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.

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The post Functional Medicine PCOS Treatment 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.

In my office, I frequently see women dealing with period problems. Unfortunately, many providers have told these women that their experiences are “normal” even though they are far from optimal. So, they go along in life thinking that they need to deal with uncomfortable symptoms like unpredictable bleeding, irregular periods, cramping, PMS and more. In these instances, it make take years to get an accurate diagnosis. For other women, however, the change in period symptoms is what catches their attention. Their periods used to behave one way and then, all of a sudden, things changed. Even still, many providres write this off as normal, even when it’s not. “Bodies change,” they say. While this is true—bodies do change—we still have criteria that need to be met in order to classify something as normal.

With regards to a vague symptom like a period starting, then stopping, then starting again, many providers may write this off as normal because:

1. It isn’t going to kill you
2. It typically doesn’t affect quality of life enough to become debilitating
3. It’s really common

…and this is true. Unpredictable bleeding won’t cause end of life, and unlike severe cramps, it’s not painful, merely inconvenient. Plus, it’s a symptom many people deal with. However, providers in the traditional medical model aren’t equipped to deal with a symptom like this. They haven’t been trained in piecing out these symptoms of hormone imbalances and don’t have tools to address it apart from completely overriding your hormones altogether, like through hormonal contraception.

Abnormal bleeding might look like spotting mid-cycle, or having your period start as normal, stop for 24-36 hours, then resume again. Other times, it may stop for 3-4 days and then resume. These patterns indicate different root causes.

In this post, I’m going to outline a few reasons that a person may experience unpredictable bleeding of this nature. Whether you’ve been dealing with this problem for years or it’s a new symptom that suddenly changed, you deserve to have your health explored in detail.

Reasons for Unpredictable/Irregular Bleeding

1. Hormone Imbalances: At the start of your period, hormones drop quite low, comparatively to how things typically “flow” throughout the remainder of your cycle. Take a look at the graphic above: ovarian hormones drop quite low during the first phase, the menstrual phase of the cycle. Irregular hormone production, particularly of estrogen, can easily cause these levels to stop and start. Both high and low estrogen levels may cause irregular bleeding. High estrogen without enough progesterone to balance it out is problematic, growing the uterine lining too much and leading to this “extra” bleeding. Low estrogen dips can produce spotting.
2. Breastfeeding: Nursing, even after periods have returned postpartum, causes real-time hormone fluctuations. Paired with exercise, sleep deprivation, or stress, this can be a big tax on the body. Consider TLC and working on stress managment techniques to help support the demands on your body during this time.
3. Stagnation: This is a term from Traditional Chinese Medicine! In the TCM perspective, blood and energy, called qi, flow through the body in predictable channels. If there’s an interruption to this flow, blood may literally not flow how it should, getting “stuck” and causing irregular patterns of starting and stopping! Especially combined with clotting, dark colored blood, cramping, breast pain, irritability, bloating, and other symptoms associated with stagnation, you should see a TCM practitioner and/or acupuncturist!
4. Stress: Similar to the flow of energy in TCM, emotional stagnation can cause problems in the body. As with the effects of trauma and stress on the body’s neurological pathways (i.e. “The Body Keeps The Score” by Bessel van der Kolk, MD) emotions also affect physiological pathways. If emotions aren’t flowing freely, it can cause other areas of the body to get “stopped up” too. Think: constipation, difficulty crying, insomnia, headaches, muscle tension. Do you notice that you’re holding your breath or struggling to breathe deeply Do you have tightness and tension in your pelvis Are you feeling rushed, under pressure, or frustrated Find healthy outlets for emotional frustration. Focus on finding targeted means of relaxation. See a therapist, talk to a close friend, build TLC into your day. Even better, employ cycle syncing methods to help support emotional vitality and “let go,” especially during your period.
5. Fibroids/Polyps: If you have mid-cycle bleeding, particularly after physical exertion, sex, or bowel movements, you may have a structural abnormality of the uterus that may need surgical removal. Make an appointment for a pelvic ultrasound.
6. Ovulation Bleeding: Mid-cycle spotting (very light, pink or brown; not red) at the time of ovulation as identified by tracking basal body temperature is a different kind of bleeding, not related to your period. This one truly may be normal, associated with changes to the ovary at the time of ovulation. However, if you have new ovulation spotting when you never did previously, it may be time to see a healthcare provider for some hormone testing.

Overall, periods that start, stop and then start again after a few days are not normal, no matter how common they are. If you experience this, talk to your doctor about it. If they dismiss it, it may be time for a new approach through functional medicine. Pay special attention to the effects of emotions, stress and how energy flows through your body. After all, the body really does keep the score.

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 Why Does My Period Stop and Start Again? appeared first on Dr. Alexandra MacKillop.

But first as a woman, and second as a functional medicine doctor, I definitely do not see this as an acceptable standard for care, mostly because I know that there are other options that are not only more effective, but also much safer than the pill. Let’s dive in…

A few things to keep in mind as you read this post:

There are many reasons for abnormally painful periods and this post covers just three of them. But more importantly, if you’re struggling with painful periods, or any other symptom, it’s extremely important that you discuss your concerns with a licensed healthcare provider. There are many factors that could be at play, and you deserve to be heard and cared for in the very best possible way.

