Is your thyroid medication actually working for you?

Do you take Synthroid or levothyroxine but continue to have symptoms of hypothyroidism?

One of the most common reasons that many people don’t feel great on T4 only medications (such as Synthroid or levothyroxine) is that their body is doing a poor job turning their medication (T4) in the active thyroid hormone T3. In order to feel energized, maintain your weight, and feel your best, you need high levels of T3 hormone which is the active thyroid hormone.

You can take medications which make your TSH and even T4 levels “normal” but if no one is testing your Free T3 levels you have no idea if your body is actually converting your medication into the active hormone.

Why do so many women struggle to convert their medication to T3? Well, there are several factors which can quickly derail conversion of T4 to T3.

Here are the most common factors that reduce conversion of T4 to T3:

  • Deficiencies of selenium, iodine, zinc, vitamin A, and vitamins B2, B6 & B12
  • Increased stress and high cortisol
  • High levels of cadmium, mercury, lead and fluoride
  • Starvation or very restrictive eating patterns
  • High carb/low protein diet OR very low carb diets
  • Chronic illness
  • Kidney or liver disease
  • Certain medications: beta blockers, birth control pills, estrogen

Wondering if you’re having a problem converting your medications properly? Find a practitioner who will test your Free T3 and Reverse T3 levels. Click here to read by article about my 5 Essential Thyroid Tests.

Want to learn more about my approach to thyroid health?

Book your FREE, no obligation, 15-minute Meet & Greet consultation with me.

3 Natural Treatment Options for Vaginal Dryness

Vaginal dryness is a common complaint during peri-menopause and menopause but it can happen at any age.  As estrogen levels start to drop, vaginal moisture dries up which can result in vaginal atrophy, painful intercourse and an increased risk for vaginal infections. The hormonal changes following childbirth can also cause vaginal dryness and painful intercourse.

The good news is there are a variety of natural treatment options for vaginal dryness.

1. Hydrate your vagina from the inside out

Keeping your body hydrated and moist is crucial to combat vaginal dryness. Drink at least 2L of water each and every day. Increase your intake of healthy oils including cold-pressed olive oil, coconut oil, avocado oil, flax oil etc. Aim for at least 1 tsp with every meal. If you’re still experiencing vaginal dryness, consider adding a Sea Buckthorne supplement. Sea Buckthorne is an omega-7 fatty acid which specifically helps relieve vaginal dryness (and it makes your skin look great as an added bonus). I love NFH’s Sea Buckthorne SAP which is available at Docere Naturopathic Clinic + IV Lounge and through our online dispensary.

2. Try Dr. Sarah’s compounded vaginal cream

This non-hormonal option is great for younger women with vaginal dryness or women who can’t or prefer not to use hormones. It combines hyaluronic acid (which helps to attract and retain moisture) and vitamins A and E to help hydrate and heal the tissues. Apply it every night for 2 weeks then 2 times per week or as needed. Just ask for a prescription at your next appointment! Another option is the over-the-counter product Cala-Gel by St. Francis Herb Farm.

3. Ask about bio-identical estrogen cream

Estriol is the weakest of our 3 naturally made forms of estrogen. It can be applied as a cream vaginally which is extremely safe and poses minimal risk. Estriol is so safe that it’s actually being used in women who have a history of breast cancer. Ask Dr. Sarah if this product may be right for you. It’s also applied nightly for 2 weeks, then 2 times a week for 2 weeks then as needed.

Is Stress Shutting Down Your Sex Drive?

One of the most frequent complaints that I hear from women in my office is that they have no sex drive. Like zero. Nada. Nothing. It’s as if that part of their brain has turned off and doesn’t seem to want to turn back on anytime soon.

There are many reasons why women experience a low sex drive including side effects from birth control pills, low estrogen and low testosterone. But, in my experience, the number one cause of low libido is STRESS.

The reality is that our sex drive is turned down as a PROTECTIVE MECHANISM. What you need to understand is that stress shuts down our sex drive for good reason.

When the body is under stress, it activates the sympathetic nervous system which is also known as our “fight or flight” response. When this response is activated, our body engages in a variety of activities that help us to survive and cope with that stress. We send lots of blood to our brain (so we can respond quickly and appropriately) and lungs and muscles (so we can run away). We may not be fighting off saber tooth tigers anymore but our body still responds in the same way. And let’s face it ladies, between family, work, and social obligations, we’re under low-grade stress all the time.

