Causes and Treatment of Menorrhagia

womentowomen on December 2, 2013

by Marcelle Pick, OB/GYN NP

The causes of menorrhagia can vary greatly between women, but some problems are commonly root causes of the unusually heavy bleeding. Such things as fibroids, low progesterone relative to estrogen (both common in perimenopause), polycystic ovary syndrome (PCOS), or other hormonal imbalances are usually to blame.

Occasionally an intrauterine device (IUD) could cause excessive menstrual bleeding, but his is not the norm unless there is an infection. Other less common problems, but ones that certainly need to be considered, include a thickened build up of tissue also called a thickened endometrium, uterine hyperplasia, polyps, uterine or cervical cancer, ectopic pregnancy, cervical lesions, pelvic inflammatory disease (PID), hypothalamic dysfunction, hyperprolactinemia, parathyroidism or other thyroid problems, even premature ovarian failure (POF).

Some practitioners when doing the initial workup will test a woman for vitamin K deficiency, a vitamin necessary for maintaining blood-clotting platelets. A woman with bleeding issues may also have a coagulation problem (coagulopathy), or other blood-related (hematologic) causes. For example, genetic variants such as Von Willebrand’s disease, factor VIII, or factor XI deficiency are relatively uncommon, autosomal traits that may be suspected in a woman who has had heavy periods since menarche, bruising issues, or prolonged bleeding after surgery, childbirth, or trauma. In fact it is the first thing I will do if someone comes to me with heavy bleeding as this is often overlooked and helps greatly with the patients understanding of what is going on. Heavy menses may be the only sign of this genetic condition. See your practitioner if you suspect you have a clotting disorder as it is only a simple blood test and often goes undiagnosed.

The truth is that we see heavy bleeding often but rare disorders and not usually the cause. Rare disorders aside, our first and major concern for women with menorrhagia is anemia. A (CBC) better known as a complete blood count tells us if you are indeed anemic and need to add an iron supplement and more hormonal support. If hormone levels are imbalanced, especially in perimenopause, we may want to try a combination of nutritional intervention and endocrine support for you. Though rarely our first-line choice, when the bleeding needs to be kept under control, we will prescribe a synthetic form of progesterone like Aygestin or Provera. It does work extremely well and has its place when necessary.

We are happy to say that in our experience, most cases of heavy periods can be brought under good control with diet and exercise modifications, along with a medical-grade nutritional supplement and progesterone support. Of note is that the time we see the most problems with heavy bleeding (outside the usual pattern for our patients) is around the holidays, when stress levels are often over the top for women.

Gentle phytonutrient support and the use of a pharmaceutical grade multivitamin (Click here to learn about our specially formulated one that Women to Women offers) can also help keep your estrogen-to-progesterone levels on a much more even keel. But we always place equal weight on looking at addressing the impact your emotions and stress have on your hormonal symphony once a woman’s body gets the support it needs, it usually resumes its normal menstrual cycles—without having to resort to surgery. We see this on a daily basis in the clinic and online.

For more information, read our informative article, “Menorrhagia and Hypermenorrhagia.”

Menorrhagia and Hypermenorrhagia

womentowomen on December 2, 2013

by Marcelle Pick, OB/GYN NP

Menorrhagia Hypermenorrhagia Heavy Irregular Periods Young WomanLet’s talk about one of the women that I have worked with. You might be able to identify with her and her situation. After graduating from college, Celeste landed an internship with a public relations company. She was thrilled by this exciting opportunity—but worried about how her difficult periods would affect her work life. “My bleeding has always been heavy, but lately it’s gotten just ridiculous—and my cramps are so painful that I can’t concentrate on anything else. I’ve been to a couple of gynecologists, but all my tests came back normal. One of them offered to put me on the pill, but I don’t like the side effects. If I have to tough it out, I guess I can— but I really want to figure out what the problem is. I worry that something serious may be going on!”

For Celeste it turned out that imbalanced hormones were her real problem. As you also may have experienced, her menstrual cramps were playing havoc with her energy, her mood, her psyche, her appearance, her weight, her profession, and her sex life. Celeste had gone to her healthcare practitioner for help, but she hadn’t really gotten any help. Instead, she was given the message that nothing was really wrong, that the problem she faced was just a normal part of a woman’s life.

Thank goodness this isn’t true. Painful periods are often the result of a hormonal imbalance. When your hormones are balanced again, these problems can disappear. And balancing your hormones is surprisingly simple. You’ll be amazed to discover you can do this through a combination of diet, herbs and supplements, lifestyle, and psychological support, in some cases complemented with some gentle bioidentical hormones.

Now at this point, you may be wondering why, if these problems are so real and the solutions are so simple, your own health-care practitioner hasn’t already given you this information. The answers to that question are not so simple. So let’s take a closer look.

Heavy menstrual bleeding and blood clotting are common problems for a lot of women, especially in the perimenopausal years or when the cycle just begins. When a woman soaks a pad or a tampon in an hour for several hours or more, or if she bleeds for more than a week and a half each month, this is called menorrhagia. This is a usual occurrence for many women. If she soaks through two or more pads or tampons in an hour, this is generally considered hypermenorrhagia.  These are fancy medical words – but they do have their place.

Excess bleeding such as this can be worrying when it occurs and, as any woman knows who has experienced it, terribly inconvenient. Remembering to bring a change of clothes or to not wear white during those times seems unfair. So much so that it is a leading reason for elective hysterectomy. As with many other menstrual irregularities, however, the primary cause of heavy periods is most frequently hormonal and/or nutritional imbalances resulting from diet, lifestyle, and stress. This is good news then because then you can do something about it. And in many cases, substantial menstrual bleeding can be relieved without a surgery or a hysterectomy.

