PMS, Endometriosis, Fibroids, PCOS, oh my! Alright, I apologize. That was pretty bad. But in all seriousness, why are female conditions such as these so taboo to talk about in our society? I recently spent a few hours listening to the first portion of a 4 part webinar series that centered around the complexities that are the female hormones through a women’s lifespan. Let me tell you, everything from the food we eat to the environment we live in has a major effect on our hormones. All of the conditions I mentioned above can be caused by estrogen dominance (or too much estrogen) in a women’s body and I am here to give you the low down on each of them.
Before we dive into our discussion, let’s have a quick physiology lesson so we are all on the same page, shall we? Here’s a little background info on a few of the hormones we’ll be talking about.
- Estrogen: a group of hormones that include estradiol, estriol, and estrone which are responsible for the development and release of eggs in females and stimulates the growth and maintenance of the female reproductive tract.
- Progesterone: A single hormone that, in a nutshell, is all about helping women become pregnant and support pregnancy.
- Testosterone: You may be surprised to learn that testosterone is not a solely male hormone. Women have small amounts of this hormone in the body to help support the maintenance of the female reproductive system and to support bone density.
- Androgen: Androgens are a group of hormones that cause male traits and reproductive traits.
- Cortisol: This a hormone secreted by the adrenal glands in response to stress that can have an effect on metabolism and inflammation in the body.
What is Estrogen Dominance?
As I mentioned earlier, estrogen dominance is when there is too much of the estrogen available in the body compared to progesterone levels. Estrogen dominance can be caused by three main scenarios: normal estrogen levels and low progesterone levels, high estrogen levels and normal progesterone levels, or high estrogen levels and low progesterone levels.
These abnormal hormone levels can be caused by any of the following:
- Imbalance in the good bacteria in the gut (a condition called gut dysbiosis)
- An unhealthy diet
- Increased cortisol levels, which often is a result of high daily stress levels
- External intakes of hormones (hormone replacement therapy, birth control methods, etc.)
- Environmental toxins
- Abnormalities in the production and elimination processes of estrogen.
How do you know if your estrogen levels are out of whack? A few symptoms and signs of estrogen dominance include:
- Mood swings
- Anxiety, depression
- Painful and/or heavy menstrual periods
- Breast tenderness
- Unintentional and unexplainable weight gain
Some women experience PMS (Premenstraul Syndrome). It is defined as the physical and emotional symptoms that can impair a women’s daily life which are experienced a few days prior to the onset of the menstrual period. These can include mood swings, cravings, fatigue, irritability, bloating, acne, decreased concentration, and depression. PMS is often caused by the shift in serotonin levels in the brain during certain parts of the female cycle.
The Mediterranean influenced diet along with regular exercise and stress management has been shown to help decrease the severity and frequency of the symptoms. Supplements such as chasteberry, curcumin, magnesium, and a B complex have also been shown to decrease frequency and intensity of PMS symptoms.
Endometriosis is a condition in which endometrial tissue (the type of tissue that lines the inside of the uterus) begins to grow and form on the outside of the uterus and forms sacs of tissue. The most common place for these tissue sacs to accumulate is on the ovaries and fallopian tubes. Because the displaced tissue still maintains the same properties as normal endometrial tissue, it will still thicken, break down, and bleed during each menstrual cycle. Because this blood has no way to exit the body, additional cysts along with scar tissue and adhesions may form. This explains why endometriosis is so painful!
Research has shown that inflammation and immune dysregulation in the body is a major contributor to the development of endometriosis. What is the largest and most common cause of inflammation in our bodies? It is food we consume! Inflammation in the gut leads to an increase in inflammation in the rest of the body. But how does all this lead to estrogen dominance? The ectopic endometriotic tissue (the endometrial tissue outside of the uterus) has a higher level of an enzyme called aromatase. Aromatase is a necessary component in the production of estrogen. Because there is more aromatase available, the body thinks it needs to use it and create more estrogen when, in reality, that is not the case. When more estrogen is available in the body, more estrogen receptors become available on the surface of cells which leads to an increase in inflammatory cytokines, which is just a fancy term for cells that cause inflammation in the body.
Now that we know the basics of what endometriosis, let’s talk about management strategies. The main goal is to decrease inflammation and decrease estrogen production. A huge component here is nutrition. Chose whole foods (try to avoid processed foods because these cause extremely high amounts of inflammation) such as fruits, vegetables, whole grains, and lean proteins. Think about it in a super-easy way: does the food come packaged in the grocery store? In most cases, we want to avoid these pre-packaged and processed foods along with foods that are high in sugar and processed grains. High amounts of fiber has also been shown to help with the elimination of estrogen from the body, so make sure to consume those high fiber foods! Supplements including fish oil, curcumin, and chasteberry have all been shown to help decrease inflammation levels along with support healthy estrogen levels.
Uterine fibroids are non-cancerous growths in or on the uterus. This is also thought to be caused by inflammation due to high levels of inflammatory cytokines, the same type of cytokines mentioned when talking about endometriosis. These cytokines stimulate aromatase production, leading to high levels of estrogen. Fibroids can be genetic and/or related to obesity. Because fat cells produce and store estrogen, it is extremely important to maintain a healthy body composition when living with fibroids because lower amounts of fat cells help keep estrogen levels down and in the normal range.
Inflammation is a major contributor to fibroids as it is in the other conditions mentioned. Using whole foods and regular exercise to decrease inflammation along with fish oils, curcumin, and chasteberry can help manage symptoms.
Polycystic ovary syndrome is a condition when small fluid-filled follicles develop on the ovaries and the ovaries then fail to regularly release eggs. Symptoms of PCOS include irregular or prolonged periods, excess acne, and excess facial and/or body hair (due to excess of the male sex hormone androgen). It is unclear exactly the cause of PCOS, but research has shown that increased levels of insulin are most likely the underlying cause of the condition. Increased levels of insulin often lead to an altered function of the hypothalamus. Because the hypothalamus is responsible for secreting FSH and LH (both of which play important roles in the function of the ovary and development of the egg in a female), these hormones are released at abnormal levels. The increased levels of LH that are secreted, leads to an increase in androgens produced by the ovaries. Increased insulin levels also cause a decrease in Sex Hormone Binding Globulin (SHBG) which is a protein produced by the liver and floats around in the blood. SHBG transports sex-related hormones in the blood in their biologically inactive forms (aka the body is not able to use the hormones in any way when they are attached to SHBG, it is like they are invisible in the blood!). Low levels of SHBG lead to increased levels of bioavailable testosterone in the blood (because the testosterone has nothing to bind too) which causes SHBG levels to drop even lower, and the cycle continues. These low levels of SHBG also lead to increased levels of bioavailable levels of estrogen in the blood, causing this condition to be an estrogen dominant condition. I apologize for that huge information overload, but bear with me!
Because high levels of insulin are thought to be the underlying cause, keeping insulin levels are in-check is extremely important. This can be done by avoiding high processed carb and high sugar foods along with incorporating regular exercise. Adding in a fish oil and curcumin supplement to decrease inflammation can only be helpful, too!
In conclusion, it is crucial to reduce inflammation, oxidative stress, and estrogen levels along with maintaining a healthy gut to help in the management of these estrogen dominant conditions. Even if you do not experience any of these conditions, keeping inflammation and oxidative stress down along with maintaining a healthy gut are great ways to help avoid these nasty and painful conditions.
-Dr. Alison, D.C.