Progesterone is a tiny molecule that plays a big role in the hormonal picture. When levels start to go awry, our health and well-being suffers. Understanding how our hormones affect wellness is not only an important tool for self-care, but this knowledge also gives us the power to advocate for ourselves so we can access the care we deserve. Whether your goal is to regulate your cycle, conceive and carry a healthy pregnancy, reduce the long-term risks associated with hormonal imbalances, or just gain some good, old-fashioned information about how your body was designed, read on!

Hormones throughout Your Cycle

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

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

When progesterone levels drop too low, or aren’t produced in a functional ratio in comparison to other sex hormones like testosterone and estrogen, our health suffers. Chronically low progesterone can increase risk of osteoporosis, poor blood sugar control and diabetes, breast cancer, depression, anxiety, and other neurocognitive disorders. Low progesterone also leads to symptoms such as:

• Migraines
• Absent or irregular periods
• Bleeding or spotting between periods
• Low libido
• Recurrent miscarriages
• Painful periods
• Insomnia
• Luteal phase defect
• Infertility
• and more…

What Causes Progesterone Deficiency?

The production of progesterone from the ovaries is regulated by the hypothalamic-pituitary-gonadal axis, a delicate web of signals between the brain and reproductive organs. Progesterone deficiency can result from interruptions along the entire axis, whether from a signaling problem at the brain level, or from dysfunction of the ovaries themselves. One of the most common reasons for low progesterone is chronic stress. Elevated stress hormones create a negative feedback loop that interrupts the signaling between the brain and ovaries, decreasing progesterone production. In many cases, especially with women who are over-exercising or under-eating, stress acts on the HPG axis to prevent ovulation altogether. Without ovulation, the corpus luteum doesn’t form, and the main mechanism for producing progesterone during the luteal phase is completely taken out of the picture.

Here are a few other reasons for low progesterone:

• Adrenal dysfunction
• Perimenopause
• Vitamin deficiencies
• PCOS
• Low body fat
• High prolactin (such as in breastfeeding women)
• Calorie or carb-restricted diet
• Too much exercise (especially high-intensity or weight training)
• Use of contraceptives containing synthetic progestins
• Oophorectomy (surgical removal of ovaries)
• Hypothyroidism
• Inflammation
• Estrogen Dominance (creating a relative progesterone deficiency)

What to Do About Progesterone Deficiency

As with any hormonal imbalance, effective treatment starts with identifying the root cause. This is why it’s so important to work with a naturally-minded healthcare provider to review diagnostic tests and lifestyle/history to get to the bottom of the progesterone deficiency. If undereating is the driving force behind low progesterone, for example, no amount of vitamins or supplements will effectively solve the problem. The nutrition (and the relationship with food) needs to be addressed, first!

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

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

Lifestyle

Diet and Exercise: Overdoing it in the gym and under eating are the main forces behind low progesterone. These create a state of allostatic overload, lowering progesterone output or altogether inhibiting ovulation—a condition called hypothalamic amenorrhea. When I’m working with a patient whose history and labs point to progesterone deficiency, the first place I start is with cutting back on exercise, and upping her intake of carbohydrates and fats. Hormones are produced from fat and cholesterol, so adding in foods like eggs, butter, and oily fish are essential. Carbs are also extremely important for women, and we can’t menstruate without them. Low-carb and calorie-restricted diets also affect production of all kinds of other hormones, including thyroid, immune, metabolism, and more.  

Stress: In my clinical experience, the most common cause of hormonal imbalances among women are related to stress. Whether that source of stress is emotional, relational, physical, nutritional, or otherwise, stress management is key. Progesterone and cortisol are both produced from the same hormonal precursor, called pregnenolone. When stress levels are high, the body allocates its resources towards producing cortisol, which means there aren’t many leftovers for producing progesterone. (This is called pregnenolone steal.) The end result is a low progesterone level. Stress also inhibits the HPG axis at the brain level, preventing the LH surge that triggers ovulation. Without ovulation, it’s impossible for progesterone levels to remain high enough for health and fertility.

