Root Causes of Period Loss & Infertility

Apr 30, 2024 | Let's Hear From The Experts

Root Causes of Period Loss and Infertility

Dr. Kelsey is a licensed Naturopathic Physician from Portland, OR who specializes in fertility + menstrual health. Balancing roles as a devoted mother of 2 and a thriving practitioner, she weaves comprehensive medical expertise with a holistic approach that nurtures physical, emotional + energetic wellness. In both her busy private practice and nationwide support for couples, she sees the incredible impact digestive + hormone health have on women’s health + fertility. She is very passionate about bridging gaps in comprehensive healthcare, empowering women with education and nourishing the transition into Parenthood. 

Follow Dr. Stang on Instagram https://www.instagram.com/drkelseystang/ 

Get in touch with Kelsey at www.drkelseystang.com

Products we’re loving: Tempdrop

Use code “AFfoodfreedomfertility” for 10% off 

In This Episode:

  • Can micronutrient deficiencies cause amenorrhea?
  • Simple ways to incorporate mindfulness to support nervous system regulation 
  • The best ways to support your detox pathways
  • Ways to limit endocrine disrupting chemicals to support your fertility
  • Signs of lingering low hormone levels even when you are getting your period 
  • Primary Ovarian Insufficiency vs. Hypothalamic Amenorrhea 
  • How often to test your hormones to get a full picture of your fertility 
  • Financial considerations during your fertility journey 

Connect with Lindsey Lusson: 

Instagram: @‌food.freedom.fertility
Website: www.foodfreedomandfertility.com/
Twitter: @LindseyLusson
Tiktok: @food.freedom.fertility

Transcript:

Lindsey Lusson  00:00

What are some of the other physical signs that you’ve seen that might be lower level hormone imbalance that could be preventing someone from getting pregnant?

Dr. Kelsey Stang  00:07

I look at cervical mucus a lot.  The quantity and stretchiness of cervical mucus can be a good indicator of estrogen levels. Also basal body temperature. If folks are tracking, we can see if there’s still low hormone levels. If there’s still a sub optimal hormone levels in the body, then oftentimes basal body temperature altogether is a little bit lower. Then when folks are ovulating, women start ovulating more regularly, then we’re really looking for that rise in the luteal phase. 

Dr. Kelsey Stang  00:34

What we really want to see is an arc. A beautiful little arc of the baby’s body temperature that coincides with the arc of progesterone in the luteal phase that you would see in a textbook. Right? But most often, it’s a spike and then a fall. So those are all kind of indicators that there’s still some deeper hormone nourishment that we can work on.

Lindsey Lusson  00:52

Welcome to the Period Recovery and Fertility Podcast. Here we discuss the challenging, rewarding and life changing process of recovering your period and finding freedom with food and exercise. Whether you’re hoping to regain your cycle to get your health back on track or you’re ready to become a momma,  this podcast is for you. While the recovery process isn’t always rainbows and butterflies, it’s my hope to bring you both information and inspiration during your own recovery journey. I’m your host, registered dietitian and fellow HA woman, Lindsey Lusson. 

Lindsey Lusson  01:24

Dr. Kelsey is a licensed Naturopathic Physician from Portland, Oregon who specializes in fertility and menstrual health. Balancing roles as a devoted mother of two and thriving practitioner, she weaves comprehensive medical expertise with a holistic approach that nurtures physical, emotional and energetic wellness. In both her busy private practice and nationwide support for couples, she sees the incredible impact of digestive and hormone health and the impact that it has on women’s health and fertility. She is very passionate about bridging gaps in comprehensive health care, empowering women with education and nourishing the transition into parenthood. 

Lindsey Lusson  02:00

All right, everyone. Welcome back to the Period Recovery and Fertility Podcast. I have my friend, Dr. Kelsey Stang here. Welcome, Kelsey. 

Dr. Kelsey Stang  02:08

Thank you so much. 

Lindsey Lusson  02:10

Well, we have been chatting over Instagram and DMing and fan girling each other’s content for months now. So it is about time that we get to chat a little bit more about all things fertility. 

Dr. Kelsey Stang  02:20

Yeah, it’s so true. I love just so much of the content that you put out in terms of education and awareness for menstrual health and fertility. And I’m excited to chat more about all of those things.

Lindsey Lusson  02:33

Yeah. Well, maybe just to kick us off, I feel like what got me into this space was just the lack, the gap in the – you go to your OB GYN or maybe even you’re just starting with your primary care physician. And I’m not getting my period or my periods are really heavy or my periods are really irregular. So often the solution is birth control without really looking under the surface. Would you say that that’s why a lot of people kind of end up coming to you is  because they’re sick of just getting this kind of umbrella advice of taking the pill?

Dr. Kelsey Stang  03:06

Totally. Yeah, just getting that recommendation from providers. And then I would say most people who are seeking out naturopathic medicine at this point, also really want an alternative solution. They’re already changing the foods that they’re eating or feeling more in control of their health in a way. But there’s some missing link as to why they’re not healing the underlying issue.

Lindsey Lusson  03:30

Yeah. What are some major things., I come in for a baseline visit, like in your practice, and I’m like,  “Dr. Stang, I haven’t had a period in six months?” What are just some standard baseline tests that you are running? Things that are kind of going through your mind that you’re either testing for or testing to try to rule out?

Dr. Kelsey Stang  03:50

I do really comprehensive testing right up front, if we can do it. And that’s going to include a full thyroid panel, looking at metabolic function. I do everything — Lipids, CBC. I want to see the size and shape of your red blood cells. Because all of it goes into assessing,  is there low nutrient status? Is there low iron? Different things like that. They can all contribute to changing how often we’re getting our period.  That can also inform me to other underlying issues that might be going on in the body. 

