This post is a tale of two parts. Part One is how I came to appreciate that stress has a fundamental impact on my fertility and Part Two focuses on the practical steps I take to control it to improve my chances of conceiving.
Can stress effect prolactin levels?
Early on in this tortuous journey of trying to conceive my GP called to inform me that my prolactin levels were outside the normal range. I had never heard of prolactin (I used to be a 'normal' person before infertility struck who couldn't recite the names and functions of all human hormones, how times have changed), so I asked my GP to spell it for me so that I could go away and obsessively Google it. Prolactin is a hormone that rises as a result of breastfeeding, as the result of a tumour on the pituitary gland or as the result of stress, amongst other things.
As prolactin tends to rise in response to physiological stimuli my GP was prompted to ask whether I was experiencing any stress at work, going through any life events or undertaking strenuous exercise. I had spent the previous year tearing my hair out in my new job, we were in the process of buying our first house and I was training for a marathon in which I wanted a faster time then my legs could possibly carry me. Err, so...yes, all of the above. She advised me to work on reducing my stress. I then became stressed about the need to tackle my stress, which was highly stressful for a stress head like me. So I put in place a plan to take daily steps to me to chill out and ultimately reduce my prolactin. It worked! Within 3 months my prolactin levels were back within the NHS range for normal (although still pretty high for optimal fertility) and within one year my levels had almost halved.
Does stress delay my period or ovulation?
You bet yah. With so many changes to my health and lifestyle taking place all at once it is sometimes hard to establish what is making the difference. But the direct impact of stress on my cycles can be witnessed in my monthly report cards (i.e my monthly cycle charts using the fertility awareness method). My body is the all seeing all knowing accountant over which I cannot pull a fast one. Trust me, I've tried. There have been two instances of obvious stress and both times the impact on my fertility has been delayed ovulation.
Travelling to a different time zone - May 2016. Long distance travelling is stressful for the body. I have read this on numerous occasions and dismissed it. Wussies, I thought. My body is too robust to be effected by a flight. How ridiculous. A thought that proved to be completely wrong, obviously, and confirmed me rather harshly to be an arrogant idiot. A 9 hour flight (without any inflight entertainment, what's that about Lufthansa?), a change of time zones and sh*tting a brick by being an introvert forced to present a large conference, delayed my ovulation by 3-5 days (3 days later than the months before and 5 days later than the months following). Humph. Maybe there is something to the notion that travel is physiologically stressful after all.
Long working hours and lack of sleep - March 2017. If sleep were an olympic event I would be a contender to represent GB. I can sleep like the best of them, ideally aiming for 9 hours every night. But at the start of this current cycle I spent around ten days working between 13 and 15 hours a day. I found that stressful and I could feel it in my shortness of breath and racing mind. I wondered whether it would impact my cycle and I pondered over whether the relaxing holiday I went on mid cycle would undo any earlier negative effects. The results were 'yes' and 'no' respectively. Ovulation graced me with its presence on day 20 of my cycle, the last time my ovulation was that late was 8 months previous.
It just goes to show how immediate the impact of stress can be on my body and on my ovulation. But following the last bout of stress in 2016 my cycle bounced back just like Alan Partridge and I am hoping that if I take the daily steps below my next cycle will also return to normal in double quick time.
How can we reduce stress? 10 practical daily steps
1. Using Meditation to reduce stress
A meditation app that is all about taking ten minutes a day 'for you'. I do a session on my train into work each morning. It is just me, numerous sweaty London commuters and Andy, the narrating ex Buddist monk with a shaved head and totally ripped body. The first ten sessions of Headspace are free to trial and then later as you become more experienced you can chose from a selection of mediation packs such as stress, balance, sleep and acceptance. There is even a pack for pregnancy. Fingers crossed I will need that one day. You can also link your account to your 'buddies' and track each others' progress. It allows me to be secretly competitive with my friend Lucy, who (unknown to her) I was racing to reach 200 meditation sessions. She lost, although she doesn't know it, sucker! It may not be in keeping with the spirit of meditation, but you can't always be zen and a winner.
Circle and Bloom
Circle and Bloom design programmes of guided mediation and visualisation specifically designed for fertility. I have been using the Natural Cycle for Fertility Programme for 4 months and it has made me feel like a healthy, fit, functioning human being, which is something I have been doubting about myself ever since failing to fall pregnant. Again, I do these meditation and visualisation sessions on the train, which requires the soothing American voice to be interrupted with a gruff English one announcing on the tannoy that we are transiting through Woking. But it still remains the best time to slip it in to my daily schedule. There are also fertility meditation programmes for IVF, IUI, PCOS and more.
2. How to reduce stress with breathing techniques
Ever heard of qigong breathing? Nope, I hadn't either until I read the Traditional Chinese Medicine book The Infertility Cure by Randine Lewis. Qigong breathing is a technique for relaxation, calming the nervous system, improving the flow of energy around your body and increasing your immune system. All good stuff in my eyes. A useful step-by-step guide to how do do qigong breathing is available on here. If you were thinking this sounds all a little too hippy, well it isn't. How do I know? Because even the NHS is recommending breathing techniques to control stress, and you cannot get more mainstream than the NHS.
