Live Like a Girl with Dr. Mindy Pelz - The Pill & Beyond: Unexpected Ways Birth Control Shapes Our Lives with Dr. Sarah Hill

Episode Date: March 17, 2025

Ever wondered how birth control affects your natural hormonal rhythm? Listen to Dr. Sarah Hill reveal the truth about hormones, health, and life choices. This episode explores how synthetic hormones from birth control pills can influence a wide range of bodily functions, from brain activity to immune system responses, and how these effects can differ significantly from natural hormone cycles. Dr. Hill addresses the potential long-term impacts of starting birth control at a young age and staying on it for years, including fertility concerns and hormonal imbalances. Uncover the hidden truths about birth control, menopause, and hormone therapy with Dr. Sarah Hill! Let's embrace a healthier, natural rhythm.  To view full show notes, more information on our guests, resources mentioned in the episode, discount codes, transcripts, and more, visit https://drmindypelz.com/ep279 Dr. Sarah E. Hill is a researcher and professor at TCU, lead science advisor for 28 Wellness, and the author of "This Is Your Brain On Birth Control". Sarah's groundbreaking research has resulted in close to 100 research publications. Her work has been featured in The New York Times, The Washington Post, Scientific American, The Economist, and on television shows like Good Morning and Today. Sarah is also a sought-after speaker, consultant, and media expert in women's hormones and sexual psychology. More at https://www.sarahehill.com/ Check out our fasting membership at resetacademy.drmindypelz.com. Please note our medical disclaimer.

On this episode of The Resetter podcast, have I got a treat for you? This is Dr. Sarah Hill, who is a researcher, a professor, and a lead science advisor, and has really been diving deep into what happens to the female brain and the female body when we go on to birth control. So what's really interesting here is so many of you are in your pari and postmenopausal years. So it would be easy to think of birth control as a thing in the past. But why I wanted to bring Sarah to you was because when we are on the birth control pill for years, sometimes decades, there are actually not only lasting changes to our body, but there can be lasting changes

and manipulation of our relationships. The birth control pill can actually change our stress response. The birth control pill can affect bone density. And all of these things matter when you transition into those perimenopausal and menopausal years, that knowing what the effects of the pill has been on your body so that you know how to back fill in with lifestyle, you know what kind of hormone replacement, you know what kind of hormone replacement therapy you might need. All of these are what we address in this conversation. So Sarah is a sought-after speaker. You'll see she's phenomenal. She's a consultant and media expert

for sure. This was a great conversation. And she specializes not just in women's hormones, but sexual psychology. We talk a lot about the birth control pill and hormone replacement and sexual identity, sexual preference, all of that is in the back half of the conversation. This is one, if you're a menopausal woman, you're going to want to really think about if you were on birth control for many years, but also if you have daughters or granddaughters that are navigating their choice of birth control, I highly recommend you send this to them. because there is so much more to think about here than just not getting pregnant. And even in the hormone replacement conversation, there's so much more to think about

than just taking hormone replacement to make yourself feel better. There's a depth of conversation that we all need to be having as women. And Sarah and I have it in this episode. So I hope you love it as much as I enjoyed receiving the information from Sarah. So as always, I hope is so. Welcome to the Resetter podcast. This podcast is all about empowering you to believe in yourself again. If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you.

Well, Sarah, I have to start by welcoming you to my Resetter podcast. I'm going to tell you a couple funny stories, interesting stories. The first was, so I'm 55 now, and when I was a teenager and had a very awkward conversation with my mom about the birth control pill or what my birth control options were, my mom was a pioneer and a woman ahead of her time. And she said, I'm willing to talk to you about all of them except the birth control pill. You cannot get on the birth control pill. And she didn't really give me any reasoning why. And then fact, forward through all my education and all my studies on women's hormones. When my daughter and I were having the discussion around the birth control pill, she wanted the birth control pill because she's like, oh, my friends are taking it. It's so much easier. And I said, that's the only one I am not okay with you being on. And there's, I had some, again, some very strong opinions. So when I saw the title of your book, when I saw what you were writing about, I'm like, hallelujah,

finally somebody's talking about the downside of the birth control pill. So can we start this conversation from, wait a second, I thought I took a pill every day for a month. I didn't get pregnant. It was really great. You're now telling me it's not so great. What is it we need to know about that? Right. I think that most people when they go on the pill, they do it for, like you said, very targeted effects, right? They're like trying to avoid pregnancy. Sometimes they're just like trying to clear up their skin or they don't like the fact that their cycles are irregular. And so they're looking to have a more predictable experience for when they bleed. And so they take the pill and just assume that's the end of the story is that it's all about reproductive health. And it does all of those

things. But the thing about hormones is that there's no such thing as a localized effect of a hormone. And the reason for this is once hormones get into the body, regardless of how they get there, whether they're created by our own bodies or whether, you know, we take them in the form of a pill, they get into the bloodstream and then they travel everywhere that blood goes, right? And then from there, they get picked up by cells in the body from head to toe that have receptors for the hormones. And the thing about women is because we have bodies that are wired for pregnancy, that means that almost all the cells in our body have hormone receptors, right, with sex hormone receptors in particular. And this is because almost every single thing that our body does, whether it's the functioning of our circulatory system,

the functioning of our immune system, and of course the functioning of the brain, all change in response to pregnancy. And so our body is wired to be sensitive to sex hormones. And so you take in a sex hormone or something that changes a woman's profile of sex hormones, and it's going to be affecting cells in the body from head to toe. And a lot of us aren't really, we don't think about that, right? Because nobody tells us. And our doctors, I don't even think our doctors think our doctors think about it honestly. And so they just like give it to you for a handful of effects. And then it ends up having these, you know, causing these sweeping changes from head to toe that for some women can feel less noticeable, but for some women can feel very noticeable. You know, it's interesting when I first

dove into functional medicine and really trying to understand root cause natural health care, I was sitting in a conference where we were talking about the thyroid. And I remember the instructor saying that you have almost every cell in the body has a receptor site for thyroid hormones. And it was the first time, this is about 15 years ago, it was the first time that I had heard anybody talk about the systemic effect of hormones, to your point, that we think of it as like, oh, they pop in, they help us, you know, ovulate, and they help us bleed, and then they go away. But their secondary effects throughout the whole body are some of their most powerful, you know, reasons for being there. So can you talk a little bit about what is the difference if I take a synthetic hormone as opposed to my own body making a hormone on these secondary receptor sites that you're talking about?

