EP 278 Egg & Sperm Health, Post Pill Conception Prep and More with Lisa H. Jack
3/26/2024
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57:52
Lisa Hendrickson-Jack is a certified Fertility Awareness Educator and Holistic Reproductive Health Practitioner who teaches women to chart their menstrual cycles for natural birth control, conception, and monitoring overall health. She is the author of three bestselling books The Fifth Vital Sign, the Fertility Awareness Mastery Charting Workbook, and her most recent book Real Food For Fertility, which she co-authored with Lily Nichols RDN. Lisa works tirelessly to debunk the myth that regular ovulation is only important when you want children by recognizing the menstrual cycle as a vital sign. Drawing heavily from the current scientific literature, Lisa presents an evidence-based approach to help women connect to their fifth vital sign by uncovering the connection between the menstrual cycle, fertility, and overall health. With well over 4 million downloads, her podcast, Fertility Friday, is the #1 source for information about fertility awareness and menstrual cycle health. Fertility Friday: fertilityfriday.com Real Food For Fertility: realfoodforfertility.com The Fifth Vital Sign: thefifthvitalsignbook.com Instagram: @FertilityFriday Facebook: Facebook.com/FertilityFridays LinkedIn: Lisa Hendrickson-Jack For more information about Michelle, visit www.michelleoravitz.com The Wholesome FertilityFacebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ Instagram: @thewholesomelotusfertility Facebook: https://www.facebook.com/thewholesomelotus/ Transcript: Michelle (00:00) So welcome to the podcast, Lisa. Lisa Jack (00:03) Thanks so much for having me back. Michelle (00:05) Yes. So having you back again, we had a little mishap, issue with the recording for some reason, but we are on a new recording software. So hopefully this is going to be great and I'm excited to pick your brain again. Lisa Jack (00:21) Well, I'm happy to be here. I mean we can never anticipate the tax nafus. It's part of online business, I suppose. Michelle (00:28) Oh, totally. 100%. So we had so many good things too. That's what's really frustrating. We had such a great conversation about so many things. But for people who are first hearing about this, I know that a lot of people think that there's certain textbooks like menstrual cycles, or they have like sort of an idea in their mind of what a perfect menstrual cycle looks like. And since this is... your absolute specialty and you understand it from like A to Z, can you describe what a healthy menstrual cycle should look like? Lisa Jack (01:06) Yeah, I mean, that's a great place to start. And just to put it out there when I'm working with clients and practitioners, I always say there's no such thing as a perfect menstrual cycle because you're a human, not a robot. And so when we look at what a healthy menstrual cycle looks like, we should be looking at a range. And basically, what I can lay out is the different parameters that we're looking at. Often when I talk about the menstrual cycle, people's minds will go straight to the period. Michelle (01:17) Right? Lisa Jack (01:34) and they'll kind of think, okay, well, what is a healthy period? But then they don't necessarily think about all the other parameters. So when we're looking at what makes a healthy menstrual cycle, we can look at the overall cycle length, which ideally would be somewhere between about 24 and 35 days. We can look at the pre -ovulatory phase in particular. So we can look at the period. So the period is its own category. We want to have a menstrual period that overall is somewhere between three to seven days with an average of about five days. And I always say the period should be like a sentence. It should have a beginning, a middle, and an end, and then it should be over. So if it's like trailing on for days and days of bleeding, if you're getting bleeding throughout your whole cycle, as opposed to just when you have your period, these are things we should be looking at. And although it's really common to have several days of spotting before you start your actual bleed, it's not optimal. So it's helpful to understand that piece of it. And then in terms of pain, Michelle (02:08) I love that, that's so good. Lisa Jack (02:32) It's also extremely common for women to experience menstrual pain. And so there's always this question of like, is it normal or not? And there is debate. So there are definitely people who are more on the like, it's normal kind of, you know, because so many people have it. So it has to be normal. But, you know, outside of your period, pain is thought of as a problem. And so if you thought of any man in your life, anyone, your father, brother, cousin, whoever, friend, boyfriend, if he had pain in his period, in his penis for. Michelle (03:01) in this period you imagine. Lisa Jack (03:02) Right? But if he had pain in his penis for two to three days every month, such that he needed to take medication and possibly couldn't go to work if the medication didn't kick in, no one would think that that's okay. So that's also just a bit of an aside where when we look at what's happening during a menstrual bleed, it is a natural inflammatory process by which you shed that lining. And so in order for your uterus to shed that lining, there does have to be some inflammation. And we do have... prostaglandins that we produce that help to induce those smooth muscle contractions to make this all happen. So what's interesting is that when we look at what the research says, women who have pain, they have a higher level of these prostaglandins. So they have a higher outside of normal inflammatory response. So at very least, pain with menstruation that's moderate to severe is a sign of