Pelvic Problems

Nature's Solutions for Pesky Pain
and Devilish Discomforts

Before Victoria Homeier learned to use visualization to ease the pain, endometriosis left her down and out one week out of every four.

"The pain during my menstrual periods was debilitating," recalls Homeier, a 30-year-old undergraduate student at the University of Colorado in Greeley, who was diagnosed with endometriosis at age 18. "My doctor prescribed painkillers, but the drugs made me so drowsy that I'd end up sleeping through the week."

A condition in which pieces of the endometrium (the lining of the uterus) grows outside of the uterus, endometriosis is a fairly common problem. And a puzzling one. No one knows exactly why endometrial tissue shows up where it shouldn't. Some women have tissue attached to their ovaries, intestines and even their lungs. Though displaced, the endometrial tissue bleeds when a woman has her period, just as the lining of her uterus does. The bleeding can cause cysts and scarring that can lead to chronic pain or infertility. In extreme cases, doctors may recommend surgery to remove the stray tissue or a hysterectomy to remove the uterus.

"I didn't want to consider surgery until I'd tried everything else," says Homeier. "So when we learned about visualization in one of my classes, I decided to try it and see whether it could help. And it did."

To deal with endometrial pain, Victoria set aside 20 minutes a day for visualization. "I'd visualize the inside of my pelvic wall, imagining the endometrium tissues attached there getting smaller and smaller until they disappeared," she explains. "What a relief it is to no longer have debilitating pain."

Certain alternative therapies, like visualization, food therapy, herbal medicine, and vitamin and mineral therapy can help treat a range of gynecological problems, from endometriosis to vaginal itching, among others, says Tori Hudson, doctor of naturopathy, professor of gynecology at National College of Naturopathic Medicine and director of A Woman's Time clinic, all in Portland, Oregon.

"Natural remedies are, by and large, nontoxic and safe, so you don't have to worry about the side effects that you might get with drugs or the complications associated with surgery," says Dr. Hudson.

Here's a problem-by-problem guide to common gynecological problems and their recommended natural therapies, followed by across-the-board strategies that can also help.

CERVICAL CHANGES: KEEP TROUBLE IN CHECK

No one likes getting a Pap test. No matter how high you register on the aplomb scale, it's hard to feel comfy lying on an exam table, waiting patiently while a doctor uses a tiny spatula to scrape cells from your cervix. But a Pap test is something that you shouldn't forgo. An annual test can save you from cervical cancer. A Pap test tells your doctor whether your cervical cells are normal or whether they are developing abnormalities that could lead to cancer. Given early warning, your physician can treat precancerous abnormalities before they become cancerous or treat early cancer before it spreads.

Since cervical changes usually come with no symptoms attached, the Pap test is absolutely essential, says Chris Meletis, doctor of naturopathy and clinic director, chief medical officer and medicinary director at the National College of Naturopathic Medicine in Portland, Oregon.

What causes cervical abnormalities? Research points the finger at the sexually transmitted human papillomavirus (HPV). Not everyone who has HPV, however, develops cervical abnormalities. A strong immune system, it seems, can help protect you from abnormalities even if you have HPV, says Dr. Hudson.

If you've been diagnosed with cervical abnormalities (cervical dysplasia), you should be under a doctor's care, says Dr. Hudson. If abnormalities are cancerous, you'll need surgery. If things haven't progressed that far, a variety of alternative treatments can help reverse abnormalities.

Fortify with folic acid. The supplemental form of the B vitamin folate, folic acid can help prevent and, in high doses, help reverse cervical abnormalities, research suggests. Population studies find that women who get little of this vitamin run a higher risk of developing cervical changes. To help fend them off, Dr. Hudson recommends 2,500 micrograms of folic acid daily for women who are at higher risks, such as smokers, women on birth control pills and women with changing sex partners. (Amounts higher than 400 micrograms can mask signs of B₁₂ deficiency, so higher doses should be used with a doctor's guidance.) It is best to take folic acid with other B vitamins as found in a multivitamin/mineral or B-complex supplement, he advises.

If your doctor has determined that you have cervical abnormalities, ask her if a prescription-level dose of folic acid can help restore your cells to normal.

