The body and hormones are complex. Way more complex than our minds ever give them credit for. As a health care provider, I will never know everything there is to know about the body. And I would never expect other health care providers to either. I also recognize that I’m a young practitioner, have a ton to learn and there are many doctors, physician assistants and other nurse practitioners out there to learn a lot from. My hope is to never stop learning.
But one thing I have learned in my career so far, is that we over pathologize hormonal issues. We make them out to be conditions that require extreme treatments. And as a healthcare field, we are far too quick in finding a “solution.” Even though I I believe most health care providers are well intentioned and want to keep their patients safe, sometimes (more often than not) that quickly proposed solution can do more harm than good. Because hormonal issues are complex and there is no one size fits all approach.
SO WHAT CAN BE CAUSED BY HORMONAL ISSUES?
Think of things such as…
- hypothyroidism or thyroid issues in general
- PCOS
- hypothalamic amenorrhea
- fertility issues
- acne
- “adrenal fatigue” –> this isn’t an actual diagnosis but the term is trendy in the media lately
- insomnia
- anxiety and depression –> because these can be associated with blood sugar and thyroid issues
The list can go on and on and on. The endocrine system is insanely dynamic. And because it is insanely dynamic, we cannot muddle the treatment for “balancing hormones” down to eating xyz foods, exercising xyz way, and taking xyz supplements. There are also many things that go into these conditions, hormones can be one piece of the puzzle.
Unless you have an actual hormone deficiency, no synthetic hormone (like birth control, synthroid, etc) is going to completely fix your hormone issues. No specific eating protocol or exercise routine is going to fix your hormonal issues. And no cocktail of supplements is going to magically ‘balance out’ your hormones.
All these specific solutions and protocols are rarely the answer. Really I want to say they are never the answer, but nothing in life is certain, therefore I hate using the word never. Except when telling people to NEVER diet.
These rules often don’t work because they leave people feeling more stressed about taking care of themselves. More often than not it feels like something else to do or fix. In the short term, regardless of the psychological stress or side effects, we might experience immediate results with these “1-2-3” guides to fixing your health problems. But if we think about our overall and long term health, we know from the research that chronic stress induces subtle chronic inflammation (which leads to a wide array of chronic diseases), suppresses the immune system, causes GI disturbances and symptoms, disrupts thyroid function, and increases insulin resistance. And the list goes on.
SO WHAT IS THE SOLUTION?
Healing hormonal issues is way more elaborate than following a protocol or set of guidelines because we have to account for psychological stress, or in other words, perceived stress. Each person has a different threshold for the amount of perceived stress they can handle. If you surpass your body’s threshold, you begin over activating the body’s HPA axis. Think of your HPA axis as your fight or flight system. When activated in short spurts, this system allows your body to survive. Then the stressor ends and your body returns to homeostasis. But when the HPA axis is activated on a continual basis (because of the high stress, go go go, overly productive world we live in….it causes chaos.
One of the many reasons over activation of your HPA leads to hormonal chaos is because your HPA directly impacts your HPG (hypothalamic pituitary gonadal axis) and your HPT (hypothalamic pituitary thyroid axis). That means your HPA is going to affect your reproductive health (fertility, amenorrhea, PCOS, etc) and your thyroid function. I use these two images below often when explaining this concept to clients.
This first image above shows your HPA and your HPG. Let’s look at the left side and focus on the HPA. The stressor happens, which stimulates your hypothalamus to release CRH, which then acts on your pituitary gland to release ACTH into the bloodstream. That ACTH travels down to the adrenals and signals them to produce cortisol, in addition to other hormones. Cortisol plays a big role in your body’s stress response. This is a very intricate system, but I’m over simplifying this concept so it’s easy to understand.
On the right side let’s look at the HPG. Essentially this is the cascade of hormones that occurs to bring about your menstrual cycle. The hypothalamus secretes GnRH which signals the anterior pituitary to release FSH and LH which act on your ovaries. Your ovaries produce estrogen and progesterone. This is a very rhythmic system that is highly sensitive to stress.
All that cortisol produced by the HPA axis has a direct impact on your HPG axis. It inhibits the release of GnRH which then impacts the amount of circulating LH. You need LH to ovulate. And of course you need to be able to ovulate to have a menstrual cycle. At the same time, cortisol production suppresses the production of progesterone. This causes higher levels of estrogen compared to progesterone, leading to all sorts of hormonal problems in women. Things like PMS, heavy/painful periods, fibroids etc.
