When we think about polycystic ovary syndrome (PCOS), we often focus on the elevated testosterone levels associated with the condition. But did you know that PCOS also involves imbalances in oestrogen? In fact, women with PCOS often experience prolonged exposure to high levels of oestrogen due to an extended follicular phase. This extended phase can contribute to many of the symptoms associated with PCOS.

Let’s take a closer look at how oestrogen plays a significant role in PCOS, how this prolonged follicular phase leads to oestrogen dominance, and why it’s important to consider hormonal balance beyond just testosterone.

PCOS: It’s More Than Just High Testosterone

Yes, elevated testosterone is a hallmark of PCOS, but it’s not the only hormone at play. In women with PCOS, the menstrual cycle is often disrupted. Specifically, the follicular phase, which is the first half of the cycle where oestrogen rises to prepare for ovulation, can become much longer than normal. When ovulation doesn’t occur regularly or at all, the body experiences a prolonged period of high oestrogen without the counteracting effects of progesterone, which rises after ovulation, released from the corpus luteum.

This extended exposure to oestrogen contributes to many of the symptoms experienced by those with PCOS, but aren’t always easy to be explained by the evelated levels of insulin and testosterone. So keep in mind it’s not just about high testosterone—oestrogen plays a big role, too!

Signs of Excess Oestrogen in PCOS

If you have PCOS, you might be familiar with some of the signs of oestrogen dominance, such as:

• Breast tenderness
• Heavy or prolonged periods
• Bloating or water retention
• Mood swings and irritability
• Weight gain, especially around the hips and thighs

These symptoms are the result of an imbalance between oestrogen and progesterone. When oestrogen is allowed to remain elevated for too long without progesterone to balance it out, you may start to notice these classic signs of oestrogen dominance.

The Phases of the Menstrual Cycle

To understand how oestrogen dominance happens in PCOS, let’s briefly review the phases of a normal menstrual cycle:

1. Menstrual Phase – This is when you get your period, and the uterine lining is shed.
2. Follicular Phase – Oestrogen rises as your body prepares for ovulation. For many women with PCOS, this phase can be prolonged.
3. Ovulation – Ideally, a mature egg is released during ovulation. Oestrogen needs to peak in order to trigger a surge of LH, which then triggers the egg to be released from the follicle. For many women with PCOS, ovulation doesn’t occur regularly, leading to what’s called an anovulatory cycle, or an extended follicular phase.
4. Luteal Phase – After ovulation, the remainder of the follicle from which the egg from release – the corpus luteum – releases progesterone. Progesterone levels rise in the luteal phase, which balances the effects of oestrogen. However, if ovulation doesn’t happen, there’s no significant rise in progesterone, leading to relative oestrogen excess.

In PCOS, it’s common to have anovulatory cycles, meaning ovulation doesn’t occur, and the body doesn’t produce the necessary progesterone to balance out the high oestrogen levels. This leaves many women stuck in an extended follicular phase with prolonged exposure to oestrogen.

How Testosterone Can Convert to Oestrogen

Another important factor to consider in PCOS is how testosterone can be converted into oestrogen. This happens through a process called aromatisation, where testosterone is transformed into oestrogen in the body’s tissues, including fat cells. For women with PCOS, who often have elevated levels of testosterone, this can result in more oestrogen being produced, contributing further to the oestrogen dominance that many experience (Xu et al., 2024).

Increased Sensitivity to Oestrogen in PCOS

Interestingly, not only are oestrogen levels higher for longer in many women with PCOS, but there’s also evidence to suggest that their oestrogen receptors are more sensitive. This means that even if the levels of oestrogen aren’t dramatically high, the body may respond more strongly to it, intensifying the symptoms of oestrogen dominance (Xu et al., 2024). This heightened sensitivity further contributes to the hormonal imbalance that can make PCOS so challenging to manage.

The Impact of Endocrine Disrupting Chemicals (EDCs)

As if managing PCOS wasn’t complex enough, exposure to endocrine-disrupting chemicals (EDCs), such as bisphenol A (BPA), can further complicate the hormonal picture. Research has shown that women with PCOS often have elevated levels of BPA in their plasma, urine, or follicular fluid. BPA can mimic oestrogen and bind to oestrogen receptors, increasing their activity. This leads to more pronounced symptoms of oestrogen dominance and is linked to insulin resistance, polycystic ovarian morphology on ultrasound, and even markers of chronic low-grade inflammation (Srnovršnik et al., 2023).

If you have PCOS and are concerned about environmental factors like EDCs, it’s worth considering ways to reduce your exposure to BPA and other hormone disruptors, as these chemicals may worsen the hormonal imbalances associated with the condition.

Read more about endocrine disrupting chemicals and their impact on hormones and fertility here and here

Low SHBG Levels in PCOS and Its Effect on Oestrogen and Testosterone

Another key factor in PCOS is the role of sex hormone-binding globulin (SHBG). SHBG is a protein that binds to hormones like oestrogen and testosterone, controlling how much of these hormones are “free” and active in the body. Women with PCOS tend to have low SHBG levels, meaning they have more free (unbound) oestrogen and testosterone circulating in the bloodstream. This not only contributes to higher androgen symptoms (like acne and male pattern hair loss) but also increases the effects of oestrogen on the body (Emanuel et al., 2022).

Want to Learn More About PCOS?

If you’re dealing with PCOS and want to dive deeper into understanding how these hormonal imbalances affect your health, I’ve written several other blog posts on this topic. Check them out here:

Busting PCOS Myths

A Holistic Guide to PCOS

If you’d like to know more about hormones and how they affect your health and wellbeing, and how you can support your hormonal wellbeing and cyclical health, I would love you to look into my e-course The Cyclical Woman

Final Thoughts

PCOS is a complex condition that involves more than just high testosterone. The extended follicular phase, lack of progesterone due to anovulation, increased aromatisation of testosterone to oestrogen, and heightened oestrogen receptor sensitivity all contribute to the hormonal imbalances experienced by those with PCOS. By understanding how oestrogen plays into the bigger picture, you can take steps to manage your symptoms more effectively and work towards achieving better hormonal balance.

References

Emanuel, R. H. K., Roberts, J., Docherty, P. D., Lunt, H., Campbell, R. E., & Möller, K. (2022). A review of the hormones involved in the endocrine dysfunctions of polycystic ovary syndrome and their interactions. Frontiers in Endocrinology (Lausanne), 13, Article 1017468. https://doi.org/10.3389/fendo.2022.1017468

Srnovršnik, T., Virant-Klun, I., & Pinter, B. (2023). Polycystic ovary syndrome and endocrine disruptors (bisphenols, parabens, and triclosan) – A systematic review. Life (Basel), 13(1), 138. https://doi.org/10.3390/life13010138

Xu, Y., et al. (2024). Roles of estrogen and its receptors in polycystic ovary syndrome. Frontiers in Cell and Developmental Biology, 12, Article 1395331. https://doi.org/10.3389/fcell.2024.1395331

The post PCOS and Oestrogen: The Hidden Hormonal Imbalance You Need to Know About appeared first on Alison Mitchell Naturopath.

Acne is such a common issue that people ask a naturopath to help with. It can really affect your self esteem, and in some instances can be painful and uncomfortable.

There’s no magic, quick fix for acne whether you see a naturopath or try the conventional medicine route, and sometimes you have to try a few different approaches before finding what works best for you. Typical timelines are often small improvements within two weeks, and more visible results around 3 months. When treating the underlying causes of acne naturopathically, this can sometimes take even longer, however the benefits of treating these underlying causes are often wide reaching.

As with most naturopathic approaches to health issues, it’s about finding out what the underlying cause of the issue is.

In the case of acne, it’s important to consider that skin is connected to other body systems – in particular the nervous system, the endocrine system (that’s hormones) and the digestive system. Imbalances in one or more of these systems will very commonly cause skin problems.

I’ll talk in more detail about these systems later, how to tell whether they’re the issue for you, and what you can do to help them.

Listen to the audio of this article here

It’s been a hot minute since my last episode of Guts and Girl Bits, I have been occupied with my busy home clinic and I have also been writing some e-courses, which I will talk a bit about later. Of course, I have also been spending time with family, would you believe my youngest Lara is now in Kindergarten? How time flies!

It was almost a year ago I started planning this podcast episode but I got rather distracted by everything else. However I’ve had some spare time to sit down and record, and I am hoping to stay on this momentum and release some more podcasts in the next few months. Please get in touch if you enjoy these podcasts, and if you have any questions or requests for future episodes I’d love to hear from you.

Sorting out your skin issues can be sooo frustrating when you’re doing it by yourself – do I need to go on medication? Does my diet make a difference? Are my hormones out of balance? Maybe this skin product will help? No, maybe this one, no, this one, no this one. Maybe I need a skin peel? Maybe I need laser? Maybe I need to go vegan? Maybe paleo? Do I need to detox? AUUUGH!

Rest assured you’re not alone, soo many women (and I do treat men occasionally to) come to me at their wits end with their acne.

Naturopathic approaches to any type of health condition always stem from one of the core naturopathic philosophies: treat the cause.

What the cause of acne is may vary from person to person, and that’s where a naturopaths consultation questions come in handy – delving into the different body systems like gut health, nervous system health and hormones, and sometimes using functional testing to get to the bottom of it. I’m going to try and give you some clues about it later so you can get a bit of an idea for yourself, and I will also discuss some of my favourite treatment options.

Emunctories

When it comes to root cause medicine, the way that the body is able to eliminate waste is an important consideration for any skin concern.

Naturopathic medicine is built around a set of philosophies, and one of these is the theory of emunctories.

The term emunctories is a bit of a funny word, but it refers to an organ or duct that removes or carries waste from the body.

Traditional naturopaths often consider the theory of emunctories when establishing a treatment plan, they may not use the term emunctories (I do, I think it’s a fun word to say, can you tell, I’m saying it a lot) but we always want the body to be eliminating waste efficiently, and to minimise the burden on our elimination systems. If our eliminatory system is unable to handle the load that is placed onto it, this will cause symptoms to express.

The emunctory system exists in tiers. These tiers will prioritise the primary emunctories, and if that system is overloaded it will progress downwards.

Primary emunctories are the main channels of elimination of the body that we want to be carrying the majority of our waste burden.

The primary emunctories are:

• Sweat
• Through the liver and intestines, passing bowel motions
• Through the kidneys and bladder, urination
• Through our breath

We can support our primary emunctories by drinking adequate water, eating lots of fibre and supporting our gut microbiome, breathing exercises, sweating through exercise or saunas.

The secondary emunctories include the skin and the mucous membranes of the urogenital tract, the respiratory tract, the digestive system. If our primary emunctories are overloaded or not working effectively, then toxins can be excreted through the secondary emunctories. This often shows itself as skin conditions, phlegm, diarrhoea (usually this may be a bit more mucousy).

What can commonly occur is that symptoms that express on this level are treated with suppressants, for example cortisone based creams, decongestants or cough suppressants.

If the secondary emunctories are suppressed or unable to cope, symptoms may start to appear in other areas such as in menstruation, emotions, swollen lymphatic glands, fevers and other irritations of mucous membranes.

So if we were to look at treating acne in keeping with this philosophy of emunctories it would look like this:

1. Making sure you’re eliminating properly through your bowels, by working on your diet and using herbal medicines that support this
2. Using herbs that are classed as ‘depuratives’ – these are herbs such as burdock and clivers, and they help to improve the elimination of the primary emunctories
3. Drinking plenty of water to support kidney function
4. Encouraging good lymphatic flow with lymphatic drainage techniques and exercise
5. Making sure you’re getting your sweat on – exercise or saunas

The importance of the gut

So let’s talk a bit about the digestive system how does that affect acne. It’s no secret that the health of your gut will impact on almost every system of the body, so of course it affects skin. There’s a few ways in which it can do this.

