Dr. Sarah King, ND
Each woman’s experience with her period is different and unique. There are some of us that really connect to our cycles. We track them and take notice where we are in the moon cycle. We might have a deep love for our uterus; we may even be happy with or pleasantly welcome menstruation. And then there are others who dread each cycle. Perhaps planning out what those 3-7 days will look like. Do we need to take time off of work? Do we need to refill a pain medication prescription? What events are coming up that we might not be able to participate in due to menstrual symptoms.
In an ideal situation, menstruation shouldn’t be overly painful or hindering. Menstrual flow shouldn’t be so heavy that we can’t leave the house; That we have to sit or lay there changing pad after pad, hoping that we haven’t soaked through our clothes or bedsheets. But it happens to many women. Most of the time we pass it off as “normal,” this is just how menstruation is: heavy, painful, moody. We attribute PMS moodiness with “hormones” but we rarely address it as something we can change. Meanwhile relationships may take a little beating, or we need a day or two off from all social affairs so that we can prevent that inner rage from causing too much destruction. However, there are many tools and much information that we as women should share about how to possibly shift our hormones and change how we experience our cycles and even the days leading up to menstruation.
Menstrual or cyclical symptoms are often experienced as a result of a hormonal imbalance. Each of our hormones plays a role in physiological regulation, and we have receptors for these hormones everywhere in our body. Some even overlap in function; for example, we often link our metabolism to thyroid function and thyroid hormones, but the activation of estrogen receptors (specifically estrogen receptor alpha) can also influence metabolism and oppose adiposity1.
Hormones have their many individual roles, but they also influence each other and thus work on multiple systems. One example is progesterone: administering progesterone has been shown to increase levels of the thyroid hormone, T42. Increased levels of T4 and T3 may then cause a feedback loop, decreasing the amount of secreted thyroid stimulating hormone (TSH).
Presenting symptoms, both premenstrually and during menstruation, can help us to identify where these imbalances may lie. Similar fluxes can appear in perimenopause and thus common symptoms are linked to specific hormone imbalances. For instance, low progesterone can be found in both menstruating females and perimenopausal females, and the symptoms of low progesterone will be similar, if not the same, in both cases. These include breast tenderness, sleep disruptions, headaches, bloating and irritability3.
In hormone “dominance” pictures, we’re referring to the activity of a hormone relative to another hormone with similar or influencing effects. As with estrogen and progesterone, these two hormones function in cycles and both play major roles in menstruation and pregnancy. An “estrogen dominance” can present if estrogen levels and/or activation are high, but also if progesterone levels are low, or if progesterone receptors are down-regulated, relative to estrogen. Symptoms of this estrogen dominance include: mood swings, breast tenderness, cramping, heavy bleeding, bloating and water retention, insomnia, headaches, and fatigue3.
Estrogen dominance may occur due to altered metabolism of estrogen by the liver, high alcohol consumption, lower amounts of progesterone, and an increase in exogenous estrogens such as xenoestrogens or synthetic estrogens from the birth control pill.
Although less common, progesterone dominance is another hormonal possibility and could be the result of low estrogen, or from taking progesterone hormone therapy. Symptoms of a progesterone dominance include: depression, fatigue, and urinary incontinence3.
But estrogen and progesterone aren’t the only hormones that affect your menstrual cycle; thyroid function and cortisol levels have also been correlated with premenstrual symptoms. One study showed that compared to controls, women with premenstrual syndrome (PMS) had attenuated cortisol levels in response to stress4. Clinically, this suggests that we may improve hormone balance, and potentially PMS symptoms, treating the adrenal glands and supporting normal cortisol levels. Alternatively, by attending to other factors that influence PMS, we could conceivably support the adrenals and improve stress responses via supportive treatments for PMS, including regular yoga practice5.
When we look further at the body’s stress response from the adrenal glands, progesterone is a precursor to cortisol. As the demand for cortisol production increases from stress exposure, so does the need for additional progesterone to produce the cortisol. By managing cortisol levels and supporting the adrenal glands, we may alleviate PMS symptoms as well as those from excess or deficient cortisol levels. In this way, stress management plays a huge role in hormone balancing.
There are several different factors that can influence our hormonal regulation. One thing to keep in mind is that it can take time to see these changes, in many cases, up to three cycles of treatment. For medical interventions such as the birth control pill, changes may be seen much sooner as treatment involves taking low dose daily amounts of estrogen and/or progestins. However, it is common for patients taking hormone contraceptives to still experience the effects of hormone imbalances. Experiencing breast tenderness, bloating and cramping during your period while on a hormonal contraceptive is an indication that the dosing of estrogens and progestin in your contraceptive might not be the right dose for you. Too high or too low of a dose can cause symptoms, so it’s important to find your specific “normal”/asymptomatic range.
