Authored by Dr. Brittany Stamer

Let’s discuss how hormonal contraception works to prevent pregnancy. Normally, the two dominant sex hormones that are produced during a menstrual cycle are estrogen and progesterone. They are mostly produced by the ovaries, but also in smaller amounts by the adrenal glands and adipose tissue. These hormones ebb and flow throughout a cycle in order to mature a follicle and eventually ovulate.
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Hormonal contraception such as birth control pills, hormonal IUDs (Mirena, Skyla, Kyleena, Liletta), implants, or the shot contain synthetic forms of progesterone and/or estrogen. Some types or brands of birth control will contain only synthetic progesterone while some will contain both synthetic progesterone and estrogen. Due to the route of administration and variations of hormones these types of hormonal contraception can each work a little differently, but the basics are similar. These synthetic versions of sex hormones do not act in the body the same way natural hormones do and because the body is receiving a synthetic form of these hormones it does not receive the signal to create it’s own estrogen and progesterone. Meaning hormonal contraception completely shuts down these entire hormonal pathways.

One of the most crucial ways hormonal contraception works is that it impedes ovulation from occurring. In a normal physiological state in relation to ovulation, the brain secretes hormones which then communicate to tell the ovaries to make estrogen and progesterone allowing people of reproductive age to ovulate and become pregnant if desired. When on birth control this entire communication between the brain and ovaries is non-existent. The body “thinks” it has natural estrogen and progesterone based on the synthetic hormones that are being consumed. This communication disruption does not allow ovulation to occur because the ovaries are now not receiving the signal to produce the hormones needed to develop and release a follicle. 

This lack of ovulation means that the bleed that occurs on oral birth control is not technically a menses. For a monthly bleed to be considered a menses there needs to be a flux of natural hormones and ovulation must have occurred. The bleed on oral birth control instead happens due to the withdrawal of synthetic hormones while taking the placebo/sugar pills. 

This lack of natural estrogen and progesterone also prevents pregnancy in many other ways besides inhibiting ovulation. 

Birth control also prevents pregnancy by making cervical fluid inhospitable to sperm. Cervical fluid is necessary to become pregnant. Fertile cervical fluid which looks watery or similar to egg-white occurs immediately before ovulation. It creates a safe haven for sperm to wait until ovulation occurs, creates a sperm ‘highway’ to help the sperm travel quicker and farther into the uterus, has nutrients to feed the sperm, protects and harbors them against the more acidic vaginal pH, and filters abnormal sperm out. Normally, estrogen would signal to the cervix to make this cervical fluid, but because hormonal contraception does not allow the natural influence of estrogen to occur cervical fluid becomes thicker and less functional therefore preventing pregnancy. 

While on birth control the endometrial/uterine lining of the uterus also becomes thinner. This is due to the minimal influence of natural estrogen and progesterone. As an analogy, estrogen will normally act as the bricks and progesterone acts as the mortar of the uterine lining thickening the lining throughout the course of the menstrual cycle. Without these natural influences the uterine lining is much thinner and this makes it very difficult for an embryo to implant and develop there. 

IUDs can prevent pregnancy in the previous ways mentioned, but in addition can create local inflammation in the uterus as well. This prevents pregnancy by making the uterus an inhospitable place for sperm and for fertilized eggs to implant. 

Hormonal contraception can also prevent pregnancy by lowering libido for some users, although this is not true for all. 

All of these reasons are why hormonal contraception is so effective! It works in multiple ways to prevent pregnancy. Most forms of hormonal contraception are above 99% effective with perfect use! 

Yet, for some this high level of effectiveness does not come without side effects. 

Hormonal contraception has been shown to decrease libido by lowering testosterone as previously mentioned. It also can decrease the size of the clitoris. It has been studied to decrease vitamins and minerals possibly contributing to mood changes. One study even revealed that 51% of women experienced a negative mood altering effect from hormonal contraception. It has been shown to cause a slight increase in breast, cervical, and liver cancer as well. The International Agency for Research on Caner (IARC) classifies combined oral contraceptives as a group one (I) carcinogen. It can also negatively affect gut health and thyroid function. While taking oral birth control a protein called sex hormone-binding globulin (SHBG) increases in the body. It is normally responsible for binding to sex hormones in the blood and renders sex hormones inactive while attached. If this SHBG is too high it can keep too large of an amount of sex hormones inactive which can cause significant hormonal dysfunction. SHBG can stay elevated for years after discontinuation.  

