Fertility Awareness Method Explained: What Doctors Don’t Teach About Ovulation and Birth Control | Lisa Hendrickson-Jack

26:30And there are medical professionals who have training in fertility awareness-based methods, but you have to understand that that's not part of their actual foundational training. That was something that they had to take extra time and effort to educate themselves about separately. I just want to point out how funny it is that doctors have no problem saying, this is anecdotal evidence and the studies say otherwise. But when it comes to fertility awareness method, they have no problem leaning on anecdotal evidence to support their bias and ignoring all of the research studies. I just, I find that amusing, but also sad.

27:09Let's get into the two truths and a lie though. Okay. So you can get pregnant while breastfeeding. True or false? That is true. Okay. Why is that true? Because a lot of women think if I'm breastfeeding, there's no way I could get pregnant. Well, so I think there's certainly nuance to that. There is a birth control method called the lactation amenorrhea method. And the research on that is really fascinating. The lactation amenorrhea method has a 98 % effectiveness rate. And it's based on the premise that if you are fully breastfeeding, meaning no pacifiers, no supplementation, like it's just you and the baby.

27:47I'm a pacifier. One of my friends called, you know, she called herself Moo when she's breastfeeding, like mobile milk unit. So that's you. And then in addition to that, one of their criteria is that you don't also menstruate at any point during that six-month period. And so because there is an actual method of birth control, because I'm sure you've heard people say breastfeeding isn't birth control, which is, I would say, true. But there is this method of birth control called the lactation amenorrhea that, like I said, has these criteria. But it's only women who meet those criteria during that first six-month period that would even be, like, they would only be the candidates.

28:29So with that said, you know, the reason why breastfeeding itself isn't birth control is because, you know, part of the reason that breastfeeding can delay ovulation is because of those suppressive effects. So interestingly, the duration, the frequency and duration of suckling is what has the most significant suppressive effect on ovulation. So that means then that how you're breastfeeding, how frequently, you know, all of those things play a role in that. So we can't just blanket say that anybody who's breastfeeding just won't get pregnant. And then we can look at studies that show when menstruation tends to return and it varies quite a bit.

29:09Yeah. So there's a lot to that, but I would say that would be the reason. And from my perspective, again, coming from a bit of bias as a fertility awareness professional, I would say that, you know, breastfeed and track your cycle. If you're tracking your cycle, the biggest sign that your fertility is returning is when we start to see cervical mucus flowing again. And that for women who are tracking and who are using postpartum charting strategies, like that's what they can look for. And that's how they can identify when their cycle's likely to start to return. So there are ways to kind of manage that.

29:46But yeah, I wouldn't suggest to just breastfeed only and think that you're good. Yeah. And there's an infant variable to this as well. And so anecdotally, my oldest great feeder, great latch, giant baby, I really like ate so much. And it wasn't until like 12 months when I night weaned that my period then came back. My youngest, not the best latch, we did struggle with breastfeeding. I still was able to exclusively breastfeed, but there was just this difference in the suckle and the number of times I got mastitis and my period came back at six months. I remember it was like Thanksgiving and I was like sitting at the table and I was like, is that the period?

30:31And I was like, I was pretty sure I saw fertile cervical mucus like a couple of weeks ago. I just thought I had more time, which is kind of silly on my part. But I just say that for moms listening because I think when it comes to breastfeeding, it's so easy to be like, it's all in me. It's what I didn't do right. And to recognize that there's also a baby variable. There's a whole nother human, and that's a variable involved. And I would also say that there's the person-to-person variable because it's really fascinating. Some women fully breastfeed, no pacifiers, all that stuff we're talking about, and they might get their period back after three or four months, whereas others might get their period back at six months or eight months.

31:09So there's a lot of different factors there. And so it's like further to the point, right? Yeah. So, okay, next one, we had fertility awareness is as effective as the pill when done correctly. True or false? True. Okay. Break it down for us because some people's jaws just hit the floor. I know, right? Well, I shared that 99.4 % perfect use stat and the 98 % typical use stat. And even, you know, I was looking at, there's interesting studies, like I said, that compare different fertility awareness-based methods. And so the key point, the key takeaway is that there are multiple different ways to do this.

31:43And so when we look at, again, the double-check symptom thermal methods, which are using mucus and temperature and also using this last infertile day calculation so that if we break down the cycle, it's only the first half of the cycle before ovulation when pregnancy can happen. So the effectiveness of the method is how well we manage that pre-ovulatory phase. So with these methods, we can look straight at the research, but ultimately what they're doing is they're really locking down the pre-ovulatory phase and giving you very specific rules to learn how to manage that. So if we go back to what we talked about earlier, which is that there's six days of the cycle, that's the fertile window.

32:26So we can really learn how to identify those six days, but also put the guardrails before and after to ensure that we're giving ourselves enough time to confirm ovulation, make sure that we've confirmed that before we open up the infertile post-ovulatory window, it can really work. But I think, you know, the reason why people's jaws could be dropping is because we're basically brainwashed all through junior high to believe that we can get pregnant on every single day of the cycle. That was what I was taught. And I have met zero women who were not also taught that. And even interestingly, when you learn this information, when you like read it and you learn it, there's a part of you that doesn't believe it.

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33:43EBCLIS can be used with or without topical corticosteroids. Don't use if you're allergic to EBCLIS. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EBCLIS. Before starting EBCLIS, tell your doctor if you have a parasitic infection. Ask your doctor about EBCLIS and visit ebclus.lily.com or call 1-800-LILY-RX or 1-800-545-5979. You know, I talk about these three stages of kind of mastery, if you will, when you're learning fertility awareness. So like the first stage is like the book knowledge.

34:13So that's like where we're at right now. You know, you can read the study and you're like, wow, look at the mucus and the temperature goes up. And like, this is a whole thing. And wow, I can touch my cervix and it actually feels different. So that's like the knowledge part. when you start to understand it. You understand the hormones in the cycle. You understand how to tell when you've ovulated. I would say the second part is when you actually start charting. Then it kind of becomes real because instead of it just being in the textbook, you're actually seeing your own temperatures rise and you're seeing that coincide with your mucus going away.

34:45And then you're seeing your period come back, you know, 12 to 14 days after you ovulated and you see that consistently. So now it's real, but there's still part of you that doesn't believe it. Yeah. And so I would say then the third stage, which no one can do for you if you are charting your cycle and if this is a method that you've chosen to use, is when you actually start using it. So when you've actually charted and you start to track your cycle, you know your fertile days, you've worked with somebody, you've done your research, so you're not just kind of randomly checking something on TikTok, but you actually understand what the rules are for the method that you're using.

35:20and then you have unprotected sex on the infertile days. And after your little mini freak out, you gather yourself together and then your period comes and then it comes again and it comes again. And I feel like it's really not until you've actually done it that you truly, truly trust it because the indoctrination and brainwashing, it's deep. Yeah. So let me ask you. So first, let's do this. Let's put the pill efficacy, typical versus perfect use up against fertility awareness method, the one with the highest efficacy rate. How do they compare? I mean, I shared the stats for the fertility awareness method.

36:00The pill typical use efficacy typically ranges somewhere between like 92 % to, you know, 95%. So I think that's mind boggling for people because this is the method we put on the pedestal. And the typical use stats are not 99%. No. So that's interesting. I mean, there's a lot of different variables there. And I think one caveat for someone who wants to come at me to say, come on, right, it's not as effective. It goes back to what I said about there being this umbrella term that we say fertility awareness. And anybody can be in that. There are studies that won't really define that well. And so if someone says, I'm using an app, or if someone says, sometimes I take my temperature, they're going to be included.

36:48And of course, those failure rates are really high. So that's when we're seeing, you know, 70 % efficacy and things like that. So I think that if we're wanting to provide accurate information for women so that they can make informed choices, we have to be able to understand that there's nuance to this, understand that there are multiple different methods. And so the first thing is, well, which method appeals to you? Some women prefer mucus-only methods. Those methods do tend to have a lower efficacy rate. You know, some women, it's like life or death. They were on birth control. They had horrible side effects, but they need birth control, and they feel like they have no other options.

37:26So for those women, we need to be able to educate them about the fertility awareness-based methods that do have the highest efficacy. You know why? Because no one ever forced anyone to chart their cycles. So women who choose this, I always say they're self-selecting. Yep. If you're listening to this and this resonates with you, you know what I mean? You're like, this is amazing. I never knew that there was a way for me to prevent pregnancy successfully without hormones. I've been struggling with these side effects, and this is actually giving me another option. There are plenty of women who are really drawn to this.

37:59We are capable of figuring this out. With the right support and the right practice, you can do it. I think the wrong thing is just to, out of hand, say fertility awareness methods don't work. There's a lot of women who do experience failures. We could talk about that too. And user failures are the most common. But my question would be, well, which method were you using? Like, what were you following? Who trained you? Like, did you seek support from a trained instructor? Or like, how did you determine your fertile window? Like, what was happening here, right? There's a reason why a lot of women don't have success.

38:36For people who want to come at you, I just want to say, you're not saying an opinion here. None of this is your opinion. everything is based on the research. We will put the citations as always in the show notes so you guys can read the studies for yourself. I think that's just really important to understand is that this is not opinion. And I also find so often when people are like, my cousin did this method and it failed. I've had patients that are like, I tried this, it failed. We go through, what were you doing during your fertile window? Well, we just pulled out. I'm like, oh, okay. So you weren't doing fertility awareness method.

39:07You were doing the pullout method and it has like a 20 % failure rate because men are not super great at overriding like the amygdala and everything and knowing like there's a that is a male fail failure not like you failed and it's something completely different before we move on to what the lie is what is typical versus perfect use because we're using that term all the research uses that term but we also are never taught that you know in is this Normal, I wrote about how U.S. sex ed is fear-based. You'll be afraid of STIs, be afraid of getting pregnant, be afraid. We see some of the highest rates of teenage pregnancy, STIs.

