Infertility – Part 1

Posted by on Jul 2, 2020

  Important to know the Underlying Cause     What is infertility? The definition of infertility differs based on the age of the female trying to conceive because age is the single most influential factor when it comes to fertility. It is generally regarded that female fertility begins to decline after about age 30. This is because females have all of their eggs at birth and over time the reserve of eggs dwindles resulting in a lower number and quality of eggs available. Infertility is defined as not being able to get pregnant after trying for a year. However, this definition is amended to a window of trying for 6 months if a woman is 35 years or older.     What causes infertility? Infertility is a mixed bag and can be a result of female factors, male factors, or unknown. Roughly one-third of cases are attributed to female causes, one-third to male causes, and about one-third are in a frustrating bucket where no known cause can be found.   It is important to note that each family is unique and can be made up of persons anywhere on the gender spectrum. When discussing the creation of an embryo we talk about male factors relating to sperm and male reproductive organs and female factors relating to eggs, female reproductive organs, and pregnancy. However, this process can be achieved through a range of options based on each family’s unique make up.     Common female factors: Female fertility is complex because it pertains not only to the health of ovaries, fallopian tubes, uterus, and the egg but also to the ability of first the sperm and then the embryo to navigate through the female reproductive system and ultimately implant in the uterus. Let’s break this down based on location:   Ovarian factor infertility pertains to elements that can alter ovarian function and ovulation. Without regular ovulation there will be no egg to meet with the sperm to create an embryo. Conditions that result in altered hormone function like polycystic ovarian syndrome (PCOS), thyroid disorders, hyperprolactinemia, and hypothalamic disorders (often caused by too much exercise or disordered eating) can all disrupt ovulation. Additionally, diminished ovarian reserve or primary ovarian insufficiency (POI), a condition where the ovaries stop functioning and the person enters early menopause (before age 40) may play a role in ovarian factor infertility. POI may be due to a history of pelvic radiation or chemotherapy, Turner’s syndrome, Fragile X syndrome, or may be unknown.   Uterine or cervical troubles can complicate the sperm’s ability to travel through the female reproductive tract in order to join with the egg. The shape of the uterus due to genetic conditions or the...

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Four Uses of Melatonin

Posted by on Jun 1, 2020

  What is melatonin? Melatonin is a hormone that is secreted by the pineal gland in the brain and plays a key role in the maintenance of the sleep-wake cycle. In addition to its function regarding sleep, melatonin has been proposed to have many varied properties as it also functions as an antioxidant and anti-inflammatory. Because of melatonin’s diverse characteristics, it has been studied for a wide variety of common ailments including the following:   Insomnia: Sleep is one of the most fundamental elements supporting human health; it is necessary for healthy cognitive functioning and supports our mental and physical wellbeing. Unfortunately, insomnia is incredibly common and is responsible for over 5 million medical office visits annually in the United States. This complex condition has many potential causes and can lead to widespread disruptions to a person’s general health. Whatever the cause, sleep hygiene can be a baseline factor in treatment plan. Here are a few key points on how to improve your sleep hygiene, laying the groundwork to achieving a night of quality sleep. Daily exercise can help promote quality sleep. However, many people find that intense physical activity close to bedtime can also disturb sleep. Timed light exposure. To ensure a healthy sleep-wake cycle we want more robust exposure to sunlight during the morning and daytime and then a reduction in light exposure in the evening and night. Keep your sleep environment cool, dark, and quiet. Creating a cool sleeping space can be as simple as making sure to remove the extra blanket as we transition into spring and warmer weather. Or could entail the addition of a small fan or cracked window to help keep a bedroom cool. You may consider blackout curtains or an eye mask to ensure that you are sleeping in a dark room. Ideally, your sleep space will be dark enough that if you stretch your arm out in front of your face, you will not be able to see your hand. To craft a quiet room – use of earplugs, a fan, or white noise machine can help even out background noises. Establish a pre-sleep routine. Even if our personalities do not love a routine, our bodies do. Choosing a couple of activities that you perform as a pre-bedtime ritual can help signal to the brain that it is time to start winding down and preparing for sleep. Examples of such activities could include light reading, a warm shower, a small cup of relaxing tea, or meditation. Go to sleep at the same time each night and wake at the same time each morning on a schedule that will allow you to get 7-9 hours of sleep nightly. Limit or avoid...

