“A woman’s health is the barometer of her environment. It is moulded and shaped according to her evolution in the womb and the social, cultural and ecological environment of her childhood. It is created out of her relationships, her joys and traumas. It is grounded in the quality of her nutrition and the purity of the air and water around her. ” Hyman MA. The life cycles of women: restoring balance. Altern Ther Health Med. 2007;13(3):p10
The female menstrual cycle is a complex physiological process that forms the foundation for ongoing female reproductive health. Women have many different hormones, all essential for optimal health.
Changes in mood, along with symptoms of pain and discomfort associated with menstruation are too often accepted as ‘just a normal part of being a woman’. Nevertheless, despite being common, if and when symptoms do arise they should be viewed for what they are – a system ‘out of balance, and as such are not something that need to be endured. Instead, they should be addressed and resolved once the underlying causes of the imbalance are identified and treated.
We hope that the information in these articles will help you get to know your hormones and body better and learn how to listen to what they are telling you about your health. Developing a relationship with your body in this way can help you better manage your hormones, leading to increased health and wellbeing.
PHYSIOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM
It is estimated that as many as 90% of women of reproductive age experience some menstrual and/or hormonal disorder that affects them on a regular basis. This includes conditions such as premenstrual syndrome (PMS), dysmenorrhoea, endometriosis, uterine fibroids and polycystic ovarian syndrome (PCOS). Many women seek out natural solutions for the management of these conditions.
We will discuss aspects of these below with more detail in individual blogs.
ANATOMY OF THE FEMALE REPRODUCTIVE SYSTEM
The female reproductive system is a delicately balanced system incorporating a number of endocrine glands and reproductive organs. This system is sensitively attuned to a woman’s overall health. Dietary, lifestyle and environment factors play a vital part in female hormonal, menstrual and reproductive disorders.
Essentially, many female menstrual and reproductive disorders arise as a consequence of disturbances in hormonal production, elimination and metabolism. Disturbances in the balance of these hormones may be the result of environmental toxins, inflammation, stress, poor diet and lack of exercise.
The ovaries are the primary female sex organs and are about the size and shape of prunes. Ova (eggs) are formed in the ovaries and are about the size of a full stop. Just to put things in perspective, around 25 million sperm can fit on the area of a full stop! The egg is surrounded by a bubble called a follicle which holds the forming egg in protective fluid. Each menstrual cycle, around 20 follicles develop.
Each month one follicle goes on to mature and develops; becoming the dominant follicle and releasing an egg at ovulation. Ovulation usually alternates between the left and the right ovary from cycle to cycle. After release, the egg is then scooped up by the fallopian tubes and is carried along by the sweeping action of tiny fibres within the tubes, The tubes are about ten centimetres in length and their inside diameter is about as thick as a bristle on a hair brush. It is in the fallopian tubes that conception may take place. If there is no conception, the egg is reabsorbed by the body.
The fallopian tubes open out into the uterus, which is about 7.5cm long and pear shaped. If the egg has been fertilised, the embryo will implant within the uterus around seven days after conception. The cervix sits at the bottom of the uterus and is an organ in its own right. It contains glands that produce mucus in response to the body’s steroid hormone levels. The sperm may rest here for approximately two days before progressing to the fallopian tubes. The cervix can be damaged by biopsies and surgery, impairing mucus production and, hence, fertility. At the bottom of the cervix is a small opening through which the sperm gain entry to the uterus, and during ovulation menses may pass out.
THE MENSTRUAL CYCLE
Women’s fertility is cyclic in nature and goes through constant change. These changes occur, not only through the transition from childhood to menopause, but on a monthly and, indeed, daily, basis. Hormones mediate these cyclical changes and balanced hormones are essential for female reproductive health.
To understand the full process, see our following blog on Sex Hormones and The Reproductive Cycle.
The “dreaded” Premenstrual syndrome (PMS) affects up to 75% of women at some time in their lives. PMS is described as a cluster of symptoms appearing during the 10 – 14 days before menstruation, that usually resolve with the onset of menstruation. Symptoms are variable between women, and may include mood swings, anxiety, insomnia, irritability, abdominal bloating, headaches, cravings, physical fatigue, to name a few.
There is so much available to help relieve the symptoms of this distressing syndrome. Don’t despair. Talk to one of our dedicated Naturopaths at Nurtura Health and let them support you to start enjoying life without this cyclic challenge.
