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.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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 Are You Using LH Strips Wrong? 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

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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 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!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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 Herbs for Estrogen Dominance and Hormonal Balance appeared first on Dr. Alexandra MacKillop.

Please note: When referring to hormonal contraceptives, birth control pills or “the pill” in this post, I am referencing medications containing both estrogen and progesterone analogs (estradiol and progestin).

The menstrual cycle plays a powerful role in women’s health, and not just in terms of fertility. As I often say, our periods tell us way much more about our sense of well-being than whether or not we’re pregnant, and that information is so, so important! If our cycle is out of sync, it’s really important for us to address those concerns early so that the underlying causes–like thyroid, metabolic, adrenal, or other hormone imbalances—don’t worsen and lead to disease.

Masking the Root Cause

Because of their ability to give us early warning signs about our health, our periods are referred to as our “fifth vital sign” along with heart rate, blood pressure, temperature, and breathing rate. When it comes to our cycles, deviations from the norm often signify an underlying health concern that will intensify, eventually leading to a more serious problem. For example, most chronic illnesses that we see today are either triggered or worsened by stress. Even if a person isn’t experiencing a flare up of their chronic symptoms (or maybe they have a genetic predisposition that hasn’t yet manifested), our bodies can send us warning signals that our stress is reaching a critical level through changes to our menstrual cycles. Stress interrupts the delicate web of signals between our brains and the organs that secrete our hormones (sex hormones, thyroid hormones, metabolic hormones, and more) leading to missing, painful, or irregular cycles. (For more about the details of what your period can tell you about your health, check out this post.)

Birth Control Pills Shut Down Our Natural Hormonal Processes

As I explain in my book, Go with Your Flow, the main event of our menstrual cycle isn’t the bleed, but rather it is ovulation–the release of an egg. The first two weeks of the cycle are all about ramping up the hormonal signals (mainly estrogen) required to mature and release an egg so that your body can become pregnant. After ovulation, progesterone takes over, preparing the uterus to become a suitable environment for a growing baby if the egg meets a sperm along its journey through the fallopian tube. As you learned in sex ed, the egg passes through if it isn’t fertilized, and the uterine lining sheds away. This shedding of menstrual blood–your period–marks day one of the next cycle.

Birth control pills are made up of chemicals that resemble estrogen and progesterone, overriding your body’s natural signaling pathways. Their purpose is to prevent the release of an egg while still allowing your body to “go through the motions” (i.e. by thickening and shedding the uterine lining every 28 days.) While it might seem easier to just not have a period at all, the processes that take place during your cycle are about more than fertility, and shutting them down completely would be very dangerous, leading to osteoporosis, heart disease, and other health problems. So in lieu of completely eliminating your period, the pill shuts off the “main event” of your cycle, aka ovulation, while setting up a carefully curated hormonal environment that mimics a healthy period.

Except it isn’t a healthy menstrual cycle because it isn’t a menstrual cycle at all. It’s just a bleed. Without being able to control their own hormonal fluctuations, our bodes lose their ability to communicate with us about our hormonal health status.

Because of the way that the false periods induced by birth control pills so closely resemble healthy cycles, the pill is often prescribed for reasons other than contraception. Patient suffering from hormonal acne, PMS, painful periods, PCOS, and other women’s health conditions are often given birth control pills because it seems to solve these problems. But the root cause of these issues goes much deeper, and the pill simply masks over the real issue. It’s kind of like breaking your toe and “curing” the problem by chopping off your whole leg. It completely misses the point. Your toe stops hurting, but only because you don’t have one anymore! The same is true of using the pill for non-contraceptive purposes. Your period seems normal but only because you aren’t really having your cycle anymore! As a result, the underlying cause is left to fester, and often returns with a vengeance as soon as you come off the pill.

Health Risks

In addition to masking over our health problems, the pill often outright creates health risks of its own. Here are just a few:

• Infertility: Despite being often marketed as a “fertility drug,” the pill does not support the optimal function of the female body. It actually does the opposite, by shutting off reproductive function and inhibiting ovulation. Unfortunately, many women struggle with fertility problems even after they discontinue use of the pill. It’s not as if ovulation magically starts up again after being chemically prevented. It takes time for the body to re-learn how to secrete hormones in a balanced and functional way. Sometimes, the body can’t reach that place post-pill on its own without medical support.
• Hormone Imbalances: Even if ovulation resumes, many women find that they struggle with metabolic, thyroid, adrenal, or other hormonal imbalances outside of fertility upon coming off the pill. As I describe in this post, our various hormonal systems are all interrelated, so when we so drastically interfere with one aspect of the HPATG axis (as is the case with the pill), other bodily systems can become imbalanced too. Symptoms like fatigue, weight gain, thinning hair, insomnia, and more can all point back to hormonal contraceptive use, or discontinued use.
• Blood Clots: A widely known fact in the medical community that is seldom talked about in a clinical setting is that oral contraceptives containing estrogen or estrogen analogs increase the risk of blood clots forming, even in otherwise healthy women with no underlying conditions. While certain factors increase risk of this phenomenon (smoking, being over 35 years of age, prolonged inactivity, and family history), the likelihood of blood clots goes up dramatically for all women. These blood clots form in deep veins of the body (most often the legs), and if they break off, they can become lodged in the heart (causing a heart attack), lungs (causing a pulmonary embolism) or brain (causing a stroke). This risk is increased even if a woman follows a healthy lifestyle. [Note: Blood clots from using oral contraceptives is often presented as a low risk, but it’s not really that low. Different sources say different things, but it’s typically discussed about as being about 1/1,000, or 0.1%. Let’s add some context…the CDC estimates that 28% of US women are currently using oral contraceptives, which is about 10.6 million women. I’ll let you do the math, but 0.1% of 10.6 million isn’t a small number—and it seems even larger when it’s someone you know. I personally know of three women in from my own personal life (not even counting patients) who experienced this in their twenties.]
• Heart Disease: Long-term exposure to hormonal analogs like those found in the pill act like a biochemical source of stress in the body. These chronic stress exposures alter the metabolism of lipids and carbohydrates in the body, raising blood cholesterol and triglycerides and increasing risk of chronic disease, especially heart disease in women. Once again, this is true even for otherwise healthy individuals.
• Increased risk of some cancers—namely breast and cervical cancer. Breast cancer is the number one most common type of cancer among women, and cervical cancer is the fourth most common type of cancer in women, worldwide.
• Insulin Resistance: One of the ways that oral contraceptives affect metabolism is by increasing blood glucose levels and subsequent insulin secretion. With time, this can increase risk of insulin resistance and the development of metabolic syndrome and/or diabetes.
• Gallbladder and Liver Dysfunction: Part of the role of the liver and gallbladder in our health is to detoxify our bodies from old, broken down hormones, red blood cells, and other waste products. This is a natural and normal process, but sometimes it can become overloaded if the amount of waste buildup is higher than the normal capacity of these organs. Sex hormones like estrogen are one of the major substrates of the liver and gallbladder, and can “clog up” the system leading to low-grade damage. Some women who experience this manifest skin reactions like itching, rashes, or yellowing of the skin (jaundice).

Female Empowerment

It still blows my mind that so many important women’s health topics are still taboo. Sure, sex is a private matter, but healthcare information shouldn’t be limited or kept secret. As women, we deserve to understand our bodies, including the implications of the medical interventions we receive. Ovulation and menstruation are normal and necessary parts of a healthy woman’s body if she is of reproductive age, and these functions (or lack thereof) give us valuable insight into our well-being. They don’t need to be shut off, and we don’t need to be quiet about it.

Our level of understanding of the female body in science doesn’t require us to subdue our femininity in order to allow us to make family planning decisions in accordance with our values. Likewise, we deserve better medicine—safe and effective, individualized treatment plans that address the root cause of symptoms, whether in terms of our reproductive health or otherwise. If the birth control pill fits your goals and values for your life, that’s awesome! I totally support you. But I also want you to know that if it doesn’t, there are other options for you that protect your health and your values, and which allow you to make informed decisions on behalf of both your family and your own body.

Censorship of these conversations limits a woman’s access to essential information about her sense of well-being. Sexual health isn’t gross or weird, and it shouldn’t be hush-hush. In fact, every single person on earth is only here because of the function of a woman’s reproductive system. The female body is amazing, and each of us should have the privilege of understanding it on a personal level, especially when making the very personal decision about whether or not to use hormonal contraceptives.

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!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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 Risk of Blood Clots and Other Dangers of Hormonal Birth Control appeared first on Dr. Alexandra MacKillop.

Progesterone is quite the buzz word these days. Whether you’re in perimenopause and considering hormone replacement therapy (HRT), you’re newly pregnant and having levels tested, or you’re experiencing some menstrual irregularities attributed to imbalances between estrogen and progesterone, the term has likely come up for you. But, what is progesterone What does it do for the body How do you know if you have enough of it How can you test progesterone levels at home Read on to find answers to all these questions and more.

What is progesterone and how can you test progesterone levels at home?

Progesterone is a hormone primarily produced by the ovaries in women, particularly after ovulation during the second half of the menstrual cycle. After ovulation, a gland called the corpus luteum forms which secretes progesterone. If you don’t ovulate, you can’t make progesterone because you won’t have a corpus lutem. You need progesterone because it plays a crucial role in regulating the body’s functions, including:

1. Menstrual Cycle: Progesterone helps prepare the uterine lining for potential implantation of a fertilized egg. It also prevents the uterine lining from getting too thick or shedding too quickly.
2. Pregnancy: If pregnancy occurs, progesterone helps maintain the uterine lining, supporting the developing embryo. This is where progesterone gets its name from: pro-gest(ation)
3. Breast Development: It also protects breast tissue from too much estrogen and prepares the breasts for milk production during pregnancy.