3 Reasons for Painful Periods

As I noted above, there are many women’s health diagnoses that have period pain as a symptom—things like endometriosis, fibroids, PCOS, and more. For this discussion, we will focus on reasons for period pain in women who don’t have a formal diagnosis. However, even if you do have an existing diagnosis, addressing some of these issues may actually help improve your symptoms.

1) Hormone Imbalances

The menstrual cycle can be divided into two main parts: the follicular phase (pre-ovulation) and the luteal phase (post-ovulation). We typically think of estrogen as the “main” hormone of the follicular phase, and progesterone as the “main” hormone of the luteal phase, but really Both are present and working all the time, just at different levels.

Sometimes, the relative proportion of estrogen and progesterone (in relation to each other) fall out of balance, and this can cause symptoms like cramps and other forms of menstrual pain. For example:

During the luteal phase (after ovulation), the menstrual lining starts to build up in case the egg is fertilized. Estrogen’s job is to build up the lining, directing blood flow and tissue growth in the uterus, whereas progesterone’s job is to keep things from getting out-of-control, so to speak. If estrogen levels are disproportionately high in relation to progesterone levels (i.e. estrogen dominance), the uterine lining will become more robust, often leading to a heavy period with clots, which may be painful to pass. Additionally, high estrogen levels lead to higher levels of prostaglandins in the uterus, which causes higher levels of inflammation and pain (see point #3).

Estrogen dominance and progesterone deficiency are just two examples of hormone imbalances that can cause period pain. Other hormones like cortisol and thyroid hormones (especially hypothyroidism) affect the menstrual cycle and can cause symptoms such as pain.

2) Feminine Protection Products

I would give a TMI warning but really I don’t think periods should be a taboo subject anymore. Frankly, ever person alive is here because of the functioning of a woman’s reproductive system, and I think we all could stand to understand it a little bit more. So, yes…we’re going there.

Tampons are convenient, but not if they’re causing painful cramps—and yes, tampons can cause or worsen cramps if they aren’t inserted correctly. Take a look at the graphic above. The tampon pictured is right up against the cervix. When the uterus contracts to expel blood, it will bump up against the tampon causing pain, kind of how punching a wall hurts a lot more than punching into the air.

Instead, angle the applicator downward. By pointing the applicator downward (and relaxing during insertion), the tampon will be able to reach an area of the vagina called the posterior fornix, which is behind the opening of the cervix. Then, instead of bumping into the tampon, which is held firmly in place by the muscles of the vagina, it will slide past the tampon, which is much more comfortable.

However, some women have cramps no matter where the tampon is located. Alternatively, you can use pads or a menstrual cup. The Diva Cup takes a little getting used to (you’ve gotta be up close and personal with your lady parts) but rather than stopping at the cervix, it encircles it, eliminating any possibility of bumping and pain. The plus side of a menstrual cup is that it only needs to be changed every 12 hours, rather than 4-6.

Another reason women tend to tolerate pads or menstrual cups better is because most brands of feminine hygiene products contain preservatives and bleaching chemicals that can irritate the vagina, increasing the local levels of inflammation and causing pain. (More on inflammation in point #3). For this reason, I typically recommend keeping foreign objects out of the vagina and instead using external protection (pads), a menstrual cup (made from silicone), or organic tampons such as seventh generation, Rael, Tampax pure, or OB Organic.

3) Inflammation

When you have cramps What do you do?

If you handle it the way I did for many years, you pop an Advil, take a nap, and pray that you feel better in an hour. And, if you’re like me, it works.

That’s because napping and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen both reduce inflammation in the body, and it’s inflammation that’s responsible for period pain.

The inflammation caused by a period comes from chemicals called prostaglandins, which are naturally produced in the lining of the uterus to trigger contractions during menstruation and labor. In addition the triggering muscle contractions, these prostaglandins also create low-grade inflammation , which is perceived as pain in the pelvic area (i.e. cramps).

Whenever we have a localized area of inflammation, we have pain. This pain can vary in intensity, but in general, the higher the level of inflammation, the worse the pain is. That’s why bumping your shin on the corner of the bed hurts, but not as badly as breaking your leg would. The injury is much worse in the latter case. However, bumping your shin on the bed hurts more when you already have a bruise from doing the exact same thing the day before, or if you have a sore leg from running a marathon, or if your whole body is sore because you have the flu. That’s because in each of those cases, there is pre-existing inflammation in the body and the higher the level of inflammation, the worse the pain is.

The same is true with the localized inflammation in the uterus during menstruation. The naturally produced (and very necessary) prostaglandins in the uterine lining cause some inflammation, enough to produce mild cramping during the first couple days of a period. However, if there’s already a heightened degree of inflammation in the whole body, be it from chronic stress, poor nutrition, crash dieting, over-exercising, illness, or otherwise, the total amount of inflammation in and around the pelvis is higher. The higher the level of inflammation, the worse the pain is.

No matter the reason for the period cramps, whether due to a hormone imbalance, endometriosis, fibroids, or anything else, reducing the total amount of inflammation in the body will decrease the level of pain.

