polycystic ovarian syndrome

When Should Teens Go to the Gynecologist?

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When should girls start going to the gynecologist? The general consensus from the medical community and public health education is that a girl need not see a gynecologist until she becomes sexually active..I disagree.

Reproductive Care Should Begin with the First Period

Consider this; the average age of menarche in the United States is a little above 12 years of age. The average age a woman loses her virginity in the United States is 17. Based on what is taught in health class, that leaves 5 years of no reproductive care for the average American female. Although the average teenager may not need annual visits to the gynecologist, reproductive care should not be ignored. This means pediatricians must be better informed about gynecological care.

Just because a young girl is not sexually active does not mean her reproductive system does not exist. Amenorrhea, dysmenorrhea, endometriosis, polycystic ovarian syndrome and menorrhagia are all terms (or concepts) that young girls of reproductive age should be familiar with; and yet a majority of girls of reproductive age would not be able to identify any of these terms.

Abnormal Periods are a Sign of Trouble

Young girls should be taught that abnormal periods, painful periods (dysmenorrhea), an absence of periods (amenorrhea), or extremely heavy periods (menorrhagia) are not normal and should be evaluated by a doctor. In many cases, finding the causes of abnormalities in menstruation early on, could prevent further complications down the road.

Most women who have uterine or menstrual abnormalities do not get a diagnosis or proper treatment until they discover they cannot conceive. That is because by the time these women go to the gynecologist for the first time they have been lead to believe that abnormal is their normal.

My Story

When I was twelve I was getting my period every other week and I was told that was normal and that every girls’ period takes some time to regulate – which is true.  However, it wasn’t true for me. I had endometriosis and uterine didelphys (two uteri) which required surgery, but because I was young, it was two and a half years before my painful periods were taken seriously. This is an all-too-common experience. Many women report suffering for decades.

In the case where a young girl’s menstrual problems are impacting her daily life – isn’t it better to be safe, rather than sorry? Read my full health story here.

The Need for Pediatric Gynecologists

Pediatricians and family doctors alike need to sit down with their female patients and have a detailed discussion about menstruation. No one should assume that health education in secondary schools is adequate to teach a young girl to stand up for her own reproductive care. The stigma of being too young (or not yet sexually active) to go see the gynecologist should be disregarded. Regardless of age, if any other part of the body wasn’t working one would go to the doctor to get it looked at; the same should go for the reproductive system.

How old were you at your first gynecologist appointment? When did your menstrual problems begin?

Why is PCOS so Common?

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We are in the middle of an alarming trend. More and more women are being diagnosed with polycystic ovarian syndrome (PCOS), an endocrine disorder that causes irregular periods, acne, hair loss, and hirsutism.

The disorder is not new, but it is increasing at a dizzying rate. Two decades ago, PCOS was infrequent amongst my patients. Today, I see it all the time. Polycystic ovaries are estimated to now affect close to one in five women, with an even higher incidence in teenagers. What is going on?

Insulin Resistance

A big part of the problem is insulin resistance which is is the hallmark condition of our modern age, affecting 1 in 4 adults. Insulin resistance is the result of too much sugar (concentrated fructose) in our diet, as well as smoking, obesity, trans fat, stress, and environmental toxins. Untreated, insulin resistance can lead to diabetes and cardiovascular disease.

Insulin resistance is estimated to affect between 50-70% of PCOS-sufferers [1], and is generally understood to be a major contributing cause of the condition [2]. Excess insulin causes polycystic ovaries because it impairs ovulation and stimulates the ovaries to make testosterone instead of estrogen.

We have an epidemic of insulin resistance, so it makes sense that we also have an epidemic of PCOS. Except that not all PCOS sufferers have insulin resistance, so what else is going on?

Misdiagnosis by Ultrasound

Proper diagnosis of PCOS requires clinical evidence such as irregular periods, combined with a blood test that shows high androgens. There may or may not also be the ultrasound finding of polycystic ovaries, but that finding alone cannot be used to diagnose PCOS. Why? Because polycystic ovaries occur in up to 25% of normal women, and also in many women on on the birth control pill [3].

Would a family doctor or OB/GYN really attach the label of PCOS to a normal woman solely based on one ultrasound finding? Sadly, the answer is Yes in many cases, and that can lead to a lot of unnecessary confusion and heartache. I almost never accept a diagnosis of PCOS at face value. Instead, I order extra blood tests form my patients to confirm that they do have high androgens.

