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Women’s Health: a Case for Letting Nature take its Course

by Euan MacLennan(more info)

listed in women's health, originally published in issue 237 - April 2017

The Story of Women’s Health

Women are everywhere. They comprise approximately 50% of the planet’s population. You may be one yourself or you may be married to one; you will certainly have one as a mother and maybe a sister, cousin, aunt, best friend, grandmother or daughter. Women are key to our survival and nurture us from the moment of our birth to our last breath. However, in terms of health, sometimes we let them down. We don’t treat them or their health with the care, delicacy and attention that allows them to flourish.

The medicalization of women’s health can start very early in life with girls in their early teenage years taking the contraceptive pill for reasons such as alleviating menstrual cramps, regulating periods and treating acne. Clancy argues that, although benefits exist for oral contraceptive use amongst at-risk teenagers, there may also be health worries including long term oestrogen exposure and a greater incidence of other sexually transmitted diseases (Clancy 2012). There is also the argument that hormonal contraceptives may adversely affect human biological rhythms.(Bentley, 1994)

The use of medicines to control hormones and their symptoms continues throughout life with the widespread use of painkillers, anti-inflammatories, smooth muscle relaxants, antidepressants and hormone replacements therapies (HRT). All of these medicines are widely available and, although there are times when they are necessary, there is an argument to be made that they are overused and may, in many instances, be replaced with gentle, effective herbal medicines or lifestyle changes.

A Complex Cycle of Hormones

In order to more fully understand and discuss women’s health, it is perhaps useful to first consider the complex and beautifully orchestrated natural hormonal cycle. There are two main phases to a menstrual cycle, the growth (follicular) phase and the secretory (luteal) phase. The normal cycle length falls somewhere between 24 and 35 days (NHS, 2014), with 28 days being regarded as the more common and clinically recognized model.

Hormones Involved in Women's Menstrual Cycle
Hormones Involved in Women's Menstrual Cycle

The major hormones involved in the menstrual cycle are oestrogen, progesterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH). We can break this down further and look more specifically at what each of these hormones does in terms of guiding the cycle and bringing about the physiological changes experienced by a woman during menstruation.

Levels of female hormones are low at the beginning of the cycle (days 1-5); it is these low levels (especially the withdrawal of previously high progesterone levels) that causes the menstrual bleed to occur. At the same time, FSH is produced by the pituitary gland. FSH directs follicles on the ovary to mature, one of which will become dominant and the egg housed within it will prepare itself to be released. During the following days, up until day 12, oestrogen is produced in ever increasing amounts to stimulate growth and repair of the previously shed uterine lining (endometrium). This is necessary to provide a healthy surface into which an egg can implant. Just prior to day 14, a strong surge of LH is produced to trigger ovulation and cause an egg to be released from the mature follicle. The empty follicle turns into a structure called the corpus luteum and starts to secrete progesterone that has the job of maintaining the now fully grown endometrium in place for egg implantation. After approximately 14 days, if there has been no fertilization of the egg, the corpus luteum will stop producing progesterone and the cycle returns to day 1 where a menstrual bleed occurs.

Some of the medicines we have mentioned above have the effect of substantially altering this cycle or arresting it altogether. Again, sometimes this might be necessary but would it not be preferable to work alongside the cycle, leaving it intact but supporting its pattern and the individual woman for whom it is central during her fertile years? This is especially important considering research where a strong relationship is evident between the use of such medicines as combined oral contraceptives and cardiovascular disease, including venous thromboembolism, ischaemic stroke, haemorrhagic stroke and heart attack (Parkin et al, 2011).

When Things Go Wrong

There is a plethora of conditions that can affect women’s health. They can range from the mild and easily treatable to conditions that are complex and difficult to both diagnose and manage effectively. It is perhaps useful for us to consider a few of the more common conditions and we can then discuss further below how we can approach the treatment and management of women’s health.

