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

What are LH strips?

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

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

To give you a few examples:

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

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

Why

Because not all luteal phases are 14 days in length.

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

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

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

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

How Do LH Strips Work?

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

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

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

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

An Overview of Ovulation

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

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

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

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

The Confusion About LH Strip Timing

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

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

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

To flush this out a little bit more:

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

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

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

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

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

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

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

How LH Strips Work 

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

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

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

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

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

Understanding LH Strips in Real Life

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

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

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

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

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

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

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

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

Do you see the problem?

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

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

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

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

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

The Bottom Line on LH Strips

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

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

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

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

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

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

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

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The post How to Naturally Increase Fertility 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

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Sign Me Up!

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

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

If you are worried about your hormones, you’re probably not wrong. You know your body best. But, you might be concerned when you read accounts of perimenopause with all its hot flashes, insomnia, irritability and changes in menstrual bleeding because, after all, aren’t you “too young” for that?

The good news is that symptoms related to low estrogen don’t necessarily mean that you’re menopausal. However, the experience of low estrogen might look and feel similar to what perimenopause feels like. It’s quite the roller coaster ride.

What is Estrogen Deficiency?

Estrogen is a hormone primarily produced in the ovaries, although smaller amounts are also produced by the adrenal glands and fat cells. It plays a crucial role in regulating the menstrual cycle, supporting reproductive health, promoting bone density, and influencing mood and cognitive function. Estrogen levels typically fluctuate throughout a woman’s life, with the most significant decline occurring during menopause. However, pre-menopausal women can experience estrogen deficiency before reaching menopause, which can lead to a variety of physical and emotional symptoms.

Causes of Estrogen Deficiency in Pre-Menopausal Women

There are several potential causes of estrogen deficiency in pre-menopausal women. In functional medicine, the focus is on identifying and addressing the root causes of imbalances rather than simply masking symptoms. Key factors contributing to estrogen deficiency in pre-menopausal women include:

1. Stress and HPA Axis Dysfunction

Chronic stress is a major factor that can lead to hormonal imbalances, including estrogen deficiency. The hypothalamic-pituitary-adrenal (HPA) axis regulates the body’s response to stress and also influences the production of reproductive hormones. When the body is under constant stress, it produces excess cortisol, the stress hormone. Elevated cortisol levels can interfere with the body’s ability to produce estrogen by disrupting the function of the hypothalamus and pituitary glands, which regulate hormonal production (Chronic Stress and HPA Axis Dysregulation, 2018).

Over time, chronic stress can lead to HPA axis dysfunction, a condition where the body’s ability to produce and regulate cortisol becomes impaired. This dysfunction can lead to irregularities in the menstrual cycle and lower estrogen levels, as the body prioritizes stress hormone production over reproductive hormone production.

2. Irregular Eating Patterns and Poor Nutrition

Diet plays a significant role in maintaining hormonal balance. Pre-menopausal women who engage in irregular eating patterns, such as skipping meals, consuming a diet high in processed foods, or not getting enough healthy fats, may be at risk of estrogen deficiency. Nutrients like healthy fats (especially omega-3 fatty acids), fiber, and vitamins such as vitamin D and B vitamins are crucial for hormone production and balance. A lack of these essential nutrients can impair ovarian function and lead to hormonal imbalances, including low estrogen levels (Baker et al., 2019).

Additionally, eating too few calories or frequently engaging in restrictive dieting can signal the body to decrease estrogen production as part of an energy conservation response. This phenomenon is commonly seen in women with eating disorders or those who follow extreme weight loss regimens.

3. Ovarian Function Decline

Ovarian function naturally declines as women age, but premature ovarian insufficiency (POI), also known as early menopause, can occur before the age of 40. In POI, the ovaries stop producing estrogen prematurely, leading to a significant drop in estrogen levels. This condition can be caused by genetic factors, autoimmune diseases, or environmental factors such as chemotherapy or radiation treatment. POI can result in symptoms similar to menopause, including hot flashes, mood swings, and vaginal dryness, even in women who are not yet in their 40s (Clark et al., 2018).

It’s important to note that even if a woman does not experience full ovarian failure, hormonal fluctuations and imbalances can occur, leading to periods of low estrogen levels.

4. Poor Sleep and Hormonal Imbalance

Sleep plays a pivotal role in maintaining hormonal balance. Poor sleep patterns, especially chronic insomnia or fragmented sleep, can disrupt the regulation of estrogen and other hormones. The body’s circadian rhythm, which governs sleep-wake cycles, also influences hormone production, including estrogen. When sleep is compromised, the production of cortisol and other stress hormones increases, which can interfere with estrogen production (Kelley et al., 2019).

Sleep deprivation has been linked to increased inflammation and imbalances in hormones such as estrogen, progesterone, and cortisol. Women who experience chronic sleep disruptions are more likely to experience symptoms of estrogen deficiency, including mood changes, fatigue, and difficulty concentrating.

Signs and Symptoms of Estrogen Deficiency in Pre-Menopausal Women

Estrogen deficiency can manifest in a variety of physical, emotional, and cognitive symptoms. Pre-menopausal women experiencing low estrogen levels may notice the following:

1. Irregular Menstrual Cycles

One of the earliest signs of estrogen deficiency is irregular menstruation. Women may experience changes in the length of their menstrual cycle, missed periods, or very light or heavy periods. Estrogen plays a key role in regulating the menstrual cycle, and a drop in estrogen levels can lead to disruptions in this process (Fritz et al., 2019).

2. Hot Flashes and Night Sweats

Although hot flashes and night sweats are often associated with menopause, they can also occur in pre-menopausal women with estrogen deficiency. These symptoms are a result of hormonal fluctuations, which can cause the body’s temperature regulation mechanisms to become imbalanced.

3. Mood Swings and Anxiety

Estrogen has a significant impact on mood regulation and cognitive function. Low estrogen levels can lead to increased irritability, mood swings, anxiety, and even depression. Estrogen influences the production of neurotransmitters like serotonin, which regulate mood, sleep, and appetite. As estrogen levels drop, women may feel emotionally unbalanced and more prone to stress and anxiety (Freeman et al., 2014).

4. Fatigue and Low Energy

Women with estrogen deficiency may experience chronic fatigue, low energy levels, and a general sense of exhaustion. Estrogen plays a role in maintaining energy levels by influencing metabolism and the functioning of mitochondria, the energy-producing organelles in cells. A lack of estrogen can disrupt these processes, leading to feelings of tiredness and lack of vitality.

5. Vaginal Dryness and Decreased Libido

Estrogen is essential for maintaining vaginal health and lubrication. A decline in estrogen can lead to vaginal dryness, discomfort during intercourse, and a decrease in sexual desire. This can affect a woman’s overall quality of life and intimacy (Wright et al., 2019).

