Ask Stefani: PCOS Edition

Ask Stefani: PCOS Edition

More questions about PCOS this afternoon!   No surprises here.  Below are some thoughts on endometriosis and PCOS, quinoa, feeling restricted, allergies, and moving forward with hypothalamic amenorrhea.

If you find that a question you asked me is below and I have not stripped it enough of your personality to post it here, please let me know.

 

Help!  I have both endometriosis and PCOS.  I don’t understand– I thought endometriosis was a condition of high estrogen levels, and PCOS a condition of low estrogen levels.  What gives?

 

There are two ways to answer this question.  First, PCOS patients can have high estrogen levels, and in fact many of us do.  For this reason, you can have both endometriosis and PCOS without rocking the boat of your theory.   On the other hand, I also believe it is entirely possible to have endometriosis and to have low estrogen levels.  This is because endometriosis and endometrial pain is related to high estrogen levels, but there are a variety of other factors in the development of endometriosis.  Having an impaired immune system and inflammation are two big ones on the list.  Once those things happen together, and you plant endometrial tissue somewhere in your abdomen (and in all likelihood aided by having high estrogen levels), then you have endometrial tissue that is going to be very difficult to weaken.  That is just the nature of the tissue.  It does not just shed off effortlessly.   In this time period your estrogen levels can drop and your immune system can improve, but your tissue may still cause you pain.  This is how you can have low estrogen and endometriosis.  The solution is to mitigate the problems as best you can, reducing stress and inflammation, healing your gut, boosting your immune system, and eating a hormone balancing diet such as the paleo diet.

I wrote about endometriosis at great length here.

 

I stumbled upon your website researching the Paleo lifestyle and was pleasantly surprised to see the tie in to PCOS! I’m sure you’re wondering why I’m commenting on this article but being an avid consumer of marijuana, I had to click and read. Admittedly, I was quite disappointed in what I read not about marijuana but more about seeds, nuts and quinoa. I was under the impression that quinoa was NOT a grain but rather a seed. I’ve successfully omitted all grains, beans, soya from my diet and this was a major bummer to read.  I am feeling very deprived right now thinking of the possibility of having to omit this as well. Thank you for the great article however and keep up the great work.

 

Quinoa is in fact not a grain.  It is called a “psuedo cereal” because it does not come from grains or grasses, but is rather the seed of a plant.  It is gluten free.  That being said, it also has many properties that seeds do, such as having a relatively high amount of phytoestrogen content (and will contain many of the phytates inherent to legumes, beans, and grains all).  Phytates are also a bit of a problem for PCOS because they have the potential to limit calcium and magnesium absorption– two ions quite crucial for the development of healthy and fertile corpus lutea.  All of which is to say that seeds are not great for PCOS, but unless you are eating buckets they will not make or break your case.  Probably, at least, in my opinion.

My thoughts about restriction are of course always complicated.  If quinoa is something that is necessary for you to feel good about food and your body, then I advocate keeping it in your diet at least for a while.  Clean up as much as you can, and relax into your food choices.  Try eating less whenever it seems easy to do so.  If it’s a battle, don’t fight it.  Just phase it out only as you can let it go with peace.  This will happen over time with patience and with love.  And if it does not, I really think that’s okay, too.  Take care of your brain first and foremost.   It is going to be your most important tool by far for taking care of your body for the rest of your life.

 

I have question. I had a hysterectomy in May 2012. I struggle with endometriosis, hashimoto’s, Sjögren’s syndrome & celiac. I’m on estrogen therapy & the autoimmune protocol but my allergies are getting worse! I eat meat, non starchy vegetables & fruit. I can’t tolerate any spices or starches & my allergies continue to worsen. Any suggestions?

 

You may wish to try eating a GAPS diet to heal your gut further.   Allergies are not my specialty– but I highly recommend first doing everything you can to assist your immune system, since this is where allergy problems are rooted.  This includes reducing stress, getting as much sunlight and/or vitamin D as possible, eating organ meat often–I’d advocate at least once each week–getting as much sleep as possible, and potentially getting your micronutrient levels checked to see if you have any deficiencies that are hindering immune function.    Boosting immune function will help your immune system react appropriately to foods without leaping into panic mode.  It also depends very much on what your allergies are and how you are reacting to them.   Are they definitely allergic reactions, or are they food intolerances?  This is a crucial difference.  An allergy is rooted more in immune issues and food intolerance is rooted more in the gut.  Allergen-specializing docs are probably the best place to go for troubleshooting this sort of issue.   You also want to make sure you are taking care of your hypothyroidism appropriately — are you supplementing with thyroid hormone?  because with Hashimoto’s you may need to be, so speak with your doctor about it — because thyroid hormone is crucial for immune function, for cellular repair, for probably energy usage, and just about everything else cells do.

 

I have had HA since february, since I stopped taking the birth pill. I am really underweight (5’10 and 100#). I lost a lot of weight when I started crossfit and doing a low-carb diet for two years. I am now trying to conceive.   My hormone levels are all very low.  I haven’t worked out for several months.   I only walk daily for one hour. I started seeing a therapist about my anxiety, who is helping me gain weight.   She makes me track my calories in order to gain weight. I have to eat more than 2,000 calories but rarely go over.  I am a bit scared of carbs.  Gaining weight is not working although I eat more and stopped working out. I keep counting the carbs and feel bad having potato chips and a cookie (too much carbs).   I do eat a good amount of fat (teaspoons of coconut oil, nut butter bacon, greek yogurt etc…).   What should I do?

