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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/

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.