What to Do About Your Mirena IUD (And Other Hormonal Issues)

What to Do About Your Mirena IUD (And Other Hormonal Issues)

Since publising the original article about the Mirena IUD on this blog, thousands of women have come out of the woodwork writing to me asking for help.

When I originally wrote the article, I was spurned on by my observations of the women in my practice who had experienced a rise in estrogen dominance and low progesterone after the insertion of their IUDs (which were often inserted to treat hormone imbalances!).

At that point I never imagined that so many women would be affected by the IUD, or that even more were suffering from so many hormonal symptoms that drastically affected their lives and health.

It makes sense: our society does not set us up for proper hormonal function.

Our diets are carbohydrate-heavy, promoting insulin resistance and blood sugar dysregulation, which impacts our ovaries’ ability to make estrogen properly.

An excess amount of body fat produces more estrogen in the body and acts as a reservoir for the toxic estrogens in our environment.

We lack many of the micronutrients necessary to process our hormones properly, such as vitamin D, B vitamins, magnesium, zinc, omega 3 fatty acids, glutathione, and amino acids.

Many of us have impaired or suboptimal liver function, or sluggish digestion, which keeps hormones in our bodies around longer than they should be.

A dysbiotic gut has the tendency to turn estrogen in the gut back “on”, putting it back into circulation when it was otherwise on its way out of the body.

Stress alters our hormonal function, including our ability to make progesterone, DHEA-S, convert thyroid hormones, and process estrogen properly.

Xenoestrogens in our food and environment, from plastics, fragrances, pesticides, and processed soy products, contribute to overall body burden of the hormones in our body, throwing off our delicate balance, and contributing to symptoms.

The result of all this is that many women suffer from hormonal imbalances.

10% of women have some form of PCOS, or Polycystic Ovarian Syndrome, characterized by the body’s inability to properly make progesterone or estrogen, instead making loads of male hormones, like testosterone. PCOS alters fertility, promotes weight gain, and causes things like unwanted facial hair growth, acne, and missed periods. PCOS is often connected to stress and insulin resistance.

Many women in my practice suffer from PMS or PMDD, experiencing often debilitating symptoms sometimes even two weeks before their periods begin. They might get migraines, intense cravings for sugar, and massive mood changes, such as anxiety, intense irritability, or devastating depression. Panic attacks can occur at this time as well. Many of them comment that their mood and personalities flip once their hormones levels reach a certain point, causing them to act like different people. This can jeopardize their relationships with spouses and children, coworkers, friends and family.

Tender and painful breasts, or breast lumps, are also common in many of these women.

Acne, weight gain, stress, fatigue, disrupted sleep, depression and anxiety are all symptoms I see in women with hormonal imbalances.

Many women have horrific cycles, experiencing painful and heavy periods that often cause them to miss days of work every month. Many of these women struggle to keep their iron levels in the optimal range, suffering from hair loss, fatigue and weakness.

Many women are diagnosed with fibroids, or endometriosis, or are concerned about their risk of female cancers like breast, ovarian, uterine and cervical cancer.

All of these symptoms are often linked to relatively higher levels of estrogens compared to progesterone, sometimes termed Estrogen Dominance by functional medical practitioners who look at the underlying causes of bodily imbalances.  

I feel terrible that I can’t help more of the women who write to me. My license prevents me from giving advice to those who live abroad, especially to non-patients over the internet. It’s a shame, however, because oftentimes the solutions are relatively simple, despite how complicated many of these symptoms might seem.

I’m hoping that this article can provide some direction to many of the women who suffer.

Firstly, I want to state that I am not against birth control or even the Mirena IUD (or other IUDs, for that matter). The vast majority of women with the IUD tolerate it. For many women with debilitating heavy periods and endometriosis it can be the only viable solution that makes life tolerable.

In my social practice at Evergreen, many of the women I see experiencing homelessness, drug addiction, or PTSD from relationship trauma, rely on the efficacy of IUDs to prevent unwanted pregnancies. Their lives often don’t allow for them to remember to consistently take pills every month.

