PRECONCPETION

007: Post-Birth Control Syndrome And Fertility w/ Jolene Brighten, ND

007

007: Post-Birth Control Syndrome And Fertility w/ Jolene Brighten, ND

Welcome to the Healthy Happy Mami podcast!

Our guest today is Dr. Jolene Brighten, a pioneer in women’s medicine and award winning naturopathic physician. She is the author of Beyond the Pill and Healing Your Body Naturally After Childbirth.

A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones.

She is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Elle, Bustle, The Guardian, and ABC News. Dr. Brighten is also part of the MindBodyGreen Collective and a faculty member for the American Academy of Anti-Aging Medicine.

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In today’s episode we are talking all about how to get ready for a baby after years of hormonal birth control, as well as the state of women’s healthcare. 

Highlights:

  • Dr. Brighten’s journey
  • What is Post-Birth Control Syndrome (PBCS)?
  • Why is it so difficult for women to come off of birth control?
  • Why it’s so important for women to be educated about their bodies
  • The effect the Pill has on fertility after coming off of it
  • Info about CoQ10

Important Links

Find Dr. Brighten online here

Check out Dr. Brighten’s Hormone Kit

How to Choose the Best Prenatal Multivitamin

Follow Dr. Brighten on Instagram | Facebook | Pinterest | YouTube

Quotes

“Post-Birth Control Syndrome is a collection of signs and symptoms that arise typically anywhere from four to six months after coming off of birth control, although symptoms can show up sooner or later. For some women, they are the very symptoms that got them on birth control in the first place. So, irregular periods, painful periods, acne, heavy periods, migraines, cyclical headaches. And so, those can come back.”

“If you’re a woman and you’re dealing with periods that are painful and you’re at home because you can’t leave your house because you’re going to bleed or because you have a headache or because you feel terrible, that’s not normal. It’s common, but it’s not normal.”

007: Post-Birth Control Syndrome And Fertility w/ Jolene Brighten, ND TRANSCRIPT

Dr. Carrasco:                      Welcome back to the Healthy + Happy Mami Podcast. Our guest today is Dr. Jolene Brighten. Dr. Brighten is a naturopathic physician and prominent leader in women’s medicine and the emerging science of post-birth control syndrome, studying the effects of hormonal birth control on female health.

Dr. Carrasco:                      She’s a fierce patient advocate and is completely dedicated to uncovering the root cause of hormonal imbalances. Dr. Brighten empowers women worldwide to take control of their health and their emotions. She’s an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health.

Dr. Carrasco:                      Dr. Brighten is also part of the mindbodygreen collective, and a faculty member of the American Academy of Anti-Aging Medicine. Her work has been featured in The New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian and ABC News. Welcome to the show, Dr. Brighten.

Dr. Brighten:                      Hey there. Thanks for having me.

Dr. Carrasco:                      Thank you so much for being here with us. So, first and foremost, before we dive into post-birth control syndrome, we just want to hear a little bit more about why you do what you do and a little bit about your journey.

Dr. Brighten:                      Well, I work in women’s medicine. And that’s not just because I am a woman, although that is a really big part of my own personal experience and coming to this. But the biggest reason, so I actually thought, okay, I was at a crossroad. I was getting my master’s in nutrition. I was considering applying to conventional medical school, and then this thing called naturopathic medicine came onto my radar. And I decided to go that route.

Dr. Brighten:                      I was really interested in pursuing a different philosophy by a perspective that looked at the body as a complete system and how all the systems operated together. And having had a past history of significant gastrointestinal issues and coming out of nutrition, I was like, I’m going to be a doctor who focuses on gut health.

Dr. Brighten:                      Until I made the observation and really the reality came full force that women’s health is often done to them, not with them. And that there’s been a lot in the history of medicine where things like women, it’s not been consensual in terms of even the gynecological Pap smear. That’s not always consensual. Yes, you agreed to come there, but then things are just done to you instead of with you.

Dr. Brighten:                      We see how childbirth has been historically for women and even still persists in some states and some parts of the world. And that there’s just been a lot of medical experimentation and medical neglect of the female body altogether. And it was in recognizing this that I saw an opportunity for me to actually step up to be part of the change that we needed in women’s health.

Dr. Brighten:                      And having been a nutritional biochemist, the hormones of women fascinated me. And instead of coming to it from the perspective of like, oh, women’s bodies are just so complicated. We just need to medicate all their symptoms away. I really came from a, huh, that’s so interesting kind of perspective. And having that curiosity and really the complicated state of being a woman is what drew me in, but it really was initially from that perspective that so much of women’s medicine is done to them.

Dr. Brighten:                      We don’t teach women about their body. We wall off any knowledge about the female body between the woman and the white coat. As women, we’ve been asked to just be good girls, do what your doctor says, don’t ask too many questions, you might be labeled hysterical. And gaslighting is completely acceptable as long as it happens behind closed doors in a physician’s practice.

Dr. Brighten:                      I really just want to change that narrative. And I know you guys do too. It’s why you do what you do, and I think it’s fantastic that here we all are having a conversation on your podcast.

Dr. Carrasco:                      Well, thank you.

Dr. Maren:                          Yeah. I love that. I love that you’re such an advocate for women’s health. And I really do feel like it is changing the face of medicine. So, thanks for what you do.

Dr. Carrasco:                      Yes, thank you so much. And thanks for being here with us. So, okay, so many women in our audience are starting to think about growing their families and preconception health. And a lot of women in our audience are on birth control pills and trying to figure out when to come off of them for a healthy conception.

Dr. Carrasco:                      So, first of all, I’d love for you to educate our audience about post-birth control syndrome. What is that? Can you kind of deep dive into that for us?

Dr. Brighten:                      Yeah. So, post-birth control syndrome is a collection of signs and symptoms that arise typically anywhere from four to six months after coming off of birth control, although symptoms can show up sooner or later. For some women, they are the very symptoms that got them on birth control in the first place. So, irregular periods, painful periods, acne, heavy periods, migraines, cyclical headaches. And so, those can come back.