In addition to its role in female reproductive health, progesterone is involved in other bodily functions, including mood regulation, sleep and maintaining bone density. (Because it’s so important, and because many providers don’t test levels in office, it’s helpful to know how to test progesterone levels at home.) It is also used in hormone replacement therapy and in various contraceptive methods. Let’s take a closer look:

Progesterone and Brain Health

Progesterone significantly affects the brain and mood due to its influence on neurotransmitters and brain function. Here are some key ways it affects mood:

1. Neurotransmitter Modulation: Progesterone enhances the effects of certain neurotransmitters, such as gamma-aminobutyric acid (GABA), which has calming effects and reduces anxiety.
2. Mood Regulation: Changes in progesterone levels during the menstrual cycle lead to mood fluctuations. Higher levels in the luteal phase (after ovulation) contributes to feelings of calmness, while lower levels pre-menstruation correlates with mood swings or premenstrual syndrome (PMS).
3. Anxiety and Depression: Studies show that progesterone protects against anxiety and depression, though the relationship varies from person to person. I describe estrogen as an “energizing” hormone, which motivates and gets you going. But all that energy, when not balanced by the cool, calming effects of progesterone, becomes anxiety and irritability. Knowing how to test progesterone levels at home is helpful when struggling with premenstrual symptoms like depression or anxiety. If you can track your levels, you can anticipate better how to support your mood.
4. Neuroprotection: Progesterone may have neuroprotective properties, potentially supporting brain health and cognitive function. Maintainin healthy progesterone levels throughout life decreases risk of brain fog and neurodegeneration.
5. Sleep Quality: Progesterone is also linked to improved sleep quality, which subsequently boosts mood. Insomnia is a problem for many perimenopausal women, and the most common prescription is estrogen hormone replacement therapy. However, progesterone actually is much more effective at improving sleep both in perimenopause and at other times of life.

Progesterone and Metabolism

Progesterone affects metabolism and blood sugar control in several ways:

1. Cortisol Interaction: Progesterone interacts with cortisol, the stress hormone. High levels of cortisol affect blood sugar levels and metabolism, and progesterone helps moderate some of these effects.
2. Reproductive Health: In women with polycystic ovary syndrome (PCOS) or other hormonal imbalances, therapeutic strategies that increase progesterone also help regulate menstrual cycles and improve metabolic outcomes. In many cases, low progesterone levels in early pregnancy can lead to miscarriage, which is why it’s helpful to know how to track progesterone levels at home (so you can advocate for yourself in a healthcare provider’s office!)

Progesterone and Thyroid Function

Progesterone affects thyroid function in several ways, largely due to its interactions with thyroid hormones and the overall hormonal balance in the body. Here are some key points:

1. Thyroid Hormone Regulation: Progesterone changes how and when the body makes thyroid hormone, influencing metabolism. It also helps support the synthesis of thyroid hormones and enhances their effects.
2. Binding Proteins: Progesterone affects the levels of thyroid-binding globulin (TBG), a protein that binds thyroid hormones in the blood. Increased levels of TBG can lead to higher total thyroid hormone levels, and increased metabolic rate/response.
3. Metabolic Rate: Progesterone benefits metabolic rate, partly by influencing thyroid hormone activity. This dramatically impacts energy levels and weight management.
4. Hormonal Balance: In women, fluctuations in progesterone during the menstrual cycle influences thyroid function. For example, low progesterone levels are associated with conditions like hypothyroidism and infertility.

Progesterone, Adrenal Function and Cortisol

Progesterone has several effects on adrenal function and cortisol levels, primarily through its interactions with the endocrine system. Here are the key points:

1. Stress Response: Progesterone helps modulate the body’s response to stress. It has a calming effect and counterbalances some of the stimulating effects of cortisol and estrogen.
2. Hormonal Balance: The relationship between progesterone, cortisol, and other hormones is complex. High cortisol levels can lead to a decrease in progesterone, contributing to hormonal imbalances that can affect mood, energy levels, and overall health.

Does the birth control pill have progesterone?

Progestins, the synthetic versions of progesterone used in many forms of birth control, differ from natural progesterone in several key ways:

1. Chemical Structure: Progestins are chemically modified molecules of testosterone that have been changed to interact with the human brain and ovaries. Although they are chemically similar, they are not exactly the same.
2. Hormonal Activity: While progestins mimic some of the actions of natural progesterone, they can have varying degrees of activity on progesterone receptors and other hormone receptors (like androgen and glucocorticoid receptors). This leads to side effects that are not typically associated with natural progesterone. The progestins in birth control contribute to insulin resistance, thyroid disorders and depression whereas natural progesterone prevents those things.
3. Side Effects: The side effects of progestins differ from those of natural progesterone due to their altered hormonal activity. Many experience mood changes, weight gain, or acne with artificial progestins, while these effects don’t occur with natural progesterone.
4. Impact on Menstrual Cycle: Progestins can affect the menstrual cycle in ways that natural progesterone does not, such as altering bleeding patterns, causing lighter or more irregular periods, or even stopping menstruation altogether in some users.

