Restoring Health After the Pill

Welcome to Everyday Wellness podcast. I'm your host, nurse practitioner, Cynthia Thurlow This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives This is the start of a new Thursday series called The Midlife Minute that is really designed to address listeners' questions in a little bit longer length of time and or deeper dive into topics Ideally, we're gonna keep these podcasts under twenty minutes. Occasionally, we make over to thirty but I'm trying to reinforce some key concepts and ensure that I'm addressing listeners' questions in a way that's really helpful. So the questions that I will be addressing, topics are gonna be items that I'm being asked over and over and over again. I hope you enjoy this series. Please share with your friends. And as you know, you can always send your questions to support at Cynthiaurlo. com. I appreciate each and every listener Okay our latest Midlife minute is talking about oral contraceptive use in perimenopause and menopause and how many women start this in their teens or twenties and they continue oral contraceptives plus or minus for contraceptive protection, or even to help control or ameliorate symptoms. I posted on Instagram yesterday. I got tons and tons of questions about this specifically, so I thought it might be interesting to unpack this in greater detail, really looking at the research And we know that millions of women are prescribed oralontraceptives, many of which are utilized to control perimenopausal symptoms, heavy bleeding, cycle irrecularity mood alterations. And when they stop, sometimes there's no roadmap or guidance provided. And so I thought this would be helpful today You're going to see me looking at notes because I did pull up a bunch of research And I want to be really clear, stopping oral contraceptives and perimenopause and menopause is different than when we're in our twenties, largely because our hormonal landscape is so incredibly different in midlife as opposed to when we're in our peak fertile years. So let's talk about what birth control actually does before we unpack the net impact on our bodies. So number one, oral contraceptives work by suppressing the hypothalmic pituitary ovarian ais that essentially shuts down communication from the brain to the ovaries. In our twenties and thirties, the suppression is superimposed on a functionally, hopefully, hormonally appropriate system, which starts to unwind in perimenopause and menopause We know that in perimenopause Hill is essentially creating an artificial hormonal environment on top of an already changing biological environment. AKA alterations in progesterone and estrogen and testosterone in perimenopause and menopause I think a lot of women don't fully understand that the pill in many instances is actually suppressing symptoms, which makes them feel better, but it's not necessarily fixing the root cause of what's actually transpiring I think most of my listeners know, oral contraceptives contain synthetic Estrogen and progestin, theseese are not bioidentical or body identical hormones And they create a relatively flat hormonal landscape as opposed to the hormonal fluctuations we have in our peak fertile years and even in perimenopause. And things like hot flashes, night sweats, a cyclirregularity and other perimenopausal type symptoms are often blunted or absent while on the pill. which for many women alleviates symptoms. So if you're someone that is in perimenopause and you chose to take oral contraceptives, there's no judgment. It's just providing some much needed education up front. And we know that Singly molecules like FSH follicular stimulating hormone, glutenizing hormone These are pituitary hormones that start to unravel in perimenopause. they're suppressed by the pill, meaning that standard perer menopausal or menopausal labs are not going to be reliable and largely meaningless if you're taking oral contraceptives. Research published in menopause confirms that FSH levels cannot reliably indicate Menopausal status in women taking oral combined contraceptives, which means many women on the pill are really, literally and proverbially. Flying blinds So what happens when we stop? Number one, when women stop oral contraceptive use after long term use, the hypothalamus pituitary ovarian axis begins to reactivate. But a woman in her fifties, what reactivates is this hormonal environment of perimenopause or menopause, not the hormonal environment of a woman in her peak fertile years. I was on the pill from like sixteen to thirteen thirty ish, thirty one, thirty two So sixteen years and when I went off I started documenting, I was looking at my temperature throughout my menstrual cycle. It was very clear, very quickly. Even three, six, more months out, I was not ovulating at all Now whether or not that was a byproduct of mild thin phenotype, what used to be called PCOS, now called PMOS We're not entirely sure at this point, but it was very clear to me that I was one of those outliers that was not getting this regular menstrual cycle. that a lot of my friends didn went off the pill and