Many women don’t tolerate combination birth control because of a history of blood clots, female cancers, or migraine headaches associated with their periods, and therefore the Mirena IUD, which is progesterone only, is a safe alternative for preventing unwanted pregnancy.

That all being said, many women do suffer on the Mirena IUD (or other forms of birth control). They were perhaps put on the Mirena to deal with some of the above symptoms of hormonal imbalance, or for contraception. Many of them noticed that their symptoms became worse after insertion of the IUD.

How the Mirena IUD and Birth Control Works:

The Mirena works by secreting small amounts of progestins, a synthetic form of progesterone, into the uterus and surrounding tissues. While it is not fully known how the Mirena works, the end result is a suppression of ovulation. This results in either very light periods or a complete cessation of periods until the IUD is removed (after 5 years when its hormones run out).

It is important to say here that, while birth control can certainly treat the symptoms of hormonal imbalances, it does not correct them.

All forms of birth control, with their synthetic versions of the hormones estrogen and progesterone, simply induce further hormone imbalances in the body. They introduce versions of hormones that may suppress or alter symptoms (such as heavy and painful bleeding, or acne), but the versions of hormones are not fully recognized by the body and therefore don’t fully replace all the hormones’ important functions, such as mood regulation, immunity, or blood sugar balance.

The effects of both altering the body’s natural hormonal balance, while ignoring the underlying cause of hormonal issues, is often what causes symptoms to continue or worsen.

For example, women with PCOS are prescribed birth control to manage acne or promote monthly periods. However, when women with PCOS miss periods, it is because they are not ovulating. The missed periods are not the problem; the lack of ovulation is.

Despite that, many women with PCOS experiencing amenorrhea (or missed cycles) will be prescribed birth control. However, birth control does not address the underlying cause of amenorrhea. It simply further suppresses ovulation (because its main purpose is to prevent unwanted pregnancy).

The periods you get while on birth control are not periods. Periods from birth control are withdrawal bleeds. After 21 days of taking hormonal pills, pills are stopped or replaced with placebo pills. The withdrawal of hormones in the pills induces a bleed that resembles a period, but is not one.

Hormonal contraception does not correct hormonal imbalance, it imposes further hormonal imbalance to manage symptoms. This is not always bad!

But it is an important difference.

Many women do require symptom suppression, particularly if their symptoms are severe. Many individuals in my practice experience periods so heavy that the only way for them to get through the month is with an IUD. Genetic variability in how our bodies process hormones can make us susceptible to intense hormonal symptoms, through no fault of our own.

In my opinion, however, it is important to attempt to address the underlying cause and to set our bodies up for better hormonal regulation, making as many changes as our lifestyles will allow.

What You Can Do About It: 

If you are like any of the people I described above who seek my help, there are a few things that you can do to get started on correcting hormones.

Working With a Professional:

The first thing I advise is finding a licensed naturopathic doctor or functional medicine practitioner who understands hormones, can order lab tests, and will address the underlying cause of your hormonal imbalances by taking the time to fully understand your body and lifestyle.

This practitioner might be a naturopathic doctor (you can find one in North America by looking one up at naturopathic.org), or a medical doctor, a chiropractor, or a highly skilled nutritionist or nurse practitioner. Research this person well, read their articles, and perhaps book in with them for a complimentary meet and greet.

Testing: 

I often test patients using simple blood tests, on day 21 of their cycles (or about 7-9 days before they expect their next period).

I will test their blood, looking for anemia, will test iron and B12 levels, homocysteine (to gauge their ability to methylate), vitamin D, cholesterol (to see if their diets are promoting proper hormone synthesis), estradiol, estrone (the more toxic, problematic estrogen), progesterone, free testosterone, a thyroid panel, fasting glucose and fasting insulin (to calculate insulin resistance using something called the HOMA-IR), HbA1C (to look a long-term blood glucose control), FSH and LH (two hormones made in the brain that talk to the ovaries and orchestrate the menstrual cycle), DHEA-S, to name a few.

Some women will require more testing. Others will require less.

These labs are interpreted from a functional perspective. Even though you are in the “normal” ranges (which take into account the entire population, many of which are not healthy—they are seeing their doctors, after all!), these blood markers may not be optimally balanced, giving us an opportunity to correct things before they go further.

Testing allows us to match symptoms to underlying imbalances and to be able to properly direct treatment protocols. Women with estrogen dominance may be experiencing high levels of estrogen and normal progesterone, which indicates a body burden of estrogen or impaired liver and digestive system clearance. Other women may be experiencing normal levels of estrogen but low progesterone, indicating a failure of their bodies to ovulate, due to high stress, and PCOS (or the Mirena IUD and birth control pill).

Other options for hormonal testing are month-long salivary hormone testing, or DUTCH testing, which looks at hormone breakdown in the urine. I sometimes run these tests, but find that blood testing is useful, accurate, and more cost-effective.

Treatment: 

Once you understand your individual hormonal situation through testing (and through working with a practitioner who is putting the testing together with your symptoms and health history), your practitioner may recommend a variety of treatments.

I personally combine diet and lifestyle with key herbal and nutritional supplements, to target what is going on under the surface with my particular patients.

These treatments may include herbs that boost ovulation, aid liver detoxification, or regulate the stress response. I might recommend nutraceuticals that encourage methylation, or aid in hormone production.

My treatments take into account the individual’s symptoms, labs, diet, lifestyle, and any other health issues she may be facing like fatigue, digestive disturbances, or poor sleep.

What You Can Do Today: 

Barring more individualized assessment and advice, there are some best lifestyle practices that can help most women balance their hormones better, whether they are still using birth control to control and address their hormonal symptoms or prevent pregnancy.

Diet: 

When it comes to diet and hormone support, we need to ensure that we are balancing blood sugar, boosting liver detoxification pathways, promoting hormone synthesis, and supporting digestion, especially if experiencing constipation.

  • Consume more leafy greens: kale, spinach, collards, beet greens, arugula, etc. Eat 1-2 cups of these foods every day. Leafy greens contain active folate, which boosts methylation and detoxification. They also contain magnesium which is essential for hormonal regulation as well as 300 other important biochemical reactions in the body that balance mood and hormones.
  • Consume more cruciferous vegetables: broccoli, cauliflower, brussel sprouts, cabbage, bok choy, etc. Eat 1-2 cups of these foods every day. Crucifates help the body make glutathione, and contain indole-3-carbinole, which helps eliminate excess estrogens from the body. Broccoli sprouts are potent players in these pathways. Consume them as often as possible.
  • Ensure adequate dietary fibre intake: I often recommend ground flaxseeds or chia seeds in smoothies, avocados, fruits and vegetables and legumes (if tolerated) to make sure that women are having regular bowel movements to clear excess estrogens out of the body. 2 tbs of ground flaxseed (or more) every day can help balance estrogen levels and promote daily bowel movements.
  • Balance blood sugar: consume protein, fat and fibre at every meal. Avoid refined starches and flours. Avoid all sugar, even natural sugar like maple syrup, coconut sugar, cane sugar, honey, agave, etc. Try stevia or avoid sweets. Limit carbs (grains, legumes, root vegetables like potatoes or sweet potatoes, to 1/2 cup to 1 cup per meal). Only consume whole grains like quinoa, buckwheat, steel cut oats, millet, and teff. Cook them yourself!
  • Avoid soy, particularly processed soy, like vegan burgers, or soy milk.
  • Consume omega 3 fatty acids in fatty fish like salmon and sardines, or nuts and seeds like flax and chia seeds, walnuts, and pumpkin seeds. Get 2-4 tablespoons of these nuts and seeds every day and 3-4 servings of fatty fish a week.
  • Consume animal products: eggs contain choline, which is essential for liver function, meat contains vitamins B6 and B12, which are essential for hormonal regulation and production. Cholesterol in animal products are the backbones of our sex hormones. Iodine, found in animal foods, regulates estrogen balance in the body. If possible, try to obtain organic animal products from pastured or free-range animals to boost omega 3 intake, to lower your impact on the environment, and to promote animal welfare.

