Hormones: A Problem Worth Fixing

Stress is inevitable but how we deal with it and whether it causes further hormone imbalances is not. In order to help you balance your hormones naturally, lose weight, and feel grounded and happy, I wrote my first book, The Hormone Cure. This new Q&A about it will tell you why I wrote it, how it might help you, and what to try next for your own health.

What inspired you to write your first book, The Hormone Cure?

In my mid-thirties, I was stressed out, struggled with PMS, and didn’t want to have sex with my husband. My doctor suggested an antidepressant and birth control pills, and that made me realize that millions of women with my symptoms were being told the wrong thing. Instead of looking at the root cause of my symptoms, my doctor offered prescriptions to mask the symptoms. That’s no way to live.

Instead of taking the pills, I formed a hypothesis: my hormones were off balance. In med school, I learned that measuring hormone levels is a waste of time and money, because hormone levels vary too much. Yet we tracked hormones such as estrogen, progesterone, thyroid, and testosterone when women were trying to conceive or were in the early months of pregnancy. So I wondered why those numbers would be important indications of a woman’s health in one situation but not another? So I went to the lab. It turned out that my cortisol (stress hormone) was three times what it should be, my estrogen level was too high compared with my progesterone, and my thyroid was slow. I addressed these hormonal imbalances naturally—no pills—and my symptoms resolved in four weeks.

At the time, I had been practicing integrative and functional medicine for twenty years. So I looked at the symptoms most women experience between 35 and 55+, identified the root causes, and wrote up holistic protocols for the top 7 hormone imbalances. That’s what you’ll find in the book!

How did you notice the need for a book like this?

Millions of women around the world suffer with hormone imbalance. Many doctors say, “You’re just getting older. This is normal!” and offer prescriptions for anxiety, sleep, and depression. Women gain weight, particularly in the belly. They have a lot of stress from superhuman expectations of women—and signs like hair loss, feeling tired but wired, low energy, cold feet. Ignoring the root cause is not the path to total health.  We need a systems-based, more intelligent way of addressing the symptoms women face. Not all hormones are treated equally in the female body; for example, high cortisol from an overtaxed system causes other hormones to be out of whack, like estrogen, progesterone, thyroid, and testosterone.

Why is this information so important?

Because you don’t find the answer to health in a prescription pill bottle. You need a personalized, precise, integrated approach. That’s the promise of functional medicine, the type of medicine that I practice. We investigate down to the root cause and develop a customized approach for each patient, based on her lifestyle. I like to think of this type of medicine as addressing the body from cell to soul.

What are the typical hormone problems women have?

High cortisol: Your body releases cortisol in response to stress, and most of us run around stressed all the time. All those stress hormones wreak havoc over time, and make you store fat—especially in your belly. High cortisol is also linked to depression, food addiction, and sugar cravings, so that you overeat the wrong foods like cookies and processed foods. What’s the net result? You get fat.

Low progesterone: Anxiety, disrupted sleep, and PMS are common signs of problems with progesterone. In certain women with PMS, progesterone after ovulation changes the GABA receptor in your brain so that it is no longer able to respond to progesterone and other neurosteroids. This creates a form of “progesterone resistance.” Progesterone is like a complicated key that fits snugly into a lock (GABA receptor) and opens a door to normal function. When the lock gets jammed, the key can’t unlock the door. So there’s no calmness for you or you have endometriosis, fibroids, painful periods, and mood problems.

Low thyroid: Starting in a woman’s thirties, thyroid function can become irregular, usually due to Hashimoto’s, which shows up as infertility, weight gain, depression, hair loss, and constipation. Thyroid is your metabolism hormone, so if it’s low, you might gain weight too easily. While many of the symptoms of a low thyroid are written off as normal for aging women, it’s simply not true.  It’s not normal to get fat, feel flat, and lose your hair as you get older.

What are signs that your body is not in balance?

Here are some symptoms of hormonal imbalance:

  • Feeling wired but tired, struggling to settle down
  • Sugar or salt cravings
  • Skin conditions like eczema or thinning
  • Muscle weakness, especially around the knee, muscle or joint pain
  • Excess hair growth on your face, chest, or arms
  • Cyclical headaches (particularly menstrual or hormonal migraines)
  • Painful and/or swollen breasts
  • Irregular menstrual cycles, or cycles becoming more frequent as you age
  • Mood swings, PMS, depression, or just irritability
  • Weepiness, sometimes over the most ridiculous things

What is the most important thing you can do to get your body in balance?

