Herbal Therapeutics in Female Infertility - Carol Guyette
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Transcript of Herbal Therapeutics in Female Infertility - Carol Guyette
Herbal therapeutics in female infertility
Herbal practitioner:Herbal practitioner:
Carole Guyette MNIMHCarole Guyette MNIMH
History Taking for Fertility Problems 1History Taking for Fertility Problems 1
Delay in conceptionDelay in conception DurationDuration Previous Previous
investigations/treatments investigations/treatments Effect on client's lifeEffect on client's life
History Taking for Fertility Problems 2History Taking for Fertility Problems 2
Menstrual HistoryMenstrual History Menarche - age & how it was experiencedMenarche - age & how it was experienced Menstrual cycle - length/regularity/changesMenstrual cycle - length/regularity/changes Dysmenorrhoea - self help? Dysmenorrhoea - self help? Premenstrual symptoms Premenstrual symptoms Blood: colour/flow/clots/ease LMPBlood: colour/flow/clots/ease LMP Use of pads/tampons - how many? Use of pads/tampons - how many?
Symptoms related to ovulation -Symptoms related to ovulation -
History Taking for Fertility Problems 3History Taking for Fertility Problems 3
Mittelschmerz Mittelschmerz Mucus changes, bleeding Mucus changes, bleeding Bleeding irregularities - post Bleeding irregularities - post coital, stress...coital, stress...
Feelings/comments re cycle & Feelings/comments re cycle & others' perceptionsothers' perceptions
History Taking for Fertility Problems 4History Taking for Fertility Problems 4
Reproductive HistoryReproductive History Previous pregnancies Previous pregnancies Same/different partners Same/different partners Time taken to conceive Time taken to conceive Health during pregnancy Health during pregnancy Outcome - incl terminations, Outcome - incl terminations,
miscarriages miscarriages Residual feelings/body/cycle changes Residual feelings/body/cycle changes Labour & delivery, term/pre-termLabour & delivery, term/pre-term
History Taking for Fertility Problems 5History Taking for Fertility Problems 5
Sexual History Sexual History Intercourse Intercourse Frequency Frequency Enjoyment Enjoyment Lubricants Lubricants Dyspareunia Dyspareunia DifficultiesDifficulties
History Taking for Fertility Problems 6History Taking for Fertility Problems 6
Past contraceptive history Past contraceptive history Preference, changes, "failures" Preference, changes, "failures" Oral contraception - Duration, time Oral contraception - Duration, time
of cessation, resumption of of cessation, resumption of menses, side effects menses, side effects
IUD - symptoms of infectionIUD - symptoms of infection
History Taking for Fertility Problems 7History Taking for Fertility Problems 7
History of Mothers History of Mothers and Grandmothers and Grandmothers May reveal interesting May reveal interesting
patterns/attitudespatterns/attitudes
History Taking for Fertility Problems 8History Taking for Fertility Problems 8 Past Medical HistoryPast Medical History
Pelvic inflammationPelvic inflammation STDsSTDs Peritonitis Peritonitis
Pelvic operations Pelvic operations Tubal pregnancy Tubal pregnancy Appendectomy Appendectomy Drug therapy Drug therapy EndocrineEndocrine
Weight changeWeight change GalactorrhoeaGalactorrhoea HirsutismHirsutism Acne Acne
SmearsSmears
History Taking for Fertility Problems 9History Taking for Fertility Problems 9
Social History Social History Occupation & intentions Occupation & intentions Domestic circumstances Domestic circumstances Relationship with partner Relationship with partner DietDiet Smoking Smoking Alcohol Alcohol Stress Stress ExerciseExercise
History Taking for Fertility Problems 10History Taking for Fertility Problems 10
Psychological history Psychological history Reasons for wishing Reasons for wishing
conception conception Conflict re. conception Conflict re. conception Depression Depression Previous psychiatric Previous psychiatric
problemsproblems
Female Infertility/ Sub-fertility
What is cause? physical/emotional/mental/spiritual
What block/s prevents successful pregnancy?
Case History Taking
Ideally see both parties Fully assess nutritional status/ alcohol,
cigarette or drug use/ exercise/ stress/ lifestyle/ environmental factors
Further investigations? Treat underlying pathology e.g. Endo,
PID, PCOS, Infections such as Chlamydia, low thyroid function…
Common presentations
failure to conceive (no underlying pathology)
recurrent miscarriage (includes implantation failure)
Diet/supplements/lifestyle
Foresight 99% success – hair mineral analysis
Exercise aerobic 3-4 x weekly Yoga, Tai Chi
Woman slow to conceive/history of miscarriage
Spend 3-6 months preparing woman (improve general health & hormone balance)
Don’t try to conceive in this time Set time limit with patient e.g. 12months
(to review) Inspire hope/ positive thought; identify
blocks Avoid blame – remember that everything
happens for a reason – ?unknown
Herbs contraindicated in pregnancy Toxic herbs: e.g. Phytolacca, Sanguinaria, Aconitum,
Bryonia (Lobelia can be useful for threatened miscarriage & in childbirth) (Gelsemium can be useful in childbirth). Internal use of essential oils due to high risk of overdosage (small quantities fine in flavourings)
Other herbs: Angelica sin. – not in 1st trimester Artemesia spp. - no more than 500mg/day Caulophyllum - only take in last 6 weeks Chelidonium – no more than 1000mg/day Datura – suspected teratogen Mentha puleg. Petroselinum – due to apiol content (negligible in Apium) Peumus boldo Ruta Sarothamnus Tanacetum parthenium – no more than 500mg/day Tanacetum vulgaris Thuja Viscum – only take in last 6 weeks Zingiber – no more than 2000mg/day Panax ginseng – only at delivery Eleutherococcus
Herbs to avoid at high dose > 3g daily (i.e. 6ml 1:2, 15ml 1:5, av. 2 teasp dried)
Achillea Aesculus Angelica arch. Barosma
betulina Berb spp. Hydrastis Juniperus Lycopus Salvia
Herbs to use with caution Essential oils external use –
Cinnamon, nutmeg (these 2 useful for massage in last few weeks), myrrh, clary sage (useful for delivery), jasmine, juniper, pennyroyal, marjoram, oregano, cypress, thyme, sage, savoury, wintergreen, hyssop, basil, aniseed, fennel
Laxatives (avoid though probably safe at normal dosage) Aloe, Rhamnus, Cassia, Rheum
Herbs for infertility FAILURE TO CONCEIVE
Problems with ovulation and/or cervical mucus usually strong hormonal component e.g. amenorrhoea - post-pill, commonly seen
after shock or bereavement, excessive exercise, seriously underweight/overweight… VITEX
Sperm antibodies – what’s going on in relationship?
ensure patient knows fertile times MUCUS CHART Monitor mucus and other
signs of ovulation (e.g. mittelschmertz/temp changes)
Herbal Therapeutics in Female Infertility
Ovulating and no known reason for not conceiving What is condition of tissues? (incl
emotional/mental blocks) What actions required?
Cleanse toxins – individual needs, ensure no GU infection, fertility treatments?