Sure. And so the first thing that we need to do is just orient ourselves to a natural menstrual. cycle for a cycling woman. And to do that, like, we're going to just, you know, picture the first day that you get your period, and that is day one of your cycle. And so on the day that you get your, the day that you get your period, your levels of sex hormones are super low. And actually, the thing that initiates bleeding is the crashing of your hormones that occurs at the end of the cycle. So levels of estrogen, which is our first primary sex hormone, and then levels of progesterone, which is our second primary a sex hormone, both of those hormones are really low, which is actually kind of funny because, you know, women get a hard time about being hormonal when they have their periods. And it's like literally

when our hormones are the lowest. Yeah. You know, I have a theory on it. And this is what I wrote about in Fast Like a Girl. I think it's because we don't take care of the of the week before our period. Oh, yeah. So we feel horrible in whence our period comes. But that's because you didn't rest and recover and eat more carbs and slow down the week before. Amen. No, exactly. And when you look at, and you talk about this in your book, and there's some really neat research out there looking at the use of amino acids at different points in the cycle and the body. And we get absolutely depleted during the last two weeks of the cycle, what during the luteal phase when the body is preparing the endometrium, it's just like sucking up all of these amino acids to create all this new tissue. And if we don't replace those things, then yeah, it's like we feel terrible because our body's completely depleted and we're wrung out. But so yeah, so just to orient ourselves back to the cycle with our with our fun little asides, you know, day one of the cycle, your hormone levels are really low. And when hormone levels are low, the brain sees this as a problem because it wants to make babies. And, you know, that's like unconsciously, you know, one of the things our brain is here to do is that it really wants to get pregnant. And so the brain sees this as a problem. And so it starts to tell the ovaries like, hey, you know, start stimulating those egg follicles because we need to release one. And so then the egg follicles start maturing because the the brain is stimulating the ovaries. And as that happens, it leads to the release of estrogen. And estrogen levels begin to increase and they begin to increase. And then as a dominant follicle takes

over, which is the one that's going to ultimately release and result in the release of this egg, as that one begins to take over and mature really rapidly, it leads to this big surge in estrogen that you get right prior to ovulation. And then at ovulation, you get this empty egg follicle that turns into a little temporary endocrine structure, and it starts releasing women's second primary sex hormone, which is progesterone. And so for naturally cycling women, you get this nice waxing and waning for the first two weeks.

Estrogen is the primary sex hormone. And then during the second two weeks of the cycle, during what's known as the ludial phase of the cycle, progesterone is the primary sex hormone. And each of these two sex hormones is charged with different types of activities. And so for the first half of the cycle, when estrogen is the primary sex hormone, the body is optimized for attraction and sex. And this is because this is the period in time when

pregnancy is possible from sex. In particular, that five-day window prior to ovulation and then within 24 hours of ovulation. Is that why our skin glows and our hair is like, yeah. Yeah. Like our body is just like rolling out the red carpet looking for sex. It's just like, oh, it's pretty funny how that works. Yeah, it is. It's like you look great. And everybody. looks great to you. It's like men. It's just like, yes. You're like, yes. And they're like, yes, because you smell better. You move sexier. You talk sexier. Our voices sound different. We expose more skin and the clothes that we're wearing. And estrogen is like doing all of these things because it's essentially optimizing our body for the possibility of conceiving. And so it's like

making us our sexiest version of ourselves. After the egg is released and then we're releasing progesterone, this is during the phase in the cycle. when pregnancy is not possible from sex. And this is a period in our body that's optimized for conception and pregnancy. And so this is a totally different set of problems, right? Our body wants to do different things. It's not all of a sudden it's not about sex. And instead, it's about things like resting and accumulating calories to make sure that we have

enough calories to be able to build this really costly endometrial tissue that our body will use for pregnancy and preparing for pregnancy and keeping us safe at home. women were very sort of primed and attuned to the possibility of threats because our body is in a vulnerable state and so on and so forth. And so for a naturally cycling woman, you kind of go between these two hormones and, you know, and that's kind of the way that life is. And you get to wax and wait and enjoy all the beautiful bounty of being a duly hormonal creature. And now when you go on birth control pills, what you're doing is you're taking a daily dose of a synthetic form of progesterone called a progestin. And then when you have a combination product, like combination

hormonal birth control pills, this is also accompanied by a level of micronized or ethanol estradiol. So it's a synthetic estrogen. And the synthetic estrogen is more or less biologically identical to estrogen. It acts a lot like estrogen in the body. And then you have the synthetic progesterone, this progestin, which I'm going to return to in just a moment. But the that these products work is the progestin in the birth control product. It stimulates the progesterone receptors in the brain to such an extent that the brain believes that it is just ovulated. Right. So the brain thinks it's just ovulated. So it doesn't stimulate the ovaries, right? Because it thinks that it's waiting to see whether or not that fertilized egg is actually going to implant itself. And so

the body is sort of fooled into believing it's in the alludeal phase of the cycle. All the time? the whole time. Yeah, so every day you're getting the same daily dose of a relatively high level of progestin, this artificial progesterone, and then some of the products don't even have any estrogen in them at all. And then for the ones that do have estrogen in them, it's a relatively low level, particularly compared to the level of progestin. And so when you go on hormonal birth control, some of the side effects that women experience are simply the result of the fact that they never get to be and enjoy that really beautiful estrogen-dominant phase of the cycle. Yeah.

