• What are peptides?
• Are they safe?
• How can they benefit my health?
• Where can I get them?

You can find answers to all of these questions and more in today’s article.

What Is Peptide Therapy?

Peptide therapy is a medical treatment that uses specific peptides—short chains of amino acids naturally found in the body—to target and enhance various biological functions. By mimicking or influencing natural processes, peptide therapy offers the potential to support a wide range of health goals, including improved skin health and slowed aging, accelerated injury recovery, boosted muscle growth, enhanced fat metabolism, regulated hormones, a strengthened immune system, and improved sexual function. Because peptides are highly targeted and generally well-tolerated, this form of therapy is often used in functional and regenerative medicine to promote healing, performance, and overall wellness.

The peptide therapy that has gained the most notoriety (and controversy) in recent years is the class of peptides known as GLP-1 agonist drugs. These drugs contain the active ingredient, Semaglutide, which is a peptide that looks and acts similarly to the body’s own GLP-1, and brings about many similar effects, like blood sugar control and satiety in appetite.

Other peptides provide similar mimicking effects, though they don’t all act like GLP-1. Instead, other peptides impact a wide variety of biological functions. For this reason, it’s important to remember that peptide therapy cannot be used to affect just one single function of the human body. Because these peptides affect so many other areas of the body, just like how GLP-1 affects both blood sugar and appetite, it’s impossible to isolate just one effect of a given peptide.

Many peptides are very early in their research timeline, meaning that there is very limited data available about their safety, and even how they work in the body. We may have identified some applications for use, such as one particular parameter of health (i.e. muscle recovery for BPC-157) but we have yet to understand fully how this peptide affects the other bodily systems. This is particularly the reason that peptides, especially Ozempic and other drugs akin to semaglutide that have gained notoriety, are so controversial. There’s just a lot that we still don’t know, and might never know.

However, particularly in circumstances where few good options exist, peptide therapy might prove to be one of the best options out there. Let’s discuss how peptide therapy can offer benefits, in spite of some of the potential risks.

How Can Peptide Therapy Benefit Health?

Peptide therapy can be applied across a wide range of health and wellness areas, with specific peptides targeting different physiological systems.

Anti-Aging Peptide Therapy

In the area of anti-aging and longevity, peptides such as CJC-1295, Ipamorelin, Sermorelin, collagen peptides, IGF-1, and Thymosin Beta-4 (TB-500) help boost growth hormone levels, improve skin elasticity, enhance energy, support deeper sleep, and promote overall cellular repair and regeneration.

Peptide Therapy for Sports and Recovery

For sports medicine and injury recovery, peptides like BPC-157, Thymosin Beta-4, IGF-1, GHRP-2, GHRP-6, and Hexarelin are used to accelerate healing from injuries, reduce inflammation, regenerate muscle and connective tissue, and support faster recovery times. In the context of weight management and metabolism, peptides such as AOD 9604, CJC-1295, Ipamorelin, and Carterine (GW-501516) play a role in stimulating fat breakdown, increasing metabolic rate, enhancing lean muscle retention, and improving energy levels during fat loss efforts.

Peptide Therapy for The Immune System

For immune system support and inflammation reduction, peptides like Thymosin Alpha-1 (TA1), BPC-157, and vasoactive intestinal peptide (VIP) help strengthen the immune response, reduce systemic inflammation, and support healing, especially in autoimmune or inflammatory conditions. In the area of sexual health and hormone support, PT-141 (Bremelanotide), Kisspeptin, and Gonadorelin are used to enhance libido, improve erectile function, and regulate reproductive hormones, making them useful for both sexual performance and fertility.

Peptide Therapy for Muscle Growth

Lastly, for muscle growth and performance enhancement, peptides such as Follistatin, IGF-1, GHRP-6, GHRP-2, Hexarelin, and Carterine are employed to promote muscle hypertrophy, increase strength, enhance endurance, and inhibit myostatin—a natural limiter of muscle growth. Collectively, these peptides offer a broad therapeutic toolkit for improving physical health, performance, recovery, and overall vitality.

Which Types of Conditions Benefit from Peptide Therapy?

Neurological & Cognitive Disorders

• Cognitive decline / brain fog
• Alzheimer’s disease / dementia (e.g., Cerebrolysin)
• Depression & anxiety (via BDNF-related peptides or ones that support neurotransmitter balance)
• Traumatic brain injury (TBI)

Peptides like Dihexa, Selank, and Semax are neuroprotective and enhance focus, memory, and mood.

Musculoskeletal & Injury Recovery

• Tendon, ligament, and joint injuries
• Osteoarthritis
• Post-surgical healing
• Muscle recovery & growth

Common peptides: BPC-157, TB-500 (Thymosin Beta-4) – promote tissue repair, angiogenesis, and reduce inflammation.

Anti-Aging & Longevity

• Decreased growth hormone production
• Fatigue / low energy
• Wrinkles, thinning skin

Peptides like Ipamorelin, CJC-1295, and GHRH analogs stimulate natural growth hormone production.

Metabolic & Weight-Related Disorders

• Obesity / weight gain
• Insulin resistance / Type 2 diabetes
• Low energy

Peptides: GLP-1 agonists (e.g., Semaglutide, Tirzepatide), AOD-9604 for fat loss, Motilin agonists for digestion.

Hormonal Imbalances

• Low testosterone / estrogen / thyroid
• Adrenal fatigue
• Sexual dysfunction

Peptides can modulate LH/FSH, improve libido, and optimize endocrine system. Example: Kisspeptin-10 for LH/FSH stimulation.

Immune System Modulation

• Autoimmune diseases
• Chronic inflammation
• Recurrent infections

Peptides like Thymosin Alpha-1 and Thymosin Beta-4 support immune regulation and antiviral defense.

Skin, Hair & Aesthetic Applications

• Hair loss (androgenic alopecia)
• Skin aging / damage
• Scarring

Peptides like GHK-Cu (copper peptide), Melanotan II (for tanning, though there are many documented risks), and others are used cosmetically.

Sleep Disorders

• Insomnia
• Poor sleep quality

Peptides such as DSIP (Delta Sleep-Inducing Peptide) are being explored for sleep enhancement, and even has clinical utility in management of withdrawal from alcohol and opiates.

What Are Some Types of Peptide Therapy?

Here’s a list of some common peptides used in peptide therapy and their potential benefits:

1. Growth Hormone-Releasing Peptides (GHRPs)

• GHRP-2 / GHRP-6 / Ipamorelin: These peptides stimulate the release of growth hormone (GH) from the pituitary gland, which can help improve muscle growth, fat loss, and recovery.
  • Benefits: Increased muscle mass, fat reduction, better recovery, enhanced energy.

2. CJC-1295 (Modified GRF 1-29)

• A synthetic peptide that stimulates the release of growth hormone by enhancing the action of ghrelin.
  • Benefits: Increased muscle mass, fat loss, improved skin elasticity, enhanced sleep quality.

3. BPC-157 (Body Protective Compound-157)

• A peptide that promotes healing and tissue repair. It’s often used for injury recovery.
  • Benefits: Accelerates wound healing, reduces inflammation, improves joint health, and promotes tendon and ligament recovery.

4. Thymosin Beta-4 (TB-500)

• A peptide that plays a role in tissue repair and regeneration.
  • Benefits: Accelerates healing of wounds and injuries, especially related to muscles, tendons, and ligaments. Helps with inflammation and scar tissue reduction.

5. Melanotan II

• A peptide that stimulates the production of melanin in the skin.
  • Benefits: Used for tanning purposes, and some studies suggest it could also have appetite-suppressing effects and potentially improve erectile function.

6. Thymosin Alpha-1 (TA1)

• A peptide that modulates the immune system and helps in the recovery of infections.
  • Benefits: Enhances immune function, reduces inflammation, and may improve the body’s response to viruses or other pathogens.

7. IGF-1 (Insulin-like Growth Factor-1)

• A peptide similar to insulin that promotes cell growth and development. It’s sometimes used to help build muscle and support repair after intense workouts or injury.
  • Benefits: Promotes muscle growth, speeds up recovery, supports tissue repair, and enhances fat loss.

8. Carterin (GW-501516)

• A peptide used primarily for fat loss and endurance enhancement.
  • Benefits: Improves endurance, promotes fat loss, increases metabolic rate, and boosts cardiovascular performance.

9. PT-141 (Bremelanotide)

• A peptide used to treat sexual dysfunction, specifically in people with low libido.
  • Benefits: Increases sexual arousal and libido in both men and women.

10. Follistatin

• A peptide that inhibits myostatin (a protein that limits muscle growth), promoting muscle growth.
  • Benefits: Muscle growth, enhanced recovery, and potentially improved fat metabolism.

11. Kisspeptin

• A peptide that plays a role in reproductive health, influencing sexual function and fertility.
  • Benefits: Regulates puberty onset, increases LH and FSH (important hormones for sexual function), and can be used to treat infertility.

12. Gonadorelin

• A peptide that stimulates the release of hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH), supporting sexual health.
  • Benefits: Increased testosterone in men, ovarian function in women, and potential fertility enhancement.

13. Hexarelin

• Another peptide that stimulates the secretion of growth hormone.
  • Benefits: Supports muscle growth, fat loss, and recovery, with fewer side effects than other growth hormone secretagogues.

14. AOD 9604

• A modified fragment of human growth hormone (hGH) that targets fat burning.
  • Benefits: Stimulates fat breakdown without affecting muscle tissue or increasing appetite.

15. Vasoactive Intestinal Peptide (VIP)

• A peptide with anti-inflammatory and immunomodulatory effects.
  • Benefits: Used for conditions like autoimmune diseases and chronic inflammation, improves circulation, and has potential neuroprotective properties.

16. Sermorelin

• A peptide that stimulates the release of growth hormone from the pituitary gland, used for anti-aging and muscle-building.
  • Benefits: Enhances growth hormone release, promotes muscle development, fat loss, and better sleep quality.

17. Collagen Peptides

• Peptides derived from collagen, commonly used for skin, hair, and joint health.
  • Benefits: Improves skin elasticity, promotes joint and bone health, and may reduce wrinkles.

Peptide therapy represents a promising frontier in modern medicine, offering targeted support for everything from anti-aging and muscle recovery to immune health and hormone regulation. While some peptides like GLP-1 agonists have gained widespread attention and sparked debate, many others are still being explored for their broad and sometimes unpredictable effects on the body. Despite the need for further research, peptide therapy holds significant potential as a versatile tool for enhancing overall wellness, addressing chronic conditions, and improving quality of life. As interest grows, it’s important to approach peptide therapy with informed guidance and professional oversight to safely unlock its many benefits.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Sign Me Up!

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Everything You Need to Know About Peptide Therapy appeared first on Dr. Alexandra MacKillop.

Why Women Seek Functional Medicine PCOS Treatment

Many of my patients come to me looking for an alternative to the birth control prescription given to them by their OB/GYN. Others have friends or family with a PCOS diagnosis, and are wondering if that’s the reason for their own irregular and/or painful cycles. Some ladies worry if they’ll ever be able to have children, since PCOS has complicated their fertility, and still more patients come to me out of desperation—they’ve already worked with another “natural doctor” who had put them on an extremely restrictive diet and told them to lose weight. I have even heard of PCOS patients being prescribed gluten-free, dairy-free, low-carb, sulfur-free diets. Functional medicine PCOS treatment offers hope of realistic, sustainable treatment where most other providers give a grim prognosis or simply leave patients feeling overwhelmed.

In this post, we’ll be diving into the details about PCOS: what it is, what it isn’t, how it’s managed by most healthcare providers, functional medicine PCOS treatment strategies, and more. As a starting point, I encourage you to check out my fertility overview post (Female Fertility 101) if you aren’t familiar with the ins and outs of your menstrual cycle. That post lays the groundwork for understanding the status quo of periods, hormones, women’s health, and it’s important to understand these topics before we start talking about with cycles that fall outside of the norm. [Although it’s the most common, it’s not the only period problem faced by women. To learn more about what your period can tell you about your health, check out this post.]

What Is PCOS, and How Is It Diagnosed?

