Amenorrhea
Absence of menstruation. Amenorrhea may be primary (the girl has never begun her periods) or secondary (the woman had her periods once and then stopped having them). Physiologic amenorrhea is the lack of menses before menarche, during pregnancy and early lactation, and after menopause (all considered normal). All other causes of amenorrhea are pathologic.
Causes of Primary Amenorrhea
Physiologic delay: The late onset of menses in a physiologically normal female. No workup is necessary in the female who has secondary sexual characteristics but no menstrual cycles until she is 18; however, if no secondary characteristics appear by age 14 and no menses has occurred, then a workup should be started earlier. The age
of menarche of the mother will often provide clues as to when the female child should expect to begin.
Primary ovarian failure: These patients are divided into two groups: those with normal but infantile genitalia (e.g. Turner's syndrome), and those with ambiguous genitalia (e.g. hermaphrodites). Karyotyping is necessary. Causes include: hypothalamic or pituitary failure (insufficiency or organic disease of either of those organs); congenital abnormalities (vaginal agenesis, vaginal septa, cervical atresia, uterine agenesis, uterine septi, or bicornuate uterus); imperforate hymen (This could impede the outflow of the menstruum. The girl will report monthly cyclical abdominal cramping due to the buildup of the menstrual flow. Treatment includes opening the hymen after a needle aspiration of the area behind the hymen demonstrates that a vagina exists.)
Causes of Secondary Amenorrhea
Endometrial sclerosis: This usually occurs as a result of a D&C after which the tissues heal by fibrosis.
Cervical stenosis: This can occur after a cervical conization where the cervix scars or the os cannot be found. Intrauterine growths must be ruled out.
Anovulation: This may be sporadic or constant. These can be causes for anovulation:
- Hypothalamic causes*: The organ disorder may be due to organic lesions (tumors, scars) or insufficiency
(polycystic ovarian disease, hyperprolactinemia amenorrhea).
- Pituitary causes *: Including insufficiency (Sheehan's syndrome) or organic disease (tumors, adenomas).
- Ovarian causes*: From scarring, tumors, cysts.
- Low Body Fat from Excess Exercise*: (less than 10% body fat). Although this form of anovulation is similar
to that which is induced with anorexia nervosa, in this type, when the patient regains weight or stops exercising excessively, the period will return.
- Adrenal Dysfunction: Hyperplasia, adenomas, tumors.
- Systemic Causes of Anovulation: Cushing's disease; post oral contraceptive agent syndrome; hyperprolactinemia; both over and underactive thyroid problems; and other disease (ulcerative colitis, diabetes mellitus, steroid use for autoimmune diseases, celiac disease). Usually when these diseases are corrected the menses will return to normal.
*indicates primary or secondary causes, usually secondary
Suggested Nutritional Supplementation
- Estrium - 2 scoops mixed in water twice daily.
Targeted nutritional medical food for healthy estrogen metabolism.
- GLA-Forte - 1 softgel daily.
240 mg gamma-linolenic acid
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
Contributing Factors
- Poor diet
- High stress
- Impaired fatty acid conversion
Dietary Suggestions
- FirstLine Therapy® Diet
Cervical Dysplasia
Dysplasia of the uterine cervix. Epithelial atypia involving part of the squamous epithelium; more common in young women.
Cervical dysplasia is now considered a sexually-transmitted disease because of the implicated role of human papilloma virus (HPV) in bringing about tissue changes. It is considered a precancerous lesion, since dysplastic changes often precede malignant transformation. Risk factors include:
- Early age of first intercourse
- Multiple partners
- Sexual exposure to men who have HPV (Human Papilloma Virus)
- Sexual exposure to men sexually exposed to women with CIN (Cervical Intraepithelial Neoplasia)
- Sexual exposure to men of low socioeconomic status
Cofactors in development of cervical cancer include:
- Smoking Poor Diet
- Long-term Oral Contraceptive Use Chronic Cervicitis
- HSV Infection Immune Compromise
- Environmental Carcinogens
Signs and Symptoms
This is a microscopic finding usually found routinely with a PAP smear.
Course and Prognosis
The condition may either progress through various stages, potentially ending in cervical intraepithelial neoplasia (CIN), or regress spontaneously or with treatment. Prognosis is excellent with appropriate treatment. Conventional treatment includes laser surgery, but does not address the underlying causes. Regular PAP smears are essential
to monitor cervical status.
Differential Diagnosis
- carcinoma
Suggested Nutritional Supplementation
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
- EstroFactors - 3 tablets daily with food
EstroFactors promotes healthy hormone balance in women of all ages by featuring targeted nutrients that support healthy estrogen metabolism and detoxification.
- Intrinsi B12/Folate - 2-3 tablets twice daily with food.
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- E-Complex 1:1 - 1-2 softgels daily with food.
E Complex-1:1 is a unique, natural vitamin E supplement that features a 1:1 ratio of alpha- to gamma- tocopherol; this ratio more closely resembles the tocopherol profile found naturally in vitamin E-rich plants.
- Zinc A.G. - 1 tablet twice daily with food.
Highly absorbable zinc/true amino acid chelate.
Contributing Factors
- High Fat Diet Obesity
- Caffeine Intake Impaired Fatty Acid Conversion
- Alcohol Intake
Dietary Suggestions
- Anti-Inflammatory Diet
Dysmenorrhea / Excessive Menstrual Cramps
Dysmenorrhea, or painful menstruation, is the second most common gynecologic complaint, superseded only by premenstrual tension. Dysmenorrhea has been described as a discrete clinical entity, characterized by "labor-like" pains. The morbidity attending this condition is manifested in the voluminous hours lost in the workplace and schools as a result of dysmenorrhea.
There are three types of dysmenorrhea. The first type is primary, characterized by the absence of an organic etiology. This most commonly occurs in adolescence, about 6 to 10 months post-menarcheal. Dysmenorrhea almost invariably is associated with ovulatory cycles. Thus, women taking oral contraceptives rarely experience dysmenorrhea. It is ameliorated in many women by pregnancy due to a decreased excitability of associated nerve fibers. However, some women experience an increase of primary dysmenorrhea after pregnancy, with some women continuing to experience dysmenorrhea throughout most of their reproductive years.
Another type is classified as secondary dysmenorrhea, the pain being secondary to specific pathologies. These include endometriosis (the most common secondary cause and misdiagnosis of primary dysmenorrhea), ovarian cysts, adhesions, pelvic inflammatory disease, fibroid polyps, adenomyosis, cervical stenosis, and possibly uterine displacement with fixation.
Membranous dysmenorrhea describes the third and most infrequent type. It is characterized by the passage of
an intact cast of the entire secretory endometrium through a non-dilated cervix.
Prevalence
Investigations by Moos, Coppen, and Kessel have noted moderate or severe dysmenorrhea in 45% of women surveyed. Additional studies have described similar prevalence rates. A survey of 113 patients from a family practice setting revealed the incidence of dysmenorrhea to range from 29% to 44% in any given two-month period. Extrapolations from currently available data indicate that approximately 10% of women of child-bearing age suffer from severe primary dysmenorrhea, rendering them unable to continue their normal work tasks at employment, school, or home. Budoff reports that dysmenorrhea is a major cause of work absence, totaling 140 million work hours annually. One study revealed that 10 to 15% of teenage girls missed one to two days of school each month due to dysmenorrhea.
Suggested Nutritional Supplementation
Mild
- EstroFactors - 3-6 tablets daily. Targeted nutritional support for healthy estrogen metabolism.
Targeted nutritional support for healthy estrogen metabolism.
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
Moderate to Severe add
- Fem Premenstral - 2-3 tablets twice daily 7-10 days prior to menses.
Herbal combination designed to work as an anti-spasmatic, smooth muscle relaxant and anti-inflammatory.