 

Since your primary concern– and biggest obstacle– in getting pregnant is convincing your body that you are fed, you want to err on the side of eating more rather than less.  This should be the case all of the time.  Also, I recommend that you eat whatever you want.  Anything you want. I personally eat a very high carobhydrate for extended periods of time to zero ill effect. Do your absolute best to stay within the range of non-toxic foods (ie, skip the gluten, deep fried foods) and eat heartily. The more frequently you can hit your 2000 mark, or even better, go over, and the less you obsess, the faster you’ll regain hypothalamic health.

I cannot stress to you how much all of the factors of relaxing, reducing your anxiety, and gaining weight are all important for your ability to conceive.  This takes a lot of work.  You are going to have to have patience, and to forgive yourself as much as possible for all of the difficulty you are having moving forward.  The thing is that it is not your fault.  You have become inordinately thin as a result of psychological pressures put on you by an external environment, and now you are stuck with fighting that.  Keep your chin up and move forward as lovingly as possible.  Accept yourself as a natural body with natural needs.   When you look in the mirror, don’t obsess.  As a matter of fact, don’t look in the mirror.  It is way too easy to start seeing ourselves as bigger than we used to be– and even while we need to gain weight to be and even look healthier, by the simple fact of being “bigger” we think we look huge.  Don’t let your brain trick you into such radical subjectivity.   Do your best to put your evolutionary need and your fertility at the front of your mind, and be excited when you see yourself put on a bit of weight.  Do it slowly and make sure to protect your brain in all of this, but embrace your needs.  You are a woman with some strong ovaries and the power to carry children.  Nourish yourself as your body is crying out for, and take as much pride in that as possible.   Being thin doesn’t make you worthy.  Being a badass and tackling these problems with as much love and determination as possible does.

Eat carbohydrates!!!!  Carbohydrates a) do not make you overweight, they just don’t, period, and b) are supremely healthful for you, especially in a state of metabolic distress.   Start eating them slowly and learn bit by bit the lessons I am telling you.  You will see that they make you feel and look better without making you balloon in some ridiculous fashion.  They are just food, same as fat and protein.  Period.  Eat them whenever, however, and however much of them as you want.

Be patient, however, love.  These things can take time depending on how much damage has been done and how diligent you are about allowing some weight gain and calorie intake.   Increase what you are doing as much as possible, and make sure that you are erring on the side of nourishing yourself more rather than less.  Believe it or not you have already made radical progress.   You have started therapy– something most women never do!– and you have admitted that you need to work on some of these issues.  And you have really cut back on your exercise, and you are working on eating more and gaining weight.  These are all awesome things.  You are doing it, and you have so much to be proud of moving forward.  You will get there, especially with love, forgiveness, and harmony with your natural body on your side.

 

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You can read more about my work and opinions and plans for PCOS in the manual PCOS Unlocked.

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So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.

Ask Stefani: PCOS Edition, and Cyber Monday Part II!

Ask Stefani: PCOS Edition, and Cyber Monday Part II!

Due to a lovely letter and set of questions I received from a reader last week, I have decided to respond to a set of reader questions about anything on a bi-weekly basis.  These questions will also occasionally be devoted specifically to PCOS.   Today is the first of the series, huzzah!

I have also decided to run Cyber Monday back again!  From 9AM EST Monday morning (this December 17) until noon EST (December 18) PCOS Unlocked: The Manual will be available for half off the half off!   How enormously fun. !

How to get the discount:

Go to the PCOS Unlocked page.  Scroll all the way down to the bottom of the page where you can purchase it beneath the title “for discounts.”  Enter “december2012” into the discount box, and away you go!

 

 

 

And here we go!

 

1) I lost my period at about 8 stone 10 pounds. I am 5’5.

Over the many years I have suffered form HA I regained my period on quite a few occasions – sometimes for a few cycles. Previously it was always at that weight that I regained it – and then, like a fool, I would try to lose a few pounds. However, I stopped getting it at that weight nearly two years ago – and I have since gained more weight (I have been 9 stone for nearly 6 months) and I still don’t have my period back.

Is it possible that every time you have your period, and then lose it, your ‘set weight’ at which you get your period back increases? Or do you think it is more to do with the diet I am currently eating/ have eaten before?

 

In my opinion, the best way to think about amenorrhea is to think of it as an algebra equation.  Remember from the 8th grade chalkboard?

 

 aX + bY + cZ + … = Result

 

Think of X, Y, and Z as variables that affect amenorrhea.  X could be weight status, Y could be phytoestrogen intake, Z could be your stress level… other variables might be genetic predispositions, ovarian health, different hormone levels, how much you exercise, what you eat, your micronutrient levels, your degree of sexual activity, your age, whether or not you’ve born children… everything.

Then a, b, c, the multiplying factors, would be how important each of those factors are, and how strongly they are present in your body at any given point in time.  With an enormous value at b, you may not have any problems at all save for stress.  Or perhaps your stress levels are moderate, but your insulin resistance is moderate, so those two factors coupled together increase your “Result” enough to push it over the edge into amenorrhea.

