Under the Influence (with Jo Piazza) - Sunday Nice Things： How Do I Balance My Hormones？

00:00:00.000 Hello, all, and welcome to Sunday Nice Things. Today, I'm bringing you the podcast about

00:00:12.440 periods that you didn't know you needed. Periods are a big topic in our house. Ever

00:00:19.360 since we were at a rest stop on the Garden State Parkway, and my five-year-old daughter 0.97

00:00:24.020 declared, oh my god, mommy's dying, look at all of that blood in the toilet. And so I gave a

00:00:30.900 masterclass on periods and women's anatomy to a five-year-old girl and a seven-year-old boy

00:00:35.360 that they will never forget. This makes me happy, because I want periods to be something that we

00:00:40.820 talk about in our house. My older son has two younger sisters, and I want him to run out and

00:00:46.880 buy us tampons, okay? The Cramped Podcast is one nerd's quest to find out why we know next to

00:00:53.980 nothing about period pain. Tired of suffering from death cramps with no diagnosis for 20 years,

00:01:00.880 Kate Downey decided to look for her own answers. And what she finds will change how you think about

00:01:06.400 your own body and the medical system. In this episode, which is very relevant for Under the

00:01:12.300 influence fans. Kate gets sucked down the rabbit hole of hormone-balancing influencers on TikTok. 0.98

00:01:19.380 Some of these are real doctors. Most of them are not. But what happens next is an enlightening

00:01:25.340 and often hilarious journey through hormone function, cortisol, and how our bodies actually

00:01:31.700 work. In the search for answers to my period pain, I ended up turning to an unlikely place.

00:01:45.700 Or maybe it's the most likely. It was TikTok. I thought TikTok might be a place that I could

00:01:50.640 hear about other people's period pain. And maybe there'd even be doctors on there sharing some

00:01:55.100 information I didn't have yet. I started specifically searching TikTok for cramp

00:01:59.620 content. I found shockingly little, especially considering we now know dysmenorrhea affects up

00:02:06.140 to 90 percent of menstruating people. It seems like every little weird facet of life is explored

00:02:12.260 on TikTok except period cramps. I did find a few TikToks about that moment when you're having

00:02:18.580 cramps and suddenly you get a sharp pain in your butthole. What do you want from me? What do you 0.98

00:02:23.980 I didn't really find much about the experience of having period cramps or what has helped people with their period cramps.

00:02:33.920 But what I did find was an avalanche of TikToks about hormone balancing.

00:02:39.060 Here's five signs that you're running on stress hormones and high cortisol.

00:02:43.000 When and where you are breaking out can tell you exactly which hormones are causing this.

00:02:49.440 When we're in a state of insulin resistance, this tells our ovaries to make more testosterone. 0.98

00:02:55.220 If your metabolic health sucks, your hormonal health is going to suck.

00:03:01.060 And once I started watching some of these, the almighty algorithm just served me more and more. 0.98

00:03:06.320 In the last six months, I'm not a cortisol protocol. 0.93

00:03:09.200 L-E-9, ashwagandha, hydrogen-wines, ice-weat-strike-gay-tabons. 0.54

00:03:13.360 It was overwhelming trying to understand what these hormones did in the first place and what might be going wrong and trying to match my symptoms up with this information while also trying to sort out the wellness grifters and the influencers from the actual experts. 0.92

00:03:29.900 But I kept watching because honestly, this was the closest I'd felt to getting useful information that might help me in a long time.

00:03:37.760 I know we just talked last week about all the amazing research happening at the GYRL lab,

00:03:43.340 but that's research that probably won't result in actual relief from my period pain for years.

00:03:49.660 I'm looking for something to help me now. 1.00

00:03:51.980 These women were talking about quality of life. 0.96

00:03:54.640 They were talking about pain and discomfort and mood swings and bloating, 0.88

00:03:59.280 things that most doctors just brush off.

00:04:02.120 This whole time, has everything that's been plaguing me just been a hormone imbalance?

00:04:08.700 Could a supplement from the TikTok shop fix me?

00:04:11.980 Or is this just another weight loss scam dressed up like wellness?

00:04:16.000 What does balancing your hormones even mean?

00:04:18.940 And how can I do it? 1.00

00:04:31.520 the female body. Welcome back to Krantz, the 1.00

00:05:01.320 podcast where I try to find answers to my severe period pain and then try to understand why answers

00:05:06.780 have been so hard to find. And look, I'm not new to the internet. I know scammy wellness bullshit

00:05:13.580 when I see it, but not all these people talking about cortisol were selling things. Some of these 0.99

00:05:19.080 people seem to be legit medical practitioners, and some people were just talking about their

00:05:23.700 own positive experiences. After 20 years of not getting help from doctors for my period pain,

00:05:29.660 I'm getting desperate for some way to understand what's happening to me.

00:05:33.540 I'm getting desperate for some hope that I'll ever get relief.

00:05:37.300 This hormone balancing thing was starting to sound pretty good.

00:05:40.740 And I'm not the only one that feels this way.

00:05:42.840 I got in touch with one of my personal favorite podcast producers

00:05:46.060 to talk about her experience getting sucked into TikTok wellness.

00:05:51.180 I'm Alex Sujong Laughlin.

00:05:53.020 I am the supervising producer and co-owner of Defector Media.

00:05:56.940 and I have experienced crippling menstrual pain for my entire adult life.

00:06:04.360 Welcome. You're in good company. What is the kind of pain that you experience? 0.99

00:06:10.040 It feels trite to even call what I experience pain. That feels like too small a word for the

00:06:16.360 pain that I feel. In its most basic form, it is cramping in my uterus, but that extends

00:06:23.500 across my whole back and up my shoulders and into my head and I have headaches and dizziness and

00:06:30.560 nausea and it's terrible. It's the worst kind of pain. How long does it last usually? It really

00:06:35.740 comes and goes. I don't have a regular period anymore because I'm on birth control to manage

00:06:41.540 the pain. So I am on a 90-day cycle, which means that in theory, it should only last for a week

00:06:49.760 every three months. In practice, what that means is that I still get monthly menstrual pain. It's

00:06:56.840 just not quite as intense. I'm sorry that you experienced that. That's really hard. It sucks.

