Can fish oil help with dysmenorrhea (aka painful periods)?



Dysmenorrhea is pain and cramping in the lower abdominal region during a woman’s menstrual cycle. There are two types of dysmenorrhea: primary or secondary. In primary dysmenorrhea there is pain with no organic disease present and this form starts six months to two years after menarche (a woman’s first period). Secondary dysmenorrhea is pain with menses that is associated to a disease process. This form starts typically when women are in their twenties and becomes increasingly worse with age. Secondary dysmenorrhea can be associated to a range of different disorders, including endometriosis, uterine polyps, leiomyoma (fibroids), ovarian cysts, and many more. Although dysmenorrhea is not a life threatening disorder in and of itself, it impacts a woman’s quality of life greatly and is the most common gynecological problem among menstruating women. Numerous studies have also shown that women who suffer from dysmenorrhea have higher rates of absenteeism from school or work, which can be correlated to lost societal productivity.


The standard first-line allopathic treatment of dysmenorrhea is the use of NSAIDs. Another common course of treatment is the use of oral contraceptives. If neither of these treatment protocols work there is additional inquiry required to rule out secondary dysmenorrhea. Even if secondary dysmenorrhea is identified, NSAIDs and oral contraceptives are commonly prescribed. Like any medication, these two are not without their associated risks. Of particular concern is peptic ulcers and thus internal bleeding in relation to the use of NSAIDs. A low but serious risk factor associated with the use of oral contraceptives that contain estrogen is the development of blood clots. This risk further increases among women who smoke cigarettes.


While conventional medicine uses anti-inflammatory medication, an ND may look at reducing overall inflammation in the patient’s body through diet. Often this begins with an elimination diet, to try and identify whether there is any food that aggravates the patient. This may extend into more permanent elimination of common triggers, such as dairy or gluten. Encouraging the patient to avoid sugar, alcohol and smoking would also be critical to decrease an inflammatory state. Other dietary approaches with varying levels of evidence that may help with dysmenorrhea include regular breakfast habits, aspartame ingestion and low fat vegan diets. Nutritional supplements that also have research to back up their efficacy in treating dysmenorrhea include magnesium, thiamine, vitamin E, iron, niacin, flavonoids, ginger root and of course omega-3 fatty acids. According to a 2001 Cochrane Review on herbal and dietary therapies for dysmenorrhea, the authors concluded that based on all available evidence, vitamin B1 and magnesium both may have benefits in the reduction of pain with dysmenorrhea.

An ND may also use some or all of the following modalities: hydrotherapy, homeopathy, lifestyle change counseling, botanical medicine and acupuncture.

For example, with hydrotherapy, an ND may recommend the use of hot compresses to relax the muscles, hot sitz bath as an analgesic and constitutional hydrotherapy for increased circulation and cellular metabolism.

Many different botanicals could also be used to help with dysmenorrhea. Desirable actions for these herbs would be antispasmodics, nervines, diuretics, uterine tonics and hormonal normalizers. For example, a common tincture prescription for people suffering from dysmenorrhea is Viburnum prunifolium (antispasmodic), Scutellaria lateriflora (nervine and antispasmodic) and Cimicifuga racemosa (anispasmodic, anti-inflammatory, nervine).

A very big lifestyle recommendation would be for patients who suffer from dysmenorrhea to regularly exercise. Exercise can have the effect of lowering the incidence of dysmenorrhea through mediating stress and hormones.

Finally, the use of acupuncture can help to decrease dysmenorrhea. For example, from a Traditional Chinese Medicine perspective, dysmenorrhea is a common symptom in patients who present with liver blood stasis. Causes of this are Qi stagnation, cold and heat. Acupuncture points that may be beneficial include, but are not limited to, stomach 36 (tonifies Qi), liver 3 and liver 4 (promotes smooth flow of liver Qi).


