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Curcumin – the Anti-Inflammation Wonder Herb

Turmeric (Curcuma longa) is a culinary herb that is an amazing medicinal multi-tasker! It has a bright yellow/orange hue that gives curry its vibrant color. A member of the ginger family, turmeric contains many compounds including several in the curcumin family. Curcumins are known to have anti-inflammatory, anti-oxidant, anti-cancer properties.

Despite that curcumin has been used medicinally in Ayurvedic medicine in India for centuries, it is only more recently that interest has caught on in the U.S. Luckily for all of us, the enormous potential of curcumin has resulted in a growing body of research to help us understand how it works and which scenarios it works best in. Currently there are ongoing studies looking at arthritis, inflammatory bowel disease treatment, colon cancer prevention, Alzheimer’s disease, depression, to name just a few.

Cooking with turmeric is an easy and healthy way to benefit from curcumins. It adds a delicious color and flavor to dishes. Turmeric tea is another excellent way to enjoy this powerful herb.  It does seem, however, that the doses needed to get full medicinal effect are much higher than one could ever get in a helping of your favorite curry. Although I always encourage people to get their nutrition from food before supplements, this is one case where taking a curcumin supplement does much more for you than simply cooking with it.

How to use Curcumin Medicinally

Arthritis

In the case of arthritis, curcumin works by neutralizing free radicals as well as by inhibiting pain and inflammation. In fact, it suppresses multiple inflammatory chemical messengers that the body makes.  It does this by inhibiting several enzymes along the inflammation cascade, the very same enzymes that ibuprofen and naproxen block.

And research supports this. A well designed study of 367 arthritis patients found it to be as effective as the traditional anti-inflammatory drug, ibuprofen with fewer side effects1.  Additionally, curcumin has been found to decrease substance P in nerve cells which is an additional way that in can improve pain in all kinds of arthritis.A typical dose would be 500mg taken 1-3 times a day.  

PMS

As a gynecologist I am always looking for ways to help women manage their period problems. For the same reason that curcumin helps arthritis, it is logical that it would be helpful for pain associated with menstrual cramps. One prospective randomized trial of 70 women with PMS showed that 100mg taken twice a day for 10 days starting one week before menses reduced PMS scores by 59% compared to just 14% in placebo group. Effects were seen for all three symptom categories: physical, behavioral, and emotional2. What’s nice about this study is that the authors used a relatively low dose compared to other applications. Lower doses mean fewer potential side effects.

Ulcerative Colitis

Curcumin’s powerful anti-inflammatory effects and limited absorption from the GI tract make it an excellent agent to treat inflammation in the gut. There are ongoing studies looking at curcumin as a treatment for inflammatory bowel disease. One such study of 89 people with ulcerative colitis found that when in remission, those who took 1,000mg curcumin twice a day for six months, along with their regular medicine, had lower relapse rates than those who took placebo.3

Cancer

From a cancer perspective, curcumin has the ability to alter gene transcription and actually stop cell growth, known as apoptosis. Its anti-cancer properties are also thought to come from anti-inflammatory and antioxidant effects. It has been studied and used for prevention or treatment of colorectal cancer, pancreatic cancer, breast cancer, multiple myeloma, lung cancer.  Interestingly, there are also studies to suggest that whole turmeric has anti-cancer properties beyond curcumin extracts alone.4

Things to Know:

Because curcumin is not well absorbed by itself you will need to use a preparation that has been specially formulated so that your body can digest it. Many supplement preparations have black pepper, also known as bioperine, added to it which improves intestinal absorption by about 1000%. There is some concern that pepper is irritating to the GI lining which might be problematic. Alternatively, some brands have specially formulated the herb in a delivery system that optimizes absorption.

Dr. Blum’s non-GMO Super Curcumin, available in our online store, is formulated with super-absorbable sunflower lecithin so that you will reap the benefits of every milligram. See it Now

Who Should Not Take Curcumin

Curcumin is usually well tolerated but can lead to GI upset if taken in high doses and could cause an allergic reaction. People with gallbladder obstruction should avoid curcumin because it can cause the gallbladder to contract. This can be helpful for some kinds of digestion, but could make things worse if you have a gallstone blockage. Additionally, patients with gastric ulcers should avoid curcumin. Patients on blood thinners should be careful with curcumin. Always tell your healthcare provider if you are taking any herbs.  I don’t recommend curcumin supplements in pregnancy due to lack of safety data.

