Podcast Rewind: All About the Menstrual Cycle

Dr. Robert Rountree

This is The Thorne podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements, and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and Functional Medicine Doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who expressed them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.

Hi everyone, and welcome to The Thorne Podcast. This is your host, Dr. Bob Roundtree. And this week we have a returning guest, Dr. Amy Divaraniya, who has a PhD in genetics and genomics, which she'll tell us in a minute exactly what that means. She's also the CEO and founder of OOVA, which is an app and a home-testing regimen that helps with fertility or infertility problems. And I think it's also fair to say she's a women's health guru. And she's going to tell us how she got to be in that position. So welcome back to the show, Amy. How are you doing today?

Dr. Amy Divaraniya

I’m good thank you so much for having me again.

Dr. Robert Rountree

Yeah, you bet. Maybe you could tell our listeners just a few tidbits about your journey. So how about women's health guru?

Dr. Amy Divaraniya

Totally self-taught, I'll say that. Yes, so my background is heavy on the science side. As you said, I've a PhD in biomedical sciences focusing on genetics and genomics, but I'm actually a trained data scientist and was in industry for several years before becoming this entrepreneur that I've become. Never thought I'd be here. I'm here because I went through my own journey with infertility, and it really enlightened me to just how underserved the female population was. And it forced me to really educate myself on what my body was naturally doing. So hence the term women's health guru, because I had to literally teach myself what was happening inside my body.

Dr. Robert Rountree

So I remember one thing from our conversation before is that you basically said women want data. I can almost see a protest with women holding up a sign, “Women want data.” Could you tell us what that means, that women need data, want data…? Data for what? What kind of data?

Dr. Amy Divaraniya

I mean, so you could take one step back right? Like we're all taught to advocate for our self, right? When it comes to our health, if something, doesn't feel right, speak up. But if that soapbox that you're standing on to advocate for yourself, this is built up of Google searches and Facebook comments and anecdotal advice. It's really hard to stand on that with stable ground. What if you can build that soapbox off of objective data and hormonal measurements and symptom tracking and be able to synthesize all that into something that is an actual picture of what your overall health is. Now, when you go to your doctor, you are empowered with information to have a two-way conversation and ask questions and demand answers. That's a piece that I think has been missing. Women haven't been empowered with that information to be able to truly advocate for their own health and when things are wrong.

Dr. Robert Rountree

So, you know, there's apps out there that say track your symptoms. You know, I eat this food and I get gut pain, right? Or I get migraines itself. But those are all kind of superficial. You're talking about a different kind of data. You're talking about data about specific hormones. And to that end, I wonder if you could tell us in a nutshell what goes on in a woman's menstrual cycle. You know, I heard from you earlier that 87 percent of women have irregular menstrual cycles at some point in their lives, which is a huge number. Like irregular cycles are the norm, not the ab-norm. So what makes for an irregular menstrual cycle? What are all the factors that feed into that and what does that look like in terms of things that you measure?

Dr. Amy Divaraniya

Sure. So a menstrual cycle I think is also kind of mis-defined by a lot of women. A menstrual cycle is a lot more than a period. Right? There's a lot more that happens in a woman's menstrual cycle than just shedding your tissue every month. That's really just the first portion of it. There's a lot that happens if you look at your menstrual cycle, it's really divided into two phases: follicular and luteal phase. And if you want to be very granular, you can break it up into four: the menstrual phase, the follicular phase, ovulatory, and then luteal phase. They all have their own meanings. There's different things that are happening in each phase. We can dive into that. But when you're talking about a regular cycle, what does that mean? It's really about having this cyclical effect happen. All four of those phases happening at some regular interval that could be 40 days, it could be 20 days, it could be 28 days, whatever it may be. But it has to be at some sort of a predictable interval that would be defined as a regular cycle. An irregular cycle is if you're having that cycle happens at different times every single time.

Dr. Robert Rountree

How does the body know to do this right? Is it… You know, we have circadian clocks, all right? Every cell in our body knows what time of day it is. There's a morning. Is it evening? How do certain parts of our body, whether it's the brain or the ovaries or some other tissue, how do they know that it's time to bleed? I mean, you know, so there are four phases. How is that possible? What’s going on?