Sleep: Sleep and stress go hand in hand. When we aren’t sleeping enough, cortisol production goes into overdrive, creating all the problems described above. Lack of sleep also distorts the circadian rhythm, changing the natural patterns of sleep hormones and neurotransmitters that regulate cyclical patterns in the body—everything from the sleep/wake cycle to the menstrual cycle. Lack of sleep also tends come along with over-use of stimulants such as caffeine and nicotine, which create their own subset of hormonal fallout.

Progesterone has a reciprocal relationship with sleep deprivation. Since one of the roles of progesterone is to create a feeling of calm and relaxation, low progesterone can feed forward into insomnia symptoms, furthering the degree of sleep disruption and deprivation. Targeting issues like insomnia at their root cause is essential for true health and healing.

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

Supplements

Progesterone Cream: Progesterone cream is a supplemental form of progesterone that is applied as a lotion to the skin and absorbed into the blood stream. Just like a pill, progesterone cream supplements the existing amount of progesterone produced by the body, but does not address the root cause behind the progesterone deficiency. However, progesterone cream can be a helpful temporary step for women who are suffering from extremely painful periods, or who are experiencing fertility struggles due to low progesterone.

Vitamin D: Vitamin D really is more appropriately classified as a hormone than a vitamin. Like other hormones, it is derived from cholesterol and circulates throughout the body, communicating with almost every organ system. Vitamin D also plays a regulatory role in the production of sex hormones. Because of our largely indoor lives and the risk of skin cancer from UV exposure, most Americans are deficient in vitamin D. In my clinic, I test every patient’s vitamin D levels so that I can safely prescribe supplements to restore functional vitamin D levels and hormonal balance.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4507331/Vitamin B6: In women suffering from a luteal phase defect (a luteal phase that lasts 11 days or fewer, which is a consequence of low progesterone), supplementation with vitamin B6 has been proven to extend the length of the luteal phase. This helps correct for associated fertility struggles, in which the fertilized egg doesn’t have sufficient time to implant in the endometrial lining before menstruation begins—an event triggered when progesterone levels dip.

DHEA: Like cortisol, testosterone is produced from the same precursor as progesterone: pregnenolone. When cortisol levels or testosterone levels are high, progesterone production tends to suffer. DHEA is an intermediate between pregnenolone and testosterone, so supplementing with DHEA in women who are suffering from low progesterone because of elevated testosterone can reduce the consumption of pregnenolone for testosterone production. That leaves more available for progesterone production. DHEA can also cross-react with the pathway for progesterone production, elevating levels even in women whose deficiency is not the result of hyperandrogenism.

Vitex: Naturally occurring iridoids and flavonoids present in Vitex mimic the role of the corpus luteum, acting on the ovaries to stimulate the production of progesterone. In this study, Vitex was dosed at levels of 20 mg tablets daily.

Closing thoughts…

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

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

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

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

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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

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

The post Natural Treatment for Progesterone Deficiency appeared first on Dr. Alexandra MacKillop.

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

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

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

Estrogen Dominance and Progesterone

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

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

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

What Causes Estrogen Dominance?

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

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

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

What to Do About Estrogen Dominance

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

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

Lifestyle Modification for Estrogen Dominance

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

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

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

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

Nutrition for Estrogen Dominance

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

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

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

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

Supplements for Estrogen Dominance

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

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

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

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

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

Closing thoughts…

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

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

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

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

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

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

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

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

Maybe you can relate: for most of my life I preferred not to think about my period very much. I found it to be inconvenient and, at times, embarrassing. (We’ve all been there…) Once I got married, though, I started paying more attention to everything going on in relation to my cycle. At first it was for family planning purposes, but I slowly started to notice cyclic, predictable changes in my body that had nothing to do with “that” time of the month—energy levels, hunger patterns, motivation, introversion versus extroversion, and more. I found it super fascinating, especially when I started comparing those changes to the hormonal patterns I’d learned about in school.

