Acupuncture treatment for fertility
Acupuncture and herbs have been used for years to treat many gynecological conditions. Acupuncture can improved ovarian and follicular function as well as increasing blood flows to the endometrium, helping to facilitate a thick, rich lining.
Length of treatment for fertility
Patients may be treated for two to six months before considering natural conception or assisted reproductive technology. Typically, about one to two treatments per week is required to have a therapeutic effect before progressing to insemination, in vitro fertilization (IVF), or donor-egg transfer.
Acupuncture protocol for IVF
In a study by Stener-Victorin et al from the Departments of Obstetrics and Gynecology Fertility Centre, Scandinavia and University of Gothenburg, women are encouraged to receive acupuncture treatments pre and post embryo transfer.
Common conditions treated with acupuncture
· Repeated pregnancy loss/miscarriages
· Luteal phase defect
· Hyperprolactinemia
· Polycystic ovarian syndrome
· Endometriosis
· Male infertility factors
Understanding Medications and Drugs for In Vitro Fertilization
By Karen Y. Gordon
In Vitro Fertilization is commonly referred to as IVF. IVF is the process of fertilization by manually combining an egg and sperm in a laboratory dish. When the IVF procedure is successful, the process is combined with a procedure known as embryo transfer, which is used to physically place the embryo in the uterus. There are basically five steps in the IVF and embryo. Monitor and stimulate the development of healthy egg(s) in the ovaries, collect the eggs, secure the sperm, combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth and finally transfer embryos into the uterus.
Fertility drugs are used to ovulate the ovaries by causing the production of numerous follicles and drugs may be given in a variety of combinations, which are called protocols. The physician determines the individualized specific treatment protocol for each patient.
Fertility drugs remain the primary treatment for women with ovulation disorders; some are taken orally and some are injected. In general, these medications work by causing the release of hormones that either trigger ovulation or regulate it. Even people using assisted reproductive techniques such as in-vitro fertilization, fertility drugs are still an important part of treatment.
With the standard IVF protocol, four types of fertility drugs may be given: Lupron a gonadotropin-releasing hormone (GnRH) antagonist, which acts on the pituitary gland to inhibit gonadotropin (FSH and LH) secretion and prevent premature ovulation. Ganirelix is a GnRH agonist and may be used instead of Lupron to control ovulation timing. Progesterone helps supports endometrial development and maintains early pregnancy. Gonadotropins are medications consisting of FSH alone or combined FSH and LH. They directly act on the ovaries to stimulate the development and maturation of the eggs. Human chorionic gonadotropin (hCG) known commercially as Pregnyl or Ovidrel, these medications act directly on the ovaries to cause the release of eggs from the ovarian follicles.
Down regulation or ovarian suppression with Lupron allows the physician to have greater control over ovarian stimulation, which provides for an even growth of ovarian follicles and prevents a condition known as premature luteinization. This is a premature attempt by your body to ovulate.
Lupron is administered subcutaneously, meaning underneath the skin and not into the muscle. This medicine is typically injected into the thigh and is easily self-administered. Lupron is usually given 10 to 14 days before ovarian suppression occurs, but may also be given earlier without affecting the ovarian stimulation. Approximately 10 percent of patients require longer than 10 to 14 days of Lupron to completely suppress the ovaries. The Lupron dose will typically be reduced in half once the stimulation phase of the cycle begins.
Ganirelix and Cetrotide are both gonadotropin releasing hormone (GnRH) antagonists that suppress the pituitary gland’s LH secretion by binding to the GnRH receptor. These act immediately to suppress pituitary LH secretion to prevent premature ovulation. Depending on the patient, the physician may decide to use one of these medications in place of Lupron. Ganirelix Acetate or Cetrotide is usually started after ovarian stimulation has begun, typically around stimulation day 6, or when the lead follicles are approaching 12 mm in mean diameter. Ovulation triggering is handled similarly to a Lupron cycle.
A menstrual period should begin within 7 to 14 days from starting the Lupron injections. The clinic should be notified when the period starts so that a baseline ultrasound and blood estradiol test can be scheduled. The purpose of these tests is to confirm that the Lupron has successfully suppressed the ovaries to a baseline state. Depending upon the results of these tests, the Lupron medication may be extended for another week and the patient may be asked to return for another sonogram and blood estradiol test. Occasionally an ovarian cyst aspiration may be performed for a persistent ovarian cyst.
After ovarian suppression has been achieved, ovarian stimulation using gonadotropin fertility drugs may commence at a scheduled time, which is referred to as the cycle start. These gonadotropin fertility drugs are continued throughout the stimulation phase of the cycle until hCG is administered.
The dose of gonadotropins will be based upon age, weight, number of follicles, cycle day 3 FSH and estradiol levels, and the response to previous stimulation cycles. The initial dose of medication will be taken for 2-3 days before returning to the clinic in the morning for an estradiol blood test. The dose of medication may be changed based upon the level of estradiol. Medication will usually be taken for two more days before for another estradiol blood test.
Studies have shown the estrogen administered during the luteal phase after egg retrieval improves pregnancy rates. It can be transdermal or oral routes. Estradiol levels are checked one week after embryo transfer and if levels are excessively high, the estrogen support is discontinued.
Sonograms are conducted starting on day 6 or 7 of the stimulation. In general, return follow-up sonograms and estradiol blood tests occur every one to three days to monitor the growth of the follicles. Patients will be asked to return more frequently toward the end of their ovarian stimulation. Most people require eight to 12 days of ovarian stimulation, thus necessitating four to six sonograms and estradiol blood tests.
When the follicles have met the criteria that indicate the eggs are mature, patients are instructed to administer hCG (Pregnyl or Ovidrel). In general, at least two follicles with a mean diameter of at least 18 mm and an appropriate estradiol level must be present before hCG is administered. Usually 5,000 to 10,000 units of hCG will be injected about 36 hours before the planned oocyte retrieval.
Administration of hCG is commonly called follicle triggering. The purpose of this medicine is to induce the final stages of oocyte maturation and the release of the eggs by the ovary. Timing the administration of this medication is extremely important and the physician/nurses instructions must be followed exactly.
There is a risk of multiple pregnancies when more than one embryo is placed into the womb. Carrying more than one baby at a time increases the risk of premature birth and low birth weight. It is unclear whether IVF increases the risk of birth defects. Side effects of fertility drugs include local reactions e.g. mild bruises and soreness at the site of injections. This is more common with HMG preparations than purified or recombinant FSH. There is also a small risk of a generalized allergic reaction.
Other drugs may cause headaches, mood changes, hot flushes and vaginal dryness in some women, etc. these are usually short-lived and are no cause for concern.
It may be possible for patients to develop functional cysts while on GnRH agonists regimes. These cysts may produce estrogen, and sometimes are associated with a poor IVF outcomes. If this happens, the patient will be advised to continue taking GnRH agonist drugs until the cysts resolve by themselves. Aspiration of the cyst may be required.
Traditional Chinese medicine has been found to be helpful in aiding patients through IVF process. Traditional Chinese Medicine has a very long history of helping infertile couples in China and all over Asia. In the last few decades TCM has helped the growing number of couples in the Western world who require assistance to have a child.
A large number of clinical trials have been conducted throughout the world which demonstrate that acupuncture can increase IVF pregnancy rates and reduce anxiety related to infertility and the IVF process.
TCM focuses on the overall health of the parents with special emphasis on the kidney-Qi (energy) and jing (essence) as the kidneys are in charge of reproduction and development according to TCM. Typically for patients undergoing IVF and other Assisted Reproductive technologies (ART), Chinese herbal medicine is not preferred because the drugs that they are given are very strong and have unpredictable responses.
Chinese medicine are used to increases the thickness and the quality of the lining of the uterus. It does this by promoting corpus luteal function in producing high levels of progesterone and increasing blood flow to the uterus. Patients who take Chinese medicine before and after egg pick-up during IVF have high progesterone readings.
The use of acupuncture has a very good effect and enhances IVF results. There is no restriction with its use. Acupuncture is useful in facilitating movement in the fallopian tubes and preventing spasm of the fine muscles in the walls of the tubes.
A recent study published in Fertility and Sterility found that 26% of women undergoing IVF became pregnant following the procedure compared to 43% who received acupuncture before and after IVF. This represents a nearly 50% increase in effectiveness of IVF combined with acupuncture. Women in both groups were matched for age, number of transferred embryos and number of previous cycles among other criteria. As IVF is an expensive procedure, increasing pregnancy rates with acupuncture could save women both money as well as decrease emotional distress associated with the repeated use of this procedure.
According to another study recently published in the journal Medical Acupuncture, acupuncture may stimulate egg follicle development in women undergoing IVF. In a small study of six women who all had difficulty with follicle production despite maximum hormonal therapy, three produced significantly more follicles with acupuncture treatment and all three conceived, although only one pregnancy lasted past the first trimester. Acupuncture also appeared to increase estrogen levels.
By combining conventional and natural medicine, patients could increase their chances for assisted reproduction to be successful, and for the pregnancy to result in a healthy baby.
Reference List
Luteal Phase Defect
By Karen Y. Gordon
A Luteal Phase Defect, also called “inadequate luteal phase” is described in western medicine as in terms of its symptoms such as shortened luteal phase or disrupted basal body temperatures. Generally we could describe that Luteal Phase Defect is a failure of the uterine lining to be in the right phase at the right time. Since embryo implantation is highly dependent on the state of the lining, Luteal Phase Defect can consistently interfere with a woman's ability to get pregnant and carry a pregnancy successfully.
In an ideal menstrual cycle, the body begins to produce follicle-stimulating hormone several days after the onset of menses. The increased levels of follicle-stimulating hormone result in the formation of a mature egg, containing follicle on one of the ovaries. When the follicle has adequately matured, a surge of luteinizing hormone is triggered.
This surge performs two interrelated functions. First, it prompts the follicle to burst and release the egg into the fallopian tube, where fertilization may take place and as the follicle begins to refill after bursting, the increased levels of LH cause the fluid inside the follicles to change into a thicker yellowish substance. This resulting structure is now called a corpus luteum rather than a follicle, and it is responsible for producing the hormone progesterone in the second half of the cycle. (Fritz, Marc and Speroff, Leon, 2011)
As a result of elevated progesterone levels, the uterine lining will thicken and develop additional blood vessels, which gives the embryo a place to attach. Progesterone will also prevent a premature onset of menses in which a pregnancy might be lost. In a normal menstrual cycle, the corpus luteum will produce progesterone for approximately twelve days. However, a normal cycle can be disrupted in several places. Three causes of Luteal Phase Defect could include poor follicle production, premature demise of the corpus luteum, and failure of the uterine lining to respond to normal levels of progesterone. These problems can also be found in conjunction with each other. Poor follicle production has its origins in the first half of the cycle. The body may not produce a normal level of FSH, or the ovaries do not respond strongly to the FSH, leading to inadequate follicle development. Because the follicle ultimately becomes the corpus luteum, poor follicle formation leads to poor corpus luteum quality. In turn, a poor corpus luteum will produce inadequate progesterone, causing the uterine lining to be adequately prepared for the implantation of a fertilized embryo. Ultimately progesterone levels may drop early and menses will arrive sooner than expected. Premature failure of the corpus luteum can occur even when the initial quality of the follicle/corpus luteum is adequate. There could be many possible reasons such as age, illness but also for reasons not wholly understood, the corpus luteum sometimes does not persist as long as it should. Initial progesterone levels at five to seven days past ovulation may be low; even if they are adequate, the levels drop precipitously soon thereafter, again leading to early onset of menses.
Progesterone is responsible for the rise in basal body temperature during the luteal phase. (Lyttleton, 2004) Women who monitor their basal body temperature will therefore often note that luteal phase temperatures do not stay reliably elevated for twelve days. Additionally, women who monitor the time of ovulation often notice that their next cycle begins sooner than the normal 12-14 days after ovulation.
Once a diagnosis of LPD is suspected, a serum progesterone test will often be performed at about seven days past ovulation. Should progesterone levels prove to be low, the temptation is often to "treat the symptom" by giving the patient progesterone supplementation during the luteal phase. In the case of inadequate corpus luteum performance, progesterone support may indeed be the appropriate solution. However, inadequate follicle development may also be causing the low progesterone levels. For this reason, it is important to measure mid-cycle follicle size (via ultrasound) and estradiol levels (via a blood test). If follicle development is normal, then progesterone supplementation during the luteal phase is normally the correct treatment. If follicle development is inadequate, an ovulatory stimulant such as Clomid or an injectable drug may be used at this time.
Some doctors use injections of human chorionic gonadotropin to further stimulate the corpus luteum. However, these injections can cause false positive pregnancy results. An endometrial biopsy is the gold standard in diagnosing LPD. However, especially in persistent cases, many doctors will use an endometrial biopsy. The endometrial biopsy is normally performed a few days before the next menstrual cycle is expected, ideally after a negative pregnancy result for the cycle has been obtained. The procedure consists of sampling a small amount of uterine lining and sending it to a pathologist for evaluation. Because the evaluation is done at a cellular level, the knowledge gained from it is at its most detailed and precise. The pathologist categorizes the lining as being typical of a particular cycle day. If this categorization is consistent with the actual cycle day that the sample was taken, the result is considered normal, and the uterine lining is in phase. If there is a discrepancy of more than two days, the lining will usually be considered out of phase.
Luteal Phase Defect (LPD) can lead to mistiming of the menstrual and ovulatory cycles, which must work together for conception and pregnancy to succeed. In cases of LPD, the uterine lining isn’t thick enough to sustained pregnancy. Also related to luteal phase defect is luteinized un-ruptured follicle (LUF) where a relatively mature follicle receives just enough luteinizing hormone to cause progesterone production, but not enough to cause the egg to release from the follicle.
Women who are concerned about the possibility of LPD are encouraged to use several cycles of BBT charting and other ovulation detection methods in an effort to enhance the diagnosis. Treating LPD is a matter of affecting the hormone levels in a timely manner, in hopes of bringing the menstrual and ovulatory cycles into sync with one another. Specifically the following may be used: Clomiphene citrate or injectable fertility medications Progesterone supplementation after ovulation injections of hCG to stimulate the corpus luteum for more natural progesterone supplementation.
In Traditional Chinese Medicine, we view and evaluate Luteal Phase Defect in relations with Kidney’s Yin and Yang deficiencies. TCM treatment included: Nourish the ‘Kidney yin/ yang” or both with herbs Coordination of yin and yang using both Chinese herbs and acupuncture are effective Regulation of qi and blood combination of tonification with reduction. After a complete history is taken and the precise imbalance is identified the appropriate herbs are combined to correct this imbalance. The luteal phase is slowly lengthened without any side effects.
In Traditional Chinese Medicine, Kidney is in charge of reproduction, and exuberant Kidney function is a prerequisite for menstruation and pregnancy. In western medicine, luteal phase defect associated with hypo-secretion of gonadotropic hormones is regarded as an important cause of infertility. Some modern pharmacological studies suggest that Kidney-tonifying herbs have a gonadotropic action.
In the four menstrual periods the Kidney-yin and yang decrease and increase, but at the same time they are interdependent. Therefore, such herbs as Yin Yang Huo and Zi He Che that tonify Kidney-yang could be added to the prescription of nourishing Kidney-yin in the post-menstrual period, and Nu Zhen Zi and Han Lian Cao were added to nourish Kidney-yin in the pre-menstrual treatment of tonifying Kidney-yang, with consequent improvement in symptoms and BBT. Regulation of Qi and blood: Free circulation of Qi and blood is a prerequisite for menstruation and pregnancy. Therefore, Qi and blood regulating herbs such as Dang Gui, Dan Shen, Xiang Fu, Mu Xiang and Wu Yao could be adopted to promote the circulation of Qi and blood for the regulation of menstrual cycles. Combination of tonification with reduction: The principle in treatment of luteal phase defect is tonification of Kidney-yin and -yang. However, potent tonics may impede the circulation of Qi therefore adding 12 g of Ze Xie in each prescription could be used in order to prevent excessive tonification.
Many studies now suggests that overall balancing of Kidney’s Yin and Yang with herbs as well as regular acupuncture treatments could improve LPD conditions with less or no side effect.
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What is Prometrium?
By Karen Y. Gordon
According to the Prometrium drug website, Prometrium is an FDA-approved micronized progesterone made from plant sources. It is structurally identical to the naturally occurring progesterone produced by a woman's body. Progesterone belongs to a class of hormones called progestogens, and is the major naturally occurring human progestogen (Prometrium. Retrieved from http://www.prometrium.com/patient).
Speroff and Fritz (2005) stated that like other steroids, progesterone consists of four interconnected cyclic hydrocarbons. Progesterone contains ketone and oxygenated functional groups, as well as two methyl branches. Like all steroid hormones, it is hydrophobic. Progesterone exerts its primary action through the intracellular progesterone receptor although a distinct, membrane bound progesterone receptor has also been postulated. In addition, progesterone is a highly potent antagonist of the mineral corticoid receptor and it prevents mineral corticoid receptor activation by binding to this receptor with an affinity exceeding even those of aldosterone and other corticosteroids such as cortisol and corticosterone
Progesterone has a number of physiological effects that are amplified in the presence of estrogen. Estrogen through estrogen receptors up-regulates the expression of progesterone receptors. Also, elevated levels of progesterone potently reduce the sodium-retaining activity of aldosterone, resulting in natriuresis and a reduction in extracellular fluid volume (Wikepedia. Retrieved from http://en.wikipedia.org/wiki/Progesterone).
Progesterone withdrawal, on the other hand, is associated with a temporary increase in sodium retention (reduced natriuresis, with an increase in extracellular fluid volume) due to the compensatory increase in aldosterone production, which combats the blockade of the mineralocorticoid receptor by the previously elevated level of progesterone (Wikepedia. Retrieved from http://en.wikipedia.org/wiki/Progesterone).
In reproductive system, since eggs release progesterone, sperm may use progesterone as a homing signal to swim toward eggs (chemotaxis). Hence substances that block the progesterone binding site on CatSper channels could potentially be used in male contraception. Progesterone is sometimes called the "hormone of pregnancy", and it has many roles relating to the development of the fetus. Progesterone converts the endometrium to its secretory stage to prepare the uterus for implantation. At the same time progesterone affects the vaginal epithelium and cervical mucus, making it thick and impenetrable to sperm. If pregnancy does not occur, progesterone levels will decrease, leading to menstruation (Speroff & Fritz, 2005).
Normal menstrual bleeding is progesterone-withdrawal bleeding. If ovulation does not occur and the corpus luteum does not develop, levels of progesterone may be low, leading to anovulatory dysfunctional uterine bleeding. During implantation and gestation, progesterone appears to decrease the maternal immune response to allow for the acceptance of the pregnancy.
Progesterone decreases contractility of the uterine smooth muscle (Speroff & Fritz, 2005).
In addition progesterone inhibits lactation during pregnancy. The fall in progesterone levels following delivery is one of the triggers for milk production. A drop in progesterone levels is possibly one step that facilitates the onset of labor. The fetus metabolizes placental progesterone in the production of adrenal steroids. In nervous system, progesterone like pregnenolone and dehydroepiandrosterone, belongs to the group of neurosteroids. It can be synthesized within the central nervous system and also serves as a precursor to another major neurosteroid, allopregnanolone. Neurosteroids affects synaptic functioning, are neuroprotective, and affect myelination. They are investigated for their potential to improve memory and cognitive ability (Speroff & Fritz, 2005). It also increases core temperature (thermogenic function) during ovulation. It reduces spasm and relaxes smooth muscle. Bronchi are widened and mucus regulated. Progesterone receptors are widely present in submucosal tissue. It also acts as an anti-inflammatory agent and regulates the immune response. It can however reduce gall-bladder activity. It can also normalize blood clotting and vascular tone, zinc and cooper levels, cell oxygen levels, and use of fat stores for energy. It may affect gum health, increasing risk of gingivitis (gum inflammation) and tooth decay. It also appears to prevent endometrial cancer (involving the uterine lining) by regulating the effects of estrogen (Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Progesterone).
Progesterone is sometimes used with another medication (a type of estrogen) as combination hormone replacement therapy (HRT) in women after menopause. Combination HRT can rarely cause very serious side effects such as heart disease such as heart attacks, stroke, serious blood clots in the lungs and legs, dementia, and breast cancer. Some of these risks appear to depend on the length of treatment and other factors. Therefore, combination HRT should be used for the shortest possible length of time at the lowest effective dose so you can obtain the benefits and minimize the chance of serious side effects from long-term treatment. Combination HRT should not be used to prevent heart disease or dementia (Drug information online. Retrieved from http://www.drugs.com/cdi/prometrium.html)
The dosage is based on your medical condition and response to therapy. Side effects could include nausea, bloating, breast tenderness, headache, change in vaginal discharge, mood swings, blurred vision, dizziness, or drowsiness may occur. A very serious allergic reaction to this drug is rare but before taking progesterone, but this product may contain inactive ingredients (such as peanut oil), which can cause allergic reactions or other problems dementia (Drug information online. Retrieved from http://www.drugs.com/cdi/prometrium.html)
This medication should not be used if you have certain medical conditions such as history of blood clots, history of bleeding in the brain, liver disease, cancer of the breast or other female organs, vaginal bleeding of unknown cause, a loss of pregnancy with some tissue remaining in the uterus ("missed abortion”) recent stroke or heart attack (within 1 year). This drug may make you dizzy or drowsy. Driving, use machinery, or do any activity that requires alertness should be avoided. Alcoholic beverages should be limited or avoided. Smoking combined with this medication further increases your risk for strokes, blood clots, high blood pressure, and heart attacks. This medication may cause blotchy, dark areas on your skin (melasma). Sunscreen and protective clothing is necessary when outdoors for sunlight may worsen the effect of melasma. This medication may be used during pregnancy only as directed by a doctor. There is conflicting information about whether progestins may cause harm to an unborn baby for this drug passes into breast milk dementia. Drugs and herbs affecting liver enzymes that remove progesterone from your body such as rifampin, St. John's wort, azole antifungals including itraconazole, certain anti-seizure medicines including carbamazepine, phenobarbital, phenytoin should be used with caution (Drug information online. Retrieved from http://www.drugs.com/cdi/prometrium.html)
Because progestational drugs may cause some degree of fluid retention, patients with the following conditions may be affected and should be closely monitored: epilepsy, migraines, asthma, and cardiac, or renal dysfunction. A decrease in glucose tolerance has been observed in a small percentage of patients taking estrogen-progestin combination treatment. Diabetic patients should be carefully monitored while receiving progesterone therapy in combination with estrogen. Progesterone gel should not be used concurrently with other local intravaginal therapy. There should be a time interval of at least 6 hours before or after the use of the gel (Speroff & Fritz, 2005).
When given in combination with estrogen, the administration of progesterone is started after 2 weeks of estrogen therapy. Recent published studies support the hypothesis that progesterone supplementation reduces preterm birth in women at high-risk. The American College of Obstetricians and Gynecologists Committee on Obstetric Practice has issued an opinion on the use of progesterone to reduce preterm birth. The committee believes that further studies are needed to evaluate the use of progesterone in patients with other high-risk obstetric factors (Lyttleton, 2004).
Progesterone, if used, should be restricted to only women with a documented history of a previous spontaneous birth at less than 37 weeks of gestation, because optimal route of administration and long-term safety of the drug remain to be resolved (Speroff, S. L., & Fritz, M. A., 2005).
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Endocrine system and TCM
By Karen Y. Gordon
The general definition of a hormone could be said to be a substance that is produced in a special tissue or a chemical that endocrine glands send throughout the body. It could also be described as a substance that is produced in a special tissue and is released into the bloodstream to travel to distant responsive cells, where the hormones show its characteristic effects.
Generally speaking, hormones (which can be protein or lipid in nature) affect growth, puberty, metabolism, weight, figure, shape, physical appearance, reproductive behavior, and emotions. Hormones and neurotransmitters are means of communication to maintain balance throughout the body. When animals evolved into complex organisms, special glands developed to produce hormones that could be used in a more sophisticated fashion. Every cell contains the genes necessary for hormonal expression and this communication can also be viewed as chemical regulatory and signaling agents. Hormones travel through the bloodstream to distant sites as wells local sites to communicate. Three important local sites for communications are paracrine, autocrine and intracrine.
Paracrine communication is an intercellular communication involving the local diffusion of regulating substances from a cell to nearby cells. Autocrine communication is an intracellular communication whereby a single cell produces regulating substances that in turn act upon receptors on or within the same cell. Intracrine communication is a form of intercellular communication that occurs when un-secreted substances bind to intracellular receptors, a regulating factor within the cell that secretes it.
The endocrine system influences almost every cell organ and function of our bodies. The endocrine system is instrumental in regulating mood, growth and development, tissue function, metabolism, sexual function and reproductive processes. In general, the endocrine system is in charge of body processes that happen slowly, such as cell growth. Faster processes like breathing and body movement are controlled by the nervous system. Though the nervous system and endocrine system are separate systems, they often work together to help the body function properly.
The foundations of the endocrine system are the hormones and glands. As the body's chemical messengers, hormones transfer information and instructions from one set of cells to another. Many different hormones move through the bloodstream, but each type of hormone is designed to affect only certain cells. A gland is a group of cells that produces and secretes, or gives off, chemicals. It selects and removes materials from the blood, processes them, and secretes the finished chemical product for use somewhere in the body.
Some types of glands release their secretions in specific areas. Exocrine glands, such as the sweat and salivary glands, release secretions in the skin or inside the mouth. Endocrine glands, on the other hand, release more hormones directly into the bloodstream where they can be transported to cells in other parts of the body. The major glands that make up the human endocrine system include: hypothalamus, pituitary gland, thyroid, parathyroid, adrenal glands, pineal body and reproductive glands, which include the ovaries and testes.
The hypothalamus, a collection of specialized cells that is located in the lower central part of the brain, is the main link between the endocrine and nervous systems. Nerve cells in the hypothalamus control the pituitary gland by producing chemicals that either stimulate or suppress hormone secretions from the pituitary. No bigger than a pea, the pituitary gland, located at the base of the brain just beneath the hypothalamus, is considered the most important part of the endocrine system. It's often called the "master gland" because it makes hormones that control several other endocrine glands.
The production and secretion of pituitary hormones can be influenced by factors such as emotions and changes in the seasons. The hypothalamus provides information sensed by the brain such as environmental temperature, light exposure patterns, and feelings to the pituitary. The tiny pituitary is divided into two parts: the anterior lobe and the posterior lobe. The anterior lobe regulates the activity of the thyroid, adrenals, and reproductive glands. It also produces hormones such as growth hormone, which stimulates the growth of bone and other body tissues and plays a role in the body's handling of nutrients and minerals. Prolactin activates milk production in women who are breastfeeding. Thyrotropin stimulates the thyroid gland to produce thyroid hormones and corticotropin stimulates the adrenal gland to produce certain hormones.
The pituitary also secretes endorphin chemicals that act on the nervous system and reduce feelings of pain. Further, the pituitary secretes hormones that signal the reproductive organs to make sex hormones. It also controls ovulation and the menstrual cycle in women. The posterior lobe of the pituitary releases antidiuretic hormone, which helps control the balance of water in the body. The posterior lobe also produces oxytocin, which triggers the contractions of the uterus in a woman having a baby.
The thyroid, located in the front part of the lower neck, is shaped like a bow tie or butterfly and produces the thyroid hormones thyroxine and triiodothyronine. These hormones control the rate at which cells burn fuels from food to produce energy. The production and release of thyroid hormones is controlled by thyrotropin, which is secreted by the pituitary gland. The more thyroid hormone there is in a person's bloodstream, the faster chemical reactions occur in the body. Also thyroid hormones play an important role in child bone growth and development, and they also play a role in the development of the brain and nervous system in kids.
Attached to the thyroid are four tiny glands that function together called the parathyroid. They release parathyroid hormone, which regulates the level of calcium in the blood with the help of calcitonin, which is produced in the thyroid. The body also has two triangular adrenal glands, one on top of each kidney. The adrenal glands have two parts, each of which produces a set of hormones and has a different function. The outer part, the adrenal cortex, produces hormones called corticosteroids that influence or regulate salt and water balance in the body, the body's response to stress, metabolism, the immune system, and sexual development and function. The inner part, the adrenal medulla, produces catecholamines, such as epinephrine. Also called adrenaline, epinephrine increases blood pressure and heart rate when the body experiences stress. The pineal body, also called the pineal gland, is located in the middle of the brain. It secretes melatonin, a hormone that may help regulate when you sleep at night and when you wake in the morning.
The gonads are the main source of sex hormones. Most people do not realize it, but both sexes have gonads. In males the gonads, or testes are located in the scrotum. They secrete hormones called androgens the most important of which is testosterone. These hormones tell the male body when it is time to make the changes associated with puberty, like penis and height growth, deepening of voice, and growth in facial and pubic hair. Working with hormones from the pituitary gland, testosterone also tells the male body when it is time to produce sperm in the testes.
The female gonads, the ovaries, are located in her pelvis. They produce eggs and secrete the female hormones estrogen and progesterone. Estrogen is involved when a girl begins to go through puberty. During puberty, a girl will experience breast growth, begin to accumulate body fat around the hips and thighs, and experience a growth spurt. Estrogen and progesterone are also involved in the regulation of the menstrual cycle. These hormones also play a role in pregnancy.
Although the endocrine glands are the body's main hormone producers, some other organs not in the endocrine system such as the brain, heart, lungs, kidneys, liver, and skin, also produce and release hormones. The pancreas is also part of the body's hormone-secreting system, even though it is also associated with the digestive system because it produces and secretes digestive enzymes. The pancreas produces in addition to others, two important hormones, insulin and glucagon. They work together to maintain a steady level of glucose, or sugar, in the blood and to keep the body supplied with fuel to produce and maintain stores of energy.
Once a hormone is secreted, it travels from the endocrine gland that produced it through the bloodstream to the cells designed to receive its message. These cells are called target cells. Along the way to the target cells, special proteins bind to some of the hormones. These proteins act as carriers that control the amount of hormone that is available for the cells to use. The target cells have receptors that latch onto only specific hormones, and each hormone has its own receptor, so that each hormone will communicate only with specific target cells that have receptors for that hormone. When the hormone reaches its target cell, it locks onto the cell's specific receptors and these hormone receptor combinations transmit chemical instructions to the inner workings of the cell. When hormone levels reach a certain normal amount, the endocrine system helps the body to keep that level of hormone in the blood.
For example, if the thyroid gland has secreted the right amount of thyroid hormones into the blood, the pituitary gland senses the normal levels of thyroid hormone in the bloodstream. Then the pituitary gland adjusts its release of thyrotropin, the hormone that stimulates the thyroid gland to produce thyroid hormones. Another example of this process is parathyroid hormone. Parathyroid hormone increases the level of calcium in the blood. When the blood calcium level rises, the parathyroid glands sense the change and reduce their secretion of parathyroid hormone. This turnoff process is called a negative feedback system. Too much or too little of any hormone can be harmful to your body. For example, if the pituitary gland produces too much growth hormone, a teen may grow excessively tall. If it produces too little, a teen may be unusually short.
In Traditional Chinese Medicine, hormones could be closely linked with internal regulation of storing and secreting of Essence. And generally speaking, the kidney is the organ that stores the Essence that we inherited from our parents. It is believed that physical and mental over-exertion could deplete Essence and further weaken the kidney. This could lead to imbalance, which would lead to illness. The similar functions are performed by the hypothalamic-pituitary axis of the endocrine system in that the capacity to grow, mature, reproduce, maintain stability, generate blood and marrow, adapt to stress, repair body tissues are governed by the kidney. Inherited and acquired Essence, pooled within the reservoir of the kidney, are stored and dispensed as needed. When Essence is plentiful, our ability to resist disease and adapt to change is optimal. Essence is the origin of all Yin which could be describe as blood and moisture and Yang which could mean Qi and Warmth. Loss of libido, stamina, hearing, and vision, lower back pain, sore hips or knees, apathy, despair, dull mindedness, memory problems, vaginal dryness and atrophy, thinning of bones, and deterioration of teeth and gums are all symptoms of deficient Essence. When Essence becomes depleted, so do Blood and Qi, Yin and Yang. Lack of Qi produces fatigue, weakness, dull thinking, melancholy, and decreased motivation. When kidney Essence declines, deficiencies would eventually impact the liver, heart, spleen, and lung. When kidney yang is weak, the spleen becomes unable to extract the necessary nutrients to generate adequate moisture and blood. This results in dryness (dry eyes, skin, hair, and vagina, brittle nails, constipation, even cystitis). This in turn undermines shen-jing (heart essence), the unified relationship between heart and kidney, mind and essence. Therefore, kidney yang deficiency leads to spleen weakness, causing symptoms such as lethargy, weakness, easy bruising, poor concentration, fluid retention, indigestion and bloating. It also leads to a weakening of the kidney's capacity to anchor the qi, permitting true yang to leave its proper place in the lower burner and surge upward, producing agitation, flushing and perspiration, followed by chilliness, weakness, and fatigue. Many women have signs of both kidney yin and yang depletion with such symptoms as hot flashes, sweating, agitation, and dryness.
In Traditional Chinese Medicine, balancing the patient’s body and mind is often discussed and applied in treatment. Much like the TCM treatment principle, endocrine system has this similar idea of trying to keep things balanced and regulated within the bodily system. Therefore, when discussing Essence, I think that the kidney’s functions and its relations with Essence should include every aspect of the Western understanding of endocrine system.
I feel that with acupuncture treatment, we trigger the part of the endocrine system as well to release and inhibit proper hormones to reach a calming physical as well as a mental state. A part of a endocrine system is very much dependent upon exterior environment changes including stress. Therefore, acupuncture and herbal treatment could help not only to regulate the endocrine system by encouraging proper bodily flow, but to calm the mind so that the body could naturally reach balance for a better sense of being.
Reference List
Treating Endometriosis with TCM
By Karen Y. Gordon
According to the Journal of the American Medical Association (JAMA), endometriosis affects approximately 5 to 7 million American women. Most of the women affected are between the ages of 30 and 40. Some women are debilitated by this condition while others may have mild to no symptoms. It affects 10-15% of women of childbearing age in the U.S and is even more common in women of Asian descent, although it affects women of all races.
Endometriosis is a disorder in which the cells that form the lining of the uterus or endometrium grow outside the uterus. It is a non-cancerous condition and in Western medicine, the cause is unknown. Theories as to what causes it abound in Western medical texts. The cause of endometriosis is unclear in conventional medicine, although there are many theories. There are major three theories. First theory is that small bits of menstrual tissue flow backward into the fallopian tubes and out into the abdominal cavity where they seed with hormonal stimulation and begin to grow. Second theory is that cells from the uterine lining may be transported through the bloodstream into other locations where they seed and grow. Third theory is that cells outside the uterus may change into uterine cells with hormonal stimulation in those who are genetically predisposed. Each month the endometrium builds up in the uterus then breaks down and sheds off, resulting in vaginal bleeding or menstruation. It is speculated that this same cycle occurs with the endometrial tissue located outside the uterus. However, endometrial tissue outside the uterus that sheds off and bleeds is trapped inside the body and is slowly absorbed. This process can create pain and inflammation and may lead to the development of local lesions, masses, and larger amounts of endometriosis. Common locations for the growth of this abnormal endometrial tissue are the ovaries and ligaments that support the uterus. Less common locations are the outer surface of the colon and small intestines, the ureters, bladder, vagina, pleura of the lungs, and pericardium.
The symptoms of endometriosis depend on where the tissue is growing. Pelvic pain is the most common symptom followed by heavy menstrual bleeding, dyspareunia, and pain with bowel movements. Rectal bleeding is not unusual as a result of this condition, as is pain with urination. Also women with endometriosis are often unable to conceive. Women with endometriosis may experience pelvic pain 5-7 days before menstruation, during menstruation or with ovulation. Many women experience low back pain with periods, nausea, vomiting, intestinal upsets, fatigue, pain with sexual intercourse, and pain with urination or bowel movements.
It is estimated that 30 to 40 percent of women who report infertility problems have endometriosis. The most common symptoms of Endometriosis are pain before and during periods, pain with intercourse, general, chronic pelvic pain throughout the month, low back pain, heavy and/or irregular periods, painful bowel movements, especially during menstruation, painful urination during menstruation, fatigue, infertility, diarrhea or constipation. Other symptoms include headaches, low-grade fevers, depression, hypoglycemia (low blood sugar), anxiety and susceptibility to infections, allergies.
One of the biggest problems regarding Endometriosis is that the signs of this disease in the early stages appear to be the normal bodily changes that take place with the menstrual cycle. It is only as time goes by that a woman begins to suspect that what is happening, and the symptoms she feels, are not normal. The pain of her menstrual cycle gradually and steadily becomes worse and worse as the months go by. This is only the beginning of what will become a gradual decline in a woman’s general health, as well as the health of her reproductive system. However, there are odd instances where some women do actually have Endometriosis, but they are nearly free of any symptoms. These women will only be diagnosed by default, for example when they have surgery for other issues, and only then is Endometriosis found. That is what makes this disease so enigmatic, difficult to interpret or understand. Endometriosis does not follow any distinct pattern, which is why it is difficult for the medical profession to know that a woman has the disease. Some of the symptoms will mimic those of other health problems, including ovarian cysts, ectopic pregnancy, pelvic Inflammatory disease, irritable bowel syndrome, ovarian cancer, fibroid tumors, colon cancer and appendicitis.
Endometriosis is diagnosed through a laparoscopy. This procedure allows the surgeon to see inside the abdominal cavity through a tiny-lighted optical tube that is inserted through a small incision in the navel. Part of the problem that causes the delay in diagnosis of Endometriosis is that many people in the medical profession are not fully aware of the extent of this disease today. There are a variety of methods that can be used to assess whether a woman has Endometriosis, but laparoscopy is the only reliable way to confirm the presence of the disease is by visually inspecting the abdominal organs. Before a laparoscopy is done a full gynecological evaluation should be done covering the patient’s medical history. Diagnosis methods of Endometriosis can include physical examination and a pelvic examination. These examinations involve the physician feeling and looking for abnormalities that are associated with endometriosis. Physical findings depend on the severity and location of the disease. There may be palpable nodules or tenderness in the pelvic region, enlarged ovaries, a tipped-back (retro-displaced) uterus, or lesions on the vagina or on surgical scars. Danazol (derivative of the synthetic steroid ethisteron) is taken for 6 weeks prior to an operation to shrink the endometrial growths and ease the surgical removal. Following surgical removal of endometrial tissue, birth control pills may be prescribed that contain both estrogen and progesterone, to be taken continuously for up to nine months. This will induce a pseudo-pregnancy, with the aim to allow the body time to rest and heal.
In Traditional Chinese medicine, Endometriosis is understood based on the differentiated clinical manifestations associated with each individual. It is important in TCM to diagnose the patient according to his or her own specific pattern. Each individual has a pattern that marks the foundation and progression of the disorder. Traditional Chinese medicine (TCM), including acupuncture and herbs has been used successfully in treating a wide range of female health disorders including endometriosis. The primary aim of the TCM doctor in the treatment of endometriosis has always been to remove blood stagnation. Endometriosis is a Western medical label not TCM, but the scientific medical understanding of this diseases has contributed to the notion that this is a diseases characterized by blood being where it shouldn’t and unable to escape the body. Symptoms such as severe stabbing period pain, clotty menstrual flow and palpable nodules or masses in the abdomen appear to verify the diagnosis of stagnation blood.
TCM doctors treatment protocols in infertility clinics in China, doctors found that more pregnancies resulted if treatment of women with endometriosis targeted the kidney for endometriosis lesions that can produce secretions which clog up the system (phlegm damp in TCM) also boosting Kidney Yang is generally rather effective at clearing such phlegm damp. In TCM, more attention is paid to moving blood, clearing stasis and breaking up masses during the period and fortifying the Kidney Yang and moving Blood at ovulation. If there is such severe stagnation that a pregnancy is impossible, then treatment will focus on the stagnation during the entire cycle. We know that menstrual blood travels not only downwards from the uterus and out through the cervix but also upwards through the fallopian tubes and out into the peritoneal cavity. This small quantity of blood carries with it bits of discarded endometrium. Women with strong uterine cramps due to Liver Qi Stagnation are more likely to close more menstrual flow upwards through the tubes. The blood and the tissue will either be reabsorbed or will remain and establish itself somewhere in the pelvic cavity. If Kidney Yang is strong, then movement of Qi in the pelvis will mobilize the menstrual debris, which shouldn’t be there and it will be reabsorbed. So Weakness of Kidney Yang will allow the accumulation of blood and tissue, which creates stagnation. The pattern that suggests endometriosis is when temperature does not drop very much when the period comes, or if it does drop it may start to go up again after 1-2days. These patterns indicate that the switch to Yin from Yang has not been on time or complete. These patterns all indicate inadequate Kidney Yang function.
