New Review: Premature Ovarian Insufficiency

Reading this recent review - check it out.

Premature Ovarian Failure

Robert W. Rebar, MD

Premature ovarian failure is the term usually used to describe women aged younger than 40
years who present with amenorrhea, hypergonadotropinism, and hypoestrogenism. Such
women may ovulate and even conceive after the diagnosis is made, so it may be more
appropriate to refer to these patients as having “primary ovarian insufficiency,” or alternatively,
as having “hypergonadotropic hypogonadism” or “primary hypogonadism.” The clinical presen-
tation is diverse, and several different disorders can lead to premature ovarian failure. Affected
women should be investigated for premutations of the FMR1 gene (causing fragile X syndrome
in its fullest form) and for adrenal antibodies. Thyroiditis is the most frequent autoimmune
disorder associated with premature ovarian failure and should be ruled out as well. Osteopenia
is increased in women with premature ovarian failure, and measures to prevent accelerated bone
loss are warranted. Hormone therapy (HT) should be provided to eliminate symptoms of
estrogen deficiency and help prevent osteopenia, but will not necessarily (and inexplicably)
prevent pregnancy in the 5–10% of women who conceive spontaneously after the diagnosis is
made. There are no data indicating that these young women are at increased risk of side effects
from HT. If pregnancy is desired, use of donor oocytes with in vitro fertilization is most likely to
result in pregnancy.
(Obstet Gynecol 2009;113:1355–63)

Resolving Differences in Libido

Yesterday, I taught "Yoga for Restoring Energy & Libido" at Yoga Kula in Berkeley, and realized afterward that we didn't spend the 10-15 min I had prepared on how to resolve differences in desire, and sometimes, when needed, to compensate for both high and low libido when your libido is discordant than your partner's. Most partners have discordant libido, and how your find the middle path together is an essential part of a deepening, mature, mutually toe-curling sexual connection.

I mean "compensation" in the most loving, inclusive way -- such as how a kinesthetic learner would compensate for a class that requires visual learning, such as in Art History. I mean it with no judgment and no shame associated with it.

If you have low libido, I recommend a comprehensive medical exam, ideally with someone who is well-versed in hormones and their role in energy and libido. While causes for low libido such as adrenal dysregulation, fatigue, low testosterone, estrogen dominance, and underactive thyroid are described in previous blogs, as well as their natural solutions, I will focus here on the ways that have been shown to help bridge the divide if you have a partner with a higher or lower desire than yours, at least stronger than yours, and perhaps it's motivating you to do something about it.

For those with low libido:

1. Lean into your strength - Identify and fortify your sexual strengths. Even when desire is relatively low, often other aspects of your sexuality such as technique, variety, talking about sex, sensuality, romance, verbal intimacy or body image are areas where you are interested in putting more energy. For more info on this, and to perform a helpful survey to identify your sexual strengths and your partner's, read Pat Love's book, Hot Monogamy, esp pages 18-39, Mapping Your Sexual Relationship. 
2. Realize the power of receptivity. Recent thought leaders such as Rosemary Basson have recognized that spontaneous drive is common for men, and relatively uncommon for women. In fact, our most recent conceptual model shows that women do not need to have sexual desire or drive to have a satisfying sexual connection with their partner. Further, many women have difficulty distinguishing desire from arousal. Sometimes just a small opening in our receptivity to our partner's bid for sex can mean the difference between a mutually satisfying sexual connection and a connection that causes distress. 
3. Fan the fire when it strikes. Sometimes we have a small glimmer of interest in sex or sensuality, and the more we act on it, fan it, encourage it, the better. A crucial task here is to identify patterns in your life that are associated with greater libido: perhaps Friday or Saturday is a better day for you than during the week, maybe it's after your husband watched the kids while you went to a yoga or meditation workshop. Maybe it's day 9-14 of your menstrual cycle, when testosterone peaks.
   

For those with high libido:

1. Initiate sex out of love and desire, not habit. We often get locked into how sex needs to be, and breaking out of this habit will create more life and vitality in your connection. 
2. Improve technique. New expertise in love-making can go a long way in getting your less libidinous partner interested and receptive to your bid. We can always learn more and try new things. If you live in the Bay Area, attend a workshop at Good Vibes in Berkeley, or Celeste and Danielle's Become An Extraordinary Lover.  
3. Be respectful of your partner's parameters on sex. This requires verbal fluency in talking about sex, and how to optimize your partner's interest and openness to your bid. Ask your partner what some of their preconditions for sex are (kids are in bed and asleep, dishes are done, prefers sex in the mid-day), and do your best to satisfy them. 
4. Don't take your partner's lower libido personally. Many of us are just born with lower libidos - it's a bell-shaped curve. Find the way to negotiate a mutually satisfying plan for sex that honors your needs as well as those of your partners. Your partner's low libido is your issue as a couple - do not make your partner feel inadequate or that there is something wrong. 
5. Broaden your definition of sex. One brilliant sex therapist I love, Ruth Cohn, defines sex as "any erotic activity that is pleasurable, connecting, makes me feel good about me, good about you (my partner) and good about us." You can create your own list of what would now be defined as sexual activity, and it may include watching a romantic movie together while you hold hands and laugh together, or giving each other a massage and delighting in the pleasure of touch without it becoming sexual.

