We’ve got a corker for you today! I’m so pleased to share my conversation with Dr Sarah Hill, the author of the books How The Pill Changes Everything: Your Brain on Birth Control and The Period Brain: The New Science of the Luteal Phase and How To Thrive Through It on today’s episode of Period Story.
In this episode, Dr Sarah shares:
- Why her experience as a psychologist led her to write two books on the effects of women’s cycling hormones and the brain
- Her thoughts on biological essentialism and how our biology, including our hormones, influences what we do
- Why progesterone is underrated, including the amazing fact that our peak progesterone levels are up to 250 times higher than our peak oestrogen levels
- Why we need to eat more in the second half of our menstrual cycle
- Why PMS is not a pathological condition, but an inevitable consequence of experiencing hormonal changes in a world that wasn’t created with female bodies in mind
- What the vagus nerve is and how vagal nerve stimulation can be a helpful treatment in decreasing the symptomology of PMDD, perimenopause, and heavy menstrual bleeding
- And of course, the story of her first period
Dr Sarah says that it’s important to learn to listen to your body and trust what it’s telling you, so you believe your body.
Thank you, Dr Sarah!
Get in touch with Dr Sarah:
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SHOW TRANSCRIPT
Le’Nise Brothers: Hi, Sarah, thank you so much for coming onto the show today. I’m so excited to speak to you. I’ve been a fan of your work since your first book. So let’s get started with me asking you the question that I start each episode with, which is tell us a story of your first period.
Dr Sarah Hill: Okay, so this is, it’s embarrassing.
As I’m sure everybody’s story has at least a little undercurrent of that. But I was about, I think I was about 12 and a half and I had, um, I had this like, crampy feeling. I was in home ec like home economics class, which is like where you learn to sew and cook. Um, and I was in that class and I felt kind of crampy and, and I was like, thought maybe I had something gastrointestinal going on.
And so I went and excused myself to the bathroom. And I went to the bathroom and I saw that I got my period and I was horrified. I was horrified and I didn’t want to tell my mom. And I didn’t want to tell my mom because I was afraid that she was going to make a big deal of it. Because, you know, when she first explained the idea of like puberty and everything, to me it was all of this idea of like, you know, becoming a woman.
And I was kind of a tomboy and I like had absolutely no interest in becoming a woman. I was afraid that it would mean that I had to start wearing pantyhose, you know, I just like, I thought that it was going to mean this whole set of expectations for me that I just didn’t want anything to do with. And so I actually, I didn’t tell my mom about it until several months after I got it.
So I went to my cousin’s house and got menstrual products. And so, ’cause she was older than me and so, so I would steal her menstrual products. Well, I wouldn’t steal them ’cause she would give them to me. She would like surreptitiously give them to me on the side. ’cause I told her, you can’t tell your mom because then she will tell my mom.
And so then I finally, months after I got my period, I was like, finally, I’m like, I’ve gotta tell my mom. And so I, and I was agonised over it. I was agonising over it because I was just so embarrassed and it just felt so personal. And then I was also, like I said, I was afraid it was going to be this whole set of expectations that that I didn’t want, like they, it didn’t feel like it fit me. It was this whole thing. And who knew that all those years later, you know, that I would be somebody who talked so openly about, you know, periods and, and everything related to women’s cycles and hormones.
Le’Nise Brothers: How did your mom eventually find out?
Dr Sarah Hill: Well, I told, well, I told her, and then I also, I did tell her that I, that it had happened a while ago and she was just like, why in the world did you wait so long to tell me about this? Like, what did you think? Like, what did you think I was going to do? And um, and I told her, I was like, you know, I, this whole idea of like becoming a woman or whatever, I’m like that just like, I, it’s just so cr it felt cringey.
Like the, the word cringey wasn’t a thing back in the nineties, you know, when I got like nine, I think it was probably, it had to have been 1990 that I got my period. ’cause I was born in 78. And if you do the math, like that word wasn’t around, but like, I wish that it would’ve been around ’cause that would’ve exactly described how I felt.
The whole experience around talking about periods with my mom. It just felt cringey. Like, oh, oh, like, like stop talking about becoming a woman. That’s the worst thing I’ve ever heard. And, and, um, and then flash forward here I am, I who would’ve thought.
Le’Nise Brothers: Was there a point where you started to be comfortable with having a period?
Dr Sarah Hill: I mean, I, I don’t know that I ever felt super uncomfortable with it. You know, like, it wasn’t so much the fact that I had a period as it was all of this like, conversation around womanhood. You know, it was like, like everything that, that, that, womanhood meant to me seemed like something that I just sort of rejected and not because, you know, and I wasn’t like a super tomboy, right?
So like, I, I didn’t play sports. I wasn’t into cars or trucks or, you know, in the, in the way that other tomboys might be. But I just was not somebody who felt like, you know, I kind of rejected a lot of traditional female type of roles because I’m, I have a very assertive personality and, um, and I’ve always been that way.
