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Ontario Cervical Screening Guidelines

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October 9, 2017
ontario cervical screening guidelines

Do you remember your first pap? I do. Vividly. Truthfully, this is not a test that most women love to get done – but it’s an important one! The pap test screens for cervical cancer as it looks for abnormal cells changes of the cervix. These are not perfect tests, but hopefully routine screening will catch any abnormal cells

When should screening begin?

By 21 years of age, cervical screening (a Pap exam) should begin for women if they are or have been sexually active. Sexual activity includes intercourse, as well as oral and digital sexual activity with a male or female partner. Read: women who have sex with women still need to be screened.

If you are pregnant, screening should still be taking place – but may be done in the post-natal period.

For transgender men who still have a cervix, they should be screened according to the guidelines.

For women who have not been sexually active by the time they are 21, they should delay cervical screening until they are sexually active. 

How often should screening take place?

For normal results:

Screening should take place every 3 years. For immunocompromised women, screening should be occurring every year.

Even if your last test came back as normal within the 3 year period, but you recently experienced vaginal bleeding (outside your period) or abnormal discharge – get screened again. 

For abnormal results:

If you are less than 30 years old, you are re-tested in 6 months. If your results come back as abnormal a colposcopy will need to be performed. But, if your results come back normal, you will undergo another test at 6 months. If those results are abnormal you will need to have a colposcopy done. But if that final round is normal, you will re-enter the 3 year cycle.

If you are over 30 years old, there will be testing for cancerous HPV strains. If the results are negative, then you will cycle back into that 3 years screening cycle. But if the results are positive for oncogenic HPV strains, a coloposcopy will be done.

When does screening stop?

When a woman is at least 70! It’s true! If she’s had at minimum 3 normal pap exams over the last 10 years, then screening can stop.

What happens if a woman has had a hysterectomy? If she still has a cervix (in the case of a subtotal hysterectomy), then guidelines should still be followed until she’s 70 and has at least 3 normal tests.

Where can you get screened?

You can make an appointment with your medical doctor or your naturopathic doctor (I do these tests!). If you can’t fid a healthcare provider, you can find someone here. Some pelvic health units and community health centres may also perform screenings.

How to get ready for a test

Check your period tracker to make sure that you’re not getting a pap while you’re on your cycle. It’s also advised that you don’t have sex, use tampons, apply or insert any medications or creams inside your vagina for at 2 days before the test. Nevertheless, even if these cannot be avoided – still get screened. 

After the test

If the results are normal, hooray! See you in 3 years! (Unless you begin to experience abnormal vaginal bleeding and discharge).

If the results are abnormal, your health care provider will contact you and the Ontario Cervical Screening Program will also send you a letter. This does NOT mean you have cervical cancer. But you will have to have a discussion with your healthcare provider and repeat the test in 6 months. You may also need to see a specialist for other tests such as an HPV test. 

What’s next?

If you have yet to have a Pap test and you’re over 21 and have been sexually active, book an appointment! If it’s been over 3 years since your last test, book an appointment! If you can’t remember when your last test was, book an appointment! 

Whether it be with me, or your medical doctor – make sure you get screened!

Ontario Breast Screening Guidelines

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October 16, 2017
breast cancer, breast screening guidelines, ontario breast screening, toronto naturopath, self breast exam

October is breast cancer awareness month, therefore I wanted to shed light on Ontario’s breast screening program guidelines. Breast cancer is the most common cancer in women, and will affect many families – including mine. I am fortunate to say that my grandmother is a breast cancer survivor and now I use my voice and education to help educate women about what they can do about their risk of getting this disease. 

Of course, I will also begin with diet and lifestyle – however, it is crucial to screen yourself or get it done annually to decrease your risk.  

When does screening start?

Mammograms are recommended every two years for women over the age of 50, who have average risk. You may need a health care provider referral or self-referral (this may happen by doing a self exam). Criteria include: not experiencing any acute breast symptoms, no personal history of breast cancer, no current breast implants and no screening mammogram in the last 11 months. 

If a woman is considered high risk, mammograms start at the age of 30. Criteria include: 

  • They are a known carrier of a gene mutation, like BRCA1 or BRCA2

  • They are a first degree relative of a carrier of a gene mutation, that has had genetic counselling and declined genetic testing

  • They were assessed by a genetic clinic as having equal or greater than a 25% personal lifetime risk of breast cancer based on their family history

  • They received chest radiation before they were 30 years old, and at least 8 years before.

How often should screening happen?

For average risk women, screening happens every 2 years using a mammogram.  

For high risk women, screening happens every year using a mammogram and breast MRI/ultrasound.

Self-screening should be done every month, no matter your age or risk. 

When does screening stop?

For average risk women, screening stops at 74 years old. 