Another side-effect of this stress response is a reduction of blood flow to your reproductive organs and putting a major damper on your sex drive. WHY? The last thing your body needs when it’s under stress is another human being to take care off (aka a baby). You see, when you are under stress, your body shuts down your sex drive to limit the chances you’ll become pregnant in an effort to try to help you.

Even if you’re post-menopausal or on birth control and technically can’t get pregnant, your body will still shut down your libido because it doesn’t know any better. It’s a automatic response that is hard wired into us that actually helped keep our ancestors alive.

So, if you want that part of your brain to wake up and re-activate, you need to practice getting out of that sympathetic “fight or flight” response and start hanging out in a more relaxed parasympathetic “rest and digest” state. This is when the body is relaxed, feels safe and can start to warm that fire in your loins. (PS. men also need to be in this state to achieve and maintain an erection).

My best strategies for tapping into “rest and digest”:

  • Get at least 7 hours of sleep every night (this is the ultimate relaxed state)
  • Take 10 deep abdominal breaths before each meal
  • Learn to say “no” (and not feel guilty about it!)
  • Start a daily meditation practice such as the HeadSpace App (and come try our new service: MUSE Biofeedback Meditation)
  • Cultivate mindfulness (try to enjoy the present moment.) Start with simple activities such as mindfully brushing your teeth. Keep your mind focused by paying attention to the smell and taste of your toothpaste, the feeling of the brush against your teeth, the sounds it’s making. It’s simple but it works!

Wondering if stress is really affecting your sex drive and overall health?

Get your stress hormone levels test with our Adrenal Function Panel. It’s a simple at home saliva test that maps out your cortisol and DHEAS. You can learn more about it here. Test Cost = $220.

When it comes to your period, what’s normal?

I don’t know about you, but my girlfriends and I never really got into the nitty gritty details of our periods. Most of us don’t talk about how often we’re changing our tampon or how many clots we pass, which leaves many of us assuming that what we experience every month must be normal. But just because cramping and PMS are common, it doesn’t mean that they’re normal and you have to live with them. Periods don’t have to cramp your style (pun intended!) And while there is definitely some variation from woman to woman, here’s what’s “normal” when it comes to your period.

1. Your cycle length (aka how often you’re getting your period)

  • NORMAL: 21-35 days (most women assume their cycle is 28 days which is the standard cycle when you take the birth control pill but most women’s cycle isn’t exactly 28 days).
  • NOT NORMAL:
    • Less than 21 days: could be a sign of a cycle without ovulation, short follicular phase (aka time between your period starting and ovulation), progesterone deficiency, perimenopase, or stress.
    • More than 35 days: cycle without ovulation, long follicular phase, stress, recent illness, thyroid disease, PCOS (aka polycystic ovarian syndrome), high prolactin (hormone involved in milk production).

time-calendar-saturday-weekend-60032

 2. Your flow length (aka how long you bleed)

  • NORMAL: Most women bleed for 3-5 days (with days 1 and 2 being heaviest), including a day or two of light spotting as it finishes up.
  • NOT NORMAL:
    • Less than 3 days: can be a sign of estrogen deficiency (especially if flow is very light and pale pink).
    • More than 7 days: can a sign of high estrogen, endometriosis or fibroids.

 3. How much you bleed

  • NORMAL: You should lose about 50 mL of blood.
    • One soaked regular pad or tampon = 5 mL
    • One super tampon = 10 mL
    • 50 mL = 10 fully soaked regular tampons or 5 fully soaked super tampons over the span of your period
  •  NOT NORMAL:
    • Light period (aka less than 25 mL): can be a sign of PCOS, high stress, estrogen deficiency, or thyroid disease.
    • Heavy period (aka more than 80 mL):  can be a sign of a cycle without ovulation, excess estrogen, low progesterone, estrogen dominance, PCOS, thyroid disease, fibroids, endometriosis.

 4. What your blood looks like

  • NORMAL: menstrual fluid should be liquid, with no large clots. Your menstrual fluid should a reddish-brown colour.
  • NOT NORMAL:
    • Brown blood: is typically a sign of old blood that wasn’t shed during your last period
    • Large clots (bigger than the end of your thumb): can be a sign of high estrogen or estrogen dominance, endometriosis, or fibroids.

