Dr. Lora Shahine

Dr. Lora Shahine Reproductive Endocrinologist, Director of the Recurrent Pregnancy Loss Program at PNWF in Seattle, author Not Broken: An Approachable Guide to Miscarriage

08/05/2026

Fertility is complicated and nuanced

Nutrition, lifestyle, habits are important but one energy drink isn’t the issue

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Curious about fertility? Comment here or DM me with ‘Fertility101’ (no spaces) for my free ebook with answers to 101 of the most common questions on fertility, ovulation, miscarriage, IUI, IVF, endometriosis, and PCOS. Be sure to follow for me to DM link to you.

Educational proposes only - talk to your doctor about your personal situation

08/05/2026

She thought she got her period. She’d been pregnant the whole time.

This happens more than you’d think — and here’s the part most people never hear.

We all say “implantation bleeding” like it’s settled science. It isn’t. When researchers tracked daily hormone samples in 151 pregnant women, most bleeding episodes occurred at least five days after implantation had already happened. Their conclusion, word for word: they found no support for the idea that implantation produces vaginal bleeding. (Harville et al., Human Reproduction, 2003)

So what is it? Early pregnancy bleeding — which is real and common, affecting up to 1 in 4 pregnancies. We just tend to name it “implantation” afterward, because it makes a tidy story.

Which is exactly why you can’t sort this out by vibes.

What should make you suspicious 👇
Your period has a shape: it starts light, builds, you pass clots, it lasts days, you’re changing products.

Early pregnancy bleeding usually doesn’t do that — it’s light, pink or watery, it doesn’t build, and it’s often over in a day or two. Spotting where a period should be.

The only tip that actually matters: if the bleeding isn’t your typical period, take a pregnancy test.

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This is for educational purposes — ask your doctor about your situation.

08/04/2026

Ovulation to luteal: the two-week personality change nobody warned you about.

Full breakdown in the reel — here’s what didn’t fit:
How to know you’ve ovulated (without an app guessing for you): your basal body temperature rises about half a degree and stays up. That temperature shift is progesterone. It’s the
most reliable free signal your body gives you.

When symptoms peak: not right after ovulation — most people feel fine for the first week. It’s the final 3–5 days, when estrogen and progesterone both fall off a cliff, that the bloating, breakouts, and mood shifts land hardest. If you’re tracking, that’s the window to protect.

The hunger is real, and it’s measurable. Your resting metabolic rate rises in the luteal phase.
You are not “losing willpower” the week before your period. You need more food. Eat it.

Two things with actual evidence behind them: calcium (~1,200 mg/day) has been shown to
reduce PMS symptoms, and NSAIDs work better when you start them before the cramps begin,
not after.

One honest caveat on “cycle syncing”: the hormone shifts are real, but the rigid workout-and� food-by-phase plans you see online are mostly extrapolation, not evidence.

Track your pattern.

You’re the study.

And the line I want you to sit with: premenstrual symptoms are common. Symptoms that damage your relationships, your work, or your sense of self are not something to endure. That’s PMDD, and it’s treatable.

Tell me: what’s the one luteal-phase symptom that always catches you off guard?

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Educational content, not medical advice.

07/31/2026

Your period didn’t come. Now what?

First: take a pregnancy test. Even if you’re sure. Even if you’re on birth control. Rule it out first

Then consider the rest — because a missing period is rarely random.
🧠 Stress, undereating, or overexercising (hypothalamic amenorrhea — your brain shuts down ovulation when it senses there isn’t enough fuel)
⚪ PMOS (PCOS) — the most common cause of chronically irregular cycles
🦋 Thyroid disease — a simple blood test
💊 High prolactin — from a medication, or a small pituitary tumor
⏳ Perimenopause — normal in your 40s, but not before 40
🏷️ Contraception, breastfeeding, big weight changes, or one genuinely brutal month

Call your doctor if:
⚠️ No period for 3 months in a row, or fewer than 9 periods a year
⚠️ Your periods stop before age 40
⚠️ You have ni**le discharge, headaches, or vision changes
⚠️ Your period never returned after a uterine procedure
⚠️ You’re trying to conceive

Here’s why it matters. A missing period isn’t just an inconvenience — it’s information.
Chronically absent cycles can mean low estrogen, which costs you bone density. Or, in PMOS/PCOS, a uterine lining that never sheds — which carries its own long-term risks. You can’t address what nobody’s named.
One skipped cycle after a hard month is usually just that.
A pattern is a message.

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Educational content, not medical advice.

07/29/2026

Cycle bloating explained
Finally!

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07/29/2026

Do you know how much blood you actually lose during your period? Most people have no idea and that’s exactly why heavy bleeding goes undiagnosed for years.

The average is about 30–40 mL per cycle. That’s 2 to 3 tablespoons. Total. For the whole period.

More than 80 mL (about a third of a cup ) is heavy menstrual bleeding. That’s not “just a bad period.” It’s a diagnosis, and it has treatable causes.

How to estimate with what you already use:
🩸 Fully soaked regular pad or tampon ≈ 5 mL
🩸 Fully soaked super pad or tampon ≈ 10 mL
🩸 Most menstrual cups hold 20–30 mL and have measurement lines
🩸 80 mL ≈ 16 fully soaked regular products in one cycle

Talk to your doctor if:
you’re soaking through a pad or tampon every hour for several hours,
doubling up on protection,
setting an alarm to change products overnight,
passing clots bigger than a quarter,
bleeding longer than 7 days, or
filling a menstrual cup every 2–3 hours.

And if you’re exhausted, dizzy, short of breath, or craving ice: these can be signs of anemia

Fibroids, polyps, adenomyosis, thyroid disease, and bleeding disorders are all treatable.

Heavy bleeding is common, but common is not the same as normal.

You don’t have to plan your life around your period.

📚 The 30–40 mL average and the 80 mL cutoff come from Hallberg et al., Acta Obstet Gynecol Scand 1966 — the population study that still defines the threshold today. ACOG uses >80 mL per cycle to define heavy menstrual bleeding, but also emphasizes that bleeding counts as heavy if it disrupts your quality of life you don’t have to hit a number to deserve care.

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Educational content, not medical advice. Talk to your own doctor about your bleeding.

07/28/2026

Bloating before you cycle It’s not weight gain. It’s physiology.

After ovulation, progesterone rises — and progesterone relaxes smooth muscle. Your gut is smooth muscle.

Everything slows down: slower transit, more gas, more constipation. That’s not fat, that’s transit time.

Meanwhile, shifts in estrogen and aldosterone signal your kidneys to hold onto sodium and water. That’s the 2–5 lb swing on the scale. It’s fluid. It leaves.

Then your period starts, progesterone drops, and prostaglandins surge — the same chemicals that make your uterus cramp also act on your bowel.

Hello cramping, urgency, and “period poops.” It’s also why the bloat often deflates once bleeding begins.

What can help:
🚶‍♀️ Movement
💧 Hydration
🌾 Adequate fiber
💊 NSAIDs started before cramps begin, since they block prostaglandin production

If premenstrual symptoms are wrecking your life every month, that’s not something to just tolerate — hormonal options can help. And bloating that never resolves isn’t cyclical bloating. Talk to your doctor.

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Educational content, not medical advice.

07/25/2026

“Male birth control trial shut down because men couldn’t handle acne.” 🙄

The real story is more interesting.

Here’s what actually happened:
📍 The trial ran from 2008 to 2012. 320 men, a hormone injection every 8 weeks.
📍 It worked. 96% effective — better than condoms.
📍 The men did NOT quit. An external WHO review panel halted it in 2011, reportedly without consulting the scientists running the study.
📍 It wasn’t the acne. The panel’s concern was mood — depression, and one su***de attempt.
📍 And the part nobody posts: over 75% of participants said they’d still use it if it were available.

So is there a double standard?
Yes. Just not the one in the memes.
The pill was approved in 1960, before modern FDA safety rules existed.
Women’s mood side effects weren’t taken seriously — they were dismissed for decades.

The lesson isn’t “men should tough it out.” It’s that women deserved that same scrutiny, and we didn’t get it.

Male birth control is still coming.

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07/24/2026

One take - excited for awards season 🏆

Which one is your favorite?

Seriously though up to 50% of Fertility issues are related to male factor. Do not skip the semen analysis in your evaluation.

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Seattle, WA
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