Fortunately, there are calls to rename the condition, and to re-educate doctors about the relevance of the polycystic finding.  According to Dr. Robert A. Rizza from the Mayo Clinic:

“[The name PCOS]..focuses on a criteria—namely the polycystic ovarian morphology—that is neither necessary nor sufficient to diagnose the syndrome. It is time to assign a name that reflects the complex metabolic, hypothalamic, pituitary, ovarian, and adrenal interactions that characterize PCOS.” [4]

Post-Pill Syndrome

There is one more reason for the increasing incidence of PCOS: The Birth Control Pill. In my clinic, I speak to so many women who simply cannot get their periods going again after stopping the Pill. Some of them did not have regular periods before taking the Pill, so, in their case, stopping the Pill has merely unmasked a preexisting problem. Then there are the women who did have regular periods before the Pill, but now they’re gone. For these women, the Pill seems to be a clear cause of PCOS and hypothalamic amenorrhea.

We don’t yet know exactly how the Pill causes PCOS because that research has not yet been done. We do know that the Pill causes insulin resistance, which in turn, causes PCOS [5]. We also know that the Pill suppresses the pituitary-ovarian communication, which of course it’s designed to do, but that suppression is supposed to be temporary. It’s supposed to be temporary, but some women experience an ongoing elevation of the pituitary hormone LH (even in the absence of other PCOS markers such as insulin and androgens). Without treatment, post-Pill LH elevation can persist for months or even years after stopping the Pill.

What to do about PCOS

If you or your patient has been diagnosed with PCOS, then first find out if it was diagnosed by ultrasound alone. If it was, then the PCOS diagnosis is not certain.  Ask for further blood testing to see if there are high androgens, and most importantly: If there is insulin resistance.

When it can be determined that insulin resistance is the cause of PCOS, the best treatment is to eliminate concentrated sugar (desserts) from the diet, and also to supplement nutrients (such as magnesium) that improve insulin sensitivity.

When insulin resistance is not the cause of PCOS, things get a little more complicated. Non-insulin-resistant PCOS is often the result of the Pill (as discussed above), but it can also be the result of other underlying health issues such as chronic inflammation. I explore the natural treatment of PCOS in my new book Period Repair Manual.

References

  1. Ibricevic D et al. Frequency of prediabetes in women with polycystic ovary syndrome. Med Arch. 2013;67(4):282-5. PMID: 24520755
  2. Dunaif A et al. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997 Dec;18(6):774-800. PMID: 9408743
  3. Clayton R et al. How common are polycystic ovaries in normal women and what is their significance for the fertility of the population? Clin. Endocrinol. 1992 37 (2): 127. PMID 1395063.
  4. http://www.highbeam.com/doc/1G1-323971757.html
  5. Diamani-Kandarakis E et al. A modern medical quandary: polycystic ovary syndrome, insulin resistance, and oral contraceptive pill. J Clin Endocrinol Metab. 2003 May; 88(5): 1927-32. PMID: 12727935

 

 

PCOS and Endocrine Disruptors

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Endocrine disruptors are chemicals that interfere with the body’s endocrine (hormonal) system. They can affect everything from normal development, reproductive fertility to neurological health. Unfortunately, endocrine disruptors are everywhere in our society. And there are many different types.

Some examples of endocrine disruptors include dioxin, PCBs, DDT, other pesticides and bisphenol A (BPA). Many of us have heard of the risks associated with various pesticides and the BPA in our plastics. These little guys can hide out everywhere – in our household cleaners, personal care products and cookware.

Endocrine Disruptors and Polycystic Ovarian Syndrome (PCOS)

PCOS is characterized by a group of signs and symptoms. These include excess androgens, insulin resistance, cysts on the ovaries, hirsutism (excess hair growth), acne, weight gain, irregular periods, depression and more. As PCOS is a hormonal disorder, anything that effects our production and/or filtration of hormones (like endocrine disruptors) will affect PCOS. Many studies have been conducted around this very topic.

Bisphenol A (BPA). Let’s talk about one of the most prevalent and widely-researched endocrine disruptors: bisphenol A. BPA is a chemical generally used in plastics and the lining of some metal items. For the consumer, BPA is found mostly in the lining of cans, plastic water bottles and containers. Now, this may not sound too bad but the BPA in these containers can seep into your food and drink- posing serious health risks.

