Hormonal Balance Enemy No. 1: Estrogen Dominance
When discussing the basics of hormonal balance, it’s important to explain the purpose of our two main sex hormones: estrogen and progesterone. These two girls are responsible for maintaining a healthy menstrual cycle and pregnancy, yet they are frequently imbalanced with each other causing those annoying and painful PMS symptoms, infertility, and miscarriage.
Many of us walk around with imbalanced estrogen and progesterone. This imbalanced ratio can come in many forms. You may be in the normal range for both progesterone and estrogen but low-normal for progesterone and high-normal for estrogen, leading to estrogen dominant symptoms. Or you may be low in progesterone and normal or high in estrogen which is very common in a stressed autoimmune-diseased body, if you have low body weight, or if you suffer from adrenal fatigue. Heck, you can even be low in both progesterone and estrogen and STILL be estrogen-dominant! As you can see, it’s a tight rope to walk when balancing these two uber-important hormones, which is why working with your doctor or a functional medicine doctor can be incredibly helpful in tracking your progress towards hormonal balance.
Estrogen dominance is on the rise in both pre-menopausal and menopausal women. We pick up estrogen from our modern day environments quite easily, especially in our food choices (i.e. non-organic meats and produce sprayed with herbicides and pesticides, soy products, and conventional dairy to name a few) and the over-use of the birth control pill which can both cause estrogen-dominance symptoms and cover up existing dominance. For menopausal women, it’s even more difficult to fight estrogen dominance because as we age progesterone naturally decreases by up to 75% while estrogen may only decrease by half that amount or less! This is why hormone replacement therapy (HRT) has become incredibly popular as a treatment for menopausal symptoms such as mood swings and hot flashes.
To help combat estrogen dominance, make some environmental and lifestyle changes such as switching from plastic containers and water bottles to glass ones, buying only organic meat and produce (and peeling any non-organic produce if that’s all you can afford), and avoiding conventional cosmetics that contain xenoestrogens (toxins that mimic estrogen in the body) such as parabens. You may also need to work with a practitioner who can prescribe the proper amount of progesterone to raise progesterone levels, decreasing estrogen dominance symptoms.
Progesterone can be a very protective and health-promoting hormone for women. It is also incredibly vital for a healthy pregnancy and increased levels have to be maintained to promote the growth of the fetus. Low progesterone in pre-menopausal women can be caused by several factors including stress, poor diet, history of birth control pill usage, anovulatory cycles (where a period can exist without ovulation leading up to it), and defects in the corpus luteum (which releases progesterone during your menstrual cycle and helps prevent miscarriage in early pregnancy).
Estrogen can get a bad rap especially when talking about its dominant nature. It is after all responsible for growth. Growth of our uterine lining, growth of our hips and breasts, and even growth of healthy, thick hair. There are 3 main estrogen components commonly tested in salivary and serum blood tests on hormone panels: estrone (E1), estradiol (E2), and estriol (E3). When in healthy balance, estriol comprises about 70% of estrogen, while the remaining 30% is divided somewat equally between E1 and E2. Not only is it important for these 3 estrogen components to be in balance with each other, but they also must balance with our progesterone levels. Want to learn a lot more about estrogen dominance? I love this article for its comprehensiveness.
What about all those other glands?
While researchers don’t understand exactly how overactive or underactive thyroid affects fertility, they do know that both conditions can affect ovulation, healthy growth and development of a fetus, ability carry a full-term pregnancy, and has been associated with an increased risk of stillbirths. Thyroid function is especially important to monitor before conception for women with a history of thyroid disorder or those with a family history. Make sure that your thyroid is in tip-top shape prior to conception and advocate to have it monitored consistently throughout pregnancy to ensure the health of your baby. If you are trying to conceive but have abnormal menstrual cycles or suspect you aren’t ovulating, make sure to get a full thyroid panel done to check for underlying disorder.