I'm thinking now, like, my mom was incredibly wise because I would have missed out on all that estrogen, which brings serotonin and dopamine and acetylcholine and amazing things. Yeah, it's when most women feel their best. And I know, like, so I had the experience of, you know, I was on hormonal birth control for a very long time. And when I went off of it, I'll never forget the first time that I, that I cycled afterward, because I was just like, hello. What have I been missing? Like, how have I been missing out on this? I was so, I'm so upset that I'd be missing out in this really lovely experience that you have during the first half of the cycle. And so women were using hormonal

birth control, part of the things that we see, like, in terms of, you know, decreased sexual desire and less attunement to sex and pleasure, these things are all the result of the fact that their estrogen is pretty much flatlined during the course of the cycle and that they're constantly in this state that is more similar to the ludial phase or the progesterone dominant phase of the cycle

than the other half. The other thing that happens, the other set of side effects is the fact that these progestins that are in hormonal birth control are really funky. And they're molecularly funky because they're not,

they're not derived from progesterone. So like ethanol estradial, like feels pretty much like estrogen and it's got good binding affinity and binding specificity for estrogen receptors in the brain and the rest of the body, meaning that it kind of acts like estrogen. Progestins are not synthesized from progesterone. Most of them are synthesized from testosterone. And so they're just monkeyed with molecularly in a way that allows them to stimulate progesterone. testosterone receptors in the brain, which is what shuts down ovulation, right? Because the brain thinks that it just ovulated. But they don't have good binding specificity, meaning that they bind to other things. So, for example, sometimes they'll bind to testosterone receptors. And this is why

women who take these second generation progestins, like lirvonagestrel, which is a very popular type of progestin that's used in a lot of hormonal birth control, can have some side effects like skin breakouts and even like things like getting facial hair because their androgen receptors or their testosterone receptors are also being stimulated. Wow. And they also don't have necessarily great binding affinity either. And so they will kind of fall off the receptor and not have some of the effects that we might want from progesterone, right, some of the positive effects of progesterone. Right. And one of the things that they do, so well, there's two of them. So two of the things that that this is most relevant to is one. In addition to sometimes stimulating testosterone receptors,

these funky monkey regestins have also been known to have affinity for binding to glucocorticoid receptors. And this is, of course, the receptors that bind the stress hormone cortisol. And this can actually create a state of chronic stress within the body, right? Because it's having these receptors stimulated over and over and over again. And what we see is that because of this, women who are using hormonal birth control, a lot of times their bodies will actually shut down the cortisol response to stress because that's what the body does when it's undergone chronic stress, is that it'll just say no more stress for you, and it just shuts down the functioning of the HPA axis. And what we tend to see is that women who use hormonal birth control, many of them

don't get a cortisol response to stress, which is not adaptive. And it's something that actually minimizes a woman's ability to cope with stress. And it minimizes the ability to regulate your emotions and response to stress. This is what we tend to see in people who have PTSD. Like their body shut down the stress response. And that's part of what's responsible for their symptomology is that their body is like, you know, there's too much cortisol release going on when they're going through whatever it is that's triggering the PTSD.

And so the body is like, no more cortisol for you. Just because cortisol is so disruptive when it's constantly being, constantly being released. And so this is one set of effects also that can, you know, result from using hormonal birth control. But the other thing about these funky progestins that can lead to some of the side effects that we see in women who are on hormonal birth control is that when they get metabolized in the body, because they're not actually progesterone, they get metabolized in a completely different way and it leads to different metabolic products. And so what we know about progesterone is that it's actually, even though it gets kind of a bad rap, which I think it gets a

bad rap because people confuse it with progestins in birth control, but it gets kind of of a bad rap and in and in and in and and and so of the bad rap yeah you know because people I love progesterone I wish she would come back I know yeah no progesterone the best I mean you know and I think that there is a little bit of confusion but yeah it is it is like it's an amazing it's a beautiful hormone it does a lot of really great things in the physical body it does things like promoting neuroplasticity in the brain like there's some really cool research looking at using progesterone in the context of things like traumatic brain injury because it does increase neuroplasticity I saw some research on that. Yeah. Yeah. So it's beautifully protective to the brain. And then when it gets metabolized, one of the things that it does is it releases this really powerful neuro steroid called alapregnanolone. And alipregnanolone is a really powerful stimulator of GABA receptors in our brain. And GABA receptors in our brain lead us to feel some of the things that we like to feel when we're like sitting by the fireplace and relaxing. Right. We just finish a yoga class, right? Or meditating.

that's like the feeling of GABA. Another thing that stimulates GABA receptors is alcohol, right? And so if anybody's had alcohol, right, you know that feeling that you get where you're feeling kind of relaxed. It's a very same type of an experience, right? You get this feeling of like relaxation and being chilled out. And women who are naturally cycling and releasing progesterone, we get a free dose of this every month when we're releasing progesterone because our body is producing this powerful metabolite that chills out the brain and makes us increase. of neuroplasticity across the cycle. So even out of the, even out of the ludial phase, but hormonal birth control, because it does not contain progesterone, it contains progestin,

and these progestins when they are metabolized do not lead to the release of alipregnolone. They're lacking some of this really beautiful activity that helps to regulate many women's moods across the cycle and helps to maintain psychological balance and mood balance in naturally cycling women. That was a beautiful description, by the way. I really appreciated that. So what would a symptom, what would this symptomatology look like of like a 25-year-old? And I know we're going to get into menopause and perimenopause. But what would it look like? Does it look like I can't, I'm react, I overreact to stress and I can't calm myself. So now they put me, what, on an antidepressant or something to counterbalance that? Yes. Yes.

Yes and yes. So essentially it feels like being really easily overwhelmed by everything. Yeah. Right. Having sensory stimuli and everything else just be too much, right, where you feel like you can't regulate, you can't absorb your environment. You can't like regulate your emotional responses. Sounds like menopause. Yeah, no. Well, no, totally. I mean, I think hormonal upheaval, like, even in all of its various manifestations, feels the same in a lot of ways. Because it's like you also see similarities between like postpartum depression and PMS and PMDD and PMD. and, you know, and puberty and then the menopausal transition. I mean, anytime that our hormones are being shuffled up like a deck of cards, it just, you know, leads to, you know, all kinds of evil. But yeah, like feeling overwhelmed, feeling depressed, feeling like you can't cope. These are some of the ways that you can experience these feelings, feeling like you can't regulate your emotions. And, you know, for some women, this, they have the experience of like recognizing that it's happening.

Like they can see themselves almost in the third person and reacting in the same. And reacting in the way, but they can't talk themselves out of it because they're just not able to quite regulate their emotional responses. So that, I mean, that to me is a lot of menopause symptoms. And which would make sense because in menopause, you're missing hormones. So what I'm hearing is that you're missing hormones when you're taking the birth control pill. Oh, 100%. Yes. Because you don't get that beautiful, you don't get the really beautiful changes in estrogen and you also don't get these really nice changes with respect to progesterone. Right. Are you still, are you still releasing an egg if the estrogen isn't high enough.

