[SPEAKER_00]: Hello and welcome to the Aquaman podcast.
[SPEAKER_00]: This is an exploration of woman kind.
[SPEAKER_00]: Here we discuss what it is to be a woman in the modern world while utilizing ancient and modern modalities in tandem to create a bounty of health for the body, mind and spirit.
[SPEAKER_00]: good day everyone and welcome back to the part I hope you're having a beautiful morning afternoon or evening wherever you are in the world.
[SPEAKER_00]: Today we are talking all things abortion and how you can heal after your termination.
[SPEAKER_00]: We're going to be talking about hormones, nutrients, labs, all of the things that
[SPEAKER_00]: You're told, you don't really need to worry about after you've had this procedure.
[SPEAKER_00]: Done, but before we get into it, let's pay our respects to our elders, past, present, and emerging in the lands of which Rita Tasmania where I'm recording this podcast today.
[SPEAKER_00]: Always has.
[SPEAKER_00]: Always will be baby.
[SPEAKER_00]: So let's talk about termination or abortion.
[SPEAKER_00]: I'm going to be
[SPEAKER_00]: using both of those words interchangeably in this podcast today.
[SPEAKER_00]: So, most termination content online is either really political or purely clinical.
[SPEAKER_00]: Nothing really explains what's happening, hormonally leading up to your termination and afterwards.
[SPEAKER_00]: So, we're going to be talking about what a termination actually is, the difference between a medical and a surgical abortion,
[SPEAKER_00]: What early pregnancy already has been doing to your eye and be 12 in your hormones for for the procedure and what happens afterwards and the evidence we know so we can build a case on how you can rebuild and feel a lot better soon afterwards.
[SPEAKER_00]: I think it's really sad.
[SPEAKER_00]: that we don't actually have this conversation with women about this is what the pregnancy did to you before you had your termination this is what's happening during and after a termination and this is what you can do to rebuild right so there's no real dialogue on that I think a lot of women are told it's going to be fine see you later if you don't have to worry about it and then women have things happen to them maybe they had low be 12 or for a pregnancy and then they had a termination and their be 12 is really really low and they have all of these symptoms
[SPEAKER_00]: and they attach that to the termination.
[SPEAKER_00]: They think the abortion of the termination caused this, and it's not the case.
[SPEAKER_00]: A pregnancy is a huge metabolic event.
[SPEAKER_00]: It uses up a lot of nutrient, and that's why you have to be super healthy on the lead up to pregnancy and after pregnancy as well, because you need to rebuild.
[SPEAKER_00]: Because building a fetus takes a lot of energy and a lot of resources, and it's going to take it from you, right?
[SPEAKER_00]: So,
[SPEAKER_00]: Don't attach what's happening to you after a termination or an abortion to the event of termination or abortion.
[SPEAKER_00]: Attach it to the event that pregnancy itself is a hugely metabolic plea demanding and resourcefully it's a demanding process and that's how we need to think about it basically.
[SPEAKER_00]: So this whole podcast is basically a dialogue on how you can rebuild after a termination.
[SPEAKER_00]: What this podcast is not is a political conversation on abortion.
[SPEAKER_00]: abortion is healthcare.
[SPEAKER_00]: It's one of the many reasons why women live better lives today.
[SPEAKER_00]: I've had an abortion and it was one of the best things I've ever done.
[SPEAKER_00]: If you're leaving comments on here about how abortion is murder, you're going to be blocked.
[SPEAKER_00]: Okay, you're going to be blocked.
[SPEAKER_00]: I don't care about your stance on abortion.
[SPEAKER_00]: You know why?
[SPEAKER_00]: Because if you have a vagina and you don't like abortion, super easy man, super easy.
[SPEAKER_00]: You know why?
[SPEAKER_00]: Just don't have one.
[SPEAKER_00]: Just don't have an abortion.
[SPEAKER_00]: It's so so so easy.
[SPEAKER_00]: We're not going to police other women's decisions.
[SPEAKER_00]: Okay, and if you have a penis and you're against abortion again, super easy, you're never going to have one.
[SPEAKER_00]: So it's not a year business.
[SPEAKER_00]: Okay, so let's talk about a abortion.
[SPEAKER_00]: Let's talk about what the termination of a pregnancy actually is to start off.
[SPEAKER_00]: So, the termination of a pregnancy, also known as induced abortion, is ending a pregnancy by medication or procedure.
[SPEAKER_00]: And it's actually one of the most common, gynecological interventions on the earth.
[SPEAKER_00]: Just in Australia, Ranskog says that one and four women will access an abortion within their lifetime.
[SPEAKER_00]: So that's a quarter of women when you're walking down the street count 1, 2, 3, 4.
[SPEAKER_00]: and we can assume that at least one of those four women have had an abortion in their lifetime.
[SPEAKER_00]: In Australia and New Zealand, the abortion rate is around 15 per 1,000 women of reproductive age.
[SPEAKER_00]: Medical abortions, so when we're taking the pill and we're taking a home,
[SPEAKER_00]: accounts for about 25% of abortions in Australia and 44% in Ariatollah in New Zealand.
[SPEAKER_00]: So New Zealand, they have a lot more medical abortions, so the Miffle Pristone and the Miffle Prostop, the two pills you take home in comparison to surgical, so a surgical abortion is a lot more common in Australia.
[SPEAKER_00]: Ranskog defines trimesters as your first trimester is up to 14 weeks.
[SPEAKER_00]: The vast majority, over 80% of your abortions will happen in this period of time.
[SPEAKER_00]: Most women are having abortions in the first 14 weeks and your second trimester is from 14 weeks.
[SPEAKER_00]: The most the reason why we see women having abortions in the second and even the third trimester is because they couldn't access it.
[SPEAKER_00]: and there are many reasons for this as well, financially they couldn't afford it.
[SPEAKER_00]: Maybe they weren't mere a clinic and they lived incredibly rurally.
[SPEAKER_00]: Maybe they're in a situation where they don't control their finances and they're being financially controlled by their male partner.
[SPEAKER_00]: We often see in these cases of women where they
[SPEAKER_00]: can't financially access.
[SPEAKER_00]: That thinks because there are no relationship that is bordering on violence, we also see that they might be reproductively being coerced here as well.
[SPEAKER_00]: So there are lots of different reasons why women don't access abortion in those first 14 weeks.
[SPEAKER_00]: Also, if you have PMOS and you already have a regular cycles, maybe you didn't know you were pregnant.
[SPEAKER_00]: Okay, so there are a lot of different reasons why women have so-called late term abortions, and even in the third trimester, up to 40 weeks, incredibly rare.
[SPEAKER_00]: incredibly rare, the most women are having them in the first trimester, and if they're not them having them in the second trimester, and we're seeing very extreme and rare cases after about 34 weeks.
[SPEAKER_00]: Okay, so the two mainstream methods that we see being used in that first and sometimes in the second trimester, it's different for everyone, is that move a priest to an amissile postal, being used in tandem, that's something you can do at home.
[SPEAKER_00]: And then your surgical, which is a vacuum aspiration or dilation and evacuation.
[SPEAKER_00]: So, miscarriage and early pregnancy loss.
[SPEAKER_00]: If you're listening to this thinking, I just had a miscarriage, maybe this will help me.
[SPEAKER_00]: I will be covering that really soon.
[SPEAKER_00]: Probably next week.
[SPEAKER_00]: I just thought it would be really insensitive for me to cover.
[SPEAKER_00]: termination and miscarriage in the same podcast.
[SPEAKER_00]: I just thought that if you're so inappropriate, so if you've just had a miscarriage and we will be covering that really really soon, this whole podcast is specifically only about abortion and termination.
[SPEAKER_00]: Both of these mainstream methods, so you're surgical and your medical abortion, are very, very safe.
[SPEAKER_00]: So we're we're looking at the full comparative data in a few segments, specifically segment six.
[SPEAKER_00]: So if you want to know about that, skip forward.
[SPEAKER_00]: So, let's move on to our first method of termination, our medical termination, your mythopristone, and your mice are hostile.
[SPEAKER_00]: So, mythopristone are u486.
[SPEAKER_00]: That's also what it's known as.
[SPEAKER_00]: Is a competitive progesterone receptor agonist?
[SPEAKER_00]: What does that mean?
[SPEAKER_00]: It means it will compete with progesterone at its receptors and it blocks progesterone from binding to its receptor.
[SPEAKER_00]: If we look at the word progesterone, progestation, okay?
[SPEAKER_00]: That's the whole purpose of progesterone.
[SPEAKER_00]: It's been released from your corpus lydium.
[SPEAKER_00]: Once it gets the message that there has been implantation, implantation sends a message to the corpus lydium and corpus lydium goes great.
[SPEAKER_00]: I'm going to release progesterone until the placenta can make it, right?
[SPEAKER_00]: Progesterone, what does it do?
[SPEAKER_00]: So it maintains the internal lining of your endometrium and it keeps the endometrium and muscle quiet in a way.
[SPEAKER_00]: So myometrial
[SPEAKER_00]: doesn't move around and it doesn't contract, okay?
[SPEAKER_00]: So when we block progesterone, it causes the endometrium to break down and it causes the detachment of the pregnancy and increases your myometrial sensitivity to prostate glands and it's prostate glands and it's almost always present, they change throughout the cycle, but they also increase towards birth, so in your last trimester and it also softens and ripens the cervix as well.