Herbal Supplements for Estrogen Deficiency

Functional medicine focuses on addressing the root causes of estrogen deficiency and using natural remedies to support hormonal balance. Several herbal remedies have been traditionally used to promote estrogen production and alleviate symptoms of estrogen deficiency:

1. Black Cohosh

Black cohosh is one of the most well-known herbs for balancing estrogen levels. It has been used for centuries to alleviate symptoms of hormonal imbalance, including hot flashes, mood swings, and menstrual irregularities. Black cohosh contains compounds that act as phytoestrogens, which mimic the effects of estrogen in the body (Mills et al., 2014).

2. Dong Quai

Dong Quai, often referred to as “female ginseng,” is an herb commonly used in traditional Chinese medicine to support female reproductive health. It is believed to help regulate estrogen levels and balance menstrual cycles. Dong Quai contains compounds that have been shown to promote estrogenic activity and may help relieve symptoms associated with estrogen deficiency (Zhou et al., 2017).

3. Maca Root

Maca root is a powerful adaptogen that helps regulate the body’s stress response and support hormonal balance. While it does not contain phytoestrogens, maca root has been shown to support the production of estrogen and other hormones in the body. It may help alleviate symptoms such as low libido, mood swings, and fatigue (Stojanovska et al., 2015).

4. Chaste Tree (Vitex)

Chaste tree, or Vitex, is an herb commonly used to regulate hormonal imbalances, particularly those involving estrogen and progesterone. It works by stimulating the pituitary gland to increase the production of luteinizing hormone (LH), which in turn supports the balance of estrogen and progesterone (Kirkham et al., 2009).

Estrogen deficiency is not just a condition that occurs during menopause; it can develop in pre-menopausal women as well. Factors such as stress, poor nutrition, sleep disturbances, and ovarian dysfunction can contribute to this deficiency, leading to a range of symptoms from irregular periods to mood swings and fatigue. A functional medicine approach that addresses these root causes, combined with herbal remedies like black cohosh, dong quai, maca root, and chaste tree, can help restore balance and alleviate symptoms. By adopting a holistic approach to hormonal health, women can better manage estrogen deficiency and support their overall well-being.

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

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

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

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

References

Baker, L. D., et al. (2019). Nutrition and hormone regulation in women’s health. Journal of Women’s Health, 28(3), 227-233. https://doi.org/10.1089/jwh.2018.7167

Chronic Stress and HPA Axis Dysregulation (2018). Hormone Health Journal, 3(1), 45-52.

Clark, M. A., et al. (2018). Premature ovarian insufficiency: Diagnosis and management. Journal of Clinical Endocrinology & Metabolism, 103(9), 3097-3105. https://doi.org/10.1210/jc.2018-00885

Freeman, E. W., et al. (2014). Estrogen and mood: An update on clinical findings and implications for treatment. Journal of Clinical Psychiatry, 75(7), 732-739. https://doi.org/10.4088/JCP.13r08744

Kelley, G. A., et al. (2019). Sleep and estrogenic regulation of metabolic function. Sleep Medicine Reviews, 45, 67-79. https://doi.org/10.1016/j.smrv.2018.02.004

Kirkham, L., et al. (2009). The use of Vitex agnus-castus in the management of hormonal imbalances. Journal of Herbal Medicine, 3(3), 103-110.

Mills, E., et al. (2014). Black cohosh for menopausal symptoms: A systematic review. American Journal of Obstetrics & Gynecology, 210(2), 154-161.

Stojanovska, L., et al. (2015). Maca root: A functional food and its potential health benefits. International Journal of Food Science & Technology, 50(4), 982-988.

Wright, R. D., et al. (2019). Hormonal balance and female health: The role of estrogen. Women’s Health Journal, 30(1), 12-19.

The post Estrogen Deficiency In Young women: It’s More Than Just Menopause appeared first on Dr. Alexandra MacKillop.

Progesterone plays a crucial role in maintaining healthy menstrual cycles by regulating the various hormonal changes that occur throughout the cycle. After ovulation, the ovaries produce progesterone, which prepares the uterine lining for potential implantation of a fertilized egg. This hormone promotes the thickening of the endometrium, ensuring it is nutrient-rich and conducive to supporting early pregnancy. If fertilization does not occur, progesterone levels decline, triggering the shedding of the uterine lining during menstruation. This hormonal balance is essential for a regular menstrual cycle; insufficient progesterone can lead to irregularities, such as heavy or missed periods, and can contribute to symptoms of premenstrual syndrome (PMS). Additionally, adequate progesterone levels help to stabilize mood and prevent excessive estrogen, reducing the risk of conditions like endometriosis and uterine fibroids. Thus, maintaining appropriate progesterone levels is vital for reproductive health, emotional well-being, and the overall regularity of menstrual cycles.

Herbal Strategies

Herbal remedies can be a gentle way to support hormonal balance and enhance progesterone production. Below are some herbs known for their progesterone-supporting properties. Please be aware that not all herbs are appropriate for all women, and it’s not safe to use all herbs when you are trying to become pregnant. The most straightforward way to correct the problem of low progesterone/progesterone deficiency is by having a thorough laboratory workup from a licensed functional medicine doctor. Please make sure to discuss any herbal strategy with a functional medicine doctor before starting them for yourself.

Vitex (Chaste Tree)

• Mechanism: Vitex affects the pituitary gland, stimulating the production of luteinizing hormone (LH), which can promote progesterone secretion through ovulation. One of the primary reasons that I use vitex in my practice is in cases where women concomitantly have hypothyroidism, hyperprolactinemia (a common reason for the prescription Cabergoline) or are over 40.
• Dosage: Commonly taken as a tincture or capsule, typically in doses of 400–1000 mg per day.
• Considerations: May take several months to show effects; I usually start my patients on vitex for 3 months, and we don’t use it longer than 6 months except in rare cases.

Maca Root

• Mechanism: An adaptogen that helps balance hormones by supporting adrenal function and improving overall endocrine health. One of the plus sides of this herb is that it is a medical food as well as a supplement, and may be safe to take when breastfeeding (check with your healthcare provider!) I myself took it after the birth of my first child because of intense anxiety, and it helped a lot! For this same reason, it’s also one of the adaptogens I’m more likely to recommend when TTC because it doesn’t carry the same risks as others, such as ashwagandha.
• Dosage: Usually available in powder form, with a typical dosage of 1.5–3 grams daily.
• Considerations: Can be added to smoothies or baked goods; start with a lower dose to assess tolerance.

Dong Quai

• Mechanism: Known as “female ginseng,” it may help balance estrogen and progesterone levels by acting as a phyto-estrogen. Women who are perimenopausal are particularly likely to benefit from the effects of this herb.
• Dosage: Commonly taken in capsule or tincture form, with typical doses ranging from 300–600 mg.
• Considerations: Should be used cautiously, especially by women with certain health conditions or who are pregnant.

