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Five common signs of a vitamin D deficiency

Five common signs of a vitamin D deficiency

Here naturopath, nutritionist, medical herbalist and BodyTalk practitioner Merran Lusher, ND tells us how to spot a vitamin D deficiency.

Vitamin D is one of the hottest topics within the field of health sciences. If you live in the northern hemisphere and are trudging through these stark winter months, then the changes of having a deficiency is high. Yet your doctor may say your vitamin D test result is normal. But is it?

I’ll lay out the latest research, give you the run down on how the signs and symptoms and how to spot a deficiency. Plus advice on how to best optimise your vitamin D levels.

Five common signs of a deficiency

According to Michael, F Holick, Ph.d., M.D. a foremost expert on vitamin D and the author of ‘The Vitamin D Solution‘ the following signs and symptoms are classic indications of a deficiency:

  • Ongoing musculoskeletal pain and achy bones: often misdiagnosed as chronic fatigue and fibromyalgia
  • Frequent illness/infections
  • Neurological symptoms: feeling blue, depression, headaches, migraines, confusion, forgetfulness, difficulty concentrating.
  • Fatigue and daytime sleepiness
  • Head sweating

Do I need to take a vitamin D supplement?

As conveyed in one of my lastest posts, ‘The Vitamin D Deficiency Epidemic’, regular sun exposure first and foremost is the most effective way to boost our vitamin D status. If sunlight isn’t an option, then the next best thing is high grade vitamin D3 supplementation – especially during the winter months. Recent studies have also shown that UVB rays emitted from sunbeds and sunlamps are also very effective at optimising our vitamin D levels. Some foods contain vitamin D, but simply not enough to support healthy levels.  

Before supplementing however, getting your vitamin D levels checked through a blood test is highly recommended. While a deficiency is problematic, a toxicity is equally so – as this in itself can cause other health complications. 

The best way to know whether or not you need supplemental support is via a blood test. Experts recommend we test twice a year. Early Spring (after winter) and early autumn, when your levels are likely to be at their lowest and highest points. If you are pregnant, trying to fall pregnant…or have cancer – then testing twice yearly is really important.

My doctor said my test result is normal – but is it?

Unfortunately, the standard testing and ‘normal references ranges’ used by many GP practices worldwide is outdated and simply not in line with the latest research. In my own practice, clients commonly say, ‘my doctor said my test results are normal’. And yet from my own clinical observations - it is so evidently clear that their levels are sub optimal and not normal. 

The latest research shows that 20 ng/mL (50 nmol/L), considered to be the current accepted minimum cut off for sufficiency – is still seriously inadequate and harmful to health. GrassrootsHealth, a nonprofit public health research organisation with an international panel of 48 senior vitamin D researchers states that ‘healthy blood levels are considered to be within 40 to 60 ng/ml. And for optimal disease protection, a vitamin D blood level between 60 to 80 ng/mL (150 to 200 nmol/L) is recommended’.

So how much vitamin D do we need?

It’s a hard question to answer. As everybody is so unique, and there are so many variables to consider. Experts say, you simply can’t go by dosage alone and that you should take whatever dose required to get your vitamin D levels in your blood back up to a healthy range.

The recommended daily intake (RDI) of vitamin D for government’s around the world typically ranges from 400IU to 1,000IU per day. The national health service (NHS) here in Britain states that children from the age of one, adults and pregnant women ALL need just 10mcg (400IU) daily. Yet there is a well-respected body of growing research recommending that adults require around 4,000IU daily to reach their optimal blood level. Children need less and pregnant women require even more. That’s quite some discrepancy. This in itself could contribute to why so many early stage health conditions, (despite presenting with symptoms) are not being picked up on and indeed continuing to worsen.

If you are deficient, and sunshine isn’t an option, then boosting your levels through high grade supplemental D3 gels, capsules, drops or spray is a convenient option. I prefer drops as they are easy to dispense and get absorbed directly into the blood stream quickly and efficiently.

So if your test results come back ‘normal’ but you are prone to any of the aforementioned signs and symptoms or think you may be deficient, why not book an appointment and I can help you to manage your levels more accurately. I offer face to face appointments from my two London based practices as well as distance appointments via FaceTime, WhatsApp and Zoom.

The D minder app

Michael F. Holick, Ph.D., M.D. has developed a revolutionary and free app called DMinder.info. Simply plug in your details – country, amount of vitamin D you might already be taking, estimated daily sun exposure, your Fitzpatrick skin type. And the app then estimates what your blood levels are so that you can manage them accordingly. Country dependent, it also tells you the best time of day to optimise your levels. Of course it’s all subjective, based on the data you input. But still – I think it’s a really clever idea and a helpful tool. 

Two notes to consider

When supplementing with vitamin D3 new research tells us that:

  • vitamin K2 taken alongside vitamin D3 helps to direct calcium into the bones and away from our soft tissues and arteries.
  • consuming magnesium can reduce the risk of vitamin D deficiency: a 2013 study found that people who consumed high levels of magnesium were less likely to have low vitamin D.

Final thoughts

The organisation Grassroots health is a brilliant, scientific resource offering the latest research and information.

My basic advice would be to get out and about in the sunshine where possible. Supplementation and even safe sunlamp and sun bed UVB exposure are the next best options. Use common sense and reasonable caution and make regular sun exposure a natural part of your lifestyle. Sunshine is good for the soul - and it really IS the best medicine.

Did you know that sunscreen inhibits the absorption of Vitamin D? Tune in for the third part of my vitamin D series where I’ll share with you my advice on natural vs chemical sunscreens and my favourite chemical-free brands.

London naturopath, nutritionist, medical herbalist and BodyTalk practitioner Merran Lusher, ND offers science-based intuitive holistic health consultations and healing for mind, body and soul. Merran consolidates other natural therapies into her treatments including energy work, homeopathy, reiki, dietary and lifestyle advice and much more. She runs a busy weekly remote clinic to clients around the world and also consults across two busy London practices in Chelsea and North London. You can read more about her here.

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Vitamin D deficiency epidemic

Vitamin D deficiency epidemic

Here naturopath, nutritionist, medical herbalist and BodyTalk practitioner Merran Lusher, ND explains why sunshine is so essential for our health.

Here in the Northern Hemisphere, the lack of sunlight over the drawn out Winter months has put our endurance to the test. That coupled with the coronavirus pandemic sweeping the globe - we’re all in need of a lucky break.

Now that Spring has arrived, the days are at least beginning to blossom and brighten and our thoughts turn to the sun-rich, hot and summery days ahead. And it’s a magical alchemy of sunshine and vitamin D that IS essential for our health and longevity, now and in the long and winding road ahead.

