Tamoxifen is a pharmaceutical drug used to hormonally treat breast cancer post surgery and halt recurring cancer coming back (for example to the other breast). The drug is also used within women who have a high risk of developing breast cancer (Cancer Research, 2020). 

Hormone sensitive cancers, such as breast cancer, can be stimulated by the female sex hormones (oestrogen & progesterone). Tamoxifen is usually prescribed for the use in people who may have oestrogen receptors in breast cancer tissues (oestrogen receptor positive cells).

Tamoxifen works to lock these oestrogen receptors and halt oestrogen from attracting them - thus the oestrogen cant stimulate the cells to divide/grow. The drug also promotes apoptosis in oestrogen receptor positive tumours. 

Increase tumour pain, hot flashes, nausea, fatigue, mood swings, depression, headache, hair thinning 

'Indols downregulate the expression of the oestrogen-responsive genes and upregulate the BRAC1 (human tumour suppressor gene - responsible for repairing DNA). They inhibit th expression of cycline-dependent kinase-6 (tumour activators) and induce a G1 cell cycle arrest independent of oestrogen receptor signalling - Hechtman, 2018


Indol-3-Carbinol (I-3-C) is a naturally derived substances from glucobrassicin found in green cruciferous vegetables (broccoli, brussel sprouts, collards, kale, mustard greens) which are known for their detoxifying enzymes in the gut and liver. This substance is formed into a sulphuric powder and has potent anti-tumour properties, I-3-C can be consumed in conjunction of instead of Tamoxifen. I-3-C has been shown to reduce the incidence of spontaneous and carcinogen-induced mammary tumours. 

I-3-C is used in prevention of breast and colon cancer and has been reviewed by the National Institutes of Health (NIH) as a potential preventative agent and is now being properly sponsored for research in breast cancer prevention. I-3-C and its metabolite DIM attack the cancer cell-cycle regulation 

Indol-3-Carbinol is mostly safe when taken as medicine for breast cancer - high doses above 400mg/day may cause nausea, balance problems and tremors. 

As seen in the table above, Indol-3-Carbinol is proven to provide more potent activity when it comes to its ability to work in tissue that contains oestrogen receptor negative breast cancer then Tamoxifen.  This natural nutritional medicine is highly effective in promoting healthy breast tissue. The consumption of green vegetables from the Brassica family is also effective in its anti-cancer actions, however to receive a therapeutic dose it is recommended 200-400mg/day. 

As we settle into the warmer months and Christmas looms over us the season of wine, cheese and biscuits sets in.. This short article will cover the 'do's and don'ts' of the festive season whilst still highlighting the need for some fun. 

Choosing foods over Christmas can be quite a challenge with the mince pies, mulled wine and roast ham, however making tiny changes will support your health and get you through unscathed. 

1. Picking green Brassica veggies such as brussel sprouts, kale, chard and broccoli support the detoxification pathways, boost your immune system, inhibit CY1A2 enzyme activation via their phytochemical content + high levels of vitamins and minerals (vitamin C, potassium, vitamin K, folate and beta-carotene).  Cook your greens in high quality extra virgin olive oil and squeeze some lemon over the top at serving to increase absorption of these vital nutrients. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488002/ - this article provides further information on dietary choices to improve metabolic detoxification 'Modulation of Metabolic Detoxification Pathways using foods and food-derived components: A Scientific Review with Clinical Application" (Hodges & Minich, 2015). 

2. Choose more veg over meat on your plate - loading up on vegetables and reducing your meat consumption will help with overall digestions due to the fibre content, lower levels of saturated fat (unless you smother them in butter!!) and lower caloric intake. 

3. Water - drinking plenty of water away from meals will help to improve metabolism of large portions and help to detoxify the body of alcohol. 

4. If you can get off the couch after Christmas lunch, some light exercise an hour after eating a high fat meal will help to lower triglycerides in the blood 

5. The most important thing over the Christmas is to REST, REST, REST!! To support the adrenals and improve your stress response for the new year  

Silybum marianum (St. Mary's Thistle), Cynara Scolymus (Globe Artichoke), Taraxacum officinale (Dandelion root) - liver and body trophorestoratives, choleretic, cholagogue

Products such as 'Legalon', MediHerbs 'LivCo' and BioCeuticals 'Liver Care' are all appropriate for detoxifying the liver, gallbladder and pancreas 

Other herbs with adaptogenic properties (Withania, Siberian ginseng, Astragalus and Bacopa) will support energy/stress levels 

Teas - 'After Party Tea'  at Healthy Heights 
- containing organic thistle, fennel, licorice root, calendula, dandelion, coriander, nettle, mint 

ASSESS YOUR NEED WITH YOUR HEALTHCARE PROFESSIONAL BEFORE USING. 

