Latest / The XX Lab / We're in an Age of Hormonal Hypocrisy | #7 with Dr. Lara Briden

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We're in an Age of Hormonal Hypocrisy | #7 with Dr. Lara Briden · The XX Lab

• Sarah: Why do hormones suddenly become important at 45 when they never were before? So women at 45 must replace them, but women at 25 can flatline them with hormonal birth control and go for decades like that w like and that's somehow okay. Dr. Lara Bryden, welcome to the XX Lab. It was long thought that. The only reason that humans experience menopause was that, ⁓ this must be evolutionary time lag. Recently, it has become very evident that menopause is in fact being actively selected for. Welcome to the XX Lab, where we explore the science and stories that matter to you. Today on the XX Lab, I'm sitting down with Dr. Lau Bryden. Dr. Bryden is a naturopathic doctor, period revolutionary, and the author of three books, including the Period Repair Manual. The Hormone Repair Manual and Metabolism Repair for Women. She's a leading authority on all things hormones, cycles, and women's reproductive health. In today's conversation, we're going to be talking about the importance of women's sex hormones. We're going to talk about why we're framing menopause all wrong and how we can support women with PCOS and endometriosis using tools other than the birth control pill. You're going to walk away from this conversation with a deeper understanding of your sex hormones. And you can also walk away with understanding how you can support yourself in your cycle across the lifespan. Before we get started, please note that my opinions do not necessarily reflect those of TCU, the College of Science and Engineering, or the Department of Psychology. Instead, this is part of my mission to give women everywhere access to science and stories to help them live well. This is the XX Lab. I'm Dr. Sarah Hill. Let's get started. Dr. Lara Bryden, welcome to the XX Lab. Thanks so much, Sarah. It's great to see you again. ⁓ It's so great. It's so great to see you too. It's ⁓ I I we have so many things in common that it was ⁓ it was amazing in some ways that we ended up kind of studying some of the same things because our paths are so similar to one another. Right. Yes, exactly. So I mean we've we're coming at it from slightly different angles, but we're both have a passion for evolutionary biology, which I think will explorer today. And we've met in person. I always I w when that's the case, I always like to state it because in this online world people are it's that's quite an unusual thing. So yes. It is an unusual thing. Yeah. We've met in person ⁓ in with our shared fondness for ⁓ Dr. Gerald and Pryor. And so like giving having the opportunity to spend time with you and with her ⁓ like got me out out of Texas and on an airplane to go to Vancouver to meet up with you all. And ⁓ and it was absolutely invaluable to me that I learned so much from both of you. So anyway, yes, we have had the wonderful opportunity of getting to know each other in person and and take a really lovely walk because I know that we're both big fans of of taking a walk. That's something else we have in common. Yes. Yeah. So I wanna start by actually talking about your background because ⁓ one of the things that I love ⁓ for listeners, you're gonna get to learn everything about ⁓ about ⁓ Dr. Bryden. Do you want me to call you by your first name or do I want me to call you Dr. Brothers? Just call me Lara. Yeah. Okay. Okay. So you're going to learn all these wonderful things that that Lara knows. ⁓ but we both ended up in the world of ⁓ women's hormones and ⁓ women's reproductive health. Me studying it from the sort of psychological point of view and ⁓ and Lara being a doctor. ⁓ but we both started out in evolutionary biology. And so I really would love to know a little bit about what. took you from studying evolutionary biology ⁓ and then sending you on the path of becoming a naturopathic doctor. Yeah let's let's chat about that a little bit. It's always fun. I'm sure your guests are gonna love getting a chance just to talk about themselves a little bit personally. But I'll lead with a quote which I don't I don't know who to attribute it to, but it's quite a famous quote. You know, nothing in biology makes sense except in the light of evolution. And I would say the same for health. Nothing in health to me makes sense except through the in the light of evolution and I through the lens of evolution. And I th it's one of these things where you can't unsee it. Like once you've once you've been given that lens, it's like it it's there forever. I mean that's that's been my experience. ⁓ Yeah. Yeah, so that quote is actually ⁓ Theodosius ⁓ Dazansky. And so on my syllabus I teach a class in evolutionary psychology and on the top of my syllabus it says that. And then underneath it it says nothing in psychology makes any sense either. Your professor. I love it. We love we had we have the same quote. Or maybe I got that quote from your latest book. I can't remember where it came into my radar, but ⁓ yeah. Yeah, it it it's so true. I mean, it's like once you start understanding that the reason that we have the traits that we have is because we inherited them from a successful ancestor who is either, you know, able to reproduce and s you know, survive long enough to be able to do that, ⁓ it you can't unsee it. You know, I I've I've I have the same experience that you do is like once I learned about the process of evolution by selection, it was everywhere. I couldn't I couldn't I saw it in everything and and especially like the the design of the body, which is such a big mess of spaghetti that really doesn't make sense if you try to understand it as an engineer. But if you understand it as this, you know, we're this really complex interconnected organism that ultimately has its current form because the traits that we have must have helped our ancestors, you know. Find a mate and ⁓ and successfully reproduce, it it all makes sense. ⁓ and I have to just on that topic, and I will get back to how you know my background, but in your period brain book, I l I did like how you sort of ⁓ framed it into the t the modes of the menstrual cycle, each have a different purpose, which is totally makes sense. And more broadly, female physiology has lots of different modes, which is male are quirky male men are quirky in that they I like to frame this is my framing too from an evolutionary biology perspective. Female is the standard, you know, ⁓ default version. Male is the quirky variant. But so female physiology, human physiology has these different modes, you know, within the menstrual cycle, but also, you know, then pregnancy and postpartum and even I would argue menopause, postmenopause is a different mode that is still being selected for because I mean, we're done reproducing by that point, but the genes, our genes are still in the in play. And so what happens after menopause, you know, can still be quite important. So It is it is still important. Yeah, yeah, you know, it's funny because ⁓ and this is one of the things that we'll we'll talk about 'cause I know that you and I have a similar perspective on on menopause and the way that it's being treated currently. Yeah. But ⁓ you know, so it w it was long thought for those of you who ⁓ don't have any familiarity with ⁓ evolutionary biology, it was long thought that the only reason that humans experienced menopause and that women stopped reproducing was that, ⁓ this must be evolutionary time lag. You know, look at that. We're living longer than we used to live. And therefore, the fact that we are no longer able to reproduce at a certain age is just a byproduct of the fact that, you know, that we're living longer and selection didn't act on our reproductive capacity ⁓ past a certain age. And ⁓ more recently it has become very evident from ⁓ looking at ⁓ different ⁓ genet that you you can do these ⁓ for those of you guys who really want to nerd out, you can do these like Hardy Weinberg equilibrium models that help look at whether or not traits are being actively selected in a population or whether it's like a byproduct of something else. And it appears that menopause is in fact being actively selected for. ⁓ Tell us, I know that you know about this. So what what is that? You know, if we talk about women's life as being these different modes, what is that mode? I know. Well let's let's explore it a little bit because I'm pretty passionate about it's it's the intersection of female physiology, evolution, aging, you know, pushback on the the narrative, the quite destructive narrative that you've just described, which is that ⁓ menopause is an accident of living too long that we're just now Like left like we're leftovers, like we're just like nothing. And that's just not I mean, if that were true, then I guess we would just accept it and, you know, deal with that. But th that is from a through the scientific lens, that is that does not appear to be the case. As you just said, it is evidence gr and I love how evolutionary biologists like crunch the numbers. It's like a math thing, right? Like they put the numbers in and see what what works, like what will it like ⁓ in sort of game theory, like what will play out, when will menopause evolve, under what conditions. And in that scenario like in the in different scenarios, the idea would be what the way I've heard it framed is a longer human lifespan for both sexes, arguably, was selected for because women in their post reproductive years are so beneficial to the family group. So like selecting for those longevity genes arguably primarily because of women was it you know what happened. And so men got the I mean, I'm sure it was both, but like in that through that lens, men got the benefit of living longer because fif women in their fifties, sixties and seventies are just so important for the group. There's in we know in the Hadza and other modern day forager people, women in their fifties, sixties and into those seventies gather more food than any other demographic, which I just love. Like men are off telling stories by the fire. Women are like, okay, let's we've got to feed, we've just got to feed the group here. And of course, they they gather more food, they share a lot of it because their own physio our own physiology has in a way, I mean, we've kind of we've shifted gears again into kind of a leaner physiology, which in our modern world with evolutionary mismatch can be negative because it can sort of push us more into insulin resistance, but we can circle back to that. But like in our ancestral state, how amazing that we didn't require as many starchy tuber, you know, vegetables. We could give share all of that with the young women and the babies. And we could like