Psychological stress and female hormones: a recipe for fertility disaster
by Stefani Ruper | Oct 10, 2012 | Blog, Body, Fertility, Hormones, HPA axis, Hypothalamic Amenorrhea, Mental Health, PCOS |
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.
———————————–
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.
--------
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.
by Stefani Ruper | Jul 19, 2012 | Acne, Blog, Body, Hormones, Hypothalamic Amenorrhea, PCOS |
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.
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?
——-
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, serums, creams and topical probiotics (my absolute fave!) I use.
--------
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.
by Stefani Ruper | Jul 3, 2012 | Blog, Body, Fertility, Hormones, HPA axis, Hypothalamic Amenorrhea, PCOS, Stress |
PCOS and hypothalamic amenorrhea are two specific, different diagnoses. Most medical professionals would never dream of diagnosing a patient with both. Nevertheless, my research, personal experience, and work with clients have demonstrated without doubt that millions of women suffer from both.
PCOS and Hypothalamic Amenorrhea: Why People Think They’re So Different
The majority of women who have PCOS fit into a particular category, and most medical professionals lump all women with PCOS into this category.
For this reason, PCOS typically is understood as a condition of excess. I describe this in great depth in my post on The Causes of PCOS, and also in my manual for overcoming PCOS – PCOS Unlocked. For them, PCOS means being overweight, means high insulin levels, and means high testosterone levels. Other hormone levels might be elevated, too.
For women who fit the PCOS norm, inflammation, overeating, and high hormone levels are considered a problem – thus the idea of excess.
Unfortunately, there are millions of women who suffer from PCOS but who are not quite in the same state of excess. I’ll talk about them (I am one of them) in the sections below.
On the other hand, hypothalamic amenorrhea is typically understood as a condition of scarcity. In hypothalamic amenorrhea, women tend to be very thin, tend to undereat, tend to overexercise, and tend to have very low hormone levels.
For these women, their hormone problem is that they do not produce hormones. Their bodies believe that they are starving, so they shut down reproductive function. This is an evolutionary adaptation. It is potentially life-threatening to be pregnant in a state of famine. To protect against that threat, the female body shuts down when it thinks it may be starving. This is what happens to women and girls with hypothalamic amenorrhea.
PCOS and Hypothalamic Amenorrhea: Why They are Not So Different
PCOS is complicated. It’s an easy diagnosis, but the causes of it are rarely understood. This is because cysts crop up under a wide variety of hormonal circumstances. We might think that this would mean that the medical community recognizes the need for diverse treatment among PCOS patients, but actually it does not. Instead of considering the wide variety of PCOS needs, many doctors (especially those who are not endocrinologists) use blanket diagnoses and treatments for all of their PCOS patients.
The current understanding of PCOS is flawed in two major ways. First is what I just described above. The second flaw is a corollary of that nearsightedness: most members of the medical community (though there is a real debate getting off the ground) believe that it is impossible to have both PCOS and hypothalamic amenorrhea at the same time.
I disagree.
The belief in problem number two, ie, that HA and PCOS are incompatible, derives from the first problem, ie– the lack of a nuanced understanding of PCOS. PCOS is widely regarded as a problem of insulin resistance and being overweight. These are two significant factors that generate cystic ovaries. But they are not the only ones. Only 60 percent of PCOS patients are overweight. Some normal weight PCOS patients are also insulin resistant. Yet others still are not. What causes normal weight women to develop cystic ovaries? And what about insulin-sensitive women?
PCOS and Hypothalamic Amenorrhea: How to Be Different
Each woman needs to have two of the following three characteristics in order to be diagnosed with PCOS:
-Cystic ovaries, as detected via ultrasound
-Elevated male sex hormone (like testosterone) levels
-Irregular or absent menstruation
The thing is that these symtpoms indiciate that the process of menstruation is not completed properly. They indicate that there is an imbalance between male and female sex hormones in the body. The condition of excess of insulin and testosterone I mentioned above is one way to make that happen. It is, however, by no means the only way.
The dominant pathway by which women develop poly cystic ovaries is, again, that of the overweight woman. It is a fairly simple process:
1) insulin stimulates testosterone production in the ovary, and
2) excessive testosterone production throws a wrench in the menstrual cycle.