39:49It's a failure the way we're doing it. We look at countries like Germany and the Netherlands who take more of a science-based consent and giving real honest information. And what they actually found is that almost their entire population is delaying their first time they have sex because they're like, I want it to be meaningful. Like sex is more than just, you know, they don't get pressured into it and they report more satisfaction. So you're actually seeing people as adults are having better sex lives and better experiences and less risk because of the education. So I'd like to educate people.

40:27What is the typical versus the perfect use when we're talking about, talking about the pill, talking about fertility awareness method. I mean, the thing about the IUDs, there's no typical. You just put it in and it should stay put, hopefully, but there is that variable. But you didn't do anything wrong there. Yeah. I mean, in general, when we talk about typical versus perfect, perfect would mean that the person is doing everything exactly the way that they're supposed to be doing it. So whether we're looking at a study on condom efficacy or withdrawal efficacy or if we're looking at pill efficacy, then, you know, we have exactly how it's supposed to work if you do the right thing every time.

41:06And then we have what actually happens. So those studies are really fascinating to look at because you are actually seeing then how this typically plays out. Obviously, people are not perfect and things can go wrong. So I do think it is important, you know, a lot of people say, and I don't disagree, that we should be looking at the typical use efficacy when you're trying to determine which method is going to be best for you, because obviously that's going to show you what is working the best in the real world. And so this is why the fertility awareness conversation is a little bit more nuanced, because I think most people are not crazy in the weeds all the time with the research.

41:41If you actually look at fertility awareness research, I can't stress enough, I keep saying it, it's not like there's one method and that wouldn't even be an effective study. Like if some methods use a totally different way of tracking, then how could you just lump it all together and say that there's one efficacy rate? So I think for anybody who's seriously looking at fertility awareness-based methods, it's worthwhile to actually look at the research, even if it makes your eyes curl back in your head, pop it into chat, GPT, right? Whatever you need to do, right? But understand that when you're looking at studies and people giving these exceptionally low rates of effectiveness, we do have to ask, well, what method were they using?

42:23Because, you know, for example, mucus methods, some of the most common mucus methods do tend to have lower efficacy rate because there could be less specificity. For example, if you're using mucus only, because, I mean, there's nothing that's 100 % all the time. That means you're not using temperature, so you have one sign. There's different ways to track and check. There's a bit more subjectivity there. So if you really want to understand, you have to kind of understand that there's nuance and you have to apply some sort of approach to this. You can't just kind of throw it all under the bus. So I hope that that answers the question.

43:00But I do really think, you know, I think that some people would say that maybe I'm too optimistic with fertility awareness or maybe I'm overstating the efficacy. But I would say I'm not overstating the efficacy. I'm breaking down the different types of efficacy for different methods. And I have chosen to teach the method with the highest efficacy because that really gives my clients the best shot at this working. Yeah. And we're going to go into the method with the highest efficacy coming up. But ovulation always happens on day 14. True or false? False, obviously. Obviously, no, that's obviously because because I'm gonna tell everybody right now, if you have an app, and it's like we can predict when you will get pregnant, and all it asks for is your last menstrual period, delete that app now.

43:49Oh, because no. But no, a lot of this here. So here's the thing. When we teach about the menstrual cycle, we say 28 days, right? We say like day one is the first day of your period. On day 28, hormones drop. You know, everything starts again. Day 14 is ovulation. We teach this as a framework to help people wrap their head around it. But what gets lost by the sex educator, by the way, um most of them there's a study where they're not even comfortable saying vagina they won't say vagina they don't differentiate for the vulva but they'll say penis oh yeah it's not a problem right i mean i think maybe part of it yeah but i want to be fair that i think media makes penis is funny and so it feels a little more comfortable right like movies there's jokes and things like that but what i think gets lost in all of this conversation is that that standard by which we have laid out framework to teach the menstrual cycle doesn't mean it's true for your body.

44:50So it's not obvious, I think, to a lot of people. Explain why ovulation doesn't always happen on day 14. Well, so, I mean, we're not robots. That's fair. Well, I mean, and for me, I even, when you say that that's how we teach it, I would say that's not how I teach it, you know, because, but I think part of that is because I'm aiming to really come up against that. If we really want to understand the menstrual cycle, it's important not to actually be so rigid in the teaching, you know, and even I understand that that's how people like, okay, so, you know, there's a lot of protocols coming out. Periods are really popular right now.

45:28So there's a lot of protocols that are like, do this from days one to seven, do this from days seven to 14. And all of that really reinforces it. So at one, like on one hand, we're saying, okay, well, that's not how it always is. But on the other hand, we're always reinforcing that that's how it is. So again, if we go to the data, what's interesting now is that we have all these apps. And so there's a lot of studies that are, you know, in case you didn't know that they're selling your data, there's a lot of studies now that are capitalizing on like hundreds of thousands of cycles of data. So we can actually see the data, which is great, right?

46:00And so I think what's key to understand is that we do have a clear average. You know, you can look at multiple different studies of cycle length and different cycle characteristics. And the average for women of reproductive age does tend to be 28 days of the cycle length. And obviously, if the average is 28 days, that puts ovulation somewhere around day 14 or 15. But I can't stress enough that that's the average. And if we look at what happens in real humans, real human women, then what we see is that there's fluctuation. So anyone who tracks their cycle, let's say for, you know, six to 12 cycles, you're going to see that there is a range.

46:36you're going to see that some of the cycles might be 29 days, some of them might be 27, it might be 32, it might be 31. So in real life, how this plays out is it's not always like that. And so I would say we can look at the data as evidence, and we can also look at what happens in real women's bodies. And you might think, well, you know, what's the big deal? But I've seen how it can play out negatively in a variety of circumstances. We've kind of touched on a little bit of that in the example of early ovulation and the possibility of pregnancy during those last days of your period. But it can play out where women are trying to conceive, and they're always having sex on day 14, and maybe they're ovulating on day 12.

47:19This can go on for months. Similarly, if they're ovulating closer to day 20, and what can happen from the fertility charting standpoint is that you ignore what's actually happening. So you ignore the mucus, you ignore all the actual signs, and you default to your, you know, assumption. Bigger consequences can be related to hormone testing. Obviously, if we're doing hormone testing on day 21 and making decisions based on that, you know, that's kind of arbitrary because it doesn't really matter what the textbook says. What matters is the woman in front of you, what's happening with her. And if we really want to understand what's happening with her, if she has questions about her cycle or hormones or whatever the case, we have to actually be looking at her and not test for the day.

48:02But if we're trying to find midluteal, we need to actually identify when her ovulation was so we can be accurate when we look at the midluteal, for example. Good sleep is everything. That's why Oli's science back support is made with a blend of melatonin and L-theanine for both kiddos and grownups. So when your mind won't switch off, you've got something that can help. Erasing thoughts and restless nights won't stand a chance. Find OLLI Sleep Solutions for the whole family at OLLI.com. That's O-L-L-Y.com. Yeah, I want to zoom in on the luteal phase, but for people listening, what you're referencing is testing progesterone.

48:39So we test progesterone five to seven days post ovulation. That is what is accurate. But a lot of times doctors will say, well, that's day 19 to 21 of the cycle. I would love it to always be day 19 and 21 of the cycle. But the other thing that women should know, I will often have labs in front of me and someone's like my doctor says I need progesterone because I have zero progesterone and I'm like well did you ovulate and they're like I ovulated I'm like you can't have zero progesterone then and I'm like this is looking with your estrogen a lot like you got this done on your period yeah that's when I got it drawn you will have zero progesterone then you don't need progesterone during the follicular phase you need estrogen because it's doing all kinds of things it doesn't need to be challenged by progesterone yet but there was something that I saw on social media.

49:24If I can find this clip, I might put it up on YouTube. This doctor, who I think she's a wonderful doctor, but she had made a statement that the luteal phase for women is only seven to 10 days. And I was like, oh, that is so wrong. This is a gynecologist. She's a GP, really lovely person. But this piece of information was totally incorrect. And red flags. If somebody comes to me and their luteal phase is seven days, I'm like, girl, if you're not like 45, we got to figure out what's going on. Talk to us about the luteal phase. How long should the luteal phase be and why? Well, absolutely. And so, you know, the luteal phase, a healthy luteal phase, I would say, should be at least somewhere between 12 to 14 or 15 days.

50:10And what's interesting, I mean, when I first started learning about cycle charting, you know, back in the day, you know, we learned that the luteal phase was a bit static. And I think one of the things that I learned that I don't think is as accurate now was that, you know, once you started to see the length of your luteal, it would always be about the same. So what we need to know about the cycle is that if we look at the overall average 29-day cycle situation with ovulation around day 14 or 15, right, for argument's sake, what we need to know is that the follicular phase is actually the most variable aspect of the cycle.

50:43And that would be why we can see such cycle fluctuations and variations. So, you know, cycle length typically varies anywhere from, let's say, 21 to 35 days. Typically, that is considered to be a healthy cycle length. But what's interesting is that whether you have a 25-day cycle or whether you have a 35-day cycle, typically the luteal phase is going to be pretty constant. And so, I mean, part of that is what's happening hormonally. Once we ovulate, the ovary, ovarian follicle releases the egg. the follicle becomes the corpus luteum, which is, if we were to look at an ovary, the corpus luteum would look kind of like a little scar, a little yellow scar on the ovary.

51:27And that corpus luteum is producing progesterone, and it has a lifespan. So unless we conceive and become pregnant, the corpus luteum is going to disintegrate within about 12 to 14 days. So we have actually this time frame. But what you brought up, you know, if the luteal phase is seven days or 10 days. It shows us that it's not just static because, again, we're not robots. And the health and longevity of the corpus luteum is heavily based on what's happening hormonally, what stresses we're going through. There could be a variety of different factors if we're not eating enough, if we're exercising a lot.

52:05And so the luteal phase is a really interesting part of the cycle to pay attention to because it gives us so much information about what's going on. So like you said, if you're working with someone and their luteal phase is seven days, that's a huge flag. And even from a practical perspective, if you had a client who was trying to conceive and her luteal phase was seven days, the process of implantation takes about 10 to 14 days. It takes about two weeks. So if someone's starting their period seven days after ovulation, that wouldn't even give the egg enough time to implant. So not only is there a practical issue with it, but it also shows a profound hormone imbalance.