In the same way that gentle nutrition practices have helped me build trust with my body, learning about my cycle in a more personal way (rather than just reading a textbook) has helped me manage my health more confidently. It feels so good to know that everything is working as it should, and what to do if something seems amiss. If you’re interested in learning about that too, this post is for you! (Want to go deeper Check out my book, Go with Your Flow: a revolutionary guide to better periods, balanced hormones and a cycle that works for you)

Hormones and the HPATG Axis

If you’ve read my post about the hypothalamic-pituitary-adrenal-thyroid-gonadal axis, or HPATG axis for short, you’ll remember that our monthly cycles begin and end in our brains. Part of the brain called the hypothalamus sends hormonal signals to the pituitary gland, triggering another hormone cascade that tells our reproductive organs what to do, and when. Although different circumstances can interfere with that communication axis, for the most part, the hormonal pathways work like this:

The main signals sent out by the pituitary gland are luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones travel through the blood stream to the ovaries, stimulating the production of estrogen and progesterone. These four hormones rise and fall in predictable patterns throughout the menstrual cycle to trigger ovulation, thicken the endometrial lining, and shed unused tissue if pregnancy doesn’t occur.

The menstrual cycle is divided into two main stages: the follicular phase and the luteal phase. Within those two phases we have two pretty noteworthy events (ovulation and menstruation), so I like to think of the cycle as having 4 phases, beginning with the first day of your period (cycle day 1 [CD 1]). Although the length of normal cycles can range anywhere from 21 to 35 days, most textbooks use a time frame of around 28 days, so that’s the reference range I’ll be using in this post.

• Phase 1 (Menses [Cycle Days 1-7]): This is probably the part of your cycle you’re most familiar with: your period. When counting the days of the menstrual cycle, we count the first day of the cycle as the first day of a period. Some women experience light spotting in the days leading up to their period, but those days are counted as part of the luteal phase (phase 4). Cycle day 1 (or CD 1) is counted as the first full day of bleeding. Technically, the days of your period fall within the follicular phase, because they start the beginning of the hormonal processes that lead to menses in the following month’s cycle. In terms of your hormonal cycles, the formal end date of your period doesn’t matter so much as the first day of bleeding.
• Phase 2 (Follicular Phase [Cycle Days 1-13]): During this phase (yes, even starting on the first day of your period), your body is starting to prepare for next month’s period—or a possible pregnancy. The first day of the follicular phase, CD1, is the day when hormone levels are at their lowest. Estrogen and progesterone are at their minimum, and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are laying low, too. Over the course of the first week, FSH levels slowly start to rise, stimulating ovaries to slowly ramp up production of estrogen. The estrogen circulates throughout the body playing a number of different roles, but the most noteworthy action in terms of fertility takes place locally, at the ovary. When estrogen levels begin to rise, about 12-18 ovarian follicles start to ripen. Eventually, most of these follicles die off, and just one finishes the maturation process, an event that corresponds to the day when estrogen is at its highest. Estrogen production peaks at around days 11-13, then sharply falls. The pituitary gland senses this drop in estrogen through a feedback loop. Its response is to send out a surge of FSH paired with an even stronger surge of LH to trigger ovulation.
• Phase 3 (Ovulation [Cycle Day 14]): On the day of ovulation, the sharp rise of FSH and LH stimulate the mature ovarian follicle to burst open, releasing the egg. The egg travels down through the fallopian tube, and if unfertilized, dissolves within 24-36 hours. What’s left of the follicle collapses, becoming the corpus luteum, and begins producing progesterone which is the dominant hormone of the luteal phase.
• Phase 4 (Luteal Phase [Cycle Days 14-28]): After ovulation, FSH and LH levels drop back down again, and hormones in generally reach another realative low. Beginning with the day of ovulation, however, the corpus luteum takes over hormone production, secreting progesterone and some estrogen, which thickens the uterine lining to prepare for a possible pregnancy. Progesterone levels peak at about CD 21, followed by a gradual decline of both estrogen and progesterone. (Eventually the corpus luteum breaks down into the corpus albicans, ultimately dissolving completely.) When the hormones levels bottom out, the menstrual lining begins to slough off and the cycle starts all over again.

Getting to know YOUR cycle

In my experience, women typically express an interest in their cycle when they start the process of trying for a baby. While unprotected intercourse technically could lead to a pregnancy at any point in the follicular phase depending on each individual woman, there are really only 5-7 days each cycle that conception is really possible. These days correspond to the 5 days leading up to ovulation, the day of ovulation itself, and then the day after ovulation.

