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How Does The Pill Really Affect Me?

5/19/2017

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This week's post is a guest post from hormonal health coach, Kara DeDonato of Libera Wellness. She's an NYC local and, like Katinka and I, is super passionate about giving women tools to use the Fertility Awareness Method. This piece is a two part-er. Part 1 will cover effects from your hormonal birth control you might not have covered with your gyno (like a decrease in clitoris sensation!) Part 2 will delve into supporting your system coming off hormonal contraception to make a smooth transition to using FAM.


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My entire journey to becoming a women’s fertility coach started with one simple desire: to go off of my hormonal birth control without a recurrence of acne or the loss of my period.

I had been on the pill for nearly a decade, and while I had no major symptoms prior to taking it, each time I tried to go off of it my period slowly deregulated and disappeared completely, and my skin broke out in tons of angry little bumps along my jaw line, and on my chest and back. Not fun.

Ultimately, I decided that, as a healthy twenty-something year old, I should not need to be on a prescription medication to manage my cycle or skin. I began to research how to go off of the pill without these unwanted side effects and what I started to learn about the hormonal contraception I had been taking for years shocked me.

The birth control pill and other hormonal contraceptives were simply not created to cure any period-related ailment. They were also not created with long-term use in mind, and the effects of long-term hormonal contraceptive use are still being studied.

While the pill and hormonal methods of contraception do an excellent job at preventing pregnancy, they do not come without risks. I remain grateful for the years of safety from unwanted pregnancy that it provided. However, I do wish I learned more about the downside to the pill earlier in my life and believe it would have affected my choices if I had.

CANCER RISK
The World Health Organization lists it as a Class One Carcinogen. This is the highest classification for a cancer-causing agent. It's been on their list, despite the periodic review of new lower-dose pills, since 1999.
While it's true that the pill does lower your risk of ovarian cancer, the high levels of estrogen it contains could put you at a higher risk of breast cancer. Recent studies on women in their teens and twenties taking the pill continuously have indicated that it increases breast cancer risk by as much as 40%.

DEPLETION OF NUTRIENTS
Hormonal contraceptives rob your body of essential nutrients. Metabolism of birth control hormones by the liver requires extra B-complex vitamins, vitamin C, magnesium, zinc and selenium. B-complex vitamins play a major role in happiness, stable mood and warding off depression and anxiety. Magnesium is essential to over 300 biological processes and also plays an important role in stress and anxiety management. These same nutrients are also critically important to pregnancy and the developing fetus.

COMPROMISED GUT AND LIVER FUNCTION
The birth control pill compromises gut health. The pill can have a similar affect on gut flora as antibiotics - that is, it can kill the good bacteria and make way for bad bacteria and organisms like candida to colonize the intestinal tract. This compromises digestion (further exacerbating nutrient deficiencies), increases inflammation in the body, and could even weaken the immune system. This can also lead to increased frequency of yeast infections. It is also bad news for acne-sufferers as recent studies have found connections between plentiful gut bacteria and clear skin.
The extra work the liver has to do to break down excess synthetic hormones often results in a dark spot on the liver, visible on the liver by X-rays. Some women even develop benign liver tumors. Adverse affects have not been connected to either condition, but a dark spot on the liver still sounds pretty scary to me.

ANATOMY AND SEX DRIVE
The birth control pill can alter a woman's actual anatomy. A 2013 study in The Journal of Sexual Medicine found that "after only three months of use, pill users had thinner labia, smaller clitorises and a decreased entrance of the vagina." A study on Yaz showed that after only 3 months, some women's clitorises had decreased in size by 15%.
The hormones in the pill dry up the crypts that make cervical fluid, (think natural lube) and even age the cervix twice as fast. This can also weaken orgasms. That same study showed decreased orgasm, measured by both intensity, frequency and ease of achievement, in the women on the pill. Other studies have indicated that the pill can even decrease the frequency of sexual thoughts.
It may alter sex drive - even after you stop taking it. The pill causes the liver to make a protein, sex-hormone-binding-globulin (SHBG), in excess. Normal levels are 20-30 nmol/L and pill users often have levels of 200-300 and up to 500 nmol/L. SHBG binds to free testosterone, which is primarily responsible for sexual response, and makes it unavailable. Even after six months off the pill, former pill users still had elevated levels of SHBG.

