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✏️ Words
Courtney Goudswaard\n \n \x3c!-- --\x3e\n \n
🧪 Science
Dr. Vamsee Thalluri
🎨 Illustrations
Amelia Hanigan
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.
Normal Ovaries
PCOS Ovaries
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.
You\'ve got this.
\x3c!--kg-card-begin: html--\x3e✏️ Words
Courtney Goudswaard\n
🧪 Science
Dr. Vamsee Thalluri
🎨 Illustrations
Amelia Hanigan
Before we even begin, a quick note:
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.
• Mental health affects ALL OF US, but we can probably all do a better job of talking about it.
• 4.8 million Australians had a mental or behavioural condition in 2018, and one in ten people had depression or feelings of depression.
• Be careful of burnout and overwork: even if you enjoy heading into the office every day, your mind might be taking a toll.
• Help is always available, and you always have the option to reach out.
• Social media can absolutely impact your mental health. But there are tools to take control of it.
• Don\'t rush into any appointments you\'re unhappy with, and understand that it might take a while to find the treatment, or medical professional, that works for you.
According to the World Health Organisation (WHO), mental health is one of the highest contributors to the global burden of disease and disability.
Yet, mental health is something that most of us don’t like talking about, particularly when it comes to our own.
It’s a complicated topic. Not only are there countless variations of illnesses and concerns, there are varying degrees of severity and symptoms.
In 2007, the National Health Survey of Mental Health and Wellbeing estimated that 45% of the Australian population aged 16 to 85 would experience a mental disorder at some time in their life.
Maybe the most important thing to note when it comes to mental health is that you’re not alone. Talking about it, and seeking help, shouldn’t need to be taboo.
Mental health concerns can arise from so many factors faced throughout a person’s life, and with varying degrees of severity, it’s no wonder that so often they go undiagnosed.
A study released in 2019 by the Housing Income and Labour Dynamics (HILDA) at the University of Melbourne shows that the diagnosis of certain disorders, namely anxiety and depression, has dramatically increased over the past eight years. In 2017, the percentage of young women aged 15 to 34 diagnosed with these disorders hit 20.1%, up from 12.8% in 2009. Young men showed a similar increase, although an overall smaller percentage.
Anxiety disorder is the most prevalent of these illnesses, affecting 1 in 7 people, based on the HILDA study mentioned above, which followed the lives of 17,500 Australians over the course of eight years.
However, this study reports on diagnosis, rather than symptoms shown, meaning our mental health as a nation isn’t necessarily getting worse, we’re just more likely to seek treatment and be diagnosed.
The 2017-18 National Health Survey reported that 4.8 million Australians had a mental or behavioural condition, and one in ten people had depression or feelings of depression.
As with many diseases, there are a range of factors that affect your likelihood of developing mental health conditions.
Socioeconomic status, genetics, environmental experiences throughout your life, and your perceptions of these experiences, can greatly impact your mental health and how it develops.
Biologically, as women, we experience varied changes in our hormones throughout our reproductive lives that can have a drastic effect on our anxiety levels. Particularly, surges in oestrogen and progesterone that occur during pregnancy, and to a smaller extent, our menstrual cycles, are known to contribute to symptoms of depression and anxiety.
In a study conducted by the University of London, women were not only more inclined to show poor mental health outcomes for biological reasons, but socially were more at risk of experiencing psychosocial stressors as well.
These include physical violence, victimisation, gender disadvantages, and marginalisation in the workplace.
While in the Western World we may be talking much more about these factors and taking steps in the right direction, there’s still a ways to go in terms of changing our society’s beliefs about women.
Of course, gender is only one factor: Women of ethnic minority or varying sexual preferences face further discrimination, and a proven increased chance of many illnesses, mental and otherwise.
In a study by San Diego State University’s Graduate School of Public Health, Professor Heather Corliss discovered that lesbian and bisexual women are 27% more likely to develop Type 2 Diabetes, and develop it at a younger age. However, perhaps even more interesting, is that Professor Corliss’ extensive efforts to get the study funded uncovered that only 0.1% of the National Health Institutes funded studies look at the LGBTQ community and only 13.5% of those studies were focused on women in the sexual minority. In itself, this information showcases the huge gender disparities that exist between men and women, not to mention adding any additional minority demographic into the mix.
Anxiety
Anxiety is defined as excessive worry, fear or apprehension of events that have not happened. When these worries become extreme, extended over a long period, or interfere with your day-to-day life, they become classed as Anxiety Disorders.