​•It is SO important to ensure you choose natural skincare over conventional chemical skincare as your skin is the largest organ of your body and needs to be protected!
•This slideshow will provide information to teens to support healthy skin by using nutrition as a means of solving skin issues, provide tools to help you improve your skin such as what to use on it and practices such as yoga to help reduce stress and increase overall wellbeing 

•It is so important today to ensure you are really critical of what choices you make when you pick skincare or ‘superfoods’ from online forums as some of them may be low quality and not well researched leading to you spending lots of money and not receiving the outcomes you may want!
•The best way to go about it is to chat to your local nutritionist or naturopath about what is going on and they will be able to provide you with the best quality products for the best outcome!

​•The best way to go about it is to stick to products that have been tried and tested and proven to work!!
•Choosing products online can sometimes be beneficial but make sure you ask your local healthcare provider about their thoughts on the ingredients before you buy!!

​•Hormones – during your teens hormones fluctuate so much so a few spots here and there are totally normal, however larger reactions can mean that something further is happening
•Nutrition – refined and unnatural processed foods e.g. fizzy drinks, white breads, saturated fats, low in vitamins and minerals
•Environmental factors – poor access to fresh air, nature and living in a big city like Sydney can clog pores and cause a reaction
•Lifestyle – getting good quality sleep (9 hours per night!), exercising and doing things that you love truly help your inner and outer glow shine!

​•Collagen powder – from beef (provides a great amino acid profile for your skin), or from marine sources!
•Green vegetables – kale, spinach
•Fresh fruit – berries, oranges, pineapple, acai
•Healthy fats – avocado, olive oil on salads, nuts and seeds (especially hemp, chia, walnuts and almonds), fish (salmon, tuna)
•Anti-inflammatory foods – when your skin breaks out or feels red and sore try putting anti-inflammatory foods in your everyday meals e.g. turmeric grated into your stir fries, soups or even porridge!

​•Vitamin D – 15-30 minutes per day in the sun is so good for your skin but make sure you don’t spend extended time in the sun!
•Jumping in the ocean is great for removing dirt and excess oils from the skin and makes you feel amazing!
•Tea tree oil on spots is a great alternative to normal spot cream as it dries up the area and is antimicrobial so no more bacterial can grow and spread (just be careful applying as it is quite strong!)
•Beautiful natural skincare such as Evohe
•Organic sunscreen to protect the skin from harsh Australian UV rays 

​•Journal – write down your feelings, emotions, plans, what has made you happy/sad lately and what you want to work on
•Yoga – is such a lovely form of movement and calms the mind and digestion and is proven to help circulation to the skin
•Meditation – insight timer app, lots of deep breaths etc. 

•Naturopaths and nutritionists aim to clear hormones
•Clean skin product
•Chaste tree – a herb that helps to regulate hormones and can be used with the help of a Naturopath
•T clear – includes peony and licorice to help skin healthy and clear
•Pre and Probiotics
•Vitamin A, zinc, D
•B vitamins – boost energy, vitality
•Vitamin C – helps to produce collagen (a protein in the body which helps to build skin, bones and ligaments!) leading to plump and clear skin
•Fish oil supplement – omega 3s are proven to keep skin hydrated and reduce inflammation that may come with acne

Prebiotics versus. Probiotics 
​•Prebiotics – fibers from food such as fruit, veggies and wholegrains and also fermented foods such as yogurt, sauerkraut and tempeh
•Probiotics – living microorganisms that provide health benefits to the gut flora in your tummy! They can improve so many aspects of your life such as improve mood, digestion and skin! 

Today the incidence of tension headaches has increased due to strain from sedentary lifestyles due to different work environments as well as low amounts of exercise. Herbs such as Rosemarinus Officinalis, Mentha x piperita and Eucalyptus globulus all provide a warming sensation to the skin as well as acting as a brightening agent for a foggy brain. The combination of these herbs as essential oils in a burner or carried around have been proven to alleviate such symptoms. 

