“Estrogen dominance” is not a term typically used by the research or professional medical community. If the condition were described to them, however, they would be able to identify it. It is a real and common thing for women to have excessive estrogen levels. It just so happens that the natural health community is deliberate about addressing it.
The basic problem of estrogen dominance is that estrogen levels are too high relative to other hormones, specifically progesterone. Usually it occurs when estrogen levels go too high, though it can also happen when progesterone levels fall too low. It can occur at any time during life — during reproductive years, perimenopause, or even menopause.
It can also be coming from a wide variety of sources within a woman’s diet and lifestyle. This makes estrogen dominance a bit of a complex nut to crack. But a holistic approach to health (you can read my recommendations for women’s health in my best-seller, here) should at least get everyone on the right track, and provide a proper learning environment in which you can figure out precisely where your dysregulation is coming from.
Estrogen dominance: symptoms
Estrogen dominance can cause a wide variety of symptoms, as well as increase the risk for a wide variety of diseases and conditions. Symtpoms associated with estrogen dominance include:
High emotional sensitivity
Conditions that appear to be more common in women with estrogen dominance and that may in fact explicitly develop as a result of estrogen dominance include:
Hypothyroidism (estrogen is antagonistic to thyroid hormone)
These aren’t problems we can just shrug off of our shoulders. In many ways, we can reasonably view estrogen dominance as contributing to the deaths of thousands of women every year.
Estrogen Dominance: Causes
The causes of estrogen dominance are wide and varied, but largely have to do with metabolic dysregulation and organ malfunction. Some dietary factors may also offset the balance.
1) Being overweight:
Fat cells perform a function called “aromatization” which converts testosterone to estrogen. The more body fat, the more the body tips the balance towards estrogen and away from testosterone.
Now, this does not mean testosterone levels are necessarily low in overweight women. To the contrary: testosterone levels tend to be high in overweight women. This is not always the case but is quite common: it’s because testosterone production is stimulated by insulin, and many overweight women have some degree of insulin resistance.
Woman predisposed to insulin insensitivity often experience increases in both testosterone and estrogen levels. Progesterone receives no bump from weight gain, however: progesterone thus remains incapable of offsetting the estrogen increases associated with higher body fat percentages in overweight women. (To learn how to lose weight in a way that is healthy, sustainable, and hormone supporting, check out this resource)
2) Overburdening the liver
The liver is responsible for clearing the body of “old” hormones, especially estrogen. If the liver is overburdened with a hyper-caloric diet, with high volumes of sugar, with high volumes of alcohol, or with high volumes of processing chemicals, then, it becomes sluggish in it’s ability to process everything. When the liver slows down, estrogen ends up becoming back-logged in a way, and wreaks havoc on the reproductive system as it waits for the liver to heal and to catch up in its bloodstream clearing capacity.
This effect is interestingly even more pronounced in men than it is in women, and it accounts largely for the development of breast-like fat deposits in heavy drinkers. Being overweight and being stressed may also contribute to this process in men.
Stress wreaks havoc on all body systems. Perhaps most pressingly for women, however, it decreases the production of progesterone in the body. When a woman is stressed, her adrenal glands “steal” the precursor to progesterone and instead use it to produce cortisol, the stress hormone. This process is called “pregnenolone steal.”
High volumes of stress can yank the rug out from under progesterone, which can precipitously tip hormonal balance in favor of estrogen.
4) Consumptions of phyto and xenoestrogens
Much as I have difficulty with soy in my own life, I typically preach caution when talking about soy. I honestly believe that it is a good therapeutic tool for some women, and each of us needs to use it appropriately. Sometimes it can be helpful. More often than not I think it is probably harmful.
In every single case, however, soy, flax, legumes, and other sources of estrogen interfere with natural estrogen production.
Phytoestrogens can increase the aromatization process in fat cells that I described above. They increase the rate of testosterone and other hormones being converted into estrogen.
They can also simply just dump an increased estrogen load into the body, which automatically tips the balance. In a properly functioning metabolism, the liver should probably be able to clear out this increased estrogen load. But sometimes the load is too heavy or the liver not quite strong enough, and that becomes an impossibility.
Phytoestrogens are from plants. Xenoestrogens are from chemicals in the environment, such as BPA. Plastics and aluminums typically have BPA and you may ingest it if you aren’t careful. Here’s my favorite BPA free coconut milk, and an awesome bottle that I use for my water.
It is also entirely possible to become estrogen dominance as a result of birth control pill use – a process which I describe in great length in this PDF.
5) A low fiber diet
Estrogen is processed by the liver, but it is also processed partly by gut flora, and also excreted through the digestive track.
It has been shown many times that low fiber diets are associated with estrogen dominance. There are many cofounding variables that may play a role here, but the general idea is that estrogen can be reaborsed through the intestinal walls. With poor gut flora and with slow intestinal motility, estrogen can sit too long in the gut and gets reabsorbed back into the bloodstream.
If you are constipated, this may be an issue for you.
So the answer is not necessarily fiber – fiber may not be what helps get rid of constipation for you – but it is one potential option.
Fiber is generally correlated with improved digestive pace and motion, though not exclusively. A proper amount of fiber helps push things along in the digestive track. Too much fiber can obviously be damaging. It causes something health advocates like to call “roughage.” It is abrasive, and it can lead to gut deteriorating conditions such as diverticulitis. In any case, however, regularly consuming fruits and vegetables can be quite helpful for gut motility… as well as the rest of the body.
If you are really struggling with constipation still you could always try paleo fiber. Though I believe magnesium (my favorite here) may be a healthier way to supplement for constipation. The best possible thing to do however may be to eat fermented foods like these or consider a probiotic supplement like this.
Estrogen dominance: treatment
The best possible thing for estrogen dominance is a natural, paleo-type diet. Cooling inflammation, supporting organ – and particularly liver – function, minimizing phytoestrogen intake, and maximizing nutrient status are all excellent, estrogen-managing aspects of paleo.
A paleo-template type diet includes healthy, grass-fed or wild-caught animal products (with both the protein and the fat), seafood, fruits, vegetables, olive oil, coconut products, starchy vegetables, and to some extent seeds and nuts.
