1. Women’s Health Issues
Enrique Saguil, MD

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

3. Anatomy 101

4. The Hormonal Axis

5. Allies vs Axis

6. The 28 day cycle

7. 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 occurrence
Thoughts and emotions
Stress
Anxiety about pregnancy
Illness or physiological imbalance eg thyroid conditions

8. Types- 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 ovulation.
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.

10. 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

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

12. The PAP-(a necessary evil)

13. Treatments
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.

15. 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.

16. 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

18. Testing
Ultrasound
Magnetic resonance imaging (MRI)
Laparoscopy

20. Laparoscopic view

21. 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 finding)

22. 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 endometriosis

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

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

25. Image sports

26. Weight dependant sports

27. Non-athletes that “find” exercise

28. 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 healthy.)
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).

29. 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 bone.

30. amenorrhea
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

31. Osteoporosis
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 year old will be that of a year old

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

33. 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.

34. Vaccination?
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 26.

35. 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

36. 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"

37. 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.

38. 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.)
Adaptogens?

39. 5. OVARIAN CANCER
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 Women’s Health Initiative Dietary Modification Randomized Controlled Trial
Journal of the National Cancer Institute Advance Access published online on October 9, 2007

40. stats
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

41. TESTING 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

42. “The screening test” pelvic pain and abdominal pain;
urinary frequency and urgency;
increased abdominal size or bloating;
difficulty eating or feeling full.

43. 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 time.
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

44. 6. BREAST CANCER The most common type of cancer for women in the US
The leading cause of cancer deaths in women (second only to lung cancer)
200,000 diagnosed this year, 40,000 will die
2,000 cases dx’d in men, 400 will die

45. 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

46. RISK factors Female and older (50) High breast tissue density
Radiation exposure in youth
Estrogen exposure-menarche <12, menopause >55
Nulliparous or 1st >30
OC’s and HRT
Overweight or gaining after menopause
BRCA1 2 gene

47. Testing
Self breast exam
Check up
Mammogram?
Ultrasound
MRI?

48. 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 appointment.
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.

49. 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 movement
invested nearly $1 billion in “race for the cure”

50. 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.

51. 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

52. Studies
 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 , 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

54. Prepare for the worst and hope for the best

55. 7. MENOPAUSE missed periods sleep disturbances hot flashes
vaginal dryness
changes in mood
lack of sex drive

56. 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.

57. HOTFLASHES
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

58. 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

59. 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 Medicine.
(against estrogen)

60. 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)

61.
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

62. www.4woman.gov 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

63. Alternative suggestions

65. 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 > 50 higher risk fx than prostate ca
20% fx’s will die w/in 1 yr
50% require long term care

66. Screening DEXA all women 65> 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

67. Treatment Early prevention Vit d, calcium citrate Exercise Soy +/-
Traditional medicine (fosamax, evista)
retesting

68. + Polycystic Ovarian Syndrome
prevalence of PCOS of 5%–10% 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 hyperandrogenism
The theca cells are over-responsive, increase in size and overproduce androgens

69. PCOS
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

70. 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).

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

72. 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

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

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