Almost all women will tell you that they have experienced heavy bleeding and or clotting at some point or another in their lives, and some women have regular intense menstrual flow. If your periods are heavy on a regular, cyclic basis, then that is your normal.

Or, if you have some irregularities in your flow that go away the following month, there is probably nothing too serious going on. I tell all of my patients that two irregular cycles a year is probably normal for many women. If you encounter extreme menstrual bleeding for two successive months, and this is different for you or if your periods are heavy and ongoing in an erratic fashion, it would be good idea for you to check in with your healthcare provider.

Other things associated with menorrhagia and hypermenorrhagia include:

  •  A menstrual period that lasts longer than 10 days and is different
  •  Menstrual flow that includes large blood clots and that is not your norm
  •  Heavy periods that interfere with your regular lifestyle
  •  Constant pain in your lower abdomen combined with heavy menstrual periods
  •  Tiredness, fatigue, or shortness of breath (symptoms of anemia)

For more information, read our article, “Causes and Treatment of Menorrhagia.”

Alternatives To Hysterectomy

womentowomen on December 2, 2013

by Marcelle Pick, OB/GYN NP

In the event that you may have the choice to forego a hysterectomy, you ought to know that together with hormonal support plus changes in lifestyle, there are many alternate options to explore that will take care of heavy bleeding, endometriosis, fibroids, and even polyps.

Current treatment options include:

  •  Medical/hormonal management
  •  D&C and hysteroscopy
  •  Endometrial ablation
  •  MRI–guided focused ultrasound (MRgFUS)
  •  Laparoscopy and endometriosis excision
  •  Myomectomy
  •  Uterine artery embolization (UAE)

The actual success rates of these techniques differ greatly according to the patient and the support that is given pre and post-surgery, so it’s important to support whatever method you personally pursue with the healthiest lifestyle choices you can. A lot of women respond wonderfully to the nutritional measures , and several report how it has helped them make a speedy recovery from a variety of procedures — including hysterectomy!

Looking Ahead

Although heavy bleeding or even a diagnosis of fibroids may be disconcerting, it is seldom necessary for a woman to jump into surgery quickly. Considering additional options and techniques may guide you in a different direction with different results.

Since hysterectomy and fibroids are so common, studies looking into other options are constantly underway, and new techniques are being developed and studied in many parts of the world. Although the results of these innovations may be mixed, the good news is that these less invasive techniques do work for a number of women.

Unfortunately, the reasons being unclear at this time, no truly scientific, randomized double blind studies have yet been done to fully evaluate the various hysterectomy alternatives, their side effects, risks and benefits. Nor are any such studies currently being planned, though some observational studies on UAE (the surgery Dr. Condoleeza Rice had in 2004) have been done, comparing outcome satisfaction, failure rates, and cost compared to traditional hysterectomy methods. Visit the UAE Fibroid Registry at the SIR website for more information.

What Can You Consider Now?

We understand that numerous women have a choice when it comes to a hysterectomy; it may not necessarily be their destiny. Women to Women explore natural and less-invasive options and alternatives before stating that surgery is the only course of action. However, we also know when surgery is necessary. Did you know that certain women feel amazing after they have had a hysterectomy? Not only that, but those women suffer no side effects.

In case you do decide on surgery, we suggest preparing yourself for surgery in advance to increase your chances of a positive experience. Whether you opt for a nonsurgical alternative or you’re awaiting your date, investigate the measures you can take immediately to boost your nutrition, reduce your recovery time, and balance your hormones. The bottom line is – do what is necessary to feel well, whether that includes surgery or not, but know that by using pharmaceutical nutrient support, lifestyle changes and phytotherapy, these can all make the experience that much better.

Different Types Of Hysterectomy Procedures

womentowomen on December 2, 2013

by Marcelle Pick, OB/GYN NP

A large number of women of my mother’s era had no clue what was involved in getting a hysterectomy. Today, we are lucky because we now have a variety of degrees of a hysterectomy, as well as different techniques that are commonly used to perform the surgery. For any woman who is thinking about getting a hysterectomy, it is recommended that you take the time to learn the different types of hysterectomies performed today, and discuss each technique with your doctor. Women to Women truly believes that women should keep their bodies as whole as possible, as long as doing so does not interfere with their health, comfort and safety. We encourage women to opt for the least invasive technique that is available to them.

Total hysterectomy

In a total hysterectomy, the entire uterus and cervix are removed (ovary status is officially referred to separately). Total hysterectomy can be done abdominally (abbreviated TAH), with an incision most often these days made along the bikini line. In more emergent situations, a vertical type of incision is made through the abdominal wall from the belly button to the pubis. This type of surgery required more downtime and healing time as well. TAH can also be performed through the vagina, with no large incision through the belly. If this procedure is an option, it may be one to consider as the healing time will be less.

The newer and more sophisticated procedures use laparoscopy to assist the hysterectomy procedure. In laparoscopic hysterectomy, the organs are visualized and manipulated through a laparoscope, and the uterus is removed either through the vagina (laparoscopically assisted vaginal hysterectomy, or LAVH) or through a small incision in the stomach.

Whether they use the vagina or the small incision in the abdomen depends on the size of the uterus and issues that are requiring the surgery to begin with. The incisions are tiny (~½”, beneath the belly button and on the lower pelvis/abdomen, beneath the bikini line). You may have several small incisions that tend to heal very quickly.

