151. Could Inflammation Be Behind Your Cycle Symptoms?

To submit your comments about the Excepted Benefits Fertility Rule, go to this website for more information and a link to the submission information: https://iirrm.org/proposed-us-federal-rule-on-expected-fertility-benefits/

--------------------------------------------------------------------------------

Inflammation is one of the most searched health topics right now — but when it comes to menstrual cycles and fertility, the conversation is rarely specific enough to be useful. What is inflammation actually doing inside your cycle? How would you know if it is a factor for you personally? And what can genuinely be done about it?

In this episode of Cycle Wisdom, Dr. Monica Minjeur goes deeper than the buzzword and walks through exactly how chronic low-grade inflammation disrupts follicle development, impairs ovulation, compromises the uterine environment for implantation, and drives some of the most frustrating and persistent cycle symptoms women experience. Through Renee's story — a patient with two unexplained miscarriages, heavy painful periods, and repeatedly normal labs — you will see what a complete inflammatory workup can find that standard testing almost always misses.

You will learn:

• How inflammatory cytokines interfere with follicle development, delay ovulation, and compromise the implantation environment
• The most common and most overlooked sources of chronic inflammation — including gut dysbiosis, thyroid antibodies, insulin resistance, and chronic endometritis
• What a targeted anti-inflammatory evaluation and treatment plan looks like — and how quickly meaningful improvement is possible

If you have been told your labs are normal but your symptoms say otherwise, inflammation may be the missing piece. Learn more or schedule a free discovery call at radiantclinic.com.

Transcript

Speaker 3 0:00

Before we get into the episode, I would like to ask your help with something big. There is currently a rule at the federal level that is requesting input from the general public in regards to fertility benefits being able to be provided through employers independently. The comment period for this rule is only open until midnight Eastern Standard Time on July 13th, and I need your help. We are trying to get as many people as possible to write in and share your personal story about how your life or the lives of your loved ones have been improved or positively impacted by the availability of restorative reproductive medicine. For more information and the website to submit your story, please click on the link in our show notes to be directed to the International Institute for Restorative Reproductive Medicine, where you can read more about the proposed rule and get help with drafting your comments. If you have any further questions about this, feel free to send us an email at hello@radiantclinic.com. And now, on to today's episode