[SPEAKER_00]: So basically, we're opening up the cervix
[SPEAKER_00]: and we're causing the endometrium to sloth because it's becoming more sensitive.
[SPEAKER_00]: Two of those post-glandards and we're seeing movement in the uterus.
[SPEAKER_00]: So it causes a miscarriage, so to speak.
[SPEAKER_00]: My so-prostal is a post-glandone E1 analog.
[SPEAKER_00]: So we're taking mythopristone, which competes with progesterone receptor agonist.
[SPEAKER_00]: So it basically stops progesterone attaching to the receptor.
[SPEAKER_00]: So progesterone isn't doing its job in the uterus anymore,
[SPEAKER_00]: And that's going to bind to myometrial prostate gland and receptors, and that's going to cause strong uterine contractions, and that's going to ripen the cervix, and that's going to expel the pregnancy.
[SPEAKER_00]: So we always take myth of pristone first, and that primes the myometrium, so myocoprostal given 24 to 48 hours later works a lot more effectively than myocoprostal alone.
[SPEAKER_00]: Okay, so the standard regimen here, we usually take 200 milligrams of oral if a presto in first, and then you take your 800 micrograms of my so-prostal.
[SPEAKER_00]: Okay, and so you can take that internally or vaginally as well.
[SPEAKER_00]: And that's taken 24 to 48 hours later.
[SPEAKER_00]: So that's why they say,
[SPEAKER_00]: It's going to take a few days to take some time off work and make sure because you probably will have some symptoms from taking them with a presto, which stops progesterine working at the receptor site and then you take your master postal afterwards.
[SPEAKER_00]: So this isn't affected medication up to 77 days or 11 weeks.
[SPEAKER_00]: early pregnancy loss protocols extend to 84 days, okay?
[SPEAKER_00]: So in Australia MS2 step, that's what it's called MS2 step, is TGA authorised up to 63 days, so nine weeks.
[SPEAKER_00]: So it's usually taken within nine weeks.
[SPEAKER_00]: So they say, when was your last period?
[SPEAKER_00]: How long do you think you are?
[SPEAKER_00]: Maybe they'll do an ultrasound to double check the size and make sure you're within the range that you can take this medication.
[SPEAKER_00]: In New Zealand, the protocol extends to 70 days, which is probably why in New Zealand, Ariratola, it's 44 as opposed to Australia 25%.
[SPEAKER_00]: Yeah, so beyond 9 to 10 weeks,
[SPEAKER_00]: We increase the dose.
[SPEAKER_00]: So a second, 800 MCG, my suprostal dose.
[SPEAKER_00]: So that's the proste Glendon.
[SPEAKER_00]: Four hours after the first improved success rates.
[SPEAKER_00]: In a 2020 systematic review, so this looked at 34 publications.
[SPEAKER_00]: They looked at 25,000 medical abortions in low and middle income countries.
[SPEAKER_00]: 95% effective rate up to 63 days, right?
[SPEAKER_00]: With 0.6% average continuing pregnancy rate.
[SPEAKER_00]: So very, very, very effective.
[SPEAKER_00]: these countries, which is why MS2 step is really amazing for women in these countries and that's why it's been used even in other countries all over the world because it is very, very effective even beyond kind of that nine to ten week range, but of course we can't take it into I guess the middle of your second trimester that's where we can run into more problems.
[SPEAKER_00]: So that's why
[SPEAKER_00]: we take the medical abortion kind of earlier in pregnancy because the mass is smaller and the risk therefore for the mother is smaller as well and therefore the risk for the woman is also smaller.
[SPEAKER_00]: So, after you take a myth of pristone, so myth of pristone, blocks, progesterone, at the receptor site, you often feel like minimal sensation,
[SPEAKER_00]: And you might see some lights budding begin.
[SPEAKER_00]: After you take a missile across stools, that's one to two days after you've taken with a piston, you will experience cramping and bleeding typically within one to four hours.
[SPEAKER_00]: So you can't take that and then go out for coffee with the girls.
[SPEAKER_00]: You've got to go home, you've really just got to bunk a down, feel safe, probably have a good friend.
[SPEAKER_00]: And the heaviest bleeding and passage of the pregnancy usually occurs within two to six hours after you've taken that medication.
[SPEAKER_00]: So it takes about one to two hours to sit in,
[SPEAKER_00]: and generally it's all over in its kind of intensity within six hours.
[SPEAKER_00]: So it will take a day.
[SPEAKER_00]: I would say.
[SPEAKER_00]: It takes about half a day for the intensity to kind of end.
[SPEAKER_00]: So the bleeding is characteristically heavier than a period, often with a lot of cloths.
[SPEAKER_00]: So this is expected.
[SPEAKER_00]: It's not a red flag on its own.
[SPEAKER_00]: So if you see that, don't worry about it.
[SPEAKER_00]: That is just what your endometrium looks like during an early part of a pregnancy, which you are terminating and living
[SPEAKER_00]: So the common transient masterprostoral side effects, low grade fever, so getting hot and getting cold, chills, so I'm feeling really cold, nausea, vomiting, and diarrhea.
[SPEAKER_00]: nausea, vomiting, and diarrhea is because it's a prostitute, and okay, I would say taking some electrolytes on the day during the process is really going to help.
[SPEAKER_00]: With the diarrhea and the vomiting and the nausea, taking some magnesium in the morning might also be really nice just to suit this process because magnesium helps.
[SPEAKER_00]: but you get a risk contract and smooth manner.
[SPEAKER_00]: You can also manage this with anti-inflammatories for the pain as well.
[SPEAKER_00]: After the intensity of this, the bleeding then will take up and the average total bleeding and spotting duration is about 9 to 16 days after.
[SPEAKER_00]: So about two weeks after, you will experience some spotting.
[SPEAKER_00]: If it doesn't taper off, that's when you contact a health provider because that's not normal and there might be something going on.
[SPEAKER_00]: That you need to talk to them about.
[SPEAKER_00]: Okay, so that's your medical termination that you usually can do at home with a friend, hopefully you have a friend, you have the house to yourself, you have a bath, you have some calm music, and you've got a few days off afterwards, okay?
[SPEAKER_00]: And maybe book in to see your therapist, okay?
[SPEAKER_00]: So that's kind of what it looks like on the day.
[SPEAKER_00]: Next, let's talk about your surgical termination.
[SPEAKER_00]: So that's your vacuum aspiration and your DNA.
[SPEAKER_00]: Okay, so on the day of your surgical termination,
[SPEAKER_00]: They would say, hey, how's it going?
[SPEAKER_00]: They might do an ultrasound to see with a location of the fetuses.
[SPEAKER_00]: They'll talk to you.
[SPEAKER_00]: They'll counsel you.
[SPEAKER_00]: They'll make sure that you feel very comfortable with this decision.
[SPEAKER_00]: Often you're not allowed to drive alone.
[SPEAKER_00]: So you often will be dropped off.
[SPEAKER_00]: I love to want to pick up.
[SPEAKER_00]: And so they'll make sure that you're being taken care of, that you're going to a safe place.
[SPEAKER_00]: They will talk to you about the relationship you're in.
[SPEAKER_00]: And if it's a safe relationship, all of these things are clinic is a very, very safe place.
[SPEAKER_00]: For nurses, we'll take very, very good care of you.
[SPEAKER_00]: Then basically, after that kind of interview process, they might take some blood very rarely.
[SPEAKER_00]: They'll take blood's unless you have any co-morbidities or any illness or anything that you're dealing with at the moment, you'll go into the waiting room and you will be given maybe some medication before you go in and then you'll go into theater.
[SPEAKER_00]: Okay, and then the procedure happens, and then often you will wake up.
[SPEAKER_00]: Don't give you a little bit of jelly, you'll be picked up by your loved one and you go home.
[SPEAKER_00]: Okay, so all happens within a day.
[SPEAKER_00]: So let's talk about the manual vacuum aspiration, also known as an MVA.
[SPEAKER_00]: So that's a handheld syringe device or an electric vacuum aspiration.
[SPEAKER_00]: That's called an EVA suction pump.
[SPEAKER_00]: and that basically evacuates the uterus through a thin cannula after surgical cervical dilation.
[SPEAKER_00]: So the standard first trimester surgical method usually used up to 14 weeks, okay?
[SPEAKER_00]: So the World Health Organization in 2022 uses 14 weeks as the vacuum aspiration threshold.
[SPEAKER_00]: So vacuum aspiration is up to 14 weeks.
[SPEAKER_00]: So let's talk about the actual procedure.
[SPEAKER_00]: It only takes about five to 10 minutes.
[SPEAKER_00]: Usually you're put under local anesthetic, so you are not conscious.
[SPEAKER_00]: That's usually what is happening in Australia and New Zealand.
[SPEAKER_00]: It's very rare for you to have a conscious sedation.
[SPEAKER_00]: And if I could, I would highly recommend that you are not conscious.
[SPEAKER_00]: If you can ask your health provider, I don't want to be conscious for this.
[SPEAKER_00]: I think it's a lot easier for you to process afterwards than being conscious for this.
[SPEAKER_00]: So basically what they do beforehand as well is cervical priming.
