HEALTHY HORMONE SERIES PART II

THE PMS CODE - YOUR BODY IS TRYING TO TELL YOU SOMETHING 

Written By: Brittani Kolasinski (BHSc Nut, Adv Dip Nut Med) 

Premenstrual Syndrome (PMS) is believed to affect approximately 90% of women each month, with the presentation for each being vastly different. I’m certain the men in our lives think that we make most of this stuff up, that we are just being sensitive or overly emotional and irrational, which I must admit I have been more than a few times. But, unfortunately PMS is a real thing, but although it might be so common its most definitely not normal. Our periods should not be this way, they should not impact our lives to such an extent or the lives of our loved ones and people around us.

When PMS rears its head it’s not something for us to just suck up and push through, but to stop, take a moment to listen and really feel what your body is showing you, and from there address the underlying imbalances that are causing such discomfort. PMS can be a thing of the past, once you understand what is driving it.

There are many, many different presentations of PMS with symptoms effecting our physical, mental and emotional worlds. Mood swings, appetite changes, fatigue, irritability, acne, fluid retention, anxiety, depression, brain fog, insomnia, pain, migraines, breast tenderness, indigestion and constipation are just some of the many presentations of PMS. The timing of these symptoms may also differ woman to woman, for most these may occur during the second half of their cycle and pass with the onset of their period or very soon afterwards.

The development of PMS is not exactly clear cut. Its hypothesised that PMS can be due to fluctuations in sex hormones, a result of too much stress and disruption of our hypothalamus-pituitary-adrenal axis, from abnormal GABA function (a neurotransmitter responsible for calming the body), altered serotonin levels leading to feelings of sadness and altered bowel movements, a reduction in opioids and blunted response to endorphins.

Our reproductive hormones impact on many of our neurotransmitters and chemicals within the brain, hence why mood is affected when suffering with PMS. Progesterone for one, influences GABA. GABA is responsible for feelings of relaxation, is calming on the body and promotes restful sleep. Therefore, with lowered progesterone levels, GABA is affected and can cause changes to mood, inducing feelings of anxiety and impairing sleep.

Dysmenorrhea is the term used for painful periods. This pain is described as a dragging, dull ache or a heaviness with episodes of cramping and is generally located around the lower abdomen and pelvic region but may also spread to the lower back. Pain can be from the muscular contractions needed to shed the lining to induce the bleed, however extreme pain or pain that occurs at different times during the cycle, not relating to the bleed itself can all be indications that something else is going on and would warrant further investigation.

Endometriosis is a condition that can be responsible for such severe pains and its worthwhile to have this properly investigated if you suspect something is not quite right. There are slight differences to the pain of endometriosis in comparison to dysmenorrhea. Endometriosis pain may begin up to 10 days before the day of bleed and remain for up to a week after, there may also be pain present around ovulation (mid cycle) whereas dysmenorrhea is generally felt the day prior, or the day of the bleed and will pass shortly after, within a couple of days. More on Endometriosis in future articles, stay tuned!

Cracking the Code

Firstly, its best to log the symptoms you experience and when in your cycle they are occurring, as we have previously discussed in the last article there are many hormones fluctuating at different points during your cycle. Doing this can also give you an understanding of what is going on internally. For most, the symptoms present indicate signs that there is too much estrogen or too little progesterone. Although it’s a much more complex and intricate hormonal dance that’s happening within the female body, these two are centre stage and worth looking at in more detail.

Signs you have too much oestrogen

Feeling particularly aggressive and irritable, with fluid retention and bloating, breast tenderness as well as constipation, which then leads to more oestrogen reabsorption and further sustaining the distress.

Signs you don’t have enough oestrogen

A common sign of oestrogen deficiency is vaginal dryness, but other symptoms include dry skin, insomnia, weight gain, fatigue, hair loss and depression – I mean who wouldn’t feel depressed with symptoms like this! But more technically speaking, the low mood is to do with the relationship oestrogen has to serotonin, our ‘happy hormone’.  Oestrogen deficiency may occur when you’re unable to ovulate, this can be due to a number of things – under eating, stress or an underlying pathology. If you’re still ovulating it may just be that your oestrogen is on the lower end, and this might be noted with a lighter bleed with your period, referred to as a scanty flow. Changes to diet and lifestyle can rectify this and restore the balance.