Also, another important side effect or result not often discussed is how hormonal contraception can be used as a ‘fix’ for issues like painful periods, endometriosis, fibroids, PCOS, or similar. But, often these conditions are not properly addressed and root causes are not treated before hormonal contraception is initiated. The first time some of these issues are addressed are when patients discontinue birth control and desire to become pregnant. I often see that because these hormonal imbalances had been masked for so long it can take a lot of time and effort to resolve, and this can be difficult when patients want to become pregnant right away. So, while hormonal birth control is a wonderful effective and widely accessible tool to help people plan their futures by preventing pregnancy, which is by far the biggest and best benefit, it absolutely does not cure hormonal issues. Hormonal contraception can actually hide hormonal issues, and the process that may be leading to these imbalances will likely go unaddressed for years until hormonal birth control is discontinued.
To learn more about what contraception choices are best for you and your life I recommend going to www.bedside.org/birth-control.com to explore hormonal and non-hormonal options. 

References 

1. “The Fifth Vital Sign” by Lisa Hendrickson-Jack
2. Bedsider.org 

Authored by Dr. Brittany Stamer

Ovulation is vital to the health of menstruating women. Ovulation is the only way women make a significant amount of progesterone. Progesterone is the hormone responsible for creating the relaxed feeling in the second half of the menstrual cycle, can promote better quality sleep, it can protect against certain cancers, and can reduce PMS or PMDD symptoms. It is also absolutely necessary to become pregnant and to maintain a pregnancy. 

But, it is not a given that every woman between the ages of menarche and menopause are ovulating. There are many reasons ovulation isn’t occurring and these reasons are worth discussing considering it is so important for overall health.  

A very normal reason ovulation may not be occurring is the time around menarche which the first menses. The average age of menarche is 11.9 years. What a time! I remember my mom brought me flowers and gave me a big hug, which basically led me to feel unbelievably mortified. In my older years I grew to appreciate my menses and my mom’s sweetness, but many women can relate to the initial shock I am sure! I digress. Menarche is a very normal time to not ovulate. You might have heard about young women having irregular cycles for a few cycles before them regulating. This could mean the body is not ovulating and is very common. When cycles start for the first time it can take the body some time to get into the rhythm of how the brain communicates with the ovaries. This should normalize within a few months, but if it doesn’t or any significant symptoms such as acne, cramps, mood issues, or otherwise come up it is a great idea to seek support from a holistic practitioner.

Another very normal reason ovulation does not take place is in perimenopause which means the time before menopause. The average age of menopause is 51 years old. As fertility normally decreases ovulation occurs less often as well. 

There are many other reasons that lead to lack of ovulation that should be addressed and treated. Some of the most common reasons are polycystic ovarian syndrome (PCOS), hypothalamic amenorrhea, thyroid disorders, primary ovarian insufficiency (POI), or hypothalamic or pituitary signaling issues. 

PCOS is one of the most common reasons for lack of ovulation, otherwise known as anovulation. There are many causes of PCOS but no matter the cause the underlying mechanism that leads to anovulation is the same. There are too high of androgens or male type hormones in the blood that interfere with the delicate hormone signaling between the brain and ovaries and ovulation cannot occur. Instead, multiple cysts develop on the ovaries revealing an attempt of the ovary to ovulate, but the inability to. PCOS has 4 main causes which include blood sugar dysregulation and insulin resistance, stress or adrenal PCOS as it is sometimes called, inflammatory PCOS which can occur from a host of issues including disrupted gut health or hidden infections, or post-birth control PCOS. 

Hypothalamic amenorrhea occurs when the body simply does not have enough energy to expend to ovulate. The communication from the brain to the ovaries is simply not occurring. This is due to overexercising, under-eating, or excessive stress. 

Thyroid disorders including both hypothyroidism and hyperthyroidism, can both lead to anovulation and can cause either shortened cycles or lengthened cycles respectively. 

Primary ovarian insufficiency (POI) occurs when a woman is headed towards menopause before 40 years old. This can occur due to genetics, radiation, endocrine issues, lack of blood supply to the ovaries, autoimmune conditions, infections, or environmental toxin exposures (heavy metals or mold). This can be slowed or reversed in some cases depending on the cause, if the assaulting factors are removed. 

Pituitary or hypothalamic signaling issues are another issue that can cause anovulation. The most common occurrence in this cause is actually when a woman is breastfeeding! Which is a very normal reason to not ovulate. To breastfeed, the pituitary releases a hormone called prolactin to stimulate the making of breast milk. When prolactin is high it suppresses the body’s ability to ovulate. This can also happen pathologically with something like a tumor in the pituitary which is called a prolactinoma. Prolactin is a common lab test completed when a woman, who is not breastfeeding, is not having a period. This is completed to ensure this more serious cause of anovulation is not part of the picture. 