Think back to what we talked about with the concept of emunctories and how important that is. An overburdened digestive system will overburden the emunctories, leading to skin congestion and inflammation. Your skin is like a looking glass to your gut health.

Gut health impacts on hormonal health. Oestrogen has to be metabolised through the liver and bowels, and if that’s not eliminating effectively than oestrogen doesn’t get fully eliminated, instead it gets recycled in a more active form, and too much oestrogen will have a proliferative effect on your acne.

Intestinal permeability, or leaky gut, can cause inflammation, often via histamine excess. Histamine and inflammation will often show up as redness and acne. Histamine will also be driven up by oestrogen, which is why acne may be worse at certain times in your cycle.

One of the subtypes of acne which is caused by a fungal overgrowth often goes hand in hand with an altered gut microbiome.

Gut issues are linked to other types of skin condition as well such as eczema psoriasis and rosacea.

Clues that your gut may a problem for your skin health:

• You experience gut symptoms like bloating, altered bowel motions, IBS, gas.
• You experience fungal infections such as thrush or tinea.
• Your acne flares up after eating certain foods
• Your acne is mostly around forehead, mouth and cheeks.

Improving gut health

The main things that we want to be focusing on when improving your gut function is

• making sure that you’re digesting food appropriately with good levels of digestive acids and enzymes
• ensuring that you have the right balance of gut bacteria, and that you are absorbing your nutrients effectively as well
• supporting the lining of the gut health with herbs and nutrients
• avoiding highly inflammatory foods and any foods that you might be intolerant to as these will aggravate inflammation worsening any type of skin condition.

The nervous system

Does stress cause health issues? I’ve heard this concept dismissed a lot, but I am a firm believer that yes, stress can cause physical symptoms, especially things to do with the skin.

When we’re going through high periods of stress we will experience impacts on our inflammation levels due to an increase in our cortisol and histamine levels, and our reproductive hormones can be affected which increases sebum and keratin production, and increased hormone sensitivity in your skin.

Stress will also impact on our gut health, which will contribute towards skin inflammation and increased chance of skin infections.

Signs your nervous system could be a player with your skin health:

• Feeling like you’re constantly on edge
• Oversensitivity to sensory stimulation e.g. noise
• Brain fog, difficulty thinking clearly
• Poor quality sleep
• You’ve been living off coffee and stimulants
• Feeling out of balance emotionally, anxious or depressed
• Fatigue
• Low libido

How to support your nervous system

1. Make sure you’re doing fun things and laughing, as these are great ways to burn off your stress hormones
2. Try to reduce sources of stress, if that’s at all possible – maybe that might be asking for help with something that is putting a burden on your shoulders.
3. Make sure you’re eating enough – low calorie, and nutrient poor diets can be a source of stress to the body. Similarly for those who are in need of nervous system nourishment, focus more on weight training and low intensity exercise rather than high intensity exercise.
4. Get plenty of sleep
5. Practice screen boundaries
6. Practice mindfulness exercises each day
7. Get someone to talk to, perhaps a psychologist or a counsellor.

Stress can have such a big role on our health that I consider it to be one of the most important things to address. I have created an online group Naturopathic program that provides individualised care in a group setting, focusing on the pivotal factors for a healthy nervous system and adrenal gland health. If you are feeling like your nervous system needs some nourishment, I’d love for you to join me in my program Beat Burnout.

Hormone Balance

One of the most well known hormones that cause acne is testosterone. Testosterone and it’s family of hormones, androgens, cause acne by binding to receptors in the skin, increasing oil and keratin production, resulting in oilier skin with a potential for blocked pores. The bacteria (and sometimes fungi) which causes inflammation in our skin loves to feed on this, so extra fuel for the bacteria means the bugs grow, triggering an immune response in the area, resulting in more acne.

If you have a irregular periods, hirsutism (excess hair growth, such as chin hair) or have been diagnosed with PCOS there’s a good chance that high testosterone levels are a driver for your acne.

If your acne tends to get worse around the time that you are ovulating as well as when you are about to get your periods but then gets better when you start your period that’s a sign that the fluctuating levels of oestrogen are playing a role.

We need oestrogen, it can be our best friend but if we’re not metabolising or excreting it properly then it can elevate histamine, causing inflammation. Oestrogen needs to get metabolised and excreted through the gut to be in a good balance, otherwise it can be too proliferative.

Oestrogen and histamine work closely together when oestrogen is at its highest histamine will follow suit and if you have issues with high histamine that can also cause oestrogen to be high as well.

If you are not ovulating regularly or well, you may not have enough progesterone to counter oestrogen, and lack of progesterone doesn’t help skin health either.

Signs you may have hormonal acne

• Your acne worsens around ovulation or premenstrually
• Acne is located on the chin, jawline, back and chest
• Your period is irregular or painful
• You may also experience PMS symptoms
• You have oilier skin than normal
• You have thicker, coarser or more hair than normal for your genetics

How to assess your hormones

There are several ways to get an insight into your hormones

I am a big fan of using the DUTCH test, which is performed using urine sample to measure hormone metabolites. It can give you insight into not just the overall level of your hormones, but also the quality of metabolism of your hormones, whether they are being metabolised down the friendly or the angry pathways.

Blood tests don’t look at metabolites but they are very useful to get insight into your overall hormone balance. It’s vital to test on specific times in your cycle to be able to make use of these results.

Testing at day 2 or 3 of your cycle (the 2^nd or 3^rd day of your bleed) will give a baseline of low levels. Test FSH, LH and Oestradiol at this time.

After you ovulate, your hormones will start to raise, and usually peaks 7 days after ovulation, so at this time you want to do another test, measuring progesterone and oestradiol.

At either of these tests you will want to also measure testosterone profile (SHBG, androstenedione, testosterone, DHEA, free testosterone), prolactin, thyroid profile and fasting insulin.

If you are on the OCP, the female reproductive tests will not be reliable by thyroid function and insulin can be measured.

Does your diet make a difference to acne?

Yes, it does.

Your diet can affect your skin in different ways but one of the big drivers of acne we know is inflammation and then another big driver for acne as well is your hormone balance.

It makes sense that if we’re eating foods that are inflammatory then that’s going to make your gut health and acne worse. Inflammatory foods may be foods that you are intolerant to, or it may be foods which are generally considered to be inflammatory.

Some of the big ones for that is wheat and dairy. I often recommend cutting out dairy as a first step when you try to address acne because it reduces inflammation and so you could swap that for almond milk or oat milk or rice milk whatever your preference is. Lactose free milk isn’t really going to make that much of a difference because a lot of the inflammation comes from the protein. Some people find that A2 milk can be helpful for them but initially I recommend cutting it out altogether to get an insight.

After inflammatory foods, bad guy #2 is sugar. Sugar, in particular refined sugar and highly processed foods are an issue because it can increase the production of a substance called insulin like growth factor 1 (IGF-1). This acts to increase the hormones known as androgens in our body such as testosterone and what these can do is make our skin produce more oil and keratin. Rewind back to the section on hormones if you need a refresher on this.

Insulin is an important hormone but when we’re eating a high GI diet it’s often going to be making acne worse so aiming for a low GI diet is going to make a big difference there. Imbalances in blood sugar levels can also trigger cortisol and histamine imbalance so you really want to be keeping your blood sugar levels nice and stable.

If you have a blood test that shows up high levels of insulin then this can actually be a marker that you do have a bit of insulin resistance which is a sign that you really need to get your blood sugar levels back under control. Insulin resistance is a leading cause of high testosterone and PCOS.

Now don’t get me wrong sugar is not all bad I am a big fan of fruit and potato but what we want to avoid is foods that have a lot of sugar and have a lot of refined carbohydrates and not much else and so that might look like ice creams, jams, juices, packaged foods, excessive amounts of white breads and pasta, sauces with added sugar, soft drinks, lollies, cakes and other sweets.

The other important dietary consideration is your fibre and water intake. Because one of the goals when supporting skin health is improving elimination through the gut and supporting our emunctories, you want to ensure that you’re getting plenty of water and fibre.

Fungal acne

Let’s talk about fungal acne.

For some people, the cause of their acne is actually fungul.

Some people experience a little bit of a different type of acne that can be more stubborn and doesn’t respond to the typical types of treatments. One of the reasons that this is so stubborn is that because a lot of skin products that are recommended for conventional acne will feed this fungus.

Fungal acne is also known by the term pityrosporum folliculitis – an infection with a type of yeast called Malassezia which lives in the hair follicles and eats our natural oils and any oil that you happen to apply onto it. This type of acne tends to express itself more on your forehead, and may also show up on your back, chest, shoulders and along the hairline and in the T zone.

When tackling this type of acne the treatment goals are to support your immune system, gut microbiome and balance hormonal health.

If you suspect that you have fungal acne, you may like to try an anti-fungal shampoo or cream which, if beneficial will provide insight into your acne cause.

Q&A Transcript

I did a shout out for some questions when planning this podcast:

One of the submitted questions was how to prevent acne coming off the pill and this is such a fantastic question because it’s a really common thing that people consult with me about. If you had acne before you went on the pill there’s a pretty good chance that you’re going to experience some acne when you come off the pill again. Unfortunately taking the oral contraceptive pill doesn’t always fix any underlying issues that might have caused the acne to be there in the first place but what it does a fantastic job of is reducing the oil production in the skin which means that you’re going to have very little acne if any. When you come off the pill this oil production is going to increase and it gets a little bit confused because you haven’t really been making any oil for however long so it’s like hang on how do I do this how much oil do I have to make again and so it goes a bit crazy and usually it’s going to be crazy for around six months or so then it starts to settle down but there are things that we can do to help reduce the intensiveness intensity of the crazy.

So what can you do if you’re about to come off the pill? I recommend starting with cutting down inflammatory foods and for most people I recommend supplementing with zinc. I typically don’t prescribe hormonal regulating herbs for three months after coming off the pill because I want the body to try and set up that communication through that HPO axis itself but what I do like to do is encourage emunctory support with herbs, support liver function to improve the clearance of the contraceptive and to make sure your lymphatic system and your immune system is happy.

Question 2 – How long does it take to fix acne?

How long remedies may take to fix acne will depend on what the underlying cause is.

In my experience the redness and inflammation will settle down within a few weeks, and then the frequency and severity of breakouts reduces, and healing time improves.
It’s different with everyone, and as much as I wish everyone had great results there are some people who take a bit longer to see changes, and some people who get occasional relapses.

On the whole I find 6-12 months a typical length of time until someone is able to ease off the herbs and supplements, they’re feeling good about their skin at this point. If there’s a lot of scarring this then needs to get sorted with a beautician, especially one who does laser treatments for scarring.

Question 3 – Are probiotics helpful for acne?

Yes, I usually do have a focus on gut health when treating acne, especially if it’s on the cheeks. But probiotics can be helpful.

A general reminder with probiotics is that you want to be strain specific. The code at the end of the probiotic name tells you which species it is, and therefore you understand which role it plays.

Some of the strains I look at using are Lactobacillus salivaris ls-03, lactobacillus rhamonsus LL, lactobacillus casei lc03, and some Bifidobacterium such as the breve br03, or the animalis ssp.

Question 4 – My teenager has acne, I don’t want her to go on harsh medications, is there anything that can be done?

Yes of course! Treating teen acne is not too dissimilar to treating adult acne. We want to be balancing blood sugar levels to reduce it’s impact on hormones, and reducing inflammation by cutting down on inflammatory foods such as dairy, and potentially high histamine foods. Supplements can be handy, for instance zinc, vitamin B5, inositol and or berberine rich herbs.

A summary of my favourite treatments for acne:

• A probiotic specific for acne health
• Balancing mineral health – typically this may be zinc, but in some cases copper may be needed. You can use a HTMA to assess mineral levels
• Support gut function with gut healing nutrients and diet
• Lower inflammation by eating a low dairy, or low histamine diet
• If hormones are out of balance you can address this. Here is where it gets a bit more individual. Ensuring good ovulation is an important first step. Some common nutrients I provide for this is inositol which supports blood sugar level balance and ovulation. Zinc has an anti-androgen effect and can be helpful.
• Balancing omega- fatty acids through diet, and potentially supplements.
• Herbal medicine to support emunctories, stress levels and hormone balance, as well as reduce infection and support immune health. Some common herbs I opt for are Coptis, which is rich in berberine, Chaste tree, if indicated for ovulation, Withania for stress support, burdock as an emunctory support.

Thank you for listening, if you have enjoyed this episode please leave a review, subscribe if you haven’t already and as always feel free to get in touch.

The post A Naturopath’s Deep Dive Into Acne appeared first on Alison Mitchell Naturopath.

Guts and Girl Bits Episode #51

In this episode I interview Women’s Health Physiotherapist Brooke Blair (previously Hile) about her health journey. We discuss how naturopathy and women’s health physiotherapy can work alongside each other. We chat about period pain, bladder health, prolapses, rectoceles, constipation and of course, poo.

This episode was recorded in early 2020 when the COVID-19 outbreak had just begun in Australia.

Listen to the audio:

Get in touch with Brooke

https://www.herhealthphysiotherapy.com.au/ 0423471651 Instagram

 

 

Guts and Girl Bits is now on teachable where you can find a collection of e-courses on womens health, children’s health and more.

http://gutsandgirlbits.teachable.com

Subscribe and listen to the other podcasts here:

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Transcript

Alison Mitchell 0:00

Hi everyone, you’re listening to Guts and Girl Bits, I’m Alison Mitchell a practicing naturopath, and I hope to share with you all sorts of information about women’s health and digestive health to educate and empower you to make informed choices about your own health. Please remember that all information is general and does not replace consulting with a health care practitioner. Hi everyone welcome to Guts and Girl Bits. Today, I’m joined again with the lovely physiotherapist, Brooke, no longer Brooke Hile… We have a newly married woman- Brooke Blair! Welcome.

Brooke Blair 0:40 Thank you.

Alison Mitchell 0:42 It’s so exciting. You had a little surprise wedding didn’t you?.

Brooke Blair 0:47 It was a bit stressful, having everything happening with Coronavirus around the time of it but it worked out perfectly and it was beautiful, and everyone was surprised, which we didn’t think they would be.

Alison Mitchell 1:00 I was certainly surprised when I found out

Brooke Blair 1:05 Noone was expecting it, which was good.

Alison Mitchell 1:07 Yeah. And so for everyone listening, we’re kind of in that stage at the moment of that level one lockdown but Brooke was able to sneak her wedding her surprise wedding in just before all of these massive isolation started so it was literally like two days before.

Brooke Blair 1:25 Two days before they stopped all weddings unless it was just the five people there so we’ve managed to have 60 I think 55 to 60 of our closest family and friends and it was perfect. It was very good timing. Couldn’t we couldn’t. If we hadn’t had it a day later, it wouldn’t have happened.

Alison Mitchell 1:45 so exciting and today we’re going to be talking about your personal history and how you’ve gotten into your realm of work and how you and I have come to work together as well so yourself as a women’s health physio and myself as a naturopath and talking about some of the areas that these two types of modalities really mesh nicely together. So, if you haven’t had a listen before, Brooke and I have done some really interesting podcasts on how your body changes during pregnancy, and about hypertonicity, which is like when your pelvic floor is really overactive and causes vulval and vaginal pain, and also we talked about mastitis and how physiotherapy can be helpful for that. So have a listen to some of those if you want to as well. And yeah, let’s get started let’s talk about your history.

Brooke Blair 2:45 Yeah, it’s a very long one. So I’ve got lots of notes here about where everything started, but I feel like. So I did get into women’s health physio therapy in my third year of uni and everyone says to me they say why, why women’s health like that’s such a bizarre area of physio to get into. And if you have asked me in my second year of uni, I was definitely going to be a sports physio had never considered the realm of women’s health, that was just something really bizarre and weird to me and pregnant women were terrifying because what if you lay them the wrong way or something like that so that was not in my realm, at all. But then in our third year of uni we started covering women’s health, and we were lucky enough to be taught by the wonderful Taryn Hallam who is amazing in the women’s health physio world and all women’s health world in general. And so that’s what really started my love of women’s health. And then I think it kind of made sense when I then started to look back at my history as to why it sparked my interest. So when I was younger I think I started getting my period when I might have been 13 or 14. And they were horrendously painful, and I would have one or two days of school each time I got my period, or I would just have to sit at the back of the classroom, sometimes I take a heat pack with me, definitely always armed with my Panadol my Nurofen Naprogesic when that was around as well, and I was trying everything and still was in a lot of pain, and even though my mom had gone through the same thing she would just say to me, it’s all right darling like it’ll be okay this is just your period and you’ll get better. And it obviously didn’t. So eventually we ended up going to see a gynecologist, and my options she basically said yeah sounds probably like you’ve got endo. Options are, we do a laparoscopy, which is the operation that you know about where they open you up and they check and see if you’ve got endo there and at that stage I think they were still burning it out rather than removing it. So it was that as an option, or the pill. So, as a 14 year old who was not sexually active, had never heard of any of these things before. My mum was a bit like I don’t really want her on the pill and I don’t really want her having an operation. So eventually we did come to the conclusion to go on the pill that seemed kind of like the lesser of two evils. At that point in time. And it didn’t really do anything other than giving me the ability to be able to stop my periods, a little bit so I’d still get my breakthrough bleeds when I got a period, it still sucked, and I hated it. So I think it would have been so I went on it when I was 14, and then stayed on it until uni, and in that time I was still having lots of issues, not only with my period but with my bowels. So, it would have been in year 10. So 2010 I might have been 15 Maybe 16 And I’ll never forget it. I was constipated for four weeks over Christmas, we were away on holidays and it was the most horrible most uncomfortable four weeks of my life and my mum just kept saying well you know have some bread maybe that’ll be good for you but I felt like I was up to my eyeballs in things inside of me. So I was in lots of pain before and after that I was bloated I was uncomfortable. So there was a lot going on in that side of things as well, so things just weren’t great with my bowels, things weren’t great with my hormones my periods. So eventually we got home from holidays and we went you know what this is just ridiculous I tried gluten free diet I tried dairy free diet. I was still getting abdominal pain, period pain, the whole shebang still constipated and then I’d get diarrhea for a little bit. So that was really fun. So we thought, let’s maybe start to yeah so fun, so we thought let’s start to look into it a little bit more. And the first avenue that we went down was we went back to the naturopath. I mean, the gyneocologist sorry, you came in a bit later. We went back to the gynecologist who said right, let’s do the laparoscopy then and let’s just see. So, I had my laparoscopy just before I started at uni, where they did find they confirm that I had Endo, but also she said I had a very distended bowel at the same time. So she said that might be something worth looking into as well. So she’d removed my Endo, or however much she could remove of it. Put me straight back on the pill so nothing there really changed. And then from there, my periods, pretty much stayed exactly the same, we I skipped them so that I was only having three maybe four periods a year. And my gut and my bowels still were horrendous, so I then went to a gastroenterologist and did a colonoscopy endoscopy, which he came back and said well you’re not intolerant to anything but you’ve got irritable bowel syndrome. And at that point in time I went, Oh cool, like I’ve got a diagnosis it all, it all makes sense. Knowing what I know now I’m like, okay, that just tells me that I’ve got the symptoms, I’ve got it gives me nothing else but all right. Um, so from there I trialed a FODMAP diet, which really stressed me out because I felt like there was not a lot I was able to eat, and if I do eat something that I wasn’t meant to, I got stressed about it, which made me realize a lot of my gut problems were made worse by stress. So it made a lot of sense that in year 10 I was constipated for four weeks because that was around the time I had school certificate. Then, around HSC, I would get bowel issues because it was that time and everything was stressful. I’m starting uni, it was really bad because I was really stressed at uni. So then the FODMAP diet added that extra layer of stress of I know I shouldn’t be eating this but I have nothing else that I feel like I can eat right now, I’m stressed about it and it’s not going to do me any good. So then it kind of all just culminated and became this really vicious cycle that was quite horrible. And so I never really got to the bottom of that except for going, Okay, I know that stress really affects me so I’m going to try and avoid stress, which is not always easy to do, as I’m sure you’re aware, but I managed to sort of go okay if there’s a scenario that I’m putting in, I can try and not stress about it, and then hopefully my gut will be okay, but my gut also gave me a really good indication of when I was stressed so I knew that I needed to do a bit more self care and take care of myself a little bit more. Then to add on top of that I started getting thrush really chronically, which fantastic. So I probably would have been all through uni, I would have thrush, at least once every two to three months, sometimes I would trade it but it wouldn’t really be 100% So I just keep having these thrush flare ups wondering why my vagina just felt so horrible all the time. Around that time I’d also become sexually active so sex was quite painful and uncomfortable. Of course, having thrush and being irritated in the vagina didn’t help anything. So there was those things that were starting to happen at the same time as well, which then come the time that we were in our third year covering Women’s Health physio, and we started to talk about how all of these conditions can really be affecting one another, and that conditions of the uterus, of the vagina can affect the bowel and conditions of the bowel can affect the bladder. Thankfully I never had any bladder conditions. But just knowing that there was that really big Interplay it made me go well hang on I know I’ve got endo technically they didn’t find anything on my colonoscopy, so maybe I don’t actually have a true bowel issue, but maybe there’s something that’s happening that’s got to do with my endo that’s causing things to be a little bit flared up and so then I started really loving women’s health and that’s how I got into it and just the idea of pain with sex which I’d experienced and pregnancy, which I haven’t experienced yet will one day soon, maybe. But yeah, all of those different conditions but I think a lot of women get told, Oh, it’s just a period you’ll be fine or, you know, it’s fine. You’ll be okay just take some Panadol and everything will be okay, or yeah pain with sex is normal, get over it. A lot of those really resonated with me because I’ve been through a lot of them and I didn’t really feel like I had any answers as to why those things were affecting me. So that’s why I so much love women’s health and love being able to work with you because we can kind of cover things from both sides, both the anatomical side and the muscular side, as well as what’s happening at an internal cellular level and hormonal level, and being able to actually start to get to the bottom of things, which is really nice.

Alison Mitchell 12:42 Oh my gosh, it’s, it’s such a connected thing everything’s all so connected, and all of those things working together. Oh my gosh what a journey.

Brooke Blair 12:57 Yeah, so it took some time it’s still ongoing as you know we’re currently working on lots of things at the moment. But I think that having been through all of that has made me very much, empathetic towards the women that come in who are having these conditions who they might have seen a practitioner who said, Oh yeah, that’s just normal, that’s just what happens in women. And they’ve been constantly told it’s normal, it’s okay, everything’s fine. It’s all in your head. And then when they can come in and sit down and I can go. I’ve been there and I know that there’s things we can do to treat it and no it’s not all in your head. It’s really quite a lovely process and quite a nice journey to be able to go through with women.

