Female Reproductive System

1. Female Reproductive System Kellie Lynch Materia Medica II

2. The Female Reproductive System Organs • Vagina • Ovaries • Uterine Tubes • Uterus and Cervix • Mammary Glands

3. Understanding the Common Experience • I was drawn to look deeper into the female reproductive system because this is where many of my friends and family experience difficulties. I believe many women today believe a painful cycle is normal and just pop Advil when in reality our bodies are always communicating with us. If something is painful enough to disrupt our daily routine, then usually something is out of balance. I wanted to look deeper into this system to have a better understanding of how to help those close to me.

4. Female Reproductive System Function • Ovarian Cycle  • The ovarian cycle regulates the release of eggs from the uterine tubes   • Menstrual cycle  • The menstrual cycle prepares the uterine lining for pregnancy  • Reproduction  • Reproduction occurs when an egg that is released at ovulation is fertilized by a sperm, forming a zygote which implants by the ovarian lining (prepared during the follicular phase of the menstrual cycle) resulting in pregnancy.  • Lactation  • Production of milk by the mammary glands which then provides nutrients to an infant by the breast

5. Herbal Actions for the Female Reproductive System

6. Emmenagogue • Supports regular menstruation/brings on menstruation  • Herbs • Caulophyllum thalictroides (Blue Cohosh) • Dong Quai (Female Ginseng/ Angelica) • Vitex agnus-castus (Chaste Tree)

7. Astringent • Tightens and tones tissue. • Herbs • Capsella bursa-pastoris (Shepherd's Purse) • Leonurus cardiaca (Motherwort) • Rubus idaeus (Red Raspberry) • Achillea millefolium (Yarrow)

8. Antispasmodic • Relieves muscular spasms (often associated with menstrual cramps) • Herbs • Cimicifuga racemosa (Black Cohosh) • Dioscorea villosa (Wild Yam) • Matricaria recutita (German Chamomile) • Zingiber officinale (Ginger)

9. Analgesic • Helps relieve pain • Herbs • Corydalis ambigua (Corydalis) • Lactuca virosa (Wild Lettuce) • Salix alba (Willow)

10. Adaptogen • Helps the body adapt to stress, normalizing hormones • Herbs • Astragalus membranaceus (Astralagus) • Pan ax ginseng (Ginseng) • Withania somnifer (Ashwaganda)

11. Common Conditions • PCOS • Dysmenorrhea • Endometriosis 

12. Dysmenorrhea

13. Understanding Phases of Reproductive Cycle • Follicular Phase • GnRH secreted from hypothalamus. Stimulates release of FSH and LH from anterior pituitary gland • FSH and LH stimulate the growth of a primary follicle in the ovary which becomes the egg that is released during ovulation. • Ovaries secrete estrogen, causing surge in LH and ovulation • Luteal Phase • Progesterone is secreted from the corpus luteum, preparing the endometrium lining of uterus for possible implantation.  • Without implantation, lining of uterus is shed = menses

14. Pathophysiology of Dysmenorrhea • After ovulation, as the body prepares for pregnancy, estrogen begins to stimulate cell growth on the endometrial wall. As growth occurs, the cells uptake omega-6 fatty acids which are then broken down into the lipids prostaglandins and leukotrienes. During mensuration , these lipids are released and cause vasoconstriction as well as an inflammatory response associated with the symptoms of dysmenorrhea including cramps, diarrhea, headaches, and nausea.  Although certain levels of prostaglandins and leukotrienes are normal and are essential for the shedding of the uterine lining, when too much is formed, that is when dysmenorrhea occurs.

15. Herbal Actions for Dysmenorrhea • Adaptogen • stress has been linked to dysmenorrhea  (Wang, et al, 2004) • Adaptogen herbal action helps the body regulate HPA axis • Antispasmodic • help relieve the spasms created by the vasoconstriction action upon the uterus by prostaglandins and leukotrienes.  • Anti-inflammatory • help counteract the inflammation present by prostaglandins and leukotrienes  and help reduce the pain associated with dysmenorrhea • Analgesic • help reduce the pain of dysmenorrhea

16. Market Evaluation

17. Two Products for Dysmenorrhea • Moon Ease Tea by Mountain Rose Herbs • PMS Comfort by Herb Pharm

18. Moon Ease Tea • Ingredients • Spearmint leaf, • Cramp bark • Vitex berries • Skullcap • marshmallow root • Passionflower • ginger • Dosing and Safety: • Not mentioned on website.

