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

Lisa Hendrickson: [00:00:00] Periods weren't really looked at as a good thing. My whole argument is that we should be considering the menstrual cycle as a vital sign, and instead of thinking of it like there's something wrong with me, my body's broken, it flips to, okay, what is my body trying to tell me? And what happens if I start to listen to that?

Medicine hasn't necessarily studied the female body enough to really know it. We've only scratched the surface in terms of women's health. 

Dr. Brighten: Doctors tell women they can get pregnant 

Lisa Hendrickson: anytime in the months. What's the truth? For the majority of the cycle, women can't conceive because the cervix is actually closed, and the cervical mucus, like I said, acts as this gate and outside of that window, not only is the cervix closed, but the vagina itself is acidic.

Dr. Brighten: The myth of you can get pregnant any day of the month becomes the heartache of Why can't I get pregnant? 

Narrator: Lisa Hendrickson Jack is transforming how we understand women's health, showing that the menstrual cycle is a vital sign, not just about fertility. 

Narrator 2: A fertility awareness educator, bestselling author, and host of the [00:01:00] Fertility Friday podcast, with over 4 million downloads, she helps women decode their cycles and reclaim their health.

Dr. Brighten: You've been called anti-feminist because you question the pill. How do you respond to that? 

Lisa Hendrickson: Whenever I talk about the pill, I'm always clear that I'm not wanting people not to have access to anything. What I'm trying to do is allow women to make informed choices, and so while the pill was certainly positioned as this ticket to freedom, it certainly wasn't without.

Dr. Brighten: Welcome to the Dr. Brighton Show, where we burn the BS in women's health to the ground. I'm your host, Dr. Jolene Brighton, and if you've ever been dismissed, told your symptoms are normal or just in your head or been told just to deal with it, this show is for you. And if while listening to this, you decide you like this kind of content, I invite you to head over to dr brighton.com where you'll find free guides, twice weekly podcast releases, and a ton of resources to support you on your journey.

Let's dive in. Doctors [00:02:00] tell women they can get pregnant anytime in the months. What's the truth? 

Lisa Hendrickson: Well, the truth is definitely not that. What the research tells us is that a woman can get pregnant for about six days per cycle. And when we look at that, those would be the five days leading up to ovulation plus ovulation day itself.

So who can get pregnant every day or know who, I guess I could flip that question and say, in men are the ones who are fertile every single day from puberty forward. Let's like, you know, really 

Dr. Brighten: weed this out for people because sperm that lives for five days, women can't in fact actually get pregnant six days outta the month.

What is the truth around conception? Because I feel like the myth of you can get pregnant any day of the month becomes the heartache of why can't I get pregnant? 

Lisa Hendrickson: Well, so when I, when we talk about the fertile window, I think the difference is the, the language that I use. So you're right, women can't actually get pregnant six days of the cycle.

There's one day of the cycle, and that [00:03:00] would be ovulation day. But what happens is we produce cervical fluid for those five days leading up to ovulation, and that extends the fertile window. And when we hear that sperm can survive for up to five days, it's not like that can just happen at any point in the cycle.

It's really only during those days that we're producing cervical fluid. So truthfully, it's a six day fertile window. If we have sex on one of those days, the cervical mucus present could keep the sperm alive for up to five days. And then that would lead us to ovulation day, which is really truly the day that pregnancy could occur.

Dr. Brighten: So to just make sure everyone understands this, the sperm who are loitering just hanging out, it's only because the female anatomy and physiology has allowed for that during the fertile window. Outside of that, the, the cervical mucus is not there. The hormones are not optimized to actually support sperm being present for five plus days.

Lisa Hendrickson: Well, yeah, absolutely. And really what we have is, um, we have a, there's cervical mucus [00:04:00] has been referred to as nature's gate. It's, um, been referred to, I mean, I like silly analogies, so I talk about it like the bouncer in front of the club or something like that. And the cervix itself, when we track our cycle, we can track when it's open, when it's closed based on the change of sensation.

So for the majority of the cycle, women can't conceive because the cervix is actually closed. 

Dr. Brighten: Mm-hmm. 

Lisa Hendrickson: And the cervical mucus, like I said, acts as this plug, as this gate that determines whether or not the sperm can enter or not. So during that six day fertel window, that would be when the bouncer is effectively off duty.

And that's the only time when the sperm can actually get in and outside of that window, not only is the cervix closed, not only is it filled with a thick mucus plug, but the vagina itself is acidic. The um, G type cervical mucus, that's the technical term for the mucus plug is also acidic, and so that environment kills sperm within minutes or maybe hours.

Whole blooded vagina. I 

Dr. Brighten: know right Now, [00:05:00] here's the thing on the internet, everyone swears. You can get pregnant on your period. If you have sex on your period, you can get pregnant. What is the truth around this? 

Lisa Hendrickson: So I feel like the infuriating answer, and this is one of the topics that I share in my programs, is a yes and no.

So let me break that down. So, um, typically a woman isn't going to be ovulating when she's actively bleeding, but what can happen is if she's having a short cycle and she wouldn't have a heads up that that's happening, what can happen is when her active bleeding stage is done, and she's kind of in the last couple days, lighter bleeding, there could actually be cervical mucus present on those days.

So when you hear someone who said, I got pregnant on my period, it's possible that they had sex on one of those days where the cervical mucus was present, but they were also bleeding. So they wouldn't have necessarily checked and maybe they don't even track their cycles so they wouldn't even know.

Mm-hmm. And that cervical mucus can keep the sperm alive for up to five days. So in the event of an early ovulation, it is actually [00:06:00] possible, but it doesn't mean she quote, got pregnant on her period. 

Dr. Brighten: Yes. I think that's really important for people to understand. 'cause I, I will often explain this like, yeah, you weren't pregnant when you were bleeding.

There's this whole process of egg meets sperm, there's a traveling little dividing bowl of cells, there's implantation, like, there's so many days that are happening between that. But I think it is important to understand, and especially as you just said. This, we see a lot in perimenopause. So the periods start to kind of drag on.

They're like, okay, what's happening? I've got trickle for like three days. And ovulation can start to move and it can be hit or miss. And so while, you know, typically you're not gonna fall pregnant on day one, two of your period, if you have sex, then there is a possibility just depending on these other variables, is what I'm hearing.

Where does ovulation fall and what does your period actually look like? Right? Because we're still considering it a period as women when we're, we're like still spotting and it's like day six, we're like, oh, that's a [00:07:00] period. But the shifts in estrogen. And that's the thing. I think people, they, you know, we talk about, um.

You know, these different phases of the menstrual cycle and people to understand that, uh, the whole agenda is get that egg ready as soon as possible. And the ovaries don't care what the uterus is doing. They have their own agenda. 

Lisa Hendrickson: Well, and I feel like that what you, you know, what you pointed out with the changes that can happen in perimenopause, I mean, that can have implications for women who are trying to conceive as well as trying to avoid.

Mm-hmm. So, you know, one of the characteristic changes that happen as women get into those earlier years of the last 10 years before their, their men, um, before menopause, before their last period is obviously that the cycles can shorten. Mm-hmm. So while in reproductive life, the average cycle's about 29 days or so during that period of time, especially during the first five years of that last 10 years, before the final period, the average cycle could even shift to like 26 days.

Yeah. Meaning earlier ovulation. So if you're trying to avoid pregnancy, like you said, and you are having [00:08:00] sex on your period thinking it's fine, that's a problem. So it's really important to start to understand, uh, to check for cervical mucus to, to, to track when ovulation is happening. And I think the most important thing is to get out of what I like to call the rhythm method thinking.

Mm-hmm. Which is where we kind of assume that our cycles, well, you know, we kind of assume our cycles are always gonna be 28 days with ovulation on four, day 14 as the, the standard, but we also kind of assume that our cycles are gonna continue to be how they were. And so for anyone who does track their cycles, let's say over like a 12 month period, you'll notice that you will have at least one cycle that's a lot shorter and maybe one cycle that's a little bit longer, but you don't know when that's gonna happen.

So for women who are in that stage, if you're avoiding pregnancy, you really wanna be vigilant and not have sex. Um, you know, beyond those early days, there's a more, there's a whole lot more to that, but I'll just leave it at that for now. And if you're trying to conceive, the key is not to think about day 14 or not to assume that ovulation is always just gonna be like it always was.

Mm-hmm. [00:09:00] And if you see cervical mucus, even if it's like day five, or even if it's like day six, instead of thinking, oh, it's too early, you actually go with what you're seeing versus what you think. 

Dr. Brighten: Mm-hmm. What do you think is the most common fertility sign 

Lisa Hendrickson: that women miss? Well, I definitely think it's, it's mucus.

Yeah. I think part of it is because most of us don't even know what it is. Like I can remember when I was, uh, a teenager, you know, I think it was before men A, I started to see mucus, but now I know it's mucus. Yeah. But you know, I didn't know that before. And I remember asking my mom and she just gave me panty liners, and that was kind of the end of the story.

So I think cervical mucus, a lot of us don't know what it is. We hear the word discharge. Some of us might assume that there's something wrong. Um, but really and truly, we're not really being taught a lot about our bodies. So we're relying on whether it's ovulation strips or whether it's even just mm-hmm.

The idea that ovulation is happening on day 14 and ignoring the mucus. Men 

Dr. Brighten: get ejaculate, they get semen, they get, you know, all these names. Why do we get just mucus? [00:10:00] Think about I am just like, let me clear my throat, let me blow my nose. Like that's mucus. How, how did that term even come up? 

Lisa Hendrickson: So I mean I think that the reason, 'cause I know a lot of people don't like that term.

Mm-hmm. I mean, I've been in the field for like a really long time and a lot of people are more comfortable with fluid and things like that. But from a scientific standpoint, that's what it is. We have mucus membranes in our cervical crips mm-hmm. In our cervix. And so the correct scientific term is mucus.

And interestingly the, the mucus in our cervical crips kind of behaves like some of the mucus in our other mucus membranes. So for example, if you have allergies and you take antihistamines to kind of dry up the mucus flow, it'll also dry up your cervical mucus. So while we don't always love that term, it is, I think, accurate.

Dr. Brighten: Yeah. Well I appreciate you breaking that down because I was already foreseeing that was gonna be the top comment we got was why are you calling the mucus because it's coming from the mucus membrane. 

Lisa Hendrickson: Well, and when we jump into the weeds and actually track [00:11:00] it and, you know, test for it and pick it up and try to, you know, classify it, it kind of looks like it's not.

Can I say that? Yeah. I mean, 

Dr. Brighten: no, you're not wrong. You're not wrong. And you know, you're right. A lot of women are not taught about this. I mean, I've had patients who come off the pill and it's one of the most shocking things when they start ovulating again because they haven't. They, some of them haven't ovulated in 30 years and then they're like, what is this?

Is my vagina thick? What is happening? And it is like, no, no, no, actually that's really healthy. That's a great sign That points to great estrogen and that your body's performing the way that it should. Why do you think we're not taught the basics of fertility in school? 

Lisa Hendrickson: You know, I was thinking, I've been thinking about this for a long time.

I don't think there's one simple answer. I feel like there's a lot of different pieces. I mean, one, if you think about high school, junior high, your homeroom teacher obviously doesn't have an ex expertise or background in fertility. So I think one practical reason is just that, you know, those who were teaching us sex [00:12:00] ed or whatever the case is, they just didn't know.

I think there's bigger reasons than that because if we look at professional training programs, if we look at medical schools, they're not trained in the intricacies of cervical. Because from this perspective, so I'm coming at this from the perspective of a fertility awareness educator. Um, and for example, in chapter three of my first book, the fifth Vital Sign, it went to all this detail about cervical fluid, the different types of Crips that produce, the different types of mucus and how it's been studied under the microscope and the different aspects of it.

And I've consistently been told by medical professionals, like that's not something that we learn in school. Mm-hmm. So, you know, while you're getting some basic information, it's absent from. The medical school curriculum. So how possibly could we have learned it in school? 

Dr. Brighten: Mm-hmm. You are so right. And I don't think people really understand how much is absent from a, a general OB training.

And it's something that I've been really thinking about this over this last year, and I just think it's time [00:13:00] for subspecialties. I think we're expecting OB GYNs to do too much, and that is part of why women hate their doctors. And it makes me so sad because, you know, I've talked with, especially like in the endometriosis world and the PCOS world, like great gynecologists in those areas have gone above and beyond like decades more training themselves, funding it all themselves to figure this out to serve women.

And they're like, it's not that my colleagues don't care, it's just that they didn't get the education and they think that their solutions might actually help when in fact they don't. And I think that we need to start reframing and looking at like, we've got a big systemic issue. Like gynecologists should absolutely understand the basics of the menstrual cycle and how ovulation all of that works because they're the first stop that women go through too when they're having trouble getting pregnant.

Often the referral becomes the reproductive endocrinologist at that point. And what we know about the reproductive endocrinologist is that if they're [00:14:00] working in one of the majority of clinics that are owned by private equity, the goal is cycles IVF cycles, IVF cycles. Not like when are you doing the deed it kind of conversation.

So I think that's, you know, part of why this podcast in particular is so important and firm. Yeah, I wanna say thank you for coming and being willing to educate women because this is the information everyone should have gotten about their body, but they didn't. You mentioned, you titled your book The Fifth Vital Sign.

This was your first book. Why did you choose that name? 

Lisa Hendrickson: Well, I chose that name because my whole argument is that we should be considering the menstrual cycle as a vital sign because when we learn about the menstrual cycle and when we track it in a very specific specialized way, we can see that it responds in real time to various changes in health.

Similar to any of the other vital signs that we are familiar with. Things like body, uh, temperature, things like respiratory rate. When you actually track the cycle, if a woman's experiencing stress or if she does experience some [00:15:00] sort of a, a health issue, if she has, you know, insulin resistance, like as a case with PCOS or if she loses her cycle entirely, as is the case with ha as a severe response to, you know, stress and undereating.

We see those changes in real time in the cycle. And on the flip side, if you are working with someone who is experiencing hormone imbalances and you start to work on the foundations, you can see whether or not it's working in real time as well. Mm-hmm. So it's, you know, as someone who has been doing this, and that's my focus, I can't imagine working with women without that information.

And so I feel like that is a big part of that message of, of the book to really get people to start thinking about it. And I would say another aspect of it too is that. At least when I was growing up, and I'm sure you can relate, periods weren't really looked at as a good thing. Mm-hmm. A lot of us have a really negative experience.

What was it, 2015 was the year of the period. Was that when 

Dr. Brighten: it was, I think that it was 2015. You and I were online. Yeah. We were running our mouths about it. Yeah. 

Lisa Hendrickson: But that was kind of the first time people were talking about it. [00:16:00] Yeah. In a certain kind of way. But if you really look at what people are saying, like go to Twitter, go to social media, see what people are saying about it.

Mm-hmm. You know, a lot of women have a lot of negative experiences with their cycles. They don't have the information that they need to improve it. And so part of looking at it as a vital sign is also starting to kind of rebrand it or actually acknowledge. Mm-hmm. Its importance. And instead of looking at it as just this annoying thing that I can just take the pill and suppress forever and then worry about kids later, to actually understand that it's always giving you information about your body.

And when we look at it that way, it changes everything. And it helps us, I think, to appreciate our, our bodies more. And even to pay more attention to, you know, when things aren't going right and instead of thinking of it like, there's something wrong with me, my body's broken. It flips to, okay, what is my body trying to tell me?

And what happens if I start to listen to that? 

Dr. Brighten: Yeah. I just wanna mention, 'cause you said ha for people who are listening, that's hypothalamic amenorrhea and what you were referencing is the high stress [00:17:00] shuts down ovulation. But I wanna ask you, what's the biggest cost of not understanding our cycle? 

Lisa Hendrickson: The biggest cost?

That's a tough one because I mean, I, I, I can think of a lot of different, you know, negatives. Um, in, in some ways I think the biggest cost is that we're detached from our bodies. Mm-hmm. And we stop listening and paying attention to what's happening, and we become susceptible, I would say, to medical gaslighting.

So, for example, if you are experiencing something in your body and you know that that's what you're experiencing, but your doctor kind of dismisses it, or, you know, whatever they're doing, they're not listening to it for sure, then you're more likely to listen to them and believe them and distrust what's going on in your, in your body.

So what I've seen is that when you actually pay attention, when you recognize that your cycle is a vital sign, when you actually start to realize that, wait a minute, that spotting isn't just normal. Yeah. Wait a minute. That pain isn't just normal. I mean, you wrote a whole book on that. Right? But when [00:18:00] you realize that, wait a minute, like irregular cycles aren't just.

Normal or in inconsequential, it's actually related to specific markers of health that have been studied. And it, you know, when you know that you can actually do something about it, I feel like when you have that information, then all of a sudden you are empowered. And even if you have a negative experience with a health professional, you already know what's going on in your body and that empowers you to keep searching until you find the right answer, until you find someone who's actually gonna listen to you.

Dr. Brighten: I love that. I think that is such great advice because one of the best ways not to be gaslit is to know your truth. And I think that, you know, how you teach about charting your cycle and having all that data, your doctor should be invested in that data because it says so much about your body, but it also makes it really hard to gaslight you when they say, oh no.

Like, you're probably imagining that. I mean, I went through that when I came off the pill, lost my period, and my doctor was like, no, you probably always had a [00:19:00] regular period. And I was like, oh, hell no. I didn't know I had endometriosis at the time, but I did count down. I remember being 14 and being like X on the calendar, like hate my life, like being, you know, 14 moody and really dramatic about my period.

Um, my period was being dramatic though, so I think in the energy match, but, you know, I remember the him saying that to me and I was like, mm-hmm Mm. Like I know for a fact this has never been my body. And I think that this happens so often to us and charting that data. Is super, super important. So I wanna play a game here.

Um, and for everybody listening, you can go to YouTube, leave us a comment, I'm gonna pick a winner from that, we're gonna have some prizes for you. So we're gonna play two truths and a lie, and Lisa's gonna unpack this for us. So, okay, first statement, you can get pregnant while breastfeeding. Fertility awareness is effective as the pill when done correctly.

And the third one is ovulation always happens on day 14. [00:20:00] So everyone listening, we're gonna give you a minute to go right in your answers. And while they're doing that, I wanna ask you, most medical providers say fertility awareness doesn't work. What do you say to that? 

Lisa Hendrickson: Well, obviously I say that that's not true.

Mm-hmm. Um, I mean, I think it's, it's a big topic though, because when we say the word fertility awareness, we kind of think it means one thing and that everybody agrees on what that means. And when we actually look at the research and science that has been done in this area, we have the term fertility awareness based methods, which is an umbrella term for a variety of different ways to do this.

Mm-hmm. So some methods would look at mucus only. Some methods might look at temperature only. Some methods might combine the mucus in the temperature, and some methods might include a specific last and fertility day calculation. And so what we have when we actually look at the data is that we have a variety of different methods with varying efficacy, but interestingly, the efficacy of the, the methods studied is usually higher [00:21:00] than given credit for.

Mm-hmm. Um, and there's also interesting research that looks at how doctors have been trained. Whether or not, and other medical professionals, whether or not they've received any information or education about fertility awareness, education, um, and their efficacy. And there was an interesting study that I was looking at, um, recently where, you know, you had a variety of different providers that were tested.

97% were female, so half of them were nurses. These were the, these would be the providers we would assume would have the top fertility awareness knowledge. Even the providers who knew about fertility awareness based methods and regularly recommended them, they still underestimated their efficacy significantly.

Mm-hmm. So not only do we have medical providers that aren't being trained in fertility awareness space methods, but even the ones who know a little bit about it are not really aware of the efficacy. So I think, you know, I mean, we could go into, I teach the Symptothermal method, the double check symptom [00:22:00] thermal method, which involves tracking mucus and temperature, and then you have an optional cervical position sign.

And when I'm teaching our practitioners, we also include elast infertile day calculation, because that has been shown to be the most effective method. And so when we look at what the research has to say about double check symptom thermal methods, they're up to 99.4% effective with perfect use, and 98% effective with typical use.

Mm-hmm. Which is really high. Now, not all fertility awareness space methods would have an efficacy rate that's that high. So it does range, but it's certainly higher even for some of the other methods than most practitioners would even imagine. 

Dr. Brighten: You had this quote on your social media where you said, what if it isn't the method that's broken, referring to fertility awareness method, but instead their professional training?

What did you mean by that? 

Lisa Hendrickson: Well, and that was related to the study that I was mentioning because mm-hmm. You know, it was an interesting study that not only measured like the, the facts and the data, but it also had [00:23:00] qualitative aspects of it. So it was asking practitioners to kind of explain and talk. And so you gotta see in their own words why they had a bias against fertility awareness space methods, and um, and so ultimately you have providers who are not.

Trained in the actual research, so the data that shows us the actual efficacy numbers. So that's an issue. But you also have a lot of their personal biases. So, you know, in the study there were things like, my aunt had seven kids and she was using fertility wear, so obviously they didn't work, or it's too complicated and most of my patients could never do it and whatever.

And you know, so there's a lot of bias. Um, but I, so when I said, you know, the system is broken, it's, it's literally saying they're not even trained in it. So they're not aware of the latest research with regards to efficacy. They also have a lot of personal bias around it. Mm-hmm. You said something interesting earlier, which is that we sometimes expect too much from medical professionals, which I think is true [00:24:00] because if I go to McDonald's and I expect them to change my oil and I have like a whole fit on the counter, um, and someone puts me on TikTok, like that would be crazy because obviously if I'm going to McDonald's, I should expect burgers and fries, right?

So I think we do have to have an understanding of what our medical professionals specialize in and what they don't. And understand that if you're wanting to learn more about fertility awareness, you would wanna go to someone who actually has training in it. And there are medical professionals who have training in fertility awareness space methods, but you have to understand that that's not part of their actual.

Foundational training. That was something that they had to take extra time and effort to educate themself about separately. 

Dr. Brighten: I just wanna point out how funny it is that doctors have no problem saying this is anecdotal evidence, and the studies say otherwise, but when it comes to fertility awareness method, they have no problem leaning on a anecdotal evidence to support their bias and [00:25:00] ignoring all of the research studies, I just, I find that amusing, but also sad.

Let's get into the two truths and a lie though. Okay. So. You can get pregnant while breastfeeding. True or false? That is true. Okay. Why is that true? 'cause a lot of women think, if I'm breastfeeding, there's no way I could get pregnant. 

Lisa Hendrickson: Well, so I think there's, there's certainly nuance to that. There is a birth control method called the lactation amenorrhea method.

Mm-hmm. And it, it, the, the research on that is really fascinating. The lactation amenorrhea method has a 98% effectiveness rate, and it's based on the premise that if you are fully breastfeeding, meaning no pacifiers, no supplementation, like it's just you and the baby. Why the pacifier? One of my friends called, you know, she called herself, uh, Moo when she's breastfeeding, like mobile milk unit.

So that's you. Yes. Um, and then in addition to that, one of their criteria is that you don't also, um, menstruate at any point during that six [00:26:00] month period. Mm-hmm. And so, you know, so because there is an actual method of birth control, 'cause I know, I'm sure you've heard people say like breastfeeding isn't birth control.

Mm-hmm. Which is, I would say true, but there is this method of birth control called the lactation amenorrhea that, like I said, has these criteria. Um, so, but it's only women who meet those criteria during that first six month period that would even be like, they, that they would only be the candidates. So with that said, you know, the reason why breastfeeding itself isn't birth control is because, you know, part of the reason that breastfeeding can.

Delay, um, ovulation is because of those suppressive effects. So interestingly, um, the duration, uh, the frequency and duration of suckling is what has the most significant suppressive effect on ovulation. So that means then that how you're breastfeeding, how frequently, you know, all of those things play a role in that.

So we can't just blanket say that anybody who's breastfeeding just won't get pregnant. Um, [00:27:00] and then we can look at studies that show when menstruation tends to return. And it varies quite a bit. 

Dr. Brighten: Yeah. 

Lisa Hendrickson: So there's, there's a lot to that, but I would say that would be the reason. And from my perspective, again, coming from a bit of bias as a fertility awareness professional, I would say that, you know, breastfeed and track your cycle.

If you're tracking your cycle, the biggest sign that your fertility re is returning is when we start to see cervical mucus flowing again. 

Dr. Brighten: Mm-hmm. 

Lisa Hendrickson: Um, and that for women who are tracking and who are using postpartum charting strategies, like that's what they can look for and that's how they can identify when their cycle's likely to start to return.

Um, so there is, there are ways to kind of manage that. But yeah, I wouldn't suggest to just. Breastfeed only and think that you're good. 

Dr. Brighten: Yeah. And there's an infant variable to this as well. And so anecdotally, my oldest, um, great feeder, great latch, giant baby, he really like ate. So you had the judge and [00:28:00] I, it wasn't until like, uh, 12 months when I night weaned that he, that my period then come back, came back.

My youngest not the best latch. We did, um, struggle with breastfeeding. I still was able to exclusively breastfeed. But there was, there was just this difference in the suckle and the number of times I got mastitis and my period came back at six months. I remember it was like Thanksgiving. I was like sitting at the table and I was like, is that, what is, is that my period?

And I was like, I was pretty sure I saw a fertile cervical mucus like, uh, a couple of weeks ago. I just thought I had more time, which is kind of silly on my part. But, um, I just say that for moms listening 'cause I think. When it comes to breastfeeding, it's so easy to be like, it's all in me. It's uh, what I didn't do Right.

And to recognize that like there's also a baby variable. Yeah. Like there's a whole nother human and that's a variable involved. 

Lisa Hendrickson: And I would also say that there's the person to person variable. 'cause it's really fascinating. Some women fully breastfeed, no pacifiers, all that stuff we're talking about. And they [00:29:00] might get their period back after three or four months.

Mm-hmm. Whereas others might get their period back at six months or eight months. So there's a lot of different factors there. And so it's like further to the point. Right? 

Dr. Brighten: Yeah. So, okay, next one. We had fertility awareness is as effective as the pill when done correctly. True or false. True. Okay. Break it down for us because, well, I shared some people's 

Lisa Hendrickson: jaws just at the floor.

I know, right? Well, I shared that 99.4% perfect U stat. Mm-hmm. And the 98% typical U stat. And even, you know, I was looking at, there's interesting studies, like I said, that compare different fertility awareness based methods. And so the, the key point, the key takeaway is that there are multiple different ways to do this.

Mm-hmm. And so when we look at, again, the double-check symptom thermal methods, which are, you know, using mucus and temperature and also using this last infertile day calculation so that, um, if we break down the cycle, you know, in the, it's only the first half of the cycle before ovulation when pregnancy can happen.

So the effectiveness of the method is how [00:30:00] well we manage that pre ovulatory phase. So with these methods, we can look straight at the research, but ultimately what they're doing is they're really locking down the pre ovulatory phase and giving you very specific rules to learn how to manage that. So if we go back to what we talked about, you know, earlier, which is that there's six days of the cycle, that's the fertile window.

