PCOS and Thyroid Disease: Is there a link?

By Breea Johnson, MS RD

In a previous blog posting, I recommended that women with PCOS (Polycystic Ovary Syndrome) get screened for autoimmune thyroid disease as research has shown that women with PCOS are three times as likely to also have an autoimmune thyroid disease.  The autoimmune thyroid diseases are Graves Disease and Hashimoto’s Thyroiditis. In both cases, immune system antibodies attack the cells of the thyroid gland which can lead to the gland’s eventual destruction – producing symptoms which can include weight gain or loss, depression, anxiety, rapid heart rate, and in some cases infertility. While most Reproductive Endocrinologists routinely test for Thyroid Stimulating Hormone (TSH) which can determine an over-active thyroid gland (hyperthyroidism) or under-active thyroid gland (hypothyroidism), autoimmune thyroid disease needs to be tested by determining levels of antibodies that the immune system is producing such as anti-thyroid peroxidase antibodies (anti-TPO) or anti-thyroglobulin (anti-TG)antibodies.

In addition to the higher incidence of autoimmune thyroid disease in women with PCOS, a recent study showed that infertile women suffering from PCOS with anti-TPO values that exceeded the upper level of normal were significantly more likely to be resistant to Clomid compared to Clomid responders and Metformin responders. They went on to conclude that elevated anti-TPO levels (an indicator of autoimmune thyroid disease) are associated with poor treatment response in infertile women who suffer from PCOS.

So, why is it so common to see PCOS and Thyroid Disease together?  There is no definitive answer, but there are connections.  Both the thyroid gland and the ovaries are part of the endocrine system.  Insulin resistance, which is very common in women with PCOS, is also associated with thyroid function as studies have found that increased levels of TSH correlate with an increase in insulin resistance (read more about the insulin resistance and PCOS connection in a previous blog ). There also may be specific nutritional deficiencies that PCOS and thyroid disease have in common.

While the research is still limited in the area of infertility, thyroid disease and PCOS, there is a link between all of them and getting tested and screened for both PCOS and thyroid disease may be beneficial in your fertility journey. Nutrition also plays a large role in the treatment of PCOS and thyroid disease including helping to lessen insulin resistance. To book a nutrition consultation at Pulling Down the Moon, call (312) 321-0004 or visit www.pullingdownthemoon.com .

Sex and the Fertile Gal

Tami’s got a smoking hot blog on PDtM’s Fertility Authority blog today – check it out!

In addition to the tantric tips Tami provides, the simple act of relaxing and being present can make a huge difference in your sex life.   If you’re stressed and find it hard to be “in the moment” you may want to enroll yourself  (and maybe even your partner, too) in our four-week long iRest (r) for Fertility class at PDtM in Chicago .  This deeply restorative class can help you release negative patterns of stress and sooth your over-tired and over-emotional mind.

Alternate Nostril Breathing

Today is the Autumn Equinox, a time when the length of day and night are nearly equal.  It is a time to reflect on balance and equilibrium, and to address areas of imbalance in our lives.  Alternate Nostril Breathing is a yoga breathing technique that is deeply calming for both body and mind.

Practice Alternate Nostril Breathing with PDtM yoga instructor Jenilyn Gilbert.

Anna’s News: Fertile Feet

PDtM Acupuncturist Anna Pyne has this fabulous self-care suggestion for fertility.  Read her post on  Pulling Down the Moon’s blog at Fertility Authority!

And for more about those sweet little piggies…check out this previous post on our FA blog about the importance of feet for fertility.

Quick Tip – Eating Out

By Breea Johnson, MS RD LDN

Eating out at restaurants can be especially challenging when you are trying to eat well for fertility. Try these three easy tips to make better choices at restaurants.

1. Review the menu ahead of time (if possible) and decide what you are going to eat so you make the best “nutrition decision” when you order. If you leave your decision to the last minute and are “starving” by the time you have to order you are more likely to order the less nutritious option.

2. Don’t be afraid to ask for changes when you eat out. Do you want broccoli instead of French fries? Or tomato slices instead of hash browns? Greens instead of bread? You can add vegetables to almost anything and most restaurants are happy to accommodate you.  A Pulling Down the Moon nutritionist can help you learn which foods are best for your fertility so you can even optimize your meal with a fertility-friendly choice.

