Women are more likely than men to seek out health care both for themselves and their children. However, women often have reproductive health concerns that present their own unique set of challenges. According to one group of researchers, “Menopause, premenstrual syndrome, dysmenorrhea [menstrual cramps], female fertility, and mastalgia [breast pain] are common problems not easily treated by conventional medicine. Women often seek alternative therapies to help address these conditions.”¹ Getting to the root cause is essential, because for every action within the biochemistry there is an equal and sometimes greater ripple effect.

In this article, we will address common female health concerns and approaches that functional medicine providers can use to eradicate or improve women’s health issues. While reading this article, it is important to recognize that it takes a while to change the ecology and microecology of the body to the point where efforts lead to significant improvement in women’s health.

Female Health Starts with Cellular Support

Treating the entire human organism is so vitally important. This fact is sometimes put by the wayside in a world that is driven by ICD-10 coding and reductionism. Continuing to notice how all the insurance codable boxes can be connected allows the functional medicine provider to not be limited by merely one or two boxes, rather to exist outside of “in-the-box thinking.” This is why we want to start our discussion of women’s health with cellular health.

The human body—whether female or male—is constantly providing us clues as to the proverbial state of the union of the trillions of cells that comprise each and every one of us. This is true of both women and men, but we must start the healing journey in our female patients by paying attention to cellular health. Functional medicine clinicians are able to use the expected lifespan of cell types to determine nutritional status and whether a given patient falls within a healthy reference range. For example, the lifespan of a red blood cell (RBC) provides us a glimpse of the last 90-120 days of iron, folate, and B12 status based on total RBC count, hemoglobin, and mean corpuscular volume. In turn we often use RBC nutrient status of magnesium, zinc, etc. to help us ascertain intracellular nutrient status.

Cells take time to turnover and cellular turnover can vary greatly depending upon where they are located. For example, the stomach lining is continually broken down by digestive acid and must be replaced every few days. Conversely, cells in the bones can take years to turn over. In some areas of the body, such as the brain, many cells can stick around from the time of a person’s birth to late in life. We can expect that, depending on the lifespan of cells, it will take at least that long to start to see substantive results. On a woman’s wellness journey, it takes a while to get lost, but it takes at least that long to get unlost. The table below indicates the lifespan of certain cells. If a woman is not given the tools necessary for these cells to be replaced, the result is damage to overall health.

Lifespan of Select Cells²

Cellular Health and the Skin

Female patients are particularly concerned about how their skin looks, and female concerns are sometimes associated with skin problems, such as the connection between dysmenorrhea (painful periods) and acne (more on this later). The skin is the body’s largest organ covering a surface area of 1.5 to 2 square meters. It weighs between 7.5 to 22 pounds, comprising approximately one-seventh of a body’s weight. Yet, it’s a mere few millimeters thick at its thickest point.

Because the skin is exposed to the world, skin cells must be regenerated frequently. If you cut or injure your skin, skin cells divide and multiply to replenish any lost skin. Skin cells also die and are replaced even if your skin isn’t damaged. Each minute, a person sheds 30,000 to 40,000 skin cells, which amounts to about 50 million cells daily.

Whether a woman’s skin has a radiant glow or looks drawn and ashen can tell a functional medicine provider a lot about the woman’s health. The condition of the skin can reflect nutritional status, toxicology, and overall health. Therefore, for a woman to have healthy skin, it is best to address any nutrient deficiencies, detoxify the body, and go after any female-specific or overall health problems. Evening primrose oil is one supplement of interest to women concerned about their skin health. In one study, 500 mg EPO capsules twice per day for 12 weeks, significantly improved transepidermal water loss, skin firmness, elasticity, and roughness.³

Dysmenorrhea

Primary dysmenorrhea (i.e. menstrual cramps) is characterized by a lower abdominal pain that occurs during the menstrual cycle and is not correlated with any other disease or pathology. The word “dysmenorrhea” is derived from the Greek term for “painful monthly bleeding.” It is one of the most common gynecological issues among all women independent of age or race. It’s estimated that between 16% to 91% of women of reproductive age have dysmenorrhea, with 2% to 29% of those women suffering from severe pain.⁴ One study found 79.7% of female adolescents have dysmenorrhea and of those about 38% suffer from a severe form of the condition.⁵

Risk factors for primary dysmenorrhea may include the following⁶:

• Age, although as noted above it can happen at any age during the reproductive years.
• Smoking
• Being on a diet
• Higher body mass index
• Depression or anxiety
• Having a first period at an earlier age
• Never having given birth to a child
• Longer and heavier menstrual flow
• Family history of dysmenorrhea
• Disruption of social networks

In addition to abdominal pain, symptoms of dysmenorrhea can include nausea, bloating, diarrhea or constipation (or both), along with vomiting and indigestion, as well as irritability, headache, and low back pain. Some women with dysmenorrhea also report tiredness and dizziness. Dysmenorrhea can prevent women from attending work, school, or social events.

