Well Woman Weekly: Dr. Jolene Brighten on Post-Birth Control Syndrome and Hormonal Imbalances

Every Friday, we send out a weekly roundup of what’s new on Blood & Milk along with articles you may have missed from the archives. We also include an interview with an inspiring woman and this week we’re excited to Dr. Jolene Brighten. To get the newsletter, sign up here.

Dr. Jolene Brighten is a prominent leader in women’s medicine and the emerging science of Post-Birth Control Syndrome—studying the effects of hormonal birth control on female health. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. Dr. Brighten is also part of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine

Dr. Jolene Brighten

We’re inspired by your work in studying Post-Birth Control Syndrome (PBCS). Can you share first what that is and how it’s inspired the work you do advocate for women’s health, specifically hormones? 

PBCS is a constellation of symptoms that arise after discontinuing hormonal birth control. For myself personally and the many patients that I meet with, hormonal birth control is often offered as the one-size-fits-all approach to anything hormonal-related. Unfortunately, birth control does not treat the root cause and while it’s very good at managing symptoms, it can also bring on side effects that women are never prepared for. My passion is helping women understand their bodies and educating women so well that they can take ownership of their health and their hormones. It’s about getting them the education that they really should have received back in health class. Whether or not women choose to use birth control, I aim to educate and support them in making the best decision for themselves and minimizing side effects. 

Outside of your many degrees in chemistry, nutrition science, clinical nutrition, and your Doctorate of Naturopathic Medicine—what first propelled you into studying hormones and learning a more functional approach? 

I first became interested in women’s health, specifically, endocrinology, when I had the realization in medical school that women’s health was often done to them, not with them, So often when women go to the doctor, they are told what to do and expected to just “be a good girl” and do it. There isn’t an active partnership that provides why the recommendation is being made or given options so that they can make the best decision for themselves. I personally have experienced these physician’s visits. We’re often told that women’s hormones are too complicated to test for or that having mood swings, PMS, and painful periods is just the way it is. It was my frustration with how women are treated in medicine that inspired me to become board certified in naturopathic endocrinology so that I could provide root cause solutions and partner with patients to help them get the care they deserve. 

You’re a huge advocate for the proper treatment of PCOS. Can you share a bit more about the condition and how you started helping women unable to get a proper diagnosis? 

It can take people with PCOS an average of 2-3 years before getting the diagnosis. Because people with PCOS present with symptoms of irregular periods and acne, hormonal birth control is usually the first option. Part of the delay in diagnosis is that they are prescribed birth control with no discussion as to why they may have those symptoms. Not only does it delay the diagnosis, it also does nothing to address the complex metabolic issues such as diabetes, heart disease, hyperlipidemia (high cholesterol), etc. that can arise with PCOS. Hormonal birth control also does not address the mental health components like anxiety and depression that can accompany this condition. I educate women on these factors and help them understand the Rotterdam criteria to get the diagnosis of PCOS, which includes anovulatory (not ovulating) cycles, symptoms or blood work that shows elevated androgens, and the sign of polycystic ovaries on an ultrasound. Medications are always an option in treatment, but there is so much that can be done by way of nutrition and lifestyle. In my opinion, the majority of what it takes to heal happens outside the doctor’s office. 

For many women, hormone imbalance is not only overwhelming but hard to identify. What do you recommend a woman should do first if she’s experiencing hormone imbalances? 

I recommend that women track their symptoms first to get a good understanding of the frequency, the duration, and if there’s pain, how bad is the pain on a scale from 1-10. If the issue is heavy bleeding determining how long the bleeding lasts, how heavy it is in terms of tampons or pads, and how often it occurs can help you get a sense of the seriousness. Having quantifiable data will help them be more successful in navigating a conversation with their provider and helping their provider understand the seriousness of their concerns. All too often in women’s health, we are often gaslit and told that our symptoms are not that bad or are just a normal part of being a woman. Tracking your data and having it written down in front of you when you go to the doctor’s office can help you be more confident in advocating for yourself and also take you a step further in getting the help you need. 

What are some signs that hormonal birth control is affecting the body negatively and causing hormonal imbalance? 

One of the biggest signs that birth control is not working for you can be depression. We know that all forms of hormonal birth control are associated with changes in mood and that may be true for you. If it is, it is important that you seek help from your prescribing provider. In addition, you may also experience things like low libido, vaginal dryness, hair loss, fatigue, digestive issues, and surprisingly, sometimes acne can also get worse. 

For those ready to consider alternatives to birth control, what are safe and effective approaches that you recommend? 

The ability to prevent pregnancy is crucial for so many women’s lives, which is why chapter 13 of Beyond the Pill gives attention to the alternatives if you choose to stop hormonal birth control. The copper IUD is the most effective, non-hormonal birth control (over 99% effective), but it is a device that needs to be inserted into your uterus, and not every person is going to want a device within their body. If you have heavy or painful periods or a history of endometriosis, then it would be contraindicated for you. Even if you are on hormonal birth control, if you’re not in a monogamous relationship, you should be considering barrier methods. Things like condoms are very good at preventing STIs and they can be used in the interim as you come off of hormonal birth control and maybe adopt the Fertility Awareness Method as a form of hormonal birth control. FAM when done correctly, is a very effective method, although you will rely on a barrier method, abstinence, or other activities during your fertile window. 

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