For high risk women, screening stops at 69 years old.  

How you can perform a self screen

Self breast exams should be done on a monthly basis, and be part of your annual physical exam. When you are performing them yourself, there are 3 different ways to do it – in the shower, in front of a mirror and lying down. The best time to perform one of these exams, is after your cycle (if you still experience one) as your breasts may no longer be swollen and tender. 

In the shower

Use the pads of your fingers to move around the entire area of your breast in a circular pattern. Begin from the outside breast, towards the centre. Be sure to check the entire area including the armpit, as lymph nodes reside there. You are assessing to see if there are any lumps, thickening, or hardened knots. If you discover anything, have it evaluated by your medical doctor. 

In front of a mirror

Visually inspect your breasts four different ways: 

1. With your arms at your sides
2. Ams overhead
3. Palms on your hips while flexing your chest muscles
4. Hips bent and arms towards the mirror

Your left and right breast may not exactly match (ie. one may be bigger than the other), and that’s normal. What you’re looking for is dimpling, puckering or any changes.  

Lying down

When you are lying down, your breast tissue will spread out evenly along your chest wall. Whichever breast you decide to check first, put a pillow underneath that shoulder and that arm behind your head. Using the pads of the fingers of the opposite hand, move the pads of your fingers around that breast in small circular motions assessing the entire breast area and armpit. 

Next Steps

This month we will be inundated with walks, runs, and pink products to bring awareness to the cause. I believe that many women know about breast cancer, and that the awareness is already there. I would then encourage them to start self-screening and think of ways to minimize their risk. 

I watched a documentary a few years ago called Pink Ribbons, Inc. and it helped to change the way I look at products, and it also began my journey into natural beauty and minimizing toxic exposure

For more information about exposure, foods and other factors that affect breast cancer risk, I really enjoyed reading this post by Meghan Telpner.

At the end of the day, it is estimated that 1 in 8 women will develop breast cancer in her lifetime. That’s pretty significant! Do what you can, do reduce your risk.

Top 7 Hormones You Should Be Testing

September 18, 2017
hormone testing, naturopathic doctor toronto

If you don’t know this already, Naturopathic Doctors like myself, love discovering the root cause of your problems. Once we find the root cause and address it, your unwanted symptoms will disappear. For good. Sometimes it can be easy to find the root cause (ie. You can’t sleep because you’re drinking a coffee 30min before bed), and sometimes it can be more difficult (ie. your period is irregular). 

Just because the cause isn’t blatantly obvious, doesn’t mean that it’s impossible to discover. In these situations, we’ll commonly recommend lab testing to see how your body is functioning at a chemical and cellular level. 

When it comes to irregular, heavy or painful periods, hormone testing is the way to go. Using the information we get from hormone testing, Naturopathic Doctors can create a plan with the best treatment for you. This is especially helpful if you’ve used Dr. Google in the past to treat singular symptoms. Our hormones can be quite complex, and different patterns may be be responsible for what you’re experiencing. If you find yourself constantly at the health food store looking for a supplement per symptom – investing in hormone testing will likely serve you better in the long run. 

Symptoms associated with hormonal imbalance

– Weight gain OR weight loss
– Breast tenderness
– Abdominal cramping
– Bloating
– Headaches
– Skin changes
– Hair changes
– Low sex drive
– Insomnia
Fatigue
– & MORE!

Hormones you should test:

1. Estrogen

Estrogen is not a singular hormone, it’s present in three forms: estradiol, estrone and estriol. When we think of estrogen, we’re actually thinking of estriol which is the predominant form. Estrogen is mainly produced by the ovaries, and by the adrenal glands (in menopause) and fat cells in smaller quantities. This is the main hormone of the menstrual cycle, especially the first half of your cycle where it controls the thickness of the uterine lining.

Estrogen helps to: control vaginal moisture, enhances sex drive, prevents UTIs and urinary incontinence. Moreover it has great effects on the brain, nervous system and the skin. 

2. Progesterone

Progesterone is another hormone produced in the ovaries, and following menopause is produced in small amounts by the adrenal glands. This hormone dominates the second half of the menstrual cycle as it leads to the thickening of the uterine wall in case a fertilized egg implants. In the event that fertilization does not occur, progesterone levels decrease and triggers the start of your period. 

Progesterone helps promote urination, improves sleep, aids in mood and works with the thyroid to stimulate metabolism. A little known fact, but when you’re undergoing chronic periods of stress, your body will use progesterone to make cortisol. 

3. Testosterone

Testosterone is an androgen – a male hormone. Nevertheless, this hormone is produced within the ovaries and adrenal glands of women. As women age, production of this hormone decreases. 

This hormone is associated with sex drive, bone density, muscle mass and strength. Overproduction of testosterone is associated with a common condition called Polycystic Ovary Syndrome (PCOS). 

