Understanding and treating missing periods naturally.

Hypothalamic Amenorrhoea (HA) is a condition you may have been hearing about more frequently lately. Despite being a bit of a mouthful to pronounce, this condition is unfortunately more common than many women realise. In simple terms, HA occurs when your brain stops communicating properly with your reproductive system, causing your periods to go completely AWOL! Let’s explore this condition in depth to help you understand what’s happening in your body.

Understanding Primary vs Secondary Amenorrhoea

Before diving deeper, it’s important to understand the difference between primary and secondary amenorrhoea:

Primary amenorrhoea refers to when a young woman hasn’t started menstruating by age 16, despite having undergone other normal pubertal development.

Secondary amenorrhoea, which includes Hypothalamic Amenorrhoea, occurs when menstrual periods that were previously normal and regular stop for three or more consecutive months in a woman who was previously menstruating.

Photo by Rodolfo Sanches Carvalho on Unsplash

What is Hypothalamic Amenorrhoea?

Hypothalamic Amenorrhoea exclusively affects women, as it’s directly related to the female reproductive system. This condition is characterised by the absence of menstrual cycles for three months or longer, and in some serious cases, periods can disappear for years.

HA stems from disruptions in your hypothalamus function – a small but mighty structure located in your brain. The hypothalamus serves as the control centre for numerous vital bodily functions, including:

• Regulating body temperature
• Managing hunger and thirst signals
• Controlling blood pressure
• Governing your sleep-wake cycle
• Influencing sex drive
• Orchestrating hormone production and activity

When the hypothalamus senses that your body is under stress, it responds by reducing the production of gonadotropin-releasing hormone (GnRH), which subsequently affects the release of follicle-stimulating hormone (FSH) and luteinising hormone (LH) – both crucial for ovulation and menstruation.

What Causes Hypothalamic Amenorrhoea?

Several factors can trigger this protective response from your body:

• Nutritional deficiencies or inadequate caloric intake: Your body needs sufficient energy to maintain reproductive function
• Excessive exercise or overtraining: This can occur across many activities and sports, not limited to any particular field. Even regular fitness enthusiasts can experience HA if their exercise regimen is too intense relative to their individual needs and caloric intake
• Chronic or elevated stress levels: Both psychological and physical stress can disrupt hormonal balance
• Low body weight or rapid weight loss: Even if you’re not clinically underweight
• History of oral contraceptive use: Some women experience delayed return of menstruation after stopping the pill
• A combination of these factors: Often multiple stressors compound the effect

It’s important to note that susceptibility to HA varies significantly between individuals. Some women can maintain intensive exercise routines or experience temporary stress without losing their periods, while others are more sensitive to these factors. This is why comparing your diet and exercise regime to others isn’t a good idea – your body has its own unique thresholds and requirements.

Many women experiencing HA don’t fit any stereotype. Even moderate caloric restriction combined with regular exercise and everyday stress can be enough to trigger this condition in susceptible individuals.

Why Does My Body Stop Menstruating?

From an evolutionary perspective, your body has sophisticated mechanisms to protect you during times of perceived threat. When your brain detects signals of potential famine (insufficient calories), physical danger (excessive exercise), or emotional threat (chronic stress), it essentially puts reproduction on the backburner to conserve energy for survival.

Think of it as your body’s wisdom – if resources are scarce or conditions aren’t optimal, it’s not an ideal time to support a pregnancy. Your body prioritises vital functions over reproductive capabilities until conditions improve.

The intricate hormone cascade that regulates your menstrual cycle requires everything to be working in harmony. When disrupted, the delicate balance of oestrogen, progesterone, LH, and FSH becomes compromised, resulting in anovulation (lack of ovulation) and subsequently, no menstruation.

It’s important to note that while HA is a common cause of secondary amenorrhoea (periods stopping after they’ve been established), other conditions such as PCOS, thyroid disorders, and premature ovarian insufficiency can present similarly. This is why proper diagnosis through a healthcare provider is essential.

Signs and Symptoms of Hypothalamic Amenorrhoea

Beyond the obvious absence of menstruation, you might experience:

• Low energy levels and fatigue
• Mood changes, including anxiety or depression
• Disrupted sleep patterns
• Reduced sex drive
• Dry skin and brittle hair
• Cold intolerance (feeling cold frequently)
• Bone density concerns (if prolonged)
• Difficulty concentrating
• Digestive changes

Comprehensive Approach to Managing Hypothalamic Amenorrhoea

Restoring your menstrual cycle requires a holistic approach targeting the root causes. As a naturopath, I find that a balanced strategy incorporating lifestyle modifications, nutrition, targeted herbs, and supplements offers the most effective path to recovery.

Nourishing Nutrition for Hormone Health

• Increase caloric intake: Most women with HA need at least 2,000-2,500 calories daily, sometimes more depending on activity level and body composition
• Prioritise carbohydrates: Adequate carbohydrate intake is absolutely crucial for hypothalamic function and hormone production. Your brain relies heavily on glucose, and including plenty of complex carbohydrates is essential. Include foods like sweet potatoes, pumpkin, whole grains (freekeh, quinoa, buckwheat, rice), sourdough bread, legumes, and starchy vegetables to provide essential energy for hormone production
• Include quality protein: Aim for 1.2-1.8g per kg of body weight from varied sources like eggs, fish, legumes, and quality animal products
• Prioritise healthy fats: Your reproductive hormones are made from cholesterol and require adequate fat intake. Include avocados, olive oil, nuts, seeds, and fatty fish in your diet
• Don’t fear dietary fat: 30-40% of your calories should come from healthy fats to support hormone synthesis
• Support gut health: Consume fermented foods (yoghurt, kefir, sauerkraut) and prebiotic fibres to maintain the gut-hormone connection (Note: fermented foods may not be suitable for those with histamine intolerance)
• Important: Under no circumstances should you attempt a low or no-carb diet when dealing with HA – your body needs carbohydrates to signal reproductive safety

Supportive Lifestyle Practices

• Effective stress management: Practice daily meditation, journalling, or gentle breathwork
• Prioritise sleep quality: Aim for 7-9 hours of uninterrupted sleep in a cool, dark room
• Connect with nature: Forest bathing (shinrin-yoku) has been shown to reduce cortisol levels
• Sunlight exposure: 15-30 minutes of morning sunlight helps regulate circadian rhythms and vitamin D production, both crucial for hormone health
• Mindful breathing: Practice 4-7-8 breathing (inhale for 4, hold for 7, exhale for 8) several times daily to activate your parasympathetic nervous system
• Create boundaries: Learn to say no to excessive commitments that contribute to your stress load

Appropriate Exercise Modifications

During recovery from HA, it’s crucial to scale back high-intensity exercise until regular menstruation returns. Consider these gentler alternatives:

• Restorative yoga: Focus on yin or gentle hatha practices that activate the relaxation response
• Pilates: Build core strength without excessive cardio stress
• Mindful walking: Particularly in natural settings at a conversational pace
• Gentle swimming: Non-weight bearing and relaxing for the nervous system
• Mobility work: Maintain flexibility without taxing your adrenal system

Once your cycles have returned consistently for 3-6 months, you can gradually reintroduce more intensive exercise while carefully monitoring your menstrual health.

Herbs & Supplements for Hormonal Support

Herbal Allies:

• Adaptogenic herbs: Help balance the body’s stress response and support adrenal function
  • Withania (Ashwagandha): Helps reduce cortisol and supports thyroid function
  • Rhodiola rosea: Enhances stress resilience and energy without stimulation
  • Holy Basil (Tulsi): Balances stress hormones and supports metabolic health
• Nervous system supporters:
  • Chamomile: Gentle calming effect without sedation
  • Passionflower: Reduces anxiety and promotes restful sleep
  • Lemon balm: Uplifts mood while calming the nervous system

Targeted Supplements:

• Acetyl-L-carnitine: Supports LH production and egg quality
• Magnesium glycinate: Essential for over 300 enzymatic reactions, including hormonal pathways (300-450mg daily)
• Zinc: Critical for reproductive hormone function and thyroid health (15-30mg daily)
• Vitamin D3: Many women with HA have insufficient levels (2000-5000 IU daily, based on blood levels)
• B-complex vitamins: Support energy production and stress response
• Omega-3 fatty acids: Provide building blocks for hormone production (1-3g daily)

When to Seek Professional Support

Recovery from Hypothalamic Amenorrhoea typically takes 3-12 months, depending on the severity and duration of the condition. While some women see improvements within weeks of implementing these changes, others require more time and personalised support.

