MomCave LIVE

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

• Jennifer Weedon MomCave / Dr. Kelly Culwell

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Hold on to your hot flashes, folks! We've got the amazing Dr. Kelly Culwell in the MomCave, where the coffee is strong, and our sanity is on a coffee break. Dr. Kelly, not just your typical doctor—she's the OBGYN rockstar with a prescription for laughter and a cure for the chaos that is perimenopause. Buckle up for a rollercoaster of hormones, hilarious anecdotes, and maybe a few tips on how to survive your next family argument. Let the perimenopausal party begin!

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Transcript:

Jen: Hi, welcome to MomCave LIVE where we may have lost our minds, but we haven't lost our sense of humor. And as usual, Instagram is lagging behind and I'm trying to get there we go now we're live on the places. Okay. I have a really, really fun guest for you guys tonight. But not only is she fun, she's really knowledgeable. And here she is. Welcome Dr. Lady Doctor, Kelly Culwell.

Dr. Kelly Culwell: Hello. I love the intro, by the way.

Jen: Oh, thank you. Oh, my real family members really being loud and annoying as they do.

Dr. Kelly Culwell: Wow. Puts you in the mood. Definitely.

Jen: I know! Hide in your MomCave you may hear them at any moment. They were all arguing upstairs just before we went live. So, Kelly, there's so much to say about you. Kelly is a doctor a real doctor, obviously an OBGYN. But you work. You're the head of research and development and developing new birth control methods. She teaches, she made a web series. There's so many things, but we've brought her here today because you're going to help us out with the whole birth control situation. Yes,

Dr. Kelly Culwell:  Yes. Happy to do it.

Jen:  Um, so a lot of people of different ages watch MomCave. Like, when I started doing MomCave a long time ago, my kid was a newborn. So, we were talking about postpartum and when can you have sex again? And what can you do? What kind of birth control can you use? Well, it's been a few years. And now a lot of the people that follow here are going into perimenopause. I just got really sad when I said that. I like went off in another land. And so, we've got the new moms that find us still but we've also got a lot of us not so new moms who are going to this other stage of life. So, first of all, what is perimenopause?

Read more here:
https://www.momcavetv.com/perimenopause-panic-drkellyculwell-momcave-live/

Jennifer Weedon Palazzo:

Hi, welcome to MomCave LIVE where we may have lost our minds, but we haven't lost our sense of humor. And as usual, Instagram is lagging behind and I'm trying to get there we go now we're live on the places. Okay. I have a really, really fun guest for you guys tonight. But not only is she fun, she's really knowledgeable. And here she is. Welcome Dr. Lady, Doctor Kelly Culwell. Hi.

Dr. Kelly Culwell:

Hello. Hi. I love the intro, by the way.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

Wow. Puts you in the mood. Definitely.

Jennifer Weedon Palazzo:

I know! Hide in your momcave you may hear them at any moment. They were all arguing upstairs just just before we went live. So, Kelly, there's so much to say about you. Kelly is a doctor a real doctor, obviously an OBGYN. But you work. You're the head of research and development and developing new birth control methods. She teaches, she made a web series. There's there's so many things, but we've brought her here today because you're going to help us out with the whole birth control situation. Yes,

Dr. Kelly Culwell:

yes. Happy to do it.

Jennifer Weedon Palazzo:

Um, so a lot of people of different ages watch MomCave. Like, when I started doing MomCave a long time ago, my kid was a newborn. So we were talking about postpartum and when can you have sex again? And what can you do? What kind of birth control can you use? Well, it's been a few years. And now a lot of the people that follow here are going into perimenopause. I just got really sad when I said that. I like went off in another land. And so we've we've got the new moms that find us still but we've also got a lot of us not so new moms who are going to this other stage of life. So first of all, what is perimenopause?