DYSMENORRHOEA (PAINFUL PERIODS)
Dysmenorrhoea, or painful periods, is common. Debilitating, painful, cramping periods are one of the leading causes of female school and work absenteeism. Dysmenorrhoea literally means “difficult monthly flow” and the characteristic pain is most acutely felt at the onset of menstruation, lasting for 1 – 2 days. Symptoms of dysmenorrhoea may include moderate to severe cramping, low back & upper leg pain, headache, diarrhoea, nausea, among others.
Periods are not optional but pain and heavy bleeding is. Talk to one of the dedicated Naturopaths at Nurtura Health to ask how you may get support and relief from what is often a debilitating condition.
AMENORRHOEA AND OLIGOMENORRHOEA
Amenorrhoea is the absence of the menstrual cycle during a woman’s reproductive years, excluding pregnancy and lactation. Amenorrhoea, whether primary or secondary, is a symptom of some underlying cause, ranging from hormonal failure, physical obstruction, extreme stress (including over-exercise), metabolic dysfunction or hormonal imbalances. Many causes may overlap to cause secondary amenorrhoea, most commonly polycystic ovarian syndrome (PCOS), low body fat or major stress. Oligomenorrhoea on the other hand, is characterised by infrequent or very scant menstruation. The cycle is longer than 35 days, and may occur as little as four times per year.
Both amenorrhoea and oligomenorrhoea may be symptoms of pregnancy or lactation (amenorrhoea), hormonal contraception, excessive stress, low body fat mass, PCOS, pituitary tumours, and/or some medical therapies such as chemotherapy. At Nurtura Health, our dedicated Naturopaths utilise herbal and nutritional formulas specifically indicated for the support of healthy reproduction and ovarian function in women.
Menorrhagia is the term for excessive (greater than 80ml blood loss) and/or prolonged (no longer than nine days) menstrual bleeding. Menorrhagia due to hormonal factors is most common in the first years of menarche, and approaching menopause due to hormonal influences, and may be exacerbated by other pathology, most commonly, uterine fibroids. Some other causes of menorrhagia may include annovulation (failure to ovulate), abnormal blood clotting, miscarriage, pelvic inflammatory disease, excessive oestrogen, to name a few.
To relieve pain and heavy menstruation we consider formulas based on traditional Chinese herbal medicine. Warming properties help to relieve menstrual pain by invigorating and moving stagnated blood in the abdomen and uterus. Herbs may also assist in the management of painful menstruation via the regulation of blood circulation. Talk to one of our dedicated to Naturopaths to support your hormones back into a balanced state.
LUTEAL PHASE DEFECTS
A luteal phase defect is a menstrual cycle abnormality where low progesterone levels in the luteal phase of the menstrual cycle result in delayed development of the endometrium. This deficiency of progesterone in the luteal phase is more often termed “oestrogen dominance”. Oestrogen dominance is thought to affect 3-5% of infertile women and up to 5% of women with a history of repeated miscarriage, and yet may be present in as many as 30% of all women.
Symptoms of a luteal phase defect include a short or irregular menstrual cycle, PMS, menorrhagia, infertility and/or menstrual spotting. To maintain balance, hormones such as oestrogen need to be excreted via healthy detoxification. This process occurs primarily in the gut and liver. It is also important to support healthy hormone balance both in the follicular phase and the luteal phase. Specific herbal combinations and nutritional remedies may be prescribed by our caring Naturopaths to support a return to a balanced and healthy cycle.
POLYCYSTIC OVARIAN SYNDROME (PCOS)
PCOS affects 4 – 7% OF WOMEN. It is characterised by ovaries containing multiple cysts – polycystic ovaries, signs of excess body hair; male pattern baldness; abnormal, irregular or scanty periods and metabolic syndrome (high insulin, obesity and hypertension). Polycystic ovaries can be 2-5 times the normal size, as follicles fail to ovulate and develop into cysts with a thickened white capsule.
Obesity is present in nearly half of all women with PCOS due to increased peripheral insulin resistance and high insulin production. Obesity amplifies the hormonal abnormalities of both PCOS and metabolic syndrome causing increased insulin resistance. Elevated insulin levels then further increase LH effects on ovarian function, exacerbating symptoms. This becomes a viscious cycle! The most beneficial support for PCOS includes individual assessment by one of our dedicated Naturopaths. Although PCOS has a “name” there are many layers and each woman has her own unique set of underlying drivers whether it be hypofunctioning thyroid, insulin resistance/blood sugar irregularities, inability to metabolise and detoxify fats, dietary and appetite challenges.