Speaker 1:09

Inflammation is one of the most searched health topics right now, and for good reason. But when it comes to menstrual cycles and fertility, the conversation is rarely specific enough to be useful. Today, we're going deeper. What is inflammation actually doing inside your cycle? How would you know if it's a factor for you personally? And most importantly, what can genuinely be done about it? I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their wellbeing through personalized healthcare grounded in clinical excellence. So let's start off today with a story about a patient of mine who we'll call Renee. Now, Renee came to us after having gone through two early miscarriages. Her OB doctor said they were unexplained, and she should just try again. However, she was concerned because she also was having very heavy and painful periods in addition to significant acne, fatigue, and she was told that her labs were normal. She was frustrated by all of the normal lab results, yet having so many symptoms, and a friend suggested that she check out our clinic. She wanted to know specifically, "Why am I having these miscarriages? And why am I having these other symptoms?" There's a significant chance that they're related. So we started off, as always, with getting her to chart her cycles, looking at her symptoms, and casting a wide net when it came to her evaluation. We started off with some blood work, as well as evaluation for chronic endometritis. What we found was that she had thyroid antibodies that were positive, so she had a new diagnosis of Hashimoto's disease. This was previously undiagnosed because she had normal TSH. Her lab levels also showed that she had low vitamin levels across the board, and in our world, this oftentimes leads to some other gut absorption issues. We dug a bit deeper and found that she actually had a significant gluten intolerance. And finally, the endometritis testing that we did confirmed that she had a bacterial overgrowth and did not have enough of the healthy lactobacillus. This oftentimes can contribute not only to implantation failure, but to significant symptoms. Over the next few months, Renee and I worked together on targeting interventions to help restore her dietary health, her gut, her thyroid, as well as treating the endometritis that was found. Over the course of those months, she found significant improvement, primarily in her symptoms, and she was able to conceive again. She is currently in her third trimester of pregnancy, a place she has never been before, and more importantly, she is feeling well after addressing all of the different inflammatory components that were playing a role for her So why is inflammation present in the first place? The big picture here is that inflammation in our bodies is actually protective in the short term. When you have an infection, when you're fighting off something, your body's inflammatory response mounts up in order to be able to help protect you from anything that is foreign in your system. However, if we have chronic systemic activation of your inflammatory components, it can become a disruptor to many of your body's more sensitive systems, like hormones and reproductive system. Inflammation oftentimes in our world is discussed around endometriosis, but its effects on the cycle can be significantly broader. As we noted in Renee's case, having problems with thyroid dysfunction, having problems with her gut, and having the endometritis all led to this chronic low-grade inflammation, which can also impact not only the function of the ovaries and implantation, but also the signaling of hormone production from the start. Inflammation is unfortunately one of those topics that is incredibly broad. There is not one specific test that we can look at to say, "This is what's going on with inflammation," but it's also part of the reason why we cast a wide net when we're looking at things from a diagnostic perspective, especially in our patients that have suffered recurrent pregnancy loss, but also in any of our patients that are having any other cycle-related symptoms. Many of our patients come to us being told, "My labs were normal from my last doctor. There must not be inflammation present." And unfortunately, standard blood work rarely picks up some of those other factors. So things like thyroid antibodies are not commonly checked. Oftentimes, nobody is looking at that big picture to understand what else might be going on from a standpoint of gut dysbiosis or overgrowth or improper absorption of your nutrients. And most importantly, when it comes specifically to the uterus, there is not one specific blood test we can do that discerns if there is endometritis present. So how does inflammation actually impact ovulation? So with inflammation, there is a protein in our bodies, and they kind of act like a messenger. So these proteins are called cytokines. Cytokines are produced during chronic immune cell activation, and these cytokines interfere with or can completely block the development of a follicle and the LH or the luteinizing hormone surge that triggers ovulation to happen. When we have these excess cytokines that are blocking or impairing follicle development, this can lead to cycles where ovulation just doesn't happen at all. It can also sometimes lead to a delayed or a postponed ovulation, which can sometimes be difficult to understand unless you're actually tracking your cycles. And finally, it can also cause inflammation of the ovaries themselves, which disrupts the local environment that the follicle maturation is trying to occur. So you can imagine if we've got tiny little ovaries that are generally less than two or three centimeters in size, and all of a sudden we have a follicle that's trying to develop that is generally going to be about one to two centimeters in size, that follicle is going to have a hard time being able to grow and do what it needs to do if there is a lot of swelling in that area from those cytokines. So this is why it's important that we look for and evaluate specifically inflammatory and immune markers as these can contribute not only to fertility problems, but also to ongoing problems with symptomatic pain, inflammation, bloating, and other systemic symptoms beyond just the reproductive tract When it comes specifically to implantation if you are trying to conceive, successful implantation requires many different things beyond