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Interviewer: I think many of us have already heard or know that mindfulness can help with stress and depression and anxiety, but did you know mindfulness can also help with a lot of physical conditions as well, such as pain management, high blood pressure, diabetes, heart disease, AIDS, cancer? It can help improve your sleep, stomach issues, and even eating disorders.

Trinh Mai is a mindfulness educator at The Resiliency Center at University of Utah Health. And mindfulness can help all these physical ailments as well, huh?

Trinh: Yeah. Isn't that wild?

Interviewer: It is wild. Tell me more about that. I mean, how does that work exactly?

Trinh: What all of those conditions share in common is that chronic stress can contribute to all of those conditions — hypertension, diabetes, heart disease, digestive conditions. Often stress is at the root of it, and stress is also the outcome of a lot of health conditions. So if there's a practice like mindfulness that can help you to better manage stress, then it's going to help you to better manage those symptoms.

Interviewer: This isn't something right now that I think a lot of physicians necessarily do. I bet you I could go to my doctor and say, "Hey, tell me about mindfulness and how that could manage my diabetes." You might get a blank stare. So are more and more physicians kind of adopting it, or how is this manifesting itself in traditional healthcare?

Trinh: Actually, how I came to mindfulness was my neurologist. I don't just teach this, I practice it and I'm a believer because I went to my neurologist about 10 years ago and said, you know, "I'm having all these neurological issues, pain, numbness." And we did a workup, and luckily I didn't meet any particular diagnoses, but she said, you know, stress often contributes to pain.

So she actually recommended that I take mindfulness-based stress reduction, and that's a course that I currently teach now so I feel really lucky. But that course changed a lot for me. It helped me to become more aware of what triggered my pain, and then it helped me to be aware of, you know, how I react to my pain can actually reduce it or exacerbate it. Sometimes the reactions actually make things a lot worse than the initial problem.

And then I, through the practice, actually became more aware and then I hopefully have been able to reduce my pain in other aspects. Hopefully, I'm less of a pain as a parent and as a partner. But yeah, it's awareness. That's what mindfulness is. And when you're aware, then you have more choices of what course to take.

Interviewer: I know a lot of people personally, and probably even me a few years back, if a physician in medicine would have told me what your neurologist told you, I'd be like, "Oh, they just can't figure out what it is. This is ridiculous." I can almost hear somebody going home and go, "Yeah, they told me I need to be more mindful. How's that going to help? Give me a pill, give me a diagnosis, tell me what's wrong."

And I think a lot of us have a hard time believing that stress can cause some of these other health conditions. So that story was great because I think it just really illustrated, you know, it did, it made a difference in your life and it can make a difference for a lot of people.

So let's get to the question now. So somebody is listening to this podcast, maybe they're suffering from one of the things we mentioned, maybe it's something else. How do they do it? Let's give somebody a first primer and then we'll give some resources.

Trinh: Yeah. So let me start with, first of all, I think that a lot of people that I've taught they'll tell me, "Oh, yeah, it's not for me because my mind races and I just can't make it stop," or "I can't sit still, that makes me too nervous." Well, you know what? I totally get that. I come from generations of people, particularly women, that cannot sit still. Like my mom, she's 70 something, she's retired, but she does not sit still. So I totally get that.

And it's like anything, the more we do, the stronger our muscles are to be able to do it, and the better we get. The other thing I think it's important to know is that you don't have to make your mind stop. So I'm going to just repeat that. You do not have to make your mind stop. We can't necessarily control that, but what we do have control over is if we pay attention to it or not, and we can bring attention to our bodies.

So for example, if I were to ask you now, can you bring attention to your feet on the ground and feel the surfaces of the ground? And if you can do that, you're practicing mindfulness.

Interviewer: That's it?

Trinh: Yes. And, you know, your mind's going to wander off to, "Oh, well, I got better things to think about." And that's cool. But when you notice that, you can bring it back.

So now I'd like to invite you to bring your attention to your breath and maybe see if you can pay attention to three breaths, the inhale, the exhale, feeling the air enter the nostrils, and opening up your body. Exhaling completely, feeling the body contract.

The mind wanders off. You notice. That means you're aware and you bring it back to your breath. And then at the end of the next exhale, maybe just check in and notice how you feel. See if there's any shifts.

Interviewer: I feel more relaxed already, and we did that for like, what, 18 seconds. That was amazing.

Trinh: Thanks for practicing along, Scot.

Interviewer: That was fantastic. So it doesn't seem like it's hard. You just kind of have to be paying attention. I'd imagine there's a lot of resources that you can get to it. There's apps I hear advertised or probably YouTube videos. Is there any place, in particular, you'd like to go for somebody who just wants to start?