Fertile Days

These fertile days really depend on the lifespan of sperm. The actual union of sperm and egg can only take place on the day of ovulation and the 24-36 hours thereafter, until the egg dissolves. Sperm, however, can live up to five days in the uterus and fallopian tubes, waiting around for the egg to be released. In a 28 day cycle, these fertile days would correspond to CD 10 through CD 15. Having unprotected sex on any other day corresponds to a very, very, very low chance of conception, and this awareness serves as the basis for Fertility Awareness Methods of family planning.

But of course, not every woman’s cycle lasts the textbook length of 28 days. In order to get to know you and your cycle, there are a number of personalized methods you can use. I explain these in detail in my book, Go with Your Flow, but here is an overview:

Cycle Tracking Method #1: Hormone Testing

At-home urine hormone tests can be used to predict and confirm ovulation, and they’re pretty inexpensive. The testing procedure involves placing a urine dipstick into a sample of urine. If the hormone target is present in the urine, it will react with a reagent and bind to a dye strip—similarly to a home pregnancy test.

Ovulation predictor test strips qualitatively measure levels of luteinizing hormone in the urine, and generally show a pale pink line on most days of the follicular phase. On the day of LH surge, the test strip will turn dark pink, indicating a sharp increase in the level of LH. This LH surge means that ovulation will likely take place within the next 24-48 hours. (Note: LH typically peaks between midnight and 8:00 am, so the first morning urine tends to catch the LH surge better than other times of day.)

Affiliate Link: Ovulation Test Strips (LH)

In a small percentage of women (particularly those with PCOS), the pituitary gland sends out a surge of LH, but the follicle fails to release an egg. Because of this, many women prefer to confirm that ovulation has taken place by testing for progesterone metabolites in the urine. During the luteal phase, as progesterone production ramps up, so do the levels of the breakdown products detectable via urine test strips.

Progesterone test strips function similarly to ovulation predictor kids, except in reverse: a second pink line showing up (in addition to the control line) indicates a negative test, and the absence of a line indicates a positive. (Note: progesterone test kits typically recommend testing the first morning urine.)

Affordability: Good. LH test strips each cost less than 50 cents each, but the downside (especially with ovulation predictor kits) is that you need to test every day—sometimes multiple times per day. (Progesterone test strips are a little pricier.) If you have no idea when you might be ovulating, using these strips regularly, or for multiple months in a row, can add up.

Ease: Excellent. Open, dip, read, move on.

Validity: High. The test is either positive, or it isn’t. When both the LH and progesterone tests are positive in a given month, there is a near-perfect likelihood that ovulation has taken place.

Accuracy: Pinpointing ovulation with urine test strips is not really possible. The LH surge simply means that ovulation will take place sometime in the next day or two. Progesterone test strips mean that it has taken place sometime in the week, give or take. Using urine strips alone would not be considered a reliable way to prevent pregnancy if you are tracking your cycle for contraceptive purposes.

Cycle Tracking Method #2: Basal Body Temperature

If you look back at the chart at the top of the post, you’ll see that the very top line corresponds to body temperature. Sometime throughout history, women realized that the menstrual cycle creates predictable changes in basal body temperature (BBT)—our core body temperature while at rest.

Throughout the follicular phase, our BBT is at its low point. The day after ovulation, it takes a sharp rise, usually of more than 0.2 degrees. This temperature rise is sustained until a few days before your period, when it slowly drops back down again. After tracking your BBT for a few cycles, you’ll have a pretty good idea of when you ovulate and when to expect your period, which can be helpful whether you’re trying to conceive, or altogether avoid pregnancy.

Affordability: Excellent. However, measuring BBT requires a more precise measurement than most at-home thermometers are capable of. In order to offer the level of precision needed for accurate monitoring, the thermometer needs to read more than two places past the decimal point. Thankfully, this method is popular enough that BBT thermometers are extremely affordable—less than $10. [Affiliate link: Basal Body Temperature Thermometer]

Ease: Medium. Basal body temperature readings are only valid if they are taken first thing after waking up, even before getting up to use the bathroom, get a drink of water, or anything else. The reading also must be taken after at least 3 hours of uninterrupted sleep. If you’re a restless sleeper, struggle to remember to take your temperature, or snooze abuse, this method might not be right for you.

