Disturbance of a woman’s hormonal cycle can play a major role in the development of various medical conditions. Women are affected both by their monthly hormonal cycle and by the hormonal phases associated with the life cycle of adolescence, maturity, pregnancy and childbirth, and menopause. Knowledge of these natural events is invaluable in understanding and treating a multitude of symptoms.
“A wide variety of symptoms and seemingly separate diseases can result from hormonal imbalance,” says Dr. Michael Wald. “This is where medicine gets confused because they think of hormones only in the narrow range of reproduction. Finally, we are hearing about cardiovascular connections. But there are many other subtle concerns. A loss of estrogen usage in the brain has been associated with dementia and even Alzheimer’s. A loss of progesterone usage in the gut is associated with various gastrointestinal symptoms. Chronic inflammation of tissues is a result of hormone imbalance in general. These look like different concerns. Fundamentally, there is hormone disruption.”
Among the common problems associated with hormonal imbalance are premenstrual syndrome (PMS), infertility, breast cancer, osteoporosis, heart disease, fibroids, endometriosis, memory loss, mood disorders, and hot flashes.
For more than 40 years, women have been led to believe that the best approach to hormonal imbalance, re-mineralization of the bones, and turning off hot flashes is synthetic estrogen replacement therapy. At any given time, ten million American women are using it. Now, according to the best scientific literature we have, about 14 percent have adverse effects. Those adverse effects include heart attacks, strokes, breast cancer, ovarian cancer, colorectal cancer, and dementia.
When you consider that we have no monitoring system whatsoever in the United States to determine if a person’s heart attack or stroke came from synthetic hormone replacement therapy, then we’re talking about numbers that could be in the multiple millions, and yet we don’t know. All we know is that a person is more likely to have an effect. The extent of that effect, again, has never been quantified.
Despite known risks, mainstream medicine continues to claim that synthetic hormones remain the most effective solution for the symptoms of menopause, while denigrating any form of natural hormone replacement therapy or rebalancing as nonsense, anecdotal, and quackery. Natural, or bioidentical, hormones are very similar to the ones that are made by the body, and therefore do not carry many of the risks associated with synthetics. However, their use is still a matter of debate, among conventional practitioners as well as in the alternative medicine community. (See chapter 43 for more discussion on the debate over bioidentical hormones).
As you will see in the sections below, hormones of any type are just one part of the solution for hormonal imbalance and not necessary for many women, as lifestyle changes, exercise, herbs, and supplements can often provide relief and restoration of health on their own.
Dr. Sherrill Sellman, a naturopath, psychotherapist, and author of the best-selling book Hormone Heresy, tells us that for the body to function properly, estrogen and progesterone have to be in balance. These hormones stimulate and help balance each other. One function of estrogen is to stimulate estrogen-sensitive tissues, which include cells in the breast, ovaries, and uterus. Estrogen helps develop the curviness of women. It produces their secondary sex characteristics. It is a very powerful stimulant of these tissues. Progesterone, on the other hand, helps slow down the growth of cells and stabilizes mature cells so that their growth doesn’t get out of hand. The proper relationship, as Nature designed it, is one of checks and balances.
“We are seeing a predominance of estrogen in relation to just a little proges-terone,” Dr. Sellman says. “That’s caused by the drugs and food we eat and the disharmony in our own bodies. It’s been noted that 50 percent of women over the age of thirty-five are not ovulating each month. Now, only if women are ovulating, releasing an egg, can a little endocrine gland called the corpus luteum, which is the primary source of progesterone, be formed on the surface of the ovary. If a woman doesn’t ovulate due to stress or bad diet, she can go a whole month without producing the progesterone to balance the estrogen. As a result, women are progesterone-deficient.”
