Wednesday, 18 October 2017

The Hormone Dance

Cramping. Bloating. Breast distention and tenderness. Irritability. Moody. Weepy. Cravings. Digestive Changes.

If I had to rate the concerns that bring people into my office, I think it would be a toss up between digestive issues and menstrual issues for the number one spot. Often times when I ask about menstrual cycle and any premenstrual symptoms I get the response 'Oh, the normal stuff.'

However, the truth is, though symptoms are common, they aren't normal. It's a pretty novel concept, I know, considering the fact that the majority of women have some sort of symptoms associated with menses.

The other response I get when I ask about cycle details is 'I don't know...' However, this is your body- get to know it and your cycle. I always recommend downloading a Period Tracker App which makes tracking everything much, much easier, and now a days, who doesn't have a smart phone.

Understanding your Menstrual Cycle

Image From SBI- 4U Website
When it comes to female hormones involved in menstruation, there are a couple key players- estrogen, progesterone, LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone), and each has it's own role to play in the menstrual cycle. There are other hormones that will affect menses- testosterone, cortisol, thyroid- to name a few but those are the big four and their levels and roles change throughout the cycle. The full cycle is also broken down into 3 phases.

Phase 1 is the Follicular Stage and includes the actual menstruation. This is like the prep stage where everything resets and starts again. During this stage estrogen and progesterone levels are at their lowest point which allows the endometrial lining (the uterine lining) to shed, this is menstruation. These low levels of estrogen and progesterone are detected in the brain (pituitary gland) and in response FSH and LH is released. FSH acts on the ovary to start producing follicles. As the ovary starts to mature follicles, estrogen, and to a lesser degree, progesterone start to be produced and begin to rise again.

Around Day 13, we enter Phase 2 which is known as Ovulation. This is the time when FSH peaks- follicle is fully developed, and LH peaks- this is what allows the egg to be released. Estrogen also hits it's peak and drops at this point. Once ovulation occurs, the remaining empty follicle, known as the corpus luteum (where the egg developed), starts to produce high amounts of progesterone and estrogen. 

Once ovulation occurs, we enter Phase 3- The Luteal Phase. During this time, the corpus luteum continues to release progesterone and estrogen. These rising hormones signal the body to start building up the uterine lining to accept a fertilized egg. If implantation occurs, the implanted egg begins to produce Hcg which signals the corpus leteum to continue producing estrogen and progesterone until the placenta takes over around 10 weeks. If implantation doesn't occur, the corpus luteum starts to break down, progesterone and estrogen begin to drop and the cycle starts all over again.

So Why The Symptoms?

The hormonal cascade that is the menstrual cycle is pretty amazing, it all works so intricately together however, because of those intricacies, throw off one thing, and everything gets a bit thrown off. 

Generally, when we are seeing Premenstrual Symptoms it's because estrogen and progesterone aren't balanced. Most symptoms are actually related to low levels of progesterone. However, it gets a bit more complicated as progesterone itself can be low OR estrogen can be too high which makes the progesterone low in relation to estrogen. If you check out the image above, what you will notice is that estrogen's main peak is before ovulation, however, after ovulation, during the luteal phase, estrogen has a second rise as the progesterone rises. It's this balance between estrogen and progesterone that will often lead to those common (though not normal) symptoms. This balance also affects the actual menstrual flow and symptoms and even ovulation.

Symptoms of low progesterone include breast tenderness, poor sleep, headaches, bloating and irritability.

Symptoms of high estrogen include mood swings, breast tenderness, cramping, heavy bleeding, bloating, water retention, insomnia, headaches and fatigue.

Notice how many of those symptoms actually overlap since both conditions have low progesterone, even if just relatively low. When hormones get way out of balance we can also see conditions things like PCOS and endometriosis being diagnosed. On the good side, knowing that it's an imbalance causing the symptoms, it means that we can rebalance things and this isn't 'just the way it is.' The trick it just figuring out what part of the system needs the boost.

Hormonal Imbalance What?

So, the next question is, why did these hormones shift out of balance anyway? There are actually a lot of things that can shift your hormones. 

