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Endometriosis Staging

Many women in my practice have never heard of endometriosis before they are diagnosed with it.  And often that diagnosis took years to get.  Endometriosis is a notoriously difficult condition to diagnose – it can’t always be seen on an ultrasound and diagnosis often requires an MRI or a surgical procedure (a laparoscopy) to identify the endometriosis and provide information on staging.

The symptoms of endometriosis are often ignored as well, both by women and their health care providers.  Many women have to see 3 or more doctors before they receive an appropriate diagnosis – and delaying diagnosis can make this already difficult condition even more difficult to treat.

Endometriosis Staging

Once a diagnosis of endometriosis is made many women are given a staging level for their endo.  The American Society for Reproductive Medicine classification is based on a point system looking at the following characteristics:

  1. Location and size of the endometriosis – on the peritoneum and ovary – and whether it is superficial or deep
  2. Obstruction (obliteration) of the cul de sac – partial or complete
  3. Adhesions on the ovary and fallopian tubes – filmy or dense and their overall size

Based on the points given for these findings, a stage is given. 

            Stage I – Minimal endometriosis (less than 5 points)

            Stage II – Mild endometriosis (6-15 points)

            Stage III – Moderate endometriosis (16-40 points)

            Stage IV – Severe endometriosis (>40 points)

*Follow the link for the exact point calculations. 

Concerns with Staging Endometriosis

While staging of endometriosis can be useful for women and their health care providers to understand the overall appearance of the endometriosis, the staging system has some flaws.

The staging system only describes what the endo looks like – it doesn’t help a woman (or her health care team) predict pain levels, response to medications, risk for associated conditions, or quality of life.  Women with Stage IV may have minimally painful periods, while women with Stage I may suffer incredibly each month. 

Ultimately, I don’t treat women based on staging of their endometriosis.  I treat women based on their symptoms and their desired outcomes.  A woman who wants to get pregnant will be treated differently than a woman who wants to reduce pain – every woman in my practice is treated individually to help her achieve her optimal state of health while living with endo. 

For more information on endometriosis, check out the other articles in my endometriosis series, including Understanding Endometriosis, Endometriosis in Adolescence, Endometriosis and Infertility, The Endometriosis Diet and Endometriosis and Naturopathic Medicine.

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 Most Important Test for Preventing Miscarriage

Pregnancy is one of the most significant women’s health topics – we spend our teens and early 20’s avoiding pregnancy, and many of us spend our 30’s and early 40’s trying to get pregnant.  And once a woman is pregnant, we want to ensure a healthy pregnancy with the outcome of a happy, healthy baby.

Lack of Lab Testing

In Ontario, where I run my women’s health practice, the standard of care is for women to receive only very basic testing when they discover they are pregnant.  Women are screened for sexually transmitted illnesses (chlamydia, gonorrhea, syphilis), public health testing (rubella), blood type and Rh factor.  But few women are screened for one of the most common, and preventable, causes of miscarriage – one that can be easily identified and often has no symptoms. 

Comprehensive Testing

The one test I insist all women in my practice have at the first sign of pregnancy is a comprehensive thyroid panel.  The thyroid gland, sitting in your throat near your voice box, is one of the most important hormone producing gland in your body.  Thyroid hormones are essential for metabolism – creating energy in our cells to meet the demands of our body.  In pregnancy we need to be able to make a lot of energy – making a whole new human is hard work! 

In pregnancy our requirements for thyroid hormones increase – and if our body isn’t able to meet that demand, the result can be early pregnancy loss (miscarriage).  We can identify women who may be at risk for this by running a simple TSH (thyroid stimulating hormone) test and treating women who fall outside the normal range with thyroid replacement hormones during pregnancy. 

But TSH isn’t the only important thyroid test for a pregnant woman.  Testing thyroid antibodies, especially anti TPO antibody is also essential for preventing miscarriage.  Thyroid autoimmune disease is the most common autoimmune disease in women who are in their childbearing years – impacting up to 15% of women.  Many of these women have no symptoms of thyroid disease and their TSH levels are totally normal.

Having TPO antibodies however, is a major risk factor for miscarriage.  There is a strong association with TPO antibodies and miscarriage, preterm delivery, and other negative outcomes in pregnancy (such as low birth weight and smaller head circumference). 

