Acupuncture, Ancient Art of Infertility Treatment

Following is quoted from WebMD Feature:

The Ancient Art of Infertility Treatment

When it comes to getting pregnant, old world techniques may be just what today's high-tech doctors will order.

By Colette Bouchez

Reviewed by Brunilda Nazario, MD

"Most of our patients are referred to us by reproductive medicine specialists -- they are usually women who have failed one or usually more than one attempt at IVF (in vitro fertilization), and their doctor is looking for something to help implement the success of their treatment, over and above what the protocols alone can accomplish," says Raymond Chang, MD, the medical director of Meridian Medical and a classically trained acupuncturist as well as western-trained medical doctor.

Acupuncture is an ancient Chinese medicine treatment that relies on the painless but strategic placement of tiny needles into a "grid-like" pattern that spans the body, from head to toe. The needles are used to stimulate certain key "energy points" believed to regulate spiritual, mental, emotional, and physical balance. And, for many women, it's often just what the doctor ordered.

"It can allow you to cross the line from infertile to fertile by helping your body function more efficiently, which in turn allows other, more modern reproductive treatments, like IVF, to also work more efficiently," says James Dillard, MD, assistant clinical professor, Columbia University College of Physicians and Surgeons, and clinical adviser to Columbia's Rosenthal Center for Complementary and Alternative Medicine.

Indeed, in a study of 160 women, published April 2002 in the reproductive journalFertility and Sterility, a group of German researchers found that adding acupuncture to the traditional IVF treatment protocols substantially increased pregnancy success.

In this study one group of 80 patients received two, 25-minute acupuncture treatments -- one prior to having fertilized embryos transferred into their uterus, and one directly afterwards. The second group of 80, who also underwent embryo transfer, received no acupuncture treatments.

The result: While women in both groups got pregnant, the rate was significantly higher in the acupuncture group -- 34 pregnancies, compared with 21 in the women who received IVF alone.

But increasing the odds of IVF is not the only way acupuncture can help. Chang says it can also work to stimulate egg production in women who can't -- or don't want to -- use fertility medications to help them get pregnant.

Acupuncture pregancy and beyond

Acupuncture and Chinese Medicine assists variety of conditions during stages of child birth. If there is no specific conditions, food with herbal functions are recommended most.

(article written by Dawn Balusik, AP, published in Select Magazine, Mar-Apr 2009)

ACUPUNCTURE FOR PREGNANCY, CHILDBIRTH AND BEYOND

Though, at first, you may not think to put acupuncture on your “to do” list when you find out you are pregnant, it is actually a valuable and natural way to help ensure a healthy pregnancy, a smooth delivery and a quick post-partum recovery.

Why acupuncture and Oriental medicine?

If we look back through Chinese history and the ancestral worship that is part of it, we see a very strong cultural commitment to have healthy children. As a result, throughout the centuries, Oriental medicine developed effective treatments to help couples get pregnant and to promote healthy pregnancies and uncomplicated deliveries.

Acupuncture and Oriental medicine focuses on re-establishing and maintaining a healthful natural balance and flow of vital energy (or Qi “chee”) within the body. Qi is the basis for the proper functioning of all of our organs and physiological processes, including reproduction: it provides structural integrity and stability, physiological efficiency and the potential for life, health and healing in general.

Qi is thought to circulate in pathways throughout the body, known as meridians. In Oriental medicine, one is said to be in perfect health when this Qi is balanced and flowing unimpeded, in the correct direction and in an adequate amount throughout the body. When this energy becomes imbalanced, blocked or deficient, we experience pain, discomfort and disease.

Acupuncture needles, placed properly, directly access and regulate the flow of the energy in the meridians and correct imbalances, thereby creating healing and harmony within the body.

Acupuncture is a safe, effective and natural way for women to reduce their symptoms of pregnancy. Moreover, it does this without the risks and side-effects of pharmaceutical medications, most of which are contraindicated during pregnancy anyway.

