Understanding IUD’s

Understanding IUD’s

According to a 2012 study which sought to reveal how American woman view intrauterine devices for birth control, the majority of those surveyed had inaccurate information about the efficacy and health concerns associated with IUD’s. Areas of misinformation included:

Efficacy: Most women did not know that IUD’s are more effective than the pill
STD’s: Nearly half of the women did not know that IUD’s do not increase STD risk
Cost: Most women did not know IUD’s are more cost effective over time than the pill

In other developed countries, especially throughout Europe, IUD’s are a leading form of birth control. For comparison’s sake, consider the following: IUD’s were used by only 2% of U.S. women on contraception in 2002, whereas countries such as Norway reported usage rates of greater than 20%.

I cannot speak to why IUD’s lack popularity among American women, but I do believe this lack of popularity, in part, explains why so many of us have incorrect information. With less popularity comes less use, and therefore less exposure to information (both professionally and through the experience of friends and family). IUD use appears to be on the rise in the U.S., but many woman are still hesitant to consider this form of birth control due to a lack of understanding. IUD’s are not ideal for everyone, and when appropriate, I advise patients to look elsewhere for contraception. However, in many cases IUD’s are a reasonable and safe alternative to systemic hormonal options, such as oral contraceptive pills and the Depo-Provera shot.

Below is the basic information I share with my patients when they are considering an IUD. If knowledge is indeed power (and I believe it is), I hope that the following basics of IUD contraception empower you to select your best form of birth control.

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IUD’s are ideal for women seeking long-term, reversible birth control, and especially those in monogamous relationships with least exposure to STD’s.

There are 3 types of IUD’s available in the U.S.:
1. Paraguard — Copper, hormone-free, lasts approximately 10 years
2. Mirena — Localized progestin, lasts approximately 5 years
3. Skyla — Localized progestin, lasts approximately 3 years (recently FDA approved)

Paraguard is the better choice for hormone-sensitive women. However, it does increase bleeding and cramping and should not be the first choice for those with irregular, heavy, or painful cycles.

Mirena is the better choice for women with heavy, painful periods. The localized hormone decreases bleeding and calms the smooth muscle of the uterus. For some women, there may be minor systemic symptoms from the progestin, including nausea, breast tenderness and headaches.

Skyla is a recently FDA-approved IUD that (like the Mirena) supplies localized progestin, but in a smaller dose. Whereas the Mirena contains 52mg of Levonorgestrel at time of insertion, Skyla contains 13.5mg. Skyla may be a more appropriate choice for women with heavy, painful menses who are more hormone sensitive, and also for those hoping to conceive in the next five years.

For women hoping to conceive in the near-future:
1. I do not recommend an IUD unless you plan to wait at least 2 years before trying to conceive.
2. This recommendation is based on cost and inconvenience of discomfort. IUD’s cost between $500-$1,000 and the insertion process can be painful, as can removal. In some cases, the IUD will be expelled by the uterus and insertion must be repeated.

Some advantages to consider:
1. Compliance is automatic – no need to remember your pill or schedule an injection
2. IUD’s will not suppress your body’s hormonal system (though sensitive women may feel some symptoms of hormonal imbalance when using the Mirena)
3. Most woman can conceive immediately after removal
4. Decreased pain & bleeding with the Mirena

Some disadvantages to consider:
1. Discomfort during insertion (mild pelvic & back pain should resolve after the first few days)
2. Irregular menstrual cycles for up to 6 months
3. Increased pain & bleeding with the Paraguard
4. IUD’s do not protect against sexually transmitted diseases

Though an IUD does not increase risk of STD’s (a common misperception according to the study mentioned above), there are rare but significant health risks that every woman should understand before selecting this form of birth control:

PID – Pelvic Inflammatory Disease
IUD’s do not increase the risk of acquiring STD’s, but they do increase the risk of developing Pelvic Inflammatory Disease if you do become infected. PID is an infection of the uterus and fallopian tubes that lead to infertility and may even become life-threatening if untreated. I recommend an alternative form of birth control for women with a history of Pelvic Inflammatory Disease, or those at increased risk for STD’s such as Chlamydia. Remember, IUD’s do not protect against STD’s. Combine with a barrier device such as a condom to prevent spread of infection.
Expulsion