And it was just like, I, I thought of this idea of like womanhood as this thing that just didn’t fit for me. And you know, and it’s funny because as I’ve developed and gotten older, I’ve definitely very much settled into my feminine energy, which I, I really love. But it, you know, I wasn’t ready for it.
Like, I wasn’t ready for it when I was 12. I wasn’t, I was just like, I reject this. Like, no, I don’t, like, no, I don’t, I don’t want anything to do with this. I don’t want to wear pantyhose, I don’t want to, I don’t want to be, um, only speaking when spoken to which, you know, isn’t even the type of family I grew up in, my mom always worked, you know?
So it’s like, it’s not even that, that I had these role models of women that I didn’t want to be. It, it wasn’t that at all. I don’t, I don’t even know what it was, honestly, but it was like, I had this idea of womanhood and becoming a woman that just seemed really not fitting with who I saw myself to be.
And so I really wrestled with it. And so, like, the act of bleeding never really bothered me, you know? And, um, and having a period didn’t really, didn’t really bother me. And I’ve, um, except for, so, so here’s a funny story. Um, this is like the worst. So you, you didn’t ask me this, but I’m going to tell you the worst period story that I have, and here it’s
Le’Nise Brothers: okay.
Okay.
Dr Sarah Hill: I was, I was in high school and at this point I had not yet become comfortable with tampons. And and so I was, you know, wearing these, uh, wearing these pads even when I didn’t have underwear that was necessarily very well suited for wearing a pad. And I used to wear these big wide-legged jeans, like these JNCOs and like, if, if, um, if you’re familiar with them, because I was kind of a, I was kind of a club kid, and so I wore these big wide-legged pants and I was in a history class.
I still remember this. And I stood up to leave the classroom and the pad fell down my leg. And thankfully I was able to quickly cover it with my shoe before anybody saw it. But then I had to quickly like, put my backpack over it and like, sort of jam it under and like run out, run outta the room with it.
But I mean, that was, that was like the most horrible thing. But, you know, other than that I’ve mostly been like, okay with the fact that I’ve had a period, you know, my whole life has never been something that I thought, was, was embarrassing. It was just more this idea of like, becoming a woman that I had an issue with because I felt like it, it just didn’t really fit me at the time.
Le’Nise Brothers: And so, given all the work that you do. And we’re going to talk about that in a minute. And all the education that you, that you share, what is your relationship with your period now?
Dr Sarah Hill: Yeah, I mean, I, I welcome it, and, and especially at the age I’m at, you know, I’m in my late forties, and so I welcome it.
I have a lot of women who are in perimenopause, like my friends are in perimenopause, and they’re just excited to get rid of their period. But because I think about the period as just being this sort of endpoint in this process of creating hormones, um, which I love and I’m a huge fan of I, I welcome it, you know, I’m, I’m, I’m happy to have it.
And so, um, I have a very different relationship with my period than I did when I was 12 and a half.
Le’Nise Brothers: So thinking about hormones and your most recent book, which is called The Period Brain: The New Science of the Luteal Phase and How to Thrive Through It, which was released at the end of last year.
The work that you do around hormones is it’s slightly different, which is interesting because a lot of the books in this space are focused on your hormones and then the connection with menstruation or ovulation and the kind of more mechanical side of it, but you focus on the brain, which I think is really exciting because a lot of people don’t make the connection between the effect that our hormones have on the brain.
Mm-hmm. Can we talk a little bit about, firstly, why the brain was the starting point for this book, but also for your, your first book?
Dr Sarah Hill: Yeah. Yeah. Well, the reason is because I’m a psychologist, and so if I was going to write, you know, this is your, these are your breasts on progesterone or, you know, like this is your, these are your breasts on birth control.
I wouldn’t have been well qualified to write that book.
And so, uh, so for me, um, you know, obviously being somebody who’s in in psychology that’s the book I would write. But like a lot of people, I think that I’ve, I’ve had the experience of really not appreciating the role that my hormones play in the way that I experience myself, and then the way I experience the world around me.
And, um, and so it wasn’t until going off of hormonal birth control that I really started to put two and two together in terms of hormonal changes and and the way that they influenced how I experienced myself and the world around me, because I, I, even though I knew about that, yeah, like, I’d read papers, I’d even published papers on the effects of women’s cycling hormones on the way that the, on women’s motivational states in particular, their desire to attract partners near ovulation.
And but even though I like had this awareness of this research, it, it really didn’t hit home for me until I went off of the pill. And then I started to feel so differently. And that was like the wake up call I needed, you know, just sort of like. Duh. Of course this like matters in a really important way, uh, or, or this is, you know, really significant in terms of the way I experience myself, my, my hormones.
And so, yeah, that’s, that’s ultimately what led me to start asking those research questions.
Le’Nise Brothers: Going into those, that new type of research or asking those questions, did you get any pushback on that? What was the response from your colleagues?
Dr Sarah Hill: It’s funny ’cause um, I didn’t really get so much pushback from my colleagues.
