Genetic testing often enters the fertility conversation through IVF, when embryo testing before transfer identifies certain chromosomal and inherited risks. Many couples appreciate this information, though there are potential moral concerns regarding what to do with carriers. Embryos aside, however, gene testing before pregnancy can also offer insight into a mother (or father’s) health as it applies to successful conception, miscarriage prevention, and reducing risks for the baby both before and after being born. Moreover, valuable genetic insight does not require IVF. This is great news, as most couples actively seek ways to conceive naturally and avoid invasive reproductive technology. Gene testing before pregnancy delivers similar information through the lens of functional medicine while still supporting informed and proactive choices.

Why Complete Gene Testing Before Pregnancy?

When mothers and couples have access to their genetic information, they gain clarity. This clarity pertains not just to potential diagnoses, but about long-standing health patterns and inherited vulnerabilities that may otherwise go unnoticed. Gene testing before pregnancy allows care to shift from reactive to truly preventive. Rather than waiting for complications to surface during pregnancy or delivery, couples have the opportunity to intervene early with lifestyle strategies to support their genetic, and epigenetic health.

This kind of foresight is foundational in functional medicine. Strategies like nutrient repletion, supporting detoxification pathways, reducing inflammation, and optimizing hormone balance are far more effective when they’re guided by genetics instead of reactions or guesswork. After all, you can’t correct, prevent, or support a risk you don’t yet know exists.

Who Should Consider Gene Testing Before Pregnancy?

Genetics are part of everyone’s health story. Our genes carry disease risk, but our environment and exposures throughout life, both positive and negative, influence whether those genes are expressed. High-quality nutrition, for example, can help quiet genes associated with cancer risk as well as fertility-related conditions like PCOS, endometriosis, and autoimmune disease. On the other hand, environmental toxins, chronic stress, and repeated or high-dose antibiotic use can switch these same genes on. When that happens, health can suffer in ways that directly and sometimes dramatically affect fertility.

Because of this, it’s reasonable to argue that nearly everyone can benefit from understanding their genetic health, and many may want to consider gene testing before pregnancy as part of a proactive approach to family planning.

Age adds an important layer of urgency to this conversation. After age 35, egg quality naturally declines, and genetic vulnerabilities tend to exert a stronger influence. Issues like chromosomal instability, impaired methylation, oxidative stress, and clotting tendencies can impact fertility and pregnancy outcomes more significantly. This is not just a maternal issue. Paternal genetics matter as well, since a healthy pregnancy and child require both a healthy egg and a healthy sperm.

In this post, we’ll explore five ways prospective mothers and fathers can use gene testing before pregnancy to optimize their own health and support the long-term health of their future children.

1. MTHFR (Methylenetetrahydrofolate Reductase)

One of the most commonly discussed genetic findings in preconception care involves the MTHFR gene. Variants in MTHFR can affect folate metabolism, methylation efficiency, and the body’s ability to detoxify effectively. Impaired methylation has been linked to miscarriage, preeclampsia, placental dysfunction, and neural tube defects.

Gene testing before pregnancy gives prospective parents the opportunity to identify these risks early and support detoxification and DNA synthesis before those demands increase during pregnancy. Testing for MTHFR typically identifies variants such as C677T or A1298C through saliva or blood samples. An individual may carry one copy (heterozygous) or two copies (homozygous) of a given variant, which can influence how significantly methylation pathways are affected. Insurance coverage varies and is often dependent on a history of pregnancy loss or clotting disorders.

From a functional medicine perspective, these findings guide targeted interventions, including the use of methylated folate and other B vitamins, limiting exposure to synthetic folic acid, and reducing environmental toxin burden. This becomes especially important when evaluating standard prenatal vitamins, many of which may not be appropriate for individuals with certain MTHFR variants.

2. Factor V. Leiden

Clotting genetics are another critical piece of the preconception puzzle. Inflammation and abnormal clot formation pose serious risks during pregnancy and can contribute to pregnancy loss at any stage. One of the most well-known examples is Factor V Leiden, a genetic variant that increases the tendency toward excessive clotting and can interfere with normal placental blood flow. This disruption raises the risk for miscarriage, stillbirth, fetal growth restriction, and preeclampsia.

Gene testing before pregnancy can identify whether an individual carries one copy (heterozygous) or two copies (homozygous) of this variant through blood or saliva testing. Insurance coverage often depends on family history or a record of prior pregnancy complications. When clotting risk is identified early, care can focus on reducing inflammation, supporting healthy circulation, and coordinating obstetric management, including anticoagulation when clinically appropriate.

• Treatment: Strategies usually include blood thinners (anticoagulants) such as low molecular-weight heparin (LMWH) and sometimes, aspirin. Functional medicine also offers natural benefit from higher dose fish oil. Talk to your doctor about your options for Factor V as well as mutations in Prothrombin G20210A (below).

3. Prothrombin G20210A

Another important clotting-related gene to consider is the Prothrombin G20210A mutation. This variant also increases the risk of abnormal clot formation and can compromise placental circulation. Pregnancy places significant demand on vascular health, and genetic interference in these pathways raises the risk for both maternal and fetal complications.

Gene testing before pregnancy can identify this mutation through standard laboratory testing, with insurance coverage typically following the same criteria used for Factor V Leiden. From a functional medicine perspective, this knowledge allows care to focus on prevention rather than crisis management. Targeted nutrient support, inflammation control, and proactive monitoring can be put in place early, empowering mothers to pursue appropriate maternal care long before a pregnancy complication ever occurs. As a functional medicine doctor, my #1 treatment is a whole foods, ancestral diet that includes organ meats, fish and healthy animal fats.

4. COMT (Catechol-O-Methyltransferase)

Genetics related to hormone metabolism also play an important role in fertility and overall pregnancy experience. Variants in the COMT gene influence how the body clears estrogen, regulates neurotransmitters, and responds to stress. Slower estrogen metabolism can contribute to hormone dominance, implantation difficulties, and more pronounced pregnancy symptoms. Increased stress sensitivity disrupts cortisol balance, which in turn affects immune tolerance and hormonal signaling throughout pregnancy. COMT variations may also influence how an individual responds to certain antidepressant medications, a consideration that is especially relevant given how many women are using these medications prior to conception or during pregnancy.

Gene testing before pregnancy often evaluates COMT through saliva-based genetic panels. Insurance coverage is uncommon, and self-pay rates vary depending on which other markers are involved on the genetic panels. (I’ve seen anywhere from $100 to $350). In functional medicine, these results guide strategies such as supporting estrogen detoxification pathways, improving stress resilience, and providing targeted micronutrient support. Because stress and impaired hormone metabolism can significantly challenge both conception and pregnancy, addressing these risks proactively allows many of these obstacles to be prevented rather than managed after the fact.

5. CFTR (Cystic Fibrosis Transmembrane Conductance Regulator)

Carrier screening plays a crucial role in responsible family planning. CFTR gene testing identifies carrier status for cystic fibrosis and sheds light on certain male fertility issues. An estimated 1 in 25 people is a carrier of CFTR mutations, so couples benefit from knowing this about themselves before conception. Gene testing before pregnancy uses blood or saliva samples to determine carrier status rather than disease presence. Insurance frequently covers this screening during pregnancy planning or when family history exists. Genetic counseling supports informed decisions when both partners carry variants.

