Video summary
Dr. Sarah Hill explains how hormonal birth control fundamentally alters a woman's natural cyclical experience of reproduction, effectively shutting down the body's ability to wax and wane between an estrogenic state characterized by high sexual desire and vitality, and a progesterone-dominant luteal phase associated with nurturing qualities. The pill achieves this suppression primarily through synthetic progestins that mimic progesterone enough to activate brain receptors and inhibit ovulation; however, these molecules are chemically distinct from natural progesterone. While they successfully prevent pregnancy by stopping the ovaries from releasing eggs, they do not replicate the physiological benefits of a natural cycle, resulting in a state where women experience relatively high levels of synthetic progestin alongside low levels of estrogen daily. A critical distinction highlighted is that these synthetic compounds are often derived from testosterone or spironolactone rather than progesterone itself. This difference prevents the body's metabolism from releasing allopregnanolone, a calming neurosteroid naturally produced when breaking down real progesterone. Allopregnanolone plays a vital role in promoting mental health and mood stability; its absence due to progestin use is argued by Dr. Hill to be a primary mechanism linking hormonal birth control to increased risks of depression and anxiety disorders. Consequently, studies indicate that all contraceptives raise the risk of depression by approximately 40% in teens and women, with European regulatory bodies increasingly acknowledging these mood-related side effects while American groups have been slower to communicate them widely. The impact on interpersonal relationships is also significant, as research suggests women on the pill report a 10 to 20% lower relationship satisfaction compared to their natural cycles. Dr. Hill attributes this decline partly to mental health issues stemming from low allopregnanolone levels and partly to the suppression of sexual desire and attraction, which are fueled by estrogen. When the body is prevented from cycling through its full hormonal bandwidth, women lose access to both the intense libido associated with high estrogen phases and the emotional closeness linked to progesterone dominance. This effectively turns down the volume on a crucial aspect of romantic relationships, leaving users feeling like they have taken half the pieces out of their relationship jigsaw puzzle without fully understanding how it affects their overall satisfaction. Ultimately, Dr. Hill posits that taking birth control can feel like being permanently stuck in the final two weeks of the menstrual cycle but with additional unanticipated negative effects due to the synthetic nature of the hormones used. She acknowledges that this state masks an authentic part of a woman's self, similar to how antidepressants might alter one's essence, and notes that for some individuals, feeling better on medication is preferable regardless of whether it represents their natural baseline. Despite these caveats regarding mental health risks and relationship dynamics, she maintains that the pill remains effective and safe if chosen by women who prefer this masked version of themselves, though she warns against dismissing the profound physiological changes involved in favoring a static hormonal environment over dynamic biological function.
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talk to me about how the pill impacts
the period brain like tying together
book one and book two.
>> Yeah. So the pill essentially takes, you
know, we've been talking about the fact
that women have our bodies have these
two jobs we have to do to reproduce. And
the result of this is that we wax and
wayne between these two hormonal states,
right? The estrogenic state, which is
like the wild sex kitten version of
ourselves, and then, you know,
progesterone and the ludial phase, which
shifts us into kind of our earth mother,
you know, mom jeans side of ourselves.
And so for a naturally cycling woman,
you're kind of waxing and waning between
these two um these two different but
complimentary states. Uh and when when
you take the birth control pill, it
shuts all of that down. So essentially
what it does is um the progesterine
which is the money maker. I mean just in
terms of the action that prevents um
pregnancy in uh different types of
hormonal birth control but that
progesterine is mimicking the acts of
progesterone which again is that hormone
that's released during the second half
of the cycle. Um, and it it activates
progesterone receptors in the brain. And
when the brain is reading when the
progesterone receptors are reading a
signal, so they're getting signal, that
tells the brain not to stimulate the
ovaries to not produce an egg. And then,
of course, you don't produce estrogen.
And then if you don't ovulate, you don't
produce progesterone. So, um, by virtue
of these synthetic, uh, progesterines,
which are very different from
progesterone, by the way, so I don't we
don't need to get into the weeds on all
of that, but just, um, for listeners to
understand that the way that you feel on
a progesterine, which most women feel
pretty awful, is not the same as the way
that you feel on progesterone. They
actually are completely different
molecules and they act very differently
in the brain and very differently in the
body. But the progesterines do get
picked up by the progesterone receptors
in the brain sufficiently enough to, you
know, inhibit um the brain from telling
the ovaries to release an egg. And so
what this does is it flatlines women's
hormone production. So women are no
longer producing high levels of their
own endogenous or internal sex hormones
and instead they're getting the same
daily dose of a relatively high level of
synthetic progesterone known as the
progesterine and then a relatively low
level of estrogen. And what this means,
of course, is that when you're on the
pill, you don't get that nice big
beautiful bump in estrogen that makes
women feel so sexy and alive. Um, and
instead, you're living in the state of
hormonal deja vu where you have a
relatively high level of progesterine
and a low level of estrogen. And this of
course, you know, it it has all kinds of
sweeping effects on the way that we
think and feel and experience the world
because our hormones of course um play a
really integral role in in what that
means for women.
>> So, is it kind of like permanently being
in the final two weeks?
