#Womenshealthwednesday

August 14, 2019

TPROGESTERONERESITANCEhe cause of endometriosis is unclear, and with an unclear reason for a pathology to be present, a targeted treatment becomes difficult – each women is going to respond to different therapies with variable outcomes. What is known about endometriosis though, is that there is significant disregulation with respect to the estrogen and progesterone receptors at the level of the endometrium.

Estrogen stimulates the proliferative component of the endometrial lining, stimulating it to grow more robust during the follicular phase of the cycle, and then progesterone comes in after ovulations to counter act the proliferation, and promote the secretory phase of the endometrial lining development, stopping growth but preparing the lining for potential implantation.

What can be seen in endometriosis, is a progesterone resistant endometrial lining. What does that mean? The progesterone receptors are not as responsive to the progesterone signals as they should be. This results in over stimulation of estrogen, because progesterone isn’t being received at the endometrium to counter balance it, causing the endometrial tissue to build and build – potentially in the wrong spaces too. This excess endometrial lining can result in increased cramping during menses to try and shed the extra tissue that has been built up, and if there is excess endometrial lining in an area it’s not supposed to be (ie outside of the uterus) that can be inflammatory to that environment.

So as well as progesterone resistance contributing to pain, this also plays a major role with respect to fertility. The uterine lining needs adequate progesterone exposure to go from proliferatory –> secretory after ovulation the menstrual cycle in order for a blastocyst to be able to implant properly. Queue up progesterone suppositories as a potential fertility treatment option in endometriosis!

If you’ve been following along on my IGTV videos, where I’ve discussed the menstrual cycle, estrogen and progesterone, you’ll see that the whole cycle and the function of these hormones work in a fine dance with respect to each other, and endometriosis is an example of when that balance is off and a pathology can arise.

PMID: 31387263


 

July 30, 2019 

Women's Health Wednesday-2Basal body temperature can give us a glimpse into what your hormones are up to throughout the cycle, and the regularity of your cycle. Today I want to talk about a specific aspect of your cycle we can gauge through a BBT chart, and can have a direct impact on your fertility – the length of your luteal phase.

The luteal phase is the second half of your cycle – after ovulation until menses. An optima luteal phase length (to allow adequate time for implantation to occur) is between 12-14 days. Shorter than that is where we can begin to run into some fertility problems.

The incidence of a luteal phase deficiency in infertile women ranges from 30-40%. That number may seem high, but if a short luteal phase is the only contributing factor to infertility, a progesterone prescription may be a safe and effective solution.

If conception is in the future for you, I encourage you to start get familiar with your cycle, track it, and assess luteal phase length (from the time you see a spike in temperature until menses). That way you can know whether or not your luteal phase length may be a factor in conception.


July 17, 2019

Not all oral contraceptive pills are created equally. Combined Oral Contraceptive Pills Women's Health Wednesday(COCPs) consist of a synthetic estrogen (Ethinyl estradiol) combined with a progestin. “Progestin” is an umbrella term for synthetic progesterone that consists of multiple chemical structures that all have the capacity to act similarly to progesterone in the body.

Progestins however are not BIOIDENTICAL to progesterone (bioidentical= EXACT same biochemical structure), so they also have slight estrogenic and androgenic activity too. Not all progestin structures are created equally, with some having more potent progestogenic effects and others with more potent androgenic effects – just to clarify, androgenic = testosterone activity

Some COCPs with progestins that have higher androgenic side effects are: Loestrin, Estrostep, Levelen, Allesse, Ovral, Norlestrin

The above listed COCPs are commonly used due to their low estrogen dose which gives them a better safety profile and are more tolerable, however if you naturally have higher androgens these COCPs can heighten your androgen activity resulting in an increase in acne, oily skin and increase hair growth on the chin, belly and pubic region.

If you are currently on a COCP and are struggling with side effects, please come in and talk to me! We can find a COCP that better fits your biochemistry, and/or talk about other options that are available for you.


July 3, 2019

stressestrogenEstradiol (a form of estrogen in the body) and one of our stress hormones (cortisol) are both steroid hormones and interact with each other – this means that your stress levels and stress response may be heightened or reduced depending on where you are in your cycle.

A decreased cortisol response has been studied in the late follicular phase – when estrogen is building to its peak, and you’re in that “feeling on top of the world” mood those few days leading up to ovulation.

We have estradiol receptors in the brain that are involved in our response to psychosocial stress. A study found that high estradiol (late follicular phase) showed a slower/weakened response to emotional stimuli vs another study demonstrated that low estradiol levels can exaggerate the effect of psychosocial stress.

A different study was done assessing the stress response (via questionnaires) in women with a natural menstrual cycle, in comparison to women undergoing an IVF stimulation (very high estrogen) cycle. The results of the study showed no clear differences between the two groups, so no clear conclusion can be drawn from this study on estrogen + stress tolerance.

Stress is a tricky aspect to study. It’s completely subjective on how someone is going to perceive a stressful situation, and that perception is going to moderate how they react to it. Estrogen, and where you’re at in your cycle is just one of many aspects to consider when it comes to stress and stress perception.

One of the best things you can be doing in your day to day is finding and working on techniques that help manage stress. Whether its meditation, yoga, restorative exercise, reading, taking a hot bath – it’s important we have these go to’s when life gets crazy that can help us mange our stress response!

 

PMID: 31244718


June 19, 2019 

oxidativestresspcosOxidative stress – imbalance between antioxidants (how the body defends itself) and the creation of excessive amounts of reactive oxygen species (go on to cause inflammatory damage)

 

 

“Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS”

With significant oxidative stress in the body, and playing a role in propagating the pathology, you want some key antioxidants on your side to help slow that roll. A randomized controlled study was done looking at the effects of multi-nutrient therapy in the management of PCOS. The multi-nutrient therapy consisted of : Omega – 3 fatty acids, folic acid, Vitamin E, green tea extract catechin, glycyrrhizin and CoQ10. The control group received two capsules of only folic acid.

The main parameters evaluated were: AMH, total testosterone and androstenedione. LH, FSH, SHBG and estradiol were also looked at. After three months of treatment with the multi-nutrient therapy, there was a significant decrease in the LH:FSH ratio, testosterone and AMH in comparison to the control group only using folic acid.