Tonify/nourish/rebalance/relax/stimulate etc…
Fertility tonics Useful herbs:
Chamaelirium (cultivated) – prime fertility herb, magnificent uterine and ovarian tonic, strengthens pelvic tissues and promotes pelvic nutrition. Up to 30ml/week
Rubus – strengthens and tones pelvic muscles, relaxing at same time. Soothes kidneys, tones mucous membranes. Tea or tincture - up to 40ml/week
Relaxes uterus when contracted, contracts uterus when relaxed. Provides excellent support. Emotionally - helps soften the heart and
allow for greater receptivity and intuition. Viburnum prunifolium – uterine sedative, anti-spas, relaxant to
uterine muscle, spec. for uterine irritability & painful conditions of pregnancy improves uterine & ovarian circ > promotes pelvic nutrition Strengthens pelvis after prev. miscarriage One of best remedies for nervous conditions in pregnancy or affecting
fertility
Fertility tonics Vitex increases Progesterone & LH
Hormonal balancer par excellence esp. where low progesterone – e.g. woman prone to early miscarriage e.g.9/40 spotting or miscarriage
Brings inner strength & emotional balance. Alchemilla vulgaris –
Uterine tonic. Hormone balancer. Promotes fertility. Haemostatic. Traditionally for soft, gentle women
Mitchella – Uterine strengthener, inspires self-confidence
Leonurus – Uterine tonic and sedative, reduces nervous tension, anti-spas,
helps pelvic irritability. Helps with fears around motherhood. Dioscorea –
Powerful smooth muscle relaxant relieving spasm and inflammation, regulates hormones, opens up blood vessels
Fertility tonics
Trifolium Alterative, Hormone balancer (phytoestrogens),
lymphatic cleanser, anticoagulant. Trigonella
“there’s a baby in every cup” (Weed) – bitter & warming, stimulates uterus, soothes irritable tissues, reduces blood sugar & cholesterol, benefits weak digestion
Serenoa Adaptagen, sedative, warming, helps sex drive, urinary
antiseptic, endocrine stimulant, helps intimacy & openness, learning to give & receive
Anemone Sedative, anti-spas, reduces pain in repro system,
soothes inflamed mucous membranes
Fertility tonics Too cold
Zing Achillea – improve circ to pelvis Pelvic congestion
above & Calendula – improve circ of blood & lymph, Attention to NS
Scutellaria, Avena, Hypericum, Passiflora, Valerian, Verbena, & Raise vital force
Salvia
Uplift Rosemary, Melissa
Loss of libido Vitex, Serenoa Healthy sex life depends on good ovarian, adrenal and pituitary function (&
psychological) Cause could be hormonal, exhaustion, depression, drug-related,
relationship difficulties, fear of pregnancy… related to family attitudes, childbirth…,psychological(eg prev. abuse)
Turnera aphrodisiac, sexual stimulant, anti-depressive, promotes well-being,
relieves anxiety
Case history 1Case history 1 Woman 40yrs Sec. school teacher – v.busy
lifestyle – worrier/stressed Trying to conceive for 12/12. Stable, happy
relationship. No prev. pregnancies. History of PMT. Regular, ovulatory cycles apart
from times of high stress. Chocaholic. R Vitex 20 Chamaelir 20 Verbena 20 Scut 20
Avena 20 (x2) sig 7 ½ ml. bd Kept her on same or similar mix for 3 months.
Drastically reduced sugar & chocolate. PMT disappeared, reduced Vitex to 10 & put in Chamomilla. Conceived after total 7 months. Healthy pregnancy & normal delivery.
Case history 2Case history 2 Woman 41yrs Trying to conceive 7years. MH 1 healthy FT
pregnancy @ 25. Unplanned. Daughter age 15, raised by patient’s mother for 1st 3 years. GRIEF & ANGER , husband told her she was ‘depressed’ for those years although she did not remember clearly.
Normal ovulation and hormone levels. Partner’s sperm – good numbers & motility
Wanted to avoid IVF. Aim: to dissolve grief and other emotions trapped in tissues. Facilitate letting
go of mistaken beliefs. R Rosa 20 Borage 20 Leon 20 Alth rad 20 Anem 10 Chamaelir 10 (x2)
sig 5ml bd R Alchemilla vulgaris Tea one cup daily + flower essences
Released huge grief. Woke in night saying “I’m not a bad mother”. Healing dreams. Now feels a different person.
Similar herbs over 8 months leading to conception and healthy FT pregnancy.
