Skip to main content

Understanding Endometriosis

Endometriosis is a relatively common reproductive condition affecting between 10-15% of women in their teens, 20s, 30s and 40s. Endometriosis can cause significant pain and discomfort with menstrual periods and is associated with infertility in a large number of women.

This article will help you to understand the basics of endometriosis and is a great starting point to taking an empowered approach to your health care.

What is Endometriosis?

Endometriosis occurs when endometrial cells migrate and implant in areas outside the uterus. The most common sites for endometrial cells to implant are the cervix, vaginal-rectal space, ovaries, fallopian tubes, colon and bladder wall. Two out of three women with endometriosis with have implants on the ovaries – these are called endometriomas.

These rogue endometrial cells continue to respond to the hormonal stimulation of estrogen and progesterone despite their location outside of the uterus. This means that they will bleed during the monthly menstrual period. In endometriosis there is no way for this blood to leave the body, so it stagnates at the site, causing inflammation, pain and possibly scarring.

Symptoms of Endometriosis

Painful mensesSome women with endometriosis have no symptoms at all – in one third of women with endometriosis the only symptom is infertility. For women who do experience symptoms the most common are:

  • Painful periods (can get worse with time)
  • Painful intercourse
  • Infertility

Other symptoms that are also associated with endometriosis include:

  • Premenstrual spotting (bleeding prior to your period)
  • Bleeding at other locations (including nose bleeds) during your period
  • Back pain or abdominal pain during your period
  • Painful digestive upset
  • Pelvic pain that worsens before or during your period
  • Pain with bowel movements
  • Recurrent bladder infections
  • Shortened menstrual cycles (<28 days), heavy menstrual flow and long periods (>7 days)
  • High levels of pain can lead to exhaustion, depression and anxiety

How Do I Know If I Have Endometriosis?

Endometriosis is diagnosed based on surgical biopsy, usually performed during a procedure called a laparoscopy. Occasionally endometriosis can be seen on ultrasound, but only if the endometrial lesions are located on the ovaries. A blood test called CA-125 is often elevated in endometriosis and can be a useful screening tool as well as a way to monitor treatment.

Endometriosis and the Immune System

There are significant abnormalities in the immune function of women with endometriosis. You can read more about these changes in this article. Normalizing the function of the immune system is a key component to any treatment plan for endometriosis.

Mainstream Treatments for Endometriosis

Pain medicationTreatments for endometriosis often do not address the underlying causes of endometriosis, but rather are used to manage symptoms or remove endometrial lesions, many of which recur.

Pain-relieving medications are typically used for discomfort during periods. Non-steroidal anti-inflammatories (NSAIDs) are the most common prescription or over-the-counter medication for endometriosis. These medications are not without side effects and can negatively impact fertility with regular use.

Surgery or hormone-controlling drugs can be used to shrink or remove endometrial growths, although in approximately 40% of cases the endometriosis will recur.

Beyond Understanding

At this point you have an understanding of the symptoms and mainstream treatments of endometriosis. Continue your understanding by reading about Endometriosis and the Immune System, Endometriosis and Infertility, Endometriosis in Adolescence and learn about your options in Naturopathic Medicine in Endometriosis, Endometriosis and Acupuncture and the Endometriosis Diet, all by Dr. Lisa Watson, ND.

If you are ready for support in healing your endometriosis, Dr. Watson is currently accepting new patients. Contact her for a complimentary meet and greet appointment or book your initial appointment today.

References

Hudson, Tori. Women’s Encyclopedia of Natural Medicine. New York: McGraw Hill, 2008.

Lauersen, Niels H and Bouchez, Collette. Getting Pregnant. New York: Fireside, 2000.

Lewis, Randine. The Infertility Cure. New York: Little, Brown and Company, 2004.

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.

 

 

 

Endometriosis and the Immune System

Endometriosis results when rogue endometrial tissue implants outside of the uterus. One of the leading theories behind the development of endometriosis is that retrograde (backward) flow of menstrual blood spills out of the fallopian tubes and implants on the fallopian tubes, ovaries and other areas. But studies have shown that nearly all women experience some degree of this backward flow – why do only 1 in 10 women develop endometriosis?

The answer, it seems, may lie in the immune system.

Immune Surveillance

When the immune system is functioning optimally, retrograde menstrual flow is met by a swift immune response, destroying the renegade tissue before it has a chance to take hold and grow. When there is a malfunction in this immune system surveillance the endometrial tissue is able to implant on the nearest organ and grow.

So what causes this disruption in immune surveillance? It’s hard to say. Scientists don’t necessarily agree – diet, stress, estrogen dominance, auto-immunity? Likely some or all of these factors contribute to the development of endometriosis in individual women.