[SPEAKER_00]: So they might give you in that waiting room.
[SPEAKER_00]: They'll give you an osmotic dilator and amyseprostal.
[SPEAKER_00]: And so that's going to rip in the cervix so it's easier for them to dilate.
[SPEAKER_00]: The few recommends vacuum aspiration over sharp cutterage adencies.
[SPEAKER_00]: So we're not cutting into the cervix we're dilating the cervix.
[SPEAKER_00]: Going in there with a very thin syringe and we are removing the pregnancy.
[SPEAKER_00]: Okay, so that's your vacuum aspiration.
[SPEAKER_00]: So what about a DNC?
[SPEAKER_00]: So a Georgian population study they found that DNC carried about four times the hemorrhage risk of vacuum aspiration.
[SPEAKER_00]: So if you can, please opt for a vacuum aspiration over a DNC.
[SPEAKER_00]: Specifically, if you have low iron, maybe you have low vitamin K, which clots your blood, that might carry higher risk for you for blood loss.
[SPEAKER_00]: And it's generally just a lot safer.
[SPEAKER_00]: And if you have a choice around your pain medication, in your first trimester surgical termination, if you're offered inhalation or volatile gas and a sphysia, that produce significantly higher intraoperative blood loss as well.
[SPEAKER_00]: So DNC and also gas also known as laughing gas as your pain management they both increased hemorrhaging.
[SPEAKER_00]: So that's something that you need to take into account going in there when they talk to you about all of these things you need to talk to your health provider and your doctor before you do this and say, hey, I have really heavy periods or I have a low vitamin K or low iron.
[SPEAKER_00]: I need to be really careful about hemorrhage and blood loss because I'm already a little bit low.
[SPEAKER_00]: So these are a few things that you need to know before you go in.
[SPEAKER_00]: and hopefully they're giving you a few different options in Australia and New Zealand as far as I know.
[SPEAKER_00]: It's quite common for local anaesthetic to be used.
[SPEAKER_00]: Those are a few things that you need to keep in mind as per your surgical termination.
[SPEAKER_00]: But again, it's an incredibly safe procedure.
[SPEAKER_00]: It's just a day procedure.
[SPEAKER_00]: You are there for tops for hours and then you'll be taken home.
[SPEAKER_00]: Okay, hopefully by a loved one, I hope no one is driving or walking themselves home after you have a surgical termination.
[SPEAKER_00]: Okay, so let's talk about the differences of bleeding complication and the numbers in medical versus surgical because a lot of women are like which one do I do?
[SPEAKER_00]: So measured blood loss is generally lower with a surgical aspiration than a medical abortion.
[SPEAKER_00]: So you medical abortion remember it's taking you pill at home.
[SPEAKER_00]: The misoprystallum is a pristine.
[SPEAKER_00]: So you're taking that at home.
[SPEAKER_00]: So again, if you have low iron, low vitamin K, if you have heavy periods, I would really opt for your surgical aspiration abortion.
[SPEAKER_00]: So your vacuum aspiration, because the hemorrhaging is a lot lower and the blood loss I would say is a lot lower than the medical abortion that you can have at home.
[SPEAKER_00]: So in a comparative trial in China, Cuba, and India, the medium blood loss is 53 milliliters with surgical and 84 to 101 milliliters with your medical
[SPEAKER_00]: at home one.
[SPEAKER_00]: Your mean hemoglobin blood drop after your first trimester medication abortion is really modest, rarely it's clinically significant, but you can monitor it if you bleed really, really heavily against.
[SPEAKER_00]: So this is a conversation you need to have with your health provider if you have low iron historically.
[SPEAKER_00]: I will also say that you are going to perceive a medical abortion bleeding as a lot heavier when clinical measures are similar.
[SPEAKER_00]: So even if you had a surgical abortion that you weren't aware and you weren't awake for, you're not aware of the blood loss that you're experiencing during that procedure because you're not conscious, but whereas if you have a medical abortion, you're awake for the entire
[SPEAKER_00]: process.
[SPEAKER_00]: And so you are going to perceive that blood loss as a lot more.
[SPEAKER_00]: So again, if you're a bit squimish and you don't think you are going to be able to psychologically handle that process, surgical abortion is a lot safer psychologically.
[SPEAKER_00]: So you don't have to go through that.
[SPEAKER_00]: But if you're like I'm fine, I actually think that that's going to be cathartic.
[SPEAKER_00]: and it's going to be a good spiritual process for me to actually pass this pregnancy and be a wake for it by all means go for it.
[SPEAKER_00]: What I will also say though, hemorrhaging in medical abortions, we see about 15 to 16 percent versus surgical is around 2 percent as well.
[SPEAKER_00]: In complete abortion is something we also need to talk about.
[SPEAKER_00]: So it's only 6.6 with a medical at home.
[SPEAKER_00]: and 1.6 with surgical as well.
[SPEAKER_00]: So I think that's one of the reasons also why in Australia, surgical abortions are a lot more common because the risk is slightly lower and in some women a lot lower as well.
[SPEAKER_00]: So surgical reevaluation needed in about 5.9 of medical abortions and 0.4 of surgical.
[SPEAKER_00]: Okay, infection in both models is around 1.7.
[SPEAKER_00]: So incredibly low after you've had
[SPEAKER_00]: Any type of termination, if you have chills, if you can't sleep, if you're sweating and you have a fever, if you can't eat in your nauseous, up to a week after, that's not okay even a few days after I would say that's a sign of a possible infection and you need to present to your health writer and be taken care of.
[SPEAKER_00]: Just in case, the might take some labs and they'll probably give you some anti biotics to take care of that just in case you have an infection Okay, so that's an abortion and what leads up to it and I guess some intel on how you can weigh up your options and what actually works best for you I will say that neither of them are better than the other the trade-off is largely your control and privacy So a medical one is at home, and it's a deeply personal experience that you have hopefully with a loved one or maybe if you're choosing to be alone
[SPEAKER_00]: procedural is speed and lower measured blood loss, okay?
[SPEAKER_00]: So you're going to have to weigh that up, neither is objectively that up.
[SPEAKER_00]: But we will be better for you personally based on your personal needs and once around your termination, okay?
[SPEAKER_00]: So next let's talk about early pregnancy physiology and what's actually happening.
[SPEAKER_00]: And I think this is really important for you to learn about so you know how to heal after a termination because very often a health provider is like here's
[SPEAKER_00]: And I guess a lot of women in this period of time are like, okay, this procedure has happened.
[SPEAKER_00]: How do I do some aftercare and there's no dialogue there.
[SPEAKER_00]: So let's learn about what's happening in early pregnancies.
[SPEAKER_00]: So we can prepare for how we can understand post care for your termination and how you can rebalance the best afterwards.
[SPEAKER_00]: Okay.
[SPEAKER_00]: So you had sex implantation has occurred when implantation.
[SPEAKER_00]: happens.
[SPEAKER_00]: So that's basically the fertilized egg with a new dataset, I guess.
[SPEAKER_00]: So the fertilized egg borrows itself into an implants into the endometrium.
[SPEAKER_00]: As soon as it does that, HCG is a hormone and that rises incredibly fast.
[SPEAKER_00]: So that roughly doubles every two days in early pregnancy and it peaks around 8 to 11 weeks.
[SPEAKER_00]: And so the job of that is to tell the corpus sodium to say, hey, can you please secrete heaps and heaps of progesterone, pro-pregnancy hormone until I have a placenta that can make its own at 10 weeks.
[SPEAKER_00]: So your corpus sodium is there for about, you know, 10 weeks.
[SPEAKER_00]: I would say to 12 weeks to produce progesterone and once that placenta starts to produce her, it will basically say, hey, I'm producing my own progesterone and then the corpus sodium will start to disintegrate.
[SPEAKER_00]: Progesterone is relatively stable before nine weeks, and then it rises as the placenta assumes production after 10 to 12 weeks.
[SPEAKER_00]: So it maintains the endometrium, it suppresses myometrial contraction, and it also supports maternal fetal immune tolerance as well.
[SPEAKER_00]: So I wouldn't say a down regulator, but it really calms the immune system down to stop the immune system from seeing the fetus almost as a threat and attacking it.
[SPEAKER_00]: What's happening with estrogen?
[SPEAKER_00]: So estradiol rises pretty progressively and it drives you to own growth and blood flow changes.
[SPEAKER_00]: We also see plasma volume changing, so your blood plasma changing at six to eight weeks, and it climbs really steeply through the second trimester, ultimately, 50 above baseline.
[SPEAKER_00]: So that's a huge change we're seeing in your circulation.
[SPEAKER_00]: Your red cell mass rises, so your red blood cells, they increase in size by about 25.
[SPEAKER_00]: And the fluid compartment
[SPEAKER_00]: And so you're probably imagining, okay, this is going to take a lot of iron, and yes, it does.
[SPEAKER_00]: And this produces that psychological and neemia of pregnancy.
[SPEAKER_00]: So we're seeing the hemodilution of your red blood cells, not a true iron loss on its own.
[SPEAKER_00]: But we are seeing an anemia diagnostic cutoff shift at about 11 grams per disc later.
[SPEAKER_00]: And that's used in that first trimester threshold.
[SPEAKER_00]: It's lower than standard non pregnant cutoff.
