Lauren Rubal, MD, FACOG

Who else struggles with insomnia but wants to avoid pharmaceuticals?

This is important in all phases of life… I know I see this all the time in my fertility patients and those who are dealing with PCOS, irregular periods, anxiety, and depression.

…

Of course, please see a doctor to ensure that there aren’t any other conditions or medications that may be affecting your sleep. This includes alcohol and stimulants, like my beloved coffee.
…

BOTANICALS FOR INSOMNIA

🍃Valerian
▫️used for millennia to aid sleep.
▫️Studies overall support its use in improving sleep quality and decreasing time to sleep.
In fact, one randomized double blind study showed valerian was similar to a benzodiazepine in improving sleep.
▫️If used for a prolonged period, valerian should be decreased slowly and under a physician’s care.

🍃Ashwaganda
Ashwaganda use has exploded. Every juice bar worth its salt seems to carry some iteration of it.
▫️It’s an adaptogen, which means it’s designed to help the body adapt to stress. ▫️from the plant Withania somnifera. That’s right: somniferous. It’s a sedative so it’s best avoided if you want to be alert.
▫️It can take up to a month to have a sedative effect and is especially helpful for the anxiety component of insomnia.
▫️Though people overall tolerate it well, it shouldn’t be used if pregnant, nursing, or if you have liver issues.

🍃Passionflower
This botanical is gentle and slow-acting, and has anti-anxiety and sedative effects.
▫️There isn’t much data examining its use in insomnia but the trials to date are promising for its benefit in sleep quality. ▫️However, don't use in pregnancy.

🍃Kava
This botanical has well-documented anti-anxiety effects, but its use in insomnia isn’t as fleshed out.
▫️Prior trials support its help in decreased insomnia and anxiety, but side effects may include vivid dreams and dizziness.
▫️Avoid use in pregnancy or possibly with liver issues.

🍃Chamomile
Many use chamomile as a sleep aid, though the studies on its use in insomnia are sparse.
▫️It helps decrease anxiety and is considered quite safe.
▫️Therefore, it may be a useful adjunct for insomnia.

…

Next up… SUPPLEMENTS FOR INSOMNIA

Posted • Join one of our LIVE Q&As
#1: April 7th 7:30pm CET / 1:30pm ET
#2: April 7th 7:30pm PDT

The experts joining us for Q&A #2 are:

⭐️Dr. Lauren Rubal (USC-trained Reproductive Endocrinology & Infertility physician)
⭐️Hana Ilg (Fertility Awareness Educator)
⭐️ Grace Stark (Editor of Natural Womanhood).

This is a FREE event! You don’t necessarily have to have watched the documentary, but of course you should if you can!

🩸Have questions related to hormonal birth control and your options?

Join us!

We can't wait to hear from you.

Link in bio to register! 👆✨

Posted • Join one of our LIVE Q&As
#1: April 7th 7:30pm CET / 1:30pm ET
#2: April 7th 7:30pm PDT

The experts joining us for Q&A #1 are:

⭐️Dr. Mariza Snyder (Functional Practitioner, Women’s Hormone Expert and Bestselling Author)
⭐️Hana Ilg (Fertility Awareness Educator)
⭐️ Dr Nat Kringkoudis ('The Hormone Revolutionist' and Women's Health & Natural Fertility Practitioner)
⭐️ Nicola Cloherty (Menstrual Cycle Awareness Advocate and Women’s business coach)

This is a FREE event! You don’t necessarily have to have watched the documentary, but of course you should if you can!

🩸Have questions related to hormonal birth control and your options?

Join us!

We can't wait to hear from you.

Link in bio to register! 👆✨

Are You Reading This at 2 AM? How to take an integrative approach to insomnia 😴

There’s a reason that sleep deprivation is used as a form of torture. You desperately want to sleep, but it’s not in your control and seems like it’ll never happen. You’ve been religious at optimizing sleep hygiene and perhaps you’ve even left your cool, dark room to peruse this with your blue light blockers on.

You’ve come to the right place, o weary one — read on for integrative approaches to insomnia.

