womentowomen – Page 18 – Marcelle Pick Site

Birth Control Questions To Consider

womentowomen on November 27, 2013

by Marcelle Pick, OB/GYN NP

Birth control is an important decision that a woman of reproductive age
faces. You will want what works best for you in your situation. This is one of
the most important health matters that will affect your lifestyle and
emotions, as you will deal with birth control several times during the course
of your lifetime. Becoming pregnant and giving birth can be an incredible
experience. You, as the mother, are empowered to decide when that time
is right for you by choosing birth control.

Naturally, I receive a considerable number of questions about birth control
from women at the clinic. I’ve chosen an assortment of frequently asked
questions. I hope you will consider the most pertinent questions that are on
your mind and that these will help you choose your birth control wisely

1. Which is the best birth control pill? Is there really one?

2. Is the drug Seasonale safe, with only four menstrual periods a year?

3. Does the pill cause cancer?

4. Does the Evra patch really work? Does it stay on? Is it safe?

5. Will my partner or I feel the NuvaRing during intercourse? What if it falls out?

6. How reliable are condoms?

7. I have always had my partner use a condom. How did I end up with genital warts and herpes?

8. Having the man “pull out” doesn’t count — does it?

9. Will I get osteoporosis from the Depo-Provera shot for birth control?

10. Are shifts in sex drive typical soon after tubal ligation?

11. Will the pill affect my sex drive?

12. Will I have trouble getting pregnant if I use the pill?

Blood Pressure Readings — Taking Your Vital Signs

womentowomen on November 27, 2013

by Marcelle Pick, OB/GYN NP

When you get your blood pressure taken, the cuff of a sphygmomanometer (your doctor should offer you a lollipop if you can pronounce it!) is placed manually over your brachial artery, the largest artery in your arm, and inflated by a pump. This compresses the artery and stops blood flow. The air in the cuff is slowly released while the practitioner listens with a stethoscope.

As the pressure in the cuff deflates, blood begins to pulse through the artery again. The first sound the stethoscope detects is called the systolic pressure, or peak pressure. This is the pressure that gets exerted when your heart beats, pumping blood from the arteries to the veins. Diastolic pressure, or resting phase, is the pressure in the vessels in between heartbeats. It is the lowest pressure and the last sound picked up by the stethoscope.

The following are standard guidelines for assessing blood pressure (the healthy range has been lowered in recent years).

Standard Blood Pressure Guidelines per mmHg (millimeters of mercury)

Low <89 / <50
Normal <120 / <80
Prehypertension 120–139 / 80–89

Mild Hypertension 140–159 / 90–99
Moderate Hypertension 160–179 / 100–109
Severe Hypertension >180 / >110
Isolated systolic hypertension >140 / <90

How often should you get a blood pressure test?

Remember, high blood pressure is insidious. You won’t likely have a clue that you have it unless you get checked. This means you need to get checked regularly — at least annually, and more often depending on your history and risk factors.

When a woman comes in to see me for her annual exam, I always ask her, How’s your life? How’s your diet? How are your stress levels? These questions are a big part of the blood pressure equation! I like to take at least two blood pressure readings per visit, one before I examine her and another when she’s ready to leave. I may also ask her to get blood pressure tests in-between visits and have her fax or phone the readings in to me, so I can adjust for environmental factors or identify trends.

One reason for this is “white-coat syndrome,” a benign phenomenon where a patient’s blood pressure skyrockets at the mere sight of a lab coat. Other environmental factors, such as an extra cup of coffee or a stressful commute, can temporarily spike your blood pressure.

I like to see my patients somewhere in the vicinity of the optimal levels, but I always keep in mind each patient’s individual physiology and emotional status. If we get several elevated readings in a row, then I know we need to discuss dietary and lifestyle modifications now — well before you get into trouble. But what a great wake-up call!

“Owning” your blood pressure — should you buy your own cuff?

If you’ve been diagnosed with hypertension or prehypertension, you need to check your blood pressure frequently. Depending on your age, situation, and risk factors, you may want to think about buying a blood pressure cuff. There are many models available, but you can get a good one for $50–100. Here are some compelling reasons to justify this expense:

First of all, you’re investing in your health. Having your own cuff can certainly make it easier for you and your provider to keep a close eye on your levels. And it is empowering to have the ability to test yourself. Self-testing means you can know for yourself at any time, even enabling you to pinpoint triggers that might “set you off” as an individual.

For some, stopping off at the local grocery store or pharmacy for a quick check is a convenient option. On the other hand, having to do this may add just one more demand to your daily shuffle — one you can readily “blow off.” And that’s no way to take care of yourself.

In addition, readings can vary widely between blood pressure cuffs, and when you own your own, you can be sure how often it gets calibrated. Like synchronizing watches, you can bring your cuff along to your doctor’s office for ready comparison.

Another consideration is that blood pressure levels of even the healthiest people fluctuate over the course of a day, and having your own will allow you to check it at the same time for consistency. But remember that readings can also vary according to what that day holds in store for you or what it delivered in the way of frustration, stress, fulfillment, satisfaction, and relaxation. And when you adopt the consistent self-care approach we recommend, it’s a beautiful thing to watch your blood pressures return to a normal range — and stay there!

So whether you have must monitor your pressures regularly or you’re simply intrigued by your body’s vital signs, having your own blood pressure cuff is a great way to expand your healthy toolkit!