Taken together, these tests form a powerful foundation for prevention, but modern prenatal care rarely encourages couples to complete this testing outside of IVF offices. However, all couples deserve to know the truth about their health so they can hopefully avoid the pain and devastation of fertility and pregnancy challenges. Gene testing before pregnancy replaces uncertainty with strategy. Each result informs nutrition, supplementation, and lifestyle choices for maximally effective preventative medical care.

Functional medicine is founded on this level of personalization. Work with a functional medicine doctor to unlock your own genetic potential to maximize your health, fertility, longevity and more.

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 Gene Testing Before Pregnancy: Why and How to Harness the Power of Your DNA appeared first on Dr. Alexandra MacKillop.

Things to Consider When Meal Prepping for Pregnancy

There are two types of meal prep you want to consider when getting food ready for yourself. This could include both 1) meal prepping for yourself when pregnancy leaves you too exhausted to pack a lunch and 2) meal prepping for postpartum so that food and nutrition is an easy, streamlined process.

The good news is that both of these meal prep goals involve the same strategies! Meal prepping for pregnancy or postpartum both involve the creation of easy, nutritious, low-toxin meals that are freezer-friendly and reheat with ease.

Two Types of Meal Prep

When meal prepping for pregnancy, you want to make two things happen. The first, is you need to make sure that you have something quick and easy on hand to grab and go when you only have a few minutes for a lunch or late dinner. The second is that you want a real, hearty meal available for when the whole family is sitting down to dine but you don’t have the time or energy to get out for groceries, assemble meals, and cook them all while holding a hungry, snuggly, and possibly crying newborn.

Whether you’re a busy pregnant mama or looking to the future after your little one arrives, you need both meals for yourself to grab and go as well as something that you don’t need to think about when it comes to a sit-down meal for everyone else, too.

Toxins When Meal Prepping for Pregnancy

Nobody wants to think that their food can be harming them, and the good news is that it isn’t, most of the time. Most foods are nutritious and beneficial to include in a well-rounded healthy diet. However, we can run into a few problems when considering toxins with our food, especially considering toxins that may be added to the food, or that may leach into the food through packaging.

Pesticides and Preservatives

The heart behind these food toxins is actually good. Of course we want pests to stay away from our crops, and we want our food to be protected from rot and degradation! However, the chemicals involved in accomplishing these tasks actually harm our health in doing so. In order to make sure that you family has the healthiest meals possible whether you’re eating for two or cooking when your arms are full, look for:

• Foods without preservatives addedd, like sodium benzoate, EDTA, potassium sorbate, nitrates and BHA, BHT or TBHQ
• Pesticides added to non-organic food and animal feed are a huge problem. Look for organic labeling whenever available.

Note: Other food additives, beyond preservatives, also can be harmful. I recommend avoiding artificial sweeteners like aspartame an acesulfame potassium, natural flavors, food dyes, and carageenan to name a few.

The good news is that apart from pesticides, if you are choosing whole foods to cook and meal prep with, you really don’t need to worry about the other additives.

Toxic Packaging Materials

Now, the downside about a grab-and-go meal strategy is that the packaging we sometimes use to do so can also pose risks to our health. Materials like plastic and aluminum leach into our food and can affect neurodevelopment of baby, hormone balance, cancer risks and more. Microplastics have been found in everything from the brain to the placenta, and it’s never something we want more of. Instead of disposable aluminum trays or plastic containers, consider the following ideas:

• Stainless Steel Casserole Dishes: This is the most cost effective product I’ve found on Amazon, comes in a pack of two, and can be reused over and over again. If you stock up on 8-10, you can easily prep several dinners that will last for multiple days for a meager investment and cultivate a habit of doubling any recipes you bake or cook going forward.
• Silicone Freezer Bags: Instead of meal prepping for pregnancy in Ziploc freezer bags, consider reusable silicone ones. While silicone is not ideal for hot food applications, they are safe for cold use, and provide a similar layer of freezer protection.
• Glass Jars: The standard for food preservation is usually Ball Jars, which are available in most grocery and home improvement stores. However, if you’re not actually using them for canning, the metal lids can easily corrode and stop being usable over time. These adorable freezer jars have plastic lids (which won’t be touching your food) and hold up better for repeated use. I recommend using individual serving jars like this for meal-prepped broths and soups. They also come in neutral colors.

Meal Prepping for Pregnancy Recipes

During the postpartum period, or even if you’re meal prepping to eat these dishes during pregnancy, nutrition is more important than ever. Consider the following strategies when meal prepping for pregnancy:

1. Lower Carbohydrate (In moderation)

• Blood Sugar Stability: After childbirth, many women experience fluctuations in blood sugar levels. A lower-carb diet can help stabilize blood sugar, preventing energy crashes and promoting consistent energy throughout the day.
• Avoiding Insulin Resistance: Some women may face insulin resistance or have higher blood sugar levels during pregnancy (e.g., gestational diabetes). Postpartum, focusing on lower-carb meals can support insulin sensitivity and help with long-term metabolic health.
• Weight Management: Postpartum weight loss or maintenance can be supported by consuming fewer refined carbohydrates, which can prevent fat storage and cravings. A more balanced approach helps maintain a healthy weight without drastic spikes or drops in energy levels. While weight loss should not be a top priority postpartum, eating nourishing meals will help your body naturally level out at the rate that is most appropriate for oyu.

2. High-Quality Animal Protein

• Muscle Repair & Recovery: Childbirth is physically demanding, and the body needs to repair and rebuild muscle tissue after the exertion of labor. High-quality animal proteins (like chicken, beef, turkey, eggs, and fish) provide essential amino acids that support muscle recovery and tissue healing.
• Breast Milk Production: Protein is also critical for producing breast milk. Amino acids from protein-rich foods are the building blocks of the milk, supporting both quality and quantity for breastfeeding moms.
• Hormonal Balance: Protein helps in balancing hormones, including the ones responsible for mood regulation (like serotonin and dopamine). Postpartum hormonal shifts can cause mood swings, so supporting hormonal health with protein is crucial.

3. Complex Fiber

• Gut Health: After childbirth, many women experience changes in digestion, including constipation or slower gut motility. Complex fiber (found in vegetables, legumes, and some whole grains) promotes regular bowel movements and supports gut health, which is vital for overall health during recovery.
• Blood Sugar Regulation: Fiber helps to slow the absorption of sugars in the bloodstream, preventing sharp spikes and crashes in blood sugar. This is important for postpartum recovery, especially if the body is recovering from insulin imbalances.
• Satiety: High-fiber foods also help keep you feeling fuller longer, reducing the tendency to snack on less nutritious foods or overeat. This is especially useful if you’re managing weight while also needing more energy for breastfeeding or caring for a newborn.

4. Slow-Cooked Meals

• Nutrient Retention: Slow-cooking, especially when using methods like stewing or braising, helps retain more nutrients in foods, particularly minerals and vitamins that are sensitive to heat. The longer cooking time at low temperatures allows for better extraction of nutrients, especially from tougher cuts of meat, bones, and fibrous vegetables.
• Digestibility: Slow cooking also breaks down proteins and fibers, making them easier to digest, which is helpful for a postpartum body that might be more sensitive to foods.
• Ease of Meal Prep: Slow-cooked meals are perfect for batch cooking, which is a huge benefit when you’re short on time during the postpartum period. A large pot of stew, soup, or curry can be made in advance, stored, and reheated as needed, saving time and effort. I recommend a slow-cooker with a latch-on lid for easy transport, and programming like this Crock Pot Cook & Carry.