WHAT EXACTLY IS INSOMNIA, ANYWAYS?
💤 takes more than 30 minutes to get to sleep
or
💤difficulty staying asleep
💤happens 3 or more times a week for more than 3 months
💤impacts functioning during the day
💤sufficient opportunity for sleep exists and other conditions have been ruled out (sleep apnea, restless leg syndrome, bladder issues necessitating nighttime urination)

THE BENEFITS (AND BEAUTY) OF SLEEP
💤repairs our muscles and bones
💤quiets our cortisol and our cardiovascular system
💤 results in decreased risk of heart disease and stroke (compared to insomniacs)
💤insomnia increases risks for
▫️diabetes
▫️obesity
▫️ depression
▫️cancer

With better sleep, we are mentally tougher, physically stronger, and happier.

More to come tomorrow on natural remedies and nutraceuticals for sleep!

The privilege of being a healer, of being a Doctor, is one that we swore to uphold.

It’s the road we walk along *with* our patients, and not *out* on them.

It’s the tailored decision-making for each individual and not blanket mandates for all, without concern or acknowledgment of that person’s background and story.

Bring back our vocation. Bring back the patient-physician partnership. Bring back personalized medicine instead of administrative decrees.



📸 https://www.liveauctioneers.com/item/11687364_737-an-old-framed-copy-of-the-hippocratic-oath

What supplements can I take for OBGYN issues? (Part 2/2).

🍄Medicinal mushrooms and their properties were revelatory to me.
➡️They are immunomodulators, anticarcinogens, antibacterial and antiviral.
➡️Certain species improve focus, decrease fatigue, and optimize blood pressure, sugars, and cholesterol.
➡️I use a blend to optimize mental clarity. It’s so effective that I didn’t realize I hadn’t had my daily latte until I got a raging withdrawal headache.

🟠Uva ursi is what I use to help with a bladder infection.
➡️This botanical has antiseptic and antibacterial actions in the bladder through its conversion to hydroquinone in the liver.
➡️It’s active against common bladder infection-causing bacteria in vitro, like E. coli, Ureaplasma urealyticum, and Staph aureus.
➡️And double-blinded clinical trials confirm it may be effective in prevention of recurrent urinary tract infections when combined with dandelion root.

🟠A prenatal vitamin with sufficient choline, omega-3 fatty acids, vitamin D, and methyl folate.
➡️This is true even if you’re not actively trying to get pregnant.
➡️It supplies essential nutrients that we may not be adequately intaking from diet alone.

🟠Ginger root powder is a potent anti-inflammatory.
➡️It has been shown in studies to be as effective as pharmaceuticals in decreasing period cramps.
➡️It’s also accepted as first-line treatment of nausea in pregnancy.
➡️In doses greater than 5 grams daily, it may thin the blood.

🟠Valerian root to help with insomnia.
➡️This botanical may also be helpful for anxiety and menopause.
➡️There have been studies comparing this root (in conjunction with passionflower or St. John’s wort) to pharmaceutical anti-depressants and found equivalent improvement.
➡️It can take weeks to become effective, so don’t expect an immediate result.
➡️I combine it with therapeutic toe-tapping and a relaxation 4-7-8 breath (Dr. Andrew Weil has an informative video about this) for sleep readiness.

📸: Landon Parenteau on Unsplash

Peek into an Integrative OBGYN’s Medicine Cabinet (1/9):

1. A probiotic specifically made for the reproductive tract.

🐛 Our microbiome protects us from invading organisms. And these bacterial good guys are organ-specific.
🐛So, even though you’re taking a gut probiotic (which I also recommend!), the species colonizing the reproductive tract are different.
🐛They are mostly Lactobacilli dominant.
Why is this type important?
➡️ produce hydrogen peroxide.
➡️creates as acidic va**nal environment. ➡️this helps fend off the higher-pH-loving bacterial vaginosis bugs, amongst others.

❔Which are the bacteria that are associated with better pregnancy, fertility, and urinary tract outcomes?

🐛Lactobacilli rhamnosus (especially strain GR-1)
🐛L. reuteri (strains B-54 and RC-14)
🐛Lactobacilli crispatus
🐛L. jenseneii

📸 CDC on Unsplash.

**nalhealth **nalhealthtips

Happy Independence Day!

