menstrual cycles

weight 2

How to lose weight and keep it off

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How to lose weight and keep it off

Faddy diets come and go, with many jumping on the bandwagon in a bid to shed weight as quickly as possible. Sustainable, healthy weight loss cannot be achieved by drinking only cabbage juice for weeks on end or popping green coffee bean tablets like they are going out of fashion. A healthy lifestyle, exercise and a balanced, nutrient-rich diet is the only way you can budge the bulge and kickstart your sluggish metabolism.

Fad diets

Fad diets are unhealthy and do not work for long-term weight loss. They often involve cutting out entire food groups (such as fibre or carbohydrates) and key nutrients the body needs which can lead to fatigue, gut issues, dehydration, and other health problems.

Healthy and sustainable ways to lose weight

If you have been struggling with your weight or are in a perpetual cycle of losing weight, only to put it back on again, here are some useful tips to help you lose weight naturally.

  • Avoid processed foods and junk food as they contain an array of toxic ingredients such as damaged oils, hidden sugars, preservatives, flavouring enhancers, and sweeteners that can lead to blood sugar and hormone imbalance, cravings, and poor metabolism.
  • Prepare your food fresh so you know exactly what you are eating, giving you total control over what you put in your body. Fresh food contains more flavour and nutrients, and is ultimately better for your health. Go for seasonal produce, direct from a farm or farmer’s markets wherever possible.
  • Eat an array of different coloured fruits and vegetables as they contain an abundance of minerals, vitamins, and antioxidants – key nutrients that promote healthy metabolism and blood sugar balance. If your body gets all the nutrients it needs to function optimally, you will feel more energised and experience less cravings for foods with empty calories.
  • Ditch sugar and refined carbohydrates/ grains (white flour products) as sugar negatively impacts hormones and blood sugar balance in the body. Healthy blood sugar levels are important for weight loss.
  • Include quality plant protein at every meal such as beans, lentils, peas, nuts, and seeds. Protein anchors your blood sugar levels, reduces hunger hormones, and increases the hormones that make you feel satiated after eating. Protein also helps you build muscle which aids fat burning.
  • Don’t be afraid of eating fats. Healthy fats are essential for good health; they help the body to make hormones, protect your cell membranes and aid the absorption of fat-soluble vitamins (vitamins A, D, E and K). Good fats such as avocado, extra virgin olive oil, nuts, flaxseeds, chia seeds and flaxseed oil can also promote healthy weight loss as they provide fuel for cells and not just extra calories.
  • Increase your soluble fibre intake (beans, sprouts, sweet potatoes, broccoli, pears) as fibre helps reduce your appetite by keeping you fuller for longer. It also keeps your gut bacteria healthy and improves the way your body responds to insulin. This is important for weight loss as it keeps your blood sugar levels regulated. Insulin works by decreasing blood sugar levels by pushing glucose into cells so it can be used for energy, instead of being stored as fat.
  • Minimally cook foods to maintain nutrients. Heating foods to a high temperature, whether that be boiling or frying, reduces the vitamins, minerals and antioxidants in food, especially heat-sensitive nutrients like vitamin C. Try to eat foods in their raw form or lightly sauté or steam where necessary.
  • Avoid frying and cooking foods with damaged, hydrogenated oils such as rapeseed or vegetable oil. Be aware that dairy-free spreads are also a source of damaged oils. Nut or seed butters are a more nutritious, healthier option.
  • Season your foods with herbs and spices instead of adding salt and sugar.
  • Don’t drink sugary drinks including juices, fizzy drinks, energy drinks and sport drinks. They all contain huge amounts of sugar which causes inflammation and weight gain. Also avoid low-sugar alternatives as they tend to contain artificial sweeteners such as high-fructose corn syrup. The body does not metabolise fructose well so consuming large amounts of it can lead to diabetes, insulin resistance, high blood pressure and obesity. Instead, drink filtered water with lemon, peppermint, or cucumber to give it more taste.
  • Avoid alcohol as it is very inflammatory and causes certain metabolic changes in the body, including blood sugar dysregulation. Alcohol also contains sugar and unnecessary calories that contribute to weight gain.
  • Exercise daily as moving your body helps to regulate hormone production and burn excess calories and fat. Exercise also helps build muscle mass which can reduce insulin resistance.
  • Manage stress and relax more. Stress is incredibly detrimental to your health and can create unhealthy eating habits and hormonal imbalance. The body’s stress response triggers the release of extra cortisol (your stress hormone) which stimulates carbohydrate and fat metabolism, increasing your appetite and cravings for sweet and fatty foods. Learn how to relieve stress naturally.
  • Get good quality sleep. Poor sleep affects your body in a similar way to stress, stimulating extra cortisol production. Adopt a healthy sleep routine and ensure you relax before bedtime. Limit screen time and do something relaxing before bed like taking a bath, reading a book, or drinking a cup of chamomile tea.
IVF test

What is IVF, ICSI & IUI? 

