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Dr. Vamsee Thalluri
We don\'t often talk about our ovaries. But when you consider that 1 in 10 women are affected by Polycycstic Ovary Syndrome (PCOS), we need to!
Just like 1 in 10 people are left-handed, or 1 in 12 have asthma - are we not talking about PCOS because we\'re not immediately affected by it? Maybe. But how do you know you\'re not?
Many women don’t find out that they have PCOS until they are actively trying to get pregnant, have trouble and then look to get their fertility hormones tested.
In fact, research estimates that about 70% of women with PCOS are either misdiagnosed or undiagnosed.
We deserve this information, and we deserve it much earlier in life!
PCOS is a condition where your reproductive hormones, more specifically, androgens (male sex hormones; like testosterone and DHEA) are out of balance. This imbalance encourages the ovaries to produce way more androgens than they should.
Studies have not been conclusive about how some women get PCOS and others don\'t. But researchers believe there are two things that can play a role:
🧬Genetics: Women with relatives with PCOS are more likely to have PCOS.
😈Insulin Resistance: When insulin is not working effectively, the body produces more insulin. When there’s more insulin hanging out in the blood, this can increase the production of androgens such as testosterone, causing an imbalance of hormones.
In Australia, the most widely-accepted criteria for diagnosing PCOS is known as the Rotterdam Criteria 2003.
If you show two of three of the following symptoms, it is grounds for a diagnosis:
For women who want to fall pregnant, getting told you have PCOS can feel like you\'ve just been passed a fertility bomb.
Despite its damning name, you can still have PCOS and not have cysts on your ovaries. But if you do, this is what’s happening.
Your ovaries are filled with immature follicles. Each month, a small group of these follicles are told by your reproductive hormones that they need to start growing.
If you ovulate, one of those follicles emerges as the dominant one - larger than the others - and basically tells the other follicles to take a hike.
However, if you don’t ovulate (which is sometimes what happens with PCOS), then you will not form a dominant follicle and suppress the other follicles.
Instead, the other follicles will keep on growing just a lil\' bit. The problem with this is that you end up with many small, undeveloped follicles. These undeveloped follicles are officially called \'cysts.\' This is what shows up in your ultrasound.
Symptoms for PCOS can be different for every woman. You could experience one or a combination of the following:
Bear in mind, if you\'re currently using hormonal contraceptives - these symptoms can be masked. In other words, as soon as you come off hormonal contraception, you might start noticing them again.
Also, if you had any of these symptoms before you went on hormonal contraception, they may still persist once you come off it.
As we mentioned earlier, PCOS is a commonly misdiagnosed or undiagnosed condition. This becomes a bigger problem beyond your fertility if it\'s not managed properly.
Poorly managed PCOS can sometimes lead to lifelong increased health risks - such as type 2 diabetes, heart disease, endometrial cancer and high blood pressure.
It\'s important that if you have PCOS, or suspect you may have the syndrome, you build relationships with doctors who are experienced and well-versed in PCOS. You may be referred to a gynaecologist as well.
Women with PCOS have irregular ovulation. This makes it hard to predict the timing of ovulation, if ovulation happens at all. Why does this matter? Well, in order to get pregnant you need 4 things:
Most women with PCOS will take longer to get pregnant because they might only release an egg every couple of months or perhaps not at all. But, there are options you can take to kickstart or regulate ovulation (more on this later!).
It\'s not a life-long fertility sentence - many women with PCOS go on to have healthy pregnancies and deliver healthy babies.
If you have PCOS and are struggling with any of the these symptoms, the first thing you need to do is make some lifestyle changes.
Studies have shown that weight loss of 5-10% can make a big difference in:
Come on, even the most anti-gym goer can admit - that is a lot in return for a max of 40 minutes of moderate exercise everyday.
Experts typically look at this based on your BMI, which is the number calculated by considering your weight to height ratio. You can use an online BMI calculator to check yours.
Generally speaking, the goal is to get your BMI to a healthy range, between 20-25.
If your goal is to maintain your BMI, aim for around 20 minutes a day at moderate intensity.
If your goal is to reduce your BMI, aim for around 40 minutes a day at moderate intensity.
If you’re new to exercising, start small! Remember, every bit of physical activity helps, even a brisk walk around the block counts.
Check out the Sweat app. We love it because it\'s designed for all women, regardless of what fitness and exercise level you are. It will help you stay accountable. It offers a lot of variety - jiu jitsu, pilates and boxing to name just a few that caught my eye. If you do love variety, then try out Class Pass which has been designed specifically to help you try a range of new exercise regimes. 😍
There\'s actually no right or wrong way to approach an exercise regime for PCOS. It\'s about finding what you enjoy, so you stick to it.
We don\'t like the word diet either. But research has found that what women eat can significantly help manage PCOS symptoms like acne, weight gain and fertility.
Generally speaking, women with PCOS have elevated insulin levels or insulin resistance. Being able to adjust your diet to keep these levels stable is key to reducing the impact of PCOS symptoms.
In fact, studies have shown that a low-GI diet can help your insulin levels behave.
Quick note on GI (short for Glycemic index): It measures how quickly a particular food raises blood sugar levels. A low-GI diet consists of eating foods that raise blood sugar levels slowly - like steel-cut oats - which help prevent insulin spikes and improves insulin resistance. You might want to introduce some anti-inflammatory foods too. They can assist with fatigue.
We\'ve broken down this into your own cheat guide. Pretty simple really, and there is nothing revolutionary. Just a whole lot of natural whole foods and not a huge deal of processed and packaged foods we\'re afraid.
But, just imagine how good you\'ll feel! 🤩
If you’re struggling with these changes and may need some help with early weight loss, Metformin may be something you discuss with your doctor, as studies have shown that Metformin helps to improve insulin sensitivity in women with PCOS.
Not ovulating regularly? If your BMI is below 35, there are safe medications that can be prescribed to help you release eggs more regularly.
It\'s a treatment either taken orally or can be injected at the beginning of your menstrual cycle. They work by stimulating the ovary to start or regulate your ovulation. The medication is typically called Clomid tablets or gonadotrophin injections.
Your doctor will monitor this treatment carefully by ultrasound and blood tests so they can tell you when you are due to ovulate. This will help you work out when it\'s the best time to schedule baby-making sex.
In Vitro Fertilisation (known as IVF) can be an option for some women. It\'s the most effective fertility treatment available. Yet, it\'s still not guaranteed to work and can be expensive.
The process of IVF starts with injecting fertility drugs to help stimulate your ovaries to start maturing as many eggs as possible. As many eggs as possible are then retrieved from the ovaries with a simple procedure, and combined with sperm in the clinic to fertilise them - with the hope that some embryos will form. If successful, one of these embryos are then transferred and implanted into the uterus.
Before you go jumping down the IVF path, there are a number of things you should consider to decide whether IVF is right for you. We\'ll cover that off in an IVF guide (watch this space!).
Unfortunately, it can. It does increase your risk of some pregnancy complications such as gestational diabetes, high blood pressure and miscarriage.
Which is why obstetricians will screen women with PCOS for diabetes when they become pregnant, and check in again later down the track (between 24 and 28 weeks).
If you are diagnosed, most pregnant women can maintain good blood sugar levels with diet and exercise.
Also, 1 in 7 women with PCOS will need to take insulin shots during the last part of their pregnancy.
Have a chat with your GP or obstetrician who can help you manage or reduce the risk of these complications by monitoring your blood sugar levels and other tell-tale symptoms.
Now, let\'s talk weight for a second. A touchy subject we know but when you\'re pregnant with PCOS, you need to be strict about a weight gain goal.
The best way to keep the weight off? Walking. Even if it\'s just a light 30 minute walk each day.
Hormonal contraceptives can help you balance out the reproductive hormones (in particular, reducing androgens) in your body. This helps manage PCOS symptoms like acne and unwanted hair growth.
Hormonal contraceptives include the pill, patch, ring, the Depo Provera shot, implants (like Implanon) and hormonal IUD. Not all of them will be suitable for you, so you\'ve got to discuss that with your Doctor so you find the right fit.
If you\'re getting into a tough headspace due to your PCOS symptoms, just know that you\'ve got this. It\'s frustrating as hell, but it\'s also in your control.
We believe there is strength in knowledge. By knowing what is happening in your body and what you can do about it can be used to your advantage.
Keep reminding yourself that you’re not alone in this (remember, 1 in 10!). Getting support from your friends, family or health professionals early can help ease the very real emotions you’re experiencing.
LYSN is a great online platform that puts you in touch with psychologists without having to leave the house.
But if you want to see someone in-person, in Australia, there’s a Mental Health Care Plan that you may be able to access if you have Medicare. Talk to your doctor about it - they\'ll find out if you\'re eligible. If you are, you’ll be entitled to access 6-10 sessions with a psychologist per year.
No doubt, PCOS can be a confusing and overwhelming diagnosis to receive. But as you can see, there is plenty you can do to help you take back control.
There is even a community that has been created by people with PCOS to share their experiences and support eachother. They call themselves "cysters" (um, amazing). Cysters often find each other online, through websites like Soul Cysters, in Facebook groups and awareness raising organizations. Get amongst it!
At the very least, find a doctor, endocrinologist or fertility specialist who you trust to help you manage and understand PCOS.
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Dr. Vamsee Thalluri
This guide has been a long time coming.
As with many women’s health issues, there are plenty of questions surrounding Premenstrual Dysphoric Disorder (PMDD), but not enough well-studied or concrete answers.
What we discovered in the process of writing this guide is that there is information (i.e clinical trials and research papers) on PMDD out there, but you have to go digging for it.
Most of it is inconclusive evidence and requires further investigation. Plus, it’s all in science-speak (aka hard to understand).
This means PMDD continues to be poorly understood and in many cases, not managed or diagnosed properly.
This guide aims to nip this misunderstanding in the bud. We’ve done the reading for you and put it into chapter chunks (in case you want to jump around a bit).
Otherwise, keep on reading through the whole guide in its entirety for a full picture of PMDD.
PMDD or Premenstrual Dysphoric Disorder is described as an extreme form of PMS that includes physical and psychological symptoms that are often so severe, they can strain social, family and professional relationships to breaking point.
