contraception

How Hormones Rise and Fall Throughout the Menstrual Cycle

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Fertility Awareness Method For Contraception

Back in 2012, I was really sick and while we were trying to figure out what was going on, my doctor recommended I discontinue hormonal birth control for a while. For about 6 months, I used conductivity monitoring to avoid pregnancy. Each morning, I’d record the conductivity of my salivary and vaginal secretions looking for a change to indicate I was approaching ovulation and another change to indicate ovulation had occurred.

Back then, it felt confusing to me and a little black box”ish”, so when I was cleared to go back on hormonal birth control, I went back on it and didn’t give another thought to Fertility Awareness Methods (FAMs), until I decided to ditch hormonal birth control again.

This time, I did a deep dive and discovered new methods alongside familiar methods of FAM, and I went head-over-heels into the science of it.

In the decade since I relied on FAMs last, at-home urinary monitors are now available, and being a data driven girl, this is the method I opted for. Qualitative devices such as the ClearBlue Fertility Monitor (CBFM) didn’t quite offer the numbers I craved, so I went with the Mira Fertility Monitor even though, to date, no FAM endorses the use of this monitor for contraception (though Marquette University is actively testing the Mira against the CBFM with its protocols).

This ability to monitor your hormones at home also revolutionizes maintaining healthy hormonal balance and body literacy. Indeed, body literacy and the natural rise and fall of hormones throughout a healthy cycle is the topic of this post.

Hormones of the Menstrual Cycle

In this article, we will discuss:

  • follicular phase and ovulation
    • follicular development, how follicles are recruited and begin maturing throughout a woman’s reproductive life span
    • how testosterone and estradiol are produced in the developing follicles
    • the role of the hypothalamus and pituitary glands in follicular development and ovulation
    • the role of progesterone in ovulation
  • luteal phase
    • key changes in hormone production during the luteal phase (second half of the cycle)
  • finally, the entire menstrual cycle will be summarized in a single graph showing the rise and fall of hormones throughout the cycle

Why does all of this matter? When you understand how the menstrual cycle works, it becomes much easier to determine hormonal imbalances and much easier to navigate fertility. Women are only fertile for around a maximum of 5 days during any given menstrual cycle and when you have a condition like PCOS (polycystic ovarian syndrome) or experience delayed ovulation (or anovulation) for any reason during a cycle, menstrual cycle literacy makes it possible to pinpoint your fertile days when trying to conceive and naturally improve your chances of conception in each cycle.

For women who are not trying to conceive, cycle awareness is profoundly beneficial to overall health because you are better able to determine which part of your cycle is unhealthy and better able to address the underlying imbalance simply by knowing how your cycle works. Maintaining a healthy cycle throughout your reproductive years is of utmost importance even when your intention is to avoid pregnancy because the reproductive hormones impact every system within your body and are critical for everything from maintaining a healthy weight to a healthy heart.

This particular article (while containing lots of information) is an overview of the topics bulleted above. You will find a more in-depth discussion of these topics in this post.

An Overview of Follicular Development

Non-cyclical follicular development: Early follicular development of pre-antral follicles (follicles that don’t respond to follicular stimulating hormone) happens in a way that is not well understood by modern science and this part of follicular development is not governed by the menstrual cycle but instead occurs throughout a woman’s reproductive years beginning at the onset of puberty and ending with menopause.

Cyclical follicular development: A follicle is a structure within the ovary and it contains an ovum (immature egg). Each ovary houses several hundred thousand follicles at birth and throughout a woman’s reproductive life, these follicles mature and are responsible for releasing the reproductive hormones, estradiol and progesterone, which control release of these hormones:

  • GnRH (gonadotropin releasing hormone) released by the hypothalamus in a pulsed pattern
  • FSH (follicular stimulating hormone) released by the pituitary gland
  • LH (luteinizing hormone) released by the pituitary gland

The brain’s role in follicular development and ovulation: The tempo at which GnRH releases from the hypothalamus controls the secretions of FSH and LH by the pituitary, and these two hormones influence ovarian hormone patterns and those ovarian hormones affect the tempo of GnRH pulses by the hypothalamus. This feedback loop is what the term, hypothalamic-pituitary-ovary (HPO) axis refers to. It is important to know about the brain’s involvement in follicular development and ovulation because when there is a problem with the menstrual cycle, practitioners generally look at where in this axis the misfire is occurring. Conditions like hypothalamic amenorrhea (HA) arise due to an issue with the release of GnRH from the hypothalamus and we will revisit this condition along with others caused by a dysregulation of hormonal release in the brain rather than the ovaries in future articles.