[SPEAKER_00]: So there is a change in how we defined anemia in pregnancy.
[SPEAKER_00]: because of this circulation change.
[SPEAKER_00]: So that's going to take a lot of copper.
[SPEAKER_00]: It's going to take a lot of iron.
[SPEAKER_00]: It's going to take a lot of magnesium and vitamin D. And all of these other b vitamins, to support the blood system.
[SPEAKER_00]: In the fetus, the first thing that really forms is the blood system.
[SPEAKER_00]: So.
[SPEAKER_00]: that's why on top of the blood loss after a termination, we're generally seeing all of these minerals and vitamins are a little bit depleted and that's why you feel a little bit low after a termination.
[SPEAKER_00]: I think psychologically it has an impact but also from a mineral balance.
[SPEAKER_00]: That's what's happening in early pregnancy and so that's how it impacts you.
[SPEAKER_00]: Okay, so let's get into why I and B12 and folate actually deplete.
[SPEAKER_00]: So the daily requirement of this growing fetus is 0.8 milligrams a day in the first trimester, lower, because menstruation has stopped and we have iron stores to work from in the body to about 7.5 milligrams a day in the third trimester.
[SPEAKER_00]: And so we're seeing it gradually, the iron requirements increase increase increase increase increase increase.
[SPEAKER_00]: Okay?
[SPEAKER_00]: This exceeds what diet alone can typically supply.
[SPEAKER_00]: So the gap is then filled by drawing down on maternal ion stores, your ion stores, your circulation.
[SPEAKER_00]: So this is why saron ferritin generally will fall progressively across the pregnancy and we generally see it lowest in the third trimester, from both hemodiolution and mobilization stores of
[SPEAKER_00]: So the first trimester HB Infererton predicts later anemia risks as well.
[SPEAKER_00]: We also see Seren B12's falls across the pregnancy due to hemodilusion, decreased binding of protein, and increased renal excretion.
[SPEAKER_00]: So higher geofar.
[SPEAKER_00]: and direct fetal transfer.
[SPEAKER_00]: There's a few different reasons why we're seeing a serum B12 is decreasing across a pregnancy.
[SPEAKER_00]: So for example, in one cohort of pregnant women, they took their total B12 in the first trimester and it was about an average of 297 so about 300 let's say.
[SPEAKER_00]: And in the second trimester so 14 weeks later, it was 237 females per leader.
[SPEAKER_00]: Okay, so that's a pretty significant drop that we're seeing here.
[SPEAKER_00]: When we're testing B12, testing active B12 is a lot more of a stable marker than total B12 for assessing your status.
[SPEAKER_00]: That's something to keep in mind if you're wanting to test your B12 after a termination, okay?
[SPEAKER_00]: Your requirements of B12 rise sharply for neural tube formation and increase red cell production of the fetus and also in your body to support the pregnancy.
[SPEAKER_00]: Okay, so if you're not increasing your B12 during the pregnancy, then it's going to take from your stores.
[SPEAKER_00]: All right, and so that's also why we see Seren vollez will also fall with hemodilution and placebo transfer.
[SPEAKER_00]: So, vollez B12 and I and they're all going to deploy.
[SPEAKER_00]: if you don't supplement them in during a pregnancy because it takes so much of this mineral and all of these bite-be vitamins to support the circulation and to create a new circulatory system in the fetus.
[SPEAKER_00]: Follet deficiency is a lot more common than B12 deficiency in pregnancy because Follet stores a smaller and the turnover of folate to support your neural tube in the fetus.
[SPEAKER_00]: We need a lot more folate and we don't tend to store as much folate as we do B12 in a woman.
[SPEAKER_00]: So, nausea and vomiting of early pregnancy reduce the intake and absorption of these nutrients as well.
[SPEAKER_00]: So it compounds all of the above depletion mechanisms.
[SPEAKER_00]: You don't want to eat a steak when you're vomiting up everything you eat.
[SPEAKER_00]: And if you're smelling someone's perfume and you're vomiting, like of course, you're not going to want to eat foods that are high in B vitamins and INRU.
[SPEAKER_00]: In a Turkish study, they looked in first trimester women at about nine weeks.
[SPEAKER_00]: That was kind of the average 40% of them, 40.3 exactly.
[SPEAKER_00]: had depleted ion stores.
[SPEAKER_00]: 4.5 had an ion deficiency enemia and they also had B12 and folate deficiencies as well.
[SPEAKER_00]: Okay, so your trimester comparison studies here as well.
[SPEAKER_00]: We see progressive declines in HB, ion, ferrison, B12.
[SPEAKER_00]: and folate.
[SPEAKER_00]: We also see vitamin D deficiency is pretty common in early impregnancy, 82.8% below efficiency in one Indonesian first trimester cohort.
[SPEAKER_00]: And then we're seeing 10% in a Swedish cohort.
[SPEAKER_00]: And we could also put that down to diet as well.
[SPEAKER_00]: I think the Swedish diet is a lot higher in vitamin D sources than a typical Indonesian intake as well.
[SPEAKER_00]: Zinc.
[SPEAKER_00]: Requirement, it will rise again.
[SPEAKER_00]: Zinc increases from your need of 8 milligrams a day to 11 to 12 milligrams a day and Serum zinc declines progressively through the pregnancy as well.
[SPEAKER_00]: Magnesium also tends to fall from the second trimester onwards to and that's because we need a lot of magnesium to support the uterus.
[SPEAKER_00]: Okay
[SPEAKER_00]: So that's a lot of vitamins and minerals that we're generally seeing depleting quite significantly in that first 14 weeks.
[SPEAKER_00]: Okay?
[SPEAKER_00]: So if you are wanting to have a termination and you think it doesn't make any sense to supplement in these things to support a fetus, it's actually going to make your life easier after a termination if you supplement these things in.
[SPEAKER_00]: Specifically, IN
[SPEAKER_00]: zinc or even eating foods that are really high in these nutrients if you can tolerate it.
[SPEAKER_00]: If you have nausea and vomiting and you are like, I am wanting to have a termination.
[SPEAKER_00]: I don't want this pregnancy, but I can't eat foods that are high in these nutrients.
[SPEAKER_00]: Talk to a health provider and make sure you're supplementing them in because it could be a sign also that you're low in these nutrients as well.
[SPEAKER_00]: I know it sounds really counterintuitive to support a pregnancy that you are planning to terminate, but if you can just think about it as like this fetus is
[SPEAKER_00]: from me.
[SPEAKER_00]: So this is actually going to make my life post-termination a lot easier if I supplement and focus on foods that are rich in these nutrients and it also make your life in those days leading up to the termination easier because you actually feel a lot better as well.
[SPEAKER_00]: Okay, so you've had your termination.
[SPEAKER_00]: how do we hormonally grab every balance afterwards?
[SPEAKER_00]: So what's actually happening in this transition from pregnancy to not pregnant?
[SPEAKER_00]: Okay, so your initial half life of H C G is 0.63 days over the first two days and 3.85 days.
[SPEAKER_00]: So
[SPEAKER_00]: We're seeing basically that HCG is falling significantly so it falls by 80% within the first seven days after complete abortion and it helps to exclude a topic and ongoing pregnancy as well.
[SPEAKER_00]: So complete disappearance of HCG averages about 35 days after first trimester abortion.
[SPEAKER_00]: So it takes about 30 days for HCG to fully leave your body.
[SPEAKER_00]: That is the hormone that you use and you can pick up in a urine pregnancy test, for example.
[SPEAKER_00]: I think a lot of women after a medical abortion, for example, or even a surgical abortion, they will do a pregnancy test in their a bit scared, that two weeks after their abortion, they're still getting a positive test.
[SPEAKER_00]: I just want to give you a bit of reassurance.
[SPEAKER_00]: Your urine test is typically negative within four to six weeks.
[SPEAKER_00]: A positive test at four weeks suggests a retained tissue or ongoing pregnancy.
[SPEAKER_00]: So it's really important to flag this to your provider.
[SPEAKER_00]: So if you get to four weeks and you do a urine test and it's coming up with positive, you might still be pregnant or you have to hate CG, that is not having an easy time leaving the body, so it might be residual in tissue, so you might still have maybe some placental tissue, you might not have a pregnancy, you might still have some placenta there.
[SPEAKER_00]: So that's more common with your medical abortion, then it is your surgical, although it can happen with your surgical abortion as well.
[SPEAKER_00]: So this is good thing to keep in mind a month after you have your termination, do a year-end test if it's coming up positive, you need to reach out to your provider but also keep in mind that it can still be positive at six weeks and even if you don't have any placental tissue, even if you don't have an ongoing pregnancy.
[SPEAKER_00]: So that's HCG.
[SPEAKER_00]: What about progesterine and estridile?
[SPEAKER_00]: So progesterine and estridile, they fall really rapidly, reaching low values two days post abortion.
[SPEAKER_00]: So progesterine can drop 50% within hours of a medical abortion, so you're pill.
[SPEAKER_00]: And estridile can rise again from day seven as a new follicle develops.
[SPEAKER_00]: So, you can start cycling soon after, but your progesterone is going to be very, very, very low, which is why you are going to feel maybe a little bit more anxious.
[SPEAKER_00]: You might have trouble sleeping and your mood might flip around quite a lot.
