Being a woman it is easy to blame any of our hormonal symptoms on the main hormones in our menstrual cycle namely estrogen and progesterone, and rightfully so as both these hormones can create some pretty intense symptoms when they are out of balance. Both estrogen and progesterone are very closely linked with our nervous system and are responsible for our mood, mental state, energy, libido and even in part for our heart and bone health. However, these hormones are very far down the list of hormones in the cascade of hormones and neurotransmitters that are released, and although they do create some pretty intense symptoms, they are usually just taking instruction from much bigger players beneath the scenes. Although we can get some improvement of symptoms from targeting our menstrual cycle, true long-lasting results or real healing usually does not occur until the underlying reasons are addressed first. Here are the 5 most common root causes that can lead to imbalances in estrogen, progesterone and our menstrual cycle as a whole.
Although acute inflammation from a short term illness or injury is necessary and can resolve quickly with no long-lasting effects on hormones, chronic inflammation has been shown in studies to interfere with a number of hormonal systems, it can lead to insulin resistance, high testosterone and high cortisol (1). These conditions can further be associated with female hormone imbalances such as PCOS or can alternatively lead to low output of ovarian hormones due to high cortisol. Each woman can respond to inflammation differently, but in general, inflammation causes disturbances in the menstrual cycle like heavy and painful periods, estrogen dominance symptoms like PMS and tender breasts but also can lead to low estrogen and low progesterone and can greatly interfere with fertility. Poor gut health is often a huge culprit of widespread inflammation. Improving gut function, correcting gut dysbiosis through the removal of gut stressors like alcohol (2), sugar (3) and saturated fat (4) as well as the careful and slow introduction of a wide variety of plant foods containing fibre is one of the most beneficial things to do for lowering inflammation on the whole (5).
Blood sugar balance
Blood sugar balance is oftentimes a root cause of hormonal imbalances. Both high blood sugar and low blood sugar can cause hormone imbalances and disturbances in the menstrual cycle. High blood sugar and insulin resistance is common in many women and worsens with age, insulin resistance is the largest known contributing factors in women with PCOS (polycystic ovarian syndrome) (6) and also contributes greatly to the menstrual cycle disturbances and mood disturbances in perimenopause (7). Insulin resistance leads to excess production of testosterone which can lead to irregular cycles due to inconsistent absent ovulation as well as symptoms like weight gain, acne, thinning hair or unwanted body and facial hair. On the other hand, generalised low blood sugar also causes hormone imbalance. This is because when blood sugar drops too low it releases adrenalin into the system which is responsible for many of the blood low blood sugar symptoms including anxiety. Eventually, adrenaline spikes the hormone cortisol (the stress hormone). Cortisol and adrenalin send a message to the pituitary gland in the brain that there is “danger” or a “threat” and the brain responds by lowering sex hormone output while diverting energy to deal with more important bodily functions. Low blood sugar occurs from frequent consumption of refined sugars (cakes, sweets, soft drinks) because a very rapid and large rise in blood sugar is followed by a very sudden and severe drop in blood sugar (8). However low blood sugar is also caused by inadequate calorie intake (not eating enough) or waiting too long between meals. Low blood sugar is associated with nervous system dysregulation, anxiety or aggression (hangryiness) and generalised lower hormonal output leading to inadequate estrogen and progesterone production, longer cycles and even missing cycles (9).
Nervous system dysregulation/stress
Stress can easily be dismissed as inconsequential for our female hormones but in fact, it is likely the biggest factor causing hormonal imbalances (16). An overactive stress response whether from a busy stressful lifestyle or from conditions such as anxiety causes elevated cortisol levels. Cortisol is the stress hormone produced in the adrenal glands. Chronic exposure to elevated cortisol has widespread effects on the female hormonal system. As cortisol performs direct actions of the liver, pancreas, fat tissues, muscles, nervous and immune system cortisol is a big deal (11). Cortisol has a direct ability to lower both estrogen and progesterone and can lead to a short luteal phase (infertile menstrual cycle) delayed ovulation or even lack of ovulation or missing periods (10). It does this by sending a signal to the pituitary gland in the brain. Under stress dopamine production decreases, which intern increases the hormone prolactin (usually responsible for creating breastmilk in new mothers) prolactin suppresses ovarian hormones in women leading to low progesterone, low estrogen and even a lack of ovulation if stress is severe (12).
Stress can also simultaneously cause estrogen dominance symptoms as it directly slowing liver function and making it harder for the liver to process used up estrogen, so although estrogen and progesterone decrease with stress, the estrogen that is produced is much more likely to get stuck within the body. Stress also slows down gut function can further lead to the reabsorption of estrogen from the gut. (see my article about estrogen dominance here: https://hazelandcacao.com/understanding-estrogen-dominance/ ) This is why we have studies showing that increased stress can increase PMS symptoms including period pain by up to 4x in any given menstrual cycle (13). Chronic sustained stress is the largest factor involved in low thyroid function. Prolonged adrenal dysfunction from stress can affect thyroid function which will affect overall energy levels, mood and metabolism (weight gain). Thyroid hormone imbalances also affect the menstrual cycle leading to longer cycles with heavier periods (14) (15).
Nutrients form the building blocks of our hormones, we can not have adequate hormone production without the nutrients needed to create hormones. Nutrients are also crucial is hundreds of enzyme reactions that help our hormones do their job. Common nutritional deficiencies associated with hormonal imbalance include magnesium, vitamin d, b vitamins, vitamin c, iodine and zinc (18). But the reality is that any nutrient deficiency can affect hormones whether directly or indirectly. Different hormones require different nutrients in different amounts and so the type of nutrient deficiency can also be related to which hormones are out of sorts. Many nutrient deficiencies are not bad enough to show up on a blood test, but that does not mean that the body has optimal levels of a particular nutrient to create hormone balance. Stress alone is highly depleting in magnesium, calcium, b vitamins, zinc, potassium, vitamin c and sodium (the main nutrients required by the adrenal glands) and these nutrients need to be constantly replenished in order to restore balance (19). Women that have come off hormonal birth control need to be especially mindful of nutrient deficiencies as hormonal birth control is highly depleting of various nutrients including magnesium, b6, selenium (17) this is one of the reasons that underlying hormonal imbalances can become worse once hormonal birth control is discontinued.
Our world is becoming increasingly toxic. There are hundreds of new chemicals that are introduced into our environment every day, many of which are not adequately tested for human safety. Many chemicals have been found to be endocrine disruptors. Although we do not have enough data on all the chemicals out there, we know that certain chemicals found in beauty products, pesticides and herbicides, food additives, plastics and many other synthetic materials contain substances known as “xenoestrogens” these are compounds that mimic estrogen in the body which can dysregulate estrogen in the body by binding to estrogen receptors all over the body. Most commonly they are found to lead to estrogen excess which can eventually contribute to some estrogenic cancers like breast cancer and other cancers (20). Toxins are also readily stored and concentrated in the fat cells of humans and animals. Eating animal products can often expose us to higher doses of toxins as animal fat stores and concentrates that toxins found in pesticides and herbicides etc (23). The high toxic load can also lead to weight gain. Increased body weight can lead to estrogen excess as fat cells produce their own estrogen (22). Xenoestrogens can also block estrogen in the body leading to low estrogen. Overall they are very demanding on the liver which is highly involved in estrogen metabolism. It is not possible to completely avoid all harmful toxins but with some care to reduce our exposure by switching to more organic non toxic natural products especially in our beauty products and foods we can greatly diminish our overall exposure.