How to Naturally Reduce Inflammation

1. Acupuncture: this is probably my #1 recommendation for co-management of care with women’s health concerns in practice. Traditional Chinese Medicine is incredibly powerful in terms of its ability to help balance hormones, reduce stress, and decrease the inflammatory response.
2. Nutrition: Not eating enough, or enough of the right nutrients, can create imbalances that lead to heightened inflammation. Some of the most common nutritional deficiencies that predispose women to painful periods include omega-3 fatty acids, magnesium, and vitamin D. Talk to your doctor about having your levels checked.
3. Musculoskeletal Problems: Tight muscles are painful muscles, and if you’re dealing with chronically tight and painful muscles, that probably means you’re also dealing with high levels of inflammation in your whole body. I’m always amazed by how much better I feel when I rub epsom salt lotion into sore shoulders, massage out the knots in my neck with my acucurve self-massager, or stretching out on my foam roller.
4. Sleep: Poor sleep causes all kinds of problems, not just in terms of periods. Not getting enough sleep is interpreted by the body as a chronic form of stress, and pretty much all other health efforts will be blunted if you’re not sleeping enough. Adults need 8-10 hours per night.

In general, it’s not normal to feel awful during your period. While I’m a firm believer that menstruation is a natural process (and therefore it’s normal to feel different at different times of the month), but if your period is getting in the way of your ability function, that’s not okay. You deserve to find out what’s going on so you can feel your best and live a fulfilling 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.

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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 3 Reasons for Painful Periods (and Natural Treatment) appeared first on Dr. Alexandra MacKillop.

*Note: in this post, I make a lot of references to hormones and phases of the menstrual cycle. If you are unfamiliar with these topics, I encourage you to first read these posts:

• How to Balance Hormones Naturally
• Understanding Hormones for Women

What is BBT and why should we track it?

Basal body temperature (BBT) refers to the temperature of our bodies when we are at rest, typically measured after a period of sleep of at least four hours. When we’re awake, up, and “at it” in our daily lives, our metabolisms are revved up and producing heat as a by-product from using energy. But when we’re sleeping, energy output is low, and we’re in an environment with a stable temperature, allowing our bodies to find an optimal hot/cold balance.

In addition to exercise, eating/drinking, and the tasks of life, our hormones have a large influence on the temperature of our bodies. However, unlike the activities of daily living, our hormones influence our body temperature while we are at rest. While thyroid hormones do play a role, their influence tends to be more steady/stable in comparison to sex hormones—namely estrogen and progesterone. Progesterone is especially responsible for changes in basal body temperature because it creates an increase of about 0.2-0.4 degrees Celsius when levels are at their highest versus when they’re at their lowest.

This temperature change from progesterone is important because once that rise first starts to take place, it means progesterone is being produced at a high level. As I describe in this post about female fertility, this progesterone increase is triggered by ovulation. By charting basal body temperature, we can learn the exact day on which we ovulate in a given cycle, predict the day of ovulation in a future cycle, and identify our fertile days, which is helpful both if we’re trying for a pregnancy or trying to avoid one.

How to Chart BBT

To track your basal body temperature, you need two things: a basal body temperature thermometer and a means for graphing your temperature points. Some women prefer to do this the old fashioned way with pen and paper, but I like to use an app, such as Fertility Friend or Kindara. Keep in mind that in order to accurately chart, you need a thermometer that reads up to two places past the decimal. Most oral thermometers only read to on place past the decimal, and these are not accurate enough for this purpose. BBT thermometers are affordable (usually less than $20) and you can find them on amazon. Here’s a link to the one I use.

Temperature readings need to be taken as close to resting as possible, which means first thing in the morning after you wake up from at least 4 hours of uninterrupted sleep. As much as possible, try not to roll or move around too much (or get up to use the bathroom) before taking your temperature. Keep your thermometer in a place that is easily accessible from your bed, like your night stand. Since I log my chart in a phone app, my morning starts off with waking up, taking my temperature, recording it in my app, and then doing everything else. It took a few days to get the hang of it, but now it’s just part of my automatic routine.

Interpreting BBT Charts

As already mentioned, progesterone is responsible for the cyclic increase in basal body temperature after ovulation, and decreasing progesterone levels correspond to the decline of basal body temperature back to the baseline low. This rise/fall of progesterone and subsequent rise/fall of BBT is the basis for charting.

Throughout the follicular phase, our BBT is at a low. The day after ovulation, it takes a sharp rise, usually of more than 0.4 degrees, due to the sharp rise in progesterone. This temperature rise is sustained until a few days before your period, when it slowly drops back down again. As you can see on this chart example, there is a notable increase in temperature from 97.7 degrees on cycle day 15 up to 98.3 degrees on cycle day 16. Based on this information, we can interpolate that ovulation took place on cycle day 15. (We know this from our understanding of hormones that the corpus luteum formed after ovulation produces progesterone.)

When interpreting your own BBT chart, look back over your first month of charting to see when the temperature rise first took place. The day before this temperature rise corresponds to the day of ovulation. This is the most important piece of information gained from tracking BBT.