52:43So the last thing I'll say about that is if we go back to the average cycle, 29 days, that design by definition gives us about as much exposure to estrogen as progesterone in a sense. So we would have about as many days of estrogen exposure primarily to about as many days of progesterone exposure. And that balance, and I use the word, like it's not a literal balance because we produce significantly more progesterone, like, you know, but it's supposed to be balanced. We're supposed to have that two weeks-ish duration of time of progesterone exposure to counter the effects of estrogen. So there's a lot going on there, but at the end of the day, hopefully if you post that clip and gently tag that doctor.

53:32I don't like call out and slamming people and I actually block creators that do that because I just think, I think that studies will look back and judge us very poorly for how we shaped humanity by always just calling out and like hating on people and trying to rally against people. I think it's really a toxic internet culture. And like I said, there's not everything, but he's going to get everything right either. And I think we have to like hold space for that and an opportunity for all of us to always grow and learn. And I, If I got something wrong, and I have gotten things wrong, I appreciate when people are like, let me present this to you in a way that is not judgmental, that is not trying to tear you down and not, you know, oh, you're an idiot or something, and actually teach you because we're not going to know everything.

54:19We have to be open to learning and also teaching one another. But I think what I want women to definitely understand is that it could take up to eight to 10 days before an embryo even reaches the uterus. if you are struggling to try to conceive and you just identified that your luteal phase is less than 10 days, you're not going to get pregnant because there's just not the opportunity for the embryo to land there, to then burrow its way into your uterus and to have the time to set up shop and say, this is my new home. And so that is something that I think is, I asked you what's one of the biggest things about, you know, that could hurt us from not tracking our cycle.

54:56I think that right there. So you're tracking your cycle, you identify that, and you're like, this is me, it's time to see a provider because you shouldn't just struggle on your own or buy their BS of like, just try for six to 12 months and see what happens. No, if you identify those issues, you need intervention now. I want to ask you, you've been called anti-feminist because you question the pill. How do you respond to that? Yeah, I mean, it's so interesting when I think back to when I started my podcast, I was out there, that was over 10 years ago now, there was a lot more pushback about the pill.

55:33And I think it comes from the history. So the pill was really connected to this feminist movement and to the sexual revolution and all that kind of stuff. And it was really thought to be this ticket to freedom, I guess you could say, for women, it was the first time that women could be sexually active without necessarily it being directly related to having a child. So I think there's a lot of, I don't know what you'd call it, but there's this connection there and people are really bound to that. I also think that, you know, in recent years, like I was saying to you, I'm Canadian, so I'm not directly in the American political landscape.

56:17But obviously, there's a lot of people who are concerned that maybe if you talk about the pill, you're also trying to limit access to it. So whenever I talk about the pill, I'm always clear that I'm not wanting people not to have access to anything. What I'm trying to do is allow women to make informed choices. And so while the pill was certainly positioned as this ticket to freedom, it certainly wasn't without consequence. And that's the part that we need to talk about. We need to be able to talk about the side effects. We need to be able to look at what the research has to say. And fortunately, the pill is one of these drugs that has been around for, is it 60 years?

56:5765 years. So we have an incredible amount of research to look at. So I think in the last few years, that has backed off a little bit. Because again, there's so much research that we can't really, you can't really deny it. You can't really come hard at me. even if, I mean, I guess they can, but I feel like there's a little bit less ground to stand on. But I mean, when it comes to the pill as being, you know, anti-feminist, I have kind of a different definition, I guess, of feminism. And even when we were talking about the menstrual cycle being the fifth vital sign, I think that if we can really start to track our cycles, understand what's happening in our bodies, that could be the new version of feminism, right?

57:42That could be a different situation where instead of suppressing our body's natural function, we can learn to work with it, learn to understand it, and use it as a way to monitor our health so that we can actually feel better, right? Like, what a concept. I would love the propaganda PR team that the pill got. For me personally, I just think that, like, the pill can do no wrong, right? I mean, it's very interesting because when Beyond the Pill came out, the go-to people would, they would say, like, She's just this alt-right conservative Christian woman. And I was like, firstly, there are alt-right conservative Christian women.

58:19And we're not using that to insult people, okay? People get to have their own beliefs and we don't belittle other people. Secondly, I would hope that you're intelligent enough to bring something better than that than to make up lies about me. And I just found it super ironic, the number of gynecologists who made up lies about me on the internet around this. and I'm like you're doing the same thing that Margaret Sanger did when the pill came out so the truth about the pill is that it was taken to Puerto Rico these women were told we'll stop sterilizing you because they were being forced sterilized if they wanted to have jobs if they wanted to have access to just food and living they were being forced sterilized they had two kids somebody showed up you lost your uterus they said we'll stop doing that to you if you participate in this birth control pill trial.

59:08They do. They hate it. They report all these horrible side effects. The doctors are like, ignore them. They're dying. Ignore them. Some doctors left and were like, I can't be a part of this. It's so unethical. When the pill was finally available, they priced out these women. They did not give them access to it. The women of Puerto Rico never got access to the pill. They got more forced sterilization. And that is the true history of the pill. and I talk about that and people are like, you're just trying to like get people to take, like, you know, take away the pill. And I'm like, I just think that if you are going to exploit a Latina's body, like, and do this to them, that they deserve some recognition of what they went through.

59:52Because when some people say, thanks, birth control, you know, there's that whole slogan. I'm like, no. Thank you, Puerto Rican women who sacrificed their bodies to be able to make this possible. This is the history, the true history of gynecology is that the bodies of Black and Brown women have been completely exploited over and over and over to the benefit of white women. Did white women do this? No. Did white women cause this? No. The women benefiting from it now, are they supposed to feel guilty in the end? No. No, no, no. That's not what I'm saying. I'm saying is that there are these really dark industries and history that it is very unfair if we just ignore the women who sacrificed so much for us to have access to these things today.

1:00:39And for me, even saying things like that, I'm sure I'll get people in the comments who are going to be very angry about it, right? Because we're not supposed to talk about race. We're not supposed to vilify the pill. We're not supposed to vilify Margaret Sanger. Seriously, she's the worst if you look at the history of it um i think the only time i've ever agreed with candy so much told the history of margaret sanger and i was like that's facts like that that is facts there but that gets put as like that's only a conservative talking point these are people who are anti-pill and i think but it doesn't have to be like it doesn't it's very funny because we live in this really weird time you're not in the u.s where now if you talk about eating whole foods you're now considered conservative and i'm like i don't know i've been doing this for like 25 years Um, like what's changed here?

1:01:23So can I add to a little bit of history? Because obviously that it's, it's horrific. It's, it's completely just bizarre. And one of the aspects of the pill history that I often talk about as well was that the, it's more around the kind of full disclosure, informed consent piece. So these women, some of the women in the study, um, were trying to get pregnant and they were kind of told that if they suppress the hormones, it'll kind of bounce back their reproduction or whatever. So that's because you're kind of thinking if someone's trying to conceive, why would they put them on the pill? But what happened is that the women didn't understand how it worked.

1:02:00And at the time, the first, I called the beta trial, but the beta pill trial, they didn't have the, you know, induced sugar pill week. So these women, they were put on this pill continuously. They stopped having cycles. And some of them actually thought they were pregnant and we're like celebrating that and really happy about it. And then the doctors were kind of like, no, no, no, you're not actually pregnant. It's the drug. And then when they realized that it was a side effect of the drug, the women were like inconsolable, right? So that's how they came up with the 28-day pill pack. So it could have been 40 days.

1:02:35It could have been whatever they wanted, or it could have just been continuous. But they did that because they wanted it to mimic a woman's cycle. And so it was kind of like this white lie because they wanted to make it seem like, no, no, no. It's the same as when you're not on the pill. You still get a period. You just can't get pregnant. And this lie has continued, right? And one of the things I often share too is these trials were happening in the late 50s. So in the late 50s, there was no precedent for this. There had never been a drug like this. And actually, the pill was the very first drug ever invented to give to healthy people to suppress a natural bodily function.

1:03:11And for people listening, that is a marketer and businessman's best dream in the pharmaceutical industry. It's like, we don't have to have a diagnosable condition. You just have to have been born with ovaries. Correct. Well, yeah. And so, I mean, that lie still persists to this day because when we hear things like the pill regulates the cycle, people believe that, you know, except it doesn't do that. And so interestingly, how you could be vilified for just saying what it really does, like just reading the science and saying, well, it suppresses ovulation and it prevents the uterine lining from developing to a thickness that would support life.

1:03:46And, you know, it does cause that thick mucus plug to always be there in the cervix. And those are the kind of like the three main modes of action of combined birth control pills. But it's interesting because, you know, this lie is what allowed women to accept it. Because before the pill, the only time a woman would lose her period was if she was pregnant, breastfeeding, or potentially very ill, right? So, you know, know, they had to get marketed in a way that that was acceptable. And, you know, interestingly as well, the pill is the reason why we have drug inserts because it caused so many side effects.

1:04:22And because feminists fought for it. That's right. The feminists didn't fight for the pill. They actually fought for like, we need an actual informed consent because on top of all of this, contraceptives for women somehow still get this like hush free pass that you don't have to give a true informed consent. When I talk about IUDs and like how they work, when I talk about, and if it fails and there is implantation that I, well, the IUD is not going to allow implantation. And doctors will say, don't tell women that they would not use it if they believe that life begins at conception. And I'm like, oh, wait a minute.

1:04:57My belief is not superior to her belief. And if that's her belief, she has to have an informed consent. If you believe that, and listen, anyone listening, if you don't believe that, that's fine. But I want you to just sit in someone else's shoes for a second. If you believe life begins at conception, someone put an IUD in you, and then you learn after the fact that it could actually keep that life from implanting. How do you reconcile that with your faith and what you believe the end outcome is in terms of like, do you go to hell? Like what happens with that? Like that creates tremendous mental pressure, stress, and emotional duress on a woman because she wasn't given that informed consent.

