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

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

Masking the Root Cause

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

Birth Control Pills Shut Down Our Natural Hormonal Processes

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

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

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

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

Health Risks

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

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

Female Empowerment

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

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

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

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

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

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

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

But, that doesn’t mean it’s impossible. Or even unlikely. Quite the opposite, actually.

One of my favorite parts of my job is seeing patients get better, but the icing on the cake is when they have a truly dramatic and objective improvement, such as getting pregnant and delivering a healthy baby after sometimes years of unsuccessfully trying to conceive. Sometimes my pregnant patients have been previously told by other providers, including fertility specialists, that they will never conceive naturally…

As a functional medicine doctor, I’ve had the privilege of seeing women and couples from all walks of life conceive successfully and finally fulfill their dream of become parents, or perhaps become parents a second or third time after things didn’t go as smoothly after the birth of their first child(ren). Yes, this includes couples over 40, too.

In the world of fertility, time is of the essence. In today’s day and age, couples are waiting longer to start trying in the first place and, if fertility problems pop up, it really can throw a wrench in a couple’s plans. For this reason, many OB/GYN offices refer patients out for fertility treatments if they don’t successfully conceive after just 6 months of trying. While many couples who don’t have fertility problems naturally conceive without a problem within a year of trying, the setback of an additional 6 months turns into sometimes additional years once the decision to start IVF (after IUI attempts) has been made and finances secured. At some point, they say, a woman just gets “too old.” Or, does she?

I won’t dispute that age is a factor when it comes to fertility. Obviously, natural conception is virtually impossible after menopause. But, menopause aside, 40 is not “too old” to get pregnant despite what many fertility specialists might say.

I’ve seen plenty of women, both patients and otherwise, conceive successfully well into their 40’s. The key difference between women who conceive easily and women who don’t comes down to understanding a few key things about fertility. Let’s dive in…

1. Egg quality isn’t just about age

A woman is born with all the eggs she will have in her lifetime, but not all those eggs are fully mature at the same time. Rather, the primordial, pre-eggs reside in ovaries and ultimately develop and differentiate into mature eggs or “oocytes” over the course of a couple menstrual cycles. This maturation process depends on nutritional quality, hormonal balance, and control of factors that can degrade the quality of the eggs, such as environmental toxins and yes, aging. But biological age and oocyte age are not the same thing. There’s no “hard and fast rule” for what is too old to conceive. I’ve had young women in their 20’s with poor egg quality that we’ve reversed through functional medicine as well as women in their 40’s who have had excellent egg quality. (We measure this with Anti-Mullerian Hormone, or AMH, on blood work.)

Egg quality can be improved, and there are many factors that can help slow down the processes of aging and poor egg quality. The most important factors to improve egg quality are lifestyle-related ones like:

• Stopping smoking
• Reducing or eliminating alcohol
• Sleeping at least 9 hours per night
• Exercising 5 or more days per week
• Eating enough calories and cabohydrates, but also maintaining an ideal body weight
• Controlling insulin resistance (look into a CGM to get a better idea of your body’s glucose control)
• Drinking clean water and avoiding endocrine toxins like plastics, parabens and phthalates
• Managing stress

Egg quality can also be dramatically improved with supplementation techniques like:

• Melatonin
• Zinc
• CoQ10
• Pycnogenol
• Pterostilbene
• NAD

These supplements generate energy for the cells (powering up mitochondria), reduce oxidative stress, scavenge free radicals and help slow down the aging process of cells. A little supplementation can go a very long way, and these are staples in my fertility arsenal for any patient over 40.

2. You need to know what diagnosis you’re working with

“Unexplained infertility” is not a diagnosis. It simply means that the doctors haven’t yet dug deep enough to find an answer and create a treatment plan to solve the problem.

Conditions like hypothalamic amenorrhea (HA) and polycystic ovarian syndrome (PCOS) are hallmark reasons for irregular ovulation and difficulty conceiving. Perimenopause may also cause less frequent ovulation and unpredictable periods, making family planning efforts more challenging. That being said, perimenopause at any age, including over 40, does not prohibit pregnancy. But irregular periods can easily be chalked up to “probably perimenopause” if a proper diagnosis isn’t made. This means you need thorough testing to identify problems like:

• Low FSH/LH, meaning the brain is not signaling to the ovaries to develop an egg, as is the case in hypothalamic amenorrhea (HA)
• Elevated androgen levels, possibly elevated LH despite normal FSH, as is often the case in polycystic ovarian syndrome (PCOS)
• High or unpredictable levels of estradiol, low progesterone, and elevated FSH, as is often the case in perimenopause

But that all isn’t even to mention the impact of thyroid disorders, including hashimoto’s, which often go undiagnosed.

