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What is Cycle Monitoring?

February 19, 2019
cycle monitoring, fertility, ivf, toronto naturopath, naturopathic doctor toronto

When you first start working with a fertility clinic, cycle monitoring is done as it determines when you’re ovulating so your fertility doctor can figure out the best time for insemination or have sex – to ultimately increase your chance of a pregnancy.

Cycle monitoring is done for:

  • Natural cycles
  • IUI, where ovulation timing is determined
  • IVF, to measure the number and size of the follicles
  • Donor cycles, where uterine lining is determined in the recipient

Monitoring is typically done in the mornings to get the best glimpse of your hormones, and to determine how you are responding to any drugs you may be taking.

When does cycle monitoring start?

Cycle monitoring takes place in the first half of your menstrual cycle. It begins when you start your period, and are experiencing substantial flow, not spotting. You will usually need to visit your fertility clinic around days 2-4 of your period where blood testing and ultrasounds will be done.

What does cycle monitoring monitor?

Blood work measures estrogen levels, a hormone that’s necessary for follicular growth as well as development of the uterine lining. Your ovarian reserve is also measured because your doctor will be looking for 6 to 10 follicles that will continue to grow in the next few days.

Ultrasounds are also done to visualize the progressive growth of the follicles and lining. Right before ovulation happens, a dominant follicle should be about 20 to 24mm in diameter. This, along with hormones (estrogen and LH), will indicate that ovulation will happen.

What happens after ovulation?

At ovulation, the dominant follicle is released, and is basically waiting for sperm to fertilize it. Your doctor may give you a trigger shot of hCG to facilitate ovulation.

At this point, you will be told to have sex or an insemination is done once (or twice) to fertilize your egg.

Depending on the type of cycle you have, you might go back to the clinic in the luteal phase to measure your progesterone levels, or and ultimately determine if you are pregnant.

Final Thoughts

Cycle monitoring can be particularly stressful because of the frequency of visits, as well as feeling anxious about how your hormones and follicles are doing.

Because you have a lot on the line – time, money, hope, there’s a desire to get everything right. Do the best you possibly can to get the outcomes you want. Expanding your health team, potentially including a naturopathic doctor, may support and enhance these treatments.

What are Uterine Fibroids?

January 7, 2019
uterine fibroids, toronto naturopath, naturopathic doctor toronto, fertility naturopath

When you think of fibroids, your brain may automatically jump to the scary C word. But fibroids are not the same as cancer.

Uterine fibroids are tumours that that come from the same tissue as the uterus. They grow at a modest rate, and are affected by hormones like estrogen and progesterone.

Uterine Fibroid Risk Factors

Some of the risk factors for uterine fibroids include:

  • Increasing age, around 40-50 years old
  • Family history of uterine fibroids
  • Getting your period before 12 year old
  • African American
  • Obesity

Types of Uterine Fibroids

Subserosal Uterine Fibroids

These fibroids project outside of the uterus. Surgical removal isn’t typically recommended and they don’t appear to impact fertility.

Submucosal Uterine Fibroids

These fibroids project within the uterus and can impact fertility in a negative way by affecting implantation rates, clinical pregnancy rates, ongoing pregnancy, miscarriage and live birth rates. Pregnancy rates may improve following surgical removal of the fibroids.

Intramural Uterine Fibroids

These fibroids are found within the myometrium (middle layer of uterine wall). They may affect fertility by negatively impacting implantation and clinical pregnancy rates.

Signs and Symptoms of Uterine Fibroids

The most common symptom is heavy, prolonged or abnormal bleeding. Unsurprisingly this can be followed by iron deficiency anemia.

You may also notice pelvic pain or pressure, although this is rare. And obstructive symptoms may present with larger fibroids.

Fertility may also be impacted depending on the type of fibroid you have.

Confirming the Presence of Uterine Fibroids

Palpation can give you an idea if you have fibroids, but you’ll need a more definitive diagnosis – preferably with imaging.

Two of the most common (and least invasive) tests are:

  • Transvaginal and transabdominal ultrasonography
  • MRI

Uterine Fibroids in Fertility

Depending on the location of your fibroid, it may decrease your fertility. Fibroids may decrease implantation and clinical pregnancy rates, based on where they present. Intramural and submucosal will affect fertility more than subserosal.