5. Additional Benefits for Postpartum Health

• Anti-Inflammatory: Many slow-cooked dishes, especially those featuring bone broth or grass-fed meats, contain nutrients like collagen and gelatin, which help repair tissues and reduce inflammation. After childbirth, inflammation is common, and foods that support recovery can promote healing and comfort.
• Hydration: Slow-cooked meals like soups and stews can be rich in water, which is vital for hydration—important for breastfeeding and overall recovery.
• Comfort & Healing: Comfort foods are often slow-cooked, providing not only nourishment but also emotional support during a time of physical and emotional stress. The act of eating well-cooked, hearty meals can be soothing and help mothers feel nurtured during a challenging recovery period.

Meal Prepping Recipes

Here are some of my favorite recipes, to be prepared during pregnancy and enjoyed postpartum, or any time that you’re in need of a nourishing meal. Any soups or stews can easily be prepared ahead of time and frozen in individual servings, or ingredients can be stored together in freezer bags to easily throw in a pot or crockpot at a later time.

Breakfast

• Breakfast Burritos (make with almond flour or cassava tortillas)
• Low Sugar Baked Oatmeal (consider adding 1/2 cup collagen to the recipe)
• Paleo Banana Chocolate Chip Walnut Muffins (use unbleached muffin liners and a toxin-free, stainless steel muffin pan)
• Paleo Breakfast Casserole
• Almond Flour Cheddar Biscuits (high protein, low carb)

Lunch/Dinner

• One Pan Chicken Fajitas (prepare and freeze ingredients separately. You can even freeze a pack of tortillas together with the bag of chicken and veggies. Or, serve with rice)
• Veggie-Rich Taco Casserole (make with rice or quinoa)
• Ratatouille Soup (add diced grilled chicken)
• Pasta E Fagioli (omit pasta, if you wish)
• Instant Pot Rotisserie Chicken (serve with bagged salad)
• Beef Stew (sub tapioca starch for Paleo)
• Thai Chicken Curry Soup (store rice noodles separately in pantry, or serve with fresh rice/quinoa instead)
• Indian Curry Soup
• Chicken Potato Soup
• Zucchini Lasagne
• Chicken and Broccoli Casserole (no canned soup in this recipe! can omit cheese, and use bone broth instead of milk)
• Shepherd’s Pie
• Cabbage Roll Casserole (can substitute rice with quinoa for higher protein)

Snacks

• Protein Popsicles (made with silicone popsicle molds)
• Protein/Oat Balls
• Pistachio Date Balls (can omit oats)
• Low Carb Peanut Butter Bark

To sum it up, meal prepping for pregnancy is a smart, effective way to ensure that you and your growing family are nourished with wholesome, nutrient-dense meals. By focusing on simple, healthy recipes that are rich in high-quality protein, complex fiber, and slow-cooked goodness, you’ll be setting yourself up for smoother days, both during pregnancy and postpartum. Whether you’re meal prepping for pregnancy to manage your energy levels or preparing meals that support recovery after childbirth, the right foods will help you feel your best. So, take the time to plan ahead, minimize toxins, and create meals that are easy to grab, heat, and enjoy—your body and your baby will thank 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 Your Guide to Meal Prepping for Pregnancy appeared first on Dr. Alexandra MacKillop.

If you’re wondering how to naturally increase fertility, the most important thing you should know is that fertility isn’t just about the reproductive organs—it’s a whole-body indicator of health. As a functional medicine doctor, I’ve helped countless patients learn how to naturally increase fertility by addressing imbalances across all systems of the body. If you’re trying to conceive without resorting to pharmaceuticals or IVF, this guide will give you the strategic, root-cause roadmap to reclaim your fertility naturally.

Why Increase Fertility Naturally?

Natural fertility optimization isn’t just about conception—it’s about creating the healthiest possible environment for you and your future child. Couples choose to increase fertility naturally because they want to avoid synthetic hormones, invasive procedures, or expensive treatments that ignore the real cause of the issue. They want to heal, not override, their bodies. IUI, IVF and other fertility treatments can alo be extremely costly, which is another important reason to consider learning how to naturally increase fertility. However, even when pursuing fertility treatments, or perhaps undergoing a process of egg retrieval for egg freezing or a sperm harvesting for sperm freezing, it’s still a good idea to take all possible measures to increase fertility naturally so that the eggs have the best possible chance of success.

Conventional medicine often reduces fertility to a hormone problem. But infertility is a signal—your body is telling you something is off. When we listen, investigate, and treat the underlying dysfunction, the result isn’t just fertility—it’s vitality, balance, and lasting health.

Lifestyle Practices That Harm Fertility

Before we can build fertility, we need to stop destroying it. The modern lifestyle is fertility-toxic. Here’s how:

• Chronic Stress: Activates the HPA axis and shuts down reproductive hormones. Cortisol hijacks your cycle, suppressing ovulation and libido. It also significantly suppresses testosterone production and sperm quality in men.
• Poor Sleep: Disrupts circadian rhythms and hormone production—especially melatonin and progesterone, as well as testosterone in men.
• Toxin Exposure: Pesticides, BPA, phthalates, and heavy metals mimic hormones and disrupt endocrine balance. There is also data out there that exposure to plastics in clothing also act as fertility disruptors, creating changes in electrical and magnetic signaling that negatively impact ovarian function and sperm quality. Look for clothing that is free of plastics, PUFAs, and other synthetics.
• Nutrient-Deficient Diets: Low-fat, high-sugar, or overly restrictive diets destroy hormone production and egg quality. Our ultra-processed modern diet is void of nutrients despite being rich in processed carbohydrates and seed oils. In fact, both simple carbs and seed oils have been proven to negatively impact fertility. Aim to include high-quality animal proteins and fats as well as organic, darkly colored fruits and vegetables like berries and leafy greens. I also recommend a daily carrot salad for hormone balance.
• Overtraining/Under-Eating: Particularly common in driven, Type A women, this leads to hypothalamic amenorrhea, where the brain shuts down ovulation entirely.
• Alcohol, Caffeine, and Smoking: All three impair egg quality, sperm health, and hormone balance. I recommend avoiding all three if you’re TTC.

A note about these lifestyle factors: These foundational elements are pretty universal amongst articles describing methods for how to naturally increase fertility. Because they’re so ubiquitous, it may seem tempting to overlook them in search of something more direct, more exclusive, or more granular. While I do offer such recommendations below, I want you to know that lifestyle is the single most important factor in fertility as well as in health as a whole. It will do you no good to look to supplements or anything else for how to naturally increase fertility while overlooking the lifestyle. There is no supplements, and honestly no drug, that can undo the effects of poor sleep, high stress, toxin exposure, calorie deficits, substance abuse, and a poor diet.

How to Naturally Increase Fertility by Identifying the Root Cause of Fertility Disorders

To truly increase fertility naturally, you must identify why your body isn’t conceiving. Here are the most common root-cause conditions that sabotage fertility:

1. Thyroid Disorders

Low thyroid function (hypothyroidism) decreases progesterone, disrupts ovulation, and increases miscarriage risk. If your TSH is “normal” but you’re still tired, cold, or constipated—get a full thyroid panel. Subclinical hypothyroidism often flies under the radar. Hyperthyroidism, such as seen in Graves’ disease, also negatively impacts fertility. If you’re wondering how to increase fertility naturally, you should start by getting your thyroid thoroughly checked out.

2. PCOS (Polycystic Ovary Syndrome)

PCOS is an insulin-resistance and androgen-dominance issue. It impairs ovulation, leads to cystic ovaries, and causes irregular cycles. You must correct blood sugar dysregulation, reduce inflammation, and support hormone detoxification to restore ovulation.