Getting Tested

Despite all the evidence, known to doctors since the 1990s, comprehensive thyroid testing still isn’t available as a screening test for most women in early pregnancy. But that shouldn’t stop you from seeking it out. Available from your Naturopathic Doctor for under a hundred dollars, this test could make all the difference in your pregnancy. And since this cause of miscarriage is completely treatable, I encourage you to have the test done as soon as possible after you discover you are pregnant. Miscarriage is all too common already, I don’t want any more women to have miscarriages that could be prevented.

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.


Hormones and Hair Loss

One of my favourite/ least favourite stories to tell is how I became a Naturopathic Doctor.  I was in my late teens, finishing my last year of high school, when I began losing my hair.  What was happening to my thick full hair?? It was falling out more and more, but my doctors assured me I “still had lots of hair”, as if that was what mattered.  I was not taken seriously – whether because I was a teen girl, or because my doctors didn’t see how much hair I was losing every day, it didn’t matter.  My hair loss was destroying my self confidence and I was convinced it meant something was wrong.

A Familiar Story

Of course, it did mean something was wrong.  For myself, it was a combination of low iron (which I talk about as a root cause of hair loss) and significant stress.  And this loss of trust in the conventional medical community led me to change my plans from becoming a Medical Doctor to becoming a Naturopathic Doctor.

I’d like to think my story is unique.  But I’ve come to see that it is not.  Many women (and teen girls) come to my practice with similar stories.  Being dismissed and told that their hair loss is not a significant symptom.  Being told that it is normal.  Or having little to no testing done to identify the underlying cause of hair loss. 

I may not be able to help all of the millions of women who experience hair loss, but I hope by sharing my story, and some of my expertise, that I may be able to impact some. 

Hormones and Hair Loss

Hair loss can happen to a woman at any age, and while it may be more common as we get older, that doesn’t mean that it is a normal occurrence at any age.  Keep in mind – common is not the same as normal!  In this article I’m going to focus on the hormonal causes of hair loss, some of the most common causes I see in my practice.  In order to properly diagnose your hair loss, be sure to use the Hair Loss Lab Testing Checklist and get to the root cause. 

Thyroid Imbalances

Your thyroid is a small but mighty gland located in your neck, near your voice box.  The primary role of the thyroid is to encourage energy production by the body.  When the thyroid isn’t functioning optimally, there can be consequences throughout the body, including the hair.  Hair loss can occur with too little thyroid hormone (hypothyroidism) or too much (hyperthyroidism).  A condition known as alopecia areata is also linked to autoimmune thyroid disease, or Hashimoto’s thyroiditis

Conventional testing for thyroid function is not always adequate to identify an underlying thyroid condition.  If you suspect your thyroid may be contributing to your hair loss, get a comprehensive thyroid panel completed with your Naturopathic Doctor, functional medicine doctor or MD.  This test will look beyond TSH and test for free T3, free T4 and thyroid antibodies. 

Testosterone Overload

One of the most common causes of hair loss in women and men, high levels of testosterone can lead to hair loss, especially at the frontal hairline and the top of the head.  While typically thought of as a man’s hormone, women produce testosterone as well.  The real issue isn’t testosterone specifically, but a metabolite of testosterone called dihydrotestosterone, or DHT.  This form of testosterone is much more powerful than regular testosterone and binds strongly to hair follicles on the scalp, face, back and chest – leading to hair loss on the scalp, and acne on the face, back and chest. 

Many women can have lab testing for testosterone that looks normal, but DHT levels may still be high.  It is important to have both these hormones tested, especially if you have other signs of high androgens such as acne or irregular periods, or have been diagnosed with PCOS

Low Progesterone

Progesterone is a damn important hormone.  The natural balancer to both estrogen and testosterone, many hormonal imbalances are a result of low progesterone.  Progesterone is able to block testosterone from accessing receptors, preventing it from leading to hair loss.  Progesterone is also the reason women’s hair grows so thick and healthy during pregnancy! 

The three times in a woman’s life when low progesterone are most common are:

  1. If she is using the birth control pill.  On the pill you do not ovulate, and do not produce progesterone (the synthetic progestins in the pill are not the same thing)
  2. If she has PCOS and does not ovulate
  3. As she ages.  Progesterone production drops through your 30s and many women in their 40s are not making enough to balance their estrogen and testosterone levels.  Women in menopause make hardly any progesterone at all. 