Dolores Perri, a nutritionist from New York City, lists factors that can interfere with normal hormonal production and balance:
ALCOHOL—Alcohol blocks the body’s gamma linolenic acid (GLA) production, preventing the manufacture of natural hormones. This quickens the aging process. Alcohol creates deficiencies in B vitamins, magnesium, and calcium, which upset hormone balance. Further, alcohol damages the liver, which in turn interferes with hormone metabolism.
ANIMAL PROTEINS—Animal proteins are loaded with hormones and synthetic antibiotics that throw our own hormone levels out of balance.
BIRTH CONTROL PILLS—Birth control pills deplete the body’s B vitamins, which are needed for natural hormone production; increase susceptibility to allergies; and may cause liver damage, which can affect hormonal balance.
CAFFEINE—Caffeine is found in coffee, tea, chocolate, soft drinks, and certain medications. Like alcohol, it blocks GLA production. Chocolate inhibits the liver’s breakdown of hormones. Tea interferes with the absorption of iron and zinc, particularly if drunk with meals. Caffeine also raises adrenaline levels and increases stress.
EXERCISE—Professional athletes and women who train vigorously may use up so many vitamins and minerals that the body has insufficient means to maintain normal hormonal production. This can lead to an abnormal menstrual cycle and even the absence of menstruation altogether.
PHOSPHATES AND POLYPHOSPHATES—The phosphates and polyphosphates found in many food products—such as soft drinks, processed meats, and cheese—can interfere with the absorption of nutrients.
SMOKING—Cigarettes contribute to hormonal problems by increasing the need for vitamins and minerals to detoxify the poisons in tobacco smoke. This reduces the amount of nutrients available for hormone production.
STRESS—Stress is a major contributor to hormonal imbalance. Any type of adverse stimulus that requires the body to change and adapt, such as day-to-day hassles, psychological trauma, financial problems, and environmental pollution, can cause stress. External stress can cause hormones to decline, which puts stress on internal body systems. This further diminishes hormonal production and can interfere with immune function, which can lead to the development of allergies and autoimmune illnesses such as thyroiditis and lupus. Conversely, stress can create problems by causing the body to secrete too many hormones.
SUGAR—Sugar interferes with nutrient absorption, particularly of B vitamins. It also interferes with the circulation of hormones throughout the body.
WEIGHT PROBLEMS—Excess weight adversely affects hormonal balance. The ratio of fat-to-lean body mass is critical in the initiation and continuation of the ovarian cycle. Being too thin is equally undesirable. If you fall below a certain weight, the pituitary hormone stops sending messages to the ovaries, and ovulation and menstruation stop.
OTHER FACTORS—Other conditions that contribute to hormonal imbalance include food sensitivity, allergy, chronic illness, candidiasis, menstrual and gynecological problems, drugs taken over long periods of time, and low levels of thyroid hormone.
Dr. Elizabeth Vliet is founder of the Women’s Center for Health Enhancement and Renewal at All Saints’ Hospital in Fort Worth, Texas, and author of Screaming to Be Heard: Hormonal Connections Women Suspect and Doctors Ignore. She describes some of the conditions that hormonal imbalance can trigger and tells when they are likely to occur. “Women’s bodies are cyclic in their response to hormones. They have a monthly rhythm of hormonal changes from puberty to menopause, which have a critical bearing on many dimensions of health. Men’s bodies, on the other hand, have a tonic pattern of secretion, which means that the same amounts of key hormones are produced every day. They vary within twenty-four hours in terms of their hormone production. But basically each day is similar to the day before and the day after.
“For women, the first half of the menstrual cycle is dominated by a rise in ovarian estradiol. This is the primary estrogen that is active at receptor sites on all the cells in the brain and body, from puberty to menopause. This rise in estrogen allows the ovary to prepare the follicle that will become the egg released at ovulation.
“At ovulation, when the egg is released, the estradiol level drops briefly. The egg then takes over and produces progesterone for the second half of the cycle. Progesterone levels rise, and estrogen levels rise again, though not as high as in the first half of the menstrual cycle. Progesterone and estrogen drop prior to bleeding, when the egg is not fertilized. The body sheds the lining of the uterus and starts over.”
