Hormones are powerful. They can impact menstrual symptoms, energy, mood, sleep, body composition, skin and hair, libido, brain function, metabolic and cardiovascular health, fertility and more. Women’s Hormones include Estrogen, Progesterone, Testosterone and DHEA. They are all steroid hormones made from the same raw material, cholesterol. There is a relationship between all of the steroid hormones, with a significant impact on many of the body’s systems and overall well-being.
Testing Hormones
Hormones can be tested through blood and your naturopathic doctor may recommend a DUTCH test (dried urine test for comprehensive hormones) which gives additional information about your hormone metabolism, leading to more targeted treatment.
Common Hormone Patterns in Women
Here are some common hormone patterns in women. Naturally, your pattern is individual to you and can be more nuanced. A DUTCH test will tell you if your hormones are imbalanced and how you breakdown, convert and metabolise hormones.
Estrogen Dominance
The most common hormone pattern in women in their teens to early 40s is Estrogen Dominance. Estrogen Dominance occurs when the overall balance of estrogen is higher than progesterone. If both hormones were on a teeter-totter, the balance would be in favor of estrogen.
Symptoms of Estrogen Dominance
- PMS (premenstrual syndrome) including irritability and emotional sensitivity, bloating, breast tenderness.
- Heavy periods and cramping
- Chronic vaginal yeast and bacterial infections
- Cystic acne
- Conditions of estrogen dominance including endometriosis, uterine fibroids
Causes of Estrogen Dominance
Exposure to xenoestrogens: these are chemicals that are powerful estrogen mimickers in the body including plastics, pesticides, and parabens in cosmetics.
Poor Detoxification: there are 3 phases of Estrogen Detoxification
Phase 1 Liver Detoxification: called hydroxylation, estrogen is first processed by the liver into different metabolites including, 2-OH, 4-OH and 16-OH Estrone. (said 2, 4, and 16 hydroxy estrone). The DUTCH test will break down these metabolites to determine the percentage of each. 2 is the most healthy, 16 and 4 are the most potent, and can be harmful in high amounts. 4-OH can damage DNA if not detoxified by phase 2, leading to increase risk of hormone cancers.
Phase 2 Liver Detoxification: called methylation and conjugation. Methylation makes the products of phase 1 liver detoxification less potent and easier to eliminate. Conjugation makes estrogens more water soluble so they can be eliminated in urine and bile. There are several genes involved including MTHFR and COMT. If you carry a variant of these genes, which is very common, you won’t detoxify estrogen well.
Phase 3 Estrogen Detoxification: once the liver is finished processing estrogens, they are sent to the gut and kidneys for removal from the body. My favorite way to flush the kidneys is this… water! In the gut, the body can actually reabsorb estrogens, especially if there is chronic constipation. It is so important that there is enough fibre in the diet to bind and remove the estrogen that the liver has packaged up into bile. An imbalance in the microbiome can also increase the recycling of estrogen, leading to more estrogen dominance.
Reducing Estrogen Dominance
A naturopathic doctor will help you implement strategies to reduce estrogen dominance through diet, lifestyle and targeted treatments. Some simple strategies to get started on are:
Eat Phytoestrogens – such as ground flaxseed and non-GMO organic soy
Support the Liver – with 1-2 cups of Brassicas (broccoli family) per day, consume garlic and onions, lemon water and leafy, bitter greens. Talk to your naturopathic doctor about supporting your liver detoxification and ways to get bile moving through the gallbladder.
Consume enough fibre – 2 tbsp of flax is a great addition to a smoothie. Other fibres include fruit, vegetables all with the skin on, chia seeds, beans and whole grains such as brown rice and oatmeal.
Optimize your Microbiome – Talk to your naturopathic doctor about optimizing your microbiome to prevent constipation and the recycling of potent estrogens by the gut bacteria.
Androgen Dominance
A less common patten in women in their 20s and 30s is androgen or testosterone dominance. One condition that can look like androgen dominance is Polycystic Ovarian Syndrome (PCOS).
- Polycystic Ovarian Syndrome (PCOS).