Do You Suffer With Arthritis?

Are you ready to live a pain-free life? Whether you suffer with an autoimmune condition like Hashimoto’s or arthritis, Dr. Blum can help you!

In her new book, Healing Arthritis, Dr. Blum presents the exact 3-Step Protocol that we use with patients at Blum Center for Health. You will learn the best food plan for arthritis, the precise supplements and dosage we recommend for an arthritis-free life, how to build resiliency so that life’s stressors won’t affect your health, and what your gut has to do with your arthritis symptoms. In essence, Dr. Blum gives you all the tools you need to fix your gut and heal your arthritis. Get The Book Now

Resources:

  1.  Kuptniratsaikul V et al Clin Interv Aging. 2014 Mar 20;9:451-8. Efficacy and safety of curcum domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study.
  2.  Khayat S et al Complement Ther Med. 2015 Jun;23(3):318-24  Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial
  3. Hanai H, et al  Clin Gastroenterol Hepatol. 2006 Dec;4(12):1502-6   Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial
  4.  Devassy JG, et al  Nutrition Reviews, Volume 73, Issue 3, 1 March 2015, Pages 155–165.  Curcumin and cancer: barriers to obtaining a health claim

 

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Surviving Menopause: Hormones, Herbs, and More

Woman practicing yoga for self-care

A common question from patients is: “Should I take herbs or hormones for menopausal symptoms, and if so, which ones?”

This is a huge topic and the truth is there is no “right answer.”

Treating menopausal symptoms needs to be based on each woman’s unique situation accounting for her personal history, family history, current health goals. Without question, estrogen replacement is the most effective treatment for hot flashes and other menopausal symptoms.

While hormone replacement isn’t for everyone, there IS a lot of buzz right now around bioidentical hormones. For you to make an educated decision, it’s important to understand the difference between bioidentical (often compounded) and non-bioidentical hormones (conventional), and when you might consider using them.  In my upcoming talk at Blum Center, and further down in this blog, we will review all of this information.

But, not everyone wants to take extra hormones or can’t take hormones for health reasons.  Well, hope is not lost!  I will review several herbal remedies and lifestyle changes that women can use successfully.  This is a meaty topic, so let’s dive in!

“Hot Flashes?  No Hormones?  No problem!”

Many women come to me seeking strategies to address things like hot flashes, vaginal dryness, sleep disruption, and mood changes without hormones. In this case we have SO much to offer. Conventional medicine offers several antidepressants that have been found to work for hot flashes: paroxetine and venlafaxine are some examples. Gabapentin is another option.  Unfortunately, these drugs do tend to have other unwanted side effects such as sleepiness, headache, nausea, dizziness, and more. Rest assured, this is NOT our approach at Blum Center!  You don’t have to take an antidepressant to get you through menopause!

Here are just a few of the options that we can offer you:

St. John’s Wort has been shown in multiple studies to improve women’s sense of wellbeing, decrease hot flashes, improve sexual wellbeing, and reduce overall menopause rating scores (Grube, 1999 and Abdali , 2010).  Studies show that improvement was seen after 2-3 months and dose is typically around 300 mg taken three times a day.  St. John’s wort is metabolized in the liver and can interfere with the metabolism of many other drugs, so always tell your doctor if you are taking it.

Panax Ginseng has been shown to improve menopausal symptoms of depression and well being, increase energy, decrease insomnia (Wiklund, 1999 and Tode, 1999).  The dose is typically a standardized extract of 200mg a day.

Sage has been shown to decrease sweating by up to 64% in women who have hot flashes (Bommer, 2011).  If you are using dried leaf in capsule or tea take 1000mg twice a day.