The biggest takeaway is that using artificial progestins, by design, prevents your body from producing its own progesterone. If you have progestins, you can’t have progesterone, and you’re therefore automatically progesterone deficient. In this case, it won’t be helpful to test progesterone levels at home.

How to Test Progesterone Levels

The first and most important thing is to determine if you’re ovulating. If you aren’t ovulating, you can’t make progesterone because you won’t have the corpus luteum gland we discussed earlier. It is impossible to “test” progesterone levels at home if you’re not ovulating because you will not have any meaningful level of progesterone in your body. That means that if you’re using oral ceontraceptives like the birth control pill, or other forms of hormonal drugs like the implant, the Nuva Ring, or certain types of IUD, you aren’t ovulating and subsequently are progesterone deficient.

However, other health conditions may also cause low progesterone because of anovulation, like thyroid disorders, hypothalamic amenorrhea (stress-induced anovulation and lack of periods), and PCOS to name a few. If you aren’t having ovulatory periods at least every month, you are likely deficient in progesterone.

1. How to Track Progesterone Levels at Home with Ovulation

To track your progesterone levels at home, you first need to find out if you’re ovulating and when. The most straightforward way to know if you’re ovulating is to track your cycle using basal body temperature. I wrote a blog post all about how to do this which you can access here. You also can track ovulation using prediction methods, such as urinary LH testing or tracking cervical fluid, though it’s important to note that these methods do not confirm ovulation. Rather, they predict when (generally) in your cycle you may be close to ovulation.

When tracking ovulation, mark the following…

• The day before your basal body temperature rises above baseline
• The day after you have a positive LH test strip
• The day before your cervical fluid transitions from watery/ewcm (egg white cervical mucus) to a thick, dry, gluey texture

2. How to Track Progesterone Levels at Home with Luteal Phase

Once you have identified the day of ovulation, the next step in learning how to track your progesterone levels at home is calculating your average luteal phase length. The luteal phase is calculated from the total cycle length (i.e. 28 days) minus the day of ovulation (i.e. day 14). In the example just given, a 28-day cycle minus ovulation day of CD 14 would be a 14-day luteal phase, which is optimal.

A short luteal phase, which is less than 10 days long, is a sign of progesterone deficiency.

However, tracking luteal phase at home also helps you to know when the optimal day to test progesterone levels is, whether using a urinary hormone test at home or you are visiting a lab facility to have a progesterone blood draw. The optimal day to test progesterone levels is 5 to 7 days before your next period. Obviously, if you have no idea how long your luteal phase is, you don’t know when to predict that optimal 5-to-7-day period. This is why it’s important to track cycle length, day of ovulation, and luteal phase length for several cycles before tracking progesterone levels at home. Testing on the wrong day might give results that make it seem like you have a less-than-optimal level of progesterone.

Basal body temperature charts can also give indication of progesterone levels. While they are an indirect measure, if you have an elevation of your body temperature above baseline that is less than 0.5 degrees Fahrenheit, it may be a sign of low progesterone levels.

3. How to Track Progesterone Levels at Home with Luteal Phase

After the corpus luteum makes progesterone, the body breaks it down into a progesterone metabolite called Pregnanediol Glucuronide (PdG) which can be measured in urine, similarly to urinary LH test strips. While it is not exactly the same as progesterone, it reflects progesterone production and levels in the body.

PdG test strips can be purchased inexpensively over the counter, such as Easy @ Home, Proov and Inito (a comprehensive fertility hormone testing system that also includes estradiol, LH and FSH levels). Using urinary PdG, a level of 5 ug/mL indicates successful ovulaiton, which is roughly equivalent to a serum progesterone level of 10 ng/mL. The optimal levels for urinary PdG and blood serum progesterone would then be 7.5 ug/mL (urinary) and 15 ug/mL (serum) respectively.

How to Track Progesterone Levels at Home with Signs and Symptoms of Progesterone Deficiency

While clinical symptoms don’t confirm progesterone deficiency, they may serve as a clue that you are low on progesterone and should consider starting to test your progsterone levels at home. These include:

• Irregular Menstrual Cycles: Changes in cycle length, missed periods, or very light or heavy menstrual bleeding.
• PMS Symptoms: Increased premenstrual syndrome (PMS) symptoms, such as mood swings, irritability, and bloating.
• Mood Changes: Anxiety, depression, or mood swings that are more pronounced around the menstrual cycle.
• Sleep Issues: Difficulty sleeping or insomnia.
• Hot Flashes: Symptoms resembling those of menopause, including hot flashes and night sweats.
• Weight Gain: Unexplained weight gain or difficulty losing weight, often due to changes in metabolism.
• Low Libido: Decreased sexual desire or changes in sexual function.
• Fatigue: Increased fatigue or low energy levels.
• Breast Changes: Tenderness or changes in breast tissue, including fibrocystic changes.
• Hair Loss or Thinning: Changes in hair growth, including thinning hair or hair loss.

