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Women s Health Issues Enrique Saguil, MD Hormonal axis Menstrual irregularities Endometriosis Female athlete triad Human papilloma virus Ovarian cancer Breast ... – PowerPoint PPT presentation

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Title: Women

Womens Health Issues
  • Enrique Saguil, MD

  • Hormonal axis
  • Menstrual irregularities
  • Endometriosis
  • Female athlete triad
  • Human papilloma virus
  • Ovarian cancer
  • Breast cancer
  • Menopause
  • Osteoporosis

Anatomy 101
The Hormonal Axis
Allies vs Axis
The 28 day cycle
1. Menstrual irregularities
  • New cycle , that is the irregularity experienced
    by some young girls at the onset of the periods.
  • Dietary problems , eg. anorexia, bulimia or
    simply poor diet
  • Too much exercise
  • Drugs -  prescription and recreational
  • Break in routine
  • Sexual activity -  especially when it is a new
  • Thoughts and emotions
  • Stress
  • Anxiety about pregnancy
  • Illness or physiological imbalance eg thyroid

  • Long Term Irregularity
  • -Long term irregularity can be anything from a
    cycle that varies in length from month to month
    to the experience of various abnormal symptoms,
    for example, excessive bleeding, no cycle for
    months at a time, very painful periods or
  • Sudden or Short term Irregularity
  • -Short term irregularity can be attributed to any
    of the causes previously mentioned, and are
    generally a one off or sporadic occurrence. These
    cases are probably not a cause for great concern
    unless you are experiencing pain or just feel as
    if something is wrong.

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When to call
  • You have soaked through a pad or tampon every
    hour for 2-3 hours.
  • Your bleeding has lasted longer than one week.
  • You are pregnant.
  • You have severe pain, especially if you also have
    pain when not menstruating.
  • Your periods have been heavy or prolonged for
    three or more cycles, compared to what is normal
    for you.
  • You have a fever or abnormal vaginal discharge,
    especially if it has an odor.
  • You have bleeding after menopause.
  • You have bleeding or spotting between periods.
  • You have nipple discharge, excessive hair growth,
    deepening voice, unintentional weight loss or
    gain, or new acne

  • Pap Smear
  • Endometrial biopsy
  • Pelvic ultrasound
  • Lab tests such as thyroid function tests, CBC,
    pregnancy test, glucose

The PAP-(a necessary evil)
  • The Pill or any other hormonal contraception will
    give you a regular cycle but once started most
    likely the pill will have to continue.
  • Diet is very important. If you eat lots of fast
    foods you are not giving your body the
    nourishment it needs. If you eat sporadically,
    miss meals and diet constantly - you essentially
    send your body into survival mode. Your body
    thinks it is starving and shuts down unnecessary
    systems. A body that thinks it is starving will
    not cycle regularly.
  • Consider taking a quality womens Multi with
    Menstrual herbs in it (eg chasetree and dong
    quai). This will help with missed nutrients and
    the herbs will help balance your hormones.
  • Many irregularity stems from irregularity, being
    regular in Routine will always help to regulate
    the axis. This would mean wake, eat, work,
    exercise and sleep on a regular basis.

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Dong quai
  • Experiments show that whereas the volatile oil in
    the root causes relaxation of the uterine muscle,
    both water and alcohol extracts stimulate uterine
    contractions alcohol extracts are stronger.
    Dongquai also normalizes irregular uterine
    contractions, improving blood flow to the uterus.

2. Endometriosis
  • Very painful menstrual cramps
  • Pain with periods that gets worse over time
  • Chronic pain in the lower back and pelvis
  • Pain during or after sex
  • Intestinal pain
  • Painful bowel movements or painful urination
    during menstrual periods
  • Heavy and/or long menstrual periods
  • Spotting or bleeding between periods
  • Infertility (not being able to get pregnant)
  • Fatigue

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  • Ultrasound
  • Magnetic resonance imaging (MRI)
  • Laparoscopy

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Laparoscopic view
Women with Endometriosis
  • get their monthly period
  • are 27-years-old on average
  • have symptoms for two to five years before
    finding out they have the disease
  • have gone through menopause and have virtually
    eliminated symptoms-(more of a retrospective

Higher chance of developing if-
  • began getting your period at an early age
  • have heavy periods
  • have periods that last more than seven days
  • have a short monthly cycle (27 days or less)
  • have a close relative (mother, aunt, sister) with

Suggested prevention
  • exercise regularly
  • avoid alcohol and caffeine
  • Antiinflammatory diet
  • Turmeric, Boswelia, white willow bark

3.Female athlete triad
  • Disordered eating
  • Osteoporosis
  • Amenorrhea (loss of menstrual cycle)

