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Dr. Pakula

(PCOS)Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is one of the most common causes of infertility in women. This hormonal disorder affects about 6 percent of pre-menopausal women. It, also, affects 90% of all women with irregular menstrual cycles. This condition is also known as Stein Leventhal syndrome.
What is Polycystic Ovarian Syndrome?
Polycystic ovarian syndrome (PCOS) is a disorder of the endocrine system. It affects the hormones, the ovaries, and the eggs which are developing within the follicle.
What are the possible causes of Polycystic Ovarian Syndrome?
• A genetic component may be involved.
• Excess levels of the luteinizing hormone (LH) interferes with normal ovarian function. High levels of both LH and insulin stimulate the ovary to produce excessive androgens.
• Insulin issues
• Abnormalities in the ovaries and adrenal glands
• Abnormalities in the central nervous system. Cases of both hypothalamic and pituitary gland dysfunction have been reported.

What are risk factors for Polycystic Ovarian Syndrome?

Risk factors are excess adrenal hormone disorders like:
• Cushing syndrome
• Androgen-secreting tumors in the ovaries
• Thyroid problems
If left untreated, PCOS can put women at risk for:
• Heart disease
• Diabetes
• High blood pressure
• High cholesterol
• Infertility
• Obesity
• Increased risk of miscarriage
• Type 2 diabetes and gestational diabetes
• Endometrial or uterine cancer
• Sleep apnea

What are the symptoms of Polycystic Ovarian Syndrome?

Symptoms may first appear around the time of puberty. But for most women, signs do not become noticeable until their early teens.
• Hirsutism, which a growth of excessive body hair, appears on the chin, upper lip, neck, sideburn area, chest, nipple area and the lower abdomen along the midline.
• Irregular or infrequent periods.
• Abnormal levels of insulin as well as insulin resistance
• Late or absent ovulation
• High prolactin hormone levels (hyperprolactinemia)
• Prolonged premenstrual syndrome (PMS) symptoms, such as bloating, pelvic pain, headaches, mood swings and/or depression.
• Excessive weight gain.
• Acne and/or oily skin.
• Polycystic ovaries or enlarged ovaries containing more than 12 follicular cysts.
• Darkening of the skin around the areas of the neck, arms, breasts, or thighs and is usually indicative of insulin resistance.
• Skin tags which are small pieces of excess skin around the armpit or neck area.

Stein-Leventhal syndrome

Polycystic Ovarian Syndrome – The Traditional Eastern View

In Traditional Chinese Medicine, Polycystic Ovarian Syndrome is seen as a heterogenous disorder, consisting of quite a few possible pattern discriminations. They are broken down into two main subcategories:

Vacuity Repletion

Kidney yang vacuity

Phlegm dampness

Kidney yin vacuity

Liver depression/depressive heat

Spleen qi vacuity Blood sta

How does Chinese Medicine treat PCOS?

Research shown on women with anovulatory PCOS showed restoration of ovulation in one-third of the test subjects using electro-acupuncture. Endocrine indicators of PCOS were also affected including mean testosterone concentrations, beta-endorphin concentrations, and LH to FSH ratios. Hence, acupuncture works to restore optimal function of the hormonal and sympathetic systems, and helps to rebalance the nerve and blood supply in ovaries. Combining acupuncture, herbs, diet, and Reproductive Organ Massage has lead to many women experiencing less symptoms and pregnancy.

Western Treatment and prevention of PCOS

• Weight management to address obesity or unwanted weight gain. According to the American Society for Reproductive Medicine, losing as little as 5 to 10 percent of total body weight may help women resume normal ovulation. In addition, a healthy diet and regular exercise are the best ways to prevent long-term consequences of PCOS such as cardiovascular disease and diabetes.
• Quit smoking because it increases the risk of complications associated with PCOS like heart disease.
• Get regular gynecological examinations to detect early signs of either ovarian or uterine cancer.

For women with PCOS who are trying to conceive, treatment varies and may include:

• Ovulation drugs are used as the first line of treatment for women with PCOS. The most common drug is Clomiphene Citrate (Clomid). A second, more aggressive therapy which may be used, involves injectable drugs called gonadotropins.
• Antidiabetic agents are medications that increase the body’s sensitivity to insulin. Normally prescribed by your physician is metformin (glucophage).
• Laparoscopic ovarian drilling is a surgery that stimulates ovulation, regulates the menstrual cycle and increases a patient’s chances of becoming pregnant.
• In Vitro Fertilization (IVF) is another option for women with PCOS.