Essential fatty acids act as precursors to prostaglandins, prostacyclins, thromboxanes and leukotrienes. These substances have critical influences on immune function, smooth muscle function, platelet aggregation and inflammation. Omega-3 fatty acids are responsible for 3-series prostaglandins while omega-6 fatty acids are responsible for 1-series prostaglandins. Generally speaking, the western diet is lacking in omega-3 fatty acids as it is not present in a lot of our common dietary oils and cold water fish and linseed oil are not a part of the typical diet. On the other hand, it is common to find omega-6 fatty acids in dietary oils. If the body receives a higher amount of one of these, it inhibits the metabolism of the other.

Before a woman menstruates, she has a progesterone withdrawal. At this time there is a cascade of prostaglandins and leukotrienes in the uterus. The ensuing inflammatory response is responsible for cramps, nausea, vomiting, bloating and headache. The prostaglandins that are produced could be 3-series or 1-series prostaglandins. Omega-3 prostaglandins (3-series) are less potent than the ones produced by omega-6 fatty acids (1-series). If a woman produces less potent prostaglandins the result could be less myometrial contraction, vasoconstriction, ischemia and pain. Thus, if a woman is taking an omega-3 fatty acid supplement, there is a higher likelihood that she will experience less dysmenorrhea based on the above information. This may be more applicable to women with primary dysmenorrhea, but could potentially play at least a partial role for women with secondary dysmenorrhea, depending on the cause.


The author of this article examined studies that compared fish oils to placebo and other oils in the treatment of dysmenorrhea. Papers that looked at surveys and case reports were also included. The overarching theme was that, at least to some degree, supplementation with omega-3 fatty acids does decrease symptoms associated with dysmenorrhea. For example, in a 2011 research paper 120 women with dysmenorrhea were randomly divided into two groups. One group received 100mg/day of fish oil and the other group received ibuprofen. Both fish oil and ibuprofen provided pain relief among these women. In another study it was identified that fish oil with B12 appeared to have the greatest effect in pain reduction. Surveys that examined dietary habits among women of reproductive age also found that those who consume less fish appeared to be more likely to have dysmenorrhea. More studies that compare the intake of omega-3 fatty acids to standards first line conventional treatment of dysmenorrhea (ie NSAIDs or oral contraceptives) should be done in order to determine whether omega-3 fatty acids are in fact a comparable treatment.


Naturopathic Doctors will commonly prescribe fish oil to patients for a variety of conditions. Research has demonstrated its efficacy in relation to a variety of mental health conditions, alzheimer’s disease, autism, skin conditions such as eczema, coronary artery disease and rheumatoid arthritis. Outside of patients with fish allergies, the intake of omega-3 fatty acids is considered safe when taken up to 3.5 years. A common concern regarding the intake of fish oil is that it may increase one’s chance of bleeding. A 1992 study followed 365 patients over seven-years who took a daily fish oil supplement. These patients had ischemic heart disease, hyperlilipedmia or a strong family history of ischemic heart disease. The research found that there were no adverse effects. Of course, an ND must look at each patient as an individual and decide based on their entire picture whether fish oil is warranted and safe. However, based on the overarching lack of harms associated with the intake of fish oil, fairly accessible prices and significant potential overall health benefits, relating to dysmenorrhea and beyond, it appears that omega-3 fatty acid supplements, commonly in the form of fish oil, are an excellent supplement to prescribe to patients. Alternatively, encouraging patients to increase their intake of fish in the diet would also be advisable and patients could budget this into their weekly groceries spending as opposed to having to buy a supplement separately.


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Moghadamnia, AA, Mirhosseini, N, Abadi, MH, Omranirad, A, Omidvar, SH. Effect of clupeonella grimmi (anchovy/kilka) fish oil on dysmenorrhoea. Eastern Mediterranean Health Journal. 2010; 16: 408-413.