 5. PMS & Cramping

  • NORMAL: its common to feel a little congestion or cramping in your lowpexels-photo-735966er belly before your period, and to experience mild mood changes, fatigue and a desire to stay in and binge-watch Netflix.
  • NOT NORMAL: being a sugar-crazed carb monster, having swollen super-sensitive breasts, needing to wear a bigger pant size and flying off the handle at the slightest annoyance. PMS is often a sign of either high estrogen, low progesterone or both. Menstrual cramps that cause you to miss work or need pharmaceutical pain relief can be a sign of magnesium
    deficiency, inflammation, hormone imbalance, endometriosis or fibroids.

 6. Spotting

  • NORMAL: its normal to have light spotting on the day of ovulation (more common with low estrogen).
  • NOT NORMAL: Light bleeding before your periodcould be a sign of progesterone deficiency.

If you experience several symptoms that are “not normal” every month, check in with your family doctor or  naturopathic doctor to see if you might have a hormonal imbalance that requires some attention.

Book your FREE 15-minute Meet & Greet consultation with Dr. Sarah
to get started on getting back to a healthy, happy, feel-good life.

 

Vitamin D Deficiency: the missing key to your optimal health?

Vitamin D is best known for its role in forming strong, healthy bones, however, it also plays a critical role in the following areas:

  • Immune system
  • Hormone balance
  • Muscle function
  • Cardiovascular function
  • Respiratory function
  • Brain development
  • Anti-cancer effects

What are the best ways to get vitamin D?

Commonly known as “the sunshine vitamin,” the skin is able to make vitamin D when it is exposed to sunlight. There are also small amounts of vitamin D in foods such as fortified milk, and yogurt, cheese, eggs, cod liver oil, beef liver, and fatty fish such as salmon, trout, and tuna. However, it is very difficult to meet you requirements through diet alone.

How much vitamin D do I need?

The Recommended Dietary Allowance (RDA) for adults is 600 international units (IU) for adults, and 800 IU for seniors over the age of 70. These are the bare minimum amounts you need to prevent rickets but they are FAR from enough for most adults to optimize vitamin D levels to get all of its benefits (including anti-cancer effects).

According to the Vitamin D Council (and based on my clinical experience), most adults require 4000 IU or more during the winter months depending on their blood levels. Many adults who supplement the recommended 1000-2000 IU per day are still deficient when their blood levels are tested.

Factors that affect vitamin D status:

  1. Insufficient sun exposure: If you work 9-5 or are wary of the sun, and therefore don’t spend much time outside, or cover-up and use sunblock, you likely aren’t getting enough vitamin D from sun exposure. And if you live in Canada, it’s essentially impossible to make vitamin D during the winter, even on sunny days.
  2. Skin pigmentation: People with darker skin tones have more melanin in their skin, which can interfere with the amount of vitamin D that the skin can produce. While fifteen minutes in the sun may be enough for a fair-skinned individual, someone with a deep complexion may require as much as six times the amount of sun exposure.
  3. Age: Seniors have an increased risk of developing vitamin D deficiency for a few different reasons. As we age, we lose some of the ability to synthesize vitamin D from sunlight. Vitamin D also needs to be activated in the kidneys, which also decrease in function with age. Lastly, many seniors are housebound and therefore aren’t able to get adequate sun exposure outdoors.
  4. Kidney dysfunction: With age, the kidneys lose some of their ability to convert vitamin D into its active form.
  5. Digestive disorders/diseases: When the digestive tract is unable to absorb vitamin D, for instance, due to conditions such as Crohn’s disease, cystic fibrosis, and celiac disease.
  6. Obesity: Vitamin D is extracted from the blood by fat cells, thereby reducing its circulation throughout the body. Obese individuals typically require higher amounts of vitamin D supplements to prevent deficiency.

What are the symptoms of vitamin D deficiency?

  • Joint and muscle pain
  • Muscle weakness
  • Fatigue
  • Brain fog/Difficulty thinking clearly
  • Fatigue
  • Mood changes
  • Frequent infections or slow healing time

How can I get my vitamin D levels tested?

A simple blood test can be used to see if you have vitamin D deficiency. Your results can indicate the following:

vitamin D capsule

  • Severe Deficiency = less than 30 nmol/L
  • Deficiency = between 30 nmol/L and 75 nmol/L
  • Normal levels = between 75 nmol/L  and 100 nmol/L
  • Optimal levels = between 100-200 nmol/mL

How can I raise my vitamin D levels if I’m deficient?