For women not trying to conceive, treatment usually involves restoring a normal menstrual cycle and may include:

• Birth control pills are used to regulate the menstrual cycle and to reduce the risk of endometrial and uterine cancer.
• Corticosteroids are used to suppress androgen production by the adrenals.
• Anti-androgens like spironolactone and flutamide block the effect of androgens and can prevent unwanted hair growth and acne.
• Gonadotrophin-releasing hormone (GnRH) agonists (luprolide) suppress production of sex hormones and induce a temporary menopause in pre-menopausal women. These types of medications also reduce skin problems such as acne, and may cut down on hirsutism for as long as they are taken.

Western Drug Therapy:

• Metformin (Glucophage) improves both glucose tolerance and insulin sensitivity.
• Pioglitazone (Actos) works primarily by improving insulin sensitivity and glucose tolerance.. Periodic liver function tests are recommended for the first year of therapy.
• Rosiglitazone (Avandia) works by improving insulin sensitivity.

Balanced diet

PCOS is an endocrine disorder, which has wide ranging effects on both fertility and general health. After many years of study and experience with the disease, we believe that a balanced diet, proper nutrition, exercise, and a healthy lifestyle can contribute greatly to the treatment of PCOS. We prescribe the following changes for the enhancement of fertility and the path to greater health and well-being:
• Eat organic foods and avoid processed foods. People who have PCOS already have a hormonal and/or chemical imbalance, and processed foods contain chemicals, additives and artificial colorings, which make conditions worse.
• Avoid sugar, artificial sweeteners, soda, fruit juice and refined carbohydrates, which impact insulin resistance. Eat only complex carbohydrates, such as whole wheat or grains, oatmeal, and brown rice.
• Avoid cold food and ice cold drinks. Cold food and drinks take longer to go through the digestive system and slow the body’s metabolism. People who have PCOS usually also have a low metabolism. Having warm drinks and foods are better for PCOS sufferers
• Avoid physical and mental exhaustion; get plenty of rest and maintain regular sleep patterns. Longer hours of regular sleep can play a major role in maintaining good homeostasis and general well being
• Eat plenty of fresh vegetables–like broccoli, cauliflower, carrots and dark green vegetables, which contain high amounts of Essential Fatty Acids (EFA). EFA regulates hormonal balance, which is very important when trying to conceive.
• Avoid alcohol consumption. Alcohol can lead to a disturbance of hormonal balance.
• Stop smoking. Smoking may affect the fertility in tubal pregnancies, cervical cancer, pelvic infection and early menopause.

Acupuncture & Herbal Medicine

Can Effectively Manage Endometriosis

Endometriosis involves the growth of cells from the endometrium (the uterus lining) in other areas of your abdomen. About 12 million American women report having this condition– that’s 10-20 percent of the female population.

Endometriosis begins with a backup of endometrial tissue that builds up throughout the month during a regular menstrual cycle. The cause of this tissue backup is still unknown. Instead of flowing out of the uterus, some of the tissue moves back up through the fallopian tubes (which transport ovulated eggs) and falls out into the abdominal cavity. These living cells are often called implants, and continue to respond to cyclical hormonal changes. They grow, build up, and bleed, just like they did before in the uterus, except there’s nowhere for the blood to go. The blood can be absorbed slowly by the lining of the abdomen, but the remaining buildup of weblike tissue and blood clots cause the scarring and adhesions that can affect your fallopian tubes, ovaries, bladder, or bowel. A conventional Western doctor usually diagnoses endometriosis with laparoscopy, an outpatient surgical procedure that allows the doctor to examine your internal abdominal structures.

A laparoscopy is an outpatient surgical procedure most commonly used to diagnose endometriosis. A tiny, lighted tube is inserted through a small incision in the navel, so that your surgeon can look inside the abdominal cavity.

Endometriosis Risks and Symptoms: Could This Be You?

