27
Sep, 2020

By Dr. McKenzie Nisbet, ND

Endometriosis

ENDOMETRIOSIS

Endometriosis is one of the most common causes of pelvic pain and infertility in women and many women do not know they have it.

Endometriosis is where tissue similar to what grows within the uterus growths outside of the uterus. This growth can occur on the ovaries, fallopian tubes, bowels and other areas within the pelvis.

SIGNS & SYMPTOMS:

– Chronic pain in pelvis, back and/or legs

– Ovulatory pain

– Period pain before or after your period

– Pain with intercourse

– Cramping and/or pain with bowel movements

– Heavy bleeding and/or spotting between periods

– Infertility

DIAGNOSIS

The best way to diagnose endometriosis is with a laparoscopic surgery – to visualize the tissue. A blood parameter “CA-125” can also be used to help detect endometriosis. This marker is present in most (but not all) women with endometriosis – around 80%. You can be negative for CA-125 and still have endometriosis.

TREATMENT

There is no known cure for endometriosis, however symptoms typically resolve with menopause. Until then, conventional treatments include hormonal suppression (such as the birth control pill), painkillers, and surgery.

Naturopathic approaches such as addressing inflammation, hormonal imbalances (ex estrogen dominance) and scarring/adhesions can help manage symptoms of endometriosis.

Questions? Book your free 15-Minute Meet & Greet Session and let’s chat!

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05
Sep, 2018

By Dr. McKenzie Nisbet, ND

Hormone Balancing: Testing

HORMONE BALANCING: TESTING

 

Have you had your hormones tested? Do you remember the time of day or time of month they were tested? Was it blood, saliva or urine? If you’re not doing the right type of sample at the right time your results could be meaningless, and your imbalances could be overlooked.

Hormones act as chemical messengers in your body. They control many different functions, such as your stress response, hunger, metabolism, temperature, mood, and of course your menstrual cycle and fertility. When your hormones become imbalanced your body shows symptoms. These include anything from menstrual irregularities and peri-menopause, to weight gain, acne, low libido, hair loss, abnormal hair growth, constipation, depression, anxiety, insomnia, and plenty more.

Hormonal testing is essential to understanding what is going on below the surface. Many hormonal imbalances have overlapping symptoms, so testing is used to eliminates the guesswork. The key is to know when the testing should be done and what type of testing is required . Proper testing allows us to get to the root cause of your symptoms to get you feeling better, sooner.

 

TIMING

Both the time of day and time of month matter when it comes to accurately testing your hormones. Progesterone for example needs to be tested 5-7 days after ovulation (day 19-21), versus LH (luteinizing hormone, released from the pituitary gland) needs to be tested on day 3 of you cycle. If you have an irregular cycle, Basal Body Temperature tracking can be used to map out your cycle and ensure we get the most accurate results possible.

 

TYPE OF TESTING

There are 3 ways hormones can be tested: blood samples, saliva samples, or urine samples. Each has pros and cons associated with them.

 

BLOOD

Blood testing is great for measuring pituitary function (LH, FSH, and prolactin) and thyroid function, as well as vitamin D, vitamin B12, iron levels, blood sugar and insulin levels. Testing can be done at any Life Labs location. Hormones such as estrogen, progesterone and testosterone can also be run via blood but this is not the best choice and won’t show how the hormones are functioning within your body.

 

SALIVA

Saliva testing can be done using a special kit at home which is then mailed to the lab for evaluation. Hormones such as estrogen, progesterone, testosterone, DHEA, and cortisol can all be tested in this manner. Though salivary testing is quite comprehensive there is a lack of information regarding hormone metabolites and detoxification pathways.

 

URINE

Urine testing is also done using a special kit in the comfort of your own home. Like salivary testing, the samples are then mailed to the lab for evaluation. Dried urine testing provides the most comprehensive results available, including estrogens and their metabolites, progesterone marks, androgens (such as testosterone), cortisol and cortisone curves, DHEA, as well as organic acids and nutritional markers (such as Vitamin B12).

 

When it comes to your health and your hormones, don’t guess. Find a healthcare provider that will run the proper tests, at the proper time to help uncover the root cause of your symptoms and restore your balance.

 

Questions about testing and your hormones? Send me an email or book a free 15-minute consult and let’s get started!

 

 

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29
Nov, 2017

By Dr. McKenzie Nisbet, ND

Cycle Tracking: Get To Know Your Temperature

CYCLE TRACKING: GET TO KNOW YOUR TEMPERATURE

 

WHAT IS CYCLE TRACKING?

