women's health Archives - Hammersmith Books

The following is an extract from ‘The Plant-Based Dietitian’s Guide to Fertility’ by Lisa Simon RD and looks at the effects stress can have on fertility. The book will be available for purchase on Hammersmith Health Books and other online vendors this month.

I cannot emphasise enough how significant an effect chronic stress can have on your health. I would go so far as to say that it is at a level playing field with nutrition and, if it isn’t addressed, quite simply you will not improve your health.

Your body’s response to stress is instant and starts in your brain. It begins a series of interactions between the hypothalamus, pituitary and adrenal glands. This results in the release of adrenaline and cortisol, two of the ‘stress hormones’, from the adrenal glands. Once the stress has passed, your cortisol and adrenaline levels reduce back down. This step is really important as the communication between the glands in your brain and the adrenal glands above your kidneys also influences the production of sex hormones. If the stress doesn’t pass, the stress response doesn’t stop and this results in disruptions to your reproductive hormones. It is because of this that chronic stress may lead to poorer sperm quality and infertility in both men and women.

The effects of chronic stress on fertility

So, the effects of chronic stress on general health but also on fertility can be significant, and sometimes it feels like a bit of a vicious circle. Struggling to conceive is stressful, going through fertility treatment is stressful, and worrying about the effects of stress is stressful! Add that to general life stressors like work, relationships, social pressures, financial strains etc, and you can see how present stress is daily, even if you are not always aware of it. This is when the effects of such stress can start to become apparent in your state of health and affect your fertility, and this is why it is so important for both your mental and physical wellbeing to have in place some great stress management techniques. In terms of fertility treatment, data show that men report feeling stressed providing sperm samples on the day of egg retrieval, and this may negatively affect overall semen quality, with effects on sperm concentration and motility. However, it is difficult to say whether stress results in reduced semen quality, or whether it is a consequence of decreased semen quality.

Being diagnosed with infertility, frequent medical appointment, and failed IVF treatment are all very stressful events. It isn’t just the stress itself though that can affect sperm quality; how you respond to stress may also play a part. Responding by being assertive or confrontational may negatively affect fertility by increasing adrenaline production which then results in the blood vessels in the testicles tightening. This reduces testosterone production and the making of new sperm, so for men, stress management techniques are just as important as for women.

As stress causes an increase in cortisol and subsequent suppression of sex hormones, this can lead to a decreased sex drive and can also lead to undesired weight gain. Whereas acute stress is more likely to result in a reduced appetite, chronic stress is more likely to decrease behavioural control and increases impulsive behaviour. An estimated 35-40% of those experiencing stress increase their food intake. The types of food likely to be chosen are foods high in sugar and/or fat, with low-energy, high-nutrient foods, particularly fruit and vegetables, decreasing. This may then lead to overeating, which in turn can lead to weight gain and potentially increase feelings of anxiety and depression. Conversely, some experiencing chronic stress may decrease their food intake, leading to weight loss, with potential adverse effects on their mood, energy, concentration and, for women, their menstrual cycle.

Managing Chronic Stress

Managing stress is the third pillar of lifestyle medicine and essential to improving your chances of conceiving a healthy baby. In terms of techniques for doing so, everyone is different, and what might work for one person may not necessarily work for the next. For example, I’ve had patients telling me that meditation is their idea of ‘hell’, but then when I explore further, I find their concept of meditation is sitting on a yoga mat, cross legged, with both hands raised, fingers touching, while gently humming. This stereotypical image does not reflect the broad spectrum of meditation and is very different to most people’s practice.

Note from the author: In my new book, The Plant-Based Dietitian’s Guide to Fertility, I recommend the following from which you can pick and mix what is right for YOU. Please do see the book for the full information:

Guided meditation
Controlled breathing
Positive visualisation
Laughter therapy (yes! You heard right)

My experience of managing stress after embryo transfer

I can’t say that I didn’t worry at all during the two week wait after embryo transfer as I think some degree of anxiety is inevitable when you are pinning so much on something working, but every time I felt as though my anxiety was starting to get too high, I would apply some or all of the stress management techniques I describe in the book to bring it down.

Another thing I would highly recommend, if it is possible for you after embryo transfer, is to book those two weeks off work, or at least the first week. You want to remain as calm and stress-free as possible during that time, not having to deal with the commute if you are not working from home; work stress is something that you just don’t need. Also, finding something to occupy your mind is crucial so you don’t spend long periods trying to second-guess whether you are pregnant. That can be really counterproductive, and please, STEP AWAY FROM GOOGLE! It can be so tempting to search the internet for ‘signs I am pregnant’ or ‘what does implantation feel like?’ but this can raise stress levels and mean that you are obsessing over the slightest little sensation. Try and spend those two weeks doing lovely things with either your friends or your partner. Go out for relaxing meals, watch a film in the cinema, organise a pamper evening, do some crafting – anything that helps you to relax and distracts you from negative thoughts.

And remember, if none of these techniques are for you, there are many other forms of stress management that can be equally as effective. These can be going for a lovely walk, or a gentle run outdoors in nature, curling up with a cuppa and your favourite book, or having a lovely warm (not hot) bubble bath. As long as you take some time out, away from your phone and other screens, and just focus on being present, you will feel much better for it.

The following blog is by Lisa Simon RD, author of upcoming book ‘The Plant-Based Dieticians Guide to Fertility’ which will be available on the Hammersmith Health Books website and other online vendors from 27th April 2023.

