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Understanding Spotting Between Periods

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

What is Spotting

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

Causes of Spotting

  1. Ovulation

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

  1. Birth control pill

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

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

  1. Polycystic ovarian syndrome

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

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

  1. Local infections

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

  1. Uterine or Cervical Polyps

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

  1. Perimenopause

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

  1. Thyroid hormone imbalances

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

  1. Pregnancy

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

  1. Uncommon causes

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

Testing for Spotting

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

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

Menstrual spotting checklist

Disclaimer

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

Hormone Testing

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

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

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

Hormone Testing

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

            Timing of Testing

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

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

Testing Sample Type

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

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

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

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

            Balance Over Absolute Values

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

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

Disclaimer

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

Natural Treatment Options for PUPPPS

 

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

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

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

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

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

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

6 Natural Treatment Options for PUPPPS

  1. Increase vegetable consumption and vegetable juice consumption

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

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

  1. High quality omega 3 rich oils

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

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

  1. Moisturize the skin with a soothing moisturizer

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

  1. Dandelion Root (Taraxacum officinalis)

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

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

  1. Milk thistle (Silybum marianum)

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

  1. Avoid food sensitivities

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

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

Disclaimer

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

Naturopathic Acupuncture

As a Naturopathic Doctor, I have received extensive training in Traditional Chinese Medicine (TCM) and acupuncture. TCM is a system of medicine that has been used to prevent, diagnose and treat disease for over 5000 years. It is based on the Eastern philosophy of “Qi” (life energy). Traditional Chinese Medicine seeks to balance the flow of Qi in the body in order to maintain health, treat illness and relieve pain.

Acupuncture is the use of very fine, sterile acupuncture needles inserted into specific points (acupoints) in the body to manipulate and control the flow of Qi. Acupuncture has been proven to be beneficial in the treatment of many conditions including joint pain, chronic back pain, digestive difficulties, menstrual irregularities, depression, insomnia, migraine and many others.

In my practice I use TCM and acupuncture for a variety of conditions, most notably fertility enhancement, IUI and IVF cycle support, female and male hormone balancing, menstrual irregularities, endometriosis, labour induction, menopause symptoms (hot flashes, night sweats), anxiety, depression, insomnia, headaches and digestive complaints (diarrhea, constipation, heartburn). Acupuncture is safe and effective for all adults, including pregnant women. Acupuncture provided by Dr. Lisa is covered by most extended insurance plans under Naturopathic Medicine.

Celiac Disease in Pregnancy

Celiac disease

Celiac disease is more than a gluten intolerance. It is an immune reaction that is triggered by exposure to gluten (a protein found in wheat, rye and other grains) that results in inflammation and damage to the digestive tract. The small intestines, the part of the digestive tract that is damaged by gluten in celiac disease, is also the location of most nutrient absorption. This inflammatory damage can lead to significant nutrient deficiencies and health problems outside the digestive tract.

More than 330 000 Canadians are thought to have celiac disease (rates have doubled in the past 25 years), but only one-third of those people have been diagnosed. Women have higher rates of celiac disease, although we’re not entirely sure why. Celiac disease does not always manifest clear symptoms (gas, bloating, diarrhea) so it can go for years without a diagnosis.

Celiac Disease During Pregnancy

Bread slicedWomen with undiagnosed or untreated celiac disease can experience negative outcomes in pregnancy – longer time to conceive, increased rates of neural tube defects, increased rates of miscarriage, more fetal growth restriction and increased low birth weight babies. Additionally, women with undiagnosed or untreated celiac disease have been found to have a shorter duration of breastfeeding (about 2.5 times shorter) than treated women with celiac disease.

The poor absorption of folic acid in celiac disease may be the primary cause of the majority of these outcomes. Folic acid is necessary for DNA replication and the production of new cells – two very important functions in early embryo development. We know that folic acid deficiency can lead to an increased risk of neural tube defects and has been linked with an increased risk of miscarriage. Additionally, deficiencies in zinc and selenium are common in untreated celiac disease. These nutrients are also necessary to ensure healthy pregnancy.  You can read more about the nutrient deficiencies in celiac disease in my article Nutrient Deficiencies in Celiac Disease.