No, so you're not even releasing eggs? No, and that's actually how it prevents pregnancy, right? So it's like, it's like really clever in that way because it's like it prevents your body from stimulating the egg follicles so you never release an egg and then you don't ever get pregnant. But releasing, like creating and releasing eggs is how we make hormones. And so when you. Right, right.

It's beyond just having a baby. So then what happens if you go on like the birth control pill at 16? and you get off of it at 45. And you've never, you haven't been releasing eggs. You don't have your own natural hormonal rhythm. Right. What happens at 45? You know, that's a really great question.

And the thing is like, there's almost no research looking at the effects of hormonal birth control on like the development of the brain or the rest of the body, especially during adolescence. You know, because a lot of women are put on it really early. Like you were saying, like if you're 16, you know, or even if you're really, if you're any age, before 20 and you're going on this, your brain and your body are still developing. And, you know, they're going through the pubertal transition and the leading, you know, sort of architecture in the transition, you know, of building your, taking your childlike brain and body and turning it into the grown-up version of itself are your sex hormones. I mean, they're leading the orchestra

in terms of coordinating all of the development that goes on in your body during the pubertal transition. And so then to suppress hormone production, right, and replace it with these synthetics that are either, you know, inadequately stimulating our hormone receptors or simulating some of them but not the other ones or stimulating the wrong ones altogether, we don't know what that does to development. But there's absolutely no way. It would literally require a miracle from the scientific heavens for it not to affect development. Because this is no way. I mean, it's like our hormones. You've manipulated a core system in our body now. Yeah, I mean, there's just no way that when you take it during the developmental years where sex hormones are playing an organizational role in the body that is not going to have a lasting impact. And we just don't know what it is or whether it matters. Do you know what I mean? Like it could be that it affects all these systems. But if you really look at, you know, outcomes, like how people feel and experience that it doesn't really matter. I don't think that that's probably the case, but it could be because we just don't know. But there's just no way it doesn't affect it. Yeah, I mean, it seems impossible. And if you're not releasing eggs, I mean, I have so many thoughts on that because there's a lot of wisdom in those eggs. And then what, do they just die inside the ovaries? Like, what happens? If they don't have hormonal juice, do they just wither away and die in there?

Yeah, well, so that's a really interesting question. It's not one that we have a really full answer on, but I'll tell you what we do know, and it's like little pieces of information. So we do know that they don't just stay there and get preserved, right? Because or else it would be wonderful, right, if women just went on the pill and then they were like 45 and went off it and then could be fertile. Yeah. You know, for 15 years. Yeah. Like that would be fabulous. Yeah, no, totally. And so. So that doesn't happen, unfortunately, because people have looked into that. And so what seems to be happening is that there's a little bit of egg, like the egg follicles are starting to get stimulated because like the levels of the hormones in birth control aren't high enough to fully suppress it completely. But it just leads to these little minuscule amounts of endogenous or internal estrogen being released. Not anything that's like physiologically noticeable. But it does seem to suggest that what's probably happening is that these egg follicles are starting to get stimulated where they're growing a little bit. but then, yeah, then they ultimately wither away it die. What, what, what. So I'm pretty sure that all the avid listeners of the Resetter podcast are now sending this episode to their daughters that are in their 20s.

I can pretty much guarantee that. But what about when you do hit your mid-40s, like knowing that this occurred and now you're technically moving into the other end of the hormonal spectrum, Are there some tried and true things that a perimenopause menopausal woman needs to know if she's been on birth control since she was 16? Like, and eat like a girl, I did some research on the nutrients that are lost through the birth by taking regular use of the birth control pill. Is there any way we can ease the transition off of that when you're in your perimenopausal years? Oh, right. I mean, I would imagine that whatever, you know, the types of things that are going to ease. the transition for a cycling woman are going to be very similar, if not exactly the same as what it would be for a paramedopausal woman. So the recommendations that you make for readers of your book about nutritional

deficiencies, for example, that you can try to address when you're transitioning off of birth control, I think can be very helpful to paramedopausal women. I think that the transition into the paramedopausal transition and then the transition in a full menopause. I think that, you know, that transition is probably going to be pretty similar for women who have been using hormonal birth control and those who are not, except that, you know, there's this tendency with doctors when women are going through, you know, the menopausal transition is to stick them on the birth control pill or just to keep them on the birth control pill. Yes, I've heard this so many times. Yeah, I've got friends who were, who've been on it for a really long time and they're entering their late 40s.

And their doctors are just recommending that they stay on it, you know, until they're absolutely sure that they won't be cycling anymore, like in their 50s. And, you know, you know, I don't. What are your thoughts on that? Well, I just, I just don't know. So here's the, I, here's the story with that. So, you know, for a naturally cycling woman who's going off of hormonal birth control, it can, you know, usually starts with a decrease in the release of progesterone.

That's the first, you know, hormone to leave the party is that you have these sort of wonky cycles where we start to mature an egg, but it really doesn't go anywhere. And so you're releasing estrogen, but then because there's not really a nice, healthy egg follicle that's releasing this nice healthy egg, you're not releasing progesterone. And so you kind of go through this period where progesterone levels are low, estrogen levels are high. You kind of, you know, and you kind of have to ease into that. and then estrogen levels start to get lower and you have to kind of ease into that. And it's not fun for anybody.

Like, I don't know anybody who's like really celebrates this as an amazing time during their adult lives. But it can be relatively smooth sailing if you handle it right. We can talk about what some of my thoughts are on that because I do think that some women really do well using hormone therapy. And so we can kind of talk about that. Yeah. And then also like ultra-

to that if you don't want to do that, because I know that there's also a lot of women who are like, I don't want anything to do with synthetic hormones. And there's things to do about that too. But for women who are transitioning off of hormonal birth control, especially if they've been on it for a really long time. And you're transitioning from that into cycling. That's a little, I mean, it's a little bit of a, it's some bumps. Right. Yeah. Yeah. You get some bumps in the road because you go from having this brain that's used to getting the same hormonal message every day. And especially if you've been giving your brain that same message every day for several years, right? In some cases, decades, you know, where women are on it for like 20 or 30 years and they're getting the same hormonal message. And then all of a sudden you take that away and then it's being replaced with this dynamic, you know, these dynamic changes.