Dr. Amy Divaraniya

So they're driven by hormones. So there's critical hormones that are dictating each phase and kind of leading the body through phase after phase after phase. So we can go through what those hormones do right now if you’d like.

Dr. Robert Rountree

You like? Sure. Yeah. Well, I'm wondering, like, so does the brain control those hormones or is it the other way round or both?

Dr. Amy Divaraniya

It's a little bit of both.

Dr. Robert Rountree

OK. So let's start at the beginning.

Dr. Amy Divaraniya

Start at the very beginning. All right. So with your menstrual cycle, that's when everything is at its baseline. Your body is shedding its uterine lining because you haven't gotten pregnant. If you think about a woman's body, this whole menstrual cycle is really designed for woman to get pregnant. Right. And if she doesn't, then all the lining sheds so you can reset for a possible pregnancy in the next cycle. Once that menstrual phase is over, she's done bleeding. Now she's in the later part of the follicular phase. At this point, her estrogen will start to go up. The role of the estrogen, it starts to trigger the pituitary gland in the brain to release LH. But LH doesn't come out in a stream.

Dr. Robert Rountree

LH is luteinizing hormone.

Dr. Amy Divaraniya

Correct. Yes. So luteinizing hormone is released in little bursts. It's a pulsatile hormone, so it comes out in little, little bursts, at a frequency every time the estrogen pings the pituitary gland, you're going to get a little burst of LH. What ends up happening is your estrogen starts elevating, and that signals to the pituitary gland to release more and more LH. As the LH is increasing, the ovary starts getting a signal, “It's time to release an egg.” And when the LH peaks, that's when the egg is released. And that's considered ovulation.

Dr. Robert Rountree

So LH is a signal that you can actually measure that says something about the readiness for ovulation?

Dr. Amy Divaraniya

Correct. So once the egg is released, the egg starts to flow down the fallopian tube and enters into the uterus. Once it's there, it begins to form a corpus luteum, which is this yellowish skin wrapping around the egg, and that releases the progesterone. The purpose of that progesterone is to make that uterine lining incredibly sticky and soft and cushiony. So if a sperm meets with that egg and an embryo is formed, that embryo can nestle into the uterine lining and then stick. And that's where you will have your baby, would grow. Now, if that embryo doesn't form, what's going to happen is the corpus luteum will stop generating the progesterone. Progesterone will reduce, and then everything shuts. So it now signals that another period should start. That's the full cycle of a menstrual cycle. Now, if you get pregnant, what's going to happen is the progesterone is going to keep on going, and you're going to end up being able to support that baby. And the hormones kind of pivoted and there's a lot more that happens.

Dr. Robert Rountree

A lot more that happens a lot. Your life changes. So the estrogen goes up then that, actually. And that's the first thing that happens, that then tells the brain to make more LH, and then LH feeds back and kind of ripens things, shall we say, in the ovary. And so if you're going to measure this, if you're going to do testing like you do at OOVA, what are the choices you have in looking at these hormones to determine the health of the cycle, the readiness for ovulation, a lot of different things you could test. So why those?

Dr. Amy Divaraniya

Currently our product tests LH and progesterone quantitatively. So we are really focusing on that fertile window and then confirming that an egg was released that cycle. Now what's really critical about OOVA is because we're quantitative, we're able to understand what a woman's baseline levels are for those hormones, and we have her start testing early in her follicular phase. We can then detect fluctuations in her daily levels to tell her when she's entering her Ovulatory phase and when she's entering the luteal phase. So that's really important for women with a hormonal imbalance because she may not necessarily meet the standard curve that's in our textbooks. She may fit a very unique pattern that is unique for her, but totally normal. So OOVA can learn all those nuances and actually help her achieve her fertility goal.

