Farrar Duro [0:00]
Well, hello, everybody and welcome back to the PCOS Revolution Podcast. I’m here today with Dr. Lara Briden, who is a naturopathic doctor, and a period revolutionary. She’s leading the change to better periods. We’re going to talk today about some topics she discusses in her book “The Period Repair Manual”. For those of you who don’t know her or haven’t read her book, I would strongly encourage you to check out her website. We’ll definitely list the link for that here. So The Period Repair Manual is actually a manifesto of natural treatment for better hormones and better periods. It provides practical solutions for using nutrition, supplements and natural hormones. It’s now in the second edition and it has been an underground sensation working to quietly change the lives of thousands of women. So very excited to talk about this today. Welcome, Dr. Briden. So let’s start off with what really sparked your interest in working with the cycle and women’s health and PCOS as well.

Dr. Lara Briden [1:04]
Hi, Farrar, thanks for having me. Yeah, well, I’ve been working in women’s health as a naturopathic doctor for almost 25 years. I guess it’s a long time. I’ve been working with women with period problems, all that time spending back to the days when, in the 90s, no one was really yet talking about how diet can affect PCOS. That means surgery back then was something called ovarian drilling, which is a surgical procedure, which is really bizarre to think about now, but even back then I said it from a naturopathic perspective, we’ve been taught that there can be an element of blood sugar or insulin. I’ve been sort of coming at it in different ways, for the last couple of decades and of course, seeing great results because it’s the kind of condition that responds better to natural treatment lifestyle treatment than it does to really any conventional medicine.

Farrar Duro [2:01]
Definitely, it’s so rewarding to see improvements with the cycle just by making a few changes here and there. We were talking a few minutes ago about what is going on with the whole landscape of women’s health and how you’re seeing and I see sometimes my practice that PCOS might be becoming over-diagnosed. Could you talk a little bit about about why that is?

Dr. Lara Briden [2:26]
The problem is the ultrasound finding. So here’s the takeaway, which I’m sure has been said on your podcast before but it needs to be said again needs to be stated. PCOS is a hormonal condition that cannot be diagnosed or ruled out with ultrasound. Yeah, it’s some it’s quite a problem. There’s both an over-diagnosis problem with this condition and an under diagnosis problem, as you probably know, so on the over-diagnosis side of things, you get a lot of younger women, especially young women, who are being mistakenly told they have PCOS based on the finding of polycystic ovaries which can be used that way because one of the big changes is that since the Rotterdam guidelines were made in 2003, the sensitivity of the ultrasound technology has increased hugely. So now it’s much easier to pick up to see more follicles and their follicles or eggs which are normal for the ovary, they’re not cysts, the way we have other kinds of abnormal ovarian cysts. It’s common, it’s normal for young women to have more eggs in their ovaries. Almost by definition, being young, you’re going to have polycystic ovaries. There’s one statistic where I think up to 86% of normal women will show it polycystic ovaries on an ultrasound at one time or the other. As soon as you combine that finding, which is essentially a normal finding, with doesn’t take much, having irregular periods for some other reason, maybe it’s post pill or, more commonly under-eating. One of the things that concerns me the most is see women who actually have under eating or hypothalamic amenorrhea, that’s the term for losing your period due to under eating, being mistakenly told they have PCOS and going down the wrong track. That’s on the over-diagnosis side. I’ll just finish up by saying on the under-diagnosed side, I also see women who have insulin resistance, and obviously, anovulatory cycles, no ovulation, irregular cycles, signs of male hormones, and I say, “Well, I think this is PCOS”, and they’re like, “Oh, no, my doctor ruled that out. I have my ultrasound is normal, so that’s been ruled out”. It’s like no, no, you can have the condition the full blown condition and have normal ovaries and ultrasounds. So I really hope that’s clear. I would like to see that the ultrasound finding removed completely from the diagnostic criteria. I think that’s going to help a lot going forward.

Farrar Duro [4:54]
Yeah, that’s so good that you said that because also its not recommended to do ultrasounds to diagnose PCOs in adolescence either, so that shouldn’t really be a criteria.

Dr. Lara Briden [5:05]
Thank goodness, of course. The reason is because they have multiple eggs or follicles in their ovaries because they’re young.

