Red Clover (Trifolium pratense, Fabaceae): copyright Juliet Blankespoor
Women today live in a very different world than our foremothers. Our female predecessors began menstruating later in life, had more children, breastfed longer, underwent menopause earlier, ate whole foods, and lived in a cleaner environment. Women today have approximately ten times as many menstrual cycles as their great-great-grandmothers. Our bodies did not evolve with the hormonal inputs of perpetual ovulation and menstruation. As a result, more women than ever are experiencing reproductive disorders, such as endometriosis, uterine fibroids and ovarian cysts. Painful menstrual cramps, persistent acne and cyclic breast tenderness are so common that they are taken for granted as a normal aspect of female physiology. Many natural practitioners address these issues with herbal hormone balancers, such as chaste tree (Vitex agnus-castus, Lamiaceae) and black cohosh (Actaea racemosa, Ranunculaceae). These herbs are often effective, and certainly have their place in treating female reproductive disorders. However, it is important to not overlook underlying dietary and lifestyle factors that contributed to the initial hormonal imbalance, as these harmful inputs are likely to create other issues down the road, if left unaddressed.
In this article, we will explore various factors affecting the hormonal ecology, or hormonal environment, of contemporary women. I will start by outlining the three major sources of estrogens, each of which is described in detail later in the article. The term endogenous is used to describe any substance generated from within an organism. Thus, endogenous estrogens are estrogens produced by the human body. Phytoestrogens are compounds, produced by plants, with an ability to bind to estrogen receptor sites. In contrast, xenoestrogens are human-made chemicals, which are also capable of binding to estrogen receptor sites. Xenoestrogens are a subclass of endocrine disruptors (hormone disruptors), which are described below.
It is important to understand that a variety of compounds have the ability to fit into estrogen receptor sites—natural and human-made molecules will alter a woman’s overall estrogen pool. A woman’s ovaries may be producing healthy levels of estrogen and progesterone, but her cells may be bombarded with strong estrogenic inputs from unnatural substances in her diet, water and air. Humans are exposed to environmental chemicals beginning at conception, absorbing novel compounds through the placenta, and then through breast milk. These endocrine disruptors (chemicals which disrupt hormonal physiology) have the potential to alter the reproductive ecology of the body, often with drastic effects, such as reproductive cancers and chronic female reproductive disorders.
Phytoestrogens have the ability to bind to hormonal receptor sites; they exert a beneficial effect on the female physiology. Our bodies’ hormonal systems have evolved with phytoestrogens, which are helpful in treating estrogen dominance (relative imbalance of estrogen to progesterone), as well as reducing menopausal symptoms. Most modern peoples in wealthy industrialized nations consume very little phytoestrogens and are regularly exposed to endocrine disruptors. I believe that these two factors play a large role in the increasing rates of reproductive pathologies.
Flax seeds: copyright Juliet Blankespoor
Our diets are different than those of our great-great grandmothers—with easy access to processed “foods”, as well as chemically grown and genetically modified foods. We are often not as active as our foremothers, and many women are overweight and obese. The world is a different place, and in many ways the decisions about how we live, eat and reproduce are not as simple. Some health care professionals believe the increase in modern women’s estrogen pools should be mediated with oral contraceptives. I do not agree with that strategy, and instead propose the judicious intake of dietary and herbal phytoestrogens, along with specific lifestyle changes aimed at lessening the stress of excess estrogen.
Males are also exposed to novel chemicals in the environment, which present equal challenges to their hormonal systems. Much of the following information will be relevant to both sexes, especially the info on phytoestrogens and xenoestrogens.
Toasted sesame seeds: copyright Juliet Blankespoor
Phytoestrogens are a diverse group of compounds, found in plants, which have the ability to bind to estrogen receptor sites and elicit an estrogenic effect (phyto = plant, estrogen = estrus [period of fertility for female mammals] + gen = to generate). These “plant estrogens” are fairly abundant in a whole foods diet, and are found in many commonly eaten seeds, grains, and beans. In addition, many medicinal herbs used to treat female reproductive disorders contain phytoestrogenic compounds.