Add antioxidants. Vitamins such as beta-carotene and vitamins C and E, along with the mineral selenium, protect healthy cells from damage by free radicals--byproducts of oxidation that occurs in the normal course of living and breathing, in all tissues. Your body needs antioxidants to build healthy cervical tissue and keep your immune system going strong, says Dr. Meletis. In a preliminary study conducted at the University of California in Irvine, women with cervical dysplasia took 30-milligram (50,000 international units, or IU) supplements of beta-carotene daily for 19 months. When checked 6 months later, 21 of the 30 women were free of abnormalities.

To prevent and reverse cervical changes, Dr. Meletis recommends a good diet that includes dark leafy greens, 800 micrograms of folic acid, 25,000 IU of beta-carotene and 400 IU of vitamin E every day. He also recommends 500 milligrams of vitamin C two to three times daily and up to 100 micrograms of selenium. (If high doses of vitamin C give you diarrhea, cut back.)

See a naturopath. To treat cervical dysplasia, a naturopath might take a multi-pronged approach: She may prescribe supplements of immunity-boosting vitamins, plus antiviral herbs (such as echinacea), and paint your cervix with a solution made from natural ingredients like zinc chloride, among others, that encourage your body to shed abnormal cells, explains Kareen O'Brien, a naturopathic physician and academic dean at Southwest College of Naturopathic Medicine and Health Sciences in Scottsdale, Arizona.

ENDOMETRIOSIS AND UTERINE FIBROIDS:
VITAMINS AND IMAGERY HELP

If your menstrual periods have progressed from minor annoyances to disabling episodes of heavy bleeding, cramps and pain, you probably don't need a book to tell you to seek medical help. But diagnosing the problem can be tricky, even for doctors.

For many women, the cause of severe pelvic pain turns out to be either endometriosis or uterine fibroids, sinewy growths that develop in the uterus.

Fibroids can compress the endometrial lining, causing excessive bleeding during and between periods. If uterine fibroids grow in such a way that they block the ureters, the tubes draining the kidneys, they can trigger kidney problems. Fibroids are noncancerous growths.

Like endometriosis, uterine fibroids are puzzling. No one knows exactly what causes them. It's clear, though, that excessive estrogen levels makes fibroids worse.

Some women have such severe uterine fibroids or endometriosis that surgery (to remove either the problem tissue or the entire uterus) is the only effective option, says Dr. O'Brien. In less severe cases, doctors may prescribe hormones that mimic menopause and limit estrogen production, shrinking fibroids or endometrial fragments. Or doctors may prescribe oral contraceptives, which can control the bleeding from endometriosis. The catch is, birth control pills can deplete a woman's folate stores, increasing her risk of cervical dysplasia, says Dr. O'Brien.

If endometriosis or fibroids are mild enough, natural remedies for pelvic pain due to endometriosis or uterine fibroids may get equally good results, Dr. O'Brien says.

Bring on the bioflavonoids. Found in citrus fruits, garlic, onions and all vegetables, bioflavonoids are plant compounds related to vitamin C. Among other benefits, bioflavonoids seem to reduce excessive bleeding by strengthening capillary walls. They may also help lower excessively high estrogen levels. Dr. Hudson recommends supplements of 1,000 milligrams of bioflavonoids daily. They're available at health food stores.

Bolster your Bs. B vitamins help your liver rid your body of excess estrogen, notes Susan Lark, M.D., author of The Estrogen Decision Self-Help Book. She recommends 50 to 100 milligrams of vitamin B-complex daily and up to 300 milligrams of vitamin B₆ for women using birth control pills.

Caution: When taken over a long period of time, amounts of more than 50 milligrams of vitamin B₆ can cause unstable gait and numb feet. So don't take more without the consent of your physician.

Visualize a healthy uterus. Visualization exercises can help you manage the symptoms of endometriosis and fibroids, says Dr. Hudson. Visualize your uterus intact, free of maverick tissue and disruptive growths. You should practice this 10 to 30 minutes a day, three to five times a week.

Consult a naturopath. Naturopathic physicians may prescribe other herbs and supplements that help the liver clear excess estrogen from the body. They may also prescribe natural progesterone, a laboratory-modified herbal extract that relieves pain and reduces bleeding, says Dr. O'Brien.

Since progesterone modified in this way is essentially a drug, the only way to utilize it is via a naturopath.

