Balancing Your Hormones

If you’ve been struggling with PMS symptoms, heavy periods, acne, breast tenderness or symptoms of PCOS or perimenopause then you’ve probably come across a DIM supplement as a solution.  That’s because DIM supports healthy estrogen levels in the body. 

What Are DIM Supplements?

DIM is short for diindolylmethane, a metabolite of indole-3-carbinol. DIM is a compound that can only be made from cruciferous vegetables. When broccoli, cauliflower, and other cruciferous vegetables are exposed to stomach acid after chewing, indole-3-carbinol is created, which is then converted into DIM. 

While DIM can be derived from food, it would take eating a whole lot of broccoli to match what can be found in a supplement. That is why many people take a concentrated amount in the form of a supplement.

DIM supplements also skip the entire process of converting it to its active form and deliver the specific nutrient.

As I’ll explain in this article, DIM supports the body in producing more favorable estrogen metabolites, specifically 2-hydroxy estrogen (2OH).

It also can inhibit the conversion of testosterone to estrogen, which may help balance these two hormones.

This nutrient has a lot of potential hormonal health benefits for women — particularly in the case of excess estrogen, which is why many people opt for the supplement 

Keep reading if you’re experiencing:

• Breast tenderness or fibrocystic breasts
• PMS
• Heavy periods
• Painful periods
• Bloating before your period
• Difficulty with weight gain on your hips, butt, or thighs
• Fibroids
• Endometriosis
• Adenomyosis 
• Perimenopause
• Menopause
• Hair loss, or hair popping up where you don’t want it

What Does DIM Do For Hormones?

One of the most significant things DIM may do for women is improve estrogen metabolism. Estrogen imbalance or excess estrogen, often called “estrogen dominance” can lead to a cascade of undesirable symptoms like hormonal headaches, breast tenderness, and PMS, to name a few. 

What Is Estrogen Dominance?

Put simply, estrogen dominance refers to a situation where there is too much estrogen in the body in general or when there is too much estrogen relative to progesterone (i.e. there is not enough progesterone to oppose estrogen).

I’ve written at length about estrogen dominance and the impact it may have on the body. Estrogen dominance could unfortunately come about for various reasons: anovulation (no ovulation), stress, adrenal issues, excess fat in the body, the environment, digestive problems, and autoimmune conditions. 

This can result from the ovaries or other tissues producing too much estrogen, testosterone being converted into estrogen, or from poor metabolism of estrogen itself.

Symptoms of estrogen dominance can include:

• Irritability
• PMS
• Weight gain
• Heavy periods
• Painful periods
• Fibrocystic breasts
• Fibroids
• Endometrial hyperplasia
• Water retention

In some instances, estrogen can look normal in labs but the metabolites that are produced in the liver can be problematic. More on that soon.

Now, I just want to clear something up. I know estrogen is often demonized, but we need estrogen! It’s an essential hormone for women, and is responsible for so much good stuff — like cognition, protecting our bones, and helping us have healthy pregnancies. But, like all hormones, it needs to be balanced. So the goal would not be to drop estrogen as low as possible.

Problems can arise when there is too much estrogen circulating in our bodies or the wrong metabolites.  

What Does DIM Do To Your Estrogen?

To understand how DIM supports your estrogen we first have to understand how estrogen is metabolized. 

When your body no longer needs estrogen it is the liver’s job to package it up so it can be sent out via the urine and stool. Within the liver there are two steps to estrogen metabolism known as Phase 1 and Phase 2 detox.

During Phase 1 your liver converts estrogen into 3 metabolites—2 hydroxy estrone (2OHE1), 4 hydroxy estrone (4OHE1), and 16 hydroxy estrone (16OHE1). The most favorable of the three is 2OHE1. The other metabolites, 4OHE1 and 16OHE1 are associated with unfavorable growths of breast and uterine tissue, including cancer. 

In Phase 2 detox these metabolites are methylated and prepared for excretion via the kidneys and bowels. Many people mistakenly think that the liver is the only organ involved in estrogen metabolism and while it is very important, so is the health of your kidneys and bowels. This is why drinking ample water, eating fiber, supporting microbiome health, and ensuring regular bowel movements is so important to your hormone health.

How Does DIM Affect Your Estrogen?

DIM works at the Phase 1 detox level to help your liver make the most favorable metabolite, 2OHE1 and reduce the excess production of potentially harmful 4OHE1 and 16OHE1.

Potential Benefits Of DIM Supplements

Studies on DIM have shown promise for breast health, acne, and reducing PMS. There is also data to support its benefits in certain cancers. DIM may be helpful for breast health because it supports Phase 1 metabolism of estrogen in the liver, favoring 2OHE1. Although there is research and anecdotal evidence to suggest benefits, it is important to note that more data is needed.

DIM For Breast Health

DIM supports liver enzymes that may help with Phase 1 estrogen metabolism, which is the phase that packages hormones and toxins up for elimination. 

The best estrogen metabolite is 2-hydroxy estrone (2OHE1), which DIM promotes over the problematic estrogen metabolite, 16 alpha-hydroxy estrone (16OHE1). When estrogen moves down the 16OHE1 pathway, mastalgia (breast pain) may result. Keep in mind that 16OHE1 is the type that can lead to mastalgia and may stimulate estrogen-sensitive cancer cells, like breast cancer.

A double-blind, randomized controlled study showed that 150 Pharmaceutical researchers are taking note and testing indole carbonol-based formulations for mastalgia.  

