Transcript document

Women’s Health Issues
Enrique Saguil, MD
Hormonal axis
Menstrual irregularities
Endometriosis
Female athlete triad
Human papilloma virus
Ovarian cancer
Breast cancer
Menopause
Osteoporosis
Anatomy 101
The Hormonal Axis
Allies vs Axis
The 28 day cycle
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
TypesLong 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.
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
Tests
Pap Smear
Endometrial biopsy
Pelvic ultrasound
Lab tests such as thyroid function
tests, CBC, pregnancy test,
glucose
The PAP-(a necessary evil)
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.
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.
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
Testing
Ultrasound
Magnetic resonance imaging (MRI)
Laparoscopy
Laparoscopic view
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)
Higher chance of developing ifbegan 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
Suggested prevention
exercise regularly
avoid alcohol and
caffeine
Antiinflammatory
diet
Turmeric,
Boswelia, white
willow bark
3.Female athlete triad
Disordered eating
Osteoporosis
Amenorrhea (loss of menstrual cycle)
Image sports
Weight dependant sports
Non-athletes that “find” exercise
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).
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.
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
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
Treatment
Increasing protein intake
Psychotherapy-(sports psychology, EFT)
Decreasing exercise duration, intensity
and involvement
St Johns Wort, Calcium, Vitamin D
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.
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.
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
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"
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.
The shot
transient dizziness, injection-site
swelling, fainting, fever or nausea
A dangerous condition called GuillainBarre syndrome was found (but the
incidence was similar to that seen in
unvaccinated girls.)
Adaptogens?
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 Women’s Health
Initiative Dietary Modification
Randomized Controlled Trial
Journal of the National Cancer Institute
Advance Access published online on
October 9, 2007
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
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
“The screening test”
pelvic pain and abdominal pain;
urinary frequency and urgency;
increased abdominal size or bloating;
difficulty eating or feeling full.
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
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 dx’d in men, 400 will die
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
RISK factors
Female and older (50)
High breast tissue density
Radiation exposure in youth
Estrogen exposure-menarche <12,
menopause >55
Nulliparous or 1st >30
OC’s and HRT
Overweight or gaining after menopause
BRCA1 2 gene
Testing
Self breast exam
Check up
Mammogram?
Ultrasound
MRI?
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.
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/
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.
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
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.
Prepare for the worst and
hope for the best
7. MENOPAUSE
missed periods
sleep disturbances
hot flashes
vaginal dryness
changes in mood
lack of sex drive
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.
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
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
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)
WHI Study of Younger Postmenopausal
Women Links Estrogen Therapy to Less
Plaque in Arteries
Women's Health Initiative (WHI) EstrogenAlone 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)
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
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
Alternative suggestions
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 > 50 higher risk fx than prostate
ca
20% fx’s will die w/in 1 yr
50% require long term care
Screening
DEXA all women 65>
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
Treatment
Early prevention
Vit d, calcium citrate
Exercise
Soy +/Traditional medicine (fosamax, evista)
retesting
+ Polycystic Ovarian Syndrome
prevalence of PCOS of 5%–10% 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
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
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).
Treatment options
Control hormone pathways
Bandaids
Dietary control of glucose
Exercise to control weight
Omega 3, multivit, kidney formula
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
Traditional medicine
Hormonal axis
Menstrual irregularities
Endometriosis
Female athlete triad
Human papilloma virus
Ovarian cancer
Breast cancer
Menopause
Osteoporosis
nsaid, oc
nsaid, oc
therapy,oc
vaccine,surg
onc
onc
bandaid
fosamax
The Saguil Approach
Hormonal axis
Menstrual irregularities
Endometriosis
Female athlete triad
Human papilloma virus
Ovarian cancer
Breast cancer
Menopause
Osteoporosis
(teeth)
If relief, chaste
If relief
EFT, St Johns
adaptogen
adaptogen
adaptogen
soy, probio, bc
cal, vit d, soy