Enhancing Erection Naturally

February 23, 2019

Getting (and maintaining) an erection is a complicated process. It involves your heart, head, hormones, blood vessels, nerves, and even your mood. But erectile dysfunction is largely about inadequate blood flow. You can get stronger erections by improving your heart health and blood flow.

An erect penis contains up to eight times the amount of food as a flaccid penis. Anything you can do to increase your overall cardiovascular health and blood flow goes a long way towards treating or even preventing erectile dysfunction (ED). 

 

4 Ways to Get Stronger Erections without ED Medication

  • Exercise regularly
  • Eat a healthy diet
  • Sleep more
  • Avoid alcohol and cigarettes

Stronger Erections with Exercise

On average, your heart beats 100,000 times a day and pumps over 2000 gallons of blood throughout your body. Your heart is incredibly strong, but you need to take care of this vital muscle. Exercise is one of the best ways to strengthen your heart (and your erections). It also increases stamina, strength and flexibility, which are all important in the bedroom.

Stronger Erection with Diet

Several studies have linked a healthy diet to reduced risk for ED. A good diet also helps reduce the risk for type 2 diabetes and obesity (which are both risk factors for ED). The goal is to increase your fruits, veggies, and grains and reduce your intake of processed foods, sugar, and red meat.

Men who eat less red meat, processed foods, and sugar, and eat more fruits, veggies, and whole grains are less likely to experience ED

Obesity is a primary risk factor for diabetes, high cholesterol, high blood pressure, and ED.  Extra belly fat interferes with your ability to send enough blood to the penis. It can even damage blood vessel lining and cause testosterone levels to drop. Even a small decrease in body fat can improve ED (among many other things). Eating a heart-healthy diet that’s low in sugar and refined carbohydrates and high in “good” fats can help lower your risk for the cardiovascular conditions associated with obesity.

There’s no miracle food to prevent erectile dysfunction. However, there is some evidence that certain foods may help. Evidence that foods can help with ED is probably related to a vascular connection. Erectile problems are usually due to not having a good blood supply to the penis, so foods that are good for your vascular system may also help prevent ED. 

Nitrates in Leafy Greens and Beets

Leafy green vegetables, like celery and spinach, may increase circulation because of their high concentration of nitrates. Beet juice has been found to be really high in nitrates. Nitrates are vasodilators, which means they open up blood vessels and increase blood flow. Several case reports on the beneficial effects of nitrates for erectile dysfunction had already been published. The ED drugs used today are based on the relaxing effects of nitrates on the blood vessels that supply the penis.

Flavonoids in Dark Chocolate

A recent study found that flavonoids in dark chocolate improve circulation. That could be good for erection problems that are due to poor circulation. Flavonoids are naturally-occurring antioxidants that protect plants from toxins and help repair cell damage. Studies show that flavonoids and other antioxidants have similar effects on people. They may help lower blood pressure and decrease cholesterol, both of which are factors that contribute to ED.

Protein in Pistachios

A recent study found that men with ED who ate pistachio nuts every day for three weeks experienced significant improvement in sexual issues, including ED, sexual desire, and overall sexual satisfaction. The benefits of pistachios for erection problems may be due to a protein called arginine, which may help relax blood vessels.

 

Zinc in Oysters and Other Shellfish

track.pngThe oyster has always had an aphrodisiac reputation. One reason may be that oysters have high levels of the mineral zinc, which plays an important role in the production of the male hormone testosterone, and low levels of testosterone could be one reason for erectile dysfunction. Research presented at an American Chemical Society meeting may offer another connection: Raw shellfish contain compounds that stimulate the release of sexual hormones, in both men and women.

 

Antioxidants in Watermelon

Some studies show that watermelon may have effects on erectile dysfunction that are similar to the ED drug Viagra and may also increase sexual desire. Watermelon is rich in beneficial ingredients known as phytonutrients. Phytonutrients are also antioxidants. One of their benefits is that they relax the blood vessels that supply an erection. Although watermelon is 92 percent water, the other 8 percent may work wonders for your heart and your sexual enjoyment.

 

Lycopene in Tomatoes and Pink Grapefruit

Lycopene is one of those phytonutrients that is good for circulation and good for sexual issues. Lycopene is found in deep red fruits like tomatoes and pink grapefruits. Some studies show that lycopene may be absorbed best when mixed with oily foods like avocados and olive oil. So you might want to make yourself an ED-fighting salad. Research also shows that antioxidants like lycopene help fight male infertility and prostate cancer.

 

Sex Tip:

It helps if you avoid large meals before having sex. Erections are mostly about blood flow. Eating a big meal diverts blood towards digesting your food, and away from giving you an erection. It’s also a good idea to avoid large meals even when you’re taking ED medications. Because a fatty meal can block absorption of the medication, making it less effective.

Stronger Erections with Sleep

Lack of sleep can increase your risk of heart attack, slow your metabolism, weaken your immune system, and cause erectile dysfunction. Sleep deprivation and even sleep apnea can decrease testosterone levels. And a dip in testosterone can lower your libido, making it harder to diagnose ED.

Life is hectic. But getting 7-9 hours of sleep every night is one of the best things you can do for your health…and your erection.

Stronger Erections: Avoid Alcohol & Cigarettes

ED is extremely common in men who:

  • Smoke at least 10 cigarettes a day
  • Drink more than three alcoholic drinks a day

Smoking damages your blood vessels, which are a big part of getting an erection. In fact, men who smoke are twice as likely to experience erectile dysfunction as non-smokers. The good news is that quitting smoking can improve your health (and your erection) almost immediately.

In the short term, alcohol relaxes the soft muscle tissues in the penis. This stops blood vessels from closing and trapping enough blood to get an erection. In the long run, excessive alcohol consumption can cause liver damage, high blood pressure, and damage to blood vessels resulting in erectile dysfunction. Alcohol is also a nervous system depressant that can block messages between the brain and the body. (It’s why people get slurred speech when they drink).

Bottomline: reducing alcohol consumption and quitting smoking will improve your overall health and sexual performance.

Intermittent Fasting

January 27, 2019

Intermittent fasting is the process of cycling in and out of periods of eating and not eating.

 

Although people do experience weight loss with intermittent fasting, it is less of a diet plan and more of a lifestyle choice to reap a variety of health benefits.

 

There are different intermittent fasting methods. These are:

  • 5:2: This method allows you to eat normally five days a week. The other two days are your fasting days, although you do still eat. Just keep it between 500 and 600 calories
  • Eat-stop-eat: With this one, you restrict all food for 24 hours, once or twice a week.
  • 16/8: You eat all of your daily calories within a shortened period — typically 6 to 8 hours — and fast for the remaining 14 to 16 hours. You can do this every day, or a few times a week.

 

When you don’t eat any food for a set period of time each day, you do your body and your brain a lot of good.

 

It makes sense from an evolutionary standpoint. For most of history, people were not eating three meals a day nor were they grazing on snacks throughout the day. Instead, humans evolved in situations where there wasn’t much food, and they learned to thrive when fasting.

 

There is a lot of incredibly promising research on intermittent fasting — highlights include weight loss; and reduction of blood pressure, cholesterol, and blood sugars. A growing body of research suggests that the timing of the fast is key, and can make intermittent fasting a more realistic, sustainable, and effective approach for weight loss, as well as for diabetes prevention.

 

Intermittent fasting makes intuitive sense. The food we eat is broken down by enzymes in our gut and eventually ends up in our bloodstream. Carbohydrates, particularly sugars and refined grains (think white flours and rice), are broken down into sugar, which our cells use for energy. If our cells don’t use it all, we store it in our fat cells — as fat.