DIM In Estrogen Receptor Positive Breast Cancer

It is also important to note that 16OHE1 metabolites could also stimulate estrogen-sensitive cancer cells, which if left unchecked, could lead to breast tumors. 

In a randomized, placebo-controlled trial, women prescribed tamoxifen (a treatment for hormone-receptor positive breast cancer) were either assigned 150 mg of an oral DIM supplement or a placebo for a 12-month period. DIM increased the 2OHE1 ratio compared to the placebo with minimal adverse effects. Researchers concluded that, in women taking tamoxifen, DIM promoted healthier estrogen metabolite production. 

DIM For PMS 

While this is not true for everyone, the root cause of PMS could be due to estrogen dominance. If you are struggling with heavy periods, tender breasts, mood swings, hot flashes and water retention, there is a high chance that you are estrogen dominant. That’s the bad news. 

And supplementation may sometimes be a useful tool in helping the body optimize your hormones. Because it helps regulate estrogen, DIM is a great supplement to look into for women experiencing PMS and period problems (such as cramps and heavy periods), especially when combined with nutrients like calcium and herbs like Vitex.

Read more about supplements for PMS here. 

DIM For Heavy Periods And Cramps

As we’ve discussed, estrogen can stimulate tissues to grow, which includes the endometrium. When the endometrial lining is overstimulated it can result in endometrial hyperplasia, which can lead to heavier periods. 

Fibroids, polyps, and endometrial lesions, like those seen in endometriosis, can also be stimulated by estrogen. This can result in painful cramps, heavy periods, pain with sex, and spotting between periods. Left untreated, these conditions can progress and require surgery.

The good news is that you don’t always need to rely on painkillers or the pill as the only treatment for these conditions. You can take action at home by beginning to incorporate cruciferous vegetables, fiber, and other nutrients to support your hormones. You can get started with this free recipe guide and meal plan. 

While we understand the mechanism by which this may work and many women report benefits, it is important to note that research is lacking.

The Potential Of DIM For Thyroid Proliferative Disease

A pilot study showed that DIM is an effective estradiol modulator (estradiol is a form of estrogen). In the study, a small sample of patients with thyroid proliferative disease (which includes cancer, goiter and adenoma) were given 300 mg of DIM daily for two weeks. It’s important to note that a higher dose of DIM was used because this was a study on patients with thyroid proliferative disease.

In the pilot study I mentioned first, urine analysis showed that DIM regulated estrogen metabolism in patients. After two weeks of taking DIM, patients with thyroid proliferative disease had more good estrogen metabolites, which results in more balanced hormones. After two weeks of supplementation, the ratio of 2OHE1 (the more beneficial estrogen metabolite) to 16OHE1 (a metabolite associated with the growth of tissue) increased, which is a shift in the right direction. 

Hold up. What does the thyroid have to do with estrogen? Another study shows that increased levels of 16OHE1 may lead to a greater chance of thyroid proliferative disease. 

DIM For Perimenopause And Menopause

Perimenopause is the period between a woman’s later reproductive years and menopause. Periods will start to become irregular, until they disappear altogether. After a year without a period a woman is considered to be in menopause. 

During both perimenopause, hormone patterns begin to change. One of those hormones is — you guessed it — estrogen. While in perimenopause, a woman’s progesterone levels will begin to decline as her ovulation is less regular. Left unchallenged, estrogen is allowed to stimulate tissues and as it goes through its own peaks and troughs, it can trigger hot flashes, night sweats, and mood swings. Once in menopause a woman’s estrogen will decline. 

We know an imbalance of estrogen and progesterone is not ideal at any time, but during the perimenopausal period, it often dramatically affects a woman’s quality of life. Studies have shown that women in perimenopause and menopause experience a reduced health-related quality of life, as well as higher work impairment.  

And that’s where DIM comes in. As I’ve already mentioned, DIM promotes the production of more beneficial  estrogen metabolites (2OHE1), and discourages the production of problematic  estrogen metabolites (such as 16OHE1). By helping the body maintain a more favorable estrogen profile, DIM may help mitigate the symptoms of perimenopause and menopause when the culprit is estrogen imbalance. 

Support Healthy Testosterone Levels

DIM may be effective at inhibiting aromatase. Aromatase is an enzyme that assists in the conversion of testosterone to estrogen. This is why DIM can possibly prevent the excess production of estrogen and support healthy testosterone levels.

DIM may also inhibit DHT, a form of testosterone that is five times more potent than testosterone. DHT is the form of testosterone associated with prostate cancer in men and conditions like hirsutism (hair where you don’t want it) and acne in women. 

How Much DIM Do I Need?

Eating a diet rich in cruciferous vegetables may supply you with the DIM your body needs to support healthy estrogen metabolism. Remember that it requires you to chew well and have healthy hydrochloric acid levels present in the stomach. While a DIM supplement may be helpful for some women, it is not essential for everyone. The best way to determine how much DIM you specifically need is to have lab testing that includes estrogen and estrogen metabolites.  

There is research showing the benefits of eating cruciferous vegetables, but understand when DIM is specifically looked at, all the benefits come from supplements.

DIM Dosage

Typically, DIM supplements come in 50–300mg capsules. Starting with a lower dose of 50-100 mg is often best to avoid headaches, which can occur when you begin supplementing with DIM. Work with your doctor to determine whether DIM supplementation could be beneficial for you, and to determine the right dose for your body.

Food Sources Of DIM

Cruciferous vegetables contain Indole-3-Carbinol (I3C), which is converted to DIM by the body. 

