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The PCOS Solution

Depression and insulin resistance: Which came first

Saturday, January 16, 2016
image credit mensaticMaybe this is you, maybe someone you know is caught in this catch-22: Someone who feels depressed, and also has poor blood glucose regulation, maybe even pre-diabetes.

If you’re feeling depressed you’re probably not exercising, because it’s really hard to motivate yourself off the couch when you’re feeling down. And you’re probably not eating well, either. Maybe even chasing sugary foods as a way to manage your mood? And all that extra sugar plus immobility leads to poor blood glucose regulation. 

Scientists have noticed the connection: that people with depression are more likely to have insulin resistance (poor blood glucose regulation that can lead to diabetes). And people with insulin resistance are more likely to be depressed. This is certainly the case with PCOS (polycystic ovary syndrome) where underlying insulin resistance seems to contribute to a low mood.

But which came first? Does one cause the other, or is their dual presence coincidental? And how do you get out of this tangle?
First, if your blood glucose regulation is out of control, you’re probably not exercising. Movement automatically eases insulin resistance and also creates endorphins, neurotransmitters that boost happy feelings. But being active is incredibly challenging when your depressed mood dissuades you from even getting out of bed.

So here’s the problem: You need to get off the couch to overcome your depression and insulin resistance. But the very nature of depression is likely to deactivate your intentions, keeping you inactive, unmotivated, and hurtling towards diabetes.

What’s the way out of this tangle? You’re going to have to somehow get yourself out the door and moving. A tough ask when you can barely get yourself out into the day.

The key to escape from this trap could be in getting help to shift your mood enough to get you started, and support to help you keep the momentum going long enough to overcome the insulin resistance and the depression. Then your symptoms for both conditions are likely to ease. You’ll be on an upward spiral: Happier as well as feeling more energetic and motivated.

So if you’re stuck in the depression and insulin resistance merry-go-round and want to get off, the best way could be to reach out for some professional prescribing to help your brain think more positively. Natural remedies that change how your brain works chemically could be the key to uncoupling the connection between your mood and your blood glucose regulation.

If you enjoyed this article, you might also enjoy reading about natural mood boosters.



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PCOS depression and insulin resistance the connection

Friday, December 18, 2015
It’s no secret that many women with PCOS also experience depression: researchers estimate that as many as 40% are affected. What’s known is that having PCOS promotes depression: There’s the self-esteem eroding effect of facial hairiness, acne, the difficulty with losing weight, disruption to your menstrual cycle and on top of all that, the threat your dysfunctional ovaries pose to your fertility. 

What’s also known is that people with depression are more likely to have insulin resistance. And people with insulin resistance are more likely to be depressed.

The connection between insulin resistance, depression and PCOS becomes clearer when you consider that insulin resistance is the disorder underpinning PCOS, so it’s probable that if you have PCOS you probably have insulin resistance too, and if you have insulin resistance it’s quite possible you’ll experience feelings of depression.

Because - 
- If your insulin resistance is out of control, you’re probably not exercising daily (exercise is the key to overcoming insulin resistance)
- If you’re feeling depressed you’re probably not exercising, because it’s really hard to motivate yourself off the couch when you’re feeling down. And you’re probably not eating well, either. Maybe even chasing sugary foods as a way to medicate your mood.

So here’s the rub: You need to get off the couch to overcome your depression and insulin resistance. But the very nature of depression is likely to deactivate your intentions, keeping you inactive, still depressed, and heading towards diabetes. 

What’s the way out of this tangle? Either you’re going to have to somehow get yourself out the door and moving, plus overcome those cravings for sugary foods. A tough ask when you can barely get yourself out from under the doona and into the day.

The key to escape from this trap could be in getting help to shift your mood enough to get you started, and support to help you keep the momentum going solidly enough to overcome the insulin resistance and the depression. Then your PCOS symptoms are likely to ease, and your fertility is enhanced.

Mother Nature, bless her cotton socks, has a huge range of remedies waiting to help you; whether it’s herbs, homoeopathic remedies, or nutrient supplements. Your naturopathic practitioner will select the right supplements to help you keeping your safety in mind (Remember that many medications and natural remedies clash, so please don’t self-prescribe). Your practitioner will also help you overcome the thinking blocks that have kept you weighed down, unmotivated and depressed.

