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Hormone Harmony during Breastfeeding

Going through my pregnancies with my two sons, and supporting hundreds of women in my practice through their pregnancies and beyond, I am always interested in the information that is given to pregnant women and what that says about what our society deems important.

Women going through pregnancy know a lot – they know what to eat, what to avoid, when their baby develops eyelashes (32 weeks) and what position to sleep in. They know how to track contractions, how often to breastfeed and the best positions for breastfeeding.

What women know very little about is what is happening in their own bodies. What the hormonal changes that occur during pregnancy, breastfeeding and the postnatal stage mean for their own energy, emotions and health.

This article is here to close that gap – to help women understand the hormonal changes that occur during breastfeeding and when that hormone balance is normal, and when to seek support when it is not.

Breastfeeding Hormones

Breastfeeding is associated with production of two specific hormones: prolactin and oxytocin. These two hormones allow for peak production of breastmilk as well as bonding with your new babe. Let’s look at each one in more detail.

Prolactin

Prolactin, or “pro-lactation hormone” is produced during breastfeeding to increase breast milk supply. Levels rise for almost an hour after the baby begins to feed, encouraging the alveoli in the breasts to make milk.

But that is not all prolactin does. In fact, not just breastfeeding parents produce it – all parents produce it. Prolactin is a calming and relaxing hormone that decreases progesterone and testosterone production in both parents. It can cause mothers to feel deep relaxation (and sometimes deep fatigue) during breastfeeding and for some time after.

Interestingly, prolactin is also released during sexual intimacy, counteracting the effects of dopamine (which is associated with sexual arousal) and resulting in a sensation of gratification and calm. With high circulating levels of prolactin during the breastfeeding stage, there is often less sex drive – your body feels like it’s already in the afterglow, and your libido is no where to be seen.

Oxytocin

Mostly commonly referred to as the “love hormone”, oxytocin is released to encourage let down during breastfeeding. Oxytocin increases bonding and is produced in both parents during cuddling and intimate contact – with both the baby and with each other. Oxytocin levels are highest during new relationships, such as with your brand new baby, and while baby is breastfeeding.

Most of the time we respond to oxytocin in positive ways – it feels good to be awash in these bonding hormones. But it isn’t this way for all women. Some women are very sensitive to such high levels of oxytocin and feel more anxious, irritable or overwhelmed while breastfeeding.

Women’s Hormones in Breastfeeding

It is no surprise that women’s hormones fluctuate a lot in the time after pregnancy – after all, those hormones that helped to sustain the pregnancy are now dropping off (quickly!) to pre-pregnancy levels. How a woman feels in the months, and years, after her baby is born has a lot to do with the balance of her hormones.

Estrogen

Estrogen levels can hit menopausal levels for the months after giving birth – and for some women they stay low throughout the time she is breastfeeding. Low estrogen levels can cause mood swings, irritability, hot flashes and night sweats as well as vaginal dryness, tenderness and discomfort during sexual intercourse. Low estrogen can also zap your desire for sexual intimacy (let alone how dry your lady garden is…) Using a water-based lubricant, and engaging in foreplay can help to overcome some of these low estrogen issues, but if the concern persists, talk to your ND about a low dose topical estriol cream.

Low estrogen can also contribute to an increased incidence of yeast infections, especially in women who are prone to them. If this happens, talk to your Naturopathic Doctor about treatments that are safe during breastfeeding.

Progesterone

Progesterone – “pro-gestation hormone” is at sky-high levels during pregnancy and it can feel like a rollercoaster free fall when you return to pre-pregnancy baselines in the weeks after delivery. Prolactin production suppresses ovulation, especially during the first six months after delivery, and with no ovulation progesterone production is incredibly low.

Symptoms of low progesterone can include anxiety, depression, mood swings, low libido, and insomnia. Many clinicians believe that low progesterone is a contributing factor to the development of post-partum depression in some women. There are many available treatments for post-partum depression, if you are concerned that you may have PPD, talk to your Naturopathic Doctor right away.

Testosterone

Produced mainly by the ovaries, but also in the adrenal glands, testosterone levels are also low in breastfeeding women. Testosterone can contribute to sexual desire, as well as sexual response. Low levels can impact mood, focus and libido.