instantly got pregnant or had no issues with their hormones returning to vibrant levels. That was not my experience So for some people Coming off the pill in perimenopause menopause may feel abrupt And it's because we're going from suppressing are natural cycling hormones with synthetic hormones and then coming off. A lot of women when they come off the pill, in their forties and fifties will actually start experiencing symptoms. So more often than not, hot flashes and night sweats because the synthetic estrogen is now gone. So that buffer is gone. These can be significant in intensity. Obviously, I think that I tell all my patients that the perimenopauseal menopause transition is as unique as the female. Andrea Donsky's team has identified over one hundred perimenopausal symptoms. So if you're listening and you're like, I went off the pill and I didn't have a lot of symptoms That's great, but a most women do at this stage of life. Research in the journal, Mauratius has shown that vasom motor symptoms can emerge or worsen significantly in the months following discontinuation in perimenopausal women So obviously, you can have cycle changes. A woman in her fifties who stops the pilming experience in a regular cycle, very light cycles or no cycles at all. and it's impossible to predict which of those you're going to experience. Same thing happens in your forties The absence of a withdrawal bleed, which is not a real bleed when you're on the pill, you know for many women not having that with bleed, it can be disconcerting because they've had it this kind of rhythmic. they know they're going to go twenty eight days and have this withdrawal bleed And I think for a lot of women, they don't even know that the withdrawal bleed they experienced while on oral contraceptives was not an actual shedding of their lining. It actually wasn't. We see a lot of mood changes when oral contraceptives are stopped. Some may feel like their emotions are blunted or even flat. We use the term anhedonia For some people, stopping can bring a period of mood instability as the brain's neurochemistry readjusts, specifically things like GABA and serotonin that have been affected by the synthetic hormones. So remember, GABA and progesterone go together, serotonin and estrogen go together, but these are impacted when we're taking synthetic hormones Research published in Jama Psych found that hormonal contraceptive use was associated with altered mood regulation Discontinuation can produce a rebound effect, particularly women with a history of mood sensitivity. I had terrible PMS on the pill. I had no PMS off the pill. So I think for every woman, it is very much a bioindividual thing. And what most clinicians do not actually tell women is that a significant portion of the post pill mood changes are gut driven We're going to get to that. The microbiome disruption from long term orocontraceptive use can directly impair serotonin and GabA, compounding the hormonal mood component with a neurochemical gut component that requires its own targeted intervention I certainly experienced this. I remember thinking, I had horrific PMS, very, very, very flat mood And then as soon as I was off the pill, I felt great. I felt much better We know there can be libido changes when you come off the pill. We know that oral contraceptives raise sex hormone binding globulin, a protein that actually binds to testosterone. The cruel irony is that it protects you from getting pregnant, but then you have no libido. Long term oral contraceptive use can persistently can produce persistently elevated sex hormone binding globulin even after discontinuation a phenomenon sometimes called the post pill SHBG persistence effect. And research published in the Journal of Sexual Medicine found that SHBG levels remained elevated for up to six months after stopping oral contraceptives with some studies suggesting even longer persistence in long term users Something I hear constantly from women in our community and something I understand personally is this Nothing about your effort has changed and yet our bodies are responding differently Your midsection feels different, Y blood sugar is much less stable and your cravings may have shifted And let's be honest, your energy probably isn't what it used to be As a nurse practitioner with over twenty five years of experience, I want to be completely transparent with you about why. Estrogen is one of the body's master regulators of metabolic health It influences how we store fat, how our tissues respond to blood sugar changes, and how efficiently our metabolism functions at the cellular level As estrogen shifts during perimenopause and menopause, the same lifestyle choices, diet, exercise, sleep genuinely do not produce the same results. This isn't a failure of effort. It's a precise biological transition, and most solutions don't address the root causes That's why I want to tell you about mit acute hormonal metabolic control It's formulated with S equL, which is a highly bioavailable phytoestrogen that supports healthy estrogen signaling We know that eighty percent of women cannot