Just a few of the many health risks associated with BPA exposure include:

  • Reduced number of oocytes (eggs in our ovaries)
  • Lowers successful number of births
  • Heightens stress response and anxiety
  • Increases testosterone
  • Reduces function of estrogen receptors
  • Developmental problems in fetuses and children
  • Impaired glucose metabolism (blood sugar problems)
  • Cancer

PCOS and BPA

Fetal Exposure. Several studies have been conducted to test the connection between BPA use or exposure and polycystic ovarian syndrome. What scientists have estimated is that a woman is much more likely to develop PCOS if there was BPA exposure as a fetus. This means that if your mother used canned foods lined with BPA or lots of BPA-containing plastic containers and bottles during her pregnancy, it could have contributed to your PCOS[i][ii].

Increased Testosterone. These studies have also show that BPA exposure leads to increased levels of testosterone. The reason for this is because BPA exposure is linked to decreased filtration of testosterone. A few studies have noticed this correlation.

Estrogen Dominance. Another connection between PCOS and BPA is an increase in estrogen production. Remember, there are many types of synthetic estrogens, but the most prominent endogenous (those made by the body) estrogens include: estrone, estradiol and estriol (high in pregnancy). Generally in PCOS, testosterone and estradiol reign high, with the body unable to produce enough progesterone. This can create what has been called estrogen dominance[iii]. This is bad news for women trying to balance their hormones.

BPA and other endocrine disrupting chemicals contain estrogen-mimicking compounds (xenoestrogens) that increase our body’s supply of the hormone. As we know, approximately 50% of women with PCOS are overweight. These xenoestrogens are fat-soluble, meaning that they get stored in fat. So, the more overweight a woman is, the more likely her symptoms of PCOS and estrogen dominance will be severe.

Glucose Metabolism. There is one more way that endocrine disruptors are bad for women with PCOS, and that is glucose metabolism. Insulin resistance and blood sugar issues are extremely common in women with PCOS[iv]. Scientists have discovered that endocrine disruptor exposure alters glucose metabolism and pancreatic function[v]. The pancreas is our blood-sugar-regulating hub, so this is bad news. Risk of developing diabetes is also heightened.

How to Avoid and Detox Endocrine Disruptors

Glass Cookware and Food Storage. Many of the endocrine disruptors we are exposed to are in some way related to our foods. Canned foods often have a BPA liner on the inside, which seeps into our food. We store our food in plastic containers and bottles that are made with BPA. It’s important to find alternatives to these storage methods to reduce our exposure.

Try using glass storage containers and bakeware instead of plastic. Glass is sturdy, easy-to-clean and can last a lifetime. A small investment in glass storage will go a long way to reducing your exposure. Another thing to try is avoiding cans lined with BPA. Generally, companies won’t tell you if a can is lined with BPA, but the ones that don’t use it will put it on the label. Not sure? Avoid canned foods altogether and only use fresh foods.

Whole Foods Diet. We all know we should eat for health and that whole foods are better than packaged foods, but how many of us are really doing this? We lead such busy lives it can be difficult to grasp the concept of cooking fresh, from scratch. If you are concerned about exposures to endocrine disruptors, eating fresh foods  will drastically reduce your exposure.  And for a bonus, – use organic fruits, vegetables, dairy products and meats wherever possible. Endocrine disruptors are also in the pesticides, hormones and antibiotics used to cultivate conventional foods[vi]. Still not sure? Why not try purchasing a share of a local farm that you trust. These are called CSAs, or community-supported agriculture. You pay a fee and get a weekly box of fresh goodies during the growing season.

Natural Remedies for Exposure to Endocrine Disruptors

Sweat. The skin is our largest organ. It’s also one of the ways our bodies detoxify. When you sweat regularly, the body is able to filter and release excess toxins, chemicals, hormones and other substances- this includes BPA. Sweat regularly through exercise, saunas and hot baths. But make sure to rehydrate your body with pure, clean water afterwards!

Lemon Water. Speaking of hydration, pure, filtered water is a huge helper for our bodies in filtering toxins. When we drink warm water with fresh lemon juice upon waking, it helps our bodies release toxins that is has filtered while we were sleeping. It also helps to set our digestion for the day, so we are better able to prevent toxins from getting into our bloodstream in the first place.