Dr. Kelly Culwell:

That's a good question. Yeah. And there's a lot of attention on on menopause right now. And so the question is, you know, what's the difference between perimenopause and menopause? And, you know, when does all this start? And what does it mean? So menopause is it's pretty simple. I mean, it literally means stopping the period like men-no-pause. And basically, the menopause is defined by not having had a period for one year, in the absence of any other medical problems that might be causing you not to have a period. So. So that's what menopause. So technically, it's kind of a moment in time. When you go through menopause, and then before then you're Peri menopausal, and after that you're postmenopausal. And so perimenopause just really means the period around the time that you're going to stop having your menstrual periods. So that time period and it can be up to 10 years. So if you say the average age of menopause is in the early 50s, you know, 51, then you know, women as early as their early 40s can start experiencing and even sometimes even earlier than that and start experiencing symptoms that people usually associate with menopause. So those that you think are hot flashes, night sweats, mood swings, vaginal dryness, you know, those kinds of things, which are the sort of standard menopause symptoms really started happening in that perimenopausal period or that period leading up to when you stop having menstrual periods. And the other fun little party gift that happens during that time

Jennifer Weedon Palazzo:

Oh there is more?

Dr. Kelly Culwell:

Yeah, well, while most women are, you know, people associate menopause with stop bleeding, right? In the perimenopausal period, you might have heavier bleeding, you might have more frequent bleeding, you might have irregular bleeding. And so that also can be going on, which is very surprising to people because they expect as they get older, you know, periods will get lighter, or less frequent. or something. Yeah, but sometimes it's the opposite of that. It's sort of like it goes out with a big, a big bang. A big Hurrah.

Jennifer Weedon Palazzo:

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 answer it. Um, of course, I have many questions. I know some people who have started perimenopause, even in their mid 30s. That stinks. But I don't know when I was growing up until I got to be a certain age. I always thought there was like, just it just stopped like, Okay, hi, I'm fertile I'm fertile I'm fertile it stops.

Dr. Kelly Culwell:

Right.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

It absolutely is yes. So part of the reason why some people in the perimenopause will have irregular bleeding is because they're not ovulating regularly. So most one of the most common reasons for having irregular periods at any point in your in your reproductive life or is to not ovulate so the ovulation is what really triggers the hormonal cascade that makes those periods kind of come and go in a regular fashion. So you you ovulate in the middle of your menstrual cycle, and then approximately two weeks later, that's when you have your period. And it's because of the hormones that get kicked into effect. Once that egg pops out. In the perimenopausal period, you're not having an egg pop out every month. And in fact, you could go several months with no ovulation. Also, the eggs that are being produced are not necessarily as easily easily fertilized. And they, you know, everything about the sort of reproductive system gets a little bit slower. So your fertility does kind of wax and wane. But the The important thing is that someone might have say, no period for three or four months think I must be good. Stop using birth control. And then that next month, they can put an egg out and all of a sudden, you have you know, an unexpected pregnancy and your late 40s. And in fact, the two most common times for unexpected pregnancy are teenage years, and mid to late 40s.

Jennifer Weedon Palazzo:

Wow.

Dr. Kelly Culwell:

Because people are not expecting you know that they have much you know that they have your fertility left. And in fact, is this sort of like up and down cycle, which is also why it's very hard to check hormones during this time. So a lot of people say, Well, how do you diagnose this, right? You do a blood test. The problem is, is they're going like this, you know, you're having these hormones. So if you catch them on a day, it could look like you're menopausal. But if you catch them on another day, it might not. And so that's why it's a little bit difficult to say tell someone okay, you don't need birth control anymore. Right? Because next month, you might. So it's it's definitely a challenge in that sort of, yeah, late 30s to to early 50s. Time Period.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

No, I don't think so. I think, you know, obviously, the risks of pregnancy go up with age. But more importantly, they are related to your health. Right. And so, you know, I have seen many very healthy pregnancy in women in their 40s. And even in early 50s. I have seen healthy pregnancies. I think all of us who have been through a pregnancy and are now in our 40s or 50s. Recognized, we might not have the stamina we had when we when we were pregnant. So you have to think about that. I mean, you know, it is

Jennifer Weedon Palazzo:

you already feel tired and gross and pregnant. So

Dr. Kelly Culwell:

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, it definitely puts people at pregnancy is is a health, it's risky. You take you know, you, you are risking your life when you get pregnant, actually. And that does increase with age, but I would not say there's an absolute cutoff, where you absolutely should not get pregnant, because it really depends on your health. And yeah, and and each person's sort of individual situation situation.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