produce S equL naturally because it requires specific gut bacteria most of us just do not have. This formula bypasses this entirely. It also includes a particular bacterial strain B breve, which works via the gut hormone access to support estrogen pathways and help ease occasional bloating and chromium to support healthy blood sugar balance. This is a targeted cellular support for the transition we are all in and's designed specifically for women in perimenopausea menopause and built around what actually is effective Go to wWW dot mitoQ dot com slash Cynthia and get ten percent off your first order Again, that's mIT oQ dot com slash Cynthia to get ten percent off your first order Again, I use myself as an example My generation was put on oralchondrptives for every single type of menstrual like irregularity known to man mine I regular cycles for years Even if it wasn't for contraceptive purposes, my generation was put on oralontraceptives because that was one of the very few treatments to address this. And we know that low free testosterone comombined with sex hormone binding gllobulin being up can translate into low libido reduced clitoral sensitivity and vaginal dryness Yeahay, yay, those fun things. This is one of the most undertreated and under recognized consequences of long term contraceptive use, not just in younger women, but in middle aged women We know that we can see skin and hair changes, specifically synthetic estrogen has an anti anrogenic effect It suppresses the mild androgen excess that can drive acne and hair thinning. When the pill is stopp, the relative androgen excess of the post menopausal hormonal environment can produce acne flares and changes in the hair, texture or density Huge pain point for women I don't see as much acne, but there's a lot of pain points around hair And this is where people will ask me, you know, what do you do for your hair Why do you have such the care Maybe this is like one of those few things that has not knock on wood has not been an issue for me. but I know for many, many women, this is a huge problem, whether it's low ferritin, combined with thyroid issues, combined with sex hormone changes a lot of women and then you add in the use of GLP one s, we know that fifteen pound weight loss is kind of that entry point for when we start seeing significant hairs shedding And so just keep in mind, hopefully if you are experiencing changes in hair after stopping oral contraceptive use, hopefully that will change. I'm just looking at my notes to make sure I stay on tack And here's the one thing that I found really interesting as I was writing the menopause gut Again, the missing conversation that Hen's having, this piece of the post pill conversation is almost entirely absent from mainstream medicine. And it is the piece that I think you all need to hear about. The oral contontraceptive pill is not just a hormonal intervention, it is a microbial intervention. And the consequences for the gut microbiome are significant meeasurable and in many cases, persistent after discontinuation For a woman in her forties and fifties, coming off of long term oral contraceptives, the gut disruption is not a side note. I think it is a central driver of the symptoms you are experiencing and it requires its own kind of dedicated process So what does the research actually show about the use of oral contraceptives in the gut microbiome? Now, I did discuss this in the gut the menopause gut But just to kind of reiterate and I have like multiple things here There was a A longitudinal study that was done, the most rigorous human study available initially found no significant change in diversity after oral contraceptive initiation, a more accurate framing looking at cross exxional study suggests minor associations, but the research on oral contraceptes' effects on gut diversity shows mixed findings. cross sectional studies suggesting modest changes and the only longitudinal human study showing no significant diversity shifts within six months of initiation though functional microbiome changes were observed For a woman in her forties and fifties who's already experiencing the natural microbial changes that I talk about in the book, the decline that accompanies perimenopause and menopause, long term oral contraceptives compounds this loss significantly. So we know we get a reduction in diversity, beneficial species, more inflammation. This gets magnified when you're taking oral contraceptives. The triple hit that most clinicians are not talking to their patients about is that oral contontraceptive driven dysbiosis. layered on top of the natural microbial decline of perimenopause and menopause, layered on top of changes in the astrobolome from declining endogenous, meaning the aestrogen our body makes These three gut microbiome insults. out problematic. So you know I understand We make choices about how to manage our symptoms in midlife. No judgment I just think if you're taking oral contraceptives and perimenopause and menopause You have to it's like you have to be thinking even more thoughtfully and methodically about your gut We