Despite the name, vitamin D is actually a steroid hormone that’s obtained primarily through sun exposure (via UVB rays).  With extensive coverage over the past few years it’s one of the biggest areas of research within the health sciences. Thousands of studies have attested to the health benefits of Vitamin D. Playing a critical role in disease prevention and optimising health, it’s actively involved in:

  • healthy immune function and the modulation of innate and adaptive immune responses. It’s also plays a critical role in reducing our susceptibility to infection as well as defending the immune system against foreign organisms, like viruses (this coronavirus), bacteria, parasites etc.
  • preventing autoimmune diseases
  • preventing various types of cancer including skin cancer
  • lowering heart disease and type 2 diabetes
  • reducing chronic inflammation, Alzheimer’s disease and age-related macular degeneration.
  • enhancing fertility health
  • mood and brain health: low levels are linked to depression and anxiety
  • seasonal affective disorder (SAD)
  • sleep quality
  • healthy bone (and teeth) development and the prevention of osteoporosis and osteopenia
  • healthy gene expression: of our 25,000 genes, vitamin D affects over 2000 of them + all the vitamin D receptors on every cell in the body.

We simply can’t get enough vitamin D through our diet. So the BEST way to optimise our levels is through good old-fashioned daily sun exposure: to the face, arms, chest and legs. The time of day is important too. And emerging research recommends exposure when the sun is at its highest point in the sky – around midday.

What do the experts say?

We are facing an epidemic of vitamin D deficiency and it’s a major global public health issue. Around one billion people worldwide are said to have an end scale deficiency and 50% of the population, sub optimal levels. Michael, F Holick, Ph.d., M.D. a foremost expert on vitamin D and the author of ‘The Vitamin D Solution‘ says, ‘the time of day, season of year, latitude, degree of skin pigmentation, acclimation, indoor lifestyle and the use of sunscreen all have influences’ on our ability to utilise and manufacture it. The likelihood of a vitamin D insufficiency also increases across the elderly, obese and those with malabsorption syndromes.

Another important consideration is the common use of sunscreen which inhibits the utilisation of vitamin D. Founder of the Vitamin D Council, Dr. John Cannell says that ‘the advice to avoid the sun can have equally if not greater adverse health effects’. Linking this issue to melanoma and other types of skin cancer. An interesting paradox to note that dermatologists for many years have recommended people avoid the sun and wear sunscreen all year round.

So, you might see how a year-long deficiency could manifest under the sun-shy Winter months and sunscreen-rich warmer months. And regardless of the season, our modern lifestyles see us working longer hours and simply spending more time indoors – further promoting sub optimal levels.

Experts say the pros far outweigh the cons and that Vitamin D  acquired through UVB rays is essential for health and longevity. Of course, during the cooler months – that’s not possible and supplementing with high quality Vitamin D3 supplementation is advisable. But getting the dose right can be tricky and important to monitor.

How much sunshine do we need?

There is much confusion and controversy around this contentious issue as it’s no straight forward matter. As already noted, individual requirements depend on many factors. Skin type is an important one and can be determined through the Fitzpatrick scale – a basic guide to understanding sensitivity towards burning.

More recently it was thought that 10-30 minutes of ‘daily’ sunshine is enough. But with six different Fitzpatrick skin types, the optimal length of sun exposure varies for us all. With so much conflicting research and advice, it’s hard to know what’s what.

In a nutshell my conclusion is that somewhere between 10-20 minutes for the fairer maiden and around 30-40 minutes for the more exotic skin tone, would be a fair enough estimate, but again it’s unique for us all.

A reliable resource is GrassrootsHealth. Offering a wealth of evidence-based research on Vitamin D, it’s breaking new ground – moving research into practice. The UV index is one of the three key factors for managing sun exposure and a helpful tool to better understand how to manage vitamin D levels.

So there are a lot of variables to consider and it doesn’t stop there. Tune in for my next article where I’ll share with you the latest research around testing and managing your vitamin D levels. I’ll also help you to navigate your way through the controversial advice around supplementation and what dose is right for you.

London naturopath, nutritionist, medical herbalist and BodyTalk practitioner Merran Lusher, ND offers science-based intuitive holistic health consultations and healing for mind, body and soul. Merran consolidates other natural therapies into her treatments including energy work, homeopathy, reiki, dietary and lifestyle advice and much more. She runs a busy weekly remote clinic to clients around the world and also consults across two busy London practices in Chelsea and North London. You can read more about her here.

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Explaining the Unexplained: tackling PCOS head on

Explaining the Unexplained: tackling PCOS head on

Here Alex O'Connor, a fertility acupuncture specialist, from Essex Fertility in her Explaining the Unexplained series talks about how we can take practical action to tackle PCOS.

At its root Polycystic Ovarian Syndrome (PCOS) is linked to insulin resistance. Increasing evidence suggests that a common underlying factor in PCOS is the maintenance of the correct levels of myo inositol into d-chiro inositol. These inositols are part of the B vitamin  family and found in cell membranes; when these are disrupted, it can lead to insulin resistance which in turn can cause problems for fertility.

Studies have shown up to 80% of obese women with PCOS and 40% of lean women with PCOS show signs of hyperinsulinemia which can trigger symptoms such as sugar cravings, intense hunger, anxiety, finding it difficult to concentrate, lacking focus and fatigue. When insulin levels are erratic it has a knock on effect of disrupting menstrual hormones.

Tackling PCOS through diet

The good news is that any dietary changes that can improve insulin regulation can have a dramatic effect on PCOS, to the extent that it is possible to control symptoms of PCOS through diet and in doing so, restore ovulation and improve fertility. The basis of a good diet for someone with PCOS is to eat a natural, paleo style balanced diet, whole, real foods that you buy in a natural state and cook at home, avoiding processed foods and artificial sweeteners. 

The most important thing when trying to tackle PCOS through diet is to cut out sugar. It isn't easy, but there are lots of resources out there to help. Magnesium and a vitamin B complex which includes Vitamin B6 may help to take the edge off the sugar cravings!

A healthy gut is vital for hormone regulation, we rely heavily on our gut microbiome to help us to assimilate the necessary hormonal components and to help us to eliminate excess hormones in order to maintain the correct hormone balance.  As I write this, millions of people across the world are in lockdown at home, providing a perfect opportunity to take stock of our diet and lifestyle and to put changes into place for long term benefit.

Your diet needs to contain the following elements:

Protein

  • Include lean fish, chicken and red meats if you can in your diet - choose free range if possible. Protein should be eaten with every meal, but not in large amounts. For your main meal, aim to have a portion of protein that is about the size of the palm of your hand.
  • If you cook with any cuts of meat with bones, learn how to make a bone broth – you can then either have it as a broth or add it to other soups/casseroles to seriously increase the richness of micronutrients. Hundreds of recipes on the web, very easy to do.
  • Try to get a bit of salmon into your diet if you can, or line-caught yellowfin tuna (thought to have a lower mercury content than regular tuna).

Eggs 

  • It is really good to start the day with a hot breakfast with some healthy protein rather than starting the day with something carbohydrate based such as toast/cereal.
  • Eggs are a fantastic breakfast, especially if you are working from home and have a bit more time! Get into the habit of cooking yourself a small omelette in the morning or have a poached egg with an avocado, a sprinkling of seeds and spoonful of kimchi on the side (optional!).

Vegetables 

  • Approximately half of your plate should be vegetables
  • Fill your boots with non-starchy vegetables such as salads, cooked green leafy veg (spinach, kale, chard), cauliflower, carrots, green beans, broccoli, mushrooms, aubergine, celery, cucumbers, onions, avocado and tomatoes (those last two are particularly good to include if you can - get some tomato plants so you have a supply all summer long!).
  • Try to use starchy vegetables in place of the more processed carbs, so have sweet potatoes, white potatoes, parsnips or butternut squash instead of pasta or bread.

