More about the adrenals, chronic fatigue syndrome and fibromyalgia

I've studied up a bit on the affect of prolonged stress on the adrenals and cortisol in relation to my partner's panix-anxiety -- we were able to successfully treat him based on our findings and coupled with the male infertility vitamin supplements he's been off of Paxil and without any big attacks for almost 2 years now.

So, this cortisol thing for me has really piqued my interest. My partner and I have similar lifestyles obviously (we eat, live and work together) so what is bad for the gander is bad for the goose. I've been looking at medical articles this afternoon about the adrenals and progesterone and fertility and I found a few more things that might interest you.

Chronic Fatigue is associated with elevated cortisol and decreased adrenal function

(Hypothalamo-pituitary-adrenal axis dysfunction in chronic fatigue syndrome, and the effects of low-dose hydrocortisone therapy)

I don't think I've got this but decreased adrenal function is also associated in a different type of pattern as having low estrogen and progesterone with lesser amounts of LH released. I don't have amenorrhea, my LH appears to be fine I think based on my fertility monitor and trying to use its sticks prior to my period being due, a time of the cycle where the LH normal increases. Still it is interesting to read the summary.

(Isolated adrenocorticotropin deficiency presenting as primary infertility.)

Fibromalgia patients have a similar pattern of but with lowered estrogen. Still, it seems to be related to these other patterns in terms of what happens with the hormones. The elevated prolactin was interesting here. Also, before I started working with a naturopathic doc a few years ago, part of my PMS set of symptoms including burning in my extremeties, my partner couldn't touch me hardly at all because it was painful to me. Evidently "Psychological stress and hormonal changes also may be possible causes of fibromyalgia."

(Secretory pattern of GH, TSH, thyroid hormones, ACTH, cortisol, FSH, and LH in patients with fibromyalgia syndrome following systemic injection of the relevant hypothalamic-releasing hormones.)

At any rate, perhaps I've been periodically dipping into deeper levels of adrenal exhaustion, insufficiency and depletion. Qigong, the dietary changes and acupuncture will all help. What I found though was that there is an additional supplement that can help.

L-Carnetine, one of the supplements that is commonly included in the MFI vitamin regime, also helps to treat a variety of issues including chronic fatigue syndrome.

(L-Carnitine: therapeutic applications of a conditionally-essential amino acid.)

"Although L-carnitine deficiency is an infrequent problem in a healthy, well-nourished population consuming adequate protein, many individuals within the population appear to be somewhere along a continuum, characterized by mild deficiency at one extreme, and tissue pathology at the other."

We have some L-carnetine in the cabinet downstairs and I ran down and took one. I think The Infertility Cure might have mentioned this supplement as well, or else it was Arginine. Very interesting. We'll have to see what regular supplementation will do to help me out. I'm so freaking tired all the time since the miscarriage, even worse than prior when I was just waiting to miscarry.

There was an Italian study from a while back that tried treating women at risk of miscarriage with carnetine and it seems like it helped cause some improvements in the quality of their blood, specifically myoglobulin which helps carry iron:

[Serum myoglobin in pregnant women treated with tocolytics and carnitine]


Here's an article that mention chronic fatigue, miscarriage and infertility:

Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease

I bet something will show up in my bloodwork next week. When I had my pooled progesterone checked a couple years ago and I got the results back I was like "I told you so." go figure that reproductive endocrinologists aren't good at figuring out the pathology of normal endocrine issues. They like to just go for the big guns and it is so like they say, when you are a hammer everything looks like a nail.


GENERAL ADRENAL INFO

Your Adrenal Glands

Adrenal Glands - Wikipedia

Anatomy of the Adrenal Gland (PDF)

adrenal gland from Columbia Encyclopedia

Pelvic Adhesions

Adhesions are really common after pelvic surgery but they don't necessarily have to cause you problems or impact your fertility. Some doctors will perform an HSG (hysterosalpingogram) a few months after a myo for women wanting to try to conceive but mine thought we should just see what happened for a few cycle on our own. We were able to conceive and have implantation in my uterus so no problems there for me.