For more comprehensive information about blood pressure, read our informative article, “High Blood Pressure – Lowering the Strain.”

Reprogram Your Genes and Cells For Healthy Weight

womentowomen on November 27, 2013

by Marcelle Pick, OB/GYN NP

The set point — reprogramming your genes and cells

Everyone goes through life with a certain amount of “baggage” — an inheritance that’s both physical and emotional in nature. When it comes to our physical inheritance (our genes), many women feel that there’s not much they can do to change matters. But “DNA” doesn’t spell “destiny” — and we do have the ability to influence how our genes respond to our environment.

The conversation between your genes and your environment is particularly encouraging when it comes to weight loss. Women who struggle with their weight often feel as though they are pre-programmed to be heavy. So let’s learn how the metabolic “set point” works — and how we can change it.

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What is the “set point”?

The job of a healthy metabolism is to keep a woman’s body at a set point, which is a body-to-fat ratio within a 10- to 15-pound weight range that optimizes her chances of survival. Set points are individualized and stubborn — your body likes stability — and your metabolism defends your set point by slowing down or speeding up when your weight approaches the outer limits of your set point’s range.

When the idea of a set point was first introduced, scientists believed it was immutable and determined by genetics. If your parents were “wired” to be skinny people, then you would be, too — and likewise, if you came from heavy-set people, it would be your eventual destiny to become overweight no matter how hard you fought it.

But in the past few decades it has become clear that the set point isn’t predestined and unchanging. In fact, your set point is also governed by your environment, even from the time you are growing in utero.

Research shows that a disturbed intrauterine environment (for example, due to the mother’s stress levels, a high-carb diet, nutrient deprivation, and drugs) can negatively influence the metabolism of the developing fetus, raising the potential for serious adult conditions like insulin resistance, diabetes, obesity, coronary heart disease, hypertension, and more.

In other words, obesity does run in families, but it has as much or more to do with the mother’s health and weight during pregnancy than her genetics.

Obviously, you can’t do anything about what your mother did when she was pregnant with you, just like you can’t go back and exchange your genetic makeup. But what you can do — even if you have struggled with a high set point since before you were even born — is take steps that help your genes reset your metabolism. Such steps include lowering your stress burden, changing your diet, losing extra weight, and protecting your health long-term.

Has your lifestyle upset your set point?

In recent decades there has been an explosion in artificial foods and preservatives. The average American diet is also extremely high in sugar, refined grains, and bad fats. Our growing and harvesting methods strip our food of its nutrients, and pollutants, pesticides, and dangerous chemicals are all around us. We drive instead of walk, sit at desks instead of working outdoors, and the average food serving size has doubled. In short, we have lost a good quotient of our nutrition while dramatically increasing our toxic load and reducing our activity levels.

The modern American diet and lifestyle have sent the average set point soaring. We all hear it and see it on a daily basis: obesity is an epidemic. And not just in this country — over 300 million people worldwide were deemed “grossly overweight” in the year 2000, leading the World Health Organization to coin a new term: globesity. But it doesn’t have to be this way.

New research into the body-wide phenomenon of metabolic syndrome, or syndrome X, is proving that weight is a vastly more complex issue than measuring calories. Conventional ideas about weight loss are being supplanted by another school of thought — one that understands weight loss as a “universal” process and treats the body’s major functions, including neurochemistry, immune function, digestion, detoxification, musculoskeletal function, and hormonal balance, all at once.

Communicating with your genes: emotions, exercise, and food

In functional medicine, changes in health — good or bad — often reflect communication between your environment and the tissues, cells, and genes of your body. “Environment” in this sense means the physical world you live in; the food, air, and water that you take in as nourishment; and your emotional surroundings, past as well as present. Certain forms of communication can be healthy for one person but profoundly unhealthy for another, depending on our genetic blueprint. All this potential variation explains why some people can eat gluten or dairy and have no ill effects, for example, but others cannot, or why an acute illness or other stressor can precipitate all kinds of health problems where before there were none.

Yet while our genes may be tuned toward frequencies that promote ill health, including toxic weight gain, these communications can also be dialed down, or even turned off. The question my patients always ask me is, How?

Emotional buttons — switching genes on or off

We’ve always known intuitively that laughter is the best medicine, but before now we haven’t really grasped why. Some of the most interesting research being done today is showing how gene expression can be altered by emotions. Studies of laughter therapy in type 2 diabetics showed that as many as 23 different genes were altered as a byproduct of laughter. Not only that, but the activity of several blood enzymes and their precursors changed as well, in ways that were beneficial toward preventing a range of metabolic imbalances.

So one of the ways that we can send positive signals to our genes, cells, and proteins is by cultivating positive emotions. At the same time, addressing sources of negative emotions — particularly trauma from our past that is a continual source of sadness, guilt, shame, or anger — can reduce the flow of negative messages to our genes and cells. (For further guidance, read Dr. Candace Pert’s Molecules of Emotions.)

Exercising regularly — and having fun

Exercise, too, has been shown to affect gene expression. When you start using your muscles more, genes within skeletal muscle cells respond by programming the production of different amounts of proteins and new muscle cells, along with changing metabolic processes. These changes are beneficial, for the most part, although it’s also possible to over-exercise — and when we do, that’s actually stressful for the body, and triggers cell damage.

