Periods, Birth Control and Fertility with Ali Moxley

Photo from: @lyla_freechild

This is an interview with 25 year old Ali Moxley. I am absolutely honored that she took the time to answer these questions and spread some knowledge about periods, fertility and birth control to my readers. A lot of these questions were genuine in that I wanted to know the answers as well! And some answers shocked me. So Ali, thank you; You are doing important work. And actually~ this interview and talking with Ali are a big part of why I have decided to go off of the birth control pill!

Ali Moxley is originally from Georgia, and is now a graduate student at Montana State University in the Health and Human Development Department. Her previous degree is from Appalachian State in Sustainable Business and Nutrition. It is important to recognize that she does not have any type of medical degree... That being said, who cares!! (No, I'm kidding, but if I've learned anything in my research regarding going off the pill it's that the medical field still has a long way to go when it comes to women's health and research) Soooo that being said... she has taken an 8 week course about Fertility Awareness and Human Anatomy. Moxley continues to keep up to date on research that is coming out in this field and has also just completed a 10 day intensive course on hormone balancing. Her other interests include climbing, skiing, gardening, cooking, running, talking to strangers, and acro yoga.

I asked about Ali's journey with birth control and her cycle, and what led her to take the 8 week fertility course, and Moxley went on to say:

In January of 2019 I was fed up. I was in the middle of dealing with my 6th UTI in an 8-month period and my gut was pretty messed up from continually being on antibiotics. This was despite doing all the key things that help prevent UTIs: wiping front to back, peeing after sex, not wearing tight underwear, ect. The month before I had met with my OBGYN to discuss my options. He said there wasn’t much to do, but prescribed me a low dose antibiotic that he wanted me to take after EVERY TIME I HAD SEX. I got the prescription filled as a backup, but decided I wasn’t interested in this option. It felt like he was trying to put on a bandaid instead of addressing what was clearly a huge issue my body was trying to deal with.

I decided to get my hormones tested to see if that could be part of the underlying issue. When my results came back they indicated that my progesterone levels were low even for a menopausal woman (when you go through menopause progesterone levels typically drop lower and stay lower than a normally cycling person). That pushed me over the edge and I decided I wanted to see what life was like without hormonal birth control. I had been taking it since I was 17 because my OBGYN had said it would help give me a more regular period. At the time I was a runner in high school and would only have a period once every few months. I ended up switching between 3 different types of birth control pills in high school and eventually got an IUD when I was in college. I don’t remember having many side effects from the pill except for one: I stopped taking one specific type and my boobs noticeably got smaller (I was bummed at the time).

I started taking the fertility awareness course soon after I received my test results and got my IUD out about a month later. I now use the Symptothermal method of birth control and haven’t had any UTIs since. I have a regular 28-30 day cycle and feel healthy and strong.

Photo from: @jocelyndaher

Can you explain ovulation and when it happens in a woman’s cycle?

Ovulation occurs when a follicle in an ovary bursts and an egg is released. It then travels down the fallopian tube where it has the potential to meet up with a sperm. This can only happen once a cycle and that egg will only be alive for 12-24 hours. This typically happens around day 12-17, but depends on each individual. There are factors that may delay ovulation such as stress, fasting, or sickness. This makes it very important to never try to predict ovulation purely based on when someone has ovulated during their previous cycles.

How do hormones change throughout a natural cycle?

During the first half of the ovulation cycle estrogen is rising. Right around ovulation a short spike in luteinizing hormone and follicle stimulating hormone (FSH) happens. After ovulation occurs progesterone will rise. This change in hormones is a chain reaction. In order for LH to be released, estrogen needs to reach a certain level and so on. (see diagram below).

Is there any significance in having a light or heavy flow?

A super heavy flow, also known as menorrhagia, is not normal and is commonly due to some sort of hormonal imbalance. If someone bleeds for more than 7 days, has to change a tampon/pad more frequently than every 2 hours, or has clots larger than a quarter in size, this is considered “too heavy." One of the most common reasons for heavy periods is oestrogen dominance. When estrogen levels are too high the uterine lining gets thicker than it normally would and when it comes time for menstruation there is more lining to shed. There are a variety of factors that can lead to estrogen dominance, but generally with diet change and supplement use it can be brought back into check. Some other root causes of a heavy flow may include: estrogen dominance, hypothyroidism, bleeding disorders, fibroids (non-cancerous tumors or growth in the uterus), ovulatory dysfunction, blood thinning medications, like aspirin, cancer, Pelvic Inflammatory Disease (PID), liver or kidney disease, perimenopause childbirth, endometritis, and iron deficiency. The copper IUD, Paragard, has also been known for leading to heavier periods. If periods are extremely heavy I would recommend looking into getting some lab testing done.

If your period is particularly light or begins to disappear altogether this might be due to not having enough body fat to support hormonal health, onset of perimenopause, PCOS, pregnancy, or stress levels that are affecting ovulation (mental or physical). People who are breastfeeding or have recently had a child may take some time for their bodies to sink back into the normal rhythm of their cycle.

How can a woman honor herself and her body during her period?

