- As a 36 year old female,
I've been on birth control for
at least 10 years if not more.
And, when I had to switch over
to a Progesterone-only oral contraceptive,
boom! in like two months,
I have dark,
if I didn't have makeup on
you'd see dark splotches all along here.
I wanted to create this series
all about hormones.
Because, I personally have been struggling
with my own for a few years now.
And by being pushy,
asking a lot of questions
and seeing a lot of specialists,
I've learned so much.
But I wanted you to learn from it too.
So that you don't have to go through what I did.
And, that's where the idea for this series was born.
Now, in order for you to understand my situation,
I'm gonna have to take you back a couple of years
to the Christmas of 2018.
Now, Sean and I were headed back to Washington.
Which is where we are right now.
To visit my family for the holidays.
And, the day before my flight,
my mom called me.
And, just like anything I assumed
she was telling me to make sure
I packed an extra jacket,
or bring this or that.
But, she actually called to tell me that my grandmother
had been rushed to the hospital.
Because, she had had a series of small strokes.
She didn't know much more than that at the time.
But, we quickly learned
that my grandmother
was gonna make a full recovery.
Thank God.
However, she did have to have surgery on her carotid artery.
That's the one in your neck.
To clear it all out.
Because, she has what is called
Leiden Factor V.
Which I'm sure you're not familiar with.
And, it's really just a blood clotting disorder,
caused by a mutation of the protein in the blood.
The surgery goes great.
And, my grandma is released on Christmas day.
Now, Sean and I go to pick her up.
And, her doctor asks if I'm a blood relative of hers.
And when I tell him that I'm her granddaughter,
he asks if I've been tested for Leiden Factor V.
Well, I hadn't.
And, he is extremely shocked and worried.
And tells me to do it immediately.
Now, I'm gonna be completely honest with you here.
I didn't do it right away.
I was 35 at the time
and I hadn't had any issues.
And I was kind of scared to even know.
Ignorance is bliss, right?
Well, not really.
And so about eight months later,
I go in for my yearly physical,
which you all should do.
And, I ask to be tested for it.
And it turns out that I am a carrier
of the Leiden Factor V.
But, I still needed to be cautious
and make some changes.
And one of those,
was stopping birth control.
One of the warnings
associated with taking an Estrogen-based birth control,
is that it increases your risk of stroke.
Meaning that birth control can already
cause our blood to be hypercoagulable.
Or, in non-medical speak,
more likely to clot.
So, I immediately made an appointment
to see my gynecologist.
When I shared the results of my blood test with her,
she's also scared for me
and recommends that we try
a Progesterone-only contraceptive.
I make the switch from a Low-Estrogen birth control
to Progesterone-only one.
And well, it didn't go great for me.
I started to feel on edge, not myself.
And even Sean started to notice
and asked what was wrong.
I even went down a rabbit hole
of why someone should go off birth control.
And the history behind the creation.
And its relationship to PMDD, PMS, acne.
And of course, mental health issues.
(gentle music)
- It's very common in females.
And this is something that
we see and we treat
all the time.
Usually, I would start just by taking history
and getting a better idea of what precipitated this
and what else you have going on with your skin.
- Yeah, okay.
- Have you tried any treatments yet for the Melasma?
- No, nothing.
The Alpha Hydroxy thing
was my first attempt
for cellular turnover.
I don't really know what I'm doing.
I just know one of my girlfriends was like,
"Oh, it really helped me with
"just getting rid of age spots and stuff."
So that's why I started that.
- So if it's inflammatory
and it's a response
of your pigment
because you were in the sun,
you have UV rays.
Then you want to.
- Stay out of the sun.
(speakers laughing)
I mean, most of it
is a lot of common sense.
Stay out of the sun.
Use a physical blocker.
That's one thing that we're really big on here.
Our office is that,
you want professionals
taking care of your skin.
- Yeah.
- You know, this is something we do everyday.
I see patients.
My aesthetician Jo,
she's very accomplished.
You'll be seeing her
at some point to go over some skincare regimens.
Our physician's assistant, Brittney.
Our nurse, Tricia.
We work with skin all day.
And we know the latest research.
We know the latest products.
And for example,
like the Alpha Hydroxy Acids that you're using,
they're probably making it worse.
- Because Melasma is,
usually it's thought to be
some type of inflammatory response.
- It's ironic 'cause
as a mental health professional,
I'm always telling people,
"Don't diagnose yourself.
(Dr. Hirsch laughing)
"Take your symptoms into someone."
- Exactly.
- And then here I am just like
talking to my friends and be like,
"I'll buy that product.
"We'll try this out."
- Yeah give it a shot right?
There's a difference.
Again, when you go to a doctor's office
who treats skincare
it's a totally different thing.
We understand the structure,
the anatomy of the skin
and that every patient is different.
