Skip to main content

Optimizing Fertility: Menstrual Cycle 101

One of the most important things you can do when optimizing your fertility is to learn about your menstrual cycle – the ebb and flow of hormones that allows for pregnancy to occur!

Many women have little to no understanding of the events that lead up to their period. Many women don’t even know when to expect their period because they have never tracked it. I too was guilty of this before I began trying to become pregnant!

Other articles on this website will teach you how to track your basal body temperature and cervical fluids, but this article will take you through the hormonal changes that allow our body to become pregnant – each step of which is vital for optimal fertility.

Remember – these dates are approximations based on a “typical” 28-29 day cycle. In every woman there may be individual variations.

The Big Events

Days 1-5

The biggest event in our menstrual cycle is arguably our menstrual period. It’s certainly the most noticeable event! On the first day of our period our major fertility hormones, estrogen and progesterone are at their lowest level. This low hormone state allows for the period to start. It also triggers our pituitary gland to start making hormones (LH – lutenizing hormone and FSH – follicular stimulating hormone) to stimulate growth of new follicles in the ovaries.

Day 7

At the end of the first week estrogen levels are increasing and in the ovaries the follicles are growing rapidly. One of these follicles surpasses the others and becomes the dominant (graafian) follicle. The follicle starts producing its own estrogen, adding to the high total amount of estrogen.

Days 7-12

The high levels of estrogen stimulate the lining of the uterus to thicken and prepare for possible implantation later in the cycle. The glands of the cervix also begin to produce a new type of cervical fluid – the fertile cervical mucus.

Eggs a source of vitamin B12Days 12 and 13

High levels of estrogen act on the pituitary, stimulating it to produce lutenizing hormone (LH). The LH surge stimulates production of enzymes and prostaglandins in the dominant follicle, preparing the follicle to ovulate its egg.

Day 14

Ovulation occurs when enzymes breakthrough the follicle wall and prostaglandins stimulate the release of the egg.

Day 15-25

The follicle that released its egg at ovulation is now a corpus luteum. The corpus luteum produces progesterone. Higher progesterone levels are noted on the basal body temperature tracking chart as an increase in body temperature of 0.4-0.5oC. Under the influence of progesterone the uterine lining continues to thicken and secrete nutrients. Progesterone also inhibits the pituitary from producing any more follicle stimulating hormone (FSH), preventing more follicles from developing in this cycle.

Day 19 or 20

Peak progesterone levels allow for implantation of a fertilized embryo in the lining of
the uterus.

Day 25-28

If implantation of an embryo does not occur the corpus luteum stops producing hormones and levels of progesterone and estrogen drop. This sudden decline in hormone levels leads to loss of the endometrial lining as a menstrual period. The drop in hormones also signals the pituitary gland to once again start production of FSH and LH to prepare a new group of follicles for ovulation.

This knowledge, combined with the information gathered from your BBT tracking and cervical fluid monitoring can help you to take charge of your fertility and optimize your chances for conception each month.


The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Antioxidants May Improve Ovulation in PCOS

Improving outcomes in women undergoing fertility treatments is the focus of many research studies. One specific antioxidant is showing promise in clinical studies of women with polycystic ovarian syndrome (PCOS).

N-Acetyl Cysteine

N-Acetyl Cysteine (NAC) is a precursor for the primary antioxidant in the human body, glutathione.  Glutathione is both an intracellular (in the cell) and extracellular (outside the cell) antioxidant and is involved in DNA synthesis and repair, free radical scavenging, metabolism of toxins and carcinogens, and preventing negative effects of aging.

Despite it’s impressive benefits in the human body, glutathione is not useful as an oral supplement because it is inactivated by enzymes in the gut.  Glutathione is also not able to cross cellular membranes, preventing it from being uptaken into cells.

Luckily, N-Acetylcysteine is able to be absorbed in the digestive tract, and can easily cross the cell membrane and is converted within the cell to glutathione.

NAC and Clomid for PCOS

A study published in the Journal of Obstetrical and Gynaecological Research looked at the combined use of clomiphene citrate (Clomid) and NAC in women with PCOS and compared to Clomid alone, found significant improvements in:

  • Number of follicles >18mm
  • Mean endometrial thickness
  • Ovulation rates
  • Pregnancy rates

No adverse effects were seen and no cases of ovarian hyperstimulation were reported.

Hope for PCOS

While the results from this study of 180 women are preliminary, the impeccable safety profile for NAC and the promising findings in multiple parameters (number of follicles, endometrial thickness, ovulation and pregnancy rates) suggest it may benefit women with PCOS, especially in combination with Clomid.


The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Selected References

Salehpour S, Sene AA, Saharkhiz N, Sohrabi MR, Moghimian F. N-Acetylcysteine as an adjuvant to clomiphene citrate for successful induction of ovulation in infertile patients with polycystic ovary syndrome. J Obstet Gynaecol Res. 2012;38(9):1182-6.

Natural Medicines Comprehensive Database. N-Acetyl Cysteine monograph. Accessed July 10, 2014.



Managing Gestational Diabetes Naturally

The incidence of gestational diabetes (carbohydrate intolerance that is first identified during pregnancy) is increasing.  With up to 10% of pregnancies affected this is becoming a major health concern in North America.

Diagnosing Gestational Diabetes

It is standard practice in North America to screen all women for gestational diabetes using the oral glucose challenge test (GCT)  While this universal screening is controversial (the benefits of screening all pregnant women are not established, and there is a high rate of women testing positive for gestational diabetes who do not, in fact, have this condition) it is still common practice for women to be screened between 24 and 28 weeks.