Anxiety disorders are by far the most common type of mental disorders, and are far more common in women than men. Although, this could be due to the fact that women are more likely to express their feelings of anxiety than men, or are more likely to seek help.
OCD
Obsessive Compulsive Disorder, or OCD, is characterised by unreasonable thoughts and fears (obsessions) leading to compulsive behaviour.
OCD affects around 2% of Australians and studies suggest that gender is significant in the occurrence of and diagnosis of OCD, but results are vague. Overall, most seem to agree that males tend to experience symptoms in adolescence and females are more likely to develop it in later years.
Depression
Depression is a mental condition characterised by feelings of severe despondency and dejection, typically also with feelings of inadequacy and guilt, and accompanied by lack of energy and disturbance of appetite and sleep. It’s usually classified in two categories: Major Depressive Disorder and Persistent Depressive Disorder.
Major Depressive Disorder is a more serious diagnosis, however, Persistent Depressive Disorder can actually have an overall greater impact as it is characterised by feeling some depressive symptoms over a period of a number of years.
PTSD
Around half of the population will experience a traumatic event in their lifetime. The majority will absorb the effects over time, but around 8% develop lasting symptoms, known as Post-Traumatic Stress Disorder (PTSD).
A study by the American Psychological Association, conducted over 25 years, showed that women are nearly twice as likely to be diagnosed of PTSD than men. And while women are more likely to experience childhood abuse and sexual abuse, they are less likely to experience nonsexual assaults, combat, witness death or injury, or experience disaster than their male counterparts.
The results led researchers to conclude that perhaps sexual trauma may cause more emotional suffering than non-sexual trauma. But even when men and women were compared on the same type of trauma, women were more likely to experience PTSD. This led researchers to suggest that it may be due to the fact that PTSD is assessed on the cognitive and emotional spectrum, which are more likely to be discussed amongst women.
Body Dysmorphic Disorder
Most of us, men and women, will have some insecurities in our lives around the way we look. However, similarly to other conditions discussed, when these insecurities begin to interfere with your everyday life and affect your overall mental health, they become a bigger issue.
Body Dysmorphic Disorder (BDD) arises when perceived flaws about your appearance overtake your thoughts to a point where you are constantly looking at them, trying to hide them or, even attempting to change them through surgery, exercise, or medication.
Usually these thoughts are focused on one particular perceived flaw, where your own perception of that "flaw" is extremely exaggerated, and sufferers of BDD often hold the belief that others take particular notice of these flaws as well.
As with any mental health conditions, BDD can be caused by a number of factors, both biological and environment. It’s more common in individuals with a genetic history of obsessive compulsive disorder, or who’ve experienced childhood neglect.
Sufferers of BDD are also more at risk to suffer from anxiety, depression, and eating disorders. And because many symptoms of these conditions overlap, BDD is commonly misdiagnosed.
While most illnesses have an equal opportunity to affect men and women, the reality is that women are more likely to experience, and/or be diagnosed. That said, there are a number of additional factors only women face that make them even more prone to the issues.
Polycystic Ovary Syndrome (PCOS) is a common hormonal imbalance in women, estimated to affect 8-13% of Australian women, and is a leading cause of infertility.
According to a study of 1,605 women by Monash University in Melbourne, women diagnosed with PCOS reported high levels of depression, moderate levels of anxiety, and overall mental wellbeing lower than women diagnosed with cancer and heart disease.
Yes, women with PCOS have an overall lower mental wellbeing than women with cancer and heart disease.
Read More:
\nGuide to Managing PCOS
\nI use The Pill to help with PCOS
Treatment of PCOS is not sufficient if it does not take mental health into consideration.
The symptoms of PCOS include physical attributes such as excessive body hair, no period, heavy or irregular period, acne on face and body, hair loss, mood changes, and more. All of which can contribute to self-esteem issues, leading to significant levels of anxiety and depression. Of the women surveyed by Monash, 77% believed counselling would help and 69% said they needed more support socially and psychologically around their PCOS and the symptoms associated. That is a huge percentage of people who do not feel they are getting the mental support they need.
Another study done at Columbia University suggests that irregular menstrual cycles are the biggest factor associated with increased anxiety and depression (rather than other physical manifestation such as body hair or weight gain), which is an interesting thing to note. It shows how much of an impact the regulation of our hormones can have on us mentally.
