Post on 18-Nov-2014
description
Jump to first page
Polycystic Ovarian syndrome Should be called polyfollicular, they
are not really ovarian cysts. 20% of the population have the
condition inherited. Possibly condition of survival, since
the calorie use is very efficient, also very efficient at storing calories; whole week of fasting might be needed to produce weight loss.
Jump to first page
PCOS a condition which consist of the presence of two out of the following three criteria, with the exclusion of other aetiologies
Oligo- and /or anovulation hyperandrogenism (clinical and /or biochemical) polycystic ovaries(ovary with 12 or more follicles,
measuring 2-9mm in diameter and or increased ovarian volume).
Although the number of cysts may be of less relevance than the volume of ovarian stroma, which correlate with serum testosterone concentrations.
Jump to first page
A women having polycystic ovaries in the absence of an ovulation disorder, or hyperandrogenism, should not be considered as having PCOS, although she may develop syndrome over time. E.g. if she gains weight.
Should be considered as complex endocrine disorder.
Jump to first page
Pathophysiology of PCOS Poorly understood Multifactorial Genetic link; father premature baldness. High incidence
in South Asian women.Also with type two diabetes. Environmental; nutrition, weight thyroid involvement metabolic syndrome; some suggest a genetic
susceptibility to insulin stimulation of androgen secretion, blocking follicular maturation. Seem to be that abnormal insulin response is the key underlying factor.
Jump to first page
Too many follicles, ovulatory and anovulatory.
In anovulatory PCOS follicles do not mature.
Jump to first page
Diabetes (NIDDM); increasingly common, as is PCOS.
Causes of insulin resistance; Associated with abdominal obesity, excessive intake of carbohydrates, lack of exercise, and stress..
Fitness a greater link than diet and obesity. Weight gain; worsening of symptoms
Some with ovulatory hyperandrogenism can present with normal insulin and glucose tolerance, indicating additional factors involved.
Jump to first page
symptoms
Acne, hirsutism, alopecia menstrual disturbance infertility obesity asymptomatic
Jump to first page
endocrinology
Increase fasting insulin, androgens (testosterone and DHEA-S), LH, oestradiol, and oestrone, prolactin while FSH low.
Progesterone low. Decreased SHBG the cycle of abnormalities tend to
be perpetuated.
Jump to first page
Elevated androgens Ovarian and adrenal production increased Possible due to hyperactive production of
CYP17 enzyme, responsible for forming androgens in ovaries and adrenals from DHEA-S.
Elevated testosterone correlates with elevated LH levels.
High androgens levels in ovary inhibit FSH, and therefore inhibit development and maturation of the follicles.
Jump to first page
Elevated DHEA due to stimulation by ACTH, produced by the pituitary in response to stress. Excess DHEA converts to androgens, contributing to elevated androgens.
Jump to first page
Skin and adipose tissue
Aromatase and 17betahydroxysteroid activities are increased in fat cells, and peripheral aromatisation increases with body weight.
Chronic hyper-estrogen production. Hirsutism incidence higher in USA in
women with PCOS, possibly due to genetically differences in 5-alpha-reductase activity, diet, exercise.
Jump to first page
Excessive adrenal androgen production; could be at puberty , or perhaps because of stress.
Androgen converted to oestrogen. Leading to increase LH, which leads to increase
ovarian androgen production, which could impair folliculogenesis, and so perpetuating the cycle.
Increased gonadotrophin releasing hormone, leading to pulsatile increase LH. FSH not increased due to negative feedback of elevated oestrogen.
Jump to first page
25% PCOS have elevated prolactin levels, resulting from elevated oestrogen feedback to pituitary gland, contributing to elevated oestrogen.
HPA axis weakened by chronic stress, insulin sensitivity heightened, adversely affecting the thyroid, and adrenals, excess cortisol, triggers elevated levels of prolactin and sympathetic nervous system response. Prolactin inhibits FSH, elevates LH.
Jump to first page
Chronic elevation of serum insulin levels associated with elevated androgen levels. High levels insulin, lowers presence of SHBG; increased amount of free androgen in serum.
Which stimulate the peripheral androgen receptors, resulting in an increase in 5-alpha reductase activity directly increasing the conversion of testosterone to the more potent dihydrotestosterone
Excess adipose tissue provides site for peripheral conversion of androgens.
Leading to elevated acyclic oestrogen, as well as increased pituitary sensitivity to GnRH
Insulin alters hormonal production; insulin and insulin like growth factor receptors are located in ovarian tissue.
