Podcast Summary: Culture Apothecary with Alex Clark
Episode: "Your Brain on Birth Control ... and PMS | Sarah Hill, PhD"
Date: November 14, 2025
Host: Alex Clark
Guest: Dr. Sarah Hill, Evolutionary Psychologist and Author
Overview
In this episode, Alex Clark hosts Dr. Sarah Hill, author of This Is Your Brain on Birth Control and The Period Brain. Their wide-ranging, candid discussion covers the profound and often overlooked effects of hormonal birth control and menstrual cycles on women’s brains, moods, relationships, and lives. They debunk common myths, explore why PMS is misunderstood, and advocate for a radical rethinking of women’s health that truly respects cyclical female biology rather than forcing women into a “male-shaped silhouette.” Interwoven throughout are personal stories, clinical anecdotes, and clear science-driven explanations—plus actionable advice for both women and men.
Key Discussion Points & Insights
1. How Hormones Shape Female Experience
- World Designed for Men: The conversation opens with Dr. Hill highlighting that many health and lifestyle guidelines are based on studies of men, or women only at certain points in their cycle (02:04–04:16). This male-centric bias leaves women misunderstood—especially during the luteal phase.
"Most of our ideas about what it means to be human are based on a male ideal." – Dr. Sarah Hill (02:44)
- The Luteal Phase: Often pathologized, the luteal phase is when progesterone rises. This shift impacts sleep, calorie needs, emotional sensitivity, and threat detection.
"All of those things change as we go into the season of progesterone in the luteal phase." – Dr. Hill (02:44)
2. Sexual Desire & Cycle Differences
- Spontaneous vs. Responsive Desire: Women’s spontaneous sexual desire peaks during the fertile window (days 7–14), then shifts to a more connection-driven desire during the luteal phase (04:16–07:23).
"Spontaneous sexual desire…for women tends to happen right around days five or seven to about day 14. And then after that, our sexual desire tends to be more responsive…" – Dr. Hill (06:00)
- Men's Sexuality: Men's hormones reset daily (testosterone peaks in the morning), while women’s cycle monthly, leading to fundamentally different sexual psychologies (07:27–09:46).
3. PMS: Nature or Nurture?
- Threefold Origin: PMS symptoms stem from purposeful biological changes, misinformation about women’s needs, and a toxic environmental context (10:01–15:16). For example, women need ~7–11% more calories in the luteal phase—a fact rarely taught.
"Most women are not told that…You're going to get food cravings, you're going to be tired and you're going to be grumpy…because we're not actually giving our body what it needs…" – Dr. Hill (12:35)
- Workplace Realities: Modern rigid work environments ignore women’s cyclical needs, exacerbating hormonal struggles (15:16–17:00).
4. Feminism, Medicine, and Ignoring Sex Differences
- Denial of Difference as Disservice: Earlier feminist movements sought to downplay women's biological differences, which has led to medical and social harm, such as inappropriate drug dosing (Ambien example) and greater risk of side effects in women (19:54–24:20).
"Denying sex and denying the importance of biological sex is not good for anyone, but it's especially dangerous for women." – Dr. Hill (24:20)
5. Birth Control: History, Research, and Unintended Consequences
- Origins: The pill was intended to liberate women by enabling child-spacing—albeit not initially for the kind of “free sex” later associated with it (25:54–29:15).
- Benefits and Costs: While birth control has afforded career and educational gains, it also comes with physiological and psychological costs, especially when prescribed to very young women (29:15–29:43).
"...it's so effective, has been that it has allowed women to sort of put a stake in the ground and say, I'm going to achieve this...But it just hasn't come without a cost." – Dr. Hill (28:07)
6. Birth Control, Attraction, and Relationships
- Partner Selection: Cycling hormones affect women’s attraction to traits in partners; estrogen heightens preference for testosterone-related "sexiness," while progesterone shifts focus to stable, nurturing qualities. Birth control blunts these cyclical preferences (30:16–36:58).
"When women are on hormonal birth control...it kind of taps the brakes on these preferences..." – Dr. Hill (30:22)
- Real Relationship Consequences: About 30% of women who chose their partner while on the pill become less attracted to them after quitting—sometimes leading to divorce (35:35).
"I know several people who've gone through divorces for this very reason." – Dr. Hill (35:35)
- Informed Consent: Understanding these potential shifts is vital, not to frighten but to inform women (37:02–37:33).
7. IUDs, Side Effects, and Common Myths
- Hormonal IUDs: Contrary to common medical advice, hormones in IUDs are systemic, not local—affecting the whole body and brain (51:33–53:20).
"You heard it here first. There's no such thing as a locally acting hormone." – Dr. Hill (51:33)
- Copper IUD: Less likely to affect hormones, but comes with other risks like cramping, pain, and potential (though rare) copper toxicity (54:01–55:43).
8. Mental Health, Birth Control, and the Brain
- GABA Pathways: Natural cycling releases metabolites that calm the brain (allopregnanolone/GABAergic activity). Synthetic progestins in birth control do not, possibly contributing to increased risk of depression, especially when used in adolescence (65:03–68:26).