Yes.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

Well, what we always say is, the best method is actually the best method for you. So exactly the most, the most effective method for any individual person is the one that they that they can use consistently and correctly. And so IUDs can be a great option at any age, because there's sort of a set it and forget it type method. Right. So there's two different kinds of IUDs on the market. Right now, there's the nonhormonal, which is a copper IUD. There's only a single copper IUD right now. And then there's the hormonal, which is kind of a group of IUDs that have the same hormone, just variety of different doses. And so they're good for different periods of time. The both of them have some advantages in the perimenopausal period. So the non hormonal one, obviously, no hormones, you'll continue to have your menstrual cycle. So that will, you know, you can sort of monitor your own kind of cycle and see how things change. And so you'll have a sense of if you stop having periods that's more likely to be related to menopause rather than any birth control that you're taking. So you can kind of continue to monitor that the downside with the copper iud is that sometimes, especially the one that's currently available now, it can cause heavier menstrual bleeding and more painful menstrual bleeding and in the perimenopause, when you're already kind of maybe having some of those months that are a little heavy. That can be a challenge. The the hormonal IUDs. There's some real advantages to those in the perimenopause. Because so one thing that people will sometimes talk about is hormone therapy in menopause. 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 both estrogen and progestin. So estrogen is really is what's helping your symptoms. So it's, it's a low estrogen situation that's causing your hot flashes, your vaginal dryness, you some of your mood swings, even muscle, muscle aches, you know, difficulty sleeping. But you can't just take estrogen if you have a uterus because estrogen actually causes growth of the lining of the uterus. And so you need to take a progestin which counters that estrogen to keep that lining from overgrowing and becoming precancerous.

Jennifer Weedon Palazzo:

Wow.

Dr. Kelly Culwell:

So the nice thing about the hormonal IUDs is they are progestin based. So you can actually have that hormonal IUD and take your estrogen, either orally or by a patch, or even a ring, vaginal ring. So you can take your estrogen and not have to take a separate progestin because you already have it in your IUD. So your IUD is protecting your uterine lining. So that's a nice benefit it also the the hormonal IUDs also decrease menstrual flow. So again, in this period, menopausal period, where, you know, some sometimes you're having very heavy bleeding from month to month, these hormonal IDs can help decrease that. So those can and plus both both types of IUDs are highly effective. And they're sort of set it and forget it. If your life is crazy, in this period of our lives, most of our lives are crazy between work and parents and kids. An IUD as a thing, you don't have to remember to do something every single day. So

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

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't tolerate it, you know, they just they can't tolerate either the insertion or having it in or anything like that. So there are basically any options that are available are totally appropriate for perimenopausal women. The only exception is if you you're a smoker, or you have some health conditions like high blood pressure or heart conditions. But if you don't have those conditions, or if sorry, migraines are another one, if you don't have those conditions, or any other sort of health risk factors, you're pretty much open to take any method, one method that can be good in the perimenopausal period, which, because it can help ease the transition is birth control pills. Either the pills, the patch or the ring, actually, because both all three of those methods have both estrogen and progesterone in them. And so what they do is they actually regulate your cycles. So when you're having all these crazy up and down cycles, they help to keep you know cycle regular, not too heavy. They also provide they're about three times as strong as menopausal hormone therapy. So if you're having hot flashes, night sweats, etc, they're going to treat those and and also provide you with contraception. So if you're someone who can tolerate hormonal birth control, and you don't have any health risks that make it not safe for you, that can be a very good option in the perimenopause as well.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

That's good.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

Yeah, well, it is a very high dose and it's more than you need. So when you talk about sort of, if you were going to take menopausal hormone therapy just to sort of, you know, replace what is falling during menopause. Like I said, the dose would be about a third of what it is in a birth control pill. So you would be overdosing yourself if you continue to take birth control. And birth control is not without its risks. So hormonal birth control. There are risks even for any women of any age, so it does increase your risk for blood clots. It can increase your risk for heart conditions as well. In some women, it might increase risk for breast cancer, although that risk is extremely low compared to its benefits, so it actually decreases your risk of uterine cancer, decreases your risk of ovarian cancer decreases your risk of colon cancer. So it definitely has a lot of positives. But it is a medication that does have side effects does have some risks. So we wouldn't keep someone on it forever

Jennifer Weedon Palazzo:

Right

Dr. Kelly Culwell:

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

Jennifer Weedon Palazzo:

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 be healthy and stop doing this whole hormone thing and torturing the woman, is there a time does it ever like level off?