Eat nutrient-dense food, especially a range of vegetables to detoxify your body. Avoid refined carbs and sugar like the plague. Cravings for sugar or alcohol could be a symptom of high cortisol. Don’t go there. It just keeps spiraling downward and doesn’t make you feel better. Opt for slow carbs at night such as sweet potatoes or yucca. Cut out alcohol and caffeine.

Exercise moderately and frequently. Exercising at moderate intensity for thirty minutes four times per week decreases PMS. Try adaptive exercise like yoga and Pilates to build up energy. For all you marathoners, frequency is more important than intensity. Over-exercising can cause wear-and-tear on your hormones. Like many healthy practices, exercise has a U-shaped association, meaning that moderate amounts are optimal but low or high levels can be harmful. The general recommendation is to exercise twenty to thirty minutes per day four times per week.  Aim to add bursts of movement that fold into your natural rhythm. Do a one-minute burst of enthusiastic dancing after you wake up. Invest in a stand-up or treadmill desk, and use it daily. Practice heel lifts while you chat on the phone or stand in line at the grocery store. Perform twelve push-ups after going to the bathroom. The point is to incorporate moments of movement rather than only forced discipline that’s devoid of pleasure. Start small by adding one to five minutes of new movement to your routine each day during the week and build yourself up from there.

Meditate. Meditation reduces cortisol by teaching us how to mitigate stress better. The same goes for any relaxation-inducing behavior, whether it means going outside to get in touch with nature, spending some time with good friends, or practicing deep breathing. Guided visualization, a technique that uses imagery and feelings of calmness, has been shown to increase vaginal temperature, a proxy for a rise in progesterone, and to improve PMS. Less stress and more progesterone are moves in the right direction.

Master your sleep. Only 6 percent of the population does well on less than eight hours of sleep. It keeps cortisol in check, which prevents the muffin top.  Getting better sleep gives your body the proper rest to cleanse itself and restore balance.

Detoxify. I often find that women who come to my office wanting bioidentical hormones have upstream toxic effects. Years of eating too many carbohydrates and being a sugar burner, with sugar cravings and weight loss resistance, has led to insulin block. Or excess heavy metals have interfered with their pituitary’s ability to produce hormones. So when the usual methods in The Hormone Cure aren’t working, the next step is a thorough detox, which I cover in my next book, The Hormone Reset Diet.

Fill in any nutritional gaps with supplements. Vitamin D, omega-3s, B vitamins, and magnesium are some of the most common I suggest, but certainly consult with your doctor on what you should be taking and dosages.

How can people use this book to get the body back in balance?

In the Gottfried Protocol, I combine the latest medical advances and cutting-edge techniques with ancient treatments validated by modern research. The recommendations in this book are based on this evidence-based integrative approach. This three-step strategy is a sequential system that includes:

  1. Lifestyle design: food, nutraceutical, and targeted exercise
  2. Herbal therapies
  3. Bioidentical hormones

Most of my recommendations are available without prescription. When women put an earnest effort into Step 1 of The Gottfried Protocol—and implement a customized food plan; specific supplements that include missing vitamins, minerals, and amino acids; and targeted exercise—they find most of their symptoms of hormone imbalance disappear. Try this for four to six weeks before moving to Step 2. If symptoms haven’t disappeared, Step 2 begins proven botanical therapies for another four to six weeks. Less than 5 percent of my patients did not feel better by this point so after completing Steps 1 and 2, they went to a knowledgeable clinician for bioidentical hormones (Step 3). For those who do, the doses and duration of treatment are often lower than if they’d skipped the lifestyle design and herbal therapies.

Interested in more? Pick up a copy of my book, The Hormone Cure.


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Sara Gottfried MD About Sara Gottfried MD

Sara Gottfried, MD is the New York Times bestselling author of the new book, Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years. Her previous New York Times bestsellers are The Hormone Cure and The Hormone Reset Diet. After graduating from Harvard Medical School and MIT, Dr. Gottfried completed her residency at the University of California at San Francisco. She is a board-certified gynecologist who teaches natural hormone balancing in her novel online programs so that women can lose weight, detoxify, and slow down aging. Dr. Gottfried lives in Berkeley, CA with her husband and two daughters.