Soy, Red Clover, Kudzu all contain various isoflavones such as daidzein, genistein, and puerarin. These compounds act as weak estrogen receptor modulators. Data on isoflavones for hot flash relief is mixed. Some studies show a benefit, others do not.  The tricky thing about some of these compounds, like daidzein, is that it turns out your gut bacteria have to convert it into equol to have the biggest impact. But it is estimated that only 30-50% of humans are “equol producers.” This may account for why soy seems to help some women more than others when it comes to hot flashes.My suggestion is to try it for about a month and if you see no improvement then stop. For soy, I would rather see patients eat whole, organic soy foods such as edamame, tofu, soy milk instead of taking a pill. Food is always better than supplements and foods with whole soy proteins (not soy protein isolate) are better for you. As always, any food or herb that has estrogenic qualities, you must use with caution in the setting of an estrogen-related cancer. Additionally, soy in large quantities (three times a day) can impact your thyroid function, so ask your doctor if you need to limit it. Also, these could interact with platelet/anticoagulant medicines.

Black Cohosh has shown mixed results in studies for menopausal symptoms. Many studies look at Black Cohosh along with a few other herbs. This is common practice in botanical medicine, taking advantage of the synergistic effects that herbs can have when taken together. It does make it more difficult to know if individual ingredients are beneficial. Black Cohosh is generally well tolerated and I mention it because it shows up in a lot of supplements that are geared for women’s health, menopause in particular. It is unclear if Black Cohosh directly interacts with estrogen receptors in humans, but to be on the safe side, I would avoid this one if you are an estrogen receptor positive cancer.

Clinical Hypnosis can decrease hot flashes by 55% compared to 13% in one well designed randomized study of 187 women (Elkins GR, 2013).  Hypnosis also helped with improvement in hot flash interference, sleep quality, and treatment satisfaction.

Acupuncture has been shown in multiple studies to improve sleep disruption (Chiu, 2015).  Researchers did a summary review of 31 studies involving over 2400 patients and found there was significant improvement in sleep as well as changes in blood hormone levels of estradiol and follicle stimulating hormone. And the larger the hormonal changes, the bigger the improvement on sleep. Data on acupuncture for hot flashes, however, is mixed. It appears that when acupuncture is compared to no acupuncture, there is a significant improvement seen. But when researchers compare real acupuncture with sham acupuncture, they don’t see a difference. This indicates that at least for hot flashes, acupuncture probably has a strong placebo effect. In my opinion, when the placebo effect works in our favor, it is a wonderful thing and I think we should take advantage of it!

Yoga has also been shown to be beneficial for hot flashes and emotional symptoms like stress in multiple studies (Joshi, 2011 and Chattha, 2008). Yoga has so many health benefits that I recommend it to almost all of my patients. In this fast-paced world, the practice of yoga slows down our sympathetic nervous system which is integrally involved with hot flashes. One caveat: I don’t recommend hot yoga as that will most assuredly make hot flashes worse!

“I’m Fine with Hormones – Bring Back the Estrogen!”

There has been a lot of research in the past few decades looking at hormone replacement for menopausal symptoms and the field is constantly growing. As with most medicines, there are risks and benefits to consider when deciding if you want to take hormones and it is important to have that discussion with your healthcare provider, or come and see me to discuss, because your personal and family history influences this decision enormously. In general, we do believe that hormone replacement therapy, especially bioidentical therapy, in low dose for the first few years of menopause is safe for most women.

My approach?  I always use bioidentical hormones and aim for the lowest effective dose, and prefer topical or local estrogen to limit unwanted effects.

“Bioidentical, Synthetic, I’m Confused…”

Bioidentical hormones are compounds that exactly mimic the hormones that we have circulating in our bodies. Those bioidentical hormones may be synthetic, in the sense that they were made in a lab, and that is not necessarily bad. Two of the most common hormones prescribed in this country are not bioidentical: conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA). These compounds act similarly to our own estrogen and progesterone, but nevertheless, have actions in our bodies that are distinct.

Historically, we assumed that CEE and MPA would be equivalent to bioidentical hormones, but as researchers have begun to compare the two in head-to-head studies, we now know there are differences especially in the progestogens (Stanczyk, 2013). Consensus is now building that bioidentical progesterone is probably safer than MPA. Although CEE and MPA are the most commonly prescribed hormone replacement regimens in this country, there are plenty of FDA approved bioidentical options for us to choose from including estradiol pill, patch, or gel form as well as micronized progesterone in pill form.

“So What is Compounding?”