00:07:03.480 Especially, I imagine, if we're here and you're talking about being on a birth control now, 0.98

00:07:08.920 you've tried a lot of different things. It's frustrating because I've been to so many doctors

00:07:13.600 and been like hello my period pain is destroying my life it is making it so that I cannot do

00:07:20.320 anything for two out of every four weeks and most of my doctors have either prescribed

00:07:26.680 antidepressants or just said hey did you know that you can take Tylenol and Motrin at the same time

00:07:34.240 and then get stomach ulcers yeah so a lot of just over-the-counter painkillers and hot baths

00:07:41.080 heating pads, e-stim devices, every pain relief solution you can imagine.

00:07:47.440 Yeah, but nothing that really works.

00:07:50.420 Yeah.

00:07:51.160 You wrote something that I immediately devoured.

00:07:54.640 It was an article about hormone balancing.

00:07:57.040 Yeah, I started writing this because I was noticing that on TikTok and on YouTube and Instagram,

00:08:05.100 a lot of the women that I followed who like are not generally health and wellness or fitness

00:08:11.060 content creators. They're just lifestyle creators. This rhetoric about balancing your hormones was 0.99

00:08:18.360 starting to creep in to a lot of their content. And so I would be watching a girl who I love her

00:08:24.880 content for her fashion stuff, her lifestyle stuff. She has a cool life in New York. And then 0.99

00:08:31.260 she drops a whole video that's about how she balanced her hormones and finally got things in 0.98

00:08:36.280 check. And yes, she did lose 15 pounds. That was part of it. But also she's happier than ever. She 1.00

00:08:43.540 feels better in her body, all of this stuff. I just started to notice that I was getting a lot

00:08:48.840 of targeted content about hormones. It seemed like it was the explanation for any possible

00:08:55.380 physical ailment that you could have. It's, oh, you're struggling to lose weight. Oh, you're

00:09:00.500 irritable you're having a hard time sleeping you have bad digestion anything that could be wrong

00:09:06.100 with your body including really bad menstrual pain could be magically explained by hormones

00:09:12.020 this just like general magical thing so i looked into that because i could feel myself getting

00:09:18.120 swept away by that rhetoric too yeah it's really nice especially after going to doctors for years

00:09:24.380 and years and have them be like huh don't know to have somebody be like hey do you have this list

00:09:29.840 of symptoms, including horrible menstrual cramps or like really bad PMS, this might help. That's

00:09:36.340 really nice to hear. Yeah. And it's really validating to have women, like young women

00:09:43.560 on social media being like, hey, I went through the same experience you did. All of these doctors

00:09:50.160 said that there was nothing to be done, but I tried this thing and I feel better. Yeah. It's

00:09:56.080 That magic combination of I see you, you're not alone, and there's a solution that I can

00:10:02.780 give you or sell you.

00:10:04.400 Yeah, that's what makes misinformation of all kinds so potent and spreadable because

00:10:10.720 it speaks to that vulnerability that we have.

00:10:13.760 If this could be the explanation, sure, I'll try it out.

00:10:16.760 Why not?

00:10:17.480 Totally.

00:10:18.160 Yeah.

00:10:18.520 And it felt like I was hitting a crescendo in terms of how bad things could be.

00:10:23.840 I felt really bad.

00:10:25.000 I was really depressed.

00:10:26.080 I needed to like make changes and I was in a place of like real desperation and so I was like

00:10:32.740 you know what I'll order this supplement and I ordered some supplement off of TikTok shop

00:10:37.500 and it's the first time I've ever purchased anything from TikTok shop. I remember when it

00:10:42.200 came in the mail I felt so ashamed because I was like I cannot believe I fell for this. Oh my gosh

00:10:48.880 I hate myself. Did you see any difference or is it just may as well? It was definitely a might as

00:10:54.700 well thing. But I will say like I started that at the same time that I started a handful of other

00:10:59.880 supplements that I started on with a health care provider. And I feel so much better in so many

00:11:06.640 ways. All these months later, it's definitely a weird thing where I'm like, yeah, this science is

00:11:11.280 fake. And also I'm taking this supplement every day. Do you have any questions that you would

00:11:18.760 ask to someone who actually knows about hormones and balancing. What is a hormone? And how are

00:11:24.940 they so powerful? Why are they so powerful? Are they so powerful? And yeah, I guess I'm just

00:11:30.180 wondering if my gut feelings about things being off vaguely have any sort of truth in them or

00:11:38.400 any possibility of truth in them. I had similar questions, so I found a hormone expert to talk to.

00:11:46.100 before we even get to the expert a hormone is a chemical in your body that coordinates different

00:11:52.860 functions basically hormones act like messengers or signalers they tell your body what to do and

00:11:58.920 when to do it so far scientists have identified over 50 hormones some control metabolism some

00:12:04.960 control sleep and waking up some handle temperature blood pressure fluid electrolyte balance some are

00:12:11.300 in charge of your mood and of course some like the ones we're going to talk most about today

00:12:15.520 are calling the shots when it comes to your sexual and reproductive functioning.

00:12:20.060 The endocrine system is the term that's used for all the hormones in your body and what they do.

00:12:25.740 Hormones get complicated, so I am so glad we have someone who can make it make sense.

00:12:32.780 My name is Dr. Thara Baiali. I'm a naturopathic doctor.

00:12:36.780 I'm the co-founder and the chief medical officer of a women's wellness company

00:12:40.280 that focused on women that are what I call the forgotten demographic.

00:12:44.780 It's like you're not pregnant and you're not menopausal.