So if we can really learn how to identify those six days, but also put the guardrails before and after to ensure that we're giving us ourself enough time to confirm ovulation, make sure that we've confirmed that before we open up the infertile post ovulatory window, it can really work. Mm-hmm. But I think, you know, the reason why people's jaws could be dropping is because we're.

Basically brainwashed all through junior high to believe that we can get pregnant on every single day of the cycle. That was what I was taught and I have met zero women who were not also taught that. Um, and even interestingly, when you learn this information, when you like read it [00:31:00] and you learn it, there's a part of you that doesn't believe it.

You know, I talk about these three stages of, of kind of mastery, if you will, when you're learning fertility awareness. So like the first stage is like the book knowledge. So that's like where we're at right now. You know, you can read the study and you're like, wow, look at the mucus and the temperature goes up and like this is a whole thing and wow, I can touch my cervix and it actually feels different.

So that's like the knowledge part. When you start to understand it, you understand the hormones in the cycle, you understand how to can tell when you've ovulated. I would say the second part is when you actually start charting. 

Dr. Brighten: Mm-hmm. 

Lisa Hendrickson: Then it kind of becomes real because instead of it just being in the textbook, you're actually seeing your own temperatures rise and you're seeing that coincide with your mucus going away, and then you're seeing your period come back, you know, 12 to 14 days after you ovulated and you see that consistently.

So now it's real, but there's still part of you that doesn't believe it. Yeah. And so I would say then the third stage, which no one can do for you, if you are charting your cycle, and if this is a method that you've [00:32:00] chosen to use, is when you actually start using it. So when you've actually charted and you start to track your cycle, you know, your fertile days, you've worked with somebody, you've done your research.

So you're, you're not just kind of randomly checking something on TikTok, but you actually understand what the rules are for the method that you're using. And then you have unprotected sex on the infertile days. And after your little mini freak out, you gather yourself together and then your period comes and then it comes again.

Mm-hmm. And it comes again. And it's, I feel like it's really not until you've actually like done it, that you truly, truly trust it because the indoctrination and brainwashing, it's deep. 

Dr. Brighten: Yeah. So let me ask you, so first let's do this, let's put the pill efficacy, typical versus perfect use up against fertility awareness method.

The one with the highest efficacy rate. How do they compare? 

Lisa Hendrickson: I mean, I, I shared the stats for the fertility awareness method, the pill, typical, typical use [00:33:00] efficacy typically ranges somewhere between like 92% to, you know, 95%. So, and that, I think that's mind boggling for people because this is the method we put on the pedestal.

And the typical use stats are not 99%. No. Um, so that's interesting. I mean, there's a lot of different variables, variables there. And I think one caveat for someone who wants to come at me to say, come on. Right, it's, it's not as effective. Um, it goes back to what I said about their being. This umbrella term that we say fertility awareness, and anybody can be in that.

There are studies that won't really define that well. And so if someone says I'm using an app, or if someone says, sometimes I take my temperature, they're gonna be included. And of course those, uh, failure rates are really high. So that's when we're seeing, you know, 70% efficacy and things like that. So I think that if we're wanting to provide accurate information for women so that they can make informed choices, we have [00:34:00] to be able to understand that there's nuance to this, understand that there are multiple different methods.

And so the first thing is, well, which method appeals to you? Some women prefer mucus only methods. Those methods do tend to have a lower efficacy rate. Um, you know, some women, it's like life or death. They were on birth control, they had horrible side effects, but they need birth control and they feel like they have no other options.

So for those women, we need to be able to educate them about the fertility rebased methods that do have the highest efficacy. You know, why? Because no one ever forced anyone to chart their cycles. So women who choose this, I always say they're self-selecting. Yep. You know, if you're listening to this and this resonates with you, you know what I mean?

Like you, you're like, this is amazing. I never knew that there was a way for me to prevent pregnancy successfully without hormones. I've been struggling with these side effects, you know, and this is actually giving me another option. There are plenty of women who are really drawn to this. We are capable of figuring this out with the right support [00:35:00] and the right practice.

You can do it. I think the wrong thing is just to out of hand say fertility awareness methods don't work. Uh, there's a lot of women who do experience failures. Mm-hmm. We could talk about that too there, and user failures are the most common. But my question would be, well, which method were you using? Like, what were you following?

Who trained you? Like did you seek support from a trained instructor? Or like how did you determine your fertile window? Like what was happening here? Right. Yeah. There's a reason why a lot of women don't have success. 

Dr. Brighten: For people who wanna come at you, I just wanna say, you're not saying an opinion here.

None of this is your opinion. Everything is based on the research. We will put the citations as always in the show notes so you guys can read the studies for yourself. Um, I think that's just really important to understand is that this is not opinion. And I also find so often. When people are like, my cousin did this method and it failed.

Um, I've had patients that are like, I tried this. It failed. We go through, what were you doing during your fer fertile [00:36:00] window? Well, we just pulled out. I'm like, oh, okay. So you weren't doing fertility awareness method, you were doing the pullout method. And that has like a 20% failure rate because, um, men are not super great at overriding like the amygdala and everything.

And knowing like there's a, that is a, a nail fail failure, not like you failed and it's something completely different before we move on to what the lie is, what is typical versus perfect use, because we're using that term, all the research uses that term, but we also are never taught that, you know, and is this normal?

I wrote about how us sex ed is fear-based and we would be afraid of STIs, be afraid of getting pregnant, be afraid. It ha we see some of the highest rates of teenage pregnancy STIs. It's a failure the way we're doing it. We look at countries like Germany and the Netherlands who take more of a science-based consent and giving real honest information.

And what they actually found is that [00:37:00] almost their entire population is delaying their first, uh, time they have sex because they're like, I want it to be meaningful. Like sex is more than just, you know, this thing. They don't get pressured into it and they report more satisfaction. So you are actually seeing.

People as adults are having better sex lives and better experiences and less risk because of the education. So I'd like to educate people what is the typical versus the perfect use When we're talking about, talking about the pill, talking about, uh, fertility awareness method. I mean, the thing about the IUDs, there's no, uh, typical use.

You just put it in and. It should stay put, hopefully, but like there is that variable, but you didn't do anything wrong there. 

Lisa Hendrickson: Yeah, I mean, in general, when we talk about typical versus perfect, perfect would mean that the, the person is doing everything exactly the way that they're supposed to be doing it.

Mm-hmm. So whether we're looking at a study on condom efficacy or withdrawal efficacy, or if we're looking at pill efficacy, then you know, we have [00:38:00] exactly how it's supposed to work if you do the right thing every time, and then we have what actually happens. So those studies are really fascinating to look at because you are actually seeing then how this typically plays out.

Obviously people are not perfect and things, uh, can go wrong. So I do think it is important. You know, a, a lot of people say, and I I don't disagree that we should be looking at the typical use efficacy when you're trying to determine which method is gonna be best for you, because obviously that's going to show you what is working the best in the real world.

And so this is why the fertility awareness conversation is a little bit more nuanced because I think most people. Are not crazy in the weeds all the time. Um, with the research, if you actually look at fertility awareness research, I can't stress enough, I keep saying it, it's not like there's one method and the study like that wouldn't even be an effective study.

Mm-hmm. Like if some methods use a totally different way of tracking, then how could you just lump it all together and say that there's one efficacy rate? So I think for anybody who's seriously looking at fertility awareness based methods, it's [00:39:00] worthwhile to actually look at the research, even if it makes your eyes crawl back in your head, popping into chat, GBT, whatever, right?

Yeah. Whatever you need to do, right? But understand that when you're looking at studies and people giving these exceptionally low rates of effectiveness, we do have to ask, well, what method were they using? Um, because, you know, for example, mucus methods, uh, some of the most common mucus methods do tend to have lower efficacy rate, um, because there could be less specificity.

For example, if you're using mucus only, um, a mucus. I mean, there's nothing that's a hundred percent all the time. That means you're not using temperatures. So you have one sign. There's different ways to track and check. There's a bit more subjectivity there. So we, you know, if you, if you really wanna understand, you have to kind of understand that there's nuance and you have to apply some sort of approach to this.

You can't just kind of throw it all under the bus. So I hope that that answers the question. But I do really think, you know, um, [00:40:00] I, I think that some people would say that maybe I'm too optimistic with fertility awareness or maybe I'm overstating the efficacy. But I would say I'm not overstating the efficacy.

I'm breaking down the different types of efficacy for different methods. And I have chosen to teach the method with the highest efficacy. 'cause that really gives my clients the best shot at this working. 

Dr. Brighten: Yeah. And we're going to go into the method with the highest efficacy coming up. But ovulation always happens on day 14.

True or false? 

Lisa Hendrickson: False. Obviously. 

Dr. Brighten: Obviously. No, that's not obviously because, because I'm gonna tell everybody right now, if you have an app and it's like we can predict you when you will get pregnant and all it asks for is your last menstrual period, delete that app now because no, uh, but no, a lot of this here.

So here's the thing. When we teach about the menstrual cycle, we say. 28 days, right? We say like, day one is the first day of your period on day 28, hormones [00:41:00] drop. You're, you know, everything starts again. Day 14 is ovulation. We teach this as a framework to help people wrap their head around it. But what gets lost by the sex educator, uh, by the way, um, most of them, there's a study where they're not even comfortable saying vagina.

They won't say vagina, they don't differentiate for the vulva, but they'll say penis. Oh, not a problem. Vulva all the time, right? I mean, I, I think maybe part of it, yeah, but to tell you, I wanna be fair that I think, um, media makes penises funny and so it feels a little more comfortable, right? Like movies, there's jokes and things like that.

But what I think gets lost in all of this conversation is that that standard, by which we have laid out framework to teach the menstrual cycle doesn't mean it's true for your body. So it's not obvious, I think, to a lot of people. Explain why ovulation doesn't always happen on day 14. 

Lisa Hendrickson: Well, so, I mean, we're not robots.

That's, that's fair. That's the whole reason. True. Um, well, I [00:42:00] mean, and, and for me, I, I, even when you say that, that's how we teach it, I would say that's not how I teach it, you know? Mm-hmm. But I think part of that is because I'm aiming to really come up against that if we really wanna understand the menstrual cycle, if's important not to actually.

Be so rigid in the teaching, you know? And even I understand that that's how people like, okay, so you know, there's a lot of protocols coming out. Periods are really popular right now. So there's a lot of protocols that are like, do this from days one to seven, do this from days seven to 14. And all of that really reinforces it.

So at one, like on one hand we're saying, okay, well that's not how it always is, but on the other hand, we're always reinforcing that that's how it is. Mm-hmm. So again, if we go to the data, what's interesting now is that we have all these apps and so there's a lot of studies that are, you know, in case you didn't know that they're selling your data, there's a lot of studies now that are capitalizing on like hundreds of thousands of cycles of data so we can actually see the data, which is great, right?

And so I think what's key to understand [00:43:00] is that we do have a clear average, you know, you can look at multiple different studies of cycle length and different cycle characteristics. And the average for women of reproductive age does tend to be 28 days of the cycle length. And obviously if the average is 28 days, that puts ovulation somewhere around day 14 or 15.

But I can't stress enough that that's the average. Mm-hmm. And if we look at what happens in real humans, real human women, then what we see is that there's fluctuation. So anyone who tracks their cycle, let's say for, you know, six to 12 cycles, you're going to see that there is a range. You're gonna see that some of the cycles might be 29 days, some of them might be 27, it might be 32, it might be 31.

So in real life, how this plays out is it's not always that. It's not always like that. And so, um. Uh, I would say we can look at the data as evidence and we can also look at what happens in real women's bodies. And you might think, well, you know, what's the big deal? But I've seen how it can play out negatively in a variety of circumstances.

We've kind of touched on a little [00:44:00] bit of that in the example of early ovulation and the possibility of pregnancy mm-hmm. At, you know, during those last days of your period. But it can play out where women are trying to conceive, and they're always having sex on day 14, and maybe they're ovulating on day 12.

Mm-hmm. This can go on from months. Yeah. You know, um, similarly, if they're ovulating closer to day 20, you know, and what can happen from the fertility charting standpoint is that you ignore what's actually happening. So you ignore the mucus, you ignore all the actual signs, and you default to your, you know, assumption.

Mm-hmm. Bigger consequences can be related to hormone testing. Obviously if we're doing hormone testing on day 21 and making decisions based on that, you know, that's kinda arbitrary. 'cause it doesn't really matter what the textbook says. What matters is the woman in front of you and what's happening with her.

And if we really wanna understand what's happening with her, if she has questions about her cycle or hormones or whatever the case, we have to actually be looking at her and not test for the day. But if we're trying to [00:45:00] find mid luteal, we need to actually identify when her ovulation was so we can be accurate when we look at the mid luteal for example.

Dr. Brighten: Yeah, I wanna, I wanna zoom in on the luteal phase, but for people listening, what you're referencing is testing progesterone. So we take test progesterone five to seven days post ovulation. That is what is accurate. But a lot of times doctors will say, well that's day 19 to 21 of the cycle. I would love it to always be NI day 19 and 21 of the cycle.

But the other thing that women should know, I will often have labs in front of me and someone's like, my doctor says I need progesterone 'cause I have zero progesterone. And I'm like, well, did you ovulate? And they're like, I ovulate. I'm like, you can't have zero progesterone then. And I'm like, this is looking with your estrogen a lot.

Like you got this done on your period. Yeah, that's when I got it drawn. You will have zero progesterone then You don't need progesterone during the follicular phase. You need estrogen because it's doing all kinds of things. It doesn't need to be challenged by progesterone yet. But there was something that I saw on social media.

Um, if I can find this clip, I might put it up on YouTube. [00:46:00] This doctor who I, I think she's a wonderful doctor, but she had made a statement that the luteal phase for women is only seven to 10 days. And I was like, whoa, that is so wrong. This is the gynecologist, she's a gp, really lovely person. But this piece of information was totally incorrect.

