Dealing with Thyroid Disorders
The thyroid is one of the most important glands to control bodily functions. Having a thyroid that isn’t functioning optimally can wreak havoc on a woman’s cycles and general health. Luckily, women who chart have an advantage over others in that they can often spot a potential problem by merely observing the pattern of their waking temps.
Excessively low temps (in the 96s and low 97s preovulatory) are often the first clue that they may have hypothyroidism, but temps alone are not enough. If you notice low temps with any of the other symptoms listed below, you should ask to have a thyroid blood test that measures not only TSH and T4, but free T3, free T4, and TPO. In the case of the latter three, you may need to be more assertive, because they are often not tested as part of a routine blood work panel.
Among the most common symptoms of a thyroid disorder are the following:
•Anovulation
•Long or irregular cycles
•Prolonged, less-fertile-quality cervical fluid
•Short luteal phases or other signs of luteal phase issues
•Heavy, prolonged, or painful menses
•Low libido
•PMS
•Infertility
A lot of the lifestyle and nutritional suggestions in this chapter can help you achieve better thyroid functioning. As Dr. Datis Kharrazian, author of Why Do I Still Have Thyroid Symptoms When My Labs Are Normal? so aptly asks: “If the check-engine light on your car lights up, which would be smarter: to investigate the engine or remove the light?”
Luteal Phase Problems
As you’ve read, the luteal phase following ovulation is when progesterone is released. Whether you are trying to avoid or get pregnant (or just going about your life!), ideally you want it to be about 12 to 16 days. For pregnancy avoiders, this will give you more time to enjoy your infertile phase, and for pregnancy achievers, it’s crucial for the fertilized egg to have enough time to implant in the uterus.
If you discover through charting that you do in fact have too short a luteal phase, there are a few natural treatments you might try. Marilyn Shannon, author of Fertility, Cycles, and Nutrition, is a major authority in the field and believes that luteal phase deficiencies are intricately related to PMS. She therefore suggests the supplement Optivite PMT or ProCycle PMS along with an increased consumption of flax oil and/or fish oil. You can also consider herbal supplements covered earlier in this chapter. If these fairly simple suggestions are not effective, I discuss other options in Chapter 14.
Working with a Complementary Health Practitioner
It used to be that any health practitioners who weren’t trained in traditional medical schools were referred to as “alternative” and were thought to be practicing voodoo science. Today, though, there’s a more positive acceptance of licensed complementary health practitioners, in part because so many people report such positive results. They either work independently, in a clinic with other natural health practitioners, or side by side with conventional doctors using either complementary or integrative approaches.
Regardless, traditional Western medicine alone is not necessarily the most effective modality for all health conditions. In the case of balancing women’s hormones, the most appropriate specialists to consult with first might be nutritionists (really considered mainstream today) as well as complementary practitioners such as naturopaths, acupuncturists, Chinese herbal medicine specialists, and even traditional doctors who also practice more natural modalities. The basic principle that applies to all of these approaches is that it is often preferable to use gentle but effective ways of treating women’s health conditions without having to rely on invasive procedures and powerful drugs that cause numerous side effects.
Most of these practitioners will work with various treatments, from bioidentical hormones and herbal supplements to hands-on therapies such as acupuncture. Each woman has a unique set of circumstances that will determine what is best for her (for example, a woman with PCOS will be best treated by following certain protocols in diet and lifestyle that may be very different from a woman who is dealing with PMS). However, depending on your situation, I would encourage you to more thoroughly explore this topic on your own, since so much of your fertility and general health can be adversely impacted by being hormonally out of kilter.
Bioidentical hormones
Many clinicians believe the key to hormone balancing is the use of truly natural, or bioidentical, hormones, as opposed to the synthetic types manufactured by pharmaceutical companies in a lab. These bioidenticals are extracted from plant sources such as soy and wild yams, but they are exactly the same in molecular structure as the progesterones and estrogens that are made in female bodies.
They are available in many forms, including pills, patches, and various vaginal creams, and there are also custom blends of estrogen and progesterone that are produced by various compounding pharmacies. And even though both bioidentical and synthetic hormone therapies are associated with the treatment of menopausal symptoms such as vaginal dryness and hot flashes, younger women can also benefit from hormones if they have irregular cycles, few or no periods, or other signs of a hormonal imbalance.
You should be aware, though, that hormonal therapy of any kind is an incredibly complicated topic, and while it’s true that many physicians and others claim that bioidentical hormones are more effective, safer, and have much fewer side effects than the synthetic versions, all of these assertions are widely disputed by others in the medical community. In any case, if this is an option that attracts you, you should know that even those who swear by bioidenticals will tell you that if you want to try using them to optimize your own hormonal balance, you will need to work closely with your doctor or other medical professional in order to both carefully analyze your needs and individualize your treatment.
