By Dr. Katheleen Mahannah, ND
“Hormone Imbalance” is a broad, general term that can describe a myriad of symptoms in women or men (although in this podcast, I’ll be focusing on women). Sometimes, hormone imbalances occur during hormone transitions in life. Think of puberty: major shifts are occurring hormonally, leading to symptoms like acne, moodiness, or irregular periods. Later in life, menopause is another period of transition: symptoms like hot flashes, insomnia, mood swings, anxiety or depression, or difficulty losing weight are all signs of changing hormones. Pregnancy and post-partum are other examples of major hormonal shifts in a woman’s body that comes with its own array of physical changes and sometimes symptoms.
What hormones can be imbalanced, and what do the symptoms look like?
Aside from these life stage hormone transitions, there are other hormone imbalances in women that can sometimes cause bothersome symptoms or more serious problems. There are many important hormones in our bodies; a few that we focus on typically include, but are not limited to: estrogens (estradiol, estriol, estrone), progesterone, androgens (including testosterone and DHEA), cortisol (the “stress hormone), thyroid hormones, and insulin. When problems arise with these hormones, they can manifest in many different ways, such as:
PCOS (Polycystic Ovarian Syndrome), endometriosis, infertility or difficulty conceiving,
Symptoms related to the stress hormone cortisol: feeling exhausted, tired all the time, difficulty falling asleep at night, weight gain around the middle,
Bothersome PMS: moodiness, depression, anxiety, irritability, or physical symptoms like breast tenderness, or water retention.
Skin problems related to testosterone: acne breakouts as an adult, especially around the chin or jaw or right before the period,
Period problems: absent period, irregular period (<21 days or <35 days), excessively heavy bleeding
Thyroid hormone problems: hypothyroidism, hyperthyroidism, difficulty losing weight or weight gain, burnout, hair loss, or dry skin.
How do you test these hormones?
If you are experiencing bothersome symptoms that you think may be related to a hormone imbalance, it is important to speak with your family doctor or your Naturopathic Physician about your testing options. Blood testing is useful for examining thyroid function, and certain hormone conditions related to estrogen, progesterone and testosterone, and cortisol in some cases.
One challenge with hormone testing in females is that a woman’s hormones can vary dramatically depending on what day she is at in her monthly cycle. Indeed, female hormones can fluctuate hourly, not just monthly. For this reason, we often aim to do blood testing on particular days of her menstrual cycle, or sometimes at a particular time of day.
In some cases, a Naturopathic Physician will utilize functional testing to examine the fluctuations and changes of a woman’s hormones in greater detail. Functional testing uses urine or saliva samples to examine estrogens, progesterone, cortisol, and androgens. Cortisol, the “stress hormone,” is another test that can be performed using blood, or saliva. A blood test will help identify any major diseases or pathologies; however, for women who experience fatigue, burnout, weight gain, difficulty sleeping, or other cortisol dysregulation symptoms, these may not be reflected in a blood test. Again, functional testing using a “4 Point Salivary Cortisol Curve” can be useful to help identify cortisol problems that aren’t OVERT disease processes, but are contributing to bothersome symptoms.
How can women get access to hormone testing? Is it covered by MSP or extended medical testing?
I encourage women to speak to their health care providers or their Naturopathic Physicians about their symptoms, and have a discussion about what testing might be helpful from a medical perspective, and speak to an ND about functional testing options. Naturopathic visits are covered by most extended medical benefits these days, and many of them will also help to cover naturopathic or functional testing. I always encourage my patients to speak directly to their extended medical providers to see what exactly they can cover.
How would you go about treating hormone imbalances as a Naturopathic Doctor?
This is the fun part! The reason I like to use testing is because then we can better identify the underlying cause of the problem, and specifically choose treatments that will target and address that problem. Each woman is unique. Her life circumstances, diet, stress levels are unique, and her particular hormonal picture should be treated uniquely. I could do a whole podcast on each of these topics, so I will explain my approach broadly here:
Firstly, I examine the diet, and add in foods and specific nutrients that support hormones. For example, foods to support thyroid function, like seaweeds (iodine) or Brazil nuts (selenium). Or, incorporating more healthy fats, because cholesterol is the backbone of our sex hormones (estrogen, progesterone, androgens)! I often prescribe coconut oil, avocados, extra virgin olive oil and nuts/seeds as part of a nutrition plan.
I will examine the diet to look for foods that might be impairing hormones, such as high sugar, excess white refined flour, processed foods, to name a few.
Discuss bathroom habits, to ensure that they have healthy digestion so that they can actually absorb their nutrients. If she has symptoms of Irritable Bowel Syndrome (IBS), or inflammatory bowel disease, then I’d look more at supporting the gut.
Look at the lifestyle. When we are very stressed, it can impact our hormones. I talk to my patients about incorporating stress-reducing activities into the routine to support hormone health: things like meditation, or yin-style yoga, or getting out into nature for a walk or a hike. Exercise, especially aerobic exercise has been shown to reduce PMS, and waking in nature has been shown to reduce blood pressure and cortisol. We’ll be chatting in another podcast about treating stress and burnout, so stay tuned for that episode!
In addition to the diet, I often incorporate herbs and specific nutrients into my treatment plan. Again, any interested listeners/readers should speak to a Naturopathic Physician before adding herbs to their routine, as some of them can interact with medications. Some examples of my favourite herbs for hormone support in women include:
Chaste tree for period problems like irregular or absent periods
For PMS: chaste tree, vitamin B6 or a B complex supplement, and calcium
For stress and cortisol problems: ashwaganda, licorice (but not for women with high blood pressure, as licorice can increase blood pressure), vitamin C, B vitamins
For perimenopause: Black cohosh and valerian root for night sweats, ashwaganda for energy, maca to support libido,
For hypothyroidism, we might add zinc, selenium, iodine, vitamin D, ashwaganda to support thyroid function.
Prescribe Bioidentical Hormone Therapy (BHRT), when needed. For some women, using BHRT can be incredibly helpful in treating hormone imbalances. As a Naturopathic Physician, I’m trained to prescribe medicine including BHRT, and will have thorough discussions with women to help them decide whether this is a safe and effective option for them.
Acupuncture for hormone balance. As a Naturopathic Physician, I have been trained to perform acupuncture on my patients. I frequently use this in many of my female patients to support hormones and fertility.
Overall, my approach to treating hormone imbalance includes a thorough assessment through discussion, physical exams, and appropriate testing. For there, I use the best of natural and modern medicine to help women feel better, energized and vibrant. For more information about hormone testing and treatment, you can reach me through my website (drkathleenmahannah.com), subscribe to my women’s health and natural medicine blog, or find me on Facebook or Instagram (@dr.kathleenmahannah).
Dr. Kathleen Mahannah is a Naturopathic Physician practicing in her hometown of North Vancouver at Restoration Health Clinic. Dr. Kathleen takes an integrative approach to her practice, using the best of natural and modern medicine in her main areas of clinical focus: women’s health, hormone balancing and digestive health. For more information about hormone testing or Dr. Mahannah’s practice, please visit www.drkathleenmahannah.com or follow her on social media @dr.kathleenmahannah