If it has never occurred to you that your birth control may be changing the way your brain is functioning, you are not alone. Dr. Sarah Hill is an evolutionary psychologist, researcher, and professor who was on the pill for more than a decade. After coming off the pill Dr. Hill’s life went from grayscale to full color, and she realized that more research into the effects of the birth control on women from the neck up was critically necessary.
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Evolving, Expectations, & Taking Risks
This discovery lead Dr. Hill to write her new book, This Is Your Brain on Birth Control, which works to help women understand the gap between the knowledge of women’s biochemistry and how birth control affects the way your brain is working.
Dr. Hill is not anti-birth control, but she is pro-education. By helping women understand the affect birth control is having on their brains, she works to help women become active participants in the conversation around birth control and help them make informed decisions about their health and who they want to be.
Birth control can play a role in everything from how you select a partner to your mood and your ability to handle stress. Hormones play a massive role in who we are and our experience of the world, and it is only through educating yourself on the role birth control plays in that will you be able to make the decision that is right for you. If you want to learn how birth control is affecting you from the neck up, this is an episode you can’t miss.
Have you ever considered how the birth control could be affecting you in ways beyond what your doctor may have told you? Share your birth control experience with us in the comments below!
On Today’s Episode
- Exposing the lack of research and knowledge surrounding how the pill affects your brain (16:05)
- Understanding how the pill functionally and structurally changes women’s brains (24:05)
- Illustrating the role birth control can play in women’s sex and stress hormones (32:15)
- Deconstructing the overall effect of the pill on neurotransmitters in the brain (41:51)
- How birth control can increase your risk of anxiety, depression, and more (42:30)
Resources Mentioned In This Show
“The spirit of the book is about giving women information and actually allowing us even greater independence and greater agency in terms of making decisions that are informed about who we want to be and about our health.” (11:15)
“Another thing I really wanted to do with this book is to make women aware of this in addition to sort of raising some of the questions we should be asking about the way that the pill changes our brains, also letting women know that its time that we need to push science to change what they are doing.” (22:19)
“It is all consistent with this idea that the birth control pill may influence women’s attunement to things that are sexy and that it might sort of deprioritize or deemphasize women’s attunement to these qualities.” (31:42)
“We can start talking about what are the research questions that are really critical in terms of being answered next and in terms of allowing women to optimize their birth control and also optimize their lives and their health.” (41:28)
“All of these things kind of together almost make the perfect storm in terms of not necessarily promoting positive mental health outcomes, especially among people who are vulnerable.” (50:54)
“I tolerated the pill really well, but then when I went off of it I had this feeling of transitioning from a two dimensional, black and white sort of grayscale drawing to life, fully vibrant, awake, alive life. And it really was eye-opening to me.” (53:37)
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245: This is Your Brain on Birth Control w/ Dr. Sarah Hill FULL TRANSCRIPT
Steph: Hello there. Welcome to episode 245 of harder to kill radio. I’m your host, Steph Gaudreau. You have landed on another Tuesday episode, which is where I invite an expert guest to the show. They share their zone of genius with you, what they do in the world, why they love doing it and pass on some knowledge, expertise and perspective to you, the very lucky listener. So thank you so much for joining me today on this episode and this one’s a good one. I am so very pleased to welcome Dr. Sarah Hill to the podcast. She is an evolutionary psychologist, researcher and professor at Texas Christian university and she is the author of a new book that’s out called This is Your Brain on Birth Control. In this episode, Dr. Hill is really deep and digging into her perspective on hormonal birth control, why she’s not anti-birth control and what she really is attempting to do with this book.
Steph: We’re talking about why there’s such a gap in our understanding of women and women’s bodies and their biochemistry and how birth control affects them in the research. And then we’re talking about some of the really fascinating and surprising things that she learned from her research and doing this book, particularly how birth control affects women’s brains – as she says, from the neck up – and our choices in mate selection and our neurotransmitters. And there’s so much in this show that’s really super interesting. So I can’t wait to share this one with you in case you haven’t done this yet. I would love to invite you to pick up a copy of my newest book, The Core 4: Embrace Your Body, Own Your Power. This is really a four pillar approach to sustainable wellbeing. To get off the I hate my body and I just need to shrink it and change it so that I’m happy train and there’s so many topics in this book that I know are powerful and have the ability to really help you transform your mindset, your strength, and how you see the world.
Steph: You know what would be really, really great is when you head over to Amazon or wherever you love to buy books. To pick up a copy of Dr. Hill’s book today, put The Core 4 in your cart as well and make sure you go over to core4thebook.com after you do that and claim the free bonus gift, but I also have to offer, today’s show is brought to you by the Nutritional Therapy Association in 2018 I had the really good pleasure of being certified as a Nutritional Therapy Consultant through the NTA and they also train and certify Nutritional Therapy Practitioners. What I really learned was the bio individuality and range of nutrition strategies that can really support individual wellbeing. The NTA really does such a great job with providing students with a range of different educational tools, different techniques to really work with people one on one in such a powerful way to uncover nutritional imbalances and what to do about those things as well as different things regarding lifestyle in their clients and of course they also provide training on how to launch a successful career in holistic nutrition.
Steph: You can learn more about the nutritional therapy association at nutritionaltherapy.com they also have a free seven day course. I would really encourage you if you’re curious to check it out and you can find that at nutritional therapy.com/nutritional-therapy-101. Without further ado, let’s go ahead and jump into today’s episode.