PCOS stands for Polycystic Ovarian Syndrome, one of the most common endocrine and metabolic disorders in women of reproductive age. The syndrome is defined by hormonal imbalances and ovarian dysfunction, and it’s diagnosed only after other causes for the patient’s symptoms have been ruled out (such as hypothalamic amenorrhea). Because of this, many women have to go through a frustratingly long and drawn out process in order to get answers for their health struggles. However, functional medicine PCOS treatment offers faster results because it gets to the root cause.

Functional Medicine PCOS Diagnosis

The name “polycystic ovarian syndrome” is a bit of a misnomer, because although ovarian cysts are common in PCOS patients, they aren’t part of the diagnostic criteria—many women with PCOS don’t have any cysts on their ovaries at all. Rather, a PCOS diagnosis is given when at least two of the three following criteria are met: [Reference]

• Hyperandrogenism (elevated androgen hormones, assessed via lab work)
• Anovulation or oligo-ovulation (absence of ovulation or infrequent ovulation, usually leading to irregular cycle length)
• Polycystic appearance of ovaries (assessed via ultrasound imaging)

The general consensus in the medical community is that a PCOS diagnosis should be given when a woman has either polycystic ovaries and/or irregular cycles in addition to high androgen levels on her blood work. When making the diagnosis, doctors are careful to rule out other causes of high androgens, such as adrenal disorders, thyroid disease, drug-induced androgen excess, and other hormonal disorders, as well as alternative causes for irregular cycles.

Types of PCOS

PCOS patients typically fall into two different categories: insulin resistant, and non-insulin-resistant types. As is the case with most hormonal disorders, more than one level is out of balance. The vast majority of women who suffer from PCOS also present with insulin resistance, glucose intolerance, dyslipidemia, and elevated levels of inflammation. Part of what makes treating PCOS so complex is that these hormonal imbalances feed off of each other: elevated insulin levels trigger a feedback loop via the HPATG axis that leads to further androgen levels, and vise-versa. Apart from the insulin resistance piece, functional medicine PCOS diagnosis further divides PCOS into 4 separate categories which you can read about here.

Symptoms of PCOS

The symptoms experienced by women with PCOS vary because not everyone meets the same diagnostic criteria, and the extent of those experiences can vary too. Some women experience only mild elevations in androgens, and symptoms are consequently lesser. Women who have cysts on their ovaries often experience pain related to the formation and/or rupture of cysts, which are symptoms that wouldn’t be experienced by women who do not have cysts. Likewise, symptoms for women who concomitantly deal with insulin resistance face different symptoms than women who do not.

• Symptoms Related to Excess Androgens
  • Excessive hair growth (face, chest, back, buttocks)
  • Thinning hair
  • Oily skin
  • Cystic acne
• Symptoms Related to Anovulation/Olig-ovulation
  • Long cycles (more than 35 days) or irregular cycle lengths
  • Difficulty conceiving or repeated miscarriages
  • Abnormal uterine bleeding
• Symptoms Related to Polycystic Ovaries
  • Painful periods and/or pelvic pain
  • Sudden, intense abdominal pain resulting from ruptured cysts
• Symptoms Related to Insulin Resistance
  • High blood pressure and/or high cholesterol
  • Fatigue after meals
  • Weight gain, especially in the abdominal area
  • Dark patches of skin, particularly along neck creases, in groin and under breasts (this is called ancanthosis nigricans)
  • Skin tags

Due to the fluctuating hormones, many women also experience generalized symptoms related to hormonal imbalances, which include (but are not limited to): fatigue, insomnia, anxiety, depression, headaches, etc.

Functional Medicine PCOS (Causes and Treatment)

The root cause isn’t really known. The current understanding is that it’s a mixture of genetic predisposition and environmental triggers, but other theories include nutritional conditions in the uterus, prenatal exposure to androgens, insulin resistance on an and more [reference]. Because of this, most treatments focus on managing symptoms—painful periods, irregular cycles, insulin resistance, etc. Hormonal contraceptive use also can induce a reversible type of PCOS, but the symptoms can continue for months or even years (called “post-pill PCOS”).

On a physiological level, we know that elevated androgens and insulin resistance result from dysfunction in the hypothalamic-pituitary-adrenal-thyroid-gonadal axis. In women with PCOS, the pituitary gland releases higher-than-normal levels of luteinizing hormone (LH), which stimulates the ovaries to produce more testosterone than usual. (Ovaries normally produce some testosterone, but problems result when they produce too much.) This over-stimulation of the ovaries by luteinizing hormone also cancels out the mid-cycle LH surge that typically triggers ovulation.

Pituitary Hormones and PCOS

At the same time, the pituitary gland releases lower-than-normal levels of follicle-stimulating-hormone, which prevents eggs from reaching full maturity. When this happens, the follicle does not release the egg (ovulation does not occur, AKA anovulation). The immature egg either dissolves, or remains in the follicle, forming a cyst. Since the follicular remnant after ovulation (called the corpus luteum) is responsible for producing progesterone during the luteal phase, many women experience additional symptoms related to low progesterone levels. (Read more about luteinizing hormone, follicle-stimulating hormone, progesterone, and the luteal phase in this post: Female Fertility 101)

The Birth Control Pill and PCOS

Most OB/GYNs prescribe oral contraceptives as a first line of treatment for PCOS, because the artificial hormones suppress the natural cycling of luteinizing hormone, follicle-stimulating hormone, estrogen, progesterone, and testosterone. The simulated hormonal environment causes the endometrial lining to develop and shed as it would in a natural period, but it take the ovaries out of the equation: no egg matures, no egg is released, and fertility is not possible.

My goal as a functional medicine doctor is to promote the natural fertility of my patients, empowering them to have healthy cycles rather than suppress the normal functioning of their bodies. That being said, sometimes the healthiest thing for a patient and her values is to reduce the pain, control the hormonal dysfunction, and reach a place where she feels that her health is manageable. If that means medication, that’s okay—the most important thing is that she is able to manage her wellbeing according to her values.

Prescription Medications for PCOS

Another medication used in the treatment of PCOS is spironolactone, which is typically used as a diuretic drug for individuals with cardiovascular disease. However, this drug also has a secondary effect of reducing androgen levels in the body, which can be helpful in controlling irregular bleeding, hair growth, and other symptoms of high androgens in women with PCOS. Like birth control pills, using spironolactone targets hormonal pathways of PCOS without addressing the root cause. This is where functional medicine treatment for PCOS can fill a huge gap and meet a huge need.

The third medication that is used in the management of PCOS is metformin, which is a drug typically given to patients with diabetes. Metformin improves insulin resistance, which can be helpful in the treatment of PCOS because of the amplifying effect that insulin plays in the production of testosterone. When insulin sensitivity improves, often testosterone levels follow suit. You can read more about the use of metformin as a fertility drug (and natural alternatives) in this post.

Functional Medicine Treatment for PCOS: Lifestyle & Supplements  

Most of my patients come to me because they are looking to avoid the use of prescription drugs in managing their fertility. If that describes you too, keep reading!

1. Lifestyle Factors for Balancing Hormones: The #1 thing we can do to support hormonal balance is building a foundation for well-being. This means taking nutrition, rest, exercise, stress management, and psychological/emotional health into account. Neglecting even one of these areas can create huge interruptions in the HPATG axis, making symptoms of PCOS and other hormonal disorders so much worse. These lifestyle factors include eating enough (in terms of calories, macronutrients, and micronutrients) as well as eating frequently enough to keep blood sugar stable. It also involves balancing exercise and rest to prevent elevations in cortisol, the stress hormone, which interrupts the production of sex hormones like progesterone. This is part of the reason why stress management, sleep hygiene, and social support are so important.
2. Eating a Diverse Diet:Gut health is a huge topic in the media lately, and research continues to show that the best way to support GI health and microbiological diversity is to eat a varied diet, with many different types of plant foods and fibers. The more restrictive our diet (limiting the types of foods we eat to just a few varieties), the more likely we are to disturb our gut microbiome, which plays a huge role in balancing our hormones. (Did you know that bacteria both produce and metabolize hormones When we disturb our gut microbiome, it affects our bodies ability to make hormones as well as clean out the old, broken down ones.) Gut health also helps modulate blood sugar control, which is an important consideration in insulin-resistant PCOS. Check out this study to learn more about the relationship between PCOS and the gut microbiome.
3. Micronutrient Balance: Research has shown that women with PCOS tend to follow certain patterns of vitamin deficiencies, including vitamin D and B vitamins (especially folic acid). Vitamin D plays an important role in supporting the thickness of the endometrial lining, which is often depleted in women with PCOS due to low progesterone levels. Likewise, B vitamins such as folic acid play an important role in follicular maturation, and supplementing with elvels at 700 μg/day can support successful ovulation. Other nutritional deficiencies have also been identified in the majority of women with PCOS, including calcium, zinc, selenium, and chromium. [Reference] While the best way to prevent nutrient deficiencies such as these is to eat a varied and balanced diet (and avoid restriction of food groups of calories), some women may benefit from using supplements—especially Vitamin D. Studies have also shown that supplementing with omega-3 fatty acids, such as those found in cod liver oil, prevent excess inflammation, help manage dysglycemia, and support hormonal balance in women. [Reference]
4. Evidence-Based Supplements:
   1. Inositol: Inositol is a type of sugar alcohol that has been shown to improve insulin sensitivity, lipid synthesis, hormonal signaling, and maturation of oocytes (female eggs) during the follicular phase. Supplementation of inositol in women with PCOS lowers androgen levels, improves insulin sensitivity, and increases rates of ovulation in women with anovulatory cycles. Supplementation is effective when administered in ratios of 40:1 of myo-inositol to D-chiro-inositol, at levels of 4000 mg per day in conjunction with 400 μg of folic acid.
   2. Alpha-Lipoic Acid: This chemical is a free-radical scavenger, meaning that it prevents premature breakdown of biochemicals and hormones in the blood stream. Studies show that supplementation with alpha-lipoid acid decreases prevalence of ovarian cysts and increases progesterone levels in women with PCOS.
   3. Melatonin:While this hormone is typically thought of as a supplement for promoting sleep, it is not a sleeping pill, but rather a hormone. (There are many reasons to avoid using melatonin as a sleep aid, but that’s a topic for another post.) When used in women with PCOS, supplementation at night has been shown to improve ovulation rates, corpus luteum formation, progesterone levels, and pregnancy rates for those who are trying to conceive. Melatonin supplementation also decreases hirsutism and androgen levels when used at 10 mg/night.
   4. Black Cohosh: As described in this post about fertility drugs, research has shown that dosing 20 mg daily of black cohosh at the beginning of the cycle modulates the LH surge during the follicular phase, improving rates of ovulation. This supplement also results in higher progesterone levels during the luteal phase, improving the thickness of the endometrial lining and supporting a luteal phase that is long enough for implantation and pregnancy in women who are trying to conceive.

Closing thoughts…

As if the symptoms of PCOS aren’t difficult enough, the journey towards a diagnosis to explain the symptoms, and finding a treatment strategy that works for you in the context of your own life can add enormous loads of stress to an already challenging life experience. There is a whirlwind of information out there, which only adds to the confusion and frustration of trying to manage your health. It can be a lonely and scary place, but I want you to know that you’re not alone. Consider making an appointment with a functional medicine doctor who can deliver personalized care and help you achieve your health goals.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Functional Medicine PCOS Treatment appeared first on Dr. Alexandra MacKillop.

Have you heard of estrogen dominance Or maybe, you already know you’re dealing with this hormone imbalance. Excess estrogen (or deficient progesterone) disrupts hormonal balance, triggering symptoms such as weight gain, mood swings, heavy periods, and fatigue. Functional medicine targets root causes with precision, and understanding why you have estrogen dominance is key to treating this condition. Herbs for estrogen dominance play a pivotal role in restoring estrogen balance by supporting detoxification, improving insulin sensitivity, and enhancing progesterone production. Below, I detail clinically supported herbs for estrogen dominance that that effectively address their mechanisms, and recommended dosages.