just quietly get things done. So I mean that's I th I say we, it's collectively, like it's and I very much embrace this, even though one thing I can share about myself is I have I didn't have biological children. I have a stepdaughter. So when I speak about, you know, biology and and lineages and evolution, it's it's not through a personal I mean, it I d I I don't see it that way. It's it's a much more it's almost like a spiritual, it's a collective, like we come from this long lineage. of women and I'm part of that regardless of whether my own personal genes make it into the next generations, right? It's it's bigger than that. Yeah. It yeah, it is, it is bigger than that. And it's ⁓ you know, the the way I always think about it is like I've inherited the wisdom of, you know, a continuous line of successful ancestors. Like I the wisdom of a million women or you know, a thousand women or however many women that is in my baked into my psychology. Yeah. And how wonderful that is. And sometimes that psychology ⁓ leads you on a path where you decide to have children. Sometimes it leads you on a path where you decide not to have children. And all of those things are equally valid and equ equally explainable by our biology. And it's like it's an amazing and ⁓ and really wonderful thing. And it and and it does help to provide explanations for things like ⁓ like menopause and and like you were saying, the grandmother hypothesis, which is that sort of leading hypothesis out there right now about the evolution of menopause. And it's essentially that at a certain point if women become more valuable in terms of the survivability of their relatives ⁓ by not reproducing and not, you know, you know, creating opportunities for gene transmission directly, but instead with aiding the group, right? So aiding their female relatives, ⁓ and especially, you know, if they have children and grandchildren and so forth. ⁓ go ahead. Well, no, it's they're male relatives as well. So there's so one of the studies I and I think that it's all still in motion. Like it's all still in play. The scientists are crunching the numbers and like which is great, which is fun. Like so more things, more insights might come. But one study I saw, which really piqued my interest, was that menopause evolved. Menopause will evolve. Menopause evolves when adult sons stay with their mothers. So at that point. So that's true in orcas and a c like a couple of the other, the only other sort of mammals that have this extended post reproductive period. So basically what they're at what they crunch the numbers is like at some point, if you're in f still influential over your adult son, you become vicariously male. I don't know if people are kind of following that logic, but like you one of the things orcas do for their adult sons is they stop them from fighting. Well they guide them to food. They like they increase the survival. And so then you become vicariously male because your adult sons can actually make a you know father pass on a lot more genes than your adult daughters. It's probably both. Probably you're helping your daughters and your granddaughters, but also your sons. So I just think that's yeah. Yeah, it it is really it's it's almost like like the way I think about it sometimes is like it's almost like in ant colonies, you know, you have the reproductive queen and so she's having sex and making babies. And then you've got a lot of these drones, right? They're non reproductive and because they share genes with the queen They're doing all of this work and tending to the colony and doing all of this stuff and supporting the queen being able to reproduce. And this is their best strategy for getting genes into the next generation is not to reproduce at all, but instead to h do this auxiliary work that's just as important. And what's cool about human females, you know, and and some of these other species is like we get to do both. Yeah. You know, like we get to be the primary reproductive and then at a certain point where the risks ⁓ of of pregnancy sort of outweigh the benefits of pregnancy. And then we can aid in our ⁓ in the survivability of of our group and and our sons and our daughters and their sons and daughters and so on and so forth. It's so fascinating. It is. It is and ⁓ the reason I mentioned before about me not having personally having biological children, because I've seen a bit of pushback on social media against the grandmother hypothesis saying, Well, but what if you're not a grandmother? I'm like, it doesn't matter if you're a grandmother. Yeah, no, I mean the meaning is still there. Yeah. Yeah. Right. Well, I mean it's like a menstrual cycle, right? It's like, well, what if I don't want to have children? Well, that's great. Like and you have that choice and and isn't it wonderful to live in a time where you can make that decision? Because it used to be that if you were a woman who liked to have sex with men, you were going to be a mother, or whether whether you wanted to or not. And ⁓ and that's not the case anymore. And isn't that wonderful? But that still your menstrual cycle is still going to be acting as if you are going to be having a baby. And and every month it's that's going to happen. hundred percent. We'll circle back to the menstrual cycle because there's I mean obviously we both have a lot to say about that. But one thing I would say, I mean, one of my key takeaways, which could get it in the first, you know, ten minutes of the podcast, is that ⁓ regular ovulatory cycles, regular ovulation is how women make hormones. So it's again, this is an example of the default human physiology is cyclic, at least for you know, three or four j three or four decades. And then, you know, males Men are weird. Like men make their hormones every day. It's like what a you know, what a strange, quirky thing to do. Although you know, men, we might have talked about this in one of our previous interviews, but the thing I love about male hormones, they is how much they're in maybe this is in your book too. How much they're influenced by social things, like more than women more than women are. Like so their testosterone, I love this particular stat and I'd be curious to know if it's been replicated in but that there was a study where like testosterone n plummets. after a man's sports team loses and it like it pl not the team they're playing on, but just the team they're a fan of and it like stays low for a couple of days. And I just I just find that really kind of charm in de endearing. Yeah. Yeah. Like their hormones are all over the place. Yeah, no, it's so funny 'cause ⁓ and I and I talked about that in and I think I talked about it in both books, honestly, that ⁓ that women get the you know, we always get a hard time about being hormonal. And are being unpredictable and fickle and you know, this and that and the other. And the fact of the matter is, like our primary sex hormones are not responsive to the environment in the way that men's sex hormones are. And so for men, you know, they have this incredibly dynamic hormone system with testosterone. And yeah, you get these wild swings where if a man's favorite sports team wins, like they get a big surge in testosterone. If their sports favorite sports team loses, they can get a big decrease in testosterone. And one of my favorite studies was ⁓ showing that if you put a man in a room next to firearms, so you just set him and there's a gun on the table, he'll get a big rise in testosterone just simply from being in the in the presence of a gun. And ⁓ and you know and and and it's like funny we can and we can laugh about it. And it's like, thank goodness, you know, like thank goodness that we have ⁓ that we have these ⁓ sex differences and and and that our hormones are responding to the types of things that they're supposed to be responding to. ⁓ to get us to guide our behavior in ways that are are functional in terms of promoting our survival and and promoting our reproduction. And, you know, I ⁓ as somebody who is, you know, married to a man, I like the idea that if my my partner saw something potentially dangerous that his testosterone would increase so that way he would potentially ⁓ that would put him in a better position to be able to fight and protect me and the rest of our family. Agree. I'm I'm actually also quite a big fan of I'm also married to a man. I mean, ⁓ but not I know not all our listeners are, so that's fine. We'll just we'll just but ⁓ they one other interesting thing about men, just on the topic of testosterone and I think their hormonal profile, I'm curious. We're just now just sharing like ⁓ trivia about ⁓ hormones, but you know th I forget what they call the list, but there's the list of people who like heroes basically, selfless, who put their own lives at risk for others. And then you make this list and It's like ninety five percent men. So women only occasionally will do that, which actually makes sense from an evolutionary perspective. I mean, maybe different ways to analyze that, but men are more likely to l li put their life on the line, basically, which I think more broadly, even if you don't have a man personally in your life, or like that's something in society that is pretty interesting, I think, and has been part of our evolution as a species. Yeah. ⁓ yeah, no, a hundred percent. Because females, you know, historically, because they're mothers and they're the greater investing sex. So in addition Yeah, in addition to being the ones who have to ⁓ go through pregnancy, then there's all that time spent lactating. And ⁓ and females, you know, for those reasons, because we play such a great ⁓ a greater role historically in the reproductive act that makes us more valuable. Yeah. ⁓ just in terms of like what would the cost be to offspring if this person is lost, and especially for young children, the loss is greater for mother than it would be for father. And ultimately that leads us to be more conservative and also ⁓ it, you know, sort of there's benefits to men. In addition to them like, you know, sort of being quote unquote less valuable, there's also potential huge reproductive benefits that can come from a man who does some sort of a big act of valor. Yes, some a heroic act that could potentially lead to mating opportunities that he wouldn't be able to get outside of that. Many mating opportunities, potentially yes. Yes. Yes. That could then reward that type of heroic act ⁓ in you know in a way that would lead the to the inheritance of a brain that when it's doing that internal Darwinian calculus about do I do this thing or do I not do this thing, ⁓ the potential reproductive rewards are ultimately baked into the system, making the the man's foot more likely to press on the gas pedal than than a woman's. They're more risk taking. They're arguably