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Female Hair Loss: Lab Testing

My expertise in treating hair loss in women started with a personal experience of hair loss in my 20s. After being dismissed by my Medical Doctor who assured me it was “totally normal” I persisted in understanding why a healthy woman in her 20s would start losing hair.

Laboratory Testing for Female Hair Loss

As I discuss in my article, Getting to the Root of Female Hair Loss, treating hair loss can only be effective if you understand the root cause – why is a woman losing hair? Through laboratory testing an answer can often be found.

When I am working with women with hair loss I generally advocate for a tiered approach to lab testing for hair loss – starting with the most likely causes and progressing to the more complex.

For myself, the issue was an iron deficiency. By correcting that iron deficiency I was able to resolve my hair loss in under a year and it hasn’t recurred since.

Use the checklist below with your Medical Doctor or Naturopathic Doctor to determine the root cause of your hair loss. And if you’re ready to work with someone experienced in hair loss in women, get in touch and book an appointment today.

Female Hair Loss – Printable PDF

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

 

Are Menstrual Clots Normal?

One of the “joys” of womanhood, our monthly menstrual flow, can sometimes come with some surprises. One of those occurrences for many women is menstrual blood clots. Most women want to know if this is normal – and why it is happening.

Your Period

During your monthly cycle the lining of your uterus (endometrium) grows thick and increases the blood supply to support a potential pregnancy. When a pregnancy does not occur the drop in hormones (especially progesterone) leads to a release of the innermost lining of the uterus and we experience a period. In an average period women lose 30-40ml (6-8 tsp) of blood, with women experiencing heavy periods losing more than 60ml (12 tsp).

Blood Clots During Your Period

In a typical menstrual flow, the blood is not clotted due to the release of anticoagulants. The contraction of the uterus also stops further bleeding from the remaining blood supply to the uterus, and helps to expel the menstrual blood. After 3 to 4 days of bleeding, most of the inner lining of the endometrium (the “stratum functionalis”) has been released and blood loss slows considerably.

Blood clots are often a consequence of heavy menstrual flow. When the blood loss is too much, or too fast, the anticoagulants produced are not adequate to breakdown the lining of the uterus and prevent further clotting. Most women who experience clotting do so on the heaviest days of their menstrual period.

Possible Underlying Causes of Menstrual Blood Clots

  1. Miscarriage

Sometimes clots are actually a very early stage miscarriage. These clots may be found along with small gray clumps of tissue. If you experience other signs or symptoms of pregnancy along with clots, you may consider having your beta HCG levels tested to determine if it was, indeed, an early miscarriage.

  1. Uterine Fibroids (Leiomyomas)

Uterine fibroids are benign (non-cancerous) growths that occur in the muscular layer of the uterus. Some women with fibroids experience no symptoms at all, but for many women with fibroids they experience heavy periods (and blood clots) as a result. Fibroids are more likely to occur as we get older, especially after having children. Fibroids are also more common in women of African descent, those who are overweight and those with a family history of fibroids.

  1. Adenomyosis

Adenomyosis occurs when the endometrium breaks through into the muscular layer of the uterus (the myometrium). This can cause cramping, bloating, heavier menstrual periods and the presence of blood clots. Adenomyosis is also more common with age, in women who have had children, and in those who have had uterine surgery (such as a Caesarean section).

  1. Iron deficiency

In one of the great injustices in women’s health one major consequence of heavy periods, iron deficiency, can also lead to heavy periods. If you are experiencing heavy periods it is vitally important to test your hemoglobin, hematocrit and ferritin (iron) levels and build up your iron levels if needed.

  1. Hormonal imbalances

Imbalances between the two main female hormones, estrogen and progesterone, can lead to increased thickening of the uterine lining, resulting in heavy menstrual periods and blood clots. Imbalances in these hormones can occur at any stage of the reproductive life span, but are most common during adolescence and through the 40s and perimenopausal years.

  1. Thyroid imbalances

The thyroid is a small, butterfly shaped gland in your neck that controls your metabolic rate and has significant impacts on your hormonal health. An underactive thyroid can cause many symptoms – fatigue, difficulty losing weight, hair loss, and heavy periods. And with these heavy periods may come menstrual blood clots.

Recommended Testing for Menstrual Clots

If you regularly experience blood clots during your period, having some laboratory and imaging studies done is a good idea. It can help you understand why you are experiencing blood clots and your Naturopathic or Medical Doctor can work with you to determine an appropriate treatment plan.

Complete blood cell count – including hemoglobin and hematocrit to look for healthy red blood cells

Ferritin – to assess for iron deficiency anemia

TSH and complete thyroid panel – to assess health of the thyroid

Female hormone panel – to compare levels of estrogen and progesterone, along with other reproductive hormones, to ensure balance

Transvaginal or pelvic ultrasound – to identify uterine fibroids or other abnormalities of the uterus and uterine lining

MRI – a further visual assessment of the uterus if ultrasound is not adequate

If you are experiencing heavy periods and menstrual clotting, speaking to your Medical or Naturopathic Doctor can help you understand why you are experiencing these symptoms and develop a treatment that is as unique to your body and your period.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

References:

Young, B. Wheater’s Functional Histology, 6th Edition, 2014.

Melmed, S. Williams Textbook of Endocrinology, 2016.

 

Understanding Spotting Between Periods

“Why am I spotting?” is a common question that comes up in my naturopathic practice, impacting up to 1 in 3 women at some point in their reproductive lifespan. Spotting is most common in women during adolescence and during the transition to menopause, but can occur at any point in a woman’s life. While most women are told spotting is not significant, speaking to your doctor is suggested to determine the underlying cause.

What is Spotting

Spotting, also called intermenstrual bleeding, or even more technically “metrorrhagia” occurs when there is bleeding from the uterus at irregular intervals, most often between expected menstrual periods.

Causes of Spotting

  1. Ovulation

Ovulation is the most common cause of spotting in women. Around ovulation estrogen levels drop off slightly as an egg is released from the ovary. This drop in estrogen can lead to bleeding that is most often significantly lighter than a period and lasts for a shorter time. The blood may also be a different colour – brownish or pink. This ovulatory spotting is considered to be normal, but you should discuss with your health care provider to ensure nothing else is causing this symptom.

  1. Birth control pill

Birth control pills, and other forms of hormonal contraception (IUDs, patches, injections and implants), commonly cause spotting (called “breakthrough bleeding”) during the first few months of use. Most common in the first three months, for some women it doesn’t improve – if this happens a higher dose birth control or different method of contraception may be needed. Breakthrough bleeding is also common if you don’t take your pills as directed (missing a day or not taking at the same time each day). Women who smoke and take birth control pills are more likely to experience breakthrough bleeding (and should consider other forms of contraception due to the increased risk of blood clots.)

Other medications have also been found to be associated with intermenstrual bleeding, including anticoagulants (warfarin, heparin), antipsychotics, corticosteroids, and selective serotonin reuptake inhibitors (SSRIs.)

  1. Polycystic ovarian syndrome

One of the hallmarks of PCOS is irregular periods. In PCOS women do not ovulate, which leads to a lack of progesterone production and unopposed estrogen causes continued growth of the uterine lining. The lining will continue to thicken until it outgrows its blood supply and degenerates. Different sections of the lining may outgrow their blood supply at different times, causing spotting.

This lack of ovulation can also have similar results in adolescent girls who do not yet have a mature reproductive hormone cascade, resulting in spotting.

  1. Local infections

Infections of the vagina, cervix and endometrial lining can all cause spotting between periods. The infection is most often secondary to a sexually transmitted infection, but can also occur with pelvic inflammatory disease. Inflammation of the cervix (cervicitis) or uterine lining (endometritis) can also cause bleeding after sexual intercourse.

  1. Uterine or Cervical Polyps

Polyps are soft growths that can occur on the inside surface of the uterus or on the surface of the cervix. These growths are benign but may cause irregular bleeding, especially after intercourse.

  1. Perimenopause

The changes in hormone balance that occur in the years prior to menopause can lead to irregular periods and spotting between periods. With the transition to menopause comes a decrease in egg quality, resulting in less progesterone production and shorter menstrual cycles. The decline in successful ovulation can also lead to longer cycles. And both of these states of hormonal imbalance can lead to spotting.

  1. Thyroid hormone imbalances

The healthy function of the thyroid directly influences the healthy function of the reproductive organs. Under functioning of the thyroid (hypothyroidism) has been known to cause menstrual spotting, and correcting the underlying imbalance typically resolves the symptom.

  1. Pregnancy

Spotting in pregnancy can be an alarming symptom, but for many women it is totally normal. Some women experience spotting associated with implantation that can be very similar to a menstrual period. If you do experience spotting in pregnancy, see a doctor immediately to ensure optimal safety for both mom and baby, and to rule out an ectopic pregnancy which can be life-threatening if not treated.

  1. Uncommon causes

Less common causes for intermenstrual spotting include foreign bodies in the vagina (most often toilet paper or tampons) and certain types of reproductive cancers, including cervical, ovarian, endometrial and vulvar cancers. Clotting disorders can also worsen spotting and should be considered in teen girls with heavy periods or frequent spotting.

Testing for Spotting

While most spotting between menstrual cycles is benign and normal, it is important to try to identify an underlying cause, and correct it if possible. Achieving hormone harmony is possible, and can be done with the support of your Naturopathic Doctor.

Discuss this checklist with your Medical or Naturopathic Doctor to help you achieve your personal hormone balance.

Menstrual spotting checklist

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Hormone Testing

The importance of hormones for human health can’t be understated. The over 50 hormones in the human body act as chemical messengers that control most major bodily functions – from hunger, stress, mood and emotions to reproduction.

The body maintains an intricate balance of hormones, a state called homeostasis. When this delicate balance is challenged a wide variety of symptoms can occur – insomnia, fatigue, depression, anxiety, weight gain, acne, premenstrual syndrome, endometriosis, PCOS, diabetes, menstrual irregularities, and many, many more.

When identifying an unbalanced hormonal state, hormone testing can provide valuable information that will allow you to take steps to restore your optimal hormone balance, resolve symptoms, and restore optimal health.

Hormone Testing

Three important factors need to be considered when seeking testing for hormone balance.

            Timing of Testing

Time of day and time of month are important factors in getting valuable information from hormone testing. For most hormones, testing should be done first thing in the morning. An exception to this rule is cortisol, which is often tested at multiple points over the course of the day.

Time of month, or more accurately, time of the menstrual cycle, is also an important consideration for women. Generally hormones should be tested about one week before an expected period, when levels are at their peak.

Testing Sample Type

There are three main ways to test for hormone levels – blood (serum), saliva or urine. Each has it’s benefits and can be used, depending on the information needed.

Blood – a simple blood draw can give a great deal of information about thyroid hormones, insulin and blood sugar levels, vitamin D, prolactin, FSH and LH. It’s a quick process with well established reference ranges. However, it’s not considered the best test for steroid hormones like estrogen and progesterone, as levels in the blood stream do not accurately reflect free hormone levels available for action in the body.

Saliva – a home saliva test kit will provide excellent information about the free hormone levels of many steroid hormones: cortisol, estrogen, progesterone, DHEAS and testosterone. This test is often considered the most accurate reflection of hormone balance in the body. The drawbacks to salivary testing are the less well established reference ranges and the lack of testing for hormone detoxification pathways.

Urine – a newer testing type for hormone balance, the dried urine test for comprehensive hormones (DUTCH), gives a good overview of the steroid hormones estrogen, cortisol, progesterone, testosterone, DHEAS as well as the metabolites produced when our body breaks down these hormones.

            Balance Over Absolute Values

The last important consideration for hormone testing is that the results of your hormone test should be interpreted by a practitioner with a great deal of expertise in hormone testing and hormone balancing. When looking at a hormone test the most important information is the balance between the different hormones, rather than the absolute values of each individual hormone. A low normal progesterone with a high normal estrogen results in the same symptoms as a normal estrogen and a very low (or abnormal) progesterone.

Hormones are responsible for a vast variety of functions in our bodies, and their imbalance is an important (and common!) cause of symptoms. If you suspect you may have a hormonal imbalance, book an appointment with your Naturopathic Doctor today to discuss your options.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Diagnosing PCOS

Diagnosing PCOS

Polycystic ovarian syndrome is one of the most common conditions that I treat in my naturopathic practice. It affects 1 out of every 10 women and can manifest in many different ways – hair loss, facial hair growth, acne, difficulty losing weight, irregular menstrual periods or infertility. Because of the many different symptoms of PCOS, an accurate diagnosis is important.

The Rotterdam Criteria

The diagnosis of PCOS is currently made according to the Rotterdam Criteria, a 2003 consensus reached by the Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM).

Diagnosis of PCOS requires that a woman meets two of three criteria:

  1. Infrequent or no ovulation (resulting in irregular or absent menstrual periods)
  2. Signs and symptoms or laboratory tests that show high androgen (male hormone) levels – these include acne, hair loss, facial hair growth, darkening of the skin at skin folds
  3. Cysts on the ovaries on ultrasound

For a diagnosis of PCOS it is also important to rule out other causes of these symptoms, such as a pituitary, thyroid or adrenal disease.

Clinical Evaluation

taking-notesThe first step in diagnosis of PCOS is a thorough evaluation with your medical or naturopathic doctor. Your doctor will ask a lot of questions. Be sure to share if you experience any of the following:

  1. Irregular periods – menstrual cycles that are longer than 35 days, infrequent periods or no periods at all can all be associated with anovulation and PCOS.  (Keep in mind: 1 in 5 women with PCOS still have regular periods, so having a regular period does not rule out PCOS)
  1. Acne – facial, chest, or back acne can be a sign of elevated androgens
  2. Hirsutism – abnormal growth of coarse hair in a male pattern (lip, chin, torso)
  3. Hair loss – elevated androgens is a major cause of head hair loss in women
  4. Oily hair or skin
  5. lump-sugar-549096_640Sugar cravings – a sign of insulin imbalance, one of the major hormonal imbalances in PCOS. Other symptoms include dizziness, lightheadedness or irritability (or “hangry”) if a meal is missed.
  6. Recurrent yeast infections – a sign of elevated blood sugar levels. Other symptoms include excess thirst and frequent urination.
  7. Overweight or difficulty losing weight – often a cause, and consequence, of the hormone imbalances in PCOS
  8. Darkening of the skin – especially at the back of the neck or in the skin folds at the underarms, under the breasts and between the thighs. This darkened skin is called acanthosis nigricans and is associated with elevated testosterone.
  9. Infertility – difficulty getting pregnant is often the driving factor for a diagnosis for PCOS
  10. Family history of PCOS or diabetes

 Laboratory Testing

Laboratory testing is the second criteria for a PCOS diagnosis. Many different lab tests can be used to confirm a suspected PCOS diagnosis, and these tests may highlight the underlying hormonal imbalances that cause PCOS. If you are taking the birth control pill to suppress your PCOS symptoms these tests will not provide accurate information.

Luteinizing hormone (LH) – high – produced by the pituitary gland to stimulate ovulation, levels are often elevated because ovulation is not occurring

Follicle stimulating hormone (FSH) – normal or low – typically assessed in relation to LH levels, some women with have a higher than normal LH:FSH ratio (greater than 1:1)

PCOS laboratory testingSerum testosterone (free and total testosterone) – high – 80% of women with PCOS have elevated levels of androgens. DHT levels may also be elevated

Progesterone – low – during the second half (luteal phase) of the menstrual cycle progesterone levels will be low due to the lack of ovulation

Estradiol – normal – typically in PCOS estrogen levels are normal or slightly elevated

Sex hormone binding globulin (SHBG ) – low – if tested, levels may be low

Fasting blood glucose – high – women with abnormal blood sugar levels typically have higher body weight, have higher androgen levels and are more insulin resistance

HbA1C – high – a long term (3 month) measure of blood sugar stability

Anti-Mullerian hormone (AMH) – high – levels of AMH are often elevated in PCOS due to the lack of regular ovulation

DHEAS – high – half of women with PCOS will have elevated adrenal production of DHEAS

Prolactin – normal – elevated prolactin can cause symptoms similar to PCOS; if your prolactin levels are high a pituitary tumour must be ruled out.

Thyroid stimulating hormone – normal – should be measured to rule out other causes of menstrual irregularities

Cortisol – normal – should be measured to rule out Cushing’s syndrome

Additionally, a pelvic or transvaginal ultrasound may reveal multiple 2-6mm follicular (simple) cysts on the ovaries. Ovarian volume or area may also be increased.

Moving Beyond Diagnosis

PCOS DietAn appropriate diagnosis of PCOS is important for women seeking optimal hormone balance. But the diagnosis is only the beginning. Your naturopathic doctor can be your partner as you move beyond diagnosis towards understanding and hormone balance. Read the other articles in the PCOS Series by Dr. Lisa Watson: Understanding PCOS, The PCOS Diet (also available as an infographic), PCOS and Infertility, PCOS in Adolescence, PCOS and Pregnancy, Hormonal Balance in PCOS and Naturopathic Medicine for PCOS.

Dr. Watson is currently accepting new patients at both her Toronto clinics. Contact her for a complimentary meet and greet appointment, or book your initial consultation today. The best time to start balancing your hormones is now.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Pin this article for later: https://www.pinterest.com/pin/207165651589076259/

Healing Your Hormones: Progesterone Deficiency

Women’s health is both the focus of my naturopathic practice and a passion in my life. There is no topic I am more excited to talk about, read about and learn about. And within women’s health there is no more important topic than hormone balancing. Because hormones are the main factor that differentiates men from women across the lifespan.

In this series I will take you through the basics of some common hormone imbalances that occur in women – progesterone deficiency, estrogen deficiency, estrogen excess, low thyroid hormone, excess thyroid hormone and testosterone excess.

So whether you are just interested in learning more about hormones, or hoping to identify some of your own signs and symptoms in this series, read on and get ready to learn how to heal your hormones.

What is Progesterone?

The reproductive system in women has two main hormones – estrogen and progesterone. Progesterone is our “pro-gestation hormone” – it is produced in the ovaries after ovulation to prepare the uterus for pregnancy. It is also produced in small amounts in the adrenal glands and in large amounts by the placenta during pregnancy.

What Does Progesterone Do?

Hormone sleepProgesterone prepares the body for pregnancy by stimulating the production of proteins that prepare the uterine lining for implantation. Progesterone also regulates our menstrual cycle – if a pregnancy does not occur, progesterone levels drop off and a menstrual period will result.

Progesterone is much more than just a pregnancy support hormone. Receptors for this hormone are found in the brain, breasts, blood vessels, and bones, in addition to the receptors in the reproductive organs. Progesterone is the natural balancing agent for estrogen – preventing estrogen from producing too many growth-stimulating effects on our tissues.

Progesterone also has significant anti-anxiety and relaxing effects on the body. It helps our mind and body cope with stress and can promote healthy sleep.

Changes in Progesterone Hormone Balance

Production of progesterone peaks in our mid-reproductive years – around 25 years of age. After that age we see steady declines in progesterone production until perimenopause and menopause when production drops off almost entirely.

Women who do not experience regular periods, or women who are not ovulating typically have low levels of progesterone as well.

Symptoms of Progesterone Deficiency

Low levels of progesterone can lead to a vast number of symptoms. Many of the symptoms are not taken seriously by doctors or may be attributed to other causes (especially anxiety, depression, insomnia and PMS). But for a large number of women the real cause of symptoms is an imbalance in progesterone levels.

 Escalator hormone balanceSymptoms of Progesterone Deficiency

  • Premenstrual mood changes
  • Painful or lumpy breasts
  • Insomnia
  • Premenstrual headaches
  • Anxiety
  • Infertility
  • Recurrent miscarriage
  • Unexplained weight gain

The Progesterone Hormone Web

No hormone functions in isolation. Each hormone in our body interacts with other hormones for optimal balance. Progesterone interacts with a number of important hormones, a few of which are noted here:

Estrogen

Progesterone is the natural balancer to estrogen. When progesterone levels are deficient, we can see symptoms of estrogen dominance. These include the symptoms listed above but also:

  • heavy periods
  • fluid retention
  • foggy thinking
  • decreased sex drive

Cortisol

Progesterone is the direct precursor to the production of cortisol, our stress/survival hormone. If progesterone levels are low, our ability to cope with stress diminishes and we may develop anxiety, depression, insomnia or feel overwhelmed.

Thyroid Hormone

Thyroid hormones stimulate the production and release of progesterone from ovarian cells. Thyroid hormone also influences the formation of progesterone receptors on cells throughout the body. If your thyroid function is low (hypothyroidism) you may also be experiencing low progesterone levels.

Hormone Healing for Progesterone Deficiency

Yoga natureLaboratory testing is necessary for all women seeking treatment for progesterone deficiency. It is imperative to understand the balance in the different hormones before starting any type of hormone treatment.

A lifestyle approach to improving progesterone levels is the foundation for all other treatments. Decreasing stress levels, encouraging a healthy diet that provides adequate protein and healthy fats, and engaging in regular exercise are all important to balancing progesterone levels.

There are a vast number of nutrients, and plant-based botanical medicines that can influence the production of progesterone. Some women also choose bioidentical progesterone cream, which can be prescribed by Naturopathic Doctors in Ontario who have prescribing rights.

Vitamin B6

Necessary for appropriate ovulation and subsequent progesterone production. If you are deficient, you will likely also be deficient in progesterone. Excellent food sources include tuna, salmon, turkey, chicken, sweet potato, sunflower seeds and dark leafy greens.

Magnesium

Magnesium is necessary for detoxification of hormones, especially estrogen. If you are deficient in magnesium you may have higher circulating levels of estrogen, resulting in a relative progesterone deficiency. Food sources of magnesium include pumpkin seeds, leafy greens, soy beans, sunflower seeds, and beans.

Chaste berry (Vitex agnus-castus)

Chaste berry (or chaste tree) has been found to increase progesterone levels during the second half of the menstrual cycle. It can also help to balance other hormones such as prolactin. Your Naturopath can help you decide if chaste berry is right for you

Bioidentical progesterone cream

Bioidentical hormone replacement therapy (BHRT) uses hormones that are identical to those in your body to balance your hormones and relief symptoms of hormone imbalance. Bioidentical progesterone is made from wild yams or soybean and is typically applied in cream form during the second half of the menstrual cycle.

Transdermal progesterone results in effective absorption of progesterone and movement of progesterone to the target tissues – brain, uterus, breast and blood vessels – to decrease symptoms. It is typically used twice per day and dosages vary – your Naturopath will work with you and a compounding pharmacy to establish your proper balance of hormones.

Hormone imbalance is not in your head – it is in every cell in your body. If you think your hormones are out of balance, talk to an experienced and qualified Naturopathic Doctor to help you find your optimal balance.

The PCOS Diet

A nutritious diet is the cornerstone of health – a foundation on which we can build healthy choices and behaviours. In no condition is this more true than polycystic ovarian syndrome. Choosing the right foods for PCOS and avoiding others can be enough for many women to balance their hormones and decrease symptoms of PCOS. And there are no harmful side effects – just the benefits of a healthy diet and vibrantly healthy lifestyle.

The PCOS Diet – What to Avoid

  1. Refined grains

Breads, bagels, muffins, crackers, pasta – all the many forms of refined grains that are common in the western diet, should be avoided in women with PCOS. These high glycemic-index foods quickly raise blood sugar levels and can lead to insulin resistance – a condition where your cells no longer respond to insulin. This is thought to be one of the underlying hormonal imbalances in PCOS.

  1. Refined sugars

Fighting Sugar AddictionSugars found in cookies, cakes, candies, sodas and sweetened beverages can wreak havoc on your hormones in a similar way to refined grains. Best to leave these foods out of your diet entirely and instead opt for naturally sweet fruits to nourish your sweet tooth.

  1. Alcohol

Alcohol is one of the most hormonally devastating things we can put in our body. Not only is it made of mostly sugar (and in PCOS we know what sugar can do to our insulin response!) it also prevents the liver from being able to effectively process and eliminate excess hormones. Women with PCOS also have an increased risk of non-alcoholic fatty liver disease. Limit alcohol consumption to red wine, have no more than one serving per day and don’t have it every day.

  1. Red meat

Red meats are high in saturated fats and contribute to inflammation. Saturated fats can also lead to increased estrogen levels. I recommend limiting red meat to lean cuts of grass-fed, hormone free meat and consuming it no more often than 1-2 times per week.

  1. Dairy

Dairy is a significant source of inflammation, unhealthy saturated fats and should be avoided by women with PCOS. Additionally, dairy increases the production of insulin-like growth factor (IGF) which is known to negatively impact ovulation in PCOS. Rather than reducing dairy, you should consider avoiding it all together to help manage your PCOS.

The PCOS Diet – What to Enjoy

  1. Vegetables and fruits

Eat food

The foundation of the PCOS diet is a plant-based diet. Vegetables, fruits, beans and legumes, nuts and seeds are provide the body with essential nutrients and fiber. Soluble fiber such as that found in apples, carrots, cabbage, whole grains such as oatmeal, and beans and legumes, can lower insulin production and support hormone balance in PCOS.

  1. Proteins

Healthy proteins are an absolute necessity for women with PCOS. While dairy and red meat are not recommended, plant based proteins like nuts, seeds, beans, lentils and legumes are encouraged. Other healthy proteins like turkey, chicken breast, eggs and fish should also be emphasized. For most women with PCOS, a daily intake of 60-80g of protein per day is recommended.

  1. Wild salmon

An excellent source of protein, wild salmon is also rich in omega-3 fatty acids. Omega 3s improve insulin response and blood sugar metabolism and studies have shown lower circulating testosterone levels in women who supplement with omega 3s. Choose wild caught salmon and other cold water fish two to three times per week and incorporate other healthy sources of omega 3s such as walnuts and flax seeds into your diet.

  1. Cinnamon

CinnamonSpices are an amazing way to increase antioxidants in your diet, and cinnamon is especially useful for women with PCOS because it can help to regulate blood sugar. Sprinkle it on apples, oats or quinoa in the morning, add it to teas and use it in flavourful stews or curries.

  1. Pumpkin seeds

    These zinc-rich seeds help to lower testosterone levels and are an easy, high protein snack to enjoy every day!

  2. Green tea

Studies have shown that green tea extract helps to improve the response of cells to insulin, as well as lower insulin levels. Consider drinking a few cups of green tea daily – or better yet, have some matcha to get a big nutritional benefit!

  1. Spearmint tea

Spearmint tea for PCOSAs little as two cups of spearmint tea per day for a month can lower testosterone levels and improve symptoms of abnormal hair growth (hirsutism) in women with PCOS. A must for all women with polycystic ovarian syndrome!

  1. Broccoli

Cabbage, cauliflower, bok choy, broccoli, kohl rabi, kale – these brassica vegetables are a source of indole-3-carbinole, a compound thought to support the detoxification and breakdown of hormones in the liver.

  1. Walnuts

Researchers have found that consuming 1/3 cup of walnuts per day for six weeks can reduce testosterone levels, improve insulin sensitivity, and improve fatty acid status in the body. Combine these with your pumpkin seeds for a satisfying afternoon snack!

  1. Leafy greens

Spinach, kale, arugula and all the amazing variety of leafy greens are good sources of vitamin B6 – a nutrient necessary for balancing prolactin levels – a hormone that is often elevated in PCOS. Greens are also high in calcium, a mineral necessary for healthy ovulation. One more great reason to get those greens!

I hope you will embrace the PCOS diet – you really can heal your body through food medicine. If you need more support or guidance, contact me to book a free 15 minute consultation and together we can find your vibrant balance.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select References

Kaur, Sat Dharam. The complete natural medicine guide to women’s health. Toronto. Robert Rose Inc. 2005.

Hudson, Tori. Women’s encyclopedia of natural medicine. Los Angeles. Keats publishing. 2007.

Spearmint Tea for PCOS

Hormone imbalances are a characteristic feature of polycystic ovarian syndrome (PCOS) – you can read more about the many imbalances in my article Understanding PCOS. But research has shown that a simple treatment may help to balance one of the most common hormone imbalances in PCOS – elevated testosterone.

Researchers have found that drinking spearmint tea, two cups per day over a 30 day period decreased free and total testosterone levels compared to a group consuming a different placebo herbal tea. More importantly, the women in this study self-reported improvements in hirsutism (abnormal hair growth patterns).

This finding is remarkable for a number of reasons. First – improvements in testosterone levels can lead to more regular ovulation in women with PCOS and decrease symptoms associated with elevated testosterone (such as acne). Second – a decrease in hirsutism after just 30 days of study is a result many women with PCOS would be pleased to experience. A longer duration of spearmint tea use would likely result in more significant improvements in abnormal hair growth due to time needed to see changes in hair follicle response to androgen hormones.

Spearmint tea is also delicious, inexpensive and easy for most women to incorporate into their daily routines. Discuss with your Naturopathic Doctor whether spearmint tea might be a useful addition to your PCOS treatment plan!

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Reference:

Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010 Feb;24(2):186-8.

 

 

Understanding Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) affects up to 1 in 10 women. It truly is a multi-headed beast – each woman manifests the hormonal imbalances and symptoms of PCOS differently. Only through understanding the underlying imbalances unique to each woman can we hope to overcome polycystic ovarian syndrome and achieve balanced, vibrant health.

What is PCOS?

PCOS is a “syndrome” – in medical language that means it is a condition characterized by a group of symptoms, not all of which are necessary for diagnosis. To be diagnosed with PCOS you must have two of the following:

  1. Infrequent or no ovulation (irregular or long menstrual cycles or no menstrual periods)
  2. Signs or symptoms (or laboratory testing) showing high androgens (testosterone or dihydrotestosterone) – these include acne, abnormal hair growth, hair loss, darkening skin at skin folds
  3. Polycystic ovaries on ultrasound

As you see it is possible to have PCOS and not have polycystic ovaries! It is a syndrome that results from hormone imbalances in the body – hormones that directly impact the ovaries and ovulation.

Causes of Polycystic Ovarian Syndrome

What causes the hormone imbalance that leads to the symptoms associated with polycystic ovarian syndrome? We don’t have a clear answer to that for every woman. There are some risk factors associated with developing PCOS, but women with no risk factors can still develop this syndrome.

            ScaleRisk Factors for PCOS

  • Genetics
  • Family history of diabetes
  • Obesity
  • Insulin resistance
  • High blood sugar
  • Low blood sugar
  • Use of seizure medication (valproate)

Hormones and Polycystic Ovarian Syndrome

There are a vast number of hormonal imbalances that are intricately intertwined in PCOS. A brief summary is given below, for a more in depth exploration, please read the article Hormones and Polycystic Ovarian Syndrome.

hormone balanceTestosterone and dihydrotestosterone (DHT) – levels of free and total testosterone are often elevated. Production of androgens (male hormones) in the ovaries is increased in PCOS. The increased levels of testosterone and DHT lead to the characteristic acne associated with PCOS.

Luteinizing hormone (LH) – increased LH is characteristic of PCOS. The diagnosis of PCOS is often identified when the LH:FSH ratio is greater than 2:1.

Follicle stimulating hormone (FSH) – can be low or normal. The lack of ovulation that occurs in PCOS is partially due to the lack of follicle response to FSH.

Sex hormone binding globulin (SHBG) – levels are decreased. SHBG binds to testosterone and DHT, rendering them biologically unavailable. With low levels of SHBG, increased action of testosterone is seen in tissues (resulting in hair loss, abnormal hair growth, and acne).

Insulin – high levels of insulin, or resistance to insulin in the tissues, is thought to be a primary cause of PCOS. Many doctors think that insulin imbalances are the first step in the cascade of hormone imbalances that occur in PCOS.

Symptoms of PCOS

The symptoms of PCOS occur as a result of the hormonal imbalances at the root of this condition. Your symptoms can help guide an experienced clinician to identify the dominant imbalances resulting in your PCOS.

            Common symptoms of PCOS:

  • Obesity and weight management issues (only in 40-50% of PCOS sufferers)
  • Acne (typically along the chin and around the mouth)
  • Oily skin
  • Polycystic or enlarged ovaries (found on ultrasound)
  • Blood sugar imbalances (“hangry”, dizziness, lightheadedness)
  • Darkening of skin at skin folds (acanthosis nigricans)
  • Long or irregular menstrual cycles (due to lack of ovulation)

Naturopathic Management of PCOS

Naturopathic medicine has great potential in the treatment of polycystic ovarian syndrome because it focuses on individualized care. There is no “standard” protocol for PCOS, your ND will need to discuss your symptoms and recognize your state of hormonal imbalance to develop an effective treatment plan.

Organic VegetablesYour naturopath may order additional laboratory testing if the underlying hormonal imbalances are not clear. Testing may include salivary or blood tests, depending on which hormone is being assessed. You may be asked to keep a record of your Basal Body Temperature, a simple means of tracking the hormonal ebb and flow of your monthly cycle.

The cornerstone of treatment for PCOS is improving response of the body to insulin. This often involves exercise and consuming a whole foods diet that is low in refined and processed sugars. Botanical medicines and nutritional supplements may also be used to address specific hormone imbalances such as elevated testosterone or decreased sex hormone binding globulin. Please read the article Naturopathic Medicine for PCOS to learn about the many treatment options available.

Beyond Understanding

At this point you have an understanding of the symptoms and hormonal imbalances associated with PCOS. Continue your understanding by reading other articles in this series by Dr. Lisa Watson, ND including Hormonal Imbalances in PCOS, PCOS and Infertility, The PCOS Diet, PCOS in Adolescence and Naturopathic Medicine for PCOS.

If you are ready to start working on achieving your healthy balance, Dr. Watson is currently accepting new patients at both her Toronto clinics. Contact her for a complimentary meet and greet appointment, or book your initial appointment today.