Gagua clinic

                                                    Besarion Tkeshelashvili
Obstetrician-Gynecologist, Associate Professor, Academic Doctor of Medicine

In the 21st century, evidence-based medicine has established standardized approaches to patient care through clinical protocols and guidelines based on high-quality scientific research. However, particularly in non-surgical specialties, many highly effective medications achieve excellent clinical outcomes while carrying the potential risk of short- and long-term side effects.

There are also many situations—including diabetes, obesity, migraine, cardiovascular disease, blood clotting disorders, cancer, or an inherited predisposition to malignancy—where hormonal or certain pharmacological treatments may not be appropriate or may even be contraindicated.

Can complementary, non-hormonal, and non-pharmaceutical approaches provide an alternative in these cases?

To discuss this topic, we spoke with Dr. Besarion Tkeshelashvili, Obstetrician-Gynecologist, Academic Doctor of Medicine, Professor at Tbilisi Medical University, Board Member of the Georgian Association of Obstetricians and Gynecologists, Founder of the Urogynecology and Colposcopy Associations, author and principal investigator of numerous scientific studies, who currently practices at Gagua Clinic.

-Is it possible to regulate the menstrual cycle and hormonal imbalances without hormonal medications?

- Yes, in many cases it is possible. The first step is to identify the underlying cause of the disorder. Very often, menstrual irregularities result from an unhealthy lifestyle and disruption of the body's natural physiological balance.

Important factors include nutrition, sleep quality, physical activity, exposure to natural daylight, daily biological rhythms, harmful habits, emotional stress, and physical stress.

Patients should understand that unless these lifestyle factors are addressed, they may eventually require treatments that can carry potential side effects, affecting both short-term and long-term health.

-What types of complementary treatments are available?

-Desired outcomes may be achieved using herbal medicines (phytotherapy), carefully selected low-dose hormonal therapies, homeopathic and homotoxicological treatments, as well as reflexology (acupuncture).

The choice of treatment always depends on the patient's individual condition and follows a comprehensive medical evaluation. Regardless of the treatment selected, lifestyle modification remains a fundamental component of therapy.

-Does lifestyle play a role in gynecological diseases?

-Absolutely.

There is virtually no acquired disease in which lifestyle has no influence. Improving nutrition, sleep, physical activity, and stress management positively affects treatment outcomes across almost every area of medicine.

Although numerous scientific studies support this relationship, these findings are not yet fully reflected in many clinical guidelines.

Over more than 40 years of clinical practice and numerous scientific investigations in obstetrics and gynecology, I have consistently observed that sustainable improvements in women's health require meaningful lifestyle changes.

Helping patients make these changes often requires long-term communication, empathy, and support—particularly for women who have experienced prolonged unsuccessful treatments and have become emotionally exhausted.

-Can you provide some examples?

-There are many.

My research, published in scientific journals in the United States, Germany, Italy, Turkey, the Czech Republic, and Colombia, has examined conditions such as:

• Menstrual disorders
• Painful menstruation (dysmenorrhea)
• Hirsutism caused by excess androgens
• Pregnancy complicated by hypothyroidism
• Polycystic Ovary Syndrome (PCOS)
• Benign uterine and breast tumors
• Cervical dysplasia

One of our most recent publications on cervical dysplasia appeared in the Journal of Clinical and Molecular Oncology (USA) in late 2024.

Across these conditions, inadequate nutrition and poor sleep consistently emerge as important contributing factors, influencing both disease development and prognosis. Scientific evidence increasingly explains the biological mechanisms linking lifestyle factors to reproductive health.

The primary goal is to identify the most rational treatment strategy that provides long-term improvement rather than temporary symptom relief.

For example, women with Premenstrual Syndrome (PMS) often experience significant improvement when lifestyle modifications are combined with phytotherapy. Symptoms such as headaches, breast tenderness, emotional instability, and cognitive difficulties frequently improve considerably.

A similar approach has also shown benefits in women suffering from persistent inflammatory conditions and recurrent infections.

-What about preventing pregnancy complications for both mother and baby?

-Unfortunately, this aspect of reproductive medicine still receives insufficient attention.

Many couples focus exclusively on achieving pregnancy as quickly as possible—including through IVF—without adequately preparing the mother's overall health beforehand.

Although pregnancy may be achieved, inadequate preconception preparation increases the likelihood of miscarriage and pregnancy complications affecting both the mother and the developing fetus.

How should couples prepare for pregnancy?

Preparation does not necessarily require anything extraordinary.

The goal is to identify nutritional deficiencies, hormonal imbalances, or lifestyle factors that require correction through appropriate medical evaluation.

Folic acid alone is not sufficient.

Particular attention should be paid to the mother's nutritional status, which plays a critical role in fetal programming and healthy fetal development.

The physician should determine when the woman's body is optimally prepared for pregnancy before recommending conception.

-What is expected from the father?

-The same principles apply.

The father's health, nutrition, sleep quality, alcohol and tobacco use, and overall lifestyle significantly influence fertility and reproductive outcomes.

Comprehensive evaluation is especially important after infertility or previous pregnancy loss.

-Does this also apply to IVF treatment?

-Absolutely.

Proper preparation improves both egg and sperm quality before IVF treatment.

Alongside appropriate vitamin and micronutrient supplementation, balanced nutrition—including adequate protein and healthy fats—is extremely important.

Weight optimization, stress reduction, improved sleep, and emotional well-being all contribute to better IVF outcomes.

Such preparation increases the likelihood of successful conception, whether naturally or through IVF, while also improving the chances of maintaining a healthy pregnancy.

-You mentioned "fetal programming." What does this mean?

-The concept of fetal programming gained prominence toward the end of the 20th century when research demonstrated the profound influence of maternal health on the future health of the child.

Environmental conditions during pregnancy affect not only fetal development but also influence the individual's long-term risk of developing diseases later in life.

Research has linked fetal programming with conditions such as:

• Hypertension
• Polycystic Ovary Syndrome (PCOS)
• Diabetes
• Autism spectrum disorders
• Various chronic diseases affecting multiple organ systems

Among the most influential factors is maternal nutrition, both before conception and throughout pregnancy.

-Your recommendations for women

-Everything we have discussed is relevant across all areas of medicine, particularly preventive healthcare.

A carefully designed health optimization program is one of the most effective investments anyone can make—especially women planning pregnancy.

Healthy lifestyle choices before conception and during pregnancy contribute not only to a healthier mother but also to healthier future generations.

Ultimately, they promote better physical health, emotional well-being, longer life expectancy, and an improved quality of life.