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.

Low Dose Naltrexone & Its Role In Autoimmune Disorders

September 21, 2018

Low dose naltrexone (LDN) is being prescribed for autoimmune conditions by a greater number of providers.  

 

What exactly is LDN?   Naltrexone is an FDA-approved medication, although it has only been approved to help with heroin and opioid addicts by blocking opioid receptors.  In the 1980’s, studies were done with lower doses of naltrexone, and realized that it can modulate the immune system.  Soon thereafter it was found that LDN can benefit many people with autoimmune conditions, although it can also help with certain types of cancers, as well as some other chronic health conditions.

 

The question of what controls the immune system has plagued the medical community for decades.  Clearly there are multiple factors that play a role.  However, a growing body of research over the past two decades has pointed repeatedly to one’s own endorphin secretions (our internal opioids) as playing the central role in the beneficial orchestration of the immune system. Bone marrow progenitor cells, macrophages, natural killer cells, immature thymocytes and T cells, and B cells are all involved. The relatively recent identification of opioid-related receptors on immune cells makes it even more likely that opioids have direct effects on the immune system.

 

How Does LDN Work?

By taking LDN just before bed – ideally between the hours of 9 PM and 2 AM, there is a brief blockade of opioid receptors.  When LDN is taken before bedtime, the actual blockade would occur between the hours of 2 AM and 4 AM.  It is believed that this brief period of blockade, produces a prolonged up-regulation of vital elements of the immune system by causing an increase in endorphin and enkephalin production. In general, in people with diseases that are partially or largely triggered by a deficiency of endorphins (including cancer and autoimmune diseases), or are accelerated by a deficiency of endorphins (such as HIV/AIDS), restoration of the body’s normal production of endorphins is the major therapeutic action of LDN.

 

LDN and the Research

Unfortunately there is not a lot of research regarding the benefits of LDN.  Some studies showed that LDN might act as an anti-inflammatory agent in the central nervous system, and can help with chronic pain disorders. Other studies show that LDN can benefit those dealing with the pain associated with fibromyalgia.  Other studies concluded that it can be helpful for some people with gastrointestinal disorders.  A small study suggests that LDN might help some people with active Crohn’s disease.

 

LDN And Thyroid Dysfunction

When someone is dealing with suboptimal thyroid function or Hashimoto’s, most medical providers (including myself) will recommend thyroid hormone medication and/or supplements to enhance thyroid function.  Similarly, it is common for medical providers to recommend antithyroid medication for those with overactive thyroid and Graves’ Disease.  In certain cases when we struggle to obtain thyroid normalization, it makes sense to try LDN.  

 

But why is this important?  Consider a condition such as Hashimoto’s Thyroiditis, which involves the immune system damaging the thyroid gland.  Thyroid medication will help replace or modulate hormone levels that are out of balance.  However, taking thyroid hormone medication is not going to do anything to stop or slow down the destruction of the thyroid gland.  LDN has the potential to prevent further damage of the thyroid gland from occurring.  This could potentially allow patients to decrease doses of thyroid medication, achiever better control of thyroid-related symptoms, and keep other immune factors (that are usually associated with Hashimoto’s) in check.  Now consider Grave’s Disease, a condition where the thyroid gland is activated and over-produces thyroid hormone.  Patients with Grave’s generally use medication like Methimazole to decrease production of thyroid hormone.  A lot of patients do not tolerate this medication due to side effects and changes in liver function enzymes.  By modulating the immune system, using LDN, we may be able to help patients who don’t tolerate medication avoid radioactive iodine and/or thyroid surgery.

 

Are There Risks Associated With Taking LDN?

Although side effects are rare with LDN, research indicates that some patients who use LDN report vivid dreams, and occasionally, during the first week of use, patients may complain of difficulty sleeping (less than 2% of users.)  Usually reducing the dose of medication will eliminate sleep disturbance.  

 

LDN Dosing Recommendations

The normal range for LDN is between 1.5 and 4.5 mg per day, taken about an hour before bedtime- NOT in the morning. There are a couple of reasons for this timing. First, since LDN blocks endorphins, doing it in the middle of the night prevents you from noticing that you feel lousy. Second, the endorphin response is greater at nighttime. I generally start with a 3 mg dose.  If there is a positive effect at 3 mg, stay on that dose. If there is still no effect, I raise the dose to 4.5 mg.  If there are negative effects on the 3 mg dose, I decrease the dose to 1.5 mg. That being said, the key to LDN is the low dose. So many times you may actually need to lower the dose if you don’t notice a beneficial effect.

