Many of you enjoyed the Q&A style post I did a couple weeks ago and left many questions in the comments. So here is round 2!
I recently had my thyroid levels tested and all are within “normal” range, but just barely. They are all on the lower end. Is there such thing as suboptimal thyroid function that’s “normal” but not necessarily healthy?
This is a great question! The gold standard in traditional practice is to initially test for TSH…sometimes doctors test for total or free T4 in addition to TSH. By testing only these two markers, we are assuming that you body can properly convert T4 to T3 (the metabolically active form of thyroid hormone) When I see patients at my full time NP job with symptoms that could be related to thyroid I do the full panel including TSH, free T4, free T3, reverse T3, thyroid peroxidase antibodies (aka TPO Ab) and thyroglobulin antibodies (TgAb). I’ve never had a problem with insurance covering the entire panel so I see no reason not to draw it — you need the full picture to know what’s going on! So I would make sure you have all these labs drawn before having your health care provider conclude that your thyroid function is “normal.”
To read more about the function of each of these thyroid hormones and how everything works together read this post I wrote last month. The TPO Ab and TgAb are also important labs to get in order to rule out autoimmune thyroid conditions where your body turns on itself and begins attacking and destroying it’s own thyroid gland. I actually just had a patient come in last week with hypothyroidism symptoms. I drew the entire thyroid panel and when her lab results came back on Monday, all her thyroid hormone levels were normal but her antibody levels were elevated. If I hadn’t ran the entire panel I would have missed that. So my point here is — make sure you have all the labs drawn.
If everything is still in normal range, that doesn’t mean you have optimal thyroid function. No test is going to tell you how thyroid hormone functions once it enters the cell and how well your cells are utilizing thyroid hormone. So it’s possible for all the labs to be “normal” but to have symptoms due to issues arising in individual cells. Even more so, everyone is unique and has different ranges that are ideal for them, so even if your levels are “normal” that might not be optimal for YOU. I truly believe in not slapping a prescription on abnormal thyroid levels, so I’m way more concerned with treating the patient through lifestyle/short term supplements vs managing a medication based on lab values.
Many times these “normal ranges” are misinterpreted. The American College of Endocrinology considers a TSH level over 3.0 abnormal. That’s less than the upper limit range given on your lab results. And this is true with many of the ranges — just because you are in range (which actually varies from lab to lab) doesn’t mean that range is optimal. And the labs all need to be interpreted together.
Can not getting your period be related to very bad acne? The first thing I hear from dermatologists is to cut out *insert any food group here* to clear acne…but I’m hesitant with my ED history. I just want to know if there could be a hormonal link between both my acne and amenorrhea?
It’s a delicate dance with eating foods that nourish and heal your body while also practicing intuitive eating and cultivating peace with food and your body. Gut health, inflammation and hormones are all underlying causes of acne. There are so many reasons that someone could be experiencing acne, I do know that a topical or oral medication is not fixing the problem, it’s temporarily controlling the symptoms. With co-existing diagnoses such as amenorrhea, PCOS etc…acne is almost always a symptom of the hormonal imbalance at play. Taking a look at lifestyle (nutrition, sleep, stress and exercise) usually can identify an underlying cause so you can work towards healing and as a result, the acne resolves. Acne is simply inflammation that manifests itself on your skin, the key is to figure out what is causing that inflammation! Remember that stress is inflammatory too and a huge reason for acne. It doesn’t matter what you put on your plate or how many amazing creams you use if you’re stressed.
I know this is a personal question, but what do you do for birth control to prevent pregnancy?
This is so individual. I have friends who use birth control pills, IUDs, rings, condoms and natural family planning. You do what feels right to YOU. I always want women to feel supported and never judged by what they do that feels right for them. With my history of hypothalamic amenorrhea I knew that I didn’t want to take anything that would interfere with my natural cycle. I always wanted to know what my cycle was doing – not only for an indicator of my health, but so when we did decide to start a family, I would be in a healthy and fertile place to do so. I looked into Paraguard (a non hormonal IUD) but decided against it since we weren’t looking to prevent pregnancy long term and I didn’t want to deal with the possible side affects of cramping, heavy bleeding, etc after insertion.
So, we do a mix of natural family planning and condoms (yes, condoms. I know. such a buzzkill, but not so bad :)) I monitor my cervical mucus and know when my fertile days are so we use condoms during that time. To much TMI for a Wednesday? Hope not! I can write a post on cervical mucus monitoring if you guys are interested. I think it’s fascinating no matter if you’re married, single, never planning on having kids or whatever. I think knowing when you’re ovulating and where you’re at in your cycle based on your body is so awesome and empowering. Again, what I do is not what is right for everyone. Do what’s right for you.