more expendable. I guess which is kind of a a th it throughout society, which has been, ⁓ women are more valuable. Anyway, it's it's an interesting it is interesting once you start zooming out and yeah, I'll acknowledge, you know, some of the things that come from our evolutionary history end up being a little bit sort of uncomfortable socially. And we don't have to go into all that. But like, you I that's just I mean, I think that's just sort of about being reality based. And we we try to be as you know, interpret things as realistically as possible and not I mean there is I guess I will ⁓ in case any listeners are sort of having these thoughts, like you know, one danger with seeing things through the lens of evolutionary biology is you can sort of create narratives around things that aren't true. So this is where science comes in, you know, trying to sort of check these things and replicate them and yeah. Right. Yeah, and test the hypotheses. Right. Because they're not always they're not always right. No. They're not always right. Some stories that have been come up with through the evolutionary lens are not correct. So ⁓ Right. Yeah. No, that's so what led you? Yes, okay. Yeah. Into going into ⁓ into naturopathic medicine. Yeah, good qu so b broadly, I'm Canadian, even though I live in New Zealand and I lived in Australia for a long time. And I as I just I'm just I'm going way back just briefly. Like I won't I'm not gonna give my whole life story, but you know, I really loved I grew up in the wilds of Canada, like really in a very wilderness area. And so I loved You know, I grew up around, I think maybe this had an influence. Like I I went to this tiny my school ⁓ was like less than two few hundred fewer than two hundred people in the from kindergarten to grade twelve, and they half of them were ranchers, like farmers. So I grew up in this very like surrounded by nature kind of area. So that probably had an influence. I was ⁓ very interested in I was a avid reader. So when I got to university I was just keen on biology and English and literature. I do think that I'm curious if you 'cause you're such a good writer too and like writing. I'm curious if you have that background in sort of reading fiction or writing as well. Is that yeah? I actually yeah, yeah. For me, I ⁓ actually thought I was gonna go into creative writing. Okay. And then I found science. It was like it was the weirdest it was the weirdest thing. But I actually ⁓ I found that it works really well because ⁓ the thing that made me You know, people think that I would be a good creative writer is that I'm creative and I come up with ideas, but that's actually like the best thing you can do with that type of brain is put it in science. Because it's like that's all that science is, is like looking at things and saying, I don't think so, and then coming up with a new idea. Right. Being able to come up with a new possible story for what's going on. Right, like what's going on and then test it. Right. And then see whether or not you're right. So yeah, that yeah, that's really interesting that you also sort of were going down the path of considering writing. I was. So I was like writer, biologist, and then I was and then I I w definitely went more into biology, more into I love si I did love science. So I was do working as a biologist. I published a peer reviewed so out of my honors thesis, still undergraduate, but I did I did do quite a lot of field work. I studied I probably talked to you about this before. I've I was looking at sex differences in the foraging behavior of bats specifically. So it was a lot the thing about biology that kind of I'll be honest, that pushed me out of it eventually. ⁓ Especially field biology, it is so much work. I don't know if people realize how much work scientists do. Like it is just and at the end of the day, I like I wanted to be a biologist. I did love that. And I did also realize that once you get to the higher level and PhD and you can just let all the w you know, you can have your grad students do a lot of the work. But I just thought between I just don't know if I can put in the hours that are required to be a scientist. Yeah. ⁓ I was gonna say in some of the places that you have to go, like like so actually so one of my very first research papers, this will be funny for people who follow my work, was ⁓ because it's so far outside of field, but it was looking at the mate choice copying behaviors of the ⁓ sailfin molli, which is a fish. It's a species of fish that lives in the San Marcos River, which is this gunk filled, stinky brown river. in ⁓ in San Marcos, Texas. And so I had to go down there to cause we need to catch wild type fish because we want to see how this plays out like in the wild. And so you have to go and capture these things. And I remember and I went out there and and you know I'm in I'm in the psychology department and I was collaborating with a biologist. So I show up and my pink flip flops and my shorts and I remember and I and the biologists who I was going with are they in waiters. Yeah. And 'cause they told me to wear water shoes. And so I thought like these pink You know, flip flops. We're gonna be No. So I he's then one of the postdocs who was there looked at me and he's like Miss Hill. Yeah. This is not a day at the beach. No, I'd go in there I'd go and catch my feet immediately got sucked under into this muck. I mean, it's that is hard work and a lot of times it it puts you in really kind of not so desirable places. Okay. Well, you just were exactly on the same page. So yeah, my early field work in that f early re and I did a lot of different types of biology research, but it was they were setting bats, so we were catching bats, which it w involves at night. Like we were sleeping in the tent during in the mountains of Canada, sleeping in a tent ⁓ during the day, which is hard to do, out crashing through the forest at night when there's bears and also like wading through a marsh. I mean, we were wading too, and there's mosquitoes and it's It's not as romantic as people might think, like doing biology research. It's and all but also through all of that, I do feel still feel like biologists are my tribe. Even now, like forty years later, when I'm occasionally around a biologist, I'm like, ⁓ they're my people. Like that like they really 'cause I think they do have this like been through the wars, like kind of like toughness that yeah. So to any biologist listening, yes. Yeah, yes, I love you. I get I get the thank you for all your hard work. so I I recently had a chance to go back. So I did a one peer reviewed paper, I wrote some other just sort of ⁓ like graduate kind of honors thesis level papers, and I recently had a chance to go back and read some of them or I went back and read some of them. And I was so th I thought, ⁓ my god, how stu I was thinking, how stupid was I? I I'm just scared to read what I wrote at twenty two. Like what on earth was I writing? And was actually surprisingly good. You should go back sometimes and re I mean, it's not I was like I was in a little like scientist in training. So I was using all the right words. I was also very it like now, 35 years later, I can look back and think, ⁓ I was so interested in female physiology and f that framing female physiology as normal. That was my calling from y you know, in the n the nineties, basically. I was that keen on taking that lens. So that's Only later did I ⁓ sort of only now have I able to been able to understand how much that influenced my later work. But what made me s transition from I did seriously like at the end of my honors thesis think about okay, which graduate program in evolutionary biology am I gonna and I had it the the paths were open to me. I was on in that route, but my main and I it's you know, it's not very flattering to me, but my main reason for turning away was just the amount of work that was gonna be required to go down that path. And also the way scientists, especially at least at that time in that field, had to just put your kind of life on on like you had to go where the which university would take you. Is this I you you said you so you couldn't just say, I wanna live in this place and I'm gonna do my job here. You had to it was it felt like a lot and I wasn't prepared to do that. Yeah. It is a lot. Like I mean it's so many people I know, yeah, they have to take a job and they live in a middle of a cornfield in North Dakota and and that's just what you get, you know, you get what you get and you don't throw a fit is how it works in academia. Yeah. So academia. And so Yeah. And also ⁓ no, I was gonna say Yeah, go ahead. Yeah. No, I was an ask. Like like so so th the that like but why naturopathic medicine? Well I think I I also part of it I wanted to work more with people. I do I do like people, even though I'm s a strong introvert, I mean that's another part of it. I don't love I'm not super good gregarious. But I'm very interested in people's stories. That comes from the love of literature, I think. That's maybe the w where that's coming in. But even now, I still do I mean, writing is my main occupation now, but I still do a few d a few ⁓ days a month with patients. I just did one yesterday actually. Where I just genuinely love he hearing people's stories. Like it's just like sitting down and like it's maybe a little bit voyeuristic, like okay, d tell me the like, you know, tell me what's going on. And also, you know, being able to help people. That that's part of it. But I think the first layer is actually just curiosity about people. And so yeah. So that's driven that's been there throughout. I think I think actually curiosity is a common theme. I think that has to be there for scientists, biologists. I think it has to be there for good clinicians. Well, hopefully I'm a good clinician, but it has to be there for clinicians as well. Like it's this constant Like, ⁓ I'm d what does that mean? I mean, you know, maybe is this c and it's it's it's an open mindedness, I guess, or c ⁓ curiosity. Is that the same curiosity that led you to really dive into the menstrual cycle and how you know what the purpose of the cycle is? And you know, a lot a lot of ⁓ people know you from your work, you your first book, ⁓ the period repair manual, and then there's a hormone repair manual, and then we moved on to metabolism. Yeah. And ⁓ and so but and and you have a a big ⁓ public presence just in terms of helping to educate the masses, ⁓ which I is wonderful because like about about their cycles and about how the female body produces hormones and what it all means. And ⁓ and it's information that like I didn't learn any of that until I was in a PhD program. And what I love about what you've done is ⁓ you've taken that information that that, you know, normally a person would have to get