The Food Medic - S9 E5: The lowdown on hormonal contraception

Episode Date: February 6, 2023

This week on The Food Medic podcast we are joined by Alice Pelton and Dr Fran, from The Lowdown - the UK's leading contraception review and subscriptions platform.This episode covers: The story behind The Lowdown What are your options? Different forms of contraception Pill-bashing and fear mongering online Does hormonal contraception affect fertility? How long is too long to be on the pill? Advice for those considering stopping or changing their form of contraception Natural family planning and fertility awareness methods A new form of male contraception? If you loved it you know what to do - leave us a review, a rating (hopefully 5 stars) and share it with someone you know will love it too. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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exclusions and terms apply. Instacart, groceries that over-deliver. Hello and welcome back to the Food Medic Podcast. I'm your host, Dr. Hazel. Today, we're going to talk about contraception, a conversation which I personally feel we don't talk about enough. For this episode, I'm joined by two guests from The Lowdown, the UK's leading contraception review and subscriptions platform. Alice Pelton is the founder of Lowdown and set it up after struggling for years to find a contraceptive method that didn't negatively impact her mood. They've just closed their two million seed round and have big plans to use their unique community first approach

to put the next billion women in control of their healthcare decisions. And alongside Alice, we have Dr. Fran, one of the Lowdown's medical directors and the first doctor to join the Lowdown team in 2020. When she's not offering exceptional contraception consultations to the Lowdown community, Fran works as a GP in Sheffield where she's also a clinical lead for her primary care network and trains allied health professionals, especially in all things women's health. Her favourite topic is the vulva. This episode is not about scaremongering or telling you to flush your pills down the toilet but to help you make informed decisions about the right

contraception for you. This episode is brought to you by Whoop. We're a few weeks into the new year and I want to know how you're getting on with your new year's goals and resolutions. I'm actually pretty happy with how consistent I've been with my sleep schedule, but I'm not going to lie, there have been one or two slip ups. But one thing that has been keeping me accountable is my WHOOP, which reminds me daily when I should be getting into bed for optimal rest and allows me to track my progress with daily, weekly and monthly reports of my sleep outcomes. If you've also slipped up on your New Year's resolution, Whoop can get you back on track so that you can optimise your performance

throughout the year. Whether you are hoping to sleep better, exercise more, drink less alcohol or just live a happier, healthier life, daily insights from Whoop are tailored to help you meet your goal. There's still time to set yourself up for success in 2023. So if you've not had a chance to get started, but you're looking to up your game in 2023, go to join.whoop.com slash thefoodmedic to get started. You'll get your first month on me for free. Alice and Fran, welcome to the Food Medic podcast. Thanks for having us. Thank you. It's so nice to the Food Medic podcast. Thanks for having us.

Thank you. It's so nice to have you both here. I love having two people as well. It just feels like we're all having a nice conversation and sit down together. Alice, I would love to start with you because I'm so fascinated by your story. And I want to know and I want you to share with the listeners why and how you started the lowdown. So I went on the combined pill when I was about 16 and it took me a couple of years to realise that it caused me quite a few side effects. So it really impacted my mood, it made me feel

quite kind of out of control in my emotions and like I always had a lump in my throat and was about to cry and I then went on a bit of a journey over the next 10 years to try and find a contraceptive method that worked for me and on that that journey I realized that there are a number of problems in this space that I started to become really passionate about changing. The first is that there's a huge lack of data around contraceptive side effects, you know, gold standard clinical research evidence that really helps guide our decision making. It all just seemed a bit of a black box. And going on to Google and googling my symptoms or my side effects, I couldn't find anywhere on the internet that really catered to the questions that I was asking it was either like the NHS website or Cosmopolitan articles and I felt like I felt like there should be something in the middle there's no in between the second thing was that when I went to see my GP I realized how short that GP consultation is and how difficult it is to get all of your