 

  

Conditions That LDN Can Be Used To Treat

  • ALS (Lou Gehrig’s Disease)
  • Alzheimer’s Disease
  • Autism Spectrum Disorders
  • Hereditary Spastic Paraparesis
  • Multiple Sclerosis (MS)
  • Parkinson’s Disease
  • Post-Polio Syndrome
  • Post-Traumatic Stress Disorder (PTSD)
  • Primary Lateral Sclerosis (PLS)
  • Progressive Supranuclear Palsy
  • Transverse Myelitis
  • Ankylosing Spondylitis
  • Behcet’s Disease
  • Celiac Disease
  • Chronic Fatigue Syndrome
  • CREST syndrome
  • Crohn’s Disease
  • Dermatomyositis
  • Dystonia
  • Endometriosis
  • Fibromyalgia
  • Hashimoto’s Thyroiditis
  • Irritable Bowel Syndrome (IBS)
  • Myasthenia Gravis (MG)
  • Nephrotic Syndrome
  • Pemphigoid
  • Primary Biliary Cirrhosis
  • Psoriasis
  • Rheumatoid Arthritis
  • Sarcoidosis
  • Scleroderma
  • Sjogren’s Syndrome
  • Stiff Person Syndrome (SPS)
  • Systemic Lupus (SLE)
  • Ulcerative Colitis
  • Wegener’s Granulomatosis

A Little More About MTHFR (C677T Mutation)

August 31, 2018

Over the past few months, a handful of patients have asked what they can do if they have the MTHFR C677T mutation. Recommendations can vary depending on whether an individual has a heterozygous (1 copy of C677T) or a homozygous (2 copies of C677T) mutation. While there is definitely conflicting information in the literature, the following is intended to provide a small amount of clarification and guidance. 

 

The biggest differences in recommendations between these two types of mutations are:

  • folic acid needs to be avoided more seriously by homozygous individuals
  • the amount of methylfolate required for homozygous mutations is greater
  • the blood thinning requirement is greater for homozygous individuals

 

Recommendations those with C677T MTHFR mutations:

  • Limit ingestion of folic acid in fortified foods as you cannot process folic acid well.
  • Limit or cease taking supplements or drugs with folic acid in them. Talk with your doctor before stopping.
  • Avoid folic acid blocking drugs such as birth control or Methotrexate.
  • Avoid drugs which increase homocysteine such as Nitrous Oxide (most used in dentistry).
  • Avoid antacids as they block absorption of vitamin B12 and other nutrients.
  • Begin understanding which of your symptoms may be related to the C677T MTHFR mutation.
  • Get your homocysteine levels measured.
  • Inform family members so they can also be tested for the MTHFR mutation.
  • Find a doctor who is knowledgeable about MTHFR or is willing to learn.
  • If you are pregnant, find an OB/GYN or midwife who is knowledgeable about MTHFR.
  • Eliminate gluten from your diet – especially wheat.
  • Eliminate or reduce dairy from your diet. If you must have dairy, use goat milk.
  • Sauna or sweat somehow (epsom salt baths, sports, yoga, etc.) at least once to three times a week.
  • Limit intake of processed foods.
  • Increase intake of whole foods and home-prepared meals.
  • Eat the ‘rainbow of colors’ from fruits and vegetables – daily
  • Limit intake of high methionine-containing foods, if homocysteine elevated
  • Coffee enemas for detoxification.
  • Filter chlorine from your drinking water, shower and baths.
  • Drink at least two liters of filtered water daily mixed with Vitamin D and electrolytes.
  • Eat smaller, but more frequent meals, throughout the day with some form of protein.
  • Limit protein intake to approximately 0.7 grams protein per kilogram of body weight.
  • Avoid cooking, drinking, storing and heating in any type of plastic container.
  • Use an air purifier in your home and office.
  • Eliminate carpets from your home and install low VOC wood or tile flooring.
  • Eat grass-fed beef, free range, hormone free and antibiotic meats and eggs.
  • Cook with electric stove and oven and remove gas stove and oven.

