Still over here chatting about period pain, which means I get to put a lil extra added spotlight on one of my favourite topics in menstrual health; Endometriosis

Endometriosis is more common than you think, affecting more than 1 in 10 menstruators. It’s an immune and inflammatory condition that can also be affected by hormones (estrogen potentially being the main one). Endo is a whole body inflammatory and immune modulated disease. It’s not CAUSED by hormonal imbalances though, so if you’ve been recommended hormone balancing treatments options only for your endo, then it’s time to dive deeper.

Clues that your period pain might actually be endometriosis? Severe debilitating period pain. The type that lasts for multiple days, pain killers don’t seem to touch, and can get so bad that you have to vomit. Pain can also occur during bowel movements and intercourse with endometriosis.

Many people with periods who experience endometriosis symptoms are told they should go on the birth control pill. And while it can help to relieve symptoms, an integrative approach to the treatment of endo MUST ALSO address immune system modulation and decrease inflammation. This can be done through an individualized approach to nutrition, herbal and supplemental supports.

The pain of people with periods is a feminist issue. Your pain is important. You are the best judge of your own pain. It’s not all in your head. It’s time that healthcare started taking it seriously

Dr. Jennah Miller, ND is a Toronto and Halifax based Naturopathic Doctor, with a passion for menstrual health and hormones. She works with women and people with periods in co-creating supportive health practices that integrate seamlessly with their lifestyle and goals. Jennah has a passion for finding solutions to PMS, PCOS, period pain, and fertility for folks of all ages.

As a naturopathic doctor with a passion for menstrual and hormonal health, menstrual cramps are one the most common concerns I see in my practice. As with all things, different root causes to your menstrual cramps should garner different treatment plans (individualized medicine!). One of the first things I do with patients is try to differentiate between PRIMARY vs SECONDARY period pain (also called dysmenorrhea).

PRIMARY DYSMENORRHEA

Primary period pain is usually caused simply by inflammation (thanks to fun little inflammatory mediators called prostaglandins, that when you make too much, cause pain, those good ol’ loose period bowel movements, and cramping)

SECONDARY DYSMENORRHEA
Secondary period pain, however, requires a little extra detective work. It’s caused by an underlying process that tends to worsen over time. Some examples include endometriosis, ovarian cysts, and uterine polyps. In this case, we can’t just work on reducing inflammation, we also have to target the underlying reason for why that inflammation is even happening at all.

So, wondering which type you may have?

Primary period pain tends to occur with the onset of flow, has likely gotten better/less severe over the course of your life, and doesn’t extend to significantly before or after your period. Secondary pain can occur at any point during your menstrual cycle and tends to get worse as you age/time goes on. This isn’t definitive, but it can help to gives us some initial clues. If we suspect secondary causes, the next step is typically collaborating with your primary care provider and/or gynecologist to garner referral for a pelvic and transvaginal ultrasound to get more detailed assessment.

Good news is that we can help to reduce your pain no matter what type! The first step is determining the root cause, then we get targeted with herbs, nutrients, diet, and acupuncture

Do you have painful periods and need some extra support for managing them? I offer free 15 minute meet and greet appointments to discuss your health goals.

Dr. Jennah Miller, ND is a naturopathic doctor based in Toronto and Halifax, with a passion for menstrual health and hormones. She works with women and people with periods in co-creating supportive health practices that integrate seamlessly with their lifestyle and goals. Jennah has a passion for finding solutions to PMS, PCOS, period pain, and fertility for folks of all ages.

I’d like to set aside a small space on the internet to talk about my “why”.

The big WHY.

Why I do what I do. My guiding principles. How I, as a naturopathic doctor with a focus on menstrual and hormonal health have shaped my practice in a way that resonates with me (and hopefully with you)!

I work with weird and wild humans in co-creating their own state of wellness. This means working towards health on YOUR TERMS. No health fads. No wellness trends. No doing things just because wellness culture dictates you should.

Instead, your healthcare should be as unique as you are. You should feel heard and safe in your healthcare practitioners office. You should be able to feel as though you are part of your own health care team, co-creating in a way that values your autonomy and sovereignty. You deserve a healthcare model that is inclusive, feminist, and unafraid to put the power back in the hands of the patient (you!)

My primary goal is to empower women and people with periods to take their health into their own hands - to teach them self advocacy, and to help them realize their own power. There’s a quote from Michelle Obama that states "Communities and countries, and ultimately the world, are only as strong as the health of their women”- and that sums up literally everything that I stand for as a naturopathic doctor! I am here for you. You deserve better from your healthcare

Because above all, when we elevate the health of the individual, we elevated the health of the collective. And that sounds like a pretty cool way to start changing the world, don’t you think?

If my approach resonates with you, and you’re seeking naturopathic care, check out my online booking to schedule a free 15 minute meet and greet appointment. I look forward to co-creating health with you!