Dysmenorrhea is linked to significant impacts on emotional and psychological health as well as the ability to function effectively. In addition, there is a relationship between having a history of dysmenorrhea and developing hypertensive disorders during pregnancy.⁷ Because adult acne in women can often flare up during the premenstrual period due to cyclic alterations in hormones, it is often accompanied by menstrual abnormalities such as dysmenorrhea.⁸

Dysmenorrhea also is associated with increased levels of oxidative stress that results from the emotional stress a woman undergoes while experiencing painful periods.⁹ To protect against excessive oxidative stress, a woman’s body produces more of a substance known as adrenomedullin (AM) during menstruation, which in turn boosts production of nitric oxide (NO).⁹

Conventional treatments for dysmenorrhea include over-the-counter pain relievers or a prescription for oral contraceptives. Some dietary supplements have also been found to be effective. In three trials of women with dysmenorrhea, magnesium was more effective than placebo for pain relief. Furthermore, the women taking magnesium supplements needed less additional medication.¹⁰ Magnesium is involved in the relaxation of the smooth muscle, including the smooth muscle tissue of the uterus (the myometrium).¹¹ Tending to the health of the smooth muscle is critical as hormonal alterations in women can alter not only the myometrium but also other areas where smooth muscle is present including the following¹²:

• GI tract
• Cardiovascular system
• Respiratory tract
• Ciliary muscle and iris of the eye
• Outer protective layer of the skin
• Bladder and urinary tract

Vitamin B1 (thiamin) is another nutrient that has garnered some support in helping women with dysmenorrhea. One large trial found that vitamin B1 was more effective than a placebo in reducing menstrual cramps.¹⁰

Additionally, a large study of 70,709 women and several smaller studies confirmed a possible link between a lower risk of endometriosis (a condition often associated with dysmenorrhea) and increased intake of omega-3 fatty acids,¹³ which are important for the cell membrane.

There’s also indication vitamin D can improve dysmenorrhea, as well as menstrual problems and premenstrual syndrome in adolescents.¹⁴ Vitamin D plays an important role in female reproduction, possibly via its impact on calcium homeostasis, cyclic sex steroid hormone alterations, or neurotransmitter function.¹⁴

Supporting healthy nitric oxide levels through supplementation with a nitrate-rich supplement containing beetroot may defend against the oxidative stress that occurs in dysmenorrhea. Nitric oxide also has a relaxant effect on the smooth muscle of the myometrium and may inhibit uterine contractions, therefore suppressing dysmenorrhea.¹⁵

Mastalgia

Mastalgia is pain in the breast tissue. It is the most common breast symptom motivating women to seek help from their physicians. Up to 68% of women may have cyclic mastalgia at some point in their lifetime.¹⁶

Mastalgia is divided into two types: cyclic mastalgia and noncyclic. Cyclic mastalgia is related to the menstrual cycle. It usually begins one to two weeks prior to menstruation and ceases when bleeding begins. It is poorly localized, can affect both breasts, and is often described as a heaviness or soreness that often radiates to the armpit and arms. It usually occurs in women under 40 years old. Most often, it happens during the luteal phase of the menstrual cycle due to a rise in water content in breast tissue caused by increasing hormone levels.¹⁷

Risk factors of mastalgia may include emotional stress, drinking caffeine, smoking, breast feeding three times or more, and body mass index.¹⁷

Noncyclic mastalgia is unrelated to the menstrual cycle and can occur in only one breast. Women who have this type of pain often describe it as sharp and burning and it’s localized to the breast. Noncyclic mastalgia occurs most often in women 40 to 50 years old.

Before implementing possible treatments for mastalgia, it is always a good idea to try to eliminate any external sources. A postmenopausal woman who once visited Dr. Meletis’ clinical practice complained of pain in one breast and a strong family history of breast cancer. On her own, she sought annual mammograms. After she arrived at his clinic, he ordered bloodwork and an ultrasound. When those came back negative for any overt problem, Dr. Meletis postulated the problem was a change in physical activity. Ultimately, he determined that the amount of time she was spending as a grandmother taking care of and lifting two toddler twins, was likely the cause of her mastalgia. Upon changing her physical exertion, her symptoms completely abated.

