Hormonal imbalances would have to be THE most common reason for consulting with a Naturopath, apart from digestive issues. Even if a woman is not specifically coming in for hormonal reasons, it nearly always comes up as a very common imbalance in a woman’s body. And, like many other health conditions, but particularly hormones, the female reproductive system is a very complex, nutritionally rich and dynamic system. Meaning, there are many presentations of hormonal imbalances, mainly due to the many hormones involved.
There are 4 main patterns of hormone imbalances – oestrogen excess, progesterone deficiency, oestrogen deficiency and testosterone excess, which affect both women and men alike. But, it is not as easy as just treating each one hormone profile on its own. Often there is a whole network of things at play with each pattern such as hormone conversion problems, detoxification issues, receptor activity and even environmental pollutants affecting the hormone levels for example.
Oestrogen Excess– expresses as heavy and painful periods, fibroids and endometriosis, with inflammation and growth. Dysplasias are common as are cancers of the cervix and breast and prostate problems in men.
Progesterone Deficiency – shows up as mood disturbances, pain and infertility. PMT will be common with symptoms such as breast pain and fluid retention, anxiety, irritability and depression. Recurrent miscarriage is another sign.
Oestrogen Deficiency – occurs around mid-life with mood disturbances, heat, dryness and atrophy. This is menopausal hot flushes, sweating, vaginal dryness, and skin thinning and wrinkling.
Testosterone Excess – is associated with infertility, absence of menstruation or very light irregular periods and insulin resistance. This may present as PCOS- polycystic ovaries, with male pattern hair growth, acne, and no periods.
Oestrogen excess is characterised by inflammation, growth and proliferation. It also goes hand in hand with poor detoxification in the body and the influence of zeno-estrogens, ( environmental toxins), in the environment. The liver cannot cope with a high oestrogen load and if there is a big exposure over the years to oestrogens in the environment, such as plastics and pesticides, this will make matters worse.
Symptoms of high oestrogen include heavy and painful periods often with clotting. There may be fibroid growths in the uterus, endometriosis, and a high oestrogen is often the cause of breast and prostate cancers.
Treatment of high oestrogen involves modulating oestrogen production, making sure is it being used and eliminated properly and reduce oestrogen exposure. The education of toxins in the environment and the way they impact liver function and how some toxins take up our oestrogen receptor sites is important.
Soy isoflavones have a modulating effect on oestrogen. They can block the binding of excess oestrogen or provide a source of oestrogen in low oestrogen cases such as menopause. Soy isoflavones have been shown to bind to an inflammatory dangerous type of oestrogen and help in eliminating it from the body.
When there is an excess of oestrogen, the body is in a very inflamed state. Anti-inflammatory herbs work well here such as turmeric, rosemary and milk thistle. These herbs whilst being anti-inflammatory, also work on the liver to help with excreting excess oestrogen from the body. To further help the detoxification, methylating nutrients such as folate, B12, and B6, all support the liver to detoxify properly. I often do a comprehensive detox with high oestrogen cases as a detox will support liver function to clear excess oestrogen effectively.
As with all health conditions, it is important to find the causes/triggers or drivers of a condition. Common causes of hormonal imbalances include stress, nutrient deficiencies, insulin problems, liver congestion, toxicity, and inflammation and thyroid imbalances.
Magnesium is often low in hormonal imbalances. In conditions such as PMS, menstrual migraines, PCOS and menopause, magnesium is often low. Did you know that the oral contractive pill decreases magnesium levels in the body? Magnesium deficiency decreases a key enzyme in the body responsible for metabolising hormones and can contribute to oestrogen excess if magnesium is deficient in the body. Magnesium is involved in bone formation and good levels prevents bone loss associated with decreasing oestrogen levels associated with menopause. Other nutrients crucial for hormone metabolism include zinc, calcium, and B6.
