PCOS, Endometriosis, & Abnormal Growths

Question 1

About X% of normally ovulating women experience polycystic ovaries but do not experience other criteria surrounding a PCOS diagnosis.

Answer 1

25%

Question 2

True or False: Polycystic Ovary Syndrome is characterized by a certain set of conditions rather than one standalone diagnostic parameter such as polycystic ovaries.

Answer 2

True

Question 3

Why can’t PCOS be diagnosed through ultrasound alone?

Answer 3

We now understand is that this syndrome is way more complex, and is characterized by a certain set of conditions, rather than one standalone diagnostic parameter such as polycystic ovaries. It is said that about 25% of normally ovulating women experience polycystic ovaries but do not experience other criteria surrounding a PCOS diagnosis

Question 4

There has been recent conversation of if Polycystic Ovary Syndrome is an accurate name for this condition, and if it should be renamed as BLANK, as not all cases have polycystic ovaries.

Answer 4

Metabolic Reproductive Syndrome

Question 5

In order to diagnose PCOS properly, according to the Androgen Excess & PCOS Society Criteria, a woman must experience which 3 of the following biomarkers?

Answer 5

• Irregular cycle OR polycystic ovaries
• High androgens or symptoms of high androgens
• Ruled out other conditions that could potentially cuase hyperandrogenism

This criteria for diagnosing PCOS is perhaps more accurate than other forms but is met with high controversy in varying medical communities.

Question 6

What is hyperandrogenism?

Answer 6

High androgens

Androgens like testosterone are sex hormones.

Question 7

What are symptoms of high androgens?

Answer 7

• Deepening or hoarsening voice, acne, especially along the chin-line
• Hirsutism, which is characterized as male-patterned hair loss or hair thinning, facial, nipple, or other body hair growth.

Question 8

What are other conditions that could potentially cuase hyperandrogenism?

Answer 8

• Congenital adrenal hyperplasia
• Cushing’s disease
• Ovarian or adrenal tumors
• Certain medications, such as progestin-only birth control with a high androgen index

Question 9

What is the Rotterdam criteria?

Answer 9

Was formed to diagnose PCOS as an alternative criteria option with less rigorous parameters.

Although potentially less accurate, it is more commonly used to refer to and diagnose PCOS.

Question 10

According to the Rotterdam criteria, a woman must have 2 of the 3 following biomarkers to get diagnosed with PCOS?

Answer 10

• Polycystic ovaries on ultrasound
• Irregular cycles
• High androgens or symptoms of high androgens (as well as ruling out other conditions associated with hyperandrogenism)

This means that a woman could technically be diagnosed with PCOS if she shows having polycystic ovaries and irregular cycles, but not hyperandrogenism, which is considered amongst many as a main characteristic of PCOS, as it tends to be the driving factor behind ovarian suppression leading to the other symptoms

Question 11

What is the issue with the Rotterdam Criteria?

Answer 11

A woman could technically be diagnosed with PCOS if she shows having polycystic ovaries and irregular cycles, but not hyperandrogenism, which is considered amongst many as a main characteristic of PCOS, as it tends to be the driving factor behind ovarian suppression leading to the other symptoms.

Question 12

What are some of the reasons that could cause a woman to experience anovulation and irregular cycles that aren’t specifically related to high androgens?

Answer 12

• Physical & psychological stress
• Elevated prolactin
• Exposure to endocrine-disrupting chemicals
• Decreased FSH
• Perimenopause
• Any other condition that would suppress or interfere with hypothalamic & pituitary hormone output

Prolactin is a hormone that’s responsibel for lactation, certain breast tissue development and milk production.

Question 13

What are Polycystic Ovaries defined as and why?

Answer 13

12 or more pre-antral follicles measuring 2–9 mm and/or an increased ovarian volume.

Because in a normal ovulating woman, it is common for up to 12 pre-antral follicles to develop per ovulatory cycle, of which only one is chosen to become the primary antral follicle that will go on to ovulate an egg. The rest are merely suppressed and may resemble small cysts during the follicular phase until they are reabsorbed by the ovaries

Question 14

Teenage girls may exhibit up to BLANK pre-antral follicles per ovulatory cycle, so the definition of polycystic ovaries may vary upon age.

Answer 14

25

Question 15

Should a doctor diagnose a teenage girl with PCOS?

Answer 15

Only time can tell for these young women if they do indeed have PCOS or not, as their pre-antral follicle count may eventually lower to average levels, and their body may become accustomed to their hormonal cycles, leading to more regular ovulatory cycles.

Question 16

Despite all the varying diagnostic criteria, there is a general consensus that PCOS is characterized by BLANK and BLANK

Answer 16

ovulatory failure and high levels of androgens

Although this may seem simple, we have to consider that there are varying driving factors that contribute to these situations, which may be different for each individual.

