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We spend a lot of time talking about fertility on this podcast, but today's conversation goes beyond conception.
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Because ovulation isn't just about getting pregnant.
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It is, however, one of the most important hormonal events in a woman's body month after month for decades.
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And when it's missing, whether because of a medical condition, a lifestyle pattern, or suppressive medications, the consequences can build up quietly throughout your entire body, oftentimes long before anyone notices that a change is being made.
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Today, I'm going to be making the case that ovulation is not optional but necessary for overall long-term health.
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I'm Dr.
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Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their wellbeing through personalized healthcare grounded in clinical excellence.
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So let's get started today with a story about a patient that I'll call Charlotte.
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Now, Charlotte had started on birth control pills at age 17 for irregular cycles.
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She stayed on them until she was 28 years old, and when she came off, she was trying to conceive.
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Unfortunately, Charlotte had spent the last two years trying to get pregnant, but this was going to be near impossible, as she didn't have a return of her cycles after stopping birth control pills.
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During her history, she mentioned to me that she had had a bone density scan done previously by her primary care provider that revealed she had thinning of the bones, or osteopenia.
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In fact, her bone loss was equivalent to what we would normally expect to see in a 50 or f- 60-year-old woman.
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This was the thing that brought her to our clinic.
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She was so concerned about the bone density loss.
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She had assumed that taking birth control was neutral or even protective, and she had no idea why her cycles hadn't restarted again.
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This was the turning point she needed to start asking additional questions, and she came to us not just looking for the fertility answers, but also looking for reasons why she wasn't ovulating, that her cycles hadn't returned, and more importantly, if her bone health had something to do with her hormones.
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We started off, as always, with getting her to chart her cycles.
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Now, unfortunately, she didn't have any menstrual bleed that was happening, but there was still a lot of data that can be gained just by starting to track her symptoms and looking to see if she had any ovulatory patterns.
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We were able to confirm that she hadn't had a cycle and likely had not been ovulating for at least 22 months after stopping her birth control pills.
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Her bone density showed a Z-score of negative 1.8, and again, this is showing some bone density loss, not necessarily osteoporosis, but bone thinning, which is not to be expected of somebody who is about 30 years of age.
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We also completed some lab work, which showed low testosterone and DHEA, confirming that she likely had some adrenal dysfunction, and we did a cholesterol panel that showed that her LDL, which is part of her bad cholesterol, was elevated, while her HDL, which was part of the good, protective cholesterol, was actually low, and this is a pretty common pattern that we see in women that have years without ovulation.
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Most importantly, we diagnosed PCOS, and this was through anovulation as well as an ultrasound that showed that she had enlarged ovaries.
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This was likely the underlying reason why Charlotte had had irregular cycles in the first place when she was a teenager.
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But since she went on birth control, this underlying problem was actually covered up and masked for over a decade while she was on birth control pills.
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When it came to treatment, we started off with the focus of restoring everything, not just her menstrual cycle, but ovulation, progesterone, bone support, metabolic care, adrenal support, and most importantly, honest education about what she deserved to have been told years earlier but never had that conversation.
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After two months on treatment with our clinic, her cycles returned, but it took another three months before she started to ovulate again.
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Charlotte is still under care in order to try and help make sure that she continues to consistently ovulate, and soon we will be starting on some medications to help improve her fertility.
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But I mention this to say that it is not always a quick fix.
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Many women assume that after they come off of birth control, that their cycles will return regularly.
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And for many women, that is the case.
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But there are a large percentage of women as well that struggle to get their ovulation back and their cycles, and this can be the case for many women over the years.
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And here's the big picture.
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Ovulation is not just a fertility event.
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It is the primary hormone event of the entire female cycle.
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Without it, progesterone is absent, and that cascade of downstream consequences also follows.
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Unfortunately, anovulation is much more common than most women realize.
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In fact, it accounts for anywhere from 25 to 40% of all female infertility cases, depending upon the study you look at.
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And those subclinical ovulatory disturbances are estimated to occur in another 25% of all menstrual cycles.
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This means that a woman might be ovulating, but it may be a suboptimal ovulation, meaning poor quality, small follicle, or even poor hormone levels.
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This all can happen even if you have apparently normal-looking periods.
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Now, there are two major causes of anovulation that happens long term.
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The first is going to be what we call iatrogenic, and this means something that is caused by medical care.
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Most commonly, this is going to be from some sort of hormonal contraception that is suppressing ovulation by design.
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That is one of the ways that the birth control pill works, for example, is to suppress or block ovulation from happening altogether.
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So that is a common, oftentimes obvious cause of chronic anovulation.
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The other major category would be things that are medical in nature.
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So oftentimes these can cause some dysfunction or some irregular cycles from the start, and if you don't understand why those ovulation events are not happening in the first place, oftentimes those symptoms can get masked by being put on birth control or other things that can cover up those other symptoms.
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So as was the case with Charlotte today, she had PCOS, or now called PMOS.
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That is a very common reason for anovulation, and probably one of the most common that we see in our practice.
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Other causes that are medical in nature can include dysfunction of your hypothalamus.
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Again, most commonly this is going to be caused from I'm not eating enough food, I'm exercising too much, things that can cause that hypothalamic pituitary axis to shut down and not send the signals in the first place that ovulation is supposed to happen.
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And other categories that can cause anovulation would also be thyroid dysfunction or elevated prolactin, and that can be from lots of different reasons.
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But it's important to understand why you're not ovulating if that is the case, because once you understand the why, it helps to make the treatment so much more clear and obvious moving forward.
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Now, importantly, many women will still have a period even if they're not ovulating.
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So this is called an anovulatory bleed or a withdrawal bleed, and it is not the same physiologically as an ovulatory menstrual cycle, meaning it does not produce the same hormone cascade, primarily progesterone, and therefore it can't deliver the same health benefits.
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So women that come in and say,"Well, I'm having a period.
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My cycles must be normal and my hormones are normal," this is not always necessarily the case, and this is why we always wanna make sure that ovulation is actually happening.
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Other women are told,"Well, because you're taking the pill, that's going to regulate your hormones." And the reality is that while a pill can cause a withdrawal bleed to happen, it does not improve your hormone levels.
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In fact, in most cases, it will actually suppress that hypothalamic pituitary ovarian axis, which means it's not regulating the hormones.
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It's just replacing the cycle with synthetic or artificial hormones.
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This does not lead to a functional corpus luteum or ovulation event or natural progesterone production, which is so important for all of the other health benefits that we discussed just a couple weeks ago in episode number 158 where I talk about the important role of progesterone in our system So what is actually happening with ovulation?
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Primarily progesterone.
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So progesterone is triggered to be released from the system when the corpus luteum forms.
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So ovulation occurs, that egg is released from the follicle or the shell, that shell becomes your corpus luteum, and that's what produces progesterone.
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No ovulation, no progesterone, and every downstream impact of progesterone requires this monthly event to happen, whether that's building bones, whether that's brain health, whether that's protecting the uterine wall lining or supporting the thyroid.
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All of these rely on that progesterone to happen.
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We also know that testosterone rises around the ovulation time, around the midpoint of your cycle, and this can help add to increasing libido, energy, motivation, building of your protein synthesis in your muscles.
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All of these are really important to have with that testosterone surge, which also oftentimes is going to be triggered by that ovulation event.
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We also know that an estrogen surge is released around the time that the LH surge happens, and this triggers ovulation because we have that preceding estrogen surge.
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Now, this is very different than just having a chronic state of estrogen if you're not ovulating or even from having synthetic estrogen that you can get through birth control pills or other contraceptives.
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This incredibly delicate balance of estrogen and LH and testosterone and progesterone all takes place each month, and if we collapse all of that with not ovulating, all of the rest of the hormones can fall into a state of disarray, causing lots of the other cycle symptoms that we would see if you're not ovulating.
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So we're gonna spend just a little bit of time talking about the different systems that are impacted if you're not ovulating, as well as ways to help improve that or ways to get around that.
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So the first one that I wanna mention is bone health, and we talked about this a little bit in Charlotte's case, is that we need that progesterone in order to stimulate osteoblasts, and these are cells that build new bone separate from estrogen itself.
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So in Charlotte's case, because she was not ovulating for so many years, she never had that actual bioidentical progesterone that was firing, and so she did not have the benefits of having the progesterone on board to help with that new bone growth development Years of it not ovulating, whether it's from the birth control pill or PCOS or hypothalamic amenorrhea, all of these increase your risk for problems with bone mineral density in some populations.
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I specifically wanna call out here Depo-Provera.
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That's the birth control injection, and this is associated with significant bone density loss, especially in long-term use in adolescents and young adults who are still working to build their peak bone mass.
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Now, this is something that is listed on the side effect profile of this medication, but unfortunately, most young women never see the full package insert because these injections are delivered directly at their doctor's office.
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So it's really important to make sure that you understand all of the potential side effects and the long-term impacts of these medications because some doctors are not great about explaining all of those risks.