questions answered in that consultation when it comes to contraception and I don't really know how many doctors or GPs could fit in a proper contraceptive consultation in that time and then the third problem was just how frustratingly difficult it is to access contraception and that's either just the admin of having to remember to pick up your prescription or trying to get an appointment to get your prescription renewed or the waiting list to get a coil fitted in your local sexual health clinic it just always felt to me like it was easier to try and get pregnant than it was to try not to get pregnant and that it was something that a lot of me and my friends were finding quite frustrating so So I sort of took those issues around

data, advice and access. And I went on sabbatical with my partner in 2017. And I had this idea for a contraceptive review platform. And I went home and I googled it thinking that it already existed. But it didn't. No one had built it it so I then spent the next year building the website and I launched it in 2019 and I guess you know our review platform is there to solve that data gap but we like to blend the anecdotal kind of messy data of our review you know lived experience with the the clinical evidence where it does exist to help give people specific detailed information on how every contraceptive method could make them feel. And then I met Dr. Fran in 2020 and she helped me build out our consultation service so women can book in to speak with a doctor for a full 20

minutes about their contraception to give them the time and the expertise to really figure out what might be right for them and then finally our goal is to make the most convenient easiest way to access contraception in the UK so we built a subscriptions platform so you can get the pill the patch the ring the injection delivered to you every three six or twelve months and we've got some really exciting plans to transform and reimagine how the experience of getting a coil or an implant fitted is. So it's been a bit of a journey from going on microgyne on age 16

to ending up running this company. But I've spent a lot of time over the last five years really understanding this problem and getting incredibly passionate about how we can help transform quite an archaic and not very innovative space yeah absolutely I think that's it's such an incredible story and such a great mission as a woman and as someone who's trained as a doctor as well I understand those frustrations and also that huge

gap in our knowledge. And I completely agree with you because I think from, you know, speaking to my friends or reading magazines, a lot of it's hearsay, a lot of it's anecdotal. And then we're just filling in the gaps with like very scant research. And I feel like more recently, there's been a lot more conversation about hormonal contraception, a lot more women asking

questions it's no longer just taking what we've been told to take or what our friends are taking or what the doctors prescribed a lot more women are asking questions there's I guess TikTok and Instagram and things like that I mean not all of the posts are good and there's a lot of misinformation out there are you finding there's a big uptick in people accessing your resources and asking questions definitely I'd say the pill you know came out over 60 years ago and like with any new technology it there's always this you know wave of excitement and fear and then people accept it and then people start to criticize it or become disillusioned with it so we're sort of at that like disillusionment point and that's not necessarily a bad thing

because hopefully that will make people change and innovate and create better methods and ways to stop people from getting pregnant I'd say that the lowdown launched and started growing at a time where all of that media discourse really started to take off. And things like the fact that it was 60 years since the pill came out in 2020. So there was a lot of pieces in the media around that and people asking, is the pill what we should be taking, etc. So, yeah, it was a combination of that timing I think society challenging things and also I guess our review data set was a valuable resource to help people really interrogate

and investigate how people feel about the contraception that they're using. I think more recently there's maybe been a lot more like negative coverage of contraception and it's very easy to paint each form with the same brush but every woman is individual every person is individual and we all respond to these different forms of contraception differently so Dr Fran let's go back to basics and talk about what different forms are available to us yeah um of course so there are quite a lot of forms out there so I like to break it down into sections. Firstly we have hormonal contraception and non-hormonal contraception so concentrating on the ones that use hormones they mainly work by either preventing us from releasing an egg or ovulating every month. They also can help to thin out the womb lining,

so a pregnancy can't implant and grow. And also, sounds quite gross, but thicken up the cervical mucus, so it's harder for sperm to enter. Within that group of hormonal contraception, we have ones that are either short-acting, so ones that you take every day, like the pill, but also the patch and the ring. And then we have the longer-acting forms of hormonal contraception,

