Women

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Womens Health Issues

• Enrique Saguil, MD

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• Hormonal axis
• Menstrual irregularities
• Endometriosis
• Female athlete triad
• Human papilloma virus
• Ovarian cancer
• Breast cancer
• Menopause
• Osteoporosis

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Anatomy 101
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The Hormonal Axis
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Allies vs Axis
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The 28 day cycle
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1. Menstrual irregularities

• New cycle , that is the irregularity experienced
  by some young girls at the onset of the periods.
• Dietary problems , eg. anorexia, bulimia or
  simply poor diet
• Too much exercise
• Drugs -  prescription and recreational
• Break in routine
• Sexual activity -  especially when it is a new
  occurrence
• Thoughts and emotions
• Stress
• Anxiety about pregnancy
• Illness or physiological imbalance eg thyroid
  conditions

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Types-

• Long Term Irregularity
• -Long term irregularity can be anything from a
  cycle that varies in length from month to month
  to the experience of various abnormal symptoms,
  for example, excessive bleeding, no cycle for
  months at a time, very painful periods or
  ovulation.
• Sudden or Short term Irregularity
• -Short term irregularity can be attributed to any
  of the causes previously mentioned, and are
  generally a one off or sporadic occurrence. These
  cases are probably not a cause for great concern
  unless you are experiencing pain or just feel as
  if something is wrong.

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When to call

• You have soaked through a pad or tampon every
  hour for 2-3 hours.
• Your bleeding has lasted longer than one week.
• You are pregnant.
• You have severe pain, especially if you also have
  pain when not menstruating.
• Your periods have been heavy or prolonged for
  three or more cycles, compared to what is normal
  for you.
• You have a fever or abnormal vaginal discharge,
  especially if it has an odor.
• You have bleeding after menopause.
• You have bleeding or spotting between periods.
• You have nipple discharge, excessive hair growth,
  deepening voice, unintentional weight loss or
  gain, or new acne

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Tests

• Pap Smear
• Endometrial biopsy
• Pelvic ultrasound
• Lab tests such as thyroid function tests, CBC,
  pregnancy test, glucose

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The PAP-(a necessary evil)
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Treatments

• The Pill or any other hormonal contraception will
  give you a regular cycle but once started most
  likely the pill will have to continue.
• Diet is very important. If you eat lots of fast
  foods you are not giving your body the
  nourishment it needs. If you eat sporadically,
  miss meals and diet constantly - you essentially
  send your body into survival mode. Your body
  thinks it is starving and shuts down unnecessary
  systems. A body that thinks it is starving will
  not cycle regularly.
• Consider taking a quality womens Multi with
  Menstrual herbs in it (eg chasetree and dong
  quai). This will help with missed nutrients and
  the herbs will help balance your hormones.
• Many irregularity stems from irregularity, being
  regular in Routine will always help to regulate
  the axis. This would mean wake, eat, work,
  exercise and sleep on a regular basis.

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Dong quai

• Experiments show that whereas the volatile oil in
  the root causes relaxation of the uterine muscle,
  both water and alcohol extracts stimulate uterine
  contractions alcohol extracts are stronger.
  Dongquai also normalizes irregular uterine
  contractions, improving blood flow to the uterus.

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2. Endometriosis

• Very painful menstrual cramps
• Pain with periods that gets worse over time
• Chronic pain in the lower back and pelvis
• Pain during or after sex
• Intestinal pain
• Painful bowel movements or painful urination
  during menstrual periods
• Heavy and/or long menstrual periods
• Spotting or bleeding between periods
• Infertility (not being able to get pregnant)
• Fatigue

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Testing

• Ultrasound
• Magnetic resonance imaging (MRI)
• Laparoscopy

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Laparoscopic view
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Women with Endometriosis

• get their monthly period
• are 27-years-old on average
• have symptoms for two to five years before
  finding out they have the disease
• have gone through menopause and have virtually
  eliminated symptoms-(more of a retrospective
  finding)

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Higher chance of developing if-

• began getting your period at an early age
• have heavy periods
• have periods that last more than seven days
• have a short monthly cycle (27 days or less)
• have a close relative (mother, aunt, sister) with
  endometriosis

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Suggested prevention

• exercise regularly
• avoid alcohol and caffeine
• Antiinflammatory diet
• Turmeric, Boswelia, white willow bark

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3.Female athlete triad

• Disordered eating
• Osteoporosis
• Amenorrhea (loss of menstrual cycle)

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Image sports
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Weight dependant sports
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Non-athletes that find exercise
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Disordered Eating

• Food restriction - limiting overall food intake
  or there are many foods that will not be eaten
  because their thought to be "bad for you" and
  will make you fat.
• Rigid food patterns - you eat exactly the same
  thing every day. For example, you eat a bagel
  every morning, yogurt and salad each day for
  lunch and meatless pasta at dinner. You have a
  significant nutrient gaps with this kind of
  strict eating.
• Inadequate protein diet - you only occasionally
  eat meat, poultry, fish, dairy products or other
  good protein sources like beans, legumes, nuts or
  soy products.
• Thought patterns such as preoccupation with food,
  dissatisfaction with one's body, excessive fear
  of becoming fat and a distorted body image (you
  think you're fat, but in reality you're thin or
  healthy.)
• Prolonged fasting.
• Bingeing (out of control eating) and purging (use
  of diet pills, diuretics or laxatives to control
  weight or vomiting because you feel guilty about
  the food you've eaten).