Cycle tracking consists of measuring your basal body temperature (BBT) each morning. Your BBT is the lowest temperature your body reaches while you sleep.

When you understand what is happening in your body at a physiological level you can determine if and when something is abnormal so you can take action.

HOW DOES IT WORK?

Your menstrual cycle has 2 main phases: the follicular phase and the luteal phase. Your temperature will vary based on which stage of your menstrual cycle you are in. Your BBT will be slightly lower during the follicular phase. Then it will raise slightly during the luteal phase due to the thermogenic effect of progesterone (so as progesterone falls later in the luteal phase so will your temperature).

FOLLICULAR PHASE

  • The follicular phase is the first half of your cycle and is typically 14 days long. Its starts on day 1 of your cycle (the first day of your period), and ends at ovulation.
  • This phase is governed mainly by estrogen, FSH and LH.
  • Follicular Phase Temperature: typically ranges from 36.11 – 36.50°C

LUTEAL PHASE

  • The luteal phase is the second half of your cycle. It begins at ovulation and ends with the start of your period (where you then enter the follicular phase again).
  • This phase is also typically 14 days long, and is governed mainly by progesterone.
  • Luteal Phase Temperature: typically ranges from 36.50 – 36.83°C

The most noticeable change is the transition from the follicular phase to luteal phase, marked by a temperature shift – a spike in your BBT (basal body temperature). The last day of a low temperature BEFORE the temperature spike is the day of your ovulation.

How do you know if you’ve had a true temperature shift? Temperature shifts vary drastically between women. Some of us have larger more obvious shifts, while other’s shifts are more subtle. You will be able to spot your shift pattern after a few months of charting.

Here are some things to look for in a (large) shift:

  • Your temperature on the day of your temperature shift will be at least 0.11°C higher than the previous day and 0.05°C higher than each of the previous 6 days.
  • Your temperature must remain at least 0.05°C above those previous 6 days for 3 days in a row.

This is an example of what your cycle tracking chart may look like. This one is from the Kindara App (its in °F but the pattern will look the same in °C).

 

 

WHY SHOULD I TRACK MY CYCLE?

After a few months of tracking you will see a pattern in your BBT (basal body temperature). This pattern will show when (and if) you are ovulating, which will predict your fertile days.

Depending on your goal, knowing when you will ovulate can help you avoid pregnancy or help optimize your attempts at getting pregnant.

The pattern will also show how your hormones are functioning together and alert you to any imbalances – such as an imbalance of progesterone and estrogen.

 

WHAT ELSE SHOULD I BE TRACKING?

You can also track your physical and emotional symptoms, your cervical fluid, the position of your cervix, and anything else you notice varies with your cycle – such as acne or headaches. This more advanced cycle tracking is called the Fertility Awareness Method (FAM). I will be posting more about this over the next few weeks.

For now, learn how to start tracking your cycle!

 

HOW TO GET STARTED

1. Download a fertility awareness app. My favourite (and free) app is Kindara.

2. Buy a basal body thermometer (around $10).

  • You will be measuring your basal body temperature (BBT), which is the lowest temperature your body reaches.
  • Ensure you are using a basal body thermometer (not a regular thermometer). We need it to display 2 decimal places (ex. 36.40°C). These are often referred to as ‘ovulation thermometers’ and may be located alongside more basic thermometers or in the family planning section of stores.

3. Start tracking!

 

Use these rules for accurate cycle tracking:

  • Take your temperature as soon as you wake up in the morning (before you start to move around).
  • Take your temperature at the same time each morning (within a 30 minute window).
  • Take your temperature after a minimum of 3 hours of consistent sleep.
  • Make a note in the app of anything that may change your temperature:
    •  A poor nights sleep, feeling unwell, consuming alcohol the night before.
  • After 3 or more months of tracking you should have a good picture of your menstrual cycle pattern, including predictions of the day you will ovulate and the days/length of your period.

 

If you want to learn more about cycle tracking and how to optimize your hormonal health naturally feel free to contact me here.

Happy tracking!

 

 

Resources:

Miller, C. (2014 Apr). When Should I Mark a Temperature Shift in the App https://www.kindara.com/blog/when-should-i-mark-a-temperature-shift-in-the-app

 

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27
Nov, 2017

By Dr. McKenzie Nisbet, ND

Your Menstrual Cycle

 

YOUR MENSTRUAL CYCLE

 

This is your menstrual cycle. It’s a spectacular, yet complex system and I want to help you understand it. Understanding your cycle gives you a foundation for taking control of your reproductive health. I’m going to help break down the key players and the phases of this balancing act.

