A functional medicine approach to female hormones and a healthy cycle

Top 10 tweaks to your diet and lifestyle to support your hormones & cycle – A Functional Medicine approach to hormone health

Do you struggle with hormonal issues, such as PMS, PCOS, acne, painful periods, endometriosis, fibroids or other, and have been told that the only solution is to go on the pill? But you’d like to naturally support your cycle with dietary and lifestyle choices? Then this blog post is for you. 

Before we get to some simple tricks you can use to optimise your hormones, starting to day, let’s have a short look at how our hormones work. As always, my goal is for you to understand the basics, so that you can become empowered to make educated choices that make sense to you.

Hormones for girls and women in their reproductive years (from the first period sometime in our teens to the last one sometime in the 40ies or 50ies) follow a distinctive monthly rhythm. And while not all of us want to procreate, the rhythm of these hormones is designed to prepare our uterus for a pregnancy.

The Menstrual Cycle

The cycle starts with the first day of our period, where the uterus, after no implantation of a fertilised egg has occurred, sheds its lining – aka we bleed. During that time, we are at an all month low of all three of our main sex hormones, estrogen, progesterone and testosterone.

https://www.britannica.com/science/menstrual-cycle

The next phase, also called the follicular phase, is defined by a rise in estrogen. A sharp rise in estrogen around day 12 sends signals to the brain to release something called LH which triggers ovulation (around day 14).

If you are wanting to get pregnant, those days leading up to ovulation are when you want to have sex. The elevated estrogen, along with a short spike in testosterone, not only makes you hornier, it also thins the cervical mucus, allowing sperm to swim through to reach and fertilise an egg.

Once ovulation has occurred, and an egg has been released, the now empty follicle turns into something called ‘corpus luteum’ which releases progesterone.

During the second half of the cycle, if all is healthy and well, we have a nice rise of progesterone and estrogen, with progesterone being the main player to keep everything nicely controlled.

Estrogen ‘makes things grow,’ including thickening of the endometrial lining.

Progesterone is needed to keep that growth in reins, and helps mature that endometrial lining to make it more fertile and allow a fertilised egg to nest and stick.

It also helps balance the stimulating effects of estrogen, allowing us to stay calm, steadying our mood, sleep better, reduce anxiety and ‘too much growth’ as found in estrogen dominant conditions like endometriosis, cysts and fibroids.

If this does not happen, hormones drop at the end of the cycle, triggering the endometrial lining to shed, aka the next period.

You aren’t trying to get pregnant? Then this monthly cycle is still important, as without a healthy ovulation, progesterone won’t rise during that second phase of the cycle, leading to many the unpleasant symptoms us women have simply grown to ‘just live with’.

 

Estrogen dominance

Common symptoms of estrogen dominance or low progesterone in the second half of the cycle include:

  • PMS or even PMDD
  • Bloating and water retention
  • Swollen and painful breasts
  • Difficulties sleeping
  • Painful and heavy periods
  • Excess growth: cysts, fibroids and endometriosis.
  • If this persists long-term, it can even contribute to cancers such as breast, ovarian etc.

PCOS

Another common concern is PCOS and the high androgen (testosterone and its derivatives) levels that come with it. Symptoms include:

  • Polycystic ovaries – too many cysts that don’t mature enough to ovulate and release an egg, leading to anovulation and infertility
  • Acne
  • Hirsutism – hair growth in unwanted areas, such as face and body.
  • Male pattern hair loss – hair loss on the head

PCOS often coincides with estrogen dominance, but may suppress hormones other than androgens (testosterone etc) all together.

While the most common way of dealing with hormone issues is the contraceptive pill, which blocks the brain’s signals to make hormones and therefor stops ovulation and the cycle from happening altogether (and thus lessens any symptoms of overgrowth like endometriosis, painful periods, fibroids etc), this does come with some serious side effects if taken long term (more on this in another post).

If you have landed here, you likely are interested in natural ways of addressing these. As always in Functional Medicine, before simply putting a plaster on (or a pill) to suppress symptoms, we ask ‘Why is this happening? What is causing our hormones to go haywire in the first place?’ and ‘How can we best support our body to heal and balance its hormone production naturally?’.

