Posted by Ramneek S. Bhogal, DC, DABCI on Sep 18, 2018 11:16:05 AM
Helping female patients determine the best care plan for supporting their reproductive health can be an uphill battle for functional medicine practitioners.
It’s rare that your female patients will see you for the same reason they might schedule an appointment with their gynecologist.
Patients sometimes draw a line between functional medicine and traditional medicine in this context, and it’s up to you to create a space where you can partner with your patients to create plans that demonstrate how holistic approaches can complement the regular health regimen established by their gynecologist.
Some of the most common reproductive-related symptoms functional medicine practitioners see in adult women are irregular menstruation, ovarian cysts, and other fertility challenges. Any of these symptoms can be indicative of a nuanced hormonal imbalance. This post discusses some emerging evidence concerning holistic strategies for preventing and fighting common reproductive health issues in women.
A particular hormonal imbalance tends to appear along with the reproductive symptoms we see most often: estrogen dominance. This term is somewhat misleading, as it doesn’t mean a woman has more estrogen than is normal.
Generally, there are two ways for estrogen dominance to develop. Either a woman is deficient in progesterone, which allows her estrogen to run unchecked, or her estrogen is being produced in such a way that it results in the development of “dirty estrogen.” When your patient’s body is under stress, it can result in this less favorable form of estrogen. Regardless of how you get there, estrogen dominance is not a great destination for the body’s reproductive system.
When a patient’s estrogen and progesterone levels become imbalanced, the accompanying symptoms can form a veritable quagmire. Patients often report:
Warning signs of estrogen dominance may arise early in a woman’s reproductive years. For example, a young woman with excessive acne or one who begins menstruating at an atypically early age may exhibit symptoms. If a woman comes in with symptoms much later, though, it’s possible the imbalance has gone untreated for years. In many cases, these issues have been “covered up” by hormonal contraceptives.
If your patient is coming to you with concerns about reproductive health because they are looking to conceive, it’s possible that weaning off the pill has led to a resurgence of the previous imbalance.
If your patient is experiencing debilitating pain, especially during their periods or sexual intercourse, it’s prudent to refer them to a gynecologist. However, if they are experiencing less dramatic symptoms on the list above, such as irregular menstrual cycles, resolving estrogen dominance is possible through naturopathic care.
As previously noted, estrogen dominance can be a misleading prognosis. It’s not as simple as reducing the amount of estrogen in your patient’s system. In fact, that’s the exact wrong course of action to take.
The first approach to solving this problem for patients is to increase the amount of progesterone in her system. This can be done using either endogenous or exogenous means. The second approach focuses on the quality of estrogen your patient’s body is producing—can we clean out the “dirty estrogen” and prevent more from being produced?
You might be thinking, “But what about reducing the amount of estrogen?”
That’s usually not a good course of action for a functional medicine practitioner. The reason being that estrogen dominance is not indicative of excessive estrogen—by aiming to reduce the estrogen in your patient’s body, you are effectively altering their natural baseline. It’s a slippery slope for the body to be permanently operating with a deficiency of two crucial hormones.
Luckily, we’re able to provide a patient with options to elevate her natural level of progesterone.
One way to do this endogenously is through the use of a botanical called chasteberry, or Vitex agnus-castus.
Chasteberry is a natural berry with intrinsic properties that increase the body’s sensitivity to available progesterone.* This is a way to increase progesterone sensitivity in an effort to help raise levels in the body without having to provide an exogenous source of progesterone.*
However, in functional medicine, it’s common to use bioidentical hormone creams that are yam-based. These creams are often a transdermal delivery system for various forms of progesterone. They come as gels or creams, and the patient applies them to target areas on the body in a certain pattern. Low levels of bioidentical progesterone cream can very slowly elevate the intrinsic progesterone value in women. The slow speed is a net-positive as it’s unwise to rapidly change the amount of any given hormone in your patient’s body.
A common compound used by functional medicine practitioners to clean up the “dirty estrogen” is DIM (diindolylmethane).*
DIM is a product of Indole-3-Carbinol or I3C, which is an extract of the cruciferous vegetables that are normal to our diet. We’re talking about broccoli, kale, spinach, collard greens—all of your cruciferous greens, essentially. But it’s very difficult to get an adequate amount of I3C through diet alone.
Once the supplement hits your stomach, I3C is converted into diindolylmethane (DIM). The synergistic relationship between these two compounds cleans up the estrogen in your female patient’s body. Administering DIM along with an exogenous, transdermal treatment can provide a two-pronged approach to estrogen dominance*
The goal of this two-pronged approach is simple: increase the amount of progesterone in your patient’s body, and try to increase the amount of quality estrogen.
Hormone imbalances can be challenging to identify, but identifying them is crucial to long-term female reproductive and hormonal health. It’s important to listen to your patient’s story, understand the full picture of their reproductive health over time, and identify “tip of the iceberg” symptoms that could indicate more extensive underlying hormonal imbalances.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
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