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PCOS Types

Syndrome of PCOS

Polycystic ovarian syndrome (PCOS) is condition impacting up to 1 in 10 women in North America. PCOS is a “syndrome” – a medical term for a condition that can have different symptoms in different people. In PCOS we can see a wide variety of presentations. Some women have many symptoms, while others have few. Some of the symptoms that can present in PCOS are:

  • Irregular periods
  • Long time between periods (prolonged cycles)
  • Infertility
  • Hair growth where you don’t want hair (chin, upper lip, neck, chest, back, breasts, buttocks)
  • Hair loss where you do want hair (scalp)
  • Weight gain
  • Oily skin
  • Acne

Diagnosis of PCOS

Ultimately the diagnosis of PCOS is based on the Rotterdam criteria – you must have 2 of the 3 criteria (irregular periods, cysts on your ovaries, signs or laboratory evidence of elevated androgens) to be diagnosed. To learn more about diagnosis, read this article by Dr. Lisa on PCOS Diagnosis.

As a Naturopathic Doctor I think we should move beyond mere diagnosis, and really get to the underlying causes of PCOS. And this is where the PCOS Types come into play.

Types of PCOS

Type 1: Insulin-Resistant PCOS

The classic presentation of PCOS – a woman experiencing weight gain, irregular or no periods, acne and facial hair – is represented by Type 1 PCOS, a condition associated with insulin resistance. The lack of response of the ovaries to insulin leads to a hormonal cascade that results in increased testosterone levels, the underlying cause of those unfortunate symptoms.

Women with insulin resistant PCOS have an increased risk of developing diabetes and depression – two other conditions associated with insulin resistance.

Treatment for insulin resistant PCOS involves improving the body’s response to insulin. Supplements such as inositol, chromium and cinnamon can be helpful. Spearmint tea can help to decrease testosterone levels and reduce facial hair growth and acne.

Weight optimization and following the PCOS Diet can also be part of this process. However, please keep in mind that not all women with insulin resistant PCOS are overweight. Slender women can also have insulin resistance as a result of their diet.

Type 2 PCOS: Non-Insulin Resistant PCOS

What once was a rare occurrence, I am now seeing many more women in my practice with non-insulin resistant PCOS. This can be caused by a number of different causes including:

  • Inflammation
  • Immune system challenges (including autoimmune diseases)
  • Vitamin D deficiency
  • Iodine deficiency
  • Thyroid hormone imbalance
  • Stress
  • Low dose chronic environmental exposures
  • Discontinuation of the birth control pill
  • A diet inconsistent with your body’s individual biochemistry

This type of PCOS requires more investigation and understanding that the classic insulin-resistant PCOS. Often I will run more extensive blood work than is typically offered to a woman with PCOS. Depending on the woman I may look at nutritional levels, hormone balance (prolactin, thyroid, LH, progesterone, cortisol, DHEA, testosterone), autoimmune antibodies, inflammatory markers, and food sensitivity testing.

The approach to managing non-insulin resistant PCOS is a personalized medical approach. It is essential that we uncover the root cause of the PCOS and address it directly with an approach that encourages balance and optimum function. Often women respond quickly once the cause has been identified and balance is restored.

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.

 

Problems with the Pill

There is no doubt that the birth control pill was a huge player in the feminist revolution. First released in 1960, the pill allowed women to delay pregnancy and focus on their career, transforming the lives of women and society. While the pill may be a political powerhouse, and be effective at preventing pregnancy, my belief is that it is being overprescribed, and women are under-educated on the impact that the pill can have on their health.

This article will share some of the concerns that I, as a naturopathic doctor and women’s health expert, have regarding the pill. The purpose is not to convince you to give up the pill, but to empower you with information so that you can make an informed choice as to whether this medication is the right choice for you.

Problems with the Pill

  1. The Pill Depletes Nutrients

One of the biggest problems with the pill is the nutrient deficiencies that result from use. From B vitamins to essential minerals, the pill changes the absorption, utilization and metabolism of a number of different nutrients. These nutrient depletions are the underlying cause of many of the negative side effects of the pill – things like weight gain, moodiness, fatigue and blood clots. You can read all about the nutritional problems with the pill in this article.

  1. Weight gain

The estrogen in birth control pills can cause an increased appetite and fluid retention, leading to weight gain, especially in the first few months on the pill. Long term weight gain on the pill is more likely due to the decreased levels of B vitamins, necessary for carbohydrate and fat metabolism (i.e. burning fat for energy).