  1. Get outside: practice safe sun exposure but don’t be afraid of the sun!
  2. Take a vitamin D3 supplement (dosing will be based on your blood levels)- gelcaps or drops are best for absorption.
  3. Get a series of vitamin D injections to raise your levels more quickly (as your Naturopathic Doctor if they offer these.

Resources

5 Essential Thyroid Tests for Women

If you are experiencing some of the following symptoms, it may be worth having your thyroid tested to rule out thyroid hormone imbalances:

  • Very slow or very fast heart rate
  • Weight gain or difficulty losing weight (or rapid weight loss)
  • Change in menstrual cycles (irregular periods, heavy periods)
  • Always feeling very cold or overly hot (or going from one extreme to the next)
  • Fatigue
  • Hair loss
  • Elevated LDL cholesterol level
  • Depression

5 Essential Thyroid Tests to ask for:

  1. TSH (thyroid stimulating hormone)
  2. Free T4
  3. Free T3
  4. TPO-antibodies & TG-antibodies
  5. Reverse T3

Understanding Your Test Results

1. TSH is short for thyroid-stimulating hormone, a hormone made by the pituitary gland (located in the brain) which tells the thyroid what to do. Think of it as the knock on the door. If the thyroid is not doing it’s job, the pituitary will knock more loudly (elevated TSH) whereas if the thyroid is working optimally, the knock will be very light (lower TSH). As you can see, TSH is not made in the thyroid meaning it’s an indirect way of looking at thyroid function.

High levels of TSH may indicate hypothyroidism (i.e. underactive thyroid), a pituitary gland tumor, or inadequate thyroid hormone medication in the treatment of a preexisting condition. Low levels of TSH may indicate hyperthyroidism (i.e. overactive thyroid), damage to the pituitary gland, too much thyroid medication in the treatment of a preexisting condition, or pregnancy in the first trimester.

  • Normal Range: 0.4-5 mIU/L
  • Optimal Range: 0.4 -2.5 mIU/L
  • Hypothyroidism = TSH > 5 mIU/L
  • Hyperthyroidism = TSH < 0.4 mIU/L

2. Free T4: T4 is the main hormone produced by the thyroid so it’s the most direct way at looking at actual thyroid gland function. Keep in mind that T4 is a very weak, mostly inactive hormone that’s main purpose is to be converted into T3 (see below).

  • Normal Range: 9-22 pm/L
  • Optimal Range: 14-18 pm/L
  • Hypothyroidism = < 9 pm/L
  • Hyperthyroidism =  > 20 pm/L

3. Free T3: is made from T4 throughout the body but mostly in the liver. T3 is the most active form of thyroid hormone and is responsible for giving us energy, revving up our metabolism, keeping us warm and with hair on our head. It’s vital to look at T3 hormone levels in order to gauge if there is thyroid dysfunction because you can have normal TSH and T4 levels but if you aren’t converting well to T3 you can still have symptoms of thyroid imbalance.

  • Normal Range: 3.4-5.9 mIU/L
  • Optimal Range: 4.5-5.5 mIU/L
  • Hypothyroidism =  <3.4
  • Hyperthyroidism =  > 6

4. Thyroid Antibodies (TPO and TG): Thyroid peroxidase (TPO), an enzyme found in the thyroid gland, plays a key role in the production of thyroid hormones. A TPO test detects antibodies against TPO in the blood, the presence of which suggests that the cause of thyroid disease is an autoimmune disorder (e.g. Hashimoto’s or Grave’s disease).

  • Normal Range: < 35 kIU/L
  • Auto-immune disease (e.g. Hashimoto’s or Graves’s) > 35 kIU/L

5. Reverse T3: is essentially a “dud” hormone that is made when the body is under stress. A small percentage of our T4 hormone is always converted to reverse T3 in order to prevent the body from being overstimulated by T3. However, in certain conditions, especially with higher stress and cortisol hormone levels, the body can convert too much T4 into reverse T3 which essentially blocks other thyroid hormones from doing their job.

  • Normal Range = < 9-24 ng/dL
  • Optimal Range = less than 18 ng/dL

These tests are all done through a simple blood test which your MD can request. Naturopathic Doctors are also able to run these tests which will cost approximately $100.

Is Estrogen Dominance causing your weight gain, heavy periods, and breast tenderness?

digestive-upsetWhat is estrogen dominance?