Question 17

For many, PCOS tends to be a low-BLANK stage, which goes against the common belief that excess estrogen can drive PCOS symptom. Why is this?

Answer 17

Estrogenic

Often the result of improper aromatization due to leptin resistance and abnormalities in the follicular granulosa cells, which can be partial to blame for both hyperandrogenism and anovulation in women with PCOS.

Question 18

Because women with PCOS do not ovulate regularly, they tend to experience BLANK dominance by ratio, potentially contributing to symptoms such as PMS and heavy periods.

Answer 18

Estrogen

Question 19

Roughly 70% of women with PCOS have been shown to have decreased BLANK sensitivity, suggesting that BLANK may be an extremely common factor behind many PCOS cases

Answer 19

Insulin; insulin resistance

Question 20

Interestingly, there may also be a connection between BLANK downregulation in women with PCOS, further contributing to dysregulated blood sugar and insulin resistance.

Answer 20

GLUT4

Question 21

Why do we refer to Insulin resistance-driven PCOS as Ovarian PCOS?

Answer 21

Because high insulin levels can increase LH production, causing the ovaries to produce more androgens and less estrogen.

Lutenizing Hormone, spurs ovulation and helps with the hormone production needed to support pregnancy.

Question 22

What may account for the abnormal elevation in LH in women with PCOS?

Answer 22

Altered GnRH pulsation, as well as lowered Inhibin B,

Gonadotropin-releasing hormone is a releasing hormone responsible for the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary

Question 23

What is a common pattern we see in PCOS?

Answer 23

A higher LH to FSH ratio (high LH, low FSH), typically a ratio of 3:1

Question 24

High insulin can contribute to increased BLANK and BLANK.

Answer 24

Weight gain and adipose tissue

Question 25

What may be a primary reason why obesity is so prevalent in individuals with PCOS?

Answer 25

Insulin is a storage hormone.

When it is not able to properly deliver glucose to cells for energy production, it will be delivered to adipose tissue for storage instead. This in turn can increase weight gain .

Question 26

Not everyone with PCOS is BLANK, and not everyone who is BLANK with ovulatory or fertility issues has PCOS.

Answer 26

obese; obese

Question 27

Those who do have PCOS in addition to obesity are at more risk for developing worsening BLANK issues.

Answer 27

metabolic

Question 28

What is Non-Alcoholic Fatty Liver Disease?

Answer 28

A common condition associated with PCOS; where fatty acids deposit within the liver (as well as other organs) causing inflammation, scarring, and damage of liver cells.

Question 29

Non-Alcoholic Fatty Liver Disease (NAFLD) is commonly associated with what?

Answer 29

Insulin resistance, visceral obesity, high cholesterol, and metabolic syndrome.

Viseral obesity is belly fat found deep within your abdominal cavity. Metabolic syndrome includes high blood pressure, high blood sugar sugar, too much fat around the waist, and irregular cholesterol levels.

Question 30

The high prevalence of obesity and adipose tissue deposition in BLANK can also factor into BLANK, which may lead to aromatization deficiency, lowered estrogen, and anovulation.

Answer 30

PCOS; leptin resistance

Question 31

Leptin is considered the BLANK hormone

Answer 31

Satiety.

It is produced within adipose tissue and plays a role in controlling appetite regulation.

When energy is needed, leptin decreases to allow for the sensation of hunger and desire to eat, whereas when energy is not needed, leptin steps in to increase satiety and a feeling of “fullness”.

Question 32

When energy is needed, BLANK decreases to allow for the sensation of hunger and desire to eat, whereas when energy is not needed, BLANK steps in to increase satiety and a feeling of “fullness”.

Answer 32

Leptin; Leptin

Question 33

With BLANK, the dysfunction that can occur is similar to that of insulin resistance and adrenal insufficiency. When adipose tissues are constantly being filled with glucose stores, leptin levels will increase.

Answer 33

Obesity.

Question 34

Eventually, the BLANK can become desensitized to leptin’s message, leading to leptin resistance

Answer 34

hypothalamus

When the brain is resistant to leptin’s signals for satiety, it can increase feelings of hunger and desire to over-eat, further perpetuating insulin resistance and obesity-related issues.

Question 35

When the brain is resistant to BLANK’s signals for satiety, it can increase feelings of hunger and desire to over-eat, further perpetuating insulin resistance and obesity-related issues.

Answer 35

Leptin’s

Question 36

BLANK resistance can interfere with the development of oocytes and can downregulate aromatization, leading to higher testosterone and lowered levels of estrogen which can contribute to a higher prevalence of anovulation and hyperandrogenism.

Answer 36

Leptin

Question 37

With PCOS, low levels of BLANK can further exacerbate hyperandrogenism by initiating a faulty feedback loop

Answer 37

Estrogen

When estrogen levels are low, this signals to the brain that there’s a need for more estrogen.