In PCOS, testosterone and female sex hormones become improperly balanced, and the rest of the menstrual cycle, which takes its cues from the rise and fall of estrogen levels, suffers. LH and FSH, two pituitary hormones that tell the ovaries what to do and when, are of particular concern. LH and FSH levels become dysregulated with dysregulated estrogen because they take their cue from blood estrogen concentrations. This is why the vast majority of PCOS patients have a reversed and high LH and FSH ratio compared to healthy women. The pituitary gland keeps trying to make the body ovulate, but it does not read estrogen signals properly, and the ovaries do not hear the pituitary properly. So these are the markers of the typical PCOS diagnosis: inverted LH and FSH, insulin resistance, overweight, and elevated testosterone levels.
Yet there are other means by which a woman’s hormonal profile can create cysts. One is hypothyroidism (which you can read about and it’s relationship with PCOS in the blog post here).
Today, the problem of primary concern for us is hypothalamic amenorrhea.
PCOS and Hypothalamic Amenorrhea: How to Have Both
HA is known by many to be exactly the opposite of PCOS. It’s a condition of hormonal scarcity.
If hormones are scarce, however, they can still be out of balance.
Most medical professionals consider PCOS a condition of excess. But it is in fact a condition of imbalance. PCOS arises when male sex hormones are elevated over female sex hormones in the body. This can happen when testosterone goes too high — as is the case with the “normal” PCOS patient (though there really is no such thing) — but it can also happen when DHEA-S, another male sex hormone, rises, or when estrogen, progesterone, LH, and FSH drop.
Hormone levels tend to drop in conditions of scarcity.
The body interprets stress, eating too few calories, exercising too much, and having too little body fat as indicators of starvation and scarcity.
Hormones can be imbalanced with the condition of scarcity in a number of ways. I list a few examples below.
PCOS and Hypothalamic Amenorrhea: Examples of having both
-A woman is really stressed out by work and life. While most of her hormone production plummets, her DHEA-S production (the top-of-the-food-chain hormone produced by the adrenal gland) skyrockets in response to HPA axis dysregulation. DHEA-S is an androgen, and it influences the development of cystic ovaries if estrogen levels are not equally as high.
-A woman is fairly healthy but has slept poorly throughout her entire life. This pushes her towards insulin resistance, but more than that it dys- and up-regulates her cortisol production. Cortisol signals to the HPA axis to decrease pituitary activity, and it does so. Her hormone levels all decrease. This woman’s predisposition to insulin resistance coupled with adrenally-induced fluctuations triggers the development of ovarian cysts.
-A woman is stressed out via the typical HA pathways–caloric restriction, excess exercise, and stress–so her pituitary hormones decrease in potency. Testosterone and estrogen levels are low but okay, and the woman is probably thin but may also be larger, depending on the degree of stress. Nevertheless, this time it is progesterone that takes the largest hit from the stress (taking it’s cue from both estrogen and LH), and menstruation can never occur without sufficient progesterone levels.
-A woman has a tendency towards insulin resistance, and is overweight, and then loses weight. While this corrects the insulin problem, the drop in estrogen levels she experiences from the weight loss (since estrogen is produced in fat cells) causes an imbalance in her predisposed-to-testosterone-production ovaries.
– Or a similar phenomenon occurs with leptin: In this case, a woman may be a bit insulin resistant, and therefore have a predisposition to testosterone production, but she does not test into a “dangerous” testosterone zone. Instead, her problem lies in the fact that she lost weight, and with it, she lost the potency of her leptin stores. During puberty, each woman’s body adapts to whatever levels of estrogen and leptin she has circulating in her blood at the time (creating a bit of a leptin “set point”). Later in life, one of these women loses weight. As she loses weight, and, significantly, if she is restricting calories or exercising excessively, her leptin (and estrogen) levels drop. The hypothalamus perceives this drop as an indication of a time of famine, and initiates a starvation response, primarily by decreasing the production of sex hormones. In this woman’s case, therefore, estrogen is low, and testosterone may be low to high, depending on the degree of insulin resistance and ovarian malfunction, but LH and FSH are both also low. She does not present with typical PCOS. She does not over-producde hormones, but, instead, under-produces.
-A woman has the MTHFR gene mutation, which predisposes her to high stress hormone levels, inflammation, and high testosterone levels, but which does not change her female sex hormone levels. When she experiences weight loss or a low body weight, it easily tips the body into a state of imbalance.
All that said, these are some examples of how typical HA problems can cause the cystic condition that is typically associated solely with PCOS. Stress, excess exercise, restricted macronutrient intake, restricted calories, and weight fluctuation can all contribute to cyst development. Many of these situations can co-occur, and that totally depends on a woman’s genetics, epigenetics, lifestyle, and diet.
