Hormone Balance in Women: Estrogen, Progesterone, PCOS, and more

Hormone Balance in Women: Estrogen, Progesterone, PCOS, and more



This is a short edited segment taken from my original Hormone Balance Talk.

Learn all about ESTROGEN DOMINANCE and PCOS!

Watch the full talk here:

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➡️ Estrogen Dominance:

➡️ PCOS:

Community health lecture given at St. Jude Rehab and Wellness February 18, 2020

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Rajsree Nambudripad, MD

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[Music] so let's talk about hormone balance in women so in women there are two main hormones that need to be in balance and they are estrogen and progesterone so estrogen makes you female it gives you soft skin female characteristics like breast tissue and hips it's also very important for your brain and for your bones and then progesterone is the calming hormone so it helps prevent anxiety and helps you sleep at night so in fact did you know that pregnancy is a high progesterone state which is why a lot of women feel really calm when they're pregnant so it's all about having these hormones balanced if your estrogen is too high or too low or your progesterone is too high or too low you're gonna have symptoms so women who have excess estrogen they'll have bloating and weight gain they'll have breast tenderness cyclic headaches moodiness heavy periods it can even lead to fibroids and endometriosis which I'll talk about today now women who are going through menopause they experience a drop in their estrogen they can get hot flashes vaginal dryness dry skin and memory issues similarly if your progesterone is too high you can get symptoms of being groggy bloated or nauseous and then if your progesterone stool oh you can have menstrual irregularities anxiety trouble sleeping and weight gain so let's go over the menstrual cycle briefly so estrogen peaks in the first half of the month and progesterone Peaks in the second half of the month an ovulation takes place right in the middle of the month around day 14 so ovulation is when one of the ovaries releases an egg so progesterone will naturally go down in the last week of the month and because progesterone is the calming hormone when it goes down that can lead to a lot of symptoms such as PMS anxiety breast tenderness or migraines there's also a rise in the insulin levels at the end of the month which leads to sugar cravings which is why a lot of women crave sweets right before their periods now you only make this progesterone in the second half of the month if you ovulate so women who are not ovulating regulate regularly or who are not having periods regularly for example women going through perimenopause which is the years leading up to menopause these women will not be ovulating so they won't be making progesterone and remember progesterone is that calming hormone so that's why these women will have a lot of symptoms such as anxiety mood swings PMS breast tenderness and insomnia so what I like to do in my practice is to check hormone levels on day 21 of the cycle because that is when progesterone typically Peaks if a woman ovulates so based on that peak progesterone level we can tell if a ssin has taken place or not so we call this the mid luteal phase hormones so let's go over a case example so emily is a 45 year old woman who is suffering from heavy periods with cramps she has breast tenderness and dense breasts she suffers from constipation and she's about 15 pounds overweight so I checked Emily's date twenty-one hormones and her estradiol which is her estrogen is 350 which is very high because normal estradiol for this time of the month is a hundred and fifty and then her progesterone is three which is low because if someone if the woman ovulates we expect the progesterone to be 12 or higher so I send Emily for a pelvic ultrasound and it shows large fibroids so fibroids are benign tumors in the uterus so what's Emily's diagnosis so Emily has estrogen dominance so as you can see her estrogen is much higher than her progesterone and the estrogen is causing these fibroids to grow which is then causing her heavy periods estrogen is also causing her breast tenderness and contributing to her weight issues so estrogen dominance can cause a lot of symptoms it's basically when estrogen is not balanced with the progesterone and the excess estrogens are not being cleared or detoxified properly so it can lead to a lot of issues so in the breast it can cause dense breasts breast cysts and unfortunately even breast cancer it can cause fibroids which again are the benign growths in the uterus which can then lead to heavy periods sometimes the fibroids get really big it can cause pain and pressure in the pelvic area it can lead to endometriosis which is where the inner lining of the uterus spreads to other parts of the pelvis where it's not supposed to be and cause extreme pain during periods it can cause ovarian cysts thyroid nodules and headaches women with estrogen dominance often struggle with their weight because the excess estrogen makes them hold on to weight they also can have mood swings