The most recent statistics we could find on PMDD indicate an estimated 5-10% of reproductive women suffer from PMDD. And they make a good point: ‘This number does not account for missed or misdiagnosis nor women whose ovulatory cycle is suppressed by hormonal, chemical, or surgical means.’
After years of debate, PMDD finally appeared as a distinct psychiatric condition in the Diagnostic and Statistical Manual of Mental Health Disorders (fifth edition) of the American Psychiatric Association in 2013.
Despite the growing body of scientific research into its causes and cures, it’s still a condition that is widely under or misdiagnosed; leaving women to discover it for themselves.
Why is this? The sheer lack of support services for women’s mental health and reproductive support could be one major clue, but medical literature explains the importance of getting the diagnosis right.
PMDD is a disorder of consistent yet irregular change in mental health and behaviours. This irregularity can make it difficult to make a link between PMDD and your symptoms in a psychiatric evaluation.
Treatments are often very different for PMDD from the other mood disorders, so it’s important medical professionals get this diagnosis right.
What’s incredibly alarming is the link between suicide and PMDD; it’s a huge differentiating factor when comparing PMDD with PMS.
The International Association For Premenstrual Disorders (IAPMD) says 30% of women with PMDD will attempt suicide in their lifetime while a larger percentage experience suicidal thoughts and self-harm.
There are over 150 reported symptoms associated with PMS but for PMDD, there is a stricter diagnostic criteria.
So, how can you tell when your PMS symptoms are something more severe?
You need to be experiencing five or more of these 11 symptoms in such a way that your life is severely impacted.
Before you jump to any diagnostic conclusions, it’s important to remember that the reason why there is so much confusion around PMDD diagnosis is because it can be hard to differentiate mild premenstrual symptoms, which may be annoying, but aren’t severe enough to interfere with your daily life.
Let\'s break this down further.
The Psychological Symptoms of PMDD
Most women will experience some form of emotional change in the lead up to their period. You can feel short-tempered, irritable and generally feel low.
But the psychological symptoms of PMDD, to put it into perspective, is when you experience cyclical events of extreme depression that can interfere with your day to day life.
These symptoms will happen a week or two before your period, that’s why they are referred to as ‘cyclical events.’
This psychological symptom of extreme depression can make women suffer debilitating anxiety and have suicidal thoughts.
These kinds of symptoms are what provides the distinct difference between PMDD and PMS; and it is important to know this.
In a quick summary:
PMDD = extremely severe and often disabling hormonal condition that disrupts a woman\'s life and relationships so completely, she may despair that life itself is not worth living.
PMS = painful and annoying symptoms, but typically manageable to carry on with your day to day.
With PMDD you don’t necessarily have good and bad days, it’s not that black and white. Instead, you have days where things are more manageable and days that are ‘slightly better.’
The Physical Symptoms Of PMDD
On paper, the physical symptoms of PMDD sound similar to PMS; bloating, breast tenderness, irritability, fatigue and so on. This is where women are often misdiagnosed or their symptoms are dismissed as being PMS.
Despite this, women with PMDD will often experience PMS-like symptoms at an extreme level, which helps in some way to ensure a correct diagnosis.
The two main physical symptoms women experience with PMDD is fatigue and change in appetite.
Some other women also experience nausea, heart palpitations, dizziness and fainting which fluctuate throughout their menstrual cycle. All of which are side effects of anxiety.
The exact cause of PMDD is still unknown. If you haven’t already ventured down this path of information overload, let us save you a step.
There are two main possible factors widely spoken about:
Some studies have demonstrated that PMDD could have a heritability range between 30-80%. However, a significant limitation for most of these studies is the sample size.
Fortunately, there have been some new discoveries made by the researchers at the National Institute of Mental Health (NIMH), that helps us understand how genetic factors can contribute to a woman’s susceptibility to experience PMDD.
And it has a lot to do with how a woman responds to the sex hormones produced by the ovaries during the luteal phase.
NIMH’s study has found that women with PMDD have an altered gene complex that processes the body’s response to hormones produced by the ovaries.
Why is this important? Well, it has established a biological basis for the mood disturbances of PMDD.
What this means is that the extreme emotional or physiological behaviours of a woman suffering from PMDD are completely out of her voluntary control.
They’ve also published data that supports the theory that the changes in hormone levels, not just the hormones themselves, trigger the symptoms of PMDD.
They are continuing to learn more about this gene complex by recreating what happened in these clinical trials by essentially replicating it in a laboratory setting.
They call it ‘disease in a dish’ which sounds gross, but it’s how they are able to model the human patient that suffers from PMDD to be able to study this more on a molecular level.
NIMH is going to continue studying this gene complex with the aim to help improve future treatments of PMDD patients.
Only time will tell.
Diagnosing PMDD isn’t a straight-forward path. But there’s two main steps that help kick-start the process:
To get a formal diagnosis of PMDD, there is some reliance on the woman to be able to track her daily symptoms for two full monthly cycles.
This self-reporting aims to help your doctor differentiate between mild PMS and moderate to severe PMS and PMDD. They also check if any of your symptoms could be due to another underlying psychological condition or disorder.
There are a number of self-reporting questionnaires and tools that have been listed in medical literature.
Here\'s the main ones we found:
Next time you speak with your Doctor, you could ask them about these tests and see whether they have a different or similar approach when it comes to tracking symptoms.
The following criteria is most widely known for diagnosing PMDD, and it’s broken down into five areas.
One or more of the following must be present.
1) Mood swings, anxious, sadness or tearful and increased sensitivity to rejection. 2) Feeling irritable, angry or having increased conflicts with people around you. 3) Depressed mood, feelings of hopelessness, or self-deprecating thoughts. 4) Experiencing anxiety, tension, and/or feelings of being keyed up or on edge.
One or more of the following must be present in addition to the category of symptoms above.
1) Decreased interest in usual activities.
2) Finding it difficult to concentrate.
3) Feeling lethargic, easily fatigued or have a lack of energy.
4) Change in appetite; overeating or specific food cravings.
5) Sleeping too much, or can’t sleep at all.
6) A sense of being overwhelmed or losing control.
7) Physical symptoms such as breast tenderness or swelling; joint or muscle pain, feeling bloated or weight gain.
And! You must be showing a total of at least five symptoms when combining the emotional and physical symptoms above.
3. The severity of symptoms: These symptoms need to be causing you significant distress and interfering with your work, school, social activities and relationships.
4. Considering other psychiatric disorders: A medical professional will want to rule out the possibility that these symptoms are not a result of another disorder - such as major depressive disorder, panic disorder, persistent depressive disorder or a personality disorder.
5. Confirmation of the disorder: The symptoms need to be present for a minimum of two consecutive menstrual cycles. The criteria also says that the symptoms need to be checked that they aren’t attributable to the physiological effects of a drug substance or another medical condition.
Hang on, if this criteria exists, then why are so many women still getting misdiagnosed or having to discover it for themselves?
Published on Tidings, Stephanie Anderson shares her personal story of how she discovered she had PMDD and talks to Jayashri Kulkarni, a Professor of Psychiatry at Monash University, about the misinformation around PMDD.
Kulkarni talks about the main reasons why PMDD falls under the radar in the medical community.
Short answer: Kulkarni said the medical community takes a fragmented approach to diagnosing PMDD.
Both psychologists and psychiatrists will focus on the mental health and mental symptoms, forgetting about the physical symptoms and body history of the patient.
Given that the nature of PMDD symptoms come and go suddenly within a few days before and just after your period starts, Kulkarni noted that psychological problems don’t operate in the same manner.
Therefore, the key to the diagnosis of PMDD is that the physical and psychological symptoms come and go at the same time of the menstrual cycle.
In Stephanie’s case, she spent time researching the condition herself and took the findings to confirm with her Doctor. Fortunately, her Doctor agreed with her but the same outcome doesn’t happen for a lot of other women.
Despite this, the diagnosis is only the very start of this painful journey. While treatment options exist for PMDD, the most effective are not always prescribed.
And while researchers continue to explore the underlying cause of PMDD, we can continue to hold hope that even more effective treatment is on the horizon.
So what are the most effective options to treat PMDD currently?
Over the years, many treatments have been evaluated for the management of PMDD.
However, the most effective are not always prescribed. Broadly speaking, some PMDD symptoms may be treatable through lifestyle changes, natural remedies or medications. A woman may need only one, or a combination to see any improvement in symptoms.
Here’s what’s recommended, and why:
Serotonin is a naturally-occurring neurotransmitter that helps us to balance our mood and general wellbeing. Hormones changes can cause a serotonin deficiency which has historically been associated with depression. Vitamin B6 deficiency has also been associated with depression as well.
The body needs other nutrients to properly make and use serotonin, including vitamin B6. Another key nutrient for mood is an amino acid called tryptophan which is a precursor to serotonin production.
So filling your diet with foods rich in Tryptophan and Vitamin B6 is the best way to boost your body’s natural production of serotonin.
When you need some Tryptophan in your life, eat:
If you need to up your Vitamin B6, eat:
Even though it hasn’t been well studied for PMDD, there are studies that have found three sessions per week for 60 minutes of aerobic exercise is effective in reducing the symptoms of PMS and PMDD.
If you feel up to it, schedule in some brisk walks, swimming, running or cycling into your diaries. The other benefit is that exercise increases endorphins which helps reduce stress and improve energy levels.
There isn’t much conclusive evidence to show that supplements can improve PMDD symptoms.
But a Chinese Herbal Supplement called Xiao Yao Wan has been widely used as an alternative and effective treatment of depression in China.
One study found this supplement does appear to be effective in improving symptoms in patients with depression. However, it has also been pointed out these trials have poor methodological quality and there is a need for more trials to be conducted that follow international standards.
Before you stock up on the herbs, it\'s recommended you first consult with your Doctor as taking herbal supplements (although natural) can have side effects on other medication you might be taking.
Same deal as herbal supplements, there is limited evidence which supports the efficacy of alternative medicinal interventions such as acupuncture.
However, some studies have shown acupuncture treatment can provide relief in symptoms of PMS and PMDD with a 50% or better reduction.