However, in an estrogen dominant system, seeds and nuts can act as phytoestrogens and tip the hormonal balance in favor of estrogen, so they should be carefully stepped around.
Foods that support thyroid health such as seafood and seaweed should also be quite helpful for boosting metabolic health and hormone clearance (if you do not consume seaweed regularly consider a small dose kelp supplement).
Foods to emphasize for estrogen clearing are those that boost B vitamin levels, omega 3 levels (fermented cod liver oil is an excellent way to meet the body’s need for omega 3 while also getting the rare but crucial vitamins A, D, and K), choline (for the liver!), zinc (here), magnesium (here), calcium, and vitamin D.
For that reason, eggs (choline), fish (omega 3 fats, iodine, selenium, and vitamin D), liver and other organ meats (vitamin A, vitamin K, B vitamins, and iron, zinc, manganese, etc), and high quality animal protein may be your best companions in this journey.
Foods to be avoided are all processed sugars, grains, omega 6 seed oils, phytoestrogens which include soy, flax, legumes, seeds, and some herbs, which I list in great detail here, and alcohol.
Some herbs have also been rumored to be helpful. Personally, I don’t love to recommend herbs, especially ones that affect hormone balance, such as chasteberry. (Though chasteberry, and I did link to a good grand, has been rumored to be quite effective). They simply have not been studied to any significant depth. Everything we know about herbs and hormones comes from what people say – not science.
If you are still interested, the absolute best herbs I can recommend for estrogen dominance are ones that support liver health and may help support estrogen excretion. For that the absolute best are milk thistle and/or dandelion root, in my opinion. You can see a good milk thistle here and a good dandelion root here.
Additionally, L-taurine promotes bile circulation, which enhances estrogen’s excretion out of the body.
Exercise is incredibly important, as it can speed up the liver’s detox processes, sharpen insulin sensitivity, boost weight loss, help mitigate mood swing problems associated with estrogen dominance, and reduce levels of stress hormones in the body. You can read all about my exercise recommendations in this book.
Getting off of the pill or getting on a very low-dose pill is critical. You can read about the side effects, risks, and management tricks of birth control in this PDF.
Stress reduction is huge. I cannot emphasize enough how important this is. Without progesterone, it is nearly impossible to rectify estrogen dominance. They must be in balance. Even if every other aspect of estrogen mitigation is in place, if progesterone is low then estrogen dominance may persist.
Estrogen dominance: In sum
Estrogen dominance plagues a wide variety of women, and at all stages of life.
Supporting organ health, reducing stress, and generally focusing on healthful foods should get us most of the way there towards greater hormone balance.
There are, of course, many other things you can to do help mitigate problems associated with estrogen dominance– for example, experimenting with neurotransmitter supplementation or boosting neurotransmitter health with diet and supplements in order to mitigate mood swing problems– but those are wide and varied and left for their own places in this blog at an upcoming time.
Foods and supplements I have linked to above and which I have personally seen work really well with some clients:
Desiccated liver (in case you don’t like eating it!)
My favorite fermented foods for gut healing, healing constipation
cod liver oil for reducing inflammation and getting the important but rare A, D, and K vitamins
Milk thistle for liver support
Dandelion root for liver support
A great probiotic supplement like this
My favorite magnesium here
A list of my favorite fermented foods here
A good small dose kelp supplement
BPA free coconut milk
BPA free water bottle
And that’s a wrap!
You can check out my quick guide PDF on birth control and how to manage it’s symptoms – here – or check out my extensive work on another alarmingly common hormone condition, PCOS – here.
For the real skinny on the impact of hormones on your life, see my book, Sexy by Nature, at its site or read reviews and buy it directly from Amazon!
In the meantime: what is your experience? Does paleo help with these symptoms? Are you estrogen dominant? What parts of your diet and lifestyle are best for keeping you hormonally balanced and healthy? What’s worked, and what hasn’t?
Do you have a pair of special “fat pants” (I know, a terrible, terrible term) that you have to wear when you PMS every month? You’re not alone. I am most certainly a co-sufferer. As are millions of other women.
It’s challenging to link water weight to the menstrual cycle if you do any digging online. Unsuccessfully looking for a link drove me crazy for months. I really wanted to know, but couldn’t seem to find, a scientific explanation for why I gain a full notch on my belt, a pant size, and an inch of padding around my middle for several days at the end of each cycle.
I have also noticed that I gain the same inexplicable water weight whenever I am “dating” a person I really like (dating in airquotes because … well, you figure it out.). I know I sound crazy – but I really don’t think its too much of a leap to connect these two dots, either. Regular sex increases body processes like vaginal lubrication, hypothalamic productivity, and sex hormone production. Sex happens…some sort of hormone production goes up … and, it seems, Stefani gains weight. Fortunately I’ve learned to love my body enough that I haven’t given up sex in order to be skinny.
Is there a real, scientific link between estrogen, progesterone, and water weight?
Turns out there is.
Receptors for estrogens and progesterone are found in all sorts of tissues – not just the reproductive ones – such as the hypothalamus, the cardiovascular system, and the kidney. All three of these organs are intimately involved in the water retention process.
Via these receptors, estrogen and progesterone have the effect of:
-Regulating fluid intake
-Regulating sodium appetite
-Regulating renal (kidney) fluid
-Regulating sodium retention
In all female bodies. In healthy ones, the effects are minimal, but still present.
Both estrogen and progesterone do these things, and in somewhat opposite fashion.
Estrogen causes tissues to reabsorb sodium, which increases sodium levels in the body’s fluids. Elevated sodium causes water weight, because the body balances the extra sodium with extra water. The more sodium you have floating around in intercellular space, the more water your body is going to send to that space.
Estrogen makes sodium work like one of those little foam dinosaurs you get at the dollar store that expands to 60x its size once you put it in water.
My waistline is a brontosaurus.
Progesterone, on the other hand, also causes sodium retention, but it doesn’t store it in the same free-floating space as estrogen it does. Instead, it stores it in certain “extracellular fluid compartments” and also works to cause certain chemical changes to capillaries and other such things. It also tends to work more on regulating other important hormones in this process, which down the line causes extra excretion of fluid rather than retention. Thus, progesterone is somewhat of a diuretic. THIS IS SCIENCE SPEAK FOR ‘PROGESTERONE DOESN’T MAKE YOU RETAIN WATER WEIGHT; IT ELIMINATES IT.
