RHR: Healthy Birth Control, Irregular Periods, and UTI’s

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This one is for the ladies! We grouped together a number of questions we’ve received on topics ranging from mammograms and pap smear recommendations, to how to treat bacterial vaginosis during pregnancy, to what to do about irregular periods, to healthy methods of birth control.

In this episode, we cover:

2:36 The latest mammogram and pap smear recommendations
11:46 How to safely treat UTI’s or Bacterial Vaginosis during pregnancy
17:55 What to do about irregular periods
29:31 Healthy methods of birth control

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Full Text Transcript:

Steve Wright:  Hi, and welcome to another episode of the Revolution Health Radio Show brought to you by ChrisKresser.com.  I’m your host, Steve Wright from SCDLifestyle.com, and with me is integrative medical practitioner, licensed acupuncturist, and healthy skeptic, Chris Kresser.  How’s it going in the Bay Area, man?

Chris Kresser:  I feel like I almost wouldn’t know.  It’s been pretty crazy for me around here just getting the High Cholesterol Action Plan out the door, and my daughter, Sylvie, is teething and has had a pretty brutal cough for about a week, and she’s recovering well, but she’s been keeping her mom and dad up at night.  So I’m gonna practice what I preach, and we’re gonna do a shorter show today so I can take some time to just chill out a little bit.

Steve Wright:  Well, I can’t say I’ve been there, but I completely understand.

Chris Kresser:  Haha, yeah, I know what you mean.  I had a sort of vague idea of what it would be like before I got into it.  I have six nieces and nephews, and so I saw a little bit of it behind the scenes, but it’s certainly different when you’re the one getting up and changing that diaper or whatever!

Steve Wright:  Haha, doing it!

Chris Kresser:  Yeah.

Steve Wright:  The act of doing it is different than thinking about it.  I think you have a quote about that somewhere.

Chris Kresser:  That’s absolutely true.  But we got some good questions.  We’ll get into as many of them as we can, and then we’ll be back in a couple weeks full strength.

Steve Wright:  Yeah, this is gonna be the ladies’ show.  And in the meantime, Chris, go take a nap.  I’m gonna tell the listeners about Beyond Paleo.  If you’re new to this radio show, you’re new to the paleo diet, or you’re just interested in optimizing your health, you’re gonna want to check out what Chris has put together.  It’s an email series, 13 parts in total, and it covers Chris’ best tips on burning fat, boosting energy, and preventing and reversing disease without drugs.  It’s called Beyond Paleo, and you can sign up at ChrisKresser.com in the big red box.

All right, Chris, wake up.  Time to go!

Chris Kresser:  All right, I’m back.  I’m here.  Got my green tea.

The latest mammogram and pap smear recommendations

Steve Wright:  Awesome.  Well, let’s get started.  This first question comes from Torea.  She says:  “I’m a 41-year-old female.  For years, I’ve used a standard American gynecologist and have always followed their advice.  But as I educate myself more on health, the status of the American health system, etc., I now have doubts about the advice that I was getting from the OB/GYN.  I know that I’m about to face quite a few hormonal changes with pending menopause.  What would be your recommendation on such things as annual mammograms and Pap smears for ongoing health monitoring as I move from pre- through post-menopausal?”

Chris Kresser:  Yeah, this is a controversial issue.  It seems like we’ve been talking a lot about those lately, and it seems like there are a lot of those in the health and nutrition world.  The background on this is that in 2009 the US Preventative Services Task Force recommended pretty dramatic changes to the breast cancer screening guidelines that were in place up until then.  And the proposed new guidelines recommend starting regular screening later at age 50 rather than at age 40, which was the previous recommendation.  And then they recommend screening before age 50 only for women who are at much higher than average risk of breast cancer.  And then the new guidelines also called for mammograms to be done every other year instead of every year as the previous guidelines suggested.

So there’s been a lot of debate about this, and there are pretty prominent groups, like BreastCancer.org, that have strongly objected to the new guidelines.  And they lay out a few reasons why they think they’re not a good idea.  Number one, the analysis of the task force was based on older mammography techniques, meaning the researchers mostly looked at the results from film mammograms instead of digital mammograms, which are known to be a lot more accurate.  The analysis was based on some inaccurate assumptions about optimal treatment after breast cancer is diagnosed.  For example, it’s assumed that women diagnosed with hormone receptor-positive early-stage breast cancer would receive and benefit from hormonal therapy but not chemotherapy even though there’s some data that many of those women do receive and benefit from chemo after surgery.  So assumptions like that may have caused the researchers to underestimate the number of lives that would be lost if the proposed changes were put into effect.

The analysis also didn’t adequately consider the combined benefit of early detection with current screening guidelines and new treatments that have resulted in improving survival rates in recent years.  And their point is kind of that screening can’t be looked at in isolation as a snapshot.  It happens as we continue to improve both diagnosis and treatment, but you can’t, of course, treat what isn’t diagnosed.

Steve Wright:  This is BreastCancer.org’s refuting?

Chris Kresser:  Yeah, exactly.

Steve Wright:  OK.