CBT is a non-drug based therapy that can help women find new ways to behave by changing their thought patterns. In this case, it helps women navigate their behaviour and emotions related to PMS and PMDD.
Studies have experimented with this theory and found there was a significant difference in psychological symptoms before and after Cognitive Behavioural Therapy.
Due to the extreme nature of PMDD symptoms, you might reach a point where natural remedies and treatment isn’t helping at all. That’s when medical treatments may be necessary.
The medical options to treat PMDD are the same as treating PMS medically. The main two are:
However, there are a few things to consider when treating PMDD with these medications.
Multiple studies have confirmed using Selective Serotonin Reuptake Inhibitors for PMDD treatment is effective.
Researchers found that SSRIs kicked in quickly to help women manage their symptoms better within a few days of starting treatment.
Depending on the severity and timing of your symptoms, your doctor may recommend taking the antidepressant medication in the following ways:
Continuous: For women who have severe emotional symptoms such as depression, anxiety, anger and mood swings that happen all cycle round, not just exclusively to premenstrual time.
Luteal phase only: When the medication is taken from day 14 of the cycle (start of ovulation) until the beginning of the period.
Symptom-onset: Taken at the first sign of PMDD symptoms and continued until a few days after bleeding has started.
Are there any side effects I should worry about? Side effects are dependent on the dose but the most common include nausea (which usually resolves within 4 to 5 days of starting therapy), headaches, insomnia and decreased libido.
You may end up trialling different ones to see which ones work best for you and it’s entirely dependent on your symptoms and your cycle. Your doctor can help you decide if this is the right option for you.
Although SRI treatment is considered the first option for treating PMDD symptoms, some women may not want to take them (if they can avoid it) and would prefer to combine their need for contraception and need for PMDD relief.
Taking a COCP has been found to significantly improve the emotional and physical symptoms of PMDD. But it does depend on the type of contraceptive pill you take.
Yaz was the first combined contraceptive to be approved by the FDA (U.S Food and Drug Administration) in 2006 to treat symptoms of premenstrual dysphoric disorder (PMDD) for women who choose to use an oral contraceptive for contraception.
In case you’re interested in why, it’s to do with the ingredients. The type of combination pills that have proven most effective in treating PMDD are those which use a combination of 20mcg ethinyl estradiol and 3mg drospirenone.
But Yaz might not be appropriate for some women.
Treating PMDD requires careful counselling with a Doctor to ensure you are properly informed and recommended the right hormonal contraceptive care. It’s also important to have a plan for follow-up appointments to monitor your symptoms and progress, especially if you’re suffering significant mood symptoms.
One thing to keep in mind is that it’s normal to experience mild PMS symptoms (feeling irritable, fatigued or bloated).
But as soon as your symptoms become more severe and interfere with your life in an extreme way, then it’s important you speak with your Doctor as soon as you can.
Once you approach this conversation, the quicker you can discover your options and figure out what treatment may be able to help ease your symptoms.
Regardless of whether you have full-blown PMS or seeing signs of PMDD, If you haven’t started keeping tabs on your cycles and symptoms yet, it’s not a bad idea to start.
However you do this is up to you! Keep a physical diary, download an app or write some notes in your calendar. And seeing as symptoms happen cyclically, having this insight is going to help you plan to take extra good physical and emotional care of yourself during these difficult days.
One last thing.
Please share this guide with the women in your life if you can. Lifting the lid on these unknown and misinformed topics of women\'s health is how we\'re going to continue helping other women, to make more informed choices about our bodies and feel more connected to those who may be on similar journeys.
If you or someone you know is feeling anxious, experiencing depression or thinking about self-harm, you can call Beyond Blue on 1300 224 636, or even chat via their website which is here. If you think it\'s a bit more of an emergency, you can call Lifeline at 13 11 14, or visit their website here. If you need immediate emergency assistance, please dial 000. International suicide helplines can be found at befrienders.org.
Do you have symptoms that seem to happen like clockwork every time you’re about to get your period? Irritability, crying spells, aches, bloating, the list goes on. But once your period arrives - poof! ✨- these symptoms seem to disappear almost instantly or at least a day or two after?
That, in a nutshell, is PMS, also known as Premenstrual syndrome.
And it’s really, really common.
PMS affects up to 75% of women around 7-14 days before a period.
PMS is defined as a collection of physical and/or psychological symptoms that cyclically (meaning repeat) occur in the luteal phase, the second half of your menstrual cycle.
The amount of pain you feel and the symptoms you experience can change cycle to cycle and can vary greatly between women.
The causes of PMS is not yet well-defined and is a hot topic in the medical research field. The lack of understanding in the past has led to "PMS" becoming a catch-all phrase in pop culture to describe anything related to female hormone issues and emotional episodes.
This needs to change, and thankfully, it\'s starting to.
As further research and conversations surface, we’re beginning to understand more about PMS symptoms, why they are happening, how to manage them, and knowing when our bodies could be telling us its something more serious.
There are over 150 symptoms associated with PMS. All of which can affect how we’re feeling, what we’re thinking and our behaviour. It’s no wonder why we’re often not feeling ourselves when our period approaches. But the nature and frequency of the symptoms can vary greatly.
Some women have predictable PMS symptoms every cycle, others seem to have potluck.
Roughly 80-90% of women with PMS say their most common emotional symptoms are irritability, depression, mood swings and anxiety. And, 50% of women report difficulty in concentrating and forgetfulness. On the physical side, the most common symptoms include bloating, headaches and breast tenderness.
Here\'s a symptoms overview:
These symptoms begin in the luteal phase of your menstrual cycle which is the second half of the menstrual cycle. PMS symptoms start to drop in from Day 14 of a regular 28 day cycle, and can continue right up to a few days after bleeding has started.
There are other factors at play here too. Things like travel, illness, stress, weather changes and other environmental factors may affect ovulation, length of menstrual cycle and the severity of your PMS symptoms.
There’s no single clear theory yet to explain exactly what causes PMS. But there is evidence which suggests it has something to do with how much our reproductive hormones fluctuate when we ovulate and how they impact the neurotransmitter systems in the brain.
Let’s break this explanation down.
PMS symptoms can begin in the early, mid, or late luteal phase. Which is from day 14 of a typical 28-day cycle.
When we ovulate, our ovaries produce high levels of progesterone to start preparing the body for pregnancy.
At the same time, women become susceptible to physical and emotional PMS symptoms such as mood swings, breast tenderness, bloating, headaches and constipation.
The reason why this happens is due to the small changes in oestrogen and progesterone levels in the body. Once they start fluctuating, it starts to affect the chemical messengers in our brain.
Which chemical messengers are we talking about? There’s three.
Now let\'s put this into context with rising levels of progesterone and falling levels of oestrogen.
Oestrogen directly influences the neurotransmitters of serotonin and dopamine. When oestrogen levels are low, this affects the levels of serotonin which can give rise to PMS symptoms around mood and behaviour.
Progesterone fluctuations have been thought to affect how the GABAergic system functions. When the GABA chemical messenger is affected by these fluctuations, it can’t do its job properly in reducing stress, balancing moods and helping the body relax.
While this does provide some answers as to what factors may contribute to certain PMS-like symptoms, the underlying cause of PMS is still unclear. But the good news is there are ways you can treat the symptoms.
We may not be able to tell you exactly what causes it, but at least we can explain ways you can show PMS who’s boss 👊🏼.
PMS can generally be treated using non-medical methods. Here what\'s recommended:
Studies have found three sessions per week for 60 minutes of aerobic exercise is effective in reducing the symptoms of PMS. So start scheduling in some brisk walks, swimming, running or cycling into your diaries. The other benefit is that exercise increases endorphins which helps reduce stress.
We naturally want to retreat when our period approaches which is likely the PMS at work. Perhaps this is one where you need to give into this urge and take up some mindfulness exercises, meditation or practice some yoga.
We love sleep, yet most of us struggle to get enough of it. Unfortunately, one of the PMS symptoms some women experience is insomnia. To combat the nightly tossing and turning, focus on getting enough exercise to encourage deep-sleep, avoid alcohol and keep a sleep diary. Knowing when you struggle with sleep might be able to help you plan your life a bit better around that (i.e avoiding any early morning meetings where your brain isn’t quite awake yet).
Heat provides temporary relief of physical discomfort such as abdominal cramps and back pain, and helps the body de-stress.
CBT is a non-drug based therapy that can help women find new ways to behave by changing their thought patterns. In this case, it helps women navigate their behaviour and emotions related to PMS. Studies have experimented with this theory and found there was a significant difference in psychological symptoms before and after the therapy.
While research on the effectiveness is limited, there are studies which suggest acupuncture can help with both mood and physical related PMS symptoms.
There are two main approaches to treating PMS medically:
If a woman wants to be on contraception, the second approach is prioritised. Whereas if a woman doesn’t want to be on contraception, the first approach is used.
How does serotonin targeting work?
The drugs that have the best proven efficiency and safety are SSRIs (Selective Serotonin Reuptake Inhibitors) which is a type of antidepressant medication. Typically the benefits are seen from the first cycle and if not, the dosage is increased. SSRIs work better for combating mood related symptoms as opposed to physical related symptoms.
SSRIs can be taken in 3 different ways:
Continuous: This is generally recommended for women who have severe emotional symptoms such as depression, anxiety, anger and mood swings that happen all cycle round, not just exclusively to premenstrual time.
Luteal phase only: When the medication is taken from day 14 of the cycle (start of ovulation) until the beginning of the period.
Symptom-onset: Taken at the first sign of PMS symptoms and continued until a few days after bleeding has started.
What are the side effects of SSRIs?
Side effects are dependent on the dose but the most common include nausea (which usually resolves within 4 to 5 days of starting therapy) , headaches, insomnia and decreased libido.
You may end up trialling different ones to see which ones work best for you and it’s entirely dependent on your symptoms and your cycle. Your doctor can help you decide if this is the right option for you.
The COCP (Combined Oral Contraceptive Pill) is used to suppress the changes in ovarian hormones. These hormones have a direct effect on the changes to the chemical messengers in our brains we mentioned earlier: dopamine, serotonin and GABA.