At this time there is also a decrease in certain critical brain neurotransmitters. “This is associated with mood changes women describe—feelings of irritability, insomnia, depression, or anxiety,” Dr. Vliet says. “This may be a time in the cycle when women get migraines. The drop in estrogen that triggers changes in serotonin, norepinephrine, and endorphins sets off a cascade of blood vessel spasms that are involved in migraine headaches. That also affects chemical messengers involved in regulating the immune system, the gastrointestinal tract, the heart, heart rate, blood vessels, and as many as 400 other functions.
“We also see hormonal connections in women who have the diffuse muscle aches of fibromyalgia. These women often develop aches, pains, and tender points after some type of hormonal change, such as postpartum or post–tubal ligation, or following a hysterectomy, even if the ovaries are left in place. We see this in menopause too. If we look at the patterns of this type of pain in women, we see that 80 percent of fibromyalgia patients are female, and that the average age when fibromyalgia appears is about forty-four or forty-five.”
Dr. Sherrill Sellman notes that infertility and miscarriage are both directly related to hormonal imbalance: an excess of estrogen and a deficiency of progesterone.
How does a woman know that she has a hormonal imbalance that requires some form of professional intervention? Dr. Sangeeta Pati, president and medical director of the Sajune Institute for Restorative and Regenerative Medicine in Orlando, Florida, who has been practicing both conventional and alternative medicine for over 20 years in the United States and abroad, helps us understand.
Hormonal fluctuations actually start early in life, she says. “Cortisol fluctuations start in our very early teens. When we have stressors, cortisol goes up. When the stressors go away, cortisol goes down. When we are in our teens, our reserve is high. If we’re in good shape, we recover well after the stressors are gone. What happens as we get into our late twenties and early thirties is that this reserve starts to dwindle.”
The first hormone that drops in young women is progesterone. “The main reason is because progesterone can feed the cortisol pathway,” Dr. Pati says. “When our adrenal gland becomes more deficient in making cortisol, we’re able to make up for it with progesterone. As the ovaries start to decline in production of progesterone, we start to feel the symptoms. The more stressors we have, the more nutritional depletion we have, the earlier we start to feel these symptoms.”
Among the symptoms of low progesterone are anxiety, irritability, mood swings, and the feeling of being overwhelmed. In addition, there may be sleep disturbances, mid-abdominal weight gain, and decreased sex drive. “Because progesterone is the hormone that stops proliferation of breast, uterine, and ovarian cells, we start to see all those cells proliferating and dividing,” Dr. Pati says. “There is more bleeding, breast cysts, and fibroids. As women continue with these symptoms, we see an increase in hysterectomies because of the bleeding, breast can-cers, and bone loss.”
The next hormone that declines is thyroid. “With nutrient deficiencies and toxicities, stress, and the inordinate amount of electromagnetic radiation that we’re being exposed to, we find thyroid dysfunction starts a lot earlier,” Dr. Pati says. Among the symptoms are low energy; less mental clarity; difficulty with memory, focus, and concentration; and depression. About 30 percent of people have weight gain. This number is important because many people assume that if they are not gaining weight, they must not have a thyroid issue. But only a third of people who have low thyroid will have the weight gain. Other symptoms include dry hair and skin, cold hands and feet, hair loss, constipation, and loss of motivation and joy in life.
After thyroid, testosterone starts to dip. This can cause changes in sexual function and sex drive, body composition, muscle to fat ratio, bone building, and blood flow to the frontal lobes of the brain. Cognition, memory, and mental clarity also decrease.