Fruits

  • Low sugar fruits such as berries, grapefruit, apples, oranges, pears, pineapple are best.
  • Some of the more sugary fruits such as mango, grapes and bananas are slightly less helpful but still useful if you need something sweet.
  • Don’t forget dried fruits, dried apricots, figs and dates all make a healthy, nutritious snack. Try filling a date with a spoonful of nut butter for a delicious little snack.

Nuts, Seeds & Oils

  • Nuts, seeds and oils are amazing for micronutrient content that really help us to support hormone health.
  • Pick up a pot of seed sprinkles and keep them on the kitchen counter to scatter on your food - you won't notice them in small amounts but they will make a big difference.
  • Put a bowl of nuts out - pecans, almonds, cashews, walnuts. You may think you don't like them, but if you leave them around where you can see them and eat one every now and then it is better than not eating them at all!
  • Monounsaturated oils are surprisingly good for your hormone regulation system, oils like extra virgin olive oil, avocado oil and coconut oil. You can sprinkle oil lightly over steamed vegetables, or include a serving of nuts, seeds or avocado each day to make sure you take in enough. You can buy a mild coconut oil from Biona which doesn't taste of coconut and is amazing to cook with - for scrambled eggs, frying, roast potatoes etc)

Herbal teas 

  • Green tea is particularly good for helping to regulate hormones.
  • Spearmint tea is another very good tea for helping with excess androgen hormones.
  • Liquorice tea can also help to gently regulate excess androgens in the system.
  • All of the above teas can help recovery from polycystic ovaries - so if you can learn to like them, they will be very good for you. You may need to buy spearmint tea from a health shop or online, I am not sure they stock it in the supermarkets.

A Word about Gluten

There is also a strong link between PCOS and inflammation, so it is a good idea to try eliminating gluten from your diet – not through choosing heavily processed ‘gluten free’ foods, but by choosing not to eat foods that contain gluten! Gluten is found in wheat, spelt, rye and barley. Evidence suggests it is mildly inflammatory to anyone; it can create a situation where the gut wall becomes inflamed, leading to ‘leaky gut’ and increased immune reactions. If you want to know whether gluten is causing an increase in your baseline inflammation level, eliminate gluten for a month to see whether it improves how you feel. When/if you do reintroduce it, again, observe how you feel – you may find that you feel much better if you consume a much lower amount of foods containing gluten. Gluten has been shown to increase leptin resistance which in turn creates more hunger – so reducing gluten should also help you to control your hunger more easily.

Supplements

In terms of supplements to take to support hormone regulation if you have PCOS, one of the most useful supplements seems to be myo-inositol. Inofolic is specifically designed to support hormone regulation to improve fertility for PCOS women.

Your doctor may prescribe Metformin to help regulate your insulin levels, but if not, check out Berberine as a natural alternative.

There are a wide range of other supplements that are often recommended for people with PCOS, but there are several different presentations of PCOS and not all supplements would be beneficial for everyone. The two mentioned here are both useful in terms of the insulin regulation issues that accompany PCOS.

Slowly does it

If you have a high BMI and are trying to lose weight to improve your fertility and decrease your PCOS symptoms, aim to lose weight very slowly over a long period of time rather than going for a rapid weight loss program. In most cases, losing 5% of your body weight should be enough to restart ovulation, but do it slowly. Rapid weight loss can trigger the body to shut down reproductive hormones which is not helpful if you are losing the weight to improve your fertility! Acupuncture and diet can help to get things going again, but it is better not to trigger that response in the first place by making sure your weight loss is slow and steady.

Acupuncture for PCOS

I would recommend you look for an acupuncturist who specialises in fertility acupuncture to work with you. A Fertility Acupuncture Specialist would be able to support you properly, adjusting their treatment and lifestyle advice according to your blood hormone profile to help you to restore a healthy, natural cycle and improve your fertility. The dietary changes discussed above would be beneficial to anyone with PCOS, but there are many different presentations of PCOS so it is definitely worth discussing your hormone levels with blood tests with your specialist to see what is really happening before diving too deeply into supplements - one size does not fit!

Read more about Alex and Essex Fertility here.

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Fertility 101: Miscarriage - what are the different types of miscarriage and what does this mean for me?

Fertility 101: Miscarriage - what are the different types of miscarriage and what does this mean for me?

Kate Davies, Fertility Nurse Consultant, IVF coach and founder of Your Fertility Journey explains the different types of miscarriage and shares details of where you can find miscarriage support.

 

What are the different types of miscarriage and what does this mean for me?

There are so many different types of miscarriage and it can feel confusing when hearing these different terms, especially as many of the terms sound medicalised and often bear little relation to what you may be experiencing both physically and emotionally.

The term miscarriage means the loss of a baby in the first 23 weeks of pregnancy, with early miscarriage being the loss of a baby in the first 12 weeks. Sadly, miscarriage is very common with approximately one in four pregnancies ending in a miscarriage. 

What happens during a miscarriage?

When a miscarriage occurs, it is often associated with vaginal bleeding and lower abdominal pain. However, confusingly not all miscarriages start out in this way. Below is an explanation of the different names you may hear and what this means and importantly what may happen during this type of miscarriage.

What are the different types of miscarriage?

Chemical Pregnancy: The term given to a pregnancy that ends in a miscarriage before the first 5 weeks of pregnancy. Advances in the sensitivity of pregnancy tests mean that you may find out that you are pregnant very early and in some circumstances a pregnancy does not develop as it should and whilst you may have enough pregnancy hormone to be picked up by a pregnancy test, a few days or weeks later the test may become negative. You may notice a heavier than normal period.

Threatened miscarriage: This is when you are experiencing bleeding or pain that ‘threatens’ to develop into a miscarriage. When examined by a doctor the entrance to the uterus is closed and the risk may resolve and the pregnancy continue, or you may go on to miscarry.

Inevitable miscarriage: This is as it sounds, the entrance to the uterus is open and a miscarriage will occur. Your doctor will likely inform you that a miscarriage will happen. It is likely that your doctor will advise that you miscarry at home.

Complete miscarriage: This means that a miscarriage has occurred, and no pregnancy tissue is left in the uterus. This is generally determined by having an ultrasound scan and an examination.

Incomplete miscarriage: This occurs when a miscarriage has happened, but some pregnancy tissue remains in the uterus. You may be experiencing bleeding and pain and to avoid the risks of infection your doctor may suggest that you have a minor surgical procedure to remove the remaining pregnancy tissue.

Missed or delayed miscarriage: This is when your baby’s heartbeat cannot be seen on an ultrasound scan and there is no further development or that the heartbeat has stopped. It is likely that you will be offered another scan a week or so later to confirm that the pregnancy has ceased.  At this point you may still feel pregnant, but your pregnancy symptoms will start to subside. You may go on to miscarry or it may be necessary to remove the pregnancy tissue surgically.

