Postpartum Symptoms That Never Left with Dr. Alexandra MacKillop

She goes, well, of course you're tired. You just had a baby. That's not what I was talking about, right? Of course you're tired. Sleeplessness and deep bone-aching fatigue are not the same thing.

I want every woman over 40 listening to me right now to think back, not to last month, not to when your periods started becoming irregular, Not to when you first noticed the belly fat, the poor sleep, the brain fog, anxiety, or hormone changes. I want you to think back further. What happened after you had your babies? Did your hair fall out and never completely come back? Did you become anxious for the first time? Did you develop constipation that you didn't struggle with before? What about your thyroid? Did it start acting differently? And did your periods become heavier? I hear that all the time. Okay, lastly, did you develop insulin resistance after having gestational diabetes and just assumed it was all normal? Well, of course I'm tired. I had a baby. Of course I can't get rid of the weight. I had a baby. We're going to talk about sex being painful, leaking urine, that weight you can't lose, so many crazy things, depression, which is something I struggled with. It is not just a postpartum issue, ladies. This continues on way after postpartum. And so we are talking about it today. You moved on 'cause your baby's got older, but your body is still struggling. So let's get into it.

Woo, this is gonna be such a good episode today. I'm so excited about it. And I know that if you're listening right now and you're like, I had a baby 20 years ago, it doesn't matter how long ago it was. You need to hear this episode because what you're feeling today probably started back then, whenever that was.

Oh my gosh, it's so good. And there are women who haven't had children, right?

Right.

But they've been struggling since they started their period, since menarche. Like, they've never felt their hormones have been in balance, especially if you've been diagnosed with PCOS, now called PMOS. Like, this episode is for every woman. I think the foundational understanding has to be That things develop over time.

Yeah.

And they don't just automatically go away because time has lapsed. So exactly.

I also feel like, um, when I was prepping for this episode, we've come really far in women's health for what they tell them after they give birth. So for example, um, my son started high school today and I feel like just this year I really fixed my pelvic floor and I had a C-section. However, I have been blessed with 3 adult children from my husband. And so I have a grandson. And when my daughter-in-law gave birth, they sent her to PT the next week. And I was like, wait, you're going to PT already? I was like, this is amazing. So things really have changed. But those of us in, you know, like me, I've been struggling for 15 years. And so I'm so grateful that things have changed. But those of us who have been struggling, there's hope for us. We need to do stuff still. And it's okay to use the excuse of like, I had a C-section.

Thank you for sharing that. That is really important for women to understand. And I have shared that my first delivery, I had a 4th-degree tear. You ladies who have had issues like that, you know what that means.

Yeah.

You don't just bounce back. You don't. You're just not normal after that. And like you, there was no physical therapy. There was nothing. There was no exam. I got stitched up and sent on my way and have been struggling ever since. So we are making progress. I'm excited about that. But nobody's connecting the dots for women. Nobody is helping them understand the significance of the postpartum period. And so we have a guest today.

Yeah.

She is dropping an amazing book, The Postpartum Check-In. I'm so excited because literally this is not only for women who just had a baby. It's for all of us.

Yes, it is.

So I'm really excited. Oh my goodness. Dr. Alexandra, welcome to the podcast.

Thank you so much. It's such a joy to be here.

Oh my gosh. If anybody watched the Midlife Reset Summit that we put on last year, it was a 5-day live virtual summit. You were an amazing guest. And, um, by the way, that summit is still available. There is so much amazing content, like 50 Experts talking about perimenopause from a faith perspective.

Yes.

So good. Oh my gosh. But Dr. McKillop was such a joy to have on that summit because we really talked about irregular periods and all the things women struggle with before going into menopause. But now she is serving a new audience. This is so good. Like, she's all things baby infertility, but I really think like this book is going to bless all women. And not just women who have just had a baby. Like you said, you're doing PT 15 years later. What the heck?

It's okay. Things are good now. You know, he'll graduate high school and I'll graduate PT. It'll be great. Oh my gosh.

Okay, so let's see. What made you write this book, Alexandra?