As we get started, here are a few key things to keep in mind when it comes to estrogen dominance:

• Estrogen dominance is a condition in which negative symptoms occur because of a high estrogen level in relation to progesterone
• Estrogen dominance may be caused by excess estrogen production, deficient progesterone production or both
• Certain underlying diseases and syndromes increase risk of estrogen dominance, like obesity, PCOS, type 2 diabetes and hypothyroidism
• Even if you have symptoms of estrogen dominance, it doesn’t necessarily mean you have it. It’s essential to test your hormones and understand your diagnosis before using any treatment strategies

Herbs for Estrogen Dominance, Explained

1. DIM (Diindolylmethane): Detoxify Excess Estrogen

DIM is one of the most powerful herbs for treating estrogen dominance. This is a compound derived from cruciferous vegetables, promotes healthy estrogen metabolism by enhancing Phase 1 and Phase 2 liver detoxification pathways. It shifts estrogen breakdown toward beneficial 2-hydroxy metabolites and away from harmful 16-alpha-hydroxy metabolites linked to estrogen dominance and cancer risk. Impaired gut function or excess production of estrogen are key candidates for treatment with DIM.

• Dosage: 100-200 mg daily
• Evidence: A randomized controlled trial found DIM supplementation significantly improved estrogen metabolism in women with estrogen dominance symptoms [2].

2. Calcium D-Glucarate (CDG): Support Estrogen Clearance

CDG inhibits beta-glucuronidase, an enzyme that reverses estrogen conjugation in the gut, preventing reabsorption and facilitating elimination. This reduces circulating estrogen levels, decreasing estrogenic load. Those who eat a diet high in ultra-processed foods and sugar are likely to benefit from supplementation with CDG when high estrogen levels have been documented on labs at any point in the cycle. This could be considered either a food or one of the best herbs for estrogen dominance.

• Dosage: 300-400 mg daily
• Evidence: Clinical studies demonstrate CDG enhances detoxification and lowers estrogen recirculation, supporting hormonal balance.

3. Berberine: Target PCOS and Insulin Resistance

Polycystic Ovary Syndrome (PCOS) drives estrogen dominance via insulin resistance and androgen imbalance. Berberine improves insulin sensitivity, regulates blood glucose, and supports gut microbiota diversity—addressing core PCOS mechanisms. Berberine may also be helpful in those with impaired gut detox pathways due to imbalances in good and bad bacteria, as berberine affects microbiological diversity.

• Dosage: 500 mg twice daily with meals
• Evidence: Multiple randomized trials show berberine’s superiority to metformin in reducing insulin resistance and improving ovulatory function in PCOS patients.

4. Evening Primrose Oil: Boost Progesterone Production

Evening primrose oil supplies gamma-linolenic acid (GLA), a precursor to prostaglandins that stimulate progesterone synthesis. Increased progesterone balances excess estrogen, alleviating symptoms like breast tenderness and PMS. If estrogen dominance and related symptoms are caused by deficient progesterone, meaning there isn’t enough progesterone to balance out otherwise normal estrogen levels, EPO may be the right solution.

• Dosage: 1,000-2,000 mg daily
• Evidence: Clinical reports confirm evening primrose oil’s efficacy in improving luteal phase defects by increasing progesterone.

5. Fish Oil: Modulate Inflammation and Hormonal Balance

Omega-3 fatty acids reduce systemic inflammation and improve insulin sensitivity, indirectly supporting estrogen metabolism and progesterone activity. Inflammation is a major driver of excess production of estrogen in men and women from abdominal fat cells.

• Dosage: 1,000-3,000 mg EPA/DHA daily
• Evidence: Supplementation reduces inflammatory markers and improves hormonal profiles in women with hormonal imbalances.

6. Fenugreek: Support Hormonal Regulation

Fenugreek seeds contain phytoestrogens that modulate estrogen receptor activity and stimulate progesterone production, improving estrogen-to-progesterone ratio.

• Dosage: 500-600 mg daily
• Evidence: Controlled trials indicate fenugreek improves hormonal balance and reduces estrogen dominance symptoms.

7. Fennel Tea: Natural Estrogen Modulator

Fennel contains anethole, which exhibits estrogenic activity that regulates menstrual cycles and reduces estrogen dominance symptoms such as bloating and cramps.

• Dosage: 1-2 cups of fennel tea daily
• Evidence: Clinical use supports fennel’s effectiveness in managing menstrual disorders related to estrogen imbalance.

8. Cinnamon: Improve Insulin Resistance and Hormone Balance

Cinnamon enhances insulin sensitivity and lowers blood glucose, indirectly reducing ovarian androgen production and estrogen dominance, especially in PCOS.

• Dosage: 1-3 grams daily
• Evidence: Studies confirm cinnamon’s role in metabolic and hormonal regulation in women with insulin resistance.

9. Chamomile: Calm Inflammation and Support Progesterone

Chamomile’s anti-inflammatory properties reduce systemic inflammation that disrupts hormone production. It also supports progesterone synthesis through improved adrenal function.

• Dosage: 1-2 cups chamomile tea daily or 300 mg extract
• Evidence: Research validates chamomile’s efficacy in reducing inflammation and improving hormonal balance.

10. CBD Oil: Regulate Endocrine and Stress Response

CBD modulates the endocannabinoid system, which influences hormone regulation and reduces cortisol-driven estrogen dominance. It also supports liver detoxification.

• Dosage: 10-50 mg daily, titrated individually
• Evidence: Emerging studies demonstrate CBD’s role in hormone balance and stress reduction [20].

11. Boron: Enhance Hormonal Balance and Bone Health

Boron increases circulating levels of free testosterone and estrogen metabolites, promoting a favorable hormonal environment and supporting bone density.

• Dosage: 3-6 mg daily
• Evidence: Clinical trials report boron’s capacity to increase steroid hormone levels and improve metabolic health.

12. Black Cohosh: Promote Ovulation and Progesterone Production

Black cohosh exhibits estrogenic effects that stimulate ovulation and improve progesterone synthesis, directly countering estrogen dominance.

• Dosage: 40-80 mg daily standardized extract
• Evidence: Clinical trials validate black cohosh’s role in improving luteal phase and balancing estrogen-progesterone ratio.

13. Adaptogens (Reishi): Balance Stress Hormones and Support Endocrine Health

Reishi mushroom modulates the hypothalamic-pituitary-adrenal axis, reducing cortisol and supporting overall endocrine harmony, which indirectly regulates estrogen dominance.

• Dosage: 1,000-1,500 mg daily
• Evidence: Studies show Reishi’s efficacy in reducing stress-related hormonal imbalance and inflammation.

Functional medicine’s approach to estrogen dominance requires targeted, evidence-based herbal interventions. DIM, CDG, berberine, evening primrose oil, fish oil, and other botanicals address detoxification, insulin resistance, inflammation, and progesterone support. Combining these herbs with lifestyle modifications establishes hormonal balance and improves patient outcomes.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post Herbs for Estrogen Dominance and Hormonal Balance appeared first on Dr. Alexandra MacKillop.

Please note: When referring to hormonal contraceptives, birth control pills or “the pill” in this post, I am referencing medications containing both estrogen and progesterone analogs (estradiol and progestin).

The menstrual cycle plays a powerful role in women’s health, and not just in terms of fertility. As I often say, our periods tell us way much more about our sense of well-being than whether or not we’re pregnant, and that information is so, so important! If our cycle is out of sync, it’s really important for us to address those concerns early so that the underlying causes–like thyroid, metabolic, adrenal, or other hormone imbalances—don’t worsen and lead to disease.

Masking the Root Cause

Because of their ability to give us early warning signs about our health, our periods are referred to as our “fifth vital sign” along with heart rate, blood pressure, temperature, and breathing rate. When it comes to our cycles, deviations from the norm often signify an underlying health concern that will intensify, eventually leading to a more serious problem. For example, most chronic illnesses that we see today are either triggered or worsened by stress. Even if a person isn’t experiencing a flare up of their chronic symptoms (or maybe they have a genetic predisposition that hasn’t yet manifested), our bodies can send us warning signals that our stress is reaching a critical level through changes to our menstrual cycles. Stress interrupts the delicate web of signals between our brains and the organs that secrete our hormones (sex hormones, thyroid hormones, metabolic hormones, and more) leading to missing, painful, or irregular cycles. (For more about the details of what your period can tell you about your health, check out this post.)

Birth Control Pills Shut Down Our Natural Hormonal Processes

As I explain in my book, Go with Your Flow, the main event of our menstrual cycle isn’t the bleed, but rather it is ovulation–the release of an egg. The first two weeks of the cycle are all about ramping up the hormonal signals (mainly estrogen) required to mature and release an egg so that your body can become pregnant. After ovulation, progesterone takes over, preparing the uterus to become a suitable environment for a growing baby if the egg meets a sperm along its journey through the fallopian tube. As you learned in sex ed, the egg passes through if it isn’t fertilized, and the uterine lining sheds away. This shedding of menstrual blood–your period–marks day one of the next cycle.

Birth control pills are made up of chemicals that resemble estrogen and progesterone, overriding your body’s natural signaling pathways. Their purpose is to prevent the release of an egg while still allowing your body to “go through the motions” (i.e. by thickening and shedding the uterine lining every 28 days.) While it might seem easier to just not have a period at all, the processes that take place during your cycle are about more than fertility, and shutting them down completely would be very dangerous, leading to osteoporosis, heart disease, and other health problems. So in lieu of completely eliminating your period, the pill shuts off the “main event” of your cycle, aka ovulation, while setting up a carefully curated hormonal environment that mimics a healthy period.

Except it isn’t a healthy menstrual cycle because it isn’t a menstrual cycle at all. It’s just a bleed. Without being able to control their own hormonal fluctuations, our bodes lose their ability to communicate with us about our hormonal health status.

Because of the way that the false periods induced by birth control pills so closely resemble healthy cycles, the pill is often prescribed for reasons other than contraception. Patient suffering from hormonal acne, PMS, painful periods, PCOS, and other women’s health conditions are often given birth control pills because it seems to solve these problems. But the root cause of these issues goes much deeper, and the pill simply masks over the real issue. It’s kind of like breaking your toe and “curing” the problem by chopping off your whole leg. It completely misses the point. Your toe stops hurting, but only because you don’t have one anymore! The same is true of using the pill for non-contraceptive purposes. Your period seems normal but only because you aren’t really having your cycle anymore! As a result, the underlying cause is left to fester, and often returns with a vengeance as soon as you come off the pill.

Health Risks

In addition to masking over our health problems, the pill often outright creates health risks of its own. Here are just a few:

• Infertility: Despite being often marketed as a “fertility drug,” the pill does not support the optimal function of the female body. It actually does the opposite, by shutting off reproductive function and inhibiting ovulation. Unfortunately, many women struggle with fertility problems even after they discontinue use of the pill. It’s not as if ovulation magically starts up again after being chemically prevented. It takes time for the body to re-learn how to secrete hormones in a balanced and functional way. Sometimes, the body can’t reach that place post-pill on its own without medical support.
• Hormone Imbalances: Even if ovulation resumes, many women find that they struggle with metabolic, thyroid, adrenal, or other hormonal imbalances outside of fertility upon coming off the pill. As I describe in this post, our various hormonal systems are all interrelated, so when we so drastically interfere with one aspect of the HPATG axis (as is the case with the pill), other bodily systems can become imbalanced too. Symptoms like fatigue, weight gain, thinning hair, insomnia, and more can all point back to hormonal contraceptive use, or discontinued use.
• Blood Clots: A widely known fact in the medical community that is seldom talked about in a clinical setting is that oral contraceptives containing estrogen or estrogen analogs increase the risk of blood clots forming, even in otherwise healthy women with no underlying conditions. While certain factors increase risk of this phenomenon (smoking, being over 35 years of age, prolonged inactivity, and family history), the likelihood of blood clots goes up dramatically for all women. These blood clots form in deep veins of the body (most often the legs), and if they break off, they can become lodged in the heart (causing a heart attack), lungs (causing a pulmonary embolism) or brain (causing a stroke). This risk is increased even if a woman follows a healthy lifestyle. [Note: Blood clots from using oral contraceptives is often presented as a low risk, but it’s not really that low. Different sources say different things, but it’s typically discussed about as being about 1/1,000, or 0.1%. Let’s add some context…the CDC estimates that 28% of US women are currently using oral contraceptives, which is about 10.6 million women. I’ll let you do the math, but 0.1% of 10.6 million isn’t a small number—and it seems even larger when it’s someone you know. I personally know of three women in from my own personal life (not even counting patients) who experienced this in their twenties.]
• Heart Disease: Long-term exposure to hormonal analogs like those found in the pill act like a biochemical source of stress in the body. These chronic stress exposures alter the metabolism of lipids and carbohydrates in the body, raising blood cholesterol and triglycerides and increasing risk of chronic disease, especially heart disease in women. Once again, this is true even for otherwise healthy individuals.
• Increased risk of some cancers—namely breast and cervical cancer. Breast cancer is the number one most common type of cancer among women, and cervical cancer is the fourth most common type of cancer in women, worldwide.
• Insulin Resistance: One of the ways that oral contraceptives affect metabolism is by increasing blood glucose levels and subsequent insulin secretion. With time, this can increase risk of insulin resistance and the development of metabolic syndrome and/or diabetes.
• Gallbladder and Liver Dysfunction: Part of the role of the liver and gallbladder in our health is to detoxify our bodies from old, broken down hormones, red blood cells, and other waste products. This is a natural and normal process, but sometimes it can become overloaded if the amount of waste buildup is higher than the normal capacity of these organs. Sex hormones like estrogen are one of the major substrates of the liver and gallbladder, and can “clog up” the system leading to low-grade damage. Some women who experience this manifest skin reactions like itching, rashes, or yellowing of the skin (jaundice).