know that and next we're going to talk about the asterbolome Oral contraceptives directly alter the composition and function of the aestrobone, the community of gut bacteria responsible for metabolizing and determining how much estrogen we are recirculating This is really, really important Because how many of us were on oral contraceptives for five, ten, fifteen years, or longer We know that synthetic estrogens and oral contraceptives are metabolized differently than the estrogen our body makes. They alter beta glucoronidase activity. This is the key enzyme that helps cleave off estrogen helps us process, package and poop it out, and changes the estrogen metabolite profile circulating in our bodies Research published in the journal Gut Microbes has shown that oral contraceptive use shifts the balance of estrog metabolites Cord's pathways associated with increased inflammatory signaling and altered hormonal feedback And when the pillows stop The strobum simply does not reset. This is a big takeaway. It It has been operating in this synthetic hormonal environment potentially for decades. Hello, sixteen years. and may require active restoration to functionally optimize in the conteact of a woman's natural now significantly lower Eestrogen environment Okay, this is exactly why my book is so important. and this is why I will be creating content and programs moving forward because I just think there's such a need for it. We also know people that are taking oral contraceptives are at increased risk for leaky gut So we know small intestinal hypermeability. multiple studies have linked oraloc contraceptive use it to leaky gut. The mechanisms involve in altered tight junction expression and changes the mucus layer that protects the gut lining. A twenty twenty study in the World Journal of Gastroenterology identified oral contontraceptive use as an independent risk factor for leaky gut, particularly with long term use. Guys, this is huge As someone who has had one, two, three, four autoimmune conditions, I think that, you know, you take susceptibility, so high A scores for me, you know, layer and oral contraceptive uses, it's like the perfect storm for why women are know, we're just seeing escalating rates of autoimmune conditions. You know increased permeability of the small intestine allows bacterial end the toxins to leak into the bloodstream, thingsings like liposeep poolysaccharides And this drives chronic, low grade inflammation that underlies so much of what we're experiencing in midlife anyway. And for women stopping the pill in her forties and fifties, this means you may be entering menopause with the gutline that has been compromised for years I don't share this with you to scare you. I share this with you to empower you. And the systemic inflammatory load from all that permeability for long term use. Let's talk about higher risks of inflammatory bowel disease. There was a landmark study published So I'm just looking back and forth paper that was published in Gut reported an association between oral contraceptive use and Crohn's risk The one point five one pooled relative risk comes from the Cornish meta analysis in the American Journal of Gastroenterology. I mean, here it is, you think about this One point four four or actually one point five one pulled relative wrisk This risks appear to be duration dependent, increasing with longer use. So if you've been on oral contraceptives for you for a long time, that can increase the likelihood that you could potentially go on and develop Crohn's. Again, the proposed mechanism related to oral contraceptive use inflammatory bowel disease changes in gut microbial composition, leaky gut, altered mucosal immune function, all of which just create the perfect storm for inflammatory bowel disease. And let me be really clear, this doesn't mean that if you take oral contraceptives, you're going to develop inflammatory bowel disease, but it just increases the likelihood if the right parameters are set. We also know that oral contontraceptives alter bo acid metabolism and fat digestion. I talk a lot about how estrogen' so important for bile acids. Oral contontraceptives alter bile acid metabolism. The liver produces the bile acids that are essential for fat digestion. They help break down and emulsify fats, and the absorption of fat soluble vitamins, vitamin A, vitamin D, vitamin E, vitamin K The changes in biile affect the gut microbiome directly. This is also why HRT is not does not yet have another clinical indication yet But another reason why I think HRT is so important is estrogen is declining. It changes the way we break down and emulsify fat. Bile acids are signaling molecules in our bodies that regulate microbes in the gut and change bile acid profiles Research published in the Journal of Hepatology has documented that oral contraceptives associated chleostasis and alterations in bile flow that have downstream consequences for both fat digestion and microbiome composition I was someone in my first pregnancy where I had chleoostasis. I had a very did this two or three weeks of horrific itching. Thankfully, I