[SPEAKER_00]: Your progesterone function, so that rising of FSH will recover within four to nine days, post abortion.
[SPEAKER_00]: So your body immediately, a few days after, even though HTCG might be elevated and might still be present in your body and it takes a while to come down, your body is pretty amazing and will start cycling attempting to cycle fairly soon.
[SPEAKER_00]: So your first mid-cycle LHPG might be 16 days post-abortion and generally what we see.
[SPEAKER_00]: So about two weeks after, you've had your termination, you might see signs of ovulation.
[SPEAKER_00]: So I think a lot of women after their termination think,
[SPEAKER_00]: Because HCG is still high and my progesterone is so low and I've just had this termination I can't for pregnant.
[SPEAKER_00]: No honey, it is still possible to for pregnant within two to three weeks after you have termination.
[SPEAKER_00]: So please making sure you're using barrier methods or you are making sure you are using some contraceptive method, fertility when a method after termination is not appropriate at all.
[SPEAKER_00]: I don't support that whatsoever.
[SPEAKER_00]: You need to wait about three cycles after termination
[SPEAKER_00]: a really clear cycle and a pattern that you can kind of look at.
[SPEAKER_00]: El Hage might be a good biomarker that you can use, but because you might still have some bleeding, but because your cervical mucus might not be very clear.
[SPEAKER_00]: and HCG can change some temperature.
[SPEAKER_00]: What can happen basically is you can't really trust your bi-markers in this period of time.
[SPEAKER_00]: So please don't use fertility awareness method.
[SPEAKER_00]: You will be ovulating fairly soon.
[SPEAKER_00]: So about two to three weeks after your termination.
[SPEAKER_00]: Some studies will also show ovulation returns on average three weeks after a medical abortion.
[SPEAKER_00]: So 20 days.
[SPEAKER_00]: So
[SPEAKER_00]: 8 to 36 days is kind of what they saw in that study.
[SPEAKER_00]: With a myth of pristone has no lasting effect on a variant function as well.
[SPEAKER_00]: So that's another thing I think I need to say is that there's a lot of misinformation around medical abortions specifically causing infertility.
[SPEAKER_00]: That's just not true.
[SPEAKER_00]: Myth of pristone has no association with a variant function whatsoever.
[SPEAKER_00]: We've known that since 2011.
[SPEAKER_00]: 83% of women ovulated in their first cycle, post abortion, summers early as day 21.
[SPEAKER_00]: Again,
[SPEAKER_00]: So just pushing that forward, please use contraceptive methods.
[SPEAKER_00]: If you're not wanting to for pregnant, you've just had a termination, so make sure you're protecting yourself from that occurring again.
[SPEAKER_00]: Okay, so what about menstruation?
[SPEAKER_00]: So menstruation can occur within four weeks to eight weeks.
[SPEAKER_00]: So I think it's normal between any of those if you're waiting
[SPEAKER_00]: more than two months for your period to return.
[SPEAKER_00]: Again, that's something that you need to talk to your health provider about.
[SPEAKER_00]: If that was normal for you previously, say if you have a P-MOS, that could mean nothing for you, but again, you still need to present to your health care provider if you haven't had densities in eight weeks post termination.
[SPEAKER_00]: So what's happening post-termination and related to your termination and kind of your hormones basically?
[SPEAKER_00]: So most of the direct post-termination endocrine mood studies are very limited.
[SPEAKER_00]: So we're going to be working from the closest evidence that we can relate on mechanistically, which is your post-partum literature.
[SPEAKER_00]: And we're going to extrapolate that pretty cautiously.
[SPEAKER_00]: So we're going to be using the methodology and the understanding of what happens post-partum
[SPEAKER_00]: and give birth to it physiologically otherwise.
[SPEAKER_00]: So a abrupt Estrodial and progesterone withdrawal, recalibration of a pregnancy hyperactive HPA access.
[SPEAKER_00]: So the placenta will have a withdrawal and we'll also see transient law cortisol and that's associated with mood vulnerability in susceptible women.
[SPEAKER_00]: So what does that mean in language that I understand?
[SPEAKER_00]: What am I going to feel?
[SPEAKER_00]: Your moods are going to flip around a lot.
[SPEAKER_00]: You're going to be very teary, very easily, and very sensitive.
[SPEAKER_00]: You know, your partner could say something they usually say to you and it upsets you beyond what it usually would.
[SPEAKER_00]: I think you'd be really sensitive to most of the senses, so things like bright lights, that noises.
[SPEAKER_00]: You are just going to want to basically be in your own little woman cave and quite sheltered from the world in a way because you're going to be very, very sensitive.
[SPEAKER_00]: Two days onwards post termination.
[SPEAKER_00]: What I will say though, it's hard for us to look at post-partum studies and extrapolate it to post termination because the magnitude of the hormonal exposure and withdrawal in early termination to pregnancy.
[SPEAKER_00]: You just can't even really compare them really because the amount of progesterone estrodio hcg around at 16 weeks versus 40 weeks, it's really hard to compare.
[SPEAKER_00]: So it's almost like you're going through a mini birth without the oxytocin around that cushions you from that in a way.
[SPEAKER_00]: If you can understand it, something that you also might need to keep in mind as well.
[SPEAKER_00]: If you have thorough dysfunction before during
[SPEAKER_00]: your pregnancy that you terminated.
[SPEAKER_00]: And we do see postpartum, a thyroid dysfunction.
[SPEAKER_00]: So that can include postpartum thyroiditis.
[SPEAKER_00]: So that it affects up to 17% of women and it's associated with mood symptoms and TPO antibody positivity is a risk marker.
[SPEAKER_00]: So if you had high TPO anti-TPO before and during your pregnancy, that's something you definitely want to keep an eye on after your termination because we can see those antibodies increase.
[SPEAKER_00]: And so if you're noticing mood symptoms, if you're noticing you're exhausted, if you're noticing that you're not really metabolizing food probably maybe your pants and feet are really cold, you don't have any energy, maybe your hair is feeling quite thin or maybe you're losing hair.
[SPEAKER_00]: You know all of the symptoms, if you have Hashimoto's or if you've just had a thyroid condition for a while, maybe keep an eye on antitepio post termination, maybe check it about three to four weeks after, just to make sure it hasn't increased because we do see that in women post-partum.
[SPEAKER_00]: Okay, so let's talk about the first mineral we're going to replete, which is IAN.
[SPEAKER_00]: I have a whole podcast on IAN, have a lot of resources on IAN if that's something you want to look in.
[SPEAKER_00]: For most healthy women, the procedure itself carries really modest blood loss, but the actual process of pregnancy is kind of where we're going to be losing most of the blood.
[SPEAKER_00]: So the biggest driver of iron deficiencies in women post-termination is a pre-existing depletion from the pregnancy itself.
[SPEAKER_00]: So you already had really low iron and then the pregnancy has taken away a lot of iron as well.
[SPEAKER_00]: Okay, so Ferretin at lower than 30 micrograms a leader, that's kind of the practical diagnostic threshold for an eye-end efficiency.
[SPEAKER_00]: That's from Power Void at AL in 2020.
[SPEAKER_00]: The World Health Organization uses something far lower for depleted stores of Ferretin, which is 15.
[SPEAKER_00]: I'm not sure if I agree with that.
[SPEAKER_00]: I really, really don't.
[SPEAKER_00]: If I saw someone with the Ferretin of 15, I'd be very, very, very concerned.
[SPEAKER_00]: I think we
[SPEAKER_00]: Generally women should be aiming for about 50 nanograms per milliliter of ferretin.
[SPEAKER_00]: Yeah, so that's kind of where we want to see 40 to a say 90 to 100 is kind of what we like to see lab They're like 30 to 200.
[SPEAKER_00]: I think that's in at least Australia.
[SPEAKER_00]: I think that's quite wide metric I think if we just sink in a little bit in the middle we see better outcomes here
[SPEAKER_00]: Another blood marker you want to be looking at is transferrin and transferrin saturation.
[SPEAKER_00]: So transferrin also known as total iron binding capacity TIPC.
[SPEAKER_00]: So that's the blood plasma protein that binds to iron and helps it transport us through our body.
[SPEAKER_00]: So transfer and also plays a role in iron metabolism here as well.
[SPEAKER_00]: So we want to be looking at transfer and itself how much of this protein do we have and how saturated with iron is it.
[SPEAKER_00]: So you can look at iron transfer and saturation.
[SPEAKER_00]: So there's a two things you want to be looking at for transfer and transfer and saturation.
[SPEAKER_00]: So when we look at lab studies, transfer and saturation, they like to say about 13 to 47.
[SPEAKER_00]: I think 20 is pretty good.
[SPEAKER_00]: 20 is kind of what snuck at al in 2021 and bcg found as well.
[SPEAKER_00]: That's good especially when ferretin might be falsely elevated by inflammation.
[SPEAKER_00]: So ferretin can go up pretty significantly and can increase when we're inflamed.
[SPEAKER_00]: So it's really good to look at transfer and transfer in saturation and they're suggesting 20% and I would agree with that too I think that's a pretty good marker.
[SPEAKER_00]: Okay, so what about Sarah myon so Sarah myon major component of hemoglobin really important for Ion really important for transporting oxygen around the body so normal lab ranges are about
[SPEAKER_00]: five to I would say 20 to 30 emails per liter.