Validity: Medium. BBT can easily get thrown off from things like illness, alcohol, sleeping next to a warm person, or even temperature changes in your bedroom. But when the conditions are right, BBT charting can be highly effective.

Accuracy: When done correctly, BBT charts are a highly accurate method for tracking fertility. The post-ovulatory temperature rise is a pretty clear indication that ovulation has successfully taken place.

An additional benefit of this method is that sometimes it can serve as an early method for detecting pregnancy. Many women experience an “implantation dip” about 6-12 days after ovulation, when the temperature drops around 0.3 degrees, and then rises back up again. If the temperature remains high and doesn’t start to drop off, as is the case before menstruation, this usually is an indicator of pregnancy, sometimes even earlier than a home pregnancy test.

Cycle Tracking Method #3: Tracking Cervical Mucus

This method is the most…intimate of all. It requires that you get really comfortable with yourself and your anatomy.

Vaginal discharge (AKA cervical mucus) is a normal part of female health. Significant changes in color or odor can indicate infections, but outside of these instances, clear, white, or pale yellow discharge is a predictable part of being a woman. Throughout the cycle, the texture and color of cervical mucus changes in predictable patterns:

To accurately assess your cervical mucus, you can wipe your vaginal area before urinating, and observe the tissue. Alternatively, with clean hands, you can insert a finger or two slightly inside your vagina and observe the color and texture of the mucus between your fingers.

On days when cervical mucus is scant, fertility is low, meaning pregnancy is highly unlikely. But on days when cervical mucus is more abundant, and especially when watery and stretchy in the days leading up to ovulation, fertility and chances of conception are very high. Typically in the few days leading up to ovulation, cervical mucus will become clearer and more abundant, resembling raw egg white. Not only do these days signify pending ovulation and a time frame in which sperm can survive, but the egg white cervical mucus (EWCM) actually serves to promote sperm survival. It contains high levels of water and nutrients, promoting sperm fertility as well as a nutritious environment to help them traverse the journey up through the fallopian tube to wait for an egg. If you’re trying to conceive, the days you notice EWCM are the days you and your partner should focus on physical intimacy.

Affordability: Excellent. All you need are your own two (clean) hands and/or some toilet paper.

Ease: Medium/Low. This method of cycle tracking requires a degree of personal intimacy and comfort that the other methods don’t. Learning how to differentiate among the different textures and quality of cervical mucus can also be really challenging during the first few months. It’s not as cut-and-dry of a method as taking your temperature or using a test strip.

Validity: Medium. The results are mixed with this method, as not all women follow quite the same patterns. For example, some women may produce low amounts of EWCM, making it difficult to identify fertile days.

Accuracy: Medium. When EWCM is present, chances of conception are high. However, for women trying to avoid pregnancy, tracking cervical mucus alone may not be sufficient to identify fertile days.

Cycle Tracking Method #4: Symptom Spotting

I’m listing this method last because it really shouldn’t be used as a method for pregnancy prevention, or even timing intercourse for conception. However, paying attention to your internal, bodily signals at different times of the month can give you valuable insight into your own body’s needs, informing your self-care routine throughout the month.

Menses: Letting Go

Most women tend to feel lethargic and less social during the first few days of their periods. Looking back at the rise and fall of hormones throughout the cycle, this totally makes sense. Estrogen and progesterone are at their all-time low during the first few days of your period, and low levels of these hormones are known to correspond to feelings of anxiety, depression, and fatigue.

I used to find these low-energy feeling extremely inconvenient, but as I gained knowledge of and trust in my body, I slowly came to recognize that things go so much better when I accept my natural design instead of trying to battle against what my body is doing. Menstruation is a natural part of life as a woman, and when I set aside my pride, I can see that this natural time of release and letting go can be really healthy depending on how I respond.

Many women (myself included) find that symptoms like cramps and breast tenderness are less severe when I accept my body’s invitation to slow down and rest. I tend to naturally feel more introverted and tired during the first few days of my period, and I’ve realized that I feel so much better if I don’t push myself to perform or be social, and take it easy with exercise. Instead of focusing on my productivity, I try to use this time to relax, reflect, and let my body go through its own process of restoration.

