Everything You Need to Know About Hormones - From PMS to Menopause
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For most women, a lot of us don’t have any understanding of our hormones. Or what information we do have about our hormones is often based on myths and stereotypes. We might think that PMS is normal, that cortisol is always bad or that there’s no way to test our hormones (all false, by the way!)
Whether you’ve been on the path to wellness for a while and are looking to deepen your knowledge, or you’re brand new to better caring for your mind and body, I’m here to guide you on the way…
In this blog, I’ll walk you through everything you need to know about your hormones, from PMS to menopause. You’ll learn:
What supplements to take at each season of life
What PMS really is and what causes it
How hormones change during pregnancy and postpartum
What hormone imbalances cause infertility
How hormones affect weight gain
Exactly what menopause is and common myths
This is a big one, but it’s full to the brim with information you absolutely need if you’re serious about reclaiming your health. Let’s dive in!
WHAT SUPPLEMENTS SHOULD WOMEN TAKE AT EACH SEASON OF LIFE?
REPRODUCTIVE YEARS: a multivitamin or prenatal multivitamin, fish oil, probiotic, and vitamin D with Vitamin K. Magnesium is also very beneficial and often overlooked!
PREGNANCY: a prenatal multivitamin, DHA fish oil for the development of baby’s brain, probiotics, Vitamin C for immune support, Vitamin D with Vitamin K and magnesium.
PRO-TIP: Usually women need more magnesium during pregnancy to improve digestion and release muscle tension and also more iron. It’s really important that your provider check iron and ferritin levels more than once or twice during pregnancy! Beef liver supplementation is a great way to keep iron levels healthy without risking iron overload.
POSTPARTUM: a prenatal, fish oil, Vitamin D with Vitamin K, magnesium, probiotics and herbs that are safe during pregnancy including Ashwaghanda and Avena sativa or milky oats to help with energy, breast milk production, stress and tension.
PRO-TIP: Iron-containing supplements can aggravate the baby if you’re breastfeeding, so you may opt out of the multivitamin that has iron and supplement with beef liver whether in food or supplement form.
PERIMENOPAUSE: Ah, this is a wonderful time when everything goes haywire! Perimenopause is a phase when hormones start to fluctuate and women between the ages of 35-50 start to experience symptoms of hair loss, water retention, fatigue, menstrual cycle irregularities and libido changes. It’s good to have the basic supplements as in previous phases of life, then include the following if needed (I highly recommend testing levels first):
Adrenal support to help maintain optimal cortisol and sex hormone levels
DHEA
Phytoprogesterone herbs that mimic progesterone like Vitex or wild yam root. Wise Women Herbals has a great blend.
PRO-TIP: Progesterone decline in women in perimenopause is one of the leading reasons for symptoms of hair loss, mood swings, irritability, and irregular, skipped, painful, and heavy menstrual cycles.
Maca or Ashwaghanda to aid with declining libido and testosterone levels
DIM-IC3 to help improve estrogen metabolism and combat elevated estrogen levels that some women experience during this time
MENOPAUSE: This is when a woman has not had a menstrual cycle for at least 12 months. In addition to the foundational supplements mentioned above (multivitamin, Vitamin D+K, probiotic, magnesium, and fish oil), women in menopause need to make sure their calcium levels are optimized and may consider doing a DEXA scan to check for bone density changes before supplementing with calcium and other minerals.
To relieve symptoms of hot flashes and vaginal dryness women can consider S-equol (soy derivative), black cohosh, ground flax seeds and alfalfa all of which mimic estrogen and can provide relief. Women can also include phytoprogesterone herbs mentioned under perimenopause. Maca can also be a great herb to include during this time as it can help increase declining hormone levels. Other things to consider with menopause include:
PRO-TIP: if women don’t start on estrogen replacement therapy within the first 10 years of menopause, unfortunately, they shouldn’t start at all.
Julva Cream by Dr. Anna Cabeca is an excellent vaginal cream for any vaginal dryness women may experience
DHEA hormone may be necessary to incorporate at this time
Serovital is a great supplement for improving growth hormone levels and can help with sleep and overall wellbeing in menopause
POST-MENOPAUSE: This is when a woman has not had a cycle for over 12 months. The line can be blurry between menopause and post-menopause, but essentially similar supplements would be appropriate at this season.
PRO-TIP: Review this list of a la carte supplements. The above listed supplements are foundational and relevant for most women but the following are more specialty based on your body’s unique needs:
Digestive enzymes
Thyroid support such as zinc, Vitamin A, selenium and iodine
B-Complex may be necessary in addition to a multivitamin depending on energy status
Melatonin for sleep
NAC, Liposomal Glutathione and Liposomal Vitamin C to support the immune system
Electrolytes
L-Tyrosine for restless leg syndrome as many women suffer from this
Hair, skin and nail vitamin such as Luminous by Vitaminca
Nutrafol supplement and Biotin for hair loss
Collagen
Before we go any further, let's differentiate between progestin and progesterone! You’ll hear me reference progesterone a lot so this is important to know…
Progestin is the synthetic form of progesterone and bio-identical progesterone mimics our body's natural progesterone.
However, progestin is typically used in birth control and has negative side effects including: increased risk of blood clots, bloating, acne, excess facial hair growth, and increased risk of breast cancer, especially when combined with estrogen replacement therapy in menopause.
On the other hand, progesterone is cancer protective, can reduce bloating and acne, can improve hair loss, sleep, fertility and mood!
WHAT IS PMS AND WHAT CAUSES IT?
First of all, there’s PMS (premenstrual syndrome) and there’s a more severe version of PMS, which is PMDD (premenstrual dysphoric disorder).
PMS symptoms happen due to hormonal changes leading up to a woman’s menstrual cycle. A woman experiencing PMS can have symptoms including breast tenderness, irritability, food cravings, fatigue and mood swings.
PMDD is exponentially worse, disabling and almost paralyzing for women. Many of my female patients who complain of PMDD would describe it as loss of self control and inability to regulate physicical and emotional symptoms.
The most common myth about PMS is that it needs to be regulated with birth control and antidepressant or anti-anxiety medications. It’s simply not true!
The reality is that balancing hormones can lead to improvement in both PMS and PMDD symptoms. The most common reason for PMS and PMDD is low or suboptimal progesterone levels and disproportionate estrogen levels. Estrogen is aggravating, progesterone is soothing.
I personally suffered with terrible PMS leading up into my 30s until I resolved my own hormonal issues! Like many young women, I was prescribed birth control pills and my family thought I was crazy. I wasn’t crazy, and you’re not either. It took me a medical school education to improve my health, self-confidence and my life and I’m trying to do the same for you!
HOW DO HORMONES CHANGE DURING PREGNANCY AND POSTPARTUM?
Oh, the hormone changes that women have to go through! Many women actually feel their best during pregnancy, and that’s because sex hormones —mostly estrogen and progesterone— are at their highest. Autoimmune symptoms also tend to go into remission.
As a physician, I find that it’s important to monitor thyroid levels in women who are already on thyroid medication or may need thyroid medication during pregnancy. If women start on progesterone therapy leading up to pregnancy, they can also stay on progesterone during pregnancy to prevent miscarriages.
…but then during postpartum, everything tanks! The hormonal changes that occur postpartum cause women to lose about 5% of their brain mass. That’s a staggering statistic! How you feel postpartum is an indicator of how you will feel in menopause–it is so important to know and understand your symptoms, hormone levels, and to advocate for yourself.
Now, what about breastfeeding? How does nursing affect hormones? Prolactin is a hormone that’s released to stimulate breast milk production in women. It also minimizes the production of estrogen and progesterone and can prevent ovulation. This is why women have a lower risk (not zero!) of getting pregnant while breastfeeding and generally don’t have a menstrual cycle during this time. As breastfeeding becomes minimal, things start shifting back to normal.
I generally suggest that women test their hormones and nutrient levels three months postpartum.
Not sure how to ask your care provider about testing for hormones?
Sign up below to get my PDF cheatsheet with a script to use and list of exactly what you should test for!
WHAT HORMONE IMBALANCES CAUSE INFERTILITY?
First, if you’re struggling with infertility, I’m so sorry— it’s such an incredibly difficult challenge to face. Let’s look at how hormones might be affecting your fertility…
High prolactin, low progesterone, hypothyroidism or subclinical hypothyroidism (meaning labs may not show it, but a woman has the symptoms) and high estrogen levels are the most common causes of infertility.
Many women struggling with infertility need to address diet, stress, malnutrition, and nutrient deficiencies that can contribute to these hormonal imbalances. From there it is possible to bring hormone levels back to normal naturally (depending on a woman’s age) or by incorporating hormone replacement therapy.
IS WEIGHT GAIN A NATURAL PART OF AGING?
Weight gain can happen for a variety of reasons. It may be “natural” as in due to normal changes to our metabolism as a result of hormonal fluctuations, but it doesn’t have to be “normal.” We live in the 21st century where this doesn’t have to be the case–we can prevent this from happening or solve the issue of weight gain.
Most women (younger and older) will experience weight gain due to:
Thyroid issues— whether it’s hypothyroid or subclinical hypothyroid (meaning you have the symptoms, but your labs are “fine”)
Poor diet (a diet high in processed foods)
Sedentary lifestyle
Elevated estrogen
Low testosterone
High cortisol
Elevated blood sugar and insulin
Low growth hormone
…are some of the potential causes for weight gain. It’s never one thing, and usually a mix of factors.
So what can you do if you’ve noticed weight gain you want to turn it around?
Start by looking into potential hormonal causes, dietary and lifestyle factors, and improving blood sugar levels along with reducing insulin resistance can help prevent weight gain and support weight loss.
If you get your insulin levels checked, most providers will check insulin levels in the morning fasting. However, I suggest testing insulin two hours after a meal. If the levels are not below 8 uIU/dl then there could potentially be some insulin resistance. You don’t need to be diabetic to have some level of insulin resistance.
Also, re-evaluate your exercise: many women will do tons of cardio or weight exercises with 5 lb dumbbells. I like to see women increase resistance training, join classes or work with a personal trainer to include exercises that are more challenging.
WHAT IS MENOPAUSE?
There are actually three disctint phases to this later season of a woman’s life: perimenopause, menopause and postmenopause.
Perimenopause is a time when women start to experience fluctuations in hormones that are indicative of menopause. In some women, perimenopause can happen for a few months before menopause, or last as long as 2-10 years before menopause…that’s a big range and women suffer unnecessarily!
During perimenopause women find themselves having heavier and/or more painful cycles, irregular cycles, experiencing mood changes, libido changes, hair falling out, insomnia, weight gain, memory loss, trouble gaining or maintaining lean muscle mass, food cravings and the list goes on.
For some women it can start to happen between 40-44 years of age, and for others in their mid-30s.
Menopause is when you stop having your period for at least 12 months and your FSH is elevated. FSH is the follicle stimulating hormone and starts to rise as ovulation comes to a halt. As estrogen and progesterone start to decline, FSH goes up with the hopes that it can revive the ovulation process.
Post-menopause happens right after menopause. So if a woman hasn’t had a cycle in over twelve months and has an elevated FSH, she is in post-menopause.
The most common myth about menopause is that women don’t need hormones.
Providers will tell women things like “Well you’re not going to have babies, and it’s normal to have low hormone levels in menopause, so why do you need hormones?”
Hormone replacement therapy (and not just supplementing with estradiol!) is absolutely essential for women in menopause. If we want to reduce the risk of bone fractures, prevent dementia and Alzheimer’s, reduce risk of cardiovascular disease, have great sleep, sex, mood and a healthy metabolism–it’s extremely hard to get through this phase of woman’s life all in one piece without some sort of hormone support–and by that, I don’t mean birth control pills!
Hormones truly rule all aspects of your health and wellbeing – don’t ignore them any longer!
If you’re ready to go deeper and make lasting change (without blame or shame) I hope you’ll join me in my signature course —Hormone Potential Foundations— that takes the confusion out of hormones, gain clarity into your symptoms, gain confidence in your body and become the master of your health– at any season of life.