Contributing Factors
- Impaired Fatty Acid Conversion
- High Fat Diet
- Hypothyroidism
Dietary Suggestions
- Anti-Inflammatory Diet
Endometriosis
The ectopic occurrence of endometrial tissue. A common problem which has no known etiology but a higher occurrence is seen in women who defer pregnancy until later in life. Fiberoptic laparoscopic techniques allow a direct look at the problematic tissue.
Endometriosis is a painful, devastating disease in which small islets of endometrial tissue somehow migrate into the muscular wall of the uterus, out along the Fallopian tubes, and even to the surface of the ovaries and the pelvic contents, including the nearby colon. When observed at surgery, these small islets appear as tiny chocolate-colored blobs scattered here and there, some so small as to be nearly invisible to the unaided eye. Being endometrial tissue, they respond to the monthly surges of estrogen and progesterone exactly like the endometrium within the uterus, i.e., they swell with blood during the month and then bleed at menses time, causing considerable pain starting shortly before menstruation and not subsiding until after menstruation. The small drops of blood trapped in the tissue in which the endometrial islets are embedded become chocolate-colored over time. When confined to the muscular wall of the uterus, the condition is called adenomyosis and can cause significant pain with menstruation, otherwise known as dysmenorrhea.
The cause of this disorder is presently unknown. There is no mechanism known by which endometrial tissue could migrate throughout the pelvis as some cancers are able to. The hypothesis that scattered islets of endometrial tissue persist from embryonal time likewise is unproved. Further, the disorder appears to be of modern origin; it
is difficult to imagine that such a painful disorder could have existed a century or two ago without some medical
comment of it being made.
Some have hypothesized that it has something to do with the long time (and the many menses) between menarche and the first pregnancy. Until this century, women in the Northern hemisphere typically experienced only two or three years of menstruation before becoming pregnant, menarche being at about age 16 and first pregnancies at about age 18 or 19. Now, menarche is common at age 12 and pregnancy is often delayed until after the mid-20's.
It has been calculated that the number of menses between menarche and first pregnancy was typically less than
30, whereas now it customarily exceeds 150. The outward migration of endometrial cells may somehow result from such a long run of menstrual cycling in sexually active women without the hormonal "rest" of pregnancy. Further study is obviously needed.
Medical treatment of this disorder has included low-dose synthetic estrogen (to suppress endogenous estrogens), high-dose synthetic progestins taken daily or as long-acting IM injections of synthetic progestins (to suppress menses), and analgesics, including codeine and narcotics, for pain. The results are generally unsuccessful. The favorite treatment for young women with mild endometriosis is to recommend pregnancy as soon as possible. This is often successful when the recommended treatment can be followed.
Surgical treatment attempts to resect all visible endometrial lesions. This is rarely successful. Almost invariably, it becomes necessary to ablate (remove or destroy) both ovaries, tubes, and the uterus, regardless of the patient's age. When confined to the uterus (adenomyosis), hysterectomy is usually recommended.
Natural progesterone offers a more benign alternative since sufficient serum progesterone inhibits FSH and
LH.
Signs and Symptoms
If this tissue is growing adjacent to or on the lumbar nerve plexus, or on the colon, the symptoms can be varied and the diagnosis hard to pin down: dull, aching, cramping pain; bearing down pressure in the low back and pelvis; dyspareunia (pain with intercourse) may occur; abnormal bleeding may occur; palpable, tender nodules along the uterosacral ligaments; a fixed, tender, retroflexed uterus; thickening of the adnexa.
Course and Prognosis
The ectopic endometrial tissue can grow anywhere and responds to the same hormonal messages as other uterine tissue, swelling and changing with the menstrual cycle. Pain tends to increase with time and begins progressively earlier in the menstrual cycle. Laser techniques to destroy it are currently popular in conventional medicine, as is removing the uterus, ovaries (and perhaps appendix) thus stopping the menstrual cycle altogether.
Differential Diagnosis
- musculoskeletal problems causing back and pelvic pain
- dysmenorrhea
- PID
- ovarian tumor
Suggested Nutritional Supplementation
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
- Femarone 17 1/4 to 3/4 tsp on clean skin once daily (A.M.)
Natural Progesterone Creme
Dr. John R. Lee, M.D. recommends to patients with mild to moderate endometriosis that they use natural progesterone from day 10 to day 26 monthly, increasing the dose until they are satisfied that their pelvic pains are decreasing. Once that dose is reached, they continue it for 3-5 years before
gradually lowering it. Their menstrual flow will become considerably less and their bodies will have time
to heal the endometriosis lesions. If the pains recur, some patients will continue this treatment until menopause. Since 1982, none of his patients with mild to moderate endometriosis have had to resort to surgery.
- EstroFactors - 3-6 tablets daily
Targeted nutritional support for healthy estrogen metabolism and overall hormone balance
- Lipo-Gen - 1-2 tablets 2 times daily with meals.
Comprehensive lipotropic formula
- GLA-Forte - 1 softgels 2 times daily with meals.
240 mg gamma-linolenic acid
Contributing Factors
- High Stress
- High Fat Diet
- Impaired Fatty Acid Conversion
Dietary Suggestions
- Anti-Inflammatory Diet
Fibrocystic Breast Syndrome
Multiple names exist to describe cyclical breast tissue changes and the clinical symptoms that occur monthly under the hormonal influence of the menstrual cycle. The names include: cyclic mastalgia, fibrocystic disease, aberrations of normal development (ANDI), benign breast disease, fibrous disease, benign breast syndrome, cystic breast disease, and mammary dysplasia. In this nutritional handout this phenomenon will be referred to
as Fibrocystic Breast Syndrome (FBS), as this term coins the two most common breast changes which occur
(cystic, fibrous), and defines the condition as a syndrome and not a disease.
The condition of fibrocystic breasts has been labeled a syndrome, and is no longer recognized or properly referred
to as an actual disease manifestation. Indeed, Hutter in 1985 posed the question, "Is it reasonable to define as a disease any process that occurs clinically in 50% and histologically in 90% of women?" Additionally, the fibrocystic breast was classified as a manifestation disease, based upon the spurious belief that women with this condition were at 2 to 4 times the risk of developing breast carcinoma. This is currently not considered to be the case. Most women with cyclical fibrocystic breast changes are not at increased risk of cancer. Rather it is a special subset
of these women who are at risk. Dupont and Page, in 1985, demonstrated in a study of 10,366 breast biopsies over a period of 17 years, that women are at increased risk of cancer only if the breast syndrome is histologically atypical hyperplasia and/or there is a familial risk factor; the majority of women (70%) who underwent breast biopsy were not at risk.
Incidence
The incidence of FBS peaks in 30 to 40 year old women, occurring more frequently in the left breast. In most women it is experienced as a mild to moderate aching, burning, or intermittent sharp discomfort in one or both breasts during the premenstruum, at any time from ovulation to the onset of the menses.
Suggested Nutritional Supplementation
Mild
- Celapro - 1 tablet 2 times daily with meals.
Promotes healthy cellular aging
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
Moderate to Severe add
- EstroFactors - 3-6 tablets daily.
Targeted nutritional support for healthy estrogen metabolism.
Contributing Factors
- High Fat Diet Obesity
- Caffeine Intake Impaired Fatty Acid Conversion
- Iodine Deficiency Alcohol Intake
Dietary Suggestions
- Anti-Inflammatory Diet
Menopause - Hormone Dysregulation
Due to the early termination of the National Institutes of Health (NIH) research on Hormone Replacement Therapy
(HRT), many women who are either on HRT, or are considering it, have a difficult decision to make. Whether
or not to go on HRT is a critical decision because estrogen imbalance is responsible for many of the adverse effects associated with menopause. Estrogen may be, on occasion, a woman's best friend, but its fluctuation throughout life causes a host of problems for some women. It has been documented that in the United States, synthetic estrogen pharmaceuticals are among the most commonly prescribed and dispensed drugs in community practice. However, there are significant risks associated with this form of therapy.