IE – Progesterone is the straw in our dinosaur water glass.
I am an artist.
Put simply – estrogen makes you retain water, and progesterone makes you dump it.
The Menstrual Cycle
A quick primer on the menstrual cycle is in order in order to understand how its related to water weight.
Day one of the menstrual cycle is the first day of bleeding. On day 1, estrogen and progesterone levels are both at their lowest. For the next two weeks–called the follicular phase–the body is in a fairly calm and neutral state. Estrogen and progesterone levels increase toward the end of the follicular phase, but not to drastically high levels.
At the end of these two weeks comes ovulation, which lasts about 36 hours.
After ovulation is the luteal phase, in which estrogen and progesterone levels gradually rise to very high levels, then fall for about a week preceding menstruation.
Then the cycle begins anew.
The fluctuating levels of estrogen and progesterone demonstrate why some women don’t experience PMS-related water weight, why some experience it at the middle of the luteal phase, why others experience it at the end, and why some have it the whole time.
As estrogen levels rise, the tendency to carry water also rises.
Progesterone is a counter-balance at this point, but sometimes it isn’t enough to balance the water weight, especially if you’re estrogen dominant.
Estrogen levels then begin to fall. This causes an eye in the calm of the storm – you may experience a decrease in water weight.
Yet the reason there is more storm to come is that, as progesterone levels are also falling, the body all of the sudden doesn’t have the same hormonal strength telling it to excrete water (this is the best theory so far, in my opinion, anyway.) It has become accustomed to higher progesterone levels, so as the progesterone levels fall off, the body loses some of its diuretic power, and water gets retained.
By day 1 or so of the next menstrual cycle most women’s bodies come back into water weight balance, as both estrogen and progesterone are low, and much better balanced than in the tumultuous times of the luteal phase.
Other bodily effects? More important ones?!
It is worth noting, moreover, that the impact of estrogen and progesterone on body fluid is not limited to your pant size. It’s actually super important for your health!!!
Premenopausal women have long been notoriously known for experiencing lower incidence of cardiovascular disease than men. These differences tend to even out post-menopause. This has caused many researchers to theorize that estrogen and progesterone play a critical role in supporting cardiovascular health, as proper hydration and electrolyte balance are critical for blood pressure maintenance.
You don’t want to have excess estrogen and progesterone as a woman – but healthy levels help regulate blood pressure, and minimize the threat of cardiovascular stress. The trick is to keep your dinosaurs robustly healthy, but not too big, and to have a healthfully functioning straw in your glass of water at all times.
So… what do I do?
The best ways to minimize the effects of water retention throughout your menstrual cycle are to:
-Be as healthy a weight as possible, which will reduce estrogen dominance
-Overcome estrogen dominance via these tips
-Be on a variety of birth control that is right for you and keeps your hormones in good balance
-Sleep well (Use blackout curtains, blue blockers, and natural bedding and sleepwear to keep pleasantly cool)
-Eat a paleo type diet! (Here’s one of my favorite resources on making the transition to paleo!)
-Eat lower carbohydrate – or lower starch, which tends to bloat a bit more than fruit does in terms of carbohydrate choice – at the times of the month you ordinarily bloat
-Monitor your salt intake and keep it on the low end during PMS (p.s. if you’re using regular table salt you are missing out! This stuff is the BEST!)
-Drink plenty of fluids (Use BPA free bottles-I prefer glass ones like this– to help avoid estrogen dominance)
–Love your body no matter some extra padding on its middle! Life is about so many important and beautiful things that are worthy of undivided attention.
And, of course, for more on being a woman and maintaining a healthy weight, JUST YOU WAIT for my kickass new weight loss book, Weight Loss Unlocked, which comes out on January 1!
In the meantime, grab a free chapter of the book @ http://unlocked.paleoforwomen.com!
UPDATE: Weight Loss Unlocked is HERE! Yay! Check it out now!
Ladies! My apologies.
I have been writing a blog on womanhood and the paleo diet for years now, and I have yet to write a post on PMS.
Better late than never, I say! What follows is the low down on Pre-Menstrual Syndome (for cramps specifically, which is different, see here).
No, you do not have to go crazy every month just because you are a woman. Do not resign yourself to the fates society is trying to give you! Diet and lifestyle can save you. I do not promise perfection — your journey will undoubtedly have bumps, and you may get a bit cranky for the next few dozen years. But you do not have to be a monster. Here’s why it happens, and how to fix it.
In some ways, being a woman is uniquely challenging. Throughout the course of a regular month, we bleed out of our vaginas for a week, we enjoy one week of peace and freedom, and then we ovulate and have two weeks of fluctuating estrogen and progesterone levels, which can lead to breast tenderness, water retention, acne, insomnia, moodiness, depression, anxiety, headaches, cravings, and cramping. Technically, you will only be diagnosed with PMS if you experience the mental symptoms, which include depression, irritability, anxiety, and mood swings. But the physical symptoms that accompany these are often equally unpleasant. What gives? Is menstruation supposed to be this way? Does it have to be this way?
How it works: PMS
Menstruation is not supposed to be this way. It is not supposed to be painful, make you crazy, or make you depressed. Sure, even after you adopt a diet based on whole, natural foods, you may experience echoes of these symptoms. But they can be greatly mitigated by supporting the health of your reproductive and nervous systems. You have the power to turn what may be a truly terrible state into a mere inconvenience.
As far as theorists can tell, PMS is caused primarily by two things: estrogen dominance and neurotransmitter dysfunction.
Estrogen dominance (Read more about estrogen dominance in my post on the topic here)
Estrogen dominance is one of the primary causes of PMS, but PMS is not it’s only drawback. Symptoms associated with estrogen dominance include being overweight, weight gain, mood swings, emotional sensitivity, heavy periods, breast tenderness, headaches, decreased libido, sluggish metabolism, and insomnia. Conditions that are found more often in women with estrogen dominance and that may develop explicitly as a result of it include cystic fibroids, endometriosis, adenomyosis, hypothyroidism, breast cancer, cervical cancer, and ovarian cancer. From the list of symptoms and associated diseases, it’s a no-brainer that estrogen dominance is a problem that deserves attention.
