Not long after you blew the candles out for your 40^th birthday cake, you likely started to notice some subtle shifts in how you were feeling. Maybe you started feeling a bit more irritable, anxious, or sluggish. Perhaps your menstrual cycle started to alter. Or maybe your libido took a hit. While menopause occurs around 50 years of age for most women, it’s possible to start experiencing the hormonal shifts of perimenopause –  the period of time that leads up to the time your menstrual cycle stops for good – in their early 40s.

Here are some of the most common questions that people have around perimenopause, and what can be done to help support their hormones naturally.

What are the symptoms of perimenopause?

Perimenopause is a time of hormonal fluctuations, and with this many symptoms can occur. Some of the most common symptoms that women experience sleep disturbances, mood swings, reduced stress tolerance, lowered libido, hot flushes, menstrual irregularity, changes in menstrual flow (may be lighter or heavier than usual, sometimes with significant increases), bloating, brain fog, joint or muscle aches, hayfever, itchy ears, fatigue, vaginal dryness, increased tendency to thrush or BV, and headaches/migraines.

Why do women get perimenopausal symptoms?

Unlike after menopause, when hormones are at a lower state and symptoms can occur because of these low levels, in perimenopause symptoms can be caused by the fluctuations of oestrogen and the gradual decline of progesterone. These hormonal shifts can cause the adrenal response to stress to be affected, which also means that stress can be harder to deal with.

Why do hormones change in your 40s?

Hormonal balance is largely a result of regular, healthy ovulation. The follicular phase, the time between the start of menstruation and ovulation is a time of abundant oestrogen, and then in the luteal phase, oestrogen declines (with a few spikes) while progesterone levels come to the show. It is all dependant on ovulation.

For this to all work in harmony, many factors need to be working seamlessly, such as stress hormones, inflammation, mitochondrial health and nutritional health. The previous cycle will affect subsequent cycles, as low progesterone often triggers higher levels of FSH.

As oocyte (egg) numbers decline and mitochondrial health depletes, the signals of the HPO axis in perimenopause are altered and ovulation doesn’t occur every cycle. This results in a gradual decline in progesterone, and fluctuating levels of oestrogen as the brain tries to adjust to the fluctuation of irregular ovulation.

Photo by Jonathan Borba on Unsplash

What is the difference between menopause and perimenopause?

Perimenopause is the time leading up to the definitive marker of menopause, the time when there has been 12 months since the last menstrual bleed. You are perimenopause in the time leading up to this moment, and post menopausal afterwards. Menopause is the umbrella term that incorporates all of these. It is worth noting that it is still possible to experience a random bleed in the post menopausal period, and if this occurs you should discuss with your health care practitioner as while it can be a renegade menstruation, it can also be a sign of something more concerning.

Should I take supplements to support my hormones?

Not everyone needs to take supplements, and many nutrients can be obtained through your diet. But there are a lot of people who aren’t eating enough of the vitamins and minerals that are essential for healthy hormones and nervous system health, or have genetic polymorphisms which increase their demand for certain nutrients.

These are some of my favourite supplements to support the perimenopausal period:

• Magnesium glycinate – this is important for nervous system health, blood sugar level regularity and is important for hormone creation and detoxification.
• Taurine – I often prescribe this alongside magnesium, as it can help with improving mood and energy (it interacts with GABA receptors, producing a calming effect). It is also important for bile acid formation and mitochondrial health.
• Ubiquinol – The activated form of Coq10 is more effectively used in those who are over 30 years of age. CoQ10 and its activated form ubiquinol are important for mitochondria health, which has many wide-reaching benefits including cardiovascular health, energy, immune function, skin health and other anti-aging properties and more.
• Collagen – As oestrogen lowers, the body’s ability to make and repair collagen reduces, so supplementation can help to offset some of this loss. Collagen can be helpful for improving skin, bone and joint health, and often is useful for digestive health concerns.
• Phyto-oestrogens – In particular, soy which is abundant in isoflavones have a regulating effect on hormones. Isoflavones have been studied abundantly and found to be helpful for managing menopausal symptoms, as well as being protective against several of the long-term risks of menopause such as osteoporosis and cardiovascular disease. It is protective against many forms of hormone-dependant cancers. I advise avoiding the overly refined forms of soy products, and opting for those made with the whole bean such as traditional soy foods, or milks made from the whole bean rather than the isolate.

There are many more nutritional supplements that can be beneficial, as well as herbal medicines that can support you through this period. I discuss these in more detail in my ecourse Natural Menopause Support. Alternatively, get in touch with your health care practitioner to help work out what your individual requirements are, as well as what doses you may need.

How do I know if I’m going through perimenopause?

This is a very common question, and unfortunately it doesn’t have a simple answer. Hormone testing can provide some insight into whether you are getting closer to perimenopause, but it can be difficult to interpret because of the fluctuations that occur in perimenopause.

The best way to know if you are going through perimenopause is taking several factors into consideration such as your age, your maternal family’s menopausal experience, your symptoms – notably your cycle regularity and whether this has changed.

Blood tests may show a gradual increase in FSH (follicle stimulating hormone) and a decline in progesterone. Oestrogen levels can fluctuate in perimenopause, so they may be high or low. After menopause when you have not ovulated for at least 12 months, oestrogen and progesterone will be considerably lower, and FSH will usually be much higher.

How to lose weight in your 40s

It may seem like losing weight as you get older becomes more of a struggle, and that’s because your hormonal shifts cause your metabolic health to change. Insulin resistance is a by product of reduced oestrogen, which makes losing weight, especially around the abdomen more difficult than it was when you were younger. If there are other hormonal imbalances at play such as PCOS, oestrogen excess, thyroid dysfunction or chronic stress/HPA dysfunction this can also contribute towards difficulty losing weight with standard methods.

Assessing your hormonal situation is the first step to identify barriers to weight loss, and then you can make diet and exercises choices that will work best for you.

In the majority of cases the staples of weight loss still need to come into play, such as ensuring you are eating the correct amount of calories, exercising and maintaining muscle mass, and getting adequate sleep.

GLP-1 and GIP medications are becoming more popular, and while they can be very helpful in the weight loss journey they do have side effects and risks that need to be managed. As with any other weight loss approach, they are not a long term solution but can be helpful whilst other factors such as diet and lifestyle habits are improved, and hormonal imbalance is supported.

When should I consider HRT?

This is an individual decision and needs to be done in collaboration with your health care practitioner. Menopausal Hormonal Therapy (MHT), previously known as Hormonal Replacement Therapy (HRT) has had many advances in safety and can be used to help navigate the symptoms with low oestrogen, progesterone and/or DHEA. In perimenopause, progesterone therapy is more commonly used cyclically, with oestrogen being more beneficial only in the times when low oestrogen occurs. As oestrogen fluctuates in perimenopause, it is often not used until after ovulation has ceased.

Some people experience negative effects from taking MHT, but this doesn’t mean that MHT is not for you, but rather that you need to have your individual needs taken into consideration. If you feel worse from MHT, this may be due to poor detoxification of oestrogens or because your hormones are still fluctuating too wildly, as taking additional oestrogen when it is already high can cause issues such as heavy bleeding, headaches or mood changes.

You may be able to find out if you are not detoxing your hormones properly with a test that assesses the ratio of your hormone metabolites, such as the DUTCH test or EndoMap.

Should I see a naturopath for perimenopause?

Perimenopause and menopause are one of the most common reasons that people seek help from a naturopath, and for good reason. There is so much that can be done to support people going through this transition naturally, including supporting symptoms and hormonal fluctuations with herbal medicine, nutritional supplements to reduce symptoms and improve wellbeing, and education and guidance around diet and lifestyle adjustments that can help to both reduce the symptoms of this time and reduce the risks associated with after menopause such as osteoporosis, genito-urinary changes and cardiovascular and metabolic health.

Because this is such a common thing that people seek help with, I have created an ecourse – Natural Menopause Support – which provides an abundance of education about what is going on in menopause and perimenopause, as well as guidance on navigating the remedies that may be helpful.

As you move through your 40s, understanding and supporting your hormones can make a world of difference to how you feel each day. Perimenopause doesn’t have to be a confusing or uncomfortable time — with the right nutrition, lifestyle support, and individualised care, you can navigate this stage feeling strong, informed, and in tune with your body.

If you’d like to dive deeper into natural ways to manage symptoms and restore hormonal balance, you’ll find plenty of guidance in my Natural Menopause Support eCourse, where I share practical tools and naturopathic insights to help you thrive through perimenopause and beyond.