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What is IVF, ICSI & IUI?

IVF, ICSI and IUI are common procedures that can assist you to have a baby when natural conception is not working. They are all very different fertility treatments, and clients always wonder which would be the best option for them.

What are the differences between IVF, ICSI and IUI?

IVF In-Vitro Fertilisation

What is IVF treatment?

IVF involves using fertility drugs to gently stimulate the ovaries to produce good quality mature eggs, which are then retrieved and fertilised in the clinic’s laboratory with sperm from your partner (or a donor). The Sperm and eggs are placed together in a special dish and eggs monitored for signs of fertilisation.

The embryo of greatest quality is selected for transfer, where it is then placed into the uterus to implant and grow for pregnancy.

Advantages of IVF treatment

IVF maximises the chance of fertilisation by placing eggs with sperm. Your clinic can select the embryo with the highest potential for pregnancy. Many clinics have an advanced embryo selection method, which include time-lapse monitoring and Preimplantation Genetic Screening. If you have more than one good embryo from your cycle, you can also choose to freeze the remainder to use in future treatment cycles if you so wish.

Why IVF may be advised

IVF is intended to overcome issues that can prevent sperm from fertilising an egg, such as fallopian tube issues (scaring or blockages). It may also be advised in some cases of unexplained infertility, or in mild ‘male factor’ fertility cases.

ICSI Intracytoplasmic Sperm Injection

What is ICSI?

Instead of sperm being mixed with the egg in the laboratory, the best single, healthy sperm is extracted from the sample and injected directly into the egg to fertilise it.

Advantages of ICSI

ICSI can help achieve pregnancy when male factor fertility issues are seen. Due to the sperm being injected directly into the egg it bypasses the other stages of early fertilisation. Only the best quality sperm is used for fertilisation, which is identified by an embryologist.

Why ICSI may be advised

ICSI is designed to overcome male fertility issues, such as

  • low sperm count
  • poor sperm mobility,
  • surgically-retrieved sperm
  • High levels of DNA damage.

IUI Intrauterine Insemination

What is IUI?

It involves inserting sperm (or donor sperm) into your uterus at the time you are ovulating, in the hope the egg is fertilised for pregnancy. This is often referred to as artificial insemination.

Advantages of IUI

IUI can be carried out with natural cycles, without using fertility drugs, relying on the egg you naturally ovulate that month. However, as the outcome of IUI closely mimics natural conception, you may need more than one insemination attempt to achieve pregnancy.

Why IUI may be advised

Those who need donor sperm to conceive choose IUI as it can be a quick, simple way to try to achieve pregnancy.

For IUI to be successful, fallopian tubes must be clear, sperm must be healthy, and an egg must be mature to fertilise. If you have irregular ovulation, fertility drugs can be used in combination with IUI. Otherwise, IVF may be advised as an alternative.

IVF, ICSI or IUI: Which is best?

The results of your fertility tests will help your fertility clinic decide which type of fertility treatment is best for you. An individualised approach is vital to give you the highest chance of success.

The clinic will take into account factors such as your medical history, age, and response to any previous cycles of treatment you may have previously had.   

You may be given the option to try IUI, or they may recommend you go straight to IVF or ICSI, if your partner’s semen analysis test reveals a sperm abnormality.

IVF cost

The cost of private treatment can vary, but 1 cycle of IVF can cost up to £5,000 or more. There may be additional costs for medicines, consultations and tests.

All treatment decisions should be made in consultation with you, so you’re fully aware of what your treatment path involves and your likely outcome, along with transparent costs.

Remember that everyone’s fertility journey is different, and what may be advised for one person may not be right for you.