Beyond Hormones

The months after giving birth are a challenging time for everyone. My take home message here is that while lack of sleep, and an exhausting schedule are huge factors in the way women feel during the months and years of breastfeeding, there are also hormonal influences at play that need to be considered.

If you have been feeling off, feeling exhausted, or have mood swings or low moods don’t just attribute it to the busy-ness of having a baby – talk to someone about how you can support your hormones and restore your hormone harmony throughout breastfeeding.

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.

150 Symptoms of PMS

With 3 out of 4 women experiencing some symptoms of premenstrual syndrome, most of us can come up with a pretty good list of symptoms for ourselves. But did you know that 150 symptoms have been identified? That’s a pretty substantial number!

Ranging from mild bloating to severe mood changes and migraines, and everything in between, PMS can seriously impact a woman’s mood, quality of life, and relationships.

And remember, you don’t just have to accept PMS. You can manage it and treat it effectively. But that’s in another article. This one is The 150 Symptoms of PMS.

Digestive Symptoms

  1. Bloating
  2. Weight gain
  3. Constipation
  4. Diarrhea
  5. Nausea
  6. Vomiting
  7. Gas
  8. Cravings for salt
  9. Cravings for sweets
  10. Cravings for alcohol
  11. Increased appetite
  12. Decreased appetite
  13. Increased sensitivity to alcohol
  14. Increased sensitivity to taste/ spices/ flavour
  15. Increased thirst

Physical Symptoms

  1. Fatigue
  2. Water retention and swelling
  3. Increased sweating
  4. Night sweats
  5. Hot flashes
  6. Fatigue
  7. Increased sleep hours/ desire for sleep
  8. Clumsiness
  9. Easy bruising
  10. Increased heart rate
  11. Irregular heart beat
  12. Increased sensitivity to light
  13. Increased sensitivity to sound
  14. Increased sensitivity to touch
  15. Increased sensitivity to chemicals
  16. Seizures

Ear, Nose, Throat and Head

  1. Tinnitus (ringing in the ears)
  2. Dizziness
  3. Lightheadedness
  4. Headaches
  5. Migraines
  6. Cold sore outbreaks
  7. Puffy eyes
  8. Blurred vision
  9. Hordeolum (eye stye)
  10. Dry mouth
  11. Rhinitis (runny nose)
  12. Worsening of allergy symptoms
  13. Increased sensitivity to odours

Respiratory System

  1. Shortness of breath
  2. Worsening of asthma
  3. Sore throat
  4. Sensation of lump in throat
  5. Hoarse voice

Muscles, Bones and Joints

  1. Back pain
  2. Leg pain
  3. Joint pain or worsening arthritis
  4. Muscle weakness
  5. Muscle stiffness

Lady Garden Symptoms

  1. More frequent urination
  2. More frequent yeast infections
  3. More frequent urinary tract infections
  4. More frequent HSV outbreaks
  5. Dry vaginal tract
  6. Painful intercourse

Breast Symptoms

  1. Breast tenderness
  2. Breast swelling
  3. Increase in breast size

Skin Symptoms

  1. Acne
  2. Dry skin
  3. Oily skin
  4. Oily scalp
  5. Increased sweating
  6. Swelling of face or extremities
  7. Worsening of rosacea
  8. Worsening of eczema
  9. Worsening of psoriasis

Mood and Emotional Symptoms

  1. Increased libido
  2. Decreased libido
  3. Poor decision making
  4. Eating disorders
  5. Anger
  6. Aggression
  7. Irritation
  8. Forgetfulness
  9. Indecisiveness
  10. Poor concentration
  11. Brain fog
  12. Inability to think clearly
  13. Poor learning, less able to retain information
  14. Lack of motivation
  15. Increased sensitivity
  16. Avoidance of social interaction
  17. Avoidance of responsibilities
  18. Withdrawn
  19. Confusion
  20. Excitability
  21. Mood swings
  22. Restlessness
  23. Hopelessness
  24. Anxiety
  25. Depression
  26. Loneliness
  27. Guilt
  28. Apathy
  29. Poor self esteem
  30. Reduced confidence
  31. Jealousy
  32. Paranoia
  33. Fearfulness
  34. Tension
  35. Poor coping
  36. Inability to relax
  37. Feeling keyed up or on edge
  38. Sadness
  39. Suicidal thoughts
  40. Frequent outbursts
  41. Sudden outbursts
  42. Feeling overwhelmed
  43. Feeling out of control
  44. Difficulty controlling anger or sadness
  45. Crying
  46. Melancholy
  47. Defensiveness
  48. Stubbornness
  49. Negative outlook
  50. More easily offended
  51. More easily hurt or upset
  52. Lack of coordination
  53. Intentional self harm
  54. Increased addictive behaviours (shopping, drugs, alcohol)
  55. Increased productivity
  56. Decreased productivity
  57. Hypersomnia
  58. Insomnia
  59. Lack of pleasure in life
  60. Worsening of pre-existing mental health concerns
  61. Possible increase in criminal behaviour