Having what seems to be a normal and regular cycle does not mean that ovulation is occurring. Most of the time ovulation is occurring in these instances, but not always. There are multiple ways to evaluate if you are ovulating. Cycle charting by tracking cervical mucous and basal body temperature is my favorite way as it connects women to their bodies and allows them to be in tune with themselves. But, completing a blood draw for progesterone post-ovulation in the second half of your cycle can also confirm ovulation. Any value of progesterone above 5 ng/mL means ovulation occurred. 

As I have mentioned in my previous blog post “What is Ovulation Anyway?" a follicle undergoes its most robust development 120 days before being released. This means it can take a significant amount of time for hormones to change enough for ovulation to occur. When trying to correct some of the imbalances that lead to anovulation like PCOS or hypothalamic amenorrhea, patience can be difficult! Especially when it comes to possibly imbalanced hormones and the symptoms people can be experiencing, but these symptoms can improve, these conditions can be treated, and ovulation can happen. 

Even if ovulation is happening, having good egg quality is essential for becoming pregnant and maintaining a pregnancy. Good egg quality is a hard thing to measure unless the eggs are retrieved, as they are in in-vitro fertilization (IVF), and genetically analyzed. But, the level of progesterone in the body post-ovulation can give us a hint about egg quality. Usually higher progesterone means better egg quality. This can mean chances are higher for people to become pregnant.  

You can support ovulation and egg quality/adequate progesterone in many ways. Some of these recommendations can be different based upon what cause of lack of ovulation someone is prone to. But, some basic ways to support healthy ovulation include:

• Eat a well-balanced omnivore diet. I recommend a diet with at least some animal products as they are very nutrient dense, have a lot of protein, and fat. 
• Keep your blood sugar balanced. Eat protein and fat with every meal. 
• Don’t restrict calories. 
• Exercise regularly, but not too much. Overexercise is perceived as a stress on the body. I was a college athlete and had some friends lose their period temporarily from our exercise regimes. 
• Reduce stress. You can do this with anything you like including having fun with friends, laughing, doing a creative project you like, going to therapy, watching TV, reading, yoga, exercise, quitting something that isn’t serving you or your health, and many more things! 
• Sleep! I recommend at least 8 hours of sleep per night. 
• Reduce inflammation. This can mean SO many things. I recommend eating a healthful organic diet, exercising, laughing with loved ones, and reducing stress as the basics. Sometimes this is when testing can help identify the causes of inflammation as they can be hidden like with environmental toxins, heavy metals, mold, hidden infections, or gut health issues. 
• Avoid environmental toxins. Many of these environmental toxins act as synthetic hormones in the body. Avoiding most plastics in the house, getting rid of any products with fragrance, and using a water filter are all good places to start when trying to avoid these toxins. 

References 

1. “The Fifth Vital Sign” by Lisa Hendrickson-Jack 
2. "Trends and Patterns in Menarche in the United States: 1995 through 2013–2017” by National Health Statistics Reports. 
3. "Menopause" by the Mayo Clinic. 

Authored by Dr. Brittany Stamer

Menstruating gets a lot of attention from people with uteruses, but ovulation is really the main event of the menstrual cycle. 

Ovulation is when an egg is released from one of the ovaries. It will then travel down the fallopian tube and into the uterus. It will either be fertilized by sperm, implanted into the lining of the uterus, and a pregnancy is underway or the egg is not fertilized and in approximately 12-16 days the uterine lining will be released and a menses will occur. 

This description of ovulation may lead us to believe that ovulation is only crucial for pregnancy, but that is absolutely not true! 

Let’s discuss the menstrual cycle a bit more to help understand why ovulation is so important and what it means for your overall health. 

A normal menstrual cycle is considered to be between 21-35 days, but I would consider an optimal menstrual cycle to be between 26-33 days. The reason why I think a shorter window is optimal is because this likely means you have a more ideal balance of estrogen and progesterone in the body, which paves the way for fewer negative hormonal symptoms. The menstrual cycle is divided into two sections, a follicular phase where estrogen is dominant and a luteal phase where progesterone is dominant. The first 3-7 days of a normal menstrual cycle is when the uterine lining sheds.

Now, for a little more about how these hormones connect to ovulation:

During the menses and for approximately the first half of the menstrual cycle (note: it is normal for this “half” to vary from month-to-month or person-to-person) estrogen is increasing more and more each day. This increase helps an egg (aka a "follicle") in the ovary to develop. While an egg speeds its development quickly during the menstrual cycle it is released in, it actually takes about 4 months (or 120 days) for an egg to become fully mature.