Estrogen dominance plagues millions of women, perhaps more so than any other hormone imbalance discussed in this book. This is largely because estrogen is produced in fat cells, and the majority of American women are overweight. But that’s not the only way to develop estrogen dominance. Causes of estrogen dominance are both powerful and diverse, and include:
Being overweight: Fat cells perform a function called aromatization that converts testosterone to estrogen. The more body fat you have, the more estrogen your body produces. (Read my book Weight Loss Unlocked to help you lose weight in a healthy, supportive, and hormonally balanced way.)
Overburdening the liver: The liver is responsible for clearing the body of old hormones, especially estrogen. If the liver is overburdened by a hyper-caloric, inflammatory diet that includes high volumes of sugar, alcohol, processing chemicals, and toxins, it becomes sluggish in its ability to process hormones.
Being stressed: Stress decreases the production of progesterone in the body. When progesterone levels decline relative to estrogen, symptoms of estrogen dominance emerge.
Consuming phyto- and xenoestrogens: Consuming estrogens from toxic chemicals such as fertilizers and BPA is unquestionably a bad idea. Consuming plant estrogens such as soy and flax may be helpful sometimes, but in the case of estrogen dominance, it probably is not.
Eating a low-fiber diet: Estrogen is processed not only in the liver but also by gut flora, and it is excreted through the digestive track. Many other variables are likely at play here, but the general idea is that estrogen can be reabsorbed through the intestinal walls. If you do not eat any fiber, and you therefore have little added bulk to your stool, your digestive process will slow down. When it takes a long time for your body to excrete waste, estrogen sits too long in the gut and is reabsorbed into the bloodstream. Fiber may help push the digestive process along and keep the estrogen moving properly. Fiber supplements are unnecessary, however. The fiber you get from natural fruits and vegetables in the Sexy by Nature diet is plenty.
Poor gut flora: Since having poor gut flora is another way to slow down digestion and impair estrogen processing, it is another means by which estrogen levels rise. (A probiotic, fermented foods, and gelatin can all help the gut to heal)
Taking the pill: Sometimes birth control pills help decrease estrogen levels. Other times, the pill elevates estrogen levels above progesterone significantly enough to cause extreme discomfort. (Read my book Birth Control:Unlocked to learn about how your birth control may be effecting you.)
Living a sedentary lifestyle: Exercise improves insulin sensitivity, liver function, weight loss, and stress reduction.
Estrogen dominance has many causes and may seem too complicated to overcome easily, but by already emphasizing exercise, phytoestrogen moderation, and anti-inflammatory, gut-enriching, liver-supporting foods, the Sexy by Nature approach to health addresses all of them in one fell swoop.
Symptoms of estrogen dominance occur for many women in the two weeks prior to menstruation. In these two weeks, the body is gearing up for menstruation, so deviation from natural health and hormone balance is a fair bit easier than at other times of the month. Elevating estrogen over progesterone causes symptoms of PMS because the brain is full of receptors for these two hormones. When the brain encounters a hormone imbalance during this time, it has trouble achieving the level of stability it attains at other times of the month. Improper hormone balance can cause a decrease in serotonin, dopamine, and endorphin levels, all of which are important for mental health. Anxiety, irritability, depression, and insomnia may ensue. Correcting hormone balance is a primary concern for any woman experiencing trouble with PMS.
Maintaining neurotransmitter health is also crucial for avoiding PMS. Poor diet leads to poor neurotransmitter synthesis. Dietary elements particularly important for neurotransmitter synthesis are complete protein—so make sure to eat sufficient protein throughout the day—vitamin C, and B vitamins, especially B6. These nutrients are easily obtained from a diet rich in vegetables and animal products such as the Sexy by Nature diet, though supplementation might also be appropriate. This book may help you to discover where you are lacking and what supplementation you might benefit from.
In addition to mitigating these two causes of PMS, you can support your mental health throughout the menstrual cycle by reducing inflammation, which can be a great help to your brain. Two of the most important ways to do so are by maintaining a healthy blood sugar metabolism—which helps neurotransmitters function more stably—and focusing on consuming plentiful omega-3 fat.
Omega-3 fat is a great tool for fighting PMS not only because it is anti-inflammatory, but also because the brain is composed largely of fat. The higher-quality fat you have in your diet, the higher-quality brain function you are going to have. Omega-3 fat helps with the flexibility of neuronal structures, which ultimately leads to greater peace and alleviation of PMS symptoms. This fermented cod liver oil can help with inflammation in the body.
What to do for PMS
-Exercise, which increases serotonin and dopamine levels.
-Get adequate sleep to increase serotonin levels.
-Reduce estrogen dominance by the methods listed above: reduce stress, eat an anti-inflammatory diet that eschews the potential gut irritants grains, legumes, and dairy, consume plenty of vegetables and fiber, support liver health by reducing toxin load and focusing on natural foods. Leafy greens are particularly helpful since they have potent liver-supporting effects.
-Consider supplements that may help with estrogen detox, such as milk thistle extract, alpha lipoic acid, and the amino acid N-acetylcysteine (NAC).
-Eliminate phytoestrogens such as soy and flax from your diet, and minimize exposure to xenoestrogens such as BPA (found in plastics) and fertilizers on the skins of fruits and vegetables.
-Consume at least 50 grams of protein each day.
-Eliminate or minimize omega-6 oil consumption and consume at least three servings of fatty fish such as salmon every week to reduce inflammation.
-Consider supplementing with cod liver oil or a high-quality fish oil for omega-3 fat.
-Eat animal products and vegetables for vitamins B and C, respectively, which support neurotransmitter synthesis.
-Consider supplementing with 400 milligrams of magnesium daily to minimize anxiety, insomnia, and depression.
-Expose yourself to the sun for 20 minutes every day or consider supplementing with 2,000-5,000 IUD of vitamin D daily to provide crucial support mental health.
And that’s it! My thoughts on PMS, and ways to overcome it with whole foods and a stress-reduced lifestyle. No monsters. No crazy. No depression. (If depressed, please see a medical professional!)
Just women being women.