Selection of one follicle for ovulation: Once follicles have matured into antral follicles, further development is governed by FSH and the follicles need FSH to not only continue growing but also to prevent atresia (follicular death). More than one follicle matures during each menstrual cycle and because of the well-designed negative feedback between estradiol concentrations and FSH, the fastest growing follicle generally outcompetes all other follicles by releasing more estradiol, which then suppresses FSH production and starves out the remaining developing follicles. The dominant follicle survives this period of FSH famine because it has more FSH receptors. The additional FSH receptors make it better able to sequester the small amounts of FSH released at this time. It is also larger and has more energy reserves than smaller and slower growing follicles. This is why women typically release only one egg (mature ovum) at ovulation.

Testosterone and estradiol in follicular development: During follicular development, follicles produce both testosterone (and several other androgens [male hormones]) and estradiol (plus small amounts of estrone). The androgens are produced in the theca cell layers. The theca cell layers are not able to convert these androgens into estradiol or estrone because they lack the necessary enzymes. Instead, through diffusion, these androgens enter the granulosa cell layer of the follicle where the necessary enzymes are found (aromatase) to convert testosterone to estradiol and androstenedione to estrone. A separate enzyme converts the estrone into estradiol within the granulosa cells. In conditions like polycystic ovarian syndrome (PCOS), there is an imbalance in the androgen and estradiol ratio with higher levels of androgens suggesting a problem with conversion of these hormones in that condition. We will revisit this in future articles on PCOS.

Ovulation

Progesterone prompts ovulation. Historically, it was thought that the LH surge caused the follicle to release the mature ovum (egg) in a reversal of the negative feedback loop between estradiol and the pulse of GnRH which suppresses release of both FSH and LH from the pituitary. New research suggests that the adrenals release a small surge of progesterone that stimulates ovulation and prompts a rise in LH. This pathway explains why women who are under stress experience delayed ovulation.

Based on my own at-home hormone monitoring of urinary metabolites of estradiol and progesterone plus LH and FSH, I can confirm this pre-ovulatory temporal rise in progesterone. In fact, if this new theory proves correct, it may help explain the sudden shift in the electrolyte composition of vaginal secretions at ovulation.

Progesterone concentrations just prior to ovulation are much lower than concentrations mid-luteal phase, and so it is likely that the adrenal cortex, rather than the developing follicles, are producing the progesterone necessary to prompt the surge in luteinizing hormone (LH). It is also of note that high concentrations of progesterone (like those produced during the luteal phase and during pregnancy) inhibit ovulation. In in-vitro fertilization, when progesterone is given at doses to simulate the blood concentration seen during the luteal phase, this prompts the “vanishing follicle” phenomenon suggesting that a low progesterone concentration is vitally important to successful ovulation.

This theory may also explain why women under stress do not ovulate. It is common for women who develop a cold or illness during the peri-ovulatory phase to have either delayed ovulation or an anovulatory cycle. Other forms of stress (mental, over-exercise, disturbances to the circadian rhythm) are also known to delay ovulation. Considering that pregnenolone is the precursor to both cortisol and progesterone, this progesterone rise theory as the key event leading to ovulation evolutionarily fits the concept of conserving eggs or preventing reproduction when conditions aren’t favorable to pregnancy. Elevated demands for cortisol during times of high stress would deplete the body’s ability to create progesterone.

Role of LH: LH (luteinizing hormone) transforms the follicle into the corpus luteum. While the follicle primarily generated the hormones testosterone and estradiol throughout follicular development and leading up to ovulation, the corpus luteum releases progesterone and estradiol to maintain the uterine lining after ovulation.

Key Takeaways From the Luteal Phase and Menstruation

Progesterone released by the corpus luteum throughout the luteal phase is vitally important for pregnancy because it sustains the uterine lining providing nourishment to the developing embryo until the placenta fully forms around 12 weeks gestational age. It is especially important that concentrations of progesterone be maintained until implantation of the fertilized egg occurs. Luteal phase deficiencies, which we will talk about more in future posts, is one of the common causes of implantation failure.

In the absence of pregnancy, the corpus luteum atrophies between 10 and 16 days after ovulation. As the corpus luteum atrophies, levels of progesterone and estradiol both fall, resulting in atrophy of the uterine lining resulting in onset of menses.

An Overview of a Healthy Menstrual Cycle

In summary, a slowdown in the rate of release of GnRH from the hypothalamus prompts an increase in FSH secretion from the pituitary and this awakens further development in antral follicles within the ovaries. As these follicles mature, both testosterone and estradiol are made by the developing follicles increasing the amount of both these hormones within the body. Estradiol quickens the release rate of GnRH by the hypothalamus which reduces FSH secretions by the pituitary gland.