If you’ve been in the health and wellness sphere for longer than 3 seconds, you know all about the dreaded adrenal fatigue. It’s the real deal and certainly not a fabricated disorder made up so that supplement companies have something tangible to target. Many, many, many (x 100, if we’re talking numbers) people in our modern day world suffer from some level of adrenal fatigue due to chronic stress. This stress can be either mental or physical (or worse, both) in nature and leads to a pretty nasty cycle of hormonal imbalance.
In short, a common way the adrenals affect our estrogen and progesterone balance is like this: our adrenals are responsible for producing a hormone called cortisol. Cortisol helps our body respond to stress by adjusting vital body functions such as metabolism, blood sugar, and immune activity. It is also is on the same “pathway” as progesterone, which is one of the precursors of cortisol in addition to pregnenolone and cholesterol. Progesterone also is at the fork of another pathway that results in estrogen, which is also made by DHEA. If our body is in a constant stress response, it prioritizes balancing life-or-death functions such as metabolism and insulin response rather than fertility and menstruation. That means our body shuttles progesterone to the production of cortisol leading to low progesterone levels, estrogen dominance and potentially anovulatory cycles or amenorrhea.
The HPA axis is too complex of a subject for this article. If using a top-down approach, one could really start with the hypothalamus-pitutary-adrenals trifecta of feedback cycles and hormonal production. Here’s a short article explaining how HPA axis dysfunction can negatively impact fertility and ovulation. To quickly sum it up, low body weight, over-exercising, and emotional stress can wreak havoc on hormones for years until properly addressed.
Natural Ways to Restore Hormonal Balance
Note that the majority of supplements are poorly studied in well-controlled research. Many of these compounds have been used in Traditional Chinese Medicine for hundreds, possibly thousands of years. They may or may not work for you, but either way it is important to work with a qualified practitioner such as a naturopath, TCM doctor, or functional medicine practitioner to ensure accurate dosage and safety. Supplements tend to be more gentle and work more slowly than prescription-based hormonal therapy.
DIM for lowering “bad estrogen” and increasing “good estrogen” also balancing testosterone levels
– Used in weight lifting community as a fat loss supplement successfully because of its effect on estrogen activity
– May help restore fertility caused by estrogen dominance
-Verdict: anecdotal and case study evidence suggests DIM can have a powerful and quick effect on estrogen and testosterone levels in the body. Be sure to source a soy-free product such as
Vitex (chasteberry) for increasing low progesterone
-In studies, Vitex seems to relieve PMS and PMDD symptoms, but studies have not consistently proven its efficiency as a fertility treatment.
-It is often recommended to women with low progesterone levels to ease menopausal symptoms, prevent miscarriage, and increase fertility by naturopaths and Chinese medicine doctors
-Verdict: Unknown. Some studies have shown effects only after taking Vitex for at least 7 months.
White Peony, Shatavari, and Schisandra (FemCo by Standard Process)
– White Peony is often used in Traditional Chinese Medicine (TCM) to stimulate circulation in the pelvic region, reduce the size of painful uterine fibroids, and reduce symptoms of PCOS by decreasing testosterone levels.
– Schisandra is an adaptogenic herb also often used in TCM to treat fertility issues by decreasing the stress response of the body and improving liver function.
– Shatavari is recommended by ayurverdic, TCM, and naturopathic doctors to increase overall fertility by boosting libido and acting as a “cleanser” for the reproductive system in both women and men.
– Verdict: this may be a helpful combination as it addresses common estrogen-dominant issues such as poor stress response and liver function (which is responsible for clearing excess estrogen out of our system).
Seed Cycling to balance hormones throughout the cycle
– It can’t get much more “granola” than literally eating different seeds during different times of the month to help balance your hormones so that the follicular phase and luteal phase have the correct balance of estrogen and progesterone. Supplementation of fish oil and evening primrose oil is also recommended.