Um, there is pushback in the field. I will say that, that you know, when you look in the field of psychology, especially not so much in neuroscience, neuroscience, like, everybody seems a lot more, I think that because they’re in the mechanics of it so much and they don’t think about the experiential, um, I, I think that they’re just, you know, sort of more, um, looking at things almost like an engineer instead of a person, which actually is good when you’re talking about the effects of hormones on the brain.
Because neuroscientists are like, well, of course hormones affect the brain, like there’s, you know, receptors for them everywhere. Whereas when you talk to somebody who studies behaviour and you talk about hormones affecting behaviour, that’s where people get a little bit skittish, where they’re like, wait a minute, are you saying that women are hormonal and are you saying that women shouldn’t be able to vote because they’re hormonal? And it’s like, no, no, no, no, no. You know, just because our hormones influence, uh, our brain and what we do, that doesn’t make us any less rational than men because men have hormones that affect their brains too.
That this, doesn’t compute. But there is still a handful of, uh, people in the social sciences in particular, sort of the social science end of psychology, like social psychology where they tend to be very averse to the idea that hormones affect the brain at all.
Because they don’t want it to be true that women cycling hormones affect women because they think that that’s step one in an argument that women should have their rights taken away. And, you know, and on the one hand, like, I’m very sympathetic to the concerns, right? Because certainly, um, and you know, here in, uh, the United States you know, the political climate is such that women are rightfully fearful of their rights and, um, and their continued rights.
And so I, I, I understand the concern about anything that can be leveraged to take women’s rights away being something that we should be really cautious about discussing. But on the other hand, you know, science just doesn’t support the idea that, um, that women are any less biological than men.
And that means that our biology, including our hormones, influence what we do. And they’re supposed to, I mean, that’s like, just like part of the machinery that, um, that creates the experience of being who we are. And so there is a little bit of a little bit of pushback in, like I said, especially the sort of social psychology side of, of, um, the field, um, when you talk about hormones and their influence on women.
But for the most part, you know, I have to say that, um, I got less pushback than I thought I was going to. Like, I was prepared for the world to come, you know, um, guns a blazing when I published that book, just because for so long we’ve been taught that if you’re going to be a good feminist, that you don’t criticise the birth control pill.
And so when I wrote that book, I was challenging that. And, um, and it ended up landing a lot better than I thought it was going to.
Le’Nise Brothers: It’s so interesting that you mention that because whenever I talk about the pill, I always have to add this caveat that of course it’s been incredible for women.
It’s in been incredible for our freedom and our ability to do more. But…
it, I just wonder about, ’cause you mentioned earlier about the critiques that you’re getting from social scientists, and sometimes when I talk about, again, a caveat is around talking about cycling and cycling hormones. I, I have to talk, you know, everyone has a different experience. This is a framework, but you know, your experience of this might be different and people sometimes call this biological essentialism.
And what do you say? Do you ever hear that?
Dr Sarah Hill: I do, I do hear biological essentialism. And I mean, and to be clear, you know, I, um, because I, my background is, is biology, and I look at things from the perspective of biology and neuroscience. I do tend to be like sort of what, what we would call a materialist, meaning that I think that we can understand everything about human behaviour by looking at the biological gears and sprockets.
I don’t believe that there’s a ghost in the machine. Um, I think that, we can actually understand things down based on their individual parts. And that doesn’t mean that we can predict, you know, what anybody’s going to do at any given moment. Because clearly, you know, we have consciousness and we have free will and all these other things.
These things are just biological, you know, free will is the result of, of synaptic pathways and neurotransmitters and hormones. What our free will decides to do, so like, that can be seen as reductionist, but it, but it’s not. And yet I’ve heard this, this idea being essentialist as well.
Like, well, this means that, that this is all that there is to being female, or that this means that this is what you’re supposed to do because you’re female. And to to all of that, I, I just say no. Like, no, you know, just because we can use biology to explain how things happen and like different contributing factors to things that are happening, um, that doesn’t mean that it’s prescriptive and, and that it’s telling us what we should be doing.
And it, it doesn’t mean that that there’s not agency. It’s like each one of us, you know, and it is like, I, the way I always explain it is that there’s, whenever we make a decision to do something, it’s always a combination of like bottom up like emotional motivational states, things that are unconscious that we don’t have a lot of control over, and then top down cognitive processing, right?
And this is the stuff where it’s like, we make the decision, like, do I eat a hot fudge sundae for breakfast, right? And my motivational states might be saying, yes, like, you really want to eat a hot fudge sundae for breakfast because it’s delicious, right? And then my top down cognitive processes are saying like, no, you’re going to feel terrible in the afternoon and have a sugar crash.
And and you’re a little lactose intolerant and so it’s going to make you feel awful. And so then I make the decision not to do it. Just because we can reduce things and understand things in terms of the constituent parts, the biological parts, that doesn’t take away from any of the magic of, of being human.
Le’Nise Brothers: Mm. You mentioned the word prescriptive and something that people can be prescriptive about is their experience of the, luteal phase and This idea of everyone experiencing PMS. And your book is of basically breaking down these myths and misconceptions around the luteal phase and this idea that we all experience PMS.
