Office Hours: We're talking birth control, femtech, and fundraising as a mother & older person. I'm Dr. Sophia Yen.
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Office Hours: We're talking birth control, femtech, and fundraising as a mother & older person. I'm Dr. Sophia Yen.Featured
Posted in:Office HoursHealth & WellnessStartups
Hi Elphas!I have over 20 years of experience in medicine and I’m the CEO and Co-founder of Pandia Health –the ONLY #WomenFounded #WomenLed #DoctorLed birth control delivery company that also provides online consults with doctors. I also serve as a clinical Associate Professor of Pediatrics in the Division of Adolescent Medicine at Stanford Medical School.I particularly like talking about birth control options, sexually transmitted infections, that menstruation is optional, and treating acne and menstrual cramps.Ask me about the latest and greatest in birth control from IUDs with hormone to emergency contraception, making #PeriodsOptional, fundraising while being a woman, mother, doctor, or older person, or anything else!
cadran·Apr 13, 2020cadran·Apr 13, 2020Thanks so much for joining us @sophiayenmd!Elphas – please reply with your questions before this Thursday. @sophiayenmd may not have time to answer every question, so please emoji upvote the ones you're most interested in.
Oh gosh! I want to know about optional periods! In the last year I suddenly have a much shorter cycle and have been getting my period every 2-3 weeks which is absolutely infuriating! The up side is they’ve been very light and almost pain free but it’s just too often and I just actually cannot deal (I’m there again right now and feeling particularly emotional about it). The last time I was on the pill it made me fat and I absolutely refuse to go down that path again. What options are there to either properly regulate or eliminate the damn thing? I’m never going to have kids and am gay so do not have to worry about accidents. Thank you for being here!
Thanks for all the details! (disclaimer, this is just information and you should consult your doctor.) Sounds like you might be perimenopausal. If so, you can consider:There are 8 different progestins and 3 different levels of estrogen in birth control pills, so if ONE didn't work for you in the past, we could probably find one that works for you now. However, you could try the vaginal ring (which has estrogen and progesterone) And there are now 2 different rings, monthly which has about 20mcg of estrogen and the once a year ring which has 13 mcg of estrogen. And just use them continuously and not have a bleed at all.There is also the IUD with hormone in which 20% of women get to no periods and the rest have lighter periods.There are also the implant (but that is often really irregular) but some do great on it, the patch (high estrogen), the shot (munchies and bone density issues).If you are nowhere near perimenopausal, then you should get checked for thyroid, stress, insufficient calories for activity, other. (see your doctor).
Thank you for your response. I’ll definitely check out more options. I’ve heard such conflicting things from different women about the hormonal IUD which is what I’ve been considering. Didn’t know about the vaginal ring. I’m 40 so I guess perimenopause might be the thing but it just seems early. Sigh.
Do check in with your doctor. Maybe thyroid, stress, nutrition. Thyroid happens commonly at 40.
Thank you 🙏
Hi Sophia,Thank you for taking the time for us :)I want to ask which segment of the Femtech industry you think has the most potential in the next years. Which needs have not been addressed enough yet (or at all).
Femtech is a very broad category. I'm not the expert in Femtech, but I am in Femtech. There is still a lot to be desired in terms of birth control options (i'd like to see IUDs and implants with different progesterones). Fertility seems well covered. Menopause has many approaches. Postnatal support (depression, help with baby care, more) needs more.
Postnatal support please! And pregnancy & miscarriage support as well. So often apps are geared towards only the pregnancies that go "well" and when things go sideways, the relationship with the app feels awkward, disjointed, or dispiriting.
I'm very interested in the scientific published research backing the statement that menstruation is optional. Could you share links to those publications?In parallel, many thanks for your work towards making contraception accessible to more women!