Lacking a Killer Instinct

Endometriosis and immune functionScientists have identified several different immune system changes associated with endometriosis. The first is a suppressed natural killer (NK) cell activity. NK cells are tasked with keeping tumour and other abnormal cells in check by releasing cell toxins.

Not surprisingly, this decrease in NK cell activity results in decreased immune surveillance and defense against the invading rouge endometrial tissue.

We know from our scientist friends that there is a strong correlation between high levels of estrogen – also known as estrogen dominance – and decreased NK cell activity. Managing estrogen dominance is a key feature of treating endometriosis because the endometrial cells respond to estrogen. Decreasing estrogen can also give these NK cells back their killer instinct.

More Macrophages!

Perhaps as a result of the shoddy surveillance by NK cells, the pelvic cavity and fallopian tubes of women with endometriosis have higher than normal levels of macrophages – the immune cells that attack and consume foreign cells like viruses and bacteria. Macrophages release cytokines, hormone-like substances that kill sperm (unfortunately for women with endometriosis and infertility) and trigger inflammation.

Increasing Inflammation

Macrophages and cytokines are joined in endometriosis with high circulating levels of interleukins, T lymphocytes and tumour necrosis factors – all with the same end result – more and more inflammation. Targeting these pro-inflammatory immune cells and decreasing their activity with anti-oxidants and anti-inflammatories is one of the most promising treatment strategies for endometriosis.

Auto-Immunity

As if that wasn’t enough. High levels of immunoglobulins are also found in endometriosis. Specifically we see increases in autoimmune immunoglobulins or auto-antibodies – immune cells that cause destruction of the body’s own tissue. In the case of endometriosis we see high levels of these auto-antibodies against ovarian and endometrial cells. Evidence of our immune system trying to make up for it’s poor surveillance perhaps.

Beyond Immune Function

Endometriosis and InfertilityThe immune system malfunctions associated with endometriosis are numerous, and give us key opportunities for addressing and managing this debilitating and frustrating condition. In other articles we will be looking at Understanding EndometriosisEndometriosis and Infertility, The Endometriosis Diet, Acupuncture for Endometriosis and Naturopathic Approaches to Endometriosis. Read those for further insight, or consider booking an initial consultation to start healing your endometriosis and mastering your immune system.

References

Hudson, Tori. Women’s Encyclopedia of Natural Medicine. New York: McGraw Hill, 2008.

Lauersen, Niels H and Bouchez, Collette. Getting Pregnant. New York: Fireside, 2000.

Lewis, Randine. The Infertility Cure. New York: Little, Brown and Company, 2004.

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.

 

Endometriosis and Infertility

Endometriosis impacts around 1 in 10 women of menstruating age and one-third to one-half of those women will struggle with infertility – about twice the rate of infertility of the general population.

This article will help you understand the many ways endometriosis can impact your fertility. It is only through understanding that we can hope to find an end to the pain and suffering of endometriosis, and the pain and suffering of infertility.

Endometriosis and the Fallopian Tubes

Blausen_0349_EndometriosisEndometriosis is the presence of endometrial cells outside of the uterus. These cells migrate and implant themselves in other structures, sometimes creating significant blockages and scarring that can impact fertility.

The most common sites for endometriosis to occur are the ovaries, fallopian tubes, vaginal-rectal space, colon and bladder wall.

When endometriosis occurs in the fallopian tubes scar tissue can form and create an obstruction that interferes with the ability of sperm to reach the egg, or for a fertilized egg to travel to the uterus. This physical blockage significantly reduces fertility and can also explain the increased incidence of ectopic (outside the uterus) pregnancy in women with endometriosis.

Additionally, the production of prostaglandins (inflammatory particles) that are produced by endometriosis can cause spasms in the fallopian tubes. When this occurs a fertilized egg can be pushed to the uterus so quickly that the endometrium does not have enough time to prepare for a healthy implantation. This may result in no implantation, early miscarriage or possibly premature labour.

In one of the great injustices in the world, women with endometriosis have a risk of miscarriage that is 3 times greater than other women.

Endometriosis, Ovaries and Ovulation

Two out of three women with endometriosis will have endometriomas – endometriosis on the ovaries. These endometriomas lead to the formation of blood-filled “chocolate” cysts on the ovaries – so named because of their characteristic colour and texture.

When endometriosis impacts the ovaries the overall health of the ovary is affected, blood flow may be altered, inflammation and hormonal changes are common. The health of the ovary is not the only concern, but egg growth, development and release are also affected. Women with endometriosis have increased rates of luteinized unruptured follicle syndrome – a condition further exacerbated by the use of NSAID pain relievers for pain management in endometriosis.

Endometriosis and the Uterus

Endometriosis can also invade the muscular wall of the uterus, a condition known as adenomyosis. When this occurs scar tissue can develop within portions of the muscle wall and interfere with proper implantation. And if implantation does occur, it can keep your baby from growing properly within the uterus, resulting in a dramatically increased risk of very early miscarriage in women with endometriosis.