My goal by the end of this post is to have the image below look a bit less daunting.

THE KEY PLAYERS

YOUR HORMONES: These are the  chemical messages that control changes in your body.

  • Estrogen – facilitates the growth of the lining of your uterus in preparation for pregnancy
  • Progesterone – helps estrogen prepare your body for pregnancy in the second half of your cycle
  • FSH (follicle stimulating hormone) – is responsible for the maturation of the egg so it is ready to be fertilized
  • LH (luteinizing hormone) – triggers the releasing the egg from your ovary (ovulation)
  • GnRH (gonadotropin releasing hormone) – controls the hormones above and is released from your hypothalamus

YOUR GLANDS, ORGANS & MORE: These create, send and receive the hormone messengers (they use hormones to communicate with one another).

  • Hypothalamus – produces GnHR and is located in your brain 
  • Pituitary gland – produces LH & FSH and is located in your brain 
  • Ovaries – the follicle (egg) is made here
    • At ovulation the egg is released from your ovary, leaving behind the corpus luteum
  • Fallopian Tubes – the egg travels through this tube to your uterus after ovulation
  • Uterus – the functional endometrial lining of your uterus grows during your cycle and is expelled during your period
    • If your egg is fertilized it’s goal will be to implant in the thick lining created during your cycle
  • Follicles – these are present in your ovaries
    • Each cycle numerous follicles will begin to mature in each ovary, but only one will be selected to fully mature as the dominant follicle

 

YOUR CYCLE

Your cycle begins on the first day of your period: “Day 1”.

A normal cycle can be anywhere from 21-35 days, with the average cycle being 28 days. We will use a typical 28 day cycle as the example below.

I’ve separated the cycle into four sections:

  • Your Period: the first part of the follicular phase, Day 1, up to day 8
  • The Follicular Phase: Day 1-14
  • Ovulation: the transition between the follicular phase and the luteal phase
  • The Luteal Phase: Day 15-28

 

Your Period

DAY 1: Your period starts. 

The first day of bleeding marks the first day of your menstrual cycle. The period usually lasts 4-6 days (but 2-8 is considered normal for some women).

DAY 4-6: Your period ends.

Your period is the natural removal of the functional layer of the endometrial lining of your uterus. This layer gets built up during your cycle in preparation for the implantation of a fertilized egg. If there is no implantation your body is triggered to release this extra lining so the cycle can start all over again. We’ll chat more about the hormones in this stage near the end of the post.

There are two phases during your cycle: the FOLLICULAR phase and the LUTEAL phase.

We’ll start with the follicular phase since it comes first.

 

Follicular Phase (Day 1-14)

  • Goal: mature the egg so it is ready for fertilization by the sperm
  • Length: around 14 days – from the start of your menstrual cycle (Day 1), until ovulation (Day 14)
  • Key Players: Estrogen, FSH, LH

Lets start with FSH. The blue line in the picture above shows the change in FSH throughout the cycle. You can see FSH start to rise at the end of the menstrual cycle and continue to rise at the start of the ‘next’ cycle.

What causes this increase in FSH?

  • Estrogen (grey line) and progesterone (purple line) decline at the tail end of your cycle which triggers FSH to start to increase, and
  • Your hypothalamus starts producing GnRH in pulses which tells your pituitary to release more FSH

What does this increase in FSH do?

  • FSH is the “follicle stimulating hormone”. It is in-charge of maturing the follicles (eggs) so that one is full matured by the time we reach ovulation around day 14. 

During the follicular phase multiple follicles will start to mature in both your ovaries, but only ONE follicle from ONE ovary will fully develop.

  • This follicle is called the ‘dominant follicle’ and will be selected by Day 8.
  • It sends out signals telling the other follicles to stop maturing. 

DAY 8: At this point you have a high FSH and a maturing dominant follicle.

Around this time estrogen levels start to rise. 

What causes an increase in estrogen?

  • Essentially the maturation of the follicle causes this increase in estrogen. As the follicle gets bigger the amount of estrogen will increase. 

What does the increase in estrogen do?

  • Estrogen prepares your uterus for the implantation of the fertilized egg. It does this by building up the functional endometrial layer of your uterus. This is the layer that will be expelled during your period, if no pregnancy occurs.

As estrogen increases and the follicle matures, your FSH starts to drop.

Lets shift our focus to LH as we near ovulation. 