Historically, it was believed that once estradiol achieved a critical threshold, this negative feedback loop reverses, and FSH spikes along with an LH surge to cause ovulation. New research shows a transient rise in progesterone ahead of the LH surge. This rise in progesterone is about one-tenth the maximum rise in progesterone seen during the luteal phase of the cycle and is presumably produced by the adrenal cortex. If this theory (that a transient concentration-dependent rise in progesterone) prompts ovulation, then this better connects the dots between why stress and undereating cause anovulatory cycles.

Luteinizing hormone, which spikes around the time of ovulation, elicits key changes within the follicle allowing for rupture of the mature egg from the follicle and conversion of the follicle into the corpus luteum. The corpus luteum produces both progesterone and estradiol and in the absence of pregnancy naturally atrophies resulting in falling levels of progesterone and estradiol. As circulating blood concentrations of these two hormones, which are necessary for maintaining the uterine lining fall when the corpus luteum atrophies, the uterine lining itself also atrophies and sloughs off the walls of the uterus leading to the onset of menses between 10 and 18 days after ovulation in a healthy cycle.

hormones across menstrual cycle
Figure 1. Hormone concentration throughout the menstrual cycle.

In Summary

This very quick overview of the menstrual cycle (aka ovulation cycle) forms the basis of every single fertility awareness method (FAM) today. Whether the method involves monitoring changes in cervical mucus, cervical position, basal body temperature, electrolyte composition of salivary/vaginal secretions, and/or at-home urinary hormone monitoring, these methods are highly reliable for predicting ovulation and are so reliable that their efficacy for avoiding unplanned pregnancy vies that of hormonal birth control.

These methods are also invaluable for shining light on a woman’s reproductive health and elucidating where hormonal imbalance lies within her cycle when things are a bit off. FAMs also provide real time data for women who are tracking their cycles so that you are able to adjust diet and lifestyle to support hormonal balance.

I will refer back to this article often in future posts on FAMs and hormonal health.

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Why I Made a Documentary About the Birth Control Pill

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I began using the birth control pill in my early 20’s. After 3 years of using the pill, I decided it was time to stop. I didn’t expect the process of coming off birth control to be so harsh. I was wrong. The withdrawal symptoms were unlike anything I had ever felt before. I developed extremely high blood pressure, had tingling and weakness throughout my body, brain fog, and a frightening sense of depersonalization. Not a single doctor could give me any information about what was causing these symptoms, when they would end, or even if they would end. In fact, most of the physicians I saw denied that pill withdrawal was a thing. They said that my symptoms were anxiety and suggested an antidepressant. I knew that couldn’t be the cause of these unique, first-time symptoms. I felt like there was no hope in sight. Through research, I found that I was not alone. There were many women who experienced similar symptoms while withdrawing from hormonal contraceptives, In fact there were thousands of women just like me.

I wrote an article about my full experience coming off the birth control pill and published it on this website, here. Since then, the article has received hundreds of comments from women who developed similar withdrawal symptoms. I decided to make a documentary about hormonal birth control in an effort to help spread awareness, and, to comfort other women who were struggling. Filming a documentary with no crew, no production money, and no experience, will fully test one’s sanity, but I was determined to uncover and document the health effects of hormonal contraceptives. After 4 years of work, I released the documentary entitled, “Hormoneously Alone,” on YouTube.  It can be found here.  I learned a lot from filming this documentary, and over the next few months, I will be writing a series of articles about the topics discussed in the film as well as other information that I was not able to include.

Ninety-eight percent of the female population will use a hormonal contraceptive in their lifetime. This is likely because it is 99% effective at preventing pregnancy when taken regularly. Using the pill alleviates worry and it is easy to use. In the US alone, this means that about 13 million women use hormonal birth control, with 6 million between the ages of 15-24 and 7 million between the ages of 25-34. I also learned that about 60% of women who have taken the pill have done so for other issues unrelated to pregnancy. Acne, bloating, and cramps are some of the main catalysts for using the pill.

What you may not know, and what I did not know before I began taking the pill, is up to 60% women who use hormonal contraceptives, whether for the prevention of pregnancy or for other reasons, stop taking the pill within 6 months because of side effects.  Unfortunately, there is little research on pill withdrawal and why it effects some women and not all. Through my own research, I’ve personally estimated that about 15% of women will experience withdrawal symptoms.  This is troubling because these withdrawal symptoms seem to only be recognized by the women who use these products. There are few experts in women’s health who understand pill withdrawal. Most doctors and gynecologists seem unaware of these effects. This leaves most of us struggling to recover on our own.