By the early fifties, women feel the decline of estrogen. Estrogen levels have actually been dropping since the age of twenty-five. “At some point, when you stop having the periods for a year because it’s low enough, we call it menopause,” Dr. Pati says, “but usually what women experience in the late forties and early fifties is a wild fluctuation of estrogen. It swings way up high and way down low, and way up high and way down low until, finally, we get to the point where the estradiol production stops all together. This is the point in time when one could consider using a bioidentical estradiol to support brain, bone, and heart.”
The final hormone to discuss in more depth is cortisol. “Cortisol is considered to be the life hormone,” Dr. Pati says. “It responds by increasing your blood pressure, when you are under stress. It mobilizes the body for the flight or fight response, and the body will, basically, shunt everything towards the cortisol system when there is an emergency. . . . Because all other hormones can make cortisol, when we are exposed to an inordinate amount of stress and the adrenal gland is not able to recover, we draw and shunt all the other hormones there. This is one of the reasons that we’re starting to see so many young women with premature ovarian failure. Partly because of nutrient deficiencies and partly because of toxicities but very much, also, because of the amount of stress that their bodies are undergoing, and the fact that all of the ovarian hormones shunt to the cortisol system.”
Symptoms include extreme fatigue, anxiety, hypervigilance, and being overwhelmed. Eventually there will be inflammatory diseases such as cancers, arthritis, diabetes, and heart disease. Because cortisol is responsible for keeping the body in an anti-inflamed state, there may be more allergies, psoriasis, eczema, gastric issues, salt cravings, and hypotension.
As mentioned above, synthetic hormone replacement therapy (HRT) was touted for decades as the number one conventional treatment for menopausal women with hormone imbalance. The situation changed in 2002, however, when the Women’s Health Initiative reported that Prempro, one of the main drugs being used, was linked to an increased risk of breast cancer, heart attacks, and stroke. Still, HRT using Premarin, Provera, or Prempro is often recommended.
Dr. Ericka Schwartz is among many practitioners who have been sounding the alarm on synthetic hormones for years. “I think we need to understand first of all what these synthetic hormones are about because once we understand them, commonsense tells us that there is no use to taking them because it’s just hurting ourselves.
“Conjugated estrogen, which is Premarin, is a toxic waste product of what the pregnant mare eliminates after she has used the hormones that she needs to sustain the fetus. It comes out of pregnant mare’s urine, hence the name Premarin. It contains 200 molecules of estrogen, of which only two or three are similar to the molecule of estrogen that our body makes when we’re young and healthy. The rest of them are foreign molecules that belong to the horse. What they will do is create reactions from the body because they’re foreign to the body. So you will have immune response reaction. You will have abscess formation. You will have cancer growth. You will have increased thickness of the blood, creating increased incidence of strokes, thrombophlebitis, and blood clots. You will create all these horrible side effects because they’re synthetic and they’re not recognized by the body as their own. So that’s what Premarin is about.
“A balance of Premarin is called Provera or Progestin, which has been created specifically to eliminate or negate the negative effects of Premarin on the uterus, which is increased uterine cancer. Progestin is supposed to be a kind of progesterone, but when you look at more of the formula it doesn’t look anything like natural progesterone, and it is purely a synthetic medication made to basically countermand the negative effects of another medication. So that’s the problem with synthetics. Why would anybody in their right mind prescribe them or take them?”
Alternative medicine practitioners use a variety of therapies to bring a woman’s body back into balance. Dr. Beth McDougall explains her approach. “I try to work with vitamins, minerals, essential fatty acids, amino acids, or bioidentical hormones that are native to the human body and to remove things that are foreign to the body, because all of the toxins that we’re exposed to in the environment or that come in the form of synthetic hormones or pharmaceutical medications tend to interrupt biochemical pathways and throw a woman’s body off balance.”
Dr. Vliet says women need to be aware of the relationship between hormonal cycles and medical conditions. “One of the ways to do that is to track patterns relative to cycles, and to test the blood for various hormones that women’s bodies produce. I’ve developed an approach to doing that by measuring the hormonal levels at the right time of the menstrual cycle. This helps women know what is happening to their hormone levels at the time that they are having symptoms. I become frustrated when doctors tell me that we don’t need to measure the female hormones because they vary. I respond that that’s the whole point. They do vary, and how they vary, relative to women experiencing problems, is what we must find out in order to offer them the most constructive options.”