 

Sugar can only enter our cells with insulin, a hormone made in the pancreas. Insulin brings sugar into the fat cells and keeps it there. Between meals, as long as we don’t snack, insulin levels will go down and fat cells can then release their stored sugar, to be used as energy.

 

We have evolved to be in sync with the day/night cycle, i.e., a circadian rhythm. Our metabolism has adapted to daytime food, nighttime sleep. Nighttime eating is well associated with a higher risk of obesity, as well as diabetes. Just changing the timing of meals, by eating earlier in the day and extending the overnight fast, significantly benefited metabolism even in people who didn’t lose a single pound.

 

There is evidence to suggest that the circadian rhythm fasting approach, where meals are restricted to an eight to 10-hour period of the daytime, is the most effective means of intermittent fasting.

 

Additionally, when you fast, several things happen in your body on the cellular and molecular level. First, the body adjusts hormone levels to make stored body fat more accessible. Also, cells initiate important repair processes and change the expression of genes.

 

Other changes that occur in the body with intermittent fasting include:

  • Human Growth Hormone (HGH): The levels of growth hormones skyrocket, increasing as much as 5-fold. This has benefits for fat loss and muscle gain, to name a few.
  • Insulin: insulin sensitivity improves and levels of insulin drop dramatically. Lower insulin levels make stored body fat more accessible.
  • Cellular repair: When fasted, your cells initiate cellular repair processes. This includes autophagy, where cells digest and remove old and dysfunctional proteins that build up inside cells.
  • Gene expression: There are changes in the function of genes related to longevity and protection against disease.

 

TAKE AWAY POINTS —

  1. We lose weight if we let our insulin levels go down.  The entire idea of intermittent fasting is to allow the insulin levels to go down far enough and for long enough that we burn off fat.
  2. There is some good scientific evidence suggesting that circadian rhythm fasting, when combined with a healthy diet and lifestyle, can be a particularly effective approach to weight loss, especially for people at risk for diabetes.
  3. Changes in hormone levels, cell function and gene expression are responsible for the health benefits of intermittent fasting.

 

In summary, switching to an intermittent fasting diet expands your limits and boosts your performance in a number of ways.  Here are some of the powerful benefits of intermittent fasting:

  • Boosts weight loss
  • Increases energy
  • Promotes cellular repair and autophagy (when your body consumes defective tissue in order to produce new parts)
  • Reduces insulin resistance and protects against type 2 diabetes
  • Lowers bad cholesterol
  • Promotes longevity
  • Protects against neurodegenerative diseases such as Alzheimer’s and Parkinson’s
  • Improves memory and boosts brain function
  • Makes cells more resilient

 

People with advanced diabetes or who are on medications for diabetes, people with a history of eating disorders like anorexia and bulimia, and pregnant or breastfeeding women should not attempt intermittent fasting unless under the close supervision of a physician who can monitor them.

Could Cannabis Lube Be the Secret to Enhanced Female Sexual Pleasure?

November 25, 2018

Cannabis Lubrication and Sexual Pleasure

 

Just when I thought I had finally become familiar with all the possible medical uses of cannabis, I came across a few articles touting the benefits of cannabis lube for female orgasm. 

 

Cannabis lubricants and other cannabis-infused sensual aids are on many women’s radars, not to mention going into their nightstand drawers.  But does cannabis really help with women’s sexual health and wellbeing?

 

Anecdotally, Women Say Cannabis Lube Can:

 

  • reduce their stress that, in turn, can facilitate more pleasure.
  • enhance their creativity which could translate to a willingness to try new things.
  • lower inhibitions to get them “out of their head.”
  • increase hormonal production that could ‘open up’ emotions such as passion.
  • ease discomfort and pain, particular during and post menopause.
  • enhance physical sensitivity and sensation and potentially increasing orgasms or orgasm intensity.

 

The Skinny On Cannabis Lube

 

  • It is just as much a relaxation aid as a sexual aid.
  • It takes 20-40 minutes to work.
  • Cannabis oil is an experience in itself. Sex isn’t required, but it certainly makes it better.
  • A lot of cannabis lube formulations should not be used in combination with latex. The oils in the product can cause latex to break down and render your protection useless.

The Basic Breakdown of How Cannabis Lube Works Its Magic:

Isolated Cannabis Bud for making cannabis lube

  1. The mucous membranes present in a woman’s genitals (and there are a lot) absorb the THC in the oil lubricant
  2. The cannabinoids act locally on the cannabinoid receptors.
  3. This causes the capillaries to dilate and increases blood flow to that area.  This causes the lower portion of your body to relax and increases blood flow to all parts of your vaginal.
  4. This enhanced circulation magnifies sensitivity and sensation.

 

Put all those things together and you’ve got a very enjoyable experience.

 

THC absorbed in the vagina technically should not make you feel ‘high’.

 

** Take careful note that if you are using an oil-based lube, they are not compatible with latex or polyisoprene condoms and can degrade any rubber-based sexual aids or accessories. While no substance introduced with condoms is 100% safe for the integrity of the condom material, some product websites claim they should be okay to use with lambskin, polyurethane, or nitrile condoms. 

 

Click Here to Learn More About Cannabis Lube

Boost Your Mood With Vitamin D

October 2, 2018

Do you get enough vitamin D?

 

There could be many warning signs or symptoms of vitamin D deficiency in your life or of someone you know.

 

It is essential to understand the importance of getting enough of this crucial vitamin.

 

 

Vitamin D Basics

Vitamin D is best known for building bones. However, this highly-potent vitamin is essential for overall brain and body health. Optimal vitamin D levels can help improve your mood, boost your overall brain function, and generally improve your wellbeing. Vitamin D may be involved in the healthy regulation of as many as 900 human genes.

 

Vitamin D is converted by the liver and kidney into a hormone that is so important to brain function its receptors can be found throughout the brain. Vitamin D plays a critical role in the brain’s early development, its ongoing maintenance, and in its functions to maintain healthy mood and many of the most basic cognitive functions including learning and making memories. 

 

Avoid Vitamin D Deficiency

Unfortunately, vitamin D deficiency is becoming more and more common, in part because we are spending more time indoors and using more sunscreen when having fun outdoors. Research suggests that 70% of all adults and 67% of children, aged 1-11, do not have adequate levels of vitamin D. Low levels of vitamin D have been associated with low mood, behavioral difficulties in children, and psychological difficulties in adults. Vitamin D supplementation is consistently linked to higher quality of life and better wellbeing with the passing of the years.

 

Recommended Daily Vitamin D

In the United States, the current recommended daily dose of vitamin D is 400 IU. However, most experts agree that this is well below the physiological needs of most individuals. Instead, it is suggested that all adults take at least 2000 IU of vitamin D daily – unless directed to take a higher dose by their healthcare provider. We all should get our blood vitamin D levels tested every 4-6 months and if necessary increase our daily intake to as much as 5000-10000 IU per day to ensure we achieve blood levels of at least 60 ng/mL.

Avoid taking vitamin D2 supplements since D2 can interfere with the actions of vitamin D3 which is the body’s natural vitamin D.

 

The Vitamin D Challenge

Getting necessary amounts of vitamin D can be challenging during the winter season in some parts of the country —typically from November to March—when there are fewer hours of sunlight and when the sun itself is less intense. This is particularly true if you live in the northern half of the United States. Due to colder temperatures and inclement weather, the tendency for many people is to stay inside where it is warm and hunker down for the winter. However, failure to get enough vitamin D, as well as exercise, can lead to health problems and other mental and physical difficulties. For individuals who struggle with low mood during the winter, the colder months can produce feelings of melancholy and desperation.

