If you’ve been trying to conceive for any length of time (or at least thinking about it for any length of time) you have probably heard of LH strips (AKA OPKs, LH test, ovulation test, luteinizing hormone tests, ovulation predictor kits). LH strips are a pretty standard tool in the TTC communities and are often recommended to help improve odds of getting pregnant in any given cycle. But the way you use LH strips, whether correctly or incorrectly, could make or break your TTC efforts. This article will help you avoid making this common mistake.

What are LH strips?

LH strips are home urine tests that can be used to identify the surge of luteinizing hormone (LH). LH strips, when used correctly, predict ovulation to help couples who are trying to conceive by improving the precision of their efforts. Conception really only is possible during a six-ish day window of the menstrual cycle, corresponding to the five days leading up to and including ovulation, plus the day after. [Learn more about fertility, hormones, and the fertile window in my book, Go with Your Flow.] Contrary to most Sex Ed classes (or what is exemplified in the movie Mean Girls) a single sexual encounter is actually less likely to result in pregnancy then it is to cause it, statistically speaking. 

Knowing this, most cycle tracking apps offer a predicted fertile window to aid users in identifying the days of the month when they are likely to conceive from intercourse. Now, of course, these apps make their predictions based on averages (which ironically do not actually reflect the average woman) that assume a luteal phase length of 14 days, with ovulation occurring approximately mid-cycle.

To give you a few examples:

• For a woman with an average cycle length of 28 days, her app would predict ovulation on day 14, with a 14-day luteal phase thereafter
• A woman with a 35 day cycle would receive a prediction for ovulation on cycle day 21 (again with a 14-day luteal phase)
• A woman with a 24 day cycle would receive a prediction for ovulation on cycle day 10 (based on a 14-day assumed luteal phase)

While any of these scenarios could be true for a given woman, it is also true (and especially important to note) that countless other variations are also possible.

Why

Because not all luteal phases are 14 days in length.

Let’s go back to the “textbook” 28-day cycle for a moment: this woman may have:

• A 14-day luteal phase with ovulation on day 14
• But she just as easily may have a 12-day luteal phase with ovulation on day 16.
• Or even the somewhat atypical 15 (or more) day luteal phase with ovulation on day 13.
• She also could have a less-optimal but still potentially fertile 8-day luteal phase with ovulation on day 20. 

Even within just this 7 day variation, you can see easily that miscalculating the day of ovulation could mean completely missing the entire fertile window. Yikes.

So, instead of relying on the law of averages and missing the important detail of individual biology, scientists have come up with easy, at-home ways for tracking ovulation, based on the hormonal dance that takes place throughout a menstrual cycle. Ergo, LH strips or “ovulation predictor kits.”

How Do LH Strips Work?

In order to understand the lowly LH strip, we first need to understand it’s namesake hormone, LH–or luteinizing hormone.

In a nutshell, luteinizing hormone is a chemical signal sent by the brain to tell the ovary to release an egg.

The menstrual cycle is divided into two parts (which are, as we already learned, not necessarily halves) by ovulation, marking the transition point between the two.

The first part of the cycle, called the follicular phase is all about the development of an ovarian follicle (AKA egg) which bursts open during the event of ovulation. If a sperm is there, ready and waiting, when this occurs, fertilization and subsequent conception could theoretically occur. (Note: It goes without saying that many other factors are involved when determining whether or not pregnancy occurs, but those are beyond the scope of this article.) 

An Overview of Ovulation

During the follicular phase, the brain releases FSH, or follicle stimulating hormone, to facilitate maturation of the egg. As the egg matures, it produces increasing levels of estrogen, which the brain monitors. In addition to thickening and developing the uterine lining to prepare for a possible pregnancy (or period), this rising estrogen level serves as a communication signal to the brain to keep the nervous system in the loop about the status of the egg and it’s development. Once estrogen levels reach a high enough point, the brain then responds with its own signal (LH) to trigger ovulation.

After the follicle releases its egg, it then transforms into a progesterone-producing gland called the corpus luteum, which serves as the namesake for the second part of the cycle: the luteal phase. 

In reality, LH is produced at least a little bit every day of the cycle, even when menstruating. However, the key differentiating factor between “everyday LH” and the LH surge is the tremendous increase in amount of LH being released in any given moment. For younger women, the daily average LH level may be less than 1.0 mIU/mL, though for someone who is perimenopausal, it may fall into the tens-range. With regards to the brain-ovary line of communication, it’s not so much the actual numerical value of LH as much as it is the magnitude of change. To trigger ovulation typically LH levels must rise by a factor of 10, but for some people it is much more than this. It is not uncommon for LH levels to exceed 100 mIU/mL at the peak of the surge.

LH levels may also be high at a baseline in women with PMOS (formerly named PCOS) because of dysregulated estrogen signaling from polycystic ovaries. Both in the case of PCOS/PMOS and perimenopause, these slightly higher baseline LH levels may result in the rupture of more than one follicle at a time leading to a multiples pregnancy. This is why fraternal twins are statistically more common in women of older age and in women who have PCOS/PMOS. 

The Confusion About LH Strip Timing

Because LH starts to rise shortly before the release of the egg, and because conception is most likely if sperm are already ready and waiting in the fallopian tube at the time of ovulation, studies have identified that the most fertile days-–or the days of the cycle on which conception is most likely–-do not correspond to the day of ovulation itself, but rather to the day prior, and even the day before that. This allows sperm to make their way through the reproductive tract, undergo the capacitation process (which basically is just a fancy term for saying the sperm reaches its own peak maturity, which takes about 10 hours), and be ready to greet the egg when she make her arrival. 

To use an LH strip, a woman simply collects a urine sample, dips the test strip in the urine, and then waits a few minutes during which the LH present in her urine reacts with dye and adheres to a small line of antibody printed on the strip. Like a pregnancy test, LH strips also have a control line which is always dark in color. However, the key difference between a pregnancy test and an LH strip is the fact that LH is always present (whereas the pregnancy hormone hCG is not.) So, with an LH strip, a pale pink test line indicates a negative whereas a dark pink test line (which is as dark as, or darker than the control line) indicates a positive. 

But here’s the catch… LH surges for most women last multiple days. (Studies show an average of 4.8 duration.) Typically over this timeframe, the LH levels rise rapidly, peak, and then fall back down to baseline. While the actual length of the LH surge varies from woman to woman, the key factor here when predicting ovulation is to pay attention to the beginning of the LH surge rather than the peak. It’s the dramatic rising nature of LH that triggers ovulation, not the absolute maximum (as we have already discussed that the peak itself can vary in magnitude from woman to woman, as well as throughout a woman’s life, depending on the season of her fertility).

To flush this out a little bit more:

• One woman might have a 4-day LH surge with the peak occurring at the 48-hour mark
• Another woman might have a 1-day LH surge with the peak occurring at the 12 hour mark

Although the day of the peak itself varies in this scenario by over a day and a half, the important thing is that the beginning of the surge falls on the same day for both women. Because ovulation occurs roughly 12 to 36 hours after the start of the surge, both of these women would have ovulation happening on the same day. But for the first woman, her LH surge didn’t peak until after she actually ovulated. 

The real kicker is that this, statistically speaking, is the norm:

Medical researchers have found that for roughly 94% of ovulating women, LH peaked 1.2 days after ovulation already occurred. (Study link)

This means that if you are relying on the peak day, meaning the day that your LH strip is the darkest rather than the first day that you get a positive, and you are timing, your TTC efforts according to this, there is a very good chance that you will not be having sex until after ovulation has come and gone. Which means you aren’t going to get pregnant even if you have a perfectly healthy egg and a perfectly healthy sperm. (Chances of conception on the day after ovulation are 5% or less.)

Now this is an area of confusion that I often see among patients, in my real life conversations, and online. While many LH strips delineate the first positive day as being of highest importance in their instructions, the whole thing gets a little bit confusing because the test strips don’t provide numerical values; they simply use an analog, observation-based indicator. For women who are new to using LH strips, the color gradient can be kind of confusing. 

But let’s say you are among the women who know to count from the day of the first positive test. Well, because of the whole individual variation principle, and because of the variation among test sensitivity on LH strips from different manufacturers, you still might accidentally be missing the start of your LH surge. Here’s why…

How LH Strips Work 

I touched on this a little bit earlier, but to go into a bit more detail:

In an LH strip assay, urine flows across the strip and carries LH molecules toward antibodies attached to colored particles. The LH binds to these color-labeled antibodies, forming pink LH–antibody complexes. These complexes continue moving until they reach the test line, where another set of antibodies captures them. The accumulated colored particles produce the visible test line, with more LH generally producing a darker line. A separate control line confirms that the sample flowed correctly and the assay functioned properly.

Just like pregnancy test, which come indifferent sensitivity levels (i.e. 6.3 mIU/mL for the First Response Early Result compared to 25 mIU/mL for most standard tests and “internet cheapies”) LH strips can come in different sensitivity levels, generally ranging between 10 and 40 mIU/mL. An LH strip with a lower detection limit. (i.e. 10 mIU/mL) can pick up on lower level levels of LH hormone in the urine and will provide a brighter or darker test line. Meanwhile, an LH strip with a lower sensitivity. (i.e. 40 mIU/mL) will pick up LH in urine only when it has a higher level. Therefore, the same concentration of LH in the same urine sample would show up differently on these two tests: a darker line on the higher sensitivity LH strip (10 mIU/mL) and a lighter line on the lower sensitivity LH strip (40 mIU/mL).

If you are somebody who has a generally lower LH level and a comparatively lower peak, LH strips are going to show up lighter overall than someone who has a generally higher LH level. If you are using a high sensitivity test, this shouldn’t be a problem as it’s going to show test lines of the appropriate darkness and identify the beginning of your surge without issue. Like anyone else, your line will get darker as you reach the peak–but as we have already covered, it is the beginning of the surge that matters the most. This means that for the high sensitivity (10 mIU/mL) LH strip, the test line is equivalent in shade to the control line. But sometime thereafter, the test line would get darker than the control line (around your peak). However, if you were to use a lower sensitivity LH strip (i.e. 40 mIU/mL), your test line might not be dark enough at the start of your surge to indicate a positive test (as identified by a test line of equivalent darkness to the control line) even though, biologically speaking, the LH surge has started. 

In other words, you might not see a positive until you reach the peak of your LH surge which–if you are like the 94% of women in the world, is 1.2 days after ovulation rather than 12 to 36 hours before.

Understanding LH Strips in Real Life

Let’s take a look at this chart made using an Inito fertility monitor, which provides numerical data for all four fertility hormones (LH, estrogen, FSH and PdG, which represents progesterone).

As you can see on this chart, the purple line (LH) has risen dramatically from baseline levels. (This isn’t evident in the photo, but the day prior, the LH level was 0.08 mIU/mL). Having risen to 3.14 mIU/mL, it increased by several orders of magnitude, indicating the beginning of the LH surge. This indicates that ovulation will occur within 12-36 hours.

Now, let’s compare that same test to a standard, analog, over-the-counter LH strip:

The LH strip at the top of this photo was taken on the same day, with the same urine sample as the Inito reading. According to the definition of “positive” being the test line as dark as the control, this test would not be considered positive.

But we know that it is, because of the several days of preceding data identified with the Inito monitor.

