0:07

Welcome to the Just Ingredients Podcast. I'm

0:09

Cara Lynn, and here we talk all

0:11

things nourishing to the mind, body, and

0:14

soul. This is a place where you

0:16

can find just good ingredients to life.

0:23

Dr. Sarah Hill is an

0:25

award-winning research psychologist and professor

0:27

with expertise in women, health,

0:30

and sexual psychology. At

0:32

the intersection of evolutionary biology,

0:35

social psychology, and neuroscience, Dr.

0:37

Hill's research is aimed at

0:39

understanding the role that hormones,

0:41

the immune system, and the

0:43

environment play in relationship and

0:45

health behaviors, especially in women.

0:48

Dr. Hill's research laboratories are located

0:50

in the Department of Psychology at

0:53

TCU in Fort Worth, Texas. Welcome

0:55

back to the show, everyone. Today, like you

0:58

heard in our bio, is Dr. Sarah Hill,

1:00

and I am really excited to talk to

1:02

her today. I know you listeners are

1:04

going to love this topic today because

1:07

I always get so many questions about birth

1:09

control and how it affects our health and

1:11

things like that. I'm excited to talk to

1:14

you today. Thank you for being here.

1:18

As we begin, will you just tell

1:20

my listeners a little bit about yourself,

1:22

your background, why you got interested in

1:24

studying about the pill, things like that?

1:26

I'm a researcher, I'm a

1:28

psychologist and a university professor,

1:30

and my background is in

1:32

evolutionary psychology. I actually really

1:34

interested in evolutionary biology when

1:36

I was in college. Then I

1:39

learned that you can use the

1:41

same principles, just like understanding the

1:44

biological function of different types of traits,

1:46

and you can apply that to the human mind and

1:48

to try to better understand behavior and why

1:51

we do the things that we do. I was always

1:53

interested in women because a

1:55

lot of research, especially when you

1:58

have researchers studying biological

2:00

basis of behavior in humans,

2:03

a lot of those researchers tend to be

2:05

men. And a lot of the perspective in

2:07

terms of understanding things like partner preferences and

2:10

motivational states and everything, it kind of had

2:12

a male slant to it. And so I

2:14

was really interested in trying to understand these

2:16

things in women. And so much of my

2:18

early career was spent understanding women and

2:21

like partner attractions, like who are women attracted

2:23

to, why they're attracted to them, risky

2:26

sexual behavior in women. So really interested

2:28

in, you know, why women

2:30

take sexual risks when they know that, you

2:32

know, they're not good for them, and so

2:35

on and so forth. And what ultimately led

2:37

me to study the birth control pill was

2:39

going off of it. And I had the

2:41

experience that so many women that I've talked

2:44

to at this point have had,

2:46

and that is that I went off of the

2:48

pill. And all of a sudden,

2:50

I felt like I woke up, I was like,

2:52

Oh, it was about three months after

2:55

I was off of it. I was like, Oh,

2:57

my gosh, like, I, I recognize this person that

2:59

I am. And it's different than what it has

3:01

been for the last 10 years, you know, that

3:03

I was on the pill. I noticed

3:05

that I had more energy, I was feeling

3:08

things more deeply. So it was like things

3:10

that were joyful felt more joyful, and things

3:12

that were hard felt more hard. But it

3:15

felt good, vibrant in a way that I

3:17

had in I was I was downloading new

3:19

music. For the first time in, you

3:21

know, 10 years, I like, started

3:23

downloading playlists, I started listening to music when

3:25

I cooked, I was enjoying cooking more enjoying

3:28

going to the gym more, I was enjoying

3:30

sex more, we just felt more alive. And

3:32

I was like, Hmm, I wonder

3:34

if this is something to do with going off of the birth control

3:36

pill. And you know, what's funny

3:38

about this is that up until

3:41

this point, because I was on the pill much of my

3:43

early adult life, like, I went on it when I was

3:45

about 17 or 18.

3:47

And I was on it for, you know,

3:49

10, 11, 12 years,

3:51

pretty much straight, except for having my

3:53

two kids and then lactating. But

3:56

that's not really a normal hormonal state for anyone, but

3:58

I didn't spend a whole lot of time. I'm off

4:00

as a naturally cycling woman after, you know, at the

4:02

time I was 18. And

4:05

during that time, I had done research

4:07

and I published papers on the effects

4:09

of women's sex hormones on motivational

4:11

states and attraction and, you know, some

4:13

of these other processes and I never

4:16

connected the dots that, okay, so hormones

4:18

affect all of these things and you're

4:20

putting a hormone in your body that's

4:23

shutting down your own hormone production and

4:26

you expect it's not gonna have any change on

4:28

your psychological state. It's like, that's nuts. You know,

4:30

after I went off of it and I had

4:32

these experiences of feeling so different and feeling so

4:34

much more alive and just like more three-dimensional, I

4:36

started doing research into like, what do we know

4:38

and not know about

4:41

the effects of hormonal birth control on the

4:43

brain and then on women and just their

4:45

sense of themselves. And that research

4:47

is what led to the writing of the

4:49

book, This Is Your Brain on Birth Control,

4:51

because there was so much information that was

4:53

out there. And there's also a lot of

4:55

information that's not out there yet, but

4:58

there's really important research questions that need to

5:00

be asked about the way that the pill

5:02

changes women. So interesting. So

5:04

I'm curious, did you

5:07

feel like bad on the pill or

5:09

you just didn't even notice you felt

5:11

different until you actually went off the

5:14

pill? No, you know, it's

5:16

really funny because I didn't feel bad on

5:18

the pill. I had the experience many women

5:20

do where they're like, I'm great on the

5:22

pill. It feels just fine. I didn't have

5:24

major like mental health problems or major problems

5:26

with libido, but I will say

5:28

this, and this is so interesting. And I've heard this

5:30

also from a lot of women is

5:32

that I've always had this narrative

5:35

about myself as being somebody who

5:37

becomes really easily overwhelmed and

5:39

can sort of fall into a deep

5:42

funk pretty easily. And

5:44

that ends up not being true. That was the pill,

5:46

but I had no idea. Yeah, I

5:48

had no idea. I thought that that was who

5:50

I was. And it didn't feel intolerable. You know

5:52

what I mean? Like I never had to go

5:54

on psychotropic medication. It wasn't like I was like

5:56

depressive. And it wasn't like I was so anxious

5:58

that I was having panic. attacks and, you know,

6:01

having to rearrange my life. Instead, it was just

6:03

that I felt like, oh, I'm a really anxious,

6:05

you know, I'm a pretty anxious person. And like,

6:07

oh, you know, it's really easy for me to

6:09

fall into a deep gray funk. But then after

6:11

I went off of it, I was like, neither

6:14

of those things are true. And what's really

6:16

funny about that is that it's taken almost,

6:19

you know, I've been off of it now for almost

6:21

probably more than a decade now. And yeah, no

6:23

more than a decade now. And it took me

6:26

about 10 years to actually understand that story I

6:28

had about myself wasn't true. That's

6:30

like, that's not me, because for the last, you know, 10,

6:32

15 years, that hasn't been

6:34

true of me. And so it must

6:36

have been, it must have been birth control. So I

6:38

didn't really record, like, I didn't have a problem with

6:40

the pill. You know, you don't really notice, I think

6:42

that when we experience changes in the pill, I think

6:45

they're gradual. And in that you just sort of, in

6:48

your narrative about yourself changes, because we're constantly

6:50

updating our, you know, sense of self and

6:52

who we are based on the way that

6:54

we respond to different environments. And over time, we

6:57

sort of develop a story about ourself. And that

6:59

changes over time based on experiences. And, and

7:01

yeah, the story that I'd been telling myself

7:03

turns out that it wasn't really even true. Yeah,

7:06

that is so interesting. So

7:08

I have a lot of questions to ask

7:11

you about the birth control pill. And, you

7:13

know, so many things that we're hearing out

7:15

there in social media, I want to see

7:17

if they're true or not. But let's just

7:19

maybe start more at the basics of like,

7:21

what is the birth control pill and what

7:23

is it doing to your body? To

7:25

understand the way that the birth control pill works.

7:28

The first thing we really have to understand is

7:30

how a natural cycle works, because

7:32

the birth control pill works by switching

7:34

that off. And so

7:36

just for a minute, to orient people

7:38

who aren't really familiar with the changes

7:41

in our sex hormones and the way that our

7:43

cycles work, the first day

7:45

of your cycle is the day that you

7:47

get your period. So that marks the beginning

7:50

of a new cycle. I'm in that cycle

7:52

day one. And at that point, hormones are

7:54

really, really low. So your

7:56

sex hormones crash at the end of

7:58

each cycle. And that's actually what prompts

8:01

your period, prompts endometrial lining

8:03

to begin to release. And during

8:05

that time hormone levels are low. And when

8:07

hormone levels are low, the brain

8:10

picks up on that because we have

8:12

hormone receptors on our brain and on

8:14

the hypothalamus specifically. And it picks up

8:16

on the fact that hormones are low,

8:18

which means that you have not just

8:20

released an egg and that you probably

8:22

should start developing a new one. And

8:24

so a state of low hormones tells

8:26

the brain you need to stimulate the

8:28

ovaries and get, you know, some follicles

8:30

developing. So that way we can begin a

8:32

new process of ovulation. So the

8:35

brain starts stimulating the ovaries, the ovaries start

8:38

maturing egg follicles. And as that's

8:40

going on, that causes the release

8:42

of estrogen. And so what happens is

8:44

your follicles are being stimulated that causes

8:47

estrogen release. And then one dominant follicle

8:49

takes over, which is the one that's

8:51

going to mature fully into the

8:53

egg that gets released. And once

8:55

it starts maturing, then estrogen levels

8:57

really start to climb and continue to

8:59

climb really sharply until right before

9:01

ovulation, which for most women happens

9:03

around day 14 of the cycle.