To understand how phytoestrogens work, it is important to grasp the following: varying substances can bind to the same receptor site and elicit differing effects, depending on the exact molecular fit. Phytoestrogens exert a weaker estrogenic effect on cells than endogenous estrogens and xenoestrogens. Phytoestrogens have an anti-estrogenic effect premenopausally by competitive inhibition of hormone receptor sites. When receptor sites are occupied with the less estrogenic phytoestrogens, there are fewer sites available for the more potent endogenous estrogens or xenoestrogens. Imagine a lock on a doorknob (estrogen receptor site), now picture a key (phytoestrogen) fitting into the lock and turning the key. Now imagine a second key coming along (endogenous estrogen); it can’t fit into the lock because there’s already a key there, blocking its way (phytoestrogen). The phytoestrogen key opens the door gently, while the endogenous estrogen would cause the door to fling open with wild abandon. Why do we want to gently open the door? Because most modern women have estrogen dominance, or a relative imbalance of estrogen to progesterone—turning down the estrogen dial by slowly opening the door is a good thing.
In menopausal and post-menopausal women, estrogen production from the ovaries slows, and then stops. As menstruation ceases, phytoestrogens have a positive effect by increasing the estrogenic effect on the body. Although phytoestrogens are less estrogenic than endogenous estrogens, they still increase the net estrogenic effect. This is evidenced by epidemiological studies demonstrating fewer menopausal symptoms, greater bone density, and lower breast cancer in populations of women who regularly consume phytoestrogens as part of their diet. [i]
Sources of phytoestrogens:
Isoflavones (genistein, daidzein, formononetin, and biochanin A) are primarily found in the bean family (Fabaceae) and are some of the most potent and well-researched phytoestrogens. Soybeans (Glycine max, Fabaceae) appear to be the most concentrated dietary source of isoflavones. Soy foods, listed in order of isoflavone concentration, include miso, tempeh, soymilk, tofu, and edamame. Soy is one of the most controversial foods today, either vilified as a harmful substance or praised for its nutritional superiority. There are some possible negative aspects to soy: it is a common allergen, difficult for many to digest, and typically grown as a genetically modified monoculture. However, it is a traditional food, consumed by Asians for millennia, and can be grown organically, without any chromosomal foul play. It is crucial to understand the difference between its traditional whole foods forms (tempeh, miso, tamari, edamame, and tofu) and the industrially produced processed “food”—soy protein isolate. Much of American soy consumption is from the latter form in processed meats from fast foods.
Soy beans (Glycine max, Fabaceae): copyright Juliet Blankespoor
Traditional Asian cultures ingest about one ounce of soy daily on average, often in fermented forms such as tempeh, miso, and tamari. These fermented foods are easier to digest than other forms of soy. When eaten in moderation, they serve as a high protein phytoestrogen, with the following benefits: increased bone density; fewer menopausal symptoms; and lowered incidence of breast, uterine, and prostate cancers. It appears that soy consumption via breastfeeding (with mothers who consume soy foods) and in youth, reduces breast and prostate cancer later in life.[ii] Population studies show that early consumption of soy is also linked to a reduced amount of menopausal symptoms.
Most of the confusion and misinformation about soy stems from two misunderstandings: One, people do not differentiate soy’s whole fermented organic traditional forms, such as miso, tamari, and tempeh from its industrial counterpart —soy protein isolate. Many authors and speakers extrapolate from studies done on soy protein isolate to include all soy foods. That is simply inaccurate, and similar to lumping high fructose corn syrup together with organically-grown, non GMO corn tortillas, and declaring all of corn-derived foods as unhealthy and unnatural. Two, people do not understand how phytoestrogens, sourced from whole plant foods and herbs, are part of traditional diets all over the planet, and that our hormonal systems evolved with these substances. Phytoestrogens are not the same as xenoestrogens; these substances have very different effects on the human body. Comparing the two is worse than comparing apples to oranges, it’s akin to comparing DDT to broccoli, and yet, people often blur the distinction.