What Your BBT Chart Can Tell You

Charting empowers us to be able to identify the day of ovulation with a very high degree of accuracy. With the menstrual cycle, ovulation is everything, and it is what informs our knowledge of conception, contraception, and everything else. Knowing when we ovulate is key in terms of timing sex to promote chances of pregnancy, or avoiding unprotected sex in order to prevent pregnancy. Ovulation is the key factor in conceiving a child, and if the lifespan of the sperm doesn’t overlap with the day of ovulation, it’s impossible to get pregnant. Fertile days are calculated in relation to the day of ovulation, including the 5 days prior to, the day of, and the day after ovulation (7 days total). Outside of that “fertile window,” pregnancy is pretty much impossible. (As with any form of birth control, surprises happen. But with this highly accurate, informed method, they are rare.) Along the same lines, we know that the days with the best chance of conceiving are the day of ovulation and the two days prior. When you know what day you ovulate, you can time sex to optimize your chances of success.

• When to expect Aunt Flo: In addition to knowing the number of days in your average cycle, tracking BBT gives clear information about when your next period is due. Just as rising temperatures signify elevated progesterone as the result of ovulation, falling temps towards the end of the cycle indicate that hormone levels are dropping, and your next period is just a few days away. If you have an “off cycle” due to stress or travel or something and your period is coming early or late, BBT will give indicators by falling temperature. I’ve found this to be helpful, as surprise visits are never welcome.
• Conceiving a pregnancy: If you’re trying to get pregnant, charting BBT gives you the best information as to what your fertile days are. Look back on your last cycle and identify which day of your cycle you ovulation. For the next cycle, your best chances of conceiving will be the day of ovulation and the two days prior. While it’s a good idea to have sex at least every other day for about a week (starting the five days leading up to ovulation), you can focus your efforts on a few days to have better accuracy and feel less pressure.
• Contraception: You can’t get pregnant if you don’t have sex during your fertile window. By using BBT to inform the days you do and don’t use protection, you can avoid the health risks and unpleasant side effects of products like birth control pills, implants, and IUDs. If you want to be ultra conservative, I recommend using a barrier method like condoms for the seven days of your fertile window plus three for a total of ten days. This would correspond to the seven days before ovulation, the day of ovulation, and the two days after. Of course, a barrier method is necessary to reduce risk of sexually transmitted infections, but if you’re in a relationship where pregnancy is your only concern, then a mixed method such as this one could be a good fit for you and your values.
• Anovulation: In addition to telling us when we’re ovulating, BBT charting can help shed light on situations in which we aren’t ovulating. While not ovulating often results in a missed period, it’s possible to have periods (even regular ones) in which ovulation doesn’t take place. (This is what happens with birth control pills. They cause a monthly bleed via artificial estrogen but prevent ovulation.) If this is the case for you, it’ll show up on your chart. Instead of having a biphasic chart, which refers to the two periods of time before and after the temperature rise, your chart will be monophasic. There will be no distinct temperature rise.
• Early pregnancy detection: Another phenomenon of BBT charting is early pregnancy detection. As you can see on the chart example above, body temperature starts to fall starting at around cycle day 28. This results from decreasing progesterone levels as the cycle comes to an end. In a non-pregnant cycle, the corpus luteum is at the end of its “life span” and has stopped producing hormone. The uterine lining is getting ready to shed. However, in a pregnant cycle, the embryo implants around 6-12 days after ovulation and starts producing estrogen and progesterone in addition to what the corpus luteum is making. Because of this, the progesterone levels stay high (and steadily increase) rather than tapering off. By the end of your cycle, if you’ve had unprotected sex during your fertile window, and your BBT remains high, there’s a good chance you could be pregnant. Additionally, some women experience what’s called an “implantation dip” around the time that the fertilized egg becomes embedded in the uterine lining. On a chart, this looks like a sudden drop in temperature of 0.3 degrees or more followed by a sharp return the following day. Another sign of pregnancy (though this is present in up to 5% of non-pregnant cycles too) is what’s called a triphasic chart. After implantation in some pregnant women, a third temperature rise takes place. Instead of a baseline, rise, and plateau in a biphasic chart, a triphasic chart will have a second rise and plateau. Keep in mind that implantation dips and triphasic chart appearances are not completely reliable methods for identifying pregnancy. The only way to know for sure that you are pregnant is to have a positive pregnancy test, which is most accurate on or after the day of your expected period. (As a side note…many women take tests early, but false negative rates are very high until the day Aunt Flo is due.)

My book, Go with Your Flow, explains more about cycle tracking in detail. Check it out to go deeper with understanding your hormones at home.

Troubleshooting Your Chart

BBT charting can be confusing the first month you do it. I know for myself, I thought I was doing something wrong because my chart seemed like it was all over the place. However, by the time I made it to the end of the month, I could clearly see the expected pattern, and was relieved to know that I hadn’t messed it all up.

Because body temperature is sensitive to the environment, things like illness, alcohol, restless sleep, travel, stress, or excessively hot/cold sleeping temperatures can create fluctuations in temperature. Despite these outliers, the pattern is still readily apparent. Just keep in mind that you might need to make it through your first whole cycle before you get the full picture.

As an example, here is a picture of one of my first ever charts. I had a few days where the temperatures deviated quite a bit from my baseline, but the app I used (Kindara) allowed me to mark those days as “questionable” (seen as gray dots) which gave me a clearer overall picture.