>> It's kind of like being in the final two
weeks um but with a caveat. And so I'm
I'll just quickly without getting into
the weeds too much um just say that you
know on the one hand it's like the last
two weeks of the cycle because you do
see decreased sexual desire for example
and you do see less of a preference for
masculineized male faces, voices and
behaviors, right? And so you do tend to
see some of those um changes in sexual
psychology that are similar to the
second half of the cycle. But you also
get a bunch of other stuff that um that
nobody's really bargaining for when
they're taking hormonal birth control.
And and the reason for this is that the
synthetic uh progesterone that um is
used in most commercially available uh
birth control is not synthesized from
progesterone. And in fact, no
progesterines that are used um on the
market are synthesized from
progesterone. They're um they're all
either synthesized from um from
testosterone. most of them are
synthesized from testosterone or they're
synthesized from um spiralactylone which
is a diuretic. Um and this is important.
This distinction between something you
know this progesterine which is
synthesized from not progesterone right
either testosterone or spiralone um and
progesterone ends up being really
important because when the body is
breaking down actual progesterone it
releases this um really calming uh
metabolite. It's a neuroststereroid
called alopregnanolone
that's really good at promoting mental
health and um mood stability and a bunch
of other things that um help women
function and feel pretty good. Um
whereas these progesterines
when they're being broken down in the
body because they are not made out of
progesterone you don't get the release
of alopregenolone. And so women who are
on the pill actually have a a really low
levels of this really calming
neurosteroid that does help to promote
um mood balance, mental health and other
things like that. And and it's actually
been argued that you know this is
probably one of the primary mechanisms
um by which hormonal birth control has
been linked with mood disorders and
anxiety disorders.
>> All contraceptives raise depression risk
by 40% in teens and women.
>> Yes. Yeah. It's pretty it's pretty s uh
pretty substantial. It's a pretty
substantial increase. And it's something
that you know until recently and and and
it's even now it's like only the
Europeans are actually stating this like
like their their um their group that you
know uh does the licensing for OBGYNS
finally you know acknowledge that yes
you can get mood related side effects
from hormonal birth control. The
American group is less to um less quick
to um accept that and like make that
something that they communicate to their
patients. But yeah, it's it's a real
issue for a lot of women, especially
teenagers. Um, teens are the ones who
are asymmetrically hit with the mental
health side effects from the pill. And
so, it's likely the result of those
funky progesterines and the fact that
they don't metabolize like a regular
progesterone.
>> Interesting. Okay.
Women on the pill show a 10 to 20% lower
relationship satisfaction.
Where's that coming from?
>> Yeah, that's really interesting. So um
my guess is that what's happening with
that is is twofold is that one anytime
that you have some sort of a mental
health related thing like something like
depression or anxiety that might be
caused as a result of the the lack of
alopregnanolone of pill users um that
can just decrease your satisfaction with
everything right so it might not
necessarily just be about your partner
it just might be that you're more
critical about everything and so that's
one possibility and another possibility
is that I I think that when you aren't
able to experience yourself as a
naturally cycling woman who's going
between these phases, you know, of
estrogen being high and then
progesterone being high. Um, it's like
when you're naturally cycling, you get
the full bandwidth of like what's good
in relationships, right? like you're
able to like really, you know, feel
sexual satisfaction and desire and
you're able to feel, you know, this like
emotional closeness and and desire and
um and I think that that is part of what
creates within us like a feeling that we
have a satisfying relationship. And for
women on the pill who generally have
lower levels of sexual desire, right?
And they've also tend to report lower
sexual satisfaction, less attraction in
their relationships, and not necessarily
because they chose the wrong partner,
right? Although there's some research
that indicates that that might be a risk
too. But instead, because they're not
experiencing sexual desire, it's just
like turning the volume down on what is
a like a really important aspect of a
romantic relationship. And so not to
really have much of a libido and then
not to really feel that much attraction
to your partner just because, you know,
attraction and sexual desire is all
fueled by estrogen, you know,
>> suppressing.
>> Yeah. And it's suppressing that. And so
it's like women are missing out. But
it's almost like you have a jigsaw
puzzle and you take out like half of the
pieces and then you're like, "How do you
like the puzzle?"
>> You're like, "I don't know. I guess it's
okay."
>> Is it right to say women on the pill
lose an authentic part of themselves?
>> Yeah, I do. I I do. I think that it's
masking an authentic part of yourself,
you know? And this could be for better
or for worse, right? The same way that
we could say, you know, that taking an
SSRI or an anti-depressant is masking,
you know, a person, like a real essence
of a person as well. um which I think is
true, but you know, some people prefer
the way that they feel on it and so they
want that to be masked, but it is
nonetheless masked, right? And the same
with the birth control pill. It's like
it's not, you know, you're not really
yourself when you're on the pill. And
and like I said, and that could be for
better or for worse. Some women feel
better when they're on it and and they
like that version of themselves and and
you know, and if that's if that's how
they feel, God speed, you know, you can
be on it safely and it is um and it's
effective. So,
>> could oral contraceptives be the biggest
unexamined mental health experiment
that's ever happened?
>> Yeah. No, I think so. I do. I think that
and uh teenage anti-depressant use. I
think that both of those things are
>> and a lot of those are going to be
happening in collaboration with each
other as well.
>> Yeah. No, they are because the risk of
being prescribed an anti-depressant goes
up significantly after you start
hormonal birth control.
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