The use of Rosemarinus officinalis or Rosemary focuses on stress relief thus reducing the prominence of tension headaches. Rosemarinus officinalis oil has strong anti-inflammatory, antispasmodic and analgesic properties. It improves circulation to the section of the body that it is applied to, relaxing the muscles which can be tense around the face and jaw. The use of Rosemarinus officinalis has been proven to increase brain function leading improved memory, increased alertness, greater relaxation and stimulation of blood supply. This essential oil also provides antioxidant preservative actions.
 
Mentha x piperita or peppermint is an uplifting essential oil that is very commonly used topically to the temples treat headaches as is contains menthol which acts as a muscle relaxant and analgesic. Peppermint oil also efficiently works to keep you alert, improve concentration and alleviate mental fatigue or the feeling of restlessness.
 
Eucalyptus globulus or eucalyptus can be used to relieve sinus pressure and opens nasal passageways which relieve headaches due to nasal congestion. Eucalyptus globulus acts as an anti-inflammatory and analgesic due to the monoterpene components of the oil, thus providing relief from pain and tension. With its strong aroma, this essential oil works to relieve stress whilst giving a rejuvenating energy which alleviates mental strain and fatigue whilst stimulating the brain to concentrate on tasks. 

Safety data 
St. Johns Wort has been used to treat nervous conditions since the Ancient Greeks. Hypericum perforatum is not advocated for severe depression, psychotic indications, or suicidal threat. It is not recommended to use it in place of conventional care without professional advise prior or in replacement of seeing a health care provider. 

Depression
The major constituents in Hypericum perforatum, especially hyperforin, act to alleviate depression and display mechanisms that both relate and differ from standard antidepressants e.g. selective serotonin reuptake inhibitors (SSRIs). Hyperforin has shown to delay the neuronal uptake of serotonin, monoamines, dopamine, norepinephrine, amino acid neurotransmitters glutamate and GABA (Nathan, 2001). This occurs in a non-competitive manner via intracellular Na+ ion concentration enhancement, providing anti-depressant action. The constituent hyperforin also acts as an anxiolytic and enhances cognition (Zanoli, 2004). Studies have shown that Hypericum perforatum acts indirectly with pH gradients, causing a pH reduction through the synaptic membrane creating the diffusion of uncharged monoamines into the cytoplasm. This surge in concentration reduces the transmembrane gradient of neurotransmitters inhibiting the uptake by hyperforin (Braun & Cohen, 2018). Other constituents such as adhyperforin and hypericin demonstrate a strong inhibitory effect on neurotransmitter intake. Evidence shows that Hypericum perforatum is extremely helpful during all phases of depression and is on par with common SSRI drugs (Braun & Cohen, 2018). Within a 26-week clinical trial that involved 124 people, Hypericum perforatum and a standard antidepressant (sertraline), alongside with placebo were both just as effective in treating major depression. Hypericum perforatum also proved to have fewer side effects than orthodox antidepressants (National Centre for Complementary & Integrative Health, 2012). Further studies of 426 patients in 2008 show that Hypericum perforatum use reduces the possibility of relapses after 6 to 12-months during a maintenance period than common pharmaceuticals (Kasper et al, 2008)
 
Anxiety & Obsessive-Compulsive disorder
Hypericum perforatum binds to GAB-A and –B receptors reducing GABA uptake which promotes an anxiolytic effect. A 2010 study involving 21 patients with anxiety showed that 71% had positive effects on lowering their anxiety rating after being prescribed the herb at a therapeutic level. This came without a high risk of unwanted side effects that occur from conventional anxiety medication (Lakhan, 2010). Thus, Hypericum perforatum is moderately helpful in reducing anxiety. OCD is an anxiety disorder affecting 2% of Australians and is characterised by the necessity to frequently check or partake activities with an irrational and impulsive nature (SANE, 2019). A study of 12 individuals with OCD over a 12-week duration showed that Hypericum perforatum had a positive effect on symptoms of OCD. After the study, 5 out of 12 patients were rated “very much improved” by clinicians and 6 were pronounced “minimally improved” thus presenting the significant impact of Hypericum perforatum on OCD anxiety conditions (LH et al, 2000). Historically, Hypericum perforatum has been recognised for 2,000 years, especially for its ability to assist hysteria and nervous imbalances especially with depression (King, 1876).
 