3. What yoga poses relieve stress?
Yoga has been a god send for reducing my stress and putting my life and focus back into perspective. There are set poses within yoga that are especially good for reducing stress, such as those explained (with photos) by The Huff. The key move we wiggle in to in my yoga class to help with stress is Legs-Up-The-Wall, which involves doing exactly what it says on the tin. There are photos of this pose and others in the Huffington Post article referenced above, although I have to admit that I personally do not find the Extended Triangle Pose to be in the slightest bit relaxing (although my parasympathetic nervous system might) and I gawp at the idea of holding the Dauphin pose for longer than 20 seconds. But the Puppy pose, oh I love that one, and I cannot get enough of the Cat pose.
Another added benefit of yoga is that the pituitary gland is important for ovulation and being upside helps blood to flow to the head and stimulate this gland. As explained by Julia Indichova in her wonderful book inconceivable "Yoga is probably the only exercise, if you can call it that, which actually targets the hormonal system. The upside down poses are very important because they stimulate the connection between the ovaries and the pituitary gland".
Spending time upside down is something that I do regularly during the first half of my cycle, although I don't tend to do it during my luteal phase and definitely not when I'm menstruating. Headstands and shoulder stands can be tricky (and potentially dangerous for your neck) if you are not a regular yoga attendee, so kneeling upright with the top of your head on the ground in front of you would also have similar benefits, as the aim if to get the head below the heart.
4. Taking a walking in nature to relieve stress
Walking in nature is known to be calming on the mind and soul and it has that effect on me. At weekends I make an effort to go for a long walk in the country, often borrowing a fabulous miniature Labradoodle dog called Tinker (using the website Borrow My Doggy) which makes me incredibly happy.
Getting outside and 'back to nature' is trickier during the working week, given that my office is based in the concrete metropolis of London. But I no matter how busy I find myself with work I try to take my full lunch break and head out for a walk around the local Park, in my case St James' which features some excellent birds. Along with picking my 'bird of the day', I walk along clearing my mind, deep breathing and think of the positive benefits of the sunlight hitting my skin and eyes (as well as working out how many hours I have left at work before I can escape for 'home time'). It has become a ritual which I sorely miss on any days in which I am unable to do it.
5. What is a stress journal?
Yep, I've gone there. I have started keeping a journal of my inner most thoughts and feelings. Most of it is utter dross, but as mum defensively declares when she accidentally farts, 'it's better out than in'. I'm hoping that by writing it down I can work through any blockages and issues in my mind, like a self administered, gentle therapy. And there is evidence that journalling has health benefits, both physically and mentally.
Life Companion: Journal Writing as a Spiritual Quest I require structure to underpin my journalling efforts, otherwise I spend 5 minutes writing about the first thing in my mind, which is invariably what I plan to eat for breakfast. The journalling book that I have been using to keep me on track is Christina Baldwin's Life Companion: Journal Writing as a Spiritual Quest. This is undoubtedly on the hippy end of the scale but I am thoroughly enjoying it and feel like it is beneficial to making space in my crowded mind.
Five Minute Journal Another great journal for increasing daily focus and levels of gratitude (and therefore happiness) is the Five Minute Journal with a good description of what to expect from the journal here. It is less soul searching than Life Companion, so although it may make you happier, which is a big step forward, it may not help you to deal with the stress of struggling with infertility.
Akey aspect of journalling for me has been understanding what I think and feel about my (in)fertility. I sincerely believe that our beliefs make a difference and can have a clear impact on our psychical state. Naomi Judd was spot on that 'your body hears everything your mind says' and my mind can be a bit of an arse. For more on the science of how thoughts and perception of the environment in which you live impacts on your biology, I found the podcast episode The World is Your Petri Dish with epigenetics and stem cell researcher Bruce Lipton on Bulletproof radio to be enlightening (available to download for free here (18.06.2016)).
Changing my mindset on infertility. The Natural Fertility Info website has a number of questions to journal your way through to gain a better understanding of the beliefs underpinning your fertility. I went through the 9 questions, along with where I think the belief comes from and whether I agree with it. It turns out that I had very strong negative beliefs about some aspects of my fertility, but with no firm reasoning behind it.
6. Reduce stress by creating a sleep schedule
In a regression to my childhood days I now have a set 'bedtime'. Unless I am out pretending to be a fun, young 30 something, at 9.00 pm I pootle off up the stairs and take myself to bed. I set my alarm for the same time every morning and my body is now used to its new sleep pattern. Like a petulant child, I have had to be strict with myself. I have a little routine that I should stick to (tricky, tricky, tricky): no phone or internet after 8pm, turn down or off most lights after 8pm, bed at 9pm, smoother myself in magnesium (more on that below), wake up and get up at 6am.