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Does what and how we drink impact breast health?

Posted by on May 15, 2020

    Roughly 1 in 8 women will develop breast cancer in her lifetime. With this outstanding number in mind, many women ponder what can be done to reduce breast cancer risk. While a genetic predisposition for development of cancer cannot be altered there are other factors that can be modified. One such modifiable risk factor is alcohol consumption.   Does alcohol increase risk for development of breast cancer? Compared to women who drink less than one drink daily, women who regularly drink 1-2 alcoholic drinks per day have a statistically significant increased lifetime risk for the development of breast cancer. This risk further increases when consumption exceeds 3 drinks per day. However, not all alcohol consumption is noted to have deleterious impact on health; consumption of alcohol between 3-5 drinks per week is actually associated with reduced all-cause mortality in women.   What is one drink anyway? One drink equals 12 ounces of 5% beer, 5 ounces of 12.5% wine, or 1.5 ounces of 40% hard liquor.   Does alcohol consumption matter when it comes to breast cancer outcomes? A large observational study of over 7,000 women concluded that there was no increased risk for overall or all cause mortality in women who consumed alcohol before or after breast cancer diagnosis.   Does alcohol impact risk for recurrence of breast cancer? In a 2013 publication evaluating risk for recurrence, women who were postmenopausal at time of breast cancer diagnosis and regularly consume more than 4 drinks per week had nearly 20% higher risk of recurrence than those who drank less. However, there was no difference in recurrence risk in women who were premenopausal at the time of their breast cancer diagnosis.   What can you do? Attempt to keep alcohol consumption down, ideally to three or fewer drinks per week. But reducing alcohol intake does not mean reducing socialization. The next time you want to have a drink consider a mocktail.   Mocktail recipe: – 1 ounce fresh squeezed lime juice – 1 ounce homemade simple syrup – 4 ounces seltzer water – garnish with fresh fruit or edible flowers Combine ingredients and enjoy!   For further and more comprehensive advice on how to reduce the risk of breast cancer with specific guidelines regarding diet, exercise, and supplementation, please make an appointment at A Woman’s Time.  I’d be happy to assist you.   References: Kwan ML, Chen WY, Flatt SW, et al. Postdiagnosis alcohol consumption and breast cancer prognosis in the after breast cancer pooling project. Cancer Epidemiol Biomarkers Prev. 2013;22(1):32‐41. doi:10.1158/1055-9965.EPI-12-1022 Lowry SJ, Kapphahn K, Chlebowski R, Li CI. Alcohol Use and Breast Cancer Survival among Participants in the Women’s Health Initiative. Cancer Epidemiol Biomarkers Prev. 2016;25(8):1268‐1273. doi:10.1158/1055-9965.EPI-16-0151 Newcomb...

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Pain with Sex After Menopause

