Birth Control During Perimenopause | with Dr. Kelly Culwell | MomCave LIVE - MomCave LIVE

Episode Transcript
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Jennifer Weedon Palazzo (00:13):
Hi, welcome to MomCave LIVE where we
may have lost our minds, but wehaven't lost our sense of humor.
And as usual, Instagram islagging behind and I'm trying to
get there we go now we're liveon the places. Okay. I have a
really, really fun guest for youguys tonight. But not only is
she fun, she's reallyknowledgeable. And here she is.
Welcome Dr. Lady, Doctor KellyCulwell. Hi.

Dr. Kelly Culwell (00:36):
Hello. Hi. I love the intro, by the way.

Oh, thank you. Oh, my real family
members really being loud andannoying as they do.

Wow. Puts you in the mood. Definitely.

I know! Hide in your momcave you may
hear them at any moment. Theywere all arguing upstairs just
just before we went live. So,Kelly, there's so much to say
about you. Kelly is a doctor areal doctor, obviously an OBGYN.
But you work. You're the head ofresearch and development and

(01:10):
developing new birth controlmethods. She teaches, she made a
web series. There's there's somany things, but we've brought
her here today because you'regoing to help us out with the
whole birth control situation.
Yes,

yes. Happy to do it.

Um, so a lot of people of different
ages watch MomCave. Like, when Istarted doing MomCave a long
time ago, my kid was a newborn.
So we were talking aboutpostpartum and when can you have
sex again? And what can you do?
What kind of birth control canyou use? Well, it's been a few
years. And now a lot of thepeople that follow here are

(01:48):
going into perimenopause. I justgot really sad when I said that.
I like went off in another land.
And so we've we've got the newmoms that find us still but
we've also got a lot of us notso new moms who are going to
this other stage of life. Sofirst of all, what is
perimenopause?

That's a good question. Yeah. And there's a
lot of attention on on menopauseright now. And so the question
is, you know, what's thedifference between perimenopause
and menopause? And, you know,when does all this start? And
what does it mean? So menopauseis it's pretty simple. I mean,
it literally means stopping theperiod like men-no-pause. And
basically, the menopause isdefined by not having had a

(02:35):
period for one year, in theabsence of any other medical
problems that might be causingyou not to have a period. So. So
that's what menopause. Sotechnically, it's kind of a
moment in time. When you gothrough menopause, and then
before then you're Perimenopausal, and after that
you're postmenopausal. And soperimenopause just really means

(02:55):
the period around the time thatyou're going to stop having your
menstrual periods. So that timeperiod and it can be up to 10
years. So if you say the averageage of menopause is in the early
50s, you know, 51, then youknow, women as early as their
early 40s can start experiencingand even sometimes even earlier

(03:17):
than that and start experiencingsymptoms that people usually
associate with menopause. Sothose that you think are hot
flashes, night sweats, moodswings, vaginal dryness, you
know, those kinds of things,which are the sort of standard
menopause symptoms reallystarted happening in that
perimenopausal period or thatperiod leading up to when you
stop having menstrual periods.
And the other fun little partygift that happens during that

(03:41):
time

Oh there is more?

Yeah, well, while most women are, you know,
people associate menopause withstop bleeding, right? In the
perimenopausal period, you mighthave heavier bleeding, you might
have more frequent bleeding, youmight have irregular bleeding.
And so that also can be goingon, which is very surprising to
people because they expect asthey get older, you know,

(04:05):
periods will get lighter, orless frequent. or something.
Yeah, but sometimes it's theopposite of that. It's sort of
like it goes out with a big, abig bang. A big Hurrah.

And it's over. Anyone who's watching
if you have a specific question,feel free to put it in the
comments and Kelly will answerit. Um, of course, I have many
questions. I know some peoplewho have started perimenopause,
even in their mid 30s. Thatstinks. But I don't know when I

(04:38):
was growing up until I got to bea certain age. I always thought
there was like, just it juststopped like, Okay, hi, I'm
fertile I'm fertile I'm fertileit stops.

