How I got pregnant after 12 years of infertility

Ok, like SO many pregnancies, I actually wasn’t trying to get pregnant….but so it goes. Turning 40 this year, and being in a pretty fresh relationship I had pretty much given up on having a natural pregnancy and a family of my own. I had come to a place of peace with it and was moving on in an exciting new chapter of my work and personal life. Truth be told, was actually trying to avoid pregnancy (I had a copper IUD). That being said, it turns out I did SUCH a good job restoring my fertility, the universe simply had other plans for me and my partner and I welcomed this surprise with somewhat petrified yet open arms.

If you are like me and have been struggling with infertility, irregular periods, anovulation (aka not ovulating regularly) or have lost your period all together here’s a simple road map to help you get back on track and regain your natural fertility.

Achieving a state of healthy fertility means achieving a state of balance and peace WITHIN your body and sometime most importantly in your mind. If you’ve been following this blog you’ll remember this is something I’ve been working on and experimenting with for many years now. If you’re totally new to all of this, I’d suggest checking out these posts :

https://cavegirlplusone.com/blog/2017/9/3/my-struggle-with-hypothalamic-amenorrhea-ha-how-i-got-my-period-back

https://cavegirlplusone.com/blog/2018/3/9/hypothalamic-amenorrhea-update

Basically, as you’ll learn in these posts, after a LOT of physical, mental and emotional work to regain my period after losing it for 10+ years, I got it back after radically changing my entire life. From how I work, how I sleep, how I eat and how I move (or don’t move) my body.

In the two years after getting my cycle back, I’ve been really just cruising. Enjoying long distance running again, big days in the mountains (up to 26hr days!), ski touring a ton and getting fast when skiing uphill again generally I’ve been feeling all around fabulous, spending time with friends, tackling new and different work/school projects and exploring a different side of life.

My cycles started to really regulate despite an increase in activity and last August and I began ovulating most months (except when I travelled a ton, that threw me off, which is normal). When I sit down and really reflect back on what helped me the most I can chock it up to 4 key principles which I’m going to share with you today.

Yes, I needed a manicure…but I also needed dairy free gelato at my fave spot in France :)

Yes, I needed a manicure…but I also needed dairy free gelato at my fave spot in France :)

  1. NUTRITION:

    • Never go hungry. When you’re truly hungry, eat.

    • Fuel your activity. When I’m out in the mountains or on runs longer than an hour I always try to consume 100-200 calories/hr and eat a generous dinner (and desert) when I get home.

    • Eat well. If you don’t really know what that means try following the Core 4 principles of nutrition and eating from the program Baby Making and Beyond This program is great for hormone balance AND pre-conception/pregnancy/postpartum. It also has a great feature called “ Build Your Plate” which will help you with the ever day decisions about how to fill your plate.

    • Eat carbs….you need them. Eat them. Going low carb for active women INCREASES stress in your body. Or that was certainly the case for me. I eat carbs at every meal.

    • Don’t care SO MUCH! When I really loosened the reigns, I saw a lot of good things happen to not only my sense of emotional wellbeing but also my hormones. I ate sushi on days I didn’t go for big runs, I ate ice cream 4 days in a row because it tasted good…..after years of saying ‘no’, I decided to say ‘yes, why not’. This didn’t mean binging, it meant enjoying food in reasonable amounts and not fussing too much!

  2. SUPPLEMENTS:

    • Over the past 12 years I tried EVERY SUPPLEMENT known to man! When I got pregnant I was taking NOTHING (aside from a probiotic)

    • Did any work? Honestly, I don’t know. I don’t really think so. There are a few however that stand out.

      • A strong B-complex (taken every once in a while)

      • Algae based DHA (because I am allergic to fish)

      • A probiotic

      • DIM (when my estrogen got too high (common when regaining your cycle regularity), this did naturally bring it back down)

      • Amino Acids…I see a huge potential here. I experimented with these myself and while I didn’t find I really needed them, I can see how they can make a huge difference for someone EARLY in recovery or for anyone who struggles with anxiety or who is postpartum struggling with regaining hormonal balance following weaning.

    • Too often in my practice women relying on supplements to solve their hormonal imbalances. Sometimes too much. My suggestion is to supplement wisely under the guidance of a practitioner who DOESN’T sell supplements. If you ever need a little 1:1, you can always send me a note. I don’t sell supplements, in fact, I try to avoid them :)

  3. STRESS and SLEEP:

    • You really got to get this one in check! For me, taking a BIG break from being an on call midwife was the best thing I have ever done. The reduction in anxiety when KNOWING I’ll have a good nights sleep was immensely powerful and when my circadian rhythm was able to get more normal hormonally, a lot shifted. If you are a nurse or other shift worker struggling with infertility, seriously consider a new job. For me it meant a 70% pay cut….a huge blow. That being said, you only have one body, one life…..for me the choice was clear.

    • Cope with your stress….whatever that means for you….and don’t just go though the motions. For example, I see many women in my practice who say they manage stress by walking or doing yoga….but really, they are just going through the motions and not letting the activity work it’s magic. If you’re doing yoga or going on a long walk to ‘check it off your list of things to do’, it likely isn’t helping. You need to find a style of restorative yin yoga (not hot or power or flow) that is really going to FILL YOU UP. Never underestimate the power of chanting. It sounds woo woo but it’s true.

    • Spend time with your friends….enjoy life…..welcome in happiness and pleasure daily. It has value.

  4. MOVEMENT

    • When I got pregnant I was doing a lot of activity. I was running the fastest I’ve ever run and when I found out I was actually away at a surf camp surfing 6-8hrs a day! It seems for me as long as balanced my activity with rest, sleep and appropriate nutrition, it had no impact on my cycle (or on my body fat percentage to be truthful). This may not be true for you. Some women are very triggered by too much activity. It’s something you’ll need to experiment with yourself.

    • Some weeks I ran 100km or ski toured every darn day….. some weeks I ran 10km, swam, did yoga and chilled out….they key here is to balance your activity with your energy levels and great things will happen!