Yeah, I— the simple answer is all of my patients. Right? You know, I see primarily women, and I joke that I don't send out screeners to prospective patients to say you have to be a woman in your 30s, 40s, 50s to be my patient. That's just kind of what happens because unfortunately a lot of people fall through the cracks, right, in the medical system. And so my patients will come and they'll tell me, hey, I've been struggling with this problem. And you know, when you, when you conduct a patient interview or you have that first appointment, you know, tell me when did this start? And so many times I was hearing the same thing over and over again. Well, you know, shortly after I had my first baby or after my last baby, or, you know, I had a baby later in life and maybe it's related or not, I don't know. And I always— it gave me pause to hear things like that from my patients because when I was in school, I was taught that the hormone shifts associated with pregnancy and childbirth or any hormonal shift in a woman or female's life can predispose them to problems in other avenues of their health because our hormones talk to so many other parts of our bodies. And I started to realize, wait a minute, if all these women are having problems that started around these major hormonal shifts in their lives and it's not getting diagnosed until now, it means that there is something majorly missing in postpartum care. So I took a look at some of what the current recommendations are and I started to find these really upsetting paradoxes where, for example, the American Thyroid Association would suggest a woman with anti-thyroid antibodies, so that corresponds to a condition called Hashimoto's. It's a thyroid disorder. If a woman has those antibodies, she should be tested for her thyroid function every month in the first half of her pregnancy and then postpartum. But they don't recommend broad screening of the population for anti-thyroid antibodies. And so I thought to myself, well, how is somebody supposed to know if they have anti-thyroid antibodies if it's not being screened routinely? And, you know, in my world, I work in functional medicine. Anti-thyroid antibodies, full thyroid panels, autoimmune screenings, nutritional screenings, that's like basic level intake, right?

Basic.

So in my vocabulary, I already know if you have anti-thyroid antibodies, but not every woman has the privilege of ever being seen by someone who's so thorough with their health. So I, you know, in my own experience, I have felt dismissed by medical providers, and because I'm a physician, I could advocate for myself, but not everybody can say that, and not everybody knows what they need to ask for. So I said to myself, hey, I'm going to make a handbook for women who feel intuitively that something's not right with their health, but they, they've been sort of dismissed by their providers— well-meaning providers, right? You know, we don't want to over-medicalize women and childbirth and hormone shifts, but that sometimes comes at the expense of catching very real health conditions. So I wrote this book, The Postpartum Check-In, to help women understand what's changing everywhere else in my body when my hormones change. And what do I need to be on the lookout for so that I could catch an emerging health problem earlier rather than having to wait a year or 10 years to get a diagnosis that's causing suffering in the meantime?

Absolutely. So we joke about the fact that the intake form of our medical practice is like 100 pages or something. I mean, it's not really, but it feels like it. And so much of it is your female history, not only like when did you start your period, how are they, what kind of birth control history have you had, but like details of your pregnancies, not only how you had your baby, but what kind of diagnoses did you have? Because if you've had preterm labor, if you've had preeclampsia, gestational diabetes, thyroid disease, we know as functional providers that that is currently potentially impacting your health right now and going forward. So I would love to talk about this because I think some women are probably going to be really surprised hearing this today. Something as simple as, I had gestational diabetes, but it was diet controlled and they told me not to worry about it. And we're supposed to do a glucose challenge test after delivery, but By and large, that is not being done, right?

Yeah. Yeah. I've never had a patient who even had that appropriate a follow-up after a pregnancy condition. You know, we focus so much on the imminent sort of acute illnesses that can pop up postpartum, and obviously, we need to be aware of those things. Postpartum preeclampsia, for example, you know, those are urgent. But we miss the things that are chronic and affect quality of life or predispose to some of these other diseases that do eventually become urgent.

I feel like we do so many doctor's appointments when we're pregnant, and especially towards the end. And then it's like, we'll see you in 6 weeks. And then it's like, hey, I hope everything's good. Good luck out there. And it's so wild to me. You get all this attention and then you finally give birth and then there isn't any attention. The attention's all on the baby, which is important, but you are important too.

Yeah, I think that's part of the struggle is that all of a sudden you're going to the pediatrician every week, you know? So you still have doctor's appointments, but they're no longer focused on you.

Yeah, that's so true.

And so yes, things get forgotten. And I have seen countless times women who they should have had their thyroid medication adjusted and it didn't happen, right? So I would love for you to talk about like what are the What are some of the biggest things on this checklist that women probably don't realize they need to even know about?