The NIH study (Press Release: Tuesday July 9, 2002) and additional studies, including several published in the Journal of the American Medical Association (JAMA) and in theNew England Journal of Medicine, have indicated that the risks associated with HRT far outweigh the benefits. Some of the adverse side effects associated to long term use of HRT are invasive breast cancer, ovarian cancer, endometrial cancer, endometriosis, heart attack, stroke, blood clots, insulin resistance, type II diabetes, adult onset asthma and a wide range of other frequent adverse effects, such as abdominal bloating, migraine, or other kinds of headache, weight gain, anxiety, depression and breast tenderness.
In simple terms, according to the data in the NIH study, if 10,000 women took the drugs for a year and 10,000 did not, women in the HRT group would have 8 more cases of invasive breast cancer, 7 more cases of heart attack, 8 more cases of stroke and 18 more instances of blood clots. Since 6 million women are currently on hormone replacement therapy, this translates to almost 25,000 cases of life-threatening (and in some cases
life-terminating) side effects. Another study published in JAMA, July 17, 2002 (288:334-341) followed a group
of women for 10 years or more, who used HRT, they were found to be at significantly increased risk for ovarian cancer. These studies also indicated that the study participants who developed these diseases had no family history of the disease.
With these obvious, documented risks, alternative therapies to HRT should be considered before any decision is made.
Some of the Natural Alternatives to Hormone Replacement Therapy
Women who decline to use HRT may choose from a variety of natural remedies that are available. These include: plant hormones called phytoestrogens, which are found in soy based products, and herbs such as black cohosh, ginseng, dong quai, and licorice root which have been used safely for centuries to eliminate menopausal symptoms. Past research has indicated that phytoestrogens may prevent heart disease, and slow bone loss without the risks associated with HRT. Creams containing wild yam extract offer enzymatically converted hormones with molecular structures that are identical to what the body produces. Menopausal symptoms such as hot flashes and vaginal dryness can be addressed using these bio-identical natural hormones.
Natural versus Synthetic Estrogens
To test the effect of natural estrogens, called phytoestrogens (found in soy foods and herbs such as Black Cohosh), researchers at Tufts University School of Medicine in Boston exposed estrogen-dependent breast-cancer cells to
a variety of synthetic estrogens (the same hormones found in traditional hormone replacement therapy).
They found that the synthetic estrogens promoted cell proliferation in the breast cancer cells, while the natural estrogens inhibited breast cancer cell growth.Nutrition and Cancer, 1998;30;232-9.
The Benefits of Soy Isoflavones in Menopause
Considerable evidence appears to indicate that soy isoflavones in the diet exert "weak" estrogenic effects that may confer anti-aging benefits, help prevent bone and joint disease, and cancer. They also promote cardiovascular wellness, help to maintain a healthy urinary tract, and modify the symptoms of menopause.
Earl Mindell, PhD, in his popular consumer book titled Earl Mindell's Soy Miracle, points to the value of soy in
suppressing menopausal symptoms. Dr. Mindell clearly reports the results of studies by Canadian researchers
of Japanese women where menopausal complaints such as hot flashes are much less prevalent in Japanese than Western women. Dietary supplementation with soy phytoestrogens offers a possible alternative to the commencement of synthetic hormone replacement therapy with all its known drawbacks.
The prospect of using a natural means with soy isoflavone supplementation to reverse these adverse associations
of menopause is very exciting.
Phytoestrogens for a Healthier Menopause by Steven Holt, MD published in Alternative and Complementary
Therapies-June 1997.
The Benefits of Black Cohosh in Menopause
Black cohosh (Cimicifuga racemosa) has demonstrated estrogenic effects due to the action of several of its constituents. Both clinical studies and patient reports have found Black cohosh to be effective in eliminating many of the symptoms of menopause including hot flashes, vaginal dryness, depression and anxiety. In one study, researchers gave 110 women either a concentrated extract of Black cohosh or a placebo for 8 weeks. The Black cohosh group had a significant reduction in luteinizing hormone (LH) secreted by the pituitary gland in the brain. It is thought that high levels of LH as well as another hormone from the pituitary called follicle-stimulating hormone (FSH) are responsible for some of the unpleasant symptoms associated with menopause. If a woman produces enough estrogen, however, excessive levels of LH and FSH are usually kept in check.
Another study conducted in Europe showed that Black cohosh actually decreased menopausal symptoms better
than synthetic estrogen, including symptoms of vaginal dryness and discomfort. Black cohosh also has a record
of being extremely safe.
Duker, EM., Kopanski, L., Jarry, H., et. al. "The effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariecustomized rats". Planta Medica (1991)57;420-424.
The Benefits of Natural Estrogen and Progesterone Creams in Menopause
Transdermal cream of naturally derived progesterone and estrogen can be useful in coping with the symptoms associated with the decrease in hormone production during perimenopause, menopause, and following a hysterectomy. The formula should be designed to match the natural pattern of circulating estrogens found in the female body; 80% estriol, 10% each of estrone, and estradiol. Progesterone should be no less than 480 mg per ounce of cream. The advantage of transdermal application is better absorption. It goes directly into the bloodstream, thereby bypassing the problems associated with poor digestion and liver breakdown that can occur with oral supplementation.
Wright, JV., Morgenthaler, J. Natural Hormone Replacement. Smart Publications, Petaluma, CA, 94955, 1997. Lee, JR., Hopkins, V. What Your Doctor May Not Tell You About Menopause, Warner Books, Inc., 1271 Avenue
of Americas, New York, NY 10020, 1996.
Types of Menopause
- Natural, or physiologic menopause is caused by ovarian failure due to senescence. For example, at birth there are about 2 million eggs within the ovaries; at puberty this is reduced to about 300,000. At menopause, the eggs are virtually absent.
- Surgical, or artificial, menopause refers to the woman who has had both of her ovaries surgically
removed. Upon removal of the ovaries, the production of estrogen is dramatically reduced. This creates
an artificially induced, yet veritable state of menopause. According to one report, as many as 30% of postmenopausal women in the United States have had menopause surgically induced. These women possess the same capacity to suffer from the clinical symptoms and complaints associated with natural menopause.
- Premature menopause refers to idiopathic ovarian failure before the age of 40. Possible contributing
factors include radiation exposure, smoking, cancer, drugs, or surgery that reduces ovarian blood supply.
Dietary Suggestions
- FirstLine Therapy® Diet
NOTE: Due in large part to dietary factors, there is no word for menopause in the Japanese language because Japanese women do not experience any of the symptoms associated with this natural transition. Japanese women have a diet high in isoflavones and have virtually no hot flashes. Selestro features NovaSoy®, a patented super concentrate of soy isoflavones.
Suggested Nutritional Supplementation
Peri Menopause
Light to Moderate Symptoms
- EstroFactors - 3 tablets daily with food (can be taken in one dose)
- EstroFactors features nutrients that support healthy hormone balance and proper detoxification of unhealthy synthetic estrogens that increase risk to cancer, heart disease and diabetes. EstroFactors contains no hormonal constituents. EstroFactors is recommended if the patient is or has been on synthetic hormone replacement therapy (HRT).
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
Severe Symptoms Add
- Selestro - 1 tablet one to two times daily
- Selestro contains both soy isoflavones and black cohosh to help manage menopausal complaints such as hot flashes/night sweats, occasional sleep disturbances, mild mood swings, and occasional irritability.
Menopause Nutritional Support
Light to moderate symptoms
- EstroFactors - 3 tablets daily with food (can be taken in one dose)
EstroFactors features nutrients that support healthy hormone balance and proper detoxification of unhealthy synthetic estrogens that increase risk to cancer, heart disease and diabetes. EstroFactors
contains no hormonal constituents. EstroFactors is recommended if the patient is or has been on synthetic hormone replacement therapy (HRT).
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
- Selestro - 1 tablet one to two times daily
Selestro contains both soy isoflavones and black cohosh to help manage menopausal complaints such as hot flashes/night sweats, occasional sleep disturbances, mild mood swings, and occasional irritability.