  1. No glory for our guts

The pill is known to alter the balance of healthy bacteria in our guts. Estrogen affects gut permeability (a risk factor for autoimmune disease) and bacteria balance, a condition known as dysbiosis. Healthy bacteria are incredibly important for our overall health – especially our immune, mood and digestive health. The pill has been linked to symptoms of gas, bloating, IBS, and an increased risk of Crohn’s disease in women with a family history of the digestive condition.

The change in healthy bacteria balance, combined with the estrogen in the pill, also makes women more susceptible to vaginal and digestive yeast infections. If you get frequent or recurrent yeast infections, or significant gas or bloating symptoms, consider if your pill may be part of the problem.

  1. Moodiness

Any woman can tell you that hormones can have a significant impact on your mood. The rises and dips in estrogen and progesterone that occur over a woman’s monthly cycle can lead to moods and behaviours that foster relationships, encourage sexual intimacy, and make women weepy, emotional and volatile. While some women on the pill notice very little difference in their mood states, other women find their normal emotional states become heightened in intensity and more difficult to manage. The reasons for this are very individual – some women don’t tolerate the high levels of estrogen and others find the high progesterone problematic. In either case, if the pill makes you moody switching to another pill is unlikely to help.

  1. Blood clots

Possibly the most well known side effect of the pill, the risk of blood clots is highest in women who are obese, are smokers or who have a family history of blood clots. The estrogen in the birth control pill is the most likely culprit, increasing the production of clotting factors and increasing a woman’s risk of blood clots by three-to-four fold. Deficiencies of key nutrients can also contribute to an increased risk of blood clots, most notably vitamin B6, vitamin E and magnesium – all of which are depleted by the pill.

  1. Thin endometrial lining

The endometrial (or uterine) lining is necessary for a successful implantation and pregnancy. In women wanting to have a family, long term use of oral birth control pills could thin the endometrial lining, leading to difficulty conceiving or maintaining a pregnancy. The underlying cause of this change is thought to be a down-regulation of estrogen receptors in the uterus, resulting from long term use of synthetic progesterone. The upside to this situation, is that this same mechanism is thought to be the reason why the pill reduces the risk of endometrial cancer.

  1. No sex drive

Never mind a thin endometrial lining if you can’t get up the urge to have sex at all. Many women report a low libido as a major issue they have with taking the pill. The pill lowers androgens and the lowered testosterone is likely responsible for the lack of sex drive. Around ovulation women typically experience a small, but significant, testosterone surge, causing them to seek out sex. On the pill you don’t experience this testosterone surge and your urge for sex can all but dry up. On a positive note – this decrease in testosterone is the reason why the pill can improve acne. But there are other ways to clear acne than giving up your lusty libido.

  1. Ignoring Mr. Right

Some of the most intriguing research on the pill surrounds a woman’s decision making around possible partners. Women who are on the pill tend to be attracted to more masculine, macho men with more ‘manly’ physical characteristics, and ignore men with softer, more ‘feminine’ features. Dr. Julie Holland, in her book Moody Bitches, refers to this as the “dad-or-cad” dilemma – women on the pill are more likely to be attracted to the bad-boy, rather than the more sensitive man who may be more acceptable as a long term partner and father to her children. Dr. Holland suggests it might be a good idea to get off the pill if you’re entering the dating pool, to prevent later regrets!

As if that wasn’t enough, another study found that women on the pill tend to seek out men with more genetic similarities to themselves, increasing their risk of miscarriage and genetic issues in their offspring. Women off the pill tend to choose men that are more genetically dissimilar – a pairing that tends to result in healthy pregnancies, happier relationships, more satisfying sex, and an increased likelihood of female orgasm.

  1. Masks symptoms

One of my biggest concerns with the pill is that it is used by conventional doctors as a band-aid for every female reproductive issue. Got PCOS? Take the pill! Got endometriosis? Take the pill! Got fibroids? Take the pill! PMS or menstrual cramps? Take the pill! Perimenopausal? You get the pill too! In no way does the pill address the underlying issues of these women’s health issues. The pill just provides a steady state of synthetic hormones, suppressing and masking the symptoms of the underlying imbalance. When you get off the pill you are no better than when you started – but you are older. And if you want to try and start a family you still have to address the underlying imbalance. The use of the pill as a way to suppress and deny the imbalances in women’s hormones is a disservice to women and I deplore it.

  1. The pill is a carcinogen

Ok. I get it, this sounds scary. But it’s true. The International Agency for Research on Cancer includes oral birth control pills as a carcinogen on its list of known human carcinogens. Studies have shown that birth control pills can increase the risk of breast cancer, cervical cancer and liver cancer. It can reduce your risk of ovarian and endometrial cancers, however. In general I’d suggest using the pill for as short a duration as possible and consider other forms of contraception for the majority of your reproductive years.