Now let’s move on to the next day in this cycle:

On this next day, the Inito fertility monitor identified an LH level of 19.37 mIU/mL (corresponding to the peak of the surge) and the standard, over-the-counter LH strip turned positive (as evidenced by the bottom strip in the photo on the right, where you can also see the old, dried out strip from the day prior for comparison). The Inito identified the start of the LH surge on cycle day 12, whereas the OTC LH strip was negative. In reality, ovulation occurred sometime thereafter, and was likely complete by the time the LH surge reached its peak on day 13. The OTC LH strip did not identify a positive until cycle day 13, but as we know from Inito, ovulation had already likely occurred.

Here’s another example with Inito. In this cycle, the LH surge was identified on cycle day 16, with both the peak and the first positive taking place on the same day. In this case, the standard OTC test strip would be positive too.

Do you see the problem?

In short, standard, over-the-counter LH strips are great if you’re someone with a generally high LH level, but they may miss the start of the surge for women with lower levels (or more dilute urine). Missing the start of the surge by just one day could mean missing the day of ovulation altogether.

Of course, the obvious way around this is to make sure that you’re having intercourse (or, as it’s more commonly referred to on the online forums, “baby dancing”) daily throughout your fertile window. (If you don’t know when that is, I would suggest starting as soon as your period ends and continuing until you’re sure you’ve ovulated, whether via monitoring cervical mucus, basal body temperature, or with a device like Inito.)

Alternatively, you could check the sensitivity of your LH strips.

LH strips come with different sensitivity levels. When in doubt, use a high-sensitivity strip. Here are a few options:

• The Inito Fertility Monitor, which provides numerical data up to two tenths of a decimal (0.01 mIU/mL) for LH, plus the other 3 fertility hormones
• PreMom Quantitative Ovulation Predictor Kit and LH Strips which range from 0-65 mIU/mL
• Clearblue Advanced Digital Ovulation Test, which is sensitive to 40 mIU/mL
• Easy @ Home LH Strips, which observe 25-30 mIU/mL

The Bottom Line on LH Strips

If you’re using LH strips to time conception, don’t wait for the darkest test line to start trying. Pay attention to your month-to-month averages, and make sure you’re TTC well before your LH strips show a positive. View the LH positive as a signal for when you can stop trying (a few days after your positive) rather than a signal to start. Because a standard LH strip may miss the earliest part of your surge, consider testing more frequently as you approach your fertile window, and choose a more sensitive or quantitative test if your strips tend to turn positive late.

Most importantly, don’t put all your timing eggs in one hormonal basket: combine LH testing with cervical mucus, cycle patterns, or another method of confirming ovulation. The goal isn’t to perfectly predict the moment the egg is released, but to make sure sperm are already there waiting when it happens.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post Are You Using LH Strips Wrong? appeared first on Dr. Alexandra MacKillop.

What all these symptoms have in common is the indication that a person may be suffering from a form of chronic stress commonly known as “adrenal fatigue.” While it’s important to keep in mind that the cause behind these symptoms is not always adrenal fatigue (many other health concerns can present with these symptoms,) adrenal fatigue is a common topic that comes up in the Functional Medicine conversation.

Because the goal of Functional Medicine is to restore the body to optimal function, understanding adrenal fatigue first requires some context about how the body’s stress organs and stress responses ordinarily function under optimal circumstances.

Understanding Your Body’s Stress Response

The human nervous system always occupies one of two stress-related states—parasympathetic and sympathetic—commonly referred to as the “rest-and-digest” state or the “fight-or-flight” state, respectively.

During moments of relaxation, the parasympathetic nervous system is activated, and we enjoy all of our bodies’ healthy, restorative, balancing physiological functions. These include digestion, low blood pressure and heart rate, fertility, and a feeling of peace and calm.

During periods of stress, the sympathetic nervous system or “fight-or-flight” system becomes dominant, increasing heart rate and blood pressure, and slowing down bodily functions that are not essential in overcoming the stressor.

While it is both normal and expected for us to face periods of stress throughout our lives (maybe even on a daily basis, to some extent), staying in the sympathetic state for too long or facing stress triggers too frequently can lead to health problems that often bring debilitating symptoms.

What is Adrenal Fatigue?

Life stress comes in many different forms, though we often think of it in terms of psycho-emotional factors such as work demands or relational strains. However, the stress response in the body may also be triggered by illness, exertion (including intense exercise), nutritional inadequacies (especially under-eating), and more.

When a healthy person faces stress in his or her life, the body’s natural stress system (the sympathetic division of the nervous system) is well equipped to handle it. In a healthy stress response, the brain sends signals to a pair of glands located in a person’s abdomen, triggering the release of stress hormones. These hormones, including adrenaline, cortisol, DHEA and more, then enter the blood stream and travel throughout the body to create changes such as slowed digestion, elevated blood pressure, dilated pupils, an increased heart rate and breathing rate, increased mental focus, and more.

Once the stress trigger is overcome, everything is then free to relax: the adrenal glands stop producing the high level of stress hormones, and we resume our status quo.

The Stages of Adrenal Fatigue

When a person is exposed to too much stress—that is too long, or too frequently—the body’s stress response falls into dysfunction. This dysfunction follows a predictable pattern, culminating in a set of symptoms commonly known as adrenal fatigue:

• Stage 1: In the first stage of chronic stress, the body’s stress response becomes overactive, in a sense. This means that the release of stress hormones in response to a trigger increases more quickly than usual and remains elevated even long after the stress trigger has resolved.
• Stage 2: In the second stage of chronic stress, after the body has been stuck in a heightened stress state for a period of time, the body begins to lose track of what is and is not an appropriate reason to elicit a response. This results in a functionally backwards pattern in which the body triggers stress hormones to be released during times when no stress trigger exists; likewise, in situations in which a person might expect to feel triggered, the body fails to produce the appropriate stress response.
• Stage 3: In the third stage of chronic stress, the body altogether fails to produce a normal stress response. Even when real triggers are present, the nervous system fails to communicate with the adrenal glands properly, which subsequently fail to produce sufficient levels of stress hormones. The symptoms that accompany this stage are often referred to “burnout” or “adrenal fatigue,” but the medical term for all three stages of the chronic stress syndrome is hypothalamic-pituitary-adrenal axis dysfunction, or HPA axis dysfunction.

The timeline for progression through the three stages of HPA axis dysfunction—and chronic stress—looks different for different people, and depends on factors like age, biological sex, co-existing diagnoses, and personal history. This means that some people facing chronic stress may progress quickly to stage 3, possibly within just a few months, but others may not reach that point for years.

What Are the Symptoms of Adrenal Fatigue?

The specific symptoms may likewise differ from person to person, but most people experience some of the following:

• Body aches and pains
• Hair loss
• Headaches or migraines
• Skin discoloration
• Weight gain or weight loss
• Loss of libido and/or motivation
• Anxiety or depression
• Frequent respiratory infections
• Low blood pressure
• Dizziness
• Fatigue
• Mental confusion (i.e. “brain fog”)
• Insomnia

What Causes Adrenal Fatigue?nbsp;

Chronic exposure to psycho-emotional stress is the most commonly known cause of HPA axis dysfunction, though it is not the only one. Excessive exercise, inadequate nutrition habits (especially undereating), use of stimulants such as caffeine or nicotine, poor sleep habits, use of certain medications, and other lifestyle habits may also contribute to the development of adrenal fatigue. For most patients, it is a combination of triggers over time that ultimately predisposes them to develop symptoms.

However, the symptoms of adrenal fatigue are not unique to HPA axis dysfunction. This means that other conditions may be the true root cause. Other conditions that may contribute to the development of these symptoms include:

• Thyroid dysfunction
• An imbalance in gut bacteria
• Nutritional deficiencies
• Clinical depression, anxiety, or other mood disorders
• Adrenal diseases such as Addison’s Disease
• Neurologic disease
• Autoimmune disease
• …and more!

Because the of the diversity of potential causes underlying a person’s symptoms, it’s essential to not assume that adrenal fatigue is the correct label. Functional Medicine Doctors at Aligned Modern Health are committed to an evidence-based approach, which means that we run diagnostic tests with our patients so that we can make accurate diagnoses and put together a safe, effective, and minimally invasive treatment plan for our patients.

How Does Functional Medicine Test for Adrenal Fatigue?

Testing for adrenal fatigue involves a combination of blood test and specialty diagnostic testing through saliva. Depending on a patient’s symptoms and history, his or her Functional Medicine Doctor may order some additional or alternative tests in order to rule out the possibility of other conditions. The most common test used in suspected cases of HPA axis dysfunction is a saliva test which a patient completes by collecting saliva samples in small tubes at different periods throughout the day. These tubes are then sent to a laboratory for analysis of hormone levels, and the results are then assessed by the doctor in making a diagnosis and putting together a treatment plan.

How Does Functional Medicine Treat Adrenal Fatigue?

Because everybody is different and the underlying factors contributing to HPA axis dysfunction vary so widely from person to person, treatment plans likewise look different for each patient. However, every treatment plan will involve a variety of lifestyle interventions (nutrition, exercise, sleep hygiene, stress management) and nutraceuticals (clinical-grade herbs and supplements) to help support the body in healing. Some patients may also be referred for co-management with other providers, such as an acupuncturist or nutritionist.

If you are struggling with symptoms that you suspect may be related to chronic stress or anything else make an appointment with a functional medicine doctor for a thorough workup. Personalized diagnosis and treatment is the only way to get to the bottom of your symptoms and truly get the care you deserve.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Stages of Adrenal Fatigue appeared first on Dr. Alexandra MacKillop.

Are you wondering how to make kombucha from scratch Here’s everything you need to know.

As a functional medicine doctor, one of my favorite conversations with patients is about gut health and using naturally fermented foods to boost well-being in all systems of the body. The truth is, nearly all aspects of our health relate to our gut microbiome and the function of our guts, and fermented foods play a key role in keeping our gut healthy. My favorite foods to support gut health are homemade yogurt, fermented vegetables, and yes, kombucha, which I even give to my kids. But here’s the thing: there are tremendous benefits not just from drinking kombucha, but also in learning how to make kombucha from scratch. When you know how to make kombucha from scratch you get to control the ingredients, and flavor, but the actual fermentation culture morphs in ways that help reduce allergies and support gut health even more than store-bought varieties. This is exactly why I recommend that everyone I know learn how to make kombucha from scratch. Homemade is the ultimate form of food as medicine.

What is Kombucha?

Kombucha is a fermented tea made with brewed tea, sugar, and a SCOBY, an acronym which stands for symbiotic culture of bacteria and yeast. When you learn how to make kombucha from scratch, you see firsthand how this living culture transforms sweet tea into a tangy, effervescent, health-promoting drink. Kombucha tastes lightly sour, slightly sweet, and naturally fizzy. Many people drink it as an alternative to soda, for digestive support, or for a gentle energy boost without the crash that comes from coffee. It’s grown in popularity over the past decade or so, and because of this, it can be quite pricey (up to $4 or $5 per bottle!) It’s much less expensive to make it at home, and this is another reason that so many people want to lear to make kombucha from scratch.

Health Benefits When You Make Kombucha from Scratch

From a functional medicine perspective, the health benefits of kombucha include improved digestion, support for gut microbial diversity, organic acids like butyrate that help balance harmful bacteria and repair the gut lining, and antioxidants from tea polyphenols. When I’m asked why someone would want to make kombucha from scratch, I explain that homemade kombucha often contains more active enzymes and beneficial compounds than store-bought versions.