DIM. Diindolymethane (DIM) is an antioxidant and phytonutrient compound found in brassica family vegetables. These include broccoli, Brussel sprouts, cauliflower, cabbage and kale. Studies have shown DIM to have superior abilities to reduce excess estrogens and risk of some female cancers such as breast cancer[vii]. This is a supplement that could be useful for women with PCOS who have estrogen overload due to endocrine disruptors. DIM will safely bring the estrogens back into balance and restore healthy tissues. This can be helpful in hormonal weight gain, excess androgens and PMS issues.

Probiotics. Probiotics are “friendly” bacteria that reside in our gut. They help to regulate our immune system, digestion and so much more. They have become quite popular lately and are added to a variety of foods. Probiotics can also be taken in supplement form.

Probiotics detoxify endocrine disruptors like BPA because they are able to break them down[viii]. When this happens, those harmful chemicals are excreted through our bowels. Some examples of probiotic foods to include in your diet every day are plain, unsweetened yogurt, kefir, kombucha, raw, unpasteurized sauerkraut, kimchi or pickles, and raw apple cider vinegar.

BPA and other endocrine disruptors can wreak havoc on women with PCOS, and may even contribute to the syndrome developing in the first place. Prevent further complications from these chemicals by balancing your hormones, losing weight if necessary and enjoying a whole foods diet full of phytonutrients like DIM. And don’t forget to avoid sources of BPA like plastic containers and food cans as much as possible. When you take care to do these steps, PCOS may become more manageable.

References

[i] Eleni Kandaraki, Antonis Chatzigeorgiou, Sarantis Livadas, Eleni Palioura, Frangiscos Economou, Michael Koutsilieris, Sotiria Palimeri, Dimitrios Panidis, and Evanthia Diamanti-Kandarakis. Endocrine Disruptors and Polycystic Ovary Syndrome (PCOS): Elevated Serum Levels of Bisphenol A in Women with PCOS. The Journal of Clinical Endocrinology & Metabolism 2011 96:3 , E480-E484.

[ii] Evanthia Diamanti-Kandarakis, Jean-Pierre Bourguignon, Linda C. Giudice, Russ Hauser, Gail S. Prins, Ana M. Soto, R. Thomas Zoeller, and Andrea C. Gore. Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement. Endocrine Reviews 2009 30:4 , 293-342.

[iii] Slater, W. (n.d.). The Role of Estrogen Dominance in PCOS (Polycystic Ovarian Syndrome). Retrieved November 16, 2014, from http://www.ovarian-cysts-pcos.com/estrogen-dominance.html

[iv] Dach, J. (2014, May 19). PCOS, BPA and Endocrine Disruptors Part Three. Retrieved November 15, 2014, from http://jeffreydachmd.com/2014/05/pcos-bpa-endocrine-disruptors-part-three/

[v] Evanthia Diamanti-Kandarakis, Jean-Pierre Bourguignon, Linda C. Giudice, Russ Hauser, Gail S. Prins, Ana M. Soto, R. Thomas Zoeller, and Andrea C. Gore. Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement. Endocrine Reviews 2009 30:4 , 293-342.

[vi] Evanthia Diamanti-Kandarakis, Jean-Pierre Bourguignon, Linda C. Giudice, Russ Hauser, Gail S. Prins, Ana M. Soto, R. Thomas Zoeller, and Andrea C. Gore. Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement. Endocrine Reviews 2009 30:4 , 293-342.

[vii] A Super-supplement for Hormone Balance: DIM. (n.d.). Retrieved November 16, 2014, from http://blog.healthybynaturehwc.com/2013/08/06/a-super-supplement-for-hormone-balance-dim/

[viii] Gallaghan, H. (2013, December 5). 7 Ways to Drain BPA From the Body. Retrieved November 19, 2014, from http://www.activistpost.com/2013/12/7-ways-to-drain-bpa-from-body.html

About the Author. Robyn Srigley is the The Hormone Diva, holistic nutritionist, author and speaker. Robyn helps women replace anxiety with joy to open possibility in their lives and have a positive impact on the next generation. Robyn’s struggle with PCOS helps her with clients suffering from PMS, PCOS, Endometriosis and much more.