Uterine Fibroids in Pregnancy

Fibroids might remain the same size or become smaller in pregnancy. In the postpartum period, fibroids may shrink or completely disappear.

Sometimes they may have an impact on pregnancy outcomes, including an increased risk of malpresentation of your baby, increased chance of c-section, and increased risk of preterm delivery.

Treating Uterine Fibroids Naturally

Uterine fibroid treatment is dependent on the symptoms you’re experiencing.

If you’re not experiencing any symptoms, then doctors usually take a watch and wait approach. If you are experiencing symptoms, then treatment depends on your desire for fertility.

There are many drugs out there for the treatment of fibroids, and if you’re familiar with my website, I often focus on natural alternatives instead. Moreover, if you’re here because your fibroids are affecting your fertility, many of the recommended treatments wouldn’t be compatible (ex. birth control).

It’s important to note that natural therapies may not make your fibroid completely disappear. And this is one of the conditions where we’re focusing on the symptoms you’re experiencing.

Nutrition and Uterine Fibroids

One of the goals when you have fibroids is to adopt an anti-inflammatory diet. This means whole foods, fresh and organic fruits and vegetables, cold-pressed oils, oily fish, and nuts and seeds.

Sadly this leads to an avoidance of red meat, processed foods, refined carbohydrates, sugar, saturated fats, fried foods, dairy, caffeine, and alcohol.

Fibre is very important in assisting the elimination of estrogen and promoting bowel movements. Before you chug back some psyllium husk, berries and leafy greens are a great source of soluble fibre (the type of fibre that bulks up your stool). An easy way to ensure you’re getting enough fibre during the day is to start your morning off with a berry and spinach smoothie (ps. don’t forget the fat and protein!).

Lifestyle and Uterine Fibroids

Because obesity plays a role in fibroid development, it may be helpful to achieve a healthy body weight. Obviously many factors (ex. hormones) affect weight, so one of the simplest ways to start to process is to focus on nutrition.

Stored fat is often transformed into estrogen which may become stored in the body and ultimately affect hormones.

Liver Support and Uterine Fibroids

Yes, I brought up the liver because it detoxes! While we know that your liver knows how to detox. It’s important to consider that it may be burdened with outside estrogens. This may be affecting how your fibroids grow, and ultimately, this might slow down its detoxing job.

Detoxification happens in 2 steps, and if you don’t have the necessary nutrients for both, your liver may not do its best work. So what’s a person to do? Instead of tossing a pre-packaged detox into your cart, make sure you’re eating a variety of protein, getting your daily dose of B vitamins, and making broccoli (and other brassica vegetables) are you friend.

Once your liver gets these toxins out, they still need to be excreted via urine or stool. A healthy gut microbiome and frequent bowel movements will ensure that estrogen is not recirculated back into your system. But if you experience constipation (ex. less than 1 bowel movement per day) or uncomfortable digestive symptoms, then you may need some digestive support.

Nutrients and Uterine Fibroids

These vary and are based on the symptoms you may be experiencing. However, one important nutrient will be iron, especially if you’re noticing excessive menstrual bleeding (losing over 90mL of blood each cycle). Having your ferritin tested, will give your ND an idea if you should be supplementing.

Other nutrient actions that may be beneficial are anti-inflammatories, immune support, and specific antioxidants.

Herbs and Uterine Fibroids

This is another category that varies based on your symptoms and goals. We may want to consider:

  • Hormonal modulators (to improve hormonal regulation)
  • Liver tonics (to support liver detox)
  • Uterine tonics (to improve uterine tone)
  • Uterine astringents (to reduce uterine bleeding)
  • Uterine stimulants (to relieve pelvic stagnation)
  • Uterine antispasmodics (to reduce pain)

Obviously this is a huge list, and I haven’t listed off any herbs – mostly because you should be taking them under the supervision of a ND or herbalist.

Acupuncture and Uterine Fibroids

It’s no secret that I love acupuncture the most out of all my tools. This can’t be done at home, and should be done in your Naturopath’s or Acupuncturist’s office.

In the case fibroids, your ND will likely focus on ensuring the smooth flow of energy and movement of blood throughout the body. A few treatments are typically needed to see results (it’s not a one and done type of treatment).