This is a personal decision. One way I honor myself is by making sure I don’t do heavy physical exercise/cardio the first few days of menstruation. This allows me to have more energy and perform better throughout the rest of my cycle. This also allows me to slow down and do some planning for my next few weeks. I will also increase my self care and try to be kind to myself/increase positive self talk. Some people like to paint with their menstrual blood and water their plants with it as well!

Photo from: @theyonigaia

Period sex. What do you think?

If everyone involved is into it, I think period sex can be great.

Can you get pregnant on your period?

Someone cannot get pregnant on their period if they are having a normal cycle length and normal period length. If someone on hormonal birth control is having a withdrawal bleed they cannot get pregnant either because they did not ovulate in the first place.

*Note-- if you have shorter period cycles and ovulate at the end of menstruation it is possible to get pregnant on your period. This is rare.

What are the various birth control options for women?

1. Barrier methods- this includes condoms for penis and vaginas (2 different types), sponge, diaphragm, and cervical cap. Sometimes spermicide is paired with one of these methods.

2. Birth control pill- combination pill (estrogen + progestin) and mini pills (progestin), over 30 options on the market

3. Implant- Nexplanon

4. Vaginal Ring- Nuva Ring

5. Birth control patch

6. Intrauterine device (IUD)- hormonal (Mirena, Kyleena, Liletta, and Skyla) and copper (Paragard). Hormonal IUDs can be left in for 5-7 years depending on the brand. The copper IUD is FDA approved for 10 years.

7. Fertility Awareness Methods- Symptothermal, the Standard Days Method, Cervical Mucus Method, Two Day Method, Justisse. One more time for the people in the back, this is NOT the Rhythm Method.

8. Sterilization- vasectomy, tubal ligation, tubal implant

It is important to note a couple of points here. Each of these methods can have different side effects and have different effectiveness rates. It is important to do research to see how effective each method is. The only non-hormonal birth control options are the copper IUD, FAM methods, or permanent sterilization. The ONLY option currently on the market for men is a vasectomy. This speaks to the burden society has placed on womxn in the reproductive health realm and how womxn’s health side effects are less relevant than men’s.

Many people are put on birth control at a young age as a way to address other health concerns such as infrequent periods, acne, PCOS, or heavy flows. A lot of the time when people come off of birth control these symptoms will return. This is because hormonal birth control can act as a temporary bandaid and can mask these types of symptoms, but is not typically fixing any type of root problem (which is frequently a hormonal imbalance).

How does one begin to use the fertility awareness method(s)? How do those methods really work?

There are multiple ways to track an ovulation cycle. I am most versed in the Symptothermal method of Fertility Awareness, so that is the method I will speak to. The way this method works is by tracking a variety of biomarkers. These include basal body temperature (BBT), cervical mucus, and luteinizing hormone (LH) levels. This involves recording your basal body temperature daily, making note of your cervical mucus at every opportunity, and testing for LH a few days a cycle. The reason tracking temperature works well is because after ovulation metabolic rate increases resulting in a rise in temperature. Temperature will stay higher until right before menstruation starts.

For me, on a day to day basis this looks like: wearing my Tempdrop to sleep (this tracks my BBT as I sleep), waking up and syncing my Tempdrop to my phone, plotting my temperature on Kindara (the app I use to track my cycle), making cervical mucus observations when I use the restroom, recording cervical mucus observations in Kindara at the end of the day, and occasionally testing my LH levels.

It is really important to note that fertility awareness methods should not be associated with the Rhythm Method. This is an old school method that tries to predict ovulation based on previous data cycles. I highly recommended turning off all predictions when using any type of phone app that helps track cycles. In order to use this method effectively I highly recommend trying to take some type of short term course.

For anyone looking for more information regarding fertility tracking I would recommend the following resources:

1. Dr. Jolene Brighton, Famtastic Fertility, The Cvntsultant, Chloe Skerlak

What birth control method would you recommend?

For me this very much depends on someone’s lifestyle. What I view as the most important factor is being aware of how the birth control method you are using is affecting your body and the potential short-term and long-term effects.

They say when you take birth control you have a “fake period” during sugar pill week. Is this is true?

This is absolutely true and backed by research. Part of how hormonal birth control (HBC) works is by suppressing ovulation. This phenomenon is known as a withdrawal bleed and occurs as a result of your body no longer receiving the hormones that are typically delivered when taking pill birth control. If ovulation does not occur you do not have a real period. I didn’t know a pill bleed was not a normal period until I was 23! No OBGYN, sex education program, or doctor of any kind had ever explained this to me.

Photo from: @justnakednyc

Is it safe to skip your period on birth control by skipping the sugar pills?

The only real purpose of taking the sugar pill is to keep you in the habit of taking a pill every day. It is fine for most people to skip them, although it is best to check with your medical provider. If someone decides they do not want a withdrawal bleed they can skip the sugar pills and move straight into their next month of pills. The main drawback of this method is not knowing if you are pregnant. Even though a withdrawal bleed is different than a normal period, this will still only occur if someone is not pregnant. If someone routinely skips the sugar pills and goes straight into the next pack of pills, they may initially have some breakthrough bleeding, but this generally goes away.

