Bringing Your Hormones into Alignment

Bringing Your Hormones into Alignment

Bringing Your Hormones into Alignment

Aviva Romm, MD

Doctor, herbalist, and midwife Aviva Romm, MD, describes the menstrual cycle as our sixth vital sign: The length of our cycles, the heaviness of our flows, and the signs and symptoms that pop up along the way can all tell us something about the state of our hormonal health. That’s why Romm encourages people with uteruses to pay close attention. Her new book, Hormone Intelligence, is a written guide to periods, hormonal conditions, and the pursuit of well-being in a time when hormonal issues affect an increasing number of people, many of whom don’t receive adequate help.

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Romm points out that Hormone Intelligence is not just for women who are going through hormone problems. It’s a book for anybody who has (or has had) a uterus and wants to live a healthier life. “It’s not just about fixing problems,” Romm says. “It’s also about having a new conversation with our bodies, a new way of understanding our bodies, a new way of celebrating our bodies.” She imagines that the book is something people will pick up and go back to again and again—right now, maybe, because they are having period problems, but then again after they’ve had a baby and again when they’re heading into perimenopause.

A Q&A with Aviva Romm, MD

Why do hormones affect so many of the systems in our body at once?

Hormones are chemical messengers. They are produced in glands throughout our body, released from those glands, and circulated to different organs. They influence all sorts of different functions—like bone growth, metabolism, and ovulation—that depend on the hormone released and the cells it’s acting on. For example, hormones released from the hypothalamus and pituitary glands in your brain stimulate your ovaries to grow and release an egg, leading to ovulation. Ovulation, then, causes us to make the hormone progesterone.

We have dozens of hormones and millions of hormone receptors, which are like docking ports on the outside of cells that allow hormones to enter and do their jobs. Estrogen is an amazing example of a hormone that does so much. We have estrogen receptors in our heart, bones, and brain—not just our uterus. That’s why estrogen can affect so much of our body at once, including our menstrual cycles as well as cognitive function and bone density and so many other functions. The same is true of cortisol, our thyroid hormones, and many others.

These hormone systems are also interconnected. Your thyroid function affects your production of estrogen, your levels of estrogen impact your thyroid, your levels of cortisol affect thyroid function, and your levels of cortisol influence ovarian function. These systems are all communicating all the time. It’s like a game of telephone. When the messages are getting communicated properly, the functions that are supposed to be triggered by the hormones are able to do their jobs smoothly. But as in a game of telephone, the messages might not get passed on properly. The messages might not even get passed on at all. Or there might be some messages that get passed on too loudly, or too many messages happening at once. If the messages aren’t passed on correctly, what’s supposed to happen at the other end is like static on the channel. The messages can be confused. And that’s how hormonal issues happen.

What is hormone imbalance?

“Hormone imbalance” is a colloquial term that we tend to use when we aren’t feeling quite aligned with our cycles or when we’re having trouble with something gynecologically or emotionally. If our periods are really heavy or we’re skipping periods, we’ll often say, “Oh, I’m having a hormone imbalance.” But “hormone imbalance” is a misnomer: Hormones are constantly fluctuating throughout the day, throughout the night, throughout the month during our menstruating years, and across our life cycles. Our hormone levels in puberty are different from our hormone levels in our twenties and thirties, which are different from our hormone levels in our forties and fifties. They’re different when we’re pregnant. They’re different when we’re in menopause. So there’s no one state of hormone balance.

More accurately, what we’re referring to is the feelings we have when our hormones are or aren’t within expected optimal ranges for the stage of our life or the time in our menstrual cycle we’re currently in (or both). When you’re in that optimal range, things are typically humming along well. You feel well, and you’re not struggling with symptoms. When you’re not in those ranges for our various hormones, there’s a predictable set of symptoms and conditions that can occur.

How do you detect hormone imbalances? By hormone testing?

Not necessarily. For example, if you have heavy periods along with cyclical breast tenderness and bloating from water retention, we don’t have to test your hormones to know that you probably have elevated estrogen. If you’re not ovulating, we know that you won’t produce progesterone; you have to ovulate to make progesterone, so we don’t necessarily have to test for that either. If you can pinpoint what your symptoms are and when they occur, you can often identify the underlying hormone imbalance. I use a symptom checklist in my practice. (The list is included in Hormone Intelligence.) If there’s a reason to confirm a diagnosis with labs, I will. But often it’s not necessary. First, I like to explore the data that comes from tracking cycle length, the amount of bleeding with a period, cyclical changes in cervical mucus, and temperature readings from a basal body thermometer.