Not every pregnant woman needs to be screened for gestational diabetes.  You have the option to decline this screening test.  However, all pregnant women with risk factors for developing gestational diabetes should be screened with the GCT.  Risk factors include:

  • Glucose in the urine (found on routine urinalysis)Naturopathic Treatment of Gestational Diabetes
  • Diabetes in a first-degree relative (parent, sibling or child)
  • History of glucose intolerance, including gestational diabetes in a previous pregnancy
  • Obesity
  • Previous infant with high birth weight

A high blood sugar level (greater than 7.8mmol/L or 140mg/dL) after the GCT is not diagnostic and does not mean you have gestational diabetes.  A diagnosis can only be made after a 100g three-hour oral glucose tolerance test (OGTT).

In Canada, to be diagnosed with gestational diabetes following the 100g three-hour OGTT you must exceed two or more of the following blood sugar values:

Fasting:                                                 95mg/dL             or            5.3mmol/L

          One hour after glucose load:          180mg/dL            or            10.0mmol/L

          Two hours after glucose load:         155mg/dL            or             8.6mmol/L

                   Three hours after glucose load:      140mg/dL            or             7.8mmol/L

Large babies and gestational diabetes

Complications of Gestational Diabetes

The potential risks of unmanaged gestational diabetes include:

  • Large birth weight babies and increased risk of shoulder dystocia and other birth traumas (including brachial plexus injury)
  • Higher rate of Caesarean section
  • Postnatal infant hypoglycemia
  • Increased risk of mother developing Type II Diabetes

Naturopathic Treatment for Gestational Diabetes

While I don’t believe that all pregnant women should undergo the glucose challenge testing, there are benefits to managing blood sugar during pregnancy and this should be a priority regardless of a diagnosis of gestational diabetes.

Here are my tips for managing blood sugar for all pregnant women, including those with gestational diabetes.

  1. Avoid simple sugars.  No “white” foods – no white bread, white pasta, white rice.  Avoid candies, cookies, cakes and other confections.
  2. Eat regular meals.  Eat at the same time every day.  Eat every three hours.
  3. Never consume a carbohydrate without a protein or fat.  For example: if you are eating an apple have some almond butter, almonds or yogurt at the same time.
  4. Increase dietary fiber.  Have a tablespoon of ground flaxseeds with every meal.  Mix ground flaxseeds with applesauce or yogurt or sprinkle on salads, rice, etc.  Ideally, grind your flaxseeds at home with a coffee grinder rather than purchasing them pre-ground.  If you do purchase pre-ground flaxseeds, keep them in the freezer for freshness.
  5. Swimming for gestational diabetesEat the majority of your carbohydrates at lunch rather than breakfast or dinner.  Keep portions of carbohydrate foods small (one slice of whole grain bread, one half cup of brown rice, one half cup of whole wheat or brown rice pasta, one half cup of quinoa, etc.)
  6. Exercise for at least thirty continuous minutes once or twice per day.  A walk is an easy way to do this but you could consider swimming or yoga or other activities to keep it interesting and to engage other muscles (insulin is used by skeletal muscles – get those muscles using it!)

For gestational diabetes specifically, inositol is a supplement that can be used safely in pregnancy and has been found in studies to improve insulin sensitivity and decrease glucose levels.  It takes a few weeks for maximal effects so see your Naturopathic Doctor as soon as you are aware of abnormal blood glucose levels to gain control over your blood sugar faster.

Gestational diabetes is usually well managed with diet, exercise and simple supplements.  In rare cases where drugs are necessary your Naturopathic Doctor can continue to provide support with lifestyle and dietary counseling and stress management to ensure you and your baby are healthy throughout pregnancy and beyond.


The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Fertility and Chinese Medicine

Any person who has struggled with fertility is familiar with terms like “luteal phase defect”, “premature ovarian failure”, “polycystic ovarian syndrome” and “unexplained fertility”.  Not many are familiar with “Liver Qi stagnation” or “Kidney Yang deficiency”.  But these terms may be the key to your fertility struggle and may be the diagnosis that unlocks your body’s imbalance and allows for pregnancy to occur.

The Diagnosis of Infertility with TCM

Traditional Chinese Medicine (TCM) views health as a state of balance between all of the systems of the body.  In terms of fertility there are four organ systems – Kidney, Spleen, Heart and Liver that, when unbalanced, can lead to infertility.

In addition to the organ systems, there are four vital substances – Yin, Yang, Qi and Blood that can become deficient, excessive or stagnant and create a state of unbalance that may manifest as infertility.

All TCM treatments for fertility are founded upon restoring balance and health to these organ systems and vital substances.

Common TCM Diagnoses for Infertility

TCM diagnoses are made by Naturopathic Doctors after a thorough physical examination and comprehensive intake.  Naturopaths who use TCM in the treatment of fertility will also look at your tongue and take your TCM pulses to both diagnose your TCM pattern and to monitor treatment.

The terminology used in TCM diagnosis may be unfamiliar to you.  They are a different way of looking at patterns in your body.  Toronto Naturopath infertilityWhile Western medicine may say you have low progesterone, a TCM diagnosis may say you are lacking in Kidney Yang.  It’s a different way of saying similar things – a different perspective on your health and fertility.

While a comprehensive intake is necessary for proper diagnosis, some of the most common TCM imbalances leading to infertility are:

Liver Qi Stagnation 

The movement of Qi through the Liver is necessary for both ovulation and menstruation to occur.

Women with Liver Qi stagnation often experience symptoms of imbalance both at ovulation (bloating, irritability, breast tenderness) and at menstruation (premenstrual breast tenderness, irritability, anger, painful periods).

This pattern is often seen in women with polycystic ovarian syndrome (PCOS) and in women with long menstrual cycles.

Spleen Qi Deficiency

In TCM Spleen Qi manages the second half of the menstrual cycle (the luteal phase).  Together with the Kidney Yang, the Spleen Qi allows for buildup of the endometrial lining and supports progesterone production.

Women with Spleen Qi deficiency typically have low energy, cravings for sugar or breads, poor circulation and may experience spotting before their periods, menstrual cramps and fatigue during their periods.