Posted by on Jan 31, 2019

  With the menopause transition comes a change in estrogen levels. That change affects just about EVERYTHING, including sex. Estrogen is responsible for keeping the tissue of the vagina moist and well lubricated. It keeps this tissue plump and healthy and even helps keep the good bacteria in the vagina healthy! When estrogen levels decline, the tissue in the vagina can become dry, thin, less lubricated and less elastic, all of which can cause sex to feel painful or cause a burning or tearing sensation. For some, this pain can be significant enough to deter all interest in sexual activity. Fortunately, there are many things that can be done to protect this tissue and to keep sex (touch and/or penetration) comfortable. Vaginal moisturizers and lubricants are the first options to consider but the two are quite different from each other.  We can think of vaginal moisturizer similarly to lotion that we use on the rest of our bodies when we have dry skin. The purpose of a vaginal moisturizer is simply to provide moisture to vaginal tissue and should be used on a regular, even daily basis. Lubricants are used to increase pleasure and decrease friction with sexual activity. They are typically made in a base of water, oil, or silicone but some brands can have some less desirable additives such as parabens and petroleum so make sure to read the labels, because there may be some undesirable short and long term effects of these two ingredients.   Ideally, your lubricant will have a pH that is similar to that of the vagina helping to keep your vagina healthy and balanced.  If vaginal moisturizers and lubricants are just not doing the job, we have other options!  Lose-dose, select hormones applied directly to the vagina and/or vulva can often provide substantial benefit to the local tissue.   Research strongly supports the use of either vaginal estrogen or DHEA (Dehydroepiandrosterone) low-dose hormones for the treatment of vaginal dryness. Fortunately, very little of these low-dose hormones are absorbed into the blood stream, which makes them a good option for a wide range of women. There are even vaginal estrogen products and vaginal DHEA products that are considered safe for some breast/endometrial/ovarian cancer patients. However, if you have a history of breast or other hormone sensitive cancer it is always best to speak with your doctor prior to attempting any hormone therapy. It is also important to note that there are numerous methods by which these hormones can be delivered including: suppositories (large and small), creams, tablets, and rings. Having this variety of options allows clinicians to individualize the treatment to find the best delivery method for you. Finally, regular sexual activity can...

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Yeast Vaginitis (and boric acid)

Posted by on Dec 6, 2018

Roughly 75% of reproductive aged females will experience at least one vaginal yeast infection (vulvovaginal candidiasis or VVC), with half of them developing a second episode at some point.  Additionally, between 5-9% of these women will go on to develop recurrent vulvovaginal candidiasis, meaning numerous episodes over the course of a year. Vulvovaginal candidiasis is clearly noted as one of the most common vaginal infections experienced by women of childbearing age with symptoms that are very familiar to many of us. Symptoms of VVC often include vaginal and vulvar itching, burning, irritation, pain with intercourse, and a thick, white discharge. Unfortunately, symptoms of VVC often overlap with other vulvovaginal conditions and thus are often assumed to be VVC when in fact they are a constellation of symptoms attributable to another condition. Furthermore, it is not uncommon for individuals to have more than one microbe responsible for the upset within her vaginal ecosystem. For these reasons it is important for women experiencing vaginal symptoms to be evaluated by a provider so that objective testing may be used to decipher the precise cause of imbalance. Such testing may include vaginal pH evaluation, microscopy, culture, or testing for fungal DNA. There are numerous factors that play a role in the development of recurrent VVC. For example, an increased estrogenic state such as that seen in pregnancy or achieved with use of oral contraceptive pills may increase the risk of a patient developing VVC. The use of antibiotic medications should be considered as a potential risk factor for a woman developing VVC as it likely alters the vaginal microbiota. While I am in no way advocating against the above listed medications, I am encouraging a heightened awareness of VVC in persons with these conditions or using these medications. Additionally, persons with compromised immune systems are often at heightened risk for the development of recurrent VVC. Although most women with VVC do not have the following conditions, individuals who have been diagnosed with diabetes, human immunodeficiency virus (HIV), or who routinely take glucocorticoids or immune suppressing agents may experience recurrent episodes of VVC Conventional treatment of VVC generally includes an anti-fungal agent, often one that falls into the azole class of medications, such as oral fluconazole or topical miconazole. Although there are numerous additional options within the azole class, additional classes of antifungal medications are few.  These limited treatment options have presented a challenge, as there are increasing numbers of cases of azole resistant candida. Candida albicans is the predominant culprit with VVC, however, several other species of yeast may contribute to symptoms. Knowledge of the distinct species may be helpful in selection of treatment as not all species of candida are susceptible to...

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