Finding a fertility doctor near me

If you are asking yourself ‘How do I find IVF near me that is trustworthy’? Use this reputable link to choose a fertility clinic service that’s right for you. If you’re an NHS patient, use it to research the clinic you’ll be having treatment at.

https://www.hfea.gov.uk/choose-a-clinic/clinic-search/

thyroid-blog

How Your Female Hormones Affect Your Thyroid

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How Your Female Hormones Affect Your Thyroid

Do you suspect thyroid issues are behind your health concerns?

You couldn’t survive without your thyroid gland, so it’s worth looking after. It can be affected by many lifestyle factors– nutrient deficiencies, inflammation, stress and lack of sleep, as well as exposure to toxic metals and pollutants. But one unsuspected cause of thyroid issues can be an imbalance in female hormones.

How does your thyroid work?

The thyroid produces thyroxine, literally controlling how quickly your cells produce energy. Not enough thyroxine and the brakes are applied to your metabolism and everything becomes sluggish.

Your thyroid is asked to make thyroxine by your brain’s pituitary gland. This constantly measures the amount of thyroxine in your blood and sends a message to your thyroid to make more when levels drop. It’s a well-ordered system, but it’s not infallible.

Symptoms of low thyroid

  • Tiredness
  • Dry skin
  • Constipation
  • Weight gain
  • Feeling the cold

Because the gland affects every cell in your body, if it is not functioning well, it may cause a huge array of other symptoms. Some of these are very similar to those caused by female hormone imbalances, like irregular or heavy periods.

Oestrogen, Progesterone and Thyroxine

Inside your body, your hormones are constantly talking to and influencing one another, so if something affects one hormone, it will affect the others too.  Your female sex hormones oestrogen and progesterone have a particularly close link with your thyroid, and they all affect each other.

Oestrogen Dominance

Thyroid health can be affected when oestrogen becomes excessively high compared to progesterone. Oestrogen tends to increase the levels of a protein-binding thyroxine, making it less accessible to cells and therefore less able to influence them. High oestrogen levels increase inflammation, impairing thyroid function, encourage antibodies to be produced against your thyroid and block the messages coming from your pituitary gland.

Progesterone on the other hand increases the availability of thyroxine by making sure it’s not bound up with protein.

Too much oestrogen relative to progesterone is called oestrogen dominance. This situation is very widespread, particularly in perimenopause, the period running up to menopause. At this stage in your life, you often won’t ovulate every month. If ovulation doesn’t happen, no progesterone is released in the second half of the month. Because progesterone prevents oestrogen levels from climbing too high, there’s then nothing to oppose oestrogen.

Environmental factors: the environment is awash with synthetic chemicals able to mimic oestrogen by latching onto cells’ oestrogen receptors and fooling them into thinking they’re your body’s oestrogen. These substances, found in plastics, personal care products and pollutants are considerably stronger than your natural oestrogen.

Stress: anxiety and tension can make oestrogen dominance worse because it steals progesterone, dominating oestrogen. An unhealthy gastro microbiome also tends to increase oestrogen levels because good gut bacteria can play an important role in excreting unwanted oestrogen. In a vicious cycle, when your thyroid is struggling you can’t process oestrogen well in your liver and gut, making oestrogen dominance worse.

Even though you don’t make as much oestrogen after menopause, it can still remain high relative to progesterone, especially if you’re stressed. Progesterone is made in your stress glands after menopause, and they won’t prioritise making it if they’re busy making stress hormones.

Functional Testing

Your GP may test your blood thyroid hormones, but these tests don’t always measure how much of the hormones are in an active form. So, it’s impossible to tell whether your hormones are affecting your cells in the way nature intended. Because not all thyroid issues show up on a GP’s blood test, it might look like there’s nothing wrong even though your symptoms shout otherwise.

To look at the whole picture, functional tests examine the levels of both your female hormones and your thyroid hormones and reveal the quantities of active and inactive hormones you’re producing.

Combine these test results with an in-depth consultation examining your nutritional status, lifestyle and health history and it becomes much clearer what’s behind your health issues. Only by understanding the route cause, we can make appropriate strategies to put things right. 

 Contact Me

menstrual-cycle

The truth about getting pregnant on cycle day 14

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You do not need to ovulate on day 14 to get pregnant.

Only 10% of the population of women with a 28-day cycle even ovulate on day 14, this means a 21-day progesterone blood sample is likely to be misleading for many of us.

If you are ovulating you are likely doing so 10-14 days before the end of your cycle when your next period would start. That means if you have a 40-day cycle length, ovulation is most likely to occur between days 26 -30. If you have a 60-day cycle then it would be days 46 – 50. If you average 35 days, then you are likely to ovulate from day 21-25. See my blog on ‘Ovulation is what makes progesterone’.

