Michelle Pouliot, ND

Women’s Sexual Health Issues

When asked, over 60% of women will admit they have concerns about their sex lives. In my practice, this is most often expressed by my patients who are menopausal.  In the context of having a previously satisfying sex life, along with other menopausal changes, they’re experiencing lower libidos, weaker orgasms, and discomfort with intercourse. For some women, this can become an issue in their relationships and is affecting the quality of their life.

Female sexual response is not well explained by scientific reductionist research. Physical and emotional health is equally important to women’s sexual vitality. Hopefully, it’s no surprise that relationship discord is a major predictor for lowered female sexual responsiveness.

The menopausal transition heralds decreasing levels in estrogen, progesterone, testosterone and DHEA and oxytocin. These hormones affect female desire, arousal, receptivity, pelvic vasocongestion, and orgasm. Convention treatment for menopausal sexual dysfunction often involves hormone replacement. Some of my patients choose not to use estrogen, progesterone, and testosterone therapies but want to try supplemental herbs and nutrients to support sexual health.

There are three Biotics Research products that help many women with menopausal sexual concerns. BioDrive®, DHEA and b-VITAL® often improves women’s over all energy and desire for sexual intimacy. Of course, other health issues that contribute to lowered libido and sexual response should be addressed, such as cardiac, neurological and endocrine imbalances. Also, these products shouldn’t be taken by women with breast cancer concerns because they may increase a woman’s endogenous production of hormones.

BioDrive® contains Rhodiola, American Ginseng, Damiana, Nettles root and Gingko. Rhodiola and American Ginseng are adrenal adaptogens that decrease fatigue, improve recovery from physical and emotional stress and support sexual vitality. Damiana is an aphrodisiac.  Nettles root moderates sex hormone binding globulin (SHBG) that allows for increased free hormone activity. Gingko is a peripheral vascular dilator that improves pelvic blood flow.

DHEA, dehydroepiandrosterone, is an adrenal hormone that serves many physiological purposes, including the production of estrogen and testosterone. DHEA levels drop precipitously with menopause. A DHEA level above 200 mcg/dL appears to be necessary for women’s libido.

b-VITAL® contains Peruvian Maca and Elk Velvet Antler (EVA).  Maca has been shown to reduce sexual dysfunction in menopausal women without changing Estrogen, FSH, LH or SHBG. EVA has been used for centuries as an aphrodisiac. In men, it can increase testosterone levels though I haven’t found research showing it to have the same effect for woman. Woman in my practice do report DHEA with b-VITAL® seems to improve their sex drive.

Women’s sexual vitality is marvelously complex and multidimensional. Good sex requires good sleep, energy, mood, health and relationships. From the women in my practice, I’ve seen that BioDrive®, DHEA, and b-VITAL® can help.


Michelle J. Pouliot, ND

Dr. Michelle J. Pouliot, Naturopathic Physician (Bastyr 1991), has been in practice in northwest Connecticut for the past 15 years. Her practice is focused on meeting women’s healthcare needs with botanical and nutritional medicine. She specializes in women’s conditions, menarche, PMS, peri-menopause, menopause, libido issues and osteoporosis. Dr. Pouliot is an adjunct professor at the University of Connecticut and Northwestern Connecticut Community College and is devoted to educating women and their healthcare practitioners about the value of naturopathic medicine.

Women’s Health…Women’s Choices

As a naturopathic physician practicing women’s health for the past 20 years, I’ve watched my patients be overwhelmed, excited, or conflicted by the amount of “medical” advice that comes their way. From self-help books to health food store free magazines, research articles quoted in newspapers to on line advice and Dr. Oz, women are being told what supplements, diets, drugs, tests and exercises are essential for them to be happy, healthy, and hopefully forever young.

What patients need most is competent diagnosis then respectful individualization of their care. An example from my practice would be a treatment approach for three women with migraine headaches. One young woman has premenstrual migraines, another has peri-menopausal premenstrual migraines, and the third woman has migraines that began with taking the birth control pill. Conventionally, all these women would be recommended to take a prescription medication, such as Imetrex or Relpax. From an integrative perspective, while all of these women would probably benefit from a multiple vitamin and magnesium supplementation, my advice would differ according to their health history and headache etiology.

Younger women with premenstrual migraines often respond to increased intake of B vitamins, especially riboflavin. If she also has severe menstrual cramps, Evening Primrose Oil (500mg bid) often helps with the dysmenorrheal as well as the headaches. Perimenopausal migraines often require hormonal balancing, though I’ve seen the most improvement for women who undergo a detox protocol as well. I highly recommend the Biotics Research 10-Day BioDetox Kit. Oral contraceptives are a common cause of migraines. The best choice if the birth control pill is causing migraines is for women to choose a different method of contraception. If that’s not an option, then in addition to B vitamin supplementation, a botanical formula containing Petasites hybridus “purple butterbur” can be effective for these types of migraines.

With many women’s health concerns (PMS, peri-menopause, menopause, osteoporosis, weight gain, and sexual health issues), comprehensive care addresses the cause but also focuses on treating the individual.


Michelle J. Pouliot, ND

Dr. Michelle J. Pouliot, Naturopathic Physician (Bastyr 1991), has been in practice in northwest Connecticut for the past 15 years. Her practice is focused on meeting women’s healthcare needs with botanical and nutritional medicine. She specializes in women’s conditions, menarche, PMS, peri-menopause, menopause, libido issues and osteoporosis. Dr. Pouliot is an adjunct professor at the University of Connecticut and Northwestern Connecticut Community College and is devoted to educating women and their healthcare practitioners about the value of naturopathic medicine.