Image sports
Weight dependant sports
Non-athletes that find exercise
Disordered Eating
  • Food restriction - limiting overall food intake
    or there are many foods that will not be eaten
    because their thought to be "bad for you" and
    will make you fat.
  • Rigid food patterns - you eat exactly the same
    thing every day. For example, you eat a bagel
    every morning, yogurt and salad each day for
    lunch and meatless pasta at dinner. You have a
    significant nutrient gaps with this kind of
    strict eating.
  • Inadequate protein diet - you only occasionally
    eat meat, poultry, fish, dairy products or other
    good protein sources like beans, legumes, nuts or
    soy products.
  • Thought patterns such as preoccupation with food,
    dissatisfaction with one's body, excessive fear
    of becoming fat and a distorted body image (you
    think you're fat, but in reality you're thin or
  • Prolonged fasting.
  • Bingeing (out of control eating) and purging (use
    of diet pills, diuretics or laxatives to control
    weight or vomiting because you feel guilty about
    the food you've eaten).

The cycle of events
  • Restrictive eating and excessive exercise can
    cause a women to develop an energy deficit.
  • This energy deficit or stress condition changes
    the body's hormone levels.
  • The reproductive system shuts down and the normal
    menstrual cycle is disrupted.
  • If hormones aren't brought back into balance, the
    body begins the silent process of destroying

  • Amenorrhea means that you stopped having your
    period for three months or longer. If you haven't
    had your first period by age 16, this is also
    considered amenorrhea

  • Usually it would be an early onset osteoporosis
    but unfortunately by the time it is investigated,
    its too late to prevent
  • The bone density of a 30-40 year old will be that
    of a 50-60 year old

  • Increasing protein intake
  • Psychotherapy-(sports psychology, EFT)
  • Decreasing exercise duration, intensity and
  • St Johns Wort, Calcium, Vitamin D

4. Human Papilloma Virus
  • the rate of infection for females aged 14 to 24
    was 33.8 percent, or about 7.5 million young
    American women. That rate is substantially higher
    than previous estimates of about 4.6 million HPV
    infections in this same age group, the
    researchers noted
  • Feb. 28 issue of the Journal of the American
    Medical Association.

  • The CDC currently recommends that the vaccine be
    routinely given to girls 11 and 12 years of age
    to help prevent infection with the sexually
    transmitted virus
  • The National Advisory Committee on Immunization
    Practices also recommends Gardasil for use in
    girls beginning at age 9 -- at the provider's
    discretion -- and in young women up to the age of

Reasons that led to vaccine
  • HPV prevalence rose during adolescence and peaked
    among college-age women (20 to 24 years of age),
    with almost half (44.8 percent) of women in this
    age group testing positive for the virus

Association with hpv and cancer
  • 3.4 percent of women aged 14 to 59 were infected
    with one of the four HPV strains covered by the
    Gardasil vaccine -- strains 6, 11, 16 and 18.
    Strains 16 and 18, especially, are suspected of
    being especially "oncogenic"

Cervical Cancer (from HPV)
  • According to the American Cancer Society, more
    than 11,150 new cases of invasive cervical cancer
    will be diagnosed in U.S. women this year, and
    about 3,670 women will die of the disease.

The shot
  • transient dizziness, injection-site swelling,
    fainting, fever or nausea
  • A dangerous condition called Guillain-Barre
    syndrome was found (but the incidence was similar
    to that seen in unvaccinated girls.)

  • Historically ovarian cancer was called the
    silent killer because symptoms were not thought
    to develop until the chance of cure was poor
  • Low-Fat Dietary Pattern and Cancer Incidence in
    the Womens Health Initiative Dietary
    Modification Randomized Controlled Trial
  • Journal of the National Cancer Institute Advance
    Access published online on October 9, 2007

  • Ovarian cancer is the eighth most common cancer
    among American women
  • the fifth leading cause of cancer death.
  • Around two-thirds of women with ovarian cancer
    are 55 or older

  • An annual pelvic exam in a must, especially among
    older women
  • Ultrasonography
  • CT scanning/ MRI
  • The screening test picked up early stage
    ovarian cancer 56.7 percent of the time
    advanced-stage disease 80 percent of the time
  • Ovarian Cancer National Alliance

The screening test
  • pelvic pain and abdominal pain
  • urinary frequency and urgency
  • increased abdominal size or bloating
  • difficulty eating or feeling full.