This type of surgery leads itself to a much quicker recovery, with far less disruption of the bowel and pelvic floor architecture. It is best performed by a laparoscopic specialist, someone that does this type of surgery often, as not all surgeons are skilled at this. The choice here depends on the reasons for doing the surgery, the patient’s anatomy, and the surgeon’s preference. If you have a preference, undoubtedly communicate this to your surgeon.

While doing a hysterectomy, a surgeon may also remove the ovaries and fallopian tubes. Sometimes this is not decided until the time of the surgery. This is called a bilateral salpingo-oophorectomy, or BSO. (Together with a total abdominal hysterectomy this is referred to as a TAH/BSO). There are numerous considerations to make before you consent to this surgery, mainly because of the artificial onset of menopause due to loss of your natural sex hormones. Again, the decision depends on the individual problems that are at issue here. If this is the only choice available to you, be certain that it’s possible to regain your hormonal balance with the help of excellent support measures and a healthy lifestyle.

Young women who must undergo a BSO should seriously consider suitable estrogen replacement for several health benefits. The younger you are the more important it will be to consider replacement. We try to suggest bio-identical transdermal estradiol options when needed — complemented with bioidentical progesterone and nutritional supplements. When supplemented properly many young women can feel excellent post-surgery.

Partial hysterectomy

In a partial or subtotal (supracervical = above the cervix) hysterectomy, the ovaries and/or cervix are left whole. These procedures, too, can be performed abdominally, vaginally, or laparoscopically. Regrettably, a lot of women either are not made aware or don’t know these options exist. Several doctors take out the cervix automatically as a precaution against cervical cancer.

At our practice, we’ve seen that the benefits of retaining your cervix (more sexual enjoyment and sounder inner pelvic architecture) outweigh the relative risks. If you do choose to keep your cervix, you will need to continue normal annual screenings and Pap tests.

At Women to Women, we typically refer women for a laproscopically-assisted supracervical (partial) hysterectomy (LASH, or LSH). We suggest women try to keep their ovaries (no BSO); if at all possible, however this is case and personal dependent as well. Again, not all doctors are skilled in these newer techniques. Those who are skilled often specialize in endometriosis treatment, as well. You may have to look for them in your local area or be willing to travel somewhere else to have your procedure.

We also recommend considering your options on preparing yourself for surgery. To start you may want to read our articles about hysterectomy, sign up for a few sessions of acupuncture, and use Peggy Huddleston’s book and audiocassette, Prepare for Surgery, Heal Faster, to enhance your healing and decrease your recovery time.

Common Reasons For Choosing Elective Hysterectomy

womentowomen on December 2, 2013

by Marcelle Pick, OB/GYN NP

Hysterectomy is the second-most common significant operation performed on females inside the United States. (The most common is cesarean section delivery). Every year, more than 600,000 women undergo a hysterectomy. Despite the fact that some progressive doctors claim that up to 90% of hysterectomies are unnecessary, more conservative estimates put that number between 20–30%. Either way, that is a lot of women that may be having unnecessary hysterectomies.

There are quite a few reasons why women are recommended to consider an elective hysterectomy. The most common are intense bleeding, when many things have been tried and failed, large fibroids, endometrial polyps, endometriosis, causing debilitating pain and discomfort and other endometrial concerns. Some women are fed up with the discomfort or the bloating that accompanies a large fibroid uterus, or have a uterine prolapse, (a condition in which the uterus drops). More serious indications include cancers of the uterus or ovaries — conditions that truly merit immediate surgery. However, if we take a closer look, the latter are relatively uncommon and leave women with few choices, so this conversation and topic is geared toward women who are considering surgery for less clear-cut reasons.

Heavy bleeding

Throughout traditional medical practices heavy blood loss is termed “dysfunctional uterine bleeding” when it is not the normal amount of bleeding but no demonstrable organic pathology is found. Diagnosis is made by exclusion since organic pathology always has to be ruled out. What may be more useful for us to identify as “dysfunctional,” or imbalanced, are the environmental and lifestyle influences affecting our hormones and sending the uterus mixed messages. Every now and then these influences lead to a state of estrogen dominance, and in other cases the menses may be out of sync, because of general hormonal imbalance. In whichever case, tuning in and paying attention to what the body and mind require can restore balance naturally. Furthermore, what is dysfunctional for one woman may not be for another, and the term is somewhat subjective by nature, so it should be discussed with a knowledgeable and experienced provider.

Having reached a state of hormonal imbalance, a woman’s body can get stuck, and even her greatest efforts to restore balance can take quite a few months. The annoyance of having to change pads hourly, double up on tampons, wash extra linen, never wear white at that time of the month and timing activities around heavy flow leads several women to the end of their gynecological rope. When women in this situation ask for a hysterectomy, nearly all doctors in America will respond by scheduling surgery as soon as possible and who can blame them. But in our book, surgery should never be the first, or even the second, recourse in the face of heavy bleeding. That is because we have seen firsthand how much things can change when the right steps are taken. The good news is, no matter what, an old dictum from surgery generally applies: bleeding eventually stops when a woman goes through menopause.

Heavy bleeding often occurs, even if it has never happened before, around perimenopause and in several cases can be successfully addressed with many natural measures before pursuing surgery. In nearly all cases, a woman with dysfunctional uterine bleeding can be offered a trial of non-surgical intervention such as “medical management” (using a progesterone effect on the uterus) of dysfunctional bleeding prior to referral for “surgical management.” This approach is normally safe, as long as the lining of her uterus has been appropriately evaluated with an endometrial biopsy or D&C if necessary, and as long as her red blood count remains sufficient.