If you enjoyed this article, you might also enjoy 'Natural Treatments For PCOS' and why not download your free e-book 'When Good Hormones Go Bad'


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Your gallbladder and the oral contraceptive pill

Wednesday, December 16, 2015

If you’re considering use of the oral contraceptive pill, a contraceptive implant, a mirena coil or post menopause hormone therapy, you should know that this may increase your risk for gall bladder disease. The research is conflicting, as research often is; but there’s enough in the scientific literature to give you pause before you talk this over with your doctor. (*I’ve listed some papers at the end of this article if you’d like to research further yourself.)


Synthetic hormones are proposed to affect gall bladder function several ways.

- First, they increase the cholesterol saturation in bile, so that formation of cholesterol stones becomes more likely. 

- Secondly, synthetic hormones may increase the formation of inflammatory molecules (arachiodonic acid and prostaglandin) which can cause the gallbladder wall to become inflamed. 

- Lastly, the motility (ability of the gallbladder to squeeze out bile) is affected by synthetic hormones.

It’s important to note that other factors can promote gall bladder disease, including too much of your own hormones, insulin resistance, and a family tendency to gall bladder problems.

Here’s what’s supposed to happen: Your liver is constantly producing bile, but obviously doesn’t need it all right away. So some is stored and concentrated in your gallbladder, in readiness for your next meal. After your repast the fats in the food make it through your stomach and into your small intestine, where a digestive hormone, cholecystokinin, detects them and signals the gall bladder that fats are present. In response your gallbladder squeezes out some bile, the fats are dismantled into molecules and all the good nutrients in that food (including fat soluble vitamins) can now be absorbed. 

So what can you do if you have to use synthetic hormones? After all, there are some situations where medical intervention like the pill is the only way you’ll be able to function – for instance if you have severe endometriosis or excruciatingly painful periods. It’s always a risk-benefit balance decision. However what you can do to help is optimise your gallbladder function and hose down inflammation. Work with your practitioner on the causative factors for your problem while you’re taking the oral contraceptive pill to ease the symptoms.

Diet and lifestyle factors often underpin the symptoms of endometriosis and painful periods. Issues like insulin resistance, a pro-inflammatory diet. Issues that can be addressed while you’re managing your pain through using the oral contraceptive pill.

*The papers are
Etminan et al ‘Oral contraceptives and the risk of gallbladder disease: a comparative safety study 2011 Canadian Medical Association Journal

Cirillo et al ‘Effect of estrogen therapy on gallbladder disease’ 2005 American Medical Association

Thijs et al ‘Oral contraceptives and the risk of gallbladder disease: A meta-analysis’ 1993 American Journal of Public Health

If you enjoyed this article, you might also enjoy 'A brief guide to your gallbladder' 

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How a muffin top affects your ovaries in PCOS

Saturday, October 17, 2015

Having a tubby tummy may seem pretty harmless – but that muffin top is helping tangle your hormones and impair your fertility, thanks to a particular hormone, leptin, being secreted by your fat cells.


It may seem a little odd that fat cells are secreting hormones, but they produce leptin for a very worthy reason: informing your body just how much fat you have stored.  The fuller a fat cell, the more leptin it secretes. This sends two main messages to your brain: One to let it know you don’t need more food. (to reduce your appetite). The other is to let your brain and ovaries know that there are enough energy stores to support a pregnancy. 

Your leptin secretion lifts at puberty, as shape changes from the androgyny of childhood to a female form, with more fat deposits than males. As fat stores build in early adolescence more leptin is secreted. Your hypothalamus, one of the master glands in your brain, keeps an eye on just how much leptin is being produced. When energy stores (fat stores) are high enough to support a pregnancy, the hypothalamus permits onset of the reproductive cycle. 

Your ovaries are looking out for leptin too; because they’re not going to release an egg to be fertilised unless they’re sure your body has sufficient energy reserves to support a pregnancy.