Severe Symptoms Add
- Estro Pro Cream - ¼ teaspoon, once or twice daily applied topically or intravaginally for women who are seeking relief of vaginal dryness. Apply to any soft part of the body (i.e. face, neck, belly, wrist,underarm or thigh), rotating to different areas periodically.
Estro Pro Cream is a transdermal cream containing bio-identical human progesterone and estrogens designed to match the natural pattern of circulating estrogens found in the healthy female body.
Hot Flash Acute Management
- Fem Estro HP - 15 drops in mouth every 30 minutes reducing to 3-4 times a day.
Adreno Pause (Adrenal Insufficiency)
As a woman begins to enter menopause, her ovaries stop producing estrogen, and it is the adrenal glands that become the primary source of estrogen production. If you consider the profile of your patients with menopausal symptoms, they are more than likely single mothers, career women, and/or women with a high level of stress in their lives. It is the adrenal glands that support the body's ability to cope or adapt to stress! Thus it is important
for the clinician to address altered adrenal function in menopause especially in the presence of the "unnecessary
symptoms of menopause" (e.g. Hot Flashes, mood swings, night sweats,etc.).
For Adreno Pause add:
- Adreset - 1 tablets, two times daily between meals.
Adreset contains nutrients and herbs to support adrenal function and hormone balance. The adrenals pick up the production of hormones as the ovaries shut down, if the adrenals are stressed, they are unable to perform this function, causing more profound symptoms of menopause
Comprehensive Bone Nourishment for Women with Known Bone Loss
It is extremely important for all women, especially those of menopausal years, to be on a comprehensive bone
support formula. The decline in estrogen contributes to accelerated bone loss.
- Cal Apatite Plus - 2 tablets twice daily with food, may take up to 8 tablets daily for significant bone loss. Cal Apatite Plus is a complete bone food that has been documented in scientific literature to regenerate
bone (even in post-menopausal women). The ipriflavone contained in Cal Apatite Plus has been shown to reduce osteoclastic activity (bone breakdown) while increasing osteoblastic activity (bone building) without any adverse side effects.
Additional Considerations
If hormonal testing has been performed, the following may be considered:
Low Progesterone, Normal Estrogen and Testosterone
- Femarone 17 - ¼ teaspoon, once or twice daily applied topically or intravaginally for women who are seeking relief of vaginal dryness. Apply to any soft part of the body (i.e. face, neck, belly, wrist, underarm
or thigh), rotating to different areas periodically.
Femarone is a totally natural progesterone cream from wild yam which is enzymatically converted to bio-
identical human progesterone.
Low Progesterone, Low Estrogen, Normal Testosterone
- Estro Pro Cream - ¼ teaspoon, once or twice daily applied topically or intravaginally for women who are seeking relief of vaginal dryness. Apply to any soft part of the body (i.e. face, neck, belly, wrist, underarm or thigh), rotating to different areas periodically.
Estro Pro Cream is a transdermal cream containing bio-identical human progesterone and estrogens
designed to match the natural pattern of circulating estrogens found in the healthyfemale body.
Low Progesterone, Low Estrogen, Low Testosterone
- Estro Pro Cream - ¼ teaspoon, once or twice daily applied topically or intravaginally for women who are seeking relief of vaginal dryness. Apply to any soft part of the body (i.e. face, neck, belly, wrist, underarm or thigh), rotating to different areas periodically.
Estro Pro Cream is a transdermal cream containing bio-identical human progesterone and estrogens
designed to match the natural pattern of circulating estrogens found in the healthy female body.
- BioSôm - 1 spray serving under tongue, 1-4 times daily. Mix with saliva for 20 seconds, and swallow. BioSôm is a liposomal DHEA for maximum uptake and effectiveness. In women, DHEA converts directly and safely into testosterone alleviating symptoms of low testosterone and supporting adrenal function.
Contributing Factors
- Poor Diet
- High Stress
- Impaired Fatty Acid Conversion
NOTE: Estrogen plays a role in the pathophysiology of asthma and that long-term use and/or high doses of
postmenopausal hormone therapy increase subseq uent risk of asthma.
- Am J ��espir Crit Care Med, Vol. 152. pp. 1183-1188, 1995.
Menorrhagia / Excessive Menstrual Blood Flow
Dysfunctional uterine bleeding accounts for 30-40% of all gynecological visits, and 60% of all dilatation and curettage procedures. Fifty percent of patients undergoing hysterectomy for menorrhagia in Oxford, England, were scheduled for surgery because of regular heavy menstrual bleeding of unknown cause. The most commonly occurring causes of true excessive menstrual bleeding are: leiomyomas (fibroids) of the uterus, pelvic inflammatory disease, endometriosis and adenomyosis, lesions in the uterine cavity, such as submucous leiomyoma, intrauterine polyps, and intrauterine contraceptive devices.
In the absence of any clinically apparent pelvic disease as described above, excessively heavy menstrual bleeding is called "dysfunctional uterine bleeding." Benjamin and Seltzer describe dysfunctional uterine bleeding
as "abnormal uterine bleeding in which there is absolutely no organic pathological condition to be detected on clinical pelvic examination." In one study, 42 women who underwent hysterectomy for excessive menstrual blood losses were found to have no obvious pathology, nor an excessive number of arteries for abnormal glandular distribution. In other words, it is common for women to suffer from excessive menstrual bleeding for no known organic cause. Often the cause is due to biochemical imbalances produced by vitamin and mineral deficiencies and/or essential fatty acid imbalances, which may be systemic or tissue-specific.
Suggested Nutritional Supplementation
Mild
- EstroFactors - 3-6 tablets daily.
Targeted nutritional support for healthy estrogen metabolism.
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
Moderate to Severe add
- Femarone 17 - 1/4 - 1/2 teaspoon twice daily for the last 10 - 14 days of the cycle. Liposome natural USP progesterone & anti-oxidant body creme
Greater than 70% of Dysfunctional Uterine Bleeding (DUB) cases are associated with anovulation. The bleeding in anovulatory women is generally a result of continued stimulation of the endonetrium with unopposed estrogen. The specific hormone lacking in nonovulatory DUB is progesterone.
- Hemagenics - 1 tablet 3 times daily.
Nutritional support for red blood cell formation
Contributing Factors
- High Fat Diet
- Low Iron Despite Normal
- Impaired Fatty Acid Conversion
- Hematological Parameters
- Obesity and excess adipose tissue
Dietary Suggestions
- FirstLine Therapy® Diet
Ovarian Cyst
A cyst on an ovary. When associated with other disorders of the hypothalamic-pituitary-ovarian axis, and many cysts are present, it is termed Polycystic Ovary Syndrome (aka Stein-Leventhal Syndrome). Ovarian cysts may
be due to endometriosis, follicular or corpus luteum cysts, malignancy, or dermoid cysts. In Polycystic Ovary
Syndrome, follicular cysts develop as a result of pituitary overproduction of LH to try to initiate ovulation.
Ovarian cysts are products of failed or disordered ovulation. One or more ovarian follicles are developed monthly
by the effects of follicle stimulating hormone (FSH). Luteinizing hormone (LH) promotes actual ovulation and the transformation of the follicle (after ovulation) into the corpus luteum which produces progesterone. In young women, during the early years of menstrual cycles, ovulation may coincide with a small amount of hemorrhage
at the follicle site. This will cause abdominal pain, often with a slight fever, at the time of ovulation (in the middle days between periods) is commonly called mittelschmerz (German for "middle" and "pain"). Treatment consists only of mild analgesics, reassurance, rest, and perhaps a warm pack. It is unlikely to recur and portends no future problems.
Later in life, usually after her mid-30's, a woman may develop an ovarian cyst which may be asymptomatic or may cause variable pelvic pain. Palpation may detect a smooth, tender mass at one ovary site or a cyst may be found by sonogram visualization. The cyst may simply collapse and disappear after a month or two; or it may persist and increase in size and discomfort during succeeding months. Such cysts are caused by a failed ovulation
in which, for reasons presently unknown, the ovulation did not proceed to completion. With each succeeding month's surge of LH, the follicular site swells and stretches the surface membrane, causing pain and possible bleeding at the site. Some cysts may become as large as a golf ball or lemon before discovery. Treatment may require surgery during which the entire ovary may be lost.