There may also be an immune component to the impact of untreated celiac disease on pregnancy. It has been postulated that anti-transglutaminase antibodies may be able to damage the placenta or the maternal endometrial cells. These antibodies are only present during active, untreated celiac disease.

Testing for Celiac Disease in Pregnancy

Some researchers suggest that all women with unexplained miscarriages be tested for celiac disease. Some suggest that all women who are trying to conceive be tested. Still others recommend testing only if hemoglobin or ferritin (iron) levels are low. Testing is done with an initial blood test which can then be followed with a biopsy of the lining of the small intestine to confirm the diagnosis. Your Naturopathic Doctor or Medical Doctor can help you decide whether testing is warranted.

Managing Celiac Disease During Pregnancy

The negative outcomes of celiac disease on pregnancy can all be managed by consuming a gluten free diet and taking appropriate supplementation to ensure nutrient adequacy. In the majority of women, 6 to 12 months of a gluten free diet can reduce the risk of negative pregnancy outcomes down to normal levels. Using a professional quality prenatal or folic acid supplement can also help to improve pregnancy outcomes in women with celiac disease – discuss with your Naturopathic Doctor which gluten-free supplements will be most appropriate for you.

Select References

  1. Moleskia SM, Lindenmeyer CC, Veloskic JJ, Millera RS, Millera CL, Kastenberga D, DiMarinoa AJ. Increased rates of pregnancy complications in women with celiac disease. Ann Gastroenterol 2015;28:236-40.
  2. Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, et al. Celiac disease and reproductive disorders: meta-analysis of epidemiological associations and potential pathogenic mechanisms. Hum Reprod Update 2014;20(4):582-593
  3. Martinelli P, Troncone R, Paparo F, Torre P, Trapanese E, Fasano C, et al. Coeliac disease and unfavourable outcome of pregnancy. Gut 2000;46(3):332-5.
  4. Dickey W, Stewart F, Nelson J, McBreen G, McMillan SA, Porter KG. Screening for coeliac disease as a possible maternal risk factor for neural tube defect. Clin Genet 1996;49(2):107-8.
  5. Rostami K, Steegers EA, Wong WY, Braat DD, Steegers-Theunissen RP. Celiac disease and reproductive disorders: a neglected association. Eur J Obstet Gynecol Reprod Biol 2001;96(2):146-9.

Disclaimer

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

Natural Labour Induction

As every pregnant woman approaches the last weeks of pregnancy they can’t help but start thinking of ways to bring on labour and get the chance to meet their baby sooner.

A pregnancy is considered full term at 37 weeks and the techniques discussed in this article should not be started until after this point.  Some women choose to wait until 40 weeks, or their due date to begin trying to naturally induce labour.

Below are suggestions for natural labour induction methods that can be attempted at home and also those that should only be administered by a qualified Naturopathic Doctor.

Techniques for Natural Labour Induction at Home

1.     Sexual intercourse

One of the simplest methods of inducing labour (if you’re up for it!)  The prostaglandins in semen can help with the dilating and effacing (thinning) of the cervix.  If you are able to achieve orgasm this can further open the cervix.  Additionally, sex can trigger the release of oxytocin, the ‘contraction’ hormone.  Sex, even this late in pregnancy, is perfectly safe for both the mother and baby.

2.     Nipple stimulation

Stimulating the nipples (manually or with a breast pump) can lead to increased frequency and strength of contractions.  Stimulating the nipples causes the release of oxytocin, the same hormone that is responsible for uterine contraction.  This technique is best done if you are already experiencing infrequent contractions, labour has stalled or you are several days past your due date.  There are several methods that are suggested:

i.   firm pressure of nipple with fingers for 2 minutes, rest for 3 minutes.  Repeat for 20 minutes.

ii.  15 minutes of firm nipple (including the areola) stimulation (alternating breasts midway through) each hour for several hours in a row.