didn't have elevated liver enzymes. My obstetrician followed me really closely. It only happened with my first pregnancy, but I wonder now with what I know All those years of oral contraceptives might have primed me for developing this in pregnancy And I didn't have it with my second. Thank God. So Myile acid pece is important because it impacts nutrient depletion, fat soluble vitamin deficiency and long term oral contraceptive use is particularly driven by compromised fat digestion. Mind blowing, right? I didn't know that before Also common to see candida and bacterial overgrowth in oral contraceptive users, they alter the vaginal and gut microbiome in ways that increase susceptibility to candida. A twenty thirteen review in the Canadian Medical Association Journal confirmed the association Now remember, association is not causation, but it just kind of just to make you be thinking about this, confirm the association between oral contraceptive use and recurrent vulva vaginal candidiasis or Candida, fungal infection, and the gut is the primary reservoir for where vaginal candida is seed Women stopping the pill after long tierm muse who have a history of recurrent yeast infections, may find that gut candida overgrowth is a significant driver of their ongoing digestive symptoms, brain fog and sugar cravings And then CBOS' small intestinal bacterial overgrowth, has also been observed at higher rates in oral contraceptive users, likely related to changes in motility and altered gut microbiome composition. This is why when I say fully informed consent is critically important. So if you're listening and you have a daughter, or a young adult and their're on oral contraceptives, it doesn't mean that there's intrinsically anything wrong with that as a choice, right? We want our young women to have choices. However It also makes me as a parent, I have boys. But if I had daughters, I would be like shortest duration of time using oral contraceptives, given what we now know We know the microbiome in the mood. there's this post pill anxiety connection. The gut produces, as we know, anywhere from seventy to ninety percent of serotonin in significant amounts of GABA or main inhibitory neurotransmitter. Oral OCP, let me just shorten it, OCP driven dysbiosis directly impairs the microbial production of neurotransmitter precursors which may explain some of the mood instability, anxiety and emotional dysregulation, many oral contraceptive users have. likeike I mentioned I had bad PMS, like really bad PMS on the pill and I didn't when I was off. Research published in psychosomatic Medicine found associations between gut dysbiosis and anxiety and depressive symptoms, not surprisingly. The post pill mood changes many women experience are not purely hormonal. They have significant gut microbiome opponent that they may almost never address clinically mind blowing This means that treating postpill mood changes with antidepressants or even hormoneotherapy alone without addressing the gut dysbiosis is incomplete Like underline, underline, underline. you have to think about the gut concurrently. And here's the big question. I'm sure everyone's like, well, Cynthia, does the microbiome ever kind of recover I think it depends. I think it depends on a lot of things, based on what I've read, based on the research I did for my book, based on all the research I did over the past twenty four hours, really wanting to pull this together as a cohesive conversation. Some studies suggest partial microbiome recovery after oral OCP discontinuation Diversity begins to improve within weeks to months of stopping in some women. However, research also suggests that long term orral contraceptive use can produce persistent alterations in microbiome composition that do not fully recover or resolve without active intervention A twenty twenty one study in M systems found that prior OCP use was associated with distinct microbiome signatures, even years after discontinuation, suggesting the microbial consequences of long term use are not simply erased by stopping. Now, like I said I want this to be like an empowering conversation. I think knowledge is power. This is why passively waiting to me is not sufficient. The other thing about oral contraceptive use that I didn't learn until many years later is that you have this nutrient depletion conversation This is one of the most clinically relevant things to be thinking about and most persistently overlooked. So what do oral contraceptives deplete? Number one are B vitamins. And if you are a poor methylator like I am that is problematic. Long term OCP use is associated with significant depletion of B six, B twelve, folate, and riboflavin, all essential for the methylation cycle, neurotransmitter production, DNA repair and cellular energy A twenty thirteen review in the Journal of Biomedical Sciences confirmed that oral contraceptives impair B vitamin status through multiple mechanisms, including increased urinary excretion and altered absorption These six is important for mood. B six is required for serotonin and dopamine synthesis, which explains some