An alternative treatment for ovarian cysts is natural progesterone. Biofeedback mechanisms dictate that sufficient gonadal hormones inhibit hypothalamic and pituitary centers, such that FSH and LH production are also inhibited. That is, in the usual circumstances, the successful response to FSH and LH hormones is the rise in progesterone from the corpus luteum. If sufficient and natural progesterone is supplemented prior to ovulation, LH levels are inhibited and regular ovulation does not occur. This is the effect of contraception pills, for example. Similarly, the high estriol and progesterone levels throughout pregnancy successfully inhibit ovarian activity for nine months. Therefore, adding natural progesterone from day 10 to day 26 of the cycle suppresses LH and its luteinizing effects. Thus, the ovarian cyst will not be stimulated and, in the passage of one or two such monthly cycles, will very likely regress and atrophy without further treatment.
Signs and Symptoms
Non-Polycystic
Often, these cysts are asymptomatic; abdominal pressure, discomfort, pain with palpation, heaviness (there is rarely sharp sudden pain that would tend to indicate a different pathology such as rupture, hemorrhage, or ovarian torsion); bleeding with ovulation; metrorrhagia.
Lab Findings : endometrial biopsy in women over 35 years old; laparoscopy.
Polycystic
Normal maturation of sexual development; hirsutism (usually only on the face); obesity; anovulating periods;
irregular periods with extended periods of amenorrhea; infertility; ovaries are enlarged and polycystic.
Lab findings: increased serum LH and normal FSH; serum testosterone (increased); urine 17-KS (increased);
endometrial biopsy (in women over 35 years old); serum androstenedione (increased); with luteal cysts.
NOTE: Metabolic Syndrome is often associated with polycystic ovary syndrome.
Course and Prognosis
In non-polycystic cysts, treatment is only needed if the cyst becomes symptomatic (unless there is a malignancy).
Conventional treatment is usually surgery.
In polycystic ovary syndrome, while the course is typically benign, achieving pregnancy may be problematic (usually fertility must be drug-induced). Otherwise, normal conventional treatment consists of suppressing the pituitary release of LH by giving low-dose estrogen BCPs.
Suggested Nutritional Supplementation
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
- EstroFactors - 3-6 tablets daily.
Targeted nutritional support for healthy estrogen metabolism.
- GLA Forte - 1-2 capsules daily.
240 mg gamma-linolenic acid.
- Zinc A.G. - 1 tablet twice daily with food.
Highly absorbable zinc/true amino acid chelate.
Progesterone Deficiency, if indicated by laboratory assessment
- Femarone 17 - Gently rub 1/8 to 3/4 teaspoon on clean skin (wrists, neck, face twice daily. Use 21 days and stop for a week and repeat. Application is intended for external cosmetic use.
Higher potency enriched moisturizing creme with 980 mg progesterone, phtoestrogen compounds and antioxidant
vitamins
Contributing Factors
- Hypothyroidism Obesity
- Low Fiber Intake Liver Damage/Dysfunction
- High Fat/Caffeine Intake High Stress
- Impaired Fatty Acid Conversion
Dietary Suggestions
- FirstLine Therapy® Diet
- Restrict caffeine and alcohol
PMS (Premenstrual Syndrome)
Premenstrual tension has been described as a progressive symptom complex occurring seven to ten days premenstrually, thereafter improving with menses. Clinical experience now shows that PMS may encompass one to 150 different symptoms that occur cyclically in women during their estrogen active years. Dr. Susan Lark describes PMS to be one of the most common problems afflicting younger women. It is believed to affect between one-third and one-half of all American women between the ages of 20 and 50-in other words, 10 to 14 million women. Dr. Penny Budoff succinctly states, "It is curious that in this day and age when we are probing outer space that we permit more than 50% of our population of the world to suffer."
Suggested Nutritional Supplementation
Mild
- Fem Premenstrual - 2-3 tablets twice daily 7-10 days prior to menses or 1-2 tablets daily all month long.
Premenstrual support formula
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
Moderate to Severe Add
- EstroFactors - 3-6 tablets daily.
Targeted nutritional support for healthy estrogen metabolism.
- Chasteberry Plus - 1 tablet twice daily. Herbal support for female hormonal balance
A randomized, double blind, placebo controlled study of 170 women reported significant improvement by 52% of the participants taking chasteberry. British Medical Journal2001, 322: 134-137.
Contributing Factors
- Hypothyroidism Diuretic Use
- Obesity Liver Damage/Dysfunction
- Impaired Renal Clearance High Stress
- Impaired Fatty Acid Conversion High Fat/Caffeine Intake
- Low Fiber Intake
Dietary Suggestions
- FirstLine Therapy® Diet
- Restrict Caffeine and Alcohol
Polycystic Ovarian Syndrome
Polycystic ovary syndrome (PCOS) may be the most common endocrine disorder in women. It is estimated to
be present in 5% to 10% of premenopausal women. Despite its prevalence, the etiology of PCOS has yet to be determined. The diagnosis of PCOS, also known as Stein Leventhal Syndrome, is complicated by the lack of standard diagnostic criteria, and the fact that very few patients present with identical clinical symptoms.
PCOS is a loosely defined, heterogeneous disorder. It is characterized by the presence of polycystic ovaries associated with one or more of the following conditions: hirsutism, obesity, anovulation, infertility, menstrual disorders, hyperinsulinemia, insulin resistance, and hormonal imbalances. Included in the differential diagnosis
of PCOS is Cushing's syndrome, hyperprolactinemia, congenital adrenal hyperplasia, idiopathic hirsutism, and androgen-secreting tumors.
In addition to the distressing symptoms of PCOS, patients with this syndrome are at increased risk for a variety of serious medical complications. These include non-insulin dependent diabetes mellitus (NIDDM), hyperlipidemia, hypertension, cardiovascular disease, endometrial cancer, ovarian cancer, and possibly breast cancer. As a result, the proper diagnosis and treatment of this syndrome is vitally important.
Diagnostic Criteria
The presence of polycystic ovaries is a primary diagnostic criterion of PCOS. Polycystic ovaries are detected by transvaginal ultrasound. They appear as increased ovarian central stroma with the presence of eight or more peripheral follicular cysts 10mm or less in diameter. It is important to remember, however, that polycystic ovaries may be present in women without PCOS, or may be indicative of syndromes other than PCOS.
Role of Insulin Resistance
Insulin resistance, a condition characterized by decreased tissue sensitivity to insulin, is a key component of the clinical picture of PCOS. Insulin resistance leads to increased insulin production (hyperinsulinemia), progressive pancreatic beta-cell deficiency, and impaired glucose tolerance, eventually leading to the development of NIDDM. Obesity is highly correlated with insulin resistance, and approximately 50% of women with PCOS have central obesity. In addition to obesity, genetic predisposition, pregnancy, drugs (such as corticosteroids), and lifestyle factors (such as smoking) contribute to insulin resistance.
As it relates to PCOS, a growing body of evidence points to insulin resistance as a cause of the hormonal disturbances seen in the hypothalamic-pituitary-ovarian axis in patients with PCOS. Typically, the hormonal profile in PCOS shows increased gonadotropin-releasing hormone (GnRh), increased luteinizing hormone (LH), pulse frequency, increased LH, normal follicular-stimulating hormone (FSH) (resulting in increased LH/FSH ratio), elevated testosterone, and elevated insulin. Additionally, about 50% of women have elevated DHEA-S levels, and approximately 20% of PCOS patients have elevated prolactin levels.
Other Lifestyle Factors in PCOS
Weight management and exercise should be top priorities in a PCOS treatment plan. Numerous studies support the use of weight loss and aerobic exercise as effective means of lowering insulin resistance.