These studies conclude that women with PCOS show symptoms of distress to the same extent as psychiatric patients by comparison. So, we’ll say it again, thorough treatment of PCOS needs to include screening for mental wellbeing. If you’ve been diagnosed with PCOS and are feeling any of the symptoms we’ve discussed so far, speak with your GP about getting support from a mental health professional.
Most of us would have heard of postpartum depression, a disorder affecting women in the months after giving birth. But the focus shouldn’t all be on what happens after birth, as these symptoms can appear at different times throughout pregnancy. In fact, up to 20% of women feel minor anxiety or depression during their pregnancy and up to 3 months after birth.
“Baby blues” are more common and less extreme, and are due to the sudden drop in hormones in your body after giving birth. It’s normal to feel exhausted, overwhelmed, have concerns about your abilities as a mother, and to feel heightened emotions in this time after birth. Usually, these feelings ease within two weeks postpartum.
However, if they don’t, it’s important to speak to your doctor, as there are varying levels of severity, including postpartum psychosis, which can manifest as bipolar disorder. At its most severe, postpartum depression can consist of suicidal thoughts, cause hallucinations, and even cause you to have harmful thoughts toward your baby.
Women with a history of anxiety and depression, or who are in unsupportive or stressful partnerships or environments, are at higher risk of perinatal depression. But overall, as we’ve discussed previously, the incredible influx of hormones into your body throughout pregnancy can wreak havoc on your emotional wellbeing.
Unfortunately, many cases of antenatal and postpartum disorders go undiagnosed, so it’s important to continue to screen for the disorders long after birth if you experience any kind of symptoms.
According to Theresa Nguyen, Vice President of policy and programs at Mental Health America, the average workload for one person today equates to that of three people 15 years ago. Not only are we piling more on, but we’re being placed under the impression that the entirety of the outcome falls on our shoulders.
For the millennial generation, this pressure isn’t even coming solely from our bosses, but our own belief systems that we should be ‘always on’ and never give up the hustle.
Anne Helen Petersen, author of ‘Can’t Even: How Millennials Became the Burnout Generation’, stated in a New York Times article that we’re so used to being productive all the time that we fill every minute in some capacity, to the extent that we are either forced to give up or constantly feel bad about how much we achieve.
The burden of too much work, too little time, falls on everyone, not just women. But, add to that the reality that women are disproportionally placed into positions of lower power, and paid less than their male counterparts, and suddenly the burden gets heavier.
The problem for women in the workplace doesn’t lie so much in the proverbial glass ceiling and the inability to hold C-suite level positions, but the ability to reach management positions in the first place. Thanks to amazing work by women all over the world, we’ve seen huge shifts in companies appointing women to top positions, but the problem is far from fixed.
When it comes to mental health, feeling like we’ve lost before we’ve even begun the race has devastating effects. These feelings of doubt and disbelief imbed into our psyche and are continually reaffirmed unconsciously (or consciously) through our experiences. Often, women won’t even ask for promotions or pay rises, but even if they do, one failed attempt can succeed in reaffirming the belief that they aren’t working hard enough, or that they’ll never reach their goals.
Again, these symptoms of self-doubt and stress are not gender-specific, however, in a society that has continually placed women as subordinate for decades, these beliefs often aren’t even conscious; they’re ingrained into the way we grow and develop as women.
Additionally, these thoughts can hinder our willingness to seek and ask for help at work, including for emotional or mental support.
Thanks to the work of many great women over the years, movements such as Time’s Up and Me Too have brought issues of discrimination and sexual harassment to the forefront of the media and our collective awareness.
However, being aware is only step one.
With issues such as these engrained so deeply into our societal belief systems, the road to equality is a long one. That said, the recent acknowledgement of these organisations, and the problems they address, means these issues are no longer flying under the radar. Women are feeling more empowered to speak up for their rights, about experiences they’ve had, and how their mental health has been impacted.
So, while there is still a long way to go both in how we view mental health as a whole, and how we as women are placed in our societal roles, we’re on the right track.
There’s no way around it, social media has dramatically changed our lives. After a little over a decade of prominent use, many people today are quick to jump to the negative impacts of social media on our mental health and wellbeing. Of course, there are many ways social media can affect us negatively, but it’s not all bad.
Let’s call it what it is: social media is a place where we can put our best face forward, curating our images and content to showcase the best parts of our lives. For the most part, we’re sharing our interests and beliefs, and what makes us happy and proud.