I have seen plenty of women conceive when they ovulated late into a long cycle. If you have been told you don’t ovulate because your cycle is longer, then you were told something based on incomplete data. If you were told you don’t ovulate because they drew progesterone levels on day 21 of a longer cycle, the same thing applies.

So how can you tell if you are ovulating?

Many women move straight to ovulation predictor kits – also known as OPKs. This isn’t recommended for a few reasons, but especially for PCOS, where you can see a lot of false positives. I recommend instead learning what cervical mucus is and investing in a basal body temperature thermometer. Starting to collect data on the mucus your body makes and when your temps go up and down can literally tell us not only “if” you are ovulating, but also “when”.

You can ovulate with PCOS. Many of us can do so with a simple diet, lifestyle, and supplement tweaks. Many of us, it’s that simple to go from “infertile” to “fertile”, just getting us to ovulate. Then there are other things to learn, like how to time intercourse, how to support progesterone levels, and so on. But, be assured, you can get pregnant at different points in your cycle. Remember, it is possible to be a mum even if you have PCOS – I’m living proof and would love to support you on your journey.

maximising-fertility

Maximising my fertility

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Whether you want to get pregnant tomorrow or in a year, there are some actionable steps I can guide you with to maximize your fertility potential.

Lab work

It is never too soon to make sure your thyroid function is on point, inflammation is well managed, nutrients look good, hormones are in a healthy range, glucose is normal. This I can guide you through via your GP and functional testing.

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Start tracking your menstrual cycle

Depending on your goals, this could mean anything from tracking your cycle in an app to collecting all the information with basal body temperature and ovulation predictor kits. The more familiar you are with your unique patterns, the easier it will be to determine if something is off, and the quicker we will be able to zone in your fertile window. See my blog on ‘Do you know when you’re ovulating?’. ⠀⠀⠀⠀⠀⠀⠀⠀⠀

Focus on nutrient density

I can guide you each step of the way. As a rule, eating a rainbow of fruits and vegetables is the best way to ensure broad-spectrum antioxidants, phytochemicals, and micronutrients. A Mediterranean-style food plan that is antioxidant-rich, anti-inflammatory, and full of healthy fats is a good choice for many people. During a 3 month programme, we will create a food plan together which is specifically tailored to you.

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Supporting your emotional mindset

You are deserving. You are capable. You are full enough to give to another. This journey can seem such an emotional rollercoaster, your note alone, I’ve been there and completely understand your pain. It doesn’t have to be this way, let me support you, as a Freedom Fertility Formula Specialist I am trained to support you with the emotional aspect of your journey. Freedom Formula Specialist

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Clean up your cleaners and beauty products.

One hormone that is very relevant to reproductive health is oestrogen and some chemicals (xenoestrogens), or foods and plants (phytoestrogens), mimic the action of oestrogen produced in cells and can alter hormonal activity.

Hormone disruptors get into our bodies when we breathe, eat, drink and have skin contact with them.  There is no way to avoid them entirely, but reducing your exposure to them to the extent that it is within your control should help.  Some of the worst offenders when it comes to hormone disruption are:

  • BPA Plastics- Bisphenol A (BPA) is commonly used in some plastic products such a food storage containers, plastic drinks bottles and linings of canned food, and
    Phthalates – used in cosmetics, fragrances and other personal products.

Emphasize non-toxic products – you are what you eat, breathe, and absorb.

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Supplementation

Nutrition is the key to laying down the foundations for the health of your conception, pregnancy and baby. Nutrients play an essential role in creating and maintaining healthy eggs and sperm that will go on to fertilise, implant and grow a healthy baby. There is so much conflicting advice around diet and supplements when trying for a baby naturally, together we can develop a personalised and targeted nutritional plan which includes supplementation that is right for you.

Together we can work towards nourishing that new life

birth-control pill with date of calendar background, health care

Is Birth Control Messing with Your Nutrition?

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Oral contraceptives are prescribed beyond preventing pregnancy, for reasons such as
  • To regulate menstrual cycles
  • Provide some relief for pain during menstruation
  • Acne
  • Ovarian cyst prevention.
  • PMS and PMDD relief
  • Endometriosis management
  • Menstrual migraine relief

However, there are many drawbacks of the contraceptive pill which may be affecting your future fertility. In this blog I am going to focus on nutrition depletion.