9:06

So about two weeks after

9:08

the day that your period started is

9:10

generally when most women ovulate. And

9:12

so at that point, the egg gets released

9:15

and estrogen levels fall. And

9:17

then that empty egg follicle actually

9:19

turns into a temporary endocrine structure

9:22

and it starts to release progesterone, which

9:24

is women's other primary sex hormone. And

9:26

so progesterone is then released during the second half

9:29

of the cycle, which is called the luteal phase

9:31

of the cycle. And this is the

9:33

phase of the cycle in which the body is

9:35

waiting to see whether that egg that was just

9:37

released is going to

9:39

be fertilized and then implant itself. And

9:42

so progesterone, when it's being released, this

9:44

is a time in the cycle when

9:46

one, you can't get pregnant from sex you

9:49

have. So if you have sex in the

9:51

luteal phase, because train has already left the

9:53

station with the egg being released on this

9:55

is an infertile time in the cycle. But

9:57

it's also a time in the cycle where the

10:00

brain does not stimulate the ovaries

10:02

any longer because an egg has already been

10:04

released. Right, so the release of progesterone, again

10:06

that hormone from the second half of the

10:09

cycle, is actually a signal to

10:11

the brain not to tell the ovaries to

10:13

develop any eggs. Because it's essentially it's like

10:15

your body waiting to see whether

10:17

that egg had already released is going to be

10:20

fertilized in a plant. And so it's sort of

10:22

a wait and see time with

10:24

a brain ovarian axis. And

10:27

the way that the birth control pill works is

10:29

by mimicking the second half of the cycle. Because

10:32

it has a synthetic progestin,

10:34

which is a synthetic form of

10:36

progesterone. And the way that this

10:38

works is that it stimulates progesterone

10:40

receptors in the brain in the

10:42

hypothalamus. And this tells the brain,

10:44

hey an egg has already been released. You don't

10:47

need to stimulate the ovaries and tell them to

10:49

start maturing egg follicles because we need to see

10:51

whether we're going to get pregnant from this last

10:53

one that was released. Right, and

10:55

so taking that same daily dose of hormone, it

10:57

keeps telling the brain the same information. It's like,

10:59

oh we're waiting to see whether or not we're

11:02

pregnant. Don't do anything. Don't stimulate the ovaries. And

11:04

that's why we don't ovulate. That's because you take

11:06

the same daily dose of this medication and then

11:08

that just keeps telling the brain you don't need

11:10

to stimulate the ovaries. And then you get that

11:12

message over and over and over again. And then

11:15

when you take the placebo pills and you're not

11:17

getting that same hormonal message again, you

11:19

again experience a hormone crash, similar to what

11:21

you do at the end of a natural

11:24

cycle. Because during the luteal phase, which is

11:26

that second half of the cycle when progesterone

11:28

is released, what you get

11:30

is you get progesterone rising until about the beginning

11:32

of the second week of the luteal phase, which

11:34

is the week before your period starts. And

11:37

that's a point at which either fertilized

11:39

egg is going to implant itself or

11:41

it's not. And if it hasn't,

11:43

then progesterone levels start to fall. And then when

11:45

hormone levels totally crash at the end of the

11:47

cycle, that's then what prompts the

11:49

release of the endometrial lining your period and

11:52

then the start of a new cycle. So

11:54

anytime that hormone levels are low,

11:56

the brain starts stimulating the ovaries.

11:58

And when estrogen is high, They're

12:00

starting to rise when that's the dominant hormone.

12:03

That's also a signal to the brain that

12:05

needs to be communicating to the ovaries to

12:07

keep on stimulating egg follicles. And so essentially

12:09

the pill works by putting us into this

12:11

other state. We're never in a state

12:13

where hormone levels are kept really low for any period

12:15

of time. And we're never in

12:17

a state where estrogen is the dominant sex

12:19

hormone. Instead we're constantly in the state where

12:21

our brain is being stimulated by a

12:24

synthetic form of progesterone to keep

12:26

it from communicating with the ovaries

12:28

to start maturity egg follicles. You

12:30

did such a great job explaining that.

12:33

That was nice and easy to understand

12:35

a big complex thing. Oh, I have

12:37

so many questions after that because now

12:39

I'm curious, the brain, it

12:41

has to adapt to these hormonal changes,

12:43

correct? Yeah, I mean,

12:46

absolutely. The thing is, is our brain,

12:48

it used to be thought that neuroplasticity

12:50

was something that stopped once brain development

12:52

stopped, but we know better than that

12:54

now. And the brain is a dynamic

12:56

process. It's like it's always changing

12:58

and adapting to the things going on in

13:00

the environment. And although this is slower once

13:03

you're an adult than it is when you're

13:05

younger, we do still get this sort of

13:07

adaptation. And so a

13:09

person would expect that when you've been

13:11

given the same daily dose of this

13:13

hormone every day, that your body does

13:15

adjust to that. And so for example,

13:17

one thing that we know from women

13:20

who are using hormonal birth control is

13:22

that they're never in a state of

13:24

high levels of estrogen like you are

13:27

when you're a naturally cycling woman. Because

13:29

for a naturally cycling woman, you get

13:31

this really beautiful sharp rise in estrogen

13:34

that precedes ovulation. And so we

13:36

go through this period of estrogen dominance, but not

13:38

in the bad way that most of us tend

13:40

to think of it. It's just this period where

13:42

this is our dominant hormone and you never get

13:44

that as a naturally cycling woman. You have one

13:46

prediction that a person could make. And

13:49

I think that there's probably some evidence that this is

13:51

true. There's at least evidence pointing in this direction is

13:54

that you'd either have more receptors

13:56

for estrogen than you would

13:58

otherwise, just simply because that.

38:00

And the party line in science

38:02

is that birth control, no, does

38:04

not affect waking, right? It's like,

38:07

okay, unless it is the

38:09

birth control shot. So that's the one

38:11

where everybody's willing to concede the fact

38:13

that yes, women do seem to be

38:16

gaining weight at a disproportionate rate when

38:18

they're put on the birth control shot

38:21

relative to other forms of hormonal birth

38:23

control. But if you look

38:25

at the research, and you look at

38:27

it a little bit more closely, the

38:29

answer is a lot more complicated than

38:31

yes or no. For example, in one

38:33

study, and I break this down in

38:35

this research, recent research paper of mine,

38:38

where we looked at the data that was

38:40

presented showing, you know, it was another,

38:42

it was a study done where they

38:44

randomly assigned women to take this type

38:46

of birth control or not. And then

38:48

they measured their weight gain over time.