I find it plausible that as you stress your system more and more, your body requires more and more “help” from other areas in order to have optimal fertility.   This does not mean that your set point is increasing– it may be, but I could not ever say for sure– but it does at least mean certainly that variables and stressors on your body are changing shape.   Diet is certainly important– but that depends entirely upon what you are eating at any given point in time.  Keep the toxins out, eat whole foods (check out my book for more on this), get plenty of calories in all of the macronutrient categories, repeat.

 

2) Coffee. I am loathe to give it up, and I have mensturated in the past whilst drinking. However, I will stop if this is a big issue. I can’t see any reference to coffee in the manual. Do you have an opinion?

 

Excellent question!  I do have an opinion.  I would refer you again to the equation I described above.  You may have menstruated while drinking coffee in the past, but perhaps coffee has always been a stressor on your body and you were just able to overcome it at that point in time.  Now it may be a stressor that your body is not capable of bearing.  I would call this a legitimate concern for women who struggle with stress and adrenal health.  If you think your PCOS problems are related to stress, I would consider cutting the coffee.  Or at least reducing the intake and seeing if it helps.  Coffee has the potential to wreak some very serious havoc on our stress responses (really it prevents the body from calming down) and that can disrupt the HPA (hypothalamic pituitary adrenal) axis.  With a dysfunctioning adrenal gland, the hypothalamus and pituitary glands can go off the rails as well.

That said, some women handle both coffee and stress quite well.  It’s an issue of individuality.  I will say however that I believe it is worthwhile to experiment with removing the coffee, simultaneous with increasing your sleep quality and duration, and doing as much stress reduction as possible.

3)  This question is a bit more random – but one Im really interested in.

I am currently married and met my husband a few years ago. When we first got together I began mensturating regularly, although I had suffered with HA before. I also gained a bit of weight so that I was about 8.5 stone, instead of 8. I mensturated for a few months and then lost a bit of weight and lost my period.   I have experienced periods ONLY after instances in which I was quite happy about and excited with my sexual situation. I would also regain my periods after shortlived affairs during periods where I was single.

I do realise many factors that come into play; when I engaged in happy sexual activity I would often eat heavily the next day. However I have also done this without getting my period back. I also appreciate that it may be that oestrogen levels peal and I, in turn, become more attracted to people when happily sexual.

Have you ever heard of the theory that oestrogen levels are spiked by sexual attraction? I knew a girl with PCOS who didn’t mensturate, but when she started an affair she started to.

I’ve heard rumors of such things before and I like the theory.  A quick (quick!) search through some academic databases hasn’t yielded much, especially because you are asking about sexual attraction rather than sexual activity.

I have heard many anecdotes of women who have regained their periods after beginning to engage in regular sexual activity.  I consider this the best method for correcting hormone imbalances.

What these women have claimed to me is that “you lose it if you don’t use it” — or at least that it is true in their cases.  I haven’t been able to learn much about this scientifically.   I can guess, however, how the hormonal cascade might work — dopamine levels, oxytocin levels, and other happy molecules such as serotonin rise relative to baseline when engaged in sexual activity (perhaps to a degree even when just flirting or snuggling.)  In fact, it has been shown that snuggling has a very real effect on hormone levels: oxytocin is produced while cuddling and is also known in the popular press as the “cuddle hormone.”   So this increase in happiness with a sexual edge may very well be like giving your pituitary gland a hug.

Neurotransmitters such as dopamine and serotonin have not been well studied with regards to PCOS.  It has been proposed however that hormones such as LH rise due to the activity of excitatory neurotransmitters such as dopamine.  It stands to reason that when you are engaged in sexual attraction, flirtation, feelings of comfort, or feelings of excitement, your dopamine and other excitatory neurotransmitter levels increase.  These, in turn, may help boost your pituitary function.

All of which is to say that these things– glands, brains, hormones– are still largely a mystery to us.  If you have found a pattern in your life, I suggest running with it.  Learn from it as much you can, and do your best to achieve that kind of happiness / pleasantness as much as possible.  If it’s good for your heart, chances are quite good that it’s good for your body.  Convincing your body you are in prime reproductive condition via regular sexual engagement doesn’t hurt, ever.

4) Over the past six months I have gained weight, stopped exercising and I think I am eating a very nutrient rich diet. I eat lots and lots of eggs, butter, liver and coconut oil. I also dont think I am very stressed. Since my period has not returned – and I am very light boned anyway – I feel like Im now getting stressed. At what stage might would you recommend going on birth control or HRT to protect bones?

 

That’s definitely something to talk with your doctor about– but I would say when your estrogen levels drop below what is typically established as “healthy” or “dangerous.”  That should be indicated on your blood tests, and OBGYNs generally know boatloads about estrogen and bone health standards.

That said, however, there are a wide variety of factors that go into bone health.  Also, if your estrogen levels are low only for a short period of time, you may want to discuss with your doctor the possibility that you continue to try naturally before working on the estrogen with HRT.   I would not stress about it, personally.  That’s largely because I wouldn’t stress about anything so long as I could avoid stressing.  Also this is a matter of personal opinion and understanding the risks.  What you need to know is that your risk for bone porosity increases as your estrogen levels decrease, but your general health and nutrient status is important, too, and short term fluctuations should be fairly well tolerated by most women.   It is also a risk happily born by some women.  I don’t recommend that, but I’m not recommending anything here.

 

5) The final loaded question, which is about calories.