a PhD it to understand how their body works, which is insane. And instead you're taking this information and you're making it something that's available to everyone. And and yeah, and so and so what what got you so interested in specifically the issues of ⁓ the menstrual cycle and and women's hormones? Yeah, good great question. Well, again, different layers, but the first step was that's who was coming to me in my practice. So once I qualified as an atropathic doctor, I just hung my shingle. I s my first ⁓ five years of work were in again back in the wilderness area where I grew up. So small town. Like most of my my patients were like ranchers and teachers and like just like just quite like in many ways quite practical people. Like just thinking back, I mean I'll get to the women's health aspect of it soon. But like to those early patients, it it it always made sense to them that their diet affec would affect their health. Like 'cause they're it that was true with their animals. So that was not a That was not a radical idea for a lot of them. So that was very grounding as well. But back just back from almost from day one, I I was seeing treating some men, but mostly it was women. And as you can imagine in the nineties, like these are like like I mean it's hasn't improved that much today, but like the the high dose birth control pills, the old school Premarin ⁓ t old type of HRT, which was which was like watching a train wreck in slow motion, I'll t tell you that. Lots of hysterectomies. Like it was just on the ground, like, okay, we I've got to come up with something different for these patients. And thankfully, some the tools I'd been given did like women's bodies respant respond incredibly well, which is not that surprising, but would respond to some of these things. And so it was kind of a I mean, my early work in the menstrual cycle was just a survival as a clinician, like I had to come up with solutions. And my patients helped me learn what worked and what didn't work. So that there's nothing more valuable than that, actually. The the four you know, the eight years of training, university training are nothing compared to like what comes later when you're actually trying to, you know, help people. so there was yeah, so there was that. And then there was also I think another part of my personality, which I guess I know is partly what you're doing in this podcast, is exploring what makes people tick. is and and I'm sure I share this with a lot of people and but I really don't like When something is the narrative is wrong, like when there's like a glaringly wrong narrative. Like I don't like I'm not I wouldn't say I'm not an activist in any sense really, but like the the narrative, like what became pretty obvious to me early on, this narrative, which is very strong. I mean, it's it's I call it the you know the era or the epoch of contraceptive drugs. So there's like it was very strong in the 90s, it's lessened a bit now, but this idea that like it's Fine, like the solution to any women's health thing is to shut it all down with hormonal birth control. It's like it's like if there's a problem you know, just shut it all down. And back in the nineties I was like, that doesn't seem right. Like, why should women have to shut down their hormones? Like, you know, we need horm like from my biology lens, I'm like, well, we need hormones f you know, for health. And this pr you know, ⁓ prevailing narrative that it it was r a lot of wishful thinking, I think, went into that narrative. It's like we can I mean, I'll just I'll just sketch out what I would see as been the the narrative of contraceptive medication for the last si sixty, seventy years. ⁓ of course we've got right to the meat of it. 'Cause I mean, this is the area where my work has been controversial, but although it's far less controversial now than it was twenty years ago when I started writing about this. But the narrative is okay, we've got these hormone like medications, they you know, sw they switch off Communication between the brain and the ovaries, they switch off ovarian hormone production to menopausal levels in many cases, depending on the type of birth control. They flatline hormones. And in place of hormones, we're gonna have these medications that are, you know, kind of like estradyle and progesterone, but not really. And we're just gonna hope for the best. There's been a lot of wishful thinking. It's like we're gonna hope that's good enough for everything, for the brain, for the so it was this, it's this jarring, and I'll tell you what I'll tell you the jarring thing. Like now in twenty twenty six, the sort of jarring thing that I have similar sensation is so we ha in twenty twenty six we have a great enthusiasm f on on the one hand for female hormones from a in the context of perimenopause, like you know, okay we we lose them, we must replace them. It's like, okay. And they have all these benefits. And I'm not we can explore that a bit more. I mean, I I would agree with that to s to a large extent, but it's very to me very jarring that Why do hormones suddenly become important at forty five when they never were before? So women at forty five must replace them, but women at twenty five can flatline them with hormonal birth control and go for decades like that w like and that's f somehow okay? Like I th this is an example of like me not being able to stay silent and I'm like, I just don't think that makes any sense. Yeah. I that's so well, it's so interesting 'cause I've had that exact same thought. ⁓ because it it's it's completely contradictory, right? Where it's like hormones are so important. We need to have hormones to support brain health, you know, et cetera, et cetera, et cetera. With the cardiovascular health. ⁓ the healthier bones. Yeah. Right. ⁓ Jerilyn would talk to us about that. Right. And then in the same breath, you know, s saying that that, ⁓ no, you can ⁓ you should start going on hormonal birth control as soon as you get your period if your periods are irregular and you know why do you have to bother with this? And it's like No, that's actually how your body is is producing hormones and without and and when you're taking it, ⁓ it can keep I mean, it keeps your levels so low that you're not getting the benefits of your sex hormones during your reproductive years. And I will be absolutely astonished, you know, if I if we learn that that has no downstream clinical impact on on like the brain or any other body part. I know. And it's it's it's very it's been a weird time. I mean I mean this is all and I'm also okay, the other thing I'm interested in. Just for another little bit about me, is my main ⁓ one of my main pastimes is history podcasts. So I do like history as well. And so if you start looking at medical like history, medical history and the different narratives that kind of take hold. And I would just say at any one time, like you know, we look back and we think at okay, you know, h 150 years ago what they were doing, that's was very weird. But from their lens, like at that time, that was totally, totally normal for them. Like that was like the f the established narrative. And I will acknowledge that, you know, modern medicine is pr quite a bit more informed than probably than it was 200 years ago. Fair enough. But still, just the nature of of how it works, there are gon there are some narratives today that future generations of doctors and scientists are gonna look back on and think, What the heck? Like what were they doing? So I mean, I think we've been in one. And I kind of I mean, I hope I live long enough to see just how the tail end of that, like sort of how it's future scientists might look back on all of this. I will find it very interesting. It's it's also ⁓ quite quite humbling, I think, to see things through that broader lens. So we've talked about seeing things through the deep history lens of evolutionary biology, but I think it's also value in seeing things through the human history lens of just the hubris of previous generations and what they you what I mean? Like when they thought were so certain about things that later were like, mm So I think there's been a lot of certainty around contraceptive medication. that was a lot of there's a lot of it's been wishful thinking. And all that said, I mean both of us agree. Like I'll just we have to give the the obligatory little like of course, it's you know, it's it a val an effective way of avoiding pregnancy and it can certainly relieve symptoms. So there's always nuance. Neither of us have ever stated that categorically it's all bad and no one should take it. Like that's obviously not what we're saying. But there has been from a scientific lens through a scientific yeah lens there's been sort of a bit of missed nuance around right well I mean you know in in w and with some of that missed nuance, I mean I think that there's also missed opportunities because even if we ⁓ accept the fact that, you know, women do not have a lot of options for preventing pregnancy right now. We just don't. We don't have a lot of good ones. And so hormonal birth control right now is still going to be the best option for many women, I I believe. And and I think that if I was 25 again, I would be one of those women. Knowing everything that I know now, I would still be on it. But I would know the trade offs I was making. And more importantly, I think that you know one thing that's like really been lost, you know, in in this conversation that we've had culturally where ⁓ women's hormones don't matter and they're they're just this problem that needs to get managed and let's just go ahead and shut them down and who cares. You know, before we decided they were so important only for women in menopause, ⁓ you know, which makes no sense at all. ⁓ then asking the question, well, what if we treat women on hormonal birth control like menopausal women and give them hormone therapy? And so one thing that we're doing in my lab right now is trying to ⁓ examine like whether you can reduce some of the negative symptoms of hormonal birth control by supplementing with micronized progesterone. ⁓ and because women who are taking hormonal birth control, because progestins are not the same as progesterone, you don't get some of these really lovely the effects that progesterone has, ⁓ especially ⁓ it has these beautiful anti-inflammatory effects in the body, it's got ⁓ anti-excytotoxic effects in the brain. And so what we're wondering is whether if you give women progesterone, which is then going to have these lovely downstream consequences that you don't get from progestins. And we supplement women who are on the pill with this, might this lead to a better experience or putting them on testosterone? Because we also know that they that their testosterone levels tank. And so, like, are there things that we can be doing to make the birth control experience better by acknowledging the fact that it's not perfect? Yeah. I love I love that your lab's doing that. You mentioned that before. I think that's gonna be fascinating. yeah, I'm really excited about it. I mean, I I'll keep you Yeah, totally. I'll totally keep you posted on it because I I really do think that, you know, we need to if we accept the fact that hormones matter and that they're good for women and that biologically our experience as a human is is relied on having them and then we shut down their hormone production, we need to do something. Yeah. You know, to to improve their experiences. Yeah. It's yeah. Yeah. ⁓ no it's great. I think that's amazing. I think that's I can't wait to share that research when when it's available. One other thing just while I'm thinking of it and just to as a practical detail ⁓ I know people have probably heard me talk about this before, but the hormonal IUD does not suppress hormones to the extent that ⁓ most other types do. So for many women, especially older women, when the there's a more robust signaling between the brain and the ovaries, ⁓ it is possible to ovulate and have actually real menstrual cycles through the hormonal IUD, which it can be a bit weird because you might not you might not bleed. So just a as a little compare and contrast is on on the estrogen methods of hormonal birth control that induce a bleed, those kinds of things. They sh they shut down hormones, they switch off ovaries, but they indu medically induce a bleed. on those types you can bleed but not cycle. And on the hormonal IED, ironically, you can cycle as in make your hormones in a cyclic pattern, but sometimes not bleed. So they're yeah, they're quite different, which is where again where this nuance in the different types of Right. And I do feel like I mean, I don't know if you've you've probably looked at the data. There is a move away from the estrogen sort of really ⁓ like hormone flattening types more towards hormonal IEDs. Would you see is that is that there in the data that women are younger women especially are choosing yep. Yeah. Yeah. ⁓ that aren't necessarily not positive. I want to hear Well here's so here's my here's my all right. Here's my my tinfoil hat. So I'm putting put my tinfoil hat on. ⁓ and say that ⁓ you know the ⁓ the progestin as used in the hormonal IUD is still under patent. That's that's why I think that it's getting recommended. It's because the drip i it's under patent or it's no longer yeah. No, it is still under patent. ⁓ and so and so they can still make money off of prescribing it. And so I think that when the patent expires on the hormonal AUD that I think that it might change people's tune about the extent to which they're pushing it. And again, this is just me being ⁓ slightly paranoid. I'm sure there's other reasons, you know, ⁓ most doctors like it like I I think most doctors are absolutely wonderful human beings who are absolutely doing what is best for their patients. ⁓ and you know, and and some of the education that doctors get is from drug companies and that's just the way that it is. ⁓ and ⁓ and and it's not because the doctors are doing anything wrong. So let me just say that. And ⁓ but but I do think that ⁓ I think that at least in the US, the shift toward the hormonal IUD, I think ⁓ a lot of it was being pushed very heavily by the drug companies to get people on that IUD because it was a new way of using Levonogester. Yes. ⁓ which then allowed it to go back into ⁓ patent. ⁓ it was back 'cause I was saying it's an old progestant, but it's back under patent because of the delivery methods. The new yeah, because whenever you have a new use of an old ⁓ an old drug, you can you can get it you can get the patent extended. And so anyway, that's that's you know, it's that's my own pr like tinfall hat thing. But I'll say this about the hormonal IUD that I think is really interesting. And ⁓ and as you noted, you can cycle on it. Yes. And and produce your own hormones and and all of that. But what's interesting about it and why I think it's so messy to talk about. Yeah. Is because for some women, ⁓ and it it's actually many women, when they're on it for the first year or so, they don't ovulate at all. Right. and and so they're producing no hormones and they're not getting any hormones from the IUD because they're very, very low. And so like when women are first on it, it can be an absolutely jarring experience because here it is, you're not producing any hormones and you're not getting any hormones exogenously. And that creates a weird place. ⁓ and you know, when we look at the hormonal, like when you look at the research that ⁓ looks at the differences in psychological side effects, I'm I'm talking about mental health related side effects in particular, like depression and anxiety, like w what they tend to find is that the hormonal IUD with teenagers has these like outsized negative effects on mental health. And I think that it gets at kind of what you were saying, and that here's this group where the communication between their brain and their ovaries is underdeveloped. And so there's not a lot the the brain and the ovaries aren't very well practiced with each other yet. And then, you know, when ovulation is is being fully shut down, I I think that it just creates essentially like psychological or neurobiological cacophony. Yeah. I think you're right. And I r I remember the hormonal LED did in terms of that old that well, old now, 2016 Danish study. That was like that was a watershed moment in all of this conversation that people can we put that in the show notes. They for the first time kind of unambiguously pointed there was a signal, cut like a pretty strong sign. It wasn't a huge effect, but like a s a sort of undeniable effect of negative mood from hormonal birth control. And I remember the hormonal LED did was one of the worst. And so I I think progestin only methods are always gonna be worse because they don't ⁓ the synthetic estrogen, as much as it's not quite as good as estradiol, it still has mood stimulating beneficial effects. Would you agree? I estrogen and almost any kind of estrogen is is is positive to mood. when it's in the right at the right level. Yeah. Yeah. And in fact I From what I understand, ⁓ the only reason that they started including estradiol or est or estrogen, you the ethanol estradiol in ⁓ hormonal birth control was because it made people feel better. To offer that's my understanding of the history as well. They originally started with progestin only, didn't they? And then added estrogen to make so it's le was less horrible. Yeah, less horrible. And so ⁓ you know, generally and I always ⁓ tell you know, women this if they're just asking for my counsel ⁓ after I remind them that I'm not a medical doctor and that they should never follow any advice that I give them. But that, ⁓ you know, that generally what the research finds is that ⁓ women's experiences on the progestin only ones does tend to be a little bit more psychologically risky than the combination products, which that little boost of estrogen can lead to ⁓ a more favorable psychological outcome ⁓ from birth control. ⁓ so this is good. I'm so happy to talk to you again. I every time I talk to you I like I I learn things and also that's kind of confirming It's just good good for me to sort of collaborate with you that that that's that was my understanding too, about the progestin only. The other just quick thing about progestin-only methods with the levinogesterol is there was it's androgenic. So women can get skin breakouts, even hurtism, facial hair, hair loss to some extent from prog after a long time on progestin-only methods. And that had been obvious clinically. This is one of like this is the classic story. So there's some things that have been obvious clinically for a long time and the research takes a while to catch up. I this is actually just the nature of medicine. So this is not unique to women's health. But there was a study that came out just I think in the last twelve months, I can if people are interested, I can put it the show notes, but demonstrating or observing that yeah, higher likelihood of androgen like ⁓ breakouts, facial hair f on and and hair loss on the progestin only methods, including the hormonal IEDs and like and also I would put weight gain in that category potentially. ⁓ depending on the type of progestine. Some progestines don't cause weight gain, but some can. Yeah. Yeah, especially the second the second generation progestins from my read of the literature seem to be the ones that are most likely to have some of those androgenic side effects because they are the most androgenic and ⁓ and so you get the weight gain, ⁓ the acne, yeah, as you noted, the hair. So they're derived from testosterone, just to be clear to people. I mean those that second generation are derived, they're not derived from progesterone. They're not I love I love we must put your sub stack in the in the show notes or how many I'm I wanna sh I'm gonna share it again in my next newsletter. You're one about how like progesterines are not progesterone is progesterons are not progesterone. They're not even cousins. Like they're not like they're only Yeah no they're not they're most they're only like the most vaguely related. Like they don't a lot of them are quite different from progesterone. And in that sense that's again where some of the confusion comes from. Because so The ethanol estradiol, like the synthetic estrogen, is somewhat similar to estradiol. Like it's it's on the same page anyway. Like they're sisters. Right, yeah. ⁓ I I would I would call those sisters. Yes. And it's stronger and there's different this differences, but they're not as like jarringly different as progestins are from progesterone. And also the other thing about estrogen versus progesterone, for clarity, because words matter quite a lot. Estrogen is a generic term. So estrogen The word li estrogen can legitimately describe all kinds of things, including the synthetic estrogen in the pill. Progesterone is not a generic term, it's a biochemical term. And so because they get used like they're paired, we tend to think of progesterone as also being generic, but it's not. Just for No, no. It's a progestogen, right? That's the generic term, right? A progestogen. And then progestin and progesterone are both progestogens. Yeah. In my Yeah, I think there's not scientifically classify those. I think that there is. I I I do think that it is ⁓ progestogen. I'll I'll verify that and drop that in the show notes as well. Yeah. ⁓ but yeah, I mean progestins are most of them are synthesized from testosterone. Yeah. ⁓ generations one through three, and then the fourth generations are ⁓ synthesized from spirolectalone. ⁓ also not progesterone. No. ⁓ and so in all cases they just manipulate the molecules enough to stimulate progesterone receptors. Which then quiets the communication between the brain and the ovaries. So it tells the brain not to stimulate the ovaries. And ⁓ and that's how you prevent ovulation. Yeah. ⁓ but it doesn't have the beautiful downstream consequences that actual endogenous progesterone does, which has, you know, those benefits in terms of ⁓ it's anti proliferative, which means it can have anti cancer effects. It is helps to ⁓ lead the to the I I don't remember if it's a growth or differentiation of osteoblasts in the bone, so it helps to contribute to bone strength. It is anti-excytotoxic, meaning it's calming to the brain. It also is anti-inflammatory. It has all these really beautiful effects and you don't get any of those from progestin. Let's give a tiny biochem biochemical detail. I'm sure your listeners might already know this, but just we'll just mention allopregnenolone because it's it's the it's the ⁓ the neurosteroid Like but it's like a it's like a s a st a steroid version of a neurotransmitter, I guess. I mean your this is your area more. But this is where the the wishful thinking comes in because one of I mean progesterone it acts on progesterone receptors, but it also has this neurosteroid that acts on GABA receptors. So it's it's quite dynamic. And is it true to say that no progesterone metabolizes to allopnant alone? Yes. Yes, that is true. None that's available. So I read and this is probably I don't know, t five years ago. Yeah. I read a paper about a progesterone derived progestin. Okay. That is only used in like a very small population. I believe in like Central America or South America it's available there, but nobody else uses it. So I'll I'll say that I'm not gonna say that there's no such thing 'cause I can't say that anymore 'cause I did read about this. Yeah. But it's not available anywhere. So, ⁓ any of the progestins that you can get that's in the birth control that you are on, listener, ⁓ is not derived from ⁓ is not derived from progesterone. And therefore when it gets broken down in the body, you don't release this really beautiful neurosteroid called allopregnantolone. And that's kind of the moneymaker in a lot of these positive effects is that it's activating, ⁓ for example, GABA receptors in the brain. And and what we find is that women who are using hormonal birth control, they have lower levels of this calming neurosteroid in their systems. ⁓ in the periphery. So when you're studying this in humans, you have to study it in the periphery, which just means outside of the brain. Yeah. ⁓ because obvious there's obviously the brain. You can't yeah, like look inside the brain with humans is tricky. But they've done ⁓ some rodent model studies where they look in the in ⁓ the central nervous system and they see less expression of allopregnantolone ⁓ in the nervous systems of ⁓ the mice that are treated with ⁓ progestines. It's it's the devil's in the details, right? Like this this feels like a very important detail. Of course, sixty years ago when they started using progestins, nobody was thinking about allopre I I would venture to say nobody was contemplating allopregnantalone or anything to do with that. But it was this is one of those examples of like wishful thinking. It'll be I'm sure it'll be fine. It'll be fine. Yeah. What could possibly go wrong? Well, I think that, you know, it's like I think that we, you know, it's people started to think, ⁓ well, pr ⁓ estrogen matters. And I think that that's part of the menopause conversation that we're having now. Yeah. And you know, it's essentially like where they like count receptors, you know, it's like, ⁓ wow, there's receptor sites for estrogen everywhere. Like, wow, like this is a brain in the brain, like this everywhere. And you know, and when it comes to like receptor to receptor, ⁓ you know, progesterone has fewer receptors in the brain, but it has almost as many receptors throughout the progesterone. like throughout the body as estrogen and progesterone breaks down into allopregnantolone, which gets picked up by GABA receptors, which is the primary inhibitory neurotransmitter system in the brain. So this is the primary set of brakes that the brain uses to slow neurotransmission. And the fact that, you know, women who are on hormonal birth control don't have, you know, they're not getting sufficient al allopregnantolone production because the primary way by which female bodies produce allopregnantolone Is through ⁓ is through ovulation and the release of progesterone. Yeah. So that's kind of a big it's kind of a big deal. It is a big deal. There are I mean to be for there's never absolutes, because there are ⁓ now I'm just getting a little biochemistry lesson from you, but there are other ways the brain also makes its own allopregninolone, right? And this other it it can derive from other not just from ovarian progesterone, but other Right. Yes, like from adrenal so we do produce some progesterone from our adrenal glands, ⁓ especially in response to stress and that too. produ ultimately leads to the release of allopergnenolone and you can get ⁓ like de novo production of allopregnenolone in the brain. What's really interesting about de novo production of anything in the brain is a lot of times it happens in response to what's happening in the periphery. So just to give you an example of this, ⁓ like when you have heightened levels of ⁓ inflammatory activity in the body, you also get ⁓ de novo production of cytokines in the brain. Yep. And a lot of that is to deal with and and you can get some leakage through the blood brain barrier, but essentially it is the brain trying to replicate what's happening in the periphery ⁓ because of the blood brain barrier and needing to essentially create this experience that's also going on in the rest of the body. That is very which is fascinating. Yeah, no, I didn't know about that. I that's very interesting. one thing about just this is just came into my mind. I just wanna 'cause this is a one of the little I would say myths that there's out there. Again, it's not absolutely a myth, but it essentially is this idea that progesterone converts to cortisol. I just want to clarify this. So I mean, it can convert to cortisol in the adrenal glands. It's part of the steroid cascade. But if for all intents and purposes, like for you know, ovarian progesterone or exogenous progesterone that you take mostly goes to allopnetolone. Is would you agree? Is that true? Yeah. Yes. No, I yes. And I would say that ⁓ this idea and and this idea lives out there like the progesterone steel hypothesis, I think is what it's called. Yeah. And ⁓ and this has been more or less ⁓ debunked in the world of science where it's like, yes, it is true that when women are experiencing a lot of stress. that ⁓ that leads to lower levels of progesterone, but it's not because the progesterone is being cr like i gobbled up and turned into ⁓ into ⁓ cortisol. No. Instead what's happening is that you're not ovulating. And ⁓ and so the chain of you know the sort of causal chain is like cortisol stress, right? Chronic chronic stress, chronic stress, failure to ovulate, lower levels of progesterone. ⁓ and so the best thing that we can do to support progesterone, ⁓ one of the best things that we can do is to ⁓ is to support our nervous system and and prevent chronic stress, but it's not because the the stress is gonna be stealing our progesterone. Yeah, that's good. I just wanted to get that out there because also then people are scared to take progesterone because they're like, ⁓ because it's all it's all gonna turn to cortisol. It's like, no, it's it's not. No. So that's ⁓ that's interesting. Yeah, 'cause clinically of course, you know, I'm not a clinician and so I don't like I don't deal with people like saying, I don't wanna take this because of this. So yeah, that's really interesting. Yeah. And so ⁓ so ⁓ I wanna like ⁓ step back for a minute, because we talked about birth control. Yes and clearly, you know, you think that ⁓ that a healthier, happier way to be as a female is to be cycling, right? And to enjoy the production of your sex hormones. And ⁓ and just for those of you who aren't familiar with the menstrual cycle, like as you begin, you know, your egg follicles are maturing, your body starts releasing estrogen, you ovulate. The empty egg follicle becomes a a temporary endocrine structure that starts releasing progesterone that rises, and if you're not pregnant, it falls and then you bleed and then it all starts over again, right? So you get this beautiful rise and fall of estrogen, a rise and fall in progesterone, ⁓ lather, rinse, repeat. And ⁓ and this is kind of part of the experience, you know, historically for most of human history, this is when you're a reproductive age woman, this is your this is your life when you're not pregnant or or breastfeeding. And so ⁓ You know, given that, you know, you're a proponent of supporting hormones and supporting hormone production, which I am I am too. Yeah. ⁓ and and given that so many women are put on birth control for issues like ⁓ PCOS and endometriosis, ⁓ in particular, I I would be really interested in hearing about like what listeners can do. Let let's say that we have somebody who's listening and she's got PCOS or she's got endometriosis. Like what are some things that they might do differently? That can help support their cycle without the birth control pill. Yeah. Okay. Great question and big big question too. Yeah. Yeah. So and maybe we can like well maybe we can just start one at a time. We can start with like PCOS. So just like quick quickly just describe what that is and like what like what do you do? Yeah. Okay. Let's give it let's let's touch let's just touch but and of course I mean my a lot of my writing is around all of this. Like because on the one I can't be someone on the one hand who says actually there are problems with taking hormonal birth control and then not offer Alternatives, right? So a lot of my most of my work is about providing al alternatives and like ways to not have symptoms. so just yeah. So PCOS is is a I would say at its core. I mean it depends how it's one of those things where it's I mean, all almost anything in medicine. And I love that analogy of like there's an elephant and and all the blindfolded scientists and everyone's just like, ⁓ it's a feeling the tail. It's like that's a rope. ⁓ that's a like this. That's a wall. That's a like Yeah, yeah. So so depending on who's looking at PCOS, it's different things. I mean, it arguably is a metabolic whole body metabolic situation. ⁓ it but I guess primarily it's ovulatory disturbance. So it's it's a it's a disc it's it's it's just too about how the ⁓ calibration