Chris Kresser:  And then they also claim that the proposed changes would mean that a lot of breast cancers would be diagnosed at later stages, which make them a lot harder to treat, and the survival rates, of course, decrease the later that they’re diagnosed.  Because when you’re diagnosed at a later stage, it’s more likely that it could evolve into metastatic cancer that spreads to other parts of the body.  And then lastly, they claim that the proposed changes would mean that younger women would be diagnosed later.  And breast cancer in younger women tends to be more aggressive than it is in older women, so early diagnosis and treatment is more critical for them.

So in contrast to the US Preventative Services Task Force, the BreastCancer.org group recommends that if you’re 40 or older and you have an average risk of breast cancer, they do recommend yearly screening mammograms.  And then if your breast cancer risk is higher than average, they even suggest talking to your doctor about a more aggressive breast cancer screening plan that may include breast MRI or ultrasound in addition to mammograms.

I’m not sure, frankly, where I come down on this at this point.  I feel like I need to investigate it further before I can make any kind of recommendation.  I’ve started to wade into it several different times, but I quickly realized that I wasn’t gonna be able to reach a kind of coherent conclusion just in a few hours of reviewing the research.  It’s a pretty vast topic, and like a lot of these topics, there’s a lot more than meets the eye, so the best I can do at this point is direct people to the BreastCancer.org site.  They have a pretty interesting discussion of the US Preventative Task Force recommendations.  I think, in general, where I tend to come down on these screening tests is perhaps with an appreciation of the risk involved in some of the screening tests, the exposure to radiation.  And then the other thing to consider is — and this is more true with prostate screening, for example — is the additional treatment that often comes from additional screening and the risks associated with that additional treatment.

Again, I’ll just have to keep digging before I can make a recommendation, but check out BreastCancer.org as an alternative viewpoint.  It’s something that you probably are gonna have to run through your own filters, too, because everyone has different risk tolerance and threshold with this kind of thing.  You know, we talked about this in the context of raw milk.  There are some people who if there’s a 1 in 100,000 chance of them contracting an illness or a serious disease from eating a food or drinking something, they feel absolutely fine doing that.  They’re not concerned about that.  But for other people, even a 1 in 100,000 chance is enough to scare them away from doing that.  So there’s some element of that here, individual risk tolerance, and what kind of sense these guidelines make for you will have to be run through that filter.

So, let’s talk a little bit about Pap smears because I think it’s not quite as controversial as the breast cancer guidelines.  In the 1930s, cervical cancer was actually the deadliest cancer for women in the US.  At that time, it killed more women each year than breast cancer or lung cancer.  But over the past 80 years, there’s been a huge decline in the death rate from cervical cancer because of improvements in treatment and screening, and today death from cervical cancer is relatively rare in the US.

In March of this year, the US Preventative Services Task Force, same group, announced new recommendations for Pap tests to screen women for cervical cancer, and the guidelines advise women to reduce the number of tests they receive over their entire lifetime to ensure that they get the benefits of testing while minimizing the risks.  There was one big change in their recommendations, which is that women under the age of 21 shouldn’t be tested.  And women over 21 should undergo a Pap screening test every three years instead of annually, which was their previous recommendation, because HPV can take more than a decade to progress to cervical dysplasia or cancer.  So their recommendations now are that all women should start screening at age 21.  It used to be that screening was recommended three years after starting vaginal intercourse, but they’ve backed away from that.  Women age 21 to 29 should get a Pap test every three years.  For women 30 and over, Pap tests should be done every three years, and the guidelines recommend against annual or more frequent Pap testing in that age group.  And they suggest combining the Pap test with HPV testing every three to five years for women 30 years and older.  I haven’t seen much controversy about the changes in those guidelines, so I don’t see really any reason not to follow them in the case of Pap tests.

Steve Wright:  Well, thanks for clearing those things up.  I know that’s gonna help a lot of people.

Chris Kresser:  We’ll do an update in the future once I have a chance to look into it a little further.

Steve Wright:  Yeah, I’m sure that everybody will be very grateful when you do get a chance to dive into the breast cancer research.

How to safely treat UTI’s or Bacterial Vaginosis during pregnancy

OK, well, we have a slew of questions here that were asked by men and women alike, just a lot of questions that all kind of were grouped together, so I just am gonna go ahead and say that these questions are from the crowd, because I whittled them down to one-line statements, and then Chris is gonna go ahead and tackle them one by one.  So, we want to thank everybody who sent these in.  I apologize if I trimmed your name off.  So, the first one from the crowd is:  What happens when you’re pregnant and you get a UTI or bacterial vaginosis?  How do you handle this, and is it gonna hurt the baby?

Chris Kresser:  Yeah, that’s a good question.  I get that a lot.  Bacterial vaginosis, or BV, as we’re gonna refer to it for convenience’ sake, is really common.  Current studies suggest that the prevalence of BV among non-pregnant women is something like 15% to 30%, and up to 50% of pregnant women have been found to have BV, so 1 in 2.  That’s really, really common.  That said, the majority of cases of BV are asymptomatic, so they don’t even get reported because the woman doesn’t even know that she has it, and they don’t obviously get treated.  BV was previously considered to be benign, but recently it’s been associated with a lot of gynecological conditions and complications of pregnancy, including pelvic inflammatory disease, post-hysterectomy vaginal cuff cellulitis, endometriosis, amniotic fluid infection, preterm delivery and labor, preterm rupture of the membranes, and possibly spontaneous abortion, although there’s not really enough data to know for sure about that.  BV usually involves an overgrowth of gram-negative bacteria and a reduction in the amount of hydrogen peroxide-producing lactobacilli, which is one reason that some women use hydrogen peroxide wash as a treatment.  BV can resolve and recur spontaneously, but the environment, you know, the behavioral, hormonal, microbial milieu that determines whether it resolves or recurs is not completely clear yet.