And the above blog post on PMS is actually more or less an excerpt from my book on women’s health, Sexy by Nature: The Whole Foods Solution to Radiant Health, Lifelong Sex Appeal, and Soaring Confidence. 99 percent of you know already, but it’s available on Amazon today for a remarkable 27 % off — and if you’ve read it, go give us a review!
Starting this upcoming week, Paleo for Women is going to be embarking on Birth Control Week! Which will likely in fact last more than one week. Or one month. Did you know there are nearly two dozen different types of birth control?!
And we shall be talking about all of them!
September will be the month of Your Sex Life, Your Pleasure, Your Method. I want to help you find the most empowering, most healthful, and most delightful birth control method for you. This should be more than a bit of a blast.
In addition to the posts in this series, be sure to check out the book I wrote on the subject. Birth Control Unlocked: Your Body, Your Options, Your Guide is available here.
Following this will be explorations of menopause and conception and pregnancy and breastfeeding, Oh. My.
Beforehand, I would like to “kick off” the birth control series by introducing and advocating to you the wonders of The Diva Cup, which is a an alternative to pads and tampons. Each of these methods have their own pluses and minuses, but in my opinion, the Diva Cup’s pros sometimes appear lifesaving and far outweigh it’s cons.
The Diva Cup is a small, bendy 1 oz. cup that you insert into your vagina to capture blood flow. It is uniquely designed to suction to the walls of your vagina, so 100 percent of the time it is inserted correctly it does not leak. Most women do not shed more than 4 oz of blood per menstrual cycle, so the cup does not need to be emptied all that often– for some women just at morning and at night.
To insert the cup, simply fold it in half (like so), wiggle it up there, and rotate it once or twice in order for the suction to take hold. If you tug on the bottom afterwards and it doesn’t move easily, then it’s suctioned.
To remove, really get your fingers up there, disrupt the suction around the sides, and pull out (keeping the cup vertical!).
Pull out the cup when you go to the bathroom, pour the blood out into a toilet or sink, and re-insert. Over time, you can probably learn how heavy your flow is at different times of your period, and learn how to time your Diva-emptying for optimal cleanliness.
For women starting out on the Diva Cup, it might be wise to also wear pads while you get used to how the cup works. It takes a time or two, for example, before learning the difference between suction against the vaginal walls and just plain hanging out in there.
Moreover, I think most women on their first month of the Diva Cup go through an interesting and hopefully hilarious learning experience. I had more than one episode in a college library being stuck in a bathroom stall for fifteen minutes while yanking vociferously on that damned suctioned cup that just won’t budge, for example.
Step number one with the Diva Cup is don’t. panic.
But trust me, it comes out, always. We just all need to learn the shape of our vaginas and how to navigate them with the Diva Cup.
Diva Cup Cons
-It requires being intimate with your vagina and cervix, something that some women just aren’t ready for.
-It can be interesting navigating public bathrooms.
-You can totally get blood all over your hands from time to time.
-You can totally get blood all over the bathroom if you’re a bit of a doofus about it, ie, pulling the cup out sideways. Plus it’s just hilarious– life goes that way sometimes.
-The suction can make it tough to pull out once in a while, but gets easier and easier with practice. (Read: don’t give up!)
Diva Cup Pros
-It’s environmentally friendly (no waste!)
-And therefore is perfectly suited for camping
-It’s biologically safe (the company sells a special soap if you’re interested)
-It’s way cheaper in the long run (only 35 dollars up front… 3-6 months worth of other methods)
-It’s comfortable (and in my experience, completely undetectable once inserted)
-It’s hassle-free (once you get the hang of it)
-You don’t have to carry tampons or pads around with you
-You can sleep with it in
-You may spot a bit at the beginning as you learn the Diva Cup, but later will almost never leak
-So therefore it’s great for athletics
-There’s no string or bulkiness, so the Diva Cup makes bikinis and lingerie worry-free
–The Diva Cup sits high up against the cervix, so vaginal lubrication can still come through the vagina
–You can still have pleasurable and blood-free oral and manual sex!
In all cases, I recommend trying it. No harm, right?
So clearly I have a bias for the Diva Cup. I understand that not all women have the same experience, and I invite you to share your reasons and feelings about the Diva Cup below.
The reason personally that I love it so much is that it is empowering. More freedom, less fear of spotting and/or needing to change things. More benefits for the environment and your pocket. More intimacy with your own body. More pleasure. More sex. Huzzah! More life.
Have experiences, positive, negative, hilarious, mortifying, with the Diva Cup? Share in the comments! Would be an honor to hear them.
Endometriosis is a widely encountered but poorly understood condition (as is the case with most hormonal disorders, such as PCOS.) It affects, by some estimates, up to 20 percent of women of reproductive age, and by more modest estimates, around 5-10 percent. In either case this population comprises millions of women.
Moreover, no one is really sure how the endometriosis situation varies between countries–I have struggled for a while to dig up any information–but in general everyone seems to agree that endometriosis happens to everyone, but to Western, and, in particular, American, women the most. And the most painfully.
Endometriosis is usually diagnosed in women through inspection of their infertility or their menstrual pain. The reason this is the case is that endometriosis is the condition in which endometrial tissue grows in places outside of the endometrium. Common locations include the ovaries, the fallopian tubes, and the abdominal cavity and bowels. The fact that endometrial tissue may be found in important reproductive areas is in part why many women find out they have endometriosis when they have trouble conceiving children. With tissue blocking a fallopian tube, sperm and eggs have a hard time communicating, and fetuses, growing.
Why endometriosis is painful
Endometrial tissue can cause women pain first because they are abnormal tissue growth that can hinder normal physiological function. And secondly, they grow over time. Yet the most important reason endometriosis causes pain is that ectopic (misplaced) endometria act in the same way as the true endometrium does, just spread out throughout the entire body, wherever they are located.
Endometrial tissue responds to hormonal changes in the blood in the same exact manner no matter where it is located in the body. For this reason, ectopic (misplaced) endometria become inflamed, pulse, grow, and bleed throughout the course of a woman’s menstrual cycle. This magnifies the pain of menstruation and distributes it wherever a woman might have endometrial tissue. If a woman ordinarily has premenstrual cramps, but then the cramps occur also on her ovaries and in her intestines, she may be in for an increasing difficult menstrual cycle throughout her life.