Compounding medicine is the practice of taking one or more individual ingredients and mixing them together in the lab and creating a new compound that isn’t otherwise sold as a brand name product. The new medicine can be specially formulated for an individual patient to avoid allergenic ingredients, create new doses, convert a pill to a cream, combine medicines into one, etc.

Having access to high quality compounding pharmacies is extremely valuable in expanding the range of pharmaceutical offerings to the public.  For example, one FDA approved bioidentical progesterone product on the market in the US. contains peanut oil which some women are allergic to. This is a prime example of when compounding progesterone is a life saver!

There are pros and cons to using FDA approved drugs vs compounding drugs. The advantage of using an FDA approved medicine is that the approval process is stringent in terms of demonstrating safety, appropriate dosing, and efficacy. Additionally, the FDA drugs and facilities are highly regulated. Also, since the majority of research has been done using FDA approved drugs, physicians feel more comfortable prescribing them as they have been thoroughly vetted in clinical trials.  [A side note: the drug companies are the ones that fund the bulk of research since they can afford to do so. It costs millions of dollars to carry out a large clinical trial and very few entities can fund those studies.] The disadvantage is that sometimes we might want to give a drug in a different form than is available. In terms of compounding, the advantage is the ability to tailor a medicine specific to the needs of an individual patient.  The downside is that there is not as much safety and efficacy data on individual formulas, nor as much regulation on the actual compounding pharmacies themselves.

My approach to menopause is to get to know my patient, figure out what her goals are for the menopause transition, determine her risk profile, and come up with the best treatment plan together.

Meet Dr. Fitz:  Bronwyn Fitz, M.D. is a board certified Obstetrician Gynecologist who is fellowship trained in Integrative Medicine. In her practice she melds traditional medicine with non-Western approaches, nutrition, botanicals, mind/body therapies and lifestyle interventions to help women address their gynecological and reproductive health concerns. Her interest in mindfulness and meditation led her to pursue a two-year Fellowship at The Arizona Center for Integrative Medicine, under the leadership of world-renowned Integrative physician, Dr. Andrew Weil.

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How Chasteberry Supports Women’s Health

Vitex agnus-castus, also known as Chaste Tree or Chasteberry is a powerhouse herb in women’s health. Indigenous to Central Asia and the Mediterranean, it has been used for thousands of years for menstrual irregularities, premenstrual syndrome, premenstrual dysphoric disorder, breast tenderness, infertility, and more. The Latin root: agnus castus means “chaste lamb” purportedly alluding to the ancient culinary use of Vitex (also “monk’s berry”) to curb libido in monks!   

Historical uses aside, what we DO know about Vitex is that it contains glycosides, flavonoids, essential oils, essential fatty acids (oleic and linolenic). It works at the level of the brain to decrease prolactin levels, increase progesterone levels, and bind opiate receptors — which might be how it improves anxiety, food cravings, physical discomfort associated with premenstrual syndrome (PMS). Vitex is approved by the German Commission E for use in menstrual cycle irregularities, premenstrual disturbances, and mastodynia (breast pain).

3 Reasons To Consider Taking Chasteberry

Do you have PMS?

There are multiple studies that validate chaste tree for gynecological problems including PMS. One well-designed study of 170 women compared Vitex to a placebo pill during three consecutive menstrual cycles and women who got the herb reported 52% improvement in symptoms compared to just 24% in the placebo group. Specific symptoms looked at in this study were irritability, mood changes, anger, headaches, breast fullness, bloating and ALL had significant differences between Vitex and placebo pills1.  

Heavy Bleeding

Many women suffer from heavy bleeding during their periods.  This can be especially true for women who have a copper containing intrauterine device (IUD). One prospective study of 84 women looked at Vitex compared to mefenamic acid (an anti-inflammatory medicine) to reduce heavy bleeding in IUD users over the course of 4 menstrual cycles. Researchers found that women in both groups had significant improvement in symptoms, 52% in the anti-inflammatory group and 46% in the Vitex group2. I look forward to seeing additional studies with more subjects and that include a placebo group to fully understand the role for Vitex.