between the brain and the ovaries How that's calibrated. Some of that would be ancestral. So some of that would be from just back to our evolutionary biology. This this would be be peop women are more likely to develop the situation if they come from a long lineage of kind of higher androgen survivors. So these would be, you know, a lineage of women who I mean, without being getting too fanciful or getting all into the narrative, but like this is a tougher group. And I I that's I think it's great. I mean, I think it's they're great genes. They're not they're not bad genes, but it does mean There can be this calibration to higher testosterone, relatively higher testosterone levels, which can be much too high in some cases in the modern environment and from probably from lots of things from environmental toxins. Like so many things in women's health, one of my messages too is it's not your fault. Like I think especially when we start talking about lifestyle and things we can do to help calibrate and then it there comes with this like almost built in like, well, then because you've done something wrong is why you've ended up here. That's I would say that's not the case for almost any of the treat conditions I treat. I think there's a lot of evidence that when women get pushed into the higher androgen not ovulating state of PCOS, it's some of it's from way beyond their control. It's from environmental toxin exposure in utero, which was nobody's fault, or it's from like multi epigenetics over the generations, or just to kind of really ⁓ contextualize it. But yes, women can be in this and it it's confusing because as younger women were higher androgen lower ovulation anyway. So there's a real so the P the true PCUS state can look a lot like just the early teenage years when you're just getting your period and not ovulating yet. So higher androgens, higher insulin resistance potentially. So fortunately PCUS responds really beautifully to a combination of natural treatments. ⁓ I'll just like the one of the big heavy hitters is inositol. It's one of the supplements that helps promote ⁓ healthy ovulation improves insulin sensitivity. And as soon as and it's a self-regulating system. So as soon as this is be my this is where this is the contrast with so the conventional approach is you're not ovulating, so let's shut down ovulation. Like it to me again, that's another jarring counterintuitive. Like treat a condition of not ovulating with suppressing ovulation. I mean, and by the suppressing ovulation, they're also suppressing androgens, which is where the you know the therapeutic comes in, which is valid. But you can also suppress androgens by regulating the system. So promoting ovulation. As soon as progesterone starts kicking in on its own, or you can also in some cases take natural progesterone to help this process. Progesterone has its both estradiol progesterone have beneficial antiandrogen effects. So they help to mature the cycle, lower androgens. And and you can sort of mature and a lot of women can grow out of PCOS. This is the other thing too. So this is a whole other conversation, not a future next time we meet, but in in the coming years. Let's have a conversation about ⁓ I'm gonna be doing a bit more content about this, about where your diagnosis lightly, like the the whatever the diagnosis is, this would be true, I would s argue in mental health, in women's health to a large extent. These diagnoses can be they can be helpful because they can help Point to what you need to do, but they can also, would you agree? Like they can also be kind somewhat constraining. So I feel like if someone they message to women out there, like if you've been given the diagnosis of PCOS in the past, fine. And maybe that was totally valid, but there can come a time where you maybe need to reevaluate that and think, is that still serving me or is that still relevant? Because the it can be outgrown. And also the thing about PCOS, and I never I try to always remember to mention this, any podcast I do. There's a lot of misdiagnosis going on. So one of the classic ways to not ovulate is to undereat. N maybe not intentionally, but just overtraining, under eating, or stress, or just like the the especially in young women, this the system's very sensitive to that. And so if you if that's your situation, so you're not ovulating regularly, irregular periods, may maybe have a few pimples because you've just come off one of the hormonal medications that like ⁓ one of the types of hormonal birth control where that can lead to post-pill. acne and then a doctor happens to do an ultrasound where they see polycystic ovaries, you're gonna be slapped with the diagnosis of PCOS, which is possibly in your case not correct. So that's just a a clinical thing. so and the reason that's so important to mention is because often the the narrative around PCOS or the mainstream advice is to eat less, I guess, you know, to put it simply, or to modify diet or low carb or something, which I'm not again, I'm There can be a place for that and I've written extensively about how to manage that. But if think of the scenario where a woman's lost her period to under eating and is then t mistakenly told she has PCOS and decides to go low carb or under le eat less to correct it. So I mean, I I've had multiple conversations with patients where I say, You are unfortunately walking in the you're moving in the completely wrong direction from where you need to go to get your period back. So it's it's Yeah. This is where the individual Yeah. So there are things then that ⁓ that people can do. Like like to manage their PCOS. Yeah, and and you do have ⁓ and I'm gonna put all of your books and and your website in the in the show notes because I I know that there's so much information in those books about the things that I've got a new book coming on, periods. So that's my new project. So hopefully by the end of this year, early next year, a new Yeah, a mostly treatment manual for all these things. So Yes, so there are treat there are treatments for PCOS. I that was and I'll just briefly treatments for endo. Endometriosis is also having kind of a moment. ⁓ just say to people, so endo is about and endo. We're all that familiar with it. You know, poor endometriosis is is about to undergo a major paradigm shift. There's like a there's the rumblings of seismic. So without going into yes, obviously we're kind of at time here, so I won't go into all the details, but I would say the old paradigm of cut it out, you know, the so endometriosis is this condition where there's these lesions similar to uterine lining that grow in other places and it can be quite a devastating, debilitating condition, but just zooming out, there is a lot there's actually a lot going on with pelvic pain and s endo when it's maybe not really endo and there's just a lot going on. And I would point people to another one of my sort of favorite Clinicians, I mean, she's a gynecologist in Australia. There's something going on with Australian gynecologists. They're just a radical group, ⁓ some of them. And so she's got a book called Healing Pelvic Pain, where she s tries to take a really fresh look at endometriosis. Her name's Dr. Peter Wright. So if people Yeah, I mean I've I've my new book has a big section on endo as well, but I would direct people to that and just say there is hope. So I mean, categorically, hormonal birth control is not the only solution for and the thing I would say about endometriosis, too, part of the paradigm shift. its old paradigm is that it's progress a progressive disease that has to be stopped. It's not. It can be. Like it can be in some cases, but in many cases it's not progressive. It can go away on its own, even more severe cases. So on its own or with natural treatments. So I mean that's quite a that's quite a paradigm shift in itself, don't you would you agree? Like that's cause ⁓ yeah. Yeah, no, totally. Totally. I mean it currently, you know, I the only I mean I've I've heard so many different like Yes poor approaches to endometriosis. I mean I've ⁓ there there's the birth control is your only answer. I've heard that as, you know, the the answer that women have been given. I've had women I've had women, including ⁓ one of my nieces, who's cut open to get diagnosed with endometriosis, but then they just put her back together again without doing anything about it. And then they're like, if you want to have this taken out, then you need to have another surgery. You know, and ⁓ th and then you have people who do superficial surgeries that aren't actually getting at the you know, the core of the issue. And then in in your be you're suggesting that that might not even be necessary at all and that it might be something else altogether. Yeah. So this this is endo of all the areas in women's health, and we've talked about some controversial ones today, perimenopause, I say is is has its own controversy going on. PCOS, but of all the women's health endometriosis is the most Like there's a lot going on there. I'll just I'll acknowledge that people are it's it's very ⁓ yes. So there's ⁓ without being too vague, I th I I think is a a lot of people, very smart people are backing away from surgery. Not as not as a never do it. I mean ⁓ most people say there can be times when it's it's the best option, but it's it's it's like back to the drawing board with a lot of this. So I would just encourage people to just take a breath, take a beat. I know it's hard to take a beat or th and you know, think again when you're in debilitating pain. And I so I mean part of part of Dr. Peter Wright's work is just to acknowledge women's pain. Everyone should be on the same page that women should not be in terrible, excruciating pain. Nobody wants that. So I mean there are other women should not have to put up with it. And there are lots of smart people like tr figuring out and there are I mean and and and just anecdotally, even very debilitating severe cases of endo can respond incredibly well to seemingly quite simple things like ⁓ you know, diet changes and ⁓ pel pelvic physiotherapy. Like there's there's a lot it's it's a dynamic situation. One thing I just wanted to just thinking about this is this is segue now, but like off topic, but this quote, I had this great quote from a follower about ⁓ perimenopause. This is I just want to speak a little bit in closing, I guess, to the the current so the current mode we're in in twenty twenty six on social media is a lot of biochemical speak. Like people feel like they have to like they're they all know about like their cortisol curves and like even even us, like we mentioned allopregnenolone and cytokines and insulin signaling and so people and so I heard this this one of my followers said, I who knew that going through perimenopause I'd have