Dementia
Cognition-enhancing herbs assists in improving learning and memory. Dementia involves symptoms that affect the brain via memory and behaviour. Hypericum perforatum is indicated in prevention of this condition due to its ability to decrease oxidative stress within the brain (Sanchez-Reus, 2007). Hyperforin proves to help the release of acetylcholine in the hippocampus thus proving its cognition-enhancing effect on humans as well as providing protection from developing dementia (Klusa, 2001). Acetylcholine receptors provide a role in encoding new memories in the brain and improves cognition, learning and object recognition (Hasselmo, 2006). 

Mentha x Piperita or peppermint is part of the Lamiaceae plant family and is a low-growing, perennial aromatic within the mint family (Herbal Gram Peppermint , 2006) . The aerial parts (stem or leaf) of the plant are used medicinally for distilling essential oils (Braun & Cohen, 2018).  The leaves and the stem contain volatile oils which provide the plant with its strong fragrance and taste. The major constituents for M. x piperita are menthol (40.7%) and menthone (23.4%), further components include menthyl acetate, 1,8-cineole, limonene, beta-pinene and beta-caryophyllene. Mentha x piperita leaves contain about 2.5% essential oil, 19% total polyphenolic compounds, 12% total flavonoid compounds (eriocitrin, luteolin-7-O-rutinoside and hesperidoside) and 7% total hydroxyl-cinnamic compounds (including rosemarinic acid) (Duband et al, 1992). Mentha x piperita as a medicinal herb has many actions that treat different ailments within the body. For example, it works as an antispasmodic, carminative, a Choleretic, has antimicrobial properties, antiviral properties, is an antioxidant and a stimulant as well as a coolant and an analgesic (Braun & Cohen, 2018).
 
Irritable bowel syndrome (IBS) is characterised by bloating, abdominal pain and constipation or diarrhoea. Mentha x piperita has direct antispasmodic action on the smooth muscles of the digestive tract. The continuous use of the herb as a remedy for IBS is proven through its use as a powerful diffusible stimulant, carminative, antispasmodic, stomachic working to correct spasm and irritability whilst improving tone and function of the digestive process (Ellingwood, 1919). Trials performed with enteric-coated peppermint oil capsules proved to treat IBS and found a success rate of 58% compared to 28% for the placebo (Balch, 2012). The use of this herb in capsules is highly successful for IBS patients that have minor constipation and is successful in alleviating such symptoms of IBS, improving quality of life due to a reduction in pain or bloating in the abdomen as well as relief of flatulence (Thompson, Meah & Ahmed, 2013). The flavonoids within Mentha x piperita as an essential oil may have a cholagogic effect and stimulate bile secretion which in turn sooths digestion (Rotblatt, 2002).
 
Dyspepsia or indigestion occurs when there is  acid reflex and eructation after the consumption of food. Dyspepsia is defined as a persistent pain and discomfort in the upper abdomen and can lead to bloating, belching and gas, and a burning sensation within this region of the digestive tract (WebMD. N.d). Peppermint oil acts on the smooth muscle of the bowel, it works to relax the gastrointestinal sphincter and serves as a carminative and soothes eructation that can occur during dyspepsia (Henkel, 1869). It provides release of spasm in the intestinal muscle. The use of peppermint leaves in a carminative tea infusion creates a spasmolytic action that reduces acidic reflex and indigestion as it soothes the digestive tract (Weiss, 1988). Carminatives reduce muscle spasm in the digestive tract and aid in expelling gas that occurs due to dyspepsia. Peppermint has been used for a lengthy period to sooth complaints of the stomach and has a warm bitter taste working as an astringent which causes constriction of the digestive tract and creates short term barrier for inflammation and irritation (Culpepper, 1880).
 