While the causes of endometriosis is still unclear, here is a valuable list of the current medical thoughts on the condition:

  • Deficiency in the immune system
  • Family history of endometriosis
  • Menstrual cycle length of 27 days or less
  • Early onset of menstruation
  • Periods lasting seven or more days
  • Reported mostly by women who have never been pregnant

The symptoms of endometriosis can be difficult to evaluate. In the beginning, many women do not have any symptoms. Others who have severe buildup of tissue have no pain, while some women with only small adhesions have disabling discomfort. Although endometriosis is usually diagnosed between the ages of 25 and 35, the condition could begin about the same time that menstruation starts. Many of these symptoms are frequently ignored or thought of as a normal part of the cycle. Have a conversation with your health care provider if you experience any of these symptoms:

  • Increasingly painful periods
  • Severe pelvic cramps or abdominal pain one to two weeks
  • before the menstrual period
  • More frequent or irregular menses
  • Pelvic or low-back pain felt at any time during the cycle
  • Pain during or following sexual intercourse
  • Pain with bowel movements
  • Infertility (approximately 25-50 percent of these cases are due to endometriosis)If you have symptoms of endometriosis, make sure you use a pad and not a tampon during menstruation. Tampons can increase pain and cramping during your cycle and may make reflux menstruation (the tissue backup) more likely.

How can Chinese Medicine and Acupuncture help endometriosis?

From a Chinese medicine perspective, we work to restore a pain-free natural menstrual state. Each symptom of the disorder is addressed whether it is pain, dark and clotted menstrual blood or excess estrogen imbalance causing heightened feelings of PMS. Both acupuncture and herbs can work to reduce the pain, breakup the old stagnated blood and encourage fresh red flow and promote hormonal balance. Reestablishing proper estrogen/progesterone ratios is essential to healing from this condition and acupuncture works to this effect. A woman with mild endometrial symptoms may be able to use Chinese medicine alone to heal naturally from the effects of endometriosis. More severe cases need to employ the use of both western medicine and Chinese medicine to have the best prognosis for long-term cessation of symptoms.

Elevated FSH

What is FSH?

Follicle Stimulating Hormone (FSH) is one of the two “gonadotropins” secreted from the pituitary gland to regulate the function of the ovary (LH or Luteinizing Hormone being the other). FSH stimulates the ovaries’ production of estrogen and promotes development of the follicles. The estradiol produced by the ovaries signals the brain to decrease the production of FSH. Therefore if there is not enough estrogen produced by the ovary, then the brain doesn’t receive the signal and FSH production continues.

What is ovarian reserve and why is it important?

Ovarian reserve is defined as the health of the ovaries and the eggs they contain. As a women ages, the amount of eggs in reserve naturally decreases and her FSH levels increase. The amounts of eggs in reserve can only be approximated.

How is ovarian reserve tested?

  • FSH blood test on Day 3
  • Estradiol blood test on Day 3
  • Clomiphene Challenge Test (CCT) on Day 3 of the menstrual cycle to determine the FSH level. Then Clomiphene is given on days 5-9 and then retest the amount of FSH on day 10. If the FSH is elevated as well on day 10, then this usually is an indicator of diminished ovarian reserve.
  • Test for low inhibin B levels which have to do with the feedback system from the ovaries to the brain and FSH production. If this number is low, then there is low ovarian reserve.
  • An ultrasound can be performed to see if basal antral follicles are present.

What is High FSH?

Remember FSH levels predict low fertility when they are abnormal but they do not accurately predict high fertility when normal. Also the cut off values are very laboratory dependent and your FSH can vary from cycle to cycle. High FSH, as a general rule, can be defined as a Day 3 value of over 10 mg/dl.

What are the causes of High FSH?

The underlying causes of High FSH may include extreme stress, diminished blood flow to the ovaries, or lack of ovarian response to pituitary production of FSH.

What are the symptoms of High FSH?

Typically, symptoms of High FSH may include hot flashes, night sweats, vaginal dryness, infertility, irritability, menstrual irregularity, decreased libido, and headaches.

Western Treatment options for women with elevated FSH and reduced ovarian reserve:

  • In vitro fertilization with assisted hatching
  • In vitro fertilization with coculture
  • In vitro fertilization with donor eggs

Chinese Medicine Treatment for High FSH:

In our clinic, we use acupuncture, herbs, reproductive organ massage,dietary guidelines. By implementing these methods, we will be able to increase blood flow to the ovaries, relax the body and reduce stress, regulate the Hypothalamus-Pituitary-Ovarian axis, and increase egg quality.

Chinese Medicine and Polycystic Ovarian Syndrome


Conditions | Acupuncture for Fertility in Pembroke Pines FL Center in Broward County, Florida
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