Common Antidepressant Medications

womentowomen on December 1, 2013

by Marcelle Pick, OB/GYN NP

A list of antidepressants and their side effects

Depression includes a wide range of normal negative emotions and often manifests physically in symptoms that won’t respond to treatment, including but not limited to weight gain, chronic pain, and digestion disorders. But clinical depression differs significantly from minor or situational depression or mood disorders, even though the symptoms can be the same. How can you tell which you have? The difference is that in mild depression the symptoms ebb and flow and eventually lift, while in major depression they spiral down into a full-blown mental health crisis. Patients often describe the sense that they are on the edge of, or slipping into, a deep, dark hole. If you’ve been feeling any of the following symptoms consistently for over a month, you should immediately seek medical advice, preferably from a trained psychiatrist, psychologist, or social worker.

  •  Overwhelming, persistent feelings of grief, anxiety, guilt, or despair
  •  A sense of numbness or hollowness
  •  Feelings of hopelessness
  •  A loss of interest or pleasure in activities that you once enjoyed, including sex
  •  Dullness
  •  Decreased energy
  •  Difficulty concentrating or making decisions
  •  Disrupted sleep patterns
  •  Loss of appetite
  •  Suicidal thoughts or attempts and obsessing about death—these are serious warning signs that need to be addressed immediately

If this sounds like you, please don’t worry. You can get better. Depression is a physical and mental condition that responds very well to treatment, both conventional and integrative. The most important thing is to get some help. You may be asked to take medication as part of your treatment plan. If so, then you’ll want to know what some of these are, so you can help choose what’s best for you. Following is a list of the many antidepressant medications that are used in conventional medicine. The listing is not comprehensive as the medications change rather quickly with new ones coming out all the time but it will let you know the medications used for depression and their biochemical family. Some side effects of antidepressants are listed below, just look for the headings for the various types of antidepressants. Many side effects can occur even with short-term use. Relatively little is known about the long-term effects of most drugs for depression as they were never studied for long term use, or their interactions with other drugs. For a more comprehensive discussion about antidepressants, or if you’re curious about natural alternatives to antidepressants, be sure to read our articles on antidepressants and alternative treatments for depression.

Common Antidepressant Medications

Chemical name

Antidepressant family

Brand name
amitriptyline tricyclic Elavil
amoxapine tricyclic Asendin
bupropion aminoketone Wellbutrin
citalopram SSRI Celexa
clomipramine tricyclic Anafranil
desipramine tricyclic/SNRI Norpramin, Pertofrane
doxepin tricyclic Adapine, Sinequan
duloxetine SNRI Cymbalta
escitalopram SSRI Lexapro
fluvoxamine SSRI Luvox
fluoxetine SSRI Prozac
imipramine tricyclic Tofranil
isocarboxazid MAOI Marplan
maprotiline NRI Ludiomil
mirtazapine “NaSSA” Remeron
nefazodone SNRI Serzone
nortriptyline tricyclic Aventyl, Pamelor
paroxetine SSRI Paxil
phenelzine MAOI Nardil
protriptyline tricyclic Vivactil
sertraline SSRI Zoloft
tranylcypromine MAOI Parnate
trazodone serotonin modulator Desyrel
trimipramine tricyclic Surmontil
venlafaxine SNRI Effexor

 

Tricyclics

These drugs have been around for a long time and they affect norepinephrine and serotonin. They are as effective as SSRIs in many people, but they do have a much stronger side effect profile. Thus they are usually suggested as a second or third level option of treatment. Some of the common side effects of include dry mouth, constipation, bladder problems, sexual dysfunction, blurred vision, dizziness, drowsiness, and increased heart rate.

MAOIs

Monoamine oxidase inhibitors (MAIO) are really helpful for some people, with major depression, who don’t react to other antidepressants. They can also use to treat panic disorder and bipolar depression. People who take MAOIs have many things to remember as they have to avoid taking decongestants and eating many foods that contain high levels of the monoamine tyramine, including fish, chocolate, and fermented foods (such as alcoholic beverages, cheeses, soy sauce, processed meats, and pickles).There are also many vitamins and nutrients that can interact with MAOIs. So if you are on an MAOI remember to read labels of the interactions. One of the most notably interactions of tyramine with MAOIs is they can bring on a sharp increase in blood pressure that can lead to a stroke.

SSRIs

The side effects of serotonin reuptake inhibitors (SSRI) include sexual dysfunction, nausea, nervousness, insomnia, agitation, and decreased sweating with increased body temperature. These side effects may be enhanced when an SSRI is combined with other medications or herbs that affect serotonin (such as St. John’s Wort and SAM-e). There are many people however, that do very well with these herbs, just remember that we are all different with different reactions. In extreme cases, the combination of medications (for example, an SSRI and an MAOI) may result in a potentially serious or even fatal serotonin syndrome, characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems.

Newer drugs

There are new classes of antidepressants being developed and being made available for use. Classifying them is not always clear, because of their combined biochemical action. One of the new classes is serotonin/norepinephrine reuptake inhibitors (SNRI), such as the tricyclics. This class of drugs affects both norepinephrine and serotonin levels but has a fewer side effect profile.. SNRIs include Effexor (venlafaxine) and Serzone (nefazadone). Cases of life-threatening liver failure have been reported in patients treated with Serzone, and this trade name was actually discontinued in 2003; however, the generic version of Serzone (nefazodone) remains available. Some of this is probably related to a genetic SNP affecting how drugs are detoxified by the liver. Patients should call their doctor if they have the following symptoms of liver dysfunction: yellowing of the skin or whites of the eyes, unusually dark urine, loss of appetite that lasts for several days, nausea, severe lethargy or abdominal pain. In addition, there are other new medications that are not chemically related to the other antidepressants, however, they have similar side effects to SSRIs. These include Remeron (mirtazepine) and Wellbutrin (bupropion). These drugs must not used by anyone who has, or might be at risk for, seizure disorders.

Postpartum Depression

womentowomen on December 1, 2013

by Marcelle Pick, OB/GYN, NP

Postpartum depression’s silver lining

Women who have had a baby know that pregnancy and childbirth are most often not the picture-perfect image that we see displayed in the media (for example magazines, movies, television, and the internet). One of the most common instances of this difference is when a new mother experiences postpartum depression (PPD), especially if she’s had a terrific, even enjoyable pregnancy and then has symptoms of PPD. However, for me, a story of a good prenatal experience that is followed by a bad case of postpartum depression points to a specific health issue that might otherwise go unnoticed – a hormonal imbalance that can resurface or persist all the way through your life especially into menopause.

Maybe you’re way past your childbearing years, or perhaps you’ve just recently had a baby. Either way, you should understand that it’s important for you to pay attention to your postpartum emotions. If you are a new mom who is feeling mildly depressed, or even if you felt that way when your now-teenage son or daughter was still in diapers, please understand that there are physical issues related to these emotions. Even years later, these symptoms are important to recognize.

I have patients tell me all the time, “I haven’t felt quite right ever since I gave birth,” long after her child has grown out of babyhood. This makes complete sense: if there was an imbalance in your body before you had a baby and that manifested itself with PPD symptoms, then it’s highly likely that it’s still with you even after PPD resolves.

And here’s the good news – that’s the silver lining to PPD. Having PPD symptoms can highlight a hormonal imbalance problem that you can do something about before it starts causing you major difficulties with your menopausal transition. This is especially important if you’re an older mom who might already be starting perimenopause. When you try to balance your hormones while you are chasing a toddler around, it can be a challenge, to say the least! The two simply do not seem to go together. So let’s discuss what happens to your hormones after you have a baby (postpartum) and how PPD can act as a signpost for regaining your hormonal balance afterward.

It’s not just a “mood” you’re in—your hormones after pregnancy

As we so often tell our patients who come to see us at Women to Women, your endocrine system is inextricably linked with your brain and nervous system. It is like an orchestra, that needs to have everything in balance or the overall effect is off. This explains why women are more prone to problems with mood during their hormonal fluctuations. These periods of vulnerability include puberty (menarche), premenstruation, pregnancy, childbirth, and menopause.

