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Fertility and Hypothyroidism

August 1, 2019
fertility hypothyroidism, fertility hashimotos, conception, ovulation, toronto naturopath, naturopathic doctor toronto

Becoming and staying pregnant can be difficult (and heartbreaking if the latter occurs). Oftentimes we don’t know exactly why miscarriage happens, but we do know about the involvement of the thyroid in some women. Recent studies have looked at the association between fertility and the thyroid gland and found that conditions like hypothyroidism and Hashimoto’s Thyroiditis are contributors to infertility. 

Thyroid disorders may affect your period in the following ways:

Hormones such as thyroid stimulating hormone (TSH) and thyroid hormones (T4 and T3) are important for menstrual regularity, egg development and implantation. 

Hypothyroidism

Hypothyroidism occurs when TSH levels are increased beyond their normal limits, when there is not enough T4 secretion, or when there isn’t enough conversion of T4 to T3. The latter means that you can have NORMAL TSH levels but T4 and T3 could be off.

Hypothyroidism signs and symptoms look like:

  • Low metabolism, which can lead to weight gain
  • Low basal body temperature
  • Low pulse or blood pressure
  • Dry and/or scaly skin
  • Dry hair and/or hair loss
  • Slowed reflexes
  • Intolerance to cold
  • Depression

Hashimoto’s Thyroiditis

Hashimoto’s is essentially an autoimmune version of hypothyroidism. It occurs when the body doesn’t recognize the thyroid gland as its own and attacks it, leading to the production of thyroid antibodies such as anti-TPO and thyroglobulin.

Additionally, there is also a connection between Hashimoto’s and gluten sensitivity/celiac disease. So if you’ve been looking for a reason to limit your gluten intake, here it is!

TSH During Pregnancy

During pregnancy, having ideal levels of TSH and thyroid hormones is important because they are associated with increased gestation (time between conception and birth), hypertension, growth restrictions, premature delivery and fetal hypothyroidism. It’s clear that the thyroid should be monitored throughout pregnancy.

Thyroid Testing

The American Thyroid Association recommends that TSH should be checked in all women experiencing infertility, and some groups indicate that TSH should be equal to or less than 2.5mIU/L to reduce miscarriage risk.

Here’s the thing though, usually only TSH will be tested but this isn’t good enough! It’s important to understand everything that’s going on with the thyroid so ask for a comprehensive workup that looks like:

  • TSH
  • T4
  • T3
  • Anti-TPO
  • Thyroglobulin

Thyroid and IVF

IVF can be a stressor to the thyroid. And although no studies have showed that treating hypothyroidism leads to an increase of live births, one study has shown that hypothyroid women have less of a response to ovarian stimulation and a lower rate of embryo transfer.

Next Steps

With infertility being so common nowadays, it’s important to take a good look at the thyroid – especially if you have a family history of thyroid disorders or experiencing any of the above signs or symptoms.

Treating thyroid conditions does not just require medication, particular nutrients like selenium or Vitamin D can also be helpful, as well as trying out some dietary changes if you happen to have high antibody levels. Speak to your naturopathic doctor to see how they can complement your treatment plan.

References

Busnelli, A., Somigliana, E., Benaglia, L., Leonardi, M., Ragni, G. and Fedele, L. (2013). In Vitro Fertilization Outcomes in Treated Hypothyroidism. Thyroid, 23(10), pp.1319-1325.

Biondi, B., Cappola, A. and Cooper, D. (2019). Subclinical Hypothyroidism. JAMA, 322(2), p.153.

Maraka, S., Singh Ospina, N., Mastorakos, G. and O’Keeffe, D. (2018). Subclinical Hypothyroidism in Women Planning Conception and During Pregnancy: Who Should Be Treated and How?. Journal of the Endocrine Society, 2(6), pp.533-546.

Green, K., Werner, M., Franasiak, J., Juneau, C., Hong, K. and Scott, R. (2015). Investigating the optimal preconception TSH range for patients undergoing IVF when controlling for embryo quality. Journal of Assisted Reproduction and Genetics, 32(10), pp.1469-1476.

Orouji Jokar, T., Fourman, L., Lee, H., Mentzinger, K. and Fazeli, P. (2017). Higher TSH Levels Within the Normal Range Are Associated With Unexplained Infertility. The Journal of Clinical Endocrinology & Metabolism, 103(2), pp.632-639.

What is Postpartum Depression?

December 7, 2018
postpartum depression, PPD, postpartum naturopath, toronto naturopath, naturopathic doctor toronto

Happiness always follows after the birth of your baby, right?