Adhesions & Pelvic Pain
What Women Need To Know About Prevention and Treatment

Pelvic Adhesions

Pelvic Adhesions - Their Role in Infertility and How to Prevent Them
PDF brochure from RESOLVE

Reduction of Adhesions

Asherman's Syndrome

Pelvic Abnormalities: Pelvic Adhesions (photos)

International Adhesions Society
(they are also conducting a survey of patients regarding informed
consent forms with regards to mention of adhesions)

Adhesion Related Disorders

Chronic Pelvic Pain
(includes some info about how to minimize adhesion formation)

Pelvic Adhesions
(fairly clinical and scientific information about adhesion formation and prevention in a Powerpoint presentation)

Pelvic Pain Needing Treatment

Wound Healing and Scarring - Sutures

Prospective clinical trial of SprayGel as a barrier to adhesion formation: an interim analysis.
(there are other media that can be used to prevent adhesion formation as well, if you are interested continue searching on these terms:
"pelvic adhesions barrier agents")

Fibroids and Pregnancy

Behavior of Leiomyoma during Pregnancy

Dr Walker's study of UAE and pregnancy

Fibroids During Pregnancy

Fibroids in Pregnancy

Fibroids in Pregnancy
scroll down the page to get to this section

If you join the uterinefibroids Yahoo Group there is more information available about fibroid degeneration and pain during pregnancy based on individuals experiences in the Links area.

Fibroids and Fertility

Some of the better links I've found which discuss fibroids and fibroid treatments impact on fertility.

GENERAL

Fibroids & Fertility

Fibroids and Younger Women

Management of Uterine Fibroids

Myomectomy: It's Role in Infertility

FIBROIDS AND MISCARRIAGE

Recurrent Miscarriage (Pregnancy Loss)

Small fibroids may increase miscarriage risk
Small uterine fibroids may increase the risk of miscarriage, according to early findings from a study by researchers at the University of North Carolina at Chapel Hill.


MYOMECTOMY & UFE

Gynecologic Myomectomy

Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy

Myomectomy
Article about endoscopic myomectomy

Myomectomy During Cesarean Section – Time To Reconsider?
A medical article looking at removing fibroids during cesarian delivery

Myomectomy: a retrospective study to examine reproductive performance before and after surgery.
Watch a web video of a myomectomy being done

Replay of: Abdominal Myomectomy-A Treatment for the Removal of Fibroids

About Degenerated or Infected Fibroids

Here are some links I've found which deal with fibroid degeneration or the very rare condition, pyomyoma, where fibroids can become infected.

DEGENERATION
Unusual Appearances of Uterine Leiomyomas: MR Imaging Findings and Their Histopathologic Backgrounds
Lots of images of fibroids with degeneration and other changes

An Unsuspected Case of a Degenerating Leiomyoma
requires free registration

Photo of a fibroid that has undergone degenerative change

Thrombophlebitis (aka Deep Vein Thrombosis)
Can be associated with red degeneration; general risk to women with fibroids and possible post surgery complication

PYOMYOMA - INFECTED FIBROIDS

Streptococcus agalactiae Endocarditis and Giant Pyomyoma Simulating Ovarian Cancer
Medical article looking at one case in particular and reviewing other cases since 1945


Uterine Pyomyoma as a Complication of Pregnancy in an Intravenous Drug User
JOSEPH A. PRAHLOW, MD, JAMES O. CAPPELLARI, MD, and SCOTT A. WASHBURN, MD, Winston-Salem, NC (1996)

Back from the doctor's

There are two ways to interact with a doctor. One is to sit back and see what they tell you. The other is to research more about your situation, symptoms and options and then ask a lot of questions. I prefer the latter as the former doesn't get you very far with today's managed care and insurance limitations. Doctors seem to get a little less engaged (if they ever were otherwise I don't know) and just give you the standard answer. I don't want the standard answer, which I anticipate was that our second loss was just bad luck. I want real answers.