Irregular Periods

Many women have irregular periods and are often prescribed progesterone to help regulate their period, either in the form of birth control pills or sometimes progesterone alone.  Since we know that Vitex increases one’s one progesterone production, it makes sense that we would use it to help regulate an irregular period. Additionally, chaste tree works by decreasing prolactin, which for some women is the culprit in causing too few periods. I always lean towards supporting your body’s ability to make its own hormones over prescribing additional ones, especially if the ones we give are synthetic progestins. After all, synthetic progestins (the type of progesterone in birth control pills) can cause side effects such as weight gain, bloating, acne, moodiness, hair loss: not what you are looking for when suffering already from period problems!

Chasteberry and Infertility: A Word of Warning

Some people take Vitex for infertility due to irregular periods since it increases progesterone. Adding progesterone during infertility treatments is quite common. The studies on Vitex for infertility are mixed, leaving us without firm conclusion that it will help you get pregnant. While historical use supports this approach, there is no safety data on Chaste tree during pregnancy or lactation. For these reasons, I do not recommend starting it specifically for fertility and I DO recommend stopping the herb if you become pregnant.  

How to Take Chasteberry

Chasteberry does take time to see full impact, so stick with it for at least three months before deciding if it is working for you.The dose is usually 200-500 mg a day of dried fruit or 20-40mg/d of extract standardized to agnuside or casticin. At Blum Center for Health, we use Chasteberry Plus, at the dose of 1 tablet in the morning and 1 in the evening, with or without food.  Because Chasteberry has an impact on your body’s hormone production, it is wise to avoid if you have a hormone sensitive cancer, are pregnant, or are nursing. It could potentially impact hormonal birth control. It could interfere with dopamine-related medicines, such as some medicines used in Parkinson’s and some antipsychotic medicines. Side effects are not common but include GI upset, headaches, fatigue, increase in menses, hair loss. Rarely women with a history of depression may see a worsening of their symptoms.  Before starting herbal remedies, if you are taking other medications or have any hormone related health issues, remember to always check with your doctor, or come and see me at Blum Center.

Live in our neighborhood and want to learn more about using herbs for women’s health? Make an appointment with Dr. Fitz!  In her practice at Blum Center for Health she takes a multi-pronged, holistic approach, a combination of medical and lifestyle considerations, to address, diagnosis and treat your condition. For more information, call 914-652-7800.

Meet Dr. Fitz:  Bronwyn Fitz, M.D. is a board certified Obstetrician Gynecologist who is fellowship trained in Integrative Medicine. In her practice she melds traditional medicine with non-Western approaches, nutrition, botanicals, mind/body therapies and lifestyle interventions to help women address their gynecological and reproductive health concerns. Her interest in mindfulness and meditation led her to pursue a two-year Fellowship at The Arizona Center for Integrative Medicine, under the leadership of world-renowned Integrative physician, Dr. Andrew Weil.

 

References:

  1. Schellenberg R BMJ. 2001 Jan 20;322(7279):134-7.
  2. 2. Yavarikia P, Shahnazi M, Hadavand Mirzaie S, Javadzadeh Y, Lutfi R. J Caring Sci. 2013 Aug 31;2(3):245-54.
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Herbs As Medicine: What You Need To Know

Herbs are used medicinally all over the world. For instance, morphine comes from the Poppy plant, aspirin comes from Willow Bark, digitalis comes from Fox Glove, taxol an important cancer drug, comes from the Yew tree. The list goes on.

It is ironic that doctors in the U.S. don’t learn about the healing powers of plants given that many powerful medicines are derived from plants. As a traditionally-trained Ob Gyn I was taught to prescribe a lot of medicine —  hormones, antibiotics, non-steroidal anti-inflammatories (NSAIDs), to name a few.

The problem is that many of these medicines have pretty hefty side effects.  NSAIDs are prescribed widely for menstrual pain and heavy bleeding, but prolonged use can cause GI bleeding. The three month injectable progestin shot, medroxy progesterone acetate (aka: “Depo”) works very well to prevent pregnancy, but at the expense of bone density.  It is well established that Depo users sustain a decrease in their bone density while taking the shot, but long term outcomes were not known until relatively recently.  According to a 2015 Cochrane review, we now we have evidence that postmenopausal women who took Depo in the past have increased risk of bone fractures.  