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Female Pelvic Exams


With International Women’s Day this month, I thought now was a great time to write a blog post about female pelvic exams. I come to realize, time and time again, that many people are misinformed about what a Naturopathic Doctor can offer as part of our services. Although this will vary from province to province, in Ontario, Naturopathic Doctors are able to perform female pelvic exams. Not all NDs have the clinic setup or clinical focus that will allow for this examination, so always ask an ND if they provide this service before you book an appointment.

While studying at the Canadian College of Naturopathic Medicine (CCNM), I received excellent training on how to perform this exam. After passing a series of practical competency examinations, first on plastic pelvic simulators, then on paid models, we were then required to complete a certain number of pelvic exams on patients during our final clinical year. Fun fact, during my second year of the program, I was actually one of the paid gynecological models! So not only have I been tested in my skills, I have also had the opportunity to experience the vulnerability of being the one on the examination table many times. In addition to the training I had at CCNM, I also was trained in female pelvic exams when I was working as a Public Health Nurse. I did this through the McMaster University Well Women Workshop training program. What’s especially neat about this training, is that the models give you real time feedback on your technique. My model, this amazing woman who has been helping health care providers become more proficient in this sensitive and important skill, actually reached down and put her hand on my hand while I was inserting the speculum, so that she could show me the exact position that allowed her to feel optimal comfort.

Okay, so enough background information, let’s get to the nitty gritty. What do I even mean when I say female pelvic exam anyway?

First, I will spend time asking you about your health history. We will determine what parts of the pelvic exam are required for you, if any. For example, the Ontario Cervical Screening Program recommends that women who are or have been sexually active have a Pap test every 3 years starting at age 21. You will also be able to share with me any fears or concerns you have regarding this exam. We will be sure that you feel comfortable and empowered at all times.

For the actual exam, you will be in a private room at the clinic where I work on the Danforth. I will take good care to explain to you everything you should expect, and let you know that you can ask me to stop the exam at any time for any reason. Once we begin, there is first an external examination of the vulva for both a visual and physical assessment. The second part is the Pap test and/or a swab for cultures. The final part is a bimanual examination (where two fingers, wearing a medical glove, are inserted into the vagina) where I will assess the health of your uterus and ovaries. I will explain each step before I begin, and you will be in control the entire time. At the end of the exam I will test the pH of your vaginal fluid, as a part of an overall assessment of vaginal health.

Here are some FAQs that you may be curious about:

Q: What can a Naturopathic Doctor test for when it comes to the female pelvic exam?

A: Naturopathic Doctors can perform pap smears, which collect cells from the cervix. The sample is sent to the laboratory where it is examined for any abnormal cells which may indicate pre-cancer or cancer of the cervix. Naturopathic Doctors can also swab for Bacterial Vaginosis, Candida and Trichomonas.

Unfortunately, at this time, Naturopathic Doctors cannot swab for sexually transmitted infections, such as gonorrhea or chlamydia.

Q: Is this covered under OHIP?

A: Naturopathic Care is not covered under OHIP. Many extended health insurance plans cover the cost of the appointment when you see a Naturopathic Doctor. The pap test and/or swab is at an additional cost. Please feel free to contact me for details.

Q: Why would I see an ND for this instead of my Medical Doctor?

A: There could be many reasons for this, but at the end of the day, you should see whoever feels like the right fit for you and your health needs. Sometimes people seek out a Naturopathic Doctor for female pelvic exams as we can spend more time with the patient, explaining the process and ensuring you feel comfortable. We also strive to make it a very educational experience, where you leave feeling empowered about the knowledge you have gained in regards to your health and your body.

I hope this blog post has been interesting and informative for you! Feel free to reach out if you have any questions, or book in an appointment to learn more about your pelvic health.

