Selects: How The Pill Changed the World

Summary

Podcast Summary: "Stuff You Should Know"
Episode: "How The Pill Changed the World"
Release Date: December 7, 2024
Host/Authors: Josh Clark & Chuck Bryant
Production: iHeartPodcasts

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Introduction

In this compelling episode of Stuff You Should Know, hosts Josh Clark and Chuck Bryant delve into the transformative impact of the birth control pill on society, culture, and women's lives. From its controversial inception to its widespread adoption, the episode explores the multifaceted repercussions of one of the most significant pharmaceutical developments of the 20th century.

Historical Context and Early Contraception

[02:00] Josh Clark: "Back in the day, if you were a woman and you didn't want to get pregnant, you had to coordinate with your husband that he wear a condom."

Before the introduction of the pill, women's contraceptive options were severely limited and often unreliable. Methods ranged from folk remedies and herbal douches to early gynecological aids, many of which were ineffective or even harmful. Social norms dictated that only single men were generally permitted premarital sex, placing the burden of contraception solely on women.

Margaret Sanger and the Birth Control Movement

[07:08] Josh Clark: "Margaret Sanger pioneered the birth control movement and coined the term 'birth control' in 1912."

Margaret Sanger, a nurse and early advocate for women's reproductive rights, envisioned a "magic pill" to prevent conception. Despite her controversial views, including ties to the eugenics movement, Sanger's efforts laid the groundwork for the development of hormonal contraception. Her collaboration with philanthropist Mary Katherine McCormick provided the necessary funding to pursue scientific advancements.

Scientific Breakthroughs: Progesterone and Estrogen

[08:19] Josh Clark: "Dr. Russell Marker discovered how to synthesize progestin from wild yams in 1941, making the pill more affordable and accessible."

The identification and synthesis of progesterone and estrogen were pivotal in creating effective hormonal contraceptives. Initial formulations were animal-derived hormones, but advancements led to synthetic versions that reduced side effects and improved usability.

Development and Clinical Trials

[09:46] Hoda Kotb: "Clinical trials in Puerto Rico and a women's mental asylum in Massachusetts were conducted without informed consent."

The collaboration between Sanger, McCormick, Gregory Pincus, and Dr. John Rock faced numerous ethical challenges. Conducting trials in Puerto Rico, where regulatory oversight was lax, allowed for rapid testing but raised significant ethical concerns regarding informed consent and exploitation.

FDA Approval and Market Introduction

[11:22] Josh Clark: "Searle's discovery that women were using the pill off-label for contraception led to its formal FDA approval in 1961."

Despite initial skepticism about women's willingness to adopt daily pills, the contraceptive pill quickly gained popularity. By its first year, 1.2 million American women were using it, marking a monumental shift in reproductive autonomy.

Health Concerns and the Rise of Informed Consent

[13:01] Hoda Kotb: "Barbara Seaman's 1969 book, The Doctor's Case Against the Pill, highlighted severe side effects and sparked Senate hearings."

Health issues, including hypertension, blood clots, and increased cancer risks, emerged as significant concerns. The backlash led by activists like Alice Wolfson during Senate hearings in 1970 catalyzed the movement for informed consent in the pharmaceutical industry.
[15:58] Hoda Kotb: "Informed consent was literally born that day, forever changing the pharmaceutical landscape."

The Pill as a Cultural Icon and Symbol of Patriarchy

[16:36] Josh Clark: "The pill transitioned from a feminist icon to a symbol of medical patriarchy, emphasizing the importance of patient autonomy."

While the pill empowered women with reproductive control, it also became entangled in broader societal and political struggles, reflecting tensions between feminist movements and established medical authorities.

Understanding the Menstrual Cycle and the Pill's Mechanism

[21:44] Hoda Kotb: "The pill manipulates the menstrual cycle by maintaining consistent levels of synthetic hormones, preventing ovulation."

Hosts Josh and Hoda provide a detailed explanation of the menstrual cycle, illustrating how the pill interrupts natural hormonal fluctuations to prevent pregnancy.
[27:14] Hoda Kotb: "The pill hijacks the entire process synthetically, keeping hormones steady to stop ovulation."

Types of Birth Control Pills

[42:18] Hoda Kotb: "There are three main types of oral contraceptives: combination pills, progestin-only pills, and extended-release pills."

1. Combination Pills: Contain both estrogen and progestin; the most commonly prescribed.
2. Progestin-Only Pills (Mini Pills): Suitable for breastfeeding women and those sensitive to estrogen.
3. Extended-Release Pills: Designed to reduce the frequency of periods, with formulations allowing for four periods a year or even continuous use.

Controversies and Ethical Implications

[46:30] Hoda Kotb: "The Black Power movement criticized the pill as a tool of population control, citing unethical sterilizations of Black women."

The episode addresses the darker aspects of the pill's history, including its use in controlling minority populations and the lack of informed consent in clinical trials.
[48:37] Josh Clark: "Anti-abortion groups argue that the pill acts as an abortifacient by preventing a fertilized egg from implanting."

These ongoing debates highlight the pill's complex role in societal and ethical discussions surrounding reproductive rights.

Modern Day Implications and Future Considerations

[50:07] Hoda Kotb: "There are no long-term studies on menstrual suppression from oral contraceptives, raising questions about future health impacts."

The hosts discuss the need for comprehensive research on the long-term effects of hormonal contraceptives, especially as newer formulations aim to further alter traditional menstrual patterns.
[46:08] Josh Clark: "The pill is so much larger than just birth control; it's intertwined with cultural, political, and health narratives."

Conclusion

Josh Clark and Chuck Bryant conclude by reflecting on the pill's enduring legacy. While it has undeniably provided women with unprecedented control over their reproductive lives, it remains a topic of significant ethical and health-related debate. The episode underscores the importance of informed consent and ongoing scrutiny in the development and distribution of pharmaceutical interventions.

Notable Quotes

• Josh Clark [03:22]: "The pill is monumentally huge as far as pharmaceuticals and medicine go."
• Hoda Kotb [13:59]: "These hearings were run only by men, with witnesses all men, until Alice Wolfson and the DC Women's Liberation Group blew it up."
• Josh Clark [15:16]: "Informed consent was literally born that day."