A Spleen Qi deficiency pattern is common in women with luteal phase defect.

Kidney Yang DeficiencyToronto Naturopath treating infertility

Kidney Yang works together with the Spleen Qi to control the luteal phase of the menstrual cycle.  Kidney Yang supports the production of progesterone and maintains an elevated body temperature after ovulation.

Women with Kidney Yang deficiency experience symptoms of coldness – cold feet or hands or an intolerance to cold.  They may have menstrual cramps that feel better with use of a heating pad.

Kidney Yang deficiency often occurs with a Spleen Qi deficiency and is common in women with a luteal phase defect and in women with a prolonged follicular phase or long menstrual cycle (greater than 30 days).

Kidney Yin Deficiency

While Kidney Yang and Spleen Qi control the luteal phase, Kidney Yin controls the follicular phase (the first half of the menstrual cycle, while the egg is developing prior to ovulation).  Kidney Yin also controls production of cervical mucus and opening of the cervix during ovulation.

Women with Kidney Yin deficiency may experience night sweats, hot flashes and have little or no midcycle cervical mucus.  They may not experience any significant symptoms around their period.

Kidney Yin deficiency often occurs with shortened follicular phases, prolonged follicular phases and in elevated FSH and low estrogen states.  Amenorrhea (absence of menses) is also often indicative of a Kidney Yin deficiency.

There are many other TCM imbalances that can contribute to infertility.  The ones listed above are by far the most common but other imbalances may include:

    • Blood stasis
    • Blood deficiency
    • Heart deficiency
    • Excess Heat

Treating a TCM Imbalance

Once you have received a TCM diagnosis from your Naturopathic Doctor you embark on a journey of rebalancing your body to support your fertility.  Whether you are using natural therapies exclusively, or working with a reproductive endocrinologist or assisted reproductive therapies (IVF or IUI) you can begin making changes to balance your systems and improve your chances of pregnancy.

I use a four-step program to help women rebalance their bodies and support their fertility.Infertility naturopathic medicine Toronto 

Step One: Appropriate diagnosis of imbalances and develop a plan for harmonizing your systems and balancing your energy

Step Two: Lifestyle and dietary changes to support balance in your systems.  In TCM certain foods and activities have specific properties.  You can use food, exercise, relaxation techniques, yoga, Tai Chi, Qi Gong and more to increase energy to your Kidneys, boost your Spleen Qi or clear Liver stagnation.

Step Three: Balance the energetic meridians through acupuncture.  A series of acupuncture sessions can balance the organ systems and support smooth flow of Blood and Qi to the reproductive organs and throughout the body.

Step Four: Correct imbalances and increase chances of pregnancy through herbs.  Herbs are natural energetic substances that can gently and effectively correct imbalances and optimize fertility.

If you have been struggling with infertility and are interested in another approach, a Traditional Chinese Medicine diagnosis may be a good place for you to start.  Bring balance back to your body and book an appointment with a Naturopathic Doctor who is knowledgeable about TCM in fertility today.

For further reading, I highly recommend The Infertility Cure by Dr. Randine Lewis.  A fantastic overview of the TCM approach to fertility with sections on each of the imbalances associated with fertility.


The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Photo credits:

Evan Leeson via Compfight

aussiegall via Compfight

Felix Schmidt via Compfight

Natural Support for Amenorrhea

As women we experience approximately 500 menstrual cycles in our lifetime.  Impressive, isn’t it!  But when we miss our period for 3 months and we are not pregnant, breastfeeding or menopausal then we have amenorrhea (absence of menses).  This can be a serious symptom of a greater underlying imbalance and reason for a consultation with a doctor.

Types of Amenorrhea

There are two types of amenorrhea.

Primary amenorrhea – when menstruation fails to occur by 16 years of age

Secondary amenorrhea – when menstruation has previously occurred, but has been absent for at least three months (if your cycle was regular) or six months (if your cycle was irregular)

Causes of Amenorrhea

There are a number of things that can lead to not getting your period.  Primary amenorrhea is caused by a genetic abnormality in about one-third of cases.  Hormonal imbalances, environmental exposures, malnutrition, low body weight, eating disorders, anemia, strenuous exercise, stress, infectious disease (like mumps or tuberculosis), cancer treatments, autoimmune disease, polycystic ovaries, and structural defects can also lead to amenorrhea.

Five of the most common causes of secondary amenorrhea are:

  1. Ovarian failure (pre-mature menopause)
  2. Elevated prolactin levels
  3. Inadequate estrogen production
  4. Chronic lack of ovulation (due to PCOS or other causes)
  5. Low body weight/ low body fat

How Do I Know What is Causing My Amenorrhea?

A full spectrum of tests, combined with a physical exam and comprehensive intake should give enough information to determine the cause of amenorrhea for most women.  Your Naturopathic Doctor will ask you questions about your:

  • Menstrual and fertility history
  • Emotional stress
  • Weight gain or weight loss
  • Lifestyle including alcohol intake, dietary practices and exercise
  • Prior medical history – accidents, illnesses or injuries
  • Medications and supplements
  • Family medical history

Laboratory testing will likely be needed as well.  A pregnancy test, pelvic ultrasound, blood tests for cholesterol levels and thyroid functioning as well as blood or saliva tests for hormone levels are often indicated.

Treatment of Amenorrhea

In Naturopathic Medicine we strive to treat the underlying cause of imbalances rather than just the symptoms.  When you see a Naturopathic Doctor for your amenorrhea the treatment will be individualized to you – treating your individual imbalances rather than your symptom of amenorrhea.  Once the underlying imbalance is corrected, the symptom will resolve.