The inflammatory reaction that occurs with endometriosis can also cause the endometrial cells in the uterus to stop producing a key protein marker (beta-integrin-3) that is necessary to encourage fertilized eggs to implant in the uterus.

Endometriosis and the Immune System

The endometrial lesions found in women with endometriosis produce high levels of prostaglandins. These excess prostaglandins create inflammation and can cause your internal environment to become so biochemically hostile that sperm is destroyed before it can reach the egg for fertilization.

Another key finding in the immune function of women with endometriosis is a higher than normal number of macrophages, a specific type of immune cell that scavenges and consumes foreign cells such as viruses and bacteria. These same cells have been demonstrated to have the ability to kill sperm (a foreign cell) as it moves towards the egg or to destroy embryos as they travel to the uterus for implantation.

Moving Beyond Understandingempowerment

Understanding the ways endometriosis can cause infertility is the first step towards overcoming this diagnosis. In other articles we will discuss Understanding Endometriosis, the Immune System in Endometriosis, The Endometriosis Diet, Acupuncture for Endometriosis and Naturopathic Treatments for Endometriosis. Please read on or book an appointment with Dr. Lisa Watson, ND to discuss your options for managing your endometriosis. You don’t have to do this alone!

References

Hudson, Tori. Women’s Encyclopedia of Natural Medicine. New York: McGraw Hill, 2008.

Lauersen, Niels H and Bouchez, Collette. Getting Pregnant. New York: Fireside, 2000.

Lewis, Randine. The Infertility Cure. New York: Little, Brown and Company, 2004.

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.

 

Uterine Fibroids: Five Things You Need To Do

Fibroids are non-cancerous growths that develop in the muscle layer of the uterus. Depending on the method of diagnosis a staggering 5 to 77% of women have been found to have fibroids. Fibroids can be very small or very large (up to the size of a watermelon!!)

Symptoms of fibroids depend on the size and location of the fibroid. Fibroids can cause pain, bloating or heavy periods.

We don’t understand exactly what causes the development of fibroids but risk factors include African descent, a family history of fibroids, being overweight and perimenopause. There is also a strong association of fibroids with high estrogen levels, a condition known as estrogen dominance.

While we don’t know exactly how fibroids form, here are five things you should do right now if you have fibroids.

Five Things You Need to Do if You Have Fibroids

  1. Check Your Vitamin D Levels

If you have dark skin or live in colder climates (like Canada) you may have a vitamin D deficiency. Low levels of vitamin D can contribute to the development of fibroids and can lead to inflammation and altered insulin response.

If you have fibroids, you should see your Naturopathic Doctor or Medical Doctor to have your vitamin D levels assessed. A vitamin D supplement is recommended for all Canadians during the winter months, so knowing your current levels is important for determining your individualized optimal dose.

  1. Love Your Gut

    Fermented foods promote healthy bacteria balance
    Fermented foods promote healthy bacteria balance

An imbalance in the levels of bacteria in your digestive tract could be contributing to fibroid growth. This imbalance, known as “dysbiosis”, can lead to increased production of inflammatory mediators which migrate to the pelvis and stimulate the growth of atypical cells that develop into fibroids.

Having dysbiosis can also lead to high levels of estrogen by promoting recirculation of estrogen rather than allowing the body to eliminate it.

Digestive dysbiosis can be caused by antacid use, antibiotics, stress, poor digestion, frequent illness and use of birth control pills.

Dysbiosis can be treated by your Naturopath with the use of probiotics, fermented foods, gut healing nutrients and botanicals.

  1. Be Kind to Your Liver

Balancing hormones requires a healthy liver. The two-phase detoxification process in our livers that allows us to detoxify and eliminate estrogen can be influenced by our diet, stress, herbs and medications.

Make healthy choices every day to love your liver and support estrogen detoxification. Limit or eliminate alcohol, eat less gluten, drink green tea, and eat lots of leafy green vegetables. Your Naturopath may also recommend specific herbs to support the liver or a B complex vitamin supplement.

  1. Balance Your Hormones with FoodCruciferous vegetables for hormone balance

One of the most important things you can do if you have fibroids is to follow a hormone-balancing diet – one that decreases inflammation, balances blood sugar and prevents estrogen dominance.