– Verdict: Unknown. I have not found any “good science” on seed cycling and whether or not it truly makes a significant difference in hormonal levels. At worst, you’re getting in some healthy seeds high in minerals, vitamins, and omega-3s!
Common Western Medicine Ideas
Many believe hormone creams to be more fast-acting and effective than compounded hormones, but it’s also harder to regulate exactly how much hormone you are receiving through the skin barrier.
Medical and functional medicine doctors may prescribe compounded hormones to increase deficient hormones such as in the case of menopause or peri-menopause women with estrogen or progesterone deficiency.
You will need to get lab values tested or record any new symptoms of too much or too little hormone such as changes in breast tenderness, weight, mood, water retention, skin health, and energy, so your doctor can adjust accordingly.
Tend to take several months to regulate hormones enough that glands can pick up where they left off.
Birth control pills
Highly unlikely to be prescribed by a functional medicine doctor for hormonal imbalances, but a common go-to by western medicine docs. The pill overrides your body’s need to produce its own estrogen and progesterone and can mask deficiencies in either hormone.
Some doctors believe amenorrhea must be treated this way. Give them the pill and they will be sure to get a period. This is probably true but it’s what I call an artificial period; rather it is not your body’s own natural hormone production creating your monthly cycle.
Birth control pills are becoming more and more recognized for their poor effects on post-pill hormonal health.
Ignore it – they say there is “no medical need for a period” and well… health effects usually aren’t deathly unless that hormonal imbalance leads to hormonally-driven cancers such as breast and ovarian.
Some doctors (and even some ill-informed patients) will proclaim that it’s no biggie if you don’t get your period. There’s no medical need for one! Well, they’re right in a sense. You aren’t going to die in 3 weeks if you don’t get your period like if you didn’t have access to food. It’s not required for respiration, kidney and liver function, or to keep your heart from stopping. But what these doctors and patients fail to recognize is the chronic and long-term effects hormonal imbalances and deficiencies can wreak on a woman’s sensitive body.
The risk of osteoporosis increases especially for white women under the age of 30.
Mental health can be affected by hormonal imbalances. I think our mental health IS a medical necessity. Hormonal issues commonly caused anxiety and depression in women that can continue for years before treated by balancing hormones.
Listen Up! Your body is trying to tell you something.
Women tend to me the more intuitive of the genders. We must use this intuition to make accurate and evidence-based observations about our hormonal health. That may mean charting your cycles in a variety of ways.
- Write down the first day of your period every month.
- Chart your morning basal body temperature before you get out of bed in the morning using a mercury thermometer. As little as .1 degree increase in body temperature can indicated ovulation is occurring, notifying you of your most fertile days.
- Chart your symptoms. Is your luteal phase getting shorter and shorter (i.e. are there less and less days in between periods?) Are symptoms such as breast tenderness, bloating, and cramping worsening? This may indicate rising estrogen levels and are often signs of estrogen dominance.
- Advocate for your body. Do you having a feeling that you’re not ovulating or that you are experiencing estrogen dominance? Make an appointment with your physician and ask to receive the proper testing!
Getting Ready to Conceive?
Aim to get omega-3’s in your diet as often as possible. My favorite way to do this is with wild salmon, oysters, shrimp, mackerel, and anchovies. If you tolerate flax and chia seeds, they are also good sources of omega-3’s, but not autoimmune-protocol friendly nor do they have as good of an amino acid profile as seafood. Omega-3s
Get your thyroid tested. Ensure your thyroid hormones free T3, free T4, reverse T3 and your pituitary hormone TSH are well within normal range. If you have Hashimoto’s, it is now conventionally accepted (albeit not by all conventional doctors) that many people feel best with a TSH in the bottom 25% of the range and T3 and T4 in the top 25% of the range.
Take prenatal supplements full of methylfolate (NOT FOLIC ACID), B vitamins, zinc, magnesium, calcium, vitamin C, DHA, and vitamin D. You may also want to be on a probiotic and cease any supplements after conception that may affect hormonal levels like DIM or Vitex until you can talk to your doctor about their safety.
