PRECONCEPTION

011: Fertility Awareness And Understanding Your Menstrual Cycle w/ Lisa Hendrickson-Jack, FAE

011

011: Fertility Awareness And Understanding Your Menstrual Cycle w/ Lisa Hendrickson-Jack, FAE

Welcome to the Hey Mami podcast!

Our guest today is Lisa Hendrickson-Jack, 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.

In her new book, The Fifth Vital Sign, Lisa debunks 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 fertility awareness and menstrual cycle optimization.

She hosts the Fertility Friday Podcast, a weekly radio show devoted to helping women connect to their fifth vital sign by uncovering the connection between menstrual cycle health, fertility, and overall health.

Or listen on Apple Podcasts | Spotify | Stitcher | TuneIn | YouTube

In today’s episode we are talking all about fertility awareness: what it is, how it works, and why ovulation is so important (whether or not you want to have children).

Highlights:

  • Lisa’s journey
  • Why birth control isn’t the only option
  • Why is it important to have a healthy menstrual cycle?
  • What does a healthy menstrual cycle look like?
  • Why is regular ovulation important for general health and wellbeing?
  • How can women use fertility awareness for birth control?
  • How to find a qualified fertility awareness instructor
  • Why fertility tracking devices should be used cautiously

Important Links

Find Lisa online here

The Fifth Vital Sign: Master Your Cycles & Optimize Your Fertility

Association of Fertility Awareness Professionals

Facts About Fertility

Taking Charge of Your Fertility

Tempdrop

Ava

Follow Lisa on Instagram | Facebook

Quotes

“When the menstrual cycle is falling outside of the normal parameters on a consistent basis, if you stop menstruating, if you have significant issues with your period and your menstrual cycle, it’s a sign that there’s something wrong..”

“We care about cervical fluid because it is what changes the pH of our vagina to make it hospitable to sperm. It keeps sperm alive for up to five days, it plays a key role in sperm transport.”

011: Fertility Awareness And Understanding Your Menstrual Cycle w/ Lisa Hendrickson-Jack, FAE TRANSCRIPT

Dr. Carrasco:                      Welcome back to the Hey Mami Podcast. Today, we have an awesome guest and I can’t wait to introduce her. Her name is Lisa Hendrickson-Jack and she’s a Certified Fertility Awareness Educator and Holistic Reproductive Health Practitioner who helps women chart their menstrual cycles for natural birth control, conception, and monitoring overall health. In her new book, The Fifth Vital Sign, Lisa debunks the myths that regular ovulation is only important when you want children by recognizing the menstrual cycle as a vital sign.

Dr. Carrasco:                      Drawing heavily from the current literature, Lisa presents an evidence-based approach to fertility awareness and menstrual cycle optimization. She hosts The Fertility Friday Podcast, a weekly radio show devoted to helping women connect to their fifth vital sign by uncovering the connection between the menstrual cycle, health, fertility, and overall wellness and health. Thank you and welcome to our show. Thanks so much for coming and joining us.

Lisa:                                       Well, thanks so much for inviting me on.

Dr. Carrasco:                      Yes, it’s our pleasure. I would like to start by just learning a little bit more about you and your journey and how you got to where you are and how you dove into all of the things that you talk about in your book. Then, I’d like you to share about your book as well.

Lisa:                                       Sure. Well, thank you. I discovered fertility awareness at a pretty young age, so I think my journey in a way is a bit atypical. From my very first period, it was painful and it was heavy. So I went to the doctor when I was 16, 15 years old because I was really into sports and obviously, heavy, painful periods aren’t conducive. I didn’t know anything other than to ask for the pill, so fortunately, I only had to say about three words and then the doctor was already writing the prescription, so that was done. But because I wasn’t using the pill at that time for birth control, it was like just imagine a 15 year old, the painful, heavy periods. You take the pill, they’re magically a little bit better in my case, and so I was like, “Sweet, I’m fixed.”

Lisa:                                       Then I would come off of the pill because I was always a curious person, and every time I stopped taking the pill, my periods would come back the same with a vengeance, you could say. So from an early age, I had the sense of like, “Okay, it’s doing something but it’s obviously not fixing the actual problem, whatever it is.” So when I did need birth control first year of university, I decided that I was going to come off the pill and use condoms because I had the sense that, “I don’t know what’s going on with my body, but there’s something. I feel like it shouldn’t be that way.” I didn’t have the words that I do now to describe it, but I just had this sense that maybe I shouldn’t be on it. And I was also nervous to trust it because I hadn’t taken it at the same time every day, all that kind of stuff.

Lisa:                                       It was right around that time that I was making this decision that I stumbled on fertility awareness. So university campus, there was a women’s center, all the feminist stuff, and there was a speaker who just mentioned it when she was talking about her book. And so that’s how I discovered fertility awareness. I ran out and bought Taking Charge of Your Fertility and on my university campus, there was a group of women, some of whom were educators, and they would meet every month and talk about fertility awareness. Obviously, this wasn’t a coincidence, given what has transpired since, so I feel very fortunate to have discovered it in that time when I was so young, but also in that way. Because very soon after, I took a class with a bunch of girls in my early 20s and we were teaching this.