Ectopic Pregnancy: An ectopic pregnancy is one that occurs in the fallopian tube or elsewhere in the pelvis. You may notice pain and have some bleeding. Unfortunately, a pregnancy is not able to survive outside the uterus and will not continue to develop. An ectopic pregnancy can be managed medical with drugs or removed surgically. On rare occasions an ectopic pregnancy can be life threatening but it is likely that you will be carefully monitored during this time to make sure that you stay well.

Molar Pregnancy: This is a pregnancy that doesn’t develop correctly. In general, the pregnancy tissue needs to be removed surgically and you may be advised to wait for a few months before trying to conceive again.

Blighted Ovum: A blighted ovum is where a pregnancy sac develops but when you have an ultrasound there is no embryo visible in the sac. 

Recovering after a miscarriage

It is normal to have bleeding and crampy pain similar to a period for up to two weeks following a miscarriage. Your next period may be a little later or earlier than expected. It is also normal to feel tired after a miscarriage and you may prefer to take some time off work to recover.

It is also important to take the time to recover emotionally. Having a miscarriage can cause a great deal of emotional upset and it is quite normal to feel sadness, disappointment, frustration and anger. You might also be worrying about getting pregnant in the future and if you will miscarry again. The majority of women who experience a miscarriage go on to conceive and have a normal pregnancy. However, if you are concerned about this, speak with your doctor.

Causes of miscarriage

In most cases, the cause of an early miscarriage is not known and there is nothing you could have done to prevent it. Early miscarriages usually happen because the embryo is not developing as it should. Chromosome problems are thought to be one of the most common causes.

Investigating why you have miscarried

In general, you will only be offered further tests if you have had three or more miscarriages. This may feel upsetting at the time but because early miscarriage is common and often no treatable cause can be found, it is advised to wait until you have 3 miscarriages. After this time your doctors will thoroughly investigate and look for any potential causes and how they may be able to treat this.

When can I try to conceive again?

In general, you can start trying to conceive again as soon as you feel both physically and emotionally ready. You may wish to wait until you’ve had a period before trying again, however there is no reason why you can’t start trying as soon as you wish.

Where can I get support following my miscarriage?

There are many resources you can tap in to following a miscarriage. Some of these may be online support, forums and groups or local support groups. Below are some recommendations:

The Miscarriage Association

Tommys

Saying Goodbye

Kate Davies (RN, BSc (Hons), FP Cert) is a fertility nurse consultant and IVF coach. She is the founder of ‘Your Fertility Journey’, a clinic offering high quality advice and support for women and couples who were struggling to conceive. Find out more about Your Fertility Journey here. Kate is also co-host of The Fertility Podcast.

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Explaining the Unexplained: AMH

Explaining the Unexplained: AMH

Here Alex O'Connor, a fertility acupuncture specialist, from Essex Fertility in her Explaining the Unexplained series gives us the ins and outs of AMH.

AMH - Does It Represent Egg Reserve?

It is not unusual for a woman to contact me after a visit to an IVF clinic for a 'fertility assessment' having had her Anti-Mullerian hormone (AMH) measured. People are usually told that the AMH level indicates egg reserves and if the level is anything short of great people get very worried. AMH can be indicative of egg reserve but not egg quality, and it is not a good predictor of how readily someone will conceive; it is actually a better indicator of how someone would respond to IVF stimulation, as this article will explain.

The table below shows the typical range of AMH at different ages.

Your AMH level will change over your lifetime, it is usually quite high in your mid-twenties, and gradually declines until menopause but along the way it can go up and down as it reacts to lifestyle, nutrition, stress and medications. Some GPs will test AMH, but it others argue that it is an expensive and unnecessary test as other tests are more useful for determining what is going on with your cycle; NICE guidelines recommend AMH is not offered routinely as a test to check for premature ovarian deficiency.

Does AMH Only Go Down?

Many people assume that AMH only goes in a downwards direction, but it is much more fluid than that. The oral contraceptive pill has been shown to cause AMH to decline by up to 50%, smoking can reduce AMH and stress can also be a factor in lower AMH.

Low AMH can often be improved with diet, lifestyle and acupuncture. In an example from my own clinic, a client came to me about 8 months after stopping the oral contraceptive pill having just had had a blood test to check her AMH - the result showed it was quite low for her age.  A repeat AMH blood test after two cycles of acupuncture showed it had more than doubled in that time to the top of her age range.

Ovarian surgery such as removal of an endometrioma can create scar tissue within an ovary. This can also result in a temporarily lower AMH level which can persist for few months after surgery.

AMH and PCOS

A particularly high level of AMH (over 48.5 pmol/l) is one of several indicators of Polycystic Ovarian Syndrome (PCOS). A very high level of AMH usually indicates that the ovaries have an excessive number of pre-antral follicles and small follicles because it is these follicles that secrete AMH. In normal conditions at the beginning of a cycle there are a handful of follicles on each ovary waiting to grow on, at some point in the follicular phase, one of these overtakes the rest and becomes the dominant follicle which then grows considerably and releases the egg mid cycle. If the AMH is very high, in the early part of a cycle and there are too many small follicles, the process of selection of the dominant follicle may fail to work properly. When that happens it is possible that none of the follicles manage to grow to full maturity in a natural cycle. Ovaries with lots of pre-antral and small follicles can be seen clearly on an ultrasound, these ovaries are described as polycystic ovaries.

These small follicles also secrete testosterone so if there are lots of them it can create an excess of testosterone in the system which can also interfere with ovulation. Not all cases of polycystic ovaries are accompanied by high levels of testosterone; it is also possible that the large amounts of testosterone is being converted into an excessive amount of oestrogen which is another indicator of polycystic ovaries. In a normal cycle, that oestrogen comes from the dominant follicle as it grows and matures the egg, but in a PCOS cycle the oestrogen comes from a large number of follicles, sometimes none of them large enough or mature enough to release a mature egg.

When you work with a Fertility Support Trained Acupuncturist, they will work with you to establish what is going on with your hormones and your cycle and determine whether your cycle is dominated by testosterone or oestrogen. This knowledge will help them to treat you more effectively and offer you the most appropriate advice to help correct the imbalance. As the overall balance of hormones improves, the high AMH level should return to a more normal level.

One of few benefits of PCOS comes with age. At the age where AMH is falling too low for many women, in a PCOS woman AMH is just slipping down into a more healthy range, so there can be a window in which fertility actually improve in these later years.

Is a Low AMH Good?

If AMH is very low, there will only be a few pre-antral and small follicles at the beginning of the cycle. This can impact on the success of an artificially stimulated cycle (see below). However AMH is not an indicator of egg quality and for any normal cycle only one follicle is selected as the dominant follicle and grown on to maturity, so as long as the cycle is healthy it is very possible to ovulate successfully with a low AMH. A new study has shown that as long as you are regularly ovulating, a lower AMH does not make a huge difference to your chances of conceiving. The study showed that the chances of achieving a natural pregnancy with a lower AMH stood at 62%, whereas the chances of achieving a natural pregnancy with a normal range AMH was 65%.