According to the Lyttleton’s “Treatment of Infertility with Chinese Medicine”, the treatments would be divided into three phases, post-menstruation, ovulation and post ovulation. During post-menstruation, build blood and reinforce the Yin by using such formula as Gui Shao Di Huang Tang with Shu Di 12g, Shan Yao 10g, Shan Zhu Yu 10g, Fu Ling 10g, Mu Dan Pi 10g, Ze Xie 12g, Dang Gui 10g, Bai Shao 10g. Add Yang Tonics in small doses on day 8-9 with herbs such as Tu Si Zi 5g, Rou Cong Rong 5g, Xu Duan 5g. Also use high doses if Yang deficiency is predominant with such herbs as Tu Si Zi 10g, Rou Cong Rong 10g. If blood Stagnation predominant add Chi Shao 10g, Sheng Shan Zha 15g, Tao Ren 5g, Hong Hua 5g, Wu Ling Zhi 5g. Recommended acupuncture treatment would include KD13, Ren 7, KD14, KD18, Ren3, Ren4, SP6, LV8, Ren12. During ovulation phase, treatment such as dispeling blood stagnation and resolve masses would be applied along with Wen Yang Hua Yu Fang (Warm Yang And Transform Stasis Formula) with Dang Gui, Chi Shao, Bai Shao, Shan Yao, Shu Di, Nu Zhen Zi, Mu Dan Pi, Fu Ling, Xu Duan, Tu Si Zi, Wu Ling Zhi all 10g and Hong Hua 5g. For more blood moving add Shan Zha 10g, Dan Shen 10g
And for abdominal masses with strong patient with no desire for conception add San Leng 5g, E Zhu 5g. To clear LV Qi Stagnation with Damp and SP Qi Deficiency add Cang Zhu 10g, Chen Pi 5g, Fu Ling 10g, Zhi Ke 10g, Xiang Fu 10g and acupuncture treatment with LV3, LV11, ST29, Zi Gong Xue, SP12, SP13 may be used. During post-ovulation, promote qi to build yang treatment is used with Jian Gu Tang modified (Strengthen and Consolidate Decoction) with Dang Shen, Bai Zhu, Shan Yao, Yi Yi Ren, Tu Si Zi, Ba Ji Tian, Lu Jiao Pian all 10g. For masses to reinforce KD Yang add Wu Ling Zhi 5g, Dan Shen 10g, Sheng Shan Zha 10g with acupuncture treatment with Ren4, KD3, ST29, BL23, PC7, LV2, SP1, HT7 could be used.
Diet changes can help reduce the symptoms of endometriosis. According to “ Endometriosis Diet” by Levett, Carolyn, increasing omega-3 fatty acids, fiber and avoiding meat, dairy products, wheat and sugar, modulate estrogen. Also avoid caffeine and alcohol, refined foods, e-numbers, additives, minimize or avoid soy products seem to help patients with Endometriosis.
The origin of the pattern differs according to the individual. Other factors need to be taken into consideration when determining the pattern for endometriosis such as emotional stress, anxiety, constitutional weakness, surgical history, exposure to cold temperatures especially during menstruation, diet, chronic illness or weakness, or a history of genital infections. Understanding these patterns could produce more comprehensive treatment approach to dealing with Endometriosis.
Reference List
PCOS (Polycystic ovarian syndrome)
By Karen Y. Gordon
Polycystic ovarian syndrome is a common health problem that can affect teenage girls and women. Although no one really knows what causes PCOS, it seems to be related to an imbalance in hormones.
Both girls and guys produce sex hormones, but in different amounts. In girls, the ovaries produce the hormones estrogen and progesterone, and also androgens. These hormones regulate a girl's menstrual cycle and ovulation when the egg is released. Even though androgens are sometimes referred to as "male hormones," every female produces them. In girls with PCOS, the ovaries produce higher than normal amounts of androgens, and this can interfere with egg development and release. Sometimes instead of the eggs maturing, cysts, which are little sacs filled with liquid, develop. Instead of an egg being released during ovulation, like during a normal menstrual cycle, the cysts build up in the ovaries and may become enlarged. Because girls with PCOS are not ovulating or releasing an egg each month, it's common for them to have irregular or missed periods.
Research has suggested that PCOS may be related to increased insulin production in the body. Women with PCOS may produce too much insulin, which signals their ovaries to release extra male hormones. PCOS seems to run in families, too, so if someone in the family has it, the likely would increases.
If PCOS is not treated properly, there could be other complications. Girls with PCOS are more likely to have infertility, excessive hair growth, acne, obesity, diabetes, heart disease, high blood pressure, abnormal bleeding from the uterus, and even cancer. The good news is that, although there's no cure for PCOS, it can be treated.
The most important step is diagnosing the condition, because getting treatment for PCOS reduces a girl's chances of having serious side effects. A key sign of PCOS is irregular or missed periods because the effects of the condition on the ovaries can make a girl stop ovulating. However, because it can take up to two years after her first period for a girl's menstrual cycle to become regular, it can be hard to recognize missed periods as a sign of PCOS in teen girls. Imbalanced hormone levels can cause changes in a girl's entire body, not just her ovaries. So doctors also look for these other signs that might indicate PCOS such as very heavy periods or irregular periods, weight gain, obesity, or difficulty maintaining a normal weight, especially when the extra weight is concentrated around the waist. Also a condition called hirsutism, where a girl grows extra hair on her face, chest, abdomen, nipple area, or back could be another sign of PCOS however, a little of this is normal for most girls but thinning hair on the head also called alopecia, acne and clogged pores, darkened, thickened skin around the neck, armpits, or breasts also called acanthosis nigricans, high blood pressure, high cholesterol, or diabetes mellitus (high levels of sugar in your blood) could raises the signal for PCOS.
Also girls who show certain signs of puberty early, such as girls who develop underarm or pubic hair before the age of 8 may be at greater risk of having PCOS later on as well. A gynecologist or an endocrinologist generally diagnoses polycystic Ovary Syndrome. The gynecologist or endocrinologist will ask about any concerns and symptoms a patient might have along with past health, family's health, any medications the patient might be taking, any allergies, and other issues. Doctors also ask you lots of questions specifically about the patient’s period and its regularity. In addition to your medical history, the doctor will do a physical examination, which includes checking the weight, and checking especially for physical signs such as acne, hair growth, and darkened skin. The doctor may also perform a gynecologic examination to rule out other possible causes of your symptoms, but this is not always necessary for diagnosis. A doctor may also perform blood tests to diagnose PCOS or other conditions, such as thyroid or other ovarian or gland problems. Blood tests allow doctors to measure androgen, insulin, and other hormone levels. The results of these tests can help doctors to determine the type of treatment a girl will receive. Depending on the circumstance, a doctor also might order an ultrasound to look at the patient’s ovaries and to determine if there exist any cysts or other abnormalities of the ovaries. Because cysts are not always visible, this test is not always used.
Early diagnosis and treatment for PCOS are important because the condition can put girls at risk for long-term problems. Getting treated for PCOS is important for fertility reasons. PCOS often causes infertility if it's not treated. But when PCOS is treated properly, many women with the condition could go on to have healthy babies.
Also, many girls with PCOS can get pregnant. Therefore, if a girl is sexually active, she needs to use condoms every time having sex in order to avoid getting pregnant or getting a sexually transmitted disease. Although there's no cure for PCOS, there are several ways that the condition can be treated and managed. If a girl is overweight or obese, a doctor will recommend that she lose weight. Weight loss can be very effective in lessening many of the health conditions associated with PCOS, such as high blood pressure and diabetes. Sometimes weight loss alone can restore hormone levels to normal, causing many of the symptoms to disappear or become less severe.
There are many literatures that suggest how to better exercise and also how to tailor an activity for a weight-loss program for PCOS patients. Exercise is a great way to help combat the weight gain that often accompanies PCOS as well as a way to reduce bloating, another symptom girls with PCOS sometimes experience. Sometimes doctors do prescribe medications to treat PCOS. A doctor might first have a girl try birth control pills or another hormone pill called progesterone to help control hormone levels in her body and regulate her menstrual cycle. Birth control pills may help control acne and excessive hair growth in some girls, but they don't work for everyone.
Other medications used to treat PCOS include anti-androgens, which counter the effects of excess androgens on a girl's body. Anti-androgens can help clear up skin and hair growth problems in girls with PCOS. Another medication, metformin, which is used to treat diabetes, can lower insulin levels. In some girls with PCOS, it can help control ovulation and androgen levels. This can make a girl's menstrual cycles more regular. Some girls and women treated with metformin have also experienced weight loss and lowering of high blood pressure.
Having PCOS can be hard on a girl's self-esteem because some of the symptoms, such as skin and hair problems and weight gain, can be noticeable. Fortunately, there are things that could be done to reduce the physical symptoms and take care of the emotional side of living with PCOS. Although the medications used to treat PCOS will slow down or stop excessive hair growth for many girls, different types of products and precedures available to help a girl get rid of hair where she doesn't want it.
In severe acne symptom of PCOS, it may improve if part of the treatment includes birth control pills or anti-androgens. If it doesn't, a dermatologist could help for further acne treatment. A dermatologist may also be able to recommend medications to help reduce skin darkening or discoloration, and to prevent hair growth. Some girls with PCOS may become depressed, in which case it may help to talk to a therapist or other mental health professional. Talking with other teens and women with PCOS is a great way to share information about treatment and get support.
In Traditional Chinese Medicine, PCOS could be viewed as blood stasis when there’s pain along with irregularity of menstrual cycle and also the depletion of Essence. To address these concerns, two major organs are focused, liver and kidneys. TCM has successfully treated PCOS with its traditional individual approach by addressing each patient’s different needs. Generally, acupuncture treatment are used to boost the bodily function to remove the stagnation that causes cysts and herbs are also used to support and supplement the acupuncture treatment by nourishing the body to regulate bodily functions such as strengthening organs, removing obstruction and balancing hormones.
In Traditional Chinese Medicine, hormones could be closely linked with internal regulation of storing and secreting of Essence. And generally speaking, the kidney is the organ that stores the Essence that we inherited from our parents. It is believed that physical and mental over-exertion could deplete Essence and further weaken the kidney. This could lead to imbalance, which would lead to illness. The similar functions are performed by the hypothalamic-pituitary axis of the endocrine system in that the capacity to grow, mature, reproduce, maintain stability, generate blood and marrow, adapt to stress, repair body tissues are governed by the kidney. Inherited and acquired Essence, pooled within the reservoir of the kidney, are stored and dispensed as needed. When Essence is plentiful, our ability to resist disease and adapt to change is optimal. Essence is the origin of all Yin which could be describe as blood and moisture and Yang which could mean Qi and Warmth. Loss of libido, stamina, hearing, and vision, lower back pain, sore hips or knees, apathy, despair, dull mindedness, memory problems, vaginal dryness and atrophy, thinning of bones, and deterioration of teeth and gums are all symptoms of deficient Essence. When Essence becomes depleted, so do Blood and Qi, Yin and Yang. Lack of Qi produces fatigue, weakness, dull thinking, melancholy, and decreased motivation. When kidney Essence declines, deficiencies would eventually impact the liver, heart, spleen, and lung. When kidney yang is weak, the spleen becomes unable to extract the necessary nutrients to generate adequate moisture and blood. This results in dryness (dry eyes, skin, hair, and vagina, brittle nails, constipation, even cystitis). This in turn undermines shen-jing (heart essence), the unified relationship between heart and kidney, mind and essence. Therefore, kidney yang deficiency leads to spleen weakness, causing symptoms such as lethargy, weakness, easy bruising, poor concentration, fluid retention, indigestion and bloating. It also leads to a weakening of the kidney's capacity to anchor the qi, permitting true yang to leave its proper place in the lower burner and surge upward, producing agitation, flushing and perspiration, followed by chilliness, weakness, and fatigue.
Many women have signs of both kidney yin and yang depletion with such symptoms as hot flashes, sweating, agitation, and dryness. In Traditional Chinese Medicine, balancing the patient’s body and mind is often discussed and applied in treatment.
Much like the TCM treatment principle, endocrine system has this similar idea of trying to keep things balanced and regulated within the bodily system. Therefore, when discussing Essence, I think that the kidney’s functions and its relations with Essence should include every aspect of the Western understanding of endocrine system.
I feel that with acupuncture treatment, we trigger the part of the endocrine system as well to release and inhibit proper hormones to reach a calming physical as well as a mental state. A part of an endocrine system is very much dependent upon exterior environment changes including stress. Therefore, acupuncture and herbal treatment could help not only to regulate the endocrine system by encouraging proper bodily flow, but to calm the mind so that the body could naturally reach balance for a better sense of being. I feel that TCM approach of nourishing and sooth liver to stop pain and regulating cycle is important but also addressing kidney is very import for PCOS condition since this condition has significant impact on the patient’s physical as well as metal health.
Reference List
Acupuncture and herbs have been used for years to treat many gynecological conditions. Acupuncture can improved ovarian and follicular function as well as increasing blood flows to the endometrium, helping to facilitate a thick, rich lining.
Length of treatment for fertility
Patients may be treated for two to six months before considering natural conception or assisted reproductive technology. Typically, about one to two treatments per week is required to have a therapeutic effect before progressing to insemination, in vitro fertilization (IVF), or donor-egg transfer.
Acupuncture protocol for IVF
In a study by Stener-Victorin et al from the Departments of Obstetrics and Gynecology Fertility Centre, Scandinavia and University of Gothenburg, women are encouraged to receive acupuncture treatments pre and post embryo transfer.
Common conditions treated with acupuncture
· Repeated pregnancy loss/miscarriages
· Luteal phase defect
· Hyperprolactinemia
· Polycystic ovarian syndrome
· Endometriosis
· Male infertility factors
Understanding Medications and Drugs for In Vitro Fertilization
By Karen Y. Gordon
In Vitro Fertilization is commonly referred to as IVF. IVF is the process of fertilization by manually combining an egg and sperm in a laboratory dish. When the IVF procedure is successful, the process is combined with a procedure known as embryo transfer, which is used to physically place the embryo in the uterus. There are basically five steps in the IVF and embryo. Monitor and stimulate the development of healthy egg(s) in the ovaries, collect the eggs, secure the sperm, combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth and finally transfer embryos into the uterus.
