Happy World Contraception Day everybody!

Progesterone vs. Progestin

Side Effects of Hormonal Contraceptives

• Depression and anxiety. Some women, especially those aged 15-34 years can experience depression, mood swings or anxiety as a result of the OCP. This still needs more research, however one of the larger studies in this area (1 million women over 13 years) showed that 23% of adolescent women who started the OCP and had not experienced depression before, needed an antidepressant after starting the OCP.
• Blood clots. This is a risk that is so great that for those women who smoke or are overweight, they really should not use the OCP. For women without these factors, their risk of clotting still increases fivefold, and can be greater depending on the type of contraception that they use.
• Metabolic syndrome. Depending on the type of pill you are taking, the OCP can negatively affect cholesterol levels and raise triglycerides. It can also raise blood glucose and reduce insulin sensitivity, potentially leading to insulin resistance. For women choosing to take the OCP as a way to control Poly-cystic Ovarian Syndrome (PCOS), this can unfortunately worsen the condition as Insulin Resistance is a contributing factor.
• Low libido. This side effect also needs further research, and while I have seen this very common in clinic there is not that many papers which support it. One of the mechanisms is potentially the drop of natural hormones responsible for a healthy libido such as oestrogen and testosterone, but I also suspect that the nutritional deficiencies that can occur as a result of the OCP, such as zinc, magnesium and B vitamins can also play a role. While not necessarily harmful to ones health, it can cause some issues in a relationship and also goes against the concept of greater sexual freedom that should come with the OCP.
• Candida/Thrush and other infections of the reproductive and urinary system. Many women experience thrush whilst on the OCP, especially in the initial period of use. The risk of candida infection is actually higher for IUD use rather than OCP, and is also affected by other factors such as hygiene and antibiotic use.
• Post Pill Amenorrhoea. The standard length of time for a woman’s period to return after stopping the OCP is 3 months, however for some women they may return to normal straight away (yay!) or it can take much, much longer. This can be a real bother when the woman is stopping the OCP to try to fall pregnant. It may be that the pill was masking hormonal problems such as PCOS (a condition that is often made worse by the OCP) or that the woman was put on the OCP at such a young age that her hormones never had a chance to regulate themselves. Or potentially the hormonal production and messenging has been disrupted by the OCP, and the normal time to recover this is longer for some women.

So what are some safer alternatives?

• Pen and paper or app supported Fertility awareness method. Apps I recommended include Kindara and Read Your Body, but the purpose of these apps is for record keeping rather than analysis. For true accuracy you must input your cervical mucous, and this is not something that an algorythm in an app can read. Learn from an instructor for approximately 3 months before using this as a method. This is my recommendation of choice.
• Daysy is a fertility monitoring device that learns your cycle and uses this information to report back to you when you are fertile or not, based on your morning temperature.  Simply insert the tip of Daysy under your tongue each morning and allow it to take your temperature, input menstruation on the days that you have it. You can tell from either an App or the device itself whether you are in your fertile period or not, or if Daysy is still learning your cycle. Its accuracy is reported at 99.3% however as I mentioned above you cannot rely on an algorhythm to predict fertility and the analysis of cervical mucous must be included for accuracy and reliability.  Daysy retails at $499. I no longer recommend this device.
• Natural Cycles in an app which requires you to take your temperature and input the data into the app, and this then calculates the information and tells you whether you are fertile or not. The app is available on a monthly or yearly subscription. In the past I have recommended this app, however with further learning I have realised that temperature alone is not effective at predicting ovulation, and so this poses many concerns with those using it for contraceptive purposes. I no longer recommend this app.
• Condoms and diaphragms. Not everyones favourite but they are side effect free (except when allergic to the substance they are made from, however latex free condoms do exist). They are known to break, and there are many instances where they have been forgotten to be used in the first place.
• IUDs. Not free from side effects, but the side effects are less than other hormonal contraceptives. the copper IUD has no hormonal activity, is effective and not subject to user error. It can potentially worsen period pain for some women, and like all implants has a slight risk associated with the implatation and removal. The Mirena IUD has hormonal activity but seems to be less likely to produce the other risks and side effects than other implants, injections and the OCP.
• Vasectomy and tubal ligation. Effective and long lasting, mostly side effect free, not subject to user error,  and with a pearl index of 0.02 for male sterilisation and 0.13 for female sterilisation, this is something that can be considered once a couple has decided they are ready.

The post Knowing your contraception options appeared first on Alison Mitchell Naturopath.

WHAT IS ANDROPAUSE?

It is both scientifically documented and socially accepted that when a woman reaches her mid 40’s to 50’s, she will experience “change of life” or menopause. But did you know that a similar “change of life” can also affect men?

This phenomenon goes by many names: testosterone deficiency syndrome, male menopause, andropause or Partial Androgen Deficiency in Ageing Men (PADAM). This condition affects every male beginning from roughly the age of 40 to varying degrees, however it is a condition that very few people know about.