Self sovereignty of your hormonal health begins with learning what is normal in your own body. I'm a huge advocate for menstrual cycle awareness and tracking, as it helps us to tune in to what our baseline is, and eases us into a gentle awareness of where we can begin to support ourselves.

You've been tracking your cycles for a few months, have some data points, but have no idea if what you're experiencing is . . . okay? healthy? normal? If not, what should you be doing about it?

CYCLE DURATION

A perfect 28 day menstrual cycle is honestly a bit of a misconception. More commonly, the amount of time that you should spend from the beginning of one period to the beginning of the next, is 21-35 days. This can fluctuate by a few days every cycle, which is normal. Anything more or less than that, indicates that you may have an underlying concern that is impacting ovulation, and further assessment may be indicated.

FLOW DURATION AND HEAVINESS

Your bleeding phase should be between 2-7 days in length, and you don’t want to lose more than 80 mL of menstrual fluid over all the days combined. If a regular tampon holds 5 mL when fully saturated, this looks like 16 full tampons over the course of your full cycle - anything more than that is considered "heavy menstrual bleeding"

PAIN + CRAMPING

Normal amounts of period pain occur during the first day or two of bleeding, and is mild enough that it does not interfere with school, work, or other daily activities. Standard period pain can easily be relieved by an over-the-counter anti-inflammatory support (or naturopathic support!)

Severe period pain is a concern when it extends later into your bleeding phase, or starts to show up around ovulation and the PMS phase as well. It does not respond to standard painkillers as well, and can be a sign of an underlying medical problem such as endometriosis. Please work with a healthcare practitioner if this is the case for you.

PRE-MENSTRUAL SYMPTOMS

As for the pre-menstrual phase - symptoms in this phase are common, but not an inevitability. Some shifts in energy, mood, and hunger are all part of the hormonal transition in this phase, but if you're finding your PMS is impacting your quality of life, know that you have options for support.

---

About Dr. Jennah Miller ND - Your Hormonal Health Ally

Welcome to the world of holistic healing, where your menstrual and hormonal health takes center stage! I’m Dr. Jennah Miller, ND, your dedicated Toronto + Halifax based naturopathic doctor, and I’m on a mission to make your well-being the star of the show.

Feminist Healthcare Advocate: I’m proud to champion feminist healthcare principles. Your health choices are yours, and I’m here to empower you every step of the way. Let’s challenge norms, break barriers, and embrace a healthcare journey that respects your unique body and your choices.

Hormonal Health Naturopath: From PMS to PCOS and everything in between, I’m your go-to guide for hormonal harmony. Let’s unravel the mysteries of your hormones and create a roadmap to balance and vitality.

Science and Nature Unite: I bring you the perfect marriage of modern science and evidence backed natural healing. It’s a blend designed to promote your best health.

Ready to take the reins on your health story? Let’s rewrite the narrative together. Book your consultation now and experience the support of a naturopathic and feminist centered healthcare model for yourself!

If you have a period, you've probably heard the term PCOS thrown around many times before. When one in ten folks who menstruate can expect to be diagnosed with PCOS at some point in their lives (or already have been), it makes sense that it comes up in conversations around menstrual health among friends and family, or in your researching possibly symptoms online.

PCOS is a metabolic and hormonal health condition that can be somewhat challenging to get a proper diagnosis for. There are many other hormonal conditions with overlapping or similar presentation and it can sometimes be frustrating to get your hormonal symptoms taken seriously to initiate a proper workup/assessment. PCOS can have extensive impacts on your menstrual cycles and periods, and when untreated, it can also lead to increased risk of other negative health outcomes associated with high cholesterol levels, insulin resistance, and long term risk for type 2 diabetes.

This is why confirming a diagnosis and going through a proper assessment with a healthcare practitioner you trust is so important. The sooner you are able to identify and treat PCOS, the sooner you can engage in a treatment focused on health promotion and disease prevention - so you can be the best and most balanced version of yourself, now and in the future!

Let's break down how to know if you might have PCOS. From an individual perspective, you may begin to notice changes to your menstrual cycle and hormones such as:

1. Irregular menstrual cycles - typically ones that stretch longer than 35 days apart

2. Increased body or facial hair growth

3. Increased hair thinning along the temples or hairline

4. Increased acne

While these changes immediately make me as a practitioner curious about PCOS, these aren't enough on their own to confirm diagnosis. Currently, the most commonly accepted diagnostic criteria used by healthcare practitioners is called the Rotterdam Criteria. As part of this criteria, and individual needs to have any TWO of the THREE criteria to formally be diagnosed with PCOS:

1. Clinical or laboratory signs of elevated androgens - this means physical symptoms (acne, hair growth/loss) or lab work (high DHEAs, androstenedione, or testosterone) via blood test. You can have one or both, and still check off this box.