I don’t think anyone who has not experienced endometriosis can truly understand just how debilitating a condition it can be. I say this because I was diagnosed in 2010 and it is one of the reasons I decided to write my book, ‘The Plant Based Dietitian’s Guide to Fertility: From pre-conception to healthy delivery’, and to dedicate a chapter to endometriosis, a condition that can reduce fertility for many individuals. I feel passionately about helping as many women and men as possible to optimise their fertility and to help those women who are now in the same position I was and who are experiencing debilitating symptoms on a monthly basis. Nutrition is a key area that can help improve our situation. Unfortunately there is so much nutrition misinformation out there which often causes confusion and even harm, so my aim was always to write a book that could be relied upon to provide only information that is backed up by a referenced evidence-base. This evidence increasingly supports a whole food, plant-based diet and I give guidance on how to get started, including some stand-by recipes that I hope you will find helpful.

How many women are affected by endometriosis?

Around 1.5 million women are living with endometriosis in the UK and around 176 million worldwide. However, it can take on average eight years to be diagnosed, meaning that many women live with chronic pain and fatigue for a long time before they are given a formal diagnosis.

What is endometriosis?

Endometriosis is a chronic, inflammatory, oestrogen-dependent condition that arises where cells similar to those that line a woman’s uterus are found elsewhere in the body. Most commonly they are found in the pelvic cavity, but they may also grow in the intestine, bladder, liver, kidneys and nasal cavity, on caesarean scars, and even in rare cases in the lungs and brain. These cells respond to each menstrual cycle and bleed, but unlike those in the womb which are shed as a woman’s monthly period, they have nowhere to go and so become inflamed. This results in pain and the formation of scar tissue which can then lead to pelvic pain, bowel and bladder symptoms, painful and/or heavy periods, painful intercourse and infertility.

The risk of misdiagnosis

The reason that it can take so long to get a diagnosis is that many of the symptoms of endometriosis are very similar to another chronic condition, irritable bowel syndrome (IBS). This means that women are often sent to see a gastroenterologist and subjected to a number of investigations before being given a diagnosis of IBS along with advice on how to manage this condition. This may or may not result in some symptom relief because often IBS and endometriosis can co-exist. However, this is then often seen as the end of the road rather than a referral also being made, or initially being made, to gynaecology, meaning that if endometriosis is present it is not detected.

What can you do to ensure you receive the correct diagnosis?

I would always advise you take a pain and symptom diary and a written list of all your day time and nocturnal symptoms with you to your initial GP appointment. This ensures that you are giving as much information as possible so that the chance of you being referred to the correct specialist is increased. So for at least a week before your appointment write down when you experience pain, where it is in your menstrual cycle, and how you would rate it on a scale of 0-10 (where 0 is no pain and 10 is the most pain you could ever experience). If symptoms get worse in line with your menstrual cycle, this should ring alarm bells for your doctor.

How did endometriosis affect me?

I first experienced the pain of endometriosis shortly before my 30^th birthday when I was studying to be a dietitian. I was walking to a lecture when suddenly I was immobilised by excruciating pain on the left side of my abdomen; it literally took my breath away and it was terrifying because I had no idea what it was. The only thing I could do was to wait for it to be manageable enough for me to drive myself home. This recurred often over the next few months and I began to notice the pain was roughly at the same time each month, although I did sometimes experience pain outside of these times. I couldn’t tell if it was around the time of my period because I was experiencing a pretty much absent cycle but I had suspicions it was gynaecological rather than IBS pain (I had been diagnosed with IBS in my late teens).

I saw my GP who referred me to gynaecology but the waiting list was long and all I could do was put up with chronic pain which significantly impacted my life. I missed several weeks in total of university, and missed out on spending time with friends and family because the pain was such that all I could do was lie curled up in a ball on the sofa with a hot water bottle in a desperate attempt to reduce it. Perhaps this sounds familiar to you?

Eventually I could not cope with it any longer and saw a gynaecologist privately with a subsequent laparoscopy, a surgical procedure where a camera is inserted through a cut by the belly button and if endometriosis is seen it is removed. I ended up having two of these operations because the cells grew back a few years after the initial surgery. I experienced post-surgical complications after the second surgery which resulted in a longer hospital stay.

I also experienced secondary infertility. When my husband and I started trying for a baby I assumed I would fall pregnant pretty quickly as I already have a seven year old son at that time. However, after failing to conceive for two years and given our ages (I was 36 and he was 41) we decided to go down the IVF route. All the routine tests were performed and we were diagnosed with unexplained infertility. However, I knew that endometriosis was likely playing a part.

Everything changed for me when I adopted a whole food, plant-based diet and really looked at other areas of my life where I could make positive changes. I am happy to say that these days I do not experience pain during my monthly periods (which have now returned) and I attribute much of that to my revised dietary pattern and lifestyle. There is a growing evidence-base supporting the benefits of adopting a plant-based diet and also for the role of exercise in helping to manage conditions that involve inflammatory processes, like endometriosis.

I am thankful that our IVF treatment was successful and I am now the mother of two lovely children. My experience with infertility and IVF treatment, and the physical and emotional impact means that I fully understand what each of my patients goes through and I feel empathy with each and every one.

Tag: women’s health

The Damaging Effects of Chronic Stress