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Fertility: An Integrative Health Approach to Reproductive Health

In all the rollicking changes a woman experiences in her twenties and thirties, one thing remains constant: her reproductive cycle. Every month triggers a cascade of hormones designed to ready a woman’s body for pregnancy. It is one of the most complex physiologic processes the body performs. Which is why, when things don’t go quite as smoothly as they should, it may be time to turn to an integrative approach.

Here are some of the ways integrative medicine can help with the ups and downs of your menstrual cycle and, when you’re ready, pregnancy.

PREMENSTRUAL SYNDROME

Find yourself with significant irritability, bloating, fatigue, weight gain, acne and breast tenderness in the week or two before your period? You may be among the 40 percent of women with premenstrual syndrome (PMS). While anti-depressants, hormones and anti-inflammatories offer a traditional approach, there are other options: 1

  • Diet. Try a diet low in dairy, refined sugar, high-sodium foods and animal fats, which studies suggest can help reduce the symptoms of PMS. 1
  • Vitamins and minerals. Supplementing with magnesium, vitamin B6, and/or calcium may improve symptoms, likely through their effects on inflammation and mood-related brain chemicals. 1
  • Herbal supplements. Chasteberry, black cohosh, St. John’s wort and gingko can ease PMS symptoms through a variety of mechanisms, including reducing inflammation and regulating hormonal actions. It’s important, however, to discuss the use of any supplements with your doctor, as they may interfere with other medications and/or have side effects. 1
  • Mind and body approaches. These include relaxation techniques, biofeedback and guided imagery. Yoga is particularly helpful, with an analysis of 15 studies concluding that yoga reduced premenstrual symptoms. 2
  • Acupuncture. As with many of the reproductive issues highlighted here, acupuncture can also help relieve the symptoms of PMS. A review of eight studies of different forms of acupuncture found the treatment improved physical symptoms of PMS by up to 50 percent. 3
  • Exercise. Numerous studies find that aerobic exercise is an effective treatment for PMS. In one large survey of 1800 women, more than half of whom used exercise to manage their PMS symptoms, 80 percent said it helped. 4

FIBROIDS, ENDOMETRIOSIS AND POLYCYSTIC OVARIAN SYNDROME

Integrative medicine may help manage the severity and symptoms of reproductive conditions such as fibroids, in which benign tumors grow in the uterus; endometriosis, in which uterine tissue grows outside the uterus; and polycystic ovarian syndrome (PCOS), a hormonal condition that leads to fertility problems, weight gain, acne and unwanted hair growth, as well as cardiovascular risk factors such as high blood pressure and cholesterol, prediabetes and diabetes. These diseases affect millions of women and are primarily treated with hormonal therapies or, in the case of fibroids and endometriosis, surgery. Adding complementary and alternative medicine (CAM) approaches to the medical focus may provide greater relief.

Fibroids

In one study of 72 women with large uterine fibroids, researchers randomized half to receive traditional Chinese herbal medicine, acupuncture, weekly deep tissue massage and guided imagery and meditation, while the other half had conventional medical treatment only (control group). Fibroids shrank or stopped growing in 22 of the women in the treatment group compared to just 3 in the control group, although the treatment cost significantly more. 5

Studies also find that diets high in red meat and fats, particularly animal fats, increase the risk of fibroids and risk factors for fibroids, including high blood pressure. Aim for a diet high in flavonoids, oily fish, green vegetables, fruits and beans. 6

PCOS

One of the hallmarks of PCOS is insulin resistance, in which cells doesn’t respond well to the release of insulin and so can’t use the glucose they need for energy. The pancreas keeps making more insulin to try and keep blood glucose levels at a manageable level, but eventually it fails, leading to diabetes.

Exercise can reduce insulin resistance by building muscle. Indeed, one study of 62 women with PCOS found improved inflammatory markers and glucose/insulin levels after three months of an exercise training program compared to a similar group that did not get the training. 7 In fact, exercise is the only treatment that improves all markers of metabolic syndrome.

Weight loss is also important. Many women with PCOS are overweight; losing just 5 percent of their body weight can restore regular ovulation and menstruation and improve fertility. 8

Herbal medications, particularly chasteberry, cinnamon, black cohosh, Tribulus terrestris, licorice and Chinese peony, also show some benefits. 9 In addition, a study in 72 women with PCOS who received acupuncture, participated in exercise or received no intervention found that the women in the acupuncture group had less depression and anxiety, while the exercise and acupuncture groups had improved health related quality of life scores compared to the control group. 10

Metformin and PCOS

Most women with PCOS will receive oral contraceptives to improve ovulation and reduce the potentially dangerous effects of too much estrogen on the uterine lining.