to essentially become a biochemist to like understand all the So I would just as a takeaway, I would say you you you don't. Like you don't you don't have to whatever the health problem you're facing, you y you shouldn't have to become like totally versed in every biochemical or, you know, anatomical nuance of the condition. There are there is a way through that, I don't know how to this the w the I mean the body does if if you c i it it can come back to some basic principles. If you can give the body what it needs, it will a lot of the time surprise you and do, you know, it I I the w the segue for me was coming from the the topic of endometriosis. So I mean of course because the pain can be so terrible, people think, well, if it's if the pain is that terrible, then obviously the treatment has to be match that. Like the treatment has to be Do you know what I Like it's like yeah, like like equally as intense. Like as it like yeah. Like like people say, Well there's no way this pain's gonna respond to simple things like diet and you know, pelvic physio. It's like it it can. Like it does. Because of the dynamic nature of biology and how you and this has been a a theme in a lot of my work is like give your body what it needs. Mm-hmm. And again, not absolutists. Sometimes ⁓ ho stronger interventions are required, but you'll be surprised. But the b the body wants to be well. It doesn't want to be in pain or be not ovulating. It it's ⁓ and that's my that's from thirty years of clinical practice. I can just tell you, like bodies are responsive, especially in yo and this is one thing I'll say, especially in younger w younger women. So by the time I get into our forties, yeah, things are a little harder, maybe require stronger interventions. But young women respond so well. Like you just give their body half a chance to ovulate and it will. You just you just the simplest interventions for period and so I'll just say for period pain, a takeaway before we finish. ⁓ consider zinc. It's been clinically trialed for period pain. it's a very simple intervention. sometimes I do people can look at my writing about, you know, avoiding normal. types of cow dairy can dial down histamine and sort of pain pathways in some people, again, not everyone. And also just work with the nervous system. This is your field. But I mean the nervous system, especially the autonomic nervous system, affects everything. And this is where you have to get one of your guests, you have to when you at I'm gonna try to share all your podcasts because I'm so interested. But when you get your if you could get guests talking about the autonomic nervous system and the female autonomic nervous system in particular, I'd be very curious because don't you think that it's Again, I think the way this is our sympathetic parasympathetic, the way it's calibrated or wired is probably the normal, but men's is a little different. So I mean the female autonomic nervous system is quite special, I think. Yeah. Yeah, it's i ⁓ so I actually ⁓ I just did an episode with somebody talking about a vagus nerve simulation. Yeah. ⁓ and which ⁓ there's been some really great work. ⁓ looking at that and ⁓ endometriosis of all things. And what you can find is that even ⁓ is su is supporting nervous system function and ⁓ and supporting the communication pathway between your brain and the periphery ⁓ can improve symptoms in just about anything. And you know and and and and as I was saying to ⁓ to my guests, the way that I think about this is that when you are 'cause You know, everybody always thinks about the when they think about the communication between the brain and the and the periphery with the vagus nerve is they're thinking about the brain telling the body what to do. But a l most of the the directionality in the relationship between ⁓ the brain and the periphery and the vagus nerve is coming from the body up to the brain. I know. And so it is how our brain is learning about what's happening around it. So that way it can help regulate our systems. And the fact is, like if we're stressed out, yeah, right, then we're in a sympathetic nervous system type of a response and that is outward facing where we're picking up on what's going on in the outward environment because it could potentially, you know, create danger and then figuring out what sorts of bodily changes need to happen to prepare for this thing that's going on on the outside. Whereas when you are experiencing your parasympathetic response, your body is able to direct that information internally. Right. And your brain is able to pick up on what's going on in the rest of the body and then make adjustments that way. And so, you know, when you look at something like endometriosis, it's like w of course you're gonna support your body's ability to regulate pr the proliferation of endometrial tissue when your brain is given the opportunity to listen. Right, to listen to the body. Yep. And then make adjustments, you know, accordingly. And and so I'm I I'm really excited about ⁓ the research that's being done on the vagus nerve because again, because the body is a big mess of spaghetti, as we've talked about. you know, because of bi the way our biology works. ⁓ it's like one of these things that I think is gonna have positive impacts on systems all over the place. I agree. No, the autonomic nervous system is fascinating. And obviously we'll have to as we'll talk about that next time. But one thing about just quickly, is it true that the female I mean, so the autonomic nervous system calibrates and matures through our childhood and into our twenties before it kind of reaches it I mean it's never fully it's a dynamic system, so it's never static. But my understanding through some of the research is ⁓ the female for women, it there's sort of a slower maturation. And this is why I mean, this is why I mean clinically, any clinician will know young you get these young women with low blood pressure, crashing blood sugar, like this is this sort of autonomic instability that you can get ⁓ into a woman's like into her sort of early twenties when whereas for men that t for boys that tends to kind of stabilize a bit earlier. Is that something that you've come across in your research or Yeah no, I have not no, I've not come across that. That's really fascinating. And it's also fascinating when you consider, you know, 'cause when you look at ⁓ research and this this isn't looking at ⁓ autonomic stability specifically, but I mean even just like looking at the brain structurally and functionally, you know, you get changes with pregnancy and postpartum and all these other things where I feel like ⁓ the human form ⁓ like the female form Yeah. Is just a dynamic system. It's it it it in in in some ways it's more of a dynamic process, I think, than the male than the male body. ⁓ just because there is all of this constant remodeling. And so it wouldn't surprise me to learn that there is sex differentiation in that. Yeah, for sure. ⁓ it's been so great. It's been very funny. Yeah, I'm sorry to have kept you long. I didn't even get to we did not even get to some of the things I was hoping to talk about. ⁓ yeah, metabolism and we'll have to save that for another Yeah, we'll do we'll do we'll do a part two. So I'm gonna ⁓ ask like a wrap up question and we'll cut all this little stuff out where I cried about how sad I am. I didn't get to ask all my questions. So so so Laura, as somebody who's been I mean, really you've been so instrumental in in so much of the work and and the awareness out in the world about ⁓ i increasing women's awareness of hormones and cycles and women's reproductive health. And like what are you most excited about? moving forward. Like what like what are you excited about in the world of of women's health and hormones? Yeah. Well I for me currently in 2026, and it's to do with I mean I just poured all my heart into this new book about periods. I've really moved back to young women. Like so I mean obviously I have a book on perimenopause. I feel like the perimenopause discussion has dominated so much. And I I saw some quote, like someone said on social media, it's like, okay, you need to start thinking about perimenopause at 25. I'm like, no you don't You do not. You don't. You need to start thinking you need to think about ovulation and like so I mean, yes, so I'm pretty passionate about and not only not just women in their twenties, but teenagers. I mean, I think this is where through again, through the biology lens, we if you can get the system, the biological system early on like relatively early on, it like the downstream you can really ⁓ change the trajectory of w how it all goes. So I I'm I've got a workshop coming up for teenagers. I'm gonna be in London actually doing You're are you're not in London in June by any chance, are you? Be but no, but maybe I will be. Okay. I'm gonna be doing a workshop. Yeah, teenage girls and yeah. So it's I just that's where my my passion is. And again, this is even though I don't have any of my own female descendants, I think I think I'll just in closing I'll say like and I'd be curious for your listeners if they share this. even f well, maybe not especially, but even for those of us who haven't had biological children, there is after I'm in my late fifties now, like there is this thing kicks in of like maybe not for everyone, but anyway, for me, I'm definitely feeling this like I wanna say matronly, but like I just I really want young women to be okay. Like I'm just like really I mean I I care also about perimenopause women, like I just feel like they've got, you know, you've got this. Like they've got a lot going on. But like let's let's look at the teenagers and the you know women in their twenties and you know anyway, this is this is where I'm feeling most passionate. And hopefully I can make a difference there. I love that. I think that's wonderful. And well, I think that you've played, even though you don't have ⁓ direct offspring of your own, I think that you've played a really important role in raising generations of women now, ⁓ with the teaching that you've given them on their, you know, increasing their body literacy and and learning about their hormones and learning about their cycles. And and no, I think that we all owe you a debt of gratitude. So it's very strange. Thank you. No, and I and I mean it. I mean, ⁓ there's it This is something that, as you noted, people weren't talking about for a very long time. And ⁓ and you are a big part of where the public awareness ⁓ of all of these issues has come from. So thank you, Dr. Bryden. Yeah. Thank you, Sarah. And that's it for today's episode of the XX Lab. If you want more, subscribe wherever you get your podcasts. And if you're enjoying the show, a rating or review helps other people find it. See you next episode.