[SPEAKER_00]: I think that's okay.
[SPEAKER_00]: But if you can kind of go in the middle of that range, 12 to 22, 12 to 25, I think that's pretty good.
[SPEAKER_00]: So if you go into your labs and they come back a little bit low, what can you do?
[SPEAKER_00]: So the World Health Organization suggests that 30 micrograms, 30 milligrams I think it is for about three months of elemental iron.
[SPEAKER_00]: And that's fine.
[SPEAKER_00]: You might also have some gut problems with that as well.
[SPEAKER_00]: So you can also try something else called iron by glycinate and you can take 25 to 35 milligrams a day.
[SPEAKER_00]: And that's going to reduce the GI side effects.
[SPEAKER_00]: and that's also going to improve your your absorption.
[SPEAKER_00]: So if you want to improve your absorption as well, vitamin C, to boost your absorption and avoiding T and coffee at the same setting.
[SPEAKER_00]: I think there's a lot of information online, a lot of content online at the moment about iron supplementation and how tricky she is.
[SPEAKER_00]: It's not really that tricky.
[SPEAKER_00]: Just take it with dinner and maybe have a cup of orange juice with it.
[SPEAKER_00]: With your iron as well, you want to be taking iron every second day.
[SPEAKER_00]: Iron increases something called hipsidin and hipsidin negatively impacts how we absorb iron.
[SPEAKER_00]: So studies actually show that taking iron every second day is a lot more effective than taking it every day because of hipsidin.
[SPEAKER_00]: So taking it every second day at dinner with orange juice super easy because no one's having a cup of coffee at dinner.
[SPEAKER_00]: or at least I hope you're not.
[SPEAKER_00]: So if you had low eye and before during and after your pregnancy, you want to continue supplementing for about three months after your termination with your full-faritan replacement, you know, that can take four to six months.
[SPEAKER_00]: It's a really slow rebuild.
[SPEAKER_00]: So your ferretin is the first to go down because it's storage and it's the last to come up.
[SPEAKER_00]: So when your ferret is come back to a normal level and healthy holistic level, that's when you know you've reached your target and you can stop or decrease your supplementation, you can just focus on high iron foods, okay?
[SPEAKER_00]: What about B12, folate, vitamin D and the rest?
[SPEAKER_00]: So routine replacement isn't universally indicated post-termination.
[SPEAKER_00]: So you have to check and treat it yourself with your healthcare provider.
[SPEAKER_00]: This is something that you need to ask about.
[SPEAKER_00]: and you need to go and get the labs for again.
[SPEAKER_00]: No one post-terminations going come in and let's do a full blood count, let's look at your B12, your full late vitamin D. That doesn't happen so you need to make sure you're doing it on your own alongside iron.
[SPEAKER_00]: If you had low full late in your post-termination labs, you can take about 400 micrograms a day that's your standard.
[SPEAKER_00]: if further pregnancy is impossible.
[SPEAKER_00]: So in your R2 protection begins at pre-conception and then your higher doses around five milligrams a day used to can treat confirmed deficiency.
[SPEAKER_00]: So if you have low folate taking around those doses can help be 12 as well.
[SPEAKER_00]: Your oral 1,000 micrograms a day works for best for male absorption as well.
[SPEAKER_00]: Also with your B vitamins, if you have MTHFR, which is basically,
[SPEAKER_00]: In your liver, you're going to get really nerdy here.
[SPEAKER_00]: In your liver, your body will take your B vitamins, and it'll add a methyl group to it.
[SPEAKER_00]: So it's more easily used in the body.
[SPEAKER_00]: Okay, that's its user-friendly mode.
[SPEAKER_00]: If we don't have a methyl group added to your B vitamins, we can't really use them very well.
[SPEAKER_00]: Some women have an MTHF gene mutation where we can't do this.
[SPEAKER_00]: It's really interesting.
[SPEAKER_00]: I think I have it in my family.
[SPEAKER_00]: I'm going to be doing the test for it.
[SPEAKER_00]: It's a simple blood test that you can do.
[SPEAKER_00]: That doesn't cost a lot of money, and they're pretty sure, and Australia,
[SPEAKER_00]: your standard blood test, don't think it's very complicated.
[SPEAKER_00]: If you have that, you need to take a methylated B vitamin.
[SPEAKER_00]: So these are B vitamins that already have a methyl group attached to them.
[SPEAKER_00]: So you can actually use those B vitamins in the body.
[SPEAKER_00]: Of course, before we're doing any vitamin intake and supplementation, we're going to be testing.
[SPEAKER_00]: If we're not testing, we're guessing so.
[SPEAKER_00]: Hopefully, we're going to be looking at our B12 and full late levels, and remember, with your B12, you're looking at active B12, because that's kind of more of a functional look at how B12 was working in the body.
[SPEAKER_00]: If you just look at B12, and you have MTHFR, G mutations, OK, yeah, B12 is there, but what's its active form?
[SPEAKER_00]: Is it methylated?
[SPEAKER_00]: If you have a lot of B12 there, but none of it is methylated, OK?
[SPEAKER_00]: Well, it's not being used in the body at all, really, is it?
[SPEAKER_00]: so we need to add in a methylated before late there.
[SPEAKER_00]: Again, so a deficiency in B12 and folate is fairly common in early pregnancy.
[SPEAKER_00]: So you need to check and replace two deficiency.
[SPEAKER_00]: And the reason why is because it supports bone immune and immune function, it's really important for sleep as well.
[SPEAKER_00]: I think a lot of women, after your medical or your surgical abortions and terminations, they have trouble sleeping and that might be because of look B12,
[SPEAKER_00]: and be six because we need them to make serotonin and then turn serotonin into melatonin.
[SPEAKER_00]: So if you're taking a long time to fall asleep, it's not always cortisol.
[SPEAKER_00]: It could be a be vitamin deficiency which is fairly common in early pregnancy.
[SPEAKER_00]: Another one which might be good is zinc because in early pregnancy it increases to about 11 to 12 micrograms.
[SPEAKER_00]: Zinc might also be a good one to work in as well, not necessarily to supplement unless you're testing, but if you have a few oysters, maybe if you have some beef liver, chop up some beef liver in your spaghetti bolognese, maybe you're eating more nuts and seeds.
[SPEAKER_00]: These things can be really great to kind of just replete all of you by vitamins, maybe some vitamin D, so cod liver oil can be really great.
[SPEAKER_00]: Egg yolks getting out in the sun a little bit more taking vitamin D supplement can be great as well.
[SPEAKER_00]: if you're noticing that you're not feeling very energized.
[SPEAKER_00]: So these are the things that you can work in with nutrition and also with supplementation after you've tested.
[SPEAKER_00]: So zinc, B12, folate, vitamin D, magnesium can also be really beautiful.
[SPEAKER_00]: Just as a nervous system calmer, I love magnesium glycine to hold the whole podcast on magnesium glycine that you can go and listen to about 200 to 400 milligrams a day.
[SPEAKER_00]: is your normal supplemental dose that I think is really beautiful.
[SPEAKER_00]: You don't have to take it at night.
[SPEAKER_00]: You can just take it in the morning and that can be really, really great.
[SPEAKER_00]: Just to rebalance and calm down your body after a termination because it is kind of a stressful thing for your body to go through in a way.
[SPEAKER_00]: Okay, so what is some practical recovery care and some red flags after you have a termination?
[SPEAKER_00]: So
[SPEAKER_00]: If you had a medical termination, you're heaviest bleeding and cramping within hours of misoprostal and then your bleeding and spotting will average 9 to 16 days.
[SPEAKER_00]: Remember, if you're spotting, you can still be obelating, okay?
[SPEAKER_00]: And that's why we don't use fertility awareness method.
[SPEAKER_00]: So normal activity is often within one to two days after your medical abortion and your period can return within four to eight weeks.
[SPEAKER_00]: If it hasn't, you need to contact your health care provider.
[SPEAKER_00]: With your surgical abortion, you have a very, very light bleeding, typically up to two weeks.
[SPEAKER_00]: Very often it's only a few days.
[SPEAKER_00]: If you have any cramping, it usually will settle within a few days.
[SPEAKER_00]: Cramping is also something that magnesium is really beautiful with, and it can reduce your cramping, also things like omega-3s and fish can be really great.
[SPEAKER_00]: But generally, your surgical abortion, you have a faster physical resolution overall in comparison to your medical abortion.
[SPEAKER_00]: hemorrhage.
[SPEAKER_00]: So that is soaking two maxi pads in an hour.
[SPEAKER_00]: If you're bleeding consecutively for a few hours, if you're passing large clots, larger than a 50 cent piece, that is hemorrhaging.
[SPEAKER_00]: And then you need to seek urgent medical care.
[SPEAKER_00]: If you're experiencing that a few days after a medical abortion or any time after a surgical, we need to seek urgent medical care because that's not normal, okay?
[SPEAKER_00]: please seek out care.
[SPEAKER_00]: Another thing that you might notice is persistent or heavy bleeding, cramping fever for a few days to a week after.
[SPEAKER_00]: It's quite rare.
[SPEAKER_00]: You usually only see that in up to 5% of terminations regardless of the type.