Nope, not always. 

Postpartum depression (PPD) is a condition that between 7-20% women experience after delivery. Nowadays more light is being shed on PPD because it’s a serious public health issue that affects women, children, and families. Even though the defined postpartum period is between 2-6 weeks after birth, postpartum depression can happen anytime between 2 weeks to 1 year after birth. 

About 7% of women experience a major depressive episode within the first 3 months, but if you factor minor depressive episodes, about 20% of women experience those within the first 3 months. 

Within the 2 week to 1 year time period, women may experience major depressive episodes. And other common symptoms mainly experienced in PDD (when compared to major depressive disorder) are psychomotor agitation (ex. anxiety or nervous excitement) and lethargy. You may also notice exaggerated changes in mood and pre-occupation with your baby’s well-being. Anxiety, ruminative thoughts and panic may also happen too. 

PPD is a little different than postpartum blues and postpartum psychosis:  

  • Postpartum bluesmild dysphoria occurring in the first week after delivery

  • Postpartum psychosisa condition with a rapid onset associated with hallucinations or bizarre delusions, mood impairment swings, disorganized behaviour, and cognitive dominant symptoms, including extreme sadness and loss of interest or pleasure in things previously enjoyed. Usually occurs in conjunction with bipolar disorder. 

Risk Factors of Postpartum Depression

  • Depression or anxiety during pregnancy

  • Depression prior to pregnancy

  • Changes in hormone levels

  • Your age

  • Chronic health problems

  • Psychological stress

  • Lack of social support from friends and relatives

  • History of pregnancy loss

  • Unwanted pregnancy

  • Socioeconomic status

Symptoms of Postpartum Depression

  • Depressed mood or severe mood swings

  • Excessive crying

  • Difficulty bonding with your baby

  • Withdrawing from your family and friends

  • Loss of appetite or eating much more than usual

  • Inability to sleep (insomnia) or sleeping too much

  • Overwhelming fatigue or loss of energy

  • Reduced interest and pleasure in activities you used to enjoy

  • Intense irritability and anger

  • Fear that you’re not a good mother

  • Feelings of worthlessness, shame, guilt or inadequacy

  • Diminished ability to think clearly, concentrate or make decisions

  • Severe anxiety and panic attacks

  • Thoughts of harming yourself or your baby

  • Recurrent thoughts of death or suicide

Criteria for a Major Depressive Episode

At least five of the following nine symptoms in the same 2-week period:

  • Depressed mood

  • Loss of interest or pleasure

  • Change in weight or appetite

  • Insomnia or hypersomnia

  • Psychomotor retardation or agitation

  • Loss of energy or fatigue

  • Feeling worthlessness or guilt

  • Impaired concentration or indecisiveness

  • Recurrent thoughts of death and/or suicidal ideation or attempt 

And also have to meet this criteria:

  • These symptoms cause significant distress or impairment

  • The episode is not attributable to substance abuse or a medical condition

  • The episode is not better explained by a psychotic disorder

  • The patient has never experienced a manic or hypomanic episode

Next Steps

May moms are reluctant to seek help because they’re unable to recognize their own mental health symptoms and accessing care can be difficult. An easy screening tool that will help you determine is PPD is affecting you is the Edinburgh Postnatal Depression Scale. This scale is used by most health practitioners like myself. 

If not treated properly, PPD can affect your overall functioning. While untreated PPD may cause health and developmental problems in your baby – and even affect the whole family. Treatment does not always have to be simply holistic. It may involve medications, and that’s perfectly okay. The important thing is that you’re getting the support that you need and deserve. 

If you prefer to approach PPD from a holistic lens, be sure to check out postpartum depression and Naturopathic Medicine.

References

Horibe M, Hane Y, Abe J et al. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open. 2018;5(2):131-138. doi:10.1002/nop2.121.

Polmanteer, R., Keefe, R. and Brownstein-Evans, C. (2018). Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework. Social Work in Health Care, pp.1-16.

Schiller, C., Meltzer-Brody, S. and Rubinow, D. (2014). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(01), pp.48-59.

Mom Squad with Lindsay Forsey (Tenth Moon Mothercare)

September 5, 2017
mom squad, tenth moon mothercare, naturopath toronto, toronto naturopath

A few months ago, I stumbled across Tenth Moon Mothercare on Instagram and fell down the rabbit hole. It’s a company that promotes self care for mom in the postpartum period and covers all aspects of discomforts after childbirth! While I don’t have a baby registry (nor a baby), when that time comes this package is going to be first on my list! Blend up a bulletproof coffee and learn why Lindsay of Tenth Moon Mothercare cares so much about your postpartum experience, and why you should too!