which would be injections you use every three months, the implants, which can sit in your arm for three years, and then also the coils, which are between three to six years. If we look at non-hormonal options, which I think are becoming more and more popular, we have a copper coil, which works because copper is actually quite toxic to sperm and eggs. That can last between five to 10 years. And then we have the barrier methods, which people will typically just think condoms, but that also includes female condoms and the cervical cap or diaphragm and then something which is becoming more and more popular and people are talking

about a lot at the moment is natural family planning methods which actually have been around for centuries but now they have clinical evidence they've been through trials and so more people are using methods such as the natural cycles app and tracking their cycle to use that as part of contraception so they're your main options there's loads of options loads of options and lots of different brands and things in your consultations or perhaps in your practice outside of this what are some of the common concerns that you find people are asking when they're looking for hormonal contraception or they want to change or they want to stop it really varies i think a lot on an individual person and also where they are in their reproductive cycle um or reproductive life

really so younger women or teenagers might have concerns about side effects such as acne and bleeding problems. As you move on to women who are more reproductive age thinking about children, fertility becomes a really big issue that they want to talk about. Reassuringly, hormonal contraception, it's only the injection which can have any impact on fertility. And often we have or we hear this rhetoric that hormonal contraception has masked or prevented me from getting pregnant. Whereas I like to try and talk about it in a more positive way and say, actually, if you have had female health problems, which hormonal contraception has been masking,

it's actually been treating them. Problems like endometriosis or polycystic ovary syndrome we treat with hormonal contraception and it can actually prevent there being any fertility problems in the future and then as as we get older towards the perimenopause and menopause women start to be concerned about things like blood clots or cancer risk i like to talk about blood clot risk in context with numbers so there there was a lot, especially with the COVID vaccine, about the risk of blood clots with that and how that could also play with hormonal contraception. So the numbers I say are every woman walking around, you have a two in 10,000 chance per year of having a blood clot. Being on, for example, the pill increases that to five to seven out of ten

thousand. Some brands of the pill increases that further to nine to twelve but actually if you look at when you're pregnant that risk increases to 29 out of ten thousand per women and then after you've just had a baby it's 300 out of every ten thousand. So blood clot risk, while it is a concern, you have to look at that risk in context of the comparison. And finally, the cancer risk. There's a lot of concern about breast cancer and cervical cancer, as there is research that shows the pill, the combined pill, can slightly increase your risk of that. But again, in context, actually drinking alcohol and being overweight can increase your risk of breast cancer more than the combined pill. and if you're getting your up-to-date cervical smears it shouldn't really be a concern if if you are worried about cervical cancer they're the main

concerns i see fertility blood clots cancer risk and and side effects which is why the low down is so important because side effects are a big concern for women at the moment. Yeah, 100%. Can you expand on when you mentioned the injection and fertility? Because I know that women listening who are using that form of contraception might be thinking, how is this going to affect me in the future? So when you stop using hormonal contraception, some women are fertile immediately. Other women, it can take one to three months for your cycle to return. The exception is with the injection, which when you stop using the injection, your fertility can come back quickly. But for some

people, it may take up to 12 months after you've stopped using the injection for your fertility to return to your normal baseline level and this is from both clinical evidence and also our users reviews and experiences. So if you are thinking about trying for a family in the near future and you are on the injection you might want to start thinking about a change earlier rather than later. Yeah I agree. Do you think we're having thorough enough consultations in general practice with patients around hormonal contraception? Do you think obviously there's time restraints and other demands there but are women fully informed of the risks because because all of these questions are coming out you would assume that they're not. As an NHS GP myself, I have to say it's exceptionally difficult to do a thorough contraceptive consultation within 10 minutes.