3. Endometriosis

This inflammatory, estrogen-driven condition causes pelvic pain and infertility by distorting reproductive anatomy and disrupting implantation. Gut health, immune balance, and estrogen metabolism must be addressed aggressively.

4. Hypothalamic Amenorrhea

This is the brain pulling the emergency brake on fertility due to perceived stress or lack of energy availability. It’s common in athletes, perfectionists, and under-eaters. Recovery requires restoring adequate caloric intake, body fat, and nervous system calm.

5. HPA Axis Dysfunction (Adrenal Fatigue)

The hypothalamic-pituitary-adrenal axis controls the stress response. When it’s dysregulated, it suppresses reproductive hormones. You must rewire the stress response through nervous system regulation, sleep, and adrenal support to restore fertility.

How to Naturally Increase Fertility with Supplements

Certain nutrients powerfully support reproductive function. Many of these are key players in my practice for optimizing fertility:

• Myo-Inositol: Improves insulin sensitivity and ovulatory function—especially critical for PCOS.
• CoQ10 (Ubiquinol): Enhances mitochondrial function in eggs and sperm, improving quality and developmental potential.
• Omega-3 Fatty Acids: Reduce inflammation and support hormone production.
• Methylated B Vitamins (especially B9/Folate): Crucial for methylation, egg health, and preventing neural tube defects.
• Magnesium: Calms the nervous system, supports adrenal function, and improves sleep—all essential for fertility.
• Vitamin D3: Regulates hormone production and immune balance. Low levels are directly linked to infertility and miscarriage.

How to Naturally Increase Fertility by Looking at the Whole Body

Your uterus does not operate in a vacuum. Fertility is the result of systemic harmony, not isolated hormonal tweaks. Here’s how the entire body affects your ability to conceive:

Brain & Nervous System

The hypothalamus and pituitary gland orchestrate your reproductive cycle. Chronic stress rewires your brain to shut down reproduction. Nervous system regulation—via breathwork, somatic practices, and trauma healing—is fertility medicine.

Gut Health

The gut regulates nutrient absorption, immune response, and estrogen metabolism. Dysbiosis, leaky gut, or SIBO drive inflammation and hormone imbalance. Heal the gut, and you lay the groundwork for conception.

Liver Function

The liver detoxifies excess estrogen and metabolizes hormones. A sluggish liver leads to estrogen dominance, PMS, and ovulatory issues. Support with cruciferous vegetables, dandelion root, NAC, and targeted herbs.

Blood Flow

Pelvic blood flow is essential for ovarian and uterine health. Sedentary lifestyle, poor circulation, and inflammation impair oxygen and nutrient delivery to reproductive organs. Movement, dry brushing, acupuncture, and castor oil packs all enhance circulation.

Musculoskeletal System

Tension in the pelvis, scar tissue, or misalignment in the spine can block blood flow and nerve signaling. Bodywork (chiropractic, craniosacral therapy, pelvic floor therapy) helps clear the path for conception.

Lymphatic System

The lymphatic system clears cellular waste and toxins. A stagnant lymph system clogs hormone pathways and raises inflammation. Rebounding, sauna, hydration, and manual lymph drainage support this overlooked detox pathway.

Final Thoughts: Fertility Is a Barometer of Health

To naturally increase fertility, you must stop chasing hormones and start chasing health. When your body feels safe, nourished, and in balance—it will create life. This isn’t theory. I’ve seen it happen over and over with patients who were told their only option was IVF.

Natural fertility is not luck. It’s the result of uncovering root causes, supporting the body as a whole, and restoring biological wisdom. Your body is not broken. It’s communicating.

You just need to learn how to listen—and how to heal.

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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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 How to Naturally Increase Fertility 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.

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

What Is Letrozole?

Letrozole is a medication primarily used in the treatment of breast cancer but is also widely prescribed to women struggling with infertility, especially those diagnosed with polycystic ovary syndrome (PCOS). It works as an aromatase inhibitor, reducing the production of estrogen from precursor molecules like DHEA and other androgens. By lowering estrogen levels, Letrozole stimulates the release of follicle-stimulating hormone (FSH), which, in turn, promotes ovulation. Ovulation is essential for conception, and Letrozole helps correct the problem of excess estrogen (estrogen dominance) by regulating the brain-ovarian axis. However, the way it accomplishes this is by overriding an inborn system rather than helping to support the natural design of the body. Natural Letrozole alternatives accomplish the same goal without relying on prescription drugs that block hormone systems.

Doctors typically prescribe Letrozole to women who don’t respond to Clomid (clomiphene citrate) or for those who have PCOS but are looking for a less invasive alternative to injectable fertility drugs. It’s generally favored for its relatively mild side effects compared to other fertility medications. If you are looking for natural alternatives to Letrozole, you’re reading the right article.

Why Is Letrozole Prescribed for Fertility?

Letrozole is prescribed when women fail to ovulate on their own. Not ovulating is a key cause of infertility. However, the number one thing to consider when looking for natural alternatives to Letrozole and other fertility drugs is answering the question of why a person is not ovulating to begin with. I see three main reasons in my practice for lack of ovulation which include:

• Hypothalamic Amenorrhea (a condition in which the body’s stress response inhibits ovulation)
• PCOS (a condition in which high androgen levels prevent ovulation)
• Perimenopause (a condition in which aging of the ovary and reduce egg quality lead to irregular or absent ovulation)

There are many hormone imbalances that can cause lack of ovulation, including hypothyroidism and hyperthyroidism, though those are separate imbalances that typically don’t result in a Letrozole prescription.

The condition of hypothalamic amenorrhea, in my opinion, is not an appropriate time to use Letrozole because the body is already in a suppressed estrogen state. In this case, natural letrozole alternatives and addressing the root cause are much more effective. In perimenopause, FSH levels may already be high, and using Letrozole to further increase them may not actually help. However, estrogen levels are often also high in the early stages of perimenopause so advanced maternal age, in my clinical experience, is a more appropriate use of Letrozole. That being said, natural alternatives to Letrozole are often more appropriate and more effective. For PCOS, this would be the classic use of Letrozole because high estrogen and low FSH are common in this condition. That being said, understanding the root cause of PCOS is essential when treating the condition naturally and identifying viable natural alternatives to using Letrozole or other fertility drugs.

While Letrozole does its job effectively in many cases, it’s not without potential side effects like headaches, fatigue, and ovarian cysts. For those seeking to avoid pharmaceutical options, natural Letrozole alternatives provide a safe, non-toxic way to stimulate ovulation and improve fertility.

How Does Letrozole Compare to Other Fertility Medications?

Compared to other fertility medications like Clomid (clomiphene citrate) and injectable gonadotropins, Letrozole is less likely to cause multiple births (twins or more). Clomid, for instance, can lead to a higher incidence of multiple pregnancies, whereas Letrozole tends to result in single, healthy pregnancies. Letrozole is also often preferred over Clomid for women with PCOS due to its more favorable side effect profile.

Injectable gonadotropins, another common fertility treatment, stimulate the ovaries to produce eggs directly, often resulting in more aggressive stimulation and a higher risk of ovarian hyperstimulation syndrome (OHSS). Letrozole, however, works in a more controlled manner by stimulating the body’s natural hormone production.

Despite these benefits, Letrozole still relies on hormone manipulation, which can be taxing on the body and may result in rebound hormone imbalances after pregnancy. This is why many patients turn to natural Letrozole alternatives—herbal supplements that naturally support the body’s hormonal balance without the need for synthetic drugs.