I3C is found in cruciferous vegetables, such as:

• Broccoli
• Cauliflower
• Brussels Sprouts
• Kale
• Cabbage
• Watercress
• Garden cress
• Mustard greens
• Horseradish
• Turnips
• Bok choy
• Kohlrabi

You will not get as much DIM from a vegetable as you would from a capsule. For example, to obtain the dosage of 100–300mg of DIM recommended for women, you’d need to eat a lot more broccoli and cabbage than you might want to. 

Should You Take DIM Everyday?

In order to see the benefits, DIM should be taken daily for at least 30 days. Daily supplementation is best if you’re going to use DIM.

Drug Interactions With DIM

Diindolylmethane may help the liver work more efficiently, so if you’re on prescription medication that the liver is primarily responsible for breaking down, it’s possible that your medication may not stay in your system long enough to be effective. Always let your doctor and pharmacist know if you’re taking DIM and any other supplement so that they can advise you about interactions. 

Excessively high amounts of DIM may deplete sodium, an essential nutrient. It takes a lot of DIM to mess with your sodium on its own, but if you’re taking diuretics, you might reach your limit faster. Again, let your doctor know you’re taking DIM if you’re on any other medications, whether prescription or over-the-counter.   

Supplements With DIM

DIM can be taken on it’s own or in a combination formula with other estrogen supporting nutrients. While DIM alone can help with Phase 1 detox metabolites, it is best taken in a supplement that contains Phase 2 detox nutrients like folate, B12, and magnesium. This can help prevent headaches and other unwanted issues that can arise when using a Phase 1 nutrient alone. In addition, having calcium d-glucarate available can ensure your bowels are able to effectively move the estrogen metabolites created by the liver out of the body.

In cases of microbial dysbiosis in the gut it is possible for an enzyme known as betaglucuronidase to reactivate the metabolites created in the liver and put estrogen back into circulation. Calcium d-glucarate mitigates the effect of betaglucuronidase. It’s important to support the entire system of estrogen metabolism. 

Balance Women’s Hormone Support

Balance – Women’s Hormone Support is a comprehensive formula designed to help support a healthy hormone balance of estrogen, progesterone and testosterone in women. It contains ingredients that support Phase 1 and 2 estrogen metabolism in the liver, as well as calcium d-glucarate to ensure the body is able to safely remove estrogen from the body. 

Learn more about Balance – Women’s Hormone Support. 

DIM, The Hormone Helper

DIM is a compound with a myriad of potential hormonal health benefits for women. By modulating estrogen and estrogen metabolism, DIM may help women with various hormonal difficulties. 

Because it helps move estrogen down the pathway that produces more favorable  estrogen metabolites, DIM may be useful for women struggling with estrogen dominance, PMS, period problems, perimenopause, and menopause. It may also help maintain breast health and could prevent painful breasts (mastalgia). 

Have you tried DIM? Let us know in the comments.

If you’ve got ovaries that ovulate, it is highly likely that you develop an ovarian cyst at sometime in your fertile years. You may not even notice the ovarian cyst symptoms or it may be very painful depending on the type and size of the cyst.

Each ovulatory cycle, an egg matures inside of a follicle. Then the follicle bursts open and the egg gets released. Next, either you become pregnant, or your period arrives. After that, the follicle forms the corpus luteum, which is a cluster of cells in the ovary that starts producing progesterone – although not everybody produces enough progesterone. 

Sometimes, parts of this process become problematic. For example, if the follicle doesn’t release the egg…The follicle grows and turns into a follicular cyst.

Or, a corpus luteum cyst forms because the follicle bursts open as it would every month, but then it fills with fluid and sticks around a little longer. 

When we’re talking about these two types of cysts, they can also be called simple or functional cysts. Two different names for the same condition.

Often, these cysts simply shrink and then disappear. They come and go and you don’t realize that they’ve even been hanging around in your ovaries.

Other times, these cysts become enlarged. This can cause pain and other complications. Sometimes, cysts rupture and can even damage the ovary.

What Are Ovarian Cysts?

Ovarian cysts are fluid-filled pouches that form in or on the ovary. They can range in size from less than 1cm to 10cm. In some cases, there are no ovarian cyst symptoms and in others there may be pelvic pressure or pain. 

What Are The Types Of Ovarian Cysts? 

Simple cysts aren’t the only kinds of ovarian cysts. There are also complex cysts. 

Complex cysts include endometriomas, cystadenomas, and dermoids.

Endometriomas

These are cysts that sometimes occur in women with endometriosis. This happens when tissue that is similar, although distinct, to the uterine lining  invades the ovaries. These are sometimes referred to as chocolate cysts.

Cystadenomas

These cysts are pockets of mucus, fluid, and ovarian tissue on the outside surface of the ovary. They are usually benign growths but they can get rather large.

Dermoid

Dermoid cysts, also known as teratomas, commonly occur in the ovaries. In fact, they are one of the most common kinds for women between 20 and 40 years old. These may contain ovarian germ cells and tissues like teeth, hair, or fat. While they may not sound benign, they are for the most part and are rarely cancerous.

While these complex cysts can and do cause problems for many women, in this article, I’ll be focusing on functional cysts.

Ovarian Cysts Symptoms and Signs

If you have a cyst that simply shrinks and fades away, you may never even know that it was there.

However, if your cyst is problematic, there are several symptoms you may experience: 

• Pelvic pain (especially around ovulation)
• Irregular cycles
• Spotting mid-cycle
• Lower back pain
• Nausea
• Vomiting
• Fever
• Abdominal bloating 
• Feeling full or heavy
• Painful bowel movements or urination (the cyst can put pressure on the bowel or bladder)
• Lack of ovulation
• Fertility struggles
• Painful sex

If you’re experiencing any of these symptoms, and especially if they’re accompanied by sudden pain or fever, it’s important to contact your doctor right away.