There are additional advantages when you learn how to make kombucha from scratch at home. First, the SCOBY becomes stronger and healthier SCOBY over time, which improves fermentation quality. You can’t buy time at the grocery store, which is a godo reason to learn to make kombucha from scratch at home.

The most important reason to make kombucha from scratch, though, is because the culture changes and adapts based on the environment. In grocery store kombucha, the food manufacturers use the same bacteria and the same fermentation conditions exactly the same way for every, single batch. This is a good thing because then their products taste exactly the same, every time. I don’t know about you, but if there’s a product I love, I am not very happy when it tastes different without warning. However, the limitation of a standardized bacterial culture is that it is only adapted to the temperature-controlled fermentation chamber; it doesn’t pick up any diversity of strains based on the environment. When you make kombucha from scratch, though, the SCOBY and the fermentation medium pick up strains of bacteria and yeast from your house, and this educates your own immune system how to learn to “tolerate” non-self material. Allergies and intolerances are the epitome of immune system intolerance, meaning that our immune systems wrongly react against normal, healthy things in our environments. Consuming home-fermented foods allows our guts to become exposed to these allergens in controlled, healthy ways, supporting overall immune health and reducing the propensity to develop and react to allergens. With allergies on the rise, the fact that I know how make kombucha from scratch, is, as I see it, one of the best skills for helping to support my children’s health.

How to Make Kombucha from Scratch

To make kombucha from scratch, you will need the following ingredients and equipment:

• Filtered water
• Black (or black and green) tea (tea bags or loose leaf)
• Organic cotton strainer, if using loose leaf tea
• Sugar (I recommend organic cane sugar)
• A large, 1-gallon glass jar for fermentation (do not use the kind with a spout, as this is hard to clean and can harbot bacteria)
• Cheese cloth or paper towels
• A large rubber band
• Kitchen funnel
• Glass bottles, with seals
• A SCOBY (synbiotic colony of bacteria and yeast) with cultured kombucha
• A cool, dark space for fermentation

Choosing the Tea

The basic process for how to make kombucha from scratch starts with tea selection. Black tea works best because it provides caffeine and nitrogen (tannins) that the SCOBY needs. If you do choose to use green tea, it’s recommended to use half green tea and half black tea to provide a source of the tannins. Without them, the SCOBY may die. If you’d like to use exclusively green tea, it is recommended to use a “Jun SCOBY.”

When using tea, it is important to only use pure tea, not flavored teas or aromatic black teas like Earl Grey/Lady Grey/Bergamot tea or Jasmine Green Tea (which are flavored with citrus oils that can suffocate the SCOBY; see below).

Herbal teas should be avoided, as they lack the nutrients required for proper fermentation and often contain essential oils which can suffocate the culture. (Oils rise on top of the liquid and block oxygen from getting to the SCOBY, suffocating it.) If you’d like to flavor your kombucha, use a second ferment with fruit juice (see below).

A note about tea bags: Tea bags notoriously leach plastic and endocrine-disrupting chemicals into the tea. When learning how to make kombucha from scratch, you have the power to take steps to avoid this sort of contamination. I recommend using loose-leaf tea, or cutting open the tea bags and pouring into an organic cotton straining bag instead. Alternatively, you could brew the loose leaf tea and then pour through an unbleached coffee filter.

Sugar

Sugar is necessary to make kombucha from scratch because it feeds the yeast and bacteria. Using honey, maple syrup, or artificial sweeteners disrupts fermentation and may cause mold or kill the SCOBY, which is why traditional sugar is essential when starting to make kombucha from scratch. I recommend using organic, unbleached cane sugar. If you’re worried about sugar intake, don’t be! Properly prepared kombucha means that the bacteria consume most of the sugar through the fermentation process, so although the finished product tastes slightly sweet, it has much less sugar than the ingredient list calls for.

Flavor Variations

The recipe on this page explains how to make kombucha from scratch, but it is for making plain kombucha. Plain kombucha can be flavored in 3 ways. The first and most common is with a second cycle of fermentation. To do this, bottle the finished, plain kombucha with a small amount of fruit juice and return it to the fermentation location for another few days (we like to do about 7 days with a ratio of 4 parts kombucha to 1 part juice) before moving to the refrigerator. Avoid using citrus juices as these may contain citrus oils that may suffocate the culture. Do not use this flavored kombucha to bulk ferment with a SCOBY, as it can hurt the SCOBY and increase risk of mold growth.

The second way to flavor kombucha is by serving with a fresh slice of lemon or some frozen fruit as “ice cubes” to impart flavor after the kombucha is finished.

The third way to add flavor to kombucha from scratch is by mixing it into a “mocktail” with a splash of fruit juice, some seltzer, and maybe a glass with a salted rim. Get creative or look up some tried-and-true favorites online.

A note about kombucha flavor: the relative acidity and sweetness of the kombucha can also be adjusted based on fermentation time. The longer the kombucha ferments in the initial phase, the more acidic (like vinegar) and less sweet it will become. If you leave the kombucha too long, it may turn into vinegar and kill the SCOBY. The first round of fermentation typically ranges from 7-14 days. My family tends to prefer a shorter time, closer to 8 or 9 days. If it tastes too acidic (or if I ferment it longer) I typically dilute it with water before serving. When performing a second ferment with fruit juice, I usually opt for an additional 5-7 days, but you can go up to 10.

How to Make Kombucha from Scratch: Troubleshooting

Sometimes, the kombucha SCOBY can become contaminated and grow mold. It is not safe to drink kombucha with a moldy SCOBY. Mold appears fuzzy and blue, green, or black. If you see mold, discard the batch. Stringy brown strands are normal yeast and are part of healthy fermentation.

The SCOBY should always appear smooth and “wet,” but will likely be multicolored with different areas of brown, beige and tan. This is all normal. Anything that looks “dry” or furry is not. When it doubt, throw it out and start again.

That being said, contamination is rare when you use properly cleaned and sanitized equipment. Basic kitchen hygiene practices are an essential piece of learning how to make kombucha from scratch! That being said, you should never bleach your equipment, as residual bleach may kill the culture. Instead, scrub with a soapy sponge, rinse well with hot water, and sanitize with boiling water. Then, air dry completely before using the equipment.

Storing Kombucha

Prepared kombucha really can last indefinitely in the refrigerator, but develops off flavors if left too long. We typically consume within 3 months.

How to Get a SCOBY

The best way to get a SCOBY to start brewing kombucha from scratch is by knowing a friend who can share a SCOBY with you. However, if you don’t know of a home-brewing friend, you can make one yourself using prepared plain kombucha. See this blog post for details: How to Make a SCOBY (from scratch!)

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How to Make Kombucha from Scratch

How to make gut-healthy kombucha at home from scratch with natural ingredients and a SCOBY

Prep Time 15 days days

Cook Time 10 minutes minutes

Servings 6 cups

Equipment

• 1-Gallon Glass Jar
• Cheese cloth
• Rubber band
• Glass bottles with pop seal
• Funnel

Ingredients

• 8 cups Filtered water boiling
• 4 teaspoons Black tea or 4 tea bags
• 1/2 cup Cane sugar organic, unbleached
• 1 SCOBY
• 1/2 cup Brewed kombucha with cultures

Instructions

Brew Kombucha (First Ferment)

• Sterilize the 1-gallon jar and any measuring cups you plan to use.
• Brew half-strong tea for 2-5 minutes by combining 8 cups boiling water and 4 teaspoons loose leaf tea (or 4 tea bags).
• Remove tea bags, straining cloth, and/or tea leaves.
• While tea is still hot, stir in sugar using a clean metal spoon until dissolved.
• Allow tea to cool completely to room temperature.
• Pour cooled tea into the clean 1-gallon glass jar. Add SCOBY and the 1/2 cup prepared kombucha with cultures.
• Cover with cheese cloth and a rubber band and place in a cool, dark place to ferment for 7-14 days, according to taste preference. Check daily for mold growth and to taste-test.
• When the kombucha reaches your desired flavor profile, either pour into jars and refrigerate, or proceed to the second fermentation step. Reserve SCOBY and 1/2 cup of liquid from the bottom of the jar, which contains most of the culture strands to repeat this step for additional fermentation cycles.

Second Fermentation Step (optional)

• Sterilize glass bottles with boiling water.
• Fill the bottles about 2/3 full with prepared kombucha.
• Fill the bottles the rest of the way with fruit juice, leaving 1 inch of headspace.
• Seal bottles and return to the fermentation location for another 5-10 days, or until desired flavor profile and effervesence is achieved.
• Store finished, flavored kombucha in the refrigerator. Do not use flavored kombucha to bulk ferment kombucha using a SCOBY.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post How to Make Kombucha from Scratch appeared first on Dr. Alexandra MacKillop.

If you already know how to make kombucha from scratch but don’t have a SCOBY to get started, the next natural question is how to make a SCOBY at home. The good news Learning how to make a SCOBY is surprisingly simple and easy, requires very few ingredients, and is an empowering step toward truly DIY fermentation.

As a functional medicine doctor, I love teaching patients how to make a SCOBY because it reinforces an important concept: our bodies thrive when we work with microbes, not against them. Making your own SCOBY at home allows beneficial bacteria and yeast to adapt to your environment, supporting gut and immune health in ways store-bought cultures simply can’t.

What Is a SCOBY?

A SCOBY is a Symbiotic Culture of Bacteria and Yeast. It’s the living fermentation starter that transforms sweet tea into kombucha. When making a SCOBY, you’ll see this culture form gradually as bacteria and yeast from prepared kombucha colonize fresh tea and sugar, creating a new, rubbery disc at the surface of the liquid.

This natural process of fermentation is what has worked for thousands of years. The bonus is that when you make it today, you are combining ancestral history with your own modern environment for immune support and gut health that transcend the bounds of time.

Why Learn How to Make a SCOBY from Scratch?

Many people ask why they should bother learning how to make a SCOBY instead of buying one. From a functional medicine perspective, there are several important reasons:

• Homemade SCOBYs adapt to your home environment, so the microbial community becomes more diverse over time
• You avoid preservatives or processing used in commercial cultures
• You gain a deeper understanding of fermentation and food as medicine
• If you don’t know someone who has a SCOBY to share, you might be limited to buying one online. That can carry risks. Making a SCOBY from scratch is also a safety measure!

What You’ll Need to Make a SCOBY

You will need to following materials to make a SCOBY:

• 1 quart (4 cups) filtered water, boiling
• 2 black tea bags or 2 teaspoons loose-leaf black tea
• ¼ cup organic cane sugar
• 2 cups plain, unflavored, raw kombucha (store-bought or homemade)
• 1 wide-mouth glass jar (ideally 1-gallon size, as you’ll be using this to brew kombucha in the future)
• Cheese cloth or paper towel
• Rubber band

The quality of your kombucha matters here. For best results when making a SCOBY, choose kombucha that is raw, unpasteurized, and free from added juices or flavors.

Step-by-Step: How to Make a SCOBY

1. Brew the Sweet Tea

Bring the water to a boil, steep the tea for 2–5 minutes, then remove the tea (bags). Stir in the sugar while the tea is hot, allowing it to dissolve completely. Let the tea cool to room temperature.

This is critical, as hot liquid can damage beneficial microbes.

2. Add the Kombucha

Once cooled, pour the sweet tea into your glass jar and add the prepared plain kombucha. This inoculates the tea with the bacteria and yeast needed to begin forming a SCOBY.