Black Cohosh

• Mechanism: Traditionally used to alleviate menopausal symptoms; black cohosh is beneficial because it can likewise act like a natural alternative to the drug Clomid, triggering ovulation in women who otherwise might not be ovulating. Without ovulation, you can’t make progesterone, so although black cohosh is a phytoestrogen, it helps improve overall progesterone balance. Anovulatory periods are always estrogen-dominant.
• Dosage: Commonly available as a tincture or tablet, with dosages around 20–40 mg per day.
• Considerations: Not recommended for long-term use; consult a healthcare provider for guidance.

Red Clover

• Mechanism: Contains phytoestrogens that can help balance hormones and support progesterone levels. Similar to black cohosh, red clover can help improve ovulation rates.
• Dosage: Available as a tea, capsule, or tincture, with a typical dosage of 40–80 mg per day.
• Considerations: May interact with some medications; consult a healthcare provider.

Lifestyle Strategies

In addition to herbal remedies, certain lifestyle changes can support hormone balance and increase progesterone production.

Nutrition

1. Balanced Diet
   • Focus on whole, nutrient-dense foods rich in vitamins and minerals.
   • Include healthy fats (avocados, nuts, seeds) that support hormone production.
   • I always recommend that patients include animal products in their diets, especially fish (including whole fish such as sardines)
   • Make sure that you are eating enough calories and macronutrients overall. In my experience, women need at least 100-125 grams of carbohydrates per day to ovulate.
2. Incorporate Zinc and Magnesium
   • Foods rich in zinc (pumpkin seeds, shellfish) and magnesium (leafy greens, dark chocolate) support hormone balance and promote ovulation.
   • Consider supplementation if dietary intake is insufficient.
3. Limit Sugar and Processed Foods
   • High sugar and processed foods can lead to insulin resistance, negatively affecting hormone balance by promoting insulin resistance, which negatively impacts metabolism and ovulation. Insulin resistance changes ovarian function, which can be reversed easily within 90 days using a whole food diet
   • Aim to reduce refined sugars and prioritize whole foods

Stress Management

• Mindfulness and Meditation: Practice mindfulness techniques to reduce stress, which can help regulate cortisol levels and support progesterone balance.
• Yoga and Breathing Exercises: Incorporate regular yoga or deep breathing exercises to promote relaxation and hormonal balance.

Regular Exercise

• Balanced Physical Activity: Engage in moderate exercise, such as walking, swimming, or cycling, to maintain a healthy weight and support hormonal health. The best kind of exercise is always the type you enjoy doing.
• Avoid Overtraining: Excessive exercise can lead to hormonal imbalances; prioritize rest and recovery.

Sleep Hygiene

• Quality Sleep: Aim for 7-9 hours of quality sleep per night to support hormonal regulation.
• Sleep Environment: Create a relaxing bedtime routine and a comfortable sleep environment to improve sleep quality.

Healthy Weight Management

• Maintaining a Healthy Weight: Excess body fat can lead to higher estrogen and insulin levels, both of which can disrupt ovulation and production of progesterone. At the same time, being underweight may lead to anovulation and subsequently the near absence of progesterone production.
• Balanced Caloric Intake: Focus on a diet that supports a healthy weight through balanced caloric intake and nutrient-rich foods. Make sure you are eating enough protein, fat, carbohydrate and overall calories in optimal proportions. Avoid skipping meals or prolonged fasting. If you choose to follow time-restricted eating, consider an earlier eating window (i.e. 9 am – 3 pm) instead of a later one (i.e. 1 pm – 7 pm).

Increasing progesterone naturally involves a multifaceted approach that combines herbal remedies with lifestyle changes. By focusing on a balanced diet, stress management, regular exercise, and proper sleep, women can support their hormonal health effectively. It is essential to consult with a healthcare provider before starting any new supplement or herbal regimen, especially if you have existing health conditions or are pregnant, and to make sure that you have an accurate diagnosis. With the right strategies, you can achieve better hormonal balance and overall well-being that last a lifetime.

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

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

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

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The post Herbal Supplements for Low Progesterone appeared first on Dr. Alexandra MacKillop.

The Mirena Crash is a type of hormonal imbalance occurring as an IUD’s hormones wear off, or when it is suddenly removed, leading to various physical and emotional symptoms. In this post, we’ll explore what the Mirena Crash is, how the Mirena IUD works, the benefits of natural progesterone, and natural treatment options for the Mirena Crash. First and foremost, the best way to prevent a Mirena Crash is to not get an IUD in the first place; but if you already have one, don’t fret! In this post, I’ll explain everything you need to know.

What is the Mirena Crash?

The Mirena IUD is a popular contraceptive device that releases a synthetic form of progesterone called levonorgestrel. This is not the same as real progesterone, does not behave exactly like real progesterone, and consequently lacks the benefits of real progesterone. It also comes with some significant risks. Really, all IUDs have these synthetic progestins, so the term “Mirena Crash” really should be “IUD Crash.” But that doesn’t even fully encompass the full scope of the problem, either, because all forms of hormonal contraceptives run the risk of causing major problems to the body’s systems. (Read: Natural Alternatives to the Birth Control Pill) However, for the sake of this trending topic, we’ll keep calling it “Mirena Crash” in this post.

While some women experience a smooth transition off the IUD, many don’t. This term describes the withdrawal symptoms that can occur after the hormones in the device run out (the Mirena is approved in the US to last up to 8 years for pregnancy prevention) or after the device is removed. This hormonal crash often involves symptoms like mood swings, anxiety, fatigue, hair loss, weight gain and other manifestations of hormonal imbalances. The severity of these symptoms can varies but the common denominator is that people who experience the hormonal reverberations of using these endocrine-disrupting contraceptives feel awful. Why Well, it all comes down to how the Mirena and other IUDs work.

How Does the Mirena IUD Work?

The Mirena IUD works primarily by releasing levonorgestrel directly into the uterus. Here’s how it functions:

1. Thickens Cervical Mucus: This makes it more difficult for sperm to enter the uterus.
2. Thins the Uterine Lining: A thinner lining reduces the chances of implantation if an egg is fertilized. You should be aware that this means that IUDs prevent the implantation of fertilized eggs, which may be a moral concern for some.
3. Inhibits Ovulation: Although this is not its primary function, the hormonal release can prevent ovulation in some women: around 55% of cycles in the first year of use, but that number drops to around 25% after 4 years. [Source: FDA Insert]

Hormonal IUDs also run the risk of systemic side effects, even though they’re often advertised as locally-acting. While the pregnancy-prevention effects are locally-induced (read: changes in cervical fluid and endometrial lining thickness) the hormones enter the blood stream and affect organs all the way up to the brain, which is how they interfere with ovulation, and how they cause a hormonal crash after they’re suddenly removed.