increased inflammation, something we should be aware of. And at worst, it could be a sign of a more serious condition like endometriosis. So as an aside, although common, we want to consider moderate to severe pain to be not optimal. And we want to be looking a little bit deeper into that. And for many women, they often need that nudge to do so, especially if they've had pain very consistently from their first period, for example. So outside of the period then, when we move into the actual, like the rest of the pre -ovulatory phase, we want to look at when ovulation is happening. So in order to have a cycle that falls within that 24 to 35 day range, we do need ovulation to happen typically somewhere between days 10 and days 22 or days 23. So approximately. So we want to be looking at when ovulation is taking place. And as you approach ovulation, you're supposed to be making some healthy cervical fluid. And typically we would expect to see that for about two to seven days leading up to ovulation. So we want to look at the quality of that, how many days you're seeing. Like if you're not seeing any at all, that can be a sign of. low hormones or an issue with your cervix. If you see it all the time, that can be a sign of something as simple as a yeast infection or something more serious potentially. So it's helpful to even know that that's a thing. And then after ovulation, that period of time, the post -ovulatory phase or luteal phase, as we call it, should be about 12 to 14 days. And so if it's, you know, seven days, that's a problem that could impede your chances of conception. It's a sign of extremely low progesterone. If you have... moderate to severe PMS symptoms, if you have spotting, as I had mentioned previously before your period. So like interesting, right? Because you asked a pretty simple question, what does a healthy cycle look like? So I think what's good about this, just to kind of pull it back then, is that we're not looking for any one factor to be perfect. Within each of those factors I listed, there's a bit of a range. And so you could potentially have one of those aspects that's a little bit off, but overall, the rest of it is pretty strong. And so that can help you to understand that you don't need to have a perfect cycle for it to be healthy. We just need to have it for the most part fall into those parameters. Michelle (05:58) For sure. And I also look at like, you know, as a practitioner, I look at like what's normal for you, because some people have always had a short cycle, but they're normal. Or, you know, it's usually when things become out of whack for you, or it's kind of like not like you're, they almost have like personalities, menstrual cycles, right? Lisa Jack (06:17) Yes. Well, and I agree with you to a point because I used to be one of those people that was like, my cycles are long and that's normal because my cycles are always long. Right. So when I first started training, so I think there's a balance between understanding what the normal parameters are to make sure you're within them and then understanding what your normal is. And absolutely, when you're used to experiencing ovulation, you know, in a certain range and all of a sudden it's like 20 days later, yes, we need to be looking at that. But. Michelle (06:27) Mm -hmm. Right. Lisa Jack (06:46) because of my own experience and what I've seen with many clients, there's a lot of things that we can experience a lot, like period pain is a good example, or even that pre -evaluatory spotting where we can just tell ourselves, well, I always experience that, that's totally normal, but it might not be. Yes. Yeah. Michelle (06:58) I'm not talking about abnormal though. I'm talking about within like 26, like say you have a 26 day cycle and that just tends to be your thing. As long as it's not abnormal or within like sort of a more like red alarm position. Lisa Jack (07:11) Yes. Yes. No, I tend to be I tend to be like, because I because this is what I do, right? Like I'm like lazery. So I'm like, well, the 20 days, 26 day cycle is within the normal range. But you could have a 29 day cycle or a 28 day cycle. That is actually problematic. Like you could let me give you an example. You could have a 28 day cycle where you're ovulating on day 20 with an eight day luteal. Right. So so this is why it's helpful to look at the whole picture. Michelle (07:29) Right. Bye. 100%. I think that what you do is very important. And, you know, looking at like the temperature, looking at the cervical mucus, looking at, well, possibly position, but like really understanding it in a way that has a different lens. Because for me, at least, I know that I really appreciate when patients come in and they do their BBT charting. Why? Because I look at the yin and the yang. And if it's too low, that tells me a lot. Usually when, Lisa Jack (07:55) Yeah. Michelle (08:09) The luteal phase, which is more of the yang part of the cycle, yang mean more heating. Yin is more cooling and moist. So that's kind of like more of the estrogen aspect of it. And it's pretty wild when you can actually see that. What we learned in textbooks actually being reflected in the menstrual cycle. But when we see that as practitioners and we can really look at it, I really appreciate being able to see that chart because it helps us. see much more and a lot of other practitioners in the same boat, like they see what I'm talking about. It just helps you to understand it at a different And unfortunately, some people are very resistant to doing it because they say when I do my BBT, and I want to actually address it because I want to see what your thoughts on this. Sometimes people say that if they start to look and like kind of chart their cycle, that it throws their cycle off and that they get really stressed