LH (pink line) begins to rise slightly in the mid-follicular phase. Notice the huge increase in LH right before ovulation? This is often referred to as the “LH surge”. 

What is LH for and why does it spike?

  • LH is released from your pituitary.
    • At first it is released in less frequent bursts, then as we get further into the follicular phase it is released more and more frequently.
    • This increased frequency causes more LH to be detectable in your body at once, so we get that sharp rise in LH: the LH surge. 
  • The surge begins roughly 34-36 hours before ovulation and peaks roughly 10-12 hours before ovulation.
  • The LH surge is why we often use LH strips (detects LH in the urine) when we are trying to conceive. The rise in LH predicts ovulation so having sex around this time increases your likelihood of conception.

You’ll also notice a small increase in FSH at the time of the LH surge. This is because the LH surge triggers a quick increase in progesterone which triggers a short lived increase in FSH. 

(Just Before) DAY 14: LH surge begins 34-36hrs before ovulation and peaks 10-12hrs before ovulation. Estrogen reaches its highest level and we get a small peak in FSH.  

So what now? We have a LH surge which represents the time of ovulation, but what is actually happening during ovulation?

 

Ovulation

The surge of LH triggers changes within the follicle which causes the egg (known as the “secondary oocyte”) to be released from your ovary.

This egg now makes its way from your ovary to your fallopian tube.

Your body now takes one of two paths: fertilization or no fertilization. 

  1. Fertilization – a sperm successfully fertilizes the egg and they travel to your uterus. In your uterus they will implant themselves into your thick uterine wall which estrogen has created for them. This fertilization causes the creation of hCG (human chorionic gonadotropin) which is what a pregnancy test detects.
  2. No fertilization – the egg stays in the fallopian tube for 24-48 hours. If it does not meet a viable sperm it will disintegrate.

Lets assume that no fertilization took place in this example.

DAY 14: Ovulation (egg is released) and we enter the luteal phase. At this point FSH and LH have fallen, estrogen has dipped slightly, and progesterone is on the rise.

 

Luteal Phase (Day 15-28)

  • Goal: maintain the functional endometrial lining so the fertilized egg can implant 
  • Length: around 14 days – from ovulation (Day 14) until the end of your period
  • Key Players: Progesterone (mainly)

Progesterone is the main hormone in this phase of your cycle.

This rise in progesterone ensures two things:

  • Your uterine lining remains thick and healthy in case the egg is fertilized and continues its way to your uterus.
  • A mucous plug forms at your cervix so no more sperm can enter your uterus.

But where does the progesterone increase come from?

  • The corpus luteum!

When the egg is released from your ovary it leaves behind the rest of the follicle (all of the supporting cells that helped it mature and grow during the follicular phase). These cells grow, join other cells from your ovary and become yellow in colour – hence the name “corpus luteum” (yellow body). 

The corpus luteum releases progesterone which keeps your uterus ready for implantation. The functioning of this group of cells reaches a peak around 8-9 days after ovulation when implantation is expected.

Progesterone is often tested on Day 18-21 of your cycle to catch this peak in it’s production.

DAY 18-21: Progesterone reaches it’s peak and then starts to decline as the corpus luteum starts to breakdown.

After this point the corpus luteum stops receiving signals to produce progesterone and it starts to decline in size. By the end of the luteal phase it becomes scar tissue in your ovary known as the “corpus albicans” (white body). 

This drop in progesterone means the functional endometrial lining of your uterus is no longer being maintained and your period begins.

  • Deceased progesterone levels cause the blood supply to this functional layer to change. These changes prevent oxygen and nutrients from reaching this layer. Now that the layer can no longer survive it begins to naturally break apart from the rest of your endometrial lining. When the uterus contract it helps remove this obsolete layer from your uterus. This is your period.

This first day of bleeding marks Day 1 of your next cycle and it begins all over again.

Even by the second day of your period (Day 2) your body may already be building a new functional endometrial layer. 

DAY 28: Progesterone has dropped completely which triggers your period and the start of your next menstrual cycle: DAY 1

That ladies (and maybe a few gentleman) is your menstrual cycle! Hopefully this image makes a bit more sense now and you have a feel for how wonderfully complex your hormones are.

 

If you have any questions or want to know more about your cycle send me an email! 

 

 

 

Resources:

Reed, BG. (2015 May 22). The Normal Menstrual Cycle and the Control of Ovulation. https://www.ncbi.nlm.nih.gov/books/NBK279054/

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Endometriosis
Hormone Balancing: Testing
Cycle Tracking: Get To Know Your Temperature
Your Menstrual Cycle