Dr Sarah Hill: Mm-hmm.
Le’Nise Brothers: And something that’s really interesting is that in your book, you split the luteal phase into early and mid luteal sub phase and the late luteal sub phase. And that might be surprising to some people who might just label it as PMS or maybe they’re learning the word luteal. And to break it down even further might be like, whoa, what, what do you mean?
Can you say a little bit more about that?
Dr Sarah Hill: Yeah, yeah. And so I wrote this book because when we look at the discourse around cycles and hormones with women, there’s so much conversation around ovulation and oestrogen and like, that’s all that anybody’s ever talking about. And, um, and I was really interested in the second half of the menstrual cycle, um, after ovulation specifically, because this is a time that so many women struggle.
Um, a lot of women report that they don’t feel well, or, emotionally they feel all over the place. And and so I wanted to really get my arms around that and try to understand like, what is actually the function of this? Because so much has been focused on the function of ovulation and sex and, you know, feeling your best and everything else, but we really didn’t know much about that.
And so I wanted to do a deep dive into understanding like, what is it that progesterone is actually trying to get us to do that may in fact be functional. And one of the things that I do in terms of breaking things down into different sub phases is just recognising the fact that for women you know, in the second half of the menstrual cycle when progesterone is rising, which is what happens after ovulation occurs, and that empty egg follicle starts releasing progesterone during that period of time, that’s actually cueing to the body that it’s preparing for the possibility of implantation and pregnancy.
So that means that, you know, your body is starting to put all the pieces together to prepare for the possibility that an egg may implant. And this means remodelling the the endometrial layer and getting that prepared. It means making a bunch of immunological shifts to prepare for the possibility of implantation.
And our body temperature goes up and all of these, all of these things happen. And then after, like if an egg does not implant, so if, um, you know, you reach peak luteal phase where your body’s releasing a bunch of progesterone, if an egg doesn’t implant, then levels of progesterone start to fall.
And that’s actually cueing something completely different in the body. So when progesterone is rising, it’s telling us, Hey, pregnancy might be possible. Let’s gear up and get ready for that. And then when progesterone starts to fall, that’s actually sending a signal to our body that pregnancy did not occur, and now your body has to make this, sort of like the reverse Humpty Dumpty, right? So it’s like instead of putting it all back together again, it’s taking it all, um, back apart and getting it ready for getting the body ready for the possibility of, you know, having to ovulate again. And so these are cueing different things. And so what this means is that the challenges that the body is trying to solve differ depending on where you are in the second half of the menstrual cycle.
And it also, it means you know, what happens, mechanistically during these times is also very different. During the first half of the luteal phase, what you see is that levels of progesterone are rising and progesterone, even though it kind of gets a bad rap, um, and I think one of the reasons it gets a bad rap is that people can confuse it with progestins in hormonal birth control, which really do make people feel pretty terrible.
Um, but endogenous or body produced progesterone is very different than progestins. And one of the ways that it’s different is that when progesterone is being broken down in the body. It releases a very potent, uh, neurosteroid called Allopregnanolone, which, um, has the effect of binding to GABA receptors in the brain.
And these are very calming. And this creates inhibitory neuro transmission, which has the effect of, you know, sort of calming the brain, slowing it down, and it has mood stabilising benefits. And so what we see is when levels of progesterone are rising, you’re getting more of this activity.
You get an increase in calming activity in the brain. But then what happens in the second half of the luteal phase is all of a sudden progesterone levels are falling. And you have all of, these these brain areas that are used to now getting exposure to allopregnanolone and getting this GABA, or we call it GABAergic activity with this like calming activity.
And all of a sudden there’s not as much of that there, right? And so you have all these like, naked receptors and um, and that can create feelings of anxiety, um, that so many women feel, uh, especially in the late luteal phase. And so oftentimes what we see is that you get increased feelings of wellbeing in the early to mid luteal phase, very similar to what we see in women who are pregnant.
‘Cause during pregnancy a lot of women report just feeling sort of calm and that they have a lot of wellbeing and um, they just feel, you know, sort of homey and nesty and good. And you get those same types of feelings early luteal phase. And then as levels begin to decline, that’s oftentimes when for women, the wheels start to come off a little bit emotionally.
Le’Nise Brothers: Building on what you just said about the wheels coming off, you wrote in your book that PMS is an inevitable consequence of experiencing hormonal changes in a world that wasn’t created with female bodies in mind.
And most of us are living in a way that doesn’t account for the effect that cycling oestrogen and progesterone have on our bodies.
Dr Sarah Hill: Mm-hmm.
Le’Nise Brothers: For some people hearing that, that might be quite mind blowing.
Dr Sarah Hill: Yes.
Le’Nise Brothers: Can you say a little bit more about that?
Dr Sarah Hill: Yeah. Yeah. So, you know, what really got me interested in writing this particular book was just this idea of PMS, right?
Which is, you know, sort of this catchall phrase that we have for the way that we feel in the last two, or like one to two weeks of our menstrual cycle. So the two weeks before we have our periods, or the week before we have our periods, or the few days before we have our periods right, during this period of time, women will experience changes in mood and energy levels and food cravings and so on.
