Activities that include social time and play are ideal. Any kind of movement helps manage stress and hormone balance. Pre-menstrual syndrome (PMS) affects 90% of women at some point. In 25% of these cases clinical intervention is required. I treat a number of women for PMS, fertility, menopause and other hormone related issues using acupuncture and functional medicine.
What is the Replacement Model?
PMS is not well understood but we do know that stress, inflammation and auto-immunity are contributing factors. Excess estrogen relative to progesterone is what occurs and conventional medicine uses a replacement model to treat. Birth control is given. In more sever cases antidepressants are also prescribed. Given what we do know this strategy is absurd. Functional psychiatrists are now using diet and lifestyle to treat all kinds of conditions without pharmaceuticals. NSAIDs and other painkillers undermine the gut lining and can lead to more problems if used long-term.
Functional medicine looks deeper than symptomatic changes and treats the underlying cause of imbalance. Mood swings, appetite changes, insomnia, brain fog, headaches, breast tenderness, fatigue, skin issues, back pain, digestive issues are all related symptoms. Any five of these symptoms at once may be diagnosed with PMDD or pre menstrual dyphoric disorder. The medications that are used may temporarily relieve symptoms but were never meant to be used long-term and have a detrimental effect on hormone health instead of supporting the body in finding homeostasis.
Exercise: Help or Hinder Hormones?
Appropriate amounts of activity and exercise move the liver’s blood promoting a healthy cycle. If you enjoy endurance training, then fat is the best source of energy as it has a slow burn. Protein is key for building and maintaining muscle. Whey protein stimulates insulin for a stable metabolism and increases glutathione for liver function. The best protein supplements will include glycine and come from a grass-fed animal source. Protein powders with pea, soy and egg white are not recommended due to the irritating effect on the digestive system.
The tendency for a lot of active people is to under eat so that why we talk about pre and post workout meals. Muscle repair happens at a slower rate if there isn’t an immediate source of energy to help with recovery time. Thirty grams of carbs and fifteen grams of protein is an ideal pre-workout snack. Fasted exercise means a slower recovery time and maintaining muscle becomes more difficult.
Water: How Much?
Having enough fluid is important. Two litres per day is a good baseline. A reduction of 2% than needed can result in a 20% reduction in performance. For every hour of exercise add an extra half litre. Squeeze in a lemon or add some mineral rich salt. Sodium, potassium and magnesium are important for absorption. Most electrolyte drinks are full additives that our ancestors wouldn’t recognize and some are harmful. Plastic packaging is known to have xeno-estrogens which contribute estrogen dominance.
What about fertility?
PCOS or polycystic ovarian syndrome is now the leading cause of infertility in young women with insulin resistance is the main cause of PCOS. Fasting after exercise is especially concerning for women because of this so 30 grams of carbs within an hour post exercise is recommended.
A diagnosis of PCOS is made when two of these are present: elevated testosterone or other androgenic hormones, irregular or absent menses and/or cystic ovaries. Only 60 % of women with PCOS are overweight which indicates there is a high number of women are likely to fall into the category of female athlete triad meaning that they are overtraining and under recovering from exercise.
Exercise can be a healthy stressor but if you don’t feel good after it means you are over doing it given your current metabolic state, HPA axis regulation and overall resources which are all individual. Symptoms related to over training include: depression/anxiety, unintentional weight gain/loss, digestive distress, recurrent injury or illness, muscle strength loss, fatigue, brain fog, loss of cycle or painful cycle.
I will be writing and talking a lot more about the solutions to this kind of dysregulation and how to regain health. Getting enough rest and sleep is key. Varying activity and cross training with low intensity activity like swimming or yoga is ideal. Ensuring enough calorie intake is very important and there are some great online tools for determining ideal macro-nutrient ratios. Protein intake needs to be higher than most people eat which is why supplements are used for training periods or for those wanting to eat a nutrient dense diet without restricting calories. Often when people cut out carbohydrates that are low in nutrients their overall caloric intake drops below what is needed to maintain good health.
Loss of menstrual cycle due almost always relates with the function of the HPA axis and increases the chance of osteoporosis later in life. Contributing factors include low body weight, low intake of calories, too much exercise causing higher cortisol which is related to production of the luteinizing and follicle stimulating hormones.
Preparing for Pregnancy & Parenthood
For fertility, pregnancy and breast-feeding nutrient deficiencies are crucial to look at. Folate is required for new DNA and fetal cell division. Folate absorption is dependant on zinc status and should not be taken in form of folic acid. Neural tube defects have been related to choline deficiency and 86% of women don’t get enough. Egg yolks are an excellent source of choline. Vitamins A, D and K2 are especially important. Retinol from liver is the best way to get Vitamin A. D and K2 need to be taken together. High methionine depletes the body of folate, choline and B12. Ensuring an intake of the animal parts normally reserved for stock and regularly consuming bone broth will create a balance of methionine to glycine. Iodine deficiency can result in mental defects and cretinism. Kelp is a good source of iodine. Any thyroid dysfunction in the preparation stages can be a cause for miscarriage and infertility.
Circadian rhythm and artificial light at night may affect fertility in both sexes and increase miscarriage. Research shows that we need 8-10 hours/night. We also need enough natural light each day. Travel between time zones can affect circadian rhythm and losing just one hour lost in a night can be disruptive and cause inflammation. Parents must be resilient and be cautious with their resources as the early years of a child’s life is full of sleep disruption.
Once pregnancy is achieved no additional calories are required during the first trimester but in the second an additional 200-300/day will be important. The last trimester should be 400-500 extra calories/day above baseline. Breastfeeding requires a similar amount.
The Power of Preparing for Menopause
Menopause is another powerful shift in hormones and symptoms may include insomnia, low libido, vaginal dryness and hot flashes. Avoiding the replacement model is a choice that many women make. Others use the replacement model for hormones but only for a short period of time because they know this area has not been researched enough. Preparing for menopause means it can be an easy transition. Strength training increases the human growth hormone and the cascade that follows. Eating a nutrient dense diet and reducing caffeine can also go a long way.