I would also add that doing less intense exercise that you enjoy is probably more beneficial than too much high-intensity exercise that just isn’t fun, not only because you’re more likely to continue exercising regularly if you like what you’re doing, but because the boost you get from having fun adds to the benefit on all levels.

Food as information

Today there’s an entire field of research called nutrigenomics, or “nutritional genomics,” investigating the effects nutrients have upon genes in both disease and health. The information our genes receive from our food can be a powerful way to “convince” them to respond in ways that are healthy — and it’s not so much about how much we eat (although obviously, overeating isn’t going to help anyone) than about what we eat. Food that is rich in phytonutrients and low in added sugars and chemicals speaks differently to our genes and cells than processed foods. A healthy diet of whole, organic foods reminds our genes and cells of how a healthy body should respond and supports smooth functioning of the body’s systems.

A recipe for “re-setting” your set point

It’s a revelation to many women that they can influence their genes and aren’t doomed to being overweight because of their heredity. For many women, this means changing long-standing ways of thinking or acting, and that can be difficult — but it’s far from impossible, and the benefits last a lifetime.

If you’re ready to have an enrolling conversation with your genes, there are several actions you can take to help fine-tune your set point:

Look for the core imbalances that may lie at the heart of your original weight gain. It’s important to identify these health issues and imbalances, because until they’re addressed, you will have a tough time resetting your metabolic dial.
Examine your emotional inheritance, particularly if you’re an emotional eater. Very few women in our culture go through life without ever experiencing a powerful, and often unhealthy, relationship with food. Understanding the feelings that trigger unhealthy eating habits can take you a long way toward changing those habits.
Look for enjoyable ways to fit exercise into your routine — even if it’s for only 20 minutes or so. During that 20 minutes, try “bursting” four to six times — ramping up the intensity for about a minute — to boost your metabolism without over-exercising. Your body is built to move, so begin gently if you need to, and work up from there.
Optimize your nutrition. Eating healthy doesn’t have to be an all-or-nothing effort — simple changes to your diet can reduce your toxic load and increase your nutrient intake. Taking a quality multivitamin–mineral and essential fatty acids will help fill common gaps. Emphasizing specific nutrients appropriate for your metabolic type will provide additional benefits in the long-term.
Prepare yourself for change. Many women struggle with their weight because the day-to-day priorities of work and caring for others interfere with the changes they want or need to make. Often women get discouraged when their initial efforts fail. Luckily, we can make a fresh start with each new day. Our article on making life changes can help you learn to prepare for changes to improve your health.
Laugh! Studies have shown again and again that a positive attitude and good sense of humor help many health conditions — and many of the imbalances that lead to weight gain have a strong stress component.

Start a healthy dialogue with your cells

It’s so important that women realize that we can communicate with our genes and get them to change their behavior — we talk to them all the time through our nutritional choices and the patterns of our emotions, whether we realize it or not. Where our metabolic set point and weight are concerned, we can start by having a conversation with our body — paying attention to our emotions, our nutrition, and our exercise.

Choosing Birth Control

womentowomen on November 27, 2013

Choosing birth control—options for women

by Marcelle Pick, OB/GYN NP

It shocks me how frequently patients believe that when I ask them about contraception, I’m asking about birth control pills. This confusion tells me how little the majority of women are taught about contraceptive options and how they work, because the pill is just one of many different forms of ways to not become pregnant. There are so many birth control methods available to women nowadays, from patches, to rings, to implanted uterine systems, that the contraception you choose can evolve as your needs change throughout your lifetime.

Practitioners now have so many options to give to our patients. It means we can really work with you to find the best technique for your lifestyle, and for your sexual needs, thereby reducing unfavorable side effects and increasing your comfort level, satisfaction, and safety.

Women to Women’s approach to choosing birth control

So lets look at an easy approach to choosing a birth control method that is right for you. It’s my hope that you and/or your partner will use this information to choose the birth control method that meets your needs, and perhaps then you will be able to use it as a basis for discussion with your daughters—or sons. After all, birth control is not only a woman’s concern.

No birth control except abstinence (not having any sexual intercourse) is 100 percent fail-proof and no barrier method (blocking the sperm from entering the uterus) is 100 percent effective against sexually transmitted diseases. However, you will be better able to understand your options, if you have more information. It will be easier to find a method that works safely and efficiently for you. This also applies to women in perimenopause who may have distinct requirements because of symptoms of hormonal imbalance, or because they have been on birth control pills for many years and would like to discontinue hormonal contraception.

Preventing pregnancy

Initially, I always ask a woman to consider her birth control options by thinking about just how important it is to her right now to NOT get pregnant. I also try to establish how motivated she might be in using the method of her choice—no birth control will be successful if she forgets to use it or if she uses it incorrectly. These two items of discussion help narrow the methods that will most effectively support your goal in regard to preventing pregnancy.

For example, if a woman really does not want to get pregnant (perhaps she’s in school, or starting her career, or not married) but she does want to be sexually active, I would suggest a method that has the highest level of success—even a combination of methods for optimal reassurance against both pregnancy and sexually transmitted diseases (STDs) —such as using birth control pills and condoms. From a different perspective, if she’s in her late 30’s and is not opposed to a potential pregnancy if it occurs, but she would rather avoid becoming pregnant and having a baby at this stage of her life, and if she is also leery of taking synthetic hormones, she might use something other than the pill, even if it is slightly less effective, such as a diaphragm or a sponge.

