With such high rates of fertility and inflammatory conditions associated with reproductive health, women’s health Dr. Andrea Huddleston is back talking with Dr. Damian Kristoff in this second part of our podcast series on the biomechanics of reproductive health covering the final of 5 ‘S’s’.
In part 1 of our series, Andrea shared the ways that spinal position and stress impacted women’s health and reproductive health. In this second instalment of the podcast series, Andrea shares her final 3 S’s, sugar, synthetic hormones and sleep and how they impact reproductive and hormonal health.
Both Damian and Andrea demonstrate the ways in which collaborative care and holistic practice are integral to the care for women experiencing hormonal or reproductive health challenges.
Covered in this episode
[00:38] Welcoming back Dr. Andrea Huddleston
[02:28] Recapping what was covered in part 1: stress and spinal problems
[06:04] Connections between the spine and overall health
[10:42] How sugar and diet affects hormones
[16:13] Two case studies on how hormones influence pain
[24:05] The impact of sleep on hormones
[29:37] Synthetic hormones and their longterm effects on women’s health
[35:26] Holistic care during menopause
[40:57] Thanking Andrea and closing remarks
- Part 1 of this podcast series covered the impact uterine and spinal position has on reproductive and women’s health and the impact of physical, chemical and emotional stress on hormonal health.
- Part 2 of the podcast series looks into the role of synthetic hormones, sleep and sugar have on reproductive and hormonal health.
- The innervation and position of the pelvis can be influenced by changes to the spine at both the cervical and lumbar ends. Trauma to the spine in any area can influence the function of the reproductive system.
- Sugar has the capacity to interrupt hormonal functioning and stimulate inflammation, which is a concern for inflammatory conditions including endometriosis and PCOS.
- There is a direct relationship between oestrogen, carbohydrate metabolism and blood glucose regulation.
- Increased sugar intake is associated with inflammation, gut microbiome and gut–mucosal barrier changes, triggering immune changes.
- Endometriosis and PCOS are immune-mediated inflammatory conditions exacerbated by hormonal imbalance.
- Pain can impact hormones levels which can in turn act as biomarkers for uncontrolled pain.
- Short term use of NSAIDs can influence a period of sex hormone suppression including testosterone.
- Sleep deficiency can impact ovulation, hormone production and increase atherosclerosis risk. Sleep deprivation can decrease beneficial bacteria, increase insulin resistance and inflammation.
- Sleep deprivation and sugar interact with the leptin receptors in the brain and influence satiety, sugar cravings and overeating.
- We know that the more natural cycles women are able to have reduces co-morbidities for the rest of their life.
- It can take up to 10 years for the endocrine and reproductive systems to balance pubertal hormones.
- The way a women experiences menstruation can influence her perimenopause and menopause experience.
- 75% of bone loss occurs in the 20 years from the onset of menopause due to the drop in oestrogen which is an important consideration for treatment if a woman experiences premature menopause.
Resources discussed in this episode
|Dr. Andrea Huddleston
|The Wellness Women
|Study: Intricate Connections between the Microbiota and Endometriosis (Jiang, et al., 2021)
Damian: This is FX Medicine, bringing you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Dr. Damian Kristof, a Melbourne-based chiropractor and naturopath and joining us today is Dr. Andrea Huddleston. This is part two of two in our series on the biomechanics of reproductive health.
Andrea is women's health, natural fertility expert and integrative chiropractor practising in Perth. She's the co-host of the award-winning top-rated podcast, Wellness Women Radio, and is affectionately referred to as "The Period Whisperer" by her patients. In addition to her chiropractic degrees, Dr. Andrea holds two postgraduate master's degrees in women's health medicine and reproductive medicine. She's an absolute leader in women's health. She's a sought-after presenter, an avid coffee addict, and a crazy dog lady. Andrea, it's so great to have you back.
Andrea: Oh, Damian, thanks so much. It's always so weird having someone introduce you.
Damian: Well, I imagine having that with Marcus Pearce every week. Like, it's crazy.
Andrea: I know. And I'm sure he embellishes on all of it each time for you, Damian.
Damian: Every time. Andrea, the last podcast that we did, it pretty much broke the internet. Everybody absolutely loved it.
Andrea: Oh, that's so lovely.
Damian: And such great feedback, and people going, "Tell us the other three S’s. You only got through two of the S’s." So thank you so much for joining me to go through all of that again.
Andrea: Damian, thanks so much for having me back. And I have to say that this is obviously part two of our recording, and for the first time in my podcasting history, I had to go back and listen to a podcast that I've done. That's the very first time that I've ever done that in the hundreds of shows that I've recorded. It's the very first time I've actually re-listened
Damian: That’s so good. Why don't we just do a quick recap and just go through what we covered very quickly in the first podcast, just in case people are listening to this one, part two of two, if they're listening to this one as the first one. So we covered off two of the five S’s to start with. Let's just recap those.
Andrea: Yeah. So, in a very simplistic way, and this is the way that I communicate with patients, which I think it's why it's relevant, that I break down hormonal imbalances and the causation of those into five categories. And I call it my five S’s of hormonal imbalances. And the ones that we covered were stress and also spinal problems.
So we looked at the different uterine positions relevant to the causation, from pelvic misalignments and different shifts in the pelvis, and the sacrum, and everything else. And we talked about the innovation to all of that and how that's relevant. And we talked about symptoms of anteverted versus retroverted uteruses, and coccyx issues, and trauma, and all of those sorts of things.
What else did we cover, Damian? We gently touched on the pain and hormones, and the interaction there. And we talked about...
Damian: I want to deep dive into that a little bit later on. I reckon we deep dive into that, because that's so important, pain and hormones, what's the relationship? And I know you've got some great stuff to talk about with that, so we'll go into that a little bit later on?
Andrea: Yeah. Sounds good. And we obviously talked a lot about stress, and how that influences our hormones, our whole hormonal picture, the menstrual cycle and everything else.
Damian: Yeah. And it's a really great thing just to consider stress because quite often we talk about stress just being an emotional thing, but from a chiropractic perspective, we talk about stress being from three different aspects. We talk about the physical stressors that we might actually encounter, which could be trauma, maybe the birth process, maybe even sitting or whatever else. We talk about the emotional component of stress, of course. And then, of course, there's the chemical component of stress, which we will be talking about. We'll be talking about synthetic hormones, we'll talk about sugar later on, which affects the way in which the brain communicates with the body and the way the body communicates with the brain.
So that model of afferent communication, so feedback to the brain, from the body to the brain, and an efferent communication that's feed forward communication from the brain to the body, is impacted from stress, whether it's physical stress, emotional stress, or chemical stress. And we want to make sure that everyone listening to this today gets at least a little bit of a grasp of where we're coming from from a chiropractic perspective, as well.
Andrea: Yeah. And I think that we really downplay the effects of stress for women, as well. We think about, say, emotional stress just as being some sort of big trauma like the loss of a loved one. But it can simply be just that constant chronic rushing around. The always trying to get the kids to school on time, and their hectic mornings, and then literally having five different full-time jobs because they've got kids and a job, and trying to be a wife, and friends, you know, the demands on women these days are greater than they've ever been, ever. So is it any wonder that our hormones and our whole hormonal picture and reproductive function is the worst it's ever been?
Damian: Yeah. There's no wonder in my mind, no way. And for the men listening to this, we're not discounting stress for men either. It's just that you don't have a uterus or ovaries. And so we're not talking about you today. This is all about the girls. So just keeping it real. Keep it real.
Andrea, some of the questions that came back from that particular podcast that we did revolved around, is there a relationship between the cervical spine and the lumbar spine, and the innervation to the pelvis as a result of that?
And my immediate answer is, yes, of course. Where there's dysfunction up high, there's dysfunction down low. And so, for me, that's a really important thing for us to consider and to talk about. Are you able to maybe elaborate a little bit on that connection between the cervical spine and the lumbar spine?
Andrea: Holy moly.
Damian: Or I can do it.
Andrea: Thanks, Damian. Look, the first things that come to mind when you say, is there a connection between the cervical and lumbar spine? And, of course, there is because everything within the body is connected, and particularly everything in the spinal column is connected. And even just dural tension patterns on one part of the system we know will twist and contort in that reciprocal area from top and bottom.
So, if you can imagine almost like twisting a towel and you see where those anchor or tension points is, it's kind of similar within that dural system that coats or covers that spinal cord. And there's that neurological, I guess, reciprocity between top and bottom. Does that, kind of, make sense?
Damian: Yeah, it does.
Andrea: Is that how you'd explain it, Damian?
Damian: So, when you were saying, I was like, "That's exactly how I explain it, Andrea." And what's really important to just bring that back one step is that the spinal cord is connected to the inside of the vertebra through the meninges. And the meninges have a degree of tension in them that's normal. So the normal tension that's in the meninges offers the spinal cord protection from the environment. So the cerebrospinal fluid that surrounds the spinal cord, as well as the brain, gives a padding, I suppose, or a gravity-less environment for the nervous system to be protected in.
And so, any kind of forward head posture, or trauma to the neck, or dysfunction in the thoracic spine, or accentuated lumbar curve, or any of those sorts of things that we see as chiropractors definitely can be related to what we're talking about with regards to the health of the reproductive system. And one of the things we like to say is “A healthy spine, a healthy body.” And this is where this comes from.
Andrea: Damian, I read a study a long time ago that was done in monkeys that showed that there was a bi-directional relationship between the sacral nerves and the hypothalamus. And, so I was trying to understand the correlation or the impact of physical stress on the body, say, trauma to the pelvis or trauma to the sacrum. And is there a direct follow-on effect to, say, the hypothalamic-pituitary-ovarian axis or something like that?
And obviously we know that the hypothalamus is the absolute control mechanism that then projects to the pituitary, and so on and so forth. And it did show that there was this, like I said, a bi-directional relationship directly with those sacral nerves and projecting directly to the hypothalamus. And I can't remember the exact neurophysiology that created that. But it spoke to that there is obviously potential there.
But also, I think what you've just described is why we always look at the whole person, and why we can't be reductionistic in our way of how we're looking at a person's health or looking at their physical body, or anything else. Because whatever's happening in their pelvis, in their uterus, we've got to look at the whole person rather than just one tiny, little component of it, because then we're missing the big picture.
Damian: Yes. I agree with you. And I think that's something that I hung on after listening to our podcast the other day together. It was just that reinforcement that this is a collaborative approach, using integrative approaches that not only include chiropractic and nutritional herbal medicine, and integrative medicine, and so on and so forth. We've really got to be mindful that we're dealing with a person here, not just a reproductive system. We're dealing with a human being, not just some dysfunctional ovaries or a uterus that doesn't want to behave itself. We've got a human here. So we've got to manage the health of the patient. And that would include assessment of the spine and nervous system as much as it would the health of the hormones.
Andrea: Yeah. Exactly.
Damian: All right. So that's a good little recap on where we got to with the first episode, the first two S’s. Let's move on to the third S, the third S being sugar. How is this related? What's sugar got to do with anything? I mean, it tastes good. What's it got to do with anything, Andrea?
Andrea: And I think that this is certainly not going to come as a surprise to practitioners because they're fully aware of these things, but I think it's really important for patients to understand how much of an influence their diet has on their whole hormonal picture, and even their stress levels, and their inflammation and everything else. And I think that the summary of this, the whole culmination of white sugar, or just processed carbohydrates, in general, are such a problem is because it disrupts our hormones because of how it stimulates that inflammatory cascade.
And if we look at two of the major conditions that are so problematic for women these days, like endometriosis or polycystic ovarian syndrome, those two conditions are already so inflammatory in nature. So if we can decrease the influx of that inflammation from, say, a dietary perspective, then surely that is going to be beneficial to them.
And isn't it interesting, Damian, that women who present with that classic picture of, say, oestrogen excess also have really disordered blood glucose levels? Like, I always think that it's not a coincidence at all. And there's always that Goldilocks effect for the right amounts of oestrogen, the right types of oestrogen, how our body's processing it, but there is...now, I could be going off on a bit of a tangent here. So if I am, just stop me. But there's certainly that persistent perception that oestrogen has this adverse effect on carbohydrate metabolism.
So, when our hormones are disrupted, we're already having changes to how we're going to be processing those sugars in the first place. But then what comes first, the chicken or the egg? Is it the fact that we were consuming too much of it in the first place? But we also know that short-term, super physiological oestrogen administration in, for example, oral contraceptive pills or hormone replacement therapy, or something like that has an adverse effect on glucose tolerance. So we get the suppression of that. Oh, sorry, Damian. Did I interrupt you?
Damian: No. I was loving this because it just sounds like a complete circle for me. So, at some point on the timeline, it's either you're eating too many carbs and it's affecting oestrogen, or it's your oestrogen, and that's affecting your glucose metabolism. But it's one or the other, so you've got to work out, I suppose, and it's up to the practitioner to work out, where's the fault here? Is it the fact that you're producing, or there's too much oestrogen, whether it be synthetic, and we'll talk about synthetic hormones shortly. Or is it endogenous, you're producing too much yourself? And is that because you're eating too much carbohydrate? Is your blood sugar dysfunctional because of the food and then affecting your hormones, or is it the other way around? That's up to us to work that out, isn't it?
Andrea: Yeah, exactly. And, like I said, it's like this Goldilocks effect. So if we have too much of, say, synthetic oestrogen, that's going to affect our glucose tolerance. But then we also know, and I think the only evidence I've seen is from animal studies, but I've seen this certainly with my patient population, as well, is after, like, an oophorectomy, they have less insulin stabilisation. So we see an increased risk of diabetes after that. And so what is that connection there? And sugar is obviously so pro-inflammatory, and we know that it disrupts and changes the gut microbiota, it alters that gut-mucosal barrier, which obviously triggers immune changes.
And then if we go back to, say, endometriosis, that's that immune-mediated inflammatory condition that, again, is exacerbated by those hormonal imbalances. So it's just adding fuel to the fire there. And then sugar encourages that neutrophil infiltration into the gut, increases our IL-6 and all of our pro-inflammatory markers, then it increases E. coli and the Candida species in the gut. And both of those are great at signalling inflammatory stuff, too.
And we've also seen that higher levels of E. coli in the uterine microbiome is associated with much more painful periods. There's a much stronger propensity for that in cases of things like endometriosis. So there's so many ways that sugar and excess carbohydrates, and processed sugars, and everything is entangled into hormonal disruption, but I think the summary of it is that because of how it stimulates that inflammatory cascade, it is just what disrupts that whole hormonal pathway.
Damian: So fascinating. And I know the naturopaths and the doctors who are already up to speed with a lot of this at the moment going, "Yeah, yeah, we get that. I get that," but I think the key thing here that we want to talk about and bring this back to is that this is a consideration, too, within the manual therapy space where we operate. And so we are also considerate of this, and this is where we all start to work together. This is this dovetailing of professions to get this right, to get our patients' care right.
But what is really interesting about this is that inflammation occurs in the body, and it may or may not cause pain. But you spoke about something earlier on, and also in the last podcast, where you mentioned that pain can also impact hormones. And so I just wonder whether or not it's worth us talking right now about the influence of pain over appropriate regulation of hormones in a female's body.
Andrea: Damian, this whole connection between pain and hormones is so interesting. And it's what's actually made me interested in pain in the first place. But I think I said previously, is that there's this line that adequate pain control cannot be achieved without hormonal homeostasis. And our hormone levels can serve as biomarkers of uncontrolled pain.
And I know previously we talked about, say, cortisol and chronic stress, and how when a patient is in chronic pain, and, say, they've got chronic pelvic pain, their hormone levels match that of a really chronic, stressful state. And depending on, say, the patient's presentation, whether or not it's a woman with all of this oestrogen excess, they're going to be someone who has a completely different influence on their pain processing. They're going to have completely different immune modulation of that. They're going to have a high incidence of autoimmune diseases and all sorts of other things because of the way their body is perceiving that. And it's the same for men and their testosterone levels, too, and I think we briefly touched on that before.
And maybe I'll tell you a case study from one of my patients that will help to bring this all together.
Damian: Please do that. Everyone's going to want to hear about it. Like, this is the real world data that people want to hear about.
Andrea: So, let me tell you. I've got a male and a female scenario here. So, one of my patients, Aaron. He's given me permission to talk about this. He is a fireman. He's a 40-year-old guy with congenital adrenal hyperplasia, and he's the only patient I've ever seen with this condition. It is, you know, it is fairly rare. So his body doesn't make cortisol. And obviously this is the one and only hormone that our body cannot live without.
And when I first saw him, he was in...he's been on a lifetime of corticosteroids because of the fact that obviously his system doesn't actually produce cortisol for itself. But he is this very highly strong, very stressed, but in a huge amount of pain as well. And he had an injury at work where he got an L5-S1 disc herniation, and he had just irretractable pain. There was nothing that would touch the sides of that.
And he obviously had to have surgery for that, and then after the surgery, he completely crashed because he went adrenal crisis, because there was just too much stress on his system for him to handle, and they couldn't touch the edges of that pain. And when you look at his whole hormone picture, he's got little to no testosterone, really low DHEA, and it's just interesting that his lifetime use of corticosteroids is influencing all of that.
So it's not just the stress on his system, it's the fact that he's obviously had to be on steroids for such a long time. But we also see that intermittently, in short term, with patients taking things like non-steroidal anti-inflammatories, we know that there's a refractory period of hormonal and sex hormonal suppression when they do that, which really worries me particularly with men if they're taking, like, ibuprofen and all those sorts of things. It's actually suppressing their testosterone function. And when Aaron started actually using testosterone and DHEA therapeutically, his pain completely changed. He was able to actually get on top of it. Now, this is not to say that that is the solution for patients who are in pain, but for him, that was the missing link for him and obviously working on all of the other stress reduction techniques. But those two things were what actually addressed that.
And then, if we look on the other side of the spectrum, I had a patient who was a nurse. She was 44. She had huge fibroids, like this really big, bulky uterus that resembled a woman who was 25 weeks pregnant. She had severe dysmenorrhoea, severe menorrhagia, and just chronic, chronic pelvic pain. She'd had a lifetime of trauma as well, and then all the other yellow flags that are associated with that. And they're wanting to put her on multiple medications, we were trying to avoid her having hysterectomy and everything else. But her chronic pain was just so debilitating. And she had all of the classic picture of that oestrogen excess.
And when we actually tested it, her estradiol was over 4,000, and at its absolute peak when you're ovulating, we would look at that, maybe about 1,300. So it's, like, four times what that should be. And she didn't have the capacity to be metabolising that properly. So no wonder that she was just so incredibly inflamed. She was in so much pain all the time. So I think that those are just two classic pictures on each end of the spectrum of that oestrogen excess or that really low testosterone function, as well, and how that is presenting in those patients with chronic pain.
Damian: That's so unbelievable. And so, then, like, from a management perspective of that, there's a chiropractic component of that. There's a nutrition component to that. I would think that you're not using those interventions exclusively, like, you're not going, "Oh, let's just do nutrition here," or, "Let's just do chiro here," or, "Let's just do some herbal medicine here." You’re involving all of that?
Andrea: Yeah, exactly. And I think that there's, like, a beautiful marriage there between manual therapies, between herbal medicine and nutraceuticals and everything else because there has to be a change in diet, lifestyle, stress. There has to be a change in the way that body perceives stress, as well. And I think that that's something that we do really well as chiropractors, or physiotherapists, or osteopaths. Whatever it is is just changing the way that that body maps and perceives that pain.
So, for the nurse, for example, she always associated her pelvic region with just severe pain. So she would be cringing before you would even try and palpate her abdominal area. She's expecting it to be painful. So you can imagine that association in her brain with that. So changing the way her brain is mapping that area to be of safety, it's going to make a really big difference for her. And the same with Aaron the fireman, everything we had to do with him had to be about him experiencing safety within his body. And that's obviously something that we're working on, is changing the way the body perceives stress.
Damian: Oh, my goodness. That is a rabbit hole we could definitely go down. There's a whole day's worth of seminar in that one I reckon. But we haven't got all that time. So, Andrea, I love that and thanks for sharing those two case studies with us. I think that that's a great eye opener for everybody listening to this podcast as to how involved this can be and how important it is to be involving other practitioners in the care of these patients.
Andrea: And this is probably a pretty easy one that we can go over, but I always like to call sleep a force amplifier. So if you're sleep deprived, life is pretty hell. And you ask any new mother on how difficult it is to tolerate that, whereas if you get a good night's sleep, you can take on the world.
Sleep is when our hormones are made. It's when most women ovulate, is during the night. It's overnight, when we sleep. We know that sleep deprivation increases our risk of so many things like...well, pretty much everything, but including atherosclerosis. It increases our time to conceive. It affects how we make our hormones. If we're not sleeping, we're not making human growth hormone, we're not doing all of those, that healing and repair that we need to be doing. We know that melatonin is one of the most important hormones involved in egg quality. So hence if we're too stressed to be making melatonin, to be getting good night's sleep, then we're going to have pretty crappy eggs, too. So that's obviously going to affect our fertility potential.
Damian: That's a big deal.
Andrea: And it shows that just two nights of partial sleep deprivation has been shown to decrease our beneficial bacteria, increases insulin resistance, so hence inflammation again, and it affects that hormonal balance. So, is it any wonder that mothers with young kids who maybe haven't recovered completely their sleep cycles from maybe first bub, and now have their second bub, and they haven't had a good night's sleep in maybe five years, is it any wonder that they are then presenting with, all of a sudden, and almost in epidemic proportions, hypothyroidism or thyroid problems? Because that's in the way that I view the whole endocrinology of a patient, that's one of the last stepping stones of that hormonal dysfunction. So it's no wonder. So sleep is not just for rest and relaxation. Our whole body repairs and restores itself, including our hormones.
Damian: Yeah, totally. There's a whole lot to be done with regards to sleep, and I know there's other podcasts within the FX Medicine series that have covered sleep. And I think maybe Adrian might have done a podcast on sleep. I might be wrong there, but maybe just go back and listen to all of the other podcasts on FX Medicine just to make sure that Adrian has or hasn't done one. But I think he has. But I wanted to talk about that...
Andrea: Just in case. Yeah.
Damian: Yeah. Just in case. Listen to them all.
But what I was thinking about that when you were just mentioning that is the importance of sleeping in circadian cycles, in a circadian rhythm. So, a lot of people go, “You’ve got to get your eight hours' worth of sleep." Well, you've got to get, you know, I don't know, I don't know, 12 would work. Eleven hours' worth of sleep, or whatever it's got to be. People have this rudimentary number, that's, sort of, eight hours out there.
But if you think about and you consider a sleep cycle being 90 minutes, you know, 45 minutes in, 45 minutes out ideally. When you do the maths on that, eight hours just doesn't work. It's six hours, seven and a half hours, or nine hours. They're the kind of cycles of sleep that you want to be doing.
Because if you're breaking your sleep, that, of course, initiates the stress response, as well, which is one of the things I talk about in that Crack Your Stress Code talk, Andrea, that I do. And it dovetails beautifully into what you're talking about here with regards to hormone regulation, and melatonin, and how important melatonin is. I suppose just as a quick summary, sleep's really important, and you need the right amount of sleep at the end of the day, don't you? Isn't that right?
Andrea: And I just find it so fascinating how I think a lack of sleep or that chronic sleep deprivation just predisposes you to everything. So, we know a couple of the things that mess with our leptin receptors in our brain, that obviously block that satiation response, and the two main things there are sleep deprivation and sugar.
So, when we're chronically sleep deprived, and I'm sure everybody has experienced this at one point, you can literally stand in front of the fridge and eat all day long, and not feel full. And it's just because you're sleep deprived. And it's just interfering and messing with all of your leptin production or receptors in your brain and everything else.
And then you're craving sugar, you're craving those things that's going to give you that quick energy fix, which is going to further exacerbate that problem. So everything is entangled there. And I think that getting sleep right for a patient, if you can't get that right, I just find that nothing is going to change, which, Damian, is one of the things that I really love about the work that we do, as well, because what is one of the most common things that we hear from our patients initially when they start care is that they're sleeping so much better.
Damian: Yeah. Totally. And this comes back to that sympathetic dominant state where people are so tired and wired that they can't get to sleep. But from a chiropractic perspective, the impact on the sympathetic nervous system is just so profound, in calming the sympathetic nervous system. So I love that, and it's a really nice...that's a dovetail.
Again, another reason why working with your chiropractor, and in collaboration from a nutritional perspective, naturopathic perspective, integrative medicine perspective, osteopathic perspective, we all have our own little strings and bows. But there's some really nice things that we can do to work together, which is really important.
Damian: Andrea, there’s an epidemic of overuse of synthetic hormones. I'm hearing, and I met with a girl the other day who's struggling with her health and well-being and at the age of 13, she was put on the contraceptive pill. And now she's 26 years old, she’s never actually had a proper cycle. She's sometimes never ever taken the sugar pills because she just didn't want to have a bleed, and so she's just continually taking synthetic hormones.
And for me, that is the height of...it's poor management, I have to say. Like, it's almost mismanagement. I would say you'd have to go as far as saying that the people who prescribe these drugs haven't managed these patients properly. And so now, 13 years down the track, their whole life doubled on these pills, on this hormone replacement therapy, causing problems. What are you noticing, and being the fifth S, how do synthetic hormones impact the work that we're doing?
Andrea: Damian, I always get so sad and frustrated for that picture that you just talked about, and I hear that so often. It's that classic clinical picture that we see. I might be working with a woman in her late 30s desperately trying to conceive. And it's normally the things that she may have done in her teen years and 20s that are affecting her reproductive capacity at that stage.
And when you go through that hormonal health history or that reproductive history, and she tells you that she was put on the pill when she was 13 or 15, but she only really had 1 menstrual cycle before that happened, it's so frustrating because, you're right, I do think it's completely mismanaged because they've not allowed that hypothalamic-pituitary-ovarian axis to mature at all.
It takes almost 10 years for our system to become sensitive enough to the huge influx of hormones that happens at puberty. So it can be 10 years for those little cellular receptors to be able to figure out what to do with all of those different hormones, to figure out how to metabolise things properly and everything else, and then for our brain to know what to do with them, as well. And then when we're adding in oral contraceptives, which is sometimes 10 times stronger than what our own body makes, so those absolutely super physiological levels of, say, synthetic oestrogens, you can imagine the changes that that initiates for the body and how it completely suppresses or takes their own ovarian function offline.
And sometimes it's irreversible. Like, I've seen women with that hypothalamic amenorrhoea and that primary amenorrhoea because of the fact they haven't actually been allowed to initiate puberty properly without the influx of those hormones. And it's completely devastating to their system.
And we also know that oral contraceptives during those teen years dramatically impacts mental health and increases their risk of depression and anxiety for life, and even after they've stopped the oral contraceptive pills or hormonal contraceptives. So it increases their risk of mental health issues for life. It also increases the risk of having deep infiltrative endometriosis.
These things can be bubbling below the surface, but there's that Band-Aid that's been put over it so they're not necessarily feeling or noticing those signs and symptoms that are giving them the warning signs that their reproductive system has gone a little bit haywire. And then, all of a sudden, women come off the pill and their system is going completely berserk, and it's because of how disrupted all of their hormones are. That's my little soapbox for the moment.
Damian: I'm loving it.
Andrea: But it's devastating.
Damian: It is devastating.
Andrea: We know that the more natural cycles women are able to have, there's a direct correlation with that, and essentially a reduction in co-morbidities for the rest of their life. So we know that having healthy, normal menstrual cycles for as long as possible is the healthiest thing that a woman can do for her body to stay healthy and well for a really long time. And that's obviously not a surprise to us, but being on the pill or hormonal contraceptives definitely does not create that same state.
And my biggest issue with it is that now it's being used as the wonder drug for absolutely everything else that it was originally designed for. The pill came out in the 1950s as part of our, like, the female reproductive revolution, which was great, but now we're seeing all the dark side of it, and how it has such a devastating effect on pretty much all areas of the body. What else do you want to go into there, Damian, in regards to those hormones?
Damian: There's so much we could get into there.
Andrea: I know.
Damian: There's so much. But obviously that's a huge consideration, I think, that every single person listening to this podcast to be aware of that. And it's really nice just to tie in S for synthetic in this space because these are all considerations that we all must think about with regards to all female reproductive health issues.
But one of the things that we...not that we're neglecting or we're not speaking much about, is the other end of the female reproductive age being menopause. And, so I'd love to just talk about that just briefly over the next five or so minutes, I suppose, Andrea, just as we come to the close of this podcast because it's so important.
Yes, all good things come to an end, and menopause is the end of the reproductive term for a woman. It signals that. But so many things actually happen at that point in time. From a chiropractic perspective, we consider it of bone mass, of course, but what else is going on with menopause that we need to be aware of from a chiropractic perspective that we can dovetail into the care that we're all providing?
Andrea: I think that to really take care of women from a holistic perspective as a chiropractor, or a naturopath, or whatever sort of practitioner that you are, really understanding menopause properly, and how it affects obviously the female system, and how everything changes so dramatically is really critical to honouring that system. And knowing that you've got about 400 hints to get it right in menopause.
So the way a woman, I guess, does her menstrual cycle, and how balanced that is is going to give you some really good hints as to what menopause or perimenopause is going to be like for them. So they may go through that perimenopausal hell that I'm sure all women and practitioners are well and truly aware of, that hormonal transition is just as fluctuating as, say, puberty. It's such an immense time of hormonal chaos.
And then when we get to menopause, we haven't necessarily taken care of ourselves or tried to look after ourselves well enough, and got our stress and everything else under control, then menopause is obviously going to be hell. And our risk factors and co-morbidities in that other half of our life, they're just going to be so much higher.
And if we're looking at, say, structural considerations, I think it's really important to remember that obviously there's a change in our hormones when we get to menopause. And it's not that the ovaries give up the ghost and they've just stopped working. They're just, their function changes, and obviously the adrenal glands take over the production of all of our reproductive hormones from that point. So we've got to make sure that we're helping women to really nurture their adrenals when they're in menopause so that we've still got hormonal balance, because we're designed for hormonal balance through the entirety of our life. We're not necessarily designed for hormonal chaos.
And so, when we're in menopause, obviously there's going to be a reduction in oestrogen production. That's natural, that's healthy, that's what's supposed to happen. But inevitably with that, bone loss does occur, and that loss of oestrogen is a major factor affecting osteoporosis for menopausal or postmenopausal women. And there's a 75% bone loss that occurs in about 20 years from the onset of menopause.
Andrea: So, how critical is that for us to actually know and understand? And that's not necessarily age-related. So, if a woman goes through early menopause or has that premature ovarian dysfunction or failure, and she goes through menopause in her 30s, by the time she's 50, she's already had 75% bone loss. So that's pretty important to make sure that we're picking up on any of those signs and symptoms early, and that is because obviously of the declining oestrogen and testosterone.
But that vertebral bone mass significantly decreases in perimenopausal women. So not just in menopause, but in perimenopause. And in the instance of, say, a lumbar scoliosis, it increases significantly in the postmenopausal years, and that is independent of bone density or osteoporosis. So say a woman…
Damian: All right. Sort of, more, from a ligamentous tension and... Is that what you said? Yeah, right.
Andrea: Yeah. And just because of that, the fact that it's actually because of the biomechanics. And that lumbar scoliosis, because it's independent of osteoporosis, it's direct result of, I guess, poor spinal biomechanics. So, how critical is actually what we do for prevention of that? Because it's not just inevitable that our bone mineral density changes, but that scoliosis will increase dramatically within that time if it's not properly taken care of.
But then there's also the follow-on effect from that. We know that we see a high incidence of prolapses in the bladder. Especially if a woman's had a hysterectomy, we can see bladder weakness, all sorts of things like that, but there is really that direct influence of the balance of oestrogen on musculoskeletal function, bone strength, bone mineral density, tendons, ligamentous structures, collagen production, connective tissue.
Damian: So much.
Andrea: It's very, very far-reaching, and we really need to understand that and be able to look for those signs and symptoms in those perimenopausal and menopausal women. And there were hints from their cycling years as to what that is going to be like.
Damian: Far out. I tell you what, everyone listening to this podcast, better be rewinding because there's so much gold in this, Andrea. And I just want to thank you again for joining us for part two of two in this FX Medicine series, particularly related to our role as chiropractors and manual therapists in the care of the female patients. So thank you, Andrea, for joining us today. It's been mind-blowing, enlightening, and so entertaining and educational. So thank you, Andrea.
Andrea: Damian, thanks so much for having me. Thanks again.
Damian: Thank you. Now, to get more information on Andrea, go to andrea...oh, I beg your pardon, drandrea.com.au. You can go to andrea.com.au, but I don't think you'll get anywhere. Go to drandrea.com.au. You can find her on Facebook as The Period Whisperer, or you can go to thewellnesswomen.com.au and you can listen to all of her other podcasts, which will fill your bucket, too. There's incredible information in that.
Now, thanks, everybody, for listening today. Don't forget that you can find all of the show notes, transcripts, and other resources on the FX Medicine website. I'm Dr. Damian Kristof. Thanks for joining us.
About Dr. Andrea Huddleson
Dr Andrea Huddleston is a women’s health, natural fertility expert and integrative chiropractor practising in Perth. She is the co-host of the award winning, top-rated podcast Wellness Women Radio and is affectionately referred to as ‘the period whisperer’ by her patients! In addition to her chiropractic degrees, Dr Andrea holds two post graduate, masters degrees in Women’s health medicine and reproductive medicine.
She is a leader in women’s health, sought after presenter, avid coffee addict and crazy dog lady!
Instagram: @drandrea.xo | Facebook.com/theperiodwhisperer