The second image above that I show clients illustrates the connection between your HPA and HPT (hypothalamic pituitary thyroid) axis and how cortisol can affect your thyroid health. On the right side is the HPT. Your hypothalamus releases TRH (thyrotropin releasing hormone) which tells your pituitary to release TSH (thyroid stimulating hormone). TSH acts on your thyroid to produce T4, your inactive thyroid hormone. T4 then gets converted into T3, which is your active thyroid hormone. Again, I’m oversimplifying drastically here to make it easy to understand.
Your HPA impacts your HPT. You can see in the picture above that cortisol inhibits both the release of TSH and the conversion of T4 to T3. What you end up with is unhealthy levels of thyroid hormone. Depending on what your thyroid hormone levels are you can experience a lot of unpleasant symptoms the we will get into in another post.
SO WHAT ACTIVATES YOUR HPA?
Your HPA is activated all the time from things like…
- inappropriate exercise – moderate to high intensity exercise has been found to increase levels of cortisol (your stress hormone)
- inadequate energy (aka calorie) intake OR inadequate macronutrient intake (carbs, proteins, fats)
- too little sleep (raises cortisol and increases insulin resistance)
- perceived stress (which includes monitoring your food intake and self esteem and self efficacy)
Let’s focus on perceived stress. Perceived stress could be anything from running late for work, caring for a baby, or spilling coffee on your white shirt to things like meeting a large deadline at work, going through a divorce, caring for a sick loved one, poor body image, low self esteem, paying off credit card debt and also monitoring your food intake. Research shows that simply monitoring what you eat, even without calorie restriction, increases levels of perceived stress.
SO WHAT DOES THIS ALL MEAN?
I have only brushed the surface with a little bit of physiology and how that affects our hormones. There are many, many systems at play here and many symptoms and diseases that are associated with hormonal health. We haven’t even talked about the gut-brain connection which plays a role here too. What I hope you take away, is that these issues are multifaceted with many moving parts. The question to answer is… “What is REALLY causing the problem?” And that is going to be different depending on your own individual story. There is no protocol to follow. It’s about understanding your body and learning how to take care of it best based on your own life circumstances.
I understand that food can and does have a therapeutic affect. But does the physical benefit outweigh the psychological distress of eating a particular way. That is the question that we don’t often account for. There is no supplement or food that is going to alleviate the perceived stress in your life. That takes a lot of mind/soul work and it’s a lot harder to change than your food choices. And that is why you will never see a step by step guide written here on the blog. Because there is no specific set of steps you need to follow in order to be healthy. It’s about learning your body’s emotional, mental, spiritual, relational and physical needs and how to meet those needs that will lead you to long term health. As health care practitioners, we can help guide you there, but only you have all the answers.
So before you go down a rabbit hole of all the things you have to change about your life to “get healthy”…what about taking a step back and pausing to think about what might be really causing the symptoms. And then weighing all the factors at hand. Perhaps you need to doing less and not more. Because while I still have a whole lot to learn, I do know one thing. No matter how green and clean and rainbow filled your plate is, and no matter how regimented your exercise routine is, and no matter how non toxic your beauty products are… if all that is stressing you the ef out…you won’t be heathy at all.
If you’re a dietitian or aspiring RD or interested in women’s health…
And you’re interested in learning more about a non-diet approach to women’s health issues including PCOS, fertility, and amenorrhea, I hope you’ll check out the RD Real Talk round table series hosted by Heather Caplan that I’ll be speaking on again this month. There is nothing that gets me fired up more than combining by RD and NP education to approach women’s health through an IE/HAES lens. Here’s a link with more information. You can listen anytime! You can also purchase a listen only option, or full registration, which includes a 20 minute mentoring call with one of us panelists. Here’s the link to register!
This is really interesting! I’ve noticed that if I’m badly stressed, I will get bad cramps in the night, regardless of where I am in my monthly cycle. (Which, of course, causes me to sleep badly, which causes me more stress…) It’s nice to see scientific connection. Thanks for taking the time to explain.
Glad it was helpful!
Thanks to your posts, I’ve been focusing on managing my stress more effectively and sleeping well. I don’t have control over my weight but I can (mostly) control how much I sleep. Thanks again!
Yes! Control the things that we can and that matter 🙂
As a physician I would be careful in having your readers think all the things you listed are directly tied to hormones. Yes many can be correlated with hormonal problems but many are caused by entirely different things. Acne is caused by overactive sebaceous glands. Depression and anxiety by imbalanced brain chemicals. Sure hormones are part of this but they aren’t the “fix” a lot of the time!
100% agree Mal, I hope that is not the picture I’m portraying at all. I don’t think I said hormones are the only direct cause but please let me know if I did! These sentences below pulled from the post I hope give that message. I do appreciate your comment because I would never want to lead readers astray.