Birth control methods

After we’ve discussed her personal preferences for a birth control method, I usually review the list of options, beginning with the most effective options, if used correctly every time (also reviewing what happens if the method is not used correctly every time, which reduces it’s effectiveness) and progressing to the least effective options. I like to use a visual aid of contraception options with pictures and information, and I also keep samples of a NuvaRing, intrauterine device (IUD), Evra patch, and diaphragm available for us to see and touch while we are talking about it.

As we move through the list, I ask my patient to consider any age, health, or lifestyle habits that may make her a better candidate for some options and a poor candidate for others. Personal medical history, family medical history, weight, smoking, or having multiple partners are all major factors.

As an example, some women could have a strong family history of a blood-clotting disorder and carry a genetic mutation that places them at greater danger for a clot when using hormonal birth control. Other women experience an increase in blood pressure when using the pill, and will usually choose to use another method.

Birth control pills are not ideal for smokers, and most practitioners won’t prescribe them to women who smoke if they are over the age of 35, because the risks increase greatly at that point. In addition, if a woman weighs more than 180 pounds, the pill may be less effective. In this case the extremely low-dose versions are specifically not advisable.

Most women with symptoms of depression or individuals who have already been sensitive to hormones in the past may want to steer clear of longer-acting hormonal approaches like the Depo-Provera. Women with irregular cycles at all ages uncover that it is difficult to predict ovulation, so the rhythm technique and its successors (basal physique temperature, Billings technique, etc.) are usually not the wisest selections for them simply because they depend on the ability to accurately predict the exact days they may be the most fertile.

When choosing the best method to prevent pregnancy, every woman should talk with her health care advisor about her personal needs and her health considerations. As always, we work from the inside out at Women to Women, within the framework of your whole health history. We want to consider your lifestyle, your nutrition, your emotions, and give you the best information that will be essential for you to make your best choice.

Preferences for contraceptives

I always ask each woman to consider the method of contraception that appeals most to them I remind her that she should consider and take into account her own fulfillment, satisfaction, convenience, ease of use, any side effects, fears, and, in most cases, she should also consider her partner’s cooperation and satisfaction with the birth control method that she chooses.

Making the best choice of birth control will take some time and a lot of thought. At the clinic, we use a comparison sheet that our patients take with them to process and/or discuss with their partners. The various methods are listed by type and from most effective to least effective. This list does gives a wide range of choices, but not every birth control method is included. We strongly encourage you to review and discuss these and other options with your health-care practitioner before deciding which method to use.

Sexually transmitted diseases and birth control

If you have more than one sexual partner, if you start new physical relationships often, or if you suspect your partner of infidelity (having a sexual relationship with someone else), any discussion of birth control needs to include a discussion about preventing STDs.

Barrier methods, such as condoms, are the best prevention from infections carried in the semen, such as the human immunodeficiency virus (HIV), but condoms will not protect you from infections that can be transmitted by skin-to-skin contact, such as herpes and the human papillomavirus (HPV).

Most birth control methods, such as the IUD or the pill, are not adequate in a circumstance of multiple partners or frequently changing partners, because although the mentioned methods do prevent pregnancy, they do not protect against STDs. Using a condom does provide better (though not total) protection from infections.

Carrying condoms with you and handing them to a potential partner may feel a little awkward, but remember that you are worth it. It is important to be proactive to protect your health. If you were to get onboard a boat, knowing that there was a high likelihood that it would sink, I’m fairly certain that you would want a life preserver—no matter how awkward you felt wearing it. I really encourage women to empower themselves and feel this self-worth—after all, if you are going to have sex with someone, shouldn’t he care enough to wear a condom to protect you? If he puts up resistance, ask yourself, is he really worth it? In the long run it is not worth getting something that you will have to have for the rest of your life.

However, there are times when a woman in a monogamous relationship is the last to know that her companion has been unfaithful and sex with another person has not been revealed. As clinicians we are charged with protecting our patients’ health, it’s our job to be unbiased regarding fidelity, but hopefully your discussion with your practitioner will be conducted in a sensitive and tactful way.

Most people understand that teens and girls in their early 20’s are at a higher risk for numerous STD’s, but menopausal females are within the most rapidly developing groups of HIV infections. The best protection in contracting any STD is not surprisingly abstinence, and then the next best protection is condoms. But discussing previous sexual histories also can safeguard you even when in a monogamous partnership.

What do you do to not get pregnant?

Phrasing the question this way tends to get a more accurate answer than if I ask “What do you use for birth control?” because if she doesn’t use a hormonal method such as the pill, she will often answer nothing. When I pose the question what do you do to prevent yourself from getting pregnant I hear things like, “Oh—my husband had a vasectomy,” or “I have an IUD,” or “We use the calendar for timing and he pulls out.”

Not surprisingly, not having sex with men or abstaining from intercourse also prevents pregnancy for our celibate or lesbian patients. It is also a woman’s right to choose not to use birth control when having sex, as long as she acknowledges that this is a choice that frequently results in pregnancy. This is a complicated concept for some teens to grasp, but highly vital. It is essential to emphasize that what your partner does about birth control also counts. It is not just the female in a relationship. We encourage you to try to have as open a dialogue about sex and birth control as you can together with your partner, your medical doctor, and yourself. It might take several visits to your practitioner’s clinic to finally determine what feels suitable for you. But taking the time to learn about your options is the best way to find a method that will meet your needs.