Right.

And what so then, as you just
explained, that doesn't happenwith a period. Does it happen
with your fertility or are youare you slight? Is it
fluctuating during this time,the fertility?

It absolutely is yes. So part of the reason
why some people in theperimenopause will have
irregular bleeding is becausethey're not ovulating regularly.
So most one of the most commonreasons for having irregular
periods at any point in your inyour reproductive life or is to
not ovulate so the ovulation iswhat really triggers the

(05:23):
hormonal cascade that makesthose periods kind of come and
go in a regular fashion. So youyou ovulate in the middle of
your menstrual cycle, and thenapproximately two weeks later,
that's when you have yourperiod. And it's because of the
hormones that get kicked intoeffect. Once that egg pops out.
In the perimenopausal period,you're not having an egg pop out
every month. And in fact, youcould go several months with no

(05:47):
ovulation. Also, the eggs thatare being produced are not
necessarily as easily easilyfertilized. And they, you know,
everything about the sort ofreproductive system gets a
little bit slower. So yourfertility does kind of wax and
wane. But the The importantthing is that someone might have
say, no period for three or fourmonths think I must be good.

(06:10):
Stop using birth control. Andthen that next month, they can
put an egg out and all of asudden, you have you know, an
unexpected pregnancy and yourlate 40s. And in fact, the two
most common times for unexpectedpregnancy are teenage years, and
mid to late 40s.

Wow.

Because people are not expecting you
know that they have much youknow that they have your
fertility left. And in fact, isthis sort of like up and down
cycle, which is also why it'svery hard to check hormones
during this time. So a lot ofpeople say, Well, how do you
diagnose this, right? You do ablood test. The problem is, is

(06:47):
they're going like this, youknow, you're having these
hormones. So if you catch themon a day, it could look like
you're menopausal. But if youcatch them on another day, it
might not. And so that's whyit's a little bit difficult to
say tell someone okay, you don'tneed birth control anymore.
Right? Because next month, youmight. So it's it's definitely a

(07:08):
challenge in that sort of, yeah,late 30s to to early 50s. Time
Period.

Yeah.
Would you say that there is anage where it's just too risky to
risk getting pregnant?

No, I don't think so. I think, you know,
obviously, the risks ofpregnancy go up with age. But
more importantly, they arerelated to your health. Right.
And so, you know, I have seenmany very healthy pregnancy in
women in their 40s. And even inearly 50s. I have seen healthy

(07:41):
pregnancies. I think all of uswho have been through a
pregnancy and are now in our 40sor 50s. Recognized, we might not
have the stamina we had when wewhen we were pregnant. So you
have to think about that. Imean, you know, it is

you already feel tired and gross and
pregnant. So

yeah, it is a huge burden. Pregnancy is a huge
burden on the body. You know,there's no question about that.
And so that's why, I mean, itdefinitely puts people at
pregnancy is is a health, it'srisky. You take you know, you,
you are risking your life whenyou get pregnant, actually. And
that does increase with age, butI would not say there's an

(08:22):
absolute cutoff, where youabsolutely should not get
pregnant, because it reallydepends on your health. And
yeah, and and each person's sortof individual situation
situation.

Um, Stephanie on Instagram says,
yeah, that's why I have an IUDat 39. Because I don't want any
surprise pregnancies.

Yes.

Yes, she has. She has that. So now
that we've we're going to talkabout some specific methods.
What do you think is the bestmethod in perimenopause?