Women with PCOS should avoid excessive intake of caffeine. One study showed that drinking coffee increases blood sugar levels significantly as compared to placebo. The greatest increase in glucose levels occurred 2-3 hours after coffee ingestion. The mechanism of the hyperglycemic effect is postulated to be due to caffeine- induced catecholamine release. Cigarette smoking should also be avoided in women with PCOS, as it has been shown to worsen insulin resistance in patients with NIDDM.
Suggested Nutritional Supplementation
- UltraMeal Plus 360 - 2 scoops twice daily
Nutritional support for the management of conditions associated with metabolic syndrome and cardiovascular disease (CVD).
- High Concentrate EPA-DHA Liquid - 1 tsp. twice daily
High Concentrate EPA-DHA Liquid provides at least 2,800 mg per serving of EPA, DHA, and other purity- certified, omega-3 essential fatty acids in triglyceride form.
- Cenitol - 1 scoop twice daily
Cenitol supports a healthy mood and overall nervous system function by featuring inositol-an important, naturally occurring component of cell membranes. Cenitol also supplies magnesium in the form of a fully reacted amino acid chelate designed for enhanced nervous system support.
Based on previous studies, scientists discovered a deficiency of inositol, a nutrient related to insulin activity,
in patients with diabetes, impaired glucose tolerance, or insulin resistance. With this knowledge, scientists initiated a double-blind, placebo-controlled clinical trial to evaluate the effect of inositol on obese women with PCOS. By the end of the study, the treatment group had significant improvements in insulin action and glucose tolerance. Consequently, ovulatory function improved and decreases occurred in plasma triglycerides, serum androgens, and blood pressure. In the placebo, these variables were not significantly altered.
- Estrium - 1 scoop daily
Estrium is a low-allergy-potential, powdered medical food that provides a combination of macro- and
micronutrients specially selected for their ability to promote optimal hormone balance.
or
- EstroFactors - 3 tablets daily.
EstroFactors promotes healthy hormone balance in women of all ages by featuring targeted nutrients that support healthy estrogen metabolism and detoxification
Suggested Mixing Instructions
- 2 scoop UltraMeal Plus 360
- 1 tsp. High Concentrate EPA-DHA Liquid
- 1 scoop Cenitol
- 1/2 scoop Estrium
Blend, shake, or briskly stir into eight ounces of chilled juice, soy, almond, rice, or organic cow's milk, or water.
Additional Nutritional Support Considerations
Progesterone Deficiency (if indicated by laboratory assessment)
- Femarone 17 - Natural Progesterone and Phytoestrogen Topical Cream
Gently rub 1/8 to 3/4 teaspoon on clean skin (e.g. wrists, neck, face, etc.) twice daily. Use 21 days and stop for a week and repeat. Application is intended for external cosmetic use.
Dietary Suggestions
- FirstLine Therapy® Diet
Pregnancy
Achieving a Healthy Pregnancy (adapted from the seminar "Achieving a Whole Pregnancy: Bringing
Holism into Birth" by Joel M. Evans, M.D.
Because pregnancy is physically demanding, it's useful to think about reasonable changes to diet and lifestyle that
you might make in order to improve your general health and well-being and prepare the way for pregnancy.
1. Reducing your chemical load: When you eat foods that have a lot of additives and preservatives, you consume chemicals that are more difficult for the body to break down.
If you want to begin your pregnancy with your body functioning as well as it can, it's better to eat foods with fewer chemicals. Overall, that means eating whole grains and five to seven daily servings of (preferably organic) fruits and vegetables, and avoiding foods with artificial sweeteners as well as packaged foods (like snack foods) with
a long shelf life. And, if possible, detox before pregnancy!
2. Preparing for pregnancy: Once you become pregnant, you need more vitamins and minerals like calcium, iron, zinc, folic acid, choline, and the omega-3 fatty acids (EPA-DHA).
How important is detoxification/reducing your chemical load and increasing your vitamins, minerals and fatty
acids?
- Of the 287 chemicals detected in umbilical cord blood, 180 cause cancer in humans or animals, 217 are toxic to the brain and nervous system, and 208 cause birth defects or abnormal development in animal tests.1
- Fetuses of women who ate an "imprudent" diet (including high intakes of chips/crisps, sugar,
confectionary, white bread, soft drinks, and red meat and low intakes of fruit/vegetables, rice/pasta, yogurt, and wholemeal bread) had reduced ductus venosus shunting and increased liver blood flow, which have longer-term detrimental consequences for lipid and clotting factor homeostasis.2
- Recent research has established that acute lymphoblastic leukemia (ALL), the most common childhood cancer, and the second most common cause of mortality in children aged 1-14 years, can originate in utero, and thus maternal diet may be an important risk factor for ALL.3
Omega- Fatty Acids
Nutritional roles of omega-3 fatty acids during pregnancy and neonatal development reported positive effects of
omega 3's in pregnancy:4-13
- promote brain and eye development
- encourage fetal weight gain
- reduce preterm labor, preeclampsia, gestational diabetes
- increase the nutritional value of breast milk
- impact the immune system to decrease childhood atopy, allergy and asthma
- stabilize mood and prevent depression
Choline
A vitamin that is a precursor for acetylcholine, phospholipids, and betaine. Requiredfor the structural integrity of cell membranes, cholinergic neurotransmission, lipid and cholesterol metabolism, and transmembrane signaling. Rat studies show significant improvements in memory and brain development. Dietary intakes of choline were associated with reduced neural tube defect (NTD) risks. NTD risk estimates were lowest for women whose diets were rich in choline, folic acid, betaine, and methionine. Pregnancy and lactation are periods when maternal reserves of choline are depleted. At the same time, the availability of choline for normal development of brain is critical. Thus, memory fuction in the aged is, in part, determined by what mother ate.14-17
Folic Acid
Folic acid, also known as folate, is a nutrient in the B-complex vitamin group (there are eight B vitamins altogether).
It's been shown to reduce the rate of fetal abnormalities, particularly defects to the brain and spinal cord such as spina bifida (an opening in the spine), by 50 to 70 percent. It also reduces the recurrence rate of these defects
in subsequent children by as much as 80 percent. In addition, animal studies have shown that prenatal folic acid reduces the incidence of childhood cancers. Folic acid also offers important health benefits to adults, lowering the risk of heart disease, certain cancers, depression, and abnormal Pap smears.
Because the spinal column and brain begin to develop almost immediately after conception, it's ideal to have been taking folic acid while trying to conceive - no matter how long it takes. However, if you haven't been taking prenatal vitamins while trying to conceive, increasing your folic acid right after you learn you're pregnant is still a good idea for you and your developing child.2,3-14
Calcium
As you probably know, you and your baby both need calcium for strong teeth and bones. But calcium does more than build healthy bones-among other things, it helps the body maintain regular circulation, muscle action, and nerve function. Since the baby will take the calcium he needs from you no matter what, you need to replenish your own stores of the nutrient.
Why Choose Wellness EssentialsTM for Pregnancy?
Wellness EssentialsTM for Pregnancy is carefully formulated to comprehensively support key organ systems in both mother and child-all in a once-daily program!
Featured Ingredients:
- Omega-3 fatty acids - Guarantees optimal daily intake of EPA and DHA to enhance fetal growth and
development, support a smooth pregnancy, and help relieve postpartum negative mood.
- Folate - Delivers 1 mg of body-ready folate to support healthy hormone metabolism, DNA synthesis,
cardiovascular health, and neurological development.
- Choline - Features enhanced levels of choline to support healthy digestion (particularly of fats),
neurological health, and fetal brain development.
- Calcium and magnesium - Supplies calcium and magnesium to help relieve muscle tension, promote a
sense of calm, and support a smooth pregnancy.
- Antioxidants - Provides a nutritious blend of vitamin C, mixed carotenoids, zinc, and selenium to
support optimal immune system function and help maintain reproductive health.