just the adequate hormones and ovulation. It also requires a receptive uterine environment where there's not systemic inflammation. Again, chronic endometritis, as we've talked about in the past, um, you can go back and listen to episode 135 if you wanna hear more about that, but this entity of endometritis oftentimes is accompanied by a low-grade bacterial or fungal infection, which creates, again, those cytokines, which creates inflammation of that uterine wall lining. You can imagine that if something is inflamed and swollen and infected, there's not a great environment for being able to allow implantation to occur, and this is why it's so important to not only screen for endometritis, but to be on the lookout for what are the other symptoms that might be present. If we treat it, did we get it treated effectively? And this is an ongoing area that we're always paying attention to. In many of our patients, they have no symptoms at all, no pain, no fever, no obvious signs, and sometimes we only pick this up when we do specific testing. Endometritis is being increasingly recognized as an under-diagnosed and under-treated contributor to unexplained infertility and recurrent pregnancy loss, but testing is still a little bit challenging. You can get evaluated for endometritis with hysteroscopy or a specialized endometrial biopsy, which, let's be honest, is not super pleasant, or there are newer tests you can have done that evaluate the menstrual sample blood. Now, none of these tests independently is perfect, but if we show any signs of inflammation or infection on any of these tests, getting treated absolutely makes a big difference in what that pregnancy outcome looks like Okay, maybe you're not trying to conceive, but you are having terrible period pain or bloating. This can also be from inflammation. Prostaglandins are another inflammatory compound that's produced in the uterine lining during your menstrual cycle. In fact, these prostaglandins actually help to encourage the contractions that expel the menstrual blood during your period. However, when you have inflammation throughout your whole body, not just in the uterus, that systemic inflammation is elevated, therefore your prostaglandin levels are higher, which oftentimes then is going to increase sig- more significantly the contractions that you have, which then also leads to increased pain and sometimes even heavier periods when those prostaglandins are firing. Many women are still told that period pain is just normal. That's how it is. You have to deal with it. However, when we remove the source of inflammation, whether it's endometriosis, endometritis, treatment of thyroid antibodies, helping to restore gut health, we can oftentimes see significant changes when it comes to the period pain and intensity. More importantly, we can also help to improve systemic inflammation symptoms by doing other things that can modify the amount of inflammation that's present on a regular basis. So things like an anti-inflammatory diet can actually produce meaningful improvement in many patients. This can then translate to improved symptoms of decreased menstrual pain, decreased bloating, decreased s- joint swelling, weight, skin changes, and many other factors that can play a role when we get that inflammation under control So there are lots of different things that can actually be the cause of that inflammation, and I'm gonna list a few here. This is definitely not a completely exhaustive list, but things to be thinking about and considering. Many times the symptoms that come along with these things are going to be very specific to what you are experiencing, but can also cause generalized inflammation. So sometimes we don't have to test for all of the things, but that's why it's so important to work with somebody who is keen to find what are your symptoms showing us, and what do we need to be looking for in order to get the correct diagnosis, which then helps us to get the treatment in the right direction. So as we discussed with Renee, one of the very common things we often find will be problems with your gut. Now, gut dysbiosis, which is also known as imbalance of the bacteria or microbiome dysfunction, or sometimes people will talk about it as leaky gut or intestinal permeability, gut imbalance or dysbiosis is a significant driver when it comes to inflammation because the gut is the largest immune organ in our body. If our gut is not doing well, we cannot absorb nutrients appropriately, which then also signals problems as far as nutrition deficiencies leading to ongoing inflammation and the cycle continues. One of the most common reasons we see for gut dysbiosis is actually food sensitivities, specifically gluten and dairy, as well as sugar and sometimes eggs. Now, I'm not saying you have to cut all of those things out, but we typically will talk with our patients that have gut symptoms about trying to reduce or consider at least a partial or temporary elimination of these foods in order to see if it makes a difference with their systemic symptoms. Many of our patients who are very sensitive or who have a lot of inflammation do well to significantly reduce or completely eliminate gluten, dairy, and sugar, and that's one of the things that we always talk about to determine if that could be playing a role for you. Another common source of inflammation is going to be autoimmune disease. So as we mentioned with Renee's case, she ended up having autoimmune thyroid disease. Now, autoimmune thyroid disease is incredibly common in reproductive age women, and for many women, you can have a disruption of your menstrual cycles because of this. The tricky thing with autoimmune thyroid disease is that it doesn't always follow with overt thyroid dysfunction. So if your doctor is only checking a TSH, for example, or a thyroid-stimulating hormone, we may be missing the picture altogether. I talk a lot more about this in episode 133, where I talk all about thyroid antibodies and their impact on fertility, but one of the reasons why this plays a role is because of the antibodies and the inflammation that's created Another driver of inflammation is dysregulation of blood sugar and insulin. This insulin resistance creates pro-inflammatory cytokines, again, those proteins that encourage inflammation. And so if your body is constantly fighting that insulin resistance, we can have significant problems not only with