🇺🇸

Peek into an integrative OBGYN’s medicine cabinet!
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I have a problem with purchasing anything. I dive deep into every posted review, cross-reference those between different sites, then follow it up by trying to find the best deal. This usually ends with a few gray hairs, slightly gnashed teeth, but also the most economical yet functional blender of 2021.
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But now my headache is your reward. Have you ever wondered what’s in your OBGYN’s medicine cabinet? Here is your chance to see!
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I’ve also exchanged many products once I started my Integrative Medicine Fellowship. So this reflects a more holistic and natural approach to women’s health.
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Any discussion of supplements deserves an explanation regarding quality. I used to think that supplements were the Wild West of medications. This is not true. Though the FDA doesn’t regulate them, they must comply with multiple federal rules.
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However, there is still a large range between brands and their commitment to testing standards. The best quality brands are those which undergo 3rd party testing (examples of this independent quality control include the labels “USP” or “NSF”). What does this stamp actually mean the company is doing?
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💊 Ensuring per-lot testing of suppliers
💊Performing continuous assessment for contaminants
💊Using organic materials to decrease exposure to pesticides
💊Confirming that the supplement has accurate and appropriate potency.
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So, do your research to ensure that you are getting the product you are seeking. This is especially true if you’re using it medicinally. It may takes weeks or even months to see the full effect of these supplements.
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And of course, check with your doctor first before taking any of these!
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Stay tuned for the items holding a coveted spot on my counter!
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What supplements may be helpful for the eggs? (A looong pt 4/4).
A) mitochondria support.
🔋Mitochondria are the cell’s energy powerhouse.
🔋 unique because their DNA code is outside of the cell’s nucleus.
🔋Unfortunately, they don’t have the same repair mechanisms or the interweaving with histones that also protect nuclear DNA. So mitochondria are vulnerable.
🔋Animal studies support that damage to or aging of the mitochondria may be associated with negative egg and embryo effects.
💊 Coenzyme Q10 is a supplement that most fertility patients on. But why that is isn’t always described. It’s a critical cofactor to mitochondria.

💊Studies also support CoQ10 as effective at preventing or reversing these effects in mice. The data in humans is more sparse but one short-term study suggested benefit.

B) anti-oxidants
🌿Counteract the chromosome-damaging effects of free radicals.

💊N-acetyl cysteine is the precursor to glutathionine, one of the most potent antioxidants. It’s been shown in studies to be associated with benefit in endometriosis and PCOS.

💊Alpha lipoic acid also exerts its effects through glutathione.

💊Resveratrol is a plant polyphenol that may explain the health benefits of red wine.

C) anti-inflammatories
💊Ginger is renowned for its inflammation-fighting properties.

💊Turmeric (and its active component, curcumin) has also been shown in studies to have benefit against inflammation.

4) androgen balancing
☯️ The right balance of male hormones to the female hormone estrogen is critical for proper egg maturation in the follicle microenvironment.

☯️Male hormone levels decline with age.

☯️This isn’t for every patient (and certainly baseline male hormone levels should be assessed to best tailor your response), but using male hormones may be helpful in pregnancy chances.

What lifestyle strategies can help egg quality? (Part 3 of 4!)

🥬 Food is medicine. As such, there are clear diet patterns to support a lower state of inflammation.

🥬 Decrease processed foods. This is the one change with likely the greatest impact.

Consume a diet rich in:
🥬omega-3 polyunsaturated fatty acids (wild salmon and walnuts, for example).
🥬monounsaturated fats (keep the extra virgin olive oil flowing)
🥬vegetable and seed fiber (brussels sprouts or kale are powerhouse veggies)
🥬legumes (soybeans)
🥬whole grains
🥬lean protein (grass fed and organic is best)
🥬spices (like turmeric and cinnamon)

Next up, what supplements may help!

📸 Avinash Kumar via unsplash

So, how can I test my egg quality? (Part 2/3)

Here’s the crux: there is no test for egg quality.

🔥We presume it based on a woman’s age. 🔥Like other cells in the body, the accumulation of cell damage may eventually overwhelm the DNA repair mechanisms that our body has in place.