The Mechanism of Action Behind Letrozole and Natural Alternatives

Let’s Review: Letrozole operates by inhibiting the aromatase enzyme, which is responsible for converting androgens into estrogen. As estrogen levels decrease, the body responds by increasing the production of follicle-stimulating hormone (FSH), which stimulates the ovaries to release mature eggs.

Natural Letrozole alternatives work by leveraging similar mechanisms to promote fertility. They either directly inhibit aromatase or support the body’s endocrine system to regulate hormone production, such as estrogen levels. While these alternatives don’t work as rapidly as prescription medications, they offer a gentler and sustainable way to address infertility.

Root Causes of Infertility and Letrozole Prescription

When Letrozole is prescribed, the root cause of infertility is often related to hormonal imbalances, specifically in women with PCOS. PCOS leads to an overproduction of androgens (male hormones) which are converted into estrogen at high levels. Very high levels of this nature contributes to the inhibition of ovulation seen in PCOS. Letrozole works by reducing estrogen, thus triggering ovulation and improving the chances of pregnancy.

For other women, infertility can result from issues like poor egg quality, irregular cycles, or insufficient progesterone. In such cases, Letrozole is used to support ovulation, but it may not address underlying hormonal imbalances or deficiencies. Natural Letrozole alternatives, however, take a more holistic approach by addressing the broader spectrum of hormonal imbalances contributing to infertility.

Natural Letrozole Alternatives for Fertility

1. Resveratrol
   
   • How It Works: Resveratrol functions as a direct and effective natural aromatase inhibitor. In women with estrogen-dominant conditions or polycystic ovary syndrome (PCOS), this conversion process becomes dysregulated, leading to suppressed ovulation and hormonal imbalance. Resveratrol blocks the activity of aromatase at the cellular level. It binds to the enzyme’s active site, reducing its ability to synthesize estrogen from androgen precursors. This inhibition lowers circulating estrogen levels, which signals the hypothalamus and pituitary gland to increase the release of follicle-stimulating hormone (FSH). Elevated FSH promotes the development and maturation of ovarian follicles, which directly supports ovulation and improves the chances of conception, acting in direct similarity to Letrozole and offering a natural Letrozole alternative.
   • Advantages: Unlike Letrozole, Resveratrol offers this action without the synthetic load on the liver or disruption of other hormonal systems. It also delivers strong antioxidant and anti-inflammatory support, which helps reduce oxidative stress in the ovaries and improves overall endocrine function. For women seeking natural Letrozole alternatives, Resveratrol provides targeted hormonal modulation. It mimics the clinical benefits of Letrozole—ovulation induction, estrogen control, and follicular development—through a plant-based, bioavailable pathway that supports the body rather than overriding it.
   • Typical Dosage:
     • Dose: 150–250 mg per day
     • Standardization: Choose trans-resveratrol supplements with 98–100% purity to ensure bioactive effectiveness
     • Form: Capsule or softgel, ideally in a micronized or liposomal form for increased absorption
     • Timing: Take once daily with food, preferably in the morning to align with cortisol rhythm and minimize GI upset
     • Duration of Use
       • Use for a minimum of 8–12 weeks to support estrogen clearance, normalize ovulation, and improve egg quality
       • Best applied during follicular phase or as part of a broader preconception protocol when preparing the body for ovulation
     • Synergistic Combinations
       • Combine with quercetin or EGCG to amplify aromatase inhibition and antioxidant protection
       • Pair with NAC or milk thistle to support phase I and II liver detox—crucial for estrogen metabolism
       • Use alongside inositol for added insulin regulation in PCOS-driven infertility
2. Green Tea Catechins (EGCG)
   • How It Works: EGCG, the active polyphenol in green tea, acts as a potent natural aromatase inhibitor. It directly suppresses the activity of the aromatase enzyme, which converts androgens into estrogens. EGCG not only inhibits estrogen synthesis by directly binding to and blocking aromatase (similarly to Resveratrol) but also modulates gene expression linked to estrogen metabolism. It downregulates CYP19A1, the gene encoding aromatase, further limiting estrogen production at the source. The result: restored ovulatory cycles, improved egg maturation, and increased fertility potential.
   • Advantages: Unlike synthetic drugs, EGCG delivers this hormonal recalibration without liver toxicity, ovarian overstimulation, or long-term endocrine disruption. There is also robust evidence regarding the benefits of EGCG for modulating other estrogen-dependent diseases, like estrogen-dependent cancers. EGCG offers a biologically intelligent solution—working with the body’s natural systems to correct the root dysfunction behind anovulatory infertility. As a natural Letrozole alternative, EGCG provides targeted, reliable aromatase inhibition. It shifts the hormonal environment in favor of ovulation and conception, while simultaneously reducing oxidative stress and inflammation—two major contributors to ovarian dysfunction.
   • Typical Dosage:
     • Therapeutic range: 300–400 mg per day, standardized to ≥90% EGCG
     • Form: Use decaffeinated green tea extract capsules or powders to avoid overstimulation
     • Timing: Divide the dose into two servings (e.g., 200 mg AM, 200 mg PM) to maintain stable blood levels
     • Duration: Use for at least 3 menstrual cycles to assess full impact on ovulation and hormonal balance
     • Critical Guidelines
       • Always take EGCG with food to reduce potential gastrointestinal irritation.
       • Avoid taking EGCG within two hours of iron or folate supplements—it interferes with absorption.
       • Combine with antioxidant cofactors like quercetin or vitamin C to enhance bioavailability and reproductive tissue protection.
     • Cautions
       • Doses exceeding 800 mg per day increase risk of liver stress, particularly in women with compromised detox pathways (e.g., MTHFR mutations, sluggish phase II liver detox).
       • Monitor liver enzymes if using alongside other herbs or medications.
3. Saw Palmetto
   • How It Works: Saw Palmetto delivers powerful endocrine modulation by directly inhibiting both aromatase and 5-alpha reductase—two key enzymes involved in hormonal imbalance. As a natural aromatase inhibitor, Saw Palmetto blocks the conversion of androgens into estrogens at the tissue level, particularly in adipose and ovarian tissue. By blocking this pathway, Saw Palmetto reduces DHT load, rebalances androgen levels, and removes one of the most common roadblocks to ovulation.
   • Advantages: Unlike synthetic drugs that override the endocrine system, Saw Palmetto reestablishes proper feedback between the hypothalamus, pituitary, and ovaries. It stabilizes estrogen and androgen levels, supports follicular development, and promotes timely ovulation without the side effects linked to pharmaceuticals like Letrozole. As a natural Letrozole alternative, Saw Palmetto addresses the same root dysfunction—excess estrogen production and androgen imbalance—through targeted, multi-pathway inhibition. It restores hormonal order and fertility function with precision and without compromise.
   • Typical Dosage:
     • Dose: 320–400 mg per day
     • Standardization: Use extracts standardized to 85–95% fatty acids and sterols—the active constituents responsible for enzyme inhibition
     • Form: Softgel or liquid extract for superior absorption
     • Timing: Take once daily with a fat-containing meal to optimize bioavailability
     • Duration of Use:
       • Use consistently for at least 8–12 weeks to see measurable shifts in hormonal patterns and ovulatory cycles
       • Best used as part of a comprehensive protocol that includes blood sugar regulation, adrenal support, and anti-inflammatory nutrition
       • Combine with zinc for enhanced 5-alpha reductase inhibition, or vitex/inositol to further regulate LH, FSH, and ovulatory signaling
       • Stack with EGCG or resveratrol when estrogen suppression requires broader enzyme inhibition
     • Cautions
       • Avoid use during active attempts at conception without supervision, as it may suppress DHT levels beyond optimal range if overdosed
       • Monitor for mild gastrointestinal discomfort or changes in menstrual flow—these reflect hormonal shifts, not toxicity
4. Grape Seed Extract
   • How It Works: Grape Seed Extract contains proanthocyanidins, which exert strong antioxidant effects while simultaneously blocking estrogen biosynthesis via aromatase inhibition. This dual action not only promotes ovulation but also protects ovarian tissue from oxidative stress—one of the hidden drivers of poor egg quality and anovulation.
   • Advantages: As a natural Letrozole alternative, Grape Seed Extract delivers precise hormonal recalibration without the synthetic overload of pharmaceuticals. Its high concentration of proanthocyanidins neutralizes free radicals and halts the oxidative stress that fuels chronic inflammation in reproductive tissues. This antioxidant activity protects ovarian follicles, preserves egg quality, and stabilizes the endometrial environment—critical factors for successful conception and implantation.
   • Typical Dosage
     • Dose: 150–300 mg per day
     • Standardization: Choose extracts standardized to 95% proanthocyanidins—the active compounds responsible for aromatase inhibition and antioxidant effects
     • Form: Capsule or powder; use encapsulated form for precise, therapeutic dosing
     • Timing: Take once or twice daily with meals to improve absorption and reduce gastrointestinal irritation
     • Duration of Use
       • Continue for at least 8–12 weeks to lower estrogen levels, support ovulation, and improve overall reproductive function
       • Integrate into the follicular phase of the cycle or use as part of a full preconception plan to reset hormonal balance before conception attempts
     • Synergistic Combinations
       • Stack with resveratrol or EGCG to intensify aromatase inhibition and estrogen detox
       • Pair with vitamin C to enhance antioxidant capacity and stabilize proanthocyanidin activity
       • Combine with inositol or chromium to simultaneously support insulin sensitivity and ovarian function in PCOS cases
     • Cautions
       • Avoid combining with blood thinners or high-dose NSAIDs without supervision, as Grape Seed Extract also promotes vascular flexibility
         Monitor menstrual cycle shifts—reduced estrogen load often triggers faster follicular development and earlier ovulation
       • Doses above 400 mg daily increase risk of gastrointestinal symptoms and do not increase therapeutic effect proportionally
5. Shatavari
   • How It Works: This botanical works on multiple levels. Its steroidal saponins bind to estrogen receptors and modulate their sensitivity, reducing the overstimulation caused by high estrogen levels. At the same time, Shatavari supports the adrenal glands and reduces cortisol output, protecting the reproductive system from stress-induced dysfunction, particularly relevant in cases of Hypothalamic Amenorrhea, PCOS and Perimenopause.
   • Advantages: Shatavari enhances follicular development, supports egg maturation, and improves cervical mucus quality—three non-negotiable factors for natural conception. It also stabilizes progesterone levels post-ovulation, supporting luteal phase health and implantation.
   • Typical Dosage:
     • Dose: 500–1000 mg per day
     • Standardization: Use standardized extracts containing 10–20% steroidal saponins, the bioactive compounds responsible for aromatase inhibition and hormonal support
     • Form: Capsule or tincture; choose high-quality, standardized extracts for consistent potency
     • Timing: Divide into two doses daily, preferably with meals to enhance absorption and minimize gastrointestinal discomfort
     • Duration of Use
       • Administer for at least 8–12 weeks to achieve meaningful hormonal recalibration and improved ovulatory function
       • Most effective when incorporated into a broader fertility protocol focused on stress reduction, blood sugar balance, and anti-inflammatory nutrition
     • Synergistic Combinations
       • Combine with ashwagandha or rhodiola to support adrenal function and reduce cortisol’s disruptive impact on reproductive hormones
       • Pair with vitex or inositol to enhance follicular maturation and regulate pituitary hormone signaling
       • Use alongside Grape Seed Extract or Resveratrol to strengthen aromatase inhibition and estrogen metabolism
     • Cautions
       • Avoid excessive dosing beyond 1000 mg daily to prevent hormonal overstimulation or digestive upset
       • Monitor menstrual cycle and ovulation patterns closely—Shatavari’s potent endocrine effects often manifest quickly in cycle regularity and luteal phase support
       • Not recommended during confirmed pregnancy without professional guidance due to its hormonal activity

