AmenorrhoeaAmnenorhoea basically means ‘no menstruation’. This is diagnosed when the menstrual cycle ceases after it has already commenced at puberty. It can be quite normal for women to miss a period here and there. However if more than 3 consecutive menstrual cycles are missed, this should be investigated. Amenorrhoea can be cause by a variety of factors including
- Nutritional deficiencies
- A deficiency of iron and/or zinc can be a contributing factor as well as lack of vitamin C and B vitamins. You can request a test from your GP to check your nutrient status and correct supplementation has been shown to help correct these deficiencies. Also taking a good multivitamin can help provide a general baseline of important nutrients to help prevent deficiency.
- Acute stress can cause a temporary loss of your period or missed cycle. Even positive ‘stress’ such as getting married or going on a overseas holiday can cause you to miss a period. However, if the stress is ongoing and becomes chronic stress, this can lead to a longer-term loss of menstruation.
- Being significantly overweight or underweight can cause amenorrhoea. This can also apply to excess or lack of body fat, even if the BMI is within normal range. For example athletes with very high muscle mass and very low body fat can experience amenorrhoea even though their weight on the scales is apparently ‘normal’. These factors can be positively influenced by changes to diet and exercise.
- Lack of a menstrual cycle can be a symptom of an underlying condition known as Polycycstic Ovarian Syndrome.
- Thyroid imbalance
- An overactive thyroid or hyperthyroid can cause amenorrhoea.
- Nutritional deficiencies
Short CyclesShort menstrual cycles can indicate that ovulation is not occurring or you may have a shortened luteal phase. Both of which, impair your chances of conception.
A short luteal phase is known as luteal phase defect. It is assessed as less than 10 – 12 days. This shortened time frame does not allow sufficient time for full development of the endometrium. This can mean that if an egg is fertilised, it may not properly implant or may miscarry shortly after implantation.
The most common cause of a luteal phase defect is lack of progesterone. Although there is no specific diagnostic test for luteal phase defects, the length of your luteal phase can be assessed using our menstrual charting tools and tracking the days from ovulation to the commencement of your next menstrual cycle. Your doctor may also perform blood tests to assess follicle-stimulating hormone (FSH) levels, luteinising hormone (LH) levels and progesterone levels or in some cases an endometrial biopsy may be performed.
Luteal phase defects can be treated using prescribed medications such as progesterone tablets or injections, human chorionic gonadotropin or clomid. Alternatively vitex-agnus castus is a herb with progesterone stimulating properties, which has been found to be an effective natural treatment especially when combined with vitamin B6.
Long or Heavy PeriodsLong or heavy periods can be a sign of hormonal imbalance and/or a failure to ovulate. This is generally related to a high estrogen to progesterone balance. Healthy progesterone levels are necessary for ovulation and conception as well as helping to stop excess bleeding during your period. Bleeding which continues longer than normal or is heavier than normal can indicate low progesterone or a low progesterone to estrogen balance (estrogen dominance). Your Doctor may prescribe medication to help rectify any imbalance. You can also assist natural hormonal balance by supporting the excretion of excess estrogen via the liver through diet and herbal support and using herbal treatment to help correct underlying hormonal imbalance.
Bleeding or ClotsHealthy menstrual flow should be free flowing and bright red in colour. Menstrual flow that is dark or brown in colour or contains clots can be old blood left over from the previous cycle. This can be caused by poor uterine circulation, sluggish menstrual flow or poor uterine tone. Following a healthy diet, such as outlined in the 90 day fertility diet, and keeping well hydrated and active will help to improve circulation and blood flow.
SpottingSpotting can be a regular occurrence for some women and often times it’s no cause for concern. However in some cases it can be a sign of an underlying condition such as
- Failure to ovulate (or some women also experience spotting at the time of ovulation)
- Hormonal imbalance
- Excessive exercise
- Poor diet/nutrition
- Cervical abnormalities
- Ovarian cysts
Therefore if you do experience spotting and are trying to conceive, you should advise your Health Care Professional.
Age MattersAge is the most important determinant of your fertility. Up to the age of 35, couples have approximately 20 – 25% chance of conceiving each month. Fertility declines markedly after the age of 35, reducing by approximately 50% at age 40 and continues to drop before ceasing at menopause. The reason for this significant decline in fertility is due to
- reduced egg quality and quantity
- lowered estrogen levels
- increased follicle stimulating hormone (FSH), produced in response to the lack of responsiveness in the ovaries
- less frequent ovulation
- reduced cervical mucus
- reduced blood flow to the reproductive organs
Women over 40 are also more likely to suffer miscarriage due to high chromosomal abnormalities relating to the reduced egg quality.
Although assisted reproduction techniques have come a long way in the past decade, IVF is not the magic bullet many people would like to believe. The amazing advances in IVF technology are helping more and more people achieve pregnancies that would have otherwise been impossible or improbable. However, success still relies on your own fertility health, of which, age has significant impact.