Perimenopause

One of the hallmarks of perimenopause is a shortening luteal phase length, shorter menstrual cycles and less progesterone. Estrogen also takes off on a roller coaster ride. You can diagnose perimenopause with an elevated FSH level in combination with a normal or increased LH level, or with increased LH and FSH in combination with having had a menstrual period in the last 12 months. Being age 40 or above is also a good sign that your progesterone levels are changing.

Test for Progesterone with Lab Testing

Of course, the only way to know for sure that you have low progesterone levels (provided that you are ovulating) is to test them. A progesterone level of at least 4.44 ng/mL (this may vary slightly depending on the lab) is required to confirm ovulation. However, what we care most about is the peak progesterone level achieved in the luteal phase. Because normal luteal phases typically range from 10-14 days, you need to test your progesterone level between 5 and 7 days before the start of your next period.

If you have regular menstrual cycles and track ovulation with basal body temperature, you know exactly when you’ll reach the midpoint of your luteal phase. If you don’t know when you ovulate, look at the average length of your menstrual cycles. If your cycles are between 24 and 28 days long, I’d recommend scheduling a blood draw 5 days before your next expected period. If they are 29 days or longer, I’d recommend scheduling a blood draw to be 7 days before your next expected period. Note that this isn’t a perfect algorithm; it’s possible to have a 14-day luteal phase in a 24-day cycle and a 10-day luteal phase in a 33-day cycle. However, particularly in the case of perimenopause, a short cycle is more likely to be accompanied by a relatively shorter luteal phase. The target is at least 15.0 ng/mL at the peak progesterone production, however higher is always better. (Note: non-pregnant cycles rarely exceed 28 ng/mL)

Not having enough progesterone leads to a range of health risks and complications, particularly in women. Symptoms include irregular periods, heavy bleeding, or amenorrhea (the absence of menstruation). This hormonal imbalance also exacerbates premenstrual syndrome (PMS) symptoms, leading to heightened mood swings, anxiety, and irritability. Additionally, progesterone deficiency is associated with an increased risk of endometrial hyperplasia, a condition where the uterine lining becomes too thick, potentially raising the risk of endometrial cancer. It also affects bone health, as progesterone plays a role in maintaining bone density; low levels may contribute to osteoporosis over time. Furthermore, inadequate progesterone leads to fertility issues, as it is essential for preparing the uterine lining for implantation of a fertilized egg. Overall, a lack of progesterone significantly impacts physical and emotional well-being, so if you are concerned about your progetserone levels, be sure to seek care from a functional medicine physician.

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!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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 Test Progesterone Levels at Home appeared first on Dr. Alexandra MacKillop.

What Is Letrozole?

Letrozole is a medication primarily used in the treatment of breast cancer but is also widely prescribed to women struggling with infertility, especially those diagnosed with polycystic ovary syndrome (PCOS). It works as an aromatase inhibitor, reducing the production of estrogen from precursor molecules like DHEA and other androgens. By lowering estrogen levels, Letrozole stimulates the release of follicle-stimulating hormone (FSH), which, in turn, promotes ovulation. Ovulation is essential for conception, and Letrozole helps correct the problem of excess estrogen (estrogen dominance) by regulating the brain-ovarian axis. However, the way it accomplishes this is by overriding an inborn system rather than helping to support the natural design of the body. Natural Letrozole alternatives accomplish the same goal without relying on prescription drugs that block hormone systems.

Doctors typically prescribe Letrozole to women who don’t respond to Clomid (clomiphene citrate) or for those who have PCOS but are looking for a less invasive alternative to injectable fertility drugs. It’s generally favored for its relatively mild side effects compared to other fertility medications. If you are looking for natural alternatives to Letrozole, you’re reading the right article.

Why Is Letrozole Prescribed for Fertility?

Letrozole is prescribed when women fail to ovulate on their own. Not ovulating is a key cause of infertility. However, the number one thing to consider when looking for natural alternatives to Letrozole and other fertility drugs is answering the question of why a person is not ovulating to begin with. I see three main reasons in my practice for lack of ovulation which include:

• Hypothalamic Amenorrhea (a condition in which the body’s stress response inhibits ovulation)
• PCOS (a condition in which high androgen levels prevent ovulation)
• Perimenopause (a condition in which aging of the ovary and reduce egg quality lead to irregular or absent ovulation)

There are many hormone imbalances that can cause lack of ovulation, including hypothyroidism and hyperthyroidism, though those are separate imbalances that typically don’t result in a Letrozole prescription.