Nutrition for Amenorrhea

  • Achieve and maintain a healthy body weight.  Women who are underweight can have amenorrhea due to a lack of adequate body fat to manufacture hormones.  Women who are overweight can have amenorrhea as a result of excess androgens associated with excess body fat.
  • Consume adequate protein.  You need at least 40 grams of protein daily.
  • Consume adequate calories.  Depending on your body type (height, weight) you will have individual caloric needs.  A minimum of 1500 calories daily is a good guideline for anyone.
  • Consume 20% of your calories as fat.  Good quality fats such as nuts, seeds, extra-virgin olive oil, flaxseed oil, and fish oil ensure you are consuming enough fats to produce sex hormones (including estrogen and progesterone)
  • Consume 55-65% of your calories as complex carbohydrates.  Brown rice, wild rice, millet, oatmeal, amaranth, quinoa, barley, spelt, kamut and buckwheat provide fiber, B vitamins and support proper detoxification of hormones
  • Ensure you are getting the nutrients you need by eating a diverse selection of foods every day.

Lifestyle Changes for Amenorrhea

  • Sleep in a dark room
  • Go to bed before 11pm
  • Eat regular meals (at regular times).  Eat every 3 hours.
  • Maintain a steady, healthy body weight. Avoid rapid weight gain or weight loss.
  • Balance thyroid function.  Measure basal body temperature to determine if your thyroid is underactive.
  • Avoid environmental toxins – pesticides, preservatives and food additives.  Consider hair mineral analysis to assess toxic burden
  • Consider cranial sacral therapy, Reiki, or rolfing to bring awareness to emotions connected to femininity, sexuality, body image, maturation, independence, and second chakra issues

Herbal Medicines for Amenorrhea

There is an entire class of botanical medicines that is used for amenorrhea.  These herbs are known as emmenagogues and are used to promote menstruation.

Some of the most common herbal medicines used for amenorrhea are include:

  • Mugwort (Artemesia vulgaris)
  • Partridgeberry (Mitchella repens)
  • Blue cohosh (Caulophyllum talictroides )
  • Chaste tree (Vitex agnus-castus)
  • Black cohosh (Actea racemosa)

These herbs should be used under supervision of a qualified Naturopathic Doctor and should be taken only as prescribed.

There is help available for amenorrhea.  You can have a normal menstrual cycle – but only if you address the underlying cause of your lack of menses.  Contact a qualified Naturopathic Doctor for a consultation today.


The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Photo credits

Mait Jüriado via Compfight


Six Natural Treatments for Menopause

Menopause is the natural transition out of the childbearing years of a woman’s life.  So why is this natural transition often treated with synthetic hormones that have increase your risk for stroke, pulmonary embolism, coronary artery disease and breast cancer?

Symptoms of menopause begin for most women between 46-55 years of age and can persist for 2-20 years (8 years is average).  With the risks associated with synthetic hormone replacement therapy (HRT) more and more women are looking for natural alternatives.  Learn more about six of the top recommended natural treatments for menopause and how they may help you transition smoothly through menopause.

Black cohosh (Actaea racemosa)

Black cohosh (Actaea racemosa)

Black cohosh is one of the most important and popular natural remedies for menopause.  Several large studies have found that daily use of black cohosh for a minimum of 8 weeks improved symptoms of menopause including hot flashes, night sweats, headaches, insomnia, mood swings, irritability and vaginal dryness.

Black cohosh is often self-prescribed but should be used under supervision of a Naturopathic Doctor.  Studies suggest that the effectiveness of black cohosh can be increased by combining it with other natural treatments.


Isoflavones are compounds found in plants that have estrogen-like actions in humans.  They are also known as “phytoestrogens”.  Clinical studies have shown that isoflavones can reduce symptoms of hot flashes and vaginal dryness in menopause.

Additionally some isoflavones (particularly those in soy) are also effective preventative agents for certain types of cancer, including breast cancer.  Isoflavones also protect the body against heart disease, increase good (HDL) cholesterol, decrease bad (LDL) cholesterol and triglycerides, and help prevent osteoporosis.

Isoflavones are most commonly found in combination with other phytoestrogens.  A diet high in soy may also provide a significant amount of isoflavones, especially if fermented soy products like natto or miso are consumed.  Do not take soy based isoflavones, or consume a high soy diet if you have a history of thyroid disease.

Red Clover (Trifolium pratense)

Red clover (Trifolium pratense)

Red clover is a popular phytoestrogen supplement for management of menopausal symptoms.  It is most effective for hot flashes and night sweats.  It contains isoflavones so also has many of the same benefits listed above (decreasing bad cholesterol, prevention of osteoporosis).

There are multiple drug-herb interactions for red clover, so it should only be taken under supervision by a Naturopathic Doctor.  Red clover interacts with blood thinners and antivirals and may not be appropriate if you are taking these medications.

Vitamin C

Vitamin C and citrus bioflavonoids are known to improve the integrity of blood vessels and promote healthy blood flow.  This has been shown in preliminary studies to improve symptoms of hot flashes.  Vitamin C is also incredibly safe and can be taken in food form.  Good sources of vitamin C include citrus fruits, papaya, bell pepper, strawberries, cauliflower and dark green leafy vegetables.


Exercise should be incorporated into a healthy lifestyle during the menopausal transition and beyond.  A list of some of the benefits of exercise in menopause are listed below.  Exercise has been demonstrated in clinical studies to improve quality of life in menopausal symptoms, and decreases the frequency and severity of hot flashes.  A combination of weight bearing and aerobic exercise at least 3.5 hours per week is recommended for women in menopause and postmenopausal women.

Health Benefits of Regular Exercise in Menopause           

  • Relief from hot flashes
  • Decreased bone loss
  • Improved cardiovascular function and circulation
  • Decreased blood pressure
  • Decreased cholesterol levels
  • Increased self-esteem, mood, endurance and energy levels


The natural menopause treatment that has been getting the most media attention is acupuncture.  Acupuncture, when individually tailored to a woman’s menopausal symptoms can be extremely effective in decreasing discomfort and relieving symptoms.  A range of 6 to 12 sessions over an 8 to 12 week period should be used to determine if acupuncture will be effective.