3. Cover and Ferment

Cover the jar with a breathable cloth secured by a rubber band. Place it in a warm, dark location away from direct sunlight for 10-14 days.

Now the real magic begins.

What to Expect During SCOBY Formation

Within 3–7 days, you may notice a thin, cloudy film forming on the surface. This is the early stage of SCOBY development. Over the next 1-2 weeks, that film will thicken into a solid, rubbery disc. Cooler temperatures may slow the process, while warmer environments speed it up.

A finished SCOBY is typically ¼–½ inch thick and smooth in appearance. Brown strands or sediment beneath it are normal and healthy. As you use the SCOBY to brew kombucha, additional layers will form, right on top of each other. You can peel these layers off and share them, along with 1/2 cup of brewing liquid, with friends and family so that they can brew their own kombucha.

Troubleshooting

If you see fuzzy blue, green, or black growth, that is mold—not good. Discard the entire batch and start again. Pay attention and make sure that you use clean equipment sterilized with hot water. Do not use bleach, and make sure that any soap is thoroughly washed off before sterilizing.

Healthy SCOBYs look wet, glossy, and cream-colored to tan. When in doubt, trust your instincts.

Using Your Homemade SCOBY

Once you’ve successfully made your SCOBY, you can use it to brew your first full batch of kombucha. The liquid underneath your SCOBY is now strong starter tea and should be saved for future batches.

Over time, your SCOBY will grow and form layers. These “baby” SCOBYs can be shared, stored, or used to continue brewing.

Final Thoughts

Learning how to make a SCOBY is one of the most empowering skills you can develop in your fermentation journey. It connects you to traditional food preparation, supports gut and immune health, and reinforces the idea that healing often starts in the kitchen.

When we invite beneficial microbes into our homes through intentional fermentation, we’re teaching our immune systems tolerance, resilience, and balance. And that, in my view, is true food as medicine.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Make a SCOBY (from Scratch!) appeared first on Dr. Alexandra MacKillop.

Early awareness of signs of pregnancy before missed period depends on pattern recognition rather than a single symptom. It’s common to have one of these signs or symptoms at nearly any time throughout the month. However, when many occur at once during your two-week-wait, you should pay attention—though of course you will still need to take a test to confirm.

Symptoms-Related Signs of Pregnancy Before Missed Periods

1. Tender Breasts

Breast tenderness ranks among the most reported signs of pregnancy before missed periods. Rising progesterone and estrogen increase blood flow and glandular activity within breast tissue, leading to fullness, sensitivity, or a heavy sensation. Observation requires no tools, only awareness of changes that differ from a typical premenstrual pattern. In other words, if you don’t normally experience breast tenderness before your period but this month you do, pay attention. It could be pregnancy. Other explanations include luteal phase progesterone surges, high prolactin from stress, caffeine excess, or a new exercise routine.

• Research Brief: 76% of pregnant women experience breast pain or tenderness during the first trimester, whereas research on US women noted that only 69% experience it as a PMS symptom.

2. Mood Changes (Atypical for You)

Mood shifts often appear early among signs of pregnancy before missed period. Neurotransmitter signaling responds quickly to progesterone metabolites, influencing emotional processing, irritability, tearfulness or just a greater overall emotional sensitivity. One good way to identify if changes in mood could be a sign of pregnancy is by tracking mood daily through journaling. Mood changes are common during pregnancy, but if you notice a change in the intensity or type of moods you experience, it could be a sign to pay attention to. Other causes of mood variation include PMS, sleep disruption, blood sugar instability, or psychosocial stress. For most of us, our moods change day-to-day. However, a pattern that feels distinctly different from prior cycles carries more weight.

• Research Brief: A large international study showed that up to 64% of women experience mood changes in the premenstrual period. In contrast, a global study revealed that the prevalence of depression, anxiety and stress in the first trimester averages about 27%. Depending on your individual situation, a lack of mood swings in the premenstrual window when you usually have them may be more of a flag for possible pregnancy.

3. Vivid Dreams

Intensified or unusually vivid dreams frequently accompany signs of pregnancy before missed period. High levels of progesterone alter sleep architecture, increasing REM density and dream recall. Noticing this change involves subjective reporting rather than measurement. Relative accuracy stays low to moderate. Similar dream changes follow melatonin disruption, magnesium deficiency (or supplementation), late-night eating, or anxiety.

• Research Brief: The research here is somewhat limited, so we need to draw some extended lines. But here’s what we know: across both genders, about 54% of people report frequently recalling their dreams. On the other hand, up to 91% of pregnant women report dream recall. This may be due to hormonal reasons, a lack of REM sleep, interrupted sleep, among others.

4. Cramping and Spotting

Mild uterine cramping or light spotting often reflects implantation and ranks among classic signs of pregnancy before missed periods. Implantation typically occurs 6–10 days after ovulation, triggering localized inflammation and capillary disruption. That being said, many women do report cramping or spotting before their periods. “Implantation bleeding” is typically light pink or brown spotting that resolves quickly, and tends not to be bright red. Premenstraul bleeding gets progressively heavier. Cramping when you don’t usually experience it before your period (or during) is certainly something to pay attention to. That being said, women with adenomyosis or endometriosis are more likely to experience cramping during times of the month when they aren’t actively bleeding. Other causes of bleeding include luteal phase spotting from low progesterone, cervical irritation, or ovulation-related bleeding.

• Research Brief: There actually is no research identifying the prevalence of premenstrual cramping, meaning cramping that occurs before your period starts. Regarding spotting, only roughly 6% of women report premenstrual spotting. Notably, this isn’t normal and actually should be evaluated. (More on this in my book, Go with Your Flow.) On the other hand, approximately 25% of pregnant women are reported to experience vaginal bleeding in the first trimester.

At-Home Signs of Pregnancy Before Missed Periods

1. Cervical Position

Cervical height and texture change in response to estrogen and progesterone, making this a useful at-home marker among signs of pregnancy before missed period. During early pregnancy, the cervix tends to feel higher, softer, and more closed. When performing this self-check, make sure you have clean hands and a habit of checking cervical position before the two-week-wait when trying to conceive. Ovulation, arousal, and infection also influence cervical position. Learn more about checking cervical position for fertility or as an early sign of pregnancy in my book, Go with Your Flow.

2. Increased Basal Body Temperature (BBT)

Sustained elevation in basal body temperature ranks among the most objective signs of pregnancy before missed period. Progesterone raises resting temperature after ovulation; pregnancy maintains that rise beyond 14 days. One of the best ways to identify pregnancy without a urine test is with a sustained temperature past 18 days post-ovulation. This is an extremely accurate predictive method for those who regularly track their cycles with basal body temperature. Fever, alcohol intake, poor sleep, or thyroid imbalance also elevate BBT.

• Check out this post: Basal Body Temperature 101

3. Increased Resting Heart Rate (RHR)

Resting heart rate often climbs early among signs of pregnancy before missed period due to increased metabolic demand and plasma volume expansion. Wearable devices (like a FitBit or Apple Watch) or morning pulse checks with a pulse oximeter are two ways to track RHR and identify changing patterns. A sustained increase of 3–10 beats per minute compared with baseline could be suggestive of early pregnancy. Because heart rate changes rapidly, this method is not as predictive or accurate as BBT. Dehydration, overtraining, illness, or stimulant use also raise RHR.

Lab-Based Signs of Pregnancy Before Missed Periods

Laboratory markers offer higher specificity among signs of pregnancy before missed period, especially when interpreted within clinical context. Of course the best and most accurate measure is with blood test for beta-hCG. However, I’ve accidentally identified pregnancy in patients who weren’t actively trying to get pregnant through these routine hormone blood tests.

1. High Prolactin

Prolactin supports breast development and milk production during early pregnancy. Nonpregnant reference ranges typically fall between 5–20 ng/mL. Early pregnancy often shows levels above 20–30 ng/mL. Prolactin is evaluated through a fasted morning blood test. However, high levels aren’t always a sign of pregnancy; elevated prolactin also appears with pituitary adenomas, hypothyroidism, chronic stress, or certain medications, so correlation matters.

2. Elevated Progesterone

Progesterone sustains the uterine lining and plays a central role in sustaining a pregnancy. Luteal phase values often range from 5–20 ng/mL, though they ideally sit between 12 and 20 ng/mL. Early pregnancy usually maintains levels above 10 ng/mL, often rising toward 20–40 ng/mL within weeks. Serum testing around 7–10 days post-ovulation offers useful insight. Supplement use, ovarian cysts, or timing errors also influence results.

Note: If you know you are pregnant and your progesterone level is lower than 15 ng/mL, this may be a miscarriage risk. Talk to your provider and learn more about ways to boost progesterone for fertility.

3. Rising Estrogen

Estradiol supports placental development and vascular growth, contributing to many signs of pregnancy before missed period. Typical luteal phase values range from 60–250 pg/mL. Early pregnancy often pushes levels above 200–600 pg/mL, with a steady upward trend. Blood testing works best when compared against prior cycle baselines. Estrogen dominance, ovarian hyperstimulation/cysts, or liver clearance issues also raise estradiol levels.

Putting the Signs Together

Of course, no single marker confirms pregnancy before a missed cycle unless that marker is directly testing hCG, the pregnancy hormone. However, a careful eye looking through a functional medicine lens can identify signs of pregnancy before missed periods by evaluating cycle history, nutrition, stress load, and metabolic health. When multiple symptoms, at-home observations, and lab trends align, it can help create hope during the two-week-wait.

If you’re seeking clarity, knowing the how’s and why’s behind these signs of pregnancy before your missed period empowers you to know your own body and understand your physiology on a deeper level. Tracking patterns over several cycles will improve the predictive power of these strategies and help you to know what is, and isn’t normal when deviations pop up. Of course, if you’re concerned about preconception signs and symptoms or anything else concerns you about your health, make an appointment with a trusted healthcare provider so that you don’t have to navigate your journey alone.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Signs of Pregnancy Before Missed Period: Your Complete Guide appeared first on Dr. Alexandra MacKillop.

Genetic testing often enters the fertility conversation through IVF, when embryo testing before transfer identifies certain chromosomal and inherited risks. Many couples appreciate this information, though there are potential moral concerns regarding what to do with carriers. Embryos aside, however, gene testing before pregnancy can also offer insight into a mother (or father’s) health as it applies to successful conception, miscarriage prevention, and reducing risks for the baby both before and after being born. Moreover, valuable genetic insight does not require IVF. This is great news, as most couples actively seek ways to conceive naturally and avoid invasive reproductive technology. Gene testing before pregnancy delivers similar information through the lens of functional medicine while still supporting informed and proactive choices.

Why Complete Gene Testing Before Pregnancy?

When mothers and couples have access to their genetic information, they gain clarity. This clarity pertains not just to potential diagnoses, but about long-standing health patterns and inherited vulnerabilities that may otherwise go unnoticed. Gene testing before pregnancy allows care to shift from reactive to truly preventive. Rather than waiting for complications to surface during pregnancy or delivery, couples have the opportunity to intervene early with lifestyle strategies to support their genetic, and epigenetic health.

This kind of foresight is foundational in functional medicine. Strategies like nutrient repletion, supporting detoxification pathways, reducing inflammation, and optimizing hormone balance are far more effective when they’re guided by genetics instead of reactions or guesswork. After all, you can’t correct, prevent, or support a risk you don’t yet know exists.

Who Should Consider Gene Testing Before Pregnancy?