D1 of Our Group Cleanse -- Join Us

D1 of Cleanse. Join us virtually?

first step: remove caffeine over the next 7 days. if you're quite addicted to coffee or black tea, take it slow. best to first switch to black tea if you're a coffee drinker, green tea if you're addicted to black & white tea if you're into green. My fave substitute: warm cup of filtered water with fresh Meyer lemon & a pinch of cayenne. That and skin brushing in the morning (get your skin brush at Whole Foods) gets you going so you don't need the caffeine.

Know that caffeine INCREASES cortisol, anxiety & sugar cravings. And thickens your waist. And makes you retain fluid.

Get off caffeine completely for 14 days.

Are You Mercury Toxic?

Great post by Mark Hyman, MD, on mercury toxicity, in the Huffington Post. Read it right here. Then read Part 2.

Important stuff especially if you have kids or have symptoms of high mercury (fatigue, difficulty with weight loss, low libido, headaches, hair loss, etc).

Let NutrEval Rock Your World

Ever wondered how well you're absorbing your pile of supplements and plates of healthy, organic food? Curious what else you could optimize to feel even better? Here's a test for you.

NutrEval is the queen of tests -- I've started recommending it more regularly as I see the deep benefits it brings.  A combo of urine and blood tests, it's a comprehensive nutritional evaluation that identifies imbalances of vitamins, nutrients, and co-factors. You'll also discover if you have problems with bad bacteria in the gut (dysbiosis), how much Omega 3s and 6s you need, and assess for any detoxification problems particularly in the liver.

NutrEval is an ideal test when finishing a cleanse, such our recently sold-out January 2010 cleanse, or if you are just looking for more guidance in order to age gracefully.

You have to order the test through a doc (that's me), and I'm offering this test to any patients, yoga students or cleansers in our community.

To me, the amazing part is the cost. For now, the cost is $147 with most insurance companies (except Aetna, Humana, Kaiser, Principal & Tufts) while the street price is $1500. Genova banks on your insurance paying the difference and you will not be charged if they do not (that's why they call it "Pay Assured").  Just copy that insurance card and include it in the box.

The processing is a bit cumbersome and beyond the capability of most of our local blood draw centers (bless them), so I recommend springing for a to-your-door phlebotomist service run by Nathan Cron. He's a dream as is his team, and they will handle all those labels and complications that you can't be bothered with.

Three weeks later--make a 25 min phone appt. with me to review your dissertation on your health. Transformation will be yours.

Colcannon: Get Your Irish Kale On!

Colcannon is a yummy dish that hails from the Irish. Here is the version that my local nutrient-dense, community-sponsored kitchen, Three Stone Hearth, is putting on for us in honor of St Patrick's Day.

Willey Farm Yukon Gold potatoes are mashed with plenty of butter and Straus milk, then combined with sauteed Ibarra Farm green kale and yellow onions, minced scallions and parsley, salt and pepper, for this classic Irish side dish.

Recipe is Gluten-free and Contains Dairy.

Ingredients: Yukon Gold potatoes, kale, onions, Straus milk, scallions, parsley, butter, sea salt, black pepper

Making the Case for Pleasure

Today I was having one of those, "If only..." reveries. You know the type - if only we lived in Point Reyes and I didn't have to see so many patients, if only we didn't have to fret so much over meeting our bloated budget and retirement and could do the work we most love, if only I could teach yoga more, blah blah blah. It's a trap. Where we are is where we most can create abiding pleasure and contentment. Don't wait for things to change.

It's time to play. Thank you, Mae.

Here's the case for pleasure as articulated by Mae West.
I felt it was time to play. Most of my thoughts, time and energy had gone into creative effort. And this restriction of the love drive, the headshrinkers will tell you, is the greatest urge one really has. When one sublimates the sex drive info creative work it puts a person in high gear, mentally. I admit it. But it is against my nature to bottle up the biological plans of pleasure for any length of time. I hope I don't sound as if I have discovered the secret salve that soothes the universe, but I do want to add my small footnote on the subject.