I don’t think many people would disagree that having a baby is near the top of the list of hormonal transitions, when it comes to how “big” its impact is in our lives! Mother Nature gives many amazing ways to maintain our wellness through change, however historically; childbirth has been the biggest risk to survival that a woman may face. The hormonal tides of adolescence, perimenopause, and menopause usually appear in our lives in a more gradual way, but the hormones in childbirth act like a tsunami, flooding us all at once. In the world of today, a mother’s survival through childbirth is not usually a big concern. However, the risk of depression and other mood problems does rise during these unique times in a woman’s life, especially when she is under stress of any kind (as most of us usually are). The transition post pregnancy with respect to the hormones is actually quite drastic. One moment you are pregnant the next you are not. Postpartum emotions can make you feel as if something is really wrong. In fact, your feelings are normal and natural—in the sense that they reflect the hormonal changes that are happening in your body and brain—but that doesn’t mean that they are the most favorable for keeping you and your child healthy. Most likely, the message they are sending is, “Send more support!” And that can mean emotional support, help with caring for the baby, and most importantly, support for your physical healing.

If your symptoms of PPD are long gone, you might be saying, “NOW you tell me!” — but hear me out, because it’s still not too late to benefit from your PPD experience.

What PPD tells us about our hormones

One of the most significant hormones related to PPD is progesterone. During pregnancy, the levels of progesterone in a woman’s body are at there highest. Progesterone helps to prevent lactation (secretion of milk from your breasts) during pregnancy, and then a sudden drop in its level takes place just before birth. This allows labor to begin and lactation to start. Isn’t it amazing what our bodies can do? However, a few women will have symptoms of depression that include, severe irritability, poor sleep, and agitation, restless behavior (these are the women who go down to the basement to clean it when they feel out of sorts, some have more severe symptoms). Alternatively, progesterone has a calming effect on your brain, and if you’re one of the women affected this way, your mood can change following childbirth, as it returns to your prepregnant levels. This will be around day five after delivery. For you, and women like you, a deficiency of progesterone is an important characteristic of PPD.

But what’s complicated about progesterone is that it’s not always that the hormone is deficient. Some women are extremely sensitive to fluctuations in progesterone levels. That means that even if the hormone level is what is considered a “normal” level, these women’s bodies and brains respond as if they’re experiencing abnormally low progesterone. For them the balance of the hormones, the orchestra is out of tune. So in response, we cannot simply perform a test to determine if the progesterone level is low—we also must find out if a woman has a history that points to this kind of sensitivity.

So how can you find out if you’re one of the women who is highly sensitive to fluctuations in progesterone levels? As I encourage all women to gain more knowledge about their bodies, I suggest that you understand your personal reproductive rhythms. In your menstrual cycle, progesterone is at its highest after ovulation, and then it drops just before menstruation. There are mood changes that you might feel that are associated with this drop in progesterone. These changes are similar to those seen in PPD—it’s almost as if PPD is a magnified form of your PMS moods. If you have major mood changes before, during, or after your menstrual cycle, it could indicate that you are highly sensitive to the changes in your progesterone levels. This means that you’re more likely to develop PPD. And if any of the above sounds an alert for you—“This is me!”— then more than likely, you could have a hormonal imbalance when you reach menopause.

When motherhood and menopause converge

We’ve heard over and over that many women who are age 35 and above are becoming first-time mothers. This is often seen as a challenge to determine what this increase of mothers in their late 30’s and 40’s means for maternal health during and after pregnancy. For many they are considered advanced maternal age patients. We think that concern is overstated, and that there are advantages for women who choose to delay their families until their 30’s or 40’s. One of these is the lower incidence of PPD. A healthy 40-year-old woman actually has less risk than some younger mothers for PPD, because she probably has a stable family life and a social support system, in addition to a stronger sense of self. Mothers in their late 30’s and 40’s have probably spent more time planning for motherhood, and they may be better prepared for the challenges of caring for a newborn. They are also much more aware of themselves and are able to sustain many challenges with more grace than when they were younger. Studies show that women who are over 35 will more likely seek help for their symptoms of depression.

One area of concern for mothers in their 40’s (compared to younger moms) is their hormonal balance. It’s not unusual for a later-life mom to go right into menopause after childbirth without any interlude. If you’re a new mom nearing (or in) perimenopause, it’s very important that you do your best to take care of your overall health to try to avoid PPD, in addition to decreasing your menopause symptoms while caring for your young children (particularly if you’re breastfeeding). Remember perimenopausal changes can occur 10 years prior to official menopause.

So let’s review some options that you can do right now, whether you want to address PPD or if you want to restore hormonal balance long after childbirth:

  • Think nutrition, nutrition, nutrition. Food is the most powerful drug we have. If you’re a new mom and are breastfeeding, I hope that you are taking the prenatal vitamins offered to pregnant women. You should definitely keep taking them! I would also like you to consider adding a high-grade omega-3 fatty acid supplements if it is not already in your prenatal nutrients. Studies show that it can act as a natural antidepressant. However, if you’re not breastfeeding, or if you’re long past childbirth, then it’s still important to get your key vitamins and minerals. The old days of us being able to get all of the necessary nutrients just from our food is long gone. I can’t stress enough how important a pharmaceutical-grade multivitamin is as a first step—but understand it is not the only step to good nutrition. Food sends messages to your bodies’ biochemistry which in turn help to restore your body’s balance. the suggestions we offer in our article on eating to support your adrenal glands are just as effective in helping to heal your hormonal imbalances uncovered by PPD.
  •  Include movement into your routine. Most of us need some sense of routine in our life to feel “normal.” If you’re a new mom and you’re feeling not quite right, remember to add a new routine for yourself. It needs to be flexible enough to work with your baby’s changing schedule. Just the regimen of getting up each morning, bathing, and getting dressed will help you feel better, but the more you can do to move your body, the better you’ll feel. Start with a gentle, simple exercise that can help you build and tone your muscles slowly, something such as yoga, t’ai chi, or walking taking your newborn for a walk—these are relatively easy to include in your schedule, even with a new baby. And do what you can to get outside and enjoy the sunshine and fresh air every day! That’s free and easy for everyone. Even if PPD is in your past, you might find it helpful to make changes to your existing routine to improve your hormonal balance. For example, if you’re not already into an exercise routine, make an effort to move your body daily. It doesn’t have to be an ambitious, hour-long, high-impact aerobics class! Just go for a walk, get out in the garden, stretch your body, or think of some other activity will give your health a boost. Exercise promotes mood-stabilizing hormones and relieves stress—which are both important components to regain hormonal balance. Most gyms now have babysitting services, this is something you can ask about when looking at your options.
  • Prioritize your health. Busy moms sometimes forget to take time for themselves, as their focus is on the new baby. You might not realize that when you neglect your health, you and your whole family suffers. One of the best things you can do is to take care of yourself, as much for you as for your children and your family. You will find you have more to give when you are filling up your needs first. If you’ve been feeling physically out of sorts since childbirth—even if years have passed—talk to your healthcare practitioner about what’s been going on. There may be simple things that need to be adjusted. Look at our articles on adrenal health and fatigue to see if you see a pattern in your life, and take steps to correct these problems. Above all, don’t feel badly about taking care of yourself! You have to have the stamina and energy to run the show as many mothers do.
  •  Explore your emotional story. We have previously discussed the link between stress and health in our articles on emotions, health, and stress. Where PPD is concerned, some of what happened to you as a child might be enhancing your emotions about being a parent. Think back on these questions. Were your parents loving and present in your life, or were they detached and absent, or even abusive? Sometimes we try to overdo what we saw as a lack in our own childhood. Do you feel confident about your capabilities as a mother, or are you frightened, confused, and unsure if you’ll be able to properly care for your child? (We don’t have classes on parenting in high school or college). These factors can affect your physical well-being more than you might imagine, and if they’re part of your circumstances, consider talking with a therapist or using emotional healing techniques to address them. Even if your child is grown, it’s still wise to look at your feelings about being a parent, if this is a source of stress for you. This for some can transform how they parent.
  •  You many want to consider bioidentical progesterone therapy. When we see women at our clinic with PPD, we often check their progesterone level. If it is unusually low, we recommend bioidentical progesterone therapy. Though there are no controlled studies to date of progesterone in the prevention or treatment of postpartum depression, at Women to Women we have used prescription-strength bioidentical progesterone replacement to help women whose levels remain very low postpartum, with fantastic results. We sometimes use this practice in women whose depression shows up in symptoms of restlessness, sleeplessness, or agitation, even if their progesterone levels are normal, as these are the women who seem to be unusually sensitive to hormonal fluctuations (as was mentioned previously). We especially use this if we see a cyclic nature to the symptoms. Natural progesterone has a known effect on the GABA receptors in the brain—the same receptors that opiate drugs (narcotics) bind to. I will say that this protocol is somewhat controversial; so many conventional practitioners may be unwilling to try it. We and our contemporaries, however, regularly see dramatic improvement in these women’s depression and anxiety, and although there have been no large trials to date that prove its efficacy, we have used this protocol with great effect many times for many years.