Dr. Brighten:                      But also, there can be new symptoms that come about as women discontinue hormonal birth control. They can be the same ones that I mentioned, but we can also see issues with having persistent vaginal dryness and their libido that went missing on birth control, that continues as well. And maybe things get worse in that department.

Dr. Brighten:                      And so often, I want to say, we look at birth control as a reproductive medication, therefore, it only impacts the reproductive system. However, we can see new onset of neurological symptoms, like headaches migraines, but also anxiety, depression. That’s because within the brain, there are receptors for these hormones. We can also see digestive issues come on.

Dr. Brighten:                      So, this is why that gets the term syndrome is because it can be a constellation of signs and symptoms, and you can have all of them, most of them, or only a few of them. And it really can look different from woman to woman, which was what makes it a little bit confusing, is, well, one woman, she may come off of hormonal birth control, never had any issues with her skin, now has oily skin and lots of acne. Another woman may have perfect skin coming off of birth control, only now she’s having panic attacks all the time.

Dr. Brighten:                      And so, it’s really important that if you’re coming off of birth control to track those symptoms. The earlier things are caught as they start to show up, the less you have to struggle. And so, if you’re tracking these issues, like I talked about in my book, Beyond the Pill, there are things that you can do to start to intervene. And there’s data that you can collect to bring to your provider so that they can help get you solutions sooner than later.

Dr. Maren:                          Yeah, I love that. I think it’s so important whenever we talk about any intervention, including birth control to think about, like, what are the risks and what are the benefits? And sometimes, as you would say, the benefits of birth control outweigh the risks, and sometimes they don’t. And so, that’s just a conversation to really kind of research how with your provider, read your book, all of that.

Dr. Maren:                          But I think one of the really interesting parts is when you go on birth control as a way to mask underlying symptoms, it’s not really curing anything. It is just putting a little Band-Aid on it, or just covering it up with a blanket, but the problems are still there. And if we don’t deal with them, they usually come back worse.

Dr. Carrasco:                      Yeah. I think that a lot of patients in my practice are really surprised when they come off of the pill only to find that symptomatology that they experienced beforehand is still present.

Dr. Carrasco:                      And I mean, it’s not surprising, but I think that some people find it very, very surprising. So, that kind of leads us into the next question, Dr. Brighten, why is it so difficult for women to come off of birth control?

Dr. Brighten:                      Well, you I love what you guys said there because we are led to believe that birth control will fix our issues. So, I started hormonal birth control at 17. I was bleeding more than seven days out of the month. I was in pain, hot water bottle hugging, oh, let’s be real, back then, it was heating pads, because I’m old like that, electric heating pads, on the floor, taking NSAIDs, vomiting sometimes. And it was so awful.

Dr. Brighten:                      And the story that I got is the story that so many of us get. Periods are basically your punishment and hormones betray you, and your body is just broken and dysfunctional. And you can’t exist in a state within your own body and be comfortable or achieve anything unless you’re taking this medication that is your savior. And so, we take it under the guise that it is regulating our periods, that is fixing our hormone imbalances. And I share this because I believed that too. So, for people listening, it’s not like I’m just some genius who’d never drank the Kool-Aid here. I totally did. And I totally thought, oh, birth control has fixed my periods.

Dr. Brighten:                      And in reality, the way that birth control works, so, if you are in form of hormonal birth control that stops you from ovulating, it works at the brain level. This is why it’s just silly when doctors are like, you can’t have any mood symptoms or brain symptoms, this is a reproductive hormone. And it’s like well, yeah, but wait a minute, it actually elicits is effect in the brain. We’re actually a whole system.

Dr. Brighten:                      Those hormones, they have … I mean, the thing about hormones is that they’re really important for neurological health. I mean, we know that our natural progesterone, which you only get the ovulation. You do not ever get any progesterone while on hormonal birth control. That actually helps with neuroplasticity, so, our ability to learn new things and grow new neuronal pathways and the myelin sheath, like the layer that protects the neurons so that they can fire, as I talk right now, that’s all like brain chemistry happening there.

Dr. Brighten:                      So, with that, it’s a negative feedback loop in which we give hormones that are in excess, so to speak. So, just excessive amount of hormones that are coming from outside the body. This is synthetic estrogen and a synthetic form of progesterone that’s a progestin. So, it’s not actually progesterone, it’s structurally different.

Dr. Brighten:                      And what that does is it feeds a negative feedback loop. And it says to the brain, “Do not produce brain hormones. Do not talk to the ovaries. The ovaries should not make hormones because we are good. We have more than enough.” So, then the brain doesn’t signal the ovaries and the ovaries don’t mature follicles, they don’t ovulate and you don’t get pregnant. Very, very important if you don’t want to get pregnant.

Dr. Brighten:                      However, if it’s being given and you’re being told, well, this is going to fix your period, or this will balance your hormones, that’s not true by the basis of how it operates. Now, what I will say because some women always asked like, “Well, what about the progestin based IUDs, Kyleena, Skyla?”

Dr. Maren:                          Mirena.

Dr. Brighten:                      Mirena And I’m like, who is the OG? Mirena. So, with that, they don’t always shut down ovulation. So, those progestin base, they sometimes do, they sometimes don’t. So, that’s just important to know that, right, we have to look at what’s true for your body.

Dr. Brighten:                      A big myth about those IUDs, when they came out, a big myth, and you guys probably heard this too, you probably taught this, everybody was taught this. Oh, it’s localized. Because we put it in the uterus, it’s localized, and it doesn’t go systemix, it stays local. Except we never actually had any studies to prove that that statement was true. Because while you could put progesterone in the uterus, you can have metabolites that do go systemic. And that’s not necessarily what you’re testing for in the blood.

Dr. Brighten:                      And it took decades of women being given this. And one of my first patients who came to me complaining of birth control side effects and really woke me up to, wow, there’s a lot more women who had experiences like I did. I was told it was just me, when I developed depression, when I developed all these things. The side effects of birth control was a patient that had an IUD placed. And then she was having anxiety and severe panic attack. She’d never heard that before in her life. Her doctor was dismissing her saying it couldn’t be the IUD. The IUD is localized.

