Whether you’re preparing for pregnancy, actively trying to conceive, or having fertility challenges, understanding your hormonal status is a huge advantage.
Hormonal imbalances impact a surprising number of seemingly “healthy” women.
These imbalances can cause problems with ovulation and skipped periods, and ultimately lead to fertility challenges, such as increased time to pregnancy, miscarriages, and full-blown infertility.
Per the CDC, about 10 in every 100 women and 12-13 in every 100 couples will have trouble getting pregnant or staying pregnant1 (and I suspect that number is actually much higher as not all cases are reported, not all cases are categorized as “infertility”, and not everyone seeks medical help).
As many of you know I’ve struggled with fertility issues myself, so I know how scary and frustrating it is when something that should be so natural doesn’t come so naturally.
But here’s what I learned through these struggles (and what allowed me to become a healthy mother of 3): my fertility issues were my body’s way of telling me something wasn’t right; which forced me to seek help in uncovering the root cause.
But where do you start?
One test I recommend for anyone interested in becoming pregnant is getting a clear picture of your hormonal status.
The DUTCH Test: My Go-To Hormonal Lab Panel
While most of us only learn about hormones in relation to puberty, sex, menses, and pregnancy, these miraculous signalling molecules affect every function and system in our bodies—from growth and development to metabolism, libido, and even nutrient levels.
Thus, when one (or more) hormones go out of balance it creates a domino effect that can quickly impact various aspects of fertility.
An imbalance in female sex hormones (and thyroid hormones!) can interrupt ovulation, prevent the uterine lining from thickening, and cause issues with implantation.
This is why I use the DUTCH test in my clinical practice (which stands for Dried Urine Test For Comprehensive Hormones). Unlike other hormone tests which may only measure a few hormones with questionable accuracy, the DUTCH test measures levels the following levels in the urine:
- Progesterone in the second half of the cycle (called the luteal phase)
- Estrogen and estrogen metabolites
- Testosterone and testosterone metabolites
Metabolized and free cortisol
In terms of fertility, the DUTCH test helps me identify the following trends that directly impact a woman’s hormonal health.
And with hormones it’s all about balance, not too much and not too little…let’s take a look at those trends now.
Trend #1: Estrogen dominance
If you’ve been researching hormonal imbalances, you’ve probably heard a lot about estrogen dominance which is characterized by high estrogen levels in relationship to progesterone.
Symptoms of estrogen dominance include:
- Heavy periods
- Painful periods
- Mood swings
- Tender breasts
- Fibrocystic breasts
- Weight gain
What causes high estrogen levels? High or excess estrogen is typically caused by two things:
#1: Xenoestrogens (aka: external estrogens we ingest or absorb)
These come from foods, such as conventional meats, dairy, or foods high in plant-based estrogens, such as soy. They also come from hormone-mimicking chemicals, such as phthalates2 and parabens3 which are present in many personal care products, cleaning products, and other environmental toxins (learn more in my free ebook: 12 Ways to Detox Your Home).
#2: Impaired estrogen detoxification
This has to do with the health of your body’s detoxification processes, specifically the liver and gut, to efficiently excrete estrogen. Most of the body’s detoxification happens within three stages that involve your liver (predominantly), gut, and kidneys. If those pathways are compromised, estrogen will build up creating imbalance over time. Here’s how these phases of detoxification work:
Phase 1 detoxification uses CYP enzymes in the liver that help break down estrogen into smaller molecules (also known as metabolites) via 3 pathways: 2-OH, 4-OH and 16-OH. The 2-OH pathway is considered the favorable and protective one. Conversely the 4-OH pathway is considered higher risk, since its metabolites can create reactive products that damage DNA. The third pathway to 16-OH creates the most estrogenic of the metabolites and may exacerbate high estrogen symptoms. So supporting the liver in Phase 1 metabolism is super important.
Phase 2 focuses on methylation of estrogens – which helps to deactivate and eliminate them. Low methylation can be caused by low levels of nutrients needed for methylation and/or genetic polymorphisms (SNPs) like COMT and MTHFR. Some of the most important nutrients in this phase are magnesium, B6, folate and B12. I use nutrigenomics to help identify vulnerabilities here. We know that folate is a critical nutrient during pregnancy, so this is an area to focus on.