However, for some, social media is a place they look for comparison. How are their friends (or strangers) doing better than them? Looking better than them? More successful, more privileged, more alive than them? This is a recipe for disaster, particularly on a young or already fragile mind.
Most commonly, social networking sites have been associated with symptoms of depression, anxiety and low self-esteem.
Based on a study out of the UK, researchers found that social media had a particularly detrimental effect on young females’ mental health, and that 60% of that could be attributed to cyberbullying and disrupted sleep patterns. Overall, the study concluded that while social media itself didn’t cause mental health issues, high frequency of use, and negative experiences associated (such as cyberbullying) could interfere with habits that contribute to positive mental health, such as sleep and exercise.
The use of social networks to connect with friends and family anywhere in the world has done wonders for our ability to communicate, overall an overwhelmingly positive impact. However, even this ability to connect over social media has its negative results, including generating feelings of FOMO (fear of missing out), a disproportionate amount of time spent connecting online rather than in-person, and even feeling that we’re ‘all caught up’ on each other’s lives just by watching Instagram stories, without ever taking the time to actually check in.
How many times have you been catching up with a friend who tells you a piece of news about their life and you say, “yeah, I saw that on Instagram.”? Our increased ability to connect digitally is failing us on some of our most basic human needs.
But, like we said, it’s not all negative.
As mental health, sexual harassment, and gender and minority discriminations are getting more and more share of the limelight, social media gives us all a platform to share, learn, and connect.
Talking about your mental health online may not be your thing, or it may be, and both are completely okay. But the important part of this is that many everyday people just like us, as well as mental health professionals, are out there sharing stories, information, and resources. Sometimes just hearing someone else’s story is all it takes to understand that you’re not alone.
The most important thing to consider with your social media usage is how it is making you feel. If you find that scrolling through your feed is bringing up feelings of anxiety, loneliness, or feeling not good enough, change your habits, do a total detox of your friends, followers, and those you are following. Take some time offline to connect to yourself and others you love in person. Take a step back regularly and acknowledge how you’re feeling and acting, and take some time to consider why.
If it’s becoming apparent that your social media use is a problem, here are some practical steps you can take to help limit the time you spend online, and hopefully, start to have a positive impact on your mental health.
Turn Off Notifications
It sounds simple, but those little pop-ups do a lot to feed our ego and it’s really easy to become addicted to that feeling, and get sucked into feeling the need to immediately check out who’s, well, checking your page out. Switching off notifications allows you to put your social media out of your mind because you won’t be getting constant reminders to check it.
Limit Times of Use
Another good piece of advice is to limit the times you use your social media. To implement this and actually follow it, log out or straight up delete the apps from your phone. Then, during your designated checking times you can log back in, or check on a desktop browser.
We’d also recommend setting limits on when and where you use your phone. For example, enforce phone-free meals with your family or no-phone evenings with your partner. Put your phone on Do Not Disturb mode when you go to bed (or even better, an hour before) to help you disconnect and ease into a more relaxed state. Or buy an old school alarm clock and leave your phone outside the bedroom at night.
Apps Can Help
There are a whole list of apps that can help you limit your screen and social media time. They all have different features and ways of motivating you, including notification blockers and sleep modes. Some even have games that help you stay on track, like Forest, where you plant a seed every time you start a new task and it grows as you leave your phone untouched. If you pick up your phone or close the forest app, the tree will die. You continue to build and add to your forest as you complete new tasks. Plus, the company partners with real-life tree planting organisation, Trees for the Future, to translate users’ virtual trees into the real life trees. That’s a pretty positive outcome to a little disconnection from your phone.
Other apps include Daywise, which blocks notifications for set periods of time and ZenDesk which forces you to spend a set time off your phone for every set time on it. For example, for every 10 minutes spent on your phone in the morning, the app will lock your phone for 20 minutes, giving you proper time to get up and get ready for your day. It also allows you to set bedtimes and entertainment limits, and more.
Most smartphones also have Do Not Disturb modes and Screen Time information. These allow you to block notifications, review your usage and even set limits and reminders. There is also an inbuilt activity tracker on Instagram which allows you to set usage limits.
Most of these third-party apps come at a small fee, but if you’re really struggling to focus or to stay off your social media, it’s a small price to pay for a positive outcome on your mental health.
Regardless of whether or not you have been diagnosed with a mental health condition, checking in on yourself and putting some parameters in place is important.