To be more specific: If you are on the birth control pill, patch, ring, shot, implant, IUD with hormone, periods can be optional. if you are NOT on hormones and you are in the US, then you should menstruate every month. Otherwise, your doctor needs to look for the cause of your loss of menstruation e.g. pregnancy, stress, thyroid issues, insufficient nutrition, too much physical activity, eating disorder, etc.The UK National Health system in Jan 2019 updated its contraceptive guide to state that it is OK not to take the placebo pills in a pack of birth control pills. "There is no health benefit from taking a seven-day break from birth control pill. In fact, continuously taking oral contraceptives has been associated with a reduced risk of endometrial, ovarian, and colorectal cancer, improve symptoms of polycystic ovary syndrome (PCOS), and provide some relief from endometriosis and premenstrual syndrome."For publications supporting that it is more natural to have fewer periods than we are having now, look at the research by Dr. Beverly Strassman studying the Dogon tribe in Mali. They start their periods later, they have only 100 periods in their lives vs first world countries that have 350-400. This is because we have only 2 babies vs their 8, and we only breastfeed for 0, 3, 6 months vs. their 12-18 months of breastfeeding. Read "John Rock's error" published in the Annals of Internal Medicine by Malcolm Gladwell There is also the book "Is Menstruation Obsolete" by Drs Elsimar M Countinho and Sheldon Segal.
Apologies for the slow reply, I missed your comment.Many thanks for elaborating on this topic. Playing devil's advocate, I'm curious if you could share the additional cost per pack (assuming 1 pack last 1 month) of substituting the 7 placebo pills by 7 birth control pills. Thanks again for your work in this area.
It would take 17 packs per year instead of the standard 13. so $15/pack x 4 packs = $60 a year extra to NOT bleed. Or if you have insurance, it should be "free" = no copay, no deductible.
Hi @sophiayenmdThanks a lot for doing this session! I'd be glad to learn more about your top pieces of advice for startup founders mothers, and how being a mom impacted (or not) your fundraising experience.
1. Make sure you are NOT doing all the "invisible work" or working the "second shift." Read FairPlay Life by Eve Rodsky and check out her website https://www.fairplaylife.com and/or Getting to 50/50 by Sharon Meers and Joanna Strober2. Find your support group(s) like elpha! various female founder groups on FB and fffl.co and Female Founder Collective 3. Leverage your mother status for the benefit of your company if possible/applicable: e.g. expertise, access to target market, women helping womenIt didn't impact my fundraising experience. However it did impact my experience as a co-founder of another startup. They assumed that I couldn't work as hard because I had "family and child duties." They were wrong. I can work harder because I can multi-task and I am more efficient. Also, I have my husband, my parents, and my nanny to help.
Thank you very much for the advice & insights! :)
hi, Sophia! I am very curious to hear about making periods optional. It seems counterintuitive to wind down a biological process in our bodies that plays such a huge evolutionary role. I don't want to make mine optional, but I would like to decrease the corresponding symptoms. Have you found any supplements or eating patterns that help mitigate PMS? Particularly the mental and emotional side of it. I get it very bad the days leading up to my period.I have the copper IUD, and my period cramps are worse on it. I personally will not take birth control/hormonal birth control, because I don't like the way I feel on it.
I had a copper IUD (paragard) before and it was too painful! My cramps were unbearable and my period was so heavy so I decided to have it removed - I will also not take the pill :)
My doctor was telling me that if I get a hormonal IUD, my period cramps should diminish/stop (I get really bad, debilitating ones). Is this more likely to happen with a hormonal IUD than with copper? Either way, I think I'm too scared to try because I've heard a lot of people say their cramps got worse and also that the insertion process was really bad. When I brought up being afraid of the insertion process with my doc, she didn't offer any painkiller/sedative/anything options and I'm confused why doctors don't do that.
It's almost certain if you get a copper IUD, your cramps will be worse. If you get a hormonal IUD, it supposedly does decrease your cramps and PMS. I have not gotten one - only copper IUD. Insertion hurts regardless of type. I would recommend taking Advil before. I know friends who got a sedative beforehand, but I didn't want to use one. Having a friend to hold your hand would be helpful, too.
In my personal experience, don't do it. I had a hormonal IUD after taking a break from birth control for a year and a half. My cycle was fine before without any issues and periods were light. Insert IUD. It took my body about 8 months to adjust and then about 2 years in, I started getting horrible cramps (could not wear anything with a waistband I was so bloated). And I had a lot of pelvic pain. Long story short, I had to get the IUD surgically removed, doctors had no solutions for my symptoms and kept telling me to take more birth control to manage the symptoms and not treat the underlying problem. And that's when I turned to ayurveda and chinese medicine. A year later, I am fine, things are back to normal, and my system has corrected itself simply by helping my body follow its natural processes. This is a long way of saying that I lost all faith in western medicine's understanding of and approach to women's health. I could go on for hours, but here's the cliff notes: patriarchy is an asshole.