The most common treatment for BV in the conventional world is Flagyl, which is a pretty heavy drug with a fair amount of side effects.  And it’s usually fairly effective, but I, of course, worry about the impact of Flagyl on mom’s flora, her gut flora and her vaginal flora, and thus the baby’s flora.  Antibiotics are generally considered to be safe during pregnancy, but when drugs are studied in pregnancy, the safety profile often really comes down to whether they cause birth defects or not.  Antibiotics in most cases haven’t been shown to cause any birth defects, but that doesn’t mean they don’t have other effects that could harm the mother and baby possibly much later in life.  What I mean by that is we know now — and I’ve talked about this before and written about it several times — is that the changes in the baby’s gut flora at birth can actually affect their lifelong health.  It can predispose them possibly to obesity and diabetes and other metabolic problems when they’re in their childhood and even increase their risk of dying from a heart attack under 60 years of age.  So it’s definitely something that is getting an increasing amount of attention but still isn’t really referred to in these kinds of discussions about the safety of certain drugs during pregnancy.

So I would consider other possibilities that might be less harmful to the mom and the baby’s microbial environment, and one possible option is monolaurin, which we’ve talked about before.  We talked about it in the episode where I discussed treating viral infections.  When lauric acid, which is in mother’s milk and coconut oil, is attached to glycerin, it forms a monoglyceride known as monolaurin, and that is effective not only against viruses, which we discussed, and yeast and fungi, but also parasites and bacteria.  I haven’t seen any studies of the safety of monolaurin in pregnant or lactating women, but it is a component of mother’s milk and it’s been used by pregnant and lactating women for years without reported problems.  I have seen several studies suggesting that taking probiotics can increase the efficacy of antibiotic treatment of BV, so I’d assume the same would be true with monolaurin.  For example, in vito studies have shown that lactobacillus strains can disrupt BV and yeast biofilms and inhibit the growth of urogenital pathogens, and other studies have found that vaginal probiotic suppositories may also be effective.  So I’d probably suggest trying monolaurin and probiotics first.  The brand of monolaurin I recommend is Lauricidin, and that was developed by the researcher that first isolated monolaurin extract, and it’s the most standardized and potent form, I think.  So you could take both an oral probiotic and a probiotic in the suppository form.  Jarrow makes a specific probiotic called Fem-Dophilus that contains two strains that are particularly beneficial for the vaginal tract.  You could either open some capsules in water and make a douche with that, or you could try a probiotic suppository such as PurFem.  I think the Jarrow Fem-Dophilus product works pretty well both orally and then in a douche form.  So give that a shot, and let us know how it works.

What to do about irregular periods

Steve Wright:  OK, great.  Great ideas to start with.  Let’s move on to the next one.  This question comes for all the women out there who might not be having regular periods even though their overall health markers are OK and they eat clean paleo, they probably exercise pretty well, and they’re trying to mind their stress and their sleep levels.

Chris Kresser:  Yeah, of course, I see a lot of these women in my practice.  You kind of described one of my main patient populations.  Most of my patients are already on a primal/paleo type of diet and they’re already living a pretty healthy lifestyle, but they’re still having issues.  And problems with the menstrual cycle are one of the main things that I see in my practice.

I’m really a strong believer in testing for this kind of thing.  I like to do a full cycling monthly hormone profile where we test estrogen and progesterone levels throughout the entire month.  And a lot of naturopaths and holistic kind of practitioners and some MDs will do this kind of testing.  It’s really, really important because as all of you women out there know, I mean, you don’t need me to tell you this, your hormones fluctuate throughout the month, right?  That’s part of the natural cycle.  If you look at a chart of what a woman’s estrogen and progesterone levels should be through the month, it’s not a flat line, right?  So if you only do a single hormone sample at one day during the month, you’re only gonna get an idea of what the hormones were on that day, and that certainly can be useful information, and especially if you time that test in a certain way around day 21, you can get a pretty good idea of what’s happening in the luteal phase with progesterone and estrogen, and that can give you a starting place.  And I often do that with patients as a beginning thing, just because the monthly test takes a while, and depending on when they come in and when the first day of their next cycle is, it might be at least two months before we get results back.

But if you really want an idea, an accurate idea of what’s happening with female hormones, you have to do a monthly cycling panel, because when you look at a chart of estrogen and progesterone throughout the monthly cycle, you’ll see they’re both fairly low early in the cycle, and then estrogen starts to increase gradually, and then you should see a spike right around mid-cycle, which precedes the LH spike, and that indicates that ovulation has occurred, and then you’ll see the estrogen levels kind of taper off a little bit and then increase a little bit and then go down again in the second half of the cycle.  So that’s an optimal estrogen curve.  And then for progesterone, you’ll see it kind of stay low the first half of the cycle, and then as soon as ovulation happens, progesterone starts to go up and the corpus luteum is made, and then progesterone stays high — should stay high through most of the second half of the cycle and then drop along with estrogen right before menses begin again.

