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How to restore or maintain it

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Hormone imbalances are becoming more common among women in their 30s, and after 40, the odds of unpleasant menopause-related symptoms are greater today than ever before, for several reasons. Our environment is rife with hormone-disrupting chemicals, our culture induces chronic stress, today’s starchy diets contribute to hormonal imbalances, and birth control pills trigger additional problems.

Although every woman’s experience is unique, underlying any combination of symptoms, there is a pattern of hormonal changes we all go through. Understanding what helps to keep hormones balanced—or disrupts them—can keep you out of hormonal hell.

Hormone Basics

Physiologically, around the mid-30s, a woman’s ovaries start winding down. Both estrogen and progesterone production will start to decrease but at different rates, creating an imbalance.

“Progesterone drops faster, so you become estrogen dominant, even though you may be low estrogen; it’s all relative,” says Kent Holtorf, MD, a hormone specialist, researcher, and medical director of Holtorf Medical Group, based in Torrance, Calif.

Progesterone naturally has a calming effect. Below-optimum levels can cause changes in menstrual patterns, sleep problems, weight gain, and bloating, and decrease the ability to handle stress. Unfortunately, chronic stress inhibits the effect of progesterone, creating a vicious cycle.

Although depleted progesterone isn’t the only problem, it is a major one. Low estrogen and imbalances among other hormones all contribute to menopausal symptoms.

Common—but misguided—conventional treatments are birth control pills for menstrual irregularities and anti-depressants for mood swings or hot flashes. Ironically, according to a study of more than 1,500 American women, anti-depressants can trigger night sweats, especially between the ages of 41 and 55. Supplements of St. John’s wort and black cohosh can be effective natural remedies for mood problems and hot flashes without side effects.

Birth Control Pills Rob Progesterone

Birth control pills make matters worse, regardless of whether they are taken to prevent pregnancy or as an ill-conceived remedy for menstrual problems. The pills contain an artificial form of progesterone, called progestin. To keep track of which is which, remember this: progesterone rhymes with “own,” and is the hormone produced by a woman’s own body.

The foreign form, progestin, stops ovulation but also suppresses the natural ability of a woman’s body to produce progesterone, explains Holtorf, both during and after taking the pill. This depletion of natural progesterone contributes to side effects of the pill and later, intensifies menopause-related symptoms such as weight gain, bloating, and irritability, and increases risk for breast cancer.

Progesterone levels can be restored with a natural form of the hormone. When used in conjunction with birth control pills, says Holtorf, natural progesterone reduces side effects without increasing the odds of pregnancy. And as a woman approaches menopause, natural progesterone can help to rebalance hormones.

Over-the-counter, natural progesterone is available in low-dose creams from supplement stores, and helps many women. Higher-dose versions are available by prescription through physicians who specialize in customized, natural hormone treatment, which typically involves testing and rebalancing multiple hormones.

Stress Wreaks Havoc

“Stress hormones hijack the rest of the hormonal system,” says Sara Gottfried, MD, an integrative physician in Berkeley, Calif., and author of The Hormone Cure (available in March, 2013). Stress elevates cortisol, the fight-or-flight hormone, and cortisol blocks your body’s ability to use progesterone—which would normally calm you down—as well as thyroid and other hormones.

Cortisol also raises levels of blood sugar, explains Gottfried, leading to sugar cravings and belly fat. A starchy diet magnifies the effect. And, chronically elevated cortisol intensifies both PMS and pre-menopausal symptoms.

Toxins Disrupt Hormones

Pesticides, hormones given to dairy and meat cattle, toxic preservatives in skin-care products, plastics, and linings of cans contain xenoestrogens, foreign substances that act like estrogen in our bodies. This contributes to an imbalance between progesterone and estrogen and suppresses the action of thyroid hormones.


Just as a combination of factors disrupts hormones, a combination of changes can restore balance.

Diet: Limit carbohydrates, and eat plenty of fresh vegetables with lean protein. Eat organic food as much as possible.

Exercise: While lack of exercise is unhealthy, activity that is too intense can trigger stress hormones and disrupt others. Exercise that has a relaxing effect, such as yoga or gentle aerobics, helps to restore balance.

Toxins: Avoid them in food, skin care, and household products. Look for BPA-free plastics and cans. Several supplements can help counteract the overload of estrogenic substances in environmental toxins: Indole-3-carbinol (I-3-C), found in cruciferous vegetables; di-indolylmethane (DIM), which our bodies make from I-3-C; and calcium d-glucarate (not the same as calcium). These act as detoxifiers, helping to eliminate harmful estrogenic substances or convert them to less harmful forms.