INFERTILITY: THINK YOURSELF PREGNANT

When Boston's Deaconess Hospital introduced a program to help women deal with the stress of infertility, the results were both predictable and surprising. As expected, nearly all of the women who practiced stress-reduction techniques such as yoga, meditation and breath work felt less stressed-out after finishing the program. Surprisingly, almost 40 percent of them were pregnant six months later.

The high pregnancy rate among program graduates isn't proof that stress causes infertility. But it strongly suggests that stress contributes to the problem and that stress relief can help solve it, says Alice Domar, Ph.D., psychologist, program founder and author of Healing Mind, Healthy Woman.

Aside from stress, an array of physical problems can impair fertility. As mentioned, severe endometriosis and uterine fibroids can also contribute to infertility in women, as can aging. Fertility drops slightly between the ages of 25 and 35, then drops sharply after age 35, followed by an even more dramatic fall after age 40.

Among women, the most common causes of infertility are chlamydia and gonorrhea, which can scar the fallopian tubes, explains Adriane Fugh-Berman, M.D., former head of field investigations for the Office of Alternative Medicine at the National Institutes of Health in Bethesda, Maryland.

If you're having a hard time getting pregnant, you and your partner should see a doctor who can help you get to the heart of the matter. Some problems, like blocked fallopian tubes, require surgery. But depending on the cause, fertility can be restored with simpler measures. Here's what you can do to boost your odds of getting pregnant.

Use "reverse" birth control. Sometimes, infertility is no more than a matter of bad timing, says Joseph B. Stanford, M.D., assistant professor at the University of Utah School of Medicine in Salt Lake City. Studies find that nearly all pregnancies can result from intercourse during the time that starts five days before ovulation and ends with the day that you ovulate. If you don't have intercourse during your fertile period, you won't get pregnant.

To figure out exactly when you're fertile--and when to have intercourse--Dr. Stanford says, "Use Natural Family Planning." (For information on how to use Natural Family Planning, see page 466.)

Slip your man some supplements. Supplemental doses of vitamins E and C, selenium and folic acid can improve sperm quality and improve the odds of conception, says Dr. Fugh-Berman. She recommends 150 micrograms of selenium, 500 milligrams of vitamin C, 400 IU of vitamin E and 800 micrograms of folic acid daily. Talk to your doctor before taking more than 100 micrograms of selenium, and keep in mind that amounts higher than 400 micrograms of folic acid can mask signs of B₁₂ deficiency.

Cut out caffeine. High doses of caffeine can lead to delayed pregnancy, says Dr. Meletis. A study that followed 1,400 women found that among those who downed more than 300 milligrams of caffeine daily and had unprotected intercourse, most took more than a year to get pregnant--considerably longer than those who curtailed caffeine. For the record, 300 milligrams is about what you'd get in three cups of coffee.

Say, "I can be a mother." In addition to yoga, meditation and breath work, the stress-reduction program at Deaconess Hospital teaches women cognitive therapy techniques. The basic premise behind cognitive therapy is that you can enjoy better mental and physical health if you scuttle irrational and negative beliefs.

Women with fertility problems are often bogged down with negative thinking, repeatedly telling themselves things like, "I'll never be a mother," Dr. Domar notes. You can use the following cognitive therapy technique to disabuse yourself of such notions, she says. The next time you tell yourself that you can't have a baby, ask yourself, "Did the doctor say that I couldn't have a biological child?" The answer is probably no. In light of that, ask yourself, "Is my belief logical?" Again, the answer should be no. By repeating the exercise, you should be able to snap yourself out of illogical, negative thinking.

VAGINAL DRYNESS: EASING PAINFUL INTERCOURSE

Sex should feel wonderful. But it can feel downright painful if your vagina loses its natural ability to self-lubricate and ease intercourse.

More often than not, dryness is the result of hormonal change or nutritional deficiency, says Dr. Meletis. Certain drugs or menopause can cause hormonal changes that contribute to dryness. When you stop menstruating, your ovaries produce less estrogen, the hormone that helps keep vaginal tissues moist, thick and flexible, says Dr. Meletis.

If your doctor has ruled out thyroid problems or other medical causes, these remedies can restore vaginal moisture.