Your doctor may suggest you start a trial using a 4 day placebo period as opposed to a 7 day as these seem to be more effective. If that’s the case, you might be put on a lower dose COCP to begin with. If symptoms persist or you get continuous spotting, your doctor will increase the dose.
If symptoms continue after increasing the dose, your doctor may talk to you about taking the pill continuously without the placebo pills.
Side effects can include weight gain, breast tenderness, headaches and nausea. To learn more about the pros and cons of the COCP, skip to that section in our contraception guide.
While there is no concrete way to positively diagnose PMS, Doctors still work to establish a premenstrual pattern in order to help you find a way to treat your PMS symptoms.
They need to understand if the symptoms you’re experiencing have a relationship with your menstrual cycle. They’ll delve into questions related to your sexual health, menstrual cycle, and your mental health.
The best way for you to be prepared for this discussion is to start tracking your symptoms in a diary (or find a period tracking app) so you have some anecdotal evidence.
Tracking your cycles gives you answers around the length and regularity of your cycles, what types of symptoms you have and the severity of them and how they impact your everyday life.
Beyond your symptoms, your Doctor will also ask about your mood in general to make sure your symptoms aren’t indicating something more serious such as depressive or anxiety disorder. A blood test may be required to rule out any potential medical issues that could be causing the symptoms too.
It’s really important that you don’t put this conversation with your Doctor off. PMS has a significant impact on the lives of women all over the world. And despite the growing awareness, there is still a lack of knowledge about the necessity to consult a doctor or seek treatment for PMS symptoms.
On an even more serious note, while PMS is super common there’s actually a less common (more severe) disorder that affects about 15% of reproductive women. It’s called Pre-Menstrual Dysphoric Disorder (PMDD for short).
PMDD is very different, and far more severe than PMS. It’s now officially recognised in the DSM-5 - the American Psychiatric Association’s classification system which is widely used in Australia.
We strongly encourage you to learn the differences between PMS and PMDD not only for yourself, but for the women around you.
Every woman\'s fertility journey is unique. But when it comes to dealing with something as common as PMS, the more detail we reveal, share, and discuss, the more knowledge we\'ll have to make more informed choices about our health.
1. Hartlage SA, Freels S, Gotman N, Yonkers K. Criteria for premenstrual dysphoric disorder: secondary analyses of relevant data sets. Arch Gen Psychiatry 2012; 69:300.
2. Schmalenberger KM, Eisenlohr-Moul TA, Surana P, et al. Predictors of premenstrual impairment among women undergoing prospective assessment for premenstrual dysphoric disorder: a cycle-level analysis. Psychol Med 2017; 47:1585.
3. Epperson CN, Steiner M, Hartlage SA, et al. Premenstrual dysphoric disorder: evidence for a new category for DSM-5. Am J Psychiatry 2012; 169:465.
4. Budeiri DJ, Li Wan Po A, Dornan JC. Clinical trials of treatments of premenstrual syndrome: entry criteria and scales for measuring treatment outcomes. Br J Obstet Gynaecol 1994; 101:689.
5. Gehlert S, Song IH, Chang CH, Hartlage SA. The prevalence of premenstrual dysphoric disorder in a randomly selected group of urban and rural women. Psychol Med 2009; 39:129.
6. Dennerstein L, Lehert P, Heinemann K. Epidemiology of premenstrual symptoms and disorders. Menopause Int 2012; 18:48.
7. Schmidt PJ, Martinez PE, Nieman LK, et al. Premenstrual Dysphoric Disorder Symptoms Following Ovarian Suppression: Triggered by Change in Ovarian Steroid Levels But Not Continuous Stable Levels. Am J Psychiatry 2017; 174:980.
8. Bethea CL. Regulation of progestin receptors in raphe neurons of steroid-treated monkeys. Neuroendocrinology 1994; 60:50.
9. Marjoribanks J, Brown J, O\'Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev 2013; :CD001396.
10. Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev 2012; :CD006586.
11. Eisenlohr-Moul TA, Girdler SS, Johnson JL, et al. Treatment of premenstrual dysphoria with continuous versus intermittent dosing of oral contraceptives: Results of a three-arm randomized controlled trial. Depress Anxiety 2017; 34:908.
12. O\'Brien PM, Bäckström T, Brown C, et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health 2011; 14:13.
13. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
14. Kulkarni, J. Health Check: why women get PMS and why some are more affected. The Conversation, 2018
15. Prevalence of specific premenstrual symptoms among 1,057 women meeting criteria for moderate-to-severe premenstrual syndrome, Nurses’ Health Study 2 PMS Sub-study (1991–2001).
• DON’T PANIC! COVID-19 (aka coronavirus) is not going to kill us all.
• The most important goal is to #flattenthecurve.
• A few little precautions go a VERY long way.
• Staying in is fun anyway.
• We all need to make sacrifices to benefit society as a whole.
When you read about “coronavirus” you’re reading about COVID-19 (which is short for Coronavirus Disease - 2019). COVID-19 is a new strain of novel coronavirus, which is a type of viral infection that can cause severe respiratory illness in extreme cases.
If you’re older than 25, you might remember a big media storm over a similar disease called SARS back in 2002 and 2003. SARS (short for severe acute respiratory syndrome) is actually a precursor of sorts to COVID-19, in fact, the very same strain of the original SARS epidemic is most likely the cause of the current pandemic.
Both are thought to have originated from bats in China.
Self-isolation is one of the most effective ways to stop the spread of a viral infection. If you, or somebody with whom you have been in direct contact, has been officially diagnosed with COVID-19, it is imperative that you self-isolate for 14 days to ensure that you don’t infect anybody else.
The Australian Government is so serious about stopping the spread that self-isolation is also now enforceable by law if you have travelled overseas, have been diagnosed with COVID-19, or have been asked to self-isolate by a health authority due to a suspected case.
This means you cannot leave your residence for anything, including a trip to the shops, pub, or even a friend’s house, meaning a few simple lifestyle changes are in order to guarantee a fast and successful recovery, or time spent indoors that won’t drive you bonkers.
Not to sound like a broken record, but we will say it again: self-isolation is one of the most effective ways to stop the spread of a viral infection. If you or somebody with whom you have been in direct contact has been officially diagnosed with COVID-19, it is imperative that you self-isolate for 14 days to ensure that you don’t infect anybody else.
There are five main reasons to self-isolate:
In short, somebody will tell you, though it may not be because of a test result, and here’s why:
COVID-19 tests are in dangerously short supply the whole world over. This means that just because you think you need to be tested, or would like to be tested (just to be safe), it might not be possible.
If you arrive at a testing facility you will see all staff in personal protective equipment (like in the movies). To determine whether you qualify, you will be interviewed by a triage nurse who will ask you three questions.
You will only be swabbed if you are displaying symptoms AND:
Close-contact means having spent a significant time within a small distance from somebody who is confirmed, not just having attended a music festival or wedding where one person happened to get a sore throat.
If you do not have symptoms, or do not meet any of those three criteria, you won’t be swabbed, as there simply aren\'t enough swabs to go around (yes, this means don\'t bother going, you\'ll be safer staying home away from the queue of sneezing people anyway).
If you do have any cold or flu symptoms but don’t meet those three criteria, you will still need to self-isolate for 14 days.
If you DO meet the criteria, you will be given a face mask and asked to wait in line to be swabbed. If this happens, you MUST self-isolate until your test results are returned (currently around three days).
You’re also not allowed to travel home from the clinic on any public transport, including taxis and ubers, so be prepared for a long walk if you haven’t arranged a lift with a friend (preferably one with a face mask and hand-sanitizer in the glovebox).
Remember, this might all sound very extreme and confusing, but the sooner we slow the spread, the sooner we all go back to living "normal" lives.
For many, working from home will be an entirely new concept, but it’s a really important measure if you have the luxury of being able to do your job remotely (plus lunch hour is more fun with your partner/TV anyway).
It also comes with a whole array of advantages, including not wearing pants, being able to dress your cat or dog up as your secretary, and making transport to and from the office as simple as walking down the hallway.
But it can also be a bit of a shock to the system for those not used to it. Here are some tips for ensuring a productive day in “the office” when you’re not in the actual office.
Working from home can have many advantages and disadvantages, however you approach it. It can make or break any organisation at a time like a pandemic outbreak, so it’s important to set a few personal rules and stick to them, so that filing good, productive work wearing nothing but undies and a sloppy joe can be beneficial to all.
Food. Without it, you will get hungry, and eventually die. We strongly recommend the regular consumption of food during self-isolation to avoid this outcome.
What will be hard during self-isolation, especially if it is the enforced kind, is getting a decent supply of fresh food into your house (and stomach) without spreading any infection. A trip to the grocery store is off the cards, so try to use home-delivery services.
You can also, of course, get stuff delivered from your favourite restaurants. Now is probably a good time to support these businesses anyway to make sure they’re still there to serve you Aperol Spritzes and the like one we’ve collectively kicked coronavirus’ butt.
Here are the best ways to do that.
There are also meal-kit delivery services that make staying in, but still eating healthy meals that won’t break the bank, a reality. Here are four good ones:
Cancelling your plans to get on a flight to Hawaii for two weeks because 500-odd people have a cough might seem extreme, and it’s easy to get upset with the hysteria whipped up by the media right now, especially when it gets in the way of a beach, a tray of piña coladas, and a luau.
But it is important.
One of the most important things to keep in mind about coronavirus is that we still don’t have loads of information.
Going on the information we do have, it’s probably going to be okay for the most of us. But for a few, it can and will be devastating, and those few could easily be people in your own friendship circles, or even family.
The mortality rate isn’t terrifyingly high, and the symptoms are, for most, manageable. Like 95 per cent of the population, you probably won’t even need to be admitted to a hospital if you were to contract it.
But it’s not about you.
The vulnerable in society (i.e immunosuppressed people including the elderly and those on chemotherapy) are most at risk here, and it’s important that we keep our hospitals at or below capacity to provide the proper care and support to these patients.
Even though you might be “fine” coming down with a case of coronavirus, with mild symptoms for a few days then back to the office, this just isn’t safe, especially with so much still unknown about how COVID-19 spreads.
Worldwide, doctors are currently encouraging everybody to “flatten the curve”. This means slowing down the rate of infection drastically, so that emergency services and health workers aren’t swamped with a litany of cases all at once.