Dr. Brighten:                      And at that time, in my practice, I’m like, I know, that’s what they say. However, your timeline is saying something different. And can we get you on a backup method of birth control and just have it removed. Her provider didn’t even want to remove it. This is another thing that I think it’s complete BS and it’s like, you guys can see me right now this is where I start to get like upgrade.

Dr. Maren:                          How firey.

Dr. Brighten:                      About to go to blows on this.

Dr. Maren:                          Talking with your hands and stuff over there?

Dr. Brighten:                      No, when a doctor places an IUD or an implant, so a cervical implant, and then says to a woman, “Oh, no, this is the best thing for you. And I won’t take this out. I won’t take this out because I’m deciding for you what will be your contraceptive of choice or what your reproductive health.” Yet medicine still perpetuates this idea that the doctor gets to be the lord over your reproductive health and to actually say, “No, I won’t actually remove it.” And her doctor actually said, “No, I won’t remove it.” She would to go to a different doctor and get it removed.

Dr. Maren:                          Wow.

Dr. Brighten:                      At the time, in my practice, I wasn’t doing IUD removals, I just didn’t have the hemostats for that. And we’ve waited long enough hemostats, I could have just done that myself.

Dr. Brighten:                      But with that, she was so desperate that she just went to Planned Parenthood and got it removed. She knew she could get in and same day have it removed, and her symptoms did improve. So, I think it’s so important for so many of us to understand that and start talking about that and start talking about our experiences as well. It really wasn’t until the last few years that I became aware of how grossly lacking medically accurate sex education is in our schools.

Dr. Brighten:                      What’s interesting is that in August of 2020, the Guttmacher Institute actually came out with reports and it’s still 17 states mandate medically accurate sex education. And I think it’s something like nine require it to be culturally competent. That means that they’re not required to actually take any gender into consideration or to take any culture or race into consideration as they teach this information, which blows my mind.

Dr. Brighten:                      So, I made this TikTok video on how you can only get fertile or you’re only fertile one day out of the month, right? Okay, so your LH spikes, your brain says, “Yo, let’s bust out with an egg.” Your ovaries like, “I got you.”

Dr. Brighten:                      And about 24, 36 hours later, that egg comes out. And if it is not fertilized within 12 to 24 hours, it dissolves. It’s done. Corpus luteum is left behind. It’s like I’m going to try really hard, make this progesterone, get ready for a baby. Whoops, no baby. Okay, let’s have a period. So, I put that video up. I think it has 1.2 million views within four days.

Dr. Carrasco:                      Wow.

Dr. Brighten:                      Yeah, I was like, I am this many years old when 1.2 million people have viewed my video about ovulation. The vast majority of comments are, “I have never heard this before my life.” Some people are like, “How did I graduate high school, I don’t know this?” Other people, “How did I graduate college, I don’t know this?” There’s a few people, “How do I teach biology and human physiology, and I don’t know this?” I’m like, “Hold on, what?”

Dr. Brighten:                      And then, there’s others who are like postmenopausal now and I’m just learning this, I’m like, this is a major issue. And this really exemplifies and highlights the misinformation that will be purposely spread by medicine and even these programs in order to keep women under the belief that they can get pregnant any day of the month. And there was actually a couple doctors who commented and said, “You shouldn’t be sharing this because now we’re going to have unwanted pregnancies.”

Dr. Brighten:                      And I actually deleted their comments because I was like, I can’t even handle that right now for you to have doctors your title and to say, you should not share medically accurate information. You should help us continue to spread misinformation about women’s bodies because there will be unwanted pregnancies otherwise.

Dr. Brighten:                      I’m like, what you’re saying is, is if we tell women about the truth about their body, they’re just too stupid to use the information responsibly. Nowhere in that video did I say, and I actually did say, sperm can live five to six days. Some people say seven. There’s been some accounts as seven. That’s more rare. But that’s why we have a six-ish, six plus fertile window.

Dr. Brighten:                      When do most women receive this information? When they say to their doctor, “I want to become pregnant.” And I’ve seen you guys’ Instagram posts and they’re awesome. And you echo a lot, we share a lot of same stuff about thyroid.

Dr. Brighten:                      When do women get information about hypothyroidism, how this can be detrimental to their reproductive health? When they want to get pregnant. Your choice to procreate should not determine the amount and the type of medical information you receive about your body.

Dr. Maren:                          Yeah, I almost feel like most of the time people actually get this information is when they can’t get pregnant, right? Like [crosstalk 00:18:37] trying, it’s just like [crosstalk 00:18:39] when they’re successful.

Dr. Carrasco:                      Trying to figure out the problem. And I think that probably the root of all of this like Dr. Brighten says is that reproductive health has been such a taboo issue. And so, it’s like, some people feel uncomfortable talking about it. But I agree that everyone needs to have autonomy and understand how their bodies work so they can make the best choices for themselves.

Dr. Brighten:                      Yeah. And I think so many of our physician friends would agree, when we talk about bioethics and our hippocratic oath, we agree that autonomy, a patient’s ability to make their decision for themselves, is a primary tenet that we all learn. And I would say yeah, like with anything, if your provider is not listening to you, it’s like, well, maybe then that’s when it’s time to find a different provider.

Dr. Brighten:                      But I think so many good things in there. I think the other piece is like, listen to your intuition, because I think so many women really know like, no, something is wrong. And if you have an intuition that’s telling you something’s wrong, I can follow that. I mean, I think intuition is usually guiding you. So, I think tuning into that.

Dr. Brighten:                      And then I think the other thing if we rewind a little bit, it’s just back to painful periods. If you’re a woman and you’re dealing with periods that are painful and you’re at home because you can’t leave your house because you’re going to bleed or because you have a headache or because you feel terrible, that’s not normal. It’s common, but it’s not normal. So, there are definitely people out there who can help you figure out what that is literally.

Dr. Carrasco:                      Absolutely, yes. Yeah, you definitely have to work with the right provider, the right physician. And if your current physician isn’t listening to your challenges or is dismissing you, then it’s time to get a second opinion or a third opinion or a fourth opinion, I mean, until you find someone that really can collaborate with you.

Dr. Maren:                          And advocate.