3. Avoid the salad trap – a lot of salads aren’t very nutritious and instead of loaded with lots of high calorie and low nutrition toppings. Does it have chopped vegetables? Protein? Nutrient dense toppings? An olive-oil based dressing? Make sure to check first.  In addition, salads can be “cold” and in many traditional medicine systems (Traditional Chinese Medicine and Ayurveda), eating cold foods are thought to dampen the digestive fire and potentially decrease fertility.

Heart-Opening Meditation

We feel so much better when we are able to love.  Reserarch shows that people in community tend to live longer and enjoy better health than those who live in isolation.  Yet fertility challenges can be deeply isolating. This simple meditation can open and energize the heart center, rekindling our ability to give and receive love:

Sit with a straight spine (either cross-legged on the floor or in a chair with a straight back, feet in contact with the floor) and close your eyes.  Breathe quietly in and out of your nose for a few minutes.

Bring your awareness to the heart center and notice any sensation there.  Perhaps there’s a sense of constriction, or alternatively, a feeling of warmth and expansion.  Observe without judging.

The meditation continues in three phases:

May I dwell in the awakened heart.
As you repeat these words silently to yourself, feel your heart center waking up.  Visualize a wheel of the brightest green glowing in your chest.  Sit with this phrase for several minutes, breathing into the heart, feeling it wake and glow with a fertile, radiant green light.

May I attend to what clouds the heart.
As you repeat this phrase, you may want to silently chant it on the exhale and “see” the clouds of your pain, disappointment, loss and anger dissolving in the radiant green glow of the heart.  Sit with this phrase for several minutes, until you feel that the heart is unobstructed and bright.

May my awakened heart be extended to all beings.
As you now silently repeat this phrase, feel the radiant light of your heart extending out beyond your body, wrapping the world in a huge loving hug.  Rest for a few minutes and allow a free give and take – offering the world this love and receiving love in return.

To end the meditation, join your hands in front of your heart in a gesture of reverence and gently bow to your own loving heart.

PCOS and Miscarriage Rates

By Breea Johnson, MS RD

Women with PCOS (polycystic ovary syndrome) may endure a lot to get pregnant – from utilizing medications to induce ovulation to undergoing IVF – all while experiencing the typical PCOS symptoms. But, does PCOS also impact miscarriage rates? Pregnancy loss rates amongst women with PCOS have been reported to be as high as 30% to 50%, but some research has shown that information to be conflicting. In a recent study, women with PCOS were found to have a 2-fold increase of miscarriage loss after undergoing ART (IVF or IUI) (Chason et al, 2010).  While not the 30-50%  reported previously, the rate found by Chason et al.  is pretty substantial considering the general reproductive population has about an 11% miscarriage rate.  PCOS has also been found in approximately 40% to 80% of women with recurrent miscarriages (Palomba et al, 2009).

Insulin levels also seem to play a factor in miscarriage, as studies have shown that Metformin has positive effects on reducing miscarriage rates in women with PCOS.  In a study comparing three groups of women with PCOS on Metformin, all rates of miscarriage decreased while on Metformin but the groups that stopped at 8 weeks and 12 weeks had a statistically significant drop in miscarriage rates while the group that stopped immediately after a positive pregnancy diagnosis did not have a statistically significant drop (from roughly 20-40% down to 4-8%). However, a meta-analysis of randomized controlled trials showed that preconception intake of Metformin did not have a beneficial effect on reducing miscarriage rates in women with PCOS (Palomba et al, 2009). The research is still very limited in this area.

Factors in women with PCOS that may be contributing to increased miscarriage rates include higher Lutenizing Hormone (LH) levels which can be increased by elevated insulin. Elevated testosterone levels, obesity, insulin levels and infertility treatments are also factors that may be involved (Palomba et al, 2009). Many of these altered hormone levels seen frequently with PCOS are greatly affected by diet and lifestyle and may be improved through working with a nutritionist.  Acupuncture has also been used to minimize the chance of miscarriage.  Please call Pulling Down the Moon at (312) 321-0004 or visit our website at www.pullingdownthemoon.com for more information.

