Integrative Gynecology

The Future Of Gynecology

Though formally trained as a medical doctor specializing in Obstetrics and Gynecology, I have deepened and expanded my training to incorporate complementary healing practices.  The beauty of integrative medicine is its ability to take Western, conventional medicine training with its modern understanding of the human body and modern therapeutic techniques and integrate it with ancient healing traditions and naturopathic practices.  It is not simply using ancient healing philosophies to “complement” medical practice or to use them as an “alternative” to conventional medicine.

Integrative Gynecology

My interest in integrating traditional with naturopathic approaches is a result of over 16 years of a robust gynecology practice.  As women became more knowledgeable about their bodies and their hormone health, we as practitioners needed to look beyond our limited, somewhat narrow focus on gynecologic diseases.  All too often, women are offered very limited options in terms of relieving intrusive and troubling symptoms related to hormonal imbalance.  I look back at my early years of practice when my therapeutic arsenal contained Prempro, Birth Control pills and Prozac to treat every hormonal malady: PMS, menopausal symptoms, painful periods, endometriosis, fibroids, breast tenderness, depression, anxiety, irregular periods, heavy periods and low libido.  I am by no means saying there is no role for these pharmaceutical agents, for many women it has been truly helpful and even life altering, but I am saying that there is a lot of benefit to embracing natural healing techniques, nutritional medicine, herbal and vitamin therapies, and mind-body medicine.  I have many patients to thank for pushing me to learn and discover the power of integrative medicine.

Bio-Identical Hormone Therapy

I began to learn about natural hormones in my first year in practice 16 years ago after reading a book by Uzzi Reis entitled “Natural Hormone Balance” Uzzi Reis is a well-regarded gynecologist in California who has been using bio-identical hormone replacement for over 30 years with excellent success.   I turned to a layperson’s book for this type of education, because four years of Cornell University medical school in New York and four years of specialty training in Obstetrics and Gynecology residency at North Shore University Hospital on Long Island though excellent in many regards, did not impart any appreciable amount of useful or practical knowledge I could use to handle a predominantly office-based practice — a terrifying endeavor when I was used to delivering babies, doing hysterectomies, and “crash” C-sections.   I was convinced that this was a wonderful approach to helping women who weren’t adequately treated with the conventional wisdom of either birth control pills, anti-depressants and Prempro.

The Bio-identical hormone therapy I learned was probably the most misunderstood concept to hit modern medicine in a long time: vilified and demonized by medical professionals and glorified and worshipped by media savvy patients — both parties strikingly ignorant of what it means and what it is.    Although I never called myself a specialist in bio-identical hormone therapy, I was certainly very comfortable incorporating it into my practice.    Unfortunately for both me and my patients, this did not seem the cure-all it was supposed to be—for some it was the answer, but for the majority it did not deliver what it was supposed to—freedom and relief from severe menopausal symptoms, PMS, libido concerns and the like.    This forced me to look in other directions.

Adrenal Fatigue

My understanding of female hormone balance and its effect on quality of life and quality of health when hormones become out of balance, has developed quite extensively since my early years.   I have come to realize that estrogen, progesterone and testosterone are the tip of the iceberg.   They serve as messengers of deeper more profound disturbances in a woman’s physiology brought on by many different factors in our modern day living.   Dr. James Wilson’s book entitled “Adrenal Fatigue…” is a wonderful introduction to the concept of adrenal dysfunction and its effect on health and its role in disease and hormonal imbalance.

His book emphasizes the role of stress in its many different forms (physical, emotional, dietary, emotional) and its relationship to illness and physiologic fatigue and deterioration.   He elegantly discusses how various chronic stressors impact our health and well-being in a variety of ways.   Chronic stress is identified in conventional medicine as an important cause of illness, however, our health care system is based on pharmaceutical-based therapy and not on long term, preventative systems of care that promote wellness and restoration.

Western medicine is a symptom-based approach to managing health and disease and therefore therapy is drug-centric.   Couple this with the unrealistic demands of third-party payers to see high volumes of patients for poor reimbursement and you end up with a health care system that favors the quick fix (with a pill) over the long term benefit of nutrition counseling, exercise instruction, psychosocial support and general education in healthful living strategies.   Consider the long list of “Non-Diagnoses” for conditions that are the norm in Western society: Irritable bowel syndrome, Chronic fatigue syndrome, Fibromyalgia, Chronic migraines, Premenstrual syndrome, Gastro-esophageal reflux, chronic constipation – these are merely fancy medicalized descriptions of symptoms that look no further as to the cause of such symptoms.   But there is a drug available for each condition.

Compare this to a mind-body approach that treats the individual patient on several different levels – physically, emotionally, socially and spiritually.   This approach unifies all the fundamental components that impact health and most importantly looks to unearth the cause of pain and suffering.   Most of you are aware of the so-called “placebo effect” — that is, the ability to achieve statistically significant healing from a “sham” treatment due to the belief on the part of the patient that the medicine (or whatever treatment that is being studied) will improve their illness.   Placebo effect is the power of positive thinking in action.   It isn’t insignificant at all.   We should learn to harness this powerful effect without the use of drugs whenever possible.

This brief history of my professional development and current healing philosophy hopefully introduces you to a fundamentally more integrated approach to hormonal health and wellness.   I believe that it is time for us to shift from managing illness and disease to nurturing health and wellness.   Not early diagnosis, but disease prevention.   Not symptom management but restoration of health and hormonal balance.

The Five Big Symptoms

Dan Kalish, from the Kalish Institute of Medicine in California, is a trained chiropractic and also practices functional medicine on the west coast.   He coined a phrase — “The Big Five” — to describe a complex of extremely common, almost universal symptoms plaguing countless individuals in the United States.

These symptoms either together or individually describe Adrenal burn out or Adrenal fatigue.   Adrenal fatigue is not the CAUSE in and of itself.   It is the result of chronic stressors on the individual that overwhelm the body’s adrenal gland, thus resulting in global body system dysfunction.   Our approach to treating these Big Five symptoms employs a functional medicine diagnoses-based assessment, uncovering which body systems are depleted, or under-functioning, and resulting in general health deterioration.

We use very specialized laboratory assessment of body system function to then design a program specifically tailored to the patient’s physiologic needs.