If a significant amount of women use hormonal contraception at some point in their lives, and the side effects both on and off the pill are not well studied, do we really know enough about the well-being of the girls and women who use them? With teenagers especially, are we doing more harm to the developing brain and body when we prescribe artificial hormones for things like acne and painful or irregular periods? Given the large number of girls and women who use the pill, do we as a society, not just as women, understand what we are committing to when we take the pill? From what I experienced and what I learned while producing the documentary, even though the pill has been on the market for over 60 years, we still do not fully understand the implications of using artificial hormones. Over the next few articles, I will be tackling some of these big issues that many women wonder about while on the pill, and off the pill. Hopefully, what I have learned will help others make more informed decisions and feel empowered to know what’s right for their body, and their body only.

Hormoneously Alone – A Birth Control Documentary

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It’s Not All In Your Head: Mental Health and Hormonal Birth Control

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Once upon a time, a 26-year-old woman went to her doctor and asked to be put on the new birth control pill that allowed women to only have four periods a year. She had seen it advertised on television. Four months later, 15 pounds heavier and suffering from mild depression, she returned to the doctor feeling miserable. The doctor told her the weight gain and depression were not from the pill because those were not side effects of hormonal birth control. Wait, does this sound familiar? It’s the same story I told in my article about hormonal birth control and weight gain. Only this time, I’m talking about mental health.

The truth is that I gave my mood changes and my mild depression very little thought. Once the doctor told me they were not a symptom of my new birth control pills, I figured it was my fault I was sad and not dealing with things very well.

What They Knew in 1970

I remembered the connection between my birth control pills and that bout of depression when I began reading the Nelson Pill Hearings. One of the first doctors to testify pointed out that there had been a suicide during the original pill trials in Puerto Rico. Neither the suicide, nor the other three sudden deaths (of five total deaths during the experiments) were investigated. But what really got my attention was that the page after the mention of the suicide was the only one missing in the nearly 1500 pages of testimony. I have since been able to get a copy of that page and while the testimony doesn’t seem that damning given the laundry lists of risks, concerns, and dangers with hormonal contraceptives that are examined at the hearings, it does bring up an interesting point.

Doctor Edmond Kassouf’s testimony answers questions from Mr. James Duffy, minority counsel at the hearings (page 6112):

Mr. Duffy:  One of the five deaths was suicide.

Dr. Kassouf:  Yes.

Mr. Duffy:  So what I would like to understand is how does one take a suicide and link the case of death to the pill?

Dr. Kassouf:  Very simply. It has been of current concern. Many physicians and psychiatrists are concerned about depression and the pill. If this is true, suicide may well be the end result of that combination and, therefore, a reasonable suspect, a reasonable link.

Suicide Attempts While on the Pill

“I’ve really got to look into this more,” I thought. Well, I had to look no further than page 6447 and the testimony of Dr. Francis Kane, Jr., Associate Professor of Psychiatry at the University of North Carolina. To sum up his testimony about the studies conducted with regard to mental health and oral contraceptives, he says this (page 6457):

“There is considerable incidence of mild to moderate psychiatric morbidity [disease] associated with the use of combination oral contraceptive agents… In three of the four studies, there seems to be agreement that those who have required psychiatric care in the past will be more at risk for the development of morbidity, including psychosis. One study also suggests that there may be some increase in the depth of illness the longer the medication is taken.”

Dr. Kane describes a study conducted in England of 50 women on oral contraceptives who were compared to a control group of 50 women who had not used hormonal contraception. There were no differences in socioeconomic status, age, or history of past depressive episodes. But in the group taking the pill, 14 women “had depression of mild to moderate proportions, while only three of the control group reported this.” The pill users also reported greater depression as well as particularly high scores for “guilt, self-absorption, and loss of energy.”

He goes on to say, “Two suicidal attempts in the pill sample were found, which had not been disclosed to the general practitioner. Since completing the study, another depressed pill-taker had made a serious suicidal attempt.” Three suicide attempts in a study of 50 women? That seems incredibly high to me. Ludicrously high. Especially given that there are other methods of contraception.

But Wait, There’s More!

But that’s just one doctor testifying about a few studies, right? Sure. But the next person to testify was Dr. John McCain (not the senator). One of the first things the doctor points out is (page 6471):

“The contraceptive pills are potent steroid hormones. Alterations of the anterior pituitary function are produced by them… the potential endocrine and systemic disturbances are almost unlimited. The effects produced through the anterior pituitary may be so indirect that years may elapse before a correlation is established between the abnormality and the administration of the contraceptive pills.”

You know what else is a hormonal medicine? Anabolic steroids. “Roid rage” is pretty well documented. Is it really such a leap to think that hormones in birth control can also cause changes in mental health?

Dr. McCain spent years documenting the patients in his practice who suffered serious side effects from hormonal contraception. In that time, he recorded episodes from 52 patients. And per his own testimony, his largest concern was mental health (page 6473).