When you have too much leptin circulating (because you have too many full fat cells – the tubby tummy) your hypothalamus is flooded with leptin messages. In response, this gland and another, the pituitary, amplify their fertility messages directed at the ovaries. Your ovaries now receive an overdose of luteinizing hormone, and the tidy process of egg development and release is disrupted. The result can be polycystic ovaries and an untidy menstrual cycle. This is how a tubby tummy can affect your fertility.

Other aspects of the modern lifestyle also affect leptin production: Stress lifts leptin levels, as does sugar, partly through development of insulin resistance.  One way to help ease polycystic ovaries and boost fertility is to reduce your fat deposits; although this can be challenging when your hormones are unbalanced and if you also have insulin resistance. 

The key tools you need to reduce fat stores and get your leptin levels back to normal are exercise, especially cardiovascular and weights (resistance) training, along with a less sugar-rich diet and effective stress management.

If you enjoyed this article you might also enjoy "How exercise helps balance your hormones" here

Image credit: Maena

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How exercise helps balance your hormones especially in PCOS

Wednesday, September 23, 2015
Hormones in a tangle? You’ve probably heard that exercise helps. But did you know that engaging in specific kinds of exercise, enough, could be the most effective hormone balancing tool you have. Let’s look at the biological mechanisms, the scientific evidence, and how exercise breaks the connection between resistant fat deposits and out-of-control hormones.

FOCUS ON INSULIN FIRST

The major advantage exercise gives you is overcoming your cells’ resistance to insulin. Your cells need glucose to function, and usually signal when they need more. They communicate this need by expressing receptors on the cell membrane that read: ‘Glucose needed here’.  Insulin, the glucose salesman, duly arrives at the cell’s doorstep with a delivery of glucose and passes it over. But if your cells don’t need more glucose because you’re sedentary they won’t put out that ‘glucose needed’ sign.

As a result your blood glucose levels rise. Your pancreas tries to cope with this by producing more insulin, but that doesn’t fix the problem. (Like responding to a glucose sales slump by employing more insulin salesman when the problem is that the cells have their doors shut to insulin’s deliveries.)

Exercise helps by using up the glucose your cells already have; that induces them to once again open their doors to a glucose delivery. As soon as you start exercising your circulating blood glucose levels fall, your pancreas takes a rest from producing insulin, and your hormones start to change.

MORE EXERCISE = LESS FAT = HAPPIER HORMONES

Better blood glucose regulation through exercise doesn’t affect your hormones directly as much as it affects the amount of fat you’re carrying; because fat cells emit their own endocrine message. When you get active (enough, and in the right way) your fat stores diminish, and here’s where your hormones really start to respond. One big change is the lift in sex hormone binding globulin (SHBG). This natty little protein circulates through your body effectively ‘mopping’ up excess hormones.

Another change happens within your ovaries: Insulin resistance causes your ovaries to produce more androgens. Secreted by the theca cells surrounding each egg follicle, this disrupts the normal process of egg maturation. You end up with many under-developed egg follicles going nowhere (polycystic ovaries). Worse, too much androgens exacerbate insulin resistance and fat accumulation in the peripheral tissues, creating a self-perpetuating cycle of fat accumulation, insulin resistance and androgen excess. 

EXERCISE: ENOUGH AND THE RIGHT KIND

When you exercise you use up energy, which, along with improving your insulin sensitivity, reduces the fat stores in your body. Now, I’m not talking about just a stroll around the block every day or so; enough exercise to make a difference. The PCOS Australian Alliance pulled together guidelines in 2011 for assessment and management of PCOS. They recommended at least 150 minutes of exercise per week; just over half of this time in moderate-to-high-intensity activity.  You’ve probably already reached for your calculator: 22 minutes a day isn’t Olympic level training.

Unfortunately, the guidelines omitted resistance training. In 2014 Australian researchers stepped forward to recommend that resistance training should be included in these recommendations. Their article, published in Sports Medicine, proposed that since progressive resistance training can improve insulin resistance in type 2 diabetes it should be part of PCOS treatment too. 

Is exercise actually more powerful than diet in untangling hormones? Maybe so. A Pilot study produced by researchers at the University of Saskatchewan in Canada proposed that exercising, unlike food restrictions, won’t make you feel deprived so you’re more likely to stick with the program – a key reason so many abandon diet plans. 