At our clinic, we’ve had excellent results treating heavy bleeding with high-dose bioidentical progesterone, in the form of creams or oral tablets, along with other supportive supplements. Lifestyle and dietary changes that decrease stress and increase core nutrition are also extremely effective in this arena.

Several bleeding issues reflect irregularities of the endometrium, so the symptoms are strongly influenced by the monthly ebb and flow of estrogen as well as progesterone. Simply because of this, these difficulties normally react extremely well into a natural rebalancing of hormones by way of diet plan and life style changes. Furthermore, a natural approach should be given a trial before advancing to surgical intervention. Surgery is no small matter, and the removal of organs can lead to additional problems that are just as troublesome or more so, only different. And, just as heavy bleeding dissipates with menopause, so too do conditions of the endometrium.

Postmenopausal bleeding

Be aware that post-menopausal bleeding is a completely different matter, in addition to any sort of bleeding that happens after menopause, and needs to be immediately assessed by your healthcare provider. Women with postmenopausal bleeding are often referred for vaginal ultrasound so the endometrium of the uterus can be evaluated and measured. If the endometrial thickness is above a certain width, an endometrial biopsy is recommended. Certain drugs such as Tamoxifen for breast cancer can cause the thickening, and women on tamoxifen who have thickened stripes should be seen by GYN specialists for this side effect.

Adenomyosis

Constant heavy bleeding that does not stem from a discretely recognizable source such as fibroids, and which doesn’t respond to medical management, is often a result of adenomyosis of the uterus. Adenomysis is generally referred to as endometriosis interna. In this condition, which is sometimes mistaken for uterine fibroids, the glandular endometrial lining of the uterus invades the bulk of the uterine muscle wall. This is also known as endometriosis of the muscle.

Although most women who have adenomyosis never have symptoms, it can cause the uterus to grow 2–3 times its normal size and be accompanied by severe menstrual cramping. During the pelvic exam, the uterus can feel large and bulky. It occasionally is recognized by ultrasound, or more definitively by MRI, and confirmed by pathology after a hysterectomy; however it is technically seem as a benign condition.

Adenomyosis frequently fails to respond to the influence of progesterone under medical management. If you have exhausted all natural measures and still suffer with persistent heavy bleeding, you might want to enquire further about this potential diagnosis. Endometrial ablation is one alternative that has shown for some to be very helpful and is an alternative to hysterectomy, along with the Mirena IUD; either may be considered in certain cases.

Fibroids

No less than 40% percent of hysterectomies performed are for fibroids. (Fibroids technically are not part of the endometrium). Nobody understands just what exactly will cause them, but they are certainly a hassle. They are extremely real and women’s worries about them must not be dismissed as merely worrying. We suspect their growth is most likely fueled by estrogen but are unsure yet regarding the details.

Fibroids are fairly common: at least one in five women over age 35 has them. So many women think mistakenly that if they have fibroids they will sooner or later need a hysterectomy. This just isn’t true. Often doctors recommend a hysterectomy for patients with fibroids even when they are symptom free! This is like cutting off your nose to spite your face.

At Women to Women, we have countless patients who deal with their fibroids successfully through dietary changes, lifestyle changes, including looking at their stress levels and working to change them, and supplements — as well as acupuncture, if they are having symptoms. We suggest the book Women’s Bodies, Women’s Wisdom, written by my friend and colleague, Christiane Northrup, MD, which includes a fabulous section on treating and living with fibroids without surgical interventions. See our articles for more information on the causes as well as natural treatment for fibroids.

Fibroids may cause bleeding and pain or discomfort, an ever present sense of fullness and can grow in some, but certainly not all cases. A fibroid’s size is described as though someone was pregnant, comparing it to the gestational age of the fetus — for example, a 5-month size fibroid — or it can be described as a fruit, the size of a grapefruit or orange, etc. Women can have several fibroids of various sizes and shapes. Some fibroids grow very little over time, and many women are oblivious that they have them. Your healthcare provider can often feel an enlargement of the uterus while doing a pelvic exam and may order an ultrasound if they feel it is warranted.

An ultrasound will measure the fibroid and better evaluate any other abnormalities that are there as well. You could be sent for repeat ultrasounds to make certain your fibroids are not growing too big or too quickly over time. Your doctor may in addition order a CT scan or an MRI if additional information is needed. Fibroids are very seldom cancerous and are not needed to be biopsied. But remember that any kind of dysfunctional uterine bleeding should probably be evaluated with an endometrial biopsy to rule out any other causes for the bleeding.

Polyps

Uterine polyps or endometrial polyps are irregularities of the inner uterine lining (something like fleshy skin tags, only on the inside). Polyps are often the source of irregular bleeding and can be a large nuisance, BUT they are not commonly cancerous. Polyps of the uterine lining are often difficult to see on regular ultrasounds, but a “sono-hyst” (sonohysterography) or saline-infused ultrasound is much better at diagnosing this more accurately. It is not unusual to obtain fragments of a polyp when getting the results back on a sampling that was taken when an endometrial biopsy was done.

Nearly all endocervical polyps can be removed through the vagina, as they are present at the opening of the cervix, but uterine/endometrial polyps are usually removed via the D&C with hysteroscopy method, which is slightly more invasive but definitely less traumatic than a hysterectomy.

Endometriosis

Endometriosis is a condition that is normally more painful than dangerous. A lot of women who have endometriosis are unaware of its presence until they attempt to become pregnant. Endometriosis can cause severe fertility problems and always needs to be ruled out if someone has cramping with their menses and can’t get pregnant. It can also cause irregular spotting, bleeding, and pain, including pain with intercourse. For women with severe endometriosis, the pain can be unbearable, especially around their period, and or around ovulation.