To add more to the list, endometriosis is also a common culprit for fertility disorders, with its abnormal tissue growth and accompanying inflammation that can damage the ovaries. While harder to diagnose than conditions which show up on blood tests (endometriosis requires surgery to formally diagnose, though it may show signs on an MRI), there are still hopeful options, such as excision surgery, anti-inflammatory strategies and even platelet-rich plasma (PRP) injections which all provide next steps for women of any age dealing with infertility.

Tip: the first two cycles after endometriosis excision surgery are often considered the “most fertile” time for women struggling with fertility and endometriosis.

3. You need to know your cycle

Are you ovulating How do you know

If you can’t confidently answer both of those questions, you might be experiencing some important road blocks to fertility in your 40’s which can easily be overcome.

One of the major shortcomings of our sexual education practices in America is that we emphasize birth control and pregnancy prevention, but don’t much dive into how to actually help couples conceive when the time comes. As a result, many women have no idea when to time intimacy in order to facilitate a swift family planning process. (Not all days of the month are equally fertile!)

In fact, most women I’ve spoken to have never heard of the concept of a “most fertile day,” or don’t know what their cervical fluid means. Still more have never even heard of luteinizing hormone, much less learned how to identify its surge.

I recommend that all my patients track their cycles using basal body temperature, or a home fertility tracking strategy such as over-the-counter test strips for urinary LH, or a fertility monitor such as Inito to predict and confirm ovulation. If you know for sure when you’re ovulating, you can streamline your efforts for trying to conceive to max on O-2, which is two days prior to ovulation, the day you most typically will see a positive LH strip (AKA ovulation prediction test kit), experience peak production of egg white cervical mucus (ewcm) and be the most fertile. Sex on this day will result in an abundance of healthy sperm waiting in the fallopian tube for a healthy egg to be released.

4. You need to know your options

If you have tried all the things and are looking to fertility treatments as a next step, don’t forget that alternatives do exist. That’s my bread and butter in functional medicine, which is helping identify the root cause. But, sometimes you just need to make it happen. If you haven’t already, check out my blog post regarding natural alternatives to fertility drugs if you’re looking for ways to avoid Clomid, bromocriptine, letrozole, and other prescriptions.

If you’re over 40 and TTC, it’s not too late for you. There is hope and you have options!

Baby dust!

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 How to Get Pregnant After 40 (Without Fertility Treatment) 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.

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 How to Survive The Mirena Crash 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.

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

But first as a woman, and second as a functional medicine doctor, I definitely do not see this as an acceptable standard for care, mostly because I know that there are other options that are not only more effective, but also much safer than the pill. Let’s dive in…

A few things to keep in mind as you read this post:

There are many reasons for abnormally painful periods and this post covers just three of them. But more importantly, if you’re struggling with painful periods, or any other symptom, it’s extremely important that you discuss your concerns with a licensed healthcare provider. There are many factors that could be at play, and you deserve to be heard and cared for in the very best possible way.

3 Reasons for Painful Periods

As I noted above, there are many women’s health diagnoses that have period pain as a symptom—things like endometriosis, fibroids, PCOS, and more. For this discussion, we will focus on reasons for period pain in women who don’t have a formal diagnosis. However, even if you do have an existing diagnosis, addressing some of these issues may actually help improve your symptoms.

1) Hormone Imbalances

The menstrual cycle can be divided into two main parts: the follicular phase (pre-ovulation) and the luteal phase (post-ovulation). We typically think of estrogen as the “main” hormone of the follicular phase, and progesterone as the “main” hormone of the luteal phase, but really Both are present and working all the time, just at different levels.

Sometimes, the relative proportion of estrogen and progesterone (in relation to each other) fall out of balance, and this can cause symptoms like cramps and other forms of menstrual pain. For example:

During the luteal phase (after ovulation), the menstrual lining starts to build up in case the egg is fertilized. Estrogen’s job is to build up the lining, directing blood flow and tissue growth in the uterus, whereas progesterone’s job is to keep things from getting out-of-control, so to speak. If estrogen levels are disproportionately high in relation to progesterone levels (i.e. estrogen dominance), the uterine lining will become more robust, often leading to a heavy period with clots, which may be painful to pass. Additionally, high estrogen levels lead to higher levels of prostaglandins in the uterus, which causes higher levels of inflammation and pain (see point #3).

Estrogen dominance and progesterone deficiency are just two examples of hormone imbalances that can cause period pain. Other hormones like cortisol and thyroid hormones (especially hypothyroidism) affect the menstrual cycle and can cause symptoms such as pain.

2) Feminine Protection Products

I would give a TMI warning but really I don’t think periods should be a taboo subject anymore. Frankly, ever person alive is here because of the functioning of a woman’s reproductive system, and I think we all could stand to understand it a little bit more. So, yes…we’re going there.