And your brain has to do a lot of, you know, figuring things out. And you have to have a lot of neuroplasticity to be able to like create new hormone receptors and all these other things for your body to deal with that. And so to transition off, then naturally cycle and then have to, you know, then transition from that into the hormonal. It can be a little bit of a, a little bit of a rocky road. Yeah. But, you know, I don't, you know, I, it's, I, I think that getting the benefits of cycles is always a good idea. Just because hormones and the release of hormones, they have so many positive effects on our body. they affect bone density, they affect neuroplasticity in the brain. And so, you know, if you're in that sort of

spot where you're having to, you know, figure out, like, do I just stay on birth control forever? Or do I capitalize on the benefits that I get from actually cycling? I would say benefit from the actually cycling for that period of time to get the benefits of the other hormones, even though it is a little bit of a rocky road, that it might be worth it. Yeah. That's what I'm thinking is find a natural rhythm because one of the things that I've heard, and this was my big complaint around my daughter beginning on the birth control pill, is now you're synthetically manipulating a natural cycle. So if you go from the birth control pill to hormone replacement, where is the woman's natural rhythm? Like the brain doesn't really know that. And that seems like

it could be a little dangerous. Yeah, yeah. I think that that can be, I think it could be, if nothing else, really confusing. Yeah. For the... Confusing might be the best way to be. Like for the poor brain, you know? Like, what is this? Like, what are we doing here?

Yeah. So I do think that there's, I think that there's benefits from transitioning off and like trying to reap as many benefits as you can from cycling while you can. Yeah. And then, you know, and then deciding whether or not you want to, to use hormone therapy. And, and, you know, to get at the hormone therapy point, like, I have had women ask me about, you know, like, is hormonal birth control? Like, is this the same as, as hormone therapy? And the answer to that is that it's not. And the things that are different is that when you're doing hormone therapy

is that the hormones that are that you're using are biologically identical, meaning that they have good binding affinity and specificity to the hormone receptor. And this is true for the ethanol, or for the ethereal oestradele, so the estradial that you use. And also, instead of a progestin, you can you use actually micronized progesterone. And this is a replacement. Yes, in hormone replacement. And this is an important distinction because for women who are going through the menopausal transition, and if you're depriving them of, you know, alipregnolone,

that really nice neuro steroid that you get when your body's breaking down progesterone. Yeah. I mean, it's just not, you're not getting all of the benefits of hormones. You know, it's like you're getting all the costs of having low levels of hormones and you're getting none of the benefits. And so sometimes. Right. Sometimes women's doctors will be like, let's just keep you on hormonal birth control this, you know, this whole time. And to that, I say, I don't think so. Like, I would just try to go off of that, get as many benefits as you can from your natural cycles while you're having them. And then during that time, you can make a decision about whether or not then you want to kind of like supplement your hormonal changes after a period of time once you've got a handle on your cycles. Supplement that with the use of, you know, synthetic estrogen or. You know, or a micronized progesterone.

Because both of those things can be helpful to women as they're going through the hormonal transition. And especially if they're working with a thoughtful provider who's willing to, you know, allow them to do things like, for example, take micronized progesterone during the ludial phase of the cycle, just, you know, during the last two weeks to help supplement the fact that many women get progesterone deficient in the menopausal transition, where they're having all that gnarliness that you get from,

from unopposed estrogen, which, you know, you'd think would be a lot of fun. Unopposed estrogen. I like the way it's, you said that. Go ahead. Keep going to go ahead. Yeah, I mean, you think that'd be a lot of fun where you have this cycle where it's just like estrogen and then like no progesterone. But it doesn't feel that way.

It doesn't feel the way at all. It's like women feel on edge and they feel, you know, like just like totally overwhelmed and crappy. We may just keep talking and never stop talking. Yeah. Like, I could just, yeah, progesterone chills us out. So that's pretty funny. Yeah. Yeah, no, totally. And so, so, you know, using micronized progesterone as part of hormone therapy is a totally different animal than using hormonal birth control, which contains these progestins. And so the hormonal sort of the traditional hormone replacement therapy is, is a lot more in tune with what actually goes on biologically in women's bodies. So if, so if you're listening to this and you're 50 and your doctor said, stay on the birth control pill. What I'm hearing from this is let's have a different conversation with your doctor or get a

different doctor who can move you over to a different hormone replacement or bioidentical so that you get actually something that's more age appropriate. Well, right, exactly. And also, you know, I would suggest that rather than jumping from one thing to the other, right, that you take a couple of cycles and figure out where you're at because a lot of women don't even know, you know, it's like they've been on it forever. And then they're like, I have no idea if I'm metapausal or not. That was our biggest surprise when fast like a girl went out into the world was how many women didn't know where their cycle was.

A lot of them were 20 and 30. You know, we've seen with fasting and fasting for your cycle and with monopausal women, I have them fast according to the moon cycle. So that they have some kind of rhythm that they can work with. I love that. It's really, when you dive into it, you start to see how connected we are to water. all of it, it makes so much sense. But on the surface, it sounds very, very witchy, but it's really quite remarkable. And what I see with these women is when they come back to some kind of cycle, whether they're 60 or 70,

oftentimes they'll have one or two days of a period. And I will get like an email or when I was in my clinic, they would come in and they'd be like, oh, my God, I'm 60 and my breasts are tender. and then the next week they'd be like, I actually bled for a day and all of that. And they hadn't had a period in a decade. And my belief in that was we were just bringing a lifestyle and giving them the rhythm that the female body was supposed to have. And that's what Fast Like a Girl did. I love it.

I love it. It's like, that's so amazing. That's so amazing. Yeah. But then, but then, you know, I would always be like, well, I don't know. I actually am thinking now that is there any. risk if you've been on the birth control pill for decades, then you go into your perimenopause or postmenopausal years and you're trying to reestablish a rhythm. I mean, even if you don't have

a very consistent cycle or you have no cycle, you may have some eggs in there that haven't been used and you could be a little surprised. Right. I would be, yeah, I think that, you know, I would get some hormone test done just to like see, kind of see where you're at. Because if there's any chance of pregnancy, then at least while you're figuring things out, use some condoms. Yeah, right. Just to make sure, because God help us. You know, I learned something the other day. I was, like, talking to somebody, and this was just in the context of women's reproductive

rights and kind of how hard things have gotten. And, you know, and there's this, like, misunderstanding out there that the, you know, that abortion rights, for example, are things, you know, that are, it's because all these young girls are doing all of, you know, using it as birth control. Yeah. Yeah. Yeah. It's like the number one age group of women who terminate pregnancies are women in their 40s.

