All women 20 years of age and older should perform breast self-exam (BSE) each month, two to three days after your period, or on the same date each month if you no longer have periods. Monthly BSE helps you learn the way your breasts normally look and feel and allows you to notice changes. If you should find a lump or thickening in or near your breast or under your arm, a change in the size or shape of your breasts, a discharge from your nipple that occurs without squeezing or a change in the color or feel of the skin on your breasts, areola or nipple (dimpled, puckered or scaly), this should be reported to your health care provider for further examination. A clinical breast exam by an experienced physician should be a part of every yearly health exam for women 20 years of age and older.
Women 40 years of age and older should have screening of their breasts every 1-2 years depending on personal and family history and any other personal risk factors, to screen for breast cancer. A mammogram has generally been recommended for most women but additional imaging with sonography may be necessary if breasts are very dense. A breast MRI may be indicated if there is evidence of increased personal breast cancer risk. Mammography is a low dose X-ray that shows the inside of your breasts. During a mammogram, two smooth, flat plastic plates are placed around one of your breasts to flatten your breast tissue. Flattening your breast provides the best exam using the lowest dose X-ray. Two or more X-rays will be taken of each breast. If you have periods, have your mammogram during the week after your period when your breasts are less tender.
Some have recommended other screening methods due to concern about repeated radiation exposure to breast tissue over a woman’s lifetime with mammography. Thermography is just such a tool. While this technology has been widely utilized and recommended by some providers as a substitute for mammography, we do not have comparative data to support substituting thermography in place of mammography for routine breast cancer screening. Some women have opted for less frequent mammograms if they are low risk choosing to have breast thermography performed annually in between. While this may be a reasonable compromise, more data is needed with head to head comparison of these imaging options.
Infertility is defined as failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years. It affects up to 15% of couples.
An initial fertility workup should include a comprehensive review of the medical history, physical examination, and additional focused testing for both partners. For the female partner, tests will focus on ovarian reserve, ovulatory function, and structural abnormalities. Imaging of the reproductive organs provides valuable information on conditions that affect fertility. Imaging modalities can detect tubal patency, pelvic pathology and assess ovarian reserve. Men should have semen analysis performed as well.
Infertility is a significant source of stress for couples and can have devastating effects on relationships. Unexplained infertility may be diagnosed in as many as 30% of infertile couples. At a minimum, patients should have evidence of ovulation, tubal patency, and a normal semen analysis confirmed.
Currently, studies suggest that 40 to 50 percent of infertility cases among Heterosexual couples are due to male infertility. A reduced sperm count is also associated with increased all-cause mortality and morbidity. Scientists believe that the relationship between sperm count, morbidity, and mortality is mediated by testosterone; adequate testosterone is required for sperm production and protects against cardiovascular disease, diabetes, and obesity, three leading causes of morbidity and mortality. Finally, a low sperm count is associated with an increased risk of other male reproductive health problems, including testicular cancer.
Decreased sperm count, therefore, has significant implications beyond fertility and may be an important indicator of health across a man’s lifespan. A growing body of research indicates that environmental factors may lie at the root of this disturbing phenomenon. Many environmental factors have been linked to reduced sperm count, including endocrine-disrupting toxins, poor dietary habits, and the use of certain drugs. In order to protect male reproductive health and fertility, it is crucial that men reduce their exposure to these harmful environmental factors by making simple lifestyle changes.
The fertility of women decreases gradually but significantly beginning around age 32 years and decreases more rapidly after age 37 years, reflecting primarily a decrease in egg quality. The mechanisms involved are poorly understood but appear to include multiple factors encoded by genes. However, many of the environmental factors that impact men also impact women, especially the presence of endocrine disrupting substances in our environment.
As age increases, the risks of other disorders that may adversely affect fertility, such as leiomyomas, tubal disease, and endometriosis, also increases. Women with a history of prior ovarian surgery, chemotherapy, radiation therapy, severe endometriosis, smoking, pelvic infection, or a strong family history of early menopause may be at an increased risk of having a premature decrease in the size of their follicular pool and decline in fertility.