Diet plays an important role in helping oestrogen excess. Specific foods such as oranges, grapes, mushrooms, celery, onion, coriander and fennel contain aromatase inhibitors which reduce the excessive production of oestrogen. Others, like the cruciferous family, are active in phase 1 and phase 2 liver enzymes helping the liver to detoxify environmental toxins and decrease excess oestrogen. Fibre rich foods improve the clearance of oestrogen through the bowel. And isoflavone rich foods such as soy products and flaxseeds, prevent excess oestrogen from binding to receptors reducing the risk of breast cancer, endometriosis and menopausal symptoms.
Omega 3 oils or fish oils in the diet will help with the inflammation of oestrogen excess as will fruits, vegetables and seeds with anti-inflammatory properties such as turmeric, ginger, rosemary, dill, fennel ,berries, kale and spinach to name a few.
Alcohol moderation goes a long way in a high oestrogen picture. Moderate to high consumption of alcohol has been implicated in the development of breast cancer. Even a low consumption of 1-2 drinks a day increases breast cancer risk by 10%. The higher the consumption of alcohol, the greater oestrogen levels in the body.
While high oestrogen is inflammatory, progesterone is ant-inflammatory.
Symptoms of low progesterone include low mood, anxiety, depression, cravings, breast pain and period pain or dysmenorrhoea. It is associated with PMS, irregular cycles and infertility. Low progesterone often occurs with oestrogen excess as they cannot both be high or low. Low progesterone as the dominant condition presents as menstrual irregularities and symptoms such as breast swelling and pain, moodiness and irritability, anxiety and depression, due to the role progesterone plays in the brain.
When progesterone is low, combined with a deficiency of some neurotransmitters such as serotonin, combines to create many of the mental and physical symptoms of low progesterone.
Progesterone stimulates the neurotransmitter GABA which relieves symptoms of anxiety, irritability and pain. High oestrogen and stress decreases GABA enhancing those symptoms.
So treatment of low progesterone hormonal conditions will not only support progesterone production, but also support healthy neurotransmitter production also which further supports mood related symptoms.
Good progesterone levels are vital for an embryo to implant and to stay implanted so progesterone plays a big role in fertility.
Treatment will involve increasing progesterone and this can be very successful using the herb vitex angus castus or Chaste Tree- the cycle regulator. Vitex has dopamine-like effects in the brain mediating a mild opiate-like effect helping elevate mood, decreasing anxiety, irritability and depression, cravings, headaches, bloating and breast pain.
Low levels of thyroid hormone can lower progesterone levels so it is important to always check thyroid function in any hormonal condition. Thyroid hormones are needed for the conversion of the hormone pregnenolone to progesterone. Often women with thyroid issues have worse period problems and trouble conceiving and maintaining a pregnancy. The herb Withania works well here supporting thyroid conversion. Also nutrients such as iodine, selenium and magnesium.
Progesterone production is affected by inflammation and oxidative stress in the body. The menstrual cycle is naturally an inflammatory process, but when there is excess inflammation in the body, it will make symptoms worse. Making sure the gut is healthy and inflammation is in check will go a long way to ensuring good progesterone levels and decreasing inflammatory symptoms such as breast pain and painful periods. A high antioxidant and anti-inflammatory diet as well as herbs such as ginger, turmeric, and boswelia also vitamin E work well here.
Supporting nutrients such as magnesium and liver support are needed to support progesterone and also to help with the excess oestrogen commonly associated with low progesterone. Magnesium and B6 are effective in relieving PMS symptoms such as cravings, depression, anxiety, migraine and fluid retention.
Diet and lifestyle changes are important with PMS associated with low progesterone. A diet high in anti-inflammatory phytonutrients and oils, rich in essential minerals and protein, supports brain and ovarian function to balance hormones. Exercise reduces cortisol, increases progesterone and endorphins, improving PMS symptoms.
Adequate sunlight and vitamin D levels promotes healthy hormone levels and protects against many debilitating hormonal conditions such as endometriosis, PCOS and painful periods.
Low oestrogen is commonly associated with Menopause with a slow decline of oestrogen causing debilitating symptoms such as wrinkling skin, vaginal dryness, osteoporosis, increased cardiovascular risk, and mood disturbances. The body still uses oestrogen post-menopausal, sparingly, converting it from the adrenal hormone DHEA. This is why some women who go into menopause who have experienced a lot of stress, have worse menopausal symptoms because their levels of DHEA are low.