Web: http://www.thehormonediva.com

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Twitter: http://www.twitter.com/thehormonediva

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Surfing the Sugar Wave: PCOS and Insulin Resistance

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After a wonderful Valentine’s day filled with candy, chocolate, and carbs, I was riding the sugar wave and loving every minute. On Friday evening, after two cups of coffee, the combination of sugar and coffee was keeping me buzzed and happy. But by Saturday I woke up with a headache, feeling moody and miserable. I felt like a grey cloud was hanging over my head. Why was I in such a funk? By the time Sunday rolled around – after more cake and more carbs, and a barbeque lunch with friends – I came home and crashed…literally.

All day I had felt on the verge of tears and when I walked in the door, they all came tumbling out. My husband watched helplessly as I wept and sobbed uncontrollably, and when I was done he put his arm around me and handed me a cup of soup. But where were these emotions coming from? And why did they come on so suddenly?

What is PCOS?

To fully understand, we must travel back to 2008, the year I was diagnosed with Polycystic Ovarian Syndrome, or PCOS. The syndrome, which affects nearly five million women in the United States, often goes undiagnosed and if left untreated can lead to high cholesterol, diabetes, and heart disease. The name Polycystic Ovarian Syndrome refers to small cysts that form around the ovaries, but it is really an endocrine disorder in which the sex hormones estradial and progesterone are out of balance. Women with PCOS typically have an increased production of androgens (the male sex hormone) causing acne, increased hair growth, irregular menstrual cycles, and male pattern baldness. This can also lead to weight gain and infertility.

Coming away from my doctor’s office I was left confused. What was Polycystic Ovarian Syndrome? My OBGYN had actually read me the disorder from her textbook and then handed me a prescription for birth control pills. Because PCOS has no documented cure and because doctors still know very little about the cause of the disease, patients are often left helpless, searching for answers on the Internet or among their peers. My doctor never once told me there might be a link between what I eat and my disorder. She never once mentioned that diet and exercise were important factors in controlling my PCOS symptoms. And because I was “thin.” she assumed I was healthy.

The truth was, I was far from healthy. I had come from a country where most food was prepared from scratch, ingredients were natural and from the earth, and dinners were bought from the butcher or farmer, not a box. When I moved from Kenya to the US in 1999, my diet drastically changed without me giving it a second thought. I went from rice and beans to TV dinners, from curry and vegetables to Ramen noodles. In college I existed on pasta, fried chicken, alcohol, caffeine, frozen meals, and anything I could lug across campus from the food store. Although outwardly I appeared fit, I was eating the kind of diet that leads to heart disease and high cholesterol.

After college, my diet consisted of pizza, pasta, canned beans, canned soup, and anything else I could fix up really quick on the stove. Because I was a terrible cook I turned to things that were high in sugar, salt, and saturated fat, all the while not understanding the link between these foods and my PCOS. I was at the top of my sugar wave and the more sugar and carbs I consumed, the more I was addicted to them. It was a vicious cycle that I was unwilling to break. I started gaining weight, losing hair, and developing acne, all the while working out as hard as I could and getting nowhere.

It was not until I began to read more about the disease and learn to cook for myself that I saw what I was really doing to myself.

PCOS and Insulin Resistance

In 2011, I began seeing a specialist at local fertility clinic. This was the first time that someone addressed my PCOS as a real syndrome that needed to be attended to. The doctor gave me a food chart and asked that I wrote down all that I ate for a week. She then sat me down and showed me on a diagram just how much sugar I was taking in and how little protein and fiber I was getting. She suggested I try a low carb, high protein diet similar to the Atkins diet. “Why?” I asked. She explained that PCOS has been linked to insulin resistance. “Let me explain it this way,” she said, “For example, if I eat a cupcake and you eat a cupcake, I will burn off that cupcake in a day or so. Whereas women with PCOS may eat the cupcake and it could take a week to burn off that cupcake.”

I was shocked. Why had nobody told me this before?

According to the PCOS Foundation, “Insulin resistance (IR) is a physiological condition where the natural hormone, insulin, becomes less effective at lowering blood sugars. The resulting increase in blood glucose may raise levels outside the normal range and cause adverse health effects.” If left untreated these high insulin levels can lead to a diagnosis of type 2 diabetes. Additionally, increased insulin levels causes the increase of androgen production, leading to excess hair on the body, loss of hair on the head, and acne. It also may lead to infertility.

Sugar Crash  versus Hormone Roller-Coaster

So what caused my crash off the sugar wave?  I believe that my sugar filled weekend, coupled with a sudden stop of food (I hadn’t eaten in 5 hours) lead to a dramatic drop in glucose. Although I am no doctor, I also think I was emotional because my hormones had been up and down all weekend.