And what’s really incredible to me is now that I’ve seen so many of these cycling monthly hormone panels is how rare it is to see a woman who actually has a normal graph, you know, a normal estrogen and progesterone level in the way that it should look all the way through the cycle.  Now, you have to consider that the women that I see in my practice are dealing with health issues and oftentimes hormone issues, so it’s not a representative sample.  Surely there are a lot of women out there who have normal hormone levels, but what I mean is that for the women that I’m testing that are complaining of all of these symptoms that are related to their monthly cycle, it’s very common that something is off.

And there can be three possible problems, really, and they happen kind of in a sequential way, like from less serious to more serious.  So the first thing that tends to happen is that you’ll see progesterone levels dropping too early in the later part of the cycle, and that can cause all kinds of problems, like PMS, spotting, early bleeding.  It can cause longer periods.  It can cause headaches, all of the kind of typical signs of progesterone deficiency.  And you can actually even, like if a patient comes in and says:  Wow, I get these headaches every month.  And I say:  OK, do you chart your cycle?  Do you have any idea about that?  Oh, yeah, I do.  OK, so what day of your cycle?  Oh, well, geez.  Now that you mention it, it seems like they always happen on day 24 of my cycle or, you know, day 23.  And then we look at the chart, and sure enough, on day 23, you can see the progesterone levels dropping out.  So that’s the first problem.  That’s a problem of distribution, like the distribution of progesterone throughout the cycle is not optimal.

The second problem is one of production, and that means that not only is the distribution not right of the hormones through the cycle, the overall amount of hormone that’s being produced is low.  And that usually corresponds to some significant amount of hypothalamic-pituitary-adrenal stress or fatigue, which a lot of people refer to as adrenal fatigue, because keep in mind that the female hormones don’t just go out of balance for not reason; 7 or 8, 9 times out of 10, they usually go out of balance because something else has happened first, like the adrenals have gone out of whack.  Pregnenolone is the precursor hormone to all of the hormones in the body, and it can be either channeled into the DHEA pathway, which goes down to estrogen and testosterone, or it can be channeled into the progesterone pathway, which eventually goes to cortisol.  So if a woman is under a lot of stress, either emotional, psychological, or physiological stress, then what’s gonna happen is something called the pregnenolone steal, where an excessive amount of pregnenolone is stolen or diverted into the cortisol pathway to help support the stress response.  And there’s a lot less left over for sex hormone production and even for progesterone production.  So initially in that process progesterone levels will go up, but over time in that chronic stress response, progesterone levels will eventually go down; cortisol levels, which were high initially, will start to go down; and that whole system gets depleted.  And then over time, estrogen levels will also start to drop because of the pregnenolone steal.  So stage two, you have this problem with production, and it usually corresponds with the adrenal fatigue, so you really have to treat the adrenals along with the female hormones or it’s not gonna be a successful treatment.

And then the last stage is a timing issue, where ovulation is either not happening at all, it’s happening too early, or it’s happening too late.  So then that throws off the whole cycle, and of course, for women who are trying to get pregnant, that’s the really important part.  And there are things that we can do to push the ovulation forward if it’s happening too early, or move it back if it’s happening too late, or get it going again if it’s not happening at all.

All of this, though, depends on accurate testing, and I should say that in Chinese medicine, there are other ways of diagnosing these problems that use a completely different language, a completely different system of diagnosis, which involves reading the pulses and looking at the tongue, and I’ve seen that be very effective both in my own experience and in working with teachers and mentors when I was in school and things like that, and I do use herbal medicine still in treatment of hormone issues, but I prefer to use modern testing, partly because I work with patients over the phone, and it’s pretty hard to read their pulse and look at their tongue and do that kind of thing, but also partly because that’s just my bent.  I’m really more of a functional medicine practitioner than a Chinese medicine guy at this point.  So yeah, that’s what I would do.  Try to find someone that’s doing that kind of hormone profile.  I think it’s really important.  Unfortunately, it’s not as common as it should be, so you could maybe ask practitioners if you’re interviewing a practitioner whether they work with that kind of testing and what kind of treatment they use as a result.

Steve Wright:  So Chris, I want to get everyone crystal clear here.  If you’re a woman and you’re not experiencing regular periods, that’s a bad sign, right?

Chris Kresser:  I think that’s a normal part of female physiology and from an evolutionary perspective that that’s part of our developmental history, and I do think it’s normal, and I think it usually reflects some kind of hormone imbalance that’s not happening.  Obviously we’re talking about premenopausal women.  There’s a pretty wide difference in age in terms of when women enter menopause, and so we’re not really having a discussion about that.  We’re talking more about younger women who haven’t entered menopause that are not cycling normally.

Steve Wright:  Right, so if you’re not cycling normally, that’s a bad sign.  That’s definitely a sign that even though you’re doing your best to get your health under control that there’s something else you need to investigate.