 

5 Tips for How to Get More Vitamin D In Your Life

1.  Alternate Light Source

Daily exposure to appropriate levels (even just 10-30 minutes per day) of direct sunlight can boost vitamin D3 levels which can help improve your mood. If you have a hard time getting enough natural light during the winter, consider buying a vitamin D lamp for your home or work desk. Though many artificial light boxes claim to do the job, make sure to purchase one that is as close as possible to the natural sunlight spectrum and proven to increase vitamin D levels.

2.  Go Somewhere Sunny

If getting sufficient levels of UVA (ultraviolet A) rays from the sun proves difficult during the winter months, especially if you live anywhere near the Great White North, consider saving up some money during the summer for a vacation to a sunny destination (the Caribbean, for instance) during the winter. This will make enduring the cold, dark months more bearable.

3.  Get Quality Sleep

Insufficient and inconsistent sleep can increase irritability, moodiness and poor judgment. To remain at the top of your game, it is recommended that you get between 7-9 hours of sleep each night. Getting appropriate levels of sunlight during the day, or adequate amounts of vitamin D from foods or supplements can also help maintain your body’s natural production of serotonin. In the evening, the brain naturally converts serotonin into melatonin, our main sleep hormone that improves our chance of getting a good night’s sleep.

4. Vitamin D-Rich Diet

Foods can be an important source of vitamin D. Examples of vitamin D-rich foods are fortified milk, eggs, mushrooms and fish (especially wild salmon, tuna, and mackerel). A 4-ounce portion of salmon can provide over 250% of your daily recommended allowance of vitamin D. Wild salmon contains about 988 IU of vitamin D per serving, while farmed salmon contains 250 IU, on average.

5.  Take Sunshine Supplements

When it comes to mood, the scientific evidence is clear – the higher your vitamin D levels, the more likely you are to feel happy rather than blue. A 2014 study showed that the positive effect of vitamin D3 on mood was clinically very substantial as compared to other options. Since it promotes healthy mood, vitamin D3, which is often referred to as the sunshine vitamin, can help you get through the doldrums of the winter season.

Diagnosing Thyroid Disorders – Is TSH Adequate?

July 26, 2018

Thyroid deficiency is a common disorder where there is inadequate cellular thyroid levels to meet the needs of the tissues. Typical symptoms include fatigue, weight gain, depression, cold extremities, muscle aches, headaches, decreased libido, weakness, cold intolerance, water retention, premenstrual syndrome (PMS) and dry skin. Low thyroid function can cause or contribute to the symptoms of many conditions.  Unfortunately, thyroid deficiency is often missed by standard thyroid testing. This is frequently the case with depression, hypercholesterolemia (high cholesterol), menstrual irregularities, infertility, PMS, chronic fatigue syndrome (CFS), fibromyalgia, fibrocystic breasts, polycystic ovary syndrome (PCOS), hyperhomocysteinuria (high homocystine), atherosclerosis, hypertension, obesity, diabetes and insulin resistance.

TSH traditionally has been thought to be the most sensitive marker of tissue levels of thyroid hormone.  Despite this traditional thinking, newer information suggests that a normal TSH does not necessarily indicate that a person’s tissue thyroid levels are adequate. In fact, a more thorough understanding of thyroid hormone physiology demonstrates how TSH is NOT an accurate marker of the body’s overall thyroid status.

It is certain that TSH inversely correlates with pituitary T3 levels.  However, physiologic stress, depression, insulin resistance and diabetes, aging, calorie deprivation (dieting), inflammation, PMS, chronic fatigue syndrome and fibromyalgia, obesity and numerous other conditions, are often associated with diminished cellular and tissue T3 levels – and increased reverse T3 levels. Thus, with physiologic or emotional stress, depression or inflammation, pituitary T3 levels do not correlate with T3 levels in the rest of the body.  As a result, TSH is not a reliable or sensitive marker of an individual’s true thyroid status.

 

Serum levels of thyroid hormones

TSH is merely a marker of pituitary levels of thyroid function and not of thyroid hormone levels in any other part of the body.  Only under ideal conditions of total health do pituitary thyroid hormone levels correlate with thyroid hormone levels in the rest of the body, making the TSH a poor indicator of the body’s overall thyroid status.  With the above-mentioned conditions, most individuals with diminished tissue levels of thyroid hormone will have a normal TSH.  In other words, the relationship between TSH and tissue thyroid hormone is lost in the presence of physiologic or emotional stress, depression, insulin resistance and diabetes, aging, calorie deprivation (dieting), inflammation, PMS, chronic fatigue syndrome and fibromyalgia, obesity and numerous other conditions. In the presence of such conditions, a normal TSH cannot be used as a reliable indictor that a person is euthyroid (normal thyroid) in the overwhelming majority of patients.

 

Value of Serum T4

In the presence of such conditions, T4 levels also are not a reliable indicator of adequate thyroid function.  These conditions lead to a suppression of the tissue’s ability to convert T4 into T3.  Furthermore, there is an increased conversion of T4 to reverse T3 – an inactive form of T3 (a thyroid inhibitor for all practical purposes). AlthoughT4 levels are important, as with the TSH, the serum T4 level is often misleading and an unreliable marker of the body’s overall thyroid status.

 

Current best method to diagnosis

With increasing knowledge of the complexities of thyroid function, it has become clear that TSH and T4 levels are not the reliable markers of tissue thyroid levels as once thought – especially with chronic physiologic or emotional stress, illness, inflammation, depression and aging. It is common for an individual with. normal TSH and T4 levels  to complain of symptoms consistent with reduced thyroid function.

While there are limitations to all testing and there is no perfect test, obtaining TSH, free T4, free T3, reverse T3, and T3/reverse-T3 ratios can be helpful to obtain a more accurate evaluation of overall thyroid status – and these values may be useful to predict those individuals who may respond favorably to thyroid supplementation. Many symptomatic patients with normal TSH and T4 levels significantly benefit from thyroid replacement, often with significant improvement in fatigue, depression, diabetes, weight gain, PMS, fibromyalgia and numerous other chronic conditions.

With an understanding of thyroid physiology, it becomes clear why a large percentage of patients treated with T4 only preparations continue to be symptomatic. As discussed above, with any physiologic stress (emotional or physical), inflammation, depression, inflammation, aging or dieting, T4 to T3 conversion is reduced and T4 will be preferentially converted to reverse T3, which acts a competitive inhibitor of T3 (blocks T3 at the receptor), reduces metabolism, suppresses T4 to T3 conversion and blocks T4 and T3 uptake into the cell.

While a normal TSH cannot be used as a reliable indicator of global tissue thyroid effect, even a minimally elevated TSH (above 2) is a clear indication (except in unique situations) that the rest of the body is suffering from inadequate thyroid activity. Thus, treatment should likely be initiated in any symptomatic person with a TSH greater than 2. Additionally, many individuals will secrete a less bioactive TSH so for the same TSH level, a large percentage of individuals will have reduced stimulation of thyroid activity, further limiting the accuracy of TSH as a measure of overall thyroid status. Reduced bioactivity of TSH is not detected by current TSH assays used in clinical practice.

Due to the lack of correlation of TSH and tissue thyroid levels, a normal TSH should not be used as the sole reason to withhold treatment in a symptomatic patient. A symptomatic patient with an above average reverse T3 level and a below average free T3 (a general guideline being a free T3/reverse T3 ratio less than 2) should also be considered a candidate for thyroid supplementation. 

Growth Hormone – Are You Deficient?

June 1, 2018

The older you are, the harder it is to lose weight. You can eat right, exercise, and cut out sweets, but the scale doesn’t budge. Why? It has a lot to do with your hormones.