The road to conception can be difficult and frustrating, but you don’t have to rely solely on pharmaceutical treatments like Letrozole to address infertility. Natural Letrozole alternatives offer an empowering way to regulate hormones, promote ovulation, and support overall fertility health. Whether you choose EGCG, Shatavari or other herbal remedies, these natural options provide a gentler, holistic approach to fertility, addressing the root cause of hormonal imbalances while avoiding the side effects of synthetic medications.

Incorporating natural Letrozole alternatives into your fertility journey is a step toward taking control of your reproductive health. With patience and proper guidance, these natural remedies provide an effective, safe, and sustainable solution to support your body’s ability to conceive.

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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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 Natural Letrozole Alternatives: Holistic Fertility Treatment Through Functional Medicine 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.

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 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.

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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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In this post, we’ll explore the most important foods to avoid for each type of PCOS from a functional medicine perspective, while also offering evidence-based supplements and beneficial foods to help balance your hormones naturally.

Types of PCOS

1. Adrenal PCOS

Adrenal PCOS is driven by excess androgen production from the adrenal glands. This type of PCOS is typically associated with high stress levels, poor adrenal function, and imbalances in cortisol. Women with adrenal PCOS may experience symptoms such as excess body hair (hirsutism), scalp hair thinning, acne, and irregular periods.

Foods to Avoid for Adrenal PCOS

• Caffeine: Excessive caffeine can stimulate cortisol production, exacerbating adrenal stress. It’s best to avoid caffeinated beverages like coffee and energy drinks.
• Refined Sugars: Refined sugars and processed carbs cause blood sugar spikes and crashes, which can lead to further cortisol imbalances.
• Alcohol: Alcohol places additional stress on the liver, impairing its ability to detoxify and regulate hormones.
• Processed Foods: These often contain trans fats and additives that may disrupt hormone function and contribute to inflammation.

Beneficial Foods for Adrenal PCOS

• Adaptogenic Herbs: Foods like ashwagandha, maca root, and holy basil can help regulate cortisol levels and support adrenal health.
• Healthy Fats: Avocados, olive oil, and omega-3-rich foods (like salmon and flaxseeds) nourish the adrenals and promote hormone balance.
• Leafy Greens: Rich in magnesium, spinach, kale, and Swiss chard help calm the nervous system and reduce stress.

Supplements for Adrenal PCOS

• Ashwagandha: Known for its adaptogenic properties, ashwagandha can help lower cortisol and support adrenal function.
• Vitamin C: High-dose vitamin C can reduce cortisol levels and improve adrenal function.
• B Vitamins: B5 and B6 are especially helpful for adrenal support and stress management.

2. Post-Pill PCOS

Women with post-pill PCOS develop symptoms of PCOS after discontinuing birth control pills. The synthetic hormones in birth control pills can suppress natural hormone production, and once the pill is stopped, the body may take time to rebalance itself. Common symptoms include acne, hair thinning, and irregular cycles.