Well, try as I might, I could only find 133 symptoms of PMS.  To be considered a PMS symptom, it must have the following characteristics:

  1. Restricted to the luteal phase (second half) of the menstrual cycle
  2. Resolve by the four day of the next cycle (fourth day of the period)
  3. Cause impairment or distress for the woman
  4. Occur in at least two cycles
  5. Not be an exacerbation of another condition

Can you think of any PMS symptoms I may have missed? Were you surprised by any of the symptoms on here? Let me know in the comments below!

 

DUTCH test, hormone testing,hormone test, women's hormones, hormone health

DUTCH: Gold Standard in Hormone Testing

In my work with women’s health and hormones, one of the biggest areas of debate is hormone testing. Women are confused about when and how to test their hormones, and if I’m honest, a lot of doctors are confused as well. Which is leaving women under-diagnosed and under-treated for their very real (and very annoying) hormone imbalances.

But no more. Science has come a long way and right now we have the ability to test for hormones in ways that we never have been able to before. And women everywhere can benefit. So if you’ve ever wondered, “Do I have a hormone imbalance?”, now we can easily answer that question.

The DUTCH Test

Hormone testing with the DUTCH testDUTCH is an acronym that stands for Dried Urine Test for Comprehensive Hormones. It is a simple, but sophisticated test that looks not just at your hormones, but how your body processes and metabolizes them.

The DUTCH test looks not just at your reproductive hormones (although it does look at those quite thoroughly), but it also looks at your stress hormones, your androgens (male pattern hormones), your melatonin and the new DUTCH test also looks at organic acids – markers for mood and nutritional balance in the body.

8 Reasons the DUTCH Test is the Gold Standard for Hormone Testing

  1. Simple collection

Nothing is easier than peeing on a piece of filter paper. (Ok… some people might get a little pee on themselves, but still… is that the worst thing that can happen to you today?)

  1. In depth hormone levels

If you have a question about your hormones, the answer is likely to be found in the DUTCH test. While your Naturopathic Doctor may still recommend blood testing for hormones like thyroid hormone, FSH or LH, just about every other hormone is covered in the DUTCH test.

  1. Metabolism matters

Hands down, the reason the DUTCH test is the best, is that it measures metabolites. The absolute level of your hormones matter – but what can matter more is what your body does with those hormones. This is metabolism – does your body turn testosterone into nasty acne-promoting 5a-DHT?? Does your body turn estradiol into DNA damaging 4-OH estrone? Are you healthfully metabolizing and eliminating estrogen from your body? The DUTCH test can tell you.

  1. It’s all about those curves

Not every hormone has stable levels over the entire day. In particular, our primary stress hormone, cortisol, and its metabolite cortisone, have a curve that changes over the course of the day. Blood tests only give us a single snapshot of your cortisol levels, but the dried urine test gives us not only the total levels of cortisol and cortisone, but also the curve – how those levels change over the day. This is some VALUABLE information for people who are struggling with stress, fatigue, anxiety, decreased libido, trouble sleeping and insomnia.

  1. Balanced estrogen

Estrogen is one of the most important hormones in our bodies, and it has so many benefits for our health, but it can also have negative impacts if it is not in balance.

Typical hormone testing for estrogen looks just at estradiol, the dominant estrogen in the body. But that only tells us such a small bit of information. If we want to balance our estrogen, and prevent complications of estrogen dominance, then we want to understand how our body copes with our burden of estrogen. What metabolism pathways does our body use? Are those the best pathways?

If you are considering bioidentical hormones (BHRT) for perimenopause, or menopause symptoms, then the DUTCH test is highly recommended at the initial visit to understand how you will metabolize the hormones.