The uterus will sometimes partially or fully expel the IUD via smooth muscle contractions. This is most likely to happen shortly after insertion, but it can occur at any time, causing pain and bleeding. The old IUD must be removed and a new one inserted.
“Lost” IUD
Less commonly, an IUD will slip out of place within the uterus and day surgery may be required to remove the contraceptive. IUD position and need for surgical intervention can be assessed with pelvic ultrasound.
Ectopic Pregnancy
A very small percentage of women may become pregnant while using an IUD. For this group, there is an increased risk of ectopic pregnancy. Similar issues of pregnancy, miscarriage and increased risk for ectopic pregnancy are present with other forms of contraception, as well.

 

Remember, these are only the basics. Make an appointment with your healthcare provider to discuss your specific questions and needs.

 

Dr. Kaley Bourgeois

 

 

Sources:

Callegari, LisaS. “Perceptions of intrauterine contraception among women seeking primary care.” Contraception. (2012): n. page. Print. <http://www.contraceptionjournal.org/article/S0010-7824(13)00048-6/abstract>.

FAQ: Contraception.” . The American Congress of Obstetricians and Gynecologists, Web. 25 Feb 2013. <http://www.acog.org/~/media/For Patients/faq014.pdf?dmc=1&ts=20130225T1735419185>.

Sonfield, Adam. “Popularity Disparity: Attitudes About the IUD in Europe and the United States.” Guttmacher Policy Review. 10.4 (2007): n. page. Print. <http://www.guttmacher.org/pubs/gpr/10/4/gpr100419.html>.

Eating to Erase Eczema

Eating to Erase Eczema

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A friend recently asked me what she could do to treat her eczema. After finding minimal help with prescription corticosteroid creams and antihistamines, she was hoping for an affordable, lasting treatment approach that she could manage at home.

Is there a home treatment worth trying? “Yes,” I told her. “You can find relief by eating to erase eczema.”

Eczema, also known as Atopic Dermatitis, is by no means a simple condition with one simple solution. The rash is an outward sign of inward dysfunction in the immune system, involving over-reactive inflammatory cells, often accompanied by a history of hay fever and asthma. Causes of inflammation and specific triggers vary from person to person, but most of us can get considerable relief by avoiding the most common dietary allergens and inflammatory foods. This gives the immune system a chance to calm down, and allows the rash an opportunity to heal.

By following a few strict, but straightforward dietary recommendations, my friend saw her eczema begin to resolve after 2 days. Another friend, this one suffering from Phompholyx (a form of eczema on the hands and feet) watched the itchy, painful bumps disappear after 1 week.

Below are the recommendations that worked for them.

For at least 2 weeks, remove the following top allergens:
1. Zero dairy (this includes foods with added whey or casein).
2. Zero grains (this includes corn, gluten free products such as rice, and items thickened with flour).
For at least 2 weeks, remove foods that promote inflammation:
3. Zero cane sugar (use stevia, or honey or palm sugar in moderation).
4. Limit red meat & eat only grass-fed, free-range animal products (animals fed grains and corn produce higher levels of inflammatory proteins that you then ingest).
Additional Recommendations:
5  Eat healthy fats in abundance (olive oil, coconut oil, fish oil, avocado, nuts & seeds).
6. Avoid already-known food allergens (such as eggs, soy, so on).

In my experience, most people report symptom relief, better energy and an increased sense of well-being after following steps 1-6. These patients often choose to stay on a grain-free, dairy-free diet. For those that hope to regularly enjoy a tasty rice pilaf or a thick wedge of gouda cheese, I recommend trying the following steps:

After at least 2 weeks, once the rash has significantly improved:
1. Add back 1 food per week (for example, cheese week 1, rice week 2, so on)
2. If the eczema begins to return, the most recently re-introduced food is likely a trigger for you. Avoid it.
3. Continue to minimize sugar–it will exaggerate any inflammatory response, regardless of the trigger.