The insulin sensitizer metformin offers another option if birth control pills aren’t effective or you can’t or don’t want to take them. It works by reducing the amount of glucose the liver releases and increases the amount of glucose absorbed in the intestine, both of which reduce the need for insulin. 11 12 Studies find it can restore ovulation and menstruation in 30 to 50 percent of women with PCOS. 13 14

Using metformin along with CAM options is a good example of integrative medicine.

Endometriosis

One of the hallmarks of endometriosis that is most likely to benefit from CAM is pain. Numerous studies find that cognitive behavioral therapy, massage, acupuncture and mindfulness approaches such as meditation and deep breathing can reduce the perception of pain in a variety of conditions. 15 – 17

One of the few studies to evaluate an intervention specifically for endometriosis-related pain compared neuromuscular stimulation, in which a low dose of electrical energy is applied to the muscles, to no treatment in 154 women. Researchers found that women receiving treatment for 10 weeks showed significant reductions in all objective indications of pain. 18

Researchers are also looking at herbal and nutritional supplements that affect the cellular processes that lead to the overgrowth of blood vessels associated with endometriosis. These include green tea extracts, resveratrol, viburnum, flavonoids, genistein and St. John’s wort. However, most of the studies on these supplements have been done in the laboratory rather than in clinical studies. 19

FERTILITY AND INTEGRATIVE MEDICINE

Regardless of when you decide to get pregnant, it’s important to begin preparing your body before you toss your birth control. That includes maintaining a healthy weight (women who are obese may take twice as long to become pregnant, and underweight women four times longer than women at a healthy weight); quitting smoking, which can increase your risk of infertility by 60 percent; avoiding alcohol (two or more drinks a day can increase your risk of infertility 60 percent); reducing your caffeine intake; and keeping away from illegal drugs, including marijuana. 20 This is also the time to start taking prenatal vitamins—don’t wait until you get the positive pregnancy test. It is particularly important to start taking folic acid, a B vitamin, before you start trying to get pregnant.

WHY CAN’T I GET PREGNANT?

So you and your partner have decided to give it a go. You’ve embraced a healthier lifestyle and said goodbye to birth control. Most couples will get pregnant within about six months to a year. But nearly 9 percent of married, childless women aged 15 to 29 years, 11 percent of those aged 30 to 34 years, and 23 percent of those aged 35 to 39 years will encounter problems getting or staying pregnant. Overall, about 12 percent of all women between the ages of 18 and 44 years, regardless of marital status, will have problems getting or staying pregnant. 21

There are numerous reasons. One of the most common, of course, is physical. If you’re not ovulating, have blocked fallopian tubes or your partner has fertility issues, you may need surgery or medications. However, other lifestyle issues, including weight, overall health and stress, can also play a role.

That’s where integrative medicine comes in. Many couples turn to CAM to address their infertility. One study of eight infertility practices involving 428 couples found that a third had used some form of CAM to treat infertility, including acupuncture, herbal therapy, body work such as chiropractic or massage and meditation. 22

Integrative medicine approaches are particularly effective in reducing stress, which can impact conception. Acupuncture, massage, meditation, deep breathing and other relaxation techniques can reduce the stress associated with conception and, possibly, improve the chance of conceiving. 22

Certain supplements may also help with conception, including chasteberry and large doses (750 mg/day) of vitamin C. 23 It is important that you discuss any supplements you’re taking with your health care provider, however.

INTEGRATIVE MEDICINE AND ASSISTED REPRODUCTIVE TECHNIQUES

Many infertile couples turn to assisted reproductive techniques in the hope of conceiving. These may include fertility drugs, artificial insemination or in-vitro fertilization (IVF), in which the egg and sperm are fertilized in the laboratory and the embryo transferred to the woman. However, only about a third of all IVF attempts in the United States result in a live birth. 24

There is some evidence that certain CAM approaches may improve the likelihood of success in IVF. For instance, a review of several high-quality studies on the effects of acupuncture during fertility treatment found improvements in female and male infertility, as well mental health. 25 Another study found that giving acupuncture on the day of the embryo transfer increased the likelihood of pregnancy. 26

We don’t know what’s behind the effects, but theories suggest acupuncture may stimulate the release of certain brain chemicals related to reproduction, promote blood flow to the uterus, increase the number of egg follicles available for women undergoing IVF and reduce stress and anxiety. 27 28

Over the past 20 years, reproductive specialists have come to understand the importance of the mind and body connection on fertility and begun integrating CAM, including meditation, reiki, massage, nutritional support, yoga and acupuncture, into their medical practices or partnering with integrative medicine specialists.

