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

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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.

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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