This study was not controlling for the participants diet. I think its impressive that they saw a shift in some of their study parameters after three months with just focusing on antioxidants to reduce the oxidative stress component of the pathology. At the root of PCOS is insulin resistance that contributes to the oxidative stress in the body and results in changing the hormone profile in these women. Just imagine the results you could see if you were to hone in on combating the oxidative stress, but also addressing the insulin resistance!

PMID: 31101977

 


June 12, 2019

progesteronepregnancyEstrogen is responsible for building the uterine lining (creating a healthy and happy home for growing baby) and progesterone is responsible for maintaining that lining. Progesterone is produced by the corpus luteum AFTER ovulation has happened at the ovary. There is no standardized “ideal” level of serum progesterone in the luteal phase – other than the fact that if you’re above 9.5 nmol/L we can say with confidence, yes ovulation happened that cycle, but beyond that, serum progesterone levels are finicky to read heavily into.

Progesterone has cyclical variation (ie – elevated in the luteal phase, low in follicular phase), but it also has pulsatile secretion throughout the day.

“Serum progesterone levels can fluctuate 8-fold in a 90-minute period during the mid-luteal phase and range from 7.3 to 127.5 nmol/L during a 24-hour period in the same healthy subject” Mesen et.al (2015)

Due to this large variation, it is difficult to say what the standard of progesterone should be in the luteal phase to maintain a pregnancy. And of course – it’s going to depend on the individual and other aspects of health!

 

Screen Shot 2019-06-12 at 10.17.16 AM
Click here for reference

 

The second image on this post is a graphic from a paper looking at healthy pregnancies and pregnancies with threatened miscarriage, and their respective progesterone levels. Keep in mind – there are MANY factors that go into a healthy pregnancy, and MANY factors that contribute to a miscarriage. Progesterone (what this study is looking at) it just ONE of those factors, so I want to be clear, it is not the be all end all cure for miscarriage and recurrent pregnancy loss, however it is a modifiable factor (a simple prescription) to increase progesterone levels and lengthen luteal phase length – which may be indicated in certain cases.

In general, a luteal phase of 12-14 days is a healthy length to allow for adequate embryo implantation (again, not always the case for certain individuals, but in general!) and more robust progesterone secretion is always good to see. In early pregnancy, you also want to be seeing gradual increase in progesterone. In those early days – it should be increasing by roughly 1-3 mg/mL every couple of days until it reaches the peak for the trimester

PMID: 25681845

PMID: 30185145


June 5, 2019

My vagina has an ecosystem?vaginalicrobiome

Yes! Just like in your digestive system, there is a bacterial flora that is unique to your vaginal mucosa. The microflora plays a role in maintaining an optimal pH (acidity) that helps prevent pathogenic bacteria or yeast from rooting in.

Following up last weeks women’s health Wednesday post, I wanted to talk about some key factors that you can modify to optimize the health of your vaginal microflora.

There are a couple of key factors that are going to influence the vaginal microflora – hormones, diet and hygiene.

Hormones – Did you know that Estrogen helps keep your vagina at an optimal pH? If your hormones are out of whack (ie – low estrogen), your vaginal pH will change, (becoming more alkaline) potentially allowing an opportunistic vaginal infection to take root.

Diet – similarly to the gastrointestinal microflora, what you’re eating is going to influence what species thrive in that environment. Diets high in sugar and refined carbohydrates/processed foods are more likely to feed candida – the more you feed it sugar, the more it will thrive potentially resulting in a full on yeast infection.

Hygiene – your vagina is meant to have an ecosystem! When your hormones are thriving contributing to a balanced pH, allowing all those good bacteria to survive and thrive and protect your body from infection and boost immune function, the last thing you want to do is come in there with a chemical storm and disrupt the beautiful harmony your body has created. Yes – keep it clean, but be mindful of the products you use – avoid products full of chemicals and artificial smells – if you wouldn’t eat it, you shouldn’t be putting it on your body.

By keeping you hormones healthy and happy, supporting your diet with vegetables, fruits, healthy fats and proteins as well as being mindful around personal hygiene can set you up to have a healthy vaginal microflora!


May 29, 2019 

IVFIVF or IVF-ICSI (intracytoplasmic sperm injection) achieve live birth rates ranging between 25-35% per cycle. There are so many factors that go into whether or not the embryo transfer is going to take, and even more factors coming into play if the pregnancy is going to result in a live birth.

A prospective study was done assessing one of the factors that may play a role in the success of IVF – the composition of the vaginal microbiome. The study evaluated the different compositions of the vaginal microbiome in women undergoing IVF and then assessed the implantation rates of their IVF cycle.

The study found that women with a lower percentage of lactobacillus bacteria as a part of their vaginal microbiome were less likely to have successful embryo implantation. The study found that women who had favorable lactobacillus species in their vaginal microbiome but had <60% composition of lactobacillus crispatus had a higher chance of pregnancy.

This study opens up conversation around the role the vaginal microbiome may play in embryo implantation and pregnancy – however this study is only looking at implantation with respect to ART, not non-ART pregnancies. As well, this study is only looking at successful implantation, not necessarily pregnancy outcomes after implantation.

It is neat to think though, that if more research is to come out on the vaginal microbiome and its correlation to pregnancy outcomes, clinically that is something we can manipulate via healthy diet, probiotic supplementations and vaginal hygiene. If more solid research is to come out on this topic and we have the ability to clinically control one of the many factors that goes into implantation rates, that would be amazing!

Click here for the link to an overview of the paper.. 


May 22, 2019

ANXIETYPREGNANCYToday for #womenshealthwednesday I want to direct your attention to a website a colleague showed to me. It’s a website written by women, for women – discussing all the different ways anxiety may show up during pregnancy and in the post-partum period. As well as discussing hypotheticals on where anxiety may present itself, the website provides you with ideas and strategies you can begin to implement into your life to manage the stress and anxiety that may come along with becoming a new mom.

Click here to explore the website!


May 15, 2019

Women's Health WednesdayLet me start out this #womenshealthwednesday post by saying I’m NOTanti-birth control pill” – there is a time and a place for the use of all types of birth control, what’s important is that you find one that works for you. My goal with this post today is to talk about some of the things that may not have been mentioned to you when you started to the pill, but are VERY real when you do some off of it (don’t worry, there’s plenty to be done to support your body through this process!)

If controlling skin and preventing breakouts was one of the reasons to start birth control in the first place – you might be in for a wild ride with your skin (and hormones, but today I’m focusing on skin!) when you decide to come off of hormonal birth control.