From silent to not so deadly
  • Researchers report that the test -- a checklist
    of symptoms and their frequency -- picked up
    early stage ovarian cancer 57 percent of the
  • The researchers then tried to detect patterns
    among the survey results. They found that certain
    symptoms indicated cancer if any one of them was
    present more than 12 days a month but for less
    than a year

  • The most common type of cancer for women in the
  • The leading cause of cancer deaths in women 40-59
    (second only to lung cancer)
  • 200,000 diagnosed this year, 40,000 will die
  • 2,000 cases dxd in men, 400 will die

  • 2,000,000 survivors in the US
  • Number of deaths seems to be declining
  • Risk factors have been identified and earlier
    detection along with more effective treatments
    are thought to be responsible

RISK factors
  • Female and older (50)
  • High breast tissue density
  • Radiation exposure in youth
  • Estrogen exposure-menarche lt12, menopause gt55
  • Nulliparous or 1st gt30
  • OCs and HRT
  • Overweight or gaining after menopause
  • BRCA1 2 gene

  • Self breast exam
  • Check up
  • Mammogram?
  • Ultrasound
  • MRI?

Pretest checklist
  • To help minimize discomfort during mammography,
    schedule your mammogram to take place one week
    after your period (when breasts are less tender).
  • If possible, bring your previous mammogram with
    you, or bring a list of where and when you have
    had previous mammograms with you to your
  • On the day of the examination, do not wear talcum
    powder, deodorant, lotion or perfume under your
    arms or on your breasts. These substances can
    cause artifacts on your mammogram making the
    images harder to interpret (aluminum flecks in
    some powders and deodorants can mimic
    microcalcifications on the x-ray image).
  • Wear a two piece outfit so that you only have to
    remove your top and bra for the examination a
    blouse which buttons in the front is optimal
    since it can be easily removed, while pullover
    tops are less convenient.
  • Any jewelry worn (especially earrings or
    necklaces) should be easily and quickly
    removable, especially if you will have a
    procedure which requires you to lie face down.
  • Any breast symptoms or problems that a woman is
    experiencing should be described to the
    technologist performing the examination.

Susan Komen foundation
  • Nancy G. Brinker promised her dying sister, Susan
    G. Komen, that she would do everything in her
    power to end breast cancer forever.
  • In 1982, that promise became Susan G. Komen for
    the Cure and launched the global breast cancer
  • invested nearly 1 billion in race for the cure
  • http//ww5.komen.org/home/

Thermography alternative
  • How It Works   Thermography combines
    ultra-sensitive digital photography and
    specialized computer programming to record the
    amount of heat present at the skin's surface.
    During the 30-minute procedure, the patient
    disrobes to the waist and acclimates to the
    ambient temperature in a cooled room. A certified
    female technician then takes a series of five
    images from various angles. There is no pain, no
    compression and most importantly, no radiation.
       The images are transmitted electronically to
    physicians to interpret thermographic scans.
    Advanced software allows doctors to identify
    temperature differentials, note potential problem
    areas and offer suggestions for additional study.

  • Breast thermo-graphy is a physiology test,
    meaning it looks for functional changes in breast
    tissue which may indicate trouble years before a
    tumor starts to form. For example, cells that are
    inflamed and pre-cancerous grow rapidly,
    requiring a markedly increased blood flow. The
    cells release substances that stimulate the
    formation of new blood vessels to deliver
    nutrients. The increased blood flow elevates the
    skin surface temperature. These physiological
    changes alert the doctor that aggressive
    detoxification measures are immediately needed.
    In contrast, mammograms detect structural
    changes, or changes in anatomy, after a fully
    formed mass has developed. A lump large enough to
    be detected by traditional methods (cancerous or
    not) may have been present for as long as ten
    years before it is identified

  •  Breast thermography is an alternative choice for
    all women, regardless of age or breast size, who
    desire a painless and radiation-free screening
    procedure. This type of imaging has been shown to
    detect 86 of non-palpable breast cancers and up
    to 15 of cancers that were not visible by
    mammography. (Gamagami P Indirect signs of
    breast cancer Angiogenesis study. In Atlas of
    Mammography, Cambridge, Mass., Blackwell Science
    pp.231-26, 1996.)   Like mammography and
    ultrasound, infrared imaging does not diagnose
    cancer, but merely indicates the presence of an
    abnormality. Only tissue biopsy can actually
    diagnose cancer. The key benefit to thermography
    is that it can detect an abnormality far earlier,
    and interventions can be undertaken immediately
    to induce normalization of the tissues. Coupled
    with regular self-breast exams, thermography is
    especially appropriate for women under 50, but is
    convenient and safe for all women of all ages.
    For more information, see www.thermologyonline.org

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  • Prepare for the worst and hope for the best

  • missed periods
  • sleep disturbances
  • hot flashes
  • vaginal dryness
  • changes in mood
  • lack of sex drive

  • Hot flashes are caused by an increase of blood
    flow in the blood vessels of the face, neck,
    chest and back.
  • Vaginal dryness is caused by thinning of the
    tissues of the vaginal wall, are the two side
    effects most frequently complained about.
  • The mood changes and lack of sex drive may result
    partially from the hormone decrease, but may also
    result from having to deal with hot flashes and
    vaginal dryness.