The condition of hypothalamic amenorrhea, in my opinion, is not an appropriate time to use Letrozole because the body is already in a suppressed estrogen state. In this case, natural letrozole alternatives and addressing the root cause are much more effective. In perimenopause, FSH levels may already be high, and using Letrozole to further increase them may not actually help. However, estrogen levels are often also high in the early stages of perimenopause so advanced maternal age, in my clinical experience, is a more appropriate use of Letrozole. That being said, natural alternatives to Letrozole are often more appropriate and more effective. For PCOS, this would be the classic use of Letrozole because high estrogen and low FSH are common in this condition. That being said, understanding the root cause of PCOS is essential when treating the condition naturally and identifying viable natural alternatives to using Letrozole or other fertility drugs.

While Letrozole does its job effectively in many cases, it’s not without potential side effects like headaches, fatigue, and ovarian cysts. For those seeking to avoid pharmaceutical options, natural Letrozole alternatives provide a safe, non-toxic way to stimulate ovulation and improve fertility.

How Does Letrozole Compare to Other Fertility Medications?

Compared to other fertility medications like Clomid (clomiphene citrate) and injectable gonadotropins, Letrozole is less likely to cause multiple births (twins or more). Clomid, for instance, can lead to a higher incidence of multiple pregnancies, whereas Letrozole tends to result in single, healthy pregnancies. Letrozole is also often preferred over Clomid for women with PCOS due to its more favorable side effect profile.

Injectable gonadotropins, another common fertility treatment, stimulate the ovaries to produce eggs directly, often resulting in more aggressive stimulation and a higher risk of ovarian hyperstimulation syndrome (OHSS). Letrozole, however, works in a more controlled manner by stimulating the body’s natural hormone production.

Despite these benefits, Letrozole still relies on hormone manipulation, which can be taxing on the body and may result in rebound hormone imbalances after pregnancy. This is why many patients turn to natural Letrozole alternatives—herbal supplements that naturally support the body’s hormonal balance without the need for synthetic drugs.

The Mechanism of Action Behind Letrozole and Natural Alternatives

Let’s Review: Letrozole operates by inhibiting the aromatase enzyme, which is responsible for converting androgens into estrogen. As estrogen levels decrease, the body responds by increasing the production of follicle-stimulating hormone (FSH), which stimulates the ovaries to release mature eggs.

Natural Letrozole alternatives work by leveraging similar mechanisms to promote fertility. They either directly inhibit aromatase or support the body’s endocrine system to regulate hormone production, such as estrogen levels. While these alternatives don’t work as rapidly as prescription medications, they offer a gentler and sustainable way to address infertility.

Root Causes of Infertility and Letrozole Prescription

When Letrozole is prescribed, the root cause of infertility is often related to hormonal imbalances, specifically in women with PCOS. PCOS leads to an overproduction of androgens (male hormones) which are converted into estrogen at high levels. Very high levels of this nature contributes to the inhibition of ovulation seen in PCOS. Letrozole works by reducing estrogen, thus triggering ovulation and improving the chances of pregnancy.

For other women, infertility can result from issues like poor egg quality, irregular cycles, or insufficient progesterone. In such cases, Letrozole is used to support ovulation, but it may not address underlying hormonal imbalances or deficiencies. Natural Letrozole alternatives, however, take a more holistic approach by addressing the broader spectrum of hormonal imbalances contributing to infertility.