 

Hormones play an integral role in health and wellness. They promote growth within the body and influence metabolism, organ function, energy, and weight management. There are many factors that can interfere with hormone production, including aging. As people age, their body may not produce adequate levels of hormones. This creates havoc with your ability to maintain a healthy weight, slowing metabolism and energy levels. And hormone balance can begin to change as early as your 20s.

 

The good news is that you can rebalance your hormone levels with targeted therapies and can effectively manage hormone imbalance.

 

Growth hormone-releasing hormone is a hormone produced in an area of the brain called the hypothalamus. The main role of this hormone is to stimulate the pituitary gland to produce and release growth hormone. Growth hormone acts on virtually every tissue of the body. Growth hormone stimulates production of insulin-like growth factor from the liver and other organs, and this acts in the body to control metabolism and growth. In addition to its effect on growth hormone secretion, growth hormone-releasing hormone also affects sleep, food intake and memory.  

 

If your body produces too little growth hormone-releasing hormone, the production and release of growth hormone from the pituitary gland is impaired.  Adults with growth hormone deficiency may have a wide range of symptoms. The most important consequences of reduced growth hormone levels are changes in body structure (decreased muscle and bone mass and increased body fat), tiredness, being less lively and a poor health-related quality of life.  When these symptoms are severe, they can reduce people’s ability to function – both socially and professionally – and this can dramatically lower the quality of their lives. 

 

Other signs and symptoms include:

  • decrease in the amount of muscle bulk and strength
  • increase in the amount of fat in the body (especially around the waist)
  • abnormalities in the amount of ‘good’ and ‘bad’ cholesterol – this can lead to an increase in the risk of heart disease
  • abnormalities in the blood and in the circulation
  • osteoporosis
  • low energy levels and decreased stamina
  • impaired concentration and memory
  • sleep disturbances 

 

Sermorelin

Sermorelin is a bio-identical synthetic hormone peptide that may be used in conjunction with bio-identical hormone replacement therapy, various weight loss programs and erectile dysfunction treatment.  Sermorelin, a growth hormone-releasing hormone (GHRH), can enhance overall health and well-being by stimulating the production and release of hormones by the pituitary gland. This kick starts your metabolism so that your weight loss efforts are more effective!  It holds the potential to slow the effects of aging in humans by spurring growth of new tissue, muscles and synapses in the brain. It even has the potential to help patients think more clearly.  As you age, your body produces fewer hormones, a phenomenon that is considered one of the principal medical signs of aging. Sermorelin therapy encourages the body to naturally produce hormones. Sermorelin is different from many similar treatments, as it stimulates a natural process rather than requiring patients to directly add hormones to the system – this distinction makes our Sermorelin therapy much less likely to lead to complications.

 

While results may vary from patient to patient, studies have shown that Sermorelin anti-aging treatment can lead to a range of physical and mental benefits, such as:

  • Increased lean body mass
  • Fat reduction – improves the ability to burn fat
  • Improved energy
  • Increased vitality
  • Increased strength
  • Increased endurance
  • Accelerated wound healing – improved recovery and repair from injuries and inflammation
  • Better sleep quality
  • Improved bone density
  • Improved skin quality and higher collagen density
  • Regenerate nerve tissues
  • Strengthen the cardiovascular system
  • Strengthen the immune system
  • Improve cognition and memory
  • Increased sex drive

 

Patient Benefits Over Time

Benefits for patients on Sermorelin shown over the first eight weeks of protocol may include improvements in:

  • Week 1 Quality of sleep
  • Week 2 Recovery from workouts
  • Week 4 Mental clarity
  • Week 6 Skin elasticity
  • Week 8 Body composition

 

Tree of Life Medical is proud to announce Sermorelin for help with reduction of belly fat via lipolysis, boosting energy levels, increasing the skin’s elasticity, elevating endurance levels, promoting speed healing of wounds, ameliorating vision, and promoting deeper sleep. This formula can also strengthen libido in both men and women. Those who have experienced loss of libido are good candidates for therapy. In addition, people who are struggling to control their weight may find it easier to slim down with the help of this formulation.

 

An initial appointment will include a consultation to discuss your health history, your health goals, and review pertinent medical information. Blood tests may be required to determine levels of hormone imbalance and if Sermorelin is right for you.

The IUD – What You Need to Know

May 1, 2018

An IUD is a tiny device that is placed in the uterus to prevent pregnancy. It is long-term, reversible, and one of the most effective birth control methods available.  IUD stands for intrauterine device. It is a small piece of flexible plastic shaped like a T.

 

Types of IUDs

There are 5 different brands of IUDs that are FDA approved in the United States: ParaGard, Mirena, Kyleena, Liletta, and Skyla. These IUDs are divided into 2 types: copper-containing IUDs (ParaGard) and hormone-containing IUDs (Mirena, Kyleena, Liletta, and Skyla).

 

The ParaGard IUD does not have hormones. It is wrapped in copper, and it is effective for up to 12 years.  The Mirena, Kyleena, Liletta, and Skyla IUDs use the hormone progestin to prevent pregnancy. Progestin is very similar to the progesterone. Mirena and Kyleena are effective for up to 5 years. Liletta works for up to 4 years. Skyla works for up to 3 years.

 

How Does the IUD Work?

Both copper IUDs and hormonal IUDs prevent pregnancy by changing the way sperm moves so they can’t get to an egg. If sperm can’t make it to an egg, pregnancy can’t happen.

 

 

The ParaGard IUD uses copper to prevent pregnancy. Sperm is adversely affected by copper, so the ParaGard IUD makes it almost impossible for sperm to get to that egg.

 

 

The hormones in the Mirena, Kyleena, Liletta, and Skyla IUDs prevent pregnancy in two ways.  First, hormones thicken the cervical mucus, which blocks and traps the sperm.  Second, the hormones sometimes stop ovulation, which means there is no egg for a sperm to fertilize. No egg, no pregnancy.

 

 

One of the advantages of IUDs is that they last for years — but they are not permanent. If you decide to get pregnant or you just do not want to have your IUD anymore, it can quickly and easily be removed. You are able to get pregnant immediately after the IUD is removed.

 

IUDs For Emergency Contraception?

The ParaGard (copper) IUD works well as emergency contraception. If you have it placed within 120 hours (5 days) of unprotected sex, it is more than 99.9% effective. It is the most effective way to prevent pregnancy after sex.

 

IUD Effectiveness

IUDs are more than 99% effective. That means fewer than 1 out of 100 women who use an IUD will get pregnant each year. IUDs are effective because there is no chance for you to make a mistake. You cannot forget to take it (like the pill), or use it incorrectly (like condoms). And you are protected for 3-12 years, depending on which kind you get. Once your IUD is in place, you can pretty much forget about it until it expires – just keep track of your insertion and removal date.

 

Do IUDs protect against STDs?

No, IUDs do NOT protect against STDs.

 

Where Do I Get an IUD?

An IUD has to be put in by a healthcare provider.

 

The IUD Insertion

People usually feel slight cramping or pain when the IUD is placed. The pain can be worse for some, but it only lasts for a minute or two.  Some people feel dizzy during or right after the IUD is inserted. You might want to ask someone to come with you to the appointment so you don’t have to drive or go home alone, and to give yourself some time to relax afterward.

 

What To Expect After an IUD Insertion

Most people feel perfectly fine right after an IUD insertion – although some people need to take it easy for a while after the insertion. Heating pads and over-the-counter pain meds can help ease cramps.

