Gynecological problems account for much of the morbidity that occurs in women, being one of the four most common reasons for consulting a general practitioner.
As a woman, you deserve healthcare that not only addresses your gynecological needs but also treats you in the context of the whole, unique individual that you are. A “one size fits all” approach often doesn’t work and treatment needs to be individualized. Integrative gynecology that combines conventional treatment with evidence-based complementary therapies and mind/body medicine has become a growing field of healthcare that strives to serve this demand. In integrative gynecology, conventional and complementary approaches are joined in a way that aims to optimize outcomes and prevent adverse events. Women experiencing symptoms of menopause, premenstrual syndrome, dysmenorrhea, mastalgia, and infertility may often try to self treat or seek alternative therapies. It is important to use evidence-based resources when seeking information about herb and supplement products.
Dietary supplements are defined as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following: a vitamin, mineral, herb or other botanical, amino acid, a dietary substance used by man to supplement the diet by increasing the total dietary intake or a concentrate, metabolite, constituent, extract or combination of any of the ingredients described above.” Dietary supplements are regulated as foods and can be marketed to consumers without providing support for claims of efficacy and safety. Many such supplements and remedies have been widely studied and found to be extremely efficacious in treating gynecological disorders. Most of these supplements should be and are being used as complementary therapy along with approved pharmacological therapy for the same.
Abnormal uterine bleeding is a manifestation commonly encountered during a woman’s reproductive phase and approximately 20% of the female patients visiting a general gynaecologist are women with this problem. About one half of all patients who experience this problem are over 40 years of age and about 20% are adolescents. When administering treatment to a patient with abnormal uterine bleeding, it should be borne in mind that menstruation is not a purely physical phenomenon– the awareness of its onset, regularity and associated discomfort are strongly influenced by psychological and cultural factors. Because menstruation is a normal process, it does have the ability to readjust itself after abnormal bleeding. For this reason, many therapies in the past have been considered to be successful when, in fact, they may have no scientific basis and are empirically instituted.
Among adolescents presenting with menstrual problems, about 50% constitute abnormal uterine bleeding and dysmenorrhoea. Dysmenorrhea is a common symptom among young women and a leading cause of absenteeism from work and school. Many herbs and dietary supplements have been proposed as being effective for primary and secondary dysmenorrhea, including primrose oil, black cohosh, chasteberry, dong quai, black haw, omega-3 fatty acids, vitamin E, thiamine (vitamin B1), niacin (vitamin B3), and magnesium.
There are around 150 symptoms associated with PMS, but most women only experience a handful of them. Some of the most common physical symptoms are tiredness, bloating, tender breasts, acne, weight gain, headaches and stomach pain. Frequent emotional symptoms can include feeling irritable, angry or depressed, anxious, insecure, mood swings, insomnia and difficulty with concentration. Some of the complementary therapies include hypnotherapy, reflexology, acupuncture, evening primrose oil, dietary supplements like calcium, vit. B6, folic acid, magnesium.
There is evidence in the literature that the development of a fit-for-fertility programme can have a positive effect on fertility. This would address a lifestyle programme including diet, exercise, stress management and education. Weight is known to have an effect on fertility both in the patient who is overweight, often associated with polycystic ovary syndrome, or is underweight. Therapies including aromatherapy and reflexology may only be stress relieving techniques at a minimum but this in its own right can have a positive effect. There is increasing evidence of the role of acupuncture in infertility.
Pregnancy and child birth:
Pain relief in labour and delivery is well recognized at providing an integrated approach. Labour pain could be diminished by familiarizing the mother with the process of childbirth by creating an atmosphere of confidence. Other therapies include focused breathing, hypnosis, Yoga and music therapy. There is evidence that water immersion during the first stage of labour reduces the use of analgesia and reported maternal pain, without adverse outcomes on labour duration, operative delivery or neonatal outcomes.
By treating women going through the menopause in an integrated way we can offer women a range of choices both self help and professional, complementary and orthodox, incorporating a regime of lifestyle changes, diet and appropriate therapeutic agents. Many areas need to be addressed. Diet is very important and it is accepted that dietary interventions need to start as early as possible even in teenage years. Correct fats in the diet are essential and there is good evidence that a reduction in saturated fatty acids helps reduce coronary heart disease. There is increasing evidence of the benefit of long chain omega-3 fatty acids in health. Probiotics, ‘live microbial feed supplements which beneficially affects the host animal by improving its intestinal balance’, are beneficial. The best studied probiotics are Lactobacillus spp. and Bifidobacterium spp. There is increasing evidence that they can help irritable bowel syndromes and recurrent candida infections as well as urinary tract infection in menopausal women. Nutrition plays an essential role in the prevention of bone loss and maintenance of bone mass. Most studies have shown that about 1.5 g of elemental calcium is necessary to preserve bone health in postmenopausal women. Vitamin D alone also appears to reduce the risk of vertebral and nonvertebral fracture. Exercise is essential. Exercise has been demonstrated to help many of the complaints that hormone replacement therapy can, without the potential side effects. Regular exercise helps reduce the risk of osteoporosis and prevent coronary heart disease and type 2 diabetes mellitus. Physical activity can improve mood, urinary incontinence, hot flushes and insomnia. Carefully structured exercise regimes can also be beneficial in the management of established osteoporosis, mainly related to increased well being, muscle strength and postural stability. Phytoestrogens are plant substances that have similar effects to oestrogens. They are grouped into four main categories: isoflavones, coumestans, lignans, and flavonoids. The most widely studied group are the isoflavones, Soybeans are a rich source of isoflavones, and flaxseed is a source of lignans. Red clover contains compounds that are metabolized isoflavones after consumption. Populations that eat a diet high in phytoestrogens do appear to show a reduction in the rate of vasomotor symptoms, cardiovascular disease, osteoporosis, breast, colon endometrial and ovarian cancers. Placebo-controlled studies on Black Cohosh (Actaea racemosa) are promising but we do need to know more about potential long-term safety and toxicity. Other complementary therapies that may help hot flushes include reflexology and acupuncture.
Nearly 40% of women use complementary therapies. Many women do not disclose their complementary therapies to their gynecologists, treatment plans are often not coordinated. Thus, the risk of adverse events and interactions of complementary with conventional therapies may be increased along with the risk of polypharmacy. Sharing of information between providers of conventional and complementary treatments is important to optimize health outcomes and safety. Good communication is essential.