the book, I talk about general dietary guidelines. When you are aware of the specific nutrients that the pill is depleting, so in addition to B vitamins, zinc, magnesium, Co-enzyme Q10, selenium, there’s a lot of different nutrients that kind of go haywire. If you take some time to address that and just take some time even to work with a functional practitioner who can help you to optimize those levels, if you’re really nervous about coming off of it, you could take a couple of months to do that and kind of minimize the possible coming down effects that might be there, because I know a lot of women are concerned about that.

But, I feel like one of the main messages that I like to share is that a lot of women, in our lives, our lives as women are so complicated and the way that our culture views pregnancy is also very complicated. So, as a women, we’re often waiting for that perfect time for everything to come into perfect order and that means that education, we gotta get that done. We’ve got to get the job. We’ve gotta get the house. We’ve gotta get the partner. We’ve gotta get everything in order before we’re even willing to consider pregnancy, which is just part of our culture. But, what happens is that because we’re so terrified of getting pregnant the second we come off the pill, we often wait until everything is timed perfectly to come off the pill. Then, because we’ve been taught that we can get pregnant on every day of our cycles and all that, we expect that pregnancy to happen immediately, even if we don’t say we do. Even if we’re like, “Well, you know, even if it doesn’t happen the first cycle, it’s okay.”

We really do expect to get pregnant because you spent your entire teens and 20’s trying actively to prevent it, and so one of the things that I talk about in the book is in addition to the side effects that women may experience while they’re taking it, what the research shows us is that the pill is associated with a temporary delay in the return of normal fertility. What that means is that there’s a specific period of time where you are subfertile and it takes your body … it’s a transition period that your body goes through.

Now, we all know some women get pregnant immediately after coming off it, and some women may even get pregnant while taking it, but at the same time, you don’t know how your body is going to respond. So, an absolute minimum period of six months is warranted, depending on the type of birth control that you’re taking. But, I actually suggest a period of 18 months to two years. Because, when you track your cycles, and you know that there’s a normal parameter of what a healthy cycle looks like, women who come off the pill for the first nine to 12 cycles, typically have longer luteal phases, meaning delayed ovulation. Especially those first couple off of it, it can take time to ovulate, but when you first come off it, depending on how long you’ve been on it. In addition to that, women coming off the pill often have suppressed mucous production for a while. I’ve worked with women who they come off the pill, they’re ovulating, but their cycles are dry, meaning they are not producing any mucous and that’s a side effect of hormonal birth control that is temporary.

These women then start to produce mucous once their hormones kind of go back in balance, but that can affect your chances of getting pregnant. Then also, women coming off of birth control typically have a shorter luteal phase for several cycles after coming off. So, the luteal phase, the time between ovulation and your period, it needs to be about 12 to 14 days because that’s how long it takes for the egg to implant. So, a woman coming off the pill, she may have a luteal phase of eight days or nine days and it might take several cycles before that lengthens out to a healthier range, 11, 12, 13 days, and that can interfere with your chances of getting pregnant as well. So, there’s a lot of things to take into consideration and again, it really comes down to the informed consent piece and the pill. It’s not harmless, and we, as women, we’re not being taught about this very real transition period that our bodies go through when we’re coming off of the pill.

Amy:                     Such good information, and I pulled aside two highlights from your book that I just wanted you to mention before we finish the podcast. Can you talk to us a little bit about light exposure and your cycle and then I want you to just sort of give us the lowdown on toxicity and menstrual products. So, those two things, and we’ll wrap it up.

Lisa:                       Awesome, yes. Well, I mean, light exposure, when it happens at the right time of day, can actually support your menstrual cycle. So, this goes along with our understanding of the circadian rhythm. For instance, when we wake up in the morning, often if it’s really dark in your room, you might feel a bit groggy, but then when you open the blinds or when you step outside for a minute and you’re exposed to that light, it stimulates your cortisol production and that makes you feel awake. I think it’s safe to say that all of us have experienced that. So, light stimulates our cortisol production. It’s like nature’s coffee, because it really does wake us up. Conversely, at nighttime, we need it to be dark in order to stimulate our melatonin production. So, the way that light affects the menstrual cycle, because our menstrual cycle then is … we talked about estrogen and progesterone and how these two hormones really impact.

Our cycle is really a printout of what’s happening with these two hormones. When your melatonin production is disrupted, for instance, at nighttime with light exposure when you’re not supposed to have light exposure, that can really reduce our progesterone production. So all of these things are related. What that comes down to in the most practical terms, is that ideally our melatonin production starts to rise at nighttime, so say 8:00, 9:00. That’s when it’s kind of starting to rise. It reaches its peak in the middle of the night, when we’re sleeping. So, in order to have optimal hormone balance that would then be reflected in our menstrual cycle, a healthy menstrual cycle, with a robust second half, a robust luteal phase, we would really need to support that melatonin production at night.