Acupuncture for a healthy mother and baby

Acupuncture treatment once or twice a month during pregnancy is valuable for both Mom and Baby. It will help ensure optimal health of the mother and the fetus at different stages of development, cell differentiation and growth. It can also prevent and treat pregnancy-related symptoms.

Acupuncture for childbirth

One popular acu-point used during pregnancy is Zhubin (K9) known as “the beautiful baby point”, located on the inner part of the lower leg. It is said to calm the mind, relieve anxiety, build blood and benefit the fetus.

During the final 4 to 6 weeks of pregnancy, weekly treatments are recommended, to help prepare for labor. Typically, a session lasts 30 to 45 minutes, and women usually only feel a mild pressure or heaviness sensation at the site of the needle insertion.

Some women have pre-existing medical conditions that may worsen during pregnancy, but can be safely addressed with acupuncture. This is a great option when pharmaceuticals are contraindicated or the mother just wants treatment as natural as possible.

Acupuncture for pregnancy-related symptoms

Acupuncture significantly relieves fatigue, anxiety, migraine headaches, bleeding and, of course, the morning sickness that can be common during the first trimester. An Australian study published in the journal Birth reported that of nearly 600 women suffering with morning sickness, (all of whom were less than 14 weeks pregnant), those who received acupuncture treatment reported having less frequent and shorter periods of nausea than those who did not get acupuncture.

The second trimester can bring stress, sinus congestion, heartburn, constipation and hemorrhoids which acupuncture can help to alleviate. Other second trimester symptoms that acupuncture can assist are edema, elevated blood pressure, elevated blood glucose or excessive weight gain, but these conditions are potentially dangerous, and should also be monitored by a western-trained physician or midwife.

Sciatica, back pain, pelvic pain, joint pain and carpal tunnel syndrome can be common during the third trimester. Acupuncture treatment is known to bring relief to these symptoms, and it can bring this relief quickly, without any medications. In fact, a recent study published in the American Journal of Obstetrics and Gynecology found that acupuncture in combination with standard treatment was more effective at relieving mixed pelvic/back pain during pregnancy than standard treatment alone.

If symptoms are particularly severe, weekly treatments may be necessary to get you through a particular period of time during the pregnancy.

Beginning around 32 to 34 weeks, special acu-points will be included during treatment to encourage the proper head-down positioning of the baby for birth. Also at this time, acupuncture treatment frequency will increase to weekly to help optimize childbirth.

Acupuncture for labor induction

For pregnancies that have gone beyond their due date, acupuncture is amazingly valuable to help induce a natural labor. A woman who is past her due date is facing either a Cesarean section being induced with the drug pitocin. Neither of these are desirable options, as they present more risks and side-effects. Pitocin forces the body into labor whether it is ready or not.

Acupuncture is a great alternative. It is safe and encourages the body to go into a natural labor. Acu-points to induce labor are deliberately avoided during the 9 months of pregnancy, and are now used freely to encourage uterine contraction. Acupuncture for labor induction will also help to tonify the mother’s vital energy as well as calm her anxiety. This helps her to relax, which also facilitates a healthy delivery.

For labor induction, acu-points are used in the sacrum, hands, feet and shoulders. Electro-stimulation may be used on the needles to strengthen the treatment effect. Typically, treatment will aim at producing some contractions immediately. In my practice, daily acupuncture treatment for 3 to 5 days is usually sufficient to induce labor. Chinese herbal formulas may also be given to increase circulation in the pelvic area and to nourish the mother’s energy, which is needed for labor.

Acupuncture during labor itself is used to reduce pain and to boost energy, but can also be used to strengthen weak contractions. In China this is a common practice, because birth is seen as a natural process that is to be interfered with as little as possible; acupuncture facilitates the natural process, it doesn’t force anything to happen.