Stress is another common cause of progesterone deficiency, as the body will steal all the available progesterone to make cortisol, our body’s main stress hormone. 

Insulin and Blood Sugar Imbalances

No hormone acts on the body in isolation.  They all influence each other.  Insulin, the hormone produced to encourage our cells to take up sugar and regulate the levels of sugar in our blood, can have an impact on hair loss when it is imbalanced.

When your diet is too high in refined or processed carbohydrates, your cells can become resistant to insulin, causing higher circulating levels of blood sugar.  When this occurs your ovaries can become resistant as well, an imbalance which disrupts healthy ovulation and causes your ovaries to produce more testosterone and DHT. 

Stress and Cortisol

You may pull your hair out when you are stressed, or stress may cause it to fall out.  Stress can cause increased or decreased cortisol levels, both of which can contribute to hair loss.  Excessive stress can also cause your hair to enter its telogen, or hair fall phase, prematurely.  This will often result in hair loss 2-3 months after the stressful event. 

High cortisol will also deplete progesterone and allow for more testosterone to bind to hair follicles, which can further exacerbate hair loss.  If you have significant stress, consider what changes need to be made to help lessen your stress, and explore whether cortisol testing may help to reverse and resolve your hair loss.

Stopping Hair Loss

Understanding the hormonal causes of hair loss for women is just the first step.  To get to the root cause of your hair loss comprehensive testing is almost always necessary.  The problem is that many doctors don’t take hair loss seriously (I know from my personal experience!).  You may need to pay out of pocket to get the level of testing that you need, but in the end, that knowledge can help you put an end to your hair loss and allow you to regain not only your hair, but balance your hormones and give you your quality of life back.

Selected References

Ohnemus U, Uenalan M, Inzunza J, Gustafsson JA, Paus R. The hair follicle as an estrogen target and source. Endoc Rev. 206;27(6):677-706. https://www.ncbi.nlm.nih.gov/pubmed/16877675

Ohnemus U, Uenalan M, Inzunza J, Gustafsson JA, Paus R. The hair follicle as an estrogen target and source. Endoc Rev. 206;27(6):677-706. https://www.ncbi.nlm.nih.gov/pubmed/16877675

Randall VA. Androgens and hair growth. Dermatol Ther. 2008;21(5):314-28. https://www.ncbi.nlm.nih.gov/pubmed/18844710

Randall VA. Hormonal regulation of hair follicles exhibits a biological paradox. Semin Cell Dev Biol. 2007;18(2):274-85. https://www.ncbi.nlm.nih.gov/pubmed/17379547

Levy LL, Emer JJ. Female pattern alopecia: current perspectives. Int J Womens Health. 2013;5:541-556. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769411/

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. 

Banishing Breast Tenderness

A woman’s relationship with her breasts can be… complicated.  I should know. I had comic book heroine sized breasts up until a breast reduction after weaning my youngest child.  At that time breast tenderness was just a part of my day-to-day life.  That experience has given me a lot of compassion for women who experience breast pain.  This article is what I am giving back – hope for those women who suffer with pain, and a plan to overcome it.  Take back your ta-tas. 

Breast Tenderness Types

There are typically two types of breast pain – cyclical and noncyclical.  Cyclical breast pain is associated with your period, most often starting a few days (to weeks) before your period and stopping during or just after your period ends. 

Noncyclical pain doesn’t happen just around your period but can happen at any time.  It can be caused by pregnancy, breastfeeding, trauma or injury to the breast, pain from the muscles around the breast, or simply from having large breasts.  It can also be caused by medications, including birth control pills, antibiotics, and antidepressants. 

Most of this article will talk about how to overcome cyclical pain, but women with noncyclical pain can benefit from following these recommendations as well.

Is it Breast Cancer??

No.  It mostly likely is not breast cancer.  Breast pain is not typically linked to breast cancer, and having breast pain does not put you at higher risk of developing breast cancer. 

But don’t hesitate to see your doctor for a second opinion and a breast exam.  Especially if you have symptoms like heat in a specific area of your breast, a fixed/ non-moving breast lump, or changes to your skin on your breast. 

Why Do My Breasts Hurt?