 

You may have cramping and spotting after getting an IUD, but this almost always goes away within 6-8 weeks. Hormonal IUDs eventually make periods lighter and less crampy, and periods mights stop completely. Copper IUDs may make periods heavier and cramps worse. For some people, this goes away over time. There is a very small chance that your IUD could slip out of place. It can happen any time, but it is more common during the first 3 months. If your IUD falls out, you are NOT protected from pregnancy, so make sure to go see your doctor, and use condoms or another kind of birth control in the meantime.

 

How soon after getting an IUD can I have sex?

You can have sex as soon as you want after getting an IUD.

 

Who SHOULDN’T Get an IUD?

Most people can use IUDs safely, but there are some conditions that make side effects or complications more likely. You may not be able to get an IUD if you:

  • have certain STD’s or pelvic infection
  • think you might be pregnant
  • have cervical cancer that has not been treated
  • have cancer of the uterus
  • have vaginal bleeding that is not your period
  • have had a pelvic infection after either childbirth or an abortion in the past 3 months

 

 

Additionally, you should not get a ParaGard IUD if you have a copper allergy or a bleeding disorder that makes it hard for your blood to clot.  Very rarely, the size or shape of someone’s uterus makes it hard to place an IUD correctly.

 

Risks of IUD

There are possible risks with an IUD, but serious problems are really rare.

 

The IUD can sometimes slip out of the uterus — it can come all the way out or just a little bit. If this happens, you can get pregnant. If the IUD only comes out part of the way, it has to be removed. It is possible — though extremely unlikely — to get pregnant even if the IUD is in the correct location. If you get pregnant with an IUD in place, there is an increased risk of ectopic pregnancy and other serious health problems.

 

It is possible to get an infection if bacteria get into the uterus when the IUD is inserted. If the infection is not treated, it may affect your chances of getting pregnant in the future.

 

When the IUD is inserted, it could push through the wall of the uterus. If this happens, you could need surgery to remove the IUD. This is very rare.

 

What Warning Signs Should I Know About?

Chances are that you will NOT have problems with your IUD. But it is important to pay attention to your body and how you feel after you get your IUD. Here are the warning signs to watch out for:

  • the length of your IUD string feels shorter or longer than previously
  • you can feel the hard plastic bottom of the IUD coming out through your cervix
  • you think you might be pregnant
  • you have bad cramping, pain, or soreness in your lower abdomen
  • there is recurrent pain or bleeding during sex
  • you get unexplained fever, chills, or have trouble breathing
  • your vaginal discharge is different than normal
  • you have vaginal bleeding that is heavier than usual

 

IUD and Breastfeeding?

Yes, it is safe to use the IUD while you’re breastfeeding.  It should not have any effect on how much milk you produce, and it will not hurt your baby. In fact, the IUD is a great method to use if yo a’re breastfeeding and you do not want to get pregnant.

 

IUD Side Effects

Some people have side effects after getting an IUD. They usually go away in about 3–6 months.  Side effects can include:

  • pain when the IUD is put in
  • cramping or backaches for a few days after the IUD is put in
  • spotting between periods
  • irregular periods
  • heavier periods and worse menstrual cramps (ParaGard)

 

 

Pain medicine can usually help with cramping. If the bleeding or cramping gets worse or does not get better, tell your healthcare provider immediately.

 

IUD Removal

Getting an IUD removed is quick and easy. A healthcare provider gently pulls on the string, and the IUD slips out. You may feel cramping for a minute as it comes out.  There is a small chance that your IUD will not come out easily. If this happens, your healthcare provider may use special instruments to remove it. Very rarely, surgery may be needed.

 

 

You can get your IUD taken out whenever you want. ParaGard should be replaced after 12 years.  Mirena and Kyleena should be replaced after 5 years.  Liletta should be replaced after 4 years.  Skyla should be replaced after 3 years.

 

You should feel completely normal after getting your IUD removed. You may have some spotting. Your period will go back to how it was before you got your IUD.

 

Your fertility goes back to normal right after your IUD is removed.  It is possible to get pregnant right away. If you get your IUD removed and you don’t want to get pregnant, use another method of birth control.

MTHFR Mutations

April 17, 2018

What Is MTHFR?

MTHFR is a gene that provides the body with instructions for making a certain enzyme called methylenetetrahydrofolate reductase. There are two main MTHFR mutations: C677T and A1298C. Mutations can occur on different locations of these genes and be inherited from one or both parents. Having one mutated allele is associated with increased risk of certain health problems, but having two increases the risk much more. An MTHFR mutation can change the way a person metabolizes and converts important nutrients from their diets into active vitamins, minerals and proteins. In some cases, although not all, changes in how this enzyme works can affect cholesterol levels, brain function, digestion, endocrine functions and more.

 

MTHFR mutations affect people differently. It is believed that 30-50% of all people may carry a mutation in the MTHFR gene. Around 14-20% of that population have severe effects that impact overall health more drastically. People with this mutation tend to develop certain diseases, including ADHD, Alzheimer’s, atherosclerosis autoimmune disorders, autism, more often than those without the mutation. There is still a lot to learn about what this type of mutation means for people who carry it. To date, there have been dozens of different health conditions tied to MTHFR mutations, although just because someone inherits this mutation does not mean that person will wind up experiencing any problems.

 

Treating MTHFR Symptoms

 

Consume More Natural Folate, Vitamin B6 and Vitamin B12

People with MTHFR mutations have a harder time converting folic acid into its useable form and actually experience worsened symptoms from taking supplements containing folic acid. Look for the bioavailable form of folate in supplements (called L-methylfolate) and consume plenty of foods with folate. Some high-folate foods include:

  • Beans and lentils
  • Leafy green vegetables like raw spinach
  • Asparagus
  • Romaine
  • Broccoli
  • Avocado
  • Bright-colored fruits, such as oranges and mangoes

 

People with a MTHFR mutation are also more likely to be low in vitamins B6 and B12.  You can get these vitamins from supplements or food sources. To get more B vitamins, focus on eating quality protein foods, organ meats, nuts, beans, nutritional yeast and raw/fermented dairy products.

 

Treat Digestive Problems, Like Leaky Gut and IBS

Digestive complaints are common among people with MTHFR mutations. Many things affect digestive health, including nutrient intake, inflammation, allergies, neurotransmitter levels and hormone levels. For people who are already prone to nutrient deficiencies, leaky gut can make problems worse by interfering with normal absorption and raising inflammation.

 

To improve digestive/gut health, the following dietary changes can be beneficial:

  • Reduce intake of inflammatory foods, such as gluten, added sugar, preservatives, synthetic chemicals, processed meats, conventional dairy, refined vegetable oils, trans fats and processed/enriched grains (which often include synthetic folic acid).
  • Increase intake of probiotic foods, which supply ‘good bacteria’ that aids in digestion.
  • Consume gut-friendly foods, including bone broth, organic vegetables and fruit, flaxseeds and chia seeds, and fresh vegetable juices.
  • Consume health fats only, like coconut oil or milk, olive oil, grass-fed meat, wild-caught fish, nuts, seeds, and avocado.

 

Reduce Anxiety and Depression

MTHFR mutations are tied to higher incidences of mental disorders, including anxiety, depression, bipolar disorder, schizophrenia and chronic fatigue. High levels of stress can make MTHFR mutation symptoms even worse. Tips for dealing with these conditions include:

  • Supplement with omega-3 fatty acids: reduces inflammation and beneficial for cognitive health
  • Practice natural stress relievers: meditation, journaling, spending time outside, giving back or volunteering, praying, etc.
  • Regular exercise
  • Use soothing essential oils, including lavender, chamomile, geranium, clary sage and rose
  • Eliminate recreational drugs and reducing alcohol intake

 

Protect Heart Health

Studies show that homocysteine levels tend to rise with age, smoking and use of certain drugs – so the first step is to focus on taking care of yourself as you get older and limiting use of harmful substances. Other tips for keeping your heart healthy include:

  • Eating a healthy diet, especially one with plenty of high fiber foods
  • Getting regular exercise and keeping your weight in a healthy range
  • Managing stress to prevent worsened inflammation
  • Consider the following supplements, which can help improve blood flow, cholesterol and blood pressure: magnesium, omega-3s, CoQ10, caretenoids and other antioxidants, selenium, and vitamins C, D and E. 