Natural Letrozole Alternatives for Fertility

1. Resveratrol
   
   • How It Works: Resveratrol functions as a direct and effective natural aromatase inhibitor. In women with estrogen-dominant conditions or polycystic ovary syndrome (PCOS), this conversion process becomes dysregulated, leading to suppressed ovulation and hormonal imbalance. Resveratrol blocks the activity of aromatase at the cellular level. It binds to the enzyme’s active site, reducing its ability to synthesize estrogen from androgen precursors. This inhibition lowers circulating estrogen levels, which signals the hypothalamus and pituitary gland to increase the release of follicle-stimulating hormone (FSH). Elevated FSH promotes the development and maturation of ovarian follicles, which directly supports ovulation and improves the chances of conception, acting in direct similarity to Letrozole and offering a natural Letrozole alternative.
   • Advantages: Unlike Letrozole, Resveratrol offers this action without the synthetic load on the liver or disruption of other hormonal systems. It also delivers strong antioxidant and anti-inflammatory support, which helps reduce oxidative stress in the ovaries and improves overall endocrine function. For women seeking natural Letrozole alternatives, Resveratrol provides targeted hormonal modulation. It mimics the clinical benefits of Letrozole—ovulation induction, estrogen control, and follicular development—through a plant-based, bioavailable pathway that supports the body rather than overriding it.
   • Typical Dosage:
     • Dose: 150–250 mg per day
     • Standardization: Choose trans-resveratrol supplements with 98–100% purity to ensure bioactive effectiveness
     • Form: Capsule or softgel, ideally in a micronized or liposomal form for increased absorption
     • Timing: Take once daily with food, preferably in the morning to align with cortisol rhythm and minimize GI upset
     • Duration of Use
       • Use for a minimum of 8–12 weeks to support estrogen clearance, normalize ovulation, and improve egg quality
       • Best applied during follicular phase or as part of a broader preconception protocol when preparing the body for ovulation
     • Synergistic Combinations
       • Combine with quercetin or EGCG to amplify aromatase inhibition and antioxidant protection
       • Pair with NAC or milk thistle to support phase I and II liver detox—crucial for estrogen metabolism
       • Use alongside inositol for added insulin regulation in PCOS-driven infertility
2. Green Tea Catechins (EGCG)
   • How It Works: EGCG, the active polyphenol in green tea, acts as a potent natural aromatase inhibitor. It directly suppresses the activity of the aromatase enzyme, which converts androgens into estrogens. EGCG not only inhibits estrogen synthesis by directly binding to and blocking aromatase (similarly to Resveratrol) but also modulates gene expression linked to estrogen metabolism. It downregulates CYP19A1, the gene encoding aromatase, further limiting estrogen production at the source. The result: restored ovulatory cycles, improved egg maturation, and increased fertility potential.
   • Advantages: Unlike synthetic drugs, EGCG delivers this hormonal recalibration without liver toxicity, ovarian overstimulation, or long-term endocrine disruption. There is also robust evidence regarding the benefits of EGCG for modulating other estrogen-dependent diseases, like estrogen-dependent cancers. EGCG offers a biologically intelligent solution—working with the body’s natural systems to correct the root dysfunction behind anovulatory infertility. As a natural Letrozole alternative, EGCG provides targeted, reliable aromatase inhibition. It shifts the hormonal environment in favor of ovulation and conception, while simultaneously reducing oxidative stress and inflammation—two major contributors to ovarian dysfunction.
   • Typical Dosage:
     • Therapeutic range: 300–400 mg per day, standardized to ≥90% EGCG
     • Form: Use decaffeinated green tea extract capsules or powders to avoid overstimulation
     • Timing: Divide the dose into two servings (e.g., 200 mg AM, 200 mg PM) to maintain stable blood levels
     • Duration: Use for at least 3 menstrual cycles to assess full impact on ovulation and hormonal balance
     • Critical Guidelines
       • Always take EGCG with food to reduce potential gastrointestinal irritation.
       • Avoid taking EGCG within two hours of iron or folate supplements—it interferes with absorption.
       • Combine with antioxidant cofactors like quercetin or vitamin C to enhance bioavailability and reproductive tissue protection.
     • Cautions
       • Doses exceeding 800 mg per day increase risk of liver stress, particularly in women with compromised detox pathways (e.g., MTHFR mutations, sluggish phase II liver detox).
       • Monitor liver enzymes if using alongside other herbs or medications.
3. Saw Palmetto
   • How It Works: Saw Palmetto delivers powerful endocrine modulation by directly inhibiting both aromatase and 5-alpha reductase—two key enzymes involved in hormonal imbalance. As a natural aromatase inhibitor, Saw Palmetto blocks the conversion of androgens into estrogens at the tissue level, particularly in adipose and ovarian tissue. By blocking this pathway, Saw Palmetto reduces DHT load, rebalances androgen levels, and removes one of the most common roadblocks to ovulation.
   • Advantages: Unlike synthetic drugs that override the endocrine system, Saw Palmetto reestablishes proper feedback between the hypothalamus, pituitary, and ovaries. It stabilizes estrogen and androgen levels, supports follicular development, and promotes timely ovulation without the side effects linked to pharmaceuticals like Letrozole. As a natural Letrozole alternative, Saw Palmetto addresses the same root dysfunction—excess estrogen production and androgen imbalance—through targeted, multi-pathway inhibition. It restores hormonal order and fertility function with precision and without compromise.
   • Typical Dosage:
     • Dose: 320–400 mg per day
     • Standardization: Use extracts standardized to 85–95% fatty acids and sterols—the active constituents responsible for enzyme inhibition
     • Form: Softgel or liquid extract for superior absorption
     • Timing: Take once daily with a fat-containing meal to optimize bioavailability
     • Duration of Use:
       • Use consistently for at least 8–12 weeks to see measurable shifts in hormonal patterns and ovulatory cycles