Alison Mitchell 13:39 I think a lot of the time when people feel heard, they feel acknowledged that they’re not crazy about it, that this is such a big relief for them in many ways. Oh, I’m not making this up so I know a lot of my patients say that and I know that some of yours do too. And like you were saying like sometimes other practitioners might say yeah that’s just part of having periods but sometimes it can be because things evolve and we know that certain things aren’t normal anymore, but our parents practitioners might have told them that their stuff was normal. Until then, our parents have told us here, that’s just normal, that’s what I had. That’s what my sister had that’s what your sisters had all of that sort of thing and so you just come to expect it and so it’s just breaking that cycle and, you know, takes one person to say, Hang on, we can actually do something about that. And that’s what I love about what we do as well as we’re with we’re popping that bubble we’re saying: You don’t have to have people sex and didn’t have painful periods, and you shouldn’t even notice your digestive system, they should just be like, La-La-La Everything feels wonderful. Yeah, absolutely. But it is a journey isn’t it.

Brooke Blair 14:54 absolutely is. I’m trying to think how many it’s probably been 11 or 12 years but I’ve been working through all of this stuff and we’re still going. And that’s being educated and knowing that there’s things that we can do to help. That’s, you know, other women don’t have that education and they haven’t been told that there’s things they can do so it’s gonna take a lot longer for those women.

Alison Mitchell 15:21 I definitely see that with naturopathy because it’s not as conventionally well known, it’s not as accepted, and what sort of avenues you can work on with with diet is not that well known, so I might have like someone that’s never really even realized they can work on them for something until you know they listen to a podcast or they read an article and they’re like, I wish I had known that earlier.

Brooke Blair 15:48 Absolutely. So I hope that this podcast goes out and people listen and go, oh hang on a second, I can go and get help, amazing.

Alison Mitchell 15:57 Yes. And, you know, I know that some of the things that you and I are working on together, it’s, it can be a little bit off putting when you hear that like it’s actually a bit of hard work that you have to do for a little while.

Brooke Blair 16:13 It is.

Alison Mitchell 16:13 *Nodding vigorously. But it’s worth it because it doesn’t last forever. And so, like, a month of hard work. Compared to years of pain and discomfort is so much better.

Brooke Blair 16:28 Yeah, it’s worth it, that’s for sure.

Alison Mitchell 16:32 So, I guess we could talk about how you and I came to me. Well I guess I should we say that because we might have actually spoken about this in some previous podcast but I’ll say it again anyway. I was pregnant with Lara with my second baby, and I had had a caesarean section with my first baby, and it was a bit of one of those situations where you’re not completely sure what happens, like I was very much adamant that I was going to have a natural birth but then all of a sudden, something like, like there was a non reassuring heartbeat, and my obstetrician had said to me previously I’m not sure about the shape of your pelvis, and I was very unsure what she meant by that. So she was basing that on like some internal examinations and I was like, like what does that even mean and so I was adamant. I was going to have a really great natural birth for my second baby. And so, I’m just, I’m very grateful that Ash is healthy and I recovered fine but I also had some really bad abdominal separation following him, and I had heard some great things about about you, about Brooke, about helping with abdominal separation or, because I had only heard that you know you just shouldn’t do sit ups. Okay. Bring it on, never get up out of bed. And so this was two and a half years that was two and a half years was no it was probably two years that I had had this abdominal separation for and it was. I mean, it was fairly severe, wasn’t it like five fingers. At that point is that moderate or severe or moderate,

Brooke Blair 18:32 moderate, I’m trying to think back to the integrity of your abdominal wall as well.

Alison Mitchell 18:37 thats a long way back for you to remember. anyway I thought I put on a bit of weight but now I just had like my abdominal muscles were just so weak, and then I had all this back pain because of that. So all of these sorts of things that started to fall into place like my back pain. The abdominal separation and then I also just wanted to make sure that everything was in tip top shape ready to have a natural birth. And I think it was like, probably our third appointment, where it was a natural person you’re like, oh, I should thinking about doing a community for women’s health, with one of the Chelsea from Mummy Movement. And I was like, Y’all be involved in that I love spreading awareness and then it just blossomed from there.

Brooke Blair 19:31 And I think I said let me tell you all about my horrible periods.

Alison Mitchell 19:34 I think there might have been a couple of people that, because you were like what did what do you treat with naturopathy and I was like, I do lots of children’s health. Lots of women’s health, and you were like “hmm.. hmmm… I might send some of my bed wetting children to you and period pain people and then yeah it just grew didn’t it.

Brooke Blair 20:02 It did, and now we have this very good communication and lots of clients that we share together which is amazing,

Alison Mitchell 20:07 and it just it just gets that next level of results really doesn’t it.

Brooke Blair 20:13 Absolutely, absolutely.

Alison Mitchell 20:15 And I think for me, I’ve always, I’ve always had that awareness, pure hypertonicity so pelvic floor problems can worsen Endo, because it creates this local inflammation that worsens pain, but I also didn’t have anyone that I could refer to, because you women’s physio is a few and far between.

Brooke Blair 20:38 Yeah, it’s a growing field which is amazing. There’s actually a lot more of us than what most people know about and it’s funny going to courses and you meet and you go oh hang on, you work in the mountains, I’m like not that far away from you. And then there’s about six people who work in the mountains and you oh wow okay there’s a lot of you in the mountains im just down here. There’s actually a lot of women’s health physios, it’s just that, a lot of us work in musculoskeletal physio practices so it’s not necessarily a world that people know so much about. Whereas if you are either a sole practitioner like I currently am, who has a business name that sounds like women’s health, or who specifically says Women’s Health physio as the main point of call. That tends to be how people are finding us a little bit easier, but there is actually a lot more now, which is amazing.

Alison Mitchell 21:32 That’s so good.

Brooke Blair 21:33 Yeah, yeah.

Alison Mitchell 21:36 first before you I only knew of one, and then you showed me a few more and then all of a sudden you do start to see it when, when you’re looking around for referrals for people. Oh, it’s a lot more.

Brooke Blair 21:49 Yeah, which is nice because there’s so many women who have so many concerns and just like a naturopath I’m sure everyone does things slightly differently in women’s health physio, everyone does things slightly differently. So, what works for one person might not work for the other and a different type of treatment might be what that person needs that maybe this other person couldn’t give you. So it’s always nice that there’s lots of people out there lots of different opinions and ways of doing things and ways of looking at the body that helps women to be able to get their best results which is nice.

Alison Mitchell 22:24 Yeah, that’s lovely. So I guess we could, you know, move on from that to talk a bit more about how much Naturopathy and physio work well together. So I think the probably the one of the things we could start with our favorite thing to refer for which is period pain.

Brooke Blair 22:41 Yes, personal experience of course we’re going to refer for that.

Alison Mitchell 22:48 So you and I both have a strong history of period pain. And so mine has settled down a lot with a little bit of time and using herbal medicine and possibly even having kids as well that might have something to do with it too but we’ve both got that passion for it and also that level of empathy for our patients that have it too. But there’s a really strong correlation between like having the stuff going on internally, like you said before at a cellular level hormonalIy as well as having the physical, the muscular component to. So, working on one side of those without addressing the other is going to be not as complete as could be. And this is actually applies to everything else that we’ll be talking about. So, you can’t do as good a job without doing both sides of it.

Brooke Blair 23:43 Exactly, you just get that extra bit better so that you get that extra little bit so you can get to 100% Rather than just sitting in being happy at 90%. If you know both working together, then you can get such better results and it’s amazing to see.

Alison Mitchell 23:58 Exactly. So, in terms of how I as a naturopath go about addressing period pain. I’m looking at, like there’s a few different aspects of what causes period pain and so when I’m working, I’m looking at people from a more energetic constitutional level as well when it comes to pescribing herbs which I mean might sound a little bit strange, but I do find that it gets the best results so you’re looking at like a person is hotter or colder. And so if you’ve got a lot of cold. For instance, like, there would be stagnation and dark red blood and clots, and they feel better for applying heat and so we use herbs that are going to be warming and stimulating. And then if they’re very hot person to then there’s usually that bright red blood, and they feel better for having a cold bath or a cold shower or buying an ice pack, and like there’s various other things that you look at in like the tongue, their skin and their hair, or like, assessing where they are at a constitutional level, but using herbs that are specific to that, as well as thinking about what are their hormones doing and what is their immune system doing because with things like endo with endometriosis, it’s very immune driven condition, so you need to think about what’s causing your immune system to go shonky in the first place, like is it a bit of a bug that’s hiding around, or is it something that you’re eating that your body is reacting to, and then it’s also things like is there a nutritional deficiency, that’s causing your body to be more immune driven, or is it an deficiency that’s causing you to become tighter and more crampy. So those are some of the areas that I look at with period pain.

Brooke Blair 25:48 Okay, I sort of way that as women tell physios we, that’s why I love working with you because you can work with things that are causing some of the pain. And then I can treat some of the byproducts of that pain, so a lot of women, particularly with endo sometimes with polycystic ovaries or just women who do have incredibly painful periods. I’m more so looking at the musculoskeletal system and the neural system to work out what’s happening more so at a pelvic floor level, but more recently we’ve sort of been looking all the way up basically to your neck and all the way down to your toes to work out if there’s something that may have set off some of the pain. So, for girls who have endo/ polycystic ovaries, some of them will be coming in not just because they get pain with their periods, but because they’re now starting to experience sexual pain, or they’re getting difficulty using tampons or different things like that that they starting to notice that isn’t normal. They shouldn’t be having where previously they were able to use tampons just fine. Or they’ve had sex pain free, but something has triggered this pain to start up. And so we’re starting to look at why is that happening, is it because they’ve had these pain because of that inflammation that you were talking about, for such a long time that the body has just started to go into a protective cramping type state trying to protect all of the organs and protect everything vaginally and saying no I don’t want anything inserted here because it could cause me pain. In some women, I see they could have had an injury so they may have had completely fine periods, they may have always had endo but not had any symptoms of Endo, but their periods were fine, and then all of a sudden they’ve had an incident where they’ve fallen and they’ve hit their tailbone, or their hip or they’ve whacked their knee, and all of a sudden they’ve started to get painful periods crampy sensations the pain with sex. Sometimes even leakage, and those sorts of things are very different for them and so yes we know there’s probably going to be findings in a pelvic floor level but also elsewhere throughout their body we might need to see what’s happened at their knee, we might need to see why their tailbone is sore and work out that perspective rather than just going straight to treat vaginally.

Alison Mitchell 28:08 Exactly because the body is a unit. And one thing is going to be like causing another area to shift and your body will always try and compensate, and just keep compensating compensating until it’s current anymore and then it’s like, ouch!

Brooke Blair 28:23 what’s happening here. Yeah, so it’s nice to be able to see and unravel all of those sides of things I had a lady in the other day, and I think she was in her 50s and she was having period troubles, and no one had ever brought up the idea that potentially there could be something hormonally or systemically like Endo, or something like that, but she has had painful periods and vaginal pain for the last 40 odd years. And so I sat down and I took her history with her for an hour, and we took it all the way back to as a child, she’d had eczema vaginally, and she had, I think she had constipation and gut issues as a child, and then all of a sudden she got her periods and they were really painful and then she woke up one day with vulvodynia and that’s never gone away. And even just sitting with her and going back through her whole history and her going wow no one’s ever sat with me and gone all the way back to my childhood to work out that actually, these things have been happening since I was very young, before I got my periods. So she’s another person, I’m going to get to come and see you to work out what’s happening at a gut level because she was close. Yep. Yep, exactly. Yeah, it’s lovely to be able to work on those sides of things and work out where the pain is coming from rather than going yeah cool you’ve got Period Pain what next. Yeah.

Alison Mitchell 29:49 Oh my goodness, I can’t believe that it was going on for that long, but this is this is often what happens in this realm of vaginal pain period pain but also digestive pain is because you don’t, you don’t get people asking you about these things and, often, if it’s something vulnerable, you to be too nervous to bring it up. So like what situation and will you be and so going to the doctor directly about that where that will get asked. Apart from an appointment, like a women’s physio or a naturopathic appointment or potentially even the gyno but often they’re very focused on a specific issue in conventional appointments, and so it doesn’t get brought up unless you specifically do so it is important to talk about these things. And I know that I mean, I probably ask the weirdest questions when I do my naturopathic screening I’m like, do you like talk about poo a lot people say I’ve never had a conversation about my poo as in depth.