00:12:47.000 Nobody is thinking about you.

00:12:48.960 Can you give me just like a real 101 on hormone balance?

00:12:53.540 Yeah, yeah.

00:12:54.000 Okay, so first of all, there's no such thing as balanced hormones.

00:12:57.540 When people say I have to balance my hormones or you need to balance your hormones,

00:13:01.240 it really just means something's not working for you.

00:13:03.860 And it seems like it has to do with periods and hormones.

00:13:06.700 Everyone's so different.

00:13:07.460 There's a huge study that was done starting in 1996,

00:13:10.260 still going on women across the nation called SWAN.

00:13:12.760 it's incredibly valuable data over and over again the variability of women's hormones through

00:13:18.080 cycling women is so huge there's no way for us to just be like this is the right level of

00:13:23.920 everything there is of course what we expect during a cycle but there is no way to just be 0.98

00:13:28.980 like your hormones are balanced or not this is a classic I tested everything that's normal

00:13:34.620 everything came back in the normal ranges so my hormones are balanced but that's not what I was

00:13:38.460 actually saying when I said my hormones were out of balance what I was trying to say is I'm

00:13:41.700 suffering. So when people are saying my hormones are out of balance, it's a way that they're saying

00:13:46.340 something is wrong, but it's not something diagnosable, but I'm suffering. Yes. And something

00:13:53.840 needs to change and I need a way to change what's happening to me. Yes. The other part of this is

00:14:00.300 that we have two specialties. One is endocrinology is like above the belt. It's like all the hormones

00:14:07.000 that come from the brain, the two glands in the brain, and then travels down. And then as soon as

00:14:13.600 it enters ovarian function, it generally gets split into OB-GYN. In general, the split is at

00:14:20.820 the belt. So the OB treats everything below the belt and the endocrinologist treats everything

00:14:26.120 above the belt. Which just seems like such a great way to treat a human body.

00:14:30.480 this above the belt below the belt divide is also known as the hpa axis and the hpo axis

00:14:39.060 the h and p stand for hypothalamus and pituitary two glands in our brains that tell the hormones

00:14:46.480 what to do and make some hormones in hpa the a is for adrenals which are little glands that

00:14:53.600 sit above our kidneys. In the HPO axis, the O is for ovaries. Somehow, our medical system doesn't

00:15:00.840 think that these should be the same specialty. So when something is out of whack with our hormones,

00:15:05.880 it can be really hard to figure out where exactly it's going wrong, partly because different doctors

00:15:12.020 are in charge of different parts of a hormonal system that works as a whole. And what does this

00:15:17.320 have to do with TikTok? The adrenals do make one hormone that no other organ makes, which is

00:15:25.040 cortisol, which is all the rage right now. Everyone's talking about cortisol. And so cortisol

00:15:31.020 is a hormone that some people relate to stress, but it's actually an anti-inflammatory. If you

00:15:36.480 ever think about having like eczema or some conditions where you have rashes, you put

00:15:41.140 hydrocortisone on it because it's anti-inflammatory. And that's actually its role, even in period pain,

00:15:47.040 We release cortisol to put out the fire.

00:15:50.320 Why is it talked about as, oh, it's causing all of these symptoms in you?

00:15:54.940 This is where I think misinformation is rampant.

00:15:58.840 So cortisol is needed for inflammation.

00:16:01.360 It's needed for your immune system.

00:16:02.600 It's needed for your blood pressure.

00:16:03.840 It's needed for your ability to feed yourself properly.

00:16:06.100 It also like helps you wake up in the morning, right?

00:16:08.080 Yes.

00:16:08.400 Yeah, exactly.

00:16:09.000 It is part of your circadian rhythm.

00:16:10.460 So it helps you wake up.

00:16:11.960 If it's not high in the morning, it's actually a big problem because it's hard to drag yourself

00:16:15.420 out of bed.

00:16:16.000 It's what keeps you going and it should go down by the end of the day and help you sleep.

00:16:19.800 And so when we look at stress in our lives, there are these few different phases that cortisol can go through.

00:16:25.680 So cortisol's role, it's coming from your adrenal glands.

00:16:28.680 The other two hormones that come from your adrenal glands and only from your adrenal glands is adrenaline coming from the adrenals and noradrenaline.

00:16:35.760 So when you are in a situation where there's a real emergency, adrenaline is what's going to get you through that.

00:16:42.280 So you have to lift the car off of the baby.

00:16:44.580 you will do something that seems super human because adrenaline is letting you do that but

00:16:49.220 adrenaline only lasts for 20 minutes in the body okay that's why if you ever have an epi pen you

00:16:53.980 have to re-push after 20 minutes because it's good it's important it needs to move out ideally

00:16:59.380 somebody comes within 20 minutes but if it doesn't and you still have to hold that car up another

00:17:04.280 hormone needs to come in and cortisol is the hormone that comes in so cortisol is a fire hose

00:17:08.780 it comes in it's supposed to be big and loud and fast it should go super high and allow you

00:17:13.740 to hold that car up. And it can last for a long time in our body because we regularly circulate

00:17:21.080 it. Dr. Thera explained that one of the tricky ways cortisol acts on our bodies is by suppressing

00:17:27.940 the immune system. Our immune systems generally only do their jobs when we're safe, when we're

00:17:34.000 not in the middle of an emergency. When our immune systems attack viruses or bacteria,

00:17:39.980 that's what gives us a runny nose or a cough or a fever.

00:17:43.880 I always forget that those symptoms aren't caused by the actual bacteria or the viruses.

00:17:49.380 It's usually our own immune system putting up a fight that makes us feel sick.

00:17:54.180 So when my body is busy responding to an emergency and it's pumping cortisol to help me survive,

00:18:00.360 it's not going to also fight some invading bacteria in a way that might give me a fever

00:18:05.800 that would maybe make it harder for me to run or climb or lift a car,

00:18:10.520 my body's going to prioritize getting me out of the immediate danger

00:18:14.680 before dealing with more routine immune system business.