Are you doing natural cycling to prevent pregnancy? What kind of changes did you implement when you turned to Ayurveda and Chinese medicine?
Yep! And it's been effective thus far. The thing about birth control is its a reaction to patriarchy and men abusing women's bodies and voices. I've found that I've had to find a new voice where I communicate better with my partner about what I need and what is and isn't okay. I realize that unfortunately, this is a privilege and not all women are lucky enough to be in a similar situation. But as a single woman, it's been empowering to re-find this voice. For ayurveda, I made significant diet changes mostly kapha to pitta. Birth control had morphed my body into a kapha constitution. According to Chinese medicine your period is a regular and necessary cleansing process. When you don't have it, you're storing dampness in the body, which results in kapha like symptoms. I had to start with acupuncture treatments and an herbal protocol to get my body to learn how to release and cleanse again. Once it started to do that, my constitution for ayurveda started to transition back to pitta and so I had to adjust my diet accordingly. My period is way lighter again and my cramping is back to normal. I highly recommend reading Woman Code by Alissa Vitti.
I spent a ton of money trying chinese herbal medicine & acupuncture when I was trying to get off the pill but felt little to no change on my period *shrug* Really happy that the pill exists because I don't experience any side effects from it and it makes my life sooo much easier, but sorry to hear about all the issues it caused for you.
The copper IUD is known for making cramps worse. The IUD with hormone should make them better. If you are afraid of the insertion of the IUD, you can read our blog piece on tips how to make the experience optimal. https://www.pandiahealth.com/tips-for-getting-an-iud/There is now a 1 year vaginal ring. If you are 30 years or older, you might want to consider that because it is NON invasive in that you just put it in your vaginal and you can leave it there for a year.If you are under 30, then I recommend the monthly ring (higher estrogen which is better for your bones until you are 30) and just change it monthly.
So, it's actually more natural for us to have fewer periods. In the past and in areas where women have no access to birth control, they only have 100 periods in their lifetimes. We are having 350-400. This is because those women are pregnant or exclusively breastfeeding for most of the time. The birth control ring, patch, pill "tell our bodies that we are pregnant" and thus we stop the up and down growing and shedding of the lining of our uterus each month when we are taking them and we skip the placebo/sugarpill/withdrawal bleed week.The progesterone only methods: IUD with hormone, implant, and shot, thin the lining the of the uterus and stop ovulation 30-70% of the time. Thus with those methods, many women don't have monthly bleeds and if they do, it's far less than a regular bleed (which is a thicker lining because it needs to build up enough to support an embryo).Unfortunately, the 2 major side effects of the copper IUD is more blood and more cramps/pain.You might want to consider switching to the IUD with hormone which would not have those side effects. If you want to treat/decrease PMS, one way is to get rid of the "M" = get rid of the menstruation. This is most reliably done with the ring or birth control pill. KNOW that there are 8 different progestins and 3 different levels of estrogen. So if one pill didn't work before, there might a few others to try.For the emotional side of PMS, you could consider seeing a psychiatrist and getting an anti-depressant just for those days. Supplements that mimic anti-depressants are St John's Wort and anecdotally tryptophan (from food) BUT those are just have I heard and not based on any papers I know of. All of this is just information, and you should see your doctor/provider before taking any action/medications.
So good to know! It makes perfect sense. It's crazy to me that information like this is not more widely available. I recently watched a standup comedy show in which the comedian said that if MEN had periods "we would have figured this shit out by now" which really sums up how I feel about it ;)
Hello Sophia,I hope you're doing well.Thanks for doing the Office Hours!2 Questions1 What are tips for managing imposter syndrome?2 What is your go to motivational song?Thank you.Warm Regards,Ekua
Hi Ekua, Thank you for the fun question of the day!1. For imposter syndrome, what might help: make a list of all of your qualifications and expertise and remember those. Compare those to your competitors. There will always be someone smarter than me. But I'm not afraid to ask for help. When I think "I don't belong here," I think of my competitors (men, lawyers, what do THEY know about birth control??? MBAs, newbies to reproductive health, newbies to women's health.) and if they can make it, then certainly I can too! Know your worth! Know why you are better! As my mom says: claim all your titles. Get your credit!2. I have a #SheHeroes playlist. My favorites are: Confident by Demi Lovato and Beyoncé - Run the World (Girls)
Hi Sophia!1. What are your thoughts on brand vs. generic birth control pills? Specifically, have your users reported variability in their side effects to brand vs. generic versions of "the same" rx? 2. Do you think the vast majority of doctors have enough information to know which birth control rx to prescribe to alleviate illnesses (e.g., PCOS, endometriosis, PMDD)? Why or why not? How is this information kept up to date?Thanks!