Botanical preparations, which do not act as hormones directly, help to influence the proper cyclical surges and responses (via receptor sites) of hormones. Botanicals such as Vitex agnus-castus (Chaste Tree), Actaea (cimicifuga) racemosa (Black Cohosh), Angelica sinensis (Dong quai), and Dioscorea spp. (Wild yam) have been used clinically to help modulate hormone regulation. Some of these effects include helping to initiate menstruation in prolonged cycles, regulating an irregular and unpredictable cycle, and helping to tonify the uterus to alleviate menorrhagia (heavy menstrual flow).
In cases of estrogen dominance, we look to add support for liver detoxification pathways as these control estrogen metabolism and the elimination of estrogen metabolites; As well, reducing our exposure to xenoestrogens such as parabens in body and hygiene products, and bisphenol A (BPA) in our plastics.
Lifestyle changes that support a healthy period
Weight management and dietary choices have a great impact on our hormones and the symptoms we experience. Including healthy fats in the diet helps to provide the essential fatty acids necessary to make cholesterol and its derivatives, progesterone, estrogen, testosterone and cortisol. Additionally, intake of healthy essential fats such as EPA and DHA has not only been shown to increase progesterone but it also reduces the risk of anovulation6. This supports natural progesterone secretion from the released follicle after ovulation, and improves fertility as it promotes normal ovulation.
Proper weight management also influences our hormones. As mentioned above, proper healthy fats are important to support normal ovulation. But when it concerns our body composition, women need to maintain a body fat percentage in the range of about 18%- 24%.7 Women who are underweight will often experience dysfunctional ovulation, or a lack of menstruation. On the other end of the spectrum, a higher body fat percentage may increase estrogen levels; increased adipose tissue can lead to increased aromatase activity, which converts testosterone into estrogen. This shift in estrogen and testosterone can greatly affect the sex drive, as decreased testosterone can cause a low libido.
Exercise and stress management, in addition to a healthy diet, are the pillars of good health. Hormone balancing can seem complicated because there are so many factors of influence, but the point is that there are many options to help find your specific balance. Life isn’t stagnant, we’re always faced with stressors, but we can help the body to adapt to these changes easier. Addressing the adrenal glands and stress, hormone use, and healthy dietary choices are just a few ways to promote hormonal health. With a proper assessment, a naturopathic doctor can help to identify these imbalances and help you to correct them for a happier period and perhaps dampened or eliminated PMS symptoms.
Dr. Sarah King is a licensed Naturopathic Doctor, graduating from the Canadian College of Naturopathic Medicine in 2014. Prior to completing her medical studies, she attended Nipissing University where she received her Honors Bachelor of Science in Biology. Sarah has a passion for women’s health and is a birth doula in Durham and Toronto Region. She treats a wide variety of health conditions including menstrual disorders and hormone balancing, fertility, prenatal care, digestive concerns, skincare and mental health/anxiety. Outside the office Sarah is an avid runner with a love of the GTA’s best forest trails. She also continues to improve her yoga practice and teaches breath work as part of stress management counselling to her patients.
1 Frank, A., Brown, L.M., and Glegg, D.J. “The role of hypothalamic estrogen receptors in metabolic regulation” (2014) Front Neuroendocrinol. 35(4): 550-557
2 Sathi, P., Kalyan, S., Hitchcock, C.L., et al. “Progesterone therapy increases free thyroxine levels — data from a randomized placebo-controlled 12-week hot flush trial” (2013) Clin Endocrinol. (Oxf). 79(2): 282-7
3 Turner, Natasha. The Hormone Diet: A 3-step Program to Help You Lose Weight, Gain Strength, and Live Younger Longer. New York: Rodale, 2010. Print.
4 Huang, Y., Zhou, R., Wu, M., et al. “Premenstrual syndrome is associated with blunted cortisol reactivity to the TSST” (2015) Stress. 18(2): 160-8
5 Bharati, M. “Comparing the effects of yoga and oral calcium administration in alleviating symptoms of premenstrual syndrome in medical undergraduates” (2016) J Caring Sci. 5(3): 179-185
6 Mumford, S.L., Chavarro, J.E., Zhang, C., et al. “Dietary fat intake and reproductive hormone concentrations and ovulation in regularly menstruating women” (2016) Am J Clin Nutr. 103(3): 868-77
7 Hudson, T. “Women’s Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine for Total Health and Wellness.” McGraw-Hill, 2008