You inhabit an amazing body that performs a myriad of functions every second of the day. This incredible feat is controlled by your brain and co-ordinated by your hormones. Millions of women are affected by hormonal changes throughout their lives but have little idea about how or why. Hormonal imbalances can lead to:
Hormones are essentially chemical messengers secreted by endocrine glands in the body that are designed to adjust metabolic functions in cells. They do this by regulating the production of a specific protein or by activating enzymes.
There are two basic types of hormones, steroid and peptide. They travel to their target organs in the bloodstream and work in complicated harmony to maintain balance at all times. Steroid hormones are fat soluble compounds that can easily pass through cell membranes.
Some of these include:
Peptide hormones are water soluble compounds that are able to dissolve in the blood in order to be transported around the body. Some of these include:
Hormones are secreted by the endocrine system which is largely controlled by the pituitary gland - in the brain - under the direction of the hypothalamus.
Hormone balance (Homeostasis) is maintained by a key regulatory mechanism called ‘negative feedback’ which either opposes the release of certain hormones or causes hormones to act antagonistically by opposing each other’s actions.
For example if blood sugar (glucose) levels are too high the brain sends a signal to release insulin which lowers blood glucose. If blood glucose levels drop too low the brain triggers the release of glucagon which raises blood sugar.
Hormones co-ordinate many diverse areas including:
When the correct balance of hormones is maintained most daily challenges are met and the body thrives, but if levels are too high or low it can lead to health problems such as thyroid disease, polycystic ovaries, endometriosis, infertility, fibroids, depression and acne.
Female hormones exist primarily to promote growth and reproduction and have a significant effect on a woman’s development throughout her life. The two main female hormones, oestrogen and progesterone are produced predominantly in the ovaries but also in the adrenal glands which sit just above the kidneys.
At puberty oestrogen is responsible for the development and maturation of the uterus, fallopian tubes, breasts and vagina. It also plays a key role in the growth spurt and deposition of fat around the buttocks, hips and thighs.
There are at least six different oestrogens, however only three are synthesised in significant amounts:
Beta-estradiol, Estrone & Estriol.
Progesterone is involved in regulating the menstrual cycle and is vital for supporting a healthy pregnancy. It is also particularly important for balancing and controlling oestrogen performance, opposing some of the powerful effects of excess oestrogen. For instance oestrogen triggers release of the stress hormone cortisol while progesterone counters it.
Oestrogen stimulates cell growth, while progesterone ensures growth is maintained at healthy levels. Low progesterone levels lead to uncontrolled oestrogen which results in hormonal imbalances. Low levels of progesterone may affect:
Women also produce a little testosterone (normally considered a male hormone) from their ovaries, which helps to promote muscle mass and bone growth. These levels naturally decline post menopause.
During this stage the ovaries are stimulated by luteinising hormone (LH) and follicle-stimulating hormone (FSH) which are secreted by the pituitary gland under the influence of the hypothalamus.
These hormones bring about the physical changes associated with puberty. Menstruation usually occurs around the time that a woman’s growth spurt slows down. The whole process takes around 4 years.
This is a time when a woman’s hormones change dramatically:
The lead up to the menopause (the peri-menopause) starts around the age of 40 and ends on average at age 52. Whilst there are considerable hormonal changes that occur during puberty and the childbearing years - the menopause and post menopause seem to be the most problematic. This life stage can be extremely challenging for some women.
Oestrogen plays a vital role in protecting the heart, bones, bladder and vagina as well as maintaining the breasts. Lack of oestrogen and progesterone during the menopause can create hormonal imbalances which have significant consequences for health with an increased risk of osteoporosis and heart disease and can also result in a range of distressing symptoms.
The ratio between oestrogen and progesterone is critical for the maintenance of homeostasis. Often the effects of high oestrogen are due to a combination of mildly high oestrogen levels together with a mild progesterone deficiency.
An increase in the ratio of oestrogen to progesterone can lead to:
Hormone function can be disrupted if too much of a hormone is produced or too little. This may be due to a number of factors including:
Undereating, a poor diet, insufficient calories and nutrients, reliance on stimulants and junk food can lead to a nutrient deficiency which will ultimately affect hormone production. For example, Studies have found that B6 supplementation has positive effects on some PMS symptoms. It is likely that B6 helps to balance oestrogen and progesterone levels mid cycle. B6 is also a co-factor in the synthesis of serotonin.
Being underweight with insufficient fat reduces cholesterol which is needed to produce sex and stress hormones. During the menopause oestrogen is produced in the abdominal fat cells as ovarian function diminishes.
Poor liver function
Oestrogen has to be metabolised by the liver and excreted in bile. If the liver is not functioning efficiently oestrogen levels in the blood may remain relatively high.
Overloading the liver with alcohol, drugs, caffeine and chemicals in food may lead to poor liver function.
Too much sugar, alcohol, chocolate, fried foods, trans fats and refined carbohydrates can affect liver function which could contribute to higher oestrogen levels.
Before used oestrogen can be eliminated via the stool it has to be modified by intestinal bacteria and bound to fibre. This bulks out the stool and encourages normal bowel movements.
Good levels of healthy gut bacteria and plenty of dietary fibre are essential for this process otherwise the used oestrogen may be recirculated.
Chemicals in food
Certain chemicals such as pesticide residues found in non-organic dairy and meat products can mimic oestrogens in the body.
Oestrogens are also included in cattle feed to fatten them up.
Environmental factors and xenoestrogens
There are many petrochemical products that affect the balance of hormones in the body. These include:
Alkylphenol ethoxylates in detergents and emulsifiers; nonylphenol ethoxylates used as spermicides and plasticisers; bisphenols used in certain industrial and chemical processes and dental fillings, the birth control pill and HRT
There may be a family history of early menopause or low thyroid function.
Prolonged stress may be a key factor in hormone imbalances. Stress affects blood sugar balance which disrupts the function of the adrenal glands.
In the long term, constantly fluctuating blood sugar levels may result in insulin resistance leading to high levels of insulin circulating in the blood. High circulating insulin:
Being aware of the tell-tale signs is the first step towards managing symptoms and regaining balance. Some of the typical symptoms experienced by women include:
Many of these symptoms can be easily addressed through dietary and lifestyle changes. But first you need to identify whether or not you have a hormonal imbalance or whether you might have nutrient deficiencies.
This can be achieved by carrying out functional medicine tests through stool, breath, blood, and saliva or urine analysis as part of a comprehensive detailed consultation in order to gain a clear and accurate picture of your current health status.
Functional medicine recognises that chronic disease is almost always the result of a prolonged period of declining function in one or several of the body’s systems. It is a dynamic approach to assessing treating and preventing complex chronic disease by addressing the whole person and not just an isolated set of symptoms.
Functional medicine takes a personalised approach to health care which recognises the uniqueness of each individual, their genetic history, environment, diet, economic status and lifestyle – all the things that have influenced the development and progression of their particular health condition.
The difference between conventional laboratory tests and functional medicine testing Your GP can offer you standard blood tests in relation to specific symptoms you are experiencing that may point to conditions such as peri-menopause or low thyroid function. These tests are looking for an already established disease process.
The tests carried out will assess whether or not your hormones are within a certain range and your GP will only take action if they are out of the normal range. The tests aim to identify markers that point to disease rather than evaluating how the physiology of the body is functioning that may be contributing to health issues.
Conventional testing does not take into account the many individual factors that lead to disease. The intimate relationship between hormone function and nutrition is particularly important in relation to the adrenal, thyroid and reproductive glands.
This connection together with stress and lifestyle are not necessarily taken into consideration with standard biochemical testing and therefore it may not give an accurate guide to hormonal balance when making a diagnosis.
The goal of functional medicine testing is to prevent disease before it happens, by assessing patterns of imbalance that will lead to chronic disease if preventative measures are not taken.
The aim is not only to determine the disease a patient may be suffering from but also to understand the underlying causes and physiological dysfunctions that underpin each individual’s specific symptoms.
There are several functional medicine tests available that can give an overview of all the systems in the body. Some of these are specifically able to help you understand your hormone balance. Most commonly a test will involve a breath, blood, saliva or urine sample.
Some of these can be carried out at home but others may require a visit to a laboratory to provide samples. Tests available to evaluate different hormones include:
Adrenal Stress Hormone Profiles
The adrenal hormones influence metabolism, thyroid function, anti-inflammatory response and resilience or resistance to stress. Unfortunately adrenal fatigue is a very common condition in today’s society.
Adrenal stress tests can give accurate indications of your body’s stress function by measuring vital stress hormones such as free cortisol, glucocorticoids, creatinine and DHEA. The test may involve the use of saliva samples and urine samples.
Adrenal stress tests serve as a critical tool for uncovering biochemical imbalances underlying anxiety, depression, chronic fatigue syndrome, obesity, headaches, salt cravings, brain fog, sleep irregularities, abnormal blood sugar levels, and a host of other clinical conditions that may affect day to day life.
Thyroid Hormone Profiles
Thyroid abnormalities have become increasingly common worldwide. Normal thyroid function is essential as it affects virtually every metabolic process in the body.
Any imbalance in this important organ can result in a broad spectrum of chronic conditions and has a significant effect on mood, weight, energy levels, bowel movements, brain function and libido.
Typically a comprehensive blood test panel measures levels of TSH, free T4, free T3, reverse T3 and antibody levels commonly found with Hashimoto’s disease (the most common cause of low thyroid function). Overall the test helps to pinpoint any weakness in the thyroid pathway
Sex Hormone Profiles
Sex hormone levels may be altered in many common conditions, such as the menopause, pms, dry skin, menstrual abnormalities, endometriosis, polycystic ovaries, depression, insomnia, infertility, low libido, vaginal dryness, hot flushes and fatigue.
Female hormone levels can be tested via: Saliva, urine, blood spot and full blood sample. If, any imbalances are found following assessment, nutritional and lifestyle intervention can frequently balance these hormones out over the following months.
There are many other more specialised functional tests available, some of which are offered at Amchara as a core part of our treatment regimes. With the support of your naturopathic practitioner one or some of these might be suggested:
Serum testing is the preferred method in the medical profession and is ideal for testing peptide hormones such as FSH, LH, prolactin, fasting insulin, and thyroid hormones, including reverse T3, as well as thyroid antibodies. However for sex hormones it may be less effective.
For most sex hormones there is no distinction between bound and ‘free’ hormones in serum. Free means that the hormone is not bound to binding proteins in the blood, which allows for an approximation of how much hormone is available to enter the tissues.
Without this distinction there may be misleading results where hormone levels appear to be normal due to an abundance of bound hormone. However if the ‘free’ hormone level is low an individual may be symptomatic and not functioning well despite normal total hormone levels. A further limitation to serum hormone testing is that it only gives a snapshot in time.
Hormones are secreted in a pulsatile manner throughout the day and night, so it is difficult to determine whether the results from the serum represent a peak, a drop or something in between.
As well as this serum hormone testing does not commonly allow for the measurement of oestrogen, androgen and adrenal metabolites which can provide a wealth of information for understanding an individual’s condition and the potential to fine-tune treatment options.
Saliva is a ‘real time’ fluid that reflects an individual’s health status at the moment of collection. It has the advantage of being non-invasive as well as allowing for multiple sample collections over a period of a day or month, which can help elucidate abnormal hormonal patterns. Salivary hormone measurement is the most accurate way of evaluating the balance of oestrogens, progesterone, and testosterone, particularly in women still menstruating.
It can also be used to evaluate cortisol secretion patterns by taking multiple samples over the course of a day and evening. Additionally salivary testing measures the ‘free’ or bioavailable hormone levels.
The multipoint versatility and measurement of ‘free’ hormone makes saliva a better measure than blood serum for evaluating un-supplemented hormone status.
Saliva measurements are greatly affected by the use of exogenous hormones, Because of this, patients are asked to discontinue the use of hormones between 12 to 36 hours prior to collection. Whilst saliva can be used to evaluate estradiol, estrone and estriol, progesterone, testosterone, DHEA and cortisol, steroid hormone metabolites are not measured in saliva, limiting its utility in assessing metabolism of hormones.
Saliva collection, like blood, is a single-point collection. Although cortisol can be collected multiple times, sex hormones are measured from a single morning collection. As is the case with serum tests, one specific collection point does not account for individual variation and may only identify a peak or a valley in hormonal secretion.
A 24-hour urine collection is the preferred method for testing hormones that are secreted at night and during deep sleep, such as growth hormone and melatonin, and is the most economical and reliable way to evaluate steroid hormone metabolites. Twenty-four hour urine collection provides a more comprehensive hormonal picture.
It accounts for the full day and night of hormonal secretion and covers a much broader range of hormones including pro-hormones and hormone metabolites. Hormone metabolites are the by-products or end products of hormone metabolism.
Evaluating these metabolites is most important when evaluating the adequacy and safety of exogenous oestrogen supplementation and in assessing adrenal function. 24 hour urine collection eliminates the possibility of falsely elevated or depressed levels that may be obtained from a single point collection and are excellent for evaluating the function and health of the adrenal glands.
There are some disadvantages to urine tests particularly for those with kidney disease who do not excrete urine or metabolic products normally making this type of test unsuitable. The elderly often find urine collection difficult so urine testing may not be an accurate method.
Dried urine is a relatively new and innovative form of testing hormones and offers several benefits over serum, saliva and conventional urine tests. Although saliva tests allow for multiple samples therefore capturing the fluctuations of hormones throughout the day, the collection method can be time consuming and tedious.
Similarly whilst conventional urine tests have an advantage over blood or saliva because they can measure both parent hormones and metabolites, the collection method can be quite messy and inconvenient. The advantage of a dry urine test is its ability to capture all of the above information in one simple test.
The dried urine test is carried out four times in one day by urinating on filter papers that are then left to dry. Those test strips are then utilised to give a complete hormone panel including metabolites which cannot be measured in saliva or blood.
Please note: Serum, saliva, and urine testing can present important insights into an individual’s hormonal status.
Each has its own strengths and limitations, which may necessitate a combination of testing methodologies on occasion.
Restoring hormonal balance is a whole-body concept which involves changes to diet, lifestyle and environment. This is a big commitment because eating the right foods and living well should be long term goals that will help you live the rest of your life feeling the best you can.
However be realistic – make gradual changes and don’t beat yourself up if you occasionally fall off the wagon! Remember, patience is a virtue changes take time and won’t necessarily happen overnight.
1-Eat a well-balanced diet
Many common medical conditions respond very well to diet therapy. This is because a healthy balanced diet supplies an abundance of nutrients that are needed to address the underlying cause of an illness rather than simply cover up the symptoms.
What you eat can directly affect your hormone balance so you need to choose foods that nourish your body, helping your hormones to function normally.
Enjoy a Mediterranean type diet which includes:
Phytoestrogens are compounds that gently mimic natural oestrogen and can bind to oestrogen receptors. This has the advantage of either blocking the uptake of oestrogen if the body has too much or raising levels of oestrogen where there is too little, helping to balance hormone levels.
2-Supplement where necessary
You may need additional therapeutic herbs and nutrients that can target your symptoms, such as Black Cohosh which has been shown to help reduce hot flushes.
Agnus Castus which helps to normalise irregular periods. Iodine, selenium and tyrosine are known to support thyroid function and probiotics play a role in the metabolism of substances that affect hormone balance.
Herbs like Rhodiola and Ashwaganda can be useful for reducing stress and anxiety whilst St John’s Wort and the nutrient 5HTP help to raise mood.
*Always take advice from a qualified naturopath, herbalist or nutritional therapist.
3-Balance blood sugar
Constantly fluctuating blood sugar levels play havoc with your hormones.
To avoid this it is important to make sure that the foods you eat are broken down slowly to release the sugars needed for energy gradually throughout the day. Making sure you eat protein or healthy fats at each meal helps to delay the emptying of the stomach and slows down the digestion of carbohydrates into simple sugars which raise blood glucose rapidly.
The hormone insulin is needed to chase glucose into the cells but if you eat too many sugary foods too often, over time the cells may become de-sensitised to insulin which can result in the condition type 2 Diabetes.
Moving more and sitting less helps to improve circulation, detoxification and nutrient delivery for hormones.
Exercise has also been shown to improve thyroid function, strengthen bones, reduce stress and raise mood. Find an exercise plan that suits you and leaves you energised rather than exhausted.
Choose activities that you look forward to. Walking is the easiest option and free, but you could just put some music on and dance around the room. Try to move for at least 30 minutes a day and if you have a sedentary job, set an alarm to remind you to get up and walk around every hour.
5-Improve your environment
Minimise your exposure to chemicals and toxins. Choose natural products free from pesticides, artificial scents and additives and avoid plastic, mercury fillings and aluminium products. Place plants around your home and spend more time around nature - trees give out more energizing oxygen. Some plants are known to extract substances from the air such as chemical cleaning fumes, perfumes, chemicals from printers and cigarette smoke.
Treat yourself to some Spider plants, English Ivy or Aloe Vera. 6-De-Stress, Detox & Sleep Manage your stress levels firstly by avoiding situations which you know are stressful. Then use techniques that are known to lower blood pressure, reduce stress and create a relaxed feeling of wellbeing such as yoga, peaceful calming music, deep breathing exercises and meditation.
Get at least 8 hours sleep by ensuring you sleep in a dark room, switch off gadgets, avoid late night caffeine drinks, take a hot bath with Epsom salts, ban TV from the bedroom and avoid reading too. Following the healthy diet and lifestyle tips above will allow your body to function more efficiently and give your liver the nutrients it needs to detoxify effectively.
Jacqueline Newson BSc (Hons) Nutritional Therapy
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