Phase 3 is all about excreting estrogens, which is largely accomplished through your gut. If you’re experiencing constipation or irregular bowel movements estrogen will likely not be excreted efficiently and can be reabsorbed into your system. So gut health, as always, is a big deal!
How to treat estrogen imbalance
I recommend almost everyone consume a lot of cruciferous vegetables which are great for detoxification.
For women with estrogen dominance, I often recommend a supplement with DIM (diindolylmethane), and/or I3C (indole-3-carbinol). Both are derived from compounds found in cruciferous vegetables such as broccoli, Brussels sprouts, and cabbage, and known to support the breakdown of estrogen to its protective metabolite 2-OH in phase 1 of estrogen detoxification. However these are not appropriate for everyone, so please only use them under doctor’s supervision and only if you know your estrogen levels are too high. You don’t want to deplete estrogen too much, as that can disrupt ovulation.
Finally, if digestion is suboptimal or a gut health issue is at play, I’d recommend addressing those issues in order to heal and restore those pathways.
Trend #2: Low estrogen
Convinced you have estrogen dominance? Not so fast! Low estrogen levels are also a common factor in fertility issues.
Low estrogen levels can affect fertility by disrupting ovulation (which shows up as Irregular or absent periods).
Symptoms of low estrogen include:
- Irregular or absent periods
- Vaginal dryness
- Painful intercourse
- Recurrent UTIs
- Mood swings
- Hot flashes
What causes low estrogen levels?
Low levels can be caused by anything that affects your ovaries.
In young women this is often excessive exercise, anorexia, HPA axis dysfunction (AKA: adrenal fatigue), premature ovarian failure from toxins, or autoimmune conditions.
For low-estrogen, the treatment would depend on the cause. For example, if it’s an HPA axis/adrenal problem we’d use adrenal-specific herbs, stress-reducing techniques, and possibly medication to address it. If it’s an autoimmune condition, we’d need to address that on an individual basis.
Trend #3: Low progesterone
Progesterone levels increase in the second half of the cycle, called the luteal phase. If a woman does not ovulate, progesterone levels will not increase. This can decrease chances of conception and increase the risk of miscarriage.
It’s important that estrogen and progesterone are in a good ratio to keep you stable and balanced. Low progesterone often creates relative estrogen dominance, and thus shares many of the same symptoms as excess estrogen.
Symptoms of low progesterone include:
- Low libido
- Insomnia or poor sleep
- Irregular menstrual cycles
- Breast tenderness
Headaches or migraines
What causes low progesterone?
In addition to considering the causes of excess estrogen (listed above) other causes of low progesterone include:
- Hypothyroidism or Hashimoto’s
- HPA axis dysfunction or excessive stress5
How to treat low progesterone
If a patient has both excess estrogen and low progesterone, we would use a combination of remedies based on causal factors.
I also recommend removing xenoestrogens from the diet and environment as they will continue to disrupt the balance of estrogen and progesterone.
Trend #4: Polycystic Ovarian Syndrome (PCOS)
PCOS is a very common endocrine disorder in women, and one of the most common causes of female infertility. In fact it’s estimated to effect between 6-12% of women of reproductive age in the United States.[enf_note]https://www.cdc.gov/diabetes/basics/pcos.html[/efn_note]
PCOS is characterized by insulin resistance, excess androgens (like DHEA-S and testosterone), and anovulation – which shows up as irregular periods.[enf_note]https://www.cdc.gov/diabetes/basics/pcos.html[/efn_note]
Symptoms of excess androgens in women include:
- Hair loss
- Oily skin
- Excess body hair (especially upper lip, chin, chest, and abdomen)
- Increased body odor
Blood sugar imbalances/metabolic dysfunctions
Women with PCOS may also struggle with obesity, and there may be multiple small cysts in the ovaries found on ultrasound (hence, the name).
What causes PCOS?
The exact cause is not known, but there is definitely a link to underlying insulin resistance and metabolic dysfunction – and treating that with nutrition and lifestyle measures goes a long way.
In fact, many (including me) would advocate that all women with PCOS should be treated for insulin resistance.10
Factors that contribute to blood sugar imbalances and insulin resistance include:
- Chronic stress/ high cortisol
- Poor diet high in refined carbs/sugar
- Food sensitivities
- Sleep issues
- High blood pressure
- Lack of movement/ exercise
Vitamin D deficiency11
Insulin resistance is a risk factor for prediabetes/ diabetes if left untreated, and has been linked to an increased risk in gestational diabetes, heart disease, depression, and endometrial cancer.12,13 So it’s best to nip this in the bud ASAP!
The connection between PCOS and Hashimoto’s Disease
Women with PCOS also have a higher risk for Hashimoto’s disease (an autoimmune condition that causes hypothyroidism). In fact, Hashimoto’s is 3 times more common in women with PCOS than in women without it.
Interestingly, in women with both Hashimoto’s and PCOS, high testosterone is less common, but they have an elevated risk of insulin resistance – which makes sense since thyroid disorders tend to exacerbate issues with weight and metabolism.14
Remember that thyroid issues also play a huge role in fertility issues, but this can be mitigated with proper treatment.
Treatment for insulin resistance
When treating blood sugar issues and insulin resistance, we focus a lot on reducing sugar and refined carbohydrates in favor of clean protein sources, healthy fats, high fiber and whole foods.
Often, these lifestyle changes alone are enough to reverse this all-too-common trend.
Natural supplements that can help with blood sugar include alpha lipoic acid, chromium, cinnamon and green tea extract. Sometimes the medication Metformin is also used.
Trend #5: HPA Axis dysfunction
“HPA” refers to your hypothalamus, pituitary and adrenal glands, which communicate through what’s known as the HPA axis.
How does this relate to fertility?
Your hypothalamus acts as a traffic cop for the rest of your endocrine/hormonal system, sending communication to the pituitary gland, which then signals the adrenals, thyroid, and ovaries to secrete hormones.
You adrenals are the often-underappreciated powerhouse that helps control stress by producing adrenaline, cortisol, and dopamine and plays a huge role in production of sex hormones like DHEA.
What causes HPA Axis dysfunction? In a word: stress…specifically, chronic stress.
Here’s how this works: when you’re under stress your hypothalamus releases Corticotropin Releasing Hormone (CRH), which signals the pituitary to release Adrenocorticotropic Hormone (ACTH) which triggers the adrenal glands to release the stress hormone cortisol.
This natural and necessary process creates our fight or flight response, which is essential for dealing with acute periods of stress…like if you were chased by a wild animal or had to rescue your child from a sudden fall.
However, since cortisol triggers a release of glucose to bolster your energy, while suppressing your digestive system, immune system, reproductive system, and insulin production, this is not sustainable long-term.
The results of HPA axis dysfunction are low hormones levels across the board. This causes symptoms such as:
- Fatigue (often extreme, like you can’t get enough sleep)
- Mood swings
- Thyroid issues
- Weight gain
- Low immunity
- Brain fog
- Low libido
Blood pressure imbalance
So, how do we treat HPA Axis dysfunction? By learning to respond to stress in a healthier way.
The best way to do this is to find ways to change your mindset in relation to the things that are causing your constant stress yet cannot be changed (like other people), get rid of the stressors that are toxic and can be changed, and create a system of self-care that relieves everyday stressors.
I also recommend supplements to help restore adrenal health, such as methylated B-vitamins, vitamin C, ashwagandha, magnesium glycinate, and melatonin.
But the real deal breaker here is poor quality sleep! Getting enough high quality sleep is really critical for a healthy stress response.
Wondering about your hormonal trends?
Knowing your hormonal status is one of the most powerful tools in preparing for a healthy preconception, conception, and pregnancy…and I’d love to help you get started. Reach out to me if you’re ready for help!
Not quite ready for a full functional medicine evaluation? My functional medicine nutritionist can also help you get started with a practical and personalized nutrition plan.