Month: May 2022

Infertility is a remarkably common problem. It affects up to one in five people in the US who are trying to become pregnant, and 186 million people worldwide. A thorough medical evaluation can spot key contributing issues in many cases — whether in a woman, a man, or both partners — that might respond to treatment, or call for assisted reproductive tools like in vitro fertilization (IVF).

But in a substantial number of cases, no cause is found for infertility. Could inflammation be to blame for some of those cases, as recent research suggests? And if so, will an anti-inflammatory diet or lifestyle boost fertility?

Exploring the connection between inflammation and infertility

Chronic inflammation has been linked to many health conditions, such as cardiovascular disease, stroke, and cancer.

While its importance in infertility is far from clear, some evidence supports a connection:

• The risk of infertility is higher in conditions marked by inflammation, including infection, endometriosis, and polycystic ovary syndrome.
• Bodywide (systemic) inflammation may affect the uterus, cervix, and placenta, thus impairing fertility.
• Women with infertility who had IVF and followed an anti-inflammatory diet tended to have higher rates of successful pregnancy than women who did not follow the diet.

Could an anti-inflammatory diet improve fertility?

It’s a real possibility. Decades ago, researchers observed that women following a prescribed fertility diet ovulated more regularly and were more likely to get pregnant. Now a 2022 review of multiple studies in Nutrients suggests that following an anti-inflammatory diet holds promise for people experiencing infertility. The research was done years apart, but the diets in these two studies share many elements.

The 2022 review found that an anti-inflammatory diet may help

• improve pregnancy rates (though exactly how is uncertain)
• increase success rates of assisted reproductive measures, such as IVF
• improve sperm quality in men.

The authors add that improving diet might even reduce the need for invasive, prolonged, and costly fertility treatments. However, the quality of studies and consistency of findings varied, so more high-quality research is needed to support this.

Will adopting an anti-inflammatory lifestyle improve fertility?

While recent research is intriguing, there’s not enough evidence to show that an anti-inflammation action plan will improve fertility. A plant-based diet such as the Mediterranean diet, and other measures considered part of an anti-inflammatory lifestyle, improve heart health and have many other benefits.

It’s not clear if this is directly due to reducing inflammation. But this approach comes with little to no risk. And abundant convincing evidence suggests it can improve health and even fight disease.

What is an anti-inflammatory lifestyle?

Health experts have not agreed on a single definition. Here are some common recommendations:

• Adopt a diet that encourages plant-based foods, whole grains, and healthy fats like olive oil while discouraging red meat, highly processed food, and saturated fats.
• Stop smoking or vaping.
• Lose excess weight.
• Be physically active.
• Get enough sleep.
• Treat inflammatory conditions, such as rheumatoid arthritis or allergies.
• Avoid excessive alcohol consumption.
• Control stress.

Anti-inflammatory medicines may help in certain situations — for example, treatments for autoimmune disease. However, they are not warranted for everyone. And for people trying to conceive, it’s far from clear that any potential benefit would exceed the risk of side effects for parent and child.

The bottom line

It’s possible that inflammation plays an important and underappreciated role in infertility and that an anti-inflammatory diet or lifestyle could help. But we need more evidence to confirm this. Until we know more, taking measures to improve your overall health and possibly reduce chronic inflammation makes sense.

About the Author

Robert H. Shmerling, MD,

Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Hot flashes and sleep or mood changes are well-known, troublesome symptoms that may occur during perimenopause and menopause. Now, one survey suggests nearly 80% of midlife women use cannabis to ease certain symptoms, such as mood issues and trouble sleeping.

Mounting numbers of US states have legalized marijuana for medical or recreational use in recent years. This wave of acceptance runs alongside skepticism in some quarters concerning FDA-approved menopause treatment options, including hormone therapy. But a lack of long-term research data surrounding cannabis use has led one Harvard expert to question how safe it may be, even while acknowledging its likely effectiveness for certain menopause woes.

“More and more patients tell me every year that they’ve tried cannabis or CBD (cannabidiol, an active ingredient in cannabis), particularly for sleep or anxiety,” says Dr. Heather Hirsch, head of the Menopause and Midlife Clinic at Harvard-affiliated Brigham and Women’s Hospital. “Adding to its appeal is that cannabis is now legal in so many places and works acutely for a couple of hours. You don’t need a doctor’s prescription. Socially, it may be easier to justify than using a medication. But why is there a movement toward saying okay to something that has unknown long-term effects, more than something that’s been studied and proven safe?” she asks.

Survey reports on who uses cannabis, why, and how

The new Harvard-led survey, published in the journal Menopause, looked at patterns of cannabis use in 131 women in perimenopause — the often years-long stretch before periods cease — along with 127 women who had passed through menopause. Participants were recruited through online postings on social media sites and an online recruitment platform. Nearly all survey respondents were white and most were middle-class, according to income reporting.

The vast majority (86%) were current cannabis users. Participants were split on whether they used cannabis for medical reasons, recreational purposes, or both. Nearly 79% endorsed it to alleviate menopause-related symptoms. Of those, 67% said cannabis helps with sleep disturbance, while 46% reported it helps improve mood and anxiety.

Perimenopausal women reported worse menopausal symptoms than their postmenopausal peers, as well as greater cannabis use to address their symptoms. More than 84% of participants reported smoking cannabis, while 78% consumed marijuana edibles, and nearly 53% used vaping oils.

One glaring limitation of the analysis is its self-selected group of participants, which lacked diversity and might skew results. But Dr. Hirsch wasn’t surprised by the high proportion reporting regular cannabis use. “I wouldn’t be surprised if those numbers reflect the broader population,” she says.

How might cannabis help menopause symptoms?

It makes sense that midlife women reported cannabis improves anxiety, mood, and sleep, Dr. Hirsch says. The drug likely helps all of these symptoms by “dimming the prefrontal cortex, the decision-making part of our brain.”

For many women, anxiety spikes during perimenopause, she notes. Common stressors during that time, such as aging parents or an emptying nest, add to the effects of dipping hormones. “It’s that feeling of, ‘I can’t turn my brain off.’ It’s really disturbing because they get in bed and can’t fall asleep, so they’re more tired, moody, and cranky the next day,” she explains. Dimming the prefrontal cortex enables people to calm down.

Hot flashes, often cited as the most common menopause symptom, did not improve as much from cannabis use, according to survey respondents. That too makes sense, Dr. Hirsch says, because the hypothalamus — the brain region considered the body’s thermostat — isn’t believed to be significantly affected by the drug.

No research yet on long-term effects

Given a lack of clinical trials objectively testing the effectiveness and safety of cannabis to manage menopause symptoms, more research is clearly needed.

“If people are finding relief from cannabis, great. But is it safe? We think so, but we don’t know,” she says. “There are no studies of middle-aged women using cannabis for 10 years, for as long as menopause symptoms often last. Are there going to be long-term effects on memory? On lung function? We don’t know.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon