From a functional medicine perspective, postpartum cavities are not random. They are a predictable outcome of profound hormonal shifts, nutrient depletion, sleep disruption, and changes in oral and gut microbiomes that occur during pregnancy and the postpartum period. Understanding why postpartum cavities happen is the first step toward preventing and reversing them.

What Are Postpartum Cavities?

Postpartum cavities refer to tooth decay that develops during the months following childbirth. Some women notice sensitivity or pain shortly after delivery, while others discover postpartum cavities at their first dental visit after having a baby. In many cases, these cavities progress quickly and seem disproportionate to a woman’s oral hygiene habits.

This is often shocking, especially for women who brushed, flossed, and saw a dentist regularly before pregnancy. But postpartum cavities are usually less about hygiene and more about other aspects of biology.

Why Postpartum Cavities Are So Common

There is a perfect storm of factors that contribute to postpartum cavities, and they often overlap.

1. Hormonal Changes

Pregnancy and the postpartum period involve dramatic fluctuations in estrogen and progesterone. These hormones directly affect saliva production, blood flow to the gums, and the balance of bacteria in the mouth. Low estrogen postpartum can reduce saliva, and saliva is one of your primary defenses against cavities. Reduced saliva means acids linger longer on teeth, increasing the risk of postpartum cavities.

2. Mineral Depletion

Pregnancy places enormous demands on a woman’s mineral stores, particularly calcium, phosphorus, magnesium, and trace minerals. If these minerals are not adequately replenished postpartum, the body prioritizes survival and lactation over tooth remineralization. This creates a biological environment where postpartum cavities can form rapidly.

For several reasons, I usually recommend that my patients supplement with 1,000 mg of encapsulated calcium citrate beginning at 20 weeks gestation due to several studies indicating reduction in hypertension and pre-eclampsia risk in pregnant women. I recommend this practice continue for my patients who breastfeed their babies.

3. Changes in the Oral Microbiome

The oral microbiome shifts during pregnancy, often favoring more acid-producing bacteria. These changes don’t immediately reverse after delivery. When combined with lower saliva flow and mineral depletion, this microbial imbalance strongly contributes to postpartum cavities.

4. Increased Snacking and Nighttime Eating

Many new mothers eat more frequently (as well they should), often late at night (again, as well they should), to support breastfeeding and manage exhaustion. Unfortunately, frequent eating without immediate/adequate brushing increases acid exposure on teeth. This pattern is a significant driver of postpartum cavities, even when total sugar intake is not excessive.

Need an easy fix Pop a xylitol containing breath mint or chew a piece of xylitol-containing gum. Studies show that xylitol reduces the growth of cavity-forming oral bacteria. Xylitol consumption is considered safe during pregnancy (but check with your doctor) and studies even show that the children mothers who consume xylitol when pregnant themselves have lower risk of cavities.

Looking for an ultra-natural option? Underbrush Remineralizing Gum is a chewing gum made from natural tree sap with all natural ingredients and even nano-hydroxapatite which remineralizes teeth and stops decay.

5. Sleep Deprivation and Stress

Chronic stress and sleep deprivation elevate cortisol, impair immune function, and reduce the body’s ability to repair tissues. Teeth are living structures, and their ability to repair micro-damage is compromised in high-stress states. This is another underappreciated contributor to postpartum cavities.

I’ve said it before and I’ll say it again: sleep when your baby sleeps.

Why Traditional Dental Advice Falls Short

Most conventional explanations for postpartum cavities focus narrowly on brushing, flossing, and sugar intake. While these matter, they do not explain why so many women develop postpartum cavities despite good oral hygiene.

A functional medicine approach looks upstream. Postpartum cavities are a sign of systemic imbalance, not just local tooth decay. Addressing only the teeth without supporting the whole body often leads to recurring problems. Once again, a tooth problem is a gut problem, and we need to look inward to solve outward signs of toothe decay.

The Role of the Gut in Postpartum Cavities

It may surprise you to learn that postpartum cavities are closely tied to gut health. The gut microbiome influences mineral absorption, immune regulation, and inflammation throughout the body, including in the mouth.

Antibiotics during labor, C-sections, stress, and sleep deprivation all disrupt gut health postpartum. Poor mineral absorption and systemic inflammation increase susceptibility to postpartum cavities. Supporting gut healing is therefore a critical part of addressing postpartum cavities holistically.

Want to learn more about supporting your gut health Check out all the latest articles here.

Breastfeeding and Postpartum Cavities

Breastfeeding itself does not cause postpartum cavities, but it does increase nutritional demands. Producing breast milk requires significant amounts of calcium, magnesium, iodine, and fat-soluble vitamins. If intake does not meet demand, maternal stores are depleted, increasing the risk of postpartum cavities.

Based on his research in communities with little-to-no dental decay, Dr. Weston A Price (dentist) suggests a diet rich in whole foods, healthy fats, raw dairy and properly prepared (soaked, fresh-milled) grains. He also advocates for eating organ meats, bone broths, wild fish and fermented foods and avoiding processed foods. I will acknolwedge, postpartum is a time like no other to rely on prepared foods to support stress levels during the postpartum period. However, an ounce of prevention is worth a pound of cure. If you’re pregnant, check out this post about prepping nutritious meals for postpartum so that you are freed from so much reliance on food manufacturers to support your postpartum nutrition (seeing as they tend to be more concerned with their own profits than with your health, including your dental health.)

Nutrients That Protect Against Postpartum Cavities

One of the most powerful ways to prevent and heal postpartum cavities is by replenishing key nutrients.

• Calcium and phosphorus are foundational for tooth structure.
• Magnesium supports proper calcium utilization.
• Vitamin D regulates mineral absorption.
• Vitamin K2 directs calcium into teeth and bones rather than soft tissues.
• Vitamin A supports enamel integrity and immune defense.

Many women with postpartum cavities are deficient in one or more of these nutrients, even if they eat a generally healthy diet. All of these nutrients can be found in quality animal foods, like slow cooked meat on the bone. (And what postpartum mama doesn’t love a good crockpot meal?)

Blood Sugar Balance and Postpartum Cavities

Blood sugar instability is another overlooked contributor to postpartum cavities. Postpartum insulin resistance, sleep deprivation, and stress can all lead to blood sugar swings. Elevated blood sugar feeds acid-producing oral bacteria, increasing the likelihood of postpartum cavities.

Eating balanced meals with adequate protein, fat, and minerals helps stabilize blood sugar and reduce cavity risk.

What You Can Do If You Already Have Postpartum Cavities

If you’ve already been diagnosed with postpartum cavities, please know that this is not the end of the story. Dental treatment is sometimes necessary, but it should be paired with systemic support.

Addressing mineral repletion, gut health, hormone balance, and stress can slow or halt the progression of postpartum cavities and reduce future risk. Many women find that once these underlying issues are addressed, they stop developing new postpartum cavities altogether.

Practical Daily Habits to Support Oral Health Postpartum

Gentle but consistent oral care matters. Check out these tips:

• Use a soft toothbrush, particularly an electric one with a rotary head. We use the Oral B Pro 1000
• Avoid aggressive brushing (much easier with an electric brush), and consider remineralizing tooth powders or pastes. Rinsing with water after nighttime feeds or snacks can reduce acid exposure and help prevent postpartum cavities.

Avoid constant sipping on sweetened beverages, including juice and sweetened coffee drinks. Even “natural” sugars contribute to postpartum cavities when exposure is frequent.

Preventing Postpartum Cavities in Future Pregnancies

If you’ve experienced postpartum cavities once, you may be at higher risk in subsequent pregnancies. The good news is that prevention is possible.

Entering pregnancy with strong mineral reserves, supporting gut health, managing blood sugar, and prioritizing postpartum nourishment can dramatically reduce the risk of postpartum cavities the next time around.

Final Thoughts on Postpartum Cavities

If you are dealing with postpartum cavities, you are not alone, and you are not broken. This is a common and understandable outcome of the intense demands placed on the body during pregnancy and postpartum.

With the right support, education, and nourishment, it is absolutely possible to protect your teeth, restore balance, and move forward with confidence. Postpartum cavities are not just a dental issue—they are a whole-body message asking for care, rest, and replenishment.

And that message deserves to be heard.

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.

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

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

The Connection Between Reproductive Hormones and Bloating

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

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

1. Endometriosis and Inflammation-Induced Bloating

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4. Pelvic Floor Dysfunction and Bloating

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

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

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

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

How Functional Medicine Approaches Hormonal Disorders and Bloating

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

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

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

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

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

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

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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’re unfamiliar with Invisalign, they are clear, plastic, molded retainers that are designed to shift teeth over the course of time. As a teenager, I had some mild crowding on the top and bottom, so my dentist recommended a 9-month course of using these dental trays to gently shift my teeth instead of having metal orthodontic braces put in. My dentist counseled me about the importance of keeping my teeth clean so that food particles didn’t get trapped underneath, and I took him seriously. But what he failed to mention and what I failed to realize is that the Invisalign trays were also keeping important things out, and that is how my cavity developed: saliva and oxygen.

Our mouths are living ecosystems. Just like “bad bacteria” causes cavities, good bacteria produce beneficial chemicals that protect our teeth and keeps our mouths functioning normally. Healthy saliva continually bathes our teeth and gums, protecting the enamel and maintaining an optimal chemical environment so that good bacteria can grow and bad bacteria cannot. When I was wearing the Invisalign, the saliva in my mouth was blocked from reaching my teeth, which influenced the type of bacteria that were able to grow. Without that natural cleansing, bad bacteria developed.

In addition to saliva, oxygen exposure is essential for a healthy mouth. Oxygen allows certain types of beneficial bacteria to grow and kills bad bacteria, which tend to die when exposed to air and oxygen. This is also part of the reason that flossing is important because in addition to removing stuck food, flossing introduces oxygen between teeth so that bad bacteria can’t grow, and so that saliva can get in to bathe and protect our teeth. My Invisalgn dental trays were also blocking my teeth from oxygenation, which favored the growth of anaerobic species of bacteria, which ferment and produce acid as byproducts, eroding enamel and leading to cavity formation and rot.

Obviously, it’s bad news when cavities form. A generally healthy lifestyle is needed for good dental health, and it’s also important to take steps to preserve the dental microbiome. Here are some strategies from functional medicine that you can take to help support your dental health and preserve your oral microbiome.

Here’s How to Support Your Oral Microbiome through Functional Medicine

1. Stop using plastic dental trays. As I outlined above, plastic dental trays prevent oxygen and saliva from reaching your teeth which leads to unfavorable shifts in the dental microbiome. It also damages gums and can worsen receding and inflammation. Instead of Invisalign and related products, opt for traditional wire braces. Likewise, instead of plastic retainers, use either a wire retainer or consider palate expansion so that the teeth naturally stay in place without the need for the constant pressure of a retainer.
2. Ditch sugar. Sugar favors the growth of bad bacteria in your mouth. It also is the fermentable substrate that bacteria consume, converting into acid and alcohol byproducts that erode enamel. You should also be mindful of foods that break down into sugar, like crackers which become wet and form a paste, sticking to teeth and holding sugar against them over the course of time. These pasty carbohydrates can get wedged into small grooves and cracks in teeth and contribute to cavity formation over time, even if they aren’t sweet foods with sugar added.
3. Use hydroxyapatite toothpaste. This is a natural way to rebuild enamel and protect your teeth if you have had exposure to damaging substances over time. Avoid toxicants like fluoride, which harm the balance of good and bad bacteria in the mouth (fluoride is toxic to good bacteria.) You should also avoid products like hydrogen peroxide which can damage enamel and harm the microbiome by killing beneficial bacteria.
4. Consume probiotic foods. Fermented foods like yogurt, kombucha, kimchi and natural pickles seed the mouth with beneficial probiotics. They also naturally stimulate saliva production which helps keep teeth and gums clean and moistened. You should have probiotics foods with every meal.
5. Avoid alcohol-based mouthwash. Alcohol-based mouth washes are not only drying, but they also kill beneficial bacteria in the mouth. This is a problem because the oral microbiome is there for a reason! Instead, use herbal mouth rinses like the Tooth & Gums Tonic from Dental Herb Company.
6. Fix mouth breathing. When we are sleeping (or awake), we should be breathing through our noses, with our mouths shut, unless we are eating, drinking or talking. Mouth breathing dries out the mouth and contributes to decay by shifting the oral microbiome and drying out teeth. This can worsen gum inflammation, lead to break down of enamel, and disrupt the oral microbiome. Mouth breathing can be challenging to fix, but I recommend having a comprehensive evaluation of why your body tends to use that method of breathing. Are you dealing with undiagnosed allergies Do you have a restricted airway Do you need dental expansion I recommend working with an airway dentist to have a thorough examination.
7. Take oral probiotics. In my functional medicine practice, I have somewhat of an eclectic approach to gut health and proboitic use. I am absolutely an advocate for consuming probiotic foods when appropriate (individuals with some histamine problems and overgrowth patterns may not tolerate probiotic supplementaiton.) In general, I prefer for people to not need to take probiotics in order to be healthy. However, as a consequence of our food system and because of some of the problems outlined in items 1-6 on this list, sometimes probiotic supplementation is necessary. Apart from correcting imbalances as outlined in functional medicine stool microbiome testing, I often recommend the E.N.T. Biotic from Protocol for Life Balance or Adult ENT-Pro from Biotics Research Company. What’s unique about both of these formulations is that they are not capsules; rather, they are lozenges that are meant to slowly dissolve in the mouth and “seed” the oral and sinus cavities with beneficial bacteria.
8. Use Red Light Therapy. If you are dealing with chronic imbalances in your oral microbiome or chronic problems with gum inflammation (gingivitis), consider using red light dental trays to administer red light therapy to your gums to facilitate healing and reduce cavity formation. Red light limits the growth of harmful bacteria and facilitates the growth of beneficial bacteria to balance the microbiome. This strategy is also a natural method for tooth whitening that does not use harsh chemicals or erode enamel like peroxide does.

Other Strategies for Dental Health

In addition to maintaining the above strategies to support the dental microbiome, an overall health lifestyle is essential for good oral health. It’s not just as simple as brushing and flossing, though those are obviously important too.

In order to maintain your dental health, I also recommend eating a low glycemic index, nutrient-dense diet. Dental health requires micronutrients like chromium, copper, zinc, selenium, magnesium, calcium, vitamin D, vitamin C, and B vitamins. While you could certainly supplement these factors, there are additional nutrients far too numerous to list in a blog post that can only come from a diverse and abundant diet. Please also be sure to include quality animal products in your diet to support your long-term health.

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 Dental Probiotics: How Good Bacteria Can Transform Your Oral Health appeared first on Dr. Alexandra MacKillop.

For women in particular, one of the biggest reasons for hair loss on the top of the head relates to hormonal imbalances attributed to a condition called PCOS, which has four different subtypes. When I am working with a woman in a clinical setting, PCOS hair loss is often one of the most frustrating symptoms that she wants addressed as quickly as possible.

In this article, we will be discussing reasons for hair loss, how I evaluate for the causes of hair loss in my functional medicine practice, and how I help my patients reverse PCOS hair loss with natural treatment. We will also cover additional topics, such as how long it takes to reverse PCOS hair loss and whether or not the condition is likely to come back.

Diagnosing PCOS Hair Loss

The condition of hair loss itself is not hard to diagnose. In fact, it’s usually one of the easiest things to identify when a woman is experiencing it because you can see the evidence of it stuck t oyour clothing, clogging your vacuum or your shower drain, and strewn around your house. However, PCOS hair loss can also be insidious because it doesn’t always appear like patchy clumps of hair falling out. In fact, patchy hair loss of that nature is less likely to be related to PCOS and more likely to be related to another condition, like autoimmunity, nutritional deficiencies, or toxin exposure. Instead, PCOS hair loss tends to look more like thinning along the hair line and increased shedding overall.

One of the biggest challenges in diagnosing PCOS hair loss is differentiating the hair loss as specifically PCOS hair los as opposed to hair loss from other conditions. Keep in mind that not all women who have PCOS experience hair loss as a symptom. At the same time, a woman may have PCOS and also be experiencing hair loss due to other factors. Finally, a woman experiencing hair loss (and her doctor) may have suspicions of PCOS because of the hair loss, even though she might not have PCOS at all.

Treating PCOS hair loss means that a couple of things need to first be true: for one, she needs to have diagnosed PCOS and two, the hair loss needs to be because of the PCOS and not the result of other factors. Therefore, it’s important to conduct a thorough workup to make sure that other health conditions are not also at play. If those other health conditions are missed, treating the hair loss through the PCOS paradigm will result in the patient not getting better and maybe even worsening because of delayed diagnosis.

Reasons for hair loss apart from PCOS hair loss:

Here are some other common reasons that I see hair loss in my practice. Please keep in mind that this is not an exhaustive list, and it’s possible for a person to have more than one condition:

1. Hypothyroidism: Hormonal reasons are a big driver of hair loss, but those reasons are not always exclusive to reproductive hormones, such as PCOS hair loss. In fact, when I see a patient experiencing hair loss, my first thought actually is not PCOS, but rather a thyroid conditions. Hypothyroidism is more common among women with PCOS that among thos without it, and the thyroid is actually a big reason that my PCOS patients experience “PCOS hair loss” even though it’s truly driven by the thyroid.
2. Hashimoto’s and other autoimmunity: Hashimoto’s is one type of autoimmune condition, which is commonly responsible for causing hypothyroidism. However, I include it separately on this list because not all cases of hypothyroidism are caused by Hashimoto’s, and not all cases of Hashimoto’s end in hypothyroidism. Because Hashimoto’s involves an autoimmunt inflammatory response agains the thyroid and resultant thyroid damage, many people do end up developing hypothyroidism as a result of Hashimoto’s. However, the inflammation and self-reactivity associated with Hashimoto’s can also result in hair loss, even with normal thyroid function. Other autoimmune diseases such as inflammatory bowel disease (IBD), lupus, Sjogren’s syndrome, rheumatoid arthritis and others can also cause hair loss. Grave’s disease, which is an autoimmune thyroid condition associated with hyperthyroidism can also cause hair loss, all of which should be differentiated from PCOS hair loss.
3. Low Estrogen: Hair follicles don’t last forever. Instead, they experience a growth phase that can last several years and then they transition to a state of dormancy called the telogen phase, which lasts a few months before the follicle atrophies, dies and the hair falls out. Periods of low estrogen in women, such as those seen with hypothalamic amenorrhea, menopause, breastfeeding, and other health conditions shortens the growth phase of the hair, moving it into the telogen stage more quickly. PCOS is classically associated with excess estrogen, particularly when testosterone levels are very high, but other women experience low estrogen for other reasons, despite PCOS. In this case, the PCOS hair loss would be due to low estrogen levels rather than the high androgen levels.
4. Perimenopause: PCOS hair loss is classically understood to be caused by elevated testosterone levels, which cause atrophy of the hair follicles and shorten the growth phase. However, transient elevations in testosterone can also be caused by the early stages of perimenopause. While the causitive factor in the hair loss is the same (testosterone), high androgens in perimenopause that cause hair loss are not the same thing as true PCOS hair loss.
5. Nutrient deficiencies and restrictive dieting: Nutrient deficiencies cause hair loss because multiple micronutrients, like B vitamins, zinc, iron, vitamin C and countless others are essential for creating new hair (along with skin, nails, and maintaining function of the body’s organ systems.) In cases of significant nutrient deprivation, such as extreme dieting or chronic illness, nutrient deficiencies can develop which result in hair loss. (The nutrient deficiencies can also cause other health problems, like hypothyroidism, which contribute to hair loss as well.) It is also not uncommon for the ketogenic diet, vegan diets, and use of semaglutides like Ozempic to cause hair loss.
6. Post-COVID: Severe illness such as that seen from extreme cases of COVID-19 can also contribute to hair loss. The inflammation associated with the inflammatory response, or use of steroids in treatment, contribute to a shortening of the growth phase and resultant hair loss.
7. Inflammation: Apart from COVID-19, infections may trigger widespread inflammatory responses in the body that bring about similar changes to the hair follicles. These too need to be differentiated from PCOS hair loss, though keep in mind that blood sugar disorders including the insulin resistance seen in PCOS also contribute to hair loss.
8. Heavy metals and other toxicity: Heavy metals like arsenic, thallium, cadmium and mercury all contribute to hair loss by interfering with the mechanisms of hair growth. This causes weakening of the hairs themselves, increased breakage and early shedding. Thallium exposure is the most common heavy metal implicated in hair loss. Thallium exposure most typically comes from coal smelters, which release this toxin into the air, and it also becomes deposited in the soil and water. For this reason, it is essential to wash fruits and vegetables and use a high-quality water filter to ensure that what you are drinking is safe.
9. Hormonal birth control: Hormonal birth control is made from artificial progesterone, which tricks the body into not ovulating. This means that the body then is unable to produce natural progesterone, and progesterone deficiency also contributes to hair loss through a similar mechanism to low estrogen. At the same time, some types of these artificial progesterones are derived from testosterone and share characteristics to the hormone testosterone. In PCOS hair loss, testosterone receptors in the hair follicles respond to signaling from testosterone and cause atrophy of the follicles and resultant hair shedding. The artifical progesterones, derived from testosterone in the hormonal ocntraceptives, have a similar effect when they bind to testosterone receptors, causing a similar mechanism of hair loss as seen in PCOS hair loss.
10. Stress: High stress increases adrenal responses, which affect blood flow to the hair follicles. They also result in increased production of androgenic stress hormones which affect hair follicles similarly to high testosterone levels in PCOS hair loss. High stress can also induce an adrenal form of PCOS and contribute to PCOS hair loss through that mechanism.
11. Certain medications: like chemotherapy drugs which notoriously cause hair loss, use of steroid medications, antidepressants such as fluoxetine (Prozac) and lithium, blood pressure medications like ACE inhibitors, blood thinners, seizure medications, and Accutane can cause hair loss on the top of hte head, which need to be distinguished from PCOS hair loss. Many women with PCOS are taking these medications and don’t realize that their hair loss results from the medications instead of being the specific symptom of PCOS hair loss.
12. Eczema, fungal infections and other skin disorders: Inflammatory and infectious skin conditions can create inflamation that is pervasive enough to reach the hair follicles themselves. This inflammation and reactivity damages hair follicles and can cause weakness, breakage, shedding and hair loss. PCOS and the accompanying blood sugar imbalances increase risk of developing fungal infections like candida, including infections on the scalp, which can contribute to hair loss but should be differentiated from true PCOS hair loss.
13. Childbirth: During pregnancy, the body lengthens the telogen stage of hairs. This means that hairs which would ordinarily reach the end of the growth and telogen stages and fall out instead do not. They remain in the telogen stage, not growing necessarily but not falling out either. Then, after the baby is born and the hormone and immune system shift, the hairs finally fall out, all at once. For some women, this effect is delayed until breastfeeding ceases, or until periods return. In women with PCOS, return to menstruation can take much longer and women may incorrectly believe the hair loss is due to PCOS hair loss because so much time has elapsed since childbirth. This is why accurate testing and clinical workup are important for making a diganosis.
14. Hair treatments: Use of hair dye, particularly hair treatments containing bleach, chemical straightening products, and heat treatments like hair dryers, flat irons, curling irons, and even washing hair in very hot water all cause dryness and damage to the hair itself. This weakens the hairs, increasing breakage and making it more difficult for hair to grow long. This can look like hair loss, especially when the breakage occurs close to the scalp. Hair breakage can also be increased with aggressive hair brushing techniques, tight ponytails and hair styles involving the hair pulled back, frequently wearing hats and barrets, sticky elastics or clips can also pull and snap hairs.

PCOS Hair Loss

The “true form” of PCOS hair loss results from elevated androgen levels. However, keep in mind that the condition of PCOS can also contribute to hair loss as mediated through inflammatory changes, blood sugar problems, and changes in other hormone levels. However, when we are talking about the effect of PCOS in causing hair loss, we are referring to the form of PCOS hair loss that is caused by elevated androgen levels.

As I touched on earlier, elevated androgen levels induce a process called “follicular miniaturization,” in which the high androgens bind to testosterone receptors in the hair follicles, causing them the atrophy and break down. The result is thinner hairs, weaker hairs, and eventual death of hte hair follicles. This leads to not only increased hair shedding but fewer healthy and functional hair follicles in general.

Treatment for PCOS Hair Loss

When the hair loss has been proven to be truly the result of high androgens in PCOS, treatment is necessary in order to slow the progression of the condition. Because of the mechanism of testosterone in PCOS hair loss, treatment necessitates strategies for reducing androgens, increasing blood flow to the scalp to restore follicle function, and providing increased nutrients to allow the hair follicles to remain healthy and grow health hair.

In my functional medicine practice, I treat the different types of PCOS differently. Understanding what is driving the high testosterone levels is imperative for lowering them. So, we always start there. However, there is good evidence that the following strategies are also implicated in reversing the testosterone-associated changes that take place in PCOS hair loss:

1. Spearmint Tea: In PCOS hair loss, testosterone converts into a highly androgenic hormone derivative called DHT. Spearmint tea, particularly when enough is consumed, reduces the conversion of testosterone into this highly androgenic form which damages hair follicles. The research shows that drinking at least two cups of tea daily is needed to see effects. I recommend always drinking organic, looseleaf tea to reduce exposure to toxins.
2. Zinc: Similar to spearmint, zinc has been shown to reduce converstion of testosterone to DHT. It also reduces the responsiveness of testosterone receptors in the hair follicles of themselves so that the androgens have less of an effect in causing PCOS hair loss. It’s important to note that the effects of zinc supplementation in PCOS hair loss are not simply the result of correcting zinc deficiency, though many people are unknowingly deficient in zinc. Instead, the supplementation improves PCOS hair loss regardless of deficiency. However, it is possible to overdose on zinc, so it is important not to exceed supplementation past 80 mg daily, and to be mindful of the fact that excess zinc supplementation can create copper deficiency, which may also cause hair loss. In my practice, I recommend starting with 30 mg of zinc bisglycinate or zinc picolinate which are superiorly absorbed compared to other forms.
3. Saw Palmetto: Like spearmint, saw palmetto reduces the conversion of testosterone into DHT via the enzyme 5-alpha reductase. For this reason, it’s not necessary to supplement with both of them in order to control hair loss. Instead, I usually start my patients on one or the other. However, different people respond differently to them, so sometimes we prefer to use multiple strategies on the front end and cut back. Because of the timeline required to control PCOS hair loss, this solution is appealing to some patients.
4. Green Tea: Whereas saw palmetto and spearmint reduce conversion of testosterone to DHT, green tea reduces androgen levels in general. This is important because hair follicles are not the only part of the body impacted by the high androgen levels. Green tea is therefore a good solution because of its ability to treat PCOS, instead of focusing primarily on PCOS hair loss.
5. Red Reishi: This adaptogen funcitons similarly to saw palmetto and spearmint in blocking the 5-alpha reductase enzyme. However, being an adaptogen, it also provides other benefits to the body, particularly in improving the stress response, supporting the immune system, and reducing inflammation. I am inclined to prescribe this to patients when they are dealing with an inflammatory or adrenal form of PCOS, or if they have co-occurring health conditions such as those listed earlier.
6. Topical Rosemary Oil: Rosemary oil has components that block DHT, like many of the herbs listed above. However, the difference is that rosemary oil is applied topically to the scalp and massaged in, instead of taken orally. This allows more direct access to the hair follicles. It also contains compounds that stimulate the hair follicles to increase growth, and antioxidants that reduce the effects of other factors on causing damage to the hair follicles, in addition to the androgens in PCOS hair loss. Finally, topicaly application and massage stimulate blood flow which brings nutrition and oxygen, supporting the health of the follicles. I recommend applying a small amount of rosemary oil directly to the scalp, massaging for about 15 minutes, resting for another 15 minutes to absorb and then washing out. Be mindful that oils such as these may cause the hair to appear greasy, so be mindful when washing.
7. Red Light Therapy: Near infrared and red light laser therapy have excellent research to back up use for promoting hair growtih and slowing hair loss, regardless of cause. This form of light stimulates cells called fibroblasts, which produce hair growth factors and increase blood flow. The result is thicker hairs that grow more quickly, and even reversal of some of the atrophy-related changes in PCOS hair loss. Red light therapy is a great option for PCOS hair loss because it doesn’t require you to take a pill, and the devices used to administer red light therapy can be used for other applications as well. I personally use the NovaaLab red light laser, and this is what I recommend as well. If you want to use the NovaaLab laser and save 10%, use the following code(s) to get started:
   • NovaaLab Red Light Laser for targeted laser spot treatment (more potent)
   • NovaaLab Deep Healing Pad which can more easily be used to apply red light treatment to the whole head at once

How long does it take to heal PCOS hair loss?

Because PCOS hair loss so profoundly affects a person’s quality of life, one of the most pressing quesitons my patients have is how long it will take to heal the condition. PCOS itself is complicated, but the nature of how hair grows and falls out in the first place is even more so. Recall from our discussion above that PCOS hair loss comes from the effects of androgens, which cause atrophy of hair follicles that weaken the strands and death of the follciles themselves. The hormons also shorten the growth phase, and send the hair follicles into the telogen phase more quickly. The telogen stage lasts several months (often around 3) before the hairs fall out.

Treating PCOS hair loss at the root cause itself takes several months. Lowering androgens and lowering production of DHT can take several months, sometimes up to 6, to even start to see changes. Then, once the androgen levels change, the hair follicles themselves take time to heal. Once that happens, there’s still then a delay because of the telogen stage, of around 3 months. After that, we then need even more time to start to see hair regrowth.

Because of these complexities, starting to see changes in PCOS hair loss sometimes take up to a year or more. This will happen more quickly if PCOS has not been a problem for as long, because the longer the hair follicles have been exposed to the testosterone, the more time they will need to heal. It’s also going to take longer if other problems are also at play, such as those seen in the first list, like nutrient deficiencies, toxin exposure, or inflammatory conditions.

Among all the treatments outlined above for PCOS hair loss, I want to share that red light laser therapy produces changes the fastest. This is because rather than waiting for hormone levels to drop, the high-intensity laser directly reverses the effects of testosterone at the level of the hair follicles. This leads to faster healing while the additional time is taken to address the hormonal imbalances that cause PCOS hair loss. Remember, however, that because of the telogen stage of hair, even with red light laser therapy, it will require a minimum of 3 months to start to see changes in hair loss. Hair loss you’re experiencing right now is the result of the chemical state of your body at least three months in the past.

Overall, PCOS hair loss treatment is challenging and takes a long time, but that doesn’t mean it’s impossible, and it doesn’t mean you should give up hope. The fastest and most effective way to help PCOS hair loss is to make sure that you have the right diagnosis (and aren’t missing anything), and to treat the underlying root cause of the PCOS hair loss (high androgens) so that it doesn’t return in the future.

Healing takes time, and there are no quick fixes. Because of the time requirements, remember that there are no drugs or medications that can produce changes faster, so natural treatment really is your best bet. Be patient, have grace on yourself, and do the next right thing!

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 Understanding and Reversing PCOS Hair Loss appeared first on Dr. Alexandra MacKillop.

But, what’s to be done about it? You’ll find answers to that question and more in this post, which discusses the differences between diagnosis and management of eczema and psoriasis.

Two of the most common categories of skin rashes include eczema and psoriasis, and these categories both include several different subtypes within them. However, all of these subtypes share certain etiological similarities and have similar approaches to treatment even though they are individual types of eczema and psoriasis. At the same time, psoriasis and eczema share similarities, such as the inflammatory and immune components, but they are, of course, different things.

In this post, we’ll explain how psoriasis and eczema are similar but also how they’re different, so you can get a better understanding of the Psoriasis vs. Eczema equation and know how to best work with your doctor in approaching the issue, whether it’s you, your child, or someone else you know who is suffering.

Psoriasis vs. Eczema: Types of Conditions

Types of Eczema

Eczema on it’s own is not fully considered an autoimmune disease, though it is closely related to a dysfunctional immune response, and many of the treatments both in Functional Medicine and the traditional medical model treat it as though like an autoimmune condition. Eczema commonly accompanies other autoimmune condition. However, while autoimmunity involves the immune system attacking the self, with eczema, the response is more like an allergy, with the immune system inappropriately attacking allergens and irritants due to a compromised skin barrier.

1. Atopic Dermatitis (Atopic Eczema)
   • Chronic condition, often begins in childhood. May even appear on babies, and many often confuse it with “baby acne.” (Baby acne typically appears within a few days of birth and resolves by 3 weeks, whereas rashes that persist or appears for the first time after 6 weeks of age are more likely to be eczema.)
   • Itchy, red, and inflamed skin, typically on the face, hands, and behind the knees. Underarms are a less frequent location for eczema, and may be more likely to be a yeast rash, such as Candida.
   • Linked to genetics and environmental factors (allergies, asthma, antibiotic use and other gut-related conditions).
   • Skin may also become “weepy,” or crusted from dried, oozing lesions.
2. Contact Dermatitis
   • Triggered by contact with irritants or allergens. When severe, contact dermatitis may closely resemble atopic dermatitis, and doctors easily confuse the two if the causative agent is not obvious.
   • Irritant Contact Dermatitis: Caused by direct irritation from substances (e.g., chemicals, soaps).
   • Allergic Contact Dermatitis: Caused by an allergic reaction to substances (e.g., poison ivy, nickel).
3. Seborrheic Dermatitis (“Cradle Cap”)
   • Red, scaly patches on oily areas of the body, such as the scalp, face, and chest.
   • Often associated with dandruff or oily skin.
   • Often appears on newborn babies and may persist for years if untreated. Because this is a type of dermatitis, if other irritants contact the inflamed skin, it may progress to other forms of dermatitis such as atopic dermatitis.
4. Dyshidrotic Eczema
   • Small, itchy blisters on the hands and feet.
   • Often linked to stress, allergies, or sweating.
5. Nummular Eczema
   • Coin-shaped, deep red patches of irritated skin, usually on the arms, legs, or torso.
   • Often triggered by dry skin or winter weather.
6. Stasis Dermatitis
   • Occurs on the lower legs due to poor circulation.
   • Common in people with venous insufficiency or varicose veins. May also be accompanied by the appearance of bruising, spider veins and possibly even bleeding from ulcerations over veins.

Types of Psoriasis

We consider psoriasis a true autoimmune disease, and sometimes is accompanied by other autoimmune symptoms like joint arthritis. With psoriasis, the immune system attacks itself, creating thickening and reproduction of skin cells which form the inflammatory plaques.

1. Plaque Psoriasis
   • Most common type, characterized by raised, red patches with silvery scales.
   • Typically affects elbows, knees, scalp, and lower back.
   • Tends to be worsened by certain medications, like beta-blockers and lithium. It’s also worsened by stress, infection, and injury.
2. Guttate Psoriasis
   • Small, drop-shaped, red lesions, often triggered by infections (e.g., strep throat, COVID).
   • Common in children and young adults.
   • May be worsened by puberty and other hormonal shifts.
3. Inverse Psoriasis
   • Red, shiny lesions that appear in skin folds (e.g., armpits, groin, under breasts).
   • Triggered by friction and sweating.
4. Pustular Psoriasis
   • Characterized by white pustules surrounded by red skin which eventually pop and flake/itch.
   • Can occur on any part of the body, but most common on hands and feet.
   • Easily confused with infectious rashes.
5. Erythrodermic Psoriasis
   • Extremely rare, severe form with widespread redness and peeling of the skin, often across the whole body.
   • Can be life-threatening and requires immediate medical attention.
6. Nail Psoriasis
   • Affects the nails, causing pitting, discoloration, and thickening. May affect one nail or multiple nails, as well as the nail bed.
   • Often seen with other types of psoriasis.

Differences Between Eczema and Psoriasis

It’s important to note that eczema and psoriasis are similar, but their differences are significant enough that they need to be treated differently. However, before we dive into the differences, it’s important to remember what is similar about them.

Both eczema and psoriasis are immune-mediated conditions, meaning it’s wrongful activity of the immune system that drives the condition. Both create inflammatory skin changes, which influence the microbiome of the skin, favoring the growth of inflammatory bacteria. This bacteria, typically related to Strep and other species, further triggers the immune response and worsens the condition. Because the gut microbiome also influences both the immune system and the skin microbiome, gut health plays a strong role in controlling both eczema and psoriasis.

Although the types of eczema and psoriasis are varied, in this discussion we will be focusing on the most common types, which inclue atopic dermatitis (eczema) and plaque psoriasis.

• Cause (Psoriasis vs Eczema):
  • Eczema: Primarily linked to allergies, immune system dysfunction, or environmental factors that trigger an overreactive immune system. Eczema may also be triggered by food sensitivities as well as allergies and problems with gut health.
  • Psoriasis: Caused by a self-reactive immune system, leading to rapid skin cell turnover and skin thickening. Psoriasis is not as closely linked to allergies as eczema, and is more likely to exist concomitantly with other autoimmune diseases. May be triggered by food sensitivities.
• Appearance (Psoriasis vs Eczema):
  • Eczema: Typically presents with red, inflamed skin, and sometimes blisters that weep and form yellow crust.
  • Psoriasis: Characterized by raised, thickened, scaly, and often silvery patches.
• Itchiness (Psoriasis vs Eczema):
  • Eczema: Often intensely itchy.
  • Psoriasis: May or may not be itchy, but can cause discomfort, pain or physical dysfiguration.
• Triggers (Psoriasis vs Eczema):
  • Eczema: Allergens, stress, temperature extremes, and irritants. May also be paradoxically triggered by moisture and sweat, such as in the summer, or dry air as in the winter. In children, teething may worsen eczema.
  • Psoriasis: Infections, stress, injury to the skin, and certain medications.
• Location (Psoriasis vs Eczema):
  • Eczema: Commonly affects the face, hands, feet, and behind the knees.
  • Psoriasis: Commonly affects the scalp, elbows, knees, and lower back.
• Chronicity (Psoriasis vs Eczema):
  • Eczema: Often a long-term condition, that may flare up seasonally or when exposed to certain triggers.
  • Psoriasis: Also chronic and can have periods of flare-ups.
• Traditional Treatment (Psoriasis vs Eczema):
  • Eczema: The traditional medical model treats eczema with moisturizers, such as colloidal oatmeal to reduce itching and petroleum-based skin protectants. Severe cases may be treated with corticosteroids such as (short term) hydrocortisone/clobetasone butyrate or (longer term) fluocinolone. Antihistamine medications may also be prescribed. Some providers may recommend skin-prick allergy testing. More recently, biologic medications such as Dupixent and Adbry have been approved for adults and children with eczema.
  • Psoriasis: Treated with topical steroids, phototherapy (including UV light exposure), and systemic chemotherapy (methotrexate) or biologic (Humira, Enbrel, Cimzia) medications for severe cases.

Psoriasis vs. Eczema: Functional Medicine Treatment

Through functional medicine, treating psoriasis and eczema both emphasize the same principles of building a foundation of health upon which the immune system can function normally. This necessitates overall good nutrition, exercise, sleep and stress management practices, control of exposure to environmental toxins, and accurate diagnosis of the underlying root causes of immune dysfunction.

Here’s the thing about immune dysfunction, whether overreactive to self or overreactive to triggers: it all depends on exacerbation of the Th2 division of the immune system, meaning the division of the immune system responsible for “fighting” and “killing” invaders. For both psoriasis and eczema, the Th2 division becomes overreactive, “fight” and “killing” things it shouldn’t. At the same time, there develops a relative deficiency in the activity of the Th1 immune system, which is responsible for cleaning up damaged cells. When these cells fail to be cleaned up properly, the Th2 immune system ends up creating an inflammatory response against those cells, too, snowballing the problem.

The Functional Medicine Basics for Psoriasis vs. Eczema

Gut Health: The gut mediates the immune system. Everything that enters our ears, eyes, nose, mouth and stomach ultimately gets to our digestive tract, where our bodies need to decide whether what we’ve swallowed is COVID, a turkey sandwich, or ourselves. Bacteria play a tremendous role in informing our immune systems in this way. In my practice, the starting point for all skin conditions is the gut: testing for the microbiome (probiotics, commensals and pathogens), as well as screening for intestinal permeability (“leaky gut”), the ability to break down protein, carbohydrates and fats as evidenced by stool residues, as well as screening for inflammatory markers like calprotetin, lactoferrin, lysozyme and changes in pH. I also look for chemicals that play a role in maintaining the gut barrier like butyrate.

Stress: With all immune-reactive conditions, stress makes matters worse. This is a highly individualized situation, and I cannot diagnose a person’s stress the way that they themselves can. I do screen for cortisol and DHEA on blood work as well as other markers of a chronic, dysfunctional stress response. But only a person themselves (or the person’s parent, in the case of a pediatric patient) can evaluate for stress. (Stressors in children often relate to moving homes, starting daycare or school, family conflict, teething, addition of new siblings, potty training, teething, and more.)

Nutrition: Micronutrient deficiencies as well as deficiencies of essential amino acids impact the skin barrier and immune system. I test patients in office for zinc, selenium, omega-3 fatty acids, vitamin D and ensure that their diet contains animal foods. It is nearly impossible to have enough healthy protein while maintaining carbohydrate intake on a vegan or vegetarian diet. It’s also essential to limit sugar, to avoid immune-reactive foods, and to treat insulin resistance if it is present.

Exercise: The benefits of exercise for stress reduction and immune system modulation are innumerable. That’s all I will say here. Adults and kids both need to move their bodies daily.

Sleep: Adults need 8-9 hours of sleep and children need 10-16, depending on their age. Screening for sleep problems is beyond the scope of this post but if you are concerned you may have sleep apnea, or that your child may be struggling with sleep, please have an evaluation done.

Toxins: This is the big one. The term “toxins” refers to chemicals (biological, synthetic or otherwise) that enter the body or come into contact with the skin and drive a dysfunctional immune response. These may include additions to personal care products, ingredients in medications or injected pharmaceuticals, pesticides, food additives, exposure to environmental toxins in air or water, and even household cleaning chemicals. If it triggers inflammation or an immune response, it will invariably trigger the eczema, or the psoriasis, of any sort. I recommend using the Environmental Working Group and Yukka apps as starting points for eliminating toxins.

Functional Medicine Treatment for Eczema

Beyond a firm foundation outlined above, functional medicine also offers specific strategies for treatment. In eczema, the keys are allergies, inflammation and supporting the skin barrier.

Allergies: I recommend blood testing for allergens and the foods you most commonly consume if you are an adult. Skin-prick allergy testing done by an allergist is not sufficient, and does not translate to eczema because these aren’t typically contact allergies driving the eczema response. It’s oral tolerance, or lack thereof. In my office, I run IgE blood test. For children, watch them like a hawk. Pay attention to any signs of redness, itching, hives, scratching, fussiness, reflux, vomiting or abdominal pain in the 3-6 hours following consumption of a particular food. If it happens more quickly, it is much more likely to be related to an IgE-mediated allergy. Then, when these foods have been identified, confirm the suspicion with an IgE blood test for each food. (Note: for milk, eggs, soy, peanut and certain other high-risk allergens, I recommend a “component panel” rather than just the IgE. Some foods have multiple identified immunogneic proteins, i.e. “Milk Component Panel” rather than “Milk, IgE.”)

When allergens have been confirmed via blood work, or even if the IgE is negative but the skin reaction is apparent, eliminate all sources of these foods for 6 months minimum. One skin is clear, reintroduce one-by-one to evaluate for tolerance. If IgE levels were detectible, re-test the IgE level after 6 months and consider reintroducing in your pediatrician or allergist office. Always consult with a physician when conusming allergenic foods.

Skin Barrier: Babies have thin skin with a poorly formed moisture barrier, making them more susceptible to irritants, especially chemical toxicants, abrasion, irritation, moisture, dryness and other triggers. I recommend using a thick, water-protective barrier ointment on all diaper changes, as well as a lotion containing saccharomyces ferment medium/filtrate such as Tubby Todd AOO. The chemicals in this fermentation filtrate protect the skin and calm inflammation, and also play a role in inhibiting the growth of inflammatory bacteria (see below.) Food-based oils do not make a good moisture barrier because they absorb quickly and are also likely to stain clothing. Instead, I recommend using either beef tallow or a beeswax-based non-petroleum product. That being said, I’m also okay with recommending Aquaphor, which contains petroleum and also castor oil, simply because it works really well and is much safer than steroids in the grand scheme of things.

In addition to topicals, supplementing with the amino acid L-Histidine upregulates the production of fillagrin, a protein that plays an extremely important role in mintaining the skin barrier. I recommend that my adult patients take 3-6 grams daily and pediatric patients somewhere between 0.25 and 1 gram depending on age and stature (capsules can be opened up and mixed with food). This needs to be supplemented long-term, for months or years, and takes time to create change so it should be combined with other strategies listed here. I also recommend my patients take an oral prescription of the probiotic saccharomyces boulardii as well as humic acid taken three times daily before meals to prevent overgrowth of commensal bacteria.

Inflammation: Inflamed skin favors the growth of inflammatory bacteria and that bacteria, in turn, worsens the immune response. It goes like this: eczema breaks out, and the skin barrier is compromised. Staphylococcus and other skin-dwelling bacteria take advantage of the situation and enter the cracks in the skin, triggering a worsened immune response, which worsens itching, prompts scratching and the eczema snowballs. This needs to be interrupted.

In extremely acute cases of eczema, I prescribe a triple-action ointment prepared using anti-fungal medication, antibiotic ointment and topical corticosteroid to be applied to the affected areas as follows: 4 times daily for 4 days, followed by 3 times daily for 3 days, twice daily or 2 days and then once daily for 1 additional day. This will help the itching/inflammation initially calm down, control infection and allow healing to begin. You can prepare this ointment at home using a 1:1:1 ratio by weight of Polysporin Ointment, Hydrocortisone 1% Ointment, and Miconazole 2% Ointment. Note that where indicated, you must use ointment rather than “cream.”

Once the skin has begun to calm down, or even if it hasn’t, I recommend my patients utilize a twice daily application of ozonated olive oil. The ozone in the olive oil produces reactive ozonides that kill bacteria, destroying their cell wall. They also stimulate the Th1 (healing) division of the immune system to clear infection, close wounds and restore the skin barrier. The OOO should not be used as a preventative, but should only be applied to areas of redness with limited spots of broken skin.

Functional Medicine Treatment for Psoriasis

Beyond a firm foundation outlined above, functional medicine also offers specific strategies for treatment. In psoriasis, the keys are prebiotics and oxidative control.

Prebiotics: Prebiotics are the precursor fibers to the growth of probiotics. Without enough “food” to keep them growing, probiotics will die off and not stick around long enough to do anything for the skin in terms of calming the immune system. Fructooligosaccharides tend to work best for psoriasis, but note that they will flare up individuals sensitive to FODMAPs or who are struggling with SIBO.

Oxidation: In addition to the benefits for eczema in controlling bacterial colonization, the Th1-stimulating properties of ozonated olive oil work tremendously well for psoriasis. OOO should be applied in a thin layer, twice daily, to any area that shows a flare. Take caution with areas of the scalp because the oil may create unfavorable changes to hair. For a standard shampoo, I recommend using a tar-based product. Coal-Tar Shampoo suppresses skin cell growth by preventing abnormal differentiation. It also helps calm inflammation and pain, and can be used as a topical wash for non-scalp areas. Coal-Tar ointment works well for non-scalp areas.

Moreover, UV exposure is essential for controlling psoriasis, as it has a similar effect to coal tar in controlling abnormal skin cell differentiation. We often think of UV exposure as a danger or risk but it provides tremendous benefits to the skin, especially inflamed skin such as in the case of psoriasis. I recommend my patients receive 30 mintues of direct sunlight exposure twice daily, or supplementation with a UV lamp or other at-home device. Note that UV lights are not the same as black lights, “blue lights,” or “sun lamps” used for reptiles.

A third factor in controlling psoriasis is omega-3 fatty acids which, when taken above daily requirements, control inflammation, immune reactivity and abnormal growth of tissue. I recommend a minimum of 4,000 mg daily for adults (often up to 8,000 mg daily) and a minimum of a standard adult dose for my pediatric patients. Be aware that doses this high might have a blood-thinning effect which can be dangerous when taking blood thinners, if having surgery, during injury or with those at risk of stroke.

Overall, skin conditions like eczema and psoriasis can be tricky to treat, and it can be very disheartening when seeing a PCP or dermatologist and receiving a lifelong steroid prescription.

That being said, functional medicine has so much to offer, wether for psoriasis vs. eczema. Natural healings can literally be in your hands!

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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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 Psoriasis vs Eczema: Functional Medicine Treatment appeared first on Dr. Alexandra MacKillop.

The Gut Microbiome

The word “microbiome” refers to the microbial colonies that live in, on and around the human body. [Microbes = bacteria and yeast] Modern researchers estimate that as few as 30% of our cells are actually human, which means the remaining 70% are actually bacteria. This is an incredible number, but when we factor in all the functions of these bacteria, it’s not that surprising. See, the vast majority of the cells in our digestive tracts—an estimated 39 trillion—are bacterial cells responsible for clearing up waste products. Not only do these bacteria clear up our own waste after we’re finished with the food we eat, but they also get rid of all the contaminating chemicals we come into contact with throughout our lives…things like pollution, plastics and more. Our bacteria help break these chemicals down so that they don’t wreak havoc on our health. They also break down our own bodily chemicals, like old, broken-down hormones that are past their prime, and red blood cells that are no longer functional. Our liver filters our blood of these toxins and deposits them into our intestines where it then becomes the job of our bacteria to take care of the rest.

Unfortunately, we don’t always have enough of the right kind of good bacteria; and sometimes those good bacteria are crowded out by bad bacteria. This isn’t necessarily pathogenic bacteria, like E. coli or Salmonella, though those too can be problematic. Dysbiotic and inflammatory bacteria like Group B beta-hemolytic streptococcus are also of concern. These dysbiotic bacteria take advantage of us if we consume something contaminated, if we take antibiotics, if we don’t have a diet that is adequate in diverse types of fiber, and more. Even stress can shift our microbiome and make us worse for the wear.

Our gut microbiome is also closely connected to our skin microbiome. That’s because, in all actuality, the human body is rather hollow. We are an open tube from the points of input (eyes/ears/nose/mouth) to the point of output (rectum) and those openings seamlessly blend into the exterior epidermis—that is, our skin. In this way, the microbial populations of our gut hold a profound influence over the microbial populations of our skin. Yes, our skin has a microbiome too, and it plays a big role in preventing and mitigating disease.

Inflammation

When we have an imbalance in good and bad bacteria, our good bacteria is no longer sufficient to do the job of “cleaning” up inflammation in our bodies. Our good bacteria produce anti-inflammatory chemicals like butyrate which help protect our bodies from inflammation. Likewise, overgrowth of inflammatory bacteria produce additional inflammation. Inflammation in the gut becomes inflammation in the blood and on the skin and feeds forward into flare ups of chronic skin conditions. These can include psoriasis, eczema, acne and rashes like those seen in autoimmune diseases. From hives and itching to flaking and dryness, the microbioe plays a role. If you have any of these chronic skin conditions and notice flare ups in periods of stress it’s because inflammation increases in response to chemical stressors in the body, and stress likewise affects the function of our microbiome!

Immunoreactivity

Another way that the microbiome affects skin is because of how those bacteria control inflammation: through the immune system. The good bacteria in our skin and our gut stimulate anti-inflammatory divisions of our immune system such as interleukins (i.e. IL-10, IL-17 and IL-22) which protect us from infection. Our microbiome also helps teach our immune system to distinguish between self and non-self as in the case of autoimmunity, and to develop tolerance to benficial exposures like food and food allergens. Breakdown of the microbiome, or a microbiome that doesn’t have the chance to develop properly early in life can all lead to immune system problems that may manifest as skin reactions. These can include the rashes seen in autoimmune diseases (malar rash) or skin-related allergic and intolerance reactions (hives, itching, swelling, redness.)

Toxins

A third way that the microbiome affects skin is through toxins. Here’s a somewhat unrelated example to illustrate the point: sometimes newborn babies develop jaundice which involves a yellowing of the skin. This is because at birth, new babies are filled with extra red blood cells from their mothers. These red blood cells die off rather quickly and if they aren’t broken down and cleared away through the (you guessed it) GI system, chemicals from the old cells such as bilirubin will build up in the blood stream and cause damage to other organs in the system. This bilirubin chemical is yellow which is why the skin begins to look yellow when it isn’t cleared away properly. Otherwise healthy babies who drink lots of milk and have frequent bowel movements in the early days are typically able to clear away this waste product in their stools no problem. But if they aren’t digesting and metabolizing properly, and if their gut microbiome is malfunctioning, the bilirubin and toxin buildup could become fatal.

Adults process bilirubin too, as we all make new red blood cells every 3 months. However bilirubin is far from the only toxin we need to clear out of our bodies. We make new hormones every day, and consume food that needs to be broken down every couple hours. All of these processes involve waste products that need to be cleared away from the gut. Breakdown in that clearance system due to imbalances in bacteria easily leads to problems like hormonal imbalances, which can manifest on the skin as redness, acne, and other blemishes.

Let’s take a closer look at eczema, for example. Eczema is very similar to an autoimmune disease, in that the immune system creates localized inflammation on the skin which worsens in response to different immunological triggers. Exposure to irritants and toxins, such as fragrance or detergents, may flare up the skin, inflammation tumbles out of control, and the immune system reacts all the more aggressively to the now broken-out skin. It tends to create a snowball effect once bad bacteria start colonizing the breakouts—namely Staphylococcus species which are responsible for the angry, rashy redness we so often associate with eczema. Treating a condition like eczema necessitates a combination strategy that is anti-inflammatory and immune modulating, but also requires a deeper look at toxic exposures and immune triggers which are all mediated by the GI tract.

In the early stages of a flare-up, however, sometimes a topical solution is necessary to calm things down enough to get to the root cause. Ozonated oils kill inflammatory bacteria like Staphylococcus and also directly stimulate immunological healing of damaged skin. This buys the time to figure out the root-cause trigger and treat it holistically.

If you loved what you read here, check out these related posts:

• Diets and the Gut Microbiome
• Natural Eczema Treatment

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 Here’s How Your Gut Health Affects Acne, Eczema, Hives and More appeared first on Dr. Alexandra MacKillop.

But when it comes to fertility, ovulation is the foundation.

PCOS, or polycystic ovarian syndrome, is a common reason for diagnosed “infertility,” which is rising faster than ever in the US. One of the hallmark signs of PCOS is ovulatory dysfunction, meaning that a woman has irregular periods or anovulatory cycles which are menstrual cycles in which ovulation does not take place. Ovulation is crucial for pregnancy because that is the process that actually releases the egg that will eventually become fertilized. If you’re wondering how to get pregnant naturally with PCOS, the first step is to make sure that you are actually ovulating.

Why PCOS Causes Infertility

With PCOS, ovulatory dysfunction makes trying to conceive (TTC) difficult because there are fewer eggs released in any given year. Rather than having a monthly period, many women with PCOS have cycles that stretch more than 35 days, sometimes twice that, and some women don’t have periods at all. PCOS can also get in the way of TTC efforts because it’s associated with insulin resistance, inflammation, and hormone imbalances that affect the quality of the uterine lining, damage the fragile embryos in their earliest stages, and increase the risk of miscarriage. These factors combined can add up to the 6 or 12 months of unsuccessful TTC efforts that lead women over, or under, age 35 (respectively) to be diagnosed with infertility and referred for IVF.

Assisted reproductive technology has been a wonderful gift to families who were otherwise unable to conceive without it. But what if there was a way to get pregnant naturally without having to rely on medications, invasive procedures, and tens of thousands of dollars’ worth of medical appointments

Guess what There is! Read on to find out.

How to Get Pregnant Naturally with PCOS

Getting pregnant naturally with PCOS means addressing the root cause of fertility problems in PCOS. These main issues include: irregular ovulation, inflammation, and problems with egg quality.

Improving Ovulation in PCOS

The first key step in improving ovulation rates in PCOS is figuring out if and when you are ovulating. You can do this in two ways:

1. Blood Tests: In most ovulatory cycles, progesterone levels are highest on day 21. This is because ovulation usually takes place around 2 weeks before a period starts, and in a “normal” monthly cycle, ovulation would take place somewhere around day 13-16. After ovulation, the ovary starts producing progesterone, but does not do this if it doesn’t release an egg. So, to confirm if a woman is “ovulating on time,” we can run a blood test to measure the progesterone levels in her blood and if they’re in the correct range, we know she ovulated “on time.” If a woman has long but regular cycles, meaning they come after the same number of days, we would run this test one week before her expected period.
2. Tracking BBT: If a woman has irregular cycles, it is difficult to predict when to test “day 21 progesterone” or to complete that progesterone test at the correct time. Plus, the progesterone test doesn’t tell us when she ovulated necessarily, only if she ovulated and when, within a general range, that may have taken place. Instead, a woman can track her period using fluctuations in body temperature that give very specific information about the timing of ovulation. Learn how to do this here: Basal Body Temperature 101

Once you know if and when you’re ovulating, it’s time to take steps to make it more regular! Here are a few key ways to do this:

1. Reduce Stress: Stress is a major driver of adrenal dysfunction, which drives androgen production and worsens the hormone imbalances associated with PCOS. Stress also messes with blood sugar and lowers progesterone levels which can make the uterine environment unfavorable for pregnancy.
2. Consider Androgen Blockers: In the traditional medical model, spironolactone and the birth control pill are prescribed to reduce androgens because these hormones are responsible for many of the problems seen with PCOS. However, spironolactone isn’t safe when TTC, the birth control pill defeats the whole purpose, and neither allows our bodies to naturally get back into balance. Instead, natural herbs like red reishi, Chinese peony, green tea extract and black cohosh reduce androgens and improve ovulation rates. Be careful though; many of these herbs are not safe to take during pregnancy and you can be pregnant for up to a week before a pregnancy test shows positive. I recommend working with a functional medicine doctor if you’re using herbal medicines for this reason.
3. Take Melatonin: Disruptions in the circadian rhythm lead to cortisol and DHEA imbalances, which circle back to point #1 in terms of their hormone-disrupting effect. Short-term melatonin use helps regulate the stress cycle, but has also been shown to improve ovulation rates in PCOS and reduce inflammation.

Reduce Inflammation

Inflammation is caused when the immune system gets triggered by foreign invaders or toxic chemicals. Some of these toxic chemicals come from the body’s own metabolic processes (i.e. “waste products”) but others are caused by lifestyle factors. Here’s how you can lower your own inflammatory load:

1. Take Melatonin: It made it to this list too! Melatonin is just that powerful. If you look back up at point #3 above, you can see that melatonin reduces inflammation in PCOS sufferers in addition to increasing likelihood of ovulation.
2. Eat an Antioxidant-Rich Diet: The more colorful the food, the better! That doesn’t mean that white foods aren’t allowed, it just means that you can amp up your antioxidant load without needing to rely on more supplements. My favorite ways to get antioxidants every day is by eating organic beets, blueberries, arugula and raw walnuts. Better yet, I combine all of these into a salad, topped generously with extra virgin olive oil and balsamic vinegar.
3. Consider Curcumin and Vitex: Similar to melatonin, curcumin and vitex reduce inflammation and improve ovulatory outcomes. I usually have my patients take all three when they are TTC.

Work on Your Egg Quality

From a nutritional perspective, it’s pretty simple: eating eggs improves egg quality! Go figure, right That’s because eggs are an excellent source of zinc, B vitamins and choline, all of which are essential for egg quality and developing of a growing baby. Here’s an easy, non-supplement way to improve your own egg quality: eat two eggs per day! The additional protein is also valuable for keeping blood sugar balanced and reducing inflammation from insulin.

1. Eat 2 Eggs Per Day: see above for details!
2. Check out my blog post all about Fertility Supplements for Egg Quality

In closing…

If you have been told that IVF is your only option, remember that there may be meaningful steps you can take first to support your body naturally. Learning how to get pregnant naturally with PCOS starts with restoring ovulation, lowering inflammation, and improving egg quality, which are the true foundations of fertility. While assisted reproductive technology has helped countless families, it is not the only path for every woman. By identifying whether you are ovulating, addressing stress and blood sugar balance, reducing inflammation, and nourishing your body with targeted nutrition and supportive therapies, you may be able to create a healthier environment for conception. With the right testing, guidance, and a root-cause approach, many women with PCOS can optimize their fertility and move toward pregnancy with greater confidence and clarity.

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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The post How to Get Pregnant Naturally with PCOS appeared first on Dr. Alexandra MacKillop.

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

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

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

3 Reasons for Painful Periods

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

1) Hormone Imbalances

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

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

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

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

2) Feminine Protection Products

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

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

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

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

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

3) Inflammation

When you have cramps What do you do?

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

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

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

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

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

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

How to Naturally Reduce Inflammation

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

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

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

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

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

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