Given the anticipated age-related decline in fertility, the increased incidence of disorders that impair fertility, and the higher risk of pregnancy loss, women older than 35 years should receive an expedited evaluation and undergo treatment after 6 months of failed attempts to conceive or earlier, if clinically indicated. In women older than 40 years, more immediate evaluation and treatment are warranted.
Pre-pregnancy care is important to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with women to optimize health, address modifiable risk factors, and provide education about healthy pregnancy. This is also important to optimize sperm quantity and quality to produce the healthiest embryo.
This evaluation should include the previously mentioned tests along with pre-pregnancy lifestyle counseling.
Functional medicine is lifestyle medicine so it is best equipped to take a more holistic approach to this problem, especially given that many of the factors that negatively impact fertility, as mentioned, are heavily influenced by lifestyle, including environment, diet and habits. Endocrine disrupting toxins in our environment adversely affect male and female fertility but nutrition is a major factor as well since nutrient deficiencies may contribute to infertility and poor pregnancy outcome
At Willowbend Health & Wellness we understand that exposure to environmental toxins before and during pregnancy have a dramatic impact on fertility and pregnancy outcome. We offer testing to identify toxic exposure and micronutrient deficiency along with solutions to address them once identified. Dr. Gee recommends all couples actively participate in a total body detoxification program prior to attempting pregnancy. We offer many options to accomplish this goal.
Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.
Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain. Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:
- Irregular periods. Infrequent, irregular, or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.
- Excess androgen. Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
- Polycystic ovaries. Your ovaries might be enlarged on ultrasound and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.
PCOS signs and symptoms are typically more severe if you are obese. There is good evidence to support integrative options to evaluate and treat the symptoms of PCOS as well as the underlying contributors. If you have concerns about your menstrual periods, if you are experiencing infertility or if you have signs of excess androgen such as worsening hirsutism, acne, and male-pattern baldness, please contact us to schedule a consultation.
Pre-Menstrual Syndrome (PMS) is a condition that affects a woman’s emotions, physical health, and behavior during certain days of the menstrual cycle, generally just before menses. PMS is a very common condition. Its symptoms affect more than 90 percent of menstruating women. It must impair some aspect of your life for your doctor to diagnose you. PMS symptoms start five to 11 days before menstruation and typically go away once menstruation begins. The cause of PMS is unknown, although many researchers believe that it is related to a change in both sex hormone and serotonin levels at the beginning of the menstrual cycle.
Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxiety, and irritability. Ovarian steroids also modulate activity in parts of your brain associated with premenstrual symptoms. Serotonin levels affect mood. Serotonin is a chemical in your brain and gut that affects your moods, emotions, and thoughts.
Twenty to 32% of women report moderate to severe symptoms that affect some aspect of life. The severity of symptoms can vary by individual and by month and can include abdominal bloating or pain, sore breasts, acne, food cravings, constipation, diarrhea, headaches, fatigue, irritability, changes in sleep patterns, anxiety, depression, or emotional outbursts. A consultation is in order if physical pain, mood swings, and other symptoms start to affect your daily life, or if your symptoms do not improve with intervention.
Pre-Menstrual Dysphoric Disorder (PMDD) is a condition similar to PMS that also happens in the week or two before your period starts as hormone levels begin to fall after ovulation. PMDD causes more severe symptoms than PMS, including severe depression, irritability, and tension. PMDD affects up to 5% of women of childbearing age. Many women with PMDD may also have anxiety or depression.
Symptoms of PMDD vary from person to person, but can include moderate to severe irritability, depression, anxiety, panic attacks, mood swings, lack of interest in daily activities and relationships, difficulty thinking or focusing, fatigue, food cravings or binge eating, or insomnia. They often include physical symptoms as well, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain
Researchers do not know for sure what causes PMDD or PMS. Hormonal changes throughout the menstrual cycle may play a role. A neurotransmitter called serotonin may also play a role in PMDD. Serotonin levels change throughout the menstrual cycle. Some women may be more sensitive to these changes. Your doctor will talk to you about your health history and do a physical examination. You will need to keep a calendar or diary of your symptoms to help your doctor diagnose PMDD.