[SPEAKER_00]: And what usually happens if you have any hemorrhaging or any of these symptoms that are just spoken about, they'll usually give you a trans-veginal ultrasound.
[SPEAKER_00]: And if there still is some fetus there or a part of the placenta there, they might offer you a second vacuum aspiration, or they might also just offer you some mightoprostal as well, just to help your body release that last part of the placenta or the fetus.
[SPEAKER_00]: Let's get into the emotional evidence and let's retire the trauma narrative as someone who has had an abortion.
[SPEAKER_00]: I was not traumatized in the least.
[SPEAKER_00]: I think it's one of the best things I've ever done.
[SPEAKER_00]: Was it very psychologically hard for me the few days after?
[SPEAKER_00]: Yeah, personally it was, but I've met women where it wasn't hard for the middle.
[SPEAKER_00]: So let's retire this trauma narrative, okay?
[SPEAKER_00]: So, a study led by Diana Green Foster, she looked at 1,000 women recruited from 30 U.S. facilities across 21 states and they followed them for five years.
[SPEAKER_00]: And so, they looked at an analysis of emotion and decision-rightness.
[SPEAKER_00]: So, 667 women who obtain abortions surveyed 11 times over five years.
[SPEAKER_00]: So, relief was the most commonly reported emotion.
[SPEAKER_00]: at every single time point.
[SPEAKER_00]: Right after their abortion, two weeks after, five weeks after, five years after, they were relieved by their choice to have an abortion.
[SPEAKER_00]: So no evidence that abortion causes negative mental health or well-being outcomes was also followed up in a different study, so Rooka at AL in 2020 in society of Sey Med, so
[SPEAKER_00]: We're not seeing any regret.
[SPEAKER_00]: We're not seeing any negative mental health or well-being outcomes predominantly in these studies.
[SPEAKER_00]: And the predicted probability of feeling abortion was the right decision is 97.5% at one week.
[SPEAKER_00]: a 99 at five years.
[SPEAKER_00]: So women said that it was the good thing for them to do and it was the right decision for them to do a week after their abortion 97.5% of them said that and five years later 99%.
[SPEAKER_00]: So all emotions positive and negative declined in intensity over time and it became a lot more neutral of a decision.
[SPEAKER_00]: So in comparison being denied a wanted abortion is associated with worse
[SPEAKER_00]: and worse financial and physical health outcomes, and we know that from Biggs and Norhus and Foster in 2015.
[SPEAKER_00]: Pre-existing mental health conditions, not the abortion itself, predict later symptoms, so it has really nothing to do with the abortion, it's where the woman was at before and during and after, really, that impacted her experience of that abortion.
[SPEAKER_00]: So actively retiring that discredited abortion trauma syndrome narrative was done in Robinson at Al in 2009, but the name it explicitly given and how much unsupported context exists on this exact topic.
[SPEAKER_00]: So basically what I'm trying to say is this kind of a narrative that we have of abortion trauma syndrome if that is true.
[SPEAKER_00]: I'm not going to say it doesn't happen.
[SPEAKER_00]: I think some women have very complex reactions and responses to this.
[SPEAKER_00]: Maybe there are women out there who feel intense regret, but it is not the predominant theme.
[SPEAKER_00]: The predominant theme that we see in women is that they do not regret it.
[SPEAKER_00]: They feel it was the right choice.
[SPEAKER_00]: they see that they're positive and negative associations and feelings around the termination and the choice of the abortion when neutralised within five years.
[SPEAKER_00]: I am going to say though, I'm going to acknowledge that there is a normal range of emotion here.
[SPEAKER_00]: Some women do grieve, that's totally real, that's totally valid.
[SPEAKER_00]: I'm just saying that statistically, it's rare.
[SPEAKER_00]: and it really runs in the face of what we see online that women should grieve and you should feel this way and you should feel sorry and you should regret it.
[SPEAKER_00]: I don't feel any of those things towards my abortion.
[SPEAKER_00]: I think women feel a little bit of shame for not feeling that because we tie so much worth to women to motherhood.
[SPEAKER_00]: If you don't want to be a mother, you are not worth less.
[SPEAKER_00]: You are worth the same amount as someone who does want to be a mother and did choose to have a child and I think we really need to drop the narrative.
[SPEAKER_00]: that women should feel ashamed and that should be very quiet and you shouldn't really talk about it and you should feel a certain way after an abortion.
[SPEAKER_00]: We don't see that backed up by the literature and how we followed up women who chose to have and array of different abortions over time.
[SPEAKER_00]: That being said again, if you feel any negative emotions that are negatively impacting your day-to-day life, please seek out clinical help.
[SPEAKER_00]: Talk to a psychiatrist, talk to a psychotherapist.
[SPEAKER_00]: These people are amazing at their jobs and they can really help you process whatever feelings you're feeling in the moment so you can go forth with your life and live it how you want to live it.
[SPEAKER_00]: Okay, if you don't feel relief, that is okay and that is a part of the process.
[SPEAKER_00]: I think personally speaking, I know a lot of women right after their abortions felt this huge wave of grief and regret.
[SPEAKER_00]: And then a few weeks later they said, I'm actually fine now.
[SPEAKER_00]: I just needed to feel all of those feelings.
[SPEAKER_00]: Feelings are just feelings and they're designed to be felt.
[SPEAKER_00]: Feel the feeling and then just see what happens on the other side of it.
[SPEAKER_00]: And a psychologist and a psychotherapist can help you with that process.
[SPEAKER_00]: And finishing up, let's talk about some herbs that you can work in, kind of lift and balance your moods throughout the following weeks after your termination.
[SPEAKER_00]: So the first one is Safron.
[SPEAKER_00]: This is the best evidence of the bunch that I'll be presenting.
[SPEAKER_00]: So randomized control data, specifically in postpartum depression, a 30 milligrams a day, compared head to head with fluorxycane.
[SPEAKER_00]: So that's kind of an antidepressant.
[SPEAKER_00]: And a separate trial following reduced depression severity of eight weeks.
[SPEAKER_00]: the p-value for this is 0.001.
[SPEAKER_00]: That basically means it's very effective, right?
[SPEAKER_00]: More zeros you see before the numerical figure in a p-value is good.
[SPEAKER_00]: So we see that saffron is very, very effective at decreasing low mood and depression post-partum.
[SPEAKER_00]: So we can relay that to post-termination as well.
[SPEAKER_00]: So how does it work?
[SPEAKER_00]: So it modulates serotonin dopamine
[SPEAKER_00]: in that HPA access.
[SPEAKER_00]: So you're high-poured, salamic, pituitary, adrenal access and upregulates BDNF and it also reduces neuro inflammation.
[SPEAKER_00]: So again, that typical dose in those trials is 30 milligrams a day in your capsule or your teeth.
[SPEAKER_00]: So the interesting thing about this though is that it can increase menstrual bleeding and uterine stimulant effect at higher doses.
[SPEAKER_00]: So that's really worth flagging.
[SPEAKER_00]: If you're a woman prior to your termination who had low iron and you're hemorrhaging and you're bleeding, saffron is really not a good idea.
[SPEAKER_00]: If you had a surgical termination, your iron was fine previously and you get the go-ahead from your health provider to take saffron.
[SPEAKER_00]: Please go ahead saffron can be really great at stabilizing and lifting your moods post termination.
[SPEAKER_00]: The other one is Ashwaganda, so it's reasonable with its adaptogen evidence.
[SPEAKER_00]: It's thinner in this specific population.
[SPEAKER_00]: So if you're wanting to take Ashwaganda, please talk to your health provider.
[SPEAKER_00]: But let's just talk about the trial evidence and how it could apply to you if you have had a termination.
[SPEAKER_00]: So the trial evidence is mostly in general and anxiety stress populations, not post termination or postpartum specifically.
[SPEAKER_00]: the postpartum extrapolation here is really preliminary.
[SPEAKER_00]: So we have some research but not that much.
[SPEAKER_00]: The research we do have in postpartum is combined with saffron, trip to fan, El trip to fan is a precursor to serotonin.
[SPEAKER_00]: That's the amino acid that gets made into serotonin.
[SPEAKER_00]: V6 as well in one 12 week randomized control trial study that went ran for about 12 weeks for mild to moderate anxiety So if you post parlor experiencing heightened emotions and your mood is swinging around a little bit and your short of breath And you can't focus and you're having rushing thoughts and things like this Ashbaganda can really help
[SPEAKER_00]: in combination with CryptoFan and B6.
[SPEAKER_00]: Specifically, caution though, it can affect thyroid hormone levels.
[SPEAKER_00]: So if you are a woman who already had Hashimoto's or you had high anti-TPO, then Ashwaganda might not be the good one for you.
[SPEAKER_00]: And it also isn't well studied for bleeding and clotting interactions as well.
[SPEAKER_00]: So check with your provider first is really important, but Ashwaganda could be a good mood stabilizer here.
[SPEAKER_00]: If your mood is really lifted,
[SPEAKER_00]: It's an anxious lift and if you want to bring it down and regulate it, Ashwaganda could be a really good contender.
[SPEAKER_00]: I also have a huge podcast on Ashwaganda as well.
[SPEAKER_00]: Lemon balm and chamomile.
[SPEAKER_00]: I think these are really gentle.
[SPEAKER_00]: I think these are ones that you definitely want to have on the day of your termination.