Yeah, yeah. So I outline a handful of conditions in the book. Those would be autoimmune disorders, which can pop up postpartum or around other major hormone shifts, thyroid disorders, insulin resistance being one of them, nutritional deficiencies or other types of problems. overdoing it with certain nutrients, and then mood challenges. So things like postpartum anxiety, postpartum depression, which can be exacerbated by all those other conditions and, and the like.

Oh my gosh, depression and anxiety. I saw that all the time in my postpartum patients. I remember one woman in particular, she was at her 6-week checkup And she just wanted to divorce her husband. And this was a woman who was in her 20s, and she loved her husband. They were like the most beautiful little couple, but it was their second baby. And she was like, I don't want to look at him. I don't want to touch him. I make him sleep in the living room. And I was just like so dumbfounded. Like, what happened? He's been at all the appointments. Like, they're so happy. And something inside of me Realized, okay, she's breastfeeding. She's on the quote unquote mini pill, which is progestin only because you can't have estrogen when you're breastfeeding. And I just thought, we should check your testosterone level. And I was like, okay, don't do anything drastic. Just don't even talk to your husband until we get this level back because I'm really curious. And she had like zero testosterone. And I just Something inside me knew that this was contributing to the way that she was feeling, and most doctors would have just called it depression, given her Zoloft, and you know sent her on her way. But I was like, let's try to get you off this progestin. Let's do a Paragard IUD with no hormones and see if your ovaries come back online and start producing. And I'm telling you. I believe that saved her marriage, and it— or at least it definitely saved her at least a year of her life being miserable and creating damage in her relationship. And I, I just— I've never forgot that lesson. So I'm so excited that you are sharing this message with the world because women need to understand, like, it is not necessarily What we think it is, right?

Yeah, absolutely. You have to look deeper. You have to connect the dots and remember, as you brought up, you know, in, in the beginning here, that history of your health and how that all predisposes your health to evolve over time, right?

Yeah. So, okay, we got this checklist. We, we know that we need to look at the different systems, but how do these manifest? So, say somebody had gestational diabetes, they had their baby, they're living their life. What do we start to see creep in or happen?

Yeah, so one of the big things we want to be on the lookout for with gestational diabetes is potentially that insulin resistance. Insulin resistance always occurs to a, to a small degree during pregnancy. It's part of the physiology of Growing a baby and putting on body fat during pregnancy, but that's supposed to go away when you get rid of the placenta. So placenta delivery, I am also delivering away my insulin resistance. Well, if that doesn't happen, then we, we continue to feel those symptoms associated with insulin resistance. So difficulty losing weight or weight fluctuations that don't make sense, potentially irregular cravings, signs of inflammation. So Swelling, redness. Sometimes we see hot flashes, or a woman may have downstream effects of that insulin resistance and its impact on production of ovarian hormones, thyroid hormones, adrenal hormones. So we see things like fatigue, extreme fatigue, the type of fatigue where people say it's like my batteries were taken out. You know, I sleep and I don't feel more energized, right? It's a different sort of sleeplessness— or a different sort of fatigue from sleeplessness, right? So things like that. And, you know, women should feel differently as a new parent compared to how they did before, but there's always going to be some degree where we know intuitively for ourselves that, hey, this is different from what normal feels like, right? I feel like something is off versus I just noticed that my body has changed or my life has changed, right? So what we want to do with someone with those symptoms is we want to say, hey, okay, we recognize that many postpartum symptoms are normal, but we don't want to take for granted that they're normal just because they may commonly occur in a given population. And then so we want to do some testing to take a look at how your body is functioning in that situation. And that's true of any of the postpartum conditions that could be triggered by pregnancy and childbirth and hormone shifts, or that could persist for a long time following postpartum. And we want to have a plan to say, hey, we're going to screen people so that nothing slips through the cracks.

Real quick, I just want to interrupt this conversation for something super important. Even though we need to take care of ourselves spiritually, emotionally, and physically, we do have to take care of ourselves at a cellular level. And that is why I have my Fast2Face supplement line. So let's just take a minute to hear about something that might be the game changer that you need in this season. We really need to uplevel how we're taking care of our temple. I used to treat mine like a garbage can. I will just be honest. And I'm not okay with that anymore. So This is one of the most important things to me is that I'm taking high-quality supplements that are actually doing what they say they're doing. And I'm getting my money's worth and I'm not making my body worse by putting the wrong stuff in it. So let's talk about Hormone Tame Essential Multivitamin, because even though it gives you all the vitamins and minerals you need, there's extra goodness in there, isn't there? I think you have a bottle sitting next to you.

I do.

Tell us about Hormone Tame.

Hormone Tame is 5 products in one. If you listen to the other episode, one of the things that we talked about is oftentimes women are people who are taking a lot of supplements. And the nice thing about a lot of the supplements that we have here at Fast to Faith is that they're just so consolidated where you could take this and you are basically taking 5 products. So yes, this is going to be a multivitamin, but there is so much more. We actually kind of refer to it as a multivitamin on steroids. One of the key things that this is going to be helping is your mitochondria. All you need to know is that they are responsible for so many systems and processes in your body. The reason that we need supplements is because we're just supplementing areas that we just can't really kind of get with our food. So we're filling in those gaps. And so Hormone Tame is inviting the body to just fill in all of those gaps. So you got to fill those gaps. Hormone Tame will help to do that.

Yeah, absolutely. I want to hear about preeclampsia, gestational hypertension, because that often gets diagnosed. It affects their delivery. A lot of women get induced because, oh, my blood pressure went up. They said I have to deliver the baby. They get induced, and then nobody really talks about it again after the postpartum period and it's It is actually a risk factor for cardiovascular disease in the future. You need to remember that you had a blood pressure issue, that your cardiovascular system couldn't handle the pregnancy as healthy as it should have, right? So what do we do in, in that scenario?

Yeah, so many things, right? So we, we don't want to fall into a situation where we say, oh, you know, it's your fault that you didn't do something right during pregnancy and this developed. But we do know that there are certain predisposing factors during pregnancy that lead to the development of these conditions of pregnancy— preeclampsia, hypertension of pregnancy. And if we don't address those risk factors, then they are the same things that will cause cardiovascular disease later in life, right? It's sort of this early red flag warning sign, like something's not happy in your body that we need to take another look at. And if we don't take a look at it, then you're on this trajectory for that development of chronic disease. We even have studies that show a relationship between nutritional insufficiency during pregnancy and the development of some of these conditions. And those are the same relationships that we see for cardiovascular disease. So for example, deficiencies of micronutrients, things like magnesium and zinc, potentially even iron and B vitamins, As well as antioxidants, as those predispose to development of nitrous oxide and just other things that regulate our blood pressure. Sometimes it's an exercise-related anti-inflammatory type of control issue, so we don't have the healthy lifestyle strategies in place and our health is suffering when we're under increased demands of pregnancy, and then those can predispose to later in life as well. You know, when I was in school, we— when we were talking about joint pain, you know, this is a little bit of an aside, but They said pain develops or injury develops to a joint when you have a healthy joint with an abnormal stress or a normal stress on an abnormal joint, and then you can potentially injure that joint, right? And I think it applies to physiology and the scenarios of pregnancy or even perimenopause as things are acutely shifting. You know, if you have an abnormal or unhealthy lifestyle behavior applied to a healthy body, over time that's going to lead to metabolic injury. Or you could have a normal stress applied to an abnormal state. So pregnancy is not our typical state. The acute fluctuations of perimenopause are not our typical state. If we combine those 2 things, then we're going to potentially have this abnormality present itself. And so we get a little peek into the window of what can our body handle by putting it under this acute stress like we see in pregnancy or a major hormone shift. It's almost like a stress test.