 

General Nutrient Recommendations for C677T MTHFR mutations:

  • Methylfolate
  • Methylcobalamin
  • Betaine in the form of TMG
  • NAC
  • Glutathione
  • Pyridoxal-5-phosphate
  • Riboflavin
  • Curcumin
  • Mixed tocopherals (vitamin E)
  • Silymarin (Milk Thistle)
  • EPA/DHA
  • Phosphatidylcholine
  • Nattokinase
  • Vitamin C
  • Vitamin D3
  • Comprehensive multivitamin/multimineral
  • Probiotics

 

Prenatal Recommendations doe MTHFR C677T Mutation

A quality prenatal for those with this defect requires methylfolate, folinic acid and no folic acid. These prenatals are very hard to find.

 

General Supplements Recommended for MTHFR C677T Mutations

Begin by taking the most important supplement first (depending on your individual circumstances) in a small amount for at least a few days to see how you respond. If you respond well, continue taking it and add in another supplement. This way you can easily identify if a specific supplement or nutrient is giving you problems.  

NOTE: If you are not sensitive to supplements in general, then it is recommended to start with a comprehensive multivitamin and multimineral as this supports numerous biochemical functions within your body. It also provides a fast testing ground to see if you respond well to numerous nutrients.

If you do not tolerate a multivitamin well, this is a sign that you must proceed more slowly and work on healing your digestion and dietary intake and lifestyle habits first.

 

How much methylfolate to take?

Those with 1 copy of the C677T MTHFR mutation do not need as much methylfolate. The MTHFR enzyme is working at nearly 70% or so effectiveness in heterozygous individuals while in homozygous individuals, it is working at approximately 30% effectiveness. To determine how much methylfolate you need, it is best to start low and work up. This allows you to safely identify how much you tolerate without triggering very undesirable side effects.  It is highly encouraged that you proceed cautiously in order to prevent side effects from excessive methylfolate.

NOTE: If you begin supplementing with methylfolate and you have inflammation unchecked, your symptoms may worsen. This is why it is critical that you are tolerating and taking probiotics, krill oil, turmeric along with improving your diet and lifestyle first.

 

Methylfolate Side Effects

Common undesirable side effects of methylfolate include:

  • headache
  • migraine
  • rashes
  • irritability
  • anxiety
  • joint pain
  • muscle pain
  • insomnia
  • depression

If side effects occur, then the amount of methylfolate you are taking needs to be taken under consideration and likely reduced. Many times one is not yet ready to take methylfolate. There are other steps that must be taken prior to supplementing with methylfolate if these side effects occur. If side effects occur, taking Niacin helps bind the excessive methyl groups which are likely causing the issue. Consider taking approximately 100 mg of Niacin (not a whole tablet) if these symptoms occur. Flushing is common from taking niacin in the most active form, nicotinic acid. This is not harmful and will subside in about 20-30 minutes.

 

Cycling Supplements for Methylation Balance

Supplements and pharmaceuticals are designed to support methylation.  Methylation is severely disrupted in those with C677T MTHFR mutations – especially homozygous individuals. Methylation requires balance. If methylation becomes excessive, side effects will occur as noted above. This requires adjustment of your protocol. There may be a need for routine adjustment as our bodies are dynamic. Adjustments may range from:

  • stopping all methylation-supportive nutrients
  • taking these nutrients 4 days on and 3 days off
  • taking them every other day
  • taking them only in the morning
  • decreasing the amount taken every other week

 

General Side Effects

If you are feeling improvement consistently, then you are on the right track. If you begin to feel heavy, tired, dry mouth, irritable, ‘toxic’, or otherwise ‘not right’, then something in your protocol needs to change. These are all signs that you are potentially increasing the circulation of toxins and not eliminating them properly. These side effects can be eliminated quite quickly through a pure vegetable and fruit juice diet for at least one day. This means producing your own juices at home using a quality juicer.  Prepare mostly vegetable juices with some fruit juices to increase the taste. Taking niacin also helps offset many side effects.

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. 