And red flags, if somebody comes to me and their luteal phase is seven days, I'm like, girl, if you're not like 45, we gotta, we ought to get, figure out what's going on. Talk to us about the luteal phase. How long should the luteal phase be and why? 

Lisa Hendrickson: Well, absolutely and so, you know, the luteal phase, a healthy luteal phase, I would say should be at least somewhere between 12 to 14 or 15 days.

And what's interesting, I mean, when I first started learning about cycle charting, you know, back in the day, um, you know, we learned that the luteal phase was a bit static. And I think one of the things that I learned that I don't think is as accurate now was that, you know, once you started to see the length of your luteal, it would always be about [00:47:00] the same.

So what we need to know about the cycle is that if we look at the overall average 29 day cycle situation with ovulation around day 14 or 15, right, for argument's sake, um, what we need to know is that the follicular phase is actually the most variable aspect of the cycle. And that would be why we can see such cycle.

Fluctuations and variations. So, you know, cycle length typically varies anyone from anywhere from let's say 21 to 35 days. Um, typically that is considered to be a healthy cycle length. But what's interesting is that whether you have a 25 day cycle or whether you have a 35 day cycle, typically the luteal phase is going to be pretty constant.

Mm-hmm. And so, I mean, part of that is what's happening hormonally, once we ovulate the ovary, um, ovarian follicle releases the egg, the follicle becomes the corpus luteum, which is, if we were to look at an ovary, the corpus lium would look kind of like a little scar, little yellow scar on the ovary. And [00:48:00] that corpus luteum is producing progesterone and it has a lifespan.

So unless we conceive and become pregnant, the corpus lium is going to disintegrate within about 12 to 14 days. So we have actually this timeframe, but what you brought up, you know, if the luteal phase is seven days or 10 days, it shows us that it's not just static. 'cause again, we're not robots and the health and longevity of the corpus lium is heavily based on what's happening hormonally, uh, what stresses we're going through.

There could be a variety of different factors if we're not eating enough, if we're, you know, exercising a lot. And so the luteal phase is a really interesting part of the cycle to pay attention to. 'cause it gives us so much information about what's going on. Mm-hmm. So, like you said. If you're working with someone and their luteal bas of seven days, that's a huge flag.

And even from a practical perspective, if you had a client who was trying to conceive and her luteal phase was seven days, the process of [00:49:00] implantation takes about 10 to 14 days. It takes about two weeks. So if someone's, you know, starting their period seven days after ovulation, that wouldn't even give the egg enough time to implant.

Mm-hmm. So not only is there a practical issue with it, but it also shows a profound hormone imbalance. So the last thing I'll say about that is if we go back to the average cycle, 29 days, that design by definition gives us about as much exposure to estrogen as progesterone in a sense. So we would have about as many days of estrogen exposure, primarily to about as many days of progesterone exposure.

And that balance, and I use the word like it's not a literal balance 'cause we produce significantly more progesterone like, you know, um, but it's supposed to be balanced. We're supposed to have that two weeks-ish duration of time, of progesterone exposure to counter the effects of estrogen. Mm-hmm. So there's a lot going on there, but.

At the end of the day, hopefully if [00:50:00] you post that clip and gently, 

Dr. Brighten: gently tag that document. Yeah, I don't, I don't like, um, I don't like call out and slamming people and I actually block creators that, um, do that because I just think, um, I think that studies will look back and judge us very poorly for how we shaped it's true humanity by always just calling out and like hating on people and trying to rally against people.

I think it's really a toxic internet culture and like I said, there's um, not everything but's gonna get everything right either. And I think we have to like hold space for that and an opportunity for all of us to always grow and learn. And I, if I got something wrong, um, and they have gotten things wrong, it's, I appreciate when people are like, let me present this to you in a way that is not judgmental, that is not trying to tear you down and not, you know, oh, you're an idiot or something, and actually teach you because we're not gonna know everything and we have to be open to learning and also teaching one another.

But I think what I want women to definitely understand is that it could take up to eight to 10 days [00:51:00] before an embryo even reaches the uterus. If you are struggling to try to conceive and you just identified that your luteal phase is less than 10 days, you are not gonna get pregnant because there's just not the opportunity for the embryo to land there to then burrow its way into your uterus and to have the time to set up shop and say, this is my new home.

And so that is something that I think, as I asked you, what's one of the biggest things about, you know, that could hurt us from not tracking our cycle? I think that right there, so you're tracking your cycle, you identify that and you're like, this is me. It's time to see a provider because you shouldn't just struggle on your own or.

Buy their Bs of like, just try for six to 12 months and see what happens. No. If you identify there's issues, you need intervention. Now I wanna ask you, you've been called anti-feminist because you question the pill. How do you respond to that? 

Lisa Hendrickson: Yeah, I mean it's, it's so interesting when I think back to when I, you know, I started my podcast, I was out there, that was, you know, over 10 years ago [00:52:00] now, there was a lot more pushback about the pill.

Mm-hmm. Um, and you know, I think it comes from the history. So the pill was really connected to this, you know, feminist movement and to this, the kind of a sexual revolution and all that kind of stuff. And it was really thought to be this, this, um, ticket to freedom, I guess you could say for women. It was the first time that women could be sexually active without necessarily it being directly related to having a child.

So I think there's a lot of. Um, I don't know what you'd call it, but there's this connection there and, and, uh, people are really, um, bound to that. I also think that, um, you know, in the, in recent years there, I, like I was saying to you, I'm Canadian, so I'm not directly in the, uh, American political landscape, but obviously there's a lot of people who are concerned that maybe if you talk about the pill, you're also trying to limit access to it.

So whenever I talk about the pill, I'm always [00:53:00] clear that I'm not wanting people not to have access to anything. Yeah. What I'm trying to do is allow women to make informed choices. And so while the pill was certainly positioned as this ticket to freedom, it certainly wasn't without consequence. Mm-hmm.

And that's the part that we need to talk about. We need to be able to talk about the side effects. We need to be able to look at what the research has to say. Unfortunately, the pill is one of these drugs that has been around for, is it 60 years? Yeah, 65 years. So we have an incredible amount of research to look at.

So I think in the last few years that has backed off a little bit because again, there's so much research that we can't really, you can't really deny it. You can't really come hard at me. Um. Even if, I mean, I guess they can, but I, I feel like there's a little bit less, uh, ground to stand on. Um, but I mean, when it comes to the pill as being, you know, anti-feminist, I have kind of a different definition, I guess, of [00:54:00] feminism.

And even when we were talking about the, the menstrual cycle being the a, the fifth vital sign, I think that if we can really start to track our cycles, understand what's happening in our bodies, that could be the new version of feminism. Mm-hmm. Right? That could be a different, a different situation where instead of suppressing our body's natural function, we can learn to work with it, learn to understand it, and use it as a way to monitor our health so that we can actually feel better.

Right. Yeah. Like what a concept. I would 

Dr. Brighten: love the propaganda PR team that the pill got. For me personally, I just think that, uh, like the pill can do no wrong. Right? I mean, it's very interesting because when beyond the pill came out, um, the go-to people would, they would say like, she's just this alt-right.

Conservative Christian woman. Yeah. And I was like, firstly, there are alt-right conservative Christian women. And that's like, we're not using that as an to insult people. Okay. People get to have their own beliefs and we don't belittle other people. Secondly, would hope that [00:55:00] you're intelligent enough to like, bring something better than that, than to make up lies about me.

And I, I just found it so ironic, um, the number of gynecologists who made up lies about me. On the internet around this. And I'm like, you are doing the same thing that Margaret Sanger did when the pill came out. So the truth about the pill is that it was taken to Puerto Rico. These women were told, we'll, stop sterilizing you, because they were being forced sterilized.

If they wanted to have jobs, if they wanted to have access to just food and living, they were being forced, sterilized. They had two kids. Somebody showed up, you lost your uterus. They said, well, stop doing that to you if you participate in this birth control pill trial. They do. They hate it. They report all these horrible side effects.

The doctors are like, ignore them. They're dying. Ignore them. Some doctors left and were like, I can't be a part of this. It's so unethical. When the pill was finally available, they, they priced out. These women, they did not give them access to it. The women of Puerto Rico never [00:56:00] got access to the pill. They got for more forced sterilization, and that is the true history of the pill.

And I talk about that and people are like, you're just trying to like, get people to take, like, you know, take away the pill. And I'm like, I just think that if you are going to exploit a Latina's body, like, and, and, and do this to them, that they deserve some recognition of what they went through. Because when some people say thank birth control, you know, there's that whole slogan, I'm like, no.

Thank you Puerto Rican women who sacrificed their bodies to be able to make this possible. This is the history, the true history of gynecology is that the bodies of black and brown women have been completely exploited over and over and over to the benefit of white women. Did white women do this? No. Did white women cause this?

No. The women benefiting from it. Now, are they supposed to feel guilty in the and No, no, no, no. That's not what I'm saying. I'm saying is that there are these [00:57:00] really dark industries and history that it is very unfair if we just ignore the women who sacrificed so much for us to have access to these things today.

And for me, even saying things like that, I'm sure I'll get people in the comments who are gonna be very angry about it, right? Because we're not supposed to talk about race. We're not supposed to vilify the pill. We're not supposed to vilify Margaret Sanger. Seriously? She's the worst. If you look at the history of it, um, I think the only time I've ever agreed with Kandy Owens was when she told the history of Marcus Sanger.

And I was like, that's facts like that. That is facts there. But that gets put as like, that's only a conservative talking point. These are people who are anti pill. And I think, but it doesn't have to be like, it doesn't, it's very funny because we live in this really weird time. You're not in the US where.

Now if you talk about eating whole foods, you're now considered conservative. And I'm like, I don't know. I've been doing this for like 25 years. Um, like what's changed here? So Well, and can I add 

Lisa Hendrickson: to Yeah. A little bit of history because obviously that [00:58:00] it's, it's horrific. It's, it's completely just bizarre.

And one of the aspects of the, the pill history that I often talk about as well was that the, it's more around the kind of full disclosure, informed consent piece. So these women, some of the women in the study, um, were trying to get pregnant and they were kind of told that, yep, they suppress the hormones, it'll kind of bounce back their reproduction or whatever.

So that's, 'cause you're kind of thinking if someone's trying to conceive, why would they put them on the pill? But what happened is that the women didn't understand how it worked. And at the time, the first I called the beta trial. Mm-hmm. But the beta, the beta pill trial, they didn't have the, you know, induced sugar pill week.

So these women, they were put on this pill continuously. They stopped having cycles. And some of them actually thought they were pregnant and were like celebrating that and really happy about it. And then the doctors were kind of like, no, no, no, you're not actually pregnant. It's the drug. And then when they realized that it was a side effect of the drug, the women were [00:59:00] like inconsolable.

Right. So that's how they came up with the 28 day pill pack. Mm-hmm. So it could have been. 40 days. It could have been whatever they wanted or it could have just been continuous. But they did that because they wanted it to mimic a woman's cycle. And so it was kind of like this white lie because they wanted to make it seem like, no, no, no.

It's the same as when you're not on the pill. Like you still get a period, like you just can't get pregnant and this lie has continued. Right. And so, uh, and one of the things I often share too is these trials were happening in the late fifties. So in the late fifties, there was no precedent for this.

Mm-hmm. There had never been a drug like this. And actually the pill was the very first drug ever invented to give to healthy people to suppress a natural bodily function. 

Dr. Brighten: And for people listening, that is a marketer and businessman's best dream in the pharmaceutical industry is like, we don't have to have a diagnosable condition.

You just have to have. Been born with ovaries, 

Lisa Hendrickson: correct? Well, yeah. And so I mean, that [01:00:00] lie still persists to this day because when we hear things like the pill regulates the cycle, people believe that. Mm-hmm. You know, except it, it doesn't do that. And so interestingly, how you could be vilified for just saying what it really does, like just reading the science and saying, well, it suppresses ovulation and it prevents the uterine lining from developing to a thickness that would support life.

And, you know, it, it does cause that thick mucus plug to always be there in the cervix. And those are the kind of like the three main modes of action of, uh, combined birth control pills. But it's interesting because, you know, this lie is what allowed women to accept it. Because before the pill, the only time a woman would lose her period was if she was pregnant.

Mm-hmm. Breastfeeding or potentially very ill. Right. So, you know, they had to get, market it in a way that that was acceptable. And you know, interestingly as well, the pill is the reason why we have drug inserts because it caused so many side effects and because feminists fought for 

Dr. Brighten: it. That's right. The feminists didn't fight for the pill.

They actually fought [01:01:00] for. Like, we need an actual informed consent because on top of all of this contraceptives for women somehow still get this like hush free pass that you don't have to give a true informed consent. When I talk about IUDs and like how they work, when I talk about, and if it fails and there is implantation that I, well the I Uud is not gonna allow implantation.

And doctors will say, don't tell women that they would not use it if they believe that life begins at conception. And I'm like, oh, wait a minute. Yeah, my belief is not superior to her belief. And if that's her belief, she, she has to have an informed consent. If you believe that and listen, anyone listening, if you don't believe that, that's fine.

But I want you to just sit in someone else's shoes for a second. If you believe life can begins at conception, someone put an IUD in you and then you learn after the fact that it could actually keep that life from implanting, how do you reconcile that with your faith and what you believe the end outcome is in terms of [01:02:00] like, do you go to hell?

Like what happens with that? Like that creates tremendous mental pressure, stress and emotional duress on a woman because she wasn't given that informed consent. And I think as doctors, it's not our place to pick and choose what information you get. You just tell the truth and you let her decide. And even if you don't agree with what her decision is, you have to stand back and say, it's not my body.

