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Women's Health: Reproductive Tract Disorders Part B

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Disordered Eating
Amenorrhea
Osteoporosis
What is the female Athlete Triad?
85%
In Anorexia Nervosa, the body weight will be less than ____% of what is expected.
True.

Bulimia Nervosa is characterized by binge eating and then performing compensatory behaviors such as exercise, misuse of laxatives/enemas/diuretics, AND/OR self induced vomiting. A patient doesn't need to be vomiting to have Bulimia Nervosa.
T/F: A patient who binge eats and then performs excessive exercise has Bulimia Nervosa?
Twicec a week over several months
In Bulimia Nervosa, the behavior occurs at least _____________
An obsession with healthy eating.
What is Orthorexia?
Changes in the hypothalamus. Decreased levels of estrogen.
What causes Amenorrhea typically in a young female athlete?
No spontaneous Uterine bleeding by the age of 14 without development of secondary sexual characteristics
No spontaneous Uterine bleeding by the age of 16 with otherwise normal development
What constitutes primary Amenorrhea?
Six month absence of menstrual bleeding in a women with primary regular menses
Twelve month absence of menstrual bleeding in a woman with previous Oligomenorrhea
What constitutes secondary amenorrhea?
Unknown.

15-62% of female college athletes have reported disordered eating
3-66% of female athletes have reported Amenorrhea
How common is the "female athlete triad"?
Sports activities that emphasize a lean physique
Gymnastics
Figure skating
Ballet
Distance running
Diving
Swimming
Frequent weigh - ins
Pressure to 'win at all cost'
Over controlling parent
Over controlling coach
Punitive consequences for weight gain
Social isolation due to intense involvement in sport
What are the risk factors for Female Athlete Triad?
Amenorrhea.
What is the first sign of female athlete triad and therefore an excellent way to screen for it?
State it like its in the past. Then bring it into the future.
When we ask a patient about possible eating disorders, how should we do it?
Non Cancerous Tumors of the uterus
What are Fibroids?
None
Spotting
Menorrhagia/Hemorrhage
Mittelschmerz (Ovarian Pain)
Infertility
Tenderness or feeling of hardness/fullness in the pelvic area
Frequent Urination
Thinning hair or male balding hair patterns
Anemia
Low Back pain

When performing a pelvic exam, as you are palpating it the uterus might feel hard or like it doesn't give.
What are the signs/symptoms of fibroids?
Ultrasound, pelvic exam, abdominal exam, Hysterosalpingogram (HSG)
What are 4 ways we can diagnose Fibroids?
Vaginal Depletion packs (Vag Packs)
Improve circulation of the pelvic organs by suspending the uterus high in the pelvis
Substances within the packs draws fluid and infection out of the uterus.
Inhibit local bacterial growth
Stimulates the body to slough off abnormal cervical cells
Promotes lymphatic drainage
Releases nutrients and herbs to the area.
What are Vag Packs?
Estrogen

(So they could grow during pregnancy and decrease during menopause).
Fibroids grow in the presence of....
GNRH agonists
Laparoscopy
Laparotomy
Hysterectomy
MRI guided ultrasound
Uterine Artery Embolization aka Uterine Fibroid Embolization
How do Medical Doctors treat Fibroids?
A day or two and then it will come back.
If a women has Fibroids causing LBP, how long will our adjustments help for?
Progesterone is aromatized to testosterone, which decreases SHBG, which increases free estrogens, which increases breast cancer risk
Insulin resistance and progesterone don't mix, particularly in perimenopause. Why?
Two Phases done Simultaneously
1. Protocol for inhibition of PGE2, and production of PGE1
2. Protocol to enhance liver function
Generally speaking, what is the supplimentation protocol for Fibroids?
L-Carnitine - 750 mg/day
GLA - 240 mg/day
EPA/DHA - 750 mg/day
Vit. C - 5000 mg/day
Pyridoxine - 5000 mg/day
What supplements can inhibit PGE2 and produce PGE1? (5)
Methionine - 1000 mg/day
Choline - 1950 mg/day
Inositol - 650 mg/day
What supplements can enhance liver function? (3)
uterine tissue grows in ectopic sites.
What is Endometriosis?
Endometriosis may mobilize to its final destination through the lymphatic and venous systems within the body
What is Halbans theory?
1. Hereditary
2. Retrograde
3. Coelomic Epithelium
4. Dioxins
5. Sublinical Malfunctioning Liver
What are the causes of Endometriosis?
A cause of Endometriosis

Menstrual flow is 'blocked' resulting in trans-tubal regurgitation of tissue from the endometrium and subsequent tissue implantation on the pelvic organs
What is Retrograde Menstruation?
Mucous membranes of the Uterus, Fallopian tubes, vagina, external ovarian lining and internal pelvic lining are all derived from the same embryonic tissue which is capable of further differentiating
What is the Coelomic Epithelium cause of Endometriosis?
Yes
Does Endometriosis have a genetic link?
Dioxins (organochlorines AKA xenoestrogens) Dioxin is
created by incinerators burning chlorinated waste, leaded gas,
and in the manufacture of pesticides, solvents, and PVC
plastics. Dioxins can be found in bleached products. Dioxins
are found in women's sanitary products except those
manufactured specifically without dioxins.
Dioxins are created how? Where are they found?
Estrogens not properly conjugated
Increased production of inflammatory prostaglandins
Increased pain
Why can a subclinical malfunctioning liver cause endometriosis?
May be asymptomatic
Pain (often incapacitating) in the uterus, lower back
and other pelvic organs
Dyspareunia
Spotting/Bleeding
Infertility
What are the signs/symptoms of Endometriosis?
1. Adjust low back and pelvis. Will need to be frequent and will take a while
2. Abdominal massage
3. Manage anemia
4. Psoas/gluteal massage
5. Acupuncture.
6. Nutrition/herbs (good food, finger root, red raspberry, vitamin E, alfalfa)
7. Vaginal Depletion Packs
How can we treat or reduce endometriosis pain?
Insulin
Symptoms of PCOS seem to have a strong correlation with the sensitivity of what hormone?
Called Ovarian Failure
Cyst formation on and around ovaries, which subsequently can cause infertility and amenorrhea.
What happens when ovarian follicles mature but do not release an egg?
Amenorrhea or oligomenorrhea
Obesity
Infertility
Acne
Hirsutism
Polycystic ovaries
Pelvic pain
Thinning hair
Hair loss
Insulin resistance
Type 2 diabetes
Elevated cholesterol and other lipid abnormalities
Elevated blood pressure
Cardiovascular disease
What are the signs and symptoms of Ovarian Failure?
A symptom
Is amenorrhea a symptom or a diagnosis?
Primary amenorrhea is the absence of spontaneous uterine bleeding and secondary sexual characteristics by age 14 or the absence of spontaneous uterine bleeding by age 16 with otherwise normal development.
What is primary amenorrhea?
Secondary amenorrhea is a 6-month absence of menstrual bleeding in a woman with regular menses or a 12-month absence of menstrual bleeding in a woman with previous oligomenorrhea.
What is secondary amenorrhea?
Oligomenorrhea is the reduction in the frequency of menses, with an interval longer than 35 days, but less than 3 months.
What is oligomenorrhea?
Hidden menstruation. It occurs but makes no external appearance because of uterine or vaginal obstruction.
What is cryptomenorrhea?
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