Further Resources

For listeners interested in exploring the history and impact of the birth control pill in more depth, resources such as howstuffworks.com and the American Experience series on PBS are recommended.

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This episode provides an insightful exploration of how the birth control pill has shaped modern society, offering listeners a comprehensive understanding of its benefits, controversies, and lasting influence.

Transcript

[Savannah Guthrie]

All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Partisan.

[Hoda Kotb]

Partisan.

[Savannah Guthrie]

It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites, too. I just got it for 50 off. So how about a Cosmopolitan or a Mistletoe margarita?

[Hoda Kotb]

I'm thirsty.

[Savannah Guthrie]

Watch. I just pop in a capsule, choose my strength, and wow, it's beginning to.

[Hoda Kotb]

Feel more seasonal in here already.

[Savannah Guthrie]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Hoda Kotb]

Tis the season to be jollier.

[Unknown]

Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker Bartesian. Pick up your phone and shake it to get $50 off any cocktail maker. Yes, you heard me. Shake your phone and get $50 off. Don't delay.

[Chuck Bryant]

Hi, everyone. It's Savannah Guthrie and Hoda Copy from the Today Show. Nobody does the holidays like Today.

[Josh Clark]

From festive performances and great gift ideas.

[Chuck Bryant]

To tips for the perfect holiday feast, join us every morning on NBC and make today your home for the holidays.

[Hoda Kotb]

Hey, everybody, here's Chuck. This week on a Saturday with a pretty relevant topic these days. Who knew that it would be relevant again? And this is from June 19, 2018, how the pill Changed the World. I think you know what pill we're talking about.

[Chuck Bryant]

Welcome to Stuff youf Should Know, a production of iHeartRadio.

[Josh Clark]

Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W. Chuck Bryant. And there's the ghost of Jerry Roland, the Empty Chair.

[Hoda Kotb]

How do you feel about this?

[Josh Clark]

Thanks again to Ramsay.

[Hoda Kotb]

Yeah, thanks, Ramsay.

[Josh Clark]

How do I feel about this? I feel great. The pill is. It has everything. This might be. I just love this episode already.

[Hoda Kotb]

I do, too. But I kind of like when we did the female puberty episode. I just feel nervous.

[Josh Clark]

It's gonna be fine.

[Hoda Kotb]

Dude's explaining female reproduction. I just. I don't know.

[Josh Clark]

Hey, man, we're just explaining stuff.

[Hoda Kotb]

I know, I know.

[Josh Clark]

It's not like we're just explaining stuff. Just be cool.

[Hoda Kotb]

All right, so let's talk the pill.

[Josh Clark]

Yeah. The opposite of having kids.

[Hoda Kotb]

The pharmaceutical so famous that it's called the pill.

[Josh Clark]

It is. I read this New Yorker article about a book on the birth of the pill, and now I'm talking about it. So everything Comes full circle. And they were saying, like, there's like, you don't call anything else the pill. Like Viagra is not the pill. It's the little blue pill. Antibiotics isn't the pill. You don't call it the vacuum or the meat grinder. Right. Like, there's really nothing like that. Yeah, nothing compares to it. And it's for good reason. I mean, the pill is monumentally huge as far as pharmaceuticals and medicine goes. Culture on the scale of antibiotics, easily.

[Hoda Kotb]

Yeah. And it's the very first medication that was designed for a non therapeutic purpose too. Yes, very interesting.

[Josh Clark]

And so it's really difficult to overstate how much of an impact the pill had when they released it in, I think, 1960s when it first.

[Hoda Kotb]

Are we going to do history first?

[Josh Clark]

Yeah, let's.

[Hoda Kotb]

All right, let's do that.

[Josh Clark]

So let me set the stage for you, please.

[Hoda Kotb]

Ooh, you're bringing a couch out.

[Josh Clark]

Back in the day, I'm gonna do my Charles Nelson Riley one man show impression. Back in the day, if you were a woman and you didn't want to get pregnant, you had to coordinate with your husband that he wear a condom. Okay, sure.

[Hoda Kotb]

Or boyfriend.

[Josh Clark]

Well, that's like a whole other kettle of fish at this time. Yeah, supposedly socially, that went on all the time. There's plenty of premarital sex, but socially speaking, only single men were allowed to have premarital sex. Which is like, who are they having premarital sex with then? Right. If they're the only ones allowed to have premarital sex, Considering everyone refused to officially recognize homosexuality even existed.

[Hoda Kotb]

Yeah, I know where you're getting.

[Josh Clark]

Okay, so there's a lot of double standards, a lot of repression going on. But if you were a woman and you wanted to have sex, so whether it was with the guy you were having sex with or your husband, you basically had to say, you gotta wear a condom. And if you said no, well, you were SOL one way or another, either you weren't having sex or you're gonna have sex without a condom. And if that happened, there was a really good chance that you were going to end up getting pregnant just from having sex.

[Hoda Kotb]

Yeah. The ball was entirely in the man's court and women did not have much say in the matter.

[Josh Clark]

No, they didn't. There were a couple of things on the market. So before the Industrial revolution, there were like folk remedies where you could use herbs and stuff like that. Basically, I think they're called herbal douches, where you're just like squeezing stuff in there and Hoping for the best.

[Hoda Kotb]

Right.

[Josh Clark]

And then by the depression, there's something. There's a whole line of stuff called gynecological aids, or feminine hygiene, I think is what it was called. And some of them worked. Some of them kind of worked. Some of them didn't work. Some of them worked, but would kill you or give you chemical burns. There was a lot of problems. So you didn't have a lot of options. Right. And then along with the fact that you actually didn't have that many Options Socially in 1950, 30 states and the federal government said you can't have anything that can be used as a contraceptive, and you can't even learn about it from your doctor or from school. Thirty states in the federal government. This is 1950. Ten years later, the pill comes out. And a couple of Years after that, 5 million American women are using it as contraception. And now it was in their hands. They had the ability to decide for themselves whether sex led to pregnancy or not.

[Hoda Kotb]

Well. And sort of even then.

[Josh Clark]

Right.

[Hoda Kotb]

Because not all states allowed it and not all doctors would give it out. So it wasn't like, oh, FDA said, it's good to go so we can all get it.