You know, I've done extra training. I do my low down consultations all the time and I can't fit into 10 minutes. So the way we do it is we have like a tick box template. And on that tick box box we have to prove that we've discussed risks with patients but unfortunately there just isn't enough time to go into that context and balancing of risks that I was talking about earlier and when you're trying to fit in how it works what to do if you've missed a pill the risks how to take it properly you then start to lose the time where you talk about the things that

mean a lot to the patient which is side effects because really what you want to know is how is this going to make me feel as much as anything else and that's where the lowdown comes in. In my consultations on the lowdown I just have more time to really understand what patients want and despite doing extra training I've learned so much from our users and from their experiences and what they want to talk about as much as I've learned from my my training in general practice yeah that's it's very true and um I very much appreciate the time constraints there and like you mentioned having a resource like the lowdowns just so fantastic for people to even pre-read before going to your consultation with your GP so that you

feel like you're also informed going into the the consultation um what I'm hearing a lot across the board is a lot of people feeling like they need to come off the pill there's a lot of pill bashing going on online for anyone listening thinking that it's unsafe or that they need to make the switch because they've been on it too long what would be your your advice for them yeah I think one thing that I wanted to flag was what's really interesting is we have a contraception recommended quiz on at the low, which over 20,000 people have used. And it asks questions about preferences to help us and our algorithm figure out what methods might be right for you. And if you look at the data from that, it actually shows why the pill is actually still very popular.

And that's because 70% of people who've done it are open to hormonal contraceptives so you know there's still the majority of people are still open to using hormones around the same amount are happy to remember to take something every day or have a lifestyle that would suit that and then still the majority of people are not comfortable or don't like the idea of getting a coil fitted inside their womb or an implant fitted on their arm in the skin on their arm so whilst there is that rhetoric around coming off the pill we you know the pill is the most viewed product and the brands of pill are the most reviewed parts of our site and all of our preference data at the moment

is still showing why the pill can be a great way to get started. See how you get on with it. You can always come off it if you don't like it and try different brands. Yes, certainly in my practice, I'm hearing a lot more of this. I want to feel like who I am off the pill or I want to feel like me. But I also want to make people aware that the pill has done such great things for females in the last 60 years. You know, it's helped reduce gender inequality, it's let us have careers because we can decide when we're going to have children. And that is so important. And it's also important to look at the positives of hormonal contraception. You know it

treats PMS, endometriosis, polycystic ovary syndrome and so it really does have benefits as well and a lot of the pill bashing may just be because someone hasn't found the right pill for them. So often with the NHS there is only a certain number of brands that we can prescribe in an area. We always have a first line brand that we have to try and there is clinical reason for that because we're encouraged to choose the pill with the lowest blood clot risk for every woman which is usually microgynon, rigavidon or ovranet which a lot of people will have been started on first. However listening to women's side effects listening to how it makes them feel people who've got experience with contraception

we can predict how to take a pill differently or which brands to try that might reduce your side effects and make you want to stay on the pill so I think before you decide the pill is not for you or hormonal contraception is not for you speak to someone about your your concerns your issues and how it makes you feel and see whether we can tweak things a little bit or change things to make it a better option yeah that's really good advice and um just second to that another kind of concern that i'm hearing more and more is i've been on the pill for x amount of years how long is too long? Yeah yeah and you know at the lowdown I have had consultations about this people saying I've been on the pill for 10 years so I have to come off

but actually there's no evidence for that the combined pill can be used until you're 50 years old progesterone only methods like the progesterone-only pill or the implant can be used for 55 or even longer if that woman wants to stay on it. And that is as long as your medical history does not change. So if you're still able to have hormonal contraception, then why can't you? And also, you know, there's a lot of talk about hormone replacement therapy these days and the menopause. The combined contraceptive pill is used as a treatment for perimenopause and menopause. And also other hormonal contraception like the Mirena is part of HRT. So really, there is no answer to how long should I be on the pill.