Genetics are part of everyone’s health story. Our genes carry disease risk, but our environment and exposures throughout life, both positive and negative, influence whether those genes are expressed. High-quality nutrition, for example, can help quiet genes associated with cancer risk as well as fertility-related conditions like PCOS, endometriosis, and autoimmune disease. On the other hand, environmental toxins, chronic stress, and repeated or high-dose antibiotic use can switch these same genes on. When that happens, health can suffer in ways that directly and sometimes dramatically affect fertility.

Because of this, it’s reasonable to argue that nearly everyone can benefit from understanding their genetic health, and many may want to consider gene testing before pregnancy as part of a proactive approach to family planning.

Age adds an important layer of urgency to this conversation. After age 35, egg quality naturally declines, and genetic vulnerabilities tend to exert a stronger influence. Issues like chromosomal instability, impaired methylation, oxidative stress, and clotting tendencies can impact fertility and pregnancy outcomes more significantly. This is not just a maternal issue. Paternal genetics matter as well, since a healthy pregnancy and child require both a healthy egg and a healthy sperm.

In this post, we’ll explore five ways prospective mothers and fathers can use gene testing before pregnancy to optimize their own health and support the long-term health of their future children.

1. MTHFR (Methylenetetrahydrofolate Reductase)

One of the most commonly discussed genetic findings in preconception care involves the MTHFR gene. Variants in MTHFR can affect folate metabolism, methylation efficiency, and the body’s ability to detoxify effectively. Impaired methylation has been linked to miscarriage, preeclampsia, placental dysfunction, and neural tube defects.

Gene testing before pregnancy gives prospective parents the opportunity to identify these risks early and support detoxification and DNA synthesis before those demands increase during pregnancy. Testing for MTHFR typically identifies variants such as C677T or A1298C through saliva or blood samples. An individual may carry one copy (heterozygous) or two copies (homozygous) of a given variant, which can influence how significantly methylation pathways are affected. Insurance coverage varies and is often dependent on a history of pregnancy loss or clotting disorders.

From a functional medicine perspective, these findings guide targeted interventions, including the use of methylated folate and other B vitamins, limiting exposure to synthetic folic acid, and reducing environmental toxin burden. This becomes especially important when evaluating standard prenatal vitamins, many of which may not be appropriate for individuals with certain MTHFR variants.

2. Factor V. Leiden

Clotting genetics are another critical piece of the preconception puzzle. Inflammation and abnormal clot formation pose serious risks during pregnancy and can contribute to pregnancy loss at any stage. One of the most well-known examples is Factor V Leiden, a genetic variant that increases the tendency toward excessive clotting and can interfere with normal placental blood flow. This disruption raises the risk for miscarriage, stillbirth, fetal growth restriction, and preeclampsia.

Gene testing before pregnancy can identify whether an individual carries one copy (heterozygous) or two copies (homozygous) of this variant through blood or saliva testing. Insurance coverage often depends on family history or a record of prior pregnancy complications. When clotting risk is identified early, care can focus on reducing inflammation, supporting healthy circulation, and coordinating obstetric management, including anticoagulation when clinically appropriate.

• Treatment: Strategies usually include blood thinners (anticoagulants) such as low molecular-weight heparin (LMWH) and sometimes, aspirin. Functional medicine also offers natural benefit from higher dose fish oil. Talk to your doctor about your options for Factor V as well as mutations in Prothrombin G20210A (below).

3. Prothrombin G20210A

Another important clotting-related gene to consider is the Prothrombin G20210A mutation. This variant also increases the risk of abnormal clot formation and can compromise placental circulation. Pregnancy places significant demand on vascular health, and genetic interference in these pathways raises the risk for both maternal and fetal complications.

Gene testing before pregnancy can identify this mutation through standard laboratory testing, with insurance coverage typically following the same criteria used for Factor V Leiden. From a functional medicine perspective, this knowledge allows care to focus on prevention rather than crisis management. Targeted nutrient support, inflammation control, and proactive monitoring can be put in place early, empowering mothers to pursue appropriate maternal care long before a pregnancy complication ever occurs. As a functional medicine doctor, my #1 treatment is a whole foods, ancestral diet that includes organ meats, fish and healthy animal fats.

4. COMT (Catechol-O-Methyltransferase)

Genetics related to hormone metabolism also play an important role in fertility and overall pregnancy experience. Variants in the COMT gene influence how the body clears estrogen, regulates neurotransmitters, and responds to stress. Slower estrogen metabolism can contribute to hormone dominance, implantation difficulties, and more pronounced pregnancy symptoms. Increased stress sensitivity disrupts cortisol balance, which in turn affects immune tolerance and hormonal signaling throughout pregnancy. COMT variations may also influence how an individual responds to certain antidepressant medications, a consideration that is especially relevant given how many women are using these medications prior to conception or during pregnancy.

Gene testing before pregnancy often evaluates COMT through saliva-based genetic panels. Insurance coverage is uncommon, and self-pay rates vary depending on which other markers are involved on the genetic panels. (I’ve seen anywhere from $100 to $350). In functional medicine, these results guide strategies such as supporting estrogen detoxification pathways, improving stress resilience, and providing targeted micronutrient support. Because stress and impaired hormone metabolism can significantly challenge both conception and pregnancy, addressing these risks proactively allows many of these obstacles to be prevented rather than managed after the fact.

5. CFTR (Cystic Fibrosis Transmembrane Conductance Regulator)

Carrier screening plays a crucial role in responsible family planning. CFTR gene testing identifies carrier status for cystic fibrosis and sheds light on certain male fertility issues. An estimated 1 in 25 people is a carrier of CFTR mutations, so couples benefit from knowing this about themselves before conception. Gene testing before pregnancy uses blood or saliva samples to determine carrier status rather than disease presence. Insurance frequently covers this screening during pregnancy planning or when family history exists. Genetic counseling supports informed decisions when both partners carry variants.

Taken together, these tests form a powerful foundation for prevention, but modern prenatal care rarely encourages couples to complete this testing outside of IVF offices. However, all couples deserve to know the truth about their health so they can hopefully avoid the pain and devastation of fertility and pregnancy challenges. Gene testing before pregnancy replaces uncertainty with strategy. Each result informs nutrition, supplementation, and lifestyle choices for maximally effective preventative medical care.

Functional medicine is founded on this level of personalization. Work with a functional medicine doctor to unlock your own genetic potential to maximize your health, fertility, longevity and more.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Gene Testing Before Pregnancy: Why and How to Harness the Power of Your DNA appeared first on Dr. Alexandra MacKillop.

• What are peptides?
• Are they safe?
• How can they benefit my health?
• Where can I get them?

You can find answers to all of these questions and more in today’s article.

What Is Peptide Therapy?

Peptide therapy is a medical treatment that uses specific peptides—short chains of amino acids naturally found in the body—to target and enhance various biological functions. By mimicking or influencing natural processes, peptide therapy offers the potential to support a wide range of health goals, including improved skin health and slowed aging, accelerated injury recovery, boosted muscle growth, enhanced fat metabolism, regulated hormones, a strengthened immune system, and improved sexual function. Because peptides are highly targeted and generally well-tolerated, this form of therapy is often used in functional and regenerative medicine to promote healing, performance, and overall wellness.

The peptide therapy that has gained the most notoriety (and controversy) in recent years is the class of peptides known as GLP-1 agonist drugs. These drugs contain the active ingredient, Semaglutide, which is a peptide that looks and acts similarly to the body’s own GLP-1, and brings about many similar effects, like blood sugar control and satiety in appetite.

Other peptides provide similar mimicking effects, though they don’t all act like GLP-1. Instead, other peptides impact a wide variety of biological functions. For this reason, it’s important to remember that peptide therapy cannot be used to affect just one single function of the human body. Because these peptides affect so many other areas of the body, just like how GLP-1 affects both blood sugar and appetite, it’s impossible to isolate just one effect of a given peptide.

Many peptides are very early in their research timeline, meaning that there is very limited data available about their safety, and even how they work in the body. We may have identified some applications for use, such as one particular parameter of health (i.e. muscle recovery for BPC-157) but we have yet to understand fully how this peptide affects the other bodily systems. This is particularly the reason that peptides, especially Ozempic and other drugs akin to semaglutide that have gained notoriety, are so controversial. There’s just a lot that we still don’t know, and might never know.

However, particularly in circumstances where few good options exist, peptide therapy might prove to be one of the best options out there. Let’s discuss how peptide therapy can offer benefits, in spite of some of the potential risks.

How Can Peptide Therapy Benefit Health?

Peptide therapy can be applied across a wide range of health and wellness areas, with specific peptides targeting different physiological systems.

Anti-Aging Peptide Therapy

In the area of anti-aging and longevity, peptides such as CJC-1295, Ipamorelin, Sermorelin, collagen peptides, IGF-1, and Thymosin Beta-4 (TB-500) help boost growth hormone levels, improve skin elasticity, enhance energy, support deeper sleep, and promote overall cellular repair and regeneration.

Peptide Therapy for Sports and Recovery

For sports medicine and injury recovery, peptides like BPC-157, Thymosin Beta-4, IGF-1, GHRP-2, GHRP-6, and Hexarelin are used to accelerate healing from injuries, reduce inflammation, regenerate muscle and connective tissue, and support faster recovery times. In the context of weight management and metabolism, peptides such as AOD 9604, CJC-1295, Ipamorelin, and Carterine (GW-501516) play a role in stimulating fat breakdown, increasing metabolic rate, enhancing lean muscle retention, and improving energy levels during fat loss efforts.

Peptide Therapy for The Immune System

For immune system support and inflammation reduction, peptides like Thymosin Alpha-1 (TA1), BPC-157, and vasoactive intestinal peptide (VIP) help strengthen the immune response, reduce systemic inflammation, and support healing, especially in autoimmune or inflammatory conditions. In the area of sexual health and hormone support, PT-141 (Bremelanotide), Kisspeptin, and Gonadorelin are used to enhance libido, improve erectile function, and regulate reproductive hormones, making them useful for both sexual performance and fertility.

Peptide Therapy for Muscle Growth

Lastly, for muscle growth and performance enhancement, peptides such as Follistatin, IGF-1, GHRP-6, GHRP-2, Hexarelin, and Carterine are employed to promote muscle hypertrophy, increase strength, enhance endurance, and inhibit myostatin—a natural limiter of muscle growth. Collectively, these peptides offer a broad therapeutic toolkit for improving physical health, performance, recovery, and overall vitality.

Which Types of Conditions Benefit from Peptide Therapy?

Neurological & Cognitive Disorders

• Cognitive decline / brain fog
• Alzheimer’s disease / dementia (e.g., Cerebrolysin)
• Depression & anxiety (via BDNF-related peptides or ones that support neurotransmitter balance)
• Traumatic brain injury (TBI)

Peptides like Dihexa, Selank, and Semax are neuroprotective and enhance focus, memory, and mood.

Musculoskeletal & Injury Recovery

• Tendon, ligament, and joint injuries
• Osteoarthritis
• Post-surgical healing
• Muscle recovery & growth

Common peptides: BPC-157, TB-500 (Thymosin Beta-4) – promote tissue repair, angiogenesis, and reduce inflammation.

Anti-Aging & Longevity

• Decreased growth hormone production
• Fatigue / low energy
• Wrinkles, thinning skin

Peptides like Ipamorelin, CJC-1295, and GHRH analogs stimulate natural growth hormone production.