If you’re experiencing:

• Absence of periods for more than 3 months
• Symptoms that significantly impact your quality of life
• Concerns about fertility or bone health
• Difficulty implementing lifestyle changes alone

It’s time to seek professional guidance. As a naturopath specialising in women’s hormonal health, I can help identify the specific factors contributing to your HA and create a personalised recovery plan that addresses your unique needs.

Your Path to Hormonal Balance Starts Here

Hypothalamic Amenorrhoea is not just about getting your period back—it’s about restoring your body’s natural rhythms and creating sustainable health practices that support your hormonal wellbeing for life.

If your periods have disappeared or become irregular and you suspect Hypothalamic Amenorrhoea might be the cause, I invite you to book a consultation today. Together, we’ll investigate the root causes of your hormonal imbalance and develop a comprehensive plan to restore your menstrual health naturally.

Your body wants to heal—sometimes it just needs the right support to find its way back to balance.

References

Abou Sherif, S., Newman, R., Haboosh, S., Al-Sharefi, A., Papanikolaou, N., Dimakopoulou, A., Webber, L. J., Abbara, A., Franks, S., Dhillo, W. S., & Jayasena, C. N. (2021). Investigating the potential of clinical and biochemical markers to differentiate between functional hypothalamic amenorrhoea and polycystic ovarian syndrome: A retrospective observational study. Clinical endocrinology, 95(4), 618–627. https://doi.org/10.1111/cen.14571

Gordon, C. M., Ackerman, K. E., Berga, S. L., Kaplan, J. R., Mastorakos, G., Misra, M., Murad, M. H., Santoro, N. F., & Warren, M. P. (2017). Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism, 102(5), 1413–1439. https://doi.org/10.1210/jc.2017-00131

Meczekalski, B., Katulski, K., Czyzyk, A., Podfigurna-Stopa, A., & Maciejewska-Jeske, M. (2014). Functional hypothalamic amenorrhea and its influence on women’s health. Journal of endocrinological investigation, 37(11), 1049–1056. https://doi.org/10.1007/s40618-014-0169-3

Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R., & Ljungqvist, A. (2014). The IOC consensus statement: beyond the Female Athlete Triad–Relative Energy Deficiency in Sport (RED-S). British journal of sports medicine, 48(7), 491–497. https://doi.org/10.1136/bjsports-2014-093502

The post Hypothalamic Amenorrhoea – When your periods go AWOL appeared first on Alison Mitchell Naturopath.

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.

Guts and Girl Bits Episode #50

As we reach the end of Endometriosis Awareness Month I wanted to release a little recording I made a while ago for women’s health week, in which I spoke about Endometriosis.

Endometriosis is a condition that can significantly affect a woman’s quality of life, however, there is a lack of awareness and understanding of this condition.

It is estimated that 1 in 7-10 women may have this condition, however it can take many years to receive a diagnosis. In this video discuss some considerations of addressing this condition with naturopathic medicine, addressing the root causes of immune imbalance.

Watch the Video:

Listen to the audio:

Subscribe and listen to the other podcasts here:

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Related posts:

Endometriosis

10 Ways to reduce period pain

Updates on Endometriosis

Heavy periods

Choosing the right products for that time of the month

Thrush

Transcript

0:08
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 healthcare practitioner.

0:31
It’s the end of March and March is Endometriosis Awareness Month. So I wanted to share a little video that I recorded a couple of years ago for Women’s Health Week as my latest podcast because in that video, I share all sorts of information about endometriosis, and about how to get to some of the underlying drivers that causes it. So I hope that that’s helpful for you. There has been more research coming out since then, as well. But most of the new stuff that I shared in that one is still relevant. So if you want to hear more information, then please subscribe to me on @gutsandgirlbits. And stay tuned as well for all my e courses that are coming out all about how to understand yourself by understanding your cycles and understanding your hormonal balance in more depth, which you can find over at my teachable account, which is gutsandgirlbits.teachable.com

1:30
Hey, everyone, I want to talk about endometriosis today. This is the last day of Women’s Health Week. So I wanted to finish it off by talking about a condition that I really love treating and that’s that’s endometriosis. So if anyone doesn’t know what endometriosis is, basically, it’s a painful condition that affects women. And it affects almost one in seven women approximately. And it can cause quite a lot of issues. So what’s what seems to be happening is that we women get these endometrial cysts, also known as endometriomas, or chocolate cysts, which are basically the content of the lining of the uterus being where it shouldn’t be. So when we normally have our period, what should be happening is that the lining should just you know, break down and dissolve and come out as normal menstrual blood. But sometimes what’s happening is that this isn’t staying in the uterus. This is actually forming little adhesions or cysts elsewhere in the body, such as around the lining around the outside of the uterus or in the fallopian tubes or stuck to the ovaries. And it can also happen in their peritoneal cavity where it’s actually attaching to the intestines, the bowel, bladder and those sorts of things.

2:55
So back up back when I was a student naturopath, we were taught that endometriosis is a condition caused by a hormonal imbalance. But with recent research, what we’ve come to understand is that endometriosis is actually an immune condition or an inflammatory condition. So it does have a hormonal component. There is certainly a hormonal driver behind endometriosis. And that is estrogen, but the immune system is actually the biggest player when it comes to endometriosis. And so there are a lot of different factors that actually feed into why the immune system is disrupted in the first place. But what we what we’re finding is that inflammation, in particular, coming from histamine imbalance, and coming from genetic imbalances and gut health is some of the biggest issues that seem to be driving our immune immune dysfunction. So there’s currently not really a great testing option available for endometriosis. It’s unfortunately something that can only be definitively diagnosed with a laparoscopy, which is a type of keyhole surgery where there will be some small incisions made in the abdomen, abdomen, and then they go in with a little camera. And so if they can see the presence of these chocolate cysts, then that’s confirmative of endometriosis. But the laparoscopy at the same time can be used as a treatment. But that’s not that’s not always the best option for every woman. Because for some women who are particularly inflamed or have a strong immune activation, then the actual incision or the actual surgery itself can actually worsen endometriosis. There, they will find that they might actually get some further adhesions developing where those original cysts were removed. There seems to be more of an issue when the laparoscopy is performed with the laser where it’s actually burnt off rather than incised. And that’s that’s something that again, has only really been discovered recently, but it seems to be

5:00
You know, while it’s a good thing for some women, but not for every woman, and again, it goes to show that endometriosis is a really, really complex condition. And so because of that complexity, everyone needs to be treated a little bit differently. And we need to try and figure out the cause of what’s going on for those women. So there’s a few, you know, possible causes as to why women can have that particular immune imbalance. And one of those things is a gut imbalance, so and or an infection. So if you’ve got an infection, then your immune system is going to be disrupted. And then if you’ve got that genetic tendency for endometriosis to go wrong, then that’s where it’s going to go out of whack for you. There’s some some naturopaths in the field at the moment that are doing research in this and they’re finding that there’s actually a whole different microbiome, which is your bacteria balance within the peritoneal cavity, which is basically the fluid that our organs swim in, and also within the vagina itself within our reproductive organs. And so if they are out of balance, if that microbiome in that area is out of balance, and our immune system is going to be unhappy, and correcting that can be helpful. Dealing with infections can also be really helpful to under to address that underlying imbalance. Now, the other thing that can sometimes happen is because what we know that it’s an inflammatory condition, and there’s an immune imbalance going on, but there’s certain genetics that are involved in that issue. And I find that the mthfr gene, which is a pretty common gene to have, and it doesn’t having the gene doesn’t always mean that there’s an issue, but it’s if that gene is not acting properly, then it affects the enzyme that deals with a lot of different processes in the body. But in regards to endometriosis, in particular, it affects our our main antioxidant recycler, glue to fire recycling of glue to fire. And now, if we don’t have enough antioxidants in endometriosis, then we can’t really mop up all that immune damage that’s going on. So it makes the inflammation worse. And so then, as a result, that makes pain worse. And that can also, you know, make all those other sorts of reactions worse as well.

7:17
One of the things that we also find going on is that mthfr gene affects the detoxification of certain hormones throughout the liver. And if we’re not detoxifying our hormones effectively, then we get that recycling and that uptake of those hormones through through the system, and so then we lead to having too much of certain hormones where they shouldn’t be.