How endometriosis happens
Medical professionals are not sure how these endometrial implants manage to escape the fallopian tubes and to plant themselves around the abdominals like mini-tumors. Three seemingly less likely candidates are 1) Mullerianosis, in which the potential for cells to become endometrial is laid down in tracts during embryonic development and organogenesis. In this theory, an endometriosis patient is made in the first 8-10 weeks of life. 2) Coelomic metaplasia, which asserts that some tissue types transform into others, perhaps triggered by inflammation, and 3) vasculogenesis, in which tissue grows de novo (or from new) via abnormal vascular growth. Wikipedia et. al have plenty to say about these theories.
The emerging front-runner amongst these candidates, however, retrograde menstruation. Retrograde menstruation is the phenomenon in which a woman’s monthly flow does not exit the body entirely smoothly southward via the vagina, but instead can flow “backwards” out the fallopian tubes and escape into the abdominal cavity. From here, the tissue attaches itself to the lining of the abdominal cavity. It then becomes a more or less permanent fixture.
But do all women with retrograde menstruation experience endometriosis?
No. In fact, retrograde menstruation is pretty common, occurring in many women who experience no endometrial abnormalities.
So what has to be coupled with retrograde menstruation in order for endometriosis to occur?
This is where the Standard American Diet “triple threat” comes into play. Immune system malfunction, hormone imbalance, and inflammation all appear to play significant roles.
The extent to which each factor impacts endometriosis is not clear, and certainly not all doctors are on board with this theory. Many medical professions believe that genetics are a dominant factor (they are at least important), or that one of the aforementioned developmental issues is the most important. What is emerging from the literature, however, is the strong influence the varying factors of impaired immune system function, inflammation, and hormone imbalance have on endometrial development and pain. The general idea is that impaired immune system function enables the tissue to implant itself, and inflammation and hormone imbalance exacerbate tissue growth, infertility, and pain.
Immune system dysfunction
Much of the endometrial research being conducted today is focusing on the possibility that in endometriosis patients, the immune system may not be able to cope with the cyclic onslaught of retrograde menstrual fluid. It is common for menstrual flow to escape into the abdominal cavity. But some women’s immune systems are capable of properly dismantling those tissues, while others are not.
The one overarching job of the immune system is to distinguish between “us” (inside our bodies) and “them” (intruders), and to kick the intruders’ asses. One facet of this job that is less well known, however, is that the immune system also in a healthy body identifies tissue in the wrong location as “foreign” and attacks it. The immune system works just as well locally as it does spread throughout the whole body.
That is, of course, unless the immune system has been down-regulated. If the immune system has been impaired in any fashion, whether by stress, by micronutrient and vitamin deficiencies, or by an inflammatory diet, (one way in which inflammation plays a role) then it may not be strong enough to prevent the implantation of this tissue. Especially because women in the modern world ovulate far and away more often than women have throughout history… so far as we can tell, anyway. Since we are both pregnant and starving (presumably) less than ancient women.
In any case, the constant onslaught of reproductive tissue is just too much for some women’s impaired immune function to handle.
Might endometriosis be an autoimmune condition?
Endometriosis may in fact be an autoimmune condition. The jury is still far away from deciding whether or not it is a matter of impaired or of auto immunity. One of the primary markers of autoimmunity is the presence of autoimmune antibodies. In endometriosis, autoimmune antibodies are always present. However, autoantibodies may also occur in other conditions, such as cancer, massive tissue damage, and sometimes in healthy individuals. It is not yet clear whether autoantibody formation in endometriosis is simply a natural response to chronic local tissue destruction, or a pathologic response leading to more generalized autoimmune dysfunction.
That being said, endometriosis fulfills most of the classification criteria for autoimmune disease. These include polyclonal B cell activation, immunological abnormalities in T and B cell functions, increased apoptosis, tissue damage, and multi-organ involvement.
Yet despite these similarities, endometriosis appears to be, so far as reaserchers can tell, a condition in which the immune system is weak, and therefore endometriosis occurs, not so much that it is up-regulated and wreaking havoc destroying the body’s own tissues (as in the case in autoimmune diseases). What then, gives? Perhaps, in many women, autoimmune disease leads to impaired immunity, which leads to endometriosis. This would explain the correlation that exists between autoimmunity and endometriosis, but it would allow for other factors, such as inflammation or plain old decreased immune activity, to also play causative roles.
Regardless, endometriosis is strongly associated with autoimmune diseases
Autoiummune diseases correlate fairly well with endometriosis, or at least some of them do. And they may in fact be causative factors, as I just mentioned. Autoimmune diseases which may be significantly associated with endometriosis include SLE, Hashimoto’s hypothyroidism, rheumatoid arthritis, Sjögren syndrome and multiple sclerosis. The best evidence exists for an association with inflammatory bowel diseases.
There are two ways in which inflammation impacts endometriosis. First, in the genesis of endometriosis. Here, inflammation may cause endometriosis by impairing the immune response. Secondly, however, inflammation is what (coupled with hormones, discussed below) has the capacity to make endometriosis painful. Just as in some women have painful periods and others do not, so the same phenomenon translates to the endometrial tissue that is located elsewhere in the abdomen. If a woman has an up-regulated inflammatory response to her menstrual cycle, then her endometriosis will be painful. If she does not, then her endometriosis can go unnoticed for years–even for her whole life. It just doesn’t hurt her. Inflammation partly explains why there is no statistical correlation between the extent of a woman’s ectopic endometrium and her pain level. Some women have wicked ectopic endometria, but no pain because their inflammation levels are low.
So what is it about inflammation that is painful? It is the prostagladins and other inflammatory markers that are produced in endometrial tissue at the time of menstruation. These inflammatory molecules act locally. This means that they create painful signals both in the endometrial tissue as well as in the surrounding tissues. Hence why a phenomenon in such a specific place– ie, the endometrium– can hurt an entire abdomen.
When a woman has endometriosis, this inflammatory signalling and induction might be happening in various locations throughout her entire lower abdomen.