Steph: Welcome back to Harder to Kill Radio. Thank you so much for joining me on this Tuesday episode. I love when new people kind of come into my world, but they come via other people that I know who I love and admire and respect very much in today’s best [inaudible]. Just that I learned about her from Dr. Jolene Brighten who you all know you’ve heard on the show before. You know, we’re friends actually in real life, not just like internet friends, but when she told me about today’s guests, I just thought, okay, if she’s coming recommended from Dr. Brighten, then I definitely want to have her on the show. And I’m really excited because we’re going to be talking about women’s brains and the effect of birth control on women’s brains today. So please welcome to the show Dr. Sarah Hill. Are you doing? I’m doing great. Thanks so much for having me.
Steph: Yeah, I’m really excited to dig in to some of this stuff because I’m a complete science nerd. I’m awesome. I love, yeah, we I recorded a show a few weeks ago with a guy named Kiran Krishnan and he’s a gut health specialist and we, wow. We, we definitely nerded out on some gut stuff, so. Awesome. I love that. Yeah. So I’m looking forward to getting into it today on the effect of birth control and women’s brains. And you have a book coming out. Well you had a book come out last week because as the time of this shows coming out, so we’re going to just dig in.
Dr. Hill: Awesome. Sounds like fun.
Steph: I know that one of the things that comes up, and I’m sure, and I know you preface this a little bit in the book, but one of the things that comes up immediately when you start talking about birth control is that people get a little bit freaked out that it’s going to end up being an anti birth control sort of rant or they’re going to feel bad for, you know, for being on it or, you know, feel guilty or feel scared. So I’m wondering if we can just address that head on what’s, you know, what’s your city, what’s your stance and how do you approach to this in such a way to help women keep an open mind when they’re reading…
Dr. Hill: Oh yeah. Yeah, so a women’s hormones are like about as politicized of a thing as you can find, you know, and our ability to regulate our fertility has played like such an important role in our advancement. Like as a gender. I mean, when you think about all of the things that women, all of the different like sort of achievement milestones that we’ve had over the last 50 years in terms of, you know, finally becoming like a 50% of the applicants too. And now it’s even more than 50%. We’re more than 50% of the applicants to like medical school programs, to law school programs. We’re getting advanced degrees, we’re graduating from college and we’re like, you know, at greater rates than men. And a lot of this progress that we’ve made in terms of education and then achievement and staying out of the poor house owes to our ability to regulate our fertility.
Dr. Hill: And you know, that’s because our ability to meet longterm goals is you know, so much influenced by just like knowing that if we’re going to be investing our time and energy into something like knowing that we’re not going to have to stop midway due to like an unexpected pregnancy. And so I think that, you know, for women, there’s a lot of women out there who see birth control pills as being sort of, you know, this really instrumental, you know, moment and terms of women’s independence, you know, financial and otherwise from men. And I think they’re right. I mean, I think that, you know that it really has played an important role, like the ability to safely and regulate our, or, you know, safely regulate our fertility in terms of women’s advancement. And so I think that whenever you want to have a conversation about something, you know, that has played such a pivotal role in terms of women’s advancement, that it can, you know, it can make people a little bit nervous.
Dr. Hill: Because there are a lot of folks out there who might, you know, want to minimize women’s access to birth control and other things because they have a political agenda that doesn’t favor women. And you know, so my you know, I had to be really, I had to, you know, be thoughtful about this when I was when I was writing the book because I mean it, people have kind of a, you know, if you say, let’s have a conversation about the wisdom of changing women’s hormones in the name of fertility regulation. You know, there’s, yeah, a lot of, like you had said a lot of people who sort of get afraid that you’re going to have an anti birth control kind of politics and that’s not at all what the spirit of the book is.
Dr. Hill: The spirit of the book is about giving women information and actually allowing us even greater independence and greater sort of agency in terms of making decisions that are informed about like, how you know, who we want to be and, and about. And about our health. And I really think that, you know, talking about women’s hormones and the way that women’s hormones influence brains and talking about, you know, the birth control pill and how that can change what women’s brains are doing. This is like such important information for women to have and to understand so that way they can actually finally be an active participant in conversations with their doctors about their birth control options. Whether that birth control option is one of the different types of hormonal contraceptives that are out there or whether it’s something else altogether. And so this in this is really very pro information, very pro woman without being anti birth control. It’s really about you know, giving women the information that they need to make informed choices about their health and about who they want to be.
Steph: I appreciate that. And I think, you know, at least for my own personal experience, I was on birth control pills for about 16 years. And you know, I think the extent of the conversation with the whatever, you know, medical provider I was seeing at the time was something like, you know, physical risks and things like that. You know, if you smoke, if you have a family history of stroke, things like that. But I think w what you’ve got here is so much deeper than just, you know, being, being fully informed so that you can tell, you know, think about the sort of health, the immediate health implications or the, the common health implications that women tend to know. Right. We see on like the, the packet that, or the little flyer that you know unfolds. It’s like the size of a map and it comes in their bag of the pills. You’re like, Oh my gosh. But I, and I think there’s like some knowledge on that, but I think the piece that women are really craving and that you’ve delivered here is, Hmm. More a broader conversation so that we feel like we have know, fully informed choice or we feel like where it can make those decisions. Because you do talk about some stuff in the book that goes beyond that. Just sort of like stroke and
Dr. Hill: The smoking and things like that. Yeah. You know, it’s so funny because I, you know, our doctors do a really good job about communicating the way that the birth control pill affects us. Like sort of like from the neck down, you know, like but like what women are really talking about. And if you have conversations with women about their experiences on birth control, that’s not at all what they’re talking about. They’re talking about what it’s doing to how they feel. And when you look at the research in terms of like you know, what are the roadblocks that keep women from either going on or staying on hormonal contraceptives, it’s all related to changes that they feel with, you know, how they feel psychologically. And so these are the conversations that women have been having for decades. And it’s just something that I don’t think that our doctors have really paid enough attention to.