One of the main symptoms of a low oestrogen picture are hot flushes, which can be mild or severe. Hot flushes are caused by low circulating oestrogen, but it is also a heat loss problem. Some women who experience severe menopausal hot flushes lose the ability to regulate their thermostat and they can’t regulate their core temperature and any fluxuation causes an abnormal response, hence the hot flush. Low GABA, low serotonin and high noradrenalin resulting from ongoing stress, and low oestrogen all contribute to poor thermal control.
Other symptoms of low oestrogen include insomnia, night sweats, anxiety and depression, low libido, vaginal dryness.
The treatment of low oestrogen involves supporting the declining oestrogen and supporting the adrenal glands to increase the production of DHEA.
Herbal preparations work very well to support low oestrogen. Herbs such as Rhemannia, Cornus, Wild Yam, and Paeonia combine well to reduce hot flushes, sweating, palpitations and anxiety, and improves oestrogen levels. Cooling herbs such as Zizyphus support GABA and serotonin levels.
Magnesium plays an important role in low oestrogen as stress, poor nutrition and inflammation are the 3 drivers of low oestrogen and all deplete magnesium levels in the body. Magnesium and calcium both support the cardiovascular system and reduce the incidence and severity of osteoporosis.
Stress management and supporting the adrenal gland with specific adaptogenic herbs such as withania, licorice, panax ginseng and rhodiola, and meditation, relaxation and yoga are some ways to further encourage the production of DHEA and decrease cortisol.
In some cases of menopause there can be a picture of low oestrogen with hot flushes, insomnia and anxiety, and also together with a high oestrogen picture of heavy bleeding, with or without fibroids. This can be due to low oestrogen in the tissues where it is needed and a high level of oestrogen receptors in inflamed tissue such as the endometrium. These women need additional liver and anti-inflammatory support.
High testosterone is commonly seen in women with PCOS- polycystic ovarian syndrome, with symptoms such as the absence of periods, (amenorrhoea), or very light irregular periods, infertility, facial hair growth, acne, and insulin resistance. PCOS is characterised by a high circulating hormonal picture especially testosterone causing inflammation in the tissues and insulin resistance which in turn causes more levels of circulating hormones, again a vicious cycle.
Evidence suggests that PCOS begins in the developing foetus and that a shorter index finger compared to ring finger is a risk factor. Prenatal ring finger bone growth is responsive to testosterone. High hormone exposure in utero is believed to cause high hormone levels in childhood and create a more insulin resistant pattern in the fat tissue in adulthood. Obesity in childhood is another risk factor for high testosterone and PCOS.
We must look at the role of toxicity in high testosterone pictures. When hormone levels are high, the liver struggles to detoxify the hormones to bring their levels down and results in toxins being stored in fat tissue.
The treatment of high testosterone and accompanying high insulin, involves supporting liver detoxification, improve insulin signalling in the body and support hormone balance, and decreasing the exposure of environmental toxins, the burden of all hormonal cases.
Myo-inositol is naturally produced in the body and is part of the B vitamin group, and is often deficient in PCOS. Myo-inositol supplementation improves insulin sensitivity and decreases testosterone levels.
The two herbs licorice and Peony in combination suppresses testosterone production whilst the addition of magnesium and the amino acids taurine and glycine support liver metabolism and cardiovascular health which can be a side effect of high testosterone.
A low carbohydrate diet in cases of high testosterone will control too much insulin production and also promote weight control.
Gut health is paramount in all hormonal conditions, but more so with high testosterone and insulin resistance. Leaky gut promotes more inflammation in the body, and inflammation drives insulin resistance. A good gut health plan will remove dietary intolerances and provide gut healing with therapeutics such as glutamine and probiotics.
Hormonal balance comprises four main categories but can overlap with some categories occurring together. That is why there is more to achieving hormonal balance than treating one hormone alone. We need to consider thorough hormonal salivary testing to see the inter play of hormones and support not only hormone production or over production, but liver detoxification, insulin sensitivity and adrenal and stress management.