Lindsey Lusson  04:19

Do you see people coming in with amenorrhea? Like, full blown, “I haven’t had a period in 10 years.” And it is a micronutrient imbalance, low vitamin D or a little bit more.

Dr. Kelsey Stang  04:35

Usually in those cases, we’ll take a comprehensive lab panel. Honestly, what I’m looking for is the low hanging fruits. Right? The, “oh, there’s this thyroid imbalance. Why is the thyroid out of balance?” Right? So it’s kind of like the surface… The labs are showing us how the body is responding to some underlying issue. And then it’s doing the deeper work. I do more comprehensive testing at that time to figure out what other imbalances are causing your thyroid to be a little off or the micronutrient status to be abnormal.

Lindsey Lusson  05:05

Well, I love that too. Because so much stuff just gets kind of missed and misinterpreted on social media. But I do feel sometimes there’s this trends of, “oh, well, your periods missing because your thyroid is off”. And it’s, “okay, so why is my thyroid awful?” You’re just going, why, why why, further further until you get to the root. Versus being, “Oh, just take Synthroid, and that should fix it.” And then maybe it does for a little bit, or it doesn’t. So I love that.

Dr. Kelsey Stang  05:31

Yeah. It makes such a difference. I find particularly in the fertility world, when we really treat the root cause. Because then women transition into pregnancy and into postpartum and into motherhood with just so much more vitality, right? Because they’re not just putting the bandaid of the thyroid medication. And then postpartum their thyroid is going crazy. And it’s constant work to try and figure out how to recalibrate and balance the thyroid. So really getting into the root cause is totally, totally my jam.

Lindsey Lusson  06:02

And I know one thing that’s done with functional medicine doctors or naturopathic doctors like yourself, is that there’s more comprehensive thyroid testing done. Because a lot of times I go into my PCP, I’m like, “Hey, let’s check with my thyroid.” It’s often “Oh, your TSH is normal.” What other things are you testing for when you look at thyroid? And what things have you noticed in terms of being off can really impact hormones, fertility, etc?

Dr. Kelsey Stang  06:27

Yeah, I mean, the more comprehensive lab, thyroid panel is going to include thyroid antibodies, and then the free T4. Free T3. Sometimes reverse T3, also. But the root of thyroid issues is often in my opinion, adrenal dysfunction or gut health stuff.

Lindsey Lusson  06:44

Okay. Talk to us about adrenal dysfunction. What does that mean? How does someone know you’re dealing with it? And then maybe even top two or three things you’re recommending for people who do have adrenal dysfunction?

Dr. Kelsey Stang  06:56

Yeah. I mean, it’s a big category. So I’d say on the surface, most of the time symptoms are going to be fatigue, signs of irregular periods, or hormone imbalances, or amenorrhea. All of those things can totally correlate with adrenal dysfunction. Which is to put simply, I suppose. We talk about hormone imbalance often as like estrogen or progesterone. But hormones also include our thyroid and our cortisol and other hormones, right? And hormones are messaging signals. 

Dr. Kelsey Stang  07:25

This is what I’m often educating my patients on. They’re not the thing that’s causing the change as much. They’re signaling messages through the body telling organs and target tissues to do their job. So if there’s imbalances in the hormones, everything works on a feedback loop. So we have the target tissue where the hormone is going to the target tissue, and it’s saturating certain receptors. And if there’s less of that hormone, it’s going to saturate less receptors. It’s going to send the signal back to say, hey, we need to make more of this thing.

Dr. Kelsey Stang  07:52

So when there’s adrenal dysfunction, it’s usually a sign or it can usually indicate that there’s some dysregulation within the endocrine system. Which encompasses the thyroid hormone, the cortisol, adrenal hormones, testosterone, DHEA, estrogen, progesterone. So it’s kind of a bigger deal, rather than just our thinking. Oftentimes, we focus especially for fertility on what’s my estrogen levels, or my progesterone levels, right. So in terms of adrenal dysfunction, the biggest thing that we see contribute to that is stress, which is kind of obvious. 

Dr. Kelsey Stang  08:23

So I think of it in the bigger picture as like how can we set up routines in our lives? How can we really tend to our health in a way that is preparing us for the long run? Right? Isn’t just about getting pregnant, in my mind, which is a huge part of the process, right? A crux and the whole journey. But it’s more about building long term healing and strategies. And so a lot of honestly, it sounds really simple. And you might have already gathered this from my Instagram page. 

Dr. Kelsey Stang  08:23

I think most people say, I know stress is bad for me, but they don’t have the tools to shift things around. And then, knowing that stress, I talked with so many of my patients about this, “I’m anxious, I’m so anxious”. Then “I know it’s bad for my fertility, and what do I do about it?” So I’ve shifted over the years to not talk about stress management. It’s not something we can manage as much as stress resilience. We need to build up our resiliency to the stress of life. Because yes, fertility is really stressful. Having a freaking infant is really stressful. Being a parent is really stressful. 

Dr. Kelsey Stang  08:59

But I start with so many of my patients with mindful breathing. It’s something that we take for granted in my opinion. We breathe all the time, and we don’t really give much attention to our breath. But it’s really an anchor. It’s a midway point from what’s happening in our head. Right? The anxiety, the ruminating thoughts, the stress, the hyper focus on certain things in our lives that connects us and grounds us into our body.

Lindsey Lusson  09:53

Yeah, and I also love what you said just about stress is not going away, right? It’s just gonna go different in different seasons. There’s going to be seasons where stress is a little lower. Stress in seasons is feeling out of control. But really more about just equipping people with the tools to be resilient in the times of high high, high stress. So talk just a little bit about breathwork. What are some things that you do with your patients on bringing attention to the breathing? Is there even something that you could help listeners with today? Like a quick breathing exercise or something they could kind of take away and put in their back pocket?