Headaches and migraines have a debilitating effect on patients as they are neurological disorders that can be very painful and distressing. Both conditions can lead to nausea, sharp pain in the forehead and temples and increased sensitivity to light and sounds. Migraine headaches can occur due to a reduction in blood flow to areas of the cerebral cortex. The nauseous component of migraines has been scientifically proven to be relieved from the inhalation of vapour from Mentha x piperita whilst significantly reducing the necessity of anti-emetic consumption during times of nausea (Lua and Zakaria, 2012). Tension headaches occur due to muscular strains in the head and neck or due to emotional strain. Thus, treatment of headaches aims to improve blood flow and reduce strain on the upper sections of the body. Menthol receptors on sensory nerves have been identified to be able to modulate the cool sensation on strained nerves (Mills, 2005). Topical application of Mentha x piperita as an essential oil onto the temples and forehead creates this cooling sensation on peripheral circulation, dilating muscles and constricted blood vessels around the inflicted area that make tension headaches worsen (Gobel, 1996). Thus, Mentha x piperita has peripheral vasodilatory actions. Peppermint oil has been shown to significantly increase the level of skin blood flow to the head after local application to relieve a migraine. Thus, a clinical analgesic and coolant actions exists through the use of Mentha x piperita as there is a reduction in sensitivity to a headache and its symptoms due to the alteration of sensations of the nerves, spinal cord and brain affected by headaches (Gobel et al, 1995). 
 
Respiratory tract infections (RTI) are infectious diseases which affect the upper and lower respiratory systems. These RTIs affect the sinuses, throat, airways and the lungs making them a threat to health especially to those who may have already weakened immunity. Mentha x piperita as a medicinal herb can be used to soothe infections within both respiratory tracts, the upper being related to the common cold and the lower to more serious diseases such as pneumonia (Burt, 1876). Inhalation of this antiseptic and anti-inflammatory essential oil has traditionally been used to treat respiratory tract infections such as bronchitis (Braun & Cohen, 2018). The use of chest rubs containing Mentha x piperita for its menthol properties is frequently used to treat coughs and bronchitis. The inhalation of peppermint oil proves to decrease inflammation and provides antimicrobial properties that soothe respiratory tract infections (Bone, 2003). The use of the oil as a respiratory anti-inflammatory after using aerosolized mixture can significantly reduce ozone-induced nasal and respiratory inflammation (Respiratory Research, 2011). The menthol constituents in Mentha x piperita act as mucous membrane trophorestorative as it improves mucociliary clearance, reduces coughs, controls an excessive cough and improves airway calibre in vitro (Explore: The Journal of Science and Healing, 2008). Further, peppermint oil has been found to have antimycobacterial effects to help treat those with tuberculosis. (Shkuru et al, 2002).
 
Reduced cognitive performance due to lifestyle and environmental factors can lead to lessened concentration, lowered vitality and affect mood. Random testing of essential oils including peppermint has proven that mood scales after inhalation of peppermint oil improves cognition. Mentha x piperita has stimulatory actions and beneficially modulates performance during cognitive assignments and reduced overall mental fatigue associated with lengthy cognitive functioning and concentration in adults. (Kennedy et al, 2018). Peppermint was shown to enhance memory and alertness as well as positively affecting cholinergic and GABAergic neurotransmission (The International Journal of Neuroscience, 2008). The use of Mentha x piperita works to exhilarate the mind and clear it from fogginess, overbearing thoughts and headaches when breathed in (Culpepper, n.d)
 
The use of Mentha x piperita comes with some side effects such as it may lower oesophageal sphincter pressure, affect those with hypersensitivity (salicylate sensitivity), affect those with gallbladder inflammation and gallstones (MediHerb, 2018). The consumption of Mentha x Piperita in extreme cases has been shown to slightly decrease iron absorption when consumed with meals. Mentha x Piperita has been shown to not cause toxicity and is well tolerated at the recommended dosage. The safe usage of Mentha x piperita internally during pregnancy and lactation has not been determined, although external usage of the herb and inhalation is safe (WHO, 2018). It is recommended to avoid the use of peppermint oil on the face of children and infant as it is likely to affect their sensitive skin and cause a burning sensation. Allergic reactions may also occur in hypersensitive patients (Braun & Cohen, 2018). Within the elderly age group, no cautions for the use of Mentha x piperita have been highlighted. Significant interactions with drugs involve peppermint slowing the breaking down of certain medications by the liver, for example, cyclosporine, as peppermint increases the bioavailability of cyclosporine and slows the breaking down of its compounds, therefore increasing the risk of side effects for cyclosporine, thus patients should avoid concurrent usage. The use of Mentha x piperita internally may be prematurely dissolved due to the usage of antacids which reduced the stomach acids and increase gastric pH (Journal of Herbal Pharmacotherapy, 2008). The topical and internal use of Mentha x piperita as a medicinal herb comes with come contraindications and warnings, however, it is quite safe for general use within healthy individuals.
 