- Symptoms of Androgen Dominance and PCOS-like pattern
- Acne and Oily Skin
Darker hair growth on the body and face - Male-pattern hair loss
- Blood sugar dysregulation
- Weight gain
- Irregular periods and infertility
Support for Androgen Dominance
A naturopathic doctor can help promote detoxification of testosterone and can implement strategies to balance androgens in the body. If PCOS or PCOS-like pattern is a concern, a naturopathic doctor will also look at metabolic markers such as insulin resistance and can support fertility in these women.
Perimenopause
Perimenopause refers to the time before menopause and can last for as long as a decade. Women in their early and mid 40s will often have estrogen dominance, coupled with a declining progesterone. The bigger the gap between the high estrogen and the low progesterone, the more symptomatic a woman will be.
Many perimenopausal women report worsening estrogen dominance symptoms such as extreme irritability, as if they have PMS all the time. Periods may get heavier and cramping can be worse.
As progesterone declines, the symptoms of low progesterone are also in the mix, including night sweats and insomnia, since progesterone is a calming hormone, and shortening menstrual cycle lengths as progesterone governs the second half of the 28 day menstrual cycle. As progesterone declines, cycle length can shorten to less than 28 days.
Common symptoms of Progesterone Deficiency
- Insomnia
- Night Sweats
- Shortened Menstrual Cycles
- Worsening PMS or Irritability all the time!
Support for Perimenopause
One of the most important things to recognize is how powerful hormones are. I often say, it’s not you, it’s your hormones! The main focus of the treatment plan for perimenopause is balancing the ratio of estrogen and progesterone. In addition to detoxifying estrogen dominance, it is important to implement strategies to boost progesterone, including nutrients, herbal medicine and possibly a referral to a prescriber for bio-identical progesterone.
Symptoms of Low Testosterone
Testosterone levels can also decline in perimenopause and menopause. Testosterone deficiency can lead to:
- Low libido
- Loss of muscle mass
- Difficulty making decisions
- Fatigue and lack of motivation
- Poor memory and brain fog
Stress makes everything worse
All of the steroid hormones Estrogen, Progesterone, Testosterone and Cortisol are made of the same raw material – cholesterol. If a woman is more stressed in her 40s, which arguably could be one of the most stressful decades, her transition into perimenopause can be worse. Called the pregnenolone steal, our stress hormone cortisol can steal away the raw materials needed to make the other hormones, amplifying a deficiency of progesterone and testosterone, specifically.
Menopause
Menopause is a right of passage for women and should be celebrated! Menopause by medical definition begins on the day a woman is one-year without a period. Hormonally, it is characterized by the drop in estrogen, which can cause symptoms and impact a woman’s longevity. Estrogen is critical for vaginal and urinary system health and for the health of heart, brain and bones.
Symptoms of Low Estrogen can include:
- Vaginal dryness and atrophy and pain with intercourse
- Frequent bladder Infections
- Increased cholesterol and risk for heart disease
- A redistribution of body fat to the abdomen
- Poor memory and increased risk for dementia
- Brain Fog
- Depression (Estrogen feeds the brain, so think of the brain as starving)
- New symptoms of ADHD (that might not be ADHD at all!)
- Bone loss, increasing risk for fracture
- Joint pain
Support for Menopause
Naturopathic medicine takes a whole-woman approach to menopause. Treating menopausal symptoms such as hot flashes and vaginal dryness is only the first step in the treatment. A naturopathic doctor will also assess for metabolic and cardiovascular health and will implement strategies to protect brain and bone health. A naturopathic doctor can guide you about the right questions to ask your prescriber about hormone therapy and can educate you on the risks and benefits of estrogen therapy.
DHEA and Healthy Adrenals Leading into Menopause
Menopause means the ovaries are no longer producing hormones and so the adrenal glands take over the job. The adrenal glands produce DHEA which can be measured in urine and on blood tests. DHEA is converted to estrogen and testosterone post-menopause. It is very important to support the adrenal glands, our stress supporting glands, prior to or at the time of menopause. Another reason to talk to your naturopathic doctor about adrenal support!
I’ll say it again, hormones are powerful. Their impact on health and overall wellbeing is significant. Testing and balancing hormones is key to optimal health.