Functional medicine offers integrative options for evaluation to diagnose underlying imbalances that may be contributing to your symptoms including neurotransmitter and hormonal imbalances.
Uterine leiomyomata, or fibroids, are very common, affecting approximately 70% of women at some point in their lives. However, many cases go undiagnosed, increasing the probable incidence. In general, genetics and ovarian hormone exposure are the known antecedents for the development of fibroids. The heavy bleeding associated with fibroids can cause anemia, fatigue, and pain. Women with uterine fibroids report a decreased quality of life, difficulty getting diagnosed, and concerns about available treatment options. Often, women with fibroids want to avoid hysterectomy and seek alternative for which there are many now. However, in the US, uterine fibroids are the top indication for hysterectomy.
Factors that predispose women to fibroids are not yet well understood, but research has identified that modifiable lifestyle factors and antecedents play a role. Increased blood pressure, high serum lipids and metabolic syndrome can increase the risk of fibroids, suggesting a cardiometabolic connection. Low vitamin D levels may also increase risk for symptomatic fibroids. In addition, cytokines show different seasonal variance in women with and without fibroids, suggesting that a highly inflamed immune system may play a role in fibroid formation.
African-American women are much more likely to develop uterine fibroids, so they report more severe symptoms related to their fibroids. Either as part of an inflammatory milieu or otherwise, toxins also likely play a role in the development of fibroids, including exposure to air pollution. One large-scale, longitudinal study demonstrated that exposure to high amounts of air pollution [particulate matter (PM) 2.5] correlated with an increased risk of fibroids.
Heavy metals, persistent organic pollutants (POPs), and possibly PCBs are also correlated with uterine fibroid development. Estimates are that at least 23% of child-bearing women are exposed to three or more toxicants above the level of known safety. Critical windows of exposure may affect long-term hormonal patterns, especially pre-menarche exposures. A significant, dose-dependent connection between hair relaxers and fibroid risk also suggests that some African-American women may be exposed to more and different chemicals than many white women.
There now are a number of minimally-invasive surgical options that are approved and available to treat women with uterine fibroids. These procedures offer the option for women to preserve their uterus and its normal function. Dr. Gee has been recognized as a thought leader for her contributions to advancing these options for women through clinical research investigation and routine surgical offering. She has more than 35 years of experience treating women with complex uterine fibroid disease both surgically and medically.
From a Functional Medicine perspective, fibroids likely indicate hormonal imbalance, and several lifestyle interventions can assist in treatment, including improved nutrition (which may also reduce cardiometabolic risk), reduced exposure to toxins (particularly androgenic toxins), and anti-inflammatory interventions (including botanicals and lifestyle interventions). Regular detoxification to optimize hormonal balance would likely be of benefit. For the many women who suffer from fibroids but wish to avoid hysterectomy, these low-harm therapies may provide the relief they seek.
Endometriosis is a condition when the tissue that normally lines the inside of the womb (the endometrium) is found in other places in the body, for example in the fallopian tubes or ovaries. Sometimes endometrial tissue can be found in more distant locations such as the intestines, lungs or joints.
During a normal menstrual cycle, hormonal changes cause the endometrial tissue to shed, and it exits the body through the vagina. In endometriosis, the misplaced endometrial tissue is also affected by these hormonal changes. It too starts to break down and bleed, but there is no exit route for the old tissue to leave the body. This leads to irritation, inflammation and pain as the immune system tries to clear the misplaced tissue. The main symptoms of endometriosis include very painful or heavy menstruation, pain during sex, bloating, lower back pain, bowel changes especially around menstruation, infertility.
Doctors still do not know exactly what causes endometriosis but there are many theories. Some scientists have suggested that the endometrial tissue migrates backwards through the fallopian tubes. The theory is that this can then settle elsewhere in the pelvic cavity or travel via the blood and lymph to more distant body sites. Others have suggested that stem cells lining other body cavities or organs turn into endometrial cells. Likely under the influence of certain hormones or toxins. In both situations there must also be altered functioning of the immune system, stopping it from recognizing the misplaced tissue or from effectively removing it.