Tampons are convenient, but not if they’re causing painful cramps—and yes, tampons can cause or worsen cramps if they aren’t inserted correctly. Take a look at the graphic above. The tampon pictured is right up against the cervix. When the uterus contracts to expel blood, it will bump up against the tampon causing pain, kind of how punching a wall hurts a lot more than punching into the air.

Instead, angle the applicator downward. By pointing the applicator downward (and relaxing during insertion), the tampon will be able to reach an area of the vagina called the posterior fornix, which is behind the opening of the cervix. Then, instead of bumping into the tampon, which is held firmly in place by the muscles of the vagina, it will slide past the tampon, which is much more comfortable.

However, some women have cramps no matter where the tampon is located. Alternatively, you can use pads or a menstrual cup. The Diva Cup takes a little getting used to (you’ve gotta be up close and personal with your lady parts) but rather than stopping at the cervix, it encircles it, eliminating any possibility of bumping and pain. The plus side of a menstrual cup is that it only needs to be changed every 12 hours, rather than 4-6.

Another reason women tend to tolerate pads or menstrual cups better is because most brands of feminine hygiene products contain preservatives and bleaching chemicals that can irritate the vagina, increasing the local levels of inflammation and causing pain. (More on inflammation in point #3). For this reason, I typically recommend keeping foreign objects out of the vagina and instead using external protection (pads), a menstrual cup (made from silicone), or organic tampons such as seventh generation, Rael, Tampax pure, or OB Organic.

3) Inflammation

When you have cramps What do you do?

If you handle it the way I did for many years, you pop an Advil, take a nap, and pray that you feel better in an hour. And, if you’re like me, it works.

That’s because napping and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen both reduce inflammation in the body, and it’s inflammation that’s responsible for period pain.

The inflammation caused by a period comes from chemicals called prostaglandins, which are naturally produced in the lining of the uterus to trigger contractions during menstruation and labor. In addition the triggering muscle contractions, these prostaglandins also create low-grade inflammation , which is perceived as pain in the pelvic area (i.e. cramps).

Whenever we have a localized area of inflammation, we have pain. This pain can vary in intensity, but in general, the higher the level of inflammation, the worse the pain is. That’s why bumping your shin on the corner of the bed hurts, but not as badly as breaking your leg would. The injury is much worse in the latter case. However, bumping your shin on the bed hurts more when you already have a bruise from doing the exact same thing the day before, or if you have a sore leg from running a marathon, or if your whole body is sore because you have the flu. That’s because in each of those cases, there is pre-existing inflammation in the body and the higher the level of inflammation, the worse the pain is.

The same is true with the localized inflammation in the uterus during menstruation. The naturally produced (and very necessary) prostaglandins in the uterine lining cause some inflammation, enough to produce mild cramping during the first couple days of a period. However, if there’s already a heightened degree of inflammation in the whole body, be it from chronic stress, poor nutrition, crash dieting, over-exercising, illness, or otherwise, the total amount of inflammation in and around the pelvis is higher. The higher the level of inflammation, the worse the pain is.

No matter the reason for the period cramps, whether due to a hormone imbalance, endometriosis, fibroids, or anything else, reducing the total amount of inflammation in the body will decrease the level of pain.

How to Naturally Reduce Inflammation

1. Acupuncture: this is probably my #1 recommendation for co-management of care with women’s health concerns in practice. Traditional Chinese Medicine is incredibly powerful in terms of its ability to help balance hormones, reduce stress, and decrease the inflammatory response.
2. Nutrition: Not eating enough, or enough of the right nutrients, can create imbalances that lead to heightened inflammation. Some of the most common nutritional deficiencies that predispose women to painful periods include omega-3 fatty acids, magnesium, and vitamin D. Talk to your doctor about having your levels checked.
3. Musculoskeletal Problems: Tight muscles are painful muscles, and if you’re dealing with chronically tight and painful muscles, that probably means you’re also dealing with high levels of inflammation in your whole body. I’m always amazed by how much better I feel when I rub epsom salt lotion into sore shoulders, massage out the knots in my neck with my acucurve self-massager, or stretching out on my foam roller.
4. Sleep: Poor sleep causes all kinds of problems, not just in terms of periods. Not getting enough sleep is interpreted by the body as a chronic form of stress, and pretty much all other health efforts will be blunted if you’re not sleeping enough. Adults need 8-10 hours per night.

In general, it’s not normal to feel awful during your period. While I’m a firm believer that menstruation is a natural process (and therefore it’s normal to feel different at different times of the month), but if your period is getting in the way of your ability function, that’s not okay. You deserve to find out what’s going on so you can feel your best and live a fulfilling life.

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

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

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

Become a Patient

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Sign Me Up!

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

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

The post 3 Reasons for Painful Periods (and Natural Treatment) appeared first on Dr. Alexandra MacKillop.