Dr. Sara Gottfried is a wife, mother to two girls (ages 10 and 15) and a Harvard-trained MD with 20+ years of experience in gynecology and hormone balancing. She is the author of the New York Times bestselling books, The Hormone Cure and The Hormone Reset Diet.From Dr. Kresser's recent podcast interview ...
Sara: So if you’re 17 and you have acne, you end up with a prescription for a birth control pill, and there’s no careful assessment of the control system that could be leading to the high androgens or the food intolerances or the gut issues that could be at the root of the acne. And as you’ve described, if you’re 25 and you have painful periods, the pill, yet again, is considered the solution.
What I think is a problem here is that women are getting put on synthetic hormones or, in some cases, bioidentical hormones for almost any issue well into their 50s, 60s, and 70s, and there’s often a cost to it. There are long-term alterations to the control system for hormones, which I assume we’re going to get into today, and I just see this lack of regard for root cause, so that’s one.
A second mistake is the financial motive, and this one is really troubling. When you look at birth control pills and how they first started in the 1960s and maybe initially were thought to be an instrument of female empowerment, it’s now this gigantic moneymaker for Big Pharma. Just with the birth control pills that are on patent, it makes more than a billion dollars per year for pharmaceutical companies, and I have to say that I think the pill is the number-one endocrinopathy for women—which is totally caused by the prescriber—in the developed world.
Iatrogenic, absolutely. And the same is true for hormone therapy, for hormone replacement therapy for older women. Premarin or conjugated equine estrogens synthesized from pregnant horses, that was the number-one prescription in the US for a long time. Even in 2002, when the Women’s Health Initiative was published, it was the number-four prescription in the US. We then had data from the Women’s Health Initiative about how it’s dangerous and provocative to the female body, leads to a greater risk of stroke and together with synthetic progestin increases a woman’s risk of heart disease and breast cancer.
And this then leads to a third mistake, which is a lack of rigorous evidence behind the mainstream approaches to hormone problems, and maybe even more insidious, the lack of awareness of the lack of evidence by folks in mainstream medicine. Premarin was prescribed for 57 years before we finally had a randomized trial to show that it was a problem, and this is a shameful part of our past in American medicine.
They don’t know that 20 to 25 percent of women on the pill have vaginal dryness. That’s, like, the greatest irony ever, right?! Especially if you go on the pill because you want to have more sex! You have vaginal dryness, and you’re just like, “What’s going on?!” It can shrink the clitoris up to 20 percent. It just has a number of effects that may not be completely reversed when you go off the pill. That should be part of the informed consent.
There’s a study from Claudia Panzer where she looked at… you know, one thing that happens when you go on the birth control pill is that it raises this intermediary, sex hormone-binding globulin. I think of it as a sponge that kind of soaks up your androgens, and that’s one of the reasons why going on the pill can reduce your androgen levels and then reduce acne. But by the same token, when you stop the pill, up to a year later, women still have elevated sex hormone-binding globulin. There are these persistent changes to the matrix of the body that really disturb me.
There’s a way that it needs to be wrangled. I think most of us don’t learn how to wrangle stress, and so we end up with this sort of chronic stress that’s very hard to clear in the body. I find that to be the root cause of hormone imbalance in, say, 98, 99 percent of the people that I work with.
Myth #1: You sleep less as you age.
Truth: It’s not about your age, it’s about your adrenals and how you are habitually responding poorly to stress. Don’t let that rascal, cortisol (the stress hormone), get the best of you and accelerate the aging process. You have a choice. To raise melatonin — your sleep hormone — turn off the laptop and tablets after 7pm. To reduce cortisol at night, try phosphatidyl serine (400 mg) and omega 3s (2000 mg), or Cortisol Manager. Put yourself to bed as lovingly as you would a newborn baby, with a warm bath, a massage, and a loving embrace.
Myth #2: When you become a mom (or go through menopause), you might as well give up on sleeping
Truth: Mom, you need your high quality sleep now more than ever! Lack of sleep after your baby’s birth is linked to higher rates of depression, and difficulty losing the baby weight. Catch up when you can — this is one time where “sleep at night, no naps” does not apply. Nap whenever you can, even if only 20 minutes. Use a sleep sensor (such as the Zeo, the Lark, or the Fitbit).to track your hours of sleep and awakenings, and make sure you’re getting what your body needs to recover.
Myth #3: “Just take this nice sleeping pill (and don’t call me in the morning)!”
Truth: Sleeping pills have been proven in 3 large-scale studies to be associated with higher mortality, even when you take them only 20 times per year! Even worse – if you define insomnia as less than 6.5 hours of sleep each night, people who take the most common types of sleeping pills (such as Lunesta) still have insomnia (and they feel more groggy in the morning!). As a jumpstart, work with your doctor to get OFF the pharmaceuticals, and catch the angel train. That’s when you are in bed, lights out, ready for sleep by 10pm.