OB/GYN Issues

Irregular Menstrual Bleeding

Heavy menstrual bleeding (which may include clots of blood) or bleeding that occurs outside the normal cyclic menstruation is referred to as abnormal or irregular uterine bleeding. Irregular uterine bleeding is a common gynecological problem, but a thorough assessment is important to help diagnose the cause.

The most likely cause for any woman depends on whether she is premenopausal, perimenopausal (near menopause), or postmenopausal. Some causes include hormonal imbalances particularly low progesterone or estrogen levels, pregnancy or complications with pregnancy, the use of oral contraceptives, uterine fibroids, endometrial polyps, infection, and, more rarely, precancerous or cancerous growths. Infrequently, bleeding that seems to be coming from the vagina may actually come from the urinary tract or gastrointestinal tract. For severe bleeding without an obvious explanation, ask to be screened for von Willebrand disease, especially if you have a history of other bleeding problems. Fibroids can cause heavy, longer periods, sometimes with cramping and clots. More commonly, this occurs when the fibroids are submucosal and impinge on the uterine lining. Such periods are usually not irregular.

Depending on the cause of the irregular menstrual bleeding, many natural treatments such as dietary counseling, nutritional support, herbal medicine, bio-identical hormone therapy and acupuncture can help regulate the flow and timing of uterine bleeding. According to Chinese Medicine, irregular menstrual bleeding is a result of excess heat in the blood that can be treated with acupuncture and herbs.

Irregular Menstrual Cycles

Menstrual cycles generally occur every 28 days and are considered abnormal when they consistently occur less than 21 days or more than 35 days or more than three periods are missed in a row. Examples of menstrual irregularities are amenorrhea and oligomenorrhea.

  • Amenorrhea is a condition in which a woman’s periods have stopped completely. The absence of a period for 90 days or more is considered abnormal unless a woman is pregnant, breastfeeding, or going through menopause (which generally occurs for women between ages 45 and 55). Young women who haven’t started menstruating by age 15 or 16 or within three years after their breasts begin to develop are also considered to have amenorrhea.
  • Oligomenorrhea refers to periods that occur infrequently.

Many factors can affect menstrual regularity such as stress, significant weight gain or loss, travel, infections, poor diet, nutrient deficiencies such as iron deficiency anemia, and hormone imbalance associated with premature ovarian insufficiency, luteal phase defect, pituitary disorders polycystic ovarian syndrome, peri-menopause, menopause, and thyroid disorders. Medications such as oral contraceptives, hormones and steroids may also cause menstrual irregularities.

A thorough medical work-up that includes history taking, physical exam, laboratory testing, and imaging helps identify the causes of menstrual irregularity. Treatment recommendations with dietary and lifestyle counseling, herbal and nutrient supplementation, bio-identical hormones, stress management, and acupuncture and Chinese herbal medicine are offered by our practitioners to help effectively restore menstrual regularity and healthy hormone balance. Acupuncture can help balance the menstrual cycle, regulate the menstrual flow and ease pain. From a Chinese medicine viewpoint, the Liver and Kidneys meridians and organ systems are responsible for regulating the menstrual cycle. Stress can disturb the flow of energy in the Liver meridian and overwork and busy lifestyle can deplete the energy of the Kidneys which will in turn lead to irregularities of the cycle. Acupuncture can help restore energy and blood flow associated with these energy systems to regulate menstrual cycles.

Polycystic Ovarian Syndrome (PCOS)

PCOS is the most common endocrine disorder to affect women of reproductive age, affecting 1 in 15 women worldwide. Although classic PCOS presents with obesity, polycystic ovaries or multiple ovarian cysts, elevated androgen hormone levels and irregular or anovulatory cycles, many patients with PCOS experience varying symptoms and health issues that do not consistently fit the classic PCOS picture. The signs, symptoms, and health risks associated with PCOS include:

  • Absent period
  • Anovulatory cycles
  • Irregular menstrual cycles
  • Mid-cycle bleeding and/or heavy menstrual bleeding
  • Alopecia (balding)
  • Hirsutism (excessive body hair)
  • Acne
  • Acanthosis nigricans – a darkening of the skin in the armpits, back of the neck, or groin
  • Polycystic ovaries
  • History of ovarian cysts
  • Mood disorders
  • Obesity
  • Recurrent Miscarriage
  • Infertility
  • Possible increased risk for endometrial and breast cancer due to estrogen dominance
  • Cardiovascular disease
  • Type 2 Diabetes
  • Gestational diabetes

PCOS is due to insulin resistance but the exact cause is still unclear. Scientific research suggests there may be a genetic link, possible abnormal fetal development and inflammatory response contributing to the cause. PCOS is also negatively affected by diet, lifestyle and exposure to certain environmental toxins.