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And unfortunately, some of those risks are underscored or kind of glossed over.
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Things that you may not have understood when you started on them as a teenager may have been explained to your parents, but maybe isn't something that you realize long-term what those risks are.
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Something else that makes a difference is going to be your cardiovascular health, and this is going to include not only your heart health, but the rest of your vascular system, so your blood vessels, your brain health, all of those pieces.
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And specifically looking at progesterone that's produced at ovulation, this is going to be associated with having better cholesterol profiles.
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So in general, women who are not ovulating regularly will typically have more problems with their cholesterol, and longer term, this can lead to increased inflammation as well as increased heart disease.
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The most commonly studied model is going to be women with PCOS, and they are chronically not ovulating, and they have measurably higher rates of cholesterol troubles, insulin resistance, and cardiovascular disease, and this is independent of their weight or BMI, which is really important to note.
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The cardioprotective effect of having natural cycles extends throughout the menopause transition, and women who have experienced years of anovulation before menopause show up at menopause already with that baseline higher risk.
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We know that many women will go through significant changes after menopause with increased cardiovascular risk.
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But if we add onto that the fact that they already came to menopause having increased risk, that increases their problems even further.
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Additionally, the synthetic estrogen that's present in many of the combined oral contraceptive pills is associated with an increased risk of blood clots, stroke, and heart attack, specifically in women with other risk factors like smoking history or being overweight or not ever having been pregnant.
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This is not equivalent to the cardiovascular effects that we would see in women that are naturally cycling, and this is why it's so important to call this out because we want to make sure that you have an understanding of not only what is happening with my birth control pill currently, but what are the potential long-term impacts that came from starting it and that come from staying on it long term?
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We also talk about the impact of your brain health and your mood.
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And again, a lot of this goes back to those GABA receptors.
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So progesterone is converted to allopregnanolone in the brain.
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And again, we talked about this quite a bit in episode 158 just a few weeks back.
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But if we don't have progesterone that is happening naturally or being secreted by that corpus luteum, we don't have that monthly production of allopregnanolone.
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So we don't have those neuroprotective effects.
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We don't have the, you know, impact of decreasing anxiety because we're not having that an- that ovulation event that happens.
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Women with chronic anovulation and women on hormonal birth control report higher rates of anxiety, depression, mood instability, and PMS.
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And so it's important to note that those synthetic progesterones that you may be receiving in oral contraceptives do not convert to allopregnanolone.
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And in some cases, they antagonize progesterone receptors and actually worsen mood symptoms.
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Long-term impacts on neuroprotective role of ovulatory cycling and progesterone is an area of active research.
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But early hormone therapy timing suggests that the brain benefits from progesterone, and this may depend on a history of cyclical exposure.
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So it's not like we can just make it up long-term by starting to give you progesterone once you hit menopause.
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Long-term studies are showing that the impacts of having regularly cycling progesterone in your body do make a difference even going into menopause, and that's what makes all the difference.
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Finally, just a note on endometrial health.
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So that lining of your uterine wall, otherwise known as your endometrium, is stimulated by estrogen.
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It increases cell proliferation.
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And when you have progesterone that comes on board, it's produced at the time of ovulation.
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This opposes that proliferation or the thickening of the wall, and it helps to mature the lining in preparation for implantation or shedding of a menstrual cycle.
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Without having ovulation, that estrogen is just running unopposed month after month after month.
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And oftentimes, especially if you're not having a withdrawal bleed, that can create an increased thickness of that uterine wall lining that never receives the progesterone signal to mature and fully shed.
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This can lead to long-term cases of endometrial hyperplasia or abnormal cells.
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This is an abnormal overgrowth of the uterine wall lining, and most importantly, it is a known risk factor for uterine cancer.
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This is most studied in PCOS, but it applies to any cause of chronic anovulation because of the mechanism, which is that the uterine wall lining does not shed or it is unopposed by that estrogen.
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Now, women who are on combined hormonal contraceptives, which means that they have both synthetic estrogen and progestin, this does kind of help to impact and protect the endometrium from that unopposed estrogen.
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But it is still a different type of protection than what you would get from natural progesterone-driven cycles, and it does not deliver the same whole body effects, notably through that brain and bone and cardiovascular health So when you would stop hormonal birth control, any underlying anovulatory condition returns, and that endometrial risk associated with it that was suppressed is not actually being treated.
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So this is important because we know that even if your period comes every month, we don't always have ovulation happening.