The most common cause of breast pain is your hormones.  Specifically a condition known as estrogen dominance.  Estrogen is the hormone that causes breast tissue to develop in puberty, and throughout our adult lives our breasts continue to respond to estrogen stimulation.  During the week before your period estrogen and progesterone levels can become imbalanced, leading to breast pain.  This is worsened by an overburden of estrogen in our bodies, which we’ll discuss in a moment.  

Breast pain can also be more common in women who have fibrocystic breasts.  As women age her breast tissue is replaced by fat (a process known as involution).  This leads to the formation of breast cysts and fibrous tissue – and a more lumpy breast texture.  Fibrocystic breasts don’t always cause pain, but they can.  Especially as these lumps get bigger leading up to your period. 

Banishing Breast Pain: An Empowered Woman’s Guide

Experiencing breast pain is not a normal part of a woman’s life.  If you have tender breasts, try to understand why your body has developed this symptom – is it a hormonal imbalance? Are you stressed? Are you tired? Are you taking time for self-care? Is your diet and exercise up to your standards?  Once you’ve taken stock of your life, put the recommendations below into action for 2-3 months and see how much of an impact you can have on your health – you’ll be amazed at how powerful you are. 

1.Eliminate Estrogen Dominance

I’ve talked extensively about estrogen dominance elsewhere but it really is an incredibly common concern for women.  Estrogen is an important hormone for women’s health, but our levels are far higher than our systems can manage.  Increased estrogen production in our bodies from excess body fat, stress and poor diets, combined with estrogen-like chemicals in the environment (known as xenoestrogens), and terrible detoxification and elimination from alcohol consumption, low fiber diets and insufficient vegetable intake has left women living a veritable estrogen soup.   

The consequences of estrogen dominance are huge.  PMS, mood changes, low libido, sugar cravings, brain fog, crazy periods, and breast tenderness are common.  So what should we do about it?

Eliminating estrogen dominance is a huge issue in women’s health.  But luckily there are some action steps you can take now to address this hormone imbalance, and reduce your breast pain.

  • Reduce stress
  • Eat a high fiber diet – consider having 2 tbsp of ground flax seeds per day in addition to lots of healthy leafy green and rainbow vegetables
  • Eliminate excess body fat – a lot of women don’t realize that fat cells can make estrogen, so if you’re more than 15 lbs overweight, consider talking to your Naturopathic Doctor about how to achieve your healthiest body weight
  • Avoid plastics, pesticides and other sources of environmental estrogens.  Drink water and eat out of non-plastic containers.  And never microwave plastic!
  • Limit intake of dairy products

2. Detox Like a Champ

Reducing how much estrogen your body makes/ intakes is an excellent first step in banishing breast pain.  Now we move to the next step – supporting your liver in detoxifying that estrogen!  Your liver needs to take all the estrogen circulating in your body and convert it into a compound that you can eliminate (we’ll cover that in the next step!)  For effective detoxification we need to make sure we have adequate nutrients, especially the B vitamins and trace minerals.  We also want to ensure we’re not overwhelming our liver with excess alcohol intake, pain medications or other pharmaceutical medications.  One of the best things you can do to support your liver is not drink alcohol.  Risky alcohol consumption for women is anything more than one drink per day. 

To support your liver, be sure to eat lots of leafy green vegetables.  Bitter greens like kale, dandelion greens, endive or chicory are especially helpful for the liver.  You can also consider liver supportive supplements like dandelion root, turmeric, artichoke, greater celandine and milk thistle to up your detox game.

3. Master Your BMs

You can be a super-star detoxifier, but if you aren’t having daily bowel movements you are not going to be able to balance your hormones are reduce your breast pain.  Our excess hormones are eliminated in our poop – if you aren’t having healthy daily poops you are going to end up recycling a lot of that estrogen and having to detoxify it all over again.

Best bets for mastering your BMs are a high fiber diet, a regular intake of healthy probiotic bacteria – either through supplements or fermented foods, and potentially a magnesium supplement.  Magnesium citrate or bisglycinate can help to get you regular while you focus on improving your diet.  Studies suggest between 200-600mg of magnesium can help by drawing more water into your stool and promoting regular BMs.