It's a very individual choice depending on you your medical history your risk factors and how long you want to be on it for yeah up until the age of 50 of course of course and like you said it's very individual and there's so much information on your website that people can go kind of have a little read of and find out what might work for them but we mentioned at the start there's a lot of women considering natural family planning methods although they've been around for years and there's various ways you can do this can you speak a little bit to that and from the insights that you're getting with your community is it popular it's it's definitely growing in popularity. I wouldn't overstate its sort of market share though you know when we think about like the pie chart of contraceptive usage it's still predominantly

you know the pill, the combined pill, progesterone pill and then things like the patch, the injection and the coil but it's definitely growing I guess the most in terms of interest, coverage and the questions that we get asked from our community. Startups like Natural Cycles, who have developed an algorithm to take some of the guesswork out of tracking your fertility, have been doing incredibly well. But there's a huge amount of education that goes into just understanding how that method works and making sure you're doing it properly and I guess that's always been a brilliant talking point and a thing that we can help people figure out if it's the right thing for them. Yeah in consultations at the Lowdown I am recommending methods like natural cycles to women more and more because after they've tried lots of methods that is the best one for them but again it's very individual it depends a lot on on your

lifestyle um you know what you want to do how much effort you want to put into it because there is quite a lot of effort involved in cycle tracking but one thing i really would like listeners to realize is that just tracking your period often isn't good enough as a contraceptive which is why um there has to be robust clinical research into these apps to make sure they do work effectively. Natural cycles is very effective if you do it properly but just using a tracker to see when your periods are doesn't quite work as well there is some more fertility trackers that are needed to make it effective including temperature and also checking your cervical mucus. so the best thing to

do is is learn about your options read about natural cycles read about fertility awareness methods rather than just trying to do it alone yeah and i guess using a combination of those factors um so checking your cervical mucus and your temperature and using a tracker would increase the chances of it being successful but for some people it's not really a suitable method or not a reliable method and who might these people be? Yeah so I mean I joke but if you're at university 19 years old and out drinking every night and waking up at different times in the day which a lot of us have been there it's probably not the best method for you if you've got a regular partner you probably need to sit down and have a good conversation

about what it would mean if this method failed if there was a pregnancy what it would would it mean to you for some people starting on natural cycles or fertility awareness methods they say well if I get pregnant it's not really the end of the world. Whereas for other people, it would be. And that's definitely something to consider. And then also your cycle itself. So with irregular periods, it may be slightly more difficult to use because you would have less time in a month to be able to have unprotected sex. So that's another consideration because you may then be using condoms more than than you can't so in that case why not just use condoms full-time and so they're the kind of

things you'd be looking at but as with always it doesn't mean the method is a no for you you just need to have an informed conversation about it and i think something with these methods that we often forget is if you're using it as a contraceptive you shouldn't have unprotected sex during your fertile window which is often when a lot of us want to have sex and you have to be if you want to have sex during that period which a lot of us do you have to use condoms or barrier methods so you have to have a partner who's comfortable doing that etc etc so it's stating the obvious but I think it's important to know that you know for potentially 10 days a month whilst you're the most horny, you should be using condoms. Yeah. You say it's stating the obvious, but sometimes we all need that reminder, especially if you think you're like you've kind of got a handle on something.

And oftentimes we forget that, you know, sometimes we do need two methods. So I think that's really helpful quick one I have a new and exciting membership coming out and I want you to be the first to hear about it I started the food medic over 10 years ago and my mission has always been to bring evidence-based health and nutrition information that's easy to follow and practical to implement and if you're listening to this podcast I'm going to make an assumption that you're someone who prioritises their health and seeks out high quality information from trusted sources. So that's why I'm inviting you to join our new and exclusive membership, the Food Medic Hub, which allows you to take charge of your health with support from the most trusted experts

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And that's to do with a whole host of things you know it costs a lot it's very long and litigious to develop a new contraceptive method there's a high chance of you know very public lawsuits if it goes wrong and there's a sort of laziness from pharma and general society that we have enough methods and they all work so therefore we should all be kind of happy with our lot so male contraception is obviously something that we've been waiting for for a long time and other male contraceptive methods I should say apart from the vasectomy or the condom and I think what's misleading is if you read in the media you know a piece about the fact that you know a new trial has taken an extra step or it's closer to being developed

we're still about you know five to ten years away from actually having something in normal people's hands that they can use and the phases that drugs and have to go through to get put out into into the market is it's there's four phases and they all take you years. There is a male contraceptive pill that's currently being in phase one trials in the US. There is also a thing called the Vazigel, which is when a fluid is sort of injected into the vas deferens to block the production of sperm. But the thing we're most excited about is a trial that's being led by Edinburgh University called the NEST contraceptive gel trial. And that's probably the furthest along in terms of a hormonal contraceptive for men.