When an IVF clinic sees a very low AMH, they know that at the beginning of a stimulated cycle there would be very few follicles available to respond to the stimulation drugs, so they will be unable to mature and harvest a large number of eggs.

AMH and Ovarian Reserve

AMH is often cited as a measurement that corresponds well with ovarian reserve. Alternative factors that suggest ovarian reserve are high Follicle Stimulating Hormone (FHS) or low Antral Follicle Count. In reality all three of these markers should be checked before making a diagnosis of reduced ovarian reserve, but of the three, an Antral Follicle Count is the most reliable marker. Even with a low ovarian reserve, it is still possible to conceive naturally if the hormones are well balanced and the egg and sperm quality are good.

Why are IVF clinics so interested in AMH?

Studies have shown that the level of AMH correlates well with how successful IVF treatment and egg maturation will be (La Marca et al, 2007). Very low AMH (lower than 1.4 pmol/l) has been associated with lower egg yield and poorer egg quality. This is not set in stone however; other studies suggest that AMH is not reliable enough to be used as a predictor for IVF success (Broekmans et al, 2007) and some suggest that women with low AMH still have a moderate chance of conceiving.

From the perspective of standard IVF, a very low AMH indicates that for any given month there may be very few follicles ready and waiting to be matured in that cycle. As a consequence of the small number of follicles available, the chance of having a successful IVF with a sufficient number of mature eggs to harvest is smaller so some clinics are more reluctant to take on such cases.

There are clinics which specialise in working with women with low AMH levels – they may choose a less intensive approach to ovarian stimulation such as ‘egg banking’ or pre-load the cycle by stimulating in the later stages of the preceding cycle to try to encourage more follicles to be ready for the beginning of the cycle and to create a longer, more gentle stimulation phase. Egg banking is a process whereby ovaries are stimulated very gently to make the most of the few follicles available, possibly harvesting as few as one or two eggs per cycle; this is usually repeated for 2-3 cycles in order to achieve sufficient eggs prior to continuing with fertilisation and transfer.

IVF clinics are not just looking for low AMH, they are also checking to see if you have a very high level  of AMH because that tends to be more difficult to manage through IVF. If you have very high AMH you will have many, many more small follicles available for stimulation, as this mass of follicles grows they each start to generate additional oestrogen. If not carefully managed, this can result in a mass of small eggs being harvested which are not fully matured and which may fail to fertilise or fail to develop. An additional risk in this situation is that if your oestrogen level gets too high you are likely to slip into Ovarian Hyperstimulation Syndrome (OHSS) which is a potentially life-threatening condition if left unmonitored.

How To Increase Low AMH 

There is some interesting evidence that suggests Vitamin D can help raise AMH levels, particularly Vitamin D3 (Dennis et al, 2012). Vitamin D deficiency has also been associated with decreased fertility and an increase risk of early pregnancy loss, so it is definitely worth checking your Vitamin D level and supplementing if necessary.

There is some research that suggests DHEA is a supplement that could help to improve AMH but this needs to be viewed with some caution as it is not going to be appropriate for everyone. DHEA can be measured in the blood, so if you are considering DHEA supplementation it would be a good idea to check your DHEA level before starting to supplement, keep an eye out for symptoms of testosterone excess and recheck DHEA level every month. An excess of DHEA is likely to result in an excess of testosterone which would have a negative effect on your fertility.

How to Decrease High AMH

There seems to be quite a strong correlation between insulin resistance and the high AMH levels seen in PCOS. It would be prudent to recommend dietary changes to try to reduce PCOS-related high AMH levels, a healthy diet such as the Mediterranean Blood Sugar diet would be a good place to start (Pellatt et al, 2010). To see my article on how to tackle PCOS through diet, Click Here.

Melatonin

Melatonin seems to have a regulating effect on AMH as it has been shown to increase low AMH and to decrease high AMH.

  • Low AMH - There is some research suggesting that supplementing with 3mg/d melatonin can help to increase AMH, improve egg quality and the likelihood of developing top quality embryos (Jahromi et al, 2017).
  • High AMH (PCOS) - There is some research suggesting that melatonin supplementation can help decrease high AMH in normal weight women with PCOS (Tagliaferri, 2018)

Specialist Fertility Acupuncture

In clinic I regularly see hormonal levels improve and the overall hormone balance shift into a better state. As your cycle improves, various hormone markers will improve and can be used to confirm the benefits of fertility acupuncture on a case by case basis. When you choose to work with a Fertility Acupuncture Specialist you are likely to be asked to check some of your basic hormone levels at the beginning of your treatment and to monitor them as you go along so that we can see the improvements. This integration of ancient acupuncture knowledge and modern scientific knowledge is a very important aspect of how we work.

If you are starting to wonder whether you need to be worrying about your AMH, find a Fertility Support Trained Acupuncturist to work with - let them help you to work out what you need to be concerned about, let them help you to improve your natural fertility or prepare for IVF.

Read more about Alex and Essex Fertility here.

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Fertility 101: What is Premature Ovarian Insufficiency and what does this mean for my fertility?

Fertility 101: What is Premature Ovarian Insufficiency and what does this mean for my fertility?

Kate Davies, Fertility Nurse Consultant, IVF coach and founder of Your Fertility Journey explains Premature Ovarian Insufficiency and how it can affect fertility.

Premature Ovarian Insufficiency

Premature Ovarian Insufficiency (POI) is sometimes referred to as premature or early menopause, and is the term used to describe when the ovaries stop working before the age of the natural menopause. On average a women’s menopause occurs around the age of 55. Sadly, POI occurs in 1in 100 women under the age of 40, 1 in 1000 women under the age of 30 and 1 in 10,000 women under the age of 20. Some women diagnosed with POI can still be in their teenage years.

What are the symptoms of premature ovarian insufficiency?

In women who are very young, their periods may not start at all and this can be an indication, among other reasons, of the condition. Women, who have previously had periods, may notice that their periods become irregular and then stop altogether.  Other symptoms you may notice are:

  • Infertility
  • Hot flushes and night sweats
  • Insomnia/disrupted sleep
  • Palpitations
  • Weight gain (especially around waist and abdomen)
  • Skin and hair changes (dryness, thinning)
  • Headaches
  • Breast tenderness
  • Mood swings and irritability
  • Anxiety/panic attacks
  • Loss of self-esteem
  • Lowered libido
  • Difficulty concentrating and memory lapses
  • Fatigue/low energy levels
  • Joint/muscle pain
  • Vaginal dryness and urinary infections
  • Depression

How is premature ovarian insufficiency diagnosed?

Unfortunately it can be difficult to diagnose POI, and initially you may be diagnosed with other conditions that may cause periods to cease, such as polycystic ovary syndrome (PCOS). A definitive diagnosis is obtained by taking a blood sample of follicle Stimulating Hormone (FSH) and repeating 4 weeks later. FSH levels above 30 iu/l are an indicator that the ovaries are failing and menopause is approaching or has happened. However, levels can fluctuate significantly in the early stages of POI, contributing to the difficulty in diagnosing the condition.

What is the treatment for POI?