Can you share your thoughts on Paraguard?
I thought about getting Paraguard placed for several months. It’s the only non hormonal birth control out and studies show great long term safety. The main drawback is women can experience heavy bleeding and painful periods while on the IUD. So while it doesn’t affect your natural hormones, it does cause increased bleeding and pain during your period which isn’t characteristic of a healthy, normal period so it would be difficult to monitor your hormone health based on your cycle. But to have a long term option for highly effective contraception that almost guarantees not getting pregnant…I think this is a great option!
I hope this has been helpful, leave your questions in the comments section and I’ll do my best to turn them into a post 🙂
![Skin Issues [it’s not always about the food]](https://www.thereallife-rd.com/wp-content/uploads/2018/01/fullsizeoutput_e42-150x150.jpeg)
Hi Robyn! Definitely interested in hearing more about how you tell when you’re ovulating and cervical mucus monitoring. LOVE that you talk about this kind of stuff that many other people are afraid to!
Will certainly write a post on this Lindsay – glad you’re interested!
I have a non hormonal IUD and couldn’t be happier ! The insertion wasn’t painful and I cramped badly for about an afternoon but I hear sometimes depending on the person it can last up to a week.
I had heavier bleeding for about 3 months then it got back to normal. I haven’t looked back!
However that being said, even though I recommend it to all my friends who are looking for an alternative to the pill it SO BADLY depends on your trust in your Doctor. Mine was excellent and pro and explained everything to me plus she was highly skilled with IUD (not all of them are unfortunately).
I’m so glad it’s working for you Annie! And agree completely that having an informed health care provider makes worlds of a difference
Please do a post on natural family planning/cervical mucus monitoring! I am highly interested in an option beyond hormonal options/permanent methods!
yep I will!
I just loooove your blog!
I love that not only are you just a great fun authentic person to follow in the blog world
– I LEARN SO MUCH from you.
I don’t comment much, but just wanted to say Thank you 🙂 <3
Dana thank SO MUCH for following! I’m so glad you’re enjoying – means so much 🙂
Robyn, this is all amazing. I am new to my period and tracking it. I have the app “Flo” and it’s been helpful for me to document my period and it tells the expected days of ovulation. I’d like a rundown post of what’s happening with your body as you go through the month (mostly connected to pregnancy and what your body is doing). If you have resources you’d recommend, that’d be awesome too!
Great post idea India! I’ll add it to my list.
I would seriously LOVE a post on cervical mucus monitoring (kind of funny to say haha!). I have always had terrible reactions to birth control and am terrified to get any sort of IUD, as my hormones are messed up as is. Currently use condoms, but it’d be nice to have the option not to some days of the month 🙂
yep I’ll plan on writing this 🙂
Hey Robyn! Great post. Thank you for these Q and A’s. I really enjoy them!! Since you are a professing Christian, one thing to note is that some of the birth control options you discuss here (definitely IUDs and controversially different hormonal birth controls ) are known abortificients. They would prevent a conceived baby from implanting and most Christian bioethicists says they should be avoided at all costs. Since you are advising women in your NP practice and even at times publicly here, you might want to look into this. Two great resources for reproductive bioethics are Fearfully and Wonderfully Made by Dr. Megan Best and also Ethics for a Brave New World by John Feinburg. Let me know if you have any questions or want more resources/journal articles on the topic. Thanks again for this post and ALL the time you put into this blog. It’s such a blessing!
Hi Lexi! Thanks so much for your comment. I hear you and I think that my hope with blog posts and in my conversations with patients and clients is to create a nonjudgemental environment that is open to discussing any questions, concerns and beliefs. So my hope with the blog is to create education around how different forms of contraception work so women can make autonomous decisions for themselves. With Paraguard, in addition to interfering with sperm movement (since copper is a natural spermacide) and preventing egg fertilization, Paraguard can also possibly prevent implantation. The same way that hormonal bc prevents implantation by thinning the uterine lining. The main mechanism with any form of hormonal birth control and Paraguard isn’t simply the prevention of implantation (there are several factors at play in including preventing ovulation and thickening cervical mucus to prevent fertilization) but it is good for people to know it can also work in that way.
I am one who does believe life starts at fertilization so know that I hear you and appreciate your feedback!
I love these Q+A style posts, and I love that you’re tackling topics most people won’t touch! Keep it up ????
I do have a question for those in ED recovery. I’ve been in recovery for years and eating well, but all of a sudden in the past few months I’ve experienced really bad acid reflux–the kind that makes me feel like I’m going to vomit. Almost like a bubbling up in my throat. Terrible nausea, but I’ve yet to actually get sick. A doctor put me on prescription medication for the next month, and that seems to have helped.