Dr. Robert Rountree

I think I'm correct in saying this, that one of the most common causes of these irregular cycles is polycystic ovary syndrome – PCOS. It sounds like PCOS may be overdiagnosed from talking to you. What is PCOS? What makes it unique and the context of these hormonal changes? And how might your tests be able to determine that or support that diagnosis?

Dr. Amy Divaraniya

Sure. So underlying PCOS is basically an imbalance of hormones. So we know that there's female hormones, there's male sex hormones. Estrogen and testosterone are meant to have a certain balance in women versus in men. In polycystic ovary syndrome, what we typically find is that that is inverted. So there's more testosterone present than estrogen. So what that is a big downstream effect of having that imbalance, because what many women experience is elevated levels of luteinizing hormone throughout their cycle.

Dr. Robert Rountree

So you can see you can see this in the testing.

Dr. Amy Divaraniya

We can see this in our data. So we have women like when you register and you create account with us, you let us know what your reproductive history is. So what we're able to do is actually segment out patients that are polycystic ovary syndrome-positive versus those that are showing signs of PCOS that are actually don't have it. So it's very interesting. You are also seeing is that women that are saying they have PCOS actually don't necessarily have to have that elevated LH.

Dr. Robert Rountree

Wow. So when the app detects that… So will a little pop up come on the app and say, “This sure looks like PCOS?” Or, you know, if you were testing a woman in and that signal was detected, would somebody give her a call and say, “You're in this category”? how would that woman be responded to?

Dr. Amy Divaraniya

So we don't tell the woman that she has those signs, if she’s working with the doctor we provide an alert to the clinician about, “Hey, you might want to do a workup on your patient for PCOS.” We actually submitted a paper to MRSI last year, which is the Midwest Reproductive Symposium [International] conference, about looking at specific hormone patterns to determine if you should do a work up for PCOS patients. It was really informative.

Dr. Robert Rountree

I'm just wondering if a lot of cases are missed as a result of not doing the kind of testing that OOVA offers?

Dr. Amy Divaraniya

Absolutely. I mean, if you look at the testing that's being done right now, it's a snapshot measurement of hormones. You go in for a blood work annually, and you make decisions off of that. What is really needed is seeing what the trends of those hormones are over a period of time and OOVA is able to provide that. You're getting like 15 days of sequential hormonal measurements, so you can really get an understanding of what your hormones are doing in a single month.

Dr. Robert Rountree

Now I'm, I'm getting the impression from talking to you that you may think there's other options for women with PCOS besides metformin or oral contraceptives. What, what have you learned from looking at this data and then doing intervention, taking a dietary supplement or going on a particular diet? What are you learning that is kind of adding to our understanding about this?

Dr. Amy Divaraniya

It's so enlightening to see this. Like it's not Western medication that's necessary to help get PCOS under control, doing simple things like going for a five-minute walk after every meal has had drastic impacts on women with PCOS and getting their cycle regulated. Reducing stress levels. Just moving around and digesting your food. Making recommendations to add more antioxidants in our meals, getting some really good options for removing fatty foods with good fats, that's really enormous as well. We've actually made a lot of recommendations for Thorne supplements to our patients, too, and they've all had really good reactions to those as well.

Dr. Robert Rountree

Let's talk a little bit about PMS. Most women, if you mentioned premenstrual syndrome, know what we're talking about. Some men understand it. Are you learning anything about what PMS is by doing this data tracking or, you know, are you seeing any particular patterns with that? Do you have any theories about what it is?

Dr. Amy Divaraniya

So I mean PMS is something that I think is just a blanket term for discomfort that women feel about before a cycle starts. And it makes sense, right? Like your body was basically getting ready for a pregnancy that didn't happen. So you're about to shed it. Your whole body is resetting, so all your hormones are crashing because they're just down to baseline, so you can shed that lining. Think about what that means, your hormones are present throughout your entire cycle and now they're basically becoming nonexistent. That's going to have an impact on a woman. Every woman is experiencing it differently. What we're able to start doing with our data is we learn the symptoms that women are experiencing for certain parts of their cycle. And we start making recommendations on how to alleviate those symptoms when we start to see those hormonal patterns. So the most common one we see is women report migraines towards the end of their cycle. So we start to see that the hormonal patterns are following in that way, we start giving their recommendations on how to improve sleep patterns, how to remove blue light from their rooms, and they make a ton of recommendations on how to adjust sleep right before those migraines are about to hit and we’ve gotten positive feedback or having a good impact on their lives.

