Dr. Pamela Frank ND

There are lots of things that people need to look for. When I see people in my office, they often come because they’re frustrated from trying to lose weight and think there’s a thyroid problem. Sometimes, they’ve been to the doctor who maybe ran superficial testing for thyroid but didn’t find anything. However, the patient is still convinced that there’s a hormonal problem. Maybe they’re experiencing acne or hair loss, irregular menstrual cycles, heavy or crampy periods, extreme PMS, and PMDD symptoms. So, we delve a little more deeply into your thyroid and hormones and do more extensive testing than what has been offered so far.

Most naturopathic doctors have to do an initial assessment and order testing. Often, people are one step ahead when they come in and have their doctors check their hormones. However, the problem with that approach is often; doctors don’t order the full panel of hormones. They check estrogen and progesterone, LH and FSH, which are basic in terms of hormones. In addition to that, I usually would like to see DHEA, total testosterone, dihydrotestosterone and prolactin. The other problem with hormones is that the “normal ranges” that the lab supplies to your doctor are often very broad, that pretty much everybody falls inside unless there is something really abnormal.

The ranges are not ideal or based on what’s optimal. As naturopathic doctors, that’s what we’re aiming for. We want your levels of things to be optimal for your health. We don’t just want you to fall in some arbitrary range.

When people do come to me and have had their hormones tested already, I’ll go through step by step with them and say, here’s what was tested, here’s what your numbers are like, and here’s where you want it to be, and here’s how to get it to that to that level.

I do think testing is extremely important. Guessing doesn’t work. A lot of times, imbalances in different hormones can look the same. It could look like there’s too much testosterone when in fact, there’s too little estrogen. So we need to know the exact numbers.

That’s a really good question. There are two crucial times for testing for someone who’s menstruating. One is day three of the period. At that point, we usually want to test estrogen. There’s a specific target for estrogen at that point that tells us whether their estrogen is optimal.nThe only caveat is that the estrogen might be good on day three, but we can’t necessarily project or extrapolate from that if it carries on throughout the rest of the cycle.

The other key time to measure hormones is a week after ovulating. Progesterone is usually measured then because you don’t make progesterone until after you ovulate. If you ovulate around day 14 or 15, a week after that is the day to measure that progesterone because there’s a peak of progesterone.

Progesterone is an influence on weight loss. It revs up your metabolism. When you ovulate, your body temperature increases by about half a degree. The only way you can increase your body temperature is to burn more calories to maintain that higher temperature.

For women who are not ovulating, who are dealing with either PCOS or menopause, they’re not getting progesterone. This makes it harder for them to lose weight. In women with PCOS, even if they never intend to have children, it’s important to get ovulation going if they struggle with weight. You want to get that little two-week metabolism boost.

Women with PCOS have an ambulatory cycle, meaning they don’t ovulate, and the reasons for that are multiple. It is often assumed to be high testosterone. While sometimes it is high testosterone, it can be high DHEA and prolactin or an underactive thyroid. It can also be HPA Axis dysfunction, where the whole endocrine system doesn’t seem to work particularly well. A bit of progesterone can be produced post-menopause by the adrenal glands in a form called 17 hydroxy progesterone. The thing I can do for post-menopausal women is to ensure that their adrenal glands and HPA axis is working well. Bloodwork is the best way to get an answer to that and know what is happening.

Standard across most natural naturopathic doctors, we’re looking at adaptogens, herbs that help your body adapt to and handle stress more easily. Schisandra is a Chinese berry good for the ovaries and adrenal glands. Centella is a bit anti-inflammatory that can sometimes help people with weight. If more inflammation occurs, insulin levels will tend to be higher. That’s where I like Centella for its anti-inflammatory and adaptogen benefits.

In addition to that, the core things that the adrenals need are certain vitamins and minerals. B-5, B-6, vitamin C, magnesium and zinc are important for adrenal glands and the HPA axis.

Magnesium and B-6 are important for lots of things, including 300 different enzyme reactions that depend on those as cofactors. They are common deficiencies that don’t always show up in blood tests. With mineral values, the body will tend to prioritise the blood. The blood will remain relatively stable for levels like magnesium and zinc, even though tissues might be deprived.