Signs you have too much progesterone

To be completely honest, it’s not often you’ll come across this – progesterone is difficult to make. The more common scenario is a progesterone deficiency with oestrogen excess. Too much progesterone can occur with progesterone supplementation (note this does not include hormonal contraceptives, these contain a synthetic progesterone – not the real thing). Pregnancy is another time that progesterone may be high, or with oestrogen deficiency as this throws of the balance of these two hormones. In other instances, it may also indicate underlying pathology that would warrant further investigation, adrenal related problems may throw out your progesterone levels. Signs that you have too much include fatigue, morning brain fog, dizziness, water retention, sense of physical instability, anxiety and changes to libido. As these symptoms can be vague and an indication of a multitude of other health conditions its always best to work with a health practitioner to help guide you.

Signs you don’t have enough progesterone

Your luteal phase is shorter, and you will notice fertile mucous within the luteal phase, rather than around mid-cycle when ovulation should occur. If tracking your basal temperature, you may find that your temperature is lower during the luteal phase. Weight gain, low libido, irregular periods and problematic skin may also indicate that progesterone is too low. Progesterone can be more difficult for the body to create and requires consistent ovulation each month. Remember the corpus luteum mentioned in the previous post? This 4cm gland is formed from a single cell within a small window of time every month, meaning that you must be well fed and nourished. Underlying conditions that effect thyroid or to do with blood sugar imbalances must be addressed as these can impair ovulation. It takes 100 days in total for your eggs to reach maturation, so when it comes to healing hormones, be patient – it’s not an overnight fix.

A deficiency in progesterone could be due to increased stress or inflammation within the body, meaning that these will also need to be addressed to support healthy hormone production.

Apart from oestrogen and progesterone, both stress and inflammation can contribute or be the causative factor to what’s behind your PMS;

Stress is a major factor in the presentation of PMS. Cortisol, our stress hormone is synthesised from the same precursor that both oestrogen and progesterone are made. This means that during times of stress more cortisol is made from the precursor, leaving less available to make adequate hormones and leads to an imbalance that can affect your cycle as well as trigger PMS.  

Inflammation also comes into play. PMS is associated with higher levels of inflammatory cytokines, and this can manifest as pain and cramping, fatigue and migraines. Increased blood sugar levels also promote inflammation and lead to excess production of oestrogen.

When it comes to supporting your body naturally to reduce the monthly burden that your periods might often bring, it’s always a good idea to track your symptoms across the month, this allows you to gain more understanding of what exactly your body is crying out for.

Looking forward to the next part of this hormone series, ‘Natural Treatments for PMS’ where we will be considering all of the aforementioned information and breaking it down into some simple tips & tricks you can do for your body to make you menstruation more enjoyable.

Stay tuned xx

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HEALTHY HORMONE SERIES PART I

WHAT IS A HEALTHY PERIOD? 

Written By: Brittani Kolasinski (BHSc Nut, Adv Dip Nut Med)

Starting this 5-part series, where we will be talking all things hormones & health, with the topic of periods. This is our menstrual cycle. A topic near & dear to me, and often times one that comes up in conversations with girlfriends as well as in clinic with my female clients. It’s something that should be celebrated, talked about, and something that we as women (and our male companions) need more education and clarity around as many of us don’t truly understand the intricacies of the women’s cycle and the hormones at play - or how to appropriately support them. 

The menstrual cycle

This is the cycle that occurs, involving a number of hormonal and physical changes that makes pregnancy possible. The ovaries, fallopian tubes, uterus, thyroid, and brain are all involved with a number of different hormones at play. The process, in a nutshell, involves the development of an egg (ova) by the ovaries that are released (this is ovulation) to travel down the fallopian tubes and become embedded within the uterus ready to be fertilised. The lining of the uterus thickens each month in preparation for a possible pregnancy. Without fertilisation the uterus contracts to shed the thickened lining of tissue (which is our endometrial tissue) and this is the bleeding that occurs with menstruation which is known as the woman’s period.

The first day of the cycle is the first day of bleed, and the cycle finishes once the following months bleed occurs. The average length of a woman’s cycle is between 28-32 days. Anything outside of this time window is worth investigating. The entire cycle can be broken up into three stages:

1.     The follicular phase – this stage lasts typically from days 1 to 14, it is the first stage of the cycle in which the follicles in the ovary begin to mature. The follicles are tiny sacs in which an egg is contained.

2.     Ovulation/The fertile window – once an egg has reached maturity, it is released to enter the fallopian tube and make its way to the uterus. This usually takes place between days 13, 14 or 15. This ‘window’ is the fertile window, the ideal time to have sex if you’re wanting to conceive. Worth noting that not all women will ovulate at this time, so it’s important to understand and look for the signs that you have ovulated to know the ideal time for you and your partner to conceive. Ovulation does not need to occur to still experience a menstrual bleed, this is known as an anovulatory bleed.