    Remember, what worked for me, may not work for you…..reach out to a practitioner who understands and will take the time to really understand what’s going on for you in a truly holistic way. Because, as I aways say, just like snowflakes, no two are ever alike :)

Making time to visit and spend time with friends is a priceless investment in your health.

Making time to visit and spend time with friends is a priceless investment in your health.

Endometriosis and fertility.....what's the deal?

ENDO….aka endometriosis

I’m seeing more and more women in practice who have been diagnosed with endometriosis…way more than ever before. This has kind of gotten me scratching my head recently…why is this?

Is endo a product of modern society and exposure to stress and artificial estrogens? OR, are we simply diagnosing it more frequently because we go looking for it?! I don’t really have the answer to this question BUT I’m going to keep being curious and if I learn anything new I’ll update this post FO SHO.

If you’ve had a recent  OR old diagnosis here are the facts:

Hey, endometrial tissue, you don’t belong there!

Hey, endometrial tissue, you don’t belong there!

Endometriosis is a condition where cells from the uterine lining began to grow in other areas within the pelvic cavity. The symptoms of having endometriosis are generally adhesions, menstrual irregularities (short or long cycles), painful super annoying and sometimes traumatic periods, horrific “don’t touch me, don’t talk to me” PMS, and fertility challenges.

 

The diagnosis can be difficult, since laproscopic surgery is the only way to accurately identify endometriosis. Studies suggest that 7 to 10% of all women in the United States have endometriosis. It is the third leading cause of gynaecological hospitalization and the leading cause of hysterectomy. It’s kind of a big deal.

 What the heck causes Endo?

We don't really know what causes endometriosis, and possible causes or factors may be different from person to person but here are a few:

  • Genetics: women who have a close relative with the condition are up to 7-10 times more likely to get endometriosis. Also, it is common with twins that both may get endometriosis, particularly if they are identical twins.

  • Retrograde (backwards) menstruation: Normally a period flows out of the vagina, but it can also flow backwards along the fallopian tubes into the pelvis. In 90% of women, the blood, which will contain endometrial cells is absorbed or broken down and causes no symptoms; however, in women with endometriosis this endometrial tissue starts to grow.

  • Metaplasia: the conversion of the normal pelvic tissue into endometriosis.

Other possible factors that may have a role in causing endometriosis are mostly related to a state of ESTROGEN DOMINANCE (AKA having a higher estrogen/progesterone ratio).

These can include:

  • having first pregnancy at an older age

  • heavy bleeding during periods and periods lasting longer than five days

  • first period before 11 years of age

  • regularly having less than 27 days between periods, or having shorter regular cycles

  • alcohol use (this is an estrogen promoter)

  • Having been exposed to a high amount of BPA in plastics, especially when YOU were a fetus

Can I get pregnant with endometriosis?

So many women are told that they won’t be able to naturally conceive when they are diagnosed with endometriosis. I can tell you with certainty, this is horse shit. Thousands of women conceive naturally with endometriosis, and it’s estimated that only about 30% of women with endo have some reproductive challenge. That means that for the other 70%, it’s a non-issue when it comes to getting pregnant.

All of this depends on a few factors:

  • Degree if any, scarring of the tubes and ovaries from endometriosis

  • Are adhesions causing any blockage of the fallopian tubes

What you can do

In the past surgery was the only option for helping improve fertility with endometriosis. It’s important to talk to your provider about your specific types of endo but surgical treatment, does actually have some evidence to support it’s use …. that being said, keep in mind, most of the time surgical treatment should be used in conjunction with other natural methods….and natural methods are more effective when combined with surgical management….so really, these two approaches do kind of work well together for women with moderate to severe endometriosis.

 If you’ve been diagnosed with mild endo and have been told your tubes are clear (usually by an HSG test) then POSSIBLY these natural methods could be helpful on their own but again, chat with your doc and ensure you’re ovulating each month but tracking your cycles. Follow me here ;)

Natural ways to support conception with endometriosis

Naturally controlling endometriosis while trying to conceive requires a three tiered approach:

  1. Balance any out of whack hormones: MOST women with endometriosis are dominant in ESTROGEN. This man mean that they either have too much estrogen or not enough progesterone to balance out their estrogen levels. It’s important to get tested with either a DUTCH test or a day 21 blood serum panel from your provider or companies like Everly Well.

    Estrogen makes things grow (think endometrial tissue), so balancing estrogen is pretty important. This is usually why most women are offered hormonal birth control as an option to manage symptoms……but remember, this won’t REBALANCE your hormones, if anything, it could make things worse. I’d encourage you to try some of my simple lifestyle based estrogen balancing options first after consulting with your care provider. Just as an example, I’m totally practicing what I preach and am writing this post on a flight to Costa Rica to take a break and chill the heck out for a few weeks. Never under estimate the power of relaxation and rest.

    There are a number of supplments that can also he helpful for endometriosis suffers.

    In particular:

    • DIM or diindolylmethane is a natural plant-based chemical is found in the cruciferous vegetables. DIM has been shown to be helpful in reducing excessive bleeding that many endometriosis sufferers have and can help naturally reduce estrogen levels.

    • Vitex may also be helpful here as it’s been shown to causing estrogen to be less available to stimulate endometrial tissue growth.

    • Pycnogenol derived from Pine Bark has been studied and shows the capacity to reduce many of the painful symptoms of endometriosis.

  2. Reduce inflammation: The body generally has an inflammatory reaction to endometriosis bleeding and tissue growth. Inflammation causes stress in the body which can again cause a reduction of progesterone and greater state of estrogen dominance. Natural ways to reduce inflammation include:

    • Curcumin: this can be a potent anti-inflammatory and has shown to be useful in the case of endometriosis.

    • Beta-carotene encourages enhanced immunity and decreases inflammation.

    • Essential Fatty Acids decrease inflammatory responses through pathways that produce prostaglandins in the body.

    • N-acetyl cysteine (NAC) has been examined for its role in helping those with endometriosis, in particular, it helps to reduce cyst size.