And we have this like catchall term PMS that we have for this time. And and I, that seemed really unusual to me that, um, so many women would have something that seems like it’s disordered, right? Like, like how can most of the population have a disorder? PMS? And, um, and so when I really began to look into all of the ways that our sex hormones that cycle, you know, the way that they influence, the way that we experience our bodies and what our bodies are doing and what our body’s needs are, and then the way that we experience ourselves, it, you know, it really made me appreciate the extent to which our body is shifting between a state that’s optimised for attraction and sex, which is what you get during the first half of the menstrual cycle with oestrogen.
And it sort of remodels our brain and our body in a way that’s maximally oriented toward being able to tell the difference between high quality and low quality partners, and also being able to maximally be able to attract those partners and then shifting into the state that’s optimised for implantation and pregnancy, right?
And this is a, you know, the luteal phase, and this is organised by progesterone. And during this time as part of this process by which our body is preparing for the possibility of pregnancy our basal metabolic rate increases by 7 to 11%. Our basal body temperature increases, our sleep needs increase, we get more GABAergic activity, which makes us more sleepy, and it makes us more relaxed. Our amygdala, the fear centre in our brain becomes more interconnected to a greater number of regions of the rest of our brain, um, increasing vigilance to, you know, to keep us safe. And so we’re experiencing all of these changes and and a lot of times we are experiencing these changes which are very functional, right?
Which are preparing our body for the possibility of pregnancy. We experience them as pathological because women have not really been taught to appreciate and understand that they’re cyclic and that, you know, just so you know, if you’re a woman, your sleep needs are going to change across the menstrual cycle.
And just so you know, as a woman, basal metabolic rate increases. And so you need to eat almost like between 150 to 200 extra calories a day in the second half of the cycle just to keep up with your, um, metabolism. And your temperature is going to increase and your sex drive is going to decrease, and you’re going to become more emotionally vigilant and, and your threat detectors are going to go off more frequently.
And we’re not taught any of that. And the result of that is that we all think that we have something wrong with us PMS, right? Because we’re given a one size fits all set of instructions about what we’re supposed to do to take care of ourselves. And, um, and the result is that most of us feel like we’re, there’s something wrong with us, right?
Or that this is this pathological condition and and it’s not. And if we took the steps that, we needed to take to take care of ourselves as we cycle. And actually learned to trust and believe our bodies when they’re telling us what they need, um, then we can avoid a lot of the unpleasantness that many women experience as they cycle.
And just as a case in point on this, you know, one of the things that I talked about is the fact that our basal metabolic rate increases 7 to 11% in the luteal phase relative to the first half of the cycle. And we’re not taught that, right? And instead we’re given a one size fits all, like set of, uh, nutritional guidelines where it’s like, here’s the number of calories you should eat every day.
And so then you’re in the second half of the menstrual cycle and you’re trying to stick to your doctor prescribed, you know, one size fits all set of nutritional guidelines and you’re hungry. And then you start having food cravings because your body is like, eat something for God’s sake, eat something.
And you’re like, no, I, you know, I already ate my prescribed number of calories for the day and I’m doing the right thing. And so then we have food cravings and then we end up binge eating. ’cause like then we, you know, end up in the pantry because we’re hungry and we’ve been trying to ignore our body and what it needs.
And it’s, it’s madness. If women were actually taught that your cycles matter and they influence your biological needs and the in they influence your psychological needs and your needs for closeness and um, and feelings of emotional security then we can ask for what we need and not experience our bodies as, as pathological and not actually create pathology by ignoring what our bodies need.
Le’Nise Brothers: Everything you’re saying, it just makes so much sense to me. But so many women, they struggle with this. They struggle with listening to their bodies. What you said about the basal metabolic rate increasing, I was speaking to a woman this morning and she said, you know, right before my period, I get bloated, I get a bit moody and I get these cravings.
And I said, well, what do you crave? And she said, I don’t know, but I just get hungrier. And I said, but it’s normal. It’s normal to be hungrier. And she, it was like I was blowing her mind. She really, it’s normal to be hungrier. So all of this information that we should know as cycling women, women with cycling hormones.
How can we get this out there? How can more women learn about this?
Dr Sarah Hill: I think that gosh, it would be great if we, if we actually had health education that provided women with this in schools. But, you know, and, and until that happens my hope is that resources that are available, like, like my book like other people’s books, uh, social media even though social media is not a great place to be educated, ’cause there’s also a lot of nonsense out there.
Um, if you are able to, you know, follow people who actually have degrees and you know, experience in, in the areas in which they’re speaking I think that’s a good place to start. But my ultimate hope is that at some point we’re going to see the education system start to really take bodies seriously.
Because I think that it’s not just, you know, I think that the lack of knowledge and awareness around women’s cycling hormones and their impact on women, I think that that’s in a lot of ways just, um, symptomatic of a larger problem where we’re taught almost zero about our bodies. You know, we take health class and it’s all, and it’s just like the food you learn, the food pyramid and like are told to, you know, not sniff paint.