Female Empowerment

It still blows my mind that so many important women’s health topics are still taboo. Sure, sex is a private matter, but healthcare information shouldn’t be limited or kept secret. As women, we deserve to understand our bodies, including the implications of the medical interventions we receive. Ovulation and menstruation are normal and necessary parts of a healthy woman’s body if she is of reproductive age, and these functions (or lack thereof) give us valuable insight into our well-being. They don’t need to be shut off, and we don’t need to be quiet about it.

Our level of understanding of the female body in science doesn’t require us to subdue our femininity in order to allow us to make family planning decisions in accordance with our values. Likewise, we deserve better medicine—safe and effective, individualized treatment plans that address the root cause of symptoms, whether in terms of our reproductive health or otherwise. If the birth control pill fits your goals and values for your life, that’s awesome! I totally support you. But I also want you to know that if it doesn’t, there are other options for you that protect your health and your values, and which allow you to make informed decisions on behalf of both your family and your own body.

Censorship of these conversations limits a woman’s access to essential information about her sense of well-being. Sexual health isn’t gross or weird, and it shouldn’t be hush-hush. In fact, every single person on earth is only here because of the function of a woman’s reproductive system. The female body is amazing, and each of us should have the privilege of understanding it on a personal level, especially when making the very personal decision about whether or not to use hormonal contraceptives.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Risk of Blood Clots and Other Dangers of Hormonal Birth Control appeared first on Dr. Alexandra MacKillop.

Progesterone is quite the buzz word these days. Whether you’re in perimenopause and considering hormone replacement therapy (HRT), you’re newly pregnant and having levels tested, or you’re experiencing some menstrual irregularities attributed to imbalances between estrogen and progesterone, the term has likely come up for you. But, what is progesterone What does it do for the body How do you know if you have enough of it How can you test progesterone levels at home Read on to find answers to all these questions and more.

What is progesterone and how can you test progesterone levels at home?

Progesterone is a hormone primarily produced by the ovaries in women, particularly after ovulation during the second half of the menstrual cycle. After ovulation, a gland called the corpus luteum forms which secretes progesterone. If you don’t ovulate, you can’t make progesterone because you won’t have a corpus lutem. You need progesterone because it plays a crucial role in regulating the body’s functions, including:

1. Menstrual Cycle: Progesterone helps prepare the uterine lining for potential implantation of a fertilized egg. It also prevents the uterine lining from getting too thick or shedding too quickly.
2. Pregnancy: If pregnancy occurs, progesterone helps maintain the uterine lining, supporting the developing embryo. This is where progesterone gets its name from: pro-gest(ation)
3. Breast Development: It also protects breast tissue from too much estrogen and prepares the breasts for milk production during pregnancy.

In addition to its role in female reproductive health, progesterone is involved in other bodily functions, including mood regulation, sleep and maintaining bone density. (Because it’s so important, and because many providers don’t test levels in office, it’s helpful to know how to test progesterone levels at home.) It is also used in hormone replacement therapy and in various contraceptive methods. Let’s take a closer look:

Progesterone and Brain Health

Progesterone significantly affects the brain and mood due to its influence on neurotransmitters and brain function. Here are some key ways it affects mood:

1. Neurotransmitter Modulation: Progesterone enhances the effects of certain neurotransmitters, such as gamma-aminobutyric acid (GABA), which has calming effects and reduces anxiety.
2. Mood Regulation: Changes in progesterone levels during the menstrual cycle lead to mood fluctuations. Higher levels in the luteal phase (after ovulation) contributes to feelings of calmness, while lower levels pre-menstruation correlates with mood swings or premenstrual syndrome (PMS).
3. Anxiety and Depression: Studies show that progesterone protects against anxiety and depression, though the relationship varies from person to person. I describe estrogen as an “energizing” hormone, which motivates and gets you going. But all that energy, when not balanced by the cool, calming effects of progesterone, becomes anxiety and irritability. Knowing how to test progesterone levels at home is helpful when struggling with premenstrual symptoms like depression or anxiety. If you can track your levels, you can anticipate better how to support your mood.
4. Neuroprotection: Progesterone may have neuroprotective properties, potentially supporting brain health and cognitive function. Maintainin healthy progesterone levels throughout life decreases risk of brain fog and neurodegeneration.
5. Sleep Quality: Progesterone is also linked to improved sleep quality, which subsequently boosts mood. Insomnia is a problem for many perimenopausal women, and the most common prescription is estrogen hormone replacement therapy. However, progesterone actually is much more effective at improving sleep both in perimenopause and at other times of life.

Progesterone and Metabolism

Progesterone affects metabolism and blood sugar control in several ways:

1. Cortisol Interaction: Progesterone interacts with cortisol, the stress hormone. High levels of cortisol affect blood sugar levels and metabolism, and progesterone helps moderate some of these effects.
2. Reproductive Health: In women with polycystic ovary syndrome (PCOS) or other hormonal imbalances, therapeutic strategies that increase progesterone also help regulate menstrual cycles and improve metabolic outcomes. In many cases, low progesterone levels in early pregnancy can lead to miscarriage, which is why it’s helpful to know how to track progesterone levels at home (so you can advocate for yourself in a healthcare provider’s office!)

Progesterone and Thyroid Function

Progesterone affects thyroid function in several ways, largely due to its interactions with thyroid hormones and the overall hormonal balance in the body. Here are some key points:

1. Thyroid Hormone Regulation: Progesterone changes how and when the body makes thyroid hormone, influencing metabolism. It also helps support the synthesis of thyroid hormones and enhances their effects.
2. Binding Proteins: Progesterone affects the levels of thyroid-binding globulin (TBG), a protein that binds thyroid hormones in the blood. Increased levels of TBG can lead to higher total thyroid hormone levels, and increased metabolic rate/response.
3. Metabolic Rate: Progesterone benefits metabolic rate, partly by influencing thyroid hormone activity. This dramatically impacts energy levels and weight management.
4. Hormonal Balance: In women, fluctuations in progesterone during the menstrual cycle influences thyroid function. For example, low progesterone levels are associated with conditions like hypothyroidism and infertility.

Progesterone, Adrenal Function and Cortisol

Progesterone has several effects on adrenal function and cortisol levels, primarily through its interactions with the endocrine system. Here are the key points:

1. Stress Response: Progesterone helps modulate the body’s response to stress. It has a calming effect and counterbalances some of the stimulating effects of cortisol and estrogen.
2. Hormonal Balance: The relationship between progesterone, cortisol, and other hormones is complex. High cortisol levels can lead to a decrease in progesterone, contributing to hormonal imbalances that can affect mood, energy levels, and overall health.

Does the birth control pill have progesterone?

Progestins, the synthetic versions of progesterone used in many forms of birth control, differ from natural progesterone in several key ways:

1. Chemical Structure: Progestins are chemically modified molecules of testosterone that have been changed to interact with the human brain and ovaries. Although they are chemically similar, they are not exactly the same.
2. Hormonal Activity: While progestins mimic some of the actions of natural progesterone, they can have varying degrees of activity on progesterone receptors and other hormone receptors (like androgen and glucocorticoid receptors). This leads to side effects that are not typically associated with natural progesterone. The progestins in birth control contribute to insulin resistance, thyroid disorders and depression whereas natural progesterone prevents those things.
3. Side Effects: The side effects of progestins differ from those of natural progesterone due to their altered hormonal activity. Many experience mood changes, weight gain, or acne with artificial progestins, while these effects don’t occur with natural progesterone.
4. Impact on Menstrual Cycle: Progestins can affect the menstrual cycle in ways that natural progesterone does not, such as altering bleeding patterns, causing lighter or more irregular periods, or even stopping menstruation altogether in some users.

The biggest takeaway is that using artificial progestins, by design, prevents your body from producing its own progesterone. If you have progestins, you can’t have progesterone, and you’re therefore automatically progesterone deficient. In this case, it won’t be helpful to test progesterone levels at home.

How to Test Progesterone Levels

The first and most important thing is to determine if you’re ovulating. If you aren’t ovulating, you can’t make progesterone because you won’t have the corpus luteum gland we discussed earlier. It is impossible to “test” progesterone levels at home if you’re not ovulating because you will not have any meaningful level of progesterone in your body. That means that if you’re using oral ceontraceptives like the birth control pill, or other forms of hormonal drugs like the implant, the Nuva Ring, or certain types of IUD, you aren’t ovulating and subsequently are progesterone deficient.

However, other health conditions may also cause low progesterone because of anovulation, like thyroid disorders, hypothalamic amenorrhea (stress-induced anovulation and lack of periods), and PCOS to name a few. If you aren’t having ovulatory periods at least every month, you are likely deficient in progesterone.

1. How to Track Progesterone Levels at Home with Ovulation

To track your progesterone levels at home, you first need to find out if you’re ovulating and when. The most straightforward way to know if you’re ovulating is to track your cycle using basal body temperature. I wrote a blog post all about how to do this which you can access here. You also can track ovulation using prediction methods, such as urinary LH testing or tracking cervical fluid, though it’s important to note that these methods do not confirm ovulation. Rather, they predict when (generally) in your cycle you may be close to ovulation.

When tracking ovulation, mark the following…

• The day before your basal body temperature rises above baseline
• The day after you have a positive LH test strip
• The day before your cervical fluid transitions from watery/ewcm (egg white cervical mucus) to a thick, dry, gluey texture

2. How to Track Progesterone Levels at Home with Luteal Phase

Once you have identified the day of ovulation, the next step in learning how to track your progesterone levels at home is calculating your average luteal phase length. The luteal phase is calculated from the total cycle length (i.e. 28 days) minus the day of ovulation (i.e. day 14). In the example just given, a 28-day cycle minus ovulation day of CD 14 would be a 14-day luteal phase, which is optimal.

A short luteal phase, which is less than 10 days long, is a sign of progesterone deficiency.

However, tracking luteal phase at home also helps you to know when the optimal day to test progesterone levels is, whether using a urinary hormone test at home or you are visiting a lab facility to have a progesterone blood draw. The optimal day to test progesterone levels is 5 to 7 days before your next period. Obviously, if you have no idea how long your luteal phase is, you don’t know when to predict that optimal 5-to-7-day period. This is why it’s important to track cycle length, day of ovulation, and luteal phase length for several cycles before tracking progesterone levels at home. Testing on the wrong day might give results that make it seem like you have a less-than-optimal level of progesterone.

Basal body temperature charts can also give indication of progesterone levels. While they are an indirect measure, if you have an elevation of your body temperature above baseline that is less than 0.5 degrees Fahrenheit, it may be a sign of low progesterone levels.