Stress management: Get enough sleep, manage schedules to avoid unnecessary stress, and allow time for activities you find relaxing.

Chaste Berry: Also called vitex, the herb is used to relieve PMS, irregular periods, and menopausal discomfort. One study of 178 women, published in the British Medical Journal, found that chaste berry reduced a variety of PMS symptoms, including breast tenderness, irritability, and depressed mood. A common daily dosage is 225 mg in capsules. For liquid extracts, follow product directions.Isoflavones: These are plant sources of estrogen that increase levels of the hormone throughout the body. Red clover and soy, especially its genistein component, are popular sources and can be found as individual supplements or in formulas.

Dong Quai: Used in Traditional Chinese Medicine to treat menstrual problems, dong quai can also relieve menopausal symptoms and is often found in formulas. It helps balance levels of estrogen.

L-Theanine: An amino acid found in green tea, l-theanine lowers elevated stress hormones and improves sleep without causing grogginess. During the day, take 50–200 mg to reduce stress, or take in the evening for better sleep. To start, the lower dose is usually recommended. Effects take about 30 minutes to kick in and typically last about 8 hours.

Black Cohosh: A plant source of estrogen, black cohosh increases levels of the hormone in certain parts of the body, including the brain, reducing hot flashes; bones, lowering risk for osteoporosis; and the vagina, reducing vaginal dryness and thinning. A common daily dosage is 40–80 mg. Taking black cohosh with St. John’s wort is was shown to be effective in treating depression and other menopausal symptoms.

Fish or Krill Oil: Studies have found that when taken on a regular basis, either one of these can reduce PMS symptoms and menstrual pain. And, according to Canadian studies, fish oil can reduce menopause-related depression and decrease the number of hot flashes. Both supplements also help to counteract the effects of stress. Beneficial amounts: 3–6 gm daily of fish oil (providing approximately 1–2 gm of a combination of EPA and DHA), or 2 gm daily of krill oil.

Progesterone cream: Try an over-the-counter natural progesterone cream, per product directions. If you get sleepy during the day, you could be using too much. If it doesn’t help, you may need a higher dosage or the problem may lie elsewhere, so work with a physician that is a hormone specialist.

Thyroid Troubles

An underactive thyroid, the most common thyroid malfunction among women, can intensify or mimic PMS or menopausal symptoms, including weight gain, lack of energy, and depression. Thyroid hormones become inefficient when the stress hormone, cortisol, is too high or too low. And, the thyroid gland is especially prone to accumulating toxins.

“Levels of toxins in the thyroid can be 100-fold those of muscles and other organs,” says naturopathic doctor Alan Christianson, NMD, and author of The Complete Idiot’s Guide to Thyroid Disease. However, malfunction usually occurs only after an accumulation of toxins plus two other factors: genetic predisposition and some type of infection, even a cold or flu, or a bladder infection. This perfect storm triggers an autoimmune reaction, where your body attacks its own thyroid gland.

These online tests can give you a sense of your thyroid status:

Typical medical tests miss many cases of thyroid problems so if you suspect your thyroid is acting up, it’s best to find a specialist. Look for a physician who routinely tests levels of T3 and T4 as well as TSH (thyroid stimulating hormone).

Where to Find Hormone Specialists: (use the contact form);; or get a referral from a compounding pharmacist through

Herbal Libido Booster

Whether from declining hormone levels or exhaustion, libido tends to naturally wane with age. Herbal maca, a root plant once used by ancient Inca warriors to boost stamina, has shown promise in improving female hormone balance; it may help increase estrogen production. It is also known to enhance sexual desire while helping to alleviate numerous symptoms of menopause.

One to Try: Bricker Labs Macabido Women’s Formula This herbal formal blends standardized maca extract with other natural ingredients known to support sexual health and enhance energy including ginkgo and ginseng.


DREAMBRANDS Internal Harmony Progesterone Cream combines natural progesterone from wild yam, along with plant extracts and antioxidants.

GARDEN OF LIFE Oceans 3 Healthy Hormones features high-quality omega-3 fish oils for menopausal support, including reduced hot flashes and better sleep.

RESERVEAGE ORGANICS Menopause Advantage includes the isoflavones genisten, shown in research to help minimize the frequency and intensity of hot flashes.

MEGAFOOD Women Over 40 is more than a comprehensive whole-food multi—it also provides hormone-balancing herbal extracts and phytonutrients.

NATROL Promensil Menopause This formula includes red clover isoflavones to promote emotional well-being and hormone balance.