[SPEAKER_00]: and after.
[SPEAKER_00]: And the reason why is because in trials in both, they have really mild sleep supportive effects.
[SPEAKER_00]: So they increase gabbos activity in the brain.
[SPEAKER_00]: How inframing this is that it's supportive.
[SPEAKER_00]: It's really low risk and unlikely to do harm rather than like an evidence-based treatment.
[SPEAKER_00]: Okay?
[SPEAKER_00]: So that's really important just to remember that's just kind of where the evidence is and that's
[SPEAKER_00]: Of course, always talk to your health care provider, lemon balm and Camelow's great to have on the day.
[SPEAKER_00]: Maybe with some magnesium glycinate, just to calm your nervous system down and regulate your nervous system post-termination.
[SPEAKER_00]: I think a lot of women will also think, but what about Saint John's war?
[SPEAKER_00]: Isn't that really really great?
[SPEAKER_00]: I would really say, please avoid Saint John's war, post-termination, specifically.
[SPEAKER_00]: because it's a really strong CYP-3A4 inducer, and that basically means it can reduce the effectiveness of hormonal contraception.
[SPEAKER_00]: So if you've had your termination and you've started on hormonal contraceptive straight after, it can decrease the effectiveness of it.
[SPEAKER_00]: which can increase the risk of pregnancy, recurrent pregnancy, just after termination.
[SPEAKER_00]: So that's something you want to keep in mind.
[SPEAKER_00]: Also, for any other medication, you need to talk about Saint John's Wort and its interactions with any other medication that you have with your health provider as well.
[SPEAKER_00]: So those are some herbs to regulate your nervous system, depending on where you might be.
[SPEAKER_00]: It might be nice to just have them all on hand, just to see how you feel on any given day.
[SPEAKER_00]: you might want to take saffron in the morning, ashwaganda at night with some lemon mum and chamomile if you've had the go ahead from your health provider.
[SPEAKER_00]: And you've just taken into account all of these different contraindications and how these herbs can impact you.
[SPEAKER_00]: Yes, herbs and nature is incredible, but it's not inert.
[SPEAKER_00]: It can harm if you're not taking the right dose at the right time in the right body as well.
[SPEAKER_00]: That's suited to that herb.
[SPEAKER_00]: Okay, just because it's natural doesn't mean it can't cause harm.
[SPEAKER_00]: So you just got to keep all of those interactions in mind.
[SPEAKER_00]: Let's move on to some body mind, calming, and regulation techniques as well.
[SPEAKER_00]: Of course, I have another podcast all about this with I-Reen Lyon and how you can regulate your nervous system in a way we talk about all of the interactions in the body and what you might do in any of those as well.
[SPEAKER_00]: If you are processing anything, of course, always talking to a psychologist and your psycho therapist, if you're processing anything quite heavy or something you don't feel like you can
[SPEAKER_00]: But here are a few practices that you can do to connect in with your body.
[SPEAKER_00]: So if you're feeling quite anxious, I think a few things to do just before you feel like you want to go to sleep is some box breathing.
[SPEAKER_00]: I think box breathing is really beautiful in the days leading up to on the day of the termination.
[SPEAKER_00]: And after I think it's really beautiful to practice at night, so four counts in, so breathing in.
[SPEAKER_00]: two, three, four, holding, two, three, four, breathing out, two, three, four, holding out, two, three.
[SPEAKER_00]: Four, and you repeat that.
[SPEAKER_00]: And if you repeat that for about 10 to maybe even 20 counts, so that's about 5 to 10 minutes, you're going to feel a lot calmer.
[SPEAKER_00]: So practicing that the nights before your termination,
[SPEAKER_00]: and I think if you are having a medical abortion at home and you're experiencing quite a lot of pain, box breathing can be really wonderful as well.
[SPEAKER_00]: You can use that and you can use it at night before you go to sleep as well and that's really beautiful to stimulate your vagus nerve, breathing in slowly and breathing
[SPEAKER_00]: out slowly can be really great.
[SPEAKER_00]: So breathing in for about four seconds and trying to breathe out for six to eight seconds, you're breathing out, stimulate your vagus nerve as well.
[SPEAKER_00]: That's really beautiful to come down.
[SPEAKER_00]: I love a spiky mat on the back.
[SPEAKER_00]: I think that's really really great if you are wanting to kind of divert pain somewhere.
[SPEAKER_00]: So if you are experiencing pain during your medical abortion, a spiky ball in the hand,
[SPEAKER_00]: a comb in your hand can be really beautiful or a spiky mat standing on a spiky mat to kind of move the concentration of pain away from where you're feeling it and divert it throughout the body.
[SPEAKER_00]: That is a birth technique that you can use during medical abortions as well if you're experiencing pain.
[SPEAKER_00]: I also really like if I've had a stressful day from feeling stressful to pop on a spiky mat.
[SPEAKER_00]: I think they're called like a Shakti mat.
[SPEAKER_00]: There's lots of different ways that you can get them these days.
[SPEAKER_00]: Laying on your back can be really beautiful.
[SPEAKER_00]: and that can really calm down your central nervous system that's beautiful to do as well.
[SPEAKER_00]: I like to do that with my legs up the wall so if you don't like this bike, you might find that's fine.
[SPEAKER_00]: If you want to calm down your nervous system, laying down with your legs up the wall can be so beautiful and so calming and can get you ready for bed too.
[SPEAKER_00]: Okay, what if I'm feeling really anxious?
[SPEAKER_00]: What can I do?
[SPEAKER_00]: Generally, I'd say move.
[SPEAKER_00]: I don't think you're going to feel really anxious right after a termination, usually that builds within a few days.
[SPEAKER_00]: And that is, I guess, a benefit in a way, because after a surgical termination specifically, the same day or even the next day, you can tolerate really, really light activity and walking, so if you're feeling anxious,
[SPEAKER_00]: If you can move a little bit, you can do some yin yoga.
[SPEAKER_00]: That can be really great.
[SPEAKER_00]: I think movement with anxiety can be really great just to move.
[SPEAKER_00]: I think anxiety demands movement, but you have to be really careful.
[SPEAKER_00]: So our cog, that's the clinic after cache sheets that I was looking at in the research for this podcast, they suggest easing back within a few days to a week of exercise, once bleeding has settled down to light spotting.
[SPEAKER_00]: and there's no decino.
[SPEAKER_00]: So once you get to that point, it's really, really great to move.
[SPEAKER_00]: So walking, if you want to go for a light jog, if you want to lift weights at home, do some bodyweight exercise, doing some yoga.
[SPEAKER_00]: I think incorporating some movement before you start to feel anxious, is a really great idea.
[SPEAKER_00]: But you need to avoid swimming, baths, and I'm submerging in water, like pools and hot tubs until bleeding has stopped.
[SPEAKER_00]: So that's because your cervix might still
[SPEAKER_00]: great risk basically.
[SPEAKER_00]: So one to two weeks, you want to avoid any of those activities.
[SPEAKER_00]: Also, we're avoiding any high intensity or heavy impact training the first few days.
[SPEAKER_00]: Especially if you're experiencing any cramping, please just give it a week.
[SPEAKER_00]: Give your body a bit of a rest, but if you're feeling anxious and you want to move, I think that can be really really great to move the anxiety through the body.
[SPEAKER_00]: and kind of relieve the stressor in a way.
[SPEAKER_00]: Medical abortions, so if we're pursuing a missile postal, this is a more prolonged process.
[SPEAKER_00]: So active bleeding and cramping for hours and then tapering over one to two weeks.
[SPEAKER_00]: So most guidance on movement is symptom-led rather than date-led.
[SPEAKER_00]: So there's no real clinical guideline on this.
[SPEAKER_00]: It's just how do you feel?
[SPEAKER_00]: Do you feel able to do the movement
[SPEAKER_00]: resting through the acute cramping obviously you're not doing any movement through that period of time and then you can return to full training intensity within two weeks I would say.
[SPEAKER_00]: So doing some gentle movement in the week after and then going back to some heavy movement of course, if you have heavy bleeding you're not going to increase your movement.
[SPEAKER_00]: Okay, so don't say like I'm just not going to move I'm just going to totally rest for a week and then feel more and more and more anxious movement is your friend and it is recommended to move if you feel safe to do so and you don't have heavy bleeding so that can really help the resolution of any anxious feelings that you have after your termination as well.
[SPEAKER_00]: Okay.
[SPEAKER_00]: I hope you found this useful.
[SPEAKER_00]: Whatever brought you to this episode, I hope you take the time to probably care for yourself in the coming weeks.
[SPEAKER_00]: Rest when your body asks for it.
[SPEAKER_00]: Get your bloods checked if you can and be patient with the process.
[SPEAKER_00]: Healing here isn't just physical.
[SPEAKER_00]: It is an Australian line, but the evidence is genuinely reassuring.
[SPEAKER_00]: Your body knows how to reset and so do you.
[SPEAKER_00]: Thank you for spending the time with me.
[SPEAKER_00]: Take care of yourself.
[SPEAKER_00]: Thank you so much for taking the time out of your busy day to listen to this episode.
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[SPEAKER_00]: I hope you have a really beautiful morning, afternoon or evening wherever you are in the world and I will see you on the next episode.