Acupuncture for post-partum recovery

After delivery, acupuncture assists the normal recuperative process. It can help stop bleeding and discharge, relieve backache and ease pain of the perineal area. It can also help to heal a Cesarean section incision and hasten recovery from the surgery. Acupuncture and Chinese herbal medicine helps to restore the mother’s vital Qi energy and Blood, support milk production, and normalize the Qi and Blood flow through the abdomen. It is also ideal for preventing and treating post-partum depression. So, even though the new mom will be busy tending to her newborn, it is important that she still get her acupuncture treatments.

As you can see, all women would benefit from receiving acupuncture throughout their pregnancies. Acupuncture is valuable to ensure a healthy mother and fetus and to address pre-existing and pregnancy-related symptoms during pregnancy. It is also a wonderful alternative to pitocin or C-section for inducing labor. In addition, acupuncture can facilitate the labor process and assist in post-partum recovery.

BBT Notes fomat that I recommend

BBT Notes that I recommend

As I talked to my patients when they meet me first time, the BBT chart and note can help me remember and better understand daily conditions. Also they can save both precious time when we meet next time. Sometimes, it is hard to remember to bring the paper chart to our meeting and On-line electronic file which are shared by patients and me can quickly bring us to the same page.

There are 2 ways so far which can let me see patients updates of BBT and notes.

1) fertilityfriends.com membership: it has feature which can allow my patient to share chart view with me and can bring me to her web page by clicking a link inside email. Make sure to test the link first.
http://www.fertilityfriend.com/education.html

2) google document (free): patient needs to have google account. I have a sample file which patient can upload and create a new file to google document page. Remove sample date and notes; put her BBT and note each day. She can then set that file as "share" with my google mail with editing right. The google spreadsheet can be used to create chart view.

Following are some abbreviations commomly used.

Cervical Fluid (CM Line): The cervical fluid (also called cervical mucus and abbreviated CM) data line uses the following codes: Label Fluid M Menses (Period) L (Pink background) Menses Light(Period) H (Pink background) Menses Heavy (Period) * Spotting - Dry S Sticky C Creamy W Watery E Egg White A blank entry means that you did not record your CM that day. The Menses and spotting can be combined with the other fluid types in a two letter code. For example egg white fluid with spotting will be displayed "E*". Menses are displayed on a pink square. The corresponding square is colored in green when your entry denotes a clearly fertile sign. Pregnancy Tests: Label Test + Positive - Negative B+ Blood Test Positive B- Blood Test Negative Intercourse/Insemination/Retrieval (BD Line): Label Meaning X Intercourse AM Intercourse in the morning PM Intercourse in the afternoon/evening R Egg Retrieval I IUI or Home IUI XX Intercourse morning and afternoon (More than once) Ovulation Predictor Kit (OPK Line): Label OPK Result + Positive - Negative Fertile entries are displayed over a green square. Saliva Microscope/Ferning Test (Fern Line): Label Ferning Test Result F Full Ferning PF Partial Ferning - None Fertile signs are displayed over a green square. Cervix (Cervix Line): The cervix line uses a multi character representation: Label Position H High M Medium L Low Label Texture S Soft M Medium F Firm Label Opening O Open - Medium C Closed Clearly fertile input are displayed over a green square. Fertility Monitor (Mon Line): Label Monitor Display L Low H High P Peak OvWatch (OvW Line): Label OvWatch Display NF NF FD1 to FD4 Fertile Day 1 to 4 OD1 & OD2 Ovulation Day 1 & 2 LF1 & LF2 Less Fertile Day 1 & 2 Fertile entries are displayed over a green square. Cycle History/Stats (Stats Line): The stats line displays data based on your cycle history. Predicted Ovulation Days Predicted Period Days T Recommended Test Date The colored squares represent the most probable days for ovuation or menses based on a statistical analysis of your cycle history. The stats line also displays when appropriate a countdown (numbers from 5 to 1) to the test date starting 5 days before the recommended test date. Energy (Ener Line): Label Energy H High N Normal L Low Mood: The mood data entry uses the following code: Label Mood G Good OK Normal B Bad SW Swing Medications Special, Custom Data The chart also includes 3 categories of data which are displayed on multiple lines. The medications group of data is displayed on multiple lines with a predefined code. The Special and Custom data use a system of numbers with the key directly available at the bottom of the chart. Medications (Meds Lines): The Medication/Medical Procedure lines use the following code: Label Meaning C Clomid E Estrogen FS FSH FE Femara/Letrozole H HCG m Metformin P Progesterone X Other T IVF Transfer * More than one selection