  1. Androgens and acne and hair health

In my work with women, no one condition is more loathed or baffling than acne. WTF, am I right ladies? How did we reach our 30s and still have to deal with acne?? Often it’s an issue of androgen metabolism. But typical hormone testing just looks at the amount of testosterone being made, and not what your body is doing with it. If your body is sending more testosterone towards the DHT metabolites, you will have more acne and possibly hair loss (and chin/ upper lip hair growth!) The DUTCH test will tell you if this is happening – and then we can talk about what to do about it!

  1. Melatonin

If you are having difficulty sleeping, knowing your melatonin levels is amazing information to have. But not only those with insomnia or sleep challenges should know their melatonin levels. Melatonin is also a powerful antioxidant in our bodies, and optimal levels of melatonin have been found to reduce the incidence of hormonal cancers (including breast cancer). No other hormone test looks at melatonin, but the DUTCH test does.

  1. Organic acids

Natural treatments and testing for depression and anxietyA new addition in 2018 to the DUTCH test is the 6 OAT (organic acid tests). I’m so excited for this new information!

Three new markers for neurotransmitters – to help us understand your mood. If you struggle with depression, anxiety or insomnia, this information can be very significant. If you have tried antidepressants without benefit, your organic acid markers for specific neurotransmitters, like serotonin, may tell you why.

Additionally there are three new markers for nutritional levels – looking at your B6 and B12 metabolism as well as your glutathione status. If you are concerned about weight gain or inflammation as part of your hormone imbalance, now we may be able to identify why.

The 1 Reason I don’t love DUTCH Testing

  1. The test results are ugly

I know. Such an aesthetic issue. But the test results are ugly – seriously. The results are clear. The information is valuable. But the results look a lot like a airplane dashboard, and some patients find this overwhelming. So take the time to talk through the results with your ND to understand what they mean for you.

Toronto, naturopath, doctor, naturopathic doctor, holistic, functional doctor

Next Steps

If you are interested in DUTCH testing, I suggest booking a 15 minute complimentary meet and greet to discuss the details. It is an amazing, useful, sophisticated test. But it’s not the right test for everyone. So let’s talk and see if it is the right test for you.

Dr. Lisa

Further Reading

https://dutchtest.com

https://articles.mercola.com/sites/articles/archive/2016/05/08/dutch-hormone-test.aspx

 

When it’s NOT PCOS: Non-Classic Congenital Adrenal Hyperplasia

A woman, let’s call her Nicole, enters my office with a concern of acne. Acne in an adult woman is, unfortunately, not uncommon these days. After spending some time talking to Nicole we find that she also has hair loss from her scalp, and hair growth on her chin as well as irregular periods.

If you’re familiar with PCOS you may recognize these as the most common symptoms of PCOS – irregular (or absent periods), acne and hair growth on the face or hair loss from the scalp.

But it wasn’t PCOS for Nicole. It was something else.

Non-Classic Congenital Adrenal Hyperplasia

Non-classic congenital adrenal hyperplasia (NCAH) is a condition that usually develops around the age of puberty and can impact both boys and girls (this article is just about the girls – sorry guys!)

NCAH is an inherited condition where a person does not make enough of a specific enzyme, 21-hydroxylase, that converts the hormone progesterone into cortisol. When this enzyme doesn’t work more progesterone is shifted into testosterone and levels of testosterone and other androgens increase.

Why Does NCAH Look Like PCOS?

Both PCOS and NCAH have symptoms that are the result of high androgens – testosterone, androstenedione, and dihydrotestosterone. However, the source of the high androgens is different.

In PCOS the elevated androgens come from overstimulation of the ovaries by follicle stimulating hormone (FSH), without the corresponding ovulation – leading the ovaries to continue to produce large amounts of testosterone over time.

In NCAH, the testosterone comes from the conversion of progesterone (and 17-OH progesterone) into androstenedione and subsequently testosterone.

In either case, high testosterone in a woman leads to oily skin, acne, facial hair, and scalp hair loss. Not such a pretty picture.

So, is my PCOS actually NCAH??

There are some warning signs that your PCOS may actually be NCAH.

  • Did your puberty start early – before 10 years of age? Or was it significantly delayed – after 15 years of age?
  • Did you have premature development of pubic or underarm hair?
  • Are you shorter than average height for an adult?