Dr. Brighten:                      There was that study, a major demographic who often gets put on birth control and given no other options are women with polycystic ovarian syndrome. And we see that, I mean, it can take women with PCOS a decade sometimes to find a provider to actually help them and to actually work with them.

Dr. Brighten:                      Women are going through … I mean, it sounds really daunting to have to be like, oh, a third, a fourth opinion. Yeah, women we see are going through sometimes five, six, seven doctors until they find a doctor who’s actually going to listen to them and help them, which I think really highlights the issues that we have in health care. Because as we sit here and say, get another opinion, well, what if you live in a rural area, where you already have to drive an hour to go see just an OB-GYN? What if your insurance is not going to cover that second opinion?

Dr. Brighten:                      There’s a lot of issues here. What if you can’t find someone? How do you find someone? And so, it really comes back to like, I want to be careful here because I totally agree with you guys, and that also puts a lot of burden on to the patient. And I think we can all agree, yeah, you have to advocate yourself. You’re going to have to probably get two, three opinions before you get the help that you need in some instances.

Dr. Brighten:                      And we can also acknowledge that that is an unnecessary burden that is put on someone who is sick, because we have an institutionalized issue of in within women’s health, and that as much as … You guys, we’re the new gen. I mean, we’re not the young chickens, but we’re definitely in the spring chickens I guess, in the new gen of doctors.

Dr. Brighten:                      And we just see things so, so differently and we’re much more integrative. And, yeah, when you look back at when was hysteria taken out of the DSM, like a diagnosis that it was really rooted in the idea that your uterus is wondering your body and making you crazy. Now, that’s not to say that hormones or uterus can’t make you crazy. That’s not a medical diagnosis. You can say that, but your doctor doesn’t mean to diss you and say that.

Dr. Brighten:                      But there are still people who are training doctors who are residents now that that was part of their training, that was a diagnosis. And so, when we really come through that lens and we have that perspective, we can see, okay, we still have a lot of issues to clean up in our own house in terms of what is part of the curriculum? How are we talking about teaching about women’s bodies, the lack of research being done in women’s health?

Dr. Brighten:                      And why bring all this up is because the history of women’s medicine is really ugly. When you get into it, it’s super, super ugly, and it’s really uncomfortable, and no one wants to talk about it. But when we don’t talk about it, one, the women who came before us who suffered, I mean, some cases were mutilated, right? These things happen, their stories die, their voices die. What was done to them so that we can advance medicine, we’re not honoring them. Meanwhile, the dude who did this to them, they get statues so that we never forget who they are. That’s messed up, in my opinion.

Dr. Brighten:                      And at the same time, if we don’t talk about this history, if we don’t turn up on the lights on the current issues that we have, then we stand no chance at changing those and actually making things easier for the next generation of women.

Dr. Carrasco:                      Yeah, I hear you. I agree with that. And honestly, that’s why we started Hey Mami, because Christine and I as physicians, as allopathic physicians, who practice functional medicine, we felt like there was not a good source of information when we were pregnant and having our kids. And we were just like, how is it possible that after our third child, we still have so many questions and there’s not a balanced source of information that kind of pulls from science and also can have like a bigger world view. So, that’s why we came to be. Anything you want to add, Christine?

Dr. Maren:                          Yeah. No, I mean, I agree. It’s true. It’s the unfortunate reality. I think that we are seeing with telemedicine and virtual consults, we all do that. And it’s like, I can see patients who live, like way up north in Michigan and otherwise would have to drive literally for hours to come see me.

Dr. Maren:                          And so, these kind of things I think are advancing medicine. But of course, you have to be financially able to do that. Insurance is a mess. I mean, it’s hard. And I think what makes it really hard on physicians to do a good job is the insurance companies. It’s a tricky system.

Dr. Brighten:                      Yeah. Well, and that’s an important thing to highlight as well, too. Because I never want people to misunderstand that I’m trying to be like, doctors are the worst. I hate that rhetoric. I personally … I got to tell you, I really hate when I see someone say, “Your doctor works for you. So, you tell them what to do.” But they’re humans, and humans don’t respond to that super well. Would you seriously go to your mechanic and be like, “You work for me, you do what I say.” He might cut my brakes.

Dr. Brighten:                      They don’t have the ethical oath that we have. That’s the difference I want to highlight there. But nobody gets into medicine without really a deep desire to help people. It’s why doctors go into medicine. And then, I mean, you guys know, the system is really abusive to physician. The system of school, the residency, the insurance system, all of us, we’ve got a lot of problems. And it’s easy to say the solution would be to be like, “Oh, just get the doctors to fix it.” It’s bigger than that. It’s so much bigger than that.

Dr. Brighten:                      And it’s why I love what you guys are doing with Hey Mami because we have to start having conversations that are inclusive and a lot of people think like, yeah, inclusive of race and gender and yes, and inclusive that everybody has the right to choose what’s the best medical intervention for them. And we don’t go around judging them for that.

Dr. Brighten:                      So, it’s something people are always taken back where they’re like, how do you talk about the problems with birth control, but you’re not anti-birth control. And I’m like, because every woman has a right to choose what’s best for her body, and it’s my job to inform her and support her in that decision.

Dr. Brighten:                      And it’s so, so important in the birth aspect, because, my gosh, I feel like things are shifting and changing. But if you’ve got a C-section, people were so judgey. And then if you did it all natural, there’s like this cohort that’s like, what about your honor? You did it all natural, and like-

Dr. Maren:                          There’s like judgment, irrespective of what people do, there’s harsh judgment. That’s why it’s best to just do what’s best for yourself. And the more information that you have and the better educated you are about what your choices are, then the better resonance that will be within you when you make your decision.

Dr. Brighten:                      Absolutely. And that’s why I mean, you guys with Hey Mami, it’s just such a beacon of light in there because it’s like, you might want to dabble in the natural, but then people are like, “Oh, you have to be vegan and barefoot and do all this stuff.” And it’s like, “If that works for you, and then sure.”

Dr. Brighten:                      And then you’re like, well, but I want to have this want to go to a hospital. I want to have a hospital birth and people are like, “Then you better get that epidural because that’s a modern medical intervention. You better do this and da-da-da.” And it’s like, you just get to do you, no money.