3. How to Track Progesterone Levels at Home with Luteal Phase

After the corpus luteum makes progesterone, the body breaks it down into a progesterone metabolite called Pregnanediol Glucuronide (PdG) which can be measured in urine, similarly to urinary LH test strips. While it is not exactly the same as progesterone, it reflects progesterone production and levels in the body.

PdG test strips can be purchased inexpensively over the counter, such as Easy @ Home, Proov and Inito (a comprehensive fertility hormone testing system that also includes estradiol, LH and FSH levels). Using urinary PdG, a level of 5 ug/mL indicates successful ovulaiton, which is roughly equivalent to a serum progesterone level of 10 ng/mL. The optimal levels for urinary PdG and blood serum progesterone would then be 7.5 ug/mL (urinary) and 15 ug/mL (serum) respectively.

How to Track Progesterone Levels at Home with Signs and Symptoms of Progesterone Deficiency

While clinical symptoms don’t confirm progesterone deficiency, they may serve as a clue that you are low on progesterone and should consider starting to test your progsterone levels at home. These include:

• Irregular Menstrual Cycles: Changes in cycle length, missed periods, or very light or heavy menstrual bleeding.
• PMS Symptoms: Increased premenstrual syndrome (PMS) symptoms, such as mood swings, irritability, and bloating.
• Mood Changes: Anxiety, depression, or mood swings that are more pronounced around the menstrual cycle.
• Sleep Issues: Difficulty sleeping or insomnia.
• Hot Flashes: Symptoms resembling those of menopause, including hot flashes and night sweats.
• Weight Gain: Unexplained weight gain or difficulty losing weight, often due to changes in metabolism.
• Low Libido: Decreased sexual desire or changes in sexual function.
• Fatigue: Increased fatigue or low energy levels.
• Breast Changes: Tenderness or changes in breast tissue, including fibrocystic changes.
• Hair Loss or Thinning: Changes in hair growth, including thinning hair or hair loss.

Perimenopause

One of the hallmarks of perimenopause is a shortening luteal phase length, shorter menstrual cycles and less progesterone. Estrogen also takes off on a roller coaster ride. You can diagnose perimenopause with an elevated FSH level in combination with a normal or increased LH level, or with increased LH and FSH in combination with having had a menstrual period in the last 12 months. Being age 40 or above is also a good sign that your progesterone levels are changing.

Test for Progesterone with Lab Testing

Of course, the only way to know for sure that you have low progesterone levels (provided that you are ovulating) is to test them. A progesterone level of at least 4.44 ng/mL (this may vary slightly depending on the lab) is required to confirm ovulation. However, what we care most about is the peak progesterone level achieved in the luteal phase. Because normal luteal phases typically range from 10-14 days, you need to test your progesterone level between 5 and 7 days before the start of your next period.

If you have regular menstrual cycles and track ovulation with basal body temperature, you know exactly when you’ll reach the midpoint of your luteal phase. If you don’t know when you ovulate, look at the average length of your menstrual cycles. If your cycles are between 24 and 28 days long, I’d recommend scheduling a blood draw 5 days before your next expected period. If they are 29 days or longer, I’d recommend scheduling a blood draw to be 7 days before your next expected period. Note that this isn’t a perfect algorithm; it’s possible to have a 14-day luteal phase in a 24-day cycle and a 10-day luteal phase in a 33-day cycle. However, particularly in the case of perimenopause, a short cycle is more likely to be accompanied by a relatively shorter luteal phase. The target is at least 15.0 ng/mL at the peak progesterone production, however higher is always better. (Note: non-pregnant cycles rarely exceed 28 ng/mL)

Not having enough progesterone leads to a range of health risks and complications, particularly in women. Symptoms include irregular periods, heavy bleeding, or amenorrhea (the absence of menstruation). This hormonal imbalance also exacerbates premenstrual syndrome (PMS) symptoms, leading to heightened mood swings, anxiety, and irritability. Additionally, progesterone deficiency is associated with an increased risk of endometrial hyperplasia, a condition where the uterine lining becomes too thick, potentially raising the risk of endometrial cancer. It also affects bone health, as progesterone plays a role in maintaining bone density; low levels may contribute to osteoporosis over time. Furthermore, inadequate progesterone leads to fertility issues, as it is essential for preparing the uterine lining for implantation of a fertilized egg. Overall, a lack of progesterone significantly impacts physical and emotional well-being, so if you are concerned about your progetserone levels, be sure to seek care from a functional medicine physician.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Test Progesterone Levels at Home appeared first on Dr. Alexandra MacKillop.

Polycystic ovarian syndrome (PCOS) affects millions of women worldwide, presenting a variety of symptoms, including irregular menstrual cycles, acne, weight gain, and infertility. Traditional approaches often focus on symptom management, but functional medicine offers a deeper, more sustainable solution by targeting the root causes of PCOS. Rather than simply masking symptoms, functional medicine works to restore balance within the body through personalized, holistic interventions. Here’s how functional medicine addresses PCOS from every angle to promote lasting health.

Functional medicine goes beyond treating symptoms—it strives to correct the underlying factors that drive disease. With PCOS, this means addressing not only hormonal imbalances but also lifestyle factors that exacerbate the condition. These factors include sleep hygiene, nutrition, exercise, stress, and toxin exposure.

For effective treatment, patients must embrace behavioral changes. Functional medicine emphasizes:

• Improved Sleep Hygiene: Consistent, restful sleep is crucial for regulating hormones and blood sugar.
• Nutritional Adjustments: A balanced diet that supports stable blood sugar and reduces inflammation can help correct insulin resistance, a key factor in PCOS.
• Exercise Patterns: A tailored exercise regimen can regulate hormones and boost metabolism.
• Stress Management: Chronic stress elevates cortisol, which worsens insulin resistance and hormonal imbalances.
• Reduction of Toxic Exposures: Avoiding endocrine-disrupting chemicals, such as those found in plastics and personal care products, helps restore hormonal balance.

By focusing on these lifestyle changes, functional medicine doesn’t just alleviate symptoms but rewires the body’s health from the inside out.

Sleep as a Treatment for Polycystic Ovarian Syndrome

Sleep plays a pivotal role in functional medicine, particularly in its relationship to cortisol and blood sugar regulation. Poor sleep disrupts hormonal balance, elevating cortisol levels. This, in turn, increases insulin resistance—something that directly affects around 70% of women with PCOS.

Lack of sleep leads to:

• Higher cortisol levels, contributing to increased blood sugar and insulin resistance.
• Disruption of the body’s natural circadian rhythm, affecting the timing of hormone production.
• Increased cravings for high-sugar and high-fat foods, which worsens blood sugar management.

4 Strategies for Better Sleep Quality:

1. Consistent Sleep Schedule: Go to bed and wake up at the same time every day, even on weekends, to regulate your circadian rhythm.
2. Limit Blue Light Exposure: Avoid screens (phones, computers, etc.) at least an hour before bedtime. Blue light interferes with melatonin production.
3. Create a Sleep-Inducing Environment: Ensure your bedroom is cool, dark, and quiet. Consider using earplugs or a white noise machine to block disruptive sounds.
4. Relaxation Techniques: Engage in deep breathing, progressive muscle relaxation, or meditation before bed to activate the parasympathetic nervous system, signaling the body to wind down.

Nutrition as a Treatment for Polycystic Ovarian Syndrome

Managing blood sugar is central to PCOS treatment. Women with PCOS often struggle with insulin resistance, making blood sugar control a crucial factor. Functional medicine promotes a low-carb, blood sugar-controlled diet that focuses on whole, nutrient-dense foods.

Key Strategies:

• Low-Carb, High-Protein Diet: Emphasizing lean proteins, healthy fats, and low-glycemic vegetables supports stable blood sugar levels.
• Continuous Glucose Monitoring: Using a continuous glucose monitor (CGM) allows you to track postprandial glucose levels. The goal is to keep glucose levels under 110 mg/dL, which prevents insulin spikes and the inflammatory response that worsens PCOS.
• Protein and Fiber: Protein stabilizes blood sugar by slowing digestion, while fiber slows the absorption of sugar, preventing blood sugar spikes. Including protein at every meal—especially lean meats, fish, eggs, and plant-based proteins—is crucial for blood sugar regulation. Likewise, fiber-rich foods such as leafy greens, avocados, and legumes help maintain glucose balance.
• Ketones: Among low-carb diets, keto is one of the most effective for reversing insulin resistance. But it’s also the most intense. If a keto diet is not sustainable or realistic for you in the context of your health, there’s good news. Research shows that supplementing with exogenous ketones in the form of beta-hydroxybutyrate reduces both androgens and blood glucose in women affected by PCOS.

Exercise as a Treatment for Polycystic Ovarian Syndrome

Exercise is vital for hormone balance and glucose management. While all forms of exercise benefit metabolism, weight lifting stands out as the most effective for improving insulin sensitivity.

Why Weight Lifting Works Best for PCOS:

• Muscle Mass and Insulin Sensitivity: Strength training builds lean muscle mass, which helps the body use insulin more effectively, lowering blood sugar.
• Increased Resting Metabolic Rate: Muscle tissue burns more calories at rest than fat tissue, enhancing fat loss and supporting hormone regulation.
• Cardio versus Weight Lifting: The research here is mixed. Many sources claim that resistance training is more effective than cardio for controlling PCOS, but other quality, high-power studies also show that the reverse is true. As a functional medicine doctor, I simply recommend that my patients pick a type of exercise that they enjoy and then do it regularly. If 30-50 minutes of exercise, 5-days per week doesn’t alone improve insulin resistance, then the problem isn’t exercise and we need to look more broadly at overall health and lifestyle.
• Yoga: Yoga, while not as effective as resistance training for glucose control, still offers benefits by reducing stress and improving hormonal balance. A review study published in Evidence-Based Complementary and Alternative Medicine found yoga to improve menstrual regularity and reduce symptoms of PCOS.

Environmental Toxins: A Hidden Factor in Polycystic Ovarian Syndrome

Endocrine-disrupting chemicals (EDCs), found in plastics, personal care products, and household cleaners, are major contributors to hormonal imbalances in women with PCOS. These chemicals mimic estrogen in the body, exacerbating symptoms such as weight gain, acne, and irregular periods.

To minimize toxin exposure:

• Switch to BPA-Free Products: Avoid plastic containers and opt for glass, stainless steel, or BPA-free plastic.
• Use Natural Personal Care Products: Choose cosmetics and toiletries free of parabens, phthalates, and other chemicals that disrupt hormonal balance. Screen the safety of personal care products using databases such as the Environmental Working Group or Yukka.
• Air Purification: Invest in a high-quality air purifier to reduce indoor pollutants and environmental toxins.

Stress Managementas a Treatment for Polycystic Ovarian Syndrome

Stress drives androgen production from the adrenal glands, worsening symptoms like acne, excess facial hair, and hair thinning in PCOS. High cortisol levels also impair insulin sensitivity, further compounding metabolic issues.

3 Strategies for Stress Management:

1. Mindfulness Meditation: Daily mindfulness practice reduces cortisol levels and improves emotional well-being.
2. Breathwork: Controlled breathing exercises activate the parasympathetic nervous system, helping to manage stress and reduce its impact on hormone production.
3. Regular Physical Activity: Engaging in activities like yoga, walking, or swimming helps balance stress hormones and improves mental clarity.

Supplementation as a Treatment for Polycystic Ovarian Syndrome

In my practice, supplements play a huge role in managing patient health, particularly with PCOS. Here are some of the most common supplements I use to treat PCOS, and the research that backs them up:

• Inositol: This supplement, specifically in the form of myo-inositol and D-chiro inositol, has been shown to improve insulin sensitivity and ovarian function. The research pretty much shows a consensus on the effectiveness of this supplement across subtypes of PCOS. (Here’s one example.)
• Licorice Root: Licorice has anti-androgenic properties that can reduce elevated testosterone levels, improving symptoms like acne and excess hair growth. Much of the research on licorice has been done on rats, but we also have strong data on its use traditionally in treating PCOS.
• Peony Root: Peony has been used in Traditional Chinese Medicine to regulate menstrual cycles and support ovarian health. This herb is particularly useful for adrenal-driven PCOS and improving fertility.