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The cycle of events

• Restrictive eating and excessive exercise can
  cause a women to develop an energy deficit.
• This energy deficit or stress condition changes
  the body's hormone levels.
• The reproductive system shuts down and the normal
  menstrual cycle is disrupted.
• If hormones aren't brought back into balance, the
  body begins the silent process of destroying
  bone.

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amenorrhea

• Amenorrhea means that you stopped having your
  period for three months or longer. If you haven't
  had your first period by age 16, this is also
  considered amenorrhea

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Osteoporosis

• Usually it would be an early onset osteoporosis
  but unfortunately by the time it is investigated,
  its too late to prevent
• The bone density of a 30-40 year old will be that
  of a 50-60 year old

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Treatment

• Increasing protein intake
• Psychotherapy-(sports psychology, EFT)
• Decreasing exercise duration, intensity and
  involvement
• St Johns Wort, Calcium, Vitamin D

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4. Human Papilloma Virus

• the rate of infection for females aged 14 to 24
  was 33.8 percent, or about 7.5 million young
  American women. That rate is substantially higher
  than previous estimates of about 4.6 million HPV
  infections in this same age group, the
  researchers noted
• Feb. 28 issue of the Journal of the American
  Medical Association.

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Vaccination?

• The CDC currently recommends that the vaccine be
  routinely given to girls 11 and 12 years of age
  to help prevent infection with the sexually
  transmitted virus
• The National Advisory Committee on Immunization
  Practices also recommends Gardasil for use in
  girls beginning at age 9 -- at the provider's
  discretion -- and in young women up to the age of
  26.

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Reasons that led to vaccine

• HPV prevalence rose during adolescence and peaked
  among college-age women (20 to 24 years of age),
  with almost half (44.8 percent) of women in this
  age group testing positive for the virus

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Association with hpv and cancer

• 3.4 percent of women aged 14 to 59 were infected
  with one of the four HPV strains covered by the
  Gardasil vaccine -- strains 6, 11, 16 and 18.
  Strains 16 and 18, especially, are suspected of
  being especially "oncogenic"

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Cervical Cancer (from HPV)

• According to the American Cancer Society, more
  than 11,150 new cases of invasive cervical cancer
  will be diagnosed in U.S. women this year, and
  about 3,670 women will die of the disease.

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The shot

• transient dizziness, injection-site swelling,
  fainting, fever or nausea
• A dangerous condition called Guillain-Barre
  syndrome was found (but the incidence was similar
  to that seen in unvaccinated girls.)

Adaptogens?
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5. OVARIAN CANCER

• Historically ovarian cancer was called the
  silent killer because symptoms were not thought
  to develop until the chance of cure was poor
• Low-Fat Dietary Pattern and Cancer Incidence in
  the Womens Health Initiative Dietary
  Modification Randomized Controlled Trial
• Journal of the National Cancer Institute Advance
  Access published online on October 9, 2007

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stats

• Ovarian cancer is the eighth most common cancer
  among American women
• the fifth leading cause of cancer death.
• Around two-thirds of women with ovarian cancer
  are 55 or older

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TESTING

• An annual pelvic exam in a must, especially among
  older women
• Ultrasonography
• CT scanning/ MRI
• The screening test picked up early stage
  ovarian cancer 56.7 percent of the time
  advanced-stage disease 80 percent of the time
• Ovarian Cancer National Alliance

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The screening test

• pelvic pain and abdominal pain
• urinary frequency and urgency
• increased abdominal size or bloating
• difficulty eating or feeling full.