Brooke Blair 30:49 Likewise, love a poo chat.

Alison Mitchell 30:53 And, Yeah. And do you give any vulval pain, any vaginal pain if you get pain during intercourse like all of those sorts of things that people like, what, why are you asking me that

Brooke Blair 31:04 some women say, yeah, no one’s asked me that before and, but actually yes I do have these issues and it’s until you raise that conversation, they’re not going to be forthright with it and say, Actually my vagina hurts all the time. That’s just not something that a lot of people feel comfortable saying yes, and there is such a stigma around it. We just love popping. So, I think that’s just such an important area that people need to know that you don’t have to put up with

Alison Mitchell 31:36 sex should not hurt

Brooke Blair 31:38 No exactly and if somebody tells you it’s all in your head it’s not and you need to see somebody else.

Alison Mitchell 31:44 Yeah, exactly what some other areas that we love to trade together so I love working with urinary conditions. So, chronic UTI’s, and a bladder pain as well so when people are constantly getting symptoms that are not not related to an actual infection which is one of those things. It’s just like so much mind boggling for so many people but they just came back negative and why am I still getting the pain, what’s actually causing that.

Brooke Blair 32:21 Yeah so that’s definitely something that we work together on which is lovely. I see that quite a lot, a lot of women come in and they say, because if oftentimes if they’re getting symptoms like that like UTI is a lot of them are leaking as well. So they might come into the session because their GP referred them for incontinence, but then when you sit down and chat to them will actually I’ve got pain when I pass urine and I go to the toilet and I empty my bladder but even though I know I’m empty it still feels like I need to go or I never get the sensation that I’m completely empty, or things like that pain with bladder feeling all of those symptoms that you shouldn’t be aware of that. A lot of women do actually notice can be coming from something anatomically, so I treat a lot of women who they sometimes have overactive pelvic floors like we just spoke about. And it’s because of that over activity that all the nerves in that area are quite overstimulated causing bladder pain sensations. Also not allowing the bladder to fill completely or empty completely. So I go through about 20 Questions about when you sit on the toilet does your flow start straight away does it stop start does it go off in a funny direction do you feel empty, all of those sorts of questions because if that’s what your body has always been doing, you don’t know if that’s wrong or right, you don’t know if there’s an issue there.

Alison Mitchell 33:44 You’d just think it’s a funny Quirk.

Brooke Blair 33:46 Yeah, exactly, exactly. And so I’ve had women who say Oh yeah no every time I sit down I have to wait 10 seconds before my urine starts to come out and I have to really think about it, that’s not what should be happening. And so, if then they have issues with what’s happening around their urethra where the urine comes out and around their pelvic floor they might not be able to completely bladder empty, which will put them at risk of having UTI over and over again because they’re not allowing that urine to exit their body. But also, if they are constantly having an irritated bladder, whether that’s from infection or not, and they’re leaking, then they’re definitely going to be getting more at risk of having irritation infection, things like that so it’s definitely something to try and work out, why is that happening.

Alison Mitchell 34:34 And the way that I would be working with these people is using mostly herbs that work on improving the mucous membrane health of the vagina and the urethra and all of that so nutrients that work on that sorry and then herbes that work on reducing spasm of the fine, finer muscles in there and then soothing bladder herbs so we’ve got one of my favorite of all time is Crataeva because it’s just this nice most beautiful bladder tonic, but it’s so soothing. And so that’s like my staple with chronic bladder conditions of all forms, really loving Kava relaxing the muscles down there too. And that’s also really useful in treating UTI as too. And then probably leads us on to the next topic which is prolapse.

Brooke Blair 35:23 Yes, I love prolapse, I don’t love it when it happens to women, but I love trading. So I think there’s a big misconception about prolapse, in that it only happens to older women. And it means that everything is falling out of you and it’s the worst thing in the world and all you can do for a surgery. So when I have women coming in who’ve been told that they have a prolapse or who think that they have a prolapse, it’s all doom and gloom and it’s the worst thing that could possibly happen to them, and prolapse isn’t something like that, most women. I think the stat is that 75% of women will experience some level of prolapse across their lifetime. And what we’re coming to realize is that prolapse, to some extent might actually just be normal because we are upright mammals, and our pelvis and our pelvic organs are at the very base of us, and they don’t have bony support underneath them, they only have muscular support. So over time there is going to be some degree of movement that happens purely because of gravity and because of how we move around. All other animals are basically on all fours, so they’ve got the whole abdominal wall but all of their organs or the pelvis that their organs are supported by, But we don’t have that support structure. So, most women that I assess there will be some degree of prolapse that I go okay, I’m not really going to call this prolapse because it’s just the natural movement that’s happening in your body, and everyone will have some normal amount of movement, some women move not at all and some women are quite mobile in their tissues, and they are going to be the women that are more at risk of prolapse, whether it means that things have dropped internally one centimeter three centimeter five centimeters. It’s one of those things that it’s quite scary for women, to hear the term prolapse and to get the symptoms of prolapse, which are things like heaviness or vaginal discomfort or feeling like you’ve got a dislodged tampon internally but you don’t have a tampon in. I also have lots of women who start to experience sexual pain if they have a uterine prolapses. So that’s one of the really lovely things to be able to treat, is being able to work on either pelvic floor strengthening or using pessaries which are pelvic floor support devices to help support the organs, and to get rid of those symptoms and change how women are functioning so that they can feel symptom free and comfortable.

Alison Mitchell 37:49 Definitely I feel like there’s, there’s various levels of it and sometimes people are not sure whether what they’re feeling is normal or not. It’s good to also just get it assessed to like to give you that peace of mind for someone like yourself to say, actually, where you’re at right now is fairly normal for your stage of life or for everything else that’s going on. Yeah. And then, how can we work on it naturopathically Well I actually really liked working alongside acupuncture too but I look at this from structural integrity of this muscle cells themselves. So things like nutrients that help with connective tissue strength collagen strength, and then using herbes they’re have lifting actions, and reducing inflammation and then also some hormonal support too so, working on a that oestrogen level in a very gentle way. And then using herbs that help with improving digestive function because we want to be reducing any sort of pressure from their digestive system that might also be affecting it too. Which I guess is another segue into digestive digestive stuff so one of the main things that I would probably be sending people to you for in regards to digestive stuff is constipation so when I feel like there is just a poor nerve signal going on or people are deciding, they’re just not getting that urge to go to the toilet because they’ve been constipated for such a long time. So do you want to talk a bit about that.

Brooke Blair 39:27 Yeah, I love treating poo conditions, could talk about poo all day long. So when women come into me for any sort of bowel conditions more often than not it is constipation related, but oftentimes I also do treat fecal incontinence which no one really loves to talk about but it’s actually really, really common and can be caused by constipation. So, in terms of treating something like fecal incontinence, which I’ll talk about first and then talk about constipation because that’s quite commonly related. So people experiencing fecal incontinence, I think the studies, wanting for one in four men and one in five women will experience fecal incontinence in their lifetime. Oftentimes, it can be post childbirth. After third or fourth degree tears, or after nerve injuries. It can come on with things like back conditions and back pain as well. And so a lot of it comes from the muscles at the back passage not functioning optimally, meaning that people aren’t able to hold on to this tool for as long as possible and can become fecal incontinence. A lot of the time, the women that I say for this, it’s because their bowel motion isn’t where it should be. So whether it’s too soft, so it’s like your type five six or seven on a Bristol stool chart, it’s just far too soft and the body’s not made to hold on to a bowel motion like that. So working with you and giving women techniques of how to bulk up their bowel motion can be quite helpful. Then from the constipation side of things. If they come in with fecal incontinence, we need to make sure there’s no constipation there, otherwise we need to treat that first and not worried about the fecal incontinence, because what people don’t realize is, in your rectum, if you’ve got a really big firm hard bowel motion sitting there, your body’s not going to be able to push that out without extra assistance. And so what the body does is it sends this mucus layer to try and help to lubricate the rectal walls to help pass about motion. And if your body doesn’t feel like it can pass it, you just won’t feel that there’s all this mucus there and it will leak out of the rectum, like it’s a fecal incontinence, where it’s really just your body tried to help you to pass this bowel motion. So we need to try and work out. Is it true fecal incontinence or is it that there’s an underlying constipation there. Then in terms of constipation a couple of the things that I see quite commonly is women feeling like I know that I have the sensation that I need to go to the bathroom, but I just don’t feel like I can empty myself, or I feel like something gets stuck. And so from that regard, if we talk about what their bowel motion type is like, sometimes it’s a perfect bowel motion and we’re going okay we don’t need to change your bowel motion type at all, we need to change either the sensation of you going to the toilet, or what’s happening. Anatomically, so really frequently I see rectal prolapses so we call them Rectoceles, not where the bowel is dropping out at the back passage but where the bowel creates a pocket more towards the vagina, and it allows bowel motion to get caught in there, so that women pass a bowel motion but then they just feel like something’s getting stuck, and they can’t quite get it out, and they’re always gassy and uncomfortable, and they might need to go to the bathroom six or seven times in a day but they still just never feel empty. So that’s something that I really love treating because doing a good poo is actually life changing. And if you sit down on the toilet, you do a great poo and you feel empty it’s a wonderful sensation. So that can definitely be something that I work with, but then also making sure that women know what the sensation of bowel emptying should feel like. And when they should emptying, empty their bowels. So working a little bit more with their nervous system to change that up. But yeah, sometimes it’s anatomical work sometimes women don’t actually relax their pelvic floor to empty their bowels they tighten it, instead, which makes it far more difficult to empty their bowels and it’s not that there’s an issue with the bowel motion, it’s just that they’re not relaxing and we can change that also.

Alison Mitchell And I think that with the rectocele, the way that I treat that is very similar to the prolapse stuff, but also yeah like getting all, there’s so many things that can be going wrong with digestive health, and natural remedies, it’s one of my main things that I treat your digestive health, for women’s health and digestive health, so it’s very very satisfying things to treat.

Brooke Blair 44:20 Yeah absolutely people, I have women who all of a sudden they can relax their, their pelvic floor muscles and all of a sudden they do this amazing pool and I say when that happens, I want you to message me because it’s going to be the best day of your life, and they go oh my gosh I didn’t realize that I could do like that and feel this good and it’s, it’s wonderful when you get a lot of neurotransmitter release when you’re actually doing a nice big poo.

Alison Mitchell 44:40 So if you haven’t been able to do for a long time, then you’re not going to get those neurotransmitters, but then it works the other way is if you’ve got constant, diarrhea, you kind of be running low on those. So having that perfect balance makes you happy lately.

Brooke Blair 45:05 Good poos are good.

Alison Mitchell 45:10 Did you want to talk about anything else.

Brooke Blair No, I think we’ve covered off a lot of it.