Estrogen is one of the primary female sex hormones. In women, estrogen helps initiate sexual development, regulates menstruation, and effects the entire reproductive system. Normally, estrogen is in delicate balance with another primary sex hormone, progesterone. This balance is necessary for both to function efficiently, and can be susceptible to disruption if levels in either shift.

There are two ways that estrogen dominance can present itself in the body. When the body has either too much estrogen from overproduction, or a lack of progesterone, it enters a state referred to as “estrogen dominance.” That is, too much estrogen relative to progesterone.

The body produces three main types of estrogen: estrone, estradiol, and estriol. Many women’s ailments, including breast cancer, uterine fibroids and cancer, ovarian cysts and cancer, endometriosis, polycystic ovary syndrome, and hypothyroidism are caused or promoted by excesses of estradiol, estrone, environmental estrogens, and synthetic estrogens.

Estrogen in our bodies comes from five possible sources:

  • FROM INSIDE THE BODY: estrogen is made in the ovaries, placenta, adrenal glands, and fat cells.
  • FROM OUTSIDE THE BODY:
    • Estrogen-like foods and herbs (e.g. soy, legumes, pumpkin seeds, licorice root, etc.)
    • Animal products that has been raised using hormones (e.g. meat, poultry, fish, dairy.)
    • Environmental chemicals or xenoestrogens (e.g. pesticides, plastics, parabens, cleaning products, personal care products, etc.)
    • Synthetic estrogens (e.g. birth control, fertility drugs, hormone replacement therapy.)

What Causes Estrogen Dominance?

During the course of a normal menstrual cycle, estrogen is the dominant hormone for the first two weeks leading up to ovulation. Estrogen is balanced by progesterone during the last two weeks. However, as a woman approaches perimenopause and begins to experience anovulatory cycles (i.e. cycles where no ovulation occurs), estrogen can often go unopposed, thus causing symptoms. Skipping ovulation, however, is only one potential factor in estrogen dominance. Other causes may include:

  • Being overweight (i.e. body fat greater than 28%) since fat cells produce estrogen
  • Having a burdened liver, which leads to estrogen not being broken down and eliminated from the body efficiently. The result is estrogen recirculating and accumulating.
  • Being overstressed. This results in excess amounts of cortisol, insulin, and norepinephrine, which can lead to adrenal exhaustion and adversely affect your overall hormonal balance.
  • A low-fibre diet containing too many refined carbohydrates, and not enough nutrients and high quality fats. Fibre helps eliminate estrogen through bowel movements.
  • Environmental exposure to estrogen-like compounds such as phthalates and BPA.

Estrogen dominance has also been linked to allergies, autoimmune disorders, breast cancer, uterine cancer, infertility, ovarian cysts, endometriosis, polycystic ovary syndrome, and increased blood clotting, and is also associated with acceleration of the aging process.

Signs and Symptoms of Estrogen Dominance:

Estrogen dominance can result in serious long-term complications, as well as other signs and symptoms, such as:

  • Weight gain (especially in the hips and thighs)
  • Irregular/abnormal menstruation (heavy bleeding, large clots)
  • Insomnia (especially waking up in the middle of the night)
  • Thyroid dysfunction
  • Fibrocystic breasts, breast swelling and tenderness
  • Low libido
  • Sluggish metabolism
  • Foggy thinking, memory loss
  • Acne
  • Mood swings
  • Menstrual cramps
  • Headaches

Ways to Decrease Estrogen Dominance:

  • Follow a hormone-balancing diet (i.e. eat lots of fresh fruits and vegetables, enough protein, and healthy fats.)
  • Increase your fibre intake to help the excretion of estrogen, which can also prevent its reabsorption through the bowel
  • Consume cruciferous veggies (such as cauliflower, cabbage, broccoli, kale, Brussel sprouts) daily to help with estrogen metabolism and clearance
  • Choose organic meat and dairy to reduce your exposure to environmental hormones used in farming
  • Reduce excess body fat and exercise regularly to promote detoxification and circulation
  • Manage daily stress
  • Reduce your exposure to hormones, pesticides, and antibiotics in your environment and diet
  • Avoid synthetic estrogens (e.g. birth control pills, synthetic hormone replacement therapy)
  • Switch your personal care products to those that are free of phthalates, fragrances, parabens and other hormone disrupting chemicals
  • Get rid of plastic water bottles and food storage containers. Replace them with ceraminc, glass or stainless steel.

Resources:

The Super Secret Weapon to Surviving Menopause? Your adrenal glands!

