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Hormonal Imbalance

Confessions of a Tap Water Drinker: How To Combat Environmental Estrogens Without Losing Your Mind

By | Hormonal Imbalance, Hormone Testing | No Comments

I drink tap water and it is one of the major sources of xenoestrogens in our environment. I don’t have one of those fancy reverse osmosis water filtration systems, but I do have a water pitcher filter that I surely don’t replace often enough. But you know what? I’m doing the best I can, and so are you! Hormones in our environment cause hormonal imbalance within the body.

There are so many things you can do to reduce your chemical load and you don’t have to turn your life upside down to do them. I’m here to tell you that even small changes make a BIG difference when they all add up.

Xenoestrogens

Maybe I’ve gotten ahead of myself and you’ve never heard of these “xenoestrogens” I’m talking about? Xenoestrogens are chemicals we encounter daily that behave like estrogen in our bodies; they interfere with the functions of our hormones.  They’re in our water, our pesticides, our shampoo, our coffee cups, our cans/plastics and the list goes on. Well, they’re seemingly inescapable.

The bad news: When there are more xenoestrogens in our environment, we end up with more estrogen in our bodies.  These xenoestrogens are unfortunately much stronger than the natural estrogens our bodies produce, so you may experience symptoms of excess estrogen, like: breast tenderness, irregular menstrual bleeding, ovarian cysts, fibroids, PCOS, endometriosis, PMS, headaches, excess fat tissue, low libido, etc all due to environmental exposure. Xenoestrogens affect men and women.

The good news: Thankfully, our bodies are brilliant machines that have the amazing ability to remove the majority of these toxic estrogens through liver detoxification and elimination. It is only when we are over-exposed, and our bodies are over-exerted, that we start to feel the symptoms because our elimination pathways just can’t keep up with the chemical load.

There’s more good news.  The purpose of this blog is to teach you how to reduce your load of xenoestrogens so that your body is better equipped at getting rid of them.

Here’s what you can do:

  1. Enjoy foods and drinks that help your body eliminate harmful estrogens, you’re already eating anyways!

The following foods/drinks decrease the binding effects of xenoestrogens in the body:

  •      Almonds
  •      Walnuts
  •      Ground flax
  •      Sunflower seeds
  •      Sesame seeds
  •      Non-GMO, organic soy
  •      Green tea
  •      Hibiscus tea
  •      Alfalfa sprouts

The following foods/drinks increase the elimination of xenoestrogens from the body:

  •      Broccoli
  •      Cauliflower
  •      Brussels sprouts
  •      Cabbage
  •      Collard greens
  •      Arugula
  •      Bok Choy
  •      Kale
  •      Turnips
  1. Know the common sources of xenoestrogens and make small changes to avoid them

  •      Xenoestrogens can be found in a wide variety of household products: cosmetics, cleaning products, body products, cookware etc.The next time you you run out of laundry detergent buy a natural one instead, and skip the unnecessary dryer sheets full of chemicals.
  •      Skin Deep is a site where you can search cosmetics and determine whether they have hazardous chemicals, without having to read a single label!
  •      Avoid plastics as much as possible: use glass containers, use a reusable water bottle, do not heat plastics in the microwave or dishwasher, bring a travel coffee mug to work.
  •      The “dirty dozen” is a list of the top 12 produce with the most pesticides. You do not need to buy everything organic, in fact buying organic in only these 12 foods reduces your pesticide exposure by 60-90%.
  •     Avoid tap water when you can- reverse osmosis water has the fewest toxic compounds (although it is not great for the environment).

Other tips for healthy elimination of estrogens:

  •      Opt for high fiber foods, including: complex carbs, fruits, veggies
  •      Drink at least 2L of water daily to support elimination
  •      Limit alcohol intake to 1-2 glasses of red wine a week for optimal liver function
  •      Get outside in the sun and exercise: vitamin D and sweating both contribute to lower estrogen levels

Even if you only choose to make one tiny change after reading this blog, you’re still better off than you were before. I do the best I can but I don’t treat it like a full time job! I use natural cosmetics, body products, and tampons. I try to use glass containers and avoid heating plastic, but I do love coffee shops and my faithful dishwasher!

Book an appointment with Dr. Sumner. Learn about hormone testing.

References

Wozniak, M., & Murias, M. (2008). Xenoestrogens: endocrine disrupting compounds. Ginekologia polska79(11), 785-790.

Paterni, I., Granchi, C., & Minutolo, F. (2015). Risks and Benefits Related to Alimentary Exposure to Xenoestrogens. Critical reviews in food science and nutrition, (just-accepted), 00-00.

Arya, G., Tadayon, S., Sadighian, J., Jones, J., de Mutsert, K., Huff, T. B., & Foster, G. D. (2017). Pharmaceutical chemicals, steroids and xenoestrogens in water, sediments and fish from the tidal freshwater Potomac River (Virginia, USA). Journal of Environmental Science and Health, Part A, 1-11.

Michałowicz, J. (2014). Bisphenol A–sources, toxicity and biotransformation. Environmental toxicology and pharmacology37(2), 738-758.

The Top 10 Hormones Worth Testing in Blood Work & The EXACT Results You Want to See

By | Hormonal Imbalance, Hormone Testing | No Comments

You know the drill when it comes to hormone testing; it’s a lot of poking and prodding on multiple days of your menstrual cycle. In my experience, my patients have had all the right testing done (mostly), but no one has taken the time to sit down with them and explain what the results truly mean.

The biggest pitfall of serum (blood) hormone testing is that the reference ranges are MASSIVE. Which means it is highly unlikely that your results will be deemed “abnormal” even though you know you have a hormonal imbalance. So that’s what this blog is for; I’m going to break it all down for you and discuss what the results mean and the REAL range you’re looking for. Note: the following reference ranges are for women and are Canadian units.

 

1) Estradiol

What it is: Estradiol, along with LH and FSH, stimulate follicle (egg) maturation. It’s also responsible for female sex characteristics, thickening of the endometrial lining, and bone protection. Estrogen can also be converted from fat, in both males and females, by an enzyme called aromatase.

What it means: Low estradiol is present in peri-menopause and menopause. Elevated estrogen is present in early premature ovarian insufficiency (followed by low levels), and in estrogen dominant conditions like: PMS, endometriosis, PCOS, and obesity.

Reference Range:

Follicular 77-921 pmol/L

Luteal 77-1145 pmol/L

The “real” range: The width of the above ranges is ridiculous! Estradiol should be tested on day 3 and should be lower than 200 pmol/L and higher than 80 pmol/L. A level higher than this is a sign that the body is trying too hard to stimulate egg development, and the ovaries are not responding. In this case, you will likely see elevated FSH too.

2) FSH (follicle-stimulating hormone)

What it is: The name says it all. FSH is in charge of the development and maturation of follicles.

What it means: High levels are diagnostic of menopause, ranging from 27-133 IU/L. When your body is pumping out more FSH than normal, it’s a sign that the ovaries are not responding (just like estrogen). Low levels of FSH are typically present in PCOS.

Reference Range:

Follicular 3-8 IU/L

Mid-cycle 3-22 IU/L

Luteal 1.5-5.5 IU/L

The “real” range: Higher than 8 IU/L on day 3 (that’s the 3rd day of your period) is too high and the value is only going up from there. 6 IU/L is as good as it gets on day 3.