Endometriosis affects approximately 10% of reproductive aged women, and is found in 20-50% of women with infertility or chronic pelvic pain. This painful female reproductive condition is characterised by the presence of endometrial tissue which normally lines the outside of the uterus. Occurring most commonly in the pelvic region, endometrial implants may be found on the ovaries, fallopian tubes, vagina, cervix, Pouch of Douglas, uterosacral ligaments or in the rectovaginal septum. This condition is most often associated with pelvic pain and infertility but may also be found in fertile and asymptomatic women.
The common symptoms of endometriosis may include PMS and/or painful periods, pelvic pain, joint and muscle aches, fatigue and lethargy, depression, and infertility.
From a Naturopathic perspective there are a number of functions which need support in a female who is suffering from endometriosis. There is involvement of the immune system, heavy and painful periods, possible issues with liver detoxification and hormone balance, inflammation, muscle spasm and cramping, and diet. All of these aspects would be considered by our Naturopaths at Nurtura Health in supporting you in your mission to regain and restore healthy endometrial tissue and relief from symptoms.
LEIOMYOMAS (UTERINE FIBROIDS)
Uterine leiomyomas (fibroids) are benign smooth muscle tumours of the uterus that appear during the reproductive years. In addition to smooth muscle cells, they are composed of variable amounts of fibrous tissue and collagen. They are usually spherical, well-circumscribed, white, firm lesions and range in size from a pinhead to 20cm across (the average size is 2 cm). Fibroids arise in the middle layer of the uterine wall and are either pedunculated within or outside the uterus, or develop within the uterine wall. Fibroids are generally asymptomatic but may be associated with excessive or prolonged bleeding, anaemia, painful intercourse, lump or swelling in lower abdomen, infertility and/or poor pregnancy outcomes.
As this condition is normally an “oestrogen dominant” condition, having healthy liver detoxification is of paramount importance to restore hormone balance and excretion. It is important to have healthy oestrogen levels. In addition, consideration would be given to reducing inflammation and swelling; reduction in pain; ensuring iron levels are adequate; and reviewing diet and lifestyle.
PERIMENOPAUSE… MENOPAUSE… POSTMENOPAUSE
Perimenopause means “around menopause”. This refers to the 2-12 year period prior to menopause occurring. This is a time of fluctuating oestrogen levels, where your period begins to change. It is not uncommon for many women to experience a wide range of symptoms and mental disturbances during this time including hot flushes, sleep disruption and night sweats. The normal age range for menopause is between 45 to 55 years of age, with the average age being 50 years. You have officially entered menopause when you have not had a period for one year. After this time, you are in postmenopause.
Is it getting hot in here or is it just me? Despite popular belief, if a woman is experiencing a hot flush, she is not actually hotter than an unaffected woman, it is simply the brain perceiving itself to be hotter and is performing a cooling response.
There are a number of factors to consider in regards to menopause including cognitive function, thyroid function, cardiometabolic health, gut microbiome, weight and low oestrogen. These factors are in turn associated with an increased risk of bone fractures due to reduced bone density, as well as depression, cardiovascular disease, autoimmune-related thyroid disease, increased weight gain, metabolic syndrome, type 2 diabetes, increased inflammatory states, and reduced bone density.
In conclusion, female hormonal conditions are clearly orchestrated by a wide variety of mediators. This highlights the fact that simply raising or lowering serum hormones offers limited clinical efficacy. The tools that often provide patient benefit are not necessarily strong acting hormonal agents. In addition to your comprehensive individual assessment, our dedicated Naturopaths at Nurtura Health, will look for herbal and phytochemical combinations that may holistically address the various drivers behind the symptoms. Combining these with a healthy diet, exercise, stress relief and other lifestyle factors, along with a harmonious melody of hormonal signalling, may assist in restoring balance allowing you to lead a happier and healthier lifestyle.
Watch this space for future posts of each condition in more detail!Disclaimer: The advice on this website is of a general nature only and Nurtura Health expressly disclaims all liability arising out of the improper use of the information provided. Nurtura Health actively discourages any self-diagnosis or self-medication. Please consult your health practitioner regarding these important health issues. All rights reserved.