Taking the time to get to know yourself mentally and educate yourself can help you understand what symptoms are mild and likely to subside with time with some minor personal changes, and which are severe and need the support of a medical professional.
We’ve compiled a list of everyday things you can do to help look after yourself. This list is not exhaustive, but it’s a good starting point to keep you on track and get started on keeping your mental health in check.
Day-to-Day Mental Health
There are things we can do in our everyday lives that will help us keep our mental health in order. These can also help regulate more severe diagnoses, but should not be used as a replacement for professional support or medication.
Daily Routines
Having a daily routine is an immensely positive thing. This doesn’t have to mean you’re completely regimented, following a list of tasks by the minute. Put simply, having some order in your day allows you to keep certain forms of anxiety and mild depression at bay by giving you the comfort and a sense of control in how your day will unfold.
Consider this study published in the Journal of Abnormal Child Psychology, which states that healthy family routines were associated with children presenting fewer symptoms of impulsivity and Oppositional Defiant Disorder (ODD).
As children, we’re less self-aware and have less life-experience, so it’s more difficult to work through uncertainty and understand our emotions. And it makes sense that when our family life (our biggest source of stability and comfort) feels out of sorts, some extreme emotions would arise.
It’s really no different for us as adults. While we’ll usually be more self-aware and have a better understanding of emotions (although not always the case), feeling out of control of our circumstances or surroundings can switch our bodies into survival mode, agitating our system and affecting our mental health.
Daily routines help us feel in control, they help us feel accomplished, and help us work toward a goal. When we have a particularly mundane task (say, paying bills) or a particularly daunting task (say, writing a book) looming over us, it’s really easy to get triggered into procrastination to avoid confronting the thing that’s making us uncomfortable. Working these tasks into our daily routine helps build a calm, consistent approach to them. Eventually, they just become part of the norm.
Our daily routines are also a good way to help us stay grounded and aware of our feelings. As we focus on one thing at a time, we can check in with how we’re feeling and how our thoughts and emotions are changing.
Finally, studies show that interrupted circadian rhythms result in poorer mental health. Having a consistent sleep pattern is extremely beneficial to your overall mental wellbeing, so it’s important to incorporate a reasonable bedtime into your routine to ensure you’re getting enough sleep.
Not everyone has the time to build a robust morning routine before starting their day, and not everyone works within normal 9 to 5 hours either. So, whatever your situation, just do your best with what you have.
Overall, carve out some time before work that’s just for you. Consider this: if you’re waking up just minutes before you need to be out the door for work, or generally just rushing around first thing in the morning, you’re literally starting your system in a heightened state that will stay with you throughout the day.
Waking up just a little bit earlier can seem daunting if you’re not a morning person, but trust us, when you get used to it, you will find your day starts in a much more relaxed way and it will have lasting effects on the way you feel throughout.
Invest in Rest
Your sleep patterns will have not only an immediate impact on your mood, energy levels, and productivity, but they can dramatically impact your mental state over time.
While you may not be a morning person (we get it), it pays to start your day relatively early to help keep your circadian rhythm on track. Sleeping too late in the day can make you feel unmotivated and start to affect your overall sleep patterns.
Waking up in the morning and committing to doing something before you head off to work can really help you feel more in control of your day. If you’re rolling out of bed and only spending 30 minutes getting ready before starting your commute, it can feel like you’re giving all of your time and energy away to your job.
You could also try incorporating some kind of calming routine before bed. Even just 15 minutes of reading, or a calming herbal tea while you finish one more episode of your favourite show – anything that triggers your body and mind into knowing it’s time to relax and go to sleep.
The important thing is to give yourself and your body time to adjust into and out of each day in a way that feels comforting and calming.
Meditation
Meditation doesn’t have to be the first thing you do when you wake up, but generally it will allow you to start your day with a clear, calm mind. Plus, like anything, the longer you leave it through the day the more likely you are to put it off in favour of something else.
There are a lot of different ways to meditate, and all of them are beneficial. We’d recommend doing some research into the subject and finding what feels right for you. Also, running and other forms of exercise can be a great form of meditation. There’s no one way or right way, the important part is that you take some time to slow your thinking and bring your awareness to how you’re feeling in your mind and body.
A really easy place to start with with a meditation app like Headspace or Insight Timer. These apps even have free programs (although they are worth paying for) to get you started and have a range of different types of meditations for different purposes.
