3 Common Misconceptions about PCOS

  1. All women with PCOS are overweight or obese – this is not true, up to 40% of women with PCOS are thin.
  2. Women with PCOS are infertile – possibly if they don’t address the root of the problem, but I’ve helped many women with PCOS conceive and have healthy, natural pregnancies.
  3. All women with PCOS have high testosterone levels.  Nope!  Many do, but others have different reasons why they’re not ovulating regularly such as high prolactin, high DHEAs, high androstenedione etc.

 

Estrogen Metabolism or Clearing Excess Estrogen

Sex hormones are produced in the body via the following assembly line:
Cholesterol —-> Pregnenolone —-> Progesterone —–> Androstenedione —-> Testosterone —-> Estradiol (one form of estrogen).  Estradiol is our end product and when there is the right amount of our end product, it’s the liver’s job to take any extra and break it down through a series of steps known as Phase I and Phase II liver detoxification. There are several ingredients required for successful breakdown and clearance of estrogen, as well as chemicals, pollution, pesticides etc. that can act like estrogen. We want to remove any excess estrogen and these waste products so that they don’t accumulate and do harm such as promoting reproductive cancers.

The first step in estrogen breakdown is conversion of estradiol to estrone. Estrone is then metabolised through Phase I liver detoxification (hydroxylation) into 2-hydroxyestrone. Cruciferous vegetables, flaxseeds, soy and rosemary supply substances like indole-3-carbinol that are necessary for this step to occur. The next step in estrogen breakdown is Phase II detoxification (methylation) which converts 2-hydroxyestrone to 2-methoxyestrone. This step requires vitamin B6, B12 and ACTIVE folic acid (5MTHF) to proceed. The active folic acid part is important as most folic acid from supplements is inactive. Some people have a defective gene that doesn’t allow them to process folic acid properly, so that they cannot make 5MTHF. This causes sluggish liver detoxification. There are 3 final procedures the liver can do to our 2-methoxyestrone to package it up for elimination. Glucuronidation requires glucaric acid, methlyation requires active folic acid again (5MTHF) and sulfation requires sulfur.

If any of these ingredients is missing, estrogen breakdown will be incomplete and estrogen, estrogen breakdown products and other waste like it, can build up in your system creating health problems like endometriosis, acne, fibroids, painful periods, hormone related cancers, heavy periods, infertility and other hormone imbalance conditions. In treating these conditions, I find it successful to provide (in the form of supplements) each component necessary for successful completion of phase I, phase II and the final packaging steps.

The typical benefits of enhancing estrogen metabolism this way include reduced risk of hormone related cancers, lighter periods, less cramping, less breast tenderness, reductions in fibroids, improved fertility, and clearer skin.

How Often Should I Do an Estrogen Detox?

That depends on the person and their particular symptoms, but for the average person, once per year.

Should Men do Estrogen Detoxification?

Yes!  Men produce estrogen as well and  excess estrogen and accumulation of estrogen like chemicals like bisphenol a, can bind to estrogen receptors in men and promote cancer such as prostate cancer.

Source: Medicine (Baltimore). 2015 Jan;94(1):e211 . Bisphenol a and hormone-associated cancers: current progress and perspectives.  Gao H1, Yang BJ, Li N, Feng LM, Shi XY, Zhao WH, Liu SJ.

Signs and Symptoms of Hormone Imbalance

How would you know if you had a hormone imbalance? Most of the women I see already have an inkling that something is out of balance by the symptoms that they are experiencing:

  • Hair loss
  • Acne
  • Irregular periods
  • Night sweats
  • Hot flashes
  • Infertility
  • Heavy periods
  • Painful periods
  • Fibroids
  • Ovarian cysts
  • Uterine polyps
  • Excessive facial or body hair
  • PMS
  • Premenstrual migraines

Most often they have already visited their family doctor who “checked their hormones” and told them “everything is normal” or offered them the birth control pill.

There are three main problems here:

  1. By checked their hormones, most doctors mean they’ve done a very superficial screening of hormones, LH, FSH, maybe estradiol and maybe progesterone, but often not measured on specific dates of the menstrual cycle that make the results clinically meaningful.
  2. When “everything is normal” even though you feel that hormones are imbalanced, it’s because the “normal” ranges for hormones are extremely wide and so even abnormal people fall into the “normal” range.
  3. Birth control pills only mask the existing hormone imbalance, they don’t correct it.

If you feel like you have a hormone imbalance, always ask for a copy of blood work results so that you can see exactly how extensive testing was and exactly where your results fall in the “normal” range (normal is always in quotes because lab ranges rarely refer to what is actually normal, it is more often an average of unhealthy people).  99% of the time you will find that either: a) only a very few hormones have been tested and/or b) one or more of your results were borderline.

Your Hormone Levels are “Fine” (Not!)

Many of the women that I see every day feel like there is a problem with their hormones, however, they’ve been to their family doctor who has told them that their hormone levels are “fine”. These women are suffering from infertility, hair loss, irregular periods, excessive facial or body hair, acne, peri-menopause, mood swings, low libido and PCOS, all of which are fairly obvious signs of hormone imbalance.

Here’s why you may be told that your hormones are “fine” when they’re actually not:
1. Countless patients haven’t even had the tip of the iceberg measured when it comes to their hormones. They’ve been trying to conceive for 3 years, yet no one has ever thoroughly measured their hormones. They’ve never had testosterone, DHEAs, androstenedione, and DHT measured. These are all hormones that can impact fertility.
2. Hormones vary from day to day and certain ones are really only clinically relevant at certain points of the menstrual cycle, but no one specified what day to have them measured. LH, FSH and estradiol should be measured on day 3 of a menstrual cycle. Progesterone should be measured 7 days post ovulation. If there is a hormone related problem, the relevant hormones should probably be measured more than once to confirm if they’re normal or not.
3. Hormone “normal” ranges are actually “abnormal” ranges. The lab ranges for hormones are particularly unreliable as indicators of good hormonal health. As a lab insider (I worked in one for 20 years), I know how normal ranges are set. Lab technologists average the results from a given number of samples and the average of those samples becomes the “normal” range. The problem with this is that doctors only order hormone blood work from people with a hormone related condition like infertility, hair loss, irregular periods, excessive facial or body hair, acne, peri-menopause, mood swings, and low libido. So if you average the results of an abnormal population and then call that your normal range, what you’ve actually got is an “abnormal range” and abnormal people will fit nicely into it so that their results look “normal” even though they clearly have a hormone related problem.

When I’m looking a patient’s blood work, I use my own optimal range, rather than the lab’s abnormal range to interpret whether the hormone blood tests are normal or not. I also like to see thorough hormone blood work and have it done at specific points in the menstrual cycle.