For additional information on achieving a healthy pregnancy consider:
"The Whole Pregnancy Handbook", by Joel M. Evans, M.D. Ob/Gyn
Suggested Nutritional Supplementation
- Wellness EssentialsTM for Pregnancy - 1 packet daily during 1st and 2nd trimester, then two packets
daily during 3rd trimester and continuing through nursing
Daily Essentials for Before, During & After Pregnancy
When Should a Woman Begin Taking Wellness EssentialsTM for Pregnancy?
A woman should begin taking Wellness Essentials for Pregnancy the moment she starts planning to have a child, rather than waiting until after a positive pregnancy test. Research shows that fetal brain and spinal cord development begins in the earliest stages of pregnancy-a time when a woman may not even realize she is pregnant-indicating the need to establish healthy levels of supportive nutrients early on. This is especially true when it comes to proper levels of omega-3 fatty acids, folate, choline,
calcium, magnesium, and antioxidants-essential nutrients found in Wellness EssentialsTM for
Pregnancy.
- Probiotic Supplementation
- 3rd Trimester - UltraFlora Plus® DF Capsules - 1 capsule twice daily
- Birth to 6 months - BifoViden IDTM - 1 capsule twice daily
- 6 months to 1 year - UltraFlora Plus® DF Capsules - 1 capsule daily
References:
1. JAMA, July 20, 2005-Vol 294, No. 3
2. Haugen et al., Circ Res. Jan 2005;96:12-14
3. Jensen et al., Cancer Causes Control. 2004 Aug; 15(6):559-70.
4. Antenatal determinants of neonatal immune responses to allergens.
Devereux et al., Clin Exp Allergy. 2002 Jan;32(1):43-50
5. Fish Oil Supplementation in Pregnancy Modifies Neonatal Progenitors at Birth in Infants at Risk of Atopy
Pediatric Research Vol. 57, No. 2, Feb 2005
6. Fish Oil Increases Insulin Sensitivity
Popp-Snijders et al., Diabetes Res 1987;4:141-147
7. EngstrÖm et al., Prostaglandins Leukot Essent Fatty Acids 1996;54:419-425
8. Fish Oil Supplementation after 30 weeks:
i. lowers the risk of premature birth by 40% to 50%
ii. increases the length of pregnancy by 5 days
iii. results in babies with a 100-g higher birth weight
Saldeen et al., Obstet Gynecol Surv. 2004 Oct;59(10):722-30
9. [Poster: 304 American Thoracic Society 5/25/04] Maternal Fish Consumption during Pregnancy and Risk of ChildhoodAsthma
M.T. Salam et al., Preventive Medicine, University of Southern California, Los Angeles, CA
10. Both lower DHA content in breast milk and lower seafood consumption were associated with higher rates of postpartum depression. Hibbeln J Affect Disord 2002;69:15-29
11. Influence of trans fatty acids on infant and fetus development. Mojska, H., Acta Microbiol Pol. 2003;52 Suppl:67-74
12. The effect of supplementation with fish oil during pregnancy on breast milk immunoglobulin A, soluble CD14, cytokine levels and fatty acid composition. Dunstan et al., Clin Exp Allergy. 2004 Aug;34(8):1237-42
13. Changes in brain concentrations of DHA are positively associated with changes in cognitive or behavioral performance. Am J Clin Nutr Aug 2005;82:281-95.
14. Am J Epidemiol 2004 Jul 15;160(2):102-9
15. Zeisel SH., Am Coll Nutr. 2000 Oct;19(5 Suppl):528S-531S
16. Periconceptional Dietary Intake of Choline and Betaine and Neural Tube Defects in Offspring Am J Epidemiol. 2004 Jul 15;160(2):102-9
17. J Am Coll Nutr. 2004 Dec;23(6 Suppl):621S-626S
Morning Sickness/Nausea
Symptoms
Morning sickness is probably one of the most uncomfortable aspects of pregnancy. Some women may even fear that nausea and vomiting is a subconscious rejection of the baby. But experiencing nausea and vomiting is actually a good sign-an indication of a healthy pregnancy. As a pregnant woman, knowing that may allow you
to relax and enjoy your pregnancy, and understanding the causes can help to relieve anxiety.
Morning sickness commonly occurs during the first trimester of pregnancy in approximately 50 percent of expectant women, especially those pregnant for the first time. Some women suffer from nausea throughout the nine months
of pregnancy, but in most cases it disappears after three months or so. It can occur at any time during the day
but is most frequently felt in the morning and late afternoon when the stomach is empty. Symptoms range from
a slight feeling of nausea upon waking to persistent and frequent "pernicious" vomiting. The exact cause of nausea and vomiting during pregnancy is unclear-some experts believe that it may be due to a vitamin B6 (pyridoxine) or zinc deficiency. New research shows that nausea may be attributed to low blood sugar and the excess protein requirements of the developing fetus. Increased hormone production during pregnancy can also cause nausea.
NOTE: Infection with Helicobacter pylori, the bacteria that causes stomach ulcers, may also cause a severe form
of morning sickness in pregnant women. Researchers at the University of Vienna in Austria found that over 90%
of pregnant women with hyperemesis gravidarum-severe nausea and vomiting often leading to weight loss and electrolyte disturbances-were infected with H. pylori. The researchers hypothesize that in the early phase
of pregnancy, changes in a woman's body fluid concentration affect the acidity (pH) of the stomach, which may
in turn activate latent H. pylori residing in the stomach. (If you suspect Helicobacter pylori, see protocol under
"Ulcer" section of this guide.)
Indications
Nausea, sickly feeling (e.g., when driving or flying), seasickness, nausea in pregnancy (soothing effect). Nausea as the effect of other disorders, weakness of conduction, gastric catarrh, phases of impregnation, nausea of children (atrophy
and dystrophy). Acaetonemic vomiting of sucklings and children. Vomiting on rising and gastric catarrh of heavy drinkers. Cold perspiration and nausea, especially in weakness of the conduction and prior to biliary colic. Complementary remedy
in renal colic with nausea and vomiting.
Suggested Nutritional Supplementation
In addition to a good prenatal multivitamin/mineral supplement, such as Wellness EssentialsTM for Pregnancy
or Fem-Prenatal, include the following:
- Pyridoxal-5' Phosphate (CoEnzyme B6) - 2 tablets three times daily with food.
The active form of B6.
- Mag Glycinate - 1-2 tablets three times daily with food. Highly absorbable magnesium.
NOTE: An excellent homeopathic "Rescue Remedy" to be used as needed:
- D-52 Maldemar (homeopathic formula for vomiting and nausea) - Dosage: 10-15 drops under the tongue four times daily; first aid dosage: every 5-30 minutes; acute dosage: 30 minutes to hourly, decreasing to
3-4 times daily; chronic dosage: 1-3 times daily
Diet
FirstLine Thearpy® Diet
- Eat small meals often: Have frequent small meals with complex carbohydrates like bread, rice, pasta (if you can, eat whole grain versions). Eat slowly and chew your food completely.
- Keep snacks handy: Keep crackers by your bedside, so if you wake up very hungry or nauseated, there's something right there to settle your stomach. (Look for whole grain crackers that don't have saturated fats
or hydrogenated oils.) Keep snacks like pretzels or almonds in our bag or desk so you have something to nibble on if you're stuck in traffic or tied to your office. You don't want to have an empty stomach.
- Avoid strong smells and strong foods: Spicy, fried, and fatty foods are difficult to digest, so avoid them.
Also, strong smells can trigger both nausea and vomiting. If smells bother you, try to prepare simple meals
or ask your partner or a friend to prepare them for you.
- Sip liquid: Water, ginger tea, peppermint tea, red raspberry leaf tea, lemonade, clear soup, even cola or a sports drink like Gatorade. If you're vomiting it's important to make sure you are getting enough fluids.
- Eat what you can: The baby will get the nutrients she needs, so eat what appeals to you. If that means you
are living on bagels and cucumbers for a couple of weeks, so be it.
