Seed cycling for no period? Nope.

Seed cycling has been touted as helping to regulate menstrual cycles. One is supposed to take a combination of flax and pumpkin seeds (1-2 tablespoons each) during the first half of the cycle (from when your period starts until you ovulate, the “follicular phase”) and then sesame and sunflower seeds during the second half (after ovulation until your period starts again, the “luteal phase”). And if you have no period, you’re told to follow the cycle of the moon, taking the flax/pumpkin seeds from full moon to new moon, and the sesame/sunflower combo from new moon to full moon.

quick summary of evidence-based recommendations:

I find no support in the medical literature for the idea of switching seeds based on cycle phase, in fact, every study uses one (or two) seeds consistently for weeks to months at a time before benefits are seen. The highest quality evidence suggests flax seed for increasing luteal phase length, and sesame seeds for women with PCOS (increases sex homone binding globulin, which is typically low in women with PCOS). I recommend using these seeds consistently, not switching back and forth. If you do not currently have menstrual cycles, the strongest evidence suggests benefits of daily flax seed consumption.

Info on seed cycling

In some places discussions of seed cycling seems reasonable – like this article at Natural Health Perspectives, or this one at Herbal Academy where they discuss the lignans from the seed hulls as helping to modulate hormones (these are phytoestrogens that can affect your hormone levels) and fatty acids in the seed body that provide omega fatty acids that provide the building blocks for making the hormones estradiol and progesterone.  And then there seems to be a protocol making the rounds where the explanation is that during the follicular phase that you use flax and pumpkin seeds “to block excess estrogen” and then sesame and sunflower seeds during the second half of the cycle “to help block excess estrogen”. Um, what? that makes no sense. There are times in your cycle when you need and want estrogen! (like when the follicle is growing during the follicular phase).

In line with my ongoing series examining supplement use and recovery of missing periods (hypothalamic amenorrhea), I wanted to examine the scientific underpinnings of this idea. Is there any real basis to switching seeds during the middle of the cycle (especially when the explanation of how the seeds are affecting hormones seems to be the same in both phases…)?

what is the evidence for seed cycling?

If you look in the medical literature (pubmed or google scholar searches), there are no published studies comparing seed cycling with any kind of control, or looking at alterations in hormone levels when using the variation of seeds. So the only evidence we have is inference from other studies, and anecdotes.

There is some evidence for the individual seeds. I covered flax seed in a recent post, In summary, flax seed has been shown in clinical studies to be associated with more ovulatory cycles, longer luteal phase, lower stress hormones and perception of stress. I do think that having 10g (ground) flax seed per day is a worthwhile addition to your daily fare, based not only on the cycle related benefits I just listed, but also overall health benefits.

So now let’s look at the other seeds. In seed cycling, flax seed is supposed to be paired with pumpkin seed. Continue reading

Energy Balance and No Period…

Why is it that some women have no period, where others, in seemingly the same situation with exercise and energy consumption continue to menstruate regularly?

A possible explanation for this difference was recently offered by researchers in Sweden. Instead of looking at energy balance or availability for a whole day, as is the standard in energetic research, they computed energy balance on an hourly basis.

Before we get into the meat of the paper, it’s results, and my analysis, a few terms that might be helpful to understand:

  • energy balance: Total energy intake (kcal) minus total energy expenditure, i.e., resting metabolism + daily living + exercise.
  • resting metabolism: calories burned to fuel involuntary processes: pumping blood, fueling brain, building muscle and bone
  • glycogen: stores energy in the liver for short term use, ~300 kcal worth (Farenholtz et. al, 2017)
  • kcal: short for kilocalorie, measure of energy. In the US we usually say “calorie” instead.
  • negative energy balance: more calories expended than consumed; during small deficits, liver glycogen can make up the difference. During larger deficits (e.g., < -300 kcal), fuel is obtained from other body stores, for example, fat and muscle (called catabolism).

Alright – getting back to the paper. The findings were remarkable; the average time with a negative energy balance of < -300 kcal for athletes with regular periods was 17.6 hours (Interquartile range (IQR) 3.9 – 20.8 hours), versus 21.8 hours in athletes with no periods (IQR 17.8 – 22.4). Athletes with no periods were in a catabolic state (negative energy balance) for four more hours per day than athletes with regular periods.