With an IUD in place, the levonorgestrel tricks the brain into supressing hormone production. When the hormone in the IUD wears off or the device is removed, you’d think that this hormonal suppression resolves. Well, not always, and certainly not immediately. It can take months for the body to come back into balance. What’s more, because the Mirena is the longest-acting contraceptive device approved for women, it’s usually administered to women who would like to prevent pregnancy for a long time. This group typically reflects women who are done having children. By the time they have the device removed, they’re often well into perimenopause, when hormones have already begun shifting. When you take a situation of hormonal suppression as seen with the IUD, then create a crash by suddenly withdrawing the drugs, and then the return of hormones looks like perimenopause (which sometimes includes debilitating hormonal imbalances all of its own) it’s no wonder that women feel terrible. It’s no wonder we’ve started talking about it on social media. It’s no wonder that women with IUDs are both scared of the Mirena and scared of having it removed.

So, what’s to be done Enter: natural progesterone.

Levonorgestrel and other progestins are not the same as the progesterone our bodies make. Our bodies need progesterone to function properly. The fake progestins in IUDs and other hormonal contraceptives trick our bodies into not making progesterone anymore. Then, when the IUD is removed, there’s still no progesterone around. If removal takes place during perimenopause, progesterone may never come back. Fortunately, the marvels of modern medicine (read: functional medicine) have made a way to bring that back.

The Benefits of Natural Progesterone for the Mirena Crash

Natural progesterone, which can be found in supplements derived from plants like wild yam, or administered through bioidentical hormone replacement therapy, offers several benefits, especially for those experiencing hormonal symptoms like the Mirena Crash. Some of the advantages include:

1. Regulating Menstrual Cycles: Natural progesterone balances estrogen levels, leading to more regular cycles and eliminating estrogen dominance.
2. Improving Mood and Reducing Anxiety: Because the brain has abundant hormone receptors for progesterone, natural progesterone travels straight there and does what it was meant to do all along for our mood, our sleep, stress regulation and more.
3. Supporting Sleep: Progesterone keeps you cool, calm and collected, partly because it helps you sleep better.
4. Bone and Breast Health: Adequate progesterone levels are important for maintaining bone density and preventing breast cancer, as well as numerous other cancers of the female reproductive tract.

Incorporating natural progesterone is especially beneficial for women transitioning off hormonal birth control, and who are on the estrogen roller coaster ride of perimenopause.

How Can the Mirena Crash Be Treated Naturally?

If you’re experiencing the Mirena Crash, there are several natural approaches you can consider to alleviate symptoms. Of course, always talk with your doctor about trying something new:

1. Dietary Changes:
   • Whole Foods: Emphasize a diet rich in fruits, vegetables, whole grains, and healthy fats. Foods high in fiber and omega-3 fatty acids can support hormonal balance.
   • Limit Sugar and Caffeine: Reducing sugar and caffeine can help stabilize energy levels and mood.
2. Herbal Supplements:
   • Vitex (Chaste Tree Berry): Known for its ability to support hormonal balance, Vitex helps regulate the menstrual cycle and reduce symptoms associated with low progesterone and the Mirena Crash.
   • Maca Root: This adaptogen can help balance hormones and increase energy levels.
3. Stress Management Techniques:
   • Mindfulness and Meditation: Practicing mindfulness can help reduces anxiety and improves emotional well-being.
   • Yoga and Exercise: Regular physical activity helps balance hormones and improve mood.
4. Natural Progesterone Creams or Oil:
   • Consider using natural progesterone creams under the guidance of a functional medicine doctor to help manage symptoms. Progesterone cream does come with side effects and is not appropriate or needed for all women.
5. Adequate Sleep:
   • Prioritize sleep hygiene by maintaining a regular sleep schedule and create a relaxing bedtime routine to enhance recovery.

Navigating the Mirena Crash can be challenging, but understanding its causes and implementing natural strategies significantly eases the transition. Whether through dietary adjustments, herbal supplements, or lifestyle changes, there are numerous ways to support your body during this time. Always consult with a healthcare professional before making significant changes to your health routine, especially when it involves hormonal treatments. By taking proactive steps, you can regain balance and well-being after the Mirena IUD.

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

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

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

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The post How to Survive The Mirena Crash appeared first on Dr. Alexandra MacKillop.

What’s the problem with the pill?

On its own, using hormonal contraceptives (which categorically includes the pill, the patch, the shot, and hormonal IUDs) does a few things to the body that spell bad news. First, the way they function is by preventing your ovaries from making their own hormones. Here’s the real deal: we need both natural estrogen and natural progesterone in order to be well, along with the other hormones that our ovaries make in smaller doses, like testosterone and DHEA. With terms like “hormone balance” the idea is to make sure that the body is able to produce its own hormones at the appropriate levels and also detox them. Using hormonal contraceptives gets in the way of both of these things.

1. The whole point of hormone-based contraceptives is to prevent ovulation. Fake progestins trick your brain into thinking that you’ve already ovulated, so you won’t produce the necessary hormone surge to trigger ovulation (via estrogen) or any of the lovely hormones that come after ovulation (progesterone and estradiol.) Hormonal contraceptives are named as such not because they replace your hormones but because they block them. [Read: the “progestins” in the pill are not real progesterone, and ethinyl estradiol is not the same thing as the estradiol your ovaries make.] IUDs specifically also have a secondary effect of thinning the uterine lining to prevent implantation of a fertilized egg. This might be important to you for ethical reasons, so take note.
2. Your body detoxes the drugs in hormonal contraceptives through your liver’s detox pathways. But the huge overload of drugs that come from contraceptive devices backlogs the liver’s activity, leading to inflammation, changes in the gut microbiome (and subsequent gut health) and even feeds forward into imbalances in other hormonal systems, like your thyroid and adrenal health. Yikes!

But here are a few other important notes: hormonal contraceptives are contraindicated in women with migraines or who smoke, who are over 35 years old, who have family history of breast or ovarian cancer. They also increase risk of fatal blood clots, cardiovascular disease, acne, weight gain, depression, hair loss, insulin resistance, fertility problems and more.

Pregnancy Prevention Without Pills

I generally don’t recommend using hormonal contraceptives for any reason in my practice. The side effects are reason enough, but also because better options really are available! Here are two:

1. Tracking Basal Body Temperature
2. Tracking Cervical Fluid (i.e. Creighton Model)

I’ve already written a whole post about the mechanism and benefits of tracking basal body temperature so I definitely encourage you to go back and read that post if you haven’t already.

Meanwhile, you can also track cervical fluid as a marker of fertility.

How Your Cycle Works

I come back to the above graphic again and again on my blog, for good reason. It explains the hormones throughout the menstrual cycle and those hormones are everything. In your cycle, ovulation is the main event, not the bleed. Everything in the first half of the cycle is about gearing up for ovulation and everything in the second half is about enjoying the effects of ovulation. (Meanwhile hormonal contraceptives are all about preventing ovulation!) In order to prevent pregnancy, you need to avoid having unprotected intercourse in the 5 days before ovulation, as well as on the day of or day after ovulation.