[Josh Clark]

Right.

[Hoda Kotb]

It was still a fight for years and years and decades.

[Josh Clark]

It really was.

[Hoda Kotb]

So I guess we should start with a woman named Margaret Sanger. She is a very controversial figure. Founder of Planned Parenthood, She's a nurse, and she wrote in 1912 about a magic pill that could prevent conception.

[Josh Clark]

Yeah. Just a theoretical, hypothetical pill.

[Hoda Kotb]

Right. And she's controversial for many reasons, not the least as. Which is her. She was anti abortion, kind of when she was most famous, she was anti abortion and kind of went all in on the pill and was like, this is the way to do it is to prevent the pregnancy once you're pregnant. Sorry.

[Josh Clark]

Well, gotcha.

[Hoda Kotb]

And then, you know, there's the whole eugenics thing. We should do a podcast on her. Probably at some point we should. Cause that's a rabbit hole right there.

[Josh Clark]

Yeah. So. But she was the early champion of it. She coined the term birth control, and I think 1912 as well.

[Hoda Kotb]

Yeah. So in 1914, she started a newsletter called the Woman Rebel. That's where birth control was first typed out and distributed the words, like you said. And then in the 1920s, some breakthroughs happen in science where they were able to identify progesterone and estrogen and realize kind of how it all worked.

[Josh Clark]

Yeah. So at first they were looking at this stuff as fertility drugs, and then they noticed that it actually could suppress Fertility. And as they were. I think this was in the 40s when they were really starting in earnest. Or is it the 20s?

[Hoda Kotb]

Well, I mean, they were synthesizing it from animals, and it was in early 1941.

[Josh Clark]

I don't think they were even synthesizing it. I think they were extracting it. And then that's. What you got in your pill was animal hormones.

[Hoda Kotb]

Well, it says synthesize from animals, so maybe it was a process.

[Josh Clark]

Gotcha.

[Hoda Kotb]

But eventually, in 1941, Dr. Marker. Dr. Russell Marker. I just said it like James Bond. For some reason, he discovered how to synthesize the synthetic form of progesterone, which is called progestin, and that really. This is from wild yams, believe it or not. So he did that, and that changed everything.

[Josh Clark]

It did. It made it cheaper, it made it easier to obtain.

[Hoda Kotb]

You could research all of a sudden, right? Yeah.

[Josh Clark]

But you still couldn't really research. Right. Because there were laws on even doing research on birth control. So the people who were doing this, it started out as Margaret Sanger. She hooked up with a doctor named Pincus and Gregory Pincus, who was a biologist, and he was interested in coming up with birth control as well. Mary McCormick was her first name.

[Hoda Kotb]

Mary Katherine. Katherine McCormick, of the McCormick, I guess the spices. Right.

[Josh Clark]

Okay. So she lent a tremendous amount of her wealth to this research. And then a guy named John Rock, who was a doctor who was also working on a birth control pill. They all joined forces in the 1950s and started working on this really hard. But they had a lot of roadblocks up against them, and they cut a lot of corners in getting this thing out into market.

[Hoda Kotb]

Yeah. Like going to Puerto Rico because they had to for trials.

[Josh Clark]

Right. And so this is not like Puerto Rico was like, we don't want this, but you're forcing it on us anyway. Puerto Rico had the exact opposite attitudes toward birth control that the United States did at the time. So it was a good place to do it. They just didn't inform anybody what was going on with this, that this was a clinical trial. They just gave them some pills and said, here, take these. It'll keep you from getting pregnant.

[Hoda Kotb]

Yeah. Which they kind of came about by accident. Some of the pills were contaminated with estrogen, and they use that in scare quotes, I guess, just because what they really mean is mixed by accident. And that reduced a lot of the side effects, because that was one of the big problems at first and continued to be for a while. And eventually they landed on a drug company called Cyril. There were Two competing ones, and the other one was Syntex and Serle. Is that how you pronounce it?

[Josh Clark]

That's what I'm going with.

[Hoda Kotb]

S E, A, R, L, E, C.

[Josh Clark]

I want to hear you say it again.

[Hoda Kotb]

Seral. They finally came up with they thought was the right formulation. And 1962 Syntex came out with their version, and then pretty soon it was being marketed and distributed after FDA approval in 1961.

[Josh Clark]

So. Yeah. So Cyril was the one who hooked up with Sanger and Rock. Yeah, and they were the ones who provided the pills for the clinical trial in Puerto Rico. There was also a clinical trial at a women's mental asylum in Massachusetts, and the patients there didn't have any informed consent. And when they released this formula, first it was for gynecological disorders, things like ovarian cysts. They knew it could be used to treat that. And Cyril, at the time, was like, they had no expectations for this whatsoever. And then within a year, there were half a million women in America who were suddenly using this for gynecological problems. And Searle figured out, well, no, they're actually using it for contraception. And so when they went and sought FDA approval and got it, that was when the floodgates opened. Like, there was now a pill on the market that could prevent contraception. That was the woman's to take. And all of a sudden, there was. The first year there was 1.2 million American women on the pill. And Searle at first thought, they're not going to want this. Women aren't going to want to take a pill every day to keep from getting pregnant. But they couldn't even finish the name pregnant before. Like, the pills were being grabbed from their hands. You know, it was a huge deal.

[Hoda Kotb]

It was. And then these pills were not very safe. That's the upshot of this. The estrogen. There was way too much estrogen. It was dangerous. It was causing cancer. And in 1969, a very famous book came out called the Doctor's Case against the Pill, written by a medical journalist named Barbara Seaman. And she got together with a bunch of doctors and researchers and women and made a case against the pill that it wasn't safe. There was a senator named Gaylord Nelson who read the book, took on birth control in Senate hearings. And in January 1970, in the Senate chamber, there was this testimony about the pill going on, of course, run only by men, all the witnesses, with only men testifying, providing witness testimony. But there was a woman there named Alice Wolfson and her group, the D.C. women's Liberation Group, they were sitting there just getting more and more steamed.

[Josh Clark]

Yeah. In these hearings at this time, these hearings were kind of under the radar.

[Hoda Kotb]

Right.