Chris Kresser:  Yeah, I think so.  It’s a sign that more investigation is warranted, and particularly looking at adrenal hormones and sex hormones like estrogen and progesterone.

Steve Wright:  OK, so what about PMS symptoms?  What’s your take on that?

Chris Kresser:  That’s very often due to progesterone deficiency.  I mentioned those three stages that we see in the test, and the first stage is a distribution problem where progesterone drops out early in the cycle, or too early in the second phase, the luteal phase of the cycle.  And that is very often caused by progesterone deficiency, in my experience.  I mean, there are other potential causes, but that’s the first thing to look for.

Steve Wright:  OK, and I’m just trying to get a little more specific here, because I think a lot of people that I talk with, they’re not really sure what optimal is or how life could be, such as having a regular cycle and not having PMS problems.

Chris Kresser:  Yeah.

Steve Wright:  So I just wanted to hear from you to just kind of clarify that.

Chris Kresser:  It is possible not to have PMS.  That’s, I know, difficult to believe for some women, and it’s kind of part of the cultural — you know, we all grow up hearing about it as being almost kind of a normal thing, and I have a lot of women that I treat that don’t have PMS even to begin with, and then I have women that have come to me with PMS as their main complaint and that then after treatment don’t have PMS.  So yeah, just to make that clear, strong PMS symptoms are usually a sign that something’s out of balance.

Steve Wright:  Awesome.  Thanks for clearing that up.  OK, you got time for one more, Chris?

Chris Kresser:  Yeah, we can do one more.

Healthy methods of birth control

Steve Wright:  OK, well, let’s wrap this one up for the ladies.  A ton of questions come in about what is the best method of birth control.

Chris Kresser:  Yeah, well, the first thing I want to say is that as a man, I’m probably not ideally qualified to answer this question.  I recognize there are a lot of considerations that go into this, many of which I’m not personally familiar with because I have a different body with different –

Steve Wright:  Anatomy.

Chris Kresser:  Yeah, exactly!  And so, I just want to be sensitive to that, but I’ll just give you a few considerations of things to think about.  Number one, as I said with the Pap screen testing, this is really personal, obviously.  It depends on so many variables.  For example, are you using birth control for protection against an STD?  Are you using it for contraception?  Are you using it because you have really irregular cycles or painful periods?  I mean, there are so many different reasons that women take birth control.  So the answer to what’s the best form of birth control completely depends on what the goals are, because different goals will lead to different answers, right?  Planned Parenthood has a pretty extensive questionnaire that’s designed to help women choose what the best form of birth control is based on their preferences and their goals, like are they using it for STD protection or for contraception.

If someone asks me from a purely health perspective, you know, without taking all of those other things into account, which is, I realize, kind of ridiculous, but from a purely health perspective, the fertility awareness method is the best, which is a woman charting her cycle, measuring her basal body temperature, measuring her cervical mucus to determine when she’s ovulating, and then avoiding intercourse within a few days before ovulation and a few days after ovulation.  But of course, this method is far from fool-proof as a method of contraception, and it’s best used by people who could live with getting pregnant, you know, people for whom getting pregnant wouldn’t be a terrible thing or the end of the world, maybe a couple that is not planning on getting pregnant, but if they got pregnant, they would welcome the conception.

Of the other methods that are safer from a contraceptive standpoint, the cervical cap or the diaphragm might be the safest from a health perspective after the fertility awareness method along with the man wearing a condom, and those could be with or without spermicide.  And then there’s the copper IUD, which has a success, well, about 6 in 1000 women who use that become pregnant in the first year of using it, so pretty good odds, but I’m sure most women know that there’s always a chance with most forms of contraception of it not working.

So, I would love to hear from women out there and maybe women who have a particular expertise in this subject area.  Maybe you could post something on my Facebook page or on Twitter or submit an email through the contact form of my website.  This is something I’d like to learn more about, so if you have any wisdom to share on this topic, I’d be happy to hear it.

Steve Wright:  And I’m sure we’ll be all happy to learn about whatever your expertise is, and I know nothing, so I just default to Chris.

Chris Kresser:  Haha, well, I know a little bit more, but still I definitely don’t consider myself to be an expert in that area.  All right, I think that’s where we’re gonna stop.  It’s a nice sunny day out there.  I’m gonna go lie in the sun and get some vitamin D and rest a little bit.

Steve Wright:  All right, great.  Well, I hope that the rest of the family gets well soon and you can get some rest, and we’ll be talking again soon for our next episode.

Chris Kresser:  Sounds good.

Steve Wright:  We want to thank you for listening today.  Please keep sending us your questions at ChrisKresser.com using the podcast submission link.  If you enjoyed the show, please head over to iTunes and leave us a review.  It helps get the word out and spread the show to others who might be helped by it.

 

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  1. Joyce says

    Great info Chris. I really respect the way that you look at a health issue from the big picture and all angles, and then work to more specifics. It shows that you really do your homework and take your responsibilities seriously. It’s clear that you do not employ a blanket”approach to health care, but are sensitive to the individual needs of your patients.
    Keep up the excellent work!