38:50

And what they found was there's no

38:52

differences in weight gain. But then, if

38:55

you break down their results in terms

38:57

of what women's BMI was, so how

38:59

heavy the women were when they started

39:01

the study, and you look

39:03

at their weight change over time, what you

39:05

actually get is you do get differences. It

39:07

just differs depending on whether you started with

39:09

a low or high body weight. And

39:12

so for women who were in the study

39:14

who had high body weight, and they went

39:16

on the birth control pill, they lost weight.

39:18

And then for women who had low body

39:20

weight, when they went on birth control, they

39:23

gained weight. And so essentially, when you

39:25

put all those women together in a single sample, it

39:27

looks like you have no change in weight gain, right?

39:29

Because some women are gaining weight, and some women are

39:31

losing weight. And undoubtedly, because of

39:33

the way that hormones work, you're going

39:36

to find this type of interactive effect on

39:38

almost anything that's worth measuring. So for example,

39:40

sexual desire, you know, I'm guessing

39:42

that women who have really high sexual desire, you

39:44

put them on the pill, they probably have decreased

39:46

sexual desire. You have women with

39:49

sort of middling sexual desire, low sexual desire,

39:51

they might have increased sexual. I mean, there's

39:53

a fairly substantial body of evidence showing the

39:55

sexual desire effect now that women

39:57

on hormonal birth control can have lower But

40:01

with a lot of these, a lot of these effects where

40:03

they're like, oh, well, you know, there's really no evidence of

40:05

this. It's like, is there really no evidence of this? Or

40:07

are we just not studying this right? Because

40:09

a lot of the studies, the way that they,

40:11

you know, make the comparisons is between women who

40:14

are using birth control and not. And they're not

40:16

doing it in a more nuanced way where it's

40:18

asking questions, for example, like the waking question of

40:20

like, well, what was your weight starting out with?

40:22

Right. And then how does

40:25

the pill then interact with that sort

40:27

of person based variable then to impact

40:29

the outcomes? And so,

40:31

yes, it may impact weight gain,

40:33

but it may impact weight loss. You

40:36

know, it just kind of depends on

40:38

where you're at. The other things that

40:40

the pill can do to physical appearance

40:42

and it's like less of a overt

40:44

physical appearance thing, but it does have

40:47

to do with like sort of the

40:49

physicality of yourself is when you're

40:51

on a hormonal birth control. You

40:53

don't experience that nice, beautiful rise in

40:55

estrogen that we get as

40:57

naturally cycling women. And

41:00

estrogen is something that is known

41:02

like to promote all things female

41:04

sexual attractiveness. So it does things

41:07

like makes our skin more vibrant.

41:09

It makes, you know, our

41:12

gait sexier. It makes our voices

41:14

sexier. We smell sexier. And so

41:16

when women are, you know, naturally

41:18

cycling and they're going through what

41:20

we call either the fertile window

41:22

or the periovulatory window, which is

41:24

that period in the cycle of

41:26

about five or so days prior

41:28

to ovulation up to ovulation

41:30

when estrogen is rising and rising and rising.

41:33

Most women kind of feel their best.

41:35

They look their best and

41:37

they report really feeling a lot

41:39

sexier than they do at other points

41:41

in the cycle. And so

41:44

when you blunt that and

41:46

you're suppressing women's own hormone

41:48

production and then you're giving them

41:50

the same daily dose of this

41:53

progestin dominant pill, they never get

41:55

to experience that, you know, that gets suppressed.

41:57

And so a lot of women have

41:59

a lot of sex. that

44:00

they're having. They just felt more attraction to their partner

44:02

and they felt better about the sex that they were

44:04

having with their partner. Where women who

44:06

chose their partners when they were on

44:08

the pill, they were more satisfied with

44:10

things like burning capacity and the intelligence

44:12

of their partner. So it almost seems

44:14

like it nudges you to prioritize different

44:17

types of things. And when you're a

44:20

naturally cycling woman and you go through

44:22

these periods where you're really in tune with

44:24

things like sexual desire and sexiness

44:26

and that sort of thing that becomes one of the many

44:28

things that women prioritize when they're choosing

44:32

a partner. And that for women

44:34

who are on hormonal birth control and aren't

44:36

having those changes, that instead is just very

44:39

much focused on some of the other types

44:41

of qualities that women tend to value. So

44:43

things like partner's earning capacity and that sort

44:45

of thing. Sort of like flipping a light

44:47

switch off on all of the sexy related

44:49

variables in terms of partner choice. Wow.

44:52

That is really interesting. You touched

44:54

upon this really quickly, but so

44:56

people's libido then on

44:58

and off the pill, it sounds like then

45:00

it would be decreased, but you mentioned that

45:02

maybe it's increased for some, but it

45:05

sounds like you flipped that switch off

45:07

with the sexiness switch that you flipped

45:09

off. So right, right. Yeah. So what

45:12

research tends to find is that, you

45:14

know, being on hormonal birth control can

45:16

be associated with a decreased risk in

45:18

sexual desire and sexual functioning. And

45:21

that many women experience a

45:24

libido decrease in response

45:26

to the pill. And the reasons

45:28

for this are exactly what you would expect.