And when you come into
a plastic surgeon's office,
a dermatologist's office,
we're gonna treat everything
about your skin.
Not just push a product on you.
And I don't think you get that
when you go to the Med Spa.
Certainly, if you're just getting a product
from your sister or your friend,
it may not be the right thing for you.
It's something to try.
And the people on Instagram
generally don't know what they're selling.
Just selling a product.
- Yeah
- I mean, most of it is a lot of common sense.
Stay out of the sun.
Use a physical blocker, sunscreen, titanium, or zinc.
If you are gonna be in the sun.
I love the sun too.
But I always wear a hat when I go outside.
- Yeah.
- I've got a lot of real estate up here.
- So is my husband.
(speakers laugh)
you've gotta be careful.
- Exactly.
So wear a hat.
But at the time,
if it's an inflammatory response
you wanna avoid
a hat that's gonna rub on your forehead.
You wanna avoid
a hat that's gonna hold
the moisture in
or hold the heat in.
Because, you want that to dissipate.
Even sunglasses.
Aviator wire rim sunglass is very popular.
- That's what I have.
(katie laughing)
- You wanna get a nice pair of plastic rim sunglasses.
It's less reflective.
Instead of reflecting the UV,
it's gonna block the UV rays.
- Okay, good things I didn't know.
- Yeah, basic stuff.
- Yeah.
- You mentioned before that you were wearing perfume.
Believe it or not.
Perfume can actually have
kind of a phototoxic reaction.
- Really?
- Yeah, and what the perfume does is your body
becomes sensitized to it.
And, as it becomes sensitized to it
it can actually irritate your skin.
- So many irritants.
- Sunglasses, perfume, scented lotions, tightening serums.
- A lot of things.
- So Melasma and hormones.
What is the relationship between Melasma and Estrogen?
Estrogen causes an increase production of melanin.
Melanin is the pigment
that deposits in your skin,
and causes the dark spots.
- Okay.
- So people who usually experience Melasma
are pregnant women, very common.
Women on birth control pills.
Or anybody, sometimes they're taking Estrogen supplements
or just additional Estrogen.
That's when you typically see it.
Most of the time, it is centrofacial.
So it's around your face, your forehead.
- Yeah, a lot of my friends, even kids have it
in their forehead,
right by the hair line.
- Sometimes we see a malar pattern,
which on the cheeks and the nose
- That's me.
- And it tends to kind of break down into two types.
There's the type that has
like a precipitating cause.
For example, you just changed birth control
or you're recently pregnant.
It pops up, tends to fade.
And then there is a type that is
a little more persistent.
Where, it's been there for a while.
You've tried a couple of treatments.
Doesn't really go away.
And then of course
the sunscreen we talked about.
And then as far as your skincare regimen goes,
you wanna avoid skincare products
that are going to cause inflammation.
- Okay.
- So, Alpha Hydroxy Acids.
That's not where you wanna go
right after that.
- Okay.
- Typically, we would start with
some type of topical treatment.
All the topical treatments for Melasma
are geared at blocking the production of melanin.
At some point in the
hormone synthesis process.
- Okay.
- So, you know, when melanin is being produced,
when any hormone in your body is being produced,
there's multiple different points.
It's a pathway.
And so it's like,
you could block it here.
You could block it here.
You could block here.
So, all the different treatments are geared
at different points in the pathways.
And there's been a lot of research on this.
And the most common starting point
is usually the combination therapy.
- Okay.
- So we would try a combination therapy,
something along the lines of
there's usually a little bit of Steroid in it.
There's a little bit of Hydroxychloroquine.
Or Hydroxyquinone, and then often a Retinoid.
- Okay, I've heard of Retinoids.
- Yes, Retinoids, they have a couple of different
- It's like anti-aging, I've always thought.
And I don't know if that's the truth.
- It helps thin layer of the skin
increase cell turnover
which is what you want.
You wanna get rid of the outer layer.
You wanna rid of the pigment itself.
But, each of these treatments
will help arrest the development of melanin
at some point in the cycle.
Which should theoretically,
slow down the production Melanin and help your skin.
So obviously, it's not a dangerous skin condition.
It's not gonna kill you,
but it does affect your quality of life.
- Yeah.
- And, there is plenty of research about how it's damaging
to self-esteem and your outlook.
(gentle music)
- Like everybody else.
I think, I've asked a lot of friends
and watched a lot of things on Instagram
to figure out what products I thought would be good.
And, these are like expensive
and things I thought I was doing
to make my skin better.
And you all know how much I love my Coco stick.
And, this is even something dermatologist recommend.
And I had saved up
to buy these sunglasses
that are metal framed.
Look, I thought they were fancy and nice.
And I liked them.
And I had no idea that maybe this could be the culprit.
And what caused my Melasma.