Iodine Deficiency on the Rise

June 25, 2018

Iodine is an essential mineral.  Your thyroid gland uses it to make thyroid hormones, which help control growth, repair damaged cells and support a healthy metabolism.  Unfortunately, up to a third of people worldwide are at risk of an iodine deficiency. Those at the highest risk include:

 

  • Pregnant women.
  • People who live in countries where there is very little iodine in the soil: South Asia, Southeast Asia, New Zealand and European countries.
  • People who don’t use iodized salt.
  • People who follow a vegetarian or vegan diet.

 

Iodine deficiencies had been rare in the United States, where there are sufficient levels of iodine in the food supply.  However, changes in lifestyle have increased the prevalence across the United States in recent years.  Symptoms can include swelling in the neck, pregnancy-related issues, weight gain and learning difficulties.  Its symptoms are very similar to those of suboptimal thyroid function. Since iodine is used to make thyroid hormones, an iodine deficiency means your body cannot make enough of them, leading to hypothyroidism.

 

Signs that you may have an iodine deficiency:

 

Swelling in the Neck

Swelling in the neck is the most common symptom of an iodine deficiency. This is called a goiter and occurs when the thyroid gland grows too big. The thyroid gland is a small, butterfly-shaped gland in the front of your neck. The thyroid gland uses iodine to make thyroid hormones. However, when your body is low in iodine, it cannot make enough of them. To compensate, the thyroid gland works harder to try to make more. This causes the cells to grow and multiply, leading to a goiter. Most cases can be treated by increasing iodine intake. However, if a goiter has not been treated for many years, it might cause permanent thyroid damage.

 

Unexpected Weight Gain

Unexpected weight gain may occur if the body does not have enough iodine to make thyroid hormones. This is because thyroid hormones help control the speed of your metabolism, which is the process by which your body converts food into energy and heat. When your thyroid hormone levels are low, your body burns fewer calories at rest. Unfortunately, this means more calories from the foods you eat are stored as fat. Adding more iodine to your diet may help reverse the effects of a slow metabolism, as it can help your body make more thyroid hormones.

 

Fatigue and Weakness

Fatigue and weakness are also common symptoms of an iodine deficiency. Studies have found that nearly 80% of people with low thyroid hormone levels, which occur in cases of iodine deficiency, feel tired, sluggish and weak. These symptoms occur because thyroid hormones help the body make energy. When thyroid hormone levels are low, the body cannot make as much energy as it usually does. This may cause your energy levels to plummet and leave you feeling weak.

 

Hair loss

Thyroid hormones help control the growth of hair follicles. When thyroid hormone levels are low, your hair follicles may stop regenerating. Over time, this may result in hair loss. For this reason, people with an iodine deficiency may also suffer from hair loss.  Approximately 30% of those with low thyroid hormone levels experienced hair loss. If you experience hair loss because of an iodine deficiency, getting enough of this mineral may help correct your thyroid hormone levels and stop hair loss.

 

Dry, Flaky Skin

Dry, flaky skin may affect many people with an iodine deficiency. Studies show that up to 77% of people with low thyroid hormone levels may experience dry, flaky skin. Thyroid hormones, which contain iodine, help your skin cells regenerate. When thyroid hormone levels are low, this regeneration does not occur as often, possibly leading to dry, flaky skin. Additionally, thyroid hormones help the body regulate sweat. People with lower thyroid hormone levels, such as those with an iodine deficiency, tend to sweat less than people with normal thyroid hormone levels. Given that sweat helps keep your skin moist and hydrated, a lack of sweat may be another reason why dry, flaky skin is a common symptom of iodine deficiency.

 

Feeling Colder Than Usual

Feeling cold is a common symptom of an iodine deficiency. Over 80% of people with low thyroid hormone levels may feel more sensitive to cold temperatures than usual. Since iodine is used to make thyroid hormones, an iodine deficiency can cause your thyroid hormone levels to plummet. Because thyroid hormones help control the speed of your metabolism, low thyroid hormone levels may cause it to slow down. A slower metabolism generates less heat, which may cause you to feel colder than usual. Also, thyroid hormones help boost the activity of brown fat, a type of fat that specializes in generating heat. This means that low thyroid hormone levels, which may be caused by an iodine deficiency, could prevent brown fat from doing its job.