Acupuncture after IVF 'could boost pregnancy'

The women who underwent acupuncture were 65pc more likely to become pregnant
By Rebecca Smith, Medical Editor12:01AM GMT 08 Feb 2008

Acupuncture could boost the chances of a woman becoming pregnant after IVF by more than half. The effect is so significant that just 10 w omen needed to combine the treatments for one to conceive who would not otherwise have done so, a study showed.

It is not clear how acupuncture affects fertility. However, IVF is extremely stressful and it could be that the relaxation involved in the therapy helps, experts said. The findings come from a review of seven scientific trials, involving a total of 1,366 women of all ages, published in the British Medical Journal today. The study looked at pregnancy rates among women having acupuncture around the time that the embryo was transferred to the womb during IVF. It compared the results with those given a fake acupuncture treatment and women who had no extra therapy.

Eric Manheimer, of the University of Maryland School of Medicine, in Baltimore, who was the lead author of the study, said that the effect was smaller in trials where the pregnancy rate was already high. However, it still means acupuncture may be a cost-effective additional therapy in IVF because it is so cheap compared with repeated cycles of fertility treatment.

One in seven couples will experience difficulty conceiving. The average cost of one cycle of IVF in Britain is about £4,000, including drugs. Around 32,000 patients a year have IVF with about 11,000 babies born annually as a result, accounting for one per cent of births.

A previous study suggested that women having acupuncture were actually less likely to get pregnant.
However, this was based on patients who sought out the therapy on their own rather than being randomly assigned as part of a trial, meaning they were probably resorting to it because their chances of conceiving were already poor.

Prof Edzard Ernst, of the Peninsula Medical School in Plymouth, said: "On the face of it, these results sound fantastic. I would, however, be very cautious as much of the observed effect could be due to a placebo response. "IVF may not seem to be 'placebo-prone' but it probably is. If women expect it to be helpful, they are more relaxed which, in turn, would affect pregnancy rates."

The research paper said if the results were largely down to a placebo effect then there would have been increased pregnancy rates among the women who thought they were receiving real acupuncture, but were actually receiving a sham therapy, where the needles were placed at random. However, this was not the case.

Raising Fertility Chance with TCM

source: Dr Roger Hirsh OMD,LAc
http://www.metamed.com/articles/article029.htm

RAISING YOUR FERTILITY QUOTIENT WITH TCM TREATMENT

Timing and consistency of treatment, whether having acupuncture or just taking herbs, is of primary importance. Consistency of treatment is most important for men, as to raise sperm count and motility with herbs starts to take effect at the fourth month of treatment. It takes 70 days to generate new sperm.

Timing and consistency is also important for women as there are specific hormonal adjustments that can be made at each week of the cycle. Missing a week of treatment may lose an important opportunity to heal a particular segment of the four phase menstrual cycle. It takes a minimum of three consecutive cycles (12 treatments) to do the foundation work of regulation regardless of biological age. Most women can benefit from this type of concentrated foundational treatment every two years, even if they aren't trying to conceive. This should be started before a woman reaches 28 years old or earlier if birth control pills have been taken.