As with all natural therapies, the most effective approach is an integrative one.  Consultation with a qualified Naturopathic Doctor who can tailor a treatment plan to your symptoms, current health and lifestyle will allow you to reap all the benefits natural therapies have to offer.


The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.


Osmers R, Friede M, Liske E, et al: Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms.  Obstet Gynecol  2005; 105:1074-1083

Wuttke W, Seidlova-Wuttke D, Gorkow C: The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: Effects on menopause symptoms and bone markers.  Maturitas  2003; 44 (Suppl 1):S67-S77.

Tice JA, et al: Phytoestrogen supplements for the treatment of hot flashes: The Isoflavone Clover Extract (ICE) Study: A randomized controlled trial.  JAMA  2003; 290:207-214.

Wyon Y, et al: A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women.  Climacteric  2004; 7:153-164.

Lindh-Astrand L, Nedstrand E, Wyon Y, Hammar M: Vasomotor symptoms and quality of life in previously sedentary postmenopausal women randomised to physical activity or estrogen therapy.  Maturitas  2004; 48:97-105.

Nachtigall L, La Grega L, Lee W, Fenichel R. The effects of isoflavones derived from red clover on vasomotor symptoms and endometrial thickness. In: Proceedings of the 9th International Menopause Society World Congress on the Menopause. Yokohama, Japan: 1999.

Acupuncture for Infertility

Canadian infertility rates are twice what they were twenty years ago.  Up to 16% of heterosexual couples in Canada have difficulty conceiving and are looking for help.  As more heterosexual and homosexual couples and single women seek out ways to fulfill their desire to have children use of assisted reproductive technology (ART) has increased substantially.  With the rise of ART, we are also seeing a rise in men and women seeking out natural ways to enhance fertility or to improve the success rates of ART.  Acupuncture is the most popular natural fertility treatment either alone or in combination with ART.

Acupuncture and ART

The past 20 years have seen an explosion in the number of research studies demonstrating impressive results when combining acupuncture with ART.  A 2002 study performed by Paulus and colleagues in Germany rocked the reproductive world when it showed that women who received acupuncture with in-vitro fertilization (IVF) had a 42.5% success rate, compared to a 26.3% success rate for those who did not get acupuncture.  Considering the cost of IVF (both financial and emotional) this impressive result got the attention of both fertility specialists and people with infertility.

Many further studies have confirmed what Paulus reported in 2002.  In 2006 a study found that acupuncture during the second half of the menstrual cycle more than doubled pregnancy rates (33.6% vs 15.6%) for women undergoing IVF or ICSI (intracytoplasmic sperm injection – a type of IVF).  A second study in 2006 reported that acupuncture on the day of IVF embryo transfer (with acupuncture treatment administered both before and after the transfer) increased pregnancy rates from 26% to 39%.

These studies and many others like them demonstrate the profound impact acupuncture can have during assisted reproductive technology procedures.

Acupuncture and Female Infertility

Female factor infertility is implicated in half of all couples with difficulty conceiving.  There are many lifestyle, physical and hormonal issues that can lead to female fertility concerns.  Lack of ovulation, luteal phase defect, endometriosis, prolonged menstrual cycle, shortened menstrual cycle, polycystic ovarian syndrome, uterine fibroids, hypothyroidism, hyperthyroidism, recurrent miscarriage, pelvic inflammatory disease and unexplained fertility can all be addressed with acupuncture treatment.

How can acupuncture do all these diverse things?  Acupuncture works on multiple systems in our body with widespread and diverse effects.  Some of the ways acupuncture impacts fertility include:

  1. Regulate the hormone cycle: Acupuncture can regulate and support a balanced hormone cycle with a regular 27-30 day cycle, good quality fertile mucus, pain free ovulation, minimal premenstrual symptoms and a pain free period with appropriate bleeding (colour, quantity, no clots).
  2. Regulate ovulation: Acupuncture and Traditional Chinese Herbal therapies support ovulation occurring regularly on day 13 to 15 of a regular cycle, indicating that the egg is being released at its optimal developmental time.
  3. Increase blood flow to the uterus and ovaries: Acupuncture increases the blood flow to the ovaries and uterus, enhancing thickness and quality of the uterine lining, decreasing IVF failure and recurrent miscarriage. No medication currently exists that can increase blood flow to the uterus – acupuncture is the only intervention that has been shown to consistently have this effect.
  4. Enhance egg development: Clinically acupuncture has been shown to positively influence the integrity of eggs released – this may be due to increasing the blood supply to the developing follicles or by increasing the nutritional supply to the egg via the fluids that surround and nourish it.
  5. Enhance the internal environment of the fallopian tubes: Acupuncture aims to improve the elasticity and the secretions of the fallopian tubes, facilitating the passage of the fertilized egg into the uterus.
  6. Promote embryo implantation: Acupuncture used during IVF results in higher rates of viable pregnancy.  Additionally, acupuncture was found in a 2004 study by the American Society for Reproductive Medicine to lower miscarriage, reduce tubal pregnancy and increase live birth rate.
  7. Correct hormonal imbalances: Acupuncture can be used to influence hormonal secretion at the level of the pituitary, hypothalamus, thyroid, adrenals or ovaries.  Acupuncture can balance excess or deficient hormone levels and support a hormonal state that allows pregnancy to occur and proceed naturally.
  8. Decrease stress and enhance maternal health during fertility treatments and pregnancy: Stress is one of many factors that may negatively impact fertility.   Acupuncture treatments have been shown to decrease stress during fertility treatments and can support a balanced, healthy lifestyle for the mother.