Dr. Hill: Psychologists had been paying attention to it. But the, the different fields of research don’t always talk to one another. So the, the medical doctors don’t read the psychology research. Right. And the second like us, you know, like turn psychologists, we don’t read a lot of medical research. And so there’s not a lot of cross talk. And so a lot of these conversations you know, that exist in the research literature aren’t part of what doctors are talking about because they’re not really, you know, reading our literature. And so this is like giving you know, I think that this book in a lot of ways is going to just be sort of verifying things that women have been talking about and have kind of known has been going on for a really long time. And they just never knew why. And they couldn’t quite put their finger on how to describe it. And I’m hoping that this is going to give women a language to use with their doctors to help explain, you know, some of the types of feelings that they might be having. And then, you know, allowing, like I said, women to be active participants in conversations with their doctor about about their birth control and sort of troubleshooting one that might work, you know, that’s gonna work the best for them.
Steph: [Inaudible] Well, crosstalk lacking aside, maybe the bigger question is, and you can help us kind of tease this apart, might be something like why, why is this, why is our knowledge so lacking on how the pill, right, the pill affects women’s brains. Why, you know, we’ve been prescribing it for how many years now and it just seems like what we know about the effects is lacking or lagging. Give us a, give us your sort of like elevator pitch for why that is,
Dr. Hill: Right. Yeah, no. And and because I’m an academic, like my version of an elevator pitch
Steph: Flight to Cleveland,
Dr. Hill: You know so, but I’ll give you like, there are really kind of two big pieces here that I think have, ah, played a role in this and it’s all just like try to briefly touch on each of them. But I think they’re each really important in the first is that we don’t like to talk about, or think about the way that women’s sex hormones influence women’s brains. And this is another really politicized issue. The, there’s a sort of a fear out there that you know, if we acknowledge that women’s sex hormones influence women’s brains, that this is going to you know, be the first step in this like sort of movement to take rights away from women because our sex hormones just make us completely unreliable and fickle, which is ridiculous. It makes no sense at all.
Dr. Hill: But I think that people don’t like to talk about the role that hormones play in terms of creating the experiences of who we are. And so I think that’s part of it. It’s created a blind spot where we think about, you know, our, the hormones that we take in the pill as influencing everything from the neck down. But we don’t think about what it’s doing to the brain because we’ve sort of created this like, Oh, no, you know, hormones don’t really matter for the brain. Right. like that’s not important. And so I think part of it is this sort of, you know, almost like mind body, like Cartesian split. That tends to sort of go on broadly where we, like I said, like we tend not to really think too much about the way that our hormones influence our brains.
Dr. Hill: And then the other part of it is, you know, so in addition to that, so it’s like people don’t think to ask the question is that the, the research just isn’t being done because science isn’t set up in a way right now. That re it doesn’t reward doing research on women and women’s issues. Because we are harder to study than men are. And like just sort of summarize the reasons for this of really quickly. Science is incredibly competitive and in order to publish your, like publish enough research to have a successful career and to get research funding from different granting agencies you have to publish a ton of research and it, it requires being able to do things really quickly and studying women. And studying females cause this I am going to sort of talk pant in a pan species kind of language because this problem is rampant in animal research.
Dr. Hill: It’s a lot quicker to study males than it is to study females because females hormones do change cyclically. And so if you’re going to be trying to show that there’s a cause and effect relationship between different variables like between different things in the environment, you have to control for this. And what this means is that you need females at each of the sort of three major phases of the cycle. So this is three times as many female participants relative to male participants and with the females you need to know exactly where they’re at, where they are in the cycle. And this requires, you know, with humans we can usually ask them and get an approximation and then we can measure their hormone levels as a way to sort of verify where they’re at with the animals. It requires taking vaginal smears.
Dr. Hill: That’s really time consuming and complicated to do. And so what this means is that when you’re doing research that includes females in a thoughtful way it’s gonna take you longer and it’s gonna be more expensive. And because the different research journals and many of the funding agencies will still allow science to be published. That doesn’t include females at all or just sort of includes females in a really perfunctory way where there’s just like, you know, some women or some females in the study. You know, what happens is researchers will just study males or they’ll study male related issues because they’re faster to study, easier to study. And it’s easier to get the things published in high quality journals because the journal editors aren’t saying, no, I’m not going to publish this. It doesn’t have females. And so science needs to change to encourage research on females.
Dr. Hill: And once you know, once be like studying women and studying becomes like the absolute, like an absolute necessary part of science in order to get your work published and your research funded. Researchers are going to start to study female related issues, including, you know, the effects of the birth control pill on the brain and, you know and everything else, like right now, science is set up in a way that discourages research on women and female related issues because it slows, you know, slows down researchers careers and you know, the way that things are set up right now, it depends on the Goodwill of the researcher to include females or to test on female and female related issues. And, and it shouldn’t, it shouldn’t be that way. And so, you know, science is set up in a way that sort of encourages ignoring female specific issues.