Fertility drugs are used to ovulate the ovaries by causing the production of numerous follicles and drugs may be given in a variety of combinations, which are called protocols. The physician determines the individualized specific treatment protocol for each patient.
Fertility drugs remain the primary treatment for women with ovulation disorders; some are taken orally and some are injected. In general, these medications work by causing the release of hormones that either trigger ovulation or regulate it. Even people using assisted reproductive techniques such as in-vitro fertilization, fertility drugs are still an important part of treatment.
With the standard IVF protocol, four types of fertility drugs may be given: Lupron a gonadotropin-releasing hormone (GnRH) antagonist, which acts on the pituitary gland to inhibit gonadotropin (FSH and LH) secretion and prevent premature ovulation. Ganirelix is a GnRH agonist and may be used instead of Lupron to control ovulation timing. Progesterone helps supports endometrial development and maintains early pregnancy. Gonadotropins are medications consisting of FSH alone or combined FSH and LH. They directly act on the ovaries to stimulate the development and maturation of the eggs. Human chorionic gonadotropin (hCG) known commercially as Pregnyl or Ovidrel, these medications act directly on the ovaries to cause the release of eggs from the ovarian follicles.
Down regulation or ovarian suppression with Lupron allows the physician to have greater control over ovarian stimulation, which provides for an even growth of ovarian follicles and prevents a condition known as premature luteinization. This is a premature attempt by your body to ovulate.
Lupron is administered subcutaneously, meaning underneath the skin and not into the muscle. This medicine is typically injected into the thigh and is easily self-administered. Lupron is usually given 10 to 14 days before ovarian suppression occurs, but may also be given earlier without affecting the ovarian stimulation. Approximately 10 percent of patients require longer than 10 to 14 days of Lupron to completely suppress the ovaries. The Lupron dose will typically be reduced in half once the stimulation phase of the cycle begins.
Ganirelix and Cetrotide are both gonadotropin releasing hormone (GnRH) antagonists that suppress the pituitary gland’s LH secretion by binding to the GnRH receptor. These act immediately to suppress pituitary LH secretion to prevent premature ovulation. Depending on the patient, the physician may decide to use one of these medications in place of Lupron. Ganirelix Acetate or Cetrotide is usually started after ovarian stimulation has begun, typically around stimulation day 6, or when the lead follicles are approaching 12 mm in mean diameter. Ovulation triggering is handled similarly to a Lupron cycle.
A menstrual period should begin within 7 to 14 days from starting the Lupron injections. The clinic should be notified when the period starts so that a baseline ultrasound and blood estradiol test can be scheduled. The purpose of these tests is to confirm that the Lupron has successfully suppressed the ovaries to a baseline state. Depending upon the results of these tests, the Lupron medication may be extended for another week and the patient may be asked to return for another sonogram and blood estradiol test. Occasionally an ovarian cyst aspiration may be performed for a persistent ovarian cyst.
After ovarian suppression has been achieved, ovarian stimulation using gonadotropin fertility drugs may commence at a scheduled time, which is referred to as the cycle start. These gonadotropin fertility drugs are continued throughout the stimulation phase of the cycle until hCG is administered.
The dose of gonadotropins will be based upon age, weight, number of follicles, cycle day 3 FSH and estradiol levels, and the response to previous stimulation cycles. The initial dose of medication will be taken for 2-3 days before returning to the clinic in the morning for an estradiol blood test. The dose of medication may be changed based upon the level of estradiol. Medication will usually be taken for two more days before for another estradiol blood test.
Studies have shown the estrogen administered during the luteal phase after egg retrieval improves pregnancy rates. It can be transdermal or oral routes. Estradiol levels are checked one week after embryo transfer and if levels are excessively high, the estrogen support is discontinued.
Sonograms are conducted starting on day 6 or 7 of the stimulation. In general, return follow-up sonograms and estradiol blood tests occur every one to three days to monitor the growth of the follicles. Patients will be asked to return more frequently toward the end of their ovarian stimulation. Most people require eight to 12 days of ovarian stimulation, thus necessitating four to six sonograms and estradiol blood tests.
When the follicles have met the criteria that indicate the eggs are mature, patients are instructed to administer hCG (Pregnyl or Ovidrel). In general, at least two follicles with a mean diameter of at least 18 mm and an appropriate estradiol level must be present before hCG is administered. Usually 5,000 to 10,000 units of hCG will be injected about 36 hours before the planned oocyte retrieval.
Administration of hCG is commonly called follicle triggering. The purpose of this medicine is to induce the final stages of oocyte maturation and the release of the eggs by the ovary. Timing the administration of this medication is extremely important and the physician/nurses instructions must be followed exactly.
There is a risk of multiple pregnancies when more than one embryo is placed into the womb. Carrying more than one baby at a time increases the risk of premature birth and low birth weight. It is unclear whether IVF increases the risk of birth defects. Side effects of fertility drugs include local reactions e.g. mild bruises and soreness at the site of injections. This is more common with HMG preparations than purified or recombinant FSH. There is also a small risk of a generalized allergic reaction.
Other drugs may cause headaches, mood changes, hot flushes and vaginal dryness in some women, etc. these are usually short-lived and are no cause for concern.
It may be possible for patients to develop functional cysts while on GnRH agonists regimes. These cysts may produce estrogen, and sometimes are associated with a poor IVF outcomes. If this happens, the patient will be advised to continue taking GnRH agonist drugs until the cysts resolve by themselves. Aspiration of the cyst may be required.
Traditional Chinese medicine has been found to be helpful in aiding patients through IVF process. Traditional Chinese Medicine has a very long history of helping infertile couples in China and all over Asia. In the last few decades TCM has helped the growing number of couples in the Western world who require assistance to have a child.
A large number of clinical trials have been conducted throughout the world which demonstrate that acupuncture can increase IVF pregnancy rates and reduce anxiety related to infertility and the IVF process.
TCM focuses on the overall health of the parents with special emphasis on the kidney-Qi (energy) and jing (essence) as the kidneys are in charge of reproduction and development according to TCM. Typically for patients undergoing IVF and other Assisted Reproductive technologies (ART), Chinese herbal medicine is not preferred because the drugs that they are given are very strong and have unpredictable responses.
Chinese medicine are used to increases the thickness and the quality of the lining of the uterus. It does this by promoting corpus luteal function in producing high levels of progesterone and increasing blood flow to the uterus. Patients who take Chinese medicine before and after egg pick-up during IVF have high progesterone readings.
The use of acupuncture has a very good effect and enhances IVF results. There is no restriction with its use. Acupuncture is useful in facilitating movement in the fallopian tubes and preventing spasm of the fine muscles in the walls of the tubes.
A recent study published in Fertility and Sterility found that 26% of women undergoing IVF became pregnant following the procedure compared to 43% who received acupuncture before and after IVF. This represents a nearly 50% increase in effectiveness of IVF combined with acupuncture. Women in both groups were matched for age, number of transferred embryos and number of previous cycles among other criteria. As IVF is an expensive procedure, increasing pregnancy rates with acupuncture could save women both money as well as decrease emotional distress associated with the repeated use of this procedure.
According to another study recently published in the journal Medical Acupuncture, acupuncture may stimulate egg follicle development in women undergoing IVF. In a small study of six women who all had difficulty with follicle production despite maximum hormonal therapy, three produced significantly more follicles with acupuncture treatment and all three conceived, although only one pregnancy lasted past the first trimester. Acupuncture also appeared to increase estrogen levels.
By combining conventional and natural medicine, patients could increase their chances for assisted reproduction to be successful, and for the pregnancy to result in a healthy baby.
Reference List
- Lyttleton, Jane. Treatment of Infertility with Chinese Medicine. 2004. Churchill Livingstone. London, United Kingdom.
- Robinson, Bruce, MD. Biomedicine: A Textbook for Practitioners of Acupuncture and Oriental Medicine. 2007. Blue Poppy Press. Boulder, CO.
- Fritz, Marc and Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility. Eighth Edition. 2011. Lippincott Williams and Wilkins. Philadelphia, PA.
Luteal Phase Defect
By Karen Y. Gordon
A Luteal Phase Defect, also called “inadequate luteal phase” is described in western medicine as in terms of its symptoms such as shortened luteal phase or disrupted basal body temperatures. Generally we could describe that Luteal Phase Defect is a failure of the uterine lining to be in the right phase at the right time. Since embryo implantation is highly dependent on the state of the lining, Luteal Phase Defect can consistently interfere with a woman's ability to get pregnant and carry a pregnancy successfully.
In an ideal menstrual cycle, the body begins to produce follicle-stimulating hormone several days after the onset of menses. The increased levels of follicle-stimulating hormone result in the formation of a mature egg, containing follicle on one of the ovaries. When the follicle has adequately matured, a surge of luteinizing hormone is triggered.
This surge performs two interrelated functions. First, it prompts the follicle to burst and release the egg into the fallopian tube, where fertilization may take place and as the follicle begins to refill after bursting, the increased levels of LH cause the fluid inside the follicles to change into a thicker yellowish substance. This resulting structure is now called a corpus luteum rather than a follicle, and it is responsible for producing the hormone progesterone in the second half of the cycle. (Fritz, Marc and Speroff, Leon, 2011)
As a result of elevated progesterone levels, the uterine lining will thicken and develop additional blood vessels, which gives the embryo a place to attach. Progesterone will also prevent a premature onset of menses in which a pregnancy might be lost. In a normal menstrual cycle, the corpus luteum will produce progesterone for approximately twelve days. However, a normal cycle can be disrupted in several places. Three causes of Luteal Phase Defect could include poor follicle production, premature demise of the corpus luteum, and failure of the uterine lining to respond to normal levels of progesterone. These problems can also be found in conjunction with each other. Poor follicle production has its origins in the first half of the cycle. The body may not produce a normal level of FSH, or the ovaries do not respond strongly to the FSH, leading to inadequate follicle development. Because the follicle ultimately becomes the corpus luteum, poor follicle formation leads to poor corpus luteum quality. In turn, a poor corpus luteum will produce inadequate progesterone, causing the uterine lining to be adequately prepared for the implantation of a fertilized embryo. Ultimately progesterone levels may drop early and menses will arrive sooner than expected. Premature failure of the corpus luteum can occur even when the initial quality of the follicle/corpus luteum is adequate. There could be many possible reasons such as age, illness but also for reasons not wholly understood, the corpus luteum sometimes does not persist as long as it should. Initial progesterone levels at five to seven days past ovulation may be low; even if they are adequate, the levels drop precipitously soon thereafter, again leading to early onset of menses.
Progesterone is responsible for the rise in basal body temperature during the luteal phase. (Lyttleton, 2004) Women who monitor their basal body temperature will therefore often note that luteal phase temperatures do not stay reliably elevated for twelve days. Additionally, women who monitor the time of ovulation often notice that their next cycle begins sooner than the normal 12-14 days after ovulation.
Once a diagnosis of LPD is suspected, a serum progesterone test will often be performed at about seven days past ovulation. Should progesterone levels prove to be low, the temptation is often to "treat the symptom" by giving the patient progesterone supplementation during the luteal phase. In the case of inadequate corpus luteum performance, progesterone support may indeed be the appropriate solution. However, inadequate follicle development may also be causing the low progesterone levels. For this reason, it is important to measure mid-cycle follicle size (via ultrasound) and estradiol levels (via a blood test). If follicle development is normal, then progesterone supplementation during the luteal phase is normally the correct treatment. If follicle development is inadequate, an ovulatory stimulant such as Clomid or an injectable drug may be used at this time.
Some doctors use injections of human chorionic gonadotropin to further stimulate the corpus luteum. However, these injections can cause false positive pregnancy results. An endometrial biopsy is the gold standard in diagnosing LPD. However, especially in persistent cases, many doctors will use an endometrial biopsy. The endometrial biopsy is normally performed a few days before the next menstrual cycle is expected, ideally after a negative pregnancy result for the cycle has been obtained. The procedure consists of sampling a small amount of uterine lining and sending it to a pathologist for evaluation. Because the evaluation is done at a cellular level, the knowledge gained from it is at its most detailed and precise. The pathologist categorizes the lining as being typical of a particular cycle day. If this categorization is consistent with the actual cycle day that the sample was taken, the result is considered normal, and the uterine lining is in phase. If there is a discrepancy of more than two days, the lining will usually be considered out of phase.
Luteal Phase Defect (LPD) can lead to mistiming of the menstrual and ovulatory cycles, which must work together for conception and pregnancy to succeed. In cases of LPD, the uterine lining isn’t thick enough to sustained pregnancy. Also related to luteal phase defect is luteinized un-ruptured follicle (LUF) where a relatively mature follicle receives just enough luteinizing hormone to cause progesterone production, but not enough to cause the egg to release from the follicle.
Women who are concerned about the possibility of LPD are encouraged to use several cycles of BBT charting and other ovulation detection methods in an effort to enhance the diagnosis. Treating LPD is a matter of affecting the hormone levels in a timely manner, in hopes of bringing the menstrual and ovulatory cycles into sync with one another. Specifically the following may be used: Clomiphene citrate or injectable fertility medications Progesterone supplementation after ovulation injections of hCG to stimulate the corpus luteum for more natural progesterone supplementation.
In Traditional Chinese Medicine, we view and evaluate Luteal Phase Defect in relations with Kidney’s Yin and Yang deficiencies. TCM treatment included: Nourish the ‘Kidney yin/ yang” or both with herbs Coordination of yin and yang using both Chinese herbs and acupuncture are effective Regulation of qi and blood combination of tonification with reduction. After a complete history is taken and the precise imbalance is identified the appropriate herbs are combined to correct this imbalance. The luteal phase is slowly lengthened without any side effects.
In Traditional Chinese Medicine, Kidney is in charge of reproduction, and exuberant Kidney function is a prerequisite for menstruation and pregnancy. In western medicine, luteal phase defect associated with hypo-secretion of gonadotropic hormones is regarded as an important cause of infertility. Some modern pharmacological studies suggest that Kidney-tonifying herbs have a gonadotropic action.