Research has demonstrated the use of oral contraceptives may be significantly affecting bodily levels of many essential vitamins and minerals. 1-5

Here are 5 essential nutrients commonly depleted by the pill

• Magnesium

• Zinc

• Folic acid

• Vitamin B12

• Vitamin E

Magnesium

The pill and oestrogen therapy has demonstrated a depletion in serum magnesium levels, causing a potential deficiency of this essential mineral. 6,7 This is concerning for most females in where dietary magnesium intake is already low, not to mention a 21st century lifestyle that quickly uses up magnesium stores such as poor sleep, high-intensity exercise, chronic stress, and high intake of caffeine, sugar, and processed foods. 7-12

Magnesium has many benefits which have been supported by research such as supporting energy, sleep, mood, and hormone balance. Given the body’s widespread need for magnesium, low dietary intake in addition to the continual drain on the body’s stores, it is particularly concerning that the contraceptive pill may be depleting levels even further.

Furthermore, magnesium depletion alters the calcium to magnesium ratio which may affect blood coagulation.13 The deficiency in magnesium may contribute to the thromboembolic complications associated with oestrogens.6,7 Therefore, it is worth taking magnesium supplementation in addition to your diet when taking the oral contraceptive pill. 

Zinc

Lower plasma zinc levels have been observed in research dating as far back as 1968 14,15 in addition to more recent studies confirming this finding too. 16-20

Zinc is an essential trace element, used as a cofactor for more than 300 different enzymes, used in every cell, organ, bone, tissue, and fluid of the body.  Zinc is involved in immune and skin health and is important in supporting reproduction. The World Health Organisation (WHO), states the global prevalence of zinc deficiency is a surprising 31%.

The changes which occur as a result of increased oestrogen from the oral contraceptive pill may lower blood zinc levels and also increase the amount of zinc used by bodily tissues. 21-22 When these alterations occur, the need for dietary zinc increases. 20

Although not all research demonstrated a reduced level of zinc, the majority indicated that oral contraceptives, to include lower doses, have a negative effect on the nutritional status of this mineral. 16,20,23-31 Additionally, a decrease in zinc, selenium, phosphorus and magnesium in women taking oral contraceptives was found in a recent systematic review 32 which had been associated to the duration of contraceptive use.

Therefore, when oral contraception is recommended by your health professional, supplementing zinc may be useful and is best supplemented with copper due to both minerals being antagonists, which means they compete for binding sites in the body. Excess zinc can lead to a copper deficiency and vice versa.

Folic acid

Studies have demonstrated a potential reduction in blood folate levels. 33-37. One recent systematic review and meta-analysis concluded, due to reduced blood folate concentrations associated with the use of oral contraceptives, it is necessary that women of a childbearing age to continue the use of folate supplementation whilst using the contraceptive pill. 38

Folic acid is necessary within the first 4 weeks of pregnancy in order to prevent neural tube defects. Due to the folate-depleting effects of the oral contraceptive, in 2012 there was the introduction of contraceptives that were fortified with folate to help reduce the risk of neural tube defects in pregnancies that occurred during use or shortly after the discontinuation of oral contraceptives.39,40

Some evidence has shown an increase in the rate of cervical dysplasia to cervical cancer progression and that folic acid may slow or reverse this dysplasia.41,42

Recent studies recommend all women of childbearing age taking the oral contraceptive pill should supplement with folic acid. It is recommended to take the body-ready form of 5-methyltetrahydrofolate (5-MTHF) of folic acid as some people are genetically less able to convert folic acid into this active form, and therefore is less effective. Supplementing with active 5-MTHF form of folic acid bypasses the need for conversion and therefore reassures folate stores are being replenished.

Vitamin B12

The depletion of vitamin B12 in women using oral contraceptives has been found in many studies, compared to non-users .20, 43-52 In addition to folic acid, low maternal B12 status is also considered to be a standalone risk factor for neural tube defects. 53

Vitamin B12 has many functions, such as

  • Supports the blood to carry oxygen
  • Essential for healthy nerves and DNA synthesis
  • Supports the elimination of toxins   

Animal products are a rich source of vitamin B12 and are the only vitamin that can’t be reliably supplied by a varied wholefood plant-based diet.

one recent systematic review demonstrated oral contraceptives have been found to deplete vitamin B12, therefore vitamin supplements might be beneficial when taking oral contraceptives.54.55