    • Bee Propolis Propolis is a bee product collected by the worker bees from the leaves and bark of trees, they particularly like poplar and conifer trees. Propolis along with beeswax is one of the main ingredients used to construct their hives. Test tube studies, although preliminary, suggest that propolis may have strong anti-inflammatory effects. In the new study, 40 women with mild endometriosis and primary infertility (i.e., they had never been pregnant) who had unsuccessfully tried to get pregnant for at least two years were assigned to receive 500 mg twice a day of bee propolis or placebo for nine months. Women taking bee propolis had a significantly higher pregnancy rate (60%) than those taking the placebo (20%). The women taking bee propolis reported no adverse effects.

    • CBD: There is more great potential with this product. It works much like the propolis by having a powerful anti-inflammatory effect within the body. Some of my clients have tried it and really found it worked. There have been no studies to support this yet but I’m guessing we will see some in the upcoming years.

  3. Clean up your diet : studies have shown that diets RICH in colourful fruits and veggies and high in omega 3 fatty acids may help reduce endometriosis flares and growth.

    • In particular, it’s important to reduce your intake of inflammatory SATURATED and OMEGA 6 rich fats from animal sources. This means choosing leaner cuts of meat, eating meat without the skin and sourcing your meats well (grassfed beef for example has a higher omega 3:6 ratio than conventional beef).

    • Increase consumption of all dark leafy greens and colourful veggies as well as grassfed meats and fatty fish. Following our CORE 4 Diet in Baby Making and Beyond would be IDEAL for anyone who suffers with endo.

  4. Clean up your skin care and household products. Really be vigilant about this one. Eliminating any forms of xenoestrogens from cleaning products and cosmetics is as critical as what you eat and what supplements you choose. Choose natural cleaning alternatives and safe skin care. As an example, I’m a big fan of Beauty Counter for cosmetics, serums and face creams and the Seaweed Bath Co lotions, body products and shampoos.

Endometriosis is totally manageable. Birth control pills are not your only option….give these things a shot and see if they helps. Comment below if there is something you’ve tried that worked for you that I didn’t mention!

 

 

PCOS : what is it and what the heck to do about it.

Polycystic Ovarian Syndrome (PCOS) has become so UBER COMMON in our world. I would simply love to do a study on how many women actually ovulate each month in 2019 when compared to how many women ovulated each month in 1819…I think the results would be astonishing. PCOS truly is a ‘disease’ of the modern age. I use the term ‘disease’ with caution because really what PCOS is most of the time is an imbalance of hormone levels (most importantly insulin) which is most often triggered by the influence of modern day life: stress, poor sleep, diet, exercise and also epigenetic changes (more on that another time!) Here’s a quick rundown of what PCOS is all about and how you can fix it.

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Polycystic Ovarian Syndrome (PCOS) is a broad term for lack of / delayed ovulation, absent or irregular periods, excess androgens, blood sugar imbalance, and of course, polycystic ovaries (multiple follicles). 

Not all follicles produce eggs that will be ovulated. Follicles are, in essence, “baby eggs” that are immature and not large enough to become a dominant follicle, and only dominant follicles are ovulated in a normal menstrual cycle. In PCOS, a mature, dominant follicle rarely develops, if it develops at all.

And it’s not just the lack of dominant follicles that is problematic; it’s also those multiple “baby follicles:” they can produce estrogen, which can lead to estrogen overload, and this estrogen can get “aromatized” into testosterone, driving androgen excess.


Up to 70% of anovulatory cycles (aka you do not ovulate) are related to PCOS, which is generally diagnosed with blood testing for hyperinsulinemia, elevated blood sugar, androgen and sex hormone levels or with ultrasound to detect multiple follicles. Ultrasound alone is NOT a good way to diagnose PCOS, however, as many women without PCOS have multiple follicles. PCOS needs to be diagnosed with blood work and ultrasound.

While the typical PCOS sufferer is overweight, PCOS can happen to all types of women - 20-25% of cases are in lean women with BMI under 25.

PCOS is incredibly paradoxical: it may be over-diagnosed, under-diagnosed, or misdiagnosed depending on the woman and the practitioner. When it is properly diagnosed, there is a very poor clinical understanding of how it should be managed. Many functional medicine practitioners, including me, have found great success helping women with PCOS using a whole body-mind approach - much like the Core Four in my Baby Making and Beyond program

Signs You Might Have PCOS

  • Skin issues. Acne or hair growth on your chin or upper lip are signs of excess androgens, a marker for PCOS.

  • Hair thinning or hair loss. This is also a sign of excess androgen production.

  • Irregular periods without ovulation (no temp rise when you chart your BBT), a sign of overall hormone imbalance, often driven by androgens.

Blood Work & Ultrasound Testing

  • This is the most important step! Get a full blood sugar and hormone panel that includes progesterone, estrogen, testosterone, DHEA, LH, FSH, prolactin, AMH (anti-mullerian hormone), HbA1C, fasting insulin, cholesterol, and a full thyroid panel. If your practitioner is not willing to order these tests, find a new practitioner or order labs directly.

  • Blood work will likely show low progesterone; high testosterone, DHEA, LH, and AMH; high- to borderline-high HbA1C; and thyroid irregularities.

  • Ultrasounds are used to check for follicles are done in ADDITION to blood work. With PCOS, there are often 12 or more follicles within the ovary, with a diameter of 2-9 mm and/or ovarian volume 10 cm3 or greater. This many follicles do not mean you’ll release multiple eggs; follicles in PCOS are not mature and don’t develop into an egg that gets ovulated.

Common Causes

  • Elevated insulin, insulin resistance, and androgen excess. This is the primary cause of PCOS and should be the target for your treatment strategies. Insulin resistance (IR) occurs when your body’s cells become resistant to the effects of insulin, which is supposed to move glucose (sugar) into the cells when the body senses a rise in blood sugar. In IR, your cells don’t soak up all that glucose - so it stays in your bloodstream, resulting in chronically high blood sugar. The elevated insulin drives the overproduction of almost anything, including an ovarian enzyme called cytochrome P450c17α that increases androgen concentrations in the body. At the same time, if your body stays in this state for too long, the pancreas, which is responsible for making insulin, eventually gets worn out and stops making enough insulin. This is when Type 2 diabetes can develop.