Estrogen produced in the first half of the cycle can make you glow, feel energized, motivated, and want more social interaction. When estrogen reaches its peak and that egg is developed enough this is when the ovary gets a signal from the brain to release the egg...ovulation! Ovulation often occurs from every other ovary, though this is not universally true. One month you will ovulate from your right ovary and the next month from your left. Even though ovaries are about the size of almonds and an egg is about the size of a period at the end of a sentence, some women can actually still feel the sensation of ovulation, called Mittelschmerz. 

Ovulation immediately makes progesterone, which for the first half of the cycle was extremely low in the body. Progesterone is made by the corpus luteum,  the portion of the follicle (aka egg) that gets left behind after ovulation. This phase of the menstrual cycle (the luteal phase), when progesterone dominates can make people feel relaxed and improve sleep. Progesterone can also protect against certain cancers. Without ovulation occurring a woman’s body makes almost no progesterone. Meaning ovulation is absolutely essential for progesterone production. 

Ovulation is important because having that proper balance of estrogen and progesterone in the body is crucial for overall health. 

Some women might think if they have a normal menstrual cycle within that 21-35 day window that they are ovulating, but in fact many women that have a normal menstrual cycle are actually not ovulating. You can imagine knowing this information is very important if you plan to become pregnant. But, ovulation is also so important for many other reasons that have nothing to do with pregnancy. Ovulation is a sign of good health. A sign that your hormones are in balance. This balance of hormones can help support a healthy mood, decrease or resolve acne, resolve a painful menses, stop heavy menstrual bleeding, protect from some hormonal cancers, build stronger bones, protect thyroid function, and even help with your digestive health! These are just some of the areas where your hormones play a role. So having balanced hormones - and specifically ovulating - can improve many facets of health. 

Even if you don’t plan to become pregnant now or even ever, ensuring you are ovulating is essential to protect your health. Most hormonal birth controls, with the exception of a hormonal IUD on occasion, halt any of this crucial hormonal fluctuation including ovulation. 

For my menstruating patients, I recommend tracking menstrual cycles with a symptothermal Fertility Awareness Method. It can take some practice to learn, but the connectedness and body awareness you gain from it is well worth the few months of practice.

The menstrual cycle, including the knowledge of if you are ovulating, is a key indicator of your overall health. Some would even consider the menstrual cycle as the fifth vital sign, with pulse, respiration, temperature, and blood pressure. Meaning the health of the menstrual cycle, including the main event of ovulation, is just as important as healthy blood pressure.
 

References 

1. “The Fifth Vital Sign” by Lisa Hendrickson-Jack 
2. Female Reproductive System via The Cleveland Clinic 

Authored by Dr. Brittany Stamer

Fertility Awareness Method (FAM) is a body-centered method that utilizes signs and symptoms to better understand our bodies and cycles. 

This method is most widely used for conception and contraception, with a study showing it to be 99.4% effective for contraception. That is nearly as effective as the birth control pill! Yet, it is also a fantastic tool used to track menstrual cycles, to identify endocrine disturbances, to track overall hormonal health and is an amazing tool to learn about our bodies and encourage connection to ourselves. 

Fertility Awareness Method or FAM is often misunderstood as “The Rhythm Method” or “Natural Family Planning.” FAM is actually a practice that is rooted in the wisdom of the body as well as science.

So, how does it work? First, we need to discuss our menstrual cycles to understand FAM. 

Healthy menstrual cycles range from 26-35 days. This cycle is broken down into 2 dominant hormonal stages. The follicular phase is the first half of the cycle and and characterized by higher estrogen levels. The luteal phase is the second half of the cycle and characterized by higher progesterone levels. These different hormones create different signs and symptoms that clue us in to our inner hormonal health.  

Knowing our menstrual cycles can tell us when we are fertile or not, but also can track our greater hormonal health and let us know where imbalances may be. Lab tests are able to test progesterone, estrogen, thyroid markers and much more, but these labs are completed at one singular snapshot of time. Fertility Awareness Method and cycle tracking allows us to see the bigger picture and pattern of hormonal health. 

This tracking focuses on 2 primary signs, which are cervical mucous (CF) and basal body temperature (BBT). 

Cervical mucous (CF) is made from the cells of the cervix. This is different than vaginal fluid or arousal fluid. The amount, color and consistency of cervical fluid changes throughout the cycle based on the hormonal influence from your body. Cervical mucous should increase from menses until ovulation eventually looking similar to egg white. After ovulation, it becomes more creamy and opaque. Being attuned to cervical fluid can also allow us to identify any early signs of a microbiome imbalance in the vagina such as a yeast infection or bacterial vaginosis by noticing changes in color, texture and other characteristics.  