Exercise
Again, it doesn’t matter when you do it, as long as you do it. It’s important to listen to your body – don’t push yourself to get through a particularly challenging run or a tough gym session if you’re feeling tired. But even a gentle walk or a short yoga flow can do wonders for your energy levels and your mood. And sometimes, just sometimes, when you’re feeling particularly agitated and don’t want to exercise, it can be the best thing for you.
Running can be an amazing form of meditation (as we mentioned above) and can also do wonders to help clear your mind and get things moving through your body. But if you’re not a runner, that’s okay. Walking has many of the same benefits. If you’re feeling particularly frantic or disconnected, we’d recommend walking without headphones to calm the senses and help you connect with the world outside.
Yoga
A comparative review of 81 studies published in the Journal of Alternative and Complementary Medicine, showed that yoga has the same positive mental health benefits, if not more, than other forms of exercise. Yoga is known to down-regulate the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), which are heightened through stress. This means it reduces symptoms of stress, depression and even shows a positive impact on symptoms of PTSD.
The basis of yoga is actively connecting your body’s movement to your breath. At its core, it’s a form of meditation and grounding. It also helps move lymph through the body, stretches fascia, and build strength, reducing pain and inflammation and improving overall wellbeing.
If you’re interested in learning more about yoga’s effect on the body and mind, listen to the information your teachers share during class, and don’t be afraid to approach them and ask questions after. Understanding the purpose behind each pose can help you take notice of your own health, how each pose is meant to benefit it, and where you may want to focus.
There are also plenty of online resources where you can learn more. Many teachers offer their classes and lessons for free, and will walk through how each pose should feel in your body and what it’s helping. Start simple with short classes and explore different teachers. We’d start with Yoga by Adrienne and Patrick + Carling.
Journalling
If you’re not well-versed in the art of journaling, i.e. writing out your inner most thoughts and feelings onto the pages of your private diary, we’d recommend starting small.
A concept that’s gained popularity as of late is Morning Pages. It’s simply an exercise to get whatever is in your head, out. First thing in the morning, spend 15 minutes (or three pages) free-writing whatever comes to mind.
Just getting things out of our heads can make a huge difference to how we perceive and understand them. Writing isn’t for everyone, but remember, no one but you will read this, so it
doesn’t matter what you say or how well it’s written. It’s also a really good way to take account of your thoughts and feelings before sharing them with anyone else, and helps us come at situations and relationships from a more considered point of view. You may find that it helps the way you interact with and relate to others.
Journalling is also a really great way to keep track of your feelings and symptoms, giving you something to look back on to better assess how your feelings develop over time and understand what works for you in keeping yourself mentally healthy.
Diet
Around ninety-five percent of the serotonin in your body is produced in your gastrointestinal tract, and serotonin is the neurotransmitter that helps regulate sleep, appetite, moods, and pain, and is often referred to as the ‘happy chemical’.
Serotonin production is highly influenced by the healthy bacteria in your gut. This bacteria enables your body to successfully run the neural pathways that link your gut to your brain, so it’s important to ensure your diet promotes healthy production of this bacteria.
When you don’t fuel your body with food rich in vitamins, minerals and antioxidants, it can hinder your brain’s ability to function properly. Studies show that an increased intake or craving for sweet foods is one of the patterns preceding depression, and it doesn’t do much of anything for the healthy function of your body or brain.
Take note of how different foods affect your mood and energy, not only in the moment, but the next day as well. If you notice yourself feeling heavy, or down, start eliminating items such as dairy, refined sugars and meats, and see if anything changes. Every body is different and will react differently to different foods, so it’s mostly important to understand how your body feels with certain dietary measures.
Finally, limit alcohol intake. As a depressant, alcohol can have lasting impacts on your mood, not just in the moment but the days following. If you’re feeling down or struggling with one of the mental disorders we’ve discussed, take some time off from casual drinking. Not only will it help your mood improve, it will also help the quality of your sleep, giving you more energy to get out and exercise and prepare healthy meals.
You can see how a lot of this stuff can turn into a vicious cycle. Take note of your lifestyle and make the necessary changes when you notice your mental health slipping.
Opening Up to a Trusted Friend
Talking about feelings of depression or anxiety, or any kind of mental health concern, can be scary.
We’re still living in a world where mental health chat is stigmatised, and most of us don’t want to admit that we may have some ‘fault’ or ‘flaw’. However, considering the statistics at the beginning of this guide, we know that mental health concerns affect a huge portion of the population, so no one is alone in this.