Dr. Maren:                          Yes, 100%.

Dr. Brighten:                      Or there’s this other side of it, where you can’t get an epidural. How could you do that? I mean, it’s hard enough.

Dr. Carrasco:                      Yeah. I had a patient recently that was like, well, I want to have a doula, but I might get an epidural. And I was like, “Girl, I had three epidurals and I had doulas at all my births.” And it was amazing. So, you have to do what’s best for you and you can be supported through any of these experiences, any of these breathing experiences.

Dr. Carrasco:                      All right, so Dr. Brighten, let’s jump back into the pill and fertility. Can you share with us the effect the pill has on fertility after coming off of it, because I know that a lot of our listeners are really interested in this info because so many of them have been on the pill, just like I was for a decade before they decided they wanted to have a kid.

Dr. Brighten:                      Well, here’s what we all get told when we get put on the pill. It has absolutely no impact on your future fertility whatsoever. Now, that might be true. If you’re like me and you’re 17, get put on the pill and then you want to come off in less than 10 years and get pregnant.

Dr. Brighten:                      But why is this what women are told? Well, because at this time, we don’t have any great robust studies to show that, yes, the birth control does have an impact on fertility. There is no research out there to say that it has a long-term impact on fertility or put differently, there’s no research to show that hormonal birth control will cause infertility. But the conversation is much more nuanced than that. So, why is it though? Because we all have heard the story of women being no birth control caused me to be infertile.

Dr. Brighten:                      So, I want to explore that because, well, I can sit here and say, there’s no research showing that that’s true. I also want to honor that. There are women telling stories that contradict that. So, you may be an outlier. So, that’s a possibility.

Dr. Brighten:                      But here’s some other possibilities. So, one is, maybe you’re put on birth control for irregular periods. We’re going to regulate your periods or maybe there were some period abnormalities. And so, you’re put on birth control.

Dr. Brighten:                      Maybe that was due to polycystic ovarian syndrome, which is a leading cause of infertility. Maybe it was due to hypothyroidism. Birth control will not fix your hypothyroidism. And yes, hypothyroidism is very common among women and can lead to an ovulatory cycle. So, you don’t ovulate, you don’t get a period, you can’t get pregnant in the future.

Dr. Brighten:                      So, it could also be that you started it for painful periods. Maybe that was endometriosis. And so, while birth control may have been helping, it doesn’t always, but it may have helped you with your painful periods. That doesn’t stop the adhesions. That doesn’t stop the disease progression.

Dr. Brighten:                      So, then by the time that you come off and you want to get pregnant, these diseases have been left on track, maybe it’s 10 years, maybe it’s 20 years of a disease out being allowed to progress. And nobody checking in on you, nobody following up on this, nobody working you up, because you haven’t said the magic words of, “I want to become pregnant” to your doctor. And they’re like, “No, your problems are fixed. You’re on birth control, everything’s fixed.”

Dr. Brighten:                      So, we understand that about 58% of women are starting birth control for symptom management. It’s not actually for pregnancy prevention as the primary reason anymore. So, with that in mind, we have to ask why. If she wants to start birth control, and yes, birth control can help endometriosis. Yes, there are women who end up with endometrial hyperplasia, and it can help with the shedding of the uterine lining.

Dr. Brighten:                      So, doctors will often say to you, “You’re not higher risk of endometrial cancer.” Well, that’s a long way further down in the journey. It’s more like so you don’t have the worst period of your life and all kinds of pain. Birth control can help with symptom management in these conditions. But we are doing a disservice when we don’t ask why and we don’t understand.

Dr. Brighten:                      So, I mean, that’s part of why I do the work I do with birth control is I got fatigued on having to be the doctor who told the gal, oh, she’s like, “I started birth control at 15. Now, she’s coming to me at 32. She’s like, ‘Why can’t I get pregnant? Something’s wrong with me.'”

Dr. Brighten:                      Because actually, what you have is polycystic ovarian syndrome. And at 15, they should have tested you for this. You should have been made aware of this. There’s certain considerations with this because pregnancy can be more difficult. It doesn’t mean you will be infertile. And here we are in your 30s. And I have to be the person to tell you this.

Dr. Brighten:                      Or when the woman is like 37. And I’m like, “We don’t got a lot of time here.” That’s another piece of this. So, why do we use birth control? To delay pregnancy. More and more of us are delaying pregnancy later in life. So, if you’re on hormonal birth control and you come off of it at 38 thinking you’re going to get pregnant at 38, that may not be true for you. It may take three to six months for you to start ovulating again.

Dr. Brighten:                      So, we know with the Depo shot, it can sometimes take up to 18 months to start ovulating regularly. We need to be providing women with this information. Because women don’t always necessarily just go to their doctor first because they’re like, “Oh, I want to get pregnant. Let me go check in with my doctor first.” They usually will just be like, I’m just going to stop the pill, not going to place the patch. I’m going to not put that NuvaRing back in. And then they’re going to try to conceive.

Dr. Brighten:                      Well, they need to know that it can be more difficult for some women to conceive later in life. If we know your mom started perimenopause at 42, maybe she went through menopause at 45, then your fertile window may be much smaller. So, we have to have that conversation.

Dr. Brighten:                      So, does birth control cause infertility? That idea is born out of the fact that birth control was masking an underlying issue that does lead to infertility, that you delayed the coming off of birth control and you delayed pregnancy so long that you were more mature. As we know in medicine, they like to say that we have a geriatric uterus after 35. I really like that. I’ve been hearing this for more than a decade, yet my 39-year-old self still takes offense. I’m still offended.

Dr. Carrasco:                      Feel geriatric.

Dr. Brighten:                      Yeah. So, that’s another piece is that what’s going on with your family history? What’s your genetic makeup? What’s your individualized factors? And when are you delaying? And we’re often told that when we start the pill in early 20s even, hey, when you come off, that you can get pregnant immediately. Maybe.