Chason et al. A Diagnosis of Polycsytic Ovary Syndrome (PCOS) is associated with an increased likelihood of pregnancy loss with Assisted Reproduction.  October 2010.

Palomba et al. Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Fertility Sterility. 2009.

Step Up! The Surprising Benefits of Getting Involved

On October 13, Pulling Down the Moon Chicago will be hosting a Step Up Salon:  Fertility 101 with Fertility Centers of Illinois. We’re very excited about this event, both on a community level and, for me, a personal level.

One of the most vivid and painful memories of my fertility journey is sitting in my OB’s office experiencing my first miscarriage.  As the fertility gods would have it, sitting across from me was a young woman  – a girl really – who was deep into her third trimester of pregnancy.  Of course my “judge-o-meter” went haywire.  She was with her mother, wasn’t wearing a wedding ring…who was I kidding, she was barely old enough for a high school ring.   I was bleeding and she was blooming.  My loss felt so unfair.  It was the first time during my fertility journey that I felt that I was becoming the Grinch, with a heart “two sizes too small.”

I’ve often wondered if Dr. Seuss was a yogi because he wasn’t  too far off the yoga mark when he described his classic villain.  In yoga physiology, one result of the”grinchification” process is the constriction of the heart chakra.  The heart chakra is one of seven major energy wheels located along our spine.  The chakras distribute life energy to our physical and emotional systems.    When a chakra is blocked, the function of the organs and emotional processes associated with that energy wheel are challenged.  In addition, when one chakra is blocked, energy cannot flow freely through the rest, creating a disruption in the entire body/mind system.  The heart chakra (anahata chakra) is associated, not surprisingly, with the emotions of love and compassion and the ability to give and receive freely.  The heart chakra is  also believed to be linked to the cardiovascular system and the thymus (the endocrine gland associated with our immune system).

For weeks after my miscarriage my heart chakra was clenched around my loss and my sadness.  It was also clenched around the young woman in that waiting room.  I found myself obsessing about teen moms and their “stupidity”.  I saw young moms on the El, in the supermarket and on the street and I’m afraid I stared daggers.  My anger and jealousy even started to spread to “married moms” who had the nerve to snipe at their child in public.   It was a zero tolerance situation.  My heart was a mess.  On some level, too, I was ashamed to be filled with such anger and blame.

Luckily, the universe was there to snap me out of it.  My husband, who happens to be a high school teacher and coach in the Chicago city school system, asked me if I would volunteer my time and teach yoga to the Girls’ Cross Country team.  I hadn’t shared with him that I’d become a teen-pregnancy vigilante – he just thought it would be a nice thing for me to do.

And it was.  Meeting and teaching the young women on the team was one of the most powerful steps I took in my fertility journey.  Watching these beautiful young women practice their sport, listening to their excited chatter about summer, about college – about future plans – I realized that the girl at the OB office was missing out on being a girl in much the same way that I felt I was missing out on being a mom.  My stint as a yoga instructor at Whitney Young High School was brief, but profound.  It helped me realize that compassion felt better than judgement.  It also brought me home to a profound love for young women, their hopes and dreams, their sheer potential in the world.   I even felt better physically (interestingly there is, in fact, evidence that people who help others live longer , experience less depression and have more energy than those who share less).  Like the Grich cutting the roast beast, my heart grew THREE sizes that first day.

At the Moon we often talk about our “sacred sauce,” which is the healing and joy that is created when women come together and support each other.  For those of you who are not aware of the  Step Up Women’s Network , this very cool organization is dedicated to connecting professional women and underserved teen girls through mentorship, networking and advancement.  Step Up’s dual mission – to bring professional women together and to provide mentors for young women – resonates deeply with the ethos of community at the Moon.

The Salon will take place October 13 at Pulling Down the Moon’s Chicago location from 6:30 to 8:30 p.m.  There will be complimentary hors d’oeuvres and cocktails, a Q&A session with a physician from Fertility Centers of Illinois and 15% off any Pulling Down the Moon service that is booked that night.  The event is FREE.

So, amazing women of Pulling Down the Moon’s community, come on out and join us!   Take this evening to meet other women, chat with docs from FCI and learn about Step Up and ways you can get involved in changing the lives of young women.   We will be there with bells on!

