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PCOS and Mental Health

Polycystic ovarian syndrome is the most common hormone imbalance in women and yet very few people are talking about how significantly this imbalance is impacting women’s lives.

PCOS can impact any woman, at any age – from puberty to perimenopause, and in addition to the typical symptoms of irregular or absent periods, acne, facial hair growth and scalp hair loss, there can also be an increased incidence of mental health concerns.

PCOS and Depression

It has been my experience in practice that women with PCOS often have signs of depression – many of them due to the effects the symptoms of PCOS have on their body image. Researchers have found that nearly ¼ of women with PCOS have depression and they too suggest it may be linked to the “emotionally distressing” symptoms associated with PCOS, rather than the underlying hormone imbalance itself.

PCOS and Anxiety

Rates of anxiety are also higher in women with PCOS, with 11.5% of women in one study having both diagnoses (compared to an average 9% in the general female population).

Anxiety may be associated both with the physical symptoms of PCOS, but potentially may also stem from the hormone imbalances, such as low progesterone, that are common in PCOS. Progesterone is an anxiety-lowering hormone and low levels of progesterone occur when there is no ovulation – such as in PCOS.

PCOS and ADHD

Another interesting finding from the 2018 study on PCOS and mental health – women who have PCOS have an increased risk of having children who are diagnosed with ADHD (attention deficit hyperactivity disorder) or an autism spectrum disorder. The researchers suggest that it may be due to higher circulating androgens during development.

Support for PCOS and Mental Health

Focusing on whole body health, rather than just the visible symptoms of PCOS is important for all women with PCOS. While most women will want to focus on clearing acne and decreasing body weight, we must look at women as a complex entity of interlacing systems – ladies, we are all unicorns – we need to be treated individually and with attention to our specific wants and needs. Our mental and physical health are one and the same, and we should seek care from health care providers who recognize that.

Your Naturopathic Doctor can help you to put together a plan that focuses on your diet, lifestyle, obstacles to health, hormonal imbalances and mental and spiritual health.  Looking at your life and health as a whole, rather than individual symptoms to be managed, your ND works with you to achieve optimal health – in all areas of your life.

Select References

Thomas R Berni Christopher L Morgan Ellen R Berni D Aled Rees.  Polycystic ovary syndrome is associated with adverse mental health and neurodevelopment outcomes.  The Journal of Clinical Endocrinology & Metabolism, jc.2017-02667

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.

 

PCOS and Hair Loss

My personal experience with hair loss in my early 20s has given me a keen passion to support women with hair loss of any cause. In other articles I’ve discussed the Root Causes of Female Hair Loss and Alopecia Areata but in this article I’m discussing the hormonal hair loss associated with PCOS.

PCOS: Hormone Havoc

In polycystic ovarian syndrome (PCOS) the ovaries do not respond appropriately to hormonal cues from the brain (the pituitary gland to be precise), resulting in the formation of cysts in the ovaries.

These cysts are actually unsuccessfully ovulated follicles – in normal ovulation the follicle ruptures and releases an egg. But in PCOS the follicle continues to grow and becomes a cyst.

Because the follicle does not release the egg, and continues to grow, it also continues to release hormones – mostly estrogen and testosterone. And it is this hormonal havoc that can lead to hair loss.

Testosterone and Hair Loss

High levels of testosterone are known to contribute to hair loss, and women with PCOS often have elevated levels of testosterone and other androgens (including dihydrotestosterone – a super powerful form of testosterone).

The testosterone can bind to receptors in the scalp hair follicles, stimulating hair loss in a male pattern – typically hair is lost at the front of the hair line, and at the very top of the head. It’s usually in a diffuse pattern – meaning the hair falls out all over rather than in patches.

The low progesterone that occurs in PCOS (progesterone is only produced after ovulation – no ovulation, no progesterone) also binds to those same hormone receptors in the hair follicle – preventing hair loss from occurring. So the balance of high (or even normal) testosterone and little to no progesterone causes the hair loss we see in PCOS.

Treating PCOS Hair Loss

The goal of treatment in hair loss associated with PCOS is to get you ovulating again. The balance of hormones in a healthy menstrual cycle should prevent hair loss from occurring. In the early stages of treatment we may also use treatments like saw palmetto, spearmint, berberine or inositol to decrease the testosterone levels.

As with all treatments for hair loss, the benefits take time to become apparent. The life cycle of the hair is three months – any hairs that have already been triggered by testosterone to fall out will do so for the first few months. So don’t give up on your treatment if you don’t see a benefit right away. The work you do now will benefit future you.

If you have any questions about your hair loss – whether it is associated with PCOS or any other condition, book a free 15 minute consultation so we can talk.

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

Polycystic ovarian syndrome is one of the most common conditions that I treat in my hormone balancing practice. It affects 1 out of every 10 women and shows up 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

In 2003 the Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) came up with a specific criteria for making a diagnosis of PCOS – The Rotterdam Criteria.  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/

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PCOS & Berberine

While your medical doctor may not have heard of it, the functional and naturopathic medicine community is raving about berberine for polycystic ovarian syndrome (PCOS). And if you haven’t heard about it – you are about to go to school on WHY berberine may be exactly the treatment you have been looking for.

What is Berberine?

Berberine is a compound (technically a quaternary ammonium salt – damn! science!) found in several plants – most notably barberry, Oregon grape and goldenseal.  It has been used as a medicine in Traditional Chinese Medicine for over 5000 years.

Berberine Improves Insulin Responsiveness

One of the key findings in many women with PCOS is a poor response to insulin. When the cells (including those of the ovaries) stop responding to insulin, energy goes down, weight gain goes up and many of the hormone imbalances associated with PCOS show up.

One of the most common prescription treatments for PCOS is metformin, a drug that improves insulin response. But studies have found that berberine is able to do this too – and maybe even a bit better than metformin!

Berberine stimulates cells to take up glucose, so blood sugar and insulin levels drop. This can result in ovulation for women with PCOS. One study also found that the women taking berberine lost more weight than the women on metformin. Win-win!

Berberine Lowers Testosterone

The elevated testosterone associated with PCOS is the one hormone imbalance most women want addressed quickly. Elevated testosterone leads to the acne, head hair loss, chin and upper lip hair growth that women despise. Studies have demonstrated that berberine can lower testosterone levels and speed the resolution of these symptoms.

Berberine Benefits Your Gut

Berberine is not just great for your ovaries, but it’s great for your gut too. Berberine has been used for generations to treat symptoms of gas, bloating, constipation and diarrhea. Now we understand that it does this by helping increase the production of short chain fatty acids and supporting the healthy bacteria (probiotics) in our guts. Healthy bacteria help us to eliminate estrogen – minimizing the potential for estrogen dominace – another common hormone imbalance in PCOS.

Berberine Loves Your Liver

Your liver is essential in hormone balance. Berberine has been found in studies to increase the production of sex hormone binding globulin (that’s a mouthful…) or SHBG that binds to testosterone and makes it unavailable for use in your body.

Berberine has also been found to lower liver enzymes in non-alcoholic fatty liver disease, a condition that is commonly found in women who are overweight and have PCOS.

Berberine Benefits Fertility

Whether you are trying to get pregnant or just balance your hormones, it is reassuring to know that berberine can improve ovulation and pregnancy rates in women with PCOS. In women with PCOS undergoing IVF procedures, those who took berberine (no matter whether they were normal weight or overweight) had higher pregnancy rates than women using metformin or a placebo.

Berberine Boosts Weight and Fat Loss

Not every woman with PCOS is overweight (I talk about that more in the PCOS Types article), but if you are even mildly overweight berberine can help you to shed some unwanted fat.

Berberine has been found in multiple studies to support weight loss and to help target fat loss from the midsection of the body. Berberine helps to lower the production of our hunger hormone, leptin – a hormone that stimulates our appetite. Women with PCOS and women who are overweight often have abnormal levels of leptin.

Building on Berberine

Berberine is an excellent option for many women with PCOS. It can be the cornerstone for PCOS treatment and help you to achieve your dreams of hormone harmony.

Discuss with your Naturopathic Doctor if berberine is the best bet for you.  It may be used in combination with other natural treatment options, diet and lifestyle changes to improve your health and hormones, naturally.

Select Resources

Toronto Naturopath, Dr. Lisa Watson discusses the use of berberine for PCOS - polycystic ovarian syndromeAn Y, Sun Z, Zhang Y, Liu B, Guan Y, Lu M. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clin Endocrinol (Oxf). 2014 Mar;80(3):425-31

Wei W, Zhao H, Wang A, Sui M, Liang K, Deng H, Ma Y, Zhang Y, Zhang H, Guan Y. A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome. Eur J Endocrinol. 2012 Jan;166(1):99-105.

Wu X, Yao J, et al. Berberine improves insulin resistance in granulosa cells in similar way to metformin. Fertility and sterility.2006; supplement S459-S460.

Yang J et al. Berberine improves insulin sensitivity by inhibiting fat store and adjusting adipokines profile in human preadipocytes and metabolic syndrome patients. Evid Based Complement Alternat Med. 2012

Zhao L et al. Berberine improves glucogenesis and lipid metabolism in nonalcoholic fatty liver disease. BMC Endocr Disord. 2017 Feb 28;17(1):13.

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 of PCOS

PCOS is the most common hormone imbalance impacting women and teenage girls. Polycystic ovarian syndrome, meaning “multiple ovarian cysts” can start soon after puberty and can persist for years. For some women it starts later – but for all women and teenage girls, it can be an incredibly frustrating, and sometimes painful condition.

WTF is PCOS?

Ovarian cysts occur when ovulation doesn’t occur as it is supposed to. In every cycle each ovary stimulates a number of follicles to develop, one of which will release an egg at ovulation. In PCOS the follicles are stimulated to grow (totally normal), but they do not respond to the hormonal cue to release an egg at ovulation. Instead they continue to grow and form cysts within the ovary.

There are many reasons why you may not respond appropriately to the hormones and instead form ovarian cysts – you can learn more about the types of PCOS in this article.

How Do I Know If I Have PCOS?

I talk about the diagnosis of PCOS in this article, but these are the most common symptoms that may suggest a diagnosis of PCOS:

  • Irregular or absent periods
  • Infertility
  • Hair growth on the upper lip or chin
  • Hair loss from the head
  • Acne – especially on the body or on the “beard distribution” of the face
  • Weight gain or excess weight around the abdomen

If you have a family member with PCOS, you are more likely to develop it. So talk to your mom, sister, aunts and grandmothers to see if you have a family history.

If you suspect you may have PCOS, then discuss it with your MD or ND and get an appropriate diagnosis.

What Causes PCOS?

PCOS is the result of failed ovulations – so the cause can be anything that disrupts healthy ovulation. Hormone imbalances stemming from the pituitary gland, the thyroid, the adrenal glands or pancreas can all cause PCOS. Insulin resistance – when your cells no longer respond to the hormone insulin – is probably the most common hormone imbalance that leads to PCOS.

How is PCOS Treated?

In conventional care, PCOS is most often treated with the birth control pill. Other choices, like spironolactone or metformin, are also suggested if acne or insulin resistance are present. However, many women are successfully choosing a more empowered approach to treating their PCOS through diet, exercise and some health supporting supplements.

Diet and Lifestyle

While not every woman with PCOS is overweight, if you are, losing weight is an important goal. Losing as little as 5% of your body weight can reverse insulin resistance, promote ovulation and decrease testosterone (less acne and chin/lip hair!)

I go into great detail on the basics of the PCOS Diet in this article – also available as a fun infographic! Check it out for all the information you need.

Vitamins and Minerals

Many different supplements can be used for managing PCOS. These are best selected by working with your ND – knowing what your hormone imbalance is will allow you to choose those supplements most likely to work for you. Here are a few of the most helpful options:

Vitamin B6 – can help balance prolactin levels, a hormone often elevated in PCOS.

Chromium – essential for proper blood sugar regulation. Taking chromium (also known as insulin tolerance factor) increases the uptake of glucose into cells, decreasing insulin resistance.

Vitamin D – essential for healthy ovulation. Every Canadian is deficient during the winter months, and supplementation is often needed to correct that deficiency.

Herbal Medicines

Plant medicines can be incredibly powerful medicines, especially when it comes to supporting hormone balance. It depends on your type of PCOS what herbal medicines may be recommended.

Saw palmetto (Serenoa repens) – an incredibly effective hormone balancer, saw palmetto decreases the conversion of testosterone to its more powerful form, dihydrotestosterone (DHT). This makes saw palmetto an excellent choice in the treatment of acne, hair loss, and facial hair growth.

Chaste tree (Vitex agnus-castus) – one of the best known herbal medicines for PCOS, chaste tree lowers prolactin levels and raises progesterone levels. It can also restore regular ovulation, the main issue in PCOS!

Other Natural Supplements

A few honourable mentions are necessary in any discussion of PCOS – treatments that have excellent research and deserve to be considered in any woman seeking a more empowered approach to her PCOS.

Inositol – a B-like vitamin, inositol has many benefits for PCOS – it decreases insulin resistance, decreases testosterone levels and helps to promote regular ovulation. It is a super-star for PCOS treatment.

Berberine – compared in studies to metformin, berberine has powerful actions on blood sugar regulation and insulin resistance. It can reduce testosterone, and androgens. Women taking berberine also achieved greater weight loss in some studies.

Next Steps

Knowing that there are a great many different options for the treatment of PCOS, some women can feel overwhelmed by information. This is one of the many benefits of working with a Naturopathic Doctor. Your ND can help you understand your individual hormone imbalance and guide you to the treatments that will be most effective for you.

Remember, any hormone imbalance will take time to resolve. Start taking the steps now to achieve your healthy hormone balance.

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.

 

Ovarian Cysts: Simple and Complex

Ovarian cysts are small growths that form on or inside of the ovary. Many women are diagnosed with ovarian cysts on routine ultrasounds, and others are diagnosed when they experience changes in their menstrual cycles or painful periods. Often women are told they have cysts without really understanding what that means. This article will give you the knowledge you need to understand your diagnosis, and empower you to select the best treatment options for you and allow you to restore your optimal hormone health.

Simple Ovarian Cysts

Simple ovarian cysts are by far the most common type of ovarian cyst. A simple cyst forms when an egg fails to be released by the ovary at ovulation, or when the follicle the egg developed in continues to grow after ovulation. Simple ovarian cysts develop with exposure to estrogen, and are sometimes called ‘functional’ cysts.

Simple cysts often have no symptoms and will resolve on their own with time. Simple cysts are often found in a condition called Polycystic Ovarian Syndrome (PCOS) where many simple cysts develop and symptoms such as a lack of periods (amenorrhea), irregular periods, infertility, acne, hair loss or facial hair growth can occur.

Complex Ovarian Cysts

Complex cysts are much less common and are not formed during a typical menstrual cycle. There are three different types of complex ovarian cysts:

  • Cystadenomas – ovarian tissue filled with fluid or mucus
  • Dermoid cysts – composed of cells you have had since before you were born. Dermoid cysts contain cells that are used to produce dermal tissue, so they can contain skin, hair, fat, or teeth.
  • Endometriomas – a result of endometriosis. Endometriomas occur when cells from your uterine lining grow on or in the ovaries.

Complex ovarian cysts are most often benign, especially those that develop before menopause. Some ovarian cysts can be malignant so it is important to have them assessed fully.

Symptoms of Ovarian Cysts

Most simple ovarian cysts do not cause any symptoms at all. Some symptoms that may alert you to the possible presence of simplex or complex cysts include:

  • Bloating, pressure, or pain in the low abdomen
  • Frequent urination (if the cyst is large and pressing on the bladder)
  • Sudden severe pain (if the cyst ruptures)

If you have endometriomas – cysts associated with endometriosis, you may experience:

  • painful periods
  • pain during sex
  • pain during bowel movements
  • infertility

What Causes Cysts?

Simple cysts (like those in PCOS) are the result of hormonal and metabolic issues. You can read more about PCOS in these articles, Understanding PCOS, PCOS Types and Diagnosing PCOS.

Complex cysts can be present from birth and grow under hormone stimulation after puberty. Endometriomas, another complex cyst, occur when the lining of the uterus grows outside of the uterus, including on the ovaries. Cystadenomas can occur when ovarian cells mutate and grow (most often these are benign, but can be cancerous).

Diagnosis of Cysts

Most cysts are diagnosed with a transvaginal ultrasound. Some can also be detected with a simple pelvic exam. Often the type of cyst can be identified with an ultrasound, but occasionally a biopsy or blood test (such as CA-125) may also be used.

Treatment of Cysts

Simple cysts are easily treated with Naturopathic approaches – hormone balancing, blood sugar stabilization and improved ovarian response are common treatment goals.

Some complex cysts require no treatment, but some may need to be removed if they are large or causing significant symptoms. Most often the cyst is removed through a simple surgery caused laparoscopy.

Endometriomas are treated in the same manner as other types of endometriosis. If you have endometriosis, please read the Endometriosis series of articles written by Dr. Lisa on this website.

 

If you have any more questions about your ovarian cysts, don’t hesitate to get in touch!  You can send Dr. Lisa an email or book a free 15 minute meet and greet here.

 

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Empowered Menopause: Hot Flashes and Acupuncture

The most common complaint in menopause, hot flashes (and the dreaded night sweats) are experienced by 80% of women. For at least half of women these symptoms can last 7 to 10 years (years!!) and impact sleep, mood, comfort and quality of life.

There are many excellent treatments for hot flashes, bioidentical hormone replacement therapy, black cohosh, chaste berry, phytoestrogens and others, but acupuncture has been found in studies to be another excellent choice for women.

Acupuncture for Hot Flashes

Studies in the past 10 years have found that women with mild to moderate hot flashes and night sweats, acupuncture administered weekly can reduce the frequency of hot flashes by half (and for some women there was a nearly 90% reduction!) Compared to women who did not have acupuncture, who reported only a 10% reduction over the 8 week study, acupuncture was a very successful intervention.

How Acupuncture Works

While we don’t know all of the reasons acupuncture works so well, many researchers think that it may be due to the impact on the hypothalamus – the master regulator of our body temperature. Acupuncture has also been found to promote blood vessel dilation, increase the release of different pain-reducing endorphins, and balance the production of stress and reproductive hormones.

Why Acupuncture?

For women looking for a low risk intervention, with virtually no side effects, acupuncture can be an ideal option. Acupuncture is also very cost effective, especially for women with health care insurance coverage.

You will know within 4-6 weeks whether acupuncture is going to benefit your hot flashes. And if acupuncture is effective for you the great news is that it may continue to be effective even after you are done your sessions. One study found that the benefits seen 6 months of treatment was still providing benefit 6 months later.

If you are experiencing hot flashes or night sweats, book in today to discuss with Dr. Lisa whether acupuncture is the solution you have been looking for.

Select References

Avis NE, et al. Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause: June 2016;23(6):626-637

De Valois BA, et al. Using traditional acupuncture for breast cancer-related hot flashes and night sweats. J Alt Comp Med. 2010;16(10):1047-1057

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.

The Empowered Woman’s Guide to Yeast Infections

If you have been reading my blog (yay you!), then you know my core mission is to empower women to demand more from their health. No more accepting mediocrity in our bodies and our wellness. You CAN feel better.

And the one condition I am constantly amazed that women are living with, without successful treatment, are yeast infections.

Ladies! You don’t have to live like this. If this is your first yeast infection, congratulations. You are going to learn how to deal with this right, the first time. If this is your third, or fourth, or fortieth – I am so glad you are here. Because we are going to get into some serious action-oriented information that you need to learn.

So let’s do this.

 

What is a Yeast Infection

A yeast infection is an overgrowth of yeast, usually Candida albicans that causes irritation to the vagina and vulva. Also known as VVC (vulvovaginal candidiasis), candida is most often self diagnosed and treated with over the counter creams and capsules.

While most women think of a yeast infection when they experience a thick, whitish discharge, only 20% of cases actually have this symptom.   The more common symptoms of a yeast infection are itching, swelling of the vulva and pain on urination (especially after peeing).

What is NOT a Yeast Infection

While most women self diagnose yeast infections, there are a number of imbalances that can occur in the lady garden that look like yeast infections, but aren’t.

Vaginitis – an infection of the vagina with inflammation. A yeast infection is a type of vaginitis, but this can also be caused by other infections, like trichomoniasis.

Vaginosis – the overgrowth of vaginal bacteria without inflammation. Most commonly caused by Gardnerella, BV (bacterial vaginosis) is incredibly common – even more so than yeast infections. But that is the subject of another article (coming very soon!)

Other conditions that are not yeast infections – contact irritation, allergic reactions, atrophic vaginitis, menopausal dryness, cytolytic vaginosis (Write this article too) and sexually transmitted illnesses like Chlamydia and gonorrhea.

What Your Doctor Isn’t Telling You About Yeast Infections

Yeast infections don’t need to be difficult to treat. They don’t need to be recurrent. The problem is that doctors aren’t offering complete solutions to women with yeast infections.

When you talk to your MD about yeast infections, most often you are told to take an over-the-counter antifungal medication that will kill the yeast. Sounds ok right? Well, no… not right.

Killing the yeast is important, there is no doubt about that. But killing the yeast does nothing to change the environment that the yeast was growing in. And since yeast is everywhere (yeast spores are airborne – you are going to be exposed to them both in your environment and from your digestive tract every day of your life) if you don’t change the environment, you’ll like just get another yeast infection.

The Empowered Approach to Yeast Infection Treatment

I’m going to present you with my empowered approach to fighting yeast infections. It takes a bit longer than the typical over-the-counter remedies – but it works a lot better. So if you’re ready to conquer candida, for once and for all, read on.

  1. Pay attention to pH

The healthy normal pH of the vaginal tract is around a 3.8-4.5. When you have candida (or BV), that pH can be increased above a 4.5. This occurs due to a change in the healthy bacteria, Lactobacillus, that should be the main bacteria in the vagina.

If you want to resolve your yeast infection, you need to pay attention to pH. If you optimize the normal, acidic pH of the vaginal tract, the yeast and nasty bacteria can’t thrive and the lactobacillus species can.

The best way to do this is with boric acid suppositories. Boric acid sounds scary – but remember, the vaginal tract is meant to be acidic. Using boric acid will restore the optimal pH and support the healthy bacteria populations. Made by a local compounding pharmacist, boric acid is simple to use and very effective.

  1. Eradicate the yeast

Ok. Yes, we do need to eradicate the yeast. But as I mentioned above, it can’t be the ONLY step in a successful yeast treatment. Most often I recommend using nature’s favourite antifungal – garlic – often combined with some caprylic acid (from coconut). Taken orally, or sometimes vaginally, these two are a powerhouse of antifungal activity.

But we don’t stop there. We also look at your diet. Yeast thrives in a high sugar environment, so I suggest avoiding all sugar (including dairy and bread products), alcohol and some fruits for at least a month while treating your yeast infection.

  1. Restore beneficial bacteria

yeast infection, candida, candidiasisWho hasn’t heard of the amazing benefits of probiotics? Those 300 trillion lovely little bugs that live in and on our body are a huge part of what makes us healthy (or not.)

In our lady garden, our boss bacteria is Lactobacillus. And imbalances in healthy levels of Lactobacillus are associated with BV and yeast infections.

The main source of bacteria for the vagina is from the “proximity exposure” to the exit of our digestive tract. So taking probiotics by mouth can be really effective for supporting healthy bacteria levels. Using vaginal probiotics is also highly recommended for yeast treatments, especially when using boric acid.

  1. Prevent recurrence

Eradicate yeast? Check.

Promote healthy pH? Check.

Lots of Lactobacillus? Check.

Now how do we stop this from happening again? Avoiding triggers that can lead to yeast infections – like a diet high in sugar, dairy and wheat, diabetes and unstable blood sugar, tight clothing and artificial fiber underwear (cotton ladies, cotton) is imperative. You can discuss with your ND whether you should embark on a longer “Candida Diet” – this isn’t necessary for everyone, but can make all the difference for some.

  1. Don’t accept mediocrity from your lady garden

I’ve said it before – and I’ll say it once more – yeast infections are not normal. And you don’t have to live with them. Now that you know better, I hope you will want better for yourself. And go out there and do it. You have been empowered – and I’m cheering you on.

Want a personalized treatment plan to get over your yeast infections?  Book in and let’s talk.  I’m ready when you are.

DUTCH test, hormone testing,hormone test, women's hormones, hormone health

DUTCH: Gold Standard in Hormone Testing

In my work with women’s health and hormones, one of the biggest areas of debate is hormone testing. Women are confused about when and how to test their hormones, and if I’m honest, a lot of doctors are confused as well. Which is leaving women under-diagnosed and under-treated for their very real (and very annoying) hormone imbalances.

But no more. Science has come a long way and right now we have the ability to test for hormones in ways that we never have been able to before. And women everywhere can benefit. So if you’ve ever wondered, “Do I have a hormone imbalance?”, now we can easily answer that question.

The DUTCH Test

Hormone testing with the DUTCH testDUTCH is an acronym that stands for Dried Urine Test for Comprehensive Hormones. It is a simple, but sophisticated test that looks not just at your hormones, but how your body processes and metabolizes them.

The DUTCH test looks not just at your reproductive hormones (although it does look at those quite thoroughly), but it also looks at your stress hormones, your androgens (male pattern hormones), your melatonin and the new DUTCH test also looks at organic acids – markers for mood and nutritional balance in the body.

8 Reasons the DUTCH Test is the Gold Standard for Hormone Testing

  1. Simple collection

Nothing is easier than peeing on a piece of filter paper. (Ok… some people might get a little pee on themselves, but still… is that the worst thing that can happen to you today?)

  1. In depth hormone levels

If you have a question about your hormones, the answer is likely to be found in the DUTCH test. While your Naturopathic Doctor may still recommend blood testing for hormones like thyroid hormone, FSH or LH, just about every other hormone is covered in the DUTCH test.

  1. Metabolism matters

Hands down, the reason the DUTCH test is the best, is that it measures metabolites. The absolute level of your hormones matter – but what can matter more is what your body does with those hormones. This is metabolism – does your body turn testosterone into nasty acne-promoting 5a-DHT?? Does your body turn estradiol into DNA damaging 4-OH estrone? Are you healthfully metabolizing and eliminating estrogen from your body? The DUTCH test can tell you.

  1. It’s all about those curves

Not every hormone has stable levels over the entire day. In particular, our primary stress hormone, cortisol, and its metabolite cortisone, have a curve that changes over the course of the day. Blood tests only give us a single snapshot of your cortisol levels, but the dried urine test gives us not only the total levels of cortisol and cortisone, but also the curve – how those levels change over the day. This is some VALUABLE information for people who are struggling with stress, fatigue, anxiety, decreased libido, trouble sleeping and insomnia.

  1. Balanced estrogen

Estrogen is one of the most important hormones in our bodies, and it has so many benefits for our health, but it can also have negative impacts if it is not in balance.

Typical hormone testing for estrogen looks just at estradiol, the dominant estrogen in the body. But that only tells us such a small bit of information. If we want to balance our estrogen, and prevent complications of estrogen dominance, then we want to understand how our body copes with our burden of estrogen. What metabolism pathways does our body use? Are those the best pathways?

If you are considering bioidentical hormones (BHRT) for perimenopause, or menopause symptoms, then the DUTCH test is highly recommended at the initial visit to understand how you will metabolize the hormones.

  1. Androgens and acne and hair health

In my work with women, no one condition is more loathed or baffling than acne. WTF, am I right ladies? How did we reach our 30s and still have to deal with acne?? Often it’s an issue of androgen metabolism. But typical hormone testing just looks at the amount of testosterone being made, and not what your body is doing with it. If your body is sending more testosterone towards the DHT metabolites, you will have more acne and possibly hair loss (and chin/ upper lip hair growth!) The DUTCH test will tell you if this is happening – and then we can talk about what to do about it!

  1. Melatonin

If you are having difficulty sleeping, knowing your melatonin levels is amazing information to have. But not only those with insomnia or sleep challenges should know their melatonin levels. Melatonin is also a powerful antioxidant in our bodies, and optimal levels of melatonin have been found to reduce the incidence of hormonal cancers (including breast cancer). No other hormone test looks at melatonin, but the DUTCH test does.

  1. Organic acids

Natural treatments and testing for depression and anxietyA new addition in 2018 to the DUTCH test is the 6 OAT (organic acid tests). I’m so excited for this new information!

Three new markers for neurotransmitters – to help us understand your mood. If you struggle with depression, anxiety or insomnia, this information can be very significant. If you have tried antidepressants without benefit, your organic acid markers for specific neurotransmitters, like serotonin, may tell you why.

Additionally there are three new markers for nutritional levels – looking at your B6 and B12 metabolism as well as your glutathione status. If you are concerned about weight gain or inflammation as part of your hormone imbalance, now we may be able to identify why.

The 1 Reason I don’t love DUTCH Testing

  1. The test results are ugly

I know. Such an aesthetic issue. But the test results are ugly – seriously. The results are clear. The information is valuable. But the results look a lot like a airplane dashboard, and some patients find this overwhelming. So take the time to talk through the results with your ND to understand what they mean for you.

Toronto, naturopath, doctor, naturopathic doctor, holistic, functional doctor

Next Steps

If you are interested in DUTCH testing, I suggest booking a 15 minute complimentary meet and greet to discuss the details. It is an amazing, useful, sophisticated test. But it’s not the right test for everyone. So let’s talk and see if it is the right test for you.

Dr. Lisa

Further Reading

https://dutchtest.com

https://articles.mercola.com/sites/articles/archive/2016/05/08/dutch-hormone-test.aspx

 

Your Guide to Pain Free Periods

Painful periods and menstrual cramps

This is the one article series a lot of women have been asking for – what to do about painful periods and period cramps. Half of women experience pain during their menstrual cycles (and around 90% of teen girls) and 1 in 10 women have periods that are so painful they are unable to work or function for up to a week each month.

So what are we going to do about it ladies? I’m not one to just take things as they are – and I don’t want you to either! Let’s learn a bit more about why some of us get such significant pain during our periods, and then we’ll talk about what we can DO to lessen our pain, and live our amazing lives, every damn day of the month.

Dysmenorrhea

The medical term for painful periods is dysmenorrhea. And it encompasses anything from cramps in the lower abdomen to low back pain, pain/pulling sensation in the inner thighs, diarrhea, nausea, vomiting, dizziness, headache and fatigue. Dysmenorrhea is basically anything miserable during a period that interferes with our ability to function.

There are two different types of dysmenorrhea: primary and secondary.

Primary dysmenorrhea – no underlying cause, just the result of our body’s natural physiology

Secondary dysmenorrhea – occurs as a result of something else – an underlying condition that can lead to pain during periods – endometriosis, ovarian cysts, pelvic inflammatory disease, uterine fibroids, a narrow cervical opening, etc.

Ultimately we need to understand if there is a secondary cause for the painful periods – and treat that. If your periods started being painful right from your first period in your teens, then it’s most likely primary dysmenorrhea. If you had years of pain-free periods, then a full workup for secondary dysmenorrhea is highly recommended. In either case read on and learn more about what you can do to help yourself manage your period pain.

Why Are My Periods Painful?

A couple of specific physiological changes occur at the start of our periods that contribute to pain during periods.

Just before the start of our period flow the blood supply, and thus oxygen delivery, to the uterus is significantly restricted. In order for the lining of the uterus to be shed there is also an increase in the production and release of inflammatory compounds (called prostaglandins) that stimulate uterine contractions. This combination of low oxygen delivery (called ischemia), inflammatory prostaglandins, and contractions causes the pain associated with our periods.

But Dr. Lisa, not every woman experiences painful periods (lucky b*tches)

Yes, dear reader, this is absolutely true! Some factors need to be considered in those of us who do have painful periods.

Women who have painful periods produce on average 8-13 times more prostaglandins than women who do not experience painful menstrual cramps (more on this in the treatment section). Women who do not ovulate during their menstrual cycle also do not have painful periods – the drop in progesterone is what triggers the inflammatory prostaglandin production and painful uterine contractions. As we get older and make less progesterone, we also can experience much less painful periods.

And lifestyle makes a difference for some women too. Women who already have poor oxygen delivery to the uterus – smokers, women who are overweight, women who are sedentary – they tend to have cramping that is either more intense, or lasts longer, or both.

Treatment of Painful Periods and Menstrual Cramps

There is a LOT that we can do to manage our menstrual cramps. Many of the lifestyle and natural treatments are very effective for reducing pain during our periods and can give women back their vitality every day of the month. Ultimately it can be a trial and error to determine what will be the most effective for you, and working with a Naturopathic Doctor can accelerate your progress.

Below I’ve given you my top ten lifestyle modifications for managing period cramps.  Once you’ve made those changes, check out my article on Natural Treatments for a Pain Free Period. And then when you’re empowered with all that knowledge, book an appointment so we can put together the very best plan for you.

Lifestyle for Pain Free Periods

Studies have found a number of factors that can contribute to painful periods – women who eat more sugar, junk food, fast food and saturated fats tend to have more painful periods. Women who exercise regularly (not just during their periods) tend to have less menstrual cramps. Using tampons can make menstrual cramps worse, as can constipation or food sensitivities.

Below you’ll find my top ten lifestyle tips for reducing period pain

  1. Cut the sugar

Not really a newsflash, but sugar makes just about everything worse – including period cramps. Sugar interferes with the body’s ability to absorb and use B vitamins and minerals, both of which can worsen muscle tension and increase the force of uterus cramps. So quit it – you already knew you should.

  1. Ditch dairy

Prostaglandins, those inflammatory molecules produced by our uterus that cause pain, are made in our body from arachidonic acid. Arachidonic acid comes mostly from our diet, in particular dairy products (although poultry is also a high source of arachidonic acid). Reducing or eliminating dairy is a great idea for women who get period pain – and it has been suggested that eliminating dairy may provide a significant benefit (with no other treatments) for up to one-third of women with painful periods!

  1. Avoid alcohol

Ladies, I get it. The urge to have a lovely glass of wine to dull the cramping and misery, and really, you just want it. But I’m a teller of truths – alcohol is a no-go for painful periods. Alcohol is well known to deplete B vitamins as well as muscle-relaxing minerals such as magnesium. Not only that – it interferes with the liver’s ability to metabolize hormones. All of these contribute to more cramping and heavier periods (which lead to more clots, which trigger more uterine spasms, which causes more pain…)

  1. Skip the salt

Salt is something many people think they are avoiding, but that stuff sneaks into everything. While I’m not opposed to a bit of sea salt on my edamame, the primary source of salt in the diet is processed or packaged foods. Salt can increase fluid retention, which can worsen bloating and discomfort as well as period pain. So skip the salt and season with spices instead.

  1. Load up on the legumes, nuts and seeds

Nuts and seeds are excellent sources of minerals like magnesium and calcium – both of which can lessen muscle tension and reduce the pain of menstrual cramps. Additionally, eating a diet higher in plant proteins and lower in animal proteins has been found to reduce the incidence of dysmenorrhea. So skip the chicken and have some chickpeas and cashews instead.

  1. Eat your veggies

Really, is there anything vegetables CAN’T do? They are the most important component of the human diet, and eating more of them cures just about everything – including period cramps. Women who eat more fruits and vegetables have the lowest rates of painful periods. Vegetables are excellent sources of minerals, like calcium and magnesium, as well as fiber to reduce bloating and discomfort.

  1. Understand your food sensitivities

Wait, what? Food sensitivities? What do those have to do with my period cramps?

It turns out, quite a lot!

Food sensitivities can damage the lining of the digestive tract, altering the absorption of B vitamins and minerals, resulting in more cramping. Additionally, food sensitivities can cause increased production of inflammatory molecules, leading to more inflammation (and more pain) when period time rolls around. Add to the mix the irregular bowel movements that can result from food sensitivities and you have the perfect storm for period pain. So if you’ve ever wondered if you have food sensitivities and you get painful periods, I’d considering having the food sensitivity test. It may be just what you need.

  1. Exercise regularly

Exercise improves blood flow to, and from, the uterus. Exercise also helps to alter the production of prostagandins, leading to less pain. And it’s not just exercise during your period that helps – most studies show that women who exercise regularly have less painful periods than those who don’t. There are also some specific exercises that have been found to help manage period pain – you can read more about those here.

  1. Toss the tampons

We are entering a new age of period empowerment. No longer are we having to choose between bulky pads and bleached cotton tampons. There are so many options now for women to comfortably accommodate their periods.

Pain free periods. Natural treatments for period cramps

From the Diva Cup to Thinx period panties, to all natural pads that are thin and comfortable. Women who use tampons have more painful periods than those who don’t, and most of those tampons are full of chemicals that can be absorbed across the mucosal barrier of the vaginal canal – not a good thing! So toss those tampons and join women in the age of period empowerment!

  1. Try a Natural Approach

While we may be tempted to manage our period pain with Midol and Advil and other pain killers, there are a number of natural supplements – nutrients and botanical (plant) medicines that can provide amazing relief. And without the side effects of those pain killers as well! Start by reading my article on Natural Treatments for Pain-Free Periods and then work with a Naturopathic Doctor to personalize a treatment plan that can give you relief from your menstrual cramps.