Like this is not my life. And like, that's not the decision I would make. You can make recommendations and say, I strongly recommend this, but to, to manipulate information, to get someone to take a medical treatment is coercion and it's unethical. 

Lisa Hendrickson: Yeah. I mean, there's so many thoughts going through my mind and one of, I wanna hear all of them.

I'm sure one of the thoughts is back to when you asked the question of, you know, why aren't we being taught this? And then we talked a little bit about doctors and how they're trained and, and how medical schools are not necessarily teaching this information. And you'd have to go [01:03:00] outside of it to really get that specialization.

Well, why is that? Who funds the medical schools? Right? Like, we have a pharma situation. Mm-hmm. Is what we have. And when I wrote the fifth vital sign, um. You know, at the time the pill industry was estimated to be like a $30 billion, like 22 to $30 billion industry, billion dollar industry. Like, do you know what a billion dollars is?

No. Like, I remember hearing that if you had a billion dollars stacked up, like in $1 bills, it could take you to like the moon or something. Really? Yeah. I don't have a concept. Like we don't even understand. So like there's, this is, this is the problem. This is a problem. And one of the things that I've been interested in lately is that there's all these studies coming out, um, you know, talking about why women are going to social media for information.

So for everybody who's watching and listening, they're talking about you. They're like, why are you going to these, you know, non, you know, like not going to your doctor's office, but instead you're looking on YouTube or you're looking on Instagram, or you're looking on [01:04:00] TikTok and you're looking for information about PCOS, or you're looking for information about the menstrual cycle.

There, you know, and, and at the end of the day, the reason why women are looking outside is because the conversations like what we're having are not being, are not taking place in the, in their doctor's offices. Mm-hmm. But is it the doctor's fault? So that's a really important question to ask. Why is it that we are the ones talking about this, but these medical doctors are not talking about it?

Why is it that it's not part of their education? Well, if they're making billions of dollars based on this pharmaceutical model, then wouldn't it make sense to teach them in a way that, you know, encourages them to make sure that their patients are like, I, I don't know. I, I mean, I don't think I'm staying in the most eloquent way, but I think that at the end of the day, we have to really consider this.

Mm-hmm. And this is why, for me, informed consent is paramount, because obviously our institutions are more concerned about getting you on the drug than telling you what it [01:05:00] does. And how do we break that cycle? I think, I think that it's just, we just talk about it. We just share the information and we try our best to empower women.

And, you know, there's a lot of medical jargon and information, but even if we start talking about it, at least then they're empowered to ask more questions and maybe get to the bottom of it. 

Dr. Brighten: Yeah. I, you know, as we're talking all of this, I mean, I think about things like, there's gynecologists that I will see on social media who say like, I'm a fan of menstrual suppression, so I recommend it to all my patients.

And I'm like, wait a minute, you're a fan, so you make a. Huge medical recommendation, like shutting down your cycle is not something insignificant. It has been failed to be researched extensively. We had Dr. Sarah Hill on the podcast, it will link to her episode because she is one of the few researchers bold enough to be doing this research is very interesting to me.

When I talk to colleagues who are researchers and they're in the, they're in the field of women's health, and they'll say things about the pill, and I'm like, how come this isn't being researched? And they're like, oh, if I, if I [01:06:00] have a negative outcome or I say something negative about the pill, I'm never gonna get a grant again.

I'm never gonna get funding. Like they'll make sure of it. And I'm like, that's problematic. So as we talk about this, the first argument people are going to have already is like, but what about big wellness? How much money they want they make? And I want you to understand there is no such thing as pharma here and big wellness here.

They overlap. The top selling supplement companies in the United States are owned by pharmaceutical companies. What is also included, what's silly about big wellness is it also includes gym memberships and people choosing to eat healthy food. That's whack to me to be like, Ooh, this big wellness people are going to the gym, uh, as a doctor.

Am I not telling everybody to work out every day? Yeah. Check. I am. Um, the other thing that's included in that though is, um, wellness tourism. What is wellness tourism? That is when you are going to other countries and you're having medical procedures that use pharmaceuticals, like you have to understand that pharma has started the propaganda of big wellness to [01:07:00] distract you from the fact that they have their hands in everything.

And I say this as somebody who's super, super grateful that medications exist. You know, we were just talking, I just went through a knee surgery. You think I'm mad at pharma. I am not mad at pharma. I love not dying of sepsis because we have antibiotics. Like that's amazing. I love taking a thyroid medication and being alive every single day.

So I'm not anti pharma, um, by any means, but I do think it's an unchecked entity, like giant business entity that needs more oversight, especially when consider that there are only two countries in the world and one of them is the US that allows direct marketing to consumers. I remember that Yas commercial of like, it'll fix your PMS, like, it'll fix everything.

And yet, as someone with PMDD, that YAS was supposed to help, I got way worse with yas. Um, and I asked my doctor for it, Yassin actually is what it was. I asked my doctor for it because my moods were so bad, um, on the pill variation I was on, and they were [01:08:00] like, oh, okay, why did I ask my doctor for it?

Because I was 18 and I saw it on TV. And um, I, at 18, I was definitely like, well, it's on tv. Like, you know, like, it, this must be helpful. So I think there, um, anyone, just everybody who is like, you know, there's some certain people who are like, that's not fair to criticize pharma. My criticisms come from all the lawsuits that have been won.

It is verifiable. Go look at those things. These, this is what we need to be looking at is the lawsuits that have been won and the behavior that continues to repeat and the harm that is done. We need the pill. Okay? We need to have access to it. As somebody who worked in a homeless youth clinic, people will always say to me like, no, not, no.

Everyone can just do fertility awareness method. And I'm like, A girl who doesn't have a door to lock is a high threat of being raped. Like the pill being super cheap and having access to that is a really good thing. So, and that's like one extreme. The other is. It's just your choice. Like it's your choice and if you want it, you should have [01:09:00] access to it.

So I just wanna be like crystal clear because the first thing people do when you challenge a belief is to shut down and decide how you're the villain. And I just want people to understand nobody here's talking about taking away the pill. 

Lisa Hendrickson: Yeah, it's true. And you know, you mentioned choice and can you have true choice if you don't really understand what's going on?

You know, for all the women who were on the pill and were never told that it could, could, you know, cause depression or anxiety and interestingly, it doesn't always happen right away. Mm-hmm. So you could be on the pill for like three years and then all of a sudden get, start getting panic attacks. So for all those women, like desperately Googling, you know, to try to figure out what's wrong with them, and then only finding forums where women are talking about, you know, the same drug that they're on that caused them the same thing.

I mean, that's completely outrageous. Right? Yeah. You know, um, I remember when I, my editor for the fifth vital sign, she, like, she told me that she kind of fact checked when I had the black label thing. Mm-hmm. So I have this like image of a black label, like [01:10:00] I'm saying, this would be what a black label should look like.

And she looked it up 'cause she didn't even know mm-hmm That the pill has a black label warning like cigarettes do. Yeah. Right. And so, you know, this is a problem. There's so like we could, we could talk about this for the rest of the day. We could talk about the different side effects. We could talk about how women who have migraines probably should be at least given a warning from their provider that, you know, you know, if they start to, like, there's all these things that we could talk about.

And the big question is, well why aren't women being taught? And we can backtrack even more. Why aren't the medical providers being trained to be kind of, um, the word I'm looking for? It's kind of like to protect their patients first. Yeah. Right. Like, I'm not sure what the perfect word in there is, but if they were trained to kind of like, I guess that's what, what First do no harm.

I mean, yeah. Our hippocratic oath first do no harm. Isn't that interesting though? 'cause my mind is like, if they were trained to first do no harm. But they are, but they're not. So [01:11:00] like, really what they're trained to do is to prescribe first. 

Dr. Brighten: Yeah. Well, and they are trained in a way that, um, like inception has happened in their minds.

And I don't think they even have realized that. Like they put you into residency, they exhaust you, they overwork you, they do all of these things so that you mentally start to break down. And like you don't question all of the things like that is on purpose. You can't convince me that the abuse that residents face isn't on purpose.

Um, but you know, when you, when you consider this, I mean, they are taught that to, you know, when you talk about blood clots, like, well, yes, the pill could raise your risk of blood clots, but don't even worry about it 'cause it's so mild compared to pregnancy. Okay. But like, I'm not pregnant, so why are we talking about that?

You are bringing in this false equivalency and saying that like, this is lesser than, so don't worry about it. But like, my goal is not to be pregnant. So like, why are, why are we doing that? You know? And you bring up the, uh, migraines with auras. Uh, there's doctors who don't even know that's a contraindication.

I developed migraines with auras when I [01:12:00] was on the pill from the result of being on the pill and I was given iMatrix. Like that's, I was, I actually did too. 

Lisa Hendrickson: Yeah. And it wasn't until, so this was when I was maybe 16, 17. 'cause I was on the pill at that point for period pain. Mm-hmm. But it's the only time in my life I ever had migraine with aura.

And it really, like I went off the pill at some point. Well before that, that wasn't why I went off. Yeah. But, but it was only years after. I thought about it and I realized, yeah, wow. And no one, and I was, I don't know the name of the drug I was given, they were these dying, um, like diamond pills. There's literally so many, right.

They gave me hallucination, so I like took what, what? And I was like, not, not taking that again. Yeah. But, um, the solution obviously was there was no like, let's take her off the pill because we know the pill like this is bad if someone's on the pill and they're also getting migraines. None. Yeah. 

Dr. Brighten: I am. I just, I'm so grateful all the time because it wasn't until I went through a fertility workup that I found that I have a rare clotting disorder that nobody would've ever checked for.

And I'm like, I am so lucky. What if [01:13:00] I had smoked? What if I was overweight? What if I hadn't studied nutrition like very young and been like, I need to live a healthy life. Like what could have happened to me? And it's interesting because this clotting factor, when it came up, I was like, oh, like this is, or the, you know, this, this genetic mutation I have and to my doctor, I was like, I've, I'm not familiar with this one.

I've never seen it. He's like, yeah, we test it in the fertility world. I'm like, what does it mean? He's like, if you're ever on oral estrogen, we have to make sure that you are on, uh, blood thinners. So, uh, uh, you know, that's Lovenox is what it is in the United States. And so anytime I'm on oral estrogen, 'cause I needed to be for fertility treatments.

I was tested, I was followed, tested all my clotting times, clotting factors, and um, I had to be doing daily injections. And I was like, oh my God. And I'm like, had I not stopped at 27? Had I been one of those women that like carries on to 37 47, like what would that have looked like? And you know, gynecologists will argue against doing testing for [01:14:00] clotting factors because they're like, it's so minimal, the risk is so minimal.

And I'm like, unless you're factor five lighten. And I've definitely had patients I've tested and I'm, you can't be on the pill. You have factor five light. You cannot be on the pill. Um, even M-T-H-F-R is a warning in Canada. It's not in the United States. At least not as of like the last five years when I had checked.

So maybe that's been updated. Um, there are genetic mutations that we can have that means you are the person who's going to have a clot. And when you think about it, it's like maybe it's a small percentage of the population in the whole who takes birth control and will have the clot, but the clot is a stroke, a pulmonary embolism, possibly death, losing part of your brain.

Like it's not insignificant, the outcome. And I think like, no, I don't want people to be scared of using the birth control pill, but I want people to understand the risk that they're signing up for. And I also think when we prescribe the pill, we need to save. These are the signs of a clot like that you need to be looking out [01:15:00] for.

These are the signs of depression. How depression doesn't just show up one day and you're like, I'm really sad and I'm depressed. You're like, I'm not really interested and motivated in doing the things I used to. Like I'm becoming more withdrawn and antisocial. Like depression isn't a, a switch that flips usually women on the pill.

It's like over a six month period of time, personality changes and because you're in it. It's gradual. You don't see it for what it is. But if you can have people in your life that you're like, I'm starting this new medication, keep an eye on me. That's a great way to leverage community to make sure that your health is being put first.

Lisa Hendrickson: Mm-hmm. And I mean, so many things come to mind because when you talk about these things, there are always women who did use the pill. And according to them, they had no side effects. They loved it. Love that. They looked great. Yes. But when we look at research and science and studies, we find that about 50% of women discontinue using within the first year or switch to another type of contraceptive.

So, you know, it's, it's really great that there are women who don't experience a [01:16:00] lot of side effects. One thing I often say though, is that depending on how long you used it, when you come off, that's when you kind of see some of the differences that you might not have realized when you were on. But even so, um, there's still about 50% of women that are dissatisfied enough within the first year of using it that they're wanting to come off.

So, I mean, we, we really should be paying attention to, um, to these side effects. And I think, you know, to me, you know, I think about, okay, so. In this conversation, are we gonna change the entire way that, you know, medical professionals are trained regarding prescribing the pill? No, we're not. So what can we do to empower the women listening to figure this out?

One of the things I don't think a lot of people know is, um, if you think about it, pharmacists, that's their whole thing. Yeah. Great. They're trained in all of the drugs and all of the drug interactions and the different nutrient deficiencies. And you know, anytime there's been a family member who's on a, you know, medication and it's like the word is like 50 characters long and you have no idea what it means.

If you go to your [01:17:00] pharmacist, they usually always have a. Significantly more information about the drug. Um, printouts. I've received like a 16 page document on a drug before, and so I do feel like, you know, if you are taking birth control or any other medication and you've never looked it up online, pulled up the prescribing information, you can also go to your pharmacist and literally just have a conversation and ask them if they have a printout for you so that you can see the side effects.

And that would go for every drug. Mm-hmm. You know, because what you were saying, that's my perfect world, like about if you were being put on birth control, even just having the conversation about signs to watch for and even just to have that conversation about these are some of the serious side effects.

Even though they're rare, you should know about them. And if you ever experience any of these things, you need to call me immediately or you need to, you know, come to my office and I don't, I'm not anticipating that this is gonna happen, but that would be the due diligence that would make logical sense.

Yeah. If we [01:18:00] cared about. The health of all of these women, the a hundred million women worldwide that are taking this drug. Mm-hmm. 

Dr. Brighten: Yeah. And it's, I mean it's interesting 'cause it's one of the few drugs that that's not done with. But I love your tip about leveraging the pharmacist. And the other thing I would add is that anytime you get a new prescription, run it by your pharmacist.

'cause sometimes patients, they fill the prescription at one pharmacy, then they go to the other pharmacy for the next prescription. Make sure your pharmacist knows about every medication you're taking. And anytime it's a new prescription, they usually will say, okay, come over here. Do a consult with a pharmacist.

That is your opportunity to lay it all out. Because there are interactions. And also that goes for supplements as well. I know they're natural, but there are drug nutrient and drug herb interactions and your pharmacist is gonna be way more educated. Your average doctor does not understand nutrition, let alone supplements.

So it feels very frustrating when you go to them and you ask and they're just like, everything's bad. Right? It's just all bad. Uh, but if you go to the [01:19:00] pharmacist, the pharmacist has a much better understanding and they can really help you guide, like, guide you. And that's like what they're there for. I think great doctors do lean on pharmacists too.

Be able to be part of the team in supporting the patient. So I appreciate you bringing that up. Um, you know, before we started recording something that you said, uh, we were talking about pain management and you were talking about how ACOG just updated for IUDs with pain management that was born out of listening to women.

So back in like, you know, 20 17, 20 18, like when we were, you and I were online, we're talking about the pill gynecologists were like, you guys are fear-mongering because you put a study up and you linked it. And then they're like, well, that research is bad. And like something I talk about with Dr. Sarah Hill because she's a researcher, where do you doctors get their information from?

Inform researchers. There's our clinical experience and then there's the research and the audacity of these gynecologists to say, this researcher doesn't understand the science. She's like, do you know how often a gynecologist tells me that? And she's like, and they'll say she doesn't [01:20:00] understand the science.

And she's like, that's my name. That's my name on the science. I wrote, I wrote the science. I wrote the science. Um, so it just, it's uh, it's kind of like mind boggling to me. But this change we've seen in the pill where like there were gynecologists who absolutely hated on my book Beyond the Pill. I was so naive.

I think part of it's just like being autistic where I was like, why would people be mad about like the science and the truth? And they're like, yeah, no, like we hate you. I was like, oh, okay. Those same people now are going on podcasts and literally saying the same things that they had videos hating me on me for back then what changed?

Women. Women who are listening right now, they spoke up. The whole reason why the US who is freaking so far behind all these other countries had pain management for IUD placement. The only reason, and, and we saw a first gynecologist fighting with people on TikTok and being like, no, you like it doesn't hurt that bad.

You are being dramatic, dah, dah, dah. I had an IUD worst pain in my life. Zero outta 10, like [01:21:00] a thousand under 10 because no negative like I am. Like I should not have gone through that. Especially considering now knowing I have endometriosis, that should have been a red flag to my provider. How much pain I was in.

Oh yeah, maybe this girl's got endometriosis. 'cause why is somebody like screaming and crying on the table? With all that though, it was women who spoke up, they, it became too many voices to ignore. And that is what we're seeing is finally changing the conversation. So I wanna talk a little bit about it because you read the whole ACOG statement on um, IUD placement.

So can you bring all the listeners up to speed on that? 

Lisa Hendrickson: Yeah, no, it was, I mean, this is something I've been talking about for a long time. On my podcast for years, I did what, what I called my Pill reality series and my fem reality series. And essentially I was just interviewing women, women from my community who had, you know, used the pill or used the IUD, whether it was the copper or the hormone releasing or whatever the case, and they would just share their experiences.

And over the years. I mean, I've heard so many different stories. I've worked with so many different clients and I didn't [01:22:00] realize, you know, the insertion pain issue until I kept hearing it over and over. So I was, I was pounding this on my podcast and I got to the point that every time someone would tell me that they used an IUDI would just ask them what their pain experiences were.

And it wasn't that a hundred percent of every single woman I talked to had a horrific pain experience, but it was like nine outta 10. Like it was pretty 

Dr. Brighten: significant. I didn't share, my friend got an IUD the week before and she's like, oh yeah, I got it. It was nothing. I walked home afterwards. I didn't walk for like.

Seven days. Like I wasn't at home with a hot water bottle, like just could not move. So I felt I was really caught off guard by it. So I just wanna be clear, like I have endometriosis and adenomyosis, which makes it especially painful if somebody's listening right now and they're like, I love my idea. I love that for you.

Lisa Hendrickson: Well, and we're just talking about one, this is the, like what we're talking about isn't even the effectiveness or criticism of the i uud functioning itself. Like we're just talking about the insertion. Yeah. Um, and so there's a lot of pieces that I find interesting. So we've talked a lot [01:23:00] about fertility awareness and as someone who tracks cycles, like we talked a little bit about the cervical position and how it changes throughout the cycle.

And I find it interesting, it seems as though women are often advised to take a little bit of ibuprofen. They're advised to come in during their period because apparently that's supposed to be when the cervix is a little bit more open logically because the blood is coming out. But logically from someone who charts the cervix is actually really soft.

Mm-hmm. And typically more pliable in the middle of the window that that's neither here nor there. I'm just saying that even that to me is like, what are you doing guys? But interestingly, so this paper came out and as soon as I saw, you know, it, somewhere I grabbed it and, you know, read through it. The paper isn't specifically only on IUDs.

It. On various procedures that would have, you know, some involvement of the cervix. Mm-hmm. So it could also be on, um, you know, procedures for cervical dysplasia or abnormal cells or those kinds of things. But I zoned in on the IUD placement. So they actually did science go figure [01:24:00] instead of just using their opinions.

But when was this about? What, what date did they finally, what year did, did eight talk? So 20, 25 July is the, what we're talking about here and the science that I'm referring to, they looked at about 24 years, um, like a of research over like a 24 ish year period. So they went back like 2000 right. To 2004, if I'm remembering correctly.

And they just pulled a bunch of studies that actually tested the effectiveness of the different methods that they used. And I just say this with a lot of indignation and holding back on, rolling my eyes. 'cause it's like obviously this would be logical, like good for you. You actually looked at what the research had to say and instead of basing your on your opinion, you looked at what was actually effective.

So while I might not remember every single detail, the study, so, and in front of me right now, um, they did obviously look at the Tylenol, which is most effective. They looked at, there's a drug, you would probably know the name of the drug that they used to soften. The cervix. The prostaglandins, yeah. Yeah.[01:25:00] 

Um, and they looked at, um, what they looked at lidocaine shot. Mm-hmm. So they looked at actually numbing the area specifically. And their recommendation basically was that the most effective way to. Reduce and deal with IUD insertion pain was quite literally the injection of lidocaine. Mm-hmm. Into the cervix.

They found obviously the Tylenol to be ineffective. The Tylenol may help overall, or the Advil, I, I keep saying Tylenol, but it was actually ibuprofen, so my apologies. But, um, the Advil could potentially help with cramping in a general sense, but obviously it wasn't going to help for the moment of insertion.

Mm-hmm. And it's like, I could have told you that, um, 

Dr. Brighten: but, but I digress. You don't have to go to medical school. No woman has to go to medical school and say, if you pinch my cervix Yeah. The Tylenol 

Lisa Hendrickson: I took this morning isn't gonna, yeah. Yeah. Um, and interestingly, the. The agent that they used to soften the cervix, they actually found that it made the pain worse and increase the risk of expulsion.

Dr. Brighten: Yeah. Meso prestol. So this is what [01:26:00] Mr. Prestol Yeah. What we do, what this is what we also use. Um, you know, if you, if you've lost a baby, that's what they'll insert. It's very good at dilating the cervix. So there's other procedures where it will be used as well. 

Lisa Hendrickson: But, but in this case, yeah. The research that they looked at it, it was consistently not effective at reducing pain.

Yeah. Caused other problems. Yeah. And so like reading this study, I feel like was a bit vindicating. I had a lot of different emotions. You know, it's, it's, it's, it was wonderful. Like you said, they're finally listening to women, so it was incredible to see, obviously irritating that this came out in 2025. So we will just leave that right there.

Um, but I think I'm so mad about it too. So you, it's like you could see the steam, right? But I think even more so what's infuriating is that that piece of paper. It doesn't change the woman who's in her doctor's office right now getting an IUD. Mm-hmm. Because on average it takes about 20 years before the research gets into the doctor's office.

So we're making progress. [01:27:00] But you know, when I was looking at the paper and thinking about the implications of it, I'm thrilled that this has happened and I'm excited at what this means, but I still feel like we just have to talk to women and let them know. Mm-hmm. Because if anyone, if you or your friend or anyone you know is getting an IUD while ACOG has created these new guidelines, that doesn't mean that.

Your friend's experience is gonna be any different. Yeah. Today 

Dr. Brighten: I have a friend, Dr. Anna Sierra, and I will link to her episode on the podcast. She's the top trained neuropathologist in the world, which means that she is the top female surgeon to actually operate and be able to dissect, uh, pelvic nerves and separate them from endometriosis adhesions.

We love her for this, but I brought this up to her of like, they're saying the cervix has, you know, gynecologist spread chain. The cervix has no ear nerve endings. And she's like, not only does it have nerve endings, it's the terminal end of the vagus nerve, which innervates your brain, your heart, your gut, like, and, and [01:28:00] so much of how your nervous system reacts.

There's that thing called a cervical orgasm. 

Lisa Hendrickson: Yes. Really? So tell me again that there's no nerve endings in the cervix. 

Dr. Brighten: Yeah, well that's also something too that gynecologists say is not true 'cause they have zero training in sex and then they'll be like, well there's no such thing, so you're imagining it.

And I'm like, I don't know. They give you, listen to women, you learn a whole lot. And that's like, I mean, honestly the best gynecologist, 'cause there are phenomenal gynecologists out there. They listen to their, their patients, they have curiosity around it. Um, you know, I remember when the great, like IUD debate was starting on TikTok, I think it was like 2020.

And there was a pain management doctor. I think it's Dr. Su, I'll tag him 'cause shout out to him. He's such a champion of women's health, but that's not even what he does. He does pain management and he was telling these gynecologists like, you are wrong. You can numb this area. And they're like, this is my level of, I'm the expert in the pelvis and you are wrong.

And he's like, but I do. This is what I do. Like I'm telling you like I'm an expert on these [01:29:00] nerves. I numb them. Like I, this is what I do. And I'm like, the ego here. Yeah. To say that this is his expert, he's an expert in this. And then you're like, you are wrong because it's found in a woman's pelvis. And he's like, what is actually happening here?

And I'm like, that is something that I'm like, that resistance, that ego has to change. And so for everyone listening, if you have a gynecologist who listens to you, who, uh, supports you, who is going against ACOG sometimes to give you the best care, please tag them in the comments. Because trust me, they are getting so much hate behind the scenes by their colleagues.

And we have to lift up these gynecologists because they are first doing no harm and they are doing a great job. And women need to know who they are and find them. 

Lisa Hendrickson: Yeah. It's. It's just unreal that this is the time that we're, that we're living in. There's so many positives, but also like the fact that you could have, you know, when I think about this procedure [01:30:00] and, you know, if, if you, if there was any conversation at all about the pain, which there might not have even been, this woman is just sitting on the table and given no heads up.

Yeah. That this could even be, well, even what's funny 

Dr. Brighten: is they say you're gonna fill a pinch girl. If there's no like nerve endings, then why this tenaculum? If people haven't seen it, it's literally like a crab's pinch. Her claws grabbing and penetrating your cervix to hold it in place, which is good. 'cause we don't want perforation when the IUDs placed.

But it's bad if you don't have pain management. 

Lisa Hendrickson: So there's just one. Just small. The thing that I just wanna mention, just, oh my God, it doesn't sound small, but let's go. So if we were like inserting, I don't know, like a metal device into the tip of a man's penis, we wouldn't even be having this conversation.

There would be entire teams of researchers determining the best and most effective way to do that procedure while keeping men [01:31:00] as comfortable as possible. Like I've had enough. 

Dr. Brighten: Mm-hmm. Well, and it's interesting 'cause with the vasectomy, I remember, uh, there, there are women, uh, and you can certainly tell your story 'cause I do enjoy reading people sharing their truth and, and seeing how it, like, it makes them feel better to share what their experience was.

But I had so many patients and so many women online telling stories of my husband got a vasectomy, he got a trunk full of pain meds. I broke my arm. They were like, Hmm, you just need a little bit of this. Or I had a C-section. No, you need a little bit of this. Oh, I had a, you know, a hysterectomy. Oh, just like, you know, take some, take some ibuprofen, like Advil like this.

And I'm like, it is wild to me. But, but I want everybody to know and I'm gonna go search out these studies and link them that, um. And I wrote about this in, in my book, is this normal? So you may have read it, but, uh, we're more likely to die of a heart attack. We, you know, I think it's something like women, um, sit in the, we spend like 20 minutes more in the ER waiting if we have the same [01:32:00] exact symptoms as a man of abdominal pain.

Um, unless you say, oh, I think I might be pregnant, then they're like, well, it could be ectopic pregnancy. But unless there's the pregnancy variable, they leave you to sit before they ever like, give you pain meds. Like there is study after study. Uh, if you PCS or endometriosis, your diagnosis time is cut by years, three to four years.