Dr. Kelsey Stang  10:32

Yeah, for sure. One of the ways that I start in the very beginning. So if you’re just getting started with incorporating some type of breathing practice into your life, is to create a routine around it. It can be so short. So research has shown that the smaller, more frequent intervals of mindfulness practice has much more impact than going to yoga one day a week on regulating our nervous system. So two minutes a day, set a timer on your phone, or an alarm that go off. 

Dr. Kelsey Stang  10:59

Or right when you wake up in the morning or right before you go to bed for two minutes. It usually equates to about five to six breaths. And all you need to do is just breathe. Like it’s wild, how often we don’t recognize our breath. And so to take that a step further, would be counting the length that you’re inhaling and exhaling. So it allows for a little anchor for our minds to say, inhale 1234, exhale 1234. And then if you wanted to take that even a step further, it would be… One common practice that I have folks do is inhale for the count of four, hold for four, and exhale for the count of eight. And that longer exhale really helps to regulate the nervous system.

Lindsey Lusson  11:40

Okay, so but back in my health coaching days, we would do similar, we call it Foursquare breathing. Breathe in for four in, four out, repeat four times. But what I’m hearing is it is relatively simple, and it doesn’t have to be like a whole 60 minute routine. And what I’m hearing is the micro dosing of these things is more effective than out once a week.  

Dr. Kelsey Stang  12:04

 I love that microdosing some breath practice.

Lindsey Lusson  12:10

I mean, it’s so simple. But I also find in my practice, I’m sure you do too, that sometimes the simple things are the things that are just the easiest to overlook or not do.  People want the big supplement routine or they want the whole diet overhaul. Are those things that you’re also doing with your patients? I know you’ve kind of mentioned you kind of start small on the basics. What are some other basics?

Dr. Kelsey Stang  12:41

Yeah, other basics are sleep. Prioritizing, optimizing sleep. Honestly, they are so many so many basics that we focus on while also doing like you say focusing on any nutrition changes that need to happen and supplements. And kind of like we started with with getting those lab work at the initial low hanging fruit.

We’re working on those things but this is all kind of happening in the background. And I look at it as we’re creating that foundation, right? So sleep. Making sure folks are drinking enough water. As a primary way for us to detoxify. And that’s something that I think we forget about is that hydration and water moving through our body, going through our kidneys is one of our primary ways to detoxify. So people want to do these big detoxes. And sometimes it comes down to, let’s just focus on drinking 80 ounces of water a day, right? 

Lindsey Lusson  13:29

And start pooping regularly. 

Dr. Kelsey Stang  13:31

Yes, exactly. I’m just gonna say that. Yep, we need to be fully eliminating through all of our systems, especially before doing any type of bigger detox. 

Lindsey Lusson  13:39

Yeah, yeah. 

Dr. Kelsey Stang  13:40

Other routine things that I focus on is cleaning up our environments. There’s so much good research on environmental exposures that can impact our hormones, too. So just being mindful of those and creating awareness and education around them. Some people come to me having never used a synthetic chemical in five years, and they’re completely on the spectrum of full green, eco living, and there’s usually still some things that we can adjust. 

Dr. Kelsey Stang  14:09

And some people come to me completely new with that, and we start there. So that’s one of the things I see make a big impact. The way, still, it’s the long term, right? What’s the environment we want to bring baby home in? We want to bring that precious little… I remember when my first born came home, and I was, “your skin is so precious and so new”, and I don’t want anything on it. That’s gonna be problematic, right?

Lindsey Lusson  14:33

So kind of two things are coming up. We want to think about environmental exposures. Maybe let’s first define what are some of the major endocrine disruptors that we’re seeing in common beauty products, cleaning products, etc, for listeners who are unfamiliar. And then I’ll ask my second question after that.

Dr. Kelsey Stang  14:52

The first one that comes to mind… Or the big two chemicals that I’m usually thinking of are phthalates and Bisphenol A. Which are two exogenous estrogen. They kind of sit in receptors and look like estrogen to the body. So that whole feedback loop we were talking about where hormones are signaling the tissue, and then the tissue is sending a signal back. It can disregulate that activity in the body. 

Dr. Kelsey Stang  15:12

So it is kind of back to the big picture of how we can inform the health of our kiddos. And thinking of fertility, health and preconception health. That’s always something that… A lot of people will ask me, “how important is it really for me to change my body care products or beauty care products,” right? And it might not be a direct. It might not be like you remove the soap and tomorrow, you get pregnant, as much as… It’s the long term, that we’re really looking to inform the health of our bodies.

Dr. Kelsey Stang  15:12

Phthalates are most common in synthetic fragrances. So that’s usually where I start with folks is taking a note of your body care products, your things like perfume, candles, anything like that, that has a synthetic fragrance is most likely has phthalates. And I just saw research last week, actually. They found that children who were exposed to higher levels of phthalates in utero are more likely to have more behavioral issues like ADHD and things like that. 

Lindsey Lusson  16:07

Okay, so that leads to the second part of my question. So many of our listeners and myself included, have this very obsessive type A personality to when I go down a rabbit hole of finding clean personal care, beauty and home cleaning products. I read a book this summer, and I was, “Oh my gosh, I have to put this down because I am now stressing about all of the products that I’m using”. Where’s the line? Are there maybe three to five best bang for your buck? So that we could leave listeners with do these things. And then the other things are further down the line if and when you choose to.

Dr. Kelsey Stang  16:51

I love this question so much. And I think about it myself because I’m also a more of a hyper focused type A. I fully resonate with all of what you just said. And this is totally an area. Like the example I explained of having my baby at home and it was this moment of anxiety. Like “oh my gosh”. But where I’m at now, in my perspective on this, is that we aren’t going to avoid all of the chemicals. It’s absolutely impossible. So the best thing that we can do is limit the exposures that we are familiar with, or that we know.  Like synthetic fragrance candles are probably one of the higher ones on the list and perfume. 