The post How to Support Your Hormones Naturally in Your 40s appeared first on Alison Mitchell Naturopath.

Have you ever wondered why so many seemingly unrelated health issues—like hormonal acne, period pain, fatigue, and digestive troubles—often appear together? The answer lies in the intricate relationship between your gut and your hormones. From processing nutrients essential for hormone production to eliminating excess oestrogen, your gut plays a pivotal role in keeping your hormones balanced.

In this post, I’ll explore how nurturing your gut can be the key to unlocking better hormonal health and overall well-being.

How Gut Health Influences Hormones

1. Microbiome and Hormonal Metabolism
   Your gut microbiota—the ecosystem of bacteria in your digestive tract—plays a critical role in regulating hormones. Specific bacteria in the microbiome metabolize and recycle hormones like oestrogen through the “oestrobolome.” An imbalanced microbiome, or dysbiosis, can lead to excess estrogen recirculation, increasing the risk of PMS, endometriosis, and estrogen-dominant conditions.
2. Nutrient Absorption
   The gut is responsible for absorbing key nutrients (like B vitamins, zinc, and magnesium) required for hormone production. Altered absorption can lead to deficiencies of these nutrients which are vital for healthy hormone balance.
3. Oestrogen Detoxification
   It also helps eliminate excess hormones, such as estrogen, through bowel movements. Issues like constipation or dysbiosis may reintroduce excess hormones into circulation, exacerbating imbalances.
4. Stress and the Gut-Brain Axis
   This connection goes both ways, as gut issues can affect stress hormones due to the role of the gut bacteria in production of neurotransmitters and cortisol levels. Chronic stress impacts your gut lining and microbiome diversity, impairing digestion and increasing inflammation. This can disrupt adrenal hormones, leading to fatigue, poor sleep, and heightened PMS symptoms. It’s a vicious cycle.
5. Histamine and Ovarian Activity
   Dysbiosis can cause an overproduction of histamine, a compound involved in immune and allergic responses but also strongly involved in conditions like endometriosis and IBS. High histamine levels can stimulate the ovaries to produce more estrogen, exacerbating conditions like oestrogen dominance and premenstrual symptoms.

Signs Your Gut and Hormones Are Out of Sync

• Persistent digestive issues (bloating, constipation, reflux, nausea, poor appetite or diarrhea).
• Hormonal symptoms like acne, mood swings, or irregular periods.
• Low energy or brain fog that doesn’t improve with sleep or rest.
• Skin conditions such as eczema, acne or easy welting.

Steps to Support Your Gut and Hormonal Health

• Dietary Choices
  • Incorporate fibre-rich foods (vegetables, legumes, and whole grains) to feed healthy bacteria.
  • Add fermented foods like sauerkraut, kimchi, and kefir, which provide beneficial probiotics (not as much of this if you have histamine issues).
  • Have a variety of plant foods to help provide beneficial nutritional compounds and a variety of fibre types, which reduces inflammation in the gut and supports microbiome diversity.
  • Limit inflammatory foods, including sugar, alcohol, and processed items, to reduce systemic inflammation
• Supplement Strategically
  • Use strain-specific probiotics that are specific to your health concerns to support gut diversity and hormone metabolism. Consult a naturopath to find the right strains for your needs.
• Feed the gut bugs
  • Specific prebiotic fibres can help to reduce the overgrowth of bacteria which impair oestrogen detoxification.
  • Glucomman, found in konjac noodles are helpful in reducing betaglucoradinase.
  • PHGG is a low fodmap prebiotic fibre that is a good allrounder, helping to regulate bowel motions and supporting microbiome balance.
• Stress Management
  • Chronic stress and poor sleep disrupt the gut-brain axis, which can dysregulate hormones. Incorporate stress-reduction techniques like yoga, meditation, or gentle walks to calm the nervous system
• Hydration and Gentle Detoxification
  • Drinking sufficient water supports bowel regularity and toxin elimination. Simple rituals like starting the day with warm water and lemon or apple cider vinegar can enhance digestion.
  • Adequate fibre and water helps with regular bowel motions which is important because you need regular bowel motions to support oestrogen detoxification and clearance.
• Restorative Practices
  • Improve sleep to regulate cortisol and support nightly hormone repair.
  • Incorporate gentle, restorative exercise, such as walking or pilates, to avoid over-stressing the adrenals.

Long-Term Benefits

Balancing your gut is the foundation for hormonal health. By addressing digestive issues, supporting your microbiome, and managing inflammation, you can improve symptoms such as period irregularities, skin problems, and fatigue.

By healing your gut, you’re not only improving digestion but also empowering your body to regulate hormones naturally. Balanced hormones mean better skin, more energy, fewer mood swings, better hormone balance.

Supporting your gut is a long-term investment in your health. By adopting these practices and seeking personalized care from a naturopath, you can achieve better balance and resilience in both your gut and hormones.

Disclosure: Links to products are affiliate links. This means that, at zero cost to you, I will earn an affiliate commission if you click through the link and finalize a purchase.

The post The Connection Between Your Gut and Hormonal Health appeared first on Alison Mitchell Naturopath.

When we think about polycystic ovary syndrome (PCOS), we often focus on the elevated testosterone levels associated with the condition. But did you know that PCOS also involves imbalances in oestrogen? In fact, women with PCOS often experience prolonged exposure to high levels of oestrogen due to an extended follicular phase. This extended phase can contribute to many of the symptoms associated with PCOS.

Let’s take a closer look at how oestrogen plays a significant role in PCOS, how this prolonged follicular phase leads to oestrogen dominance, and why it’s important to consider hormonal balance beyond just testosterone.

PCOS: It’s More Than Just High Testosterone

Yes, elevated testosterone is a hallmark of PCOS, but it’s not the only hormone at play. In women with PCOS, the menstrual cycle is often disrupted. Specifically, the follicular phase, which is the first half of the cycle where oestrogen rises to prepare for ovulation, can become much longer than normal. When ovulation doesn’t occur regularly or at all, the body experiences a prolonged period of high oestrogen without the counteracting effects of progesterone, which rises after ovulation, released from the corpus luteum.

This extended exposure to oestrogen contributes to many of the symptoms experienced by those with PCOS, but aren’t always easy to be explained by the evelated levels of insulin and testosterone. So keep in mind it’s not just about high testosterone—oestrogen plays a big role, too!

Signs of Excess Oestrogen in PCOS

If you have PCOS, you might be familiar with some of the signs of oestrogen dominance, such as:

• Breast tenderness
• Heavy or prolonged periods
• Bloating or water retention
• Mood swings and irritability
• Weight gain, especially around the hips and thighs

These symptoms are the result of an imbalance between oestrogen and progesterone. When oestrogen is allowed to remain elevated for too long without progesterone to balance it out, you may start to notice these classic signs of oestrogen dominance.

The Phases of the Menstrual Cycle

To understand how oestrogen dominance happens in PCOS, let’s briefly review the phases of a normal menstrual cycle:

1. Menstrual Phase – This is when you get your period, and the uterine lining is shed.
2. Follicular Phase – Oestrogen rises as your body prepares for ovulation. For many women with PCOS, this phase can be prolonged.
3. Ovulation – Ideally, a mature egg is released during ovulation. Oestrogen needs to peak in order to trigger a surge of LH, which then triggers the egg to be released from the follicle. For many women with PCOS, ovulation doesn’t occur regularly, leading to what’s called an anovulatory cycle, or an extended follicular phase.
4. Luteal Phase – After ovulation, the remainder of the follicle from which the egg from release – the corpus luteum – releases progesterone. Progesterone levels rise in the luteal phase, which balances the effects of oestrogen. However, if ovulation doesn’t happen, there’s no significant rise in progesterone, leading to relative oestrogen excess.

In PCOS, it’s common to have anovulatory cycles, meaning ovulation doesn’t occur, and the body doesn’t produce the necessary progesterone to balance out the high oestrogen levels. This leaves many women stuck in an extended follicular phase with prolonged exposure to oestrogen.

How Testosterone Can Convert to Oestrogen

Another important factor to consider in PCOS is how testosterone can be converted into oestrogen. This happens through a process called aromatisation, where testosterone is transformed into oestrogen in the body’s tissues, including fat cells. For women with PCOS, who often have elevated levels of testosterone, this can result in more oestrogen being produced, contributing further to the oestrogen dominance that many experience (Xu et al., 2024).