Wow. Do you know, so whenever we did a ton of detox in my clinic and then I did nutrition and fasting and all of it was mapped to hormones. And the first thing I would say to every single woman didn't matter their age, but the older they are, the more the shock they look is I would say, be careful you can get pregnant because we're about to clean your whole system up. Yeah. And, you know, we had a few oops and we had a few surprises that were actually wonderful surprises, but it's really interesting. So does that, I'm just out of curiosity, then when people get off the pill a lot of times they struggle to get pregnant, like if they're in their 30s. So is that because no, there hasn't been a natural rhythm that the body knows hormone? Right. It was so, so maybe. So let me say this, that there's been a lot of research into the.

this very question about whether or not being on hormonal birth control changes your fertility and does it make it more difficult to get pregnant? And the research seems to suggest the answer to that is no. And so there doesn't seem the average time lag from length of time on birth control use for like getting pregnant relative to people who've never used it is only about a month and a half. Okay. So it doesn't seem like there's big differences there, but I will say this. And that is that, So on the one hand, the answer to the question is no. On the other hand, the answer to the question is maybe. And this is because, you know, when you're on hormonal birth control, it allows you to push back childbearing as, you know, forever.

Right? You're like, well, you know, I'm going to wait and get my, you know, Ph.D. Like, that was me. I'm going to wait and finish my PhD. And then, you know, and if I would have then continued to wait and I didn't, I started having my kids. And thankfully, I was able to have them really easily and it didn't cause any problems. But I have a lot of colleagues who are like, I'm going to wait until I get tenure. I'm going to wait, you know, and then they end up in their, and they wait until they're in the mid-30s and then they have a difficult time getting pregnant.

And so I think that, I think that one of the things that birth control has done or birth control pills and whatever is that it has made us not be in tune with our fertility and the fact that it's that it's not infinite. You know, it's like it's because we have so much control over our fertility with the pill that it feels like we have infinite control over our fertility. fertility and we don't. You know, and some women, they end up having a very difficult time getting pregnant even after their early 30s. You know, it's like it's not a perfect system. It makes sense. You've manipulated the system and now the system has struggles to work on its own. So, yeah, we used to, my clinic had a ton of women in their mid and late 30s that would come in trying to get pregnant and we would use lifestyle and detox to try to bring that rhythm back. So that makes perfect sense to me. And the links between, you know, and I was just having a conversation with a colleague about this, but it's like the cycle is so tuned into the health of the body, you know, and so like the work that you do with like helping to detox the body and get you get your body, you know, sort of back and it's so good for fertility. I mean, the two things are so linked to each other.

Very. Yeah. And in fact, there's, and this is, you know, it used to be like sort of thought of as kind of like woo woo medicine, right? Like this idea that health of the body and, you know, and. and fertility and, you know, ha, and kumbaya. But the National Institutes of Health even in the U.S. now has calls for research trying to look at this because they're learning that this is, in fact, you know, a very powerful predictor of overall health. And it's because when you take care of your body, it promotes fertility. And when the body is in poor condition, for whatever reason, whether it's chronic stress or you're like not eating right things or, yeah, you have nutritional deficiencies caused from birth control use or whatever it is, then this can cause issues with fertility.

That's crazy. Okay, you have to talk because about how when you are, if you're on the birth control pill and you pick a mate, you get married, and then you get off that you could have picked the wrong mate. What was the study on that? But that hit everywhere. And my brain was like, yep, that's why you don't manipulate the hormonal system. But it changed your attraction via smell to your partner. I mean, yeah, and like all over the place. So just to contextualize this for you a little bit, for about 25 years now, there's been research in psychology looking at the role of women's endogenous hormone production and how that affects mate choice. And what that research finds is that when women are at points in their cycle when pregnancy is possible.

So when estrogen is rising, that this increases our brain's attunement to, you know, things related to sexual attraction and sexual desire. So at high fertility, when estrogen is high in the cycle, not only do women look better and our skin looks amazing and we feel great, we're also like super dialed into qualities that are related to genetic compatibility. Right. So we're super dialed into, you know, things like testosterone cues, which is something that's believed to be related to genetic quality.

We're related to smell, which is related to whether or not somebody has compatible immune system with your own and so on and so forth. And so women are just like super dialed into just. genetic compatibility and sexiness when estrogen is high. And it was only more recently that researchers said, wait a minute. If estrogen increases attunement to all of these things, and when you go on birth control pills, it keeps estrogen really low because you're never ovulating. Who are these women picking his mates? Right. And so. And why are they picking them? Yes. And what are they paying attention to? And so then researchers started to follow up on that. And they started looking at the

differences between the types of qualities prioritized between women who choose their partners when they're on the pill or women who choose their partners when they're naturally cycling. And one of the things that they found is that, lo and behold, if women choose their partners when they're using birth control, that they're not really choosing based on these qualities related to sexual attraction and, you know, just sort of like sexiness and like scent and some of these other cues that naturally cycling women choose, instead they're turning to prioritize cues related to things like parenting. Like, does this person seem like they'll be a good parent? Does this person seem like they will be a good provider? Is this person somebody I get

along with? And so they're really focusing on some of those other qualities that tend to impact mate choice. Because whenever we're picking partners, we're always kind of balancing this need between you know, sexual attraction and that and then also good partnership ability. Right. Is this going to be somebody in your younger years? Yeah. Yeah. Is this somebody I can get along with? Is somebody I'll be able to raise kids with and so on and so forth. And so what this, of course, also means is that it's possible that if a woman chooses her partner when she's on the pill and then she discontinues the pill and all of a sudden she's naturally cycling and she's going through this phase in the cycle when estrogen is dialed up and she's tuned in to all things, you know, sexual

compatibility and physical attractiveness and sexual attraction and scent, that in some cases this can lead women to say, oh, I'm like, this isn't what I want. And this can happen. There's been research that shows that, and one of my favorite studies was this really nice longitudinal study of married couples where they looked at changes in sexual desire and sexual attraction within a relationship among women who chose their partners when they were naturally cycling or on the pill. And what they found is that for women who chose their partners when they were on the pill and then they go off of the pill, that you get changes in sexual desire and sexual attraction to your partner, but whether it gets better or worse depends on how attractive their partner is.

