How Stress Affects Your Hormones

The two main sex hormones in women are estrogen and progesterone (and testosterone to a lesser degree). It is very common for me in clinic to see the symptoms of an imbalance in these two hormones. I wanted to discuss some common symptoms experienced when progesterone levels are low, and explain how chronic stress can play a significant role in the decline of these levels.

Progesterone is made from pregnenolone, which is made from cholesterol. The production of progesterone occurs mostly in the ovaries just prior to ovulation and increases significantly after ovulation. It is also produced in the adrenal glands, which are endocrine glands found above the kidneys. The adrenal glands also produce adrenaline, aldosterone and cortisol, which all function to support mineral balance, glucose metabolism and the stress response.

Hormonal pathways are rather complex. Progesterone plays an important role in the pathway of hormone synthesis, being a precursor to DHEA, oestrogen, testosterone and cortisol. As pregnanolone is a primary precursor hormone, the body needs to decide whether it needs to make sex hormones like progesterone, or stress hormones such as cortisol.

This process is known as ‘progesterone steal’. During times of stress, our bodies will use pregnanolone to make cortisol instead of progesterone. This stress response may be triggered by work, a traumatic event, a lack of adequate sleep and rest and regularly over-exercising. This can lead to a whole range of symptoms and can affect your menstrual cycle and fertility in a range of different ways.

Progesterone is a vital hormone for bone strength and a healthy immune, nervous and cardiovascular system. Most significantly, it functions to cause the endometrium to secrete certain proteins during the second half of the menstrual cycle (Luteal Phase), preparing it to receive and support the growth of an implanted fertilised egg.

If progesterone levels are too low at this stage of growth, there is the potential that the fertilised egg will be unable to hold. This may then lead to an early miscarriage. After 12 weeks the placenta start making progesterone, but if the levels remain low before this time then the women may not be able to sustain the pregnancy.

Other progesterone deficiency symptoms may include low libido, headaches and migraines, hot flushes, abnormal uterine bleeding and irregular or shorter cycles. Often, when progesterone is deficient, the ratio between oestrogen and progesterone then becomes imbalanced, termed ‘oestrogen dominance’. Common symptoms of this include weight gain, low libido, uterine fibroids, endometriosis, breast tenderness and cystic breasts, heavy bleeding, irregular menstrual cycles and mood imbalances and depression.

There are a number of dietary and lifestyle influences that effect oestrogen and progesterone levels, with chronic stress playing a major role in these hormonal imbalances. If you are experiencing any of the above symptoms during your menstrual cycle or are having problems falling or staying pregnant, I recommend that you book an appointment to come and see me. We can take a thorough look into your presenting symptoms and come up with a real strategy to begin addressing them. Coming up with some practical ways to reduce and manage your stress levels is a really important place for you to start today.

Supporting Healthy Menstruation and Fertility

It was as a result of my own experience with debilitating period pain that led me to study Chinese medicine over 10 years ago. After a visit to my local GP in pain and feeling desperate, it was explained to me that it was just the way it was and that I just had to put up with it. A life on the contraceptive pill and Nurofen were apparently my only options, relayed to me with a distinct lack of compassion. I knew there had to be another way, and went on a quest to improve my health with the help of Chinese medicine.

I’m always surprised in clinic to find that a lot of women don’t really know a lot about their cycles, or what constitutes a healthy menstrual cycle. This becomes particularly apparent when they are coming in to discuss fertility issues. I find that a lot of women have put up with painful periods, pain during ovulation and intercourse, irregular cycles (short or long), PMS, short or long bleeds, thinking that this was normal or untreatable.

Some important points to note in regards to what constitutes a healthy and natural cycle include-

-The cycle length is between 28-31 days in duration.

-blood should be a deep red colour without any clotting.

-bleeding is moderate in flow and not overly light or heavy.

-it should be free from pain.

-ovulation should occur around Day 14 of your cycle.

-Fertile cervical mucus should be observed around this time, with a stretchy, thick consistency.

-Your BBT (basal body temperature) is a useful way of determining your ovulation patterns. Charting your body temperature using an app or BBT chart allows you to get to know your fertile days and can highlight any imbalances that may be occurring within your cycle. This is done by using a thermometer (either vaginally or orally) first thing each morning and recording these readings over the course of your cycle. This should be recorded at around the same time each morning, somewhere between 6-7am.

-Your BBT should lie between 36.3-36.8⁰C in the first phase on your cycle (follicular phase) and 36.8-37.1⁰ C in the second phase of your cycle (luteal phase). Ovulation has generally occurred 1-2 days prior to this temperature rise.

I usually apply a combination of acupuncture, Chinese herbal medicine, nutritional and lifestyle advice and tailored supplementation within each consultation. We can then start to address the underlying imbalances that may be causing these emotional and physical symptoms linked to your menstrual cycles. This may also be contributing to issues with fertility, which is often what brings women into my clinic in the first place. Conditions such as PCOS, endometriosis, uterine fibroids and PMS are becoming increasingly more common, and often the only solution provided to treat these conditions are oral contraception, anti-inflammatories or surgery. It is my mission to show my patients that there is another solution, provided with a level of compassion and care that is often lacking in western medical care.

The Importance of Vitamin D During Pregnancy & Breastfeeding

The following lecture (https://www.youtube.com/watch?v=O0elnh4D08g) details some research conducted by Professor Bruce Hollis on the supplementation of vitamin D during pregnancy and breastfeeding. There was a lot of controversy surrounding the data from this study, due to many perpetuating myths surrounding vitamin D supplementation and the misguided fears of over-supplementation.

Professor Bruce Hollis provides a very strong argument, based on the findings of this research, that giving 4000 IU a day to pregnant women and 6400 IU a day to breastfeeding women is not only safe but also necessary in avoiding deficiencies in both the mother and infant.

He explores the evolution of humans in order to explain why our vitamin D requirements are as high as they are in modern societies and how effected these levels are by lack of sun exposure, ethnicity and geographical location due to the variation of sunlight and intensity. He also argues that it is not possible to receive adequate amounts of vitamin D from diet alone, such as from fatty fish such as salmon, tuna and herring, milk with added vitamin D or the small amounts found in eggs and meats.

This study was motivated by the mounting evidence that vitamin D deficiency during pregnancy is a serious public health issue, affecting both the mother and foetus. Therefore, the importance of establishing the vitamin D requirements of the pregnant women is vital in preventing vitamin D deficiency. Yet regardless of this, the Institute of Medicine sets the recommended daily intake (RDA) at 600 IU per day.

This research study aims to evaluate the safety and effectiveness of high doses of vitamin D supplementation during pregnancy and breastfeeding in order to achieve vitamin D sufficiency. The study design was a randomized control, double-blind placebo study involving 516 patients of African American, Hispanic and Caucasian descent. It provided either 2000 IU or 4000 IU of vitamin D per day to pregnant mothers. Levels were then measured by the mean circulating 25 (OH) D (nmol/L).

There were no adverse effects found in this study, even though there have been medical claims that high doses of vitamin D will do damage to the foetus. The results of the data also indicate that if the “pool starts off empty”, meaning the mother had low vitamin D levels to begin with, small doses (i.e. 400 IU per day) do nothing to alter overall levels. However, supplementation of 2000 IU and 4000 IU daily resulted in a substantial rise in overall blood levels.

The need to supplement with such high levels of vitamin D can be explained in other ways, aside from our lack of daily exposure to the sun. Vitamin D has a short half-life of one day, a scientific term used to explain the time required for a quantity to fall to half of its value as measured at the beginning of the time period. This means that if vitamin D is not consistently being replenished each day, where is our vitamin D?

This study concluded that pregnant women need 40 ng/ml (100 nmol/l) to optimise the production of the active form of vitamin D. Levels lower than this were also found to compromise the absorption of calcium in the gut. It also plays a significant role in immunity during pregnancy, including the altered immune response that adapts to the growth of the foetus by avoiding the auto-rejection of the presence of new tissue. It has also been shown to turn on the innate immune system, the first line of defence that enables us to fight infection.

The second aspect of this study was to determine the sufficient requirements for vitamin D supplementation in breastfeeding mothers to avoid deficient breast milk. It found that maternal supplementation of 400 IU per day and infant supplementation of 300 IU per day lead to significantly deficient vitamin D levels in breast milk.

Similar studies have been done involving the supplementation of 2000 IU per day to breastfeeding mothers and their breast milk was still found to contain insufficient levels of vitamin D.

It determined that supplementing 6400 IU of vitamin D per day by the mother was required to pass on adequate levels to her child. Such high doses are required by the mother as the parent compound gets transferred into the milk, meaning the infant receives higher doses of vitamin D in breast milk than if the infant were being directly supplemented. This is why supplementing a breastfeeding mother with adequate doses of vitamin D are so important both for her and for her child.

Please consult with your doctor or healthcare professional before taking any supplements.