Well, what we always say is, the best method
is actually the best method foryou. So exactly the most, the
most effective method for anyindividual person is the one
that they that they can useconsistently and correctly. And
so IUDs can be a great option atany age, because there's sort of
a set it and forget it typemethod. Right. So there's two

(09:15):
different kinds of IUDs on themarket. Right now, there's the
nonhormonal, which is a copperIUD. There's only a single
copper IUD right now. And thenthere's the hormonal, which is
kind of a group of IUDs thathave the same hormone, just
variety of different doses. Andso they're good for different
periods of time. The both ofthem have some advantages in the

(09:36):
perimenopausal period. So thenon hormonal one, obviously, no
hormones, you'll continue tohave your menstrual cycle. So
that will, you know, you cansort of monitor your own kind of
cycle and see how things change.
And so you'll have a sense of ifyou stop having periods that's
more likely to be related tomenopause rather than any birth
control that you're taking. Soyou can kind of continue to

(09:57):
monitor that the downside withthe copper iud is that
sometimes, especially the onethat's currently available now,
it can cause heavier menstrualbleeding and more painful
menstrual bleeding and in theperimenopause, when you're
already kind of maybe havingsome of those months that are a
little heavy. That can be achallenge. The the hormonal
IUDs. There's some realadvantages to those in the

(10:19):
perimenopause. Because so onething that people will sometimes
talk about is hormone therapy inmenopause. You know, so when
you're having those hot flashes,night sweats, mood swings, one
of the best ways to treat those,as you know, especially in the
short term is hormone therapy,and what we, for women who have
uteruses, we need to use bothestrogen and progestin. So

(10:42):
estrogen is really is what'shelping your symptoms. So it's,
it's a low estrogen situationthat's causing your hot flashes,
your vaginal dryness, you someof your mood swings, even
muscle, muscle aches, you know,difficulty sleeping. But you
can't just take estrogen if youhave a uterus because estrogen
actually causes growth of thelining of the uterus. And so you

(11:05):
need to take a progestin whichcounters that estrogen to keep
that lining from overgrowing andbecoming precancerous.

Wow.

So the nice thing about the hormonal IUDs is
they are progestin based. So youcan actually have that hormonal
IUD and take your estrogen,either orally or by a patch, or
even a ring, vaginal ring. Soyou can take your estrogen and
not have to take a separateprogestin because you already
have it in your IUD. So your IUDis protecting your uterine

(11:37):
lining. So that's a nice benefitit also the the hormonal IUDs
also decrease menstrual flow. Soagain, in this period,
menopausal period, where, youknow, some sometimes you're
having very heavy bleeding frommonth to month, these hormonal
IDs can help decrease that. Sothose can and plus both both
types of IUDs are highlyeffective. And they're sort of

(11:59):
set it and forget it. If yourlife is crazy, in this period of
our lives, most of our lives arecrazy between work and parents
and kids. An IUD as a thing, youdon't have to remember to do
something every single day. So

Yeah, that's great not having to worry
about it. What if you don't wantto put an IUD inside your body?
What are some other options?

Yeah, absolutely. And that's the thing
is, it's not one size fits all,there's some people that an IUD
is never going to be appealing.
And some people who just can'ttolerate it, you know, they just
they can't tolerate either theinsertion or having it in or
anything like that. So there arebasically any options that are
available are totallyappropriate for perimenopausal
women. The only exception is ifyou you're a smoker, or you have

(12:40):
some health conditions like highblood pressure or heart
conditions. But if you don'thave those conditions, or if
sorry, migraines are anotherone, if you don't have those
conditions, or any other sort ofhealth risk factors, you're
pretty much open to take anymethod, one method that can be
good in the perimenopausalperiod, which, because it can

(13:00):
help ease the transition isbirth control pills. Either the
pills, the patch or the ring,actually, because both all three
of those methods have bothestrogen and progesterone in
them. And so what they do isthey actually regulate your
cycles. So when you're havingall these crazy up and down
cycles, they help to keep youknow cycle regular, not too

(13:21):
heavy. They also provide they'reabout three times as strong as
menopausal hormone therapy. Soif you're having hot flashes,
night sweats, etc, they're goingto treat those and and also
provide you with contraception.
So if you're someone who cantolerate hormonal birth control,
and you don't have any healthrisks that make it not safe for

(13:43):
you, that can be a very goodoption in the perimenopause as
well.