For starters – hormonal birth control suppresses your endogenous hormones (that’s how it works) so your hormone activity at the level of your skin is nil. When first coming off of birth control, your body all of the sudden is not suppressed anymore and gets to make its own hormones, and sometimes can go overboard at first (especially with androgens – testosterone) and unfortunately that shows up on skin as persistent cystic acne.

Certain birth control pills contain drospirenone (Yaz) that works at the level of the skin to block sebum production. Your body tries to combat this block because it’s normal to have a base level of sebum on skin, so your body up regulates sebum, only to continue to be blocked by drospirenone. So you can begin to see what’s going to happen here – you take away the drospirenone when you stop the birth control pill and BAM! your skin explodes because your body has been trying to make sebum and upregulate it and now it finally has the freedom to do so, but unfortunately too much sebum = increased likelihood of cystic acne and breakouts.

Birth control pills have also been shown to disrupt the microflora in your gastrointestinal track. An inflamed GI system can be associated with skin inflammation. Also, if your GI system is inflamed, you may not be absorbing all the nutrients you require to support your overall health and skin health, as well as the synthetic hormones in your system from the birth control pill require extra work in your liver to metabolize – resulting in depletion of specific nutrients if you’re not keeping up with a healthy diet.

There is plenty you can be doing to support your skin and overall health while still on the birth control pill, I’m not saying stop the birth control pill right now, I’m saying there are some speedbumps in your future when coming off of it, that if you put in the work now you can help support your body and smooth that transition. Come and talk to me about it!

Also another wonderful resource – “Beyond the Pill” by Dr. Jolene Brighten, you can find it at our Prince George public library!

For general information on how to support your skin health – refer to my previous #womenshealthwednesday post on Female Adult Acne 


Women are not “little men” and should not be studied or medically treated as such.HISTAMINE

One example I want to talk about today is the histamine – estrogen connection. Histamine is an inflammatory mediator released from mast cells of the immune system in response to an allergic stimulus, and histamine if not being broken down correctly, or produced in large quantities, can accumulate in the body.

High estrogen levels can trigger histamine release, and high histamine levels can result in an increase in estrogen production. You can see how that escalates quickly into a downward spiral!

This specific connection between these two biochemically active compounds is important to highlight when working on treatment for allergies and or hormone imbalances. We need to be looking at all aspects of health – making sure we don’t just hone in on the allergies component, and completely miss the hormone aspect or vice versa!

Women are not “little men” and should not be studied or medically treated as such. Yes, antihistamines work wonderfully to get you through in a pinch, but I think it’s important to consider the role of the sex hormones (estrogen, progesterone and testosterone) as well as diet (what you eat can drastically increase your histamine load in the body!) in order to treat the root cause of allergies and or hormone imbalances.


May 1, 2019 

Women's Health WednesdayYou are what you eat, but did you know what you eat is also directly impacting your hormone health? Today for women’s health Wednesday I want to discuss what seed cycling is, how you can benefit from doing it, and some research to support it.

Seeds pack a powerful punch, they are small – but full of healthy fats and minerals our body needs in order to synthesize healthy amounts of our sex hormones (estrogen, progesterone, testosterone etc!)

So how do you seed cycle? During the follicular phase of your cycle (roughly the two weeks, from menses until ovulation) you want to be consuming 1 tbsp of ground flax seed and 1 tbsp of pumpkin seeds & during the luteal phase (from ovulation until next menses) 1 tbsp of sunflower seeds and 1 tbsp of sesame seeds.

One randomized cross-over study evaluated just ground flax seed as a variable and its impact on the menstrual cycle. In the same subjects, the cycles that they consumed the ground flax seed for 3 months in a row demonstrated NO anovulatory cycles (all the women were ovulating) – in comparison to the cycles where ground flax was not consumed there were several anovulatory cycles, and the cycles where ground flax seed was consumed showed an increase in luteal phase length (important for conception!) – in comparison to the cycles where ground flax seed wasn’t consumed.

There is anecdotal evidence for the practice of seed cycling, but not a lot of study-based evidence to support the practice of seed cycling – but evidence aside, I think that various seeds & nuts are essential to a healthy well-rounded diet – full of fats, proteins vitamins and minerals we all need to synthesize healthy hormones!

To my fellow practitioners out there, I would love to see more research on seed cycling if you have any to send me way!


April 17, 2019

testinghormonesgreenI want to dive into deeper detail with testing serum (blood) for hormones. When I’m testing blood for hormones, it is a snap shot in time – That means that whatever your hormone levels happen to be the minute the blood was drawn, those are the levels I will be receiving in the report. This isn’t great for something that is constantly in flux throughout the day as well as the month. There isn’t a perfect testing method, however we can still gain valuable information if the tests are performed on certain days throughout the menstrual cycle.

 

Pituitary hormones: LH and FSH – these two are typically tested around day 3 of the menstrual cycle when I’m assessing fertility, ovarian response and ovarian reserve. These hormones are coming from the pituitary gland in the brain to signal the ovaries to start follicular development (FSH – follicle stimulating hormone’s main job) and then to trigger ovulation (LH – luteinizing hormone’s main job). The more “responsive” the ovaries are, the lower these numbers are going to be on day 3 – this is a good thing. During peri-menopause and into menopause we see a gradual increase in LH and FSH values – as the pituitary has to work harder and harder in order for the ovary to respond until eventually the ovary stops responding. These hormones also need to be considered in relation to estradiol (a form of estrogen that is tested). LH and FSH values can also be useful when comparing their values to each other – An LH to FSH ratio that is greater than 2:1 can hint towards possible PCOS – to then be followed up with a myriad of other hormone + metabolic tests.

 

Ovarian hormones: Estradiol + Progesterone

Estradiol – this is tested on day three with LH and FSH (as I said earlier, this value is looked at with respect to the LH and FSH values). This is early on in the cycle when estrogen is relatively low in the body, so day 3 is assessing a baseline estrogen / ovarian response at the start of the cycle, and it can be assumed that estrogen will increase from that baseline. We want a healthy and responsive baseline.

Progesterone – this is tested 7 days prior to next expected menses. The actual numerical value of progesterone is less important than the fact that it is just present. I’m looking for a progesterone at least greater than ~10 nmol/L in order to confirm that yes, ovulation happened that cycle. Progesterone is a tricky one to test, because it is going to also have a pulsatile secretion – meaning it will vary throughout the day as well as cycle. As long as your progesterone level is above the threshold to confirm ovulation, I don’t read to heavily into the numerical value.

