Functional Medicine in Gynecology in Turkey

The Philosophy of Functional Medicine in Women’s Health

"Genes load the gun, but lifestyle pulls the trigger!" – Caldwell Esselstyn

Everything in the body exists in such a delicate balance that the elevation or reduction of a single hormone can disrupt multiple physiological processes in a chain reaction.

In fact, hormones secreted by endocrine organs not only affect their target organs but also influence each other’s functions. This interconnected system is now referred to as the Hypothalamic-Pituitary-Adrenal-Thyroid-Gonad (HPATG) axis.

What Does Stress Do to Our Body?

When the stress hormone cortisol is elevated, it disrupts both the conversion of thyroid hormones into their active forms and the secretion of thyroid-stimulating hormone from the pituitary gland.

In hypothyroidism (underactive thyroid),metabolism slows down, fatigue and depression are triggered, and this domino effect can make the individual feel even worse. Stress also affects the reproductive system by reducing the secretion of hormones from the pituitary gland that stimulate ovarian function in women and testicular function in men.

Cortisol levels must be delicately balanced, as low levels can also lead to depression and burnout syndrome.

Functional Medicine Perspective in Gynecology

• Functional Medicine Perspective on the Menstrual Cycle
• Functional Medicine Perspective on Endometriosis
• Functional Medicine Perspective on Low Ovarian Reserve / Premature Ovarian Insufficiency (POI)
• Bioidentical Hormone Therapy
• Functional Approach to HPV Treatment
• Functional Approach to Recurrent Vaginal Candida Treatment

Functional Medicine Perspective on the Menstrual Cycle

A woman’s two key hormones, estradiol and progesterone, function in a specific balance and cycle. Unhealthy and high-calorie diets, stress, birth control pills, hormone replacement therapies, xenoestrogens (from cosmetic products),and impaired liver function can lead to estrogen dominance, disrupting this hormonal balance.

Estrogen dominance increases the risk of premenstrual syndrome (PMS),endometriosis, endometrial cancer, and breast cancer. In the functional medicine approach, the estradiol/progesterone ratio is calculated, and estrogen metabolites are assessed. If carcinogenic estradiol metabolites and/or estradiol dominance are detected, treatments are applied to accelerate estrogen metabolism in the liver (detoxification processes) and to facilitate its elimination via the intestines.

Functional Medicine Perspective on Endometriosis

Inflammation and estrogen dominance play the most significant roles in the development of endometriosis. Treatment depends on whether the patient experiences pain—such as menstrual cramps, pain during intercourse, or generalized abdominal pain—and whether pregnancy is desired. Since endometriosis is driven by inflammation, the primary and common goal of treatment is to suppress inflammation.

To reduce estrogen dominance, dysbiosis—an overgrowth of bacteria in the gut that increases the reabsorption of estrogen into the bloodstream—must be corrected. This is achieved through a proper diet under the guidance of a dietitian. A diet low in red meat, alcohol, and caffeine, as well as gluten-free and lactose-free nutrition, and limiting xenoestrogens (from cosmetic products) is recommended. Insulin resistance, diabetes, and obesity, which increase estrogen production, should also be treated.

Anti-inflammatory, antioxidant, and methylation-enhancing medications are used, along with treatments that accelerate estrogen metabolism in the liver (detoxification) and enhance its elimination through the intestines to treat estrogen dominance.

Functional Medicine Perspective on Low Ovarian Reserve / Premature Ovarian Insufficiency (POI)

Premature ovarian insufficiency is defined as the absence of menstruation for at least four months under the age of 40 and FSH levels above 25 IU/L in two measurements taken four weeks apart. The main causes include genetics, autoimmune diseases, stress, and smoking.

Treatment depends on whether pregnancy is desired. If pregnancy is not desired, bioidentical hormone therapy is administered. For patients desiring pregnancy, supportive treatments that improve mitochondrial health, antioxidant therapy, dysbiosis treatment, avoidance of environmental toxins, and cessation of smoking are recommended. These interventions enhance the success of assisted reproductive techniques in married patients and egg freezing procedures in single patients.

Bioidentical Hormone Therapy

Estrogen is secreted in three different types and acts in the body through two different receptors. Alpha estrogen receptors stimulate cells in the breast and uterus, whereas beta receptors are found in the brain and intestines and inhibit cell proliferation in the breast.

Conventional hormone replacement therapies stimulate breast tissue, which is why transdermal (skin-applied) forms are considered safer. In bioidentical hormone therapy, estriol, which has low estrogenic effect, is applied alone or in combination with estradiol via transdermal application.

Bioidentical hormone therapy is not recommended for patients with a personal or family history of breast cancer.

Functional Approach to HPV Treatment

HPV is a carcinogenic virus that can cause cervical cancer. There are many high-risk and low-risk types of HPV. Treatment planning depends on the detected HPV type and smear results.

To eliminate HPV, a Mediterranean-style diet should be followed, and smoking and birth control pills should be discontinued. The presence of bacterial vaginosis reduces HPV clearance; therefore, regulating the vaginal flora is important for HPV elimination. Antioxidants, curcumin, and green tea also increase HPV clearance. Shiitake mushroom extract (AHCC) binds HPV and is administered for six months.

Functional Approach to Recurrent Vaginal Candida Treatment

Frequent antibiotic use, acid-reducing medications, steroid and anti-inflammatory drugs, birth control pills, immune system weakness, carbonated drinks, sugar- and flour-rich diets, diabetes, insulin resistance, and stress can disrupt vaginal flora, leading to overgrowth of Candida strains.

Functional treatment involves body barrier repair, antifungal therapy, and heavy metal detoxification. Vaginal probiotics are used as the final step. Blue-green algae are utilized for heavy metal detoxification. Sitz baths with special salts, mouth rinses with special oils, and tampon applications with oils are also part of the treatment protocol.

Functional Medicine Obstetrician & Gynecologist in Turkey

Functional medicine is a branch of medicine that addresses general health issues with a holistic approach, aiming to support the body’s natural healing mechanisms. In functional medicine, obstetricians and gynecologists focus on women’s health while incorporating nutrition, lifestyle changes, and natural treatment methods into their treatment plans. This approach helps manage hormonal imbalances, menstrual irregularities, infertility, and menopausal symptoms, while carefully considering the patient’s individual medical history.

A gynecologist specializing in this field is not only well-versed in traditional women’s health and obstetric care, but also utilizes alternative therapies to improve the patient’s quality of life. Because functional medicine focuses on identifying and treating the root causes of disease, it can be particularly effective in managing chronic women’s health issues.