What I found really interesting was a diagram the researchers included, illustrating how hourly energy balance was calculated. This example shows a period of significant energy deficit at night, with no positive energy balance until the middle of the day (presumably lunchtime). Thinking of energy balance on an hourly basis like this rather than simply the amount of energy consumed in a day leads me to wonder if this might be part of the reason some women can be “all in” for 6+ months without period restoration, where others resume cycles within just 6-12 weeks. Continue reading

No period or irregular periods? Flax seed might help

There are multiple benefits to consuming flax seed, that I’ve discovered as I research the seeds used in seed cycling. 1) Fewer anovulatory cycles in normal cycling women, 2) longer luteal phase with higher progesterone/estradiol ratio, 3) reduced stress hormones and perception of stress, 4) a number of more general health benefits including improved lipid profile, reduction in risk of cardiovascular disease, decreased A1c in type II diabetics, and potentially cancer prevention. I will discuss the first three in this post – for an excellent review of the other health benefits, please see this article.

There are three major components in flax seed that are thought to have health benefits – the fiber (6% of dry weight), the lignan alpha-linoleic acid (20%), and the phytoestrogen precursor secoisolariciresinol diglucoside (SDG, 1%). One can consume either whole (ground) flax seed or lignan or SDG extracts. If you’re trying to recover your period I would recommend ground flax as the relevant studies were mostly performed with that rather than extracts. For other health benefits, I would suggest looking more closely at the studies (in this review, for example) to determine whether they used extract or whole flax (many used specific extracts).

Flax seed and menstrual cycles

Hormone levels and menstrual cycle parameters in women consuming 10g flax seed per day were examined for the duration of three menstrual cycles (comparing with three menstrual cycles in the same women where no flax was consumed but diet remained otherwise the same). For each woman, the second and third cycles were examined.

There were two important findings. First, there were no anovulatory cycles (0/36 cycles in 18 women) in women consuming flax seed compared with three anovulatory cycles during the control phase (3/36 cycles in 18 women, anovulation occurred in three different women).

Second, luteal phase when consuming flax seed was 1.2 days longer than with no flax seed consumption. I loved that this paper actually graphed the change in luteal phase between the flax/no flax cycles rather than just reporting averages: 1 woman had a shorter LP by 1 day, five women had no change, one had half a day longer LP, five had a 1-day longer LP, two had a 1.5-day longer LP, and one each had 2, 2.5, 3.5, and 4.5 day longer LPs! Both of these results suggest that daily flax seed consumption might be beneficial for women trying to regulate periods, and those with short luteal phases (another tool to add to the short LP arsenal!)

When hormone levels were examined, there were no significant changes in any hormones: estradiol in the early or mid-follicular phase, or progesterone or estradiol during the luteal phase. Testosterone levels during the mid-follicular phase were about 10% higher, a significant difference. The researchers speculated this might affect the luteal phase length. There were also 25% higher progesterone to estradiol ratios during the luteal phase (non-significant 10% higher progesterone and ~15% lower estradiol combined to give a significantly higher P/E2 ratio under flax seed consumption). This could potentially explain the longer luteal phases.

flax seed and improved stress perception

Another set of studies seem to show positive effects of flax seed consumption on hormones associated with stress response, and this is where I think that flax seed might help those who are working toward recovering missing periods, but not there yet.

The first study I want to tell you about looked at stress markers in mice fed either a control diet, or one that contained a commonly used anti-depressant (imipramine), pomegranate peel extract or flax seed extract. After 50 days various hormones were measured – cortisol, epinephrine, and norepinephrine. Flax seed extract and imipramine showed similar levels of decrease in each of these hormones, which is great for someone trying to recover from hypothalamic amenorrhea / no period, as each of those hormones help suppress the hypothalamus – decreasing levels will only help get the hypothalamus going again!

35 postmenopausal women consumed different varieties of flaxseed containing varied levels of two active components SDG and alpha-linoleic acid. Blood pressure was used as a marker of stress, and all three types of flax seed reduced blood pressure during a frustrating cognitive task, in comparison with the same task without flax seed consumption (the study was a crossover design so some women took the test with flax seed first and without second, for others the order was reversed so the reduction in blood pressure was not due to having taken the test before.) All three varieties reduced plasma cortisol as well, but the Linola 989 variety with the highest SDG showed the highest reduction.

flax seed recommendations

I started researching the effects of flax seed in the context of seed cycling. As I read the scientific literature I noted that there was not a single study that alternated seed types – all the medical literature I could find had people (or animals) taking one seed type consistently. I will present the evidence on the other seeds included in “seed cycling” shortly (pumpkin, sesame, and sunflower seeds) but I have not found any evidence to suggest value in changing between seed types.