If you use the magic words, I want to get pregnant, they're like, work you up. If you don't use those words, you are looking at an additional three to four years before somebody actually takes you seriously. Like we've had big problems in women's medicine. I wanna, I wanna get into the, um, best method for fertility awareness method.

We kind of ran on a tangent, a necessary tangent I think. But something I do want to ask you is why do you think that there is still so many women in medicine fighting against. Actual female patients having equal access to pain management, to care, to quality diagnosis. Like why [01:33:00] is it because, uh, people always assume it's a man automatically, but the majority of stories that I've encountered are female practitioners who are actually gaslighting their patients about their period pain, about the pain of IUD, all of that.

Where do you think that's coming from? 

Lisa Hendrickson: So just to clarify why female practitioners are like, why women are having a harder time with female practitioners specifically, why, why are female practitioners upholding such crappy standards for women's care? I mean, I think that the, I I like if you, you have to first look at where they were trained.

Like female practitioners don't get trained in like a totally different cool female side of, of medical school, right? So they're still being trained. I mean, I will go back to the establishment and I mean, it, it's interesting that even the science that medicine is based on, it's mostly based on the study of the male body.

Mm-hmm. And um, you know, even animal studies are done on male animals. And I recently did interview Sarah Hill about her new book [01:34:00] and we love her. We love her. And she blew my mind even more when she was talking about how even when they incorporate females and female animals into the studies, they ize the, the animals, meaning they pull out their ovaries or they only gear the study to a specific part of the cycle so that it's not interfered with so the hormones matches closely to a man.

Correct. Possible. So I would say like, that's the big elephant in the room. Like do medicine hasn't necessarily studied the female body enough to really know it. We think we're at this, you know, pinnacle of science and, and so many people trust science to have all the knowledge and information. And while we have so much information, I'm very thankful for that.

I'm thankful that I can read all these research papers and, you know, share that information through my books and my work. And I'm sure you are the same. Like, it's an incredible time really to be able to share as much research as there is, but even though we have so much, obviously we've only scratched the [01:35:00] surface in terms of women's health.

Mm-hmm. Even more so with Sarah Hill's research, which is just wild, right? Yeah. Um, like there was a study that I was talking about on the podcast recently, uh, and it was about PMDD and, and they measured the, you know, estrogen and progesterone levels of the participants and the researchers determined that hormonal changes were not in effect.

They, you know, they, they were saying, well, you know, the hormones are basically the same, so it can't really be a hormonal issue. Maybe it's just that the women with PMDD are more sensitive when you look at the study. They did one test for progesterone on one random day in the luteal phase, potentially five to seven days after ovulation and.

Even like, so to kind of break that down, that's not enough information mm-hmm. To make an actual formal, you know, scientific conclusion about whether progesterone would have an [01:36:00] effect on the cycle. So I believe, you know, and I use that as an example just to kind of share, I believe we are really in the infancy with regards to women's hormones.

And that's why I love to bring stuff it all back to the cycle. You know, that's why I'm so passionate about helping women to understand what's happening in their cycle. It, it's kind of like what the vaccination against gaslighting, because now you can actually see what's happening in real time and how it lines up.

Um, but it also shows us some of the areas where maybe the research studies miss because they're not necessarily, it's how expensive would it be to take all these women and to spot test their hormones every day or every other day throughout their whole cycles. Mm-hmm. For however many cycles to really come to that conclusion.

So it's not even like, I'm not empathetic to why it hasn't been done, but on the other hand it's like, but you're making conclusions based on your limited research. So that's a long answer, but man, we have a long way to go. 

Dr. Brighten: But I appreciate that answer because I think the default in people's mind is to think.[01:37:00] 

They hate us. Gynecologists hate us. Yeah. They don't. I see that all the time. And what you just outlined is, what people need to understand is that there are so many more layers to this and that it, I mean, we didn't even get into insurance and how insurance orchestrates so much of this. Um, and so there's a lot more layer systemically that has to change.

But I think something that's very empowering is to understand that it was women's voices taking the social media that has changed the narrative around birth control pills and around IUD pain management patients have a lot of power, especially when they're noisy. So get noisy. Um, with that set, what is the gold standard best method most, uh, uh, you know, efficacious per the research for fertility awareness method?

Lisa Hendrickson: Well, so while I would love to harp on just one method, I do wanna say before I answer that, you know, within the fertility awareness world, I've been in this world for a really long time, and there's always kind of like this loving [01:38:00] in fighting where there's a lot of different methods. And if you talk to different practitioners of different methods, they'll say, well, my method is the best because of this, or my method is the best, or whatever.

Mm-hmm. So I, I do discourage that. I think the best method really is the one that works for the patient in front of you. So I do think that, and there's different motivations. So I think this is an interesting concept. So, you know, for, for some women, efficacy is the top. But even if you think about it, if efficacy, if efficacy was the top, wouldn't we all just get sterilized?

So it, there's lots of different motivations, right? In terms of what, why a person might choose a certain method. So I know I'm, you know, giving a little bit of context, but the reason I say that is, you know, for example, some women are really happy with Athermal method of birth control. Um, other women don't wanna touch their mucus.

Some women never wanna touch their cervix. Uh, some women don't wanna have to take their temperature. So there are actually different methods that would account for that. But to [01:39:00] answer your question about efficacy, we've talked a lot about that. And, you know, the method that has found to have the highest consistent efficacy would be the double check symptom thermal methods.

And again, those methods are having the women check cervical mucus checking basal body temperature, comparing those two signs so that when you're closing the fertile window, you're comparing two different signs. And of course when you have two different, you know, biomarkers that you're comparing against each other, you're gonna have a higher efficacy.

And similarly, I've mentioned double check symptom thermo method. And in that sense, um, those methods are having a last and first all day calculation. So they're actually using past cycle data to, you know, con, you know, to give you an actual. Cutoff day. So if you're, you know, going into your cycle, your period has stopped, you actually have a specific day where either I see my mucus first, or I have this cutoff day where I'm gonna stop having sex.

And that method, when we look at the research time and time again, has the [01:40:00] highest efficacy. Mm-hmm. Um, and the reason for that, once again, is that the pre ovulatory phase is really the only phase pregnancy can happen in, because that's the phase where ovulation takes place. Once ovulation has happened, the egg survives for about 12 to 24 hours.

If it's not fertilized and then it's disintegrated. So once the egg is dead and gone, pregnancy really can't. Happen. So, you know, the reason why this method has the highest efficacy is because it really does help women to have more structure for how they're handling the fertile window. Mm-hmm. And I mean, one of the, when I'm teaching fertility awareness, one of the, the units, uh, we have our managing fertile, managing the fertile window unit.

And one of the things that I talk about is this, getting into it. Like, why does this, the method fail? What happens when a woman is using the method and, and she becomes pregnant and she didn't anticipate it. And so the majority of those failures are not necessarily method failures, but user failures.

Mm-hmm. In the sense that you were having sex on a fertil day. Yeah. And why does that happen? [01:41:00] Right. Where, you know, you might be thinking to yourself, it's too early. I never ovulate this early. It was just a little bit of mucus or whatever. So talking through those things, understanding those things, but also choosing a method and understanding the guardrails and actually following them.

Dr. Brighten: If you could give a bullet point list of like, what are the key things that you're being measured with this method? I think that would help just lay it out for women, 

Lisa Hendrickson: the key things that are being measured in 

Dr. Brighten: for this particular method. 

Lisa Hendrickson: And do you mean in the sense of like charting and efficacy, or do you mean in the sense of like other hormonal things or 

Dr. Brighten: No, no 

Lisa Hendrickson: efficacy.

Dr. Brighten: So if you, if somebody was like, okay, I want, I wanna do the best method, the one that the research has the highest efficacy, if we could just run through a punch list of like, these are all the things that are measured. I want everyone to understand this podcast will not be enough for you to start fertility awareness method and these success.

I would recommend working with a fan educator, but just so that people can kind of wrap their mind around [01:42:00] like, what goes into this? Like, I'm checking fertile cervical mucus. Like what are, what are the parameters that you're gonna be measuring? 

Lisa Hendrickson: Well, so I mean. I mentioned cervical fluid and basal body temperature.

And so like in a podcast setting, we're talking about it in a general way where, you know, it's just tracking your cycle, but when you get into the nitty gritty details, you'd be checking for cervical fluid on a daily basis. Um, different methods teach how to check for mucus in different ways. So some methods might encourage you to check internally.

Some methods might encourage you to kind of check how you feel throughout the day. Um, the method that I teach, we do external wiping with toilet paper, and we have a whole standardized system of characterizing mucus. So from that standpoint, then we're able to get more into the weeds and be a lot more specific.

Mm-hmm. So for example, if you're wanting to. Understand cervical mucus and really use it as a marker of fertility. To avoid pregnancy, you're gonna wanna get really clear on which days are fertile, which days are not, and get into the weeds when you see different types of mucus or different amounts so [01:43:00] that you can really be clear on that.

So one of the positive things when you're working with an instructor, depending on the method that you're using, is that you get really, really clear on how to identify what's a fertile day, what's not, what the different types of mucus presentations are, and how to actually track that so it does go deeper than what we're casually talking about today, so that you have a much better understanding of that.

Um, and so within that, the, the mucus aspect of it, we would identify your fertile days based on your mucus presentation. And you know, when your mucus actually, when you ovulate, one of the things that happens is that as your, as your progesterone rises, that shuts down typically mucus production. So not all women will find that they have absolutely nothing and totally dry, but you will see a significant shift in change in the amount, um, and the type of mucus that you observe after you've ovulated.

So within the method, you would be able to identify that, and that's one of the signs that you use to confirm [01:44:00] ovulation. And then when we look at temperature, you know, I could, I could spend a whole hour talking about all of the different aspects of temperature, but just to, to kind of make it shorter. I even advocate for a standardized weight of taking the temperature so that you're taking enough time to warm up the thermometer so that it's giving you an accurate reading and more consistent patterns.

Knowing what can impact the temperature and being able to chart. Like if you're having a glass of wine, your temperature could be up. So, um, basically with the method you are looking for the temperature shift. You're looking for three temperatures that are higher than the previous six. You're taking your temperature first thing in the morning, every, every day.

Um, there's different t charting apps that you might be using as well. There's different thermometers, like there's a whole conversation around that. Um, but the bottom line is that when you're getting into the weeds, the main markers that you're tracking would be the mucus and the temperature. You learn how to confirm ovulation with both, and then you crosscheck that information.

And this is why, um, I always say that if somebody is [01:45:00] wanting to learn this method, you will never have enough information in a casual conversation. It doesn't mean that it's so complicated. It just means that like, like I learned how to drive standard when I was in my twenties and like, it took a little bit of time.

What a standard mean? Oh, like a car, like the Oh stick. 

Dr. Brighten: Yeah, that's what we call it in the US stick. Alright. That's 

Lisa Hendrickson: what I learned too. Well, yeah, I, I've Standard or stick, I've heard both of them, but standard, I've never heard standard. 

Dr. Brighten: I'm like, I like that. That's, I grew up in the woods and the mountains.

Okay. Maybe like nobody else calls it stick. 

Lisa Hendrickson: No, no, no. I've heard that before. So you're not allowed. So yeah. So I learned how to drive stick, right. But at the end of the day, like it wasn't that I could just. Like read a little something and just like, it took a, a little while, it took a few weeks of me actually doing it to get the feel of it and to kind of understand it.

And I think that that's a good analogy for this. You know, there's the learning about it. But if you're really wanting, I I, I, I want women to be successful with this. There are a lot of [01:46:00] women out there, and even when I post certain things on my social media channel, I'll post about the effectiveness and there'll always be a couple people like, well, it didn't work for me.

I got pregnant, whatever. And just like you said when we were talking about the efficacy of like, well, I was using this method, and it's like, well, really, they were using pullout. Pullout, but they probably weren't doing that directly. Right? Yeah. So, you know, I really want women to be successful. And so for that reason, I think that if I go back to the, the, the study that I was, I was kind of talking about when I mentioned the efficacy and I mentioned the 99.4% efficacy of perfect use in the 98% typical use.

That study wasn't a bunch of women who heard a podcast and like bought an app, right? Mm-hmm. These were women who were trained by educators who were obviously, you know, certified in the method. They were taught over a certain period of time. They had a certain number of sessions and they were kind of followed through that process.

So they were really set up for success and that was why they were able to be that [01:47:00] successful. So bottom line, like it is effective and. You will get, you will have the highest success in the shortest time if you work with an instructor. 

Dr. Brighten: Mm-hmm. And, and I'm glad that you know, you, you said that, 'cause that was gonna be my question is like, how did these women actually achieve that?

Uh, there's gonna be people listening who don't know what basal body temperature is, and we've used that a few times in the podcast. Can you define that? 

Lisa Hendrickson: Yeah. So basal body temperature is a word for, um, kind of like your resting or baseline metabolism. Uh, and that's, so for example, if you were to have, if you were to, to sleep, so your body's at rest for a minimum of about five hours or more.

So just picture, you actually go to sleep or whatever before you get up. Before you start moving, before you start changing your body temperature and changing your metabolism, you would take your temperature. And that's kind of the idea behind taking your temperature first thing in the morning before you wake up.

Um, 'cause you're actually kind of getting that reset number of when your body was at [01:48:00] rest. 

Dr. Brighten: Okay. How do you feel about wearables that are tracking basal body temperature? 

Lisa Hendrickson: So, I mean, I, I, I, I even endorse some of them. Everything that I, that I do goes back to that informed consent piece and just really understanding what data you can gain from some of these and what you can't.