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Now, let's say for example, maybe you're not on birth control, but you're still not ovulating every month.
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How would you actually know the difference?
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Unfortunately, you can't know from a calendar.
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Anovulatory cycles can produce bleeding from estrogen withdrawal that looks like a period but is not preceded by any hormonal event that makes a cycle truly ovulatory.
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So it's why we talk about all the time on this podcast why it's so important to be tracking your cycles.
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We can see ovulation occur when we see cervical mucus changes, basal body temperature shifts, sometimes an LH surge, and most importantly, confirming that with ovulatory labs that are done after the time of ovulation to confirm that progesterone actually is rising.
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These are the things that you can do to actually confirm whether ovulation has occurred.
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If we are still stuck or still confused as to whether it's happening or not, that's oftentimes where we'll involve an ultrasound so that we can assess for ovulation happening.
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Now, what if I've been on the pill long term and I'm not ready for pregnancy?
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Is this really a big deal?
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I'm having a withdrawal bleed.
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All of this is happening.
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Why does it even matter?
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Now, the concern is not whether or not birth control is effective at managing your symptoms.
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It's that most women are never given the information to understand what years of suppressed ovulation actually means for your body.
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Informed consent means understanding the full picture and getting all of your questions answered and giving you the information about what long-term studies show when it comes to any sort of hormone therapy.
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Now, if you choose to still be on oral contraceptives and you understand all of the risks, that's valid.
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But if you'd like to explore alternatives that don't suppress ovulation, that's why we are here.
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That's why we're having this conversation today.
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And many women are frustrated because by the time they come to see us, they've been on birth control pills for years, sometimes decades.
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Unfortunately, some of those consequences cannot be modified depending upon how long you've been on some of these hormones.
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Specifically, bone density is really challenging to reverse.
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However, it is still possible to reverse the changes of bone density, cardiovascular health, metabolic health, and brain health even after years of being on birth control when we can get your cycles back on track, get you ovulating regularly, and get that natural progesterone firing again so it can produce the hormonal impacts that it needs to.
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One of the most prevalent examples is women who have PCOS, or now called PMOS, and they know that they don't ovulate regularly for years.
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And so many of them have been told,"Well, just go on birth control.
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It will get your cycles back on track, and that will help prevent any long-term damage." Unfortunately, this isn't the whole story, and I would stress the importance of working with a healthcare team that will evaluate the root cause of your anovulation and will track whether ovulation is being restored over time, not just whether or not your period shows up.
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For example, insulin resistance drives the majority of these cases of anovulation in women with PCOS or PMOS, and it is very treatable with dietary changes, supplements, and sometimes prescription-strength medications.
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Restoring ovulation in PCOS is possible for many women, and the health benefits extend well beyond fertility when it comes to looking at your long-term health.
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Imagine if every young woman who was prescribed hormonal contraception was told clearly and honestly that it suppresses ovulation and what that means long-term for your health.
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Imagine if instead, anovulation was treated as the health finding it is, and more importantly, restoring ovulation was understood as a health goal, not just a fertility goal.
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Women can arrive in their 40s and 50s having protected their hormonal systems through their most reproductively active years rather than discovering in retrospect what years on birth control or chronic anovulation had cost them.
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Ovulation is not optional.
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It is one of the most important things that the female body does month after month, year after year to keep itself healthy.
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And that is exactly why we work so hard to improve your cycles and to help you identify ovulation to improve your health for the long run.
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If you're ready to work with our elite team of healthcare professionals, go to our website radiantclinic.com to schedule a free discovery call and learn more about our package-based pricing for comprehensive care.
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We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in many different states across the US.
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Check out our website for current states that we can serve medical clients, and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach.
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Please note that our fertility educators are able to take care of clients no matter where they live.
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Thank you so much for listening to this episode.
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Please share this podcast with someone in your life who would benefit from our services.
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Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom
00:00:01.981 --> 00:00:09.080
We spend a lot of time talking about fertility on this podcast, but today's conversation goes beyond conception.
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Because ovulation isn't just about getting pregnant.
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It is, however, one of the most important hormonal events in a woman's body month after month for decades.
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And when it's missing, whether because of a medical condition, a lifestyle pattern, or suppressive medications, the consequences can build up quietly throughout your entire body, oftentimes long before anyone notices that a change is being made.
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Today, I'm going to be making the case that ovulation is not optional but necessary for overall long-term health.
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I'm Dr.
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Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their wellbeing through personalized healthcare grounded in clinical excellence.
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So let's get started today with a story about a patient that I'll call Charlotte.