Listening to my doctor, I knew right then and there that my sweet tooth had to be curbed, but it took a while to follow through on her advice.

Sugar Addicts Anonymous

It’s not easy being a sugar addict. Every day consists of riding the sugar wave:  I wake up and have tea that is filled with sugar, for breakfast I have cereal or yogurt that is filled with sugar, at lunch I have something with carbs, in the afternoon I have some chocolate, at dinner I have carbs again and some protein, and then just before midnight I raid the fridge looking for something sweet. If I go out to dinner, I must order a dessert. I am, unfortunately, a card carrying member of the Sugar Addicts Anonymous.

How Much Sugar Per Day?

  • Men should have no more than 37.5 grams or 9 teaspoons
  • Women should have no more than 25 grams or 6 teaspoons

…according to the American Heart Association.

It’s not a real club but it really should exist. There are probably hundreds of thousands (if not millions) of us living in the United States. When we live in a country where even our bread has sugar in it – yes, even our bread, just read the labels for High Fructose Corn syrup – it feels like we have been set up to fail. But there is a way out!

The truth is, just like any other addiction, you have to work hard at it. My changes began with watching movies like Food Nation and Forks Over Knives and reading books like “The Omnivore’s Dilemma” and “Women Code.” I came to realize that I needed to nurture my body and think about the things I was putting into it. At first I found sugar alternatives like agave nectar or honey, but then I realized I was using just as much (if not more) honey than I was sugar, so was I making that much of a difference?

Over the course of a year, I cut back on my sugar in small steps like instead of three spoons I had one spoon in my tea. Then I dumped out my yogurts with 18g of sugar and opted for one with 9 grams, and then one with no sugar because it was just natural yogurt (I just added fruit). I learned to read labels, I cut down on my alcohol intake (which was a huge factor), and I increased dark, leafy vegetables and grains.

I can’t say its been an easy road and weekends like this remind me what riding the sugar wave is all about. But I like to think I am riding the sugar lake now with an occasional wave coming up on the horizon. The PCOS symptoms have been under control for the past year and I know that my diet and a good exercise regime has helped to keep them at bay.

And although that chocolate cake might taste oh-so-wonderful as I scarf it down, perhaps this time I’ll give it a pass.

Read more about my sugar addiction on my blog.

Photo credit: Paul Patton

PCOS, Pregnancy, Metformin and Vitamin B12 Deficiency

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PCOS or polycystic ovarian syndrome is one of the most common hormone disorders in women. It is marked by a triad of symptoms that include: cardiovascular, metabolic and steroid hormone disturbances. Type II diabetes is common in PCOS and Metformin is the drug of choice to treat PCOS – related Type II diabetes.

In recent years, clinicians and researchers have begun to observe vitamin B12 deficiency in Metformin users. First thought to be a short term problem, researchers are now finding that with long term metformin use not only does the B12 deficiency persist, but it grows. Left alone long enough, vitamin B12 deficiency leads to a host of conditions, many that  Metformin was supposed to prevent, including:

For women, especially of reproductive age, B12 deficiency can be particularly troubling, if not downright dangerous. Vitamin B12 deficiency during pregnancy leads to an increased incidence of neural tube defects and anencephaly (the neural tube fails to close during gestation – anencephaly pictured above) . Once thought to be solely related to folate or folic acid deficiency (vitamin B9), researchers are now finding that B12 has a role in neural tube defects as well. Many women on Metformin are coming into pregnancy vitamin B12 deficient.

This is where it gets tricky. Metformin is used in women with PCOS to reduce insulin sensitivity. Metformin also tends to regulate ovulation for PCOS women and was believed to help women get pregnant (though the data here are mixed here as well). Without regular ovulation, conceiving is near impossible and so the fact that Metformin might have helped with ovulation had been seen as a breakthrough for previously infertile PCOS women. Reproductive endocrinologist embraced this new found fertility tool and as one might expect, the requisite studies (read marketing documents) flooded the esteemed peer-reviewed journals to proclaim the benefits of this new wonder drug. No wait, Metformin is not a drug, it’s a new vitamin – Vitamin M.