00:18:19.020 And you have probably experienced this.

00:18:21.640 Think about going home for winter break, your first few years of college,

00:18:25.320 or finishing a huge project or an event at work.

00:18:28.520 I always immediately get sick.

00:18:31.340 It turns out that is because my body was pumping cortisol,

00:18:35.320 trying to get me through that big stressful thing

00:18:38.220 until I got a break

00:18:39.440 or until I went to a place that felt safe

00:18:42.000 where my cortisol levels went down,

00:18:44.220 my body came out of emergency mode

00:18:46.240 and my immune system finally got a chance

00:18:48.900 to do some cleanup.

00:18:51.340 Cortisol is good and bad

00:18:53.300 and it has so many layers to what it's doing.

00:18:55.640 So then you have the phase one

00:18:57.080 where the fire hose is on

00:18:58.640 so that you can manage the situation at hand.

00:19:02.000 Evolutionarily, we are supposed to manage that situation,

00:19:04.680 get out of it.

00:19:05.320 you should not be holding that car for a long time, right?

00:19:07.980 Right, for six months, yeah.

00:19:09.780 And so what happens in our society now

00:19:13.200 is that what we end up having

00:19:14.720 is you have to hold that car for a lot longer than expected.

00:19:18.180 And your cortisol, your body evolutionarily

00:19:20.240 is not ready for that

00:19:21.680 and can't and should not be ready for that

00:19:24.100 because the car is slacks and emails instead of a car.

00:19:29.400 And they never stop.

00:19:31.400 Yeah, it's incessant.

00:19:32.980 And so what will happen is what we call phase two stress.

00:19:35.320 which is you start to be able to surge the cortisol

00:19:38.760 but it drops pretty quickly

00:19:39.940 and then you surge it again

00:19:40.940 and then it drops really

00:19:41.660 or we use stimulants to surge that cortisol

00:19:44.160 to get us through it.

00:19:45.220 Like coffee, like caffeine?

00:19:46.560 Yes, caffeine is one of those stimulants.

00:19:48.340 It's a herbal medicine essentially

00:19:49.680 and it's great.

00:19:50.820 It can increase cortisol and energy.

00:19:53.300 If you're using it to give you a perk you up

00:19:55.040 in the morning, that's different

00:19:56.260 than if you're like, okay, 6 o'clock, 10 a.m.,

00:19:59.740 12 p.m., 4 p.m.

00:20:00.960 just because I can't get through the day.

00:20:03.020 That's a signal of cortisol

00:20:04.340 starting to oscillate. Your body is trying to help you hold that car up, but it is just not

00:20:11.140 physically possible to output this much cortisol. Is that sort of like burnout or? No. So this is

00:20:16.460 the thing that's happening. So like people are saying burnout when they're up here, up high.

00:20:20.640 Oh. When you're working with burnout, there's the other phase. And these are the people who

00:20:24.580 very rarely get to speak because they're not on social media because they're exhausted. Yeah.

00:20:29.760 What has happened is the car drops, the person drops.

00:20:33.000 The cortisol just cannot do this anymore.

00:20:35.900 And so you end up with people with quite low cortisol.

00:20:38.720 And that's phase three, and that is burnout.

00:20:41.100 They don't need to lower their cortisol.

00:20:43.520 What they need is to heal and rest and be able to have their adrenals, trust them that they are safe again.

00:20:49.540 What we see a lot in the my cortisol is too high world is generally going to be in groups of people who this is their first time at the rodeo of the difficult times.

00:21:01.100 So their cortisol is going through the roof and they may honestly need to lower their cortisol.

00:21:06.360 So it might work for them.

00:21:08.460 However, there are people who have come from long histories of racialized trauma, gender trauma, that this lower cortisol train is not accurate for what they're going through.

00:21:18.120 Wow.

00:21:19.540 So it's not as simple as cortisol bad must lower.

00:21:23.380 Learning all the ways we actually need cortisol,

00:21:26.560 but also how easy it is in the world we live in

00:21:29.000 to exist in a constant state of low-level emergency,

00:21:32.800 it's kind of blown my mind.

00:21:34.560 It's not surprising that the way hormones work together

00:21:37.340 and ebb and flow is more complicated and nuanced

00:21:40.720 than a TikTok can fully explain.

00:21:43.320 We're going to take a quick ad break and be right back.

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00:22:28.120 Welcome back to Cramped.

00:22:29.600 We just had Dr. Thera Vaiali walk us through a 101 on hormones.

00:22:34.060 Let's see if we answered Alex's questions.

00:22:36.920 What she said about there's not really a such thing as being in balance was really interesting to me.

00:22:42.640 As I've navigated a lot of my health stuff this year, I have struggled with the idea that there's a normal that I should be striving for.

00:22:52.220 Because in medical messaging, there is this sense of this is the normal range.

00:22:57.760 But it's only ever a range.

00:23:00.180 And you can't impose these like really strict numbers and categories of this is good.

00:23:06.760 This is a right amount of whatever cortisol, chemicals, hormones that you should have.

00:23:11.700 It's all like this imperfect balance that happens.

00:23:16.040 When she said that people's levels come back normal all the time, but that doesn't mean that they're not suffering, that made so much sense to me of like, I don't have something diagnosable.

00:23:25.100 I'm not sick in a way a doctor can give me medicine and fix, but something is not working right.

00:23:31.060 This is the only language I have to say that.

00:23:33.580 Yeah, it makes you feel crazy.

00:23:36.320 Last year, I went to the ER because I had pain so bad that I was crying.