If a woman is nearing forty years old and has had either numerous fertility drugs (over 3 cycles), birth control pills, ART procedures, elevated FSH, polycystic ovaries, endometriosis, sperm antibodies, or a history of drug, alcohol, or smoking abuse, then it usually takes longer to balance her reproductive system. Likewise, if a man has a history of STDs, history of drug, alcohol, smoking, or sexual abuse, urinary tract infections, burning urination, chronic lower back pain, prostatitis, difficulty passing urine, or other urological health issues it takes longer to rejuvenate the reproductive function. The extent of rejuvenation is relative to the effort and inherent constitution of the individual. The couple must expect to focus six to nine months before really expecting to evaluate results. There is no quick path when it comes to conception, full term pregnancy and recovery after delivery. "Turning back the clock" is indeed possible.

If a woman is in a state of high level wellness from a traditional medicine's point of view (warm hands and feet and no PMS are just several indicators), and has a "normal" active and relatively a low stress energy abundant lifestyle, then it is appropriate to evaluate between the sixth and ninth month of consistent treatment.

Biological vs. chronological age. According to the 2,000 year old Chinese medical classic (Nei Ching su wen ling shu) there are some precepts of health and aging that are very important in this day and age. Accordingly, the normal life span for humans is over 100 years. There are documented life spans of monks that have lived in good health to well over 150 years old. In the Nei Ching there is a dialogue between the Yellow Emperor and an old Taoist teacher named Chi-po. Why does medicine exist? asks the Yellow Emperor, "...because people have severed themselves from their roots (Tao)". The reconnection between the individual and their "roots" (spirituality) is a very important aspect in the maintaining of youthfulness and is thereby inherent in the basic foundation of traditional medicine. Modern science supports this in the focus on the emerging stem cell technologies and the possible cures for major life threatening diseases. Stem cells are found in abundance in the umbilical cord which suggests this deep root connection to the Jing Qi (essential energy). Understanding the root cause and quality of one's own longevity can slow the aging process and rejuvenate the body as thoughts can create reality. Knowing with certainty that we are an ageless body is the basis for creating high level wellness in the modern world. Longevity however is more than just belief.

Correct dietary and exercise habits are just as important for the preconceptive mother as for the father. Eating salads (cold nature food) for a year is not the best diet for a person who has generally a low basal body temperature (BBT). Sometimes eating meat such as lamb (warming food) can help tonify a "cold" barren uterus. For male factor and unexplained infertility there are specific physical and mental exercises to be done by couples to generate the right environment necessary for creativity and conception.

Combining conventional reproductive technologies with ancient acupuncture and herbal techniques demands accurate communications between team members which includes the patient as captain. Communication between the patient, the acupuncturist and the reproductive specialist is a delicate process. It is important for the physician to have knowledge of the procedures of the acupuncturist/herbalist and vis a vis. Likewise it is important for the patient to inform the acupuncturist of any herbs or vitamins that are being taken while undergoing treatment, other than prenatal vitamins. Over the counter herbal remedies might be effective in some cases but may not be indicated for a particular cycle. Traditional Chinese medicines and acupuncture work quite differently than western medicines.

What if you have already had a course of acupuncture treatment in the past? When selecting an acupuncturist or any healer it is important to know that they are suitably qualified to do fertility work. Communication, experience and skill are important. Having a state acupuncture license means that the acupuncturist has passed a course of study that qualifies them as an entry level practitioner. Usually this is about a 3000 hour training, though there are some physician programs that are only 300. A growing number of practitioners have a greater than entry level experience of treating couples that are integrating oriental medicine with conventional reproductive techniques. These practitioners are to be sought out, as treating an infertile couple demands not just general practice but also specialty skill. General practice skills help remove pre-existing conditions. If these conditions are the cause of infertility then the couples fecundity quotient will be increased. However, if either reproductive function or biological age of the endocrine system is the primary contributory factor then specialty skills and experience is necessary.

Manipulating Menstruation with Hormonal Contraception — what does the Science say?

Following is an article from Center for Menstrual Cycle and Ovulation Research.