In the four menstrual periods the Kidney-yin and yang decrease and increase, but at the same time they are interdependent. Therefore, such herbs as Yin Yang Huo and Zi He Che that tonify Kidney-yang could be added to the prescription of nourishing Kidney-yin in the post-menstrual period, and Nu Zhen Zi and Han Lian Cao were added to nourish Kidney-yin in the pre-menstrual treatment of tonifying Kidney-yang, with consequent improvement in symptoms and BBT. Regulation of Qi and blood: Free circulation of Qi and blood is a prerequisite for menstruation and pregnancy. Therefore, Qi and blood regulating herbs such as Dang Gui, Dan Shen, Xiang Fu, Mu Xiang and Wu Yao could be adopted to promote the circulation of Qi and blood for the regulation of menstrual cycles. Combination of tonification with reduction: The principle in treatment of luteal phase defect is tonification of Kidney-yin and -yang. However, potent tonics may impede the circulation of Qi therefore adding 12 g of Ze Xie in each prescription could be used in order to prevent excessive tonification.
Many studies now suggests that overall balancing of Kidney’s Yin and Yang with herbs as well as regular acupuncture treatments could improve LPD conditions with less or no side effect.
Reference List
- Lyttleton, Jane. Treatment of Infertility with Chinese Medicine. 2004. Churchill Livingstone. London, United Kingdom.
- Robinson, Bruce, MD. Biomedicine: A Textbook for Practitioners of Acupuncture and Oriental Medicine. 2007. Blue Poppy Press. Boulder, CO.
- Fritz, Marc and Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility. Eighth Edition. 2011. Lippincott Williams and Wilkins. Philadelphia, PA.
What is Prometrium?
By Karen Y. Gordon
According to the Prometrium drug website, Prometrium is an FDA-approved micronized progesterone made from plant sources. It is structurally identical to the naturally occurring progesterone produced by a woman's body. Progesterone belongs to a class of hormones called progestogens, and is the major naturally occurring human progestogen (Prometrium. Retrieved from http://www.prometrium.com/patient).
Speroff and Fritz (2005) stated that like other steroids, progesterone consists of four interconnected cyclic hydrocarbons. Progesterone contains ketone and oxygenated functional groups, as well as two methyl branches. Like all steroid hormones, it is hydrophobic. Progesterone exerts its primary action through the intracellular progesterone receptor although a distinct, membrane bound progesterone receptor has also been postulated. In addition, progesterone is a highly potent antagonist of the mineral corticoid receptor and it prevents mineral corticoid receptor activation by binding to this receptor with an affinity exceeding even those of aldosterone and other corticosteroids such as cortisol and corticosterone
Progesterone has a number of physiological effects that are amplified in the presence of estrogen. Estrogen through estrogen receptors up-regulates the expression of progesterone receptors. Also, elevated levels of progesterone potently reduce the sodium-retaining activity of aldosterone, resulting in natriuresis and a reduction in extracellular fluid volume (Wikepedia. Retrieved from http://en.wikipedia.org/wiki/Progesterone).
Progesterone withdrawal, on the other hand, is associated with a temporary increase in sodium retention (reduced natriuresis, with an increase in extracellular fluid volume) due to the compensatory increase in aldosterone production, which combats the blockade of the mineralocorticoid receptor by the previously elevated level of progesterone (Wikepedia. Retrieved from http://en.wikipedia.org/wiki/Progesterone).
In reproductive system, since eggs release progesterone, sperm may use progesterone as a homing signal to swim toward eggs (chemotaxis). Hence substances that block the progesterone binding site on CatSper channels could potentially be used in male contraception. Progesterone is sometimes called the "hormone of pregnancy", and it has many roles relating to the development of the fetus. Progesterone converts the endometrium to its secretory stage to prepare the uterus for implantation. At the same time progesterone affects the vaginal epithelium and cervical mucus, making it thick and impenetrable to sperm. If pregnancy does not occur, progesterone levels will decrease, leading to menstruation (Speroff & Fritz, 2005).
Normal menstrual bleeding is progesterone-withdrawal bleeding. If ovulation does not occur and the corpus luteum does not develop, levels of progesterone may be low, leading to anovulatory dysfunctional uterine bleeding. During implantation and gestation, progesterone appears to decrease the maternal immune response to allow for the acceptance of the pregnancy.
Progesterone decreases contractility of the uterine smooth muscle (Speroff & Fritz, 2005).
In addition progesterone inhibits lactation during pregnancy. The fall in progesterone levels following delivery is one of the triggers for milk production. A drop in progesterone levels is possibly one step that facilitates the onset of labor. The fetus metabolizes placental progesterone in the production of adrenal steroids. In nervous system, progesterone like pregnenolone and dehydroepiandrosterone, belongs to the group of neurosteroids. It can be synthesized within the central nervous system and also serves as a precursor to another major neurosteroid, allopregnanolone. Neurosteroids affects synaptic functioning, are neuroprotective, and affect myelination. They are investigated for their potential to improve memory and cognitive ability (Speroff & Fritz, 2005). It also increases core temperature (thermogenic function) during ovulation. It reduces spasm and relaxes smooth muscle. Bronchi are widened and mucus regulated. Progesterone receptors are widely present in submucosal tissue. It also acts as an anti-inflammatory agent and regulates the immune response. It can however reduce gall-bladder activity. It can also normalize blood clotting and vascular tone, zinc and cooper levels, cell oxygen levels, and use of fat stores for energy. It may affect gum health, increasing risk of gingivitis (gum inflammation) and tooth decay. It also appears to prevent endometrial cancer (involving the uterine lining) by regulating the effects of estrogen (Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Progesterone).
Progesterone is sometimes used with another medication (a type of estrogen) as combination hormone replacement therapy (HRT) in women after menopause. Combination HRT can rarely cause very serious side effects such as heart disease such as heart attacks, stroke, serious blood clots in the lungs and legs, dementia, and breast cancer. Some of these risks appear to depend on the length of treatment and other factors. Therefore, combination HRT should be used for the shortest possible length of time at the lowest effective dose so you can obtain the benefits and minimize the chance of serious side effects from long-term treatment. Combination HRT should not be used to prevent heart disease or dementia (Drug information online. Retrieved from http://www.drugs.com/cdi/prometrium.html)
The dosage is based on your medical condition and response to therapy. Side effects could include nausea, bloating, breast tenderness, headache, change in vaginal discharge, mood swings, blurred vision, dizziness, or drowsiness may occur. A very serious allergic reaction to this drug is rare but before taking progesterone, but this product may contain inactive ingredients (such as peanut oil), which can cause allergic reactions or other problems dementia (Drug information online. Retrieved from http://www.drugs.com/cdi/prometrium.html)
This medication should not be used if you have certain medical conditions such as history of blood clots, history of bleeding in the brain, liver disease, cancer of the breast or other female organs, vaginal bleeding of unknown cause, a loss of pregnancy with some tissue remaining in the uterus ("missed abortion”) recent stroke or heart attack (within 1 year). This drug may make you dizzy or drowsy. Driving, use machinery, or do any activity that requires alertness should be avoided. Alcoholic beverages should be limited or avoided. Smoking combined with this medication further increases your risk for strokes, blood clots, high blood pressure, and heart attacks. This medication may cause blotchy, dark areas on your skin (melasma). Sunscreen and protective clothing is necessary when outdoors for sunlight may worsen the effect of melasma. This medication may be used during pregnancy only as directed by a doctor. There is conflicting information about whether progestins may cause harm to an unborn baby for this drug passes into breast milk dementia. Drugs and herbs affecting liver enzymes that remove progesterone from your body such as rifampin, St. John's wort, azole antifungals including itraconazole, certain anti-seizure medicines including carbamazepine, phenobarbital, phenytoin should be used with caution (Drug information online. Retrieved from http://www.drugs.com/cdi/prometrium.html)
Because progestational drugs may cause some degree of fluid retention, patients with the following conditions may be affected and should be closely monitored: epilepsy, migraines, asthma, and cardiac, or renal dysfunction. A decrease in glucose tolerance has been observed in a small percentage of patients taking estrogen-progestin combination treatment. Diabetic patients should be carefully monitored while receiving progesterone therapy in combination with estrogen. Progesterone gel should not be used concurrently with other local intravaginal therapy. There should be a time interval of at least 6 hours before or after the use of the gel (Speroff & Fritz, 2005).
When given in combination with estrogen, the administration of progesterone is started after 2 weeks of estrogen therapy. Recent published studies support the hypothesis that progesterone supplementation reduces preterm birth in women at high-risk. The American College of Obstetricians and Gynecologists Committee on Obstetric Practice has issued an opinion on the use of progesterone to reduce preterm birth. The committee believes that further studies are needed to evaluate the use of progesterone in patients with other high-risk obstetric factors (Lyttleton, 2004).
Progesterone, if used, should be restricted to only women with a documented history of a previous spontaneous birth at less than 37 weeks of gestation, because optimal route of administration and long-term safety of the drug remain to be resolved (Speroff, S. L., & Fritz, M. A., 2005).
Reference List
- Lyttleton, J. (2004). Treatment of infertility with Chinese Medicine. London, England: Churchill Livingston Elsevier. Speroff, S. L., & Fritz, M. A., (2005). Clinical Gynecologic Endocrinology and Infertility. Philadelphia, PA: Lippincot, Williams & Wilkins.
- http://www.drugs.com/cdi/prometrium.html
- http://en.wikipedia.org/wiki/Progesterone
- http://www.prometrium.com/patient/AboutPrometrium.aspx
Endocrine system and TCM
By Karen Y. Gordon
The general definition of a hormone could be said to be a substance that is produced in a special tissue or a chemical that endocrine glands send throughout the body. It could also be described as a substance that is produced in a special tissue and is released into the bloodstream to travel to distant responsive cells, where the hormones show its characteristic effects.
Generally speaking, hormones (which can be protein or lipid in nature) affect growth, puberty, metabolism, weight, figure, shape, physical appearance, reproductive behavior, and emotions. Hormones and neurotransmitters are means of communication to maintain balance throughout the body. When animals evolved into complex organisms, special glands developed to produce hormones that could be used in a more sophisticated fashion. Every cell contains the genes necessary for hormonal expression and this communication can also be viewed as chemical regulatory and signaling agents. Hormones travel through the bloodstream to distant sites as wells local sites to communicate. Three important local sites for communications are paracrine, autocrine and intracrine.
Paracrine communication is an intercellular communication involving the local diffusion of regulating substances from a cell to nearby cells. Autocrine communication is an intracellular communication whereby a single cell produces regulating substances that in turn act upon receptors on or within the same cell. Intracrine communication is a form of intercellular communication that occurs when un-secreted substances bind to intracellular receptors, a regulating factor within the cell that secretes it.
The endocrine system influences almost every cell organ and function of our bodies. The endocrine system is instrumental in regulating mood, growth and development, tissue function, metabolism, sexual function and reproductive processes. In general, the endocrine system is in charge of body processes that happen slowly, such as cell growth. Faster processes like breathing and body movement are controlled by the nervous system. Though the nervous system and endocrine system are separate systems, they often work together to help the body function properly.
The foundations of the endocrine system are the hormones and glands. As the body's chemical messengers, hormones transfer information and instructions from one set of cells to another. Many different hormones move through the bloodstream, but each type of hormone is designed to affect only certain cells. A gland is a group of cells that produces and secretes, or gives off, chemicals. It selects and removes materials from the blood, processes them, and secretes the finished chemical product for use somewhere in the body.
Some types of glands release their secretions in specific areas. Exocrine glands, such as the sweat and salivary glands, release secretions in the skin or inside the mouth. Endocrine glands, on the other hand, release more hormones directly into the bloodstream where they can be transported to cells in other parts of the body. The major glands that make up the human endocrine system include: hypothalamus, pituitary gland, thyroid, parathyroid, adrenal glands, pineal body and reproductive glands, which include the ovaries and testes.
The hypothalamus, a collection of specialized cells that is located in the lower central part of the brain, is the main link between the endocrine and nervous systems. Nerve cells in the hypothalamus control the pituitary gland by producing chemicals that either stimulate or suppress hormone secretions from the pituitary. No bigger than a pea, the pituitary gland, located at the base of the brain just beneath the hypothalamus, is considered the most important part of the endocrine system. It's often called the "master gland" because it makes hormones that control several other endocrine glands.
The production and secretion of pituitary hormones can be influenced by factors such as emotions and changes in the seasons. The hypothalamus provides information sensed by the brain such as environmental temperature, light exposure patterns, and feelings to the pituitary. The tiny pituitary is divided into two parts: the anterior lobe and the posterior lobe. The anterior lobe regulates the activity of the thyroid, adrenals, and reproductive glands. It also produces hormones such as growth hormone, which stimulates the growth of bone and other body tissues and plays a role in the body's handling of nutrients and minerals. Prolactin activates milk production in women who are breastfeeding. Thyrotropin stimulates the thyroid gland to produce thyroid hormones and corticotropin stimulates the adrenal gland to produce certain hormones.
The pituitary also secretes endorphin chemicals that act on the nervous system and reduce feelings of pain. Further, the pituitary secretes hormones that signal the reproductive organs to make sex hormones. It also controls ovulation and the menstrual cycle in women. The posterior lobe of the pituitary releases antidiuretic hormone, which helps control the balance of water in the body. The posterior lobe also produces oxytocin, which triggers the contractions of the uterus in a woman having a baby.
The thyroid, located in the front part of the lower neck, is shaped like a bow tie or butterfly and produces the thyroid hormones thyroxine and triiodothyronine. These hormones control the rate at which cells burn fuels from food to produce energy. The production and release of thyroid hormones is controlled by thyrotropin, which is secreted by the pituitary gland. The more thyroid hormone there is in a person's bloodstream, the faster chemical reactions occur in the body. Also thyroid hormones play an important role in child bone growth and development, and they also play a role in the development of the brain and nervous system in kids.
Attached to the thyroid are four tiny glands that function together called the parathyroid. They release parathyroid hormone, which regulates the level of calcium in the blood with the help of calcitonin, which is produced in the thyroid. The body also has two triangular adrenal glands, one on top of each kidney. The adrenal glands have two parts, each of which produces a set of hormones and has a different function. The outer part, the adrenal cortex, produces hormones called corticosteroids that influence or regulate salt and water balance in the body, the body's response to stress, metabolism, the immune system, and sexual development and function. The inner part, the adrenal medulla, produces catecholamines, such as epinephrine. Also called adrenaline, epinephrine increases blood pressure and heart rate when the body experiences stress. The pineal body, also called the pineal gland, is located in the middle of the brain. It secretes melatonin, a hormone that may help regulate when you sleep at night and when you wake in the morning.
The gonads are the main source of sex hormones. Most people do not realize it, but both sexes have gonads. In males the gonads, or testes are located in the scrotum. They secrete hormones called androgens the most important of which is testosterone. These hormones tell the male body when it is time to make the changes associated with puberty, like penis and height growth, deepening of voice, and growth in facial and pubic hair. Working with hormones from the pituitary gland, testosterone also tells the male body when it is time to produce sperm in the testes.
The female gonads, the ovaries, are located in her pelvis. They produce eggs and secrete the female hormones estrogen and progesterone. Estrogen is involved when a girl begins to go through puberty. During puberty, a girl will experience breast growth, begin to accumulate body fat around the hips and thighs, and experience a growth spurt. Estrogen and progesterone are also involved in the regulation of the menstrual cycle. These hormones also play a role in pregnancy.
Although the endocrine glands are the body's main hormone producers, some other organs not in the endocrine system such as the brain, heart, lungs, kidneys, liver, and skin, also produce and release hormones. The pancreas is also part of the body's hormone-secreting system, even though it is also associated with the digestive system because it produces and secretes digestive enzymes. The pancreas produces in addition to others, two important hormones, insulin and glucagon. They work together to maintain a steady level of glucose, or sugar, in the blood and to keep the body supplied with fuel to produce and maintain stores of energy.
Once a hormone is secreted, it travels from the endocrine gland that produced it through the bloodstream to the cells designed to receive its message. These cells are called target cells. Along the way to the target cells, special proteins bind to some of the hormones. These proteins act as carriers that control the amount of hormone that is available for the cells to use. The target cells have receptors that latch onto only specific hormones, and each hormone has its own receptor, so that each hormone will communicate only with specific target cells that have receptors for that hormone. When the hormone reaches its target cell, it locks onto the cell's specific receptors and these hormone receptor combinations transmit chemical instructions to the inner workings of the cell. When hormone levels reach a certain normal amount, the endocrine system helps the body to keep that level of hormone in the blood.
For example, if the thyroid gland has secreted the right amount of thyroid hormones into the blood, the pituitary gland senses the normal levels of thyroid hormone in the bloodstream. Then the pituitary gland adjusts its release of thyrotropin, the hormone that stimulates the thyroid gland to produce thyroid hormones. Another example of this process is parathyroid hormone. Parathyroid hormone increases the level of calcium in the blood. When the blood calcium level rises, the parathyroid glands sense the change and reduce their secretion of parathyroid hormone. This turnoff process is called a negative feedback system. Too much or too little of any hormone can be harmful to your body. For example, if the pituitary gland produces too much growth hormone, a teen may grow excessively tall. If it produces too little, a teen may be unusually short.
In Traditional Chinese Medicine, hormones could be closely linked with internal regulation of storing and secreting of Essence. And generally speaking, the kidney is the organ that stores the Essence that we inherited from our parents. It is believed that physical and mental over-exertion could deplete Essence and further weaken the kidney. This could lead to imbalance, which would lead to illness. The similar functions are performed by the hypothalamic-pituitary axis of the endocrine system in that the capacity to grow, mature, reproduce, maintain stability, generate blood and marrow, adapt to stress, repair body tissues are governed by the kidney. Inherited and acquired Essence, pooled within the reservoir of the kidney, are stored and dispensed as needed. When Essence is plentiful, our ability to resist disease and adapt to change is optimal. Essence is the origin of all Yin which could be describe as blood and moisture and Yang which could mean Qi and Warmth. Loss of libido, stamina, hearing, and vision, lower back pain, sore hips or knees, apathy, despair, dull mindedness, memory problems, vaginal dryness and atrophy, thinning of bones, and deterioration of teeth and gums are all symptoms of deficient Essence. When Essence becomes depleted, so do Blood and Qi, Yin and Yang. Lack of Qi produces fatigue, weakness, dull thinking, melancholy, and decreased motivation. When kidney Essence declines, deficiencies would eventually impact the liver, heart, spleen, and lung. When kidney yang is weak, the spleen becomes unable to extract the necessary nutrients to generate adequate moisture and blood. This results in dryness (dry eyes, skin, hair, and vagina, brittle nails, constipation, even cystitis). This in turn undermines shen-jing (heart essence), the unified relationship between heart and kidney, mind and essence. Therefore, kidney yang deficiency leads to spleen weakness, causing symptoms such as lethargy, weakness, easy bruising, poor concentration, fluid retention, indigestion and bloating. It also leads to a weakening of the kidney's capacity to anchor the qi, permitting true yang to leave its proper place in the lower burner and surge upward, producing agitation, flushing and perspiration, followed by chilliness, weakness, and fatigue. Many women have signs of both kidney yin and yang depletion with such symptoms as hot flashes, sweating, agitation, and dryness.
In Traditional Chinese Medicine, balancing the patient’s body and mind is often discussed and applied in treatment. Much like the TCM treatment principle, endocrine system has this similar idea of trying to keep things balanced and regulated within the bodily system. Therefore, when discussing Essence, I think that the kidney’s functions and its relations with Essence should include every aspect of the Western understanding of endocrine system.
I feel that with acupuncture treatment, we trigger the part of the endocrine system as well to release and inhibit proper hormones to reach a calming physical as well as a mental state. A part of a endocrine system is very much dependent upon exterior environment changes including stress. Therefore, acupuncture and herbal treatment could help not only to regulate the endocrine system by encouraging proper bodily flow, but to calm the mind so that the body could naturally reach balance for a better sense of being.
Reference List
- Lyttleton, Jane. Treatment of Infertility with Chinese Medicine. 2004. Churchill Livingstone. London, United Kingdom.
- Robinson, Bruce, MD. Biomedicine: A Textbook for Practitioners of Acupuncture and Oriental Medicine. 2007. Blue Poppy Press. Boulder, CO.
- Fritz, Marc and Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility. Eighth Edition. 2011. Lippincott Williams and Wilkins. Philadelphia, PA.
Treating Endometriosis with TCM
By Karen Y. Gordon
According to the Journal of the American Medical Association (JAMA), endometriosis affects approximately 5 to 7 million American women. Most of the women affected are between the ages of 30 and 40. Some women are debilitated by this condition while others may have mild to no symptoms. It affects 10-15% of women of childbearing age in the U.S and is even more common in women of Asian descent, although it affects women of all races.
Endometriosis is a disorder in which the cells that form the lining of the uterus or endometrium grow outside the uterus. It is a non-cancerous condition and in Western medicine, the cause is unknown. Theories as to what causes it abound in Western medical texts. The cause of endometriosis is unclear in conventional medicine, although there are many theories. There are major three theories. First theory is that small bits of menstrual tissue flow backward into the fallopian tubes and out into the abdominal cavity where they seed with hormonal stimulation and begin to grow. Second theory is that cells from the uterine lining may be transported through the bloodstream into other locations where they seed and grow. Third theory is that cells outside the uterus may change into uterine cells with hormonal stimulation in those who are genetically predisposed. Each month the endometrium builds up in the uterus then breaks down and sheds off, resulting in vaginal bleeding or menstruation. It is speculated that this same cycle occurs with the endometrial tissue located outside the uterus. However, endometrial tissue outside the uterus that sheds off and bleeds is trapped inside the body and is slowly absorbed. This process can create pain and inflammation and may lead to the development of local lesions, masses, and larger amounts of endometriosis. Common locations for the growth of this abnormal endometrial tissue are the ovaries and ligaments that support the uterus. Less common locations are the outer surface of the colon and small intestines, the ureters, bladder, vagina, pleura of the lungs, and pericardium.
The symptoms of endometriosis depend on where the tissue is growing. Pelvic pain is the most common symptom followed by heavy menstrual bleeding, dyspareunia, and pain with bowel movements. Rectal bleeding is not unusual as a result of this condition, as is pain with urination. Also women with endometriosis are often unable to conceive. Women with endometriosis may experience pelvic pain 5-7 days before menstruation, during menstruation or with ovulation. Many women experience low back pain with periods, nausea, vomiting, intestinal upsets, fatigue, pain with sexual intercourse, and pain with urination or bowel movements.
It is estimated that 30 to 40 percent of women who report infertility problems have endometriosis. The most common symptoms of Endometriosis are pain before and during periods, pain with intercourse, general, chronic pelvic pain throughout the month, low back pain, heavy and/or irregular periods, painful bowel movements, especially during menstruation, painful urination during menstruation, fatigue, infertility, diarrhea or constipation. Other symptoms include headaches, low-grade fevers, depression, hypoglycemia (low blood sugar), anxiety and susceptibility to infections, allergies.
One of the biggest problems regarding Endometriosis is that the signs of this disease in the early stages appear to be the normal bodily changes that take place with the menstrual cycle. It is only as time goes by that a woman begins to suspect that what is happening, and the symptoms she feels, are not normal. The pain of her menstrual cycle gradually and steadily becomes worse and worse as the months go by. This is only the beginning of what will become a gradual decline in a woman’s general health, as well as the health of her reproductive system. However, there are odd instances where some women do actually have Endometriosis, but they are nearly free of any symptoms. These women will only be diagnosed by default, for example when they have surgery for other issues, and only then is Endometriosis found. That is what makes this disease so enigmatic, difficult to interpret or understand. Endometriosis does not follow any distinct pattern, which is why it is difficult for the medical profession to know that a woman has the disease. Some of the symptoms will mimic those of other health problems, including ovarian cysts, ectopic pregnancy, pelvic Inflammatory disease, irritable bowel syndrome, ovarian cancer, fibroid tumors, colon cancer and appendicitis.
Endometriosis is diagnosed through a laparoscopy. This procedure allows the surgeon to see inside the abdominal cavity through a tiny-lighted optical tube that is inserted through a small incision in the navel. Part of the problem that causes the delay in diagnosis of Endometriosis is that many people in the medical profession are not fully aware of the extent of this disease today. There are a variety of methods that can be used to assess whether a woman has Endometriosis, but laparoscopy is the only reliable way to confirm the presence of the disease is by visually inspecting the abdominal organs. Before a laparoscopy is done a full gynecological evaluation should be done covering the patient’s medical history. Diagnosis methods of Endometriosis can include physical examination and a pelvic examination. These examinations involve the physician feeling and looking for abnormalities that are associated with endometriosis. Physical findings depend on the severity and location of the disease. There may be palpable nodules or tenderness in the pelvic region, enlarged ovaries, a tipped-back (retro-displaced) uterus, or lesions on the vagina or on surgical scars. Danazol (derivative of the synthetic steroid ethisteron) is taken for 6 weeks prior to an operation to shrink the endometrial growths and ease the surgical removal. Following surgical removal of endometrial tissue, birth control pills may be prescribed that contain both estrogen and progesterone, to be taken continuously for up to nine months. This will induce a pseudo-pregnancy, with the aim to allow the body time to rest and heal.
In Traditional Chinese medicine, Endometriosis is understood based on the differentiated clinical manifestations associated with each individual. It is important in TCM to diagnose the patient according to his or her own specific pattern. Each individual has a pattern that marks the foundation and progression of the disorder. Traditional Chinese medicine (TCM), including acupuncture and herbs has been used successfully in treating a wide range of female health disorders including endometriosis. The primary aim of the TCM doctor in the treatment of endometriosis has always been to remove blood stagnation. Endometriosis is a Western medical label not TCM, but the scientific medical understanding of this diseases has contributed to the notion that this is a diseases characterized by blood being where it shouldn’t and unable to escape the body. Symptoms such as severe stabbing period pain, clotty menstrual flow and palpable nodules or masses in the abdomen appear to verify the diagnosis of stagnation blood.
TCM doctors treatment protocols in infertility clinics in China, doctors found that more pregnancies resulted if treatment of women with endometriosis targeted the kidney for endometriosis lesions that can produce secretions which clog up the system (phlegm damp in TCM) also boosting Kidney Yang is generally rather effective at clearing such phlegm damp. In TCM, more attention is paid to moving blood, clearing stasis and breaking up masses during the period and fortifying the Kidney Yang and moving Blood at ovulation. If there is such severe stagnation that a pregnancy is impossible, then treatment will focus on the stagnation during the entire cycle. We know that menstrual blood travels not only downwards from the uterus and out through the cervix but also upwards through the fallopian tubes and out into the peritoneal cavity. This small quantity of blood carries with it bits of discarded endometrium. Women with strong uterine cramps due to Liver Qi Stagnation are more likely to close more menstrual flow upwards through the tubes. The blood and the tissue will either be reabsorbed or will remain and establish itself somewhere in the pelvic cavity. If Kidney Yang is strong, then movement of Qi in the pelvis will mobilize the menstrual debris, which shouldn’t be there and it will be reabsorbed. So Weakness of Kidney Yang will allow the accumulation of blood and tissue, which creates stagnation. The pattern that suggests endometriosis is when temperature does not drop very much when the period comes, or if it does drop it may start to go up again after 1-2days. These patterns indicate that the switch to Yin from Yang has not been on time or complete. These patterns all indicate inadequate Kidney Yang function.
According to the Lyttleton’s “Treatment of Infertility with Chinese Medicine”, the treatments would be divided into three phases, post-menstruation, ovulation and post ovulation. During post-menstruation, build blood and reinforce the Yin by using such formula as Gui Shao Di Huang Tang with Shu Di 12g, Shan Yao 10g, Shan Zhu Yu 10g, Fu Ling 10g, Mu Dan Pi 10g, Ze Xie 12g, Dang Gui 10g, Bai Shao 10g. Add Yang Tonics in small doses on day 8-9 with herbs such as Tu Si Zi 5g, Rou Cong Rong 5g, Xu Duan 5g. Also use high doses if Yang deficiency is predominant with such herbs as Tu Si Zi 10g, Rou Cong Rong 10g. If blood Stagnation predominant add Chi Shao 10g, Sheng Shan Zha 15g, Tao Ren 5g, Hong Hua 5g, Wu Ling Zhi 5g. Recommended acupuncture treatment would include KD13, Ren 7, KD14, KD18, Ren3, Ren4, SP6, LV8, Ren12. During ovulation phase, treatment such as dispeling blood stagnation and resolve masses would be applied along with Wen Yang Hua Yu Fang (Warm Yang And Transform Stasis Formula) with Dang Gui, Chi Shao, Bai Shao, Shan Yao, Shu Di, Nu Zhen Zi, Mu Dan Pi, Fu Ling, Xu Duan, Tu Si Zi, Wu Ling Zhi all 10g and Hong Hua 5g. For more blood moving add Shan Zha 10g, Dan Shen 10g
And for abdominal masses with strong patient with no desire for conception add San Leng 5g, E Zhu 5g. To clear LV Qi Stagnation with Damp and SP Qi Deficiency add Cang Zhu 10g, Chen Pi 5g, Fu Ling 10g, Zhi Ke 10g, Xiang Fu 10g and acupuncture treatment with LV3, LV11, ST29, Zi Gong Xue, SP12, SP13 may be used. During post-ovulation, promote qi to build yang treatment is used with Jian Gu Tang modified (Strengthen and Consolidate Decoction) with Dang Shen, Bai Zhu, Shan Yao, Yi Yi Ren, Tu Si Zi, Ba Ji Tian, Lu Jiao Pian all 10g. For masses to reinforce KD Yang add Wu Ling Zhi 5g, Dan Shen 10g, Sheng Shan Zha 10g with acupuncture treatment with Ren4, KD3, ST29, BL23, PC7, LV2, SP1, HT7 could be used.
Diet changes can help reduce the symptoms of endometriosis. According to “ Endometriosis Diet” by Levett, Carolyn, increasing omega-3 fatty acids, fiber and avoiding meat, dairy products, wheat and sugar, modulate estrogen. Also avoid caffeine and alcohol, refined foods, e-numbers, additives, minimize or avoid soy products seem to help patients with Endometriosis.
The origin of the pattern differs according to the individual. Other factors need to be taken into consideration when determining the pattern for endometriosis such as emotional stress, anxiety, constitutional weakness, surgical history, exposure to cold temperatures especially during menstruation, diet, chronic illness or weakness, or a history of genital infections. Understanding these patterns could produce more comprehensive treatment approach to dealing with Endometriosis.
Reference List
- Lyttleton, Jane. Treatment of Infertility with Chinese Medicine. 2004. Churchill Livingstone. London, United Kingdom.
- Robinson, Bruce, MD. Biomedicine: A Textbook for Practitioners of Acupuncture and Oriental Medicine. 2007. Blue Poppy Press. Boulder, CO.
- Fritz, Marc and Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility. Eighth Edition. 2011. Lippincott Williams and Wilkins. Philadelphia, PA.
- Levett, Carolyn. Recipes for the Endometriosis Diet: A Comprehensive Diet Resource for Women with Endometriosis. 2008. Endo Resolved
PCOS (Polycystic ovarian syndrome)
By Karen Y. Gordon
Polycystic ovarian syndrome is a common health problem that can affect teenage girls and women. Although no one really knows what causes PCOS, it seems to be related to an imbalance in hormones.
Both girls and guys produce sex hormones, but in different amounts. In girls, the ovaries produce the hormones estrogen and progesterone, and also androgens. These hormones regulate a girl's menstrual cycle and ovulation when the egg is released. Even though androgens are sometimes referred to as "male hormones," every female produces them. In girls with PCOS, the ovaries produce higher than normal amounts of androgens, and this can interfere with egg development and release. Sometimes instead of the eggs maturing, cysts, which are little sacs filled with liquid, develop. Instead of an egg being released during ovulation, like during a normal menstrual cycle, the cysts build up in the ovaries and may become enlarged. Because girls with PCOS are not ovulating or releasing an egg each month, it's common for them to have irregular or missed periods.
Research has suggested that PCOS may be related to increased insulin production in the body. Women with PCOS may produce too much insulin, which signals their ovaries to release extra male hormones. PCOS seems to run in families, too, so if someone in the family has it, the likely would increases.
If PCOS is not treated properly, there could be other complications. Girls with PCOS are more likely to have infertility, excessive hair growth, acne, obesity, diabetes, heart disease, high blood pressure, abnormal bleeding from the uterus, and even cancer. The good news is that, although there's no cure for PCOS, it can be treated.
The most important step is diagnosing the condition, because getting treatment for PCOS reduces a girl's chances of having serious side effects. A key sign of PCOS is irregular or missed periods because the effects of the condition on the ovaries can make a girl stop ovulating. However, because it can take up to two years after her first period for a girl's menstrual cycle to become regular, it can be hard to recognize missed periods as a sign of PCOS in teen girls. Imbalanced hormone levels can cause changes in a girl's entire body, not just her ovaries. So doctors also look for these other signs that might indicate PCOS such as very heavy periods or irregular periods, weight gain, obesity, or difficulty maintaining a normal weight, especially when the extra weight is concentrated around the waist. Also a condition called hirsutism, where a girl grows extra hair on her face, chest, abdomen, nipple area, or back could be another sign of PCOS however, a little of this is normal for most girls but thinning hair on the head also called alopecia, acne and clogged pores, darkened, thickened skin around the neck, armpits, or breasts also called acanthosis nigricans, high blood pressure, high cholesterol, or diabetes mellitus (high levels of sugar in your blood) could raises the signal for PCOS.
Also girls who show certain signs of puberty early, such as girls who develop underarm or pubic hair before the age of 8 may be at greater risk of having PCOS later on as well. A gynecologist or an endocrinologist generally diagnoses polycystic Ovary Syndrome. The gynecologist or endocrinologist will ask about any concerns and symptoms a patient might have along with past health, family's health, any medications the patient might be taking, any allergies, and other issues. Doctors also ask you lots of questions specifically about the patient’s period and its regularity. In addition to your medical history, the doctor will do a physical examination, which includes checking the weight, and checking especially for physical signs such as acne, hair growth, and darkened skin. The doctor may also perform a gynecologic examination to rule out other possible causes of your symptoms, but this is not always necessary for diagnosis. A doctor may also perform blood tests to diagnose PCOS or other conditions, such as thyroid or other ovarian or gland problems. Blood tests allow doctors to measure androgen, insulin, and other hormone levels. The results of these tests can help doctors to determine the type of treatment a girl will receive. Depending on the circumstance, a doctor also might order an ultrasound to look at the patient’s ovaries and to determine if there exist any cysts or other abnormalities of the ovaries. Because cysts are not always visible, this test is not always used.
Early diagnosis and treatment for PCOS are important because the condition can put girls at risk for long-term problems. Getting treated for PCOS is important for fertility reasons. PCOS often causes infertility if it's not treated. But when PCOS is treated properly, many women with the condition could go on to have healthy babies.
Also, many girls with PCOS can get pregnant. Therefore, if a girl is sexually active, she needs to use condoms every time having sex in order to avoid getting pregnant or getting a sexually transmitted disease. Although there's no cure for PCOS, there are several ways that the condition can be treated and managed. If a girl is overweight or obese, a doctor will recommend that she lose weight. Weight loss can be very effective in lessening many of the health conditions associated with PCOS, such as high blood pressure and diabetes. Sometimes weight loss alone can restore hormone levels to normal, causing many of the symptoms to disappear or become less severe.
There are many literatures that suggest how to better exercise and also how to tailor an activity for a weight-loss program for PCOS patients. Exercise is a great way to help combat the weight gain that often accompanies PCOS as well as a way to reduce bloating, another symptom girls with PCOS sometimes experience. Sometimes doctors do prescribe medications to treat PCOS. A doctor might first have a girl try birth control pills or another hormone pill called progesterone to help control hormone levels in her body and regulate her menstrual cycle. Birth control pills may help control acne and excessive hair growth in some girls, but they don't work for everyone.
Other medications used to treat PCOS include anti-androgens, which counter the effects of excess androgens on a girl's body. Anti-androgens can help clear up skin and hair growth problems in girls with PCOS. Another medication, metformin, which is used to treat diabetes, can lower insulin levels. In some girls with PCOS, it can help control ovulation and androgen levels. This can make a girl's menstrual cycles more regular. Some girls and women treated with metformin have also experienced weight loss and lowering of high blood pressure.
Having PCOS can be hard on a girl's self-esteem because some of the symptoms, such as skin and hair problems and weight gain, can be noticeable. Fortunately, there are things that could be done to reduce the physical symptoms and take care of the emotional side of living with PCOS. Although the medications used to treat PCOS will slow down or stop excessive hair growth for many girls, different types of products and precedures available to help a girl get rid of hair where she doesn't want it.
In severe acne symptom of PCOS, it may improve if part of the treatment includes birth control pills or anti-androgens. If it doesn't, a dermatologist could help for further acne treatment. A dermatologist may also be able to recommend medications to help reduce skin darkening or discoloration, and to prevent hair growth. Some girls with PCOS may become depressed, in which case it may help to talk to a therapist or other mental health professional. Talking with other teens and women with PCOS is a great way to share information about treatment and get support.
In Traditional Chinese Medicine, PCOS could be viewed as blood stasis when there’s pain along with irregularity of menstrual cycle and also the depletion of Essence. To address these concerns, two major organs are focused, liver and kidneys. TCM has successfully treated PCOS with its traditional individual approach by addressing each patient’s different needs. Generally, acupuncture treatment are used to boost the bodily function to remove the stagnation that causes cysts and herbs are also used to support and supplement the acupuncture treatment by nourishing the body to regulate bodily functions such as strengthening organs, removing obstruction and balancing hormones.
In Traditional Chinese Medicine, hormones could be closely linked with internal regulation of storing and secreting of Essence. And generally speaking, the kidney is the organ that stores the Essence that we inherited from our parents. It is believed that physical and mental over-exertion could deplete Essence and further weaken the kidney. This could lead to imbalance, which would lead to illness. The similar functions are performed by the hypothalamic-pituitary axis of the endocrine system in that the capacity to grow, mature, reproduce, maintain stability, generate blood and marrow, adapt to stress, repair body tissues are governed by the kidney. Inherited and acquired Essence, pooled within the reservoir of the kidney, are stored and dispensed as needed. When Essence is plentiful, our ability to resist disease and adapt to change is optimal. Essence is the origin of all Yin which could be describe as blood and moisture and Yang which could mean Qi and Warmth. Loss of libido, stamina, hearing, and vision, lower back pain, sore hips or knees, apathy, despair, dull mindedness, memory problems, vaginal dryness and atrophy, thinning of bones, and deterioration of teeth and gums are all symptoms of deficient Essence. When Essence becomes depleted, so do Blood and Qi, Yin and Yang. Lack of Qi produces fatigue, weakness, dull thinking, melancholy, and decreased motivation. When kidney Essence declines, deficiencies would eventually impact the liver, heart, spleen, and lung. When kidney yang is weak, the spleen becomes unable to extract the necessary nutrients to generate adequate moisture and blood. This results in dryness (dry eyes, skin, hair, and vagina, brittle nails, constipation, even cystitis). This in turn undermines shen-jing (heart essence), the unified relationship between heart and kidney, mind and essence. Therefore, kidney yang deficiency leads to spleen weakness, causing symptoms such as lethargy, weakness, easy bruising, poor concentration, fluid retention, indigestion and bloating. It also leads to a weakening of the kidney's capacity to anchor the qi, permitting true yang to leave its proper place in the lower burner and surge upward, producing agitation, flushing and perspiration, followed by chilliness, weakness, and fatigue.
Many women have signs of both kidney yin and yang depletion with such symptoms as hot flashes, sweating, agitation, and dryness. In Traditional Chinese Medicine, balancing the patient’s body and mind is often discussed and applied in treatment.
Much like the TCM treatment principle, endocrine system has this similar idea of trying to keep things balanced and regulated within the bodily system. Therefore, when discussing Essence, I think that the kidney’s functions and its relations with Essence should include every aspect of the Western understanding of endocrine system.
I feel that with acupuncture treatment, we trigger the part of the endocrine system as well to release and inhibit proper hormones to reach a calming physical as well as a mental state. A part of an endocrine system is very much dependent upon exterior environment changes including stress. Therefore, acupuncture and herbal treatment could help not only to regulate the endocrine system by encouraging proper bodily flow, but to calm the mind so that the body could naturally reach balance for a better sense of being. I feel that TCM approach of nourishing and sooth liver to stop pain and regulating cycle is important but also addressing kidney is very import for PCOS condition since this condition has significant impact on the patient’s physical as well as metal health.
Reference List
- Robinson, Bruce, MD. Biomedicine: A Textbook for Practitioners of Acupuncture and Oriental Medicine. 2007. Blue Poppy Press. Boulder, CO.
- Fritz, Marc and Speroff, Leon. Clinical Gynecologic Endocrinology and Infertility. Eighth Edition. 2011. Lippincott Williams and Wilkins. Philadelphia, PA.
- Lyttleton, Jane. Treatment of Infertility with Chinese Medicine. 2004. Churchill Livingstone. London, United Kingdom.