After practicing in the traditional model for many years, and being concerned about these types of side effects, I began to wonder, “what other choices do we have?”  This quest for more options to offer my patients led me to pursue an Integrative Medicine Fellowship, where I received extensive training in herbal medicine. I can tell you for certain that herbs are a wonderful addition, and sometimes replacement, for traditional pharmaceuticals.

3 Ways Herbs Outperform Standard Medicines

  1. Lower dose and less toxicity — The medicines I listed above — morphine, aspirin, digitalis and taxol — are all made from an active ingredient that has been isolated, extracted, purified, and packaged in a highly potent form. With high potency, comes increased risk of toxicity and side effects.  When you consume an herb in its natural form (root, leaf, bark) you are often getting lower doses of the active ingredient, which are often less toxic.  Still, even herbs can have side effects and can interact with other herbs and medicines that you might be taking.  It is important to be well informed about these potential side effects and interactions.
  1. Herbs are multi-faceted — Most medicines have one active ingredient whereas each plant has multiple active ingredients that work synergistically. There can be hundreds of distinct compounds in the plant that potentially contribute to its medicinal properties.  Sometimes these compounds work together to make the herb more efficient.  

For example: Red Yeast Rice, the fermented product of a fungus, Monascus purpureus, is known to contain monacolin K, which is lovastatin, a commonly prescribed cholesterol lowering drug. Many studies have proven that Red Yeast Rice also lowers LDL cholesterol by 30%. Some wonder how Red Yeast Rice, which has relatively low doses of monacolin K, can result in such great clinical outcomes when compared to the typical dose of lovastatin.  

Likely the answer resides in the fact that monacolin K is not the only compound in it.  Red Yeast Rice contains eight other monacolins, plus other plant compounds with beneficial health effects such as sterols, isoflavones and monounsaturated fatty acids.  

A word of caution: it is important to do research to find a reputable brand of herb to take because there is also the unfortunate practice of cutting herbal products with both active drugs (Red Yeast Rice can be spiked with lovastatin), heavy metals, or the opposite problem of not having enough active ingredient.  Working with a good Herbalist or Healthcare provider who is trained in herbs is essential.

  1. Less Side Effects — There are numerous examples of herbs that have fewer side effects than conventional medicines. St. John’s Wort (SJW) is a perfect example.  We often recommend SJW for mild depression. It has been extensively studied and found to be safe and efficacious. There is even a Cochrane Review (traditional medicine’s gold standard of evidenced-based medicine) that evaluated 29 studies of over 5,000 patients and concluded that SJW is more effective than placebo, as effective as other antidepressants with fewer side effects.  A word of caution, however: SJW can interfere with some medications (like birth control pills, antidepressants, coumadin, digoxin, cancer therapies, immunosuppressive agents) so ALWAYS check with your provider before taking it.  

Herbs are worthwhile additions to your medicine cabinet. Unfortunately, herbs are not well understood, particularly in places like the United States, where traditional medicine is the norm. Over the next few months I will be writing an informational series highlighting some of my favorite herbs for women’s health. Keep your eyes peeled!

Live in our neighborhood and want to learn more about using herbs for women’s health? Make an appointment with Dr. Fitz!  In her practice at Blum Center for Health she takes a multi-pronged, holistic approach, a combination of medical and lifestyle considerations, to address, diagnosis and treat your condition. For more information, call 914-652-7800.

Meet Dr. Fitz:  Bronwyn Fitz, M.D. is a board certified Obstetrician Gynecologist who is fellowship trained in Integrative Medicine. In her practice she melds traditional medicine with non-Western approaches, nutrition, botanicals, mind/body therapies and lifestyle interventions to help women address their gynecological and reproductive health concerns. Her interest in mindfulness and meditation led her to pursue a two-year Fellowship at The Arizona Center for Integrative Medicine, under the leadership of world-renowned Integrative physician, Dr. Andrew Weil.

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An Integrative Gynecologist’s Advice for Teens and Young Adults

Gynecological advice for teens

Making the transition from childhood into the teenage years and young adulthood is a tender time for most young women. Navigating the world of menstruation, sexual relations, sexual health, and even understanding how her body works, can create anxiety, wonder, excitement and, inevitably, loads of questions.  How can we best support young women as they make this transition? The answer lies with using a more holistic approach to Gynecology.