Treatments for POI include hormone replacement therapy (HRT) or the combined oral contraceptive pill. Treatment is important to reduce the risks of long-term conditions such as osteoporosis. Oestrogen levels significantly reduce when the ovaries stop working and healthy bones require good amounts of oestrogen. HRT treatment improves bone density and therefore reduces the likelihood of osteoporosis occurring.

What does premature ovarian insufficiency mean for my fertility?

Women diagnosed with POI are more likely to conceive using donor egg and IVF. This can initially be devastating news and it’s important to take time to consider your options and what feels right for you and your partner. Speaking with your doctor and couples who have experience of conceiving using egg donation, can be helpful in getting all the information you need.

Where can I get more information and support?

The Daisy Network is a charity dedicated to supporting women with POI. They provide a support network of people to talk to, and offer advice on the treatments available, as well as keeping you up to date with research within the fields of HRT and assisted conception

You can also become a member of the Daisy Network and receive the following benefits:

Kate Davies (RN, BSc (Hons), FP Cert) is a fertility nurse consultant and IVF coach. She is the founder of ‘Your Fertility Journey’, a clinic offering high quality advice and support for women and couples who were struggling to conceive. Find out more about Your Fertility Journey hereKate is also co-host of The Fertility Podcast.

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Explaining the Unexplained: Ovulation

Explaining the Unexplained: Ovulation

Here Alex O'Connor, a fertility acupuncture specialist, from Essex Fertility in her Explaining the Unexplained series explains all about ovulation - how do you know if it's happening and what can you do if it's not.

Are you ovulating?

Just because you 'feel' like you are ovulating, doesn't mean that you are.

A regular cycle is not proof that you are actually ovulating - it is possible for your body to bleed every month without actually ovulating.

So if you are starting to wonder about your fertility, or if you have been diagnosed with 'unexplained infertility', one of the most important things to do is to check that you are actually ovulating. 

How can you tell whether you ovulate

BBT chart

If you chart for a month or two, you should be able to tell from your chart whether you ovulate – if you are ovulating the chart will have a classic biphasic appearance (two distinct temperature phases), with the temperatures of second half of the month registering at 0.5’F or 0.3’C above the temperatures of the first half of the month. This indicates that ovulation has occurred. If the chart is continually in the same temperature range, it suggests that you have not ovulated.

It is well worth investing the time and effort into tracking your cycle with a BBT chart before looking at the next two suggestions. It would give you a rough idea of when you ovulate so that you can time scans and blood tests correctly. If you ovulate on day 22, an ultrasound scan on day 14 or a 'Day 21 progesterone blood test would both produce very disappointing results. To find out more about the basics of BBT charts, go here.

Ultrasound scan

If you are due to have an ultrasound scan in the second half of the month, your sonographer should be able to see a corpus luteum on one of your ovaries if you have ovulated. If you are having an ultrasound after you have ovulated, check whether they can identify a corpus luteum and check that there are no signs of a luteinised unruptured follicle (see below).

Day 21 progesterone blood test

When a follicle is ready to be released, Luteinising Hormone (LH) is released by the pituitary gland which triggers the rupturing of the follicle to release the egg. The spent follicle goes through a process called luteinisation, quickly turning into something called a corpus luteum which pumps out progesterone. Progesterone is used to prepare the body for potential conception, ripen the uterus lining and upregulate the thyroid. 

If progesterone is detected in your blood, it will have been produced by a corpus luteum, so in theory it is proof that you ovulated – however the amount of progesterone can also indicate the vigour and vitality of the corpus luteum and the potential quality of the egg released by the follicle. It is worth noting though that it is possible for a follicle to fail to release the egg, but to continue to luteinise and produce progesterone (see below for an explanation of an unruptured, luteinised follicle)

The 21 Day Progesterone blood test is designed to test your progesterone level at the peak of production – but timing for this test is critical. The average cycle is 28 days long, and the average ovulation is at around 14 days, so the 21 Day Progesterone tests is designed to capture the progesterone level at the peak in the average cycle. But most of us are not average - read on...

You can request this test from your GP or your fertility consultant, or you can organise your own test through a private blood test service such as Medichecks. The Day 21 Progesterone test is a finger prick test, so you can order the kit and wait until the correct day to take the test.

The 21 Day Progesterone blood test is designed to test your progesterone level at the peak of production – timing for this test is critical. The average cycle is 28 days long, and the average ovulation is at around 14 days, so the 21 Day Progesterone tests is designed to capture the progesterone level at the peak so it is important to time this test to take it at the peak of YOUR progesterone release.

Shorter cycles:

If your cycle is 23/24 days long, your progesterone level on Day 21 will probably register lower than your peak progesterone because the level may already be falling in preparation for your period. If your cycle is short, I would recommend you use a BBT chart for a month to get some information about whether you have a short follicular phase or a short luteal phase, and to work out the best time to measure your progesterone in the middle of your luteal phase.

Longer cycles

If your cycle is 33 days long, it is possible that you haven’t even ovulated by Day 21, so your progesterone test would have a disappointing result that reveals nothing about your true progesterone cycle. If your cycle is regularly long, aim to test your progesterone level 6-7 days before your period is due which should be at around the peak of progesterone.

If your doctor does not understand the importance of the timing of this test, you may have to be creative with the information you give them about when your 'day 21' occurs!

Day 21 progesterone test result

If your result comes back to say your progesterone level is over 30nmol/l, it suggests that you have ovulated and that the luteinised follicle was strong, healthy and able to generate a good amount of progesterone.

If your result comes in at less than 5nmol/l it would suggest that you did not ovulate. However that is only a valid assumption if your period started within a week of taking the blood test. If there was a gap of over 12 days between the test and when your period started, it is possible that the test was taken just before you ovulated.

If your result was somewhere in between, it could suggest several things:

  • It could suggest that you ovulated, but that the follicle was not strong or that the thyroid failed to react appropriately
  • It could suggest that the timing of the test was incorrect and that progesterone was not at it's peak when the test was taken. It is always worth noting how many days passed between taking the test and the next period as this information can help you to interpret the results correctly

So does a good progesterone level ALWAYS indicate ovulation?

No.

Unfortunately it is possible to have a Luteinising Unruptured Follicle – this is something that occurs in approximately 10% of normal menstrual cycles, but is thought to occur more frequently in women struggling with infertility. When this happens the follicle fails to rupture, but does manage to luteinise which is the process that generates progesterone. Basically the egg is trapped inside the follicle and disintegrates, but the luteinising process means the follicle still generates progesterone which in turn is still able to stimulate the thyroid to raise the body temperatures so your ovulation prediction kits, your BBT chart and a well timed progesterone blood test would all indicate ovulation had occurred. 

A luteinised unruptured follicle can be detected on ultrasound but it is not easy to identify and you may need to seek out an expert fertility sonographer to rule this out. It is possible to have a series of ultrasounds repeated through your ovulation window to identify the maturing follicle and to double check that actually ruptures. If a dominant follicle fails to rupture, it will shrink to about half the size and the remnants will contain fluid which is possible to pick up on a scan (if a follicle ruptures and releases an egg the follicle turns into a normal corpus luteum).

There is some evidence to suggest that Clomid can increase the likelihood of Luteinising Unruptured Follicle Syndrome (Qublan et al, 2006).