3) LH (Luteinizing hormone)

What it is: Ah, the hormone everyone knows and loves! The LH surge triggers ovulation and is measured by urine strips. LH also contributes to the maturation of eggs. You may not know that estrogen surges right before LH, which can also be used to detect ovulation.

What it means: On day 3, an LH to FSH ratio greater than 2:1 is indicative of PCOS. LH is elevated in PCOS for so many reasons I’ll need to dedicate another blog to it. Elevated LH also stimulates elevated testosterone production, and in turn estrogen production. Contrary to what you may think, high LH actually inhibits ovulation instead of stimulating it.

Reference Range:

Follicular 2-12 IU/L

Mid-cycle 8-90 IU/L

Luteal 1-14 IU/L

The “real” range: LH should be almost equivalent to FSH on day 3. 6-8 IU/L is ideal.

4) Progesterone

What it is: Most of the body’s progesterone is produced by the outer coating of the egg, called the corpus luteum. After you ovulate, progesterone levels increase to maintain the endometrial lining and prepare for embryo implantation. Progesterone also stimulates the production of a thick mucous that covers the cervix so no sperm can enter the uterus (FYI this is the basis of hormonal birth control).

What it means: A low level of mid-luteal progesterone indicates anovulation and luteal phase defect (short luteal phase) and predicts implantation failure/ early miscarriage.

Reference Range:

Luteal 4-50 nmol/L

The “real” range: On day 21 the minimum value is 10 nmol/L to have ovulated and 20 nmol/L to carry a pregnancy. Day 21 is arbitrary if you don’t ovulate on day 14. Progesterone is best-tested 7 days after you ovulate.

5) Prolactin

What it is: The main function of prolactin is to stimulate breast milk production. However, elevation can also occur due to the following: benign pituitary tumor, periods of high stress, hypothyroidism, PCOS, and certain medications.

What it means: Elevated prolactin inhibits the release of GnRH, which then inhibits the release of LH and FSH. Without LH and FSH, follicles will not develop.

Reference Range:

5-30 ug/L

The “real” range: Prolactin levels as high as 50 ug/L can inhibit ovulation, but small increases by a few points are relatively harmless. One-time elevation should be followed by repeat testing. As mentioned, stress is a major influence on this hormone.

6) DHEA

What it is: A precursor hormone to both estrogen and testosterone.

What it means: DHEA is often evaluated in PCOS, as elevations in this hormone increase androgen levels. It may be prescribed to improve ovarian reserve (but not without fun side-effects).

Reference Range: <9.8 umol/L

7) Androstenodione

What it is: Produced from DHEA, this hormone is the precursor to testosterone.

What it means: Elevated androstenedione is found in PCOS and adrenal hyperplasia. Both conditions inhibit ovulation. It may be elevated in isolation, or with testosterone.

Reference Range:

Follicular 1.2-8.7 nmol/L

Luteal 1.1-8.2 nmol/L

8) Testosterone

What it is: You know this hormone for its role as the primary male sex hormone, but it’s important for women too! In the ovaries, testosterone is produced by the stromal cells and converted to estrogen. It participates in follicle growth and development, not to mention male and female libido.

What it means: Too much is present in PCOS which is far from ideal, but too little can inhibit ovulation and egg development.

Reference Range:

Total testosterone 0.3- 1.8 nmol/L (some labs up to 4 nmol/L)

The “real” range: Testosterone is extremely tricky to test accurately. Free testosterone is a better measurement than total and the reference ranges (depending on the lab) have huge variability. In order to test free testosterone you need to test total testosterone and sex hormone binding globulin.

9) AMH (Anti-Mullerian Hormone)

What it is: It’s a hormone that can depict the female egg reserve because it is secreted by the eggs in the ovaries. The more eggs you have, the higher the value will be. Not surprisingly, AMH decreases with age. This is the only hormone test we have for predicting ovarian reserve.

What it means: A lower value for your age means you have a lower number of eggs than the average female. A much higher value for your age is indicative of PCOS, as the cystic ovaries in PCOS secrete excess AMH.

Reference Range: The numbers are averages based on age:

< 33 = 2.1 ng/mL

33-37 = 1.7 ng/mL

38-40 = 1.1 ng/mL

> 41 = 0.5 ng/mL

The “real” range: At any age, a value > 3.15 – 4.45 ng/mL warrants further testing for PCOS. A value of 6.8-10 ng/mL is diagnostic.

10) TSH (thyroid stimulating hormone) & Antibodies (anti-TPO, anti-TG, anti-TSH)

What it is: TSH is released by the anterior pituitary, which then stimulates the release of thyroid hormones (T3, T4) from the thyroid gland. TSH above the reference range with symptoms present is diagnostic of hypothyroidism, and below is hyperthyroidism. TPO and TG antibodies cause the thyroid condition known as Hashimoto’s, anti-TSH is more commonly present in Graves’.

What it means: Deficient thyroid function affects egg quality, embryo quality, and implantation rates. Combine that with thyroid antibodies, and there’s an increased risk of miscarriage.

Reference Range:

TSH 0.32-4.0 mIU/L

Antibodies should all be negative

The “real” range: TSH should be < 2.5 to prevent miscarriage. A full thyroid lab panel (with individual thyroid hormones) is certainly necessary in cases of recurrent miscarriage.

Book an appointment with Dr. Sumner to request & review lab work. Learn about her hormone balancing program

References

Zadehmodarres S, Heidar Z, Razzaghi Z, Ebrahimi L, Soltanzadeh K, Abed F. Anti-mullerian hormon level and polycystic ovarian syndrome diagnosis. Iranian Journal of Reproductive Medicine. 2015;13(4):227-230.

Wiweko B, Maidarti M, Priangga MD, et al. Anti-mullerian hormone as a diagnostic and prognostic tool for PCOS patients. Journal of Assisted Reproduction and Genetics. 2014;31(10):1311-1316. doi:10.1007/s10815-014-0300-6.

http://tests.lifelabs.com/Laboratory_Test_Information/Search.aspx

Huhtinen K, Desai R, Ståhle M, et al. Endometrial and Endometriotic Concentrations of Estrone and Estradiol Are Determined by Local Metabolism Rather than Circulating Levels. The Journal of Clinical Endocrinology and Metabolism. 2012;97(11):4228-4235. doi:10.1210/jc.2012-1154.

Kumar P, Sait SF. Luteinizing hormone and its dilemma in ovulation induction. Journal of Human Reproductive Sciences. 2011;4(1):2-7. doi:10.4103/0974-1208.82351.

The Top 5 Benefits of Soy for Women

By | Hormonal Imbalance, Hormone Testing | No Comments

I’ve been wondering for years why everyone seems to hate soy. As a part-time job during naturopathic medical school I used to sample health foods at various grocery stores and customers were so avid that they avoid soy. When I asked them why, they said, “Soy causes cancer”. This is a common misconception about soy. In fact, there’s evidence that soy consumption decreases the risk of many cancers such as endometrial, ovarian, gastrointestinal, breast, and prostate. If that’s not enough, I personally grew up on soy and I’ve turned out okay…so far! In a world full of fast food, microwavable meals, and plastic everything – is an innocent bean really the enemy? Since I’m passionate about female hormones, I hit the books and researched the effects of soy on estrogen and progesterone levels. I hope you’ll be pleased to read what I’ve discovered, and accept that soy isn’t so scary after all! Soy can be incredible for hormonal imbalance.