We have to keep in mind that the pill is not without problems. It contains synthetic hormones at levels much higher than our body produces on its own. Some of the side effects like acne, breast tenderness, or moodiness might be manageable, but I think women need to be empowered with knowledge to decide if the pill is the right choice for them.

If you have concerns about using the pill, want to balance your hormones naturally, or discuss natural forms of non-hormonal contraception, book an appointment now. Your hormones are in your hands – strive for hormone harmony!

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.

 

Acupuncture for IVF and IUI Cycles

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

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

A brief understanding of IVF and IUI

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

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

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

How acupuncture benefits IVF and IUI cycles

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

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

  1. Improved ovarian response

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

  1. Improved hormone balance

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

  1. Improved egg (follicle) quality and quantity

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

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

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

  1. Optimal endometrial thickness

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

  1. Decrease rates of miscarriage

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

  1. Reduce stress

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

Acupuncture treatments for IUI and IVF

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

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

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

References

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

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

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

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

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

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

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

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

Disclaimer

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

 

 

 

Understanding Spotting Between Periods

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

What is Spotting

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

Causes of Spotting

  1. Ovulation

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

  1. Birth control pill

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

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

  1. Polycystic ovarian syndrome

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

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

  1. Local infections

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

  1. Uterine or Cervical Polyps

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

  1. Perimenopause

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

  1. Thyroid hormone imbalances

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

  1. Pregnancy

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

  1. Uncommon causes

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

Testing for Spotting

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

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

Menstrual spotting checklist

Disclaimer

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

Hormone Testing

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

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

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

Hormone Testing

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

            Timing of Testing

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

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

Testing Sample Type

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

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

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

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

            Balance Over Absolute Values

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

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

Disclaimer

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

Diagnosing PCOS

Diagnosing PCOS

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

The Rotterdam Criteria

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

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

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

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

Clinical Evaluation

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

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

 Laboratory Testing

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Moving Beyond Diagnosis

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

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

Disclaimer

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

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Natural Treatments for Thin Endometrial Lining

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

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

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

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

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

Red Raspberry Leaf Tea

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

Black Cohosh

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

Red Clover

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

Bioidentical Estrogen

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

Iron

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

Exercise

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

red tulipsVitamin E and L-Arginine

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

Acupuncture

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

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

Disclaimer

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

Select references:

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

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

Low Testosterone in Men: Supportive Supplements

Many otherwise healthy men are suffering with low testosterone levels.  Testosterone is an important hormone for male sexual health, but also mood, energy, muscle strength, bone density and many many other functions in the body.

Testosterone levels decline with age, and men of this generation are producing up to one-quarter less than their grandfathers.

Symptoms of low testosterone are variable but may include:

  • Low libido
  • Erectile dysfunction
  • Depression and low mood
  • Brain fog and reduced mental functioning
  • Osteoporosis
  • Reduced muscle mass
  • Infertility and low sperm count

Low testosterone levels can be identified on blood or salivary panels. If you think you may have low testosterone, ask your doctor for a test.

You can learn about lifestyle approaches to improving low testosterone levels here, or read on to learn how specific nutritional and botanical supplements can increase your testosterone and get you back to feeling vibrantly healthy.

Nutritional Supplements

Zinc

The most important nutrient for male health, even a slight deficiency in zinc can lead to lower testosterone levels and decrease sperm counts. It is estimated that 80% of men are not getting the daily recommended intake of zinc (11mg). Good food sources are nuts, pumpkin seeds and whole grains. Take supplements only under the care of a qualified naturopathic doctor – taking too much zinc can be toxic to sperm and result in infertility. Taking zinc with folic acid has also been shown to be more effective at balancing hormones and sperm production than either alone.

Astaxanthin

This carotenoid molecule (less well-known than it’s cousin beta carotene), is isolated from algae.  Astaxanthin has been found to increase testosterone levels and sperm health after three months of supplementation. It has stellar antioxidant properties and is safe for most men.

Botanical Supplements

Mucuna pruriens

A traditional Ayurvedic herb, mucuna is able to balance the entire cascade of male hormone balance from the production of GnRH in the hypothalamus all the way to testosterone production in the testes. Human and animal studies have shown increases in sperm count and increased testosterone. It also has been found to decrease reports of stress and decreased stress hormone (cortisol) production.

Tongkat Ali

Eurycoma longifolia Jack, or Tongkat Ali, is a traditional Malaysian botanical medicine. We don’t know exactly how it works, but studies have demonstrated increases in hormones, including testosterone as well as increased libido and sperm count.