Do Ovarian Cysts Hurt?

Most cysts won’t cause a bit of pain — you won’t even know they are there. But if they become enlarged, they most certainly can become painful. 

Many women complain of lower back pain, abdominal pain, and pelvic pain associated with ovarian cysts. Still, cysts aren’t always painful – even large cysts can go unnoticed. 

Can Ovarian Cysts Cause Bleeding?

Mid-cycle bleeding is a common symptom of ovarian cysts. But it can also be a normal indicator of ovulation, or a symptom of many other conditions. If you ever experience vaginal bleeding and you know it’s not time for your period, it’s important to contact your doctor to get checked out. 

Can Ovarian Cysts Cause Back Pain?

In my practice, I’ve seen many women experience a dull, aching lower back pain if they’re experiencing complications due to ovarian cysts. Some women describe hip and pelvic pain as well. Definitely consult with your physician if you’re experiencing pain and you’re not sure why. 

Can Ovarian Cysts Cause Bloating?

It might be difficult to distinguish garden variety bloating from bloating caused by an ovarian cyst, but if your bloating is accompanied by pain, discomfort, or bleeding it could be that a cyst is causing your problems. 

Can Ovarian Cysts Cause Weight Gain?

Sometimes, as ovarian cysts grow large, women feel like they are ‘gaining weight.’ This isn’t weight gain in the traditional sense. If you have a large cyst, you aren’t putting on body fat. You may experience bloating from the cyst and that can cause water weight to accumulate.

How Do You Know If An Ovarian Cyst Has Ruptured?

Ovarian cysts can rupture without your knowledge. Usually, though, most women will feel pain or discomfort if their cyst ruptures. Sometimes fever or chills accompany a rupture. Complications may arise if the cyst is infected or the weight of the cyst causes the ovary to twist, known as ovarian torsion. Definitely contact your medical professional if you suspect that your ovarian cyst has ruptured, or if you’re experiencing lower back or pelvic discomfort, with or without fever and chills.

How Are Ovarian Cysts Diagnosed?

Ovarian cysts can be tricky to diagnose, especially since many times they don’t cause overt symptoms.

Sometimes, your doctor might discover one during your annual pelvic exam. This can usually be confirmed with an ultrasound. If you have a corpus luteum cyst, you might actually produce a false positive pregnancy test, so doctors often use this method to arrive at a diagnosis. That said, a home pregnancy test alone isn’t enough to diagnose a cyst. Ovarian cysts are also common during pregnancy, so your provider will likely test you.

In postmenopausal women, CA 125 is often ordered to assess an ovarian cyst. CA 125 testing is sometimes ordered in cases of ovarian cysts that are large in premenopausal women. It is not enough on its own to diagnose ovarian cancer and may also be elevated in cases of endometriosis, fibroids, liver or kidney disease, and cases of heart failure.

Ovarian Cysts Vs PCOS

It may seem like polycystic ovarian syndrome (PCOS) is the same thing as ovarian cysts. But they are actually two different conditions with similar names. 

In women with PCOS, multiple follicles keep growing, which do not release eggs, and multiple cysts can form in the ovary. PCOS is considered a metabolic condition that is characterized by hormonal imbalances. 

Ovarian Cysts Vs Fibroids

Functional cysts are normally filled with fluid, while fibroids are typically denser. Fibroids occur on or in the uterus and cysts occur on or in the ovaries.  

Ovarian Cysts Vs Endometriosis

Endometriosis is a condition where tissue similar to the lining of the uterus abnormally grows outside of the uterus. Sometimes, if endometriosis affects an ovary, that ovary can fill with blood. This is called an endometrioma, or a complex ovarian cyst that’s filled with blood. They are also referred to as “chocolate cysts.” 

What Causes Ovarian Cysts?

There’s no one singular cause for problematic ovarian cysts.

Technically, they can start with ovulation, but we can’t really define that as a “cause” of the cysts becoming irregular. 

Some of the common reasons cysts develop include:

• Pelvic infection: sometimes infections can travel to the ovaries, resulting in cysts
• Endometriosis: complex cysts may develop as a result of endometriosis
• Pregnancy: in early pregnancy, a cyst forms to help nurture the pregnancy while the placenta develops. It can stick around on the ovary for longer than it’s supposed to.
• Estrogen dominance: the hormonal imbalances that result when estrogen levels are high or high in relation to levels of progesterone can cause cysts to develop.

Does the Mirena® IUD Cause Ovarian Cysts?

According to the package insert, 12% of women using Mirena® develop ovarian cysts. If you have a history of ovarian cysts and you’re considering an IUD, ask your doctor if there are concerns about exacerbating the problem.  

How Ovarian Cysts Are Treated

For the most part, ovarian cysts seem to resolve themselves. Especially if they are asymptomatic, they may just disappear and you’ll never even know they were there.

For this reason, many doctors take a “wait and watch” approach before resorting to any sort of invasive treatment for ovarian cysts. 

Often, your doctor will suggest pain medications like ibuprofen or non-steroidal anti-inflammatories (NSAID) as a treatment for the pain caused by ovarian cysts. If you have a cyst or suspect you might, get a thorough evaluation and your doctor can advise you on the best course of action.

How Are Ovarian Cysts Removed?

If an ovarian cyst is causing significant pain, is larger than 5 cm in diameter, or appears related to endometriosis, your doctor may recommend surgery to have the cyst removed. Your doctor may also suggest surgery if she suspects that it may be cancerous.