When You’re Pregnant

Pregnancy is not all glowing skin and joy. Instead, it can be a nine-month slog through nausea, heartburn, back pain and insomnia. So it’s not surprising that an Australian study of 1835 pregnant women found that nearly half used some type of CAM approach (other than vitamins and minerals) during their pregnancies. 29 A similar study in American women found that 37 percent of pregnant women used some form of CAM, and 28 percent of women who had just given birth.

The most common were mind and body practices such as meditation, yoga and stress management classes. 30 However, less than half of pregnant women using CAM told their physicians. 31 That’s a mistake. If your doctor, whether traditional or integrative, is going to provide you with the best care, he or she needs to know everything about your health and habits. So talk!

REFERENCES

  1. Girman A, Lee R, Kligler B. An integrative medicine approach to premenstrual syndrome. Am J Obstet Gynecol. 2003;188(5 Suppl):S56-65.
  2. Oates J. The effect of yoga on menstrual disorders: a systematic review. J Altern Complement Med. 2017;23(6):407-417.
  3. Jang SH, Kim DI, Choi MS. Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review. BMC Complement Altern Med. 2014;14:11.
  4. Pullon SR, Reinken JA, Sparrow MJ. Treatment of premenstrual symptoms in Wellington women. N Z Med J. 1989;102(862):72-74.
  5. Mehl-Madrona L. Complementary medicine treatment of uterine fibroids: a pilot study. Altern Ther Health Med. 2002;8(2):34-36, 38-40, 42, 44-36.
  6. Dalton-Brewer N. The role of complementary and alternative medicine for the management of fibroids and associated symptomatology. Curr Obstet Gynecol Rep.
    2016;5:110-118.
  7. Giallauria F, Palomba S, Maresca L, et al. Exercise training improves autonomic function and inflammatory pattern in women with polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf). 2008;69(5):792-798.
  8. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease state clinical review: guide to the best paractices in the evaluation and treatment of polycystic ovary syndrome – part 2. Endocr Pract. 2015;21(12):1415-1426.
  9. Arentz S, Abbott JA, Smith CA, Bensoussan A. Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings. BMC Complement Altern Med. 2014;14:511.
  10. Stener-Victorin E, Holm G, Janson PO, Gustafson D, Waern M. Acupuncture and physical exercise for affective symptoms and health-related quality of life in polycystic ovary syndrome: secondary analysis from a randomized controlled trial. BMC Complement Altern Med. 2013;13:131.
  11. Madiraju AK, Erion DM, Rahimi Y, et al. Metformin suppresses gluconeogenesis by inhibiting mitochondrial glycerophosphate dehydrogenase. Nature. 2014;510(7506):542-546.
  12. Ferrannini E. The target of metformin in type 2 diabetes. N Engl J Med. 2014;371(16):1547-1548.
  13. Moghetti P, Castello R, Negri C, et al. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation. J Clin Endocrinol Metab. 2000;85(1):139-146.
  14. Unlühizarci K, Kelestimur F, Bayram F, Sahin Y, Tutus A. The effects of metformin on insulin resistance and ovarian steroidogenesis in women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 1999;51(2):231-236.
  15. American Massage Therapy Association. Consumer Views & Use of Massage Therapy. 2017. Accessed July 15, 2019.
  16. Morley S, Williams A, Hussain S. Estimating the clinical effectiveness of cognitive behavioural therapy in the clinic: evaluation of a CBT informed pain management programme. Pain. 2008;137(3):670-680.
  17. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444-1453.
  18. Bi XL, Xie CX. Effect of neuromuscular electrical stimulation for endometriosis-associated pain: a retrospective study. Medicine (Baltimore). 2018;97(26):e11266.
  19. Zheng W, Cao L, Xu Z, Ma Y, Liang X. Anti-angiogenic alternative and complementary medicines for the treatment of endometriosis: a review of potential molecular mechanisms. Evid Based Complement Alternat Med. 2018;2018:1-28. (doi:10.1155/2018/4128984).
  20. Pfeifer S, Butts S, Fossum G, et al. Optimizing natural fertility: a committee opinion. Fertil Steril. 2017;107(1):52-58.
  21. Centers for Disease Control and Prevention. The National Survey of Family Growth. 2018. Accessed July 15, 2019.
  22. Smith JF, Eisenberg ML, Millstein SG, et al. The use of complementary and alternative fertility treatment in couples seeking fertility care: data from a prospective cohort in the United States. Fertil Steril. 2010;93(7):2169-2174
  23. Lloyd KB, Hornsby LB. Complementary and alternative medications for women’s health issues. Nutr Clin Pract. 2009;24(5):589-608.
  24. Centers for Disease Control and Prevention. Assisted Reproductive Technology Statistics. 2016. Accessed March 8, 2019.
  25. Miner SA, Robins S, Zhu YJ, et al. Evidence for the use of complementary and alternative medicines during fertility treatment: a scoping review. BMC Complement Altern Med. 2018;18(1):158.
  26. Manheimer E, Zhang G, Udoff L, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008;336(7643):545-549.
  27. Zhang Y, Fu Y, Han F, Kuang H, Hu M, Wu X. The effect of complementary and alternative medicine on subfertile women with in vitro fertilization. Evid Based Complement Alternat Med. 2014;2014:419425.
  28. Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril. 2002;78(6):1149-1153.
  29. Frawley J, Adams J, Sibbritt D, Steel A, Broom A, Gallois C. Prevalence and determinants of complementary and alternative medicine use during pregnancy: results from a nationally representative sample of Australian pregnant women. Aust N Z J Obstet Gynaecol. 2013;53(4):347-352.
  30. Birdee GS, Kemper KJ, Rothman R, Gardiner P. Use of complementary and alternative medicine during pregnancy and the postpartum period: an analysis of the National Health Interview Survey. J Womens Health (Larchmt). 2014;23(10):824-829.
  31. Holden SC, Gardiner P, Birdee G, Davis RB, Yeh GY. Complementary and alternative medicine use among women during pregnancy and childbearing years. Birth. 2015;42(3):261-269.

