Polycystic ovarian syndrome (PCOS) is one of the most common conditions in reproductive-aged women. It is estimated that 8-13% of all reproductive-aged women have this condition and up to 70% of those women are undiagnosed. People with PCOS have cysts on their ovaries that cause hormonal symptoms such as:
Anxiety
Depression
Fatigue
Irregular menstrual cycles
Excessive hair growth
Infertility
Weight gain and weight loss resistance
Scalp hair loss/thinning
Oily skin/acne
Causes
Often we find that PCOS patients also have insulin resistance and/or type 2 diabetes. According to some studies, nearly 70% of women with PCOS also have insulin resistance. High levels of blood insulin increase androgen levels (male hormones such as testosterone). Excess androgens in females are mostly to blame for the undesirable effects of PCOS, including acne, weight gain, facial hair, and weight loss resistance.
Inflammation increases the risk for PCOS. Insulin resistance is just one cause of systemic inflammation. Gut health, stress levels, and weight gain can all contribute to inflammation as well.
Current Treatments
Currently, health care providers recommend weight loss as a primary approach to PCOS relief. Fat cells cause inflammation, so this makes sense. However, as many people may already know, weight loss is not always as easy as it sounds! Insulin resistance can make losing weight through exercise feel impossible.
As far as medications, health care providers often prescribe combination birth control pills to adjust hormone levels, or metformin for insulin resistance. Neither of these approaches truly address the root cause of the insulin resistance and systemic inflammation.
The B Vitamin Cycle of Doom
Just like with most medications, the common prescriptions for PCOS have side effects. Both birth control pills and metformin are known to deplete B vitamins. Metformin specifically makes it more difficult for your body to absorb B12. Birth control pills, on the other hand, are known to cause nutritional deficiencies in folate, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc.
Why are B vitamin deficiencies so concerning? B12, also known as cobalamin, is a vitamin that is essential for brain health and nervous system function. It is needed for the creation of red blood cells, which help distribute oxygen to the rest of our bodies (including our brains). It is no wonder, then, that low B12 levels have been linked to dementia.
MTHFR Gene
In addition to taking medications that deplete them, many people with PCOS have a specific gene mutation that makes it even more difficult to create active B vitamins. MTHFR is a gene that helps our bodies convert folate to an activated version that we need in order to use B12 (5-MTHF). Birth control pills deplete folate, B6 and B12 levels, so if you also have the MTHFR mutation then your body will really struggle to activate and utilize B12.
Some studies have suggested that women with PCOS are more likely to have a mutation on the MTHFR gene. So, due to medication side effects and/or gene mutations, people with PCOS often suffer from B vitamin deficiency (hence their association with Major depression).
What’s interesting is how much overlap there is between B vitamin deficiency symptoms and PCOS symptoms. It begs the question: Are PCOS symptoms made worse by B vitamin deficiency, caused by the very medications meant to bring the patient relief?
The Dr. Autoimmune Difference
Our office uses a functional medicine approach to identify and address the root cause of chronic conditions such as PCOS. Rather than using medications, we know how to help you provide your body with the tools it needs to correct imbalances naturally.
For example, our office uses continuous glucose monitoring technology to help our patients identify how certain foods affect their blood sugar. Our nutritionist works one on one with patients to develop plans that help their bodies regulate blood sugar levels more effectively. Once insulin resistance is under control, weight loss becomes much easier. Loss of excess fat= less inflammation= less PCOS symptoms.
The bottom line is that PCOS is not a life sentence- lifestyle changes such as exercise, supplementation, and diet change designed to address the root cause will provide relief. If you are ready to tackle your chronic condition and change your life naturally, click the “Start Your Journey” button at the bottom of this page.
In Part 1 of this series we covered cortisol, progesterone, and their relationship. Though the vast majority of hormones are made of protein, both of these are steroid hormones made of cholesterol. Estrogen is another steroid hormone. It is the main female sex hormone, but it also plays an important role in male bodies.
Estrogen: The Breakdown
Estrogen is responsible for most of the physical changes in the female body related to reproduction. It stores fat in certain areas leading to ‘curviness’, plumps skin, and grows the breasts and pubic hair in females. It also has other important functions such as improving immunity and memory, strengthening bones, controlling cholesterol levels, and maintaining a balanced mood.
Estrone (E1) = the only estrogen produced after menopause
Estradiol (E2) = main estrogen in females of reproductive age
Estriol (E3) = produced during pregnancy
The two main sex hormones (hormones involved in reproduction) in females are progesterone and estrogen. As we discussed before, progesterone dominates the second half of the menstrual cycle, maintaining the thick uterine lining to prepare for pregnancy. That thick uterine lining exists thanks to estrogen, who dominates the first half of the cycle. Here is that visual again to refresh your memory:
A Finicky Relationship
One of the most common hormonal imbalances seen in females is between progesterone and estrogen. This imbalance is known as estrogen dominance. In males, this presents as an imbalance between testosterone and estrogen. Even though estrogen does important things like keeping bones strong, the key to balanced health is balanced hormones! One of progesterone’s most important roles is to balance out estrogen after it gets ramped up during the first half of the menstrual cycle. When estrogen levels in the body are too high, you risk developing estrogen-related cancers and experience a range of symptoms.
Because estrogen dominance describes the relationship between estrogen and progesterone, there are a few ways it can present. Estrogen levels could be normal, but if progesterone levels are low, you have estrogen dominance. The opposite can result in the same: If progesterone levels are normal, but estrogen levels are high, you have estrogen dominance.
Symptoms of Estrogen Dominance
If you menstruate, you may have experienced some (or all) of these symptoms. Though they are common in our society, they are likely the result of a hormone imbalance that you can get under control with proper nutrition and supplementation and the help of a functional medicine practitioner.
Females:
Heavy or irregular periods
Water retention and swelling
Breast tenderness and breast changes
Headaches or migraines
Weight gain
Mood swings
Painful periods
PMS symptoms
Fertility challenges
Hypothyroidism
Sugar cravings
Uterine fibroids (benign growths around or in the uterus)
Estrogen is created in the ovaries/testes, adrenal glands, and fat tissue. In normal amounts, it keeps our bodies well balanced. However, high amounts of fat tissue can result in extra production of estrogen, which in turn encourages more fat storage. This cycle can lead to unwanted weight gain. On top of that, estrogen has been shown to discourage the breakdown of fat cells, especially in the midsection (hips and waist).
Estrogen dominance over time can lead to more serious health issues, such as heart attacks, breast or ovarian cancer, blood clots, and stroke.
Estrogen and autoimmunity
Estrogen is known to be an immune-enhancer, whereas androgens and progesterone are immune-suppressors. This is an important piece of information for people living with autoimmune diseases such as Hashimoto’s thyroiditis, rheumatoid arthritis, and multiple sclerosis. Autoimmune diseases manifest when one’s immune system is overactive and starts to attack the body’s own tissue. In this case, having estrogen continue to ramp up your immune system is going to cause further damage. This is the reason that about 78% of people with autoimmune diseases are women.
What causes estrogen dominance?
High estrogen levels can be partially hereditary, but it can also be caused (or triggered) by external sources such as hormonal contraceptives, some antibiotics, and other medications, including the popular hormone replacement therapy used to ‘treat’ menopause symptoms. Other factors that contribute are gut dysbiosis, a low fiber diet, and alcohol consumption. The most common mechanism we see in clinical practice is estrogen dominance due to insulin resistance. When insulin is spiking to control blood sugar this creates fat cells and fat cells secrete more estrogen. This in turn alters the ratios of hormones and can increase inflammation which impacts all areas of the body. As this continues it’s almost like a train gaining steam without brakes. The estrogen dominance then facilitates inflammation which in turn causes more insulin resistance (and on and on…).
Another cause of estrogen dominance can be polycystic ovary syndrome (PCOS), which we mentioned in Part 1 as a cause of low progesterone levels. PCOS can be caused by high levels of androgens (male hormones). Symptoms can include acne, facial hair or male pattern baldness in females. PCOS may be manageable through proper nutrition. One group of researchers studied women with PCOS and found that by decreasing the amount of refined carbohydrates in their diets, insulin sensitivity could be induced. Insulin sensitivity, being the opposite of insulin resistance, can help increase levels of progesterone and therefore decrease levels of estrogen.
Insulin resistance promotes the enzyme aromatase, which converts androgens to estrogen. It also inhibits sex-hormone-binding globulin, resulting in more free estrogen. We’ll talk more extensively about insulin resistance in part 3 of this series.
Excess fat, stress, impaired digestion and detoxification pathways, and external estrogen copy-cats such as xeno- and phytoestrogens can also lead to increased levels of estrogen. The body metabolizes hormones and gets rid of them through detoxification pathways. When these processes aren’t functioning properly (or genetic alterations are present), estrogen will remain in the body for long periods of time.
Xenoestrogens are synthetic, man-made chemicals that resemble estrogen and act on estrogen receptors in the body. They are found in things like plastics, cosmetics (we absorb up to 60% of what we put on our skin!), and birth control pills. Phytoestrogens on the other hand, come from plants and have less of an impact (though still an impact!) on the body’s natural estrogen levels. Soy is the most common culprit in this family of estrogen disruptors.
What’s next?
The functional medicine approach to all hormone imbalances is represented in the pneumonic “PTSD”. Let’s apply it to estrogen!
Production:
Estrogen is made in multiple places, but we can have the most control over our fat tissue. This does not mean that you need to eat less. Our bodies need to be nourished! Exercise and proper nutrition will help us control excess fat buildup.
We can limit our exposure to external estrogen-like chemicals. Choosing clean cosmetics and organic foods is one way to reduce our intake of xenoestrogens. Avoiding foods like soy can reduce our intake of phytoestrogens.
Transport
More available estrogen as a result of dysregulated transportation pathways can lead to estrogen dominance.
Sensitivity
A cell’s sensitivity to a hormone may have an impact. For instance, a cell with a rigid membrane may not allow for estrogen to enter. When estrogen receptors are defective, it can result in an estrogen resistance condition and therefore more free estrogen.
Detoxification
If detoxification pathways are not functioning optimally and estrogen isn’t being excreted at a normal rate, that leaves more of it to cause an imbalance. We can provide our bodies with nutrients that support healthy digestion and a healthy liver for detoxing.
If you suspect you may have estrogen dominance, you should consider meeting with a practitioner who understands how to identify root causes and will work with you to create a personalized plan for balancing your hormones. Contact us using the form below to get started!
Stay tuned for Part 3 of our hormone series, where we will dive deeper into another very common hormone imbalance: insulin resistance.
Polycystic ovarian syndrome (PCOS) is one of the most common conditions in reproductive-aged women. It is estimated that 8-13% of all reproductive-aged women have this condition and up to 70% of those women are undiagnosed. People with PCOS have cysts on their ovaries that cause hormonal symptoms such as:
Anxiety
Depression
Fatigue
Irregular menstrual cycles
Excessive hair growth
Infertility
Weight gain and weight loss resistance
Scalp hair loss/thinning
Oily skin/acne
Causes
Often we find that PCOS patients also have insulin resistance and/or type 2 diabetes. According to some studies, nearly 70% of women with PCOS also have insulin resistance. High levels of blood insulin increase androgen levels (male hormones such as testosterone). Excess androgens in females are mostly to blame for the undesirable effects of PCOS, including acne, weight gain, facial hair, and weight loss resistance.
Inflammation increases the risk for PCOS. Insulin resistance is just one cause of systemic inflammation. Gut health, stress levels, and weight gain can all contribute to inflammation as well.
Current Treatments
Currently, health care providers recommend weight loss as a primary approach to PCOS relief. Fat cells cause inflammation, so this makes sense. However, as many people may already know, weight loss is not always as easy as it sounds! Insulin resistance can make losing weight through exercise feel impossible.
As far as medications, health care providers often prescribe combination birth control pills to adjust hormone levels, or metformin for insulin resistance. Neither of these approaches truly address the root cause of the insulin resistance and systemic inflammation.
The B Vitamin Cycle of Doom
Just like with most medications, the common prescriptions for PCOS have side effects. Both birth control pills and metformin are known to deplete B vitamins. Metformin specifically makes it more difficult for your body to absorb B12. Birth control pills, on the other hand, are known to cause nutritional deficiencies in folate, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc.
Why are B vitamin deficiencies so concerning? B12, also known as cobalamin, is a vitamin that is essential for brain health and nervous system function. It is needed for the creation of red blood cells, which help distribute oxygen to the rest of our bodies (including our brains). It is no wonder, then, that low B12 levels have been linked to dementia.
MTHFR Gene
In addition to taking medications that deplete them, many people with PCOS have a specific gene mutation that makes it even more difficult to create active B vitamins. MTHFR is a gene that helps our bodies convert folate to an activated version that we need in order to use B12 (5-MTHF). Birth control pills deplete folate, B6 and B12 levels, so if you also have the MTHFR mutation then your body will really struggle to activate and utilize B12.
Some studies have suggested that women with PCOS are more likely to have a mutation on the MTHFR gene. So, due to medication side effects and/or gene mutations, people with PCOS often suffer from B vitamin deficiency (hence their association with Major depression).
What’s interesting is how much overlap there is between B vitamin deficiency symptoms and PCOS symptoms. It begs the question: Are PCOS symptoms made worse by B vitamin deficiency, caused by the very medications meant to bring the patient relief?
The Dr. Autoimmune Difference
Our office uses a functional medicine approach to identify and address the root cause of chronic conditions such as PCOS. Rather than using medications, we know how to help you provide your body with the tools it needs to correct imbalances naturally.
For example, our office uses continuous glucose monitoring technology to help our patients identify how certain foods affect their blood sugar. Our nutritionist works one on one with patients to develop plans that help their bodies regulate blood sugar levels more effectively. Once insulin resistance is under control, weight loss becomes much easier. Loss of excess fat= less inflammation= less PCOS symptoms.
The bottom line is that PCOS is not a life sentence- lifestyle changes such as exercise, supplementation, and diet change designed to address the root cause will provide relief. If you are ready to tackle your chronic condition and change your life naturally, click the “Start Your Journey” button at the bottom of this page.
In Part 1 of this series we covered cortisol, progesterone, and their relationship. Though the vast majority of hormones are made of protein, both of these are steroid hormones made of cholesterol. Estrogen is another steroid hormone. It is the main female sex hormone, but it also plays an important role in male bodies.
Estrogen: The Breakdown
Estrogen is responsible for most of the physical changes in the female body related to reproduction. It stores fat in certain areas leading to ‘curviness’, plumps skin, and grows the breasts and pubic hair in females. It also has other important functions such as improving immunity and memory, strengthening bones, controlling cholesterol levels, and maintaining a balanced mood.
Estrone (E1) = the only estrogen produced after menopause
Estradiol (E2) = main estrogen in females of reproductive age
Estriol (E3) = produced during pregnancy
The two main sex hormones (hormones involved in reproduction) in females are progesterone and estrogen. As we discussed before, progesterone dominates the second half of the menstrual cycle, maintaining the thick uterine lining to prepare for pregnancy. That thick uterine lining exists thanks to estrogen, who dominates the first half of the cycle. Here is that visual again to refresh your memory:
A Finicky Relationship
One of the most common hormonal imbalances seen in females is between progesterone and estrogen. This imbalance is known as estrogen dominance. In males, this presents as an imbalance between testosterone and estrogen. Even though estrogen does important things like keeping bones strong, the key to balanced health is balanced hormones! One of progesterone’s most important roles is to balance out estrogen after it gets ramped up during the first half of the menstrual cycle. When estrogen levels in the body are too high, you risk developing estrogen-related cancers and experience a range of symptoms.
Because estrogen dominance describes the relationship between estrogen and progesterone, there are a few ways it can present. Estrogen levels could be normal, but if progesterone levels are low, you have estrogen dominance. The opposite can result in the same: If progesterone levels are normal, but estrogen levels are high, you have estrogen dominance.
Symptoms of Estrogen Dominance
If you menstruate, you may have experienced some (or all) of these symptoms. Though they are common in our society, they are likely the result of a hormone imbalance that you can get under control with proper nutrition and supplementation and the help of a functional medicine practitioner.
Females:
Heavy or irregular periods
Water retention and swelling
Breast tenderness and breast changes
Headaches or migraines
Weight gain
Mood swings
Painful periods
PMS symptoms
Fertility challenges
Hypothyroidism
Sugar cravings
Uterine fibroids (benign growths around or in the uterus)
Estrogen is created in the ovaries/testes, adrenal glands, and fat tissue. In normal amounts, it keeps our bodies well balanced. However, high amounts of fat tissue can result in extra production of estrogen, which in turn encourages more fat storage. This cycle can lead to unwanted weight gain. On top of that, estrogen has been shown to discourage the breakdown of fat cells, especially in the midsection (hips and waist).
Estrogen dominance over time can lead to more serious health issues, such as heart attacks, breast or ovarian cancer, blood clots, and stroke.
Estrogen and autoimmunity
Estrogen is known to be an immune-enhancer, whereas androgens and progesterone are immune-suppressors. This is an important piece of information for people living with autoimmune diseases such as Hashimoto’s thyroiditis, rheumatoid arthritis, and multiple sclerosis. Autoimmune diseases manifest when one’s immune system is overactive and starts to attack the body’s own tissue. In this case, having estrogen continue to ramp up your immune system is going to cause further damage. This is the reason that about 78% of people with autoimmune diseases are women.
What causes estrogen dominance?
High estrogen levels can be partially hereditary, but it can also be caused (or triggered) by external sources such as hormonal contraceptives, some antibiotics, and other medications, including the popular hormone replacement therapy used to ‘treat’ menopause symptoms. Other factors that contribute are gut dysbiosis, a low fiber diet, and alcohol consumption. The most common mechanism we see in clinical practice is estrogen dominance due to insulin resistance. When insulin is spiking to control blood sugar this creates fat cells and fat cells secrete more estrogen. This in turn alters the ratios of hormones and can increase inflammation which impacts all areas of the body. As this continues it’s almost like a train gaining steam without brakes. The estrogen dominance then facilitates inflammation which in turn causes more insulin resistance (and on and on…).
Another cause of estrogen dominance can be polycystic ovary syndrome (PCOS), which we mentioned in Part 1 as a cause of low progesterone levels. PCOS can be caused by high levels of androgens (male hormones). Symptoms can include acne, facial hair or male pattern baldness in females. PCOS may be manageable through proper nutrition. One group of researchers studied women with PCOS and found that by decreasing the amount of refined carbohydrates in their diets, insulin sensitivity could be induced. Insulin sensitivity, being the opposite of insulin resistance, can help increase levels of progesterone and therefore decrease levels of estrogen.
Insulin resistance promotes the enzyme aromatase, which converts androgens to estrogen. It also inhibits sex-hormone-binding globulin, resulting in more free estrogen. We’ll talk more extensively about insulin resistance in part 3 of this series.
Excess fat, stress, impaired digestion and detoxification pathways, and external estrogen copy-cats such as xeno- and phytoestrogens can also lead to increased levels of estrogen. The body metabolizes hormones and gets rid of them through detoxification pathways. When these processes aren’t functioning properly (or genetic alterations are present), estrogen will remain in the body for long periods of time.
Xenoestrogens are synthetic, man-made chemicals that resemble estrogen and act on estrogen receptors in the body. They are found in things like plastics, cosmetics (we absorb up to 60% of what we put on our skin!), and birth control pills. Phytoestrogens on the other hand, come from plants and have less of an impact (though still an impact!) on the body’s natural estrogen levels. Soy is the most common culprit in this family of estrogen disruptors.
What’s next?
The functional medicine approach to all hormone imbalances is represented in the pneumonic “PTSD”. Let’s apply it to estrogen!
Production:
Estrogen is made in multiple places, but we can have the most control over our fat tissue. This does not mean that you need to eat less. Our bodies need to be nourished! Exercise and proper nutrition will help us control excess fat buildup.
We can limit our exposure to external estrogen-like chemicals. Choosing clean cosmetics and organic foods is one way to reduce our intake of xenoestrogens. Avoiding foods like soy can reduce our intake of phytoestrogens.
Transport
More available estrogen as a result of dysregulated transportation pathways can lead to estrogen dominance.
Sensitivity
A cell’s sensitivity to a hormone may have an impact. For instance, a cell with a rigid membrane may not allow for estrogen to enter. When estrogen receptors are defective, it can result in an estrogen resistance condition and therefore more free estrogen.
Detoxification
If detoxification pathways are not functioning optimally and estrogen isn’t being excreted at a normal rate, that leaves more of it to cause an imbalance. We can provide our bodies with nutrients that support healthy digestion and a healthy liver for detoxing.
If you suspect you may have estrogen dominance, you should consider meeting with a practitioner who understands how to identify root causes and will work with you to create a personalized plan for balancing your hormones. Contact us using the form below to get started!
Stay tuned for Part 3 of our hormone series, where we will dive deeper into another very common hormone imbalance: insulin resistance.