Dr. Hill: And I think that’s like another really big piece of this. And it’s something that women need to be aware of. I think that most women have absolutely no idea. The degree to which we’ve been excluded from the front lines of research. And the reason that our, our issues, the things that are really important to us in terms of health and wellbeing are not known. To the degree that they are known in men. And so another thing I really wanted to do with this book was make women aware of this and in addition to sort of raising some of the questions that we should be asking about the way that the pill changes our brains, I’m also, you know, letting women know that it’s time that we need to really push science to change what they’re doing and how they’re sort of structuring the reward, you know, the reward structure to promote research on women and women’s issues.
Steph: Yeah, absolutely. It’s so important. And thank you for laying all of that out. I’ve, I’ve been reading a book called Invisible Women. By Caroline Criado Perez, and she is just, what a fascinating book. I mean, yeah, totally fascinating book. I like shocking, not shocking at the same time where you’re just like, wow, you know, of course this isn’t happening. And like also
Dr. Hill: We could do better, right? Yeah, no, we totally do need to do better. And I think that you know, as, as women, as you know, when this information starts to sort of, you know, hit that tipping point where we’re women know what’s going on in science, I think that we’re going to see change because it really is embarrassing to science that, that how we’ve been mishandled throughout, you know, throughout history. And so I think that this is like the more voices that we have sort of making this something that’s aware, you know, that the public is aware of, I think that we’re going to get changed faster.
Steph: Absolutely. Okay. So let’s, let’s maybe dip into some of the big themes of the book and obviously it’s called, this is your brain on birth control. And we could probably, you know, go into a million different directions, but I’m wondering if you could share perhaps a couple of really interesting or poignant things that you found through your research and writing this book about how the pill actually structurally or functionally changes women’s brains.
Dr. Hill: Sure. Yeah. So I, you know, some of the things that I found most sort of arresting the things that kind of made me stop in my tracks. In terms of, you know, what the pill does, the brain had to do with like the, the behavioral consequences that we tend to see that are associated with the birth control pill. And one of the first of these sort of little research nuggets that I heard that I just couldn’t stop thinking about once I heard it was about how the birth control pill might influence women’s mate choice that is that the pill might influence, like who women are attracted to and then who they’re choosing as their partners. And just to give you a very brief backstory, and again, I’m a professor and we’re the worst. We just like, we just talk, no, it’s great. It’s great. That’s kinda contextual, right? Adds richness to the conversation. Oh my god. Yeah. We’re the worst. And yeah. So, so sorry, listeners. But so there’s this, there’s been research now for like 30 years or so showing that women’s sex hormones play an important role in sort of influencing the, the priority that we place on sexiness and our partners.
Dr. Hill: So there’s a lot of research that’s gone on over the, and then, like I said, it’s been about 30 years now showing that I’m the female sex hormone estrogen, which is the one that we always think about when we think about women’s sex hormones that it tends to increase women’s attunement to sexiness cues. So things like you know, sort of swagger and, you know like a deep full ways and you know, social dominance and of the square jaw and the whole thing. Things that we think of as sexy generally are qualities that are associated with testosterone. And the research finds that estrogen tends to increase women’s attunement to testosterone and their sensitivity to it and their attraction to it. And so the researcher is more recently, it was like, I think the first study of this kind came out about 15 years ago.
Dr. Hill: Some researchers said, well, gee, you know, the birth control pill actually suppresses women’s own levels of estrogen, right? It keeps it very low. And the artificial hormones that are in the birth control pill contain levels of estrogen. This artificial estrogen relative to this artificial progesterone, which is called a progestin birth control pills are all like sort of what, what we’ll call progestin dominant, meaning that of those two female sex hormones progestin is the one that’s like sort of overwhelming the effects of estrogen. And this is the type of situation that should be predictive of a decreased attunement to the sexiness cues, right? We know that estrogen loves testosterone, right? So the hormone estrogen tends to increase women’s sort of attraction to the, you know, these sort of sexy, the sexy, cute men. And progesterone is associated with a decreased interest in, you know, the sexy qualities and sort of paying more attention to other things like financial financial stability, provisioning capacity, intelligence, you know, other types of non, you know, like not these like sexy traits.
Dr. Hill: And so researchers were interested in whether or not pill taking women might deemphasize sexiness and their choice of partners. And one of the first studies that was ever done to look, look at this research question. They just simply looked at a large sample of women who had chosen their partners either when they were on the pill or off the pill, and then just looked at different types of relationship satisfaction that these women were reported across, you know, different domains in their relationship. And what they found was that for women who had chosen their partners when they were on the birth control pill, they reported feeling more satisfied with their partners relative to the non pill taking women when it came to things like financial provisioning and their partner’s intelligence. But the other thing that they found was that when you looked at all of the different sort of, you know, types of relationship satisfaction that were tied into sort of sexual functioning and sexual attraction and desire for their partner all of those you know, things the pill taking women were less satisfied relative to the naturally cycling women.
Dr. Hill: So the non pill taking, you know, naturally cycling women reported being much more satisfied with almost all aspects of their relationship that anything to do with sex. And how attracted they were to their partner and how drawn they were to their partner relative to the relative to the pill takers. And so, you know, this study was like one of the first of its kind to really look at, you know, whether or not there might be an association between being on the pill and then, you know, choosing maybe or prioritizing different types of qualities in your partner in which was welling. Good. and then more recently some researchers followed up on this looking at a longitudinal study of married couples. And so what they did is they took a [inaudible], they took a large sample of newlyweds, right?