out. Yeah. So then I'm like, okay, well, you know, what's the balance, you know, of trying it? And I say, just try it out. It's not forever. Like just see what it shows you. And then maybe it'll regulate as you're doing it. And I think that there's this resistance to it. Like they're almost overly focused on it and it stresses them out. Lisa Jack (09:10) Interesting. Mm -hmm. Michelle (09:32) So I wanted to get your thoughts on that. Lisa Jack (09:35) Yeah, well, I think the couple of things came to mind. So the first thing that came to mind when you said that, like, when I do it, it throws my cycle off. I think that that was interesting. That's interesting because that could be something a bit different. That could be that you thought your cycles were so, you know, perfect. And because people do like people think like my cycles are totally regular. Right. When you're not charting, you're like, yeah, it's always like 20 days. Like, yeah, because this is like how we think. But then as soon as you look at it, it's not it's not no one cycle is 20 days for a year. I will put money on that. It's just not, if you're actually tracking. Michelle (10:06) No, no, they still used like an app to track the numbers. So they knew what their numbers were, but they didn't do like the BBT and like a little bit more in depth. Lisa Jack (10:15) Yep. Well, I guess what I'm, so I guess the thought that I had around that was that when you actually start to look, you see not necessarily that things are wrong, but you just see more of the nuance that you weren't looking for before. And so you may not have been aware of certain nuances that were happening because if you're not tracking it, you wouldn't be aware of those nuances. That was the first thing that came to mind. The second question I think is interesting. For a couple of reasons. So now that I work with practitioners when you have your own modality as a practitioner, you know Then the people that are coming to you are coming to you for that particular modality and This whole charting thing is very niche. It's very specialized and not everybody wants to do it and that's totally okay I think that that's something that's important to remember So when you're as a practitioner seeing the value of charting and if there's a lot of value there And it's really helpful. I mean, for me, that's all I do. So it's hard for me to imagine how I would support someone without seeing it, because it really is an integral part of everything that I do. But when you get all jazzed about something, it doesn't mean that everyone else is jazzed about it too. So when it comes to then encouraging your clients to chart, coming from all different walks of life and varying levels of interest in this topic, I think that it's important to kind of put that all into perspective. So. Michelle (11:25) Mm -hmm. Lisa Jack (11:40) You can lead a horse to water, but you can't make them drink. I think you can think about your messaging. One of the things that I learned, just because I've been in the field so long, I went through my initial, everybody needs to do this face, you know, 20 years ago, and, you know, trying to ram it down. And I'm not saying that's what anyone's doing. I'm just saying, like, when you first learn about this stuff, it's like you want to, like, literally, like, all your girlfriends, you have to, right? Like, you get into this energy, and some of your girlfriends are like, you need to leave me alone. Michelle (12:03) Hahaha. Lisa Jack (12:06) right? Because like, I've got this, like, I'm good with the birth control pill, and you need to stop. And that's okay. So the way that I have approached that in my life is that, I mean, now I have my own podcast, right? Like, I talk to people who want to hear about it. And in my personal life, I don't necessarily talk about it. And I have not, I typically don't have the experience where a person is not necessarily at all coming to me for charting, because usually people are coming to me for charting. Michelle (12:21) Yeah. Lisa Jack (12:34) but I have had varying levels of interest within that. So I've had a lot of clients who are coming to me for conception and they really do want to know what's going on in their cycle. But sometimes the charting does cause a lot of stress, especially depending on what a person is going through. So I've had clients who are super motivated, like dotting all the, you know, eyes, crossing all the T's, writing every little notation and notes and like really, really detailed. And I've also had clients who resist that a bit and they... They don't necessarily get into the notations a whole lot. And so a lot of what I do in those situations is we have a conversation and talk through it. It's the same stuff. They're just not writing it down. And I try to help them achieve their goals, meeting them where they're at. Like I can think of several clients who weren't necessarily super into those notations, but through our conversations, like they were still checking. They were still observing their cervical fluid. They were still able to time sex accordingly. And they got a lot out of it. And I really tailored what I was presenting to them to what they needed. And I was always having those check -in conversations. And this is something I talk about with my practitioners, like the whole coaching aspect of it, where you can have your goals. You want to have this person chart, but they can have their own goals. And so sometimes it's like, well, what would success look like for you? You know, I see that you're not really that into the charting or I see that the charting is causing a lot of stress. We don't want more stress. We definitely don't want that. What would make you happy? Like what would success look like after, you know, our several weeks