Acupuncture and Male Infertility

Male factor infertility is also implicated in half of all infertile couples.  Male fertility requires three important features: adequate production of sperm in the testes, a clear path for sperm to travel through the seminal tract, and satisfactory delivery of the sperm to the waiting egg.  Low sperm count, poor sperm motility, poor sperm morphology (shape), anti-sperm antibodies, and low testosterone are all imbalances that may be addressed through acupuncture, usually in combination with nutritional and herbal supplements.

Acupuncture Treatments

Acupuncture treatments are tailored to your personal imbalance.  The timing and frequency of acupuncture sessions depends on your health and fertility concerns, your age, your menstrual cycle and your current state of balance/imbalance.  For women undergoing ART it is recommended in clinical studies that you begin having acupuncture a minimum of 8-12 weeks prior to IVF procedures.

Acupuncture points are selected based on clinically proven protocols (Paulus protocol, Stener-Victorin protocol), as well as points based on Traditional Chinese Medicine diagnoses and indications.  Your individual acupuncture point prescription may vary with your menstrual cycle, with different points being used based on the timing and length of your cycle.

For women undergoing IVF, your Naturopathic Doctor can accompany you on the day of embryo transfer to administer acupuncture before and after your procedure.  Discuss the option of on-site acupuncture with Dr. Watson in the weeks prior to your procedure.

Is Acupuncture Right for You?

The best way to determine if acupuncture is right for you is to have a consultation with a Naturopathic Doctor who is experienced in the treatment of fertility and proficient in acupuncture.  Dr. Lisa Watson offers free 15 minute consultations during which time you can ask questions regarding acupuncture and fertility and whether or not it would be recommended for you.


Betts D. The Essential Guide to Acupuncture in Pregnancy and Childbirth.  2006.

Dieterle, S., et al. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 2006 May;85(5):1347- 51.

Gurfinkel E, et al. “Effects of acupuncture and moxa treatment in patients with semen abnormalities.” Asian J Androl. 2003 Dec;5(4):345-8.

Johnson D.  “Acupuncture prior to and at embryo transfer in an assisted conception unit – a case series.” Acupunct Med. 2006:24(1):23-28.

Kirkey S.  Infertility rates rising for Canadian couples.  Postmedia news.  February 15, 2012.  Accessed online May 22, 2012.  Available online at:

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002;77(4):721-4.

Stener-Victorin E, et al. “Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006 Dec;24(4):157-63. Review.

Westergaard. LG, et al. “Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial.” Fertil Steril. 2006 May;85(5):1341-6.

Zhang, M, et al. “Influence of acupuncture on idiopathic male infertility in assisted reproductive technology.” J Huazhong Univ Sci Technolog Med Sci. 2002;22(3):228-30.


Treating Polycystic Ovarian Syndrome Naturally

Polycystic ovarian syndrome (PCOS) or “multiple ovarian cysts” affect many teenage girls and adult women.   PCOS often begins shortly after puberty and can persist for years.  It can be a frustrating, and sometimes painful condition.  It can also make becoming pregnant difficult.  However, there are natural treatment options available that are safe and effective even for teenaged girls.

What are ovarian cysts?

Ovarian cysts are formed when ovulation doesn’t occur as it is supposed to.  Within each ovary there are sacs called follicles that contain eggs.  Normally, one or more eggs are released during each menstrual cycle – this is ovulation.  In PCOS the eggs within the follicles do not mature and are not released from the ovaries.  Instead, they form small cysts in the ovary – ovarian cysts.

How do I know if I have PCOS?

Having ovarian cysts is not enough for a diagnosis of polycystic ovaries.  You also must have other symptoms of PCOS. Typically a combination of the following symptoms is present:

  • Ovarian cysts
  • No menstrual cycle, irregular or infrequent menstrual cycles
  • No ovulation
  • Infertility
  • Hair growth on the upper lip or chin
  • Hair loss from the head
  • Acne
  • Body fat around the waistline
  • Dark skin under the armpits, neck, groin or breasts

If you have symptoms of PCOS there are laboratory tests and ultrasound studies that should be done before a diagnosis of PCOS is made.

What causes PCOS?

PCOS is caused by hormonal imbalances.  An imbalance in a number of different hormones can lead to symptoms of polycystic ovarian syndrome.  Imbalances in the pituitary, ovaries, pancreatic and adrenal hormones have all been linked to PCOS.  Insulin resistance (a lack of responsiveness to insulin in the cells of your body) is an important factor in the development of PCOS.  Hormone testing should be done to identify your personal imbalances.

PCOS also has a genetic component – if a family member has it (your mother, aunt or grandmother) then you are more likely to develop it.

What treatments are available for PCOS?

With proper diagnosis and treatment, most PCOS symptoms can be effectively managed or eliminated.  The goals for PCOS treatment are to balance hormone levels, decrease insulin resistance and maintain a healthy body weight.

Most Medical Doctors will prescribe a daily birth control pill to manage PCOS.  This approach uses synthetic hormones to artificially ‘balance’ the body’s hormones.  Naturopathic Doctors use diet, vitamins, minerals, herbs and natural supplements to correct the body’s balance and teach it how to maintain balance without using drugs.

Diet and Lifestyle

Flax seeds are an excellent source of fiber and omega 3s

Because of the association between being overweight and having PCOS it is important to achieve and maintain a healthy body weight.  Losing as little as 5% of body weight can correct insulin resistance and decrease elevated hormone levels (specifically testosterone).

Select foods that are low on the glycemic index and high in fiber to decrease insulin resistance.  Daily exercise is also important for insulin resistance.  A daily fiber supplement can help some people meet their daily fiber goals.  Look for a fiber made from psyllium, guar gum or pectin.

Consider taking an omega 3 supplement (either fish oil or flax seed oil) and avoid consuming saturated fats.  For more information on omega 3 fatty acids read the article here.

Vitamins and minerals

Vitamin B6 can help balance prolactin levels, which are often elevated in PCOS.  B vitamins are also necessary for dopamine synthesis and adrenal hormone production.