7:41
In the case of endometriosis, what we used to think, as I said before was that it was a excess of oestrogen. But in this case, it seems to be that it’s a displacement of estrogen. So there’s too much estrogen being activated in the area of the endometrial tissue lining going on. And that’s causing a reaction with some of our other immune chemicals. So one of these immune chemicals is histamine. So histamine, can you probably know about histamine as an allergic sort of issue like, you know, hay fever and sneezes and rashes, and, and all of those. Well, when are mast cells, the immune cell that causes the histamine to be in excess is actually in reaction to the estrogen. And that causes more of that inflammatory reaction. And so then, you know, you get the pain and the redness and, and those painful reactions, that’s so common with endometriosis. And as a result of the inflammation that takes place, then when there is that, I mean, immune activation in that area, that’s why we’re more you’re more likely to actually get adhesions forming. And so this can be a really big problem for women with endometriosis is that the adhesions can cause a lot of damage, they can stick for free, you can stick your organs together, you can get the uterus can be stuck to the bow or bits of the bow can be stuck together. It can, you can have the bladder being involved as well. And all of that can cause quite a lot of pain. And it can also affect fertility quite significantly as well.

9:14
Now, and adhesions do seem to have a bit of a problem and that they can only really be resolved with surgery. So as we were talking about before that surgery isn’t certainly a good option for some women, but it’s not not the first line option for every woman. It’s actually better if you can try and get on top of endometriosis in the early days. But the thing with endometriosis is that it’s actually a condition that a lot of people are getting dismissed and missed about, if that makes sense. What I mean is that women are going to and young girls are going to their doctors and they’re complaining of pelvic pain, period pain, and they’re basically getting dismissed and it seems to be about 70% of young women with endometriosis are getting dismissed and that’s a huge number 70% so if we can get on top of this condition in the early days before adhesions formed and things are going to actually work out a lot better for these women what we need to do is we need to have the funding into a better research system but we also need to have more awareness and women need to be more empowered and educated so that they can make make these make these choices make ask the right questions so i think the fact that the main testing method is a form of surgery is probably pretty off putting but we can do a lot in terms of natural treatment and dietary techniques to actually take this under control one of the things we need to do is to get our gut flora and underbalanced under control and we also need to look at reducing our inflammation levels throughout diet for a lot of women with endometriosis one of the main inflammatory things that’s going on is that they intolerant to certain foods and the key food that i find a lot of women are reacting to is is actually dairy or cow’s protein in particular and this can be you know pretty hard to give up for a lot of women but getting that out of the system can make a big big difference now we also need to look at supporting that mthfr gene which is the one that i was talking about before so the mthfr gene basically it works on a particular enzyme which is can never remember the name of it and let me find it – methylenetetrahydrofolate reductase – and basically that works on the conversion of our fault for late into its activated form in the body now it’s more than just taking folic acid in fact if you’ve got issues with this gene you probably shouldn’t be taking folic acid you should be taking different b vitamins or activated b vitamins and so this is where it gets pretty complicated because depending on what you’ve got going on with this whole methylation pathway taking methylated b vitamin can actually make you feel a lot worse because you can be methylating too fast or too slowly and so if you’re methylating too slowly and you take methyls then that’s going to make you feel like help so we don’t want to do that so that’s where you know seeing a practitioner can come in really handy but if you can get your methylation under control that does a few things it brings histamine into balance it improves your detoxification of your hormones through the liver and it can dampen that immune dysregulation and therefore inflamed inflammation that’s going on so those are some really key things that’s going on and one of the other things is that it really really really helps with your glue to fire and recycling which is what you need to mop up all that damage that’s taking place now there are a lot of other things that we want to work on with endometriosis and as we’ve said a few times get that inflammation level under control so one of my favorite things to do is Turmeric. now turmeric does have a little bit of a blood thinning properties so depending on what your your bleeding is like if you tend to be quite heavy bleeder it might not necessarily be the thing there’s something called VAGF which is basically your some women have a higher level of capillary growth to these endometrial lining and certainly doesn’t happen with everyone but actually getting improved mop up of that area can be quite helpful with certain again immune herbes and things like that as well we also want to again work on those antioxidant levels so working on methylation is helpful but herbs and nutrients that will actually help with your antioxidant levels can be helpful to one of those is n acetylcysteine or you potentially taking gluta thione itself but n-acetylcysteine is a lot cheaper and also it can be converted into the body in the body to glorify and so that’s something that can be quite helpful for people as i was talking about before in terms of diet you want to reduce the foods in your diet that you might potentially be intolerant to that could potentially cause some inflammatory reaction for you so those are some things that you want to do and you also want to work on while it’s not hormone only cause to condition it is hormonally affected so if we can work on getting estrogen detoxification under control then that’s going to help with the estrogen displacement that’s going on some people might know that sort of concept as estrogen dominance what’s really happening though is that there’s too much estrogen in the wrong place not that there’s necessarily a lot of estrogen everywhere going on because for women with with this sort of condition they might actually experience some symptoms of estrogen deficiency like you know brain fog or hair loss and skin dryness and thinning and that sort of thing but then in other instances they’re going to be experiencing symptoms of estrogen excess such as their their period abnormalities and or pms symptoms and those sorts of things so again it comes down to the individual so that’s where you know seeing a practitioner can actually be really helpful to get that under control

15:35
so i think i’ve kind of rambled a little bit there that seems to happen when there’s topics that i’m quite passionate about i guess one of the take home points that i really want to say with endometriosis is that we know a lot more about it now we know more about the immune involvement about the inflammatory involvement and so because of that we can actually do so much more for it we can actually get really better treatment happening and so if you know if you if you were seeing a naturopath for endometriosis five or 10 years ago you’d get completely different treatment most of the time now so i would say you know if you want to get some treatment ask your naturopath what they think is the main cause of it what they would do to treat it and if they’re talking about some of these new research that’s going on then give it another try because i have a lot of patients with endometriosis nowadays that i get real good success with and we follow these these routes of look at the infections that might be driving immune imbalance and support methylation support the detoxification of the estrogen but as less of a priority you got to get all those other factors under control get that inflammation down once that see improves things start to get better for them much quicker than it used to back when i first started trading where it would take you know a good half a year’s 12 months maybe to get things much better under control whereas now it’s it’s you know half a year mostly it does always depend on the person always depends on the severity of the condition as well you know for some women their endometriosis is so severe that you know surgery is what is really really required and sometimes even going on something taking something like the marina or getting the marina in is important because that actually helps to improve local progesterone in the uterus and so that can help to improve that imbalance and so if you’ve got less of that estrogen activity taking place then you get to have less of that histamine reaction most of that immune reaction going on so you know one of the first things i would say is get your gut the gut microbiome in the gut and also in the vagina under control is blackmores women’s bio balanced is a product that i do recommend as a retail option there’s also practitioner ones that i use Femex have you know a really fresh diet full of antioxidant rich foods lots and lots of veggies eat your rainbow every day those things are really really important and you also really want to get your stress under control because i mean as you know stress has a big role and a lot of different things so we’ve got this thing called the the hpa axis hpo axis hpt axis where all of our hormones are talking to each other all of the time and if there’s some other things going out of balance for instance our hpa axis which is where our adrenal glands are out of balance that’s going to throw out our hbo axis which is where we’re talking to our reproductive hormones so we want these to be under control and calm so doing some mindfulness and some meditation taking stress herbes taking all your nutrients those are really important too in regards to nutrients i mentioned in acetylcysteine i think that can be really helpful but i also do think that you need to get your core reproductive nutrients under control so that’s firstly get using copper ratio right because excess copper can affect your estrogen levels i also think that you need to get adequate magnesium for your stress levels also to reduce into smooth tissue cramping and calcium is important too you need to have that right ratio going on and i and is is really important so you don’t want to have too much iron because iron in excess can cause oxidative stress which can be inflammatory but if you’re into if you’ve got insufficient levels of iron then you’re going to be more likely to bleed more and that’s going to be a big factor for a lot of women a lot of women with endometriosis have really really heavy blades so we don’t want that that with iron that’s one of the things that i always recommend getting iron levels tested before starting supplementation and get the dose, right? I think vitamin D is important vitamin D is really important for your immune health. And I recommend getting your vitamin D levels over, over 80. You don’t want it to be higher than 150 or so.

20:19
And you also need to be considering things that are going to help to bring down your inflammation levels. As far as Herbs and so I’ve said, I’ve said tumeric, I do love tumeric. But again, you just got to be a little bit careful with it, depending on the periods. And I also think that good quality, facials can be helpful, but the same same sort of thing. Although they do they, we’ve always had this bit of a concern with fish oils is that you know, they can cause they can cause a blood thinning activity, or they could cause excessive bleeding. But some studies that actually measured the amount of bleeding that you create with officials has shown that it doesn’t seem to actually cause that greater quantity. So it’s not like you know, you’re going to bleed out or you’re going to have like massive amounts of blood loss or anything like that. Anyway, so activated B vitamins and stay away from synthetic B vitamins, and try and also stay away from foods that are fortified with synthetic B vitamins too, because while not everyone has this mthfr gene, if that mthfr gene enzyme gets unhappy, regardless of the genes presence or not, then that’s going to cause issues with all of those other factors. So it’s going to cause issues with the histamine, the hormones, the antioxidants. So all of those things that we want to work with. Thank you all so much for listening. I hope that you’ve enjoyed today’s episode. Please join me over at the Guts and Girl bits Instagram page and share any other words of wisdom that you would like to contribute as well. TGuts and Girl Bits now has a collection of E courses that you can view online. The primary course available at the moment is natural menopause support, which provides a whole heap of information on supporting yourself through the major symptoms of metaphors and easing through this transitional life. You can find the collection of E courses at ghttp://gutsandgirlbits.teachable.com. And then you’ll also find a course of understanding underactive thyroid, and coming up soon will be a courses called The 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 Endometriosis- Natural Management Options appeared first on Alison Mitchell Naturopath.