[Josh Clark]

Until Alice Wolfson, like, blew it up.

[Hoda Kotb]

C SPAN wasn't a thing yet.

[Josh Clark]

Right.

[Hoda Kotb]

So they were just getting more and more steamed watching all these men get up there and talking about women's reproductive health.

[Josh Clark]

But not only that, they were also. These people were talking about how. How dangerous the side effects were with the pill.

[Hoda Kotb]

Sure.

[Josh Clark]

Hypertension, blood clots, heart attacks, high blood pressure, stroke, all of these things. And the women in the D.C. women's Lib movement, including Alice Wolfson, were like, we've never heard this before in our lives. How did our doctors not tell us this?

[Hoda Kotb]

Well, that was the backstory, is that none of the doctors were sharing this information because they were getting. And I think there's always been a problem, not across the board, but with doctors and pharmaceutical companies pushing certain drugs over others.

[Josh Clark]

But at the time, it was way worse than it is now. Like, there was no disclosure. Yeah. There was a mentality among doctors, male doctors, who believed that if you. A woman was better off not knowing, you didn't want to get her all upset by giving her all the information.

[Hoda Kotb]

They didn't even have side effects listed.

[Josh Clark]

Right. And if you did tell her, you ran the risk since women were so suggestible, she might develop a stroke just by thinking about it so much. So it was better off just not telling her about it.

[Hoda Kotb]

Yeah, exactly.

[Josh Clark]

That was the entire medical establishment at the time. And so the pill went from this feminist icon in the 60s to, by 1970, becoming an iconic for white male patriarchy, medical patriarchy, and how patients. Informed consent was a paramount issue now. And it just took on this other role.

[Hoda Kotb]

Well, and informed consent was literally born that day. At that hearing, they finally heard an expert say, estrogen is to cancer, what fertilizer is to wheat. And Alice Wolfson stood up and started screaming. She was screaming, why are you using women as guinea pigs? Why are you letting drug companies murder us for profit and convenience? And it got a lot of media attention. And really the aftermath of those hearings is when this consumer health movement started and they started informed consent. They started having to list side effects on bottles. And, you know, it wasn't an overnight thing, but it really changed the pharmaceutical industry forever.

[Josh Clark]

Right. So the pill managed to accept this, I guess, iconography.

[Hoda Kotb]

Right.

[Josh Clark]

It became a symbol for this other thing.

[Hoda Kotb]

Yeah.

[Josh Clark]

But still managed to keep on keeping on. Like. Like, I think 18. So 87% of women between 18 and 49 in the US followed those hearings once Alice Wolfson and the DC Women's Lib Movement made it a national thing, And I think 18% of them stopped taking the pill as a result. But the pill really didn't fall out of popularity. It stood in as the icon for informed consent. And then just after that was established, it just went back to being the pillow. I think that's amazing. It is, because it was this huge thing in 1960 for one thing, huge thing in 1970 for another thing. And now it's part of the cultural zeitgeist forever.

[Hoda Kotb]

Should we take a break?

[Josh Clark]

Yes.

[Hoda Kotb]

All right. We're going to take a break. We're all excited about history, and now we're going to get into science.

[Savannah Guthrie]

All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and pared all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Partisan.

[Hoda Kotb]

Partisan.

[Savannah Guthrie]

It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites, too. I just got it for 50 off. So how about a Cosmopolitan or a Mistletoe margarita?

[Hoda Kotb]

I'm thirsty.

[Savannah Guthrie]

Watch. I just pop in a capsule, choose my strength and wow.

[Hoda Kotb]

Beginning to feel more seasonal in here already.

[Savannah Guthrie]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Hoda Kotb]

Tis the season to be jollier.

[Unknown]

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[Hoda Kotb]

Hey, let's talk menstrual cycles.

[Josh Clark]

All right, let's man.

[Hoda Kotb]

Because that's all that's going on here is the pill manipulates the menstrual cycle by tricking the body with synthetic hormones.

[Josh Clark]

Yes, it tricks the body into thinking it's already released an egg.

[Hoda Kotb]

It's pretty brilliant.

[Josh Clark]

It is, it is. But it's also kind of lo fi. If you think about it, it is very low fi. That's neat. So we should kind of give you an idea of what the menstrual cycle is, right? It's 28 days generally. Yes, that's the rule of thumb. But yes, it's certainly different it's different for everyone. And I think it's also down to like hours and stuff like that too. It's not just days, it's a human construct. But have you stopped and ever thought about how interesting it is that the cycle of the moon is 28 days as well? No, I think it's fascinating.

[Hoda Kotb]

Oh, no, I didn't say it wasn't fascinating. I never stopped it.

[Josh Clark]

Just in researching this, I was like, that's the cycle of the moon as well. Huh, that's interesting. So anyway, over the, say, roughly 28 day period, the whole thing starts with the pituitary gland getting a little froggy and saying, hey, I'm going to release some follicle stimulating hormone.

[Hoda Kotb]

Fsh.

[Josh Clark]

And that stuff floods the body and it makes its way down to the ovaries and it stimulates follicles, hence the name.

[Hoda Kotb]

That's right. It makes these follicles in the ovaries grow and it just sets off a big series of events. Basically, estrogen triggers that pituitary gland again.

[Josh Clark]

Yeah. Because the follicles then in turn release estrogen. Right?

[Hoda Kotb]

Yeah. And so the pituitary gland is busy because then it secretes what's called gonadotropin releasing hormone. G, little N, big R, big H.

[Josh Clark]

One of the better abbreviations ever.

[Hoda Kotb]

Yeah. Because it looks sort of like Guns N Roses a little bit.

[Josh Clark]

Yeah. Oh, that is why I like that.

[Hoda Kotb]

Gnr H. And that triggers a rise in luteinizing hormone. Lh.

[Josh Clark]

Right. And so luteinizing hormone goes back down to the ovarian follicles and it gets one of the follicles. So if you have a bunch of ovarian follicles growing, one of them is going to. Clearly, it's the lead horse, right?

[Hoda Kotb]

Yeah.

[Josh Clark]

And it's going to develop into an egg. And as the luteinizing hormone stimulates it to develop into an egg, the egg pops off. The rest of the other follicles wither and die. And then the egg travels down the fallopian tube where it may or may not be fertilized.