4. Target Your Diet

Inflammation can be a major contributing factor to pain in our bodies, and our breasts are no exception.  By reducing inflammation in our diet we can significantly improve breast pain.

The ideal diet for breast pain is pretty much what you’d expect.  Eat more vegetables, lots of healthy plant based proteins, fish, leafy greens and healthy fats.  Limit or eliminate sugar, alcohol and dairy.  Coffee, especially at high amounts (more than 1-2 cups per day) can also contribute to inflammation and pain, so check in with yourself and see if you’re overdoing the drip. 

Adding in healthy fats and phytoestrogens will also help with hormone balance.  Flax seeds are a superstar for this – they contain omega 3 fats, healthy fiber and phytoestrogen lignans which bind to estrogen receptors and prevent other stronger estrogens from binding.  Flaxseeds – the overachiever of the seed family. 

5. Support with Supplements

You cannot supplement your way out of a terrible diet.  But there are absolutely some supplements than can help reduce breast pain, especially over the first few months while you are making the lifestyle and diet changes that will help you remain pain-free. 

EPO for breast pain

Vitamin E has been found in studies to reduce cyclic breast pain, especially when combined with evening primrose oil (EPO).  A fat-soluble nutrient, vitamin E reduces inflammation and acts as an antioxidant in our cells.  EPO is often used as a source of pregnenolone, the precursor hormone to progesterone, which is essential to balance the effects of estrogen in the body.  600IU of vitamin E with 2-3 grams of EPO is a typical dose. 

B vitamins are necessary for liver detoxification and can be taken as a simple B complex supplement.  Vegans and vegetarians in particular should be considering a B complex containing vitamin B12.

Iodine is another nutrient essential for breast health and low levels have been associated with the development of lumpy fibrocystic breasts.  Rates of iodine deficiency are incredibly common, and you should discuss with your ND whether or not you should test your levels.  A multivitamin supplement will provide you with some essential iodine, or seaweed snacks are a great food source. 

Chaste tree, or Vitex agnus-castus, is hands-down my favourite botanical supplement for cyclic breast pain.  Also used to reduce painful periods and PMS mood changes, chaste tree can be a game-changer for women with miserable premenstrual symptoms.  Talk to your ND to ensure this is a good choice for you. 

Taking Back Your Ta-Tas

My philosophy of women’s health is “No More Meh”.  You don’t have to accept symptoms of breast tenderness, mood changes and low libido.  You don’t have to feel exhausted and overwhelmed.  You are a force of nature.  You are a damn goddess.  Own it. 

If you want to work together, drop me a line via email or Facebook or follow me on Instagram. I’d love to meet you. 

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

Pruthi S, Wahner-Roedler DL, Torkelson CJ, et al. Vitamin E and evening primrose oil for management of cyclical mastalgia: a randomized pilot study. Altern Med Rev. 2010;15(1):59-67. https://www.ncbi.nlm.nih.gov/pubmed/20359269

Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Ahmadpour P, Javadzadeh Y. Effects of Vitex agnus and flaxseed on cyclic mastalgia: a randomized controlled trial. Complement Ther Med. 2016;24:90-95. https://www.ncbi.nlm.nih.gov/pubmed/26860808

Hormone Harmony during Breastfeeding

Going through my pregnancies with my two sons, and supporting hundreds of women in my practice through their pregnancies and beyond, I am always interested in the information that is given to pregnant women and what that says about what our society deems important.

Women going through pregnancy know a lot – they know what to eat, what to avoid, when their baby develops eyelashes (32 weeks) and what position to sleep in. They know how to track contractions, how often to breastfeed and the best positions for breastfeeding.

What women know very little about is what is happening in their own bodies. What the hormonal changes that occur during pregnancy, breastfeeding and the postnatal stage mean for their own energy, emotions and health.

This article is here to close that gap – to help women understand the hormonal changes that occur during breastfeeding and when that hormone balance is normal, and when to seek support when it is not.

Breastfeeding Hormones

Breastfeeding is associated with production of two specific hormones: prolactin and oxytocin. These two hormones allow for peak production of breastmilk as well as bonding with your new babe. Let’s look at each one in more detail.

Prolactin

Prolactin, or “pro-lactation hormone” is produced during breastfeeding to increase breast milk supply. Levels rise for almost an hour after the baby begins to feed, encouraging the alveoli in the breasts to make milk.