Diet

This is often a major cause and I have a lot of surprised patients that come in after two weeks of diet changes amazed that their menses was completely shifted. Our food is what provides all the nutrients that our body needs to make our hormones. Did you know that hormones are made from cholesterol. Yup, it's true- guess what happens to our hormones when we follow these "anti-fat diet" fads or even
a vegan diet since the ONLY source of dietary cholesterol is animal sources. High sugars will also shift our hormones and add to the inflammation in our bodies. Dairy is naturally hormonally active, even if it's dairy raised without added hormones. Just like breastmilk has (beneficial) hormonal affects on babies, cow's milk has hormonal effects. These hormonal effects are great for calves, not so great for humans. Any individual food sensitivities can impede nutrient absorption and increase inflammation. Throw in the mix the Standard North American Diet (SAD) which is already high in refined, processed foods that lack nutritional density and we are peaked to have hormonal imbalances.

Stress

This is another epidemic of our time and can totally mess up our hormones. When we are under stress our adrenals produce cortisol and adrenaline. These days, we are constantly in sympathetic mode, always running from one place to the next, filling our plates to the brim and never stopping until we conk out at night exhausted. The problem is, cortisol not only increases our inflammation but progesterone is also a precursor to cortisol. Which means, as your body pumps out cortisol, your progesterone gets depleted. Ever notice that under a super stressful period, your menses is 'off.'

Detox Pathways

This can relate back to diet and needing a nutrient rich diet to provide all the building blocks needed for proper detoxification. However, the big player in hormone regulation is your Liver. This is where cholesterol is actually converted into our main hormone precursor which is then converted into all our specific hormones such as estrogen and progesterone. However, the liver can get backed up when it's constantly trying to keep up with the car exhaust we breathe, the chemical and pesticides we ingest, the chemicals in our personal care products we use every dang day and all the other things our bodies are constantly exposed to.

Sheer Overload

We are constantly bombarded with xenoestrogens. Plastics leach these into our foods. Chemicals in personal care products are huge endocrine disruptors and xenoestrogens. Did you know, the average female is exposed to over 100 different chemicals from personal care products every. single. morning. Even our drinking water has been shown to contain hormones. With the number of women currently on oral birth control pills (OCP), our water is actually showing detectable levels of these OCP hormones. These hormones are urinated out, which then enter our water system and our current filtration systems don't filter these out. And guess who gets to deal with all this....the liver.

This is why as a Naturopathic Doctor, we try to look at all the factors. Balancing out hormones isn't a one size fits all solution and is very multifactorial. 

Why Birth Control Pills Aren't the Answer

From an allopathic model, menstrual issues and concerns are treated with oral contraceptive pills or hormonal IUDs. Though this may 'stop' symptoms, it most definitely is NOT fixing the issue or making your hormones more balanced. Hormonal birth control methods work by giving you a constant dose of hormones which shuts off those feedback mechanisms to your brain that signal FSH and LH to be released (see that great chart above). By doing this, your ovaries aren't told to develop a follicle or release an egg. You still get the bleeding not because it is an actual menses, but because your body is going through hormone withdrawal. Of course, your body still tries to keep making it's own hormones which is why there is still kind of a cycle happening. But often, after time, the exogenous hormones build up so much in your system that even the withdrawal bleeding can stop. 
Though estrogen and progesterone might be the main hormones that run our menstrual cycle and reproduction, this isn't actually their only role. Females need progesterone and estrogen for muscle development, bone development, thyroid function, metabolism, mood, etc. No one would even tell a man that he only needs testosterone for reproduction, but we are very quick to ask females questions like "why are you so attached to your menses."

I see OCP as a necessary evil. On one hand they allow women great control over their reproduction decisions without having to rely on any one else. So I completely understand why women who are trying to avoid pregnancy are on OCP. However, as a means to fix hormonal imbalances, these aren't the answer and often lead to greater imbalances down the road. Even just being on OCP will deplete nutrients like B vitamins.

The female body and it's hormonal intricacies are pretty amazing when you see how everything works well together. Every process in our body has an effect on every other process. By looking at all the factors that may be affecting your menstrual cycle we are often able to tailor a treatment plan to help balance hormones and resolve all those symptoms that are too often thought to be 'normal.'

Disclaimer: The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. This information shouldn’t take the place of seeing a Naturopathic Doctor or your primary care provider for individualized health recommendations.


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