Studies show flax alone has the potential to reduce stress hormones, and have positive effects both on the follicular phase (including ovulation) and the luteal phase of a menstrual cycle. Based on the reduction in stress hormones and perceived stress, along with other health benefits and no adverse consequences, I see no reason not to add flax seed to your arsenal as you work to restore missing menstrual cycles or to potentially help with normalizing menstrual cycles that are wonky for other reasons. Instead of making yourself crazy trying to figure out what seeds to take when, as one has to do with “seed cycling”, simply eating ground flax seed every day (the other seeds could be added as you like) might be beneficial. Note that as with other supplements, it is unlikely that taking flax alone, without increasing food intake, reducing high intensity exercise, and reducing stress will be successful. Check out No Period. Now What? for evidence and recommendations on how to do all this.

This is the ground flax I use, from BJs . My mom started adding flax seed to the yogurt she had for lunch every day ages ago, I tried it and liked it, and started adding it too (along with chia seeds, ’cause I like the crunch).

I’d suggest 10g/d as a reasonable amount based on the study finding fewer anovulatory cycles and longer luteal phases. For other health benefits, again, please examine the specific literature to find the optimal form of flax to use and what dose.

Also, note that there have not been any detrimental effects found with flax seed so far for most people, but the recommendation is not to consume flax in large quantities while pregnant as studies in rats do show some negative effects (included in this review). I wouldn’t stress if you’re pregnant and have some, but probably best not to have daily.

 

 

 

 

Can Maca help restore periods?

Can maca help restore a missing period?

A little while back I did a survey of women in my “No Period. Now What?” facebook support group and found that among 53 women 63 supplements were being taken with the idea of helping to restore missing periods. Maca was taken by 10 of these women, so I thought we’d investigate it next. Thanks to Eryn for digging up some references!

Overview of Maca

Maca, aka Lepidium meyenii, is grown in the central Andes. The part that is eaten is the “hypocotyl”, a tuberous root-like structure that is a storage organ for nutrients. Maca has been cultivated and used for food and medicinal  purposes for hundreds of years.

From https://doi.org/10.1016/j.phytochem.2015.02.030 Creative Commons License 4.0

Maca and period restoration

Our question is whether maca can be useful in a woman trying to restore menstrual cycles. I was rather surprised after reading some abstracts to find that there were hints of potential usefulness of this supplement – but after reading the full studies, my conclusion is that while maca is not going to hurt recovery, it is unlikely to help either.

In the first study, rats were fed dried maca powder as 5%, 25%, or 50% of their diet. Seven weeks later, during the “pro-estrus” phase (like the follicular phase in humans) hormones were measured, and in the rats consuming 50% maca, a 4.5-fold elevation in LH levels and 19-fold elevation in FSH levels were seen. This elevation was dose dependent (meaning elevations were seen at lower amounts consumed as well, in proportion to the amount of maca). However, there are two key points missing from the abstract, which is where that info comes from. One is that there was essentially no elevation at the lowest dose, 5% of feed, which is about 3g/kg/day.  The second point was that these elevations were very transient, seen only at the time of the pre-ovulatory surge. There was not an overall increase in LH levels.

The huge elevations in LH are clearly not reproducible in humans, because 50% of our diet as maca powder is not feasible. Even 3 grams per kilogram, i.e., 180 grams per day in someone weighing 60kg (about 130 lb) doesn’t jibe with the dosages normally prescribed. A website selling maca powder indicates that a serving is about 9 grams. In the Andes, people will often eat 100-200g of the root 2-3 times a week, a much higher amount than what is realistically available to those of us outside Peru.

https://www.themacateam.com/raw-red-maca

There are a few other studies in rodents, but unfortunately not much in humans to support or refute these results. A study performed in men (due to positive effects on sperm parameters) showed no change in FSH, LH, estradiol, prolactin, or testosterone while taking 1.5 or 3g of maca for up to 12 weeks.

These two results, an elevation in the levels of LH and FSH *only* during the pre-ovulatory surge in mice, and no change in reproductive hormones in males in response to maca suggest that maca is not going to help with no periods based on a hormonal mechanism.