45:30

And when you don't have that beautiful rise

45:32

in estrogen, where you go through that sexual

45:34

tigress state that this is going

45:36

to be something that isn't particularly

45:38

good for sexual desire because research,

45:41

tons of research finds that estrogen

45:43

levels are in fact a good

45:46

predictor of women's levels of sexual

45:48

desire. And another thing that happens on the

45:50

pill is that your body starts

45:52

releasing more of what's known as sex

45:54

hormone binding globulin. And

45:56

these little binding globulins actually grab

45:59

onto testosterone. and make it

46:01

inactive. And so women who are using

46:03

hormonal birth control usually have about 60% lower

46:06

levels of free testosterone than

46:09

naturally cycling women. And testosterone

46:11

is something that's also important in

46:14

women's sexual desire and sexual functioning.

46:16

And so you combine that

46:18

with estrogen being kept low kind

46:21

of across the cycle, and

46:23

you kind of have the perfect recipe for

46:25

a lower libido. And like I said, it's

46:27

one of these things where there

46:29

seem to be individual differences, right? The

46:31

majority of research finds a sexual

46:34

desire effect, but not

46:36

100% of research. Some research finds there's no

46:38

differences between women who are using or not

46:40

using hormonal birth control. And in

46:43

those cases, my guess is, again, is

46:45

that you're gonna have sort of a

46:47

idiosyncrasy in results

46:50

where some women are going to have a

46:52

total crash in their libido where they feel

46:54

no sexual desire. And so that's the point

46:56

of some women who may have increased sexual

46:58

desire because not having to worry about pregnancy,

47:01

for example, is something

47:03

that can be very sexually freeing, right? And make

47:05

you feel like a lot more comfortable with sex

47:08

because you're not worrying about getting pregnant, or

47:10

it could have to do with how attracted you are to

47:12

your partner. And like, if you're really attracted to your partner,

47:15

it does this to your sexual desire. If you're not really

47:17

attracted to your partner, it does that to your sexual desire.

47:19

You know, hormones are just, they touch everything in our

47:22

body. You know, it's like

47:24

they affect our brain does business. They affect

47:26

the way our immune system does business. They

47:28

affect the way that our respiration or respiratory system

47:30

does business. Our cardiovascular system does business. It

47:32

touches everything. It like flips all these little

47:34

switches all over the place. And

47:36

the way that all of that sort of

47:38

lands on each one of us is

47:41

going to be a little bit different. And,

47:43

you know, and hormones just kind of nudge

47:46

us in different directions. Like, you know, it

47:48

can kind of nudge us in and out

47:50

of a state of high sexual desire and

47:52

nudge us in and out of a state

47:54

of, you know, low mood. And

47:57

it's amazing to me that. it

48:00

took us so long to like put

48:02

two and two together and really start to

48:04

think about, okay, given all the

48:06

different things that hormones touch in the female body,

48:09

because our bodies are wired to be sensitive to

48:11

sex hormones because they have to be because of pregnancy.

48:14

And pregnancy requires the body to do a

48:16

complete workaround in everything that it's doing, you

48:19

know, whether it's our metabolism to our

48:21

sleep and everything else. And so

48:23

our bodies are wired to be very sensitive to sex

48:25

hormones. And then it took us

48:27

so long to consider the fact that if

48:29

we take hormonal birth control, that it's going

48:31

to change all of these different systems that

48:33

are sensitive to sex hormones. And that's gonna have some

48:36

pretty profound effects on the way that women think

48:38

and feel and experience the world. You know,

48:40

it's shocking to me, but I'm glad

48:42

that we're finally starting these conversations. Yeah,

48:45

well, and like you said, hormones affect so

48:47

many parts of the body. And so when

48:49

you were saying, oh, it can decrease testosterone

48:51

and it lowers that estrogen, I started thinking

48:53

to myself, well, this could cause

48:56

a lot of other effects, though, because I

48:58

know, like, your heart really needs the estrogen,

49:00

your muscles really need the testosterone, like your

49:02

immune system, you know, like you said. So

49:04

are we affecting other parts of the body

49:07

as well, possibly with physical health that we're

49:09

not paying attention to? Oh, yes, 100%. Absolutely.

49:11

I mean, one

49:13

of the things that really kind of gave me

49:15

my light bulb moment, where I was

49:18

like, oh my gosh, of course, the pill

49:20

affects everything because it affects everything was

49:22

I was at a talk where they were talking about

49:24

the fact that women who are

49:26

using hormonal birth control don't experience

49:29

a cortisol response to stress, like

49:31

every other healthy functioning human being

49:33

does. And it was just like,

49:35

why does the pill affect our stress response? And it's like,

49:37

of course it affects the stress response. It

49:39

affects freaking everything. Yes, absolutely.