BUT DON’T IGNORE YOUR STRESS

Stress disrupts hormones effectively: It makes your pituitary gland less receptive to the instructions of your hypothalamus to release LH and FSH, the hormones that direct your ovaries. If you’re feeling uptight ovulation might still happen but some under-developed egg follicles could remain, secreting more hormones to disrupt the delicate balance of interconnecting endocrine messages. If you don’t ovulate that means less of the progesterone that helps moderate pre-menstrual tension. Worse, stress means more prolactin being released, further inhibiting ovulation.

Yoga might help improve your fitness and reduce your stress at the same time: A study of the effect of yoga on PCOS proposed that yoga had a beneficial effect in two ways: this ancient exercise reduced levels of anti-mullerian hormone, (which inhibits development of ovarian follicles, leading to ovarian failure). The other hypothesis is that chronic stress disrupts the hypothalamic-pituitary-ovarian axis, and yoga relieves this. 

It’s probably obvious by now that your hormones are incredibly complex and yet intertwined, and that this message system can easily be disrupted; however you can ease the hormonal tangle simply with exercise.

WHAT YOU NEED TO DO

Of course, you should consult with your practitioner prior to embarking on fitness training, to make sure you’ll be safe. After all, if you get injured or unwell you can’t train. You can check in with your GP, or an exercise physiologist. Get the balance of cardiovascular, strength and stress-busting exercise right and your hormones will respond.

If you enjoyed this article, you might also enjoy "If I ignore this hormone problem will it just go away", here.


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Natural treatments for PCOS

Saturday, February 15, 2014
If there’s one hormonal disorder that can really turn the life of a woman upside down, it’s polycystic ovarian syndrome (also known as PCOS). The causes of this nasty hormone imbalance are still revealing themselves, but the effects can be distressing at least and at worst, devastating. PCOS can make itself evident with symptoms including disrupted periods mood swings, acne, facial hair, undeserved weight gain, depression, anxiety, and even impaired fertility. But it’s challenging to recognise the condition because PCOS presents itself in different ways for each woman. And because it’s a difficult condition to identify, many women are unaware that they have PCOS until they have trouble conceiving a baby. 

Often, just losing weight can relieve the symptoms of PCOS; but the disruption to your metabolism  and excess oestrogen that PCOS generates can make it really difficult to achieve weight loss. It creates a challenging catch-22 situation with dilemmas like these: You may want to eat less sugar, but the cravings can be overwhelming, and create some really disagreeable moods that threaten to destroy your relationships. Because you’re not feeling happy it’s extra challenging to get out there and exercise, but you aren’t likely to achieve the results you deserve from the effort you’re putting in to your training, because your metabolism is disrupted and your hormones are in disarray. Life can become a vicious cycle of food cravings, weight gain, and unhappy feelings. Not to mention the distress caused by acne or facial hair that seems resistant to whatever you try.

Despite the difficulties, diet and lifestyle changes can have a really positive impact on treatment of PCOS when combined with the right treatment to balance your hormones. Firstly, it’s become evident that ovaries are particularly sensitive to sugar, so if you have PCOS eating less sugar than you do now can help. Also, toning down the over-production of oestrogen and testosterone can help relieve the desire for sugar. Herbs are often used by natural therapists for just this purpose.

Regular exercise helps ease PCOS too, because it lifts your mood, making it easier to resist sugary foods, and relieves stress. How you feel is important because stress disrupts your reproductive hormones very effectively; learning new ways to manage your mood is an essential part of your PCOS treatment program. 

The take-home message for you is that PCOS is treatable. Diet and lifestyle changes can help relieve PCOS symptoms. Herbal and homoeopathic remedies can help balance your hormones, producing a happier mood which makes changing your diet and lifestyle easier. 

