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Recently 16 y/o female presented to clinic with cessation of menses for 4 months. History of weight gain since puberty. Relevant physical exam findings revealed some hirsutism on upper lip and temporal area. Patient currently overweight for age and height. Pelvic exam was normal. Preliminary tests included FSH, LH, Androgens, Thyroid and Adrenal Function Tests. Of these tests LH and Androgens were elevated. Thyroid and Adrenal Function were normal. Lipid panal and blood glucose were later measured and both fasting glucose levels and LDL and triglycerides were elevated. Many naturopathic treatment options exist to help relieve symptoms. Lifestyle & Diet can help tremendously and cost little to no money. Regular exercise (yoga, qi gong, running, swimming) is important for improving insulin resistance. Obesity can increase insulin resistance and androgen secretion. Regarding diet, a PCOS patient should increase animal protein and non-starchy/high fiber vegetables, grains and beans. Lowering carb intake can help lower insulin levels and therefore lower androgen levels. Patient can incorporate soy into diet (1-2 servings/day) because it lowers blood estrogens, increases SHBG and supports estrone metabolism and clearance, lowers aromatase levels lengthens follicular phase by inhibiting LH (Kumar et al., 2002) (Hudson, 2008). Incorporating green tea (3-5c/day) also increases sex hormone binding globulin (SHGB) (Nigata & Shimizu, 1998). Nutrition & Supplements can also help bring the body back to its normal state. 10,000 IU once or twice per week of vitamin D and 1,000-1,500 mg per day of calcium (including dietary sources) prevents/reduces dysregulation in follicles, general hormone and endocrine health (Thys-Jacobs, 1999). 1,000 mcg per day of chromium increases insulin sensitivity (Lydic, 2003). I personally have seen the most improvement in patients who have taken botanicals as support during PCOS, most notably Vitex agnus-castus (500 mg/day first thing in AM away from food to correspond with natural diurnal rhythm) normalizes menses, increases LH in relation to FSH creating progesterone effect (Hudson, 2008). Other herbs to consider include Serenoa repens-Saw palmetto (400mg/day) reduces conversion of testosterone to DHT by inhibiting 5alpha-reductase (Prager, et al. 2002). Urtica dioica-Nettles (600mg/day) increases and binds to SHBG which then binds up serum testosterone to lower levels (Schottner, et al, 1997). Glycyrrhiza glabra-Licorice Root extract (3.5g QD) (Armanini, 2005). Lastly, the patient may consider supporting liver phase I & II detox pathways with detoxification factors to ensure proper estrone metabolism and clearance. Consider castor oil packs may also be used if pain and inflammation accompany cystic/enlarged ovaries
Sources
Menopause. I can not express to you how many patients I have seen in my clinic for treatment of menopausal symptoms. Naturopathic medicine’s countless tools hold tremendous potential for the relief of hot flashes, anxiety, weight gain, vaginal dryness, fatigue and insomnia often experienced during menopause.Menopause is the permanent cessation of menstrual periods, determined retrospectively after a woman has experienced 12 months of amenorrhea without any other obvious pathological or physiological cause. It occurs at a median age of 51.4 years in normal women, and is a reflection of complete, or near complete, ovarian follicular depletion, with resulting hypoestrogenemia and high FSH concentrations. Perimenopause, or the menopausal transition, is a 3-5yr period that occurs after the reproductive years, but before menopause, and is characterized by irregular menstrual cycles, endocrine changes, and vasomotor, urogenital and psychological symptoms. Naturopathic suggestions include:
1) Diet: Low fat, Increase lean protein, Drink plenty of water (1/2 body weight in oz (90oz))
a. Add raw green leafy vegetables, flax seeds, black beans, sesame seeds, soybeans, walnuts, lyceum fruit, mulberries, yams, licorice
b. Add estrogenic foods: animal products, apples, cherries, olives, plums, carrots, yams, nightshade family (be wary of allergies), peanuts, soy products, chickpeas, lentils, flaxseed, lentils, coconut, red clover, brown rice, barley, oats, wheat
c. avoid cow’s milk and other dairy products, sweet foods and sugars, white bread, fried, fatty, rich and/or salty foods, red meat, refined and processed foods, alcohol (esp red wine), coffee, and caffeine, to reduce hot flashes limit hot sauces, spicy foods, hot drinks (esp coffee!)