Vitamin E

Vitamin E has many positive health benefits, to include

  • Antioxidant
  • Healthy skin
  • Immune function support
  • Cardiovascular support

Research demonstrated that the oral contraceptive had increased markers of oxidative stress and decreased levels of vitamin E in the blood. A further study found a significant rise in the clotting activity of blood platelets when taking the oral contraceptive pill, naturally accompanying decreased blood levels of vitamin E. 56-58 Research found, supplementing with vitamin E increased vitamin E blood levels and had shown a decrease in the clotting activity of platelets.59

Daily supplementation may help to support improved levels of key nutrients

Research has shown that oral contraceptives can deplete blood levels of many essential vitamins and minerals, in addition to the above, therefore if you are required to take the oral contraceptive pill you may benefit from supplementing your diet with a daily multivitamin & mineral to support these possible negative effects.

References:

1. Theuer RC. Effect of Oral Contraceptive Agents on Vitamin and Mineral Needs: A Review. J Reprod Med. 1972; 8:13-9.

2. Berg G, Kohlmeier L, Brenner H. Effect of Oral Contraceptive Progestins on Serum Copper Concentration. Eur J Clin Nutr. 1998; 52:711-5.

3. Ghayour-Mobarhan M, Taylor A, New SA, Lamb DJ, Ferns GA. Determinants of Serum Copper, Zinc and Selenium in Healthy Subjects. Ann Clin Biochem. 2005; 42:364-75.

4. Tamura T, Picciano MF. Folate and Human Reproduction. Am J Clin Nutr 2006;83: 993-1016.

5. Prevention of Neural Tube Defects: Results of the Medical Research Council Vitamin Study. Mrc Vitamin Study Research Group. Lancet. 1991; 338:131-7.

6. Seelig MS. Increased need for magnesium with the use of combined oestrogen and calcium for osteoporosis treatment. Magnes Res 1990; 3:197-215

7. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine, and premenstrual syndrome. J Am Coll Nutr 1993; 12:442-58

8. Stanton MF, Lowenstein FW. Serum magnesium in women during pregnancy, while taking contraceptives, and after menopause. J Am Coll Nutr 1987; 6:313-9

9. Akinloye O, Adebayo T, Oguntibeju O, Oparinde D, Ogunyemi E. Effects of contraceptives on serum trace elements, calcium and phosphorus levels.West Indian Med J 2011; 60: 308-315.

10. Hameed A, Majeed T, Rauf S, Ashraf M, Jalil M, Nasrullah M, Hussan A, Noreen R. Effect of oral and injectable contraceptives on serum calcium, magnesium and phosphorus in women. J Ayub Med Coll Abbottabad 2001; 13: 24-25.

11. Olatunbosun D, Adeniyi F, Adadevoh BK. Effect of oral contraceptives on Serum magnesium levels. Int J Fertil 1974; 19: 224-226.

12. Blum M, Kitai E, Ariel Y, Schnierer M, Bograd H. Oral contraceptive lowers serum magnesium. Harefuah 1991; 121: 363-364.

13. Cowan JA. Introduction to the biological chemistry of magnesium. ed. J.A. Cowan. New York. VCH;1995.

14. Halsted JA, Hackley BM, Smith JC, Jr. Plasma-zinc and copper in pregnancy and after oral contraceptives. Lancet 1968; 2: 278-279

15. King JC. Do women using oral contraceptive agents require extra zinc? J Nutr 1987; 117: 217- 219

16. Prasad AS, Oberleas D, Moghissi KS, Stryker JC, Lei KY. Effect of Oral Contraceptive Agents on Nutrients: Ii. Vitamins. Am J Clin Nutr. 1975; 28:385-91.

17. Akinloye O, Adebayo T, Oguntibeju O, Oparinde D, Ogunyemi E. Effects of contraceptives on serum trace elements, calcium and phosphorus levels.West Indian Med J 2011; 60: 308-315.18. Briggs Mh, Briggs M, Austin J. Effects of steroid pharmaceuticals on plasma zinc. Nature 1971; 232: 480-481

19. Prema K, Ramalakshmi Ba, Babu S. Serum copper and zinc in hormonal contraceptive users. Fertil Steril 1980; 33: 267-271.

20. Fallah S, Sani Fv, Firoozrai M. Effect of contraceptive pill on the selenium and zinc status of healthy subjects. Contraception 2009; 80: 40-43.