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Now, Charlotte had started on birth control pills at age 17 for irregular cycles.
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She stayed on them until she was 28 years old, and when she came off, she was trying to conceive.
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Unfortunately, Charlotte had spent the last two years trying to get pregnant, but this was going to be near impossible, as she didn't have a return of her cycles after stopping birth control pills.
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During her history, she mentioned to me that she had had a bone density scan done previously by her primary care provider that revealed she had thinning of the bones, or osteopenia.
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In fact, her bone loss was equivalent to what we would normally expect to see in a 50 or f- 60-year-old woman.
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This was the thing that brought her to our clinic.
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She was so concerned about the bone density loss.
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She had assumed that taking birth control was neutral or even protective, and she had no idea why her cycles hadn't restarted again.
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This was the turning point she needed to start asking additional questions, and she came to us not just looking for the fertility answers, but also looking for reasons why she wasn't ovulating, that her cycles hadn't returned, and more importantly, if her bone health had something to do with her hormones.
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We started off, as always, with getting her to chart her cycles.
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Now, unfortunately, she didn't have any menstrual bleed that was happening, but there was still a lot of data that can be gained just by starting to track her symptoms and looking to see if she had any ovulatory patterns.
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We were able to confirm that she hadn't had a cycle and likely had not been ovulating for at least 22 months after stopping her birth control pills.
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Her bone density showed a Z-score of negative 1.8, and again, this is showing some bone density loss, not necessarily osteoporosis, but bone thinning, which is not to be expected of somebody who is about 30 years of age.
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We also completed some lab work, which showed low testosterone and DHEA, confirming that she likely had some adrenal dysfunction, and we did a cholesterol panel that showed that her LDL, which is part of her bad cholesterol, was elevated, while her HDL, which was part of the good, protective cholesterol, was actually low, and this is a pretty common pattern that we see in women that have years without ovulation.
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Most importantly, we diagnosed PCOS, and this was through anovulation as well as an ultrasound that showed that she had enlarged ovaries.
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This was likely the underlying reason why Charlotte had had irregular cycles in the first place when she was a teenager.
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But since she went on birth control, this underlying problem was actually covered up and masked for over a decade while she was on birth control pills.
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When it came to treatment, we started off with the focus of restoring everything, not just her menstrual cycle, but ovulation, progesterone, bone support, metabolic care, adrenal support, and most importantly, honest education about what she deserved to have been told years earlier but never had that conversation.
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After two months on treatment with our clinic, her cycles returned, but it took another three months before she started to ovulate again.
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Charlotte is still under care in order to try and help make sure that she continues to consistently ovulate, and soon we will be starting on some medications to help improve her fertility.
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But I mention this to say that it is not always a quick fix.
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Many women assume that after they come off of birth control, that their cycles will return regularly.
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And for many women, that is the case.
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But there are a large percentage of women as well that struggle to get their ovulation back and their cycles, and this can be the case for many women over the years.
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And here's the big picture.
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Ovulation is not just a fertility event.
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It is the primary hormone event of the entire female cycle.
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Without it, progesterone is absent, and that cascade of downstream consequences also follows.
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Unfortunately, anovulation is much more common than most women realize.
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In fact, it accounts for anywhere from 25 to 40% of all female infertility cases, depending upon the study you look at.
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And those subclinical ovulatory disturbances are estimated to occur in another 25% of all menstrual cycles.
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This means that a woman might be ovulating, but it may be a suboptimal ovulation, meaning poor quality, small follicle, or even poor hormone levels.
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This all can happen even if you have apparently normal-looking periods.
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Now, there are two major causes of anovulation that happens long term.
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The first is going to be what we call iatrogenic, and this means something that is caused by medical care.
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Most commonly, this is going to be from some sort of hormonal contraception that is suppressing ovulation by design.
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That is one of the ways that the birth control pill works, for example, is to suppress or block ovulation from happening altogether.
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So that is a common, oftentimes obvious cause of chronic anovulation.
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The other major category would be things that are medical in nature.
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So oftentimes these can cause some dysfunction or some irregular cycles from the start, and if you don't understand why those ovulation events are not happening in the first place, oftentimes those symptoms can get masked by being put on birth control or other things that can cover up those other symptoms.
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So as was the case with Charlotte today, she had PCOS, or now called PMOS.
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That is a very common reason for anovulation, and probably one of the most common that we see in our practice.
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Other causes that are medical in nature can include dysfunction of your hypothalamus.