I did not know that so that that's
very good. So then why I'mgetting very basic here. People
are gonna think I'm I'm dumb.
But I'm trying to to be verybasic about everything.

That's good.

Why don't we just take birth control
forever then? Why don't we justtake it in our into our old age?

Yeah, well, it is a very high dose and it's
more than you need. So when youtalk about sort of, if you were
going to take menopausal hormonetherapy just to sort of, you
know, replace what is fallingduring menopause. Like I said,
the dose would be about a thirdof what it is in a birth control

(14:23):
pill. So you would be overdosingyourself if you continue to take
birth control. And birth controlis not without its risks. So
hormonal birth control. Thereare risks even for any women of
any age, so it does increaseyour risk for blood clots. It
can increase your risk for heartconditions as well. In some

(14:44):
women, it might increase riskfor breast cancer, although that
risk is extremely low comparedto its benefits, so it actually
decreases your risk of uterinecancer, decreases your risk of
ovarian cancer decreases yourrisk of colon cancer. So it
definitely has a lot ofpositives. But it is a
medication that does have sideeffects does have some risks. So

(15:08):
we wouldn't keep someone on itforever

Right

Because because as you get older, those
risks are only going toincrease. And so if you still
need it, yeah, go ahead.

Because your body does there come a time
when your body figures this out.
And it's like, Okay, I'm done.
I'm old now. I'm going to behealthy and stop doing this
whole hormone thing andtorturing the woman, is there a
time does it ever like leveloff?

It does. It does. Yeah. So when you get
through the sort of the themenopausal transition, the you
know, those big symptoms likethe hot flashes, the the night
sweats, the mood swings, thosethings start to ease off. Once
you get past that sort of rollercoaster of hormones. However,
once you get into the truemenopausal postmenopausal

(15:53):
period, you still don't reallyhave much circulating estrogen,
if any, so you're gonna thingsthat will continue will be like
vaginal dryness, pain withintercourse, those kinds of
things will definitely continue.
And so that's why in thepostmenopausal period, even if
you're not taking oral, ortransdermal or the patch for for

(16:13):
menopausal hormone therapy,sometimes you can just take
vaginal estrogen, which actuallydoesn't have any of the risks
that the oral estrogen ortransdermal estrogen or birth
control have. It really is justa local effect. So for
postmenopausal women who arestill having problems with
vaginal dryness, pain withintercourse, frequent urinary

(16:34):
tract infections, whichsometimes comes from a lack of
estrogen, just using vaginalestrogen is something that and
that's something you can useforever. You can use vaginal
estrogen for the rest of yourlife if you need to.

Great.
Good to know. Okay, I have avery, this this is obviously a
personal issue I'm having solet's just put it on the
internet. What about these moodswings and like, rage? Is that
is that part of?

It absolutely is irritability, rage? Yes, mood
swings? Absolutely. It's thehormonal fluctuations that are
going on. Now, in addition tothat, obviously, we are also in
a period of our life wherethere's a lot of stressors

So much going on.

Yeah, there's a lot going on. So it's sort of
like someone described it. Asyou know, I don't know about
you, but my kid. My one child isin adolescence. And then you
know, I've got my elderlyparents, so I'm hitting
perimenopause, my son's hittingadolescence, you know, and I,
and it's also usually the peakof our careers and our earning
potential. So like, we're busyat work, we've got crazy

(17:43):
pubertal kids, our parents needa lot of assistance. And then
our hormones are going all overthe place. So yes, irritability
is very, very common during thistime period. And it is related
to hormones, it can be it can behelped with hormone therapy. But
there are also other optionsthat you can look into that are

(18:04):
not hormonal

Like moving out and like ignoring
your family

Actually moving to moving to Bali. I
think Is one that's recommended,write a prescription for that.
Yes, no. But you know, thingsthat, you know, a lot of times
people don't like to hear, youknow, things are in your head or
anything like that. And it'sreally not it's not in your
head, it's just that your mindand your body are really
connected, right?

