January 25th, 2019
Hormonal Imbalances: Estrogen and Progesterone
Hormonal imbalance is a common problem many women face. Women are now, more than ever before, taking on more and more responsibilities - they're caregivers, nurturers, and employed in the workforce to make ends meet. As a result, we are seeing a rise in stress levels and this is one important reason why hormonal imbalances are becoming more prevalent. Exposure to xenoestrogens in household products (ie. plastic containers), personal products, and even water supply can contribute to hormone imbalance. Poor dietary choices also contribute to hormonal imbalances; imbalances arise from changes in estrogen, progesterone, and/or testosterone levels: estrogen may be elevated relative to progesterone, or progesterone may be low resulting in a relatively high estrogen reading. This article will primarily focus on imbalances in progesterone and estrogen.
1) Stress: This is a main cause of hormonal imbalance seen in women of reproductive age. A common term used to describe the result of chronic stress is adrenal fatigue. The adrenal glands sit on top of the kidneys and they produce the stress hormone cortisol. When we are in a sympathetic nervous system state (the "fight-or-flight" state) our bodies divert all resources toward immediate survival, thus favouring cortisol production; the result is less time and activity spent in the parasympathetic state and this affects our digestion, sex hormone production, etc. Chronic stress leads to changes in hormone concentrations: sometimes referred to as the "cortisol-shunt" or "pregnenolone-steal". In this situation, cortisol production is favoured over the production of the sex hormones; the body's precursors and resources are diverted to produce more cortisol and the sex hormone levels suffer as a result. (1) Mental and emotional health (including and especially stress levels) is important to consider in clinical presentations of hormonal imbalances. Naturopathic Doctors run saliva cortisol/hormone panels to determine hormone concentrations and to assess for adrenal fatigue.
2) Xenoestrogens: We are exposed to these "bad" estrogens on a regular basis, and these estrogens mimic the effects of the real hormone. Xenoestrogens are found in medications (oral contraceptive pills), cosmetic and household products, pesticides, and plastics. Estrogenic compounds, such as Bisphenol A (BPA), leech out from plastics during temperature extremes such as freezing or heating. These estrogenic compounds disrupt the body’s endocrine system and impact the concentration of the sex hormone estrogen. (2) Attempts to use as little plastic as possible can reduce your exposure to BPA and synthetic estrogens: use glass containers/water bottles, reduce canned food consumption, use plastics with recycling symbols 2, 4, and 5. (3) Xenoestrogens are more potent than hormones which naturally occur within the body; they mimic the action of estrogen by binding more strongly to estrogen receptors. (1) Chemicals which have estrogenic activity can cause health-related problems such as early menarche in women, as well as increased rates of breast and ovarian cancer. (2) Other health problems can arise from a reproductive standpoint - heavy menstrual cycles, breast tenderness, and bloating for instance signify an imbalance known as "estrogen dominance" in which the concentration of estrogen is either above normal range, or progesterone is lower than normal resulting in a “relative” estrogen dominance.
3) Poor Dietary Choices/Obesity: Excess simple carbohydrate consumption leads to the accumulation of fat cells within the body, particularly around the abdominal area. Fat cells contain aromatase, which is an enzyme that converts testosterone into estrogen. Overweight women therefore produce more estrogen than the average woman. Water supply is another source of hormone exposure (people often flush prescription drugs down the toilet instead of properly disposing of these medications at a pharmacy). A reverse osmosis system can help reduce your exposure to hormones in the water supply. (1)
3) Menopause: Hormone levels decline naturally as we age. The average age for a woman to experience menopause is 50 years old. Estrogen is the first hormone to decline, and common symptoms of this include night sweats, hot flashes, vaginal dryness and low libido. (4) Pre-menopausal women also experience such symptoms as hormones enter a state of flux. Post-menopausal women are at increased risk of osteoporosis due to the protective effect estrogen exerts on bone health.
Changes in hormones present with a variety of symptoms: ranging from physical to mental/emotional symptoms. Some women present with an estrogen dominant picture, where estrogen levels are elevated. Common estrogen dominance symptoms include: breast tenderness, bloating, heavy periods (due to fibroids), cramping (due to endometriosis), mood swings, and depression. Other presentations of estrogen dominance result from a progesterone deficiency - also known as a "relative" estrogen dominance. (1) Symptoms of low estrogen can include: vaginal dryness, hot flashes, headaches, insomnia, fatigue, and bone loss. Low estrogen increases ones risk of cancer and heart disease; natural estrogen is protective against heart disease, and osteoporosis.
Low progesterone can present with symptoms of mid-cycle spotting, clotting, long periods (lasting 7 days or longer), and increased risk of miscarriage. Progesterone is most important during the second half of a woman's cycle (the luteal phase) in order for women to sustain and carry a pregnancy to term. Following ovulation, the corpus luteum releases progesterone to support the proper development of an embryo.
The management of a hormonal imbalance depends on symptom presentation, testing, as well as addressing the cause. Naturopathic Doctors often run saliva hormone tests on specific days of a woman's cycle (ie. day 3 or 21) in order to determine the free concentration of hormones. It is important to be assessed by your Naturopathic Doctor in order to rule out any emergent conditions & presentations, and to determine the optimal day/timing for your hormone test.
1) Phytoestrogens: These are substances which act like weak estrogens and exert effects on estrogen receptors in the body. Soy and flaxseed are examples of phytoestrogenic compounds.
2) Vitex agnus-castus: This botanical herb helps with boosting progesterone and has hormone-balancing properties. A randomized controlled-trial found Vitex to be helpful in normalizing a shortened luteal phase, and increasing mid-luteal progesterone and estradiol levels. (5)
3) Indole-3-carbinol: This compound is found in cruciferous vegetables belonging to the Brassica family; it gets converted into DIM (di-indolylmethane) and helps support the body’s ability to metabolize estrogens through the activation of detoxifying enzymes.
4) Bio-identical Hormone Replacement Therapy: The use of molecules identical to those produced by the body in order to mitigate symptoms of hormonal imbalance. These are generally safer to administer and have minimal side effects when compared to hormone replacement therapy. Bioidentical hormones are synthesized in the lab from a plant chemical extract and are dosed differently depending on age and reason for use. Speak with your Naturopathic Doctor to discuss available options.
5) Liver support and fiber intake: Supporting the liver’s detoxification and elimination processes is important when it comes to the excretion of excess hormones such as estrogen. Adequate fiber intake helps bind excess hormones in the system and increases the rate of excretion by facilitating their transportation to the liver.
6) Treat the cause: Eliminate exposure to xenoestrogens/synthetic progestins, learn how to effectively deal with and manage stressors, exercise regularly and maintain a healthy body weight, and make nutrient-dense dietary choices.
Hormonal imbalances can result from poor dietary choices, unfiltered water supply, obesity, xenoestrogen exposure, the use of synthetic hormones, as well as chronic stress. It is important to identify and remove/treat the cause in order to prevent the recurrence or onset of an imbalance. Testing is a good starting point to determine what sort of imbalance is occurring, as certain symptoms can be indicative of an elevation of both estrogen and progesterone. The next step is to determine whether or not we need to support estrogen or progesterone production, or reduce exposure/encourage detoxification. Consult with your Naturopathic Doctor before starting on a new supplement regimen to ensure there are no interactions or cautions/contraindications to the treatment.
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Ashley Kowalski is a licensed Naturopathic Doctor in Embrun, Cornwall, and Ottawa. She is currently accepting new patients.