Discuss Your Medications With Your Doctor

Some medications can deplete folate levels or interfere with methylation. The following medication classes might make symptoms worse:

  • Antibiotics
  • Birth control pills
  • Hormone replacement therapy drugs
  • Anticonvulsants (like phenytoin and carbamazepine)
  • Antacids
  • NSAIDs
  • Antidepressants
  • Chemotherapy treatments
  • Cholesterol-lowering drugs

Boost Detoxification

Because reduced methylation contributes to poor elimination of heavy metals and toxins, take extra steps to help flush waste and accumulated chemicals from your body. Tips for improving your ability to detox include:

  • Consume fresh vegetable juices to increase antioxidant intake
  • Takie activated charcoal
  • Drink plenty of water and avoiding alcohol or tobacco
  • Dry brushing
  • Take detox baths
  • Exercise regularly
  • Use of saunas
  • Occasionally fast in a healthy way or use natural enemas
  • Only use natural beauty and household products that are free from chemicals

Get Enough Quality Sleep

Sleep disturbances are common among people with anxiety, hormonal disorders, autoimmune disorders, chronic pain and fatigue. Make it a priority to get 7-9 hours of sleep every night, sticking to a regular schedule as much as possible. To help you get better sleep, try natural sleep aids like:

  • Create a relaxing bedtime routine
  • Use essential oils
  • Stay off of electronic devices
  • Read something soothing
  • Cool your bedroom a bit

 

MTHFR Mutation Symptoms and Signs

Evidence exists that the following health problems are tied to one of two primary forms of genetic MTHFR mutation:

  • ADHD
  • Autism and other childhood learning developmental problems
  • Down syndrome
  • Depression and anxiety
  • Spina bifida
  • Schizophrenia
  • Bipolar disorder
  • Autoimmune disorders and thyroid disorders
  • Addictions (alcohol and drug dependence for example)
  • Chronic pain disorders
  • Migraines
  • Heart problems, including low HDL “good” cholesterol levels and high homocysteine levels
  • Hormonal problems and fertility problems, including miscarriages and PCOS
  • Pulmonary embolisms
  • Fibromyalgia
  • Diabetes
  • Chronic Fatigue Syndrome
  • Parkinson’s disease, other tremor disorders and Alzheimer’s Disease
  • Stroke
  • Digestive problems, including irritable bowel syndrome
  • Problems during pregnancy, including pre-eclampsia and postpartum depression. The severity and type of symptoms depends on the variant of the mutation, along with much how the ability to carry out methylation and make MTHFR enzymes is impacted. 

Causes and Risk Factors of MTHFR Mutation

The main reason that MTHFR mutations cause health problems is due to disruptions in the normal process of methylation. Under normal circumstances, MTHFR:

  • Facilitates methylation, which is a metabolic process that switches genes on and off and repairs DNA. Methylation also affects nutrient conversions through enzyme interactions.
  • Forms proteins by converting amino acids.
  • Converts the amino acid homocysteine into methionine. This helps keep cholesterol levels balanced and is important for cardiovascular health. Elevated homocysteine levels put someone at a greater risk for heart attacks, strokes and other problems.
  • Carries out chemical reactions that help the body process folate (also called vitamin B9). This is done by converting one form of the methylenetetrahydrofolate molecule into another active form called 5-methyltetrahydrofolate. Folate/vitamin B9 is required for numerous critical bodily functions, so the inability for the body to make and use enough can affect everything from cognitive health to digestion.
  • Methylation is also tied to detoxification because it helps eliminate heavy metals and toxins through the GI tract.
  • Methylation also helps with the production of neurotransmitters and hormones. Deficiencies in these neurotransmitters can affects things like mood, motivation, sleep, sex drive, appetite and digestive functions. Abnormal levels of neurotransmitters are tied to ADHD, depression, anxiety, IBS and insomnia.
  • In order for methylation to take place, the body requires an amino acid called SAMe. SAMe helps regulate more than 200 different enzyme interactions, and without it methylation stops.

 

Whether you carry the MTHFR C677T or MTHFR A1298C mutation determines if you’re more likely to suffer from certain diseases than others.

  • MTHFR C677T mutations are tied to cardiovascular problems, elevated homocysteine, stroke, migraines, miscarriages and neural tube defects. Some studies suggest that people with two C677T gene mutations have about a 16 percent higher chance of developing coronary heart disease compared to people without these mutations.
  • MTHFR A1298C are tied to higher levels of fibromyalgia, IBS, fatigue, chronic pain, schizophrenia and mood-related problems. This is especially true if you’ve inherited the mutation from both parents or have both forms of MTHFR mutations.

 

Testing and Diagnosing MTHFR Mutations

Many people have no idea that they carry an MTHFR mutation gene that contributes to their symptoms. If you suspect you might be affected by an MTHFR mutation, consider having a genetic test performed. Other tests that can help confirm a mutation include heavy metal tests, urine tests, homocysteine level tests, folic acid tests, leaky gut testing and hormone level testing.

 

Because it is a problem related to an inherited gene, there is no way to ‘cure’ an MTHFR mutation — however lifestyle changes and natural treatments can help manage symptoms.

Polycystic Ovarian Syndrome

March 30, 2018

Polycystic ovarian syndrome (PCOS) is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make egg that are released each month. With PCOS, eggs may not develop or may not be released during ovulation. Five to ten percent of reproductive aged women have PCOS.  Most often, women find out they have PCOS in their 20’s and 30’s when they have problems getting pregnant – but PCOS can happen at any age after puberty.  Women of all races and ethnicities are at risk for PCOS.  Your risk for PCOS may be higher if you are obese or if you have a mother, sister, or aunt with PCOS.

Conditions Associated With PCOS

  • Diabetes. More than half of women with PCOS will have diabetes or pre-diabetes  before age 40.
  • High blood pressure. Women with PCOS are at greater risk of having high blood pressure compared to women without PCOS. High blood pressure is a leading cause of heart disease and stroke.
  • Unhealthy cholesterol. Women with PCOS often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. High cholesterol raises your risk for heart disease and stroke.
  • Sleep apnea – momentary and repeated interuptions in breathing that disrupt sleep. Many women with PCOS are overweight or obese, which can cause sleep apnea. Sleep apnea raises your risk for heart disease and diabetes.
  • Depression and anxiety. Depression and anxiety are common among women with PCOS.
  • Endometrial cancer. Problems with ovulation, obesity, insulin resistance, and diabetes (all common in women with PCOS) increase the risk of developing cancer of the endometrium (lining of the uterus).

Symptoms of PCOS?

PCOS has many signs and symptoms, some of which may not seem to be related:

  • Menstrual irregularities:
    • No menstrual periods—called amenorrhea
    • Frequently missed periods—called oligomenorrhea
    • Heavy periods
    • Bleeding but no ovulation—called anovulatory periods
  • Infertility
  • Pelvic pain
  • Excess hair growth on the face, chest, stomach, or thighs—called hirsutism
  • Severe, late-onset, or persistent acne that does not respond well to usual treatments
  • Obesity, weight gain, or trouble losing weight, especially around the waist
  • Oily skin
  • Patches of thickened, dark, velvety skin—a condition called acanthosis nigricans

Because many women don’t consider problems such as oily skin, extra hair growth, or acne to be symptoms of a serious health condition, they may not mention these things to their doctor. As a result, many women aren’t diagnosed with PCOS until they have trouble getting pregnant or if they have abnormal periods or missed periods.