49:41

I have no doubt in my mind that

49:44

we have just barely scratched the surface in

49:46

terms of the way that this affects the

49:48

body from head to toe. And my research lab and I,

49:50

we just published a paper that came out this year where

49:53

we did a study looking at

49:55

women's inflammatory response to stress and

49:58

how that differs depending on on whether you're

50:00

on hormonal birth control or not. And

50:02

so what we did is we had women,

50:05

naturally cycling women who were in the luteal

50:07

phase of the cycle. So kind of trying

50:09

to hormonally match what hormonal birth control pill

50:11

users are like, cause they're in that sort

50:14

of progestin dominant state. And

50:16

we had a sample of birth control pill

50:18

users. We had them come into the lab

50:20

and we stressed them out by having to

50:22

give a public speech and

50:24

then have to count backwards from like a hundred or no,

50:26

it was like a thousand 322 in steps of 13. And

50:31

they had to do that. And if they mess up,

50:33

they had to restart. And so it's like this really

50:36

stressful paradigm. It's called the truer social stress test. And

50:38

so we stressed everybody out and then

50:41

we measured their inflammatory response to stress

50:43

because, um, our immune system, in addition

50:45

to responding to germs and vaccinations and

50:47

other things that immune systems respond to,

50:50

uh, they also respond to stress. Um,

50:52

and when we get stressed out, our immune

50:54

system starts releasing inflammatory factors because it's preparing

50:56

for the possibility that we might have to

50:58

fight or get injured. And

51:00

so we were really interested in

51:03

that specifically because there's been research

51:05

linking hormonal birth control use with

51:08

autoimmune disease. And so we

51:10

were really interested in like whether

51:12

you get an exaggerated inflammatory response

51:14

among women who are using hormonal

51:16

birth control, which is something that

51:19

we might expect given that there

51:21

don't tend to release cortisol in

51:23

response to stress because cortisol helps

51:25

to regulate inflammation. And

51:27

so we did this study and what we

51:29

find is that low and behold, uh, women

51:32

who are using hormonal birth control,

51:34

that they do have, um, a

51:36

very different, uh, inflammatory response to

51:39

stress. And in particular, their inflammatory

51:41

response to stress tends to be

51:43

characterized by an exaggerated release

51:45

of one particular type of cytokine

51:48

called TNF alpha, which is

51:50

one that is very well known to

51:52

be implicated in various forms of autoimmune

51:54

disease. And so, um, you know,

51:56

and why do they respond that way? We

51:59

have no idea. But it's just

52:01

that hormones affect everything and they

52:03

flip all these switches. And

52:06

this is going to be true for

52:08

everything ranging from our cardiovascular system, because

52:10

our cardiovascular system is sensitive to sex

52:12

hormones because pregnancy requires a total workaround

52:15

there. Our immune systems are

52:17

sensitive to sex hormones for the exact same

52:19

reason. Our digestive system

52:21

and our metabolism, that's all

52:23

affected by our sex hormones, all of

52:25

these things. And when you

52:28

change a woman's profile of sex hormones, that's

52:30

going to have these sort

52:32

of echoing effects throughout the body from head

52:34

to toe. And we're

52:36

just starting to, you know, people are just starting

52:38

to ask those questions about what does this actually

52:40

do? That is fascinating because

52:42

inflammation is like the root cause of

52:45

so many health issues out there today.

52:47

And so I'm listening to all of

52:49

this thinking like, we have so

52:51

many women dealing with stress, so many dealing

52:53

with depression, anxiety, not being able to deal

52:55

with all the pressures of life. But

52:58

then we've got so many women with autoimmune issues

53:00

and so many with inflammation. And I'm like, could

53:03

we maybe take a step back and

53:05

realize that so many women are on

53:07

birth control? Could this be one

53:10

of the many facets of why we're dealing

53:12

with all of this? Yeah, no, I completely

53:14

agree. You know, and you'd ask this similar

53:16

version of this question when we're talking about

53:18

teen mental health and, you know, we're in

53:20

the midst of a crisis with teen mental

53:22

health right now, and especially with girls. And

53:25

I have no doubt in my mind

53:27

that this isn't a contributor. Like

53:29

is it the only contributor? No,

53:32

there's lots of contributors, right? But

53:34

I would be absolutely shocked if

53:36

it wasn't an important contributor. And

53:39

same with, you know, when we look at things like autoimmune

53:41

disease, those are on the rise. Yeah,

53:44

they are on the rise. And it's like, gee,

53:46

I wonder why that is. We've been monkeying with

53:48

women's sex hormones. And I can't help but think

53:50

that those things are connected. Yeah,

53:52

that's amazing. OK, there's one other thing I want to

53:55

ask you because I hear about this a lot on

53:57

social media. Different people talking

53:59

about violence. vitamin and mineral deficiencies

54:01

on the birth control pill. So is

54:03

that true? Does it really make you

54:05

deficient or lacking in some of these

54:08

nutrients? It can. So there

54:10

is some research that suggests there's some nutritional

54:12

deficits that can come into play when you're

54:14

on it. And because I'm a psychologist and

54:17

not a physician, I don't know what they

54:19

are off the top of my head, but

54:21

I've done enough research into that to know

54:23

that there's a couple of vitamins. But

54:26

I mean, truthfully, it's something where if

54:28

you are aware of it, you could

54:30

probably take a supplement and

54:32

be just fine. But it

54:34

does seem to deplete some

54:36

important nutrients. And so

54:39

I would look, I would recommend either Dr.

54:41

Jolene Brighton's book or Dr. Laura Brighton's book.

54:44

They talk about this and they're, because they're

54:46

both in the sort of physical health space,

54:49

have a lot more information about this than I do. I

54:51

had the same question you did when I was first hearing

54:53

about that. I'm like, I don't know about that. And so

54:55

I went into the research literature and I found that sure

54:58

enough, there are some differences, but I

55:00

just don't know exactly what they are. Okay.