Lisa:                                       So, fast forward to now. Back then, I didn’t really think that I could make a career out of it. This was before the smartphones and all the great tech, so I just didn’t know how I would tell enough people about this. But ultimately, once I had my first son and I looked around and realized that I’ve been able to take this information for granted and the average woman still doesn’t know, that’s really what prompted me to start my podcast, write the book, and just not shut up about this stuff.

Dr. Maren:                          Thank you for spreading awareness about this and educating other women. It’s awesome that this goes back so far from you. It was meant to be, right? Like here’s your path. Go for it.

Lisa:                                       Yeah. In retrospect, you can’t really deny it. But at the time, I wouldn’t have been able to predict it.

Dr. Carrasco:                      Right. Well, and I think …

Dr. Maren:                          That’s a good example.

Dr. Carrasco:                      I think Christine and I sit in front of a lot of women who don’t want to be on birth control. Who’ve been on birth control for a decade. I was on it for a decade mainly for menstrual cycle issues and then also for birth control. There’s just better ways to serve women. And I grew up learning about it just peripherally because I grew up in the Catholic church. And so I know that a lot of the women in the church talked about fertility awareness as a way of tracking their cycles, but I never deeply learned about it because birth control was just so easy and that’s what everyone offered and it seemed like so much work, but truly I don’t think it is. I think you get to learn your body really well.

Lisa:                                       Well, it’s so interesting when you think about it and obviously a bit sad and frustrating because so many women in this day and age, they’re not loving their birth control, but they feel that it’s the only option. So everyone is in the same, obviously there’s plenty of women that love their birth control. But even if you look at the stats, so within the first year, 50% of women come off of the birth control is switched to another brand or another type because they’re not satisfied and it’s because of the side effects. And so it’s interesting because people like me who talk out about the side effects, get flak. Some people throw mud at us, right? You shouldn’t talk about that. The birth control pill is so important for women, right?

Lisa:                                       And it is, but at the same time, a significant portion of women don’t have positive experiences with it and also feel that there are no other options. So for me, this isn’t about saying that every woman needs to use fertility awareness. My perspective on it is that all women should understand how their cycles work and the myths that we’re taught. So that we’re taught that we’re fertile every single day, which just puts the fear in you from a young age. And it’s not even true because there’s a short window of fertility that you can identify. Learning about that is empowering because it does show you that there are periods of your cycle where pregnancy is not possible, and that’s helpful for all kinds of reasons. But as far as fertility awareness is concerned, what I always say is that, no one ever forced anybody to chart their cycles and use it as birth control.

Lisa:                                       So women should be made aware of it and this information should be there because women who want to do it are going to gravitate to it. So you mentioned like it seems like a lot of work, I’m guessing that you both brushed your teeth this morning, and I’m guessing that you’re going to brush your teeth before bed tonight. And not to be totally ridiculous, but that’s about how much work is involved in charting your cycles. Once you get into the habit of it, it’s just brushing your teeth. It really only takes a couple of minutes a day. When you think about it once you’ve gotten into the habit of it and for women who choose it, they’re thrilled. It’s really exciting to check for cervical fluid to see if it’s there or to check their temperature and to chart it and to see when ovulation happens. They’re fascinated by it. So this isn’t necessarily for everybody, but for the women who choose to do it, it’s certainly not a big hassle for them.

Dr. Maren:                          Yeah. I love that.

Dr. Carrasco:                      Yeah. And I was going to say, I think a lot of people right now are especially interested in collecting data on themselves. For example, people are wearing a lot of tech using things like Oura Rings or Fitbits or Apple watches to learn more about their bodies. So this is just, again, one more way to really understand what your biological expression is.

Dr. Maren:                          Well, and it’s just as you say in your book, it’s the fifth vital sign. It’s like this thing that we’re not necessarily raised to pay that much attention to. And whether it’s about you wanting to get off birth control or use it as an alternative, whatever it is, we’re not anti birth control. It’s like everything has its risks and benefits and there’s a time and place and for some people it works and for some people, it doesn’t, as you said, some people just have really negative side effects from it.

Dr. Maren:                          So it’s nice to know that there is this other option, but even beyond that, it’s just nice to know how to listen to our bodies. I’m in the phase where I don’t need to worry about that anymore. TMI, my husband had a vasectomy, everybody. I don’t need to deal with that but I still want to know what my body is doing. And I want to know when I’m ovulating. And if I ovulate and all of those signals to know that I’m healthy.

Lisa:                                       I just want to piggyback off that for a second, because it’s such an important piece of the puzzle that is missing for so many of us. I distinctly remember in high school biology class, learning a lot about my ears and all the parts. And I distinctly remember not learning about cervical fluid and the hormonal cycle in depth. And the thing about it is in many ways, it’s complex. You could put it in an encyclopedia, but in many ways, for the practical cyclical, just the way that our cycles work, it’s quite simple to understand. And a huge piece that I feel is missing in our culture right now is the acknowledgement of the menstrual cycle is a vital sign in that, if you are a woman, if you’re living in a female body of reproductive age, a menstrual cycle, having a healthy menstrual cycle is just a part of the normal function of your body.

Lisa:                                       So similar to how you’re supposed to have a bowel movement every day. And if you just stopped having bowel movements, it would be a big problem. No one would just be cool with that. Like, “Oh yeah, I don’t have bowel movements anymore.” Last time I had one was… right? So if we could get to the point that we can really recognize our menstrual cycle is equally important because it is a sign of health. And when the menstrual cycle is falling outside of the normal parameters on a consistent basis, if you stop menstruating, if you have significant issues with your period and your menstrual cycle, it’s a sign that there’s something wrong. It’s like the check engine light is coming out. And that’s a huge piece of the puzzle that all women should know about.