 

Changes in Heart Rate

Your heart rate is a measure of how many times your heart beats per minute. It may be affected by your iodine levels. Too little of this mineral could cause your heart to beat slower than usual, while too much of it could cause your heart to beat faster than usual. A severe iodine deficiency may cause an abnormally slow heart rate making you feel weak, fatigued, dizzy and possibly cause you to faint.

 

Trouble Learning and Remembering

An iodine deficiency may affect your ability to learn and remember. Thyroid hormones help your brain grow and develop. An iodine deficiency, which is required to make thyroid hormones, can reduce brain development. Studies have found that the hippocampus, the part of the brain that controls long-term memory, appears to be smaller in people with low thyroid hormone levels.

 

Problems During Pregnancy

Pregnant women are at a high risk of iodine deficiency – they need to consume enough to meet their own daily needs, as well as the needs of their growing baby. The increased demand for iodine continues throughout lactation, as babies receive iodine through breast milk. Not consuming enough iodine throughout pregnancy and lactation may cause side effects for both the mother and baby. Mothers may experience symptoms of an under-active thyroid, such as a goiter, weakness, fatigue and feeling cold. Meanwhile, an iodine deficiency in infants may stunt physical growth and brain development. Furthermore, a severe iodine deficiency may increase the risk of stillbirth.

 

Heavy or Irregular Periods

Heavy and irregular menstrual bleeding may occur as a result of an iodine deficiency. Like most symptoms of iodine deficiency, this is also related to low levels of thyroid hormones. In one study, 68% of women with low thyroid hormone levels experienced irregular menstrual cycles, compared to only 12% of healthy women. Research also shows that women with low thyroid hormone levels experience more frequent menstrual cycles with heavy bleeding. This is because low thyroid hormone levels disrupt the signals of hormones that are involved in the menstrual cycle.

 

Role of Iodine in Breast Health

Iodine deficiency is rapidly emerging as a major risk factor for breast cancer. Human breast tissue and breast milk contain higher concentrations of iodine than the thyroid gland itself, which contains just 30% of the body’s iodine stores. Breast tissue is rich in the same iodine-transporting proteins used by the thyroid gland to take up iodine from the blood. Iodine plays an important role in the health of women’s breast tissue. Iodine has been shown to exert a powerful antioxidant effect equivalent to vitamin C. Iodine-deficient breast tissue exhibits chemical markers of elevated lipid peroxidation, one of the earliest factors in cancer development. Iodine-deficient breast tissue also shows alterations in DNA and increases in estrogen receptor proteins. Coupled with iodine deficiency-induced increases in circulating estrogen levels, these changes can substantially increase the risk of breast cancer in women with low iodine levels.

 

Iodine also helps regulate levels of the stress hormone cortisol and contributes to normal immune function. Abnormal cortisol levels and deficient immune function are significant contributors to the risks of breast cancer; women with fibrocystic breast disease may also suffer from elevated cortisol levels. Taken together, these biological factors explain the well-known link between iodine deficiency and thyroid disease, thyroid cancer, and breast cancer, all of which predominate in postmenopausal women. The link between iodine consumption and breast cancer is most evident when you compare the Japanese and Western diets against cancer incidence. Japanese women consume a diet high in iodine-rich seaweed, which provides them with an iodine intake 25 times higher than the average American woman’s. Japanese women also have breast cancer rates roughly one-third of those found in American women, a difference that disappears in Japanese women who immigrate to the US, where they consume considerably less seaweed.

 

Studies of iodine therapy for breast cancer prevention are encouraging. Breast cancer cells avidly absorb iodine, which in turn suppresses tumor growth and causes cancer cell death. Added dietary iodine reduces the size of both benign and malignant breast tumors. Further benefits may be obtained by supplementing with selenium in addition to iodine; selenium is an essential cofactor in the enzymes used in thyroid and breast tissue to make optimal use of dietary iodine. In addition to its obvious role in preventing breast cancer, increased iodine intake may be important in mitigating another common, if less lethal, breast disorder—fibrocystic breast disease. Fibrocystic breast disease is extremely common – found in at least 9% of all women who undergo biopsies, though the actual rate is probably much higher. Fibrocystic breast changes can be reversed and women with fibrocystic breast disease can obtain substantial relief.