Yes.

And so this irritability is both a bio it
has a biological cause, but it'sgot sort of a mental effect,
right? So this is all connected.
So working on things likemeditation, yoga, relaxation
practices, acupuncture actuallycan be extremely helpful for a
lot of symptoms in theperimenopause, including this

(18:46):
sort of irritability, situation.
And then there are otherprescription medications as
well. So there are someantidepressant medications which
have been successfully used inthe perimenopausal period to
help with some of thisirritability, but also some of
the symptoms of depression thatwe experience during this time

(19:06):
as well. So you know, there's alot of options. But that's very
common, and it's very normal.
And I think all of us areexperiencing at one level or
another that are in this age

My oldest is 13. And I and I had
him in my mid to late 30s. Causelike, you know, you have a kid
when you're in your 30s and youcan like start shaping together.
Yes. All these wonderful thingsas we get older

Yes. So then the acne comes back, right. So
you're perimenopausal acne soyou can share acne washes.

It's actually quite convenient in
that way. It's not great foryour relationship.

Right

When you're angry all the time, and
you've got an angry teenager. SoI don't want to give you to give
away any trade secrets. But Ihear you're working on some new
forms of birth control in yourresearch is there Anything you
have some tell me about birthcontrol of the future?

Yeah, so I will say that more and more
companies that are working ondeveloping birth control methods
are trying to develop nonhormonal methods. So we have a
lot of hormonal methods rightnow. And they're great for what
they're for. And they canprovide a lot of relief, like we
were just talking about fromdifferent symptoms, even outside
of the perimenopause, some, youknow, people I know, want to

(20:26):
stay on their pill, because theyregulate their periods, and they
decrease their acne and theystop their menstrual headaches,
you know, so they're happy withit. But there are a lot of
people that want to avoidhormones, either because they've
had bad side effects, becausethey're worried about the health
risks, or they just don't likethe idea of it, you know,
they're living a sort of anatural lifestyle, and they're
trying to keep the hormones out.
So most, you know, mostadvancement right now is

(20:49):
happening in the non hormonalspace. So the product that my
company is working on, it'sactually a new version of the
copper IUD. So it will have alower dose of copper. And it
comes on a different type offrame that is more amenable to
different sizes and shapes ofuteruses. And so we're looking
forward to maybe having thatproduct out as early as next

(21:12):
year, which will be kind ofexciting, because it will be the
first time that the copper adthat we have now was approved in
1984. So there haven't been anyadvancements on the copper IUD
since then, some other you know,options, that there's some other
kind of on demand options thatare being looked at to work with
sort of the cervical mucus. Soone thing that we know so if

(21:36):
you've ever done sort offertility awareness, kind of
monitoring your cervical mucus,you know that your cervical
mucus changes right around thetime that you ovulate. So you
can imagine if you could sort ofharness the cervical mucus to
make it thick and inhospitableat any time of the cycle, then
you could potentially preventsperm from making their way up.
So there's there are companiesthat are working on that. So,

(21:57):
you know, potential to

As if my anger isn't making it
inhospitable.