[Hoda Kotb]

Yeah. This is called ovulation. And while this is going on in the background, the uterine lining, the endometrium, is thickening up.

[Josh Clark]

Right.

[Hoda Kotb]

It's getting ready for business.

[Josh Clark]

And the reason that is is because the estrogen and the luteinizing hormone are causing that to happen.

[Hoda Kotb]

Yeah, they're just rising and rising.

[Josh Clark]

So the mucus in the vagina, I'm saying, like even more than usual right now, but the mucus in the vagina also does it thicken.

[Hoda Kotb]

Yeah.

[Josh Clark]

So it thickens. Is that after the egg has been fertilized? Because I think it would make it. It would become. Okay, so it de. Thickens. The uterine lining thickens. I think the vaginal mucus makes it easier for sperm to make its way thick.

[Hoda Kotb]

Yeah, yeah. Correct.

[Josh Clark]

Okay.

[Hoda Kotb]

Sorry about that.

[Josh Clark]

So if all that goes according to the genetic plan, then those sperm are going to make their way to an egg. The egg's going to become fertilized. It's going to come down the fallopian tube attached to the. And it's going to start to grow into a child.

[Hoda Kotb]

Correct.

[Josh Clark]

It might also not happen. Either the woman involved might not have sex. So there might be no sperm. The sperm might not make it. There might be some sort of barrier method being made, being used, or the.

[Hoda Kotb]

Dude may have bad sperm.

[Josh Clark]

Sure. Regardless of how this happens, if the egg is not fertilized, the egg eventually withers up itself and dissolves. And that thickened endometrium is shed. Basically, yeah.

[Hoda Kotb]

The uterine lining is shed.

[Josh Clark]

Yes. So in the form of like kind of iron rich blood tissue.

[Hoda Kotb]

Right.

[Josh Clark]

Okay.

[Hoda Kotb]

That is menstruation.

[Josh Clark]

That's menstruation. So when you think of. But that's your period.

[Hoda Kotb]

Yeah.

[Josh Clark]

The whole thing's menstruation?

[Hoda Kotb]

Well, yeah.

[Josh Clark]

Okay. It's like a 28 day cycle is menstruation. Because I always think of like. Yeah, the period's menstruation. No, that's actually the end of menstruation. And then the whole cycle cycle begins again. Right after that time, the pituitary gland's like, oh, all right, I'll release some follicle stimulating hormone. The whole thing begins again. The pill interrupts this by making the body think it's already released an egg. Like when the egg comes off of the follicle and makes its way down to the fallopian tube, the ovum makes its way down the fallopian tube. That's when the estrogen and the progesterone levels are high. Okay. So the pill introduces progesterone and estrogen levels and keeps them high at all times. And therefore the body stops releasing eggs because it thinks it's already released an egg.

[Hoda Kotb]

Yeah, it just hijacks that whole process synthetically.

[Josh Clark]

Yep.

[Hoda Kotb]

The woman's body is amazing.

[Josh Clark]

It is.

[Hoda Kotb]

When you think about all that's going on.

[Josh Clark]

Yeah. Our body's not doing anything even remotely like that. It's making, like, farts.

[Hoda Kotb]

That's what I thought when I was researching this. I was like, Man, I've never felt less important. And, like, the insides of my body are just. I got some lungs doing some things, I got a heart. And then like, I guess I'm still making sperm. I don't even know.

[Josh Clark]

I've got like a wheezy old donkey running the show in there, kind of dirty.

[Hoda Kotb]

Oh, goodness. So the endometrium still builds up in the uterus and is released, but it's known as a withdrawal period. So this is if you're on the pill. But that's why your period while on the pill is going to be generally lighter and shorter.

[Josh Clark]

Yeah. And so technically, the pill mimics the structure called the corpus luteum, which is the thing that releases progesterone and estrogen once an egg is released. So the body's like, oh, the corpus luteum's got it going on. I don't need to release another egg. I also am not going to have a period because during this time after the pillow, those hormone levels start to become like a normal baseline in the woman's body. There's no endometrium that builds up and therefore there's no endometrium to shed.

[Hoda Kotb]

Right. And I don't think we mentioned this yet. Progestin, which is the synthetic progesterone, it's gonna make that vaginal mucus thicker. So you were right earlier. It is thinner to make the sperm make it excess the eggs easier. It will thicken up that mucus to make it harder for the sperm. So it, I think it's just sort of like a one, two punch to make it even harder to get pregnant. Although you can still get pregnant usually due to misuse of the pill, because what you do is you take the pill at the same time every day. It's all very synchronous and depends on that timing. And if you don't time it out right, your chances of getting pregnant are a little bit more. But apparently if you're taking it exactly right at the same time, then your failure rate is going to be 0.3%.

[Josh Clark]

Right.

[Hoda Kotb]

So it's still technically possible.

[Josh Clark]

Yes, it is 0.3% possible.

[Hoda Kotb]

Which offers up the question, like, why? Like when they were developing the pill, they had it completely in their control as to what they wanted to do with the menstrual cycle. And they decided, and I never knew this, it's very interesting, they decided to keep it on that 28 day cycle because for a lot of reasons, they thought the rock thought the Catholic Church, because he was a Catholic. They might Be more willing to approve it if it seemed more natural, I guess.

[Josh Clark]

Right. He was way off there.

[Hoda Kotb]

They thought. Way off. He thought that women would be more apt to take it if it didn't seem like it was disrupting things too much. Like I'm still in my regular cycle.

[Josh Clark]

Right. Because you do have that withdrawal period. It's not an actual real period, but it does come at the end of the pill cycle.

[Hoda Kotb]

Yeah. But they could have gotten rid of the period altogether.

[Josh Clark]

Right. And a lot of people are like, well, go do that. And there are pills on the market that we'll talk about that do take away women's periods. There's others that put them at different spaces of the amount like four times a year or something like that. And people started looking into this and they're like, well, wait a minute, shouldn't women be having periods? And the answer is not necessarily. Right.

[Hoda Kotb]

Yeah. I mean, it's controversial for sure.