Hormone testing can be informative and helpful for certain conditions. If somebody isn’t sure that they’re entering menopause, hormone testing can help. If somebody is struggling with fertility and we’re trying to figure out if there is some hormonal component causing it, then testing is helpful. If someone under forty-two is having symptoms of early menopause, hormone testing can be important. But it’s not helpful all of the time.

Can you expect the story to be different if you’re on hormonal birth control?

Hormonal birth control, depending on what kind you’re on, can skew hormone levels. If you’re taking an estrogen-based birth control, that’s going to determine your estrogen level. If you’re taking a progestin-based one, it will determine your progesterone level. These are different from the levels you would see in a normal cycle. Cycles driven by hormonal birth control are not natural cycles; they suppress your natural cycles and create a steady state of a very specific level of hormones.

When women go to see their doctor for hormonal health, what’s their experience typically like?

So many of women’s hormonal symptoms are blamed on us just being women. What I mean by that is that a woman will report period pain, and the diagnosis is: “Well, you’re a woman.” Not: “Maybe you have endometriosis or chronic pain.” If you’re having severe PMS symptoms, your doctor may just say, “Of course you are. Periods make you feel horrible.” And then the doctor will have you take an antidepressant or put you the pill. Or maybe you’re having weight gain and hair loss, and they say, “Oh, well, you’re probably just stressed or overworked.” But maybe it’s actually your thyroid. There’s broad dismissal of medical symptoms women are experiencing—and they’re dismissed because of implicit biases against women in the medical model.

At the same time, womanhood is overmedicalized. Doctors tend to treat all symptoms with a standardized approach rather than seeking to understand that maybe some symptoms are a normal response to an abnormal environment. We’re not getting under the hood of what’s really going on in women’s bodies and hormones. This is critical. We now know that women’s hormones and cycles are a vital sign. They’re an important way of assessing inner health and how external factors, like endocrine disruptors, are affecting us.

How does your Hormone Intelligence plan help resolve hormone issues?

The Hormone Intelligence plan addresses the six root causes that we know impact our hormonal health and our menstrual cycles. The symptoms show up differently in each of us, but addressing six core pillars—nutrition, inflammation, environmental factors, gut health, sleep, and stress—can help make a difference for all of us. I go through easy-to-follow but still comprehensive protocols for each in the book, which help you figure out how each of these factors impacts you and where you can adjust certain habits to support better hormonal health.

That’s not to say this plan is one size fits all. I may have more of a predisposition to stress and anxiety or sleep problems than the next person. You may have more predisposition to gut issues. So the plan allows you to go through all the root cause imbalances but also target the ones that are affecting you the most. Additionally, I give recommended adjustments for people struggling with certain conditions, including period problems, PMS, endometriosis, uterine fibroids, PCOS, perimenopause, recurrent yeast infections or other vaginal infections, and fertility struggles.

This plan isn’t all or nothing. And getting back into balance is not something that happens overnight. You don’t just change your diet and feel better in three days. Often this takes time. Symptomatic relief is important in the meantime. If you have painful periods, yes, go ahead and work on removing your inflammatory triggers and adding in the building blocks you need for healthy hormones. But if you want to use ibuprofen for those acute symptoms in the meantime, don’t feel bad about it. My goal, though, is to get you to a place where you don’t need it anymore.

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How can people start to support their hormonal health better at home?

If there were three things that I would encourage women to do to first to bring their hormones in line, it would be these.

  1. Lean into a plant-based diet. You don’t have to be a vegan or vegetarian by any means, but do get six to eight servings of fruits and vegetables every day. Leafy greens are so important—kale, collard greens, broccoli. Try to get some fish in your diet if you can. If you can’t, an algae-based omega-3 oil or a fish oil is fine. And balance your blood sugar.

    1. Three diet-related tips that you can take on to get started:

    1. Take a daily multivitamin. So many of us are not getting the micronutrients we need each day, even on a great diet, to support the levels needed for optimal hormone health. A multi can bridge that gap.