ARTICLE | Manipulating Menstruation with Hormonal Contraception — what does the Science say? by Jerilynn C. Prior and Christine L. Hitchcock

The flood of recent articles and magazine reports and even books (1) about so-called “menstrual suppression” describe taking the Pill continuously or for longer than 21 days with seven days off. The advertising suggests that this is giving women a “choice” to do away with menstrual flow or menstrual problems. The Federal Drug Agency in the USA has approved one oral combined hormonal contraceptive to be taken in four extended cycles a year. Not only do these new ways of taking the Pill allow companies a new patent on old drugs, they make it likely that the market for these products will expand from those who want to control pregnancy to those who want to eliminate menstrual flow.

We have two fundamental concerns with extended and continuous combined hormonal contraceptives: the hype surrounding these new ways of taking hormonal contraceptives is focusing negative ideas about women by making normal menstruation into a problem; and the health implications of these more continuous ways of administering higher doses of estrogen and progestin are not yet known.

Menstrual cycles are one of the fundamental differences women have from men. Because menstruation is linked to women, it is associated with women’s continuing inferior social status. Drs. Coutinho and Segal wrote, “a human menstrual period is the result of failure…” (1). Our culture certainly sees menstruation as negative, a wound (2), something messy or dirty, and to be hidden (3), especially from men. In fact, a woman CNN reporter complained that all the men producers in her department were excited by the menstrual suppression “story” because this gave them, for whom such talk would normally be taboo, the opportunity to discuss it! We as women, however, tend to have mixed feelings about our periods. Although some women have difficult menstrual cramps, heavy flow and clots or unpredictable onset of flow, most of those are either evidence of abnormal menstruation occurring without ovulation or are highly treatable (see “Painful Periods”). Even teenaged girls who complain about the onset of periods are concerned when their friends get their periods first! Likewise, both women and physicians have mixed and often contradictory attitudes about elimination of menstruation (4). Have periods have become the latest of women’s “deficiencies”? Is having regular menstrual flow a “Pill deficiency disease?!” We noticed that all of the papers that described extended and continuous use of CHC were in favour of this—the majority of studies have obvious support from the company making the CHC.

How might longer schedules of combined estrogen-progestin contraceptives work?

Higher-than-normal estrogen and at least similar levels of progestins to the menstrual cycle progesterone levels are necessary to suppress the growth of ovarian follicles and release of an egg. Our own menstrual cycles, once they get established in our early 20s, are hard to suppress. Even the usual 7-day break from the Pill is associated with increases in brain and pituitary hormones that are trying to get follicles growing within the ovary—each of these follicles makes estrogen. Occasionally ovulation will also occur on the Pill or other CHC methods but pregnancy usually doesn’t happen because the uterine lining is not lush enough for a fertilized egg to get fixed in place and grow. Evidence says that some follicles grow and some ovarian estrogen is made despite taking the Pill every day (5).

The endometrial uterine lining grows thicker under the influence of estrogen and is made more mature and thinner with progesterone or progestin. The estrogen and lower dose progestin from the CHC, plus the estrogen from growing follicles, probably explains the spotting on the long-cycle and continuous Pill. Years ago, I tried to suppress periods for women who needed to avoid the blood loss of menstruation during a bone marrow transplant. Because bone marrow makes platelets that are necessary for blood to clot, the women were at risk of heavy bleeding during the six weeks that the new bone marrow was becoming established. I tried to use progestin to help them have a period (shed their uterine lining) before their platelets got low. As soon as they had flow, I started a moderate dose Pill that they had to take every day without a break until their new bone marrow was working and their platelets were normal. What I saw was that after about six weeks of continuous Pill use women began to spot. These were women who were sick, had lost weight, were nauseated and were scared—all of these were reasons why the brain would be less likely to try to stimulate a period. Yet, most began to bleed if we had to continue the Pill longer than a month and a half.

How safe are longer or daily combined hormonal contraception schedules?