But herein lies the opportunity.
🔥Studies show that the egg undergoes its final readiness phase in the few months before it lines up for the ‘race to ovulation’, where it either is chosen to be released or, if not released, to dissolve away.
🔥This timeframe leading up to this race is when the effects of free radicals and inflammation may be counteracted by anti-oxidants and strategies to minimize inflammation.

What is the root cause that may be addressed?

🔥Inflammation is one of those responses that has the Goldilocks effect: you don’t want too little or too much, but just the right amount.
🔥It’s designed to aid in the healing process and is composed of activation of different immune cells and substances (like cytokines) to stimulate blood flow, call in immunologic reinforcements, and repair tissue.

🔥But chronic inflammation is too much of a good thing that can lead to tissue damage and harm to various organs. This happens through the nonstop activation of the immune system, new blood vessel formation, tissue fibrosis and its eventual destruction.

Does egg quality matter? Or is it all about the egg number? (Part 1/3)

🥚 Quality matters.
Yet when we talk about the ovaries, the focus is usually on egg quantity.
🥚We emphasize a woman’s ovarian reserve and go into detail about how our treatments will increase mature eggs released or harvested.
🥚Don’t get me wrong: the number of eggs matter, too (we are born with all of our eggs and that number decreases over time).
🥚But I believe egg quality is equally, if not more, important than the sheer number in the ovaries.

What does egg quality even mean?
🥚The egg is a complex cell, frozen in the midst of a chromosome division (meiosis I, for all you fellow science nerds) since before we are born.
🥚It only completes that chromosome division once it’s ovulated, which may be many decades later.
🥚The process of cell division is complex, utilizing many moving parts, including machinery to pull the chromosomes apart.
🥚I think of poor quality as rusty machinery, pulling the chromosomes apart in ways we don’t want it to.
🥚This is important because the egg’s chromosomes help comprise the embryo’s genetic code.
🥚And random chromosome errors in the embryo are a leading cause of first trimester miscarriage.
🥚Another theorized way egg quality may decrease is through exposure to free radicals or to inflammation.

Stay tuned for testing, root cause, and optimization strategies!

📸 Wilhelm Gunkel via unsplash

Heading into midweek like ... 😴 😂🤷🏻‍♀️

Do I need to be doing a handstand after in*******se?
In short, no. The va**na is beautifully designed — it naturally forms a slide of sorts, with the bottom near your cervix. So when semen is deposited there, the s***m are essentially at the entrance of the womb.
🤸‍♂️ It’s completely normal to have semen come out afterwards. Semen is typically 2+ mL in volume, so it is noticeable.

🤸‍♂️I think of it as the ‘car’ that gets the s***m riding inside where they need to be.

🤸‍♂️ Not to worry — s***m that are moving forward will be able to get into the cervix and from there, the uterus and tubes.

🤸‍♂️ In fact, interesting studies show that there are s***m in the tubes within minutes of ej*******on and in the cervix within seconds.

🤸‍♂️ I also think of the egg / dominant follicle as sending a bat signal of sorts: other studies show that the s***m travel to the side the maturing egg is on!

⚠️ However, as I tell my patients, so much of fertility is a mental game. It certainly won’t hurt to lay down for 15 minutes after ej*******on. But it’s equally fine to get up right afterwards. ⚠️

📸 Derek Thomson @ unsplash

*******se *x

edition .... miss my work family soooo much.
My mom (an amazing RN) always told me how important teamwork is in medicine.
Everyone in this photo is invaluable and patients have been, and continue to be, cared for so well by each of you!!
Reunion soon!! 💗💗.

When in my cycle is the best time to get pregnant? 🤔 🥚

🥚Studies show the best timing of s*x to get pregnant is during the fertile window (6 days leading up to the day of ovulation).

🥚The 2 days before ovulation and then the day of ovulation represents the peak time to have s*x and get pregnant, even within this window.

🥚After ovulation happens, the hormone changes and progesterone rise make it harder to conceive.

🥚There’s a window of implantation within the lining of the uterus that ‘closes’ after exposure to prolonged progesterone.

🥚The cervical mucus becomes impenetrable to s***m after progesterone rise.