Women are all too familiar with the symptoms that signal the impending doom of menopause- hot flashes, night sweats, fatigue and mood changes! These symptoms occur because the ovaries start producing less estrogen as they prepare for retirement. Rapidly declining estrogen levels can cause intense and severe symptoms that can really affect a woman’s quality of life. But menopause need not be a dreaded time in a woman’s life- for our bodies have a secret weapon that can help make the transition through menopause much smoother….our ADRENAL GLANDS!

What are Adrenal Glands?
The adrenals are two small glands that sit above the kidney (hence their name!). These glands are well known for making stress hormones such as adrenaline and cortisol, but what most of us don’t know is that our adrenal glands also produce sex hormones such as estrogen and progesterone!

Why are they important?
During the menopausal years, as our ovaries start producing less female hormones, our adrenals are called into action to be our main producers of these hormones. The problem is that most of us enter menopause with adrenal glands that are already tired and overworked due to years of living in our stress-filled modern world. When the adrenal glands are already exhausted when a woman enters menopause, they have a harder time producing these much needed female hormones.

It is therefore imperative that all women support their adrenal glands during the menopausal years (and ideally before!) so that they can produce estrogen and progesterone which will help to make the transition much smoother.

Here are my top 5 tips for supporting your adrenal glands:

1. Make sleep a priority

Our adrenal glands need a good night’s sleep in order to regenerate and recover from daily stresses. Aim to get 8-10 hours of quality sleep each night and be in bed no later than 11 pm.

2. Increase your intake of foods rich in magnesium and vitamins B5 and C.

Magnesium, vitamin C and vitamin B5 are most concentrated in the adrenal glands where they provide the nutrient needed for healthy adrenal function.  Increase foods that are rich in these nutrients.

Magnesium: pumpkin seeds, spinach, Swiss chard, soybeans, sesame seeds, halibut, black beans, sunflower seeds, cashews, almonds

Vitamin C: Papaya, Bell Peppers, Strawberries, Broccoli, Pineapple, Brussel Sprouts, Kiwifruit, Oranges, Cantaloupe, Kale

Vitamin B5: Cremini and shiitake mushrooms, avocado, yogurt, corn sweet potato, cauliflower, broccoli, grapefruit, bell peppers, and asparagus.

3. Indulge in a cup of licorice tea

Licorice is one of my favorite herbs for supporting the adrenal glands. It helps to nourish and relax the body…and it’s caffeine-free so you can have it anytime! Caution: do not use if you have high blood pressure.

4. Relax….you deserve it!

Our adrenal glands get fired up every time we perceive stress. Did you know that on average, we experience 50 brief stress response episodes per day? This means that for many of us, our adrenal glands are constantly being drawn on to help us adapt and resist life’s daily stresses. Counteract these effects by making relaxation a priority every day…whether it’s a yoga class, a hot bath, or 5 minutes of deep breathing.

5. Limit your caffeine intake

Caffeine not only gives your mind a jolt – but your adrenals too. Limit this daily assault by eliminating caffeine if possible or limiting your intake of caffeinated beverages to no more than 2 per day. In fact, caffeine itself can trigger hot flashes.

I hope you find these tips helpful and they can make your menopausal years more enjoyable. If you are interested in receiving additional support for your menopausal symptoms, book your free consultation to learn how I can help create a personalized plan for you including salivary hormone testing, nutrition guidelines, herbal support, and acupuncture.

 

 

Fertility Awareness: An Alternative to the Pill

Looking for a hormone-free form of birth control?

What are the risks of taking the birth control pill?

  • Increased risk of developing blood clots (especially with pills such as Yaz and Yasmin)
  • High blood pressure
  • Increased breast cancer risk

While the pill may be an effective and suitable option for some women, many are seeking natural and safer alternatives to contraception and family planning, such as fertility awareness based (FAB) methods. FAB methods rely of looking at several indicators of fertility that change throughout the menstrual cycle in response to changing levels of estrogen and progesterone. Three of the most commonly observed indicators of fertility are basal body temperature, cervical secretions, and cervical positioning.