Foods to Avoid for Post-Pill PCOS

• Soy: While soy is a good source of plant-based protein, it can interfere with estrogen levels and disrupt hormonal balance, particularly in women who have just stopped taking the pill.
• Dairy: Some women find that dairy exacerbates acne and hormonal imbalance due to its potential to increase androgens.
• Refined Grains: White bread, pasta, and other refined grains can spike blood sugar, which in turn elevates insulin levels and can worsen hormonal imbalances.

Beneficial Foods for Post-Pill PCOS

• Cruciferous Vegetables: Broccoli, cauliflower, and Brussels sprouts help the body detox excess estrogen and promote hormone balance.
• Flaxseeds: Rich in lignans, flaxseeds help balance estrogen levels by supporting estrogen metabolism.
• High-Fiber Foods: Fiber-rich foods like oats, quinoa, and chia seeds can help regulate insulin levels and improve digestive health.

Supplements for Post-Pill PCOS

• Inositol: A combination of myo-inositol and D-chiro-inositol can help improve ovarian function and regulate insulin.
• Zinc: Zinc supports healthy skin and can reduce acne related to hormonal imbalances.
• DIM (Diindolylmethane): Found in cruciferous vegetables, DIM supports the body’s ability to detoxify estrogen and may help with hormonal acne.

3. Inflammatory PCOS

Inflammatory PCOS is marked by chronic low-grade inflammation throughout the body. This type of PCOS is often associated with symptoms like weight gain, acne, fatigue, and insulin resistance. Chronic inflammation can exacerbate the symptoms of PCOS and interfere with hormone regulation.

Foods to Avoid for Inflammatory PCOS

• Fried Foods: High in trans fats, fried foods can increase inflammation in the body and contribute to insulin resistance.
• Sugar-Sweetened Beverages: Sodas, energy drinks, and even sugary fruit juices can spike blood sugar and increase inflammation.
• Processed Meats: Bacon, sausages, and hot dogs are often high in inflammatory omega-6 fatty acids and preservatives.
• Artificial Sweeteners: These can disrupt gut microbiota and promote inflammation.

Beneficial Foods for Inflammatory PCOS

• Turmeric: Contains curcumin, a potent anti-inflammatory compound that can help reduce inflammation in the body.
• Berries: Blueberries, strawberries, and raspberries are packed with antioxidants that reduce oxidative stress and inflammation.
• Omega-3 Fatty Acids: Fatty fish like salmon, sardines, and mackerel are rich in omega-3s, which help reduce inflammation.

Supplements for Inflammatory PCOS

• Curcumin (Turmeric): An anti-inflammatory powerhouse that can help reduce systemic inflammation and improve ovarian function.
• Omega-3 Fatty Acids: Supplements like fish oil can significantly reduce inflammation and support overall hormone balance.
• Vitamin D: Low levels of vitamin D have been associated with inflammation and insulin resistance in PCOS.

4. Insulin-Resistant PCOS

Insulin resistance is one of the most common underlying factors in PCOS. When the body becomes resistant to insulin, it leads to higher levels of circulating insulin, which can worsen hormonal imbalances, increase androgen production, and contribute to weight gain, fatigue, and acne.

Foods to Avoid for Insulin-Resistant PCOS

• High Glycemic Index Foods: Foods that spike blood sugar, such as white bread, pastries, and sugary cereals, should be avoided.
• Trans Fats: Found in many packaged snacks and fried foods, trans fats can worsen insulin resistance and increase inflammation.
• Refined Grains: These foods cause rapid spikes in blood sugar and insulin levels, exacerbating insulin resistance.

Beneficial Foods for Insulin-Resistant PCOS

• Low-Glycemic Index Foods: Non-starchy vegetables, legumes, and whole grains help stabilize blood sugar levels and improve insulin sensitivity.
• Magnesium-Rich Foods: Spinach, pumpkin seeds, and almonds are great sources of magnesium, which can help improve insulin sensitivity.
• Cinnamon: Known for its ability to improve insulin sensitivity, cinnamon can be added to smoothies or oatmeal.

Supplements for Insulin-Resistant PCOS

• Berberine: An herbal supplement that has been shown to improve insulin sensitivity and regulate blood sugar.
• Magnesium: Magnesium supplementation can help improve insulin sensitivity and reduce the risk of developing type 2 diabetes.
• Alpha-Lipoic Acid: A potent antioxidant that can enhance insulin sensitivity and improve metabolic function.

Personalizing Your Diet for PCOS

Whether you have adrenal, post-pill, inflammatory, or insulin-resistant PCOS, a functional medicine approach focuses on addressing the root causes of your hormonal imbalance through diet, lifestyle, and targeted supplementation. By avoiding inflammatory foods, refined sugars, and processed carbs, and by incorporating hormone-balancing foods, you can help mitigate the symptoms of PCOS and support long-term health.

Remember that everyone’s experience with PCOS is unique, so it’s important to work with a functional medicine practitioner or healthcare provider to customize your diet and supplement plan for optimal results.

By understanding the type of PCOS you’re dealing with and adjusting your diet accordingly, you can reclaim your health, balance your hormones, and feel empowered to manage your symptoms effectively.

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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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 How to Use Supplements for PCOS 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.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

• Facebook
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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.

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

The post Can A Hormone Imbalance Make You Bloated? appeared first on Dr. Alexandra MacKillop.

If you are worried about your hormones, you’re probably not wrong. You know your body best. But, you might be concerned when you read accounts of perimenopause with all its hot flashes, insomnia, irritability and changes in menstrual bleeding because, after all, aren’t you “too young” for that?

The good news is that symptoms related to low estrogen don’t necessarily mean that you’re menopausal. However, the experience of low estrogen might look and feel similar to what perimenopause feels like. It’s quite the roller coaster ride.

What is Estrogen Deficiency?

Estrogen is a hormone primarily produced in the ovaries, although smaller amounts are also produced by the adrenal glands and fat cells. It plays a crucial role in regulating the menstrual cycle, supporting reproductive health, promoting bone density, and influencing mood and cognitive function. Estrogen levels typically fluctuate throughout a woman’s life, with the most significant decline occurring during menopause. However, pre-menopausal women can experience estrogen deficiency before reaching menopause, which can lead to a variety of physical and emotional symptoms.

Causes of Estrogen Deficiency in Pre-Menopausal Women

There are several potential causes of estrogen deficiency in pre-menopausal women. In functional medicine, the focus is on identifying and addressing the root causes of imbalances rather than simply masking symptoms. Key factors contributing to estrogen deficiency in pre-menopausal women include:

1. Stress and HPA Axis Dysfunction

Chronic stress is a major factor that can lead to hormonal imbalances, including estrogen deficiency. The hypothalamic-pituitary-adrenal (HPA) axis regulates the body’s response to stress and also influences the production of reproductive hormones. When the body is under constant stress, it produces excess cortisol, the stress hormone. Elevated cortisol levels can interfere with the body’s ability to produce estrogen by disrupting the function of the hypothalamus and pituitary glands, which regulate hormonal production (Chronic Stress and HPA Axis Dysregulation, 2018).

Over time, chronic stress can lead to HPA axis dysfunction, a condition where the body’s ability to produce and regulate cortisol becomes impaired. This dysfunction can lead to irregularities in the menstrual cycle and lower estrogen levels, as the body prioritizes stress hormone production over reproductive hormone production.