00:23:40.820 and like for somebody who has had painful periods their entire life to reach a point where you are

00:23:47.620 crying from pain is like yeah a really high bar and I spent seven hours in the ER and they did

00:23:55.700 all these tests and it was horrible and ultimately they were like nothing's wrong it's just like such

00:24:02.360 a helpless feeling to be like I know that something isn't right but I don't have any

00:24:06.580 words to describe what it is. And I can't get help for it. That's terrifying. For me, that was such a

00:24:11.840 light bulb moment of when cortisol is high, it suppresses your immune system. So if you're like

00:24:17.980 working on a project and you're going, you're stressed out all the time. And then once the

00:24:23.280 project is over or you get a break, cortisol lowers and your immune system can respond to

00:24:29.120 the stuff that's been there all the time and you get sick. No, it totally makes sense. It's

00:24:33.700 maddening because you getting sick or you sleeping for three days or whatever it is that your body

00:24:38.520 does when your body knows it's safe is like indication that the way you're living your life

00:24:44.420 in your general day-to-day is not providing you with that sense of safety. One of the first times

00:24:51.840 I remember hearing the word hormones is when I was prescribed birth control for my severe period pain

00:24:57.900 at age 15. Looking back, it makes me feel kind of icky that the first time someone bothered to

00:25:03.880 explain what hormones are and how they work in my body was in order to put me on a medicine

00:25:09.800 that would control those hormones and change what they did. And we heard a few episodes ago from

00:25:15.220 Dr. Tang how birth control can help cramps by making the lining of the uterus thinner so you

00:25:20.940 have less clots or smaller clots and it doesn't hurt as much or cramp as much to push them out

00:25:26.820 of your uterus. And that birth control can also be used to skip your period entirely.

00:25:31.800 But since birth control is literally synthetic hormones, I wanted to hear a hormone-centered

00:25:37.420 explanation. Can you walk me through why hormonal birth control tends to reduce period pain?

00:25:46.900 Oh yes, I think that's pretty easy. So hormonal birth control, oral contraceptives,

00:25:50.800 they stop ovulation, right? That's the goal. So if you stop ovulation, you no longer have

00:25:56.480 oscillations at all in any of your hormones. You have flatlined estrogen, flatlined progesterone.

00:26:01.460 When you're on oral birth control or oral contraceptives, your days when you don't take

00:26:05.480 the pill are not a period. They're called withdrawal bleeds. You're not bleeding for the same

00:26:10.240 reasons that you do when you ovulate. No. And there is no progesterone drop triggering it.

00:26:15.220 When you quote unquote get your period, when you are on a hormonal birth control,

00:26:19.060 that is not the lining of your uterus that has built up shedding. Correct.

00:26:24.020 Where is the blood coming from? 0.95

00:26:25.960 It's still from your uterus.

00:26:27.280 It's your uterine lining, but it's not thickened through progesterone and estrogen buildup.

00:26:31.700 Wow.

00:26:32.360 I was on hormonal birth control for, I don't know, eight years, and I did not know that.

00:26:36.640 Yeah.

00:26:38.260 Okay, Dr. Thera has just blown my mind a second time.

00:26:43.180 Look, does everybody else know this, and I just missed it?

00:26:46.800 Let's check with Alex.

00:26:48.940 That's wild.

00:26:51.240 You didn't know that either?

00:26:52.220 No, I didn't know that.

00:26:53.240 I'm, like, questioning everything.

00:26:55.480 Oh, my gosh.

00:26:56.620 I do feel so galaxy-brained about this.

00:26:58.640 Yeah.

00:26:58.740 I couldn't believe that.

00:26:59.860 It's not technically your period.

00:27:01.960 Huh.

00:27:02.420 Like, I still bleed every month, even though I'm, like, technically on a three-month birth control.

00:27:08.340 Wow.

00:27:08.960 I basically have what I imagine is, like, a less bad period experience.

00:27:14.900 Like, maybe the period experience of somebody whose uterus is cooperating on hormonal birth control.

00:27:20.460 Yeah.

00:27:21.020 So, that's cool.

00:27:22.660 And yet what was sold to you was no periods for three months.

00:27:26.640 Yes.

00:27:27.200 I mean, I feel like among my friends who are cis women, we talk about being on birth control

00:27:33.380 kind of like we're rolling the dice because like none of us really knows how this is going

00:27:38.580 to affect us in the future reproductively, but like also just in general, like our general

00:27:44.760 health.

00:27:45.700 And a lot of us are reaching a point where we're like thinking about having children

00:27:50.600 in the next few years and the whole like coming off of birth control and seeing what

00:27:56.000 havoc has been wrought over the last decade is like a not insignificant part of that process

00:28:02.300 that we're all processing together. This is a question I've had too. We're told that birth

00:28:08.320 control is totally safe and it's one of the most used medications among women. But based on all of

00:28:13.960 my other discoveries of how little we know about women's bodies, I don't totally trust that. So I 0.99

00:28:20.860 asked Dr. Thera about how flatlining our hormones using birth control might affect us long term.

00:28:28.280 We have an above the belt, below the belt issue here. Right. Which is, it is totally fine from a

00:28:35.080 fertility standpoint, from a uterine standpoint. People who work above the belt, they see a lot 1.00

00:28:41.160 value to those hormones in your body. From an endocrinologist point of view, estrogen is

00:28:47.020 protective. You're hearing all about it with menopause. It's important for your bones. It's

00:28:51.200 important for your cardiovascular disease risk. It's important for your mental health and cognition

00:28:55.880 because all these reasons that both estrogen and progesterone are important for us, but they are

00:29:00.440 not relevant to whether you're getting pregnant or not. Okay. So above the belt, ovulation is very

00:29:05.600 important. Below the belt, ovulation is not important. Unless you're trying to conceive. Yeah.

00:29:09.700 Yes. And so from a risk, should you take it, should you not? Nobody is doing necessarily

00:29:14.700 assessments on the long-term risk. There's no major push to find out like, is this affecting

00:29:21.120 women in the long-term this way? And these hormones affect us in other ways. And we should

00:29:24.480 be careful and cautious before we just say, come off of them all the time.