Dr. Robert Rountree

Well, it turns out sleep's important. I mean, who would have thought? But we're in a society where we don't think sleep is important, and it's taken people like Matthew Walker to come out and say, “You know, you actually need X number of hours a night, probably at least seven, maybe eight.” You know, it seems like there's potential for combining the data you're getting from OOVA with one of those sleep trackers and being able to say, “Hey, these two things are tracking together.”

Dr. Amy Divaraniya

Yeah, absolutely. Right now we only tracked sleep by a woman entering it herself, but that’s definitely on the horizon for us to integrate or collaborate with some of these sleep trackers.

Dr. Robert Rountree

So you're learning a lot about the quote “normal menstrual cycle” and what disrupts it. What would you say are the primary factors that that you're seeing that are disruptive to a woman's menstrual cycle? What's why is this so common in our society?

Dr. Amy Divaraniya

I think the number one thing that we see in our data is stress. So stress is something that is subjective. If you say, like, what is your stress level today? Like my stress level of 10 is going to be very different from your stress level of 10. And what we see is that when women are telling us that they are feeling anxiety or stress or any sort of emotion that way, their hormonal patterns are very different than what they had the cycle before.

Dr. Robert Rountree

Wow. So you can see it right there.

Dr. Amy Divaraniya

We could see it right there. They notice it, too. So this is what I really love. Like, yes, we're seeing our data, but so are the women. And they're able to be like, “My cycle looks really different from last cycle. What happened? Oh, my God. Work was insane this week.” And this is what I'm saying about the empowerment. Letting a women really look at her information like this is what's happening with my body. I can control this. That a very powerful thing to give a women.

Dr. Robert Rountree

You know, one thing that that I've noticed in patients is people talk about stress in this global way. And what I just heard you saying is, if they go, “Well, my hormones changed this week, What's different this week? I'm feeling stress all the time. Right. But this week, what's different? This week, I knew I wasn't getting as much sleep.” So you start to narrow it down and go, “Yeah, I'm always feeling stress, but this is what's different right now. And this is something I can change.”

Dr. Amy Divaraniya

It's really funny and I'm sure you probably experience this, too, when you see your patients, but if I do these consults with our patients, I’m like, “Did you change anything this cycle?” The first answer is no. Everything was the exact same. And then I'm like, “Well, how is your sleep? How was work?” “Oh, my God, yeah, you're right. I had that deadline…” And it all opens up. It has an impact.

Dr. Robert Rountree

Yeah. And I think I've heard criticisms about health trackers, sleep trackers, things like that, that now people are going to get data obsessed, right? I’m sure you heard that feedback, too. Oh, you give women all this information and they're going to go, “Wow, my LH is at this level today.” And that people are going to get overly obsessed with that. I wonder what feedback you have, what you say about that feedback, what pushback, I should say, you have for people who say this is too much data?

Dr. Amy Divaraniya

Yeah. And I mean, you control it, right? The way that we think about it at OOVA is every single piece of data that we provide to a user has to be tied back to their health goal. There has to be a closing of the loop. So we give you the data, we interpret it for you, but we also tell you what do you do with this next? If I don't do that, we're just inundating you with information. That's not the goal here. How is what we're telling you today help you achieve your goal faster? So everything is very goal oriented in our platform.

Dr. Robert Rountree

So we'd say actionable, it’s all actionable. And I've heard that word used. The reason I'm familiar with that is because genetic testing, which is another rabbit hole we can go down, you know, a different day is that people will say, “Well, I do these genetic tests and it gives me just tons… It's a data dump. It gives me tons of information that I'm not sure what to do with because it's not actionable.” And I think that's maybe the word that I would like our listeners to take home with them today is, data is useful if it's actionable, if you can make changes.