What are the hormones in birth control and what do they do to our bodies? (What effect does birth control have on women’s bodies and minds?)

Different types of birth control have different types and levels of hormones. Generally speaking birth control either only delivers progestin (a synthetic version of progesterone) or a combination of estrogen and progestin. I think this is a helpful visual for understanding the possible side effects that any type of hormonal birth control can have on someone’s body.

One can get really in depth about any of these. Studies have been done that show that women that are naturally cycling tend to be attracted to different traits, scents, and immune systems for their partners than women on hormonal birth control. lt is important to note that this is fairly new research and it mainly focuses on white heterosexual women. For more information on how hormonal birth control might be affecting your brain I recommend the book This Is Your Brain on Birth Control: The Surprising Science of Women, Hormones, and the Law of Unintended Consequences by Dr. Sarah E. Hill.

I think it is extremely important for someone not to disqualify side effects they may be having due to hormonal birth control use. It can be very easy for someone to say, “Oh there is no way this is a result of my birth control,” especially when a health care provider says something similar. I have seen my friends experience a wide range of negative side effects: ectopic pregnancy, ovarian cysts, weight gain, acne, depression. If you are not satisfied with what is happening with your body please consider switching to another option.

Do you see it at all possible that in the future there will be birth control for men?

I think for this to happen there are going to have to be a lot more outspoken people that demand options. Right now most womxn are willing to take on the burden of being in charge of birth control. There isn’t a huge market for companies to sell this because the vast majority of womxn, specifically in developed countries, are handling this by themselves. Society will also need to stop prioritizing men’s health over womxn’s health. There is a vasectomy shot that is being tested and a reversal shot is also being developed. This would offer a non-surgical, non-hormonal option for men. That being said I believe there should be a lot more resources going into the development of male contraceptives options. In the past, studies on a male pill or male injectable contraceptive have been shut down because men complain of side effects that are very similar to what women experience on a day-to-day basis on hormonal birth control despite the fact that some trials were 96% effective.

How do you feel about the diva cup? What tool do you use during your period?

For me the diva cup works great! I think from a sustainability perspective it is a wonderful option. I have used one for about a year now and my roommate has used the same one for close to three years. Some women who would prefer to “free bleed” more might opt for period underwear or reusable pads if they are trying to minimize the waste output related to their period.

Can you debunk the “cherry” myth about the hymen? (That it acts as a “freshness seal”)

The idea of checking someone’s hymen is pretty much a load of bullshit. First off a hymen can be broken for any number of reasons unrelated to sex; biking, gymnastics, horseback riding, masturbation ect. Some womxn aren’t even born with a hymen in the first place. There are also cases when a hymen has been shown to reheal after it has been broken. I believe the hyper focus on the hymen tends to proliferate the idea that virginity is a "noble virtue."

Are there any natural or herbal remedies you know for period pain or balancing out the effects of birth control?

This can be a tricky thing to figure out if you are taking hormonal birth control because some of my recommendations depend on what part of your cycle you are in. In most cases your cycle on HBC looks very different from a natural cycle. In general ashwagandha and macca both help with hormone balancing. Drinking red raspberry leaf tea and taking supplemental magnesium can help reduce PMS or menstruation related symptoms. If you are able to determine when you are pre and post ovulation you can seed cycle. This involves eating ground flax and pumpkin seeds while your estrogen is rising and sesame and sunflower seeds while your progesterone is rising.

What can our cervical mucus tell us? What should we be looking for?

Cervical mucus can tell us so much! Cervical mucus will typically change throughout a cycle. Sometimes a person will have little to no mucus and other times mucus will be cloudy. As ovulation approaches cervical mucus gets more eggwhite, slippy, and can often stretch greater than an inch. That being said a lot of hormonal birth control suppresses ovulation altogether so cervical mucus may not be indicative of approaching ovulation in these cases. For real life images of people’s cervical mucus check out: https://cervicalmucus.org/

Why do you think women have such little knowledge about their cycle? Why aren’t we all learning this information?

A large part of the problem is poor sex education programs and negative stigmas regarding sex-centered conversations. Parents and schools alike tend to feel that if we have open conversations about ovulation and birth control we are encouraging sexual activity (god forbid). In fact, a lack of proper sex education leads to higher rates of unintended pregnancy and STIs. It is common that people do not feel it is important to educate womxn about the intricacies of their cycles until they are trying to have a child. This is a real travesty because knowing about fertility tracking can help connect women more closely with their bodies and is an incredibly useful indication of wellbeing and health. Unfortunately, learning about fertility awareness methods is not typically taught to most traditional medical practitioners/ OBGYNs. In order to learn about these options, cycling people typically have to go to holistic OBGYNs or find a FAM specific educator.

Photo from: @ladyist

Thank you to Ali Moxley for her time and knowledge. As always, thank you to my readers for keeping this blog alive. I hope you learned something new from this interview, or that it maybe even inspired you like it did me, to take a deeper look at my body and what I put into it. <3