[Josh Clark]

If you're not ovulating, you technically don't have to have a period. And this Molly Edmonds wrote this really interesting pill. Good old Molly article. Like is a Period Necessary? I think is what it's called.

[Hoda Kotb]

And because women today have many more periods than our ancestors.

[Josh Clark]

Right. Something on the order of like 450 periods over the average woman's lifetime.

[Hoda Kotb]

Yeah. About three times as many as our ancestors did.

[Josh Clark]

Yeah. So like back in hunter gatherer, pre, pre agricultural, women had about 160 or something. Right. And that was because they had more kids, they breastfed longer.

[Hoda Kotb]

They didn't live as long.

[Josh Clark]

They didn't live as long. Yeah. And so some people make the point like, well, women are having more periods than ever before and the body wasn't meant for this. It's actually kind of rough on the body to have a period. Like when the ovum pops off of the fallopian tube, it leaves a scar on the ovary. And that scar has to be repaired. And to repair, the cells in the OV have to divide. And as long as they divide correctly, that damage will be repaired. If they divide incorrectly, that damage can turn into ovarian cancer. So that's a problem with it. There's also scarring with shedding of the endometrium. Like actually having your period itself can leave scarring. Same deal, right?

[Hoda Kotb]

Yeah. And I think. Does an iron deficiency come into play?

[Josh Clark]

So that's actually a benefit of having a period.

[Hoda Kotb]

Oh, is it?

[Josh Clark]

You get rid of excess iron, which can lead to cardiovascular disease.

[Hoda Kotb]

Well, Anne, there are a couple of weeks during the menstrual cycle where women have a lot. A significant reduction in blood pressure. So during the years, you know, their reproductive years, at least they are at, I guess, a slightly lower risk of stroke and heart attack.

[Josh Clark]

I think like 10% lower.

[Hoda Kotb]

Yeah. Well, that's not bad.

[Josh Clark]

No, not at all. So there's pros and there's cons to having a period. The thing is, and this is what Molly ultimately points out is we actually don't know if a period is necessary. Like, the pill is still relatively new. And I think she quoted a doctor in there, Dr. Susan Rothko, I think, or Roco, and she called the pill that does away with periods entirely the greatest unregulated medical experiment of all time.

[Hoda Kotb]

Yeah.

[Josh Clark]

And. But she makes a chilling point, like we don't really know what the side effects are yet because all of this is too new, especially the pill that does away with the period altogether.

[Hoda Kotb]

Well, yeah. And they haven't done. There are no long term studies of menstrual suppression from oral contraceptives. At least they don't know about what that means for a woman. They don't know because most of this testing is done for women over 18. So they don't know what it means for women under 18 at all because they're just not involved in the research. Even though they do have research that shows about two thirds of women would get rid of their period if they could do so safely. Because, I mean, we haven't even mentioned PMS or ppmd, which is just. Isn't that like a really, really severe form of pms?

[Josh Clark]

Yes, it's like much worse.

[Hoda Kotb]

Yeah.

[Josh Clark]

Yeah. Whereas, like, PMS is not a picnic to begin with. This is like, go to the hospital bad, right?

[Hoda Kotb]

Can be at least.

[Josh Clark]

Yeah.

[Hoda Kotb]

So, yeah, that's really interesting to think about.

[Josh Clark]

It also treats ovarian cysts. There's other uses for birth control pills too.

[Hoda Kotb]

Yeah.

[Josh Clark]

You want to take another break and get back to it?

[Hoda Kotb]

I think so.

[Josh Clark]

Okay.

[Savannah Guthrie]

All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Partisan.

[Hoda Kotb]

Partisan.

[Savannah Guthrie]

It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites, too. I just got it for 50 off, so how about a Cosmopolitan or a Mistletoe Margarita?

[Hoda Kotb]

I'm thirsty.

[Josh Clark]

What?

[Savannah Guthrie]

I just pop in a capsule, choose my strength and wow, it's beginning to.

[Hoda Kotb]

Feel more seasonal in here already.

[Savannah Guthrie]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Hoda Kotb]

Tis the season to be jollier.

[Unknown]

Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker. Pick up your phone and shake it to get $50 off any cocktail maker. Yes, you heard me. Shake your phone and get $50 off. Don't delay.

Gifting is hard, but here's a Give the gift of connection from US Cellular. Not sure what that means? Here's a slightly more specific hint. You can choose four free phones and get four lines for $90 a month from US Cellular. Your family wants new phones? How do we know? They told us. The good news is that compared to wrapping presents, you're great at getting hints. So take the hint and get them four free phones and four lines for $90 a month.

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[Chuck Bryant]

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[Josh Clark]

Okay, Chuck, where are we? We were talking about.

[Hoda Kotb]

I'm over here hanging on this cliff by my fingernails.

[Josh Clark]

I think you're doing great. Isn't he doing great, everybody?

[Hoda Kotb]

Yes. No.

[Josh Clark]

So remember, so there are side effects, both positive and negative, to taking the pill.

[Hoda Kotb]

Right.

[Josh Clark]

There's some very common negative side effects, like nausea is a big one. Weight gain.

[Hoda Kotb]

Yeah.

[Josh Clark]

Spotting, which is called breakthrough menstruation, which is where you have bleeding during the actual pill cycle, not the prescribed period cycle of the pill.

[Hoda Kotb]

Yeah. And I don't think we mentioned yet either that in the pill prescription, in that monthly dose, there are seven. Not always, but the way they designed it was there are seven placebo pills that are in there because you only take the pill for 21 days a month. But they put those extra seven pills in there to keep women on that. I guess the thinking was if they're used to taking this pill every day, they need to keep doing it. Right.

[Josh Clark]

Otherwise to keep it as a habit.

[Hoda Kotb]

Yeah. If they don't for seven days, they might forget on the eighth day. And that's bad news.

[Josh Clark]

Yeah. So that's the most common way to do it. And that's a very easy type of pill to take. Right. Because all of them are the same level of hormone. And the. The seven inert ones are usually a different color. And they come at the end of the month.

[Hoda Kotb]

Right.

[Josh Clark]

It's supposed to be easy. There's actually a recall right now of tetula. Did you see that?

[Hoda Kotb]

No.

