What is Perimenopause and Menopause?

Perimenopause refers to the period before menopause when women’s bodies begin to decrease the number of eggs available, and hormone levels begin to change. The average age of perimenopause is 45, although it varies from woman to woman. Perimenopause lasts between 2 and 8 years. Menopause is defined as a woman not having her period for at least 12 months. In some cases a woman has her ovaries removed and goes into menopause immediately.

During perimenopause several hormonal changes occur. Follicle stimulating hormone (FSH) levels rise, estrogen levels decrease during the later stages of perimenopause and progesterone levels drop. Interestingly, estrogen levels are very high near menopause and then make a dramatic drop.

What symptoms may I see if I am perimenopausal/menopausal?

Menopause is a time in a woman’s life when many changes occur: physically, mentally, socially, spiritually and emotionally. It is a time when women are presented with options for dealing with the less appealing aspects of menopause. Symptoms vary widely and may include:

• Hot flashes
• Mood swings
• Insomnia
• Vaginal dryness
• Lowered libido
• Depression or anxiety
• Loss of memory
• Irregular bleeding/”missed” periods
• Urinary dysfunction.

What steps should I take to deal with the symptoms?

Each woman has a different and unique experience during perimenopause and menopause. Some have more debilitating symptoms, while other have very mild symptoms. However, no matter what your symptoms, age or medical history, each woman has an opportunity to improve her health during this phase of her life. Menopause is a great opportunity to embrace your changes and make steps to improve your life. Some preventive measures that women should be starting or continuing to incorporate into their lifestyles at this age are:

• An exercise program that is appropriate for your age and health which includes weight bearing and aerobic activities.
• Assessing your lifestyle habits that may be detrimental to your long term health including smoking, alcohol intake, saturated fat intake, sedentary lifestyle, unhealthy weight.
• Find a primary healthcare practitioner that you trust and are comfortable with, who takes time to address your concerns and discuss testing options such as bone mineral density testing and blood tests. Ensure that you get a complete annual physical exam. Request that your practitioner explain pros and cons of treatment and preventive options with you.
• Maintaining adequate dental health. It has been shown that having healthy teeth and gums is a good indicator for overall health.
• Beginning to consider how you can prevent developing osteoporosis, heart disease and age-related diseases.

How can a naturopathic doctor help me during this phase of my life?

Each woman is faced with the task of deciding which direction to take her health. There are many options for a more holistic, natural approach to perimenopause, menopause and menopausal symptoms. Each woman is unique, and her healthcare should be too, especially during this phase when there are so many things to consider. There are controversies surrounding hormone replacement therapy and your naturopathic doctor can help to assess your needs and discuss natural alternative options with you. In addition, it is important to assess a woman’s risk of diseases such as cardiovascular, osteoporosis and age-related cancers. Together with your naturopathic doctor a comprehensive plan can be found to decrease the side effects of menopause and increase your health in this phase of your life.

What should I know about holistic preconception care?

When a woman is ready to become pregnant, there are many ways in which she can better prepare her body for the coming changes. Pregnancy is a very exciting time in a woman’s life! The time before pregnancy is also an ideal time to maximize health in order to increase fertility and improve the chances of having a healthy baby. Ideally a woman will visit a naturopathic doctor several months before she begins to try to get pregnant. Through a thorough intake and individualized treatment plan, naturopathic doctors can offer a comprehensive pre-conception plan for moms-to-be. Some options included in the treatment plan may include:

• Increased awareness of fertility and assisting women in tracking their menstrual cycles.
• Detoxification to assist in decreasing any toxic load before the baby is due in order to decrease the chance of toxins being passed to the fetus. Detoxification may include saunas, skin brushing, liver support and heavy metal testing.
• Nutritional counseling. Everyone has heard someone say “Now you are eating for two”. And this is true so wouldn’t it be ideal to eat healthfully and appropriately for two?! Through a detailed look at your diet and any food sensitivities you may have, an optimal pregnancy-preparatory diet can be determined and your naturopathic doctor can assist you in incorporating these changes into your life.
• Determine hormonal balance in order to maximize fertility and ease of pregnancy.
• Stress management and lifestyle counseling. It is ideal to maximize your coping mechanisms and decrease stress before you are pregnant. Your naturopathic doctor can assist you in addressing your sources of stress and ways in which to alleviate it. In addition, this is a great time to address the ways your environment is affecting our health.

How can I make my pregnancy as healthy and easy as possible?

During your pregnancy, it is necessary to increase certain vitamin and minerals to meet the needs of your growing fetus. By increasing your caloric intake, and meeting appropriate protein and fat requirements, you will optimize the health of your baby as well as your health during pregnancy, labor and postpartum.

During your pregnancy, you may experience some symptoms such as increased blood pressure, gestational diabetes, decreased venous return, morning sickness, heartburn and constipation. While these symptoms are quite common, there are natural options to help relieve them as well as preventing them from recurring. Later on during the pregnancy, naturopathic medicine can offer support for preparing for labor, including providing options for turning a breech presenting baby.