Alison Mitchell 1:54 My kids are going insane so I should probably wrap up now. like there’s, so many ways that we can work well together. I just so happy to be able to share this information to people and whether they do decide to see both of us or even do some of it, I just want people to know what is available to them. So I’m just so grateful that you and other women’s physios are around and thank you so much for sharing all of your amazing information today already

Brooke Blair 45:54 thank you and thank you for helping me to work on my body. At some point we’ll have to talk about everything that’s amazing that’s happening in my body at the moment which will be wonderful. Alison Mitchell So we’ve got a little bit of a teaser there and then we can follow that up later once we’ve we’ve got you towards the end of your health journey too. perfect. Alright, well thank you everyone so much for listening. Bye! Brooke Blair Bye

Alison Mitchell 46:40 Thank you so much for listening. I hope you’ve enjoyed today’s episode. Please join me over at the Guts and Girl Bit’s Instagram page and share any other words of wisdom that you would like to contribute as well. Guts and Girl bits now has a collection of eight courses that you can view online. The primary course available at the moment is Natural menopause support, which provides information on supporting yourself through the latest symptoms of menopause and easing through this transitional life. You can find the collection of E courses at gutsandgirlbits.teachable.com And they will also find a course of understanding underactive thyroid and coming up soon will be a courses called cyclical woman. Navigating the teenage years, children’s health, nourishing the mother, and more. If you’ve enjoyed today, please leave a review and share this episode to help spread the word. Thank you.  

The post Brooke’s journey with endometriosis plus how women’s physiotherapy works with naturopathy appeared first on Alison Mitchell Naturopath.

PCOS, also known as Polycystic Ovarian Syndrome is a complex condition that can significantly affect a woman’s quality of life. One of the biggest ways it does this is by impacting on a women’s ability to conceive and maintain a pregnancy, but it can also impact a woman’s self-esteem by making it difficult to lose weight, it causes acne and hair issues, such as too much hair where a woman doesn’t want it to be, and potentially thinning of scalp hair.

Of course, there is more to it than that, but those are the major things that women report as the issues they’re most upset by.

In this article and podcast I will discuss the lack of awareness and poor understanding surrounding PCOS, how it is often misunderstood and why its name has a role in this. I discuss the common, and not so common signs and symptoms of PCOS and talk about the driving factors that can cause PCOS to develop. I talk about how PCOS is often diagnosed and discuss some of the key ways PCOS can be addressed naturally.

You can listen to this article on the podcast links below, or in the embedded player.

iPhone   Stitcher   Youtube   Soundcloud  Spotify 

Understanding PCOS

Lack of awareness

Sadly, but not unexpectedly there is a lack of awareness and understanding of PCOS, with many people who have not been diagnosed not aware of the condition at all, but also women who have been diagnosed, and some health practitioners as well, not properly understanding the condition. A big part of this lack of awareness is the lack of research into the condition, but also I believe it is part of the bigger picture of gender bias in medicine, and many conditions that are specific to women do not have the attention they deserve, perhaps the exception being breast cancer. One of the other things that doesn’t help this lack of awareness and understanding is the name of the condition itself – polycystic ovarian syndrome.

The name makes a few false implications which cause overall confusion – so here are a few points I want you to know:

1. The condition doesn’t originate in ovaries and the condition is not all about ovaries either, after menopause, the condition can persist. It is more of a metabolic condition, with systemic high androgens and insulin resistance being the core drivers.
2. A PCOS ovary doesn’t actually have ‘cysts’, rather what you can see on ultrasound is immature follicles. Follicles are the little sacks that your oocyte, or eggs sit in waiting for the hormones from the brain to tell it to mature and then ovulate. The issue is these follicles in PCOS is they aren’t developing properly, so if we got them to develop fully these so-called cysts would be a baby (if met with a sperm).

A new name?

Many physicians and researchers have proposed a name change for PCOS, however, that was being proposed in 2013 and it’s 2020, so who knows when that will happen. I agree the condition does need a name change, as I feel PCOS is not a good representation. One of the names suggested which I like is ‘metabolic reproductive syndrome’, however other names suggested were Poly-follicular ovarian syndrome with metabolic dysfunction and/or hyperandrogenic manifestations (PFOS-MD and/or -HM).

The list of potential signs and symptoms is long for PCOS, which explains why there are so many women out there that don’t know why they have the symptoms they do.

PCOS Symptoms

Most common symptoms of PCOS include:

• Irregular periods or absent periods
• Acne
• Weight gain
• Excessive hair growth, also known as hirsutism. This can vary in locations and intensity and it will also be different dependant on your nationality.

Less well known, but still common symptoms:

• Anxiety and/or depression
• Fatigue
• Brain fog
• Skin tags
• dark patches on the skin
• low libido
• Sleep disturbances and snoring (Sleep apnoea can also be more common due to the higher level of androgens. Poor sleep can worsen PCOS by worsening insulin resistance.)

And more than that, there are other complications, especially regarding fertility and baby’s health. The higher levels of androgens can increase the risk of miscarriage and are also linked with some increased risk for baby such as higher birth weight. Women with PCOS also tend to have difficulty with breastfeeding and a higher risk of diabetes after birth.

Thankfully, many of these risks are modifiable by correcting the underlying causes of PCOS, which I will discuss later.

Causes of PCOS – How does the switch get turned on

There are different ways PCOS can express, and for these different subtypes, there are different causes.

The main cause is insulin resistance, which causes the male hormones androgens to become high. Insulin, when it is too high, can trigger more production of testosterone, but it can also lower the amount of SHBG (sex hormone-binding globulin) which means our bodies can’t bind up the excessive testosterone as well, and so more is circulating our body, causing the symptoms of PCOS such as acne and hair issues. Insulin excess also affects our FSH : LH ratio which is important for ovulation, and high testosterone stops our follicles from maturing completely, so this means woman’s ability to ovulate is affected, and if that is affected their chances of conceiving is reduced, and oestrogen and progesterone balance is also affected.

There are different types of androgens, such as testosterone, DHEA and androstenedione, and depending on which one is elevated we can get an idea of what is driving your PCOS. For instance, if DHEA is high, we know that stress is a big driver.

It is also possible to have PCOS without insulin resistance and this is typically due to inflammation. this is a much rarer subtype, but certainly something to consider.

Something else to consider is your gut health can play a role in both hormone balance and metabolism. Your gut bacteria are responsible for so many things in the body, and if you’ve listened to my previous podcasts or read some of my other blog posts you’ll know that your microbiome is of vital importance in improving health. How does it affect PCOS? Well, if your microbiome is out of balance it can affect your metabolism, which can worsen insulin resistance. And an out of balance microbiome can also cause hormone problems, by allowing more of your ‘bad’ hormone metabolites to cycle back through the body.

Why do you have a PCOS ‘switch’ in the first place?

We know there is a genetic component to it, and there is some possibility that your genetic likelihood can be influenced by exposure to endocrine-disrupting chemicals in past generations, substances that are passed through generations. So effectively, what chemicals and diet your Grandmother was exposed to will impact your risk for PCOS.

This transgenerational effect has been demonstrated in animal studies when mice were fed an obesogenic diet and were given substances that mimic a high androgen state to bring about a metabolic state of PCOS, and it was found that their subsequent generations also expressed this condition.

It was also found that women with PCOS had levels of chemicals in their system that were not in use anymore and was found to have been passed through in utero from their mothers and grandmothers.

These chemicals are increasing the activity of the androgens and also acting as obesogens, contributing to the weight gain and insulin resistance.

Diagnosis issues

So how common is PCOS? The prevalence is about 8-13%, effectively 1 in 10 women. But it is a condition that is it is both over-diagnosed in young girls, and under-diagnosed in older women.

One of the issues in getting diagnosed is that there isn’t one specific diagnostic criteria, so you can get mixed messages.

Three main diagnostic criteria exist- the National Institutes of Health, the Rotterdam criteria and the Androgen Excess Society criteria.

All of the criteria require all other possible endocrine disorders to be excluded.

My criteria of choice is the Rotterdam diagnostic criteria. It requires a female to have two of these three criteria:

1. Irregular periods
2. Clinical and/or biochemical hyperandrogenism
3. “Polycystic ovaries”

Many young girls are being prematurely diagnosed with PCOS. But it is normal for young girls to present with some symptoms of PCOS and this often resolves in a few years without intervention. It can take 3-6 years for a menstrual cycle to regulate itself, however if there is early intervention this can prolong this process, and it is thought that the most common recommendation given at this time – the oral contraceptive pill (OCP) can worsen insulin resistance, which perpetuates the condition.

What are the other causes that need to be excluded?

This could be conditions such as Cushing’s, Adrenal tumours or congenital adrenal hyperplasia. Screening would include blood tests for TSH, prolactin, FSH and anything else your practitioner feels warranted based on your signs and symptoms.

PCOS and Teens

Getting back to teenage girls and their periods, it’s not uncommon for girls to have irregular periods when they’re young, and this will usually regulate itself within 6 years. My personal preference in clinic is to not interfere with hormones in young girls but to allow their bodies to regulate themselves. If hormones are interfered with too early, then it will typically delay the regulation until later. This is relevant to not just herbs, but especially to things such as hormonal contraceptives.

A common understanding is that women with PCOS literally have cysts on their ovaries. But this isn’t the case, as the name implies. the polycystic ovarian appearance that some (but important to note, not all) women have on ultrasound is actually a higher count of immature eggs within their follicles. These eggs aren’t getting the signal from the brain to mature further, triggering ovulation and release.

If you can remember the diagnostic criteria, the presence of 2 of the 3 criteria is what it takes to get diagnosed, so if a woman has irregular periods and signs of high androgens, she can have PCOS without the presences of any ‘cysts’ on her ovaries at all.

A more positive perspective.

One of the perspectives I have heard before about PCOS which I love is that this is an evolutionary trait which in years gone by was protective. if you consider that being pregnant and giving birth was a life-threatening thing at worst, and a depleting event at best, it can make sense why a condition like PCOS which can reduce one’s fertility may be protective in tough times. Insulin resistance is beneficial in times of scarcity as it allows you to store more of the energy from foods, which in famine times if beneficial. In times of plenty such as now, this, unfortunately, works against us. In a time without contraception, women may have gone from one baby to the next without a break, which can be quite a high level of stress and depletion. So, for women with PCOS who have longer times between ovulation, and so fewer opportunities to conceive, this could be considered a positive thing. Nowadays this might not be much comfort especially if you’re wanting to conceive, but I believe anytime you can view your health from more a positive light it is beneficial, so ladies with PCOS you might like to shift your frame of thinking to more of an ‘I’m a survivor’ mindset.  

Other considerations for PCOS

Sleep

Sleep disturbances are reported to be twice as likely for women with PCOS. Studies show found that women with PCOS are more likely to report difficulty falling asleep, to have restless sleep occasionally and often feel severely tired. Sleep problems also occurred in women with PCOS who were in the normal weight range.

It’s still unclear how PCOS affects sleep but we know that the metabolic impacts of the condition play a big role. The hormones melatonin and cortisol are responsible for our sleep cycles to a large degree and these are strongly influenced by insulin resistance and elevated testosterone, as well as the stress placed on the body if obese.

Sleep apnoea is also often reported in women with PCOS, more often in those who are overweight. In those people who are considered to be ‘severely obese’, (BMI >40kg/m2) the prevalence of sleep apnoea in both men and women can be as high as 92%.

The mental health impacts of PCOS which is an increase of anxiety and depression have a bidirectional association with poor sleep quality and insomnia.

Weight loss and exercise is one of the best ways to improve sleep quality in women with PCOS, and if needed there are herbal medicines which can be of support.

Nutrients such as magnesium and calcium and the amino acid l-theanine can also be supportive to calm the nervous system and promote relaxation and sleep.

PCOS and Mental Health

Women with PCOS have higher rates of anxiety and depression. PCOS can be a very distressing condition for many women and this varies from person to person, with some of the highest reported contributors to the anxiety and depression is the impact to fertility, the impact on physical appearance and self-esteem such as weight issues, hirsutism and acne, and also the frustration about the lack of a clear cut solution, and a lack of awareness and understanding of the condition. There was a study that found that women with PCOS were physically active reported less depression and anxiety than those who were inactive. So, while I love to use herbal medicines to support mood and the nervous system, I do frequently recommend exercise to support mood in women with PCOS.