Gently First: The Best Way to Get in Balance
If you’re one of the lucky ones for whom this chapter is irrelevant—great! But for everyone else, you should simply be aware that before resorting to any intensive medical procedures, you can try many simple, inexpensive, and noninvasive options to balance your hormones naturally. This shouldn’t be surprising, since the key to all healthy living is largely based in eating a nutrient-rich whole food diet, exercising consistently, maintaining a good weight, and effectively managing your stress. Indeed, the real take-home message of this chapter is that healthy hormonal balance is a reflection of a woman’s overall health, and not just about her fertility. As such, you should always try to promote and maintain a healthy lifestyle by doing what you reasonably can on your own.
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CHAPTER 10
Now That You Know: Preserving Your Future Fertility
An unfortunate reality of life is that as women grow older, their fertility declines. And yet, with the latest advances in egg-freezing technologies, younger women now have the potential to mitigate the effects of nature. Of course, this is an ethical minefield, but because this book is about knowledge and empowerment, I’d be remiss if I didn’t discuss the latest developments. As with everything in life, you should take what is applicable to yourself, and ignore the rest.
Back in 2006, a national ad campaign caused a huge controversy when the American Society for Reproductive Medicine plastered buses and billboards with this ominous message:
Reprinted with permission from ASRM.
I remember cringing at the time, because I knew it would strike a truly offensive chord among so many women. And of course it did. Many criticized the ad for being incredibly patronizing and melodramatic. Clearly, women had enough issues to contend with, and they didn’t appreciate the implied message that there was something wrong with them if they hadn’t met the right person yet, or for that matter, simply wanted to devote more time to their education and career before starting a family.
I got it. And yet, as a professional in the field, I couldn’t deny what the ad was saying. Female fertility does gradually dim
inish from the late 20s until about age 37, after which it begins to drop dramatically. In addition, the risk of miscarriage increases significantly as women age into their early 40s. This means that while I strongly believe in encouraging young women to pursue their dreams before settling down, I also know that biology dictates a woman’s range of fertile years, and therefore her possible options.
So, as intriguing as they are, try to ignore the scores of obnoxious headlines that scream out to you from the covers of all the grocery store tabloids:
“48-Year-Old Actress Expecting First Child!”
“45-Year-Old Academy-Award Winner Pregnant with Twins.”
What you likely won’t read are the details of the grueling high-tech hoops that these women often had to jump through to achieve their dreams, or, frequently, the fact that they had to use donor eggs in order to conceive. Of course, now that you know how to observe and chart your fertility signs, you’ll be able to use effective natural birth control until you one day decide that you want to maximize your odds of conceiving. Still, even though FAM is an incredibly empowering body of knowledge, you need to understand that if you decide to delay having children until your late 30s or beyond, you may still have challenges conceiving or carrying a baby to term, regardless of how much you exercise, how well you eat, or even how well you chart your cycles.
This is in large part because women are born with all the eggs they will ever have. And thus, not surprisingly, some of the most significant issues for older women trying to conceive a child is that the older your eggs are, the greater the chance you’ll have fertility issues that FAM alone may not be able to resolve.
That is why I’ve chosen to briefly and separately discuss here the various fertility-maintaining tactics, procedures, and technologies that those of you who are still in your 20s and early 30s might want to consider employing now, for your future fertility. For the reality is that no matter how young you are or how you want to use FAM today, women who might eventually want to have children should be aware of the basic dilemma posed by aging eggs and, more importantly, what they might be able to do about it while they’re still young enough.
Current Strategies and Concerns for Future Moms
The good news is that you can be proactive in preserving your fertility years before you would ever consider having a child, and in a way that maximizes your odds of being able to do so while still using your own eggs. Indeed, there are numerous ways you can keep the odds in your favor, starting as early as your mid-20s.
The first thing you might want to do is ask your mother when she went through menopause, because that age can be genetically influenced. So, if she experienced menopause as early as 45 or even 40, you may be more likely to do so, as well. Regardless, you should be aware that your fertility starts to significantly diminish about 13 years before your final period.
You might also consider being proactive by getting tested for the medical conditions listed below if you have any relevant symptoms. This is because if you did have any of them, you could work to get them under control before trying to get pregnant.
Endometriosis
As you saw in Chapter 8, endometriosis is a riddle wrapped in an enigma. Because it tends to get worse as women get older, and because one of the only effective (albeit temporary) treatments for it is pregnancy, I would suggest that if you have already been diagnosed with it, and you are already married or in a stable relationship and debating when to have children, you should consider trying sooner rather than later.
Polycystic Ovarian Syndrome
As also discussed in Chapter 8, this is one of the most common and serious conditions that can compromise fertility. But, unlike endometriosis, there are a lot of things that you can actively do to lessen its impact on both your health and fertility. And while it will admittedly take a lot of work to prompt your body to start ovulating on its own, if you can do so, you may want to take advantage of the new freezing technologies available to ensure your fertility when you are older.