Guts and Girl Bits Episode #49

Hi everyone, welcome to another episode which I’m so pleased to be able to share with you. Have you ever thought about the things that you wish you’d known when you were younger? Or what advise you would give yourself in the past, or what you’d wish for your children?

As I watch my children growing I find myself thinking of all the things I need to remember to teach them, to show them, wisdom I wish I’d learnt earlier in life.

A little while ago I asked those of you who follow the Instagram page for guts and girl bits what you’d love to hear about, and a common response was how to help your daughters.

It certainly matches a topic for an episode I’d been thinking about, and so this episode was born. I have approached several of my friends and colleagues who are wise women and asked them to share a piece of wisdom or advise to the future generation of girls. The result was an incredibly beautiful and inspiring collection of wisdom that at times reads like poetry.

I will mention that I certainly don’t mean to exclude males in this episode, but have focused this topic here based on two reasons – the requests for the topic from listeners, plus the fact that I work with women’s health predominantly and so it happens that not just this episode, but most of my podcast episodes are centred around women’s health.

Renee Lynch

Renee Lynch is a naturopath and mother, she currently practices in the beautiful Orchard St clinic, Sydney. She shares with us wisdom about being in tune with your menstrual cycle and their relation to the seasons and having a positive relationship with our bodies.

https://www.reneelynchnaturopath.com.au/

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Dear Daughters. I wanted to talk to you about your menstrual cycle, because if you’re anything like me, the chat that I had with my mum when I was 11 years of age basically consisted of her showing me a pad and a tampon and telling me that I’d need to choose one of these methods every month for many, many, many, many years come. 

It wasn’t overly inspiring, it didn’t make me want to have my period, I felt weird, nobody at school talked about it, it was just not a conversation that I would have had with my friends and I find that really sad because it is something that connects women universally and yet we turn our backs on it. We don’t talk about it, and we’re embarrassed by it. 

So as the years have gone on I’ve looked to different cycles in nature or the Universe and now I actually think that women are incredibly blessed to have this cycle to live by. If you think about the moon cycle, the tides in the ocean, the astrological calendar, there are so many incredible cycles that we live with that harness, you know, if you think of even the seasons of the year  – winter how we feel in winter is so different to how we feel in summer. and so I wanted to explain to you today about how I relate to the menstrual cycle and the different stages of our cycle, similar to the seasons of the year.

So we start on day one and that is the first day of your bleed. And this is what I like to call ‘Inner Winter’ and some of the feelings that we have in winter really correlate with how you feel in this first few days of your menstrual cycle. You may feel a little quiet, not as social, you may want to slow down, to go inward we may be feeling sensitive, you want to keep warm so this is beautiful and this should be honoured when you have your menstrual cycle this is a chance for you to slow down let go of things and just go inward. sS that might mean saying no to plans with friends on the weekend and just spending some time at home doing things for you. 

So then we go into roughly day six to 16 and this is your inner-Spring, and this is a beautiful time for creativity. you’re starting to feel more energized a little bit more playful, a little bit more social, more active, you’re definitely a lot more focused and that really correlates with how we feel in springtime especially coming out of winter. You know that feeling from Winter to Spring – everything seems more doable, you have more energy it’s exactly the same. 

So then we move into day 17 to 22 and this is when ovulation occurs and this is what we call our Inner Summer. so this is often when a woman feels her best you are definitely more social you’re feeling fresh, fun and flirty. this is often a time if you play sports that you will have your best performance, you might kick so many more goals in soccer or whatever sport you play, you’re just feeling your absolute best and that again correlates with how we feel in summer. so it’s a really great time to make plans with friends go out to enjoy yourself. 

Then as we come to the end of our cycle roughly days 23-29 this is our inner Autumn and so again this is where we’re starting to quieten down as we go back into winter so it’s a really great time to finish projects, going inward nourishing your body and just winding down for that winter. There’s even different ways that they say we can eat without cycle in that first half of your cycle which is spring summer having a lot more fresh fruits and vegetables and then in the autumn winter as you wouldin autumn winter having things that are a lot more easier to digest like slow cooked meat soups Broths that kind of thing. so this happens to us every month and i think thats just absolutely incredible and if you can understand these different elements of your menstrual cycle you can really harness that power to help you in everyday life. 

I know for me I would always seem to get quite emotional around day 21 and this is before I would track my cycle and that would be something that wouldn’t usually bother me or upset me and by tracking my cycle and understanding these different phases it made sense to me that ok this happens every month it’s just time to slow things down and focus on myself and honour that inner autumn. So I hope this helps you I really really hope to help as many women as possible get in touch with their cycle and not dread it every month and think of it is this beautiful gift that we’ve been given it’s more than just our ability to create life it’s so much more and if you want to do some more research just look into the menstrual cycle and seasons. I really hope this is helped.

Kira Sutherland

Kira Sutherland is a practicing naturopath and nutritionist with a focus in sports nutrition. She is a lecturer at various universities in Sydney, sharing her wealth of information in both nutrition and naturopathy. She is a mother to a 14 year old daughter and has been in clinical practice for 25 years.

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Dear Daughter’s, what would I like you to know or what would I have liked to have known that I’ve learnt over the years what I think will be of great benefit?

I work with a lot of teenagers and I work with a lot of women having issues around eating, emotional eating, how they feel about their body and just what society tells us we should look like and you know social media is not making it any easier for us and I just see the distress is getting bigger and bigger for teenagers twenty-something you know for everybody actually but especially for you, for you in your youth. What I really wish for you is to understand there are many different body types. We always hear this – you come in all different shapes and sizes. But if you actually go into the science of it there are three main body types and we call then an ectomorph, a mesomorph and an endomorph. 

But we don’t all just fit into these three body types. There are actually combinations of each of these body times. In reality, we actually have 6 main body types. And some people are forever going to be trying to put on weight and they’ nerve can and they’re either very short or very tall and they’re that little bird-like body build and unfortunately, in social media and in the modelling industry that’s what we get shown super tall super skinny and they’re a ‘clothes rack’ and that’s their body type and were not all built like that. There are people that put on muscle a lot more easily than others there are people that put on body fat a lot more than others. But in reality, we all have these amazing bodies that all have strengths, and yes all of our bodies have weaknesses but I would really encourage you to learn about different body types and to learn about what your body type is and to try to embrace that because fighting your genetics and fighting your body type to fit into what society says is normal is gonna crush you over time and it’s going to depress you and it’s sometimes goals that are not attainable. So you know look at how tall your parents are or your siblings, look at your grandparents. Yes if your parents are holding too much bodyweight that might now be you, you don’t have to go down that route, you can go and educate yourself on healthy eating and nutrition. but I really would love you to learn about the different body types that there are in the world and embrace the fact that if you’re not the Skinny Mini you might be the one that lays down incredible muscle and there are all kinds of sports that you’re going to excel at that other people won’t. so it’s about finding your strengths and playing to your strengths is what is actually going to make you feel more at peace with your body and with yourself and that is probably the biggest gift I wish I had been given and I try to give to my daughter very frequently we often talk about body types and it’s really powerful to watch her understand that and then learn to embrace how she feels about her body. So that is what i wish for you all. I know people always say ‘I would love for you to find self-love’ but find out who you are and what you’re made of and what you’re going to look like.   And play to the strengths in how you’re built so that’s what I ask of you. thank you very much for having me record this session.

Brooke Blair

Brooke has been a guest on this podcast many times before. She is a Hawkesbury based women’s health physiotherapist who works with women of all ages, making everyone who walks through her door feel comfortable and empowered.

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

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Dear Daughters. Pain is something you will experience across your life, however there are times that pain is not normal.

For One – your periods should not be painful.

For Two – Sex is definitely not something that should be painful.

There can be many reasons for pain, and all of these can be worked on. Please don’t bottle it up, and don’t let anybody tell you to ‘deal with it’ or that ‘it’s all in your head’ or something that you need to ‘deal with’ for the rest of your life.