MACA TOXICITY

As I was researching the toxicity of maca (which seems to be zero), I came across an article where they did a double-blind, placebo-controlled study looking at a number of health outcomes after consuming maca (3g/day) for 12 weeks (197 subjects across all groups). The health outcomes were assessed on a weekly basis, giving a really nice data set. There were no adverse events reported which is great, and they reference another study that found no toxicity in rats at up to 17g/kg, which is an enormous amount, so maca seems to be very safe to eat.

GENERAL HEALTH EFFECTS OF MACA

Some of the health outcomes that were measured in the study I just mentioned and found to be significantly different from placebo (on top of a placebo effect!) may be of interest to readers – improved libido, energy, mood, and “Health Related Quality of Life” score. The “HRQL” is a 36-question survey that contains “five items related to general health, five items related to physical activities associated with current health status, two items related to limitations on work or other regular daily activities as a consequence of reduced physical health, two items on bodily pain, one item about vitality, and five items on mental health [].”

This study suggests that there may be other reasons to take maca than period restoration per se… it may help with overall quality of life while you are working to recover. And in someone who is at a “fertile BMI,” not doing high intensity exercise, but still stressed and anxious… maybe something like maca could help with the mental stress part.

MACA for Missing periods?

My ultimate conclusion is if you like maca, go ahead and have some (after checking the sourcing, see below), but don’t feel like this is something that you need to go out and get to help you restore your missing period. It may have some mood boosting effects that could be helpful during recovery in other ways though.

I will leave you with a quote from a recent review of maca,

To date, the health claims of maca cannot be fully supported from a scientific standpoint and more research is needed. It appears that the indigenous local knowledge about the health benefits of maca has been dragged out of context to fit the demands of a growing market for herbal remedies. This globalisation (or hype esp. in China) also has had serious consequences for the local producers in Peru. The lack of protocols to regulate the production and marketing of maca during this rapid expansion, poses a threat to both the safety of consumers and the sustainability of supply.

<3

Nico

Acetyl-L-Carnitine and Restoring Missing Periods

Continuing my series of posts on supplements and recovery of mising periods… overview here, and post on Vitex here 🙂 I am going to review acetyl-l-carnitine next as it is a supplement for which there is evidence for effectiveness in restoring missing menstrual periods from controlled clinical studies. Thanks to Addie for helping with the research!

Here’s a table of contents for this post, as it ended up being super long!!

Alright, let’s get started. First, acetyl-L-carnitine, also known as L-acetylcarnitine, ALC, or ALCAR, is a derivative of the amino acid L-carnitine (aka levocarnitine). L-carnitine acts as a recipient of an acetyl group in a reaction that releases CoA for use in the Krebs cycle that generates energy (ATP) in the mitochondria. ALC is naturally synthesized in our bodies on an ongoing basis, and crosses the blood/brain barrier, therefore potentially affecting brain hormones, chemistry, or brain function. Studies have been performed examining the effectiveness of ALC in a number of indications, ranging from diabetic neuropathy to Alzheimer’s disease.

Chemical structure of Acetyl-L-Carnitine:

By Ed (Edgar181) - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=31705679

Continue reading

Does Vitex Help Restore Missing Periods?

why would I use vitex, and WHAT IS it?

To determine what supplements women might use to try and restore missing periods, I did a quick survey of women in my “No Period. Now What?” facebook support group. The most common herb/supplement mentioned  was Vitex, taken by over a third of those who responded to my survey (21/53). Vitex is a shortened name for Vitex Agnus Castus also known as Chasteberry.  Most women reported taking “vitex’, but some said “agnus castus” or “chasteberry” – as far as I can tell they are synonyms. It’s a small, bushy plant, with pretty purple flowers and small brown berries.

Vitex-agnus-castus-foliage

RESEARCH METHODS

I did a search of the medical literature using the following queries in pubmed to find research relevant to understanding whether vitex can help restore a missing period.

Vitex fertility
Vitex amenorrhea
Vitex oligomenorrhea
Vitex luteal phase
Vitex follicular phase
Vitex progesterone
Vitex estrogen
Vitex osteoporosis

RESULTS

The searches came up with between 5-25 results, many overlapping between searches. I read through abstracts where available (a few articles were in languages I don’t speak, or had no abstract available) and the full article if the abstract seemed relevant and I wanted to learn more.

My conclusion is that Vitex Agnus Castus does NOT lead to restoration of cycles in someone experiencing hypothalamic amenorrhea (unless that amenorrhea is due to elevated levels of prolactin), and may in fact be hindering the return of a missing period.