Progesterone Protocol for PPD 400 mg of bioidentical progesterone in divided doses: 100 mg in the a.m., 100 mg at noon; and 200 mg in the p.m. This regime is used from mid-cycle until menses resumes. We have reliable compounding pharmacies, such as Northern New England Compounding Pharmacy, locally we have Apothecary by Design or Women’s International Pharmacy, that make this up for our patients as sublingual troches or capsules. We are not as apt to use the creams as it is hard to get that dosage in a cream form without having to use large amounts of cream three times a day. We divide the dose to prevent associated fatigue or “spacey” feelings that may sometimes be associated with a rapid increase in progesterone levels.

  •  Reduce inflammation. Inflammation is one of the key factors in depression, and studies show that mothers with PPD have higher levels of inflammation. Other physical and psychosocial stressors — (of notes is that stress is a leading issue here), risk factors for depression — also increase inflammation. Anxiety in first-time mothers, for example, is strongly linked with activation of the inflammatory response. So anything you can do to decrease anxiety and inflammation in your body is a good first step toward treating or avoiding PPD naturally. It’s really good for your health, even if you’re long past the likelihood of PPD. One good approach is to discontinue the use of foods that are known causes of inflammation, such as refined sugar or flour, caffeine, and alcohol. At the same time, you can increase your intake of nature’s best anxiety-dissolvers and anti-inflammatories, such as omega-3 fatty acids and safe, gentle herbs (good for moms and babies) such as turmeric, boswellia and motherwort.

Exercise, cognitive therapy, and the herbal antidepressant St. John’s Wort have also been revealed to help decrease inflammation. You have many choices, but for best results, consult with a professional, particularly if you’re breastfeeding— there are some herbs that are not particularly good for your babies, and these should be avoided until you want to wean your baby. See also our articles on natural anti-inflammatories.

If you’re a new mom, these additional points apply to you

  • Seek help now if you’re currently in PPD or have the baby blues. The help that you get can make being a mother such a different experience. The earlier advice to prioritize your health goes double if you’re actually suffering from PPD right now. This is the hard part about PPD – understanding that it’s a physical problem that may need medical intervention. There seems to be a stigma associated with any sort of mental illness that new moms might have – you may not want to let on that anything is wrong. It’s our tendency as women to continue to try to do everything and we hide our symptoms and pretend that we have everything under control, when it’s not. Whether your symptoms are mild and go away in the first few weeks, or if you realize that there is something deeper going on, don’t think that taking care of yourself comes second to baby. It is essential and equally important that you take care of yourself and that you are whole and healthy to continue being a good mother. That is the best thing you can do for your baby. If you’re feeling exhausted, overwhelmed, and teary, don’t wait to seek help. Talk to your healthcare practitioner about ways to reduce your burden, and then you can start the process to heal. If for any reason, you have thoughts about harming yourself or your baby, get help immediately! Your practitioner will understand that these thoughts are a sign of postpartum depression and you can start on a treatment plan that will help. Intervention needs to happen immediately. Most importantly, you should not feel embarrassed or ashamed about it – an imbalance in your hormones doesn’t make you a bad mother! And the best news is you can do something about it.
  •  Breastfeed to reduce maternal stress. We recommend breastfeeding for two important reasons. First, it’s been proven that it’s better for the baby (except in unusual situations) as it provides essential nutrients but also, just as important, it’s good for you!. Breastfeeding can protect your mental and emotional health, because it lowers stress hormones such as cortisol, ACTH, epinephrine, and norepinephrine. Women who nurse their baby also have a higher level of oxytocin, the wonderful “cuddle” hormone. The hormone that is also excreted with love making. Breastfeeding may promote faster weight loss, which will improve your mood as you adjust to your body’s changed appearance after the birth of your baby. It also encourages you to stay well-rested and hydrated—you can’t nurse your baby effectively if you’re always on the go, nor will your milk supply hold up if you don’t drink enough water. The other side is that if you’re having challenges with breastfeeding your baby, you can become frustrated and stressed about it, but remember that you don’t have to figure out the problem alone. Most hospitals and birthing centers have lactation consultants who will assist you in learning how to breastfeed effectively. Many of them will come to your house if need be. Contrary to popular belief, breastfeeding is not something that comes naturally to every mother, and most new mothers need to learn the best ways to offer this important nutrition to their child. In addition, you can contact the La Leche League for support. Alternatively, please understand that if breastfeeding is not an option, if it becomes a source of extreme stress for you, or if you’re too depressed, it is acceptable to give your baby formula. Don’t feel that you need to always put what’s best for your baby ahead of your own needs. Sometimes doing what you need to do to improve your health and emotional welfare is far more important to the baby’s well-being than any benefit that might come from breastfeeding. Babies are very sensitive to their mother’s energy, so by making a change that will help you will also have a helpful impact on the baby.
  •  Don’t be alone any longer. Reaching out to your family, friends, and healthcare practitioner for additional support does wonders and is so simple. One of the characteristics that are different for women with PPD as compared to other forms of depression is that they feel guilty. The first thing I tell new mothers concerned about postpartum depression is that it is an “amplification” of all our feelings—joy or sadness, sheer bliss or emotional upheaval—and it is very common after giving birth in minor or major ways. It is also perfectly normal and natural. I also remind the new mom that they need a tremendous amount of support. It’s never your “fault” for needing more support through this transition. Remember we are not taught to be mothers. In our past the family was around to provide support and the information was passed on through the generation. This is no longer the case. This is also the time when a baby support group—though it may have seemed a little silly before baby arrived—can really save your day. Reach out and ask someone—your neighbor, your friend, your family to be there to help you. Most people want to help, but don’t want to intrude. If you make the first step, they will respond!

Putting the Pieces Together

When a woman comes to me experiencing what I think may be perimenopausal symptoms, there’s often an “Aha!” moment that comes when she tells me she experienced PPD after childbirth. Those dark days after giving birth, whether just recently or long ago, can become a beacon that will show you the way to changes that can transform your health. Even if you’re just now reading this information long after you had PPD, and you might have never even known that’s what it was, it’s okay. At Women to Women, we know firsthand that it’s never “too late” to restore your body’s balance and make a change. It is really the first step that counts.

 

Interstitial Cystitis

womentowomen on November 30, 2013

by Marcelle Pick, OB/GYN NP

Getting your bladder back on track — living with Interstitial Cystitis

  • What is interstitial cystitis and why haven’t I heard of it?
  • The possible causes of IC
  • IC, estrogen, and menopause
  • Discovering your trigger foods
  • The Women to Women approach to treating IC

Frequently, I am asked a myriad of questions from women who are suffering with intense pelvic discomfort as well as women who have the urge to urinate frequently. For a number of women, constant trips to the bathroom control their lives. Some of these women go to the bathroom as often as 60 times a day and 10 times during the night! Numerous women are desperate to minimize an extremely painful, stabbing pain in their pelvis. The good news is that today, women have a variety of avenues they can explore when it comes to these symptoms, a common one; however, often misdiagnosed – a bladder condition called interstitial cystitis (IC), or painful bladder syndrome (PBS) is something I want to talk about.