Dr. Kelsey Stang  17:28

Synthetic fragrances that we’re putting on our body that’s being absorbed through our skin, stuff like that. When it comes to your toilet bowl cleaner, probably not something that you’re having a lot of exposure to, right? But we’re not going to fully be avoidant of all the chemicals in our environment. The best thing in my opinion is that we build up… Again, it’s about building up that body resilience. So our immune system is stable, our detoxification process works really well. I was just thinking about this this morning. I was having peanut butter and I used to not be able to eat peanut butter because of issues with my immune system and detoxification.

Dr. Kelsey Stang  18:02

They would give me migraines. And I was like, “Oh my gosh, I love that I can eat peanut butter now liberally and not have issues” because of the work that I’ve done with optimizing my detoxification process and all that stuff.

Lindsey Lusson  18:14

So what I’m hearing is there are things you mentioned, the candles and perfume. Specially if somebody is struggling with hormone imbalances and fertility issues. Those are two things that I think we can live without, right? We don’t really need the scented candle. The lady sometimes gets a little bit of joy. Just kind of doing that and also recognizing that this is a potential additional source of stress. Just like with clean eating, you’ll never have the perfect diet. You’ll never have a completely toxic free life unless you’re living inside a ball goal and then that’s like a whole other probably a psychological issue in itself. So just kind of do the best you can.

Dr. Kelsey Stang  18:58

Absolutely yeah, I love that perspective of just… Even though the candle might bring us joy. Weighing, do I want this joyful candle right now right? And that’s okay if you choose it and it’s not going to be detrimental. As much as if you’re sitting in front of the candle or at the store right I’m gonna choose the unscented boring candle or the cookies and cream candle or something.

Lindsey Lusson  19:20

And there’s so many great alternatives. You have some favorite brands that tend to make, I’m thinking  shampoos, conditioners, body washes, stuff like that. Like fragrance-free, cleaner ingredients, like what are some of your favorites? Yeah,

Dr. Kelsey Stang  19:35

Great question. I thought you’re gonna ask me about candles at first and I was like, there’s so many good candles. I usually, for candles, go for a beeswax candle with essential oils instead of… S o there can be essential oil fragrances. There’s a spectrum of toxicity. In terms of shampoos and body care products, Oh my gosh. This is something that I talked with so many of my clients about. Sometimes they go deep into the rabbit hole of folks just wanting me to give them a list of all the different brands and companies and I go back and forth. 

Dr. Kelsey Stang  20:06

So I’m a big fan of , as simple as it is Dr. Bronner’s unscented soap. A very simple and usually well tolerated by most skin types, if you will. That’s what we use on our body for soap. For shampoo, the brand Attitude, I think. It is starts with an A. I think it’s Attitude. It’s pretty good. And then I also really love the brand Osia. They do a lot of facial hair products. That’s usually what I use. Or Living Libations, the Canadian based company that has really great facial products.

Lindsey Lusson  20:34

Are these ones that you’re having a special order, or did they have decent? Because I live in a small town in Texas, and we don’t have a lot of these things.

Dr. Kelsey Stang  20:42

No. Yeah, I order most of my stuff online. It’s not as much. It’s not as easy I don’t think to go to a grocery store and get well made products.

Lindsey Lusson  20:50

Yeah. I think the challenge is even if you do have a whole foods or natural groceries or something in the town that you’re in, there are a lot of products that are marketed really well. I think about Myers comes to brand. They’re kind of touted as this kind of clean and healthy brand. And I’m sure there are great things, but they’re also loaded with…

Dr. Kelsey Stang  21:10

Totally. Yeah, yeah. It’s the toxic to green products. Yeah.

Lindsey Lusson  21:16

Yeah. Well, as a segue, I do feel when someone is struggling with period loss, we tend to look for all of these kind of things that might be causing our period to be missing without potentially really addressing an energy balance issue that’s leading to a hypothalamic amenorrhea. Can you just bring it home for everybody? Would exposure to a toxin cause your period to be missing for 10 years? 

Dr. Kelsey Stang  21:43

No. 

Lindsey Lusson  21:47

How much hypothalamic amenorrhea or hypothalamic dysfunction like this… When I call it when somebody is getting their period every four months and it’s a day long and they’re not ovulating. How much of that do you see in your practice?

Dr. Kelsey Stang  22:02

I would say maybe 10 to 15%?  I have a private practice where I see everyone, women, children, men. It’s more of my primary care type practice. And then I also do just fertility care more virtually fertility care. So within my just fertility clientele, I would say it’s maybe more 25%.

Lindsey Lusson  22:29

And that sounds pretty in line with just  statistics that I’ve read on both fronts, right? When we talk about how common missing and irregular periods can be in just the general population versus when we’re taking a deeper look at fertility. So how do you address that with people? Do you find that a lot of people in your fertility practice are struggling with  disordered eating? And is that something you refer out to? Or do you find that it’s more just simply a lack of education? How do you kind of approach it?

Dr. Kelsey Stang  22:58

Yeah, that’s a great question. When disordered eating is a part of the picture and I’m often screening for that or looking for that in somebody with hypothalamic amenorrhea, I usually do quite a bit of support… So it’s something that I struggled with in my late teens and early 20s. So my education with them comes from my learned experience and helping other people through it. I don’t have any extra training necessarily on it. But I think that from the surface level, it’s a really important. Obviously, it’s a really important thing. But it’s also really helpful to start from the perspective of really addressing the root. Again the root cause of why someone’s feeling more of an emotional dysregulation when it comes to eating.