Among the methods used by Dr. Michael Wald to measure hormone levels are blood tests, saliva tests, and urine tests. “When you put these three tests together in the context of the symptoms and the context of family history, you might really have something to go by,” he says.
It is also important to check thyroid function. Thyroid hormone controls progesterone, cholesterol, and the ovaries. It acts as a cascading system. When not functioning properly, other hormones get out of balance.
Dr. Sara Gottfried, a Harvard-trained medical doctor and gynecologist, and author of The Hormone Cure: Reclaim Balance, Sleep, Sex Drive and Vitality Naturally, designed a three-step protocol after her own battle with hormone imbalance in her mid-thirties. Step one is to address the nutritional gap that occurs, and to make relevant lifestyle changes. “In my situation I had high cortisol, and I learned my top five strategies for how to hit the pause button when it comes to stress, and how to create that gap between stimulus and response,” Dr. Gottfried says. Dietary changes included more green vegetables, green smoothies, low glycemic index fruits, and dark chocolate. She took supplements of phosphatidylserine and omega 3. Lifestyle changes included yoga.
Step two is to use proven botanical therapies. These have been used for thousands of years and have been shown to be effective in recent randomized trials. “In my case involving cortisol, the key botanical therapies that were effective included rhodiola, ashwagandha, and ginseng,” Dr. Gottfried says.
Step three is bioidentical hormones, but at the lowest doses and for the shortest duration. “It’s amazing to me how much power foods can actually balance your hormones, and I think a lot of people don’t realize that,” Dr. Gottfied says. “They think that they need a prescription for the latest bioidentical hormone, and it turns out that much of your hormone balance, actually, comes with your fork.
“I don’t think it’s a good idea to just go on a dose of bioidentical hormones and stay on that dose forever. I don’t think that’s the best thing for the body. What we know is that just like with insulin resistance when your cells become numb to insulin, you can also develop thyroid resistance. You can develop cortisol resistance or glucocorticoid resistance. You can develop estrogen resistance or progesterone resistance. I would rather that people be working more in the step one and the step two, with the lifestyle changes and the food choices and the way you eat, move, think and supplement.”
Lorna Vanderhaeghe, a medical journalist who has been researching nutrition for twenty-five years, agrees that not all women need hormones to adapt to change or imbalance. Lifestyle changes, rest, exercise, and supplements may be enough. If testing reveals that there is a need, she recommends estriol, a safe form of bioidentical estrogen, for women with thinning of the vaginal walls, vaginal dryness, recurring urinary tract infections, and painful intercourse. Progesterone along with melatonin and valerian is suggested for hormonal migraines and sleeplessness. Other useful substances include black cohosh, vitex, gamma oryzanol (from rice bran oil), and hesperdin (a flavonoid derived from citrus fruits).
The typical American diet is high in fat, protein, caffeine, simple sugars, and salt, ingredients that interfere with optimal hormonal balance. These foods create a vicious cycle. They fuel premenstrual cravings for sweets and chocolate, and giving in to them worsens the cravings.
“I like to see a woman doing a strictly whole foods diet and really trying to avoid manufactured food products,” says Dr. McDougall. “So you kind of shop around the perimeter of the grocery store. You’re spending most of your time in the produce section and then if you choose to eat animal products then you’re looking for free range, grass feed beef, organic poultry, and organic eggs. Ideally you should be getting those things from your local farmer. I really encourage women to add as many raw vegetables to the diet as possible. Not only do they have much greater nutritional value because a lot of vitamins are destroyed in the cooking process, they also have enzymes that are intact. Most foods contain myriads of enzymes that are destroyed in the cooking process, and these enzymes help you digest the food so that you can assimilate the nutrients better.”