Click here to register!

The Role of Inflammation in PCOS

Margaret Wertheim M.S., R.D., L.D.N.

By Margaret Wertheim M.S., R.D. , L.D.N.

When most people hear the word “inflammation,” they think of a swollen ankle, red and irritated eyes, or the pain of an injury. This is called acute inflammation which occurs over a short period of time and is a helpful process in the body in response to any sort of trauma or injury. This type of inflammation helps to promote healing and prevent infection. On the other hand, prolonged or chronic inflammation in the body is harmful and is associated with many health conditions including PCOS, type II diabetes, and cardiovascular disease.

As Breea discussed in her earlier post entitled The Many Faces of PCOS , women with PCOS have differing characteristics. PCOS is present not only in overweight women, but also in normal weight women. According to a 2009 study in the journal Metabolism , levels of inflammatory markers in the blood are increased not only in overweight or obese women with PCOS but also in normal weight women with PCOS compared to women who do not have PCOS. For certain markers of inflammation, having PCOS and being obese increased inflammatory marker levels even more. This increase in chronic inflammation in PCOS is concerning, because chronic inflammation is associated with increased risk for cardiovascular disease as well as problems with fertility.

Another study from the journal Mediators of Inflammation notes that pathways in the body involved in blood sugar regulation overlap with pathways involved in inflammation which may explain a relationship between blood sugar regulation and inflammation in PCOS. Insulin resistance exists in obese and normal weight women with PCOS, but obesity worsens the insulin resistance much the same as obesity worsens the inflammation in PCOS. These results make a strong case for the beneficial role of weight loss if needed in PCOS. The importance of decreasing this chronic inflammation cannot be overemphasized, because not only may it be helpful for managing PCOS and improving fertility, but also in the prevention of cardiovascular disease.

While the cause and best treatment for PCOS has yet to determined, the research indicates that insulin resistance, blood sugar regulation, inflammation, and hormone levels appear to be linked. The nutritionists here at Pulling Down the Moon can help you to implement changes to your diet and/or recommend supplements which can help you to lose weight if needed, better regulate your blood sugar, and decrease the inflammation associated with PCOS which may help to improve your chances of conception and decrease your risk for cardiovascular disease.

References:

1. González F, Rote NS, Minium J, Kirwan JP. Evidence of Proatherogenic Inflammation in Polycystic Ovarian Syndrome. Metabolism; 2009 July; 58(7):954-962.

2. Sathyapalan T, Atkin SL. Mediators of Inflammation in Polycystic Ovary Syndrome in Relation to Adiposity.  Mediators of Inflammation

; 2010.

Supplements for PCOS: Myo-inositol vs D-Chiro-Inositol

By Breea Johnson, MS RD

In the world of PCOS, most people are familiar with the common recommended medications such as Metformin and the birth control pill to help regulate the cycle and sensitize the body’s tissues to insulin (helping to lessen insulin resistance). While research shows benefits of these medications there are still many side effects that some women do not want to risk.

At Pulling Down the Moon, we recommend FlowPro (if you visit this page, click on the research tab for a summary of the studies that have been done) for PCOS, as the nutritional supplement contains myo-inositol and magnesium that when taken daily have been shown to restore ovulation and menstruation in some women. Myo-inositol can be synthesized by the body from other nutrients but when deficient can impact the ability of the body to be sensitive to insulin. Supplementation with myo-inositol in women has been clinically shown to lower levels of circulating insulin and testosterone, promote ovulation, improve egg quality, improve hirsutism and acne, and lower the risk of ovarian hyperstimulation during an IVF cycle. Some research has found it to be equally effective as Metformin in restoring ovulation.

Another closely-related and popular supplement for PCOS is D-Chiro Inositol (DCI). There are actually nine different forms of inositol (part of the B-vitamin complex), with DCI and Myo-inositol being the two most heavily researched in conjunction with PCOS and insulin sensitivity. There has been no research comparing the effects of both supplements for PCOS, however, both have been found to be beneficial in helping insulin sensitivity.

Do you have PCOS? Have you tried Myo-inositol or D-Chiro Inositol to help manage symptoms? Please feel free to post your stories here. Thanks!

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