Opening up to a trusted friend or family member can be really helpful in regulating mental health. Not only is it comforting to feel that you’re not alone, both in what you’re feeling and in holding the burden of it, but you may find that talking it out with someone who has a different perspective brings you new ways of looking at your problem or symptoms. Similar to journalling, getting
something out of your own head and into the world will help you see it from other angles, and you never know what kind of experiences or advice your friends or family might be able to share.
If you’ve experienced extreme or prolonged symptoms of any of the conditions detailed in this guide, it’s important to seek medical help. Often, mental illnesses are left untreated for far too long, when much of the pain and suffering could have been prevented early on.
However, seeking help is not just for someone with a severe or diagnosed illness. If you’re having trouble with anything in your life and you feel that you need the help and support of a professional, there are countless individuals out there who are trained to help, whether it be with one specific issue or a general concern.
Traditional Medicine
There are a variety of different mental health professionals available with varying levels of certification and techniques. However, the first point of contact will be with your GP, who can then refer you to a specialist.
Psychiatrists are licensed medical doctors (M.D.) who have specialised in the field of psychiatry, they can diagnose mental health conditions, prescribe medications and provide therapy. A referral from your GP is needed to be able to see a psychiatrist.
Psychologists hold doctorate level certifications (Ph. D. or Psych. D.) and are trained to evaluate a person’s mental health through clinical interviews, psychological evaluations and testing. Psychologists may specialise in one type of treatment such as Cognitive Behaviour Therapy, a form of task-based therapy that addresses symptoms while they are present in an attempt to change negative thought patterns.
Counsellors, Therapists and Clinicians have masters-level (M.A. or M.S.) qualifications and are trained to evaluate mental health and use therapeutic techniques based on specific training programs. They assist their patients in reducing symptoms and finding better ways of thinking, feeling and living.
Complementary Medicine
There are a variety of forms of Complementary and Alternative Medicines that have been increasing in popularity over recent years. These options may help ease symptoms of distress, depression and anxiety. However, please keep in mind that these therapies should be used in conjunction with traditional medicine, especially in cases where diagnosis and medication is required.
Kinesiology uses muscle monitoring to understand where the body is holding onto stress in relation to emotional wellbeing. It looks at negative thought patterns and limiting beliefs, and works to clear stresses and rewire thought patterns through activation of acupressure points, the neurolymphatic system, and the neurovascular system.
Naturopathy is a holistic approach to healing the body using natural remedies. These include herbs, diet, and lifestyle management, and look at biochemical and hormonal imbalances in the body.
Acupuncture is a form of ancient Chinese Medicine which works along the belief system that the body is composed of meridians where our vital life energy (Qi) flows.
Explore everything, but like we said, if your condition needs diagnosis or medication, or is severe or persistent, be sure you’re also speaking to your doctor or a certified psychiatrist.
A good place to start is asking your GP.
Some clinics will have in-house psychology services, or can recommend where to look. You can also speak to your HR department at work. Most employers will have an anonymous mental health support service available. If it’s not written into your contract or onboarding documents, HR should be able to help. It’s a good place to start, even if it doesn’t lead you to your perfect therapist (but who knows, maybe it will).
One of the best ways to find a practitioner is through word-of-mouth. However, this requires you being comfortable speaking to your friends and family about how you’re feeling, and expects that they will be comfortable sharing their own mental health journeys. If you’re able to share and ask around for advice, you’ll get varied opinions about how certain practitioners approach their patients, how they work, and how they’ve helped people you care about.
Social media is also a great tool to research different types of practitioners and learn who’s out there and what they offer. Use Instagram as a research tool to find people who offer what you’re looking for. Read their websites, blogs, interviews, and their posts to help understand if you connect with their ways of working. Most of them will have contact information directly available.
Finding the right person takes time. You might have to try multiple people until you find someone you feel comfortable with. And, in the same vein, it takes multiple sessions to fix a problem. In fact, it’s suggested that treatment of anxiety and depression takes up to 16-20 sessions to be successful.
If someone isn’t resonating with you straight away, there’s no harm in continuing your search, just make sure you’re putting in the effort to find a solution and committed to as many sessions as needed to see results once you find them.
Mental health websites and college websites can also offer great resources. Here are a few that we feel offer a range of services:
Australian Counselling Association (ACA) Psychotherapy and Counselling Federation of Australia (PACTA)
Let’s Keep Talking!