I know it is a question of food quality and not so much of calories. But, like I said, I think I eat a really high quality diet. At 5’5 how many calories would you shoot for as a baseline? After years of undereating, and then a good few months of stuffing myself I think my leptin receptors might not be working that well. I think my metabolism may also be a bit out of whack so it is harder for me to just leave it to hunger or set weight. I can eat about 1200 calories per day and feel satisfied.

Do you have any very baseline calorie recommendations?

 

It’s interesting that you start with the statement “I know it’s a matter of quality more so than quantity…”  Because while that statement may have serious wisdom in it, calorie intake still is vital for women who are type II — that is, under metabolic stress — PCOS.

I understand your problem in calibrating your hunger and trying to figure out how much you should be eating.  It’s a struggle for anyone who has dealt with dieting, regimented eating, or even mindful eating in the past.  What I would say to you with regard to that is to always err on the side of eating more rather than less, and to never try and “go without” food.  If you think you might want to eat, you should eat.  Period!  🙂

1200 is a very serious minimum for a woman who is 5’5 and recovering from an issue like Type II PCOS or Hypothalamic Amenorrhea.  I would shoot for 1500 at minimum, but honestly push something closer to 2000.  The important part is to not just “get by” but rather to be seriously satisfied.

Your metabolism very well may be a bit confused right now.  The way to heal that is to eat as intuitively as possible and continually give it as much fuel as it needs– forever.  Wild swings in under and over eating can cause weight flucutaitons, sure.  A constantly satisfying diet over a long period of time is the only way to assure your body that you are being fed.

You also mentioned a lot of nutrient dense foods, which is awesome.  Be sure that you are including some carbohydrate in there.  Carbohydrate is the most readily available energy source, and it also happens to be crucial for the production of thyroid hormone.  Start with a few pieces of fruit or servings of potato / rice each day and see if that helps you find a bit more balance.

As a quick final note, it is possible that you are finding yourself sated in that fasting sort of way on a ketogenic diet (if you happen to be on one), and therefore severely under-eating how many calories your body truly needs.  I speak with a lot of women who confess to eating very few calories but not feeling hungry on ketogenic diets, and then hating adding carbohydrates in their diet because they feel some hunger again.  That hunger, however, may be an important signal for a woman dealing with type II PCOS / starvation / hypothalamic amenorrhea.   (Honestly I think the claim that carbohydrates beget unreasonable hunger is itself more or less unreasonable, and at the very least a matter of personal context.)  Carbohydrate intake is a touchy issue for many people.  What I prefer to leave the conversation with, therefore, are a) the fact that many traditional cultures eat high percentages of carbohydrate with no apparent health defects relative to lower carbohydrate cultures, and also b) the notion that personal experimentation with our bodies and hearts is the most important thing for our health and happiness.  If you eat carbohydrates and find that your body works better, then they are probably for you.

 

 

I’d also really like to finish with the comment that I am willing to try anything   I listened to your podcast with Diane and Liz and your words about not over emphasising stress/ adrenal fatigue etc – because 75% of it is diet –  made so much sense to me.
I know exactly what you mean when you said you would ‘try anything before gaining weight’ – I used to be exactly like that, but I really am not anymore. Now I’m just confused. To kind of summarise I am now half a stone heavier than the weight Ive mensturated at, doing stuff like drinking coconut mlik from the can and no longer exercising. I don’t think I’m picking at the details any more and I would really just value your opinion so much. I have even considered losing a bit of weight – the healthy way! – and then trying to regain it, just to give my body a bit of a shock. Im worried though that would be just like going backwards.

Uh, right.  Don’t do that.  🙂   Give your body some love and patience, and trust your body to heal itself.  Don’t panic about it.  Believe it or not, stress about this, even if it seems like it’s not all that much, really might be a significant factor for your physical health.  The fact that sexual attraction has played a role in your menstruation indicates to me that your HPA axis always benefits from some tender loving care.   Give yourself a few months and eat intuitively– you may drop weight naturally, or not, but I think you should be totally psyched about being 9 stone and 5’5– that’s a SEXY weight!– and see what happens.  Get yourself tested again and see if anything has improved.  If not, perhaps revisiting some tests and issues (such as hypothyroidism?) or vitamin supplements would be important at that point.

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So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.

Interview and in-depth discussion of my views on PCOS on Sean Croxton’s Underground Wellness

Interview and in-depth discussion of my views on PCOS on Sean Croxton’s Underground Wellness

Sean and I took the time a couple of weeks ago to sit down and really dig into the nitty gritty details of Poly Cystic Ovarian Syndrome.  It was a delightful interview and I encourage anyone interested in female hormones to take a listen.

In it we discuss the primary causes of PCOS and why it causes infertility, the different impacts of PCOS on overweight and underweight women, what I believe the different types of PCOS are, why women suffer health problems such as depression, anxiety, acne, and gut issues at twice the rate of men, and what hormones are necessary for a raging female libido.

Grab it at iTunes here!

 

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So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.

Announcing PCOS Unlocked: The Manual: The First 50 go for 50!

Announcing PCOS Unlocked: The Manual: The First 50 go for 50!

Today is the day!  PCOS Unlocked: The Manual is available.  I could not possibly be more excited.  This is important information, and I’ve finally got it in an accessible, digestible, comprehensive package.  Here we come, world!   We’re healing PCOS holistically, for all women with as many different hormone profiles that we can possibly conceive of.  I love this manual, and I think you will really love it, too.