Listen to your body, and if it’s not feeling right, speak up. There’s always help available.

Justine Curran

Justine Curran is a Sydney-based photographer – specializing in raw family photography + Children’s editorial/fashion portraits. Inspired by femininity, Motherhood and Summer vibes — Justine’s work is playful, emotive, and nostalgic.

She home schools her two children and will often share wisdom and insights into the world and motherhood that are very inspiring.

https://www.justinecurran.com.au

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Dear daughter, you are a wild creative being.

Everything you touch turns to gold.

 You are one with all and you get to choose your own reality. Choose love and magic will always follow.  In times of darkness, and there will be my love, remember to breathe. You will find the light within.

You get to own your own feelings as others own theirs.

The world is your mirror, a reflection of your agency. The playful self can seem like a trickster. But it is wiser than you think. Make sure to visit her every now and then. She will show you what is true.

Sing ever so loudly My darling. Let our ancestors hear from the stars. Your voice is powerful, my dear, don’t let anyone tell you it’s not. You are a wild creative being my love.

Laura Harrison

Herbs and healing were woven into my life from infancy. Growing up with holistic parents, the support and tool of natural medicine was our go to. As I grew up, it seemed that naturopathy was going to be my path, as it held my heart, my longing to learn and my need to connect deeper with herbs, as plants and healers.

I studied naturopathy at Nature Care College, graduating in 2011. From there my husband, Damian and I travelled to England to spend some months living with and learning with a knowledgeable herbalist in the picturesque Cotswolds. Here we gardened, foraged and created all things herbal as we emerced ourselves deeply into a land where a lot of the herbs we use today grow wildly in abundance. We attended herb festivals and met with a handful of the herbal greats of our time, including Matthew Wood, Sebastial Pole, Romy Fraser and of course our dear Anne McIntyre.

Moving home, coming back to my heartland of beautiful Bellingen we knew we wanted to start our own practice, and that is where Chamomile Naturopathy was born. The far majority of my work is with women, through life’s complexities and challenges. From menarche to menopause and all the chapters in between.

http://www.chamomilenaturopathy.com.au/

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Dear Daughters.

The other day, I called out to find my daughter and I saw her halfway down a muddy bank. She’d lost her shoes some time ago and her hair was curly and wild. Her face was beaming with radiance. She was deep in nature, deep in play and deep in happiness. What I want to teach her, what I wish I knew more when I was a young girl and what I want to learn more about as an adult and a guardian to my small folk is all about nature. 

I want my daughter to be skilled in reading the patterns of nature from the seasons to the specifics. The coming and going of creatures. The Wonder of fireflies, the breezes of springtime, the koala tracks up a tree, the honey smell of a tea tree in full blossom. 

I want her to be patient enough and quiet enough to watch the Platypus play in our river. to walk outside after the sun has gone to bed and to gaze up and watch a shooting star. I want her to be able to read the sky the stars and also the shapes between the Stars hiding their patterns within the darkness. 

I want her to be able to catch a fish and cook it on a campfire that she lit herself. 

I want her to feel her body soaked from the summer storm and give herself permission to Retreat in winter. I want her to be able to whittle herself some bush tools, even if it’s just for the fun of it. I want to walk in the forest, to swim under waterfalls and to find her way home again. 

I want her to be in her body, to feel the earth beneath her feet The Sensations of dirt, rocks sand, water and clay. 

I want her to stand tall knowing the world in which she is apart and knowing that she is a part of her world and I would love for all of our daughter’s to also take on life with this sense of belonging.

Alison Mitchell

Remember that your worth is not defined by what others think of you. When you’re growing up, it’s a challenging time of life because you are figuring out who you are as a person, but also feeling so desperate to fit in and be loved. You don’t have to put a label on yourself, now or ever, but you need to just keep doing what you love and what brings you joy and eventually that will evolve into your own unique loveliness. Don’t feel you need to change this to be like other people. This can be hard. There are so many people out there that don’t know how to feel good about themselves, and they will bring others down to make themselves feel better. Don’t be one of these people, but importantly don’t let these people hurt you. Hold on to the knowledge that you are capable, beautiful, strong, and worthy of love and adoration. Other people may seek to bring you down, by harming your self esteem, but this is a reflection of them, not you. Retain your kindness and your strength, and move on.

There is a saying that first you must love yourself. I think this is true in this case. If you don’t respect and love yourself you won’t believe yourself worthy of love, and dear daughter you are worthy. Somewhere there is a person, no, there are people that love you and adore you and don’t ask of you to change who you are.

I so want for my daughter to be kind and caring, but to be strong and resilliant at the same time. Be confident that you are awesome, just the way you are.

You can listen to the podcast on almost all channels…

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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

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Do you have heavy periods? It can be a sign of a deeper imbalance.

Whatever a woman is seeing me for as a naturopath, whether it’s anxiety and stress, tummy issues, weight loss or skin health, I always ask her about what her periods are/were like. That’s because just like the digestive system, the subtle variations of your period and cycle can reveal a lot about your hormonal status and this can have a big effect on overall health.

For instance: Did you know that your balance of progesterone and oestrogen can affect your immune system? And your sleep, your mood, and your digestion? It makes sense when you realise how much your hormones do in your body, that having imbalances in your hormone levels or not ovulating properly (such as in PCOS, amenorrhoea or when using hormonal contraception like the Pill) can have a big flow on effect to the rest of your health.

So if your period is not regular, goes for too long, or is too heavy, clotted or painful, this can be a sign that something is out of balance. Many women don’t realise that their heavy periods are not something they need to ‘put up with’, and that help is available to them. I have seen herbal medicine and nutrition work well with heavy periods, usually causing a big effect within the space of a few months. In some cases, there may be something more complicated going on (such as a clotting disorder, severe endometriosis or fibroids) which can benefit from conventional medicine alongside natural medicine.

What is a normal flow

Anything greater than 80mL of blood lost in a period (which equates to roughly 16 or more soaked pads or tampons) or a period longer than 7-8 days is considered to be a heavy flow. If you are using a menstrual cup, you can use the markings within this to count how much blood you are losing during your period, however if you are using pads and tampons you can count how many you are filling up. Many women with a heavy flow are put off from the idea of using a menstrual cup because they will have to change it during the day, or are worried about leaking, however this can be backed up with liners or absorbent underwear such as those from Modibodi. I have written about this before here.

If you experience any of these signs, you may have a heavy flow:

1. Having to change a pad or tampon every hour or less.
2. Filling 16 or more pads or tampons each period.
3. Leaking while wearing pads/tampons, despite using a high absorbency.
4. Bleeding for more than 7-8 days
5. Regularly passing clots that are larger than a 50c coin.
6. Needing to change your overnight pad once or more during the night, or leaking through onto the bedsheets.

If you need to back up your menstrual cup or tampon with a pad, consider using period absorbing underwear. They are designed with technology that helps to wick moisture and smell, and can be a much more comfortable option for women who dislike wearing pads. They’re also environmentally friendly!

Got Clots?

Why so heavy?

Iron deficiency

Oestrogen dominance

Clotting disorders

Some clotting disorders can cause a women to experience very heavy periods. If your periods are heavy from menarche (when you first got your periods) it is a clue you may have a genetic clotting disorder, for example von Willebrand’s disease. If you have a family history of this condition or you have had heavy periods from a teenager, it’s a good idea to get yourself screened by your doctor for this condition, as specific medication may be required.

Fibroids

Schematic drawing of various types of uterine fibroids: a=subserosal fibroids, b=intramural fibroids, c=submucosal fibroid, d=pedunculated submucosal fibroid, e=fibroid in statu nascendi, f=fibroid of the broad ligament

Fibroids are a non cancerous growth within or attached to the outside of the uterus that can range in size anywhere from the size of a pea to the size of a melon.
They are not fully understood but often will respond to hormonal treatment that reduces oestrogen excess, along with herbs that target the excess tissue growth.
Depending on the size and location of the fibroids they may need to be surgically removed, for instance if they are in a position that blocks the cervix affecting fertility. A lot of the time fibroids will not cause any significant problems and may not need treatment.

Menopause

All women experience menopause differently, and for some they may find that their periods become very heavy in the early stages of menopause. This may respond to uterine astringent herbs in addition to herbs to support the menopausal transition (commonly this may be herbs to help with stress and oestrogen balance).

What to do about it

Address the cause

It’s always a good idea to rule out serious issues first, so see your doctor for a pap smear, and potentially further testing such as an ultrasound and a blood test that can look for clotting issues, iron deficiency or other causes of heavy bleeding. Having identified the cause, you can begin to fix the problem with natural, and/or conventional medicine.