Farrar Duro [5:15]

There’s still a lot of confusion out there about diagnosing PCOS. It’s not easy. And the hallmark is definitely when you look at your period, and it’s over 35 days, like you mentioned, there’s, that’s that’s definitely a warning sign that you need some further investigation, I’ve seen some times where the hormone levels look almost normal as well, but all of the symptoms are there. So that’s interesting, too.

Dr. Lara Briden [5:42]

In The Period Repair Manual, and on my blog, just about to release a new blog post about this, I talk about the different types of PCOS, what I call functional types. These are different than the phenotype diagnostic types that have been put forward. This is looking at what are some of the main underlying underlying drivers, which of course insulin resistance is the most common. But when you look at it from that perspective, I’ll just give the example of adrenal PCOS which affects its accounts for about 10% of PCOS diagnoses. That’s quite a different condition in that there can be regular population, which is like can be longer cycles, but regular population which is quite different than the classic type of PCOS but yet have these high androgens or male hormones from adrenal function, excess adrenal production, and if you start to think about it that way, it makes the diagnostic criteria even a little bit murkier than they were to begin with. The way I would define PCOS these days, I think the most maybe foolproof way to define the condition is it’s a condition of excess male hormones. When all other causes of excess male hormones have been ruled out, that would include, of course, something called adrenal hyperplasia, which you have probably heard about, its a genetic condition of adrenal overproduction of androgens, and that it’s actually quite common. It’s about 1 in 100 women who are almost always misdiagnosis PCOS to begin with. It’s a different condition, it needs different treatments. The other things that can kind of cause a high male hormone picture and high prolactin. The other situation of high male hormones that does get diagnosed as PCOS and I think is quite a particular special case is post-pill. So in my work I talk about that as post-pill PCOS that’s typically when try to come off Yasmin or Yaz  pill or ones which you don’t have in the States but instead we have Diane and Brenda’s. To try to come off those pills can cause a temporary surge in androgens or male hormones during which time, that could go on for six months or 12 months. Irregular periods, quite severe acne, what I call pill withdrawal acne. That is because PCOS is really just diagnosed based on symptoms. I mean that puts women under the diagnostic umbrella of PCOS. And yet it’s a temporary situation and a lot of people have talked about this women can be in a temporary state of PCOS because they’re young, or post pill, and that is actually not the same as the full blown condition which is really a lifelong condition.

Farrar Duro [8:43]
Right. So that would be interesting if somebody actually was told to go on birth control because cycles are irregular, acne, or slightly, just maybe just acne, and that’s sometimes that’s enough reason to be put on birth control and they come off the pill. Their cycles are irregular. They’ve got more acne, more weight gain. And now they’re saying, well, maybe I have PCOS, but you’re saying it could take probably six months to a year for your body to kind of normalize off the pill depending on how long on it?

Dr. Lara Briden [9:13]
With my patients in that situation I would say, okay, right. So we have this PCOS diagnosis for whatever it’s worth, let’s just kind of leave that on the back burner. For now deal with this more as a pill withdrawal situation, see where we can get you in terms of cycle length and skin over the next 12 months and then see if the diagnosis still applies. And the other thing to say when you’re putting young teens or teenagers on the pill for skin and irregular cycles. Here’s the thing because you mentioned about the 35 day cycle is kind of the cutoff for what would be considered normal cycle that’s true for adult women. So for teenagers, I’d say really anywhere younger than like 22 or 23,  up to 45 days is normal. You have a longer follicular phase as a young woman, teenager. So that’s why the guidelines are now really that the diagnosis almost should not be given to teenagers because most of us are in a temporary state of PCOS when we’re teenagers. That said, of course, some teens are in a much more serious state with a high degree of insulin resistance. That would be different but all of us are a little bit insulin-resistant, a little bit high estrogen, anovulatory cycles, longer cycles. As teenagers, some people, some researchers talk about it as puberty is, it’s the kind of PCOS-state of puberty is sort of a natural, it’s part of the developmental stages of the menstrual cycle. So first, you go into the slightly androgen-dominant state, not ovulating regularly and then once you start to ovulate, your estrogen and progesterone kick in and both of those have regulating effects and actually anti-androgen effects that help to mature the menstrual cycle. One thing that’s interesting about the menstrual cycle, and the communication between the brain and the ovaries is that it takes 12 years to mature that. So from the time you start your periods at 13 it’s not until you’re 25 that you progress through all those stages and are making optimal levels of progesterone ovulation, and hopefully down-regulated androgens, things like that. So that’s actually a really strong argument, to not give the pill to teenagers because it interferes, potentially interferes with that maturation process.