I feel that it has made a world of difference to my levels of energy, health and ability to cope with life's stresses with a little more good humour. On lack of sleep I cannot function effectively. I forget mid sentence where I was headed with my words and tail off into an idiotic mumble. I conveniently forget that I am meant to be gluten, dairy and sugar free as my cravings burst back on to the scene. I go to work dress as a summer placement student with miss matching socks. Disaster. Oh, and I cannot cope with any stress. Not even a minuscule setback or temporary hiccup.
7. Booking time off in my diary that is non-negotiable
My paper diary, which I like to consider is retro but I suspect ages me beyond my years, contains evenings marked out for 'me-time'. I've found it necessary to commit time to just relax, treat myself or do nothing. Without this my dairy becomes filled and I become overwhelmed (even when it is fun social events), resulting in stress. The temptation is always there to cancel the alone time in my diary to accommodate social gatherings and seeing friends, but I have learnt that unless I am strong, and the ensure that the relaxation me-time is non-negotiable, it gets whittled away to nothing and I'm back to square one. So I schedule in two evenings a week when I am at home, not seeing anyone, not being a social, cool, young thing but an old fart. And I don't move or cancel these appointments with myself, only cancelling for the same sort of reasons I would cancel on a friend.
8. Can magnesium help you to cope with stress?
As well as being a mineral essential for fertility, magnesium also works to relieve stress and relax the body. I smoother myself in pure magnesium oil before bed, as a further added benefit is that is magnesium can also aid sleep. I use Life-Flo Pure Magnesium Oil and one bottle has so far lasted me 6 months and is still going strong. And strong is what this oil is, as I apply so much that on occasion it tingles my skin.
Magnesium oil helps me to sleep and it helps my body to let go of the day. I now wouldn't dream of going away, even for a weekend, without packing my magnesium. Maybe they will discover in a few years that it is highly addictive, like I have been smoothing crack on my body nightly, but until that day magnesium will remain my best friend.
9. Putting work and daily stresses in to perspective
My tendency is to chase worries around my mind in ever decreasing circles until I quietly implode. That is my personality and mind's natural starting place. That is the grow bag from which I am seeded. But I know that isn't good for my health, stress levels or my personality. I also know that I don't have to think that way. Changing my mindset to relax in stressful or worrying situations requires a long period of change, but ultimately it can be done. After all, it is not the situation per se that is stressful, it is the way that I am reacting to it. Someone else in exactly the same situation may not feel stressed by it at all.
To help me put things into perspective I remind myself:
1. I can only do what I can do. I'm sure that all offices are the same where the amount of work to be done far exceeds the resources given to the project. I used to just suck it up and work long hours, taking responsibility above my pay grade and feeling the world on my shoulders. Now I remind myself that I am one person, I will do my best at work but I can only do what one person can do. I now frame it with my boss that "It is not possible to get all of the work completed this week, so this is what I am prioritising. If you would like to rebalance the priorities I will happily work to whichever project or work is most urgent. If you would like all of this work completed this week then we will need to sub in some extra resource." It has so far worked for me and removes the pressure to deliver everything when I know that it is impossible. It often occurs to me that if the work is not urgent enough for extra team members to being brought in to help, then it is not urgent enough for me to work myself to the bone and impact my chances of having a baby, which is my focus and the most important goal in my life right now.
2. Worry is a misuse of my imagination and intelligence. Building on a quote by Dan Zadra, I repeat this saying to myself frequently in times of need. I have quite an active imagination, often dreaming up hypothetical and elaborate scenarios in my head which I then live out in my mind or embellishing stories beyond any recognition of the facts. A worry can fester in my mind for days, growing larger every time my mind gives it attention. I must remind myself that this is a misuse of my well honed day dreaming capabilities and thinking up happy scenarios (or jus doing my day job, maybe this is why I'm not getting everything done!) would be a much better use of my time.
3. Worry is the interest paid in advance on a debt you may never owe. I cannot count the number of times I have fretted over the negative consequences of something that never materialised, or did happen but turned out not to be a big deal. Now I tell myself not to worry in advance if there are no active steps I can be taking at that point in time to fix it. It's a bit like when people demand "cheer up, it may never happen" although anyone who says that always risks a well-deserved punch in the face. But they may have a point (although I'd never admit that to them) that wouldn't it be better just to deal with the situation if and when it happens? I bet the reality is not half as bad as the scenario I have concocted in my head.
10. Having a cuppa (of calming herbal tea)
My mother claims that there is nothing in life that cannot be solved by having a good cup of tea. I'm not sure if those working on the Israeli-Palestinian conflict or those doing research to cure cancer are aware of this strategy, but my mum swears by it. And mothers always know best. When I can feel myself getting wound up I take 5 minutes to go through the ritual of making myself a herbal tea. It removes me temporarily from the stressor, I focus purely on the act of having a tea break, I try to put life into perspective and just breath.
Camomile tea seems to be a relaxer for me and the Relax Yogi tea also, although it changes the water to a rather peculiar colour, not dissimilar to a (deliciously appetising) bog. There are plenty of teas out there focused on relaxation and calming. I should know as I am slowly working my way through all the ones that I can find.