Dr. Amy Divaraniya

Exactly.

Dr. Robert Rountree

Cool. Well, that's been awesome to discuss all this. I think we need to take a short break and after that, we'll be right back to answer some questions from our listeners.

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And we're back. So now it's time to answer some questions from our community. The first question this week comes from a listener who asked, Why do menstrual cycles synchronize among groups of women? I've certainly heard that for years. You know, college girls in particular that say, “Hey, we're all in the same sorority together and everybody has their period at the same time.” Is it true or is that just when it happens, you notice it?

Dr. Amy Divaraniya

I think when it happens, we notice it. I mean, there's been a lot of studies looking at what synchrony happens and the literature is kind of split down the middle on there being a chance that there is something there versus not.

Dr. Robert Rountree

So there's not some pheromone or other hormone we're sniffing that says time to start your period?

Dr. Amy Divaraniya

I don't think so. But, you know, this could be a cool study to do with OOVA and see if that actually is the case.

Dr. Robert Rountree

Could be a great thing to study. And when we come up with biomarkers for men, maybe we can figure out whether men go into some kind of regular cycle as well, because they sure seem to.

Dr. Amy Divaraniya

I 100 percent agree with that.

Dr. Robert Rountree

Yeah, something is going on with men on a regular cycle.

Dr. Amy Divaraniya

Yeah, I completely agree with that.

Dr. Robert Rountree

So the next listener says, Why does my cycle length change every month? And then kind of part of that is, well, how long can stress delay your period? I assume they're wondering how much of an impact is stress, like, it can throw it off a day or two or longer? What whatever.

Dr. Amy Divaraniya

Why does your cycle of change every month? Your body is the one that's dictating everything, right? So if your hormones are… Let's say you have stress one month, it can imbalance your hormones, that's going to delay you ovulating or it could delay luteal phase and make that a bit longer. There's so many factors that play a role here, and if you’re thinking about it, these little biomarkers are driving such important processes that if you knock one a little bit, it's going to have a ripple effect. And that's what all these things that we do daily, you can have a very strenuous workout. You could have all of this and done yoga and relaxed insanely much more than you have in a long time. You could have had a tough week at work. There's so many things that can impact your cycle that it's hard to say why it's changing, but I think if you get in tune with their body and understand your cycle, you can start to pinpoint the different things that are causing those variations.

Dr. Robert Rountree

So again, you were saying earlier that if we take this concept of stress and then we narrow it down and say, what does stress mean for one person? It means less sleep. Then that can help them look at a cause and effect.

Dr. Amy Divaraniya

Correct.

Dr. Robert Rountree

And say, OK, well, now I know the big issue for me, I didn't exercise for four days in a row, that made a difference. So when we talk about stress, we've got to go, Well, what stress and what context? Like how are you defining it? My next question is, is the number of cycles a woman will have during her life set in stone at birth. Can we predict how many cycles a particular woman is going to have? And are there a set number of eggs?

Dr. Amy Divaraniya

There are a set number of eggs, but I think it's a little difficult to figure out the exact number of cycles a woman's going to have, because every cycle you actually release numerous eggs, but only one turns into a follicle, and that's what's released from the ovary. So the number of eggs shrinks, as a woman grows if she's having more and more cycles and she's getting older. But I think it's difficult to predict the exact number of cycles. You definitely get a roundabout idea by thinking, a cycle a month by the typical lifespan of a woman. But again, that probably doesn't affect or impact every single woman.

Dr. Robert Rountree

Now, this is a question that's kind of related to that. So I'm going to jump to it. Can you talk about why young girls are having periods earlier and earlier compared to years ago? And I think young boys are going through puberty at an earlier age. And then a corollary of that is if a girl starts her period earlier, then does she go through menopause earlier? Are the two independent?

Dr. Amy Divaraniya

There is no way to say that with data right now. There's very limited data on this. But what I will say is that, yes, everyone, like women, girls are having their periods earlier and boys are getting to puberty earlier, what's driving that? I'm not sure. I think the jury's out on that. But we're definitely seeing that in the population that everyone is kind of progressing or evolving much quicker than what we have in the past.