By incorporating these strategies into a personalized treatment plan, functional medicine addresses PCOS from all angles, targeting not only the symptoms but also the root causes of the condition. Whether through dietary changes, targeted supplements, or stress management techniques, functional medicine provides a comprehensive, sustainable solution to hormonal imbalance in PCOS. Polycystic Ovarian Syndrome is a complex and multifaceted condition, but with functional medicine’s holistic approach, women can find relief and restore hormonal balance. By addressing lifestyle factors like sleep, nutrition, exercise, and stress, and incorporating smart supplementation, functional medicine provides a path toward long-term wellness.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post Treating Polycystic Ovarian Syndrome with Functional Medicine appeared first on Dr. Alexandra MacKillop.

Resources abound for hypothyroidism online. After all, it is one of the leading hormonal imbalances affecting women, and rates are rising faster than ever. But for those dealing with a different condition—or really, quite the opposite condition—of hyperthyroidism caused by Graves’ Disease, it can feel lonely and isolating when nobody is talking about, or offering help for you.

Well, you’re in the right place.

Doctors use the term hyperthyroidism to refer to a condition in which the thyroid gland is producing too much thyroid hormone, increasing metabolic rate to debilitating and sometimes dangerous levels. There are classically two main autoimmune conditions that can cause this: Graves’ Disease and Hashimoto’s Disease. While both Graves’ Disease and Hashimoto’s Disease are autoimmune conditions affecting the thyroid, they are different from each other. They are diagnosed differently, treated differently, and have different long-term health implications.

Let’s start by explaining autoimmunity.

Autoimmunity refers to the abnormal immunological process of producing antibodies against a person’s own self. Antibodies are like little soldiers made by the immune system for the purpose of fighting off foreign invaders like germs. If the body starts mobilizing soldiers against itself, that leads to problems ranging from inflammation to organ damage and even death. Graves’ Disease and Hashimoto’s Disease both involve the abnormal production of antibodies targeting the thyroid gland, but they produce hyperthyroidism in different ways.

What Is Hashimoto’s Disease?

Hashimoto’s Disease is the most common autoimmune diseases affecting the thyroid. Classically, however, it is thought of as causing hypothyroidism, and that’s because most cases do eventually result in a hypothyroid state. However, in the early stages, it can cause hyperthyroidism, or an overactive thyroid, too.

In Hashimoto’s Disease, the body makes antibodies (anti-thyroglobulin and anti-thyroperoxidase antibodies) that destroy elements of the thyroid gland. This causes swelling and inflammation of the thyroid gland. The inflammation itself is what can cause periods of thyroid overactivity because the provocation from the antibodies and resultant inflammatory processes may trigger the thyroid gland to produce even more hormone.

However, over time, as enough damage is wrought on the thyroid resulting from this autoimmune-driven inflammation, the thyroid may stop functioning as well as it should, or perhaps even may stop functioning altogether. As a result, hypothyroidism develops and while it can sometimes be improved through functional medicine, Hashimoto’s Disease that is diagnosed too late may lead to permanent hypothyroidism.

What Is Graves’ Disease?

Graves’ Disease is very different. Whereas Hashimoto’s Thyroiditis is the most common cause of hypothyroidism (ultimately), Graves’ Disease is the autoimmune disorder that is the most prevalent cause of hyperthyroidism. It occurs when the immune system produces antibodies that bind to the thyroid-stimulating hormone receptor (TSHR), leading to excessive thyroid hormone production. Under normal circumstances, the brain makes TSH (thyroid-stimulating hormone) for the purpose of binding to these receptors and stimulating the thyroid to produce thyroid hormone. In Graves’ Disease, thyroid-stimulating immunoglobulins (antibodies) bind to these receptors. In other words, the immune system mimics the brain and triggers the thyroid to make antibodies.

How Does Graves’ Disease Cause Health Problems?

Overproduction of thyroid hormone in Graves’ Disease accelerates metabolism and can result in symptoms such as weight loss, rapid heartbeat, anxiety, tremors, and eye problems like bulging eyes (Graves’ orbitopathy). Additionally, Graves’ Disease poses risks for people who are trying to get pregnant (or stay pregnant,) who struggle with anxiety, or who have cardiac conditions. It also may be challenging to function with Graves’ Disease because it often also brings other symptoms that affect quality of life, like body aches, sleep problems, and panic attacks. The immune side of Graves’ Disease is also problematic, as it can bring on episodes of full-body hives. If you’ve ever experienced this, you know just how overwhelming it can be.

How Is Graves’ Disease Diagnosed?

Diagnosis typically involves:

• Blood Tests: Measuring levels of thyroid hormones (T3 and T4), thyroid-stimulating hormone (TSH), thyroid-stimulating immunoglobulin (TSI) and thyroid-stimulating hormone receptor antibodies (TRAb) is an essential piece of diagnosing Graves’ Disease.
• Ultrasound: Assessing the size and texture of the thyroid gland. Thyroid nodules can also produce thyroid hormone, so it’s important to understand the root cause of hyperthyroidism and not simply assume that the root cause is Graves’ Disease.
• Radioactive Iodine Uptake Test: Determining how much iodine the thyroid absorbs, which is often elevated in Graves’ disease.

The Role of Gut Health in Graves’ Disease

Emerging research indicates a significant connection between gut microbiota and Graves’ disease. Studies have shown that individuals with Graves’ disease exhibit reduced gut microbiota diversity compared to healthy controls. Specifically, there is a decrease in the abundance of Firmicutes and an increase in Bacteroidetes, suggesting an imbalance in gut bacteria that may influence autoimmune responses.

Furthermore, certain gut bacteria have been found to share structural similarities with thyroid proteins, potentially triggering immune responses that lead to autoimmune thyroid diseases like Graves’ disease. The functional medicine perspective recognizes that gut health, and balancing the gut microbiome, is essential for managing Graves disease.

Functional Medicine Strategies for Managing Graves’ Disease

Functional medicine emphasizes a holistic approach to managing Graves’ disease, focusing on diet, supplementation, and lifestyle modifications to support thyroid health and overall well-being.

1. Functional Medicine Testing

• Gut Health: Gut health plays a crucial role in regulating the immune system, as a large portion of immune activity occurs in the gastrointestinal tract. An imbalanced gut microbiome or increased intestinal permeability (“leaky gut”) triggers immune dysregulation, contributing to autoimmune reactions like Graves’ disease by allowing toxins or antigens to enter the bloodstream and provoke an inappropriate immune response. Functional medicine offers testing methods for identifying the status of the microbiome including specific strains of microbes that are or are not present, allowing tangible, specific tests for treatment and rebalancing.
• Food Sensitivities: Food sensitivities overstimulate the immune system by triggering chronic, low-grade inflammation each time reactive foods are consumed. In individuals with autoimmune conditions like Graves’ disease, this constant immune activation may exacerbate symptoms or contribute to flare-ups by increasing the overall inflammatory burden. Identifying and eliminating trigger foods can help reduce immune system stress and support more balanced immune function. Functional medicine offers testing methods for IgG and IgA-mediated food sensitivies as well as Ig-E mediated food allergies.
• Histamine:Histamine intolerance occurs when the body cannot properly break down histamine, leading to an overload that triggers inflammation and immune system activation. This heightened immune response worsens symptoms in autoimmune conditions like Graves’ disease by increasing systemic inflammation and aggravating thyroid dysfunction, especially symptoms like heart palpitations, hives and anxiety. Histamine is a routine part of functional medicine testing, as well as other pathways of the body involved in histamine production and detoxification.

2. Dietary Strategies

• Anti-inflammatory Diet: Incorporate whole foods rich in antioxidants, such as fruits, vegetables, and fatty fish, to reduce inflammation. Many patients also experience food sensitivities to eggs, gluten or dairy, so testing and elimination of these reactive foods is also important.
• Limit Iodine Intake: Excessive iodine can exacerbate hyperthyroidism; it’s important to limit high-iodine foods unless testing demonstrates that you’re deficient in iodine.
• Avoid Stimulants: Reduce or eliminate caffeine and high-sugar foods to prevent overstimulation of the thyroid.
• Regular Meals: Eating at consistent times helps stabilize blood sugar levels and support metabolic function. It also helps prevent exacerbation of Graves’ symptoms, like anxiety, racing heart, or feeling dizzy.

3. Herbal and Supplement Support

• 1. Bugleweed (Lycopus europaeus)
  Action: Inhibits thyroid hormone synthesis and reduces TSH receptor activity.
  Evidence: Shown to reduce thyroxine (T4) levels and may help manage mild hyperthyroidism.
  
  2. Lemon Balm (Melissa officinalis)
  Action: Competes with TSH for receptor binding and may help reduce symptoms like anxiety and palpitations.
  Evidence: Traditionally used to reduce hyperthyroid symptoms; more robust human trials are limited.
  
  3. L-Carnitine
  Action: Acts as a peripheral antagonist of thyroid hormone activity and may relieve symptoms like muscle weakness and fatigue.
  Evidence: Effective in reversing hyperthyroid symptoms in both overt and subclinical cases.
  
  4. Selenium
  Action: Antioxidant that protects thyroid tissue and modulates autoimmunity.
  Evidence: Supplementation improves quality of life and reduces thyroid autoantibody levels in Graves’ disease.
  
  5. Vitamin D
  Action: Modulates immune function and lowers autoimmunity risk.
  Evidence: Low vitamin D is associated with increased thyroid autoimmunity and more severe Graves’ disease.
  
  6. Omega-3 Fatty Acids
  Action: Anti-inflammatory effects and immune modulation.
  Evidence: Helps regulate immune response and may reduce autoimmune thyroid inflammation.
  
  7. Ahnjeonbaekho-tang (AJBHT)
  Action: Traditional Korean herbal remedy shown to reduce thyroid hormone levels.
  Evidence: Clinical trials demonstrate improvement in T3/T4 levels and TSH normalization.
  

4. Lifestyle Modifications

• Stress Management: Chronic stress can exacerbate autoimmune conditions; practices such as meditation, yoga, and adequate sleep can help manage stress levels.
• Regular Exercise: Engaging in regular physical activity can improve cardiovascular health and support metabolic function.
• Avoid Environmental Toxins: Limit exposure to environmental toxins that may trigger or worsen autoimmune responses. It’s also important to avoid using hormonal contraceptives, as in my experience, these are a common trigger for new onset of Graves disease.

Graves’ disease is a complex autoimmune disorder with significant implications for thyroid health. Understanding its pathophysiology, recognizing the role of gut health, and implementing functional medicine strategies can provide a comprehensive approach to managing the condition. Always consult with a healthcare provider before making significant changes to diet, supplementation, or lifestyle to ensure safety and efficacy.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

References

1. ZUFRY H, ZULFA PO, HARIYANTO TI. The gut microbiota and its role in Graves’ Disease: a systematic review and meta-analysis. Biosci Microbiota Food Health. 2024 Jun 7;43(4):300–308. doi: 10.12938/bmfh.2024-020. PMID: 39364132; PMCID: PMC11444861.
2. Kiseleva EV, Kiseleva EV, Kiseleva EV. Gut Microbiota May Play a Significant Role in the Pathogenesis of Graves’ Disease. Front Endocrinol (Lausanne). 2020 May 5;11:301. doi: 10.3389/fendo.2020.00301. PMID: 32416683; PMCID: PMC7210420.
3. Lee YJ, Lee YJ, Lee YJ. An alternative therapy for graves’ disease: clinical effects and mechanisms of an herbal remedy. J Ethnopharmacol. 2008 May 28;118(3):409-13. doi: 10.1016/j.jep.2008.04.014. PMID: 18479224.
4. Komosinska-Vassev K, Olczyk K, Kucharz EJ, Marcisz C, Winsz-Szczotka K, Kotulska A. Free radical activity and antioxidant defense mechanisms in patients with hyperthyroidism due to Graves’ disease during therapy. Clin Chim Acta. 2000 May;300(1-2):107-17. doi: 10.1016/S0009-8981(00)00306-5. PMID: 10727685.
5. Ross DS, Burch HB

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These are some of the most common symptoms of what is commonly known as “adrenal fatigue.” But the biggest problem is that many patients go to their doctor, explain these symptoms, and share their concern that they are struggling with adrenal fatigue, only to be told by their doctor that adrenal fatigue isn’t real. The only problem is that your symptoms are real, and you deserve health. In other words, you deserve to know how to recover from adrenal fatigue, or whatever it is you’re dealing with.

