Whole Health emphasizes mindful awareness and Veteran self-care. The Circle of Health highlights eight areas of self-care: Surroundings; Personal Development; Food and Drink; Recharge; Family Friends, and Co-Workers; Spirit and Soul; Power of the Mind; and Moving the Body. The narrative below shows what a Whole Health clinical visit could look like during early and later adulthood and how to apply the latest research on complementary and integrative health (CIH) to women’s health.
A Whole Health approach to women’s health incorporates complementary and integrative practices, including supplements and herbal remedies, to improve health and well-being and manage symptoms related to underlying conditions.
Meet the Veteran
Julie is a 24-year-old who returned from deployment abroad last year. She presents to discuss worsening acne in addition to contraceptive options. In reviewing her gynecologic history, Julie reports irregular and infrequent periods, occurring over the last few years. On exam, she has significant acne over her face and back. There are scattered coarse, dark hairs present on her chin and chest. Based on this presentation, her provider suspects a diagnosis of polycystic ovarian syndrome (PCOS). Laboratory evaluation shows normal TSH and prolactin levels. A pelvic ultrasound demonstrates a normal appearing uterus; however, multiple simple cysts are present in her bilateral ovaries. Without additional findings to suggest an alternative diagnosis, Julie diagnosis is PCOS. Subsequent labs reveal an elevated hemoglobin A1C of 5.8% and a cholesterol panel showing elevated triglycerides and LDL.
Currently, Julie attends classes to finish her undergraduate degree while working part-time. Her days are often hectic—she eats fast food for at least one meal a day and does not exercise. She gained 10 lbs over the past year and her BMI is 29 kg/m2. She often mindlessly snacks at night while doing homework, eating a bag of chips or candy. Julie feels overwhelmed by her responsibilities, which often keep her up late into the night resulting in only 4-5 hours of sleep. She has not had much time to explore her interests, hobbies, or even to spend time reconnecting with friends.
Personal Health Inventory
On her Personal Health Inventory, (PHI) Julie rates herself a 2 out of 5 for her overall physical well-being and a 3 for overall mental and emotional well-being. When asked what matters most to her and why she wants to be healthy, Julie responds:
“Although all my time is currently devoted to financing and finishing my undergraduate degree, family and friends really matter to me. I want to be able to connect with friends and walk my dog. I need to feel like my schedule is under control.”
For the eight areas of self-care, Julie rates herself on where she is, and where she would like to be. Julie decides to first focus on the areas of Food and Drink and Family, Friends, and Co-Workers by returning to a healthy diet and dedicating a short period each week to her friends and family.
For more information, refer to Julie’s PHI.
Polycystic ovarian syndrome (PCOS) is a clinical diagnosis characterized by oligoovulation, hyperandrogenism, and often the presence of polycystic ovaries. A common disorder, PCOS affects about 10% of reproductive age women.Women often present with amenorrhea or oligomenorrhea, hirsutism with acne and male-pattern hair growth, weight gain, and difficulty with fertility. PCOS is associated with an increased risk of developing diabetes mellitus and cardiovascular disease.
Diagnostic criteria for PCOS vary by organization, although all include a component of ovarian disease and the exclusion of alternative diagnoses (refer to Table 1). Differential diagnosis includes thyroid disease, hyperprolactinemia, androgen-secreting tumors, adrenal hyperplasia, and Cushing’s syndrome. Depending on presenting symptoms, consider laboratory testing that includes a pregnancy test, TSH, prolactin, fasting glucose to insulin ratio, total and free testosterone levels, dehydroepiandrosterone (DHEA), sulfate, morning 17a-hydroxyprogesterone, and 24-hour urine cortisol level. Transvaginal ultrasound may show characteristic changes associated with PCOS but is not required for the diagnosis if the hormonal features of PCOS are present.
Table 1. Differing Criteria for Polycystic Ovarian Syndrome Among Organizations
|Organization||Criteria||Ovarian Dysfunction||Ovarian Morphology||Hyper-androgenism|
|National Institutes of Health (1990) ||Both of the following and exclusion of related disorders||Oligo-ovulation (less than six menses per year)||Not applicable||Clinical or biochemical (not specified)|
|Rotterdam Group (2003) ||Any two of three of the following and exclusion of related disorders||Oligo-anovulation (nonspecified)||Polycystic ovaries (>12 follicles 2 to 9 mm, or ovarian volume >10 mL)||Clinical or biochemical (free testosterone or free testosterone index)|
|Androgen Excess Society (2006) ||Hyperandrogenism as critical, with addition of at least one ovarian marker and exclusion of related disorders||Oligo-anovulation and/or polycystic ovaries||Oligo-anovulation and/or polycystic ovaries||Clinical or biochemical (free testosterone)|