[Josh Clark]

Tetula is made by Allergan, I think. And they recalled a lot of their pills because they put the inert ones at the beginning of the cycle accidentally.

[Hoda Kotb]

Just bad packaging.

[Josh Clark]

Yes.

[Hoda Kotb]

Oh, my gosh.

[Josh Clark]

And if you look, you can clearly see that the first, like, seven are different color. But where they're supposed to be at the end, they're at the beginning. And that is bad news if you're taking that pill. So if you have tetula, go check it right now and go get some.

[Hoda Kotb]

More yeah, but I think I interrupted you on the side effects. Nausea, headaches, breast soreness, acne, depression, moodiness, weight gain, decreased libido. And sometimes these can be, like, if you start out on the pill, it can be worse. A few cycles in, it might get better, and if it doesn't, there are different pills out there.

[Josh Clark]

There are, there's. So the. When those pills originally came out, that first formula, I think it was called, like, Inovid, that was the first one on the market, the first one by Searle. And they had 10 milligrams of progesterone or progestin.

[Hoda Kotb]

Yeah.

[Josh Clark]

And 0.15 milligrams of estrogen. And that is like a nuclear bomb pillow. Women had the worst side effects from it, like, all these side effects, like each of them a Mack truck. And they were still willing to go through it to have control of their body as far as pregnancy went. But they very quickly figured out through further research, you can do the same. And the reason they selected that is they knew that there was not going to be any ovulation with 10 milligrams of progesterone. So they figured out that you could formulate with a much lower amount of both progestin and estrogen and still get the job done. And they still do that today. I think the estrogen gets down into the micrograms and you can get like, 2.5 milligrams of progesterone in some forms of the pill.

[Hoda Kotb]

Yeah.

[Josh Clark]

And then if. So, if the pill is mistreating you, what you're saying is there are options, right?

[Hoda Kotb]

Well, yeah, There are three main types of oral. Did I say Kypes? I think I did.

[Josh Clark]

You also said Serol.

[Hoda Kotb]

There are three main types of the oral contraceptive pills now, combination pills, progestin only and extended release, which are the newest ones out there. The combination pill is the most common pill that you will get. The mini pill is the progestin only. And for some women, that's better. Like, if you're breastfeeding and you can't have the estrogen because it's going to affect your milk, you'll probably be on the mini pill. And the mini peel, it works in a couple of different ways. It makes the endometrium too thin to accept that egg and it won't allow it to attach. And again, with the vaginal mucus, it makes it too thick to allow the sperm to reach the egg. But it is a little less effective, but still effective, but a little less.

[Josh Clark]

Than the combination pill because it's Almost like a different. They're different mechanisms.

[Hoda Kotb]

Yeah. Like it's 28 active pills for the mini pill.

[Josh Clark]

Right. But rather than tricking the body into thinking it's released an egg, this is just making it hard to get pregnant.

[Hoda Kotb]

Yes, right, exactly.

[Josh Clark]

It's almost like a different kind of pill. And then there's. What's the other kind?

[Hoda Kotb]

Well, the combination pill, the most common. There's a few subtypes of that pill as well.

[Josh Clark]

Right. So there's monophasic, which is what I was talking about, where you've got 21 pills and all of them are the same dose of progestin and estrogen. And then you got the seven inert pills. And some women say, I'm not going to have a period this month. And then you just, rather than taking those seven inert pills, you just move on to the next month's 21 pills.

[Hoda Kotb]

Yes. And I believe with the monophasic, if you miss a day, you can double up the next day because it's the.

[Josh Clark]

Same amount of pills or the same level of hormones. And that's far and away the most common. There's biphasic, which has two different levels of hormones, and then triphasic has three different levels. And the point of biphasic and triphasic is they're designed to give you the absolute minimum amount of synthetic hormones that your body requires to keep from ovulating.

[Hoda Kotb]

Yes.

[Josh Clark]

Because the point is, the lower the amount of hormones you have in there, probably the better off you are, whether it's cancer risk, moodiness, who knows? You're just better off with the least amount. That does the trick.

[Hoda Kotb]

Yeah. And the kind of progestin in each of these is gonna vary, but the type of synthetic estrogen is the same. It's called ethanol estradiol.

[Josh Clark]

Eric Estrada.

[Hoda Kotb]

Estradiol. That's it. Ethanol estradiol.

[Josh Clark]

Yeah. But the progestin is the thing that differs sometimes, right?

[Hoda Kotb]

Correct.

[Josh Clark]

And depending if you're on a pill that uses one type of progestin, you can say, oh, I want to try a different type of progestin. And they'll say, here you go.

[Hoda Kotb]

And then the extended cycle, which we talked about, this is the newest one on the market and I believe. Isn't this the one that can reduce your period to a few four times a year?

[Josh Clark]

Yeah. So there's a couple of different. There's seasonal and seasonique, and they're called that because that four time a year period, you'll just be like, oh, it's fall. Oh, it's Summer.

[Hoda Kotb]

Right.

[Josh Clark]

Not in that order, but you know what I'm saying. And then there's Librel. And I'm sure there's other ones on the market too. We don't mean to buzz market or anything like that. So there's one that's like 365 days and then there's others that are 84 days. So that you have four. Either no periods at all or four periods a year.

[Hoda Kotb]

Right.

[Josh Clark]

So there you go. So there's a couple of other things I want to hit on the pill is it's so much larger than just birth control.

[Hoda Kotb]

Sure.

[Josh Clark]

I mean, just the fact that it's birth control is an enormous thing. Like you said, John Rock thought he was going to be able to convince the Catholic Church that this is an okay thing. That was not the case.

[Hoda Kotb]

No.

[Josh Clark]

In the late 60s, the Black Power movement really zeroed in on the pill, especially the men of the black power movement and said this is tantamount to black genocide. And they definitely had a case. There were plenty of cases of black women who went into hospitals and gave birth and then came out unknowingly sterilized. Like the doctor had just taken it upon himself to sterilize her after delivering her baby. So they had this evidence to back this up and it was never shown. Like, yes, there was a conspiracy to wipe out black power in America through the pill, but there were plenty of black women at the time who said, yeah, I can get birth control pills easier than anything down at the corner clinic or something like that. And even, even with the early trials from John Rock and Gregory Pincus, one of the things that they zeroed in on Puerto Rico for was because they thought that if they could show that backwards Puerto Ricans of color could learn how to take the pill regularly, it would demonstrate that women in the inner cities could, or women in developing countries could. So there was definitely like a mentality toward the white establishment being on board with the idea of at least providing the tools for other. For minorities to control their rate of birth. Right. It's just pure and simple. That was a thought of it. It was. And it's had tremendous amount of benefits too. But there was some darkness in the place that it originally came from as well.