Dr. Brighten:                      But what gets me about that statement from doctors is they know that the average healthy couple nothing wrong, nothing going on with them, they’re going to take six months to get pregnant. So, why are we telling women, “Oh, you can get pregnant right away.” That’s misinformation that then leads that 37, 38, 39-year-old woman to think like, “Oh, this stuff, I’ll get pregnant right away. No big deal.” And then they come off, they think birth control cause their infertility.

Dr. Brighten:                      Now, one more piece of this is that we do know that hormonal birth control can lead to deficiencies in particular nutrients. And some of these nutrients, as you guys talk a lot on Hey Mami about, they’re very, very important for our fertility. And I mean, we’ve got vitamin C, Vitamin E. We’ve got B vitamins, folate, so, so important. That’s why you should be on a prenatal if you are sexually active with a male, whether you’re on birth control or not, because this is where I always pull out Jeff Goldblum from Jurassic Park, life finds away.

Dr. Brighten:                      And by the time you need that folate, you don’t even know that you’re pregnant. So, baby needs folate. And then you find out you’re pregnant, you’re like, “Dang it, we already needed that.” So, that’s why it’s important to be on a quality prenatal.

Dr. Brighten:                      But CoQ10 is a big one. We know CoQ10 is super crucial antioxidant for a quality. And I mean, we all give it. If somebody’s wanting to get pregnant, we want to make the best eggs possible. We’re like, “Let’s get some CoQ10 up in the mix here.”

Dr. Brighten:                      And then we see reproductive endocrinologist will use this as well. It’s pretty well accepted. Well, birth control can deplete your levels of CoQ10. And as we age, we make less CoQ10. So, that’s where that factor of delaying pregnancy and then the impact of birth control. But we cannot say that by depleting nutrients, birth control cause infertility for you. We can’t say that. We don’t have any research to back it up. And so, I mean, it’s very complicated. With birth control, most everything is like, there’s a correlation, but causation, it’s a lot more difficult to prove all together.

Dr. Brighten:                      So, I think it’s important that we don’t dismiss women who feel like birth control caused their infertility, but we have that very nuanced discussion. And this is why with all my patients, I’m like, “I want you on a prenatal. I want your diet dialed in.” For people wanting to see the type of diet information I recommend, it’s non dogmatic. I don’t do diet dogma. You go to drbrighten.com/hormonekit, and there’s a meal plan and recipe guide. And it’s all about optimizing hormonal health all together.

Dr. Brighten:                      But as you guys know, you’ve got to have that dietary piece dialed in and you’ve got to have the lifestyle dialed in. But when you’re pregnant, you guys get this question where people are like, “What if I just eat really well, can I skip a prenatal?”

Dr. Carrasco:                      Yeah, we get that question sometimes. And it’s like, well, no, take the prenatal please because there’s so many things going on with our food that require a two-hour conversation, but yeah.

Dr. Maren:                          I think we have good studies to really back that up.

Dr. Carrasco:                      Yeah, totally.

Dr. Brighten:                      And also gut health, like how well can we absorb it.

Dr. Maren:                          That’s a lot of factors.

Dr. Brighten:                      But it’s one of those things that when it comes to growing a small human who will become the future of the human race, why risk it, right? And not to put a lot of pressure on you.

Dr. Carrasco:                      Yeah. No, but you said, why risk it?

Dr. Brighten:                      Why risk it?

Dr. Maren:                          I mean, it’s a risk-benefit thing. Anything you do, just think, what are the risks? What are the benefits? There’s a lot of essential benefits there. What are the risks? Pretty low. Okay, seems like a good thing to go forward with.

Dr. Brighten:                      How many leafy greens could you guys eat in the first trimester? I’m just curious.

Dr. Maren:                          Oh my gosh, totally. I know. We talked about that a lot. You really got to stockpile your nutrition [crosstalk 00:39:44].

Dr. Carrasco:                      Stock pile six months beforehand because [crosstalk 00:39:57].

Dr. Brighten:                      Eight weeks along when in my garden … So, I grew a lot of my own food through my pregnancy and I would be out watering and the smell of the romaine lettuce. I didn’t even know romaine lettuce had a smell, but I can smell it and I was like, no. And I was like, I’m going to be drinking green smoothies and I’m going to be satiating this and eating all this. And then the nausea hit, and I was like, “Don’t look at me, food. Don’t look at me”

Dr. Maren:                          Totally, totally, totally.

Dr. Brighten:                      And that’s the crucial formative window. Every trimester is really important, but it’s that first trimester where we’re laying the foundation for every single system in the body. And then mama nature’s like, “And you’re not going to eat.” What is that?

Dr. Carrasco:                      Exactly.

Dr. Maren:                          It’s an interesting thing how that works.

Dr. Brighten:                      Yeah. I mean, people are like, why? Why would mama nature do that? Well, your progesterone is overshooting. Your corpus luteum is like that A type, A++ student who’s like, “I’m going to work super, super hard here. And we’re going to maintain this pregnancy until the placenta can come in and fill in.” And so, yay, corpus luteum, you do good work. But that slowed motility with progesterone and all of the changes that go on physiologically that cause nausea, not a good time.

Dr. Maren:                          Yeah.

Dr. Carrasco:                      Yeah, yeah. So, Christine, do you have any other questions that you want to ask Dr. Brighten?

Dr. Maren:                          I think we’ve covered a lot of it. I just want our listeners to know really, when we talk about CoQ10, tell us about the dose because it’s really high, and I don’t think everybody knows that.

Dr. Brighten:                      Oh, yeah. And then people are like, “Can I just get it from food?” And I’m like, “It’s beef heart.” And why beef heart? Well, and you could probably eat chicken heart, too. I do like beef heart and if you are vegan or vegetarian, just stick your fingers in your ears and say, la la la.

Dr. Brighten:                      But beef heart … It’s okay, I don’t judge you. I was a vegetarian for 10 years. I just saw this doctor putting some stuff out about like, “Everybody should be vegan.” And I’m like, “Everybody should do what’s best for their body and understand that no diet is static for life. And that food can really help you.” And yeah, so that’s my little spiel of [crosstalk 00:42:24].

Dr. Carrasco:                      It won’t hurt you.