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Again, most commonly this is going to be caused from I'm not eating enough food, I'm exercising too much, things that can cause that hypothalamic pituitary axis to shut down and not send the signals in the first place that ovulation is supposed to happen.
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And other categories that can cause anovulation would also be thyroid dysfunction or elevated prolactin, and that can be from lots of different reasons.
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But it's important to understand why you're not ovulating if that is the case, because once you understand the why, it helps to make the treatment so much more clear and obvious moving forward.
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Now, importantly, many women will still have a period even if they're not ovulating.
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So this is called an anovulatory bleed or a withdrawal bleed, and it is not the same physiologically as an ovulatory menstrual cycle, meaning it does not produce the same hormone cascade, primarily progesterone, and therefore it can't deliver the same health benefits.
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So women that come in and say,"Well, I'm having a period.
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My cycles must be normal and my hormones are normal," this is not always necessarily the case, and this is why we always wanna make sure that ovulation is actually happening.
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Other women are told,"Well, because you're taking the pill, that's going to regulate your hormones." And the reality is that while a pill can cause a withdrawal bleed to happen, it does not improve your hormone levels.
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In fact, in most cases, it will actually suppress that hypothalamic pituitary ovarian axis, which means it's not regulating the hormones.
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It's just replacing the cycle with synthetic or artificial hormones.
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This does not lead to a functional corpus luteum or ovulation event or natural progesterone production, which is so important for all of the other health benefits that we discussed just a couple weeks ago in episode number 158 where I talk about the important role of progesterone in our system So what is actually happening with ovulation?
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Primarily progesterone.
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So progesterone is triggered to be released from the system when the corpus luteum forms.
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So ovulation occurs, that egg is released from the follicle or the shell, that shell becomes your corpus luteum, and that's what produces progesterone.
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No ovulation, no progesterone, and every downstream impact of progesterone requires this monthly event to happen, whether that's building bones, whether that's brain health, whether that's protecting the uterine wall lining or supporting the thyroid.
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All of these rely on that progesterone to happen.
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We also know that testosterone rises around the ovulation time, around the midpoint of your cycle, and this can help add to increasing libido, energy, motivation, building of your protein synthesis in your muscles.
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All of these are really important to have with that testosterone surge, which also oftentimes is going to be triggered by that ovulation event.
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We also know that an estrogen surge is released around the time that the LH surge happens, and this triggers ovulation because we have that preceding estrogen surge.
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Now, this is very different than just having a chronic state of estrogen if you're not ovulating or even from having synthetic estrogen that you can get through birth control pills or other contraceptives.
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This incredibly delicate balance of estrogen and LH and testosterone and progesterone all takes place each month, and if we collapse all of that with not ovulating, all of the rest of the hormones can fall into a state of disarray, causing lots of the other cycle symptoms that we would see if you're not ovulating.
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So we're gonna spend just a little bit of time talking about the different systems that are impacted if you're not ovulating, as well as ways to help improve that or ways to get around that.
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So the first one that I wanna mention is bone health, and we talked about this a little bit in Charlotte's case, is that we need that progesterone in order to stimulate osteoblasts, and these are cells that build new bone separate from estrogen itself.
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So in Charlotte's case, because she was not ovulating for so many years, she never had that actual bioidentical progesterone that was firing, and so she did not have the benefits of having the progesterone on board to help with that new bone growth development Years of it not ovulating, whether it's from the birth control pill or PCOS or hypothalamic amenorrhea, all of these increase your risk for problems with bone mineral density in some populations.
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I specifically wanna call out here Depo-Provera.
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That's the birth control injection, and this is associated with significant bone density loss, especially in long-term use in adolescents and young adults who are still working to build their peak bone mass.
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Now, this is something that is listed on the side effect profile of this medication, but unfortunately, most young women never see the full package insert because these injections are delivered directly at their doctor's office.
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So it's really important to make sure that you understand all of the potential side effects and the long-term impacts of these medications because some doctors are not great about explaining all of those risks.
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And unfortunately, some of those risks are underscored or kind of glossed over.
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Things that you may not have understood when you started on them as a teenager may have been explained to your parents, but maybe isn't something that you realize long-term what those risks are.
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Something else that makes a difference is going to be your cardiovascular health, and this is going to include not only your heart health, but the rest of your vascular system, so your blood vessels, your brain health, all of those pieces.
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And specifically looking at progesterone that's produced at ovulation, this is going to be associated with having better cholesterol profiles.
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So in general, women who are not ovulating regularly will typically have more problems with their cholesterol, and longer term, this can lead to increased inflammation as well as increased heart disease.