Trinh: So, you know, I'm biased. I work for Wellness and Integrative Health here at the University of Utah, so I am going to invite you there first. You might want to check out the University of Utah Wellness and Integrative Health YouTube channel, and it's under Be Well Utah. So that's the series that you can check out.

And then, you know, taking courses, trying a class is a lovely way to get support and structure and a community to start a habit. So we have two courses. We actually have three. We have Everyday Mindfulness, which is an introductory course, and it's four weeks. And then we have the gold standard, which is Mindfulness-Based Stress Reduction. And that's the one that John Kabat-Zinn started and has decades of research behind it. And that one is nine weeks.

And then I just started a self-compassion course during lunch, and that's only an hour long for four weeks. So a few options for you to just, you know, try it out and see what it's like for you.

Dr. Jones: So you ran out of your birth control pills and the condom broke or something like that. You really don't want to get pregnant right now or anytime soon. What do we know about your options?

Many women know about emergency contraception, and many don't, something you can do to decrease your chance of pregnancy if you had unprotected or under-protected intercourse. There are two types of emergency contraceptions approved by the FDA that are available in the U.S., and they are pills, and they decrease the chance of pregnancy if they're taken within five days of unprotected intercourse. But there are other types of birth control that would work and keep on working if you're looking for contraception for more than this month.

With us today is Dr. David Turok. He is an OB/GYN specialist in family planning and chief of the division of family planning at the University of Utah. Thanks for taking some time for us, Dr. Turok.

Dr. Turok: Thank you.

Dr. Jones: What were the background reasons to ask the question of whether the levonorgestrel IUD, which is what we're going to be talking about, would work for emergency contraception? What made you do this question?

Dr. Turok: Well, I speak with people a lot about emergency contraception because I'm very interested in it, and I think it's amazing that you can use something after you've had sex to prevent pregnancy. And every time I talk about it with people during grand rounds or during educational presentations, people always, always, always ask . . . because we know we have great data to say that the copper IUD works very well for emergency contraception, people always ask, "Well, what about the hormonal IUD, the levonorgestrel IUD? Can you use that?" So 10 years ago, we started trying to gather data on this topic, and finally we have an answer.

Dr. Jones: So people came to the clinic wanting emergency contraception and they walked into the clinic thinking that they might get some pills. How did you get so many women to participate in the study when they came for just pills?

Dr. Turok: Like in many aspects of life, Utah is unique. And currently, one of the forms of emergency contraception pills is available without a prescription. You can just walk into pharmacy or supermarket and get them. Sometimes it's behind the counter, you might have to ask, but you can get it without a prescription.

In Utah, because there are many limitations for people, young people especially, with insurance coverage, people seek out the cheapest place to get it, and that is Planned Parenthood where there's a sliding scale and where people have known for a long time that they can get the pills.

And we've done a few different surveys and a few different kinds of projects where we offer people walking in for emergency contraception IUDs, and it's around 12ish percent of people are interested in an IUD in that setting. And that's, I think, potentially driven in Utah by the fact that people don't have adequate insurance coverage and they're looking for opportunities to get better methods of contraception. And when there are low or no-cost options presented, people are interested.

So, at the peak before Plan B, one of the pills was available over the counter. Planned Parenthood statewide distributed more than 50,000 doses of oral emergency contraception. So people know, and lots of people come to Planned Parenthood clinics in our state for the service, and when you present them with IUDs, some are interested in it.

Dr. Jones: So some of them are really looking for something for longer than just this month?

Dr. Turok: Exactly. Yes.

Dr. Jones: Right. So you've known that the copper IUD . . . we've all known from data that goes back 20 years, really, that the copper IUD works. So you then offered them either a copper IUD or a hormone-containing IUD. And what did you discover?

Dr. Turok: So what we found in this study where we randomized people to get one or the other type of IUD, either copper or the hormonal IUD, we found that the pregnancy rate was low, very low, in both groups in the month after.

So with copper IUDs, we had 321 people who were assigned to that, and we got one-month outcome data on. And we expected in that group, zero or one would have a pregnancy. And it was zero.

And with the levonorgestrel group, we really didn't know. We had built into the study stopping points. Like, if there were a bunch of pregnancies early on, we were just going to stop. But what happened was there were 317 people who got the levonorgestrel IUD and there was one pregnancy. Lower than we thought and much better than the pills.

Dr. Jones: Right. That's important because the methods that are currently FDA-approved, that those 50,000 women who came to our clinics seeking pills, the failure rate or the ineffectiveness rate is much higher than what you found with the IUDs, either one of them.

Dr. Turok: Yeah. To me, one of the very cool things about the study is the other studies that got FDA approval for those oral methods, these were things that took a long time and hundreds of millions of dollars were spent to go through the FDA process to get that approval. And in this study, we took a method that was already FDA-approved and we just showed that it works for this as well.