Hormones play an intricately linked role in the genesis of and pain generation within endometriosis. Estrogen plays many roles throughout a woman’s body and in her cycle, yet one of the most important ones is to stimulate the thickening of the endometrium. This is an important, normal process that happens in all women. If estrogen levels are high, however, the endometrium grows very thick, and much larger than normal. This provides a) more tissue out of which ectopic endometria can be made, and 2) more tissue from which prostaglandins and other inflammatory markers can be released. The more endometrial tissue a woman has, the more places pain can come from. This is in fact the direct cause of most of the “normal” pain women experience with menstrual cramps…and therefore with endometriosis, too.
Estrogen dominance is caused by being overweight, possibly by consuming too many xeno- and phytoestrogens (though that is a complicated issue), and by systemic inflammation. It can also be caused by having clinically low progesterone levels, since progesterone acts as a bit of a counterbalance to estrogen in the body. Estrogen and progesterone need to be properly balanced in order for reproduction to proceed smoothly and painlessly.
See Danny Roddy’s view on estrogen as an inflammatory molecule (in excess.)
Endometriosis is usually treated with…
Surgery, birth control pills that raise progesterone levels, birth control pills that lower estrogen levels, or specific estrogen antagonistic medications. Each of these fixes has its own problems, least of which is the fact that dosing with these kinds of hormones can lead to greater hormonal dysfunction further down the road. Moreover, it does not get at the underlying cause, which is in many cases very serious.
Endometriosis might not go away entirely, but it can subside, and the pain can be minimized.
Usually women who have painful endometriosis experience a soothing of their symptoms once they undergo menopause. This is because their estrogen levels drop, and naturally.
There are other ways to naturally decrease estrogen levels. Losing weight and decreasing stress are the two biggest factors. Removing phytoestrogens, which include soy, flax, and all nuts and seeds, as well as xenoestrogens, such as BPA found in plastics, have also been implicated in throwing estrogen levels out of balance.
Yet there are even better ways to work with endometriosis. And all of them, holistically, are enabled with a paleo diet.
Endometriosis probably– at least according to the majority of medical research and speculation– would not affect women’s health if they did not have compromised immune systems. In endometriosis, it is unclear whether the women suffer autoimmunity, or if they just have the problem because their immune systems are functioning at a sub-optimal level. In either case, a paleo diet mitigates the problem.
If endometriosis is autoimmune (a theory I am not sold on), an anti-inflammatory, gut-friendly diet should ameliorate its genesis and symptoms. This means eliminating potential gut irritants such as wheat, dairy, legumes, and possibly nightshades and eggs from the diet. Eliminating omega 6 vegetable fats should also be helpful. A GAPS diet is appropriate in extreme cases.
If endometriosis is from impaired immunity (a theory I am more comfortable with), correcting gut imflammation in this case also goes a long way. Having a vitamin-rich diet including many meats, organ meats, vegetables, and fruits, low in sugar and processed carbs, with plenty of stress reduction and sleep, with moderate exercise, and with vitamin D from sun exposure, should help boost immune function over time. It is important to know that I am not promising a cure-all. These problems can be complex hurdles to get over, and may take several months if not years of troubleshooting and patience and healing in order to get right.
So endometriosis will not necessarily go away. Tissues might shrink, but they may be too far implanted to ever disappear. But endometriosis can be mitigated, and with a diet and lifestyle focusing on nourishment, and whole, natural foods and activities. The importance of stress cannot be under-emphasized, either. Stress plays a large role in inflammation and in immune system functioning. So moving forward with holistic healing–with stress-reduction, with love, with healthful foods and with a nourishing lifestyle–goes a very long way in propelling us forward into healthful, natural, kickass womanhood.
Soy contains a certain kind of molecule called a “phytoestrogen” that acts like estrogen in the body.Health professionals disagree strongly about whether phytoestrogens are healthy for women to eat. Is soy (and flax, another potent phytoestrogen-containing food) the fountain of youth, or is it a toxin?
What is a phytoestrogen?
Phyto is Greek for “plant.” Estrogen means estrogen. Phytoestrogens are varieties of estrogen found in plants. Unfortunately, they do not exactly resemble the body’s natural estrogen. This makes the effect they have on health complicated.
There are several types of phytoestrogens. The primary kinds are coumestans, isoflavones, and lignans.
So what foods contain phytoestrogens?
Phytoestrogens can be found in many foods. This list documents the phytoestrogen content in some common foods. Some of the items are not surprising; Flax and Soy rank as number one and two respectfully. Some unexpected foods that contain phytoestrogens include garlic, hops and olive oil.
By far, the foods that contain the most phytoestrogens are soy and flax. These are so high in phytoestrogens that they can impact pretty much everybody, no matter their hormone health. Foods lower in phytoestrogen content such as chick peas or wheat have a very minimal phytoestrogenic impact. For most “healthy” people they shouldn’t be a problem. For women with hormone balance issues (such as me) , however, they may also still have an effect.
In all cases, with hormone balance issues, as well as people who regularly consume vegetable oils, nuts and soy, would do well to consider how potent their phytoestrogen intake may be.
What is estrogen?
Estrogen is actually a catch-all term for a wide variety of chemicals with similar shapes and functions, such as estrone (E1) and estradiol (E2). During a woman’s reproductive years, estradiol levels are much higher than other estrogens. During menopause, estradiol levels drop off, and the bulk of a woman’s estrogen content becomes E1 and E3 (estriol). This is important because E2 is the form of estrogen the ovaries pump out, and is also what is has the greatest effect in a woman’s reproductive years on partitioning fat to the hips and thighs rather than the abdomen. Plummeting E2 is why many women experience increases in abdominal fat during menopause.
E1- Estrone – Weak form of Estrogen, prominent throughout menopause
E2- Estradiol – Strongest and most prominent until menopause, active during reproductive years
E3- Estriol – weakest of the three, levels vary throughout the reproductive and menopausal course
How does the body perform estrogen signaling?
Estrogen is a hormone, which means that it is one of the chemicals in the body that works primarily as a signal: it tells cells and organs what they should be doing. The sex hormone signaling process “begins” in the pituitary (with overhead influence from the hypothalamus in the brain). It is up to the pituitary to tell the ovaries what to do, which is to produce estrogen.