On this chart, I included a horizontal line to show the threshold I measured between my follicular phase and my luteal phase. In this cycle (which is my norm) I ovulated on cycle day 14, which was followed by a sharp temperature rise from 97.3 degrees to 97.7 degrees on cycle day 15. I knew immediately that cycle day 15 was the first day of my temp rise because it was the highest temperature I had recorded the entire cycle except for day 2 when I knew the higher temperature was an outlier. During my follicular phase for this cycle, my average temperature was about 97.4 degrees and it was about 97.8/97.9 degrees during my luteal phase. (I had a few really high temperatures but they sharply dropped off right before my next period.)

On this chart, you can also see the orange line which represents “egg white” quality cervical mucus. I don’t typically chart my mucus but I do pay attention, especially on the days when I have watery or egg white cervical mucus, as these are high indicators of fertility. I have also used urine test strips to detect luteinizing hormone as a triple confirmation of when I’m ovulating. By now, I know for sure how to identify my fertile days through charting and observation.

In addition to temperature and cervical mucus, many charting apps include options for tracking other symptoms like breast tenderness, spotting, positive or negative pregnancy tests, positive or negative ovulation tests, and more. There are different free and paid apps out there with different capabilities, and I encourage you to try out a few to find one that works for you!

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 Basal Body Temperature 101 (How to Track Your Cycle) appeared first on Dr. Alexandra MacKillop.

Estrogen dominance is a buzz word in natural health circles. With it popping up in conversations everywhere, you might be wondering what it is, whether you need to worry about it, and how to fix estrogen dominance naturally through functional medicine. If that’s you, you’re in the right place.

Women’s health concerns tend to follow predictable patterns. In healthy women, cyclic changes in sex hormones throughout the month make it possible to track fertility—everything from ovulation, to an expected period, to optimal days for conceiving or avoiding pregnancy. In the same way, dysfunctional cycles tend to follow predictable patterns according to measurable imbalances in estrogen, progesterone, and testosterone. One of the most common hormonal imbalances is estrogen dominance, which can disrupt the natural rhythm of the menstrual cycle.

Whether or not the imbalance clinically correlates to a formal diagnosis—such as endometriosis or PCOS—there’s a lot that can be done to help balance female hormones. Estrogen dominance is one key reason that cycles can get out of sync, and it’s often associated with symptoms like heavy periods, breast tenderness, weight gain and mood swings. Addressing estrogen dominance through lifestyle changes, nutrition, and targeted supplementation can make a meaningful difference in restoring hormonal balance.

Estrogen Dominance and Progesterone

Throughout the female cycle, two hormones tend to be held responsible for triggering key events such as ovulation and the start of a period.

• In the first half of the cycle, which is classically defined by estrogen dominance, estrogen rises and falls, correlating with a hormonal signal from the brain that triggers the release of an egg.
• Following ovulation, the ovary produces progesterone, which is responsible for thickening the uterine lining in anticipation of pregnancy.
• After about seven days, progesterone levels peak and begin to steadily decline; once they drop low enough, the lining starts to shed, signaling the start of a period and another cycle.

However, that delicate balance between estrogen and progesterone can easily become disrupted by other hormonal imbalances such as thyroid hormones, or cortisol—the stress hormone. Often, this leads to a relative excess of estrogen in comparison to progesterone, creating symptoms like hot flashes, moodiness, fatigue, painful periods, and more. We call this estrogen dominance. Long-term elevation of estrogen can also increase risk for cardiovascular disease, breast and ovarian cancers, diabetes, and infertility. If monthly symptoms aren’t bad enough, the long-term risks mean that addressing estrogen dominance is really important for lifelong health and well-being.

What Causes Estrogen Dominance?

The production of estrogen from the ovaries is regulated by the hypothalamic-pituitary-gonadal axis, a delicate web of signals between the brain and reproductive organs. The estrogen excess form of estrogen dominance can result from interruptions along the entire axis, whether from a signaling problem at the brain level, or from dysfunction of the ovaries themselves. Many women also experience high estrogen because the pathways involved in the synthesis of estrogen can be interrupted by hormone-disrupting chemicals (such as BPA and plastics), because the precursor hormones are being diverted into the production of other hormones (like cortisol), or because of autoimmune diseases or medication use. Here are a few other reasons for high estrogen and estrogen dominance:

• Adrenal dysfunction
• Perimenopause
• Exogenous estrogen use (such as hormonal contraceptives)
• Exposure to xenoestrogens (BPA, phtlalates, DEHP, and other chemicals found in plastic; insecticides; food additives such as BHA and those found in red dye)
• Insulin resistance
• PCOS
• Liver dysfunction
• Hypothyroidism
• Smoking
• Use of the fertility drug, Clomid (Clomiphene citrate)
• Inflammation

Note: I explain the details of what is and isn’t normal and how to explore natural treatment options in my book, Go with Your Flow. Click here to learn more.

What to Do About Estrogen Dominance

As with any hormonal imbalance, effective treatment for estrogen dominance starts with identifying the root cause. This is why it’s so important to work with a naturally-minded healthcare provider to review diagnostic tests and lifestyle/history to get to the bottom of the estrogen dominance. If adrenal dysfunction is the driving force behind high estrogen and estrogen dominance, for example, no amount of estrogen-clearing supplements will effectively solve the problem. The adrenal dysfunction needs to be addressed, first!