But that is not all prolactin does. In fact, not just breastfeeding parents produce it – all parents produce it. Prolactin is a calming and relaxing hormone that decreases progesterone and testosterone production in both parents. It can cause mothers to feel deep relaxation (and sometimes deep fatigue) during breastfeeding and for some time after.

Interestingly, prolactin is also released during sexual intimacy, counteracting the effects of dopamine (which is associated with sexual arousal) and resulting in a sensation of gratification and calm. With high circulating levels of prolactin during the breastfeeding stage, there is often less sex drive – your body feels like it’s already in the afterglow, and your libido is no where to be seen.

Oxytocin

Mostly commonly referred to as the “love hormone”, oxytocin is released to encourage let down during breastfeeding. Oxytocin increases bonding and is produced in both parents during cuddling and intimate contact – with both the baby and with each other. Oxytocin levels are highest during new relationships, such as with your brand new baby, and while baby is breastfeeding.

Most of the time we respond to oxytocin in positive ways – it feels good to be awash in these bonding hormones. But it isn’t this way for all women. Some women are very sensitive to such high levels of oxytocin and feel more anxious, irritable or overwhelmed while breastfeeding.

Women’s Hormones in Breastfeeding

It is no surprise that women’s hormones fluctuate a lot in the time after pregnancy – after all, those hormones that helped to sustain the pregnancy are now dropping off (quickly!) to pre-pregnancy levels. How a woman feels in the months, and years, after her baby is born has a lot to do with the balance of her hormones.

Estrogen

Estrogen levels can hit menopausal levels for the months after giving birth – and for some women they stay low throughout the time she is breastfeeding. Low estrogen levels can cause mood swings, irritability, hot flashes and night sweats as well as vaginal dryness, tenderness and discomfort during sexual intercourse. Low estrogen can also zap your desire for sexual intimacy (let alone how dry your lady garden is…) Using a water-based lubricant, and engaging in foreplay can help to overcome some of these low estrogen issues, but if the concern persists, talk to your ND about a low dose topical estriol cream.

Low estrogen can also contribute to an increased incidence of yeast infections, especially in women who are prone to them. If this happens, talk to your Naturopathic Doctor about treatments that are safe during breastfeeding.

Progesterone

Progesterone – “pro-gestation hormone” is at sky-high levels during pregnancy and it can feel like a rollercoaster free fall when you return to pre-pregnancy baselines in the weeks after delivery. Prolactin production suppresses ovulation, especially during the first six months after delivery, and with no ovulation progesterone production is incredibly low.

Symptoms of low progesterone can include anxiety, depression, mood swings, low libido, and insomnia. Many clinicians believe that low progesterone is a contributing factor to the development of post-partum depression in some women. There are many available treatments for post-partum depression, if you are concerned that you may have PPD, talk to your Naturopathic Doctor right away.

Testosterone

Produced mainly by the ovaries, but also in the adrenal glands, testosterone levels are also low in breastfeeding women. Testosterone can contribute to sexual desire, as well as sexual response. Low levels can impact mood, focus and libido.

Beyond Hormones

The months after giving birth are a challenging time for everyone. My take home message here is that while lack of sleep, and an exhausting schedule are huge factors in the way women feel during the months and years of breastfeeding, there are also hormonal influences at play that need to be considered.

If you have been feeling off, feeling exhausted, or have mood swings or low moods don’t just attribute it to the busy-ness of having a baby – talk to someone about how you can support your hormones and restore your hormone harmony throughout breastfeeding.

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.

150 Symptoms of PMS

With 3 out of 4 women experiencing some symptoms of premenstrual syndrome, most of us can come up with a pretty good list of symptoms for ourselves. But did you know that 150 symptoms have been identified? That’s a pretty substantial number!

Ranging from mild bloating to severe mood changes and migraines, and everything in between, PMS can seriously impact a woman’s mood, quality of life, and relationships.

And remember, you don’t just have to accept PMS. You can manage it and treat it effectively. But that’s in another article. This one is The 150 Symptoms of PMS.