So, when it comes to practical things, we all have our devices. I’ve got my laptop and my phone. As we’re winding down at night, one of the things that we can do is if you’re tied to your devices, if you’re not willing to … ideally, you’d give yourself a bit of a cutoff and maybe have a couple of hours before you go to sleep without your devices, but one of the most basic things you can do is change the color of your screen. So, I use an app that I downloaded called F.Lux, and it turns my screen orange and you can time it so that it naturally does that at nighttime. So, around say 8:00, my screen starts to turn orange and having the screen orange is what blocks out … orange or red, I would say, blocks out that blue light. So, when you’re outside and you’re exposed to the sun, that is blue light and it has the highest effect on your hormones basically. It triggers your cortisol production.

So, by changing the color of your screen to orange, and on my cellphone actually, I’ve changed it so that at nighttime it turns red, and you can do that. There’s a lot of different settings. You can kind of play around. You can even Google it. Google how to turn my cellphone red or something like that and you’ll get the directions. But by doing that, you’re minimizing your exposure to this blue light, you’re kind of dampening that out and the way that you can … it sounds really interesting just to say it, but you can actually feel the difference.

So, I’ll give an example. If you’re working late at night and you’re on your laptop and the screen is glaring, often you don’t necessarily … like it’s 10:00 or it’s 11:00 and you don’t necessarily feel tired, and that’s because that light is actively blocking your melatonin. Melatonin is what makes you feel tired. But when you have this stuff on your screen, and then it’s orange, you actually start to notice, “Oh, wow. I actually still …” like, you can feel the tired coming on, if that makes sense.

Amy:                     Yeah, and I actually have some blue light blocking glasses. They’re kind of like sunglasses and since I’ve started wearing those, even if I’m not on the screen, like if I’m just reading my book in bed with the light on, I do get sleepy faster and the quality of sleep, since reducing the blue light at nighttime, has improved so much, and it’s just a simple lifestyle shift that you can make. So, I was so happy to see that listed, that you talk about it in your book. The other thing you had mentioned, and I actually sent it to my son who is in college and he keeps texting me at 1:00 a.m. at night, I mean in the morning, but you talk about being sound asleep by 11:00 p.m. is so critical for your body’s detoxification process.

Lisa:                       And our bodies, each organ system has a period of time when it’s most active, so if you’re able to get into bed and be sleeping, ideally by 10:00, but 10:00 would be better, 11:00 would be also good, then by the time you’re actually sleeping, for instance, your liver systems are most active at 1:00, approximately, based on traditional Chinese medicine theory. But when you’re actually sleeping, you’re supporting your body’s detoxification systems and your liver, even if you’re all … so, we’re all exposed to lots of different environmental toxins, but even if we went back 6000 years or something and there were no pollutants, your liver would still be detoxifying your own hormones. Your liver still has to break down your own estrogens and progesterone, and so if you are … just by going to bed on time, you’re actually supporting that.

One of the things that my clients find, actually, it’s interesting. Some of my clients have concerns about progesterone production. Maybe they’re having spotting before their period comes or maybe their luteal phase is short, like we spoke about. One of the ways to support progesterone production is also to sleep in the dark and to make it really dark. When I say dark, I mean like you put your hand in front of your face and you can barely see it. So, it doesn’t have to be really expensive, it doesn’t have to be fancy, until you find the perfect blackout blinds, you can just put up a sheet or something over your window.

Amy:                     Or a sleep mask. That’s what I do. I love my sleep mask and that has made a huge difference in my sleep quality too.

Lisa:                       Yes, and sleep masks are great, but your skin has photo light receptors.

Amy:                     Okay.

Lisa:                       So, even if you have the sleep mask, if you still have street lights coming in and LED lights, your TV on. I know a lot of people sleep with the TV on. But even if you have the mask, your body, because you can probably relate, even if your eyes are closed or you have a mask, you know if there’s light in the room. So again, it’s best, better, you do whatever you can, but it’s just something to think about in terms of that.

One of the effects that my clients will always report is that they sleep better and more soundly and it’s kind of this unexpected benefit of having the room be completely dark. So, those are just some ways. What I love about them is that they’re free and easy and make a significant impact on your cycle, especially if you’re charting your cycle. You can actually see for yourself and you can feel the difference how much better you sleep, but just you can see in your charts.

For some women, sleeping in the dark is the thing that helps them to regulate their cycles. Now, it’s not always that easy, so I’m not saying every woman is just that easy. But, for many women, just by doing that, they’ll see a significant improvement in their cycles.