19. Moon Ease Tea Evaluation Cont. • Evaluation of Product: • I find this formula to be very therapeutic. It addresses both the physical and mental symptoms of PMS and offers support in the form of a tasty tea that has antispasmodic, anti-inflammatory, and nervine actions. Though dosing and safety are not available on the website, the product comes with dosing and safety on the container. • Evaluation of herbs used • Vitex "relieves moderate to severe PMS anxiety and other PMS symptoms caused by elevated estrogen levels or deficient progesterone levels" (Winston et al, 2008) • Skullcap and passionflower are nervines, supporting the nervous system, aiding in PMS anxiety and PMS insomnia • Ginger is an antiemetic and anti-inflammatory which can aid in both the inflammation response within the body which causes cramping as well as the nausea associated with PMS. (Winston, 2008) •  Spearmint, according to the Herbal Academy is both an antispasmodic as well as a nervine, Supporting both the cramping and emotional symptoms of PMS. (Jutise, 2016) • Cramp bark is both an anti- inflammatory as well as a smooth muscle relaxant which makes it beneficial in the case of PMS cramps. (Southern Cross, n.d) • Marshmallow is a demulcent, soothing mucus membranes which would make it beneficial in the case of intestinal cramping in response to inflammatory prostaglandins

20. Case Study

21. Client “M” • The client presented is a 22 year old female. She is highly active and a full time newly employed occupational therapist. She lives in an apartment with her best friend from childhood, both of whom are into fitness. She has a vibrant social life and reports being happy. She grew up in the Catholic Church and attends mass sometimes with her roommate or family but it is not a big part of her life. She recently began having debilitating cramps at the onset of menstruation, which is her primary reason for seeking herbal help. She has an athletic build and occasional breakouts around her jawline.Skin and tongue have a pinkish tint, and she reports weekly to biweekly constipation and reflux. Her diet primarily usually consists of eggs on toast for breakfast or Greek yogurt with granola. Hummus and sliced peppers for snack, grilled chicken and kale for lunch, and soup or pasta in the evening. She does enjoy going for drinks with friends around the city and reports having 2-5 drinks a week.

22. Energetics • For this client I would be focusing on decreasing inflammation within the body while supporting her hormones to help rebalance the endocrine system. I would be looking to have a formula to support the body throughout her cycle • Her constituent presents as hot and wet. I will be looking for herbs to aid in cooling down inflammation shown by the persistence of breakouts on her back and regularly on her jawline. • The organs I am looking to support include the endocrine system, the liver, the digestive system, the eliminatory system.

23. Herbal Actions • Bitter • Hepatoprotective • Alterative  • Adaptogen  • Normalizer  • Anti-inflammatory  • Antispasmodic  • Analgesic   • Emmenagogue

24. Taraxacum officinale (Dandelion) Root • - Primary herb (30%) • Herbal Actions: Bitter, Hepatoprotective  • Modern use: “Dandelion is a hepatic herb, supporting the liver in all its functions. Additionally, the bitter taste helps prepare the body for digestions and stimulates the secretion of bile along with other digestive enzymes. Healthy bile secretions is necessary for healthy liver function as bile stagnation can lead to disease.” (Hess, 2018) • Traditional use: “Dandelion is used as a bitter tonic in atonic dyspepsia, and as a mild laxative in habitual constipation” (Grieve, n.d.)  • Rationale: as this client experiences “habitual constipation” and reflux along with acne and painful menstruation, a sluggish liver could be seen as a connection between these symptoms as a sluggish liver leads to impaired digestion, decrease detoxification, and more internal inflammation.

25. Leonurus cardiaca (Motherwort) Aerial Parts • Primary herb (30%) • Herbal Action: Antispasmodic, nervine, emmenagogue  • Modern use “reduces pain of menstrual cramps” (Winston, 2008) • Historical use: “reduces the pain of menstrual cramps and other smooth muscle, parasympathetic cramps… increases or stimulates menstrual flow for women with amenorrhea or a clotty, scanty flow with cramps. (Winston, 2008) • Rationale: as an emmenagogue, this herb helps regulate the menstrual cycle. Additionally, as a antispasmodic, this herb will help relieve the smooth muscle spasms that are felt as menstrual cramps.

26. Glycyrrhiza glabra(Licorice) Root • Secondary herb (15%)  • Herbal Action: Normalizer, Adaptogen, Antispasmodic, Anti-inflammatory, Hepatoprotective.  • Modern use: “systemic anti-inflammatory, soothes irritated mucous membranes, used to support adrenal exhaustion” (Winston, 2008) • Traditional Use: used to treat sore throats and sticky, hard to expectorate mucus, to tonify the stomach, spleen, and liver” (Winston, 2008)   • Rationale: For this client, the herbal actions of licorice including normalizer, Adaptogen, anti-inflammatory, and Hepatoprotective will be beneficial for her.