ABOUT THE AUTHORS

DR. WAYNE JONAS

Dr. Jonas is a practicing family physician, an expert in integrative health and health care delivery, and a widely published scientific investigator. Dr. Jonas is the Executive Director of Samueli Integrative Health Programs, an effort supported by Henry and Susan Samueli to increase awareness and access to integrative health. Additionally, Dr. Jonas is a retired lieutenant colonel in the Medical Corps of the United States Army. From 2001-2016, he was president and chief executive officer of Samueli Institute, a nonprofit medical research organization supporting the scientific investigation of healing processes in the areas of stress, pain, and resilience.

Dr. Jonas was the director of the Office of Alternative Medicine at the National Institutes of Health (NIH) from 1995-1999, and prior to that served as the Director of the Medical Research Fellowship at the Walter Reed Army Institute of Research. He is a Fellow of the American Academy of Family Physicians.

His research has appeared in peer-reviewed journals, such as the Journal of the American Medical Association, Nature Medicine, Journal of Family Practice, Annals of Internal Medicine, and The Lancet. Dr. Jonas received the 2015 Pioneer Award from the Integrative Healthcare Symposium, the 2007 America’s Top Family Doctors Award, the 2003 Pioneer Award from the American Holistic Medical Association, the 2002 Physician Recognition Award of the American Medical Association, and the 2002 Meritorious Activity Prize from the International Society of Life Information Science in Chiba, Japan.

DEBRA GORDON, MS
Medical and Healthcare Writer

Debra Gordon, M.S., is an award-winning medical writer with more than 25 years of experience. Debra is a member of the American Medical Writers Association (AMWA) and has received numerous journalism awards including a past recipient of the Kaiser Family Foundation Media Fellowship, a one-year fellowship to pursue independent work in the health policy arena. Debra holds a Bachelor of Arts in English from the University of Virginia and a Master of Science in Biomedical Writing from the University of the Sciences in Philadelphia.


Topics: Complementary Medicine | Integrative Health | Women

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