There are many, many systems at play here and many symptoms and diseases that are associated with hormonal health.
What I hope you take away, is that these issues are multifaceted with many moving parts. The question to answer is… “What is REALLY causing the problem?” And that is going to be different depending on your own individual story. There is no protocol to follow. It’s about understanding your body and learning how to take care of it best based on your own life circumstances.
I think its just as over -simplistic to reduce the causes of depression and anxiety to chemical imbalances. That seems to imply that medication is necessary or perhaps the best way to “balance” brain chemicals, and that is simply not true. There are many types of therapies that can treat these conditions and research shows that a combination of medicine and traditional therapy produce the best outcomes for particularly challenging cases. I think Robyn is offering one particular avenue to explore before moving on to other treatment protocols. In other words, using a step-process to find the best treatment instead of automatically writing a prescription. Medicine is powerful and needed but it isn’t always the only solution.
Thanks for your comment Shana 🙂
Once you devote your life studies to depression and OCD you can give your two cents. It’s not over simplistic. Cognitive behavioral therapy plus SSRIs leads to the best outcomes. PERIOD. 🙂
Hey Mal, I’m totally open to healthy discussion – but discounting someone’s thoughts on the basis that they haven’t devoted their life studies to this topic feels unfair. We don’t have to always agree with others, but the comment sections isn’t a platform for telling someone when and when not they have the “right” to say something. Thanks for respecting this space 🙂 Shana said exactly what you said with combo of SSRIs + CBT, I’m not sure if you read the entire comment…
“There are many types of therapies that can treat these conditions and research shows that a combination of medicine and traditional therapy produce the best outcomes for particularly challenging cases.”
Mal,
Having seen SSRIs plus cognitive therapy lead to suicide, and natural alternative treatments lead to healing, your “best outcome” is truly horrific. Actual experience trumps “life studies” any day. By the way, have you noticed that spiffy little warning that everybody but you seems to know about? SSRIs can INCREASE suicide risk. Please keep your drug pushing to your own “practice” and keep out of places like this, unless you are finally willing to let go of your ignorance and arrogance and actually learn.
I think the overarching message here is the impact that perceived and actual stress can have on all parts of our bodies. Food seems to bear the brunt of the blame for every single physical problem these days, when in reality we need to start looking at our lifestyle as a whole. Managing stress, getting adequate sleep, eating ENOUGH calories to sustain daily activities, and resting (not binge watching tv) but truly embracing restorative rest and relaxation are so important to our physical and mental health. I agree that treatment plans need to start with or at least include these basic elements while deciding the appropriate course of medicine protocols.
I think the overarching message is that we can not be one track minded at all! 🙂
Thank you for this. I’m about to turn 50. Why has it taken me so long to figure some of this stuff out? There absolutely is no cure all and thank you for pointing out that each person needs to be treated individually! I look forward to your very insightful posts!
Better learning now than never right? Glad you are enjoying Sheri!
The new blog design is so fun!! I love it. I’m sure there was lot of work put into it. Appreciated this line the most “No matter how green and clean and rainbow filled your plate is, and no matter how regimented your exercise routine is, and no matter how non toxic your beauty products are… if all that is stressing you the ef out…you won’t be heathy at all.” Hope the packing goes smoothly!
Glad you like it! Happy weekend 🙂
I often think about what our bodies would tell us of it could talk? Are we doing too much? Are we in a monotonous cycle of stress? Maybe instead of trying to define health, we should begin to learn how to define ourselves. What makes my body feel good? What will cause me unneeded stress? Your post brought forth great insight into this issue (-:
LOVE THAT. We should begin to learn to define ourselves. <3
Robyn, I am LOVING watching you start to assert yourself as a health care provider in this field. You have a powerful voice and a powerful, well-balanced opinion, and we need more people thinking the way you do. Your posts on hormonal health and the menstrual cycle have been completely mind-blowing for me. When I read your post on fertility awareness I actually got so angry that, as women, we are not taught ANY of this valuable information about our bodies! I’ve been doing FAM ever since, just for fun! I feel like it’s put me in touch with my body in a whole new way, and I’m loving it.
Mary your comment means so much! I try to balance passion + knowledge with humility and eagerness to always be learning. I’m so glad you have found them helpful!!
Hi Robyn! I love the new blog layout! I also love reading all of your more scientific posts like this. They are really awesome and I always learn something. I was curious if heavy periods and light periods stem from the same hormone imbalances. When I say light, I mean basically nonexistent- to the extent where you would’t even have to use sanitary products. Hope you’re doing well and staying grounded in this busy season of life for you!