 

It is becoming increasingly clear that iodine deficiency interferes with optimum breast health, and intake of levels far higher than the recommended dietary allowance of 150-290 mcg is required to achieve benefits. Daily amounts of 3,000-6,000 mcg may help relieve the symptoms of fibrocystic breast disease.

 

The Role of Iodine in Cardiovascular Health

Iodine and iodine-rich foods enjoy a long history as natural therapies for hypertension and cardiovascular disease. Even when no overt symptoms are evident, hypothyroidism can contribute to heart disease and stroke, and it increases the risk of death from these conditions. Thyroid dysfunction creates unfavorable disturbances in lipid profiles, elevating low-density lipoprotein (LDL) and total cholesterol levels and raising the risk of atherosclerosis. Hypothyroidism also weakens the heart muscle, causing it to ‘squeeze’ less firmly with each contraction; it can cause cardiac arrhythmias as well. These effects may not be evident at rest, but become important during moderate exercise. Low thyroid function is also associated with higher waist-to-hip ratios, an obesity-related risk factor for cardiovascular disease. Restoring normal thyroid function helps reverse multiple cardiovascular risk factors, most notably adverse lipid profiles. Iodine therapy shows promise in safely and effectively modulating these health concerns.

 

Sources of Iodine

As with many diseases, it is better to prevent the problem rather than have to treat it. Over the last 80 years, worldwide efforts have been made to eliminate iodine deficiency. Elimination of iodine deficiency has been a major goal of the World Health Organization. Iodized salt has been the mainstay of treatment for iodine deficiency worldwide, including in the United States. Injections of iodized oil are occasionally used in regions of the world where widespread iodized salt use is not possible. Iodination of water supplies also has been effective in some places.

 

There are very few good sources of iodine in the diet. This is one reason why iodine deficiency is common worldwide. The recommended daily intake (RDI) is 150 mcg per day. This amount should meet the needs of 97–98% of all healthy adults. One teaspoon of iodized salt contains approximately 400 μg iodine. Most iodine-containing multivitamins have at least 150 μg iodine, but only about half of the types of multivitamins in the United States contain iodine.  Pregnant or breastfeeding women need more iron. Pregnant women need 220 mcg daily, while lactating women need 290 mcg daily. Because the effects of iodine deficiency are most severe in pregnant women and their babies, the American Thyroid Association has recommended that all pregnant and breastfeeding women in the United States and Canada take a prenatal multivitamin containing 150 μg iodine per day. 

 

The foods below are excellent sources of iodine:

  • Seaweed, one whole sheet dried: 11–1,989% of the RDI
  • Cod, 3 ounces (85 grams): 66% of the RDI
  • Yogurt, plain, 1 cup: 50% of the RDI
  • Iodized salt, 1/4 teaspoon (1.5 grams): 47% of the RDI
  • Shrimp, 3 ounces (85 grams): 23% of the RDI
  • Egg, 1 large: 16% of the RDI
  • Tuna, canned, 3 ounces (85 grams): 11% of the RDI
  • Dried prunes, 5 prunes: 9% of the RDI

 

 

Seaweed is usually a great source of iodine, but this depends on where it came from. Seaweed from some countries, such as Japan, are rich in iodine. Smaller amounts of iodine are also found in a variety of foods like fish, shellfish, beef, chicken, lima and pinto beans, milk and other dairy products. The best way to get enough iodine is to add iodized salt to your meals. Half a teaspoon (3 grams) over the course of the day is enough to avoid a deficiency.

 

If you think you have an iodine deficiency, it’s best to consult your doctor. They will check for signs of swelling (a goiter) or take a urine sample to check your iodine levels.

 

Too Much Iodine

Taking too much iodine can also cause problems. This is especially true in individuals that already have thyroid problems, such as nodules, hyperthyroidism and autoimmune thyroid disease. Administration of large amounts of iodine through medications (i.e.: Amiodarone), radiology procedures (iodinated intravenous dye) and dietary excess (Dulce, kelp) can cause or worsen hyperthyroidism and hypothyroidism. In addition, individuals who move from an iodine-deficient region (for example, parts of Europe) to a region with adequate iodine intake (for example, the United States) may also develop thyroid problems since their thyroids have become very good at taking up and using small amounts of iodine. In particular, these patients may develop iodine-induced hyperthyroidism.

 

Talk to your heal care provider before starting an iodine regimen.

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.

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