But what about LH test sticks?

As the dominant follicle gets large enough, it secretes a significant amount of oestrogen which triggers the release of Luteinising Hormone (LH) from the pituitary gland. In some instances there multiple oestrogen generating follicles may cause high oestrogen levels which can trigger LH before an egg is really ready for release – so an LH surge could be detected, but no egg release is triggered. It is possible for LH release to be triggered more than once in a single cycle, as the feedback mechanism for LH release can be set off multiple times.

Some people also have a very high LH throughout the cycle, which can make LH testing strips unreliable. When I have seen this in my clinic, further investigation has shown an elevated prolactin level, suggesting that the pituitary hormone regulation system was generally a bit out of kilter.

What about cervical mucus?

Production of cervical mucus is a response to the rising oestrogen level, but it does not guarantee that there is a single, dominant follicle maturing or that it will rupture and release an egg. It is possible for multiple smaller follicles to generate enough oestrogen to trigger cervical mucus production.

So what can you do about absent ovulation?

Lots.

Diet, lifestyle and acupuncture can all have an incredible impact on your menstrual cycle and help to turn a non-ovulatory cycle into an ovulatory cycle. I would recommend working with a Fertility Support Trained Acupuncturist who would be able to work with you to investigate what is happening and treat you to restore regular ovulation. We work in a particularly integrated way, blending western medicine diagnostics with ancient acupuncture knowledge to restore and rebalance your cycle and improve your fertility.

Read more about Alex and Essex Fertility here.

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Explaining the Unexplained: Low Progesterone

Explaining the Unexplained: Low Progesterone

Here Alex O'Connor, a fertility acupuncture specialist, from Essex Fertility in her Explaining the Unexplained series tells us all about low progesterone and what we can do about it.

What is progesterone?

Progesterone is one of the key hormones of the menstrual cycle, it is the counterbalance to oestrogen. Oestrogen grows and thickens the uterus lining, while progesterone matures it and thins it ready for implantation. Oestrogen suppresses the activity of the thyroid gland, while progesterone boosts it. Progesterone also helps to reduce inflammation and calms the nervous system. 

Progesterone governs the luteal phase of a menstrual cycle; the luteal phase is the time after ovulation and before the period. Progesterone is secreted from the corpus luteum which develops on the site of a ruptured follicle after the egg has been released. If the corpus luteum is strong and healthy, the luteal phase should last between 12-14 days before the corpus luteum fizzles out and progesterone level falls which triggers a bleed. Alternatively an implanting embryo triggers the release of HCG which encourages the corpus luteum to continue to secrete progesterone so a bleed is not triggered. It is the rising HCG level that produces a positive pregnancy test.

If your progesterone is low you may notice some of the following symptoms: PMT, premenstrual spotting, prolonged bleed and or a particularly heavy bleed. 

Testing progesterone

The article 'Are You Ovulating?' contains a lot of information about how and when to test your progesterone levels - to read that article, go here.

What is a luteal phase defect?

Some women have low progesterone levels at the end of their cycle, this is sometimes referred to as a 'luteal phase defect'. When there is a luteal phase defect, the corpus luteum dies away too early and the fall in progesterone triggers a bleed which will usually end any attempted pregnancy.

There are various possible reasons for this:

  • the corpus luteum may not be able to generate sufficient progesterone
  • maybe there is a sub-clinical thyroid issue which can hamper the way the body responds to progesterone
  • maybe the prolactin level is too high, hampering communication between the thyroid and the corpus luteum
  • maybe circulation in and around the ovary is sub-optimal, slowing the supply of nutrients to the corpus luteum and hampering communication between the corpus luteum and the thyroid

Is a progesterone supplement the solution?

If you consider the list of possible causes of a low progesterone given above, you will understand why simply supplementing progesterone is not really the answer to improving your fertility. A progesterone supplement will not improve egg quality, thyroid health, prolactin levels or blood supply in and around the ovary. The main benefit of a progesterone supplement would be that your progesterone level would probably normalise, but you would not necessarily be any more fertile.

Is Vitex the solution?

If you are worried about low progesterone levels, you may have come across Vitex. Vitex is a native Mediterranean herb, also known as 'chasteberry' or agnus-castus. Vitex is only for use by women, it is thought to be harmful for sperm production in men; indeed the term 'chasteberry' comes from a time when it was used to curb sexual urges of soldiers in medieval times! 

Vitex can be very effective for some women but can be counter-productive for other women, causing their cycle to shorten or the bleed to become extremely light so it is not suitable for everyone. While it can increase progesterone levels in the second half of the cycle, it can interfere with the way the egg matures in the first half of the cycle so I would recommend you seek the advice of a qualified herbalist before you take it to make sure it is the right thing for you. If you have a history of depression or you have a tendency to a low mood at the end of the month then it may not a good idea to take Vitex because it also has an effect on dopamine levels; if you do decide take it, be careful that it does not worsen these symptoms.

So how do you improve your progesterone level?

If you want more progesterone, the first place to start is with the egg. A combination of diet, supplements and acupuncture is usually all that is necessary to improve the vitality and strength of the maturing follicle, meaning that it is stronger and able to produce more progesterone. If progesterone stays persistently low, then I would suggest investigating thyroid function and prolactin levels to see whether there is something lurking there that could be causing the problem.

High stress levels can contribute to a high prolactin level which can in turn lead to a lower progesterone level. High stress levels are characterised by high cortisol levels - both progesterone and cortisol are derived from the same building block, a substance called 'pregnenolone'; if the body is producing excessive amounts of cortisol it may have less pregnenolone available to generate progesterone. If you suspect you have a luteal phase defect, it is definitely time to look to make improvements to your diet and reduce stress by actively pursuing wellness and relaxation activities such as meditation, yoga, walking etc.

So what can you do about low progesterone?

Lots.

Acupuncture can be a very good therapy for low progesterone issues, it works by boosting vitality and circulation in and around the ovaries which can result in a stronger ovulation and a stronger corpus luteum. This would is shown in several different ways - your cycle would lengthen, your 21 day progesterone blood tests would show a higher progesterone level, and if you chart your basal body temperature you would see steadier, higher temperatures through the luteal phase of your cycle.

I would recommend working with a Fertility Support Trained Acupuncturist who would be able to work with you to investigate what is happening and treat you to restore regular ovulation. We work in a particularly integrated way, blending western medicine diagnostics with ancient acupuncture knowledge to restore and rebalance your cycle and improve your fertility.

Read more about Alex and Essex Fertility here.

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Explaining the Unexplained: Prolactin

Explaining the Unexplained: Prolactin

Here Alex O'Connor, a fertility acupuncture specialist, from Essex Fertility in her Explaining the Unexplained series explains the importance of prolactin for fertility.

What is prolactin?

Prolactin is a hormone that is mainly secreted by your pituitary gland; it is often referred to as the breastfeeding hormone because it is naturally high in nursing women where it has the effect of suppressing ovulation. A high level of prolactin is known as hyperprolactinaemia, it is a hidden cause of fertility issues and studies suggest it is a factor for 1 in 10 cases of unexplained infertility.

What causes a raised prolactin level?