It absolutely is, 100%. It is a stress test, and we need to pay attention to the results of that test for sure. I'm just having flashbacks of so many patients, and it's heartbreaking to me because even though OB-GYNs have gotten to the point where we now test vitamin D at the beginning of pregnancy and we test hemoglobin, looking indirectly for low iron or anemia. We still don't do a good job at actually helping replace those vitamin and mineral deficiencies. We don't ask the question, why is this happening and what can we do about it? We just say, go to your local CVS and get some iron over the counter or get a vitamin D supplement. Like, we really do not understand as OB-GYNs The ends, the physiology that is happening—that your low vitamin D is actually increasing your risk of developing gestational hypertension and cardiovascular disease. Like there is this disconnect still happening. So I just find your book really, really important and really essential for women to understand that we're we're talking to a sick care medical system. And by and large, pregnancy is a healthy state. It is a physiological stress, but our bodies should be able to handle it. And we need to come at it from like, okay, we can naturally support it. We need our diet to be evaluated and changed, probably. We need to talk about environmental things. We need to talk about all these things, right? So we could go into that. That would be a whole nother episode. But I would love for you to also talk about the thyroid, 'cause I would say the big 3 are gestational hypertension, preeclampsia, gestational diabetes, and then thyroid. You mentioned like the majority of women are not getting thyroid antibody levels checked. And that just, you know, angers me because I developed Hashimoto's after my pregnancy and delivery at 17, and it has affected my entire life. Thankfully, my doctor was a DO, and he knew to check antibody levels. Back in the day, DOs actually didn't practice like MDs. They were very much mind, body, and soul. And so I feel blessed that he actually gave me that diagnosis. But you're right, there are probably millions of women who develop this autoimmune condition from postpartum and no one's telling them, right? So can you talk about that?

Yeah, yeah. So a big part of my practice in general, but especially in the postpartum period, is to do those early thyroid screenings. Now, there is a subdemographic of women who get a little extra thyroid care, and that's the IVF community.

Yes.

Because many of them are put on thyroid medication because we know in the research how essential proper levels of thyroid hormone are for conception and sustaining a pregnancy. I'm digressing a little bit, but the majority of people maybe don't get that active care preconception. They don't really know what's going on with their thyroid. Now, we do have a standard screening around the end of the first trimester to test you know, how's your thyroid doing? And whether or not those lab ranges are sufficient to capture all thyroid conditions is a different story for a different time. But let's say that a woman has a standard pregnancy. She conceives without additional medical intervention. She carries her pregnancy to term. She was never put on thyroid medication during her pregnancy. Nobody looks at her thyroid again, right? There is no standard plan in the in the world of obstetric medicine to follow up with a normal pregnancy, a normal uncomplicated conception, pregnancy, and delivery to look at her thyroid unless she develops really overt symptoms or she goes in and she's advocating for herself asking for it. But those thyroid symptoms, thyroid-related symptoms include anything from weight changes, fatigue, hair loss, right? Just to share from my own experience, I alluded to this a little bit earlier and I definitely talk about it in my book. I developed postpartum thyroiditis and I knew what it was, right? So when I went into my primary care office and I was explaining this to my provider, I already knew what I needed to have tested. I knew what I needed as far as follow-up. I needed some labs done ultimately. And what she first said to me when I said, look, I'm so tired and I know something's off, she goes, well, of course you're tired. You just had a baby. That's not what I was talking about, right? Of course you're tired. Sleeplessness and, and deep bone-aching fatigue are not the same thing. And not everybody knows to be able to differentiate among those things, because if you look online at normal postpartum symptoms, it could list anything, right? I mean, I almost laughed. The Cleveland Clinic listed things as vague as pain on their list of normal postpartum symptoms. What kind of pain? Where is the pain? What does the pain feel like? How long has it been there? When did it start? That could be, I have appendicitis, or it could be, I bumped my elbow while I was walking through the hallway. You know what I mean? It's frightening, actually, how normalization of so many of these intense postpartum experiences could lead someone to just think their thyroid blowing up on them postpartum is normal. So what should a woman do postpartum is they should ask for, and that's what I advocate for in my book, is to be the standard, to look for the full thyroid panel including free and total T3, free and total T4, TSH, and then those thyroid antibodies. Pregnancy is one of the unique times in a woman's life because not only is there the hormone shift, but there's the immune system shift as well, and then the nutritional demands. So you're kind of at risk of developing Really 3 or 4 depending on how you look at it, different types of thyroid disorders because of this postpartum condition. And if you never have that diagnosed in that acute postpartum time, you're going to be dealing with a thyroid issue for the rest of your life. And then it, you know, let's say you enter perimenopause and you have this another heightened hormonal experience and you start to feel really out of sorts and someone then tells you, well, that's normal for perimenopause. Right? What are you supposed to do with that if you don't, if you're not equipped with the tools to get what you need for appropriate healthcare?

Yeah. So what are you thinking, Ashley? You're like, oh my gosh, I haven't even checked this. Or do you feel like you got a good workup? Or yeah.