All estrogen is produced from the conversion of androgens, so naturally, the body is going to respond to the signal for more estrogen by increasing androgen production.

When aromatization is deficient, this can further exacerbate the faulty feedback loop, contributing to even more testosterone levels and symptoms thereof

Question 38

Because one of BLANK’s roles is to promote insulin sensitivity, low BLANK levels may be a reason behind why insulin resistance, weight gain, and ovulatory health can be so challenging to correct in individuals with PCOS

Answer 38

Estrogen’s; estrogen

Question 39

High insulin levels can also drive DHEA metabolism down the BLANK pathway, which can lead to what symptoms?

Answer 39

Alpha-reductase; more androgenic symptoms such as Hirsutism, due to Testosterone being converted into DHT (Dihydrotestosterone).

Question 40

DHT can lead to what symptoms?

Answer 40

Male-pattern balding and facial/body hair growth.

Within the hair follicle, DHT causes follicle miniaturization and eventually hair loss, whereas, in sebaceous glands of the skin, DHT production can lead to hair growth, typically around the chin, above the upper lip, around the nipples, and near the pubic region.

Question 41

In Adrenal-Driven PCOS, what is the primary marker?

Answer 41

High levels of the adrenal androgen DHEA S, rather than ovarian androgens such as Testosterone and Androstenedione.

Question 42

Why is elevated DHEA-S the distinguishing factor in Adrenal-Driven PCOS?

Answer 42

DHEA and DHEA-S are only produced within the adrenals, whereas androstenedione and testosterone can be produced in both the ovaries and the adrenals.

In Adrenal-Driven PCOS, the primary marker is high levels of the adrenal androgen DHEA S, rather than ovarian androgens such as Testosterone and Androstenedione

Question 43

Depending upon the individual, why might symptoms may remain similar as ovarian-PCOS?

Answer 43

More potent forms of androgens such as Testosterone and DHT can be produced via peripheral conversion in tissues such as the skin, hair follicles, and adipose tissue.

Question 45

It is uncommon to see BLANK as a factor with adrenal-driven PCOS as DHEA supports BLANK and high levels of BLANK tend to reduce the prevalence of DHEA

Answer 45

insulin resistance; insulin resistance; insulin

Question 46

Before adrenal-driven PCOS can be confirmed, one must rule out other factors that can lead to higher levels of DHEA, such as what?

Answer 46

high prolactin, congenital adrenal, hyperplasia, and certain medications such as Metformin, Troglitazone (used to treat type 2 diabetes), Danazol (used to treat endometriosis), Xanax, Ritalin, and Nicotine.

Question 47

What is Adrenal PCOS driven by?

Answer 47

An abnormal response to stress, characterized by HPA axis overstimulation.

When the hypothalamus perceives a stressful situation, it produces CRH in response, which stimulates the pituitary to produce ACTH. ACTH promotes the production
of both cortisol and DHEA/DHEA-S within the adrenals.

As cortisol rises, it stimulates a negative feedback response to the hypothalamus shutting off the CRH/ACTH production. DHEA is produced in response to elevated cortisol as a mechanism to protect the brain from the negative impacts of stress. However, with DHEA, there is no negative feedback shutting off production, as there is with cortisol. Thus, chronic stress, HPA dysfunction, and adrenal insufficiency may lead to increasing levels of DHEA/ DHEA-S within the system. This in turn can contribute to the onset of adrenal PCOS symptoms.

Question 48

With DHEA, is there a negative feedback shutting off production as there is with cortisol?

Answer 48

No, chronic stress, HPA dysfunction, and adrenal insufficiency may lead to increasing levels of DHEA/ DHEA-S within the system. This in turn can contribute to the onset of adrenal PCOS symptoms.

Question 49

What can contribute to the onset of adrenal PCOS symptoms?

Answer 49

With DHEA, there is no negative feedback shutting off production, as there is with cortisol. Thus, chronic stress, HPA dysfunction, and adrenal insufficiency may lead to increasing levels of DHEA/ DHEA-S within the system.

Question 50

What can contribute to irregular ovulation through stimulating cues of internal stress? How?

Answer 50

High levels of inflammation which stimulate cues of internal stress will tell the adrenals to produce the hormones norepinephrine, epinephrine, and cortisol, suppressing GnRH, and inhibiting or delaying ovulation.

Question 51

What hormones get produced from the adrenals when there are high levels of inflammation, innhibiting or delaying ovulation?

Answer 51

Norepinephrine, epinephrine, and cortisol, which suppress GnRH.

Question 53

Inflammation can damage BLANK and BLANK? Why?

Answer 53

Follicle and egg quality, as the pre-antral follicle and oocyte developmental processes are very sensitive to inflammation.

Question 54

Inflammation can also damage follicle and egg quality, which can lead to what?

Answer 54

Poor ovulatory outcome, cyst development, failure to ovulate, and if ovulation does happen to occur, poor corpus luteum quality and low progesterone production.