PCOS and Hypothalamic Amenorrhea: Recommendations
The problem with having a poorly-nuanced understanding of PCOS lies in the way in which blanket recommendations are made for women with PCOS or HA. As a result of this mindset, I have been criticized for recommending that thin women with PCOS eat carbohdyrates. This is because those who are criticizing me believe that PCOS is solely a result of insulin resistance. I do not believe so. I believe that many women with PCOS do not necessarily have a problem with insulin resistance, and even if they do, it can be compounded by factors that lie outside of that typical diagnosis.
I would, then, tentatively recommend that women who are overweight and insulin resistant follow the typical PCOS protocol and under-take insulin sensitizing and gut healing steps. On the other hand, I would tentatively recommend that potentially under-weight and overly-stressed women with PCOS consider eating more, possibly upping their carbohydrate intake, and exercising less. Women with low thyroid would do well to correct that problem however they see fit. This is, however, particular to the individual, so please do not take my musings about PCOS etiology and treatment as prescriptions. Each woman’s experience of PCOS is unique and requires individual troubleshooting.
There are many different causes of PCOS, and it is rare for a woman to only experience one of them. The key to overcoming PCOS is to figure out what is causing your PCOS, and then experimenting with treatment options.
I have written an info-packed, multimedia resource for you, precisely to show you my method for overcoming PCOS with my clients. I also happened to use this method myself, as I was one of the women who has both PCOS and HA (But not anymore!). You can read all about that and get started on your own PCOS today.
Check it out here.
And what about you? What is your experience with PCOS and hypothalamic amenorrhea? I would love to hear about it!
--------
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.
by Stefani Ruper | May 31, 2012 | Blog, Body, Carbs Fat Protein, Fertility, Food, Hormones, HPA axis, Hypothalamic Amenorrhea, Mental Health, Paleo Diet Basics, PCOS, Sleep, Stress, Thyroid |
I spend a disproportionate amount of my time telling women to eat carbohydrates.
In the paleosphere, it is incredibly common to eat a low carbohydrate diet. Plenty of people use low carbohydrate diets to lose weight, to sharpen insulin sensitivity, and to reduce appetite in the short term.
A low carbohydrate diet can also be therapeutic for people with cancer, migraines,and chronic infections or psychological disorders.
On the other hand, low carbohydrate diets can be a significant tax on people, women especially.
Because low carbohydrate diets are so popular for weight loss, it is common for women trying to lose weight and to “look good” to exercise often, eat very few carbohydrates, fast, and restrict food intake. The more of these restrictions a woman undertakes at once, the more and more her body reads this as living in a starved, stressed state.
The effects of this are significant: adrenal glands work overtime, livers get tired from performing so much gluconeogenesis, insulin sensitivity drops, body fat levels fluctuate, sleep quality decreases, and libido and fertility decrease.
The problems that come from a low-carbohydrate diet of course don’t affect every woman. Each of us is different. But women who experience stalled weight loss, low-thyroid symptoms, menstrual dysregulation, sleep and or mood and mental health related issues may find significant relief from adding carbohydrates back into their diets.
If you are trying to lose weight, take a look at my program, Weight Loss Unlocked, which will help you lose weight in a healthy, safe, and balanced way. Check it out here.
Also, this is my favorite paleo cookbook with plentiful carbs in it. It’s by Russ Crandall, and he’s an amazing chef, as well as one of my favorite people of all time.
Carbohydrates are beneficial for fertility and health because…
-Glucose is necessary for the conversion of T4 to T3 in the liver.
Without adequate glucose, the liver struggles to make enough T3, which is the form of thyroid hormone critical for healthy thyroid function.
Without sufficient T3, hypothyroidism results. Hypothyroidism is implicated in mood disorders, reproductive irregularities such as PCOS and amenorrhea, in skin conditions, and in weight gain, among other things. (For more on how to figure out your particular type of PCOS and how hypothyroidism may be at play, see my program PCOS Unlocked or read my post on the causes of PCOS)
Many women, contrary to popular paleo belief, in fact lose weight once they add carbohydrates back into their diets. This is because the carbs help the body produce more T3.
(Now, low carb dieters might be quick to point out that the liver can manufacture its own glucose. Certainly, the liver is capable of producing its own glucose with gluconeogenesis, but that process can become taxed over time, particularly if the liver is already taxed from poor eating habits in the past, mineral deficiencies, stress, or calorie restriction.)
-Glucose elicits an insulin response, which in turn spikes leptin levels in the blood.
This is a short-term spike, so eating carbohydrates should not be used as a replacement for body fat, which is the primary long-term secretor of leptin.