The hypothalamus and pituitary glands have estrogen receptors liberally positioned through them. These receptors tell them how much estrogen is circling throughout the body at any given time.
Think of it like keys and locks: estrogen receptors are the locks, and estrogen molecules are the keys. With more keys, more locks can be filled. With fewer keys, locks end up sitting there empty, and rusted.
When the locks are filled, the pituitary detects “estrogen sufficiency!” in the body, and it slows down the “please pump estrogen” signal it sends to the ovaries. This makes the ovaries produce less estrogen.
The whole purpose of this system is to maintain stable estrogen levels in the blood.
Unfortunately, consuming high quantities of phytoestrogens often interferes with this otherwise healthfully functioning feedback loop.
The medical community’s opinion on what this means
Phytoestrogens act as estrogen in the body. But here’s the problem: while phytoestrogens have a pretty good ability to bind to estrogen receptors, they are not able to signal as well as estrogen.
Phytoestrogens look enough like estrogen to bind to estrogen receptors, but they do not look exactly like estrogen. This makes their ability to perform estrogen functions inferior to true estrogen.
When you eat phytoestrogens, they enter your bloodstream. To many doctors, this means that women with low estrogen levels should eat phytoestrogens. In their perspective, phytoestrogens would signal “fullness” to the estrogen receptors. They would also perform the normal functions of estrogen in the body.
On the other end of the spectrum, many doctors argue that women with high estrogen levels should supplement with phytoestrogens. This is because the phytoestrogens would flood the estrogen receptors. These receptors would down-regulate estrogen production. And, because these phytoestrogens do not resemble true estrogen, estrogenic activity would not actually increase. It would decrease. This, many doctors argue, could overall decrease estrogen production and possibly reduce risks of certain cancers.
In both of these cases, however, the science is not clear cut. Some doctors may think that women with both high and low estrogen levels should supplement with phytoestrogens, but that’s not always a great solution. For women with high estrogen, it can still sometimes make it worse. There simply could be far too much. For women with low estrogen, it can also make it worse. Since different kinds of phytoestrogens communicate differently with different kinds of estrogen receptors, depending on which phytoestrogen women with low estrogen levels consume, it could actually do more harm than good.
Something you may want to look into then is how to support healthy estrogen production first without using phytoestrogens.
How to balance estrogen levels
– Increase fat mass, if underweight
– Decrease fat mass if overweight
– Exercise when it feels right
– Eat anti-inflammatory, paleo foods like organic vegetables and fruits, organ meats, here’s a supplement in case you do not like to eat liver), eggs, fermented foods (on this page are my favorites) and the rockstar superfood cod liver oil can go a long way.
– You can read about all of these and additional suggestions in my book, available here.
But what about the other types of Phytoestrogens?
There are three primary types of phytoestrogens (plus dozens of sub-types): lignans, coumestans, and isoflavones. There are two types of estrogen receptors: estrogen receptor alpha (ERa) and estrogen receptor beta (ERb).
Different estrogen receptors have different shapes, and are distributed unevenly throughout the body.
ERa is concentrated more heavily in the hypothalamus than ERb, for example.
ERb is concentrated more heavily in skin tissue. It also varies for fat cells, for ovarian cells, for different types of brain cells.
Edit 2017: Recently, after learning about new research and working with even more women, I’m finding that plant-based phytoestrogens may promote ER beta activity, which can lower estrogenic potency in the body as a whole, thereby decreasing the risk for certain cancers (this is not true of synthetic estrogen, like that in hormonal birth control or estrogen replacement therapy). Read more about these latest studies right here.
Coumestans have a unique chemical shape (with two hydroxy groups in the same position as estradiol). Coumestol has the same binding affinity for the ERb receptor as estrogen, but it has much less of an affinity for ERa. This means that ERb’s will get filled up by coumestans, but ERa-heavy tissue might suffer a decrease in estrogen-like activity because estrogen production in general gets down-regulated by the hypothalamus, pituitary, and ovaries, etc.., thus making estrogen levels decrease in ERa tissues relative to ERb.
Additionally, the shape of coumestans means that coumestans have the ability to inhibit aromatase.
Aromatase is the process of converting testosterone to estrogen in cells. This can be helpful to know for women with PCOS who have high testosterone and low estrogen levels: it may be helpful to avoid coumestans.
Different isoflavones bind to different estrogen receptors differently. Some bind more strongly to ERa, and others to ERb (genistein, dihydrogenistein to ERb, equal to ERa). Yet most importantly, many (though not all) isoflavanones that have been tested have the same binding affinity as actual estrogen, but half the receptor-dependent transcriptional power. This is a powerful fact: isoflavones have half of the ability to perform estrogenic function as they do to take up space. Isoflavones such as soy can help women with estrogen dominance.
Phytoestrogen biochemistry is complicated. Some studies have shown that phytoestrogens boost estrogen activity, and others have shown that they decrease estrogen activity. This is due in part to the variable biochemical components of different kinds of phytoestrogens I listed above. It may also be due to the broad diversity of women’s physiological responses to phytoestrogen. What were the women’s estrogen levels beforehand? Were they healthy women? Fertile women? Women on the pill or grew up eating soy? Those who are routinely exposed to xenoestrogens? There are too many questions and the variables are still too numerous to say whether all women should avoid soy.
Something we can say definitively however is that women should tread carefully around soy, flax, and other phytoestrogens.
I am a firm believer in bioindividuality. Some women could benefit from phytoestrogen usage. Some may not. It is up to you to figure out which you may be. If you are extremely low or extremely high in estrogen, it seems likely that phytoestrogens could help.
If you do not know, step carefully. It is better to be safe than to be sorry. You can work on balancing your hormones first and foremost through adequate carb and fat intake, through smart exercise (for a way to achieve this at home, click here), through stress reduction, and through an anti-inflammatory diet rich in nutrients.
If you want to experiment with phytoestrogens, start small. Perhaps with a daily bowl of chickpeas or hummus. This is what I personally do.
For further resources on phytoestrogens and how they interface with health :
Why I now believe Phytoestrogens may be good for you
Phytoestrogen Sources you Might not Know You’re Consuming
Menopause and Hot Flashes
Losing weight while you get older