Or, it's the birth control.
So let's talk to an OBGYN.
And, see what she has to say.
And, learn a little more.
(gentle music)
Could my birth control have led to me getting Melasma?
Because my story, the way that it kind of worked is,
I found out that I was a Leiden Factor V carrier.
I don't have the full mutation of the gene.
But, birth control can increase, you know,
the possibility of me having a blood clot.
And since that's super scary
my hematologist recommended
that if possible,
for me to go off birth control
or to switch birth controls.
And when I went from,
I was on Ortho Tri-Cyclen Lo
for many years.
Happy, pleased, no problem.
Then I switched to Generess Fe
for like a year I wanna to say.
And, I'm probably saying the name wrong.
But then, when I went into my OB, she was like,
"Okay, we will have to switch you to a Progesterone-only"
Because, I believe it's the Estrogen component
that makes it more blood clottable,
if that's a word.
And then, that's when my Melasma was like,
it came out.
which was shocking to me.
And so I was just curious
if birth control can affect our skin.
Or if you've heard people,
I know I've heard people
with their acne going away and things like that.
But, how does that work?
- Yeah, so these are
the acne and what you're referring to
are kind of two different processes.
For those who don't know
Melasma is basically hyperpigmentation
of certain areas of the skin.
And, it is distinctly recognizable on the face.
And, it's hormonally induced in a lot of cases.
A lot of people will notice it
kind of above the upper lip
and also kind of like
right around here.
And, forehead is another place.
It can also be worsened by the sun.
So, one thing you can do with Melasma
if it's not too bad
is just make sure you're wearing
a really good SPF every day.
But, if it's hormonally induced
this is from.
You know, it's interesting
that you said it got worse on the Progesterone-only.
Because, we kind of tend to think about Estrogen
as kind of pushing that forward as well.
But regardless, it's a mixture
of both Estrogen and Progesterone
that kind of triggers an increase
in melanin production
in certain areas of the skin.
And, I will not be the one that can tell you exactly
why it happens in the places that it happens.
But, it is hormonally related.
The acne side is generally,
if somebody has hormonally triggered acne,
it will be improved on a birth control pill.
Because birth control pills
that have Estrogen and Progesterone
increase a hormone called Sex Hormone Binding Globulin.
Which basically goes through your bloodstream
and finds the Testosterone that's active
and kind of stops it from being active.
One of the places that it's active
is at the skin level.
And so, a lot of people will see an improvement
in their acne.
The Progesterone-only doesn't do that
to quite the same extent.
So some people will actually notice worsening
of acne on a Progesterone-only birth control.
And then, it's always really important to say,
some acne is not hormonally triggered.
And so, every type of acne
will not improve on a birth control pill.
And some of it can be exacerbated.
But I would say,
80-90% of people will see an improvement of acne
on a combined birth control pill.
- it's interesting to learn that
it sounds like my Melasma
may not have been caused
by my changes in birth control.
Because from what Dr.Jones was saying,
it sounds like
they know Estrogen to be responsible
for Melasma not Progesterone.
Because, Progesterone is what the birth control
I switched into was like a Progesterone only type.
So, I don't know.
It's just really interesting.
And sometimes I think,
you know, when I do research online
for things that I'm dealing with personally,
it's kind of like confirmation bias.
Like I already have an idea of what I'm sure caused it.
And so, I search things according to that.
And then, I find answers
that only confirm what I already thought.
They don't challenge me to see things in a different way.
And I think that's why it's really important
that we see professionals.
People who have gone to school,
and deal with this all day long.
Because, then they can give us
the real information.
And that's also why I wanted to talk to Dr.Hirsch.
Who's a plastic surgeon.
Because, he deals with skin
all day long.
And I'm sure many of you are wondering well,
"Katie why didn't you pick a dermatologist?
"Like why are you seeing a plastic surgeon?"
Well, the truth is I did see my dermatologist
and I asked him about it.
Because, I get my moles checked every year.
As we all should.
But, when I brought up my issue with Melasma
his response was,
"Well, you know, it's fine,
"it's not affecting your health.
"There's no real reason that you should worry about it.
"Just get yourself some good concealer.
"And just cover it up.
"And wear sunscreen."
That was all he told me.
And while it doesn't affect my physical health
it definitely affects my mental health.
I don't like how it looks.
I've been very uncomfortable.
I feel like I need to wear makeup.
Which I don't like doing.
And so, I wanted to better understand
how to fix it.
And, that's why we have to advocate for ourselves.
And that's why I reached out to Dr. Hirsch.
To ask more questions about my skin.
And what he knows about it.
And how we can maybe, hopefully,
Make it better.
(gentle music)
- There are treatments for Melasma.
They're kind of broken down into two different groups.
And then, there are of course,
the simplest thing is
avoid things that are
(gentle music)