of working together? And maybe she says, I just wanted to understand how to pick up when like which days I'm fertile. Like I don't want to like write it all down or anything. I just want to be more confident in identifying that. And so, you know, my comment on that is there are lots of ways that we can improve our clients' education and confidence without necessarily going all the way down the charting rabbit hole. So we have to be flexible as practitioners with where our clients are at with these things. Michelle (14:30) No, I'm with you and I actually tell them There's a lot of other ways to figure out if you're ovulating. However, I always really enjoy being able to look at the charts because it on a different level. Lisa Jack (14:44) as a practitioner, when you have that knowledge, you can still, like it still comes through and they're still getting so much from you. And I think sometimes it's interesting hearing the charting instructor saying, you know what, if this is stressing you out, then just stop. I've had that conversation with a number of clients over the years where it's like, if this is too much for you, then just stop. Just stop charting for a month or two and see how you feel. And the interesting thing is you stop writing it down. But after you've learned all the stuff about how to identify the fertile, it's not like you're going to stop going pee. So you're going to see your mucus. and you're still going to have that knowledge and information. You're just finding a way to dance with that information that does not cause more stress. Michelle (15:28) Absolutely. So as far as birth control pills, I know this is another topic you talk about a lot and also just like how that impacts the body. So I'd love for you to talk about like how it impacts the body. And then if somebody's been taking it for a really long and wants to get pregnant after stopping, what are some of the things they should be thinking about? Lisa Jack (15:52) Mm -hmm. Love that question because not a lot of We're just not told how the birth control pill works. I was actually listening to someone Kind of a prominent person talk about the birth control pill Yesterday and it was really great because a lot of what she said was on point but she did say, you know, well, you know the pill tricks your body into thinking that you're pregnant and and so these are some of the myths that we still have Today about how the birth control pill works in the body. I So it's interesting because if we were to compare the state of a woman on birth control, so the state of her natural hormones, the most compatible or comparable state would actually be to a woman in menopause. That makes terrible PR and marketing, so they're not gonna tell you that. And so essentially, the pill, the main mode of action for the most common pill, which is the combined oral contraceptives, so it has a combination of synthetic progestin and synthetic estrogens, is to suppress ovulation. So that's the main mode of action. And that's really helpful when you're trying to avoid pregnancy, because if you're not ovulating, you can't get pregnant. So in order for it to suppress ovulation, then, it interferes with the conversation that is typically happening between your hypothalamus, pituitary gland, and ovaries. And as a result, the ovaries then become kind of dormant. And so that's why we can think of the menopause as a similar comparison, not pregnancy. Because in pregnancy, we're actually making ridiculous amounts of progesterone. So compared to the progesterone you make in your menstrual cycle, by the time you're 40 weeks pregnant, you're making 11 times the amount of progesterone. So it's not the same when you're on the pill. It's not a comparable state. And so when women are on the pill, if we were to measure their natural estrogen and progesterone, they would be very low and flat, very consistent. So the first main mode of action is to suppress ovulation. And then there are other modes of action that work in conjunction. One is to maintain a very thin, flat endometrial lining. And so they measure it with ultrasound and, you in my books, I kind of share some of those numbers because it's quite, quite thin. So even if something were to happen, then there's less of a chance of conception because the endometrium is so thin. And then it also prevents the production of fertile quality cervical fluid. So the sperm then theoretically, like they can't go anywhere because the, the cervix is blocked with this mucus plug all the time. And those are the modes of action that work together. So when a woman is then on contraceptives for a long time, and, excuse me, interestingly in the research, they define long -term as two years or more. And when you think about most of the women in your life or yourself, many women have used birth control for two years, five years, eight years, 10 years, 15 years, 20 years. So this whole concept of long -term is pretty. mainstream if they're defining it as two years. So there's a couple different ways that the pill affects the body then. One is that it does have an effect on the menstrual cycle. So when women are coming off the pill, research has shown that it takes anywhere from nine to 12 cycles for all cycles, not months, for all of those menstrual cycle parameters to normalize post -pill. So that includes everything we just talked about, like the overall cycle length, the cervical mucous production, you know, the luteal phase length. And so it's really common to come off the pill and to have a short luteal phase for it to take several months before the cycle either returns or normalizes. So some women do get their, they start ovulating and having their periods pretty, pretty quick. Others might take a couple of months and then on the, you know, a smaller percentage might take quite a while, but generally speaking, a lot of women get their cycles back within the first few months. But then those first few cycles, often ovulation is delayed. And so some of those cycles, are quite a bit longer. And then it's also quite common to have a short luteal phase for those first few cycles and to have abnormal cervical amicus patterns. So that's one way that the pill affects the body. Another thing to be aware of is it's well known that when women are on contraceptives, so if you were currently on contraceptives and you did an ovarian reserve test, for example, it suppresses ovarian function. I just said it makes the ovaries dormant. So then it's logical that those... ovarian reserve parameters are going to be suppressed. And that's what we find in the research. So I think one of the scary stats when women engage with my books is that stat on how when women are on the pill, ovarian volume shrinks by 50%. So it's saying that the pill shrinks your ovaries while you're on them. That sounds awful, right? And then the AMH is low and antral follicle count is low. And what the research tells us... is that when a woman comes off the pill, it takes about a minimum of six to seven months before those parameters start to normalize again. And interestingly then, why are we not told to come off the pill? Six to a minimum of six months or so before we start trying, we're not, but that's something important to know as well. So I don't see these things to scare you because obviously some women do come off the pill and get pregnant right off the bat. So it's not even to say that you can't. Michelle (20:46) Right. Lisa Jack (21:01) but we want to acknowledge that there's a temporary period of subfertility post -pill. And so the other way, so I talked about kind of these three ways that the pill affects the body. So I mentioned the menstrual cycle effects on the menstrual cycle. I mentioned the effects on the ovaries and then there's the effect on fertility itself. And so those are the time to pregnancy studies where they look at how long it takes a person to conceive. And so there was this interesting study that compared women who were using condoms, so non -hormonal methods, to a variety of hormonal methods, including the birth control pill, the shot, the hormonal IUD, and a few others. And in that study, the women who came off the pill, it took them an average of eight months to conceive. The ones who were using the pill, quote, long term, so two years or more, compared to the women who were using condoms, who took an average of four months to conceive. And the shot... users were the worst offenders and they took an average of about 18 months to conceive after coming off of the shot. And the IUD was about eight months as well, eight to 10 months. So that is interesting information because we're not told that. So it doesn't mean that we need to be afraid that the pill is going to impair our fertility forever, but it does mean that we need to be aware that there's a temporary period of subfertility. So then the recommendation out of that, Michelle (21:52) Mm -hmm. Wow. Right. Lisa Jack (22:19) that Lily and I make in real food for fertility is that you should consider coming off of birth control a minimum, I would say a minimum of six to 12 months before you start trying to conceive. And I would add in a caveat that if you did go on the pill because you had menstrual cycle problems, like because you actually knew that there was something wrong, you had long irregular cycles, you never knew when your next period was coming, you had extreme pain with menstruation. you had extreme mood swings or like, right, like there was some sort of kind of medical reason why you were put on birth control, then you'd want to extend that period. And I would go as far to say 18 months to two years because not because we think you won't be able to get pregnant, but because if there's an underlying issue, the pill doesn't solve it. It masks it. So when you come off of it, you still have to figure out what's going on there if you wanted to conceive naturally. So if you come off well before you're ready, so you're still. Michelle (23:06) Mm -hmm. Lisa Jack (23:16) Actively avoiding like you have to figure out your birth control and I would recommend a non hormonal birth control option So you still have to be on top of your birth control game? But during that time if your cycle is kind of wonky if things are going awry You actually have time to fix it. You have time to make your appointments You have time to normalize your hormones without the added pressure of also trying to conceive at the exact same time Michelle (23:40) Yeah. I mean, it's crazy to me because I have, I can't tell you how many people I've had come in and say, oh, my doctor said the second you get off your birth control pill, even if they've been on it for like 15 to sometimes 20 years, the second you get off, you can get pregnant. You don't have to do anything. And you're telling me the science, you know, it's crazy because they say that they're very based in science and the evidence, but. Nobody seems to be looking at that Lisa Jack (24:09) Well, and there's a couple things I can mention about the science that I think are really interesting. So, I mean, one of the ways, one of the reasons that I am digging into the weeds about this is because often when I'm working with women in real time, I'm seeing this stuff. I'm seeing the menstrual cycle regularities and it's consistent. I've worked with hundreds of women at this point who've come off of birth control in my various programs and you see it. You see these abnormal mucous patterns. You see that it takes time for the cycle to normalize. Michelle (24:26) Yeah.
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