2. Polycystic ovaries on ultrasound - a side note on this one: while the condition is called PCOS, you don't actually have to have polycystic ovaries on ultrasound (PCO) to garner a diagnosis! You can in fact have normal ovarian imaging, no cysts on your ovaries and STILL have PCOS. This is why an ultrasound by itself is not considered diagnostic. I’ve you’ve been diagnosed via ultrasound alone in the past, we may want to do some deeper investigation.

3. Irregular or anovulatory cycles - this typically means going 35 days or longer between periods, but it can sometimes be a bit more complex that that. Anovulatory cycles (ones in which you're not ovulating) can also sometimes show up as irregular spotting/breakthrough bleeding all cycle long OR very short cycles OR completely absent periods all together. Learning how to track for and confirm ovulation (or a lack thereof) is essential here

If you're unsure or unclear of any of these 3 criteria, but think you may have PCOS, working with a naturopathic doctor with a focus on hormonal health is a great next step! When I suspect PCOS with my patients, we work through a careful intake and assessment process together - referring out for an ultrasound, requisitioning blood work for androgen levels, and educating on how to track for ovulation signs.

There is so much evidence to support the use of nutrition, supplementation, and lifestyle support in the management of PCOS, though the first step in the process is an accurate and complete assessment process. For women seeking a personalized, natural approach to PCOS, consulting a naturopathic doctor with a special interest in women’s health can be a transformative step to a healthier future. If you're interested in chatting more about whether or not you have PCOS and getting started on the path to naturopathic treatment, I offer free 15 minute meet and greet appointments to discuss your health goals. I look forward to being a hormone detective with you!

Dr. Jennah Miller, ND is a naturopathic doctor based in Toronto and Halifax, with a passion for menstrual health and hormones. She works with women and people with periods in co-creating supportive health practice that integrate seamlessly with their lifestyle and goals. Jennah has a passion for finding solutions to PMS, PCOS, period pain, and fertility for folks of all ages.

Empowering Women Through Individualized Healthcare

Women's cervical and pelvic health is a topic near and dear to my heart. As someone who's seen numerous patients navigate the scary and sometimes confusing event of getting their first abnormal PAP test results, I'm thrilled to be connected with an amazing Toronto based business who understands the importance of individualized, patient centred care.

Eve Medical is the business behind the creation of the Eve Kit. This product, allows individuals to assess for HPV DNA status from the comfort of their own home (or naturopathic doctor's office). For those who have abnormal cells on their most recent PAP test, the Eve Kit allows for you to test for the presence of high risks strains of HPV - an important indicator as to whether you are at high or low risk for progression to cervical cancer. This can help to guide future treatment options, and whether naturopathic or conventional treatment is the best option for you. 

Have you been (accidentally on purpose?) avoiding your next PAP test? . . . While PAP tests are SO important for assessing the health of your cervix, it’s not always the most convenient or enjoyable experience. I totally get that. . . . Enter Eve Kit (which I’ve just started offering in my practice!). A delightful screening tool, which allows people with cervixes to screen for the presence of HPV DNA on their own time, in their own safe spaces. If you’ve had abnormal PAP tests before, HPV DNA testing can give you more information about whether you’re at high or low risk of progression to cervical cancer. . . . The strongest step a woman can take towards total health, is making sure she feels empowered in informed in her own health care journey. You should be an active participant in your own health care, and Eve Kit @helloevekit can help you get there. . . . #naturopathicmedicine #torontonaturopath #toronto #torontond #badasswomen #torontolife #the6ix #womenhelpingwomen #womeninbiz #powerofshe #health

A post shared by Dr. Jennah Miller ✨ Toronto (@jennahmiller) on Apr 5, 2018 at 9:34am PDT

PAP tests can be scary, intimidating, and downright uncomfortable, but we all know how important they are for assessing the health of our cervix on a regular basis. Screening guidelines indicate that PAP tests should be administered once every three years for all sexually active women, starting at age 21. HPV DNA testing is a nice addition to this, and can be an amazing way to become more empowered about your own health status. 

For more information about naturopathic medicine, how to navigate your abnormal PAP tests, and the Eve Kit, check out my guest blog post over on the Eve Kit blog!

I have been absolutely honoured and thrilled to be featured on A Quarter Young this past December - a blog that showcases life through the eyes of young professionals while celebrating subjective definitions of success and happiness!

(I talk a lot about periods, but let's be honest, that shouldn't surprise you at this point)

Head on over to A Quarter Young to check out the full read!

Want to know what the big deal about organic is? Have a watch, and learn my best trick when considering buying your fruit & veg organic!

Keep your hormones happy, and learn about the clean fifteen/dirty dozen!

I talk about one SUPER important tip regarding how to keep your hormones happy and balanced - from puberty all the way through to menopause!

I've recorded a short video for you, where I bust two common fertility myths (hint, they have to do with sex!) while also talking about one KEY thing to avoid when trying to get pregnant. Check it out!