Our second major concern is the safety of extended and continuous use of combined hormonal contraception. These new schedules are being presented and regulated in the USA as though their potential health risks were identical to the risks from today’s lower dose cyclic CHC agents with hormones taken for 21 days out of 28 (Standard CHC). Therefore, the standard CHC cycle has been used as a “control” for these longer hormonal schedules. None of the studies have compared the long or continuous use of hormonal contraception with normal or abnormal cycles in randomized (by a toss of a coin) and placebo-controlled (compared with a dummy pill or patch or vaginal ring) studies. Most of the studies are biased because women were previous users of CHC, and so women who didn’t feel well on CHC would have dropped out early and not been asked to participate in these studies.

So what are the health risks that may exist from longer or continuous use of combined hormonal contraception? Caution says we should remember the recent history of drugs and devices in women’s health. It would not be wise to ignore the disease and death caused by fads of former years including Thalidomide, DES, early high-dose oral contraceptives, the Dalkon shield and “hormone replacement therapy” as a preventative treatment for asymptomatic menopausal women. The risks from routine menopausal hormone therapy could have been, and were predicted (6), 10 years before the first results of the Women’s Health Initiative hormone therapy arms showed that this therapy caused more harm than good for women without symptoms (7;8).

Let’s start with the things we know about the standard Pill. Even the current “low dose” Pill containing less than 30 mg of ethinyl estradiol is four times higher (stronger) than the average estrogen in the menstrual cycle. We know that the lower the dose of the estrogen the lower the risk for blood clots, heart attacks and strokes. But the longer or continuous use of CHC means that women are getting 25 to 33 percent more estrogen hormone exposure. At the moment there are too few scientific studies to be sure that continuous CHC doesn’t increase the current danger of blood clots from the Pill and the eventual risk for breast cancer, for trouble getting pregnant when we want to, or increase osteoporosis and fractures.

New testing of the safety of long or continuous CHC use must compared this with what is normal and natural—the menstrual cycle. These new ways of taking the Pill should not be approved by government agencies unless they are shown to be safe compared with the untreated menstrual cycle!

Although we think of the Pill as safe, a 25-year study in over 45,000 British women, of whom half were on the Pill and half weren’t, showed that deaths from cancer of the cervix (mouth of the uterus) and from cardiovascular diseases (like blood clots, strokes and heart attacks) were significantly increased in women on the Pill (9). That study started when Pill hormones were about 5 times higher than they are today, but at its end Pill hormones were similar to those we use today. The overall death rate was similar between those on and not on the Pill because the Pill, although causing endometrial and heart/stroke deaths, prevented deaths from ovarian cancer (9). A recent careful combination of all studies since 1980 of cardiovascular and blood vessel diseases during current normal-cycle Pill use showed that even the lowest dose Pills cause a doubling of the risk for strokes and heart attack (10).

Another safety issue, especially when bleeding is unpredictable, is the risk for overgrowth of the lining of the uterus. If the endometrium is thicker, cells are growing (proliferation) and usually under the influence of estrogen. If progesterone or progestin levels aren’t high enough to slow that growth, there is a risk for endometrial cancer. A single 1-year study of the endometrial safety of long-cycle Pill use suggests that the lining usually becomes thin and inactive, although about 10% of endometrial biopsies show proliferation (Anderson 2005). Unfortunately, from an 8-year study of continuous menopausal ovarian hormone therapy, the lining was thin and inactive, no bleeding was happening and yet two of 41 women were found to have endometrial cancers (11).

The next safety question relates to breast cancer and continuous Pill use. We link breast cancer risk with estrogen therapy—there is a small increased risk with standard CHC use (12). What is important to remember is that the continuous Pill causes more days of higher-than-normal estrogen levels. We don’t yet have any research on the risks for breast cancer and the continuous CHC. However, the risks would likely increase based on the higher estrogen levels.

I believe that breasts need a monthly time of low estrogen levels. The normal menstrual cycle provides this “break from estrogen” during flow. Even on the standard 21-day CHC, with the usual 7-day break, breasts feel different—they feel woody and more lumpy than normal. I am sure that, without knowing, I could tell by the way her breasts felt, whether or not a woman was on the Pill. Normal breast tissue is soft and has some variable texture. Because of no break, about 20% of menopausal women will have troublesome breast tenderness on continuous ovarian hormone therapy (that has much lower estrogen levels than the Pill) (13). In my experience, that tenderness goes away with three to five days off estrogen each month.