BRAIN-OVARY COMMUNICATION
Hormonal contraceptives disrupt communication between the ovaries and brain. Because the pill pumps a woman's body full of all the sex hormones she needs, your brain no longer needs to tell the ovaries to produce the appropriate amount of sex hormones (estrogen, testosterone, progesterone). With long term pill use, this pathway erodes and it can take months (or years) to re-establish after pill use stops.
Until healthy function is restored, women are likely to experience fatigue, hair loss, dry skin and brittle nails, irregular periods, or potentially no periods at all. Women are also more likely to develop ovarian cysts when coming off the pill, and may experience oral contraceptive withdrawal symptoms like headaches, pelvic pain, and nausea. After long-term use of greater than one year, all women will experience some variety of symptoms.

PARTNER CHOICE
The pill could affect your choice of long-term partner. The birth control pill changes preferences when it comes to selecting a mate. Studies show that women on the pill rate slightly more feminine male faces as more attractive than their counterparts, who opt for more traditionally masculine features.
Women on the pill are also more attracted to men with a similar chemical makeup, as detected subconsciously via smell. Women not on the pill generally select mates with a dissimilar chemical makeup - biologists believe this was an evolutionary mechanism to diversify the genetic material of the child, decreasing the chances of recessive and potentially disordered or weak traits. It's possible that if a woman selected her partner while on the pill that she may find him less attractive when she goes off of it.

FUTURE FERTILITY
Past-users of hormonal contraceptives may experience difficulty conceiving. Recent studies have shown that women are twice as likely to have difficulty conceiving after long-term contraception use. This is sometimes attributed to the weakened connection between the ovaries and brain, and subsequent low levels of progesterone, the pregnancy hormone. Nutritional deficiencies may also be a contributing factor. Additionally, many women are prescribed the birth control pill for irregular periods or conditions like endometriosis and PCOS - these women who may have had difficulty ovulating (and therefore conceiving) before pill use, will find that the underlying issues still exist and may have worsened when they go off their hormonal contraceptive.
Doctors will often point out that many women are able to conceive within six months after terminating pill use. However, some studies indicate that women who conceive soon after going off the pill have an increased risk of miscarriage; babies with neural tube defects (which often result in a miscarriage or children born with conditions like spina bifida); or children with allergies and/or compromised gut flora (because the baby inherits the state of the mother's gut health at birth).


If you've decided hormonal contraception isn't right for you, stay tuned next week for Part 2! Kara will go in depth on ways to support your system coming off of the pill! (Or ring, or IUD, or patch, or shot...did I cover them all?) 


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Do You Want a Baby? Circle Yes/No.

5/12/2017

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The organization I am training with calls the spectrum of hormonal health The Continuum. It goes all the way from pre-puberty, into cycling, pregnancy, breastfeeding and past menopause. The phases are all part of the continuum but everyone's journey looks a little different. It might be completely normal for a woman to not ovulate or have irregular periods during a certain season. But what I like most about this concept is that it makes no assumptions about where a woman is and accounts for the fluidity of hormonal health.

I like to think of Family Planning intentions as a continuum, too. Sure, for some women, deciding whether or not to have a baby may be a definitive yes or no. But for many, it's more complicated than that. In the world of fertility charting you may have seen the acronyms (among many others) TTA and TTC. Respectively, trying to avoid (pregnancy) and trying to conceive. But a new acronym is finding its way into FAM bedrooms - TTW. Or trying to whatever.

I have seen the fear based contraceptive culture that got us here - you can get pregnant anytime, anyway, anywhere - carried over into many fertility awareness discussions. Women get scolded in support groups for using a low risk day. (A day that is considered 100% fertile for TTA women, but only a little fertile for TTW women.) Any deviation from the strict rules of charting is paraded as an invitation for an unplanned pregnancy. And that's simply bad press, we can't have that. But are we in a place to judge a couple's decision to engage in risky days? Do we really know the full story?

Consequently, efficacy rates of FABM are tricky to talk about.

With pharmaceutical contraception, and particularly LARCs, your uterus is pretty well turned on or off. But Fertility Awareness methods are so much more nuanced than that. Using FAM allows you to be tuned in to the many factors that go into deciding (or not) to procreate. During a certain season of your life, you might not necessarily be aiming for a perfect efficacy rate.