Amy:                     Yeah, and there is more and more science and research coming out that says women with PCOS has disruptive circadian cycles and melatonin, like lower melatonin, and that’s a key to helping them get back on track, so I was excited to see you writing about that in your book. You also talk about detoxification and avoiding endocrine disruptors and toxins. You bring up menstrual products, and I think that’s something that when we think about removing toxins from our environment, we don’t always think about that.

Amy:                     So, just tell us what to look for in terms of menstrual products.

Lisa:                       Yeah, menstrual products is an interesting discussion, I think. What I would say to look for is to kind of disregard the menstrual product aisle in your regular grocery store and start thinking about looking specifically kind of at what your health food store has to offer. Conventional pads and tampons are made with a variety of problematic materials, including Rayon, and just synthetic materials. So imagine, there are engineers who are hired specifically to try to find the most highly absorbent materials so they can package them and put it in these products. When you put highly absorbent material into your vagina, for example, like a tampon, if you think about what your period is, your period is not blue liquid. It’s actually blood and tissue and secretions and so having this highly absorbent tampon in your body, it can dry out … for anyone who has used tampons, you’ve had experience of when you’re at the end of your period and there’s not a whole lot and it’s kind of hard to pull out.

There was a demonstration that was done that I saw when I was probably 19 or something. It was when I first came to university, and they put a tampon in a glass of water and kind of let it do its thing and you saw how big it expanded to, which isn’t even possible in the human body, and then you pull it out and in the water was all of the little fibers and that’s what’s left in your vagina. In addition to that, menstrual products are made with cotton, and cotton is one of the most heavily sprayed and genetically modified crops. So, you’ve got these fibers that are synthetic that can be left in your vagina. You’ve got this cotton that’s often genetically modified, meaning that it’s either sprayed heavily, heavily, heavily with toxic pesticides and/or there’s a certain type of genetically modified cotton that it’s genetically modified to produce toxins to kill the bugs, which even if I say that, it sounds like science fiction. At the end of the day, it’s way too much toxins in your vagina.

So, many women find that just by switching to organic tampons, made of organic cotton, or switching to organic pads, some women will switch to menstrual cups. Menstrual cups then operate completely differently because they’re catching your blood so you don’t have the fibers in your vagina. You don’t have exposure to the drying, those types of things. It’s a lot more comfortable. A lot of women find it to be a lot more comfortable. Then also, cloth pads. Some women are … there are organic cloth pads.

So, there’s a lot of variety in terms of how to manage your period, but some women find that just by switching out those products, just by doing that, they experience fewer menstrual symptoms. Some women find that their period pain goes way down and others find that their cycle is actually different.

When you think about what these chemicals are, so whether it’s the chemicals in your pads and tampons, or whether it’s the chemicals in every single beauty product made and geared for women, like lotions and soaps and household cleaners, all of that stuff, they all contain these chemicals and these chemicals are called xenoestrogens, we can refer to them as xenoestrogens because they are molecular structures kind of similar enough to our estrogen, that our body kind of mimics the effects of estrogen, but it’s not the same. So, it can disrupt the menstrual cycle. So, some women find that just by really consciously looking at these things and reducing them over time, it’s a process, that their cycles improve and so between sleeping in the dark and reducing your toxin exposure, many women, just by doing those two things, again that are quite … I wouldn’t say free. The removing toxins can be a bit because you’ve gotta replace things, but can have such a significant impact on your cycle and just balancing your hormones.

Amy:                     Well, this has been such a helpful podcast for me, and I think for so many women listening and we really just scratched the surface of the content in your book. I’m so excited for you to get this out to the public. I think it’s coming out this week, the Fifth Vital Sign. Tell us where we can find the book, Lisa.

Lisa:                       Well, the book is available on all of your favorite online retailers, so it’s available on Amazon, in all formats, including audio book version, because I’m a podcaster, so of course I had to do an audio book. So, I’m really excited about that. For the listeners, if you’re wanting to jump in and get the first chapter, you can actually get the first chapter for free at my website,, and that’s all spelled out. So, the first chapter is where we really dive into the concept of the menstrual cycle as a vital sign, so if our conversation today interested you, then you’re going to really love that first chapter.

Amy:                     Also, I encourage listeners to check out your podcast as well, the Fertility Friday podcast. It’s excellent. You have a lot of amazing guests on that show, especially if you’re wanting to learn more about optimizing your fertility.

Lisa:                       Thank you so much, Amy. It’s been a pleasure talking to you. It’s so much fun.

Amy:                     Well, thank you again Lisa. And thank you everyone for listening. I really look forward to being with you again very soon. Take care.


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