By taking extra precautions, individuals can essentially guarantee a slower, more drawn out pandemic that is far more manageable than a huge outbreak that could leave millions around the world without proper care.⠀⠀⠀⠀⠀⠀⠀
Social distancing is different to self-isolation in that it means you can still leave the house, though with a few precautions in place to stop the spread. This is something that is being heavily recommended around the world right now, for everybody’s sake.
Ways you can socially distance include:
It is also recommended that a few extra precautions are taken when out and about (if you must be out in the first place) to help slow the infection rate of COVID-19. These include:
The Australian Government made this handy resource if you’re still unsure, and remember, with anything like this, it’s better to be safe than sorry.
Unfortunately at times like this, it’s not just a nasty virus that can be shared. The other thing that has a tendency to spread like wildfire is misinformation.
“I heard that <insert wild rumour here>” and “somebody told me <bullshit, bullshit, bullshit>” is seriously unhelpful at a time when the information we do have is a precious commodity.
As such, it’s incredibly important that you don’t fall victim to rumour and hearsay.
Make sure any information you read, or share with anybody, whether on social media or in person, comes from a reliable news outlet, government department or with the relevant tick of approval by a registered doctor.
Misinformation can do a great deal of harm during a global pandemic, but unlike a virus, it doesn’t just spread from person to person without a deliberate action. We are all responsible for this.
• About 1 in 5 medically recognised pregnancies end in miscarriage.
• Miscarriage can happen to anyone, but there are a number of things like age, lifestyle, and underlying medical conditions that can have an impact.
• 80% of pregnancy loss happens within the first trimester.
• Between 50-80% of women who experience a miscarriage become pregnant again. However, it can be an emotionally tumultuous time.
The very first and single most important thing to know about miscarriage is that you are not alone.
When we go through situations that throw us into the pits of grief, shame and utter confusion, it can be difficult to remember this simple fact. While your situation, your experiences and your feelings are unique, it’s important to know there are other women out there who have experienced their own version and can relate, help guide, answer questions or just generally validate your feelings.
Medically, miscarriage may be referred to as spontaneous abortion, miscarriage or early pregnancy loss, all of which refer to a loss prior to 20 weeks, typically within the first trimester. If a loss occurs later than 20 weeks, it’s termed a stillbirth.
So, while this situation is devastating and can be hard to accept, it helps to remember this is your body ensuring the best for yourself during pregnancy and for the overall outcome.
The commonly cited statistic is that about 1 in 5 of medically recognised pregnancies end in miscarriage, according to the American College of Obstetrics and Gynaecology.
The earliest detection of pregnancy is two weeks after implantation, at the first sign of a missed period. Often, women who miscarry in these very early weeks mistake the situation as a late period, never knowing they were pregnant to begin with. On top of that, many fertilised eggs are lost prior to implantation, which is classed as implantation failure.
However, for those who are aware of their pregnancy, miscarriage can happen anywhere along the process of pregnancy. That said, about 80% occur within the first trimester.
Loss after 20 weeks is far less common, with only 2-3% of pregnancies ending into the second trimester.
There is so much information out there on the causes of miscarriage. It can be overwhelming to consider all of the factors that may or may not affect our health on a day-to-day basis, let alone that of our unborn child, and it can often feel like ‘if only you’d done something differently’, maybe this wouldn’t have happened to you.
While certain factors do put some women at higher risk, a miscarriage can happen to anyone, and the number one cause of miscarriage, random genetic error, is completely out of our control.
Essentially, during cell division, chromosomes misalign resulting in errors that would make normal fetal development impossible. Put simply, this is the body’s natural process for expelling a pregnancy that just wouldn’t be able to develop.
On the male side of things, poor sperm parameters – as well as poor lifestyle which increases DNA fragmentation in the sperm – has been associated with miscarriage.
As hard as the reality of losing your unborn child is to cope with, simply knowing that it isn’t your fault helps ease some of the heartache and mental blocks that may arise about the future of your fertility.
So, what factors can put women at a higher risk for miscarriage?
It’s an unfortunate fact of biology that as we age our fertility naturally decreases. We’re born with all of the eggs we’ll ever produce already in our ovaries, which is kind of wild to think about.
While the ability to get pregnant naturally, and carry a full-term, healthy baby will always vary from individual to individual, chances decrease as both women and men age. For a couple in their early 30s, the chances of falling pregnant per month are about 1 in 4, whereas these decrease to 1 in 10 for women over 40.
However, the risk of genetic abnormalities in the pregnancy increases as you get older (this includes through IVF, or in-vitro fertilisation) the chances of random genetic errors occurring also increases. In fact, nearly 80% of miscarriages in women over 35 are the result of chromosomal abnormalities, according to research done by Dr Ruth Lathi of Stanford University.
One study done at the University of New South Wales shows that the risk of any chromosomal abnormality steadily increases with the mother’s age, reaching 1 in 8 by the age of 49.
As always, every individual body is different, and plenty of women are able to conceive and carry viable pregnancies later in life, but it’s important to have all of the information at hand if you’re planning on having children.
In some cases, uterine abnormalities or health conditions may raise your risk of miscarriage. Thankfully, knowing if you have any of these conditions means you can work closely with your doctor to take the best route in decreasing the effects of these issues on your pregnancy.
One such condition is uterine fibroids, the most common benign tumours in women of child-bearing age. Fibroids are associated with infertility in 1-2% of cases, and women who have them are 20-30% more likely to miscarry than women without.
Not all fibroids have an impact on fertility. The only fibroids that have been proven to cause fertility problems are those that impact into the uterine cavity. There is also an increased risk of miscarraige if there is a uterine septum.
If you’re experiencing symptoms of fibroids or know you have them, speak to your doctor about options for treatment and how they may affect your plans to become pregnant.
Other factors that may increase the risk of miscarriage include:
When these diseases are undiagnosed or poorly managed, they drastically increase the risk of fertility issues, recurrent miscarriage and a range of other intrauterine concerns including growth restriction.
However, when diagnosed and managed properly before and during pregnancy, the risk caused by these issues were drastically reduced.
If you suspect you may have, or have been diagnosed with one of the above, talk to your doctor about the best preparation for a healthy pregnancy.
Just up front we’d like to mention that any type of excessive drug or alcohol intake will increase a range of risks during pregnancy, including, but not limited to, chances of miscarriage.
An analysis of a series of studies over the last 50 years strongly proves that alcohol intake and miscarriage rates are closely correlated. Of the participants studied, those who were drinking up to five alcoholic drinks per week increased their risk of miscarriage by 6% with every additional drink.
If you feel you may be at risk of excessive use of substances, speak to your doctor about treatment plans and the best options for a successful pregnancy.
Outside of illegal drug use, it’s also important to note that there are a range of other over-the-counter and prescription drugs that can create complications and increase risks during pregnancy, including some consideration towards nutritional supplements and complementary medicines (such as herbal medicines).
For example, in Denmark, a study of pregnant women using a selection of herbal medicines for general well-being indicated that taking licorice supplements was associated with increased blood pressure. They also found that often the patients’ healthcare providers were unaware of their consumption of alternative medicines.
Overall, the use of alternative medicine during pregnancy is still being studied in detail, but the important thing is to be sure to include any supplements and herbal medications you’re taking in discussion with your doctor.
One Danish study showed that the use of anti-epileptic drugs increased the risk of miscarriage by 13%, while a study out of Quebec suggested that the use of non-steroidal anti-inflammatory drugs (NSAIDs) was associated with a 2.4 times higher risk of miscarriage. However, the Canadian Medical Journal reported that the study didn’t prove these risks were caused by NSAIDs alone.
Being completely open and honest with your doctor about your medical history and anything you currently or have recently taken (including recreationally) will help ensure the best outcome of your pregnancy.
Women whose body mass index (BMI) was classified as overweight by the World Health Organisation (WHO) standards correlated with an increased reoccurrence of miscarriage.
Menstrual disorders, infertility, and sporadic pregnancy loss are associated with women who fall into higher BMI, and complications later in pregnancy including gestational diabetes, hypertension, preeclampsia, thromboembolism, and antepartum stillbirth all increase with higher BMI.
If you feel that your BMI may put you at risk for any of these, we’d recommend speaking with your doctor about weight management or precautions you can take prior to and during your pregnancy.
Strangely, it’s a topic that medical professionals seem to disagree on, with many medical associations claiming that psychological stress doesn’t have any effect on rates of miscarriage. That said, a 2017 analysis of eight medical studies, showed significant evidence that prior psychological stress did indicate an increase in the occurrence of early pregnancy loss.
Psychological stress has a significant negative impact on the nervous, endocrine, and immune systems, therefore it is fair that it raises concerns amongst women, and stress-management should be considered when planning for a pregnancy.
When it comes to the process of supporting new life, it’s understandably easy to worry that something may go wrong, and to err on the side of caution more often than not.
We encourage any woman who is having concerns to see your doctor, because we believe you’ll rest more easily knowing you’ve acted on your concerns.
If you have questions about common symptoms and signs during pregnancy, such as bleeding and cramping, speak to your obstetrician or midwife upfront, they should be able to give you the rundown on what you can expect and what’s not so normal.
That said, here are some common warning signs which warrant a visit to your doctor ASAP.
Spotting during early pregnancy is common and 20-30% of women experience some bleeding within the first trimester.
What many women may not realise is that it’s common to experience what’s known as implantation bleeding. This is when a small amount of spotting occurs when the embryo is implanted into the uterine wall. Implantation bleeding usually occurs around the first couple of days of a missed period, so women may mistake this for a period, even though it’s generally much lighter.
All of that aside, some light bleeding during early pregnancy may be okay, but anything heavy or accompanied by cramping should be cause for concern, including the appearance of clots or tissue. If you are worried about bleeding, go to your doctor or nearby hospital. Depending on the stage of pregnancy, they may be able to do a blood test or scan to hopefully ensure all is OK.
Risk of experiencing one of these can be associated with a Cesarean section, trauma, previous uterine surgery, or the baby’s position in the womb. They are also more likely to occur if you’ve experienced them in prior pregnancy.