Jump to first page
Long term problems Diabetes mellitus dyslipidaemia hypertension, and CVD endometrial (linked to weight obesity, and use of
OCP, nulliparity and infertility, hyperplasia of endometrium) however true risk difficulty to assess. Need at least bleed every three months.
breast cancer (also associated with obesity, hyperandrogenism, and infertility).
Not at risk of osteoporosis.
Jump to first page
Jump to first page
Conventional treatment OCP; reduce androgens, increase SHBG. Combined
pill can worsen insulin resistance, so CI in obese. Hirsutism; antiandrogens, spironolactone; inhibiting
the binding of dihydrotestosterone to the receptors at the hair follicle.
Infertility; clomiphene, induces ovulation, acts by inhibiting oestrogen negative feedback at hypothalamus, enhance production FSH. laparoscopic ovarian surgery
Metformin. Weight loss
Jump to first page
Treatment
Break pattern hyperinsulinaemia, low refined carbohydrate diet.
Takes 6-9 months with drugs to improve hirsutism.
Shift in hormones needed might only be slight, oestrogen levels for PCOS tends to be within the normal ranges.
Jump to first page
Treatment PCOS Aims;
cyclic regularity fertility skin condition obesity insulin resistance, diet
Jump to first page
Weight loss; reduces androgens by interrupting
their cycle. Reduce conversion, so improve
ovulation rate. Increases SHBG reduces CVD reduces risk of diabetes 2 reduces endometrial hyperplasia
Jump to first page
phytoestrogens
Phytooestrogens and fibre; increase SHBG compete with endogenous
oestrogen. Reduce hypertrophy cholesterol clearance, and
oestrogen clearance affect the glucose tolerance.
Jump to first page
Glycyrrhiza glabra Glycyrrhetinic acid
inhibits 17beta-Hydroxysteriod dehydrogenase (converts androstenedione to testosterone). Which is active in the hair follicle, ovaries
reduced production of testosterone by ovaries (not adrenals).
Inhibits 11Beta-Hydroxysteroid dehydrogenase result in decreased conversion of cortisol to
cortisone, and the state of apparent mineral corticoids excess.
Elevated 11Beta-Hydroxydehydrogenase is responsible for androgen excess, because of the effect of insulin resistance on this enzyme
Jump to first page
Paeony lactiflora
Paeoniflorin (monoterpene glycoside)
act on ovary to reduce production of androgens in dose dependent manner.
Increase activity of aromatase promoting the syntheses of oestradiol from testosterone.
Jump to first page
May improve progesterone levels by normalising ovarian function when the activity of aromatase is inhibited.
aromatase is important in follicular maturation, ovulation and corpus luteum function, steroid hormone synthesis, and regulation conversion of androgens. The biofeedback in the pituitary gland and hypothalamus rely on aromatase to regulate prolactin and GnRH.
Modulates oestrogens and prolactin
Jump to first page
Paeony formulas improved ovulation
combined with angelica sinensis improved fertility.
Used the whole month.
Jump to first page
Combination with liquorice reduced testosterone levels and improves oestradiol to testosterone rations after 4 weeks of administration
pregnancy rates improve. Stimulates pituitary dopamine receptors, and
due to that after prolonged used LH, to FSH ration is significantly lower.
Dose equal amounts 7.5 g total. (25 ml each FE.
Jump to first page
Other hormonal herbs
Humulus; reduces LH via possibly anti gonadotropic effect.
Cimicifuga reduces pulsatile LH release serenoa repens; reduces the conversion
of testosterone to DHT via weak inhibition of 5Alpha reductase, and inhibits the binding of DHT at cellular binding sites.
Smilax spp; may competitive inhibit androgens.
Jump to first page
Long-term use of glycyrrhiza and smilax reduced hirsutism, (level androgen do not always reflect symptoms or not) might have increased androgen sensitivity, which might
be related to activity of 5 alpha reductase, this could be inherited.
changes in hair growth slow, at least 6-9 months. Changes seen in thickness, reduced growth rate of hair,
reduced frequency of waxing or other hair removal. Fennel externally spearmint internally reported to have made a change to
hirsutism.
Jump to first page
Panax and Eleutherococcus; normalising impaired glucose tolerance,
Panax normalised lipid profiles. Nervines; for normalising androgens when
they are elevated due to stress, and effect on HPO axis, if affected during stress.
Steroidal saponins containing herbs to help with the HPO axis, and stimulate ovulation. For the whole month or just follicular phase day 4-14.
Jump to first page
Vitex agnus castus
Hyperprolactinemia is related to adrenal stress and hyperinsulinemia in PCOS
needs to be given at least 3-6 months.
1-4 ml per day of a 1:2
Jump to first page
Caulophyllum thalictroides Traditionally used for
amenorrhoea, and profuse menstruation.
Useful to bring on menses. Dose 1.5-3 ml of 1:2 per day 30ml per week
Jump to first page
Insulin resistance
Galega officinalis; galegine potentiates the effect of insulin ( was used as model for chemical antidiabetic drug).
Trigonella foecum-graecum; powdered seed would include the soluble fibre, however tincture has shown to improve glycaemic control in patients with NIDDM, 6 ml/1:2 per day.
Jump to first page
Fibre; delay absorption of glucose, possibly by delaying gastric emptying. E.G. psyllium husks 5 g per meal, fasting plasma glucose, total and LDL cholesterol, and triglycerides reduced, and HDL cholesterol increased.
Aloe vera juice reduced blood glucose and triglycerides levels.
Jump to first page
Glycyrrhiza glabra; the flavonoids shown inhibitory action of aldose reductase (AR) inhibitors, which when blood glucose is raised , the polyol pathway, which is catalysed by the enzyme AR) can become activated in tissues which contain this pathway (lens, liver, kidney, Schwann cells), this leads to accumulation of the sugars sorbital, and dulcitol, which is toxic in excess, leading e.g. to cataract.
Evening Primrose oil, or the GLA also helped with the complications of diabetic neuropathy, possibly by affecting the myelin fat abnormalities.
Damage small capillaries; Vaccinium, Ginkgo.
Jump to first page
Gymnema when applied to mouth anaesthetising the sweet taste buds. Wears of after one or two hours,
extracts in Japan sold for control of obesity. rise in insulin levels towards normal, and number of beta cells in
pancreas increased. Weight loss; gymnema decreased weight gain, and food intake
in rats. Insulin dependent patient reduced insulin intake by 50% when
taking 8g of the dried herb. Lowered fasting blood glucose level by 35%, and glycosylated haemoglobin levels (a measure of long term blood sugar levels) significantly by the 6 to 8 months but sill higher then normal. Cholesterol reduced to near normal, and triglycerides were lowered, treatment period, was 6 to 30 months. .
Jump to first page
Gymnema in NIDDM; fasting blood glucose and glycosylated haemoglobin significantly reduced. Cholesterol and triglycerides also reduced. Fasting and post meal serum insulin increased. And most of the patient were able to reduce intake of drugs, and some totally and kept on gymnema alone.
Jump to first page
Disrupting sugar transport in the small intestine, and retards sugar absorption. Leading to reduction in peak blood sugar levels and better glycaemic control.
Long term trophorestorative effect on pancreatic beta cells.
Effective for reactive hypoglyaemia, and sugar craving, doses can be much lower than when treating diabetes.
Trials have used 400mg per day of extract; 8g of dried herb a day.
3.5-11 ml of 1:1 (10-33ml of 1:3 per day)
Jump to first page
Abnormal uterine bleeding Benign; organic; systemic health problems (e.g.
von willebrands disease, thrombocetopenia, hypothyroidism, liver disease, abnormal pregnancy, foreign bodies, trauma, infections, fibroids, polyps, adenomyosis, endometriosis (not usually heavy bleeding), cervicitis, uterine infections, IUD.
Malignant; cancer
Jump to first page
Menorrhagia
Pelvic congestion, capillary fragility, blood disorders, PID, oestrogen excessThyroidpoor liverpregnancy, miscarriage.adenomyosis, endometriosis, fibroids, functional menorhagia, IUD. Unoposed bleeding; Common premenopausal, and menarche.PCOS, hyperprolactinaemia, stress, obesity, weight loss.
Jump to first page
Menorrhagia; if saturating a super tampon or heavy pad more then than every hour for 6-8 hours or more.
If saturating pads every half hour or less; need intervention.
Jump to first page
Capsella bursa pastoris; antihaemorrhagic and astringent.
Used by eclectics for benign abdominal tumours
in WW1 used as replacement for ergot, to stop uterine bleeding (fungus that can grow on rye, ergot was used to induce contractions during labour, and to treat post partum haemorrhage.
In vitro extracts shown that it accelerates coagulation of blood.
Jump to first page
Achillea millefolium;astringent and haemorrhagic, tonic to circulatory system.
Used for menstrual irregularities, menorrhagia and metrorrhagia. Greeks used it for wounds American Indians to treat heamorrhagia physiomedicalist; diffusive vasostimulant, especially pelvic organs
and its circulation. Use for pelvic congestion, reduce uterine flooding, pain due to
engorged pelvic veins. Reduces clotting time in vivo. In vitro accelerates coagulation of blood. Flavonoids; decreases capillaries fragility.
Jump to first page
Alchemilla vulgaris
Astringent, antihaemorrhagic, antiinflammatory
used for diarrhoea and uterine bleeding
Jump to first page
Hydrastis, trillium uterine tonics and emmenagogues affect the
uterine tone (smooth muscle ; rubus, angelica sinsensis, caulophyllum, chamealerium luteum, Mitchella, cinnamomum)
soy and flax products iron, vit A, B complex, cholorophyl for vitamin K, vit
C., bioflavonoids, e.g. floradix Vitex agnus castus, Zingiber, Geranium maculatum
Jump to first page
Fibroids
Benign tumour in uterus, within uterine lining (intramural), towards the cavity (submucosal), or towards outer surface (subserous).
Increased growth with increased oestrogen (pregnancy, OCP)
shrink after menopause asymptomatic, menorrhage, dysparunia,
dysmenorrhoea, lower back pain, congestion. Complication; pressure on urinary tract, leading
to obstruction, urinary frequency, miscarriage.
Jump to first page
treatment
Inhibit growth. Diet; excess oestrogen avoidance,
organic, phytoestrogens, fruit,vegetables
stop bleeding. Weight loss Vit E Peaony lactiflora
Jump to first page
Thuja; by eclectics used for abnormal growths, tumours, cancers.
Traditional literature; retard growth of tumours,
astringent Castor oil pack.
Jump to first page
endometriosis
Endometrial tissue growth outside uterus
40% of those women have fertility issues. And 30% infertile because of it due to hormone imbalance, scarring
due to inflammation, immunological factors.
cyst on ovary; chocolate cyst, adhesions leading to dysparunia.
Jump to first page
Anti inflammatories
Turmeric Boswelia Cimicifuga racemosa
Jump to first page
Angelica sinensis
Enrich blood, stimulate circulation, relieve pain especially when congestion, regulate menstruation.
Anti-inflammatory;due to inhibition of the synthesis of prostaglandin. Inhibits synthesis thromboxane A2 in vitro, which may partly explain effect on circulation.
Jump to first page
Other herbs and supplements Antihaemorrhagic,anti-
inflammatory, vulnerary, lymphatic (calendula officinalis).
Fish oils, or other omega 3 work on oestrogen excess,
elimination, diet.
Jump to first page
Dysmennorhea
Spasmodic; more in young women, related to ischaemia or uterus or cervix. Pain with onset of bleeding.
Congestive; older women, may be associated with pathologies. Dragging sensation.
Severe in PID, and endometriosis, adenomyosis (typical over 40)
Jump to first page
Prostaglandins may play a role; Exercise,
Zingiber officinalis inhibits prostaglandins.
Achillea millefolium, Tanacetum parthenium.
Mg, Essential fatty acids
Jump to first page
Viburnum prunifolium
Caprifoliaceae bark is used. Native American, physiomedicalist;
viburnum opulus and prunifolium used for dysmennorhoea
Jump to first page
Traditional used for dysmenorrhoea, false labour pains, threatened miscarriage and asthma.
Folk use as a contraceptive and treatment of morning sickness have also been recorded.
Uterine sedative, bronchospasmolytic, hypotensive, astringent.
S.E Nausea and vomiting may occur with large doses.
Jump to first page
Cook; vib op primarily antispasmodic, acting on the nervous system, vib prun. More useful as uterine tonic for uterine weakness, prolapse, leukorrhoea, passive bleeding,
Felter felt that vib prun one of the most important uterine tonic.
Vib prun contains salicin, salicylic acid, arbutin, scopoletin (a coumarin also found in Angelica sinensis) which vib op does not have, flavonoids (amentoflavone), iridoid glycosides, triterpenes, and triterpenic acids.
Jump to first page
For dysmenorrhoea need to give a good dose; 2-5 ml per day of a 1:2.
The use of antispasmodics may be CI in gastric and enteric poisoning cases.
Presence of oxalate and oxalic acid; oxalate as the potassium or calcium salt present in many plants and calcium oxalate practically insoluble in water, unlikely to be present in aqueous ethanolic liquid extract in sufficient quantities to justify a precaution.
Scopoletin (coumarin)plant coumarins are unlikely to increase the risk of bleeding.
Jump to first page
Coumarin has an anticoagulant activity that is 1000x less then dicoumarol, because it lacks a 4-hydroxy group in its chemical structure, dicoumarol is formed from coumarol by bacterial action in damaged hay, properly dried plants does not contain dicoumarol and has no anticoagulant activity.There is not evidence that normal coumarins found in common plant and not altered by bacteria have any anticoagulant activity.
Jump to first page
Paeony with glycyrrhiza has antispasmodic properties. Also used with Angelica sinensis.
Anenome pulsatilla; antispasmodic, sedative, central nervous system depressant, emmenagogue.
Valeriana officinalis if real bad, Belladonna fol.
Jump to first page
Pelvic inflammatory disease Leading to adhesions, or abscesses,
and can lead to infertility. Check out what organism, need to
clear infection, antibiotics might be needed, refer.
Uterine antiseptics; thymus vulgaris, Hydrastis canadensis, Echinaceae purp and ang., Thuja occidentalis.
Jump to first page
Amenorhoea;
Premature ovarian failure hyperprolactinaeima, reduced FSH,LH as caused by
stress,weight loss eg excessive exercise, anorexia, genetic
anovulation with normal FSH, LH ; follicles not mature as in PCOD, progesterone deficiency.
Jump to first page
Diet make sure enough fat, and cholesterol, e.g. some animal products.
Vitex agnus castus Cimicifuga racemosa, Uterine stimulants; Mitchella, achillea,
Artemesia vulgaris, Caulophyllum thalictroides
phytoestrogens, soy, flax, Trifolium, Glycyrrhiza
Jump to first page
Vaginal discharge
Normal white discharge, about teaspoon per day
infections; candida vaginalis (Cottage cheese like discharge), trichomonias (fishy smell, green, yellow frothy), bacterial vaginosis.
check out diabetes, medications, oral contraceptives, antibiotics, tampon.
pessaries with calendula, teatree, thymus linalool when infection.
Yoghurt, or cider vinegar (2 tablespoons to pints)
Jump to first page
Vaginitis
Candida albicans (DD metabolic, or immune compromised, underlying cause when recurrent)
trichomonas vaginalis (discharge frothy, bubbly, yellow green, and itching, dysparunia, dysuria, occasional abodimial pain.
bacterial vaginosis (gardnerella vaginalis, thin, frothy, grey, odorous discharge
Jump to first page
Partner, safe sex clothing, loose allergie? Probiotics; vaginal microflora, feminine
hygiene products, lubricant, semen. Avoid sugar, alcohol, and have yogurts. Vit E externally less irritated, Garlic, Hydrastis, Berberis vulgaris,
Teatree,
Jump to first page
Fibrocystic breast disease Aggrevated by relative excess oestrogen, worse before period. Increases risk breast cancer hormone balancing plus lymphatics, circulation avoid coffee vit A, E, Evening Primrose Oil Iodine (mechanism not known, iodine in terminal and
interlobular duct cells, which are the cells involved in cystic changes, without iodine tissue more sensitive to oestrogen stimulation, which leads to produce mycrocyst high in potassium, an irritant producing fibrosis, and cyst isolation).
Jump to first page
Cervical dysplasia
Abnormal development of cervical cells, if untreated may lead to cancer.
Related to sexual partners,early sexual experience, genital herpes, or warts.
CIN I mild dysplasia CIN II moderate CINIII severe/ preinvasive carcinoma
Jump to first page
Pap I normal Pap II atypical cells Pap III moderate dysplasia Pap IV strongly suspicious, severe
dysplasia Pap V malignancy; invasive cancer
cells.
Jump to first page
Diet high in fruits and vegetables, for the flavonoids, carotenes, alpha carotene, lutein,
cryptoxanthinlycopene, xanthein; tomatoes, carrots, vit A, vit C, folic aid.
smoking; negative effect. Tarax rad, Hydrastis canadensis, Thuja occidentalis,
Echinacea angustifolia, Turmeric, Glycyrrhiza glabra. Douche; or pessaries with calendula
Calendula officinalis. Viola odorata