1. Basal Body Temperature

Basal body temperature is the body temperature measured immediately after awakening and before any physical activity has been undertaken.  During the phase before ovulation, waking temperatures range from 97.0 ̊ F to 97.7 ̊ F (36.1̊ C – 36.5̊ C); postovulatory waking temperatures tend to rise about 0.4 ̊ F or higher and they usually stay elevated until the next period. Temperatures rise within a day or so of ovulation and are associated with the surge in progesterone, a heat releasing hormone, which occurs at the time of ovulation. When interpreting temperatures, it is important to look at the big picture and not to focus too much on the day to day changes. The key is to look for a pattern of highs and lows: temperatures before ovulation will go up and down in a low range while the temperatures after ovulation will go up and down in a high range.

There are certain factors that can increase your waking temperature, including: having a fever, drinking alcohol the night before, getting less than three consecutive hours sleep before taking it, taking it at a substantially different time than usual and using an electric blanket or heating pad that you don’t normally use.

2. Vaginal Secretions

The quality and quantity of vaginal secretions are influenced by estrogen and progesterone. The different types of secretions either impede or facilitate sperm motility and this determines the state of fertility. When estrogen levels are low, cervical secretions may be minimal, thick, white, and sticky. The acidic environment of the vagina rapidly destroys sperm. Rising levels of estrogen alter the cervical secretions from white and sticky gradually becoming more transparent, stretchy, and wetter (due to increased water content), similar to the consistency of egg whites. Immediately after ovulation, the rise of progesterone causes the secretions to thicken to form a sticky plug which is antagonistic to sperm penetration.

3. Cervical Positioning

Estrogen and progesterone also cause subtle changes in the muscle and connective tissue of the cervix. Women can learn to recognize these changes by gently palpating the cervix at about the same time each day. As ovulation approaches, the cervix tends to rise, soften, and open. It progresses from feeling like the tip of the nose to feeling soft like lips as ovulation approaches. The cervix will drop abruptly into the vagina when estrogen levels fall, and progesterone becomes dominant after ovulation. The fertile time starts at the first sign of the cervix becoming high, soft or open and ends after the cervix has been low, firm and closed for 3 days. These subtle changes can be detected by simply inserting a clean middle finger into the vagina and assessing the following conditions: softness, height, opening, and wetness.

How effective is it?

Studies have found that when using temperature as a single indicator of fertility, the overall failure rate was 5.4% compared with a method failure rate of 1% (this refers to perfect use). This illustrates that using this method alone is only effective if used by highly motivated couples who are able to tolerate lengthy time of abstinence or are willing to use a barrier method during the fertile time. Cervical secretions were found to have a failure rate of around 3% if couples were given good fertility awareness teaching and followed the instructions correctly. However, with imperfect use the failure rate rose to nearly 20%. There are no effectiveness studies using the cervical positioning indicator alone.

These studies find that the failure rate tends to be lower when combining indicators. The most common combination is cervical secretions and temperature which has been found to have a failure rate between 0.43% (perfect use) and 2.2% (overall pregnancy rate). Perfect use refers to using abstinence during the fertile time and therefore is a measure of true effectiveness. Interestingly, one study found that there was no difference in failure rates between the learning phase (first 3 months) and subsequent months of use.  For a contraceptive method to be rated as effective as the hormonal pill, it requires a failure rate of less than 1%. The studies mentioned above found FAB to be as effective as the birth control pill when used perfectly.

What are the benefits?

Despite the limited scientific evidence, there are several advantages to FAB methods. It does not involve the use of chemical agents or physical devices and had no side effects. Educating patients on this method is empowering and fosters a sense of shared responsibility and increased communication for the couple. Also, it is not dependant on medical intervention after the initial visit, thus keeping costs low.

What are the limitations?

There are also some limitations to FAB methods. It can take time to learn and some women find charting difficult. Both partners must be committed to the practice and some couples find abstinence difficult. Times of stress or hormone changes can make charting more difficult and may affect efficacy.

If you are interested in learning more about fertility awareness methods
please contact Dr. Sarah Vadeboncoeur.

Is your BPA-free plastic waterbottle safe?

A recent study has found that almost all plastic products leached chemicals that act like estrogen when exposed to everyday stresses (including microwaving and sunlight exposure.) This includes products advertised as BPA-free. In fact, some BPA-free products released more estrogen-like chemicals than BPA-containing products!

How to avoid plastics:

  • Ditch all your plastic water bottles
  • Get a water bottle made of glass or stainless steel
  • Never re-use bottles made with soft plastic
  • Pack your lunch or leftovers in glass or ceramic tupperware
  • Never put plastic in the microwave
  • Never leave a plastic water bottle in the sun

What’s your favorite tip for avoiding plastic?