A healthy lifestyle for adequate support

Many conventional doctors do not venture beyond the call-and-response format of an appointment when you go in to discuss birth control—that is, if you don’t ask, they don’t tell. But don’t forget that good health, nutrition, and lifestyle habits are important considerations for all women of childbearing age (and beyond).

The way we eat, exercise, handle stress and take proper care of ourselves always matters. For instance, if there is a chance you might get pregnant, getting adequate folic acid (400 mcg per day) is vital because a woman needs folic acid in her system at conception — weeks before she finds out she’s pregnant — to prevent birth defects. Calcium is significant for bone wellness, particularly in case you are using the Depo-Provera shot, which is linked to lower levels in bone density. Females on the pill will want to supplement their intake of B vitamins, due to the fact birth control pills interfere with their absorption. We encourage all women – regardless of what birth control strategy they choose – to take a pharmaceutical-grade multivitamin every day.

If you have questions about birth control methods, you may want to read our answers to commonly asked questions about birth control.

Severe PMS and PMDD Treatment

womentowomen on November 27, 2013

by Marcelle Pick, OB/GYN NP

Advanced Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) Treatment

There are certain times in life that we experience strong emotions that move us, and alter our mood for a period of time. For example, watching a movie where a mother reunites with her long lost child can bring up strong maternal instincts and we often find ourselves hiding our sniffles, bawling our eyes out or hugging our own children or younger siblings tightly. Some women go through similar types of emotional and physical stress hindering their ability to lead a normal life before their menstrual cycle each month. Their PMS (premenstrual syndrome) is so terrible that they are in need of medical help. Health clinics offer specialized treatments for women who suffer from severe PMS and PMDD (premenstrual dysphoric disorder) to help accommodate their specific lifestyle and nutritional habits.

If you have the misfortune of being diagnosed with severe premenstrual syndrome or premenstrual dyphoric disorder, you might benefit from some of the advanced treatments listed below. These treatments are meant to be temporary, a person may go through a treatment anywhere from five months to a few years. The idea is to ease the transition of the body to its natural state to begin a more normal function. When the body starts to adapt to the natural state of menstruation, it balances a woman’s physical and emotional stresses, these encourage the patient to ease out of treatment. It is important to consult with a qualified healthcare practitioner before you indulge yourself in any of these advanced treatments.

Prescription-dose bioidentical progesterone for PMS and PMDD. Being a woman who suffers from abnormal premenstrual syndrome, it is a good idea for you to have your baseline progesterone levels tested. This can help determine whether the prescription progesterone intake is a good alternative to birth control and antidepressant pills.

Testing your progesterone levels may even reveal whether one suffers from overt luteal phase progesterone deficiency. If you do have a progesterone deficiency, supplemental progesterone can perform miracles for you. It can help rid woman suffering from PMS associated issues such as irregular periods or heavy bleeding. It is important to consult with a well educated and trusted practitioner as determining what can be considered low level of progesterone in a woman is often difficult. The range of what is considered “normal” is so wide that a woman might be mis-diagnosed by an inexperienced practitioner. Some women may experience chronic progesterone deficiency and instead of a temporary treatment, they might need it until they reach their menopause.

The treatment of choice for some women has been the use of birth control pills. However, a reasonable alternative would be a prescription progesterone or compounded progesterone formula. Branded formulas such as Prometrium or compounded USP (bioidentical) progesterone can be found at speciality pharmacies. Prometrium treatment for PMS is considered “off-label”, therefore it may be helpful to let your health care provider know. Bioidentical progesterone can be taken orally or in a cream form, but this technique requires a woman to get her progesterone levels checked every three to six months. This is done to ensure that progesterone is not being converted into estrogen, which can happen for some women.

Women at our clinic are often put on a regime of progesterone supplementation days 10-14 of their cycle until menses. Many times we will use 100 mg of progesterone and have it taken up to three times per day. After seeing the response from women, the dosage is adjusted accordingly. For many women the response is so amazing that they finally feel relief from symptoms they have had for years and were not able to get them under control.

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PMS Symptoms And Causes

womentowomen on November 27, 2013

by Marcelle Pick, OB/GYN NP

What causes PMS symptoms?
Lifestyle factors contribute to PMS
Simple changes to feel better

No matter if you are suffering from one particularly painful PMS symptom or 100 PMS symptoms, I want you to know that you have the ability to modify how you’re feeling. Over the years we’ve seen the majority of women affected by PMS symptoms – symptoms that can be reduced and over time, even stopped – simply by addressing the root cause – hormonal imbalance.

Did you know that researchers have found more than 200 possible premenstrual syndrome (PMS) symptoms? These include irritability, bloating, cramping, cravings, headaches, breast tenderness, and on and on. Do you sometimes feel that you have all these symptoms at once?

What Causes PMS Symptoms?

There are some hormonal changes every month that are perfectly normal, while other hormonal changes set off PMS symptoms that can range from mild to severe. The symptoms can range from mildly annoying to debilitating.

Estrogen and progesterone – these are two of our primary sex hormones that fluctuate during a 28-day menstrual cycle. As you can imagine, it is easy for our hormones, which usually have a natural rhythm, to be altered and disrupted by a variety of factors. If your estrogen and progesterone hormones get out of balance, then you can experience symptoms.