Although PCOS is a leading cause of infertility, many women with PCOS can and do get pregnant. Pregnant women who have PCOS, however, are at higher risk for certain problems, such as miscarriage.

Causes of PCOS?

The exact cause of PCOS is unknown. Most experts think that several factors, including genetics, play a role:

  • High levels of androgens. Androgens are sometimes called ‘male hormones’, although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than normal. Estrogens are also called ‘female hormones’. Higher than normal androgen levels in women can prevent the ovaries from releasing eggs (ovulation) and can cause extra hair growth and acne, two signs of PCOS.
  • High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight or obese, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.

Polycystic ovarian syndrome (PCOS) is the leading cause of infertility in reproductive age women. Lack of ovulation is generally assumed to be the cause after other anatomic, hormonal, and male factor causes are ruled out.

Diagnosing PCOS

Because there is currently no universal definition of PCOS, different expert groups use different criteria to diagnose the condition. All the groups look for the following three features:

  1. Menstrual irregularities, such as light periods or skipped periods, that result from long-term absence of ovulation (the process that releases a mature egg from the ovary).
  2. High levels of androgens that do not result from other causes or conditions, or signs of high androgens, such as excess body or facial hair.
  3. Multiple cysts of a specific size on one or both of the ovaries as detected by ultrasound.

Having one or more of these features could lead to a diagnosis of PCOS. If your medical history suggests that you might have PCOS, we will rule out other conditions that may cause similar symptoms.

Some of these conditions include:
  • Excess hormone production by the adrenal glands, called adrenal hyperplasia
  • Problems with the function of the thyroid gland
  • Excess production of the hormone prolactin by the pituitary gland, called hyperprolactinemia

After ruling out other conditions and before making a diagnosis of PCOS, we will also:

  • Take a full personal and family history because PCOS tends to run in families.
  • Conduct a complete physical exam. We will look for extra hair growth, acne, and other signs of high levels of the hormone androgen. We will take your blood pressure, measure your waist, and calculate your body mass index, a measure of your body fat based on your height and weight.
  • Take blood samples. Blood tests will include levels of androgens, cholesterol, and sugar in your blood.
  • Do a pelvic exam or ultrasound to check your ovaries.

Treatment For PCOS

  • Losing weight. Changing your lifestyle like having fewer sugary drinks and hog-calorie desserts to help control your weight, exercising each day and avoiding smoking.  These healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10% loss in body weight (for example, a 150-pound woman losing 15 pounds) can help make your menstrual cycle more regular and improve your chances of getting pregnant.  Consider counseling with a registered dietitian to help you choose healthy foods and lose weight if you are overweight or obese.
  • Removing unwanted facial/body hair. You can try facial hair removal creams, laser hair removal, waxing, or electrolysis to remove excess hair. You can find hair removal creams and products at drugstores. Procedures like laser hair removal or electrolysis must be done by a doctor and may not be covered by health insurance.
  • Slowing hair growth. A prescription skin treatment (eflornithine HCl cream) can help slow down the growth rate of new hair in unwanted places.
  • Medications.  Medicines that contain estrogen and progesterone such as birth control pills, a vaginal ring, or a skin patch; medicines to help your body use insulin better, such as Metformin (for pre-diabetes or diabetes); and/or acne medicine.

Coping With PCOS

Seeing a doctor who knows about PCOS is the first step. Choose a doctor who specializes in hormone problems or a doctor who specializes in women’s health. Remember that the sooner you get help for your PCOS, the sooner you could lower your risk for related health problems such as diabetes. Your doctor can help you find ways to feel better about your appearance. For example, you can ask your doctor about the best way to remove unwanted facial hair. If you feel worried or depressed, ask your parents or your doctor where to go for counseling. You can also go to a support group to talk with others who have PCOS.

Abnormal Uterine Bleeding in Adolescents

March 11, 2018

A female’s first menstrual cycle is an important event during adolescence. For most girls, it marks completion of puberty and the onset of reproductive capability. Menstrual problems are common during adolescence and can last 2-5 years after their first period.

 

Menstrual irregularities are a common gynecologic problem, especially in adolescents. Abnormal uterine bleeding is any form of bleeding that is irregular in amount, duration, or frequency. It can be characterized by excessive uterine bleeding that occurs regularly, by heavy bleeding at irregular times, or a combination of both. It can also be intermittent bleeding or sparse cyclical bleeding. Often the bleeding is not serious, but it can be annoying and disrupt life. The term ‘dysfunctional uterine bleeding’ is a subset of abnormal uterine bleeding and is defined as excessive, prolonged, or unpatterned bleeding from the uterus without an organic cause,  The term is frequently used synonymously with anovulatory bleeding (irregular bleeding resulting from the absence of ovulation). In adolescents, up to 95% of abnormal uterine bleeding is ‘dysfunctional uterine bleeding’. However, because ‘dysfunctional uterine bleeding’ is a diagnosis of exclusion, other potential causes of abnormal bleeding must be considered and excluded.

 

You may have abnormal uterine bleeding if you have one or more of the following symptoms:

  • You get your period more often than every 21 days or farther apart than 35 days. A normal adult menstrual cycle is 21 to 35 days long. A normal teen cycle is 21 to 45 days.
  • Your period lasts longer than 7 days (normally 4 to 6 days).
  • Your bleeding is heavier than normal.

(If you are passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered severe and you should call your doctor.)

 

The normal menstrual cycle usually consists of an average interval of 28 days (± 6 days) with a average duration of 4 days (±2-3 days). Normal blood loss is approximately 30 mL per cycle, with an upper limit of 60-80 mL. The average age of a first period in the United States is 12.8 years, with the range from 9-18 years.

 

The normal menstrual cycle is divided into three phases. In the first phase, a group of eggs are stimulated to grow in the ovaries, from which one dominant follicle (egg) is selected. The dominant follicle produces increasing amounts of estrogen. Estrogen stimulates the uterine lining to proliferate and develop progesterone receptors. When estrogen reaches a certain sustained level, a surge of hormone is released from the pituitary, causing the dominant follicle to ovulate:  the second stage of the menstrual cycle. Progesterone halts uterine lining growth and stabilizes the lining, which is the third phase. In the absence of conception, there is a rapid decline in estrogen and progesterone. The endometrium collapses and sheds as menstruation occurs, approximately 14 days after ovulation. Menstrual flow stops as a result of the combined effect of prolonged vasoconstriction, tissue collapse, vascular stasis, and estrogen-induced “healing”.

 

In summary, with normal ovulation, there is regular cyclical production of estradiol, initiating ovarian follicular growth and uterine proliferation. Following ovulation, the production of progesterone stabilizes the uterine lining. Without ovulation and subsequent progesterone production, a state of “unopposed” continuous estrogen secretion occurs. This stimulates abnormal uterine lining growth without adequate structural support. The consequence is spontaneous sloughing of the endometrium and unpredictable bleeding. In anovulatory cycles, the estrogen levels can either be high or low. With chronic high levels, there is intermittent heavy bleeding, and chronically low levels may result in prolonged light bleeding.[5]

 

Abnormal uterine bleeding in adolescents is defined as excessive bleeding occurring between menarche (first period) and 19 years of age. During the first 12–18 months after the onset of menstruation, immaturity of the hypothalamic-pituitary axis.  This means that the communication system between the brain, the ovaries and the uterus is immature and not yet communicating properly.  It is believed that this ‘miscommunication’ results in an inconsistent ‘positive feedback’ response, wherein sustained elevations of estrogen occur – which causes progesterone disregulation and prevents ovulation.  The lack of ovulation (called anovulation) is the most common cause of abnormal uterine bleeding during early adolescence. By the third year after menarche, about 75% of menstrual cycles are 21–34 days long, regardless of age at menarche.  The maturation of the hypothalamic-pituitary-ovarian axis occurs slowly in the first 18-24 months after menarche in the adolescent female. Anovulatory cycles may last up to 5 years.