⚠️ The right answer of when to have in*******se is very much dependent on you two! For some couples, weekly in*******se is very stressful. For others, it is stressful not to have s*x daily. ⚠️

🥚Couples who have s*x infrequently should use fertility awareness biomarkers to optimize timing of ovulation to give the best chance of getting pregnant.

🥚Otherwise, in*******se every 1-3 days is fine.

📸 Melani Sosa on Unsplash





*x

As a fertility specialist, one of the most common questions I get is about timing of in*******se. So... how often should you be doing it?
🐞 S***m survive in the reproductive tract for 3 days on average, but can survive up to 5 days.
🐞Studies show that even daily ej*******ons have no detrimental impact on s***m movement or count in men with normal s***m quality.
🐞Even in men who have lower s***m concentration, in*******se every 1-2 days may help their motility and count.
In fact, abstinence for too long may be detrimental.
🐞Intervals of greater than 10 days can hurt s***m shape.
🐞Intervals greater than 5-7 days may hurt s***m counts.
🐞In sum, having in*******se at different frequencies won’t hurt the s***m parameters, unless there is abstinence for more than a week or so. Having s*x each day vs every 3rd day seems equivalent to s***m quality; see my upcoming post for timing!


*******se

Bad words can be longer than 4 letters. In this case, it’s the 11-letter diagnosis of “unexplained”. It’s a special kind of torture to be dealing with infertility but without a clear reason why.
This is why I’m so excited to be a part of the LIVE Unexplained Infertility Summit on May 1. The heart of this event is to uncover real answers to “unexplained infertility,” treat the root cause, learn about restorative options to conceive naturally and potentially even avoid invasive, expensive procedures. The event will be live and recorded. Register today at www.uis2021.com!

Oysters are not just aphrodisiacs, they’re also chock full of and low in mercury toxin!
🦪 omega-3 fatty acid is a precursor to cholesterol, which in turn makes hormones.
🦪 studies suggest omega-3 may:
✔️ be associated with higher fertility compared to diets high in
✔️ are correlated with higher s***m parameters like movement and shape
✔️ improve embryo morphology in humans
✔️ help egg quality in mice
🦪 buy Eastern and Pacific oysters to take advantage of omega-3 fatty acid’s anti-inflammatory effects
🦪 other sources of omega-3 include:
✔️fish. Watch out for mercury! Wild salmon is best. Use caution with tuna or other large fish.
✔️ seeds. Flaxseed and chia are great sources.
✔️ nuts. Walnuts have the highest amount overall

So excited to partner with for an talk! (And I wonder what my bio would look like if I had my kids pen it 🤔 definitely wouldn't be as glowing as this one).

Posted • Save the date : April 22nd @ 5:30pm 🌸

Introducing Dr. Lauren Rubal, MD 🙌

Dr. Lauren Rubal began her career as one of 20 people selected nationwide for the 6 year BS/MD Honors Program in Medicine at the University of Miami, where she was awarded membership into Iron Arrow, the University's highest honor. Afterwards, she completed her Obstetrics & Gynecology residency at University of Southern California-Los Angeles County, and continued there for her 3-year REI fellowship.

Dr. Rubal has been widely recognized for her teaching, having received the Daniel R. Mishell Teaching Award 4 years straight, the USC Keck School of Medicine Faculty Teaching Award selected from amongst all specialties, the Bayer Health Care Best Teaching Resident, and the Leadership Award from her peers. She was chosen to be Administrative Chief Resident. She continues to teach University of California Irvine residents as Associate Clinical Faculty.

She has been recognized as an Orange County Physician of Excellence, a Top Doc of Pasadena, and a Southern California Super Doctor and Rising Star for multiple years running, and has been an invited speaker at multiple conferences and podcasts as well as an author of several book chapters.

Currently a Fellow in Integrative Medicine at the Andrew Weil Center at the University of Arizona and a Fellow at the FEMM-aligned Reproductive Health Research Institute, she loves to partner with her patients to achieve their longed for goals with a holistic lens.

Dr. Rubal’s ultimate mission is to identify the root cause and heal reproductive issues (such as fertility, miscarriage, and abnormal cycles) through lifestyle optimization, tailored nutraceuticals, bioidentical hormone support, and judicious oral & injectable fertility medication use, all while avoiding aggressive procedures.

