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Testosterone, progesterone and oestrogen are the sex hormones belonging both to males and females. These hormones, like the many others in our bodies, act as messengers and need to be kept in balance to ensure a healthy mind and body.
Hormonal balance is always the key when addressing symptoms that might arise from hormonal problems like pre-menstrual tension (PMS), infertility, and various perimenopausal and menopausal symptoms.
OESTROGEN/PROGESTERONE RHYTHMOestrogen and progesterone are the major sex hormones in females and there should be a healthy rhythm between these two. In the regulation of the menstrual cycle oestrogen isresponsible for the thickening of the uterine lining during the first part of the menstrual cycle (day 1 to 14), while progesterone inhibits further thickening when fertilisation has
not happened and menstruation takes place at day 28. If conception does happen, oestrogen and progesterone work together to ensure the lining thickens even more to provide a safe space for the fertilised egg to develop and grow. Oestrogen stimulates breast cells to grow, while progesterone is necessary to
prevent the development of tender breasts and cysts. Too much oestrogen causes water and salt retention in the body that can lead to increased blood pressure, a higher risk of blood clots, stroke and heart disease. Progesterone acts as a natural diuretic and antihypertensive. Other functions of oestrogen include the influence it has on the pattern of the hair on the head and body, as well as providing some protection against high homocysteine and cholesterol levels. This explains why menstruating women have a much lower risk of developing heart disease than men of the same age.
PUBERTYAt puberty, the role of oestrogen is to initiate the first period in girls around the age of 10 to 15 together with the feel-good neurotransmitters oxytocin and dopamine that influence positive emotions like pleasure, love, affiliation and satisfaction. Oestrogen stays intimately connected to adequate levels of other neurotransmitters in the brain, such as serotonin, that regulate mood, sleep and appetite.
The ideal time to measure the levels of these two hormones is around day 21 of the menstrual cycle. It can be measured with blood, saliva or urine samples. Keep in mind that hormonal levels fluctuate due to various factors and only give an indication of what is happening in the body. The results need to be interpreted with the symptoms a woman is experiencing.
TESTOSTERONETestosterone is another important hormone in both men and women and forms part of the group of androgens or male sex hormones that stimulate the development of male characteristics. Women have far lower levels of testosterone but still need some to ensure adequate energy levels, boost confidence and make it easier to maintain a lean body mass. However, excess testosterone production by the ovaries in women can lead to polycystic ovarian syndrome, characterised by infertility, excess facial and body hair and acne.
OESTROGEN DOMINANCEExcess levels of oestrogen in the body have a direct impact on hormonal health during puberty as well as later in life, both in women and men.
CausesOestrogen dominance can be caused by the normal ageing process of the ovaries, increased cortisol levels due to chronic stress, exposure to xeno-oestrogens and nutritional factors that include alcohol, unhealthy fats and inadequate fibre in the diet.
This modern day phenomenon can especially be linked to higher stress levels as well as exposure to artificial oestrogens in the environment. Xeno-oestrogens (xeno means ‘foreign’) act as hormone disruptors which are present in the air, food (especially the lining of tinned food that contains bisphenol-A) and water as well as many pesticides and herbicides. They are also found in toothpaste, deodorant, cosmetics,¹ sunscreen and various forms of plastic-containing products. The xeno-oestrogens are not biodegradable and are highly fat-soluble which can lead to oestrogen dominance, which also influences thyroid function and metabolism. This can lead to young girls and boys being affected and lead to girls having their first period at an earlier age and boys developing breast tissue (man boobs or ‘moobs’).
In men high oestrogen levels can lead to low sperm counts, infertility, less muscularity and a higher risk of developing prostate cancer.
SymptomsThe symptoms of oestrogen dominance in women include water retention, breast tenderness, painful periods, hair loss, difficulty losing weight, fatigue, depression, mental fog and/or memory loss.
Oestrogen dominance can play out in different ways, for instance:
High oestrogen relative to normal progesterone: this imbalance is often seen in overweight women where the fat cells also produce oestrogen.² Being overweight is also a risk factor, especially after menopause, as less oestrogen is produced by the ovaries, and more by fat cells. Another reason for this is exposure to xeno-oestrogens.
High oestrogen relative to low progesterone: this combination is more common and can start as early as the age of 35 during the perimenopausal period. Apart from all the typical PMS symptoms, such as breast tenderness, water retention, headaches and painful periods, women can also suffer from insomnia and a whole range of mood swings, including irritability, anxiety and even depression.
METABOLISM OF OESTROGENThere are different forms of oestrogen in the body. During the reproductive years 80% of the oestrogen produced by the ovaries is estradiol, 10% is estriol and 10% is estrone. This changes during and after menopause where the dominant form of oestrogen produced by the body is estrone.
What is also of great importance is the way the body metabolises oestrogen – i.e. how oestrogen is broken down and eliminated. This complex process happens mainly in the liver through Phase (hydroxylation) and Phase (conjugation) processes that are dependent on various nutrients. If Phase is impaired, there is a higher risk of breast, endometrial, or cervical cancer. If Phase is impaired, the body is not able to excrete the excess metabolised oestrogen through the bile, stool or urine. In both scenarios there is excess oestrogen circulating through the body. Genetic testing can be helpful to identify potential factors that can inhibit the body to metabolise oestrogen properly.
ELIMINATING EXCESS OESTROGENFortunately, there is a lot that can be done to help the body rid itself of excess oestrogen. The aim is to support the body to metabolise and get rid of excess oestrogen.
Metabolic detoxificationTo kick-start weight loss it is worthwhile to do a metabolic detoxification once or twice a year that will provide the liver with good quality protein and carbohydrates as well as micronutrients in order to optimise the body’s ability to get rid of accumulated toxins. This can be done by following an elimination diet that limits caffeine, alcohol, animal protein, gluten-containing foods and dairy for at least 7 to 10 days. It is important to take the correct supplements and medical foods that contain all the necessary nutrients to support the liver through the detoxification process.
Lose weight and exercise moreExcess weight and lack of exercise lead to high levels of insulin secretion as your body is trying to get rid of the excess glucose in the bloodstream. High insulin levels have been shown to increase oestrogen, which can lead to even higher insulin levels, resulting in a vicious cycle that makes it difficult to lose weight. Start a lifestyle plan with attention to balanced nutrition, exercise and relaxation.
Nutrition and supplementationOptimal gut health should be maintained to prevent the reabsorption of oestrogen by the gut. This means limiting dietary fat and refined carbohydrates while increasing fibre to at least 35 to 45g per day. Flaxseed is an excellent source of fibre. Eat only pasture-fed meat and dairy in moderation.³ Limit alcohol intake to one or two servings per week as alcohol increases oestrogen and slows down fat burning in the body. Eat a diet rich in vegetables, especially the cruciferous family (cabbage, broccoli, Brussels sprouts and cauliflower). Indole-3-carbinol and Di-indolemethane (DIM) are nutrients that are found in cruciferous vegetables but can also be taken in capsule or tablet form for the prevention and treatment of breast and prostate cancer. Include prunes, goji berries, beetroot and lemons to help the body get rid of excess oestrogen and lower the risk for breast and endometrial cancer. Especially berries and grapes contain resveratrol that has been shown to block the oestrogen receptors.4 Limit caffeine intake as it can raise oestrogen levels.
Soy isoflavones are phytoestrogens (plant-derived) that bind to the oestrogen receptors in the body and prevent excess oestrogen getting into the cells. It can be helpful to include in the diet, but make sure the source is not GMO derived and fermented. Red clover is also a source of phytoestrogenic isoflavones that can modify oestrogen levels.
Maintain the correct balance of essential fatty acids by supplementing with flaxseed or fish oil that contains omega-3 essential fatty acids. Omega-6 essential fatty acids are found in evening primrose oil and are helpful to manage PMS.
Other important nutrients include magnesium, zinc, vitamin B6 (prevents PMS symptoms), vitamin B12 and folate. L-methionine is necessary to increase glutathione levels that increase detoxification of oestrogen by the liver. Add seaweed or iodine to the diet to lower oestrogen in the body.
Herbs that are used to restore and balance hormone levels include black cohosh (Cimifuga racemes rhizome), dong quai and agnus castus.
Avoid canned foods and plastic containers. Use only glass, stainless steel and ceramic cookware.
Get enough sleepMake sure to get to bed by 10 pm. This provides optimal production of melatonin, which has been shown to reduce estradiol levels and prevent breast cancer.
Bio-identical hormonesThe use of a bio-identical progesterone cream can help to balance excess oestrogen. The advantage of bio-identical hormones is that they are natural and more easily metabolised by the body.
CONCLUSIONWhen your oestrogen levels are balanced, you feel youthful, feminine, sexually fulfilled and with breasts that are not too big (excess oestrogen) or droopy (low oestrogen). It is easy to maintain a healthy body weight while your menstrual cycles are regular and not too heavy with little discomfort.
References1. Komori S, Ito Y, et al. A long-term user of cosmetic cream containing estrogen developed breast cancer and endometrial hyperplasia. Menopause. 2008;15(6):1191-92.2. Freeman EW, Sammel MD, et al. Obesity and reproductive hormone levels in the transition to menopause. Menopause. 2010;17(4):718-26.3. Brinkman MT, Baglietto L, et al. Consumption of animal products, their nutrient components and postmenopausal circulating steroid hormone concentrations. European Journal of Clinical Nutrition. 2010;64(2):176-83.4. Zahid M, Saeed M, et al. Resveratrol and N-acetylcysteine block the cancer-initiating step in MCF-10F cells. Free Radical Biology and Medicine. 2011;50 (1):78-85.
DR LYNETTE STEELE,MBCHB, DIP ACUP, THD.
She is an integrative medical doctor with a whole-person approach to restoring balance and function to the mind, body and soul. By incorporating functional medicine, lifestyle medicine, stress management, health coaching, biopuncture, homotoxicology, bioenergetic tools, natural medicines and body therapies, she provides unique solutions to address various health issues. Dr. Steele has a special interest in hormonal balance and women's health. She practises in Stellenbosch, Western Cape.
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