Lindsey Lusson  23:37

Yeah, yeah. Well, and I think, too, that when someone is struggling with food stuff, there can be a whole deeper psychological thing going on, right? Whether it’s a performance thing, or a need for validation. And so, kind of going deeper and thinking about how can we meet those needs. What are some basic places you start though, with nutrition? Is it simply closing the calorie gap? Or do you get a little bit more specific with certain types of foods that can also be fertility enhancing? Or where do you typically go with that? 

Dr. Kelsey Stang  24:11

Yeah. I would say I’m probably in the middle of the road, to be honest. Because there is an element of my work that is still yeah, you want to focus on fertility enhancing foods, let’s do that. That’s a priority for you. Kind of figuring out what their priority is, right? Or if it’s, they’re only eating 500 calories a day, then yes, we’re definitely working on that caloric intake component to make sure that they feel safe when they’re eating. Or what is the reason why they’re restricting calories? So that’s kind of to your point to, there’s so many different reasons why somebody might have that emotional dysregulation when it comes to food. 

Dr. Kelsey Stang  24:45

So figuring out what that is, and then supporting that is usually what I try to do. But there isn’t a layer of… How can we also optimize food so that we’re feeling good? Because for me, at least in my journey, I felt better, right? Most people can probably resonate with this. When I feel in control of what I’m eating. And so how can you feel you’re in control, but also swing outside of those layers of control a little bit? Right? Blending the lines of not eating in this tight box. What is your comfort level? You only whatever want to eat a green smoothie in the morning? How can we add some hemp seeds in your smoothie? How can we create more within the parameters that you’re comfortable with?

Lindsey Lusson  25:29

What I often find, too, with clients and exploring things like that is there’s kind of this recovering snowball effect, if you will. Where it’s “okay, somebody’s very tight and regulated on the way that they’re eating the types of foods that we’re eating”. And as their body becomes more nourished, the anxiety around food starts to calm down. They’re like, “Oh, my gosh, I love this smoothie with the hemp seeds. I feel so much better. And I realized I’m hungry for lunch”. So things kind of start to move forward in that way. 

Dr. Kelsey Stang  25:59

Yeah. I love that. And that’s such an interesting reflection. And that there’s the physical. There’s like what are you eating? How can we shift that? And then there’s also so much of the mental emotional approach to also… Then they correlate. I love the snowball idea.

Lindsey Lusson  25:59

But yeah. I think that overhauling your diet, whether it means doing a whole diet overhaul of eating cleaner or healthier, and doing a whole diet overhaul of let’s say someone’s eating 500 calories, now they have to eat 2500 calories, right? That’s overwhelming. And so I do think that it’s important to meet people where they’re at. Bring them up inside kind of their comfort level, but also that gentle nudge outside of the comfort level. Because you do have to also address kind of a disordered restrictive part too.

Lindsey Lusson  26:45

So often. Somebody will come in, and they’ll be like, “Oh, my gosh, I can’t, I cannot eat carbs”. And I’m like, “okay, one or two, that feel a little safe and comfortable. And let’s do that”. Then they’re like, “oh, my gosh, that’s delicious and my blood sugar isn’t swinging all over the place”. “I have more energy”. It’s almost help people take that one stuff, and then I think it gets easier over time, or at least that’s what I’ve observed.

Dr. Kelsey Stang  27:10

Totally. Yeah, I totally agree. And then when they get the feedback from their body, they start sleeping better and pooping more and getting their periods back. It’s like, “oh, my gosh, this is totally my body needed”. Right? So encouraging for them. And so, it’s easier for us to see the potential, right? Then it’s convincing them that it’s worth adding some carbs in.

Lindsey Lusson  27:34

And fertility can be such a great motivator for people to to kind of come out of this very regimented time in their life. Maybe kind of fully admitting and realizing that there are some things that need to change. So I love just being in the fertility space, and letting people be able to experience that. When you’re working with clients that have more of the “Okay, I’m getting my period, but  it’s it’s really light”, or kind of some of the more complex cases I’ve come across are just kind of hormone. It’s not obvious, right?

So maybe they’re getting a regular period. Maybe we’re able to confirm ovulation. But there’s spotting and they’re luteal phase for five or six days. What are some of the other physical signs that you’ve seen, that might be lower level hormone imbalance that could be preventing, even if someone has their period back now, that could be preventing someone from getting pregnant?

Dr. Kelsey Stang  28:30

I look at cervical mucus, a lot. The quantity and stretchiness of cervical mucus can be a good indicator of estrogen levels in the body. So there’s less cervical mucus throughout the month. And then particularly around that fertile window when we want to see it more copious, then that can be a sign that hormones are are less. Also basal body temperature, If folks are tracking. We can see if there’s still low hormone levels, just in general, kind of where we were talking to the beginning about all the different hormones can be low thyroid, low adrenal function. 

Dr. Kelsey Stang  29:01

If there’s still a sub optimal hormone levels in the body, then oftentimes basal body temperature all together is a little bit lower.  Then when folks are ovulating, women start ovulating more regularly, then we’re really looking for that rise in the luteal phase. And I see this a lot. I look at a lot of people’s basal body temperature charts.

Then also I do a lot of hormone testing. And that’s also looking at hormone levels in the luteal phase. So we can see… What we really want to see is like an arc, a beautiful little arc of the basal body temperature that coincides with the arc of progesterone in the luteal phase that you would see in a textbook, right? But most often, it’s a spike and then a fall. So those are all kind of indicators that there’s still some deeper hormone nourishment that we can work on.

Lindsey Lusson  29:45

Is it safe to say that your luteal phase temperatures are an accurate indicator of what progesterone is doing and your luteal phase? If we have the textbook aren’t progesterone is probably great and good enough for pregnancy versus if we’re seeing kind of a three day rise, and then it’s dropping off. And it’s picking out what I mean? Is that correlate that way? 