“The emotional or psychiatric problems are the complications which seem to me to have the most serious potential danger. Three patients have stated that they were desperately afraid that they were going to kill themselves… After the pills were omitted, the depression and suicidal fears of the three patients disappeared, as did the depression of the other patients.”

He also points out (page 6473):

“It is disturbing to consider the patients on the pills whose depression may have ended in suicide and/or homicide with no recognition of any association with the contraceptive pills… Personality changes could be a factor in other conditions such as automobile accidents and divorces.”

Is it really so much of stretch to think that a potent steroid could cause personality changes that could lead to the damaging of personal relationships that are beyond repair? Plenty of other potent substances can and do.

What They Say Now

Dr. Kane and Dr. McCain, as well as every other expert who testified at the Nelson Pill Hearings, agreed on one thing. More research was needed.

So what does the research say now?

Medscape published an article from the American Journal of Epidemiology with the claim that “Hormonal contraception may reduce levels of depressive symptoms among young women.” Yet when you read further into their conclusions, they say that nearly one-third of women discontinue hormonal contraceptives within the first year, many because of mood changes, and those women are unlikely to restart hormones. Therefore, “hormonal contraceptive users at any time point may be overselected for less depression than nonusers.”

The study also points out that:

“Existing literature on hormonal contraception and depression has been primarily confined to small, unrepresentative samples. Among these smaller studies, few cohesive findings have emerged.”

And:

“Little research has examined the role of exogenous hormone use in suicidality, and existing research has focused on mortality from suicide rather than suicide attempts.”

And according to WebMD, there are a laundry list of medications that can cause depression. What is not included on this list? Birth control pills. The only hormonal contraception included is Norplant. Interestingly enough, the active ingredient in Norplant is levonorgestrel, a progestin found in many birth control pills as well as hormonal IUDs. So am I supposed to believe that when injected into my arm, synthetic hormones can cause me depression but when taken daily as a pill or sitting in my uterus for 5 years, they won’t? Does that make any sense at all?

It doesn’t make sense to Dr. Kelly Brogan. That’s why when she has patients that complain of depression, anxiety, low libido, mood changes, weight gain, etc. she recommends they stop using hormonal contraception.

What Have We Learned?

  • Hormonal contraceptives can cause mental health issues
  • Women who suffer from mental health issues are much more likely to suffer from increased symptoms when on hormonal contraception
  • Often the longer hormonal contraception is used, the greater the symptoms
  • Discontinuation of hormonal contraception can usually alleviate mental health symptoms
  • The research promised from the Nelson Pill Hearings has never materialized

Why, if they knew in 1970 that hormonal contraception was deeply connected not only to depression but also to suicide, has it not been further researched? It’s been nearly 50 years since Dr. Philip Ball (page 6493), a specialist in internal medicine, testified before congress. Which makes what he says all the more chilling.

“It is not considered reasonable that there be any mortality or morbidity in a pill used purely for contraception purposes. Medical research has got to offer something better than this. Physicians will probably look back on the contraceptive pill era of the past 5 years with some embarrassment.”

Exactly.

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This post was published originally on Hormones Matter on June 22, 2016.

 

The Instant Menstrual Cycle

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My uterus decided to end her 6-month vacation yesterday. This is nothing new; I’ve never had regular periods and have tried nearly everything to make my body function on a regular schedule, but it just doesn’t cooperate. Synthetic hormones prescribed by numerous doctors have always made things worse. Acupuncture, when I am working and can afford it, is the only thing that makes them more regular and manageable.

Take a moment to empathize with me – 6 months worth of bloating, fatigue, cramps, blood, etc. in one lousy week. Oh and this would be the second week of a new job – I’m onto you uterus, I’M ONTO YOU!

I’ve tried diet changes, more exercise, less exercise, meditation, medications, channeling my inner moon goddess – everything. I’m finally learning to accept that this is the way my body functions. I don’t like it, but I accept it. What I can’t accept is that we put a man on the moon 45 years ago, but we can’t figure out how to give women some relief. Women have been in science for some time now. Marie Curie won the Nobel prize for Chemistry in 1911. You’d think we could help ourselves, but the most we have advanced in menstrual related relief and technology is OTC pain relievers marketed in pink boxes with a different name and wads of cotton so toxic to our bodies that they can kill us! Don’t you think we need entire labs dedicated solely to easing the pain of menstruation and child bearing. The women scientists can wear brightly colored lab coats and eat an endless supply of chocolate while figuring out new ways to deal with age old biological functions.