It’s just like this very, it’s like this very basic not particularly compelling sets of, you know, guidelines and, uh, and education about our bodies. But I think that if we really taught people about how their bodies work and how their brains work, and the connection between the brain and the body and the way that the way that we treat our body influences how we feel and experience the world, I think that would make it more salient.
Like it would make people care about it more. And, um, and I also think that it, there, there’s just so much ground to cover, um, that’s not being covered, uh, that I would like to see included in, in health curricula in the schools. Um, that included information about hormones and hormonal changes.
Le’Nise Brothers: So talking about hormones with, we, we know a lot about oestrogen or estrogen depending on where you live
Dr Sarah Hill: Yeah. Depending on where you are.
Le’Nise Brothers: Yeah. What might fascinate people is hearing the fact that at its peak progesterone levels are 25 to 250 times higher than our peak levels of oestrogen, estrogen.
Thinking about progesterone, you talked about the good side of it and how many things that it does for our body, how many great things it does for our body. I want to talk a little bit about the dark side of progesterone and talk a little bit about PMDD, because this
Dr Sarah Hill: mm-hmm.
Le’Nise Brothers: In the UK there’s a lot of conversation around PMDD, and there actually is a lot of misconceptions, namely that it’s a more severe form of PMS.
And I’d like to hear your, your view on PMDD.
Dr Sarah Hill: Yeah. Yeah. Whenever you have women who are experiencing PMDD, which is characterised by, uh, severe mood changes in the second half of the menstrual cycle that oftentimes, but not always, can also be associated with, with suicidal ideation.
So, I mean, it’s just a really severe set of mood changes that can impair the lives of the women who suffer from it. It is sort of similar to severe PMS. They, they share a lot of, um, a lot of characteristics. But PMDD oftentimes doesn’t respond as well to simple lifestyle interventions, such as, um, for example, getting more sleep in the luteal phase, aerobic exercise, eating a diet that’s anti-inflammatory.
All of these types of things are helpful to everyone. Um, so that will help ease the distress that women feel as they’re moving through hormonal changes. Um, but oftentimes for women with, uh, PMDD it’s more severe than can be addressed with just simple lifestyle related modifications that oftentimes are pretty helpful for women who just experience run of the mill every day PMS. And, um, one thing that PMDD and um, and severe PMS and have in common is that they both seem to be related to sensitivity to hormonal fluctuations. Right. And so, you know, sometimes people think about PMS or PMDD as being related to progesterone, for example, in that it’s having progesterone on the scene that’s creating the problems.
But research really seems to suggest that it’s that some individuals are just really sensitive to rapidly changing hormones. And for those individuals, um, they have their brains and the rest of their bodies have a more difficult time making the necessary adjustments in neurotransmission and otherwise that then lead them to feel really terrible, um, when their hormones are rapidly changing.
Because hormones, as you noted, um, in the luteal phase of the cycle, the hormonal changes that happen are like, almost up to 250% higher than what you get in the, the follicular phase. You have these huge hormonal changes and they’re happening very rapidly. And if you don’t have a lot of resilience, sort of cellular plasticity, that allows you to be resilient to these changes and quickly adapt to, oh my gosh, there’s really high levels of progesterone, oh my gosh, there’s really low levels of progesterone that can create essentially like a physiological cacophony that, that makes these women feel really terrible.
And, um, one thing that’s important to note about this is that, um, you know, if you’re somebody who has sensitivity to hormonal changes, that like means that you’re probably likely to have severe PMS or PMDD, but it also means that you’re likely to experience, um, a greater, you have a greater probability of experience postpartum depression.
You have a greater probability of experiencing difficulty with depression in during the perimenopausal transition. So anytime that there’s rapidly changing hormones, um, it means that you’re going to be at a greater risk. And I think that this is really important for women to know because it’s something that they can get the necessary supports in place, knowing as they’re entering into a new phase of life that this is probably going to be a time when they need to have support.
And so for women who have PMS and PMDD, making sure that they have support and a doctor’s support when they’re going through a postnatal transition, so after having a baby, and then also once they enter into perimenopause, so that way they’ve got a game plan and they already know what to expect, and that way they can seek out help sooner than later.
And so, PMDD and severe PMS are conditions that are the number of treatments that are available for these women is still relatively limited. And, um, and it’s only, in the last I would say 10 years and which is really sad that researchers have really begun to dig into these issues to try to better understand what we can do to better treat these women besides just give them hormonal birth control, which is really palliative.
So a lot of women find a lot of help, like especially women with PMDD by levelling out their hormone production and preventing cycling. They don’t have to worry about hormonal changes, which is what they’re sensitive to and what’s giving them the symptoms. And so hormonal birth control is one option that’s been given to women.
Antidepressants is another, um, solution that has been given to these women, but it’s only within the last 10 years or so that researchers have tried to better understand the actual mechanisms that are responsible for creating this sensitivity to hormonal changes. And are now beginning to explore some different types of treatment options, um, that are non-medication based.