Basal body temperature (BBT) is the other primary sign utilized in Fertility Awareness Method. Basal body temperature is our body’s temperature immediately upon waking. In the first half of the menstrual cycle, when estrogen is dominant, BBT is lower. Then, after ovulation, in the second half of the menstrual cycle when progesterone is dominant BBT is consistently higher. 

There are also many secondary signs including the height, openness, and firmness of the cervix, breast sensations, emotional changes and/or Mittelschmerz (ovulation sensation/pain). 

All of these signs and symptoms ebb and flow throughout the cycle depending on estrogen or progesterone being more dominant. Alterations in these patterns could mean sex hormone imbalance or thyroid or adrenal dysfunction.

Tracking of these signs and symptoms are often used by people who have a consistent menstrual cycle for conception or contraception, but it is equally an incredible tool to help people identify imbalances to achieve better health, to empower yourself with knowledge and be in a greater connection with your body. 

If you are using FAM to connect with your body and are curious about what your hormones may be doing, charting your cycle would be the next step. You can find paper charts online or download an app to your phone for ease. One of my favorite apps is Kindara because it does NOT predict your ovulation, like many phone apps do. Your cycle can vary greatly from month to month depending on stress, diet changes, intimacy, sleep, travel and alcohol consumption. This is why it is so important to not use apps that use algorithms, but instead learn to follow your body’s own rhythm of that particular cycle. 

Practicing FAM requires a lot of diligent practice, especially if using it for conception and contraception. Working with a healthcare practitioner who is familiar with FAM is crucial when using it for these purposes specifically. But, you can still start the journey at any time, by tuning in to your body’s own unique language. 

To learn more about Fertility Awareness Method some amazing resources include “Taking Charge of Your Fertility” by Toni Weschler and “The Fifth Vital Sign” by Lisa Hendrickson-Jack. 



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References:

1. The Fifth Vital Sign by Lisa Hendrickson-Jack 
2. Taking Charge of Your Fertility by Toni Weschler
3. Natural Family Planning Method As Effective As Contraceptive Pill, New Research Finds 

Authored by Dr. Jillian Skluzacek

During May, we celebrate Mother’s Day! Motherhood is a beautiful gift. Moms also endure a plethora of stresses beginning right at the start of pregnancy. Today, I would like to discuss a healthcare option that is available for these amazing women we call mothers...chiropractic care. 

Chiropractic is a healthcare profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. One of the most common and well-known therapeutic procedures performed by doctors of chiropractic is spinal manipulation or chiropractic adjustment. Manipulation, or adjustment of restricted joints and tissues, restores mobility, thereby alleviating pain and muscle tightness, allowing tissues to heal. 

Why would this treatment option be beneficial for mamas during pregnancy, postpartum and beyond? 

Prenatal Care
Let’s start with prenatal care. Pregnancy is a time of many physical, mental and hormonal changes. The mother’s body is constantly adapting and providing for the fetus. Baby inhabits the uterus, which is physically attached to the pelvis and sacrum via the utero-sacral ligaments, round ligaments and broad ligaments. As baby grows, so does the space they live in! This continual growth leads to increased physical loads on the skeleton and the connecting ligaments. Postural changes and an altered walking pattern occur which the spine must accommodate balance for(1). The mother’s body also begins to produce a hormone named relaxin that promotes ligament laxity (i.e. loosening) to prepare for childbirth. The combination of increased strain on the body and relaxin production can make the sacrum and pelvic bones become easily misaligned, which can stress the surrounding ligaments and muscles. 

These stresses lead to more than 75% of women experiencing pregnancy-related low back pain, pelvic pain or a combination of these(1). Unfortunately, pregnancy and postpartum women have fewer options regarding pain-relief. Many are searching for relief options that don’t or can’t include medications; chiropractic care is one of those options.
 
Chiropractic adjustments are an effective and safe treatment option to restore alignment and provide pregnant women pain relief and support. The Webster Technique is a chiropractic technique that is used for specific analysis and adjustment to optimize pelvic and sacral positioning throughout pregnancy(2). The goal of treatment is to place the body in its optimal position to promote healing and restore normal function. This then has been found to reduce tension and discomfort, improve mobility, decrease stress, and more. 

Many women seek prenatal chiropractic care not only for pain relief, but also for wellness care to prepare for birth. Sacral restriction may contribute to difficult labor for the mother (i.e. dystocia), caused by inadequate uterine function, pelvic contraction and baby mal-presentation. Correction of the sacral restriction with regular chiropractic care throughout pregnancy may have a positive effect of all of these causes of dystocia(3,4). 