- Take prenatal vitamins strategically: If your prenatal vitamin triggers nausea, take it with your biggest meal
of the day, every other day, or before you go to bed, so you sleep through the nausea.
Vitamin B-rich foods: Some women find B vitamins help relieve nausea; they're in whole grains, avocados, corn, nuts.
Uterine Fibroids
Myometrial growths of the uterus. Also termed "fibromyoma" or "leiomyoma." These occur in 25% of women over age 35 and are often asymptomatic, discovery being made during the pelvic exam. They may, however, cause excess menstrual bleeding and/or pelvic pain or bloating. Their growth is increased during pregnancy and with estrogen therapy, and they tend to atrophy after menopause. They may either grow into the lumen, into the pelvic cavity, or remain in the wall of the uterus.
Otherwise known as myoma of the uterus, fibroids are the most common neoplasm of the female genital tract. They are discrete, round, firm, benign lumps of the muscular wall of the uterus, composed of smooth muscle and connective tissue, and are rarely solitary. Usually as small as an egg, they grow gradually to orange or grapefruit size commonly. The largest fibroid on record weighed over a hundred pounds. They often cause, or are coincidental with, heavier periods (hypermenorrhea), irregular bleeding (metrorrhagia), and/or painful periods (dysmenorrhea). Due to their mass, they may cause a cystocele (dropped uterus) later in life when pelvic floor supports weaken, leading to stress urinary incontinence. After menopause, they routinely atrophy.
Contemporary medical treatment usually is surgical. Some particularly skillful surgeons are adept at excising only the myoma, leaving the uterus intact. Generally, however, hysterectomy is performed. Here again, natural progesterone offers
a better alternative. Fibroid tumors, like breast fibrocysts, are a product of estrogen dominance. Estrogen stimulates their growth and lack of estrogen causes them to atrophy. Estrogen dominance is a much greater problem than is recognized by contemporary medicine. Many women in their 30's begin to have anovulatory cycles. As they approach the decade before menopause, they are producing much less progesterone than expected but still producing normal (or more) estrogen. They retain water and salt, breasts swell and become fibrocystic, they gain weight (especially around the hips and torso), become depressed and lose libido, their bones suffer mineral loss, and they develop fibroids. All are signs of estrogen dominance, i.e., relative progesterone deficiency.
When sufficient natural progesterone is replaced, fibroid tumors no longer grow in size (generally they decrease in size) and can be kept from growing until menopause, after which they will atrophy. This is the effect of reversing estrogen dominance. Anovulatory periods can be verified by checking serum progesterone levels the week following supposed ovulation. A low reading indicates lack of ovulation and the need to supplement with natural progesterone. The cause
of anovulation is uncertain but probably attests to premature depletion of ovarian follicles secondary to environmental
toxins and nutritional deficiencies common in the U.S. today.
Signs and Symptoms
Many are asymptomatic: menstrual irregularities; vaginal discharge; uterine pains or cramps; anemia.
Lab Findings: ultrasound; laparoscopy; D&C.
Course and Prognosis Treatment should only occur in symptomatic patients. In women who do not desire to become pregnant, conventional physicians generally perform a myomectomy or hysterectomy.
Differential Diagnosis
- Ovarian cysts or carcinoma
- Endometrial hyperplasia
- Cervical polyps
- Uterine carcinoma
- Adenomyomas
Suggested Nutritional Supplementation
- Wellness EssentialsTM for Women - 1 packet twice daily.
Daily foundation nutrition with added support for healthy hearts and bones.
- EstroFactors - 3-6 tablets daily.
Targeted nutritional support for healthy estrogen metabolism.
- AdvaClear - 2-4 capsules daily.
AdvaClear provides unique support for balanced activity of the body's detoxification processes.
Progesterone Deficiency, if indicated by laboratory assessment
- Femarone 17 - Gently rub 1/8 to 3/4 teaspoon on clean skin (wrists, neck, face twice daily. Use 21 days and stop for a week and repeat. Application is intended for external cosmetic use.
Higher potency enriched moisturizing creme with 980 mg progesterone, phtoestrogen compounds and antioxidant
vitamins
Female Conditions
Contributing Factors
- Impaired Fatty Acid Conversion
- Low Fiber Intake
- Obesity
- Liver Damage/Dysfunction
- High Fat/Caffeine Intake
- High Stress
- Metabolic Syndrome/Insulin Imbalance
Dietary Suggestions
- FirstLine Therapy® Diet
- Avoid Chocolate
- Restrict Caffeine, Alcohol, and Spicy Foods
Vaginitis / Leukorrhea
Inflammation and/or infection of the vagina with possible concurrent inflammation of the vulva. Vaginitis typically occurs one of two ways:
1. The overgrowth of a normal part of the vaginal flora, or the introduction of a foreign microorganism through sexual relations.
- Normal flora that can cause disease: yeast (often Candida albicans) may also spread from the intestines
or sexually; Hemophilus vaginalitis/Gardnerella vaginalitis: often called "nonspecific vaginitis."
- Foreign microorganisms: Trichomonas vaginalitis, Neisseria gonorrhea.
- In young girls it may be also caused by E. coli, strep, or staph due to poor hygiene.
2. Reaction to an external agent causing allergic or chemical reaction.
Signs and Symptoms
- Vaginal discharge: white and curdish (yeast); creamy white or off-white (Gardnerella); greenish-yellow, frothy (Trichomonas).
- Itching: may be severe.
- Odor: None (yeast and Trichomonas); fishy (Gardnerella).
- Vulvar irritation and redness: possible with all three infections; however, Candidais typically the worst irritant and can cause fissuring and swelling.
- Vagina: normal except for the presence of mild to extreme amounts of discharge.
- Lab Findings: (+) Wet prep and/or culture for microorganism identification. Pap smear may show inflammatory signs.
Course and Prognosis
While Trichomonas, Candida, and Gardnerella are benign infections causing no severe or life-threatening pathology, they can cause significant and unrelenting morbidity.Trichomonas, in particular, should be treated in a sexually active woman to prevent her passing it on to other individuals. Conventional treatment usually consists of nystatin (yeast); metronidazole (Trichomonas), and oxytetracycline (Hemophilus). Women treated this way have a high recurrence rate (especially of yeast andHemophilus).
Differential Diagnosis
- Differentiate infectious cause
- Foreign body (forgotten tampon)
- Malignancy
- Differentiate allergic/irritant cause
Suggested Nutritional Supplementation
Protocol for Normalization of Vaginal Flora
Two Week Program
Step 1: Purchase the Following:
Vaginal bulb, vaginal syringe, and 3% hydrogen peroxide solution (pharmacy); distilled water, live culture low fat yogurt, and apple cider vinegar (grocery store); and beneficial bacteria such as UltraFlora Plus.
Step 2: Directions (Day 1 through 7)
Mix 6 Tablespoons of the 3% hydrogen peroxide in one quart of distilled water. Fill the vaginal bulb and douche thoroughly each morning on arising and in the evening before retiring. The douche may also be used during the day if symptoms warrant it. Continue this procedure for 7 days. If symptoms have abated, proceed to Step 3. If symptoms are persisting, repeat Step 2. If at the end of this second week you are still experiencing symptoms of vaginitis, be sure to notify your doctor.
Step 3:Reintroduction of Beneficial Bacteria (Day 8 through 14)
Add 1/2 teaspoon of UltraFlora Plus to 2 Tablespoons of live culture, low fat yogurt. (Note: In case of severe hypersensitivity to dairy products, delete this step and simply add the bacteria to the apple cider vinegar solution described below). Let the yogurt-bacteria preparation stand at room temperature for 30-60 minutes and then implant it with the vaginal syringe just before bed. Insert a deodorant-free tampon to improve retention. On arising the next morning, remove the tampon and douche with the following solution: 1 pint distilled water, 1 Tablespoon apple cider vinegar, and 1/2 teaspoon UltraFlora Plus.
Continue this procedure for 4-7 day.