Question 55

What is Inflammation-driven PCOS most commonly characterized by?

Answer 55

Symptoms of PCOS without having insulin resistance, but it can very well contribute to insulin resistance over time, further exacerbating PCOS conditions.

Question 56

Why can inflammation lead to insulin resistance over time, further exacerbating PCOS conditions?

Answer 56

The inflammatory cascade can contribute to insulin resistance by suppressing the negative feedback loop of glucagon and insulin in the pancreas.

Question 57

Inflammation may contribute to excess BLANK and either an increase or decrease in BLANK, depending on the severity, which can negatively affect hormone health and ovulatory function.

Answer 57

cortisol; DHEA

Question 58

True or False: Inflammation cannot be present in ovarian or adrenal PCOS?

Answer 58

False, it can.

For this reason, it’s best to look at inflammatory PCOS subjectively and consider other areas where inflammation could be hindering ovulation and contributing to blood sugar dysregulation (with or without insulin resistance), HPA-dysfunction, and either an increase or decrease of steroid hormones.

Question 59

What other reproductive health conditions can PCOS often be confused with?

Answer 59

Hypothalamic amenorrhea, hyperprolactinemia, congenital adrenal hyperplasia, primary ovarian insufficiency, and even perimenopause.

Question 60

Why is it common for HA to be misdiagnosed with PCOS when PCOS is diagnosed through ultrasound alone?

Hypothalamic Amenorrhea

Answer 60

Both conditions can be characterized by anovulation and the presence of polycystic ovaries due to under-developed follicles.

Question 61

What are some of the clear distinctions between HA & PCOS?

Hypothalamic Amenorrhea

Answer 61

HA is commonly associated with a low/normal BMI whereas PCOS is highly associated with insulin resistance and in most cases a normal/high BMI.

One of the biggest distinguishing factors between HA & PCOS is the LH to FSH ratio.

Question 62

Although PCOS is commonly associated with symptoms of hyperandrogenism, some individuals with BLANK may also present with similar symptoms without hyperandrogenism.

Answer 62

HA; hypothalamic amenorrhea

This may be related to androgen hypersensitivity - or idiopathic hirsutism, and/or their ethnicity.

Question 63

With BLANK, you often see lower LH to FSH ratio (low LH, high FSH) unlike with PCOS.

Answer 63

HA; In both cases, LH and FSH will likely be low, but to distinguish, we’d want to look at the ratios between these two pituitary hormones.

Hypothalamic Amenorrhea

Question 64

We may see both low estrogen and low androgen levels in BLANK, whereas we are likely to see low estrogen with high androgens in BLANK.

Answer 64

HA; PCOS

Question 65

What is a common condition confused with PCOS, besides HA?

Answer 65

Congenital Adrenal Hyperplasia (CAH).

It is a rare genetic disorder of the adrenals causing them to produce too little cortisol and aldosterone, and an increase of androgens instead.

CAH and PCOS can look near identical as they can both present with similar symptoms such as with hirsutism, anovulation, irregular cycles, fatigue, insulin resistance, and obesity.

Question 66

What is the primary distinguishing factor between CAH and PCOS?

Answer 66

A blood marker for 17- hydroxyprogesterone (17OHP).

Question 67

An elevation in 17OHP occurs due to an abnormality in BLANK production. 17OHP is a precursor to cortisol, and when specific enzymes are not present to help with the conversion (due to CAH), this leaves abnormally high levels alongside lowered cortisol.

Answer 67

Cortisol

Question 68

CAH is most common in women of what descent?

Answer 68

Ashkenazi Jewish, Hispanic, and Mediterranean descent

Question 69

Primary Ovarian Insufficiency (POI) and hyperprolactinemia can be confused with BLANK?

Answer 69

PCOS

Question 70

Hyperprolactinemia may represent similarly to BLANK, specifically in regard to anovulation and irregular cycles, but is more commonly associated with BLANK than it is with PCOS.

Answer 70

PCOS; amenorrhea

Question 71

Prolactin is commonly elevated in times of high stress and may contribute to ovulatory failure, resulting in some of the hallmark characteristics of BLANK.

Answer 71

PCOS

Question 71

In most cases, ranges of elevated prolactin with PCOS do not elevate to extremely high levels, as we might see with a BLANK. what is the distinguishing factor for hyperprolactinemia?

Answer 71

Prolactinoma.

The distinguishing factor for hyperprolactinemia, in this case, would be abnormally high levels of prolactin (>25 ng/mL).

Question 71

Oftentimes pharmaceutical usage can lead to a depletion of certain what?

Answer 71

Essential vitamins and minerals.

Addressing those nutrient deficiencies in a timely manner can not only help to improve your client’s metabolic situation, but it may also help decrease the intensity of withdrawal effects or complications that one may have from stopping a pharmaceutical drug.

Question 72

Metformin has been shown to deplete BLANK and is associated with anemia, perhaps due to the depletion of those vitamins

Metformin is a pre-diabetic drug

Answer 72

B12 (potentially B9 as well)

Question 73

Spironolactone may deplete BLANK and can potentially lead to an increased loss of BLANK in the urine due to its inhibition of aldosterone receptors.

Spironolactone is an androgen-suppressing drug

Answer 73

B9; sodium

Question 74

With Ovarian PCOS, what is one of the best places to start for support?

Answer 74

Through optimizing their nutrition and helping to support their insulin sensitivity.

Question 75

What is one of the best ways to support someone who has Ovarian PCOS with optimizing their nutrition?

Answer 75

A lower-carbohydrate diet may be beneficial temporarily to help stop the insulin resistance cycle and support blood sugar balance.

Including quality fats & protein with each meal, dialing in sleep, being strategic with exercise, and supporting stress management are all foundational approaches to supporting healthy insulin sensitivity.

Question 76

With Adrenal PCOS, what is one of the best places to start for support?

Answer 76

Stress management (both external and internal)

Question 77

What is one of the best ways to support someone who has Adrenal PCOS?

Answer 77

Supporting HPA stabilization and modulating inflammation

Depending upon your client’s state of mental health, they may need to work with a therapist to address certain psychological stressors. Some research has shown that women with PTSD may inherently produce more DHEA as a result.

You may also want to consider what other forms of systemic dysfunction could be contributing to increased internal and psychological stress, such as gut dysbiosis, intestinal permeability, nutrient deficiencies, toxin exposure, etc., and address those accordingly.

Question 78

For both ovarian and adrenal PCOS, what are foundational approaches to begin with, as a burden in any of those areas may negatively exacerbate PCOS conditions?

Answer 78

Optimizing digestive function, reducing EDCs and other toxin exposure, and improving overall detoxification.

Question 79

What kinds of inhibitors may help to provide support with symptoms of high androgens?

Answer 79

Alpha-Reductase and DHT

These include Saw Palmetto, Stinging Nettles, Spearmint, Reishi Mushroom, EGCG (an active component in green tea that has been known to support high insulin sensivity and those with NAFLD), and Zinc.

Oftentimes these nutrients can be found in prostate blends as they do support male prostate health. However, they can also be great blends for women with PCOS and hyperandrogenism.

Nonalcoholic fatty liver disease

a higher intake of EGCG has been known to inhibit aromatization, which may not be helpful in those with PCOS.

Question 80

For supporting insulin resistance which supplements are good places to start?

Answer 80

• Magnesium and bERBERINE

Question 81

What is Quercetin?

Answer 81

Polyphenol that works to support PCOS conditions via a few different mechanisms. Firstly, it helps to support a healthy inflammatory response and insulin sensitivity by scavenging free radicals and modulating inflammatory cytokines such as TNF-a and IL-6.

Quercetin has been shown to normalize follicle development comparable to Metformin. Finally, Quercetin may also work to modulate testosterone and LH levels and support the production of estrogen and progesterone in subjects with PCOS

Question 82

What is Myo-inositol?

Answer 82

A sugar molecule that belongs to the inositol family, which is said to have anti-diabetic properties by mimicking insulin, improving glucose uptake, and inhibiting pancreatic beta-cells from secreting insulin.

Some research shows that in women with insulin-resistance driven PCOS, Myo-inositol improves insulin levels and promotes healthy egg and follicle development by helping to support cellular communication and normalizing FSH levels

Although Myo-inositol is considered safe in most cases, it is not recommended for those with psychological disorders such as bipolar disorder or schizophrenia.

Question 83

White Peony & Licorice Root Extract may do what?

Answer 83

Help promote normalization of LH & FSH and aromatization of testosterone to estrogen, helping to modulate overall androgen levels and increase estrogen, which may support ovulation.

Keep in mind that licorice may increase blood pressure levels, so it is best not to recommend it to individuals at risk for hypertension.

Question 84

Which stress and andrenal modulators and other nutrients may support healthy adrenal function and improves stress resiliency?

Answer 84

Adaptogenic herbs, and other nutrients that nourish the adrenals such as B vitamins, specifically B527, Vitamin C, and Copper may help support healthy adrenal function and improve stress resiliency, which may be important when it comes to modulating cortisol and DHEA production.

Question 85

What are Ovarian Cysts?

Answer 85

Fluid-filled sacs that appear on the ovaries as a response to excess estrogen and unruptured follicles.

Question 86

What can bring on Ovarian Cysts?

Answer 86

An increase in estrogen due to poor estrogen elimination and/or endocrine-disrupting chemical exposure, or they may be caused by drugs that initiate ovulation for assisted reproductive technology (ART) purposes such as IVF.

Question 87

What does it mean if cysts are functional?

Answer 87

They do not causing bother or concern for a woman, and are typically the result of hormonal imbalances and ovulatory dysfunction, or may also form from the corpus luteum during pregnancy.

Question 88

Which types of cysts are more likely to be problematic?

Answer 88

Cystadenomas, Dermoid, and Chocolate cysts

Question 89

What are Cystadenomas?

Answer 89

Benign tumor-like cysts that may grow large enough to cause intense pain and discomfort, eventually requiring surgical removal.

Question 90

What are Dermoid Cysts?

Answer 90

A quite peculiar type of cyst, as they will often contain bizarre substances inside of them such as fat, skin, hair, and even teeth, as they are formed from human egg and embryonic cells. Many dermoid cysts develop during pregnancy, and do not cause problems, but may lead to pain if grown large enough.

Question 91

What are chocolate cysts?

Answer 91

Often caused by endometriosis.

Endometrial lesions within the ovary or uterine tubes will bleed, causing the blood to become trapped, forming small cysts that will grow over time. They are often small and do not cause problems, but if they grow large enough, they may impair fertility and are at risk for rupturing.

Question 92

What can cysts lead to, if grown large enough?

Answer 92

May interfere with ovulation, impacting fertility chances.

They may also lead to ovarian torsion or rupture, which can potentially leave scar tissue in the ovaries or fallopian tubes, further impairing fertility.

However, for many, ovarian cysts are not problematic, do not interfere with fertility, and may eventually go away on their own without assistance.

Question 93

Ovarian follicle shrinkage is particuarly common with what?

Answer 93

Menopause, as menopause is a naturally lowered estrogen state.

Therefore some doctors may just wait and see if the cyst grows larger and causes problems or goes away naturally.

Question 94

How are ovarian cysts often diagnosed?

Answer 94

Through ultrasound, MRIs, and potentially pelvic exams, especially if the cyst is large enough to be felt through the abdomen.

Although they are commonly associated with estrogen excess, they can also be associated with LUF. In that case, you’d want to focus on addressing follicle and cellular health.

LUF = luteinized unruptured follicle

Question 95

Symptoms of abnormal or enlarged ovarian cysts may include what?

Answer 95

Pelvic discomfort, pain, or cramping, especially on the side where the cyst has formed.

It may also result in bleeding or spotting outside of menstruation.

Rupture of a cyst can cause an excruciating sharp pain on the side of the ovarian cyst, as well as bleeding (either internally, or externally, mimicking a period), bloating, nausea, fever, and dizziness.

If you or they suspect rupture, it is imperative they visit an ER as this is an immediate and life-threatening condition that could lead to sepsis and potentially death if not handled in a timely manner.

Question 96

What are uterine fibroids?

Answer 96

Fibroids are benign, fibrous tumors found within and around the uterus. Blood and estrogen feed into these tumors, causing them to grow.

Question 97

What are the risk factors for developing fibroids?

Answer 97

• Vitamin D deficiency
• a family history of fibroids
• Early menarche
• And history of zero pregnancies

Question 98

What are Submucosal Fibroids?

Answer 98

They will protrude from the myometrium to the inside of the uterus

Question 99

What are Intramural Fibroids?

Answer 99

Grow within the myometrium

Question 100

What are Subserosal Fibroids?

Answer 100

Will protrude from the myometrium to the outside of the uterus.

Question 101

What are some symptoms of enlarged or problematic fibroids?

Answer 101

Pelvic pain, back pain, and frequent urination, as larger fibroids can protrude and compress the bladder and irritate other pelvic organs.

It is commonly thought that fibroids cause excessive menstrual bleeding, but this is not typically a symptom of fibroids unless they are submucosal and protruding into the uterine cavity

Question 102

What are the risks with a Myomectomy?

Answer 102

It’s less invasive than a hysterectomy, but can pose risk for other issues such as scar tissue build-up and infection at the surgical site which may cause risk for Sepsis

Question 103

What is a UFE (Uterine Fibroid Embolization)?

Answer 103

They will inject Polyvinyl Alcohol into the arteries to cut off the fibroid’s blood supply. This may work for smaller fibroids but may be ineffective for larger ones.

Question 104

What can help a client with support for fibroids?

Answer 104

Focusing on hormone balance and estrogen balance (specifically liver support for estrogen metabolism), and eliminating alcohol consumption is a really good place to start.

Some people have also been able to use proteolytic enzymes at high doses (around 300,000 iu) effectively to help break down the fibrous collagen matrix of the fibroids.

There has also been some research on an enzyme that a specific strain of bacteria produces, Collagenase Clostridium Histolyticum, being beneficial for helping to break down fibroids.

Furthermore, Castor Oil packs may also help to break down scar tissue, as well as vaginal steaming, when used appropriately.

Question 105

What is endometriosis?

Answer 105

This is a condition where tissue similar (but not identical) to endometrial tissue grows in areas outside of the uterus.

These lesions may grow on the uterine tubes, ovaries, bowels, and other abdominal tissues and, in some cases, they have even been found as far away as the nose, eyes, and brain.

Question 106

What is adenomyosis?

Answer 106

Where endometrial tissue grows within the uterine myometrium muscle.

It’s similar but different than endometriosis.

Question 107

Endometriotic lesions are known to act similarly to the WHAT?

Answer 107

The uterine lining

Question 108

BLANK are known to act similarly to the uterine lining, responding to hormones like estrogen and progesterone, and causing internal bleeding which can lead to severe pain, scar tissue, and adhesions within the abdominal cavity.

Answer 108

Endometriotic

Question 109

Why are symptoms of endometriosis associated with the bowel and bladder?

Answer 109

These adhesions can bind the reproductive organs to other organs within the pelvic cavity such as the bowel and bladder

Question 110

When BLANK is found on the ovaries it often presents as Endometriomas, or chocolate cysts.

Answer 110

endometriosis

Question 110

Why can endometriosis cause fertility complications?

Answer 110

The adhesions and scar tissue build-up can scar the uterine tubes or ovaries, which can either restrict a fertilized egg from traveling down the tubes and into the uterus properly (which in some cases may lead to an ectopic pregnancy), or it may inhibit the tube from being able to pick up the egg from the ovary entirely.

Endometriosis may also lead to pelvic anatomy distortion, due to the lesions pulling the uterus into a retroverted position. Depending upon the severity, this may or may not factor into fertility complications.

Question 111

Why can endometriosis also potentially hinder fertility in ways outside of structural damage?

Answer 111

Even if lesions are in places outside of the ovaries or uterine tubes, they can still produce inflammatory cytokines leading to inflammation and an altered immune response, which may impair the endometrial environment, making it unfavorable for embryonic implantation and development.

Question 112

Although there is no known cause of endometriosis, what is it linked to?

Answer 112

High levels of estrogen, inflammation, an abnormal immune response to endometriotic lesions, and of course, genetics.

What we know about the connection between endometriosis and excess estrogen is that it can exacerbate symptoms and contribute to lesion formation in those who are predisposed with the condition.

Question 113

It has been documented that endometriotic lesions have a high quantity of BLANK

Answer 113

Mast cells

Mast cells produce histamine, which can further increase estrogen levels. When estrogen is high within the system, this can contribute to more activity of the mast cells within the lesions, leading to higher histamine and estrogen levels, worsening one’s symptoms.

Question 114

Why do so many women with endometriosis experience other symptoms associated with an abnormal immune response such as seasonal or environmental allergies, SIBO, and bladder issues?

Answer 114

Endometriotic lesions have a high quantity of mast cells. Mast cells produce histamine, which can further increase estrogen levels.

When estrogen is high within the system, this can contribute to more activity of the mast cells within the lesions, leading to higher histamine and estrogen levels, worsening one’s symptoms.

Question 115

Endometriosis symptoms are also highly associated with BLANK, specifically gut BLANK, which makes sense as the gut is a primary area where excess histamine and estrogen are eliminated

Answer 115

inflammation

Question 115

70% of the immune system resides within the BLANK, so dysfunction and inflammation within the BLANK may exacerbate endometriosis symptoms. So what is important to help manage endometriosis naturally?

Answer 115

Gut; GI system

Digestive health

Question 116

Mineral imbalance can contribute to the severity of BLANK?

Answer 116

Endometriosis

Two mineral imbalances that are important to point out with estrogen excess related issues are the relation between Copper & Estrogen, and Iron & Estrogen.

Question 117

Two mineral imbalances that are important to point out with estrogen excess related issues are the relation between BLANK & Estrogen, and BLANK & Estrogen.

Answer 117

Copper; Iron

Question 118

Estrogen, when in excess, can increase BLANK levels through impairing its detoxification. In turn, excess BLANK caused by this cascade may feed further into estrogen excess by depleting zinc, magnesium, and b6, which are necessary cofactors for liver function & estrogen clearance.

Answer 118

Copper; copper

Question 119

For many women wit endometriosis, we may see higher levels of BLANK contributing to the increase of estrogen and symptoms thereof.

Answer 119

Copper

In addition, the higher prevalence of oxidative stress and inflammation that can be caused by copper excess may further exacerbate endometriosis symptoms.

Question 120

The higher prevalence of oxidative stress and inflammation that can be caused by copper excess may further exacerbate BLANK symptoms.

Answer 120

Endometriosis

Question 121

Iron overload can contribute to oxidative stress and BLANK proliferation

Answer 121

endometrial lesion

Question 122

What can lead to iron overload?

Answer 122

Estrogen has an inhibitory affect on hepcidin, a protein that regulates iron absorption and transportation.

When hepcidin is deficient, which may be triggered by excess estrogen, this can lead to iron overload

Question 123

Retrograde menstruation may be more common than we originally thought, yet only a small percentage of individuals actually develop BLANK from the occurrence

Answer 123

Endometriosis

Question 124

Endometriosis lesion formation may actually be due to an abnormal BLANK response, as in a healthily functioning BLANK, the body is able to clear endometrial fragments and lesion formation outside of the uterus. Whereas with endometriosis, the lesions evade the BLANK response and continue to form

Answer 124

immune; immune system; immune

Question 125

Why might endometriosis be commonly associated with autoimmune diseases, particularly TH2 dominant autoimmune diseases?

Answer 125

The theory is that if a woman is TH2 dominant, the immune system will dysfunction to the point where it doesn’t kill off abnormal cell growth leading to the formation of endometriotic lesions.

The cytokines that are present in TH2 dominant mediation may not have the same ability to clear endometrial fragments due to retrograde menstruation as those found in TH1. Further suggesting that endometriosis formation may be partially due to immune system dysfunction. In general, we want a balance of TH1 and TH2 activity. Dominance in either direction may negatively affect health, particularly in regard to autoimmunity

Question 126

How ie endometriosis diagnosed?

Answer 126

Through laparoscopic investigation, also known as a keyhole surgery. This is where a skilled excisionist makes small incisions to observe the abdominal cavity with a fiber-optic camera.

Question 127

When might an MRI be used to diagnose endometriosis?

Answer 127

An MRI can be used to see larger endometriosis lesions within the intestines, and a doctor may prescribe this as a diagnostic option if a patient demonstrates clear bowel-related symptoms such as pain and bleeding with bowel movements that get worse during menstruation.

Question 128

What is the downside of using an MRI to diagnose endometriosis?

Answer 128

An MRI can still miss smaller lesions.

Question 129

What is the downside to using an ultrasound to diagnose endometriosis?

Answer 129

It is unlikely that the average sonographer would be able to detect endometriosis via ultrasound, nonetheless rule it out entirely. This is primarily because endometriosis can be quite challenging to detect, and lesions aren’t often found within the common places that sonographers check when performing pelvic exams.

Question 130

What are the downsides to serum Cancer Antigen 125 for diagnosing endometriosis?

Answer 130

Seems that this test is better at ruling in endometriosis as a high possibility in symptomatic individuals, but may not be able to rule out the condition. In other terms, a negative CA125 test cannot be used to rule out endometriosis, but if one receives a positive and also demonstrates symptoms, it is likely they do indeed have endometriosis

Question 131

What is one of the most commonly utilized treatments for endometriosis?

Answer 131

Laparoscopic surgery, and if working with a skilled excisionist, diagnosis and removal can be performed at the same time, minimizing overall invasiveness.

Question 132

What is Peritoneal Endometriosis?

Answer 132

Considered a deep infiltrating endometriosis, similar to adenomyosis but in tissues outside of the uterus.

Question 132

Why are endometriomas so common to develop again post laparoscopy?

Answer 132

A minuscule amount of endometriosis tissue can be left behind on the ovary after the surgery.

In which case, if the ovary ovulates nearby the tissue, it can swell up again, causing irritation and the formation of a new chocolate cyst.

Question 133

What is thought to cause peritoneal endometriosis? And why might a laparscopy make the condition worse for some people?

Answer 133

The dysfunction of nerve endings interacting in an abnormal way with the endometrial tissue, rather than tissue itself.

Laparoscopy, can damage nerve endings within the abdominal cavity.

Question 134

What are some ways to dial in one’s natural symptom management for endometriosis?

Answer 134

• Omega 3 Fish Oil (EPA/DHA)
• Curcumin
• Quercetin
• Vitex
• Trauma Therapy
• Pelvis Physical Therapy

Question 135

What does Omega 3 Fish Oil help do?

Answer 135

When taken regularly throughout the entire menstrual cycle, omega 3’s from high-quality fish oil can help support inflammation balance by modulating prostaglandin levels.

Take precaution recommending fish oil to those who are taking blood thinners, or who experience menorrhagia.

Question 136

What does Curcumin help do?

Answer 136

Curcumin is the bioactive ingredient found in turmeric and has been researched heavily for supporting inflammation balance and pain.

Take precaution recommending curcumin to those who are taking blood thinners, or who experience menorrhagia.

Question 137

What does Quercetin do?

Answer 137

Quercetin is a bioflavonoid shown to help reduce the proliferation of endometriosis lesions.

Quercetin may help stabilize mast cells, inhibiting excessive histamine production which may contribute to excess estrogen.

Question 138

What does Vitex do?

Answer 138

In more mild cases of endometriosis, the stabilizing effects of vitex on the hypothalamus and pituitary may help promote healthy ovulation and progesterone production, which can oppose estrogen, counteracting its triggering effects on those with endometriosis.