Relax. I have a theory that the more you try to get pregnant, the less likely it will happen. While there’s no scientific evidence behind that, give it a thought in relation to your perspective about your own fertility. Just as we can self-sabotage a job interview if overly-anxious, we can also affect our body’s ability to conceive. Sex should not be a chore, but a loving activity between two committed partners who both have parenthood goals. It’s easy to feel under pressure once you hit a certain age, but remember you have 12 times a year to try and most women DO get pregnant eventually.
Don’t fear fat. Take this point from two angles: the fear of eating fat and the fear of having fat on your body. I’m sure you have heard many times over that being underweight can negatively impact fertility. It’s the truth, ladies, no matter how much you don’t want to hear it. I’ve experienced it and so have thousands and thousands of other women. We like to think we are the exception to this loose rule (i.e. “I can exercise 7 days a week, eat 1,200 calories a day, fit into size 00 pants and still have a baby!” but for many women our bodies prefer having a little extra cushion for the labor pushin’. Some estimates suggest women have at least 18% body fat when trying to conceive (although there are athletically lean women who conceive with less body fat, it is inherently less common). Are you stuck in gym rat mode, suffer from irregular menstrual cycles and just can’t seem to get pregnant no matter what you try? Are you way too focused on your bikini bod and gym goals to the detriment of your sex hormones? Then I suggest finding a way to back off the fitness regimen. This is going to require you to re-work your mind and recognize that your body will try its hardest to work with you on your pregnancy goals as soon as you give it some loving too. If having a six-pack or cellulite-free legs is more important than having a child, well then you have just stated your priorities without even realizing it. Harsh words but they’re coming from a gal with a lot of experience in this area. You’ll have plenty of time (once the kids are in college?) to get back to your 90-minute gym sessions!
Coping with Infertility & Loss
This subject is worth a series of blog posts on its own, but I think it’s important to address in the real-world context of chronic disease and infertility. For some women, health conditions prevent you from conceiving which can be a world-crushing realization. Or those health conditions may even prevent you from carrying to full-term. The inability to conceive your own blood-born children is a deep, deep wound that may takes years to heal. If this applies to you, you must go as easy on yourself as possible. What if it were happening to your best friend? What would you say to her to make her feel better?
Children are a gift to this world, but there are other ways to reap the benefits of this gift if you cannot conceive. Adoption is always an option. I also am particularly fond of mentorship programs such as Big Brothers Big Sisters or finding a career where you can make a valuable difference in a child’s life such as becoming a child and family psychologist, occupational therapist, speech therapist, teacher, or sports coach. These can all be rewarding and different ways to affect a child’s future in the absence of fertility.
Find hope. For nearly a decade when I didn’t think pregnancy was a possibility, I went through many emotional ups and downs about how I would feel if I were unable to have my own children. Initially, I put the thought on the back burner and focused on other things going on in my life since I was in my early twenties and not nearly mature enough to mother a child. Once I met my husband and realized I wanted to spend my life with him, the idea reared its head in a very ugly way when I felt like I would be doing him a disservice if I couldn’t have children. My obsession with infertility caused such an immense amount of stress on my body that I truly believe it prevented me from healing my adrenal fatigue and autoimmune disease faster than I did. Once I had started the autoimmune protocol and my hormonal health began to rebound, I had a renewed sense of hope that children could be in our future. I also reminded myself about what countless doctors had told me despite 7 years of amenorrhea: you will be able to have children but right now your body doesn’t want them. A harsh truth but the fact that it was in the realm of possibility really fueled every decision I took to continue healing my body. So take the advice of a girl who has been through the same thing, do not give up on your fertility. Right now may not be the best time to produce a healthy child, but focus your energy on healing, remain open-minded to a life with or without children, and remind yourself of all the women who have had “miracle” children and have walked in the same shoes as yourself.