Yesterday, I couldn’t leave the couch. I was supposed to go to a barbecue with friends, do all the chores I can’t do during the work-week, and hit up the grocery store, but I was couch-ridden with a heating pad, smelly Chinese herbs, red raspberry leaf tea, and a book. I’m afraid that my friends thought I was lying to get out of the social gathering (I tend to be reclusive), and more than one male employer has given me that “uh-huh, sure” tone when I’ve called in sick over womanly problems. Thankfully, I’m a generally healthy person so that’s the only time I call in sick (and I’m extremely thankful for my health). Take a minute to imagine being in the military and having to tell a male superior that you can’t go out to the field for an exercise because of earth-shattering cramps and excessive bleeding. Then going to a male doctor at sick bay to get a ‘chit’ as proof you weren’t lying.

And I’m supposed to channel my inner moon goddess and be thankful that I’m a woman and can bring life into this world? I’m going to channel my moon goddess alright, channel her and beat her. Don’t get me wrong, I love being a woman and everything that entails, but in the name of science and entrepreneurial spirit – don’t you think it’s about time we figured out a way to ease the pain and suffering that women have to endure monthly?

In an essay originally published in the Boston Phoenix in 1990 and republished posthumously in a collection of essays titled, The Merry Recluse in 2002, Caroline Knapp, wrote, “What Women Really Need from Science.” Here is an excerpt that I think of EVERY time I have an earth-shattering, couch-ridden period, like today:

“So now women can have babies at the age of 90. Big whoop. Roll out the Pampers and Geritol. Open a Cribs ‘n’ Canes shop. And thank you, thank you, thank you, modern medicine.

Something is very wrong here. While a teensy-weensy proportion of women over the age of 75 might welcome the opportunity to procreate in their golden years, and while this development might help ease the pressure some women feel as their biological clocks tick away, most of us shudder at the news. Babies when we’re 90? Postmenopausal midnight feedings?

This news also seems to indicate a slight problem modern science has with focus. What about the here and now? What about the daily realities women face in our younger years?
Any doctor or scientist who truly understood the lives of modern women would be looking in an entirely different direction for ways to ease our burdens and make our lives more manageable. Forget about extending our childbearing years. Forget about finding new and medically thrilling was to complicate our later lives. We need help now! Here, for ambitious doctors everywhere, are a few suggestions.

The Instant Menstrual Cycle

Consider how much simpler life would be if scientists could develop a way to enable women to menstruate in a mere five minutes. No more messy, five- to seven-day bouts of bleeding. No consecutive nights curled on the couch with heating pads to ease the lower back pain. And no more worrying: Will you run out of tampons? Leak? Bleed on his sheets? The five minute menstrual cycle would pack all that discomfort and inconvenience into much more manageable form. One huge cramp. One enormous mood swing. A single flood of tears, and then – whoosh – a single rush of blood into a single, extremely absorbent tampon. If science can come up with an instant coffee, instant breakfast, and instant cameras, instant menstruation couldn’t be that hard.”

Amen sister. She goes on to list other brilliant scientific ideas for some, young scientist to snatch up and make our lives easier including: egg-laying capabilities, clones for working mothers, anti-gravity skin enhancers, and more.

Someone, somewhere, PLEASE hear my plead: We can genetically modify animals to create spider goats and jellyfish pigs, we can travel to space, we can harness the power of nuclear fusion to create electricity and bombs – so why can’t we make advancements in women’s health that would bring relief to half of the world’s population? It’s past time for the Instant Menstrual Cycle – it’s time for a revolution, ladies!

Adventures in Natural Family Planning

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Ten years ago, I began researching fertility and natural alternatives to achieving and avoiding pregnancy. The more research I did, the more I realized that there was a decided lack of current, accurate information on the internet. After becoming pregnant with my first child, I focused my research to learn how to space my children without using birth control. Though my family has a long history of breastfeeding and childbirth, they did not provide me with any information that I could use. I didn’t want to use hormones while breastfeeding but neither did I want to get pregnant again immediately. While there has been significant research validating ecological breastfeeding, at the time it had not caught on. There was very little information on the internet about practically applying it in everyday life. Needless to say, using the information on the internet, I was soon pregnant with my second child and then my third child.  At that point, my forays into natural family planning were not working.

Natural Family Planning and Physicians

I was desperate to find a way to space my children without artificial hormones or invasive devices; I looked to my OB/GYN and the local health department. My OB and the health department could not provide me with any information about natural family planning, and in fact I was openly mocked by the doctors and nurses. The health department tried giving me Cycle Beads with very little instruction. I refused them, knowing that they would be completely ineffective as I was breastfeeding and didn’t yet have a menstrual cycle. It seemed that I knew more about managing my fertility than they did.