Traditional gynecology is solely focused on reproductive health. It can feel cold and medicalized no matter how warm the practitioner is. And, let’s face it, our reproductive system is only a small part of our entire body.

The Integrative (which includes Functional Medicine) approach to Gynecology focuses on the entire body. This holistic way of viewing a woman addresses nutrition, exercise, stress management techniques, and lifestyle choices, all of which positively sets up a young woman for a lifetime of excellent reproductive health. Often, all kinds of issues, like PMS, painful periods, and polycystic ovarian syndrome, can be treated using lifestyle approaches, either alone or coupled with herbs and supplements.

Perhaps the most important difference between me and a conventional gynecologist, is that when I start working with you or your daughter, my goal is to develop a relationship. It is important to create a partnership based on trust and respect in order to most effectively help you, the woman sitting in front of me. What are your goals?  These drive everything. I start with a detailed history, paying great attentiveness to your physical, mental, and spiritual well-being.

In creating a reproductive wellness plan I incorporate nutrition, exercise, mind/body techniques, supplements, and herbs.  I may recommend acupuncture, massage/manual therapies, energy work.  Of course, if birth control is desired also, we do include contraception with or without hormones. Again, it is co-created with you, and It all depends on your goals.

For a teenager or young woman an initial appointment often may not include a pelvic exam.  This is because, truthfully, many questions/concerns don’t require one.  Eventually we’ll get to an exam but first there is benefit in educating you about your own anatomy.

Often our first visit is just a “talk” visit.  I understand that there can be fear surrounding a pelvic exam. My belief is that we don’t need to do anything that is not necessary, especially if it is uncomfortable or anxiety provoking!  Even for mature patients, we are moving away from reflexively doing a pelvic exam at each visit because the evidence shows that it is not always necessary.  I would rather spend our time with education.

So many routines that are started in our youth carry forward.  What better time to take the steps needed to build your bones up, maintain your gut microbiome, establish food choices that support reproductive health and decrease the long term risks of cancer, diabetes, heart disease?  We also teach mind/body techniques like deep breathing, meditation that helps you to handle all the stress that our crazy world throws at us.  As a young woman, the sooner you learn to manage this, the better off you will be.  It’s also important for you to learn about how toxins in the environment, food, plastics, cosmetics impact your reproductive health.  If you take steps early in life to lower the toxic load, we can ensure your future wellbeing.

You can see that I believe strongly that if we can teach the young women of today the principles of nutrition, exercise, stress management and toxin avoidance, they will be a much healthier generation tomorrow!  And my goal is to help make that happen.

Would you like to learn more and live in our neighborhood? Join Dr. Bronwyn Fitz at Blum Center for Health on May 4th at 7pm for her free community talk, An Integrative Gynecologist’s Advice for Teens and Young Adults. Dr. Fitz will describe the Integrative approach to some of the common health concerns that face young women: irregular and difficult periods, birth control, HPV vaccination, sexually transmitted infections.  Register Now 

About Dr. Fitz:

Dr. Bronwyn Fitz is a board certified Obstetrician Gynecologist who is fellowship trained in Integrative Medicine.  In her practice she melds traditional medicine with non-Western approaches, nutrition, botanicals, mind/body therapies and lifestyle interventions to help women address their gynecological and reproductive health concerns. Her interest in mindfulness and meditation led her to pursue a two-year Fellowship at The Arizona Center for Integrative Medicine, under the leadership of world-renowned Integrative physician, Dr. Andrew Weil.

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Do You have Estrogen Dominance?

Estrogen Dominance

In Functional Medicine we often refer to the relationship between estrogen and progesterone as the “dance of the hormones” or the “hormone orchestra.”

Ironically, what sounds like a beautiful evening at the ballet often plays out each month as a real hand-banging, body-slamming cacophony!

So what gives?  Why is it that we often feel out of control, and sometimes out of body, for days at a time?

The answer could be Estrogen Dominance.