Dr. Brighten:                      So, please don’t hate me for what I’m going to say. So, what I like about beef heart is you can actually go to the butcher get grass fed beef heart, it’s really, really cheap. And you can ask them to do a ground of grass fed beef with 25% ground beef heart, even 50%. You can just make it into burgers, meatballs. You won’t even know it’s there. And it can be a source of CoQ10.

Dr. Brighten:                      But for the most part with CoQ10, 100 is really the minimum, but we’re going to see more upwards of 400 milligrams. And I’ve even seen reproductive endocrinologist go even higher with CoQ10, which is the tricky thing because CoQ10 is expensive.

Dr. Brighten:                      And the thing with CoQ10, it’s so many nutrients. I just feel like, okay, so if you’re the person who when you go shopping for a pair of shoes, and you’re like, “Oh, those shoes are so cute. Oh, they’re only seven bucks. Oh, that’s awesome.” You know what you’re going to get. You get what you paid for. You absolutely know it.

Dr. Brighten:                      So, I just bring that out because you know if you actually buy a decent pair of $60 shoes and maybe they are overpriced in that way, it’s possible, but they’re going to last longer, and they’re going to probably be more comfortable. We’d like less blisters. Somebody’s going to comment below this and be like “Uh-uh (negative), I got these flip flops from Target for a $1.99, the best thing ever.” [inaudible 00:43:55].

Dr. Brighten:                      I just tried to use a relatable analogy here guys. But with CoQ10, it’s definitely one of those. And anytime I see supplements and it’s like, “Oh, but this bottle of supplements is $70 and the going rate on this other one, all the other ones are $60.” You’re going to get what you pay for in CoQ10 like a lot of these nutrients.

Dr. Brighten:                      So, I have my own supplement line. And that’s because I had a degree in nutrition and my senior project work was in the supplement industry. And what I learned through that was shocking to me, and I want to take supplements and I want to give my family supplements. I was like I want quality supplements that I’m going to take.

Dr. Brighten:                      And when you go into the supply industry, so sourcing supplements where your nutrients are coming from, third party testing. So, this is something we pay extra for third party testing. That means someone who makes no money off of what I am selling is saying whether what I’m saying on the bottle is true or not. That’s you want to look for GMP, Good Manufacturer Practice. That means the facility is holding themselves to the level of a pharmaceutical company. You want to look for third party testing is going on.

Dr. Brighten:                      And you want to look for a company that you would trust. Read up on it. If you’re going to in a general health food store and you’re finding a CoQ10 that’s super cheap, there’s no way that you can source CoQ10 that you can manufacture it in a way where it stays stable. So, antioxidants are very hard to keep stable. And it’s just impossible to get that price point down on CoQ10.

Dr. Brighten:                      By the way, guys, I don’t sell CoQ10. If you guys are like, go to my website, you’re like, where is the CoQ10? I don’t have any because it’s really, really hard. It’s really, really hard to have a really quality CoQ10. So, the companies who are doing it, when you see that price and you gasp, it’s like, I mean, I feel you on that.

Dr. Brighten:                      And yet at the same time, it’s like you are getting what you paid for. I feel like I spent a long time on that. But it’s just so important to me because patients struggle. And they’re like, “Well, my doctor said take CoQ10.” And they’re on too low of a dose or they’re on just a junk supplement.

Dr. Brighten:                      And now they’ve wasted six months, 12 months of trying to conceive. And in addition to that, all that money, I mean, you guys have seen the consumer reports where these people don’t do third party testing. It’s not even really what they say is in the capsule.

Dr. Brighten:                      I mean, there was that one where they’ve like found in the major box stores that they had house plants in their capsules. And there’s no human studies on these houseplants. I mean that freaks me out, people taking that.

Dr. Maren:                          Yeah. No, we agree, 100%.

Dr. Carrasco:                      We believe it’s definitely a worthy investment. I mean.

Dr. Brighten:                      Yeah.

Dr. Carrasco:                      Yeah.

Dr. Maren:                          Yeah, we have an article on all the things to look for, it’s how to choose the best prenatal multivitamin on heymami.com and it kind of walks you through that. But it’s the same rules apply to CoQ10 and to any other supplement you’re buying, because just buying stuff off the grocery store shelf is usually it could actually do more harm than good. You’ve got to get the pharmaceutical grade options. And so, yeah, there’s that challenge, too. And I mean, the thing is with CoQ10 is you don’t have to take it for your whole entire pregnancy, right?

Dr. Brighten:                      Yeah, so that was I was going to say is like, I was going to say, what dose do you guys advise and how long? I advise at least three months in advance. So, people understand the egg become pregnant with goes through a 90-day maturation window. So, the very minimum, if that’s what you can afford, what you do, that’s the minimum there. Six months would definitely be more ideal in that, but that’s three months before trying to conceive.

Dr. Brighten:                      And then you may have to continue if you don’t get pregnant the first time, if you’re not broken, you’re just a human. But when you understand that you’ve got this window and you’ve got this fertile cervical mucus, it’s actually easier to dial it all in.

Dr. Brighten:                      Yeah, and you don’t have to stay on it long term either. And sometimes it’s also like, kind of how we’re trained as consumers is that sometimes we’re like, “Oh, that CoQ10 is so expensive, that prenatal so expensive.” And then you start looking at the cost of IVF, and that starts to be like, “Okay, hold on.”

Dr. Maren:                          That’s expensive.

Dr. Carrasco:                      Yeah, I mean, I think we can probably all agree that, yes, modern medicine is very useful and can be very efficacious. But it’s really nice to try to do everything possible beforehand to set a strong foundation to try to kind of create the outcome for yourself without having to use a medical intervention. And so, this is setting a healthy foundation for the body.

Dr. Brighten:                      Right. And you’ve heard me say this before about how we have to view mom as the seed and the soil. It’s not just about the best egg, but it’s about where that egg is going to nest and call home and grow. And then it doesn’t stop there. Because once you have this child, your nutrient requirements go up if you’re going to be breastfeeding.

Dr. Brighten:                      By the way, 100% your choice, and yes, we can all talk about what’s best for baby and what’s best, but you know what, it doesn’t always work out the way in the most ideal scenario. Again, this is why you all want to hang out with Hey Mami so that you don’t feel judged in anything that’s going on.