I’ve heard a lot of women in ED recovery who have IBS or other digestive issues. Could this acid reflux be tied to that, too? Thanks, Robyn!
Yes certainly Maggie! A few weeks ago I wrote a long post on digestive health in EDs – I hope it’s helpful!
https://www.thereallife-rd.com/2017/07/eating-disorder-gastrointestinal-issues/
SO helpful. Thanks, lady!
Robyn, I know you mention gut health and exercise – How are those two correlated? I mainly just think of gut health and eating, but how can gut health be affected by exercise? Thanks!
<3 <3
Great post Robyn! I would be very interested to read more on what you do for cervical mucus monitoring.
Thank you for all the great information in this post! I really enjoyed it and love reading all of your blog posts! I would love to hear more about cervical mucus monitoring also if you get a chance sometime.
I’m really loving these Q&A posts, thank you so much for taking the time to do them! I would love to read a post about monitoring your cervical mucus and natural family planning if you don’t mind sharing! 🙂
Great post and yea I would love a post about cervical mucus! All so interesting.
Yes to a cervical mucus post. I find this stuff very fascinating as well!
I did the Creighton method for awhile but it ended up being a little too stressful for us in the long run… I still love the idea of it, though! Would love it if you did a post on charting cervical mucus- fun stuff 😉
awesome post! I had amenoorhea and my doctor put me on thyroid meds to help my low thyroid levels. This ended horribly in a hyper active thyroid and extreme anxiety and dizzieness. I am off it now but wish I knew better before going on thyroid meds. Now my thyroid is better regulated and got my period back! Please more info onCervical mucus….My hormones are difficult to mintor since getting my period back.
so glad to hear your thyroid regulated off meds!
Hey, thanks so much for this post! I for one would be interested in cervical mucus monitoring. Also, I have the exact same issue with my thyroid tests. Unfortunately, my doctor really doesn’t want to prescribe the more in-depth thyroid lab tests. I think it’s time for a new doctor!!
perhaps a second opinion would be good 🙂
LOVED this post! I was going to e-mail you with some questions but you answered them all in this post! Thank you for sharing. 🙂
glad it was helpful!
Thank you so much for this post. I am so thankful to you for sharing your choice of birth control. I am currently on my last year of Nexplanon and it has caused heavy bleeding, mood swings, acne, and just things that I don’t like at all. My husband and I do not want to have children, but I don’t want to be on any birth control after this final year is up. I want to experience what a normal period is like and normal hormones. We’ve talked very briefly about a vasectomy, and I am willing to get a tubal ligation, but am not thrilled about the side effects to that either. I am 35, so I know that it is going to get more difficult to get pregnant, but there is still a chance. Even with Nexplanon, we still use condoms and always have, but I am fearful to only rely on those for protection. I would love to hear more about cervical mucous monitoring and will definitely look into it. Unfortunately, I’m not very shy about asking other women about their birth control option, because I think it’s good to know and normalize talking about it.
I would love a post on cervical mucus monitoring!
Ummm, I’ll be first to say I’d be interested in a post on cervical mucus monitoring! I’ve never been a fan of birth control, especially after reading your blog, so would love a way to know when I’m more fertile (weird to type lol, oh well!) in order to prevent pregnancy.
I would love to read more on natural family planning. My little guy is 9 months old. I know I don’t want hormonal BC, but we aren’t sure we’re done having kids, so I don’t want something that has to be removed or will throw my cycle out of whack.
Your posts make me wish I could find a care provider like you in my town! No such luck.
There are great ones out there so I hope one comes your way locally!
What a great post Robyn! I really enjoy reading your posts! So helpful and educating 🙂
Your explanations of the thyroid make sense, but man, what a confusing system! I still don’t quite understand how rest and stress reduction helps thyroid function…nor how we’re supposed to tell if these non medicine approaches are working without getting thyroid tests done several times. Always like the thyroid posts–thanks for your writing!! 🙂
I have a Paragard IUD and LOVE it. It’s the best of both worlds, no hormones throwing me off and very reliable and constant protection. I have had it since February of 2012 and it is good for 10 years. I had crazy experiences with hormonal birth control pills when we got married and it was NOT for me so I switched it up. We feel really called to adopt so this choice of birth control works perfectly for us. And I know you mentioned the effects an IUD can have on a period and wanted to add my experience; mine definitely became longer in length (almost 8ish days instead of 5-6) and a bit heavier but not unmanageable. Also, I know a common fear for women looking at an IUD is the warning “if you have never had kids before, it could be really dangerous. I have never had kids and I have not had any problems with my IUD for the past 5+ years since insertion. But, I agree with what you said, find what works for YOU. 🙂 Great post!