 

A Functional Medicine approach to hormones and cycle health – Looking for the root cause

 

Research shows that there are several factors that can mess with our hormones and reproductive organs throughout the cycle. Some of the most prominent ones are

  • Genetics
  • Inflammation, Gut Microbiome Imbalance (‘Dysbiosis‘) and ‘Leaky gut’
  • Blood sugar swings
  • Over- or under-nutrition.
  • Stress

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Let’s look at each in a little more detail.

 

Genetics

Hormone issues often run in families, and it is common for a mother to have experienced similar period cramps, fibroids etc like the daughter.

We cannot change our genetics, but what we can change is our ‘epigenetics’. Epigenetics is an exciting field in research that’s really started to shine as the big start in the recent years. Epigenetics comprises all the factors ‘surrounding our genes’ that influence which genes get turned on or off. Epigenetics include nutrients (‘nutrigenomics’), our gut microbiome (1), inflammation, hormones, environmental toxin exposure, stress, and more. We will dive into a few of them below.

 

Inflammation, Gut Microbiome Imbalance & ‘Leaky gut’

 

Inflammation has been shown in many studies to be one of the main contributing factors to PCOS, endometriosis and other reproductive organ issues (2, 3). 

 

But where is this inflammation coming from? It is usually a combination of things.

1.The most important piece to the inflammation puzzle is usually the gut. You likely have heard about the importance of a healthy gut microbiome by now. Those little critters (mostly bacteria, but also some yeasts and sometimes parasites) that are larger in numbers than human cells, and influence anything from how well the gut is breaking down foods, the creation, recycling and absorption of nutrients and even hormones, but also whether our gut lining is strong and healthy, only allowing what is meant to pass through to the blood, or on the contrary being ‘leaky’, a more permeable state allowing items into the blood that the body doesn’t recognise. It is this state of permeability that can contribute to low grades of systemic inflammation.

2. Food intolerances: If the gut is ‘broken’, we often also develop intolerances to otherwise healthy foods, as they can pass into the blood at a different size and shape that the immune system is accustomed, with the immune system mounting a response (= inflammation) every time we consume them, thinking they are ‘invaders’. Common examples are healthy foods like almonds, eggs, soy.

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3. Overconsumption of food and calories, as in overweight individuals, produces palmitic acid in the body, triggering inflammation.

 

4. But even in skinny individuals, the overconsumption of certain foods like processed and sugary foods, can lead to inflammation every time they consume these.

 

5. And lastly, the underconsumption of anti-inflammatory foods, including omega 3s found in salmon and sardines, and high fiber foods that feed a healthy gut microbiome such as the rainbow of vegetables.

 

Excess sugars and carbohydrates

As briefly mentioned earlier, blood sugar swings can increase the risk of hormone imbalances via their inflammatory effects. But there is more to it. Constant blood sugar spikes mess with our insulin receptors, eventually turning our body insulin resistant. This has been touted with being one of the major reasons for PCOS and high androgen (testosterone etc) levels (4, 5).

 

Another issue with a diet high in sugary foods, even the ‘healthy’ type such as fruit, porridge and sweet potatoes, is that if we overconsume them, or eat them on their own, they will feed a type of fungus called ‘candida albicans’ in the gut, which can mess with our gut microbiome, but also hormones. It is linked to inflammation, estrogen dominance and irritability.

 

Overnutrition

Again, as briefly mentioned earlier, over-consumption of not only sugary foods, but also calories overall, in particular highly processed foods, have been linked to inflammation. Obesity in and of itself has been linked to a higher risk of hormonal conditions, such as PCOS but also estrogen dominance symptoms. Body fat acts like an endocrine organ, secreting hormones and inflammatory messenger molecules, contributing to PCOS. It also increases estrogen by upregulating aromatase, which turns testosterone into estrogen (6, 7, 8).   

 

Undernutrition

Not getting enough calories and/or nutrients on the other hand can also lead to hormonal issues. Other than the importance of anti-inflammatory foods such as omega 3s and fiber containing vegetables, we also need to signal to our brain that it is ‘safe to make babies’ just before ovulation, if we want to have a healthy cycle (and resulting hormones). Even if making babies is the opposite of what you want to achieve at this moment, without a robust ovulation, progesterone will be floored throughout the second half of the cycle, making you feel miserable (9, 10).  

 

We also need to make sure we have all the right building blocks in place for making (and breaking down) hormones, such as zinc, protein, iodine, iron, sulfur rich compounds and more (11, 12, 13, 14, 15, 16, 17, 18). 

 

Stress

Stress might be the missing puzzle piece to the hormone issues we see in our society. Many of my patients are eager to adopt certain dietary changes and an entire apothecary of supplements, yet learning to manage stress might be what’s keeping their hormones in a mess.

Just like with undernutrition and its effect on the brain, stress acts in a similar way. If we are stressed, our brain thinks we are running away from a perceived tiger (ie we are in fight-or-flight mode more often than not), and it is not ‘safe to make babies’. Result: issues with ovulation and progesterone in the second half of the cycle, contributing to those dreaded symptoms of PMS, bloating, infertility, mood swings, painful periods and more.

 

 

Top 10 dietary and lifestyle tricks to support your hormones and cycle

 

By now you should have a better understanding of what might be causing your hormones to get thrown off balance, so let’s dive into some simple tricks you can adopt starting today to assist your hormones for a better cycle.

 

1.Eat the rainbow of veggies

Fiber is your friend when it comes to your gut health, mineral and vitamin intake. The more variety the better. Make sure to mix in some cruciferous vegetables like broccoli and cauliflower or cabbage to help break down estrogen, in particular in the second half of the cycle. You may even want to experiment with Sauerkraut or kimchi, for its added probiotic (gut supporting) superpowers.

 

2. Protein is king

Protein keeps your blood sugar stable and stops cravings. It is also a building block for hormones and neutransmitters  like the thyroid hormone, serotonin and GABA, which are important to support progesterone in the second half of the cycle, plus keeping your mood steady (19, 20, 21, 22). 

Research suggests anywhere between 1.5-2.2g of protein per kg of goal body weight these days, which is quite a lot.

We also want to make sure we combine different protein sources, as they all have different benefits and building blocks (amino acids like tryptophan, lysine, arginine and more). In particular if you are vegan or vegetarian, make sure to be savvy with combining them to get enough of all.

Download a protein calculation cheat sheet here with examples of protein sources and how to best combine them!

 

3. Omega 3s to fight inflammation

Omega 3s, such as found in salmon and sardines, or algue based supplements if you’d rather stay plant-based, are important for their anti-inflammatory effects.

While other plant-based foods that are touted to be high in omega 3s, such as walnuts and flaxseeds, have wonderful other health benefits (see next point), they contain the precursor to the main active omega 3s. The body can only convert tiny amounts, making them inadequate omega 3 sources.

If painful periods are one of your concerns, you want to load up on omega 3s in particular during the week before your period, when the endometrial lining is built, and in the first days of your period. Research shows that inflammation is one of the main contributors to cramping and pain.

 

4. Tweak your carbs

We have been told that carbs are the enemy. That’s not actually true. We do need some to thrive, and going without them for a long time as in continuous ketosis can have harmful side effects, such as damaging heart muscle (fibrosis, ouch!), connective tissue and making us more insulin resistant. As so often in life, it is the quantity and quality that makes the poison or potion when it comes to carbs. I generally recommend simply shifting meal proportions, rather than cutting entire food groups out. Rather than having mostly carbs with a side of protein and veg, base your meals on veg and protein, and have some carbs (ideally whole foods such as fruit, potatoes, legumes) as a side or dessert (23, 24, 25).  

Starting your meals with veg and protein, and following it up with carbs, is another simple trick to mitigate blood sugar swings, and keep everything nice and stable.

And while you might be craving more carbohydrates and sugars leading up to your period, now is the time to really make sure to combine them with protein and veg, as your body is less insulin sensitive during this time, making you crave more, yet putting you on a blood sugar rollercoaster of cravings, bingeing, and worse symptoms (26, 27).  

 

5. Gentle intermittent fasting, but no extremes leading up to ovulation

In order to give our gut a little break to repair and digest, but also to give our body the change to get rid of problematic cells, it is important to go through phases without eating, ie intermittent fasting. However, excess fasting acts like a stressor on the brain, so we want to make sure not to overdo it, in particular in the days leading up to ovulation when we want to make sure to signal to the brain that we are ‘safe’ and not ‘starved’. What does that mean? Simply going back to 2 or 3 proper meals per day, without constant snacking, and avoiding late night eating, is a great (and safe) start to implement intermittent fasting, without it messing with the cycle (28, 29, 30, 31, 32, 33, 34, 35).

 

6. Load up on iron rich foods during your period

We need iron to make red blood cells and transport oxygen to our cells for energy. In particular women that are vegan or vegetarian are often low on iron, with symptoms like fatigue, shortness of breath, and exercise intolerance, but also inability to shift weight, thyroid issues and more. Make sure to incorporate iron rich foods into your diet, in particular during your period. Good examples are organic beef and lamb, in combination with vitamin C rich foods like lemon or broccoli, which aid the absorption. If you choose to go vegan, make sure to test your levels, and supplement if needed, as it is often difficult to get enough through food sources.

 

7. Seed cycling

You may have read about seed cycling, or heard about it on Tiktok, and for good reason. There is actual research to back this up! Adding in  

–> 1 tablespoon of pumpkin and flax seeds in the first half of the cycle, and

–> 1 tablespoon of sunflower and sesame seeds in the second half,

have been shown to improve symptoms of PCOS, estogen dominance, and support healthy hormone cycling (36, 37).

 

 

Summary of diet tweaks for better hormones:

Focus on a balanced Mediterranean style diet, with emphasis on ‘eating the rainbow’ on vegetables, plenty of cruciferous veg to help estrogen detox, adequate protein and healthy fats such as salmon, olives and nuts and seeds, and a small amount of unrefined carbs such as whole fruit, potatoes and legumes can go a long way, without having to overcomplicate things (38, 39, 40, 41). 

 

8. Stress management

As discussed earlier, anything that ‘stresses your body out’, be it blood sugar swings, starvation, overeating, or actual stress such as emotional worries, can mess with a healthy cycle. If constantly being on the go, running from one thing to the next, and even pacing your yoga class is you, then you might want to find ways to shift from fight-or-flight over to the restoring and hormone supporting (parasympathetic) mode more often.

Meditation, massages, a sauna or bubble bath, reading a book or spending time with loved ones all qualify.

An easy, yet uber powerful trick is to simply incorporate a minute of slowed down diaphragmatic breathing (belly breathing) every hour. Breathing in through the nose, while expanding the belly and keeping the chest relaxed for a count of 4, then breathing out through the nose while letting the belly button sink back towards the spine for a count of 4. Repeat a few times. Research shows how this extremely simple trick directly switches your brain over to that parasympathetic nervous system. I get my patients to set themselves an hourly timer to drink a glass of water, and do a minute of belly & nose breathing!

9. Move your body – but don’t skimp on recovery days

Regular movement is crucial to a healthy life, including our hormones. Yet overexercising, as I see often in my A type patients, can mess with the cycle, in particular if it is combined with too little food. In the worst case, that can even suppress periods altogether. Unless you are a professional athlete, more is not always better. Daily gentle movement, such as 10k walk, is important, plus adding in a higher intensity and weight workout 2 or 3 times per week. This can be anything from actual weights in the gym, to a reformer pilates or power yoga. Ideally no longer than 45 minutes, as any more and it will stress your body out excessively. With the advancement of home monitoring gadgets like Garmin or Oura ring, you can track your HRV to see what your recovery state is, and if your body is ready for another high intensity workout, or whether it might be better to have a rest and stretch day.

 

 10. Prioritise sleep

Sleep is essential to allow for the body to restore, heal, and feel ‘safe’ – which is important for a healthy cycle, as discussed in length earlier. Getting enough sleep also improves appetite control, and makes it easier to stick to healthy choices the next day (42, 43, 44). Double bonus!

 

Looking to learn step by step how to eat and live, and which tests best to run, to optimise your health, hormones and metabolism, to feel and look better for longer? Then join me in one of upcoming online workshops – Stay tuned for the march – may schedule! 

 

Found this helpful? I’d love to hear from you in the comments below!

Xxx

In Health, Mirthe

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Mirthe

It is my goal to empower you to become the CEO of your health trajectory, preventing and optimising with precision and science backed strategies to live your best life & thrive.

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HI, I'M MIRTHE

It is my goal to empower you to become the CEO of your health trajectory, preventing and optimising with precision and science backed strategies to live your best life & thrive.

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