Other Lifestyle Practices:

Boost progesterone production by managing stress:

  • Establish a self-care routine: plan regular vacations, even small outings, do meditation or yoga, take breaks from work, spend quality time with family, have a plan to get your work done on time, ask for help.
  • Sleep! Aim for at least 8 hours of sleep, and try to get to bed before 12am. Practice good sleep hygiene by avoiding electronics before bed, keeping the bedroom as dark as possible, and setting a bedtime and wake time, even on weekends. Body scan meditations and some key supplements can be helpful for resetting circadian rhythms. Regulating blood sugar can have a major impact on improving sleep. Talk to your functional medicine doctor or naturopathic doctor for individualized sleep solutions.

Eliminate exposure to toxic estrogens and boost estrogen clearance:

  • Avoid exposure to xenoestrogens: whenever possible use natural body products, deodorants and shampoos, or “edible” body products for face and hair. Avoid plastic water bottles and plastic food containers. Use natural cleaning products around the house. Avoid fragrances and processed foods, especially processed soy.
  • Encourage sweating: get regular exercise or engage in regular sauna therapy. If you don’t have access to a sauna, epsom salt baths can also work—anything that helps you sweat. Heat therapy has also been shown to benefit mood and the stress response.
  • Heal your digestion: make this a priority with your naturopathic doctor, so that you can absorb the nutrients from the foods you’re eating as well as encourage daily bowel movements and optimal microbiome balance.
  • Maintain a healthy weight: body fat is metabolically active and can increase overall estrogenic load. Work with your naturopathic doctor to manage your weight. We often attempt to lose weight to become healthy, however I find my patients have far more success (and fun!) getting healthy in order to lose weight. Healthy weight loss often involves managing stress, sleeping 8 hours a night, avoiding sugar and processed foods, and regulating blood sugar, as well as encouraging proper sweating and liver detoxification.

 

 

 

Want to balance your hormones, energy and mood naturally? Check out my 6-week foundational membership program Good Mood Foundations. taliand.com/good-mood-learn

Is Your Multivitamin Making You Sick?

Is Your Multivitamin Making You Sick?

Is your multivitamin or B-complex making you sick?

Take a look at the label on your multivitamin or B-complex and see if it contains “folic acid”.

Folic acid is often used interchangeably with “folate”, which is a vitamin needed for DNA synthesis and repair.

Every time our bodies make new cells (which is all the time), we need folate to move that process along.

Because very few of us North Americans get enough folate from leafy greens, folic acid, a synthetic precursor to folate, has been added to grain products, to “fortify” them.

Folate deficiency in pregnant women can lead to neural tube defects. Therefore making sure that your body has enough folate, especially if you’re pregnant or planning to conceive, is essential.

However, folic acid, the synthetic vitamin is NOT the same as the folate (look at the bottom of the chart below, another word for folate is 5-methyltetrahydrafolate, or 5-MTHF) that our bodies use for cell division and DNA synthesis.

As you can see by the picture, folic acid needs to go through several stages of transformation before it can be of any use to the body.

All of us are really poor at converting folic acid to DHF (first step in the pathway). This step is faster in rats. In humans, it’s abysmally slow.

This means we take folic acid from supplements and fortified grains and slowly pass it through the narrow DHFR sieve that all of us are born with. This slowly transforms our synthetic folic acid into DHF.

The same DHFR enzyme must take DHF and turn it into THF. Two steps: folic acid –> DHF –> THF. So far, none of these products is useful.

3 steps and 2 enzymes later, our body makes a product called 5,10 methylene THF, or folinic acid, which can be used for DNA repair and synthesis.

After that, an enzyme called MTHFR turns folinic acid into folate (5-MTHF). And yes, MTHFR does remind you of the word you’re thinking of!

About 40-60% of us are poor at the last step, making 5-MTHF, which results from a slow or completely impaired MTHFR gene which has trouble producing a fully functioning MTHFR enzyme.

Slow enzymes mean very few of us are going to take the folic acid from foods and cheap vitamins, and turn them into methylfolate.