  2. says

    Thanks so much for tackling the birth control question. Personally, I have never put a contraceptive chemical into my body. I am new to the whole Paleo / Primal thing, but after living with lots of girl friends who went from not contracepting to contracepting (the pill, that is), watching them go from “normal” people to a psychotic, hormonal messes, I just decided to opt out of that. However, my husband and I use Fertility Awareness (with use the Sympto-thermal method of NFP). I took Natural Family Planning classes and started charting about 6 months before we were married and we used it for about four months until we decided to “see what happened” if we didn’t chart for a month. Our son, Dominic, was conceived that very month!

    Anyway, we have now been having to use NFP to prevent pregnancy because I had an unplanned c-section and we have to wait a certain period of time to conceive again in order to be eligible for a VBAC (we’d like to have a gaggle of children, so 5+ c-sections doesn’t seem very fun to me). We have been successfully avoiding conception through abstaining from intercourse for the last 9 months. After charting for over a year (total) it’s almost a no-brainer anymore when I am getting ready to ovulate and when I have ovulated. About 13 of our friend couples went through Natural Family Planning courses the same year we did and many of the women have extremely irregular cycles, infertility, PCOS, etc., but because they became aware of their cycles rather than masking the symptoms, they were able to work with their bodies, their doctors, and in some cases with NaPro Technologies (if you have never encountered NaPro, you should really check them out, their fertility rate for couples experiencing infertility is about 60%-80%, as opposed to the 1 in 5 of IVF, plus no synthetic chemical treatments) to determine their problem and work towards healing/conception. Fertility Awareness was the absolute best thing they could have chosen!

    I still look back at our decision to use Fertility Awareness and am so utterly thankful that I didn’t once put those chemicals into my body! The World Health Organization lists a few different types of Estrogen/Progesterone therapies as class one carcinogens. I would be interested in hearing what you think about this, because people tend to just dismiss that HUGE W.H.O. study whenever I mention it.

    Thanks again for dedicating this podcast to women’s health!!

  3. says

    Hey Chris,
    Thank you so much for this podcast! I don’t feel so alone with my female problems. I have been paleo based for almost a year now. Prior to changing my lifestyle I had a lot of acne and GI problems. With in a few weeks of eating right my acne was clearing up as well as my GI problems. I am definitely intolerant to gluten/gluten-like foods and dairy (except butter).
    Unfortunately, the months following the change resulted in wacky periods (late, lots of spotting, many days of bleeding/spotting). Then I started following your Healthy Baby Code and started taking the Pure encapsulations nutrient 950 with vit. k. Still working on getting more bone broth and making my own kombucha. I noticed a big change in my periods. They are a lot healthier.
    The only problem is, is that my acne has come back and has not disappeared for almost 6 months now! I also made changes to laundry detergent, dish soap, shampoos, lotions, and face wash. Free of any parabens, sls, sulfates, gluten etc. I get enough sleep and stress is minimal. Try to meditate often. Exercise is minimal.
    If any one out there is going through or has gone through this same scenario, what did you do? I also recently had a miscarriage at 3 weeks a few months ago when I came down with some virus going around.
    Getting my micronutrient levels and my hormone levels (day 21) checked right now from my obgyn (who is paleo based).
    Any advice would be greatly appreciated.

    • says

      First, I apologize for the lengthy post. Wanted to write an update on the issue that I posted. Just in case any one else may have a similar situation. My micronutrient levels showed that I am deficient in B5 (Pantothenate) and Biotin, my other B vitamins are not great but not horrible. Also, my progesterone and DHEA are super low (1.2L and .02L).
      Prognosis: inflammed GI preventing proper absorption of B vitamins, esp. B5. My lack of B5 is causing all sorts of problems for my menstrual cycle e.g. low progesterone/DHEA. It is also causing adrenal fatigue.
      Plan of action: FODMAPS diet and supplementation of B5. Increasing my probiotics. Getting a stool sample tested for pathogens to rule it out.
      The low progesterone levels do not allow my body to carry a child. Reason for miscarriage.

      Thank you Chris for all of your articles and advice. I knew something was going on with my body and was guessing it was due to a GI problem. With the help of you, my nutrition background (BS/MS in Nutrition), and a real doctor I am hopeful that I can eventually solve my issues and have a baby. I am only 28 years old and never thought I would ever have this many problems. I now have some hope that it can all be turned around.
      Found my doctor through the paleo physician network: She is located in Bellaire, TX just right outside of Houston. Her name is Dr. Ginsberg. She believes that majority of hormone issues are due to GI problems. They also follow your Healthy Baby Code. Again, apologize for the long post.

  4. Maeve says

    I’m surprised you didn’t mention CONDOMS FOR MEN. From a perspective of protection from STD’s, including HPV strains, herpes, and AIDS, this is the gold standard. It has a 98% success rate in preventing pregnancy. It also does not leave a mess inside a woman. Women are not just sperm receptices, something men can flush into and forget about it, and this includes husbands too! The copper IUD’s have caused problems for women. If men want to have sex with women, they should not expect her to put her body or fertility at risk. I saw nothing about the men taking responsibility, and a cavalier attitude to women getting pregnant. I hope with your glorified rhythm method you espoused, that you support a woman’s choice to have an abortion if she gets pregnant.