  • Inflammation caused by blood sugar imbalance and high insulin. Inflammation is also a marker for PCOS.

  • A diet heavy in processed foods. This drives high blood sugar and insulin levels without providing adequate nutrients to the body.

  • Uncontrolled stress levels. Cortisol and other stress hormones increase blood sugar and make it harder for glucose to get out of your bloodstream and into your cells. It also makes you crave more sugar. This also applies to exercise stress, which can also lead to hypothalamic amenorrhea due to suppression of the HPA/HPG axes. Learn more about this good stuff in the Hormones and Fertility Modules of Baby Making and Beyond.

Risks Associated with PCOS

  • Infertility because you stop ovulating

  • Should pregnancy occur despite uncontrolled PCOS, there is an elevated risk for gestational diabetes, preeclampsia, and problems with breastfeeding.

  • Depression and mood imbalances

  • Possible increased risk for metabolic disease

  • Liver inflammation

Treatments for PCOS

While drugs are available to address some of the causative factors for PCOS, we also advocate a whole-body approach centered around blood sugar balance. Be sure to read our lifestyle and supplements section and find a practitioner who can help guide your treatment plan.

Drugs prescribed by your caregiver

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  • Metformin is a drug that works by lowering blood sugar and improving the cells’ sensitivity to insulin, which helps insulin levels decrease. This can increase fertility, making it a miracle drug for many women with resistant PCOS. Always take B12 with metformin, as it will decrease your B12 levels.

  • Oral contraceptives are often used to treat PCOS, but they do not address any of the underlying causes like insulin resistance or high stress. They can also deplete certain nutrients critical to a healthy pregnancy, like folate. If your provider offers this as the only solution, consider finding a new provider for a second opinion.

Supplements

In addition to our baseline supplement recommendations found in Baby Making and Beyond, the below supplements might be a worthy addition to your protocol. As always, talk to your provider before adding these into your plan.

  • Melatonin + myo-inositol. Several studies in women undergoing IVF have demonstrated the effectiveness of this combination. The sweet spot seems to be about 3 mg of melatonin (taken nightly as a chewable or drop) combined with 2-4g of myo-inositol.

  • Myo-Inositol. Taken alone, this member of the B vitamin family supports healthy insulin regulation within the body. Women with PCOS seem to be deficient in the insulin signaling pathway (inositol- containing phosphoglycan mediators), which seems to be implicated in the development of insulin resistance. (Papaleo E et al 2009)  Inositol is also important for healthy ovulation and follicle formation, so this is particularly good for women with PCOS who would like to conceive.

  • Choline. Inositol works with choline to help with the proper utilization of insulin in the body.

  • Berberine. This compound is thought to improve insulin sensitivity by upregulating insulin receptors and stimulating glucose uptake in the cells. It might also improve acne, another common complaint in PCOS. Berberine can act as an anti-microbial, which might harm the balance of your gut bacteria if taken for extended periods of time (see below for why).

  • Proboitics: In women who are overweight with PCOS, studies have shown that the gut microbiome actually plays a pretty significant role in PCOS ( due to diminished microbiome diversity) . Take a solid probiotic and alternate strains every bottle.

  • Other nutrients. Ensure you have enough Vitamin D, magnesium (we like topical magnesium or the form magnesium glycinate) and zinc. A practitioner will help you decide what levels are right for you.

A note about maca and Vitex: I can almost always tell if someone has been taking Maca or Vitex when I look at a hormone profile. I’ll see someone with high DHEA who is depleted across the board in estrogen, progesterone, cortisol, and melatonin. Maca is most often the culprit. Maca seems to raise DHEA levels and androgen hormones more than dominant female hormones, like estrogen and progesterone. Meg has also seen Vitex exacerbate PCOS.

Diet & Lifestyle

Refer to the Core Four Nutrition section in Baby Making and Beyond for expanded recommendations, and focus on the following:

Lettuce wrapped grassfed burgers are a GREAT option. I ate these with a big green kale salad. Bonus points for eating your dinner while watching the sunset instead of wheel of fortune.

Lettuce wrapped grassfed burgers are a GREAT option. I ate these with a big green kale salad. Bonus points for eating your dinner while watching the sunset instead of wheel of fortune.

  • Higher protein and fiber, and lower sugar and carbs. Eat plenty of protein and lower-carb fiber-rich plants, and incorporate some starches that feed gut flora and improve insulin levels.  (Bindels et al. 2017)

  • Organic and grassfed when possible. Watch sourcing of your animal products. Organic and grassfed likely contain fewer exogenous hormone contaminants and fewer potentially inflammatory fats.

  • Focus on an anti-inflammatory foods. Watch your consumption of excess Omega 6 fats from modern processed foods. It may also be appropriate to reduce nut and seed consumption. Reduce or eliminate processed foods, simple sugars and ALL alcohol.

  • Not keto, I repeat, not Keto, but lower-ish carb. Full-on keto can raise cortisol levels, so we’d only recommend this approach with the guidance of a health professional. Eliminating processed carbs, grains, and the highly carb-rich plants, like sweet potato and higher-carbohydrate fruit, might help.

  • No calorie restriction or dieting. Consider consulting a nutritionist or health care provider who can help you figure out how much you should be eating.

  • Intermittent fasting. Fasting for short periods of time can improve insulin sensitivity in some women, but we recommend consulting with a practitioner first to ensure it will help you. If you feel absolutely miserable while fasting, it’s probably not the right solution for you. In this case, you can simply choose a 12-hour daily “eating window” (first bite or sip of anything that’s not water starts the clock; keep your meals and snacks within that 12 hour window), AND/OR try small and frequent (5-6) protein rich meals during the course of the day to help re-sensitize your cells to insulin and keep blood glucose regulated. Experiment and see which approach works for you.