Le’Nise Brothers: So talking about other treatment options, something that you write about in your book is vagal nerve stimulation.
Dr Sarah Hill: Yes.
Le’Nise Brothers: This will be new to a lot of people. Can you say more about this?
Dr Sarah Hill: Yeah, absolutely. So, um, I’m actually really excited about this because my research lab is, is doing some of this research right now.
We’re in the very early phases of it, but we’re looking at whether stimulating women’s vagus nerve can have the impact of decreasing symptomology of PMDD. And we’re also looking at this with perimenopause since the mechanisms of, you know, action are very similar, it’s all about this sensitivity to hormonal changes.
And we are, we’ve proposed that you can decrease women’s sensitivity to hormonal changes and increase what we call their resilience to hormonal changes by increasing the amount of communication that goes on between the brain and the rest of the body. And one of the ways that the brain and the body communicate, um, is through the vagus nerve.
And, uh, the vagus nerve is this, and which is, it’s like Latin for like wandering nerve, but it’s essentially like a big strand of electrical spaghetti that branches down from the brain into the rest of the body, right? And when and, and this is how the brain learns about how the body is doing.
It’s like it gets messages from like the heart, like, Hey, how’s the heart doing? Oh, okay. Look, let’s say the heart’s doing good. Oh, how’s the liver doing? Oh, liver’s doing pretty good. Things are going good there. That’s great. How are our hormones. Okay. Hormones looking good. All right. That’s really good. How are the big, you know, how’s the big toe?
Okay. The big toe is doing good. So it’s, it’s like our brain gets information about the rest of the body and the condition of the body from the vagus nerve. And then, based on the information that the brain gets about the body, it will then tell the body what to do. So, for example, you know, if it’s checking in on the body with the vagal effends, um, and it’s getting information about like, let’s say that the big toe, like you just dropped something on your foot, right?
And it takes a second. Like you always know your foot. Like if you ever drop something on your toe and you like it, it doesn’t hurt until you know it’s going to hurt. And it’s because it takes a minute for that nerve to reach all the way up to your brain. And so your, your body’s already processing it as, ah, shoot before it actually registers as pain in our brain.
And so our brain gets that information and then it will say like, oh, okay, the toe might be injured. Like, Hey, immune system, why don’t you send down some white blood cells to surveil the area and see whether or not, we need to send out the troops. And then that’s how that whole process starts, right?
And so there’s this really beautiful bi-directional information highway that operates between the brain and the rest of the body through the vagus nerve, right? The brain learns about what’s happening in the body, and then in turn the brain directs the activities of the body. And and so what we’re interested in is stimulating the vagus nerve, um, which is something that when you stimulate the vagus nerve, essentially what it does is it opens up that communication pathway.
Because a lot of people, especially people who are experiencing or have experienced in the past chronic stress or trauma, a lot of times their vagus nerve pathway it gets kind of closed down because when the brain is dealing with a lot of stress, your attentional system, all of your brain’s effort are focused outwardly, right?
Because if you’re in a stressful environment, your brain wants to know what’s happening on the outs around you, so that way you can cope with the stressor, right? And if you’re somebody who’s experienced trauma during childhood, your brain is actually developed in a way that has biased you away from focusing on what’s happening internally.
And instead has you focusing on what’s going on externally. Because if you’re in a traumatic environment, it means you need to be vigilant, right? You need to be vigilant to the external environment because things might be happening that aren’t good, right? Bad things might be happening. And so what happens with people who are either in chronic stress right now, or who developmentally have been exposed to chronic stress, is that you get decreased communication between the brain and the inside of the body because the body is biased toward focusing the attention outward.
And so there’s not enough attention being focused inward, and that can create pathology and that can create a number of different types of pathology. All of which seem to be very responsive to stimulating the vagus nerve. ’cause when you have the effect of stimulating the vagus nerve, it essentially opens up that communication pathway between the brain and the rest of the body.
And it gives the brain a better idea of what’s going on so that way it can make adjustments so that way the body runs like a well-oiled machine. And so we’re really interested in this in the context of PMDD and perimenopause because a lot of times when women are experiencing negative symptoms, it’s the result of the fact that the body isn’t adjusting quickly enough to these hormonal changes that are happening.
And so what we’re trying to do is, is open up that communication pathway between the brain and the rest of the body so that way the brain can tell the body what adjustments it needs to make in order to be able to get more smoothly through the transition of in the case of PMDD, the luteal phase, or in the case of, um, perimenopause through the perimenopausal transition.
And what’s really interesting and what’s what I love so much about this vagus nerve research is because what the mechanism of action is, is increasing the communication between the brain and the rest of the body. It has these incredibly helpful effects in so many different systems of the body. And just to give you, um, some examples this has been one of the treatments of choice for people who have treatment resistant epilepsy.
And so people who are having seizures, when you stimulate the vagus nerve, which again is sort of, um, it helps to regulate the body, um, in, in a way that decreases seizure activity and, um, can actually prevent seizures and people who are unable to prevent seizures using any other type of method. There’s been research showing that it decreases heavy menstrual bleeding which I think is really fascinating.