Premenstrual syndrome (PMS) is a common condition, with moderate to severe PMS affecting between 20 - 32% of premenopausal women (Biggs and Demuth, 2011). It has a number of common symptoms, although they may affect each individual woman to a greater or lesser degree. These include breast tenderness, pelvic pain / cramps, anxiety or other altered mood, bloating and the appearance of cyclical acne. The cause is poorly understood but appears to be related to hormonal changes that occur in the latter stages of the menstrual cycle. It seems that obesity (Masho et al, 2005) and smoking (Bertone-Johnson et al, 2008) may be contributory factors to the occurrence or severity of PMS in some women. Caffeine and alcohol may also be linked to PMS symptoms (Biggs and Demuth, 2011).

Endometriosis can severely impact quality of life and fertility for many women, especially as diagnosis can be delayed. In this condition, the endometrial lining that we previously discussed as growing in the uterus, is found in other places within the body. Such places can include adjacent structures like the fallopian tubes but also, in more extreme cases, the bowel or even lungs can be seeded with endometrial cells. The seeded endometrial cells continue to respond to hormonal changes within the body and will have their own isolated menstrual bleed, wherever they may be situated. This causes symptoms such as pain and many of the symptoms associated with PMS. Cycle length can also be affected and menstrual flow may be heavy and thick.

Polycystic ovarian syndrome (PCOS) occurs when an ultrasound reveals the existence of multiple small cysts (in reality these are visible egg follicles) on the ovary. However, these ‘cysts’ only mean that there might be an underlying condition but many women who have this feature are entirely unaffected by health issues. It is when cysts are present in the company of other signs of hormonal imbalance, such as hirsutism, irregular menstrual pattern, acne or unusually heavy bleeding that a clinician may diagnose PCOS.

Menopause

We deliberately consider menopause outside of discussions on ‘when things go wrong’ because it’s just another stage in a woman’s life and, from a natural medicine point of view, should be supported and celebrated rather than demonized. The menopause generally occurs between the ages of 45 and 55 (Trickey, 2011) but may be earlier or later. At this time, physiological changes occur with the production of both oestrogen and progesterone gradually declining. This may lead to an initial peri-menopausal period where bleeding patterns change and menstrual cycles may become patchy and irregular. Some women experience additional symptoms that include hot flushes, mood changes and changes to sleep patterns. However, it must be emphasized that the majority of women continue to thrive and be successful in both career, family and social pursuits.

The Natural Health Approach

Although different hormones may be dominant in differing ratios as the cycle progresses, it is important to realize that this is a ‘cycle’ and is therefore a continuum. Nature operates a fine balance to the ebb and flow of hormones and, arguably, this can be upset by the use of pharmaceutical drugs that arrest this cycle or prevent it from completing. This is not to say that such medicines are invariably harmful or should be avoided. Indeed, they can be vital to improving quality of life and longevity. However, there are times when a more gentle, insightful and natural approach may provide a more complete solution to women’s health issues.

It is important to recognize that although two women may both present with a condition like PCOS, they are individuals. They may have entirely different presentations and require different interventions, both in terms of medicines and lifestyle management. This is key from a natural health point of view; it is the individual that is being treated, not the illness.

Herbal medicine provides a wealth of options for the support and management of many conditions relating to women’s health. Again, the approach for each patient would likely differ but there are excellent smooth muscle relaxants that ease pelvic pain and cramps, especially for PMS sufferers. Examples are cinnamon (Jaafarpour, 2015) and crampbark. Turmeric is a well-known anti-inflammatory (Aggarwal, 2007) and circulatory stimulant that encourages effective blood flow and can ease menstrual pain. Pukka’s Womankind capsules combine turmeric with herbs such as red clover, which contains nourishing phytoestrogens that help to gently balance hormone levels through by binding to oestrogen receptors (Yildiz, 2005). Motherwort is a traditional medicine used to alleviate anxiety and mild palpitations. It may be particularly effective to ease PMS related mood changes. As natural medicine incorporates recommendations regarding lifestyle, patients would also be recommended to reduce factors that contribute to their symptoms. This might include losing weight, smoking cessation and trying to manage stress and anxiety.

In terms of menopause, Pukka’s wholistic shatavari is a tonic for the female reproductive system. It contains steroidal saponin compounds which act gently to ease menopausal symptoms (Khulbe, 2015) of flushing and stimulate the production of a hormone called prolactin. This may have a positive effect on libido as well as acting as a galactagogue to enhance breast milk production after childbirth (Gupta and Shaw, 2011). Another notable factor with shatavari is its impeccable sustainability credentials. So many ‘women’s herbs’, such as false unicorn, lady’s slipper and black cohosh, are endangered from over-harvesting. Shatavari offers an easy-to-grow, sustainable and life-affirming alternative.

References

Aggarwal et al, Curcumin: the Indian solid gold. Adv Exp Med Biol. Vol.595, pp.1-75. 2007.

Arentz et al, Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings, BMC Complementary and Alternative Medicine Vol.14:511, doi:10.1186/1472-6882-14-511. 2014.

Bentley GR, Raging hormones: do hormonal contraceptives ignore human biological variation and evolution? Annals of the New York Academy of Sciences Vol 709: 201-3 PMID: 8154705. 1994.

Bertone-Johnson et al, Cigarette smoking and the development of premenstrual syndrome, Am J Epidemiol Vol.168(8), pp.938–945. doi:  10.1093/aje/kwn194 2008.

Biggs and Demuth, Premenstrual syndrome and premenstrual dysphoric disorder, American Family Physician  Vol.84(8), pp.918–24. PMID 22010771. 2011.

Clancy, K, Why we shouldn’t prescribe hormonal contraception to 12 year olds. Scientific American. 2012.

Gupta and Shaw, A Double-Blind Randomized Clinical Trial for Evaluation of Galactogogue Activity of Asparagus racemosus, Iranian Journal of Pharmaceutical Research Vol.10 (1): pp.167-172. 2011.

Jaafarpour et al, The effect of cinnamon on menstrual bleeding and systemic symptoms with primary dysmenorrhea, Iran Red Crescent Med J  Vol.17(4): e27032 doi: 10.5812/ircmj.17(4)2015.27032. 2015.

Khulbe, A, Asparagus racemosus (Shatavari): A multipurpose plant, Eur J Pharma Med Res  Vol.2(3), pp.599-613. 2015.

Masho et al, Obesity as a risk factor for premenstrual syndrome, J Psychosom Obstet Gynaecol Vol.26(1), pp.33-39. 2005.

NHS Choices, www.nhs.uk/Livewell/menstrualcycle/Pages/Whatisthemenstrualcycle.aspx [accessed 2 February 2017]

Parkin et al, Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: nested case-control study based on UK General Practice Research Database, BMJ  No.342: d2139. Published online 2011 Apr 21. doi: 10.1136/bmj.d2139. 2011.

Trickey, R, Women Hormones and the Menstrual Cycle, 3rd Ed.  Trickey Enterprises (Victoria) Pty Limited. 2011.

Yildiz, F, Phytoestrogens in Functional Foods.  Taylor & Francis Ltd. 2005.

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About Euan MacLennan

Euan MacLennan BA BSc PgDip MNIMH LLB is a Medical Herbalist who practises in an integrated NHS General Practice in Central London and also enjoys working as part of the herbal team at Pukka Herbs. He teaches pathology, clinical medicine and differential diagnosis to undergraduates in various medical disciplines and is conducting a clinical doctorate in gastrointestinal medicine at the University of Bath. Euan is also an editor for an Elsevier medical journal, the Journal of Herbal Medicine. He may be contacted on Tel: 07799 212116;  medicus@hotmail.co.uk   euan.maclennan@pukkaherbs.com   www.maclennanshealth.com    www.pukkaherbs.com

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