For some people the bleeding is SO heavy that an endometrial ablation may be necessary. This is when the lining of the uterus is destroyed and removed, so that a the periods are much lighter or absent. This is not ideal if you are wishing to have children, have had a caesarean section, or cancer of the uterus, cervix or endometrium.

Herbal medicine

CC BY-SA 2.5, Link

If you want to reduce your heavy periods without surgery or going on the pill, you can consider using herbal medicine. It’s best if you can see a herbalist or naturopath who can guide you through the process of addressing the cause of the heavy bleeding and can make a herbal formula specific to you. There are herbs that can help heavy periods such as Shepherd’s Purse, Beth Root, Tienchi Ginseng and Squaw Vine, can be helpful to reduce the heaviness of the bleed.

How long will treatment take

I find that heavy periods will typically respond to herbal medicine within the first cycle with a slight reduction of flow, however it may take a few months to achieve a more “normal” flow. This may be longer if the bleeding is caused by a condition such as endometriosis or fibroids.

The post Heavy Periods 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.

Ladies, this one is for you.

Certain types of pads and tampons contain chemicals that may worsen period pain, cause allergic reactions and irritation, lead to pelvic inflammatory conditions and even fertility problems.  They have a huge impact on our environment, as some of their ingredients never break down.  In this article I will look at what these synthetic products are doing to our body, and discuss some of the alternatives that are available to us.

Tampons – Is this the most important item to choose organic?

Chances are, if you’re interested in your health and wellbeing you have decided to ‘go organic’ – you shop for organic fruits and vegetables, you limit your use of house hold chemicals, you might also use organic body products.  But for women, an often overlooked source of chemicals is through our sanitary items – pads and tampons.

Most conventional pads and tampons use a variety or blend of rayon (wood pulp), viscose (synthetic product) and cotton.  Some tampons are also coated in polypropylene (a crude oil derived plastic) to make them ‘slippery’ as well as to bind and contain the synthetic fibres together (pure cotton tampons are much stronger so will not disintegrate).   Cotton is actually quite a ‘dirty’ crop – it is the most heavily sprayed crop in the world (26% of the world’s pesticides are used on cotton!) so cotton products contain a whole host of pesticides.  These cotton products are then bleached with chlorine, which as a result leaves a by-product called dioxin.  Most sanitary products also have added chemicals to absorb odour or create fragrance, however these are also derived from crude oil products.

This may in fact be one of the most important items with which to choose organic, as our ‘lady bits’ are actually extremely capable of absorbing chemicals.  This is not good news for the health conscious, and to make matters worse these chemicals can actually increase period pain!

The pesticides from cotton, the polypropylene that coats and exists within the tampon and the dioxin from bleach combine to create a hectic combination of chemicals that increase inflammation in our ‘lady parts’ and can also lead to other health problems such as endometriosis and infertility.  These chemicals are also commonly responsible for causing irritation and allergic reactions down there, so going organic can result in a much pleasanter time of the month.

Consider this rough equation:

• A woman with a regular cycle will have 11-13 periods a year.  Assuming she has a standard menarche from 13, and enters menopause at 51, that’s 456 periods.
• Take out about 42 periods for an average of 3 children (9 months pregnancy, approx 5 months of no periods during breastfeeding) to reach 414 periods.
• The average women has a period for 3-7 days (so let’s say 5), and can use anywhere from 3-6 tampons or pads a day (so let’s say 5).  That’s 25 pads and/or tampons a period.
• 25 pads/tampons a period x 414 periods = 10,350 pads/liners in a lifetime (oh and don’t forget the thousands of liners we’re probably going to use as well!)

That’s a lot of pads and tampons, and cumulatively, a lot of exposure to chemicals that you don’t want down there!

Photo by Karl Wiggers on Unsplash

GOING ORGANIC

Nowadays, many people are making efforts to reduce their exposure to chemicals – for good reason.  Good quality research papers have shown that many pesticides in our food can disrupt hormones, nervous system health and our immune system, and in addition can lead to several cancers and conditions such as chronic fatigue syndrome.

Going on from this, we can extrapolate from the knowledge that eating chemicals is bad for us, so therefore applying chemicals to our skin is bad as well.  (Cue an abundance of body creams and lotions with ‘organic’ labels, and another booming industry fraught with misinformation that misleads consumers (organic body products are not regulated in the same way that organic foods are, and many products labelled as organic may still contain harmful chemicals) – regardless of whether it is labelled as organic we should still diligently check ingredients of products we choose, and buy from reputable companies/suppliers).  Using (actual) organic body care products is another good move; in fact it may be even more important than using organic food as our digestive system, when working properly has a lot of acids and enzymes (e.g. in our saliva and stomach) that help to break down and eliminate chemicals.  Our skin is an amazing organ, and it has a great capacity to absorb anything that we apply to it, particularly when it is rubbed on in an oily based i.e. a cream.  This comes in very handy when we want to apply therapeutic creams, however not so good when the creams contain nasties.

The mucous epithelial membranes that exist within regions such as the rectum, nose, lungs and vagina have an even greater absorptive ability than the skin, which is why pessaries and suppositories have such a fast and effective action.  In addition to this the blood supply from the vagina goes directly into the pelvic plexus (the same veins the ovaries normally empty into), so when certain hormones and chemicals are applied to the vaginal mucous membranes they are directed towards the uterus before they are assimilated into the rest of the blood stream(1).

Pads and tampons are a major source of chemicals, due to the excessive spraying of cotton crops.  Tampons that contain other fibres, such as rayon, can leave trace amounts of fibre and chemicals on the vaginal wall after removal – this is an issue for not only chemical exposure, but greater risk for toxic shock syndrome.  According to Dr. Philip Tierno, a Clinical Professor of Microbiology and Pathology at NYU Medical Centre, 100 percent cotton tampons “consistently test under detectable levels for TSS toxins.”(2)  This is because non-cotton products have a structure that is more likely to shed fibres.  In the attempt to bind these fibres together tampons are coated in a type of plastic coating called polypropylene.

Check out this video to see the different tampon types hold their fibres together.  These polypropylene chemicals do not break down or decompose.  Remembering how many tampons are used in a life time this could accumulate, potentially contributing to health concerns, but it the immediate sense it can also cause irritation of the sensitive vaginal area.  Vulvovaginitis is a problem that many women experience and if it is worsened by sanitary items, it can make that time of the month a very uncomfortable time.

I have experienced in both myself and my patients a significant reduction in period pain with the use of organic sanitary items.  While there is limited research on this matter, I theorise the pain reduction to be due to a few reasons:

• By avoiding the polypropylene there is less of a topical irritation, creating less inflammatory chemicals in the area.
• Insertion and removal of tampons cause micro-tears in the vaginal wall, in which tampon residue can remain.  Synthetic tampons have a greater likelihood of leaving residue and the nature of their fibres can be more irritating.
• The removal of chemicals which can mimic oestrogen can both reduce prostraglandin production as well as reduce the exacerbation of conditions such as endometriosis, pelvic inflammatory syndrome and fibroids.

WHAT ARE OUR OPTIONS?

Organic pads and tampons

There are several brands that use organic products, and organic cotton tampons.  While they are usually a little pricier than conventional brands, I personally consider it to be worth it.

Organ(y)c, TOM Organic and Natracare are good options.  TOM Organic is an Australia based company, and also offers ‘subscription’ service, a novel idea considering this is something we use on a regular monthly basis (ooh and they’re pretty!).  Other less widely available brands include Seventh Generation.

Reusable pads.

Reusable pads usually consist of organic cotton and come in a variety of shapes and colours.  They are clipped onto the bottom of the panties and when used, need to be soaked overnight then washed as per normal.  This is considered to be more environmentally friendly than disposable pads and tampons, and many women consider this to be more comfortable as well – they feel like normal underwear and are silent (no plastic crinkling sound).  While the need to wash these pads may turn some women off, the environmental benefits are good and these are a viable option for those who do not wish to use an insertable product.

Wemoon is an Australian based company that offers a variety of reusable pads.  Lunapads also offer products online in a variety of fun colours, and also stock liners.

Menstrual cups.

Menstrual cups are bell shaped silicon or latex cups that are inserted into the vagina to collect menstrual flow.  This is a concept that has been around for a long time, however it is not commonly used or known about these days, perhaps due to a perceived ‘ick factor’?

According to the Diva Cup website, once you have tried menstrual cups you realise that most concerns are unwarranted – i.e. a typical flow is only 30mL per day, therefore removing the cup really isn’t going to be like a scene from a horror movie, and menstrual blood only smells once exposed to oxygen, so using the cup isn’t going to create more of an odour (in theory it will be less so!).  They can take a few cycles to get the hang of, to ensure they are positioned correctly.