Dr. Kelsey Stang  30:06

I have seen it correlate and not correlate. I wouldn’t say let’s bank on that as much as if you are really wanting to check in and testing your luteal phase. Checking basal body temperature, seeing if it’s a spike up in temperature or drop what however it’s flowing. And then also in terms of labs, getting more of a seven day post ovulation, progesterone. Then sometimes I use the Dutch test, and I do a cycle mapping on folks. And that’s a really great way for us to see just how the hormones are throughout the month.

Lindsey Lusson  30:37

I love that. And I want to talk a little bit more about that. First question. When you’re doing testing progesterone in the luteal phase, are we doing dried urine? Are you doing blood tests in your practice?

Dr. Kelsey Stang  30:46

It depends. So dried urine, I’ve been using the batch test. I do that a lot, especially when periods are coming back kind of the beginning of this question.  Periods are back, but they’re still not as juicy as we want them to be for fertility. That’s usually when I lean on the Dutch test. Because we can see… Is it an issue of low testosterone or low DHEA DHEA? Which is so important for follicle development.

And that’s also sending the signal back from making estrogen. All of it is really, really intricate and all connected. So that’s a really great way to get more comprehensive hormones information. I also do a serum seven day post ovulation, progesterone for folks that don’t want to do the full Dutch test.  Sometimes we’ll do the Dutch test one month. We’ll try some things. We’ll recheck the progesterone just to make sure that say it’s low and we do the Dutch test. We want to see things that are shifting in serum.

Lindsey Lusson  31:38

Yeah, yeah. I mean, it’s good that there are those options. I knew that the probably the biggest barrier with those that is the expense that comes with bench tests and things like that. But yeah, having that comprehensive. That’s something I’m it’s on my to do list for 2024 is to look for a  comprehensive overview. And I love that. 

Lindsey Lusson  31:54

One thing that I’ve come across, or I feel I keep coming across that I don’t have an answer for and I’m wondering if maybe you have any more insight in this is not HA, premature ovarian insufficiency. How is that diagnosed? And is there anything nutritionally lifestyle wise we can do with that?

Dr. Kelsey Stang  32:16

Yeah. Really good question. So I would say in terms of workup, if it’s someone who’s in their lower to mid 30s, who’s coming in with  amenorrhea, or very irregular cycles, very light cycles can sometimes also coincide with POI or primary ovarian insufficiency, then I usually start with all the things that we’ve started with. In terms of let’s try and get your periods back on track. And then usually after three months, if the body isn’t responding, nothing’s changing, then we’re doing more workup for testing in terms of is it POI?

And so one of the ways that we would test for that is with bloodwork. Doing a estradiol and serum, FSH, LH, and even an AMH. So looking and seeing if there’s very low AMH, low  ovarian response, and then low estrogen, really high FSH, so usually over 10, things like that. That said, I’ve worked with plenty of folks with POI that things totally shift around when we’re nourishing the body. So I also really love this and maybe we can have more back and forth about this at some point, what is the crossover between HA and POI.

Lindsey Lusson  33:28

So that’s a lot running into is people will be  “I have POI. I’ve been diagnosed with POI. But I had an eating disorder for 10 years. Is this something I can turn around?” I’ll be like, “Well, how was your POI diagnosed?”. “My FSH was 25.” And I’m like, “well, that’s POI”. But yeah. Because it keeps coming up. I’m like, is there a linkage? And more importantly, is there something you can do about it versus just being like, Oh, that’s it, you’re doing IVF? Because I do feel like that’s the typical, clinical solution for that. And it can have a time in place. But when you think about somebody who’s in their 20s,  maybe that’s not what they’re ready to do. And if it is something to turn around. Yeah.

Dr. Kelsey Stang  34:09

And FSH is gonna increase when the follicle isn’t responding. Anyways, so that could be because of low estrogen levels from HA.

Lindsey Lusson  34:20

Yeah. Depending upon when you had the lab work done. Yeah.

Dr. Kelsey Stang  34:24

Yeah, for sure.

Lindsey Lusson  34:27

I’ve seen that with luteinizing hormone too, right. Where there’s this big body’s trying to get up to ovulate but doesn’t quite get there. Somebody has bloodwork done just spontaneously at that point in time. And doctor and will be like, “Oh, well, your LH is three times your FSH. So you have PCOS”. And I’m like, “Whoa, let’s go back to what really been going on here”. So how frequently on that note, how frequently do you recommend people have their labs done? Because what I always tell people is I’m like, “Well, it’s a snapshot of what’s going on in your body in time. You don’t need to have a lab work done every single week, but what is the frequency that you recommend?

Dr. Kelsey Stang  35:01

If we’re trying to pinpoint POI or we’re just trying….

Lindsey Lusson  35:05

We’re trying to kind of figure out why somebody cycles or are off. 

Dr. Kelsey Stang  35:08

I mean, I use labs. But also I really love empowering women to know their bodies. So I do a lot of education around again, cervical mucus or basal body temperature. So we’re looking at many different signs and signals from the body. If we start say, we do labs and things are abnormal, and then we start treatment up for certain things. We start noticing some more cervical mucus. We start noticing a little rise in body temperature. Then I don’t usually always go back to testing until maybe six months later. If we do testing, we start stuff and nothing changes after a couple of months, then maybe we’ll go back to testing and see has things gotten worse? Things like how is the body responding right to what we’re doing?