Ingesting Mentha x Piperita as an oral medication can occur via an infusion, tincture or liquid extract. An infusion is an herbal tea that contains aqueous extracts from steeping dried or fresh herbal material in boiling water. It is recommended that an infusion of 3-6 grams of Mentha x piperita is infused into 150mL of water and consumed three times a day is sufficient (Blumenthal et al, 2000). A tincture is a medicine made by dissolving an herb in alcohol, it is recommended that a tincture of 5-15 grams of peppermint (1:5) is consumed 2-3 times daily. A peppermint liquid extract (1:2) containing 1.5-4.5 mL of peppermint can be consumed three times daily. The oral consumption of peppermint can be taken on an empty or full stomach, depending on iron needs (i.e. those who are post-menopausal or male and don’t need an excess of iron can consume any time of day), as those with lower levels of iron should take away from meals to maximise iron absorption.
 
External topical dosing of Mentha x Piperita as an essential oil can be used to treat headaches or migraines. Topical application around the temples and forehead, of 10% peppermint oil in ethanol has been shown to alleviate tension headaches (Gobel et al, 1996). Peppermint oil can also be used as a heating ointment for arthritis, fibromyositis, tendonitis and other musculoskeletal conditions (Pizzorno & Murray, 2013) when used a rub on affected areas as many times a day as a rubefacient balm, especially after a warm bath.
 
Mentha x piperita is a medicinal herb that has been used for an extended period of time to treat certain ailments such as irritable bowel syndrome, dyspepsia, respiratory tract infections, headaches and migraines and low cognitive function. It proves some interactions with other drug use, however, is safe to use in most conditions, therefore making it a versatile herbal medicine.

The monophasic oral contraceptive pill (OCP) is one of the most effective contraceptive methods and is termed a combination pill as it contains both progestin and oestrogen (Sullivan, 2017). The monophasic OCP’s aim to prevent unplanned pregnancy as well as provide other therapeutic actions. Interactions involve antibiotics, certain nutrients and the herb St. John’s Wort.
 
The hormones within the monophasic combined oral contraceptive (COC’s), progestin and oestrogen, work to subdue ovulation, thicken cervical mucus, and thin the lining of the uterus creating an environment that halts sperm from travelling up the female reproductive system and implanting (Cooper et al, 2019). The reduction of the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) occurs via the progesterone negative feedback loop within the hypothalamus to reduce the pulse frequency of gonadotropin-releasing hormone (GnRH) (Cooper et al, 2015). This halts the mid-cycle LH surge as well as the development of the follicle, preventing ovulation. Oestrogen also plays a role in inhibiting follicular development as it acts to slow FSH via its negative feedback on the anterior pituitary. However, its role is not as prominent as progesterone in stopping ovulation.

Therapeutic uses of taking monophasic OCP’s apart from contraception include regulation of the cycle for those with polycystic ovarian syndrome and premenstrual syndrome (ESHRE, 2005). When taken in uninterrupted regiments, COC’s have proven to reduce the overall volume and duration of painful bleeds. Those who suffer from extreme bleeding have experienced noteworthy declines of 50% less menstrual blood loss and shorter time frames of bleeding (Dragoman, 2014). Women who experience anovulatory bleeds (e.g. those with obesity or polycystic ovary syndrome), improve with the use of COC’s. Additionally, continuous dosing of COC’s lowers a woman’s lifetime risk of developing endometrial (50% reduction), ovarian and colorectal cancer. Other conditions improved by COC’s include acne, PMS and hirsutism (unwanted hair growth) due to reducing surplus male hormone androgen exposure and increasing levels of sex hormone globulin (Dragoman, 2014).
 
Combined OCP’s are formulated with equal amounts of oestrogen and progesterone taken orally at the same time every day for optimal efficacy and to prevent ‘breakthrough’ bleeds (Endeavour College of Natural Health, 2019). Combined OCP’s are administered in 28-day prescriptions, that contain 7 placebo pills and 21 active hormone pills. An inactive placebo pill is taken during cycle days 21-28, the lack of the active hormonal pills trigger a withdrawal bleed. Extended monophasic regimes are used by many women to delay withdrawal bleeding where the inactive pill-taking is skipped and hormonal pills are continued (Stewart et al, 2015). Women can begin taking the pill at any point in their menstrual cycle, ensuring adherence to a regime of 24-hour dosages to reduce adverse effects and full efficacy. Within the first 7 days, monophasic OCP’s are not entirely effective in avoiding pregnancy, thus other forms of contraception should be used to ensure protection (e.g. condoms). If one day is missed, then the missed pill should be taken immediately and the regular 24-hour interval should be resumed (Cooper et al, 2019).
 