Rebuild with supplements. To maintain delicate vaginal tissue, your body needs a variety of vitamins and minerals. To make sure that you have enough of the essentials, Dr. Meletis suggests that you take 400 IU of vitamin E, 25,000 IU of beta-carotene, 15 milligrams of zinc and 800 micrograms of folic acid daily. (If you take more than 400 micrograms of folic acid, your doctor needs to monitor your vitamin B₁₂ levels.)

Take a tablespoon of flaxseed oil. If your vagina is parched, you may be deficient in essential fatty acids, oils found in plants and fish that are essential to the health of vaginal tissues, says Dr. Meletis. The remedy? Swallow a tablespoon of fatty acid-rich flaxseed oil daily. You can find the oil in the refrigerated section of health food stores.

Use a lubricant. Over-the-counter lubricants like K-Y Jelly, Replens or Astroglide work well if you're dry. (You can buy vaginal lubricants at any drugstore.)

Or try a small dollop of olive oil, applied to your vagina, says Dr. O'Brien. But don't use the olive oil if you're also using a condom, since any oil will damage the latex, she says. (For practical solutions for vaginal dryness associated with menopause, see page 436.)

VAGINAL ITCHING: A SIGN OF INFECTION

Few things are as maddening as vaginal itching or pain. Often, it's the result of an infection or an allergic reaction, says Dr. O'Brien.

If you see a doctor, she may diagnose the problem as vaginitis, a catchall term for any inflammation of the vagina, whether it's caused by an allergy or an infection.

Vaginal infections are very common. And the most common vaginal infections of all are trichomoniasis, yeast infections and bacterial vaginosis. Chlamydia, herpes and gonorrhea infections are also relatively widespread.

The trick to relieving vaginal problems is knowing what you have. Many vaginal infections have similar symptoms but varying causes and consequences, explains Dr. O'Brien.

Trichomoniasis is caused by a parasite and is usually sexually transmitted. Telltale symptoms of "trich" infections include itching, burning and soreness and a yellow-gray, foamy, foul-smelling vaginal discharge. Some women, though, don't have any symptoms.

Yeast infections, on the other hand, are almost always itchy and are often accompanied by a cottage-cheesy discharge. Bacterial vaginosis can cause itching or burning, unpleasant odor and white or gray vaginal discharge. Both yeast infections and bacterial vaginosis are often caused by overgrowths of organisms native to your vagina, explains Dr. Meletis. With yeast infections, the culprit is usually an organism called Candida albicans. With bacterial vaginosis, the culprits may be Gardnerella, Bacteroides or Peptostreptococcus bacteria.

Normally, yeast, Gardnerella and the like are kept in check by other beneficial organisms found in your vagina. But douches, birth control pills, hormonal changes during pregnancy and antibiotics can kill off helpful bacteria and lead to an overgrowth of yeast, Gardnerella, Bacteroides or Peptostreptococcus.

Since yeast, Gardnerella and these other irritating organisms thrive in a moist environment, wearing stockings or nylon underwear that don't allow vaginal moisture to evaporate can also lead to increased chance of infection, says Dr. Meletis.

Bacterial vaginosis may increase your risk of complications during pregnancy, including premature birth. If the infection spreads through your cervix, uterus and fallopian tubes to your pelvic cavity, it can lead to painful pelvic inflammatory disease.

Other sexually transmitted infections--such as HIV, herpes, syphilis, gonorrhea, chlamydia and human papillomavirus--can cause other complications, says Dr. O'Brien.

Syphilis, a bacterial infection that causes a painless vaginal or vulvar sore, later a rash and still later involvement of almost any organ, can be fatal if untreated. Gonorrhea, which may cause vaginal discharge and, in rare cases, pain during urination or cause no symptoms at all, can lead to pelvic inflammatory disease. Chlamydia, which is usually symptom-free, can also lead to PID. Human papillomavirus is also virtually symptom-free but may lead to cervical changes that can progress to cancer if untreated. Herpes announces itself with painful vaginal blisters. Many of these sexually transmitted diseases make it easier for HIV infection to occur.

CHECK IT OUT

You should see your doctor for a diagnosis if you have vaginal burning, pain or discharge, says Dr. Fugh-Berman. And every sexually active woman should have tests for gonorrhea and chlamydia during an annual gynecological exam. You'll need antibiotics for bacterial vaginosis, chlamydia, gonorrhea or syphilis, she says. For yeast infections, your doctor may recommend an anti-yeast cream like Monistat or Gyne-Lotrimin.