Hi Savannah! Thanks for reading! This post might be helpful!
https://www.thereallife-rd.com/2017/08/menstrual-flow-and-hormones/
So if you’re just supposed to eat whatever you feel like eating, and you aren’t supposed to track food at all to avoid stress, exactly what should a dietitian do when working with you? The dietitian I am working with right now has me tracking everything I eat so we can look at it when I meet with her. I know this is because I would under eat and exercise too much. We’re working on balancing that out. But I will admit that I really hate tracking everything I eat and all the exercise I do. With this life season of weight gain, decreasing exercise, increasing calories, tracking food really adds to my irritation.
I think of my role as an RD to be a source of support, guidance, encouragement to help women sort through their food beliefs — all of this helps you to tune into your own body’s needs. I think it all depends on the needs of the person and then I plan my care around that.
THIS QUOTE!: “Research shows that simply monitoring what you eat, even without calorie restriction, increases levels of perceived stress.”
Pure gold. If only more people (especially those in the nutrition, fitness, and wellness industries promoting tracking of ANY kind) understood and applied this.
I haven’t done my research yet, but I’d imagine the same principle applies to exercise? (Trying to follow a day-by-day, laid out exercise plan vs. having various exercise options and truly choosing to exercise intuitively)
I would assume that monitoring any health behaviors in an obsessive way can be stress inducing!
Whoa, fancy new blog design! It looks good!
Hi Robyn! I love these educational posts. I always learn something new and your posts always get me thinking about looking at things in different perspectives, which I love. So, thank you!
This is fantastic. Thank you SO much for putting this information out there!!! As someone who struggles with some of these issues I can tell you it is so needed and so appreciated. Loving the new layout, too!
Glad you found it helpful Megan!
Is HPA dysfunction a better word or the technical term when people refer to Adrenal Fatigue? Also, what are your tips for talking to your doctor (who is very Western trained and works for a big medical group that gets patients in-and-out) about “adrenal fatigue”. I feel like they ask about stress but don’t really think about cortisol levels being imbalanced.
Also, this was a super informative post but really encouraged people to take a step back and look at their health. Thanks!!
Adrenal fatigue is a made up diagnosis, but HPA dysfunction is a real thing (and in the literature)
Maybe reference some of the studies and what you’ve learned…that can be a great start but to come at it with a hey…I’m feeling like this and think this might be going on …what do you think?
Thanks!
I absolutely love this and it’s SO important. I have written on my blog before about a time when I experienced some hormonal imbalance/irregular cycles, which ultimately led to hair loss, depression, insomnia, night sweats and more. My doctor simply prescribed birth control, which might have helped regulate my cycle, but did nothing for the other issues I was having. It was through your blog and Kylie’s that I learned I needed to be doing a lot LESS than what I was doing. At the time I experienced all of this, I was also training for a half marathon, attending cycling events, working a full time job and had other stressors in my life. When I STOPPED exercising as much and learning to listen to my body’s signals for hunger and fullness, the symptoms disappeared. I am currently doing the least amount of “organized” exercise than I have done in many years, but I FEEL better than I have in years.
Thank you for sharing your story Amber! I know I can relate and I think others can too 🙂
Hey Robyn! Thank you for going over hormones, it’s something I’ve been really focused on right now because I can tell mine are out of whack. I’ve been eating a lot more than I used to and taking exercise down several notches but have been experiences some acne that I never had before and reeeeaaallly bad cramping and fatigue the first couple days of my period. My question for you is – is there a point you should see your doctor? I’ve thought about getting blood tests done but then I wonder, is there anything I can do with that information other than the suggestions you’ve given here? Not sure if it’s worth the time/cost. Thank you and have a wonderful Thanksgiving!!
I wish I could answer those questions Katie but I don’t know enough about you to give advice and would never want to give more harm than good…I would say though, it can never hurt to see a doctor. Hope that helps. Happy Thanksgiving!!
The new layout feels perfect for this space; I love it! I also love this post, and I honestly keep proving to myself how monumental an effect sleep and stress have on both my physical and mental well-being. I still love my maca powder, though, for making me feel like I’m sort of kind of helping balance my hormones. Placebo or not, it feels like it helps things a bit.
Robyn, thank you for the very informative post! I love your posts about women’s hormones, periods, etc. and I have learned so much from you! This post really hit me because I know that the micro-managing in my life causes a lot of undo stress, and I can feel the effects on my hormones. I desperately want to find more balance and get my hormones on track, but I know that means reducing the stress in my life. Thank you for nudging me to work on this!
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