Once an appropriate diagnosis is made and healing efforts are underway, there are a number of steps that can be taken to help the body clear out excess estrogen, balance out the production of progesterone, and get the hormone levels back to a functional status quo.

Lifestyle Modification for Estrogen Dominance

Gut Health: As with many other areas of health, the gut microbiome plays a huge role in hormonal balance. Not only do the naturally-occurring bacteria and yeast in our digestive tract aid in digestion of food and absorption of nutrients, they also produce a large proportion of the body’s hormones and neurotransmitters. They also are involved in the metabolism and excretion of hormone breakdown products. The group of bacteria responsible for metabolizing estrogen and estrogen breakdown products is called the estrobolome. A disruption in the gut microbiome can easily lead to estrogen dominance.

The more different types of bacteria we have in our gut, the greater the number of functions our microbiome has. (This is why microbial diversity is important.) When our gut diversity is limited, functions such as those carried out by the estrobolome are interrupted. Rather than restricting your diet, as many “estrogen dominance diets” encourage, focus on including as many different types of plant foods and fibers in your diet as you can. No, vitamin powders or fiber supplements aren’t going to do the trick.

Stress: In my clinical experience, the most common cause of hormonal imbalances among women, including estrogen dominance, are related to stress. Whether that source of stress is emotional, relational, physical, nutritional, or otherwise, stress management is key. In an estrogen dominance hormonal pattern, progesterone is also typically low. Progesterone and cortisol a both produced from the same hormonal precursor, called pregnenolone. When stress levels are high, the body allocates its resources towards producing cortisol, which means there aren’t many leftovers for producing progesterone. (This is called pregnenolone steal.) The end result is functionally low progesterone, either creating or amplifying an existing pattern of estrogen dominance.

For more information about lifestyle methods for balancing hormones, check out this post: 5 Ways to Balance Your Hormones, Naturally

Nutrition for Estrogen Dominance

Whenever I talk about diet minutiae with my patients, the emphasis is almost always on adding rather than restricting (except in the cases of allergies/intolerances, of course.) In terms of hormonal balance, research has shown that certain foods help drive or suppress certain dysfunctional hormonal pathways because of the biochemical compounds found in those foods. This is especially true of estrogen dominance.

Flax: When estrogen is metabolized, it converts into one of three breakdown products: 4-hydroxyestrone, 2-hydroxyestrone, and 16-alpha-hydroxyestrone. Each of these metabolites plays an important role in the body, but when levels of 16 and 4 hydroxyestrone get too high, it increases the risk of hormonal symptoms and even the risk of breast cancer. On the other hand, 2-hydroxyestrone has been shown to prevent these negative health effects. The lignans found in flax help drive the metabolism of estrogen down the 2-hydroxyestrone pathway. (In order to access the lignans found in flax, the flax must be freshly ground rather than whole or pre-ground.) Flax is a great solution for estrogen dominance when used appropriately, in the correct context.

Cruciferous Vegetables: Cabbage, broccoli, cauliflower and brussel sprouts sometimes have a bad reputation because of their smell. But those stinky, sulfur compounds (such as indole-3-carbinol and di-indolylmethane) also support the estrobolome in metabolizing and excreting estrogen breakdown products. They also help protect against estrogen-receptor-positive type breast and ovarian cancers, which is an important consideration in women presenting with an estrogen dominance pattern.

Avoid Excess Alcohol: A glass of wine (or beer, or whiskey, or whatever you enjoy) a few times a week won’t harm your health, but drinking above and beyond this inhibits the enzymes responsible for estrogen metabolism, furthering symptoms of estrogen dominance.

Supplements for Estrogen Dominance

Calcium-D-Glucarate (CDG): This supplement inhibits enzymes responsible for reabsorption of partially-metabolized estrogen, helping the body with excretion. Oral doses of CDG have been shown to lower serum estrogen levels and reducing risk of estrogen-receptor-positive breast cancer as well as associated symptoms of high estrogen. CDG also has a concurrent lipid-lowering effect, which is especially beneficial in women whose estrogen dominance is driven by insulin resistance. (In addition to managing blood sugar, insulin drives the production of cholesterol and blood lipids.) Calcium-D-Glucarate is typically used in the range of 1500-3000 mg daily.

DiindolylMethane: This is one of the main compounds found in cruciferous vegetables, responsible for estrogen-detoxifying effects. This supplement is often dosed in the range of 100-400 mg daily. (Fun fact: you can get the same level of DIM by eating cabbage. The equivalent would be 3 cups per day, or 1/2 cup if consuming it cooked, as the cooking process concentrates DIM six-fold.)

Indole-3-Carbinol: This is another compound found in cruciferous vegetables, contributing to the estrogen-detoxifying effect. Research shows that supplementing at levels of 300 mg/day has been helpful in reducing estrogen levels when they are problematically high in the case of estrogen dominance.

