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Estrogen Dominance, Natural Therapies & HRT

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Well, it’s been a while since I have written a medical article.

I often find myself asking: Why Do I share my journey and how does it relate to my medical practice?

The winter was DEEP and if you do not know already,  I am a total feeler, analyzer, and dreamer.  I calculate, express, and write. And candidly share what is going on beneath the surface as soon as I pinpoint it into words.  Part of it is rather selfish: To keep notes on my progress.  Part of it is transparency of what waves I am riding and boundaries I am dancing with.  Part of it is “Hey, you’re not alone… this way is what is working for me right now.”  Practically, there is a direct connection between emotional-spritual balance and physiological homeostasis. There’s more, but let’s not go THERE.  Let’s talk SEX, LOVE, n’ ESTROGEN CONNECTION.

The 2 Parental Units of Estrogen (and the other sex hormones)

A little background on Estrogen: We want a sweet spot of her to nourish  our cells in order to make us plump with young collagen-rich skin, juicey, womanly, and protects our bones.  Yes, that means a little pouch on your tummy is healthy as you age to your mid 30s and on through menopause.  That pouch carries the estrogen you need for longevity and graceful aging.

Fact: We cannot have hormonal harmony without proper cortisol regulation and ample oxytocin (that LOVE hormone👩‍❤️‍👩).  I’m pretty sure that oxy is all of our faves.  We can up her levels with sex, hugs, baby birthing, chocolate, authentic social connection, and petting dogs.  Trust me, I went through a period the past 2 years that my dog was my ONLY source of oxy.  In order to have estrogen levels healthy, we need these two “parent hormones” to be healthy.

Why do we want our hypothalamus putting more oxytocin into our blood stream?

Well, oxytocin is known to contribute to pro-social behaviors such as trust, psychological stability, relaxation, and reduce anxiety PLUS so much more.

It’s never a one sided story that fits all.  The truth is, when we are stressed to the max, oxytocin and cortisol are both elevated.  This does not lead to a healthy balanced life.  Cortisol totally disrupts and overrides the effects of oxytocin on the body’s organs and cells.

By now, most of you have heard about “adrenal fatigue,” which is essentially HPA Axis Imbalance.  If you haven’t refreshed yourself, just know that chronically elevated cortisol (stress hormone) can lead to major inflammation throughout your entire system.  It can lead to hot flashes, worsening menopause, painful irregular periods, IBS symptoms, autoimmunity, leaky gut, diabetes, and anything else that those wild inflammatory Interleukins like to do.

The endocrine system is a complicated web, just like life.   There are no magic pills in here, but I have figured out a few to help you along the way.

systems-chart-v11-1

Why is digestion important for the estrogen connection?

Remember our old friend cortisol? Here is a refresher. Cortisol regulates the fight flight and or freeze response to stress.  The vagus nerve helps us rest and digest (or freeze – there are a few different branches we recently discovered in the science geek realm -Porges is the man responsible for that).

Okay, back to digestion & estrogen.  Estrogen is FAT SOLUBLE!  The liver needs to metabolize estrogen through phase 1 & 2 detox.

1) We need ample fats to produce ample hormones.

2) We need our liver to be functioning properly in order to metabolize excess estrogen produced through daily exposure endocrine disruptors

3) Guess what? The microbiome  The estrobolome is a fun colony of microbes that is capable of metabolizing estrogen because they synthesize beta-glucuronidase, an enzyme that deconjugates estrogens into their active forms.  Of course, when the microbiome is healthy, the sweet spot of active estrogens is produced in the gut.  In the even of dysbiosis, these microbes can majorly contribute to pathologies of excess estrogen or estrogen deficiency.

How do you know if you Have Estrogen Dominance?

Symptoms: Moodiness, inability to release weight, water retention, sore breasts before your menses, irregular periods, bloating, decreased sex drive, anxiety & panic attacks + trouble sleeping, hair loss, and/or memory issues.

Fun yeah?!

There are a number of methods to assess for Estrogen dominance.  Clinical evaluation and response to herbal therapies are a great method, but not necessarily accurate.  The magic of herbs is the fact that they are amphoteric and generally work on multiple levels of the endocrine system, therefore, they are balancing,

*amphoteric = swings both ways in the endocrine system.

Lab Tests: Serum, Salivary, or Urine?

Well, dried urine is still proprietary test.  I basically do not bother with it if a patient is seeking HRT.  It is a great test if you are seeking support for metabolization of hormones.  I look forward to seeing more research that compares the levels of dried urine test to serum and salivary.  I still use dried urine testing in clinic with full disclosure to my patients that it is proprietary.  Clinically, the dried urine has yielded great results for using specific supplement recommendations for balancing out hormones.

Salivary measures free (aka active) hormones.  It is a great indication of your levels of hormones that are actually active.

Treatments:

Foods for Estrogen Balancing

  1. Dandy & Burdock Root (Dandy Blend is amazing)
  2. Milk Thistle Seeds
  3. DIM – Broccoli Sprouts are most nutrient dense. Then, consider the brassicas.
  4. Flax & Pumpkin Seeds during the Estrogenic Phase (Day 1 -13) Day 1 = Menses / Follicular
  5. Sesame & Sunflower during the Progesterenic Phase (Day 14-28/30) = Ovulation / Luteal
  6. Fiber – the Butyric Acid and post-biotics help produce essential vitamins and mineral necessary to build and detoxify your cells. Fiber also helps drag out excess cholesterol & estrogen so it does not recirculate into your body.
  7. In summary, Whole Foods plant based.  Eat mostly plants, not too much.  Focus on the liver loving foods & DIM Foods.

Herbs for Estrogen Balancing:

To come up with a well balanced formula, it is important to consider phyo-estrogenic herbs, phyto-progesteronic herbs, liver herbs, uterine tonics, nervines, adaptogens, circulatory  herbs & antispasmodics.

Yes, all of them.  For effective dosing of these , this calls for a bi-phasic formula or multiple forms of delivery.  By biphasic formula, I mean dosing with particular herbs during the ovulation / luteal phase and changing the formula for the menses phase.  For instance, for circulatory stimulants, yarrow can be used during both.  But cinnamon may be better during the ovulation phase, while Anemone pulsatilla may be a better option during bleeding.  She is a great chill ya out & take the edge off the pain low-medium dose herb!

1) Vitex is “progesteronic” so it can help with pre-menstrual anxiety

2) Black Cohosh is great if you get PMS headaches or back aches / muscle tension

3) Dandelion, Milk Thistle, burdock and any other liver loving herbs

4) Mugwort, Wild Yam, Lady’s Mantle, Smilax spp.

When do you reach for the hormones?

This seems to be the question of the year for many of my patients struggling with estrogen balance. Hormones can be prescribed for various reasons: For menopause and you want more E and for dominance and you are trying to level up your testosterone and progesterone.  It’s also possible, you want a bit of each!

For me, hormones come into play if herbal therapies, HPA axis balancing, and lifestyle is simply not working.  OR if the patient is so freaking depleted, they cannot go on until you get some hormones flowing in their system.  Sometimes the boost from more isolated therapies such as HRT allows you to feel good enough that you can finally take care of yourself!  I know that’s the case for me!

In any case, bioidenticals are the way to go.  And you always want to be balanced in your scripts with bio-identical progesterone.  Always bring in your questions.  Do not allow a doctor to strong arm you into

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