We actually interviewed a couple who are one of 400 couples in the world who have been doing the trial for it. And it's absolutely fascinating talking to them and what it's like how it's changed their sex life how it's changed their relationship but effectively a gel is is rubbed onto a man's shoulders he has to wear a t-shirt quite a lot in case it rubs off onto the female because there can be issues if she gets that drug in on her and it works by blocking the production of testosterone which leads to the production of sperm but then it puts a fake testosterone into the body to sort of stop some of the side effects that would come from stopping a man having testosterone in his body. So we're very excited about this that first round of you

know those 400 couples have been through that trial and the makers tell me that the results are promising and they'll probably be announcing uh some of them next year and we hope that that will you know get to market and pass all of the rigorous um clinical safety checks but still it's about five to ten years away yeah i. I'm interested to know, was the feedback from the couple overly positive in general? For me, it was really interesting how, when they were still trying to work out the level of testosterone that was put into his body, just how sort of early on this is, you know,

they're still really trying to figure out, oh, actually, and he said, they took too much of my testosterone away and I was crying a lot I had mood swings yeah he it really changed his personality so they were really tinkering with it for a while but then they got the levels right and ultimately their their experience was positive and they were able to you know have a normal sex life they were completely reliant on it as a contraceptive but they said it was quite a hassle having to put the gel on his skin um every day and actually when that can be developed

into a pill form or another way of getting it into the body it'd be better yeah like a patch or something yeah so interesting though so fascinating so i'm sure after this conversation there's a lot of people listening who are thinking about maybe the method that they're on, or maybe they've been thinking about changing, or maybe they have never been on a form of hormone and contraception. And this has like sparked some interest. What's your best advice for them to find the right one for them as an individual? The first thing I would suggest is the Lowdown has a fantastic recommender tool. So if you go onto our website, you can follow the questions, put in your preferences and what you want out of your contraceptive, and it will give you some options. And then you've got

the opportunity to look in more detail at those, find out more information to see whether you think they'd work for you. If you do have any further questions, you can always speak to your healthcare professional or come to us at the lowdown where we have time to really get into the nitty gritty of things for you. And the final thing to remember is if you make a choice or you make a switch, it's not permanent. You can change your mind. You can keep trying different methods. So don't feel like there's no other option available to you. Yeah. And I'd add that, you know, you're on contraception for about 30 years.

The average the average woman is. So it's kind of like choosing a mortgage and you wouldn't take five minutes to choose your mortgage. You'd really, you know, review it hopefully every couple of years to make sure you're on the best plan for you so kind of checking in with yourself regularly whether you get into a new relationship or you're out of a relationship or yeah you're thinking about trying for a family or you've just had a baby these are all really good points when you put it like that it's um if I think back to my own personal journey when I was a teenager although we did go through very briefly methods of contraception that were available when we were in sex ed ultimately my mind just thought there's just this one thing it's the pill everyone takes it just go on that and you just do that and then going through medical school was really insightful for me because I learned in great detail the

different types the different forms the different side effects. And that caused me to make a switch. And since then, I've switched twice again because different things have come up. I'm in different situations, different relationships. And I think you're right, Dr. Fran, in saying that, you know, like these things aren't permanent. And sometimes you just have to review them because our situations do change and making one decision doesn't mean that has to be your decision for the next 30 years exactly yeah use the information that's out there and as with the lowdown community use your friends and other people's experiences to guide you as well yeah 100 amazing well we wrap up with three questions um every time um so i haven't