Baby making is biological, hormonal, situational, economical, and cerebral. In cases of difficulty conceiving and miscarriage, we don't always have complete control over our family planning.  Do we allow for that fluidity in our discussions on birth control? I have wanted a baby so badly, been anxiety ridden during the two week wait (What was I thinking? A baby??) only to be crushed to find my period grace me with its presence. It's complicated. Boiling down the drive to procreate to an on/off button does a huge disservice to women and simplifies something that is anything but.

Over the years I've practiced FAM, I've learned to be ok fluctuating on the spectrum. Communication with my partner (and myself to be honest) is uber crucial. Sincere, clear, down to the gut communication.

But that can be difficult. It's easy to communicate "Yes, I'm fertile today." "No I'm not." What's not so easy to talk about is, "It's a low fertility day. What do you think? Are we ready to take that risk?" If it's a knee jerk reaction "Heck no," that's one thing, but the grey area often proves to be a challenge.

In this sense, a couple using the fertility awareness method gets an opportunity for a valuable communication workout. In my work as a fertility awareness educator, I try to encourage this workout. It takes 2 to make a baby and there's 2 people with varying factors going into each cycle. If you don't get it out in the open to the other person, who might I add, has no other way of knowing what's going on - it might come out in another way. This isn't exactly the case for other forms of family planning and I think it's an important distinction to make.

So wherever you are on the spectrum, be there. And there. And there, too. Process it, write about it, But most importantly, talk about it with the person who might be the other half of the decision. This makes using FAM different from other forms of family planning, but I have been pleasantly surprised by this element. Without it, I'm fairly certain I wouldn't have my daughter.

xx

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Appleseed is Back...In the Big Apple!

4/23/2017

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So you know how after giving birth, women often experience a hiatus in cycles? It could be 6 weeks, 6 months or past a year. You could say Appleseed has been dormant for a bit, too. Danielle, the original creator of Appleseed Fertility, has stepped down and decided to focus on her family and art.

Never fear, however! Because the new owners, Katinka and Cassie are really stoked to have inherited such a beautiful and comprehensive platform to provide readers with FAM content. We're long time friends with Danielle and are two FAM advocates, mamas, and teachers in training residing in New York City. (Check out the about page to learn more about our backgrounds.) We will be blogging, contributing, instagramming, and tweeting all things Fertility Awareness. You can check out our journeys as fertility awareness instructors and keep up to date on upcoming events and workshops in your area. (We promise to keep it real.) We also have whispers of a launch party coming here to NYC so stay tuned for more info on that….

With all of this being said - we want to hear from YOU. The reader! What do you want to see more of? What topics haven't been covered that you wish were? Speak now, forever hold your peace.

We look forward to embarking on this journey with the fantastic community of FAM lovers here.

xx
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POAS? OPK? hCG? LH?

6/24/2016

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I am in about five different Mom Groups on Facebook (and a few different Fertility Awareness ones, too), and the pregnancy and OPK test questions are plentiful and frequent. An endless stream of anxious and hopeful (or worried, as the case may be) women post pictures of their tests, along with a plea for commenters to throw in their two cents on its interpretation and guesses as to the results. Far too often, the comments contain common inaccuracies and myths surrounding the reading of pregnancy tests and OPK's.​

Today I thought I'd clear up some of those long-standing myths. We're going to talk about how to properly read pregnancy tests and ovulation predictor kits (OPK's), what they're measuring, and what the differences are between them. They may physically appear to look the same, but they are interpreted and read very differently.


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KINDARA'S WINK THERMOMETER: A FULL REVIEW

6/4/2016

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It's finally, finally here!! If you're new to the fertility awareness world, you may not know that Kindara originally launched pre-orders for Wink in the summer of 2014--almost two full years ago! For anyone who was an early supporter (guilty as charged!), this was a long time to wait for such an exciting idea to come to fruition. But the wait is finally over and I've got my hot little hands on the Wink at last. 

WHY WINK?

You don't have to use Wink to use FAM. Any oral/vaginal thermometer that runs to the 10th degree accurately will work. So why would you drop $129 on a thermometer? Because Wink was made specifically with FAM charters in mind and has some truly drool-worthy features that make it any FAM lover's dream.

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