It is important to note that during pregnancy (and breastfeeding since your baby will essentially be “eating” what you are eating) that there are many natural therapies that you will want to avoid, similar to certain prescriptions. Western herbals have potent effects on the body. And while some medicinal herbs are ideal for dealing with the effects and changes of pregnancy, others may be dangerous to you or your developing fetus and should be avoided. Some commonly used herbs that should be avoided in pregnancy are listed in the downloadable form below. This list is by no means exhaustive. In general, using medicinal herbs during the first trimester is not recommended. If you do wish to use herbal medicines during pregnancy, you should consult an informed health care practitioner before you start.

Should I see a naturopathic doctor after I deliver my baby?

After you have delivered your baby, naturopathic medicine can further assist you with building up your strength, optimal dietary advice for breastfeeding as well as offering support for your newborn baby. Pregnancy, labor and breastfeeding can be an exciting time, however, your energy levels may be decreased. Naturopathic medicine can offer a woman exceptional support during this time.

What is infertility?

Infertility is defined as the inability to conceive after one year of regular intercourse without birth control. It affects one in 6 women in Canada. Infertility may be due to the male partner, female partner, or a cause may not be determined. Common causes of female infertility are increased age, hormonal irregularities, ovulation disorders, endometriosis and polycystic ovarian disease.

How can naturopathic medicine help?

Naturopathic medicine can assist with improving your odds of getting and staying pregnant in most cases. With a thorough intake of your concerns, a complete physical exam, an analysis of any lab tests you may have had, and a good understanding of your menstrual cycle, we can explore a variety of avenues. Ideally, and when appropriate, the man and woman will both explore how naturopathic care can assist them with fertility.

Each case of subfertility is considered individually. All patients and all couples are unique and therefore, their treatment plan is unique as well, tailored to their concerns and situations. Treatment options include:

• Nutritional counseling to ensure adequate vitamins and minerals necessary to support conception and pregnancy. In addition, this is a good time to identify food sensitivities and allergies in order to minimize stressors in your body, which may be contributing to infertility.
• Detoxification through gentle, supervised methods. In addition to supportive homeopathic and botanical medicine, women can decrease their toxic load substantially through regular saunas (when appropriate), dry skin brushing and choosing organic food. Depending on your individual situation, we can decide on a plan to eliminate/ cut down on environmental toxic exposure in order to decrease the toxins in your body.
• Chinese medicine and acupuncture are very often indicated for women who are experiencing difficulties conceiving. Acupuncture has been shown to increase blood flow to your uterus and balance hormonal regularities, which may be contributing to infertility. Acupuncture can be timed carefully to assist with successful IVF (in-vitro fertilization) or IUI (intra-uterine injection) if these are options you are considering.
• Lifestyle counseling may include assessing any lifestyle factors that may be contributing to your infertility. Smoking, alcohol intake, exercise and weight (high or low) are just some examples of lifestyle habits that may contribute to infertility. It is important to support couples in identifying and changing any lifestyle habits that may be coming in the way of conceiving.
• Fertility awareness and fertility signs tracking is one option we have for determining your most fertile days in a way that is non-invasive, inexpensive and accurate. No two cycles are alike, and women vary greatly in cycle length, ovulation day and fertile days. This process will assist you in determining exactly what is going on during your own unique cycle.

Can visiting a naturopathic doctor help with Assisted Reproductive Technology?

Yes! Naturopathic medicine can be a complementary supportive therapy that can improve the success of assisted reproductive technologies (ART) such as IUI and IVF. Chinese medicine and acupuncture have been shown to support ART in the following ways:

• Increased number of follicles resulting in increased number of eggs and increased fertilization rates in IVF
• Increased blood flow to the uterus resulting in a thicker endometrial lining
• Regulating hormones and the menstrual cycle
• Decreased number of miscarriages
• Improved semen analysis in males
• Stress reduction and management

Whether you are only beginning to explore your fertility or you have been faced with the challenge of infertility for some time, an holistic approach to your concerns can offer both an alternative to IVF and IUI and an adjunct to these treatments.

What is it?

Polycystic ovarian syndrome (PCOS) is a very common condition in women, with as many as 9-10% of women experiencing it. During normal menstruation, several follicles develop in your ovaries. One matures and is released, which is called ovulation. The other follicles degenerate. However, with PCOS, these follicles are larger than normal and may clump together and are called cysts. When these cysts cause hormonal imbalances and other symptoms, this is called PCOS. Symptoms of PCOS include:

• Hirsutism (excessive body and facial hair)
• Acne
• Obesity
• Infertility
• Insulin resistance
• Irregular menses

How is it treated?

Conventional medicine often uses a combination of birth control drugs and anti-androgen drugs as a first-line treatment for PCOS. However, there is a more natural way to treat PCOS, and that is through an individualized treatment, where the cause of the symptoms is explored with the patient. PCOS is a complex disease, with many different causes. Some common causes of PCOS are: genetic predisposition, hormonal imbalance, environmental toxic buildup and insulin resistance.