And, both because I’m so geeked about this release, and also because my birthday is tomorrow and I am swimming in a pool of effusive love, the first 50 copies of the manual are half off!!   People started finding sneaky ways to buy them last night, so grab them while you can.  I’m hoping very much it’s PfW community members who get the half price editions.

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So PCOS Unlocked is, essentially, my brain dump.  It’s everything I know about PCOS and hormones, and synthesized in an organized way.

PCOS Unlocked is a thorough explication of what PCOS is, and why you have it, and how to overcome it.

Most importantly, in my opinion, however, is that it takes into account all of the factors that go into causing PCOS.  Most medical professionals, alternative health practitioners, and authors of PCOS books only really account for insulin resistance as a cause, or focus on it to the point of exclusion of everything else.  However: insulin resistance is not the only problem.  Overweight is not the only problem.   Not even close.  Dietary and lifestyle problems abound.

So in PCOS Unlocked, I address those problems.  I share with you why and how they occur, and I teach you how to recognize them in yourself, both by looking at your diet and lifestyle and also by looking at your blood tests.  I help you understand the shape of your PCOS, and I guide you through the healing process.  I share with you the proper diet, but then I also describe specific strategies for eating and living that you might want to consider in light of which category of PCOS you fall into.

To do all of those things,

PCOS Unlocked contains:

The 130 page manual, detailing…
           What PCOS is
           Why you have PCOS: Including a breakdown of the three primary types of PCOS
           How to overcome your PCOS
An exploration of alternative treatments such as drugs, supplements, and herbs
The 7 supplemental self-empowered treatment guides
The Food Guide
The PCOS Type Summary Cheat Sheet
The Stress Checklist
The Hormone Glossary
The Type Specific Indicators Guide
The PCOS Typing Flow Chart
The Blood Test Interpretation Tables
24 audio tracks explaining everything in detail
Totalling 2.5 hours of instruction
10 video break down guides
More than an hour of breakdowns and instructions in dynamic form

See the table of contents here.

So purchase the manual if you think it’ll help inform your brain and your life!  I put many furrowed brows and beads of sweat and too late nights into the project the aim of doing so.  I’d like to think I succeeded.

I am of course receptive to your feedback, and excited to hear what you think, so please let me know in the comments here or via email at stefaniruper@paleoforwomen.com.

It’s going up to 97 dollars as soon as we get to the 51st copy!  If you want one, grab it!

 

 

Or see it at it’s home, PCOS Unlocked: The Manual.

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So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.

Psychological stress and female hormones: a recipe for fertility disaster

Psychological stress and female hormones: a recipe for fertility disaster

While the title of this post may sound hyperbolic, it nonetheless is grounded in truth.  There are a wide variety of dietary and lifestyle factors that affect reproduction.  Stress may be one of the greatest of all.

What

Dozens of studies performed on cynomolgus monkeys, bonobos, chimps, and baboons have demonstrated that having low social status–even while maintaining the exact same diet at high social status individuals–induces impaired fertility in primates.

Human models, while approximations, do not differ.   In some, a simple progesterone-dampening effect occurs,  in others the levels decrease precipitously, in most cortisol levels skyrocket, but in general a wide spectrum of reproductive disorders- from hormone deficiency to full-blown long-term amenorrheic infertility- follow from psychological stress.

This is something about which I have written before, and it’s a serious problem, causing not just outright and obvious infertility but also sneakily impaired and sub-optimal fertility all across the country.

How

Pysychological stress wreaks all sorts of havoc on the body.  Most importantly, cortisol levels rise, and the body’s inflammatory and immune responses become impaired.  Blood sugar levels rise, and insulin levels rise, too.  When these things happen, healing cannot occur, and tissues become progressively damaged with time.  This applies to reproductive tissues as much as it does to the rest of them.   Hypercortisolemia is good for nobody.

Several hormone responses also occur.  Three of the primary ones are as follows:

1)  As I mentioned, due to elevated cortisol levels, insulin levels may rise, and testosterone levels rise right alongside it. This is because insulin directly stimulates testosterone production in the ovaries.  This is bad for reproduction because a proper balance between testosterone and female balance needs to be maintained in order for proper reproductive signalling and tissue development to occur.   One particularly potent way in which this imbalance often hurts women is in the hormone condition Poly Cystic Ovarian Syndrome.  It is not the only thing that contributes to PCOS– definitely not– but it can play a big time role in it. For more on stress and PCOS (and overcoming PCOS!), check out the book I wrote. 

2)  Moreover, another effect that may occur as a result of stress is an increase in production of DHEA-S, a hormone produced in the stress glands.   DHEA-S is, like all other hormones, an important and very healthful hormone in proper balance.  But if the stress glands are in overdrive, they might over-produce everything, including DHEA-S.  This is detrimental, because DHEA-S is also a classically male sex hormone, and it plays a role similar to testosterone in PCOS.  DHEA-S in excess blocks estrogen signaling, interferes with LH and FSH signaling, and also increases hormonal acne.  DHEA-S can play a role in both type I and type II PCOS.

3) Finally, the brain, via the hypothalamus, sometimes turns off pituitary activity in response to stress.  This often leads to a cessation of LH and FSH signaling–the two primary pituitary signalling molecules–which in turn decreases levels of estrogen and progesterone in the blood.  Recall that reduced progesterone levels are one of the primary markers of reproductive distress in primate studies.  Prolactin levels may also decrease.  These facts make it impossible both to ovulate and to menstruate.