Yours in Health,

Dr. Madeleine Elton, ND


Fertility Awareness Method

Photo by Catherine McMahon

Photo by Catherine McMahon

This month instead of doing a written blog post, I decided to concentrate my efforts on a video instead! I learned about the Fertility Awareness Method (FAM) about 10 years ago when I wanted to get off of hormonal birth control (but still avoid pregnancy) and learn more about my body. I was originally taught, via one-on-one lessons, by Amy Sedgwick, back when the Red Tent Sisters was a physical store on the Danforth!

I charted my cycles for years. Not only did I become very familiar with when I ovulate and when I could expect my period, I also started to notice emotional patterns I had each month. I noticed physical changes that my body would have during certain parts of my cycle. I felt like I understood my body on a level I had never known.

To learn FAM, and to practice it with a full understanding, takes some time, dedication and patience. My video, which can be found on my Facebook page, is a very basic explanation of FAM. I just wanted to provide people with an opportunity to get a sense of what it is, but this is not the be-all and end-all, this is just the beginning. Enjoy!



5 Ways to Manage the Symptoms of Seasonal Affective Disorder


Photo by: Viktoria Hall-Waldhauser

Ah, winter time. The days are darker, the air is colder and a lot of us feel, sort of….”meh”. One potential reason for this change in mood is Seasonal Affective Disorder (or SAD). SAD is defined as “recurrent depressive episodes during autumn and winter alternating with nondepressive episodes during spring and summer”. Symptoms include low energy, irritability, overeating and weight gain. Symptoms generally begin in November and last, on average, for five months. Like with any condition, there are a range of possible causes for SAD.  It can be a mix of climate, psychological and sociocultural factors and genetic vulnerability. It also seems to disproportionately affect more women than men, and is more common among younger people.

Here are five things you can do to help manage SAD symptoms:

  1. Bright Light Therapy: These bright lights can be purchased at a variety of stores and the general recommendation is 10,000 lux (light intensity) for 30 minutes daily in the morning for up to 6 weeks. The light helps to alter circadian rhythms and modulate serotonin and catecholamines. Potential side effects include headache, eye strain, nausea and agitation. UBC has some good information on how to get a light device.
  2. Cognitive Behavioural Therapy (CBT): CBT has been shown to improve SAD symptoms, either on it’s own or alongside light therapy. Many therapists and other health care providers offer CBT services. Alternatively, there are options for working through CBT exercises online, such as with moodgym.
  3. Vitamin D: Many Canadians find themselves deficient in Vitamin D during the winter months. With the sun being further away from the earth and our skin being regularly covered with multiple layers of clothing, it’s hard to get much sun exposure. Improved Vitamin D status has been linked to improvement in depression scale scores.
  4. St. John’s Wort: This herb, also known as Hypericum, has a long history of use when it comes to depression. It can be consumed in a tea, tincture or pill form. Finding the dose that is right for you is important, as well as making sure this herb does not interact with any medications you may be taking.
  5. Melatonin: This hormone is produced by the pineal gland and helps to regulate sleep. It’s synthesis is triggered by darkness. Abnormal melatonin synthesis may be a cause of SAD. Supplementing with melatonin may help to manage SAD symptoms.

This list does not include the basic pillars for health, which are diet, exercise, stress management and sleep. These pillars should always be addressed first before beginning any sort of treatment. Seeing a Naturopathic Doctor can also help you to discover whether there is a dietary or hormonal component to your mood changes. I invite you to book a free 15 minute appointment with me, so that you can begin to feel good this winter and beyond!

Yours in Health,

Dr. Madeleine Elton, ND



Ferri, F. Ferri’s Clinical Advisor 2018.

Goth, FM 3rd, Alam, W, Hollis, B. Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. J Nutr Health Aging. 1993;3(1):5-7.

Leppamaki S, Partonen T, Vakkuri O, et al. Effect of controlled-release melatonin on sleep quality, mood, and quality of life in subjects with seasonal or weather-associated changes in mood and behaviour. Eur Neuropsychopharmacol 2003;13:137-145.