Insulin, released by the pancreas in response to dietary intake of carbohydrates and sugar and stress which triggers an increase cortisol and blood glucose is a hormone that is essential for absorption of glucose and metabolism of carbohydrates, lipids and proteins. Insulin resistance occurs when the body’s cells become resistant to the effects of insulin, disrupting metabolism and glucose regulation and causing insulin and glucose levels to be elevated. Insulin also signals the ovaries to secrete testosterone and inhibit hepatic sex-hormone binding globulin (SHBG) production which leads to an increased level of circulating testosterone. Excess insulin in the bloodstream also signals the ovaries to release more estrogen which can suppress ovulation. Women whose mothers, sisters or grandmothers had PCOS are at a higher risk for developing PCOS. Research suggests that exposure to excessive amounts of male hormones (androgens) by the developing fetus may alter proper gene expression, which may cause PCOS during the reproductive years of a woman’s life. In some predisposed people eating inflammatory foods such as processed foods, sugar, hydrogenated oils, gluten and dairy or exposure to certain environmental factors may trigger an inflammatory response, which may contribute to insulin resistance and atherosclerosis.

Effectively addressing PCOS begins with thorough laboratory testing and imaging to assess hormone abnormalities, lipid, insulin and glucose imbalances, thyroid and adrenal gland function and ovarian health. Female and androgen hormones such as FSH, LH, progesterone, estrogen, testosterone, Dehydroepiandrosterone sulfate (DHEA-s), prolactin and SHBG are tested. If needed environmental toxicity and food sensitivity testing are helpful to identify causes of inflammation. A naturopathic approach to treating PCOS involves a low glycemic and anti-inflammatory diet to balance hormones, insulin and glucose and to reduce inflammation. Nutritional and herbal supplementation to improve insulin sensitivity and hormone balance is also essential to treating PCOS successfully. Acupuncture and Chinese herbal medicine, scientifically shown to improve ovulation, regulate menstrual cycles, reduce inflammation, calm the nervous system to buffer the effects of stress, and enhance fertility are also highly recommended.

Perimenopause and Menopause

Perimenopause is also known as menopausal transition and may begin at different ages typically during the 40’s but may occur as early as the 30’s with signs of irregular menstrual cycles and bleeding. Menopause is the cessation of menstruation in women, which commonly occurs from the late forties to early fifties. Menopause is diagnosed when women are without a menstrual period for six to twelve months. Menopause is a natural transition which many hormonal changes occur, particularly a drop in estrogen and progesterone and increase in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Some women experience such signs and symptoms as hot flashes, night sweats, insomnia, palpitations, depression and anxiety, loss of memory, poor concentration, vaginal dryness, headaches, and decreased sex drive. Women who are in menopause are at higher risk for developing osteoporosis, heart disease, and Alzheimer’s disease. Consulting with a qualified naturopathic doctor is recommended to properly screen and prevent for these conditions.

There are numerous natural solutions for preventing and treating menopause that help to balance hormonal changes. Studies have shown that a nutrient-dense, healthy diet and regular physical activity can reduce hot flashes. Nutrient therapy, botanical medicine, and bio-identical hormones are also very effective for reducing menopausal symptoms.

Acupuncture is also a promising treatment for reducing hot flashes and night sweats. According to Traditional Chinese Medicine, menopause is mainly due to a deficiency of the kidneys. The kidneys are responsible for growth, maturation, and aging and can be affected by excessive stress, overwork, poor diet, and frequent pregnancies and births. A deficiency of kidney-yin is directly related to symptoms and complications of menopause. Acupuncture and Chinese herbal medicine helps to replenish kidney energy and helps ease the transition into menopause.

Premenstrual Syndrome

Premenstrual Syndrome is a recurrent condition experienced by women during the second half of the menstrual cycle. Typical symptoms include fatigue, anxiety, mood swings, irritability, depression, headache, breast tenderness, low back pain, abdominal bloating, food cravings, and swelling of fingers and ankles. No clear cause has been identified, however hormonal changes likely contribute to PMS symptoms.

Our natural treatment approach for PMS is comprehensive, incorporating proper nutritional intake and dietary changes, regular physical activity, botanical medicine, and acupuncture to help balance hormones, enhance serotonin and endorphin levels, and alleviate the symptoms of PMS.

In November, 1997, NIH’s Office of Alternative Medicine issued a consensus statement that reported that acupuncture is effective in the treatment of menstrual cramps, and some of the other symptoms of PMS. According to Traditional Chinese Medicine, PMS is very often due to blocked Qi (energy) and blood in the body. This blockage can manifest as emotional blockage (frustration, irritability, anxiety, tension, impatience) and/or physical blockage (pain, breast tenderness, water retention etc.). Acupuncture stimulates the circulation of Qi and blood throughout the body and helps to unblock the pathways of energy in our body by inserting tiny thin needles into specified acupuncture points.