Let’s take a closer look at ovulation for a minute. Immediately before an egg is released, the brain “pulls the trigger” with a huge spike of a hormone called luteinizing hormone. This hormone tells the ovary that it’s time for the fully developed egg to be released into the fallopian tubes. But what tells the brain that it’s time for the LH surge Cue: estrogen.

As the ovarian follicle (egg) develops throughout the menstrual cycle (in the so-called follicular phase), it realeases increasing levels of estrogen. When the estrogen level reaches a certain height, it tells the brain that everyone is ready for the big ovulation event. However, this estrogen also brings about other important changes in the female body. For one, it changes the texture and quantity of cervical fluid. Also known as vaginal discharge, this substance becomes increasingly watery as ovulation approaches. Immediately after ovulation, once progesterone takes the stage, cervical fluid quickly transitions to a thick, glue-like, white texture.

This transition from watery, to gel-like (so-called “egg white” cervical mucus or ‘ewcm’ if you’ve seen it on fertility boards) marks the transition from a fertile time in the cycle to a time when unprotected sex will have no subsequent influence on pregnancy, at least until the next cycle rolls around. If you track the texture and quality of your cervical fluid daily throughout the month, you’ll notice some important patterns: namely, when in your cycle you see the transition from water-rich, fertile mucus or thick, dry discharge. Sperm can’t swim through this latter type of mucus and even if they could, there would be not available egg around because the egg only lasts about 24 hours. That being said, if you were trying to conceive, tracking cervical fluid (and BBT) serve as a valuable tool for timing things correctly so you don’t need to wonder if you even have a chance that month.

The Catholic Church endorses this conservative method of contraception (often marketed as The Creighton Model) because it doesn’t carry the abortifacent risks that hormonal contraceptives do. That being said, you don’t need to be Catholic to use it. You also don’t need to be TTC, avoiding pregnancy, or even sexually active to benefit from the information it gives. One of my favorite things about both BBT and tracking cervical fluid is that they provide easy, at-home means for learning about your own body.

But what about the pill for period problems?

And that, friends, is a whole can of worms that I’m totally prepared to open! The pill does not “fix” period problems, or anything for that matter. Period problems are the menstrual manifestation of hormone imbalances, and taking the pill or using any other form of hormonal contraceptive not only doesn’t solve any problems, it actually creates new ones in its own right. Hormonal contraceptives shut the body down, interrupting the vital communication between the brain and ovaries, preventing hormone production, and overriding biology.

If you are dealing with menstrual problems like pain, PMS, mood changes, breast tenderness, irregular bleeding, acne, or anything else, I promise you that shutting down your hormones with the pill is not going to help. Here’s what to do instead:

1. Start tracking your cycle! Get information about your hormones through BBT and tracking cervical fluid. Find out if and when you’re ovulating.
2. Get some hormone labs run! If you need help knowing which ones to ask your doctor for, sign up here and I’ll send you my free hormone testing cheat sheet.
3. Once your lab results come back, read them through a functional medicine lens! Getting an accurate diagnosis makes all the difference. You won’t know how to treat it if you don’t know what you’re dealing with. If you need help interpreting your labs, I have a lab guide available in both pdf and print that can help you: The Hormone Hacker
4. Check out my book, Go with Your Flow which is all about treatment for these very conditions. It’s designed to be the only book you’ll ever need for understanding your hormones and your body. I can’t wait for it to help you, too.

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

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

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

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

The post Natural Alternatives to The Birth Control Pill appeared first on Dr. Alexandra MacKillop.

But when it comes to fertility, ovulation is the foundation.

PCOS, or polycystic ovarian syndrome, is a common reason for diagnosed “infertility,” which is rising faster than ever in the US. One of the hallmark signs of PCOS is ovulatory dysfunction, meaning that a woman has irregular periods or anovulatory cycles which are menstrual cycles in which ovulation does not take place. Ovulation is crucial for pregnancy because that is the process that actually releases the egg that will eventually become fertilized. If you’re wondering how to get pregnant naturally with PCOS, the first step is to make sure that you are actually ovulating.

Why PCOS Causes Infertility

With PCOS, ovulatory dysfunction makes trying to conceive (TTC) difficult because there are fewer eggs released in any given year. Rather than having a monthly period, many women with PCOS have cycles that stretch more than 35 days, sometimes twice that, and some women don’t have periods at all. PCOS can also get in the way of TTC efforts because it’s associated with insulin resistance, inflammation, and hormone imbalances that affect the quality of the uterine lining, damage the fragile embryos in their earliest stages, and increase the risk of miscarriage. These factors combined can add up to the 6 or 12 months of unsuccessful TTC efforts that lead women over, or under, age 35 (respectively) to be diagnosed with infertility and referred for IVF.

Assisted reproductive technology has been a wonderful gift to families who were otherwise unable to conceive without it. But what if there was a way to get pregnant naturally without having to rely on medications, invasive procedures, and tens of thousands of dollars’ worth of medical appointments

Guess what There is! Read on to find out.

How to Get Pregnant Naturally with PCOS

Getting pregnant naturally with PCOS means addressing the root cause of fertility problems in PCOS. These main issues include: irregular ovulation, inflammation, and problems with egg quality.

Improving Ovulation in PCOS

The first key step in improving ovulation rates in PCOS is figuring out if and when you are ovulating. You can do this in two ways:

1. Blood Tests: In most ovulatory cycles, progesterone levels are highest on day 21. This is because ovulation usually takes place around 2 weeks before a period starts, and in a “normal” monthly cycle, ovulation would take place somewhere around day 13-16. After ovulation, the ovary starts producing progesterone, but does not do this if it doesn’t release an egg. So, to confirm if a woman is “ovulating on time,” we can run a blood test to measure the progesterone levels in her blood and if they’re in the correct range, we know she ovulated “on time.” If a woman has long but regular cycles, meaning they come after the same number of days, we would run this test one week before her expected period.
2. Tracking BBT: If a woman has irregular cycles, it is difficult to predict when to test “day 21 progesterone” or to complete that progesterone test at the correct time. Plus, the progesterone test doesn’t tell us when she ovulated necessarily, only if she ovulated and when, within a general range, that may have taken place. Instead, a woman can track her period using fluctuations in body temperature that give very specific information about the timing of ovulation. Learn how to do this here: Basal Body Temperature 101

Once you know if and when you’re ovulating, it’s time to take steps to make it more regular! Here are a few key ways to do this:

1. Reduce Stress: Stress is a major driver of adrenal dysfunction, which drives androgen production and worsens the hormone imbalances associated with PCOS. Stress also messes with blood sugar and lowers progesterone levels which can make the uterine environment unfavorable for pregnancy.
2. Consider Androgen Blockers: In the traditional medical model, spironolactone and the birth control pill are prescribed to reduce androgens because these hormones are responsible for many of the problems seen with PCOS. However, spironolactone isn’t safe when TTC, the birth control pill defeats the whole purpose, and neither allows our bodies to naturally get back into balance. Instead, natural herbs like red reishi, Chinese peony, green tea extract and black cohosh reduce androgens and improve ovulation rates. Be careful though; many of these herbs are not safe to take during pregnancy and you can be pregnant for up to a week before a pregnancy test shows positive. I recommend working with a functional medicine doctor if you’re using herbal medicines for this reason.
3. Take Melatonin: Disruptions in the circadian rhythm lead to cortisol and DHEA imbalances, which circle back to point #1 in terms of their hormone-disrupting effect. Short-term melatonin use helps regulate the stress cycle, but has also been shown to improve ovulation rates in PCOS and reduce inflammation.