The long short of it is – if this lab work is done during the appropriate time in the cycle and combined with the clinical picture – IE signs and symptoms of hormones, fertility history,  etc. it can provide valuable insight into what is going on biochemically with respect to your hormones!

Have you had your hormones tested?


April 10, 2019

FIBROBREAST

Fibrocystic breasts, aka – extremely painful breasts during the premenstrual phase. In some ladies, it can last the whole 2 weeks after ovulation and only get better after menses has ended.

 

 

Some signs and symptoms you can look for are: pain with premenstrual aggravation, cyclic variation in breast size, multiple mobile tender nodules, swelling, and symmetry between both breasts. Since breast tissue is hormonally active – specifically in response to estrogen, if you have an excess of estrogen in your system, this may heighten or worsen fibrocystic breast changes. – refer to my post on estrogen dominance (from March 6, 2019) to learn some simple tips and tricks to reduce estrogen in your system.

But what about progesterone? Doesn’t that effect breast tissue? Yes. After ovulation, once progesterone enters our system in high concentrations it also stimulates breast tissue. However when progesterone stimulates breast tissue it tends to target the breast tissue that is closer to under the armpit as opposed to the front / bulk of the breast tissue (where estrogen will target). So next time you start to feel the pain that goes along with fibrocystic breast changes, give yourself a quick breast exam and try and pin point the location of the pain, if its normal breast changes due to progesterone in your system, or if it’s the entire breast indicating your estrogen may be in excess!

Another note – low iodine (that can go hand in hand with low thyroid function) can also contribute to fibrocystic breasts.  Fibrocystic breasts is a relatively simple fix once we look into and evaluate you hormones and get you on an appropriate treatment plan – don’t suffer through another cycle with painful breasts!


April 3, 2019

ATHLETICPERFORMANCAs women, our hormones are in a constant ebb and flow throughout each month. Periods are stimulated by a drop in our progesterone and estrogen, so during menses is when we have our lowest levels of hormones.

As the month progresses, estrogen begins to climb back up, ultimately stimulating an LH surge (from the pituitary) to trigger ovulation. After ovulation is when your body gets the surge of progesterone it needs – around mid-month (mid-cylce) is when your body is going to be exposed to its highest levels of both estrogen and progesterone.

Understanding this fluctuation of hormones is important so you can understand and reflect on how you are feeling physically and mentally.

One of my best friends + badass rock-climbing babes – knowing that I spend a good chunk of my spare time reading about women’s health and periods – sent me this fantastic article discussing the impact of the menstrual cycle and women’s physiology on sport performance. It’s a great read, and even if you’re not a rock climber – the idea can be translated to any sport, and daily living.

Click here to read the article …


March 20, 2019

PERIMEO

As a woman, our ovaries are responsible for the primary production of our Estrogen, Progesterone and testosterone. Once we reach menopause however, our ovaries are no longer hormonally active, resulting in the dramatic drop of our sex hormones.

Our Adrenal glands, the little hormonally active tissue that sits on top of our kidneys like a little hat, DO have the capacity to produce SMALL amounts of these sex hormones (estrogen, progesterone and testosterone) as long as our adrenal glands aren’t too busy pumping out CORTISOL.

Cortisol is our body’s “low grade” stress hormone that is produced in order for us to combat day-to-day stress, shifting our metabolism, improving our alertness, supressing our immune system – but too much cortisol in our system can be a bad thing. When we are stressed or in high stress situations throughout the day, our body – being the clever functioning machine that it is, is going to prioritize making cortisol over your other sex hormones within the adrenal glands.

So, if we can support your adrenal glands, minimize your day to day stress, or at least figure out stress reducing techniques that work for you in your life, we can reduce your daily cortisol demands and allow your adrenal glands to have a chance to make small amounts of estrogen, progesterone and testosterone to lessen the dramatic drop of having plenty of hormones, to having no hormones that happens during menopause.

Hit me with your questions about adrenal health! I’d love to see you in my office so we can optimize your adrenal health and ease the menopause transition.


March 13, 2019 

perimenopause

Building off of my previous to posts discussing estrogen dominance, a naturally occurring time in a women’s life when she is going to become estrogen dominant is during peri-menopause. Perimenopause is the timeframe leading up to the “official” menopause diagnosis (absence of menses for 1 whole year).

 

During peri-menopause we begin to see changes in menstrual cycles – shortening of the cycle, or complete absence of cycle for a couple months, as well as the beginning of those menopausal symptoms – hot flashes, increase in anxiety, irritability, disruption of sleep, decrease in libido – just to name a few symptoms.

During this perimenopausal time frame, your ovaries are becoming less responsive to LH and FSH (two hormones that come from the pituitary gland in the brain). Your brain essentially is working harder in order for ovulation to happen to maintain the menstrual cycle – and as time goes on there are more and more ANOVULATORY cycles, meaning ovulation doesn’t happen, so progesterone is NOT being produced by the corpus luteum (in the ovary) resulting in unopposed estrogen during these cycles – producing estrogen dominant symptoms. Eventually the ovaries wind down for good, resulting in LOW estrogen and progesterone, but in those early stages of perimenopause we need to be looking at what we can do to address the estrogen dominance in relation to the progesterone deficiency to ease those uncomfortable symptoms and smooth the transition from perimenopause into menopause. Please refer to my last weeks post on “Estrogen Dominance” to learn some of the foundations of health that can effect your hormone balance, as well as stay tuned for next weeks post as I will be discussing another hormonally active organ we need to be considering during the perimenopase and menopause transition.

 

March 6, 2019 

Estrogen Dominance pt. II 

Estrogendom

Following up from last week’s post on estrogen dominance, I want to talk about some fundamental factors to focus on in order to support your hormone balance.

 

 

Digestion – you need to be pooping at least once per day. Estrogen – being a steroid hormone, is removed from our body in our bile. If you aren’t eating healthy fats, you will not stimulate your gallbladder to contract and release bile. You need to be releasing the bile in order to get rid of the excess steroid hormones your body has in its system. Ways to support your digestion: eat healthy fats, fibers, lots of plants – basically, just eat REAL food.

Liver – the MEGA detox organ of the body (shout out to the kidneys though – those are two small badass organs) but I want to focus on the liver today. The liver is where estrogen is chemically modified through our detoxification pathways in order to be added into the bile in order to be excreted. For our liver to properly clear estrogen from our system, it needs some key cofactors in order to support the chemical conversion. Some key cofactors are: Vitamin B6, DIM, Calcium D-Glucarate, Indole 3-carbinol.