A multitude of adverse effects may come with taking COC’s making them unsuitable for some women. Adverse reactions include nausea, breast tenderness, bloating and fluid retention, decreased libido and some breakthrough bleeding (Dragoman, 2015). Breakthrough bleeds that may occur are usually short term and aren’t harmful. Woman with a strong history of migraines may have an initial rise in the incidence of attacks. However, individuals with hormonally fluctuating migraines may notice progress in the incidence due to uniformed levels throughout their cycle (Stoppler, 2019). The risk of developing arterial venous thromboembolism is very rare but increases threefold for women on OCP’s, resulting in obstruction of blood vessels by clots (de Bastos, 2014). The jeopardy increases in women who smoke, have BMI’s at either end of the scale and is contraindicated in women who have had a personal or familial history with the disease (Dragoman, 2015). The risk appears to be the highest within the first year of exposure to COC’s and reduces after a prolonged duration.
 
Women should always consult with their physician when choosing contraceptive methods to ensure that the correct type of OCP is chosen as well as understanding the potential effects and alternatives. During pregnancy and lactation monophasic OCP’s are not recommended for the foetal health and cause a decline of volume of breast milk. Further contraindications involve women who have uncontrolled hypertension and those with diabetes as they may undergo some hyperglycaemic reactions. However, these issues can be addressed by changing the type of pill and managing the condition with the support of a clinician. Women who are over the age of 35 years and smoke are contraindicated in the use of COC’s as it may affect their cardiovascular health and create symptoms of deep vein thromboembolism. Further conditions include those with reproductive cancers and heart disease due to the high-risk nature of these health issues (Cooper et al, 2019).
 
Normal physiology of the menstrual cycle involves the release of hormones from the hypothalamus with GnRH encouraging the discharge of LH and FSH from the anterior pituitary, then signalling the sloughing off endometrial cells from the uterine wall followed by bleeding. Oestrogen and progesterone are released from the ovaries and a mature oocyte is released followed by ovulation (Tortora et al, 2018). Diagram two highlights the fluctuation of reproductive hormones during a regular menstrual cycle. The action of COC’s, as seen in diagram 3, stop regular menstrual cycles by suppressing the ability of hormones including FSH and LH to be released thus halting ovulation and oocyte fertilisation. Without the influences of FSH and LH hormones the growth of ovarian follicles fragments resulting in minimal oestrogen levels. Subsequently, ovarian hormones needed to support insemination are subdued and unplanned pregnancy is avoided (Knudtson, 2019).
 
Drug interactions with OCP’s can lead to the failure of the efficacy and result in an unplanned pregnancy. The concomitant use of drugs that have microsomal enzyme-inducing activity reduces the ability of COC’s to work, such as antibiotics (e.g. tetracycline and rifampin) (D’Arcy, 1986). Rifampin has been proven to reduce serum oestrogen concentrations by increasing the breaking down of OCP’s and excretion via the bile into faecal matter, thus reducing the ability of OCP’s to prevent ovulation (Zhanel et al, 1999). Further, the interactions with the herbal medicine St. John’s Wort has been proven to reduce the ability of OCP’s due to the hypericin content. The herbal medicine is an inducer of CYP384 as well as P-glycoprotein which changes the pharmacodynamics of COC’s, meaning that the effectiveness of the drug is diminished. The mechanism of the adverse reaction means that the incidence of breakthrough bleeding can rise by 50% as well as boost ovulation levels within 16 women over 2 months when co-administering therefore, rising the possibility of unintended pregnancy (Horn et al, 2018). To prevent this adverse reaction these drugs shouldn’t be co-administered.
 