Reduce Inflammation

Inflammation is caused when the immune system gets triggered by foreign invaders or toxic chemicals. Some of these toxic chemicals come from the body’s own metabolic processes (i.e. “waste products”) but others are caused by lifestyle factors. Here’s how you can lower your own inflammatory load:

1. Take Melatonin: It made it to this list too! Melatonin is just that powerful. If you look back up at point #3 above, you can see that melatonin reduces inflammation in PCOS sufferers in addition to increasing likelihood of ovulation.
2. Eat an Antioxidant-Rich Diet: The more colorful the food, the better! That doesn’t mean that white foods aren’t allowed, it just means that you can amp up your antioxidant load without needing to rely on more supplements. My favorite ways to get antioxidants every day is by eating organic beets, blueberries, arugula and raw walnuts. Better yet, I combine all of these into a salad, topped generously with extra virgin olive oil and balsamic vinegar.
3. Consider Curcumin and Vitex: Similar to melatonin, curcumin and vitex reduce inflammation and improve ovulatory outcomes. I usually have my patients take all three when they are TTC.

Work on Your Egg Quality

From a nutritional perspective, it’s pretty simple: eating eggs improves egg quality! Go figure, right That’s because eggs are an excellent source of zinc, B vitamins and choline, all of which are essential for egg quality and developing of a growing baby. Here’s an easy, non-supplement way to improve your own egg quality: eat two eggs per day! The additional protein is also valuable for keeping blood sugar balanced and reducing inflammation from insulin.

1. Eat 2 Eggs Per Day: see above for details!
2. Check out my blog post all about Fertility Supplements for Egg Quality

In closing…

If you have been told that IVF is your only option, remember that there may be meaningful steps you can take first to support your body naturally. Learning how to get pregnant naturally with PCOS starts with restoring ovulation, lowering inflammation, and improving egg quality, which are the true foundations of fertility. While assisted reproductive technology has helped countless families, it is not the only path for every woman. By identifying whether you are ovulating, addressing stress and blood sugar balance, reducing inflammation, and nourishing your body with targeted nutrition and supportive therapies, you may be able to create a healthier environment for conception. With the right testing, guidance, and a root-cause approach, many women with PCOS can optimize their fertility and move toward pregnancy with greater confidence and clarity.

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

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

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

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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

The post How to Get Pregnant Naturally with PCOS appeared first on Dr. Alexandra MacKillop.

*Note: in this post, I make a lot of references to hormones and phases of the menstrual cycle. If you are unfamiliar with these topics, I encourage you to first read these posts:

• How to Balance Hormones Naturally
• Understanding Hormones for Women

What is BBT and why should we track it?

Basal body temperature (BBT) refers to the temperature of our bodies when we are at rest, typically measured after a period of sleep of at least four hours. When we’re awake, up, and “at it” in our daily lives, our metabolisms are revved up and producing heat as a by-product from using energy. But when we’re sleeping, energy output is low, and we’re in an environment with a stable temperature, allowing our bodies to find an optimal hot/cold balance.

In addition to exercise, eating/drinking, and the tasks of life, our hormones have a large influence on the temperature of our bodies. However, unlike the activities of daily living, our hormones influence our body temperature while we are at rest. While thyroid hormones do play a role, their influence tends to be more steady/stable in comparison to sex hormones—namely estrogen and progesterone. Progesterone is especially responsible for changes in basal body temperature because it creates an increase of about 0.2-0.4 degrees Celsius when levels are at their highest versus when they’re at their lowest.

This temperature change from progesterone is important because once that rise first starts to take place, it means progesterone is being produced at a high level. As I describe in this post about female fertility, this progesterone increase is triggered by ovulation. By charting basal body temperature, we can learn the exact day on which we ovulate in a given cycle, predict the day of ovulation in a future cycle, and identify our fertile days, which is helpful both if we’re trying for a pregnancy or trying to avoid one.

How to Chart BBT

To track your basal body temperature, you need two things: a basal body temperature thermometer and a means for graphing your temperature points. Some women prefer to do this the old fashioned way with pen and paper, but I like to use an app, such as Fertility Friend or Kindara. Keep in mind that in order to accurately chart, you need a thermometer that reads up to two places past the decimal. Most oral thermometers only read to on place past the decimal, and these are not accurate enough for this purpose. BBT thermometers are affordable (usually less than $20) and you can find them on amazon. Here’s a link to the one I use.

Temperature readings need to be taken as close to resting as possible, which means first thing in the morning after you wake up from at least 4 hours of uninterrupted sleep. As much as possible, try not to roll or move around too much (or get up to use the bathroom) before taking your temperature. Keep your thermometer in a place that is easily accessible from your bed, like your night stand. Since I log my chart in a phone app, my morning starts off with waking up, taking my temperature, recording it in my app, and then doing everything else. It took a few days to get the hang of it, but now it’s just part of my automatic routine.

Interpreting BBT Charts

As already mentioned, progesterone is responsible for the cyclic increase in basal body temperature after ovulation, and decreasing progesterone levels correspond to the decline of basal body temperature back to the baseline low. This rise/fall of progesterone and subsequent rise/fall of BBT is the basis for charting.

Throughout the follicular phase, our BBT is at a low. The day after ovulation, it takes a sharp rise, usually of more than 0.4 degrees, due to the sharp rise in progesterone. This temperature rise is sustained until a few days before your period, when it slowly drops back down again. As you can see on this chart example, there is a notable increase in temperature from 97.7 degrees on cycle day 15 up to 98.3 degrees on cycle day 16. Based on this information, we can interpolate that ovulation took place on cycle day 15. (We know this from our understanding of hormones that the corpus luteum formed after ovulation produces progesterone.)

When interpreting your own BBT chart, look back over your first month of charting to see when the temperature rise first took place. The day before this temperature rise corresponds to the day of ovulation. This is the most important piece of information gained from tracking BBT.

What Your BBT Chart Can Tell You

Charting empowers us to be able to identify the day of ovulation with a very high degree of accuracy. With the menstrual cycle, ovulation is everything, and it is what informs our knowledge of conception, contraception, and everything else. Knowing when we ovulate is key in terms of timing sex to promote chances of pregnancy, or avoiding unprotected sex in order to prevent pregnancy. Ovulation is the key factor in conceiving a child, and if the lifespan of the sperm doesn’t overlap with the day of ovulation, it’s impossible to get pregnant. Fertile days are calculated in relation to the day of ovulation, including the 5 days prior to, the day of, and the day after ovulation (7 days total). Outside of that “fertile window,” pregnancy is pretty much impossible. (As with any form of birth control, surprises happen. But with this highly accurate, informed method, they are rare.) Along the same lines, we know that the days with the best chance of conceiving are the day of ovulation and the two days prior. When you know what day you ovulate, you can time sex to optimize your chances of success.

• When to expect Aunt Flo: In addition to knowing the number of days in your average cycle, tracking BBT gives clear information about when your next period is due. Just as rising temperatures signify elevated progesterone as the result of ovulation, falling temps towards the end of the cycle indicate that hormone levels are dropping, and your next period is just a few days away. If you have an “off cycle” due to stress or travel or something and your period is coming early or late, BBT will give indicators by falling temperature. I’ve found this to be helpful, as surprise visits are never welcome.
• Conceiving a pregnancy: If you’re trying to get pregnant, charting BBT gives you the best information as to what your fertile days are. Look back on your last cycle and identify which day of your cycle you ovulation. For the next cycle, your best chances of conceiving will be the day of ovulation and the two days prior. While it’s a good idea to have sex at least every other day for about a week (starting the five days leading up to ovulation), you can focus your efforts on a few days to have better accuracy and feel less pressure.
• Contraception: You can’t get pregnant if you don’t have sex during your fertile window. By using BBT to inform the days you do and don’t use protection, you can avoid the health risks and unpleasant side effects of products like birth control pills, implants, and IUDs. If you want to be ultra conservative, I recommend using a barrier method like condoms for the seven days of your fertile window plus three for a total of ten days. This would correspond to the seven days before ovulation, the day of ovulation, and the two days after. Of course, a barrier method is necessary to reduce risk of sexually transmitted infections, but if you’re in a relationship where pregnancy is your only concern, then a mixed method such as this one could be a good fit for you and your values.
• Anovulation: In addition to telling us when we’re ovulating, BBT charting can help shed light on situations in which we aren’t ovulating. While not ovulating often results in a missed period, it’s possible to have periods (even regular ones) in which ovulation doesn’t take place. (This is what happens with birth control pills. They cause a monthly bleed via artificial estrogen but prevent ovulation.) If this is the case for you, it’ll show up on your chart. Instead of having a biphasic chart, which refers to the two periods of time before and after the temperature rise, your chart will be monophasic. There will be no distinct temperature rise.
• Early pregnancy detection: Another phenomenon of BBT charting is early pregnancy detection. As you can see on the chart example above, body temperature starts to fall starting at around cycle day 28. This results from decreasing progesterone levels as the cycle comes to an end. In a non-pregnant cycle, the corpus luteum is at the end of its “life span” and has stopped producing hormone. The uterine lining is getting ready to shed. However, in a pregnant cycle, the embryo implants around 6-12 days after ovulation and starts producing estrogen and progesterone in addition to what the corpus luteum is making. Because of this, the progesterone levels stay high (and steadily increase) rather than tapering off. By the end of your cycle, if you’ve had unprotected sex during your fertile window, and your BBT remains high, there’s a good chance you could be pregnant. Additionally, some women experience what’s called an “implantation dip” around the time that the fertilized egg becomes embedded in the uterine lining. On a chart, this looks like a sudden drop in temperature of 0.3 degrees or more followed by a sharp return the following day. Another sign of pregnancy (though this is present in up to 5% of non-pregnant cycles too) is what’s called a triphasic chart. After implantation in some pregnant women, a third temperature rise takes place. Instead of a baseline, rise, and plateau in a biphasic chart, a triphasic chart will have a second rise and plateau. Keep in mind that implantation dips and triphasic chart appearances are not completely reliable methods for identifying pregnancy. The only way to know for sure that you are pregnant is to have a positive pregnancy test, which is most accurate on or after the day of your expected period. (As a side note…many women take tests early, but false negative rates are very high until the day Aunt Flo is due.)

My book, Go with Your Flow, explains more about cycle tracking in detail. Check it out to go deeper with understanding your hormones at home.

Troubleshooting Your Chart

BBT charting can be confusing the first month you do it. I know for myself, I thought I was doing something wrong because my chart seemed like it was all over the place. However, by the time I made it to the end of the month, I could clearly see the expected pattern, and was relieved to know that I hadn’t messed it all up.

Because body temperature is sensitive to the environment, things like illness, alcohol, restless sleep, travel, stress, or excessively hot/cold sleeping temperatures can create fluctuations in temperature. Despite these outliers, the pattern is still readily apparent. Just keep in mind that you might need to make it through your first whole cycle before you get the full picture.

As an example, here is a picture of one of my first ever charts. I had a few days where the temperatures deviated quite a bit from my baseline, but the app I used (Kindara) allowed me to mark those days as “questionable” (seen as gray dots) which gave me a clearer overall picture.

On this chart, I included a horizontal line to show the threshold I measured between my follicular phase and my luteal phase. In this cycle (which is my norm) I ovulated on cycle day 14, which was followed by a sharp temperature rise from 97.3 degrees to 97.7 degrees on cycle day 15. I knew immediately that cycle day 15 was the first day of my temp rise because it was the highest temperature I had recorded the entire cycle except for day 2 when I knew the higher temperature was an outlier. During my follicular phase for this cycle, my average temperature was about 97.4 degrees and it was about 97.8/97.9 degrees during my luteal phase. (I had a few really high temperatures but they sharply dropped off right before my next period.)

On this chart, you can also see the orange line which represents “egg white” quality cervical mucus. I don’t typically chart my mucus but I do pay attention, especially on the days when I have watery or egg white cervical mucus, as these are high indicators of fertility. I have also used urine test strips to detect luteinizing hormone as a triple confirmation of when I’m ovulating. By now, I know for sure how to identify my fertile days through charting and observation.

In addition to temperature and cervical mucus, many charting apps include options for tracking other symptoms like breast tenderness, spotting, positive or negative pregnancy tests, positive or negative ovulation tests, and more. There are different free and paid apps out there with different capabilities, and I encourage you to try out a few to find one that works for you!

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

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

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

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

The post Basal Body Temperature 101 (How to Track Your Cycle) appeared first on Dr. Alexandra MacKillop.

Reasons for Fertility Drugs

The main reason for fertility struggles among women is ovulatory dysfunction. This means that throughout the menstrual cycle, the body struggles to mature and release a healthy egg at the correct time in relation to the hormonal fluctuations that naturally occur during a woman’s cycle.