Interstitial cystitis affects more than 1.2 million people in the United States, 90% of whom are women. Interstitial cystitis can affect women at all stages of life, from puberty to menopause, all of which have unique challenges with this condition. The condition is extremely uncomfortable and leads many women to search for answers. It is important to understand that our hormones, particularly estrogen, play a large role in managing (or even preventing) the inflammation that relates to IC. Even though the symptoms can feel similar to a urinary tract infection (UTI), nobody has been able to identify an infectious agent to date: consequently the condition won’t show up on regular urine cultures for bacteria and other pathogens. Unfortunately, taking antibiotics won’t help either. Nor will drinking more cranberry juice — natural UTI treatments can in fact make IC symptoms worse.

Interstitial cystitis can be downright unbearable for some women, preventing them from going to school, work, or participating in any of their normal day-to-day activities, not to mention making their sex lives very painful. Too often women just “live with it” for years before looking for help. Or a woman could see up to five different practitioners over the course of many years before being accurately diagnosed with Interstitial cystitis! I would like to talk a little bit more about this remarkable condition as well as look at what you can do to protect your bladder — as well as your sanity and over all lifestyle. Many different techniques have been tried but none have a huge success rate to date.

What is Interstitial Cystitis, and why haven’t I heard of it?

The symptoms of IC are easily confused with a wide range of other problems, from bladder infections (UTI’s) and urge incontinence to bladder cancer, endometriosis, STD’s, and kidney stones. These disorders have different root causes and need different types of treatments. A lot of women with IC see their healthcare practitioners thinking they have a UTI and are told their urine is “clean” —that means on culture that no abnormalities were seen in the urine when it was evaluated in the lab. If there is no detected “problem,” it frequently means that there simply is no easy solution for women.

There now exists diagnostic criteria for IC established by the National Institutes of Health Let’s look at what they are:

  • Bladder and low pelvic pain
  • Urinary urgency and frequency
  • Small bladder
  • Evaluation for Hunner’s ulcers (only affects about 10% of all cases)

Interstitial cystitis is most often recognized as a chronic neuroinflammatory disorder affecting the bladder — a complex interrelationship between bladder nerves, the immune system, and the urinary tract. Untreated, IC can lead to scarring or stiffening of the bladder walls as well as an inability to hold much fluid in your bladder. Glomerulations, which are identified as hemorrhages in the mucosal lining of the bladder, and can also develop star-shaped sores called Hunner’s ulcers, this is seldom seen in clinical practice.

As more medical professionals learn to identify the IC conditions, they are better able to help women manage as well as overcome this disorder. The Interstitial Cystitis Association and the Interstitial Cystitis Network are wonderful organizations that are promoting more awareness of the varied causes and symptoms so more women can get relief.

Possible causes of interstitial cystitis

We are still learning about IC, and to date there is no known cause that has been identified. There are probably many “insults” to the bladder that could lead to interstitial cystitis. What is clearly understood though is that inflammation is at play, with immune dysfunction, specifically allergies and sensitivities, having a central role. Here are a few possibilities. There does seem to be some ties with autoimmune disorders as well.

Chemicals in urine: Urine itself can be an irritant in the urinary tract, mainly if tissues were previously damaged from other primary causes. Urine will change as the diet changes. Studies show that patients with IC have a molecule in their urine called antiproliferative factor (APF). APF inhibits the normal growth of bladder wall cells, making it problematic for your bladder to repair itself if scarred.

Mast cell activation. Studies have shown that some of the contents found typically in our urine (like potassium, for example) can infiltrate the bladder lining in IC patients, leading to mast cell activation and the release of histamine — which can then result in further damage to the bladder lining and amplified inflammation. More than 70% of women with IC have highly activated mast cells. Again this is an example of the inflammatory system being on high alert.

Previous bladder damage: A number of factors can damage the bladder, making it more susceptible to the interstitial cystitis. Some of which include:

  • A history of bladder trauma, especially including pelvic surgery
  • Spinal cord trauma
  • Pelvic floor muscle dysfunction
  • Bladder over distention
  • Inflammation of pelvic nerves
  • Autoimmune disorders
  • History of frequent bladder infections
  • Chronically Low estrogen

Interstitial cystitis, estrogen, and menopause

So many women remark that symptoms of IC ebb and flow with the natural hormonal shifting that occurs in our bodies monthly. Furthermore, some notice their first symptoms throughout the perimenopausal time frame. Why, you might ask? Well, it most likely has something to do with estrogen levels. A reduction in estrogen levels can activate our mast cells. Estrogen is an anti-inflammatory agent.

When evaluating bladder mast cells researchers at Tufts who examined the mast cells under an electron microscope also noticed a large number of estrogen receptors in cells from women with IC. The net result in these women is similar to hormones that are imbalanced. They described this as similar to a progesterone deficient state which lead to increased mast cell secretion of histamine. This is the body’s immune response to an offender.

In looking at the bladder’s anatomy, the bladder lining and the muscle that essentially governs urination, the detrusor, are greatly affected by inflammation, mast cell activity, and estrogen. If we have ongoing low-grade inflammation over the course of multiple years, particularly when coupled with significant hormonal fluctuations during perimenopause and menopause, the tissues and muscle can become thinner and drier — and even more susceptible to inflammatory changes. As a result without restoring our hormonal balance, there is a greater chance that we can become more susceptible to IC.

However, women have options when it comes to treating and managing interstitial cystitis. A good place for women to start is by looking at their diet and lifestyle.

Discovering your triggers — an IC elimination diet

Subsequently a lot of women say that their symptoms decrease when they follow an alkalizing, anti-inflammatory diet by avoiding certain trigger foods, and by eliminating caffeine, alcohol and smoking. Tobacco is a particularly common trigger because it constricts the bladder’s blood vessels, making it harder for our bodies to naturally cleanse inflammatory substances from the bladder tissues.

Here are the some of the foods that the Interstitial Cystitis Network calls “the most problematic” because they trigger the most symptoms in the most people. These top offenders are an excellent place to start:

  • Coffee. The acid and caffeine in coffee can cause intense irritation and discomfort. Additionally, caffeine acts as a diuretic. Therefore lowering your coffee consumption to 12 oz. or perhaps much less per day is really a wise decision – in fact, a lot of women with IC really need to completely eliminate coffee to feel significantly greater pain relief. Tea. Black teas and even decaffeinated teas can spark inflammation in your bladder. Everyone is different so just trying this for a few days may bring great relief. Green teas and some herbal teas also have a tendency to have a certain level of acidity. Nearly all women are (quite understandably) unwilling to give up their delicious hot drinks, but you can try some other options such as hot water with grated ginger and honey or mint teas containing only peppermint or spearmint leaves.
  • Cranberry and other acidic fruit juices. Cranberry juice is actually frequently recommended for the treatment of urinary tract infections, but an IC bladder is extremely irritated from the level of acidity in cranberry juice. So if juice is a must for you, try less acid varieties like pear, apple, and blueberry. Pear juices and pear sweeteners are really considered your safest bet.
  • Diet soda. Your average diet soda contains four major bladder irritants in one shiny can: acidic carbonation, citric and phosphoric acids, caffeine, and artificial sweeteners. In case you absolutely need to have a soda pop, we recommend a non-diet, non-caffeinated root beer, and diluting it with ice cubes or water is certainly a lot better.
  • Tomatoes. Though they’re full of so many good things, tomatoes are also high in potassium, and are highly acidic, too. For tomato-lovers, low-acid varieties might be substituted as an occasional treat.

At Women to Women, we would add a few additional items to this list of top offenders.