Colloquially, men experience a midlife crisis and may eventually develop ‘grumpy old man’ syndrome. These somewhat derogative notions are well entrenched in our un¬derstanding of male behaviour. Now at last, we have a medical condition to make sense of it all.

Androgens (Testosterone) peak at 20 and are relatively stable until 30-40, and then they slowly begin to decline. Unlike menopause which leads to a sudden withdrawal of progesterone and a steep decline in oestrogen, testosterone tapers off more gradually but its affects are profound.

Andropause, like Menopause is a normal part of aging although some men who experience this often experience negative symptoms. A common experience is a feeling that they are losing their sense of self.

Men who experience Andropause often feel they have no-one to talk to about this condition. There is a huge lack of awareness of this condition, and more awareness and open discussion about this can help men to realise they haven’t just become a ‘grumpy old man’, that they are not alone, and that something can be done about it.

SYMPTOMS

While women are aware of the approach of menopause because of the cessation of their periods, there is no clear-cut signal for the arrival of Andropause. The condition develops gradually, often resulting in a lack of awareness and diagnosis.

Andropause is responsible for a variety of symptoms such as:

• decreased muscle mass and strength
• decreased bone mass
• decreased libido and virility
• erectile dysfunction
• lower energy
• depressive mood
• anxiety
• insomnia
• difficulty in concentrating, and memory impairment
• hot flushes 1

While not all men experience the symptoms of andropause (just as not all women have difficulty with menopause) if you experience any of the above symptoms it is worthwhile to get your testosterone levels checked to see if your hormone changes are severe (keep reading for more information about testing). If your levels are too low, not only could you experience some of the above symptoms, which are uncomfortable, but decreased testosterone levels are associated with increased risks of osteoporosis, metabolic syndrome/insulin resistance, type 2 diabetes and increased mortality. 2

Keeping this in mind, it makes sense that in order to protect yourself from diabetes, osteoporosis and heart disease as you get older, it is important to keep your testosterone levels healthy.

WHAT ABOUT THE PROSTATE?

One thing you need to know is that testosterone does not cause prostate disease – it is a poorly metabolised form of testosterone called Dihydrotestosterone (DHT) that does! If testosterone caused prostate disease and made you lose your hair, don’t you think that every 20 year old male would be bald? All hormones (including the female hormones) go through several pathways in the body to get to their end form, and it is when problems occur in these pathways (such as if a particular enzyme is missing) that hormones can wreak havoc.

According to the author of a 2009 study that analysed the connection between treating low testosterone and cancer risk: “To date, as documented in many reviews on the subject, nothing has been found to support the evidence that restoring testosterone levels within normal range increase the incidence of prostate cancer. In our experience, during a long-term clinical study including 200 hypogonadal patients receiving a patch of testosterone, 50 patients ended 5 years of treatment and no prostate cancer have been reported.” 3

TESTOSTERONE AND CHOLESTEROL

Testosterone is a steroid hormone, and this is derived in the body from cholesterol. There are several steps involved in making hormones in the body which require certain vitamins and minerals at each stage. However it all starts with the ‘mother hormone’, cholesterol.

We actually need cholesterol to make hormones and in some cases the body will increase its production of cholesterol in response to low hormone levels. It certainly makes you think… Is cholesterol rising because of hormone deficiencies? Does lowering cholesterol with medications result in a drop in our ability to make hormones?

There is much that can be said about cholesterol and the best way to manage it, and this goes beyond the scope of this article. If you or your man has problems with cholesterol, consider that andropause might be contributing to it. Similarly if you or your man is taking cholesterol lowering medication over a long period of time, watch out for changes in hormone levels. As this can be a much more complicated issue, always discuss concerns and treatment with your health care practitioner.

TESTING FOR ANDROPAUSE

When testing for Andropause, the right test needs to be done. If ‘total testosterone’ only is checked, the results will invariably come back indicating that your testosterone levels are fine. This is because Andropause causes more of a man’s testosterone to be bound to Sex Hormone Binding Globulin (SHBG) which is not available for use in the body.

Only ‘free testosterone’ which is not bound to SHBG is available for use in the body, therefore ‘free testosterone’ is the only effective marker of Andropause. When screened for ‘free bioavailable testosterone’ a man with these symptoms will typically show a testosterone deficiency.

In the past the test for ‘free testosterone’ was not very accurate and the results were too variable. Today, there are excellent screening techniques which can be done with either blood or saliva. Saliva tests are non-invasive and are able to measure ‘free’ hormones (those not bound up by proteins in the blood). If you think that you or your man may have andropause, talk to your healthcare practitioner about getting tested.

TREATMENT

The first step is diagnosis which can be obtained with blood or saliva testing from your healthcare practitioner (see Saliva Testing under ‘Testing’ on http://www.naturopathnsw.com.au for more information).

The next step is treatment.

Naturopathic management of Andropause depends on the individual and the symptoms that they are experiencing, but core treatment focuses on supporting hormone balance and healthy conversion of testosterone pathways (making sure it doesn’t turn into the evil DHT).