Really, mental health is so important, it’s shocking that we’ve come this far by sweeping it under the rug.
Never see your struggles as a sign of weakness, and know that it takes courage to seek help and commit yourself to healing.
Share as much or as little as you feel comfortable with, but know that the more we’re talking openly about it, to each other, to our nearest and dearest and to professionals, the closer we’re getting to better mental health outcomes.
Mental Health Emergencies
If you’re concerned about your immediate wellbeing, are having suicidal thoughts or thoughts of self-harm, or generally just feel that you’re in a state of emergency, call 000 or contact one of the organisations below for immediate help.
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6. Remes, O., et al., A systematic review on the prevalence of anxiety disorders in adult populations. Brain and Behaviour, 2016.
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8. Skovlund, CW., et al. Association of Hormonal Contraception with Depression. JAMA Psychiatry, 2016.
9. Hantsoo, L., et al., Anxiety Disorders Among Women: A Female Lifespan Approach. Focus: A Journal of Lifelong Learning in Psychiatry, 2017.
10. Corliss, H., et al., Risk of Type 2 Diabetes Among Lesbians, Bisexual, and Heterosexual Women: Findings From the Nurses’ Health Study II. American Diabetes Association, 2018.
11. Hallion, L., et al., Obsessive-Compulsive Disorder and Gender Differences. Harvard Medical School, Williams College, 2015.
12. Hosang, G., et al., Gender discrimination, victimisation and women’s mental health. The British Journal of Psychiatry, 2018.
13. Huang, J., et al., Women in the Workplace 2019. McKinsey & Company, 2019.
14. Mind the 100 Year Gap. World Economic Forum, 2019.
15. Rush, G., How Polycystic Ovarian Syndrome Impacts Women’s Mental Health and Wellbeing. Monash University. Australia & New Zealand Mental Health Association, 2019.
16. Bailey, B., et al., Differential Contributions of Polycystic Ovary Syndrome (PCOS) Manifestations to Psychological Symptoms. Journal of Behavioural Health Services & Research, 2014.
17. Cesta, C.E., et al., Polycystic ovary syndrome and psychiatric disorders: co-morbidity and heritability in nationwide Swedish cohort. Psychoneuroendocrinology, Karolinska Institute, 2016.
18. Dokras, A., Increased prevalence of anxiety symptoms in women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertility and Sterility, University of Pennsylvania, 2012.
19. O’Hara, M., et al., Perinatal mental illness: Definition, description and aetiology. Best Practice & Research Clinical Obstetrics & Gynaecology, 2014.
20. Tolin, D., et al., Sex Differences in Trauma and Posttraumatic Stress Disorder: A Quantitative Review of 25 Years of Research. Psychological Bulletin, American Psychological Association, 2006.
21. Bjornsson, A., et al., Body dysmorphic disorder. Dialogues Clinical Neuroscience, 2010.
22. Philips, K., Body dysmorphic disorder: recognising and treating perceived ugliness. World Psychiatry, 2004.
23. Pantic, I., Online Social Networking and Mental Health. Cyberpsychology, Behaviour and Social Networking, 2014.
24. Bekula, M., et al., Social media use can be positive for mental health and well-being. Harvard University, Center for Health and Happiness, 2020.
25. Viner, R., et al., Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among young people in England: a secondary analysis of longitudinal data. The Lancet Child & Adolescent Health, 2019.
26. Lyall, L., et al., Association of disrupted circadian rhythmicity with mood disorders, subjective wellbeing, and cognitive function: a cross-sectional study of 91,105 participants from the UK Biobank. The Lancet Psychiatry, 2018.
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28. Street, CC., et al., Effects of yoga on the autonomic nervous system, gamma-amenobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Department of Psychiatry, Boston University School of Medicine, 2012.
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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.
But.
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.
Longer answer:
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.
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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).
16. Steiner, M. (2000). Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. Journal of Psychiatry and Neuroscience; 25(5): 459–468.
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• 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.
Physically
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.
Natural miscarriage
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.
Medical miscarriage
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.
Breastmilk
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.
Cramps
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.
Bleeding
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.
Emotionally
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.
Guilt
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
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✏️ Words
Courtney Goudswaard\n
🧪 Science
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✏️ Words
Courtney Goudswaard\n
🧪 Science
Dr. Vamsee Thalluri
🎨 Illustrations
Amelia Hanigan