Dr. Brighten:                      But that’s why it’s so important the work that you guys do. Because once we have baby, it’s like we get a six-month checkup. Everybody’s like, “Oh, you’re fine. You can have sex. You can go exercise, la la la.” And you’re like, “But I ain’t fine.” Did I say six months? I meant six weeks, if I said six months. Six-week checkup to get checked up in six weeks, then you’re sent on your way. And then everything focuses and centers around baby from there on out.

Dr. Brighten:                      Yes, that’s important. But you know what else is really important? The primary caretaker and the person who grew that small human. Their health is very, very important. And there’s so much more. I mean, this is why I wrote my first book on postpartum health.

Dr. Brighten:                      By the way, you guys should have a book on postpartum health. I want to read your book on postpartum health. Because I was like, “Wait a minute. I just had a baby. There are all these books about pregnancy. And most of them are worthless because they’re just like these flowery pretty stories.” Okay, so my A type factfinder is showing here. I need the facts. I need some help.

Dr. Maren:                          I made the info.

Dr. Brighten:                      Yeah. And I’m like, no, there was like one that, I love postpartum hormones, and it’s an author that I’ve recommended her book that it works really well for some people. Everybody loves her. But I was like, I never want her books in my life. Get them out of my house. And it was just really because like, her books are just all about like, “You can do it, natural childbirth.” And they are really, women do need that story. I just was like, I just need someone to get to the point because something ain’t right with my body and why.

Dr. Brighten:                      And it wasn’t like, “Oh, I have cracked nipples. Oh, my vagina hurts.” Although I cover all of that in my book. It was like, “Why am I so fricking fatigued? Why is it like I have such bad brain fog? What’s going on with my anxiety?”

Dr. Brighten:                      And all the things that put and medicine says, postpartum six weeks. Postpartum is like a year. You grew human for 10 months, give me a break. You’re going to have to recover your body after that.

Dr. Brighten:                      And as it turned out, I developed postpartum thyroiditis. And then when I got and I found a study that was like one in 12 women worldwide develop this. And I was like, “Shut up. Nobody taught me about this.” We didn’t learn about this in medical school as a thing we should be screening women with.

Dr. Brighten:                      But I developed autoimmunities, the results of giving birth and all my doctors were just telling me, “You’re a new mom, of course, you’re tired.” “Oh, it’s your hormones. That’s why you’re anxious.” “Oh, you’re just probably worrying too much.” “Oh, you’re gaining all this weight, it’s because you’re lazy. You’re just not taking care of your health because you’re taking care of your child.”

Dr. Brighten:                      And we’ve all heard these things. We’ve all heard these things said by doctors. And I struggled and I didn’t get the help I needed. And in reality, when I started opening up, when I start opening up about that, when I opened up about my subsequent miscarriage because once I got my thyroid hormone right, then I got pregnant. Oh, that’s the thing too. And then, I miscarried because the doctor I was under was mismanaging my thyroid.

Dr. Brighten:                      And so, through all of that, as I started to open up about it, so many women had those stories, too, which is why like, this podcast is so important. Hey Mami is so important.

Dr. Brighten:                      But for every woman listening right now to share your story and your journey is so important, because whether it is with trying not to get pregnant because you’re on birth control or trying to get pregnant, infertility struggles, miscarriage, the whole gamut, you never know who is going to heal when they hear your story, and you never know whose life is going to be forever changed.

Dr. Brighten:                      But you also don’t realize that talking about it and having that freedom is so healing. It wasn’t until I started talking about my miscarriage. And yeah, I talked to a counselor, but it wasn’t the same as when I started sharing it with other women that, wow, I’m actually moving through a lot of stuff I didn’t realize was still there.

Dr. Carrasco:                      Mm-hmm (affirmative). Yeah.

Dr. Brighten:                      That’s crazy.

Dr. Maren:                          Yeah. Well, Dr. Brighten, this has been just such a wonderful interview and a huge wealth of information. We’re so thankful that you came on the show. And if you could share with our audience where they can find you, and where they can get your books, that would be wonderful.

Dr. Brighten:                      Yeah, well, you can find me at drbrighten.com, D-R-B-R-I-G-H-T-E-N dot com. That’s my main hub. And you can find both my books, Beyond the Pill, which is a woman’s hormone guide, and Healing Your Body Naturally After Childbirth. Those are both on my website, but you can also find them on Amazon, libraries, local booksellers.

Dr. Brighten:                      And then you can also find me on Instagram. I’m always educating there as well. That’s like the bite size piece of the deeper dive that happens on drbrighten.com. And then I love to play on TikTok as well. I do love it. It’s really fun. I have a really fun time.

Dr. Brighten:                      And then, yeah, I know we all learn differently. So, you also find videos on YouTube as well that you can check out. And if you are wanting to get started on any of these things that we talked about today, you can go to drbrighten.com/hormonekit and it talks about how to improve your fertility, boost your progesterone. And you’ll also get that meal plan and recipe guide I talked about.

Dr. Carrasco:                      Thank you so, so much. Christine, do you want to add anything else?

Dr. Maren:                          No, just I love you and thanks for being a great friend. And thanks for coming on the show. We love what you do. So, I know our listeners probably do as well.

Dr. Brighten:                      Oh, I love you guys, too. I’m so glad we got to have this conversation. I’m so glad that I found you in this way.

Dr. Maren:                          Basically, if you’re still listening, you basically just listened to us talk on the phone for an hour. These are the kinds of conversations we have.

Male fertility issues contribute to about 50% of all infertility cases. So knowing how to support fertility and better sperm health is important for healthy conception.

Our guest today is Geo Espinoza, ND, a naturopathic functional medicine doctor who is recognized as an authority in urology and men’s health.

Alejandra Carrasco M.D. and Christine Maren D.O.

Hello! We are Alejandra Carrasco M.D. and Christine Maren D.O. We founded Hey Mami because we felt a lack of support for fellow mamis. As physicians, we see women every day who struggle with fertility, are forgotten about postpartum, and have put their health on hold for years while they raise a family. We’re here to change that.

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