1. 95% of birth control pills are generic because the "technology" is so old and the meds have gone off patent. I have found that 95 % of women do fine on whatever generic their pharmacy/insurance provides. However 5% only like/do well on certain generic brands.So, if you find that you only do well on a certain generic brand, then do request it. But know that your insurance company might charge you more for it. 2. When choosing a doctor, you want one that has experience (years and volume) and one that is academic (because medical students, residents, fellows, peers) will be asking questions like "why are you doing that? The latest paper says you should be doing this instead." So, it depends if your doctor has had a lot of experience with PCOS, endometriosis, PMDD and if she/he is keeping up with the latest literature. At Pandia Health, all we do is birth control. So we see the side effects and we are the ONLY birth control delivery company led and founded by a reproductive health doctor who is also an academic (Clinical Associate Professor at Stanford). I teach other doctors how to prescribe birth control and manage side effects. I've written a chapter in a book on birth control and many papers.
Hi Sophia! I was wondering what challenges you faced when you were getting into the space. How did you overcome them? I am interested in femtech, and think that there can be a lot of development in the space. (how did I just get a menstrual cup? And how much development has been on it?) Do you think that more companies or products can spew out of the need to make periods less frustrating? Thanks!
The difficulty is NOT getting into the space. The difficulty is finding funding. 97% of VC are men. So we need to get women to become VC. and women to invest in women. If you want to invest in women or know those that do:Check out https://sheeo.world where women donate $1100 a year. and it pooled and then the SheEO investors vote on which 5 companies they want to get the $$$ that year. Check out Portfolia, Golden Seeds, Astia Angels, and Pipeline Angels.Yes. there is room for more/better solutions to dealing with the monthly flow.My bias is turning them off. Check out my TEDxBerkeley talk on the bottom of www.pandiahealth.com/periodsoptional and tell me what you think!
Hi Sophia, I would be interested in the newest options of non-hormonal birth control (of course also involving top-notch tech solutions) that you know of and can recommend. A lot of them seem to require spending a lot of time with the topic and being very diligent about daily routines, which results in extra brain power invested by women. I just had a baby and am preparing to find a good solution for myself now.Thank you!
There are things on the horizon but nothing that I would recommend because as you say, they require a LOT of investment (daily temp, daily mucus monitoring, etc) by the person with the uterus.The OLD options:vasectomy is the BEST. tubal ligation if you are in there already for c-section, otherwise vasectomy.sounds like you are in between kids, so then copper IUD (though side effects, more blood, more cramps)condoms WITH spermicide BUT if you have the time and regularity in your schedule, Natural Cycles has a 7% failure rate.future: UC Berkeley related company. https://vcresearch.berkeley.edu/bakarfellows/profile/polina-lishko
Would love to hear any fundraising stories or advise re: being 'older' ! :)
Advice: make it work for you. Emphasize your experience, your connections.
For anyone interested in seeing Sophia "in action" I had the pleasure of interviewing her a few months ago - Sophia is absolutely hilarious and a brilliant case of self-confidence.Check the interview on YouTube: https://www.youtube.com/watch?v=hxrsoHYbE9sSophia, great so see you here :*
Great seeing you here homie, you go girl! Take care and stay safe! <3
Hi there @sophiayenmd - Thank for you taking the time. I have a question about women waiting later to have children. Is this because of their career? Do you have data on that? How are they managing anxieties around deciding when to have children? In your opinion, how can we as a society help? Context - I started Prowess Project, to help women return to the workforce. We certify them in the latest tech, empathy and project management and match them with jobs. I thought the majority of our talent pool would be women returning to the workforce after taking time off to have children, however, it's actually women who have not had children yet, but are looking for flexible, remote work. I suspect it's because they are building flexibility now, but I'd love your perspective. Thank you!
Hi Sophia,OpenAI's Inclusivity ERG is interested in hosting a virtual panel next month. I would like to feature person's who have experienced ageism in this world of young tech entrepreneurs. Can we chat more? [email protected]
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