The components of soy: what’s in a bean?

  • Protein– soy contains the complete spectrum of essential amino acids, which is why it is a staple in a vegetarian diet.
  • Isoflavones– these are the constituents that act like estrogen and are the reason why it’s common to get confused about soy. Another term for isoflavone is phytoestrogen. Isoflavones/phytoestrogens can exert weak estrogenic effects in our bodies. This means they can bind to estrogen receptors in the body and prevent strong/harmful estrogens from binding. This is a good thing! It does not promote cancer, it protects us.
  • Beta-sitosterols– these are constituents that have been proven to lower cholesterol. Soy is recommended by Health Canada as part of a cholesterol lowering diet.
  • Vitamins & Minerals– soy is high in fiber, iron, folate, and B-vitamins. If you’re concerned about the bioavailability of nutrients in beans, opt for sprouted beans.
  • “Fermentability”– I may have made up this word, but I’m using it to explain all of the wonderful foods that have been created by fermenting soy, like: tempeh, miso, and natto! Fermented foods are amazing for gut health, lowering inflammation, and benefiting mood.

The Top 5 Benefits of Soy for Women

  1. Soy isoflavones bind to estrogen receptors and promote the urinary excretion of estrogen in estrogen dependent conditions like endometriosis and fibroids. With increased amounts of soy consumption, severity of endometriosis can decline and women can experience fewer symptoms.
  2. In menopausal women with low estrogen levels, soy consumption can improve serum estradiol levels and reduce hot flashes and symptoms of declining estrogen.
  3. In women undergoing IVF, those with higher soy consumption had increased fertilization rates. Women who consumed soy, compared to women who did not, had a 6% greater chance of fertilization.
  4. Not only can soy improve fertilization, but also pregnancy and live birth rates. In women who consume soy, there’s an 11-13% greater chance of pregnancy and birth rate compared to women who don’t eat soy.
  5. Soy increases a protein called sex-hormone-binding-globulin (SHBG). This protein binds estrogen and testosterone in the blood. If these hormones are bound then they are inactive, a greater ratio of bound hormone to free hormone can lower symptoms of androgen excess, like: acne, hair loss, and male pattern hair growth, as well as estrogen excess, like: breast tenderness, painful periods, and heavy periods.

What about men consuming soy? Here’s where it gets less obvious

There is a lot of conflicting research on the effects of soy consumption in men. For example, one human study showed that soy consumption lowers sperm concentration, and another showed that soy has no effect on any semen parameters. Soy has the potential to decrease testosterone levels in men who already have hypogonadism (low testosterone). It may exert estrogenic effects in men but the research is varied. However, it is undisputed that soy has great cardiovascular benefits and can lower cholesterol levels. It may also present a preventive role against prostate cancer and benign prostatic hypertrophy (BPH). If you’re male and you’re not trying to conceive, the benefits of soy likely outweigh the potential risks. It is ideal for man to eat a variety of plant and animal sources of protein; soy can be included in this daily diet.

The Bottom Line:

  • Opt for non-GMO, organic, and sugar free soy products
  • WOMEN: aim for 7-28mg of isoflavones daily (one cup of soy milk has about 6mg, 3 ounces of tofu has 20mg
  • MEN: when not trying to conceive, aim to consume about 3 servings of soy a week
  • If you’re concerned about your hormone levels, you can opt for hormone testing

Book an appointment with Dr. Sumner

References:

Die, M. D., Bone, K. M., Williams, S. G., & Pirotta, M. V. (2014). Soy and soy isoflavones in prostate cancer: a systematic review and meta‐analysis of randomized controlled trials. BJU international, 113(5b), E119-E130.

Chavarro, J. E., Toth, T. L., Sadio, S. M., & Hauser, R. (2008). Soy food and isoflavone intake in relation to semen quality parameters among men from an infertility clinic. Human reproduction, 23(11), 2584-2590.

Vanegas, J. C., Afeiche, M. C., Gaskins, A. J., Mínguez-Alarcón, L., Williams, P. L., Wright, D. L., … & Chavarro, J. E. (2015). Soy food intake and treatment outcomes of women undergoing assisted reproductive technology. Fertility and sterility, 103(3), 749-755.

Tsuchiya, M., Miura, T., Hanaoka, T., Iwasaki, M., Sasaki, H., Tanaka, T., … & Tsugane, S. (2007). Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism. Epidemiology, 18(3), 402-408.

Saeidnia, S., Manayi, A., Gohari, A. R., & Abdollahi, M. (2014). The Story of Beta-sitosterol-A Review.

Messina, M. (2010). Soybean isoflavone exposure does not have feminizing effects on men: a critical examination of the clinical evidence. Fertility and sterility, 93(7), 2095-2104.

Chen, M., Rao, Y., Zheng, Y., Wei, S., Li, Y., Guo, T., & Yin, P. (2014). Association between soy isoflavone intake and breast cancer risk for pre-and post-menopausal women: a meta-analysis of epidemiological studies. PloS one, 9(2), e89288.

5 Really Simple Strategies to Reduce Period Pain

By | Endometriosis Pain Relief, Hormonal Imbalance | No Comments

If you experience debilitating menstrual cramps, just as I do, then I’m sure you remember the first time they started and the constant struggle you’ve battled in learning to cope with them. I’ve been trying to take my own pain away since age 12 and it hasn’t looked pretty. It’s been a lot of missed work, sleepless nights, tears of desperation, hormone testing, and a couple of memorable hospital trips.

I have tried so many things I’ve lost count of what I’ve tried. I even have a closet full of half empty supplement bottles to show for it. In my countless efforts to find endometriosis pain relief, I’ve found that bringing it back to the basics has helped me cope the most. I’m not going to lie and say that I don’t have pain anymore, but I’ve found these really simple strategies helpful and I wish I had known about them sooner.

5 Simple Strategies that Make a Difference

  1. Go to sleep.

    I know that sounds crazy because the pain can make it impossible to sleep, but what I mean to say is get regular sleep before your period. You know you already want to nap all of the time before your period because of our trusty friend progesterone! Progesterone is the driving hormone in the second half of your cycle (after you ovulate) and it has been shown to promote and maintain sleep. But even better than sleeping before your period, get regular sleep all of the time. Regular sleep means going to sleep and waking up at the same time every day. When you have a predictable circadian rhythm, you produce optimal amounts of melatonin. Melatonin is an antioxidant, analgesic, and anti-inflammatory [1]. Those are all actions you want for your uterus when you have a scalding hot water bottle pressed against your pelvis and there’s no relief in sight.