Perri advises us not to reach for a prescription drug for hormonal problems. It is better to eat high-quality organic foods and avoid foods that throw the system off balance. Beans and legumes are better sources of protein than meats, which are loaded with hormones. In addition, Perri recommends cold-processed oils, nuts, seeds, fatty fish, and beans. “These foods are all very high in GLAs,” she notes. “The GLAs help us make natural estrogen in our own bodies.”
Nutrition should be individualized to meet each woman’s unique needs. According to Dr. Wald, nutrients are known as response modifiers. “Nutrients won’t sharply raise hormone levels. They won’t sharply diminish them. They help the body work better so hormone balance can be achieved as opposed to taking a synthetic/unnatural hormone, which will force it in one direction, which is almost never good.”
Dr. Schwartz has treated thousands of patients using natural hormones. “The natural, bioidentical hormones that I work with—which are FDA approved, prescription medications, with a molecular structure that’s exactly like the structure of the hormones that we make—are the ones that we need to keep us from getting old, to keep us from getting sick, and to prevent and eliminate symptoms of hormone imbalance: hot flashes, night sweats, PMS, insomnia, weight gain, sexual dysfunction.”
Wild yam and DHEA promote production of natural estrogens in the body, if the body needs them. If estrogen is not needed, these supplements are eliminated by the body, making them completely safe to use.
Dr. Wald recommends indole-3-carbinol (I3C). “You can eat indole-3carbinol in cruciferous vegetables like broccoli, cauliflower, brussels sprouts, and cabbage, but if you’re trying to deal with a hormone condition or really trying to prevent one, many of the studies I’ve read suggest that you need at least 150 milligrams of indole-3-carbinol daily. That’s equivalent to about two plates of cru-ciferous vegetables a day. Whether you do that consistently or not I think it’s a good idea to have some extra supplemental form of I3C. It has been proven to break down harmful estrogens.”
Melatonin has also been shown to restore hormonal function. Other beneficial nutrients are licorice or glycyrrhizin, which inhibits the binding of the “bad” estrogens to cells and does not interfere with “good” estrogens, and lignans, which are from flaxseeds. “Two to three teaspoons of ground flaxseed meal daily can really help balance the hormone levels,” Dr. Wald says.
In terms of vitamins, Dr. Wald suggests the following: vitamin C, vitamin E, and B vitamins. Magnesium and calcium may also be beneficial, since most women do not get enough of these nutrients.
Chasteberry, blue cohosh, black cohosh, and yarrow help balance hormone production. Other balance-promoting herbs include raspberry leaf, dong quai, wild yam, passion flower, and red clover.
Janet Zand, a naturopath, doctor of Oriental medicine, and acupuncturist, uses programs that rotate the herbs being used in accordance with the four weeks of the menstrual cycle. Herbs used during the first two weeks nourish blood and balance hormones; those used during the second two weeks clear the liver, which tends to become congested during these last two weeks.
In an article on the HealthWorld Online website (www.healthy.net), Zand recommends the following general herbal program for balancing the hormonal system and building general resistance.
FIRST TWO WEEKS—Combination of red raspberry leaf and dong quai, as a tablet, capsule, tea, or tincture, three times a day.
THIRD WEEK—Astragalus, American ginseng, or Chinese ginseng. These adaptogenic herbs tone the deep immune system. Take as a tablet, capsule, tea, or tincture, three times a day.
FOURTH WEEK—Combination of goldenseal and echinacea. These herbs have antiviral, antibacterial, and anti-inflammatory properties. Take as a tablet, capsule, tincture, or tea, three times a day.
Dr. Sherrill Sellman would add a Peruvian herb called maca. “It is wonderfully supportive of adrenal function, thyroid function, and ovarian function,” she says. “It helps with bones, and with a variety of health deficiencies.”