[Hoda Kotb]

Well, yeah. And of course anti abortion groups think that the pill still to this day is an abortion causing agent. What they call an. Do you know how to pronounce that?

[Josh Clark]

Abortifacient.

[Hoda Kotb]

Abortifacient.

[Josh Clark]

I think so, yeah.

[Hoda Kotb]

I think that's right. Which, you know, that's Long been their argument.

[Josh Clark]

Well, their argument is that it makes the uterus hostile to a fertilized egg. Like prolonged use would prevent a fertilized egg that would otherwise attach from attaching. And so that's for all intents and purposes, abortion in their position.

[Hoda Kotb]

Right.

[Josh Clark]

And yeah, that is, I don't think that one settled by any stretch of the imagination. So you got anything else?

[Hoda Kotb]

I got nothing else.

[Josh Clark]

As I predicted. This is a good one.

[Hoda Kotb]

Yeah, I think it was good.

[Josh Clark]

I think it was great.

[Hoda Kotb]

I hope we did all right.

[Josh Clark]

Yeah. Because we're not like patronizing. We've never been patronizing.

[Hoda Kotb]

No.

[Josh Clark]

Might be like white dudes. But we're very much aware that we're white dudes. And let me leave you with this. White dudes, okay. If you're a white dude, whether it's in America or the west or anywhere, your one job is to have some perspective. That's your first and foremost job. Take yourself out of your own shoes once in a while. Look around, put yourself in other people's shoes. Your eyes will open widely and in.

[Hoda Kotb]

Agog, some say, walk a mile.

[Josh Clark]

Sure, why not? Get a little weight off. Right.

[Hoda Kotb]

At least go check the mail.

[Josh Clark]

If you want to know more about the pill, just type in the pill. It'll bring up some cool stuff on howstuffworks.com and there's also a really great American experience site on PBS that had a bunch of.

[Hoda Kotb]

Oh, man, that was good.

[Josh Clark]

Yeah.

[Hoda Kotb]

So good.

[Josh Clark]

And since I said American experience and Chuck said so good, it's time for listener mail.

[Hoda Kotb]

Oh, no, it's not. No listener mail today because we. We've had some milestones here lately. And as we sit here today in real time, we as a company are celebrating the 10 year anniversary of stuff you should know again. Again. But we're actually having the party today.

[Josh Clark]

Right.

[Hoda Kotb]

And on the same day, Apple announced at their wdcc. Yeah. Their developers conference got up on stage and this one kind of hit me like we had the thousand episodes. That was good. The 10 years kind of hit me in a big way. But they got up on stage today and they said that Stuff youf Should Know is now the first podcast in history. First and only to reach 500 million downloads and streams on their platform.

[Josh Clark]

Yeah.

[Hoda Kotb]

Which is. I didn't know.

[Josh Clark]

No, it hit me too.

[Hoda Kotb]

Somehow. Adam Carolla is in the Guinness Book of World's Records.

[Josh Clark]

Right.

[Hoda Kotb]

But here we are as the only one. And that's because of you all out there.

[Josh Clark]

Yes, for sure.

[Hoda Kotb]

A gazillion times. But without you. There is no us. We would have been long gone if not for your support. So we continue to give thanks.

[Josh Clark]

Thank you again. Yeah, we and we'll continue to give thanks.

[Hoda Kotb]

And we will continue to podcast.

[Josh Clark]

Yes we will, Chuck. Yes, we will.

[Hoda Kotb]

And that's all I got.

[Josh Clark]

If you want to get in touch with us, you can send us all an email the [e-mail] and as always, join us at our extraordinarily grateful home on the web stuffyou should know.com stuff.

[Chuck Bryant]

Youf should Know is a production of I.

[Savannah Guthrie]

For more podcasts, My Heart Radio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows. All right, we're all set for the party. I've trimmed the tree, hung the mistletoe, and paired all those weird shaped knives and forks with the appropriate cheeses. And I plugged in the Bartisian Bartesian. It's a home cocktail maker that makes over 60 premium cocktails, plus a whole lot of seasonal favorites, too. I just got it for 50 off. So how about a Cosmopolitan or a Mistletoe margarita?

[Hoda Kotb]

I'm thirsty.

[Savannah Guthrie]

Watch. I just pop in a capsule, choose my strength and wow, it's beginning to.

[Hoda Kotb]

Feel more seasonal in here already.

[Savannah Guthrie]

If your holiday party doesn't have a bartender, then you become the bartender. Unless you've got a Bartesian, because Bartesian crafts every cocktail perfectly in as little as 30 seconds. And I just got it for $50 off.

[Hoda Kotb]

Tis the season to be jollier.

[Unknown]

Add some holiday flavor to every celebration with the sleek, sophisticated home cocktail maker Bartesian. Pick up your phone and shake it to get $50 off any cocktail maker. Yes, you heard me. Shake your phone and get $50 off. Don't delay.

Gifting is hard, but here's a hint. Give the gift of connection from US Cellular. Not sure what that means. Here's a slightly more specific hint. You can choose four free phones and get four lines for $90 a month from US Cellular. Your family wants new phones. How do we know? They told us. The good news is that compared to wrapping presents, you're great at getting hints. So take the hint and get them. Four free phones and four lines for $90 a month. US Cellular built for us with millions.

[Josh Clark]

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[Savannah Guthrie]

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[Josh Clark]

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[Savannah Guthrie]

Dragon back is different to Ari's Whoa. When he found out there was more.

[Josh Clark]

Than one crime scene. Which is also different to Ava's Whoa.

[Savannah Guthrie]

The moment when the stable boy became a stable man. From whoa to whoa to Amazon books, that reading feeling awaits.