Explore topics related to the Hormone Advanced Practice Module:

Explore a PCOS Case Study


What would you do if a 25-year-old female came to you reporting a possible case of polycystic ovary syndrome (PCOS) and years of hirsutism, acanthosis nigricans, cystic acne, and irregular and painful periods? What if that patient also had an elevated BMI with high abdominal adiposity, elevated testosterone, pre-diabetes, and a single cyst found in a pelvic ultrasound?

Potentially affecting 15-20% of women, PCOS is a complex endocrine and metabolic condition.1 It is a heterogeneous, heritable disorder that affects women throughout their entire lifetime.2 Insulin resistance is found in 50-70% of females with PCOS.1 Comorbidities include infertility, hypertension, type 2 diabetes, depression, menstrual irregularities, and more.1 In this full case study write-up, IFM Educator Kara Fitzgerald, ND, describes this patient’s history, treatment plan, and results. In so doing, Fitzgerald walks the reader through her process and rationale for using whole-system methods to address the patient’s chronic condition.

IFM’s Hormone Advanced Practice Module (APM) is a scientific educational program to enhance your knowledge of endocrinology and hormones. Like Dr. Fitzgerald, you can look upstream to treat root causes. Join us at the Hormone APM this July 13-15, 2017, to learn the evidence-based dietary modifications, nutraceutical supplementation, and other lifestyle changes to address hormonal dysfunction before using hormone replacement therapy.

  1. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6(1):1-13. doi: 10.2147/CLEP.S37559.
  2. Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29(2):181-91. doi: 10.1016/S0002-9378(15)30642-6.

Article by IFM educator Kara Fitzgerald, ND
Originally published at www.drkarafitzgerald.com

Dr. Fitzgerald received her doctorate of naturopathic medicine from National College of Natural Medicine in Portland, Oregon, and completed postdoctoral training in laboratory science at Metametrix Clinical Laboratory. She is a contributing author to numerous textbooks in Functional Medicine and peer-reviewed journals. An IFM Certified Practitioner, her clinical practice is located in Sandy Hook, Connecticut. Full biography.

Menopause and Hormone Replacement Therapy


By IFM Educator Shilpa Saxena, MD

IFM’s recent practitioner survey revealed an overwhelming majority of patients who visit Functional Medicine clinicians are women. With over 10 years of running a Functional Medicine practice, I can firmly state that perimenopausal and postmenopausal women are likely one of the largest demographic groups within my practice and most FM practices. Why?

Most other approaches do not address the two main hormonal goals for today’s women:

  1. Improving symptoms by addressing why each woman is uniquely imbalanced;
  2. Reducing risks with the safest options available.

The typical hormone replacement therapy (HRT) medical appointment aims to blunt symptoms and views women as a three-zone problem: bikini, breast, and brain. The goal: prescribe the lowest effective dose of HRT for the shortest amount of time in order to reduce cancer and/or stroke risks. This strategy fails to address one major problem: the underlying cause of the hormonal imbalance symptoms. Women are vastly different from each other, both biochemically and genetically, and their unique life stories play a major role in the underlying causes of their symptoms.

At the Hormone Advanced Practice Module, you will gain a greater appreciation for the most prevalent factors that contribute to both the annoying and the life-threatening set of symptoms so many women face. Throughout the course, IFM educators will detail the steroidogenic pathways for hormone production and metabolism, examine the evidence for the use of bioidentical hormone replacement therapy, and elucidate the other systems that commonly interplay with hormone health. This powerful way of thinking empowers clinicians to offer real, personalized treatment recommendations on Monday morning to their current patients and to the growing group of women who seek the same services from a Functional Medicine practitioner.

The Women’s Health Initiative, a major government-funded study, linked hormone replacement therapy with a number of health problems. It was later determined that the recommendations were inappropriate for younger women who took hormone replacement therapy for symptomatic menopause because most of the women studied were well past their early menopause symptoms. The truth is, we can no longer treat the statistical woman—she doesn’t exist. Helping women optimize the benefits of healthy hormones through the Functional Medicine model will be a vital step forward for women’s health.

How to Identify Adrenal Dysfunction

The adrenal hormone cortisol impacts nearly all body systems. Cortisol levels fluctuate throughout the day, normally peaking in the morning hours and bottoming out at night. In studies, deviations from this pattern are associated with signs and symptoms of adrenal dysfunction. One such dysfunctional pattern is a flat cortisol curve in which the amount of cortisol secreted (high or low) shifts very little throughout the day. In both seemingly healthy and clinical populations, a flattened cortisol curve has been robustly associated with a shorter lifespan and negative health indicators.
Results of one such study indicated that a flattened cortisol curve statistically predicted poor survival time in patients with metastatic breast cancer.1 Natural killer cell numbers and activity were also decreased. In the patients studied, 70 percent had flattened cortisol curves, presumably due to the physical and emotional stress of their diagnosis and treatment.1 Flattening of the cortisol curve also has been shown to predict early death from lung cancer and has been associated with low T-cell lymphocyte counts.2
In another study of healthy individuals, diurnal cortisol patterns were measured for 2 years, and then participants were followed for 6 to 8 more years.3 Participants were mostly middle-aged (average of 61 years). Flattened cortisol curves correlated with mortality from all causes, including cardiovascular deaths. 3
Measuring cortisol over the course of a day may predict health outcomes both for patients with diseases and for seemingly healthy individuals. Understanding the factors that affect cortisol secretion can inform appropriate treatment interventions. One interesting finding is that neighborhoods with more stressors are correlated with flattened cortisol curves for the populations who live there, suggesting that social status may be a factor in cortisol patterns.4

At IFM's Hormone Advanced Practice Module (APM), our experienced faculty will show you the best way to measure cortisol levels and help you understand the different types of dysfunction that can be identified from the results. You'll also get tools and techniques for applying appropriate lifestyle and nutritional therapies that address each type of dysfunction. Join IFM at the Hormone APM and come home with strategies for assessing and treating adrenal dysfunction as well as a host of other hormone-related conditions.

  1. Sephton S.E., Sapolsky R.M., Kraemer H.C. & Spiegel D. (2000)  Diurnal cortisol rhythm as a predictor of breast cancer survival. JNCI J Natl Cancer Inst 92 (12): 994-1000. Full text freely available: http://jnci.oxfordjournals.org/content/92/12/994.full Last Accessed 3/2015.
  2. Sephton SE, Lush E, Dedert EA, Floyd AR, Rebholz WN, Dhabhar FS, Spiegel D & Salmon P. (2013) Diurnal cortisol rhythm as a predictor of lung cancer survival. Brain Behav Immun. Mar;30 Suppl:S163-70.
  3. Kumari M, Shipley M, Stafford M, Kivimaki M. Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study. J Clin Endocrinol Metab. May;96(5):1478-85. Epub 2011 Feb 23. Full text freely available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085201/ Last Accessed 3/2015.
  4. Karb RA, Elliott MR, Dowd JB & Morenoff JD. (2012) Neighborhood-level stressors, social support, and diurnal patterns of cortisol: the Chicago Community Adult Health Study. Soc Sci Med. Sep;75(6):1038-47.

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