  • Cinnamon. It’s delicious, and several studies suggest it helps improve blood sugar response.

  • Get your hormones and stress in check. Test for and correct thyroid and adrenal issues, ensure your exercise is appropriate and your stress is managed, and make sure you’re sleeping.

Sometimes the best thing you can do is just chill out and watch the sunset……..

Sometimes the best thing you can do is just chill out and watch the sunset……..

Estrogen isn't the enemy. Why Estrogen Dominance isn't always the issue


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As we get set to FINALLY launch our first public module called Hormones and Fertility (other modules include Pregnancy, Birth and Postpartum) in the Baby Making and Beyond series, I find myself really thinking about the BIG picture when it comes to women’s health and hormone balance. Writing this program with my partner in crime Liz Wolfe has been such an inspiring journey and I’ve learned so much more than I thought I ever would about women’s health and hormone balance. These are things they don’t teach you in school and things that Dr. Google just won’t tell you…..because I don’t think there has yet to be a program like ours that’s really taken a truly holistic viewpoint that’s is rooted in scientific evidence and balanced with true anecdotal experience. Baby Making and Beyond is not trying to sell you a special supplement or a magic snake oil, but instead, arm you with the tools you need to make your own informed choices and support your own health in a way that’s balanced and practical. This first module is really made for EVERY WOMAN. It’s rich in nerdy science and overflowing with practical advice….so if you’re struggling with hormone imbalances, head over to the Baby Making and Beyond website and check it out :)

That being said, let’s chat about ESTROGEN! Estrogen is frequently demonized in our hyper-focused overly obsessed culture. Everywhere you turn these days it feels like women are talking about the dreaded ESTROGEN DOMINANCE. If you haven’t heard about it, Estrogen dominance is essentially a term used to describe a state of excess estrogen to progesterone ratios. This means, in theory, estrogen could be normal or even LOW..it’s all about ratios and if progesterone is all but 0, any amount of estrogen will cause this state of dominance.

A quick google search will give you a fast list of symptoms it can be blamed for including:

  • Decreased sex drive

  • Foggy thinking, memory loss

  • Fatigue

  • Trouble sleeping/insomnia

  • PMS

WHOA! With a list like that, no wonder estrogen dominance seems to garnish so much attention! There is no denying that women across the western world are suffering in record breaking proportions, but, what if there was more too this than simply having too much estrogen.

It’s my strong belief that estrogen ISN’T THE ENEMY here. Estrogen is responsible for so many important functions within in our bodies including:

See, not all bad!! @jadeteta

See, not all bad!! @jadeteta

  • Sensitizing our cells to insulin, thus lowering blood glucose and preventing insulin resistance (a cause of diabetes, PCOS and obesity)

  • Supporting our healthy bone density

  • Signalling to the pituitary gland that it needs to make LH (luteinizing hormone) which triggers ovulation and resulting progesterone production in the ovearies.

  • Protects our brain aka is neuroprotective and helps prevent things like Alzheimer’s disease, Parkinson’s disease and stroke. This is especially important in the hippocampus, cerebral cortex and striatum.

  • Helps to regulate our mood

  • Keeps our skin soft, triggering collagen production

  • Helps to keep our vaginas healthy and lubricated (Um, yes please)

So….as you can see, estrogen is doing a lot of GOOD in our bodies and needs to be celebrated not vilified. So, why do so many women struggle with these less than desirable symptoms?

Well, as you’ll learn in DEPTH in our Baby Making and Beyond program, estrogen dominance is really all about a state of IMBALANCE within all of your ‘Big 4’ hormones which include cortisol, estrogen, progesterone and thyroid hormone. There is a powerful cascade effect that occurs when one or all of these hormones fall out of balance. For example, sometimes this doesn’t have to do with having TOO MUCH estrogen, but too much cortisol which may be inhibiting ovulation (maybe by not having ENOUGH estrogen) and then causing a lack of progesterone. When that progesterone is low, it cannot oppose the estrogen’s effect on thyroid binding hormone (learn about that in BMB too!) and causes thyroid levels to plummet too (but in essence there is NOTHING wrong with your thyroid)…..see where I’m headed here??

What to do

THE NUMBER ONE THING TO DO HERE IS :

Step back, take a look at your whole life…..assess all aspects of your health. We teach you how to do this in Baby Making and Beyond’s Core 4 (Sleep,Stress, Movement, Nutrition & Supplementation)

In the situation I mentioned above, t’s common, and something I’ve even done as a practitioner to simply say well, if progesterone is low, let’s give you some progesterone….WAIT, STOP, why not simply address the root cause of the low progesterone which is 90% of the time related to STRESS.

How I mange my stress :)

How I mange my stress :)

If you have to prioritize one thing, make it STRESS REDUCTION . Stress is toxic to our hormones and our fertility. Women in particular are also much more biologically sensitive to stress than men are. Stress is a total epidemic in our society, which is likely why things like estrogen dominance are getting so much attention these days. It’s critical to find a stress management plan that works for you. In the BMB program we have an entire module dedicated to stress management. Personally, I use good nutrition, rest, movement and meditation as my medicine. Since doing this I no longer take any supplements for hormone balance (I used to take DIM/CDG ect). I find that my lifestyle change has had a much greater effect than any supplement ever could. If you’re having a hard time managing your stress levels, reach out. There are lots of us out here ready to arm you with some powerful tools to help you cope.

There have also been some interesting studies lately about the types of LANGUAGE we use (both when talking to others and ourselves) or are exposed to and both or cortisol and progesterone levels. This is another reason to always practice gentle loving kindness in your life both towards yourself and towards others. If you are surrounded by negative people, consider changing your people. If your partner is negative or says things that make you feel rejected, sad or hurt, talk to them about going to therapy together or help them to understand the power that language has on your mind and body. People are capable of great change when they are motivated to change.