       • Best used as part of a comprehensive protocol that includes blood sugar regulation, adrenal support, and anti-inflammatory nutrition
       • Combine with zinc for enhanced 5-alpha reductase inhibition, or vitex/inositol to further regulate LH, FSH, and ovulatory signaling
       • Stack with EGCG or resveratrol when estrogen suppression requires broader enzyme inhibition
     • Cautions
       • Avoid use during active attempts at conception without supervision, as it may suppress DHT levels beyond optimal range if overdosed
       • Monitor for mild gastrointestinal discomfort or changes in menstrual flow—these reflect hormonal shifts, not toxicity
4. Grape Seed Extract
   • How It Works: Grape Seed Extract contains proanthocyanidins, which exert strong antioxidant effects while simultaneously blocking estrogen biosynthesis via aromatase inhibition. This dual action not only promotes ovulation but also protects ovarian tissue from oxidative stress—one of the hidden drivers of poor egg quality and anovulation.
   • Advantages: As a natural Letrozole alternative, Grape Seed Extract delivers precise hormonal recalibration without the synthetic overload of pharmaceuticals. Its high concentration of proanthocyanidins neutralizes free radicals and halts the oxidative stress that fuels chronic inflammation in reproductive tissues. This antioxidant activity protects ovarian follicles, preserves egg quality, and stabilizes the endometrial environment—critical factors for successful conception and implantation.
   • Typical Dosage
     • Dose: 150–300 mg per day
     • Standardization: Choose extracts standardized to 95% proanthocyanidins—the active compounds responsible for aromatase inhibition and antioxidant effects
     • Form: Capsule or powder; use encapsulated form for precise, therapeutic dosing
     • Timing: Take once or twice daily with meals to improve absorption and reduce gastrointestinal irritation
     • Duration of Use
       • Continue for at least 8–12 weeks to lower estrogen levels, support ovulation, and improve overall reproductive function
       • Integrate into the follicular phase of the cycle or use as part of a full preconception plan to reset hormonal balance before conception attempts
     • Synergistic Combinations
       • Stack with resveratrol or EGCG to intensify aromatase inhibition and estrogen detox
       • Pair with vitamin C to enhance antioxidant capacity and stabilize proanthocyanidin activity
       • Combine with inositol or chromium to simultaneously support insulin sensitivity and ovarian function in PCOS cases
     • Cautions
       • Avoid combining with blood thinners or high-dose NSAIDs without supervision, as Grape Seed Extract also promotes vascular flexibility
         Monitor menstrual cycle shifts—reduced estrogen load often triggers faster follicular development and earlier ovulation
       • Doses above 400 mg daily increase risk of gastrointestinal symptoms and do not increase therapeutic effect proportionally
5. Shatavari
   • How It Works: This botanical works on multiple levels. Its steroidal saponins bind to estrogen receptors and modulate their sensitivity, reducing the overstimulation caused by high estrogen levels. At the same time, Shatavari supports the adrenal glands and reduces cortisol output, protecting the reproductive system from stress-induced dysfunction, particularly relevant in cases of Hypothalamic Amenorrhea, PCOS and Perimenopause.
   • Advantages: Shatavari enhances follicular development, supports egg maturation, and improves cervical mucus quality—three non-negotiable factors for natural conception. It also stabilizes progesterone levels post-ovulation, supporting luteal phase health and implantation.
   • Typical Dosage:
     • Dose: 500–1000 mg per day
     • Standardization: Use standardized extracts containing 10–20% steroidal saponins, the bioactive compounds responsible for aromatase inhibition and hormonal support
     • Form: Capsule or tincture; choose high-quality, standardized extracts for consistent potency
     • Timing: Divide into two doses daily, preferably with meals to enhance absorption and minimize gastrointestinal discomfort
     • Duration of Use
       • Administer for at least 8–12 weeks to achieve meaningful hormonal recalibration and improved ovulatory function
       • Most effective when incorporated into a broader fertility protocol focused on stress reduction, blood sugar balance, and anti-inflammatory nutrition
     • Synergistic Combinations
       • Combine with ashwagandha or rhodiola to support adrenal function and reduce cortisol’s disruptive impact on reproductive hormones
       • Pair with vitex or inositol to enhance follicular maturation and regulate pituitary hormone signaling
       • Use alongside Grape Seed Extract or Resveratrol to strengthen aromatase inhibition and estrogen metabolism
     • Cautions
       • Avoid excessive dosing beyond 1000 mg daily to prevent hormonal overstimulation or digestive upset
       • Monitor menstrual cycle and ovulation patterns closely—Shatavari’s potent endocrine effects often manifest quickly in cycle regularity and luteal phase support
       • Not recommended during confirmed pregnancy without professional guidance due to its hormonal activity

The road to conception can be difficult and frustrating, but you don’t have to rely solely on pharmaceutical treatments like Letrozole to address infertility. Natural Letrozole alternatives offer an empowering way to regulate hormones, promote ovulation, and support overall fertility health. Whether you choose EGCG, Shatavari or other herbal remedies, these natural options provide a gentler, holistic approach to fertility, addressing the root cause of hormonal imbalances while avoiding the side effects of synthetic medications.

Incorporating natural Letrozole alternatives into your fertility journey is a step toward taking control of your reproductive health. With patience and proper guidance, these natural remedies provide an effective, safe, and sustainable solution to support your body’s ability to conceive.

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!

Love this post Share it!

• Facebook
• Pinterest
• Instagram

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 Natural Letrozole Alternatives: Holistic Fertility Treatment Through Functional Medicine appeared first on Dr. Alexandra MacKillop.