And so what they find is that the women who happened to choose while they were on the pill just so happened to choose somebody that was really attractive and sexually desirable, that they have increased sexual attraction and increased desire and increased relationship satisfaction after they go off the pill. but for women who chose lesser sexually attractive partners, they had decreased attraction to their partners, decreased sexual desire, decreased sexual satisfaction in response to that.

And you tend to hear, you know, both sides of these stories. I can't tell you, like I've heard from so many women who've read my book and, you know, and you're listening to some of these podcasts and talking about what we know about the pill and partner choice.

And, I mean, you have some women who are like, I went off of it. And then my partner was just so, attractive to me just like I just couldn't get enough and you know but then I also have heard from women who are like yep that happened to me I picked my partner I went off the pill and then I could not stand the way that they smell and or like just I just wasn't attracted to them or the other thing is that it's not so much that I wasn't so attracted to my partner I wasn't that attracted to them but I was

finding myself very attracted to other people yeah oh wow yeah because it's almost like you know it's like when you have your estrogen shut off, you know, you're like not in tune with that whole part of yourself, right? There's this whole part of ourselves that comes out in response to estrogen. And, you know, and it's this part of ourselves that's like, you know, is sexually motivated and as, you know, like notices attractive partners and, you know, wants to have sex and all of that. And then when you have that turned off, I mean, you can imagine, you could just kind of pick a partner where you're like, oh, yeah, no, yeah, I like, like you're good looking, you know. Yeah. And then all of a sudden you turn that up again and it's like, and if it's not the person, you know, and all of a sudden you can be like, uh-oh, like the next door neighbor is like really sexy to me. And then I'm wondering too, you know, a lot of the statistics that I've seen on menopause, one of them is that, and I've seen two different statistics. One says 65% of divorces are initiated by women after 50. I've also heard 70% are initiated by women after 40. So I think there is something.

that is happening there. And one of the major reasons I wanted to bring you to have this conversation is because when we look at the menopausal journey, I feel like we don't talk enough about, well, what did it, what did all those years on the birth control pill do to you? And when you get off of it, now you're dealing not only with these low hormones, but with things like you're bringing to the conversation. And, you know, as a psychologist, I would think, like, everybody should be considering this in therapy when, in couples therapy, maybe when we're looking at the brain changes that are happening because of the hormones, how potentially the birth control pill may have manipulated the connection between a couple and then once you get off, it's different. Yeah, it's so fascinating. And I think that, you know, hormonal changes and, you know, whether it's a birth control pill or going into the menopausal transition,

And the way that that can really uproot your sense of yourself is something that we just don't talk enough about. Yeah. And it's like, I don't think it's so funny because when you talk to younger people, because I'm in my late 40s now. And so, you know, I can say I can say younger people. They're like, like when you talk to younger. You earned the right. That's right. I can say those young people.

Those youngans. Those youngans. When you talk to younger people, I don't, I don't think that they have a sense of the extent to which their hormones are part of who they are and their sense of themselves until, you know, But when you talk to women who are in the middle of the menopausal transition or on the other side of menopause, they absolutely understand it. Yeah. Like wait until they go away and then you understand exactly what they did for you. Right. You're like, oh, wow.

But it's so interesting because it's like the way that we see ourselves, right, in our identity and all of that gets wrapped up in our hormones, you know, to an extent. And I've talked to people, women who've had the experience of, and this one does not happen often. but it happens and I've absolutely no doubt that what these women are reporting is the result of the hormonal changes on the pill. But I've had people report that they've even had changes in sexual orientation where they thought that they were bisexual, for example, and then they go on or off of it and all of a sudden they are like, oh my gosh, no, I'm actually fully a lesbian. Or I thought I was bisexual and now I'm fully, I'm heterosexual and I can't imagine having a relationship with a woman anymore. And I think that we also get this in metapause, because you also

see people who have these changes and sexual orientation that even go on, you know, as there, and a lot of times the assumption is like, oh, this is just somebody who is a closeted, you know, a closeted lesbian and they had their kids or whatever, but I think there could be more too than that. I think that there could also be the role of the hormonal changes that, you know, if you're kind of on the edge, you know what I mean? Because sexual orientation lives on a curve. Spectrum. Yeah, it's a spectrum. And so some women who are kind of on the borderlines of the different sides, I can totally see how either the menopausal transition or changes in hormonal birth control can nudge them one way or the other. And it just goes to show like how important

our hormones are and just creating the experience of being who we are. Yeah. What do we have any research about how going on hormone replacement therapy changes your connection to your spouse or changes your sexual orientation? Like you're talking, about the depletion or the getting off of, but what happens if you come in with hormone replacement? That's interesting. So I haven't seen anything with respect to sexual orientation, but definitely like with, and not necessarily even like specifically attraction. But there's plenty of research showing its effects on sexual functioning and that women feel more dialed into their sexuality when they're using hormone therapy relative to what they feel when they're not using hormone

therapy. And, and the, you know, this makes sense when we think about all of the things that estrogen does. Right. And it's, and it, and there's kind of two parts to this because on the one part, it's, you know, it, it, it, it, it, it, it, it, it, it, it, it, it it flips all these little switches in our brain that make us feel, you know, sexual desire. But it also, because of the physical changes that it, you know, causes, like, it increases, vaginal lubrication and some of these other things, which also makes sex easier because a lot of times of women are going through the menopausal transition, you get a lot of vaginal dryness. And then that, of course, leads to a feed-forward cycle, right, where you're thinking about that, and then you're not thinking about sex, and it just makes it all worse. And so by eliminating some of those symptoms, it allows

women to sort of relax into their sexuality in a way that also then facilitate sexual desire. The other thing, too, that I've been deep into studying right now is estrogen's connection to oxytocin and how estrogen amplifies oxytocin. And the, and the other thing, too, that's So the question I've been pondering is, well, what happens when estrogen goes away to oxytocin? Oh, interesting. Yeah. And there's a couple of things I've I've researched. And one is definitely the desire to nurture in menopausal women is muted because you don't have estrogen amplifying oxytocin. So you're not as like, you know, wanting to take care of everybody. When you look at people pleasing,