    2. Take 2,000 IU of vitamin D a day. Vitamin D is important for mood, immunity, and blood sugar balance, which are related, respectively, to PMS, endometriosis, and PCOS. Most of us aren’t getting enough, so supplementing provides that extra support.

    3. One or two tablespoons of flaxseed, however you want to get it—in a smoothie, on a salad, in your grains or oatmeal. Flaxseed is nourishing for our ovaries and supports healthy estrogen elimination as well as healthy progesterone production across all our life cycles.

  2. Get seven to eight hours of sleep a night. I know that sounds so simplistic, but getting good sleep is one of the most important things we can do for our hormones. Our hormones are based on cyclical rhythms, and the circadian rhythm is a very important one of those. The more biologically aligned we are with a healthy sleep-and-wake cycle, the more alignment we’re going to create between our innate hormonal blueprinting and what we’re experiencing through our hormones.

  3. Get some movement that you love into your life. Walking, yoga, dance, biking. Movement, daily and in moderation, is not only powerful for our moods and mind but also keeps our digestion healthier. That’s a major plus for hormone health, keeps our blood sugar steady, and reduces inflammation—again, important for optimizing your hormonal and gynecologic health. And for conditions like period pain and endometriosis, movement can also be a natural pain reliever.

This a lifestyle, not a “wham-bam-thank-you-ma’am, let’s do this in two weeks and be over it” situation. That said, I’ve seen patients who have struggled with years of digestive discomfort and resolved their symptoms in a few weeks. I’ve seen people get better sleep in a week or two. I’ve seen people improve the issues with their period within a few cycles. So I don’t want to say you can’t see these changes quickly. But this plan is about bringing your life and your hormones into alignment so you can stay hormonally healthy for a long time.

How can people have better conversations around hormonal health with their doctors?

I encourage women who are having trouble getting answers from their care provider to do several things.

  1. Before you go in for your appointment, script out what you want to discuss with your medical provider. Most doctors have only about fifteen minutes with you and are hurried. Often, they’ll do most of the talking. Scripting out your top concerns can give you a little more confidence to stay on track and say, “Hey, I do need to talk about these things I’m feeling.”

  2. Don’t change into an exam gown until after you’ve spoken with your doctor. This is about empowerment. When we get into the doctor’s office, they’ll often want to get us ready for our Pap or exam. Now all of a sudden you’re sitting there in this totally homogenous gown that makes you look the same as every other patient who walks in the office. And the flap in the back is not giving a whole lot of rear-end coverage! Then your doctor walks in in their dress or suit and their white coat. It gets very hard to speak up for yourself and feel confident that way. So keep your clothes on, ask all your questions before you’re butt-naked in the exam room, and then if there’s a need for an exam, change into the gown.

  3. Bring an advocate with you. Physicians tend to be on better behavior when there’s a witness in the room, too, and we tend to feel more emboldened when we have someone there for moral support and to nudge us if we get nervous about asking our questions.

  4. Do your own research ahead of time on the issues you’re concerned with, and bring some documentation with you. So instead of your doctor saying, “Where’d you hear that, Dr. Google?” (which no doctor should ever say, but some do), you can say, “No, I heard this from a Yale MD, and here’s what the data says. Here’s the research article. Here are the works cited. And that’s why I do want that thyroid test.”

  5. Ask your doctor to work with your concerns and ideas. Doctors may know anatomy and physiology better than you do, but we don’t know your body better than you do. It’s not your responsibility to manage your doctor’s emotions and ego. But saying something like “I know you have my best interest in mind, and I know this might fall outside of a conventional medical approach, but I could use your help exploring this” can sometimes soften the relationship and remind them that this is a partnership. Finding the humanity in each other can help you get the support and answers you really need.

Aviva Romm, MD, is a New York– and Massachusetts-based board-certified family physician with specialties in integrative gynecology, obstetrics, and pediatrics. She is the author of The Adrenal Thyroid Revolution and, most recently, Hormone Intelligence. Romm did her medical training and internship in internal medicine at Yale School of Medicine and her residency in family medicine with obstetrics at Tufts Family Medicine Residency. She’s also a midwife, an herbalist, and a graduate of the University of Arizona Integrative Medicine Residency program.

This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.

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