Your chiropractor will determine how often visits are necessary based on a variety of factors such as severity of your current condition, the duration the adjustment is lasting, and what stage you are at in the pregnancy. Chiropractic care is generally safe throughout the 1st, 2nd and 3rd trimesters. I have personally treated women who have begun labor and are on the way to their birthing location! 

Common conditions associated with pregnancy that can benefit from chiropractic care includes, but is not limited to:

• Muscle and joint pain: low back, hip, neck, or upper back
• Sciatica
• Pubic symphysis and round ligament pain
• Restless Legs
• Insomnia
• Digestive Issues: nausea, heartburn or constipation
• Carpal Tunnel Syndrome

After Baby
After baby is born, the mother enters the postpartum stage. At this time, the mother’s body experiences a drastic shift in their body biomechanics. Her body that spent 9 months growing and changing, is now quickly adjusting to return to her pre-pregnancy state. She continues to be adapting with hormonal changes as well; the hormone relaxin we discussed earlier remains in mother’s system for 5-6 months following birth. She now has additional stresses and movements such as carrying baby and baby items, increased weight and breast size, feeding positioning, diaper changes and more. Remember, all of this is happening after she has just endured the fatiguing marathon of labor and birth. Moms are amazing!

Chiropractors commonly treat new moms with neck, pubic symphysis, upper, lower and mid-back pain. Adjustments to improve alignment will help her body recover more comfortably and combat these stresses. Addition of at-home exercises will help long-term stabilization of muscles. 

To keep it going - the stresses of motherhood then persist and continue to change throughout their child’s development. Chiropractors wish to support moms through all stages to function at their best so they can provide their best care to those they love. 


References

1. 5 Conditions Chiropractic Care Can Improve During Pregnancy by American Chiropractic Association
2. The Webster Technique: Definition, Application and Implications by Jeanne Ohm, D.C. & Joel Alcantara, D.C.
3. About the Webster Technique by ICPA
4. Optimal Positioning: Balancing the Pelvis for a Safer, Easier Birth by Jeanne Ohm, D.C.

Authored by Amy Daws, CMT, ShT

There have been so many new and expecting parents in my life lately! Many of my friends are becoming parents and I have seen an influx of bodywork clients who are pregnant or new parents in the last couple months. All this parentness has inspired me to write a post about how awesome bodywork can be during pregnancy and as a person enters the realm of parenthood. Medical professionals are increasingly recommending bodywork during pregnancy for pain, stress and anxiety relief. Although one massage during pregnancy is great, regular bodywork during pregnancy and throughout the time of parenthood can be a wonderful addition to any expecting or new parent's self-care routine.

For clients that are pregnant, massage can be a great way to relieve discomfort from the musculoskeletal changes that are inevitable during pregnancy. It is also a wonderful way to soothe anxiety or stress that comes with the current and expected changes to life. Bodywork is generally safe for pregnant individuals through the 1st, 2nd and 3rd trimester. High risk pregnancies can still benefit from bodywork, but be sure to let your practitioner know so that they can additionally modify the session. If you are not sure if bodywork is right for you it's always a good idea to check with your doctor first. 

Specific Symptoms that bodywork can address during pregnancy:

• Sciatic nerve pain
• Muscle and joint pain
• Stress and anxiety
• Swelling or edema in extremities
• Improve circulation

How is bodywork during pregnancy different than regular bodywork?

1) Focus of the session:
​In general, bodywork for pregnant clients is focused on relaxation and increasing comfort. A session can focus on addressing any of the common symptoms that arise during pregnancy: sciatica, muscle/joint pain, stress and anxiety, edema, and decreased circulation. Specific work can be done to relief muscle and joint pain, but there are certain areas of the body where deep digging is avoided because of the vulnerability of these areas. During pregnancy, the body releases relaxin, a hormone that allows for the bones and joints to shift to make room for the baby. Work in the hips and low back is more gentle. Greater care is taken when stretching to take into consideration that the joints and bones are more loose and easily manipulated. In Shiatsu, certain acupressure points are avoided as to not move the energy too forcefully downward. 

2) Positioning:
Special cushions are used to support the body during pregnancy. The cushions can be used to a certain point in the pregnancy (usually through the 1st trimester) to allow you to lay face down without pressure on the abdomen. The cushions can also be used to support you in laying on your side or in a semi-reclined position on the back. Getting a massage while laying on your side feels different than a regular massage, but still covers all the bases and allows for areas like the back, neck and shoulders to be worked on.