The typical surgeries performed to remove ovarian cysts include:

• Laparoscopic cystectomy. This is where a small incision is made to remove the cyst with the assistance of a small camera.

• Oophorectomy. This procedure is the removal of the ovary.

• Hysterectomy. This is the removal of the uterus, ovaries, and possibly fallopian tubes. 

Hormonal Birth Control For Ovarian Cysts

It’s quite possible your doctor will recommend hormonal contraception to treat an ovarian cyst. The idea is that if ovulation is suppressed, cysts won’t form, right? 

Early formulations of the pill were associated with a lower rate of functional cysts, which many physicians took to mean it could treat ovarian cysts causing them to adopt this treatment practice in the 1970’s. While this approach has shown to be ineffective, it hasn’t really stopped physicians from using it as a treatment. Plus, it can’t shrink or affect an existing cyst in any way. And, keep in mind that birth control options (especially progestin-only options) do not necessarily stop ovulation from happening.

According to a 2014 Cochrane Review, there is no evidence that oral contraceptives cause the resolution of ovarian cysts any faster than what would happen naturally. “Therefore, birth control pills should not be used for this purpose. A better approach is to wait two to three months for the cysts to disappear on their own.” 

Plus, we know that the pill can possibly cause a whole host of other unpleasant hormonal side effects. Even if hormonal contraception seemed to work, once you quit taking the pill, your cysts are likely to return if you haven’t addressed the root cause,.

If you’re struggling with any pill-induced discomforts, I’d invite you to check out my best-selling book, Beyond the Pill. 

Understand that cysts that do not self resolve often require surgical intervention.

Natural Remedies For Ovarian Cysts

If you’re experiencing pain from an ovarian cyst, there are plenty of natural things you can do to help ease the pain. 

Some of my patients swear by taking Epsom salt baths or using a heating pad to help deal with the pain.

But what about getting to the root of the problem, the whole reason cysts are developing in the first place?

Since cysts can often be caused by an overabundance of estrogen, focusing on ways to support estrogen breakdown in the liver and excretion through the digestive system can help treat ovarian cysts.

Some of the things I recommend for women in my clinical practice:

Increase Your Plants

Vegetables and fruits are rich in antioxidants that support ovarian health. They also contain important vitamins and minerals for supporting hormone health. Aim to eat leafy green daily and cruciferous vegetables at least three times a week. Cruciferous vegetables contain nutrients that your body can convert into DIM, a molecule that supports estrogen metabolism.

You can grab my free meal plan and recipe guide to help you begin incorporating these into your diet today.

Targeted Supplements

• Vitex (Chaste tree berry) supports progesterone production, which can help counter estrogen.
• Green tea extract is a potent antioxidant, which may help protect ovarian health. In one PCOS rodent study green tea was shown to reduce the rate of cysts.
• Diindolylmethane (DIM) supports estrogen metabolism and promotes 2-hydroxyestrone, a more favorable estrogen metabolite.

Balance Women’s Hormone Support is a formula that contains ingredients which may help harmonize hormones, and could help your liver process excess estrogen

Eat Your Fiber

I regularly encourage my patients to load up on vegetables for fiber. You need a healthy gut to get estrogen out and fiber can really help encourage frequent elimination, plus support a healthy microbiome.

High-quality Probiotics

Replenishing the gut with friendly microbes can lead to happy hormones. That’s because your gut is a crucial organ in helping you eliminate excess hormones. As it turns out, those gut bugs interact with your estrogen as what is known as the estrobolome. I recommend MegaSporeBiotic to my patients. 

Seed Cycling

This time-tested practice may encourage hormone balance by balancing beneficial estrogens with flax and pumpkin seeds in the first half of your cycle. Then in the second half of your cycle (after ovulation) you encourage progesterone with sesame and sunflower seeds. Check out my seed cycling article with all the details here.

Ovarian Cysts And Pregnancy

Ovarian cysts are common in early pregnancy. Because you’re getting so many ultrasounds during this time, you may be more likely to find cysts that you wouldn’t otherwise notice.

For the most part, they are nothing to worry about and will resolve on their own. But do bring up any concerns or symptoms to your OB/GYN. 

Can Ovarian Cysts Cause Infertility?

Most (about 4 in 5) ovarian cysts are asymptomatic and will simply disappear within a few months’ time. For the most part, functional cysts are considered unlikely to interfere with fertility.

On the other hand, endometriomas (cysts that are associated with endometriosis) can spawn fertility struggles. But, it’s not clear whether this is a direct result of the cyst itself, or if the underlying issues that caused the cyst are responsible for fertility problems.

Also, if surgery is required to remove a cyst, there is concern that it could interfere with future fertility. But research suggests that in women who undergo in-vitro fertilization (IVF) treatment, surgery to remove ovarian cysts doesn’t impact the chances of achieving pregnancy. 

There are minimally invasive options to remove non-cancerous cysts that shouldn’t affect the ovaries. Mention your family planning goals to your doctor when discussing treatment options.

Ovarian Cysts After Menopause

Up until this point, we’ve been primarily discussing ovarian cysts that develop in women of childbearing age, who are still ovulating.

But if ovarian cysts develop after menopause, it’s a slightly different circumstance. Since women who are post-menopausal don’t ovulate, the appearance of functional cysts will likely make your doctor want to investigate further. 

Post-menopausal cysts may be benign, but your doctor will likely want to run a few tests to determine what’s going on. Research indicates most simple post-menopausal ovarian cysts either resolve on their own or stay the same. 