Menstrual cups do have an impressive list of benefits – they are good for the environment, they can be kept in for 12 hours, reduce period pain (see above) and save money in the long term (while they cost about $60 to buy outright, they can save you up to $150 a year compared to buying disposables).

A good brand is the Diva Cup, which is approved by TGA in Australia.  Other brands include JuJu, Lunette, The Keeper (made from rubber) and The Moon Cup (made from silicon).

EDIT 3/10/17: I wanted to share my personal experience with a menstrual cup. Not long after writing this article I invested in a Diva Cup, and I can share with you that it has made my time of the month much easier, as having to change the cup only once in the morning and night means I can essentially forget about my period while I am out and about. I also have not had to buy any tampons, and only bought about 2 packets of pads (excluding maternity pads for post-partum) in the 4 years since getting the cup. I used to experience a lot of period pain, and when starting to use this I did notice there was some discomfort on the days I was worse, so I chose to use a pad on those days, however as time has gone on I now don’t have any period pain (I think due to improving my chemical exposure, using herbs, exercise, yoga and having a baby) so I can use the cup for my whole period. I used to have to wear a liner with it during the night and on day one of my period, but not at the moment. I found that it took a few cycles to get practiced enough to insert it confidently, having to learn the right angle to put it in and how to hold it so I could twist it into position, but now I can do it easily. I have on occasion had to change it whilst away from home but it is easy enough to do, I just tidy it up with some toilet paper and give it a good clean when I get home. I did read some reviews that the cup stains, but I haven’t found that to be the case, and this is 3+ years later. I also have been fine to exercise with it in, as long as it is inserted correctly to begin with. So essentially, I would definitely recommend getting a menstrual cup!

Absorbent Underwear

Companies such as Modibodi and THINX offer underwear that has absorbent section where a pad would be. They can be worn as a back up for menstrual cups or tampons, or on their own for those with a moderate-light flow. You can choose the type of absorbency that’s right for you – the range goes from 2.5ml absorbency (1/2 tampon) to 10-20mL (2 tampons).

They are reusable, so great for the environment, and save money for you over time. For athletes who don’t like wearing pads, tampons and cups during exercise, this is a great option.

Other options (that I haven’t research too extensively…)

• Reusable tampons (hard to find, most I’ve seen appear to be knitted, could that could be your next craft project?)
• Sea sponges (think re-usable tampons from the sea)
• Free bleeding (you were just going to wash those clothes anyway, I guess?)

Have you tried some of the less conventional options?  Or have you noticed a change from using organic pads and tampons?  Let me know your thoughts.

Works Cited

1. Touitou, Elka and Brian, W Barry. Enhancement in drug delivery. Boca Raton, Taylor & Francis Group : CRC Press, 2007.

2. Women Beware: Most Feminine Hygiene Products Contain Toxic Ingredients. Mercola.com. [Online] 22 May 2013. [Cited: 6 November 2013.] http://articles.mercola.com/sites/articles/archive/2013/05/22/feminine-hygiene-products.aspx.

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PMS stands for Pass My Shotgun, Pardon My Sobbing, Perpetual Munching Spree, Pimples May Surface…

PMS jokes are everywhere, as it is probably the most common female hormonal disorder. Many women accept monthly changes to their mood, appetite, energy and sleep patterns as an annoying but inescapable part of life, and yet PMS is a treatable condition. In Australia, it is estimated that up to 75% of women experience PMS at some time in their lives, with 18% of women suffering the more severe form – premenstrual dysphoric disorder (PMDD). PMS and PMDD are often poorly recognised, let alone diagnosed or treated.¹ These conditions can have a severely detrimental effect women’s lives, but PMS can be easily and effectively treated with diet, exercise and Natural Medicines.

What causes Premenstrual Syndrome?

As you would expect, most of this havoc is due to hormonal imbalance, however very commonly it is existing nutritional deficiencies, as well as diet, stress and exercise combined, that really tips you over the edge.

Studies have shown that women who experience PMS have excessive amounts of oestrogen which causes relatively lower levels of progesterone compared to women who don’t². Not everyone is the same of course, and some women may have low progesterone but not necessarily excess oestrogen.

The psychological symptoms

Progesterone has a metabolite called allopregnanolone, which acts in the Central Nervous System  by interacting with the sedating GABA A receptors to positively affect mood and behaviour, whilst improving stress response and cognitive function.³

When progesterone and its metabolites are low, less of the calming effect from the GABA receptors are experienced so you can experience all sorts of mood imbalances such as irritability, anxiety or depression. On top of this, oestrogen has excitatory effects in the CNS by acting on the glutamate system, so women with excess oestrogen often feel wound up and irritable. ⁴

The physical symptoms

A common complaint with PMS is fluid retention. High prolactin (another reproductive hormone) is associated with cyclic breast tenderness and fluid retention. Prolactin naturally elevates during the second half of your cycle and may be further increased by stress, low blood sugar and high oestrogen. Aldosterone (a hormone produced by the adrenal glands) also contributes to symptoms of fluid retention, contributing to weight gain and bloating. Stress is the key driver of high aldosterone. Interestingly, stress may also reduce your sensitivity to progesterone.⁵ Another relatively common symptom accompanying this time is latent virus activation e.g. getting cold sores at that time of the month.

What can we do about it?

The specific treatment varies on the woman as everyone experiences PMS differently. The core focus is to use nutritional supplements and herbal medicine which can help to balance hormones, support stress levels and reduce unpleasant symptoms. In clinic I use high strength herbal medicines which includes use both liquid and tablet forms, all of which are stringently tested for quality, safety and the strength of the active parts. Working towards a healthy eating (diet) and balancing lifestyle factors (e.g. reducing stress) is important as well.

One of the main herbs Naturopaths use for treating PMS is Vitex (Vitex agnus castus, also known as Chaste tree). It is best taken first thing in the morning for two or three months to see results. Various studies have demonstrated that Vitex supplementation significantly improves the spectrum of premenstrual symptoms over a period of three months. One study showed that symptoms of irritability, breast fullness and bloating were improved by 50%,⁶ whilst another found that 93% of 1634 participants reported an improvement or complete remission of symptoms monitored, including depression, anxiety, food cravings and fluid retention.⁷ Furthermore, by normalising the luteal phase, Vitex has been shown to improve fertility in women with luteal phase defect.⁸ In a study on infertile women with pathologically low progesterone levels, a dose of 36 mg of dried fruit daily improved fertility rates by approximately 15% within three months.⁹

Peony (Paeonia lactiflora) and Dong quai (Angelica sinensis) are also great hormonal regulators specific for PMS and menstrual irregularities.¹⁰

To support mood and stress levels there are herbs that calm the nervous system and balance GABA levels such as Passionflower (Passiflora incarnata), herbs to support adrenal gland function such as Rehmannia (Rehmannia glutinosa) and Licorice (Glycyrrhiza glabra); and adaptogens – herbs that help you ‘adapt’ to stress such as Siberian ginseng (Eleutherococcus senticosus) and Withania (Withania somnifera).

To further support your nervous system it’s important to ensure you don’t have nutritional deficiencies that will leave your nervous system frazzled. For example, B vitamins and magnesium are crucial for combating stress and so many people are deficient these days. Your body uses more of these when you’re stressed so if you lead a stressful, busy lifestyle at times then you most likely need top up with some supplements to get you back on track.

As well as having a diet that is high in protein, fibre and good fats (these are all crucial!), there are key nutrients that are needed for blood sugar regulation, such as chromium and magnesium, to improve carbohydrate metabolism and blood sugar control.

Vitamin B6 – for production of neurotransmitters, essential fatty acid metabolism, oestrogen metabolism, and progesterone support.

Magnesium – to reduce cramps, to support mood, for blood sugar control, to reduce aldosterone, and support energy production. Intracellular (but not plasma) magnesium levels have been found to be lower in women with PMS, so women who are deficient in magnesium are more likely to suffer from PMS.

Calcium – this is also important for nervous system support, and to regulate the control of muscular contraction and relaxation. Interestingly, symptoms of calcium deficiency are similar to many PMS symptoms and in some women PMS may be due to underlying calcium dysregulation which may be driven by vitamin D deficiency.

Chromium – essential for blood sugar level control, insulin production and pancreatic health. Chromium deficiency can lead to more sugar cravings and blood sugar fluctuations.

Omega fatty acids – Omega 3 is important for healthy prostaglandin levels, and a deficiency of Omega 3 can cause a variety of symptoms such as menstrual and premenstrual cramps, depression, irritability, dry/rough skin, acne and cravings for oily and fried foods.