Follicular Phase: Estrogen for Energy

On a biochemical level, estrogen is an energizing hormone. As levels start to rise during the follicular phase, we tend to feel motivated, energetic, and productive. I personally find that intense exercise feels really good in my body throughout days 5-15 of my cycle, and I’m madly efficient when I work on things (like writing this monster of a blog post, for example…)

I also find that I’m much more willing to get things done around the house, participate in trips and social events, and tie up loose ends at work. While I don’t necessarily go so far as to make special plans during this time, the knowledge that I’m not always so energized allows me to have a little more grace on myself when I realize that my hormones have such a profound affect on that areas of my life.

Ovulation: Transition

I personally don’t notice any remarkable changes in my body or mind during ovulation, but many women report slight cramping (mittelschmerz), breast tenderness, or light spotting on the day leading up to or day of ovulation. This can serve as another means for tracking your fertility if you find yourself with these sorts of symptoms.

Luteal Phase: Rest and Restore

Progresterone is the hormone responsible for PMS symptoms. As the corpus luteum starts to ramp up its secretion of progesterone, levels of fatigue, breast tenderness, cramping, irritability, and bloating tend to follow suit if stress levels also remain high. Digestion slows way down, electrolyte levels fluctuate (leading to water retention), and mammary tissue starts to develop in the event of a possible pregnancy—leading to swelling and tenderness.

As with the first days of my period, I tend to feel sluggish, tired, and sore during the last few days of my luteal phase. By tracking the symptoms of my own cycle, I’ve come to recognize that feeling slow and tired during exercise, mild tension headaches, and a predisposition to feel a little more introverted is normal for me. While I find these things to be a little inconvenient, they aren’t debilitating, and I generally feel pretty good when I respond appropriately to my body’s signals for rest. As it says in Ecclesiastes chapter 3, “For everything there is a season, a time for every activity under heaven. A time to be born and a time to die, […] A time to tear down and a time to build up. A time to cry and a time to laugh.”

To sum things up…

The female body is an incredible, awe-inspiring creation. I am truly amazed every time that I sit down and study the details of hormonal balance, the delicate web of connections between our hormones and our bodily systems, and the amazing miracles of pregnancy and birth. The beautiful, graceful way that everything works together inspires a deeper sense of respect for everything that my body is—and isn’t—and drives me to take self-care seriously so that I can continue to live a healthy, vibrant life. How about you?

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

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

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

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

The post Understanding Hormones for Women appeared first on Dr. Alexandra MacKillop.

“Okay, okay, hypothalamo-whatta-whatta?“

If that’s what you’re thinking, you’re in good company. The hypothalamic-pituitary-adrenal-thyroid-gonadal axis is quite the tongue twister. But don’t worry, it sounds more confusing and overwhelming than it is. In short, the HPATG-Axis is the system of hormone balance in our bodies. To understand how to balance hormones naturally, we need to first understand what hormone balance looks like through this great, big web of connections.

In a nutshell, the HPATG-Axis phrase refers to is the fact that a part of our brain called the hypothalamus communicates with our adrenal glands, thyroid, and ovaries (aka gonads) through a series of hormones produced by the pituitary gland (also located in our brain). In physiology, we often talk about those interactions separately, referring to them as the hypothalamic-pituitary-adrenal axis, or the hypothalamic-pituitary-thyroid axis. But in reality, they’re all connected, and this post will explain everything you ever wanted to know about how and why. (Okay, maybe not everything, but the basics…)

The HPATG Axis (AKA Endocrine Axis)

HPATG physiology can basically be summed up like this: the hypothalamus talks to our pituitary gland using hormonal signals, telling the pituitary gland when and how to stimulate our thyroid, our adrenal glands, and our ovaries. All of those glands send hormonal messages back to our brain with information about how much activity is going on, and whether or not there are any problems. In response, the brain tells the body to amp up activity in each of those sites, or tone it down. This is called a negative feedback loop.