In most cases, your doctor will want to perform both an ultrasound and CA 125 to screen for cancer before proceeding to a “watch and wait” stance.

Can Ovarian Cysts Be Cancerous?

Typically, ovarian cysts are not cancerous, but it can still be scary to hear the news that you have one. If your doctor is concerned that you possibly have a cancerous ovarian cyst, it’s likely that she will order bloodwork to determine your cancer antigen 125 (CA 125) levels. This blood test can help your physician understand the likelihood of ovarian cancer.

Certain factors put you at higher risk for developing ovarian cancer:

• Family history of ovarian cancer 
• Previous history of breast cancer
• Previous history of gastrointestinal cancer

Support Your Hormones (And Ovaries) Naturally

Believe it or not, painless, easy menstruation is completely possible. PMS, bloating, acne, and even ovarian cysts can be a thing of the past…you just need a blueprint for success.

Which is what I’ve created for you in my Hormone Starter Kit to help you get started on the right path.

This completely free resource is absolutely packed with hormone education and even includes a complete 7-day meal plan. It’s literally everything you need to start down the path to hormonal harmony. Download your free copy here.

Lichen sclerosus is a chronic skin disease that results in thin, white, wrinkled patches of skin, usually on the genitals. It can be excruciating and incredibly itchy to deal with. While doctors previously believed it was rather rare, in recent years, doctors have suggested it’s more common than initially thought. By some estimates, cases have doubled between 1991 and 2011. 

In this article, we will explore the symptoms, causes, and treatments for this chronic condition. 

What Is Lichen Sclerosus?

Lichen sclerosus is an inflammatory skin condition that is ten times more common in women than in men. Lichen sclerosus creates patches where the skin becomes thin, white, and shiny.  

While it can crop up on any part of the body, it usually appears on the vulva. Post-menopausal women and prepubescent girls are the most likely to develop lichen sclerosus.  

What Are The Symptoms Of Lichen Sclerosus?

Sometimes, lichen sclerosus can be extremely painful and itchy — to the point it may cause difficulty sleeping. Other times, symptoms are mild, and the only thing present is the patches of skin that have lost their pigment.

Other symptoms of lichen sclerosus include:

• Smooth un-pigmented patches of skin
• Slightly raised or wrinkled patches of skin
• Itching that becomes worse at night
• Painful sex
• Painful bowel movements
• Constipation
• Redness
• Dull or burning pain
• Torn or bleeding skin
• Sores or blisters

What Causes Lichen Sclerosus?

As with so many conditions that affect the female population, lichen sclerosus hasn’t been widely studied, and therefore we don’t have a definitive cause of it, per se.

Doctors generally agree that a few things could cause lichen sclerosus.

Trauma Can Trigger Lichen Sclerosus

The medical community has recognized trauma to the area of skin as a cause of the disease.

Sometimes, activities like horseback riding, bike riding, or even waxing can irritate the vulva’s delicate skin. Many women report lichen sclerosus after experiencing some sort of difficulty with an activity that created friction in the vulva area.

Sexual abuse, trauma, or under-lubricated sex can also trigger lichen sclerosus.

Is Lichen Sclerosus An Autoimmune Disease?

Some doctors also believe that lichen sclerosus could be related to autoimmunity. 

However, the connection seems to exist only in women, not men. In a study of 532 patients with lichen sclerosus, researchers found that women were likely to have another autoimmune condition, especially an autoimmune thyroid condition. The same likelihood wasn’t there for the male participants in the study. 

Some of the common autoimmune diseases that occur alongside lichen sclerosus include:

• Autoimmune thyroid disease
• Vitiligo
• Alopecia areata
• Diabetes
• Anemia

Hormonal Imbalance May Cause Lichen Sclerosus

Because lichen sclerosus is more likely to occur in girls who haven’t reached puberty yet and post-menopausal women, researchers believe there may be some connection between lichen sclerosus and fluctuating hormone levels.

To that end, there is some evidence to suggest that topical testosterone cream may help relieve symptoms of lichen sclerosus. However, in a high-quality study, it was only shown to be an effective treatment for the disease in 20% of cases and caused androgenic complications in 40% of the study participants. This leads most doctors to conclude that hormone replacement therapy is not the preferred treatment for the condition.

Lichen Sclerosus And Gut Health

As with many autoimmune conditions, gut health may lie at the root of the problem. Many functional medicine and integrative doctors have found that addressing gut issues can help to heal autoimmune disease. 

Because lichen sclerosus is at its core inflammatory, and gut dysbiosis contributes to inflammation, it may just be a root cause of the condition.  

How Is Lichen Sclerosus Diagnosed?

Generally, doctors diagnose lichen sclerosus with a physical exam. Most of the time, your doctor will be able to visually spot the telltale signs of lichen sclerosus.

Sometimes, your doctor will take a biopsy to confirm a suspected case of lichen sclerosus. Or, your doctor may order additional testing to rule out other conditions.                                          

Lichen sclerosus can be tricky because it can coexist with several other conditions that may look and feel the same. For example:

• Lichen planus causes genital itching and can also occur alongside lichen sclerosus.
• Vitiligo also causes the skin to lose its pigment, and can likewise exist at the same time as lichen sclerosus.
• Low estrogen levels can cause vaginal tissues to thin and lead to discomfort, itching, and painful sex. Low estrogen levels often accompany lichen sclerosus.
• Sexually transmitted infections can cause inflammation that underlies or coexists with lichen sclerosus. Many can also cause itching and painful intercourse. 

What Is The Best Treatment For Lichen Sclerosus?