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What you eat affects your PCOS: Here's the stop / slow / go list

Monday, November 19, 2012

How What You Eat Affects Your PCOS

Here’s the ‘go’ ‘slow’ and ‘no’ quick reference list for women with PCOS:

NO! (These foods will make your PCOS worse)

Sugar: This seductive substance feels good in the moment, but it will bring on mood swings and a tubby tummy – which creates more estrogen, which leads to more hormone disruption. You can find yourself on the energy rollercoaster, which will take you through the euphoric highs of a high blood sugar level, followed by the sweats and shakes of a hypoglycaemic attack. Watch out for sneaky sources of sugar, like fructose. Bottom line: If it tastes sweet, it contains sugar.

White grains (bread, cakes, biscuits, pasta) – these are pure ‘fast release’ carbohydrates which act like sugar. The more you eat, the more you want. White grain foods promote fat deposits on your tummy.

Bad fats (Processed fats like margarine, deep fried food, trans fats) – have a pro-inflammatory effect, which will have a nasty effect on your skin, and unfavourably change your cholesterol balance to help clog up your arteries. Sugar and white grains will help clog your arteries too – they also have a pro-inflammatory effect.


GO SLOW (These foods can make your PCOS worse if you eat too much)

Whole grains (brown rice, quinoa, oats) – provide fibre, and ‘complex’ carbohydrates (which means they take a long time to digest, so your blood sugar level is less likely to spike. But you need them for energy. Half a cup of complex carbohydrates is all you need at each meal if there are no starchy vegetables on your plate.

Fruit: Good in small quantities (2 pieces per day). Fruit supplies vitamins and minerals, as well as fibre.



YES! (These foods can help improve your PCOS)

Fibre: Boosts ‘sex hormone binding globulin’, a protein circulating in your blood which helps ‘mop up’ excess hormones. Legumes (like chick peas, broad beans and the like) are particularly good.  A half cup of cooked legumes every day is all you need, plus lots of non-starchy vegetables.  Aim for about 35g of fibre every day – more if you can, mostly from non-grain sources.

Good fats (oily fish, tree nuts (not peanuts), flaxseed, avocado, olives) – These fats have an anti-inflammatory effect, helping create softer skin. A ‘shot glass’ portion of raw nuts and seeds every day is good. Use olive oil for cooking. Make your meals more satisfying by including a small amount of oily food like olives and avocado. Try to eat a portion size (around 90g) of oily fish almost every day.

Vitamin A from orange vegetables and red meat – improves your skin, reducing acne. Aim for a portion of red meat (200g kangaroo or 100g beef or lamb) almost every day. Aim to include orange vegetables like carrot, sweet potato and pumpkin in your diet every day.

Protein: Satisfies your appetite, boosts your metabolic speed (making it easier to lose weight). Protein reduces the blood sugar boosting effect of carbohydrates, because it takes much longer to digest. Aim for some high quality protein at every meal, plus protein based snacks.

Zinc from seafood, meat, mushrooms, eggs: Zinc improves your skin and boosts your immunity.

Vegetables: Have a gentle phytoestrogenic action, helping balance your hormones. Green veg will help you generate better looking skin. Most people hold back unnecessarily on their vegetable portions. Aim to include vegetables at every meal. (Like this: Home made baked beans with mushroom and egg for breakfast; a salad for lunch with some animal protein, and a large serve of non-starchy vegetables with your evening meal. Cover half your dinner plate with vegetables.)



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PCOS: After the Diagnosis

Monday, November 12, 2012
You suspected something was wrong: With your menstrual cycle, with your fertility, or you might have been experiencing acne, facial hair growth, or finding it almost impossible to lose weight. So you consulted with your doctor, and she says you have PCOS. As you leave the doctor’s rooms, perhaps feeling shocked and lost, you wonder “what do I do now”? 

In this article are the steps you can take to understand more about the syndrome known as PCOS, and practical steps to take to help you decide on the best treatment for you. You’ll soon feel more informed, more empowered, and ready to take the next step.

First, before you leave the doctor’s surgery, make sure you have picked up a copy of any blood test results; you’ll need to refer to them later in your treatment. If you’ve somehow left without them, phone your doctor and arrange to collect all of them. Start a file.

Next, know that you can choose what style of treatment you want. There are two major treatment groups, orthodox medical and natural, and some parts of these treatments overlap. In many cases you can utilise both forms of treatment, as managing PCOS relies a great deal on lifestyle changes. If you decide that orthodox medical treatment is what you want, your doctor can tell you what medical treatments are available.