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From silent to not so deadly

• Researchers report that the test -- a checklist
  of symptoms and their frequency -- picked up
  early stage ovarian cancer 57 percent of the
  time.
• The researchers then tried to detect patterns
  among the survey results. They found that certain
  symptoms indicated cancer if any one of them was
  present more than 12 days a month but for less
  than a year

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6. BREAST CANCER

• The most common type of cancer for women in the
  US
• The leading cause of cancer deaths in women 40-59
  (second only to lung cancer)
• 200,000 diagnosed this year, 40,000 will die
• 2,000 cases dxd in men, 400 will die

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• 2,000,000 survivors in the US
• Number of deaths seems to be declining
• Risk factors have been identified and earlier
  detection along with more effective treatments
  are thought to be responsible

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RISK factors

• Female and older (50)
• High breast tissue density
• Radiation exposure in youth
• Estrogen exposure-menarche lt12, menopause gt55
• Nulliparous or 1st gt30
• OCs and HRT
• Overweight or gaining after menopause
• BRCA1 2 gene

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Testing

• Self breast exam
• Check up
• Mammogram?
• Ultrasound
• MRI?

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Pretest checklist

• To help minimize discomfort during mammography,
  schedule your mammogram to take place one week
  after your period (when breasts are less tender).
  
• If possible, bring your previous mammogram with
  you, or bring a list of where and when you have
  had previous mammograms with you to your
  appointment.
• On the day of the examination, do not wear talcum
  powder, deodorant, lotion or perfume under your
  arms or on your breasts. These substances can
  cause artifacts on your mammogram making the
  images harder to interpret (aluminum flecks in
  some powders and deodorants can mimic
  microcalcifications on the x-ray image).
• Wear a two piece outfit so that you only have to
  remove your top and bra for the examination a
  blouse which buttons in the front is optimal
  since it can be easily removed, while pullover
  tops are less convenient.
• Any jewelry worn (especially earrings or
  necklaces) should be easily and quickly
  removable, especially if you will have a
  procedure which requires you to lie face down.
• Any breast symptoms or problems that a woman is
  experiencing should be described to the
  technologist performing the examination.

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Susan Komen foundation

• Nancy G. Brinker promised her dying sister, Susan
  G. Komen, that she would do everything in her
  power to end breast cancer forever.
• In 1982, that promise became Susan G. Komen for
  the Cure and launched the global breast cancer
  movement
• invested nearly 1 billion in race for the cure
• http//ww5.komen.org/home/

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Thermography alternative

• How It Works   Thermography combines
  ultra-sensitive digital photography and
  specialized computer programming to record the
  amount of heat present at the skin's surface.
  During the 30-minute procedure, the patient
  disrobes to the waist and acclimates to the
  ambient temperature in a cooled room. A certified
  female technician then takes a series of five
  images from various angles. There is no pain, no
  compression and most importantly, no radiation.
     The images are transmitted electronically to
  physicians to interpret thermographic scans.
  Advanced software allows doctors to identify
  temperature differentials, note potential problem
  areas and offer suggestions for additional study.
  

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• Breast thermo-graphy is a physiology test,
  meaning it looks for functional changes in breast
  tissue which may indicate trouble years before a
  tumor starts to form. For example, cells that are
  inflamed and pre-cancerous grow rapidly,
  requiring a markedly increased blood flow. The
  cells release substances that stimulate the
  formation of new blood vessels to deliver
  nutrients. The increased blood flow elevates the
  skin surface temperature. These physiological
  changes alert the doctor that aggressive
  detoxification measures are immediately needed.
  In contrast, mammograms detect structural
  changes, or changes in anatomy, after a fully
  formed mass has developed. A lump large enough to
  be detected by traditional methods (cancerous or
  not) may have been present for as long as ten
  years before it is identified

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Studies

•  Breast thermography is an alternative choice for
  all women, regardless of age or breast size, who
  desire a painless and radiation-free screening
  procedure. This type of imaging has been shown to
  detect 86 of non-palpable breast cancers and up
  to 15 of cancers that were not visible by
  mammography. (Gamagami P Indirect signs of
  breast cancer Angiogenesis study. In Atlas of
  Mammography, Cambridge, Mass., Blackwell Science
  pp.231-26, 1996.)   Like mammography and
  ultrasound, infrared imaging does not diagnose
  cancer, but merely indicates the presence of an
  abnormality. Only tissue biopsy can actually
  diagnose cancer. The key benefit to thermography
  is that it can detect an abnormality far earlier,
  and interventions can be undertaken immediately
  to induce normalization of the tissues. Coupled
  with regular self-breast exams, thermography is
  especially appropriate for women under 50, but is
  convenient and safe for all women of all ages.
  For more information, see www.thermologyonline.org
  .

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• Prepare for the worst and hope for the best

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7. MENOPAUSE

• missed periods
• sleep disturbances
• hot flashes
• vaginal dryness
• changes in mood
• lack of sex drive

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• Hot flashes are caused by an increase of blood
  flow in the blood vessels of the face, neck,
  chest and back.
• Vaginal dryness is caused by thinning of the
  tissues of the vaginal wall, are the two side
  effects most frequently complained about.
• The mood changes and lack of sex drive may result
  partially from the hormone decrease, but may also
  result from having to deal with hot flashes and
  vaginal dryness.