"You know, when you use hormonal birth control, it is related to a heightened risk of developing depression and developing anxiety..." – Dr. Hill (66:53)
9. Cycle Tracking: Practical Guidance
- Simple to Advanced Methods: From counting days (period to period) to wearable tech (Oura ring, fertility monitors), women can learn more about their cycles (55:49–59:48).
"...if you actually want to track it and try to figure out what phase of the menstrual cycle you're in...I use the Oura ring, but you can use any other, you know, type of a tracking device." – Dr. Hill (55:49)
10. PMS vs. PMDD and Cycle Health
- PMDD Awareness: Extreme mood shifts before periods might indicate PMDD—a more serious, clinically diagnosable condition.
- Resilience Strategies: Nutrition, sunlight, community, and sleep can all buffer hormonal turbulence. Avoiding inflammation-promoting foods and improving sleep are critical steps (42:49–48:54).
"...instead of having your morning coffee inside, take it outside where you can get morning sunlight in your eyes..." – Dr. Hill (47:50)
11. Weight Gain, Birth Control, and the Science
- Complicated Picture: Some types of hormonal birth control (esp. progestin-only, like the Depo shot) are more closely linked with weight gain, while the pill’s effects are mixed and may vary by baseline body weight (60:16–62:42).
12. Men’s Hormones and Family Life
- Dynamic Testosterone: Men’s testosterone decreases in committed relationships and after fatherhood—an example of adaptive hormonal shifts, not pathology (76:26–78:44).
"...when men get in long term relationships, they take their foot off the gas pedal of testosterone a little bit. So testosterone levels fall down a little bit when men get into long term relationships." – Dr. Hill (76:32–78:44)
13. Redefining the Conversation—Advocacy for Women
- Call for Tailored Approaches: Dr. Hill advocates for medicine, nutrition, and health advice that acknowledges unique hormonal needs, empowering women through information and self-understanding (79:34–81:28).
Notable Quotes & Memorable Moments
-
On feeling fully alive off the pill:
"It was about three months later and I was just like, what was I missing? ... I just felt so much more alive...Everything had so much more dimension and amplitude."
– Dr. Hill (71:50) -
On the effects of birth control on sexual orientation:
"I've heard every different pairing that you could possibly have where they went on or off of it, and it nudged them either into or away from bisexuality...hormones don't have sledgehammer effects. They have nudging effects."
– Dr. Hill (73:40) -
On sex differences and medical research:
"...8 out of 10 new prescription drugs are pulled from the first year on a market because of...unanticipated side effects in women. 80%. Right. And this is because women aren't being studied in equal numbers... Denying sex and denying the importance of biological sex is not good for anyone..." – Dr. Hill (24:20)
-
On advice to men about women pre-period:
"Safety and security are going to be primary concerns... ask: are you feeling unsafe? Are you feeling insecure? ... Also, sexual desire is cyclical."
– Dr. Hill (40:15–42:26) -
On her “remedy” for a sick culture:
"Recognizing our humanity...having a little bit of grace and just recognizing that all of us are human."
– Dr. Hill (83:03)
Timestamps for Important Topics
- Introduction of Dr. Hill & Episode Theme: 00:48–02:04
- Luteal Phase & Women’s Health Research: 02:04–04:16
- Sexual Desire Trends Across Cycle: 04:16–07:23
- Expert Explanation—Men’s vs Women’s Hormone Cycles: 07:53–09:46
- Three Causes of PMS: 10:01–15:16
- Working Women & the Cycle: 15:16–17:00
- Feminism, Medicine, and Side Effects: 19:54–24:20
- History and Intentions of the Pill: 25:54–29:15
- How the Pill Affects Attraction & Relationships: 30:16–36:58
- Real Divorce Stories from Post-Pill Relationships: 35:35
- Hormonal & Copper IUDs—Systemic Effects: 51:33–55:43
- Mental Health Risks & Teens on Birth Control: 65:03–68:26
- Cycle Tracking 101: 55:49–59:48
- Advice for Men Supporting Partners: 40:10–42:26
- PMDD, PMS & Self-Care: 42:49–48:54
- Men’s Hormones through Life Stages: 76:26–78:44
- Advocacy for Women's-Centric Medicine: 79:34–81:28
- Favorite Remedy for Healing Culture: 83:03
Final Thoughts
This episode is essential listening for anyone seeking a nuanced, honest, and actionable understanding of women’s hormones, brain health, sexuality, and true empowerment. Dr. Hill rigorously and compassionately dismantles the myths around birth control, PMS, and female biology—equipping women (and men) with the science and vocabulary to advocate for real bodily autonomy, informed consent, and a society where women’s cyclical needs are recognized and respected.
Resources:
- Dr. Hill’s books: This Is Your Brain on Birth Control & The Period Brain
- Website: SaraEHill.com
- Mentioned apps: 28 Wellness, Flow, Natural Cycles, Oura Ring
Recommended for all—women, partners, and anyone invested in women's health.