Lichen sclerosus can be challenging to treat, and many women struggle with it for some time before finding relief. Conventional treatment typically focuses on the management of the symptoms and prevention of scarring. While most doctors view lichen sclerosus as a life-long condition, it is possible to put the symptoms into remission. With the right steps, many women can eventually experience total relief. It may not be an easy or straightforward road to recovery, but it is possible. 

If your doctor tells you that you have lichen sclerosus, it’s crucial to maintain regular check-ups with your physician. It is considered a chronic disease and does carry an increased risk for the development of skin cancer.

Steroids For Lichen Sclerosus

The most common treatment for lichen sclerosus is steroid cream. It may not be the ideal long term treatment, but many women find it a necessary part of their lichen sclerosus protocol since the itching that comes with it can be overwhelming.

The itching gets worse at night because your cortisol naturally takes a dip at night. As cortisol goes down, inflammation rises. Many women find relief from a steroid cream, which helps them get some much-needed sleep. 

Calendula Salve For Lichen Sclerosus

I also recommend calendula salve as a natural alternative. It won’t stop the itch, but it will help with the dryness and irritation.

Calendula has anti-inflammatory, antifungal, and antibacterial properties that also may help reduce swelling and combat any infections in the affected area.

Curcumin For Lichen Sclerosus

Curcumin is the active part of turmeric. There have been studies showing the benefits of turmeric in inflammatory skin conditions. 

While not a cure or specific treatment for lichen sclerosus, curcumin can offer anti-inflammatory support and antioxidant protection of the skin. Learn more about the benefits of turmeric.

Address Underlying Inflammation For Lichen Sclerosus

If your body is enduring a state of chronic inflammation due to a hidden infection, food allergies, endometriosis, other autoimmune conditions, or leaky gut, it’s important to address those as part of your lichen sclerosus treatment plan.

Unfortunately, there’s no one-size-fits-all, one and done way to do that.

Testing is vital here — removing triggers and analyzing gut flora can be the right place to start.

Tightening up your diet and minimizing processed foods while increasing your intake of organic vegetables, fruits, and proteins is essential in most cases. 

Optimizing your supplement protocol with l-glutamine, aloe, and slippery elm (all ingredients found in Gut Rebuild), and professional-grade probiotics can be a good idea.

Other Important Recommendations For Lichen Sclerosus

Some of my most important recommendations for treating lichen sclerosus involve developing good habits.

Here’s my list of non-clinical things to consider if you’re battling lichen sclerosus:

Use lube for intercourse, especially if you’re post-menopausal 

Just be careful what lube you choose, what’s in commercial lubricants can be irritants or endocrine disruptors. Try selecting one that will be gentle to your already sensitive lady parts.

Wear cotton underwear, or at least with cotton on the inside 

Cotton helps your vulva to breathe and cuts down on sweat. Synthetic fabrics could lead to irritation and harbor bacteria, which could make matters worse.

Wear loose pants 

Now is not the time to rock your tightest fitting jeans. Choose fabrics that allow airflow near your delicate areas.

Always wipe front to back 

Wiping front to back helps prevent the spread of bacteria and is a habit that helps prevent urinary tract infections.

Urinate and or wash off with water after sex 

Semen is actually not the ideal pH for your vagina. After sex, a quick rinse of the area will help get things back to a normal pH.

Wash your vulva with water only — no soap required 

Your vagina is not meant to smell like vanilla sugar cookies. Please don’t buy into the myth that all women are supposed to emit a scent of champagne and berries from their lady parts. A simple rinse with water for the vulva is all you need, and there’s never a need to wash your vagina, ever.

Is Lichen Sclerosus Contagious?

Lichen sclerosus is not contagious. You cannot get it from or pass it to another person. It is not an infection, let alone a sexually transmitted infection.

Is Lichen Sclerosus Cancerous?

Women with lichen sclerosus are at a higher risk of developing squamous cell carcinoma skin cancer of the vulva.

While lichen sclerosus is not cancerous itself, it is important to address any suspected vulvar issues immediately and treat them. As with any disease, early detection and treatment are the best defenses we have against their further development.

Don’t Be Embarrassed To Talk About Your Vulva And Vagina

There are many reasons we don’t have a plethora of good information and reliable studies on lichen sclerosus, and one of them is that women often feel embarrassed because they’ve been shamed about these conversations. It is important to seek help when you’re experiencing abnormalities in your lady parts.

It’s time for this taboo to end.

We all deserve to understand how our bodies work, and we have the right (and maybe even the responsibility) to use their clinical names without an ounce of shame.

No matter what you’re experiencing, I can promise you that your doctor’s already seen it all. There’s absolutely no reason to resist seeking help if your vulva is in less than optimal condition. And in the case of lichen sclerosus, the earlier you are able to treat it, the more likely you can put it into remission and avoid the misery of the painful itching and tearing, and possibly scarring. 

If you’re looking for more answers regarding female health and sexuality, I’d love for you to download my free hormone balancing starter kit. It’s a crash course in everything you need to know about your cycle, how to get your hormones aligned, and includes a ton of great hormone-friendly recipes. If you’re a little confused and looking for a place to start, this is it. 

You probably know serotonin best as the “happy molecule,” but how exactly is it linked to our mood? This hormone plays a role in digestion, sleep, memory, and more but is best known for its impact on regulating happiness, anxiety, and mood.

Low serotonin levels in the brain can lead to symptoms of depression, so understanding this powerful hormone is critical in protecting our mental health. Let’s explore the causes and treatments of serotonin deficiency and what links serotonin to our mood.

Depression is a very real struggle, and support is easy to reach. If you’ve found this article because you are considering self harm, call the National Suicide Prevention Lifeline at 1-800-273-8255 right now, or visit their website for free, 24/7 live chat support.

The Chemistry Of Depression

Let’s be clear– depression is more than a chemical reaction. The American Psychiatric Association states that “Psychiatric disorders result from the complex interaction of physical, psychological, and social factors and treatment may be directed toward any or all three of these areas.” That said, it’s still helpful to understand what’s going on in our brains.

There are three major neurotransmitters– molecules that help your nervous system communicate– that we know are critical for a positive mood. Dopamine, norepinephrine, and serotonin each play a role, and deficiencies in any way contribute to depression. A neurotransmitter deficiency can occur when your brain isn’t producing the amount it needs or when it isn’t efficiently using its supply.

Dopamine

Best known for its role in the reward system, dopamine helps our brains balance goals, rewards, and motivation. Low levels of dopamine may explain why people with depression struggle to find motivation or happiness from activities they once enjoyed. 

Norepinephrine

Also called noradrenaline, your body uses the hormone norepinephrine as part of your “fight or flight” reaction. While that might sound bad, this means that we need norepinephrine to recognize and respond to stressful situations. Low norepinephrine may lead to depression, ADHD, or low blood pressure.

Serotonin and Depression

Serotonin is the common name for 5-hydroxytryptamine (5-HT), but we know it best as “the happy molecule.” Low serotonin levels may contribute to depression, anxiety, mood disorders, insomnia, and a higher risk of suicidal thoughts. 

The Link Between Serotonin And Depression

The medical community links low levels of serotonin to depression. But scientists can’t yet definitively say whether low serotonin causes depression or depression depletes serotonin.

Regardless, a serotonin deficiency often points towards depression, anxiety, and mood disorders. Research shows that adequate serotonin in the brain is essential in controlling our anxiety and fear responses, as well as promoting feelings of happiness.

Learn more about serotonin:

How To Increase Serotonin Levels

Serotonin Deficiency – What’s The Risk?

Does Serotonin Reduce Depression?

For those suffering from both depression and anxiety, finding ways to boost and support serotonin in the brain may often (though not always) help alleviate symptoms. 

Serotonin is involved in mood, sleep, and digestion, all states that signal to your body, “I’m somewhere safe.” Research shows that high serotonin levels in the brain tend to correspond to happier emotions. In contrast, low serotonin levels, or fewer functioning serotonin receptors, may be linked to lower moods and symptoms of depression. 

This is why many pharmaceutical depression treatments typically revolve around promoting or recycling serotonin. Like depression itself, however, depression treatments are not one-size-fits-all. 

What Causes Changes In Serotonin Levels?

One of the best ways to increase serotonin is to identify what could be depleting it in the first place. In fact, addressing what is causing the low serotonin is essential to remedying the situation.

Inflammation, hormonal imbalances, and excessive stress can all have a negative impact on serotonin production. High alcohol intake, or a lack of sunshine are also factors that can cause a dip in serotonin.

A serotonin-deficient state doesn’t always mean that serotonin is low. Similar symptoms can also appear when your body produces enough serotonin, but isn’t using it properly. This occurs when your brain has too few serotonin receptors, or when serotonin is being stored or broken down too quickly.

One example may be seasonal affective disorder (SAD). Many people, particularly in areas with longer, darker winters, experience a seasonal depression as sunlit hours drop towards winter. While people with SAD may still be producing adequate serotonin, research suggests their brains overproduce the protein responsible for storing serotonin away and out of the active neuron synapses.

Explore more: Serotonin Deficiency, What’s the Risk?

Serotonin In Depression Treatments

One of the most common pharmaceutical treatments for depression is the use of SSRIs, or selective serotonin reuptake inhibitors. Serotonin in the brain is released and received by different neurons, acting like a messenger in the “synapse,” the space between neurons. After the serotonin molecule has delivered its message, it is reabsorbed. An SSRI acts by preventing this reabsorption so that the serotonin remains in the active synapse area and can be used over and over. Similarly, SNRIs (serotonin and norepinephrine reuptake inhibitors) reduce the reabsorption of both serotonin and norepinephrine.

Common SSRIs:

• Prozac®
• Celexa®
• Zoloft.®

Common SNRIs:

• Pristiq®
• Cymbalta®
• Savella®
• Effexor.®

While your doctor can help you decide if an SSRI is the right fit for your needs, the long-term use of SSRIs can make serotonin deficiencies even worse. Additionally, while SSRIs can reduce depression symptoms by increasing serotonin availability, they don’t address the root cause of low serotonin levels.

Lifestyle changes such as sunlight, stress management, and exercise can also be potent paths to boost your body’s natural serotonin gently. Read my article on increasing serotonin levels through lifestyle, diet, and medicine.

Many of the nutrition and lifestyle approaches can be used along with an SSRI, but of course, always check with your provider.

If you are on an SSRI or SNRI and wish to stop, you must absolutely bring this up with your prescribing doctor and adhere to their guidance on dosage. The side effects of stopping SSRIs abruptly can be brutal and dangerous, and this isn’t something you can always power through. You can avoid a lot of suffering and side effects if your doctor is keeping a close eye on your dosage adjustments and symptoms. 

Summary

Scientists are still working to understand the complex interactions between our brains and our moods, and future therapeutics could focus more on the ratios of neurotransmitters or other factors entirely. Still, understanding serotonin can be a powerful tool in understanding our mental health.

Curious about your serotonin levels? Learn more about supporting your serotonin production in this article.