3.     Exercise

Sometimes the best technique for inducing labour is encouraging the baby to assume the best position for labour and delivery.  Exercise, such as walking, swimming, belly dancing, or some yoga movements can help descend a baby into the pelvis and apply the necessary pressure on the cervix for dilation to occur.

4.     Pineapple

Fresh pineapple is a rich source of bromelain, an enzyme that some people think can encourage ripening of the cervix and bring on labour.  Eat fresh pineapple daily, juicing and canning pineapple destroys the bromelain.  Caution: large amounts of pineapple can contribute to heart burn or diarrhea in some people.

5.     Castor Oil

One of the oldest methods of bringing on labour, it is one that I don’t personally recommend unless you are past your due date.  Castor oil works by irritating the digestive tract and having purgative (vomiting) and laxative (diarrhea) effects.  This over-stimulation of the digestive tract also results in stimulation of the uterus and can be effective in bringing on labour.  However, many women would prefer not to be experiencing diarrhea or vomiting in their early labour.  If you choose to use castor oil start with smaller amounts (1-2 tablespoons) and mix with a nut butter (such as almond butter) to provide  some fat and protein to lessen the negative effects of the castor oil.

6.     Evening Primrose Oil

Evening primrose oil is a rich source of prostaglandins and can support the thinning and dilation of the cervix.  Gel caps are easily available in health food stores.  Insert 3 capsules as close to the cervix as possible each night at bedtime (wear a pad to bed in case there is a slight discharge.)

Techniques for Labour Induction Provided by a Naturopathic Doctor

7.     Red raspberry leaf tea

A botanical that is well known for it’s uterine tonifying properties.  It promotes stronger contractions of the uterus and is often used throughout the entire third trimester to ‘work out’ the uterus and get it ready for labour and delivery.  It is unlikely to induce labour on its own, but when used in combination with other methods it can speed up the progression of labour and promote strong, healthy contractions.

8.     Botanicals – blue cohosh and black cohosh

Blue cohosh (Caulophyllum thalictroides) and black cohosh (Cimicifuga racemosa) are uterine tonifying herbs.  They are known to cause contraction of the uterus and are thus contraindicated for use in early pregnancy.   They may be used in certain circumstances to stimulate labour and promote strong and regular contractions.  These herbs should never be taken without proper medical supervision from a qualified Naturopathic Doctor, midwife or obstetrician.

9.     Homeopathic Remedies

Homeopathic remedies are small doses of more potent substances and, as a result, are very safe for use during pregnancy, labour and delivery.  They are considered much safer than botanical remedies – no published studies exist showing any harm to the mother or fetus after use of homeopathics in pregnancy and labour.

The most common homeopathic remedies used to induce labour are pulsatilla, caulophyllum and cimicifuga.  Homeopathic remedies are taken by mouth at regular intervals to induce labour.  Dosages vary – contact your Naturopathic Doctor for an individualized plan.

10. Acupuncture

Acupuncture has been used for centuries to treat conditions associated with pregnancy (such as heart burn, nausea, and carpal tunnel syndrome) as well as for inducing labour.  Acupuncture to stimulate labour can be begun after 37 weeks gestation and is administered from once per week to once per day, depending on the desired outcome.  When performed after the due date, acupuncture has been shown in studies to have a success rate of up to 88% in starting labour.

Specific points are used to stimulate and strengthen uterine contractions, promote proper fetus positioning and encourage the downward movement of Qi (energy) which can bring on labour.

All published studies have shown acupuncture to be safe for both mother and fetus when applied by a qualified practitioner.  Be sure to find someone who is experienced in perinatal acupuncture protocols and techniques.

Your Naturopathic Doctor can also teach you proper acupressure techniques for you, or your birth partner, to administer to induce labour or manage pain during labour and delivery.

Remember, although most of these methods are safe and can be effective in encouraging labour in full-term pregnancies, it is important to make sure your primary health care provider (e.g. midwife or obstetrician) has given you the go-ahead for trying to induce labour.  There are some instances where waiting is the best approach for both mother and baby.