In addition to being very painful and uncomfortable, endometriosis can also lead to fertility problems. The constant inflammation around the areas of misplaced tissue can lead to the formation of scar tissue. Sometimes the scar tissue develops in a way that causes two structures to become stuck together. This is called an adhesion. These adhesions can block the passage of an egg through the fallopian tube or cause the womb to become misaligned. Endometriosis on the ovaries can also cause the development of chocolate cysts. These are blood filled sacs on the ovaries that can interfere with normal ovulation.
There is no cure for endometriosis so medical treatment focuses on managing the symptoms. In most cases, the standard treatment for endometriosis is painkillers and hormones. Frequently, the oral contraceptive pill or other hormonal contraceptive methods are recommended as these can make the menstrual cycle lighter and less painful. In severe cases, surgery can be used to remove the endometrial deposits. However, it is common for endometriosis to reappear in 45% of cases.
Dr. Gee has extensive experience treating women with varying stages of endometriosis both medically and surgically. She has been involved in many clinical research trials involving now approved treatment options for women with otherwise uncontrolled symptoms. She brings this experience to her now more integrative care approach to further reduce the need for repeated surgical procedures.
Functional medicine takes a more holistic view of endometriosis. A typical support protocol will include steps to balance female hormone levels and support the hormone detoxification pathways, support the immune system, work on gut health to ensure a balanced microflora as this directly influences the immune system, remove any foods that might be contributing to inflammation and reduced immune surveillance, assess any environmental exposures that might be contributing to the endometriosis, and put in place an anti-inflammatory diet and supplement protocol.
Perimenopause refers to the time period that begins when the ovaries begin to decline in function. It continues until menopause, which is defined as the total cessation of menstrual flow for an entire year. Many women think of perimenopause as a “change of life” or “transition period.” During this transition period, hormones can wildly fluctuate and may cause serious distress. Before you move forward in seeking relief for your perimenopause symptoms, it is important to acknowledge a number of facts about this stage in your life.
- The average length of perimenopause is 4 years, lasting up to 10 years in some women.
- On average, women enter menopause from perimenopause around the age of 51.
- Women who are perimenopausal may still become pregnant, since there is on average 5- to 10-year period between the beginning of a decline in ovarian function and the cessation of menstruation.
- Perimenopause is a time period associated with a high risk of mood disorders, including anxiety, depression and insomnia.
- Not all women experience all the symptoms of perimenopause to the same degree, and symptoms vary among women.
- Treatment of perimenopausal symptoms may include medications, hormone therapy and lifestyle changes, such as diet, exercise and quitting smoking.
Symptoms of perimenopause can begin as early as 10 to 15 years before menses completely stops. Women in their late 30’s, 40’s and early 50’s may transition in and out of a perimenopausal state many times before they finally enter menopause. If you are currently experiencing symptoms such as irregular periods, heavy bleeding, hot flashes, sleep disruption, headaches and weight gain – or any other extreme emotional distress, you may be relieved to know that these are all common signs of perimenopause
Common Signs and Symptoms of Perimenopause
Irregular periods and menstrual changes.
Hot flashes and night sweats.
Insomnia and decline in sleep quality.
Changes in libido.
Vaginal changes and dryness.
Thinning hair and dryer skin.
Changes in breast composition.
Frequent headaches or migraines.
Lack of concentration.
Estrogen and testosterone play a role in memory, motivation and mood. It is common to start noticing a loss of concentration, forgetfulness, drowsiness and an increased reaction to stress. These perimenopause symptoms can also be worsened due to poor sleep and increased anxiety (especially if you do not eat a nourishing diet).
In our fast-food culture, most women tend to be operating with an internal hormonal balance tipped toward the estrogen side of the scale. This tilt is often the result of a diet high in simple carbs and low in quality protein, a lack of vital nutrients and good fats, and chronic exposure to environmental toxins and artificial hormones, such as endocrine disruptors.
Prolonged emotional and physical stress, defined as anything that works against your state of balance, will also tip the hormonal balance. In today’s fast-paced, disconnected, eat-and-run world, it is no surprise that younger and younger women are experiencing symptoms of hormonal imbalance and perimenopause. With that in mind, as long as you follow these five crucial steps, you can count on some perimenopausal relief.