Farrar Duro [11:38]
That’s very interesting, as you’re talking about that the wheels started turning like, okay, I remember learning that you are more insulin-resistant during the second half of your cycle.  So then birth control, also potentiates insulin resistance. If we are on birth control for the time of our lives, our bodies are still adjusting to our estrogen levels, what does that do to us?

Dr. Lara Briden [12:08]
It’s actually long been known and there’s numerous studies to show that the pill worsens or causes insulin resistance. More than one expert has chimed in saying, “why are we giving a drug that causes insulin resistance to a condition that is driven by insulin resistance.” So yet another argument, it actually really makes no sense to get the pill for PCOS. I want to say something else about that. I mean, the pill’s a band-aid for each and every period problem. That’s the paradigm we live under currently. That’s the women’s health narrative that we exist under currently. That’s not how future generations are going to manage period problems, absolutely not. Because the pill was invented before anyone really understood how the menstrual cycle works, we’re using an outdated drug and that’s a problem for almost every type of period problem. It’s just a bandaid which potentially worsens some of the underlying conditions. But that’s actually really true for PCOS because A: it worsens some of the underlying drivers including both inflammation and insulin resistance. B: it’s supposedly given to regulate the menstrual cycle, which just think about it for a minute, it can’t do because a menstrual cycle is about having ovulation and the production of progesterone and the functioning of the ovaries on a cyclic basis. The pill bleeds are just a withdrawal bleed from contraceptive drugs that are taken arbitrarily that there was never a reason to bleed monthly on the pill. It makes no sense, it means absolutely nothing. And that’s actually true in some countries now, especially in the UK.

Earlier this year, they introduced new official recommendations that there’s no reason to bleed monthly on hormonal birth control. So we can dispense with that whole myth or idea. So it really raises the question “Why on earth are we giving women this drug-induced bleeds when it means nothing and is worsening the underlying condition?”  The other way I like to say it sometimes is PCOS is a problem with usually insulin resistance and failure to ovulate regularly. Supposedly we’re treating that with a drug that causes insulin resistance and suppresses ovulation so it really does nothing for the condition and that doesn’t mean that…I’ll just put it in the broader context, that doesn’t mean that I’m anti-pill for everything. I know there are other conditions out there like endometriosis where there’s pain and other symptoms that do require sometimes some suppression, hormonal suppression, but PCOS isn’t in that category. The only thing that the pill can do for PCOS, is potentially depending on which pill you take, can suppress androgens, male hormones, which, of course is welcome because it can clear up skin and suppress facial hair to some degree, but only as long as you take it.

Farrar Duro [15:26]
But it also causes hair loss, right?

Dr. Lara Briden [15:28]
It’s only as long as you take those drugs, because actually, when you stop them, those symptoms come back worse than they were before. I’m just at the point where I am just like, “what have we been doing these drugs for this condition?” There’s just so many other treatments that work better, including just simple Metformin. I mean, I still think that the lifestyle treatments and some of the supplements work a lot better even than Metformin, the diabetic drug that’s given but at least that even the Metformin is at least doing something to treat the underlying problems.

Farrar Duro [15:31]
Definitely. I was on an interview with Dr. Christiane Northrup and she mentioned women’s health is still in the dark ages. We are doing something that like you mentioned is 50 years old and we haven’t thought of anything new. What’s going on?

Dr. Lara Briden [16:29]
Yeah, A quote of Christiane Northrup that I use in some of my presentations quite often, which is that she put it like “Because we think of the standard version of human as male, we’ve all been conditioned to think there’s something wrong with the female body,” which is so profound because it’s true. The reason there’s been such a lack of research into how menstrual cycles work is because scientists have sort of been treating the male as the normal and then the menstrual cycle as this kind of add on. If anything, a liability…kind of complicated thing, and I’m trying to flip that whole script and just say, having a functioning menstrual cycle where you ovulate, and make progesterone and everything’s happening with the ovaries, that’s how the human body works. That’s how I would say the standard version of the human body, which is I say, is the female body, how we work. It’s time for a massive revolution in women’s health.

Farrar Duro [17:29]
I love that you’re doing this work, because it’s so needed. I think what’s happened is that women are waking up to this and going, “Wait a minute, I not sure if this is actually good…” We were speaking about a study that surveyed almost 700 women with PCOS and they said, the question was on the...