Cod Liver Oil: This is one of the best dietary sources of omega-3 fatty acids, especially DHA and EPA which are not found in plant sources. Since inflammation is one of the major drivers of estrogen-dominance patterns (and has a high association with elevated stress levels due to cortisol’s pro-inflammatory effect), supplementing with cod liver oil helps reduce estrogen dominance at the root cause. Supplementation should be in levels of at least 2,000 mg daily, though I often prescribe levels that are twice or three-times this amount in my practice, depending on the patient.

B Vitamins: The metabolic pathway responsible for estrogen breakdown and excretion uses a variety of enzymes which require B vitamins as cofactors in order to function, especially B12 (100 μg), B6 (50-100 mg) and folic acid (800 μg daily). These methylation reactions are also important in supporting the 2-hydroxyestrone pathway in estrogen dominance.

Closing thoughts…

As if the symptoms of estrogen dominance 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 and keep your estrogen balance in check.

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 How to Fix Estrogen Dominance with Functional Medicine appeared first on Dr. Alexandra MacKillop.

In my late teens and early twenties, my period disappeared for a while due to hypothalamic amenorrhea. In short, I was working out too much and not eating enough, so my doctors recommended I take birth control pills to kick start my cycle. Incidentally, this didn’t work, and in full disclosure, I didn’t really mind. Quite frankly, my life was much simpler without having to worry about when my period was coming.

But, when my cycle finally did return after I addressed the root cause of my amenorrhea (the technical term for a missing period), it was different than I’d experienced it in high school. I found myself wondering what was normal, and what wasn’t. Some months I felt great, but other months I felt awful…once, my cramps got so bad that I threw up! Sometimes I’d go for almost a year without any symptoms of PMS at all, and other times I’d know exactly when Aunt Flo was about to arrive because I’d have back pain, sore breasts, and a headache. I finally started getting answers when I started studying medicine, and I found it extremely helpful, empowering, and eye-opening to gain so much knowledge about my own body. I want you to be equipped with the same understanding so you can feel your very best.

And with that, let’s get into it.

Why Are Periods So Important?

The answer most people would give for this question would be fertility—conceiving and carrying a pregnancy. But our periods offer so much more insight into our own lives and livelihoods than the seasons in which we’re thinking about creating new life. Our periods, and the delicate web of hormones that makes up the menstrual cycle, have to do with so much more than pregnancy.

Time

The average woman experiences 450 cycles in her lifetime, which amounts to 10.6 years. If we’re spending that much of our lives actively having periods, we deserve to do so in comfort. Yet, so many women suffer from extreme bloating, GI trouble, excruciatingly painful cramps, mood swings, and other symptoms. It doesn’t have to be that way.

Disease Risk

Many abnormal periods don’t cause problems on their own. Clots, discoloration, and changes in flow usually are manageable without much thought or attention. But the hormonal imbalances that cause those abnormalities carry an enormous risk for long-term health problems, such as:

• Breast, uterine, or ovarian cancer
• Heart disease, including heart attacks and strokes
• High blood pressure
• Kidney disease
• Adrenal or thyroid disorders
• Insulin resistance and diabetes
• Osteoporosis
• Infertility

Women’s Rights

It still blows my mind that periods are such a taboo subject. They’re a normal part of women’s health, and give us valuable insight into our well-being. Censorship of period conversations limits a woman’s access to essential information about her sense of well-being. Periods aren’t gross. They aren’t weird, and they 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 what our period reveals about our health. So, if you have questions about your cycle, are wondering if your period is normal, or what it could mean if it’s not, you’re in the right place.

What is considered a “normal” period?

Menstrual cycles are considered normal if…

• They last between 21 and 35 days, but ideally between 27 and 32 days. The first day of your period is counted as the first day of the cycle, and you count upwards until the first day of your next period.
• Bleeding should be bright red in color, last for 3-5 days, and fill a regular pad or tampon every 4-6 hours (1-2 tablespoons of blood per day).
• A few small clots are normal, but there shouldn’t be any large clots or intense pain.
• Mild cramping , if any, is normal on the first day or two, (or even the day before) but should be light enough that it doesn’t interfere with your life and should not require medication for management. In general, if you need to take painkillers, that’s usually a sign that something is running amok. Some women also experience a day or two of light spotting leading up to their period, which is normal, but mid-cycle pain or spotting is not.

The Different Parts of the Menstrual Cycle

Usually, when we think of the menstrual cycle, we divide it into two parts: period week, and everything else. But there’s so much more going on behind the scenes:

• Ovulation (the release of an egg) takes place around halfway through the cycle (which would be day 14 or 15 of an average, 28-day cycle) and there are rhythmic fluctuations of hormones released through the hypothalamic-pituitary-gonadal axis, triggering predictable patterns of estrogen, progesterone, and other chemicals.
• Typically estrogen is highest during the first two weeks of the cycle (called the follicular phase) and progesterone takes over during the last two weeks of the cycle (called the luteal phase).
• To learn more about the details of hormonal changes throughout the cycle, the four sub-phases of the cycle and what they mean, how to track your own cycle, and ways to find out when you’re ovulating, check out this post.)

When cycles deviate from the norm, the best course of action is to make an appointment with your functional medicine doctor to get to the bottom of your symptoms and put together a treatment plan that’s right for you. But for the sake of educational purposes (not as a diagnosis or treatment) let’s talk about what could be going on if a woman’s cycle deviates from the status quo.