However, moderate, regular consumption of carbohydrate spikes leptin frequently enough to help signal to the hypothalamus that the body is being fed. Leptin is absolutely crucial for reproductive function. Without leptin, the hypothalamus does not tell the pituitary to produce sex hormones, so it doesn’t.
–Insulin is also an important signaler of the “fed” state.
In addition to leptin, the hypothalamus also responds to insulin. These two hormones are largely responsible for the female body determining whether it is in a “fed” state.
Being in a fed state is critical for convincing the body it is in a healthy enough environment to reproduce, have a libido, and also lose weight.
–Moderate carbohydrate intake is associated with better mood, stress-reduction, and sleep quality.
I see this in my work and in anecdotes, as well as in many controlled studies.
Carbohydrate intake boosts tryptophan levels in the brain, and tryptophan is the protein precursor to serotonin. Getting at least some carbohydrate in the diet helps with the vast array of issues associated with serotonin deficiency which include moodiness, stress, and insomnia. People have been shown to sleep better if their dinner includes carbohydrates in it.
This is especially true for women.
For a look at the details and complexities of the issue, see Emily Deans writing here and here. The primary takeaway of this point being that while the exact mechanism of carbohydrates boosting mood and sleep quality is unknown, carbohydrates still appear to be a healthy, and in many cases necessary, macronutrient.
Carbohydrates for fertility and health
The main point here is that carbohydrates are not just okay but important. For women who have appetite control problems, sugar addictions, and a lot of weight to lose, absolutely I believe a low-carbohydrate diet can do them wonders. For women who struggle with menstruation, fertility, stress, exercise performance, or any other hormonal oddities, carbohydrates help assure the woman’s body that she is healthy and fed. This is crucial for reproductive health.
In all cases, diet is a matter of personal physiology and experimentation. If a woman’s body works better on carbs, she should eat them, and delight in those joys rather than worry needlessly. At the very least, they are not harmful, and at their best, they are life saving.
This concept is central to my program Weight Loss Unlocked. If you are interested, it will help you figure out which path to weight loss is best for your unique body and metabolism.
Carbohydrates to eat:
-Starchy tubers such as sweet potatoes, batata, jerusalem artichoke, cassava, tarot, and bamboo. Regular potatoes are fine, too, but they contain fewer vitamins than their sweet counterparts. Of the sweet potatoes, Japanese sweet potatoes are the most delicious, in my opinion, followed by white sweet potatoes and then yams and regular orange sweet potatoes.
These starches are composed primarily of glucose.
–Fruits. All fruits! Berries and cherries tend to have more glucose than fructose, other fruits tend to have more fructose than glucose. This is not a huge point of difference but I have noticed that some women tend to do better on glucose-heavy or fructose-heavy carbs. I personally have an easier time with weight maintenance with fruits than with starches. I talk about this idea more in depth in that Weight Loss program for women I use with my clients.
-Rice Both white and brown rice are fine, but are fairly nutrient-poor.
Brown rice contains anti-nutrients in it’s shell, so white rice is more innocuous in terms of nutrient absorption. Wild rice is another option that I like. Pink rice is something that my friend Noelle from Coconuts and Kettlebells really loves and is a unique way to incorporate rice into the diet! (By the way, if you haven’t listened to The Paleo Women Podcast featuring myself and Noelle, you need to! We are the BEST and we will explain to you ALL THE THINGS. Find us here!)
-Vegetables of course are great, but they do not count for carbohydrate consumption. I know that most of the carbs in vegetables are glucose, but much of it them are also tied up in fiber, which is broken down and turned into short-chain fatty acids by gut bacteria. For this reason, vegetables alone cannot make up a woman’s carbohydrate consumption. Instead, starchy tubers and fruits work the best.
How much carbohydrate to eat for women:
For a woman recovering from stress, metabolic distress, and hypothalamic amenorrhea, I recommend eating between 100-200 g/day. That goes for athletes as well. And for pregnant women. At least 100 g/day.
I typically recommend that women start with 100 grams of dense carbohydrate like starches and fruits and experiment from there. You can definitely eat more than that – I know that I do. But you could also eat a bit less, especially if you prefer a lower carbohydrate appraoch to health.
Remember, you do not necessarily need to eat high carbohydrate. You can, but you don’t have to. It is only that a diet with at least some carbohydrates can really help with fertility, hormone balance, thyroid, and weight loss problems.
Carbohydrates elsewhere in the paleo blogosphere:
Chris Kresser and Chris Masterjohn: Cholesterol, mostly, also: Telltale signs you need more carbs
Jimmy Moore: Is there any such thing as a safe starch?
Jamie Scott: A Week of It
Paul Jaminet: Higher Carb Dieting Pros and Cons (includes a discussion of the “longevity trade-off”)
Cheeseslave: Why I ditched low carb
Beth Mazur: Why I don’t eat low carb
Julianne Taylor: Okay, People, Carb’s Don’t Kill
Melissa McEwen: What the bleep do we know about carbs
While you’re at it, go read Melissa’s post on Why Women Need Fat.
Don’t forget this is my favorite paleo cookbook full of good carbs.
And especially don’t forget to check out Weight Loss Unlocked if weight loss is one of your main goals right now, The Paleo Women Podcast, which is just so much fun, and my best-selling book Sexy By Nature, all great resources for all things women’s health, happiness, and fertility!
--------
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.
by Stefani Ruper | May 22, 2012 | Blog, Body, Disordered Eating, Fertility, Hormones, HPA axis, Hypothalamic Amenorrhea, Stress, Thyroid, Weight Loss |
The volume of emails I receive from women who start having menstrual problems on a paleo diet is staggering. It is not an enormous volume, no. But it is enough to give a woman pause. What gives? Aren’t we supposed to be healthier on a paleo diet?
Yes, we are, and really, we are. In the vast majority of women who eat a Standard American Diet, specifically those who are overweight, a paleo diet does wonders for balancing hormone levels. It is usually only when a paleo/whole-foods diet is coupled with restrictive norms that women start running into problems. Too little food, too much exercise, and too much stress are really what it all boils down to. The whole foods are not to blame– not in the slightest. What are to blame, instead, are the obsessive ways in which people interact with these foods.
There are several mechanisms that may be at play in the physiology, depending on each woman’s genetics and how each woman undertakes her paleo diet and lifestyle.
What happens in the body when it stops menstruating
The female reproductive system runs off of a sensitive fleet of circulating hormones. When one or several of them is disrupted, many of the others fail at their jobs, too.
During the menstrual cycle, hormone levels in the blood signal to the hypothalamus to signal to the pituitary to release FSH and LH, two hormones that in turn tell the ovaries what to do. FSH–follicle-stimulating hormone– is released in the first part of the menstrual cycle to incite egg development. LH–luteinizing hormone–is released in the second part of the cycle and prepares the endometrium to be shed. Without proper FSH and LH levels, the female body can never convince the ovaries to do their job. FSH and LH are crucial, and they rely on proper functioning of the HPA axis.
This job of the ovaries is to produce the follicles and the eggs, but in doing so it also produces estrogen and progesterone. This fact is important for signalling menstruation, because it is partly the rise and fall of estrogen and progesterone levels throughout the month that signal to the hypothalamus to release FSH and LH at different times. This is, in essence, a circle of signalling. LH and FSH from the hypothalamus to the ovaries, estrogen and progesterone back to the hypothalamus, and so forth.
Hormone malfunctions that cause amenorrhea
–Decreasing estrogen levels stop the pituitary from being able to send out FSH and LH.
–Decreasing leptin levels stop the pituitary from being able to send out FSH and LH. This is because decreased leptin levels signal to the hypothalamus that the woman is lacking energy stores and is, in essence, starving. When the hypothalamus thinks the woman is starving, it puts a halt to normal reproductive functioning. Leptin levels decrease proportionally with fat mass decreases. On the other hand, leptin can also go undetected when an individual is leptin insensitive. Insensitivity is in general a larger problem for overweight women, and low absolute leptin levels are in general a greater problem for thin women.
–Increased testosterone production interferes with estrogen levels.
–Increased stress and cortisol levels put a halt to hypothalamic and pituitary function.
Cause 1: Weight loss
Both estrogen and leptin are produced in fat cells. These are the two blood serum hormone levels necessary to signal to the hypothalamus that a woman is fed and happy, and that it should go ahead with normal reproduction. Without these two hormones, reproduction ceases. It is well known in the medical literature that the low body fat of anorexic women, models and athletes is what accounts for their amenorrhea. Without fat, a woman simply cannot menstruate.