What about safety for bones and osteoporosis? We know that estrogen or estrogen with progestin therapy in menopausal women prevents fractures (14). We have thought that the combined hormonal contraception would also prevent osteoporosis. And there are some studies, usually small, in older women and without good controls suggesting that is true. However, a few years ago we showed that premenopausal Canadian women ages 25-45 who had ever used the Pill had lower bone density levels than women who had never used the Pill (15). An earlier study showed that young women using the Pill didn’t gain bone normally (16). Two studies have shown that fractures are increased about 20% in women who have used the Pill compared with women who haven’t (17;18). Other more recent studies suggest that calcium therapy can prevent the bone loss caused by the usual 21-day CHC cycle in young women with diets that are poor in calcium (19). We haven’t been able to find any study of bone density changes or fractures in women using the long or continuous CHC.

Women who stop a standard 21-day pill can expect to wait about two months longer before becoming pregnant than those stopping barrier methods—the higher the estrogen dose, the longer the delay in recovery of fertility (20). It is likely that the younger the woman who uses continuous or long-cycle CHC will have more negative effects on her future fertility because she has likely never been pregnant and her system is just “learning” to be fertile. Because long and continuous CHC methods include 25-33 percent higher estrogen exposure, that would also suggest a further delayed return to fertility. We have not found any studies that have looked at how long it takes to get pregnant after stopping extended or continuous CHC.

In summary, we think that long-cycle and continuous CHC use is effective for contraception. However, we know that it is likely to cause more unexpected bleeding than usual and less expected flow. We have many unanswered questions about safety that the current studies compared with standard CHC schedules are not addressing. We are looking for a randomized, blinded, placebo-controlled comparison of continuous OC and untreated menstrual cycles.

Acupuncture help menstrual and PCOS -Healthcare Medicine Institute

Researchers have discovered that both electrical and manual acupuncture “improve menstrual frequency and decrease circulating androgens in women with polycystic ovary syndrome (PCOS).” PCOS is a common female endocrine disorder with side-effects including irregular menstruation, amenorrhea, anovulation, infertility, polycystic ovaries and excess quantities of androgenic hormones. Excess androgens may lead to acne, obesity due to insulin resistance, high cholesterol and hirsutism (excess facial and body hair).

The researchers induced PCOS in rats using 5α-dihydrotestosterone (DHT) to determine whether or not electrical or manual acupuncture was superior in the regulation of menstruation. The rats received acupuncture five times per week for 4-5 weeks. The electroacupuncture group received 2 Hz stimulation at the acupuncture points. Untreated rats served as the control group.

The manual and electroacupuncture groups showed normalization of estrogen activity and a decrease in androgens. In addition, the electroacupuncture group showed changes in the central opioid receptors of the hypothalamus suggesting that electroacupuncture may be “mediated by central opioid receptors….” The manual acupuncture group showed changes in the steroid receptors of the hypothalamus suggesting that manual acupuncture “may involve regulation of steroid hormone/peptide receptors.”

Another study published in the American Journal of Physiology – Endocrinology and Metabolism concludes that low frequency electro-acupuncture improved menstrual frequency and balanced sex steroid levels in women with PCOS, polycystic ovarian syndrome.b This study measured blood changes in human female participants. Hyperandrogenism was measured in this study by determining the total concentration of testosterone, androgens, estrogens, androgen precursors, and glucuronidated androgen metabolites. The study measured that electro-acupuncture improved menstrual regularity in women with PCOS. The sex steroid levels in the electro-acupuncture group improved significantly and acne markedly decreased. The study measured improvements in a wide range of endocrine variables such that the researchers concluded that electro-acupuncture may help induce ovulation in women attempting to conceive since participants showed significant improvement in monthly menstrual frequency.