Alternative approaches can help prevent or soothe less serious infections, like yeast infections. Here's what works.

Cover up. Protect yourself from sexually transmitted infections by using condoms, says Dr. Fugh-Berman. If you're sexually active, using condoms, spermicides, diaphrams, cervical caps and female condoms can protect against some sexually transmitted diseases, but male latex condoms are the best, she says.

Shield yourself with zinc and C. If you're prone to vaginal infections, Dr. Meletis suggests 15-milligram doses of zinc daily. "Zinc makes membranes more resistant to infection," he says. Add 500 milligrams of vitamin C two to three times daily to shore up your immune system, Dr. Meletis suggests. (If you get diarrhea from high doses of vitamin C, take less.)

Meet some nice bacteria. Among the organisms that normally inhabit your vagina are lactobacillus acidophilus, good-guy bacteria that help keep potentially irritating types like yeast in check. To reinforce your lactobacillus troops--and prevent or recover faster from yeast infections--eat eight ounces of lactobacillus-fortified yogurt daily, says Dr. Meletis. (Check the label to make sure that the yogurt contains live lactobacillus.)

If you don't like yogurt or are in the throes of a stubborn yeast infection, a naturopath can write you a prescription for a concentrated dose of lactobacillus in vaginal suppository form, adds Dr. O'Brien. (So can an M.D. or osteopath.)

Or you can tap the powder out of a lactobacillus capsule, mix it into a paste with water and put it into your vagina, says Dr. Fugh-Berman.

Adjust amino acids, help herpes. People with herpes tend to have too little of the amino acid L-lysine and too much of the amino acid arginine in their bodies, says Dr. Hudson. This imbalance can trigger blister outbreaks. By correcting the imbalance, you can help keep outbreaks under control, she says.

To do that, avoid high-arginine foods like nuts and chocolate. And take 2,000 milligrams of the amino acid L-lysine daily during an acute outbreak, says Dr. O'Brien. You can find the amino acid in most health food stores.

Allow breathing room. You can lower the odds that you'll get repeat yeast infections if you wear cotton underpants and pantyhose with cotton crotches, says Dr. Meletis. That's because yeast like moisture. And cotton, unlike nylon, lets excess moisture evaporate.

Ban all chemicals. Steering clear of scented tampons, sanitary napkins, toilet paper, douches and vaginal deodorants will help you steer clear of vaginal itching and pain due to chemical irritation, says Dr. Meletis.

WHOLE-BODY STRATEGIES
FOR GYNECOLOGICAL HEALTH

Here's a rundown on other important approaches that can help prevent and treat more than one gynecological problem.

Adopt a low-fat, high-fiber diet. A diet sparse in meat and fat, devoid of all dairy products and abundant in complex carbohydrates such as vegetables and fruit may help ease endometriosis and symptoms of uterine fibroids. Why? A high-fat diet prompts your body to produce an excess of the female hormone estrogen. And high estrogen levels exacerbate conditions like uterine fibroids.

Since meat is relatively high in fat, some women find that symptoms of both conditions improve when they switch to mostly vegetarian diets, says Christiane Northrup, M.D., in her book Women's Bodies, Women's Wisdom. Dr. Northrup is a practitioner of obstetrics and gynecology in Yarmouth, Maine, and assistant clinical professor of obstetrics and gynecology at the University of Vermont College of Medicine in Burlington.

Eat your share of fruits and vegetables. Filling up on brightly colored fruits and vegetables, instead of fat, is a good bet because bright yellow, red and green produce is rich in vitamin C and beta-carotene, nutrients that fortify your immune system and help you fight off infections, including vaginal infections, says Dr. O'Brien. Research suggests that adequate levels of folate (400 micrograms), a B vitamin abundant in leafy greens, may help prevent the human papillomavirus from causing cervical dysplasia.

Sweat it out three times a week. Exercise benefits reproductive health indirectly: Exercise boosts immunity by raising levels of natural killer cells and T cells that kill viruses, fungi and bacteria. And it increases the activity of immunoglobulins, key factors in the defense against invaders, so that you're better able to resist and fight infections.

Regular exercise also helps you burn calories and control your weight, which is important because research finds that both overweight and underweight women have a harder time conceiving th