5 Healthy, Natural Ways to Relieve Perimenopause Symptoms
Maintain a healthy diet and optimize the foods you eat. The most effective medicine that exists is in the food that you eat. A nourishing, unprocessed diet is key for boosting your intake of essential nutrients, helping your body adjust to changing hormones, managing your weight and reducing your intake of empty calories.
Foods that are most helpful during perimenopause and menopause include organic fruits and veggies, high-fiber foods like nuts and seeds, omega-3 foods, probiotics, clean and lean proteins like fish or grass-fed meat, healthy fats such as olive and coconut oil, and foods that supply natural phytoestrogens, including flax and fermented soy. You can optimize your nutrition by making sure that you consume enough vitamins, minerals and essential nutrients. There are natural supplements you can add to your daily regimen to help on this front.
Use herbal remedies to supplement your own hormones. Food is a form of medicine and there is incredible strength in plants and herbal remedies that have been known for centuries to prevent perimenopausal symptoms. It is amazing that many plants and herbs can adapt to the needs of your body. They can do this because they share various molecular features with our own hormones, allowing them to support our hormone production, make it slower, or even mimic what our own hormones do depending on your own body’s unique needs.
Various herbs and supplements can help mitigate certain symptoms of perimenopause (such as anxiety, fatigue, hot flashes and sleep-related problems).
Exercise regularly to reduce fat and rebalance your hormone ratios. Most women tell us that they feel as if they’re steadily gaining weight during perimenopause, especially around their stomachs and abdomen. This can be particularly frustrating because the weight sticks to unusual places and their scales refuse to budge.
One of the reasons that this weight gain is so common is because fluctuating estrogen levels tend to cause your body to grab onto fat. On top of this, fat can produce more estrogen, which can create even more fat. It can become a vicious cycle. Remember to pick something you like, such as walking, dancing, yoga, swimming or biking – your enjoyment is key to sticking with it!
Get a proper amount of sleep every night. Sleep is important for a great number of bodily functions. A healthy amount of sleep is essential for restoring energy, balancing hormones, keeping cortisol levels under control, and reducing anxiety or depression.
You should aim for seven to nine hours a night during perimenopause and menopause, even if you’ve functioned well before on less sleep. If you have trouble sleeping (as many perimenopausal women do), try using hormone-balancing essential oils such as lavender, reading or writing in a journal, taking magnesium supplements, using Epsom salts in a warm bath prior to bed, turning down the temperature in your room, and practicing mind-body practices such as yoga and meditation.
Reduce your stress through mind-body practices. Because sleep problems, anxiety, fatigue and depression tend to climb during the transition into menopause, it is important to manage stress as best you can. Stress can be the culprit behind additional imbalances in hormones and neurotransmitters that affect mood as well as mental function, thyroid function, digestive function, and especially blood sugar imbalances. Stress has also been linked to symptoms such as hot flashes and low libido.
When it comes lowering stress, different things work for different people. There are natural stress relievers, like aerobic exercising (walking, jogging, dancing and swimming), spending time outdoors, meditation or prayer, seeking social support, joining a helpful cause or volunteering, reading something inspirational and uplifting, and doing something creative. You might also try taking detox baths with Epsom salts, adaptive exercises (barre, yoga, pilates and weight-training), reading spiritual growth books, and fostering good relationships. These are all proven stress relievers. When women make natural adjustments to their lifestyles, not only do they feel much better about themselves, but they also feel in control of their health. It is time for you to feel inspired and take control over your perimenopause symptoms.
Start to make these small yet very important changes, as they can create some remarkable results. Add a morning veggie/fruit smoothie, start your day with a morning ritual, ensure that you remember to breathe each day and make a commitment to take helpful herbal supplements every day. With a little bit of time you’ll discover the combination of natural steps that work best to relieve your perimenopausal symptoms!
If you’re ready to begin a natural therapeutic way to address your perimenopause symptoms, Willowbend Health & Wellness is an excellent place to start. We believe in guiding you through all five of the necessary steps toward relief to help correct the symptoms you are experiencing. Reclaim Your Life, and Your Health!