While stress reduction will really arm you with most of the tools you need to rebalance your hormones (remember this takes 3 months MINIMUM), there are some supplements and dietary modifications that I’ve talked about on previous posts that can help too. Working with a practitioner who understands all of this and having appropriate testing done is CRITICAL to really target your treatment plan and get to the meat of the issue for you.

Good luck! If you’ve re-balanced your hormones, feel free to share what you did in the comments below.



How to choose a good Prenatal Vitamin

One of the most common questions I get from readers and clients is, "What prenatal vitamin should I choose"?  I've avoided answering this question for a while because it's hard to give specific brand name recommendations when there is so much to choose from and product availability varies tremendously depending on where you live. That being said, this week I'm going to offer a launching point for women. You'll find a much more in depth answer to this question on Baby Making and Beyond but for now, here's a great place to start. 

Why do I need a Prenatal if I have a tip top diet?

This is a great question. Some women do decide not to take a prenatal combination, which is cool, but there are some things that are important to consider:

- Pregnancy (and while breastfeeding) is a time with increased, some might say insane, nutrient demands. We quite simply just need, LOTS of essential micro nutrients to support the body's process of creating a new life. Most diets, even the best, can't provide all you need. The good news is that most of the time your baby will get what he or she needs by depleting you of nutrients. If you aren't replenishing your stores, you can, and will become deficient. This is especially true if you are having multiple babies  2-3 years apart or less.

If only all farms could look like this :) A view from a home visit a few years back.

If only all farms could look like this :) A view from a home visit a few years back.

- Soil and food quality just isn't what it used to be. Even the cleanest of diets won't provide all of the nutrients you need for optimal fertility and pregnancy. The carrots our grandparents ate are not the same as the ones we find in the grocery store today, even the organic heirloom rainbow ones. A Scientific American article looked at several different studies which demonstrated time and time again that from 1975 to 1997 average calcium levels in 12 fresh veggies dropped by 27%, iron levels by 37%, vitamin A by 21% and vitamin C by 30%. 

- The stress of our modern busy lives and athletic pursuits depletes all of us of essential micronutrients. Stress and high cortisol will drain you of several critical fertility and pregnancy nutrients like B- vitamins (including folate), vitamin C, zinc and magnesium. 

- If you've are a recovering vegan/vegetarian, have had a history of food restriction, over exercise or spent much of your life (like most of us) eating a standard american diet, you are nutrient depleted. It takes many years to correct these imbalances.

What to look for in a Prenatal Vitamin

- Steer clear of drugstore or mainstream brands of prenatal (centrum, costco ect). They are made with synthetic vitamins that are not well absorbed or utilized well by our bodies and may even be harmful. For example, synthetic vitamin E can cause congenital heart defects in babies and DNA damage in mamas. 

My top pick and 100% Baby Making and Beyond approved

My top pick and 100% Baby Making and Beyond approved

- Look for a brand that lists Folate (5- methyltetrahydrofolate) not "folic acid" especially if your have or suspect you have MTHFR or other methylation issues as you won't be able to utilize the synthetic form of this B-vitamin. While high dietary FOLATE is associated with a reduced risk of breast cancer,  a high rate of FOLIC ACID consumption or supplementation has been suspected in promoting the progression of breast tumours in some women and can reduce the expression of beneficial tumor suppressor genes while increasing the expression of HER2 (breast cancer promoting genes). High dose folic acid supplementation can also mask B12 deficiency which could put you at risk for preterm labour. Baby Making and Beyond will have lots more on this critical difference. Folate must be sourced from real food so a "raw or whole food" like brand will usually have folate not folic acid in it. 

- Look for the inclusion of both Vitamin K1 and K2

- Has a combination of Vitamin A from BOTH retinol and retinol palmate (Learn the details about why this is in Baby Making and Beyond) and talk to your provider about elevated or reduced need for vitamin A

- Look for choline in your prenatal  

- Look for synergistic combinations of vitamins with cofactors to aid in absorption and assimilation. These may include fruit powder extracts, enzymes or herbs.

- Ensure they don't contain soy, gluten or dairy and look for 3rd party testing and verification. 

 

Meg the Midwife's Favourite Prenatal Vitamin

NUMBER ONE VERY BEST: Seeking Health Optimal Prenatal - Not cheap but awesome ingredients and a correct blend of vitamin A sources. If you have low iron, this is pretty much the only thing that is missing.

Innate Response Baby and Me.  I love the ingredient list and in my mind this company is legit. This is a new formulation as of 2016 and it works great for the entire childbearing cycle (aka prenatal-postpartum)

If you’re too nauseated to stomach a prenatal

This happens and don’t worry, there are some options:

Seeking Health Protein Powder: This is my ideal choice. It can help stave off nausea with its high protein content and gives you all the nutrients you need. Great for Vegans.

Seeking Health Chewable: Same formula (more or less) as the Optimal Prenatal capsule but chewable

Smarty Pants Prenatal- For women who have lots of nausea and can't stomach a traditional prenatal vitamin OR who are sensitive to iron (this is iron free). If this is all you can get into you, it's a good option until your nausea clears.

Runner Up:

Thorne Basic Prenatal. Thorne's Basic Prenatal provides the active forms of folate (5-MTHF) and vitamin B12 (methylcobalamin) for optimal tissue-ready use. Basic Prenatal also contains well-absorbed iron bisglycinate, which meets a pregnant woman's increased need for iron while being easy on the stomach and non-constipating. Several of Basic Prenatal's ingredients (including vitamin C, vitamin B6, and vitamin K) have been demonstrated to benefit "morning sickness." Basic Prenatal is manufactured with the purest possible ingredients and without the additives and coatings usually found in mainstream prenatal supplements. This supplement doesn't contain K2 so it's important that you get your K2 from your diet or from another supplement. 

Vitamin Code Raw Prenatal- This one is significantly more affordable than some of the others and has some decent ingredients. If budget is a concern for you, I'd stick with this one. 