Martinez B, Kasper S, Ruhrmann S, Moller HJ. Hypericum in the treatment of seasonal affective disorders. J Geriatr Psychiatry Neurol 1994;7:S29- S33.

Ravindran et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder Section 5. Complementary and Alternative Medicine Treatments. Can J Psychiatry. 2016 Sep; 61(9):576-587.

Rohan, K, Meyerhoff, J, Ho, SY, Evans, M, Postolache, TT, Vacek, PM. Outcomes one and two winters following cognitive-behavioral therapy or light therapy for seasonal affective disorder. Am J Psychiatry. 2016 Mar 1;173(3):244-51.



Getting aligned…why I decided to offer a sliding scale


Photo by Jens Lelie on Unsplash

I feel like this post has, in one way or another, been rumbling around somewhere in my psyche, waiting for me to bring it to the surface, for many years.

I recently made the decision to officially offer a sliding scale for my naturopathic services. I’m not the first ND to offer this, and I won’t be the last, but I wanted to take a minute (or 5) and I explain why came to this decision.

I’ve always been a highly empathetic person. I knew I had this trait as an adult, but it wasn’t until I came across one of my report cards from kindergarten that confirmed that this has always been one of my stronger traits. I realized this is just me. When I was studying nursing, I really resonated with our lessons on the social determinants of health. One of the strongest social determinants of health is income and social status. In general, those who have more money are healthier. Learning about these types of concepts are what inspired me to become a public health nurse. I wanted work with marginalized populations, offering education, tools and resources to prevent and manage disease. As a public health nurse I was so blessed to work with amazing clients. I worked with different populations. Some with addiction challenges, some who were underhoused, many who barely had enough money to keep themselves and their families fed.

As much as I loved my job, I had always had an equally strong desire to study naturopathic medicine. To dive much more deeply into the body and all the natural ways to support health and healing. I wanted a career where I had more creativity and autonomy, and where I could use some of the modalities that naturopathic medicine offers. I knew, however, that I was getting into private health care, and this was something that I struggled with regularly. I remember when I toured CCNM (the school I attended) I asked my tour guide how she felt about the fact that our services aren’t accessible to the general population. She said that we work hard for 8 years (true! we have to do a 4 year undergraduate degree and then CCNM for 4 more years) and that we invest a lot of money into our education (very, very true), and so we deserve to charge those rates for our services. The truth is, I don’t disagree with this. I don’t think naturopathic doctors overcharge for their services. In fact, based on all of the research and effort that is put into our work behind the scenes, we are realistically probably under charging a lot of the time. Most people who become NDs don’t do it for the money. They do it because they are passionate about the career. You see the power of the medicine and you want to share it with others. But then you graduate and you realize that now you need to be a doctor, a business person, an accountant, a social marketing expert, a top notch researcher, oh and maybe also live your everyday life. It’s not easy.

But the reality is, many people can’t afford our services. There are more and more private health insurance companies that are covering naturopathy, and yes there are people who can afford the services no problem, but many can’t. I will argue that some people could choose to prioritize their health care more, financially, and maybe spend less in other domains. But there are also many people who, no matter how they prioritize their money, wouldn’t be able to afford it. Most of my best friends are artists: singers, dancers, actors, etc. They are my favourite people in the entire world. They feed my soul and make my heart sing. Most of them will never see an ND. They don’t have private health insurance, they probably never will, and their financial stability is up and down.

So, I had to ask myself. Where do I stand? What feels right for me? A sliding scale feels right for me. I want to be able to service artists. I want to be able to service single Moms. I believe that alternative health care should be accessible to everyone. One of my favourite teachers from CCNM, Dr. Chris Pickrell, ND, has been offering a sliding scale for years and it has been very successful for him. I recall him telling me that some of his patients who couldn’t afford the full rate finally got a job where they were making more, and they felt proud and excited to be able to offer the full price for their visits. I believe people don’t take advantage of these options, they use them because they need to.