 

Besides physiologic causes, anovulation can also have organic pathologic causes. These include hyperandrogenic states (e.g., polycystic ovary syndrome [PCOS]), hypothalamic dysfunction (e.g., anorexia nervosa and excessive exercise), endocrinopathies, and premature ovarian failure. Occasionally, the bleeding is caused by an anatomic cause (e.g., polyps or fibroids), although this is very rare in adolescents.

 

Girls and adolescents with more than 45 days between menstrual cycles, less than 21 days between menses, bleeding lasting longer than 7 days, having a single episode of 3 months between bleeding, or changing sanitary products more often than every 1-2 hours should undergo an evaluation. Regardless of reported sexual history, it is imperative to rule out pregnancy, sexual trauma, and sexually transmitted infections. Patients should be evaluated for endocrine disorders (such as thyroid disease), stress and eating disorders, and polycystic ovary syndrome (PCOS).

 

Differential Diagnosis of Abnormal Uterine Bleeding in Adolescents

 

Although the majority of adolescents with abnormal bleeding have anovulation due to age, dysfunctional vaginal bleeding is a diagnosis of exclusion.

 

Coagulation Disorder

Blood loss in the normal menstrual cycle is self-limited due to the action of platelets and fibrin. Individuals with thrombocytopenia or coagulation deficiency may have excessive menstrual bleeding.The most common coagulation disorders include thrombocytopenia, due to idiopathic thrombocytopenic purpura (ITP), von Willebrand’s disease, which affects up to 1% of the population, and platelet function defects. Of the adolescents presenting with severe menorrhagia or hemoglobin less than 10 g/dL, 25% were found to have a coagulation disorder. In those presenting with menorrhagia at the first menses, 50% were found to have a coagulation disorder.

 

Pregnancy Complications

The possibility of pregnancy should be considered in any adolescent with abnormal bleeding, and a pregnancy test is mandatory even if the client denies sexual intercourse. Any bleeding in early pregnancy should lead to suspicion of miscarriage or ectopic pregnancy.

 

Reproductive Tract Pathology

Any trauma, infection, or neoplasm can cause abnormal uterine bleeding. Infections, such as chlamydia or pelvic inflammatory disease (PID), may present with abnormal bleeding. Vaginal trauma or a foreign body may cause bleeding that might be assumed by the adolescent to be uterine in origin. Women with a foreign body in the vagina generally present with a bloody, odorous discharge. Cervical polyps, cervical carcinoma, and cervical inflammation can cause bleeding. Cervical cancer is fairly rare in adolescents but may be encountered in those who had sexual experiences at a very early age (including those with a history of sexual abuse). Ovarian estrogen-producing tumors need to be excluded in the adolescent with very heavy persistent bleeding. Finally, although rare, uterine pathology, such as polyps and fibroids, may lead to abnormal bleeding.

 

Endocrinopathies

The most common endocrine disorder to cause abnormal bleeding is thyroid disease. In general, hypothyroidism presents with hypermenorrhea, and hyperthyroidism presents with hypomenorrhea. Hyperprolactinemia caused by a prolactinoma or certain medications, such as neuroleptics, can also cause anovulation and abnormal uterine bleeding. PCOS is underdiagnosed in adolescents and should be suspected in obese teens with hirsutism, acne, and continued irregular cycles. There is some recent evidence that PCOS is more common in women with epilepsy. Other diseases to consider are congenital adrenal hyperplasia, Cushing syndrome, hepatic dysfunction, and adrenal insufficiency.

 

Others Causes

Other causes of abnormal uterine bleeding in adolescents are eating disorders, stress, excessive exercise, and weight loss. In addition, common medications, which increase the cytochrome P450 enzymatic processes in the liver, may induce the more rapid metabolism of steroid hormones, thereby decreasing their bioavailability and result in abnormal uterine bleeding that is secondary to a relative insufficiency of estrogen or progesterone (e.g., anti-seizure medications).

 

Evaluation and Management of Abnormal Uterine Bleeding in Adolescents

 

Laboratory testing should initially include an assessment of urine or serum β-hCG, a complete blood count with platelets, and TSH. Other testing should be performed based on the history and physical examination, and may include androgen levels (free or total testosterone) and prolactin. Adolescents with abnormal uterine bleeding can have a concomitant bleeding disorder. Von Willebrand disease is the most common bleeding disorder in women. Approximately one quarter of adolescents who require hospitalization or blood transfusion may have a coagulopathy. Anemia on initial evaluation should trigger further testing for a bleeding disorder including PT, PTT, and a Von Willebrand panel.

 

The goal of therapy is to decrease excessive bleeding, prevent its recurrence, and improve quality of life. A trial of combined oral contraceptives can serve as a diagnostic and therapeutic approach to the workup of abnormal bleeding in adolescents. In addition to regulating menstrual flow and providing contraception, combined oral contraceptives can provide relief of associated dysmenorrhea, acne/hirsutism, and premenstrual syndrome, prevent menstrual migraine, and potentially reduce pelvic pain associated with endometriosis. In patients who cannot use estrogen due to other existing medical conditions, Depo-Provera or a progesterone-containing IUD can also reliably provide relief for abnormal bleeding, with a substantial proportion of users achieving amenorrhea within 6 months. Rarely, incessant bleeding can become a medical emergency that requires hospitalization and more intense evaluation including a pelvic exam, ultrasound, and treatment including intravenous estrogen, fibrinolytics, and in rare cases, surgical intervention.

 

Consider coming in for evaluation if you have had irregular vaginal bleeding for three or more menstrual cycles, or if your symptoms are affecting your daily life. There are many things we can do to treat abnormal uterine bleeding. Some are meant to return the menstrual cycle to normal. Others are used to reduce bleeding or to stop monthly periods. Each treatment works for some women but not others. We will discuss all the options and find a treatment that is right for you.

 

Differential Diagnosis of Abnormal Uterine Bleeding in Adolescents

  • Immaturity of the HPO axis
  • Coagulation disorders

  Idiopathic thrombocytopenic purpura (ITP)

  Von Willebrand’s disease

  Platelet function defect

  • Pregnancy complications

  Abortion (complete, incomplete, missed)

  Ectopic pregnancy

  Trophoblastic disease

  • Genital tract infection

  Vaginitis

  Cervicitis

  Vaginal foreign body

  Salpingo-oophoritis

  Endometritis

  • Endocrinopathies

  Polycystic ovary disease

  Hyperprolactinemia

  Thyroid or adrenal abnormalities

  Premature ovarian failure

  Hypothalamic dysfunction

  Anorexia, stress, excessive exercise

  • Benign lesions of the genital tract

  Cervical polyp

  Vaginal adenosis

  Endometriosis

  Uterine fibroid

  • Iatrogenic: drugs or hormones
  • Trauma
  • Malignant lesions of the genital tract

Vaginal carcinoma

 Cervical carcinoma

  Uterine carcinoma

  Ovarian tumors