All of these findings are more common in NCAH than in PCOS.

But ultimately the diagnosis of NCAH requires a blood test.

17-OH Progesterone Testing

The first test for non-classic congenital adrenal hyperplasia is a 17-OH progesterone test. If your levels of this test are elevated, then you most likely have NCAH. While this test is routinely done in newborns, the non-classic variant can be missed until puberty.

If the 17-OH test is positive then a follow up test, known as the ACTH stimulation test, is done to confirm the diagnosis.

As NCAH is the most common autosomal recessive disorder in humans (you have to have two mutated copies of the gene to get this condition) – impacting around 1 in 100 people, this test is highly recommended if you have PCOS – especially if you don’t seem to fit the typical PCOS picture.

Moving Forward

NCAH, for some women, causes little to no difficulty. Other women have issues with abnormal hair growth/ hair loss or acne that can be difficult to treat. Other women have issues with infertility. It is a variable condition. Talk to your Naturopathic Doctor or Medical Doctor if you think your PCOS may actually be NCAH, and learn about your diagnosis and treatment options.

 

PCOS Types

Syndrome of PCOS

Polycystic ovarian syndrome (PCOS) is condition impacting up to 1 in 10 women in North America. PCOS is a “syndrome” – a medical term for a condition that can have different symptoms in different people. In PCOS we can see a wide variety of presentations. Some women have many symptoms, while others have few. Some of the symptoms that can present in PCOS are:

  • Irregular periods
  • Long time between periods (prolonged cycles)
  • Infertility
  • Hair growth where you don’t want hair (chin, upper lip, neck, chest, back, breasts, buttocks)
  • Hair loss where you do want hair (scalp)
  • Weight gain
  • Oily skin
  • Acne

Diagnosis of PCOS

Ultimately the diagnosis of PCOS is based on the Rotterdam criteria – you must have 2 of the 3 criteria (irregular periods, cysts on your ovaries, signs or laboratory evidence of elevated androgens) to be diagnosed. To learn more about diagnosis, read this article by Dr. Lisa on PCOS Diagnosis.

As a Naturopathic Doctor I think we should move beyond mere diagnosis, and really get to the underlying causes of PCOS. And this is where the PCOS Types come into play.

Types of PCOS

Type 1: Insulin-Resistant PCOS

The classic presentation of PCOS – a woman experiencing weight gain, irregular or no periods, acne and facial hair – is represented by Type 1 PCOS, a condition associated with insulin resistance. The lack of response of the ovaries to insulin leads to a hormonal cascade that results in increased testosterone levels, the underlying cause of those unfortunate symptoms.

Women with insulin resistant PCOS have an increased risk of developing diabetes and depression – two other conditions associated with insulin resistance.

Treatment for insulin resistant PCOS involves improving the body’s response to insulin. Supplements such as inositol, chromium and cinnamon can be helpful. Spearmint tea can help to decrease testosterone levels and reduce facial hair growth and acne.

Weight optimization and following the PCOS Diet can also be part of this process. However, please keep in mind that not all women with insulin resistant PCOS are overweight. Slender women can also have insulin resistance as a result of their diet.

Type 2 PCOS: Non-Insulin Resistant PCOS

What once was a rare occurrence, I am now seeing many more women in my practice with non-insulin resistant PCOS. This can be caused by a number of different causes including:

  • Inflammation
  • Immune system challenges (including autoimmune diseases)
  • Vitamin D deficiency
  • Iodine deficiency
  • Thyroid hormone imbalance
  • Stress
  • Low dose chronic environmental exposures
  • Discontinuation of the birth control pill
  • A diet inconsistent with your body’s individual biochemistry

This type of PCOS requires more investigation and understanding that the classic insulin-resistant PCOS. Often I will run more extensive blood work than is typically offered to a woman with PCOS. Depending on the woman I may look at nutritional levels, hormone balance (prolactin, thyroid, LH, progesterone, cortisol, DHEA, testosterone), autoimmune antibodies, inflammatory markers, and food sensitivity testing.

The approach to managing non-insulin resistant PCOS is a personalized medical approach. It is essential that we uncover the root cause of the PCOS and address it directly with an approach that encourages balance and optimum function. Often women respond quickly once the cause has been identified and balance is restored.

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.