Digestive Symptoms

  1. Bloating
  2. Weight gain
  3. Constipation
  4. Diarrhea
  5. Nausea
  6. Vomiting
  7. Gas
  8. Cravings for salt
  9. Cravings for sweets
  10. Cravings for alcohol
  11. Increased appetite
  12. Decreased appetite
  13. Increased sensitivity to alcohol
  14. Increased sensitivity to taste/ spices/ flavour
  15. Increased thirst

Physical Symptoms

  1. Fatigue
  2. Water retention and swelling
  3. Increased sweating
  4. Night sweats
  5. Hot flashes
  6. Fatigue
  7. Increased sleep hours/ desire for sleep
  8. Clumsiness
  9. Easy bruising
  10. Increased heart rate
  11. Irregular heart beat
  12. Increased sensitivity to light
  13. Increased sensitivity to sound
  14. Increased sensitivity to touch
  15. Increased sensitivity to chemicals
  16. Seizures

Ear, Nose, Throat and Head

  1. Tinnitus (ringing in the ears)
  2. Dizziness
  3. Lightheadedness
  4. Headaches
  5. Migraines
  6. Cold sore outbreaks
  7. Puffy eyes
  8. Blurred vision
  9. Hordeolum (eye stye)
  10. Dry mouth
  11. Rhinitis (runny nose)
  12. Worsening of allergy symptoms
  13. Increased sensitivity to odours

Respiratory System

  1. Shortness of breath
  2. Worsening of asthma
  3. Sore throat
  4. Sensation of lump in throat
  5. Hoarse voice

Muscles, Bones and Joints

  1. Back pain
  2. Leg pain
  3. Joint pain or worsening arthritis
  4. Muscle weakness
  5. Muscle stiffness

Lady Garden Symptoms

  1. More frequent urination
  2. More frequent yeast infections
  3. More frequent urinary tract infections
  4. More frequent HSV outbreaks
  5. Dry vaginal tract
  6. Painful intercourse

Breast Symptoms

  1. Breast tenderness
  2. Breast swelling
  3. Increase in breast size

Skin Symptoms

  1. Acne
  2. Dry skin
  3. Oily skin
  4. Oily scalp
  5. Increased sweating
  6. Swelling of face or extremities
  7. Worsening of rosacea
  8. Worsening of eczema
  9. Worsening of psoriasis

Mood and Emotional Symptoms

  1. Increased libido
  2. Decreased libido
  3. Poor decision making
  4. Eating disorders
  5. Anger
  6. Aggression
  7. Irritation
  8. Forgetfulness
  9. Indecisiveness
  10. Poor concentration
  11. Brain fog
  12. Inability to think clearly
  13. Poor learning, less able to retain information
  14. Lack of motivation
  15. Increased sensitivity
  16. Avoidance of social interaction
  17. Avoidance of responsibilities
  18. Withdrawn
  19. Confusion
  20. Excitability
  21. Mood swings
  22. Restlessness
  23. Hopelessness
  24. Anxiety
  25. Depression
  26. Loneliness
  27. Guilt
  28. Apathy
  29. Poor self esteem
  30. Reduced confidence
  31. Jealousy
  32. Paranoia
  33. Fearfulness
  34. Tension
  35. Poor coping
  36. Inability to relax
  37. Feeling keyed up or on edge
  38. Sadness
  39. Suicidal thoughts
  40. Frequent outbursts
  41. Sudden outbursts
  42. Feeling overwhelmed
  43. Feeling out of control
  44. Difficulty controlling anger or sadness
  45. Crying
  46. Melancholy
  47. Defensiveness
  48. Stubbornness
  49. Negative outlook
  50. More easily offended
  51. More easily hurt or upset
  52. Lack of coordination
  53. Intentional self harm
  54. Increased addictive behaviours (shopping, drugs, alcohol)
  55. Increased productivity
  56. Decreased productivity
  57. Hypersomnia
  58. Insomnia
  59. Lack of pleasure in life
  60. Worsening of pre-existing mental health concerns
  61. Possible increase in criminal behaviour

Well, try as I might, I could only find 133 symptoms of PMS.  To be considered a PMS symptom, it must have the following characteristics:

  1. Restricted to the luteal phase (second half) of the menstrual cycle
  2. Resolve by the four day of the next cycle (fourth day of the period)
  3. Cause impairment or distress for the woman
  4. Occur in at least two cycles
  5. Not be an exacerbation of another condition

Can you think of any PMS symptoms I may have missed? Were you surprised by any of the symptoms on here? Let me know in the comments below!