What is discussed less often in the literature, but is still true (see Wenda Trevathan’s Ancient Bodies Modern Lives) is the fact that a woman’s reproductive system is set up to run on the nutrient basis she has as a young girl. Throughout puberty, if a girl has a higher-than-average or higher-than-healthy body fat percentage, her ovary to hypothalamus signalling may develop as ‘handicapped’ by these fat stores. Because fat cell estrogen is so high, the ovaries do not have to produce as much. For example: If the body’s estrogen set point is 100 units, and fat cells produce 80 units, then the ovaries only need to produce 20 units. Then, if the woman loses weight, the set point remains around 100 or falls a bit to a healthier level (unique to each circumstance), and the fat cells production falls to around 30 units, such that estrogen from the ovaries is then expected to make up for the rest of the estrogen deficit. Many women have no problem with this. Their ovaries jump into higher gear. Many others, on the other hand, do struggle. Their ovaries never end up rising to fill that gap. The thing is– the set point is not stuck precisely at 100. It will decrease to a healthy level. But it might not decrease as far as a woman bent on meeting social expectations of body image is hoping.
The alignment of a woman’s sex hormone levels with the amount of nourishment she has during puberty accounts for why women who live their whole lives on the edge of starvation can still have babies, but women whose body fat percentage decrease from 28 to 21 cannot.
This is not to say that an overweight woman will stop menstruating when she loses weight. Each body is capable of menstruating within the healthiest range of body fat percentages, from around 20 percent to 30 percent. But a woman who has always erred on the side of heavier might find that she cannot dip below 23 or 24 percent body fat without losing her period. 23 or 24 percent body fat is healthy, so this is fine. It might not fly is the woman is trying to meet ridiculous standards of Western body image, but it is optimal for her to have the appropriate serum hormone levels.
Other factors that can hurt estrogen and leptin signalling may also play a role. If a woman can correct those, then she may be able to decrease her body fat levels without hurting her reproductive system. For example, chronic stress hurts hypothalamic signalling. So a stressed out overweight woman is going to have a harder time with reproductive fitness while losing weight than a totally relaxed overweight woman. This is a fact. For menstruation to take place, estrogen and leptin levels must be high enough. Body fat plays a significant role. There are some other factors that can be addresssed and help as well.
Cause 2: Exercise
Weight loss can cause decreased leptin signalling, but exercise can, too. Body fat is the major player in leptin levels, but energy deficiency in general hinders leptin. When a woman is burning more calories than she is consuming–or when she is burning a high quantity of calories while under emotional and physical stress–her body calls it quits. Instead of directing energy towards reproduction, it conserves it for other functions.
Cause 3: Low Calorie Diet
A low calorie diet performs the same function as both weight loss and exercise. It stresses the body and puts the woman in a state of energy deficit. The hypothalamus does not like being in energy deficit, so it tells the ovaries to stop working until it can get itself out of the energy deficit.
A low calorie diet is more of a problem for thin women than it is for women trying to lose weight. Leptin levels first and foremost are reliant on fat stores. The body can eat it’s own fat. That is in fact how weight loss occurs. So if a woman is eating her own fat, she is not starving. Once her body fat levels dip too low, however, and if she is maintaining a low-calorie, starvation-type diet, then she may stop menstruating.
Cause 4: Low Carbohydrate Diet
Many, if not most, women have a real need for carbohydrates. This cause is the most common cause of amenorrhea in the paleo world next to weight loss, in my experience.
Carbohydrates are necessary for the conversion of T4 into T3 (the active form of thyroid hormone) in the liver. The liver is capable of producing its own glycogen when it’s not being fed sugar, but this process can become fatigued over time, especially if the woman is under any kind of stress, or restricting calories, too.
Hypothyroidism, or sub-clinical hypothyroidism, is one of the primary causes of ovarian malfunction. Without sufficient levels of T3, organs shut down, and the reproductive organs are the first ones hit. Without T3, estrogen cannot be produced, and follicles cannot develop. Without T3, a woman cannot menstruate.
For this reason, many paleo women supplement their diets with iodine and find that their amenorrheic symptoms ease. However, many others do not. Instead, they have to add carbohydrates back in to their diets.
Another role that carbohydrates play is spiking leptin levels. Whenever insulin spikes in response to blood glucose, leptin levels rise, too. This means that carbohdyrates help signal to the hypothalamus that the woman is fed. However, this is a short-term elevation. It only spikes in bursts and with meals, so it cannot be used as a long-term solution to health. It is important to note, however, that a high fat, low carbohydrate diet is consistently associated with the lowest leptin levels possible.
Cause 5: High-Dairy Diet (an influence, at least)
Dairy is full of hormones. Even cows raised on pasture cannot help but produce certain hormones that influence a woman’s reproductive system. Dairy is the most androgenic food. It contains a protein that inhibits normal inhibition of testosterone in an individual’s body, such that when someone ingests dairy their testosterone levels can rise unchecked. This is in fact why so many people experience acne when they eat dairy. Even men. It really can increase testosterone levels that much.
Moreover, much of the dairy consumed in today’s world is not organic and grass-fed but is instead choc-full of unnaturally injected hormones. Farms and the US government are touchy about telling the public what goes into their animals, and they claim that these hormone profiles are insignificant. However, anecdotally, myself and with some other women, it seems as though these hormones really can influence women who already have compromised reproductive function. Conventionally raised animals can cause real problems. This goes for dairy, and this goes for eggs and meat products as well.
Cause 6: Altered Phytoestrogen and Hormone-Ingestion Profile
This cause is related to the cause above. We ingest hormones on a regular basis. With a healthy reproductive system, this is not a problem. Hormones from food are far less potent than hormones from the ovaries. Please keep that fact in mind. A healthy reproductive system has very little problem with phytoestrogens in foods. But some women have struggling reproductive systems for one reason or another, and they need to be aware of what hormones they have been and what they are now consuming.
Phytoestrogens are plant estrogens. They look a lot like estrogen, but are not identical. This is why phytoestrogens should never be consumed as a replacement for estrogen. Sometimes they relieve certain symptoms of estrogen-deficiency such as hot flashes, but they also fail to act exactly like estrogen does in the body. This means that other signals and connections are not being made, potentially crucial ones. Hot flashes may cease, but acne may continue to run on unchecked. And other problems can ensue. For example, breast cancer.
Phytoestrogens are primarily in legumes, nuts, and seeds. Soy is the most potent phytoestrogen, and should be avoided at all costs.
There are other sneaky ways in which hormones can infiltrate a woman’s diet, especially if a woman undertakes a paleo diet with compromised reproductive function and inattention to the quality of her food. For example, if a woman goes on an egg-heavy diet when starting paleo, but the chickens are fed a soy rich diet, she is actually eating a soy-rich diet. This is not normally a danger, but with a compromised reproductive system and a soy- or hormonal- influence from poorly treated animal products, it is worth taking into consideration.
These effects, I need to emphasize again, are not usually relevant for women with healthy reproductive systems, and should only be considered in severe cases. Only when hormone levels have dipped so low or have skyrocketed so high that the body becomes sensitive to these normally tolerable and easily managed fluctuations from food. Certainly, conventionally-raised cows are not optimal, but I would not discourage anyone from eating them (in terms of their health) at all if they have no other options. Sincerely. Far, far more important is the quality of hormones being sent through leptin and estrogen signalling within the body.
Cause 7: Stress
The final cause should come as no surprise to anyone. Stress halts reproduction: stress from toxic foods, stress from eating disorders, stress from social life, stress from exercise, stress from work, stress from existential despair… the list is vast. The physiological result of all of the possible stressors is roughly the same, however. Cortisol levels rise and these levels prevent the hypothalamus from sending the appropriate reproductive signals to the ovaries. This may, in fact, be the most important of all the factors I’ve discussed. There is no way to quantify it, and it burns ubiquitously throughout the Western world. What if all of us calmed down? What if we all lived in harmony, and peace, and did not fret? Stress is significant, and stress is real. Hundreds of thousands of American women do not menstruate because they are stressed. How many more experience hindered reproductive function because of stress? I suspect the number lies in tens of millions.
--------
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.
by Stefani Ruper | Apr 27, 2012 | Blog, Body, Fasting, Fertility, Hormones, HPA axis, Hypothalamic Amenorrhea, Mental Health, Stress |
I’m going to pick up here where I left off on my last post. There, I covered the role that exercise and energy deficits play in HPA-axis-induced amenorrhea. Here, I cover the effects of psychosocial stress, and also how the two kinds of stress play off of each other.
Hypothalamic amenorrhea (HA) typically results from pschyological stress coupled with a mild energy imbalance–so generally both social stress and metabolic distress are present. These two stressors are too intertwined to separate out in studies.
Hypothalamic Amenorrhea affects 5 percent of women of reproductive age, and subclinical women I suspect double that number, at least.
It is generally believed that psychosocial dilemmas activate neural pathways (ie, worrying about a job will stem from the prefrontal cortex) and hit the HPA axis that way, causing stress hormones to be released and sex hormone production to decline.
Exercise and weight loss disturb the HPA axis via metabolic disturbance. Although it seems logical that specific cascades exist for different types of stress — for the psychological or the physical — there is currently no method for clearly delineating psychogenic from metabolic stress. So far as we can tell, they are both equally damaging to sex hormone production, and can cause hypothalamic amenorrhea.
Hypothalamic amenorrhea: the power of stress
One way to test the potence of pyschosocial stress on female fertility is with primate studies. It enables researchers to control for all of the variables that affect human lives.
This is how big of a deal it is:
In one study, across more than 1200 menstrual cycles in cynomolgus monkeys, the stressed out, socially subordinate monkeys consistently exhibited ovarian impairment, whereas others did not.
The thing is, in primate societies, much as in our own, it is inherently stressful to be at the bottom of the social ladder. All that researchers have to do in order to study primate fertility is to monitor the behaviors and physiology of lower rung versus higher rung monkeys.
For the lower rung monkeys in this study, their cycles increased in length and variability, and both their levels of progesterone and estradiol dropped. Additionally, they experienced elevated cortisol levels (almost in a perfect inverse relationship with the estradiol), as well as osteopenia, which is the precursor to osteoporosis. (An important side note: the researchers also tested soy on the monkeys to see if it would help. It did not.)
These monkeys were not energetically stressed. They ate the appropriate amount of food. The only thing that had the power to change their reproductive capacity was psychosocial stress, and it made a significant impact.
Kinds of stress that cause hypothalamic amenorrhea
There are many stressors associated with stress-induced amenorrhea. They include affective disorders, eating disorders, various personality characteristics, drug use, and external and intrapsychic stresses.
“External and intrapsychic stresses” sounds clinical and like a small category of disease, but it is in fact huge. If you think you are fat, if you think you are stupid, if you think you are ugly, if you think you aren’t good enough, if you think other people think you’re fat, stupid, ugly, or not good enough… the list goes on and on. This is “intrapsychic stress.”
(To read about how I got rid of my own intrapsychic stress and help my clients do the same, check out my best-seller for women’s confidence, Sexy by Nature, here!)
“Intrapsychic” stress is the nebulous stuff that women impose on themselves–encouraged by society or otherwise–and it kills the HPA axis. Almost literally. Cortisol blocks signalling to and activity of both the pituitary and thyroid glands, in addition to on hormones themselves while in isolation in the bloodstream. The stress of living in today’s world is one of the greatest health threats a woman can face.
In one study, women with stress-induced hypogonadism were compared with a) “normal” women and b) women with hypothalamic hypogonadism from other pathologies. Those with stress issues were the only ones who measured unrealistic expectations and dysfunctional attitudes. They were both highly perfectionistic and sociotrophic, which is defined as (its amazing we even have a word for this)– a high need for social approval. Perfectionism and sociotrophy play off of each other. Perfectionism interferes with social approval, and social approval feeds back on notions of what being perfect is.
Women with stress-induced hypogonadism also test as having trouble realxing and having fun. They do not typically meet the criteria for eating disorders, but they do as a whole exhibit disordered eating. That’s almost as insidious, in my book. And they do exercise a lot. These two facts of disordered eating and excess exercise do not help the stressed out hypothalama.
I am going to mention my book again here, because it really has been so helpful for so many women dealing with this. Really. Take a look. 🙂 Here: Sexy by Nature.
The intersection of psychological and physical stress
Other sources of hypothalamic stress, as we’ve covered, include caloric restriction, excess exercise, and low body fat, all of which signal to the hypothalamus that the body is starving. These very often act in concert with psychosocial stress, a la the perfectionism discussed above, and feed off of each other in nasty ways.
For example, women become amenorrheic when suffering from anorexia. Clearly this is a metabolic effect, but the self-tortured stress and the isolation that often accompany anorexia take huge tolls from the cognitive angle as well.
And tellingly: once anorexic women both regain weight and supplement with exogenous hormones, such that their systems should be working normally, they still often do not experience bone accretion. Bone accretion is enabled by estrogen. The fact that these women still lack estrogen demonstrates that the normalizations these women experience from regaining weight are not 100%. They are ineffective, and clearly not all parts of the HPA axis are working properly. This is likely because psychological stress is still high and the adrenal glands have not yet recovered. It may also be due to ongoing metabolic derangements such as altered growth hormone action, or hypothalamic hypothyroidism. These women’s systems need time to recover. But they also need psychological healing, or else the HPA axis will not run happily.
In one study, 88 percent of women with hypothalamic amenorrhea recovered menstruation with just 20 weeks of cognitive behavioral therapy. Not all, but a significant portion of, women who suffer from hypothalamic amenorrhea need psychological healing, far more than anything else. After that, not only do stress levels fall, but healthier eating habits become the norm.
For more on how to recover from HA and make healthier eating habits become the norm, check out this post, or my confidence- and love- inspiring book on Amazon, Sexy by Nature.
--------
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.