When we face periods of stress (or rather, when we face too much stress for too long), our HPATG axis is completely intercepted. This is where we can run into imbalances in our thyroid hormones (such as hyperthyroidism or hypothyroidism), adrenal hormones (such as “adrenal fatigue”), or fertility problems, (such as hypothalamic amenorrhea). These problems can occur one at a time, or all at once, leading someone to feel really sick, and probably also really confused! Stress is a biggie when it comes to a properly functioning HPATG axis. In most cases, if you’re wondering how to balance hormones naturally, we need to start by addressing stress because stress is the single most powerful influence over the HPATG axis.

Stress and Stress Management

When we think about stress, we typically think about the psychological or emotional—deadlines at work, an overly packed schedule, a bad breakup, or a death in the family. But stress comes in many forms, and can even be triggered by good life events…

• Under eating (not enough calories or carbs)
• Nutritional deficiencies
• A significant/sudden change in diet/eating habits (especially yo-yo dieting)
• Over exercising (or a sudden change in the type of exercise)
• Lack of sleep or change in sleep schedule (i.e. night shift)
• Illness or injury (including surgery)
• Travel (even if it’s fun!)
• Moving
• Starting a new job or educational program
• Getting married
• Certain medications, or drug use
• Depression or anxiety
• Emotional distress (like the loss of a loved one)
• Psychological distress (like work deadlines or studying for exams)

Many of these things are normal parts of life, and when we are following a pattern of self care, our bodies are able to accommodate the stressors without falling into dysfunction. But when our self-care routine falls out of balance (or we begin struggling with disordered eating) we detract from the foundation of health. When that happens, everything else starts to crumble. One of my favorite ways to explain this relationship between stress and self-care is the bucket analogy:

Self-care fills our bucket, but stress drains our resources. When the bucket gets low, we start to notice symptoms of burnout. When the bucket gets empty, it leads to hormonal disaster, interrupting our whole HPATG axis at a biochemical level in our brains (big red stress arrow on the infographic at the top of this post). Ultimately, learning how to balance hormones naturally means learning how to identify and cope with the small, daily stressors in our lives.

Dysfunction, one axis at a time

The reason we often talk about the HPATG axis in terms of its separate components (HPA, HPT, HPG axes) is because unilateral dysfunction is common. For example, an autoimmune disease called Hashimoto’s Thyroiditis can lead to destruction of the tissue of the thyroid gland and subsequent hypothyroidism. When this happens, the thyroid loses its ability to produce thyroid hormone. When the pituitary gland realizes that thyroid hormone levels are so low, it amps up its secretion of thyroid-stimulating hormone in an attempt to tell the thyroid to do a better job. The problem is, the thyroid itself has been damaged—it can’t do its job until the autoimmune reaction is addressed. (Here’s where stress pops up again: if you’re wondering how to balance hormones naturally in terms of your thyroid hormones, you still need to pay attention to the stress piece because stress is one of the primary drivers of autoimmune disease.)

Low levels of thyroid hormone create a further stress response in the body, signaling back to the brain that something’s off. This consequently affects the signaling between the pituitary gland and the adrenals/ovaries as the body tries to balance things out. Low levels of thyroid hormone, for example, creates a dangerous environment for a growing baby, and so the reproductive system is one of the first to get shut down (via the HPATG axis). On the other hand, pregnancy causes the body to re-prioritize its hormonal resources. When a woman is pregnant, the body needs different levels of thyroid hormone, cortisol, and other hormones to carry the pregnancy to full-term. These body signals these changes through the same negative feedback loop. (All of this takes place without us ever having to think about it. You’ve got to admit, God’s design is pretty amazing!)

The HPATG Axis and Healthcare

When a patient complains of problems like fatigue, weight gain or weight loss, thinning hair, or irregular periods (just to name a few), the solution is never as simple as writing a prescription for birth control pills or Synthroid. There’s always more to the story, and that’s why its so important to identify the root cause of the problem when considering how to balance hormones naturally. In my practice, I do this primarily by talking with my patients in detail about their health history, and taking a closer look at the lab work. From a functional medicine perspective, it’s never safe to assume that the other components of the HPATG axis are functioning properly, even if we’ve already identified that one of them is out of sync. That’s why holistic healthcare means addressing the whole person, and not just using a symptom-by-symptom, band-aid approach.

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

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

The post How to Balance Hormones Naturally (Understanding the HPATG Axis) appeared first on Dr. Alexandra MacKillop.