 

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

DUTCH: Gold Standard in Hormone Testing

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

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

The DUTCH Test

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

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

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

  1. Simple collection

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

  1. In depth hormone levels

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

  1. Metabolism matters

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

  1. It’s all about those curves

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

  1. Balanced estrogen

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

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

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

  1. Androgens and acne and hair health

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

  1. Melatonin

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

  1. Organic acids

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

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

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

The 1 Reason I don’t love DUTCH Testing

  1. The test results are ugly

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

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

Next Steps

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

Dr. Lisa

Further Reading

https://dutchtest.com

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

 

When it’s NOT PCOS: Non-Classic Congenital Adrenal Hyperplasia

A woman, let’s call her Nicole, enters my office with a concern of acne. Acne in an adult woman is, unfortunately, not uncommon these days. After spending some time talking to Nicole we find that she also has hair loss from her scalp, and hair growth on her chin as well as irregular periods.

If you’re familiar with PCOS you may recognize these as the most common symptoms of PCOS – irregular (or absent periods), acne and hair growth on the face or hair loss from the scalp.

But it wasn’t PCOS for Nicole. It was something else.

Non-Classic Congenital Adrenal Hyperplasia

Non-classic congenital adrenal hyperplasia (NCAH) is a condition that usually develops around the age of puberty and can impact both boys and girls (this article is just about the girls – sorry guys!)

NCAH is an inherited condition where a person does not make enough of a specific enzyme, 21-hydroxylase, that converts the hormone progesterone into cortisol. When this enzyme doesn’t work more progesterone is shifted into testosterone and levels of testosterone and other androgens increase.

Why Does NCAH Look Like PCOS?

Both PCOS and NCAH have symptoms that are the result of high androgens – testosterone, androstenedione, and dihydrotestosterone. However, the source of the high androgens is different.

In PCOS the elevated androgens come from overstimulation of the ovaries by follicle stimulating hormone (FSH), without the corresponding ovulation – leading the ovaries to continue to produce large amounts of testosterone over time.

In NCAH, the testosterone comes from the conversion of progesterone (and 17-OH progesterone) into androstenedione and subsequently testosterone.

In either case, high testosterone in a woman leads to oily skin, acne, facial hair, and scalp hair loss. Not such a pretty picture.

So, is my PCOS actually NCAH??

There are some warning signs that your PCOS may actually be NCAH.

  • Did your puberty start early – before 10 years of age? Or was it significantly delayed – after 15 years of age?
  • Did you have premature development of pubic or underarm hair?
  • Are you shorter than average height for an adult?

All of these findings are more common in NCAH than in PCOS.

But ultimately the diagnosis of NCAH requires a blood test.

17-OH Progesterone Testing

The first test for non-classic congenital adrenal hyperplasia is a 17-OH progesterone test. If your levels of this test are elevated, then you most likely have NCAH. While this test is routinely done in newborns, the non-classic variant can be missed until puberty.

If the 17-OH test is positive then a follow up test, known as the ACTH stimulation test, is done to confirm the diagnosis.

As NCAH is the most common autosomal recessive disorder in humans (you have to have two mutated copies of the gene to get this condition) – impacting around 1 in 100 people, this test is highly recommended if you have PCOS – especially if you don’t seem to fit the typical PCOS picture.

Moving Forward

NCAH, for some women, causes little to no difficulty. Other women have issues with abnormal hair growth/ hair loss or acne that can be difficult to treat. Other women have issues with infertility. It is a variable condition. Talk to your Naturopathic Doctor or Medical Doctor if you think your PCOS may actually be NCAH, and learn about your diagnosis and treatment options.

 

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.

 

PCOS Diet: Infographic

In celebration of PCOS Awareness month this September, I have prepared this infographic on the PCOS diet.  Polycystic ovarian syndrome impacts 1 in 10 women and is the most common cause of anovulatory infertility.

It is also a condition that responds incredibly well to dietary and lifestyle changes.  Take charge of your health, and your hormones and start following the PCOS diet today.

If you need more support on your journey to hormone balance, book a free 15 minute consultation or initial consultation with me.  You can have balanced, healthy hormones!

pcos-diet-infographic_drlisawatsonnd

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.