Do-it-yourself Natural Family Planning

Discouraged and outraged, I obtained as much information as I could and assembled my own version of natural family planning. It worked for two years until I found myself pregnant with child number four. When my family and I relocated to another state, I was soon able to find a natural family planning instructor. I learned the Billings Ovulation Method. I cannot stress enough how important an instructor is when using natural family planning. This system taught me what I had been doing wrong all these years (I will write more about this and other methods in subsequent posts). I was able to successfully navigate breastfeeding my fourth child without getting pregnant.

However, my hormones started acting up in very obvious ways shortly after giving birth. None of the doctors I spoke to about it could give me an answer. I was experiencing what is known as “tail-end brown bleeding” from the end of my menstrual cycle on up to and including the day of ovulation. I went to two OB/GYNs and a hematology specialist. The answers I received ranged from “it is normal” to “there is nothing wrong.” Not one of them could explain this very obviously abnormal symptom. They all seemed unconcerned even though I knew that something was up.

I continued my research of the female reproductive system, as I realized that neither the Billings Ovulation method nor the Sympto/Thermal Method did anything to help the women who had health problems such as PCOS, endometriosis, infertility, or in my case abnormal bleeding.

Natural Family Planning With Irregular Cycles

My continued search for answers led me to another method of natural family planning called the Creighton Model FertilityCare System.  The Creighton Model is considered the gold standard of the natural family planning world. Creighton has been able to research and document in a woman’s chart hormonal irregularities and how they relate to her overall fertility and health. Finally, I had a method of not only diagnosing but also treating the abnormality I experienced. With the use of the Creighton Model and NaPro Technology it is possible to work cooperatively with a woman’s cycle to help seek treatment for health problems like my abnormal bleeding pattern.

I fell in love with this method and went through the extensive training course to become a presenter and promoter for the Creighton Model. I originally set out to become a practitioner for this method so that I could help other women get the education they needed. I soon learned about the politics that surround natural family planning.  We’ve all heard the jokes. “You know what you call a woman who uses natural family planning?……….. Pregnant.”  Well, that pretty much sums up what most people think of natural family planning. Teachers are abundantly available for those interested in learning any method of natural family planning; but there is much more work to be done to change our culture’s current paradigm surrounding natural family planning

Luckily, we have come pretty far over the last decade. There is ever more press and discussion these days about the side effects of hormonal birth control (I will add a few links here). More and more women are deciding against hormonal birth control. Though, there is still much work to be done,natural family planning is becoming a viable alternative to the pill and other devices.

A New Approach: Fertility Awareness

Fertility Awareness is catching on as the new bias free catch phrase for a concept that has been around since the beginning of the birth control explosion. I have dedicated my life to spreading and sharing the wonder that is natural “organic birth control.” What we women really need is more voices who advocate for, and promote today’s modern Fertility Awareness Methods (FAM).

Over the coming weeks, I will be writing articles about the various methods of Fertility Awareness; the pros, the cons and my personal experiences with each. If you’d like learn how to navigate pregnancy naturally or if you have been diagnosed with a women’s health problem that you are currently treating with birth control, follow me on Hormones Matter. If you’d like to share your own experiences with natural family planning and fertility awareness, click Write for Us and send us a note.

What if Endometriosis Was a Men’s Health Issue?

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As a health journalist and a co-founder of Endo Warriors, a support organization for women with endometriosis, I often get asked “what is endometriosis?”

Which is funny since it is estimated that 176 million women worldwide have endometriosis and yet no one knows about this global health issue.

Sometimes I say “it’s a secondary autoimmune disease where the lining of the uterus is found outside of the uterus and throughout the abdominal cavity — to varying degrees — causing chronic pain and infertility.

And other times I say “it sucks.”

Nancy Peterson of the ERC said “If 7 million men suffered unbearable pain with sex and exercise and were offered pregnancy, castration or hormones as treatment, Endo would be a national emergency to which we would transfer the defense budget to find a cure.” And, I don’t disagree.

If 7 million American men had unbearable pain every time they ejaculated, no one would ever suggest chopping off their balls. If they went to a health clinic that also offered pregnancy prevention services, we wouldn’t shut those clinics down. If 7 million American men were in pain every time they masturbated, urinated or tried to have sex we wouldn’t tell them “it’s all in their head” or “to take the pain like a man.”  No, we would listen and try to find them a cure that didn’t include castration or drug-induced de-masculinization.

But that’s not the case.

Instead we have 7 million American women with chronic pain related to the tissue in their uterus and their menstrual cycle. 7 million American women who have pain before, during and after their menstrual cycle. 7 million American women who experience pain while exercising, having sex and going to the bathroom. So we offer them chemical-menopause and hysterectomies and when those don’t work we throw our hands up in the air and say “well, at least I tried.” Better luck in your next life, perhaps you’ll come back as a man.