If you want to treat your PCOS naturally, your next stop after your doctor’s office is to make an appointment with your naturopath.  If you don’t already have a naturopath, you can locate one easily through the internet – just check that they are accredited with a professional association to ensure they’re actually qualified. In Australia, the ATMS (www.atms.com.au)  is one of the largest accrediting bodies for natural therapists. 

Whichever style of treatment you opt for, medical or natural, you need to become better educated about PCOS to feel fully empowered to choose the treatment that’s right for you. Head over to your local library, and borrow the books that will give you a good overview. Even a brief internet search will uncover PCOS associations and support groups with links to even more information. 

Some of the most powerful treatments for PCOS are based around improving your nutrition and your lifestyle in ways that cause your hormones to become better balanced. The decisions about which changes you need to make depends on your unique situation. To save yourself a lot of time, effort and angst, consulting with a clinical naturopath can provide the information you need to make a difference.  

Feeling a little more empowered now?

What was your experience of diagnosis with PCOS? What did you do?

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Recipe: Chicken leek and mushroom stew for one

Monday, April 02, 2012

As the weather cools, we all naturally gravitate to warmer, ‘comfort’ foods. But you don’t have to eat pies or other fatty foods to feel comforted. This stew cooks quickly, becoming an effective comfort food when served on a bed of mashed sweet potato. Even better, it’s ready within 30 minutes.

Ingredients for one person.

1 clove garlic

1 spring onion

Finely sliced leek, about 25g

1 chicken thigh fillet

One tablespoon cornflour

50g fresh mushrooms

1 cup chicken stock, heated separately.

¼ cup chopped fresh parsley

Method

Cut the chicken into large bite-sized pieces and roll in the cornflour.

Heat a little olive oil in a saucepan and brown the chicken pieces with medium-high heat. Remove to a clean plate.

Turn the heat to low, saute the leek, garlic and mushroom in the remaining oil until soft.

Return the chicken to the pot, add the chicken stock and spring onion and stir.

Simmer gently for 15 minutes, stirring occasionally. The sauce will thicken.

Add the parsley and serve on a bed of mashed sweet potato, with plenty of steamed green vegetables.

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How your hormones work together to create your menstrual cycle

Wednesday, October 26, 2011

Although it seems complex at first, once you understand the interplay of hormones through your cycle, you’ll be able to more easily feel the changes in hormones as they affect your symptoms, especially between estrogen and progesterone. Here’s what happens on each day of a ‘normal’ 28 day menstrual cycle.

Days one to five: The first day of your period is classified as ‘day one’ of your menstrual cycle. While you’re bleeding, all your reproductive hormones are generally present in minimal quantities, although FSH (follicle stimulating hormone from your pituitary gland) is already telling your ovaries to start preparing for ovulation around day 14.

Days five to 13 are known as the ‘follicular’ phase as your ovaries are stimulated by FSH and LH (luteinising hormone) to develop several potential eggs for ovulation. Estrogen levels climb steadily, prompting your pituitary to secrete LH, and also prompting your uterus to grow a new lining, ready for a fertilised egg. One of the eggs, the one with more LH receptors on its membrane, develops more fully and is ready for release by day 14.

Day 14, mid-cycle, is the ‘official’ day of ovulation: A spike of LH from your pituitary gland causes your ovary to release that one matured egg, which then begins its journey down the fallopian tube. LH, having done its job, should then decline rapidly and remain low until early in your next cycle.

You are now in the ‘luteal’ phase of your cycle, which continues from now until your period begins. On your ovary, a collection of cells remains where the egg departed. This is known as the ‘corpus luteum’, and it secretes progesterone for the next week or so. The progesterone sends the message to your uterus to mature and maintain your uterine lining, because the egg may be fertilised and ready to implant.

If the egg is not fertilised, hormonal feedback from the disintegrating egg results in diminishing progesterone production from your ovary, and a fall in oestrogen. The lining of your uterus disintegrates, you experience a period, and the cycle starts again.

This is a description of a perfect menstrual cycle. PCOS cycles are often less than perfect, or don’t happen at all for several months.



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