regulating the blood sugar, but also with ongoing inflammation and ovulation dysfunction And then the last two categories that I'll talk about are a little more challenging to pin down, but still incredibly relevant to be looking for. So one of those is chronic psychological stress. So if you're somebody who's dealing with chronic anxiety or depression or OCD or PTSD or any chronic mental illness, we know that individuals that suffer with mental illness have an increased inflammatory pathway that's activated because of cortisol, our stress hormone. This inflammation can cause chronic inflammation throughout your entire body, not just in your brain or your nervous system. So again, important to make sure that we are managing all of your mental health symptoms, utilizing medications where necessary, and looking at long-term, the fact that if we can decrease that inflammation from a systemic standpoint, oftentimes we're able to improve the long-term health and decrease your inflammation from other systemic symptoms. And then the last one, like I said, that is also a bit challenging sometimes to discern how much it's playing a role is environmental toxin exposures. Now, this one is really tricky. We did talk about this recently in episode 146, but specifically looking for any significant exposure to the PFAS, BPA, pesticides, phthalates, all of these can significantly increase your inflammation and disrupt your immune system. So again, we wanna be screening for these, looking for these things, and trying to remove them from our environment when possible. There are some lab tests that are coming out now that can help to screen for the PFAS and the BPA. It's not perfect yet, and ideally, the focus is just trying to eliminate those from your environment when and where possible. So again, go back and listen to episode 146 if you feel as though this may be playing a role in your symptoms of inflammation to discern, "What can I do about this? How do I know what to look for, and how do I do it in a way that doesn't totally stress me out to just feel like I have to live in a bubble?" So when we go looking for inflammation, what are we looking for? Again, with Renee, we kind of cast a wide net to discern what is going on. Definitely making sure that you get antibodies checked for, definitely looking for an assessment of your gut health, and also making sure that if recurrent implantation failure, early miscarriages, or pregnancy loss is a part of your history, that somebody is doing a targeted evaluation of the uterine environment to make sure there is not chronic endometritis present. When it comes to treatment, there is not a one-size-fits-all because, again, it's going to be highly dependent upon which components are playing a role for you when it comes to inflammation. A good general place to start can be looking at your diet and saying, "Where can I decrease inflammatory foods? Where can I help to restore my gut health?" So you can make meaningful changes by reducing inflammatory foods in your diet. So think about cutting out processed foods, refined carbohydrates, seed oils, and then like I mentioned, the other big three that we say to consider are to consider a temporary trial or elimination of gluten, dairy, and sugar. In many people, they will notice a significant difference in their symptoms, even just with these dietary changes over the course of anywhere from one to three cycles. And so oftentimes we will have our patients continue that if they noticed a difference. Now, if you cut out all of these foods and you don't notice a difference, great. Maybe the gut is not your source of inflammation, but it doesn't mean we don't still keep looking. So one of the most common questions we get asked, especially with our new patients, is, "I think I'm inflamed. I feel like everything is swollen, but how do I know if that's the cause of what's going on with my cycles?" Oftentimes, the key signals we're looking for are things like heavy or painful periods, worsening PMS symptoms, recurrent miscarriage, or other persistent systemic or widespread symptoms like I'm tired all the time. I have skin flare-ups at certain times of my cycle, whether that's acne or rashes or hives, or I have symptoms that don't fit a real clean hormone diagnosis. I may be having systemic issues with my gut. I feel bloated all the time. My joints are swelling. I feel stiff. Oftentimes, that piece will help give us the information we need to provide a targeted evaluation based on your specific symptoms. And the last piece I wanna leave you with today is if I improve the inflammation, will it come back? Will my cycles improve? Will this allow me to get pregnant? And in many cases, we say, yes, you can experience improvement, and sometimes in very meaningful ways that you notice other symptoms you didn't even know you had are actually better when we decrease that inflammation. The tough piece is the timeline totally depends upon what's going on. Many, many, many of our patients have multiple sources of inflammation, and so it takes some time to tackle it. For example, treating chronic endometritis, oftentimes we'll see rapid improvement in implantation even within the course of a month, but it is more prone to come back. So working with a restorative reproductive medicine physician can make all the difference in the world when it comes to making sure that your inflammation is gone and stays resolved. Imagine if your doctor asked the deeper question about your cycle symptoms. What is your immune system doing and why? Imagine if inflammation was understood not as just a wellness buzzword, but as a real, measurable, and treatable contributor to cycle dysfunction, one that shows up in your chart, on your labs, and in your pregnancy outcomes if someone thinks to look there. This way forward is possible for women to have a more complete evaluation and find answers that finally make sense. This can pave the way for a clear path forward to improve health and promote fertility

Speaker 2 21:18

If you're ready to work with our elite team of healthcare professionals, go to our website radiantclinic.com to schedule a free discovery call and learn more about our package-based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in many different states across the US. Check out our website for current states that we can serve medical clients, and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom