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I'm obsessed with all things periods, pregnancy, pelvic floor and helping women just like YOU to navigate all of life's major milestones!
It’s not you. It’s your hormones.
I speak with women all the time who have said to me that their doctor won’t investigate potential issues with their fertility until they’ve been trying to conceive for 12 months with no success; that they need to have had more than 1 miscarriage to be referred to a specialist, to just stop stressing, give it time and it will happen! Even women who are experiencing unsuccessful IVF cycles are usually just booked in for the next one.
Women are not getting the support and encouragement they need to feel in control of their fertility. Sadly, women are not routinely taught about preconception care and daily factors that could be impacting their fertility. Many reproductive conditions, many issues with ovulation and your cycle, many of those traditional PMS symptoms associated with having a period that you dread every single month are all related to an imbalance between our hormones. And we can absolutely treat a hormone imbalance. Sometimes a few small changes are enough to have a big impact, sometimes you may need artificial hormones in one form or another to address the issue, sometimes it’s harder to treat, but the key is investigating what has caused the imbalance in order to correct it.
In this episode we’re talking about hormone balance, the role of our key sex hormones and how to manage potential issues by first looking at your environment and your exposure to potential pollutants and contributors to hormone imbalance that you can address yourself.
Let’s kick off by diving deeper into the key sex hormones and why we need optimal hormone balance to optimise ovulation
Oestrogen levels peak during the follicular phase, just before ovulation. At the beginning of a new menstrual cycle, the first day of your period, oestrogen levels are low. As you finish menstruating and ovulation approaches, oestrogen levels rise and trigger that thickening of the endometrium in preparation for implantation of the fertilised egg.
High oestrogen levels also cause production of cervical mucus, , which makes it easier for sperm to pass through the vagina and reach the egg. Balanced oestrogen levels maintain healthy skin, hair and bones. Low oestrogen means less cervical mucus is produced, which can contribute to difficulties getting pregnant.
Progesterone levels are very low at the beginning of the menstrual cycle and remain low until after ovulation has occurred. This is because progesterone is a key hormone in establishing and maintaining pregnancy, so it is not required until pregnancy is possible, after ovulation.
Progesterone is essential for balancing oestrogen levels and maintaining overall hormone balance. Levels can be depleted when the body is under stress and can influence our moods and the way our body breaks down fat. Progesterone itself is not the cause of PMS symptoms even though it is at peak levels during the luteal phase when symptoms are usually experienced. It is actually the imbalance between progesterone and oestrogen that can lead to PMS symptoms, which is why it is so important that these two hormones are balanced.
When an egg is released from a follicle inside the ovary at ovulation, the follicle that remains becomes the corpus luteum. The corpus luteum secretes progesterone during the luteal phase of the cycle, after ovulation.
Progesterone then takes over oestrogen’s role of maintaining a thickened endometrium to ensure pregnancy can happen.
If the fertilised egg implants in the endometrium and pregnancy has occurred, progesterone levels will remain high to maintain the pregnancy. If the egg was not fertilised, progesterone levels will drop, quite suddenly, causing the endometrial lining to shed and your next period occurs.
Many period irregularities and symptoms are caused by an underlying hormone imbalance. There are many reasons why hormones can become imbalanced, and ultimately the menstrual cycle relies on the delicate balance between the major sex hormones to produce a consistently healthy cycle. The level of one hormone is influenced by – and will itself influence – the level of another hormone. If one level becomes too high, it may trigger the release of another hormone. If one level becomes too low, it may signal to the body to stop producing another hormone.
Understanding what has caused a hormone imbalance requires investigation by a healthcare professional. General health, diet, stress and the environment can all influence the balance of our sex hormones. Addressing general health and lifestyle factors is the best place to start when managing hormonal imbalance.
Oestrogen levels as a whole will decline as we approach peri-menopause and low oestrogen is responsible for mood swings, fatigue and difficulty sleeping, and it often occurs alongside low progesterone, especially in our fertile years.
High oestrogen is usually linked to high stress, diet or environmental factors. In general, most of us have way too much oestrogen in our bodies. Physical or emotional stress, leads to high cortisol levels. Cortisol is the stress hormone. This will impact progesterone levels and leave oestrogen levels too high or low in comparison, usually low. Your diet is a huge factor, as well as medications like the oral contraceptive pill and the mirena, which again leave your oestrogen either too low or too high.
More often than not in the Western world, women experience high oestrogen, called oestrogen dominance and it’s progesterone that suffers.
Signs of oestrogen dominance include:
This can be caused when too much oestrogen is produced, it isn’t broken down properly and is reabsorbed instead of eliminated, or progesterone levels are too low to counterbalance it.
While you can use progesterone supplements to manage this, it’s not ideal as you’re ultimately left with high oestrogen plus high progesterone too and while it’s treating the symptoms, it’s not actually addressing the cause of high oestrogen and can impact ovulation, your fertility, as well as lead to long term health problems.
Progesterone helps to eliminate excess body fluid and regulates our blood sugar levels. It helps our happy hormones, helping the brain to produce dopamine and serotonin, which helps us to sleep better. Progesterone is thought to improve the symptoms of depression for this very reason. Low progesterone can also cause insomnia and poor sleep, weight gain, water retention and bloating and it means the thyroid can’t do its job properly either. So if you notice those symptoms of anxiety or depression are heightened during the later stages of your cycle, alongside PMS symptoms in the luteal phase, this could be a sign that progesterone levels are a little lower than ideal.
Low progesterone also goes hand in hand with thyroid issues, so while any problems with the thyroid may also contribute to low progesterone; low levels may lead to hypothyroidism, where the thyroid is underactive. If the hormones that regulate your endocrine system aren’t being produced in high enough quantities, then progesterone production may be affected.
Another reason for low progesterone levels may be women with PCOS and polycystic ovaries, and anovulatory cycles. If you don’t ovulate, there’s follicle that becomes the corpus luteum which produces progesterone, and so obviously levels will remain low.
Finally, I talk about stress all the time, but stress has a significant impact on progesterone levels. Most of your progesterone is produced by your ovaries, but a small amount is also produced by your adrenal glands. It then gets converted to other hormones, including the stress hormone cortisol. Your adrenal glands are very sensitive to any stress that the body is exposed to, and it will adjust its response to stress by producing cortisol in whatever amount is required. Excess cortisol production puts our body into the “fight or flight response” and switches off any non-essential activities for survival.
The precursor to the hormone progesterone is pregnenolone. The precursor to the hormone cortisol is progesterone. Maintaining hormone balance in the body is a delicate balancing act, so any disruption to one hormone will influence another. Cortisol is the main stress hormone and progesterone is the hormone that makes you ovulate and helps you conceive. If you are under stress, your body is going to convert pregnenolone into progesterone, but then it is going to convert progesterone into cortisol. As more and more cortisol is produced, progesterone levels drop as a result. Oestrogen levels are too great by comparison, so we see signs of oestrogen dominance, creating an imbalance between the sex hormones.
To make matters worse, as cortisol levels rise, they block progesterone receptor sites to prioritise cortisol. Because when the sex hormones and the stress hormones fight it out for dominance, the stress hormones will always win because the body will prioritise survival. The frustrating part of this is that if you have a blood test, your progesterone levels will often appear normal because it is there in your body, but its affect is being blocked to produce cortisol. If the person interpreting your blood test results cannot spot this, then you’re going to be told that everything is fine.
If you’re noticing any of the symptoms I’ve mentioned and you suspect you may have a hormone imbalance, it might be worth testing. This is done through a simple blood test and you’ll likely have oestrogen, progesterone, testosterone, cortisol and thyroid levels chcked.
Because levels of the sex hormones fluctuate throughout the menstrual cycle, you’ll need to make sure you’re testing at the right time of your cycle. Some testing is done at particular points of the cycle, but remember this will likely be according to a 28 day cycle with day 14 ovulation, which is ridiculous if we’re looking at something like PCOS, so understanding your individual cycle and knowing what phase you are in – before or after ovulation – when getting your blood test is essential to interpreting your results correctly. This is where working with a practitioner who is trained in women’s health is ideal.
You’ll notice a common pattern when I talk about managing any kind of hormonal, ovulation or fertility issues and it all comes back to those 4 key pillars of fertility – diet, exercise, sleep and stress. Especially stress as I’m sure you now understand.
The first step is to understand your cycle well enough to actually detect a potential problem. The next step is to look at your environment and ways in which you can reduce the effects of hormone disruptors and environmental pollutants that you are being exposed to constantly. And finally, we’ll talk about nutrition, pesticides and why eating organic where possible can help to manage hormone balance.
Let’s start with the hormone disruptors in our environment. I talked about this in a lot of detail in Episode 24 – Household Items That May Be Affecting Your Fertility
You may never have heard before of some of these chemicals – phytoestrogens and xenoestrogens – because they are not something that’s commonly known about. Hormone disruptors are any chemical that can alter how hormones work in your body. This isn’t just limited to fertility either, then can impact all of our body systems.
Here’s a very basic chemistry lesson for you. Basically, the chemical structure of these “artificial” oestrogens are very similar to the hormone oestrogen. This means that these artificial oestrogens bind to the same chemical receptors in our body that oestrogen binds too. If all of our oestrogen receptors are blocked up with artificial forms of oestrogen or chemicals with a very similar structure, then there is excess oestrogen floating around with no receptors to bind to. If oestrogen can’t bind to its receptors, then it can’t do its job, so the body thinks there isn’t enough oestrogen and so produces more. And this is the beginning of a vicious cycle.
Our body’s normal functioning involves tiny fluctuations in hormone levels, and these small changes can have more significant effects on our bodies. Our endocrine, or hormone, system releases hormones that signal to different tissues in the body what to do next, and it’s all one big domino effect, as you’ve learnt with the hormones involved in regulating the menstrual cycle. When these disruptors enter our body and mimic our hormones, levels are disrupted. Hormone sensitive organs like the uterus and breasts are particularly vulnerable to this. And the problem is that we’re being exposed to all these different disruptors throughout our lifetime, they’re slow to break down in the environment and the long-term effects in humans just aren’t known. Xenoestrogens impact ovulation and fertility because they impact oestrogen levels. They don’t break down. They accumulate in a process called biomagnification, so they’re stored in our fat cells and a build up over time can lead to cancers, particularly breast cancer, obesity, infertility, miscarriage, endometriosis, early onset puberty and diabetes.
Here are the key hormone disruptors and environmental pollutants that I want you to start paying close attention to:
Plastics, BPA and phthalates – These are found in skincare, make up, shampoos and conditioners. They are absorbed into the skin and lubricate other ingredients, meaning moisturiser or makeup can be applied and spread more easily on the skin.
BPA is more commonly known about and is found in plastic drink bottles and food containers, canned food, even on receipt paper.
Phthalates are also found products with a fragrance like perfumes and candles, Research has shown a link between phthalates and a number of fertility markers, including sperm quality to such an extent that perfumes are banned in IVF clinics.
The other key hormone disruptor are pesticides. If you can, go organic to reduce your exposure to pesticides and always wash your fruit and veg before you eat it too. The reason why organic is so important is that the main ingredient in roundup, a pesticide, is called glyphosate and it does its job by disrupting a process in plants where they generate essential nutrients. Which means when we eat foods treated with roundup, we don’t get the nutrients we need from those foods. When ingested, glyphosate can trigger inflammation of our intestinal wall, causing gut problems. And this is just one example of the many chemicals that contaminate non-organic food. Just one week of eating organic can reduce glyphosate in the body by 70%.
Eating organic can understandably be very expensive. Some fruits and vegetables are more likely to contain higher amounts of pesticides than others, so do your research based on the foods you most commonly eat and work out where you could go organic. Google the dirty dozen and the clean fifteen and this will give you some guidance about where to prioritise eating organic. I’ll also share some more details on these commonly eaten foods on my Instagram.
Hormonal imbalance is obviously an enormous topic to tackle on its own and there are many different reasons why you could have high oestrogen and low progesterone. You could of course have high progesterone and low oestrogen, but I’ve talked about the most common presentations today and some of the most common symptoms and causes.
As always I don’t know your individual history, so I try to talk about management in a really broad sense that you can do yourself before exploring more individual options with a practitioner. And like I said, it almost always comes back to nutrition, exercise, sleep and stress, as well as managing your environment in terms of hormone disruptors and environmental pollutants as much as possible.
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