1:05:39And I think as doctors, it's not our place to pick and choose what information you get. You just tell the truth and you let her decide. And even if you don't agree with what her decision is, you have to stand back and say, it's not my body. Like, this is not my life. And like, that's not the decision I would make. You can make recommendations I strongly recommend this, but to manipulate information to get someone to take a medical treatment is coercion and it's unethical. Yeah, I mean, there's so many thoughts going through my mind. I want to hear all of them. I'm sure. One of the thoughts is back to when you asked the question of, you know, why aren't we being taught this?

1:06:20And then we talked a little bit about doctors and how they're trained and how medical schools are not necessarily teaching this information. and you'd have to go outside of it to really get that specialization. Well, why is that? Who funds the medical schools, right? Like we have a pharma situation is what we have. And when I wrote the fifth vital sign, you know, at the time, the pill industry was estimated to be like a$30 billion, like 22 to$30 billion industry, billion dollar industry. Like, do you know what a billion dollars is? No. Like, I remember hearing that if you had a billion dollars stacked up, like, in$1 bills, it could take you to, like, the moon or something.

1:06:59Really? Yeah, I don't have a concept for billion dollars. Like, we don't even understand. So, like, this is the problem. This is the problem. And one of the things that I've been interested in lately is that there's all these studies coming out, you know, talking about why women are going to social media for information. So, for everybody who's watching and listening, they're talking about you. They're like, why are you going to these, you know, non, you know, like not going to your doctor's office, but instead you're looking on YouTube or you're looking on Instagram or you're looking on TikTok and you're looking for information about PCOS or you're looking for information about the menstrual cycle.

1:07:33They're, you know, and at the end of the day, the reason why women are looking outside is because the conversations like what we're having are not being, are not taking place in their doctor's offices. But is it the doctor's fault? So that's a really important question to ask. why is it that we are the ones talking about this, but these medical doctors are not talking about it? Why is it that it's not part of their education? Well, if they're making billions of dollars based on this pharmaceutical model, then wouldn't it make sense to teach them in a way that encourages them to make sure that their patients are...

1:08:08I don't know. I don't think I'm saying in the most eloquent way, but I think that at the end of the day, we have to really consider this. And this is why for me, informed consent is paramount. Because obviously our institutions are more concerned about getting you on the drug than telling you what it does. And how do we break that cycle? I think that it's just, we just talk about it. We just share the information and we try our best to empower women. And, you know, there's a lot of medical jargon and information, but even if we start talking about it, at least then they're empowered to ask more questions and maybe get to the bottom of it.

1:08:45Yeah. I, you know, as we're talking about this, I mean, I think about things like there's gynecologists that I will see on social media who say like, I'm a fan of menstrual suppression. So I recommend it to all my patients. And I'm like, wait a minute, you're a fan. So you make a huge medical recommendation, like shutting down your cycle is not something insignificant. It has been failed to be researched extensively. We had Dr. Sarah Hill on the podcast, I will link to her episode because she is one of the few researchers bold enough to be doing this research. It's very interesting to me when I talk to colleagues who are researchers and they're in the field of women's health and they'll say things about the pill.

1:09:24And I'm like, how come this isn't being researched? And they're like, oh, if I have a negative outcome or I say something negative about the pill, I'm never going to get a grant again. I'm never going to get funding. They'll make sure of it. And I'm like, that's problematic. So as we talk about this, the first argument people are going to have already is like, but what about big wellness? How much money they make? And I want you to understand there is no such thing as pharma here and big wellness here. They overlap. The top selling supplement companies in the United States are owned by pharmaceutical companies.

1:09:54What is also included, what's silly about big wellness is it also includes gym memberships and people choosing to eat healthy food. That's whack to me to be like, oh, this big wellness, people are going to the gym. As a doctor, am I not telling everybody to work out every day? Yeah, check, I am. The other thing that's included in that, though, is wellness tourism. What is wellness tourism? That is when you are going to other countries and you're having medical procedures that use pharmaceuticals. Like, you have to understand that pharma has started the propaganda of big wellness to distract you from the fact that they have their hands in everything.

1:10:30And I say this as somebody who's super, super grateful that medications exist. You know, we were just talking, I just went through a knee surgery. You think I'm mad at pharma? I am not mad at pharma. I love not dying of sepsis because we have antibiotic. Like, that's amazing. I love taking a thyroid medication and being alive every single day. So I'm not anti-pharma by any means, but I do think it's an unchecked entity, like giant business entity that needs more oversight, especially when we consider that there are only two countries in the world and one of them is the US that allows direct marketing to consumers.

1:11:07I remember that Yaz commercial of like, it'll fix your PMS, like it'll fix everything. And yet as someone with PMDD that Yaz was supposed to help, I got way worse with Yaz. And I asked my doctor for it. Yazmin actually is what it was. I asked my doctor for it because my moods were so bad on the pill variation I was on and they were like, oh, okay, why did I ask my doctor for it? Because I was 18 and I saw it on TV. And at 18, I was definitely like, well, it's on TV. You know, like, this must be helpful. So I think there, anyone, just everybody who is like, you know, there's some certain people who are like, that's not fair to criticize pharma.

1:11:47My criticisms come from all the lawsuits that have been won. It is very viable. Go look at those things. This is what we need to be looking at is the lawsuits that have been won and the behavior that continues to repeat and the harm that is done. We need the pill, okay? We need to have access to it. As somebody who worked in a homeless youth clinic, people will always say to me like, no, not, no, everyone can just do fertility awareness method. And I'm like, a girl who doesn't have a door to lock is a high threat of being raped. Like the pill being super cheap and having access to that is a really good thing.

1:12:20So, and that's like one extreme. The other is, it's just your choice. Like it's your choice. And if you want it, you should have access to it. So just want to be like crystal clear because the first thing people do when you challenge a belief is to shut down and decide how you're the villain. And I just want people to understand nobody here is talking about taking away the pill. Yeah, it's true. And, you know, you mentioned choice and can you have true choice if you don't really understand what's going on? You know, For all the women who were on the pill and were never told that it could cause depression or anxiety.

1:12:54And interestingly, it doesn't always happen right away. So you could be on the pill for like three years and then all of a sudden start getting panic attacks. So for all those women, like desperately Googling, you know, to try to figure out what's wrong with them. And then only finding forums where women are talking about, you know, the same drug that they're on that caused them the same thing. I mean, that's completely outrageous, right? You know, I remember when I, my editor for the Vital Sign, she told me that she kind of fact-checked when I had the black label thing. So I have this like image of a black label, like I'm saying this would be what a black label should look like.

1:13:30And she looked it up because she didn't even know that the pill has a black label warning like cigarettes do, right? And so, you know, this is a problem. There's so, like we could talk about this for the rest of the day. We could talk about the different side effects. We could talk about how women who have migraines probably should be at least given a warning from their provider that, you know, if they start to, like, there's all these things that we could talk about. And the big question is, well, why aren't women being taught? And we can backtrack even more. Why aren't the medical providers being trained to be kind of, the word I'm looking for, it's kind of like to protect their patients first, right?

1:14:12Like, I'm not sure what the perfect word in there is, but if they were trained to kind of like, I guess that's what, first do no harm? Yeah, our hypothetical is first do no harm. Isn't that interesting, though? Because my mind is like, if they were trained to first do no harm, but they are, but they're not. So, like, really what they're trained to do is to prescribe first. Yeah. Well, and they are trained in a way that, like, inception has happened in their minds, and I don't think they even have realized that, like, they put you into residency. They exhaust you. They overwork you. they do all of these things so that you mentally start to break down and like you don't question all of the things like that is on purpose you can't convince me that the abuse that residents face isn't on purpose um but you know when you when you consider this i mean they are taught to you know when you talk about blood clots like well yes the pill could raise your risk blood clots but don't even worry about it because it's so mild compared to pregnancy okay but like i'm not pregnant so why are we talking about that you're bringing in this false equivalency and saying that like this is lesser than so don't worry about it but like my goal is not to be pregnant so like why why are we doing that you know and you bring up the uh migraines with auras there's doctors who don't even know that's a contraindication i developed migraines with auras when i was on the pill from the result of being on the pill and i was given imitrix like that's i actually did too yeah and it wasn't until so this was when i was maybe 16 17 because i was on the pill at that point for period pain.

1:15:40But it's the only time in my life I ever had migraine with aura. And it really, like I went off the pill at some point well before that, that wasn't why I went off, but it was only years after that I thought about it and I realized, wow. And I was, I don't know the name of the drug I was given. They were these dying, like diamond pills. There's literally so many, right? They gave me hallucinations. So I like took one once and I was like, not taking that again. But the solution obviously was there was no like, let's take her off the pill because we know the pill. Like this is bad if someone's on the pill and they're also getting migraines.

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1:16:46I'm so grateful all the time because it wasn't until I went through a fertility workup that I found that I have a rare clotting disorder that nobody would have ever checked for. And I'm like, I am so lucky. What if I had smoked? What if I was overweight? wait, what if I hadn't studied nutrition very young and been like, I need to live a healthy life? What could have happened to me? And it's interesting because this clotting factor, when it came up, I was like, oh, this genetic mutation I have. And to my doctor, I was like, I'm not familiar with this one. I've never seen it. He's like, yeah, we test it in the fertility world.

1:17:20I'm like, what does it mean? He's like, if you're ever on oral estrogen, we have to make sure that you are on blood thinners. So, you know, that's lovinox is what it is in the United States. And so anytime I'm on oral estrogen, because I needed to be for fertility treatments, I was tested. I was followed, tested, all my clotting times, clotting factors, and I had to be doing daily injections. And I was like, oh my God. And I'm like, had I not stopped at 27, had I been one of those women that like carries on to 37, 47, like what would that have looked like? And, you know, gynecologists will argue against doing testing for clotting factors because they're like, it's so minimal.

