Women’s Health Update

by Tori Hudson, ND

Women’s Health Treatment Protocols That

I Count on

The following treatment plans are sample plans in my common approaches to these problems in women’s health. Each individual woman’s case has individual nuances, including past and current history, current medications, family history, stressors, lifestyle habits, and risk for future health problems that additionally guide the plan to include either more considerations or perhaps even simpler approaches than are listed below.

In addition, I chose to include proprietary product names for this column, due to trying to offer the most instructive approach. My disclosures are listed below:

Scientific advisory boards: Integrative Therapeutics, Nordic Naturals, Gaia Professional Solutions, Natural Health International, Nutritional Fundamentals for Health, Pharmaca Integrative Pharmacies; co-owner, Vitanica.

Endometriosis

Treatment plan addresses multiple mechanisms with documentation of being involved in etiology and/or progression of endometriosis:

• abnormalities in both cell-mediated and humoral components

• increased cytokine production

• decreased phagocytic activity

• increased protein called endo I (similar to haptoglobin)

• increased interleukin 6

• decrease NK cells

• compromised immune surveillance

• peritoneal fluid: high concentrations of cytokines, growth factors, and angiogenic factors

• once endometriosis lesions: secretion of pro-inflammatory molecules, lipid peroxidation

• oxidants are proposed to stimulate endometrial cell growth

• estrogen receptor issues

Comprehensive Sample Plan

• Diet: Increase omega-3; decrease omega 6 (low saturated fats diet); soy isoflavones most days; reduce inflammatory foods

• Curcuminoids; e.g., 750 mg of BCM-95 Curcumin, yielding a minimum of 500 mg curcuminoids per capsule; 1 capsule twice daily

• Pine bark; e.g., Pycnogenol 100 mg daily

• N-acetylcysteine 600 mg 3 times daily

• Melatonin 10 mg before bed daily

• Antioxidant combination product (e.g., Antioxidant Formula; Pure Encapsulations)

Per 1 capsule:

Vitamin A (as beta carotene) 10,000 IU (200% DV)
Vitamin E 100 IU (333% DV; as D-alpha-tocopherol succinate)
Riboflavin (B2) 25 mg (1471%DV)
Zinc (picolinate) 5 mg (33%DV)
Selenium (selenomethionine) 100 mcg (143% DV)
N-acetyl-l-cysteine (NAC) 100 mg
Milk thistle (Silybum marianum) extract (seed) 100 mg (standardized to contain 80% silymarin)
Mixed carotenoids 300 mcg (as alpha-carotene, zeaxanthin, cryptoxanthin, and lutein)
Ascorbyl palmitate (fat-soluble vitamin C) 100 mg

Dose 2 capsules twice daily

• Concentrated fish oils with higher with specific doses of EPA/DHA

E.g., EPA/DHA = approximately EPA 1200 mg/DHA 900 mg

• Consider: Oral micronized progesterone 200 mg before bed, days 15–26 in those with a regular monthly menstrual cycle

• Address acute pain issues as needed

Acute Dysmenorrhea

Sample Plan

• Ginger capsules 250 mg 4 times daily starting 2 days prior to menses and continuing for first 3 days of menses

• Niacin 100 mg every 2–3 hours

  • Consider/ A combination herbal/nutrient product Cramp Bark Extra (Vitanica); 2 capsules every 3 hours during pain days (contains magnesium, calcium, B6, niacin, E, C, valerian, black cohosh, ginger, rutin)

  • Valerian capsules

  • Fenugreek 900 mg 3 times daily for first 3 days of menses

  • Cinnamon 420 mg capsules; 2 capsules 3 times daily at onset of menses

Vulvovaginal Candidiasis

Sample Plans

Acute: Compounded boric acid capsule/suppositories: 600 mg twice daily for 3–10 days

Chronic:

• Boric acid capsule/suppositories: 600 mg twice daily for 1 month, then once daily during menses only, for 4 consecutive months

• Combination probiotic formulation specific for urogenital colonization:

e.g., Fem Ecology (L. rhamnosus, L. reuteri, L. salivarius, L. plantarum, L. acidophilus); total 10 billion: 1 capsule daily for 4–6 months to assure colonization

Atrophic Vulva/Vagina

Sample plan

• If vaginal symptoms only: compounded estriol 2 mg/g cream – insert 1/2 g nightly for 2 weeks then twice weekly maintenance