While some bleeding may be normal, cramping is not. Women experience cramping during our normal cycle when the uterus is contracting to shed the uterine lining, and we experience cramping during labour when the uterus is contracting to deliver the baby.
Any cramping during pregnancy could be a sign of distress, showing that your body is reacting in a way to expel the pregnancy. This includes back pain, which may not be cause for concern if it’s mild, but we’d recommend speaking to your doctor if any of these occur.
Sometimes a pregnancy just doesn’t progress and the only way you’ll know is when your obstetrician doesn’t find a heartbeat at one of your checkups. There may just be no signs or symptoms.
Bear in mind that morning sickness (or nausea, because let’s be honest, it doesn’t only happen in the morning) usually fades after 13 or 14 weeks, but for some women it can last the entire pregnancy (known as Hyperemesis Gravidarum).
If you are experiencing morning sickness early in your pregnancy and it suddenly stops, particularly if it’s accompanied by any other precautionary signs (such as bleeding or cramping), see your doctor immediately.
As previously mentioned, 80% of pregnancy loss happens within the first trimester. Based on a study out of Victoria, Australia, performed over a two year period at an antenatal clinic, the chance of miscarriage after 13 weeks (with no other symptoms), is low, at 1.6% or less after a healthy gestational visit at 11 weeks.
The same study shows that chances of loss continuously decrease week-on-week as a pregnancy progresses up to 13 weeks.
That said, late term pregnancy loss can still occur, and the above study doesn’t consider any causes other than duration of pregnancy.
When diagnosed as a miscarriage, your doctor may refer to your loss as either complete, incomplete or missed. Complete means all of the pregnancy tissue has already passed, incomplete refers to a scenario when some of the tissue has passed but some still remains in the uterus, and missed is when the pregnancy has stopped growing but the tissue has not passed and the sac surrounding the embryo or foetus is still within the uterus.
Once a loss occurs, there are three treatment options.
The first option is to wait and let the tissue pass naturally, which can take up to two weeks. The experience can be intense, for a number of reasons, not least the pain of the contractions that assist the body to expel the pregnancy. For the most part, in the early stages of pregnancy, it’s healthy for a woman to miscarry naturally, but the situation will depend on your general health, background, and if you feel mentally able.
Women may choose this method to avoid taking medication and avoid needing to stay in the hospital but the difficult side of this aside from the above listed, is that you won’t know how long it will take to start or to pass, which can cause a lot of pain and anxiety.
You can also choose to take medication to expel the tissue within a week, which means less time waiting for the tissue to pass naturally and a less invasive process than the dilation and curettage procedure, known as D&C.
The pros of taking a medical miscarraige include speeding up the process, avoiding being put under anesthetic and avoiding the surgical procedure of the D&C. However, similar to naturally miscarrying, the process can be very painful. Additionally, with both medical miscarraige and natural miscarriage, there will always be a chance that not all pregnancy tissue will pass and you’ll end up needing to proceed with a D&C regardless.
Dilation and curettage
Dilation and curettage is the third option, which is a medical procedure used to dilate the cervix and scrape out the tissue. Many women prefer the procedure of the above options because it’s the fastest option. You’ll also be under anesthetic, which means some of the physical and emotional pain of actually passing the the tissue may be avoided. It’s also much more likely that all of the tissue will be removed the first time around with a D&C.
D&Cs can for the most part be avoided if you prefer not to go through the procedure or have the experience in the hospital, however, the procedure should especially be avoided if you have a pelvic infection, issues with clotting, or other medical issues that may raise concern (your doctor can help you understand the risks).
Complications can arise from D&C procedures including haemorrhage, infection, and perforation of the uterus. Additionally, the procedure comes with a very small risk of Asherman Syndrome, the formation of thick scar tissue, which can lead to infertility. That said, Asherman Syndrome is very rare and generally only occurs in women who’ve had multiple D&Cs.
D&C can be a good option for women who don’t feel prepared to experience the pain and processes of naturally completing a miscarriage, and while it comes with its own risks, with a proper ultrasound and medical pre-check, most can be avoided.
It seems unfair knowing that your body is switched on enough to naturally expel a nonviable pregnancy, but doesn’t recognise that once a stillbirth occurs, there is no need to carry on the rest of the birthing process. Yet, after a stillbirth, breastmilk will still be produced.
This can add to the emotional distress of the event overall, and it’s something that often gets left off when discussing the experience, meaning when it happens, it can feel crueler and more shocking.
First up, women who experience stillbirth are given medication to suppress lactation, so this will hopefully be minimal. However, if any does occur, applying ice packs and taking a mild pain relief tablet will help ease the pain of swollen and engorged breasts which occur due to milk production.
It’s normal to experience cramping similar to labour contractions as your uterus reduces back to normal size. Medication can help ease some of the pain.
Again, there are some natural birthing processes that still must occur during stillbirth, including lochia, which is the heavy period that women experience after birth. Lochia is the body shedding the lining of the womb and blood from where the placenta was attached, generally lasting around two weeks.
In a world where social media makes it easy to put our best life forward for all to see, the world of pregnancy loss can be even more harrowingly lonely and silent.
Nearly 20% of women who experience miscarriage become symptomatic for depression and anxiety. Continuing regular mental health checks starting at 6 weeks after your loss can help you manage these conditions.
Lacking the belief that society understands or accepts your experience can exacerbate these emotions. That’s why it’s important to talk about your loss (when you’re ready) and seek support from friends, family and professionals.
Because miscarriage is so uncommonly discussed, many women and couples will not only not realise it’s common, but are inclined to believe something they’ve done has caused it.
It’s easy (and normal) to be plagued with questions about why any shocking or traumatic experience has happened to you, and pregnancy loss is no exception. Particularly for a mother whose body is carrying the child, it’s easy to feel that something you’ve done has meant you haven’t provided properly for that pregnancy to grow.
But as we mentioned at the very beginning of this guide, not only is pregnancy loss common, it’s often due to completely random development issues, and while there are some factors about the mother’s health that can contribute, they are much less likely to cause miscarriage.
Something else about grief that feels important to mention: healing is not selfish. When you start to feel better (how ever long it takes) it in no way denotes your lack of care or memory of your unborn child.
Healing is healthy, it’s natural, and it will allow you to move back into the swing of things, rebuild connections with friends, family, and your partner, and eventually, if you want to, continue to plan for a family.
Shame is one of the heaviest emotions we are capable of feeling. Different to guilt over our actions or embarrassment over how we’re being perceived, shame denotes our internal feelings about ourselves – the idea that we are fundamentally bad.
It’s one of the top emotions women recall after pregnancy loss. A feeling that your body doesn’t work properly, or that you’ve let your partner down, or worse, that as a mother you haven’t been able to save or care for your baby. Or simply that you are different or worse than everyone else because you weren’t able to carry a full-term pregnancy.
In these cases it’s important to remember not only that miscarriage is common, but that it’s a natural occurrence in the body that cannot be stopped.
Speaking with your doctor after a loss and covering all of the information of what happened is a good option to help ease the questioning in your mind about why something like this has happened.
It may help you feel more in control being armed with the information, to help control the feelings of shame, guilt and loss that occur. It’s a good reminder that the loss wasn’t your fault and that, if you want to try again down the line, it doesn’t mean this will happen again.
One study out of Imperial College in London, surveyed 113 women after early pregnancy loss, monitoring their mental conditions at one, three, and nine month after the event. In this study, 38% of women reported symptoms of PTSD three months after their loss.
The Mayo Clinic defines post-traumatic stress disorder (PTSD) as a mental health condition triggered by experiencing or witnessing a terrifying event. Symptoms can include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event.
Bear in mind that miscarriage is a traumatic experience on a variety of levels, including physically, emotionally and socially. So, the fact that so many experience PTSD as a result, isn’t at all a surprise.
If you feel that you may be experiencing symptoms of PTSD, seek medical support.
Sharing your experience
Talking about your experience openly can help ease the pain, because not only will you be releasing some of the burden of holding your feelings in, but you’ll likely find that many women around you can relate or have had similar experiences, which can make you feel less alone and in turn, make them feel less alone too.
There’s really no way to avoid or ease the sense of loss of a miscarriage, it’s important to take the time you need to heal and to seek help of a mental health professional if you feel that your pain isn’t easing naturally.
As with any traumatic experience, miscarriage can test a relationship and create change. As both partners grieve, it can be difficult to know how to support one another. Many couples report that this experience creates a disconnect in communication.
While everyone has their own way of processing tough emotions, maybe the most important thing to remember is that open, honest communication is key.
Both partners should feel that they are supported in the emotional process and that their own emotions and thoughts are valid. One of the best ways to understand that is through sharing with your partner and getting their own feelings and perspectives.
Remember that as a partner, you’re experiencing both the loss of the unborn child and the pain of watching your partner endure it. And while it’s not your body that’s been through the experience, it will still have traumatic effects.
If you’re having trouble discussing the miscarriage with each other, seek professional help in grieving together. It can be hard to understand how we process and support each other through trauma if we’ve never experienced it in the relationship before.
As the partner of a woman who’s experienced a pregnancy loss, seeking outside support may be beneficial in a number of ways. Particularly, as in the early stages, she may not feel ready or capable of supporting you. Plus, outside or professional support may bring valuable insight that you can share.
The partner who experiences the miscarriage may feel that their partner lacks the depth of grief if they attempt to carry on as normal, such as going back to work or showing less emotion, and that in itself can be hard to deal with.
For both partners, it’s important to remove expectations around how the other should be reacting. Everyone experiences emotions differently, and the most important thing for anyone is knowing their feelings are valid and being given the space to experience them and the support when needed.
The most important thing to consider in any tough situation in partnership is to be kind to each other.
As much as you can try to hear and understand each other’s thoughts, feelings, and emotions, and feel completely comfortable in sharing, it will help you feel stronger and more supported as a couple and as individuals.
If you’re ready to start trying again sooner rather than later after a miscarriage, it’s important to speak to your doctor about if there are any medical reasons for you to wait.
Deciding to try again after miscarriage is a personal choice, and your mental health and physical health should be carefully considered.