27. Rumex crispus (Yellow Doc) Root • Secondary herb (15%)  • Herbal Action: Alterative  • Modern Use: “clinical herbalist use Rumex as a bitter tonic and cholagogue. It is useful for poor fat digestion, epigastric fullness, and biliary dyskinesia” (Winston, 2006) • Historical use: “the root has laxative, alterative, and milky tonic action” (Grieve, n.d.) • Rationale: This herb is rationalized for this client primarily for its alterative effects. As a secondary herb, it will help support the liver in cleansing the blood of inflammatory toxins, reducing the inflammation process which leads to dysmenorrhea in addition to relieving constipation and reflux by promoting elimination.  

28. Cinnamomum verum(Cinnamon)  Bark • Adjunctive (10%)  • Herbal Actions: carminative, antihemorrhagic,  • Historical Use: “Used to treat diarrhea, dysentery, vomiting, nausea, indigestion, GI upset, dysmenorrhea,” (Winston, 2008) • Modern Use: “relieves GI system problems: used for flatulence, nausea, bloating, mild gastric upset, poor fat digestion.” (Winston, 2008) • Rationale: As an adjunctive, this herb not only gives the formula synergy and increases the bioavailability of the herbs but it is itself beneficial for dysmenorrhea and to promote optimal digestion.

29. Formula • Formula • Taraxacum officinale - 2 part • Leonurus cardiaca - 2 part •  Glycyrrhiza glabra - 1 part •  Rumex crispus - 1 part • Cinnamomum verum ½ part • Dosage and Frequency • Formula Take 2 ml TID 30 minutes before meals over the coarse of the cycle • Safety Concerns: none

30. Lifestyle Recommendation • As client and her roommate both eat a paleo diet, one lifestyle recommendation would be to try to buy local, grass-fed meats. The meats from factory farms/grocery stores are usually higher in estrogen and act as an estrogen within our bodies. Dysmenorrhea  is usually a result of estrogen dominance as estrogen encourages the growth of endometrial lining. Within this lining, inflammatory modulators are stored and are released when it is time to shed the lining. When our bodies are heavily estrogenic, and the balance between progesterone and estrogen is tilted towards estrogen, more lining is produced and more inflammatories stored, leading to more cramping and inflammation at the onset of menstruation.

31. Conclusion • In conclusion, I truly appreciated this class and all it had to offer. I loved listening to the lectures and applying what I am learning to my daily life. I loved having the space to engage with the material, to dig deep into pathophysiology of disease processes, and having the opportunity to learn and share with each other. • Looking forward I feel like my knowledge of the female reproductive system has grown greatly and that I will have a solid foundation to stand on as I go on forward with the knowledge I gained through this learning process.

32. References • G, Skenderi. (2003). herbal vade mecum. Rutherford, New Jersey. Herbacy Press. • Jutise, A. (2016). the amazing mint. retrieved from: https://theherbalacademy.com/a-family-herb-amazing-mint/ • Rice University (n.d.) anatomy and physiology of the female reproductive system. Anatomy and phsyiology. Retrieved from: https://opentextbc.ca/anatomyandphysiology/chapter/27-2-anatomy-and-physiology-of-the-female-reproductive-system/ • Redden, J. (n.d). Female reproductive system. How to Choose a Herbal Compound. Retreived from: https://static1.squarespace.com/static/55636a78e4b0658666cb6541/t/5a73dcc0f9619aaffdcf2376/1517542593493/Great+Lakes+Female+Reproductive+System+Herbal+Compounding.FINALpptx.compressed.pdf • Southern Cross University (n.d.). cramp bark retrieved from: https://www.scu.edu.au/southern-cross-plant-science/facilities/medicinal-plant-garden/monographs/viburnum-opulus/

33. References Cont. • ´Wang, L., Wang, X., Wang, W.,  Chen. C., Ronnennberg, A. G., Guang, W., Huang, A., Fang, Z., Zang, T., Wang, L., Xustress, X., (2004). stress and dysmenorrhoea: a population based prospective study.Occup Environ Med (61). pp. :1021–1026. • Winston, D., Kuhn, M. (2008). herbal therapy and supplements. Philadelphia, PA: Lippincott and Williams. • ´Z, Harel. (2006).dysmenorrhea in ddolescents and young adults: etiology and management. J PediatrAdolescGynecol (19). pp. 363- 371.