We now have a drug that is given liberally to women who become pregnant and then continued across the pregnancy. The drug crosses the placental barrier and there are no studies to indicate either its safety or harm to the fetus. The drug causes significant vitamin B12 deficiency, which alone poses great risk to fetal development (neural tube defects) but who knows what vitamin B12 deficiency plus the endocrine disrupting effects Metformin will have on the developing fetal insulin or cardiovascular systems. Are we looking at more transgenerational effects?  Metformin does not prevent maternal gestational diabetes (as was widely speculated) and increases pre-eclampsia, pulmonary embolism and other nasty pregnancy complications.  And yet, the major patient organizations advocate for its use across pregnancy.

Have we learned nothing from thalidomide and DES?  Apparently, not.

 

Photo credit: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities

Hysterectomy and Brain Health

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Studies abound showing how the endogenous estrogens, estradiol mainly, improve memory and other cognitive functions. New research demonstrates there is an even more basic connection between the female reproductive organs – the uterus and ovaries – and the brain. The monthly menstrual cycle may control iron levels in body and also in the brain. Women who have a hysterectomy before reaching natural menopause may be at higher risk of neurodegenerative diseases such as Azheimer’s and Parkinson’s due to the increased peripheral and brain iron levels post hysterectomy.

Iron and Brain Health

Iron is an essential element for health. Both iron deficiency and excess are associated with brain pathology. In the developing brain, too little iron causes neurological impairment with significant cognitive and neuromuscular deficits. As we age, iron accumulation in the brain is also problematic and linked to neurodegenertive disorders. In part because women menstruate, they have naturally lower levels of peripheral (body) iron than men. Researchers believe that the menstrual flushing of excess iron may be in part responsible for delaying the brain iron accumulation that has been linked to early Alzheimer’s and Parkinson’s in men.

In a study published in the journal Neurobiology of Aging, researchers investigated what effect premenopausal hysterectomy had on brain iron levels. From a sample (n = 93) of healthy older, male and female volunteers, ages 47-80 years, researchers used a specialized MRI to image brain iron levels.

What they found was quite interesting. Women who had hysterectomy before reaching natural menopause had significantly higher iron levels in the white matter of the frontal cortex compared to women who reached menopause naturally. The hysterectomy group, also had higher iron levels in the other brain regions tested but those differences were not large enough to reach statistical significance. Brain iron levels in the hysterectomy group were similar to those of men, who have naturally higher iron levels in the brain and who often succumb to the neurodegenerative diseases at a much earlier age. The researchers speculated that the observed white matter iron accumulation could be a precusor to the grey matter iron accumulation observed in neurodegenerative diseases such as Alzheimer’s and Parkinson’s.

Brain Basics

White matter in the brain consists of the oligodendrocytes – a type of cell that forms what is called the myelin sheath. Myelin is the insulation that protects the axons of the neuron (in the brain) or nerve (in the body) to allow rapid conduction or messaging across the brain or to the body.  Myelin is like the plastic coating around the electrical wiring in your house. If the coating is too thick, conduction is blocked. If the coating is frayed or too thin, electrical sparks fly everywhere. Iron is a critical component of healthy myelin, too much or too little impairs signal conduction – brain messaging.

neuron

Grey matter, on the other hand, is where the unmyelinated portion of neurons – the dendrites and cell bodies – are located. These are brain regions responsible for learning, memory, emotion, sensory perception and motor control. Cells in this part of the brain rely on chemical signaling to translate information. After the dendrite receives and the cell body translates a message, it sends the signal down the myelinated axon to its target.  Iron accumulation, either in the white or grey matter would impact brain function. Iron accumulation specifically in the frontal white matter region would impact all higher order cognitive function.

What This Means

The research is still in its early stages. An observed connection between menstrual blood loss and peripheral or brain iron stores though apparent, may not represent the total picture. It is quite likely that hormones associated with reproductive health, altered by the hysterectomy, also play a role in iron regulation.  Initial research connecting the hyperandrogenic and metabolically dysregulated state of women with PCOS is  associated with increased iron stores, as is general and cancer related inflammation, and genetics. Nevertheless, this study speaks to the critical need for more research about the long-term consequences of hysterectomy. Reproductive hormones regulate more than just reproduction. Removing the organs that synthesize these hormones has health consequences far beyond reproduction. It’s high time we begin addressing this.

If you have had a hysterectomy, be sure to take The Hysterectomy Survey.

Author’s note:  I would like to thank David Wiseman Ph.D., M.R.Pharm.S.
Founder, International Adhesions Society (IAS) for introducing me to this exciting new research.