But let’s start by addressing the elephant in the room:

Is “adrenal fatigue” real?

Yes. The symptoms are absolutely real, and they are absolutely related to the adrenal system. However, no, the idea that the adrenal glands become “fatigued,” so causing the above symptoms, isn’t quite how things work. Instead, we use the phrase hypothalamic-pituitary-adrenal axis dysfunction. Let’s dig in…

Stress, adrenal glands, cortisol, oh my!

Let’s first talk about what the word “stress” means. The way I typically think about stress is any condition under which the brain or body needs to be operating at a higher-than-normal level. This could be psychological (i.e. demands at work or school), emotional (i.e. relationship problems), physical (i.e. induced by exercise or sickness), or nutritional (poor diet in terms of quantity and/or quality). Whenever we are in a stressful situation, our bodies release stress hormones into our blood stream, which help our minds and bodies to respond to the stressful situation. The most notable of these stress hormones is cortisol.

Cortisol is produced in the body through a feedback loop called the hypothalamic-pituitary-adrenal axis. Basically, this means that the hypothalamus and pituitary gland (two parts of the brain) work together with the nervous system to communicate with the adrenal glands (located in the abdomen) to produce cortisol. This cortisol is released into the blood stream and acts on every organ of the body to get it ready to encounter the stressful situation. Some of these stress responses include:

• increased blood sugar (for quick energy)
• increased heart rate and blood pressure (to get the body moving)
• decreased digestion (who has time to run to the bathroom when they’re being chased by a bear?)

This loop is important for two reasons. First and foremost, the hypothalamus and pituitary axis are responsible for managing more than just the stress response in the body. These two parts of the brain utilize hormonal signals to regulate almost every other system in the body—everything from digestion, to fertility, to the thyroid…you name it!

When stress levels are high (or stressful situations are frequent), the hypothalamus and pituitary gland are forced to focus their efforts on managing the stressful situation. That means the other bodily systems fall to the wayside, which is why many people struggle with fertility and digestive issues, for example, due to stress. Although this is frustrating, it makes a lot of sense, because fertility and digestion don’t matter so much if you get eaten by a bear. The most important thing is to get away from the bear so that you can survive long enough to worry about fertility and digestion! The issue, of course, is that we are rarely chased by bears in the modern age. Instead, we’re chased by thoughts of monstrous work assignments, relationship issues, and other worries. Or, we’re doing a whole lot of running even though there are no bears around (too much exercise). For us in our modern age, the chronic stress response isn’t about survival…it’s a health problem.

The second important consideration of this HPA-axis feedback look is the concept of cortisol resistance. This is the term we use to describe the syndrome of “adrenal fatigue.” In this situation, the cortisol rise and rise and rise, until they can’t rise any more without causing huge problems. The result is elevated cortisol that isn’t having the intended effect. (There’s a need for more of a stress response in the body, but the adrenals are working at capacity.) We call this cortisol resistance. It’s almost as if the brain is saying “we need more cortisol” and the adrenals respond by saying “I don’t think that’s a good idea!”

Out of a protective effort, the high levels of cortisol signal to the hypothalamus to stop signaling so much. In some regards, operating the adrenals at max capacity still isn’t enough, and so the body recognizes that it had might as well pull back on the amount of cortisol it produces. Just like an overworked pancreas eventually stops producing insulin in late stages of type 2 diabetes, the adrenal glands can stop producing enough cortisol to maintain healthy responses. Some circles refer to this as “fatigue,” but the adrenals don’t really get fatigued. It’s more that the body has reached its maximum stress threshold and protectively responds by shutting itself down. But it feels a lot like fatigue.

Supporting the HPA axis

The best way to avoid “adrenal fatigue” or cortisol resistance is to avoid reaching “max capacity” of the body’s stress response. While some stressors are unavoidable, others are much more manageable. Emotional and psychological stressors are much more difficult to control than physical and nutritional ones, however, so it’s always a good idea to start with a balanced diet, keeping up with regular, moderate exercise, and sleeping enough.

For everything in between, which we have less control over, we can support our adrenal responses with herbs and supplements that help us respond to stress on a biochemical level. The mechanism of action of some of these nutraceuticals vary, but the main idea is that they help reduce inflammation, moderates the severity of the stress response to any given trigger, and helps the body recover from stress faster. Some of these evidence-based supplements include:

• Panax ginseng (Korean ginseng): improves sensitivity to cortisol, so the body doesn’t have to produce as much
• Ashwagandha (Indian ginseng): counteracts biological effects of extreme stress like changes in blood sugar, helps reduce cortisol levels, reduces anxiety behaviors
• Rhodiola rosea: protects the cardiovascular system against long-term effects of stress
• Phosphatidylserine: counteracts stress-induced activation of the HPA axis
• Cod Liver Oil: reduces cortisol spike following a stress trigger

To sum things up…

Stress in life is unavoidable, but there’s a lot we can do to improve our health by managing our exposure to stress…especially long-term. From eating well, to managing exercise and sleep, to keeping work-life-balance in check, we can support our bodies’ natural ability to respond to stress. Coming down off a “stress high” (or low, really) can be really challenging to do, but working with a functional medicine provider to use herbs, supplements, and lifestyle techniques for managing the HPA axis can make a world of difference.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post How to Recover from Adrenal Fatigue Naturally appeared first on Dr. Alexandra MacKillop.

Can you relate?

For many, the symptoms of hunger are a little more than a mildly irritable mood, a grumbling stomach, and a little fatigue. In fact, many people don’t even feel hungry in their stomachs when they need to have a snack, which can make it difficult to identify that blood sugar levels are at risk of dropping. If going long stretches of time without eating, skipping post-workout snacks, eating sweets on an empty stomach, or having an especially busy day causes symptoms such as the above (fatigue, irritability, weakness, dizziness, feeling cold, breaking out in a sweat, fainting, headaches, stomach pain) then you may be struggling with reactive hypoglycemia.

Just like some individuals struggle to maintain blood sugar balance because their cells are less sensitive to insulin than normal or they don’t produce enough insulin (as with diabetes), individuals who struggle with hypoglycemia have difficulty maintaining blood sugar balance because their cells are more sensitive to insulin than normal or they produce too much insulin. The number one way to promote healthy blood sugar balance with reactive hypoglycemia is to eat balanced, regular meals. That means more food, more often.

The idea of “more food, more often” sometimes seems counter-intuitive, especially if you have a goal of weight loss. It may seem like eating more is the last thing you’d want to do. However, the case I’ll make in this post and what I want you to know is that for women, especially women with health concerns like PCOS, perimenopause, hypothalamic amenorrhea or hypothyroidism, eating more is exactly what you want to do.

As with everything on my blog, this post is not intended to diagnose, treat, or cure any illness. If you are experiencing symptoms of reactive hypoglycemia or any health condition, talk to your doctor.

What Is Reactive Hypoglycemia?

Reactive hypoglycemia is a condition where blood sugar levels drop too low (typically below 70 mg/dL) within a few hours after eating, particularly following a high-carbohydrate meal. It occurs when the body produces too much insulin in response to the rise in blood glucose, leading to a rapid and excessive decrease. Symptoms can include shakiness, sweating, fatigue, irritability, and dizziness. While not usually imminently dangerous, reactive hypoglycemia can be a sign of underlying metabolic dysfunction and may be managed through dietary changes or a targeted supplementation strategy.

What Causes Reactive Hypoglycemia?

As with any condition, the contributing factors to reactive hypoglycemia are complex and varied. More often than not, a person has a genetic predisposition to the development of the condition, which is ultimately triggered by environmental/lifestyle factors, namely stress. As I explain in this post about hormones, stress affects almost every system of our bodies, especially our metabolism. Stress interrupts the delicate web of signals between our brains and our organs, and over time this can lead to more long-standing patterns of dysfunction.

Stress comes in many forms, though we most classically think of it as being related to emotional or relationship triggers. But just like a hectic schedule, tight deadlines, or unhealthy relationships contribute to stress, too much exercise, not eating well, poor sleep habits, chronic illness or allergies, and other environmental exposures can contribute to our levels of stress. I like to describe our stress tolerance as a bucket, and each of those different types of stressors fills the bucket. When the bucket gets full, our bodies start to overflow into dysfunction and disease.

But just like stress contributes to the onset or exacerbation of our symptoms, stress management and self-care can help increase our body’s margin, making us better able to handle triggers. When we’re taking care of ourselves well, missing a snack is less likely to send me into a crisis.

Note: Stress is the most notable contributing factor to metabolic dysfunction like reactive hypoglycemia, but other factors can also contribute such as alcohol use, surgeries, liver or kidney disease, tumors, or other metabolic disorders. If you are concerned about any of your symptoms, always make an appointment with your doctor.

What Are the Symptoms of Reactive Hypoglycemia?

The symptoms of low blood sugar are varied, which is why it can be challenging for some people to recognize patterns between their eating habits and their health. Personally, I find that paying attention to my body’s signals and checking in with myself regularly has helped me to better understand how to care for myself. This helps me know when my body needs food even if it isn’t a “normal” meal time.

Some of the symptoms of low blood sugar include:

• Feeling shaky
• Being nervous or anxious
• Sweating, chills, and clamminess
• Irritability or impatience
• Confusion
• Fast heartbeat
• Feeling lightheaded or dizzy
• Hunger
• Nausea
• Color draining from the skin (pallor)
• Feeling sleepy
• Feeling weak or having no energy
• Blurred/impaired vision
• Tingling or numbness in lips, tongue or cheeks
• Headaches
• Coordination problems, clumsiness
• Nightmares
• Insomnia or waking during the night
• Seizures

Many of my patients liken the feeling of low blood sugar to feeling drunk. They describe feeling tired, disoriented, and like they have tunnel vision. They say their muscles also get weak, they might feel sweaty, or their moods becomes either anxious or irritable.

How Is Reactive Hypoglycemia (Low Blood Sugar) Diagnosed?

There are a number of different ways to evaluate a person’s blood sugar. In my practice, here are a few key flags that I look for on blood work:

• Low fasting insulin levels (less than 4 mUnits/L)
• Low fasting glucose at the time of the blood draw (<75 mg/dL)
• Low a1c (less than 4.8%)
• Low levels of LDH (less than 100 units/L)

Bear in mind that these are functional labs, which means that not all healthcare providers are willing to run them (however a fasting glucose level is usually included as part of a comprehensive metabolic panel on annual preventative wellness labs run by most primary care doctors. A1c is also often included.) You might need to ask for insulin and LDH to be run as well, to get a complete picture.

Testing for Reactive Hypoglycemia at Home

If you don’t want to make an appointment with your doctor, there are two ways that you can test your blood sugar at home. The first is with an old-fashioned fingerstick and the second is with a newer piece of technology: a continuous glucose monitor.

Finger Stick:

To test your blood sugar using a finger stick, you’ll need test strips, a lancet and a glucometer. Often, these tools can be purchased together as a package, such as the iHealth glucometer kit, which is FSA eligible. I recommend starting out by testing your blood sugar several times per day, including:

• Fasted levels, first thing in the morning
• 30 minutes after meals
• 60 minutes after meals
• 2 hours after meals

Continuous Glucose Monitor (CGM)

As an alternative to using a finger stick method, you could consider tracking your blood sugar using a continuous glucose monitor. This method tests glucose levels in the interstitial space (tissue just below the skin) which changes and updates the Bluetooth app in real time. To use, a subdermal needle connected to some adhesive and a Bluetooth device is applied to the arm, abdomen, hip or thigh and continuously monitors blood sugar levels. For many, this is less painful than recurrent finger sticks. Stelo by Dexcom is a continuous glucose monitor with both iOS and Android-compatible technology.

When tracking my blood sugar with a CGM, I log the following data:

• Meals and snacks I ate that day
• My quality of sleep
• My stress levels
• My exercise
• Blood sugar levels overnight, 30 minutes after meals, and 2 hours after meals

How Is Reactive Hypoglycemia Managed with Diet?