Use of ‘medicine bundle’ to connect with uterus – release feelings without having to analyse.
IVF etc.
Recurrent Miscarriage
Can’t stop inevitable miscarriage Properly prescribed, herbs will not interfere with nature’s
course - will not delay inevitable miscarriage or in any way endanger the patient
Use at low dose prophylactically at danger time Use higher dose in acute threatened miscarriage Uterus functionally unable to support foetus:
Chamaelirium – esp. helpful where history of miscarriage. Uterine irritability. Poor
tone in cervix. V. safe & nourishing. Ovarian & uterine tonic Vib prun-
tonic, astringent, anti-spasmodic, relaxant, uterine sedative, improves uterine circ, useful for uterine irritability
Combine Chamaelir & Vib prun for threatened miscarriage 10-20gtt every 30-60 mins for spotting, cramping, bleeding. Rept until symptoms clear > 20gtt (or more) mane until 22/40 approx.
Hormonal imbalance Vitex
helpful when history of early miscarriage esp. where low progesterone
eg 9/40 spotting (?corpus luteum insuff?) supports progest/corpus luteum/HCG
up to 10ml daily (usually much lower) if history of early miscarriage, esp. if suspect low progesterone
Case history 3Case history 3 Recurrent miscarriage & low progesterone. Woman – 33 yrs. 5/40 pregnant MH-Age 26- miscarriage at 9/40; age 28 miscarriage at 15/40; age 29 FT pregnancy
given progesterone injections from week 7 (>vomiting,constant fatigue which continued after delivery & cessation of progesterone)
RVitex 20 Chamaelir 30 Galega 10 Vib prun 20 Fucus 20 (x2) sig 5ml tds +resc. Rem Emergency drops: R Chamaelir 30 Vitex40 Vibprun30 (x1) sig 20gtt hourly prn
Started getting period-type cramps at 9/40 – lasting about ½ hr stopping & starting Cramps stopped after 2 days on emergency drops. Bed rest/ relaxation/ visualization/ inner dialogue. Keep bowel moving (avoid reflex
irritation of uterus) Cramps recurred on a few occasions up to 16/40, soon cleared with drops. Continued on original mix until 19/40 when she developed headaches. R changed to:
RChamaelirium 30 Vib prun 30 Mitchella 20 Rubus 20 (x1) sig 40gtt t.d.s. at 24/40 - RRubus 30 Mitchella 30 Achillea 30 Aesculus 10 (x2) sig 5ml bd.(varicose veins)
Went on to have normal FT delivery and healthy baby. Mother made quick recovery and reported that her energy was ‘better than it had
been for years’.
Rubus + Mitchella – Strengthening & relaxing combination for uterus. 20gtt bd/tds up to 5ml bd/tds
Leonurus – tones uterus, reduces nervous tension & spasm. Lovely uterine sedative for false labour pains, nervous debility, pelvic irritability.
Additional nervines/rescue remedy
Case history 4Case history 4
Woman 35yrs.MH Uterine fibroids. Surgery @27. Trying to conceive past 6/12. History alcohol/smoking R Calendula 20 Chamaelir 10 Rubus 20 Tarax rad 30 Achillea
20 (x2) 5ml tds Circ/lymph/ uterine/fertility tonics/ liver/ circ/
Fertility Tea on Full Moon: ALCH. VULG./RUBUS (TRIFOLIUM) Conceived after 5/12. At 32/40 niggling pains like ‘crampy period pains’ back & front on
walking (not Braxton Hicks) could last 30-60mins. No blood loss Stressed. Split with partner.
R Rubus 30 Mitchella 30 Leon 20 Vib prun 20 (x2) 5ml tds (+ rubus tea)
Pains became less frequent, shorter duration and ceased after 10days 36/40 nervine mix R Chamomilla/Val/Pass 10ml nocte
Normal delivery at 41/40 & healthy baby