00:29:28.900 By now, I shouldn't be surprised to hear that the answer isn't simple and the studies haven't

00:29:34.400 really been done. And look, by no means am I against birth control or saying don't take it.

00:29:40.680 It's an incredible medication. It can solve so many problems and give women so much more bodily

00:29:46.140 autonomy. I'm just also saying we aren't given all the information about how it affects us. 0.97

00:29:52.440 And that's partly because medical science seems pretty incurious about how manipulating our

00:29:58.280 hormones in this way might affect our quality of life or our health outside of reproduction.

00:30:05.180 And so we're left to figure it out ourselves and to experiment on ourselves. Alex knows this feeling.

00:30:12.240 When I think about like the amount of time I've lost and the amount of money I've spent

00:30:17.560 managing this pain over the course of my lifetime, it's really depressing. And I'm also like, wow,

00:30:24.260 I've still done all of this stuff with my life. Like, wow, I would have been unstoppable if I

00:30:29.900 didn't have this. Can you imagine? I asked Dr. Thera, if we can tell that something is off,

00:30:37.820 we're suffering, and our tests come back normal, what can we do to figure out what's out of balance?

00:30:45.080 I think the biggest part is what I would call body literacy. You have to know what's going on

00:30:50.980 in your body. This is like a trial and error with yourself. Am I bleeding heavily? Am I not bleeding

00:30:56.000 a lot? Can I feel my ovulation? Do I even know my cycle? Just to understand it's not just do I start

00:31:01.440 on day one? Do I end on day blank? It's can you feel your cervical mucus changes? Like you don't

00:31:07.060 have to be interested in fertility to know when you're ovulating. And your ovulation will tell

00:31:12.440 you a lot about the length of time between ovulation and bleed will tell you how much

00:31:16.500 progesterone you have. Oh, say more about that. What does that mean? So the length of the time

00:31:20.760 between your ovulation and the day you bleed is on average 14 days. For some people, it's a little

00:31:26.660 longer, some people's a little shorter, but generally, it's around there. And so most things

00:31:31.380 are mapped to tracking the fact that your menstrual fluid comes out means you must have ovulated 14

00:31:36.060 days before. Right. The way even fertility world works, it tracks backwards, but that's not always

00:31:41.360 true. And so sometimes for some people, they might ovulate and then 10 days later, they bleed. So in

00:31:47.620 the time between ovulation and bleeding, the length of time is usually determined by how much

00:31:52.360 progesterone you have. Progesterone is the mama hormone. It makes all the other hormones that are

00:31:57.440 called sex steroid hormones. So it makes estrogen and testosterone. It makes cortisol. The dance

00:32:05.040 between all those is that if cortisol is in high demand or has been absolutely drained, usually

00:32:12.540 that means that progesterone has been drained. So cortisol, it's the one that gets the most

00:32:17.980 attention. So if it's in need, again, evolutionarily makes a lot of sense. It needs to go to cortisol.

00:32:24.140 And so it reduces its output towards testosterone and estrogen. So if you have more, what is the

00:32:29.700 correlation? The more progesterone, the higher that progesterone can get, the longer the luteal

00:32:34.540 phase will be. Personally, I'm finding that learning about hormones is the same kind of

00:32:40.580 confusing as that statistics course I took in college. Like I'm with you for the first three

00:32:45.820 steps. It all makes sense. No problem. And then at step four or five or 10, I get totally lost.

00:32:53.040 I have come back to listen to this audio so many times because I can't keep straight in my head

00:32:58.540 exactly what more progesterone does to your cycle. So I'll say it here. So hopefully I remember.

00:33:04.500 the higher your progesterone the longer your luteal phase so the more time between ovulation

00:33:12.540 and getting your period if your progesterone is lower you'll have fewer days between ovulation

00:33:18.480 and day one of your period so say you figure out when you're ovulating then what then you can

00:33:26.240 understand is this an ovulation problem is this a thickened lining problem is this not enough

00:33:30.580 progesterone problem and then target those things, right? If I have a super thick lining, how much

00:33:36.220 am I bleeding? If I'm bleeding more than 60 milliliters, you're bleeding a lot of menstrual

00:33:42.400 fluid. And that is considered heavy menstrual bleeding enough to lose enough iron that you

00:33:47.260 can't replace it every month. It's enough to affect your thyroid function. It has so many

00:33:51.800 next effects, right? Sometimes addressing thyroid function will help bleeding and cycle. Sometimes

00:33:57.180 addressing iron will affect all of this. So if you can get a picture of what is actually going

00:34:01.800 on rather than, yeah, I have regular cycles, which is what we say to our practitioners.

00:34:05.640 Sometimes you see that somebody's under chronic stress to find that the luteal phase is shortened

00:34:11.440 because there's just not enough progesterone to go around. But it's not just periods that

00:34:16.400 are affected when different hormone levels are higher. The way we engage is different when we're

00:34:23.780 in different states with different hormones. So estrogen is highly verbal. What does that mean?

00:34:29.420 It means that people with a lot of estrogen use words more. Uh-oh, says the podcast host.

00:34:36.080 Like evolutionarily, it's a lot more social. It's a lot more outward. And progesterone is a lot more

00:34:40.980 inward in here. This is the nesting phase. It's the time when you're supposed to protect the egg.

00:34:44.740 And so things that you can do that can trigger those feelings inside of you, because your hormones

00:34:49.420 hormones react to that are ways that you can shift it. It's again, not a disease that you're

00:34:54.400 going to go and measure your level to be like, was I 10 milligrams higher now? The way we behave

00:34:58.880 will influence our hormones, not just the hormones influence the way we behave. That's crazy. It

00:35:04.200 makes sense, but it's crazy. I think we're all used to the idea that different levels of hormones

00:35:11.060 affect the way we feel and the way we behave. That idea is presented to us every time someone says

00:35:17.340 a woman is acting hormonal or PMSing. 0.98

00:35:20.520 We're told very clearly that this is ridiculous behavior. 0.97

00:35:24.720 It's a joke. 1.00

00:35:26.060 It's a weakness that women have. 1.00

00:35:28.020 We're at the mercy of our hormones 1.00

00:35:29.740 that make us act crazy and emotional

00:35:32.000 and want to just lie on a couch

00:35:33.760 and watch romance movies and eat ice cream.