So, I'm waiting in a consult room and my RE comes in and asks me how I'm doing. I said I was there to see about what next in light of my recent loss since even she thought there was possibly something more. I then told her, "I'm going to throw a lot of information and observations at you and I want to hear what you think" to which she agreed.

I mentioned the diagnosis of adrenal exhaustion from my naturopathic doctor a couple years ago, about my consistently low progesterone levels at each testing (not rock bottom low but always kind of a non-performer) and about how my recent acupuncture pattern has evidenced a consistent kidney yang deficiency which translates into weak adrenal functioning.

I mentioned my night sweats during my luteal phase and she said some women are really sensitive to drops in their estrogen level. Then I told her about the night sweats during my pregnancy which she said was common. I said that while I know it is a symptom of pregnancy that the stories that I've read online don't have this symptom until further along and that the ones I've seen with it starting early have also been losses. Obviously just circumstantial but when I said I had the sweats really early on I think she understood the difference.

I mentioned my charting and about how a nurse and an acupuncturist worked together to look at charting symptoms and that I have a characteristic slumping mid-luteal phase consistent with a type of luteal phase defect -- in spite of my consistent and regular ovulations and periods.

I then brought up about my sensitivity to stress and about excess cortisol and how that might impact my T3 levels and that I'd never had a full thyroid panel done. She agreed and said lets take a look and put down for the anti-thyroid antibodies which was brought up in one of the loss forums I was on. I told her that thryoid problems had surfaced for other women in my family around childbirth and that while I had always tested normal for TSH and T4 that I wanted to make sure there wasn't anything we were missing.

I talked about my pregnancy symptoms which she said could have been my body reacting to a poorly performing pregnancy as much as anything else. I mentioned the cycle I got pregnant and all my hormonal ups and downs over the past 6 months. About vitex, which she knew nothing about and I really want to send her some printouts about it, and rhodiola rosea. I mentioned the book Coming to Term and about how it said that up to four losses in a row didn't increase your risk. She hadn't heard of the book and wrote it down in her notes to check it out. We agreed that we would hold off testing for anti-phospholipid antibodies and some of the other standard repeat loss tests for now.

She said that because I'm thin she didn't think diabetes was an issue but I told that I didn't think that I had a disease or anything, but I've noticed I'm more sensitive and want to know if there's possibly a little something there as I've definately been feeling weird about eating sugar and simple carbs. She said that one a few occasions she has come across thin women with blood sugar issues that she didn't expect and thought it was worth ruling out. I asked about testing for adrenal functioning with a glucose test and mentioned the 24-hour test my partner had done. She said okay but instead we would do a fasting glucose and insulin test which since I had breakfast will be tomorrow morning.

She said when she was in medical school she thought she had 3 out of 4 diseases that she read about. I told her that really I don't think I'm diseased but I want to rule out a few things that have shown up as a part of my acupuncture treatment and since these hormones are part of the supporting cast the affect my fertility I want to make sure that we don't ignore it. I'm not a hypochondriac really. I told her about how for years I had poor eating habits and high levels of stress and anemia -- that I really ran my system ragged.

I asked if we could test my ferritin to check my iron stores and she thought we should to the full blood count again as well. She also wanted one more beta HCG to make sure it had all gone down. Yeah well, for some reason that test always makes me sad since I've had like a dozen draws to watch me get unpregnant and only 4 to watch it rise.

When I told her about feeling like needing a little break due to all that my body has been through over the past year she agreed, it was a lot for one person to go through physically. She said when we were ready to start trying again give it a few months and if nothing happened then we coudl talk about ways that she might be able to help out, which I took to mean Clomid or another fertility drug, Rx progesterone perhaps in a different format, etc. Ugh. I don't want to think about it.

I won't get test result for many of the things until Tuesday next week. I wonder if anything will show up.