shared these with you we'll go one by one so that we don't jump on to the next question i'm going to start with you dr fran what is one thing that you've changed your mind about so when you are trained as a medic you learn through clinical evidence and guidelines but since especially doing the low down doing the consultations learning from our community I've realized that medicine isn't always a science sometimes it's an art and it's so true with contraception that people don't always fit into guidelines everyone is an individual and that has changed how I approach individuals and how I approach my consultations I think having that recognition that everyone is different and it's not always like a textbook has really changed how I do things yeah I think having that awareness is so powerful

how about you Alice what have you changed your mind about I'm really stubborn I don't often change my mind that can be it I never change my mind no I do always right I think when I was first scoping the lowdown I was under the impression that there would be actually a lot more research and stuff and a lot more happening in this space but as I've spent the last five years learning this space whether it be pharma drug development or I've realized actually it's just not there so I think I've changed my mind in terms of really understanding just how important it is that we are able to push something forward and change the status quo for women right now because if we don't do it there aren't actually that many other people doing it for us I completely agree I had the same

experience writing the female factor I stepped into it thinking there'll be all of this research that I might just need to dig a bit harder to find. And actually, there was very little research and it was quite shocking for me. And so I completely resonate with you there. Which also we have a copy of The Female factor and our low down desk oh I love that amazing and Dr Fran next question is what's a non-negotiable in your day eating simply I oh I love to eat um but non-negotiable in my day is being able to at one point see my little girl she's almost 18 months and I work I work a lot I do I go away quite a lot but just being able to see her little face on a video or a photo is my non-negotiable

because she's my reason why no I love that how about you Alice tea literally I couldn't live without tea I drink this weird blend of lapsang son, which is like a smoky tea combined with a normal tea bag. And I every morning I make myself a cup of tea. I get back into bed and I drink it. And that's my sort of five to 10 minutes just to think about my day and what I, you know, what we want to do. And that just sets me up right. And if I don't have that five, 10 minutes, then I feel feel terrible. Oh, my God. I'm completely the same but

with coffee yeah yeah and such a nice way to like start your day have like a mini pause before picking it back up again and the last question we are a food podcast so what would be your death meal oh um my husband is a phenomenal cook so So basically anything cooked by him. But one of my favourite meals that he ever cooked me was a roast duck breast with mashed potatoes and loads of gravy because I'm a northern girl. He is an amazing cook. It's actually funny, we were talking about it this weekend, actually, because my death row meal was really embarrassing. It's a Marmite toast with a tea for first course and then we move into pesto pasta with those with cheese on top because for me those two foods are just comfort and yeah just

you know being a student looking after myself eating a lot of toast and pesto pasta but I get ridiculed by everyone I know because those are not very complex um food choices no they do scream comfort and I think for a very long time after uni I couldn't eat pesto on anything because why do we pesto pasta just sometimes with bacon, definitely cheese. And that was just a staple. If anything goes wrong, if you're hungover, you just make pesto pasta and everything's going to be fine. Powering dissertation since like 1986. It does taste great though.

It does. Amazing. You can't fault it. Amazing. Where shall we direct people if they want to find out more about the lowdown, about you guys? I'm sure they will after this. We'll out more about the lowdown, about you guys? I'm sure they will after this. We'll include everything in the show notes, but give yourselves a shout out.

Yeah, so our website's thelowdown.com. So just Google the lowdown contraception. And you can follow us on socials at get.the.lowdown on Instagram and TikTok. Cool. Well, thank you for coming in today. It was lovely to meet you both. And thank you for sharing all your insights with our audience. Thanks for having us. Thank you. I hope you found that helpful. Perhaps send it to someone you know it might help also. And so if you are thinking about stopping or changing your form of contraception, I have to stress, please make sure you book in a call with your GP to discuss it first. If you have

two minutes, could you please leave us a review and a rating, hopefully five stars, and it really does help boost us in the charts. Don't forget we are still taking questions for Ask Dr Hazel, so if you would like to submit a question of your own on any topic related to health, fitness, nutrition, women's health, anything that we talk about in the podcast, please send your voice recorded questions to info at thefoodmedic.co.uk. That's all from me. See you again next time.