2. Irregular Eating Patterns and Poor Nutrition

Diet plays a significant role in maintaining hormonal balance. Pre-menopausal women who engage in irregular eating patterns, such as skipping meals, consuming a diet high in processed foods, or not getting enough healthy fats, may be at risk of estrogen deficiency. Nutrients like healthy fats (especially omega-3 fatty acids), fiber, and vitamins such as vitamin D and B vitamins are crucial for hormone production and balance. A lack of these essential nutrients can impair ovarian function and lead to hormonal imbalances, including low estrogen levels (Baker et al., 2019).

Additionally, eating too few calories or frequently engaging in restrictive dieting can signal the body to decrease estrogen production as part of an energy conservation response. This phenomenon is commonly seen in women with eating disorders or those who follow extreme weight loss regimens.

3. Ovarian Function Decline

Ovarian function naturally declines as women age, but premature ovarian insufficiency (POI), also known as early menopause, can occur before the age of 40. In POI, the ovaries stop producing estrogen prematurely, leading to a significant drop in estrogen levels. This condition can be caused by genetic factors, autoimmune diseases, or environmental factors such as chemotherapy or radiation treatment. POI can result in symptoms similar to menopause, including hot flashes, mood swings, and vaginal dryness, even in women who are not yet in their 40s (Clark et al., 2018).

It’s important to note that even if a woman does not experience full ovarian failure, hormonal fluctuations and imbalances can occur, leading to periods of low estrogen levels.

4. Poor Sleep and Hormonal Imbalance

Sleep plays a pivotal role in maintaining hormonal balance. Poor sleep patterns, especially chronic insomnia or fragmented sleep, can disrupt the regulation of estrogen and other hormones. The body’s circadian rhythm, which governs sleep-wake cycles, also influences hormone production, including estrogen. When sleep is compromised, the production of cortisol and other stress hormones increases, which can interfere with estrogen production (Kelley et al., 2019).

Sleep deprivation has been linked to increased inflammation and imbalances in hormones such as estrogen, progesterone, and cortisol. Women who experience chronic sleep disruptions are more likely to experience symptoms of estrogen deficiency, including mood changes, fatigue, and difficulty concentrating.

Signs and Symptoms of Estrogen Deficiency in Pre-Menopausal Women

Estrogen deficiency can manifest in a variety of physical, emotional, and cognitive symptoms. Pre-menopausal women experiencing low estrogen levels may notice the following:

1. Irregular Menstrual Cycles

One of the earliest signs of estrogen deficiency is irregular menstruation. Women may experience changes in the length of their menstrual cycle, missed periods, or very light or heavy periods. Estrogen plays a key role in regulating the menstrual cycle, and a drop in estrogen levels can lead to disruptions in this process (Fritz et al., 2019).

2. Hot Flashes and Night Sweats

Although hot flashes and night sweats are often associated with menopause, they can also occur in pre-menopausal women with estrogen deficiency. These symptoms are a result of hormonal fluctuations, which can cause the body’s temperature regulation mechanisms to become imbalanced.

3. Mood Swings and Anxiety

Estrogen has a significant impact on mood regulation and cognitive function. Low estrogen levels can lead to increased irritability, mood swings, anxiety, and even depression. Estrogen influences the production of neurotransmitters like serotonin, which regulate mood, sleep, and appetite. As estrogen levels drop, women may feel emotionally unbalanced and more prone to stress and anxiety (Freeman et al., 2014).

4. Fatigue and Low Energy

Women with estrogen deficiency may experience chronic fatigue, low energy levels, and a general sense of exhaustion. Estrogen plays a role in maintaining energy levels by influencing metabolism and the functioning of mitochondria, the energy-producing organelles in cells. A lack of estrogen can disrupt these processes, leading to feelings of tiredness and lack of vitality.

5. Vaginal Dryness and Decreased Libido

Estrogen is essential for maintaining vaginal health and lubrication. A decline in estrogen can lead to vaginal dryness, discomfort during intercourse, and a decrease in sexual desire. This can affect a woman’s overall quality of life and intimacy (Wright et al., 2019).

Herbal Supplements for Estrogen Deficiency

Functional medicine focuses on addressing the root causes of estrogen deficiency and using natural remedies to support hormonal balance. Several herbal remedies have been traditionally used to promote estrogen production and alleviate symptoms of estrogen deficiency:

1. Black Cohosh

Black cohosh is one of the most well-known herbs for balancing estrogen levels. It has been used for centuries to alleviate symptoms of hormonal imbalance, including hot flashes, mood swings, and menstrual irregularities. Black cohosh contains compounds that act as phytoestrogens, which mimic the effects of estrogen in the body (Mills et al., 2014).

2. Dong Quai

Dong Quai, often referred to as “female ginseng,” is an herb commonly used in traditional Chinese medicine to support female reproductive health. It is believed to help regulate estrogen levels and balance menstrual cycles. Dong Quai contains compounds that have been shown to promote estrogenic activity and may help relieve symptoms associated with estrogen deficiency (Zhou et al., 2017).

3. Maca Root

Maca root is a powerful adaptogen that helps regulate the body’s stress response and support hormonal balance. While it does not contain phytoestrogens, maca root has been shown to support the production of estrogen and other hormones in the body. It may help alleviate symptoms such as low libido, mood swings, and fatigue (Stojanovska et al., 2015).

4. Chaste Tree (Vitex)

Chaste tree, or Vitex, is an herb commonly used to regulate hormonal imbalances, particularly those involving estrogen and progesterone. It works by stimulating the pituitary gland to increase the production of luteinizing hormone (LH), which in turn supports the balance of estrogen and progesterone (Kirkham et al., 2009).

Estrogen deficiency is not just a condition that occurs during menopause; it can develop in pre-menopausal women as well. Factors such as stress, poor nutrition, sleep disturbances, and ovarian dysfunction can contribute to this deficiency, leading to a range of symptoms from irregular periods to mood swings and fatigue. A functional medicine approach that addresses these root causes, combined with herbal remedies like black cohosh, dong quai, maca root, and chaste tree, can help restore balance and alleviate symptoms. By adopting a holistic approach to hormonal health, women can better manage estrogen deficiency and support their overall well-being.

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

Baker, L. D., et al. (2019). Nutrition and hormone regulation in women’s health. Journal of Women’s Health, 28(3), 227-233. https://doi.org/10.1089/jwh.2018.7167

Chronic Stress and HPA Axis Dysregulation (2018). Hormone Health Journal, 3(1), 45-52.

Clark, M. A., et al. (2018). Premature ovarian insufficiency: Diagnosis and management. Journal of Clinical Endocrinology & Metabolism, 103(9), 3097-3105. https://doi.org/10.1210/jc.2018-00885

Freeman, E. W., et al. (2014). Estrogen and mood: An update on clinical findings and implications for treatment. Journal of Clinical Psychiatry, 75(7), 732-739. https://doi.org/10.4088/JCP.13r08744

Kelley, G. A., et al. (2019). Sleep and estrogenic regulation of metabolic function. Sleep Medicine Reviews, 45, 67-79. https://doi.org/10.1016/j.smrv.2018.02.004

Kirkham, L., et al. (2009). The use of Vitex agnus-castus in the management of hormonal imbalances. Journal of Herbal Medicine, 3(3), 103-110.

Mills, E., et al. (2014). Black cohosh for menopausal symptoms: A systematic review. American Journal of Obstetrics & Gynecology, 210(2), 154-161.

Stojanovska, L., et al. (2015). Maca root: A functional food and its potential health benefits. International Journal of Food Science & Technology, 50(4), 982-988.

Wright, R. D., et al. (2019). Hormonal balance and female health: The role of estrogen. Women’s Health Journal, 30(1), 12-19.

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