    • Anna says

      NFP is not a “glorified rhythm method”. Do you have any knowledge about it? Many women including myself use it to prevent pregnancy. I have done so for over 15 years. Certainly there are caveats and it is not for everyone (e.g. if you are forgetful, have irregular cycles, etc.) But it is a perfectly legitimate form of birth control and there is no reason to lump it into the same category as the rhythm method, which is not birth control at all and I don’t think anyone has recommended for decades now. Chris is recommending NFP “from a purely health perspective”. And I agree. It does not alter hormone levels and it keeps you highly aware of where you are in your cycle. It also enables you to plan conception if and when you wish to do so.

      That said, if none of this is your cup of tea, I do agree that condoms are a worthwhile option, or complement for use during fertile days.

  5. courtney says

    Thanks Chris. How much pregnenolone do you normally recommend? and is that something you would only take during certain times of the cycle or for the entire month?

  6. Laura says

    Hi Chris,
    My husband and I are recent followers of your blog and podcast. (We found you through Robb Wolf.)

    Just a quick comment in response to this statement:

    But of course, this method is far from fool-proof as a method of contraception, and it’s best used by people who could live with getting pregnant, you know, people for whom getting pregnant wouldn’t be a terrible thing or the end of the world, maybe a couple that is not planning on getting pregnant, but if they got pregnant, they would welcome the conception.

    Are you familiar with the work of Dr. Thomas Hilgers at the Pope Paul VI institute? The Creighton model of NFP (natural family planning) is over 98% effective which is actually better than most artificial means of contraception. And of course, as you mentioned, it is also far safer for a woman to use. It does take some learning.

    Here is a paper I found using a simple google search (sorry for the long link)
    http://epublications.marquette.edu/cgi/viewcontent.cgi?article=1015&context=nursing_fac&sei-redir=1&referer=http%3A%2F%2Fwww.google.com%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3Dsuccess%2520rate%2520of%2520the%2520creighton%2520model%2520to%2520avoid%2520pregnancy%26source%3Dweb%26cd%3D1%26ved%3D0CC8QFjAA%26url%3Dhttp%253A%252F%252Fepublications.marquette.edu%252Fcgi%252Fviewcontent.cgi%253Farticle%253D1015%2526context%253Dnursing_fac%26ei%3DFidbUNrwHY-70AH4noGYDQ%26usg%3DAFQjCNEshgXCd4msWB6YcFekBeIP6uVnMw%26sig2%3DqQfmqRA3YxhXCL4_lJJRSw#search=%22success%20rate%20creighton%20model%20avoid%20pregnancy%22

    The paper states:
    If the couple was using the Creighton model to avoid pregnancy and knowingly had genital intercourse on a fertile day and the female partner became pregnant, the pregnancy would be classified as achieving-related. With the Creighton model, each couple is informed at the introductory session (with reinforcement at the follow-up sessions) that both partners will know on a given day whether the woman is fertile and that if they choose to have intercourse on that day, they have abandoned the model as a method of avoiding pregnancy and adopted it as a method of achieving pregnancy. Thus, the achieving-related classification is based on the objective behavior of the couple and not on subjective considerations of whether or not a pregnancy is wanted.

    Anyway… curious if you’ve ever heard of Dr. Hilgers, Pope Paul VI institute and NaproTechnology?

    Thanks for all you do!
    Laura

  7. says

    Hi Chris,
    When you addressed the diagnosis of Bacterial Vaginitis, nothing was said about urinary tract infections as your headline proclaimed. Your information was very good about BV but what about UTI’s which are almost always caused by e-coli? I am not now pregnant but the best remedy I have found for myself and many many thousands of women have discovered, is a simple sugar found in D-MANNOSE. It is not even absorbed into the bloodstream so it is presumably safe for even diabetic patients. It is a great preventative – I am one among many many who have never gotten another UTI while taking D-Mannose. Please check it out and I hope you will recommend it to your readers!

  8. Jennie says

    Thanks for advocating for women to learn more about their hormones, Chris! The Fertility Awareness Method helped clue me in that my irregular cycles are caused by my body trying to ovulate but not quite getting there. I use natural progesterone oil to give my body that extra surge of progesterone it needs. Right after I started using it, I had a regular cycle and we conceived our first child! And since my cycles returned after her birth, they’ve been pretty regular with the use of the oil.

  9. Patty says

    I had success using the oral probiotic, femdolphilus, for BV.

    At the time of the BV diagnosis, I was diagnosed with IBD (which was triggered by NSAID use). I had a very messed up gut. I began eating the Specific Carbohydrate Diet and couldn’t use femdolphilus since some of the ingredients were not “SCD legal”. So I used rephresh (oral suppository) and had great success with that approach. Once a minimal short course of Entocort was stopped and cleared out of my system, SCD later “balanced” the gut, no more BV!

  10. kate says

    “The evidence so far does not show that the digital images are more helpful in finding cancer than the analog/film images,” the FDA stated in a press release after approving the system. I rely on bcaction.org for impartial information and highly recommend this site. So many health nonprofits have directors with direct interests in pharmceutical and diagnostic industries, it seems.

  11. Marisa H says

    How would you advise treating the adrenal issues for women with hormone problems resulting from those, if the stressor is gone and the woman has addressed sleep and stress issues, but a period has not returned?