Withania somnifera

Ashwaganda, an excellent adaptogenic botanical, has been found in studies to improve sperm counts, hormone balance and testosterone levels. This botanical is best indicated for men with stress in addition to low testosterone levels.

Tribulus terrestris

A botanical with a long history of use for improving male virility, muscle strength and sexual potency. Tribulus is thought to enhance production of lutenizing hormone, leading to an increase in testosterone production. Studies have found daily supplementation can improve hormone parameters after as little as one month.

As with all supplements, supervision by an experienced and qualified Naturopathic Doctor is recommended to ensure safe and effective use.  Natural remedies may be natural, but they are not without side effects and potential interactions.  Your ND will help you find your ideal 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.

 

Low Testosterone in Men: A Lifestyle Approach

Testosterone is the dominant reproductive hormone in men and it has a lot of different actions in the male body. Not only is it responsible for libido and sexual health, it is also involved in prostate health, hair growth, mood, muscle strength, bone density and many many other actions.

We know that testosterone levels in the current generation are much lower than they were 100 years ago. Studies suggest that the peak testosterone production in men today is up to 25% lower than it was in our grandfathers.

Testosterone production also declines with age. There is a 50% reduction in testosterone production between 25 and 75 years of age.

Symptoms of low testosterone are variable but may include:

  • Loss of libido
  • Erectile dysfunction
  • Depression
  • Reduced cognitive function/ foggy thinking
  • Osteoporosis
  • Reduced muscle mass
  • Low sperm count/ infertility

Low testosterone levels can be identified on blood or salivary panels. If you think you may have low testosterone, ask your doctor for a test.

There are many lifestyle, dietary and naturopathic treatments for low testosterone. Discuss with your Naturopathic Doctor what treatments may be best for you.

Lifestyle Interventions

Avoid alcohol

Alcohol increases estrogen levels and can lead to low testosterone balance in men. If your testosterone levels are low, reduce or avoid alcohol to support hormone balance.

Avoid marijuana

Marijuana use can lower lutenizing hormone, decrease testosterone and lower sperm counts. We don’t know how much is needed to have these effects, so best to avoid it altogether.

Quit smoking

Cigarette smoking is one of the most damaging habits for sperm health and it also decreases testosterone levels. Talk to your ND if you need help quitting smoking.

Avoid plastics and endocrine disrupting chemicals

BPA Free bottlePlastics and other chemicals (household cleaners, pesticides, herbicides, etc) are known endocrine disrupting chemicals – they disturb our body’s hormone balance. Plastics and household cleaners are the most common EDCs in our environment. So switch to glass and all natural cleaners to prevent hormone imbalance.

Achieve an optimal body mass

Being overweight results in increased estrogen production from fat tissues and decreases circulating testosterone levels. Being underweight can also be problematic for hormone balance. Focus on a healthy exercise and diet to achieve your ideal body mass.

Get enough sleep

Peak testosterone production coincides with the onset of rapid eye movement (REM) sleep in younger and older men. Not getting enough sleep (less than 6 hours per night) can lead to lower testosterone levels. So get your 8 hours every night.

Exercise regularly

In general, testosterone levels are elevated directly following heavy resistance exercise. The greatest elevations in testosterone occur when you work large muscle groups, with moderate to high intensity, with short rest intervals. Consider working with a trainer if you are inexperienced in this form of exercise to prevent injury.

Manage stress

High stress hormone (cortisol) production leads to a greater increase in the conversion of testosterone to estrogen in fat cells (a process known as aromatization). Focus on active relaxation and stress management, and talk to your ND if your stress levels are high or out of hand.

A healthy lifestyle is one important factor in improving low testosterone levels in men.  Nutritional support, botanical medicines and acupuncture can also be helpful.  For more information check out this article by Dr. Lisa Watson, ND – Low Testosterone Levels in Men: Supplement Support.

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 PCOS Diet

A nutritious diet is the cornerstone of health – a foundation on which we can build healthy choices and behaviours. In no condition is this more true than polycystic ovarian syndrome. Choosing the right foods for PCOS and avoiding others can be enough for many women to balance their hormones and decrease symptoms of PCOS. And there are no harmful side effects – just the benefits of a healthy diet and vibrantly healthy lifestyle.

The PCOS Diet – What to Avoid

  1. Refined grains

Breads, bagels, muffins, crackers, pasta – all the many forms of refined grains that are common in the western diet, should be avoided in women with PCOS. These high glycemic-index foods quickly raise blood sugar levels and can lead to insulin resistance – a condition where your cells no longer respond to insulin. This is thought to be one of the underlying hormonal imbalances in PCOS.