What inspired you to start this company?

Let’s face it: in most of Western culture, nearly all attention falls to preparing for and caring for our babies. A new mom’s wellbeing is so often overlooked, but the reality is that it’s absolutely essential to the wellbeing of her family, and her newborn. (That’s not just my opinion; there are studies that prove it.)  

Tenth Moon Mothercare is Canada’s first postnatal care package company. In different cultures around the world, there are beautiful traditions of mothering the mother and making sure that women are taken care of so that they’re best able to thrive and care for their newborn. I find this hugely inspiring and want to create a new tradition of care for moms in Canada.

My postpartum experience with my first baby was nothing like what I had imagined. I’d ended up having an emergency caesarean and found myself physical and emotionally depleted in a way I didn’t know was possible. Even though I was a doula, I was prepared for how challenging new motherhood would be. I had tons of support from my husband and my mum, and I remember thinking, “How would I possibly be surviving right now without this encouragement and care?” A few months later, the idea for Tenth Moon started to blossom. I started making small care packages for friends, and getting requests from friends of friends. Eventually I began connecting with suppliers and fine-tuning the details and I was seven months pregnant with my second baby with I officially launched Tenth Moon Mothercare.

The business is and always has been about maternal health and wellness, with a vision to change the way we think about postpartum care in Canada. The heart-warming feedback I get from women who receive Tenth Moon packages is an amazing source of inspiration for me now.

What was your favourite product to create?

I love all of the products in our packages, but when it comes to “creation” I’d say my favourite is our Yummy Mama granola. It’s addictively delicious. It’s packed with nutrient-dense organic oats, pumpkin and sunflower seeds, coconut and pecans, and toasted in maple syrup. Oats and pecans are considered galactagogues, or foods that help to promote a healthy breastmilk supply, so it’s perfect for nursing moms. But even if someone isn’t breastfeeding, for whatever reason, it’s a super nutritious, easy snack that’s yummy any time of the day or night. Our mamas love it.   

Which of your packages is the most popular?

Tenth Moon Essentials is our most popular. It includes our Herbal Sitz Bath, Lavender Mineral Soak, Organic Raspberry Leaf Tea, Yummy Mama Organic Granola, Organic Coconut Oil and Shoosha Rescue Nipple Balm. The Essentials are included in all of our bigger packages as well.

What’s the first thing you do every morning to start your day off right?

My day pretty much always starts with my youngest daughter crawling into our bed for snuggles around 6.30 a.m. Her big sis isn’t an early riser, but she and I have a morning cuddle, too, when she wakes up. We talk about our dreams, if we can remember them. Aside from that, I start the week with sunrise yoga at 6.30 a.m. every Monday.   

What’s your favourite self-care practice?

I try to keep it simple with self-care. For the past few months I’ve been listening to a yoga nidra mediation at bedtime. I love it, because it requires me to do nothing and helps me to fall asleep with a calm mind, rather than rethinking the zillion items on my to-do list.   

What’s the best advice you’ve ever received?

I’ve done a lot of travelling and spent a few years living abroad in different places. In my early twenties, when I was getting ready to leave on my first epic backpacking adventure, my mum gave me a card with this quote by Henry David Thoreau on it:

“Go confidently in the direction of your dreams. Live the life you’ve imagined.”

It meant so much to me to receive that from her at the time, and I’m still living my life that way. (Thanks, Mum!!)  

What’s your personal or professional motto?

No official motto, but I do love listening to the super quirky 80s one-hit-wonder Break My Stride by Matthew Wilder when I’m working, whether it’s a personal project or Tenth Moon Mothercare.  

Nobody’s gonna break my stride/

Nobody’s gonna slow me down/

Oh, no. I’ve got to keep on moving/

The video features dancers in sparkly green leotards, for extra inspiration. If you’ve ever heard this song before it’ll likely be stuck in your head for the rest of the day. I hope that’s a good thing! 

How can moms connect with you?

Website:  tenthmoonmothercare.com
Facebook:  tenthmoonmothercare
Instagram:  @tenthmoonmothercare

On your way out

Join Mom Squad’s Facebook Group AND sign up here to receive the official monthly Mom Squad newsletter!

Other #MomSquad members: Angelique Montano-Bresolin, Olivia Scobie, Beth Yarzab, Stephanie Kishimoto, Rhondda Smiley