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The most commonly studied model is going to be women with PCOS, and they are chronically not ovulating, and they have measurably higher rates of cholesterol troubles, insulin resistance, and cardiovascular disease, and this is independent of their weight or BMI, which is really important to note.
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The cardioprotective effect of having natural cycles extends throughout the menopause transition, and women who have experienced years of anovulation before menopause show up at menopause already with that baseline higher risk.
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We know that many women will go through significant changes after menopause with increased cardiovascular risk.
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But if we add onto that the fact that they already came to menopause having increased risk, that increases their problems even further.
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Additionally, the synthetic estrogen that's present in many of the combined oral contraceptive pills is associated with an increased risk of blood clots, stroke, and heart attack, specifically in women with other risk factors like smoking history or being overweight or not ever having been pregnant.
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This is not equivalent to the cardiovascular effects that we would see in women that are naturally cycling, and this is why it's so important to call this out because we want to make sure that you have an understanding of not only what is happening with my birth control pill currently, but what are the potential long-term impacts that came from starting it and that come from staying on it long term?
00:14:37.316 --> 00:14:41.635
We also talk about the impact of your brain health and your mood.
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And again, a lot of this goes back to those GABA receptors.
00:14:45.285 --> 00:14:49.145
So progesterone is converted to allopregnanolone in the brain.
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And again, we talked about this quite a bit in episode 158 just a few weeks back.
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But if we don't have progesterone that is happening naturally or being secreted by that corpus luteum, we don't have that monthly production of allopregnanolone.
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So we don't have those neuroprotective effects.
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We don't have the, you know, impact of decreasing anxiety because we're not having that an- that ovulation event that happens.
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Women with chronic anovulation and women on hormonal birth control report higher rates of anxiety, depression, mood instability, and PMS.
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And so it's important to note that those synthetic progesterones that you may be receiving in oral contraceptives do not convert to allopregnanolone.
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And in some cases, they antagonize progesterone receptors and actually worsen mood symptoms.
00:15:38.658 --> 00:15:46.028
Long-term impacts on neuroprotective role of ovulatory cycling and progesterone is an area of active research.
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But early hormone therapy timing suggests that the brain benefits from progesterone, and this may depend on a history of cyclical exposure.
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So it's not like we can just make it up long-term by starting to give you progesterone once you hit menopause.
00:16:01.648 --> 00:16:12.837
Long-term studies are showing that the impacts of having regularly cycling progesterone in your body do make a difference even going into menopause, and that's what makes all the difference.
00:16:13.837 --> 00:16:16.857
Finally, just a note on endometrial health.
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So that lining of your uterine wall, otherwise known as your endometrium, is stimulated by estrogen.
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It increases cell proliferation.
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And when you have progesterone that comes on board, it's produced at the time of ovulation.
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This opposes that proliferation or the thickening of the wall, and it helps to mature the lining in preparation for implantation or shedding of a menstrual cycle.
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Without having ovulation, that estrogen is just running unopposed month after month after month.
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And oftentimes, especially if you're not having a withdrawal bleed, that can create an increased thickness of that uterine wall lining that never receives the progesterone signal to mature and fully shed.
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This can lead to long-term cases of endometrial hyperplasia or abnormal cells.
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This is an abnormal overgrowth of the uterine wall lining, and most importantly, it is a known risk factor for uterine cancer.
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This is most studied in PCOS, but it applies to any cause of chronic anovulation because of the mechanism, which is that the uterine wall lining does not shed or it is unopposed by that estrogen.
00:17:28.468 --> 00:17:41.488
Now, women who are on combined hormonal contraceptives, which means that they have both synthetic estrogen and progestin, this does kind of help to impact and protect the endometrium from that unopposed estrogen.
00:17:41.867 --> 00:18:07.617
But it is still a different type of protection than what you would get from natural progesterone-driven cycles, and it does not deliver the same whole body effects, notably through that brain and bone and cardiovascular health So when you would stop hormonal birth control, any underlying anovulatory condition returns, and that endometrial risk associated with it that was suppressed is not actually being treated.
00:18:08.198 --> 00:18:15.617
So this is important because we know that even if your period comes every month, we don't always have ovulation happening.
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Now, let's say for example, maybe you're not on birth control, but you're still not ovulating every month.
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How would you actually know the difference?
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Unfortunately, you can't know from a calendar.
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Anovulatory cycles can produce bleeding from estrogen withdrawal that looks like a period but is not preceded by any hormonal event that makes a cycle truly ovulatory.