Also be sure any practitioners (Naturopathic Doctors, homeopaths, herbalists, acupuncturists, etc.) are fully qualified and knowledgable in pregnancy and labour.  Not all practitioners have the same level of experience – ask questions and only work with practitioners you have confidence in.

Disclaimer

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

Endometriosis and the Immune System

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

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

Immune Surveillance

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

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

Lacking a Killer Instinct

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

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

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

More Macrophages!

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

Increasing Inflammation

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

Auto-Immunity

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

Beyond Immune Function

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

References

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

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

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

Disclaimer

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

 

Endometriosis and Infertility

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

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

Endometriosis and the Fallopian Tubes

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

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

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

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

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

Endometriosis, Ovaries and Ovulation

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

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

Endometriosis and the Uterus

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

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

Endometriosis and the Immune System

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

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

Moving Beyond Understandingempowerment

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

References

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

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

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

Disclaimer

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

 

Pain Medications in Pregnancy and Fertility

A large class of pain relief medications has been found to negatively impact fertility in as little as 10 days of use.

NSAIDs and Fertility

There has been evidence for over a decade that chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin,  ibuprofen (Motrin, Advil), naproxen (Aleve), celecoxib (Celebrex), diclofenac and others can reduce fertility by disrupting ovulation. More recent research has shown that even short term use of NSAIDs can inhibit ovulation with effects seen after just ten days of use.

NSAIDs interfere with ovulation by disrupting production of prostaglandins necessary for follicle development and ovulation. This disruption leads to a condition called luteinized unruptured follicle (LUF) syndrome. This condition results in women experiencing all the typical clinical signs of ovulation but does not result in the rupture of follicle and release of an egg at ovulation.

A 2015 study found that women taking naproxen (Aleve) for 10 days decreased the rate of ovulation by 75% and in women taking diclofenac, ovulation decreased by a startling 93%. In these women progesterone levels dropped also, likely as a result of the lack of ovulation.

Luckily the fertility-reducing effects of NSAIDs are temporary, with ovulation occurring normally in the next cycle for all the women in this study.

NSAIDs and Miscarriage

A further caution for women attempting to conceive: A 2011 study from the University of Montreal found that the risk of miscarriage is 2.4 times higher for women who took any type and any dose of NSAIDs in early pregnancy. Non-aspirin NSAIDs has also been shown to increase the risk of major congenital defects.

Safe Pain Relievers in Pregnancy and Fertility

Acetaminophen (Tylenol) is the only recommended pain reliever in pregnancy. It is recommended for intermittent and short-term use only.  Speak to your Naturopathic Doctor about natural pain relief in pregnancy as natural anti-inflammatories such as fish oil are not only safe in pregnancy, but can also benefit both mother and the developing fetus.

References

European League Against Rheumatism. “Non-steroidal anti-inflammatory drugs inhibit ovulation after just 10 days.” ScienceDaily. ScienceDaily, 11 June 2015. <www.sciencedaily.com/releases/2015/06/150611082124.htm>.

Nakhai-Pour HR, Broy P, Sheehy O, and Bérard A. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ, September 6, 2011

Mendonca LLF, Khamashta MA, Nelson-Piercy C, Hunt BJ and Hughes GRV. Non-steroidal anti-inflammatory drugs as a possible cause for reversible infertility. Rheumatology;2000, 39(8):880-882.

Stone S, Khamasta MA, Nelson-Piercy C. Nonsteroidal anti-inflammatory drugs and reversible female infertility: is there a link? Drug Safety;2002;25(8):545-51.

Gaytan M, Morales C, Bellido C, Sanchez-Criado JE, Gaytan F. Non-steroidal anti-inflammatory drugs (NSAIDs) and ovulation: lessons from morphology. Histology Histopathology;2006;21(5):541-56.

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.

Preparing for Pregnancy: Detoxification

Working as a Naturopathic Doctor with a focus on pregnancy and fertility gives me a unique opportunity to influence the health of the future generation while simultaneously optimizing the health of the women and men in my practice. This is an opportunity I like to seize – a chance to make the next generation as vibrantly healthy as they can be!