Why does this work?
Picture your over-reactive immune system as a well built fire. The kindling is made up of various allergens (foods, dust, mold, pollen, etc.), and the lighter fluid is sugar and other inflammatory foods. With enough allergens, the fire will keep burning. Add some sugar, and you’ve got a bonfire.

If you can remove enough of the kindling, the fire will start to die down. A little lighter fluid may string it along, but the size and heat of the fire will begin to fade. This is exactly what you do by removing dairy and grains, and limiting sugar.

An estimated 80% of your immune system lives in your gut, meaning that your inflammatory cells and overall state of inflammation are especially sensitive to the foods you eat. For most people with food sensitivities, milk and gluten proteins are at the top of the list; I’ve found that many of these individuals are reactive to the proteins in other grains, too. Removing dairy and grains may not eliminate all of your allergen exposure, but it may be enough to put out the fire.

 

For additional information on eczema, allergies, and naturopathic treatment options,  please contact us at (503) 747-2021. Diagnostic testing and effective therapies are available, including allergy panels, immune system support, and gastrointestinal medicine.

Yours in health,
Dr. Kaley Bourgeois

References:
Allam, JP, Novak, N. “The pathophysiology of atopic eczema. .” Clin Exp Dermatol. 31.1 (2006): 89-93. Web. 13 Feb. 2013.
Furness, J, Kunze, W. “Nutrient Tasting and Signaling Mechanisms in the Gut, II. The intestine as a sensory organ: neural, endocrine & immune responses.” Am J Physiol. 277.5 (1999): G922-G928. Web. 13 Feb. 2013. <http://ajpgi.physiology.org/content/277/5/G922.full>.
Gentle nerve stimulation effective for migraines

Gentle nerve stimulation effective for migraines

Non-toxic, non-drowsy, non-chemical, non-addictive headache medicine that WORKS…………….. no side effects!

This kind of medicine is more along the lines of what is needed to make a lasting difference in chronic pain.

As you can see in the quoted MedPage study below, the highlighted words indicate the merit of micro-current as an electro medical modality:

  1. Non invasive – good, decreases side effects.
  2. Non chemical – good, less chance of messing something else up and needing more treatment for that in sensitive or multiple chemical sensitivity patients
  3. Affects trigeminal nerve – great, this is a very important pain generator in migraine headache

Results of electrical stimulation of branches of the trigeminal nerve:

  • Fewer monthly migraine attacks (19% versus 4% decline)
  • Fewer days per month with any headache (33% versus 4% reduction)
  • Lower monthly intake of acute anti-migraine drugs (-37% versus +1%)

Other options:

Neuraltherapy injections to the stellate and spehnopalatine ganglia are also very effective in clearing up migraine and sinus headaches.

Cleaning up your diet by avoiding the usual culprit foods like wheat, gluten, egg etc and

supporting your liver and gallbladder also are very helpful in cutting down the pain or sometimes better.

Trigger points in the base of the skull, muscles of the neck and shoulders are also very strongly involved in migraine headache causation.

Werner Vosloo ND, MHom

Nerve Stimulation Cuts Down on Migraines

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: February 11, 2013
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

 

A noninvasive device that electrically stimulates the trigeminal nerve prevented migraines for patients whose episodes were not well controlled by medication alone, a trial showed.

The number of days with a migraine dropped significantly by about two per month in the supraorbital transcutaneous stimulation group, without a change in the sham control group, Jean Schoenen, MD, PhD, of Belgium’s Liège University, and colleagues found.

While the difference between the two didn’t reach statistical significance, the coprimary endpoint showed three times more responders with at least a 50% drop in migraine days with neurostimulation (38% versus 12%, P=0.023), the group reported in the Feb. 19 issue of Neurology.

“The therapeutic gain (26%) is within the range of those reported for other preventive drug and nondrug anti-migraine treatments,” they wrote.

An accompanying editorial called for further study due to some issues with the trial, particularly whether blinding was good enough.