What an Abnormal Cycle Could Mean:

Note: I explain the details of what is and isn’t normal and how to explore natural treatment options in my book, Go with Your Flow. Click here to learn more.

Color

First of all, if menstrual blood is dark brown or black during your period (meaning not the very beginning or end, and you’re not pregnant) that could also signify an infection, and should be discussed with your healthcare provider. Mid-cycle brown blood may result from ovarian cysts, PCOS, or uterine fibroids. Some women also experience mid-cycle spotting around the time of ovulation, and this can range from pink to red, to brown in color. Dark blood is also common during menopause.

Probably the most common “abnormal color” on this list would be light pink blood, which really just signifies a very light flow to the point where the menstrual blood is so diluted that it looks pink rather than red. This is indicative of a hormonal imbalance, which needs to be addressed.

Flow

Light flow: Pinkish blood, scant spotting (in lieu of a period), or a flow that more closely resembles a few teaspoons per day (rather than a few tablespoons) can be normal if you’re taking hormonal birth control or are approaching menopause. Most other cases point to a hormone imbalance, especially in terms of estrogen/progesterone, often resulting from lifestyle factors like overexercising, under-eating or an otherwise unbalanced diet, elevated stress levels, weight changes, lack of sleep, or new medications. Light flow can also be a consequence of imbalances in other hormones, such as adrenal or thyroid, which would be assessed via laboratory testing. A lighter-than-normal period that comes on a few days early may also be a sign of pregnancy.

Heavy flow: As with a lighter flow, heavy menstrual bleeding can be normal with certain forms of birth control, or around menopause. It also can point to an imbalance in estrogen/progesterone resulting from lifestyle factors such as those described above, thyroid dysfunction, or from a menstrual disorder such as PCOS, endometriosis, or fibroids.

A heavy menstrual flow often points to: estrogen dominance or relative progesterone deficiency which may have a number of different root causes.

Cycle Length

Long Cycles (>35 days) can be triggered by medication use, or during periods of hormonal fluctuation such as perimenopause, adolescence, or breastfeeding. Abnormal reasons include hormonal imbalances resulting from lifestyle factors, thyroid abnormalities, diabetes or other problems with blood sugar control, PCOS, or elevated prolactin (from breastfeeding or other causes). When a cycle is longer than 35 days, it is usually because ovulation is delayed (a long follicular phase). This can result from a number of different conditions, the most common of which is PCOS.

Short Cycles (<21 days) usually points to either early ovulation (or absence of ovulation), or a short luteal phase. Both of these issues can create problems when trying to conceive, whether in terms of timing of sex for conception, or because the luteal phase is not long enough for the endometrial lining to reach an appropriate thickness for implantation and pregnancy. This is usually a consequence of low progesterone levels. Short cycles may also be a symptom of thyroid or adrenal dysfunction.

Period Length

Bleeding that lasts longer than 7 days could point to a number of different problems, including anovulation, a clotting disorder, fibroids, or another type of pathology such as an infection, and should be evaluated by a healthcare provider.

Clotting

A few small clots (less than the size of your finger tip) are normal, but large clots point to a hormone imbalances such as elevated estrogen or progesterone deficiency. This can result from lifestyle factors, endometriosis, adenomyosis, fibroids, or thyroid abnormalities.

Spotting

Occasionally, women experience light spotting during adolescence or peri-menopause, but it can also occur around the time of ovulation for some women. Typically, spotting between periods points to a hormonal imbalance, especially low progesterone during the luteal phase, or from PCOS, endometriosis, or damage to the vaginal tissue. It may also indicate another type of pathology, such as an infection, fibroids, or abnormal tissue growth, and should always be evaluated by a healthcare provider.

Cramps

A day or two of mild cramps around the start of your period is normal, but if the cramps last longer than that or are severe, there may be something deeper going on. Usually, severe or prolonged cramps point to inflammation in the body, which can result from an imbalance in sex hormones (estrogen/progesterone/testosterone), thyroid hormones, adrenal hormones, or even an underlying inflammatory or autoimmune disease. If you’re experiencing intense period pain, it doesn’t have to be that way. (P.S. There’s more you can do than just take birth control.)

Some women experience one-sided cramping around the time of ovulation, which is called mittelschmerz. This is normal, but it is not experienced by everyone. If the pain is extreme, talk with your healthcare provider.

To sum things up…

Outside of the case of pathology (such as infection, PCOS, endometriosis, or life transitions like menopause), hormonal imbalances are common and can cause all kinds of changes to the menstrual cycle. Typically, abnormal sex hormone levels fall into predictable patterns of symptoms, summed up in the chart below:

We’ll be diving into these patterns (and others) in more detail in future posts, but for now…know that if your cycle feels “off” or doesn’t seem to reflect your normal, you can get help. Usually, healthcare providers prescribe birth control pills to mask over some of the symptoms related to dysfunctional sex hormone levels, but it doesn’t have to be that way. There are explanations and answers, and you can manage your reproductive health holistically if that’s something that aligns with your individual values. To get started, check out this post about balancing hormones naturally and consider making an appointment with a functional medicine doctor near you.

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 What Your Period Reveals About Your Health (it’s way more than just fertility) appeared first on Dr. Alexandra MacKillop.