If you’re someone who really suffers in the lead up to your period each month, it’s certainly worth getting some professional advice from a naturopath about the key elements of treatment for you. It’s something that many women seem to think they just have to endure and put up with, without looking into ways they could reduce their symptoms. If you’re one of those people – now you know there are things you can do, so why not give naturopathy treatment a try?

READY TO DISCUSS YOUR HEALTH NEEDS?

CONTACT ME TO MAKE AN APPOINTMENT

1. Halbreich U, Borenstein J, Pearlstein T, Kahn LS. The prevalence, impairment, impact and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology 2003; 28(3): 1-23.
2. Wang M et al. Relationship between symptom severity and steroid variation in women with premenstrual syndrome: study on serum pregnenolone, pregnenolone sulfate, 5a-pragnane-3,20-dione and 3a-hydroxy-5a-pregnan-20-one. J Clin Endocrinol Metab 1996; 81: 1076-1082.
3. Monteleone P et al. Allopregnanolone concentrations and premenstrual syndrome. Eur J Endocrinol 2000; 142: 269-273.
4. Backstrom I et al. Pathogenesis in the menstrual cycle-linked CNS disorders. Ann N Y Acad Sci 2003; 1007: 42-53.
5. Kumar S, Mansel RE, Scanlon MF, Hughes LE, Edwards CA, Woodhead JS, Newcombe RG. Altered responses of prolactin, luteinizing hormone and follicle stimulating hormone secretion to thyrotrophin releasing hormone/gonadotrophin releasing hormone stimulation in cyclical mastalgia. Br J Surg 1984; 71(11):870-3.
6. Loch EG et al. Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus. J Womens Health Gend 2000;9(3):315-20.
7. Berger et al. Efficacy of Vitex agnus castus L. extract Ze440 in patients with premenstrual syndrome. Arch Gynecol Obstet 2000; 264 (3): 150-3.
8. Wuttke W et al. Chaste tree (Vitex agnus-castus)- pharmacology and clinical indications. Phytomedicine 2003; 10(4): 348-57.
9. Bone K. Clinical Guide to blending liquid herbs. Churchhill Livingstone 2003, p 145.
10. Sakamoto S et al. Pharmacotherapeutic effects of kuei-chih-fu-ling-wan on human uterine myomas. Am J Chin Med 1992; 20 (3-4): 313-7.

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Endometriosis is the cause of up to 80% of pelvic pain or infertility. It is the most common cause of infertility in women over 25 years. It is estimated 10-20% of all women during their reproductive life are affected by endometriosis with or without symptoms, with a peak incidence at 25-35 years.

Causes

Endometriosis is caused by endometrial tissue growing in an incorrect place, such as the ovaries, tubes, outer wall of uterus, bladder or bowel. It is not well understood by this occurs.  Some theories include:

• Retrograde flow.  The menstrual blood moving back into the pelvic cavity during the period.  Interestingly, most women who do not have blocked fallopian tubes      do experience backward flow, but not everyone develops endometriosis.
• Immune dysgregulation.  There are some elements of auto-immunity in endometriosis.  Immune systems of endometriosis patients have shown impairment of natural killer cells to destroy misplaced tissue, autoimmune antibodies to endometrial tissues as well as increased T-helper cell activity and reduced T- suppressor cell capacity. There is a direct correlation between the severity of endometriosis and the extent to which natural killer cell function is impaired. Endometriosis also secretes an unidentified substance that destabilizes surrounding capillaries and brings white blood cells to the region to release irritating chemicals, thereby showing increased numbers and activity of macrophages. Macrophages can prevent fertilization of eggs, reduce sperm motility, engulf and destroy sperm, eggs and embryo, increase adhesions and stimulate the growth of endometriosis.
• Genetics.  The endometrial tissue is incorrectly located from birth.
• It is known that endometriosis is a condition of oestrogen excess, as oestrogen is responsible for the development of endometrial tissue. Since oestrogen signals the body the regrow the endometrium each month the endometrium which has been moved keeps growing.  This is usually      associated with a lack of progesterone.
• Other factors that can be involve toxin build up (certain toxic chemicals can act as xeno-oestrogens, such as dioxin, Bisphenol A, pesticides and herbicides which all lead to more oestrogen receptors); liver stagnation (the liver breaks down and removes oestrogen and toxins); past exposure to glandular fever (this impairs the immune system and can predispose the woman to auto-immunity); and an imbalance in the inflammatory      prostaglandins (these are the bodies inflammation balancing hormones, and problems will lead to increased pain, increased endometrial adhesion growth and irregular ovulation).

Signs and Symptoms

• Severe, painful periods which worsen towards the end of the period
• Infertility, decreased success rates for in vitro fertilization and increased miscarriage
• Long and heavy periods (more than 7 days) with darker, brownish blood to start. Spotting and mid-cycle bleeding can be common
• Pain before period and at ovulation
• Feelings of pressure in pelvis, one-sided pelvic pain, pain during bowel movements, pain during intercourse
• PMS symptoms, including anxiety, mood swings, bloating, breast tenderness, constipation, food/sugar/chocolate cravings, headaches

Management

Orthodox Medical Treatment

• Laparoscopic removal of lesions and cysts: reduces or resolves both period pain and other pelvic pain significantly. However, there is increased risk of adhesions and scar tissue and the endometriosis tends to reoccur with about 50% of women developing the condition again within 2-5 years.
• Hormones to inhibit ovulation and suppress menstruation results in atrophy of the endometrium, eg. the Oral Contraceptive Pill: given continuously without a breakthrough bleed. Side effects include blood clots, stroke, heart attach, especially for smokers, abnormal cholesterol ratios. However, the Pill compares favourably with other drug regimes for endometriosis that have more serious side effects. The Pill is not as effective for advanced endometriosis and is not suitable for women who want to fall pregnant. Most women have a return of symptoms within 6 months of stopping the Pill.  Other options include implants, such as Depo Provera, which are a stronger form of the Pill and although they have same side effects, have the benefit that it cannot be forgotten.
• Progestogens: side effects of nausea, bloating, acne, breast tenderness, weight gain, mood changes, increased facial and body hair, effects of the drugs as well as abnormal cholesterol ratios. About 30% of women have spotting or breakthrough bleeding until the drug starts to work or the dose is adjusted. These drugs are relatively inexpensive and give significant pain relief. Fertility is not improved by these drugs, menstrual cycle may be delayed for many months and endometriosis may reoccur after stopping therapy.
• GnRH agonists induce a temporary menopausal state. They are effective in reducing symptoms and the size of endometrial growths but obvious side effects are less severe. There is early and significant bone density loss, although this causes no symptoms until later in life but should be considered      in the decision to use these drugs. On average, endometrial cysts return to their original size, 4 months after stopping treatment, so additional      treatment is necessary.
• Hysterectomy, pregnancy.

Naturopathic Perspective

 Treatment length for endometriosis usually requires 6-12 months, depending on the severity and duration of the condition.

 Dietary and lifestyle changes are essential for successful treatment and for maintenance of the condition long term to prevent reoccurrences.

 Herbal medicines and nutritional supplements are individually prescribed to:

• Balance hormones to improve the relative oestrogen excess and prevent reoccurrences by correcting underlying hormonal imbalance, rather than superseding the body’s own hormones
• Ensure normal menstrual flow and uterine function
• Improve fertility if required
• Decrease constriction of blood vessels and muscular spasm, thereby decreasing pelvic congestion and pain
• Rebalance immune system dysfunction to address auto-immunity basis
• Improve liver function which breaks down and removes excess oestrogen, other hormones and toxins
• Soften and heal scar tissue and adhesions, and drain cysts
• Decrease heavy bleeding and spotting
• Regulate bowel habits and decrease constipation. Women with endometriosis commonly experience irritable bowel syndrome symptoms which complicate their pain and hormonal imbalance.
• Address any bacterial or fungal overgrowth
• Calm and nourish the nervous system to cope with chronic pain and anxiety as well as balance mood swings

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Eat more fish and avoid biscuits, pastries and fast foods; That’s the message that comes out of a 12-year study on how dietary fat intake affects the risk of developing endometriosis.

The study analysed prospective data on fat intake from the Nurses’ Health Study II, beginning in 1989. Of the 116,607 female participants, there were 1199 cases of laproscopically confirmed endometriosis.

Overall fat consumption was not found to be associated with endometriosis risk, however, individuals who had the highest levels of long-chain omega-3 fatty acids consumption were 22% less likely to be diagnosed with endometriosis, compared to those who had the lowest levels of intake.

In addition, women who consumed the highest amounts of trans-fats were 48% more likely to be diagnosed with  endometriosis, compared to those who had the lowest levels of intake.

Missmer SA, Chavarro JE, Malspeis S, et al. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod 2010;25(6):1528-35

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