So here's actually what I'm thinking about is all the women that we serve and all the women who are, who listen to our podcast or participate in Fast of Faith. Sometimes we silo things. So we talk about this a lot here on the podcast about how it's important when you're working with us at the medical practice that even if you go to the dentist and they— you have to get a cavity filled or they want to put you on antibiotics, that you let us know. And so I look at this as we have to stop siloing what happened in our pregnancies. Even though some people listening to this, that was 30 years ago, they need to tell their now primary care. They're probably not going to the same OB that they did 30 years ago. So they need to tell their primary care or whoever they're seeing, even if it's a functional doctor, what happened during their pregnancy. That is why we have them fill out that 45-minute intake form, because we want to know what happened in your pregnancies, 'cause it does matter. All these things impact. So that's what I'm thinking about is we have to stop siloing our healthcare, and we have to let the doctors that are serving us now, 30 years later, know what happened to us.

That's so good. Oh my goodness. Yeah, whatever you're struggling with right now, it didn't just start right now. Yeah, it didn't just start with perimenopause.

And I guarantee that if you're listening to this and you've got a group of perimenopause friends like I do, I'm thinking about like, I know you had preeclampsia, I know you had gestational diabetes, like you actually still talk about it. And you know, I'm like, oh crap, like they need to do this. So I feel like we should end with a fun little like rapid-fire game where we ask Alexandria a question and it's something that women experience after babies and you can tell us, is it normal? Is it common but deserves attention? Or does it need evaluation? How does that sound?

That would be amazing. Let's go.

Okay. All right. Are you ready? All right. So exhaustion after having a newborn.

Oh my, uh, I think that category of could be normal but needs evaluation.

All right, I love it. Okay, exhaustion that persists for years?

Never normal.

Some urinary leakage immediately postpartum?

Okay, so common, never normal. Everybody should be allowed to have this evaluated right away. I'll just add my additional qualifiers on there.

All right, so No. Temporary postpartum hair shedding.

Potentially normal depending on the magnitude and the type. You know, if it's a little bit around the hairline and it is self-limited within a couple of weeks, probably normal. If it persists, if it's patchy, if it's diffused throughout the scalp, Definitely needs a workup.

Okay, so what if it's been 30 years and my hair never recovered?

Not normal. Usually an additional layer of consideration needs to be taken.

All right. Mood changes during—

Your hair looks beautiful though.

Thank you. Mood changes during a major hormonal and life transition.

Yeah, so of course that's going to take an emotional toll. There's a spiritual toll. The baby blues are differentiated from postpartum depression by the amount of time time, so they should, you know, resolve within 2 weeks and not persist longer than that. And it's that first 2 weeks. Mood shifts that are profound that develop sometime thereafter definitely need to be evaluated.

Awesome. And you mentioned the spiritual health, and I think that's how Dr. Tabatha is going to wrap us up here today.

Oh my gosh, do you want to say anything before we close?

On the note of spiritual health, I just, I feel very strongly that God made our bodies with wisdom. I don't think he makes mistakes, and he also allows us the tools that we need to be able to sense, hey, there's a disconnect somewhere here. And so I just think that in my study of medicine, it has just led to worship of our Creator and his incredible design, his wisdom, his intelligence, and his love for us.

Ooh, amen, girl. I love that. That is so good.

Yeah. And go and get, um, your book because I will be buying it for everyone who gives birth in the future, and I might even buy it for my perimenopause friends.

I love it. It's so good. Yes, the link is in the show notes. Get your postpartum check-in. But I want to leave you with this scripture to meditate on this week. Psalm is so beautiful. 139, Psalm 139:13-14. I want you to just really talk to God about this because Dr. Alexandra is correct. For you are created my inmost being. You knit me together in my mother's womb. I praise you because I am fearfully and wonderfully made. Your works are wonderful, and I know that full well. If you start believing that your body is full of wisdom and intelligence, and it was made so beautifully and designed to actually get you through and thrive, not just survive, you will start to shift and show up differently. You will stop carrying disease, and you will start healing. So. I pray that you meditate on that scripture this week and really just thank God for the body that he gave you because it is beautifully and wonderfully made. Thank you, Dr. Alexandra.

Thank you so much. Have a good week, ladies.

Thank you.

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