Lifestyle Factors Contribute to Hormonal Imbalance and PMS Symptoms

Some of the main lifestyle factors that affect your hormones are the kinds of food that you eat, the nutrients that you receive (from food and vitamins), and the stress levels that you face every day. These can influence hormone balances and lead to PMS symptoms that are more frequent and more severe.

Do you have unstable blood sugar?

If your blood sugar is unstable, you might

Feel shaky, dizzy, or lightheaded
Experience swings of emotion
Get agitated
Have uncontrollable sugar cravings (before your period or throughout the whole month)
Feel like you must eat at this very moment or else

If you feel like you’re on an emotional roller coaster ride with PMS, it could be because of wide fluctuations in your blood sugar levels that are causing the imbalance in your hormones.

Some women are very sensitive to symptoms-causing fluctuations in blood sugar during their premenstrual period. But you can reduce your blood sugar highs and lows by reducing the amount of sugar and refined carbohydrates in your diets. Having an overall healthy diet will also give you more energy so you feel better.

Do you have a high-stress lifestyle?

If you have a high-stress lifestyle, you might

Have poor responses to things that happen that are stressful
Feel on-edge, overwhelmed, or out of control
Experience anxiety or depression

In a recent study, if women thought that their stress levels were high during the early weeks of two consecutive monthly cycles, then their chances of having PMS symptoms rose—up to 25 times higher! This is because of a stress hormone, called cortisol, that can affect the balance of your sex hormones greatly. Because cortisol is connected to the endocrine feedback loop in your brain, it can disrupt the way your ovaries make hormones. And therefore, more stress often equals more premenstrual symptoms.

Do you need a nutrient boost?

If you lack the essential nutrients you need, you might

Sleep poorly
Be irritable
Get tired and fatigued
Have muscle cramps
Experience aches and pains
Crave chocolate

Women who experience PMS symptoms are usually not getting enough calcium, magnesium, vitamin K, B vitamins (especially B6), and vitamin E, and other micro-nutrients. Without a daily supply of these essential items, your body demands urgent attention by intensifying your PMS symptoms. It is common for PMS symptoms of all kinds to escalate for women in their 40s, particularly if they haven’t been getting sufficient vitamins, minerals, and other nutrients for years – it can be a cumulative effect. What is also well documented is that those that have increased PMS also have a harder time in perimenopause.

Changing the Factors that Contribute to PMS

If your answer to any of the three questions above was “yes”, I encourage you to see what simple changes you can make today to reduce your hormonal imbalance and PMS symptoms. For more information, click here to take our PMS Quiz to assess where you are and how you can become healthier and enjoy a lifestyle that has fewer monthly emotional swings.

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Natural Relief For PMS Symptoms

womentowomen on November 27, 2013

by Marcelle Pick, OB/GYN NP

Natural relief for PMS symptoms: the Women to Women approach

Several women tell me that they’ve always assumed that premenstrual
syndrome (PMS) was just a part of life they had to live with and they
couldn’t do anything about it—and they were never told otherwise. Jenny,
one of the women that I’ve seen, is a good example. At her annual
check-up, the practitioner she used to see would simply say, “You work too
much,” when she asked about her monthly mood swings related to PMS.
She didn’t get many solutions.

However, after Jenny and I talked, and we reviewed her lifestyle and her
nutrition, she began to see the connection between her diet and stress.
She started out making small changes. She eliminated soda from her daily
routine (drinking water instead); she added multivitamins with minerals to
take every day; and she started exercising for 10 minutes and stretching.
She certainly isn’t stress-free, yet, but she’s coping much better. She
began to see so much improvement that she began to commit to much
more in the way of dietary and lifestyle changes.

I know that each one of you has the ability to start making these kinds of
beneficial changes today! Women have the most success with reducing
their PMS symptoms when they make changes to eat a more healthy diet
and make lifestyle changes that become patterns throughout the month—
not just when they have PMS symptoms. Here are a few ideas that I have
seen to be most effective:

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Try simple dietary changes. The choices you make in the food you eat
makes a great contribution toward balancing your hormones during PMS.
This helps stabilize your blood sugar and insulin levels. You can start by
eating healthy regular meals and snacks to keep your blood sugar steady
and fend off cravings. Making sure that you get protein at every meal and
decrease the carbohydrate load. Avoid high-fructose corn syrup and sugar-rich items. This will promote more balanced blood sugar levels and you will have fewer emotional swings.

Support yourself with lifestyle changes. It is essential that you take care
of yourself. This will help prevent and relieve PMS symptoms, and reduce
your stress level, which is probably the biggest concern. Begin to practice
meditation or yoga, and start a routine exercise regimen to calm your
nervous system (especially premenstrual). I’m a big Pilate’s advocate—but
you can choose whatever appeals to you to clear your head, get your heart
pumping, and focus on your breathing. There are many options and you
can choose to join a class of other women, or do this in the privacy of your
own home.

Make sure your body gets enough nutrients. Many of us are trying to eat healthier, and that’s a good thing! However, sometimes it’s difficult to get all of the nutrients that we need in the right amounts. Medical-grade, also known as pharmaceutical grade, nutritional supplements ensure that your body will get the specific nutrition that it needs—at the exact time it needs it. This is really important when your hormones fluctuate during the month.