Got a bucket list goal checked off this week....
I found a community of like-minded integrative medicine fellows and professors who taught me so much about the art of healing.
Did you know...
🙃 practicing a form of spirituality extends your lifespan by 8 years

🙃 insomnia management may be bolstered with
🌀 valerian root
🌀 toe tapping exercise
🌀 relaxation breathing (478 breath by Dr. Weil worked well for my little insomniac).

🙃 ashwaganda is the only adaptogen that can also function as a sedative

🙃 kava is one of the best anxiolytics and “social lubricants”

🙃 there are indeed multiple regulations for supplements on the market and it’s not the Wild West I imagined it to be

My brain is jam packed with so much new information and with the teaching of amazing professors who advocate for a mindful and motivational partnership between providers and patients. Truly transformational! Integrative medicine fulfills what we hope to find in our doctor and in medicine itself.

shouldn’t have to be suffered through. In honor of , it’s important to speak up and tell your doctor so he or she can help.
Though is but one of the causes, it is *really* common.
😖 1 in 10 women
😖 severe pain affects over 6 MILLION in the US and Canada
😖 can be associated with fertility issues as well
It will never hurt to initiate lifestyle changes to help with decreasing inflammation and exposure to endocrine disrupters.
🌳 Lots of organic produce
🌳 decreased gluten
🌳 decreased processed foods and sugars
🌳 consideration of decreasing dairy
🌳 avoidance of red meats
Decreased inflammation can also be achieved with supplements (this isn’t for everyone so check with your doctor first)
✅ N acetyl cysteine
✅ turmeric
✅ quercetin
✅ fish oil
✅ ginger root
✅ pycnogenol
✅ melatonin
It’s important to get evaluated to assess for causes that can be treated and managed! 💗

Did you know that cholesterol is the building block of our hormones?
🥑 So cutting out all fat from your diet when you’re isn’t the answer.
🥑 it’s much more about the *type* of fat.

🧁trans-fats should be decreased when possible
• fried fast foods
• processed sweets, like ready to eat desserts
• buttered microwave popcorn 😭
• shortening

🥑 try to stick to unsaturated fats if possible instead!
Diet is complex but small changes can have profound impacts!

Will exercise hurt your chances of getting pregnant?
It’s a complex answer, depending on multiple factors.
🥋 overall, exercise has a multitude of benefits for the body and the mind (the physicality of jiu jitsu is only matched by the mental chess game, for example)
🥋 in fact, the ideal amount of exercise is 150 minutes of aerobic activities within the week plus 2 days of strength training.
🥋 if this seems overwhelming, then starting with any amount is honestly most important. Even 5-10 minutes at a time!
🥋 when , the benefits depend somewhat on
✅intensity
✅your weight
✅your diagnosis (for example, having vs will prompt different considerations/discussions with your dr)
✅ if fertility treatments are ongoing.
Check out my post to read more: https://femalehealthcollective.com/will-exercise-hurt-my-chances-of-getting-pregnant/

How do you find info about medical conditions? (I use dr. Google, too🙋🏻‍♀️).
We all know google ends in a spiral of worst possible outcomes and that webmd is informative but sleep-inducing.
So I’m so excited to tell you about this website for women’s health by female medical professionals. I think of it as if you were getting allll the details from your friend who also happens to be the field’s expert 🙌🏼
Check out my latest posts on PCOS and the reproductive microbiome: www.femalehealthcollective.com.
So excited to be part of this brilliant group!

to : for all you who aren’t sure what type of dr you want to be, this post is for you.
This photo is of my roommates, then and now (with Allie in lieu of Liz).
It’s amazing to think that despite our shared bond of school and home (and throwback tans and dance parties 🤗), we each chose different career paths:

Pediatrics
Dermatopathology
Reproductive endocrinology & infertility
Pediatric dermatology
Did you know there are almost 100 (!) different medical specialties?!
Search hard to discover the perfect specialty for you ... it may not be in your 3rd year required rotations or even 4th year electives.
I had no idea specialties existed in and , for example.
You can volunteer at a busy hospital, help with a research project, or go on a specialty medical mission trip (like ) to see firsthand what day to day life is like.