Knowing what supplements to take during pregnancy can feel complicated. Prenatals are a good place to start but in order to optimize your health, you may benefit from taking a few other things (such as calcium, DHA ect), it's best to talk to your functional medicine practitioner about this or become one of my wellness clients and book your consult today.  

 

Guest Interview with Brittany Aäe from Magnetic North

Guest interview with Endurance Coach Extraordinaire Brittany Aäe


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Brittany is a friend of mine, and current co-collaborator on a number of new projects. If you've been following my IG lately you may have noticed that my practice has been evolving. I've been focusing more on the nutrition and lifestyle needs of the female athlete, pregnant athlete and active women looking to maintain hormone balance or achieve a pregnancy. Brittany is such a great addition to my team of co-conspirators. She has a TON of experience coaching women and pregnant athletes and is an all around awesome human. I hope you enjoy learning more about her. Check her out on her own page at Magnetic North 

 

Tell us a bit about your background and what inspired you to study the pregnant and postpartum athlete?

I am an endurance coach and creative making my home on the wily riverbanks of the čwáx (Chewuch). I founded Magnetic North in 2012. My daughter, Rumi Wren, will be two in May.

Throughout my twenties I had two careers: one in the research, implementation, and evaluation of large-scale public health programs on four continents and one as a mountain athlete. Even after leaving my corporate job for my small business, I still love diving into PubMed on a rainy day. In autumn and winter 2009 I lived in the Kumaoni Himalayas conducting primary research on rural home birth outcomes and broke 20,000 feet for the first time. Pairing my experiences at altitude and my research on the physiology and cultural environs of birth turned out to get me thinking in a revolutionary way about the pregnant body at work. I am also a trained doula.

During my 2012 speed climb on Aconcagua my then-partner Chad Kellogg and I were stuck at Camp II in a windstorm and had a lot of time to talk. He mused about how the initial ascent to altitude and the first trimester of pregnancy have similar symptoms but that the athlete and the preggo approach those symptoms differently. We talked about how I could do pregnancy differently when we had children. Where a high-altitude climber knows altitude will feel crappy at first, they know that with good nutrition, rest, and strategic training their bodies will acclimate ultimately increasing their athletic performance after returning to sea level a pregnant woman often assumes that she has no control over her symptoms and that her body can never adapt to the rigorous physiology of pregnancy.

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When I first became unexpectedly pregnant I was living in the back of my Subaru climbing, running, and fishing the mətxʷú (Methow). I was broke AF and didn’t know Rumi’s dad well so I had a choice: I could either adopt a victim mentality and quit what I loved to do, making excuses that the baby made me stop, or I could transmute the difficult experience into my medicine. Thinking back on my decade of public health research, my conversation with Chad in the tent that day, and knowing the kind of example I wanted to set for my future child, I chose the latter. I am so glad that I’ve been able to inspire and inform other pregnant athletes and the professionals who support them.

 

You have a strong understanding of the biology of training and pregnancy. What are the positive outcomes of strenuous exercise on both mom and baby during pregnancy?

Given my unique background coupling public health research and endurance athleticism, I was able to unearth evidence supporting a radical hypothesis: Pregnancy is the greatest performance enhancement known to (wo)man. I took a list of performance enhancements that elite athletes experience and cross-referenced them with the physiologic phenomena the pregnant body experiences and the results not only confirmed my hypothesis. The miracle of science totally blew my mind.

Every performance enhancement sought by professional athletes who dope comes naturally to the pregnant woman - some even to the sedentary preggo. Beginning at eight weeks pregnant, the maternal heart remodels itself to contain more blood in each stroke. The kidneys in the pregnant athlete have a higher filtration rate (which is also why you pee a lot when you’re pregnant) which has the lovely side-effect of being unpumpable while rock climbing. The hormone relaxin, that we’ve been conditioned to believe only leads to unstable joints, is actually an effective vasodilator - even more effective than most doping drugs. The plasma levels in the maternal body increase by 50% or more. The pregnant body is more resilient to exercise in heat as a result. The fetus sends its mother an extra boost of stem cells to help her repair injuries or after a hard training session. In the well-trained athlete, the slow increase in weight throughout pregnancy functions as a custom progressive weight vest which, after birth, leaves the athlete with outsized musculature to perform her mountain tasks.

For the baby, less evidence is available. Anecdotal evidence is below on my own experiences birthing a capable, strong, healthy baby the day before her due date. The midwives postulated that my ultra-endurance pregnancy allowed Rumi and me to share a joyful physiologic birth at home rather than a surgical birth in the hospital.

I have shared the science behind these shocking realizations about the pregnant body on my website and coach pregnant and postpartum athletes using this evidence. Science is the antidote to misogyny.

What effects did pregnancy have on YOUR athletic pursuits?

I am even more feral inside and more connected to the more-than-human. I’m smarter, more efficient, more discerning with how I spend my time, and more self-assured. I trust my body and my intuition completely. Physically speaking, I recover more quickly, have a better understanding of how to engage my deep core muscles, my hematocrit two years postpartum remains as high as it was after my speed climb on Aconcagua - 45. I climb harder grades, I run faster and farther, and I’ve become the coach I always dreamed of becoming. I had always dreamed of setting an only known time before becoming pregnant and I did it when Rumi was 1 on the Kettle Crest Trail. I am leaner, stronger, and more serious about my mountain practice. No fucking around for this mama.

Anecdotally, the sport project I was working on when I got pregnant proved impossible for me to send through the spring and summer. In the months before becoming pregnant I’d climbed it obsessively over thirty times, every time whipping at a different spot - I was nowhere near ready to send it. But during the first trimester of my pregnancy something shifted. I don’t know if it was my mind or the new flood of plasma making me invincible, but I crushed it. When I clipped the chains on my project at nine weeks pregnant I felt like I could take another lap on it without fatiguing. I found a similar level of high performance in all of the other sports I engage in during pregnancy, continuing them until going into labor at the climbing gym at forty weeks pregnant


Were there any challenges-- physical, emotional or social-- that you faced while maintaining an athletic lifestyle through your pregnancy?