And the upside relative to the pills is, as you know, that people who are getting this can get . . . this is not just better than the pills for this one event, but you can continue to use it as long as you want, up to seven years, or for the copper IUD, up to 12 years. And that is a set-it-and-forget-it method.

Then for the LNG IUD, there's this side benefit, which is why it's more popular than, I think, the copper IUD, in that it dramatically reduces or eliminates both menstrual bleeding and cramping. And that is a big upside. And that's why I think people really wanted an answer to this.

Dr. Jones: Well, we have some evidence from another big study that just gave women what they wanted when they asked for contraception and then followed them, that the IUDs were something like 20 times more effective than birth control pills in preventing pregnancy?

Dr. Turok: Correct.

Dr. Jones: So if a woman comes to our clinic for an emergency contraception and she wants long-term reliable contraception, would she be offered an IUD, do you think, in our clinics? Because now that the work was done around here, I'm hoping that our clinicians know that it's an option. Do you think it's going to be used in the clinics?

Dr. Turok: I want to say absolutely.

Dr. Jones: I do, too.

Dr. Turok: But I would also say as our team is working on getting this paper published, I would occasionally have these pangs of terrible thoughts that 10 years down the road, it's going to be like the authors of this paper and 10 other people that we know that know about this and nobody is going to ever have done any of it.

And so I started making lots of phone calls and sending lots of emails to people who I thought would be critical partners in disseminating the information. And one of the things that helps get the word out a lot is getting the paper published in a high-impact journal.

Dr. Jones: Right. It was published in "The New England Journal of Medicine," which is probably our premier medical research journal, I think, in the United States, or one of them.

Dr. Turok: One of the, I think, nice things about the study is "The New England Journal" publishes papers that change practice. That is their main motivator for selecting research articles. And you have a very low chance of submitting something and getting it published. But it was very reassuring to know that they felt this was important enough to be published there and that they were confident that it would change practice.

And there are lots of other organizations, professional organizations, a variety of health practitioners, and providers that can disseminate this to people who work with them.

I also have been working with the people from UpToDate to revise the article on emergency contraception to incorporate this and they were amazing. ACOG carried a piece on their listserv email and we're going to work with them to try to update Lark information in their emergency contraception information. So there are all kinds of ways to get the information out.

And a really important place to do that is also with Planned Parenthood Federation of America. As you know, they have something called the National Medical Committee that makes decisions on changes in practice. So I just sent an email and lately before this interview responding to questions from people who organize the National Medical Committee about this.

It's, I think, a great opportunity for Planned Parenthood Federation of America to lead on the dissemination of this because the information came exclusively from Planned Parenthood clinics. This is a collaboration between our team at the University of Utah and Planned Parenthood Association of Utah.

If you look at what gets published in "The New England Journal," the vast majority . . . and currently, probably nobody is a more fastidious reader and consumer of their publication than you. If you look at those trials that get published, most of them are these big, multi-site, and sometimes multinational studies with tons of sites and huge numbers of participants. This study is different.

Dr. Jones: It is. It's really amazing that you have a very local group who was completely committed to answering the question. And I think that that's a phenomenal thing.

I think, at The Scope, we're trying to get the word out also to individual women so they might be willing to come in and ask. So not only do clinicians need to know, but if individual women say, "By the way, do you think I could get this IUD today? Do I have to wait?" that changes practice.

Dr. Turok: Absolutely. So the education and dissemination of information have to be from push and pull factors from supply and demand side. And as I had mentioned, we're already working on trying to get providers up to speed. But there's lots of opportunity that we're going to be working on to make sure that people who are seeking emergency contraception will know about this.

Obviously, the internet is a fabulous place to do that. And there are also some organizations that focus specifically on emergency contraception. There's a U.S. Emergency Contraception Consortium and an International Consortium of Emergency Contraception, and they are fabulous at providing consumers information about different products and ways to access them. So we look forward to working with them as well.

Dr. Jones: Right. Well, Dr. Turok, I am very grateful for your time, and we'll work at The Scope in trying to get people the information they need. But the research to answer this kind of question takes years and takes a team of dozens of nurses, and clinic staff, and researchers, and above all, it takes hundreds of women who are willing to participate, answer questions, and follow up. To all of them, we are very grateful because "I hope I just didn't get pregnant" isn't a very good birth control method. And it's been a long time coming and I'm so glad to see it here. Thanks a lot, and thanks for joining us on The Scope.

Interviewer: So your period came early or maybe it's late. Maybe there's too much, too little. It's just not normal, or is it?

Dr. Jones, so I don't think my period is normal. Let me explain...

Dr. Jones: Please explain.

Interviewer: So I'm 28, I know I'm not pregnant, I know I'm not at that point where it should just go away, but it came earlier than expected by two weeks. Is this normal?