it's actually people pleasing is actually an oxytocin. It gives you that oxytocin-rich environment. It gives you that oxytocin, like, it made you happy. And in the presence of estrogen, that will amplify oxytocin's effect. But when estrogen goes away, all of a sudden, I mean, hang out with any menopausal woman, and you'll find really quickly she is not interested in pleasing, you know, and that there's very much a different mentality. And I think that's because of the relationship between estrogen and oxytocin. That's really interesting. And it would be really interesting to look at that with women on Horvents. hormonal birth control also because and and there's been some work and there's yeah there there's been some a little bit of work on oxytocin and birth control and so for example in one study well actually it was it was two different studies from two different labs where they found that there was some disruption in the oxytocin signaling and so it wasn't specifically like the oxytocin levels but it was that like even if they were administering internazal oxytocin that it wasn't doing the things that it's

supposed to do right in terms of promoting feeling of connectedness with others, which is really interesting. And it's also really interesting when we think about that with birth control with respect to women after pregnancy, because of course we know that oxytocin is a really important contributor to the mother child bond. Yeah. And for, you know, when women, and even when women are breastfeeding, so I remember I breastfed both my kids. And my doctor was trying to put me on birth control, like, you know, at my three month or whatever that is, six-week visit. They're like, all right, we'll take these progestin-only birth control pills. They don't, you know, they're not going to get into the, they won't affect your milk supply or whatever.

And I didn't go on them because I wasn't ovulating. And I was like, I'm just going to track my cycle and I'll know when I start ovulating again and then I'll worry about it. And so I didn't have to. But a lot of women go on it, right? The doctors give them this, you know, birth control right after they have their babies. And I wonder about the bonding between the mother and the baby. Yeah. And whether that causes a disrupt. there, which, you know, is a really important issue. Fascinating. You know, the other research I found is that there are oxytocin receptor sites in our bones. Oh, interesting. And so they believe that when you go, part of what's

contributing to menopause is not necessarily the loss in estrogen, but it's also the loss in oxytocin. And that's contributing to osteoprocess. So I wonder if with the birth control pill, if we see, like, with competitive athletes, I want to. wonder if there's more like strange fractures, stress fractures, things like that. That's really, that's a really interesting question. And also, you know, another thing with, you know, when we're looking at things like osteoporosis and that sort of thing, you know, progesterone. So everybody, you know, people seem to recognize that estrogen plays a role in bone density, but so does progesterone. And it plays a really important one. And my guess is,

if you look at osteoporosis risk of people who are birth control users and not that those who, who were birth control users because they didn't get actual progesterone, they were getting that funky monkey progestin that doesn't do any of the things that progesterone does except for stimulate some of those receptors, is that you're going to have weaker bone density.

And so I would think that, you know, for your listeners who haven't had a bone density test, if you are a former birth control user, that it's worth getting checked out to just see whether or not you need to do a little extra resistance training or other things that you can do to build some skeletal muscle

and then bone density. So well said. Either that or just hang out with your besties all the time and get a lot of oxytocin. So you can bring that back. That's even more fun. Right. Even more fun. Okay, this was so fascinating, Sarah. Like I, it's when I went to go right eat like a girl, I at that point was like, we need to put something in there about the nutrients that get depleted through birth control. So I have a little section in there of like these are the ones you're going to want to add back in. But one of the things and why I wanted to bring you here is I just keep like watching women get advised to stay on the pill. I've seen women that abruptly get off of it in their 40s and really struggle. So I think what's beautiful about this conversation, I hope everybody's catching this, is that it's a continuum.

Like from the moment the hormones come in until the moment the hormones go away, you know, that impacts everything, everything in your life. And we don't, we don't give it enough credit. Yeah, no, absolutely, 100%. So it's just, and it's incredible. And you're writing a new book, I heard? Yes. With no name, the book with no name. The book with no name. Yeah, it comes out in September. I'm very excited about it. And it's about a lot of these things that we talked about. And some of the work that I talk about is very much credit to you, because you talk a lot about the way that, you know, cycles and hormones are affected by the foods that we eat and not eat and, you know, and how we need to treat ourselves differently depending on what's happening

hormonally. And this book is just about this idea that, you know, we are cyclical and that we need to understand that. And science, unfortunately, you know, has really only studied when women are actually included in research, are only studied during the first couple of, like, days of the cycle even. And so there's this whole phase of the cycle, especially these last two weeks of the cycle when many women feel very terrible. They feel terrible because they're not taking care of their bodies, the way that their bodies need to be taken care of during that time. And so I really appreciate that that's something that's something that's be talking about in your book, but something that I'd be talking about a lot in my book. But, you know, ranging everything from sexual desire and our emotional responses to things to, yeah, how, like how we eat and exercise. Oh, thank you for doing that. I always tell authors, like, I know how hard it is to write a book. And so to take on that task and the conversation's so needed. You know, I always say like when I wrote Fast like a Girl, I really honestly wanted to give women a manual for fasting and a manual that I knew made fasting work for women. But what I did not realize is how thirsty women were to understand their hormones.

and how it plays out in all their behavior. So a book like yours is going to be incredible. And I'm going to tell everybody just Google your name or go into Amazon, put your name in and a new book should appear. I mean, the other existing book is good, sounds good too. But hopefully the pre-orders will be up soon. Thanks so much. Yeah. We're very excited about the book with no title.

You should call it like you can't name us. Like you can't, you know, it's like talking about like women's empowerment. Don't put me in a box. Right. Yeah. Where do people find you? Because I know my audience is going to love this. Okay.

You can find me on social media and my handle is at Sarah E. Hill Ph.D. And that's Sarah with an H. So Sarah E. Hill Ph.D. on all platforms. So that's where you can find me. And you can also find me on my website, which is sarahe.hill.com. Perfect. And I'm sure a name will be revealed because we are, well, we're not. Quite six months out.

Okay. Close. Okay. Well, no, I think that we are going to have a title probably by the end of the week. And so we will, in your show notes, you can put the title. It's like a treasure hunt. Yeah. Yeah.

I love it. It will be a treasure hunt. Yeah. Great. Okay. Well, my podcast producer will put it in the notes. And you all go look at the notes and then you can go find Sarah's book. So, Sarah, thank you for this conversation.

And this was, I really enjoyed this. Thank you. It was so fun. Yeah, I could geek out on hormones with you forever. So thank you again for what you're doing and just the thoughtfulness in which you're bringing this forward. So thanks so much. The world needs it. Thank you so much for joining me in today's episode.

I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends, and let me know what you. your biggest takeaway is.