Diet and exercise are the two big movers and shakers. The problem for many people is that certain foods are driving up inflammation and adding to their hunger signals. Their stomachs are inflamed, and their body feels like it needs to put food in there, but it’s not truly hunger. It’s just irritation in the stomach.

Removing the most inflammatory foods sometimes helps—dairy and gluten are probably the two. There is a food sensitivity or food allergy test that can be done to see what foods exactly might be driving up inflammation.

Carbs and sugar will also tend to drive up inflammation because when you ingest them, the insulin goes up, and when insulin goes up, inflammation goes up. And then that can be a bit of a vicious cycle because when inflammation goes up, you need more insulin to get the same effect.

Signs of inflammation include joint pain or muscle weakness, headaches, sinus problems, skin rashes, anything to do with digestion, bloating, gas, constipation and diarrhoea.

The average age for actual menopause is 52. But perimenopause, which is the lead-up to menopause, I see typically is around 45. Here, periods start to get a little less regular, ovulation isn’t necessarily happening every month, and symptoms are sometimes starting to set in, like hot flashes, night sweats, difficulty sleeping, anxiety, depression, and weight gain. Around the mid-40s is typical to see perimenopausal symptoms. And from there till 52 or so, when your period stops for a whole year, you’re considered fully in menopause.

But some women will start even as early as the late 30s and start to see some signs of perimenopause. I think that’s too young, and we can maybe work to get that reversed. I have had women in their mid-40s who felt like it was too soon, and we got them back to a few more years of regular ovulation.

It is important not to wait a year of not having a cycle to investigate your hormones and decide whether or not you could benefit from some of these treatments. You don’t have to have perimenopause for seven years; you can have it for two or three years.

The other thing that I wish somebody had told me was how you’re feeling as you’re going through perimenopause, and once you’re into menopause is not going to last forever. Some of those symptoms will gradually subside, and you will start feeling like yourself again. We can also try and mitigate some of those symptoms if they’re troublesome.

I also see some naturopathic doctors will use hormone replacement therapy; I choose not to do that. I would rather try to get your body to do what it’s naturally intended to do without adding hormones from external sources. But other naturopathic doctors have a different view.

I would usually come back to the HPA axis. You can still maintain a small amount of progesterone from adrenal glands post-menopause. When your ovaries shut down, you lose about half of your testosterone which helps with muscle mass. Having better muscle mass means being more metabolically active, so you’re burning more calories even when sleeping. Keeping your adrenal glands and thyroid working at their best is probably the best way to mitigate weight gain and go through perimenopause and menopause with as much ease as possible.

Magnesium also becomes important again because it acts like a brain chemical called GABA. GABA is a calming neurotransmitter, and it helps you feel more relaxed. There can be a lot of anxiety and depression that happen with perimenopause and menopause. Magnesium can help activate the GABA receptors.

The circadian rhythm is important. Many people’s adrenal glands suffer from being up until 11 pm. The adrenal glands have a schedule dictated based on daylight hours. They peak in the morning around six or seven. You get a good cortisol peak from your adrenal glands in the morning. People think of cortisol as being this bad hormone, but we need a certain amount of it at a certain time of the day. You want a good peak of cortisol first thing in the morning to wake you up, get you out of bed, reduce inflammation, and get the melatonin down so you don’t feel sleepy. Cortisol will gradually taper off throughout the day to the lowest between 8 pm and 4 am. At that point, you want to relax, unwind and bring it down a notch. Sleep should come by about 10 o’clock, and then you’ve got that window where adrenal glands are at their lowest, giving them a chance to recover. Work with your adrenal glands rather than against them.

Exercise is also important because it’s one of the best stress reducers. Exercising outdoors is better than exercising indoors to lower cortisol levels. But the problem arises when people push it too much. So they’re doing endurance exercises, marathons or triathlons, which are hard on your adrenal glands. We must support our adrenal glands through stress-reducing exercises and maintaining a healthy circadian rhythm. For weight purposes, there does have to be a bit of intensity sprinkled in, three or four days a week. The intensity bit also helps lower your insulin levels.