1:18:01The risk is so minimal. And I'm like, unless you're factor V light in, and I definitely had patients I've tested, and I'm like, you can't be on the pill. You have factor V light, you cannot be on the pill. Even MTHFR is a warning in Canada. It's not in the United States, at least not as of like the last five years when I had checked, so maybe that's been updated. There are genetic mutations that we can have that means you are the person who's going to have a clot. And when you think about it, it's like maybe it's a small percentage of the population in the whole who takes birth control and will have the clot.

1:18:30But the clot is a stroke, a pulmonary embolism, possibly death, losing part of your brain. Like it's not insignificant, the outcome. And I think like, no, I don't want people to be as scared of using the birth control pill, but I want people to understand the risk that they're signing up for. And I also think when we prescribe the pill, we need to say, these are the signs of a clot that you need to be looking out for. These are the signs of depression. Depression doesn't just show up one day and you're like, I'm really sad and I'm depressed. You're like, I'm not really interested and motivated in doing the things I used to.

1:19:07I'm becoming more withdrawn and antisocial. Depression isn't a switch that flips. Usually women on the pill, it's like over a six-month period of time, personality changes. And because you're in it and it's gradual, you don't see it for what it is. But if you can have people in your life that you're like, I'm starting this new medication, keep an eye on me, that's a great way to leverage community to make sure that your health is being put first. And I mean, so many things come to mind because when you talk about these things, There are always women who did use the pill, and according to them, they had no side effects.

1:19:41They loved it. They loved that pill. Yes. But when we look at research and science and studies, we find that about 50 % of women discontinue using within the first year or switch to another type of contraceptive. So, you know, it's really great that there are women who don't experience a lot of side effects. One thing I often say, though, is that depending on how long you used it, when you come off, that's when you kind of see some of the differences that you might not have realized when you were on. But even so, there's still about 50 % of women that are dissatisfied enough within the first year of using it that they're wanting to come off.

1:20:15So, I mean, we really should be paying attention to these side effects. And I think, you know, to me, you know, I think about, okay, so in this conversation, are we going to change the entire way that, you know, medical professionals are trained regarding prescribing the pill? No, we're not. So what can we do to empower the women listening to figure this out? One of the things I don't think a lot of people know is, if you think about it, pharmacists, that's their whole thing. Yeah, they're great. They're trained in all of the drugs and all of the drug interactions and the different nutrient deficiencies.

1:20:47and you know anytime there's been a family member who's on a you know medication and it's like the word is like 50 characters long and you have no idea what it means if you go to your pharmacist they usually always have significantly more information about the drug printouts I've received like a 16 page document on a drug before and so I do feel like you know if you are taking birth control or any other medication and you've never looked it up online pulled up the prescribing information, you can also go to your pharmacist and literally just have a conversation and ask them if they have a printout for you so that you can see the side effects.

1:21:25And that would go for every drug, you know, because what you were saying, that's my perfect world, like about if you were being put on birth control, even just having the conversation about signs to watch for. And even just to have that conversation about these are some of the serious side effects, even though they're rare, you should know about them. And if you ever experience any of these things, you need to call me immediately or you need to, you know, come to my office. And I don't, I'm not anticipating that this is going to happen, but that would be the due diligence that would make logical sense.

1:21:56Yeah. If we cared about the health of all of these women, the hundred million women worldwide that are taking this drug. Yeah. And it's, I mean, it's interesting because it's one of the few drugs that that's not done with, but I love your tip about leveraging the pharmacist. And the other thing I would add is that anytime you get a new prescription, run it by your pharmacist because sometimes patients, they fill the prescription at one pharmacy, then they go to the other pharmacy for the next prescription. Make sure your pharmacist knows about every medication you're taking. And anytime it's a new prescription, they usually will say, okay, come over here, do a consult with a pharmacist.

1:22:32That is your opportunity to lay it all out because there are interactions. And also that goes for supplements as well. I know they're natural, but they're a drug nutrient and drug herb interactions and your pharmacist is going to be way more educated. Your average doctor does not understand nutrition, let alone supplements. So it feels very frustrating when you go to them and you ask and they're just like, everything's bad, right? It's just all bad. But if you go to the pharmacist, the pharmacist has a much better understanding and they can really help you guide you. And that's like what they're there for.

1:23:04I think great doctors do lean on pharmacists to be able to be part of the team in supporting the patient. So I appreciate you bringing that up. You know, before we started recording something that you said, we were talking about pain management and you were talking about how ACOG just updated for IUDs with pain management. That was born out of listening to women. So back in like, you know, 2017, 2018, like when we were, you and I were online, we're talking about the pill. Gynecologists were like, you guys are fear-mongering because you put a study up and you linked it. And then they're like, Well, that research is bad.

1:23:38And like something I talk about with Dr. Sarah Hill, because she's a researcher. Where do doctors get their information from? Researchers. There's our clinical experience. And then there's the research. And the audacity of these gynecologists to say, this researcher doesn't understand the science. She's like, do you know how often a gynecologist tells me that? And she's like, and they'll say, she doesn't understand the science. And she's like, that's my name. That's my name on the science. I wrote the science. I wrote the science. So it's kind of like mind boggling to me. But this change we've seen in the pill where like there were gynecologists who absolutely hated on my book, Beyond the Pill.

1:24:14I was so naive. I think part of it is just like being autistic where I was like, why would people be mad about like the science and the truth? And they're like, yeah, no, like we hate you. I was like, oh, okay. Those same people now are going on podcasts and literally saying the same things that they had videos hating on me for back then. What changed? Women. Women who are listening right now. They spoke up. The whole reason why the U.S., who is freaking so far behind, all these other countries had pain management for IUD placement. The only reason, and we saw at first gynecologists fighting with people on TikTok and being like, no, it doesn't hurt that bad.

1:24:53You're being dramatic. I had an IUD. Worst pain in my life. Zero out of 10. Like, a thousand under 10 because no, negative. Like, I am like, I should not have gone through that, especially considering now knowing I have endometriosis. That should have been a red flag. to my provider, how much pain I was in. Oh yeah, maybe this girl's got endometriosis because why is somebody like screaming and crying on the table? With all that though, it was women who spoke up. It became too many voices to ignore. And that is what we're seeing is finally changing the conversation. So I want to talk a little bit about it because you read the whole ACOG statement on IUD placement.

1:25:30So can you bring all the listeners up to speed on that? Yeah, no, it was, I mean, this is something I've been talking about for a long time on my podcast for years, I did what I called my pill reality series and my fam reality series. And essentially, I was just interviewing women from my community who had used the pill or used the IUD, whether it was the copper or the hormone releasing or whatever the case, and they would just share their experiences. And over the years, I mean, I've heard so many different stories. I've worked with so many different clients. And I didn't realize the insertion pain issue until I kept hearing it over and over.

1:26:01So I was pounding this on my podcast. And I got to the point that every time someone would tell me that they used an IUD, I would just ask them what their pain experiences were. And it wasn't that 100 % of every single woman I talked to had a horrific pain experience, but it was like nine out of 10. Like it was pretty significant. My friend got an IUD the week before and she's like, oh yeah, I got it. It was nothing. I walked home afterwards. I didn't walk for like seven days. Like I wasn't at home with a hot water bottle, like just could not move. So I felt I was really caught off guard by it.

1:26:32So I just want to be clear, like I have endometriosis and adenomyosis, which makes it especially painful. If somebody's listening right now and they're like, I love my IUD, I love that for you. Well, and we're just talking about one, this is like what we're talking about isn't even the effectiveness or criticism of the IUD functioning itself. Like we're just talking about the insertion. And so there's a lot of pieces that I find interesting. So we've talked a lot about fertility awareness. And as someone who tracks cycles, like we talked a little bit about the cervical position and how it changes throughout the cycle.

1:27:05And I find it interesting. It seems as though women are often advised to take a little bit of ibuprofen. They're advised to come in during their period because apparently that's supposed to be when the cervix is a little bit more open, logically, because the blood is coming out. But logically, from someone who charts, the cervix is actually really soft and typically more pliable in the middle of the window. That's neither here nor there. I'm just saying that even that to me is like, what are you doing, guys? But interestingly, so this paper came out, And as soon as I saw it somewhere, I grabbed it and read through it.

1:27:36The paper isn't specifically only on IUDs. It's on various procedures that would have some involvement of the cervix. So it could also be on procedures for cervical dysplasia or abnormal cells or those kinds of things. But I zoned in on the IUD placement. So they actually did science. Go figure. Instead of just using their opinions about... What date did they find? What year did ACOG? So 2025 July is what we're talking about here. And the science that I'm referring to, they looked at about 24 years of research over like a 24-ish year period. So they went back like 2000, right, to 2004, if I'm remembering correctly.

1:28:21And they just pulled a bunch of studies that actually tested the effectiveness of the different methods that they used. And I just say this with a lot of indignation and holding back and rolling my eyes because it's like, obviously, this would be logical. Like, good for you. You actually looked at what the research had to say. And instead of basing it on your opinion, you looked at what was actually effective. So while I might not remember every single detail of the study, so I'm in front of me right now, they did obviously look at the Tylenol, which is most effective. They looked at, there's a drug, you would probably know the name of the drug that they used to soften the cervix.

1:28:56And prostaglandins. Yeah. Yeah. And they looked at lidocaine shot. So they looked at actually numbing the area specifically. And their recommendation basically was that the most effective way to reduce and deal with IUD insertion pain was quite literally the injection of lidocaine into the cervix. They found obviously the Tylenol to be ineffective. The Tylenol may help overall or the Advil. I keep saying Tylenol, but it was actually ibuprofen, so my apologies. But the Advil could potentially help with cramping in a general sense, but obviously it wasn't going to help for the moment of insertion.