When addressing cyclical mastalgia, a number of botanical substances have been found to offer support. These include Vitex agnus-castus (chaste tree), curcumin, Zingiber officinale (ginger), and Ginkgo biloba.¹⁸ Furthermore, a double-blind, randomized, controlled study of 60 women with moderate mastalgia found that “chamomile presents a safe, well-tolerated and effective treatment for women with moderate mastalgia.”¹⁹ Evening primrose oil (EPO) also has a great deal of evidence backing its use in mastalgia.^20,21 One review of the medical literature that included 13 published randomized clinical trials and 1,752 patients observed that while there was no difference between EPO and a placebo, it was similarly effective for pain control as non-steroidal inflammatory drugs (NSAIDs), the endometriosis medication danazol, and vitamin E.²⁰

We also know that some healthcare providers report that if they paint the cervix with iodine after performing a PAP test and exam, the patient has less breast pain during the following menstrual cycles. There is support for this concept in the medical literature. For example, a randomized, double-blind, placebo-controlled clinical trial was conducted with 111 otherwise healthy women with a history of breast pain.²² The woman were given a placebo or 1.5 mg/day, 3 mg/day, or 6 mg/day of iodine. Patients reported statistically meaningful declines in pain by month three in the 3 mg and 6 mg/day treatment groups, but not the 1.5 mg/day or placebo group. More than half of the 6 mg/day treatment group reported a clinically significant reduction in overall pain. It’s not surprising that these improvements may have taken up to three months to kick in; it takes time for iodine to reach and nourish the breast tissues and shift the microenvironment and tissue chemistry.

Balancing the estrogen and progesterone ratio is also critical to avoid estrogen dominance. After testing hormone levels, natural progesterone cream can be used to restore hormonal balance.

Perimenopause and Menopause as an Inflammatory State

While premenopausal women produce strong endogenous hormones, once a woman nears completion of perimenopause and enters into full menopause, factors affecting her health become even more unopposed by endogenous hormone production and the associated receptor activity. Perimenopause is actually a systemic inflammatory phase that can open the door to future neurodegenerative problems.²³ The perimenopause and menopausal transition is associated with pronounced hormonal alterations that exponentially increase a woman’s risk of stroke and Alzheimer’s disease.²³

Accumulating evidence indicates that perimenopause is proinflammatory and interferes with neurological systems that are regulated by estrogen.²³ Estrogen receptor-beta is known to govern a critical component of innate immunity known as the inflammasome, and it also is involved in regulation of neuronal mitochondrial function.²³ By interfering with these actions, perimenopause leads to increased systemic and central nervous system inflammation and alterations in innate immunity.²³

Supporting a healthy inflammatory response in this group of women is essential. This can be done using omega-3 fatty acids,²⁴ curcumin,²⁵ and avoiding sugar and processed carbs. Reducing estrogen dominance by balancing progesterone and estrogen levels is also key.

Obesity and Female Health

Obesity is linked to a number of female disorders, including reproductive problems such as menstrual irregularities, pregnancy complications, and infertility due to the inability to ovulate (anovulation).²⁶ Obese women have lower levels of gonadotropin-releasing hormones (GnRH), which are made in the hypothalamus of the brain. GnRH triggers the pituitary gland to produce luteinizing hormone and follicle-stimulating hormone, which in turn cause the ovaries to make estrogen and progesterone. Obesity dysregulates the hypothalamic-pituitary-gonadal axis and impairs GnRH neuron function, the final brain signaling system for the regulation of reproduction.²⁶

Toxins and Female Health

An extensive discussion of the effect of toxins on female health is outside the scope of this article. However, caution should be urged when implementing weight loss programs in female patients. This is because numerous studies indicate toxins are released from fat tissue into the body during weight loss.^27-29 Undertaking a detoxification program that includes drinking plenty of water and encouraging two to three bowel movements per day is essential in any woman before she begins weight loss. Additionally, enhancing blood flow and circulation can flush away toxins and metabolic waste products. This can be accomplished through use of nitrate-rich supplements that contain beetroot.³⁰ Eating an organic diet is also important to minimize toxin exposure.

Conclusion

This article was not intended to be an exhaustive discussion of all the possible therapeutics that can be used for female disorders such as mastalgia or dysmenorrhea or to reduce the inflammatory response associated with perimenopause and menopause. Rather, it is meant to touch briefly upon some of the female health strategies found to be most effective in science and/or clinical practice. We know that the peer-review literature lags and does not fully capture functional medicine therapeutics that we find helpful in clinical practice.

Women experience a number of health issues that are often frustrating, painful, and interfere with their quality of life. Using a combination of botanical support, nutrients like vitamin D and E, omega-3 fatty acids, and essential primrose oil, and hormonal support with natural progesterone can yield significant improvement. Furthermore, enhancing nitric oxide levels through the use of beetroot juice may reduce oxidative stress and improve blood flow to flush out toxins. Finally, to compensate for the increased inflammation that occurs during perimenopause and menopause, omega-3-fatty acids and curcumin are viable options.

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