Lignans are the most widely consumed phytoestrogen precursors found in the western diet and are found in high concentrations in flax and sesame seeds and to a lesser extent in other seeds, whole grains, fruits, vegetables, and beans.[iii] Flax has about ten times the lignan levels as sesame. Intestinal flora metabolize the lignans, converting them to their active forms: enterodiol and enterolactone, which produce a weaker estrogenic effect compared to the isoflavones. Lignans are not present in the oil portion of the seed, so sesame and flax oil are not good sources. Both flax and sesame seeds, in their whole form, pass through the gastro-intestinal system intact, and thus are not assimilated. I recommend grinding the fresh seeds and adding them to food after the food has been cooked. Grind flax with a hand grinder, coffee grinder, or blender and store it refrigerated for a week. Add the flax meal to oatmeal, or other breakfast gruels, salads, stir-fries, and baked goods. Gomasio is a traditional Japanese condiment made from toasted sesame seeds; try it sprinkled on salads, soup, and stir-fries. Prepare gomasio by toasting the seeds in a dry cast iron skillet and then grinding them after they have cooled, with the addition of salt or seaweed. Tahini, or sesame butter, is another excellent source of lignans.
Gomasio, made from toasted sesame seeds: copyright Juliet Blankespoor
Synopsis: Sesame can be consumed liberally in the form of tahini (sesame butter) or gomasio. This tiny seed has long been used as a traditional remedy in Ayurvedic medicine as an aphrodisiac and to strengthen the bones, hair and teeth. Sesame is considered to be a rejuvenative for Vata constitutions. In Chinese medicine, the black sesame seeds are used medicinally as a galactagogue (stimulate breast milk production) and to tonify the yin and blood. Sesame seeds are rich in calcium and protein. Two tablespoons of ground flax seed daily is a good dosage of lignans, with the additional benefit of flax’s soluble fiber (which is protective against cardio-vascular disease and helps to promote healthy intestinal flora).
For women who are able to effectively digest soy: I recommend tamari and/or miso daily. Both miso and tamari are naturally eaten in moderation, as they are so salty tasting. Tempeh or tofu can be eaten two to three times a week. I strongly caution women (and all humans) to avoid soy protein and soy protein isolate –these processed “foods” can be found in many fake meat products, fast foods, health bars, and even commercial smoothies. I am not a fan of isolated isoflavone supplements, such as genistein, and believe that dietary sources from whole foods and herbs are a better choice. Herbal sources of isoflavones include Red clover (Trifolium pratense, Fabaceae) and Alfalfa (Medicago sativa, Fabaceae).
For a more detailed look at phytoestrogens, please see Juliet’s article here.
Endocrine disruptors, or hormone disruptors, are human-made chemicals in the environment that interfere with the development and function of all body systems in animals, including humans. Endocrine disruptors can bind to hormone receptor sites, triggering a body-wide hormonal influence. They may also inhibit our natural hormones, such as androgens (male hormones), thyroid hormones, and progesterone. In addition, these chemicals can affect the production, elimination and metabolism of our endogenous hormones.
Most of the chemicals used in modern conventional industrial agriculture are known endocrine disruptors. These same chemicals are also used in home gardens and lawns. Home use of garden herbicides and insecticides are typically devoid of the same regulation and education inherent in agricultural settings. Many of the ingredients in cleaning and body care products have also demonstrated binding to hormone receptor sites. Additional exposure may come from absorbing compounds found in electronic devices and shopping receipts.
Princess Xeno, of the Endocrine Wonky Tribe: copyright Juliet Blankespoor
Most Americans have some control over reducing exposure to environmental toxins, but there are people throughout the world who do not have this privilege. Socioeconomic factors contribute greatly to accessing fresh food, and clean water and air. Pollution is typically higher in poorer areas. Endocrine disruptors do not observe political boundaries; air and water currents carry these chemicals far and wide. The decisions we make about how we live and consume have the power to affect the hormonal systems of all people and animals globally for generations to come. For more information on endocrine disruptors, including resources for learning more, please see Juliet’s article on the subject.
Synopsis: It is a common response to feel disheartened and concerned for the future generations of all life when first hearing about endocrine disruptors. That’s a good sign of humanness! However, it is beneficial to balance the facts with hope, and learn about reducing personal and planetary exposure to endocrine disruptors.
Avoid any type of plastic coming into contact with food and beverages. Use glass and stainless steel containers instead. Buy or make natural cleaning and body care products. Buy or grow food organically. If finances are an issue, focus on organic meat and dairy, as the bulk of our exposure to agricultural chemicals comes from these animal foods. Many forms of packaging contain endocrine disruptors: the inside lining of canned foods, aseptic containers, and plastic wrap to name a few. Microwaving foods in plastic should be avoided. Filter water unless it is absolutely pure spring or well water (lucky few). Avoid chemicals in clothing (fire-retardant children’s pajamas) and freshly manufactured synthetic fabrics. Try to avoid the chemicals found in conventional building materials. It can be maddening to think about all the ways we absorb environmental chemicals! Living simply is a good start, along with breathing deeply and laughing through the madness.
For many women, fasting and cleansing can be extremely beneficial if undertaken slowly and carefully. This is especially important for a woman considering motherhood, as most of her lifetime stores of fat-soluble chemicals are passed on to her infant via breast-milk. It is beyond the scope of this article to thoroughly discuss fasting and cleansing, but I will say that it is imperative to tailor the cleanse to the woman’s constitution and lifestyle. For someone who eats mainly processed foods and lives a fairly typical western lifestyle, a good start would be to eat a mono diet like kicheree (a traditional Indian dish, made from mung beans, rice and spices) for four days. During this time, offer herbal support in the form of alteratives, diuretics, and liver and kidney tonics. Examples would be dandelion leaf and root (Taraxacum officinale, Asteraceae), nettles (Urtica dioica, Urticaceae), and burdock (Arctium minus and A. lappa, Asteraceae). Sweating through exercise, saunas, and baths is also helpful in removing toxins via perspiration. Hydration is imperative, as well as daily bowel movements. If a person feels very nauseous, achy, shaky, or experiences headaches, that is a sign to slow down or stop the cleanse. The body cannot always easily metabolize fat-soluble chemicals, which enter the bloodstream when fat cells are broken down (through reduced caloric intake). One should never attempt a fast or cleanse when pregnant or nursing. Fasting is not appropriate for all people, and for many it can seriously worsen a pre-existing condition. On a final note, the support of long-term dietary and lifestyle goals should be one of the primary points of attention. After healthy patterns have been established, one may embark on fasting and cleansing.
Milk thistle (Silybum marianum, Asteraceae): copyright Juliet Blankespoor
The Liver breaks down circulating estrogen and progesterone and excretes the inactive metabolites from the body via the bile, and eventually the feces. If a woman’s liver is impaired, hormonal metabolism and excretion can be slow. Her ovaries may be producing a healthy balance of estrogen and progesterone, but the liver is allowing the hormones to circulate longer in the bloodstream, resulting in increased estrogen levels. The relationship between the liver and female reproductive health has long been recognized by most, if not all, traditional systems of medicine.
Synopsis: With any female reproductive disorder, it is important to examine the health of the liver. Symptoms of liver and gall bladder disharmony include frequent headaches, pale stools, excessive anger, irritability, digestive sluggishness, constipation, and an inability to tolerate alcohol or digest fats. Often the person will describe feeling stuck or held back. Yellow eyes and skin are other indicators of possible liver distress. Other precipitating factors include a history of alcoholism, hepatitis, excessive NSAID use, exposure to solvents and environmental toxins, and intake of pharmaceuticals or recreational drugs known to be especially hard on the liver. If possible, reduce any ongoing harmful inputs, such as the intake of excessive alcohol and fried foods, and habitual NSAID use.
Consider supporting the liver with traditional liver and blood tonics, such as dandelion root (Taraxacum officinale, Asteraceae), burdock root (Arctium lappa and A. minus, Asteraceae), red clover (Trifolium pratense, Fabaceae), reishi (Ganoderma lucidum, G. applanatum, and G. tsugae, Ganodermataceae), vervain (Verbena officinalis, V. hastata, and other species, Verbenaceae) and nettles (Urtica dioica, Urticaceae). If you suspect or know of liver damage, consider hepatoregeneratives (herbs which stimulate re-growth of damaged liver tissue), such as milk thistle (Silybum marianum, Asteraceae) and artichoke leaf (Cynara scolymus, Asteraceae). Bitters can also help to stimulate the flow of bile with the attendant excretion of estrogen. Many of the aforementioned hepatics have a bitter taste and can be taken 20 minutes before meals to optimize the bitter action. Note that most bitters are cooling and drying; add warming and/or demulcent herbs to soften the energetic effects in people who run cool and dry.
Dandelion flowers (Taraxacum officinale, Asteraceae): copyright Juliet Blankespoor
Intestinal Flora imbalance is almost an epidemic in western industrialized nations. One in three babies in the United States comes into this world through cesarean birth, and many are not breastfed; both factors contribute to the imbalance of intestinal flora. In addition, antibiotics are frequently administered to children, which also diminishes healthy populations of intestinal flora.
Our bacterial beasties help in the assimilation of phytoestrogens; intestinal flora convert lignans into their bioactive form and aid in the absorption of isoflavones. The repeated use of antibiotics and subsequent damage to intestinal bacteria has been linked to an increased risk of breast cancer, perhaps in part due to the lowered production of active phytoestrogen metabolites.[iv] Intestinal bacteria also play a role in estrogen metabolism; certain bacteria produce an enzyme capable of converting the inactive estrogen metabolites in the gut back into a viable estrogen, which is then reabsorbed further down the digestive tract. It appears that supporting healthy populations of intestinal flora helps to reduce this “reinstatement” of estrogen, thus allowing estrogen to leave the body via the feces.
Synopsis: Support healthy populations of intestinal flora by introducing the use of bitters, prebiotics, and fermented foods. Prebiotic foods (not to be confused with pro-biotics) are not digested by human intestinal enzymes, and instead are broken down and absorbed by intestinal flora. The ingestion of prebiotic foods is one of the best ways to support healthy populations of beneficial intestinal bacteria. The best way to absorb prebiotics is in food, but tea is a second best. Herbal/Dietary sources are: leeks, asparagus, and the roots of dandelion, chicory, burdock and Jerusalem artichoke tubers (not to be confused with artichoke hearts or artichoke heads). Roasting roots converts inulin (type of prebiotic) into sugars, and thus roasted root teas are less effective for supporting healthy intestinal flora. The ingestion of fermented foods is associated with a lower risk of breast cancer. Examples of fermented foods and beverages are: miso, live kimchi and sauerkraut, kefir (water and dairy), yogurt (dairy, soy or coconut), kombucha, and many others. Many of these items can easily be found in the aisles of health food stores, but it is much more economical to learn how to ferment at home. Probiotic supplementation may be indicated, but fermented foods should also be incorporated into the diet.
Burdock root (Arctium minus, Asteraceae): copyright Juliet Blankespoor
Dietary fiber intake reduces estrogen levels in the body, and is associated with a lower risk of breast cancer. [v] In addition, soluble fiber nourishes healthy populations of intestinal flora and reduces cholesterol levels in the body. A good way to remember soluble fiber is that both slimy and soluble begin with an S; soluble fiber binds with water to form a mucilaginous texture. Barley, oats, split peas, bananas, okra, and most beans are high in soluble fiber.
Synopsis: Incorporate ample sources of whole plant foods in the diet: fruits, beans, whole grains and vegetables. If you are used to eating processed grains and little fruits and vegetables, the increased fiber intake can result in painful gas. Introduce these foods slowly while taking digestive bitters before meals. Carminatives, like fennel, cinnamon, anise, and mint can also help. Over time, the intestinal flora will adapt to the higher fiber intake.
Fractal Cauliflower – artful fiber: copyright Juliet Blankespoor
Pre-menopausally, the ovaries (specifically, the follicles and corpus luteum) are the primary producers of estrogens. In addition, some of the body’s supply is derived from the conversion of androgens (male reproductive hormones) by the aromatase enzyme. This conversion (aromatization) takes place primarily in fat tissue, but also occurs in the brain, skin, muscle, and bones. After menopause, this secondary source of estrogen is particularly important as it provides for most of the body’s estrogen. During the reproductive years, aromatization can account for a significant contribution to circulating estrogen levels; the powerful effect of aromatization is demonstrated in women who have undergone surgical removal of their ovaries without experiencing the symptoms of premature menopause. Excess aromatization, however, has been linked to breast, adrenal, endometrial and prostate cancers. In summary, excess body fat contributes to excess estrogen levels through increased aromatization. Conversely, low body fat can translate to low levels of estrogen, through reducing aromatization. Low levels of body fat may contribute to amenorrhea (absence of menstruation), infertility, anovulation (lack of ovulation), or difficulty with menopause.
High caloric intake has been linked to earlier menarche (onset of menstruation) and later menopause; this leads to a longer exposure to estrogen, and increases the risk of breast cancer.[vi] Postmenopausal obesity has shown to be a strong risk factor for breast cancer, increasing the risk by as much as 50%. [vii]Excess body fat has also been linked to uterine fibroids and endometriosis. [viii]
Synopsis: Maintaining a healthy body weight can help keep the peripheral conversion of reproductive hormones in balance. It is important to rule out eating disorders, food allergies, digestive issues, depression, hyperthyroidism, body image issues, and over exercising as possible causes of low body weight. Often women are simply thin, due to genetics or constitution, without any underlying pathology. Inquire about the diet, and help to optimize the ingestion of whole foods, including high quality fats and proteins. Often, increasing wild or organic animal foods in the diet will help to build the body’s reserve and build connective tissue (including adipose tissue) and blood.
If a woman is clinically overweight or obese, excess aromatization can take place, leading to higher levels of circulating estrogen. It is important to rule out underlying causes of obesity, such as hypothyroidism, depression, and stress. Sensible plans for weight loss include exercise, coupled with reduced caloric intake, and a focus on fresh fruits and vegetables. If you are overweight, find an exercise plan that feels realistic. Walking or hiking with a buddy is a great first step. Social support is extremely effective in helping to change ingrained dietary and lifestyle habits. It is a bigger letdown to cancel a walking date with a friend, than simply convincing yourself that you don’t need to walk. Pencil in your exercise into your calendar at specific times, and you will be more likely to follow through. Start with a simple plan so you don’t set yourself up for failure. For example, walking briskly for 30 minutes every other day is more realistic goal than jogging every morning for one hour.
Who does the cooking in the household? The person who prepares meals needs to be on board with any dietary changes. Remember, for most people it is psychologically easier to add healthier foods, rather than subtract unhealthy items. A reasonable goal would be to add a fresh salad or cooked greens to lunch and dinner and to add fresh fruit to breakfast and/or snacks. Chewing slowly and using a small plate are time-tested dieting tricks.
In conclusion, there are many factors contributing to each woman’s personal estrogen ecology; these need to be explored in any female reproductive disorder. Often, herbal hormone balancers are indicated, along with appropriate dietary and lifestyle changes. It is my hope that this information is part of a foundation for sustaining healthy reproductive systems!
Resources/ Suggested Reading:
- Trickey, Ruth. Women, Hormones and the Menstrual Cycle—Herbal and Medical Solutions from Adolescence to Menopause. Fully revised and updated edition.
- Romm, Aviva. Botanical Medicine for Women’s Health.
- Blankespoor, Juliet. Phytoestrogens Demystified. http://chestnutherbs.com/phytoestrogens
- Steingraber, Sandra. Having Faith—An Ecologist’s Journey to Motherhood.
- Colborn, Theo and others. Our Stolen Future.
[i] Julia R. Barrett, “The Science of Soy: What Do We Really Know?,” Environmental Health Perspectives 114, no. 6 (June 2006): A352–A358.
[ii] Jillian Stansbury, “Gene Expression and Reproductive Health. Medicines from the Earth. Official Proceedings. June 4-7, 2010. P138-142.,” n.d.
[iii] “Linus Pauling Institute at Oregon State University,” accessed April 26, 2013, http://lpi.oregonstate.edu/infocenter/phytochemicals/lignans/.
[iv] “Risk of Breast Cancer in Relation… [Pharmacoepidemiol Drug Saf. 2008] – PubMed – NCBI,” accessed April 26, 2013, http://www.ncbi.nlm.nih.gov/pubmed/17943999.
[v] D. Aune et al., “Dietary Fiber and Breast Cancer Risk: a Systematic Review and Meta-analysis of Prospective Studies,” Annals of Oncology (January 10, 2012), doi:10.1093/annonc/mdr589.
[vi] “Breast Cancer Research | Full Text | Does Diet Affect Breast Cancer Risk?,” accessed April 26, 2013, http://breast-cancer-research.com/content/6/4/170.
[vii] Sandhya Pruthi et al., “A Multidisciplinary Approach to the Management of Breast Cancer, Part 2: Therapeutic Considerations,” Mayo Clinic Proceedings. Mayo Clinic 82, no. 9 (September 2007): 1131–1140, doi:10.4065/82.9.1131.
[viii] Ruth Trickey, Women, Hormones and the Menstrual Cycle, n.d.