The menstrual cycle is the butt of all jokes directed towards women. Bad day? Is it your period? Is Auntie Flo in town?

Seeing red? Are you on the rag?

No, actually I’m just mad that the idea of healthcare for women makes people want to cover their ears and run screaming.

Free birth control for women?

Great idea!

That is until some political pundit insinuates women should just learn to shut their legs.

Maybe instead we should learn to listen to the myriad of women on birth control for issues beyond planning pregnancies. Maybe women should just get easy access to low cost birth-control without having to recite their medical record.

October is health literacy month and when it comes to health literacy, Americans are kindergartners trying to eat the paste off their fingers.

We think Obamacare and the Affordable Care Act are two different things; getting outraged at the notion of Obamacare yet think the idea of ‘affordable’ healthcare is quite nice.

Access to low-cost health care for everyone? Let’s shutdown the government!

Rather, if we want the government out of our private healthcare, then how about they get out of our uteri as well?

The Quest for Contraception and the Plight of the Inbetweener

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When you read about what women did in ancient Greece and Rome to ward off unwanted pregnancies, you’re tempted to do a full-on spit-take! I mean, our doomed sisters had to rely on wild dances and fancy amulets to keep sperm out of the egg’s personal space.

Ever wonder how that worked out for them?

Well, we women of today also face so many nightmarish birth control options – all sorts of pills and devices that could kill us – that the ancient one of crossing your fingers as you open your legs actually sounds like a refreshing idea.

So is it really preposterous for us to want safe and affordable contraception? Is it too much to ask that a woman be able to avoid the dilemma aborting a fetus or not by safely and affordably not getting pregnant at all? Not all of us pine away to be like that ideal reality show rabbit – AHEM! I mean multi-mother – Michelle Duggar.

The struggle for reasonable contraception only gets worse for “Inbetweeners”: that growing segment of women who fall between the cracks of “too poor” and “earns too much income to qualify for…” Inbetweeners defy many stereotypes: they can be married, single, or divorced, childless or not. They can be women who’ve been thrown for a loop yet not knocked down, by huge financial setbacks like divorce, loss of home, death of a spouse, personal illness, depression and/or job loss. Inbetweeners often don’t appear “needy” in appearance or attitude though they are.

You can think of Inbetweeners as the Indiana Joneses looking for what I’ll call The Holy Grail of Contraception. Sure, their jobs might not entail surviving fire pits or jumping over piles of writhing snakes; but they toil long hours for minimum wage and have no affordable health insurance.

This propels them to the doors of Planned Parenthood, where they hope to find some contraceptive security. But Planned Parenthood has it’s own struggles. Often Planned Parenthood is at the mercy of the companies and programs that supply its contraceptives and arbitrarily change their prices. That means countless women suddenly and inexplicably get kicked off programs that have supply reduced cost birth control, leaving these Inbetweeners in the dust because they’re sorely stretched to pay the staggering full price on just a one month’s supply of birth control.  And Planned Parenthood staffers, no matter how sympathetic, can only shrug and say “I’m sorry.”

And Ms. Inbetweener can dream on about the possibility of getting a reduced-cost IUD! If she’s not destitute enough, these programs snatch that possibility from her desperate uterus, ‘cause the regular price for an IUD runs into the hundreds. In many cases, using birth control isn’t totally about avoiding unwanted pregnancy. For example, an IUD stanches periods that can be out of control and create havoc in the life of the sufferer. And many women have limited birth control options due to age or lifestyle habits.

But of course sorry is what an Inbetweener will be if she gets knocked up and can’t provide for the needy little cherub that’s been conceived. Her choices boil down to: Cough up big bucks to stay baby-free, leave the whole responsibility for “protection” with her partner (fuggeddabboudditt!), or have one baby after another, get even poorer and more dependent on public assistance, and find herself accused of  “living off the system.”

Inbetweeners aren’t financially irresponsible; it’s just that once the bills are paid, they don’t have much left for food, never mind paying for reproductive freedom. Yet they wish to make mature choices about reproducing – and shouldn’t that be respected???

Any which way an Inbetweener tries to seek help, she is discriminated. There’s just no way to win at being a grown, responsible and sexual woman in America.

Still, we women have always been more resilient than we’ve ever let on. The ladies of ancient Greece and Rome knew it in their bones as they whirled feverishly to stave off undesirable futures. Their light fingers rubbed the milky amulets while prayers dripped from their quivering lips. Though their choice always teetered between  peril and bliss, they still fiercely claimed it.

Let’s not be lesser sisters than our ancient ones – let’s keep up the good fight for safe and affordable contraception they started as best they could, long ago!