Lindsey Lusson  35:51

Okay. And I did the exact same thing. Like I always tell people, we can look at labs, we can review that. And we’re going to look at the physical signs of how your body is responding to better nourishment, more rest all those things. So I mean, yeah, I think that there’s so many physical markers that we can pay attention to. And sometimes I feel like we can get almost a little bit too obsessed with numbers and lab works can be a piece of the puzzle, it’s not the whole thing. Do you recommend any sort of even the big thing in fertility device? stuff right now is the trackers like the Inito, the Mira. I think there’s probably a half a dozen of them at this point. Do you recommend those, do you use those with people? Do you see any pros or cons with those?

Dr. Kelsey Stang  36:36

Such a good question. I recommend the Tempdrop. A very easy based body temperature tracker. When it comes to the Inito or the Mira, nine and a half times out of 10, people are already using those and they come to me. So I haven’t actually ever recommended them. Mostly for that reason that they’re already using it. They’re so well marketed. They’re everywhere, right? And they’re good data to have. Again, I often find it can create this hyper focused awareness on the testing about it. What I like about the Tempdrop is  you just slip it on, sleep. Sometimes I have people think it and not even look at their data the next day and check their data once a week, things like that. So I’m always gauging that. Is the data collection creating more stress for us than not.

Lindsey Lusson  37:22

For sure. And that’s exactly what I tell people too. I do recommend the Tempdrop for that very reason. If somebody’s in HA recovery, it might be three months before they see their period return. Do you really need to use a physical thermometer, look it, put it in your app. Whereas Tempdrop. That’s what I usually tell people is if you want to do basal body temperature tracking before your period returns, do something like a tempdrop so that it takes a lot of the stress out of it and user error out of it too, for the most part. 

Lindsey Lusson  37:50

But yeah, I feel like I keep getting more and more clients using these at home fertility test. And unfortunately, I feel like it leads to a lot of false excitement. Because people will catch an LH surge, and they’re gonna they’re like, “oh, my gosh, I’m about to ovulate”. And then hopefully.. then they don’t. And then it’s, well, I don’t know, I understand the… Because when you’re waiting two to three months for your period to return, you have something tangible to grab on to. But I just feel like I keep running into margin of error on those devices, because they’re more designed for people that already have a cycle versus people who are trying to get their cycle back. 

Dr. Kelsey Stang  38:29

Absolutely. And I think that it can all play into the stress component. I will also, not to be the bearer of bad news here, this kind of sound a little negative. 

Lindsey Lusson  38:41

Well, we’ll get through this, and then we’ll turn it around real quick. 

Dr. Kelsey Stang  38:43

Okay, good. Because those trackers can be telling us that we’re ovulating, that everything’s fine. And we’re certainly getting pregnant. Yeah. And then it really lays in this “Oh, something else is wrong with me”. “Why isn’t this working?” And that can spiral us into a whole lot. The truth is, ovulation is one small piece of the whole puzzle of getting pregnant. We need to have a healthy endometrial lining. We need to have low inflammation in the body, we need to have healthy sperm. All of this is a big component that if it feels good and nourishing for women to be tracking and monitoring things for a period of time, great. But I’m always looking for that threshold for when it becomes more of a challenge. 

Lindsey Lusson  39:21

Yeah, and it goes back to self awareness with any sort of trackers. Because I tell people this about activity trackers ,right. I’m like well sometimes was a helpful tool to help you to say okay I’ve hit X number of steps and now I’m done for movement for the day where I should say no to  going on that lunch walk with my coworker or whatever. It’s a threshold right? I’m like, where’s this helpful versus where is this creating more stress in my fertility journey. I also love that you brought up kind of sperm health because I think that that’s something that goes overlooked way too often. How often do you see male factor infertility in your fertility practice?

Dr. Kelsey Stang  39:57

I’m maybe 20 to 30% of the time. Which is less than that.  I mean, statistics is really like at 50%. But yeah, I would say maybe 20 to 30% of the time. And it’s just, yeah, it’s such an easy thing.

Lindsey Lusson  40:14

I was gonna say it’s from other facility podcasts that I’ve listened to. And I’ve talked more on this topic, because it seems because of their hormone cycle, it’s a quicker fix than our cycles.

Dr. Kelsey Stang  40:27

Yeah, totally. Exactly. And I think too especially in the population of women who aren’t having a period regularly or have amenorrhea, the default is always going to be is it’s because of my period, I’m the one. But it’s such a good time to also get an evaluation with the partner. So that if there are things to improve upon or support nutritionally for the sperm health, then you’re doing that at the same time. Rather than, okay, I’ve got my period back. Now, I’m ovulating. My Inito tracker is telling me everything is great. Why am I not getting pregnant? Oh, now we’re gonna do the sperm test. And now that’s another three months before…

Lindsey Lusson  41:02

For sure. I’ve also found too that it helps people to just have a little bit more confidence in their fertility journey, right? Because that could be a whole nother rabbit hole to go down. But if you go ahead and do the testing, and how to have your partner working on his stuff, as you’re working on your stuff, you guys are kind of doing it together. So yeah. Well, let’s kind of end on this. I’m sure the answer is yes. But have you had patients who have been through months and years, failed IVF cycles, and then come to you and be able to get pregnant? 

Lindsey Lusson  41:33

I assume the answer is yes. And what does the typical trajectory look like? Because I feel I get people who have and maybe this is just because obviously IVF didn’t work for them. So now they have to go pursue a different route. But I feel like people who just get stuck in this cycle of we’re going to do ovulation induction that didn’t work. So we’re gonna do ovulation induction with a trigger, and now we’re gonna do injectables, and nothing works. And I’m gonna do IUI. And now we’re gonna do IVF. They just get kind of get put in this flowchart of fertility stuff. And that might take them years. And so often, I feel like IVF is in some people’s brains, the fast track to baby? How do people typically work with you? And what could be a typical timeline for pregnancy? 

Dr. Kelsey Stang  42:19

In general, or somebody going through IVF?