In our experience, the following substances also have the potential to trigger symptoms:

  • Artificial food colorings (dyes) and flavorings. Food colorings happen to be incredibly common in food (even several health foods) in addition to the majority of over-the-counter multivitamins and prescription medications.
  • Foods that promote yeast. Sugar, vinegar, yeast, malt and other foods can cause yeast overgrowth. You may want to follow a yeast-free, sugar-free diet — many of the women we see with IC symptoms are found to have systemic yeast, but once the yeast overgrowth is resolved, the IC symptoms abate. This is almost always an issue when we do the workup for IC.
  • Gluten. This problematic, inflammatory protein is found naturally in grains and also in several other foods through additives and contamination. Read our article on gluten sensitivity for more on the effects of gluten and how to address them with a gluten-free diet.
  • Certain nutrients. A number of women truly have allergies or severe sensitivities to certain nutrients — which is why you may read advice recommending that women with IC discontinue multivitamins. If you cannot find other causes for your allergic reaction to foods, consider NAET — an allergy elimination technique that has helped countless people overcome problematic allergies and sensitivities.

Once you learn just what foods set you off, you can begin to create a list of your trigger foods. Once you feel a lot better – which frequently will happen in just a week or two – experiment with just how much of each and every food your body definitely will process comfortably. Take heart: even the strictest IC diet doesn’t have to last forever. (The initial dietary changes are about calming down the bladder). But changing to a more alkalizing diet has tremendous overall health benefits for your body, and I know plenty of women with IC who are able to enjoy all of the above foods in smaller amounts!

The Women to Women approach — options for treating Interstitial Cystitis

Presently, there is not a cure for interstitial cystitis; however there are effective treatment options that do exist. Because our bladders can have trouble repairing themselves when we have IC, it is important that women speak with their healthcare practitioner as well as their urologist about the best IC treatment for them.

Here are some options:

  • Keep a bladder diary. If you are suffering from very painful bladder, or even more frequency than normal, always keep a personal bladder diary. For 24 hours (or more), jot down what you eat and drink (and smoke), how often you experience the urge to urinate, the level of your pain intensity, and how relieved your bladder feels after urination. You are then able to take your bladder diary with you any time you visit your healthcare practitioner to assist in figuring out patterns and whether or not you could have IC or not. This is one of the only ways for you to see the associations that may not have been seen otherwise.
  • Understand your triggers. See the section above on common interstitial cystitis triggers and learn what you can modify in your diet to lessen your symptoms. Everyone is different and has different triggers.
  • Follow an IC/alkaline diet. Actively managing the acid–alkaline balance in your body can help all urinary disorders, and lessen your discomfort. It has also helped women cut down on the foods that cause other inflammatory issues in their bodies To start, there are amazing cookbooks that can get you started with some excellent recipes. One excellent resource is A Taste of the Good Life: A Cookbook for an Interstitial Cystitis Diet.
  • Balance your hormones. Estrogen plays a significant role in inflammation, and during times of great hormonal imbalances your body could be more susceptible to inflammation that can lead to interstitial cystitis. Consider a natural approach to hormonal balance in your system, such as a soy supplement. Many women also think about more potent natural hormone therapies when needed. In my practice this is almost always something I will start with.
  • Investigate anti-inflammatory supplements. For numerous women, calcium citrate can promote a more alkaline system and reduce the inflammation that contributes to issues like IC and vulvadynia/vestibulitis. Also turmeric is a fabulous anti-inflammatory agent along with boswellia. In addition, omega-3s have long been known for their ability to decrease systemic inflammation in the tissue and membranes.
  • Probiotics also help restore normal flora and lessen inflammation, plus help to combat systemic yeast triggers. Also, Quercetin, is an antioxidant in the flavonol group with marked anti-inflammatory actions. It is also very effective to decrease systemic allergic responses. Quercetin-containing supplements are exceptionally well tolerated and are reported to provide considerable symptomatic improvement in patients with IC.
  • Try physical therapy. Most people with IC also have severe pelvic floor dysfunction, a condition in which the muscles of the pelvic floor do not relax enough to allow easy urination. They also may have alignment issues as well. Physical therapy to rehabilitate the pelvic floor is very helpful in easing the pain of IC, as is bladder “retraining” to gradually expand the time between trips to the bathroom. And a technique called myofascial tissue manipulation and polarity therapy shows promise for reducing IC symptoms.
  • Address body and mind. Various women have regular acupuncture treatments or biofeedback to relax the bladder and detrusor muscles. At Women to Women, we have referred patients for education in the Feldenkrais method, and integrative manipulative therapy with great success Guided imagery is also a readily available interventive step with no harmful side effects — in a study on guided imagery published in 2008, IC patients reported significant improvement in pain and IC symptom management.
  • Investigate conventional approaches. Based on the seriousness of your symptoms, you could possibly first try less invasive therapies, but if you do not experience improvement, don’t give up hope – nothing is going to help every woman the same exact way. You can always talk to your practitioner about more conventional treatments, and seeing a urologist or uro-gyn specialist who is familiar with cutting edge IC treatments available, such as:
  • Oral medications. Antidepressants can block pain for a number of women. These medications seem to work by interfering with nerve activity, and their effect may also prevent psychological stress, which can activate mast cells. Stress can be a significant aggravator. A number of researchers are developing treatments based on AFP, such as the prescription medication Elmiron, which “coats” the bladder wall to protect it, thereby reducing irritation and inflammation. Numerous experts now believe you can just start a trial of this medication based on symptoms, without need for painful cystoscopy testing.
  • Bladder treatments. A number of women with especially severe cases of IC have treatments that include bladder distensions (stretching the bladder during a cystoscopy), or by inserting drugs that inhibit inflammation and pain into the bladder through a catheter. Heparin and even Elmiron can be used in this manner.
  • Surgery. For women who cannot get pain relief elsewhere, surgery to expand the bladder remains a last resort — but since so many women find success treating their IC in other ways, surgery is fortunately uncommon.

Get out of the bathroom and back to your life!

There are certainly choices for you when you have interstitial cystitis. The first thing I recommend that you do is to talk to your healthcare practitioner about a combination of natural approaches that would work best for you, along with the IC diet in order to seek relief. Because with the right treatments, whether naturally and holistically, or through conventional medicine, the majority of us can learn how to manage our IC symptoms well enough to get out of the restroom, and back to our lives!

IC is often misdiagnosed as…

  • Urinary tract infection
  • Vaginitis
  • Urge incontinence
  • Chlamydia, herpes, and other STD’s
  • Kidney stones
  • Endometriosis
  • Bladder cancer

Herbal Treatments for PMS

womentowomen on November 30, 2013

by Marcelle Pick, OB/GYN NP

Treating premenstrual syndrome naturally

  • What causes PMS
  • Nature’s answer to PMS
  • Women to Women takes you seriously

We know you’ve had to change your plans because of your symptoms of premenstrual syndrome. The question is, how often? We know that PMS affects your life by causing a disruption in your plans, and we also know about the stigma that’s attached to it. As if it’s not a valid excuse to miss work or to change your plans. For those of us who suffer with the monthly symptoms, the mood swings, food cravings, irritability, bloating and more, it can almost reach the point of altering our lives.

Common symptoms of PMS:

  • Irritability and angry outbursts
  • Bloating and periodic weight gain
  • Breast tenderness
  • Cyclic Cramps
  • Sleep disturbances
  • Blood sugar shifts
  • Cravings
  • Headaches
  • Loss of sexual desire
  • Anxiety and moodiness

Is there help?

We realize that if you suffer with PMS, you’re searching for answers that are truly effective and that also deal with the hormonal imbalances that occur in your body. If you’ve tried solutions such as antidepressants, birth control pills, or over the counter products, like Pamprin, Tylenol, and Motrin, you haven’t been aiming at the source of your symptoms. These alternatives may provide some relief for a while, but they won’t, and they can’t, prevent your PMS from coming back again and again.

We have great information to share: There are natural ways to ease and to even avoid PMS so you are able to continue doing the things you enjoy doing, without monthly intrusions.

Getting to the source of premenstrual syndrome

You’re correct in believing that estrogen and progesterone provide the basic explanation for PMS, but what you may not fully understand is that other hormones have a significant role to play as well. Our endocrine (hormone) system is centered in the brain. The hypothalamus and pituitary glands work in harmony, sending signals to the rest of the body about hormone release. This includes signaling the release of progesterone and estrogen, adrenal hormones (such as cortisol), insulin, and others. So it’s easy to understand that when one hormonal loop is off balance, others can also be impacted. The major hormones we have in our body are actually cortisol, adrenalin, and insulin.