Dr. Jones: Well, I'm glad you told me you're 28 because periods are irregular predictably at the beginning right after you start your periods and at the very end of menopause and you don't follow that. And of course there's some birth control methods and you said you're not pregnant, but you didn't tell me about the birth control method you're on. But some birth control methods make for irregular bleeding.

So what's abnormal menstruation? And that would be periods that occur less than 21 days or more than 35 days apart. If you miss your periods for more than three cycles, flow that's much heavier or lighter than usual, periods that last longer than seven days, periods that are accompanied by severe pain, cramping or nausea or bleeding or spotting that happens between your periods or with sex.

You said they came two weeks early. Now, that would be probably less than 21 days, so it means this period was abnormal. But you don't have to see a doctor for this unless it happens all the time or unless you're pregnant. So what do you have to see a doctor for?

If the period is so heavy that you're dizzy and you can't live your life, you might be anemic. You need to see a doctor. So crampy or painful that you can't live your life, you need to see a doctor. Persistent spotting between your periods or with sex could be an infection or could be cancer, you need to see a doctor. Too irregular, meaning close within 21 days or farther than 35 days, if you're trying to get pregnant because you're not going to get pregnant if your periods are too wacky, or if you have any kind of abnormal bleeding and there's a chance that you're pregnant, you need to know because there could be a problem. So one period two weeks early, you're not pregnant, you're only 28, let's see what happens next cycle.

Interviewer: Going through down your list, all of this stuff seems normal. Just happened that one time. Why did it happen that one time?

Dr. Jones: Well, the problem is we won't know why it happens just one time because next time it's going to be normal. So if it happens just one time, stress can happen. If you just didn't ovulate that cycle because you stayed up too late or you went on a big trip or you broke up with your boyfriend or you suddenly gained weight or you've been on a big diet and you've lost weight, all those things can interfere with your normal ovulation. If it happens once, no big deal. If it happens three times, that's a deal and we'll work it up.

updated: February 4, 2021
originally published: October 25, 2018

Interviewer: It is time for "Am I Normal?" We are talking with Dr. Kirtly Parker Jones, as she is the expert on all things woman. Dr. Jones, here is the situation, "I'm in my mid-20s, I'm young, I'm happy, I'm emotionally healthy, I'm physically healthy, or at least I think I am, but I've noticed that I'm starting to grow some little gray hairs that are coming out. And they keep coming out and I feel like I pluck them, and then they come out even more. . .

Dr. Jones: Aww. Don't pluck on those little wisdom hairs.

Interviewer: . . . I feel like this is the problem. Am I normal?"

Dr. Jones: Okay, well, let's talk about graying. Now you had some, actually, buried in your question are some assumptions that being emotionally unhealthy might lead you to have gray hair.

Interviewer: Like stress.

Dr. Jones: Like stress. So we'll talk about that briefly, but first of all, so Caucasian people tend to start going gray in their early 30s. Asian people in their late 30s and African-Americans in their 40s. Now, what's too early? If someone's going gray before they're 20, or they're half-gray by the time they're 40, then that's early, that's premature. So you're 20, you have a few gray hairs. I'm afraid that's still normal.

Interviewer: That's still normal for me. Okay. Okay.

Dr. Jones: Now let's talk about . . . so it's partly genetics. We do know that an acute stress can cause hair to fall out, but it doesn't usually cause hair to turn gray. So people say, "I got such a shock, it made my hair turn gray," or Marie Antoinette's hair turned gray overnight before she was put on the chopping block. Well, that's not going to happen because her hair, I'm sure, was pretty long. It's not going to all turn gray in one day.

Interviewer: That's just a myth.

Dr. Jones: That's a myth. That's a myth. So I think that there are some conditions where people start turning gray or losing the color of their hair that are medical problems. So thyroid problems, too much or too little, for people who are prematurely gray, once again I said, probably a couple ones that you're pulling out in your mid-20 is probably normal if you're . . .

Interviewer: Make it worse.

Dr. Jones: Right. If you're half-gray by the time you get to your mid-30, then that's a little early. So dietary things, you need to eat well to make color. So there are cells in the root of our hair follicle that make color, and if they don't get the right nutrients, B12, which comes in meats and proteins, and other kinds of chemicals, then they can't make color. This is one of the few reversible causes of graying.

People who have high or low thyroid and people with some autoimmune diseases that knock off the hair follicles may also go prematurely gray. But prematurely gray, gosh, I think Steve Martin and Anderson Cooper look pretty hot with their hair color. And there are women who can look really great either with some salt and pepper or when they let it grow gray completely.

Interviewer: Like platinum gray?

Dr. Jones: Platinum gray. Ooh, I want that. Well, maybe not, maybe not. But if you're growing gray before you're 20, then that's early. If you're half-gray before you're 40, then that's early. But a few that you pluck out, those are your wisdoms. I would keep them around.

updated: March 4, 2021
originally published: February 23, 2017