Sunday, April 24, 2016

Ask Dr. Michael Fox – Hormones, Endometriosis and Birth Control


Are you having problems with your menstrual cycle? Perhaps you’ve been diagnosed with PCOS or you suspect you have it? Are you interested in how low carb diets can help and how to maximize the benefits? If so you could ask your questions to our expert on the subject, Dr. Fox.

Here are three new questions answered by Dr. Fox – about hormones, endometriosis and birth control:

Hormone replacement and risks


I’m 65 and have just started LCHF for 1 week (lost 2 lbs yay!). I am not diabetic but am treated for high blood pressure (losartin + bystolic) and cholesterol (Lipitor 40 mg). My gyn took me off hormones (estrogen topical cream + progesterone for the uterus) 2 yrs ago – she said I was now in a high risk category. I still get hot flashes throughout the day and night. Although I’ve never been a good sleeper that continues to be ongoing with me. I guess my question to you is – is going back on hormones after being off for two years dangerous for my situation?


Dr. Fox:
I feel as long as you do not take oral hormone (estrogen) and you are taking a baby aspirin per day that your risk for cardiovascular events are not increased. This is debatable because the WHI study and others have shown an increase in CV events in the first 1 year after starting treatments. All those studies were with oral estrogen. Transdermal, transvaginal or injectable estrogens don’t go through the liver to increase clotting factors. Sadly, coming off the hormone has increased your risk. The sleep disturbance and vasomotor symptoms will increase your cortisol as well and further increase your risk of metabolic dysfunction. The sooner you re-start your hormones the better the benefit to you. You do need to work with your physician on this. Many physicians are very fearful of hormone replacement given our current environment.

As a side note, be careful with LCHF and blood pressure meds. You will need to monitor very carefully and decrease your medicines accordingly to avoid fainting and injury. You should monitor at home 1-2 times per day to watch for the decline and contact your physician for instructions.

Thanks for a great question,
Dr. Fox


Hi Dr Fox,
I am 36, trying to conceive for 6 months, diagnosed with endometriosis in 2011. I have no major symptoms of endo other than mild/ moderate ovulation pain, my periods are regular 27 days average cycle with ovulation day 13. As I have not conceived within 6 months I have gone back to see my specialist who has conducted blood tests – all came back normal and an ultrasound – all looked flexible and good etc. I have been on LCHF for 2 cycles and both times when ovulation has occurred I have been in absolute agony in the ovary on the day of ovulation and than mild pain the next day turning into agonising endometriosis flare up (uterus and entire area throbbing and inflamed) the next day. I am really concerned by this as obviously it’s the worst time to have the pain and inflammation when trying to conceive…. I also ovulated day 11 this month which is early. I really don’t want to stop the diet but can’t think of anything else that could be causing this change for the worse… Do you think it is just an adaptation to diet period? Why would I get an endo episode a day after ovulation?
Also, do you recommend a dr in London that shares your views on fertility treatment….
Thank you so much,

Dr. Fox:

Stella, your story is all too familiar. The mid cycle pain is due to the acute estrogen drop mid cycle with the LH hormone surge that causes ovulation. It is actually quite typical. The diet probably has improved your follicular phase of the cycle and therefore the estrogen levels. The drop then at mid cycle now is more normal and you are experiencing the pain as the result. It is a double edged sword is that you need the healthy follicular phase of the cycle to get a pregnancy but the pain is worse. Unfortunately there is not real treatment for this. At 36, you do most likely need some help in the fertility arena due to endometriosis and its effects. We also recommend complete excision of the endometriosis to better your chances of pregnancy. The benefits of the diet far outweigh any changes in pain as it relates to getting pregnant, so keep up the good work. In some ways, the change is telling us that you are doing a good job with the nutritional approach.

I’m sorry I don’t know any fertility doctors in England that subscribe to diet therapy. Dr. Jeremy Wright in London is an expert endometriosis surgeon that performs excision. Hope this is helpful.

Going off birth control?

Hi Dr. Fox,
I am hoping you can give me a bit of advice. I am a 35 year-old female. I have been taking the pill (Yaz) for a few years for my acne, which has worked wonderfully for me. It has also had the most amazing benefit of a light period as well (I used to get long heavy periods before I took this). Even though I have seen great results, I would ideally like to not take any medications at all. I have recently adopted a LCHF ketogenic diet (have been in nutritional ketosis for a few weeks) and wonder what would happen if I stopped taking Yaz? I am scared all hell would break loose with my hormones! I don’t live in a big city so do not know of any great doctors who would completely understand this issue (nor do I have a large bank balance to pay the great doctors!). What would you recommend that I do? I heard a LCHF diet helps regulate hormones but is that likely to be enough for me?


Dr. Fox:
That’s a good question. You are benefiting in a typical way from birth control pills. LCHF will improve hormone balance especially from the male hormone and acne side. The heavy cycles may return though if you stop the pill. I can’t really individually make specific treatment recommendations. A trial off of birth control would answer your question and would not be unreasonable.

Good luck!

More Questions and Answers

Read all earlier questions and answers – and ask your own! – here:

Ask Dr. Fox about nutrition, low carb and fertility – for members (free trial available)

More with Dr. Fox

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