3) How often to come:
While one bodywork session during pregnancy is awesome, regular bodywork can have additional benefits and increase comfort for the parent and child.  According to an article in Parent's magazine:

"Studies from the Touch Research Institute at the University of Miami suggest that moms-to-be who get a weekly massage have lower levels of the stress hormone cortisol and higher levels of the feel-good hormones serotonin and dopamine. Researchers have linked these hormonal changes to fewer childbirth complications, including a 75 percent reduction in premature births among depressed women. Though you don't need to be depressed to reap the benefits of massage, another Touch Research Institute study found that pregnant women suffering from depression had significant improvement in mood, as well as decreased anxiety, after receiving a 20-minute massage twice a week."

Bodywork for all new parents
​
Continuing to get regular bodywork after pregnancy is a great way to establish much needed self-care into the new routine of raising a child. Postnatal massage can help the body adjust back to it's pre-pregnancy shape more comfortably. It can also be helpful to all parents as they get used to new movements that come with raising children: feeding, carrying the baby and juggling carriers and bags. I have found that many of these sessions are focused on neck, shoulders, back and hips as you get used to these new movements. Stress and anxiety relief are also incorporated to sooth the mind and enhance the mood as parents move through this transitional time.


References:
1. The Benefits of Prenatal Massage by Belle: University Chancelor.

Authored by Dr. Lori Hulsing

Historically female fertility has received the spotlight (and blame) around baby-making and male fertility has been largely ignored by doctors and scientists alike. Only recently have researchers investigated how the health of the sperm influences conception, pregnancy outcomes, and the health of the baby. The omission of sperm health in studies and medicine has been a huge blunder considering that 50% of the genetic information is coming from the sperm. Focusing on this would likely prevent many couples from experiencing miscarriage and infertility—especially “unexplained infertility”— because many of these cases are likely caused by DNA damage or other sperm issues that are not measurable on a traditional semen analysis. Spending at least three months prior to conception focused on nutrition, healthy lifestyle choices, and a sperm-safe environment is an absolute must for every father-to-be and sperm donor.
 
Here are some steps for improving the health of sperm based on the latest research. This is not an exhaustive list but I included bullet points from a few of the most relevant fertility categories.
 
Diet & Nutrition

• A healthy anti-inflammatory diet is critical for sperm production. Deficiencies in vitamins, minerals and fatty acids have a detrimental impact on sperm health and deficiencies are very common in the United States. Aim for eating 3+ cups of vegetables and 2 servings of fruit per day. If you aren’t hitting this goal you may need additional nutrient supplementation. If you are on a more restricted diet including vegan, vegetarian, dairy-free, keto, paleo or autoimmune paleo you may need additional nutrient supplementation as well.
• Avoid sugary beverages like soda and sports drinks which decrease sperm motility.
• Avoid trans fats aka partially hydrogenated oil and polyunsaturated fats like soybean, corn, and sunflower oil. They have a negative impact on sperm and embryonic development.

 
Lifestyle

• If you smoke, quit. Smoking decreases male fertility, decreases IVF/ICSI success, and increases risk of complications if a pregnancy does occur. Some people may think smoking marijuana doesn’t count. Or maybe it doesn’t count if you eat it. No matter the delivery method, marijuana is not good for sperm either. Evidence shows it can lower motility and function of sperm. Quitting is hard so invest in a lot of support here. The effects of smoking do seem to be cumulative as well so if quitting isn’t an option cut back as much as possible.
• Exercise, but not too much. Studies show frequent intense exercise has a negative impact on sperm health as well as not moving enough.
• Heat can damage sperm and decrease sperm count so it’s important to avoid hot tubs, lots of biking, cell phones in the pocket, and computers in the lap.

 
Environment

• A focus on environmental factors is critical for improving sperm health and fertility. Eliminate all hormone-disrupting chemicals from your environment. These chemicals are found in plastics, cans lined with BPA, furniture covered in fire retardants, non-stick pans, lead paint and high VOC paint.
• Invest in a quality water filter to filter medications, heavy metals, and microbes from your water source.
• Invest in a quality HEPA air filter for your bedroom to improve the indoor air quality and reduce exposure to pollution.

 
Making lifestyle and dietary changes, taking targeted nutrients, and practicing self-care to boost fertility is not always easy. It can be so helpful to get support. If you are interested in learning more about how to boost fertility with an integrative approach, join me in the fall at my Fertility Class series designed for men and women wanting to conceive. We will cover these topics in a lot more detail with additional fertility optimizing discussions on diet and nutrition, hormone balancing, epigenetics, detoxification, environment factors, and treatment. It is never too soon to start planning!
 