Increased Sensitivity to Oestrogen in PCOS

Interestingly, not only are oestrogen levels higher for longer in many women with PCOS, but there’s also evidence to suggest that their oestrogen receptors are more sensitive. This means that even if the levels of oestrogen aren’t dramatically high, the body may respond more strongly to it, intensifying the symptoms of oestrogen dominance (Xu et al., 2024). This heightened sensitivity further contributes to the hormonal imbalance that can make PCOS so challenging to manage.

The Impact of Endocrine Disrupting Chemicals (EDCs)

As if managing PCOS wasn’t complex enough, exposure to endocrine-disrupting chemicals (EDCs), such as bisphenol A (BPA), can further complicate the hormonal picture. Research has shown that women with PCOS often have elevated levels of BPA in their plasma, urine, or follicular fluid. BPA can mimic oestrogen and bind to oestrogen receptors, increasing their activity. This leads to more pronounced symptoms of oestrogen dominance and is linked to insulin resistance, polycystic ovarian morphology on ultrasound, and even markers of chronic low-grade inflammation (Srnovršnik et al., 2023).

If you have PCOS and are concerned about environmental factors like EDCs, it’s worth considering ways to reduce your exposure to BPA and other hormone disruptors, as these chemicals may worsen the hormonal imbalances associated with the condition.

Read more about endocrine disrupting chemicals and their impact on hormones and fertility here and here

Low SHBG Levels in PCOS and Its Effect on Oestrogen and Testosterone

Another key factor in PCOS is the role of sex hormone-binding globulin (SHBG). SHBG is a protein that binds to hormones like oestrogen and testosterone, controlling how much of these hormones are “free” and active in the body. Women with PCOS tend to have low SHBG levels, meaning they have more free (unbound) oestrogen and testosterone circulating in the bloodstream. This not only contributes to higher androgen symptoms (like acne and male pattern hair loss) but also increases the effects of oestrogen on the body (Emanuel et al., 2022).

Want to Learn More About PCOS?

If you’re dealing with PCOS and want to dive deeper into understanding how these hormonal imbalances affect your health, I’ve written several other blog posts on this topic. Check them out here:

Busting PCOS Myths

A Holistic Guide to PCOS

If you’d like to know more about hormones and how they affect your health and wellbeing, and how you can support your hormonal wellbeing and cyclical health, I would love you to look into my e-course The Cyclical Woman

Final Thoughts

PCOS is a complex condition that involves more than just high testosterone. The extended follicular phase, lack of progesterone due to anovulation, increased aromatisation of testosterone to oestrogen, and heightened oestrogen receptor sensitivity all contribute to the hormonal imbalances experienced by those with PCOS. By understanding how oestrogen plays into the bigger picture, you can take steps to manage your symptoms more effectively and work towards achieving better hormonal balance.

References

Emanuel, R. H. K., Roberts, J., Docherty, P. D., Lunt, H., Campbell, R. E., & Möller, K. (2022). A review of the hormones involved in the endocrine dysfunctions of polycystic ovary syndrome and their interactions. Frontiers in Endocrinology (Lausanne), 13, Article 1017468. https://doi.org/10.3389/fendo.2022.1017468

Srnovršnik, T., Virant-Klun, I., & Pinter, B. (2023). Polycystic ovary syndrome and endocrine disruptors (bisphenols, parabens, and triclosan) – A systematic review. Life (Basel), 13(1), 138. https://doi.org/10.3390/life13010138

Xu, Y., et al. (2024). Roles of estrogen and its receptors in polycystic ovary syndrome. Frontiers in Cell and Developmental Biology, 12, Article 1395331. https://doi.org/10.3389/fcell.2024.1395331

The post PCOS and Oestrogen: The Hidden Hormonal Imbalance You Need to Know About appeared first on Alison Mitchell Naturopath.

Guts and Girl Bits Episode #50

As we reach the end of Endometriosis Awareness Month I wanted to release a little recording I made a while ago for women’s health week, in which I spoke about Endometriosis.

Endometriosis is a condition that can significantly affect a woman’s quality of life, however, there is a lack of awareness and understanding of this condition.

It is estimated that 1 in 7-10 women may have this condition, however it can take many years to receive a diagnosis. In this video discuss some considerations of addressing this condition with naturopathic medicine, addressing the root causes of immune imbalance.

Watch the Video:

Listen to the audio:

Subscribe and listen to the other podcasts here:

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Related posts:

Endometriosis

10 Ways to reduce period pain

Updates on Endometriosis

Heavy periods

Choosing the right products for that time of the month

Thrush

Transcript

0:08
Hi, everyone, you’re listening to Guts and Girl Bits. I’m Alison Mitchell, a practicing naturopath and I hope to share with you all sorts of information about women’s health and digestive health to educate and empower you to make informed choices about your own health. Please remember that all information is general and does not replace consulting with a healthcare practitioner.

0:31
It’s the end of March and March is Endometriosis Awareness Month. So I wanted to share a little video that I recorded a couple of years ago for Women’s Health Week as my latest podcast because in that video, I share all sorts of information about endometriosis, and about how to get to some of the underlying drivers that causes it. So I hope that that’s helpful for you. There has been more research coming out since then, as well. But most of the new stuff that I shared in that one is still relevant. So if you want to hear more information, then please subscribe to me on @gutsandgirlbits. And stay tuned as well for all my e courses that are coming out all about how to understand yourself by understanding your cycles and understanding your hormonal balance in more depth, which you can find over at my teachable account, which is gutsandgirlbits.teachable.com

1:30
Hey, everyone, I want to talk about endometriosis today. This is the last day of Women’s Health Week. So I wanted to finish it off by talking about a condition that I really love treating and that’s that’s endometriosis. So if anyone doesn’t know what endometriosis is, basically, it’s a painful condition that affects women. And it affects almost one in seven women approximately. And it can cause quite a lot of issues. So what’s what seems to be happening is that we women get these endometrial cysts, also known as endometriomas, or chocolate cysts, which are basically the content of the lining of the uterus being where it shouldn’t be. So when we normally have our period, what should be happening is that the lining should just you know, break down and dissolve and come out as normal menstrual blood. But sometimes what’s happening is that this isn’t staying in the uterus. This is actually forming little adhesions or cysts elsewhere in the body, such as around the lining around the outside of the uterus or in the fallopian tubes or stuck to the ovaries. And it can also happen in their peritoneal cavity where it’s actually attaching to the intestines, the bowel, bladder and those sorts of things.

2:55
So back up back when I was a student naturopath, we were taught that endometriosis is a condition caused by a hormonal imbalance. But with recent research, what we’ve come to understand is that endometriosis is actually an immune condition or an inflammatory condition. So it does have a hormonal component. There is certainly a hormonal driver behind endometriosis. And that is estrogen, but the immune system is actually the biggest player when it comes to endometriosis. And so there are a lot of different factors that actually feed into why the immune system is disrupted in the first place. But what we what we’re finding is that inflammation, in particular, coming from histamine imbalance, and coming from genetic imbalances and gut health is some of the biggest issues that seem to be driving our immune immune dysfunction. So there’s currently not really a great testing option available for endometriosis. It’s unfortunately something that can only be definitively diagnosed with a laparoscopy, which is a type of keyhole surgery where there will be some small incisions made in the abdomen, abdomen, and then they go in with a little camera. And so if they can see the presence of these chocolate cysts, then that’s confirmative of endometriosis. But the laparoscopy at the same time can be used as a treatment. But that’s not that’s not always the best option for every woman. Because for some women who are particularly inflamed or have a strong immune activation, then the actual incision or the actual surgery itself can actually worsen endometriosis. There, they will find that they might actually get some further adhesions developing where those original cysts were removed. There seems to be more of an issue when the laparoscopy is performed with the laser where it’s actually burnt off rather than incised. And that’s that’s something that again, has only really been discovered recently, but it seems to be

5:00
You know, while it’s a good thing for some women, but not for every woman, and again, it goes to show that endometriosis is a really, really complex condition. And so because of that complexity, everyone needs to be treated a little bit differently. And we need to try and figure out the cause of what’s going on for those women. So there’s a few, you know, possible causes as to why women can have that particular immune imbalance. And one of those things is a gut imbalance, so and or an infection. So if you’ve got an infection, then your immune system is going to be disrupted. And then if you’ve got that genetic tendency for endometriosis to go wrong, then that’s where it’s going to go out of whack for you. There’s some some naturopaths in the field at the moment that are doing research in this and they’re finding that there’s actually a whole different microbiome, which is your bacteria balance within the peritoneal cavity, which is basically the fluid that our organs swim in, and also within the vagina itself within our reproductive organs. And so if they are out of balance, if that microbiome in that area is out of balance, and our immune system is going to be unhappy, and correcting that can be helpful. Dealing with infections can also be really helpful to under to address that underlying imbalance. Now, the other thing that can sometimes happen is because what we know that it’s an inflammatory condition, and there’s an immune imbalance going on, but there’s certain genetics that are involved in that issue. And I find that the mthfr gene, which is a pretty common gene to have, and it doesn’t having the gene doesn’t always mean that there’s an issue, but it’s if that gene is not acting properly, then it affects the enzyme that deals with a lot of different processes in the body. But in regards to endometriosis, in particular, it affects our our main antioxidant recycler, glue to fire recycling of glue to fire. And now, if we don’t have enough antioxidants in endometriosis, then we can’t really mop up all that immune damage that’s going on. So it makes the inflammation worse. And so then, as a result, that makes pain worse. And that can also, you know, make all those other sorts of reactions worse as well.

7:17
One of the things that we also find going on is that mthfr gene affects the detoxification of certain hormones throughout the liver. And if we’re not detoxifying our hormones effectively, then we get that recycling and that uptake of those hormones through through the system, and so then we lead to having too much of certain hormones where they shouldn’t be.

7:41
In the case of endometriosis, what we used to think, as I said before was that it was a excess of oestrogen. But in this case, it seems to be that it’s a displacement of estrogen. So there’s too much estrogen being activated in the area of the endometrial tissue lining going on. And that’s causing a reaction with some of our other immune chemicals. So one of these immune chemicals is histamine. So histamine, can you probably know about histamine as an allergic sort of issue like, you know, hay fever and sneezes and rashes, and, and all of those. Well, when are mast cells, the immune cell that causes the histamine to be in excess is actually in reaction to the estrogen. And that causes more of that inflammatory reaction. And so then, you know, you get the pain and the redness and, and those painful reactions, that’s so common with endometriosis. And as a result of the inflammation that takes place, then when there is that, I mean, immune activation in that area, that’s why we’re more you’re more likely to actually get adhesions forming. And so this can be a really big problem for women with endometriosis is that the adhesions can cause a lot of damage, they can stick for free, you can stick your organs together, you can get the uterus can be stuck to the bow or bits of the bow can be stuck together. It can, you can have the bladder being involved as well. And all of that can cause quite a lot of pain. And it can also affect fertility quite significantly as well.

9:14
Now, and adhesions do seem to have a bit of a problem and that they can only really be resolved with surgery. So as we were talking about before that surgery isn’t certainly a good option for some women, but it’s not not the first line option for every woman. It’s actually better if you can try and get on top of endometriosis in the early days. But the thing with endometriosis is that it’s actually a condition that a lot of people are getting dismissed and missed about, if that makes sense. What I mean is that women are going to and young girls are going to their doctors and they’re complaining of pelvic pain, period pain, and they’re basically getting dismissed and it seems to be about 70% of young women with endometriosis are getting dismissed and that’s a huge number 70% so if we can get on top of this condition in the early days before adhesions formed and things are going to actually work out a lot better for these women what we need to do is we need to have the funding into a better research system but we also need to have more awareness and women need to be more empowered and educated so that they can make make these make these choices make ask the right questions so i think the fact that the main testing method is a form of surgery is probably pretty off putting but we can do a lot in terms of natural treatment and dietary techniques to actually take this under control one of the things we need to do is to get our gut flora and underbalanced under control and we also need to look at reducing our inflammation levels throughout diet for a lot of women with endometriosis one of the main inflammatory things that’s going on is that they intolerant to certain foods and the key food that i find a lot of women are reacting to is is actually dairy or cow’s protein in particular and this can be you know pretty hard to give up for a lot of women but getting that out of the system can make a big big difference now we also need to look at supporting that mthfr gene which is the one that i was talking about before so the mthfr gene basically it works on a particular enzyme which is can never remember the name of it and let me find it – methylenetetrahydrofolate reductase – and basically that works on the conversion of our fault for late into its activated form in the body now it’s more than just taking folic acid in fact if you’ve got issues with this gene you probably shouldn’t be taking folic acid you should be taking different b vitamins or activated b vitamins and so this is where it gets pretty complicated because depending on what you’ve got going on with this whole methylation pathway taking methylated b vitamin can actually make you feel a lot worse because you can be methylating too fast or too slowly and so if you’re methylating too slowly and you take methyls then that’s going to make you feel like help so we don’t want to do that so that’s where you know seeing a practitioner can come in really handy but if you can get your methylation under control that does a few things it brings histamine into balance it improves your detoxification of your hormones through the liver and it can dampen that immune dysregulation and therefore inflamed inflammation that’s going on so those are some really key things that’s going on and one of the other things is that it really really really helps with your glue to fire and recycling which is what you need to mop up all that damage that’s taking place now there are a lot of other things that we want to work on with endometriosis and as we’ve said a few times get that inflammation level under control so one of my favorite things to do is Turmeric. now turmeric does have a little bit of a blood thinning properties so depending on what your your bleeding is like if you tend to be quite heavy bleeder it might not necessarily be the thing there’s something called VAGF which is basically your some women have a higher level of capillary growth to these endometrial lining and certainly doesn’t happen with everyone but actually getting improved mop up of that area can be quite helpful with certain again immune herbes and things like that as well we also want to again work on those antioxidant levels so working on methylation is helpful but herbs and nutrients that will actually help with your antioxidant levels can be helpful to one of those is n acetylcysteine or you potentially taking gluta thione itself but n-acetylcysteine is a lot cheaper and also it can be converted into the body in the body to glorify and so that’s something that can be quite helpful for people as i was talking about before in terms of diet you want to reduce the foods in your diet that you might potentially be intolerant to that could potentially cause some inflammatory reaction for you so those are some things that you want to do and you also want to work on while it’s not hormone only cause to condition it is hormonally affected so if we can work on getting estrogen detoxification under control then that’s going to help with the estrogen displacement that’s going on some people might know that sort of concept as estrogen dominance what’s really happening though is that there’s too much estrogen in the wrong place not that there’s necessarily a lot of estrogen everywhere going on because for women with with this sort of condition they might actually experience some symptoms of estrogen deficiency like you know brain fog or hair loss and skin dryness and thinning and that sort of thing but then in other instances they’re going to be experiencing symptoms of estrogen excess such as their their period abnormalities and or pms symptoms and those sorts of things so again it comes down to the individual so that’s where you know seeing a practitioner can actually be really helpful to get that under control

15:35
so i think i’ve kind of rambled a little bit there that seems to happen when there’s topics that i’m quite passionate about i guess one of the take home points that i really want to say with endometriosis is that we know a lot more about it now we know more about the immune involvement about the inflammatory involvement and so because of that we can actually do so much more for it we can actually get really better treatment happening and so if you know if you if you were seeing a naturopath for endometriosis five or 10 years ago you’d get completely different treatment most of the time now so i would say you know if you want to get some treatment ask your naturopath what they think is the main cause of it what they would do to treat it and if they’re talking about some of these new research that’s going on then give it another try because i have a lot of patients with endometriosis nowadays that i get real good success with and we follow these these routes of look at the infections that might be driving immune imbalance and support methylation support the detoxification of the estrogen but as less of a priority you got to get all those other factors under control get that inflammation down once that see improves things start to get better for them much quicker than it used to back when i first started trading where it would take you know a good half a year’s 12 months maybe to get things much better under control whereas now it’s it’s you know half a year mostly it does always depend on the person always depends on the severity of the condition as well you know for some women their endometriosis is so severe that you know surgery is what is really really required and sometimes even going on something taking something like the marina or getting the marina in is important because that actually helps to improve local progesterone in the uterus and so that can help to improve that imbalance and so if you’ve got less of that estrogen activity taking place then you get to have less of that histamine reaction most of that immune reaction going on so you know one of the first things i would say is get your gut the gut microbiome in the gut and also in the vagina under control is blackmores women’s bio balanced is a product that i do recommend as a retail option there’s also practitioner ones that i use Femex have you know a really fresh diet full of antioxidant rich foods lots and lots of veggies eat your rainbow every day those things are really really important and you also really want to get your stress under control because i mean as you know stress has a big role and a lot of different things so we’ve got this thing called the the hpa axis hpo axis hpt axis where all of our hormones are talking to each other all of the time and if there’s some other things going out of balance for instance our hpa axis which is where our adrenal glands are out of balance that’s going to throw out our hbo axis which is where we’re talking to our reproductive hormones so we want these to be under control and calm so doing some mindfulness and some meditation taking stress herbes taking all your nutrients those are really important too in regards to nutrients i mentioned in acetylcysteine i think that can be really helpful but i also do think that you need to get your core reproductive nutrients under control so that’s firstly get using copper ratio right because excess copper can affect your estrogen levels i also think that you need to get adequate magnesium for your stress levels also to reduce into smooth tissue cramping and calcium is important too you need to have that right ratio going on and i and is is really important so you don’t want to have too much iron because iron in excess can cause oxidative stress which can be inflammatory but if you’re into if you’ve got insufficient levels of iron then you’re going to be more likely to bleed more and that’s going to be a big factor for a lot of women a lot of women with endometriosis have really really heavy blades so we don’t want that that with iron that’s one of the things that i always recommend getting iron levels tested before starting supplementation and get the dose, right? I think vitamin D is important vitamin D is really important for your immune health. And I recommend getting your vitamin D levels over, over 80. You don’t want it to be higher than 150 or so.

20:19
And you also need to be considering things that are going to help to bring down your inflammation levels. As far as Herbs and so I’ve said, I’ve said tumeric, I do love tumeric. But again, you just got to be a little bit careful with it, depending on the periods. And I also think that good quality, facials can be helpful, but the same same sort of thing. Although they do they, we’ve always had this bit of a concern with fish oils is that you know, they can cause they can cause a blood thinning activity, or they could cause excessive bleeding. But some studies that actually measured the amount of bleeding that you create with officials has shown that it doesn’t seem to actually cause that greater quantity. So it’s not like you know, you’re going to bleed out or you’re going to have like massive amounts of blood loss or anything like that. Anyway, so activated B vitamins and stay away from synthetic B vitamins, and try and also stay away from foods that are fortified with synthetic B vitamins too, because while not everyone has this mthfr gene, if that mthfr gene enzyme gets unhappy, regardless of the genes presence or not, then that’s going to cause issues with all of those other factors. So it’s going to cause issues with the histamine, the hormones, the antioxidants. So all of those things that we want to work with. Thank you all so much for listening. I hope that you’ve enjoyed today’s episode. Please join me over at the Guts and Girl bits Instagram page and share any other words of wisdom that you would like to contribute as well. TGuts and Girl Bits now has a collection of E courses that you can view online. The primary course available at the moment is natural menopause support, which provides a whole heap of information on supporting yourself through the major symptoms of metaphors and easing through this transitional life. You can find the collection of E courses at ghttp://gutsandgirlbits.teachable.com. And then you’ll also find a course of understanding underactive thyroid, and coming up soon will be a courses called The Cyclical Woman, Navigating the teenage years, children’s health, nourishing the mother, and more. If you’ve enjoyed today, please leave a review and share this episode to help spread the word. Thank you

The post Endometriosis- Natural Management Options appeared first on Alison Mitchell Naturopath.

Many people are aware of some of the symptoms that PMS can cause, but PMDD, a subtype of PMS that can cause symptoms of strong anxiety and depression, is something that is less well known. It can cause symptoms which can have a debilitating effect on your mental health, and this can last for the entire second half of your menstrual cycle.

If you experience PMDD or believe you may, please reach out because this condition is something which can be helped.

If you have not had a chance to listen yet you can find the PMS podcast here.

PMS and PMDD – Podcast Interview with Lisa Costa Bir

About PMDD.

Premenstrual dysphoric disorder (PMDD) is similar to premenstrual syndrome (PMS) however PMDD symptoms are more severe compared to PMS. PMDD is associated with mood swings, anxiety, depression, low motivation and even suicidal thoughts. It is also very common for PMDD sufferers to experience relationship and work issues due to their severe symptoms.

If you experience PMDD it likely indicates that there is a deep underlying hormonal imbalance occurring in your body which is causing you to experience an emotional rollercoaster. This lasts during the time period of anywhere from post ovulation (typically day 14) to the first 2-3 days of bleeding – this means it can be two weeks of the months experiencing a completely different emotional state.

PMDD may leave you with altered emotions but there are some techniques which will help to equip yourself with self-care and wellness tools to empower and soothe.

Related: Managing PMS and PMDD with Mindfulness
Related: Natural ways to treat PMS

Self-care tips for processing PMDD feelings:

1. Practice Mindfulness

Feeling governed by your emotions during PMDD time and unable to focus? Practicing mindfulness will help you to ground down into the present moment with compassion and non-judgement. Next time you are feeling overwhelmed take a moment to sit down, close your eyes and scan your body from head to toe noticing any sensations that arise. Paying attention to your body will help you to become more aware of what is happening in the present moment as well as the ability to observe the changing nature of sensations.

2. Meditation

PMDD can lead to feelings of being scattered and spacey in the mind. In meditation, focusing on the breath will help you anchor into the present moment with a sense of being more grounded and cognitively clear.

3. Gentle Yoga Practice

Gentle forms of yoga such as yin yoga works primarily on stimulating your parasympathetic nervous system (rest and digest) to allow your mind and body to slow down into a state of relaxation. Yin yoga is a form of mindfulness that holds poses for 3-7 minutes, inviting the space to find stillness within the chaotic storm that you may be feeling during this time.

4. Earthing

To ground your energy when you are feeling restless or emotional, connect to nature by going outside, take your shoes off and touch your feet on the bare earth- this is known as Earthing. Studies have shown that this technique also helps to settle the mind by activating your parasympathetic nervous system.

5. Journaling

Journaling is a healthy way to express how you are feeling during the time of PMDD, as it can be really beneficial in clearing your ruminating thoughts and feelings. Studies have shown that this technique helps to reduce stress and manage anxiety as well as depression. Journaling can help you to become more aware of how you are feeling as well as identify negative thoughts. This holds space for you to then work on a plan for resolving problems and strengthen compassionate self-talk. Set aside a few minutes a day to write down what ever feels right- you have full creative permission in your journaling practice.

6. Gratitude list

Practice gratitude when you are feeling low in mood by writing a list of 10 things that you are grateful for in your life. Studies have shown that practicing gratitude on a daily basis helps to increase psychological well being by enhancing our positive emotions. Additionally practicing gratitude helps to boost social relationships and increases social support systems for individuals. This is very beneficial for people experiencing PMDD due to their mood affecting their relationships.

7. Epsom salt bath

Do you feel tense in your body? Treat yourself to a nourishing Epsom salt bath with a couple of drops of lavender essential oil to promote relaxation and inner serenity. Bathing in Epsom salts (magnesium sulphate) is therapeutic for PMDD as it helps to stabilise your mood as well as relieve stress, depression and anxiety.

8. Talk to someone

When you are feeling low in mood, stressed or perhaps out of control with your emotions- reach out and speak to a friend, family member or health practitioner. Remember that you are not alone, hormonal imbalance is very real and your wellbeing is a priority.

The post PMDD: Processing Feelings appeared first on Alison Mitchell Naturopath.

All of your hormones and hormonal glands have an intricate relationship with each other, giving each other feedback and having an influence on each others levels. A little bit of a one hormone going up can cause another to go down, and so imbalances can have a flow on effect which can cause many symptoms.

A major connection to consider is the link between your thyroid health and your oestrogen and progesterone levels.

We know excessive levels of oestrogen can have an impact on thyroid health, with too much oestrogen making your thyroid balance go out of whack, but how does it actually do this?

Essentially…

Oestrogen can raise thyroid binding globulin, which will lower free thyroid hormone levels.

This can be a problem for women who are on artificial hormones such as the oral contraceptive pill, or for women who have higher than normal levels of oestrogen in their system.

Typically this will show up as heavy periods and longer menstrual cycles. The increased oestrogen results in a relative deficiency of progesterone which is responsible for the thinning of the endomentrial lining. It can also impact on the coagulatory factors in the blood which control excessive bleeding.

Potenially thyroid problems can also contribute towards amenorrhoea, when your period disappears for a while.

Thyroid issues can also cause oestrogen to be bound up and carried away less than it should be, as thyroid problems can indirectly cause a reduced level of Sex Hormone Binding Globulin (SHBG) which would typically bind to excess levels of hormones such as oestrogen.

Oestrogen imbalance can be the missing piece of the puzzle for many women (and men) who have issues with T3 balance. It is a cycle that feeds itself until the original cause of the thyroid imbalance or oestrogen excess is addressed.

High Oestrogen -> Increased thyroid binding globulin -> low free thyroid hormone levels.

Low Thyroid Function -> Low SHBG -> High Oestrogen

An interesting action of oestrogen is that it can increase the proliferation of thyroid cells. This isn’t always a bad thing, as it can be helpful to regulate thyroid function and help the repair of the thyroid gland when oestrogen is in normal ranges. However in excess this could result in an increased risk of autoimmune thyroid disease or thyroid cancer.

Now we know that oestrogen isn’t the only female hormone. Progesterone is another important hormone for women, and it too has a connection with the thyroid hormones.

The thyroid – progesterone connection goes two ways. Thyroid helps stimulate release of progesterone from the luteal cells. Given this, we can consider that for some women who appear to have progesterone deficiency they may have underlying issues with their T3 hormone as the cause.

And progesterone deficiency can impact on the conversion of T4 to T3 via reduced deiodinase 2 activity. So for women who are post-menopausal, who have had an oophorectomy (ovaries removed surgically) or do not ovulate regularly (e.g in Hypothalamic Amenorrhoea or PCOS) the state of their thyroid is something to consider.

Imbalances in both progesterone and oestrogen can impact your immune system balance which can increase your risk of autoimmune disease, an issue which is common for thyroid problems.

If you suspect that you have an issue with your hormones and would like some holistic support or perhaps you would like to discuss testing options, contact your health care practitioner to discuss your options.

Book an Appointment

Extra reading

Your Thyroid Needs Iron

Heavy Periods

MTHFR and your Thyroid

Thyroid Problems After Having a Baby

Thyroid Health – Part 1

Understanding Underactive Thyroid – Webinar

References

Role of estrogen in thyroid function and growth regulation.  https://doi.org/10.4061/2011/875125

Clinical review: Thyroid dysfunction and effects on coagulation and fibrinolysis: a systematic review. https://doi.org/10.1210/jc.2007-0199

An evidence for the transcriptional regulation of iodothyronine deiodinase 2 by progesterone in ovarectomized rats. https://doi.org/10.1007/s13105-013-0307-y

Menorrhagia and hypothyroidism. Evidence supports association between hypothyroidism and menorrhagia. https://doi.org/10.1136/bmj.https://doi.org/10.1136/bmj.320.7235.649

Menstrual disturbances in various thyroid diseases. https://doi.org/10.1507/endocrj.k10e-216

Thyroid disease and female reproduction. https://doi.org/10.1111/j.1365-2265.2007.02752.x

The post Thyroid Problems and Oestrogen appeared first on Alison Mitchell Naturopath.

Do you have heavy periods? It can be a sign of a deeper imbalance.

Whatever a woman is seeing me for as a naturopath, whether it’s anxiety and stress, tummy issues, weight loss or skin health, I always ask her about what her periods are/were like. That’s because just like the digestive system, the subtle variations of your period and cycle can reveal a lot about your hormonal status and this can have a big effect on overall health.

For instance: Did you know that your balance of progesterone and oestrogen can affect your immune system? And your sleep, your mood, and your digestion? It makes sense when you realise how much your hormones do in your body, that having imbalances in your hormone levels or not ovulating properly (such as in PCOS, amenorrhoea or when using hormonal contraception like the Pill) can have a big flow on effect to the rest of your health.

So if your period is not regular, goes for too long, or is too heavy, clotted or painful, this can be a sign that something is out of balance. Many women don’t realise that their heavy periods are not something they need to ‘put up with’, and that help is available to them. I have seen herbal medicine and nutrition work well with heavy periods, usually causing a big effect within the space of a few months. In some cases, there may be something more complicated going on (such as a clotting disorder, severe endometriosis or fibroids) which can benefit from conventional medicine alongside natural medicine.

What is a normal flow

Anything greater than 80mL of blood lost in a period (which equates to roughly 16 or more soaked pads or tampons) or a period longer than 7-8 days is considered to be a heavy flow. If you are using a menstrual cup, you can use the markings within this to count how much blood you are losing during your period, however if you are using pads and tampons you can count how many you are filling up. Many women with a heavy flow are put off from the idea of using a menstrual cup because they will have to change it during the day, or are worried about leaking, however this can be backed up with liners or absorbent underwear such as those from Modibodi. I have written about this before here.

If you experience any of these signs, you may have a heavy flow:

1. Having to change a pad or tampon every hour or less.
2. Filling 16 or more pads or tampons each period.
3. Leaking while wearing pads/tampons, despite using a high absorbency.
4. Bleeding for more than 7-8 days
5. Regularly passing clots that are larger than a 50c coin.
6. Needing to change your overnight pad once or more during the night, or leaking through onto the bedsheets.

If you need to back up your menstrual cup or tampon with a pad, consider using period absorbing underwear. They are designed with technology that helps to wick moisture and smell, and can be a much more comfortable option for women who dislike wearing pads. They’re also environmentally friendly!

Got Clots?

Why so heavy?

Iron deficiency

Oestrogen dominance

Clotting disorders

Some clotting disorders can cause a women to experience very heavy periods. If your periods are heavy from menarche (when you first got your periods) it is a clue you may have a genetic clotting disorder, for example von Willebrand’s disease. If you have a family history of this condition or you have had heavy periods from a teenager, it’s a good idea to get yourself screened by your doctor for this condition, as specific medication may be required.

Fibroids

Schematic drawing of various types of uterine fibroids: a=subserosal fibroids, b=intramural fibroids, c=submucosal fibroid, d=pedunculated submucosal fibroid, e=fibroid in statu nascendi, f=fibroid of the broad ligament

Fibroids are a non cancerous growth within or attached to the outside of the uterus that can range in size anywhere from the size of a pea to the size of a melon.
They are not fully understood but often will respond to hormonal treatment that reduces oestrogen excess, along with herbs that target the excess tissue growth.
Depending on the size and location of the fibroids they may need to be surgically removed, for instance if they are in a position that blocks the cervix affecting fertility. A lot of the time fibroids will not cause any significant problems and may not need treatment.

Menopause

All women experience menopause differently, and for some they may find that their periods become very heavy in the early stages of menopause. This may respond to uterine astringent herbs in addition to herbs to support the menopausal transition (commonly this may be herbs to help with stress and oestrogen balance).

What to do about it

Address the cause

It’s always a good idea to rule out serious issues first, so see your doctor for a pap smear, and potentially further testing such as an ultrasound and a blood test that can look for clotting issues, iron deficiency or other causes of heavy bleeding. Having identified the cause, you can begin to fix the problem with natural, and/or conventional medicine.

For some people the bleeding is SO heavy that an endometrial ablation may be necessary. This is when the lining of the uterus is destroyed and removed, so that a the periods are much lighter or absent. This is not ideal if you are wishing to have children, have had a caesarean section, or cancer of the uterus, cervix or endometrium.

Herbal medicine

CC BY-SA 2.5, Link

If you want to reduce your heavy periods without surgery or going on the pill, you can consider using herbal medicine. It’s best if you can see a herbalist or naturopath who can guide you through the process of addressing the cause of the heavy bleeding and can make a herbal formula specific to you. There are herbs that can help heavy periods such as Shepherd’s Purse, Beth Root, Tienchi Ginseng and Squaw Vine, can be helpful to reduce the heaviness of the bleed.

How long will treatment take

I find that heavy periods will typically respond to herbal medicine within the first cycle with a slight reduction of flow, however it may take a few months to achieve a more “normal” flow. This may be longer if the bleeding is caused by a condition such as endometriosis or fibroids.

The post Heavy Periods appeared first on Alison Mitchell Naturopath.

Insights from the Endometriosis Symposium

I recently attended the ATMS Endometriosis Symposium, and boy did I nerd out. I have always had an interest in women’s health and period pain, having dealt with my own personal issues in this area but also because I have seen countless women who were dismissed, told to ‘put up’ with their pain, or given medication that the woman didn’t feel comfortable with.

During the seminar I went from feelings of excitement about the emerging research and treatment possibilities, to frustration that there is still so much we don’t know, to sadness about the extent to which this condition can affect a woman’s life, and anger at the issues women face in seeking effective diagnosis and treatment. A key statement during this Symposium was that women with endometriosis were frequently ‘missed and dismissed’.

What is Endometriosis?

For those that have never heard of endometriosis before, it is a condition that is currently considered to be an inflammatory disease where women can experience extremely painful periods, and 1 in 3 women with endometriosis have fertility difficulty. It is diagnosed when the tissue that is normally present in the lining of the uterus is present elsewhere, such as within the pelvis however it can possibly travel elsewhere in the body.  The only way to definitively diagnose endometriosis with via a laparoscopy, a surgical procedure, however for many women the diagnosis of endometriosis is suggested without having a laparoscopy, particularly is the risks associated with the surgery outweigh the benefits of the diagnosis.

I have written about endometriosis before here, however I would like to expand on some of the points made previously and discuss some of the newer information I received from this seminar.

A key point to remember is that endometriosis is a complex condition that we still don’t 100% understand or know the best treatment for, however we do know that holistically addressing the condition by working on it like a jigsaw puzzle provides better results.

The importance of a good laparoscopic surgeon, and excision vs. ablation.

One of the key speakers, Professor Jason Abbott who is one of the leaders of surgical treatments for Endometriosis in Australia imparted the importance of seeking an advanced laparoscopic surgeon if choosing to undergo a laparoscopy, and discussed his preference for excision (cutting) rather than abalation (lasering off of tissues), something that will hopefully become more commonplace as research supports this as well.

Neither pregnancy nor hysterectomy will cure endometriosis

If you’ve got endometriosis, chances are you’ll be told to get pregnant to cure the condition. Or maybe to have a hysterectomy.

Well unless either of these options are just what you want to do, don’t rush into it! It seems that neither option really provides long lasting relief, as the underlying causes of the condition will not be addressed and symptoms can come back, or still exist.

In the case of pregnancy, many women will find that not having a period for 9+ months is a welcome relief, and the hormonal and immunological shifts that occur during pregnancy also allow many endometriosis symptoms to ease. But the condition can come back, especially if the condition is driven from an imbalance in your immune system or pelvic muscles.

A hysterectomy should theoretically address endometriosis, but unfortunately many women with endometriosis experience problems that aren’t directly related to their period and so these issues can remain. Bowel problems, muscular problems and hormonal imbalances can still persist.

Nerve or Muscular issues in the pelvis can drive endometriosis

Having worked alongside osteopaths my entire naturopathic career I am well versed in the impact that tight muscles or structural imbalances can have on internal health. Seeing the ways that pelvic muscle tightness and nerve signalling issues can contribute to endometriosis was a lightbulb moment, as for many of my patients I have felt there was something ‘missing’ in my understanding of their complete picture, and I think this was it.

A physiotherapist who specialises in women’s health can assess the internal muscles of the pelvis to assist with conditions such as vulvodynia (pain in the vulva), dyspareunia (pain during intercourse) and dyschezia (pain with bowel motion), but it can also be extremely helpful for those with endometriosis. In my clinical experience I have also found that chronic vaginal and bladder infections may benefit from a women’s physio, as tight pelvic floor muscles can cause ongoing inflammation and tension which affects the bladder from eliminating properly.

think about what a muscle cramp in your foot or your calf feels like, then imagine this feeling as happening inside your pelvis or the vagina. The normal contraction and relaxation of a muscle allows blood to flow through, but if the muscle does not effectively contract and then relax it can cause hypoxia (reduced blood flow) which is itself very painful, and it also makes the pH of the muscle more acidic. In itself this can cause pain, but the lightbulb moment for me was realising the way this sort of issue can feed, and be fed by the inflammatory nature of endometriosis.

The constant pain in the pelvis that occurs in something like endometriosis can sensitise the nerves, so that even things which aren’t normally pain can become unbearable. The sensitised nerves can make you more likely to get pelvic pain, period pain and bladder pain, and there is actually an increase of inflammatory chemicals being produced, which worsens endometriosis, an inflammatory based condition.

On a side note, vulvodynia and dyspareunia, like endometriosis is an issue that many women feel ‘missed and dismissed’ about. These problems can have big impacts on a relationship. There may be an issue with the skin such as in chronic candida or lichen sclerosis  or there may be nerve sensitisation worsening the muscle spasms and pain signalling. If you experience these issues, or if your pelvic pain occurs at times other than ovulation and menstruation, consider that there may be a muscular component. If you experience pain when your bladder is full, then again when you have finished weeing, or pain during intercourse, a women’s physio may be able to help you.

Women with Endometriosis have a different type of immune system

There are many different types of cells with different responsibilities within our immune system, and the interplay between all of these can determine whether someone can fight off infections well, or if they are more prone to inflammatory type reactions. For women with endometriosis there have been an increase of some types of immune cells and inflammatory chemicals observed, and less activities of some immune cells which are responsible for ‘keeping things in check’. Interestingly, there is also communication between the hormones progesterone and oestrogen and our immune cells, and as women with endometriosis tend to experience progesterone resistance, the type of immune cells that these hormones normally work on are not able to be reined in.

Bacteria may affect endometriosis

The balance of bacteria within our digestive system has a dramatic effect on our immune system. Normally it can affect things such as how well we can fight off infections or whether we are likely to experience an allergic reaction, however for women with endometriosis there is also a reaction that occurs that worsens their inflammation.

On the coating of some bacteria there are substances which can break off, and the immune system reacts to this by releasing a lot of inflammatory chemicals. This substance is known as endotoxins, or lipopolysaccharides (LPS) and has been shown to be present in higher quantities in women with endometriosis, and the LPS works hand in hand with the higher levels of oestradiol  to then increase certain inflammatory chemicals.

The link between the gut bacteria and hormonal actions and subsequent severity of endometriosis is interesting. If there is an imbalance of good and bad bacteria (dysbiosis) which is very likely for those with endometriosis, it appears to be a key player that needs to be addressed for a holistic approach to endometriosis.

One of the papers referenced suggested that “there may be a direct link between pathological changes of the gut microbiota and the onset and progression of endometriosis”.

Addressing the gut bacteria can improve the severity of endometriosis, as this reduces inflammation and improves immune regulation. Specifically, using herbs that are antimicrobial to gram negative bacteria (such as those containing berberine) and using herbs and nutrients to support digestive lining health and motility, as well as promoting the presence of good bacteria are helpful treatment aims.

The role of histamine

Histamine is a chemical that works in a lot of different areas in the body. It acts a neurotransmitter affecting mood, and it is involved in immune and inflammatory responses. It’s well known for it’s role in allergic responses, causing dilation of blood vessels and stimulating white blood cell activity.

Histamine also has a role in endometriosis and period pain, as high levels of histamine stimulation oestrogen, and also feed the growth of dysbiosis. Oestrogen feeds back into this cycle by reducing the DAO enzyme, which is responsible for clearing histamine, and stabilising mast cells, one of the main white blood cells involved in the histamine response. There is also a stimulation of a chemical called VEGF (vascular endothelial growth factor) which causes the endometrial cysts to grow faster, and attracts more inflammation.

Methylation, involved yet again

Once again, methylation rears its head and as player. I have spoken about methylation before here and here, and while I consider it important to understand the role it has when not working properly, I firmly believe that addressing methylation by itself won’t solve everything.

Problems with methylation can worsen inflammation pathways, and dysbiosis can worsen methylation. Methylation problems can also affect oestrogen levels, histamine processing, and sensitivity to chemicals and toxins (such as mould, viral infections and parasites), all of which affect dysbiosis, immune balance and the inflammation levels.

Where to go from here?

It may seem confusing and overwhelming, realising how much is going on that needs to be addressed. That is completely understandable, but if you are able to find a naturopath or other health care practitioner that can help you, they will be able to guide you in your health journey. Ideally, having a team of practitioners such as a GP, a naturopath, a women’s physio, an acupuncturist and a gynaecologist and/or advanced laparascopic surgeon will mean that you are getting all your bases covered.

The first thing that should be address is pain. After the level of pain is scaled down to a bearable amount, then looking at the drivers of the condition such as gut health, diet, immune imbalance, infections, methylation, stress etc can be done.

Not everyone may want to or be able to afford the testing that can be done to get a clearer picture of the underlying imbalances and that’s okay. Your practitioner should be able to get a lot of information and ideas as to what needs addressing from a thorough case history.

The decision of what form of treatment to use is also very individual, and entirely up to you as the patient. I have not gone into detail about the forms of treatment, but there are many different options in terms of natural medicine, a variety in conventional medicine as well. Natural medicine can potentially be used alongside conventional medicine, or on its own. This is always something that is best discussed with your health care practitioner.

Resources:

Endometriosis Australia

The post Updates on Endometriosis appeared first on Alison Mitchell Naturopath.

Vitamin D really is the wonder nutrient at the moment. A quick search of PubMed shows there to be almost 60 000 studies on vitamin D alone, and over 7000 of these are on vitamin D and cancer. Most of us already know about how Vitamin D is important for our bone health, but did you know it’s also important for our immune system and to protect us against cancer, particularly breast cancer (among many other things)?

Let’s take a quick look at the properties of vitamin D.

• It supports the assimilation of calcium into our bones
• It’s important for our immune system – it ‘switches on’ our immune cells to help us fight infections, but also helps us deal with auto-immune conditions and ‘foreign invaders’
• It regulates inflammation levels
• It is involved in some hormone metabolism pathways
• It is involved in our blood sugar level control and metabolism

Looking at the effects of vitamin D, it makes sense how it can also play a role in reducing our risk from cancer. But by how much does it reduce our risk? Well, the answer seems to be : a lot.

Let’s take a look at some of the research:

A 2012 study performed in Pakistan analysed the Vitamin D levels of 180 women, 90 of which had recently been diagnosed with breast cancer. In the group who had been recently diagnosed 95.8% of them were deficient in Vitamin D, compared to 77% of the women with no cancer diagnosis. This not only shows the huge prevalence of Vitamin D deficiency, but also highlights an important association between low Vitamin D levels and increased breast cancer risk [1].

It was originally thought that Vitamin D was only able to be fully metabolised in the kidneys, however studies from 2001 and on have shown that breast tissue also has the ability to metabolise Vitamin D, which may be why Vitamin D has such as affinity for breast cancer. [2]

Vitamin D may be so protective against breast cancer for many reasons.  A sub-type of Vitamin D (1,25(OH)₂D) has anti-inflammatory properties, helping to reduce the production of a chemical called prostaglandins (many people know this chemical to be a cause of period pain) which have been implicated in breast cancer. [2]

A population study published this year analysed a group of women, 593 with breast cancer and 580 who were cancer-free (controls). They found that 96.1% of the women with breast cancer had severe vitamin D deficiency, compared to 80% of the women without cancer. Similarly to the first study there was a significant Vitamin D deficiency across the whole population, but what was most interesting was the data showing the inverse association between Vitamin D and breast cancer – essentially the higher the levels of vitamin D they had, the lower their risk of breast cancer [3].

The benefits of sun exposure may be due to more than just Vitamin D, particularly for some other types of cancers.  A systemic review of studies analysed the link between vitamin D levels, sun exposure and risk for various types of cancer.  It found that higher blood levels of Vitamin D reduced the risk of breast cancer as well as colorectal cancer, but not as much for non-Hodgkin’s lymphoma and prostate cancer (however longer sunlight exposure was more beneficial for these cancers).    Long-term or ‘chronic’ sun exposure compared to short-term or ‘intermittent’ sun exposure reduced the risk of all the cancers analysed.  This may be due to a variety of factors such as the suns effect on our circadian rhythms and melatonin production [4].

Interestingly melatonin, a hormone controlled by our exposure to light and dark (among other things) which manages our sleep cycles is also a potent anti-oxidant that is protective against breast cancer.  Some research has shown that people with disrupted melatonin such as shift workers have a significantly increased risk of cancer, particularly breast cancer [5] [6]. Melatonin is helpful as it repairs our DNA from oxidative damage and inhibits tumour cell formation, but it also reduces the tumour developing affect of excessive oestrogen, encourages the immune system to recognise the cancer calls as being foreign (cell differentiation) and then destroy them (apoptosis) [7], [8], [9].  Vitamin D has also been shown to have these properties [2]. So not only do we need to have plenty of Vitamin D, but we should also get plenty of decent sleep!

How much Vitamin D do we actually need to prevent breast cancer?  Aim to get your blood levels of 25(OH)D around 100 ng/mL, but not higher than 150 ng/mL [2].  Even though this is much higher than what is considered to be normal or not deficient by pathology reports, people with these levels had the lowest risk of breast cancer [3].  Keep in mind that Vitamin D levels vary according to season, so in Summer our levels should be even higher again (about 120 ng/mL).  How supplements are administered varies a lot between health professionals, from big weekly/monthly doses of 50 000IU to frequent daily doses of 600IU.  It doesn’t seem to matter, as long as the cumulative amount of Vitamin D is high enough to get your levels up.

Vitamin D supplementation is generally very well tolerated.   Most reports suggest that the toxicity threshold is 10,000–40,000 IU of vitamin D per day [10] however this is based on the fact that these are the upper limits of what have been studied and no toxicity has been found with these, so as yet an actual toxicity limit has still not been found.

From these studies it seems clear that having good Vitamin D levels is without doubt an important way to reduce breast cancer risk, however studies analysing the benefits of Vitamin D supplementation in women with later-stage breast cancer show inconclusive results, but the studies in this area are limited [2]. So far, it seems that Vitamin D is better at preventing breast cancer than treating it.

While there were some flaws in some of the studies, such as an insufficient pairing of the study groups and not analysing all the forms of vitamin D, we can see from this research that there is definately a connection between low levels of vitamin d and an increased risk of breast cancer. I cannot stress this enough – Do not take it for granted that you spend time in the sun and therefore should have enough Vitamin D. Get your Vitamin D tested (you may have to pay for the test, but surely knowing the importance of vitamin D it is worth it?) and if your vitamin D is not over 100 ng/mL then you should consider supplementing – consult a health care practitioner trained in nutrition such as a nutritionist, dietician or naturopath for advice on which supplement is right for you.

Previous posts on Vitamin D:

Vitamin D and Allergies

Vitamin D Newsletter

Vitamin D and Asthma

The post Vitamin D reduces breast cancer risk appeared first on Alison Mitchell Naturopath.

This article follows on from the previous article, which discussed the thyroid gland and the differences between and over and underactive thyroid. In this article I am talking about how an issue with the thyroid can cause imbalances in the rest of the endocrine system, in particular the endocrine system.

Thyroid Health

 The endocrine system

Endocrine is the term used for the complex system of glands and their secretions (hormones).  The endocrine system includes the glands (pituitary, thyroid, para-thyroid, adrenal and pineal) as well as organs and tissues which are able to produce hormones (fat tissue, the hypothalamus, ovaries, testes, pancreas, thymus, kidneys, stomach, liver, small intestine, skin, heart and placenta).  There is a cross-over between different systems such as in the digestive system which includes organs also classed as endocrine.

 In the previous newsletter I gave you an overview of the thyroid and the differences between hyperthyroidism and hypothyroidism.  In this newsletter I want to give you some information about the ways in which the thyroid can affect the endocrine system over all.

 The endocrine system is all connected and an imbalance in one particular organ or gland can disrupt everything else.  One of the biggest ways that we can see this is looking at the impact of stress.  Have you noticed that when you’re stressed you’re more likely to catch a cold (remember the thymus is an endocrine organ and has a big role in our immunity), break out (the skin is responsive to hormones, pumping out more oil to feed the bacteria that causes acne) and your digestive system can get upset too(the stomach, pancreas and liver are all endocrine organs)!

Thyroid health and the reproductive system.

The thyroid gland is another big player in keeping our endocrine system balanced.  One of the most common things that an unhappy thyroid will affect is the reproductive system.

In both men and women hypothyroidism can affect libido. In men, they may experience infertility and mpotence.  In women they may experienced an irregular menstrual cycle or irregular bleed.  Fertility is also greatly affected by the thyroid gland especially in women with autoimmune thyroid disease.  It may result in not being able to conceive altogether or an increase in miscarriages.  In women of fertile age, autoimmune thyroid disease is the most common cause of hypothyroidism.

How?

• A reduction in thyroid function will leave to elevated TSH, and depressed secretion of dopamine, leading to elevated prolactin levels.
• Elevated prolactin levels, also known as hyperprolactinaemia is implicated in 1-3% of women with problems ovulating.
• Hypothyroidism interferes with an important hormone for the development of the egg and ovulation – gonadotrophin-releasing hormone (GnRH).
• Hypothyroidism can lead to a delay in luteinising hormone (LH) which causes ovulation and stimulates the secretion of progesterone.  Because of this is can cause a reduction in progesterone synthesis.
• Thyroid antibodies which can be present in both hyperthyroidism and hypothyroidism can affect fertility due to it’s impact on implantation and increasing the risk of miscarriage.  In some people antibodies
  can be present without having any signs of thyroid dysfunction.  Thyroid antibodies can be managed with herbs that modulate the immune system.

Thyroid dysfunction affects the hormones needed for healthy egg development and ovulation, which affects fertility and creates an imbalance in other reproductive hormones.

If you are having difficulty conceiving it is important to assess thyroid function and screen for the presence of antibodies to rule out any complicating involvement from this gland.

If you believe that you have a thyroid problem, don’t despair.  We can assess for and manage a thyroid imbalance using safe, effective natural remedies.

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