Dr. Hill: So a man and a woman who are married together and they followed them over time. And just by you know, chance some of these women had met their romantic partner when they were on the birth control pill. And others of them that then when they were not on the birth control pill and because they were following these couples over time, they were able to see like what would happen to these women’s relationships. Once, you know, they, if they changed their, you know, contraceptive status. So if the pill takers, what they were really interested in is what will happen to women who met their partners when they were on the pill, like once they go off of it. And so they were able to follow these follow these couples over time and look and see what happens. And what they found was that for women who are, who chose their partners when they were on the birth control pill and then they went off of the birth control pill they found that these women’s levels of sexual and relationship satisfaction changed.
Dr. Hill: And whether it changed for the better or changed for the worse was dependent on how attractive and how attractive their partner was found was that the women who chose their partner when they were on the pill, if they just so happened to choose as a partner, somebody who was attractive, they were actually then more satisfied, more sexually satisfied, and just more satisfied with the relationship overall than they were when they were on the pill. But for women who chose an unattractive partner, what they found is going off the pill, made them less satisfied with their partner, less satisfied with their sex life in, in just like less satisfied with the relationship altogether. And so what all of this shows us is that you know, it’s all consistent with this idea that the birth control pill may influence women’s attunement to things that are sexy, right?
Dr. Hill: And that it might sort of deprioritize or deemphasize women’s attunement to these qualities. And you know, and if this leads them to choose a partner that they’re not really all that chemically or like sexually attracted to once they go off the pill, this might potentially cause problems, right? And so this isn’t to say that if you choose your partner on the pill that it’s necessarily going to be bad news. Right? For half of the women in their study, they found the opposite, right? When the women went off the pill, they were like, wow. Like I like accidentally somersaulted into this relationship with this hot guy and I am happy about it. But it, it just, you know, like sort of a really provocative and interesting data point that, you know, illustrates the role of women’s sex hormones in terms of what they’re attuned to when they’re choosing partners.
Dr. Hill: And then also, you know, knowing like what’s a possible pitfall of this if women are like in the time in their life when they’re looking for a long-term partner, like, you know, maybe we, you know, that something that women to keep in mind or not keep in mind when they’re making decisions about their about their sort of contraceptive choices and also about their romantic partners.
Steph: Out of curiosity, do you know or recall if for these, this study in particular studies, like it was the attraction scale based on, was it purely subjective or was it stuff set like facial symmetry or like you said, like the, like these like testosterone dominant traits and stuff like that?
Dr. Hill: Yeah, it was they were, they were rated by outside evaluators. Got it. So it wasn’t just like what the women were reporting themselves, it was like, yeah, they had groups of evaluators evaluating their attractiveness. Fascinating. Yeah, just like totally fascinating. Which is why it’s like, it’s so PR, it’s really provocative. Like I said, the first time I had heard about this research I, it really stopped me in my tracks. It was just like, this is really, of course, of course, this is the way that it works because, you know, it’s, it’s funny because we create these blind spots in our brain and I’ve, I’ve got them all over the place and it’s like I had known forever that women’s sex hormones influence attraction and, you know, these types of things. It’s like something I’ve studied you know, as part of my career and it never dawned on me that the pill would get the pill, would influence these processes despite the fact that, you know, if the pill is changing what your sex hormones are doing, then of course it’s changing this.
Dr. Hill: I mean, there’s just no way around it. And but it’s still like stopped me completely in my tracks because it was like, Oh my gosh, of course. Like, how didn’t, why didn’t I think of that? Of course that happened hidden in plain sight I guess. Exactly. Yeah. Yeah. So that was one of the things that I found like really, wow. And then another thing that really, it really stopped me in my tracks was when I learned about the way that the pill influences the stress response. And the reason this was so surprising for me was, you know, when we talk about sex hormones and then we talk about how it might influence things like sexual desire or even made attraction and like who you’re attracted to. Like that seems really obvious in some ways. Like, okay, sex hormones, sex, I get it.
Dr. Hill: Like it makes sense. But when I learned that being on the pill can influence the nature of the stress response, it really got my attention because I’m, that’s a whole, you know, it’s a different set of hormones. It’s a different hormone communication pathway that it, you know, plays a role in the stress response. And so that research really surprised me and sort of the short version of the story with the stress hormone research is that research finds that, you know, when normal, healthy functioning adult human beings are experiencing stressful. And when I say something stressful, it could be bad stress, right? It could be like a to stampede or having to give a public presentation or it can be good stress like falling in love or like Christmas morning. But when people are experiencing stress, whether it’s good or bad, generally what we see about five minutes after the stressor has occurred is that people get this big surge in the stress hormone cortisol.
Dr. Hill: And you know, most people have heard of cortisol. It’s a stress hormone. And people tend to think of it as being a bad guy. But stress hormones aren’t what caused stress, right? Stress hormones allow us to cope with stress, right? Stress is caused by like, you know, shit going down. Like it’s not caused by your stress hormones. And our stress hormones allow us, allow our body and allow our brain to sort of reorganize themselves in a way that’s going to maximize our ability to cope with the stressor, right? So stress hormones are actually a good guy who are there to help combat the bad guy, which is the bad thing that’s happening to us. Or the, you know, even the good thing that’s happening to us. It requires our body and our brain to sort of reorganize what they’re doing. In order to deal with whatever the stressful situation is.