Thyroid Issues
Consider having your thyroid tested periodically, because it, too, is a common problem for women of reproductive age, as discussed here. And luckily, it’s much easier to treat than either of the two above.
Fragile X (FMR1)
This is a gene that in recent years has been found to play a very important role in ovarian function. Women with it may be prone to primary ovarian insufficiency, as discussed here.
Fertility Testing When It’s Most Useful
All women who think that they might want to eventually have children should at least consider having their ovarian reserve checked, as discussed here. This basically tests the number of viable eggs in your ovary available until menopause. However, by the time most women typically get these tests in their late 30s or early 40s, it’s too late to be of practical benefit. Fortunately, though, there are currently two tests that are particularly suitable for younger women, both discussed below.
The Antimullerian Hormone (AMH) Test
This is a hormone secreted by the immature resting preantral follicles. The level reflects the size of the remaining egg supply and decreases as a woman ages, so the higher the number, the better.
Antral Follicle Count
This test utilizes a vaginal ultrasound to determine the number of immature follicles available to be stimulated to release an egg each cycle. It will give you a better idea of how many viable eggs you will have left in the years ahead. If the results indicate that the quantity may be limited (especially due to premature ovarian aging), you can at least make an informed decision about how to move forward with this amazingly useful knowledge, whether that entails choosing to focus more on meeting a partner, postponing a career until after you’ve given birth, or even freezing your eggs now to be able to implant them later. The point is that you’ll be able to make an informed decision years before you would normally discover any potential problem.
Below is an example of the type of information you can glean through an antral follicle count, but each lab may interpret the numbers a little differently.
Number of antral follicles available each cycle Years of fertility left
20 to 40 10 to 15 years
10 Very few
5 Not likely to be able to get pregnant
In addition to the tests and procedures mentioned above, there are two important ways to maximize your odds of avoiding infertility issues later:
•If possible, avoid any surgery on your ovaries, since your mature eggs reside on their surface, and surgery usually results in scar tissue or adhesions that can directly impact your fertility. (For more information on ovarian surgery, click here.)
•Practice safe sex! Even STIs without any symptoms can lead to compromised fertility, especially scarring of the fallopian tubes.
Egg Freezing and Related Technologies
Finally, every young woman who thinks she might delay having children until her mid-30s or older should at least be aware of the developing technologies of egg freezing. The fact is that until fairly recently, it was only men who could preserve their future fertility by freezing their sperm (which is ironic, since unlike women, most men who haven’t had radiation or other cancer-related treatments remain fertile until the day they die). Yet, with the advent of promising new research, women may be able to bear their own biological children through their 40s—by freezing their own eggs while still in their late 20s or early 30s.
© 2011 Rina Piccolo. Distributed by King Features Syndicate. World Rights Reserved.
The process of freezing eggs (called oocyte cryopreservation) is no longer considered experimental by the American Society for Reproductive Medicine. You should be aware, however, that IVF success rates using frozen eggs are still quite low, though advances continue to be made and the technology will continue to improve in the years ahead. Indeed, there have already been many successful births, but there are still no extensive long-term studies assessing the safety of egg freezing on the children conceived
through this process. So be sure to stay current on the latest advances, and if you do decide to freeze your eggs, try to research the most up-to-date studies before you use them when you are older.
Also note that if you are already married or in a committed relationship, but for whatever reason are not likely to attempt pregnancy for several years, you would be better off freezing embryos with your partner’s sperm. This is because this technology still has a much higher pregnancy rate with IVF, and it has been proven completely safe through decades of healthy offspring.
Finally, there is a lot of work being done on the preservation of both mature and primordial follicles within various parts of the ovary, as well as on the entire ovary itself. One day, it may actually be common to remove an ovary, freeze it, and return it to the woman’s body when she’s finally ready to conceive!
Indeed, every aspect of the ovary and eggs is being explored for the possibility of freezing for future fertility preservation, yet, as mentioned earlier, the only one that is no longer considered experimental is the freezing of the mature eggs themselves. Still, if you are a young woman who would like to put off childbirth while still hoping to eventually have children, you owe it to yourself to keep apprised of these amazing and rapidly evolving technologies.
Keeping Options Open
As you already know, the decision to freeze your eggs or embryos is extremely personal and should not be taken lightly. Some of you may have religious or ethical reasons not to, while many medical facilities still consider such procedures only appropriate for women who have a medical need to take advantage of the technology. In addition, and like IVF, such a procedure is incredibly invasive and it could be prohibitively expensive—around $8,000 to $12,000, not including the annual cost for storage. For most of you, this might be money you decide would be better spent adopting a child one day if you are unable to conceive.
Taking Charge of Your Fertility Page 16