  • Avoid foods that may trigger hot flashes (hot
    drinks and spicy foods are common triggers)
  • Avoid Stress. It may contribute to the occurrence
    of hot flashes
  • Wear loose clothing and dress in layers so you
    can peel off the top layers during a hot flash

  • Estrogen is needed for proper response of vaginal
    tissue (lubrication and clitoral engorgement)
  • Estrogen can be used "locally" for proper vaginal
    response without putting the whole body at risk
    for long-term disease (breast and uterine cancer)
  • Testosterone may contribute to increased desire.
    However, in order for testosterone to work
    properly, the body needs estrogen first

Decrease in Breast Cancer Rates Related to
Reduction in Use of Hormone Replacement Therapy
  • The sharp decline in the rate of new breast
    cancer cases in 2003 may be related to a national
    decline in the use of hormone replacement therapy
    (HRT), according to a new report in the April 19,
    2007, issue of the New England Journal of
  • (against

WHI Study of Younger Postmenopausal Women Links
Estrogen Therapy to Less Plaque in Arteries
  • Women's Health Initiative (WHI) Estrogen-Alone
    Trial show that younger postmenopausal women who
    take estrogen-alone hormone therapy have
    significantly less buildup of calcium plaque in
    their arteries compared to their peers who did
    not take hormone therapy.
  • June 21, 2007, issue of the New England Journal
    of Medicine. (for estrogen)

  • The Women's Health Initiative (WHI) is a
    long-term national health study that focuses on
    strategies for preventing heart disease, breast
    and colorectal cancer and fracture in
    postmenopausal women

  • Your age, overall health, and medical history
  • Current symptoms
  • Your tolerance for specific medications,
    procedures, or therapies
  • Your opinion or preference
  • To enter an ongoing study on menopause

Alternative suggestions
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8. Osteoporosis
  • Lifetime risk of dying from hip fx same of
    breast cancer
  • Post menopausal 50 chance fx
  • 60 y/o man 25 chance fx
  • Men gt 50 higher risk fx than prostate ca
  • 20 fxs will die w/in 1 yr
  • 50 require long term care

  • DEXA all women 65gt
  • All women 60-64 with risks
  • roid use, poor nutrition, early amenorrhea,
    chronic disease, cigarette use, excessive etoh,
    caffeine use, lack of exercise, immobility,
    hyperthyroid, hyperpara, vit d deficiency

  • Early prevention
  • Vit d, calcium citrate
  • Exercise
  • Soy /-
  • Traditional medicine (fosamax, evista)
  • retesting

Polycystic Ovarian Syndrome
  • prevalence of PCOS of 510 in women of
    reproductive age, using the diagnostic criteria
    of the US National Institutes of Health.
  • primary defect may be insulin resistance leading
    to hyperinsulinaemia then functional
  • The theca cells are over-responsive, increase in
    size and overproduce androgens

  • Polycystic ovary syndrome (PCOS) is a common
    condition characterised by menstrual
    abnormalities and clinical or biochemical
    features of hyperandrogenism.
  • hirsutism, anovulation or dysfunctional
    bleeding, and dysfunction of glucose metabolism
  • diabetes mellitus is common in PCOS
  • ultrasound evidence is not necessary many women
    without PCOS have polycystic ovaries

  • Features of PCOS may manifest at any age, ranging
    from childhood (premature puberty), teenage years
    (hirsutism, menstrual abnormalities), early
    adulthood and middle life (infertility, glucose
    intolerance) to later life (diabetes mellitus and
    cardiovascular disease).

Treatment options
  • Control hormone pathways
  • Bandaids
  • Dietary control of glucose
  • Exercise to control weight
  • Omega 3, multivit, kidney formula

The Saguil Approach (legs)
  • Spiritual grounding-family
  • Stress reduction-yoga or tai chi, job
  • Exercise moderate to vigourous (age)
  • Multivitamin
  • Antioxidants
  • Protein, protein, carb diet

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Traditional medicine
  • Hormonal axis
  • Menstrual irregularities nsaid, oc
  • Endometriosis nsaid,
  • Female athlete triad
  • Human papilloma virus vaccine,surg
  • Ovarian cancer onc
  • Breast cancer onc
  • Menopause
  • Osteoporosis

The Saguil Approach (teeth)
  • Hormonal axis
  • Menstrual irregularities If relief,
  • Endometriosis If relief
  • Female athlete triad EFT, St Johns
  • Human papilloma virus adaptogen
  • Ovarian cancer adaptogen
  • Breast cancer adaptogen
  • Menopause soy, probio,
  • Osteoporosis cal, vit d,
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