That said, a study done at Mater Research Institute at the University of Queensland showed that 66% of couples who experienced stillbirth were able to conceive within the year. The participants themselves, as well as those in another study conducted in Ireland, suggested they required more frequent examinations in their subsequent pregnancies to ease their concerns about recurrent miscarriage or stillbirth.
When you feel ready to start trying again is entirely up to you, as long as you’ve been cleared by your doctor. It’s important to consider all aspects of how you’ve processed the loss and how the new pregnancy might make you feel, but it can be difficult to know until you’re experiencing it, so having the support you need in place can help ease some of the anxieties and concerns that may arise.
As most of the evidence in this guide suggests, miscarriage is fairly common, and they are commonly one-off experiences. Unfortunately, this isn’t the case for everyone.
Approximately 1% of those trying to conceive experience recurrent miscarriages, which are defined as three or more successive miscarriages.
Having a miscarriage can be a traumatic experience, full stop, so understandably, experiencing consecutive losses can take a toll and prevent couples from wanting to continue trying.
There are a few things that can increase the chances of recurrent losses, one of which is repeated genetic errors, which is the cause in 2-5% of couples.
As the leading cause of miscarriage, there is a chance that you or your partner may have chromosomal abnormalities, or the tendency to pass them along, which can be tested with a blood test, called karotyping. If this is the case, working with a geneticist for further testing to determine the cause and risks will be recommended.
Other causes include blood clotting disorders, uterine problems (such as an abnormally shaped uterus) or cervical weakness. But unfortunately, often, recurrent miscarriage cannot be attributed to any one cause.
Between 50-80% of women who experience a miscarriage become pregnant again. However, it can be an emotionally tumultuous time. While you may feel elated and hopeful, the understandable anxieties of a repeat loss will be present.
According to the above study out of the US, 68% of women reported they were still upset two years after their experience and 64% said it affected their decision to become pregnant again.
These stats are real, and being afraid is normal.
No one can tell you what you’ll feel once you do become pregnant after a miscarriage, the most important thing is setting in place the support you need to help you throughout the process mentally and physically.
Perhaps the light at the end of the tunnel of all of this information, is that becoming pregnant again and carrying a full-term, viable pregnancy is likely, and there are plenty of people in place to help you through both the processes of loss, and new pregnancy.
Planning for a baby can be full of exciting and daunting emotions all bundled into one journey.
But, key advice to any future or current expectant parent is to seek information well ahead of time.
As you could probably imagine, when you\'ve just welcomed a new baby into your family, it can be terribly hard to transition back into work straight away. Besides, you want to spend some quality time with your little human!
In Australia, more parents are spending longer at home with their newborn. About 2 in 5 women go back to work when the baby is 7 months or older.
However, sometimes it\'s actually not financially viable for some people to take the entirety of parental leave. And that\'s okay.
But it\'s still important to know the ins and outs of what exactly you are entitled to as an employee. It will give you not only peace of mind, but you\'ll be able to devise a plan on how you will take advantage of this opportunity; while still leaving you financially stable and supported.
There are a number of parental leave entitlements (paid and unpaid) that you may not be aware of, and could be eligible for.
Parental leave allows employees (full-time, part-time or casual) to take time away from work when:
If you fit the above scenario criteria, you are entitled to 12 months of unpaid parental leave, and can request an additional 12 months of leave by chatting to your employer.
The only catch is: you need to have worked for your employer for at least 12 months. If you\'re casual or part-time, you just need to have worked for 12 months on a regular or systematic basis.
And, if you do request the additional 12 months, your employer may refuse this on reasonable business grounds, which needs to be stated in writing.
These entitlements apply both to you as the mother or your partner.
The Australian Government have gone and done a nice thing where they will fund 18 weeks worth of parental leave, at the national minimum wage.
That\'s $740.60 per week before tax. Not too shabby.
Am I eligible? 👇🏼
What other criteria do I need to meet? 👇🏼
What if I\'m self-employed? You\'re still eligible as long as you meet the work test.
By the way, this also doesn\'t affect the unpaid parental leave entitlements. If you are eligible for the paid parental leave, you can get both.
What about the partners? Well, for eligible fathers and partners (including same-sex partners), the Australian Government will fund 2 weeks of leave paid at the minimum wage.
That’s $740.60 per week before tax.
Am I eligible? 👇🏼
What other criteria needs to be met? 👇🏼
More Aussie employers (currently 50%) are starting to fund their employee\'s Parental Leave.
They\'ve finally caught onto the fact that paid parental leave is a pretty attractive component to a modern workplace.
It\'s a great way for companies to attract better talent, encourage diversity and improve the work-life balance of their employees.
And the great thing about this is that you can be paid for both your employers\' paid parental leave AND the Australian Government\'s Paid Parental Leave Scheme.
Double noice 👏🏼
But the amount of time that is offered varies from employer to employer.
Also, the amount paid varies from employer to employer too.
Once you\'ve figured out where you stand in terms of the entitlements offered, you need to give your employer a certain amount of written notice and evidence if they request it.
🙋🏼 How much notice do I need to give my employer?
Under the Fair Work Act, you\'ve got to give your employer 10 weeks notice before starting your leave.
Ideally, this should be in writing and say how much leave you intend to take (and when you intend to take it).
Then, four weeks prior to your planned parental leave date you should confirm your intended leave dates with your employer in writing.
🙋🏼 How far in advance can I take leave before the expected birth or adoption?
Your leave can start up to 6 weeks before the expected birth of your child.
If you want earlier, you can chat with your employer and come to an agreement.
💁🏼 But I want to work right up until the birth, then what?
You might need a medical certificate that states you are fit to work if you want to work through part of the last six weeks of pregnancy.
🙇🏼♀️ OK, I\'ve changed my mind and want to extend my leave - is that okay?
Absolutely. But you will need to give around 4 weeks of notice before your expected return date that you originally agreed on.
You’re entitled to a bunch of extra rights if you happen to be carrying another human life.
If you experience pregnancy-related illness (morning sickness, anyone?) you are able to take sick-leave (instead of dipping into your annual leave).
This special leave is reserved for the mamas out there who are going through the awful experience of a miscarriage, abortion or stillbirth.
Also note that special maternity leave won’t reduce the amount of unpaid parental leave that an employee can take. Take your time.
Regardless of whether or not you’re entitled to maternity leave, all pregnant women are entitled to move to a safe job if it isn’t safe for them to do their usual job because of their pregnancy.
If you move to a safe job, you are still entitled to the same pay rate, hours, or work and other entitlements you get in your usual job. Nothing should change in that regard.
If you\'re not able to find a suitable safe job in your workplace, you\'re entitled to paid No Safe Job Leave. Which means you are paid at the base rate of pay for ordinary hours of work for a full-time or part-time employee.
If you are a casual employee, it will be paid at the base rate of pay (not including casual loading) for the average number of hours you would usually work.
Here are a few extra entitlements to be aware of when you\'re off work caring for your little one.
While you\'re taking parental leave, you\'re allowed to work up to 10 days without ending the parental leave period or formally returning to work if you are taking unpaid parental leave.
The 10 days doesn\'t need to be consecutive either, and can be spaced out according to what you and your employer agree on.
These days are paid at your usual rate and are designed to assist you in keeping in touch with your employer and colleagues while you are on leave.
It\'s a good way to help you return to employment after leave gradually.
Your employer must also consult with you if there are any significant changes to your job while you’re on leave.
You might decide to shorten the amount of leave than originally planned. If that\'s the case, you need to have this discussion with your employer.
In this case, they can choose to agree or not agree. If they don’t agree, you have to return to work on the planned date.
But, there is an exception: If you want to reduce or cancel your period of unpaid leave because of a still birth or death, you can end your leave by giving your employer 4 weeks notice.
If you are taking unpaid leave, you are able to apply to extend your time off. The amount of time will depend on your original leave period.
Extending leave in the first 12 months: You can extend your leave period up to the 12 month limit if your original unpaid leave period was less than that. Your employer needs to agree for anything above and beyond the 12 months.
Extending leave beyond the initial 12 months: If you’ve taken 12 months unpaid parental leave, you can apply to extend your leave to a total of 24 months. But, your employer can refuse the request on reasonable grounds but they need to have a discussion with you first.
You have every right to resign from your job while you\'re on parental leave. Just make sure you give the correct notice period to your employer and use your parental leave as the notice period.
These are your entitlements when it\'s time to return to work after your parental leave.
If you were entitled to parental leave under the Fair Work Act, then you have the right to work guarantee. What this means is that you have the right to reutn to your pre-parental leave position. Exactly the way you left it (unless your employer spoke to you about any changes while you were on leave).
If you were transferred to a safe job before you took leave you are entitled to return to the job you had before the transfer.
If, for some reason, your position no longer exists then you are entitled to another position that is similar in status and pay.
That\'s the work guarantee.
Going back to work while having a little human to care for requires some flexibility. That means you are entitled to request flexible working arrangements if you\'ve worked for at least 12 months with your employer before making the request.
You can ask for things like changes to your start and finish times, job sharing or working from home.
You can also request flexible working arrangements if you are a parent, or have the responsibility of care for a child who is school aged or younger.
Your employer has the right to refuse the request on reasonable business grounds, however, the reasons for refusal must be in writing.
The same goes for casual employees. If you’ve been working for 12 months consistently and have a reasonable expectation of continuing employment with the employer on a regular basis.
It\'s best practice for an employer to support their employees who are breastfeeding by ensuring they have suitable facilities to store and pump breast milk. You should also be given the appropriate breaks to breastfeed.
Also know that breastfeeding is a protected ground of discrimination. That means failure to provide adequate facilities may constitute discrimination and a breach of work health and safety laws.
Thinking about having another child after this one? Well, the good news is that if you have taken parental leave, you don’t have to work for another 12 months before you can take another period of parental leave with the same employer.
But, if you started work with a new employer, you will still need to work with that employer for at least 12 months before you are entitled to parental leave.
Once you\'ve worked out the type of parental leave you\'re entitled to, make sure you give your employer adequate notice.
Once you\'ve got the calendar dates set, then it\'s best to go straight to the source of truth (aka Australian Government Site) to gather extra information around what documents you might need to provide, or forms you need to fill in to ensure you get any payments you\'re eligible for.