So with a lot, and this is not a knock, I'm just, just for anyone who's like, this is a knock, it's not a knock, it's just what it is. So with a lot of the wearables, they are not actually measuring basal body temperature. Technically what they're doing is some of them are measuring like an average temperature or like an average sleep temperature.

And many of the wearables also have different algorithms. Some of them you can shut them off and on, but um, you know, they're super convenient. So there's a lot of positives. So like I said, it's not a, it's not a knock, I'm just trying to explain what it's doing. But, so with these wearables, I think the intention behind it, there's a couple things.

I think one of them is like, how do we monetize fertility awareness? You know, and it's like, well, [01:49:00] you know, thermometer, let's do that. So I think that that's definitely it. But the other thing is that temperature is variable. This is why I really appreciate the symptom thermal method for having two markers that we're always, um, comparing against.

Because in every cycle you'll have at least one kind of out there temperature, and even you'll have a little weird maybe mucus situation. So it is really helpful to have two markers. So I believe that these devices are really aimed at. Addressing some of the common pain points or challenges that women have with taking their temperature, like getting up at the same time every day?

Like, what if you have to get up earlier or later and, you know, if you did have that glass of wine or Yeah. Have, how does the glass of wine affect us? Well, so for some women it's really, it's just really interesting when you watch their charting. For some women having the glass of wine the night before, um, the next day, their temperature would just be super high.

So when you're looking at the actual chart, maybe all of the temperatures are in a certain range and then all of a sudden there's one at like 99 [01:50:00] and you're kind of like, well, what's going on there? And, you know, over the years, I'm not, there's not a blanket thing that I can say. Every woman is gonna respond the same way to alcohol, or every woman's gonna respond the way, uh, the same way to waking up at different times.

What, what I teach in, in my programs is to understand the factors that can affect temperature and then start to have your clients chart and put their data, like what were they doing that day if they did have a glass of wine or if they did have a cortisone shot or whatever. Yeah. And then you can start to see how it affects their temperature.

But at the end of the day, like even what I just described, like there's a lot of different things that can affect it. So with the alcohol specifically, some women find that the following day the temperature's really high, and that can be confusing. And then obviously, you know, if you get up at six o'clock every day for work, but then on the weekends you get up at 10, then what can happen is the, the later temperatures or the later time that you got up, the temperatures can be higher.

So I think with a lot of these [01:51:00] devices, they're there to try to simplify it mm-hmm. And make it easier, which is, makes a lot of sense. If you have little kids, if you have a new puppy and you're always up in the middle of the night, obviously, you know, so what a lot of them are doing by doing this kind of average, you know, sleep temperature throughout the night is giving you more of a seamless temperature charting experience and, and smoothing out some of those curves and some of the, the, um, devices that have algorithms.

The algorithms also kind of smooth out the curves. So the pro is that if you do have a really challenging. Schedule of work, if you work night shift or if you did just have a baby, or if you do have a new puppy, then it can be easier. It kind of takes the pressure off, you know, and it, it still works very effectively for the most part to confirm ovulation.

But I would say, you know, just as a piece of information, because it's many of these devices are not actually measuring that basal body temperature. Mm-hmm. Technically, if you were to try to gain additional information, like for example, if you are [01:52:00] tracking your cycle and you're doing like a regular oral temp and you're noticing that your temperatures are super low, like they're off the chart, sometimes that can be an indication of metabolism.

Obviously it could be an indication of an issue with thyroid or even just a undereating situation. But if you're doing the devices you can't really get the same information. So I wouldn't really recommend using the temperature for that purpose. Mm-hmm. Only for charting. 

Dr. Brighten: Okay. Can we do some rapid fire questions?

Sure. Alright, so here's my first one. If someone wants to avoid pregnancy with fertility awareness method, what's the number one thing they need to know? 

Lisa Hendrickson: I think that, yeah, I think you should work with an instructor. 

Dr. Brighten: Okay. On the flip side, what's the fastest way to use fertility awareness method to get pregnant learning mucus?

Ah. How does this approach work for women with PCOS? 

Lisa Hendrickson: So with PCOS, um. In many ways it's the same. I dunno how rapid this is gonna be. But with PCOS, obviously one of the big challenges is long irregular cycles. 

Dr. Brighten: [01:53:00] Mm-hmm. 

Lisa Hendrickson: So the myth is that if you don't have regular cycles, fertility awareness can't work. But fertility awareness is not based on.

The calendar calculation situation, it's based on observing what's happening as it unfolds. So with PCOS, there's just certain challenges that you need to overcome. So A-P-C-O-S cycle often will have many more days of cervical mucus or multiple patches of mucus, and you just have to learn how to work through that.

If you're trying to conceive, then. I think it can be actually really helpful. Imagine if you had a 45 day cycle or a 50 day cycle and you're just being told to have sex every day. 

Dr. Brighten: I mean, a lot of doctors say that. 

Lisa Hendrickson: Yeah. Like that's great advice not, but um, the fastest way to get out of the mood is to be forced to be in the mood all the time.

Yeah. And so if you chart, while you will still likely have many more days of cervical fluid than in a typical cycle. 'cause in a typical cycle you might have a week's worth of [01:54:00] mucus. But if you have a 50 day PCOS cycle, you may have multiple patches of mucus or several days of mucus lasting over 20 days if you added it altogether.

But the. Positive is that you could learn which days or which, you know, the days that you have the clear stretchy mucus in the best quality or the most amount, those are the days of, you know, peak fertility. So you can actually, while you still may have to have more sex than somebody who has a normal cycle, at least you can time it and at least you can kind of understand one would be the best.

Dr. Brighten: When someone is not seeing fertile cervical mucus, what are the, like the top culprits? 

Lisa Hendrickson: So there's, there's a lot of different reasons. I mean, the first thing I wanna know is if they're, if the cervix is healthy, if, if they had a, a history of cervical dysplasia or any type of cervical surgery. So, mm-hmm.

I've just observed and IUD placement, I'm, I have the hypothesis that after all that we talked about, it doesn't seem that out there. But, you know, I have this hypothesis because often in women with, uh, who've had [01:55:00] IUDs placed in the past, I'll sometimes see this like lower mucus presentation and I kind of wonder if it did anything to the cervical creps anyways.

So, um, history of HPV history of cervical surgeries can be associated with lower mucus. If a person has been on the pill for an extended period of time, that's can be associated with lower mucus presentation and then certain drugs can be associated with it as well. I mentioned his antihistamines earlier, so if someone's actually actively taking allergy medication that can like.

Fully suppress their mucus for um, or mostly suppress it. So that's something to be aware of. And then on the hormonal front, if somebody really is undereating or over exercising, that can do it too. 

Dr. Brighten: Mm-hmm. Can fertility awareness method work in perimenopause when cycles are irregular? 

Lisa Hendrickson: Absolutely. Uh, again, the myth is that the cycle has to be perfect, but that's because we think of fertility awareness as the rhythm method we think of, you know, it has to be regular because we have to be able to guess and anticipate when ovulation is [01:56:00] happening.

So in the same way with A-P-C-O-S cycle, you kind of have to understand what the different signs mean and track it as it unfolds. Uh, with perimenopause cycles it can be extremely helpful because you would be able to identify potentially based on mucus, if an earlier ovulation was happening, you would be able to identify how your body's responding to the different changes that are happening, even by looking at your luteal phase length.

So I think there's a lot of benefit to tracking your cycle, especially during those years. 

Dr. Brighten: Yeah, and I just wanna add onto that we don't have a great way to test you to definitively know based on blood work if you're in perimenopause because it can fluctuate so much in the early years, but you tracking your cycle and once you say like, yeah, my cycles are like 60 plus days apart, we're like, and we are on the descent now.

Now we are on our way to menopause. That is if you're, you know, if you're in your forties, if you are somebody who's in your thirties, I just want you to know that menopause is not considered normal before age 45. So if you're like, I'm 25 and hearing this, or [01:57:00] 35 and hearing this, that doesn't mean, just assume this is perimenopause.

What are the most common mistakes people make when they first start charting? 

Lisa Hendrickson: I would say, uh, definitely what I call rhythm method thinking. So Uhhuh getting on the 28 day track, the 14 day, and making assumptions. So I always say like, your app doesn't know what's in your panties today. Like if you're trusting the app true that they literally did a check for me kiss, they better not know.

Right? How invasive are these apps? Where did this picture come from? Right. But yeah, so I would say that's the biggest thing because it is a, it is a real shift. Like it's a perspective shift to go from thinking that it's based on the 28 day cycle situation to be, 'cause it's, it's not always easy. Your cycle is not always gonna unfold how you think.

Anyone who's charted their cycles for more than six months or six cycles will already know that you're gonna see things that you didn't think you were supposed to see. You were gonna experience things that you didn't think were possible. I've seen plenty of charts that [01:58:00] people would actually like tell me like, no ovulation couldn't have happened in that chart or whatever.

So again, we're not robots. So always remember that. Um, and you just kind of have to be able to go with the flow. So this is the mindset shift of, of recognizing if you see mucus before you ever did, or if you don't see mucus and then you see it later in the cycle. Yes, it's possible that ovulation can be delayed or ovulation can happen early, or you can have an anovulatory cycle and you wouldn't know before.

You just have to kind of be in that moment and track it. And what I always say to my clients is, you wanna approach charting as an objective journalist, and that means that even if you don't think you should be seeing what you're seeing, just write it down. And then once we get to the end of the cycle, we can go through it together.

Dr. Brighten: I love that. If you could challenge listeners right now to doing just one thing over the next seven days to improve their cycle, what would that be? 

Lisa Hendrickson: Uh, eat more protein. Eat protein rich breakfast. 

Dr. Brighten: Why? Well, I mean, I know why, but [01:59:00] I am like, I just honestly didn't see that one coming from you, but it's an obvious one.

Yeah. 

Lisa Hendrickson: Yeah. Well, 'cause the, the question was to improve the cycle. Mm-hmm. And I mean, one of, one of the things, there's a, there's several things that come up when you start looking at your cycle, as I'm sure you know, when you start looking at your cycle, all of a sudden you're faced with your mucus patterns and you're kind of like, what's going on there?

You're faced with when ovulation is happening in the cycle, if it's happening when you think it should be, or if it's happening later, earlier. But you're also faced with your luteal phase. And again, it's very, very telling. And I think for a lot of, that's just why low progesterone is one of the biggest, probably searched topics on the whole internet.

And why, like, you know, that is a whole topic. So when you are charting your cycle and you start to see things like lower temperatures and you start to see things like scan cervical mucus, and you start to wonder why your luteal phase is only 10 days and you start to wonder why you're having spotting or you're having this, these PMS symptoms and it's always right before your period and all those kinds of [02:00:00] things.

I, I don't have magic for you, but we just, you need to eat enough protein. 

Dr. Brighten: Mm-hmm. 

Lisa Hendrickson: Like, especially if you're working out. So if you're exercising, you, you, this is something we should be paying attention to. And I would say the reason that it's so important is because, again, if for me, I'm looking at the chart in real time, this is, this is what I do.

And so, you know, when we see those low temps, when we see that short L deal, the, that's the, the foundational block. So while it might be great to be like, oh, we need to go and take this supplement or that supplement or do this magical thing or whatever, I always like to take it back to the, what we call the foundational factors in my program, which that's what you can do to make the biggest improvement in your cycle today.

Dr. Brighten: What do you think people can expect to see change in the next five years in the fertility world? 

Lisa Hendrickson: That's a good question. I don't, I don't really, I know what I would like to see changed. Oh, tell us. I want your, your list. But I don't know that that's what we're actually gonna see. Um, but what I would like to see changed [02:01:00] is I, I would, I would like to see menstrual cycle charting as a standard part of how women are cared for.

If you're working with women of reproductive age, what better way to support them than to actually have a window into what's going on in real time? And, you know, if and when she needs additional testing, what better way to do that than based on what's actually happening in her cycle in real time timing things based on the actual stage of the cycle that she's in, instead of living in this imaginary fake bubble where we can just pretend that we can keep doing things the way we have and doing things based on a certain day, regardless of what, so that is something that I would love to see in the future.

Uh, I think that it is possible. I think that it's happening. There are, it has been really amazing to see over the past 20 years what is happened with the field. When I first started my podcast, you know, the average health professional wasn't really talking about the menstrual cycle as the vital sign.

And now a lot of people are. Mm-hmm. Um, you know, there's a lot more [02:02:00] medical professionals that are in this space now that are learning about the cycle and incorporating it into their gynecological work, into their surgical work, into their hormone workups. So we are seeing a shift. Um, and, and that's what I would really like to see.

I would like to see, because when you actually base things on what's happening in real time in the cycle. You're actually helping her, you know, and you're basing what you're doing on actual facts and data as opposed to whatever biases you have. And one of the things that I love about this, you know, field of kind of charting and chart interpretation is that if you, every, we all have our biases, right?

So as a practitioner, if you're working with somebody, you already have your biases. You already have your protocols in your head of what you think is gonna work. But when you incorporate the chart into it, sometimes your best protocol that's worked on so many of your patients doesn't touch this person.

Mm-hmm. Because you don't see any change. And that forces you to become a bit more of a, a scientist and investigate, but it forces you to really address the [02:03:00] woman in front of you. And so, you know, personalized care, I think would be where, what I would love to see. 

Dr. Brighten: I love that. Well, thank you so much for taking the time to sit down with us today and share all of this information.

This has just been such a rich conversation. 

Lisa Hendrickson: I really appreciate it. Thank you for having me and obviously for your great questions and, and yeah, I really appreciate it. 

Dr. Brighten: Thank you so much for joining the conversation. If you could like, subscribe or leave a review, it helps me so much in getting this information out to everyone who needs it.

 

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