Metabolic & Weight-Related Disorders

• Obesity / weight gain
• Insulin resistance / Type 2 diabetes
• Low energy

Peptides: GLP-1 agonists (e.g., Semaglutide, Tirzepatide), AOD-9604 for fat loss, Motilin agonists for digestion.

Hormonal Imbalances

• Low testosterone / estrogen / thyroid
• Adrenal fatigue
• Sexual dysfunction

Peptides can modulate LH/FSH, improve libido, and optimize endocrine system. Example: Kisspeptin-10 for LH/FSH stimulation.

Immune System Modulation

• Autoimmune diseases
• Chronic inflammation
• Recurrent infections

Peptides like Thymosin Alpha-1 and Thymosin Beta-4 support immune regulation and antiviral defense.

Skin, Hair & Aesthetic Applications

• Hair loss (androgenic alopecia)
• Skin aging / damage
• Scarring

Peptides like GHK-Cu (copper peptide), Melanotan II (for tanning, though there are many documented risks), and others are used cosmetically.

Sleep Disorders

• Insomnia
• Poor sleep quality

Peptides such as DSIP (Delta Sleep-Inducing Peptide) are being explored for sleep enhancement, and even has clinical utility in management of withdrawal from alcohol and opiates.

What Are Some Types of Peptide Therapy?

Here’s a list of some common peptides used in peptide therapy and their potential benefits:

1. Growth Hormone-Releasing Peptides (GHRPs)

• GHRP-2 / GHRP-6 / Ipamorelin: These peptides stimulate the release of growth hormone (GH) from the pituitary gland, which can help improve muscle growth, fat loss, and recovery.
  • Benefits: Increased muscle mass, fat reduction, better recovery, enhanced energy.

2. CJC-1295 (Modified GRF 1-29)

• A synthetic peptide that stimulates the release of growth hormone by enhancing the action of ghrelin.
  • Benefits: Increased muscle mass, fat loss, improved skin elasticity, enhanced sleep quality.

3. BPC-157 (Body Protective Compound-157)

• A peptide that promotes healing and tissue repair. It’s often used for injury recovery.
  • Benefits: Accelerates wound healing, reduces inflammation, improves joint health, and promotes tendon and ligament recovery.

4. Thymosin Beta-4 (TB-500)

• A peptide that plays a role in tissue repair and regeneration.
  • Benefits: Accelerates healing of wounds and injuries, especially related to muscles, tendons, and ligaments. Helps with inflammation and scar tissue reduction.

5. Melanotan II

• A peptide that stimulates the production of melanin in the skin.
  • Benefits: Used for tanning purposes, and some studies suggest it could also have appetite-suppressing effects and potentially improve erectile function.

6. Thymosin Alpha-1 (TA1)

• A peptide that modulates the immune system and helps in the recovery of infections.
  • Benefits: Enhances immune function, reduces inflammation, and may improve the body’s response to viruses or other pathogens.

7. IGF-1 (Insulin-like Growth Factor-1)

• A peptide similar to insulin that promotes cell growth and development. It’s sometimes used to help build muscle and support repair after intense workouts or injury.
  • Benefits: Promotes muscle growth, speeds up recovery, supports tissue repair, and enhances fat loss.

8. Carterin (GW-501516)

• A peptide used primarily for fat loss and endurance enhancement.
  • Benefits: Improves endurance, promotes fat loss, increases metabolic rate, and boosts cardiovascular performance.

9. PT-141 (Bremelanotide)

• A peptide used to treat sexual dysfunction, specifically in people with low libido.
  • Benefits: Increases sexual arousal and libido in both men and women.

10. Follistatin

• A peptide that inhibits myostatin (a protein that limits muscle growth), promoting muscle growth.
  • Benefits: Muscle growth, enhanced recovery, and potentially improved fat metabolism.

11. Kisspeptin

• A peptide that plays a role in reproductive health, influencing sexual function and fertility.
  • Benefits: Regulates puberty onset, increases LH and FSH (important hormones for sexual function), and can be used to treat infertility.

12. Gonadorelin

• A peptide that stimulates the release of hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH), supporting sexual health.
  • Benefits: Increased testosterone in men, ovarian function in women, and potential fertility enhancement.

13. Hexarelin

• Another peptide that stimulates the secretion of growth hormone.
  • Benefits: Supports muscle growth, fat loss, and recovery, with fewer side effects than other growth hormone secretagogues.

14. AOD 9604

• A modified fragment of human growth hormone (hGH) that targets fat burning.
  • Benefits: Stimulates fat breakdown without affecting muscle tissue or increasing appetite.

15. Vasoactive Intestinal Peptide (VIP)

• A peptide with anti-inflammatory and immunomodulatory effects.
  • Benefits: Used for conditions like autoimmune diseases and chronic inflammation, improves circulation, and has potential neuroprotective properties.

16. Sermorelin

• A peptide that stimulates the release of growth hormone from the pituitary gland, used for anti-aging and muscle-building.
  • Benefits: Enhances growth hormone release, promotes muscle development, fat loss, and better sleep quality.

17. Collagen Peptides

• Peptides derived from collagen, commonly used for skin, hair, and joint health.
  • Benefits: Improves skin elasticity, promotes joint and bone health, and may reduce wrinkles.

Peptide therapy represents a promising frontier in modern medicine, offering targeted support for everything from anti-aging and muscle recovery to immune health and hormone regulation. While some peptides like GLP-1 agonists have gained widespread attention and sparked debate, many others are still being explored for their broad and sometimes unpredictable effects on the body. Despite the need for further research, peptide therapy holds significant potential as a versatile tool for enhancing overall wellness, addressing chronic conditions, and improving quality of life. As interest grows, it’s important to approach peptide therapy with informed guidance and professional oversight to safely unlock its many benefits.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post Everything You Need to Know About Peptide Therapy appeared first on Dr. Alexandra MacKillop.

If you’re wondering how to naturally increase fertility, the most important thing you should know is that fertility isn’t just about the reproductive organs—it’s a whole-body indicator of health. As a functional medicine doctor, I’ve helped countless patients learn how to naturally increase fertility by addressing imbalances across all systems of the body. If you’re trying to conceive without resorting to pharmaceuticals or IVF, this guide will give you the strategic, root-cause roadmap to reclaim your fertility naturally.

Why Increase Fertility Naturally?

Natural fertility optimization isn’t just about conception—it’s about creating the healthiest possible environment for you and your future child. Couples choose to increase fertility naturally because they want to avoid synthetic hormones, invasive procedures, or expensive treatments that ignore the real cause of the issue. They want to heal, not override, their bodies. IUI, IVF and other fertility treatments can alo be extremely costly, which is another important reason to consider learning how to naturally increase fertility. However, even when pursuing fertility treatments, or perhaps undergoing a process of egg retrieval for egg freezing or a sperm harvesting for sperm freezing, it’s still a good idea to take all possible measures to increase fertility naturally so that the eggs have the best possible chance of success.

Conventional medicine often reduces fertility to a hormone problem. But infertility is a signal—your body is telling you something is off. When we listen, investigate, and treat the underlying dysfunction, the result isn’t just fertility—it’s vitality, balance, and lasting health.

Lifestyle Practices That Harm Fertility

Before we can build fertility, we need to stop destroying it. The modern lifestyle is fertility-toxic. Here’s how:

• Chronic Stress: Activates the HPA axis and shuts down reproductive hormones. Cortisol hijacks your cycle, suppressing ovulation and libido. It also significantly suppresses testosterone production and sperm quality in men.
• Poor Sleep: Disrupts circadian rhythms and hormone production—especially melatonin and progesterone, as well as testosterone in men.
• Toxin Exposure: Pesticides, BPA, phthalates, and heavy metals mimic hormones and disrupt endocrine balance. There is also data out there that exposure to plastics in clothing also act as fertility disruptors, creating changes in electrical and magnetic signaling that negatively impact ovarian function and sperm quality. Look for clothing that is free of plastics, PUFAs, and other synthetics.
• Nutrient-Deficient Diets: Low-fat, high-sugar, or overly restrictive diets destroy hormone production and egg quality. Our ultra-processed modern diet is void of nutrients despite being rich in processed carbohydrates and seed oils. In fact, both simple carbs and seed oils have been proven to negatively impact fertility. Aim to include high-quality animal proteins and fats as well as organic, darkly colored fruits and vegetables like berries and leafy greens. I also recommend a daily carrot salad for hormone balance.
• Overtraining/Under-Eating: Particularly common in driven, Type A women, this leads to hypothalamic amenorrhea, where the brain shuts down ovulation entirely.
• Alcohol, Caffeine, and Smoking: All three impair egg quality, sperm health, and hormone balance. I recommend avoiding all three if you’re TTC.

A note about these lifestyle factors: These foundational elements are pretty universal amongst articles describing methods for how to naturally increase fertility. Because they’re so ubiquitous, it may seem tempting to overlook them in search of something more direct, more exclusive, or more granular. While I do offer such recommendations below, I want you to know that lifestyle is the single most important factor in fertility as well as in health as a whole. It will do you no good to look to supplements or anything else for how to naturally increase fertility while overlooking the lifestyle. There is no supplements, and honestly no drug, that can undo the effects of poor sleep, high stress, toxin exposure, calorie deficits, substance abuse, and a poor diet.

How to Naturally Increase Fertility by Identifying the Root Cause of Fertility Disorders

To truly increase fertility naturally, you must identify why your body isn’t conceiving. Here are the most common root-cause conditions that sabotage fertility:

1. Thyroid Disorders

Low thyroid function (hypothyroidism) decreases progesterone, disrupts ovulation, and increases miscarriage risk. If your TSH is “normal” but you’re still tired, cold, or constipated—get a full thyroid panel. Subclinical hypothyroidism often flies under the radar. Hyperthyroidism, such as seen in Graves’ disease, also negatively impacts fertility. If you’re wondering how to increase fertility naturally, you should start by getting your thyroid thoroughly checked out.

2. PCOS (Polycystic Ovary Syndrome)

PCOS is an insulin-resistance and androgen-dominance issue. It impairs ovulation, leads to cystic ovaries, and causes irregular cycles. You must correct blood sugar dysregulation, reduce inflammation, and support hormone detoxification to restore ovulation.

3. Endometriosis

This inflammatory, estrogen-driven condition causes pelvic pain and infertility by distorting reproductive anatomy and disrupting implantation. Gut health, immune balance, and estrogen metabolism must be addressed aggressively.

4. Hypothalamic Amenorrhea

This is the brain pulling the emergency brake on fertility due to perceived stress or lack of energy availability. It’s common in athletes, perfectionists, and under-eaters. Recovery requires restoring adequate caloric intake, body fat, and nervous system calm.

5. HPA Axis Dysfunction (Adrenal Fatigue)

The hypothalamic-pituitary-adrenal axis controls the stress response. When it’s dysregulated, it suppresses reproductive hormones. You must rewire the stress response through nervous system regulation, sleep, and adrenal support to restore fertility.

How to Naturally Increase Fertility with Supplements

Certain nutrients powerfully support reproductive function. Many of these are key players in my practice for optimizing fertility:

• Myo-Inositol: Improves insulin sensitivity and ovulatory function—especially critical for PCOS.
• CoQ10 (Ubiquinol): Enhances mitochondrial function in eggs and sperm, improving quality and developmental potential.
• Omega-3 Fatty Acids: Reduce inflammation and support hormone production.
• Methylated B Vitamins (especially B9/Folate): Crucial for methylation, egg health, and preventing neural tube defects.
• Magnesium: Calms the nervous system, supports adrenal function, and improves sleep—all essential for fertility.
• Vitamin D3: Regulates hormone production and immune balance. Low levels are directly linked to infertility and miscarriage.