*Graphic extracted from PCOS Unlocked: The Manual.

 

These three categories– testosterone elevation, DHEA-S elevation, and pituitary decreases may occur differently in all women.  And there are a wide variety of other, more subtle, hormonal responses that also occur, especially when considered in conjunction with all of the other bodily stress that follows from psychological woes.

All that being said, STRESS IS BAD.  We know some of the reasons why, as I’ve explained above.  Others likely exist.  Even if you don’t have infertility problems, you may have hormone imbalances or deficiencies, and those can be just as insidious.  Eat right, sleep right, live well, breath deeply.  Repeat.

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Stress is a significant problem for women’s health, and particularly women’s hormonal health.  This is manifested in a wide array of problems, but also most predominantly these days in the condition PCOS, or Poly Cystic Ovarian Syndrome.

You can read more about stress and it’s interplay with cysts, as well as how to overcome it all,  in my guide, PCOS Unlocked: The Manual.  

 

 

 

 

 

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So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.

Hormonal Acne: Where It’s Coming From, and What to Do about It

Hormonal Acne: Where It’s Coming From, and What to Do about It

Even though many dermatologists would deny it, hormonal acne is a real and serious problem for women.

Gut health and inflammation are both major players in acne. (read more about causes of acne other than hormones in this post, or this amazing guide).

Yet hormones can be the biggest problem for women.

In today’s post I discuss all the variations of hormonal acne, where it comes from, and what to do about it.

Hormonal Acne: When and how it shows up

When: 

Hormonal acne for many women presents at certain times of the month. Popular times include 1) at ovulation, which occurs almost precisely smack in the middle of the cycle, two weeks after the first day of bleeding (read about how to pinpoint ovulation in this post), 2) the few days before a period, and 3) at the start of a woman’s period.

Hormonal acne can also be present all of the time. For women with hormonal problems such as PCOS (read here to start figuring out if you have PCOS) and Hypothalamic Amenorrhea (read here to figure out if you have HA), this is unfortunately the case.

When I had both PCOS and HA at the same time, I had terrible acne every day for three years.

Appearance: 

Hormonal acne usually occurs in the form of cysts. Cysts are those lovely, pus-filled, painful and inflamed red bumps. They often culminate in a peak of white pus.

Hormonal acne also appears as more mild forms called comedones. These are those whitehead “bumps” that never break the surface.

Hormonal acne can even show up just as smaller lesions. These are not quite as angry and painful as full out cysts, and may appear more rash-like or just smaller than typical acne. Below is a photo of my own cysts (on a “good” day) back in 2011.

Stage 3 Hormonal Acne

These are cysts, classified as “stage 3” acne by dermatologists. There are 4 stages of cysts in hormonal acne

Location: 

Hormonal acne occurs first and foremost around the mouth. It shows up on the chin, below the nose, around the sides of the mouth, and sometimes up the jawline.

As hormonal acne worsens, however, it spreads to the cheeks and the forehead.

Other body parts can be affected, too. This usually includes the shoulders, back, and buttocks–where the body’s testosterone receptors are most prominent.

The physiological mechanism of hormonal acne

Hormonal acne is caused by increased oil production beneath the skin. Think of it like a river. Ordinarily there is a healthy flow of oil to the surface. This is important because it lubricates the skin.

But when there is too much oil – and when it combines with the normal skin cells and other debris on the surface of the skin – it can clog the pores.

When oil clogs pores, bacteria go on a feeding frenzy. This causes inflammation.

The worse inflammation is, the more irritated the oil gland can become, and thus the more red, and the more painful.

Yet it is important to remember that hormonal acne does not occur unless there is an oil problem.

This is the reason no amount of washing will ever completely eliminate hormonal acne. Admittedly, it can be helped by antioxidant cleansers, serums, or creams.

But it will never go away completely without curing the hormonal acne from underneath. The only way to fix it is from the inside out.

Hormonal Acne: Causes of increased oil secretion

The primary causes of oil secretion are male sex hormones, also called androgens. Testosterone is the primary culprit. Another androgen, called DHEA-S, is also very important. They both increase oil secretion.

This effect is worsened when female sex hormone levels – particularly of estrogen – fall. Estrogen balances male sex hormones in the skin. Without a healthy balance, problems occur.

1. The most prominent androgen is testosterone.

Testosterone causes oil production in the skin.

Why might you have high testosterone?

You might have it if you have PCOS.

(Acne is one of the clearest indicators of PCOS.)

You may also have high testosterone if you have diabetes or insulin resistance, because when the body produces insulin, the ovaries produce testosterone. It’s a very simple yet very damaging process.

When might you show hormonal acne from high testosterone?

If you still have a menstrual cycle, you may find that you break out around ovulation. This is the middle of your cycle. It is also when your testosterone levels are the highest.

But if you have a hormone condition like PCOS – you will probably have hormonal acne most of the time.

(If you struggle with PCOS or think that you may have it, you may want to check out my handy guide on overcoming PCOS.)

2. Another androgen, called DHEA-S, causes oil production as well.

Yet unlike testosterone, which is a sex hormone, DHEA-S is a stress hormone.

It is produced primarily in the adrenal (stress) glands. Whenever a woman is under any degree of stress, her body faces a choice: it has to decide if it wants to produce normal sex hormones like progesterone and estrogen, or if it wants to produce stress hormones like DHEA-S.