1:29:34And it's like, I could have told you that. But I digress. You don't have to go to medical school. No woman has to go to medical school and say, if you pinch my cervix, that actually hurts. Yeah, the Tylenol I took this morning isn't going to, yeah. And interestingly, the agent that they used to soften the cervix, they actually found that it made the pain worse and increase the risk of expulsion. Yeah, mesopristal. So this is what we do. This is what we also use. You know, if you've lost a baby, that's what they will insert. It's very good at dilating the cervix. So there's other procedures where it will be used as well.

1:30:09But in this case, the research that they looked at, it was consistently not effective at reducing pain. Yeah. And it caused other problems. Yeah. And so like reading this study, I feel like was a bit vindicating. I had a lot of different emotions. You know, it was wonderful. Like you said, they're finally listening to women. So it was incredible to see. Obviously irritating that this came out in 2025. So we'll just leave that right there. But I think - I'm so mad about it too. Like you could see the steam, right? But I think even more so what's infuriating is that that piece of paper doesn't change the woman who's in her doctor's office right now getting an IUD.

1:30:51because on average, it takes about 20 years before the research gets into the doctor's office. So we're making progress. But, you know, when I was looking at the paper and thinking about the implications of it, I'm thrilled that this has happened and I'm excited at what this means. But I still feel like we just have to talk to women and let them know. Because if anyone, if you or your friend or anyone you know is getting an IUD, while ACOG has created these new guidelines, that doesn't mean that your friend's experience is going to be any different today. I have a friend, Dr. Ana Sierra, and I will link to her episode on the podcast.

1:31:27She is the top trained neuropelviologist in the world, which means that she is the top female surgeon to actually operate and be able to dissect pelvic nerves and separate them from endometriosis adhesions. We love her for this, but I brought this up to her of like, they're saying the cervix has, you know, gynecologists are predating, the cervix has no nerve endings. And she's like, not only does it have nerve endings, it's the terminal end of the vagus nerve, which innervates your brain, your heart, your gut, like, and controls so much of how your nervous system reacts. There's a thing called a cervical orgasm.

1:32:02Yes. So tell me again that there's no nerve endings in the cervix. Well, that's also something too that gynecologists say is not true because they have zero training in sex and then they'll be like, well, there's no such thing. So you're imagining it. and I'm like I don't know if you listen to women you learn a whole lot and that's like I mean honestly the best gynecologist because there are phenomenal gynecologists out there they listen to their their patients they have curiosity around it um you know I remember when the great like IUD debate was starting on TikTok I think it was like 2020 and there was a pain management doctor I think it's Dr.

1:32:37Sood I will tag him because shout out to him he's such a champion of women's health but That's not even what he does. He does pain management. And he was telling these gynecologists, like, you're wrong. You can numb this area. And they're like, this is my level of, I'm the expert in the pelvis and you're wrong. And he's like, but I do, this is what I do. Like, I'm telling you, like, I'm an expert on these nerves. I numb them. Like, this is what I do. And I'm like, the ego here to say that this is his expertise. He is an expert in this. And then you're like, you're wrong because it's found in a woman's pelvis.

1:33:10And he's like, what is actually happening here? And I'm like, that is something that I'm like, that resistance, that ego has to change. And so for everyone listening, if you have a gynecologist who listens to you, who supports you, who is going against ACOG sometimes to give you the best care, please tag them in the comments because trust me, they are getting so much hate behind the scenes by their colleagues. And we have to lift up these gynecologists because they are first doing no harm and they are doing a great job. And women need to know who they are and find them. Yeah, it's just unreal that this is the time that we're living in.

1:33:51There's so many positives, but also like the fact that you could have, you know, when I think about this procedure and, you know, if there was any conversation at all about the pain, which there might not have even been, this woman is just sitting on the table and given no heads up that this could even be well even funny is they say you're gonna feel a pinch girl if there's no like nerve endings then why this tenoculum if people haven't seen it it's literally like a crab's pincher claws grabbing and penetrating your cervix to hold it in place which is good because we don't want perforation when the iud is placed but it's bad if you don't have pain management so there's just one small thing that I just want to mention.

1:34:37Oh my God, it doesn't sound small, but let's go. So if we were like inserting, I don't know, like a metal device into the tip of a man's penis, we wouldn't even be having this conversation. There would be entire teams of researchers determining the best and most effective way to do that procedure while keeping men as comfortable as possible. Like I've had enough. Well, and it's interesting because with the vasectomy, I remember there are women, and you can certainly tell your story, because I do enjoy reading people sharing their truth and seeing how it makes them feel better to share what their experience was.

1:35:16But I have had so many patients and so many women online telling stories of my husband got a vasectomy. He got a trunk full of pain meds. I broke my arm. They were like, you just need a little bit of this. Or I had a C-section. No, you need a little bit of this. Oh, I had a hysterectomy. Oh, just like, you know, take some ibuprofen, like Advil, like this. And I'm like, it is wild to me. But I want everybody to know, and I'm going to go search out these studies and link them, that, and I wrote about this in my book, Is This Normal? So you may have read it, but we're more likely to die of a heart attack.

1:35:50We, you know, I think it's something like women sit in the, we spend like 20 minutes more in the ER waiting if we have the same exact symptoms as a man of abdominal pain. unless you say, oh, I think I might be pregnant. Then they're like, well, it could be ectopic pregnancy. But unless there's the pregnancy variable, they leave you to sit before they ever give you pain meds. There is study after study. If you PCOS or endometriosis, your diagnosis time is cut by years, three to four years. If you use the magic words, I want to get pregnant, they're like work you up. If you don't use those words, you're looking at an additional three to four years before somebody actually takes you seriously.

1:36:27Like we've got big problems in women's medicine. I want to get into the best method for fertility awareness method. We kind of ran on a tangent, a necessary tangent, I think. But something I do want to ask you is why do you think that there is still so many women in medicine fighting against actual female patients having equal access to pain management, to care, to quality diagnosis. Like, why is it? Because people always assume it's a man automatically, but the majority of stories that I've encountered are female practitioners who are actually gaslighting their patients about their period pain, about the pain of IUD, all of that.

1:37:11Where do you think that's coming from? So just to clarify, why female practitioners are, like, why women are having a harder time with female practitioners?

1:37:22Why are women's care? I mean, I think that the, like, if you have to first look at where they were trained, like, female practitioners don't get trained in, like, a totally different, cool female side of medical school, right? So they're still being trained. I mean, I will go back to the establishment, and, I mean, it's interesting that even the science that medicine is based on is mostly based on the study of the male body. And, you know, even animal studies are done on male animals. And I recently did interview Sarah Hill about her new book. We love her. We love her. And she blew my mind even more when she was talking about how even when they incorporate females and female animals into the studies, they oophorectomize the animals, meaning they pull out their ovaries, or they only gear the study to a specific part of the cycle so that it's not interfered with...

1:38:16So the hormones match as closely to a man if possible. So I would say that's the big elephant in the room. Medicine hasn't necessarily studied the female body enough to really know it. We think we're at this pinnacle of science. And so many people trust science to have all the knowledge and information. And while we have so much information, I'm very thankful for that. I'm thankful that I can read all these research papers and share that information. through my books and my work, and I'm sure you are the same. Like, it's an incredible time, really, to be able to share as much research as there is.

1:38:53But even though we have so much, obviously, we've only scratched the surface in terms of women's health, even more so with Sarah Hill's research, which is just wild, right? Yeah. Like, there was a study that I was talking about on the podcast recently, and it was about PMDD, and they measured the, you know, estrogen and progesterone levels of the participants, and the researchers determined that hormonal changes were not in effect. They were saying, well, the hormones are basically the same, so it can't really be a hormonal issue. Maybe it's just that the women with PMDD are more sensitive. When you look at the study, they did one test for progesterone on one random day in the luteal phase, potentially five to seven days after ovulation.

1:39:43And even like, so to kind of break that down, that's not enough information to make an actual formal, you know, scientific conclusion about whether progesterone would have an effect on the cycle. So I believe, you know, and I use that as an example just to kind of share, I believe we are really in the infancy with regards to women's hormones. And that's why I love to bring stuff, it all back to the cycle. You know, that's why I'm so passionate about helping women to understand what's happening in their cycle. It's kind of like what the vaccination against gaslighting, because now you can actually see what's happening in real time and how it lines up.

1:40:23But it also shows us some of the areas where maybe the research studies miss, because they're not necessarily, how expensive would it be to take all these women and to spot test their hormones every day or every other day throughout their whole cycles for however many cycles to really come to that conclusion. So it's not even like I'm not empathetic to why it hasn't been done. But on the other hand, it's like, but you're making conclusions based on your limited research. So that's a long answer, but man, we have a long way to go. Do you hear that? Sounds like breakfast is ready because Quaker's coming in hot with morning nutrition.

1:41:02100 % whole grain oats and a good source of fiber to fuel the rhythm of your morning and kickstart your day. And that sounds absolutely delicious. Fuel to start whatever's next. Quaker, official sponsor of FIFA World Cup 26. But I appreciate that answer because I think the default in people's mind is to think they hate us. Gynecologists hate us. I see that all the time. And what you just outlined is what people need to understand is that there are so many more layers to this. And that, I mean, we didn't even get into insurance and how insurance orchestrates so much of this. And so there's a lot more layer systemically that has to change.

1:41:48But I think something that's very empowering is to understand that it was women's voices taking to social media that has changed the narrative around birth control pills and around IUD pain management. Patients have a lot of power, especially when they're noisy. So get noisy. With that said, what is the gold standard, best method, most efficacious per the research for fertility awareness method? Well, so while I would love to harp on just one method, I do want to say before I answer that within the fertility awareness world, I've been in this world for a really long time, and there's always kind of like this loving infighting where there's a lot of different methods.

1:42:31And if you talk to different practitioners of different methods, they'll say, well, my method is the best because of this, or my method is the best, or whatever. So I do discourage that. I think the best method really is the one that works for the patient in front of you. So I do think that, and there's different motivations. So I think this is an interesting concept. So, you know, for some women, efficacy is the top. But even if you think about it, if efficacy was the top, wouldn't we all just get sterilized? So there's lots of different motivations, right, in terms of why a person might choose a certain method.