Exactly.
Exactly, exactly. If that'simportant, but good from it. The
irritability is a good form ofbirth control, really. Um, but
yeah, so that's really I think,you know, most people are in and
then people always ask me, Whatabout male contraception?
Because, you know, we've beenwaiting, like, what's happening
with that, and it is a realchallenge to develop a male

(22:24):
contraceptive for multiplereasons. So that you, you may
have heard, there was a studythat was being done on a male
contraceptive pill, and theystopped it early, because of the
some of the side effects thatmen were having. And they were
having. I know, exactly, that'swhat everybody was, like, they
had side effects, like moodswings, and you know, and in

(22:45):
depression and irritability, andpeople roll their eyes, which,
you know, like, yeah, we've beendealing with this for, you know,
60 years, but thank you. But thebig problem with when you study
a birth control method in men,men don't have the risk of
pregnancy, as much as they wouldlike to participate in the whole
thing. They don't have thephysical risk of pregnancy,

(23:06):
right. And so because of that,their risk benefit ratio is a
bit different, you know, fromjust from a from a medical
perspective, not you know, notwhether or not they're weenies
or whatever, that's one thing.
But you know, from a medicalperspective, we do have a
different perspective, becausereally, any birth control method
that we take is safer thanpregnancy. Without question,

I never thought about it that way,

Yeah. So you know, the risks that you think
about with hormonal birthcontrol, like blood clots, and
heart disease and stroke andthings like that. It's
multiplied, tenfold inpregnancy. And so that's why, in
addition to the fact that, youknow, I think women are just
sort of, we've learned to justsuck it up. But from a medical
perspective, we can accept afair amount of risk because the

(23:55):
alternative being pregnancy,whereas men, that's not their
alternative. So it has beensomewhat challenging. But there
are some studies right now,there's a gel, a gel
contraceptive for men, that ispretty advanced in clinical
studies. And it's a hormonalcontraceptive, but it has shown

(24:16):
real promise, and it's currentlybeing studied in the US, which
is, you know, that's kind ofcritical. There are some methods
like there's just one methodthat keeps coming up. It's kind
of this reversible vasectomythat was developed in India. And
it you know, it has greatclinical data in India. But the
problem is, is that if you don'thave clinical data in the US,
it's never going to get approvedhere. So you have to it's very

(24:36):
expensive to do those studies.
So, so that's been a challenge.
But I do think that I thinkwe're not as far off from a male
birth control method as we havebeen in the past, which I
usually just said, I don't know.
But I think we're gettingcloser.

That will be very interesting for us
all.

It will Yeah.

Jessica says Will the new copper IUD
still have the possibility ofheavy flow and more painful
periods.

Yeah, so the data that we've seen thus far
shows that it should be lessthan the current copper IUD. But
the women in the study still,there were still side effects.
Some women did experienceheavier, heavier menstrual
bleeding or menstrual crampswith with it, particularly in

(25:22):
the first three to six months.
But what we see is fewer thanhalf the women that we expected,
discontinued because of that.
And so they were, you know,really pretty satisfied with the
study. And we had a pretty highcontinuation rate. So we're
still, you know, finalizing theanalysis, the data and you know,

(25:43):
getting the review through theFDA and all of that stuff, but
we expect that the side effectswill be lower, you know, not
zero, but lower, ,

lower it's always better.

Yeah.

Wow. So I could keep you all night
because I have many questions,but I know that we have to get
to it. Um, everybody, you Kellyis so accessible. She's about to
relaunch her website, where shewrites blogs that teach us all
of these things, and is willingto answer questions and so you
can send her questions on socialmedia or through the blog or a

(26:17):
comment on these videos. If youhave a particular question, and
you can have the good Dr LadyDoctor answer your question. Can
you tell everyone where to findyou, Kelly?

Yes, so my website is DrLadyDoctor.com. So
it's just Dr. and then LadyDoctor dot com. And so there you
can actually sign up for mynewsletter, which I usually send
out about once a month. You cansend me questions which are
actually use potentially astopics for my newsletter as well
if it's something that I think alot of people would be

(26:48):
interested in. And then I'm alsoon Instagram and Facebook
@DrLadyDoctor so just Dr. L A DY D O C T E R so you can reach
me there as well.

We are going to keep in touch because
I'm sure there will be manyquestions for me and everyone
else here and thank you forsharing your knowledge.

Thank you.

It was wonderful being with you. Have a
great night. Thank you

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