Dr. Hill: And normally when somebody encounters me stressful, you get this big surge in in the stress hormone cortisol. And that, again, like I said, it helps your body cope with the stress. But what they find with women on the birth control pill is that they have no surge in this stress hormone cortisol. So when women on the pill experience something stressful, they feel just as stressed out as women who are not on the pill. So there’s no like get outta jail free card with this. They still feel stressed out and that’s because their sympathetic nervous system response is completely intact. And that’s the part of the stress response that most of us usually like feel. But they’re not having a big increase in this stress hormone. And in fact they’re not really having much of one at all. And this is the sort of thing that we only usually tend to see in the context of somebody who’s undergone some sort of really bad psychological trauma.
Dr. Hill: Like people who have post traumatic stress disorder don’t get a cortisol response to stress or people who like grown up in Romanian orphanages, they don’t get a cortisol response to stress. And this is because the body will actually shut the stress response, this portion of the stress response down completely if it’s going off too frequently. And it’s because it’s really bad for the body to have too much cortisol signaling, which is another reason that cortisol kind of gets a bad rap. But so women’s stress pill seeking women’s stress responses look like the stress response. If somebody who has like post traumatic stress disorder in a lot of ways, it has a lot in common. With that. And that’s obviously a little bit alarming and this especially alarming because some of the that we tend to see that are associated with post traumatic stress are the results of the, the lack of like dynamic stress response that these individuals are having because their stress response is just shut itself down completely.
Dr. Hill: So we know, for example, that I’m not having these like dynamic changes in cortisol in response to stress can be associated with problems with learning and memory problems with emotional processing problems with emotion regulation, right? And low and behold, you know, if you talked to women who’ve had, you know, quote unquote negative side effects with birth control pill one of the number one negative side effects that women report are problems with anxiety and depression, right? And these are the types of psychological sort of downstream psychological effects that we can see that can happen as a result of dysregulation in this in this stress hormone. And, and this is research that has been going on now for about 30 years. They’ve been documenting the lack of stress response among women who are taking hormonal contraceptives, but it’s not something that’s very well understood.
Dr. Hill: And you know, in the book I come up, you know, I sort of propose what I think is a reasonable explanation for what’s for what’s happening. But this is something that women need to you know, we need to really push for more research on this because, you know, one thing that we know is that the pattern of stress response that we’re seeing in pill taking women is, you know, it’s, it’s not really great for women’s like sort of psychological health and wellbeing, but it can also have neurodegenerative effects. And there have been some studies showing that a pill taking women have smaller hippocampus, so the hippocampus of their brain, which is this really important area that’s associated with learning and memory. That, that [inaudible] women’s hippocampus, I guess it was the cute plural for hippocampus are smaller than a non [inaudible] women’s and it can also have implications for things like the risk of autoimmunity.
Dr. Hill: And so there, there are a lot of really important downstream consequences that might come from dysregulation of this important stress hormone. And we know almost nothing about this. There’s, there’s no research really looking at the longterm downstream consequences of this. And I think that it’s really urgently needed. And and this is like another, you know, sort of hope with the book is that we can, you know start talking about what are the research questions that are really critical you know, for being answered next. And in terms of allowing women to sort of optimize their birth control and then also just like optimize their lives and their health. I know you did talk a little bit about sort of the,
Steph: The effect or the, the thing that a lot of women who are on birth control experience, which is dysregulation with mood or difficulties with anxiety and depression. And I’m wondering if you can dive into sort of the pills effect on specifically neurotransmitters in the brain. I think a lot of the listeners of this show are pretty savvy and sort of like up on these topics in, in wondering about like going be going a little bit beyond just sort of saying like, okay, this thing is a little bit perhaps funky when we’re taking these synthetic hormones. But I’m wondering if you can kind of go into that a little bit deeper because I think this will be really interesting for everybody listening to get a bit more insight as to perhaps the different proposed mechanisms for this stuff.
Dr. Hill: Yeah. So you know, there’s probably a couple of different things that are going on in the brain that can really contribute to a woman’s risk of anxiety and depression when they’re on the birth control pill. But the one that has by far gotten the most research has been research into the, the, I hate this word because it’s so ugly, the Gabba urging system in the brain. So the brain, you know, like neurotransmitters you know, can be like excitatory, which are neurotransmitters that sort of increase the brain’s likelihood of firing you know, messages or, or they can be inhibitory, which are the types of neurotransmitters that sort of inhibit the brain from firing, you know, messages as quickly. And so an inhibitory neurotransmitters are like our kumbaya neurotransmitters. They’re what sort of slows our brain down and makes us feel relaxed.
Dr. Hill: And and you know, among the inhibitory neurotransmitters that our brain uses, the most frequently used one is a GABA. And you know, when GABA receptors get stimulated either by GABA or other things it causes our brain to, it cause their brain to sort of slow down when it’s doing. And this makes us feel more calm, cool, and collected. And there’s been a lot of research into the ways that the birth control pill might influence this system. And in particular, what researchers have been targeting is a metabolite, which is just a chemical byproduct of the metabolism of the female sex hormone, progesterone. And one of progesterone’s metabolites is this compound called allopregnanolone. And allopregnanolone is really cool because one of the things that it does is it stimulates our GABA receptors. And what this means is that when progesterone is being broken down in our body and being metabolized, it releases, you know, allopregnanolone which then in turn calms our brain down, right?
Dr. Hill: It allows our brain to feel really sort of chill and kumbaya. And so researchers have been, you know, when they’ve been trying to track down what the different mechanisms are that might contribute to depression and anxiety. This has been one of the first things that they’ve looked at is, you know, is it possible that, you know, these artificial progestins that they’ve created to sort of mimic the effects of progesterone in the brain to stop population? Whether the, you know, the breakdown of these progestins might not, you know, lead to the release of allopregnanolone, which might lead levels to drop in both the peripheral blood and also the brain. And might this contribute to women’s feelings of anxiety. And then if the anxiety becomes unmanageable depression. And what they found is that women who are on the birth control pill, women, and they’ve also looked at this in animal models so they can actually look at it directly in the brain.