And that’s some research that’s been done by by OhmBody. I’ve actually got, this is the device that, that we’re using for our research looking at at PMDD. But they found in their research looking at heavy menstrual bleeding, that when women stimulate their vagus nerve during menstruation, it actually decreases the heaviness of their flow.
And it probably can prevent bleed outs during childbirth. Um, and that’s something that has not yet been explored. But given that that stimulating your vagus nerve has the effect of allowing your body to more carefully regulate blood flow, it suggests that that’s a possibility. And there’s also research showing that it, it decreases drug cravings and people who are who are trying to decrease addictive behaviours.
And so it has a lot of these really wide reaching effects in the body. And it’s one of these things that it’s, it’s almost all net positive. You know, it’s like, it’s, it’s not one of these things where you’re going to end up with these crazy side effects that are unpleasant. All of the side effects that you get from stimulating your vagus nerve, at least so far as we know from research so far, are very positive.
Like they, they’ve done studies looking at this whether stimulating the vagus nerve in, in children who have dyslexia, whether it can improve their ability to read and concentrate during during assignments when they’re having their nerve stimulated and it works. And, and, well, it’s, yeah.
It’s just so, it’s just so crazy. It just essentially is this tool by which you’re allowing your brain and body to be able to better regulate themselves.
Le’Nise Brothers: Hmm.
Dr Sarah Hill: Because, um, you’re opening up that communication pathway between the brain and the periphery that allows your body and, and brain to work together as a really nicely, well-oiled machine in ways that can just get disrupted in response to chronic stress or in response to trauma.
And so it’s really exciting work and, um, we’re really excited about it.
Le’Nise Brothers: The yoga part of me is thinking, when you mention, when you talk about the vagus nerve, I’m thinking, okay, what are some other things that stimulate the vagus nerve? Breathing?
Dr Sarah Hill: Yes.
Le’Nise Brothers: Yes. And you think about how many people they just breathe so shallow shallowly and you know, that the effect of sighing and taking a long, full breath and like even things like massage.
Dr Sarah Hill: Yes.
Le’Nise Brothers: But to know that there is also this research and there’s a tool that, I guess you can wear it on your, on your head.
Dr Sarah Hill: Mm-hmm.
Le’Nise Brothers: To kind of,
Dr Sarah Hill: yeah. Yeah. So the one, the one that we’re using in research the OhmBody device is actually an earpiece.
So you usually put this little guy around your ear with the electrodes, and then it is just this little guy here and you can just stick it in your pocket and and walk around and, and have your vagus nerve stimulated. But as you noted for people, um, who aren’t able to do, you know, can’t afford something like this, or they don’t want to do something like this.
Yeah. Breath work, you know, taking the deep, the deep exhale, right? The big sigh. These types of things also have the effect of putting us into that rest and digest, parasympathetic response that, again, when our body is in the parasympathetic response is not just rest and digest, it’s also that’s the time when our body and our brain starts being focused inward instead of outward.
Because when we’re in a sympathetic stress response that suggests that our brain needs to be focused on the external environment and it starts being vigilant and monitoring everything that’s happening around us. And it’s when we get into that parasympathetic response that our brain actually is able to take a scan and figure out what’s happening in the body, and then be able to better regulate the different systems that comprise, you know, our health and wellbeing.
Le’Nise Brothers: You’ve shared so much on the show today, and I am just so pleased to be able to speak to you and tap into some of your knowledge. Thinking about all of the topics that we’ve talked about today, what’s the one thought that you’d like to leave listeners with?
Dr Sarah Hill: I think that the one thing I would say is believe your body. I think that women for a really long time you know, just because of the way that we’ve been mishandled by medicine and science, uh, there’s been so many women have had the experience of going to the doctor because they think something’s wrong and they’re told nothing’s wrong and they know that something’s wrong or they’re experiencing these changes across the menstrual cycle and it feels pathological and their body is telling them this, but their doctors set of in instructions are telling them that, um, is that a lot of the wisdom that we’ve been given about what we’re supposed to be doing to our bodies or for our bodies was never made with a female body in mind.
And to just really learn to listen and trust what your body is telling you. And so believe your body.
Le’Nise Brothers: Believe your body. I love it. Where can listeners find out more about you? Where can they pick up the books? Where can they find out more about the OhmBody device.
Dr Sarah Hill: Yeah, so, um, you can find out more about me, my website is sarahehill.com and that’s Sarah with an h. I’m on social media channels. I’m most active on Instagram. And my handle is @sarahehillphd. And you can find my books anywhere that books are sold. And lastly, with the Ohmbody device, you can just look up OhmBody. Um, I do believe that it’s ohmbody.com.
And you can find, they have a commercially available device that’s sold there and they also have research resources, describing the results of the trials that they’ve done testing the effectiveness of their device with various different types of, uh, women’s health conditions.
Le’Nise Brothers: Thank you so much for your time today.
Dr Sarah Hill: Yeah, thank you so much for having me.