P.S. If you were able to read this article without getting the Footloose soundtrack in your head for a week—nice work! I cannot say the same. “Let’s Hear it for the Boy[s] . . . “
 
Resources
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Authored by Dr. Hulsing

Are you thinking about starting or growing your family in the future? Perhaps you wonder if you are doing everything you can to enhance your fertility and increase the chances of a healthy pregnancy and baby. Even if you have never considered the health of your eggs or sperm don’t feel bad. Many times we only consider our health when we don’t feel good or things aren’t working. This is especially true around fertility but there are so many things you can do to prevent problems in pregnancy, optimize the health of your future children, and increase the likelihood of getting pregnant by following a pre-conception health plan.

Preconception health is the health of men and women prior to conceiving. So a pre-conception health plan is a protocol to improve health with the goal of healthy eggs/sperm, a healthy pregnancy and healthy baby.

Pop Quiz Time! Who should be following a pre-conception health plan?
A)  Women over 35 trying to conceive 
B)  All Women trying to conceive 
C)  All Men trying to conceive 
D)  Men/Women who have been diagnosed with unexplained infertility or suboptimal fertility 
E)  Women/Couples undergoing fertility treatments including IVF and IUI 
F)  ALL of the above
The answer is F—all of the above. Are you surprised? If you chose answer “A” you aren’t alone. Many people think only women over age 35 trying to conceive should follow a pre-conception health plan. While age is one factor relating to egg health and fertility, it is certainly not the only factor and all women will benefit from improved fertility as well as healthy pregnancies and babies. Perhaps you knew this and chose answer B—which leads me to my next point.

Yes, all women should be following pre-conception health plans, but what about the men? Men are often forgotten about when it comes to fertility but ALL men trying to conceive should be following a pre-conception health protocol. The lack of knowledge and interest about all the ways men can improve the health of their sperm is absurd because sperm make up 50% of the equation and provide half of the genetics of the baby. Pre-conception health plans specific to sperm health can mean getting pregnant more easily and with fewer complications. Healthy sperm = healthy baby.

Perhaps you assumed that a preconception health plan would be too simple or basic to help men and women with unexplained infertility or suboptimal fertility but that couldn’t be farther from the truth. A pre-conception health plan that addresses the root cause could solve the unexplained infertility cases that make up 1/3 of the total cases of infertility. Comprehensive pre-conception plans that address healthy weight, toxicant exposure, adrenal hormone dysfunction, hormonal imbalance, endometriosis, autoimmunity, inflammation, nutrient deficiencies, nutrigenomics, and egg/sperm health at a cellular or even DNA level can often solve unexplained and suboptimal fertility issues.

In my experience, the previously listed items may not show up on conventional screening labs or perhaps are not addressed due to lack of familiarity by other health care providers. For example, there was research published in the journal Reproductive BioMedicine Online which showed 80% of the “unexplained fertility” cases in the study involved sperm DNA damage (This won’t show up on a basic semen analysis so it would be missed). A pre-conception health plan which addressed the health of the sperm at a DNA level by improving antioxidant status could be extremely beneficial in these situations and treat the underlying issue without resorting to more expensive and invasive treatments.

Another area which is often overlooked is the importance of incorporating a pre-conception health plan as part of fertility treatments such as Intrauterine Insemination (IUI) and In Vitro Insemination (IVF). Preparing for pregnancy and optimizing the health of the egg and sperm utilized in fertility treatments leads to more successful pregnancies. You just need to make sure you are woking with someone who is knowledgeable about combining natural and conventional therapies so you are enhancing and not interfering with fertility treatments. Integrative fertility treatment (combining conventional and natural therapies) is quickly growing in popularity because of better outcomes and there is a growing body of research published in peer-reviewed medical journals showing the efficacy of many botanical, hormone, nutrient therapies and lifestyle changes used alone and in conjunction with conventional fertility treatments. I am always happy to share these studies during appointments upon request.

Now that you know how important it is for all men and women trying to conceive to follow a pre-conception health plan, you may be wondering how far in advance you should schedule an appointment to create an individualized pre-conception health plan. This will depend on individual factors but the MINIMUM amount of time is 3 months. This is based on the amount of time it takes for the egg and sperm to complete a cycle. (It takes about 74 days for the sperm to complete a cycle and about 90 days for the egg.) It is pretty amazing that you can create healthier sperm and eggs in only 3 months. If you have known health issues or if health issues are diagnosed with basic screening tests it can take longer than 3 months so it is never too soon to schedule an appointment to create a pre-conception health plan.

Because the pre-conception health protocol is individualized to each person after considering health history, lab workup, age, lifestyle, fertility history, and goals, it is beyond the scope of this article to go into detailed treatment plans. Scheduling an appointment with Dr. Hulsing or another Naturopathic Doctor who specializes in fertility is the next step if you are interested in getting personalized and detailed recommendations to optimize fertility and achieve your goal of a healthy pregnancy and baby.