Ovulation (and everything leading up to it)

During the first half of the cycle (the follicular phase), the pituitary gland releases luteinizing hormone. This hormone acts on the ovaries to produce estrogen, which allows ovarian follicles to mature so they can eventually release an egg. As the follicle continues to ripen and approaches ovulation, the estrogen level suddenly surges upward, and then drops very quickly. This estrogen surge/drop communicates to the pituitary gland that it is time for ovulation. The pituitary gland responds by creating a surge of its own—this time, luteinizing hormone (LH). When the ovaries receive this intense LH signal from the pituitary gland, the follicle bursts open and the egg is released—ovulation has occurred.

Because fertility struggles so often result from ovulation dysfunction, most fertility drugs target these hormonal pathways that lead up to ovulation. Here’s a list of the most common fertility drugs, why they’re used, how they work, and the natural approaches you might choose to use instead.

[As always, the information shared on this website is for educational purposes only. It is not intended to diagnose, manage, or treat any disease. Always speak with your own doctor before starting something new.]

The Most Common Fertility Drugs & Natural Alternatives

1. Clomiphene Citrate (Clomid)

Clomiphene citrate (Clomid) is the first line treatment for women with ovulatory dysfunction, as its main action is to trigger ovulation by intercepting the LH/estrogen feedback loop at the level of the pituitary gland. Once in the blood stream, the drug mimics the positive feedback given by estrogen, as it binds to estrogen receptors in the pituitary gland. This amplifies the LH surge released by the pituitary gland, giving a strong signal to the ovary that it’s time to release the egg. For some women, this results in ovulation, conception, implantation, and pregnancy. But for others, it doesn’t. One of the main reasons for this is that in addition to triggering an LH surge, clomiphene citrate limits the thickness of the endometrial lining, making implantation less likely to be successful.

Natural Alternative: Clomid dosing typically begins on the second day of the cycle (anywhere from day 2 to day 5) and continues for 5 days. In place of Clomid, 20 mg daily doses of black cohosh (Cimicifuga racimosa extract) can be used daily for 10 days beginning on cycle day 2. In addition to triggering an LH surge, black cohosh results in higher progesterone levels during the luteal phase, subsequently improving the thickness of the endometrial lining.

Read more about natural alternatives to Clomid…

2. Letrozole

Letrozole functions similarly to Clomid, by stimulating the pituitary gland to create a surge of luteinizing hormone. However, Letrozole is different from Clomid in the way it brings about this LH surge. Instead of binding to estrogen receptors like Clomid, Letrozole artificially creates an estrogen drop by blocking the enzyme that produces estrogen (aromatase). For this reason, Letrozole is considered an aromatase inhibitor. In women who suffer from elevated estrogen levels (or estrogen toxicity), Letrozole can artificially balance hormones long enough to allow ovulation to take place.

Natural Alternative: Instead of using a prescription drug, some women prefer to use natural means for reducing estrogen levels. In addition to lifestyle behaviors like a balanced diet and moderate exercise, diindolylmethane and calcium-d-glucarate can be used to promote estrogen detoxification.

Diindolylmethane (DIM) inhibits aromatase, preventing excess production of estrogen when dosed at 100-400 mg daily, with 200 mg being most common.

Calcium-D-Glucarate promotes estrogen metabolism and excretion, and prevents absorption of exogenous estrogens and estrogen-like hormones when dosed at 1500-3000 mg daily.

Read more about other natural alternatives to Letrozole…

3. Metformin

In women with insulin resistance, (a common associated manifestation of PCOS,) the pancreas produces larger than normal levels of insulin. Insulin acts on ovarian follicles during the maturation process, causing them to respond to luteinizing hormone too early, preventing ovulation. Although Metformin is typically considered to be a drug for diabetes, it can be used to treat ovulatory dysfunction triggered by insulin resistance. Many patients want to avoid the use of Metformin due to side effects, such as loose stools, nausea, and vitamin deficiencies. Others don’t feel comfortable using prescription drugs. Whatever your reasoning, these natural alternatives may be a better option for you.

Natural Alternative: Lifestyle behaviors are the #1 way to improve insulin resistance (moderate exercise, managing stress, dietary methods for blood sugar control) but in the case of PCOS, insulin resistance is triggered by hormones. Lifestyle behaviors are still highest on the list, but sometimes they aren’t enough.

• Berberine doses of up to 1500 mg a day (three 500 mg doses with meals) have been shown to improve blood sugar control and insulin resistance as well as or better than Metformin.
• Myo-Inositol prevents the effects of insulin on the ovaries, supporting healthy maturation of follicles and subsequent ovulation. Myo-Inositol is dosed at 4000 mg daily, along with 400 μg of folic acid, taken with meals.

4. Bromocriptine

Another important hormone in the pathway leading to ovulation is prolactin. This hormone is typically credited for stimulating the production of breast milk, so levels are expected to be elevated in late pregnancy and during the postpartum period. Prolactin levels normally remain elevated for as long as a woman is breastfeeding. But sometimes, they stay elevated even after weaning. This is called hyperprolactinemia, and sometimes women struggle with it even if they’ve never been pregnant. (In some cases, elevated prolactin may be the result of a pituitary tumor or other pathology, so you should speak with your doctor if you have concerns about this.)

When prolactin levels are high, they communicate with the pituitary gland, inhibiting the production of luteinizing hormone. (As we discussed earlier, luteinizing hormone stimulates ovulation.) In the postpartum period, this makes sense–getting pregnant isn’t the best idea if you’ve just had a baby. But most women eventually want to have more children! So, doctors prescribe Bromocriptine to inhibit the production of prolactin in patients with hyperprolactinemia.

Natural Alternative: Vitex (Chasteberry, Chastetree, Agnus-Castus) fruit extract has been proven as an effective option for managing a variety of fertility concerns, including ovulation dysfunction resulting from latent hyperprolactinemia. Dosage typically ranges from 20-40 mg daily for 2-3 menstrual cycles. Vitex should not be used for longer than this.

To sum things up…

Trying to conceive can be an overwhelming and deeply emotional journey, especially when ovulation doesn’t occur as expected and medical interventions feel stressful or unsustainable. The good news is that natural alternatives for fertility drugs do exist, targeting the same hormonal pathways involved with common fertility drugs like Clomid, Letrozole, Metformin, and Bromocriptine. Whether dealing with ovulatory dysfunction linked to estrogen imbalance, insulin resistance, or elevated prolactin, you have options, including natural ones. Ultimately, you are the one in charge of your fertility journey, and when you know your options, only then are you empowered to make decisions that align with your body, values, and health needs.

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

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

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

Become a Patient

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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 Alternatives to Fertility Drugs appeared first on Dr. Alexandra MacKillop.