Foods that can increase inflammation, raise insulin and blood sugar levels, and promote estrogen dominance should be limited or eliminated. These include:

  • Red meat
  • Poultry
  • Dairy products
  • Gluten containing grains
  • Alcohol
  • Sugar and artificial sweeteners
  • Trans fats

Luckily there are also foods that can promote hormone balance and decrease inflammation. These include:

  • Cold water fish
  • Nuts and seeds (especially flaxseed)
  • Cruciferous vegetables – broccoli, Brussels sprouts, cabbage, kale, kohlrabi and cauliflower
  • Beans, peas, lentils, soybeans
  • Water
  1. See a Naturopathic Doctor

If you have fibroids you should consider seeing a Naturopath to get an individualized hormone balance plan. Your ND can identify possible causes of inflammation and imbalance in your life and work with you to find solutions to restore your body to a state of healthy balance. Your Naturopath can also prescribe nutritional supplements and botanical medicines to address your fibroids and overall state of health. You can find a licensed ND in your area by contacting the Canadian Association of Naturopathic Doctors or the American Association of Naturopathic Physicians.

 

Optimize Fertility: Cervical Fluid Testing

One way to optimize your fertility is to be aware of the changes that occur in your body during your fertile days. One observable pattern of change is cervical fluid. The secretions produced by the cervix (the opening to the uterus) change right before ovulation, creating an environment that helps the sperm survive the vaginal environment and travel through the cervix and the uterus.

Checking your cervical fluid takes only a few seconds and is done before you urinate. It should be tested daily, starting with the day after your menstruation ends.

How to Test Your Cervical Fluid

  1. Test your cervical fluid at least three times per day before you urinate. Be sure to test in the morning and at night.
  1. Perform vaginal contractions (Kegels exercises) on your way to the bathroom. This moves the cervical fluid down to the opening of the vagina.
  1. Check your cervical fluid when you are not sexually aroused as sexual lubrication can change the texture of cervical fluid.
  1. Separate your vaginal lips and check your cervical fluid at the lower opening (closest to your anus).
  1. Fertile Cervical Fluid TestingFeel the texture of the cervical fluid before looking at it. Rub your fingers together and note if it feels dry, sticky, creamy or slippery. Is it slippery like egg-white?
  1. Look at the cervical fluid while slowly opening your fingers and see if it stretches. If it does stretch, how much does it stretch before it breaks?
  1. If you have a hard time differentiating between cervical fluid and vaginal secretions you can do a water test. Cervical secretions are insoluble – if you drop the secretion into a glass of water the cervical fluid should form a blob that sinks. Vaginal secretions will simply dissolve.
  1. As you get closer to ovulation your cervical fluid may become so thin that it may actually disappear, but fertile-quality cervical fluid will make your vagina feel slippery or lubricated when walking around or wiping with toilet tissue.

Terms Used to Describe Cervical Fluid

Sticky – opaque white or yellow. Can be fairly thick. Not wet. Can feel like paste, gummy or
rubbery.

 Creamy – milky or cloudy, white or yellow. Can feel wet but thin. Doesn’t form peaks when fingers are separated but  remains smooth. Similar to hand lotion.

 Egg-white – usually clear but can have opaque streaks in it. Very slippery and wet (like a raw egg white). May stretch for  several inches between the fingers.  This is your fertile cervical fluid.

Identifying Your Peak Day      

The peak day is the last day you have either a lubricative vaginal sensation OR produce fertile (egg-white) cervical fluid. This is your peak day because it occurs either a day before you ovulate or on the day of ovulation.

You will only know that it was your peak day in retrospect, on the following day you will notice your cervical fluid has begun to dry up.

When used with basal body temperature testing, you will begin to recognize patterns of your fertile cycle and greatly improve your chances of conceiving!

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.

 

Menstrual Cycle 101

Women in my office are often embarrassed to admit that they don’t really understand the hormones that influence their menstrual cycle.  Don’t worry ladies, most women don’t!  It’s not something we were taught in school (unfortunately) and unless you have problems with your periods, or you’re trying to get pregnant (or not!) you’re unlikely to ever question Nature’s ways.

So for all those women interested in understanding more about their periods, for whatever reason that brought you here, may I present…

Menstrual Cycle 101

The Big Events*

Days 1-5

The biggest event in our menstrual cycle is arguably our menstrual period. It’s certainly the most noticeable!

On the first day of our period (day 1) our major fertility hormones, estrogen and progesterone are at their lowest level. This state of low hormones allows for the period to start. It also triggers our pituitary gland to start making hormones (LH – lutenizing hormone and FSH – follicular stimulating hormone) to stimulate growth of new follicles (eggs) in the ovaries.

Day 7

At the end of the first week your period has likely finished and estrogen levels are increasing.  Curious about the mood impact of estrogen – check out this blog where I discuss it.

At this point the follicles are growing rapidly in the ovaries. One of these follicles surpasses the others and becomes the dominant (graafian) follicle. The follicle starts producing its own estrogen, and estrogen levels continue to climb.

Days 7-12

The high levels of estrogen stimulate the lining of the uterus to thicken and prepare for possible implantation later in the cycle.

Further down in the reproductive tract the cervix, the exit of the uterus into the vaginal tract, has begun to produce a new type of cervical fluid – the fertile cervical mucus.  You only make this type of cervical fluid for a few days each month and it can be a great way of monitoring your fertility to both enhance, or avoid, pregnancy.

Eggs a source of vitamin B12Days 12 and 13

Super high levels of estrogen start acting on the pituitary in our brain, stimulating it to produce lutenizing hormone (LH). The LH surge starts production of enzymes and prostaglandins in the dominant follicle, preparing the follicle to ovulate its egg.  Ovulation is set to occur in the next 24 hours.

Day 14

Boom.  Ovulation.

Ovulation occurs when the enzymes breakthrough the follicle wall and the egg is released.

Day 15-25

Welcome to the luteal phase of your cycle.  The first half of the cycle (the follicular phase) was all about follicle (egg) development.  This second half is all about the uterus and its lining.

The follicle that released its egg at ovulation is now a corpus luteum, and produces progesterone.  Progesterone levels are highest during the second half of the cycle and are responsible for the increase in body temperature (BBT) found in the second half of our cycle.

With all that increased progesterone, the lining of the uterus (endometrium) continues to thicken and secrete nutrients to support a potential pregnancy.

Day 23-24

If egg has met sperm implantation most commonly occurs 9-10 days after ovulation.  The range is different for everyone, with some embryos implanting after 7 days and others taking up to 12.

Day 25-28

If no implantation occurs, the corpus luteum stops producing hormones and levels of progesterone and estrogen drop.

This sudden decline in hormone levels leads to the low hormone levels that stimulate the start of your period.  Your uterus lining loosens from the wall of the uterus and is shed.

The drop in hormones also signals the pituitary gland to once again start production of FSH and LH to prepare a whole new group of eggs for ovulation.

*Remember – these dates are approximations based on a “typical” 28-29 day cycle. In every woman there may be individual variations.

There you have it!  Did you learn something new today?

Whether you are trying to get pregnant, struggling with hormone imbalances, PMS or period pain, learning more about the hormones that influence your period is a great place to start.  Next steps? Explore this website more to learn all about your hormones and how they influence your health!  And download my free e-book to learn how to hack your hormones for health and happiness!

Yours in health, and hormone harmony

~Dr. Lisa

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.

Antioxidants May Improve Ovulation in PCOS

Improving outcomes in women undergoing fertility treatments is the focus of many research studies. One specific antioxidant is showing promise in clinical studies of women with polycystic ovarian syndrome (PCOS).

N-Acetyl Cysteine

N-Acetyl Cysteine (NAC) is a precursor for the primary antioxidant in the human body, glutathione.  Glutathione is both an intracellular (in the cell) and extracellular (outside the cell) antioxidant and is involved in DNA synthesis and repair, free radical scavenging, metabolism of toxins and carcinogens, and preventing negative effects of aging.

Despite it’s impressive benefits in the human body, glutathione is not useful as an oral supplement because it is inactivated by enzymes in the gut.  Glutathione is also not able to cross cellular membranes, preventing it from being uptaken into cells.

Luckily, N-Acetylcysteine is able to be absorbed in the digestive tract, and can easily cross the cell membrane and is converted within the cell to glutathione.

NAC and Clomid for PCOS

A study published in the Journal of Obstetrical and Gynaecological Research looked at the combined use of clomiphene citrate (Clomid) and NAC in women with PCOS and compared to Clomid alone, found significant improvements in:

  • Number of follicles >18mm
  • Mean endometrial thickness
  • Ovulation rates
  • Pregnancy rates

No adverse effects were seen and no cases of ovarian hyperstimulation were reported.

Hope for PCOS

While the results from this study of 180 women are preliminary, the impeccable safety profile for NAC and the promising findings in multiple parameters (number of follicles, endometrial thickness, ovulation and pregnancy rates) suggest it may benefit women with PCOS, especially in combination with Clomid.

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.

Selected References

Salehpour S, Sene AA, Saharkhiz N, Sohrabi MR, Moghimian F. N-Acetylcysteine as an adjuvant to clomiphene citrate for successful induction of ovulation in infertile patients with polycystic ovary syndrome. J Obstet Gynaecol Res. 2012;38(9):1182-6.

Natural Medicines Comprehensive Database. N-Acetyl Cysteine monograph. Accessed July 10, 2014. www.naturaldatabase.com

 

 

Managing Gestational Diabetes Naturally

The incidence of gestational diabetes (carbohydrate intolerance that is first identified during pregnancy) is increasing.  With up to 10% of pregnancies affected this is becoming a major health concern in North America.

Diagnosing Gestational Diabetes

It is standard practice in North America to screen all women for gestational diabetes using the oral glucose challenge test (GCT)  While this universal screening is controversial (the benefits of screening all pregnant women are not established, and there is a high rate of women testing positive for gestational diabetes who do not, in fact, have this condition) it is still common practice for women to be screened between 24 and 28 weeks.

Not every pregnant woman needs to be screened for gestational diabetes.  You have the option to decline this screening test.  However, all pregnant women with risk factors for developing gestational diabetes should be screened with the GCT.  Risk factors include:

  • Glucose in the urine (found on routine urinalysis)Naturopathic Treatment of Gestational Diabetes
  • Diabetes in a first-degree relative (parent, sibling or child)
  • History of glucose intolerance, including gestational diabetes in a previous pregnancy
  • Obesity
  • Previous infant with high birth weight

A high blood sugar level (greater than 7.8mmol/L or 140mg/dL) after the GCT is not diagnostic and does not mean you have gestational diabetes.  A diagnosis can only be made after a 100g three-hour oral glucose tolerance test (OGTT).

In Canada, to be diagnosed with gestational diabetes following the 100g three-hour OGTT you must exceed two or more of the following blood sugar values:

Fasting:                                                 95mg/dL             or            5.3mmol/L

          One hour after glucose load:          180mg/dL            or            10.0mmol/L

          Two hours after glucose load:         155mg/dL            or             8.6mmol/L

                   Three hours after glucose load:      140mg/dL            or             7.8mmol/L

Large babies and gestational diabetes

Complications of Gestational Diabetes

The potential risks of unmanaged gestational diabetes include:

  • Large birth weight babies and increased risk of shoulder dystocia and other birth traumas (including brachial plexus injury)
  • Higher rate of Caesarean section
  • Postnatal infant hypoglycemia
  • Increased risk of mother developing Type II Diabetes

Naturopathic Treatment for Gestational Diabetes

While I don’t believe that all pregnant women should undergo the glucose challenge testing, there are benefits to managing blood sugar during pregnancy and this should be a priority regardless of a diagnosis of gestational diabetes.

Here are my tips for managing blood sugar for all pregnant women, including those with gestational diabetes.

  1. Avoid simple sugars.  No “white” foods – no white bread, white pasta, white rice.  Avoid candies, cookies, cakes and other confections.
  2. Eat regular meals.  Eat at the same time every day.  Eat every three hours.
  3. Never consume a carbohydrate without a protein or fat.  For example: if you are eating an apple have some almond butter, almonds or yogurt at the same time.
  4. Increase dietary fiber.  Have a tablespoon of ground flaxseeds with every meal.  Mix ground flaxseeds with applesauce or yogurt or sprinkle on salads, rice, etc.  Ideally, grind your flaxseeds at home with a coffee grinder rather than purchasing them pre-ground.  If you do purchase pre-ground flaxseeds, keep them in the freezer for freshness.
  5. Swimming for gestational diabetesEat the majority of your carbohydrates at lunch rather than breakfast or dinner.  Keep portions of carbohydrate foods small (one slice of whole grain bread, one half cup of brown rice, one half cup of whole wheat or brown rice pasta, one half cup of quinoa, etc.)
  6. Exercise for at least thirty continuous minutes once or twice per day.  A walk is an easy way to do this but you could consider swimming or yoga or other activities to keep it interesting and to engage other muscles (insulin is used by skeletal muscles – get those muscles using it!)

For gestational diabetes specifically, inositol is a supplement that can be used safely in pregnancy and has been found in studies to improve insulin sensitivity and decrease glucose levels.  It takes a few weeks for maximal effects so see your Naturopathic Doctor as soon as you are aware of abnormal blood glucose levels to gain control over your blood sugar faster.

Gestational diabetes is usually well managed with diet, exercise and simple supplements.  In rare cases where drugs are necessary your Naturopathic Doctor can continue to provide support with lifestyle and dietary counseling and stress management to ensure you and your baby are healthy throughout pregnancy and beyond.

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.

Fertility and Chinese Medicine

Any person who has struggled with fertility is familiar with terms like “luteal phase defect”, “premature ovarian failure”, “polycystic ovarian syndrome” and “unexplained fertility”.  Not many are familiar with “Liver Qi stagnation” or “Kidney Yang deficiency”.  But these terms may be the key to your fertility struggle and may be the diagnosis that unlocks your body’s imbalance and allows for pregnancy to occur.

The Diagnosis of Infertility with TCM

Traditional Chinese Medicine (TCM) views health as a state of balance between all of the systems of the body.  In terms of fertility there are four organ systems – Kidney, Spleen, Heart and Liver that, when unbalanced, can lead to infertility.

In addition to the organ systems, there are four vital substances – Yin, Yang, Qi and Blood that can become deficient, excessive or stagnant and create a state of unbalance that may manifest as infertility.

All TCM treatments for fertility are founded upon restoring balance and health to these organ systems and vital substances.

Common TCM Diagnoses for Infertility

TCM diagnoses are made by Naturopathic Doctors after a thorough physical examination and comprehensive intake.  Naturopaths who use TCM in the treatment of fertility will also look at your tongue and take your TCM pulses to both diagnose your TCM pattern and to monitor treatment.

The terminology used in TCM diagnosis may be unfamiliar to you.  They are a different way of looking at patterns in your body.  Toronto Naturopath infertilityWhile Western medicine may say you have low progesterone, a TCM diagnosis may say you are lacking in Kidney Yang.  It’s a different way of saying similar things – a different perspective on your health and fertility.

While a comprehensive intake is necessary for proper diagnosis, some of the most common TCM imbalances leading to infertility are:

Liver Qi Stagnation 

The movement of Qi through the Liver is necessary for both ovulation and menstruation to occur.

Women with Liver Qi stagnation often experience symptoms of imbalance both at ovulation (bloating, irritability, breast tenderness) and at menstruation (premenstrual breast tenderness, irritability, anger, painful periods).

This pattern is often seen in women with polycystic ovarian syndrome (PCOS) and in women with long menstrual cycles.

Spleen Qi Deficiency

In TCM Spleen Qi manages the second half of the menstrual cycle (the luteal phase).  Together with the Kidney Yang, the Spleen Qi allows for buildup of the endometrial lining and supports progesterone production.

Women with Spleen Qi deficiency typically have low energy, cravings for sugar or breads, poor circulation and may experience spotting before their periods, menstrual cramps and fatigue during their periods.

A Spleen Qi deficiency pattern is common in women with luteal phase defect.

Kidney Yang DeficiencyToronto Naturopath treating infertility

Kidney Yang works together with the Spleen Qi to control the luteal phase of the menstrual cycle.  Kidney Yang supports the production of progesterone and maintains an elevated body temperature after ovulation.

Women with Kidney Yang deficiency experience symptoms of coldness – cold feet or hands or an intolerance to cold.  They may have menstrual cramps that feel better with use of a heating pad.

Kidney Yang deficiency often occurs with a Spleen Qi deficiency and is common in women with a luteal phase defect and in women with a prolonged follicular phase or long menstrual cycle (greater than 30 days).

Kidney Yin Deficiency

While Kidney Yang and Spleen Qi control the luteal phase, Kidney Yin controls the follicular phase (the first half of the menstrual cycle, while the egg is developing prior to ovulation).  Kidney Yin also controls production of cervical mucus and opening of the cervix during ovulation.

Women with Kidney Yin deficiency may experience night sweats, hot flashes and have little or no midcycle cervical mucus.  They may not experience any significant symptoms around their period.

Kidney Yin deficiency often occurs with shortened follicular phases, prolonged follicular phases and in elevated FSH and low estrogen states.  Amenorrhea (absence of menses) is also often indicative of a Kidney Yin deficiency.

There are many other TCM imbalances that can contribute to infertility.  The ones listed above are by far the most common but other imbalances may include:

    • Blood stasis
    • Blood deficiency
    • Heart deficiency
    • Excess Heat

Treating a TCM Imbalance

Once you have received a TCM diagnosis from your Naturopathic Doctor you embark on a journey of rebalancing your body to support your fertility.  Whether you are using natural therapies exclusively, or working with a reproductive endocrinologist or assisted reproductive therapies (IVF or IUI) you can begin making changes to balance your systems and improve your chances of pregnancy.

I use a four-step program to help women rebalance their bodies and support their fertility.Infertility naturopathic medicine Toronto 

Step One: Appropriate diagnosis of imbalances and develop a plan for harmonizing your systems and balancing your energy

Step Two: Lifestyle and dietary changes to support balance in your systems.  In TCM certain foods and activities have specific properties.  You can use food, exercise, relaxation techniques, yoga, Tai Chi, Qi Gong and more to increase energy to your Kidneys, boost your Spleen Qi or clear Liver stagnation.

Step Three: Balance the energetic meridians through acupuncture.  A series of acupuncture sessions can balance the organ systems and support smooth flow of Blood and Qi to the reproductive organs and throughout the body.

Step Four: Correct imbalances and increase chances of pregnancy through herbs.  Herbs are natural energetic substances that can gently and effectively correct imbalances and optimize fertility.

If you have been struggling with infertility and are interested in another approach, a Traditional Chinese Medicine diagnosis may be a good place for you to start.  Bring balance back to your body and book an appointment with a Naturopathic Doctor who is knowledgeable about TCM in fertility today.

For further reading, I highly recommend The Infertility Cure by Dr. Randine Lewis.  A fantastic overview of the TCM approach to fertility with sections on each of the imbalances associated with fertility.

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.

Photo credits:

Evan Leeson via Compfight

aussiegall via Compfight

Felix Schmidt via Compfight

Natural Support for Amenorrhea

As women we experience approximately 500 menstrual cycles in our lifetime.  Impressive, isn’t it!  But when we miss our period for 3 months and we are not pregnant, breastfeeding or menopausal then we have amenorrhea (absence of menses).  This can be a serious symptom of a greater underlying imbalance and reason for a consultation with a doctor.

Types of Amenorrhea

There are two types of amenorrhea.

Primary amenorrhea – when menstruation fails to occur by 16 years of age

Secondary amenorrhea – when menstruation has previously occurred, but has been absent for at least three months (if your cycle was regular) or six months (if your cycle was irregular)

Causes of Amenorrhea

There are a number of things that can lead to not getting your period.  Primary amenorrhea is caused by a genetic abnormality in about one-third of cases.  Hormonal imbalances, environmental exposures, malnutrition, low body weight, eating disorders, anemia, strenuous exercise, stress, infectious disease (like mumps or tuberculosis), cancer treatments, autoimmune disease, polycystic ovaries, and structural defects can also lead to amenorrhea.

Five of the most common causes of secondary amenorrhea are:

  1. Ovarian failure (pre-mature menopause)
  2. Elevated prolactin levels
  3. Inadequate estrogen production
  4. Chronic lack of ovulation (due to PCOS or other causes)
  5. Low body weight/ low body fat

How Do I Know What is Causing My Amenorrhea?

A full spectrum of tests, combined with a physical exam and comprehensive intake should give enough information to determine the cause of amenorrhea for most women.  Your Naturopathic Doctor will ask you questions about your:

  • Menstrual and fertility history
  • Emotional stress
  • Weight gain or weight loss
  • Lifestyle including alcohol intake, dietary practices and exercise
  • Prior medical history – accidents, illnesses or injuries
  • Medications and supplements
  • Family medical history

Laboratory testing will likely be needed as well.  A pregnancy test, pelvic ultrasound, blood tests for cholesterol levels and thyroid functioning as well as blood or saliva tests for hormone levels are often indicated.

Treatment of Amenorrhea

In Naturopathic Medicine we strive to treat the underlying cause of imbalances rather than just the symptoms.  When you see a Naturopathic Doctor for your amenorrhea the treatment will be individualized to you – treating your individual imbalances rather than your symptom of amenorrhea.  Once the underlying imbalance is corrected, the symptom will resolve.

Nutrition for Amenorrhea

  • Achieve and maintain a healthy body weight.  Women who are underweight can have amenorrhea due to a lack of adequate body fat to manufacture hormones.  Women who are overweight can have amenorrhea as a result of excess androgens associated with excess body fat.
  • Consume adequate protein.  You need at least 40 grams of protein daily.
  • Consume adequate calories.  Depending on your body type (height, weight) you will have individual caloric needs.  A minimum of 1500 calories daily is a good guideline for anyone.
  • Consume 20% of your calories as fat.  Good quality fats such as nuts, seeds, extra-virgin olive oil, flaxseed oil, and fish oil ensure you are consuming enough fats to produce sex hormones (including estrogen and progesterone)
  • Consume 55-65% of your calories as complex carbohydrates.  Brown rice, wild rice, millet, oatmeal, amaranth, quinoa, barley, spelt, kamut and buckwheat provide fiber, B vitamins and support proper detoxification of hormones
  • Ensure you are getting the nutrients you need by eating a diverse selection of foods every day.

Lifestyle Changes for Amenorrhea

  • Sleep in a dark room
  • Go to bed before 11pm
  • Eat regular meals (at regular times).  Eat every 3 hours.
  • Maintain a steady, healthy body weight. Avoid rapid weight gain or weight loss.
  • Balance thyroid function.  Measure basal body temperature to determine if your thyroid is underactive.
  • Avoid environmental toxins – pesticides, preservatives and food additives.  Consider hair mineral analysis to assess toxic burden
  • Consider cranial sacral therapy, Reiki, or rolfing to bring awareness to emotions connected to femininity, sexuality, body image, maturation, independence, and second chakra issues

Herbal Medicines for Amenorrhea

There is an entire class of botanical medicines that is used for amenorrhea.  These herbs are known as emmenagogues and are used to promote menstruation.

Some of the most common herbal medicines used for amenorrhea are include:

  • Mugwort (Artemesia vulgaris)
  • Partridgeberry (Mitchella repens)
  • Blue cohosh (Caulophyllum talictroides )
  • Chaste tree (Vitex agnus-castus)
  • Black cohosh (Actea racemosa)

These herbs should be used under supervision of a qualified Naturopathic Doctor and should be taken only as prescribed.

There is help available for amenorrhea.  You can have a normal menstrual cycle – but only if you address the underlying cause of your lack of menses.  Contact a qualified Naturopathic Doctor for a consultation today.

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.

Photo credits

Mait Jüriado via Compfight