  1. Refined sugars

Fighting Sugar AddictionSugars found in cookies, cakes, candies, sodas and sweetened beverages can wreak havoc on your hormones in a similar way to refined grains. Best to leave these foods out of your diet entirely and instead opt for naturally sweet fruits to nourish your sweet tooth.

  1. Alcohol

Alcohol is one of the most hormonally devastating things we can put in our body. Not only is it made of mostly sugar (and in PCOS we know what sugar can do to our insulin response!) it also prevents the liver from being able to effectively process and eliminate excess hormones. Women with PCOS also have an increased risk of non-alcoholic fatty liver disease. Limit alcohol consumption to red wine, have no more than one serving per day and don’t have it every day.

  1. Red meat

Red meats are high in saturated fats and contribute to inflammation. Saturated fats can also lead to increased estrogen levels. I recommend limiting red meat to lean cuts of grass-fed, hormone free meat and consuming it no more often than 1-2 times per week.

  1. Dairy

Dairy is a significant source of inflammation, unhealthy saturated fats and should be avoided by women with PCOS. Additionally, dairy increases the production of insulin-like growth factor (IGF) which is known to negatively impact ovulation in PCOS. Rather than reducing dairy, you should consider avoiding it all together to help manage your PCOS.

The PCOS Diet – What to Enjoy

  1. Vegetables and fruits

Eat food

The foundation of the PCOS diet is a plant-based diet. Vegetables, fruits, beans and legumes, nuts and seeds are provide the body with essential nutrients and fiber. Soluble fiber such as that found in apples, carrots, cabbage, whole grains such as oatmeal, and beans and legumes, can lower insulin production and support hormone balance in PCOS.

  1. Proteins

Healthy proteins are an absolute necessity for women with PCOS. While dairy and red meat are not recommended, plant based proteins like nuts, seeds, beans, lentils and legumes are encouraged. Other healthy proteins like turkey, chicken breast, eggs and fish should also be emphasized. For most women with PCOS, a daily intake of 60-80g of protein per day is recommended.

  1. Wild salmon

An excellent source of protein, wild salmon is also rich in omega-3 fatty acids. Omega 3s improve insulin response and blood sugar metabolism and studies have shown lower circulating testosterone levels in women who supplement with omega 3s. Choose wild caught salmon and other cold water fish two to three times per week and incorporate other healthy sources of omega 3s such as walnuts and flax seeds into your diet.

  1. Cinnamon

CinnamonSpices are an amazing way to increase antioxidants in your diet, and cinnamon is especially useful for women with PCOS because it can help to regulate blood sugar. Sprinkle it on apples, oats or quinoa in the morning, add it to teas and use it in flavourful stews or curries.

  1. Pumpkin seeds

    These zinc-rich seeds help to lower testosterone levels and are an easy, high protein snack to enjoy every day!

  2. Green tea

Studies have shown that green tea extract helps to improve the response of cells to insulin, as well as lower insulin levels. Consider drinking a few cups of green tea daily – or better yet, have some matcha to get a big nutritional benefit!

  1. Spearmint tea

Spearmint tea for PCOSAs little as two cups of spearmint tea per day for a month can lower testosterone levels and improve symptoms of abnormal hair growth (hirsutism) in women with PCOS. A must for all women with polycystic ovarian syndrome!

  1. Broccoli

Cabbage, cauliflower, bok choy, broccoli, kohl rabi, kale – these brassica vegetables are a source of indole-3-carbinole, a compound thought to support the detoxification and breakdown of hormones in the liver.

  1. Walnuts

Researchers have found that consuming 1/3 cup of walnuts per day for six weeks can reduce testosterone levels, improve insulin sensitivity, and improve fatty acid status in the body. Combine these with your pumpkin seeds for a satisfying afternoon snack!

  1. Leafy greens

Spinach, kale, arugula and all the amazing variety of leafy greens are good sources of vitamin B6 – a nutrient necessary for balancing prolactin levels – a hormone that is often elevated in PCOS. Greens are also high in calcium, a mineral necessary for healthy ovulation. One more great reason to get those greens!

I hope you will embrace the PCOS diet – you really can heal your body through food medicine. If you need more support or guidance, contact me to book a free 15 minute consultation and together we can find your vibrant 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.

Select References

Kaur, Sat Dharam. The complete natural medicine guide to women’s health. Toronto. Robert Rose Inc. 2005.

Hudson, Tori. Women’s encyclopedia of natural medicine. Los Angeles. Keats publishing. 2007.