Final Thoughts

If you’re experiencing heavy bleeding, it’s important to know that fibroids may be the reason why. Moreover, they may also interfere with your fertility.

If you’re hoping to retain your fertility and address your symptoms through a natural lens, feel free to try some of the above ways or work with a Naturopathic Doctor.

If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

Can the birth control pill fix my period?

October 29, 2018
birth control fix period, naturopathic doctor toronto, toronto naturopath

Short answer: No. 

You can’t fix your period with birth control because birth control doesn’t ‘improve’ your hormones. The birth control pill actually shuts off your period. 

How does the pill work?

The pill stops your natural menstrual cycle. More specifically, it prevents follicle stimulating hormone (FSH) and lutenizing hormone (LH) from being produced. This prevents follicles from maturing and releasing estrogen, and it prevents ovulation from happening, which produces progesterone. Because LH is not being produced, this causes cervical mucus to thicken affecting sperm movement and endometrial development (this is the lining that’s shed during your period). 

The birth control pill does have its own hormones: estrogen and progestin. These are not the same hormones that our body produces, but mimic them. 

If you are using a 28-day packet, 21 pills will contain the synthetic hormones and 7 will be placebo. When you take placebos, your body will experience a withdrawal bleed (often mistaken as a period). 

6 ways that these hormones are different

1. They enter your body differently

The hormones from the pill enter your bloodstream through your GI tract and portal vein (an important vein in your liver). Your ovarian hormones enter your circulation through veins in the ovary and the inferior vena cava. 

2. They have different concentrations

When you take the pill everyday, the hormones enter your body in a single, large dose. Your body’s hormones are always being produced based on where you’re at in your cycle. 

3. They have constant levels

Once you take the pill, those hormone levels don’t change. Your body’s hormones levels may change based on what’s going on with your hypothalamic-pituitary-gonadal axis. 

4. They stay in your body longer

Because the pill’s hormones are synthetic, they are designed to be more resistant to metabolism (aka. they don’t break down as easily). Therefore, they stay active in the body longer than your body’s natural hormones. It’s been thought that they can remain inside your body for at least 6 months after discontinuation. 

5. Progestin is not progesterone

Progestin is similar to progesterone, but they’re not the same molecule. Some progestins like levonorgestrel may cause hair loss because they are testosterone-like (and have a high androgen index). Progestins may also cause acne, as they suppress sebum production. 

Some progestins may have a low androgen index, and while may not cause hair loss while on the pill, they may cause hair loss after the pill is stopped because the body’s androgen levels increase. 

6. They have different actions

The hormones from the pill have a different action on hormonal receptors inside the body, compared to our hormones. This is because the structure, type, and concentration of pill hormones are different than your actual hormones. 

Then why use the pill?

The pill is the first line treatment option for many common conditions like PMS, PCOS and endometriosis. And it’s often given with the reasoning that it will regulate your period and stop the problem. But when you stop taking the pill, your problems will likely come back. 

There are times when the pill should be considered. For example, women taking accutane (which is a category X drug) should not be conceiving while on the drug. Or for women who have endometriosis, taking the pill may make the biggest difference for their pain and quality of life. 

How do I fix my period?

Ultimately, it’s important that you understand your symptoms so you can support your body. Especially if you’re using the pill to ‘fix’ the problems. You may want to figure out why these symptoms are happening, and see which dietary and lifestyle changes you can implement to support your longterm health. 

How do I start?

  • Review my articles about PMS, PCOS, and endometriosis

  • Track your symptoms, diet and your period

  • Get some blood work done (if applicable)

  • Find a Naturopathic Doctor to work with (feel free to contact me to find someone in your area)

  • Implement key dietary and lifestyle changes

  • Give your body time to adjust to your treatment plan

When I work with period problems, I figure out why they’re happening. I use information that you give me (diet/symptom/period trackers, blood work, your personal story) to determine the root cause and create a plan from that info. 

It’s not always a quick fix, but change takes time!

If you found this information helpful, check out my handy chart of the nutritional deficiencies caused by the pill!

References

Sims, S. and Heather, A. (2018). Myths and Methodologies: Reducing scientific design ambiguity in studies comparing sexes and/or menstrual cycle phases. Experimental Physiology, 103(10), pp.1309-1317.