55:03

Also, this is the million dollar question. And

55:05

I know every listener who's listening to this

55:08

podcast is like, well, okay, what are my

55:10

other options then if I don't want to

55:12

do the birth control pill for birth control?

55:14

What should I do? Do

55:16

you have suggestions you like? What's

55:19

your advice on that? Right. So

55:22

the first thing I would say to that is

55:24

if you are somebody who's using hormonal birth control

55:26

and you feel good and you

55:28

are aware of what the trade-offs are and you're happy, there's

55:31

no reason to go off of it. It is something that

55:33

you can be on safely for a number of years and

55:35

there's no real evidence that seems to suggest

55:37

that there's big problems with that. And so if you

55:39

feel better on it than off of it or you

55:41

are fine with it, you don't need to go off

55:43

it. If you do want to go

55:45

off of it because you're interested in your natural

55:47

cycle, like curious, when you

55:50

want to experience your natural

55:52

sort of hormonal fluctuations, one

55:54

possibility is the copper IUD.

55:58

So this is a non-hormonal IUD. And

56:00

it's not necessarily

56:03

a lot of fun to have put in. A

56:05

lot of women feel pretty uncomfortable

56:07

when it's being inserted. And

56:10

it can lead to heavier cramping and heavier

56:12

cycles, especially for the first little while that

56:14

you're on it. So I mean, it can

56:16

take about a year for your body to

56:19

really adjust. That is an option. And it

56:21

sounds so barbaric. I mean, this is like

56:23

where we're at. It's like, it's this kind

56:25

of semi-barbaric answer, but a lot

56:27

of women really love it. And

56:29

I mean, if I didn't have a vasectomized

56:32

partner, this is what I would be using.

56:34

It is what it is. I've had an IUD put

56:36

in before. It's not a lot of fun, but it's

56:39

ultimately like not, you don't have to think about

56:41

it. It's not hormonal. You still ovulate, you still have

56:43

your cycles and you feel pretty much like yourself

56:45

for most women. Most women feel like themselves when

56:47

they're on it. There's also the fertility

56:49

awareness method. And this is a really

56:52

great method. And I use

56:54

this even though I don't need to because I,

56:56

like I said, I've got a vasectomized partner. Thankfully it's

56:58

okay that I talk about it on podcasts

57:00

all the time. But,

57:03

you know, and this is just where you're

57:05

keeping track of where you are in your

57:07

cycle and using your body temperature and

57:09

your cervical mucus as a means

57:12

of assessing cycle phase. And

57:14

if you're really conscientious and on top of

57:16

this sort of thing, where you are, you

57:18

know, good at logging your symptoms across

57:21

the cycle, and you're also good,

57:23

because this is why I wouldn't use this. I would

57:25

use the IUD. You're also good at

57:27

not having sex during the fertile window. Or

57:31

you're willing to have sex with the

57:33

condom or some other sort of backup

57:35

mode of contraception, which requires a lot of

57:37

discipline. Because, you know, women experience

57:39

highest sexual desire, right, when they're

57:41

in their fertile window. You know, evolution would have

57:43

it no other way. And so

57:45

what happens a lot of times with women is, you

57:49

know, it's like, it's all well and good. And then they're

57:51

in this moment where they're highly fertile and they

57:53

just really want to have sex. And then they're like, oh my

57:55

gosh, okay, well, I guess we have to go find

57:57

condoms. And sometimes that can end up in a disastrous

57:59

scenario. from what I've heard.

58:01

So it's like you have

58:03

to sort of know what you're getting into

58:05

with that. But a lot of women really

58:07

love it. And I mean, honestly, I recommend

58:09

fertility awareness and not even necessarily as birth

58:11

control, but just to really understand yourself and

58:13

your body's relationship to hormones, because

58:15

you really can get so much insight

58:18

because there's so many changes that occur

58:20

in our bodies at sort of a

58:22

small level. But when we begin to see them over

58:24

time, it's like you really get in touch with who you

58:26

are, and how you respond to things.

58:29

And it's something that can really get you in

58:31

touch. It helps to kind of bring

58:33

you back to Earth where you're like, okay, I

58:35

know I'm feeling this way. My partner is not

58:37

a complete jerk. I am feeling really sensitive right now

58:39

for this reason. Or in the luteal

58:41

phase, I get allergic asthma, my

58:44

symptoms are more severe, which is very common. And

58:46

that can feel really alarming if you're

58:48

feeling like, oh my gosh, I can breathe. And why is

58:50

this happening right now? And it's like,

58:53

oh no, this is progesterone and it

58:55

does that sometimes. And

58:57

it's really useful that way. I

58:59

kind of went off the rails there, but

59:01

fertility awareness is another way of doing it.

59:04

There's also, of course, the condom

59:06

is, nobody really loves it, but

59:08

it's great at protecting for pregnancy

59:10

and also sexually transmitted infections. There's

59:12

the diaphragm, which still exists. Nobody

59:14

talks about it. And so it

59:16

seems like it's like off the

59:18

map, but it exists. It just requires a

59:21

little bit of preparation because

59:23

you've got to pop it in before you have sex and

59:25

you got to put spermicide in it. And

59:27

it's not as effective as a birth control

59:29

pill, but it is still pretty good. And

59:31

so those are some of the other options.

59:33

And like I said, and there's gels like

59:35

Fexy, right? Which is the vaginal gel that

59:38

is, it's again, the effectiveness isn't as high

59:40

as the pill. But it's

59:43

a reasonable option for women as

59:45

part of their birth control regimen.