How to Naturally Increase Fertility by Looking at the Whole Body

Your uterus does not operate in a vacuum. Fertility is the result of systemic harmony, not isolated hormonal tweaks. Here’s how the entire body affects your ability to conceive:

Brain & Nervous System

The hypothalamus and pituitary gland orchestrate your reproductive cycle. Chronic stress rewires your brain to shut down reproduction. Nervous system regulation—via breathwork, somatic practices, and trauma healing—is fertility medicine.

Gut Health

The gut regulates nutrient absorption, immune response, and estrogen metabolism. Dysbiosis, leaky gut, or SIBO drive inflammation and hormone imbalance. Heal the gut, and you lay the groundwork for conception.

Liver Function

The liver detoxifies excess estrogen and metabolizes hormones. A sluggish liver leads to estrogen dominance, PMS, and ovulatory issues. Support with cruciferous vegetables, dandelion root, NAC, and targeted herbs.

Blood Flow

Pelvic blood flow is essential for ovarian and uterine health. Sedentary lifestyle, poor circulation, and inflammation impair oxygen and nutrient delivery to reproductive organs. Movement, dry brushing, acupuncture, and castor oil packs all enhance circulation.

Musculoskeletal System

Tension in the pelvis, scar tissue, or misalignment in the spine can block blood flow and nerve signaling. Bodywork (chiropractic, craniosacral therapy, pelvic floor therapy) helps clear the path for conception.

Lymphatic System

The lymphatic system clears cellular waste and toxins. A stagnant lymph system clogs hormone pathways and raises inflammation. Rebounding, sauna, hydration, and manual lymph drainage support this overlooked detox pathway.

Final Thoughts: Fertility Is a Barometer of Health

To naturally increase fertility, you must stop chasing hormones and start chasing health. When your body feels safe, nourished, and in balance—it will create life. This isn’t theory. I’ve seen it happen over and over with patients who were told their only option was IVF.

Natural fertility is not luck. It’s the result of uncovering root causes, supporting the body as a whole, and restoring biological wisdom. Your body is not broken. It’s communicating.

You just need to learn how to listen—and how to heal.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Naturally Increase Fertility appeared first on Dr. Alexandra MacKillop.

Why Women Seek Functional Medicine PCOS Treatment

Many of my patients come to me looking for an alternative to the birth control prescription given to them by their OB/GYN. Others have friends or family with a PCOS diagnosis, and are wondering if that’s the reason for their own irregular and/or painful cycles. Some ladies worry if they’ll ever be able to have children, since PCOS has complicated their fertility, and still more patients come to me out of desperation—they’ve already worked with another “natural doctor” who had put them on an extremely restrictive diet and told them to lose weight. I have even heard of PCOS patients being prescribed gluten-free, dairy-free, low-carb, sulfur-free diets. Functional medicine PCOS treatment offers hope of realistic, sustainable treatment where most other providers give a grim prognosis or simply leave patients feeling overwhelmed.

In this post, we’ll be diving into the details about PCOS: what it is, what it isn’t, how it’s managed by most healthcare providers, functional medicine PCOS treatment strategies, and more. As a starting point, I encourage you to check out my fertility overview post (Female Fertility 101) if you aren’t familiar with the ins and outs of your menstrual cycle. That post lays the groundwork for understanding the status quo of periods, hormones, women’s health, and it’s important to understand these topics before we start talking about with cycles that fall outside of the norm. [Although it’s the most common, it’s not the only period problem faced by women. To learn more about what your period can tell you about your health, check out this post.]

What Is PCOS, and How Is It Diagnosed?

PCOS stands for Polycystic Ovarian Syndrome, one of the most common endocrine and metabolic disorders in women of reproductive age. The syndrome is defined by hormonal imbalances and ovarian dysfunction, and it’s diagnosed only after other causes for the patient’s symptoms have been ruled out (such as hypothalamic amenorrhea). Because of this, many women have to go through a frustratingly long and drawn out process in order to get answers for their health struggles. However, functional medicine PCOS treatment offers faster results because it gets to the root cause.

Functional Medicine PCOS Diagnosis

The name “polycystic ovarian syndrome” is a bit of a misnomer, because although ovarian cysts are common in PCOS patients, they aren’t part of the diagnostic criteria—many women with PCOS don’t have any cysts on their ovaries at all. Rather, a PCOS diagnosis is given when at least two of the three following criteria are met: [Reference]

• Hyperandrogenism (elevated androgen hormones, assessed via lab work)
• Anovulation or oligo-ovulation (absence of ovulation or infrequent ovulation, usually leading to irregular cycle length)
• Polycystic appearance of ovaries (assessed via ultrasound imaging)

The general consensus in the medical community is that a PCOS diagnosis should be given when a woman has either polycystic ovaries and/or irregular cycles in addition to high androgen levels on her blood work. When making the diagnosis, doctors are careful to rule out other causes of high androgens, such as adrenal disorders, thyroid disease, drug-induced androgen excess, and other hormonal disorders, as well as alternative causes for irregular cycles.

Types of PCOS

PCOS patients typically fall into two different categories: insulin resistant, and non-insulin-resistant types. As is the case with most hormonal disorders, more than one level is out of balance. The vast majority of women who suffer from PCOS also present with insulin resistance, glucose intolerance, dyslipidemia, and elevated levels of inflammation. Part of what makes treating PCOS so complex is that these hormonal imbalances feed off of each other: elevated insulin levels trigger a feedback loop via the HPATG axis that leads to further androgen levels, and vise-versa. Apart from the insulin resistance piece, functional medicine PCOS diagnosis further divides PCOS into 4 separate categories which you can read about here.

Symptoms of PCOS

The symptoms experienced by women with PCOS vary because not everyone meets the same diagnostic criteria, and the extent of those experiences can vary too. Some women experience only mild elevations in androgens, and symptoms are consequently lesser. Women who have cysts on their ovaries often experience pain related to the formation and/or rupture of cysts, which are symptoms that wouldn’t be experienced by women who do not have cysts. Likewise, symptoms for women who concomitantly deal with insulin resistance face different symptoms than women who do not.

• Symptoms Related to Excess Androgens
  • Excessive hair growth (face, chest, back, buttocks)
  • Thinning hair
  • Oily skin
  • Cystic acne
• Symptoms Related to Anovulation/Olig-ovulation
  • Long cycles (more than 35 days) or irregular cycle lengths
  • Difficulty conceiving or repeated miscarriages
  • Abnormal uterine bleeding
• Symptoms Related to Polycystic Ovaries
  • Painful periods and/or pelvic pain
  • Sudden, intense abdominal pain resulting from ruptured cysts
• Symptoms Related to Insulin Resistance
  • High blood pressure and/or high cholesterol
  • Fatigue after meals
  • Weight gain, especially in the abdominal area
  • Dark patches of skin, particularly along neck creases, in groin and under breasts (this is called ancanthosis nigricans)
  • Skin tags

Due to the fluctuating hormones, many women also experience generalized symptoms related to hormonal imbalances, which include (but are not limited to): fatigue, insomnia, anxiety, depression, headaches, etc.

Functional Medicine PCOS (Causes and Treatment)

The root cause isn’t really known. The current understanding is that it’s a mixture of genetic predisposition and environmental triggers, but other theories include nutritional conditions in the uterus, prenatal exposure to androgens, insulin resistance on an and more [reference]. Because of this, most treatments focus on managing symptoms—painful periods, irregular cycles, insulin resistance, etc. Hormonal contraceptive use also can induce a reversible type of PCOS, but the symptoms can continue for months or even years (called “post-pill PCOS”).

On a physiological level, we know that elevated androgens and insulin resistance result from dysfunction in the hypothalamic-pituitary-adrenal-thyroid-gonadal axis. In women with PCOS, the pituitary gland releases higher-than-normal levels of luteinizing hormone (LH), which stimulates the ovaries to produce more testosterone than usual. (Ovaries normally produce some testosterone, but problems result when they produce too much.) This over-stimulation of the ovaries by luteinizing hormone also cancels out the mid-cycle LH surge that typically triggers ovulation.

Pituitary Hormones and PCOS

At the same time, the pituitary gland releases lower-than-normal levels of follicle-stimulating-hormone, which prevents eggs from reaching full maturity. When this happens, the follicle does not release the egg (ovulation does not occur, AKA anovulation). The immature egg either dissolves, or remains in the follicle, forming a cyst. Since the follicular remnant after ovulation (called the corpus luteum) is responsible for producing progesterone during the luteal phase, many women experience additional symptoms related to low progesterone levels. (Read more about luteinizing hormone, follicle-stimulating hormone, progesterone, and the luteal phase in this post: Female Fertility 101)

The Birth Control Pill and PCOS

Most OB/GYNs prescribe oral contraceptives as a first line of treatment for PCOS, because the artificial hormones suppress the natural cycling of luteinizing hormone, follicle-stimulating hormone, estrogen, progesterone, and testosterone. The simulated hormonal environment causes the endometrial lining to develop and shed as it would in a natural period, but it take the ovaries out of the equation: no egg matures, no egg is released, and fertility is not possible.

My goal as a functional medicine doctor is to promote the natural fertility of my patients, empowering them to have healthy cycles rather than suppress the normal functioning of their bodies. That being said, sometimes the healthiest thing for a patient and her values is to reduce the pain, control the hormonal dysfunction, and reach a place where she feels that her health is manageable. If that means medication, that’s okay—the most important thing is that she is able to manage her wellbeing according to her values.

Prescription Medications for PCOS

Another medication used in the treatment of PCOS is spironolactone, which is typically used as a diuretic drug for individuals with cardiovascular disease. However, this drug also has a secondary effect of reducing androgen levels in the body, which can be helpful in controlling irregular bleeding, hair growth, and other symptoms of high androgens in women with PCOS. Like birth control pills, using spironolactone targets hormonal pathways of PCOS without addressing the root cause. This is where functional medicine treatment for PCOS can fill a huge gap and meet a huge need.

The third medication that is used in the management of PCOS is metformin, which is a drug typically given to patients with diabetes. Metformin improves insulin resistance, which can be helpful in the treatment of PCOS because of the amplifying effect that insulin plays in the production of testosterone. When insulin sensitivity improves, often testosterone levels follow suit. You can read more about the use of metformin as a fertility drug (and natural alternatives) in this post.

Functional Medicine Treatment for PCOS: Lifestyle & Supplements  

Most of my patients come to me because they are looking to avoid the use of prescription drugs in managing their fertility. If that describes you too, keep reading!

