Sunday, July 26, 2009

Are Those Pearls on your Ovary?

Polycystic Ovarian Syndrome (PCOS) is a problem of hormonal imbalance that creates sputtering ovulation and hyperandrogenism (too much male hormones, which causes increased male-pattern hair growth and acne). Most important in the diagnosis is exclusion of other causes, as no single lab result leads to the diagnosis. Over 6-10% of women have PCOS.

Other findings include multiple cysts on the ovary (called the “string of pearls” sign on ultrasound - see image below), overweight or obesity, high blood pressure, and acanthosis nigrans – a weird skin finding of darker, velvety skin on the back of the neck.

While the cause is unknown, we mostly consider PCOS to be a metabolic problem. About half of women with PCOS have high insulin levels (or hyperinsulinemia). Lowering insulin levels with exercise, eating low-glycemic foods, and other measures can correct erratic ovulation. Some of the natural therapies that have been shown to be helpful in PCOS include bioidentical progesterone use and cinnamon. Tieraona Low Dog, MD, showed in a small study published in Fertility and Sterility in July 2007 that cinnamon (0.5 teaspoon per day) lowers insulin resistance in PCOS.

I want to emphasize the role of exercise – it’s essential in PCOS, no exceptions! I recommend 30 minutes per day, 4 to 5 days per week, of cardio exercise at a minimum as the primary treatment.

One of the findings of PCOS is estrogen dominance – too much estrogen versus progesterone. Reducing estrogen levels can be very effective and I suggest the following measures:

• Meat/Dairy: avoid conventionally raised meat and dairy products, which contain growth promoters that act as xenoestrogens - these stimulate estrogen receptors in the body and disrupt normal hormonal signaling. Omnivores should choose organic products.

• Cruciferous Veggies: increasing consumption of cruciferous vegetables, such as broccoli and brussel sprouts, which increase metabolism of estrogens.

• Gluten-free: reducing gluten lowers your estradiol levels by 30% or more.

Finally, natural progesterone, prescribed and monitored by a knowledgeable provider, can also help balance estrogen dominance.

Women with PCOS are at greater risk of type 2 diabetes and metabolic syndrome, and should be additionally screened with glucose testing and a full fasting lipid profile.

Wednesday, July 15, 2009

Adrenals Burned Out?

Adrenal fatigue or dyregulation is the change in the ability of the adrenal glands to carry out their normal job. The main symptoms is fatigue, or in the case of hyperadrenalism, feeling tired but wired.

In response to chronic stress, many folks suffer from adrenal dysregulation, which can be either low production of adrenal hormones (hypoadrenalism) or high production, or a combo of the two. Many of my patients wake up in the morning with low cortisol, drink a cup of coffee to wake up, and then have high cortisol (coffee raises cortisol) and feel wired. Then they’re exhausted when the caffeine wears off by 2-4pm.

What causes adrenal fatigue? At Gottfried Center for Integrative Medicine, every case is individualized, but there are four common causes as identified by Dr. James Wilson:
  • Disease that overwhelm the body such as auto-immune conditions or cancer;
  • Physical stress such as poor nutrition, addiction (especially to sugar and/or flour), injury, exhaustion;
  • Environmental stress, e.g., toxic chemicals in air, water, clothing or food;
  • Emotional stress – usually arising from relationship, work or psychological sources.
Overlap with other hormone systems
Over 80% of people with adrenal dysregulation suffer from some type of decreased thyroid function. We often find that people who have both adrenal dysregulation and hypothyroidism do not get relief from thyroid replacement alone, and need adrenal support to get better. Dr. Marsha Nunley, MD, and Dr. Charlotte Massey, ND, L.Ac., are especially good at addressing both simultaneously. Dr. Nunley is available to coach patients who live outside of California, but you must visit her in Oakland to receive prescriptions.

We recommend saliva or blood testing to check your adrenal function. For your adrenal home test, order a diurnal cortisol test. Alternatively, ask your doctor to order a morning cortisol level in your blood. For your thyroid, we recommend TSH, free T3 and free T4 tests.

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I'm an organic gynecologist, yoga teacher + writer. I earn a living partnering with women to get them vital and self-realized again. We're born that way, but often fall off the path. Let's take your lousy mood and fatigue, and transform it into something sacred and useful.