Dr. Kelly Culwell:

It does. It does. Yeah. So when you get through the sort of the the menopausal transition, the you know, those big symptoms like the hot flashes, the the night sweats, the mood swings, those things start to ease off. Once you get past that sort of roller coaster of hormones. However, once you get into the true menopausal postmenopausal period, you still don't really have much circulating estrogen, if any, so you're gonna things that will continue will be like vaginal dryness, pain with intercourse, those kinds of things will definitely continue. And so that's why in the postmenopausal period, even if you're not taking oral, or transdermal or the patch for for menopausal hormone therapy, sometimes you can just take vaginal estrogen, which actually doesn't have any of the risks that the oral estrogen or transdermal estrogen or birth control have. It really is just a local effect. So for postmenopausal women who are still having problems with vaginal dryness, pain with intercourse, frequent urinary tract infections, which sometimes comes from a lack of estrogen, just using vaginal estrogen is something that and that's something you can use forever. You can use vaginal estrogen for the rest of your life if you need to.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

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

Jennifer Weedon Palazzo:

So much going on.

Dr. Kelly Culwell:

Yeah, there's a lot going on. So it's sort of like someone described it. As you know, I don't know about you, but my kid. My one child is in adolescence. And then you know, I've got my elderly parents, so I'm hitting perimenopause, my son's hitting adolescence, you know, and I, and it's also usually the peak of our careers and our earning potential. So like, we're busy at work, we've got crazy pubertal kids, our parents need a lot of assistance. And then our hormones are going all over the place. So yes, irritability is very, very common during this time period. And it is related to hormones, it can be it can be helped with hormone therapy. But there are also other options that you can look into that are not hormonal

Jennifer Weedon Palazzo:

Like moving out and like ignoring your family

Dr. Kelly Culwell:

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

Jennifer Weedon Palazzo:

Yes.

Dr. Kelly Culwell:

And so this irritability is both a bio it has a biological cause, but it's got sort of a mental effect, right? So this is all connected. So working on things like meditation, yoga, relaxation practices, acupuncture actually can be extremely helpful for a lot of symptoms in the perimenopause, including this sort of irritability, situation. And then there are other prescription medications as well. So there are some antidepressant medications which have been successfully used in the perimenopausal period to help with some of this irritability, but also some of the symptoms of depression that we experience during this time as well. So you know, there's a lot of options. But that's very common, and it's very normal. And I think all of us are experiencing at one level or another that are in this age

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

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

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

Right

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

Yeah, so I will say that more and more companies that are working on developing birth control methods are trying to develop non hormonal methods. So we have a lot of hormonal methods right now. And they're great for what they're for. And they can provide a lot of relief, like we were just talking about from different symptoms, even outside of the perimenopause, some, you know, people I know, want to stay on their pill, because they regulate their periods, and they decrease their acne and they stop their menstrual headaches, you know, so they're happy with it. But there are a lot of people that want to avoid hormones, either because they've had bad side effects, because they're worried about the health risks, or they just don't like the idea of it, you know, they're living a sort of a natural lifestyle, and they're trying to keep the hormones out. So most, you know, most advancement right now is happening in the non hormonal space. So the product that my company is working on, it's actually a new version of the copper IUD. So it will have a lower dose of copper. And it comes on a different type of frame that is more amenable to different sizes and shapes of uteruses. And so we're looking forward to maybe having that product out as early as next year, which will be kind of exciting, because it will be the first time that the copper ad that we have now was approved in 1984. So there haven't been any advancements on the copper IUD since then, some other you know, options, that there's some other kind of on demand options that are being looked at to work with sort of the cervical mucus. So one thing that we know so if you've ever done sort of fertility awareness, kind of monitoring your cervical mucus, you know that your cervical mucus changes right around the time that you ovulate. So you can imagine if you could sort of harness the cervical mucus to make it thick and inhospitable at any time of the cycle, then you could potentially prevent sperm from making their way up. So there's there are companies that are working on that. So, you know, potential to

Jennifer Weedon Palazzo:

As if my anger isn't making it inhospitable.