Yes. The biggest challenge was certainly maintaining my innate sense of what was right for my body and my baby. I had a small core of supportive loved ones who believed in me but no one told me “You should run/climb/ski while you’re pregnant!” I had to come up with the motivation myself. No one believed that I could run ultras while I was pregnant - which I did twice. No one else thought I’d send my sport climbing project while I was pregnant - which I also did. No one gave me permission to take a solo running road trip down the West Coast from six to eight months pregnant - I gave myself that permission. Rumi’s dad and I had known one another for six weeks (yes, six weeks) when I got pregnant so we worked long and hard to get to where we are now as caring co-parents. I also struggled with prenatal anxiety based on the unplanned nature of my pregnancy; my mountain practices served as medicine.

How did maintaining high levels of fitness throughout pregnancy affect your labor and postpartum experience?

First, I can’t imagine being able to successfully birth Rumi at home after thirty-eight hours of labor, twenty-seven active, and then push for four and a half hours if I wasn’t already an ultra-endurance athlete. Every time my cervix expanded, my strong abs made me puke. I vomited twenty or thirty times through the course of labor but I knew how to keep fueling specifically to keep me going based not on calories expended or actual hydration but based on this wild evolutionary thing our bodies have with sugar. Our feminine-power-denying culture posits birth as an incomparably painful, difficult, and unpredictable experience but that’s not what I experienced - I felt quite prepared for the ‘giving up’ necessary to birth because I birth myself on every solo ultra and alpine climb. My many simultaneously arduous and joyful days in the mountains gave me an excellent template for the experience of giving birth. I was able to pace myself, able to frame the productive pain of birth as yet another piece of information during an exciting experience while also being present for the other sensations involved in birth such as courage, triumph, connectedness, curiosity, gnosis, and gratitude. Rumi and I birthed like bosses.

Rumi was born a few hours before her due date at seven pounds and, because of the massive amounts of deliciously-oxygenated blood I gave her throughout my ultra-endurance pregnancy, her cord was a size usually associated with an eleven pound baby. This sturdy cord allowed me to push hard for over four hours without negatively affecting her vitals - ultimately saving us from an emergency surgical birth. After she was born the cord continued pulsing nourishing blood for over an hour and I lost less than a sixth of the blood my midwives usually saw a woman lose during birth. Rumi was immediately able to control her head and use her hands; she breastfed ably within an hour of being born. Rumi continues to be an intelligent, athletic, and funny toddler who currently measures in the 75th to 90th percentile for height and weight.

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During the postpartum experience my uterus shrank from even with my ribcage to even with my pubic bone within an hour of birth. This quick involution prevented postpartum hemorrhage and sped healing. I was immediately able to walk comfortably on my own after birth. There were only four days between my final pregnant climbing session (during which I went into labor) to my first postpartum lead falls. I took my last pregnant run and first postpartum runs five days apart. My postpartum bleeding stopped completely within five days of Rumi’s birth. My midwives agreed that I had completed the recovery that takes the general population about eight weeks in the span of five days. Like I always say: I’m not only an expert at moving fast and high in the mountains; I’m an expert at recovery. My level of fitness and mental resilience developed over the last decade of elite athleticism allowed me to be completely present with the intense and beautiful experience of birthing my baby.

You have done research on how the blood volume increase that occurs naturally in pregnancy. You refer to this as “natural blood doping.” Can you briefly elaborate on this natural phenomenon and its benefits. What else is happening within a woman’s body during pregnancy that make her stronger athletically?

Performance enhancements of any sort, whether sleeping in an altitude tent or taking performance-enhancing drugs, feels bad. Just like the first trimester of pregnancy, any sort of legal or illegal doping stimulates the body into a different balance of plasma, hematocrit, and/or stem cell activity. The difference between the performance enhancement of pregnancy and the ones that non-pregnant athletes use is the mindset.

As I mentioned before, when a climber first ascends to altitude they expect to feel unwell. Rather than languishing in AMS and feeling resigned to crappy performance the entire time they are up high, they apply evidence-based acclimatization strategies to their practice in order to bring their performance up to a higher level than before going to altitude.

Pregnancy, according to the evidence, is a uniquely powerful time for the athlete. To unlock the potential inherent in all pregnant athletes requires a shift in mindset away from a symptomatic experience to a challenging but rewarding experience for both mom and baby. I am happy to dive deep into the research with any curious mama or birth professional. Find more information on my Coaching page.

Your athletic pursuits include ultra-running, rock climbing, and backcountry skiing. Can you provide our readers with one tip in how to continue pursuing each of those sports while pregnant?

Ultra-running: Think of your power as a runner during pregnancy like you might think of a diesel truck: Takes a while to warm up, sputtering and coughing, but once it gets going it is completely unstoppable and unbelievably durable. You’ll have torque and endurance that you never believed were possible.

Rock climbing: You may experience un-pumpability. With all the extra plasma and higher glomerular filtration rate, many pregnant climbers find that they are unable to get pumped. Climb steep, climb long.

Backcountry skiing: Get someone to help you unbuckle your boots in the third trimester. Other than that skiing is surprisingly normal during pregnancy.

Overall: Develop an internally-informed, self-sufficient sense of what is right for your body and your pregnancy. By releasing expectations, your high performance may surprise you.

Through your research and experience, what has inspired you most about the maternal athlete?

Fetomaternal microchimerism. Us uterus-havers evolved to gestate, birth, brachiate, and run - with each of those ultra-endurance feats supporting our performance in the other.

Interested in learning more??

Check out her pregnant athlete e-course and stay tuned for more info about our collaboration "Training With Your Menstrual Cycle: Troubleshooting and tips" 

Yes, you can be too "fit" to get pregnant- Bustle Feature

If you've been struggling with either Hypothalamic Amenorrhea or having a hard time trying to conceive, check out this featured article I was recently  interviewed for on Bustle. So many women struggle with this and it's time we have our voices heard :)

https://www.bustle.com/p/yes-you-can-be-too-fit-to-get-pregnant-8979283

Meg