 

Botanical Medicine for Menopause

Since 2000, two million women yearly have entered menopause. By 2015, 50% of women in the U.S. will be menopausal. Menopausal symptoms affect 80% of women with different presentations and intensity. Women experience these symptoms for months to years, while for some, symptoms can be life- long.

As a naturopathic physician, I’ve treated hundreds of women for menopausal concerns. While some women choose hormonal support, many women prefer to manage menopause with botanical and nutritional medicine. By far, hot flashes, night sweats and sleep disturbance are the most common complaint my patients feel negatively affect their energy, emotions and lifestyle.

I have found Black Cohosh (Cimicifuga racemosa) to be a very effective herb for managing hot flashes. In the past 2 decades, there has been more research done on the treatment of hot flashes with Black Cohosh than on any other herb. Consensus from research shows that Black Cohosh does help with the menopausal symptoms of hot flashes, sleep disturbance, muscle aches. The mechanism of action for Black Cohosh remains unclear, but research has shown, it doesn’t have phytoestrogenic effects on the pituitary, uterus or breast tissue.

As with any botanical formula, the quality of the herbs are critical to its effectiveness. I use Biotics Research’s BioPause-AM® and BioPause-PM® with my patients. BioPause-AM® contains Black Cohosh, Rhodiola rosea, Motherwort (Leonorus cardiac), and Chaste tree berry (Vitex agnus castus). The Rhodiola supports the adrenal and emotional stress of the hormonal swings in menopause, while the Motherwort helps with heart palpatations that often accompany hot flashes and night sweats. Chaste tree berry regulates the irregular menses associated with the perimenopausal transition and also seems to decrease hot flashes. BioPause-PM® is formulated to help with night time temperature deregulation and sleep disruption. Along with Black Cohosh, BioPause-PM® includes Lemon balm (Melissa officinalis) and Passion flower (Passiflora incarnate) for its calming effects on the nervous system and Magnesium glycinate for improving sleep quality. The dose schedule is 2 BioPause-AM® in the morning and 2 BioPause-PM® in the evening about 30 to 60 minutes before bed. These herbs are slow acting, so I let women know it make take 4 to 6 weeks for them to feel better. Women continue to take the BioPause-AM® and BioPause-PM® until their menopause symptoms resolve.

BioPause-AM® and BioPause-PM® along with other integrative natural therapies has helped the majority of my menopausal patients. It is an excellent choice for an alternative to hormone replacement for menopausal woman.


Michelle J. Pouliot, ND

Dr. Michelle J. Pouliot, Naturopathic Physician (Bastyr 1991), has been in practice in northwest Connecticut for the past 15 years. Her practice is focused on meeting women’s healthcare needs with botanical and nutritional medicine. She specializes in women’s conditions, menarche, PMS, peri-menopause, menopause, libido issues and osteoporosis. Dr. Pouliot is an adjunct professor at the University of Connecticut and Northwestern Connecticut Community College and is devoted to educating women and their healthcare practitioners about the value of naturopathic medicine.

 

Female Health Concerns

The medicalization of female health concerns have lead to increasing medical, surgical, and pharmaceutical intervention of several physiological changes that naturally happen in women’s health. It is true that many women have some difficulties with conditions such as: menstruation, pregnancy, premenstrual transition, perimenopause, menopause and osteopenia. In many instances these conditions respond well to nutritional and botanical treatment that brings women’s physiological vitality back into balance.

The current conventional treatment of osteopenia in women in their 50s and 60s is a case in point. I’m seeing many patients in this age group who have DEXA T scores in the -1.0 to -2.0 ranges. They are being told they are at high risk for fracture. These recommendations on their DEXA reports are from the NOF, the US National Osteoporosis Foundation. In contrast, the World Health Association (WHO) uses a different evaluation model, called FRAX, to assess if a women is at risk for an osteoporotic fracture in the next 10 years. I take the DEXA numbers and other important information from a woman’s DEXA report and history and enter them into the FRAX template. To date, according to FRAX, not one of these patients has been at risk for fracture in the next 10 years, whose NOF based DEXA report said differently.

Standards of conventional care often recommends bisphosphonates, such as Fosomax and Actonel, for osteopenia. Bisphosphonates have many side effects, including the risk of abnormal leg fractures after taking them for 5 years, as well as increased risk of esophageal cancer and jaw bone osteonecrosis. It is also unclear if treating a women with bisphosphinates for 5 years in her 50s, will prevent her from having osteoporotic fractures in her 70s, when she may be at risk for these fractures.

I’ve been tracking my patient’s vitamin D3 levels since 2005, when the research began being published about epidemic vitamin D3 deficiencies. I’ve checked over 500 women, and only 75 of them had optimal D3 levels (>40ng/dL). In the past 6 years, I’ve seen some patients maintain, slow down and even increase bone density with the proper D3 supplementation and other nutritional and life style measures.

These natural therapies benefit not only bones but also good health in general. They are often an effective choice for addressing many female health issues.


Michelle J. Pouliot, ND

Dr. Michelle J. Pouliot, Naturopathic Physician (Bastyr 1991), has been in practice in northwest Connecticut for the past 15 years. Her practice is focused on meeting women’s healthcare needs with botanical and nutritional medicine. She specializes in women’s conditions, menarche, PMS, peri-menopause, menopause, libido issues and osteoporosis. Dr. Pouliot is an adjunct professor at the University of Connecticut and Northwestern Connecticut Community College and is devoted to educating women and their healthcare practitioners about the value of naturopathic medicine.

 

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