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HOTFLASHES

• Avoid foods that may trigger hot flashes (hot
  drinks and spicy foods are common triggers)
• Avoid Stress. It may contribute to the occurrence
  of hot flashes
• Wear loose clothing and dress in layers so you
  can peel off the top layers during a hot flash

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• Estrogen is needed for proper response of vaginal
  tissue (lubrication and clitoral engorgement)
• Estrogen can be used "locally" for proper vaginal
  response without putting the whole body at risk
  for long-term disease (breast and uterine cancer)
  
• Testosterone may contribute to increased desire.
  However, in order for testosterone to work
  properly, the body needs estrogen first

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Decrease in Breast Cancer Rates Related to
Reduction in Use of Hormone Replacement Therapy

• The sharp decline in the rate of new breast
  cancer cases in 2003 may be related to a national
  decline in the use of hormone replacement therapy
  (HRT), according to a new report in the April 19,
  2007, issue of the New England Journal of
  Medicine.
• (against
  estrogen)

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WHI Study of Younger Postmenopausal Women Links
Estrogen Therapy to Less Plaque in Arteries

• Women's Health Initiative (WHI) Estrogen-Alone
  Trial show that younger postmenopausal women who
  take estrogen-alone hormone therapy have
  significantly less buildup of calcium plaque in
  their arteries compared to their peers who did
  not take hormone therapy.
• June 21, 2007, issue of the New England Journal
  of Medicine. (for estrogen)

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www.whi.org

• The Women's Health Initiative (WHI) is a
  long-term national health study that focuses on
  strategies for preventing heart disease, breast
  and colorectal cancer and fracture in
  postmenopausal women

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www.4woman.gov

• Your age, overall health, and medical history
• Current symptoms
• Your tolerance for specific medications,
  procedures, or therapies
• Your opinion or preference
• To enter an ongoing study on menopause

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Alternative suggestions
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8. Osteoporosis

• Lifetime risk of dying from hip fx same of
  breast cancer
• Post menopausal 50 chance fx
• 60 y/o man 25 chance fx
• Men gt 50 higher risk fx than prostate ca
• 20 fxs will die w/in 1 yr
• 50 require long term care

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Screening

• DEXA all women 65gt
• All women 60-64 with risks
• roid use, poor nutrition, early amenorrhea,
  chronic disease, cigarette use, excessive etoh,
  caffeine use, lack of exercise, immobility,
  hyperthyroid, hyperpara, vit d deficiency

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Treatment

• Early prevention
• Vit d, calcium citrate
• Exercise
• Soy /-
• Traditional medicine (fosamax, evista)
• retesting

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Polycystic Ovarian Syndrome

• prevalence of PCOS of 510 in women of
  reproductive age, using the diagnostic criteria
  of the US National Institutes of Health.
• primary defect may be insulin resistance leading
  to hyperinsulinaemia then functional
  hyperandrogenism
• The theca cells are over-responsive, increase in
  size and overproduce androgens

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PCOS

• Polycystic ovary syndrome (PCOS) is a common
  condition characterised by menstrual
  abnormalities and clinical or biochemical
  features of hyperandrogenism.
• hirsutism, anovulation or dysfunctional
  bleeding, and dysfunction of glucose metabolism
• diabetes mellitus is common in PCOS
• ultrasound evidence is not necessary many women
  without PCOS have polycystic ovaries

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• Features of PCOS may manifest at any age, ranging
  from childhood (premature puberty), teenage years
  (hirsutism, menstrual abnormalities), early
  adulthood and middle life (infertility, glucose
  intolerance) to later life (diabetes mellitus and
  cardiovascular disease).

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Treatment options

• Control hormone pathways
• Bandaids
• Dietary control of glucose
• Exercise to control weight
• Omega 3, multivit, kidney formula

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The Saguil Approach (legs)

• Spiritual grounding-family
• Stress reduction-yoga or tai chi, job
• Exercise moderate to vigourous (age)
• Multivitamin
• Antioxidants
• Protein, protein, carb diet

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Traditional medicine

• Hormonal axis
• Menstrual irregularities nsaid, oc
• Endometriosis nsaid,
  oc
• Female athlete triad
  therapy,oc
• Human papilloma virus vaccine,surg
• Ovarian cancer onc
• Breast cancer onc
• Menopause
  bandaid
• Osteoporosis
  fosamax

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The Saguil Approach (teeth)

• Hormonal axis
• Menstrual irregularities If relief,
  chaste
• Endometriosis If relief
• Female athlete triad EFT, St Johns
• Human papilloma virus adaptogen
• Ovarian cancer adaptogen
• Breast cancer adaptogen
• Menopause soy, probio,
  bc
• Osteoporosis cal, vit d,
  soy