00:35:36.540 But for some reason,

00:35:37.700 I never considered the idea that it goes both ways,

00:35:41.280 that our feelings and our behaviors

00:35:43.240 affect our hormone levels.

00:35:45.160 Let's see how Alex is taking this information.

00:35:50.700 Wow.

00:35:51.460 I thought she was joking about estrogen being verbal.

00:35:54.960 Apparently not.

00:35:56.260 That's wild. 1.00

00:35:57.520 It also, it like makes me a little uncomfortable because it's like, women be yavin. 1.00

00:36:02.280 Like, I'm like, oh God, it feels a little, I don't know, gender essentialist. 1.00

00:36:07.300 But I feel like my whole process of learning my body more and like coming to a peaceful truce with it has been partially being like, okay, what if I open my mind to things that make me uncomfortable?

00:36:20.300 And those things maybe are pointing in a direction that like don't agree with my politics all the time.

00:36:25.980 It's very humbling because I think I went into this being like, I know everything.

00:36:32.280 I know what's right.

00:36:33.460 I know what's not right.

00:36:35.020 I know what's science and what's not science.

00:36:37.700 And like the more time I spend learning about it, the more I'm like, I don't know anything.

00:36:43.240 And also most people don't know anything.

00:36:45.960 Yeah, I feel like I enter medical situations like my body's doing something I don't like.

00:36:51.180 I'm going to outsmart it and maybe the doctor will outsmart my body for me.

00:36:55.380 But anything that has worked for me, it's learning from my body.

00:36:59.160 It's not trying to fight it or outsmart it.

00:37:03.140 Maybe if something is off or out of balance with our hormones, it's not our hormones that need to change.

00:37:11.160 It's our behaviors or our feelings.

00:37:13.840 And since our behaviors and our feelings are often reasonable reactions to the situations we're in,

00:37:19.580 maybe the only way to change those behaviors or those feelings is to change the situations we're in.

00:37:25.440 checking in with yourself around what feels like it's creating the problem in your bigger life

00:37:33.720 right sometimes it's like you hate your job and sometimes it's very tactical and simple and then

00:37:40.360 other times it's like oh this is really mired with my livelihood and my boss and like how do

00:37:45.960 I handle that but at least recognizing that these are the sources and so really just using the

00:37:52.120 resources that make sense. But then also to serve yourself is to become curious.

00:37:58.240 Getting curious about your own body. God, that sounds so nice. I really love the way that sounds

00:38:04.040 and the idea of it. But what does that actually look like? What does it take to discover things

00:38:10.600 about how your body works? I spent so much money this year on health stuff. Yeah, same. Oh my gosh.

00:38:17.320 And I don't feel proud of it.

00:38:18.920 And I'm not like, do what I did.

00:38:21.380 Right, right.

00:38:22.140 But I do feel a lot better than I did six months ago.

00:38:26.060 It sucks, but it feels like shoveling money onto the problem of period pain.

00:38:30.920 I guess you have to like shovel it in the right place. 0.96

00:38:33.480 But it's the only thing that helps sometimes.

00:38:36.060 And that's not available to everyone.

00:38:38.200 That's not even available to most people.

00:38:39.820 No.

00:38:40.260 That's not an acceptable way to deal with this on a population level.

00:38:45.300 Totally.

00:38:45.780 It's like if I, a childless woman in her 30s who is married, who has a great job, no parents to care for, and it is this hard for me to find relief, that's really, it's not right.

00:39:02.460 Yeah, I cannot fathom the people who are trying to deal with this with even like one less resource than me. 0.57

00:39:09.060 Yeah, I mean, I even think of my mom, like she is an immigrant from Korea.

00:39:14.080 she also had absolutely horrible period pain for her whole life and I remember she wouldn't be able

00:39:21.440 to get out of bed she would be throwing up it was really terrible and she never even questioned

00:39:27.600 whether that was how it was supposed to be she was just like yeah this is what life is like right

00:39:32.380 I think about her a lot because I'm like I have so many more resources than she did when she was

00:39:37.180 my age and I'm like so much more privileged than she was. And yet I still barely have much more

00:39:44.540 support on the pain front. Yeah. Do you feel like you have a better understanding of what's going

00:39:51.660 on with your own period cramps and your own hormones right now? I do. I am freaking blown

00:39:58.200 away by the fact that I'm not actually having periods. Oh my gosh. So like I'm going to be

00:40:04.740 thinking about that one for a while yeah and I think having a lot of this information has been

00:40:11.320 really helpful in just affirming the fact that even if something doesn't show up on like a

00:40:17.660 ultrasound or something saying that something isn't right that the pain I'm feeling is coming

00:40:23.720 from something and it's not just me being like I want to feel pain today you know yeah it's real

00:40:30.700 Yeah, it's real pain.

00:40:32.220 Yeah.

00:40:32.820 It feels so revolutionary to even acknowledge because so often the pain feels like I'm

00:40:38.520 inventing it because I'm the only person who can say that I'm feeling it.

00:40:42.060 Yeah.

00:40:42.280 And you're the only one that takes it seriously sometimes.

00:40:45.020 Yeah.

00:40:45.440 Yeah.

00:40:46.080 Also, the thing about the actions that we can take in our day-to-day lives and the effects

00:40:51.420 that they can have on our hormones and how that can directly affect the amount of pain

00:40:56.140 we're feeling, that's something that I am going to keep thinking about for sure.

