Case Study
Kylie – 30 year old female, vegan. Four months ago moved up from Melbourne and has been trying to conceive with her husband for the last three months with no luck.
She has a previous history of severe PMS symptoms. Severe depression and anxiety which has been managed with other health care providers. She does find exercise improves her mood noticeably.
From a menstrual cycle point of view, she experiences regular 27-29 day cycles. She experiences moderate period pain on the first day of her period, so much so that she is curled up in bed. Her pain is boring in quality, location is low back and suprapubic (just above pubic bone). Her period pain is better for heat, rest and pain relief and worse for cold. She experiences breast tenderness before her period and extreme tiredness in the 1-3 days after her period has finished.
She has seen egg white cervical mucous for two days around midcycle but no pain at ovulation and no spotting at all through her period.
Upon palpation in her initial consultation, I found her ‘oketsu’ or blood stagnation sign to be positive, she had cold hands and feet and a cold abdomen. However she experienced hot flushes in the evening on occasion. More frequently in the week leading into her period.
In Chinese medicine, her diagnosis was Blood deficiency and mild Blood stagnation.
Acupuncture treatments in her first session (her cycle day 10) focused on building blood, yin and moving qi to move blood before ovulation.
She was prescribed NAC, activated B6 and a good quality vegan prenatal. I asked her to start temperature charting too.
Her second acupuncture treatment was on day 14 of her cycle. She had seen a positive ovulation predictor test the day before and had been having regular intercourse. She had seen some watery mucous the last couple of days.
Her third acupuncture treatment was on day 21 of her cycle. Based on temperatures, her ovulation was confirmed on day 14 of her cycle. The treatment on this day was focused on supporting luteal phase. Her luteal phase temperatures were unstable which is not ideal, but treatment was focusing on supporting this.
At her fourth appointment, she had a positive pregnancy test. HCG was 293 and her progesterone was 47.5. Her luteal phase was continuing to show an unstable pattern. Her symptoms were tiredness and mild nausea which was reassuring.
She had weekly acupuncture treats until she was 6 weeks pregnant. She unfortunately experienced bleeding and I referred her to her GP for a pelvic ultrasound for reassurance. Unfortunately the pregnancy was found to be sitting low in her uterus and over the next three days she lost her pregnancy. I advised waiting two months before trying again.
She continued to chart. The first chart is her first pregnancy, the second chart is the one after her miscarriage and the third chart is her second pregnancy.
After her miscarriage, I added patented Chinese herbs – ChinaMed Motherhood FT 2 and ChinaMed Qi and Blood Tonic. Her luteal phase improved in this month and they decided to try again with the next month.
In her third cycle, acupuncture treatments followed her cycle to build blood, move qi and blood and warm prior to ovulation. She ovulated on cycle day 16 and had regular intercourse (third chart). Her luteal phase was much more stable as you can see.
Fifteen days after ovulation, she had a positive pregnancy test. Acupuncture treatments then focused on early pregnancy support and threatened miscarriage. She continued to take the herbs until 12 weeks. We finished acupuncture treatments at this time until I saw her at 40 weeks to help with natural labour support!.
Discussion: Chinese medicine does favour a meat based diet for falling pregnant. Meat does have healthy fats and other nutrients that support egg health and embryo implantation. Lots of blood support is needed when supporting women with vegetarians and vegan lifestyles – it can be done! I would have liked another month before she fell pregnant again but she obviously didn’t need it.
Also, just because your progesterone is good (above 30), doesn’t mean you don’t need support in your luteal phase. In her first pregnancy, Kylie’s progesterone was more than ok to support her pregnancy but her luteal phase temps were telling me her body wasn’t holding the pregnancy as well as it could. Temperature charting is so helpful for supporting diagnosis, directing treatment and seeing the effects of treatment.