• If vulvar symptoms only: Compounded estriol 2 mg/g cream- apply ½ gram nightly for 2 weeks then twice weekly maintenance

• If both vulvovaginal symptoms, then compounded estriol 2 mg/g: insert ½ g and apply ½ g nightly for 2 weeks, then twice weekly maintenance

Urinary tract infections

Sample Plan

Acute

• e.g. CranStat Extra (Vitanica): 2 capsules every 2 hours for the first 2 days, then 2 capsules 3 times daily for 1 week

Chronic

• CranStat Extra (Vitanica): 2 capsules daily

• Mannose: 1–2 g daily

• Fem Ecology (Vitanica), urogenital specific probiotic combination: 1 capsule daily

• If postpartum, perimenopausal, or postmenopausal: add vaginal estrogen twice weekly; compounded estriol 2 mg/g – insert ½ g twice weekly

Bacterial Vaginosis

Sample plan

Acute: V-Fresh Suppository (special vitamin C preparation with homeopathics; Vitanica); insert daily for 6 days; wait 1 week and repeat

Consider: vaginal prescription metronidazole gel .75 %; insert 1 applicator twice daily for 10 days

Chronic:

• Metronidazole gel 75 %; insert 1 applicator twice daily for 10 days then once per week for 6 months.

• Oral Fem Ecology (L. acidophilus, L. rhamnosus, L. reuteri, L. plantarum, L. acidophilus, L. salivarius) 10 billion per capsule; take 1 capsule daily for 4 months and insert once weekly for 6 months during the 6 months of once weekly metronidazole gel

• Avoid vaginal exposure to semen (to facilitate vaginal pH becoming acidic) and optimal to avoid oral sex for 6 months (to avoid mixing oral flora with vulvovaginal flora)

• Consider role of vitamin D deficiency, high starchy carb diet

• Consider using biofilm disruptors

Perimenopause/Menopause Hot Flashes/Night

Sweats

Mild:

1. Black cohosh standardized extract 40 mg/day or

2. Femenessence (Natural Health International): Macalife 2 capsules twice daily for perimenopause or Macapause 1 capsule twice daily for postmenopause

3. Women’s Phase II (Vitanica; wild yam, burdock root, dong quai, licorice root, motherwort): 3 capsules twice daily or

4. Pycnogenol: 100 mg daily or

5. Estrovera (Metagenics; Siberian rhubarb): 1 tablet daily

6. Grapeseed extract 200 mg per day

Moderate to Severe:

One or two of the above, likely two.

Consider estrogen/progesterone combination; dose and delivery widely variable.

1. Average oral dose: estradiol 1 mg daily + oral micronized progesterone 100 mg daily in women with uterus

2. Average transdermal estrogen patch dose: 0.05 mg Vivelle-Dot generic – apply 1 patch every 3.5 days + oral micronized progesterone 100 mg nightly before bed in women with uterus

Premenstrual Syndrome

Sample Plan

Combination product (Women’s Phase I

;

Vitanica: B6, calcium, chromium, kelp, chaste tree, St. John’s wort, ginkgo, borage seed oil extract, vitamin E, magnesium, passion flower, dong quai, wild yam, dandelion leaf): 2 capsules twice daily throughout whole cycle

If premenstrual dysphoric disorder: use the above plus add Travacor (Neuroscience)

ASCUS

HPV High Risk Positive

Sample Plan for 6–12 months:

Indole-3-carbinol 200 mg/day (e.g., Indolplex; Integrative Therapeutics)

Coriolus versicolor 1500 mg twice daily (e.g., hot water extract from Nutritional Fundamentals for Health)

Folic acid 10 mg/day (L-methylfolate in select cases)

Oral green tea 1 capsule daily or 3 cups daily

4 months of the 6–12 months:

Green tea suppositories 150 mg of 15% extract compounded from compounding pharmacy only; insert twice daily

Consider: curcumin 150 mg suppositories in HPV 16, 18 cases (refer to published research study in women for dose and regimen)

Dr. Tori Hudson graduated from the National College of Naturopathic Medicine (NCNM) in 1984 and has served the college in many capacities over the last 28 years. She is currently a clinical professor at NCNM and Bastyr University; has been in practice for over 30 years; and is the medical director of the clinic A Woman’s Time in Portland, Oregon, and director of research and development for Vitanica, a supplement company for women. She is also a nationally recognized author, speaker, educator, researcher, and clinician.