I love how you told us to investigate the root causes behind things like acne, knowing that there is a reason for really bad acne. I haven’t had really bad acne around or during my period, for which I’m thankful. And this post makes me wonder about my thyroid levels, but I’ve never had them tested.
I’m actually Catholic, and we use NFP but abstinence instead of condoms during fertile periods. There are actually a couple of different methods for Catholics–we use the Marquette Method, but I know Creighton and sympto-thermal are popular as well.
I’m still voting to hear you talk about why PMS isn’t normal!
That post is coming your way!
My whole family has had thyroid issues, and all my labs have come back “normal”, but I had one test with a significant increase in TSH. But still “normal” and we didn’t worry about it. Now I’m curious why providers don’t want to order a full panel? Love your thoughts and holistic approach to these things!
I know it’s frustrating!
It’s always so fascinating to me when you get down into the science of things! It never ceases to amaze me how many little details and components there are to our health. I love that you talk so much about female health. I feel like it’s a topic that’s really under acknowledged and even females don’t know enough about. I was wondering if you knew anything about using acupuncture or incorprating specific herbs to help with amenorrhea. Thanks 🙂 !!
xxMeah
I’d actually love to read more about the monitoring ovulation thing. I have read a lot about it before, but most sources say that you never really know for certain, and it’s better to use condoms ANY time you are sexually active. So I guess my question is how do you know for sure that you’re being safe?
nothing is 100% except abstinence but if you learn to monitor it can be highly effective 🙂 I’m going to write a post!
Definitely would love this post about how you do NFP! I was on Mirena for a year and a half and eventually started hating it! The side-effects (because, clearly it’s main goal was to ALTER my hormones… boo) became not worth it, even though we loved the convenience. Now I’m all about the non-invasive, non-hormonal methods but I only know a tiny bit about NFP. Thanks for being, real! I’ve literally thought before while reading your posts (hahaha, weird??), “I wonder what she does for birth control” so I’d love your hormone-authority voice!
HI Robyn. I read “Taking Charge of your Fertility” when we were first married and the “fertility awareness method” is a very good option. It teaches you to know when you’re fertile, and they you can decide what to do about it (condoms, abstain, try for pregnancy). I had a basil thermometer velcro-ed to the back of our headboard and I quickly took my temp before getting out of bed each morning. Back in the day I charted my temps on paper but now use a handy app on my phone.
Thanks for all you do!
Hi Robyn!
I love all of your posts and really loved this one! I would definitely be interested in a post more in depth on natural family planning/cervical mucus monitoring. I’ve been on birth control for like 11 years now which makes me nervous yet I’m also nervous to go off since I’m not sure how my body will react. Also I’m not ready to have kids with my husband yet, but that is down the road for us so we definitely want something reliable until we are ready!
Thanks again!
I have a real problem with the way you attribute acne to “inflammation” and something that can be cured with diet, sleep, and exercise. SO many young people struggle with devastating acne that no amount of healthy eating or 8 hr nights of sleep will cure. They are doing NOTHING wrong. It’s a complex interaction of hormones, clogging of follicles, genetics, and underlying proliferation of bacteria.
Hi Lauren – you are right in that it is very complex. And I never claimed that it was a one size fits all approach (which is why I never, ever give out “this is how you fix your problems” advice because it is always complex and individualized. But you can ask many many people and do the research and know that yes, acne is an inflammatory condition. I’m not quite sure why referencing it that way is offensive? It is devastating and I understand that which is why I’m so passionate about helping others get to the root problem (whatever it may be that is causing the inflammation) and heal it. I hope that helps clarify.
Hi Robyn! Not sure where people typically leave their questions, but I have a question :). Is the LEAP diet another fad diet/diagnosis? I have had a lot of mystery GI problems this past year and working with my primary care physician and GI doctor have led to a dead end. However, through this experience I did find certain foods that I never expected actually don’t work well for me – like apples! Appreciate any info on the LEAP diet.
Hi Robyn! Not sure where people typically leave their questions, but I have a question :). Is the LEAP diet another fad diet/diagnosis? I have had a lot of mystery GI problems this past year and working with my primary care physician and GI doctor have led to a dead end. However, through this experience I did find certain foods that I never expected actually don’t work well for me – like apples! Appreciate any info on the LEAP diet.
I’m not the expert on LEAP but Rachael Hartley (https://www.rachaelhartleynutrition.com) is a good friend of mine and knows a lot!
I would LOVE a post on CM. I think everything about the woman’s body is so fascinating… it tells us EVERYTHING!
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