Lifestyle – from last week’s post on the causes of estrogen dominance, you can see that a lot of those factors are from our external environment. To prevent the build-up of excess estrogen in your system do your best to avoid cooking or drinking out of plastic, use simple detergents and soaps with minimal chemical additives, shop organic as best you can, buy local grass-fed hormone free animal products, avoid makeup or personal hygiene products that contain parabens.


 

February 27, 2018

EstrogendomEstrogen and progesterone work together in a delicate dance in our bodies, and when they are out of balance symptoms may present themselves.

Estrogen dominance can result from a physical production of more estrogen in your system, or estrogen dominance can result from a relative deficiency in progesterone.

So what does estrogen dominance look like?

Irregular periods, heavy periods, fibrocystic breasts, depressed mood, anxiety, ovarian cysts, decreased libido, water retention, food cravings.

You might be thinking, this just looks like my typical PMS symptoms?

Believe it or not, your period actually isn’t supposed to be a horrendous event that occupies a week every month. As women, our environment is really working against us with respect to our hormone balance.

Some key factors that contribute to women having excess estrogen are: xeno-estrogens (also known as endocrine disruptors – some common ones are solvents, dioxins, BPA, pharmaceuticals), diets high in processed sugars and low in protein as well as lacking healthy fat consumption, lack of exercise, obesity, constipation.

Addressing all of these factors is an excellent starting point to getting your hormones back in balance – next week I’ll discuss some ways to help your body clear excess estrogen.


February 20, 2019

cervicaldysplasiaThe Connection Between Oral Contraceptive Pills and Cervical Dysplasia 

In order for an infection to take root in the body, the infecting pathogen needs to be stronger than the body’s immune system response. This applies at the level of the cervix with respect to an HPV (Human papillomavirus) infection.

 

Not everyone who is infected with HPV or carries the HPV virus is going to present with cervical dysplasia. If cervical dysplasia has presented in a patient, I’m following up with proper procedure based on the degree of the lesion, but I am also investigating WHY the HPV infected this patient in the first place. There are multiple studied factors that have shown to increase the likelihood of developing cervical dysplasia – today I want to talk about a big one – the Oral Contraceptive Pill.

OCP’s time and time again have been shown to deplete nutrients – specifically Vitamin C, Folic Acid, Vitamin B6, Vitamin B12, Vitamin B2, and zinc.

These nutrients all are key players in our immune function as well as connective tissue integrity. When those two pillars of our immune health are not getting the nutrients, they require to function optimally, we can see why if exposed to HPV, an infection resulting in cervical dysplasia may take root. Re-storing these nutrient deficiencies become a key component of healing the cervical tissue!

If you are on OCP’s, talk to your ND about what can be done to combat nutrient deficiencies while on an OCP, or discuss other birth control options available to you.

 

References:

Krause M, Mahan L. Food, Nutrition, and Diet Therapy, 7th Ed. Philadelphia: W.B. Saunders, 1984.

Butterworth CE Jr, Hatch KD, Gore H, Mueller H, Krumdieck CL. “Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives,” American Journal of Clinical Nutrition, 1982; 35:73-82.


February 13, 2019 

Women's Health WednesdayFEMALEATHELETE

The three components make up the female athlete triad:

Low energy availability

Poor bone health

Amenorrhea (no periods).

 

  1. Energy availability is at the foundation of it. You are what you eat, and as an athlete it is essential that the foods being consumed are nutrient and energy dense, and the calories consumed are enough to keep up with energy output in sport. If there aren’t enough of the right nutrients, vitamins and minerals available to your body, you will not be able to maintain muscle mass and a health BMI, or build bones properly, or be able to produce adequate amounts of hormones.
  2. When we are in our teens + early 20’s is when our bodies are building our peak bone mineral density. Building up peak bone mineral density is crucial for our overall health later on in life and will reduce the likelihood of fragility fractures. What you’re eating, and hormones are key players in developing healthy bones. See my post on the impact of hormonal birth control use for more information on bone health. 
  3. High activity levels (producing biochemical stress) have the capacity to negatively feedback and inhibit ovulation causing irregular periods, and eventually progress to inhibit menses all together. You may be thinking “Great! No periods!” but without proper levels of estrogen and progesterone in your system, you’re missing out on the benefits of having those hormones as a female!

If you’re an athlete, it’s worth chatting with your naturopathic doctor about these three elements of your health to make sure your eating enough of the right foods, supporting your bone health, and that your menstruation/ estrogen/progesterone is working optimally. The better you can support yourself with these foundations, the better your performance in your sport will be. 


February 6, 2019 

Women's Health WednesdayAnovulation – when the ovaries do not release an oocyte during a menstrual cycle.

Following up my previous post on signs and symptoms you can keep track of to know if you are ovulating, this post I’m going to talk about some factors that can impair or inhibit ovulation.

 

 

Stress

During times of stress – whether it’s physical or mental stress (the body perceives and reacts to those stressors using the same biochemical messengers), your body is not going to be thinking “this is a good time to reproduce”. Persistent low-grade stress, with the occasional “fight or flight” signal indicates to the body that all it needs to do and focus its energy on is to SURVIVE. GnRH – a biochemical messenger that eventually leads to the downstream stimulation of ovulation, is inhibited by the presence of CRH (produced in the hypothalamus in the brain, leads to the downstream stimulation of cortisol production) and Cortisol. So when your body is under stress, CRH and Cortisol levels are high, inhibiting GnRH – ultimately inhibiting ovulation. 

Diet

Diet can influence ovulation and progesterone production through a couple avenues. Your ovaries have insulin receptors (say what!) which actually play a major role in sensitization to LH (a hormone coming from the pituitary) which is the trigger for ovulation! This highlights the importance of good systemic control over your blood sugar – focus on eating real foods (veggies, fruits, whole grains, lentils, grass fed meats) and avoiding those processed and refined carbohydrates.

Progesterone is a steroid hormone, meaning it is synthesized from cholesterol. You want to supply your body with enough “building blocks” so it is able to synthesize all your steroid hormones in the quantity that your body needs – which means getting enough healthy fats in your diet (nuts, seeds, avocado, olives etc.) So even if you are ovulating, your corpus luteum may be not producing enough progesterone because it’s lacking the “building blocks” to make it.

Hormonal Birth Control

If you’re on hormonal birth control and it’s working how it’s supposed to, it is suppressing your endogenous hormones (hormones that your body is naturally supposed to be making) in order to inhibit ovulation. Even though you’re missing out on reaping the benefits of your endogenous hormones, I’m still team #thanksbirthcontrol because I understand the control over our reproduction it allows us as women and the freedom of choice it provides us. However, if you’re currently on it, there are things you can be doing to support your health in the meantime to combat side effects and nutrient deficiencies. I’ll save that for a future post!

 

The three categories I talked about in this post are not the only factors that can inhibit ovulation, however they are three major lifestyle changes that can be made to best support your ovulation. There are medical conditions that have anovulation as a component of the pathophysiology such as PCOS, Hypothalamic amenorrhea, and the female athlete triad to name a few – but those are all much more complex and deserve their own post in order to be explained!


January 30, 2019 

ovulationgreenThis is a follow up post to my previous #womenshealthwednesday on the importance of progesterone!

There are some signs and symptoms you can keep track of each cycle to know if and when you are ovulating – aka reaping the benefits of having progesterone around for the second half of your cycle! Continue reading here..

 


January 23, 2019

Progesteronewomen's health wednesday.jpgprogesterone

The unsung hero – progesterone.

I feel like estrogen gets majority of the spotlight with respect to our female hormones, with words like “estrogen dominance” “estrogen imbalance” “estrogen replacement therapy” being tossed around in mainstream conversation. But today I want to talk about the importance of progesterone

Yes, progesterone helps maintain the uterine lining in preparation for pregnancy each cycle – but it does so much more for you.

Progesterone helps decrease fluid retention caused by excess estrogen (balancing out the action of estrogen), prevents endometrial cancer and endometrial hyperplasia, normalizes libido and sexual function, improves blood lipid profiles, improves sleep patterns (progesterone metabolizes into 17-OH progesterone which interacts with GABA – A to promote sleep) and has a role to play in bone mineralization (see my previous post on the impact of Combined Hormonal Contraceptives on Bone mineralization)

Our main source of progesterone is produced by the Corpus Luteum – this is what is left of the follicle in our ovary after we ovulate. Therefore, No ovulation = No progesterone produced by the ovary. VERY small amounts of progesterone can be produced in the adrenal gland, but It is nowhere near the amount a woman needs physiologically to perform all those functions listed above.

I wanted to highlight some of the biochemical functions of progesterone to emphasize the importance of ovulating each (or most) of your cycles! How do you know if you’re ovulating? To be continued next week on women’s health Wednesday!


January 16, 2019

Endometriosis endo

What is it? It is defined as the presence of endometrial-like tissue outside of the uterus

It’s estimated to affect approximately 7-10% of women, and over 60% of women with chronic pelvic pain.

Some signs and symptoms of endometriosis are cyclical or chronic pelvic pain, pain around ovulation, severe menstrual pain, bloating, pain during intercourse, palpable mass, digestive upset (IBS type symptoms)

How do I diagnose it? There are no reliable lab tests used to diagnose endometriosis, and the cause is seemingly multifactorial and hard to pinpoint– given the ambiguity of cause and diagnosis, it becomes difficult to have a “go to” treatment for, that specifically targets the pathology.

It really is a “hidden” illness to the outside world – only you and other women with endo really know the pain you’re living through.

This is where naturopathic medicine SHINES. Collecting as much detail as possible on your subjective symptoms experienced, I aim to address your digestion, reduce systemic inflammation, balance hormones, support stress and ultimately reduce pain and lighten the heavy flow.

It’s a multifaceted and multisystem approach to treat a multifactorial condition.

To those girls & women currently suffering with endometriosis – I hear you & am here for you!


January 9, 2019 

women's health wednesday.jpgfertility

My previous post on thyroid health was a brief overview of the multiple functions of thyroid hormone in the body, and general signs and symptoms of thyroid excess and deficiency. Today I want to talk about the importance of optimal thyroid function with respect to fertility. Continue reading over on my blog post page..

 


 

January 2, 2019

Women's Health Wednesday thyroidI think of thyroid as the Queen-B hormone in the body – it has the capacity to control SO MANY of the body’s functions, which is why it becomes problematic when it’s not functioning properly.

Thyroid is a major player of our metabolism, energy levels, immune system, reproductive hormones, mood, gastrointestinal transit time, skin health, cardiovascular function – as you can see it has a hand in all of our major organ systems functioning smoothly.

Assessing thyroid hormone can be tricky – blood levels are constantly fluctuating throughout the day, and more times than not, not all of the tests to properly assess thyroid hormone are done. And then within those lab results there is a “normal” range, but normal doesn’t always equal “optimal” for the patient – and each individual is going to have a different “optimal” functioning thyroid level.

When I assess my patients’ thyroid function, I’m taking into consideration: labs (TSH, T3, T4, anti-TPO), subjective symptoms experienced by my patient, signs detected through physical exam (skin assessment, thyroid palpation, DTR’s), where my patients are in their menstrual cycle, levels of stress, and diet.

As an ND, I’m assessing the whole patient to capture a full clinical picture, and then crafting a treatment plan that is unique to their thyroid health.

Here are some signs and symptoms of Low Thyroid function

  • Depression
  • Fatigue
  • Lethargy / forgetfulness
  • Cold intolerance
  • Muscular weakness
  • Hyperlipidemia
  • Constipation / bloating
  • Puffy eyes / puffy face
  • Weak immune system
  • Low libido
  • Infertility
  • Menstrual irregularities
  • Dry skin
  • Hair loss
  • Brittle nails
  • Weight gain / difficulty losing weigh

Here are some signs and symptoms of Excess Thyroid function

  • Fatigue / general weakness
  • Warm feeling
  • Moist skin / sweating
  • Tremors
  • Palpitations / chest pain
  • Increased bowel transit time / diarrhea
  • Tearing of eyes / protrusion of eyes
  • Easy bruising
  • Weight loss
  • Irregular menstrual cycle
  • Restlessness
  • Anxiety
  • Irritability
  • Insomnia

Has your thyroid been properly assessed?


December 19, 2018 

dysmenorrheaPeriods are not meant to be painful debilitating events that knock us out for 1 week a month. If this is the case, it is worth looking into and figuring out a treatment plan that is unique to you and addresses the root cause of your dysmenorrhea.

There are two main categories when looking into dysmenorrhea. Primary – meaning that painful menstruation is not due to physical abnormalities or identifiable pelvic pathologies. And Secondary – meaning the cramps can be attributed to a pelvic condition (endometriosis, fibroids, IUD present, ovarian cysts etc.)

It is important to identify the cause in order to have a targeted treatment plan. Today I want to talk about some basic treatment options for Primary dysmenorrhea.

  1. Diet – eating a healthy whole foods diet rich with vegetables, whole grains, fruits and healthy fats and proteins. A healthy diet provides your body with the nutrients it needs to reduce inflammation – ie. antioxidants, vitamins, minerals, and doesn’t worsen inflammation the way sugars, refined carbohydrates and trans fats do.
  2. Exercise – even if it’s the last thing you feel like doing while on your period, some light movement as simple as going for a walk or yoga can do wonders for your pain. Exercise releases endorphins which decrease pain and improve mood, as well as exercise promotes blood flow and circulation to reduces pelvic stagnation that can be one of the contributing factors to the severity of the cramps.
  3. Herbal Medicine – a custom combination tincture with cramp bark, ginger, valerian and black cohosh taken leading up to your period can work wonders and reducing cramps
  4. Supplements – I like to use Magnesium and Vitamin B6 together intravenously for acute relief (see my other instagram post about that). For long term and keeping prevention of future cramps in mind, supplements that help balance hormones/ support your liver to clear out extra estrogen can be useful. Vitamins and minerals I would consider using would be: DIM, I3C, Vitamin B complex, NAC, Vitamin C, Magnesium and Calcium.

These are GENERAL treatment options for primary dysmenorrhea. It is important to check in with your primary care provider and get your dysmenorrhea properly worked up as to avoid missing potential fibroids/cysts/endometriosis etc. that could be the cause of dysmenorrhea, so treatment can then be more targeted to address the cause of your painful periods. However, I do want you to take away from this post – severely painful and debilitating cramps are NOT normal, and don’t brush it off as “just period pain”. You can DRASTICALLY improve your quality of life if you bring this to your naturopathic doctor or primary care physician and find a treatment plan that works for you!


December 12, 2018 

Women's Health WednesdaySkin health requires a multifactorial approach to healing. With acne there are many contributing factors, but to simplify it I’m going to talk about the two main contributing factors to female adult acne: Hormones& Diet. I’ll be discussing them in two separate categories, but as you see when you read on, Hormones and Diet are NOT mutually exclusive factors, they both influence each other.

 

Diet:

Diet is more commonly at the root cause of female adult acne. This is because by the time we’re in our mid 20’s our cycles/hormones *should* be regulated – this is not always the case, especially nowadays when women are commonly on a form of hormonal birth control from the time they’re in their mid-teens until mid 20’s/early 30’s when they come off of the pill. If this is the case for you, your acne may be more rooted in your hormones (to be discussed in the next section), I’ll get back to talking about diet for now.

An important factor to consider when examining diet in the treatment of female adult acne is blood sugar regulation. If blood sugar is poorly regulated (eating too many refined carbohydrates and simple sugars) this will cause spikes in your insulin and then can result in dramatic drops in your blood sugar (hello mood swings, hangry and dizzy). If this blood sugar rollercoaster persists daily, it will impair your overall insulin sensitivity and can result in excess insulin in your system. Excess insulin decreases your livers capacity to produce SHBG (Sex hormone binding globulin), and if there is less SHBG available in your system to bind testosterone, there will be an increase in bioavailable testosterone in circulation that can stimulate the sebaceous glands. If sebaceous glands are over stimulated, this will result in excess oil and sebum production resulting in cystic acne.

Another component I like to consider is gastrointestinal (GI) inflammation. If digestion is not working smoothly (gas, bloating, constipation, loose stools, cramping etc.) then there is already a baseline level of inflammation in the body coming from the GI system. Inflammation from the GI system contributes to systemic levels of inflammation. Acne is already an inflammatory condition, and the body becomes less efficient at healing the skin condition if it’s also battling GI inflammation too. Also, if your digestive system is irritated, you may not be absorbing the foods you are consuming adequately, which could result in a lack of proper nutrients required for healthy skin – specifically vitamins C, A, E, and the minerals Zinc and iron.

Some basic treatment options to get blood sugar under control are:

  • Reducing refined sugars and carbohydrates in the diet
  • Increase consumption healthy fats and proteins
  • Aim to eat 3 meals/day appropriately spaced out to reduce over-secretion of insulin

Some basic treatment options to reduce GI inflammation are:

  • Keep track of what you eat and how you feel after to be able to identify any foods that you have trouble digesting and are irritating your GI system
  • Sit down and take your time to eat meals properly. This is a way to activate your parasympathetic nervous system which gears you up to eat and digest foods properly

 

Hormones:

As mentioned earlier, hormones are another factor to consider when addressing acne. If hormones are a contributing factor at the root of your acne breakouts, there are typically other signs of hormone imbalances present (PMS symptoms, irregular cycles, heavy periods, food cravings etc) and the acne breakouts tend to be more cyclical as to when they show up. That means that the breakouts are predictable for when they are going to show up – for example they may occur just prior, or during your period, or a breakout happens midcycle. The cyclical nature of breakouts are a reflection of the ebb and flow of your hormones (estrogen, progesterone and testosterone) throughout your monthly cycle. I previously talked about how insulin – SHBG – testosterone all works together and can influence breakouts, and now I want to talk about estrogen and progesterone.

If estrogen is high relative to progesterone, this can contribute to hormonal breakouts. Some reasons why we may have high estrogen are: a poor diet high in sugar, trans fats and low in protein, lack of exercise, increased central obesity, constipation, stress, use of hormonal birth control. A reason we may have low progesterone in relation to our estrogen is lack of ovulation, inadequate consumption of healthy fats and stress (just to name a few). We get our progesterone from the corpus luteum which is what’s left of the follicle in the ovary after we ovulate, so if ovulation is not occurring, there is no corpus luteum, which means no progesterone to balance out estrogen.

Some basic treatment options to help lower estrogen levels and rebalance hormones are:

  • Foods to help clear estrogen from the body: ground flax seeds, pumpkin seeds, broccoli, cauliflower, brussels sprouts, kale
  • Support your digestion transit time by staying hydrated and eating a diet rich in vegetables and fibers.
  • Vitamins and minerals to consider when balancing hormones: DIM, I3C, B Vitamins

 

As you can see, diet and hormones are not mutually exclusive causes of acne – and in order to optimize skin health, it’s a good idea to address both of these factors.

This is meant to be an overview of two major factors that affect skin health and acne, and to provide a starting point for looking into your own health. For more a more detailed and individualized treatment plan, please consult with your naturopathic doctor!

 

 


December 5, 2018

COCPS

Not all oral contraceptive pills are created equally. Combined Oral Contraceptive Pills (COCPs) consist of a synthetic estrogen (Ethinyl estradiol) combined with a progestin. “Progestin” is an umbrella term for synthetic progesterone that consists of multiple chemical structures that all have the capacity to act similarly to progesterone in the body.

Progestins however are not BIOIDENTICAL to progesterone (bioidentical= EXACT same biochemical structure), so they also have slight estrogenic and androgenic activity too. There s a variety of different progestin structures, with some having more potent progestogenic effects and others with more potent androgenic effects – just to clarify, androgenic = testosterone activity

Some COCPs with progestins that have higher androgenic side effects are:

Loestrin, Estrostep, Levelen, Allesse, Ovral, Norlestrin

The above listed COCPs are commonly used due to their low estrogen dose which gives them a better safety profile and are more tolerable, however if you already have a predisposition to have higher androgens or are more sensitive to androgens in your system, these COCPs can heighten your androgen activity resulting in an increase in acne, oily skin and increase hair growth on the chin, belly and pubic region.

If you are currently on a COCP and are struggling with side effects, please come in and talk to me! We can find a COCP that better fits your biochemistry, and/or talk about other options that are available for you.


November 28, 2018

Bacterial vaginosis is the most common cause of vaginal infection, abnormal discharge, and odor. It can result from an alteration in your vaginal ecosystem.Women's Health Wednesday copy 4

 

My vagina has an ecosystem?

 

Yes! Just like in your digestive system, there is a bacterial flora that is unique to your vaginal mucosa. The microflora plays a role in maintaining an optimal pH (acidity) that helps prevent pathogenic bacteria or yeast from rooting in.

Did you know that Estrogen also helps keep your vagina at an optimal pH? If your hormones are out of whack, your vaginal pH will change, potentially allowing an opportunistic vaginal infection to take root.

If you’re suffering from recurring BV infections (upwards of 30% of cases can have recurrence within 1-2 months after treatment with metronidazole) then it is worth your while to take a closer look at how your hormones are doing and what you can do to promote a healthy vaginal microflora in order to prevent BV!


November 21, 2018 

Women's Health Wednesday

 

Irregular cycles are not normal. Periods should be regular. For cycle length reference and a fun fact, menstrual cycles tend to match up with the lunar cycle!

 

Many women are prescribed birth control pills to regulate their cycles. The way Oral Contraceptive Pills (OCPs) work, is by masking your bodies hormones in order to suppress ovulation to prevent a pregnancy from happening. Essentially, OCPs take over for your own hormones, and by taking them daily for 21 days (or whichever cycle you are on) and then stopping for 7 days, you force what is called a “withdrawal” bleed because your body recognizes the lack of the synthetic progestin and ethinyl estradiol it was receiving from the OCP. If your primary goal is contraception, and as a bonus your cycles are predictable when on OCPs, then OCPs may be an okay option for you at this point in your life.

However, when coming off of OCPs, your cycle will most likely return to what it was before using OCPs, doing nothing to help fix the root cause of your hormone imbalances and why your periods were irregular in the first place. This can be problematic if you are coming off OCPs in order to conceive. If your cycles are irregular, it becomes more difficult to know if and when ovulation is occurring to time intercourse during your fertile window (maximizing your chances of conception), and if your body is producing enough of the right hormones at the right time to hold the pregnancy and prevent miscarriage.

If your primary goal is regulating your cycle, there are many natural and effective options to balance your hormones (diet, herbs, targeted vitamin + minerals). If your main goal is contraception, there are many safe and effective options (natural and prescription). I believe in the power of education and that each woman deserves to make informed choices around her health that best reflect her health goals at that time in her life.

If you have questions about irregular periods and/or which treatment option is best for you, come on into my office and we can chat about ALL your options for regulating your cycle and methods of contraception, so you can make an informed decision!

 

 


November 14, 2018 

Women's Health Wednesday copy 2Acupuncture is a safe and effective treatment option to use throughout pregnancy. From assisting with conception, to easing morning sickness, aches, pains and calming anxiety, there are many applications for acupuncture.

Acupuncture can be used to “ripen” or soften the cervix, helping your body transition into labour. You might be thinking, “how can poking my body with little needles help me deliver our baby?”

Acupuncture is one of the modalities used by naturopathic doctors, originating from traditional Chinese medicine. It has been around for hundreds and hundreds of years and has stood the test of time. The body is mapped out into meridians in which energy moves through the body.

By stimulating certain points around the body, you are activating specific meridians to increase energy flow and blood flow. This increase in blood flow will promote blood flow to the uterus and cervix, aiding the natural cervical thinning process that takes place before labour, help relax the pelvic floor muscles, calm the mind and prepare the body for labour.

This isn’t a single-treatment-and-you’ll-be-in-labour kind of thing. This is a gradual process that can help ease your labour when the time comes. Ideally you want to begin this process around week 36 of your pregnancy.

Questions? Come in and chat with me, and we can see if this is something that you will benefit from.

Click here for a research paper in favour of acupuncture shortening the transition into labour.

 


November 7, 2018

Women's Health Wednesday copy

Pap test Guidelines in B.C.

 

Pap screening is an extremely valuable tool used to detect and Identify pre-cancerous lesions that can then be treated to prevent the development of cervical cancer

 

 

The BC Cancer Agency recommends that sexually active women older than 25 years old be screened every three years. More frequent screening (every year) is recommended for immunocompromised women, or those with a history of pre-cancerous lesions or a history of cervical cancer.

Cervical cancer is one of the most preventable cancers

I was trained at the BC Women’s Hospital in Vancouver to perform pelvic exams and Pap smears, and I aim to make this health experience as comfortable, educational and empowering as possible.

Click for more information on cervical cancer screening.


October 31, 2018

Women's Health Wednesday

 

 

Click to access the podcast discussing the benefits of pelvic floor physiotherapy

 

 

 

 


October 24, 2018

Women's Health Wednesday

 

 

Click to access the article discussing the impact of using cannabis during pregnancy may have on your developing baby.

 

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