Continue reading

Supplements to Recover Missing Periods?

I recently asked in my Facebook support group what supplements women had used while trying to recover from hypothalamic amenorrhea / no period as I wanted to look further into the science behind each of them. I was astounded at the range of answers – 53 women used one or more of 65 different supplements!

Can pills help recover missing periods?

By Root66 (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

How do I restore missing periods?

Unfortunately, many women are prescribed supplements instead of what we all know works – eating more, exercising less (particularly less high intensity exercise), and reducing stress. A common refrain was captured well by one poster:

Ellen: Oooh, I’ve tried so many supplements in hopes of sidestepping real lifestyle change! I’ve dabbled with vitex, maca, soy, estroven, bulletproof diet recipes, acupuncture…while some (acupuncture) really benefited me in other aspects like stress level, none served as proxies for eating bravely and resting bravely- which I am finally giving a go.

It is really important to take heed of what Ellen says – there is no way around making lifestyle changes, which you can learn more about in our book, No Period. Now What?. If you have no period due to HA, while you might (possibly – success is not guaranteed!) be able to get pregnant using injectable gonadotropins or IVF, those are not going to restore your system to balance or bring back that missing period / cycle. In the words of another wise woman: Continue reading

Menstrual Cycle Hormones

Whenever someone asks me about levels of menstrual cycle-related hormones during their cycle and the answer isn’t obvious I go to the figure below from Wikimedia (this article). What I love about it is that it shows the average (bold blue line) and then the biological variability around that average (dark blue shaded area)… and then also how much this can vary between cycles and between women.The figure is based on a study performed in 2006 that measured hormone levels in 20 ‘normally cycling women’ not on birth control pills. The data were reanalyzed in 2014 and these figures created.

One example of when I might refer to these figures is if someone tells me that they’ve just had blood drawn, they don’t know what cycle day they’re on (e.g. have not yet had their first post-HA or first postpartum period), and LH was measured at 17 and estradiol at 215 pg/mL. I can check these figures and see that that most likely corresponds to just before ovulation. If LH is 17 and e2 is 85 pg/mL that might mean that ovulation has just occurred. If LH is 17 and estradiol is 30 pg/mL then I might suggest inducing a bleed and testing a hormone panel to determine if PCOS might be in play.

I think what is unique and particularly helpful in these figures is the inclusion of variability so one has an idea of the typical range for these hormones. Let me know if you have any questions!

Nico

 

 

Do you really ovulate “late”?

Some women, as they recover from hypothalamic amenorrhea (missing periods), will be worried that they are ovulating “late” in their cycle, maybe Cycle Day 21, 22… but then they get their period around the normal time, maybe CD 28-30.

In some cases, and this was true for me, the issue is the short luteal phase (the time between ovulation and when your period arrives) leading to a seemingly long follicular phase (time between period and ovulation).

When I tracked my ovulations and periods carefully I noticed that my ovulations were routinely 28-30 days apart, as expected. So it wasn’t that the ovulation was messed up, it was more that my period wasn’t aligning with the ovulation as in a normal cycle. A similar phenomenon was observed in a research study where women with short luteal phases were observed to have longer follicular phases (this was not the main focus of the study, but my observation from data reported in Table 2).

My theory is that to some degree, our period and then subsequent ovulation are actually hormonally separate events. The period comes because of a drop in progesterone, that is unrelated to the decrease in estrogen that primes the small increase in FSH to start the new follicle growing. So in a woman with a short luteal phase, the drop in progesterone occurs early, leading to an early period – but that does NOT drive the start of follicular growth, which waits for a few days and then begins, on its regular 28 day cycle.

I know this is confusing, so check out these diagrams. Here’s a normal cycle…the small increase in FSH at the beginning leads to growth of the egg-containing follicle. In the middle of the cycle, around CD12-13, LH spikes leading to ovulation around CD14. After ovulation, the follicular structure collapses into the “corpus luteum” which starts secreting progesterone by around CD16. When progesterone levels fall approximately 12 days later, the period starts, FSH increases, and the whole cycle begins again – with ovulation around CD14 and period around CD28.