  2. Say goodbye to caffeine.

    You’ve just spent the night awake in pain and now I’m taking away your coffee? It seems cruel but it helps. Caffeine can be found in pain relieving medications (like midol) but it’s not necessarily your friend when it comes to period cramps. It turns out, period pain may be more common in coffee drinkers than non-coffee drinkers [2]. Think about this, caffeine is a vasoconstrictor (it constricts your blood vessels), which means decreased blood flow to your uterus. Reduced blood flow means reduced oxygen, which means muscle spasms, which means pain. I too love a good cup of joe in the morning, but I’ve found I do better when I give it up a few days before my period and during. You can have it again afterwards of course!

  3. Eat nuts, seeds & chocolate.

    What do they all have in common besides being a delicious trail mix? They decrease prostaglandins, which are fatty acids and hormone copycats that cause uterine contractions, pain, and inflammation [3]. Chocolate wants to heal our pain soooo badly, so let’s just let it! Make it dark chocolate (rich in magnesium) and add some almonds, walnuts, sunflower seeds, sesame seeds, pumpkin seeds, and flax seeds for the ultimate anti-inflammatory snack.

  4. Try castor oil massage.

    Castor oil is a wonderful oil used topically to decrease pain and inflammation. I’m not recommending that you drink it as a laxative! When applied over the uterus, it can increase blood flow and activate your parasympathetic nervous system (your resting and relaxing nerves) to calm uterine spasms and bowel spasms [4]. Use 1-3 tablespoons and massage it over your uterus when you’re in pain. The oil can stain your clothes so wear old pj’s and don’t be shy about the amount you use, it will absorb overnight. You can also rub it on aching joints and tissues, like your breasts and low back.

  5. Take ginger capsules. 

    They can be as effective as Advil. It’s just too simple. I avoided trying it for so long because I just figured I needed something fancy, expensive, and complicated to help my pain. Well, I didn’t. Now the dosing is important, you want to start taking ginger three days before the first day of expected pain. Pain reliving medications always work better before the pain starts; if you wait until it starts then you’re playing catch up. It’s also recommended that you take the ginger during the painful days of your period. The recommended dose in the study I refer to here is 250mg 4x a day [5]. Unlike ibuprofen, it has no liver or gastrointestinal toxicity.

    Super simple tips for preventing, reducing, and coping with period pain. If you’re like me and have spent years miserably trying to alleviate your pain, I hope you’re able to try out these techniques and see how you feel.

    Book an appointment with Dr. Sumner. Learn about her program for endometriosis

    References:

[1] Schwertner, A., Dos Santos, C. C. C., Costa, G. D., Deitos, A., de Souza, A., de Souza, I. C. C., … & Caumo, W. (2013). Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial. PAIN®154(6), 874-881.

[2] Unsal, A., Ayranci, U., Tozun, M., Arslan, G., & Calik, E. (2010). Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala journal of medical sciences115(2), 138-145.

[3] Awad, A. B., Toczek, J., & Fink, C. S. (2004). Phytosterols decrease prostaglandin release in cultured P388D 1/MAB macrophages. Prostaglandins, leukotrienes and essential fatty acids70(6), 511-520.

[4] Ozgoli, G., Goli, M., & Moattar, F. (2009). Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. The journal of alternative and complementary medicine15(2), 129-132.

[5] Arslan, G. G., & Eşer, İ. (2011). An examination of the effect of castor oil packs on constipation in the elderly. Complementary therapies in clinical practice17(1), 58-62.

The Ins & Outs of the DUTCH (dried urine test for comprehensive hormones)

By | Hormonal Imbalance, Hormone Testing | No Comments

I’ve committed myself to learning all about dried urine hormone testing (aka DUTCH) and here is what I’ve learned so far (the good, the bad….and my exact results).

The purpose of all hormone testing is to give you more information than you already have. If having more information is not going to change the diagnosis, or your doctor’s treatment plan, then lab testing is unnecessary. If you have clear and understandable clinical symptoms that can guide diagnosis and treatment you likely do not need hormone testing. If you want to know more about individual hormonal pathways or have symptoms of hormonal imbalance, then hormone testing may be for you! Keep in mind that the person is always more important than the numbers; naturopathic doctors always practice individualized medicine.

So what’s the DUTCH test and how is it completed?

DUTCH stands for dried urine test for comprehensive hormones. The test measures steroid hormones excreted in your urine (I will just be talking abut sex hormones in this blog).

In Canada, a naturopathic doctor can requisition this test for you from several different private lab companies. It’s a very simple test to perform. I used Rocky Mountain Analytical:

  • “Collection day” is 6-7 days before your expected menses- e.g. if you have a 28 day cycle you will be collecting urine on days 21-22 of your cycle
  • You’re given 4 sheets of laboratory paper for your samples
  • You are instructed to pee on the paper at 4 different times: once around dinner time, once before bed, once when you wake up, and once 2 hours after waking (I brought my pee paper with me to work, it’s the only way if your collection days don’t land on a weekend!)
  • You will be given specific instructions on how much water to drink as to not dilute the urine
  • You will fill out demographic information and answer questions about your menstrual cycle and corresponding symptoms
  • Then pack up all of the materials and send it to your lab and you’ll have the results within 3 weeks

How does the DUTCH test work?

Sex hormones exist in our bodies in many different forms. Inactive hormones are bound to proteins in the blood; active hormones are free in the blood. Hormone testing via blood measures both free and bound hormones. Urine testing measures free hormones. These free hormones are found in the urine as precursor hormones like estrone and estradiol, or in the form of free metabolites like 2-OH-E1. Estrogens for example, exist in their original forms: estradiol, estrone, and estriol, but they can also interconvert between their original forms or be converted by the liver into metabolites. I will discuss metabolite formation in detail, as it is one of the main “claims to fame” of the DUTCH test!

You may be wondering, well how do our hormones get into our urine?! And the answer is through liver processing!

In order for sex hormones to be excreted, they have to be processed by the liver. The liver is our main organ of detoxification, the goal of the liver is to take your hormones and make them more water-soluble so your body can excrete them in urine (and stool).

There are two phases to liver processing of hormones: aptly named phase 1 and phase 2:

Phase 1 takes your hormones and makes them more potent. It is during this phase that hormone metabolites are made through a process called hydroxylation. These metabolites can exert negative and positive effects in the body.

Phase 2 takes your hormones and tries really hard to get rid of them through a process called conjugation. Think of conjugation as tagging your hormones with a sticker that says “I don’t want this anymore”. Once hormones are conjugated they are ready to be excrete by your body. The hormones that are found in urine are conjugated with a sulfate or glucuronide group (now we’re getting fancy). After you’ve sent you urine samples to the lab, the lab has to break the conjugation bonds in order to measure your hormone levels.

Urine hormone testing measures free hormone levels only, because bound hormones are not metabolically active and thus are not broken down by the liver. Urine hormone testing allows you to get a picture of the active hormones in your body, not the bound and inactive hormones.

Oh but there’s more to hormone excretion- it’s called enterohepatic circulation!

After the liver detoxifies your hormones, the majority are excreted in the urine (and a small amount in the stool). However, pesky hormones can be reabsorbed by the gut before they make it to the urine through a process called enterohepatic recirculation. This is your body’s unfortunate way of storing hormones for later. If you don’t have a high fiber diet and lack healthy gut bacteria you are more prone to this recirculation. We don’t want this to happen, and supposedly measuring hormones in dried urine can help you measure this process. I’ll explain how as we go.

Now that we have a better understanding of how the DUTCH test works, I’ll explain the exciting part of INTERPRETING THE RESULTS!

Remember how I mentioned that the DUTCH test measures both “precursor” hormone levels and hormone metabolite levels? This is where interpretation gets interesting!

Here are the top 4 benefits of DUTCH testing:

  1. The DUTCH can demonstrate whether your body is efficient at turning “mother” hormones into “daughter” hormones

For example, androstenedione is a mother hormone that makes testosterone but it also makes androsterone, eticholanolone, and estrone. Elevation in androstenedione can be found in PCOS and can cause symptoms of acne and male pattern hair growth.

This is a photo from my personal DUTCH test. You will see that of the three “daughters” of androstenedione, the smallest daughter is testosterone and the highest daughter is androsterone. This is okay news for me. It shows that my body is converting androstenedione into androsterone instead of testosterone, which is an extremely weak androgen. (I owe this ability to certain enzymes I will save for another blog). This explains why I don’t have symptoms of hyperandrogenism, even though my androstenedione metabolites are extremely high! Sure serum blood tests measure androstenedione and testosterone, but they typically don’t measure androsterone…which turned out to be crucial information for me.

  1. The DUTCH measures estrogen metabolites, and certain metabolites are more harmful than others.

As I mentioned earlier, estrogen has many potential metabolites. The DUTCH test measures three estrogen metabolites: 16-OH-E1, 4-OH-E1, and 2-OH-E1.

2-OH-E1 is considered the healthiest and most protective form of estrogen. 16-OH-E1 and 4-OH-E1 are more potent and harmful and have been indicated in cancer risk. Here is the breakdown of my estrogen metabolites:

My production of 16-OH-E1 is low, which is good, however I’m not making much of the protective 2-OH-E1 estrogen either. Having this information is extremely valuable, because naturopathic medicine has the potential to alter the metabolism of estrogen in a more favourable way and preferentially metabolize estrogen into the protective and healthy 2-OH-E1. Both 2-OH-E1 and 4-OH-E1 can be methylated by an enzyme called COMT, and naturopathic medicine can support the function of specific enzymes! Pretty awesome!

  1. Speaking of methylation, the DUTCH measures the function of the COMT enzyme

    It measures the amount of methylated 2-OH-E1 in your urine. You want this enzyme in tip top shape to prevent DNA damage. Here’s my result: given the small amount of 2-OH-E1 I make, my body is doing a pretty good job with methylation.

  1. Can the DUTCH measure whether or not my body is adequately excreting hormones, and not just reabsorbing them in the gut?

    Remember that the DUTCH test is based on the urinary excretion of hormones, so you may be wondering “what if my body isn’t excreting the hormones properly, does that mean my hormone levels will look deceptively low?!?!” I’ve wondered the same thing!

The three estrogen metabolites all come from a form of estrogen called estrone, except for 16-OH-E1, which is produced from a number of reactions! Below you will find my estrone level. Next to the photo of estrone, are my metabolites. Now look at where all of the green arrows are pointing. My estrone level is midrange, however my metabolites are all low range. The makers of the DUTCH would like to see the arrows of the metabolites all pointing in the same direction as their precursors- meaning they are all in the same range. This is not to say that the metabolites should directly equal their precursors, hormone production is much more complicated than that! Given this information, my results indicate that I have high circulating levels of metabolites and I am not excreting efficiently. Do I buy this information? I’m not sure that I do! Estrogen metabolism is so interconnected that each form cannot be expected to be in the same range as another form at any given moment in time. If you have thoughts on this please comment!!!

Holy smokes?!?! I know that’s a lot of information to take in! I would like to leave you with a pros and cons summary of the DUTCH test so you can make the most informed decision possible when it comes to hormone testing.

The PROS:

It can easily be performed at home. The interpretation gives us information on metabolic pathways and enzyme function. It also gives as a greater picture of active hormones levels, compared to bound and inactive hormones in serum. It may potentially provide us with insight on hormone elimination and recirculation.

The CONS:

It is extremely new and still being validated. The creators have a lot more research ahead of them and gathering enough data to solidify reference ranges of urinary hormones. As more awareness is given to DUTCH testing, the references ranges for the hormone levels will change and there will be a greater pool of patient data to use. Many hormones, like progesterone, are not found in the urine so we rely on the metabolites of progesterone to measure overall levels. Furthermore, I mentioned that we cannot assume that metabolites are within the same range as their precursor hormones.

The CONS of ALL hormones testing:

The worst part of every hormonal test is that it’s not financially or physically feasible to test your hormone levels every day, twice a day. Given this barrier, there’s always a chance you miss something important if you do not test on the right day, or just have a weird cycle the moment you decided to test! Hormones are extremely dynamic, so testing in any medium has it’s flaws. If you’ve every used hormone testing you will see that the reference ranges for “normal” hormones are so massive that it’s almost impossible to catch abnormal hormonal levels. This is a direct reflection of the fact that hormones are extremely dynamic and don’t like to be pinned down! Here’s a little more on hormonal blood work if you’re interested.

Want to order the DUTCH? Book an appointment with Dr. Sumner

If you want to learn about more specific labs offering DUTCH, check out the links below:

ZRT Lab: https://www.zrtlab.com/images/documents/Estrogen_Metabolites_Info_Guide.pdf

Rocky Mountain Analytical: http://rmalab.com/sites/default/files/tests/spec_sheets/20160317_pt_dutch.pdf

http://rmalab.com/sites/default/files/tests/collection_instructions/20150720_dutch_collx_0.pdf

Meridian Valley Lab: http://meridianvalleylab.com/wp-content/uploads/2016/06/Urine-Hormone-Interp-Guide.pdf

References:

Tsuchiya, Y., Nakajima, M., & Yokoi, T. (2005). Cytochrome P450-mediated metabolism of estrogens and its regulation in human. Cancer letters227(2), 115-124.

  1. Whirl-Carrillo, E.M. McDonagh, J. M. Hebert, L. Gong, K. Sangkuhl, C.F. Thorn, R.B. Altman and T.E. Klein. “Pharmacogenomics Knowledge for Personalized Medicine” Clinical Pharmacology & Therapeutics (2012) 92(4): 414-417.

Im A, Vogel VG, Ahrendt G, et al. Urinary estrogen metabolites in women at high risk for breast cancer. Carcinogenesis. 2009;30(9):1532-1535. doi:10.1093/carcin/bgp139.

Sanderson, J. T. (2006). The steroid hormone biosynthesis pathway as a target for endocrine-disrupting chemicals. Toxicological sciences94(1), 3-21.

Could your yeast infection actually be cytolytic vaginosis?

By | Hormonal Imbalance, Women's Health | No Comments

We all know those tell tale signs, the itchiness, the redness, the agony; the instant you notice them you run to the nearest pharmacy and grab an over the counter pill and cream and go about your day waiting for the discomfit to pass. Then the next infection hits and you’re going through the same thing all over again. We just assume it truly was a yeast infection because the anti-fungal medication sort of works, and well, we really hope it’s not anything else! But, what about when it doesn’t work? What about when you keep getting them over again and no amount of Canesten or Monistat is doing the trick? In these cases the yeast infection you think you have may actually be cytolytic vaginosis.

It sounds scary, cytolytic vaginosis, but it really isn’t! It’s just an overgrowth of the normally occurring, protective bacteria in the vagina called lactobacilli. What’s the difference between this and a yeast infection? A yeast infection (candidiasis) is fungal overgrowth, but cytolytic vaginosis is bacterial overgrowth. Confusingly, the symptoms are exactly the same! When you have too many lactobacilli in the vagina they produce extra lactic acid and hydrogen peroxide, which cause the itchiness, redness, and white curdy discharge that look and feel exactly like a yeast infection! It can be caused by a hormonal imbalance, or a more local concern.

Yeast Infection vs. Cytolytic Vaginosis

  • BOTH present with irritated and itchy vulva and vagina
  • BOTH present with profuse white and thick discharge that has no smell
  • BOTH present with a vulva that is red and swollen
  • BOTH present with a vaginal pH that is less than 4.5 (optimal vaginal pH is 3.8-4.5)
  • ONLY a yeast infection will present with a positive swab for candida, if you have cytolytic vaginosis the candida swab will be negative

Neither a yeast infection nor cytolytic vaginosis are sexually transmitted, meaning you don’t typically “catch” them from your partner, however sex can lead to imbalance in the vaginal and penile flora so both partners (same sex or opposite sex) can develop similar symptoms. Both the penis and vagina depend on steadily controlled, protective flora in order to stay healthy.

Here is a list of some of the factors that affect our flora and predispose us to developing vaginal infections:

  • Oral antibiotics – These can wipe out the healthy bacteria in the vagina
  • Unprotected sex (with a male partner) – Semen is acidic and can irritate the vaginal mucosa.
  • Protected sex (with a male partner) – But on the other hand, latex condoms and condoms with spermicides may irritate the vagina and eradicate good bacteria.
  • Oral sex – Saliva is not the most hygienic of lubricants, but it can also interfere with the pH of the vagina (which should be 3.8-4.5). I wouldn’t ever suggest taking this away from you; just take a little break if you’re prone to infections!
  • Low vitamin D – Vaginas need sunshine too!
  • Vaginal creams – The vagina is self-cleaning, that’s why you have daily discharge, so there’s no need to use any store bought cleaning products.
  • Scented toilet paper and tampons (and wearing daily pads for that matter) – Even though Tampax makes a pumpkin spice tampon it is not our friend!
  • Food sensitivities and too much sugar – Food intolerances affect the gut flora, which often translate to the vaginal flora. Sugar is also a motivating fuel source for pathogens.
  • Not letting the vagina breathe- G-strings and skinny jeans aren’t doing as any favours, but going commando at every opportunity will!

If you’re suffering from the symptoms of a yeast infection but the vaginal swab comes back negative, you should suspect cytolytic vaginosis.

Here’s what to do to get rid of it:

Twice daily baking soda sitz baths. Fill your bathtub (or a large bucket) with a small amount of warm water and add two tablespoons of baking soda per litre of water in the tub. Sit in the bath and read a book for at least 30 minutes. The purpose of this treatment is to decrease the acidity of your vagina and reduce the lactobacilli. You should be feeling better in no time!
Book an appointment with Dr. Sumner

References

Sobel, J. D. (2016). Recurrent vulvovaginal candidiasis. American journal of obstetrics and gynecology214(1), 15-21.

Yang, S., Zhang, Y., Liu, Y., Wang, J., Chen, S., & Li, S. (2016). Clinical Significance and Characteristic Clinical Differences of Cytolytic Vaginosis in Recurrent Vulvovaginitis. Gynecologic and obstetric investigation.

Ahmad, A., & Khan, A. U. (2009). Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India. European journal of obstetrics & gynecology and reproductive biology144(1), 68-71.

Suresh, A., Rajesh, A., Bhat, R. M., & Rai, Y. (2009). Cytolytic vaginosis: A review. Indian journal of sexually transmitted diseases30(1), 48.

Pills & Periods: Everything You Want to Know in One Blog

By | Hormonal Imbalance, Hormone Testing, Women's Health | No Comments

This blog is to help you navigate the world of periods and birth control, so instead of the debilitating fear we have associated with a little mishap, or a late period….you’ll know exactly what’s going on in your body. Be empowered, knowledgeable, and in control! Periods are annoying, hormonal imbalance sucks, but I can help you navigate the physiology. Buckle in ladies!

In order to explain how birth control works, we first need to start with periods. You may also want to do some hormone testing if you have any concerns about what is happening in your body.

How Periods Work: Intro to Hormones

All you need to know is that all of your reproductive hormones are under the control of gonadotropin releasing hormone (GnRH). GnRH is released by the hypothalamus in the brain. GnRH controls:

  • Follicle stimulating hormone (FSH) – makes those eggs mature
  • Luteinizing hormone (LH) – makes the ovary ovulate the egg
  • And indirectly: Estrogen and Progesterone – does everything else

The 3 Phases

 Follicular Phase & Estrogen (about 14 days)

The follicular phase occurs when your ovaries are working on maturing the “eggs” (aka oocytes or follicles). This happens under the influence of 3 main hormones: estrogen, FSH, and LH. It’s a competition of the fittest. Typically, only one follicle is released by one of your ovaries (you have two of course). When estrogen reaches it’s peak and then falls, you subsequently develop what’s called an “LH surge” this makes one of your ovaries release a follicle and you have officially ovulated! Some girls experience ovulatory pain called mittelschmerz and they can feel which side they ovulated from! Pretty cool eh! When you’re using ovulation strips to plan for pregnancy, it is LH that is detected in the urine. This follicle maturation process takes about 14 days.

While all of this is happening, under the power of the estrogen I mentioned earlier, your uterus is developing a thick lining called the endometrium. We’ll hear more about this later.

Luteal Phase & Progesterone (about another 14 days)

Once you have ovulated, you’re now in the luteal phase. This phase is mostly under the influence of progesterone. The little follicle that was released from the ovary travels into the fallopian tube and waits to be fertilized by a little, mighty sperm. If you’re actively avoiding pregnancy, the follicle is not fertilized and it dies. The follicle only lives for 12-24 hours after ovulation. That’s not very long at all! The mighty sperm however, can live up to 5 days in the uterus waiting for the perfect follicle to fertilize. This means, there’s a chance you can get pregnant 4 days before you ovulate and the day you ovulate. That’s a very narrow window ladies! That is not to say that accidents don’t happen and result in unplanned pregnancies, but I am saying that you DO NOT need to live in fear every day of the month waiting anxiously for your period. If you know your unique body and keep track of when you ovulate then you hold the power!

Now, where was I? When this follicle was released from the ovary it left its fashionable yellow coat behind. This outer coat layer is called the corpus luteum (aka yellow body) and it secretes progesterone! How amazing is that?! Remember that thick lining we were talking about earlier? It is progesterone’s job to make it grow nice and thick so the follicle you released has a comfy spot to live once it has been fertilized. It is also progesterone’s job to keep other sperm away from the uterus after you have ovulated. No tardy sperm allowed! Progesterone blocks late sperm by creating a really thick mucous plug that covers the cervix, which is the opening to the uterus from the vagina.

The corpus luteum, which secretes progesterone, only survives for about 14 days. If the follicle is fertilized, human chorionic gonadotropin (hCG) is created. This is the hormone detected by a pregnancy test. If hCG is present, it tells the corpus luteum to stick around and keep making progesterone to support the endometrial lining. If the follicle is not fertilized, there is no positive feedback to the corpus luteum and it dies. Now there is no more progesterone. It is this progesterone withdrawal that causes bleeding.

Menses (who knows how long this lasts!)

Phew, we made it, what a relief! Now that there’s no progesterone to support the endometrial lining, your body gets rid of the “functional layer” and you have what we loving call a “period”. The length and symptoms of your period depend on ALLLLLL of the hormonal influences in the follicular and luteal phase and vary significantly from girl to girl!

Okay finally the fun stuff: How does birth control work?

The Pill e.g. Alesse

  • These pills are called “combination pills” because they contain 2 hormones: synthetic estrogen and synthetic progestin
  • These synthetic hormones suppress your body’s natural production of FSH and LH so that you do not ovulate. They essentially trick your hypothalamus and GnRH into thinking that your body has already ovulated so that you don’t!
  • Remember how progesterone created a thick mucous preventing sperm from entering the uterus? If you have synthetic progestin in your body at all times you always have this mucus plug, the progestin also changes the endometrial lining so it’s not thick and comfy for a fertilized follicle

The “pill” is 97-99% effective when used correctly

Patches and Rings

  • The Nuva Ring, which is vaginally inserted, and Evra patch, which you put on your skin, both work exactly the same way as an oral contraceptive pill

Hormonal IUD e.g. Mirena

  • The hormonal IUD only contains synthetic progestin. It creates those same mucous changes as the pill and may prevent ovulation.
  • Since it is directly in the uterus, it interferes with the mobility of the follicle and sperm, it produces “hostile” inflammatory prostaglandins, and it affects the enzymes in the endometrium preventing the fertilized follicle from implanting.

The hormonal IUD is 99% effective when used correctly

Copper IUD e.g. Nova-T

  • It is also placed directly in the uterus but does not secrete any hormones at all. It owes its effects to the copper
  • Like the hormonal IUD, it prevents mobility of the follicle and sperm by creating “hostile” inflammatory prostaglandins. It also affects the enzymes in the endometrium preventing the fertilized follicle from implanting.

The copper IUD is 98% effective when used correctly

And there we have it!

Now you have all the knowledge you need to understand what’s going on in your body and I hope this info alleviates the anxiety associated with…..well, not knowing.

Book an appointment with Dr. Sumner

The ONE Tool You Need To Figure Out Your Hormones

By | Hormonal Imbalance, Natural Fertility Support, Women's Health | No Comments

It’s a thermometer! And it only costs $10.00!

This simple and informative technique is called Basal Body Temperature Tracking

Basal Body Temperature  Tracking is the perfect tool for you if you:

  • experience PMS
  • have painful periods or cramping before your period
  • get hormonal acne or headaches or other hormonal imbalance
  • experience mid-cycle spotting or premenstrual spotting
  • you’re trying to conceive and want natural fertility support
  • you’re trying NOT to conceive
  • you have a really long cycle ( > 35 days)
  • you have a really short cycle (< 28 days)
  • you have an irregular cycle (who even knows when your period comes!)
  • you have just come off of birth control
  • you’re still on birth control
  • you’re curious about your body and want to be empowered!

If you haven’t read my blog titled “How Stuff Works: Pills & Periods” you should read it first to get a better understanding of hormone physiology and the menstrual cycle. In extremely simplistic terms, the first half of your cycle- the follicular phase– is dominated by estrogen. Once you have ovulated and are in the second half of your cycle- the luteal phase– it is dominated by progesterone.  What is unique about these 2 hormones is that they have different thermogenic effects, this means they change your body temperature. If you track your body temperature daily you can chart your hormone patterns and figure out what’s going on in your unique body. Not every girl’s cycle is a perfect 28 days with ovulation on day 14!

Here is an example of a BBT chart using an app called Fertility Friend:

  • The lower body temperatures for the first 14 days show that this gal is in the follicular phase of her cycle
  • The red cross denotes ovulation. You will see that ovulation is the last day of low temperature. Once the temperature peaks, she has officially ovulated
  • As you learned in my other blog post, progesterone is secreted from the corpus luteum which is a byproduct of the egg. Progesterone is thermogenic, as you can see from the elevated temperatures. She is in the luteal phase starting day 15
  • On day 26 you can see that her temperatures are falling, this shows that progesterone is also decreasing and the endometrial lining will be shed
  • You may have noticed that the BBT tracking method is a hindsight method. You will not know that you have ovulated until after you have ovulated and you see a temperature peak
  • After tracking a couple of months of your cycle you will see that you always ovulate at the same time in your cycle so you can plan accordingly for future months

Sweet! Now how do I do this?

I highly recommend you download the fertility friend app so that you can easily record your temperature and the app will make you a beautiful chart and show you when you ovulate with a giant red cross.

Here are the rules:

  • Take your temperature as soon as you wake up in the morning, before doing anything else. The goal is to hardly move
  • Take your temperature at the same time every morning, or as close to the same time as possible (within a 30 minute window)
  • Take your temperature after a solid few hours of sleep (minimum 3 hours)
  • If you want to get really fancy you can take your temperature using a special BBT thermometer that has more than 1 decimal place
  • Enter your data on your chart in your Fertility Friend app
  • The rise in temperature is usually about 0.4 degrees Fahrenheit or 0.2 degrees Celsius, but the rise may be as slight as 0.2 degrees Fahrenheit or 0.1 degrees Celsius or even less in some cases. Great variability is possible.
  • More important than the value of the rise, is the overall pattern of the chart. Fertility Friend helps you determine ovulation based on the pattern of the chart and all fertility signs. It’s an awesome app

If you have questions about BBT tracking book an appointment

Are Your Periods Far From Normal? 10 Causes of Abnormal Cycles

By | Hormonal Imbalance, Women's Health | No Comments

How do you know what’s normal and what’s abnormal when it comes to periods? Even after a decade or two of menstruating it can still feel like you don’t have a handle on when it’s coming, how many tampons you’ll need, and if you’ll be cringing with pain! Maybe you’re one of those people that wear a pad daily just in case, or have a heating pack with you at all times just to be sure you’re ready. If you’ve asked your friends about their periods, you probably get all kinds of answers because each of our cycles are pretty unique. Sometimes our cycles can change from month to month and then confuse us even more! This is a definite sign of a hormonal imbalance. Do you ever wish you could save your blood in a menstrual cup and show your friends, and hopefully a doctor, to get a better understanding of what on earth is going on? No one else wishes that? Okay, I guess I’m the only one! Consider this blog a discussion with a friend about the way you bleed and why that might be. The answers you’ve been waiting for could be on this page!

What’s normal when it comes to menstrual bleeding?

Cycle Length

Cycle length should be around 21-35 days (from the first day of bleeding one month, to the first day of bleeding the next month). However, the ideal cycle length is 27-30 days. In my naturopathic opinion, a 21-day cycle is too short and anything longer that 35 days is too long. With a 21-day cycle your body is going through estrogen and progesterone too quickly, with a 35-day cycle your body is likely producing either too much estrogen or too much progesterone.

Days of Flow

The bleeding should last a maximum of 7 consecutive days, and it should not be heavy for the full 7 days. Bleeding for less than 7 days is okay though; if you’re on birth control you may bleed for only 3 days. Bleeding in between periods (aka metrorrhagia) is also not normal.

Colour of Blood

Typically the blood is bright red at the beginning of your period and as your period gets lighter in flow the blood becomes a darker brown. Essentially, your body is saving that stagnated, tough to expel blood until the end. You may refer to this as “spotting”. Some women start their period with a dark brown spotting blood; this may or may not be normal. Read on to find out.

Amount of Blood

How much blood is normal? Supposedly, the average woman menstruates about 35ml of blood over a whole period (that’s a little bit over 2 tablespoons) seems like nothing, right! Bleeding in excess of 80ml in one cycle (1/3 of a cup) is considered heavy bleeding or “menorrhagia”. It is typical for the first three days of menses to be heaviest, but not that heavy. The best way to know how much blood you are losing is to use a menstrual cup, like a Diva Cup, because the measurements are written right on the cup.

Amount of Pain

No amount of pain is normal! The ideal period has no pain before, during, or after your period. This includes back, uterus, and bowel pain. It’s normal to experience an occasional spasm as the blood passes but it should not interfere with your day or require pain medications.

What if your period doesn’t sound like it’s normal?

If your cycle length, days of flow, colour of blood, amount of blood, and amount of pain are usually pretty consistent but sometimes you have an “off” period there’s typically nothing to worry about. One abnormal period should not cause alarm, however, three consecutive abnormal periods warrants further investigation.

What could be the cause of abnormal cycles?

Abnormal periods can be caused by a vast number of things, but these are the most common reasons:

  1. Anovulation

    When you do not ovulate, your body produces a lot of estrogen and very little progesterone. When there is no progesterone to oppose estrogen, you build up your endometrial lining nice and thick but there’s no hormone withdrawal to bring on menses. If you do not ovulate, you will not have regular 21-35 day cycles. The bleeding you do get is extremely sporadic because there’s just too much lining and your body wants to get rid of a little bit of it at inconvenient times. What does this look like? Unpredictable bleeding and blood that’s sometimes bright red and sometimes dark brown because different areas of the endometrium are getting sloughed off at different times during the month. Learn more about natural fertility support.

  2. Short luteal phase

    After you ovulate, you are in the luteal phase of your cycle. The luteal phase is dominated by progesterone, which is needed to have a period. If you have a very short luteal phase then you likely have a very short cycle- closer to 21 days. Without progesterone you are in a so-called “estrogen dominant” pattern, as your body produces more estrogen than progesterone. This can translate into heavy and painful periods. You can do hormone testing to figure this out

  3. Oral contraceptive induced bleeding

    Just because you are on birth control, does not mean you will have regular cycles. When starting a new form of birth control it can take your body up to 3 cycles to regulate, so it’s normal during this time to experience irregular bleeding. If you experience bleeding while you are taking the pill (not on the sugar days) or if you don’t experience bleeding while on the sugar pills, you should meet with your doctor to alter the dose of your medication. It’s also common for bleeding abnormalities to occur if you don’t take your pill regularly or miss pills! Learn more about birth control and your body 

  4. Endometriosis

    This is a pathology where endometrial tissue ends up outside of the uterus, like on the ovaries, bowel, and surrounding ligaments. Endometriosis can cause irregularities in all of the criteria I mentioned. The key feature is extreme pain: pain around menses, back pain, abdominal pain, pain during sex, and pain going to the bathroom. You may also have extremely heavy and clotted periods and experience spotting often. Learn more about endometriosis pain relief

  5. Fibroids/Cysts

    Fibroids are large masses of tissue in the uterus. They can grow in various places in the endometrial tissue, but cysts can appear in and around the ovaries too. Fibroids and cysts grow under the influence of estrogen ad cause heavy bleeding (menorrhagia). Think of it this way, when you have fibroids you have more endometrial tissue and more blood vessels to slough off when it comes to your menses. Your flow is likely greater than 80ml and is extremely clotted and stringy.

  6. PCOS

    Also known as Polycystic Ovarian Syndrome. PCOS is diagnosed based on 3 criteria: infrequent menses, cysts in the ovaries, and elevated androgens. Testosterone is an androgen, and elevated androgens in a female cause acne, male pattern hair growth, or male pattern hair loss. With PCOS, there are also often issues with insulin so you may experience difficulty losing weight and/or gain weight easily.

  7. Hyperthyroidism & Hypothyroidism

    The first is elevated thyroid hormones and the second is decreased thyroid hormones. Both an increase and decrease in thyroid hormone can impair ovulation, which will prevent you from having a regular period.

  8. Hypothalamic Amenorrhea

    This is a fancy term for not having a period because you don’t have enough stimulating hormone coming from the hypothalamus in the brain. The most common reasons for this are stress and low body weight. If you’ve skipped a couple of periods due to stress or you’re an Olympic athlete, you owe those missed periods to hypothalamic amenorrhea.

  9. Cancer

    Endometrial and ovarian cancer can cause pain and abnormal bleeding. Make sure you schedule regular check-ups with you doctor. Benign tumors in the pituitary gland of the brain can also cause abnormal hormone production and abnormal menses. Keeping communication open with your doctor is essential when it comes to cancer screening.

  10. Clotting Disorder

    Heavy bleeding may be due to a clotting disorder. Menses requires a fine balance between clotting the blood so that you don’t bleed too quickly, and decreasing clotting factors so that you can get the blood out of your system. If a clotting disorder runs in your family, speak with your doctor. Examples of clotting disorders are hemophilia and von Willebrand’s disease.If any of these causes of abnormal periods resonate with you, you may be on the path to figuring out what’s going on in your body. Always keep in mind that pregnancy and menopause will change your cycle and are worth mentioning too! Making sure you are not exposed to exogenous hormones; in meats, drinking water, and cosmetic products is also a great way to keep your period regular, light, and pain-free.

    Book an appointment with Dr. Sumner

References

Jamil, A. S., Alalaf, S. K., Al-Tawil, N. G., & Al-Shawaf, T. (2016). Comparison of clinical and hormonal characteristics among four phenotypes of polycystic ovary syndrome based on the Rotterdam criteria. Archives of Gynecology and Obstetrics293(2), 447-456.

Vilos, G. A., Allaire, C., Laberge, P. Y., Leyland, N., Vilos, A. G., Murji, A., & Chen, I. (2015). The management of uterine leiomyomas. Journal of Obstetrics and Gynaecology Canada37(2), 157-178.

Ajmani, N. S., Sarbhai, V., Yadav, N., Paul, M., Ahmad, A., & Ajmani, A. K. (2016). Role of Thyroid Dysfunction in Patients with Menstrual Disorders in Tertiary Care Center of Walled City of Delhi. The Journal of Obstetrics and Gynecology of India66(2), 115-119.

Ray, S., Ray, A., & George, A. T. (2014). Non‐surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women with bleeding disorders. The Cochrane Library.

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