and heavy periods so what's interesting is that women with estrogen dominance typically have many of these symptoms together and I can suspect it clinically just from their history and from physical exam and then I do the blood work to confirm it so what's interesting is that your body habitus can often reflect your hormones women with estrogen dominance can have a pear-shaped or hourglass shaped body habitus you know though how larger breasts and larger hips from the higher estrogen levels and this is in contrast to insulin resistance which I'll be talking about later today but insulin resistance is what causes pre-diabetes and diabetes so in this case we see more of an apple body shape a lot of the fat is in the abdomen as visceral fat and it's surrounding the organs and that is the type of fat that causes the problem with blood sugar regulation so how do we treat estrogen dominance so getting back to our case example the first thing I do is I give Emily magnesium citrate to help move her bowels so you know your all habits are one of the ways you eliminate and get rid of hormones and toxins in your body so women who are constipated they're not going to be able to clear their estrogens properly so bowel movements are one way that we're able to get reduce the estrogen levels in the body secondly I clean up her diet so I advise her to eat more vegetables to cut out all the sugar processed food and vegetable oils and in particular I advise her to eat more cruciferous vegetables which are like broccoli cauliflower and cabbage because these vegetables really help improve the healthy metabolism of estrogens I often do testing on the gut microbiome and one of the things I find is that women with estrogen dominance often have high beta glucuronidase in the gut and this is something that's causing recycling of toxins and estrogens from their gut so the gut microbiome is your bacterial ecosystem of trillions of bacteria in your gut the good news is if we find this this is something we can treat then I advise these women to avoid chemical estrogens from the environment known as xenoestrogens so xenoestrogens are found in plastics fragrances and personal care products it's also found in hormones in food such as non-organic poultry and dairy products and finally I balance the estrogen with bioidentical progesterone so my preference is to use bioidentical progesterone because it has the identical chemical structure as hormones in the human body and it's often made in a compounding pharmacy from yams it can come as capsule or as a cream in a very easy to use pump so for women who have constipation my preference is to prescribe it topically as a cream so that it doesn't affect their gut further and what I have them do is apply it at bedtime on their groin in the second half of the menstrual cycle so from day 13 through 27 of the menstrual cycle so we're just replicating what's naturally supposed to happen in the body the nice thing with the bioidentical hormones is it just adds to what your body is already making it does not so press the natural hormone cycle so it's very different from birth control pills which are synthetic hormones that suppress ovulation and suppress your natural hormone cycle so how do you clear or metabolize estrogens in your body so this diagram shows that we break down our estrogens to either protective metabolites or bad metabolites so the protective metabolites are two hydroxy estradiol and two hydroxy s strong and they are considered protective on breast tissue but if you have high levels of the bad metabolites which is the 16 hydroxy s trone then you are at higher risk of developing fibroids breast cysts and even breast cancer a lot of these conversions happen in the liver so this is why having a healthy liver is so important for healthy hormone balance for some women we actually do test for these metabolites through the urine and this can be very useful information especially for women who have a strong family history of breast cancer or for women who are breast cancer survivors so on the diagram you can see there's a tiny pink star that has two special compounds known as a 3c and dim and these really help to promote the healthy metabolism of estrogens towards the protective metabolites so where can you get those compounds so they're found in cruciferous vegetables so I 3 C stands for indole-3-carbinol and dim is died in Delisle methane so cruciferous vegetables are like broccoli Brussels sprouts cauliflower kale bok choy and cabbage so I always encourage my patients who have estrogen dominance to eat more cruciferous vegetables cruciferous vegetable family knows your glutathione stores which is your master antioxidant in your liver they also feed the good bacteria in your gut microbiome and the Gunn microbiome strongly influences your hormonal health lastly I also sometimes give my patients I 3c dim in supplement form since taking one pill can be equivalent to eating 20 pounds of broccoli and really boost the healthy estrogen metabolites so getting back to our case example so after three months Emily comes back to see me and now she's having daily bowel movements with the magnesium citrate so she is no longer constipated she's been able to lose 15 pounds with the clean diet her breast tenderness has resolved meaning that she's clearing her estrogens better and her periods are less heavy and painful with the bioidentical progesterone cream and she feels healthier and more balanced so let's move on to another case example so Gina is a 28-year old woman with irregular periods her whole life sometimes she goes months without a period she's 25 pounds overweight and she struggles with acne and facial hair so I checked jeana's date 21 hormones and her estradiol is a hundred seventy that's not too bad given that normals around 150 but her progesterone is really low at two again 12 or higher would indicate ovulation so she's she did not ovulate this cycle and then her testosterone is high at 78 because normal is under 45 in women her fasting insulin is 18 which is high because ideal fasting insulin is 6 now insulin is the hormone your pancreas makes telling your your body to take up blood sugar so if your body's receptors are ignoring insulin then your pancreas has to make even more insulin so we call this insulin resistance I send Gina for a pelvic ultrasound and it shows numerous ovarian cysts so what's the diagnosis so gina has polycystic ovarian syndrome or PCOS so PCOS is a fairly common condition in fact 1 in 10 women suffer from this condition it is a clinical so some women have mild PCOS symptoms while others have more severe symptoms there's three main things that characterize PCOS so the first is irregular cycles because ovulation is not taking place every month so we call this an ovule Ettore cycles the second is insulin resistance again this is when your pancreas is having to make a lot more insulin because your body's receptors are tuning it out the problem is insulin when it's high it can trigger more weight gain insulin is also inflammatory on the body so these women typically struggle with their weight and they may actually even develop pre-diabetes or diabetes lastly these women have hyperandrogenism which means they have high testosterone so they may suffer from acne or facial hair I've even had women tell me they they have to shave their entire face because of all the excess hair so getting back to our case example so how do we treat PCOS so the first thing I do for Gina is I give her bioidentical progesterone to regulate her cycles so she does get a period every month you know a lot of time women with PCOS are offered birth control pills to regulate their cycles but if a woman does not need this for contraception my preference is to use bioidentical progesterone and I just give it to the women in the second half of the month so from day 13 through 27 and again it can be oral as a capsule or as a cream mimicking the natural menstrual cycle so what happens is when progesterone goes up it builds up the uterine lining and then when it goes down it triggers a period so the nice thing with the bio tentacle hormones again is it just adds to what the women woman's hormones are already doing it does not suppress the natural hormone cycle and it has less side effects so for example birth control pills can often lead to weight gain and that's not always favorable especially for women who are already struggling with insulin resistance so the next thing I do is I put her on a clean léo diet so this is a diet lower in grains so this is gonna help her lose weight and help with the insulin resistance then I help to optimize her vitamin D level because vitamin D is so important for hormones and I give her a mega 3 fatty acids which are anti-inflammatory so that's like fish oil or algae oil I always address the gut microbiome because if a patient is bloated or constipated the first thing we have to do is get their gut healthy so I'll often use probiotics or magnesium to help regulate their bowel movements definitely I'll encourage daily exercise because that's going to help with the weight loss and help with the insulin resistance I often also use berberine because berberine is research proven to help with insulin resistance it activates the body's tissues to become more responsive to insulin it's also very well tolerated and anti-inflammatory and then sometimes I use my o inositol which is also research proven to help with ovulation and fertility for women with PCOS it also helps their metabolic profile as well as their high testosterone issues okay so after three months gina comes back to see me and now she's having regular periods with the bioidentical progesterone she has lost 15 pounds and she's feeling healthier her skin is clearing up and her labs show significant improvement in her fasting insulin which is now down to eight and then a year later I have her repeat her pelvic ultrasound and it shows significant reduction in the number of ovarian cysts I've actually had several women where we repeat the pelvic ultrasound and all of their ovarian cysts are gone which is absolutely amazing so it really shows the power of food diet and lifestyle on hormones [Music] [Music]

#Hormone #Balance #Women #Estrogen #Progesterone #PCOS

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