Every pathway and process in the body consists of a biochemical reaction or equation. With that particular reaction nutrients are required at each and every single step of the way. A naturopath can use various nutrients and prescribe them to rectify and normalise those particular pathways. Vitamins and minerals, when used correctly and in the right form have the ability to support hormone levels and encourage them to convert correctly through their pathways.

There are some excellent herbs that when used in the right dose and way can support testosterone levels and allow men to regain their ‘sense of self’ (and also help bring their loved one a little sanity too). One of the main herbs used in this condition is Tribulus terrestris. It is very important to ensure good quality and that correct species is used with this herb, so ensure you are getting it from a herbalist who sources good quality medicines.

Naturopaths also aim to support general wellbeing and supporting the person as a whole. In the case of people with Andropause this may also include supporting mood, stress levels, cardiovascular function, healthy circulation, good liver and digestive health and lowering inflammation. When you see a Naturopath they will support you individually.

If you or your man may be struggling with andropause, seek help from your healthcare practitioner today.

Contact me to book a personal consultation

Works Cited

[1] M. Amore, F. Scarlatti, A. L. Quarta and P. Tagariello, “Partial androgen deficiency, depression and testosterone treatment in aging men,” Aging Clin Exp Res., pp. 21(1):1-8, 2009.
[2] B. B. Yeap, “Testosterone and ill-health in aging men.,” Nat Clin Pract Endocrinol Metab, pp. 5(2):133-21, 2009.
[3] J. P. Raynaud, “Testosterone deficiency syndrome: treatment and cancer risk.,” J Steroid Biochem Mol Biol, pp. 144(1-2):96-105, 2009.

The post Andropause – Grumpy Old Man Syndrome appeared first on Alison Mitchell Naturopath.

This article follows on from the previous article, which discussed the thyroid gland and the differences between and over and underactive thyroid. In this article I am talking about how an issue with the thyroid can cause imbalances in the rest of the endocrine system, in particular the endocrine system.

Thyroid Health

 The endocrine system

Endocrine is the term used for the complex system of glands and their secretions (hormones).  The endocrine system includes the glands (pituitary, thyroid, para-thyroid, adrenal and pineal) as well as organs and tissues which are able to produce hormones (fat tissue, the hypothalamus, ovaries, testes, pancreas, thymus, kidneys, stomach, liver, small intestine, skin, heart and placenta).  There is a cross-over between different systems such as in the digestive system which includes organs also classed as endocrine.

 In the previous newsletter I gave you an overview of the thyroid and the differences between hyperthyroidism and hypothyroidism.  In this newsletter I want to give you some information about the ways in which the thyroid can affect the endocrine system over all.

 The endocrine system is all connected and an imbalance in one particular organ or gland can disrupt everything else.  One of the biggest ways that we can see this is looking at the impact of stress.  Have you noticed that when you’re stressed you’re more likely to catch a cold (remember the thymus is an endocrine organ and has a big role in our immunity), break out (the skin is responsive to hormones, pumping out more oil to feed the bacteria that causes acne) and your digestive system can get upset too(the stomach, pancreas and liver are all endocrine organs)!

Thyroid health and the reproductive system.

The thyroid gland is another big player in keeping our endocrine system balanced.  One of the most common things that an unhappy thyroid will affect is the reproductive system.

In both men and women hypothyroidism can affect libido. In men, they may experience infertility and mpotence.  In women they may experienced an irregular menstrual cycle or irregular bleed.  Fertility is also greatly affected by the thyroid gland especially in women with autoimmune thyroid disease.  It may result in not being able to conceive altogether or an increase in miscarriages.  In women of fertile age, autoimmune thyroid disease is the most common cause of hypothyroidism.

How?

• A reduction in thyroid function will leave to elevated TSH, and depressed secretion of dopamine, leading to elevated prolactin levels.
• Elevated prolactin levels, also known as hyperprolactinaemia is implicated in 1-3% of women with problems ovulating.
• Hypothyroidism interferes with an important hormone for the development of the egg and ovulation – gonadotrophin-releasing hormone (GnRH).
• Hypothyroidism can lead to a delay in luteinising hormone (LH) which causes ovulation and stimulates the secretion of progesterone.  Because of this is can cause a reduction in progesterone synthesis.
• Thyroid antibodies which can be present in both hyperthyroidism and hypothyroidism can affect fertility due to it’s impact on implantation and increasing the risk of miscarriage.  In some people antibodies
  can be present without having any signs of thyroid dysfunction.  Thyroid antibodies can be managed with herbs that modulate the immune system.

Thyroid dysfunction affects the hormones needed for healthy egg development and ovulation, which affects fertility and creates an imbalance in other reproductive hormones.

If you are having difficulty conceiving it is important to assess thyroid function and screen for the presence of antibodies to rule out any complicating involvement from this gland.

If you believe that you have a thyroid problem, don’t despair.  We can assess for and manage a thyroid imbalance using safe, effective natural remedies.

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