of the mood instability of women that are on or off the pill. And we know that B twelve and folate depletion alters methylation, which is particularly relevant for those of us that are have the genetic snip or mutation, the MTHFR snip because I'm already not a great methylator And so the gut connection here, B vitamin depletion impairs the gut's lining ability to repair itself Again, upping your autoimmune disease risk, creating a vicious cycle where nutrient depletion worsens gut permeability and gut permeability worsens nutrient depletion Next is magnesium. Oral contraceptives deplete magnesium through increased urinary excretion. Low levels of magnesium, worse and anxiety poor sleep, muscle cramps, headaches, and insulin resistance. Research in the American Journal of Clinical Nutrition confirmed that OCP users have significantly lower red blood cell magnesium compared to non users Everyone that listens to this podcast knows that I spent sixteen years in clinical cardiology, the best way to chest You're intrinsic, stores of magnesium is with a red blood cell magnesium. Most allopathic providers are not testing this covered by insurance test Everyone should know that number Most if not all of us are deficient in magnesium to begin with. So just layering in more complexity Long term oral contraceptive use compounds the deficit of magnesium significantly. We also see changes in zinc Oral contraceptives reduceed serum zinc levels. Obviously, zinc is important for immune system function, thyroid hormone, testosterone, and wound healing Zinc deficiency also directly impairs gut barrier function. So zinc carnacine is one of the most evidence based supported compounds for intestinal mucosal repair and its depletion by oral contraceptives is a direct contributor to the leaky gut picture. Next is selenium. Selenium depletion from OCP use impairs thyroid function. This is a coactor for converting T four, which is the inactive form of thyroid hormone to T three, which is the act of thyroid hormone A lot of women that get off the pill, they're experiencing fatigue, weight gain, hair loss, constipation, cold intolerance Next is Coku ten CoU ten is depleted by OCPs. This is a mitochondrial coactor essential for cellular energy production. We know Co Q ten levels decline with age. So you add in lower CoQ ten levels, oral contraceptive use, midl, and you're going to see more Fatigue and exercise intolerance. And last, in terms of nutrients, vitamin C and E, these are both antioxidants and they're depleted by OCPs, reducing our body to manage oxidative stress, which increases in the setting of changes in hormones. Vitamin C just for a note is important for gut health. It's integral for collagen synthesis and the gut lining and also important for gut barrier integrity. Next are like let's talk about labs. What are the things that I think are important? And the labs I'm going talk about are all things that are straightforward. These are not integrated medicine tasks. Number one is FSH and LH. I think this is very important lookingooking at antimalarian hormone, looking at estradiol, progesterone free and total testosterone, sex hormone binding globulin, DHEA S, which is for sulfated. This is giving a snapshot of adrenal androgen production. And obviously, you may need to have these labs drawn more than once if you're not in menopause But in terms of like nutrients, looking at B twelve, looking at folate, looking at B six, magnesium RBC Magnesum, zinc and selenium, CoQ ten, vitamin D, Ferriton. We talk a lot about Ferriton on the podcast. interestnterestingly enough Ferritin is more often than not, not addressed properly. want to see those levels greater than sixty. And then looking at gut specific labs. So I like to look at stool testing. I like microbiome testing. I like to look at zomulin, which can be a marker of leaky gut. organic acid testing, fatty acid analysis Obviously, these tests I'm talking about are tests that are functional integrative medicine tests. Looking at thyroid panels, these should be covered TSH, free and total T three, looking at a reverse T three, looking at antibodies, looking at your metabolic health markers, fasting insulin, fasting glucose, A one C, looking at lipid panels, specifically HGL and also triglycerides, and then also LP little A, looking at apolprotein B because we know that oral contraceptives can dramatically impact metabolic health, insulin sensitivity, et cetera. So when we're thinking about what we can do if we've been on the pill, whether it's been short term or long term, you know I think that There three kind of key takeaways that the pill does to the gut. Number one, there is OCP driven dysbiosis. Number two, we have the natural decline In diversity of the microbiome, the gut microbiome with changes in progesterone and estrogen and the Astrobulum disruption from declining endogenous estrogen This is a triple hit, somethinghing really worth emphasizing and something worth identifying and addressing So I'm going to walk you through like these are kind of high level things to think about. I'm not going to go into