Dr. Kelly Culwell:

Exactly. Exactly, exactly. If that's important, but good from it. The irritability is a good form of birth control, really. Um, but yeah, so that's really I think, you know, most people are in and then people always ask me, What about male contraception? Because, you know, we've been waiting, like, what's happening with that, and it is a real challenge to develop a male contraceptive for multiple reasons. So that you, you may have heard, there was a study that was being done on a male contraceptive pill, and they stopped it early, because of the some of the side effects that men were having. And they were having. I know, exactly, that's what everybody was, like, they had side effects, like mood swings, and you know, and in depression and irritability, and people roll their eyes, which, you know, like, yeah, we've been dealing with this for, you know, 60 years, but thank you. But the big problem with when you study a birth control method in men, men don't have the risk of pregnancy, as much as they would like to participate in the whole thing. They don't have the physical risk of pregnancy, right. And so because of that, their risk benefit ratio is a bit different, you know, from just from a from a medical perspective, not you know, not whether or not they're weenies or whatever, that's one thing. But you know, from a medical perspective, we do have a different perspective, because really, any birth control method that we take is safer than pregnancy. Without question,

Jennifer Weedon Palazzo:

I never thought about it that way,

Dr. Kelly Culwell:

Yeah. So you know, the risks that you think about with hormonal birth control, like blood clots, and heart disease and stroke and things like that. It's multiplied, tenfold in pregnancy. And so that's why, in addition to the fact that, you know, I think women are just sort of, we've learned to just suck it up. But from a medical perspective, we can accept a fair amount of risk because the alternative being pregnancy, whereas men, that's not their alternative. So it has been somewhat challenging. But there are some studies right now, there's a gel, a gel contraceptive for men, that is pretty advanced in clinical studies. And it's a hormonal contraceptive, but it has shown real promise, and it's currently being studied in the US, which is, you know, that's kind of critical. There are some methods like there's just one method that keeps coming up. It's kind of this reversible vasectomy that was developed in India. And it you know, it has great clinical data in India. But the problem is, is that if you don't have clinical data in the US, it's never going to get approved here. So you have to it's very expensive to do those studies. So, so that's been a challenge. But I do think that I think we're not as far off from a male birth control method as we have been in the past, which I usually just said, I don't know. But I think we're getting closer.

Jennifer Weedon Palazzo:

That will be very interesting for us all.

Dr. Kelly Culwell:

It will Yeah.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

Yeah, so the data that we've seen thus far shows that it should be less than the current copper IUD. But the women in the study still, there were still side effects. Some women did experience heavier, heavier menstrual bleeding or menstrual cramps with with it, particularly in the first three to six months. But what we see is fewer than half 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 high continuation rate. So we're still, you know, finalizing the analysis, the data and you know, getting the review through the FDA and all of that stuff, but we expect that the side effects will be lower, you know, not zero, but lower, ,

Jennifer Weedon Palazzo:

lower it's always better.

Dr. Kelly Culwell:

Yeah.

Jennifer Weedon Palazzo:

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 Kelly is so accessible. She's about to relaunch her website, where she writes blogs that teach us all of these things, and is willing to answer questions and so you can send her questions on social media or through the blog or a comment on these videos. If you have a particular question, and you can have the good Dr Lady Doctor answer your question. Can you tell everyone where to find you, Kelly?

Dr. Kelly Culwell:

Yes, so my website is DrLadyDoctor.com. So it's just Dr. and then Lady Doctor dot com. And so there you can actually sign up for my newsletter, which I usually send out about once a month. You can send me questions which are actually use potentially as topics for my newsletter as well if it's something that I think a lot of people would be interested in. And then I'm also on Instagram and Facebook@DrLadyDoctor so just Dr. L A D Y D O C T E R so you can reach me there as well.

Jennifer Weedon Palazzo:

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

Dr. Kelly Culwell:

Thank you.

Jennifer Weedon Palazzo:

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