For this reason, Hypothalamic-Pituitary-Adrenal (HPA) Axis dysregulation is usually the first place to look to as the origin of DHEA-S problems. Women with a lot of stress – whether from emotions, poor sleep, or under-feeding – have higher levels of DHEA-S levels.

3. Estrogen fights acne.

Estrogen helps promote clear skin. It does this in a number of ways.

First, it has the power to off-set high testosterone levels in the blood. Estrogen increases levels of sex-hormone-binding-globulin (SHBG), which in turn binds testosterone and makes it impotent.

Second, the skin has many estrogen receptors in it, so estrogen directly performs a balancing and soothing function at the site of acne.

For women with chronically low estrogen, hormonal acne is often a consistent problem. They have acne 100% of the time.

In women with relatively healthy hormone systems, low estrogen can still be a problem. This is because estrogen levels fall at the end of each menstrual cycle, and are low at the beginning. Having such low estrogen levels during this time can lead to monthly breakouts.

Because hypothalamic amenorrhea is characterized by low hormone, and particularly low estrogen levels, boosting estrogen is one of the main and most helpful ways women with hypothalamic amenorrhea cure their acne.

Because menopause significantly decreases estrogen levels–almost to zero–this is also the primary reason women in menopause can see a re-emergence of hormonal acne after decades of clear skin.

4. Finally, progesterone can also play a role in acne. Progesterone, in high doses, acts as an inflammatory agent, and can cause acne to flare up. Progesterone levels are highest during the days leading up to menstruation, which explains why many women experience outbreaks at this time.

Synthetic progesterone, such as that found in birth control pills, can also cause acne.

Whether a certain variety of the pill causes acne for you or not, however, is entirely dependent upon your own body chemistry and how your body reacts to external hormones. Know only that if you noticed a change in your skin while experimenting with birth control methods, this is most likely why. You may want to consider a birth control method that has a different kind of progesterone in it, or one that has a different progesterone-estrogen balance, to see if it helps relieve your acne.

Aggravators of hormonal acne

There are many factors other than hormones that can worsen hormonal acne. Here is a list of the most common:

Stress: Stress plays an important role. It acts as an inflammatory agent, especially if cortisol levels remain high for a long time. Stress also  decreases production of healthy, skin-supporting hormones like estrogen, and increases production of acne-causing stress hormones like DHEA-S. Stress is not necessarily the cause of hormonal acne, but does exacerbate it, and prevent proper healing.

Heat.  Heat is inflammatory, and also causes sweat, which can clog pores.

UV Rays. The sun’s rays are some of the most potent acne inflamers out there. Protect the skin on your face with at least an SPF of 20, or consider wearing a hat in the summer months.

Inflammatory foods: grains, dairy, nuts, and omega 6 vegetable oils can all contribute to poor gut health and inflammation.

Dairy: While already mentioned for being inflammatory, dairy deserves special mention because it is a highly hormonal food.  Pregnant cows produce several hormones designed for growth. Growth hormones can both cause androgen levels to rise as well as promote production activities that lead to acne.

I have seen enormous success with women with hormonal acne eliminating dairy for their skin.  Many people at least anecdotally least respond to dairy with acne more strongly than any other food.

Phytoestrogens: soy and flax are the primary phytoestrogens to be concerned about, with legumes and nuts coming in a distant second place. Phytoestrogens (“phyto estrogen” is greek for “plant estrogen”) have the power to act as estrogens in the body. This may sound like a good thing for acne, but this role is ambivalent and should be treated with caution, especially with the skin. Different estrogen receptors read different kinds of phytoestrogens differently, such that phytoestrogens usually perform estrogen-lowering effects in skin tissue despite what they do in other locations.

Low carbohydrate diets: Having sufficient glucose stores is important for skin healing, and can speed the recovery of acne lesions. Glucose is also helpful for preventing hypothyroidism. Find out 8 of the most important signs you need to eat more carbohydrate here.

Poor sleep: Sleep both enables healing and promotes healthy hormonal production.

Hypothyroidism:  Without sufficient levels of T3, the active form of thyroid hormone, in the blood, a woman’s skin cells lack the ability to heal properly.  Many women who suffer hypothyroidism suffer chronic acne.

Dealing with hormonal acne

The best thing you can do for hormonal acne is get blood work done and figure out precisely what your underlying problem is. That way you can target the problem and treat it effectively.

Unfortunately not all of us can afford this, so it’s okay to guess. Nevertheless, the better an idea you have of what is going on in your body, the more specific you can be about what to do to fix it.

In general, hormone dysregulation that leads to acne can be broken down into a few broad categories:

1) high testosterone from PCOS (specifically the overweight and insulin resistant type of PCOS),

2) low estrogen from low body fat levels, chronic restriction, or living in an energy deficit,

3) low estrogen from menopause,

4) high progesterone from general hormone imbalance, possibly related to PMS,

5) any of these conditions worsened by stress or hypothyroidism, and

6) any combination therein.

The ultimate hormonal acne solution

The solution to all of these problems is to correct the hormone imbalance.  I have discussed methods of doing so above and elsewhere.

So to get rid of hormonal acne for good, check out my manual that has now helped several thousand women overcome their PCOS, or some of my work on hypothalamic amenorrhea.

For women with menopause, it may just “take time” or perhaps medical interventions are appropriate, depending on the severity of the problem.

Medication for hormonal acne?

There are drugs designed to help with hormonal acne.  Spironolactone and flutamide are the two primary ones that come to mind (though I don’t recommend taking either of them), as well as birth control.

The reason birth control pills are helpful for acne is because they enforce hormone regularity on a woman’s system.  The precise pill that is helpful for each woman varies by her particular condition– but in general, BCPs are comprised of estrogen and of progesterone. BCPs can for that reason 1) raise estrogen levels–which either corrects an estrogen deficiency or helps balance the activity of runaway testosterone–and they can also 2) restore proper balance between estrogen and progesterone, which is important for keeping progesterone levels within their proper parameters.

Some BCPs also contain anti-androgenic substances, such as drospirenone, which is an added benefit for women who are living with androgen excess (but poses some health risks).  In all cases, I do not generally recommend that women get on BCP, as it can cause worse hormonal dysregulation in the long run (sort of like handicapping a delicate hormonal system), and does not solve the underlying problem.

Flutamide acts in a similar way to spironolactone, but less effectively, and with more side effects.  So spironolactone is typically the drug of choice.

Spiro has been hailed by many acne sufferers as God’s gift to womankind: it decreases testosterone activity. For many women this begets truly miraculous effects. Yet one should step cautiously with spironolactone. If a woman’s primary problem is not testosterone excess, spironolactone will very likely do more harm for her skin than good.  (Check out the panicked discussion forums at acne.org to see what I’m talking about.)  Moreover, even for those who have testosterone excess as their primary problem, spironolactone merits caution for a variety of reasons.  First, spiro usually induces an infamous “initial breakout” which can last anywhere from weeks to months.  This isn’t always the case– sometimes women improve immediately. Sometimes they never really do (I never did: in fact, my acne got worse on spiro.) But the typical case is for women to see an initial worsening of their acne, followed by relief in the upcoming months, especially if they increase their dosages.

Secondly, spiro cannot be taken by pregnant women because it induces birth defects, so women cannot stay on spironolactone indefinitely. This is problematic because spironolactone acts as a band-aid on the hormone problem, and does nothing to fix it whatsoever. What spiro does simply is block testosterone receptors.  In most cases, if the underlying problem is not addressed while a woman is taking spironolactone, her acne will return once she comes off of the drug.  This is why I recommend that women only consider taking spironolactone if they want a “quick fix” while they work on their diet and exercise in order to improve their PCOS.

Finally, spironolactone has a couple of other health concerns.  First, it lowers blood pressure, since spiro is actually a blood pressure lowering drug proscribed “off label” for acne.  Secondly, it acts as a diuretic, so women on it need to drink water constantly, may not be able to consume alcohol anymore, may have dysregulated salt cravings, and may never actually be properly hydrated.  And finally, spiro acts as a potassium-sparing diuretic, such that women cannot eat potassium rich foods, lest they risk the chance of becoming hyperkalemic, which can lead to sudden death.  It hospitalized me. An imbalance of electrolytes in the blood is no laughing matter, so women on spiro should limit their potassium rich foods as well as get their potassium levels checked periodically.  Potassium rich foods include melons, bananas, potatoes, avocadoes, tomatoes, and leafy greens, among others.

For these reasons, spiro can help, but it cannot be relied on long term.  It does not get at the root of the issue–drugs rarely do–and the true path to hormonal help is diet and lifestyle modifcation.

As a final note, bio-identical hormone supplementation can be helpful for women going through menopause.  Estrogen patches can release small amounts of hormone into the bloodstream, and can lessen acne considerably. I do not think this is necessarily detrimental to a woman’s health, if it is in fact the case that her estrogen levels have simply dropped off during menopause.  However, it does, in my opinion, make it difficult for estrogen levels to rise and hormone balance to re-establish itself on its own. This is a decision best left to the individual and to her doctor.

In conclusion

Hormonal acne is terrible, and for many women can seem incessant, and never ending.  Girls are assured growing up that they will eventually out-grow their acne, yet many women see it persist throughout their twenties and thirties, and some actually do not even see the acne manifest until their twenties and thirties.  Some women do not even see acne appear until after the birth of their first children, as their progesterone and estrogen levels are flying all over the map.

There are downsides to medication, and large ones. Medication is only ever a band-aid, and it can be a band-aid that in the long run leads to more harm than good.  Playing with hormones is like playing with fire.  Sometimes things can go horribly wrong. For this reason, meds may be best left alone, depending on the circumstance and the level of risk a woman is willing to bear.

 

It is entirely possible as well as supremely healthy to cure acne from the inside out with good diet and lifestyle practices alone, many of which you can read about in my guide on weight loss, or my guide to overcoming PCOS. It may take experimentation and patience, but don’t all good things, in the end?

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For an even more thorough blog post on the causes of acne and overcoming it, see another post on acne, here.

For my favorite resource out there on overcoming acne, see Seppo Puusa’s Clear for Life. 

For some of my favorite topical solutions to acne, check out the antioxidant cleansers, serumscreams and topical probiotics (my absolute fave!) I use.

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So, just as a heads up - some links above may be my affiliate links, which means I get a small commission if you click on it and make a purchase. Doing so is no additional cost to you, but helps me tremendously. Your support is SO greatly appreciated, so thank you in advance if you choose to do so. Check out my entire disclosure to know exactly how things work.