Potential pregnancy risks

There are a few things to consider when trying to conceive, as women with PCOS have an increased risk of some complications during pregnancy. The good news is that if PCOS has been treated, these risks return to almost the same levels as women who do not have PCOS. The risks include an increased likelihood of developing gestational diabetes, pregnancy-induced hypertension and preterm birth, and an increased risk of neonatal complications.

The increase in birth weight of babies born to women with PCOS also suggests an increased likelihood of c-section deliveries.

The treatment used in the study I mentioned before was anti-androgenic therapy, which means correcting hormonal balance before conceiving will improve pregnancy outcomes.

one small study looked at the incidence of gestational diabetes in women with PCOS and found the prevalence was 30.2%, and that these women had impaired blood sugar levels after having their babies. What we can take from this is that PCOS can have a long term impact on glucose metabolism, and again it highlights how important it is to try and take steps to improve your hormones and blood sugar level balance before conceiving.

I recommend that all couples do a preconception care program before conceiving, which at a minimum entails taking a high quality preconception care nutrient complex for 3-4 months before conceiving but if there are hormonal imbalances its important to work on this with a practitioner before trying to conceive.

Complications with breastfeeding

A lesser-known complication with PCOS is that it can cause some difficulties with breastfeeding and milk supply – however, this can also be supported by working on hormones before pregnancy, and with the support of a lactation consultant after birth. Thankfully not all women with PCOS experience difficulties breastfeeding and the information that says it is potentially problematic is only based on small studies. In the research that we do have available, the breastfeeding difficulties were only experienced in the first 3 months and seemed to regulate after that time.

Breastfeeding requires the hormones prolactin and oxytocin to work properly, but we also need adequate progesterone during pregnancy for the breast tissue to develop properly. Insulin resistance and high androgens can affect hormones in all these aspects.

How to manage PCOS

There are so many options for treating PCOS, and as it usually the case with naturopathic remedies, you get the best results when you are treated holistically. This means considering various things like what exactly is happening with your PCOS subtype.

The information I am giving you is a starting point to take to your practitioner to discuss whether it is right for you and to give you hope that there are so many possibilities to help.

while there have not been studies finding some remedies that tend to be universally helpful for most PCOS sub-types, and one of that does seem to be of great benefit is the amino acid Inositol. Taking 2g twice a day is my recommended dose for this.

Diet and lifestyle changes are great for treating insulin resistance, and while it’s tricky to find research specifically for this in PCOS we know it helps address the cause.

I recommend 150 minutes of exercise a week, which can be split into small blocks of exercise such as 30 minutes 5 times a week, or larger chunks such as 50 minutes three times a week. Eating a low GI/GL diet is also very important to address insulin resistance, and having a diet rich in antioxidants and low in inflammatory foods is also very helpful.

If you are overweight and have PCOS, then aiming to lose 5-10% of your body weight is a fantastic goal, and this amount seems to be the magic number that improves fertility rates and reduces risks for diabetes. Losing weight ideally would be done through a combination of diet and exercise.

Nutrients such as magnesium, b vitamins, particularly activated B vitamins, vitamin D and chromium can also be helpful.

Omega-3 fatty acids such as fish oil or algae oil can also help with some of the components of PCOS such as high cholesterol and inflammation.

Other herbs that I would consider is Berberine containing herbs such as Phelledendron which helps with improving insulin resistance and regulates blood lipid levels. There is also evidence showing that Black Cohosh can be helpful alongside other PCOS treatment.

The combination of Peony and Licorice has been looked at in Chinese medicine studies, and this is still a good inclusion in treatment, depending on the individual. Bulgarian Tribulus can also be helpful to regulate ovulation.

Spearmint can be helpful to reduce excessive androgens. I like this when used in a tea and is why I included it in one of my tea blends that supports skin health, to address this aspect.

Supporting gut health is also very important, as a poor microbiome can impair metabolism and worsen inflammation. So eating a diet rich in vegetables with lots of diversity is fantastic for improving the flora diversity in the gut, but it can also be helpful to take probiotics or prebiotics, so discuss this with your practitioner to make sure you’ve got the right type for you.

References

Bahri Khomami, M., Boyle, J. A., Tay, C. T., Vanky, E., Teede, H. J., Joham, A. E., & Moran, L. J. (2018). Polycystic ovary syndrome and adverse pregnancy outcomes: Current state of knowledge, challenges and potential implications for practice. Clinical Endocrinology, 88(6), 761-769. https://doi.org/10.1111/cen.13579

Bahri Khomami, M, Joham, AE, Boyle, JA, et al. Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review, meta‐analysis, and meta‐regression. Obesity Reviews. 2019; 20: 659– 674. https://doi.org/10.1111/obr.12829

Fernandez, R. C., Moore, V. M., Van Ryswyk, E. M., Varcoe, T. J., Rodgers, R. J., March, W. A., Moran, L. J., Avery, J. C., McEvoy, R. D., & Davies, M. J. (2018). Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nature and science of sleep, 10, 45–64. https://doi.org/10.2147/NSS.S127475

Guerrero-Bosagna C, Weeks S, Skinner MK (2014) Identification of Genomic Features in Environmentally Induced Epigenetic Transgenerational Inherited Sperm Epimutations. PLOS ONE 9(6): e100194. https://doi.org/10.1371/journal.pone.0100194

Guo Z, Qiu H, Wang L, et al. Association of serum organochlorine pesticides concentrations with reproductive hormone levels and polycystic ovary syndrome in a Chinese population. Chemosphere. 2017 Mar;171:595-600. DOI: 10.1016/j.chemosphere.2016.12.127.

Holton, S., Papanikolaou, V., Hammarberg, K., Rowe, H., Kirkman, M., Jordan, L., McNamee, K., Bayly, C., McBain, J., Sinnott, V., & Fisher, J. (2018). Fertility management experiences of women with polycystic ovary syndrome in Australia. European Journal of Contraception and Reproductive Health Care, 23(4), 282-287. https://doi.org/10.1080/13625187.2018.1483020

Mo L, Mansfield DR, Joham A, et al. Sleep disturbances in women with and without polycystic ovary syndrome in an Australian national cohort [published online December 26, 2018]. Clin Endocrinol (Oxf). doi:10.1111/cen.13922

Rosenwaks, Z. (2017). Polycystic ovary syndrome, an enigmatic syndrome begging for a name change. Fertility and Sterility, 108(5), 748–749. https://doi.org/10.1016/j.fertnstert.2017.09.030

The post A Holistic Guide to PCOS appeared first on Alison Mitchell Naturopath.

All of your hormones and hormonal glands have an intricate relationship with each other, giving each other feedback and having an influence on each others levels. A little bit of a one hormone going up can cause another to go down, and so imbalances can have a flow on effect which can cause many symptoms.

A major connection to consider is the link between your thyroid health and your oestrogen and progesterone levels.

We know excessive levels of oestrogen can have an impact on thyroid health, with too much oestrogen making your thyroid balance go out of whack, but how does it actually do this?

Essentially…

Oestrogen can raise thyroid binding globulin, which will lower free thyroid hormone levels.

This can be a problem for women who are on artificial hormones such as the oral contraceptive pill, or for women who have higher than normal levels of oestrogen in their system.

Typically this will show up as heavy periods and longer menstrual cycles. The increased oestrogen results in a relative deficiency of progesterone which is responsible for the thinning of the endomentrial lining. It can also impact on the coagulatory factors in the blood which control excessive bleeding.

Potenially thyroid problems can also contribute towards amenorrhoea, when your period disappears for a while.

Thyroid issues can also cause oestrogen to be bound up and carried away less than it should be, as thyroid problems can indirectly cause a reduced level of Sex Hormone Binding Globulin (SHBG) which would typically bind to excess levels of hormones such as oestrogen.

Oestrogen imbalance can be the missing piece of the puzzle for many women (and men) who have issues with T3 balance. It is a cycle that feeds itself until the original cause of the thyroid imbalance or oestrogen excess is addressed.

High Oestrogen -> Increased thyroid binding globulin -> low free thyroid hormone levels.

Low Thyroid Function -> Low SHBG -> High Oestrogen

An interesting action of oestrogen is that it can increase the proliferation of thyroid cells. This isn’t always a bad thing, as it can be helpful to regulate thyroid function and help the repair of the thyroid gland when oestrogen is in normal ranges. However in excess this could result in an increased risk of autoimmune thyroid disease or thyroid cancer.

Now we know that oestrogen isn’t the only female hormone. Progesterone is another important hormone for women, and it too has a connection with the thyroid hormones.

The thyroid – progesterone connection goes two ways. Thyroid helps stimulate release of progesterone from the luteal cells. Given this, we can consider that for some women who appear to have progesterone deficiency they may have underlying issues with their T3 hormone as the cause.

And progesterone deficiency can impact on the conversion of T4 to T3 via reduced deiodinase 2 activity. So for women who are post-menopausal, who have had an oophorectomy (ovaries removed surgically) or do not ovulate regularly (e.g in Hypothalamic Amenorrhoea or PCOS) the state of their thyroid is something to consider.

Imbalances in both progesterone and oestrogen can impact your immune system balance which can increase your risk of autoimmune disease, an issue which is common for thyroid problems.

If you suspect that you have an issue with your hormones and would like some holistic support or perhaps you would like to discuss testing options, contact your health care practitioner to discuss your options.

Book an Appointment

Extra reading

Your Thyroid Needs Iron

Heavy Periods

MTHFR and your Thyroid

Thyroid Problems After Having a Baby

Thyroid Health – Part 1

Understanding Underactive Thyroid – Webinar

References

Role of estrogen in thyroid function and growth regulation.  https://doi.org/10.4061/2011/875125

Clinical review: Thyroid dysfunction and effects on coagulation and fibrinolysis: a systematic review. https://doi.org/10.1210/jc.2007-0199

An evidence for the transcriptional regulation of iodothyronine deiodinase 2 by progesterone in ovarectomized rats. https://doi.org/10.1007/s13105-013-0307-y

Menorrhagia and hypothyroidism. Evidence supports association between hypothyroidism and menorrhagia. https://doi.org/10.1136/bmj.https://doi.org/10.1136/bmj.320.7235.649

Menstrual disturbances in various thyroid diseases. https://doi.org/10.1507/endocrj.k10e-216

Thyroid disease and female reproduction. https://doi.org/10.1111/j.1365-2265.2007.02752.x

The post Thyroid Problems and Oestrogen appeared first on Alison Mitchell Naturopath.

PCOS affects so many women but it’s not spoken about as much as it should be. This condition has many faces and because of that it can be really confusing to understand.

In this webinar I will help you to understand what’s going on in your body with PCOS , and what you can do to help it.

We will go through :

• What is happening in PCOS
• How is PCOS properly diagnosed
• What are the symptoms you might experience with PCOS
• What are some nutrients that you can take to help with PCOS
• How PCOS affects other hormones
• How you can improve PCOS with your diet
• Herbs that can help with PCOS

The live recording is 26th July 2019 – 12:30pm AEST

If you can’t make the life event there will be a replay available afterwards.

As an extra bonus you will receive 5 healing recipes to help with PCOS.

Related articles:

https://www.naturopathnsw.com.au/busting-pcos-myths

The post All About PCOS – Webinar appeared first on Alison Mitchell Naturopath.

Health & Wellbeing Podcast #29

Pelvic floor tightness, pelvic floor dysfunction, or hypertonicity of the vagina is when the muscles of the pelvic floor are too tight. This can cause pelvic pain for women that just doesn’t seem to make sense. They might experience pain during intercourse (dyspareunia or vaginismus), pain in relation to going to the toilet (1s and 2s), IBS and period pain that doesn’t get better with other treatment. These issues can be due to a tightness in one of the muscles of the pelvic floor, something which a women’s physiotherapist is able to help with.