1:43:04So I know I'm, you know, giving a little bit of context, but the reason I say that is, you know, for example, some women are really happy with the symptom thermal method of birth control. Other women don't want to touch their mucus. Some women never want to touch their cervix. Some women don't want to have to take their temperature. So there are actually different methods that would account for that. But to answer your question about efficacy, we've talked a lot about that. And the method that has found to have the highest consistent efficacy would be the double-check symptom thermal methods. And again, those methods are having the women check cervical mucus, checking basal body temperature, comparing those two signs so that when you're closing the fertile window, you're comparing two different signs.

1:43:49And of course, when you have two different biomarkers that you're comparing against each other, you're going to have a higher efficacy. And similarly, I've mentioned double check, symptom thermal method, and in that sense, those methods are having a last and first all day calculation. So they're actually using past cycle data to give you an actual cutoff day. So if you're going into your cycle, your period is stopped, you actually have a specific day where either I see my mucus first or I have this cutoff day where I'm going to stop having sex. And that method, when we look at the research time and time again, has the highest efficacy.

1:44:29And the reason for that, once again, is that the pre-ovulatory phase is really the only phase pregnancy can happen in because that's the phase where ovulation takes place. Once ovulation has happened, the egg survives for about 12 to 24 hours if it's not fertilized and then it's disintegrated. So once the egg is dead and gone, pregnancy really can't happen. So the reason why this method has the highest efficacy is because it really does help women to have more structure for how they're handling the fertile window. And I mean, when I'm teaching fertility awareness, one of the units, we have our managing the fertile window unit.

1:45:08And one of the things that I talk about is this getting into it. Like, why does the method fail? What happens when a woman is using the method and she becomes pregnant and she didn't anticipate it. And so the majority of those failures are not necessarily method failures, but user failures in the sense that you were having sex on a fertile day. And why does that happen, right? Where, you know, you might be thinking to yourself, it's too early. I never ovulate this early. It was just a little bit of mucus or whatever. So talking through those things, understanding those things, but also choosing a method and understanding the guardrails and actually following them.

1:45:44If you could give a bullet point list of like, what are the key things that are being measured with this method? I think that would help just lay it out for women. The key things that are being measured in? For this particular method. And do you mean in the sense of like charting and efficacy? Or do you mean in the sense of like other hormonal things? No, no, efficacy. So if somebody was like, okay, I want to do the best method, the one that the research has the highest efficacy. If we could just run through a punch list of like, these are all the things that are measured. I want everyone to understand this podcast will not be enough for you to start.

1:46:19Fertility Awareness Method and These Successful, I would recommend working with a FAM educator. But just so that people can kind of wrap their mind around like what goes into this, like I'm checking fertile cervical mucus, like what are the parameters that you're going to be measuring? Well, so I mean, I mentioned cervical fluid and basal body temperature. And so like In a podcast setting, we're talking about it in a general way where it's just tracking your cycle. But when you get into the nitty-gritty details, you'd be checking for cervical fluid on a daily basis. Different methods teach how to check for mucus in different ways.

1:46:54So some methods might encourage you to check internally. Some methods might encourage you to kind of check how you feel throughout the day. The method that I teach, we do external wiping with toilet paper. And we have a whole standardized system of characterizing mucus. So from that standpoint, then we're able to get more into the weeds and be a lot more specific. So for example, if you're wanting to understand cervical mucus and really use it as a marker of fertility to avoid pregnancy, you're going to want to get really clear on which days are fertile, which days are not, and get into the weeds when you see different types of mucus or different amounts so that you can really be clear on that.

1:47:30So one of the positive things when you're working with an instructor, depending on the method that you're using, is that you get really, really clear on how to identify what's a fertile day, what's not, what the different types of mucus presentations are, and how to actually track that. So it does go deeper than what we're casually talking about today so that you have a much better understanding of that. And so within that, the mucus aspect of it, we would identify your fertile days based on your mucus presentation. And when your mucus actually, when you ovulate, one of the things that happens is that as your as your progesterone rises, that shuts down typically mucus production.

1:48:09So not all women will find that they have absolutely nothing and totally dry, but you will see a significant shift and change in the amount and the type of mucus that you observe after you've ovulated. So within the method, you would be able to identify that, and that's one of the signs that you use to confirm ovulation. And then when we look at temperature, you know, I could spend a whole hour talking about all of the different aspects of temperature. But just to kind of make it shorter, you know, I even advocate for a standardized way of taking the temperature so that you're taking enough time to warm up the thermometer so that it's giving you an accurate reading and more consistent patterns, knowing what can impact the temperature and being able to chart.

1:48:52Like if you're having a glass of wine, your temperature could be up. So basically with the method, you are looking for the temperature shift. You're looking for three temperatures that are higher than the previous six. You're taking your temperature first thing in the morning every day. There's different charting apps that you might be using as well. There's different thermometers. There's a whole conversation around that. But the bottom line is that when you're getting into the weeds, the main markers that you're tracking would be the mucus and the temperature. You learn how to confirm ovulation with both, and then you cross-check that information.

1:49:24And this is why I always say that if somebody is wanting to learn this method, you will never have enough information in a casual conversation. It doesn't mean that it's so complicated. It just means that like, like I learned how to drive standard when I was in my twenties and like, it took a little bit of time. What does standard mean? Oh, like a car, like the stick. That's what we call it in the U.S. Stick. That's what I learned too. Well, yeah, standard or stick. I've heard both of them, I've never heard standard. I'm like, I like that. I grew up in the woods and the mountains. Okay. Maybe like nobody else calls it stick.

1:50:00No, no, no. I've heard that before. So you're not allowed. So yeah. So I learned how to drive stick. Right. But at the end of the day, like it wasn't that I could just like read a little something and just like, it took a little while. It took a few weeks of me actually doing it to get the feel of it and to kind of understand it. And I think that that's a good analogy for this. You know, there's the learning about it, but if you're really wanting, I want women to be successful with this. There are a lot of women out there. And even when I post certain things on my social media channel, I'll post about the effectiveness and there'll always be a couple of people like, well, it didn't work for me.

1:50:35I got pregnant, whatever. And just like you said, when we were talking about the efficacy of like, well, I was using this method and it's like, well, really they were using pull out, but they probably weren't doing that directly, right? So, you know, I really want women to be successful. And so for that reason, I think that if I go back to the study that I was kind of talking about when I mentioned the efficacy and I mentioned the 99.4 % efficacy of perfect use and the 98 % typical use, that study wasn't a bunch of women who heard a podcast and like bought an app, right? These were women who were trained by educators who were obviously, you know, certified in the method.

1:51:17They were taught over a certain period of time. They had a certain number of sessions and they were kind of followed through that process. So they were really set up for success and that was why they were able to be that successful. So bottom line, like it is effective and you will get, you will have the highest success in the shortest time if you work with an instructor. And I'm glad that, you know, you said that because that was going to be my question is like, how did these women actually achieve that? There's going to be people listening who don't know what basal body temperature is, and we've used that a few times on the podcast.

1:51:52Can you define that? Yeah. So basal body temperature is a word for kind of like your resting or baseline metabolism. And that's, so for example, if you were to have, if you were to sleep, so your body's at rest for a minimum of about five hours or more. So just picture you actually go to sleep or whatever Before you get up, before you start moving, before you start changing your body temperature and changing your metabolism, you would take your temperature. And that's kind of the idea behind taking your temperature first thing in the morning before you wake up because you're actually kind of getting that reset number of when your body was at rest.

1:52:28Okay. How do you feel about wearables that are tracking basal body temperature? So, I mean, I even endorse some of them. everything that I do goes back to that informed consent piece and just really understanding what data you can gain from some of these and what you can't. So with a lot, and this is not a knock, I'm just, just for anyone who's like, this is a knock. It's not a knock. It's just what it is. So with a lot of the wearables, they are not actually measuring basal body temperature technically. What they're doing is some of them are measuring like an average temperature or like Many of the wearables also have different algorithms.

1:53:09Some of them you can shut them off and on, but, you know, they're super convenient. So there's a lot of positives. So like I said, it's not a knock. I'm just trying to explain what it's doing. But so with these wearables, I think the intention behind it, there's a couple of things. I think one of them is like, how do we monetize fertility awareness? You know, and it's like, well, you know, thermometer, let's do that. So I think that that's definitely it. But the other thing is that temperature is variable. This is why I really appreciate the Symptothermal method for having two markers that we're always comparing against.

1:53:41Because in every cycle, you'll have at least one kind of out there temperature. And even you'll have a little weird maybe mucus situation. So it is really helpful to have two markers. So I believe that these devices are really aimed at addressing some of the common pain points or challenges that women have with taking their temperature. Like getting up at the same time every day. Like what if you have to get up earlier or later? And, you know, if you did have that glass of wine or if you have a glass of wine affect us. Well, so for some women, it's really it's just really interesting when you watch their charting.

1:54:15For some women having the glass of wine the night before the next day, their temperature would just be super high. So when you're looking at the actual chart, maybe all of the temperatures are in a certain range. And then all of a sudden there's one at like 99 and you're kind of like, well, what's going on there? And, you know, over the years, there's not a blanket thing that I can say every woman is going to respond the same way to alcohol or every woman's going to respond the same way to waking up at different times. But what I teach in my programs is to understand the factors that can affect temperature and then start to have your clients chart and put their data, like, what were they doing that day if they did have a glass of wine or if they did have a cortisone shot or whatever.

1:54:58and then you can start to see how it affects their temperature. But at the end of the day, like even what I just described, like there's a lot of different things that can affect it. So with the alcohol specifically, some women find that the following day the temperature is really high and that can be confusing. And then obviously, you know, if you get up at six o 'clock every day for work, but then on the weekends you get up at 10, then what can happen is the later temperatures or the later time that you got up, the temperatures can be higher. So I think with a lot of these devices, they're there to try to simplify it and make it easier, which makes a lot of sense.