Acupuncture can be very helpful for pain management. If fertility is an issue, PT techniques such as integrative manual therapy (IMT) and Clear Passages could be investigated. Both these techniques have been quite successful in increasing fertility when every else failed. Laparoscopy is often used in more severe cases for conclusive diagnosis and treatment. For more precise information on alternative treatments for endometriosis, see our articles on this topic.

In case your decision to get a hysterectomy is an optional one, consider yourself fortunate. You may want to spend some time researching your options and then figuring out what will be the best choice, or option for you before you decide to have surgery. The good news is that more and more options are becoming available.

Deciding To Stop Your HRT

womentowomen on December 1, 2013

by Marcelle Pick, OB/GYN NP

Expect to be successful even if you failed the first time

There are many women who seek our help who have suddenly stopped Hormone Replacement Therapy (HRT) “overnight.” But then they couldn’t deal with the explosion of symptoms, so they returned to HRT. They feel frustrated at the need to return to HRT, but at least they’re functional.

What I tell these women is to learn from that setback and to make another attempt at stopping HRT. If they put their support in place first, and then wean off HRT slowly, there is a greater chance that they can successfully stop HRT.

Expect Success If You’re Willing to Work at It

More than 80 percent of the women who participate either at the clinic or online have challenges that are obstacles to helping them to restore their health after they stop HRT. The most common issues are digestive problems (for example, floral imbalance or leaky gut syndrome) and endocrine problems (for example, insulin resistance, adrenal exhaustion, or thyroid disorders). Not surprisingly, these issues all interfere with hormonal balance.

Problems such as these have taken years for the body to develop and they can’t be resolved in a few days. Their effect can be dispiriting to women who are seeking alternatives to HRT. Women often improve and make exciting progress in the first few weeks after weaning off HRT; however, some women find themselves with too many symptoms that remain. The tendency is to blame the lack of hormone and estrogen replacement and say, “This isn’t working.” But in reality, the natural alternative to HRT is working—it’s gradually healing the years that it took for the damaging health habits to create the conditions in the first place. Adrenal function may be one of the obstacles to fast recovery when HRT is stopped.

For many women, who like to be able to “do it all,” stress appears to be unresolvable. Stress can trigger hot flashes, insomnia, weight gain, and other menopause symptoms. The sources of stress in a woman’s life can seem beyond her control. However, we’ve seen repeatedly that women can make their lives less stressful. It is called multi-talking. If you begin to take better care of yourself, you’ll get your strength and energy back. Then you can begin to make more changes that seem easier. And it will be.

Don’t be surprised if you need help, especially when first starting.

Most women know that there are more natural alternatives to HRT, and many of those same women will spend months self-prescribing soy, dong quai, black cohosh, bioidentical progesterone and so on. Each of these herbal or medicinal alternatives can have a positive effect, and they will provide relief for you, but only if you have a few, mild symptoms. Again, those women tend to be fewer in numbers. Most women who self-prescribe get discouraged with the process, and then they don’t know where to turn for additional support.

To find out where you may be, consider taking our Hormonal Health Assessment.

Expect to feel great!

One of the great things about understanding more about our bodies is that we can now view the whole of menopause as a great awakening. Remember this is adolescence in reverse. It is the time in your life when you ask the question who am I and what do I want to do for the next half of my life. And how do I expect to feel.

This is the way that nature intends for you to begin to take better care of yourself now. Over and over, we’ve seen a woman find her voice, learn more about her miraculous body, and begin making choices that work for her. We believe it is up to you to lay the foundation for decades of health, vitality on all levels and happiness ahead.

We’re always happy to welcome new patients at our medical clinic in Yarmouth, Maine, for those who can make the trip.

What To Expect When You Stop HRT

womentowomen on December 1, 2013

by Marcelle Pick, OB/GYN NP

In 2002, a government study about hormone replacement therapy (HRT) called the Women’s Health Initiative (WHI), made women acutely aware of HRT side effects and health risks. Since then, millions of women have stopped taking HRT—sometimes suddenly. In a strange twist, it’s usually the same doctor who suggested HRT who is now encouraging his or her patient to stop HRT. Interesting how time can do that even with science.

These doctors, unfortunately, don’t have much advice for the patients who want to stop HRT. In addition, there are often misleading headlines about HRT safety for younger women, and this only creates more confusion. Recently, a woman came to see and asked for my help because her menopause symptoms had returned after she discontinued her estrogen replacement therapy. She said her health-care practitioner just informed her that he didn’t know what to suggest to help her. His best guess was that if she wanted relief from her symptoms, then she would need to start back on the HRT or try an antidepressant. That’s not encouraging for women who are trying to create a better quality of life and take care of their bodies in a natural way. It’s difficult for women to not feel a bit deceived. For those of us who seek and follow a health-care practitioner’s advice, because we trust that they know better than we do what the best options are, it is a surprise to find out that they don’t.

It also might be surprising that a practitioner would not know how to help with this situation, but remember that most practitioners were taught that HRT was a near perfect answer to alleviate symptoms of perimenopause and menopause. As a positive response to this issue, the American College of Gynecology has been developing guidance for gynecologists about HRT withdrawal. However, there is a copious amount of well documented research that exists among complementary and functional medicine practitioners that can help you make better health choices for yourself. So let’s look at an overview of HRT alternatives and what you can expect when and if you want to transition and stop taking HRT.

Can you expect HRT withdrawal problems if you quit “overnight”?