High amounts of stress can lead to increased cortisol. This in turn affects progesterone levels and/or insulin production, which leads to increased mood swings, anxiety, and food cravings.

The root causes of PMS are:

  • High estrogen-to-progesterone ratio
  • Abnormal neurotransmitter response ( occurring in the brain)
  • Disrupted sodium metabolism (causing fluid retention and bloating) often caused by stress
  • Stress (causing increased cortisol)
  • Carbohydrate metabolism
  • Nutritional deficiencies

The earlier you know the source of your PMS, the sooner you can effectively treat it. Unfortunately, traditional treatment is usually aimed at symptoms rather than at the root cause. The benefit of using natural treatment, such as herbs, minerals and vitamins, is that symptoms are relieved because the body’s equilibrium is reestablished. This means that symptom-relief is on-going.

Natural answers for PMS relief

Mother Nature has valid answers for premenstrual syndrome! There are many treatment options to help with your unique symptoms. Read through the list below to see if any of your problems are addressed and how specific ingredients can help.

The herbs we’ve included in the list below are known as “adaptogenic.” This means they communicate with your system to provide you with the exact amount needed to bring your body back into its correct balance. Pharmaceuticals and over-the-counter remedies sometimes can be overwhelming to your body.

  • Chasteberry (Vitex agnus-castus). In several clinical studies Chasteberry reduced some symptoms, especially breast pain or tenderness, edema, constipation, irritability, depressed mood, anger, and headache.
  • Dong quai (Angelica sinensis). Dong quai (Angelica sinensis), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. It remains one of the most popular plants in Chinese medicine, and is used primarily for health conditions in women. Dong quai has been called “female ginseng,” based on its use for gynecological disorders (such as painful menstruation or pelvic pain), recovery from childbirth or illness, and fatigue/low vitality. It is thought to be more effective in with black cohosh.
  • Maca (Lepidium meyenii). For hundreds of years maca was used by native Peruvians to enhance fertility. Women use maca for female hormone imbalance, menstrual problems, and symptoms of menopause. Maca is also used for weak bones (osteoporosis), depression, stomach cancer, leukemia, HIV/AIDS, tuberculosis, erectile dysfunction (ED), to arouse sexual desire, and to boost the immune system. It has been found to be effective for PMS.
  • Black cohosh (Cimicifuga racemosa). Though mostly known for its relief widely of menopausal symptoms, black cohosh is wonderful herb for PMS, especially when it comes to treating rritability and sleep disturbances.
  • Lemon balm (Melissa officinalis). Lemon balm has been used for centuries for its calming effects and helps with PMS-related anxiety and insomnia.
  • Wild yam (Dioscorea villosa). Wild yam was traditionally used for intestinal problems as well as labor pains and menstrual issues. There is still debate about whether wild yam can affect our sex hormones, but we’ve found it extremely helpful for our patients who have high estrogen levels, and see consistent helpful results.
  • Burdock. Burdock is known for its anti-inflammatory effect, but because of its alterative action, and because of the small amount of plant steroids it contains, burdock can help improve the liver’s ability to metabolize hormones such as estrogen and thereby improve symptoms associated with hormonal imbalance. Therefore it is very helpful in treating PMS.
  • St. John’s wort. St. John’s wort has been used successfully to treat mild depression and the moodiness that sometimes accompanies PMS. But careful as it can interfere with the birth control pills and make them less effective. So be sure to have a discussion you’re your healthcare practitioner.
  • Ginkgo (Ginkgo biloba). Ginko is mostly known and studied in the literature for its effects on memory. Ginkgo has also been shown to be helpful for PMS symptoms, particularly when it comes to fluid retention and breast tenderness.
  • Chromium. Chromium is a mineral that has been studied often and shown to help stabilize insulin and blood sugar. This stabilization helps curtail cravings and supports appetite regulation.
  • Calcium, Magnesium and Vitamin B6. This power formula can work wonders for your symptoms. These ingredients have been researched thoroughly and provide positive results for pain, mood, and general PMS symptoms. Magnesium is particularly effective for combating chocolate cravings! By the way, chocolate cravings are a sure sign of magnesium deficiency.

At Women to Women, we’ve found that herbs, vitamins, and minerals, combined with good nutrition from a healthy diet and regular exercise is the best method for relieving the symptoms of PMS. We’ve established that several adaptogenic herbs work best in combination formulas. 

Women to Women offers solutions

Women to Women knows that PMS can have a significant impact on your life, even if it seems as though the rest of the world doesn’t take your symptoms seriously. Our approach is completely safe and natural. It offers a solution that is effective and that gets to the root of the problem, so the results are long-lasting.

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Symptoms Of Adrenal Fatigue

womentowomen on November 30, 2013

by Marcelle Pick, OB/GYN NP

Signs and symptoms of adrenal imbalance

Stressed Out Young Woman at DeskEvery day a variety of stressors signal our adrenal glands to produce stress hormones. A wide range of physical and psychological demands like a stressful job, family responsibilities, relationship dynamics, lack of sleep, financial concerns, dieting and emotional distress trigger our adrenals to provide relatively small blasts of strength in the form of hormones such as cortisol and adrenaline. From waking us up with a little burst of energy in the morning, to keeping us awake, alert, and focused throughout the rest of the day, our adrenals are crucial to our health.

When our adrenal glands are constantly required to sustain high cortisol levels, they eventually become impaired in their ability to respond appropriately. The resulting dysfunction not only affects our short-term response to stress, but it also impairs our adrenals’ ability to produce and balance other hormones which are important to our long-term health and well-being: DHEA, estrogen, progesterone, and testosterone.

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Symptoms of adrenal imbalance — an “aggravating pattern”

Symptoms are your body’s way of informing you that it’s not receiving the support it needs. While none of these features has a direct causal relationship with adrenal dysfunction on its own, a distinct “aggravating pattern” emerges when all these factors are taken into consideration. See if you recognize these tendencies in yourself:

Symptoms to look for:

  • Blood pressure:  High or low blood pressure are signs to be aware of. Low blood pressure can often have the symptom of lightheadedness associated with it.
  • Food cravings and weight changes:  Abnormal weight gain in the abdomen and thighs. Do you have cravings for salty or sugary foods, sometimes feeling uncontrollable?
  • Energy:  Unable to stop, always on speed forward, ongoing fatigue, lack of stamina, feeling tired and wired much of the time. Lack of get up and go.
  • Emotions and coping ability:  Inability to deal with day to day stress, feeling overwhelmed much of the time, struggling to get through the day, driven, having a very “short fuse”, anxiety attacks, and/or unable to reframe ones thinking.
  • Thinking:  Mentally foggy, fuzzy thinking, inability to stay focused on one task, chronic racing thoughts.
  • Immune response:  Frequent infections, taking a longer time than others to recover from illness or infections or trauma.
  • Sleep:  Inability to fall asleep or falling asleep well but waking up nightly. Sleeping soundly but waking up exhausted.

Many other conditions can overlap the above noted signs and a symptom, so know that adrenal imbalance is not always the root cause.

Click here to take our Adrenal Health Assessment to check your symptoms.

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Lyme Disease and Fatigue

womentowomen on November 30, 2013

by Marcelle Pick, OB/GYN NP

I’m sure that you’ve heard a lot about Lyme disease and how it can affect our bodies. Let’s explore more about this disease and what it might mean for you. Low-grade Lyme disease is very persistent and can exist in your body for years without being diagnosed. It usually is associated with the symptoms of feeling extremely tired and chronic fatigue. This is an important topic because the occurrence of Lyme disease has spread rapidly (it’s been identified in nearly all the U.S. states). And to compound the matter, it is frequently undiagnosed even after specific tests have been given to detect the disease. The actual diagnosis of Lyme disease if very difficult and is still even not well accepted in the medical community.

There are a variety of tests that have been developed to detect Lyme disease in humans, but vague or false results are commonly seen with the usual Lyme titers and also with the Western blot test. An increased sensitive test, called polymerase chain reaction (PCR) testing, is available in a few areas. The PCR test will identify the deoxyribonucleic acid (DNA) that is present in the Lyme bacteria. Polymerase chain reaction (PCR) is growing in its use and availability. However, PCR remains a research technique, in part because laboratories performing PCR tests must be meticulous in technique to minimize the likelihood of false-positive results

However; this only indicates if you have the Lyme bacteria in the present. If the test is negative it is certain that you do not have Lyme now. In addition, the test has not yet been standardized for regular diagnosis.

In addition, there is another confusing feature about Lyme disease. It is that although most cases respond quite well to antibiotic treatment, some symptoms might continue or recur in a few of the treated patients; and this would require additional antibiotic treatment. In some cases, a patient might develop ongoing chronic symptoms and might have permanent damage to the joints and nervous system. Some scientists speculate that treatment with specific antibiotics might even improve the survival of the Lyme bacterium, under certain conditions in some patients. This is why, if you suspect that you might have been infected with Lyme disease, it’s very important that you to contact a health-care professional who is familiar with the symptoms, the testing, and the treatment of this disease.

The good news is that you can make a full recovery from these infections (diseases such as Lyme disease and the Epstein–Barr virus) that deplete your energy. It might take a long time, even if you think you feel much better following your initial diagnosis and treatment course. We’ll talk more in other articles about immunologically–mediated symptom “constellation” conditions, such as these, that have symptoms of fatigue as a major side-effect. For now, suffice it to say that while we do not have all the answers (these conditions are complex), research continues and there is hope. Hang in there and continue to create your healthy lifestyle and take care of the most important person—you!

For more information, please see our more comprehensive articles on fatigue.

What is Lupus?

womentowomen on November 30, 2013

by Marcelle Pick, OB/GYN, NP

  • Lupus symptoms and diagnosis
  • Focus on feeling better

Lupus is a disease that has proven in the past to be quite difficult to identify and control. Lupus is an autoimmune disease which causes chronic extensive inflammation. There are a number of types of lupus, with systemic lupus erythematosus (SLE) being the most common form, The treatment for Lupus is based on each patient’s own unique case and needs. There are no standard treatment protocols, much is dependent on the symptom composite.

The word lupus means “wolf” in Latin, and erythema is a Greek word for “blush.” Often lupus is distinguished by a noticeable rash on the face. It is thought that the name may have originated from a physician who thought it looked like a wolf bite or wolf fur or at least, that is the general story! Today the rash on the face is better recognized as a “butterfly rash,” as it spreads over the nose, on both sides of the cheeks in the form of a butterfly. The types of the disease can vary from just the skin rash to a much more severe condition which involves a systemic inflammation that can damage major organs, most often the kidneys or lungs.

While I was in school, we saw a number of women with lupus in the hospital, and their cases were quite severe. Many required organ transplants or were dying from the disease. However the good news is while the frequency of milder stages of the disease has increased significantly (its unclear why), the later stages have decreased. For so many lupus patients, the symptoms of lupus can be uncomfortable, but manageable.

In the US, roughly 80–90% of lupus cases are women, making lupus about eight times more common in women than in men. Certain ethnic groups are more subject toward it, and rates of lupus can differ depending on where you live as well. The precise causes of lupus are still a mystery for practitioners, though at least two dozen genes have been discovered which may contribute to the disease, as do many environmental factors. It is an autoimmune disorder so we do know that there are multiple factors that contribute to the issue.

Lupus symptoms and diagnosis as noted by the Lupus Foundation of America

The symptoms are not the same in every person with lupus, and one of the most distressing and frustrating aspects of lupus is that since the early symptoms can appear “mild” to a doctor or healthcare practitioner, women with lupus are frequently labeled as “chronic complainers”. This is unfortunate and due to this these patients are allowed to get sicker before they get their diagnosis. As a practitioner I always shake my head at this— not only because women aren’t being taken seriously enough by their doctors, despite the fact that they have a legitimate illness that can be treated Not listening to a patient’s concerns can have a dangerous outcome and. it just doesn’t have to be this way.

The main problem is there is no simple diagnostic test for lupus. To be given an official diagnosis of lupus, you have to have 4 of these 11 criteria.

  • Malar rash – a rash over the cheeks and nose, often in the shape of a butterfly
  • Discoid rash – a rash that appears on your body as red, raised, disk-shaped patches
  • Photosensitivity – a reaction to sun or light that causes a skin rash to appear or get worse
  • Oral ulcers – sores appearing in the mouth
  • Arthritis – joint pain and swelling of two or more joints in which the bones around the joints do not become destroyed
  • Serositis – inflammation of the lining around the lungs (pleuritis) or inflammation of the lining around the heart that causes chest pain which is worse with deep breathing (pericarditis)
  • Kidney disorder – persistent protein or cellular casts in the urine
  • Neurological disorder – seizures or psychosis
  • Blood disorder – anemia (low red blood cell count), leukopenia (low white blood cell count), lymphopenia (low level of specific white blood cells), or thrombocytopenia (low platelet count)
  • Immunologic disorder –anti-DNA or anti-Sm or positive antiphospholipid antibodies

Abnormal antinuclear antibody

There are numerous blood tests that you can get, the bad news is many of the tests may come back as “normal”, even when you know you are not feeling well this is one reason lupus is often misdiagnosed. However, it is important to get the tests to know where you stand at that moment, and to rule out other problems.

At Women to Women, we highly advise that every woman with lupus or who are beginning menopause to be their own best health advocate. You can start by interviewing different healthcare professionals. Keep a journal of your symptoms, instead of trying to remember everything and bring it with you to your appointments. Then be as precise as possible, and include the frequency, severity and/or dates on which you have flare ups or when symptoms appeared. With this to guide you, your provider and you can both begin a course of action to find the right path for the management of your symptoms or flare-ups, and return your body to a more natural, balanced state.

Focus on feeling better

If I could say just one thing to a woman recently diagnosed with lupus, it’s this: take a minute and set aside the fear and concern about the diagnosis itself. Focus on reducing inflammation, and managing your symptoms inch by inch, or one at a time. Through treating each minor issue, you can achieve the broader, more complete balance to your life again.

An inflammatory imbalance is like a fire in a hearth that hasn’t been watched and is starting to burn down the house. It roars past its original boundaries in the body and, if we don’t intervene, starts to impact all our major systems, including the endocrine, digestive, cardiovascular, respiratory, lymph, and central nervous systems. In time it can contribute to a whole host of conditions, some serious, from heart attack to ulcers to multiple sclerosis to cancer—as well as the accumulation of toxic weight. And it all starts with an overburdened immune system that’s just trying to do its job. Women can manage their symptoms and prevent flare-ups by controlling inflammation and for this, there are several natural strategies to try – read more about lupus in my other articles.

Try to step away from the word “diagnosis” for a moment, just in the same way women at midlife can step away from the word “menopause.” As an alternative, take a few moments and look at your symptoms as separate from any designated condition if you can. As we examine our symptoms instead of the diagnosis, then we can figure out what we need to do to relieve those symptoms— whether it’s detoxification, soothing digestive imbalance, or above all quieting inflammation, when we address any of these factors (or all!) it will help you start to feel the relief you need. For the reason that in the end, it doesn’t matter whether you’re a “wolf” or a “butterfly” — what really matters is that you feel better! Functional medicine looks at the symptoms and begins to unravel the actual causes and they can be many. That is why the symptoms vary so much and that is why the relief can come from understand the actual causes and treating them.

Types of lupus

  • Systemic lupus erythematosus (SLE)
  • Discoid lupus erythematosus (DLE)
  • SCLE
  • Drug-induced lupus
  • Neonatal lupus

For more information on the similarities and differences between types of lupus, visit the Lupus Foundation of America website.

Uterine Fibroid Embolization Or Uterine Artery Embolization

womentowomen on November 30, 2013

by Marcelle Pick, OB /GYN NP

One of the latest most up-to-date procedures may completely change the way we handle uterine fibroids. This procedure is called uterine fibroid embolization (UFE) or uterine artery embolization (UAE). Uterine fibroid embolization is a technique which is regularly performed by an interventional radiologist. The majority of gynecologists have not been trained in advanced radiology, so this is the reason why it is usually done by radiologists working with the referring gynecologist.

UAE was first developed in France, and has been performed in the US since 1995. Prior to that the embolization procedure had been used to stop hemorrhaging after childbirth and bleeding in other areas of the body.

Many healthcare practitioner may not know of it yet, so many women are not aware there is an option to treat their uterine fibroids.

A referring GYN is not required for a woman to pursue this option The process will first begin with a consultation by the consulting radiologist followed by an initial MRI evaluation and or an Ultra Sound of the uterus. This will help to establish whether the woman is a good candidate for the procedure. If the findings state she is the procedure will be scheduled for a future date. The UAE is generally performed in the radiology department and generally you will receive a mild intravenous sedation. A small catheter is then inserted into an artery in the groin, it is carefully threaded into the uterine artery under radiological guidance, then dye is instilled to create a visual picture of the pelvis and uterine arteries. Then the radiologist will release small sand-sized pellets of synthetic material.

As the pellets lodge in the distal ends they obstruct the blood flow to the fibroid. Uterine artery embolization works by basically starving the fibroid of a sufficient blood supply over the next several months. At this time there have been no adverse effects or allergic reactions reported from these particles. The UAE procedure generally takes about 60–90 minutes. After the procedure your GYN will then do follow up within a few weeks. As a result of mapping the arteries, the UAE technique protects the blood supply to the ovaries, and menopausal symptoms are much less common than they are following surgery.You may experience some strong cramping pain during and after the procedure. More often than not many women can go home that afternoon or stay overnight in the hospital if they require pain management. It usually takes a few days to a week to recuperate and much less than when a patient has the possible side effects of general anesthesia and surgery. The results begin to become noticeable and occur slowly over the next few months.

The US Secretary of State, Condoleezza Rice, had this procedure done in 2004. Although not reported publicly we assume she has had no troublesome side effects and experienced relief from her symptoms. Many of my patients have had this done with wonderful symptom relief, including the size of the fibroid. No one to date has had any serious complications.

There is a very small chance that cancer can be found in the uterus or fibroids, so be sure to discuss this possibility with your doctor. Some women also fail to respond to the technique as desired; the fibroids may also grow back in time or new ones may arise. The good news is that I seldom see this in my practice.

UAE was usually recommended for pre- or perimenopausal women with symptomatic fibroids. Recently the procedure was reported as helpful also for post-menopausal women whose fibroids had not regressed with menopause.

UAE was not recommended for women who might want to get pregnant because it was uncertain how it would affect fertility or what the effects would be on a pregnant uterus. Today, new data has been found that UAE may be safe in certain cases, talking with your gynecologist can help you decide if it’s right for you.

Where can you get UAE?

Interventional radiology is a relatively new specialty which is one of the reasons why UAE is relatively unknown to women. UAE appeals to doctors who want to do more than just read films but are not interested in performing surgery. It is unclear exactly why but from a practitioners perspective, it’s unfortunate that this field seems to attract more male than female doctors. My hope is that more and more women will consider entering this medical field because it holds so much promise.

Interventional radiology suites are being established in many hospitals and some physicians are following this trend and have set up separate centers. Many have same-day or overnight observation units which are providing round-the-clock nursing care, yet with the feel of a comfortable hotel, not a hospital. Information on doctors trained in UAE can be found on-line from the Society of Interventional Radiology (SIR). Many insurance policies will cover the procedure. Five questions you should ask about UAE. At Women to Women we always recommend that a woman call their GYN and ask a few questions or be seen in consultation before deciding on any course of action.

Here are some important questions to ask about uterine fibroid embolization:

  • How will I know if I am a good candidate for UAE?
  • Will I need to have a pre-procedure ultrasound or MRI?
  • How long have you been offering UAE?
  • How many UAE procedures do you perform a week? A year?
  • What are your statistics on successful shrinkage of fibroids?
  • What are your complication rates? (Their statistics should be at least a 40–50% success rate).
  • When do your patients usually expect to return to work or daily activities? (Should be in less than a week).
  • What are the side effects of UAE and what should I do if I experience any symptoms? (Call your GYN if you experience fever, infection, artery injury, premature menopause. The rate should be under 1%).

For more information on causes and natural treatment of fibroids refer to our articles on this topic.

Laparoscopic Surgery For Endometriosis

womentowomen on November 30, 2013

by Marcelle Pick, OB/GYN NP

The procedure known as laparoscopy is done as surgery in a hospital operating room. The physician uses a telescopic camera that is introduced through a very small perforation in the skin, instead of using a full incision. The camera then will allow the surgeon to look at and evaluate the uterus, ovaries, and other internal female organs. The doctor may also choose to biopsy any lesions or growths that appear to be suspicious. At the same time small, externally dangling pedunculate fibroids can be removed.

Laparoscopic surgery for endometriosis  is increasing in popularity. This enables surgeons to eliminate endometrial implants by removing them with a special laser technique that is specific to each tissue type, while the reproductive system can be left intact. It allows all if not most of the endometrial implants to be removed with a less invasive procedure.

The outcome of this procedure is greatly dependent on the amount and extent of the endometriosis and the physician’s skill. In an ideal situation, it is best to see an endometriosis specialist, or someone that has done this procedure hundreds of times, who will be more familiar with this type of procedure. In some case, a repeat procedure might be recommended, because endometriosis can grow back.

Sometimes there is adhesion scar tissue that also can develop. Adhesion scar tissue is like internal filaments that adhere tissue together in the abdomen similar to a cobweb in nature.

It is not usually suggested to remove the uterus in cases of endometriosis, because the condition is systemic and not caused by the uterus. For more information, see our articles about symptoms, causes, and natural treatment of endometriosis.

Anxiety and Hot Flashes

womentowomen on November 30, 2013

by Marcelle Pick, OB/GYN NP

The May/June 2005 issue of Menopause: The Journal of the North American Menopause Society reports that standards of living factors, including anxiety levels, play a significant part in a woman’s occurrence of hot flashes through perimenopause.

Women who described themselves as “somewhat anxious” as a result of life stresses encountered 3 times more hot flashes in comparison to women who happen to be inside “normal” anxiety spectrum. The women with “higher” anxiety ratings experienced 5 times as many hot flashes. Exactly how would you clarify this?

Think back to the last time you felt good from the moment you opened your eyes in the morning to the minute you closed them to sleep. This doesn’t mean no aches and pains and hassles, but the feeling that life is good, that you can cope, that you have the energy, stamina, and resilience to deal with whatever the day—or the future—has in store. You feel content with the way you look. Even your hair looks great. You’re on top of the world.

I sincerely hope that you have experienced this at some point in your life. If so, you have an idea of your potential. If not, you have a lot to look forward to.

Recently, a study by Wayne State University School of Medicine followed pre-, peri- and post-menopausal women older than 25 years old, and found out a fascinating difference among women who suffer from hot flashes and those who do not. They found that women who have a narrow thermoneutral zone (the core temperature range the body maintains by sweating or shivering) suffer additional hot flashes.

Exactly what narrows a thermoneutral zone in animals? Norepinephrine, the neurotransmitter connected to anxiety. Consequently, the same might be thought to be true in humans.

This claim is supported by the reality that the drug clonidine lowers norepinephrine levels in humans as well as widens the thermoneutral zone — along with estrogen plus a number of anti-depressant medications. However, even now we don’t understand exactly why. Deep, paced breathing has a tendency to reduce the severeness of a hot flash as well as helps to alleviate symptoms of panic — once more, they appear to be related, but additional research needs to be done.

For more information on how to alleviate your symptoms, read our article, “Nutritional Relief For Hot Flashes.”

To evaluate your symptoms, take our on-line Hormonal Health Assessment.