Consider herbal support. There are natural herbal remedies that can
reduce and prevent your PMS symptoms. Read more about the use of
herbs in our articles about herbal treatments for PMS.

Reverse The Curse – Benefits Of Your Period

womentowomen on November 27, 2013

by Marcelle Pick, OB/GYN NP

Your period is a monthly health report card
Menstrual cycles highlight your “best times of the month”
Regular cycles help inform your health decisions

While there are many things I don’t enjoy about my period, this conversation is about embracing the positive rather than the negative. Not everything about your period has to be viewed as bad.

When I talk with other women about the benefits of our monthly periods, many women will roll their eyes, some of them laugh, and others will say “It was called ‘the curse’ when I was a young girl.”

Your menstrual cycle is essential to helping you learn, plan for, and make choices about your personal well being, mood, exercise — and naturally, your sex life.

In addition, your regular menstrual period will let you know that your hormones are in balance. This is so important when you realize that about 80 percent of the women that we see in our clinic experience symptoms relating to an imbalance of their hormones. If this issue is not looked into, it can lead to worsening premenstrual syndrome symptoms (PMS), feelings of fatigue, and weight gain. It can also lead to an increased risk for other more serious health issues. When you miss early signs of hormonal imbalance, you may also miss the opportunity to find relief.

Your menstrual cycle is distinctive to you. I encourage you to take a better look at the benefits that I have outlined below. This will help you to determine how your cycle affects your health and well-being in each area. Remember, if you are taking birth control pills, your cycle is regulated by the pill, rather than natural hormones, so you will not experience all of the benefits outlined below. Here are some of the most essential health benefits of your period:

You can know when your hormones are in or out of balance.
You can learn about your bones, thyroid, and metabolic wellness.
You can identify your best days for sexual arousal and enjoyment.
You can leverage improved energy for your exercise and fitness routine.
You can inform your health decisions about your life.
You can create emotional wellness.

What is a normal period? Regular vs. irregular

We often hear that the “regular” cycle is 28 days long, and many women’s bodies are like clockwork this way. But a cycle lasting anywhere from 21 to 36 days, if you’re regular, is also perfectly normal for many women.

What can you do about irregular periods?

If you suffer from irregular periods or PMS, your body is telling you that it may not be balanced to its fullest extent. This is an opportunity to bring yourself back into balance, so you can enjoy the health benefits of a regular menstrual cycle.

Your menstrual period provides a “monthly update” about your hormonal, reproductive, thyroid, and metabolic functioning

I want you to understand and embrace that regular periods indicate that your body is ready to become pregnant! But in addition to reproduction, your menstrual cycle rhythms reflect a balance in other bodily systems and functions as well.

This is because every month your period is the result of a coordinated discussion between your brain and your ovaries. The hypothalamus and pituitary glands are two of the areas that direct this conversation. They are also closely connected to the adrenal glands, the thyroid, and the digestive system along these same pathways. When one system is disrupted, then the other systems may suffer. Changes to your period, or if you have irregular periods, are usually the first indication of a disrupted signal along the pathway, with implications that can be felt throughout your entire body.

For example:

Hormonal imbalance. Normal menstruation tells you that the body is in homeostasis, producing acceptable levels of sex hormones optimal for reproduction. When these hormones are in balance, you feel excellent, are energetic, sleep effectively, and take interest in sex. When you’re beneath constant stress, your hormones turn out to be out of balance. An irregular period is 1 of its 1st strategies of asking for assistance.

Am I In Menopause?

womentowomen on November 27, 2013

by Marcelle Pick, OB-GYN NP

Have you been having trouble sleeping? Maybe you’ve been experiencing hot flashes. Perhaps your clothes don’t seem to fit like they used to or your thinking isn’t quite as clear as it used to be. You are concerned about these changes but they aren’t happening consistently. You might be thinking, what is going on with my body? Could it really be menopause already?

Menopause doesn’t work quite like that. It is a process that doesn’t happen overnight or even over the course of one day. Menopause takes time. Technically, it is defined as occurring exactly one year from your last period. This is why it’s hard to know if you’re at the beginning, in the middle, or at the end of the process. You might not even be close.

That’s why we’ll go over what it means to be in perimenopause (the time leading up to menopause) and menopause. This way you can find the tools you need to feel better — no matter where you are on the timeline of menopause.

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What’s happening in my body? The biology of menopause

Just as our bodies take 10-12 years to enter puberty and many teens skip periods or have irregular ones, there’s also a transition time to reach the end of your periods. This is why many women are confused about whether or not they are in menopause — there is no bright line marking the onset of menopause. And you can only confirm you’re in menopause when you look back after it’s been 12 months since your last period. And very few of us keep track at that point.

Dissecting a symptom: anxiety

In addition to well-known symptoms such as hot flashes, night sweats, and even vaginal dryness, there are many surprising menopause and perimenopause symptoms. One of the most remarkable symptoms is anxiety, though women don’t often connect it to menopause or their hormones. Of recent, the most frequent complaint I have in my patients is that they are having increasing symptoms of anxiety as they approach menopause.

However, the hormone progesterone, which helps prepare the uterus for a fertilized egg, is also involved with a neurotransmitter in the brain known as, GABA (gamma-aminobutyric acid). GABA is a calming neurotransmitter, helping us handle stress and anxiety. As progesterone levels drop during perimenopause, it can lead to an increased response to stress and — more anxiety. Many women remember the calming feeling of having high levels of progesterone in pregnancy and the calming effect it had on them.