In fact, women aged 40 – 42 have a significantly reduced success rate if less than 5 viable eggs are produced and most assisted reproductive techniques in women over 45, using her own eggs, are unsuccessful. For this reason, older women are often advised to consider using donor eggs. However the receptiveness of the uterus also plays a part in a successful pregnancy outcome, therefore even with healthy donor eggs, success rates are still lower in women over 45.
So what’s the good news? The good news is that although you can’t turn back the clock, there are ways in which you can help improve and maintain the health of your eggs at any age, increasing your personal chances of conception. So read on!
WeightMaintaining a healthy weight is vitally important for fertility. Being overweight or underweight reduces your chances of conception. This has been confirmed in numerous studies dating back to the 1920’s.
Research shows that excess body fat has a significant impact on fertility and the ability to maintain a pregnancy by
- Disturbing ovulation, leading to irregular or lack of ovulation (anovulation)
- Contributing to heavy and/or prolonged menstruation
- Reducing response to fertility medications
- Increasing the risk of pregnancy complications including gestational diabetes and pre-eclampsia
A BMI greater than 25 increases infertility, miscarriage risk and antenatal complications.
A BMI greater than 31 increases the risk of having a child with neural tube defects, central nervous system complications, cardiovascular complications and digestive disturbances.
In a clinical trial, women attending an IVF clinic were put on a diet and exercise program for 6 months, whilst ceasing IVF treatment. Results showed an average weight loss of 10.2kg. Following the weight loss 90% of women who were previously not ovulating, spontaneously began to ovulate, 18 conceived naturally and 34 conceived after IVF treatment. Miscarriage rate dropped from 75% in the same group previously to 18% after the program.
The reverse is also true. Underweight women (classed as a BMI under 18.5) are more than twice as likely to take more than a year to fall pregnant. This is largely due to low body weight affecting healthy ovulation.
SmokingWomen who smoke are at least 1.5 times more likely to have fertility issues and take longer than a year to fall pregnant. This is also the case for those who are passive smokers compared to those in smoke free environments. Cigarette smoking is associated with reduced fertility, poor reproductive outcomes and a higher risk of IVF failure. Studies show that all reproductive functions are affected by smoking including impaired ovarian reserve, fallopian tube function and embryo development as well as increased menstrual irregularities. Nicotine has shown to negatively impact the production of luteinising hormone (LH), which is vital for ovulation. If fertilisation does occur, smoking may also affect the placenta, reducing the flow of nutrients and removal of toxins to and from the developing foetus as well as increasing the risk of early miscarriage. Smoke compounds can be found in ovarian tissue, uterine fluid and in the embryo, indicating a direct toxic affect.
AlcoholThe importance of abstaining from alcohol during pregnancy is well known, but you’re not pregnant yet. Is it ok to have a few drinks when you’re trying to conceive? There are many conflicting opinions on this topic and the exact ‘safe’ limit, if there is such a thing, is extremely unclear.
However we do know that alcohol does have a negative effect on fertility. Alcohol interferes with the production of luteinising hormone (LH) and follicle stimulating hormone (FSH), both of which play a vital role in ovulation which is critical for there to be any possibility of conception.
Alcohol intake during the week of conception can also increase the risk of early pregnancy loss.
For these reasons The National Health and Medical Research Council recommends that women who are trying to get pregnant should not drink at all because a ‘no effect’ level has not been established. Although the council does suggest that that the risk associated with low-level drinking (such as one to two drinks per week) are likely to be low, they also acknowledge that this suggestion cannot be confirmed due to limitations of existing evidence.
So, the bottom line is that if you’re serious about trying to get pregnant, it’s best not to drink alcohol.
CaffeineYour regular caffeine fix may be having a greater impact on your fertility than you realise. A recent study showed that women who drink in excess of one cup of coffee per day are only half as likely to conceive as those who drink one cup or less per day. Women who drank more than 2-3 cups per day were nearly 5 times less likely to conceive compared to those who drink no coffee at all and chances of conception continue to decrease with increasing caffeine consumption.
Caffeine intake can affect healthy ovulation and the function of the corpus luteum, both of which are critical for conception and the progression of a healthy pregnancy.
High caffeine consumption also increases this risk of early miscarriage. Women consuming more than 200mg of caffeine per day (about 2 cups of coffee) have double the risk of miscarriage compared to those consuming no caffeine.
Current recommendations suggest that women trying to conceive limit their caffeine intake to 100 – 200mg per day, which equates to 1 – 2 cups of regular coffee or 2 – 4 cups of regular black tea per day. It’s also important to keep in mind that green tea, chocolate, hot chocolate and some soft drinks as well the array of new energy drinks also contain caffeine, which can add up over the day.
However in a study of patients undergoing IVF, women who consumed even modest amounts of caffeine (50mg per day/less than 1 cup) had decreased live birth rates.
So although the exact ‘safe’ intake is highly debatable, we do known that limiting or better still, eliminating caffeine from the diet positively affects fertility, conception and healthy foetal development.
Diet/NutritionYour prenatal nutrition has a direct effect on your ability to conceive and carry a healthy pregnancy. Numerous studies dating back from the 1940s to today confirm this fact. Even dating back to ancient times, women wishing to conceive were fed increased amount of nutrient rich foods. To some extent this is related to the impact of diet on weight and body fat however studies show that diet is a significant independent risk factor for infertility, regardless of body fat and BMI. This is due to the importance of diet in providing essential nutrients as well as being largely based on whole foods, avoiding chemical preservatives and additives.
The sooner healthy dietary changes are made, the better. Your eggs have a 90 day life cycle during which time you can influence the health of these developing eggs. So ideally healthy diet and lifestyle changes should be incorporated at least 3 months to a year before conceiving, the longer the better. The 90 Day Fertility Diet has been designed with this life cycle in mind to help enhance egg quality and improve chances of conception.
ExerciseToo much, or too little exercise, will both negatively impact fertility. Women participating in regular high intensity, strenuous exercise show increased cortisol levels (as found in those with high stress levels) and reduced thyroid hormones. On top of this, excessive exercise also impacts estrogen and progesterone balance.
High impact training can reduce the body’s ability to produce progesterone, which is critical for ovulation. Extremely athletic women also have greatly reduced levels of body fat. Low body fat has a direct impact on estrogen production, reducing estrogen levels, which can lead to irregular or complete loss of the menstrual cycle as well as irregular or absence of ovulation.
However, before you throw out your trainers, at the other extreme, very little exercise will also negatively impact your ability to conceive. Just as women with very little body fat, may suffer from reduced estrogen production, those with excess body fat may experience increased estrogen production. This can have the same effect on the menstrual cycle, causing irregular of loss of menstruation as well as irregular or lack of ovulation. Also, just as regular strenuous activity can increase cortisol levels, lack of exercise can also increase cortisol levels. Regular exercise aids the body’s natural stress response, improving our ability to deal with stress as well as helping to reduce cortisol levels.
MedicationsSelective serotonin reuptake inhibitors (SSRI’s)
Eg. Prozac, Zoloft, Paxil
SSRI’s are prescribed for the treatment of depression and anxiety and there is much debate about their use during both the preconception period and during pregnancy. SSRI’s don’t directly impact the menstrual cycle or ovulation and have been listed as safe during this period.
However, SSRI’s have been linked to higher rates of miscarriage, preterm birth, pregnancy complications as well as birth defects and long-term behavioural issues in the child as well as affecting the efficacy of infertility treatment.
Women with a history of depression are twice as likely to struggle with infertility and for this reason SSRI’s are sometimes prescribed, under the understanding that the benefit outweighs the risk. However there is little evidence that women struggling with infertility benefit from the use of SSRI’s and there is no evidence of improved pregnancy outcomes. For this reason I recommended that you speak with your Health Care Professional about treatment options if you are suffering depressive symptoms to make an informed decision about whether this medication is right for you. If you are currently taking SSRI’s these should not be stopped suddenly. Speak with your Health Care Professional before ceasing any current treatment.
Tricyclic antidepressants (TCA’s)
Eg. Amitriptyline, Amoxapine, Doxepin, Elavil
Tricyclic antidepressants are an older form of antidepressants and are less commonly prescribed due to their high side effect profile. However they may be used when SSRI’s are ineffective or in more extreme cases of depression. Unlike SSRI’s, tricyclic antidepressants do impact hormone production by increasing levels of prolactin, which stimulates milk production. This impacts the normal ovulation. Therefore these medications are not recommended during the preconception or pregnancy period. If you are already taking these medications you should speak with your Health Care Professional before trying to conceive.
Eg. Cortisone, Prednisone, Prednisolone
These medications have strong anti-inflammatory properties and are prescribed for conditions such as asthma, eczema and injury. General prescribed use of these medications does not appear to negatively impact fertility, in fact low doses may be prescribed during fertility treatment. However regular, high dose use may interfere with your body’s ability to produce luteinising hormone (LH) and follicle stimulating hormone (FSH), which can prevent ovulation from occurring.
Non-steroidal anti-inflammatories (NSAID’s)
Eg. Nurofen, Advil (Ibuprofen), Naprogesic (Naproxen), Aspirin
Occasional use of these medications for mild pain does not appear to negatively impact fertility or conception however regular use of NSAID’s can directly affect ovulation. Use of these medications has been linked to reduced ability for ovaries to release an egg at ovulation, leading to irregular or anovulation. Side effects have shown to reverse once treatment has stopped. If you are currently using these medications regularly you should consult your Health Care Professional about reducing, changing or ceasing these medications.
These are some of the most commonly prescribed medications, however other medications such as antipsychotics, cancer medications, prostate medications as well as some antibiotics can also negatively impact fertility. If you are currently taking any medications consult your Health Care Professional about any potential impact on fertility.