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So it's why we talk about all the time on this podcast why it's so important to be tracking your cycles.
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We can see ovulation occur when we see cervical mucus changes, basal body temperature shifts, sometimes an LH surge, and most importantly, confirming that with ovulatory labs that are done after the time of ovulation to confirm that progesterone actually is rising.
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These are the things that you can do to actually confirm whether ovulation has occurred.
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If we are still stuck or still confused as to whether it's happening or not, that's oftentimes where we'll involve an ultrasound so that we can assess for ovulation happening.
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Now, what if I've been on the pill long term and I'm not ready for pregnancy?
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Is this really a big deal?
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I'm having a withdrawal bleed.
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All of this is happening.
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Why does it even matter?
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Now, the concern is not whether or not birth control is effective at managing your symptoms.
00:19:32.857 --> 00:19:40.117
It's that most women are never given the information to understand what years of suppressed ovulation actually means for your body.
00:19:40.738 --> 00:19:55.387
Informed consent means understanding the full picture and getting all of your questions answered and giving you the information about what long-term studies show when it comes to any sort of hormone therapy.
00:19:56.657 --> 00:20:01.817
Now, if you choose to still be on oral contraceptives and you understand all of the risks, that's valid.
00:20:02.167 --> 00:20:07.718
But if you'd like to explore alternatives that don't suppress ovulation, that's why we are here.
00:20:07.718 --> 00:20:09.948
That's why we're having this conversation today.
00:20:10.428 --> 00:20:17.897
And many women are frustrated because by the time they come to see us, they've been on birth control pills for years, sometimes decades.
00:20:18.347 --> 00:20:25.057
Unfortunately, some of those consequences cannot be modified depending upon how long you've been on some of these hormones.
00:20:25.377 --> 00:20:28.847
Specifically, bone density is really challenging to reverse.
00:20:29.208 --> 00:20:50.218
However, it is still possible to reverse the changes of bone density, cardiovascular health, metabolic health, and brain health even after years of being on birth control when we can get your cycles back on track, get you ovulating regularly, and get that natural progesterone firing again so it can produce the hormonal impacts that it needs to.
00:20:51.768 --> 00:21:00.438
One of the most prevalent examples is women who have PCOS, or now called PMOS, and they know that they don't ovulate regularly for years.
00:21:00.688 --> 00:21:03.407
And so many of them have been told,"Well, just go on birth control.
00:21:03.407 --> 00:21:24.087
It will get your cycles back on track, and that will help prevent any long-term damage." Unfortunately, this isn't the whole story, and I would stress the importance of working with a healthcare team that will evaluate the root cause of your anovulation and will track whether ovulation is being restored over time, not just whether or not your period shows up.
00:21:24.688 --> 00:21:38.907
For example, insulin resistance drives the majority of these cases of anovulation in women with PCOS or PMOS, and it is very treatable with dietary changes, supplements, and sometimes prescription-strength medications.
00:21:39.407 --> 00:21:49.488
Restoring ovulation in PCOS is possible for many women, and the health benefits extend well beyond fertility when it comes to looking at your long-term health.
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Imagine if every young woman who was prescribed hormonal contraception was told clearly and honestly that it suppresses ovulation and what that means long-term for your health.
00:22:04.337 --> 00:22:16.347
Imagine if instead, anovulation was treated as the health finding it is, and more importantly, restoring ovulation was understood as a health goal, not just a fertility goal.
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Women can arrive in their 40s and 50s having protected their hormonal systems through their most reproductively active years rather than discovering in retrospect what years on birth control or chronic anovulation had cost them.
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Ovulation is not optional.
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It is one of the most important things that the female body does month after month, year after year to keep itself healthy.
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And that is exactly why we work so hard to improve your cycles and to help you identify ovulation to improve your health for the long run.
00:22:52.971 --> 00:23:05.721
If you're ready to work with our elite team of healthcare professionals, go to our website radiantclinic.com to schedule a free discovery call and learn more about our package-based pricing for comprehensive care.
00:23:06.490 --> 00:23:16.201
We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in many different states across the US.
00:23:16.921 --> 00:23:26.711
Check out our website for current states that we can serve medical clients, and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach.
00:23:27.290 --> 00:23:32.701
Please note that our fertility educators are able to take care of clients no matter where they live.
00:23:33.631 --> 00:23:35.921
Thank you so much for listening to this episode.
00:23:36.320 --> 00:23:40.451
Please share this podcast with someone in your life who would benefit from our services.
00:23:41.010 --> 00:23:49.510
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