A holistic approach to PCOS includes treating the cause of the disease. Treatment options for PCOS includes:

• Dietary and Nutritional supplementation to ensure that any nutritional imbalances are addressed. If someone is experiencing insulin resistance associated with PCOS, nutritional support will likely be part of the treatment plan.
• Botanical Medicine to address any hormonal imbalances that may be present and contributing to PCOS.
• Chinese medicine to address the root cause of the problem including hormonal imbalances and menstrual cycle irregularities.

Chronic yeast infections

Many women suffer from chronic yeast infections. Yeast infections are most commonly due to an overgrowth of the species Candida albicans. Yeast infections are often a symptom of a systemic candida problem, low immune system or damaged intestinal tract and dysbiosis. Yeast infections are also common in women who have a history of antibiotic use, nutrient deficiencies and birth control pill use. Yeast infections are characterized by:

• Discharge which may be cottage cheese-like or may be watery
• Vaginal and vulvar irritation, swelling and inflammation
• Redness
• Painful intercourse
• Urinary discomfort.

Treatment

In order for treatment to be effective, women must address the root cause or yeast infections will return. This is why women who experience yeast infections often have them recur. Over the counter antifungals may alleviate the symptoms, however they do not address what is causing the symptoms, and therefore do nothing to prevent recurrence.

Natural and holistic treatment of yeast infections should be focused on:

• Eradicating the yeast overgrowth
• Addressing the root cause
• Repopulating the vagina and, if necessary the intestines with “good” bacteria.

By identifying and treating the root cause through a holistic, comprehensive and individualized treatment plan, it is possible to eliminate recurrence of yeast infections. Treatment for yeast infections varies between individualized because several different factors may be causing them. Nutritional and dietary changes are generally necessary to effectively treat and prevent recurrent yeast infections. Dietary changes generally include decreased sugar intake, eliminating dairy, eliminating yeast-containing foods and identifying and eliminating food allergens. In addition, natural methods for acutely eradicating the yeast should be addressed to relieve symptoms and discomfort.

Cervical dysplasia

Cervical dysplasia is the development of “abnormal cells” in the cervix (lower end of the uterus). It is often regarded as a “precancerous” state, which means that if left untreated may develop into cancer. Women are tested for cervical dysplasia through the Pap smear, or more recently the alternative thin prep test. If abnormalities are present, there is a grading system which indicates the degree and seriousness of abnormality.

Who is at risk?

Risk factors for women include:

• History of multiple sexual partners
• Age of first intercourse < 18 years old
• History of Human papillomavirus (HPV) or herpes simplex II (HSV-II)
• Cigarette smoking
• Oral contraceptive use
• Nutritional deficiencies

Treatment

Treatment of cervical dysplasia depends on the underlying cause and the grade or stage of the abnormalities. Conventional treatment of cervical dysplasia includes: cryotherapy, laser therapy, excision, cone biopsy or hysterectomy. If the changes are mild, then physicians may recommend repeat diagnostic tests to monitor the changes. Holistic treatment includes addressing nutritional deficiencies and dietary factor, improving the immune system, and addressing any lifestyle habits that may be increasing your risk (ie smoking).

Endometriosis

Endometriosis is the development of endometrial deposits outside of the uterine cavity. There is a typical set of three symptoms called the “triad” which include:

• Dysmenorrheal (pain with menses)
• Dysparunia (painful intercourse)
• Infertility.

There are several causes that have been theorized about the development of endometriosis, including immunological causes, environmental triggers, hereditary, hormonal imbalance and IUD use.

How is it diagnosed and treated?

Typically endometriosis is diagnosed by signs and symptoms, as well as ultrasound, bimanual examination and laparoscopy. Conventional treatment depends on the severity of disease and includes surgery and pharmaceuticals including the birth control pill and other hormonal drugs. Unfortunately there is a high recurrence among women undergoing surgery.

Holistic treatment aims to optimize estrogen metabolism, support the liver, enhance immunity and provide pain relief. These goals are accomplished with dietary manipulation, nutritional supplementation, botanical medicine and Chinese medicine. Therapies such as hydrotherapy and homeopathy are helpful as well.

Uterine fibroids

Uterine fibroids are quite common and generally a benign abnormal growth of uterine tissue. They are believed to be estrogen-dependent, meaning that their growth is stimulated by estrogen. Groups most likely to develop fibroids are women in their child-bearing years, African American women, obese or overweight women and nulliparous (never had children) women.

Signs of uterine fibroids range from none to more severe and include: heavy bleeding, bleeding between periods, high frequency of urination, painful intercourse and infertility.

Treatment for uterine fibroids includes dietary and nutritional supplementation. Ensuring optimal liver function in order to maintain estrogen metabolism is crucial. In addition, avoiding exogenous estrogens such as the birth control pill and HRT is important. Women who want to prevent uterine fibroids should ensure they have regular menses and ovulation. If you are concerned with an irregular cycle, you can contact a naturopathic doctor. Naturopathic doctors are able to offer supportive therapy such as Chinese medicine, botanical medicines and dietary advice to assist with regulating your menstrual cycle.