Dr. Hill: But when you put in a human female or a rat female, I’m on birth control pills for a couple of cycles. And then measure the levels of allopregnanolone in their brains and blood. What you find is that the levels are starkly lower. I’m in the pill takers relative to the non-health figures. And this is something that’s true regardless of the non pill takers cycle phase. We know that progesterone tends to be higher, like in naturally cycling women progesterone’s much higher in the second half of the cycle than it is in the first half of the cycle. But even when you look at women who are in the first half of their cycle, which is the half that has natural levels of progesterone that are fairly low on, those women still have significantly higher levels of allopregnanolone relative to the pill takers.
Dr. Hill: And so and this is the type of a biological context and it’s known to be related to a number of emotional problems. So people who have lower than average levels of allopregnanolone are at a greater risk for things like anxiety in other forms of depression and other forms of mental mental health problems. And so this has been kind of the big thing that researchers have been chasing down has been whether or not this might contribute to my contribute to pill taking women’s mood symptomology. And so this is one possibility. And this is probably like, this is probably the big one. I mean, if I had to make a guess about like sort of what the big one is, I think the research has like kind of been focused on the right thing. Like this to me seems like a really, you know, plausible first sort of you know, line of defense in terms of trying to understand what can lead to mood breakdown in Pell, taking women.
Dr. Hill: Another one that’s like really, like, it’s really provocative to me because and this is again, one of those things where you know, it doesn’t seem like it’s that important, but it probably is. And that’s some research that’s been done looking at the like the effects of estrogen on like like dopamine signaling and reward signaling in the brain and you know, research like, so researchers have known for a while now that estrogen, again, this hormone that women experience relatively higher levels of in the first half of the cycle relative to the second half. So like the first half of a woman, like a naturally cycling woman’s cycle is the estrogen dominant half. And then the second half of the cycle is the progesterone dominant half. And you know, there’s been a lot of research showing that estrogen plays an important role in terms of reward signaling in the brain.
Dr. Hill: And in particular, what it finds is that you know, estrogen, like higher levels of estrogen are related to a greater reward signaling in the brain to things that are rewarding, right? So like, sex feels better, delicious food tastes yummier monetary rewards seem more amazing. And interestingly, they’ve done a lot of research on this with drug addiction as you might imagine, like apparently cocaine like feels better and like and other drugs feel better to women when, when estrogen is dominant to relative to times in the cycle when it’s not. Hmm. And we, yeah, well it’s, it’s you, which is, yeah, it’s, it’s really provocative in terms of also like treatment for drug addiction, but that’s like a different conversation for a different day. But what’s cool about this is and why I think is provocative and interesting is, you know, the birth control pill, you know, the sort of two big things that we need to keep in mind here is one the birth control pill keeps women’s own levels of endogenous estrogen really low, right?
Dr. Hill: So women aren’t creating any of their own estrogen. And when we look at the hormonal profile of these combination birth control pills that most women are on their progesterone dominant and you know, what this might create in the brain is a situation where rewards don’t feel very rewarding, right? Because it’s like women are at a constant state of, you know, not experiencing like these really huge pleasure bursts from, you know, sex and food and, and hugs and love and all of the other things that like make our lives feel meaningful, right? Is getting rewards from these types of, you know, environmental stimuli. And so you know, the Pell, by changing women’s, you know, hormonal profile in ways that keeps estrogen really low might actually tamped down women’s pleasure, like sort of across the board and over time I can imagine, right, that that doesn’t make people feel very happy.
Dr. Hill: And I think that that also might play a role in terms of making women’s lives feel a little bit blah and maybe contributing to some of the problems that we see with depressive symptoms and pill taking women. And so those, you know, those different systems. I think are [inaudible] and also the things that we talked about with the stress response of course, because if you can’t cope with stress, it’s going to make you feel overwhelmed and, and contribute to anxiety and depression. And so all of these things kind of together almost like the perfect storm in terms of not necessarily promoting positive mental health outcomes, especially among people who are vulnerable to mental health problems in the first place.
Steph: So fascinating. And I know one of the things that I think a lot of women just struggle with when they’re taking birth control, and I can attest to this as well as like everything just feels pretty dull, you know? Yeah, it kind of reminds me of a lot of people that take a acetaminophen, you know, they say take Tylenol for things and Tylenol dulls pain, but it kind of dulls everything else. It’s almost that like universal, just dulling of the good things it can be the counterbalance to things that are truly challenging in your life.
Dr. Hill: Yeah, no, for sure. It’s like, so it’s so interesting cause I’m like, for me, when I went off the pill, I mean that was really like what it was. It was like, I kind of felt like I was living in gray scale and then it was like all of the sudden somebody colored my [inaudible] picture, you know? And it was like, Oh wow. Everything just felt a little bit more dimensional and yeah, like less doll and more vibrant. And and I hear that from a lot of women, the word vibrancy like is the word that I hear people use to sort of describe the experience of like transitioning off of the pill. And I think, yeah, this is like part of it, which is why I think that these systems in the brain, I think it’s so provocative in terms of, you know, trying to better understand how we work when we’re on the pill.