Dr. Robert Rountree

And it could be anything from we’re eating more calories, right? So we're just growing faster, bigger, earlier. Everything's happening sooner just because we have such an abundance of calories compared to thousands of years ago when our genes… There’s a whole thing about the thrifty gene. Right that you know our genes are clashing with modern civilization. So it could be that or it could be organochlorines or, you know, some other kind of toxin. But it's an open question you’re saying.

Dr. Amy Divaraniya

It is an open question. I think you're right about the caloric intake, but the environmental factors, I think, play a huge role in this as well. And there's just not enough data to say what that impact will be. And unfortunately, I don't think we're going to see that for decades to come.

Dr. Robert Rountree

It's going to take us a while to get to the bottom of it. So what's the best age to get pregnant? The listener says “I'm in my mid-30s. Have I waited too long?” Well, you know, what's the age range that you generally see being optimal for getting pregnant?

Dr. Amy Divaraniya

Well, I think first I want to tell the listener that you didn't wait too long. I think that's actually the average that women are getting pregnant, in their early to mid-30s. And what we're seeing with our OOVA data, we see that I think it's 46 percent of our users are actually above the age of 35 and that's substantial because you would think above the age of 35, you're actually considered to have a geriatric pregnancy. That's not the case because they're still cycling, they're still getting pregnant just fine.

Dr. Robert Rountree

I love that – “geriatric pregnancy.”

Dr. Amy Divaraniya

One of my personal goals is how do we redefine all these terms that are used to women today because it's so archaic, but it kind of goes to my next point where all the models and most curves and the hormonal trends that we're all taught are normal, are defined based off of women in their early twenties who are getting pregnant. That's just not the norm for us anymore. And you can see, like if you look at the average age of a woman, at her first [pregnancy], it has been progressively increasing over the past decade. So unfortunately, literature and science hasn't caught up. And I think what's really lacking right now is data to redefine what that normal woman looks like. And we're starting to collect that and build those models.

Dr. Robert Rountree

You know, it's a little like osteoporosis. I do a lot of bone scans in women in their 60s and 70s and the standard is to compare to the density of a 20-something and go, “Wow, your bones are thinner than a 20-year-old.” And they go, “No kidding.” Right? “No kidding.” But it's interesting that the norm has changed that much. You know, where I mean, there's still teen pregnancies out there, obviously, but more and more women are waiting till after they've gone to college, worked a few years in a job, settling in, and have a more stable home life. I don't know what all those reasons are, but something's clearly changed in our society. And mid-30s is norm. And it's not too long. It's not too late.

Dr. Amy Divaraniya

It's not too long. Not at all.

Dr. Robert Rountree

What are you seeing, just curious, in your data in terms of all the conditions that make a woman ripe for being fertile, are you seeing a big decline that happens in the 30s or is it all still looking good? It's looking good at that age.

Dr. Amy Divaraniya

It's looking really good. So I'll give you a good example here. We have so many women. Like I said, 46 percent of our users are above the age of 35. We have a good percentage of those women who tell us that they're perimenopausal. When we look at their data. It is so clear that they are still cycling. It's just irregular. And if you dig down a layer deeper, they've always had irregular cycles. They're a little older today, so their doctors diagnose them with perimenopause. So there's just so much that we can uncover with understanding the hormonal trends and personalize it for every woman. That just hasn't been done in the past.

Dr. Robert Rountree

One thing I'm really getting from talking to you, a big learning for me, is the difference between data and evidence and perception. You know, we have the perception, women have the perception that they're cycling with their roommates. Right. But maybe not, if you actually look at the data. Women have the perception they get older, they're less fertile. But maybe not, if you're looking at the data. So data is really going to change the whole way we think about health care, especially data that we could collect ourselves at home. It's going to change so many concepts and erroneous beliefs about our health.

Dr. Amy Divaraniya

Yeah, I completely agree.