When I finally came to this decision I immediately felt lighter and more like myself. When you are trying to do what you think you are supposed to do, and it doesn’t align with your deepest ethics, it weighs you down. I encourage my patients to listen to their deepest and truest self, so if I’m not doing the same, how can I ever expect anyone to heed my advice?

Is my decision the smartest business decision I could make? Maybe it is, maybe it isn’t. Maybe I will be wildly successful. Maybe I will fail miserably. But I’d rather listen to my heart, try and fail then to have never tried at all.

I have a fixed rate for all of my standard appointments, however, if the rates do not match your current financial situation, please speak with me and we will work together to find an appropriate rate.

When I registered my business with CRA I called it Metta Health Services. I learned the word Metta when I did a ten-day silent meditation retreat. It means “loving kindness”. It’s a meditation practice where you send yourself loving kindness, and then you extend the circle and send it out to your friends and family, and then finally to all sentient beings. This is my way of practising Metta.

May you be happy. May you be well. May you be safe. May you be peaceful and at ease.

Sincerely and from my heart,

Dr. Madeleine Elton, ND


Tapping: Emotional Freedom Technique

You might be reading the title Emotional Freedom Technique (or EFT) and thinking “what is this energetic hippie non-sense that this Naturopath is making me read?”. Well, believe it or not, this is a technique that actually has a great deal of evidence behind it, including an array of Randomized-Control Trials!

This technique has been shown to decrease anxiety, depression, stress, pain, anger and tension headaches, just to name a few of it’s benefits! I kind of like to think of this technique as a good substitution for those who tell me “I can’t meditate” or “I hate meditating!”. Some people find sitting in silence a painful experience, and although I still highly recommend meditation to anyone (trust me, it can be enjoyable), EFT it a nice way to experience a lot of the same benefits without motionlessness and silence.

So, I guess the next logical question you are asking is, what the heck is EFT?? Well, I’m here to tell you! It involves tapping on specific acupuncture points (with your fingers) while focusing on an upsetting memory, issue, or emotion. As mentioned above, it can help you to lighten or release emotional distress, become more present in your body and shift your perception.

Here is how to practice EFT:

1. Choose a specific memory or experience.

2. Rate the emotional intensity from 0-10

3. Set-up: Tap the Karate Chop point on the side of the hands while saying aloud three times, ‘Even though I have this…., I deeply and completely accept myself’.

4. Tap the sequence of points, with a reminder phrase. If your phrase was “Even though I felt embarrassed when I had to speak in front of the class, I deeply and completely accept myself”, the reminder phrase would be “embarrassed when I spoke in class”.

5. Tapping the points: tap each point 7-10 times while repeating your phrase, with 2-4 fingers. The points are top of head, eyebrow, side of eye, under eye, under nose, chin, collarbone, under arm (see image below).

6. Rate your emotional intensity again from 0-10.

EFT image copy

If the emotional intensity hasn’t lessened after your tapping sequence, try to become more specific with your phrase to get at the core of the emotion you are feeling.

I love this technique because it is a reminder that no matter what happens in life, we must always return to the love that we have for ourselves. This should be our landing strip, our comfort zone, our default setting. In the words of Brené Brown (the queen of quotes that hit us in those deep feeling spaces!):

When you get to a place where you understand that love and belonging, your worthiness, is a birthright and not something you have to earn, anything is possible“.

If you’d like to learn more about EFT or other ways to help manage stress, anxiety, depression, chronic pain and more, I would love to chat! Until then, happy tapping!

Dr. Madeleine Elton, ND



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Suh, JW, Chung, SY, Kim, SY, Lee, JH, Kim, JW. Anxiety and anger symptoms in hwabyung patients improved more following 4 weeks of the emotional freedom technique program compared to the progressive muscle relaxation program: a randomized controlled trial. Evid Based Complement Alternat Med. 2015 Oct 11.