I went away to New York for the weekend, to visit my parents and brother and a few friends. It was an emotional time for me, the first time I've been home since my two miscarriages and my surgery. I'll have to post more about it when I have a chance, I wrote a bunch down on the way home on the plane.

My partner and I had dinner together last night and went for a walk and talked about stuff. We talked about the TTC stuff and when we should try again. I told him that we might need to wait and that listening to one album on the ipod on the way back reminded me of when we didn't have all this TTC crap in our lives. I asked him what he thought and he said that it was up to me, if I want to try he will try and if I want to stop trying then we can do that. We both laughed about the irony that after all we have been through now we have to worry about getting pregnant. I told him that maybe he should just get another vas done. He said that he didn't like how all our recent attempts and failures have been making me so miserable so if I thought that I could make it through with another loss or two we should keep trying but if not then maybe we need to just take a break.

My friend who I saw on Monday said she was sorry that TTC had been such a physically painful thing compared to all the other people she know who have had trouble conceiving. With my great-aunt we talked a bit about what the future might hold for me if it doesn't include children.

It's hard being 35 and having to deal with all this; less time to just step aside and let things happen so it feels. I suppose it just won't get any easier. I'll see how it goes at my doctor appt in the morning. I'm going to ask a lot of questions.

My partner and I have been more lovey since I've been back though and that's a blessing. Things were a little strained due to the m/c as it can happen. In spite of all the family crap, taking a break and even crying some both seemed to help.

More about cortisol (hypercortisol)

I opened up my reproductive endocrinology textbook this morning and found some info about cortisol. Evidently your body will produce excess cortisol in a variety of situations (addison's disease, cushing disease, anorexia/bulimia, tumors, etc.) but stress will increase it's production most certainly.

Low blood sugar will also cause an increase in cortisol production and it is related to blood sugar levels that you will have the night sweats, it has to do with some metabolic thing that happens overnight with the blood sugar.

Facts You Should Know About Night Sweats...

Here's another thing, excess cortisol will interfere with your thyroid hormones but your TSH and T4 will show up normal. It's the T3 and anti-T3(?) that will e low, and those aren't tested unless you have a full thyroid panel done, normally they only test for TSH and T4. Other signs of this pathology include low blood pressure -- how very interesting that I have that and it runs in my family. I'm also really sensitive to stress, one of my responses is to lose my appetite and thirst -- which only makes this cycle worse as it adds to the stress.

Thyroid and Anti-Thyroid Drugs

One test for adrenal function is a 24 hour test where you collect all your urine and they are able to see how your body is handling its sugar. My partner had this test a couple years ago and it showed he was hypoglycemic.

I did find mention of surgery increasing cortisol production in the body and it can be related to amenorrhea as well.

There was a liver component as well where one of these hormones (I also looked up prolactin but I don't think it was that one) in excess interferes with liver function. Potentially one might assume that this might result in one other possible cause for excess estrogen in the body -- oh yes, I've got that too -- and estrogen excess is linked to fibroids. (also too much cortisol will impair immune functioning, which might be why so many women seem to notice fibroids occuring after periods of extreme stress such as divorces and deaths in the family).

And I remembered one more thing, with this type of pattern of excess cortisol interfering with T3 and the blood sugar issues, they noted (in the case of anorexic/bulimic women) that fertility decreased during the Fall and Winter months. It had something to do with the affect of adding increased melatonin into the mix, melatonin production evidently increases as the amount of daylight decreases. How weird it all is.

In all that I've read though, the best ways to reduce your bodies cortisol production is by resting, taking regular exercise, cutting back on sugar and salt (craving these are one indicator of adrenal exhaustion), reducing stress, and eating small, regular meals. Parsley might be a help (of all things) as it is a adrenal tonic. Also rhodiola rosea which is an adaptogenic herb.

