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Acupuncture for IVF and IUI Cycles

The use of acupuncture as a supportive treatment for couples undergoing assisted reproductive therapies, including in vitro fertilization (IVF) and intrauterine insemination (IUI) is gaining in popularity, likely due to promising results in countless studies in the past 20 years.

Understanding how acupuncture can improve outcomes in IVF and IUI cycles can help you to decide if this treatment may be right for you.

A brief understanding of IVF and IUI

In vitro fertilization, or IVF is the process where a woman’s follicles are stimulated through medications to mature many follicles simultaneously. Once the majority of follicles are mature (17-20mm) they are retrieved and fertilized in a lab. These embryos grow for 3-5 days and are then transferred into the woman’s uterus (usually 1-2 at a time).

Intrauterine insemination will often also use medications to stimulate follicle growth, but the number of follicles is far fewer. The follicles develop within the woman’s ovaries and at ovulation the semen is inserted directly into the uterus and fertilization occurs within the body.

The success rates of IVF and IUI are variable. IVF alone is around 25-30% and IUI alone is around 13-20%. With acupuncture support, success rates can increase up to 40-60%.

How acupuncture benefits IVF and IUI cycles

Acupuncture has many benefits for improving outcomes (pregnancy rates and delivery rates) in IVF and IUI cycles. A 2002 study by Paulus and colleagues in Germany was one of the first to demonstrate an improvement in pregnancy rates with acupuncture in IVF cycles. The women receiving acupuncture had a 42.5% success rate, compared to 26.3% for those who did not receive acupuncture. Many more studies have since confirmed these findings, with impressive improvements in pregnancy and delivery rates.

Acupuncture is a very safe therapy, with relatively low costs and has no negative interactions with medications. Below I highlight some of the benefits acupuncture has on IVF and IUI cycles.

  1. Improved ovarian response

Acupuncture is based on traditional Eastern philosophies of meridians and acupuncture points. However, we now know that significant hormonal changes occur when we administer acupuncture to specific points in the body. Acupuncture impacts beta-endorphin levels, which in turn impact our production of reproductive hormones (notably GnRH, FSH, LH, estrogen and progesterone). Acupuncture can thus improve response of the ovaries to these hormones and optimize follicle development.

  1. Improved hormone balance

As mentioned above, acupuncture has a significant impact on hormone production and response. In IVF cycles where hormone-modulating medications are used, acupuncture can help the body to respond appropriately to medications, and minimize side effects.

  1. Improved egg (follicle) quality and quantity

Clinically acupuncture has been shown to positively influence the number and integrity of eggs released during IVF and IUI cycles – this may be due to increasing the blood supply to the developing follicles or by increasing the nutritional supply to the egg via the fluids that surround and nourish it.

  1. Improved blood flow to the uterus and increased rate of implantation

One of the most unique actions of acupuncture, increasing blood flow to the uterus can improve implantation rates and decrease rates of miscarriage. No medication currently exists that can enhance blood flow to the uterus the way acupuncture has been demonstrated to.

  1. Optimal endometrial thickness

In women with thin endometrial linings IVF can have higher rates of failure. Acupuncture can help to thicken the endometrial lining (through the enhancement of blood flow) and improve rates of implantation.

  1. Decrease rates of miscarriage

Acupuncture used during IVF results in higher rates of viable pregnancy. Additionally, acupuncture was found in a 2004 study by the American Society for Reproductive Medicine to lower miscarriage, reduce tubal pregnancy and increase live birth rate.

  1. Reduce stress

Stress is a major factor impacting most couples undergoing fertility treatments. Acupuncture treatments have been shown to decrease sympathetic nervous system activity (our fight-or-flight response), decrease stress hormone levels and increase opioid production – all resulting in a sense of calm and decreased stress.

Acupuncture treatments for IUI and IVF

Acupuncture treatments should be individualized to your IVF or IUI cycle, your personal medical history and current health state. For women undergoing IVF or IUI it is recommended in clinical studies to start having acupuncture 8-12 weeks (2-3 months) prior to your IUI or IVF procedure.

In my Toronto practices, I use acupuncture points selected based on clinically proven protocols (Paulus protocol, Stener-Victorin protocol, Westergaard protocol, Smith protocol), as well as points based on Traditional Chinese Medicine diagnoses and indications.

Success in acupuncture depends on more than just the frequency and timing of visits. It also requires a knowledgeable practitioner who can guide you through the process and help you achieve the benefits you desire. If you’d like to learn more, book a free meet and greet consultation or initial intake today.

References

Betts D. The Essential Guide to Acupuncture in Pregnancy and Childbirth. 2006.

Change, R, Chung P, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril. 2002 Dec:78(6)

Dieterle, S., et al. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 2006 May;85(5):1347- 51.

Gurfinkel E, et al. “Effects of acupuncture and moxa treatment in patients with semen abnormalities.” Asian J Androl. 2003 Dec;5(4):345-8.

Johnson D. “Acupuncture prior to and at embryo transfer in an assisted conception unit – a case series.” Acupunct Med. 2006:24(1):23-28.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002;77(4):721-4.

Stener-Victorin E, et al. “Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006 Dec;24(4):157-63. Review.

Westergaard. LG, et al. “Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial.” Fertil Steril. 2006 May;85(5):1341-6.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

 

 

 

Are Menstrual Clots Normal?

One of the “joys” of womanhood, our monthly menstrual flow, can sometimes come with some surprises. One of those occurrences for many women is menstrual blood clots. Most women want to know if this is normal – and why it is happening.

Your Period

During your monthly cycle the lining of your uterus (endometrium) grows thick and increases the blood supply to support a potential pregnancy. When a pregnancy does not occur the drop in hormones (especially progesterone) leads to a release of the innermost lining of the uterus and we experience a period. In an average period women lose 30-40ml (6-8 tsp) of blood, with women experiencing heavy periods losing more than 60ml (12 tsp).

Blood Clots During Your Period

In a typical menstrual flow, the blood is not clotted due to the release of anticoagulants. The contraction of the uterus also stops further bleeding from the remaining blood supply to the uterus, and helps to expel the menstrual blood. After 3 to 4 days of bleeding, most of the inner lining of the endometrium (the “stratum functionalis”) has been released and blood loss slows considerably.

Blood clots are often a consequence of heavy menstrual flow. When the blood loss is too much, or too fast, the anticoagulants produced are not adequate to breakdown the lining of the uterus and prevent further clotting. Most women who experience clotting do so on the heaviest days of their menstrual period.

Possible Underlying Causes of Menstrual Blood Clots

  1. Miscarriage

Sometimes clots are actually a very early stage miscarriage. These clots may be found along with small gray clumps of tissue. If you experience other signs or symptoms of pregnancy along with clots, you may consider having your beta HCG levels tested to determine if it was, indeed, an early miscarriage.

  1. Uterine Fibroids (Leiomyomas)

Uterine fibroids are benign (non-cancerous) growths that occur in the muscular layer of the uterus. Some women with fibroids experience no symptoms at all, but for many women with fibroids they experience heavy periods (and blood clots) as a result. Fibroids are more likely to occur as we get older, especially after having children. Fibroids are also more common in women of African descent, those who are overweight and those with a family history of fibroids.

  1. Adenomyosis

Adenomyosis occurs when the endometrium breaks through into the muscular layer of the uterus (the myometrium). This can cause cramping, bloating, heavier menstrual periods and the presence of blood clots. Adenomyosis is also more common with age, in women who have had children, and in those who have had uterine surgery (such as a Caesarean section).

  1. Iron deficiency

In one of the great injustices in women’s health one major consequence of heavy periods, iron deficiency, can also lead to heavy periods. If you are experiencing heavy periods it is vitally important to test your hemoglobin, hematocrit and ferritin (iron) levels and build up your iron levels if needed.

  1. Hormonal imbalances

Imbalances between the two main female hormones, estrogen and progesterone, can lead to increased thickening of the uterine lining, resulting in heavy menstrual periods and blood clots. Imbalances in these hormones can occur at any stage of the reproductive life span, but are most common during adolescence and through the 40s and perimenopausal years.

  1. Thyroid imbalances

The thyroid is a small, butterfly shaped gland in your neck that controls your metabolic rate and has significant impacts on your hormonal health. An underactive thyroid can cause many symptoms – fatigue, difficulty losing weight, hair loss, and heavy periods. And with these heavy periods may come menstrual blood clots.

Recommended Testing for Menstrual Clots

If you regularly experience blood clots during your period, having some laboratory and imaging studies done is a good idea. It can help you understand why you are experiencing blood clots and your Naturopathic or Medical Doctor can work with you to determine an appropriate treatment plan.

Complete blood cell count – including hemoglobin and hematocrit to look for healthy red blood cells

Ferritin – to assess for iron deficiency anemia

TSH and complete thyroid panel – to assess health of the thyroid

Female hormone panel – to compare levels of estrogen and progesterone, along with other reproductive hormones, to ensure balance

Transvaginal or pelvic ultrasound – to identify uterine fibroids or other abnormalities of the uterus and uterine lining

MRI – a further visual assessment of the uterus if ultrasound is not adequate

If you are experiencing heavy periods and menstrual clotting, speaking to your Medical or Naturopathic Doctor can help you understand why you are experiencing these symptoms and develop a treatment that is as unique to your body and your period.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

References:

Young, B. Wheater’s Functional Histology, 6th Edition, 2014.

Melmed, S. Williams Textbook of Endocrinology, 2016.

 

Understanding Spotting Between Periods

“Why am I spotting?” is a common question that comes up in my naturopathic practice, impacting up to 1 in 3 women at some point in their reproductive lifespan. Spotting is most common in women during adolescence and during the transition to menopause, but can occur at any point in a woman’s life. While most women are told spotting is not significant, speaking to your doctor is suggested to determine the underlying cause.

What is Spotting

Spotting, also called intermenstrual bleeding, or even more technically “metrorrhagia” occurs when there is bleeding from the uterus at irregular intervals, most often between expected menstrual periods.

Causes of Spotting

  1. Ovulation

Ovulation is the most common cause of spotting in women. Around ovulation estrogen levels drop off slightly as an egg is released from the ovary. This drop in estrogen can lead to bleeding that is most often significantly lighter than a period and lasts for a shorter time. The blood may also be a different colour – brownish or pink. This ovulatory spotting is considered to be normal, but you should discuss with your health care provider to ensure nothing else is causing this symptom.

  1. Birth control pill

Birth control pills, and other forms of hormonal contraception (IUDs, patches, injections and implants), commonly cause spotting (called “breakthrough bleeding”) during the first few months of use. Most common in the first three months, for some women it doesn’t improve – if this happens a higher dose birth control or different method of contraception may be needed. Breakthrough bleeding is also common if you don’t take your pills as directed (missing a day or not taking at the same time each day). Women who smoke and take birth control pills are more likely to experience breakthrough bleeding (and should consider other forms of contraception due to the increased risk of blood clots.)

Other medications have also been found to be associated with intermenstrual bleeding, including anticoagulants (warfarin, heparin), antipsychotics, corticosteroids, and selective serotonin reuptake inhibitors (SSRIs.)

  1. Polycystic ovarian syndrome

One of the hallmarks of PCOS is irregular periods. In PCOS women do not ovulate, which leads to a lack of progesterone production and unopposed estrogen causes continued growth of the uterine lining. The lining will continue to thicken until it outgrows its blood supply and degenerates. Different sections of the lining may outgrow their blood supply at different times, causing spotting.

This lack of ovulation can also have similar results in adolescent girls who do not yet have a mature reproductive hormone cascade, resulting in spotting.

  1. Local infections

Infections of the vagina, cervix and endometrial lining can all cause spotting between periods. The infection is most often secondary to a sexually transmitted infection, but can also occur with pelvic inflammatory disease. Inflammation of the cervix (cervicitis) or uterine lining (endometritis) can also cause bleeding after sexual intercourse.

  1. Uterine or Cervical Polyps

Polyps are soft growths that can occur on the inside surface of the uterus or on the surface of the cervix. These growths are benign but may cause irregular bleeding, especially after intercourse.

  1. Perimenopause

The changes in hormone balance that occur in the years prior to menopause can lead to irregular periods and spotting between periods. With the transition to menopause comes a decrease in egg quality, resulting in less progesterone production and shorter menstrual cycles. The decline in successful ovulation can also lead to longer cycles. And both of these states of hormonal imbalance can lead to spotting.

  1. Thyroid hormone imbalances

The healthy function of the thyroid directly influences the healthy function of the reproductive organs. Under functioning of the thyroid (hypothyroidism) has been known to cause menstrual spotting, and correcting the underlying imbalance typically resolves the symptom.

  1. Pregnancy

Spotting in pregnancy can be an alarming symptom, but for many women it is totally normal. Some women experience spotting associated with implantation that can be very similar to a menstrual period. If you do experience spotting in pregnancy, see a doctor immediately to ensure optimal safety for both mom and baby, and to rule out an ectopic pregnancy which can be life-threatening if not treated.

  1. Uncommon causes

Less common causes for intermenstrual spotting include foreign bodies in the vagina (most often toilet paper or tampons) and certain types of reproductive cancers, including cervical, ovarian, endometrial and vulvar cancers. Clotting disorders can also worsen spotting and should be considered in teen girls with heavy periods or frequent spotting.

Testing for Spotting

While most spotting between menstrual cycles is benign and normal, it is important to try to identify an underlying cause, and correct it if possible. Achieving hormone harmony is possible, and can be done with the support of your Naturopathic Doctor.

Discuss this checklist with your Medical or Naturopathic Doctor to help you achieve your personal hormone balance.

Menstrual spotting checklist

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Hormone Testing

The importance of hormones for human health can’t be understated. The over 50 hormones in the human body act as chemical messengers that control most major bodily functions – from hunger, stress, mood and emotions to reproduction.

The body maintains an intricate balance of hormones, a state called homeostasis. When this delicate balance is challenged a wide variety of symptoms can occur – insomnia, fatigue, depression, anxiety, weight gain, acne, premenstrual syndrome, endometriosis, PCOS, diabetes, menstrual irregularities, and many, many more.

When identifying an unbalanced hormonal state, hormone testing can provide valuable information that will allow you to take steps to restore your optimal hormone balance, resolve symptoms, and restore optimal health.

Hormone Testing

Three important factors need to be considered when seeking testing for hormone balance.

            Timing of Testing

Time of day and time of month are important factors in getting valuable information from hormone testing. For most hormones, testing should be done first thing in the morning. An exception to this rule is cortisol, which is often tested at multiple points over the course of the day.

Time of month, or more accurately, time of the menstrual cycle, is also an important consideration for women. Generally hormones should be tested about one week before an expected period, when levels are at their peak.

Testing Sample Type

There are three main ways to test for hormone levels – blood (serum), saliva or urine. Each has it’s benefits and can be used, depending on the information needed.

Blood – a simple blood draw can give a great deal of information about thyroid hormones, insulin and blood sugar levels, vitamin D, prolactin, FSH and LH. It’s a quick process with well established reference ranges. However, it’s not considered the best test for steroid hormones like estrogen and progesterone, as levels in the blood stream do not accurately reflect free hormone levels available for action in the body.

Saliva – a home saliva test kit will provide excellent information about the free hormone levels of many steroid hormones: cortisol, estrogen, progesterone, DHEAS and testosterone. This test is often considered the most accurate reflection of hormone balance in the body. The drawbacks to salivary testing are the less well established reference ranges and the lack of testing for hormone detoxification pathways.

Urine – a newer testing type for hormone balance, the dried urine test for comprehensive hormones (DUTCH), gives a good overview of the steroid hormones estrogen, cortisol, progesterone, testosterone, DHEAS as well as the metabolites produced when our body breaks down these hormones.

            Balance Over Absolute Values

The last important consideration for hormone testing is that the results of your hormone test should be interpreted by a practitioner with a great deal of expertise in hormone testing and hormone balancing. When looking at a hormone test the most important information is the balance between the different hormones, rather than the absolute values of each individual hormone. A low normal progesterone with a high normal estrogen results in the same symptoms as a normal estrogen and a very low (or abnormal) progesterone.

Hormones are responsible for a vast variety of functions in our bodies, and their imbalance is an important (and common!) cause of symptoms. If you suspect you may have a hormonal imbalance, book an appointment with your Naturopathic Doctor today to discuss your options.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Natural Treatment Options for PUPPPS

 

PUPPPS may sound like a cute acronym, but ask any pregnant woman who has experienced it and you will soon realize this condition is anything but cute.

PUPPPS stands for pruritic urticarial papules and plaques of pregnancy.  This translates to “itchy, allergy-like rash during pregnancy”.  PUPPPS is a hive-like rash that occurs in around 1 in 200 women during pregnancy.  The rash is itchy and most commonly starts on the abdomen and may spread to the legs, feet, arms, chest and neck but usually does not occur on the face.

We don’t know why some women develop PUPPPS during pregnancy but it most often begins in stretch marks and is more common in women with significant skin stretching. Women with large fundal measurements and those who are carrying large babies or twins and triplets are at greater risk.

Interestingly there is a higher rate of PUPPPS in women carrying boys. Statistics have shown that bw-pregnant-window70% of women with PUPPPS deliver boys. Researchers think this may be due to male DNA interacting with the mother’s body, leading to irritation.

The good news is that PUPPPS, aside from causing itching and irritation, has no long term negative effects on either the mother or the baby and tends to resolve on its own within a week of delivery.

Most treatments for PUPPPS involve hydrating the skin and keeping the mother comfortable.  Certain antihistamines may also be tried.  From a Naturopathic perspective, we focus on decreasing the allergic response of the immune system, supporting the detoxification properties of the liver, decreasing inflammation and helping to clear and possible underlying causes.

6 Natural Treatment Options for PUPPPS

  1. Increase vegetable consumption and vegetable juice consumption

To optimize liver function by supplying healthy antioxidants and cholagogues (plant based compounds that support optimal liver function). Ideal vegetables are dark green leafy vegetables, beets, carrots, broccoli, cauliflower, bok choy, brussels sprouts, kale and kohlrabi

Also increase consumption of canned tomatoes for the lycopene content, an excellent antioxidant and member of the beta carotene family – but be sure to choose organic canned tomatoes to decrease exposure to BPA. Glass containers are even better.

  1. High quality omega 3 rich oils

TomatoesOmega 3 fatty acids, such as those found in flax seeds, chia seeds, salmon and fish oil supplements help to improve the fluidity of skin membranes, decreasing the potential for stretch marks. Omega 3 fatty acids are also anti-inflammatory and can help to decrease the production of inflammatory mediators, decreasing redness and itching in skin rashes.

Consume omega-3 rich foods such as ground flax seeds and chia seeds daily. Consume omega 3 rich fish (those that are safe in pregnancy include salmon, tilapia, cod and Pollock) at least two to three times per week. An omega 3 rich fish oil supplement may also be recommended by your Naturopathic Doctor.

  1. Moisturize the skin with a soothing moisturizer

    Coconut oil is a safe choice for pregnancy and is highly moisturizing. Chickweed ointment is another stellar choice as chickweed is a natural antihistamine and can greatly reduce itching sensations.

  1. Dandelion Root (Taraxacum officinalis)

    allergy_dandelion medicineAnother highly effective treatment for PUPPPS. Dandelion acts as a hepatic and cholagogue – it enhances the function of the liver and gallbladder, clearing inflammation and congestion through that system. It is highly indicated for chronic skin eruptions, especially those that are hot, red or itchy.

    Dandelion is available as a tea (which will have diuretic effects) or as a capsule. For PUPPPS I usually recommend starting with a tea and introducing a supplement if needed.

  1. Milk thistle (Silybum marianum)

    Mike thistle is a liver supportive treatment that can be used to enhance the actions of dandelion root or on it’s own. It is effective in increasing the secretion and flow of bile from the liver and gall bladder. Milk thistle also promotes milk secretion and is encouraged for breast-feeding mothers.

  1. Avoid food sensitivities

    There is some research suggesting a correlation between food sensitivity (especially dairy) and PUPPPS. Consider food sensitivity testing or elimination diets to address symptoms.

PUPPPS can be a difficult condition to life with, and with the support of naturopathic medicine you may not need to!  Gentle and safe natural treatments are available.  Speak with your Naturopathic Doctor today to put together a plan.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Diagnosing PCOS

Diagnosing PCOS

Polycystic ovarian syndrome is one of the most common conditions that I treat in my naturopathic practice. It affects 1 out of every 10 women and can manifest in many different ways – hair loss, facial hair growth, acne, difficulty losing weight, irregular menstrual periods or infertility. Because of the many different symptoms of PCOS, an accurate diagnosis is important.

The Rotterdam Criteria

The diagnosis of PCOS is currently made according to the Rotterdam Criteria, a 2003 consensus reached by the Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM).

Diagnosis of PCOS requires that a woman meets two of three criteria:

  1. Infrequent or no ovulation (resulting in irregular or absent menstrual periods)
  2. Signs and symptoms or laboratory tests that show high androgen (male hormone) levels – these include acne, hair loss, facial hair growth, darkening of the skin at skin folds
  3. Cysts on the ovaries on ultrasound

For a diagnosis of PCOS it is also important to rule out other causes of these symptoms, such as a pituitary, thyroid or adrenal disease.

Clinical Evaluation

taking-notesThe first step in diagnosis of PCOS is a thorough evaluation with your medical or naturopathic doctor. Your doctor will ask a lot of questions. Be sure to share if you experience any of the following:

  1. Irregular periods – menstrual cycles that are longer than 35 days, infrequent periods or no periods at all can all be associated with anovulation and PCOS.  (Keep in mind: 1 in 5 women with PCOS still have regular periods, so having a regular period does not rule out PCOS)
  1. Acne – facial, chest, or back acne can be a sign of elevated androgens
  2. Hirsutism – abnormal growth of coarse hair in a male pattern (lip, chin, torso)
  3. Hair loss – elevated androgens is a major cause of head hair loss in women
  4. Oily hair or skin
  5. lump-sugar-549096_640Sugar cravings – a sign of insulin imbalance, one of the major hormonal imbalances in PCOS. Other symptoms include dizziness, lightheadedness or irritability (or “hangry”) if a meal is missed.
  6. Recurrent yeast infections – a sign of elevated blood sugar levels. Other symptoms include excess thirst and frequent urination.
  7. Overweight or difficulty losing weight – often a cause, and consequence, of the hormone imbalances in PCOS
  8. Darkening of the skin – especially at the back of the neck or in the skin folds at the underarms, under the breasts and between the thighs. This darkened skin is called acanthosis nigricans and is associated with elevated testosterone.
  9. Infertility – difficulty getting pregnant is often the driving factor for a diagnosis for PCOS
  10. Family history of PCOS or diabetes

 Laboratory Testing

Laboratory testing is the second criteria for a PCOS diagnosis. Many different lab tests can be used to confirm a suspected PCOS diagnosis, and these tests may highlight the underlying hormonal imbalances that cause PCOS. If you are taking the birth control pill to suppress your PCOS symptoms these tests will not provide accurate information.

Luteinizing hormone (LH) – high – produced by the pituitary gland to stimulate ovulation, levels are often elevated because ovulation is not occurring

Follicle stimulating hormone (FSH) – normal or low – typically assessed in relation to LH levels, some women with have a higher than normal LH:FSH ratio (greater than 1:1)

PCOS laboratory testingSerum testosterone (free and total testosterone) – high – 80% of women with PCOS have elevated levels of androgens. DHT levels may also be elevated

Progesterone – low – during the second half (luteal phase) of the menstrual cycle progesterone levels will be low due to the lack of ovulation

Estradiol – normal – typically in PCOS estrogen levels are normal or slightly elevated

Sex hormone binding globulin (SHBG ) – low – if tested, levels may be low

Fasting blood glucose – high – women with abnormal blood sugar levels typically have higher body weight, have higher androgen levels and are more insulin resistance

HbA1C – high – a long term (3 month) measure of blood sugar stability

Anti-Mullerian hormone (AMH) – high – levels of AMH are often elevated in PCOS due to the lack of regular ovulation

DHEAS – high – half of women with PCOS will have elevated adrenal production of DHEAS

Prolactin – normal – elevated prolactin can cause symptoms similar to PCOS; if your prolactin levels are high a pituitary tumour must be ruled out.

Thyroid stimulating hormone – normal – should be measured to rule out other causes of menstrual irregularities

Cortisol – normal – should be measured to rule out Cushing’s syndrome

Additionally, a pelvic or transvaginal ultrasound may reveal multiple 2-6mm follicular (simple) cysts on the ovaries. Ovarian volume or area may also be increased.

Moving Beyond Diagnosis

PCOS DietAn appropriate diagnosis of PCOS is important for women seeking optimal hormone balance. But the diagnosis is only the beginning. Your naturopathic doctor can be your partner as you move beyond diagnosis towards understanding and hormone balance. Read the other articles in the PCOS Series by Dr. Lisa Watson: Understanding PCOS, The PCOS Diet (also available as an infographic), PCOS and Infertility, PCOS in Adolescence, PCOS and Pregnancy, Hormonal Balance in PCOS and Naturopathic Medicine for PCOS.

Dr. Watson is currently accepting new patients at both her Toronto clinics. Contact her for a complimentary meet and greet appointment, or book your initial consultation today. The best time to start balancing your hormones is now.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Pin this article for later: https://www.pinterest.com/pin/207165651589076259/

Wheat Woes: Celiac disease, wheat allergy and gluten sensitivity

Many people are beginning to recognize the personal benefits of a gluten-free diet. For some individuals the simple avoidance of gluten (a protein in wheat, barley and rye) can improve or completely resolve symptoms of diarrhea, constipation, gas and bloating.

So what is the problem with gluten? Why are so many people benefiting from avoiding this specific protein? The answer is not that simple. In fact, there are three distinct medical diagnoses that may apply to people who improve on a gluten free diet.

Celiac Disease

Bread slicedCeliac disease is an autoimmune disease impacting about 1 in 100 people. In this condition the body is stimulated to produce auto-antibodies against the lining of the small intestine. These auto-antibodies are only produced in the presence of gluten in the diet. Celiac disease incidence has increased 5-fold in the past 40 years – a trend that is seen with a number of autoimmune conditions. Having celiac disease increases the risk for the development of other autoimmune conditions in your lifetime. The only treatment for celiac disease is lifelong avoidance of gluten.

Wheat Allergy

Wheat allergy results when the body produces an allergic reaction to gluten or another component of wheat. The allergic sequence is similar to other allergies, with the release of histamine from mast cells and basophils, triggered by immunoglobulin E (IgE) cross-linking. Symptoms of wheat allergy include redness, swelling, hives and other allergy-type symptoms. Wheat allergy is the rarest of the wheat-associated diagnoses with only 1 in 500 people being impacted.

Gluten Sensitivity

By far the most common diagnosis associated with wheat is gluten sensitivity. It is estimated to impact 1 in 10 people and is 6x more prevalent than celiac disease. The symptoms of gluten sensitivity include:

  • Abdominal pain (68%)Gluten Free Logo
  • Eczema or rash (40%)
  • Headache (35%)
  • Foggy mind (34%)
  • Diarrhea (33%)
  • Depression (20%)
  • Anemia (20%)
  • Numbness in legs, arms or fingers (20%)
  • Joint pain (11%)

Diagnosis of gluten sensitivity is typically a diagnosis of exclusion. If you test negative for celiac disease (auto-immune antibodies), negative for wheat allergy (IgE immunoglobulins) but still improve on a gluten free diet then you will likely receive a diagnosis of gluten sensitivity.

Food sensitivity testing, such as the IgG food sensitivity panel, can help to confirm a diagnosis of gluten sensitivity. It can also identify other food sensitivities which may be occurring simultaneously, such as a dairy, egg or nut sensitivity.

If you suspect you may be gluten sensitive, cut it out of your diet for at least three weeks and watch your symptoms for improvement. Or contact your Naturopathic Doctor to discuss comprehensive testing for celiac disease, wheat allergy and gluten sensitivity. Take charge of your health, and let go of your wheat woes!

Select references

Sapone A, Lammers KM, Casolaro V, et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011;9:e23

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

 

Hashimoto’s and Gluten

Gluten. It seems like everyone is talking about it. Books are lining shelves declaring the evils of this grain-based protein most of us have been eating for years. The grocery stores are full of “gluten-free” labels and gluten free bakeries are popping up in cities all across the country.

Gluten Free LogoWhy are we suddenly so aware of this protein? And what does it mean for people who have Hashimoto’s? Let me take you through some of the basics.

What is Gluten?

Gluten is a protein found in several different grains – wheat, barley, rye, spelt, kamut and triticale. It is a combination of two different proteins, gliadin and glutenin. Not all grains contain gluten and a gluten-free diet can still provide the essential nutrients found in these grains.

Autoimmunity

Hashimoto’s thyroiditis is an autoimmune condition where the immune system attacks and destroys the thyroid gland. It is, in essence, an immune condition with the thyroid being the unfortunate victim.

Autoimmune conditions are thought to develop when there are a combination of different factors. The three most commonly suggested factors are:

  • Genetic predisposition
  • A triggering event – this can be a nutrient deficiency, acute illness, chronic infection, dysbiosis, excess stress, food sensitivities or impaired detoxification
  • Increased intestinal hyperpermeability or “leaky gut”

The increased intestinal hyperpermeability, or “leaky gut” is where gluten becomes a major issue.

Leaky Gut

Keep outThe cells that line our digestive tract are joined at tight junctions – these close connections allow only the smallest particles of digested food to present to our immune system. Certain foods, like gluten, are more difficult for our enzymes to completely digest. These partially digested proteins, called peptides, can cause inflammation at the lining of the digestive tract, leading to damage of the tight junctions. When these tight junctions are compromised they become more permeable, or leaky, allowing larger molecules (peptides) to present to our immune system.

Once the immune system has been exposed to these large peptide molecules it may begin to produce antibodies against the peptides – an attempt to protect us from this foreign molecule.

The issue of autoimmunity, especially Hashimoto’s thyroiditis, occurs when the immune antibodies begin to circulate through our body, searching for the sequence of amino acids that make up the gluten peptide. The surface of the thyroid gland is made up of fats and proteins – and unfortunately the amino acid sequence of proteins on the surface of the thyroid is the same as the gliadin peptide in gluten. This results in the immune system destroying the thyroid gland, mistaking it for the component of gluten that triggered the response in the digestive tract.

Gluten and Food Sensitivities

wheat is a common food allergenIn my practice I recommend that all people diagnosed with Hashimoto’s thyroiditis eliminate gluten from their diet. However, leaky gut can be caused by, or lead to many other food sensitivities which can also have the same devastating effect on the thyroid gland, and other tissues in the body.

Every person with an autoimmune condition, including Hashimoto’s should seriously consider having an IgG based food sensitivity panel done to identify their own sensitivities. Understanding the action of your immune system in your body is imperative to decreasing the overactivity of the immune system and preventing further damage to your body.

For more information on Naturopathic Medicine and Hashimoto’s Thyroiditis, please read the other articles on this website written by Dr. Lisa Watson, ND: Understanding Hashimoto’s, Hashimoto’s and Fertility, Naturopathic Treatments for Hashimoto’s. If you are ready to start on your path to healing your Hashimoto’s you can book an appointment with Dr. Lisa by following the links here.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select references

Carrocio A, D’Alcam A, Cavataio F, et al. Gastroenterology. High Proportions of People With Nonceliac Wheat Sensitivity Have Autoimmune Disease or Antinuclear Antibodies.2015 Sep;149(3):596-603.e1.

Fasano A, Shea-Donohue T. Mechanisms of Disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases. Nature Clinical Practices. 2005 Sep:2(9):416-422.

 

Healing Your Hormones: Progesterone Deficiency

Women’s health is both the focus of my naturopathic practice and a passion in my life. There is no topic I am more excited to talk about, read about and learn about. And within women’s health there is no more important topic than hormone balancing. Because hormones are the main factor that differentiates men from women across the lifespan.

In this series I will take you through the basics of some common hormone imbalances that occur in women – progesterone deficiency, estrogen deficiency, estrogen excess, low thyroid hormone, excess thyroid hormone and testosterone excess.

So whether you are just interested in learning more about hormones, or hoping to identify some of your own signs and symptoms in this series, read on and get ready to learn how to heal your hormones.

What is Progesterone?

The reproductive system in women has two main hormones – estrogen and progesterone. Progesterone is our “pro-gestation hormone” – it is produced in the ovaries after ovulation to prepare the uterus for pregnancy. It is also produced in small amounts in the adrenal glands and in large amounts by the placenta during pregnancy.

What Does Progesterone Do?

Hormone sleepProgesterone prepares the body for pregnancy by stimulating the production of proteins that prepare the uterine lining for implantation. Progesterone also regulates our menstrual cycle – if a pregnancy does not occur, progesterone levels drop off and a menstrual period will result.

Progesterone is much more than just a pregnancy support hormone. Receptors for this hormone are found in the brain, breasts, blood vessels, and bones, in addition to the receptors in the reproductive organs. Progesterone is the natural balancing agent for estrogen – preventing estrogen from producing too many growth-stimulating effects on our tissues.

Progesterone also has significant anti-anxiety and relaxing effects on the body. It helps our mind and body cope with stress and can promote healthy sleep.

Changes in Progesterone Hormone Balance

Production of progesterone peaks in our mid-reproductive years – around 25 years of age. After that age we see steady declines in progesterone production until perimenopause and menopause when production drops off almost entirely.

Women who do not experience regular periods, or women who are not ovulating typically have low levels of progesterone as well.

Symptoms of Progesterone Deficiency

Low levels of progesterone can lead to a vast number of symptoms. Many of the symptoms are not taken seriously by doctors or may be attributed to other causes (especially anxiety, depression, insomnia and PMS). But for a large number of women the real cause of symptoms is an imbalance in progesterone levels.

 Escalator hormone balanceSymptoms of Progesterone Deficiency

  • Premenstrual mood changes
  • Painful or lumpy breasts
  • Insomnia
  • Premenstrual headaches
  • Anxiety
  • Infertility
  • Recurrent miscarriage
  • Unexplained weight gain

The Progesterone Hormone Web

No hormone functions in isolation. Each hormone in our body interacts with other hormones for optimal balance. Progesterone interacts with a number of important hormones, a few of which are noted here:

Estrogen

Progesterone is the natural balancer to estrogen. When progesterone levels are deficient, we can see symptoms of estrogen dominance. These include the symptoms listed above but also:

  • heavy periods
  • fluid retention
  • foggy thinking
  • decreased sex drive

Cortisol

Progesterone is the direct precursor to the production of cortisol, our stress/survival hormone. If progesterone levels are low, our ability to cope with stress diminishes and we may develop anxiety, depression, insomnia or feel overwhelmed.

Thyroid Hormone

Thyroid hormones stimulate the production and release of progesterone from ovarian cells. Thyroid hormone also influences the formation of progesterone receptors on cells throughout the body. If your thyroid function is low (hypothyroidism) you may also be experiencing low progesterone levels.

Hormone Healing for Progesterone Deficiency

Yoga natureLaboratory testing is necessary for all women seeking treatment for progesterone deficiency. It is imperative to understand the balance in the different hormones before starting any type of hormone treatment.

A lifestyle approach to improving progesterone levels is the foundation for all other treatments. Decreasing stress levels, encouraging a healthy diet that provides adequate protein and healthy fats, and engaging in regular exercise are all important to balancing progesterone levels.

There are a vast number of nutrients, and plant-based botanical medicines that can influence the production of progesterone. Some women also choose bioidentical progesterone cream, which can be prescribed by Naturopathic Doctors in Ontario who have prescribing rights.

Vitamin B6

Necessary for appropriate ovulation and subsequent progesterone production. If you are deficient, you will likely also be deficient in progesterone. Excellent food sources include tuna, salmon, turkey, chicken, sweet potato, sunflower seeds and dark leafy greens.

Magnesium

Magnesium is necessary for detoxification of hormones, especially estrogen. If you are deficient in magnesium you may have higher circulating levels of estrogen, resulting in a relative progesterone deficiency. Food sources of magnesium include pumpkin seeds, leafy greens, soy beans, sunflower seeds, and beans.

Chaste berry (Vitex agnus-castus)

Chaste berry (or chaste tree) has been found to increase progesterone levels during the second half of the menstrual cycle. It can also help to balance other hormones such as prolactin. Your Naturopath can help you decide if chaste berry is right for you

Bioidentical progesterone cream

Bioidentical hormone replacement therapy (BHRT) uses hormones that are identical to those in your body to balance your hormones and relief symptoms of hormone imbalance. Bioidentical progesterone is made from wild yams or soybean and is typically applied in cream form during the second half of the menstrual cycle.

Transdermal progesterone results in effective absorption of progesterone and movement of progesterone to the target tissues – brain, uterus, breast and blood vessels – to decrease symptoms. It is typically used twice per day and dosages vary – your Naturopath will work with you and a compounding pharmacy to establish your proper balance of hormones.

Hormone imbalance is not in your head – it is in every cell in your body. If you think your hormones are out of balance, talk to an experienced and qualified Naturopathic Doctor to help you find your optimal balance.

Natural Treatments for Thin Endometrial Lining

The uterus is made up of three layers: an outer protective layer, a muscular layer, and an inner lining (endometrium) which develops each month to support and nourish a fertilized egg. If a woman does not conceive, this lining is lost during the menstrual period.

Endometrial thickness is an important factor in improving pregnancy outcomes. An ideal thickness is between 9-10 mm at ovulation. If your endometrial lining is thin it may not allow for optimal implantation and successful pregnancy.

A thin endometrial lining can be identified on ultrasound done at or near ovulation, or can be suspected in women who have very light menstrual periods.

Women with long term use of birth control pills (10 years or longer) are more likely to experience thin endometrial lining. Use of the fertility drug Clomid (Clomiphene citrate) is also associated with thin endometrial lining, especially when used for multiple cycles in a row.

Below are some suggestions for ways to naturally increase the thickness of your endometrial lining and improve your chances for a healthy pregnancy.

Red Raspberry Leaf Tea

An herbal medicine with a very long history of use, red raspberry leaf (Rubus idaeus) is a uterine tonic that may help to optimize development of the uterine lining. It is also a rich source of nutrients to support a healthy endometrium, including iron and vitamin C. Drink three cups of the tea per day from the first day of your period until ovulation.

Black Cohosh

Another herbal medicine, black cohosh (Actaea racemosa) is a rich source of phytoestrogens that can provide further estrogen stimulation to the uterus and support a thick endometrial lining. Studies have been done combining black cohosh with clomid and found improved endometrial thickness and more successful pregnancy rates. Dosage ranges from 80-120mg per day from the first day of your period until cycle day 12. Best taken under the supervision of a naturopathic doctor who can monitor liver function for optimal safety.

Red Clover

Red clover (Trifolium pratense) is another isoflavone rich phytoestrogen, similar to black cohosh. It is used to increase blood flow to the uterus and support estrogen balance in the body. It is used daily from cycle day 1 to 12 at a dose of 40-80mg of standardized isoflavones.

Bioidentical Estrogen

red poppyEstrogen is necessary for the development of a healthy endometrium. If estrogen levels are low (which occurs as we get older) then the lining of the uterus will not develop optimally before ovulation. A blood or saliva test for estradiol can identify low estrogen levels and a bioidentical estrogen cream can be used safely to increase estrogen levels in the first half of the cycle, prior to ovulation. Your Naturopathic Doctor can prescribe bioidentical estrogen at a dose that is individualized to your needs.

Iron

Iron deficiency is the most common nutrient deficiency in women. Necessary for the health of red blood cells, low levels of iron may lead to an inadequate development of the uterine lining. If you are a vegan or vegetarian or have a history of having a thin uterine lining, ask your Naturopath or Medical Doctor to test your iron (ferritin) and hemoglobin levels.

Exercise

Inadequate blood flow to the uterus can be a significant cause of a thin uterine lining. This can be caused by a sedentary lifestyle, chronic stress or uterine fibroids. Exercise and acupuncture are two of the most effective ways of improving blood flow to the uterus. Swimming, walking, jogging, dancing, yoga or hula hooping are all excellent ways of getting the blood flowing to the uterus. Try engaging in some form of physical activity every day, especially in the two weeks leading up to ovulation.

red tulipsVitamin E and L-Arginine

Researchers have found that the use of these two nutrients can increase the blood flow to the uterus through the uterine radial artery. Published in the journal Fertility and Sterility in 2010, it was found that vitamin E increased blood flow in 72% of patients and increased the endometrial thickness in over half of patients. L-Arginine increased blood flow in 89% of patients and increased endometrial thickness in two-thirds of patients. Dosage of vitamin E in the study was 600mg per day and the dosage of L-arginine was 6g per day.

Acupuncture

Acupuncture is one of my favourite ways of addressing the issue of a thin endometrial lining. Acupuncture has many benefits for women’s hormonal health. It decreases stress, supports hormone balance, and regulates and increases blood flow to the reproductive organs. Clinical studies have demonstrated an improvement in the thickness of the endometrial lining with regular acupuncture treatments. Points that are often considered include: CV4, CV6, LI10, KI3, SP6, SP10 and ST36. Moxibustion, a warming technique, can also be used in combination with the acupuncture.

Working with a Naturopathic Doctor can help you to develop an individualized plan that will improve your chances of a healthy pregnancy. Additionally, if you difficulty conceiving be sure to have your thyroid thoroughly assessed because low thyroid function is also associated with failure of implantation.   Be sure to work with a Naturopathic Doctor who is experienced in supporting fertility and can help you achieve your goals, naturally.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select references:

Takasaki A, Tamura H, et al. Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertil Steril. 2010;93(6):1851-8.

Yu W, Horn B, et al. A pilot study evaluating the combination of acupuncture with sildenafil on endometrial thickness. Fertil Steril. 2007;87(3):S23