Chromium is necessary for proper blood sugar regulation.  Taking chromium increases the uptake of glucose into cells, decreasing insulin resistance.

Herbs (Botanicals)

Vitex agnus castus

Saw palmetto (Serenoa repens) is a very effective hormone balancer for PCOS.  Saw palmetto decreases the conversion of testosterone to its more biologically active form (dihydroxytestosterone or DHT).  This results in lower levels of circulating testosterone.  Saw palmetto is effective in addressing symptoms of acne, hair loss, and facial hair growth.

Chasteberry (Vitex agnus-castus) is another herb used for PCOS.  Chasteberry inhibits prolactin synthesis and raises progesterone levels restoring balance to two important hormones involved in the menstrual cycle.  Low progesterone levels are very common during puberty and are known to contribute to the formation of ovarian cysts.

Natural supplements

Additional natural supplements may be prescribed by your Naturopathic Doctor to address your individual imbalances.  One natural supplement that is often used for PCOS is inositol (d-chiro-inositol).  A deficiency of inositol is often seen in women with PCOS.  Inositol has many benefits for PCOS – it decreases insulin and insulin resistance, decreases testosterone levels and can help promote regular ovulation.


Natural treatment of PCOS can take some time, and a focused effort.  A minimum of three menstrual cycles is usually needed to allow for the hormones to become balanced.  Your Naturopathic Doctor will provide you with support and can modify your treatment plan as needed based on your symptoms.  Remember to inform your Naturopathic Doctor if you begin taking any prescription or over-the-counter medications during your treatment because there can be significant interactions between natural supplements and drugs.


The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.


Fertility Diet

Those who take medicine and neglect their diet waste the skill of the physician
~ Chinese proverb

Eating a nutritious diet can boost your health and improve your life in many ways.  For women struggling with issues of fertility, eating properly can boost your fertility and increase the chances of becoming pregnant.

The recommendations below incorporate traditional Chinese medicine and groundbreaking research from the Nurses Health

Study which examined the impact of lifestyle and diet on the health of nearly 20 000 female nurses.  Traditional Chinese medicine (TCM) focuses on bringing the body into balance.  When in balance a woman’s body is naturally fertile and able to nourish both her own body and her fetus.

Fertility Diet Tips

1. Consume a Whole Foods Diet

Whole foods are minimally processed and provide maximum nutrients, fiber, enzymes, antixoidants and taste without added artificial flavours, colours, preservatives, sweeteners or trans fats.

2. Focus on Slow Carbs

Slow carbohydrates are slowly digested causing a slower and more gradual rise in blood sugar after being eaten.  They include beans, peas, lentils, whole grains (such as brown rice, barley, millet and quinoa) and vegetables.  Slow carbs minimize insulin resistance, regulate blood sugar, improve fertility and prevent gestational diabetes. Eliminate all white carbs – white flour, white pasta, white rice, white potatoes and white bread.

3. Eat Primarily Plant Based Foods

Plant based foods include a rainbow of high fiber, high antioxidant fruits and vegetables, legumes, nuts, seeds and whole grains.  A plant based diet means that most (but not necessarily all) of the diet is based on plant foods.  This diet is eaten around the world and is associated with health promotion, disease prevention and longevity.

4. High Antioxidant Foods

A diet high in plant based foods will be naturally high in antioxidant foods.  Fruits, vegetables, herbs and spices decrease oxidative stress and cellular inflammation associated with decreased fertility.  Select primarily organic produce – it has been shown in multiple studies to be higher in antioxidants (and free of hormone-disrupting pesticides!)

5. Consume Healthy Fats and Avoid Trans Fats

Healthy fats combat inflammation and improve hormone sensitivity.  Healthy fats and oils include coconut oil, nuts, seeds, avocados, olives, raw (uncooked) olive oil, and fats found in wild cold-water fish.  Trans fast (also known as hydrogenated or partially hydrogenated fat) – typically found in commercially prepared baked goods, fried foods, and processed snack can disrupt with normal ovulation by interfering with a cell receptor that controls inflammation, glucose metabolism, and insulin sensitivity.

6. Eat Only High Quality Dairy Products

Small amounts of full-fat dairy products daily, such as live culture yoghurt, kefir, and high quality organic goat and cow cheeses have been shown to enhance fertility.

7. Eat Mindfully

Slow down and tune into the nutritive properties of food.  Allow mealtime to be a time when you focus on nourishing your mind, body and spirit.  Mindfulness has been shown to help decrease stress, lower blood sugar and blood pressure, decrease anxiety and depression and enhance well-being.

8. Eat For Balance

In TCM all health concerns are based on an imbalance in the body.  This may be an excess or a deficiency of one of the vital substances or a blockage of energy flow in one of the organ systems of the body.  Your Naturopathic Doctor can help you determine your imbalance and give you recommendations for foods to promote balance (e.g. foods to boost yin or clear heat).

9. Take Supplements Appropriately

Supplements can be used to enhance a healthy diet but should not be used as a replacement for a healthy, balanced diet.  A prenatal multivitamin with iron, calcium, iodine, antioxidant nutrients (A, C, E, selenium and zinc), probiotics, fish oils and others may be used to enhance fertility and support a healthy pregnancy for both mother and child.

Click here for an easily printable PDF copy of the Fertility Diet


The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select resources:

Chavarro J, Willett W.  The Fertility Diet.  Harvard Health Publications.  2008.
Lewis R.  The Infertility Cure.  Little Brown and Company.  2004.

Caffeine in Pregnancy

One of the first questions many pregnant women have is “can I still drink coffee and tea?”  The facts on caffeine and pregnancy aren’t always clear.  Read on to find out the current research and recommendations for caffeine intake during pregnancy.

Is Caffeine Safe during Pregnancy?

Yes.  Pregnant woman can safely consume caffeine during pregnancy.

Health Canada has produced guidelines that recommend pregnant women to consume no more than 300mg of caffeine daily.  Several recent studies have suggested that pregnant women limit their intake of caffeine to 200mg daily.  I recommend that pregnant women exercise caution and consume no more than 200mg of caffeine from all sources daily.

What are the Concerns with Excess Caffeine Intake during Pregnancy?Coffee in Pregnancy

Caffeine has the ability to cross the placental barrier and impact the fetus directly.  The fetal liver is unable to efficiently process methylxanthines (such as caffeine) and may experience effects of caffeine – such as increased heart rate, alertness and nervous stimulation or tremors for a longer time than the pregnant mother.  Excess caffeine also puts additional strain on the maternal liver, which is busy processing pregnancy hormones.  Additionally, caffeine constricts blood vessels and may reduce blood flow to the placenta.

Initial concerns over caffeine in pregnancy surrounded the potential that it may lead to low birth weight or miscarriage.  It was found by a team of researchers from Yale University that drinking 600mg of caffeine per day or more (approximately 6 cups of coffee) resulted in lower birth weights.

A Danish study found that drinking 8 cups or more of coffee per day (equivalent to 12-20 cups of tea) can increase the risk of miscarriage or stillbirth by 60% compared to women consuming no caffeine.  Moderate consumption of caffeine (200-300mg per day) does not pose a significant risk.

A seven year study of 1500 women found that less than 200 mg of caffeine consumed daily during pregnancy had no effect on birth weight, birth length or head circumference.  Follow-up examinations at ages 8 months, four and seven years also found no negative effects of maternal caffeine consumption on a child’s motor development or intelligence.

The negative effects of excessive caffeine don’t end at birth.  Research has shown that newborns whose mothers consumed more than 500mg of caffeine daily had faster heart and breathing rates and spent more time awake in the first days after birth.

Interestingly, tea seems to be supportive for women attempting to conceive.  A study out of Northern California found that drinking one-half or more cups of tea daily approximately doubled the chance of conception each cycle.

What are Common Sources of Caffeine?

If you are going to continue to consume caffeine safely during pregnancy it is important to understand how much caffeine is present in common foods and beverages.  The chart below will give you a good overview of the caffeine content of select foods and drinks.  Remember to consider portion size when you are calculating your personal caffeine intake.

If you are interested in further reducing your caffeine intake from tea, steep your tea leaves for a shorter period of time.  Steeping for 1 minute decreases caffeine content by 50% compared to steeping for 3 minutes.

Caffeine in Pregnancy

Chart is available here as a pdf for you to download and print: Caffeine Content of Common Foods and Beverages


The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select references

American Academy of Pediatrics’ Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics, 108(3):776-789, Sep 2001.

American College of Obstetricians and Gynecologists.  2010.  Committee Opinion No. 462; Moderate Caffeine Consumption During Pregnancy.  Obstet Gynecol 116 (2): 467-68.

Armstrong, BG, McDonald, AD, and Sloan, M. Cigarette, alcohol, and coffee consumption and spontaneous abortion. American Journal of Public Health, 82:85-90, 1992.

Barr, HM, and Streissguth, AP. Caffeine use during pregnancy and child outcome: a 7-year prospective study. Neurotoxicology and Teratology, 13:441-448, 1991.

Caan, B, Quesenberry, CP, Coats, AO. Differences in fertility associated with caffeinated beverage consumption. American Journal of Public Health, 88(2):270-274. 1998. Caffeine, Coffee and Health. S. Garattini (ed). New York: Raven Press, 1993.

Clausson, B, and Granath, F, et al. Effect of caffeine exposure during pregnancy on birthweight and gestational age. American Journal of Epidemiology, 155:429-436, 2002.

Cnattinguis, S, Signorello, L, Anneren, G, et al. Caffeine intake and the risk of first-trimester spontaneous abortion. New England Journal of Medicine, 343:1839-1849, 2000.

Differences in Fertility Associated with Caffeinated Beverage Consumption.  B Caan, C Quesenberry, AO Coates.  American Journal of Public Health.  1998; 88: 270-274.

Effects of Caffeine on Human Health, P. Nawrot, S. Jordan, J. Eastwood, J. Rotstein, A. Hugenholtz and M. Feeley, Food Additives and Contaminants, 2003, Vol. 20, No. 1, pg. 1-30.

Fenster L, Hubbard AE, Swan SH, et al. Caffeinated beverages, decaff coffee, and spontaneous abortion. Epidemiology, 8(5):515-522, 1997.

Grosso LM, Rosenberg LD, Belanger K, Saftlas AF, Leaderer B, Bracken MB. Maternal caffeine intake and intrauterine growth retardation. Epidemiology, 12(4):447-55, Jul 2001.

Health Canada.  Fact Sheets – Food and Nutrition – Caffeine in Food.  Available online at:

Maternal caffeine intake and risk of selected birth defects in the National Birth Defects Prevention Study.  Birth Defects Research. Part A, Clinical and Molecular Teratology.  Birth Defects Res A Clin Mol Teratol 2011 Feb; Vol. 91 (2), pp. 93-101.

Maslova E, Bhattacharya S, Lin SW, Michels KB.  Caffeine consumption during pregnancy and risk of preterm birth: a meta-analysis.  Am J Clin Nutr, 92 (5): 1120-1132, Nov 2010.

Methylxanthines during pregnancy and early postnatal life.  Aden U.  Handbook of Experimental Pharmacology [Handb Exp Pharmacol] 2011; Vol 200, pp. 373-89.

Nehlig, A and Debry, G. Consequences on the newborn of chronic maternal consumption of coffee during gestation and lactation: a review. Journal of the American College of Nutrition, 13(1):6-21, 1994.

Tim Hortons Canada.  Tim Hortons Caffeine Content.  Available online at: