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Hormones in Weight Loss

We believe we can get healthy by losing weight – but we need to be healthy to lose weight

Weight loss is a lot more than just watching what you eat and how much you exercise.  While diet and exercise are essential components of a weight loss program, if your hormones are not in balance you will always be fighting against your body to lose fat and improve your body composition and health.

In this article I discuss some of the most important hormones for weight loss – our hormone helpers, and our hormone haters.  For a more in depth look at your personal hormone balance, consider booking an appointment with a naturopathic doctor for individual testing and hormone assessment.

Weight Loss: Hormone Helpers

Thyroid Hormone

Thyroid hormones are our metabolism masters – they control the rate of energy production (metabolism) throughout the body. When thyroid hormones are too low symptoms of fatigue and weight gain can occur. When thyroid hormones are too high symptoms of anxiety, jitteriness and weight loss are common.

The optimal range for TSH (a measure of thyroid function) for weight loss is 0.75-2.5.  Outside of this range can alter metabolism and make weight loss difficult.

Glucagon

Glucagon hormone works with insulin to balance blood sugar – insulin rises when blood sugar is high, glucagon rises when blood sugar is low. Improving glucagon levels helps us to keep our blood sugar stable and support weight loss.

Not surprisingly, activities that support stable blood sugar can improve glucagon levels. Specifically exercise and healthy protein consumption can increase glucagon levels while a diet high in sugar decreases glucagon.

Growth Hormone

Growth hormone is produced throughout our lifetime although it’s production is highest during our younger years. Growth hormone is necessary for tissue repair, muscle building and improving the density of bone.

The majority of growth hormone is produced overnight but it is also produced during exercise. Low levels of growth hormone (associated with poor sleep, eating too close to bed and lack of exercise) can lead to fatigue, depression, cholesterol imbalances, and abdominal weight gain.

Leptin

One of our weight-loss helpers, leptin is our appetite-suppressing, full-sensation hormone. It is released by fat cells and communicates with our brain that we have had enough to eat.

We can improve our leptin levels through our lifestyle. Sleep, regular exercise, sufficient calories from our food and weight loss all help to balance leptin and improve our body composition.

We can also sabotage our leptin balance through our lifestyle choices. A regular intake of excess saturated fat and sugar leads to “leptin resistance”. When this occurs the brain no longer respond to high circulating levels of leptin and allows you to keep eating despite not being hungry.

Weight Loss: Hormone Haters

Ghrelin

Ghrelin works very closely with leptin to maintain our body weight. Ghrelin is the hunger hormone, produced when your digestive tract is empty. If you stomach is growling, ghrelin is being produced.

Ghrelin tells our brain when we’re hungry, and leptin tells us when we’re full.

Cortisol

Cortisol is most commonly known as our “stress hormone”. It is produced in high levels during stress, but our bodies produce varying levels over the course of every day.

High levels of cortisol can influence our eating habits and our hormone balance. People with elevated cortisol often crave sugary and salty foods, leading to an increase in insulin levels and all the symptoms associated with that imbalance.

Cortisol also stimulates a process in the liver known as “gluconeogenesis” – our body makes sugar to provide us fuel to get away from our stress. If we don’t use this extra sugar (by exercising) it gets deposited as fat around our midsection.

Insulin

Insulin helps our cells get energy in the form of sugar. When we eat foods that contain sugar (fruits, vegetables, grains, processed foods) our body releases insulin as a way of controlling blood sugar levels – getting the sugar out of the blood stream and into our cells.

When insulin levels are too high our cells can become less sensitive to it’s effects – leading to ‘insulin resistance’. This then leads to cravings for more sugar to meet the needs of our cells. And more insulin is released, and a vicious cycle ensues.

High levels of circulating insulin are associated with weight gain (especially around the belly). When you have excess insulin you can not burn fat as energy – your body will just demand more sugar to bring the insulin levels down. This makes losing abdominal fat almost impossible.

Serotonin

Serotonin is one of our feel-good neurotransmitters (along with dopamine and norepinephrine). When serotonin is out of balance symptoms of anxiety and depression are common. These emotions contribute negatively to weight loss by altering our motivation, drive, commitment and self esteem.

The depression associated with low serotonin leads to increases in inflammation and cortisol levels – both of which make it harder for our body to burn fat as fuel and lose weight.

Low levels of serotonin also decrease mood and lead us to crave foods that are rich in carbohydrates – a source of tryptophan, which our body uses to create serotonin.

Estrogen

Estrogen is the most common female hormone (although men have it too!) It is produced mainly in the ovaries but fat cells also produce large quantities of estrogen. High levels of estrogen, or “estrogen dominance” is as great a risk factor for obesity as having a poor diet or not exercising.

Estrogen balance is greatly impacted by our lifestyle and environment. Exposure to chemical estrogen-mimicking compounds, alcohol consumption, a high fat diet, lack of exercise and sleep deprivation can all lead to abnormally high levels of estrogen.

Hormones are incredibly important for our overall health, energy and metabolism.  If you are struggling to lose weight, or are stuck at a weight loss plateau, perhaps hormones are your issue.  Book a free 15 minute consultation now to discuss your options, and get your hormones back in 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.

Bitch Redux

In my work in women’s health I see a lot of conditions impacting the lady garden, endometriosis, PCOS, fibroids, cervical dysplasia, yeast infections and UTIs. But the one issue a lot of the women in my practice complain about is bitchiness. It might not be a medical diagnosis, but it impacts up to 80% of women at some point during their monthly cycle.

Women’s Emotions

Women have evolved to have immense sensitivity, and their emotional variations allow them to be more responsive to the environment, people and connections important to them.

Women are naturally more empathic and intuitive than men (of course acknowledging the great diversity of individual personalities). Women have always been the caretakers, the gatherers, the life-givers. Women rely more on social relationships for their survival, and the survival of their children and communities. Women have great emotional intelligence, because they need to be able to intuit and empathize with those around them – their children’s needs, their community’s goals, their partner’s intentions.

Women’s Brains

Women’s brains develop different to men, hardwiring us to feel more deeply, be more attuned to the emotional states of others, and be more reactive to the needs of those around us. At 8 weeks gestation, the testes become functional and the resulting surge of testosterone kills neurons in the communication centre of the brain. The testosterone instead develops more neurons for action, aggression and sexual drive – ultimately taking up about 2.5 times the space in men’s brains than women’s.

In women’s brains more space is allotted for language, hearing and memory. The memory center, the hippocampus, is larger in women, allowing those early female gatherers to remember where to find the food. The insula, thought to be the seat of self awareness, empathy, and interpersonal relationships, is also noticeably larger in women. This may lead to an increased intuition, or gut feeling, in women.

Women’s Hormones

Women’s hormones DO make them more moody. For women being fixed and rigid doesn’t lend itself to survival. Our emotionality is our strength – we may not be as physically strong as men, we rely more on our emotional connections and strength of connections, community and family.

Unlike men, whose hormone production spikes at puberty and remains fairly stable across their lifetime, women’s hormones ebb and flow over a monthly cycle and wax and wane over their reproductive years.

At the beginning of our menstrual cycle, at the onset of our bleeding, estrogen levels climb to prepare an egg for ovulation at midcycle. Estrogen production is strongly linked to serotonin production – and as estrogen goes up, so too does serotonin.

As estrogen continues to climb to the midcycle peak, most women note a positive mood state. During this time our biology encourages us to be more social, to connect to our tribe, more confident, to meet people and more alluring, to try to find a mate to conceive a baby with.

Estrogen acts as a stress hormone, or an anti-stress hormone. Making us more likely to brush off things that at other points in our cycle may provoke a significant response.

At midcycle estrogen levels are at their highest, along with dopamine and oxytocin. This encourages pro-social, trusting behaviour, and we are more generous and connected to others in our social network. We also talk more and are more interested in intimacy than at any other time of the monthly cycle.

Immediately after ovulation, our estrogen levels start to decline, but the rise in progesterone catches us before our moods crash. Progesterone doesn’t increase serotonin levels like estrogen does, but it supports GABA production, leading to a sense of calm and low anxiety that persists for about 10 days while progesterone levels are high.

All hell breaks loose during the final 3-7 days of the menstrual cycle however, with estrogen levels at a low, and progesterone levels steeply declining. Women during this time are more depressive, more cautious – a way for nature to keep us from harm during a time when we may be pregnant without knowing it.

The low estrogen also makes us less resilient, experience more physical pain, more emotionally sensitivity, and makes us more likely to react or respond to triggers that we would ignore during our high estrogen first half of the cycle. It’s not that we have more stress – we’re just way more likely to call it what it is and not stand for any shit.

Estrogen is essentially the “whatever you want honey” hormone – you are so much more willing to give to others and sacrifice your own needs when estrogen levels are high. But when those levels drop we are more likely to react and share our opinions – good or bad. It is not that we are reacting to things that aren’t really there – we’re reacting to things that upset or anger us – we just might ignore them at other times. If you feel underappreciated, overworked, or overwhelmed, or that you’re not in balance with your partner – it’s probably all true.

Bitch Redux

I want to encourage women to recognize the power in our hormonal fluctuations – our mood changes are adaptive – they help us seek out relationships, build connections, and preserve our energy. The mood changes that occur during our premenstrual phase are normal, and temporary. I want women to reclaim our natural hormone and mood fluctations, and be empowered by our emotions, rather than struggling against them.

My recommendation is to learn your natural fluctations and use your bitchiness as a superpower. Track your cycle – using any number of excellent free apps – and plan your month accordingly. Plan for presentations, meetings, anything requiring verbal skills for your first half of the cycle (the closer to ovulation the better! Your personality is magnetic when you’re near ovulation!) Have a task that requires fine motor skills – an intricate art project or rewiring your house? Keep that to the first half of the month as well.

Leave the tasks best left for your OCD-self for the last month of the cycle. I think most women probably read The Life-Changing Magic of Tidying Up during the last week of their cycle. So put “clean out the kitchen cupboards” on your list for the premenstrual week (maybe stay out of your closet though – many women feel less appealing during their premenstrual week and this could be a disastrous task.) Your pain tolerance is also lowest during your premenstrual phase – so skip the dentist or your tattoo appointment and get a mani-pedi or skin care facial instead.

Think of your PMS as a time to spend in reflection and personal contemplation. Your intuition is at its peak in the week before your period, so take time to do a mental health inventory – are you doing what you want? Are you where you want to be? Pay attention to the things you are critical about during your premenstrual phase – these thoughts are probably a lot more valid than you might want them to be. Write down the things that upset you/ anger you/ send you into a whirling passion of emotions and act on them in the beginning of the next cycle when you’re feeling energized and empowered again. Harness your bitchiness, it could end up being your greatest power.

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.

Problems with the Pill

There is no doubt that the birth control pill was a huge player in the feminist revolution. First released in 1960, the pill allowed women to delay pregnancy and focus on their career, transforming the lives of women and society. While the pill may be a political powerhouse, and be effective at preventing pregnancy, my belief is that it is being overprescribed, and women are under-educated on the impact that the pill can have on their health.

This article will share some of the concerns that I, as a naturopathic doctor and women’s health expert, have regarding the pill. The purpose is not to convince you to give up the pill, but to empower you with information so that you can make an informed choice as to whether this medication is the right choice for you.

Problems with the Pill

  1. The Pill Depletes Nutrients

One of the biggest problems with the pill is the nutrient deficiencies that result from use. From B vitamins to essential minerals, the pill changes the absorption, utilization and metabolism of a number of different nutrients. These nutrient depletions are the underlying cause of many of the negative side effects of the pill – things like weight gain, moodiness, fatigue and blood clots. You can read all about the nutritional problems with the pill in this article.

  1. Weight gain

The estrogen in birth control pills can cause an increased appetite and fluid retention, leading to weight gain, especially in the first few months on the pill. Long term weight gain on the pill is more likely due to the decreased levels of B vitamins, necessary for carbohydrate and fat metabolism (i.e. burning fat for energy).

  1. No glory for our guts

The pill is known to alter the balance of healthy bacteria in our guts. Estrogen affects gut permeability (a risk factor for autoimmune disease) and bacteria balance, a condition known as dysbiosis. Healthy bacteria are incredibly important for our overall health – especially our immune, mood and digestive health. The pill has been linked to symptoms of gas, bloating, IBS, and an increased risk of Crohn’s disease in women with a family history of the digestive condition.

The change in healthy bacteria balance, combined with the estrogen in the pill, also makes women more susceptible to vaginal and digestive yeast infections. If you get frequent or recurrent yeast infections, or significant gas or bloating symptoms, consider if your pill may be part of the problem.

  1. Moodiness

Any woman can tell you that hormones can have a significant impact on your mood. The rises and dips in estrogen and progesterone that occur over a woman’s monthly cycle can lead to moods and behaviours that foster relationships, encourage sexual intimacy, and make women weepy, emotional and volatile. While some women on the pill notice very little difference in their mood states, other women find their normal emotional states become heightened in intensity and more difficult to manage. The reasons for this are very individual – some women don’t tolerate the high levels of estrogen and others find the high progesterone problematic. In either case, if the pill makes you moody switching to another pill is unlikely to help.

  1. Blood clots

Possibly the most well known side effect of the pill, the risk of blood clots is highest in women who are obese, are smokers or who have a family history of blood clots. The estrogen in the birth control pill is the most likely culprit, increasing the production of clotting factors and increasing a woman’s risk of blood clots by three-to-four fold. Deficiencies of key nutrients can also contribute to an increased risk of blood clots, most notably vitamin B6, vitamin E and magnesium – all of which are depleted by the pill.

  1. Thin endometrial lining

The endometrial (or uterine) lining is necessary for a successful implantation and pregnancy. In women wanting to have a family, long term use of oral birth control pills could thin the endometrial lining, leading to difficulty conceiving or maintaining a pregnancy. The underlying cause of this change is thought to be a down-regulation of estrogen receptors in the uterus, resulting from long term use of synthetic progesterone. The upside to this situation, is that this same mechanism is thought to be the reason why the pill reduces the risk of endometrial cancer.

  1. No sex drive

Never mind a thin endometrial lining if you can’t get up the urge to have sex at all. Many women report a low libido as a major issue they have with taking the pill. The pill lowers androgens and the lowered testosterone is likely responsible for the lack of sex drive. Around ovulation women typically experience a small, but significant, testosterone surge, causing them to seek out sex. On the pill you don’t experience this testosterone surge and your urge for sex can all but dry up. On a positive note – this decrease in testosterone is the reason why the pill can improve acne. But there are other ways to clear acne than giving up your lusty libido.

  1. Ignoring Mr. Right

Some of the most intriguing research on the pill surrounds a woman’s decision making around possible partners. Women who are on the pill tend to be attracted to more masculine, macho men with more ‘manly’ physical characteristics, and ignore men with softer, more ‘feminine’ features. Dr. Julie Holland, in her book Moody Bitches, refers to this as the “dad-or-cad” dilemma – women on the pill are more likely to be attracted to the bad-boy, rather than the more sensitive man who may be more acceptable as a long term partner and father to her children. Dr. Holland suggests it might be a good idea to get off the pill if you’re entering the dating pool, to prevent later regrets!

As if that wasn’t enough, another study found that women on the pill tend to seek out men with more genetic similarities to themselves, increasing their risk of miscarriage and genetic issues in their offspring. Women off the pill tend to choose men that are more genetically dissimilar – a pairing that tends to result in healthy pregnancies, happier relationships, more satisfying sex, and an increased likelihood of female orgasm.

  1. Masks symptoms

One of my biggest concerns with the pill is that it is used by conventional doctors as a band-aid for every female reproductive issue. Got PCOS? Take the pill! Got endometriosis? Take the pill! Got fibroids? Take the pill! PMS or menstrual cramps? Take the pill! Perimenopausal? You get the pill too! In no way does the pill address the underlying issues of these women’s health issues. The pill just provides a steady state of synthetic hormones, suppressing and masking the symptoms of the underlying imbalance. When you get off the pill you are no better than when you started – but you are older. And if you want to try and start a family you still have to address the underlying imbalance. The use of the pill as a way to suppress and deny the imbalances in women’s hormones is a disservice to women and I deplore it.

  1. The pill is a carcinogen

Ok. I get it, this sounds scary. But it’s true. The International Agency for Research on Cancer includes oral birth control pills as a carcinogen on its list of known human carcinogens. Studies have shown that birth control pills can increase the risk of breast cancer, cervical cancer and liver cancer. It can reduce your risk of ovarian and endometrial cancers, however. In general I’d suggest using the pill for as short a duration as possible and consider other forms of contraception for the majority of your reproductive years.

We have to keep in mind that the pill is not without problems. It contains synthetic hormones at levels much higher than our body produces on its own. Some of the side effects like acne, breast tenderness, or moodiness might be manageable, but I think women need to be empowered with knowledge to decide if the pill is the right choice for them.

If you have concerns about using the pill, want to balance your hormones naturally, or discuss natural forms of non-hormonal contraception, book an appointment now. Your hormones are in your hands – strive for hormone harmony!

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.

 

Problems with Pill: Nutrient Depletion

Oh the pill.  Many of the women in my practice have a love-hate relationship with this medication.  Some of the things I commonly hear:

  • My skin looks better on the pill
  • I’ve been on the pill since I was a teenager and am scared to go off
  • The pill is treating my PCOS
  • I don’t want to be taking synthetic hormones but I don’t know what else to do
  • The pill makes me crazy every month
  • I’ve never really thought about the pill…

The most common thing I see is that women take the pill without ever really questioning it.  No doubt it is an incredible medicine, that had a huge impact on women and feminism.  But it is not the cure-all for women’s troubles that we are told it is.

In the article Problems with the Pill, I share some of the concerns that I, as a naturopathic doctor and women’s health expert, have regarding the pill. The purpose is not to convince you to give up the pill, but to empower you with information.  This article starts the conversation by looking at the nutrient deficiencies resulting from the pill.

Nutrient Deficiencies and the Pill 

Folic acid (folate)

Foliage (leafy greens), are the best source of folate

Since the ‘60s it has been consistently found that women taking the pill have lower levels of folate in their blood streams. Due to changes in folate metabolism and absorption, folate levels drop in women on the pill, and are lowest in women with longer use. Folate is necessary for DNA synthesis and cell division, and is essential for healthy development of a fetus (low levels can lead to neural tube defects and cleft palate.)

Vitamin B2 (riboflavin)

Riboflavin is an essential B vitamin, necessary for the production of energy, and the metabolism of fats and carbohydrates. Vitamin B2 is not stored in the body, so deficiency is common, and is worsened by the use of the pill.

(An interesting aside, supplementing vitamin B2 can be incredibly effective in managing headaches and migraines, a common side effect of the birth control pill.)

Vitamin B6 (pyridoxine)

A superstar B vitamin, vitamin B6 is needed for protein, fat and carbohydrate metabolism (turning food into muscles and energy – yes please!), it is also necessary for the production of our feel good neurotransmitter, serotonin. The drop in vitamin B6 levels in women on the pill is especially troubling because low B6 is associated with an increased risk of blood clots (a common side effect of the pill.)

Vitamin B12 (cobalamin)

Eggs are a source of vitamin B12

The last of the B vitamins depleted by the pill, vitamin B12 is essential for the production of energy in our mitochondria, for burning fat and carbohydrates as energy, and for healthy red blood cell production. B12 deficiency is even more of an issue in vegans and vegetarians, as the only food sources are from animals, or supplements.

Vitamin C

One of the most important antioxidants in our bodies, vitamin C is also essential for immune function, and preventing heavy metal toxicity. The estrogen found in the pill changes the rate of metabolism of vitamin C, leading to increased loss in the urine. A low intake of vitamin C (not getting your 8-10 servings of fruit and vegetables daily!) can make this problem much more serious. Taking a vitamin C while using an oral contraceptive may also reduce some of the cardiovascular risks associated with the pill.

Vitamin E

Not just one single vitamin, but a group of vitamins (the tocopherols), vitamin E is an antioxidant, with the special ability to be recycled and reused multiple times. It is also a fat-soluble antioxidant, meaning it can get into our cell membranes and protect them from damage. Low vitamin E levels can promote platelet clotting, increasing the risk of blood clots – again, a major concern for women on the pill.

Magnesium

Over 300 different enzyme systems use magnesium, including all the enzymes for energy production. Many of my patients also recognize the possible side effects of low magnesium levels – headaches, muscle cramps, restless legs, migraines, anxiety, and constipation. The pill can seriously reduce magnesium levels in the body, leading to imbalances in calcium and magnesium ratios, increasing the risk of blood clots (again!)

Selenium

Seeds are excellent sources of selenium

One of the most important nutrients for the thyroid, and for every cell that uses thyroid hormone (listen up ladies, 1 in 6 of you also has a thyroid dysfunction.) Deficiencies of selenium have been implicated in Hashimoto’s thyroiditis, as well as heart disease and cancer. The pill reduces the ability of the body to absorb selenium, and combined with the low selenium content of food grown in Ontario soils, this can be a serious issue in women’s health.

Zinc

The last of our nutrient depletions associated with the pill (I think that’s enough already!), zinc is incredibly important to our brain function (“no zinc, no think”), learning and memory. It is also involved in immune function, DNA metabolism and apoptosis (programmed cell death that, when it goes awry, can lead to cancer.)   We don’t know if the zinc depletion seen in women using the pill is due to changes in absorption, excretion, or increased demand, but since the 1960s we’ve known women taking the pill have lower zinc levels.

Next Steps…

A high quality multivitamin and mineral supplement may be enough to provide you with the nutrients you need while taking the pill.  However, all supplements are not created equal.  Speak to your Naturopathic Doctor about the appropriate form of nutrients and dosage for you.  And if you’re interested in working with me, book a meet-and-greet or initial consultation to get started on achieving your vibrant, amazing health.

Selected References

Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences. 2013;17:1804-1813.

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 Harmony in PMS

Welcome to the first installment of the “Hormone Harmony” series. In this series I’ll be exploring some of the most common states of female hormone imbalance, how your hormones can explain your symptoms, and some simple hormone hacks to help bring your body back into a state of hormone harmony.

Premenstrual Syndrome (PMS)

While a definition of PMS may not be necessary if you are reading this (it’s likely you’ve had first hand experience), I will try to give one that encompasses exactly what PMS is.

PMS is a recurrent set of physical and/or behavioural symptoms that occurs 7-14 days before a period and negatively impacts some aspect of a woman’s life

There have been over 150 (seriously!) symptoms of PMS identified. Some of the most common include:

  • Low energy
  • Mood changes – anger, crying, irritability, anxiety, depression, bitchiness
  • Food cravings
  • Headache
  • Low sex drive
  • Breast tenderness
  • Digestive upset – constipation, bloating, diarrhea, gas
  • Difficulty sleeping

Unfortunately we don’t really know what causes some women to experience PMS more than other women. But hormone imbalances are a common proposed cause, and in my practice I see balancing hormones as the most important means of decreasing symptoms of PMS.

Hormone Imbalances in PMS

The relationship between estrogen and progesterone is one of the most important hormone balances in a woman’s body. Imbalance in estrogen and progesterone levels is thought to be the primary cause of PMS.

Estrogen is produced throughout the month by the ovaries, adrenal glands and fat cells. It main action is growth – growth of breast tissue in puberty, and growth of the endometrial lining in the uterus during menstrual cycles.

Progesterone is produced during the second half of the menstrual cycle – after ovulation – by the ovaries.  Progesterone helps to balance the effects of estrogen and prepare the uterus for a possible pregnancy.

A too high estrogen level, or a too low progesterone level is thought to be the most likely cause of PMS symptoms in most women. This state, commonly called “estrogen dominance” is the most common hormone imbalance in women between the ages of 15 and 50. Estrogen dominance is becoming more common in North America due to increasing exposure to xenoestrogens (chemicals in our environment that mimic estrogen), high rates of obesity, decreased ability of our livers to detoxify and overwhelming amounts of stress.

The important thing to remember with PMS and hormone balance is that it is the relationship and balance of estrogen and progesterone that leads to symptoms. You may have normal levels of estrogen, but if your progesterone is low you will still experience symptoms. Progesterone levels are low in women who do not ovulate, and in those with significant stress (your body will convert progesterone into cortisol, leaving you deficient in much-needed progesterone).

Hormone Hacks for PMS

If you are a woman experiencing PMS, taking charge of your hormones and getting them into balance can make a huge difference in your quality of life. Below are some simple Hormone Hacks to get you started.

  1. Follow the PMS diet

There have been some significant findings in the diets of women who suffer from significant PMS. Compared to women who do not have PMS they eat 275% more sugar, 79% more dairy and 62% more refined carbohydrates. Avoiding these foods – and instead choosing fruits, vegetables, whole grains and healthy proteins – can diminish PMS symptoms significantly and promote healthy hormone balance.

  1. Cut the caffeine

No one wants to hear it, but drinking caffeine-containing beverages increases the severity of PMS. And those effects are worsened if you add sugar to your tea or coffee. So cut back, or cut it out all together if you want to decrease your PMS.

  1. Exercise

Women who exercise regularly have less PMS. Multiple studies have found this to be true, and the more frequently you exercise the better the boost. Exercise is known to decrease estrogen levels – so get out there and get moving.

  1. Get your nutrients in

Deficiencies in many nutrients have been found in women with PMS. Some notable ones include magnesium, vitamin B6, and zinc. All of these nutrients can be found in nuts and seeds – also known to be excellent sources of vegan protein.

  1. Get tested

Understanding your hormone imbalances can be incredibly valuable to managing symptoms like PMS. Testing your hormone levels will give you a clear understanding of what is happening in your body during a specific phase of your menstrual period. For PMS we test hormone levels (estrogen, progesterone and prolactin) about 7 days before your expected period.

  1. Herbal hormone balancers

There are some phenomenal hormone balancers in the world of herbal medicine. Vitex agnus-castus (also known as chaste berry) can improve progesterone levels, helping to balance estrogen dominance. Phytoestrogens, like those found in black cohosh, soy and flaxseeds, can also help to normalize estrogen levels by decreasing the action of our body’s own estrogen in favour of the milder estrogen signal from plant estrogens.

  1. Bioidentical progesterone

When all else fails in hormone balancing for PMS, your naturopathic doctor can prescribe low dose bioidentical progesterone in a cream that you can apply during the final weeks of your menstrual cycle. This will be helpful if your progesterone levels are low, or if your estrogen levels are high. Be sure your ND is qualified to prescribe bioidentical hormones, as additional training is required.

Don’t suffer with hormone imbalances like PMS.  You can achieve hormone harmony, and working with a Naturopathic Doctor can get you there.  Book an appointment, or a meet and greet now to find your personal 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.           

Acupuncture for IVF and IUI Cycles

The use of acupuncture as a supportive treatment for couples undergoing assisted reproductive therapies, including in vitro fertilization (IVF) and intrauterine insemination (IUI) is gaining in popularity, likely due to promising results in countless studies in the past 20 years.

Understanding how acupuncture can improve outcomes in IVF and IUI cycles can help you to decide if this treatment may be right for you.

A brief understanding of IVF and IUI

In vitro fertilization, or IVF is the process where a woman’s follicles are stimulated through medications to mature many follicles simultaneously. Once the majority of follicles are mature (17-20mm) they are retrieved and fertilized in a lab. These embryos grow for 3-5 days and are then transferred into the woman’s uterus (usually 1-2 at a time).

Intrauterine insemination will often also use medications to stimulate follicle growth, but the number of follicles is far fewer. The follicles develop within the woman’s ovaries and at ovulation the semen is inserted directly into the uterus and fertilization occurs within the body.

The success rates of IVF and IUI are variable. IVF alone is around 25-30% and IUI alone is around 13-20%. With acupuncture support, success rates can increase up to 40-60%.

How acupuncture benefits IVF and IUI cycles

Acupuncture has many benefits for improving outcomes (pregnancy rates and delivery rates) in IVF and IUI cycles. A 2002 study by Paulus and colleagues in Germany was one of the first to demonstrate an improvement in pregnancy rates with acupuncture in IVF cycles. The women receiving acupuncture had a 42.5% success rate, compared to 26.3% for those who did not receive acupuncture. Many more studies have since confirmed these findings, with impressive improvements in pregnancy and delivery rates.

Acupuncture is a very safe therapy, with relatively low costs and has no negative interactions with medications. Below I highlight some of the benefits acupuncture has on IVF and IUI cycles.

  1. Improved ovarian response

Acupuncture is based on traditional Eastern philosophies of meridians and acupuncture points. However, we now know that significant hormonal changes occur when we administer acupuncture to specific points in the body. Acupuncture impacts beta-endorphin levels, which in turn impact our production of reproductive hormones (notably GnRH, FSH, LH, estrogen and progesterone). Acupuncture can thus improve response of the ovaries to these hormones and optimize follicle development.

  1. Improved hormone balance

As mentioned above, acupuncture has a significant impact on hormone production and response. In IVF cycles where hormone-modulating medications are used, acupuncture can help the body to respond appropriately to medications, and minimize side effects.

  1. Improved egg (follicle) quality and quantity

Clinically acupuncture has been shown to positively influence the number and integrity of eggs released during IVF and IUI cycles – this may be due to increasing the blood supply to the developing follicles or by increasing the nutritional supply to the egg via the fluids that surround and nourish it.

  1. Improved blood flow to the uterus and increased rate of implantation

One of the most unique actions of acupuncture, increasing blood flow to the uterus can improve implantation rates and decrease rates of miscarriage. No medication currently exists that can enhance blood flow to the uterus the way acupuncture has been demonstrated to.

  1. Optimal endometrial thickness

In women with thin endometrial linings IVF can have higher rates of failure. Acupuncture can help to thicken the endometrial lining (through the enhancement of blood flow) and improve rates of implantation.

  1. Decrease rates of miscarriage

Acupuncture used during IVF results in higher rates of viable pregnancy. Additionally, acupuncture was found in a 2004 study by the American Society for Reproductive Medicine to lower miscarriage, reduce tubal pregnancy and increase live birth rate.

  1. Reduce stress

Stress is a major factor impacting most couples undergoing fertility treatments. Acupuncture treatments have been shown to decrease sympathetic nervous system activity (our fight-or-flight response), decrease stress hormone levels and increase opioid production – all resulting in a sense of calm and decreased stress.

Acupuncture treatments for IUI and IVF

Acupuncture treatments should be individualized to your IVF or IUI cycle, your personal medical history and current health state. For women undergoing IVF or IUI it is recommended in clinical studies to start having acupuncture 8-12 weeks (2-3 months) prior to your IUI or IVF procedure.

In my Toronto practices, I use acupuncture points selected based on clinically proven protocols (Paulus protocol, Stener-Victorin protocol, Westergaard protocol, Smith protocol), as well as points based on Traditional Chinese Medicine diagnoses and indications.

Success in acupuncture depends on more than just the frequency and timing of visits. It also requires a knowledgeable practitioner who can guide you through the process and help you achieve the benefits you desire. If you’d like to learn more, book a free meet and greet consultation or initial intake today.

References

Betts D. The Essential Guide to Acupuncture in Pregnancy and Childbirth. 2006.

Change, R, Chung P, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril. 2002 Dec:78(6)

Dieterle, S., et al. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 2006 May;85(5):1347- 51.

Gurfinkel E, et al. “Effects of acupuncture and moxa treatment in patients with semen abnormalities.” Asian J Androl. 2003 Dec;5(4):345-8.

Johnson D. “Acupuncture prior to and at embryo transfer in an assisted conception unit – a case series.” Acupunct Med. 2006:24(1):23-28.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002;77(4):721-4.

Stener-Victorin E, et al. “Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006 Dec;24(4):157-63. Review.

Westergaard. LG, et al. “Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial.” Fertil Steril. 2006 May;85(5):1341-6.

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.

 

 

 

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.