1:55:32If you have little kids, if you have a new puppy and you're always up in the middle of the night, obviously, you know, so what a lot of them are doing by doing this kind of average, you know, sleep temperature throughout the night is giving you more of a seamless temperature charting experience and smoothing out some of those curves. And some of the devices that have algorithms, the algorithms them is also kind of smooth out the curves. So the pro is that if you do have a really challenging schedule of work, if you work night shift, or if you did just have a baby, or if you do have a new puppy, then it can be easier.

1:56:07It kind of takes the pressure off, you know, and it still works very effectively for the most part to confirm ovulation. But I would say, you know, just as a piece of information, because it's many of these devices are not actually measuring that basal body temperature, technically, if you were to try to gain additional information, like for example, if you are tracking your cycle and you're doing like a regular oral temp and you're noticing that your temperatures are super low, like they're off the chart, sometimes that can be an indication of metabolism, obviously. It could be an indication of an issue with thyroid or even just an under-eating situation.

1:56:41But if you're doing the devices, you can't really get the same information, so I wouldn't really recommend using the temperature for that purpose, only for charting. Okay. Can we do some rapid fire questions? Sure. All right. So here's my first one. If someone wants to avoid pregnancy with fertility awareness method, what's the number one thing they need to know? I think that, yeah, I think you should work with an instructor. Okay. On the flip side, what's the fastest way to use fertility awareness method to get pregnant? Learn your mucus. Ah. How does this approach work for women with PCOS? So with PCOS...

1:57:17um In many ways, it's the same. I don't know how rapid this is going to be, but with PCOS, obviously, one of the big challenges is long, irregular cycles. So the myth is that if you don't have regular cycles, fertility awareness can't work. But fertility awareness is not based on the calendar calculation situation. It's based on observing what's happening as it unfolds. So with PCOS, there's just certain challenges that you need to overcome. So a PCOS cycle often will have many more days of cervical mucus or multiple patches of mucus. And you just have to learn how to work through that. If you're trying to conceive, then I think it can be actually really helpful.

1:58:01Imagine if you had a 45-day cycle or a 50-day cycle and you're just being told to have sex every day. A lot of doctors say that. Yeah, like that's great advice, not. The fastest way to get out of the mood is to be forced to be in the mood. All the time, yeah. And so if you chart, while you will still likely have many more days of cervical fluid than in a typical cycle, because in a typical cycle, you might have a week's worth of mucus. But if you have a 50-day PCOS cycle, you may have multiple patches of mucus or several days of mucus lasting over 20 days if you add it all together. But the positive is that you can learn which days or which, you know, the days that you have the clear, stretchy mucus in the best quality or the most amount.

1:58:45Those are the days of, you know, peak fertility. So you can actually, while you still may have to have more sex than somebody who has a normal cycle, at least you can time it. And at least you can kind of understand when would be the best. When someone is not seeing fertile cervical mucus, what are the top culprits? So there's a lot of different reasons. I mean, the first thing I want to know is if the cervix is healthy, if they had a history of cervical dysplasia or any type of cervical surgery. So I've just observed and IUD placement. I have a hypothesis that after all that we talked about, it doesn't seem that out there.

1:59:24But, you know, I have this hypothesis because often in women who've had IUDs placed in the past, I'll sometimes see this like lower mucus presentation. and I kind of wonder if it did anything to the cervical creps. Anyways, so history of HPV, history of cervical surgeries can be associated with lower mucus. If a person has been on the pill for an extended period of time, that can be associated with lower mucus presentation. And then certain drugs can be associated with that as well. I mentioned antihistamines earlier. So if someone's actually actively taking allergy medication, that can fully suppress their mucus for or mostly suppress it.

2:00:01So that's something to be aware of. And then on the hormonal front, if somebody really is under eating or overexercising, that can do it too. Can fertility awareness method work in perimenopause when cycles are irregular? Absolutely. Again, the myth is that the cycle has to be perfect, but that's because we think of fertility awareness as the rhythm method. We think of, you know, it has to be regular because we have to be able to guess and anticipate when ovulation is happening. So in the same way with a PCOS cycle, you kind of have to understand what the different signs mean and track it as it unfolds.

2:00:35With perimenopause cycles, it can be extremely helpful because you would be able to identify potentially based on mucus if an earlier ovulation was happening, you would be able to identify how your body's responding to the different changes that are happening even by looking at your luteal phase length. So I think there's a lot of benefit to tracking your cycle, especially during those years. Yeah. And I just want to add on to that. We don't have a great way to test you to definitively know based on blood work if you're in perimenopause, because it can fluctuate so much in the early years, but you tracking your cycle.

2:01:07And once you say like, yeah, my cycles are like 60 plus days apart. We're like, and we are on the descent now. Now we were on our way to menopause. That is if you're, you know, if you're in your forties, If you are somebody who's in your 30s, I just want you to know that menopause is not considered normal before age 45. So if you're like, I'm 25 and hearing this or 35 and hearing this, that doesn't mean just assume this is perimenopause. What are the most common mistakes people make when they first start charting? I would say definitely what I call rhythm method thinking. So getting on the 28-day track, the 14-day, and making assumptions.

2:01:44So I always say like your app doesn't know what's in your panties today. Like if you're trusting the app. True that. They literally did a check for me because it's... They better not know how invasive are these apps. Where did this picture come from, right? But yeah, so I would say that's the biggest thing because it is a real shift. Like it's a perspective shift to go from thinking that it's based on the 20-day cycle situation to be... Because it's not always easy. Your cycle is not always going to unfold how you think. Anyone who's charted their cycles for more than six... months or six cycles will already know that you're going to see things that you didn't think you were supposed to see.

2:02:23You were going to experience things that you didn't think were possible. I've seen plenty of charts that people would actually like tell me like, no, ovulation couldn't have happened in that chart or whatever. So again, we're not robots. So always remember that. And you just kind of have to be able to go with the flow. So this is the mindset shift of recognizing if you see mucus before you ever did, or if you don't see mucus and then you see it later in the cycle. Yes, it's possible that ovulation can be delayed or ovulation can happen early, or you can have an anovulatory cycle. And you wouldn't know before, you just have to kind of be in that moment and track it.

2:03:00And what I always say to my clients is you want to approach charting as an objective journalist. And that means that even if you don't think you should be seeing what you're seeing, just write it down. And then once we get to the end of the cycle, we can go through it together. I love that. If you could challenge listeners right now to doing just one thing over the next seven days to improve their cycle, what would that be? Eat more protein. Eat protein-rich breakfast. Why? I mean, I know why, but I'm like, I just honestly didn't see that one coming from you, but it's an obvious one, yeah. Yeah, well, because the question was to improve the cycle.

2:03:36And I mean, one of the things, There's several things that come up when you start looking at your cycle, as I'm sure you know. When you start looking at your cycle, all of a sudden you're faced with your mucous patterns and you're kind of like, what's going on there? You're faced with when ovulation is happening in the cycle, if it's happening when you think it should be or if it's happening later, earlier. But you're also faced with your luteal phase. And again, it's very, very telling. And I think for a lot of, that's just why low progesterone is one of the biggest probably searched topics on the whole internet.

2:04:07and why that is a whole topic. So when you are charting your cycle and you start to see things like lower temperatures and you start to see things like scant cervical mucus and you start to wonder why your luteal phase is only 10 days and you start to wonder why you're having spotting or you're having these PMS symptoms and it's always right before your period and all those kinds of things, I don't have magic for you, but you need to eat enough protein. Like especially if you're working out. So if you're exercising, this is something we should be paying attention to. And I would say the reason that it's so important is because, again, if for me, I'm looking at the chart in real time, this is what I do.

2:04:47And so, you know, when we see those low temps, when we see that short luteal, that's the foundational block. So while it might be great to be like, oh, we need to go and take this supplement or that supplement or do this magical thing or whatever, I always like to take it back to what we call the foundational factors in my program, which that's what you can do to make the biggest improvement in your cycle today. What do you think people can expect to see change in the next five years in the fertility world? That's a good question. I don't really, I know what I would like to see changed. Oh, tell us.

2:05:22I want your list. But I don't know that that's what we're actually going to see. But what I would like to see changed is I would like to see menstrual cycle charting as a standard part of how women are cared for. If you're working with women of reproductive age, what better way to support them than to actually have a window into what's going on in real time? And if and when she needs additional testing, what better way to do that than based on what's actually happening in her cycle in real time, timing things based on the actual stage of the cycle that she's in, instead of living in this imaginary fake bubble where we can just pretend that we can keep doing things the way we have and doing things based on a certain day, regardless of what.

2:06:03So that is something that I would love to see in the future. I think that it is possible. I think that it's happening. There are, it has been really amazing to see over the past 20 years what has happened with the field. When I first started my podcast, you know, the average health professional wasn't really talking about the menstrual cycle as a vital sign. And now a lot of people are. There's a lot more medical professionals that are in this space now that are learning about the cycle and incorporating it into their gynecological work, into their surgical work, into their hormone workup. So we are seeing a shift.

2:06:39And that's what I would really like to see. I would like to see because when you actually base things on what's happening in real time in the cycle, you're actually helping her you know and you're basing what you're doing on actual facts and data as opposed to whatever biases you have and one of the things that I love about this you know field of kind of charting and chart interpretation is that if you ever we all have our biases right so as a practitioner if you're working with somebody you already have your biases you already have your protocols in your head of what you think is going to work but when you incorporate the chart into it sometimes your best protocol that's worked on so many of your patients doesn't touch this person because you don't see any change.

2:07:20And that forces you to become a bit more of a scientist and investigate, but it forces you to really address the woman in front of you. And so, you know, personalized care, I think, would be what I would love to see. I love that. Well, thank you so much for taking the time to sit down with us today and share all of this information. This has just been such a rich conversation. I really appreciate it. Thank you for having me and obviously for your great questions. And yeah, I really appreciate it. Your call has been forwarded to voicemail. Hi, this is Zoe Deutsch. And Nick Robinson. Our brand new movie, Voicemails for Isabel, is all about those little moments that feel like the universe is looking out.

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