Here are typical symptoms that can be attributed to a relative excess of estrogen in relationship to progesterone:

  • irregular bleeding
  • mood swings
  • depression
  • water retention/bloating
  • painful breasts
  • hot flashes
  • heavy periods
  • painful periods
  • fatigue
  • brain fog
  • sleep disturbance

How did we get here?  Unfortunately, there are many roads that lead to estrogen dominance.  Let’s start at the beginning.

The Typical Menstrual Cycle

During a typical menstrual cycle, the first half of the month, known as the estrogen dominant phase, progesterone is relatively low and estrogen levels steadily rise. Due to some nifty feedback loops that involve the brain and other hormones, ovulation occurs at around Day 14, and an egg is released from the ovary.  During this second half of the menstrual cycle, estrogen levels fall somewhat and progesterone levels rise significantly. This is when progesterone takes the lead in our hormone tango.

5 Roads that Lead to Estrogen Dominance

  1. Irregular Ovulation — One road that leads to estrogen dominance is if ovulation doesn’t occur and progesterone doesn’t have the opportunity to take that lead. We see this type of problem in young girls who haven’t started ovulating regularly, and in peri-menopausal women who are close to the end of their ovarian reserve, and also aren’t ovulating normally.
  1. Any Type of Stress — Often stress can lead to skipped ovulation. Typically we think of extreme episodes of stress such as a severe illness, anorexia/malnutrition, intense athletic training. But commonly, your average woman who goes through a stressful time will notice that her period becomes irregular. Even long standing, chronic stress can take a toll on your female hormones.
  1. Foods and Food Packaging — In this day and age of genetically-modified, pesticide-laced, prepackaged food to go, we are constantly exposed to xenoestrogens. These are toxic chemicals that act like weak estrogens in your body. These nasty chemicals can be found in pesticides, plastics that our food comes wrapped in, that “to-go” coffee lid, even the lining of your canned goods and drinks.
  1. Cosmetics and Household Products — Other examples of endocrine disruptors are phthalates and parabens that are used in hygiene products, cosmetics, and fragrances. This is where women are potentially very vulnerable considering how many bath, haircare, cosmetic, nail, feminine hygiene products we use daily. These just add to your total estrogen “load” that your body sees on a regular basis and that your liver has to metabolize and detoxify.  It turns out that optimal liver function is very important in estrogen metabolism and clearance.
  1. Your Gut Flora — The gut microbiome and your gastrointestinal function is another major player in this hormonal dance that is now looking more like a square dance with all its moving parts. It turns out that the bacteria that reside within our GI tract plays a very important role in helping us eliminate our estrogen by-products once the liver has packaged them up nicely for excretion. Sadly, the average American diet, full of high fructose corn syrup and other inflammatory foods often keep our livers working over-time just trying to detoxify lunch, let alone efficiently remove spent hormones from our systems.  Obesity itself is a problem since estrogen is stored in fat cells.  The fact that 2/3 of Americans are overweight or obese points to how prevalent this form of estrogen exposure is.

As you can see, there are many, many influences that lead to Estrogen Dominance. It’s not just “the way you are.”

The great news is there is something you can do about it.

First, you don’t need to treat Estrogen Dominance with birth control pills!

While birth control pills may help alleviate symptoms, they do not solve the root problem, In fact, taking birth control pills to treat estrogen dominance could possibly lead to more longer-term problems. (There are other excellent uses for birth control pills, such as actual birth control, and it is important to understand a woman’s goals for her health when deciding how to treat her.)

As a fellowship-trained Integrative Medicine and Functional Medicine doctor, I attack this problem of Estrogen Dominance from many angles.  The truth is we have so many ways to help women feel better, without the use of medicine and surgery.  We can, and should, use food as medicine, weight loss, botanicals, mind-body modalities for stress management so that women can actually heal themselves.

About Dr. Fitz:

Dr. Bronwyn Fitz is a board certified Obstetrician Gynecologist who is fellowship trained in Integrative Medicine.  In her practice she melds traditional medicine with non-Western approaches, nutrition, botanicals, mind/body therapies and lifestyle interventions to help women address their gynecological and reproductive health concerns. Her interest in mindfulness and meditation led her to pursue a two-year Fellowship at The Arizona Center for Integrative Medicine, under the leadership of world-renowned Integrative physician, Dr. Andrew Weil.