Many women who decide to transition off HRT will just suddenly stop taking it, and this is very stressful for your body. We saw this happen when the study came out, as many women flushed the hormones down the drain several days or weeks after the report was made public. Your body’s internal system has grown dependent on this additional supply. Originally your body could have made its own hormones—right through perimenopause and menopause—but it cut back production when you began HRT. The good news is that your body (the wonderful creation that it is) can resume its estrogen, testosterone, and progesterone production, and it can even develop secondary hormone production sites to compensate for the decrease in hormones from your ovaries. In reality, that is the normal and natural order. However, your body will need time and your continued support to develop those sites.

Another factor to consider is that we believe that the stronger estrogen replacement therapy drugs, such as Premarin and Prempro, actually modify the estrogen receptors in your cells, so they only recognize this strong type of hormones. It takes time for those receptors to get back to their original form and accept natural HRT. For some this may not every happen, but for most it is easily accomplished. The natural HRT can be from your body’s own hormones, bioidentical HRT, or plant-based hormonal support in the form of phytotherapy.

Consequently, the type of synthetic hormones that you have taken and the length of time that you have been on them are both very important factors to consider when you stop HRT. An additional factor to think about is how severe your symptoms were before you started HRT. The more severe your original symptoms were, the stronger your HRT would have been, and the longer you used HRT, the more likely it is that you will have symptoms of HRT withdrawal when you quit. The gradual reduction may be more appropriate for you.

Some women are surprised that their symptoms get worse when they stop HRT. And that the symptoms are worse than they were before they started HRT. One major reason is usually because of the “rebound effect” that is a common response to prescription drugs. The second major reason is that women may be taking less care of themselves now than they were before. The third reason is that once the estrogen receptors have been primed they need to be supported in other ways.

Of course, each woman is different. Some women stop HRT suddenly and have absolutely no symptoms of hormone imbalance. They are however, the lucky few. Our clinic’s waiting room is full because most women who stop HRT will experience all over again all the symptoms of menopause, sometimes with more aggression, and they don’t know where to go for relief and support.

Expect a soft landing if you take care of yourself

The essential cause of hormonal imbalance is what we call the “inverted ratio.” That’s when the body burden that you place on your body greatly outweigh the support you give it. The basket is too full with demands. If you have symptoms of hormonal imbalance, you have the inverted ratio. The facts about HRT are that it relieves the symptoms, but it will not eliminate the underlying causes. I describe this as what is going on upstream that then created the symptoms.

Your body is a marvelous machine and it has the power to create and balance its hormones at every life stage. However, to do this, it needs adequate support from you. This means rich, healthy nutrition; a well-functioning, digestive system that will optimally absorb the food, and help detoxify the hormones; a robust metabolism; and a manageable routine of exercise and stress reduction. If your hormonal imbalance symptoms are moderate to severe, you can add phytotherapy to this foundation to help stabilize your levels naturally and faster.

So do you think this sounds impossible?  Let me give you a little help to make it happen.

If you understand that your body needs the extra support while you’re going through the HRT withdrawal process, you will be better able to deal with any symptoms that might occur. If your hormonal imbalance is severe, then you’ll need more support, in fact much more support. After you’ve completely stopped taking HRT, then the maintenance phase will require less support.

Ideally, you should put this plan of support in place before you begin to wean off HRT. We advise the women we see to allow 2–4 months, if possible, for the weaning process. This will allow for the body to adjust to the changes. However, some women require a little less time, some a little more time. If you proceed with care, there is a great possibility that you will feel better than you ever have in your life.

A List Of Common Toxins

womentowomen on December 1, 2013

by Marcelle Pick, OB/GYN NP

Your toxic body burden: stresses on the detox system

Your body faces a toxic burden from countless sources, including but not limited to:

Environmental toxins

  •  Outdoor pollution
  •  Indoor pollution
  •  Carpeting, especially when new
  •  Combustion by-products (e.g., carbon monoxide)
  •  Dust, at work or at home
  •  Mold and mildew
  •  Manufactured wood products, especially new house construction
  •  Household cleaning products
  •  Chemicals commonly found in drinking water
  •  Chemicals commonly found in food
  •  Processed foods
  •  Colorings, preservatives (BHT, EDTA), additives, and flavorings
  •  Pesticides
  •  Food packaging
  •  Genetically altered foods GMO
  •  Personal care products (lotions, creams, perfumes)
  •  Heavy metals (lead, mercury, arsenic)
  •  Radiation
  •  Noise pollution
  •  Plastic water bottles and food containers
  •  Plastic wraps that food is stored in

Drugs

  •  Prescriptions
  •  Over-the-counter medication
  •  Recreational (including alcohol)
  •  Stimulants (including caffeine)
  •  Additives or colors in many medications.

Allergies

  •  Pollens
  •  Grasses
  •  Dust mites
  •  Animal dander
  •  Mold outdoor or indoor
  •  Foods
  •  Lotions

Diet

  •  Trans fats or artificial colors or preservatives
  •  Excess sugar and refined products
  •  Imbalance of carbohydrates, proteins, and fats
  •  Food sensitivities and allergies
  •  Constant dieting
  •  Processed foods of all kinds

Low-grade infections

  •  Parasites
  •  Yeast
  •  Viral
  •  Bacteria
  •  Lyme, or other cofactors

Nutritional deficiencies

  •  Digestive and pancreatic enzyme
  •  Vitamins and minerals
  •  Amino acids
  •  Phytonutrients
  •  Essential fatty acids
  •  Neurotransmitter

Metabolic imbalances

  •  Hormonal Dysbiosis (gut flora)
  •  Chronic inflammation
  •  Genetic SNP
  •  Poorly functioning organs
  •  Poor cell signaling

Physical

  •  Injuries
  •  Repetitive strain
  •  Tension
  •  Lack of exercise
  •  Lack of sleep
  •  Excess stress

Work

  •  Too many responsibilities
  •  Required to put in long hours, without adequate relaxation time
  •  Daily work is boring and has unrewarding tasks
  •  Poor physical as well as emotional conditions

Psycho-emotional

  •  Suffering from low self-esteem
  •  No sense of purpose or meaning
  •  Shortage of joy or love
  •  Holding grudges/inability to forgive
  •  Judging yourself and others
  •  Feeling helpless
  •  Unable to reach out and ask for help
  •  Worrying a lot or feeling anxious
  •  Pessimism
  •  Guilt-ridden
  •  Uncertainty
  •  An inability to fully express your emotions

Social

  •  Lonesomeness
  •  Seclusion
  •  Lack of family support
  •  Divorce or break-up of long-term relationship
  •  Death of a spouse or other loved one
  •  Immigration

Spiritual

  •  Lack of trust in self, others, or the Universe
  •  Feeling separated from nature
  •  Disregarding your inner guidance
  •  Little or no feeling of gratitude
  •  Lack of kindness as well as compassion for self and others

Adapted from Total Renewal: 7 Key Steps to Resilience, Vitality and Long-term Health, by Frank Lipman, MD.

Endocrine Glands And Hormones

womentowomen on December 1, 2013

by Marcelle Pick, OB/GYN NP

The glands and hormones of the female endocrine system

Woman Holding The World In The Palm Of Her HandThis particular table lists the key endocrine glands which are commonly found in females as well as the hormones they naturally release, in addition to many of the diffuse endocrine organs plus tissues that are in your body and their related hormones. It is important to note that this list isn’t complete. Many of the hormones are not yet well understood and there is much more that needs to be discovered. However, knowing that Mother Nature usually has it right, we can be sure that our hormones play a significant role in our wellbeing.

Key Female Endocrine Glands and Their Hormones

(a partial listing) 
Gland/Organ            Hormone(s) released
Hypothalamus
  •  thyrotropin releasing hormone
  •  release inhibiting hormones
Pituitary
  •  thyrotropin/thyroid stimulating hormone (TSH)
  •  adrenocorticotropic hormone (ACTH)
  •  luteinizing hormone (LH)
  •  follicle-stimulating hormone (FSH)
  •  growth hormone (GH)
  •  prolactin
  •  melanocyte-stimulating hormone (MSH)
  •  oxytocin
  •  antidiuretic hormone (ADH, or vasopressin)
Pineal
  •  melatonin
Thyroid and parathyroid
  •  thyroxine (T4)
  •  triiodothyronine (T3)
  •  calcitonin (CT)
  •  parathyroid hormone (PH)
Thymus
  •  thymosin
  •  thymopoietin
  •  thymopoiethymic factor
Adrenals
  •  epinephrine
  •  norepinephrine
  •  testosterone
  •  estrogen
  •  dehydroepiandrosterone (DHEA)
  •  aldosterone
  •  cortisol
  •  corticosterone
Pancreas (Islets of Langerhans)
  •  insulin
  •  glucagon
  •  somatostatin (also secreted elsewhere)
Ovaries
  •  estrone
  •  estradiol
  •  estriol
  •  progesterone
  •  testosterone
Placenta
  •  human chorionic gonadotropin (hCG)
Breasts
  •  estrogen
 

The endocrine system (A partial list of organs and tissues that secrete hormones)
Tissue/organ Hormone(s) released
Adipose tissue (fat)(Note that with development of abdominal obesity, adipose tissue actually  functions as a key player in the endocrine system).
  •  leptin
  •  adiponectin
  •  resistin
  •  plasminogen activating inhibitor–1 (PAI–1)
  •  estrogen
  •  and others
Skin
  •  vitamin D3 (cholecalciferol)
Stomach and Small Intestine
  •  gastrin
  •  secretin
  •  cholecystokinin
  •  ghrelin
  •  motilin
Liver
  •  25–hydroxycholecalciferol
Kidneys
  •  erythropoietin (EPO)
  •  1,25-dihydroxycholecalciferol
  •  rennin
Heart
  •  atrial naturetic hormone
 

You will see that several of the hormones, organs, and tissues that are listed above are discussed in great depth throughout our website. Make sure to browse our Health Library if you are looking for a complete listing of all of Women to Women’s articles on female hormonal balance.

 

Diagnosing The Symptoms Of Depression

womentowomen on December 1, 2013

by Marcelle Pick, OB/GYN NP

What Is depression?

As humans, too often we seem to be struggling to maintain our balance. While modern medicine has vanquished most of the acute infectious diseases that were once our greatest threat, depression is still prevalent. I know that many of you may have had bouts of depression in your life. It’s overwhelming, but there is hope!

For example, let me tell you about Sarah. She’s a busy physician and a 46-year-old mother of two small children. When she first came to me, she was complaining of anxiety, fuzzy thinking, premenstrual syndrome (PMS) symptoms, and significant depression. She was also struggling unsuccessfully to lose about 15 pounds that she gained with her pregnancies. Sarah had a very demanding job and admitted to me that her life “was not going well.” This sounds like so many women today, as we attempt to juggle our relationships with our family, our friends, our work, and make time to take care of ourselves! That, unfortunately, comes last.

Let’s review what I told Sarah about her symptoms of depression. One of the primary things to assist you with your symptoms is for you to understand the symptoms and treatment options and see if they apply to you.

Understanding the symptoms of depression

The symptoms of depression can include a variety of normal negative emotions, and most women will experience symptoms of depression at some time in their lives. However, clinical depression is drastically different from situational or mild depression, even though some of the symptoms can be the same. There are a numerous of types of depression. But it is important to understand where and if your symptoms fit in so that you can find the best help for depression. So lets look at some of the symptoms of depression.

Symptoms of depression some may experience

  •  Overwhelming, persistent feelings of grief, anxiety, guilt or despair
  •  Feelings of worthlessness, feelings of never being enough
  •  A sense of numbness or hollowness, nothing makes you happy
  •  A loss of interest or pleasure in activities that were once enjoyed
  •  Decreased energy, dullness
  •  Difficulty concentrating or making decisions
  •  Irritability, small things make for huge reactions
  •  Disrupted sleep patterns, including insomnia or not being able to get out of bed
  •  Overeating and weight gain
  •  Reduced appetite and weight loss
  •  Lack of interest in sex, complete and utter loss of desire
  •  Sense of not wanting to get up to do your day

Mild or situational depression

In mild or situational depression these symptoms usually go back and forth and eventually they are gone. For example, this is an appropriate reaction to something that happened, such as going through a major life transition; experiencing a crisis, loss, such as a death of a loved one or trauma; or placing too much physical stress on the body. Working 15 hour days without a break. Women may experience postpartum depression or depression as one of the symptoms of premenstrual syndrome (PMS). Many women, especially in the north are affected by seasonal affective disorder (SAD), in which their symptoms of depression consistently follow a seasonal pattern.

Mood disorders

The difference between mild depression and clinical depression is that the mood symptoms are more severe and perhaps extreme, and there isn’t a clear cause of the severity of the depression. For people with clinical depression (called major depressive disorder or MDD), the symptoms are incapacitating and often occur spontaneously. Mood disorder symptoms do not go away, in spite of many changes and they often spiral into a mental health crisis.

Major depression can be accompanied by suicidal thoughts, obsession with death, or suicide attempts. If you have a general feeling of hopelessness, or if you or someone you know seems to have these symptoms or thoughts, especially if they have attempted suicide or considered it have even considered suicide you should find help immediately! Don’t wait to see if the symptoms improve. Seek the advice of your doctor or a psychiatrist, psychologist, or social worker. People with severe MDD can experience psychotic symptoms. In this case, medical treatment is absolutely necessary.

A variant form of clinical depression is dysthymia, also known as double depression. Dysthymia is recognized as chronic depression that lasts for more than two years. The symptoms are not as severe as those of MDD, but are more definitely more persistent.

Some people experience bouts of depression, but they may be mild or severe, interspersed with periods of intense energy or impulsivity. This is a sign of a more complicated disorder known as manic depression or bipolar disorder. Bipolar disorder is rare, but, we are seeing this disorder more often. You certainly hear about it more often in the media. It can become debilitating without treatment. If you are having or have had symptoms that make you question that perhaps this may be true for you, you should seek help from a mental health expert. These symptoms may include feelings of mania, excitement, excess energy, need for little sleep, and feelings of being invincible or better than others and then followed by periods of extreme depression.

Treatments for depression

For people with major depressive disorder, dysthymia, or bipolar disorder, antidepressants or mood stabilizing drugs are a very important part of their treatment. However, patients with these diagnoses will benefit greatly from additional, more integrative approaches that must include lifestyle and dietary interventions. Be sure to discuss your symptoms of depression with your practitioner or mental health provider.

Women who experience common types of mild depression can often find significant relief through alternative treatments. For more information on depression relief using a more natural approach without medications, and why this may be the best choice for you, read our full article on antidepressants.

Finally, chronic unrelenting physical symptoms that don’t seem to respond to treatment, such as headaches, overall body aches, sleep disturbances, digestive disorders, and pain can be an indication of depression, but these symptoms might be caused by an underlying physical condition that needs to be tested. Before taking antidepressants for these symptoms, you may want to get get a second opinion. Functional medical practices (those that combine alternative and conventional medicine) are extremely successful at finding the true source of these seemingly disconnected ailments. For more information, see our article on how to make alternative/functional medicine work for you.

Conclusion

Let’s see what happened in Sarah’s case. All of her conventional tests were normal, so we had Sarah take a neurotransmitter test and found that her serotonin was severely depleted and her dopamine was elevated. We also discovered that her adrenals were suffering and needed support. Our first step was to start Sarah to begin to heal by removing caffeine, sugar, gluten, and wheat from her diet; and we added a few targeted nutrients to support her body’s ability to replenish her neurotransmitters and hormones naturally.

On the lifestyle front, Sarah vowed to start putting more limits on her practice and to take more time for herself. I also recommended more exercise, at least three times per week, intense enough to break a sweat and get her endorphins going. Sarah entered psychotherapy and carved out time to exercise regularly. She was strict with herself about meals and sleep, and she reduced some of her work demands. Within a month, Sarah reported a huge shift in her mood and energy levels and began losing weight. She felt inspired to stay with her clean diet and lifestyle changes and continued on neurotransmitter supplemental support. Now, six months later, she feels that her life is back on track. She’s lost all the weight, her mood is great, and she has all the resilience and energy she needs to take care of her kids and her medical practice. But best of all, Sarah is back in control and happy with her life. Now she can be more present for herself, her patients, and her family.

Sarah’s depression and neurotransmitter imbalance was on the low end of the scale. If you have a diagnosed clinical biochemical imbalance – such as clinical depression or post-traumatic stress disorder – it may take more work – and with the help from a team of trusted health-care practitioners and therapists, I hope.