4. Cortisol

Known as our stress hormone, cortisol is produced by the adrenal glands. Cortisol helps the body adapt to daily stressors. However with prolonged stress, the adrenal glands may become fatigued and stop producing this stress hormone. 

Excess cortisol can cause havoc on our body and interfere with other hormones including the thyroid hormones, testosterone and progesterone. 

5. Thyroid Stimulating Hormone (TSH)

The thyroid is incredibly important for metabolism and the overall function of the body. It also controls menstrual regularity, fertility, body weight, energy, heart rate, and more!

TSH acts as the barometer of the body and indicates if thyroid gland is working properly. Additionally, thyroxine (T4), triiodothyronine (T3) and reverse T3 can be tested to get a solid picture of how the thyroid is functioning. 

6. Follicle Stimulating Hormone (FSH)

Follicle stimulating hormone is produced by the pituitary gland. This hormone acts to stimulate the ovary in preparation for ovulation. As women age, FSH becomes the predominant pituitary hormone. 

7. Lutenizing Hormone (LH)

Lutenizing hormone is produced by the body’s pituitary gland due to a signal of high estrogen from the dominant follicle. A surge of LH trigger’s the egg maturation and causes it to be released from the follicle. This signifies that ovulation is ready to occur.  

Using ovulation tests is a good way to determine if a surge of LH is being produced by the body, in addition other ovulatory signs to be aware of are a slight increase in body temperature (thanks to progesterone) and egg-white cervical fluid.  If women have relatively more LH than FSH, this may also signal PCOS.

Bonus Tests

Ferritin

It’s never a bad idea to test your ferritin levels. Ferritin is the storage form of iron. If you’re experiencing heavy periods, you may actually be deficient iron which can cause it’s own array of unwelcome symptoms. 

Tips for your visit with a ND

Best time to test

Hormone testing is best done in the morning, unless you’re testing cortisol – which can be done at various points during the day. Unless otherwise specified below, you can test your hormones at any point during your cycle. 

Day 3: Best time to test estrogen, FSH and LH.

Day 21: Best time to to test progesterone, although for some conditions (ie. luteal phase defect), you may want to get a 3-day value for progesterone. 

Type of Test

Blood

This is your standard blood test performed in a laboratory. This is a preferred option for testing total estrogen, progesterone and testosterone, along with the other hormones mentioned above 

Saliva

This is at-home specialized test where we use saliva to monitor excesses or deficiencies within the body, as well as look for patterns (ie. diurnal patterns of cortisol). Saliva testing allows us to look at ‘free’ hormones (not bound by proteins), and expands our clinical picture with respect to your condition. Preferred: baseline of cortisol pattern. 

Urine

Urine testing provides an average of your hormone levels and assesses their metabolites (ie. understanding if we are clearing the estrogens). Currently, there are  types of urinary tests: the first where you are collecting urine in liquid form, and the second where you are collecting dried samples of urine. Good for: comprehensive analysis of estrogen and cortisol. 

Reading the Results

Normal vs. Optimal

Naturopathic doctors want you to feel fantastic, and one of the ways we do that is assessing your lab work and determining if it’s optimal rather than normal. Typically doctors compare lab findings with their associated reference ranges to determine if the results are normal or abnormal. If your lab work falls into the normal reference range, then you shouldn’t be having any signs of symptoms of a pathology. Right? Wrong. People can be in this reference range AND continue to have specific signs and symptoms.

This is why naturopathic doctors strive to ensure that while your lab work be in the normal reference range, it also be in the optimal range. This allows us to help treat our patients preventatively, before any imbalances manifest into serious health conditions. 

Next Steps

Naturopathic Prescription

Based on your test results from hormone testing, your Naturopathic Doctor will create a custom treatment plan that will help you feel like your best! Treatment may involve dietary and lifestyle changes, and/or botanical or nutritional supplementation. But the best part is – you don’t need to self prescribe for your symptoms anymore! We’ve got you covered. 

Your homework

Once you have your results and plan in hand, it’s up to you to take the next steps! It can be daunting – but if your doctor is supportive, they’ll do their best to make sure that integrating the plan is as easy as possible. Moreover, once you have your plan it doesn’t mean your ND doesn’t want to see you again – it’s the opposite! We want to make sure that the changes are fitting your lifestyle, eliminating your symptoms and getting to the root of the issue. If some tweaks need to be made along the way, so be it!

Are you ready?

If you’ve been suffering with unwanted symptoms for years, if you want to get pregnant, or if you generally just want to feel fantastic -here’s your permission split to finally invest in yourself. Hormone testing will give us answers to what is going on, but it’s up to you to take that first step and book an appointment. You deserve to live your best life, and I am going to help get you there.