a lengthy protocol because that is something I will probably do in some of my groups. but Number one, We want to ensure our diet is dialed in. So removing sugar rememoving alcohol, eating less processed foods I think for some people looking at A whole thirty, not forever. Whole thirty is designed to be short term Maybe it's no gluten, no dairy for a little while. Maybe it's no alcohol, Maybe it's no sugar, Maybe it's looking at grains. Looking at how we can repair the gut lining, obbviously, I talk about many of these things in the menopause gut, but things like allglutamine, there's really solid research on allglutamine. This is a primary fuel for our intestinal epithelial cells, essential for repairing those tight junctions from OCP driven impermeability. Let me be clear. The loss of estrogen alone, the loss of estrodiol will drive that those changes in the small intestinal lining. So it's really, really important to be thoughtful about what you're doing thinking about utyrate supplementation. This is short chain fatty acid, supports colonocyte. Those are the cells in the colon and gut barrier integrity. Thinking thoughtfully about thirty plant varieties a week. Thinking about ferments, thinking thoughtfully about fiber in the diet, all really important. Lve When we're talking specifically about the astrobulum, fiber and the aestrobulum go hand in hand. So I like fresh ground flaxseed and chia seeds. Not only is it boost a little bit of your plant based protein, but the Arobleum loves the fiber. It's also flaxseed is also the richest food source of lignins, which directly support astrobulum directly, diversity and healthy estrogen metabolism I talk a lot about cruciferous veggies Kale Brussels sprouts, cauliflower, all really good examples. If we do a Dutch test and there's some suggestion that you have impairment In phase one, detoxification in the liver or phhase two, there are specific supplements that we may recommend Things like dim or calcium delucorate Obviously, if any of your testing demonstrates that you have candida or CIO, that needs to be addressed. And then you know really thinking thoughtfully about testing and tracking. So having a baseline microbiome test, stool test and then looking at three or six months out I always kind of base that on how bad the microbiome or the toual testing looks about how quickly we need to turn around and at that I think it's really important to about hormone therapy. So if you're going from oral contraceptives to maybe you're doing oral micronized progesterone, maybe you transition and you're doing an estrogen patch plus or minus testosterone, it's important to note that Synthetic hormones are not equivalent to bioidentical hormones. They're not chemically the same. they are similar, but they are not the same And this is where I think that working with someone that is knowledgeable about How to make that transition is important Working on gut driven protocols is helpful. I think the other thing that is really important to emphasize is How we respond differently to stress in midlife than we do when we were younger. So nervous system regulation, vagal maneuvers all become very important So I think the big takeaway that I want to make sure women understand is that Number one, there's a lot we can do coming off the pill Number two, we now understand better the long term ramifications of what the pill does to the gut microbiome and systemically to our bodies Number three We do have My book is a resource, the menopause Gut. And we also have a microbiome course, which is we're beta testing right now. And then I have something called the Gut Unpause which is going to be all about implementation, which I'm really excited about in the process of trademarking this name. I just kind of decided that given the constellation of questions that we're getting After the book came out, lots of amazing feedback. Pople want more help with implementation. So the gut on pause will be exactly that As always, keep your questions coming. I think that the research around oral contraceptives is both compelling. And I don't want anyone to take away from this conversation that you've been on oral contracept as it's all doom and gloom sixteen years of me being on oral contraceptives. Obviously now my gut microbiome is the healthiest as it has probably been in my entire life, but it is intentional. There are things I do intentionally and the things I will encourage you to do intentionally that can help fortify the gut, lessen the impact of long term oral contraceptive use and not be paranoid or fearful about it. That is never the message. This is all about education. You could literally take a transcript from this particular midlife Minute, we're including the research articles in the show notes. I'm hoping sometimes they limit the scope of show notes, but my podcast team has them So if you're someone that really wants to dive into the science and the show notes are compromised by space, we will obviously be happy to share that information with you. Keep those questions coming. 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