2) Supplementation
a. Hearty whole food based multi and fish oil
b. Vitamin E 400-800 IU/day: relief of hot flashes and vaginal complains
c. Cal/Mg. 800-1600mg Calcium/day including food sources: green leafy veggies, canned sardines,
d. Vit D 400-800u/d from food, supplements, sunlight
e. B6, B12 50-200mg/day role in serotonin and mood
f. Sublingual melatonin 2.5mg to 5mg dose as needed for sleep
g. Isoflavone supplements-natural phytoestrogen
h. DIM-di-indole methane (cruciferous vegetables) ease symptoms associated by improving estrogen metabolism
3) Botanicals: Menocaps Wise Woman Herbals (2-6caps/day: motherwort, dong quai, burdock, chaste tree, black cohosh, licorice), Raspberry & Yarrow infusion, Oatstraw tincture before bed for sleep, Lavender essential oils/pillow, Bach Rescue Sleep Remedy
4) Homeopathy: Try a Constitutional Remedy Workup, Sepia and Pulsitilla are common
5) Dr. Lee Natural Progesterone Cream (400+mg/oz)
a. Day 1-7: do not use progesterone cream (during menses)
b. Day 8-21: use ¼ tsp 2x/day
c. Day 22-28: use ¼ to ½ tsp 2x/day
d. Apply cream to palms, inner arms, chest, or inner thighs for relief of menopausal symptoms
6) Stress Management: This can include meditation, guided imagery, deep breathing exercises, accupuncture, therapy
7) Exercise: start with walking/yoga 3x/week for 30 mins, but switch up exercises every other week (try a mini trampoline-antigravity) because your body can adapt. Also try Kegel exercises for urinary incontinence
8) Temperatures: Dress in layers, air conditioning at night, use cotton sheets, keep an ice cold water bottle by your bed)
I hate, hate, the notion on a secret recipe…recipes were made to be shared. That’s how they improve, how they change, how new ideas are formed ad older ones made ripe
So that his place shall never be with those cold and timid souls who know neither victory nor defeat” Theodore Roosevelt. Sorbonne.
Seed Rotation for the restoration of hormonal balance for both women and men. It can be used to treat hormonal imbalances as seen in PCOS, cases of dysmenorrhea among other hormonal syndromes. It works so well because the hulls of the seeds contain chemicals called lignans which help modulate the hormonal pathways of the body while the seed oils are comprised of essential (or omega) fatty acids that provide the building blocks for steroid hormone synthesis.
As each seed type contains variations of these lignans and fatty acids, rotation of these seeds through the month provides the body with the variety of precursors it needs to create normal hormonal cycles.
For women: the rotation plan can be done according to either the menstrual cycle (if it is fairly regular) or phases of the moon (if the menstrual cycle is absent or too irregular)
* From days 1-14 of the menstrual cycle (or from the new moon to the full moon) have 1 Tablespoon per day of a mixture of ground flax and pumpkin seeds.
* From days 15 – 28 of the menstrual cycle (or from the full moon to the new moon) have 1 Tablespoon per day of a mixture of ground sesame and sunflower seeds.
Flu Season is upon us and I myself have already felt myself coming down with something. sore throat, cough, post nasal drip and all….try wise women herbal’s herbal cough elixer. I tried a dropper full of this tincture and I felt immediate relief. This herbal tincture contains marshmallow, mullein, elecampane which are all soothing to inflamed and irritated tissues of the respiratory tract and it also contains fennel, licorice, orange, osha, wild black cherry and propolis which all contain a certain degree of anti-viral activity and help to eliminate infection while boosting the immune system. Try it out!
Today, a great thought came to me in the midst of clinical forum. I thought, wouldn’t it be great to post a case presentation including the treatment plan so that others might get an idea of what naturopathic doctors have to offer in terms of preventative medicine and health care! I started clinic over the summer and so far it has been great, I love working with patients closely and developing a treatment tailored to the patients body and lifestyle. Stay posted, cases to come soon!
Homeopathy and Anxiety