The number one way to manage reactive hypoglycemia is to eat frequently, and make sure to pair carbohydrate foods with protein, fiber and fat to stabilize the release of glucose into the blood stream. I often recommend that my patients consume a fiber supplement, like a teaspoon of chia seed of psyllium husk with water, about 15 minute sbefore meals. It’s also a good idea to eat a protein-rich snack with fiber before bed to keep blood sugar stable enough for a good night’s sleep.

A good recommendation is also to avoid alcohol, as this can be a big trigger for hypoglycemia. Of course, there are situations when moderate alcohol use is part of a normal, healthy lifestyle, and so my recommendation is usually to restrict drinking to no more than 1 drink at a time, no more than 3 nights per week, always taken with a meal or snack that contains protein.

It’s also really important to manage stress—all types of stress. That means addressing relationship conflicts, creating boundaries to support work/life balance, eating high-quality food, exercising in moderation, developing productive coping skills, and practicing sleep hygiene. These are the most effective ways to support a healthy stress response, but in a clinical setting, I also sometimes use adaptogenic herbs and other supplements to balance inflammation, manage cortisol, and support a healthy blood sugar response for my patients. If you are interested in using herbs or supplements to manage stress or blood sugar, always check with your doctor first. Even better, work with a functional medicine doctor to find the herbs that are right for you. (This is important because some adaptogens have a blood sugar lowering effect, which could worsen symptoms of hypoglycemia.)

While reactive hypoglycemia can be extremely debilitating, it’s not the end of the story for your health. It isn’t a sentence for weight gain and you definitely aren’t doomed to feel that way your whole life. With a little digging and some strategic hacking of your nutrition and supplements, you can feel like 100% again, no matter your season of life.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Reactive Hypoglycemia Diet: How to Manage Low Blood Sugar Naturally appeared first on Dr. Alexandra MacKillop.

In clinical practice, I find that many of my patients use the word “bloating” to refer to different things. Sometimes, “bloating” refers to water retention, sort of like swelling of hands, fingers, feet, face and toes. That’s not what we’re talking about in this post. Rather, in this post, we will use the term “bloating” to refer to the sensation of distension and fullness in the abdomen, typically the lower abdomen, but it can also include the abdomen as a whole.

The sensation of fullness, discomfort, and even distension in the abdomen can be caused by several factors related to hormonal imbalances, inflammation, and other structural or functional issues in the reproductive system. Understanding how conditions like endometriosis, polycystic ovary syndrome (PCOS), ovarian cysts, fibroids, and pelvic floor dysfunction contribute to bloating can help identify the underlying causes of their symptoms and explore effective treatment options.

The Connection Between Reproductive Hormones and Bloating

When it comes to the pelvis and the organs that reside there, structure determines function. And, as I like to say in functional medicine, chemistry likewise determines structure. Swelling and inflammation of the uterus, cystic changes of the ovaries, as well as changes in bowel habits can all be driven by disruptions and imbalances in hormonal systems of the body.

Let’as take a look at how hormonal imbalances play a role in strutural changes that create the symptom of bloating.

1. Endometriosis and Inflammation-Induced Bloating

Endometriosis is a chronic condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus, typically on the ovaries, fallopian tubes, and other organs within the pelvic cavity. This growth of endometrial-like tissue leads to inflammation, pain, and a variety of gastrointestinal and reproductive symptoms, including bloating.

How inflammation contributes to bloating: Endometriosis causes the release of pro-inflammatory cytokines and other immune system factors that promote inflammation in the pelvic area (Wang et al., 2018). This inflammation can disrupt the normal functioning of the gastrointestinal tract, leading to symptoms like bloating, constipation, and diarrhea. Additionally, the endometrial tissue outside the uterus can create adhesions, which can lead to intestinal obstruction and further contribute to bloating (Viganò et al., 2004) through inflammatory immune chemicals. Whenever inflammatory immune chemicals are released, water retention follows.

In endometriosis, bloating can sometimes be severe, so much so that it has its own nickname: endo-belly.

Treatment for bloating caused by endometriosis is complex, involving many factors including food sensitivities, gut health and the immune system. However, being an autoimmune, inflammatory condition, addressing endo-belly in my practice often involves proteolytic enzymes as well as anti-inflammatory, estrogen-clearing herbs and medications, like DHA and DIM.

2. Polycystic Ovary Syndrome (PCOS) and Blood Sugar Dysregulation-Related Bloating

Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects women of reproductive age. It is characterized by irregular menstrual cycles, elevated levels of androgens (male hormones like testosterone), and cysts on the ovaries. One of the less-discussed but significant features of PCOS is blood sugar dysregulation, which can contribute to bloating because of the profound inflammation that accompanies it.

How blood sugar dysregulation contributes to bloating: in nearly 70% of cases, insulin resistance accompanies PCOS, which is a condition where the body’s cells become less responsive to insulin, leading to higher levels of circulating insulin (Teede et al., 2018). Insulin resistance disrupts normal carbohydrate metabolism, causing blood sugar levels to fluctuate. This can lead to gastrointestinal discomfort, bloating, and indigestion, especially after meals that are high in refined carbohydrates or sugars.

Additionally, insulin resistance affects gut motility, leading to slower digestion and bloating. The imbalance of estrogen and progesterone in PCOS also exacerbates gut symptoms, as these hormones influence how the gut functions (McAllister et al., 2020). Women with PCOS often report feeling bloated around the time of their period or after consuming certain foods. Elevated estrogen levels seen in PCOS negatiely impact the ability of the gut to clear inflammation and toxins, which leads to build-up of these chemicals in the body.

In my practice, treating PCOS means first identifying which type of PCOS is present. Did you know there are 4 types of PCOS Learn more in this blog post.

3. Ovarian Cysts and Fibroids: Structural Issues Leading to Bloating

Ovarian cysts and uterine fibroids are both structural issues that contribute to bloating, particularly in individuals with hormonal imbalances. In these cases the bloating doesn’t come from gas, inflammation or fluid, but of structural changes and growth that take up physical space. Both cysts and fibroids are diagnosed with ultraosund imaging.

Ovarian cysts: Ovarian cysts are fluid-filled sacs that form on or within the ovaries. These cysts can be functional (normal and temporary) or pathological (abnormal and persistent). Functional cysts typically resolve on their own, but large or persistent cysts can cause bloating, pelvic pain, and pressure on nearby organs. As cysts grow, they can push against the abdominal wall and intestines, leading to discomfort and a feeling of fullness or bloating (Sahu et al., 2017). Sometimes, surgery is required to remove large or complicated ovarian cysts. Iodine deficiency, use of hormonal IUDs, hypothyroidism and perimenopause all increase risk of developing functional ovarian cysts.

Uterine fibroids: Fibroids are benign growths in or on the uterus that can vary in size and location. Large fibroids or multiple fibroids can cause significant abdominal bloating, pressure, and pain. Fibroids can disrupt the normal movement of the gastrointestinal tract and cause a sensation of fullness, bloating, and even constipation (Lethaby et al., 2015). Hormonal fluctuations, particularly high estrogen levels, contribute to the growth of fibroids, making the condition more likely to cause bloating in individuals with hormonal imbalances.

The presence of these structural issues can also cause other symptoms like heavy menstrual bleeding, pelvic pain, and lower back discomfort, which can be exacerbated by bloating.

4. Pelvic Floor Dysfunction and Bloating

Pelvic floor dysfunction refers to a range of conditions where the muscles of the pelvic floor (the muscles that support the bladder, uterus, and rectum) become weak or overactive. This dysfunction can lead to symptoms like urinary incontinence, pelvic pain, and bloating. It also can affect passage of stool, which can trap gas or cause constipation, both of which also contribute to abdominal bloating.

How pelvic floor dysfunction contributes to bloating: When the pelvic floor muscles are not functioning properly, it can affect the body’s ability to manage intra-abdominal pressure, especially during digestion.

Individuals with pelvic floor dysfunction may also experience bloating related to the inability to properly relax the pelvic floor muscles during defecation, leading to a buildup of gas in the intestines and the sensation of bloating. The pelvic floor muscles play an essential role in normal bowel and bladder function, so dysfunction can lead to a cascade of digestive symptoms.

The best treatment for pelvic floor dysfunction is to see a pelvic floor therapist. You can find a physical therapist, chiropractor or occupational therapist of this credentialing through the Herman and Wallace Website. (This is the best, most renowned training program for pelvic floor therapists.)

How Functional Medicine Approaches Hormonal Disorders and Bloating

Functional medicine emphasizes addressing the root causes of health problems, including hormonal imbalances, inflammation, blood sugar dysregulation, and structural issues. When it comes to bloating related to reproductive hormone disorders, a functional medicine approach may include:

1. Addressing hormonal imbalances: Through personalized treatments like bioidentical hormone therapy, herbal supplements, and lifestyle changes, functional medicinebalances hormones such as estrogen, progesterone, and testosterone. For example, in PCOS, regulating insulin resistance and restoring hormone balance can reduce bloating and other symptoms (Moran et al., 2015).
2. Reducing inflammation: Anti-inflammatory approaches are crucial in managing conditions like endometriosis. Functional medicine often recommends dietary changes, such as increasing omega-3 fatty acids and reducing inflammatory foods (e.g., refined sugars and ultra-processed foods), as well as using herbal supplements like enzymes and curcumin to help reduce inflammation and manage symptoms.
3. Improving gut health: Gut dysbiosis (an imbalance of gut bacteria) can contribute to bloating. Functional medicine also involves the use of probiotics, prebiotics, and digestive enzymes to support gut health. Additionally, an elimination diet or food sensitivity testing may help identify specific triggers that exacerbate bloating (Bartz et al., 2020).
4. Supporting pelvic floor health: Pelvic floor exercises, like Kegels, stretching and physical therapy, and mindful movement techniques, can help address pelvic floor dysfunction.

Bloating can be a frustrating and uncomfortable symptom, especially when it is linked to hormonal disorders such as endometriosis, PCOS, ovarian cysts, fibroids, and pelvic floor dysfunction. The underlying causes of bloating are multifactorial, which is why understanding the root cause is essential for making progress. A functional medicine approach to treating bloating focuses on restoring hormonal balance, reducing inflammation, improving gut health, and addressing any structural or functional problems that may contribute to digestive distress.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

References

Bartz, D., et al. (2020). Gut health and its link to the reproductive system. Journal of Women’s Health, 29(7), 900-912. https://doi.org/10.1089/jwh.2020.8184

Berg, E., et al. (2015). The role of pelvic floor dysfunction in gastrointestinal disorders. The Journal of Gastrointestinal Surgery, 19(8), 1461-1469. https://doi.org/10.1007/s11605-015-2855-9

Lethaby, A., et al. (2015). Uterine fibroids and bloating: A systematic review of symptoms and treatments. Cochrane Database of Systematic Reviews, 3, CD010747. https://doi.org/10.1002/14651858.CD010747.pub2

McAllister, K., et al. (2020). PCOS and its relationship to gastrointestinal symptoms. European Journal of Endocrinology, 183(3), 277-283. https://doi.org/10.1530/EJE-20-0296

Moran, L., et al. (2015). Insulin resistance and obesity in PCOS. Endocrinology and Metabolism Clinics of North America, 44(3), 373-385. https://doi.org/10.1016/j.ecl.2015.04.003

Sahu, A., et al. (2017). Ovarian cysts and their impact on abdominal bloating. The Journal of Reproductive Medicine, 62(7), 543-551.

Teede, H. J., et al. (2018). PCOS and insulin resistance. International Journal of Obesity, 42(8), 1367-1377. https://doi.org/10.1038/s41366-018-0094-4

Viganò, P., et al. (2004). Endometriosis and gastrointestinal symptoms. The Journal of Reproductive Medicine, 49(6), 437-442.

Wang, X., et al. (2018). Inflammatory mediators in endometriosis. International Journal of Inflammation, 2018, 8478049. https://doi.org/10.1155/2018/8478049

Zhang, H., et al. (2019). The role of turmeric in reducing inflammation in endometriosis. Journal of Pain Research, 12, 513-524. https://doi.org/10.2147/JPR.S215752

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