OCP’s can affect the body’s processing of nutrients and minerals which may result in depletion of vital minerals necessary optimal functioning. Nutrients include B vitamins (B9, B2, B6, B12), vitamin C and E, as well as minerals including magnesium, zinc and selenium (Palmery, 2013). Zinc is an essential mineral that plays a role in metabolism and gene expression. The use of OCP’s reduces plasma levels of zinc due to lower absorption (Palmery et al, 2013). Selenium is a micronutrient that aids in the reduction of carcinogens and has responsibility within thyroid function. Studies reveal that OCP's inhibit selenium absorption (Palmery et al, 2013). Magnesium is essential for biological performance, within ATP function and DNA/RNA-synthesis. Over three hundred enzymes require magnesium for their catalytic purpose. OCP’s have been shown to reduce serum magnesium levels and thus increase the risk of developing thrombosis (Palmery et al, 2013). Therefore, serum levels of these important dietary nutrients and minerals need to be made aware to patients, supplementation or alternative contraception may need to be considered to maintain optimal nutritional status.
 
Adverse reactions that occur when taking COC’s usually diminish with continued use. To prevent adverse reactions, patients with any unusual symptoms are advised to switch the subscription to provide benefits. By switching to an alternative COC’s it is recommended that a new pill packet is begun without a time gap to ensure contraceptive protection is continued, other defence mechanisms should be used during this time (International Agency for Research on Cancer, 2012). Adverse effects involving hormones can be avoided by switching pills in relation to their oestrogenic or progestogenic dominance. Studies show that lower levels of oestrogen and higher levels of progesterone are associated with fewer side effects including fluid retention and nausea (Barr et al, 2010). To avoid the risk of unplanned pregnancy, women who have taken antibiotics are advised to use other contraceptives for at least seven days’ post-treatment. Reducing the risk of nutritional deficiencies is also important when using COC’s. This involves testing for appropriate levels as well as supplementation of the B vitamins, vitamin C and E, zinc, magnesium and selenium to function optimally, prevent health issues and to reduce adverse reactions of COC’s. 
 
Monophasic oral contraceptive pills are relatively safe and are a highly effective contraception choice that results in protection from an unplanned pregnancy as well as other therapeutic benefits such as lower volumes of blood during menses. There are potential individual risk factors involved in this form of contraception and some women should approach COC’s with caution due to their individual health issues, however with proper guidance and adhering to the cyclical manner of this pill they can be avoided.

Ulcerative colitis or inflammatory bowel disease (IBD), is a chronic gastrointestinal disorder that affects people at all stages of life. Australia currently has one of the largest numbers of patients suffering from IBD, more than 80,000 patients are experiencing this illness (Crohn’s & Colitis Australia, 2019). The symptoms of ulcerative colitis include abdominal cramping, pain, frequent diarrhoea and tiredness and fatigue. The disease is chronic; however, patients may suffer from symptoms that come and go due to the level of inflammation in the gastrointestinal tract.
 
The use of turmeric (Curcuma longa), part of the Zingiberacaeae family, for patients who have ulcerative colitis is known to have a long historical therapeutic use (American Botanical Council, 2018). Ayurvedic practises have continuously used turmeric to relieve inflammation of the bowels (Botanical Adulterants Prevention Program, 2018). Turmeric contains a polyphonic compound known as curcuminoids and curcumin is the principal curcuminoid in turmeric.
 
During recent clinical studies, experimental models of the use of curcumin to relieve ulcerative colitis symptoms has increased significantly. It has been effective in facilitating the inhibitory effects by scavenging free radicals, influencing signalling pathways, inhibiting myeloperoxidase and even transcription factor NF-κB. Studies have also shown that simultaneous use of curcumin and conventional drugs is successful and well-tolerated, thus not creating contraindications with other medications (Baliga et al, 2012).
 
Further research has shown that turmeric and thus curcumin has a significantly low bioavailability when it is orally administered. The addition of black pepper into the consumption of curcumin considerably increases absorption due to the natural compound piperine. Studies have shown it to increase the bioavailability by 2,000% 45 minutes after co-administering curcumin orally with piperine (Prasad et al, 2014). It is recommended that the consumption of 4000-8000mg of fresh turmeric as juice or a paste per day to receive full therapeutic effects (Gupta et al, 2013).  Turmeric should be consumed with black pepper to increase the bioavailability of the polyphonic compounds and receive the full benefits. Curcumin can then accumulate within the gastrointestinal networks, thus providing local anti-inflammatory properties, neutralise free radicals and reduce oxidative strain which will prevent relapses of ulcerative colitis (Lee et al, 2013). The overconsumption of turmeric and its constituents can result in illnesses such as nausea and headaches, thus no more than 3.6 grams/day should be consumed (Hewlings et al, 2017).