Here’s my view of what is happening when one has a short luteal phase. Let’s imagine that the first period in this diagram was induced by Provera and then Clomid is used to start the follicular growth. So the follicular phase proceeds just as above – a small increase in FSH leads to growth of the egg-containing follicle, LH spikes around CD12-13, and ovulation happens on CD14. This is where things aren’t working quite right – the corpus luteum forms, but isn’t making enough progesterone. So the increase in progesterone is lower, and for a shorter amount of time. This leads to an early period – in this diagram, about a week early, for a 6 to 7 day luteal phase.

This leads to what I’m terming the “apparent cycle day” in the figure – menses have started, so ostensibly it’s CD1 again. However. The OTHER hormones involved in the cycle are not at CD1 levels yet. They are still at CD22, 23, 24 levels. The estrogen needs to drop further to instigate the increase in FSH to start the follicular growth… and THOSE hormones are not affected by the lack of proesterone. They continue along their merry way as if it’s CD 22-28, not caring that you’re bleeding already and *think* it’s CD1. So then you get to CD14 and think that ovulation should be happening… but it doesn’t. So you get frustrated (trust me, I know!!) But in reality, your other hormones are on their normal 28-30 day cycle, when when you get to where CD14 would have been if your period had come on time at CD28, that’s when you ovulate. Does that make sense? If not, feel free to drop a question in the comments!

To further illustrate this, here’s a table with my cycle data (this was after my second son was born in September 2008… my first postpartum ovulation was 7/29/2009 while I was still breastfeeding morning and night. I got my period just five days later on 8/3/09, for a four day luteal phase. This cycle isn’t a great example as the cycle is long as is common in initial postpartum or recovery cycles. However the next one (cycle #2) is a perfect example. After only a six-day luteal phase, I got my peiod on 9/15/09 – had it been a normal length LP (e.g., CD14 ovulation, CD28 period start), my period would have come on 9/21/09 instead. I then ovulated on 10/6/09, which based on when my period actually started was apparently CD22… but had my period come when it “should have”… the ovulation would have been CD15.

One anomalous cycle happens on cycle 10 – I had gotten pregnant the cycle before, but unfortunately had a miscarriage that was resolved after two D&Cs. After that I started to use progesterone suppositories to support my luteal phase, which leads to close to normal LPs and pretty close to CD14 ovulation. I did NOT use progesterone on cycles 15 or 16… leading to shorter luteal phase and apparent later ovulation!

You can see from this data set that there’s a fair bit of variability between cycles – compare the days between ovulation and you see that mostly they’re around ~28-30 days, but there are a few that are shorter, and a few that ar longer. I know that some women are like clockwork, but that is certainly not true for me!!

I hope this helps explain why a short luteal phase and longer apparently follicular phase are associated – again, feel free to ask any questions you may have – or please share if this has been your experience as well – or not!

xox Nico

P.S. Check out Chapter 19 in No Period. Now What? for a LOT more information on luteal phases, why they might be short, and what you can do about it!!

Femara or Clomid for Ovulation Induction?

Summary: If you are not ovulating naturally even after working on recovery, and want to use medication to induce ovulation for pregnancy, Femara (letrozole) is preferable to Clomid (clomiphene)*.

letrozol3d

 

 

Letrozole, By MindZiper – Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=15991603

 

In No Period. Now What? (NPNW), our book on hypothalamic amenorrhea recovery, Chapter 21 covers the oral medications that can be used to encourage ovulation. We discuss how soy isoflavones, Femara, Clomid, and tamoxifen reduce estrogen levels to encourage an increase in follicle-stimulating hormone (FSH) that in turn leads to growth and maturation of eggs. These medications can be used when pregnancy is desired, but also to “jump-start” menstrual cycles*. It is really important to note that these meds are unlikely to work without progress having made toward recovery in the form of increased eating, reduced exercise, and reduced psychological stress – all of which you can read about in earlier sections in our book.

clomifene_ball-and-stick

 

 

Clomiphene, by MarinaVladivostok (Own work) [CC0], via Wikimedia Commons

 

 

We also cover research comparing pregnancy rates, likelihood of a multiple-gestation pregnancy, uterine lining thickness, and other metrics between Femara (letrozole) and Clomid (clomiphene citrate) to help women decide which choice is optimal for them. (Tamoxifen is an alternate that is rarely used, so there is not a large body of research to reference, although in many ways it is preferable to Clomid based on fewer effects on the uterine lining.) We also discuss dosing recommendations, what to do if the first cycle doesn’t work, and much more. 🙂

Our conclusion in NPNW is that if one is trying to get pregnant, Continue reading