Dr. Maren:                          Agreed. That is a really great… yeah. I love that the check engine light, because I talk a lot about thyroid health and it’s like, if your thyroid is off your menstrual cycles, they’re probably going to tell you that. There’s a good chance, right? It’s not perfect, but-

Lisa:                                       Well, if your thyroid is off significantly off to the point that your labs are showing it and you have symptoms, you’re going to see some issue in the menstrual cycle. And often thyroid issues are one of the biggest causes of menstrual cycle disruptions and it can show up when you’re charting your temperature, if you have a low thyroid, certainly that is one, like that’s a pretty easy way to see an issue, but also heavy periods, longer cycles, shorter luteal phases. There’s different ways that it can show up. And most women aren’t really aware of what’s normal beyond the myth that your cycle should always be 28 days, which isn’t exactly true. We’re just not really educated about what to look for, what a healthy cycle even looks like.

Dr. Carrasco:                      Why don’t we dive into that one? Can you share with us what a normal and healthy menstrual cycle looks like?

Lisa:                                       Yeah. Well, I mentioned the 28 day myth, so what’s interesting is that if you look at the research about the menstrual cycle, the average cycle length for a grown woman is about 29 days or so. So the average does typically fall around that, but the range of a healthy cycle can be anywhere from about 24 to 35 days. So that’s really helpful because some women, they have a 31 day cycle. They’ll actually think that it’s irregular, but you can have a perfectly healthy cycle that’s 31 days or 32 days. And so to take you through the menstrual cycle, often when I ask about the cycle, women will tell me about their periods. So by menstrual cycle, I mean, what happens the first day of your cycle is the first day of your period. And then everything happens until the last day before your next one starts.

Lisa:                                       So in terms of your period, healthy period lasts anywhere from about three to seven days, four to five is about average. And you would expect to have moderate to heavy bleeding at the beginning, and then for it to gradually taper off. So you’re usually losing the most blood by day two or day three, and in a healthy period, you would expect it to have a beginning, a middle and an end like a sentence, and then it’s over. So if the blood just continues, if it’s going beyond seven days, and if you’re also having random bleeding throughout your whole cycle, those are issues that you want to look at. It’s not uncommon maybe to have a little bit of spotting around ovulation, occasionally, and many women do experience premenstrual spotting where they have a couple of days before, but it’s still important to know that that is although common, still an indication that you want to look at something a little bit deeper and I’ll just make a nod to pain.

Lisa:                                       So it’s very common for women to experience pain with menstruation, but moderate to severe pain is a sign of a problem. And if you think about your favorite man in the world, if he had moderate to severe pain in his penis for a couple of days every month, we wouldn’t just be like, “Cool. Yeah, you’re on the floor, doubled over holding your penis.”

Dr. Maren:                          No big deal.

Lisa:                                       Just take an Advil, right? So there’s a serious problem with how we look at these things. And if anyone’s wondering why, because of course we’re all taught that it’s just normal and to be expected. So women who have moderate to severe pain are much more likely to have endometriosis, which is a serious debilitating condition that can affect fertility. Women who have moderate to severe pain have higher levels of inflammatory markers. So the science has already shown us that it’s not normal. But I’ll leave that because that’s its own rabbit hole. So that’s period. And then if I quickly just take you through the cycle, so in a healthy cycle, you would expect after your period is done to have a couple of days before you start to see cervical fluid.

Lisa:                                       So cervical fluid can look like creamy white hand lotion or clear stretchy raw egg whites. And you would expect to see anywhere from about two to seven days of cervical fluid as you approach ovulation. So the healthy cycle you have to ovulate. And I mentioned the range of 24 to 35 days. So that means oblation does not always happen on day 14 and can happen as early as day 10, or even as late as day 24, within that range, it can happen much later than that as well, but I’m just sharing the range of what would be normal and healthy. And so then once you ovulate, you would expect the cervical fluid to go away. So to basically dry up and 12 to 14 days later, you would expect to have your period.

Lisa:                                       So to take you through all of that, it just means that there’s two main phases, before you ovulate and after and there’s parameters that we would look at that are normal and healthy. And so I think that even just having that basic knowledge can be such a powerful tool for women to evaluate and look at things. If your second half of the cycle, the luteal phase after ovulation, if it’s only eight days, that’s a problem and that can be a challenge when you’re trying to conceive. And if you’re not looking at your cycle, you wouldn’t necessarily know that that was the case.

Dr. Carrasco:                      And in your opinion, why is regular ovulation important for general health and wellbeing? Not specifically for conception?

Lisa:                                       Well, ovulation is how we make our hormones. So if you’re not ovulating, you’re not making your significant estrogen that the levels that you’re supposed to be making, and you’re not making progesterone because we only produce significant progesterone in the menstrual cycle if we are ovulating. And it’s interesting because of course these hormones are crucial for reproductive function. So it’s estrogen that builds your uterine lining and progesterone that matures it, and progesterone is crucial for implantation and maintenance of pregnancy. But beyond that, we have receptors for estrogen and progesterone all over our bodies. We have receptors for these hormones in our breasts and our bones. And so when you are not ovulating and when you’re not producing that estrogen and progesterone it has been linked to an increased risk of things like breast cancer, even heart disease and osteoporosis. And so I think one of the most stark examples of that is HA, hypothalamic amenorrhea.

Lisa:                                       So if you think about it HA is characterized by over-exercise, under nutrition and stress. So you’re basically starving. So we often see this in athletes who are really, really working out a lot, but they’re not necessarily compensating food-wise. So your body is highly intelligent and if you’re starving, it’s like this is not a good time to reproduce a reproduction is put on the back burner. But because you’re starving when a woman loses her period, let’s say for six months or more, her lifetime risk of osteoporosis is significantly higher. She’s like wasting away. So in our culture, what we do is put her on the pill. If she’s got a really great healthcare team, they’re going to tell her to eat and workout a bit less, which is the thing that you should be telling her. But this is again a problem because often we’re just looking at it as like, “Okay, well, let’s just put her on the pill.” And then the pill will regulate her cycles, but the pill may force a bleed. And I say may because some women who lose their periods, even the pill doesn’t make them bleed. But the pill may force a bleed every 28 days, but that’s not the same as an ovulatory menstrual cycle.

Dr. Maren:                          Right. Ovulation itself is just a sign of good health as we go back to where we were. And it’s like one of the other things you said just a minute ago was like these things are common, but that doesn’t make them normal.

Dr. Carrasco:                      They’re not normal. We just accept that it’s normal because it’s so common and dysregulation of cycles everywhere, it abounds.

Lisa:                                       And I think it’s time for us to be able to demand better. You know what I mean? I feel like as women, this shouldn’t be what we expect of life. I’m just going to have these horrible periods and pain and all this horrible PMs. And I’ve been told that this is just what it is to be a woman. And so like, no, we can actually be healthy. We often have to go beyond the mainstream medical approach for those answers, because sorry to tell you, but Western medicine was not based on the female body. It wasn’t really made for us. It was based on the study of the male body. Even the animal studies were based on male animals.

Dr. Carrasco:                      It’s true. When we were in medical school, it was like all of the studies that were standardized were on a 70 kilogram white male. So there’s a lot of people that, that doesn’t include. And honestly, that’s why Christine and I started Hey Mami because we felt even as doctors there was better, there was better. We deserve better. We personally deserve better. our patients deserve better. Women deserve better. And so that’s why we’re so passionate about spreading information this. Well, can you maybe jump in and really talk to us about the nitty gritty of fertility awareness and what that means? What are the three signs of fertility? And also how can a woman that wants to get into this and learn more, what can they do?

Lisa:                                       Yeah. No, it’s really important. So there are three main signs, I’ve mentioned two of them when you’re tracking your cycle are the cervical fluid which I briefly mentioned, basal body temperature and cervical position. And so basal body temperature is essentially just a measure of your resting metabolism. And so you would measure that by once you wake up in the morning after you’ve had a good night’s sleep, a minimum of five hours is suggested, then you just pop the thermometer in your mouth and take your temperature before you get out of bed. And what’s interesting is all of these signs are essentially reflecting back what’s happening hormonally. So at the beginning of the cycle, you’re producing estrogen as you approach ovulation and then once you obviously you’re producing significant progesterone.

Lisa:                                       So as you approach ovulation, the estrogen is triggering your cervical fluid production. So the first step to tracking and understanding is just starting to pay attention. Well, I suppose the first step would be reading so that you learn a little bit more about it. So like my book, The Fifth Vital Sign, Toni Weschler’s book Taking Charge of your Fertility are the first places where a lot of people are going to get this information. But once you have a general handle on it, you have to start paying attention. So, for a lot of women, you may be noticing this already. If you’re not currently taking hormonal contraceptives, you’ve probably noticed that there’s a part of your cycle where it just feels a bit more wet down there where you go to the bathroom and you wipe yourself and perhaps you actually feel the lubricated sensation. I always joke that it’s like your hand hits the back of the toilet because it’s like pew.

Lisa:                                       So if you ever noticed that, or if you notice in your underwear, you’ve got the creamy stuff or the clear stretchy stuff it’s not an infection when it happens regularly and it’s not yellow and it doesn’t smell like this isn’t normal. So be so useful, right? For teenage girls to learn that this is a normal, healthy-

Dr. Carrasco:                      And that it’s not gross.

Lisa:                                       Exactly and it’s actually fascinating-

Dr. Carrasco:                      It’s healthy.

Lisa:                                       It’s healthy and it plays such a crucial role in fertility. So we care about cervical fluid because it is what changes the pH of our vagina to make it hospitable to sperm. It keeps sperm alive for up to five days, it plays a key role in sperm transport. So it has these chattels and the sperm is drawn rapidly into the cervix where it then hangs out like in a hotel. That’s my silly analogy, but we have these crypts they’re called cervical crypts within the cervix, which is the base of the uterus and the sperm are held in there for several days as you approach ovulation and pushed up by a certain type of cervical fluid called P Mucus. But it’s pushed up into the uterine cavity before ovulation. So it’s like a sci-fi movie or something it’s really, really fascinating.

Lisa:                                       So in addition to that, just for information sake, it also filters out sperm that is of poor morphology or motility. So cervical mucus is super, super fascinating. We produce it in response to estrogen as we approach ovulation and so those are the fertile days. So if you’re trying to get pregnant, you want to look at those days of cervical fluid as the optimal time to have sex. And if you’re avoiding pregnancy, then you avoid those days. Certainly, there’s more to know, there’s rules that you want to learn and understand, but from the simplest sense when you have cervical fluid, just think babies.

Lisa:                                       So then once you ovulate and I can quickly mention cervical position as well. So what the estrogen does in the first half of the cycle is that it softens the cervix and opens it and changes the general position of the cervix. So it’s an optional sign, the cervical position, not everyone’s comfortable inserting their finger into the vagina and touching their cervix. But if you are, then you can certainly check it once a day, palpate. And it’s really fascinating because you actually do feel that it’s different typically softer and higher, more open might feel like a little dimple. And that’s the only thing at the end of your vagina. I have to get the question, I don’t know what I’m touching? Is this really? It’s the only thing up there that’s at the end of the your vagina. There’s nothing else up there.

Lisa:                                       So you’ll notice that. And then once you ovulate and the progesterone surges, so the progesterone dries up the cervical fluid. So that is a sign that you can pay attention to for ovulation. Progesterone causes a thermogenic effect in the body. So it increases your metabolism, which is really fascinating because you can actually track your temperatures. And once you’ve ovulated, you’ll see a clear and sustained shift. And I know I was really fascinated when I was younger. When I was 18 or 19 when I first started charting because every cycle I could see this shift and it was scientific. And it really helped me to understand what was going on in my body.

Lisa:                                       So in addition to that, the progesterone also hardens and changes the position of the cervix. So after ovulation, it goes from this high soft position to a lower firmer position, and it’s pretty striking, but only on that one day, there’s this one major shift that’s really exciting. And then the rest of the time, it’s not that dramatic. But between these three signs, you can really get a sense of what’s happening in your cycle. So you can identify when in your cycle you are fertile, you can confirm ovulation second to an ultrasound done every day at your doctor’s office. This is the best way to do it, and you can do it at home. And it’s quite accurate in terms of, I would say, within a day or so of your ovulation date, you can confirm this at home.

Lisa:                                       And there was something else that I wanted to mention. So just to throw it in there, I often get the question of like, “Lisa, what do you think about teenagers learning fertility? Do you think fertility redness is appropriate for teenagers for birth control?” And I always say, “I think that condoms are appropriate for teenagers for birth control.” But when I just described your cycle, fertility awareness doesn’t actually allow you to predict ovulation because ovulation can fluctuate a little bit. It doesn’t allow you to confirm those days of fertility, but what it does allow you to predict is your period. And so for every teenage girl and for all the moms listening and future moms and aunties and all those great [00:26:17]things. One of the great things about teaching younger women about fertility and their cycle, well, I shouldn’t say fertility, I should say teaching them about the menstrual cycle and ovulation is that you can teach them how to predict when their period is coming, because talking about the menstrual cycle is not inherently sexual.

Dr. Maren:                          That’s right.

Lisa:                                       And so what teenage girl wouldn’t want to know, when you see cervical fluid, it’s great, it’s healthy, it’s a sign you’re ovulating. This is wonderful. And also when it goes away, it means your periods coming in about 12 to 14 days. This is the power of learning about your cycles.

Dr. Maren:                          Totally. And just normalizing the whole thing. This is what’s supposed to happen with our body, not the painful killed over like not talking about stuff. And I think too, like what you were talking about, Alex, and I both wear this Oura Ring, I’m not wearing it at the moment-

Dr. Carrasco:                      I am not either.

Dr. Maren:                          Yeah. I’m like where is…? I just remembered I left it on my charger but it’s really cool information. I can look back and look at my body temperature and see that it goes up 0.1 to 0.2 degrees. And then my heart rate goes up too. And I know if I’ve ovulated because I can check that which I love.

Lisa:                                       If men had these biomarkers, they’d be biohacking all day long. And there’d be conferences and maybe talk about how to optimize. Now it’s certainly becoming more of a thing with, with women because it’s important to understand your cycle and even how your mood changes throughout your cycle. I don’t love the word biohack, but you can do that and really start to appreciate that at different phases of the cycle, you might have different energy. There might be different levels of exercise that maybe more appropriate, and it’s okay to take a load off when you’re approaching your period and feeling a little bit less energetic and normalizing that for, we’re not men, we have our daily circadian rhythms. Sure. But we also have this monthly cyclical rhythm that the world wasn’t made for. So we just have to of take up that space and own it.

Dr. Maren:                          Yeah. Well, the world was made by it though.

Lisa:                                       Right. Every human being on earth came through their mother’s uterus and vagina. Well, maybe not vagina, but you understand what I’m saying? There’s different ways to come into the world, but there was a uterus involved. There was a woman involved.

Dr. Carrasco:                      Yeah. Absolutely. So, a couple of questions. So how can women use fertility awareness for birth control? That’s one question. And then the other questions that I want to ask about are what your thoughts are on tech. For example, a lot of people are using the clue app or tracking apps. Maybe you can talk about some of the techs that’s available that helps women take their temperatures in the morning, brings it all together in an app. So I’d love to know your perspective and opinions on that. Or if you think it’s better just to do it old school.

Lisa:                                       Well, that’s a great question. For birth control, so like anything that you’re learning to do, I think one of the key differences between the fertility awareness method is birth control and say the pill or the patch is that, other than the obvious difference that there’s no hormones, when you get a prescription for the pill or when you get the patch or when you get an IUD, you just go and you get it and then you take it and then you don’t have to learn anything. You have to do anything. It’s just there like [crosstalk 00:29:36]

Dr. Maren:                          Very [inaudible 00:29:36]

Lisa:                                       Exactly. IUD is a good example of that or implant, you just go and that’s it, it’s done. You don’t have to do anything else. So the fertility awareness method that is the complete opposite, it’s entirely user dependent method. The pill has a user component because you have to take it. But the fertility awareness method, like you’ve pulled the goalie. So one of the ways that I described this is when you’re using hormonal methods, you’re making your body resistant to sperm because that’s what it’s doing. Most of the hormonal methods suppress ovulation and they prevent the cervix from being open. So the cervix is closed with the thick mucus plug all the time. And so your body is essentially just like sperm, you’re dead.

Dr. Carrasco:                      Kitchen’s closed.

Lisa:                                       That’s right. But with the fertility awareness method, you’ve pulled the goalie and so your body is functioning normally. And the success of the method depends on your understanding of the method your body and the rules and all of those things. So my recommendation for women who are serious about using fertility awareness as a birth control, and I think I should also mention that, fertility awareness based methods are highly effective when used correctly. So the perfect use efficacy rates are similar to the perfect use efficacy rates of hormonal methods. So one of the most common studies quoted the Frank Herman Study showed a 99.4% efficacy rate, but these women were trained in a specific way of charting by certified instructors. So my recommendation is if you want the highest efficacy, if you’re really serious about using fertility awareness for birth control, you certainly want to take the appropriate time to educate yourself about it.

Lisa:                                       So the first step, as I mentioned before, get a book read, learn, write. So, the first step is to really educate yourself similar to if you were learning to drive a car, you’re going to read about the road signs, and then you’re going to probably take a couple lessons. So if you’re able to do so, I do recommend working with an instructor. If you are able to work with an instructor, then a minimum of one to three fully charted cycles before you would consider starting to use the method. And if you’re learning on your own, a minimum of three to six fully charted cycles is my recommendation. Before you start using the method, before you start having unprotected sex. And so there’s very good reasons for that. And it’s because, everyone is different, but we live in a different climate.

Lisa:                                       A lot of my clients actually the vast majority of my clients have a pretty significant hormonal contraceptive history. And if you’re just coming off of hormonal contraceptives, there is a period of transition that your body goes through where all of your signs typically aren’t optimal. Maybe your mucus isn’t as clear, or you’re not having as much of it or you’re having it all the time or your cycles haven’t necessarily normalized yet. And so there are more challenges in an environment like this. So it doesn’t mean you can’t use fertility awareness. It just means that you’re probably going to have more questions when you’re going through this process, because when you read the books, it’s like this is how a cycle is, and this is how many days mucus you have. And then when your cycle is exactly like that, it can be really challenging.

Lisa:                                       So I’m not saying this to be discouraging, but I’m saying this because I know a lot of women who discover fertility awareness really, really want to use it. They really want it to work and they really want to be able to feel confident using it. So the way to feel confident is to take the appropriate time to learn, to actually chart. Just to go through the process of charting your cycles, learn the rules, get an understanding, get some support, take a class, work with somebody. And once you invest that bit of time in the beginning, you’ll have this method for the rest of your reproductive life. And so similar to I only had to learn to drive the one time, I’m good now.

Dr. Carrasco:                      But it took awhile.

Lisa:                                       It did.

Dr. Maren:                          Do you have any suggestions as to where people should go to look for a qualified instructor for this kind of thing?

Lisa:                                       So of course I’m an instructor, but I’m not the only instructor obviously, but one of the places, it depends on where you are in the world and all of that, but there’s the Association of Fertility Awareness Professionals AFAP, A-F-A-P. And so that is a list of primarily secular educators who have trained and certified with some of the main programs. Natural Family Planning, so NFP so you can look up fertility awareness method or fertility awareness instructor where you live or natural family planning. They’re basically the same thing. It’s just so that you are aware of that and you might end up finding more places locally. And then there’s different places all around the world. So I don’t know that I have an exhausted list, but that’s a good place to start. Oh. And also there’s a really great organization called the fertility awareness facts Fertility Awareness Facts, Collaborative to teach a science. I just had to remember the acronym. So it’s run and founded by a medical doctor who’s also trained in fertility awareness. And so there’s a lot of good information there for people who are wanting the science and the different methods and there’s just a lot of great information there about fertility awareness based methods, all of them.

Dr. Carrasco:                      And where can our listeners find your book?

Lisa:                                       So the book is available on Amazon. It’s The Fifth Vital Sign: Master Your Cycles, Optimize Your Fertility. It’s in the paperback audio book and ebook formats. And when I wrote the book, because I am not a medical doctor, because I’m a certified fertility awareness educator, I didn’t want it to be a thing where it’s like, “Take my word for it. Trust me.” So I went overboard and cited over 1000 research citations so that you can really like if I’m talking about something in the book for the research heads out there, you can actually go to the back and find the studies and pull them and read them and learn for yourself. And especially in this climate where it’s often challenging. So you two are wonderful, but sometimes when a woman goes to her doctor and tries to talk about fertility awareness, she is laughed out of the office, unfortunately, even to this day.

Lisa:                                       And so it’s helpful at least to have that type of resource where you can, I don’t know, at least have the science, like you know that there’s science behind it. And you had asked about tech.

Dr. Carrasco:                      Tech. Yes.

Lisa:                                       Yeah. It’s amazing to see how things have changed because when I first started, I was on an Excel spreadsheet legitimately printed off from my printer. And so my only suggestions when it comes to text, so when it comes to apps, there’s so many apps now. And one thing to keep in mind is that pretty much all of the apps have different algorithms programmed into them with predictive information. So it’s telling you when it expects that you’re fertile when it expects that you ovulated and when your period is coming. And so when you’re first learning the method, if you’re using the method itself for birth control, you want to understand your cycle.

Lisa:                                       So my suggestion is to choose an app that allows you to turn the prediction setting off, because what happens is it can be confusing. There’s certain apps that have been marketed specifically for the use of birth control. And so that’s up to your discretion, but I don’t recommend using an app as birth control. So charting, putting in your data, and then it tells you that you’re good and then you’d have sex. I don’t recommend that. I recommend that if you want to use the method for birth control that you actually learn it, you can certainly use an app and I know there’s a lot of experienced charters who understand the rules and their cycles who will keep the prediction because it’s fun for them. Like is it going to get it right this time because it doesn’t always, then that’s why I don’t recommend it.

Lisa:                                       In terms of devices, so there’s lots of great devices. So I’m not affiliated or anything, but there’s the Tempdrop and the Ava and things like that. So many of these devices are not necessarily measuring your basal body temperature when you’re wearing something and it’s taking your temperature throughout the night and spitting on an average, or if it has an algorithm to fix it up, then it’s giving you probably something like an average sleep temperature, which is very helpful to confirm ovulation. And if that’s all you’re wanting to do, then these devices can be a godsend because then you don’t have to worry about fumbling with your thermometer first thing in the morning. But for a lot of my clients who were looking at the vital sign aspect, we really want to get a sense of the basal body temperature. Could there be something going on with your metabolism then I’d recommend the basic, stick the thermometer in your mouth type of thing. But obviously there’s a place for all these different tech. I just think it’s good to use tech wisely with the base knowledge there.

Dr. Carrasco:                      Yeah. I agree with that. I [inaudible 00:38:32] And okay, well, and then where can everyone find you online? You have an awesome Instagram account. I know you have an awesome podcast. So tell us a little bit more about where people can find you.

Lisa:                                       Well, thank you for that. So the podcast, Fertility Friday, it’s at it’s sixth year, which is crazy. And so there’s over 300 episodes. If this really inspired you and you’re wanting to learn more. Welcome to the rabbit hole you can type in Fertility Friday in your favorite podcast player and you’ll find me, Instagram I’m @fertilityfriday. I don’t know. I just post all kinds of fun things over there. And I mean you can head over to the fifthvitalsignbook.com for a free chapter of the book. And other than that, I think I’m around. I’m always around.

Dr. Carrasco:                      Well, that’s awesome. Christine, do you have any questions?

Dr. Maren:                          No. Thank you for what you do and thanks for coming on. I really appreciate it. And I think you spread a lot of awesome wisdom and we love your message and you explain it really well. So thank you for breaking it down for our listeners and for women all over the world. Also one more question, if our listeners want to work with you directly, is that also a possibility?

Lisa:                                       Yeah. I have group programs that I do. So live group programs. I may run them a few times a year, so usually like two to three times a year. And those are really fun because you learn obviously from me and you learn the method. And so I teach this specific method, all the rules, all the weeds, we get into all the weeds. But when you’re in a group it’s really fun because you can actually see other women at different stages. So I’ve done groups where you have, it’s my favorite, like 18 year olds. It’s like, this is so amazing to learn all this now. Okay. Just sit there and I’m just going to tell you everything, right? But then you also have women who’ve had children already or who are trying to have children and avoiding or postpartum. And so you get to see this gamut. So that’s really fun.

Lisa:                                       And then I also do one-on-one group coaching and I have an online course for those who just want to the DIY option. So I do have lots of different options for women. The podcast covers the general information. It’s like my big megaphone, like everyone needs to know this. So I try to make it accessible for everybody, depending on how far into the rabbit hole would you like to go option A, B or C?

Dr. Carrasco:                      Yeah, that’s wonderful.

Dr. Maren:                          I love that this is so relevant for like when our daughters start their period in five years or whatever it’s going to be. And then when you’re trying not to get pregnant, but then also when you’re trying to get pregnant, it’s always actually-

Dr. Carrasco:                      Or when you are-

Dr. Maren:                          [crosstalk 00:41:13] that women need to know or when [crosstalk 00:41:14]you’re trying to figure out or when you’re pyramid puzzle, it’s just.[crosstalk 00:41:18]

Lisa:                                       Well, I’m super passionate about that concept because you both know that what’s missing. One of the many things that’s missing in the discussion around fertility is the fact that we don’t really talk about preserving our fertility. So, when I think about feminism and what it means to me, I like the idea of supporting us to be able to avoid pregnancy and of course have our careers and do all our things, but it’s really important to be able to have kids when you want also and I think we need to have both choices. So one of the great things about fertility awareness is if you do use it for birth control, then your body is just you’re not doing anything to your body. If you have the awareness of what a normal cycle looks like, then you can see for yourself if it’s healthy. So you can maintain a healthy cycle while avoiding pregnancy during those years. And when you’re trying to get pregnant, you don’t have to worry about what’s going to happen when I come off the hormones, is my cycle going to be normal. You just switch up the days.

Dr. Maren:                          Yeah. And I think also you have the data to know if there’s something wrong and if you need to address some other issues going on so that your cycle is better, far before you actually start to try to conceive.

Dr. Carrasco:                      You understand your body.

Lisa:                                       In my opinion, there’s lots of stressful things, but just for the purpose of this discussion, there’s nothing more stressful than coming off of birth control not knowing that it can take several months or several cycles for everything to normalize with the idea that you were going to get pregnant right away. So there’s nothing more frustrating than having what if it takes two months for your period to come back? What if it takes four, right? What if it takes a few months and then when it comes back, your periods are totally normal.

Lisa:                                       And so doing that before, when you’re still avoiding coming off, just as I think of if it’s like insurance, just to figure it out, just to see what’s going to go on, definitely use condoms. Definitely have a backup method until you figure this out. But that is the part of the discussion that I love shouting from the rooftops, because I’ve spoken to so many women over the years who even went to their physicians and my husband and I are getting married in the fall. I’ve been on the pill for 10 years, should I come off? Their intuition is screaming at them. And the doctor’s like, “Well, no, you’ll probably just get pregnant right away.” And that’s not supported by the research.

Dr. Carrasco:                      I think honestly, in my training, I was taught come off of it when you want to get pregnant.

Lisa:                                       And it makes sense from the perspective of like no unwanted pregnancies ever, from that fear based idea, but it doesn’t… I’ve read a lot of research papers and I try to discern, right? So there’s a few trends that I’ll just point out. Typically what the research will say is that after a year, so a year post-birth control, everything is back to normal. But when you look at the studies, they’re automatically excluding women that had any type of cycle problems. So if you had PMS or not PMs, PCOS or if you had HA or if you actually had a problem, you’re not in the research study. So when they’re saying 85% of the whole, that’s 85% of the healthiest people.

Dr. Carrasco:                      Right. Yeah. They are not excluded-

Lisa:                                       Yeah. We know that a lot of the women who are on birth control are on there for different issues, and the other thing is when you look at studies actually break down like month one, month two, month three, month four. So they give you the breakdown of when these pregnancies are taking place. There is a documented period of suppressed fertility. So obviously it doesn’t mean that you can’t conceive, but it means that a lot of women come off and their fertility gradually resumes within that year. And so that sounds all well and good except when you’re 35, 37 and you’ve been on the pill for 10 years and you finally got it, you got the job, you got the band, you got everything, I’ve got the crib in the room, I’m ready. And it doesn’t happen right away. That is emotionally just destructive for women. I get why the researchers say that it’s not a big deal, but I hope you get why I say that it is.

Dr. Carrasco:                      It is. Totally. [crosstalk 00:45:31] we will see women like that in her practice all the time.

Dr. Maren:                          We do, and it’s an interesting thing, because we have a lot of friends who are OB-GYNs and midwives, and they’re very much feminists. They want to support women and support women in their decision to, or to not get pregnant and give them whatever they need to do that. But I just think it means that all of us taking another look at that, and maybe considering that there’s this other option, which is probably a really good one especially if we’re concerned about fertility and everybody is these days, it seems, it’s such a common issue. So just being empowered about that, I think is like, there’s this whole other facet that we have to consider.

Lisa:                                       Sorry. I just keep going on. There’s one thing that comes to mind when I think about how to empower professionals to feel more comfortable, because I think a big part of it too, is as a professional, you’re not comfortable recommending fertility awareness because at the end of the day, if a woman doesn’t have the time to learn, it’s 100% user dependent. So if you don’t know what you’re doing, obviously the risk is high. So I think in this day and age though, fortunately, we are not in the 1960s. So fertility awareness is becoming a much bigger thing. There are significantly more fertility awareness educators now than there were even 20 years ago when I started. And so as a professional, you can take a bit of time to educate yourself on what is actually out there. And if your clients are serious about it, you can actually recommend books and also educators and resources and feel more confident that, if a doctor says it to someone, it has a lot of weight. If you’re comfortable, if this is what you want to do, I suggest that you take a class and really learn it because it’s a legitimate method, but you really need to know what you’re doing. That would change the world.[crosstalk 00:47:17].

Dr. Maren:                          That’s all you need to say right there. And there’s your book. There you go. All the resources are here. I love it. Well, thank you so much for coming on. We appreciate what you do and all that you have taught us all today.

Dr. Carrasco:                      No, it’s amazing. And I’m just really excited for our audience to get your book, listen to your podcast, doing your courses and get educated and empowered because there are so many other options. And women, we’ve just been strung around. So it’s time to understand the full picture.

Lisa:                                       Well, thank you so much. This was a lot of fun. Obviously we could have talked for a really long time. [crosstalk 00:48:01]

Dr. Carrasco:                      We are going to have to have you back.

Dr. Maren:                          So thank you so so much.

Dr. Carrasco:                      Thank you.

Alejandra Carrasco M.D. and Christine Maren D.O.

Hello! We are Alejandra Carrasco M.D. and Christine Maren D.O. We founded Hey Mami because we felt a lack of support for fellow mamis. As physicians, we see women every day who struggle with fertility, are forgotten about postpartum, and have put their health on hold for years while they raise a family. We’re here to change that.

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