59:47

Yeah. There's no easy option is what

59:49

I always say. There's pros and cons

59:51

and hard and easy risks

59:54

with everything. So it's

59:56

what they come down to. And I know we need

59:59

to wrap up. to time, but I

1:00:01

know my listeners are going to want one other

1:00:03

question because I forgot to ask you, but it's

1:00:05

also a big question. So maybe we'll just give

1:00:07

the simplified version and they can come follow you

1:00:09

on Instagram for more advice and read your book

1:00:12

because your book is amazing. Your Instagram is amazing.

1:00:14

But I know this is a big one going around

1:00:17

on social media saying yes

1:00:19

or no to whether the birth control

1:00:21

pill affects fertility. Okay. Yeah.

1:00:24

So the short answer is no, it does

1:00:26

not affect fertility. The long

1:00:28

answer is well, maybe indirectly.

1:00:31

So you know, a lot of times what

1:00:33

happens, birth control pills, because they allow you

1:00:36

to postpone pregnancy for so long, a lot

1:00:38

of women will just keep postponing pregnancy and

1:00:41

then they get off of it and they're 30 years

1:00:44

old and they're not getting pregnant. They're like, Oh my

1:00:46

gosh, like the pill made me infertile. When

1:00:48

the fact is female fertility, it's like one of

1:00:50

the cruelest facts of nature, but it peaks at

1:00:53

about 25. And

1:00:55

so your fertility is at its apex at that point.

1:00:57

And then it just starts to decline from there. And

1:01:00

you know, for some women, it declines more rapidly. For

1:01:02

others women, it declines more slowly. And

1:01:05

so, you know, indirectly, the pill can

1:01:07

be linked to infertility just

1:01:09

simply because it allows women

1:01:11

to continue to postpone childbearing until a

1:01:14

time when it's more, it's a

1:01:16

lot more challenging. And the pill can also

1:01:18

mask reproductive problems that women didn't know that they had

1:01:20

because, you know, you take the pill and then you

1:01:22

have the withdrawal bleed and then you take the pill

1:01:24

and you have the withdrawal bleed. You don't really know

1:01:26

whether or not you have any reproductive

1:01:29

health problems because the pill is like a

1:01:31

nice band-aid and prevents their symptoms. And

1:01:33

so a woman potentially could go off of it

1:01:35

and discover that she has really bad endometriosis, for

1:01:38

example. And then that can be something that

1:01:40

has to be taken care of before pregnancy

1:01:42

is going to most likely be able to

1:01:44

be successful. And so that can create problems

1:01:46

that way. But you know, all of

1:01:48

the research when they look at what is the length of time

1:01:50

it takes you to get pregnant for women

1:01:52

who've been on the pill for a long time and for

1:01:55

women who aren't, there's a little bit of a lag time

1:01:57

for women who were on hormonal birth control, but it's only

1:01:59

about a month. Okay, so good

1:02:01

to know. And I know listeners were

1:02:03

like, ask that question. So

1:02:05

thank you so much for being here. I

1:02:07

have literally 1 million more questions

1:02:09

I could ask you because the pill is

1:02:11

so intriguing and there's so many different side

1:02:13

effects and things, but I love

1:02:15

that you are out there trying to teach

1:02:17

others about this and just informing people about

1:02:19

their side effects and risks, like you said,

1:02:22

so that they can make their own informed

1:02:24

choice. And I just absolutely love that and

1:02:26

love what you're doing. So thank

1:02:28

you so much for being here. And

1:02:30

I always end my podcast

1:02:32

episodes by asking my guests what they have

1:02:34

found to be the best ingredient in life.

1:02:36

What would you say it is? It's

1:02:40

love. It's relationships. I love that. That's

1:02:42

perfect for what you do and all

1:02:44

that you teach. Yeah, no, totally. Totally.

1:02:46

It's like relationships and health. And then,

1:02:48

you know, everything else kind of by

1:02:50

the side. Oh, I love that.

1:02:53

Well, listeners, like I said, go give her

1:02:55

a follow. You will learn so much. You

1:02:58

will find it so intriguing and fascinating. And

1:03:00

we should tell people where they can find

1:03:02

you, though, because I follow you on Instagram,

1:03:04

but tell them where else they can find

1:03:07

you. Yeah, so you can find me on

1:03:09

Instagram at Sarah E. Hill, PhD. And that's

1:03:11

my handle on all platforms. You can find

1:03:13

me everywhere. I'm most active on Instagram. And

1:03:16

I also you can find my website, which

1:03:18

is just sarahehill.com. And my book is available

1:03:20

everywhere the books are sold. I

1:03:23

have to tell you something about your book.

1:03:25

One of the people on my podcast team

1:03:27

said her book is so good.

1:03:29

It should be required reading for every woman out

1:03:31

there. And I was like, oh, it should be

1:03:33

it is good stuff. Thank you so much. That's

1:03:35

so kind. Thank you for writing

1:03:37

that book. And again, thank you so much for

1:03:39

being here. It was so nice talking to you.

1:03:42

It was so great talking to you. Thank you. Thank

1:03:50

you so much for listening. Remember to

1:03:52

subscribe to the Just Ingredients podcast to

1:03:54

learn more about your health and good

1:03:56

ingredients to life. Plus get daily tips

1:03:59

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