Stress is important to mention when it comes to menopause symptoms as well. When your body has been dealing with long-term stress and anxiety, your adrenal glands (which are responsible for responding to stress and making progesterone and estrogen after menopause, in fact they produce 50% of these hormones after menopause) are called upon to produce stress hormones such as cortisol and adrenaline, instead of supporting the body’s changing needs in terms of sex hormones. This shows how your sex hormone levels are linked to other aspects of your health, including symptoms and feelings. Click here to assess your adrenal health.

But can I confirm I’m in perimenopause?

Unfortunately, there is no precise blood test to say whether you’re in a perimenopausal state but there is good news. Your practitioner can check to see if your FSH levels are rising, which makes it likely, but not definitive. According to research, there is much help that can be obtained from using herbs in the form of passionflower, ashwagandha and more. Learn more about perimenopause and early menopause in our many articles on these topics in our Menopause and Perimenopause section.

Common perimenopause and menopause symptoms

Women may notice any of these symptoms five to ten years before menopause is official.

Irregular periods
Insomnia
Fatigue/ loss of energy
Hot flashes and night sweats
Forgetfulness or foggy thinking
Thinning hair or hair loss
Vaginal dryness
Joint discomfort /stiffness
Inflammation
Food cravings
Digestive symptoms
Pain with intercourse
Anxiety and/or sadness
Irritability and/or moodiness
Weight gain especially around the waist and hips

If any of the symptoms on this list sound familiar, take our quick Hormone Health Assessment to receive our individualized advice about how to feel better.

For more information on any of these symptoms, read our articles that address these topics.

It’s possible to chart a progression of the hormonal changes that happen from age 35 to 55:

Beginning at around age 35, our hormones generally begin to change — though you probably don’t notice any symptoms at all. At this time, estrogen begins a slow decline and progesterone begins a faster decline. But keep in mind, progesterone and estrogen ratios may increase and/or decrease before they decline permanently. This age is when ovarian follicles (containing eggs) also begin to fall off more quickly. What we generally see in these years is that estrogen goes down more slowly than progesterone and therefore we often times have an imbalance in the hormones.

By their mid-forties, most women have fewer follicles to release eggs during menstrual cycles. As a result, your body increases its effort to create viable eggs from the follicles by increasing follicle stimulating hormone (FSH) using the part of the brain known as the pituitary gland. Estrogen and progesterone ratios may be in flux during this time as well.

Sooner or later, your follicles become less sensitive to FSH and ovulation may not happen with every period. During this time, periods can become irregular. As the pituitary ramps up FSH, other hormone loops connected to pituitary gland function may be affected, including your stress response and thyroid hormones. At this point you may notice more symptoms. We call this stage perimenopause – the time leading up to menopause. That is one of the reasons we use the FSH level to determine the possibility of perimenopausal changes.

Commonly between the ages of 50 and 55, your periods will stop. Once you haven’t had a period for 12 consecutive months, you are in menopause. Symptoms may continue — or even arise for the first time — as your body adjusts to your new hormone levels.

For more information, read more in our Menopause and Perimenopause section.

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Medical Hormonal Management Options

womentowomen on November 27, 2013

For women with fibroids, heavy bleeding, or endometriosis

by Marcelle Pick, OB/GYN NP

If you suffer from symptomatic fibroids, heavy bleeding or endometriosis, you might be able to avoid a hysterectomy with the right medical management and care. For those who cannot avoid hysterectomy, therapeutic and medical care and management can help minimize the impact of surgery. The great news is you have a number of options, including various types of oral contraceptives, progesterone/progestin hormones, and GnRH agonists.

Certain forms of birth control pills have proven to help some women. The
progestin component can sometimes offset the stimulating effect of her
own estrogen, but not always since birth control pills also contain synthetic
estrogens.

The Mirena intrauterine system (IUD) is another option to consider. It
releases a synthetic progestin inside the uterus. Though it’s available as
birth control, it also helps control bleeding issues and can prevent the
need for hysterectomy in some women.

At the Women to Women clinic, we try to use natural progesterone
products for these purposes whenever possible, such as Prometrium,
prescription capsules or custom-compounded micronized progesterone
products. If contraception is also desired, birth control pills and the Mirena
are appropriate options to consider.

Sometimes women are prescribed Lupron, a type of GnRH agonist, to
bring on a sudden, temporary “medical menopause” in an attempt to shrink
fibroids or reduce endometrial implants. GnRH agonist drugs are
modified versions of the naturally occurring hormone known as
gonadotropin releasing hormone, which plays a role in regulating the
menstrual cycle. These drugs are normally used preoperatively in order to
improve ease of surgery. They may also be used in the treatment of
endometiosis. Additionally, Lupron inhibits ovarian function and severely decreases a woman’s estrogen and hormone production as well. This creates some uncomfortable side effects, including instant menopausal symptoms and potentially significant thinning of the bone. Women are usually prescribed the drug for 3–6 months and then evaluated to see how their symptoms have improved. Many of these women do go on to have surgery.

Realizing that knowledge is power is important, because as you become
more knowledgeable you are able to make the right decisions for you. No
one knows your body as well as you do.