It\'s best to get all of this admin done as soon as you can, mainly because it\'s not that fun and you could instead be buying cute baby things.\x3c!--kg-card-begin: html--\x3e
Dr. Vamsee Thalluri
Exactly how it sounds, the process of freezing your eggs involves retrieving them from your ovaries, freezing them and storing them for future use.
As we age, so do our eggs. This is a major factor in why it can be so hard for women to fall pregnant as they age.
This is where egg freezing can help. It helps your eggs stop time and maintain their youth.
This means you can keep your eggs healthy and of high quality, until you want to make a call on whether you will use them or not later in life.
It\'ll give you the choice to use the same eggs that might have otherwise declined in quality as you aged.
Well, there are both medical and social reasons for putting eggs on ice.
Medical: It\'s about fertility preservation. There are situations where women can lose their fertility earlier in life due to medical conditions such as cancer treatment, Endometriosis or signs of early menopause. In fact, egg freezing was developed initially to help women preserve their fertility who were undergoing chemotherapy or radiation treatment.
Social: Then we have women who are choosing to freeze their eggs so they can keep their options open.
The cultural mindset around having kids is changing, and women are choosing to start their families later; for a variety of reasons.
Their careers could be really taking off, they are taking the time to tick a few more things off their bucket list or they want to build a bigger financial safety net.
So, you might not be ready for babies right now, but you know it’s definitely something you want to consider later in life.
You could still be considering whether you actually want kids or not or you haven\'t met the right person yet.
Either way, because the biological realities of our fertility declining with age aren’t changing, freezing eggs might give you choices in the future.
There are 5 main steps involved in egg freezing (and then using those eggs):
1. Ovarian stimulation
This is your time to prime. Over a period of approximately 2 weeks before the retrieval procedure, you have to give yourself hormone injections that help you ‘grow’ multiple follicles in your ovaries.
During this time, your doctor will be monitoring this amazing work your body is doing through transvaginal ultrasounds. This is to help the doctor count and measure your follicles. They\'re looking for a good amount of healthy-looking eggs.
They might also do some blood hormone tests on you as well. This helps them adjust the dosage of the medication if it\'s needed.
As soon as the follicles on your ovaries are looking primed, you will have to take a "trigger shot" of a hormone called Human Chorionic Gonadotropin (HCG for short). Simply put, this tells your body to get ready to release the eggs.
The timing of the HCG shot is really important.
The doctor needs to plan the shot with your surgery. This is because your egg retrieval has to occur at just the right time so you do not ovulate before your doctor collects your eggs.
But don\'t worry, your doctor will help you work out this timing. It won\'t be all on you.
2. Egg retrieval
After lots of monitoring, a fertility specialist inserts a long and very thin ultrasound-guided needle via your vagina to retrieve your eggs.
In most cases, you’re under anesthesia for this so you shouldn\'t feel a thing! The whole process is known as a ‘cycle.’ Recovery time for this surgery is often a 1-5 days.
3. Egg freeze
If you’re freezing your eggs, after they are retrieved, they will go through a process called vitrification. Basically, this is where the freezing part happens.
They use high levels of antifreeze that protects each egg from damaging ice crystals. Then, they’re placed in a freezer and stored there until you’re ready.
And when I’m ready to use my eggs?
4. Thawing and fertilisation
When you’re ready to use your eggs, they will be thawed and fertilised. Fertilisation can be done through a standard procedure of combining a concentrated amount of quality sperm with the egg on a petri dish, in hopes that the magic of fertilisation will happen.
Alternatively, if male fertility is an issue, a process known as ICSI (Intracytoplasmic Sperm Injection) can be used, where a single sperm is injected into the egg. Once the egg is fertilised, it’s officially an embryo. 🙌🏼
5. Embryo transfer
About three to five days after the fertilisation, an embryologist (cool title) will identify the healthiest looking embryo, sometimes done through genetic testing.
Then, they\'ll transfer the embryo into the uterus via a thin, flexible catheter through the vagina and cervix.
Unfortunately the math doesn’t quite check out here, because one egg does not equal one kid.
The reality is, egg freezing is not an insurance policy.
You should be prepared for the fact that when you collect a batch of eggs, there’s no guarantee that any of them will be ready to become an embryo.
They won’t all make it through the next steps of thawing, fertilising, growing a good quality embryo, implanting and then making it through the pregnancy.
In each part of the process, we lose some eggs.
So, on average, each egg frozen has a 2-10% chance of turning into a live birth.
So really, it’s a bit of a numbers game. The more eggs retrieved from the egg freezing cycle, the more chances there are for a baby.
So, how many eggs should you freeze to give yourself the best chance?
Your fertility specialist will be the best person to help you set a good target number of eggs for you.
This will primarily depend on the age you choose to freeze your eggs and how many children you want to have with those frozen eggs.
Success with egg freezing still depends on collecting and freezing a batch of healthy eggs. But remember, as we age, so do our eggs and their quality declines.
And the older you are, the more eggs you\'ll have to collect to ensure a fair chance of achieving at least one live birth from those eggs. So if you want multiple children, freeze more eggs.
A 2017 study suggests the following as an estimate for success rates from egg freezing:
If you want to have multiple children with the eggs you’ve frozen, check out this tool that was created from the results of this study.
Knowing how many eggs you need to collect versus being able to physically collect those eggs is the consideration here.
It largely depends on your ovarian reserve (your egg count).
In an average cycle, around 9-15 eggs are collected. This number decreases as you age.
If your ovarian reserve is on the lower end, it could be harder to collect the optimal amount of eggs. Which means you may require multiple cycles (and therefore, it’ll cost you more money too).
Every woman is different, and you can test your ovarian reserve by testing your AMH.
Your AMH results will also help your fertility specialist determine what dose of medication to start you on to stimulate your ovaries for egg retrieval. If you have a lower ovarian reserve level, they are likely to start you on a higher dose to try to stimulate more eggs.
The earlier the better, right? It\'s not that simple unfortunately.
When you\'re in your early to mid 20s: For the women out there who are ready to jump on the egg freezing train in your early to mid 20s, there is a chance you might not use them. You\'ve still got many years ahead of you and you can\'t predict the future.
You could meet someone, start a family the old-fashioned way and then you\'re going to be out of pocket for not only the initial procedure, but for every year you\'re storing them it can cost you up to $500 per year. That\'s a lot of moolah for no return.
But, before you go jumping to any conclusions. Let me explain the other side of the age debate with egg freezing.
When you\'re in your late 30s or early 40s: Egg freezing does rely on being able to harvest a good amount of quality eggs. And as we\'ve said before, it gets harder to retrieve a good amount of eggs as we age. Plus, even if we do have a good amount of eggs, the quality of the eggs aren\'t guaranteed.
So, waiting to freeze our eggs around our late 30s or early 40s may mean that the eggs we collect may not be good enough to produce embryos capable of creating babies. Or, it may mean we need a few more egg retrieval cycles to retrieve more eggs to give us better chances for a baby. Which, of course, costs money.
For women in their late 20s or early 30s, specialists agree these are the optimal years to freeze your eggs.
This is when most women have a sturdy ovarian reserve and healthier eggs.
But, keep in mind that everyone is different. If you suspect you may have conditions that may impact your future fertility, it’s a good idea to speak to a fertility specialist to understand what your options would be.
Once you\'ve decided and planned to start an egg freezing cycle, the first thing you need to do is make sure you have a flexible enough schedule for a few weeks (at least).
There can be limited flexibility in monitoring schedules and appointment times (which are often in the mornings).
During this process, injections would need to be taken at the same time, every day.
Plus, you don’t have much say on timing when you need to take a trigger shot and schedule the egg retrieving procedure because your body decides when it\'s ready.
The first step of egg freezing is to inject yourself with hormones. So, be prepared to get hormonal. It\'s totally normal, but you might have some days with ups and downs.
To future-proof those shitty days, make sure you surround yourself with friends, families and medical professionals who can support you during this time.
But the main risk with the egg freezing hormones is over-stimulating your ovaries. This is a condition known as Ovarian Hyperstimulation Syndrome. It can cause severe bloating, stomach pains and nausea.
You are at greater risk of over-stimulating your ovaries if you have high AMH levels.
So, if your AMH levels are high, it’s a good idea to talk to your provider about adjusting your dosage of medication.
AMH is the main hormone we test in our Kin Fertility Test.
Hate to sound like a broken record, but the answer is - it depends.
The cost of egg freezing can vary greatly and depends on the clinic, whether you’re eligible for Medicare and the level of private health insurance you have.
🔎 The average cost of an egg freezing cycle is around $5,000 - $8,000.
This cost typically includes:
If your fertility specialist determines there are medical reasons for freezing your eggs, some of these costs can be covered by Medicare, leaving an out-of-pocket expense of around $2,000 - $4,000.
In addition to the egg freezing fee, you may need to pay separately for hormone medication ($500 - $1,500 on average), day surgery and anesthesia ($1,000 - $2,000 on average). Plus, there is typically an annual storage fee of around $500 for each year you leave them on ice.
It’s a good idea to check with your private health insurer (if you have one) as they may cover some of the day surgery and anesthesia costs.
When it comes time for you to thaw, fertilise and transfer those eggs, that’s an average cost of $3,000 - $5,000 per cycle.
Lots of numbers (and money), I know! So let’s pull it all together:
When you choose a clinic, you choose the medical team and the lab that comes with it. Make sure you feel comfortable with the medical team you surround yourself with and you trust the lab that will be handling your eggs. After all, they play a huge role in the success of your egg freezing treatment.
Hang tight, we’re putting together an Egg Freezing Discussion Guide of the questions you should be asking your clinic and fertility specialist if you’re considering freezing your eggs.
Egg freezing can make you feel empowered. It gives you options and the freedom to choose your own flight path. You\'re not ready for kids now, but want to have that option in the future.
Just remember, it shouldn\'t be treated as an insurance policy. It\'s not going to cover you if things go south with your fertility.
So, making the decision with all the facts about your chances, the number of eggs you might need to collect, the number of cycles you might need and the costs of those cycles is critical to determine whether egg freezing is for you or not.\x3c!--kg-card-begin: html--\x3e
Dr. Vamsee Thalluri