Pre-Pregnancy Detoxifying

I am not a fan of the detox fad. I feel like it implies that our bodies are dirty or incapable of maintaining health – the very opposite of what I believe. But as with so many fads, there is an essential nugget of truth at the center of it – we are living in a world that is overwhelming our bodies with chemicals – in the air we breath, food we eat, clothes we wear, soaps we use to ‘clean’ our bodies. And our bodies can accumulate these chemicals, and they can cause changes in our hormones, in our cells and in our organ function.

The time prior to pregnancy is a wonderful time to detoxify your life. Not just your body, but your environment, thoughts and behaviours as well. A time to prepare for a fresh new beginning – the beginning of a life and a family.

Detoxifying Your Environment

A landmark study done by the Environmental Working Group found 287 chemicals in the umbilical cord blood of babies born in the United States – chemicals that are known to be toxic to the brain and nervous system, lead to developmental abnormalities and cancer.

This study highlights the importance of making changes now – of reducing our exposure to chemicals to decrease our future child’s exposure.

Here are three easy ways you can detoxify your environment prior to pregnancy

  1. household cleanerUse only natural cleaning products – the Environmental Protection Agency has found that in many homes the level of pollutants are three-to-five times higher than they are outside.Minimize your indoor chemical burden by using only all natural cleansing products and avoid these big offenders: upholstery shampoo, furniture polish, all-purpose sprays, bug sprays, bathroom cleansers, room deodorizers, fabric softeners.
  1. Avoid plastic wrap and plastic storage containers. Almost all plastics contain chemicals that have been shown to disrupt hormone balance and can impact fertility and potentially increase the risk of miscarriage.
  1. Change your personal care products, cosmetics and sunscreens. All of these products can contain a plethora of chemicals all with potential negative health effects. The Environmental Working Group maintains amazing databases of these products that can help you to make healthy choices for your self, and your environment. Be sure to check out their Cosmetics Database and their annual Sunscreen Guide.

Detoxifying Your Body

The two best ways we can detoxify our body is 1) decrease our exposure to chemicals and 2) support our body in eliminating them.

My top four suggestions for detoxifying your body are:

  1. Water Eat organic produce. Hundreds of pesticides and herbicides are sprayed on conventional produce at various stages of their growth and production. Nearly two-thirds of produce contains pesticide residues – an alarming number with unknown consequences on long term health. The simplest way to decrease exposure and minimize risk is by selecting organic produce. Following the Clean 15 and Dirty Dozen recommendations from the Environmental Working Group is great place to start for understanding which produce you should always purchase organic, and which have lower potential for pesticide residue.
  1. Drink an abundance of clean water. Water is the way that our bodies move nutrients into cells – and toxins out. Drinking fresh, clean water throughout the day can greatly enhance your detoxification – and can improve energy and concentration as well.
  2. Exercise regularly. Exercise supports the lymphatic system – one of the most important systems in detoxifying the body. In order for our lymphatic system to work, we need to move our muscles, forcing movement of lymph back towards our heart. Daily movement practice should be part of any detoxification plan, and any healthy lifestyle.
  3. Do a personalized cleansing program once or twice a year. A personalized cleansing program developed by a Naturopathic Doctor can help identify specific detoxification goals for your body and help you to achieve them. Individualized programs are especially important prior to pregnancy – enhancing detoxification while maintaining optimal nutrient status will support your body now, and your baby’s in the future.

Detoxifying Your Thoughts and Behaviours

No detoxification is complete without as assessment of your thoughts and behaviours. Each of us has thoughts, attitudes and behaviours that impact our health – both positively and negatively. Time spent in personal introspection or working with a counselor can help us to identify patterns of thoughts or behaviours that we would like to modify. The time prior to pregnancy is an ideal time to explore our own feelings on parenthood, our relationship with our parents, and ourselves. It is a great time to let go of thoughts and behaviours that are not contributing to an abundant state of health – to detoxify our thoughts and behaviours and prepare ourselves for our future as parents.

 

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.