This page has more info about dietary things to do:

Adrenal Glands Revival

Look what I came across, this is what one medical author described pregnancy as:

"...a neoplastic, endoparasitic (i.e. neoparasitic) autoinfection of relatively high pathogenicity and low average virulence which is localized, self-limited, and nontransmissible; "

And we want to do this to ourselves why?

It's an article about whether or not pregnancy might be considered a disease. You can read the full thing here:

THE ILLNESS PARAMETERS OF PREGNANCY

Cortisol and Night Sweats

I'm onto something, a few things really but the one that has my attention right now is cortisol. I had really bad night sweats at the beginning of my pregnancy. Evidently panic attacks are associated with night sweats and I know from my partner who has panic anxiety that adrenal exhaustion triggers cortisol production. I came across a reference last week that mentioned that kidney yang deficiency was akin to adrenal exhaustion and I've been diagnosed with kidney yang deficiency -- boy doesn't it all come full circle with the night sweats.

ADRENAL FATIGUE

I found a couple of links about cortisol and pregnancy loss which I posted to the progesterone and miscarriage post, look towards the bottom of the links.

I've also been looking up about heparin and blood thinners to help stop immunological rejection of pregnancy. I posted a few weeks ago about some similar cases treated with chinese herbs that contained dongquai which is a blood thinner so I wonder if trying the blood thinner route might be worth it -- and then it is a matter of eastern or western medicine.

Just a quick one. I got my period today finally, the first time since April. Granted I had the bleeding with the miscarriage but if you've been there, you know it is different and doesn't count as a period. I had cramping and spotting last night and today and now just a somewhat normal flow. I don't think there will be anything dramatic this time, I sure as heck hope not.

It's hard not to be reminded of the last time I had cramps a few weeks ago and all that crazy hemorrhaging.

We're planning on going on a trip to Europe in a few weeks and I think we may need to hold off trying again until after that as my ovulation this cycle will land us not at home with my medical and acupuncture care in the early weeks of a possible pregnancy and I so don't want the experience of pregnancy and possibly loss while travelling, not with my brilliant history. I guess we can just do FAM for a cycle for avoidance.

I know that casually on the Internet it has been suggested here that you start trying again when you are ready, or as soon as your first post-partum AF has came and went, but lately I've been thinking differently. I'm not even going to go into emotional healing before TTC, but strictly about how strong you are post m/c.

With this second loss I found myself completely knocked to the ground with anemia. I lost a lot of blood, probably more than 2 pints over several hours, it is so hard to quantify as it spills out of you into the toilet. I was having horrible head rushes where everything would go black if I got up ever so barely quickly, I had no energy, I've been cold, out of breath, my skin looks a bit dry, my gums are pale, etc. All symptoms of anemia. My RE had my blood levels checked and I'm anemic, not dangerously low but need to get it up there you're not healthy low.

When healthy people donate blood, they usually only give one unit of blood (close to a pint I think, maybe someone can correct me). They tell people to wait 8 weeks before donating blood again and I've heard that it takes a month to rebuild a pint of lost blood.

It's common for women to get anemic in pregnancy due to the greater demands on her blood supply, which increases to help support the pregnancy. I was just talking to a friend of mine and she's 21 weeks pg and anemic. I imagine that she wasn't very anemic, if at all when she went into her pregnancy. Its probably doubly challenging to build your iron stores when you are already pregnant.

How unwise would it be then to get pregnant if you are definately anemic? I've just started AF, the first one since my loss, and I just don't feel like my body is up to it yet. I'm due to go in to see my RE this week and I'm going to get my ferritin checked, that's where they look not just at how many red blood cells you have but they are able to determine what your body's iron stores are like. From my uterine fibroid friends I've learned that even with just low ferritin and not low red blood cells you will have symptoms.

Based on all that I've been feeling and then learning more about this I think it would be most wise for me to wait until September until I TTC again. I did have the two losses and surgery this year so I might be a bit unique. I just wanted to share in case it helped you in your journey as well.

I've compiled some info about treating anemia and iron-rich foods previously.