Chronic Stress + Hormonal Imbalance: PCOS, Infertility, PMS, and PMDD
by Dr. Mitchell Rasmussen, DC, CFMP, FRC-ms
When it comes to hormonal imbalance, we must consider a bigger picture than just your sex organs. Too often, the 'solution' offered is a pill. The conventional medical system has limited tools to work with; and lifestyle factors are often glanced over. In our functional medicine approach, we put the MOST emphasis here.
Your diet, your stress management strategy, and your environment are levers we can pull to make a bigger impact on symptom picture than just peddling medications/supplements.
Let's zoom in on chronic stress and the impact it can have on your hormones.
Stress Chemistry and Insulin
You can have an 'ideal' eating strategy, but if you are not working to manage stress then you will never be optimal. Stress chemistry (cortisol, adrenaline, norepinephrine) affects our glucose regulation. In the absence of dietary change, stress alone has the capacity to increase blood sugar by as much as 50%!
To put that into perspective: Your diet might lend itself to a very health fasting glucose of 80; but with chronic stress, you may present in the diabetic range with a potential fasting glucose at 120 or above.
We know that increased blood glucose over time will require more insulin and sets you up for insulin resistance. Elevated Insulin is an undeniable factor in Polycystic Ovarian Syndrome. <Way more on that here>
The Inflammatory Impact of Stress
When we experience stress, whether it's acute (short-term) or chronic (long-term), our bodies release stress hormones such as cortisol and adrenaline. These hormones are part of the "fight or flight" response that prepares the body to deal with a perceived threat.
While this response is essential for survival in emergency situations, chronic stress can lead to an ongoing release of stress hormones, which can have a negative impact on the immune system and result in inflammation.
Cortisol is a hormone that functions to lower inflammation and bring the system back to homeostasis. However, prolonged elevation of cortisol can lead to an imbalance in the body's inflammatory response. Similar to the mechanism of insulin resistance, our cells can quit responding with their typical 'anti-inflammatory' response and we develop peripheral cortisol resistance.
Think of the immediate adrenaline release as the 'gas' of your stress response. The later release of cortisol is the 'brakes'. Over time, we get stuck in an "ALL GAS, NO BRAKES" situation, where the body will keep releasing adrenaline with each successive stressor, but the ability to come back to homeostasis is eventually lost. We lose the ability to receive an anti-inflammatory effect from the cortisol.
Under a heightened inflammatory state, the body struggles to regulate the immune response. We are more vulnerable to infection, less sensitive to stress chemistry, and less insulin sensitive. As you can see it is a perpetually reinforcing loop of problems.
Inflammation and Sex Hormone Function
Anything that drives chronic inflammation is going to reinforce sex hormone dysfunction.
The byproducts of inflammation, called cytokines, will impact the production and communication of the primary sex hormones estrogen, testosterone, and progesterone. Therefore, we can develop hormone imbalance from a lack of production or poor conversion of any of those key players. Even when blood hormone levels "look normal", the presence of inflammatory cytokines affects how well they can bind to carrier molecules and function properly! (One reason why looking at the metabolism of hormones is important...)
Interruption of the HPA Axis via chronic inflammation can impact the brain signaling required for hormone secretion. The same brain structures that control stress hormones are the ones that control ovulation and spermatogenesis. When these processes are interrupted, we see hormonal imbalances resulting in anovulation, Polycystic Ovarian Syndrome, endometriosis, PMS/PMDD, poor egg/sperm quality, and ultimately infertility.
It's important to note that the impact of chronic inflammation on sex hormones can vary from person to person, and the severity of disruption depends on factors such as the underlying cause and duration of inflammation, genetics, and overall health.
Some of the things we investigate and address when it comes to chronic inflammation include:
Chronic latent viral infections (like Epstein-Barr and Herpes)
Environmental toxins and poor detox ability
Oxygenation issues (whether from anemia, tissue injury, or disuse)
Blood sugar dysregulation
Bottom Line: We know that managing chronic inflammation is crucial for maintaining hormonal balance. Our first-line treatment is lifestyle change. Habits such as adopting an anti-inflammatory diet, getting regular exercise, managing stress, and avoiding exposure to environmental toxins, can all help to reduce inflammation and ultimately restore optimal sex hormone production, function, and balance.
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ABOUT THE AUTHOR:
Dr. Mitchell Rasmussen, DC, CFMP serves as Director of Functional Medicine at The Facility in Denver, CO. He sees patients in-person and via Telehealth to get to the root cause of dysfunction and restore a state of well-being using nutritional intervention, supplementation, and lifestyle change.
Want to work with a functional medicine doctor to run labs and assess nutrient status? Struggling with hormone imbalance, IBS, weight gain, mood changes? Let's look at BIOCHEMISTRY. Read more about Functional Medicine at The Facility here.
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