Steph: Why a, this is a bit of a different question, but, and we’re probably covering this at the end instead of the beginning, but is there a reason why your curiosity really got piqued in terms of this topic? I mean, it sounds like you’ve had, you’ve have a very rich history of research and publication and I’m sure you’ve had lots of different areas of personal interest in research interest, but why this one in particular?
Dr. Hill: I know this one was really personal for me, so I you know, I was on the pill for more than a decade and I was on it all through college, all through graduate school until I was ready to start having children. And I never had any problems with it. Like I didn’t get the psychological, you know, blahs and I didn’t, you know, I didn’t feel sad and I’m, I tolerated the pill really well. But then when I went off of it, it was like I had this feeling of like transitioning from like a two dimensional, like black and white sort of gray scale drawing to like life, like fully vibrant, awake, alive life. And and it really was like it was eye opening to me. And and so I started to dig around in the literature in the research literature cause you know, I’m a psychologist and I’ve been studying women and health.
Dr. Hill: Those are like my two big areas is like women. Well I guess there’s three areas. It’s like women health and relationships. So it was basically everything like this related to the one control pill, you know. And and I had never heard of any research at the point, you know, at this point in my life. That would lead me to believe that the birth control pill that I was on would be doing anything to to my brain or how I was feeling or experiencing the world. And then, so I went into the research literature to see what had been published on it. And and that’s when I started to find out that there was, you know, whole bodies of research looking at the way that the birth control pill influences these different systems. I’m in women’s in women’s brains.
Dr. Hill: And and, and to be honest with you, it was like incredibly embarrassing to me as you know, a psychologist and, and, and a woman and somebody was on the pill and I’ve published papers, you know, I’ve like, I’ve published research on the effects of hormones, women’s sex hormones on these different outcomes. And it never occurred to me that my birth control pill will be changing what my brain was doing and, and the fact that I had that huge blind spot and this disconnect between like what I study and then like what I was doing to my own body made me realize that, you know, I think that we all maybe have a little bit of a blind spot. And then some of us like that, we just really don’t think to ask the question, what is the Pell doing to my brain?
Dr. Hill: And, and yeah, and so my experience of going off it sort of, you know, directed me to the scientific literature where I then had this embarrassing epiphany or of course the pill influences all this stuff like Sarah, you know, sex hormones influence all of these things. You’ve known that forever. So when you change women’s sex hormones, it’s also gonna have influences. And so then I wanted to get all of this information out of these research journals and be able to explain it and easy to understand language so that way all women have like access to this information because I think that it’s too, it’s too important and it’s what women are talking about when it comes to the birth control pill. And so I really just wanted to get this information to women. So that way they like have all the information that they need in order to, you know, make the best sort of decisions about who they want to be, whether that means being on or off of the birth control pill, all of that. Well, this has been so very, very interesting. You know, I’ve, I took a spin through the book and was reading different sections and you’ve done such
Steph: A wonderful job with making it informational and interesting and conversational. Like I, you know, I, I know I said at the top of the show, like I’m a science nerd and I love this stuff, but there’s, the book is definitely something that a woman who’s not steeped in this world could pick up and, and find so much value from. And I love your sense of humor as well, and that’s such a great it’s such a great thing to infuse in a book that could get maybe a little bit dull or serious in terms of what you’re writing about. And I think you just do such a wonderful job of, of balancing all of that. And I, I’m just excited that it’s out there, so let us know where can we find it? What’s it called again? Where can we find it? Awesome and all that good stuff.
Dr. Hill: Okay. Yeah, no, and thank you so much. This is like, this book was an absolute labor of love and I had fun writing it. It was like fun to use that sort of part of my cause. Like normally when I’m writing papers because they go into these scientific research journals, like I can’t drop enough bomb, you know, but like I could do that. It was just like amazing. It was so fun. But the name of the book is This is Your Brain on Birth Control: The Surprising Science of Women’s Hormones and the Law of Unintended Consequences. And it is available on Amazon and indie bound and Barnes and Noble. You can find it at any of those places. And the readers can all or your listeners can also learn more about me and my research and background and everything else. And get links directly to ordering the book on my website, which is www.sarahehill.com. And lastly I am on social media and my handle at all of the different places is at Sarah E. Hill Ph. D.
Steph: Wonderful. We’ll link all of that in the show notes so people can hop around, put that in their Amazon cart. I think probably along with things like Beyond the Pill would be a great companion to this. Period Repair Manual would be a great companion to this as well. And yeah, it’s just such a wonderful, like you said, neck up look into, into this world and I, I think is to me, incredibly valuable. So I’m really grateful you took the time to sit down with us today and wish you all the very best of luck with the book.
Steph: Okay, there you go. That’s a wrap on episode 245 with Dr. Sara Hill. Remember to head over to [inaudible] dot com there you can get the show notes for every single episode of the podcast, including a summary links to my guest and everything that they’re doing in the world. Quoteables, timestamps on the topics that we talked about, and so much more. And remember to hit the subscribe button on your podcast app. I know we have two calls to action today. That’s okay. You can multitask. So when you close out of this show, make sure in your podcast app that you have hit the subscribe button. Of course it is completely free for you, but what this does is brings the podcast episodes as they’re released into your device so you don’t even have to go looking. They’ll be right there waiting for you. And of course, I just started singing Richard Marks in my head. If you’re old enough to get that reference, you’re definitely my people. All right, so make sure you do that. Leave us a review, let us know what you think of the show, and I would just love to hear your thoughts. Okay, that’s it for today. Until next time, I’ll be back Friday for an episode of Fierce Love Friday. Be well.