  12. Nicole says

    I recommend the lady-comp fertility monitor for birth control. If used properly the study they did say its 99.1% effective. Which is MORE effective then condoms, and slightly less than the pill. It is completely natural but there will be days you will need to use other methods.

  13. Sally says

    My husband and I have been married for three years and have been using the Creighton model of Natural Family planning all that time. It has helped us successfully achieve and avoid pregnancy. Sure it is a bit more work than taking a pill everyday or slapping on a condom, but it is much healthier for my body and for our marriage. It really only takes a few minutes a day to chart and monitor my fertility. I am one of those women you noted above who had low progesterone at the end of her cycle resulting in PMS and a very short luteal phase. If we hadn’t been charting I would not have been able to get pregnant or would have miscarried repeatedly before I knew what the problem was. I encourage anyone to check the Creighton model out! My husband was totally wary of whether it would be effective until we became more educated about it, and now he is totally on board.

      • Sally says

        Hi Britt – we used natural progesterone pills to increase my progesterone levels – specifically prometrium. I took them every cycle after ovulation had occurred – which I could know because of using the Creighton system and charting.

        • Patty says

          I was prescribed compounded progesterone troches (disks that dissolve under the tongue) when progesterone levels were found to be low during early term bleeding. I was prescribed the troches for 3 successful deliveries. I now know there is a risk of hypospadias with use of progesterone. One of my pregnancies did have this, although minor, so we had the option of correcting this surgically… more for cosmetic concerns. (Monica Lewinsky revealed that Bill Clinton had this condition.)

          • Sally says

            Hmm my doctor told me there were not really any risks with natural progesterone if taken through the first trimester. I know there can be risks associated with synthetic progesterone. I will have to ask about this. However, a small risk of a side effect would still be much better than suffering a miscarriage due to low progesterone levels to me. Interesting.

  14. Bria says

    I would like to comment on your discussion of Fertility Awareness, as you have called it “far from fool proof.” I have personally used the sympto-thermal method of Natural Family Planning for many years to avoid pregnancy. It’s regularly mistaken for the outdated and ineffective “rhythm method” that was taught in the past, but the method that is taught today is just as (or more) effective as birth control pills at avoiding pregnancy. A woman monitors what her body is doing from day to day, so if something does happen that changes when she ovulates, she knows right away and can act accordingly to either avoid or achieve a pregnancy. I love the method because it works with my body, rather than using hormones to change the way my body works. As a woman, it’s very empowering to understand how my body’s fertility cycle is working and know where in the cycle I am from day to day. As a woman, I encourage all my friends to learn some form of Fertility Awareness because of the empowerment it brings. And when I decide that I want to get pregnant again, there is no “waiting period” to come off the hormones of birth control pills or IUDs. My son was conceived in the first cycle of trying to get pregnant. Of course, there is a learning curve, and the first three or so cycles I felt a bit unsure of the method. Now that I have practice, charting is second-nature to me and I only have to think of it for a few minutes every day. Everything is written on a chart, so it’s easy to look and see where I am in my cycle. “Natural Family Planning” is a general umbrella term that includes many different methods of fertility awareness: sympto-thermal, Creighton, and Billings methods are a few of them. With proper instruction, they are all very effective. And instruction is inexpensive: in many cases it is even covered by health insurance.

  15. Tree says

    You didn’t mention withdrawal. It is proven to be almost as effective as condoms when used right. This means that the man withdraws every time before ejaculation. There are no sperm in the precum if the man has urinated after the last ejaculation. So if a man knows his body well and can control himself it is a good method (and it can be even part of the play between lovers). I personally think that a combination of fertility awareness for the woman, withdrawal and condoms for the man is the best. And there is no need to abstain from intercourse during the ‘dangerous’ days. The couple can use a condom and/or the man pull out. I personally don’t feel safe enough if it’s my fertile time and the man ejaculates inside even wearing a condom so at that time of the month the vaginal intercourse is always with a condom and the man ejaculates outside (after all, condoms are effective in only 98% of the cases and withdrawal – 96%). I’m sure withdrawal is one of the most used methods but people usually don’t admit it.

  16. says

    Hi Chris,

    After giving birth to my daughter 2.5 years ago, I decided to go for the Paragaurd After a lot of research, I felt like that was the most natural option available to me. I knew a lot of people that kept up with cycle charting, and was aware that was the healthiest way to go- but I gave birth to my daughter 6 weeks early, and my health wasn’t the best. Anyhow, it immediately gave me debilitating cramps. They were almost intolerable. Every time I had a bowel movement, I would get a sharp pain in my lower pelvic region. Then about 6 months later, I got a really bad case of BV- which I had never (knowingly) had before. I used a homeopathic remedy that cleared it up pretty quickly. Anyway, I assumed it was because of the Paragaurd so I had it removed. The cramps disappeared, the pain during bowel movements disappeared, and I even lost some weight. My husband and I are currently using cycle beads, and it’s prevented pregnancy for over a year. I know it’s not dependable in the long term, but it’s thee most accessible option right now. My husband says after we have another one, he’s getting a vasectomy. What are the health risks there? Does that affect male hormones? It seems like it would.

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