Most women are well aware that the muscles of the pelvic floor can get weak, but tightness of these muscles is something that hardly anyone knows is even an issue. I didn’t appreciate how much this can be a problem until I attended the Endometriosis symposium and learnt about the connection between tight pelvic floor muscles and chronic inflammatory conditions of the pelvis. Since then I have been in awe about how much this issue can affect women, but moreso how little awareness of this is out there. Learning about this issue was a light-bulb moment for me and I hope that this podcast can be as eye opening for you.

In this episode I chat with women’s physio Brooke Hile about all things related to pelvic hypertonicity.

Listen on the Soundcloud website here or in the embedded player below.

Want to subscribe to get podcasts automatically? You can do that here:

iPhone   Stitcher   Youtube   Soundcloud

Get in Contact with Brooke:

Instagram @thingsdownthere
https://www.herhealthphysiotherapy.com.au

The post Pelvic Floor Tightness/Hypertonicity – Podcast #29 appeared first on Alison Mitchell Naturopath.

Polycystic ovarian syndrome is a condition that is affecting more and more women and girls – it affects 1 in 7 women worldwide making it one of the most common endocrine disorders to affect women of reproductive age.

This is one of the most common conditions that I see in our clinic, as women are usually frustrated by the lack of conventional treatment options available to them.  Unfortunately, this condition is often incorrectly diagnosed and misunderstood in a lot of women. It is also being increasingly diagnosed in young girls – often unnecessarily

It really seems that PCOS is becoming an epidemic, and information about this condition is greatly lacking!  PCOS is a 20th century condition, along with the increase of heart disease, diabetes and obesity.  And the reason they are all increasing together is because they are all being (mostly) caused by the same things.  We’ll get into what that is later, but first we should cover what PCOS actually is.

The name poly-cystic ovarian syndrome implies that the main feature of the condition is the presence of small cysts on the ovaries, however with current diagnostic criteria this is actually not required for a diagnosed, and not all women with PCOS have cysts on their ovaries.  This is just one of the possible symptoms that makes up this condition.

In this article I wrote for Western Sydney Mum’s Hub I discuss what PCOS actually is, as well as outline the symptoms of PCOS and debunk some myths. I also talk about the causes of PCOS, and my key natural treatments.

PCOS SYMPTOMS

Symptoms may include:

·       Irregular or absent periods

·       Insulin resistance (high insulin levels picked up in a blood test)

·       High testosterone (androgen) levels in a blood test

·       Hirsutism (Excess hair growth, usually in areas such as the lip, arms, lower back)

·       Acne

·       Sugar cravings

·       Blood sugar fluctuations (e.g. feeling irritable or dizzy if you skip a meal)

·       Weight gain or difficulty losing weight, especially from around the middle

·       Ovarian cysts (picked up by ultrasound)

·       Thinning head hair

·       Painful periods or pain on ovulation

·       Fertility problems including difficulty conceiving and increased miscarriage rates

·       Skin tags

·       High cholesterol levels

Diagnosis

The condition is diagnosed differently according to different criteria, however most commonly it is by the presence of 2 of the following 3 factors:

·      Irregular or absent ovulation/periods

·      High androgen levels (the male hormone) found in blood tests

·      Symptoms of high androgen levels such as hirsutism and acne.

·      Other conditions which cause these symptoms must be ruled out.

LET’S CLEAR UP SOME PCOS MYTHS

1. 1. Having cysts on the ovaries is not the main way of diagnosing PCOS. Not all women with PCOS have cysts, and as a stand-alone symptom having cysts on the ovaries isn’t enough to diagnose PCOS.
   2. It’s normal for cysts to grow on the ovaries – these are actually your ovarian follicles (or eggs) growing and releasing, however in PCOS these do not grow properly and this is what can result in the typical appearance of a PCOS ovary.
   3. PCOS doesn’t always affect your fertility negatively. This understanding is mostly based on people with severe cases of PCOS and so the understanding of to what degree it affects the fertility of those with milder forms of PCOS is lacking.
   4. You aren’t always stuck with PCOS for life. Many young girls who are diagnosed with PCOS can grow out of this condition by the 30s.
   5. The oral contraceptive pill is not the best way to treat PCOS. Yes it can bring on a regular, predictable bleed, but remember that this is not a true period, and the pill can make the condition worse after stopping.
   6. If you get period pain it is not due to PCOS – there is likely something else going on that is contributing to the period pain such as endometriosis or primary dysmenorrhea (the fancy term for period pain not attributed to an obvious cause). It is possible to have both endometriosis and PCOS.
   7. Thin women and girls can have PCOS too, and can still have insulin resistance.

Top causes of PCOS

Insulin Resistance

Nearly all cases of PCOS have insulin resistance.  Insulin resistance is when the cells have difficulty taking up glucose from the bloodstream, often resulting in an increased secretion of insulin, which worsens the symptoms of PCOS.

Even if your blood sugar levels are normal, you can still have insulin resistance. It is vital that insulin levels are tested too, but they aren’t always automatically done, so you may need to ask.

As I was mentioning earlier, I believe that insulin resistance is the link between these 20^th century conditions.   Insulin resistance can be a genetic problem, but the food choices that we make play the biggest role in the development of this condition.  Highly processed foods, refined carbohydrates and excess sugar are the evil culprits that lead to the development of insulin resistance by causing our blood sugar levels to be elevated over a long period of time.  Insulin is a hormone that is secreted by the pancreas in response to high blood sugar levels.  Its job is to put the sugar into the cells.  When the levels of sugar in our blood are high for an extended period of time, insulin is produced more and more, and our cells begin to ignore it (like in The Boy Who Cried Wolf).  This leads to high circulating insulin, and this is where the problem comes from.

Insulin is known for its ability to lower blood sugar levels.  The way that insulin does this is by storing the sugar in the form of glycogen – but the body can only store so much of this, and when it’s full the sugar gets stored as fat (most commonly in the abdomen, causing the typical apple body shape).

High androgen levels

Androgen are a group of hormones that includes testosterone. They may be called ‘male hormones’ but both men and women produce androgens, just in different amounts and with different actions.

There are a few different types of androgen markers that are tested in blood tests, including total testosterone, SHBG, androstenedione and DHEA.

For most women with PCOS the insulin resistance is usually the biggest issue which causes high androgen levels. However, for some (approximately 20%), high androgen levels may be present unrelated to insulin resistance, and this is most often due to stress.

Other causes

Sometimes there can be some less common causes of PCOS. This can include nutritional deficiencies (such as iodine or zinc), inflammation and thyroid disorders. For some women they may have developed PCOS because of taking the oral-contraceptive pill. Often this will resolve within about a year (herbal medicine can reduce this time frame to 3-4 months).

Key Natural Treatments for PCOS

What treatment is used for PCOS depends on the underlying cause and a practitioner can guide you further on this. These are some of my favourite treatment tools:

1. Test for and treat insulin resistance, typically with an exercise regime and a low-GI diet (you can read some tips for a Low GI, Nutrient Dense Diet here).
2. Cut out/down sugar in the diet.
3. Cut out/down dairy.
4. If androgen levels are high without insulin resistance, herbs and nutrients that can reduce the excess of this hormone include Saw Palmetto, Peony and Licorice, and the mineral Zinc.
5. If DHEA is high or there is a lot of stress around the time of puberty or currently, herbal medicine to support the nervous system such as nervine and adaptogen herbs, the mineral magnesium and B vitamins can be helpful.
6. The amino acid myo-inositol is helpful for supporting blood sugar levels and reducing anxiety and can be a great tool in the kit to treat PCOS.

If you or your daughter has been diagnosed with PCOS or you suspect that this may be an issue for you, seek advice from a naturopath experienced in this area as there is much that can be done to help.

The post Busting the PCOS Myths appeared first on Alison Mitchell Naturopath.

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.

Guest Post by Hayley Stockbridge

Acne vulgaris is a disease that affects the skin’s oil glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows.

Pimple prone skin and breakouts can be hard to control and often limited relief is seen with topical treatments alone. Unfortunately medical treatments are also limited and not ideal long term strategies. The oral contraceptive pill is often prescribed to women with hormonal acne which can have many long term side effects such as increased risk of some cancers, clotting disorders and hormonal problems once the pill is stopped. Daily antibiotics are another common medical treatment which can have huge ramifications on long term microbial balance and gut health. The last resort is roaccutane, a drug that has been linked to depression and causes a huge drying effect on the skin to the point of having flaky and dry lips, eyes and hands.

The key to successfully controlling acne is to determine what is causing it in the first. For some this can be obvious (such as a poor diet or hormonal acne) while for others there may be a combination of contributing factors. The following list documents some of the most common causes of acne from a Naturopathic perspective:

1.  Acne on the chin and jaw line is often hormonally driven; particularly in females however can be present in these areas in males as well. Acne that gets worse premenstrually or at ovulation will also have a hormonal influence.

2.  Acne on the chest and back is thought to be due to generalized toxicity. This is often seen with a poor diet. This may include a diet high in sugars, processed foods or junk foods. This type of acne can be addressed by undertaking a simple detoxification program to clean out the body and lymphatic system.

3.  If present on the cheeks, this is often due to a sluggish digestive system or colon toxicity. These patients often have a history of digestive issues and may suffer from constipation, gas or bloating. This acne can be reduced by improving digestive function, regulating the bowels and following a high fibre diet.

4.  High sugar diet or high glycaemic index diet can cause acne by increasing circulation levels of insulin. This then causes an imbalance in androgen levels, which triggers an increase in sebum production under the skin. The best way of dealing with acne is balancing blood sugar levels and reducing circulating insulin. This is particularly prevalent in women with PCOS. A low sugar diet has been well researched to improve acne and is one of the best ways to control breakouts in the long term.

5.  A high dairy diet has also been linked to acne. Dairy products are acidic and inflammatory and many of my patients have been able to control their breakouts by reducing dairy intake.

6.  An infection with the bacteria Propionibacterium on the skin will also make any current acne or breakouts worse. This can be controlled by improving the immune response using either nutritional or herbal medicines. Topical application of tea tree oil diluted with some warm water also helps to keep this bacteria at bay. Start by applying each night before bed and after washing your face.

7.  A Zinc deficiency can lead to poor skin health and acne. Zinc is essential for skin healing as well as immune regulation. Supplementing with zinc helps to ensure scarring does not take place as the skin improves.

8.  A Vitamin A deficiency can also contribute to acne. Vitamin A supplementation helps to reduce sebum production under the skin and therefore goes a long way to improve skin health.

9.  Poor liver function can contribute as our liver is our major detoxification organ responsible for flushing toxins out of the body. If your liver is sluggish, toxins and waste products are not effectively cleared from the body and need to escape somewhere- this is often through the skin. A healthy liver makes a huge difference for health skin.

Hayley Stockbridge, Naturopath

B. App. Sc (Nat Stud) Post Grad Dip Nat

Hayley is a Naturopath at Better Health Practice in Stanmore, and Sydney Health and Fertility, Manly NSW. A passion for a healthy lifestyle lead her to become a Naturopath. With over 6 years of experience in the industry, a passion for a healthy lifestyle lead her to become a Naturopath.  Her major focus is always educating her patients to live healthier and happier lives. She treats women, men and children of all ages and a wide variety of health issues such as weight loss, digestive problems, anxiety/stress, food intolerances and headaches.

Check out her website for more information www.hayleystockbridge.com.au

Related Posts:

A Naturopathic Approach to Acne – Podcast
Surviving the Teenage Years, Acne
Busting the PCOS Myths

The post What’s causing your acne? appeared first on Alison Mitchell Naturopath.