00:41:00.220 Do you feel like next time you go on TikTok and it shows you a hormone balancing girly, do you feel like you're going to have a different perspective or a different way of understanding it?

00:41:09.240 Yeah, I mean, I think that I feel a lot less judgmental of them than I used to. 0.81

00:41:15.220 I went into writing that article ready to burn it down and be like, look, sheeple, like you're being led astray.

00:41:23.460 And I've also been led astray.

00:41:25.080 And, you know, I think there's an element to that. But I also think that in the absence of deeper research and treatment options and greater institutional care toward the people who are feeling this kind of pain, I can't really blame people for looking for relief where they can find it.

00:41:44.340 Yeah, absolutely. I'm sure some of those people are just trying to sell supplements and like make

00:41:49.400 a buck. But I think probably the majority of the people sharing information who are not trying to

00:41:55.020 sell something, they are doing something really kind, which is something helped me. Maybe it will

00:42:01.260 help you. Yeah, totally. Yeah. And ultimately, like, what else do we have? Yeah, we're doing

00:42:07.000 our best. And that includes our endocrine systems and our bodies and our uteruses. Yes, yes,

00:42:13.020 Yes, exactly.

00:42:13.780 Everybody's doing their best in non-ideal circumstances.

00:42:17.260 Yes.

00:42:18.580 After learning so much about how hormones work, I think I understand why things like hormone-balancing TikToks are so enticing.

00:42:26.820 We're all living lives that our hormones are not calibrated for.

00:42:31.180 Most of us are in situations that our bodies interpret as dangerous the majority of the time.

00:42:36.160 Our jobs, the responsibilities we have, the ways we're interacting with information and technology,

00:42:42.300 they all put us on high alert, and our hormones are responding to that.

00:42:46.980 We can tell that something is wrong.

00:42:49.360 Even if it's not medically wrong, we're suffering.

00:42:52.740 The real solution is usually going to be to just rest more,

00:42:57.340 to be in less stressful situations,

00:43:00.660 to spend more time in situations that our bodies feel safe.

00:43:04.140 And on some level, I think we know that for a lot of us, that just isn't possible.

00:43:08.760 That to be able to rest more and feel safe more of the time, we'd have to fundamentally change almost everything about our lives in a way that isn't realistic.

00:43:19.800 And there's a lot about our situations that isn't within our control.

00:43:25.000 Some things are just part of the systems that we live in, and without a huge social movement, we can't just change those things.

00:43:33.780 This is especially true for people of color and queer folks.

00:43:37.100 So, maybe I need a way to feel okay, despite the fact that I can't change my situation.

00:43:43.500 Maybe I need a band-aid, like a supplement or a routine that makes me feel like I can

00:43:48.140 take care of myself, even in situations my body interprets as dangerous.

00:43:52.780 These hormone-balancing TikToks, whether they're selling supplements or giving advice,

00:43:57.500 make us feel like maybe we can just start doing one or two things, or stop doing one or two things,

00:44:03.820 that we don't have to change everything about our lives to be okay.

00:44:08.340 If you're worried about your hormone balance,

00:44:10.800 if you're suffering and in pain, even though your tests are normal,

00:44:14.620 I think it's important to recognize that it may not be that something is wrong with you or your hormones.

00:44:20.560 Your body and your hormones might be reacting in a reasonable way to an unreasonable situation.

00:44:28.320 I know that's not a fun conclusion to come to.

00:44:30.920 It doesn't have a list of actionable steps that you can take right now to help balance your hormones and be in less pain or discomfort.

00:44:39.140 I don't have a fix for you.

00:44:41.040 For better or for worse, I am not on TikTok telling you how to balance your hormones.

00:44:45.940 But hopefully, you now have more information about it.

00:44:49.340 More information that will help you find the right ways to take care of yourself and the people around you.

00:44:54.640 Information that will help you be curious about your body and what it's doing and what helps and what hurts.

00:45:01.420 Information that will help you do your best in non-ideal circumstances.

00:45:07.560 Next week, I find a specialist and, drumroll please, I get a diagnosis.

00:45:19.720 Cramped is hosted and created by me, Kate Helen Downey.

00:45:23.000 Kelsey DeLonso is our editorial producer.

00:45:26.000 Sound design and mixing is by Kelly Cromeric at Maven Post Media.

00:45:30.260 Our associate producer is Caitlin Sabater.

00:45:32.560 Cramped's incredible theme song is written and performed by Faraday.

00:45:36.480 Our podcast art was created by Nicholas Shepard.

00:45:39.480 This podcast is supported by the Simons Foundation's Science, Society, and Culture Initiative.

00:45:45.440 Fiscal sponsorship for Cramped is provided by the Arkansas Podcast Collaborative.

00:45:49.620 If you'd like to hear more from Alex, check out the many episodes of the podcast Normal Gossip that she produced and some that she guested on.

00:45:57.580 You can follow Alex on Instagram at Alex Laughs or read her writing on Defector.com.

00:46:03.900 You can find Dr. Thera at theravialli.ca.

00:46:07.780 That's T-H-A-R-A-V-A-Y-A-L-I dot C-A.

00:46:13.280 Special thanks to Mia Lobel, Yvette Modenao, and Matthew Starr.

00:46:17.240 if you want to join a community of real people talking about their period pain and sharing

00:46:22.040 information email cramped podcast at gmail.com to get a link to our discord and if you like me

00:46:28.740 were intimidated by discord don't be it's basically slack if this podcast has been useful or helpful

00:46:34.780 to you please give us a five-star rating on apple podcasts or spotify and leave us a review we are

00:46:41.460 an independent podcast and taking just a minute to rate and review it genuinely helps other people

00:46:47.100 find us who might need this information what's happening to your body we don't know because we've

00:46:51.880 never really studied the female 0.99

Under the Influence (with Jo Piazza) - March 09, 2025

Sunday Nice Things： How Do I Balance My Hormones？

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