The 16 mA electrical pulses delivered by the device at 60 Hz intervals would be easy to feel if patients touched the electrodes whereas the 1 mA-, 1 Hz-sham stimuli “would be barely noticeable,” noted Eishi Asano, MD, PhD, of Wayne State University in Detroit, and Peter J. Goadsby, MD, PhD, of the University of California San Francisco.

“Taken together, this study has provided Class III evidence that neurostimulation with this device is effective and safe as a preventive therapy for migraine,” they concluded.

The PREMICE trial (Prevention of Migraine using the STS Cefaly) randomized 67 adults with at least two migraine attacks per month, regardless of aura, at five Belgian tertiary headache clinics to wear the sham or real device for 20 minutes daily for 3 months.

The Cefaly device consists of an eye glasses-style band with a self-adhesive electrode above the bridge of the nose covering the supratrochlear and supraorbital branches of the trigeminal nerve.

In an attempt to minimize unblinding, patients weren’t asked what the stimulation with their device felt like, weren’t enrolled if they were acquainted with another participant, and were kept from contact with each other during office visits so they wouldn’t have a chance to compare.

The sham group had a 20% drop in migraine days in the first month of treatment, similar to the active treatment group, but that effect disappeared thereafter.

By month 3, the mean number of migraine days in the neurostimulation group had fallen 30% to an average of 4.88 versus 6.94 per month during the run-in phase (P=0.023).

The average showed no change in the control group (6.54 versus 6.22 days per month, P=0.608).

“That the reduction in migraine days after effective supraorbital transcutaneous stimulation treatment just failed to reach the level of significance compared to sham stimulation may be due to the fact that the study was powered for responder rates, not for reduction in migraine days,” the researchers suggested.

Results didn’t differ by migraine aura status.

Among the secondary endpoints, significant advantages of neurostimulation versus sham were:

  • Fewer monthly migraine attacks (19% versus 4% decline)
  • Fewer days per month with any headache (33% versus 4% reduction)
  • Lower monthly intake of acute anti-migraine drugs (-37% versus +1%)

 

By comparison, the migraine prevention drug topiramate (Topamax) reduced monthly migraine days by 44% and monthly migraine attacks by 48%, with a 50% responder rate of 45% across its clinical trials.

Responder rates for other anticonvulsants, propranolol (Inderal), and behavioral therapy are in the same range as for the neurostimulation device.

“Since supraorbital transcutaneous stimulation therapy seems to be effective and well tolerated, it can be combined with drug treatments without risking cumulative adverse effects,” Schoenen’s group pointed out.

No adverse events or side effects occurred in either group.

The researchers acknowledged partial unblinding as a potential limitation of the study, as well as the younger age and shorter duration of migraine in the treatment group.

Citrus Fennel Chicken

Citrus Fennel Chicken

Citrus Fennel Chicken
Tangy, sweet, and down right healthy.

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Ingredients:
6 boneless, skinless chicken thighs
2 fennel bulbs
6 small tangerines
1 tbsp lemon pepper seasoning (I used Trader Joe’s)
1-2 tsp sea salt (or to taste)
2-3 tbsp olive oil
1/2 cup tangerine juice (unsweetened)

Pre-heat the oven to 400 °F

 

Preparation:
In a small glass, combine 2 tablespoons of olive oil, tangerine juice, 1/2 of your salt and 1/2 of your lemon pepper. Set aside.

Chop fennel bulbs into medium-sized chunks, approximately 2-3 cm across. Peel and separate tangerine slices. Combine fennel and fruit into a 9×9 inch baking dish and drizzle with 1 tablespoon of olive oil (optional). Sprinkle with half of your remaining salt and lemon pepper.

Place chicken thighs in dish, half burying them into the fennel and tangerine slices. Sprinkle the last of your salt and lemon pepper directly over the chicken. Pour the juice and olive oil over the entire dish, taking care to mix it immediately beforehand so that there is an even distribution of its contents.

Bake for 25 minutes at 400 °F, gently stir and flip contents, then bake for an additional 20 minutes at 350 °F.

 

Eat up!

 

Dr. Kaley Bourgeois