21. King JC. Do women using oral contraceptive agents require extra zinc? J Nutr 1987; 117: 217- 219

22. Chilvers DC, Jones MM, Selby PL, et al. Effects of oral ethinyl oestradiol and norethisterone on plasma copper and zinc complexes in post-menopausal women. Hormone Metab Res 1985; 17:532-5.

23. Tyrer LB. Nutrition and the pill. J Reprod Med 1984; 29:547-50.

24. Webb JL. Nutritional effects of oral contraceptive use: a review. J Reprod Med 1980; 25: 150-156.

25. Prema K, Ramalakshmi Ba, Babu S. Serum copper and zinc in hormonal contraceptive users. Fertil Steril 1980; 33: 267-271.

26. Smith JC, Brown ED. Effects of oral contraceptive agents on trace element metabolism – a review. In: Prasad AS (ed). Trace Elements in Human Health and Disease. Vol.II, Essential and Toxic Elements. New York: Academic Press, 1976. 315-45.

27. Vir SC, Love AH. Zinc and copper nutriture of women taking oral contraceptive agents. Am J Clin Nutr 1981; 34:1479-83

28. Hinks LJ, Clayton BE, Lloyd RS. Zinc and copper concentrations in leukocytes and erythrocytes in healthy adults and the effect of oral contraceptives. J Clin Pathol 1983; 36:1016-21.

29. Powell-Beard L, Lei KY, Shenker L. Effect of long-term oral contraceptive therapy before pregnancy on maternal and fetal zinc and copper status. Obstet Gynecol 1987; 69:26-32.

30. Liukko P, Erkkola R, Pakarinen P, et al. Trace elements during 2 years’ oral contraception with low-estrogen preparations. Gynecol Obstet Invest 1988; 25:113-7.

31. Thane, C W et al : Oral contraceptives and nutritional status in adolescent British girls. Nutrition Research, 2002, 22, 449-462

32. Dante G et al. Vitamin and mineral needs during the oral contraceptive therapy: a systematic review. Int J Reprod Contracept Obstet Gynecol. 2014 Mar;3(1):1-10

33. Trowbridge M, Jr., Wadsworth R, Moffitt E. Malabsorption associated with gluten enteropathy, do oral contraceptives interfere with folate metabolism? J Maine Med Assoc 1968; 59: 240-242.

34. Paton A. Oral contraceptives and folate deficiency. Lancet 1969; 1: 418.

35. Ryser J, Farquet J, Petite J. Megaloblastic anemia due to folic acid deficiency in a young woman on oral contraceptives. Acta Haematol 1971; 45: 319-324.

36. Whitehead N, Reyner F, Lindenbaum J. Megaloblastic changes in the cervical epithelium. Association with oral contraceptive therapy and reversal with folic acid. JAMA 1973; 226: 1421-1424

37. Shojania AM. Oral contraceptives: effect of folate and vitamin B12 metabolism. Can Med Assoc J 1982; 126: 244-247

38. Shere, Mahvash, et al. “Association between use of oral contraceptives and folate status: a systematic review and meta-analysis.” Journal of Obstetrics and Gynaecology Canada 37: 430-438.

39. Castano PM, Aydemir A, Sampson-Landers C, Lynen R. The folate status of reproductive-aged women in a randomised trial of a folate-fortified oral contraceptive: dietary and blood assessments. Public health nutrition. 2014 Jun;17(6):1375-83.

40. Fruzzetti, F. Beyaz P An oral contraceptive fortified with folate Women’s Health1 (Jan 2012): 13-9.

41. Butterworth CE, Hatch KD, Gore H, et al. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982; 35:73-82.

42. Check WA. Folate for oral contraceptive users may reduce cervical cancer risk. J Am Med Assoc 1980; 244:633-4.

43. Wilson SM, Bivins BN, Russell KA, Bailey LB. Oral Contraceptive Use: Impact on Folate, Vitamin B(6), and Vitamin B(1)(2) Status. Nutr Rev. 2011; 69:572-83.

44. Mooij PN, Thomas CM, Doesburg WH, Eskes TK. Multivitamin supplementation in oral contraceptive users. Contraception 1991; 44:277-88.

45. Lussana F, Zighetti Ml, Bucciarelli P, Cugno M, Cattane M. Blood levels of homocysteine, folate, vitamin B6 and B12 in women using oral contraceptives compared to non-users. Thromb Res 2003; 112: 37-41.

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