Several lifestyle factors can contribute to a high prolactin level, factors such as a persistent lack of sleep, ongoing high stress levels, depression (and some anti-depressants) and diet.

Running regularly without adequate breast support can also raise prolactin as the excessive amount of movement in the breast tissue set off the mechanism to increase prolactin. If you are a regular runner, make sure to wear a correctly fitted sports bra.

Hyperprolactinaemia can also be caused by a tiny tumour on the pituitary gland – these tumours are rare (approximately 4 people out of every 10,000), usually benign, and their prolactin-generating effect can be controlled with medication. 

How does a higher prolactin level affect fertility?

Prolactin is mainly synthesised in the pituitary gland, which is also responsible for the production of Follicle Stimulating Hormone (FSH); if the pituitary gland is pumping out too much prolactin, this can suppress the production of FSH. FSH is the hormone that signals to your ovary to grow follicles and it plays a key role in the processes leading up to ovulation. In this way, a high prolactin level can have a negative impact on the quality of the developing follicle and egg, and in some cases it can prevent the follicle from maturing to the point where it is able to release an egg.

While it is still possible to fall pregnant while breastfeeding, the high prolactin level in a breastfeeding mum can interfere with ovulation and for many women it provides a degree of protection against pregnancy. If you are searching for a reason for unexplained infertility, it is definitely worth ruling out a high prolactin level.

Some signs of high prolactin

Lack of cervical mucus

Hyperprolactinaemia can suppress FSH which will have a knock on effect on the production of oestrogen in the ovary. This in turn will reduce the amount of cervical mucus that is produced; cervical mucus is an essential aspect of your fertility as it enables sperm to move safely through to the egg, protecting and nourishing it as it goes. If you have persistently low levels of oestrogen, or a distinct lack of cervical mucus, it may be time to check your prolactin level.

It is worth mentioning here that there are other causes of reduced cervical mucus. Sometimes cervical mucus production is reduced after a long time on the oral contraceptive pill; Clomid is another cause of reduced cervical mucus. 

Hair loss

If you notice symptoms of excess hair loss, it may be worth getting your prolactin level checked because high prolactin levels have been linked to high DHEA levels which can in turn lead to an increase in testosterone symptoms.

Testosterone issues (acne, hair loss, irregular cycles)

If you do not ovulate, or have irregular or long cycles (>35 days) it is worth checking prolactin levels – symptoms of high prolactin can mimic some of the testosterone management issues that are frequently associated with polycystic ovarian syndrome (PCOS) as it can cause an increase in DHEA and subsequently an increase in testosterone.

Short luteal phase

If your luteal phase is short, or if your progesterone level is a bit low, that may also indicate it is time to check your prolactin level because a raised prolactin level can also shorten and weaken the luteal phase of your cycle.

Producing breast milk

Prolactin is known as the breast-feeding hormone because of the role it plays in stimulating the breasts to produce milk. If you have noticed milky secretions from your breasts, you should check your prolactin level.

Other issues to check

Hyperprolactinaemia is sometimes associated with other issues such as liver or kidney issues, PCOS or hypothyroidism. If you do find you have high levels of prolactin, you will need to investigate further to determine whether PCOS or hypothyroidism is also involved as both can have a negative impact on your fertility if left undetected. Approximately 1 in 6 people with PCOS also have hyperprolactinaemia.

Checking your Prolactin Level

Prolactin can be checked easily with a simple blood test. If your GP or fertility clinic runs some blood tests and you have any of the above symptoms, request that they also check your prolactin level. You may have some resistance from your GP because the NICE guidelines recommend prolactin only be checked in women with a known ovulatory disorder, unusual production of breast milk or a pituitary tumour.

If possible, it is best to check your prolactin in the first half of your cycle, in the morning, and avoid excessive nipple stimulation before your test! If your doctor is reluctant to test your prolactin level, you can use a service such as Medichecks who offer a simple finger-prick test to check prolactin:

Very HIGH - greater than 1000 mIU/L 

If your prolactin level is very high your doctor may refer you for a MRI to check your pituitary gland.

Moderately HIGH - between 480 mIU/L - 1000 mIU/L

A moderately high prolactin level can be caused by thyroid malfunction, alcohol and some types of psychiatric and blood pressure medication.

Mildly HIGH - around 480 mIU/L

If your prolactin level is only mildly raised, you may be advised to have it rechecked. Lots of factors can cause a temporary rise in prolactin, factors such as recent nipple stimulation, stress, mild thyroid issues, exercise and alcohol usage.

Can a high prolactin level be OK?

If your prolactin level is high, but you have no symptoms of hyperprolactinaemia it is possible that you have high levels of macroprolactin. Macroprolactin is a larger prolactin substance that is counted alongside normal prolactin in the basic test, but macroprolactin levels are not thought to interfere with fertility. Approximately 15% of results showing a high prolactin level are actually caused by a high macroprolactin level.  There is an advanced test which determine how much of a high prolactin level is really macroprolactin, but the test is more expensive and less commonly used.

How to treat hyperprolactinaemia

If you have a prolactinoma, you may be prescribed cabergoline or bromocriptine by your doctor; a prolactinoma would usually cause extremely high levels of prolactin (over 1000 mIU/L).

If you have moderately elevated prolactin, evidence suggests that Vitex (agnus castus) has a prolactin-lowering effect, equally as effective as Bromocriptine. Vitex effects hormone production by disrupting the function of the pituitary gland, it is not a herbal supplement to stay on for a long period of time and I recommend you consult a qualified herbalist before taking it. In her brilliant book '8 Steps to Reverse Your PCOS', Fiona McCulloch suggests taking Vitex for between 3-6 months can help to reset prolactin levels – take daily with a break of 5 days a month. Once ovulation normalises and your cycle is regular, adjust the timing so that you only take it during the luteal phase of the cycle.

One study of a group of women with hyperprolactinaemia showed that when they took Vitex for 3 months, their average luteal phase increased from 3.4 days to 10.5 days (Arentz S. et al, 2014).

Stress management

Stress is a contributing factor to hyperprolactinaemia, so put some concerted effort into working out how to manage your stress and encourage a more mindful, relaxed state of mind. Meditation, mindfulness, yoga and gentle walking are all good habits to adopt and if you know stress is a significant factor for you, commit regular time for activities such as these..

Keep off the beer!

Reduce your alcohol intake, but it is particularly important to avoid beer. Beer was traditionally given to nursing women to encourage breast feeding as components of beer can help to increase prolactin.

Work with a specialist fertility acupuncturist

When dealing with unexplained infertility, you may find your battle much easier if you enlist the help of a Specialist Fertility Acupuncturist. We are a group of highly trained acupuncturists with a special interest and in depth training in working with infertility.

The body has an innate ability to want to heal, acupuncture has an incredibly long history of encouraging and enabling such healing. Use our knowledge to help work out why your fertility is struggling, and our skills to support you to gently nourish and improve your fertility. We can help you to sift through the maze of fertility information you will find here and elsewhere, work out what tests you should consider, help you to interpret the results and formulate a plan to get things moving in the right direction.

Read more about Alex and Essex Fertility here.

 

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