Lindsey Lusson  42:21

Just in general.

Dr. Kelsey Stang  42:22

In general, it really varies. It can be anywhere from a month to two years. Yep. And that’s really… I mean, I’ve even had people who sign up for my program, and then, get pregnant right away. And it’s  they just needed to sign up for the program.

Lindsey Lusson  42:39

I’ve had that too, because I feel like sometimes it just takes the burden off the person. You’re like,  Okay, I am now putting this in your hands, Dr. Stang. You are gonna get me pregnant. And then they take that stress off themselves, and their bodies start to sync up in a line. So I’ve definitely experienced that too. 

Dr. Kelsey Stang  42:58

I was gonna just add there. Particularly with an IVF. That’s such a great breakdown of we think it’s going to be the fast track, but it really is many steps and a lot of involvement. And I always tell people that it’s the best time to have… care. Because your IVF doctor isn’t asking you about how you’re sleeping, and how you’re pooping and how your response to the meds is and what can we do about it. I find, at least in the 10 years I’ve been supporting folks go through IVF is that it’s a really stressful process. After coming on the heels of a really stressful fertility, trying to conceive journey already. And having someone a care provider, who you really resonate with that is gonna listen to you, honestly is like what most people respond back. 

Lindsey Lusson  43:47

Yeah, yeah. Because I know I do feel sometimes it can just be like, Oh, just try another IVF cycle. But  really addressing maybe why those cycles didn’t take. One caveat here though, is I feel sometimes when we’re talking about IVF and multiple IVF cycles, we’re just assuming that people have boatloads of money. What would be your recommendation on the more cost effective way in a perfect world? Somebody who’s struggling with infertility, what would be the more cost effective way to start their fertility journey in addressing some of the things that you mentioned? 

Dr. Kelsey Stang  43:47

Then I also do a lot of… I would say most people come in after they haven’t had a successful IVF transfer. And now they’re gonna take a break, and they want to focus on certain things, right? We dive in pretty deep in that case. Because they’ve already gotten the the couple of years of trying naturally, and they did the cycle that was regulated and then didn’t result in a healthy pregnancy. Essentially, usually dive pretty deep into lots of things. Gut health, nutrient status hormones. Like all the things that we have time for really, not usually changes the outcome so much.

Dr. Kelsey Stang  44:22

I mean can I say taking my fertility broker?  Because that’s what’s gonna be the example like, Okay, I’m taking this off my chest. Now I trust you to help me in this process. Somebody you really trust in that journey is golden. But yeah, I guess a great full circle to everything we talked about is really working on a lot of the foundational things. And most of the people that come to me are already doing all the things.

Dozens of things more than they need to be doing. And so it’s so helpful to identify and create a strategy. I meet with folks every month. Once a month we meet. Every other week in a group setting. So there’s just so much accountability and in touch point, in terms of, again, how are we monitoring progress? And how are we really shifting the root cause of what imbalances might be at play here contributing to fertility challenge? 

Lindsey Lusson  45:53

Well, I like the community aspect too. Because I’m sure you’ve noticed this, but I think the community aspect is really powerful in a lot of different settings, but especially the fertility setting.

Dr. Kelsey Stang  46:03

100%. And I was just thinking about this the other day that if it was me, 10 years ago, when I was trying to get pregnant, I would have been like, Heck, no. I do not want to talk about my fertility or my body in a group. It’s just gonna be judgment central, and I’m not about it. And it’s not the case. It was my own resistance. Thinking about my past self. Whereas when we open this door to the community, especially around health care, and fertility care, it’s so magical what happens inside of those groups in terms of being able to learn from each other, being able to resonate. Feeling we’re not doing it all on our own, because that’s oftentimes the rhetoric that we have in our minds also.

Lindsey Lusson  46:43

Yes, for sure. Well, that’s amazing. And on that note, how can somebody best connect with you? What’s your website? Is it social media? How can someone get they’re listening to this and they’re like, I’m ready to take charge of my fertility. I’m ready for a different approach. I want to address all the underlying issues instead of just be pumped full of medicine. How do they get in touch with you? 

Dr. Kelsey Stang  47:02

Yeah, my website. All my stuff is just my name, Dr. Kelsey Stang. So that’s my website, drkelseystang.com. That’s my Instagram account, you can message me on Instagram or email me at drkelseystang@gmail.com. I kept it pretty, pretty basic.

Lindsey Lusson  47:19

Pretty basic, perfect. Makes it easy for listeners. Thank you so much for your time today. And I think that listeners are gonna find this episode helpful in learning about things but also encouraging and just knowing that there’s always other things other testing that can be done. You don’t have to settle on this very frustrating, unexplained infertility diagnosis, and there’s always something you can do.

Dr. Kelsey Stang  47:41

Yeah, that’s totally my goal. Because it doesn’t have to be hard. Even though it is sometimes really hard. That emotional experience or energetic experience about it can be one where we feel empowered and confident in our bodies. 

Lindsey Lusson  47:52

I think just having answers, right? There’s nothing worse than being well, I don’t know why I can’t get pregnant and you’re literally staying up until 2am googling everything. I think just knowing that there’s testing you can do, there’s support you can get. Not only is there testing that you can do but when we’re getting conclusive results. There’s also  a plan and I think that people really like that. Yeah. 

Lindsey Lusson  48:12

Well, thanks again for coming on. And we hope you have a great rest of your day. 

Dr. Kelsey Stang  48:17

Thank you.

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MEET THE HOST
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I’m a fertility nutritionist and registered dietitian who specializes in hypothalamic amenorrhea. My passion is helping women trying to conceive find freedom with food and exercise, so they can recover their period, and get pregnant naturally.

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EPISODE 1: MY RECOVERY STORY

Jan 19, 2022

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