3.     The luteal phase – the finale, in this time the lining of the uterus has thickened in preparation for a fertilised egg. Without fertilisation the lining will break down and contractions allow this to be shed as the bleed and signaling the beginning of the next cycle.

The Hormones

Hormones are chemical messengers produced by the body that stimulate a number of reactions and responses from tissues. There are a number of different hormones needed throughout a woman's cycle for it to be completed.

Follicle Stimulating Hormone (FSH) – this is needed for puberty and healthy ovarian function. As the name indicates, its required for the stimulation of growth and the maturation of follicles to become the egg that is ultimately released during ovulation. FSH is also needed to stimulate the secretion of oestrogen. It's highest in the follicular phase of the cycle and peaks just prior to ovulation. 

Oestrogen – this is secreted by the ovaries and has a number of functions throughout the body. It's stimulating and is responsible for the drive we as women have, it promotes the growth and development of tissues, from breast to uterine lining. It halts the production of FSH so as to ensure that only one egg is matured and released with each ovulation, it stimulates the release of luteinising hormone (LH), it allows the secretion of fertile mucous (a clear indication of ovulation), which is a creamy egg white discharge that provides the sperm with an easier trip to the fallopian tubes to reach the egg.

Oestrogen levels peak during the follicular phase with a particular spike around ovulation – this triggers LH which allows ovulation to occur. Oestrogen is also needed for healthy bones, muscles, brain, heart, sleep, skin and metabolism. It tapers off during menopause, a time where there is an increased risk of bone, heart and metabolic conditions.

Luteinising hormone – a spike in LH mid-cycle triggers ovulation to occur, it’s also required for the development of our corpus luteum which is needed for the synthesis of our hormone progesterone.

Progesterone – almost opposing the effects of our stimulating oestrogen, progesterone is our calming hormone. It's secreted by the corpus luteum and also by the placenta during pregnancy. Progesterone is anti-inflammatory, involved in muscle growth, promotes sound sleep, protects against cardiovascular diseases and supports the nervous system during times of increased stress. Progesterone is needed to maintain pregnancy, its levels are highest during the luteal phase of the cycle. Without fertilisation of the egg, progesterone levels will then taper off which stimulates the contraction of the uterus to shed the lining and induce the monthly bleed.

Signs you’re ovulating

It’s common for women to experience anovulatory bleeds on the odd occasion, but regular occurrences may indicate hormonal imbalance is warrants further investigation. Without ovulation, there is a lack of progesterone made which can contribute to premenstrual symptoms including breast tenderness, insomnia, changes in mood (anxiety, depression) and increased appetite and food cravings. A lack of progesterone can also shorten the length of your cycle as the lining of the uterus cannot be maintained as long.

One way to track ovulation is by checking your basal metabolic temperature. This is a simple, effective and non-invasive tool to use. Using a thermometer which you can purchase from your local chemist, you take your temperature the moment you wake and can chart it using a hand-written method or through an app on your phone (I use Kindara). You can see what you have ovulated as you will find a rise in temperature. 

Additionally, you can watch for physical signs such as fertile mucous, this will appear as an eggwhite consistency that you will note around mid-cycle or during the luteal phase and is an indication that you are ovulating.


Premenstrual Syndrome – PMS

PMS is common, with a variety of symptoms occurring for each woman that can significantly impair their quality of life. Although incredibly common, PMS is certainly not normal. A healthy period should not cause distress, it should not induce significant pain or cramping, or be responsible for changes in weight and mood or disrupt your normal sleeping pattern. If you’re experiencing such complaints month to month it's worthwhile to work with a healthcare practitioner to make the appropriate changes to diet and lifestyle or include nutritional supplementation to restore balance and harmony.

Changes or irregularities to your period are a clear indication that something needs to be addressed, a great resource for further understanding this is the book by Sydney naturopath Lara Briden, where she refers to your period as your monthly report card. A great analogy in my opinion.

Our periods are a gift and a healthy period is a sign of balance, health and wholeness. Further articles to come will address natural treatments for PMS, look into lifestyle factors that are affecting your period, discussing what pathologies might be underlying your menstrual irregularities of pain – things like PCOS, endometriosis, fibroids etc, to finish up the week with healthy hormone foods and recipes. Here’s to happy, healthy hormones ladies!

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