1. Lifestyle Factors for Balancing Hormones: The #1 thing we can do to support hormonal balance is building a foundation for well-being. This means taking nutrition, rest, exercise, stress management, and psychological/emotional health into account. Neglecting even one of these areas can create huge interruptions in the HPATG axis, making symptoms of PCOS and other hormonal disorders so much worse. These lifestyle factors include eating enough (in terms of calories, macronutrients, and micronutrients) as well as eating frequently enough to keep blood sugar stable. It also involves balancing exercise and rest to prevent elevations in cortisol, the stress hormone, which interrupts the production of sex hormones like progesterone. This is part of the reason why stress management, sleep hygiene, and social support are so important.
2. Eating a Diverse Diet:Gut health is a huge topic in the media lately, and research continues to show that the best way to support GI health and microbiological diversity is to eat a varied diet, with many different types of plant foods and fibers. The more restrictive our diet (limiting the types of foods we eat to just a few varieties), the more likely we are to disturb our gut microbiome, which plays a huge role in balancing our hormones. (Did you know that bacteria both produce and metabolize hormones When we disturb our gut microbiome, it affects our bodies ability to make hormones as well as clean out the old, broken down ones.) Gut health also helps modulate blood sugar control, which is an important consideration in insulin-resistant PCOS. Check out this study to learn more about the relationship between PCOS and the gut microbiome.
3. Micronutrient Balance: Research has shown that women with PCOS tend to follow certain patterns of vitamin deficiencies, including vitamin D and B vitamins (especially folic acid). Vitamin D plays an important role in supporting the thickness of the endometrial lining, which is often depleted in women with PCOS due to low progesterone levels. Likewise, B vitamins such as folic acid play an important role in follicular maturation, and supplementing with elvels at 700 μg/day can support successful ovulation. Other nutritional deficiencies have also been identified in the majority of women with PCOS, including calcium, zinc, selenium, and chromium. [Reference] While the best way to prevent nutrient deficiencies such as these is to eat a varied and balanced diet (and avoid restriction of food groups of calories), some women may benefit from using supplements—especially Vitamin D. Studies have also shown that supplementing with omega-3 fatty acids, such as those found in cod liver oil, prevent excess inflammation, help manage dysglycemia, and support hormonal balance in women. [Reference]
4. Evidence-Based Supplements:
   1. Inositol: Inositol is a type of sugar alcohol that has been shown to improve insulin sensitivity, lipid synthesis, hormonal signaling, and maturation of oocytes (female eggs) during the follicular phase. Supplementation of inositol in women with PCOS lowers androgen levels, improves insulin sensitivity, and increases rates of ovulation in women with anovulatory cycles. Supplementation is effective when administered in ratios of 40:1 of myo-inositol to D-chiro-inositol, at levels of 4000 mg per day in conjunction with 400 μg of folic acid.
   2. Alpha-Lipoic Acid: This chemical is a free-radical scavenger, meaning that it prevents premature breakdown of biochemicals and hormones in the blood stream. Studies show that supplementation with alpha-lipoid acid decreases prevalence of ovarian cysts and increases progesterone levels in women with PCOS.
   3. Melatonin:While this hormone is typically thought of as a supplement for promoting sleep, it is not a sleeping pill, but rather a hormone. (There are many reasons to avoid using melatonin as a sleep aid, but that’s a topic for another post.) When used in women with PCOS, supplementation at night has been shown to improve ovulation rates, corpus luteum formation, progesterone levels, and pregnancy rates for those who are trying to conceive. Melatonin supplementation also decreases hirsutism and androgen levels when used at 10 mg/night.
   4. Black Cohosh: As described in this post about fertility drugs, research has shown that dosing 20 mg daily of black cohosh at the beginning of the cycle modulates the LH surge during the follicular phase, improving rates of ovulation. This supplement also results in higher progesterone levels during the luteal phase, improving the thickness of the endometrial lining and supporting a luteal phase that is long enough for implantation and pregnancy in women who are trying to conceive.

Closing thoughts…

As if the symptoms of PCOS aren’t difficult enough, the journey towards a diagnosis to explain the symptoms, and finding a treatment strategy that works for you in the context of your own life can add enormous loads of stress to an already challenging life experience. There is a whirlwind of information out there, which only adds to the confusion and frustration of trying to manage your health. It can be a lonely and scary place, but I want you to know that you’re not alone. Consider making an appointment with a functional medicine doctor who can deliver personalized care and help you achieve your health goals.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Functional Medicine PCOS Treatment appeared first on Dr. Alexandra MacKillop.

Have you heard of estrogen dominance Or maybe, you already know you’re dealing with this hormone imbalance. Excess estrogen (or deficient progesterone) disrupts hormonal balance, triggering symptoms such as weight gain, mood swings, heavy periods, and fatigue. Functional medicine targets root causes with precision, and understanding why you have estrogen dominance is key to treating this condition. Herbs for estrogen dominance play a pivotal role in restoring estrogen balance by supporting detoxification, improving insulin sensitivity, and enhancing progesterone production. Below, I detail clinically supported herbs for estrogen dominance that that effectively address their mechanisms, and recommended dosages.

As we get started, here are a few key things to keep in mind when it comes to estrogen dominance:

• Estrogen dominance is a condition in which negative symptoms occur because of a high estrogen level in relation to progesterone
• Estrogen dominance may be caused by excess estrogen production, deficient progesterone production or both
• Certain underlying diseases and syndromes increase risk of estrogen dominance, like obesity, PCOS, type 2 diabetes and hypothyroidism
• Even if you have symptoms of estrogen dominance, it doesn’t necessarily mean you have it. It’s essential to test your hormones and understand your diagnosis before using any treatment strategies

Herbs for Estrogen Dominance, Explained

1. DIM (Diindolylmethane): Detoxify Excess Estrogen

DIM is one of the most powerful herbs for treating estrogen dominance. This is a compound derived from cruciferous vegetables, promotes healthy estrogen metabolism by enhancing Phase 1 and Phase 2 liver detoxification pathways. It shifts estrogen breakdown toward beneficial 2-hydroxy metabolites and away from harmful 16-alpha-hydroxy metabolites linked to estrogen dominance and cancer risk. Impaired gut function or excess production of estrogen are key candidates for treatment with DIM.

• Dosage: 100-200 mg daily
• Evidence: A randomized controlled trial found DIM supplementation significantly improved estrogen metabolism in women with estrogen dominance symptoms [2].

2. Calcium D-Glucarate (CDG): Support Estrogen Clearance

CDG inhibits beta-glucuronidase, an enzyme that reverses estrogen conjugation in the gut, preventing reabsorption and facilitating elimination. This reduces circulating estrogen levels, decreasing estrogenic load. Those who eat a diet high in ultra-processed foods and sugar are likely to benefit from supplementation with CDG when high estrogen levels have been documented on labs at any point in the cycle. This could be considered either a food or one of the best herbs for estrogen dominance.

• Dosage: 300-400 mg daily
• Evidence: Clinical studies demonstrate CDG enhances detoxification and lowers estrogen recirculation, supporting hormonal balance.

3. Berberine: Target PCOS and Insulin Resistance

Polycystic Ovary Syndrome (PCOS) drives estrogen dominance via insulin resistance and androgen imbalance. Berberine improves insulin sensitivity, regulates blood glucose, and supports gut microbiota diversity—addressing core PCOS mechanisms. Berberine may also be helpful in those with impaired gut detox pathways due to imbalances in good and bad bacteria, as berberine affects microbiological diversity.

• Dosage: 500 mg twice daily with meals
• Evidence: Multiple randomized trials show berberine’s superiority to metformin in reducing insulin resistance and improving ovulatory function in PCOS patients.

4. Evening Primrose Oil: Boost Progesterone Production

Evening primrose oil supplies gamma-linolenic acid (GLA), a precursor to prostaglandins that stimulate progesterone synthesis. Increased progesterone balances excess estrogen, alleviating symptoms like breast tenderness and PMS. If estrogen dominance and related symptoms are caused by deficient progesterone, meaning there isn’t enough progesterone to balance out otherwise normal estrogen levels, EPO may be the right solution.

• Dosage: 1,000-2,000 mg daily
• Evidence: Clinical reports confirm evening primrose oil’s efficacy in improving luteal phase defects by increasing progesterone.

5. Fish Oil: Modulate Inflammation and Hormonal Balance

Omega-3 fatty acids reduce systemic inflammation and improve insulin sensitivity, indirectly supporting estrogen metabolism and progesterone activity. Inflammation is a major driver of excess production of estrogen in men and women from abdominal fat cells.

• Dosage: 1,000-3,000 mg EPA/DHA daily
• Evidence: Supplementation reduces inflammatory markers and improves hormonal profiles in women with hormonal imbalances.

6. Fenugreek: Support Hormonal Regulation

Fenugreek seeds contain phytoestrogens that modulate estrogen receptor activity and stimulate progesterone production, improving estrogen-to-progesterone ratio.

• Dosage: 500-600 mg daily
• Evidence: Controlled trials indicate fenugreek improves hormonal balance and reduces estrogen dominance symptoms.

7. Fennel Tea: Natural Estrogen Modulator

Fennel contains anethole, which exhibits estrogenic activity that regulates menstrual cycles and reduces estrogen dominance symptoms such as bloating and cramps.

• Dosage: 1-2 cups of fennel tea daily
• Evidence: Clinical use supports fennel’s effectiveness in managing menstrual disorders related to estrogen imbalance.

8. Cinnamon: Improve Insulin Resistance and Hormone Balance

Cinnamon enhances insulin sensitivity and lowers blood glucose, indirectly reducing ovarian androgen production and estrogen dominance, especially in PCOS.

• Dosage: 1-3 grams daily
• Evidence: Studies confirm cinnamon’s role in metabolic and hormonal regulation in women with insulin resistance.

9. Chamomile: Calm Inflammation and Support Progesterone

Chamomile’s anti-inflammatory properties reduce systemic inflammation that disrupts hormone production. It also supports progesterone synthesis through improved adrenal function.

• Dosage: 1-2 cups chamomile tea daily or 300 mg extract
• Evidence: Research validates chamomile’s efficacy in reducing inflammation and improving hormonal balance.

10. CBD Oil: Regulate Endocrine and Stress Response

CBD modulates the endocannabinoid system, which influences hormone regulation and reduces cortisol-driven estrogen dominance. It also supports liver detoxification.

• Dosage: 10-50 mg daily, titrated individually
• Evidence: Emerging studies demonstrate CBD’s role in hormone balance and stress reduction [20].

11. Boron: Enhance Hormonal Balance and Bone Health

Boron increases circulating levels of free testosterone and estrogen metabolites, promoting a favorable hormonal environment and supporting bone density.

• Dosage: 3-6 mg daily
• Evidence: Clinical trials report boron’s capacity to increase steroid hormone levels and improve metabolic health.

12. Black Cohosh: Promote Ovulation and Progesterone Production

Black cohosh exhibits estrogenic effects that stimulate ovulation and improve progesterone synthesis, directly countering estrogen dominance.

• Dosage: 40-80 mg daily standardized extract
• Evidence: Clinical trials validate black cohosh’s role in improving luteal phase and balancing estrogen-progesterone ratio.

13. Adaptogens (Reishi): Balance Stress Hormones and Support Endocrine Health

Reishi mushroom modulates the hypothalamic-pituitary-adrenal axis, reducing cortisol and supporting overall endocrine harmony, which indirectly regulates estrogen dominance.

• Dosage: 1,000-1,500 mg daily
• Evidence: Studies show Reishi’s efficacy in reducing stress-related hormonal imbalance and inflammation.

Functional medicine’s approach to estrogen dominance requires targeted, evidence-based herbal interventions. DIM, CDG, berberine, evening primrose oil, fish oil, and other botanicals address detoxification, insulin resistance, inflammation, and progesterone support. Combining these herbs with lifestyle modifications establishes hormonal balance and improves patient outcomes.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

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