Dr. Robert Rountree

OK, one final question. “I spot all the time after starting birth control. I've tried pills, IUD, I'm good for a day or two and it starts again. How do I stop it?” So, you know, this is a bigger question of what? What's the impact of taking oral contraceptives? Is it is this a bad thing or a good thing? Or like, what's it doing to take these things?

Dr. Amy Divaraniya

So I'm not going to say it's bad or good. But what I will say is that we don't know what the long-term impact of these medications are. Let’s break down what an oral contraceptive is. It's literally a drug that you are taking to override your natural hormone patterns to make it do something predictable. If you're on that for 10 years, 15 years, which many women are, then you get off of it because you're ready to get pregnant. Most women are not going to bounce back to whatever their normal was because they have no idea what that normal was. And if they do, after being on this medication for 15 years, you've probably adjusted to what that normal is. So you have to relearn what is normal for you. So I think there's a huge impact that we're not even addressing. And it's the go-to medication for a lot of clinicians to help regulate periods or, honestly, I think, avoiding pregnancy is probably the smallest reason to give someone a birth control pill today at a young age. There's so many other things that it’s being used for: acne, trying to regulate cycle, a variety of things. What we're seeing with our data already is that women who are jumping off of birth control, it takes them several months to figure out what their new normal is, right? The other thing I want to say is all this like these drugs, these medications that women are being put on, it's based on very little scientific research.

Dr. Robert Rountree

Oh. Oops.

 Dr. Amy Divaraniya

I mean, seriously, women weren't required to be in clinical trials until 1993. That means we have less than 30 years of clinical data to make any claim of how these medications are actually impacting our lives. And if you take that number. The woman who's coming off of birth control today is probably older or right around the same age as the data that we have. So you have no idea what the long term impact is. 

Dr. Robert Rountree

The implication for this listener who says, “Well, I'm having trouble with birth control, right? I can't keep my cycles regular. And even with an IUD, I'm having problems.” So I think what I'm hearing you saying is that doesn't mean, to this listener. It doesn't mean something is wrong with you. 

Dr. Amy Divaraniya

Right.

Dr. Robert Rountree

Right. The fact that, you know, the medicine is a square peg, right? It's not fitting properly. It doesn't mean you've got a problem. And some women just don't tolerate these things. Right. I think maybe that's the take home message is, you know, if you're doing one size fits all, there are going to be some women for whom it's just not a good fit. Is that accurate or is that what would you say? Just keep on trying.

Dr. Amy Divaraniya

No, I think that's absolutely accurate. Like the birth control, it is very much a trial-and-error process. If one doesn't work, go back to your doctor. They'll give you another one. If that doesn’t work, we'll give you another one. The number of options for birth control is not an issue. It's what suits you. So if something's not working, and you want to be on birth control or you think you need it, then there's a plethora of options to choose from. You just have to find the combination that works best for you. 

Dr. Robert Rountree

So if the ones that haven't worked or cause breakthrough bleeding have been an issue, then keep on trying you would say. It doesn't mean something is wrong with that person. That's the important thing. OK, one last thing and this is a question that it's been asked so many times. Can you have sex during your period? Really, I mean, I used to work in family planning, and I get asked that all the time. 

Dr. Amy Divaraniya

I mean yes. You can have sex, but you just most likely will not get pregnant by definition because you're shedding all the lining. There's nothing to fertilize.

Dr. Robert Rountree

So it's a safe period, so to speak.

Dr. Amy Divaraniya

It’s safe, yes, it is. It should be. Yes.

Dr. Robert Rountree

Should be. Great. Well, all right folks. That's all the time we have this week. Dr. Amy Divaraniya, thank you so much for coming on this podcast. I've learned a lot and I assume our listeners have as well. If our listeners want to follow more of your work or find out what you're up to or the latest research, where's the best place?

Dr. Amy Divaraniya

So we are actually posting all of our research at our website. If you go to www.oova.life, that's O-O-V-A dot L-I-F-E. You can see it all there or follow us on social @oovalife.

Dr. Robert Rountree

Great. And it sounds like there's a lot more data to come and you’re going to have a lot of insights. So excellent. Thank you everyone for tuning in again. Until next time!

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