Methylfolate (remember, NOT folic acid), is needed for important chemical reactions called “methylation” reactions.

Methylation is needed for with detoxification, liver function, managing inflammation, hormone production and recycling, and producing neurotransmitters. Research is establishing a connection between MTHFR gene mutations and mental health conditions, autoimmune conditions and heart disease, among other common health complaints.

Folic acid, when added to supplements isn’t just useless, however.

When it can’t be broken down (and remember, all of us are slow at the first stop, some of us just plain can’t perform the last step), it builds up in tissues, and can block ACTUAL methylfolate action.

It can also trigger inflammatory reactions.

Not good.

Most multivitamin and B complex brands at health food stores contain cheaper forms of B vitamins. Companies use folic acid and a cheaper, synthetic form of B12, called cyanocoblamin, when making products to cut costs.

This doesn’t mean you have to shell out a lot of cash for quality B complex vitamins, it just means you need to be smart about the B-complexes you buy.

B-complex vitamins can be useful for those who experience inflammation, hormone imbalances and chronic stress. We tend to use more B-vitamins, which are water-soluble, when stressed, and when on certain medications, such as birth control pills. Supplementing in these cases can be extremely helpful for boosting energy and mood, while lowering symptoms of PMS and inflammation, among other things.

Most of the patients who come into my office already on a B complex are on a form that contains folic acid. At best, their body is working harder than needed to convert this synthetic vitamin into something useful. At worst, this product may be causing them harm.

The first thing you can do, is check your multivitamins and B-complex products and see if they contain “folic acid” or “cyanocobalamin”. If so, you can toss them.

You can also consider getting tested to see if you have an MTHFR mutation. Keep in mind that naturopathic doctors who are registered in Ontario, Canada cannot recommend or interpret genetic testing.

Next, you can reassess your diet. Folic acid is also added to enriched grains. Those who are particularly sensitive to folic acid, may experience a worsening of inflammatory symptoms and mental health issues when consuming high amounts of these foods.

Also, eat plenty of leafy green vegetables, which DO provide your body with a useable form of folate, among their many other health benefits.

Finally, if you’re considering getting pregnant, have a naturopathic doctor assess your prenatal vitamins to tell you if the form of folate you’re taking is appropriate for you.

Estrogen Balance and Mental Health: Depression, Anxiety and Stress

Estrogen Balance and Mental Health: Depression, Anxiety and Stress

Estrogen levels in the brain and body affect our brain’s levels of dopamine and norepinephrine, two neurotransmitters that are implicated in mood disorders like depression, psychosis and anxiety.

Our brain has several built-in recycling processes to keep us level-headed. When neurotransmitters (brain chemicals that have mood-regulating effects) are finished with their tasks, enzymes recycle them, breaking them down into their chemical parts to be reused again at a later date. This process controls the level of chemical nervous system stimulation in our brains and keeps our moods regulated.

You’re at home, late a night, working on an important assignment, driven by the excitement of the topic at hand. Your brain is flooded with dopamine, a brain chemical that is connected to positive mood and motivation, pleasure and reward; dopamine pathways are activated when we’re engaged in a task that is pleasurable and rewarding, when our lives are flooded with meaning and we’re working towards a goal. Dopamine, however can also be connected to psychosis, conditions like schizophrenia and bipolar disorder, and also be linked to impulsive behaviour, aggression and irritability, when over-expressed.

Typing happily, you near the end of your assignment. Suddenly, your computer screen goes dark. Your heart begins to race, your skin prickles and you’re overtaken by anxiety, panic and fear. Your body is releasing norepinephrine, a chemical connected to stress, anxiety and the “Fight or Flight” response, but that also allows us to feel alert and energized. Your heart pounds as your reboot your computer. You are hyperaware of the sounds and smells around you. Your skin prickles and your breathing is loud and rapid.

You exhale with relief as your computer screen lights up again, revealing that your assignment is unharmed. Stress drains out of your body, and your norepinephrine levels fall. You begin to tire; it’s time for bed. You add some finishing touches to your work, hit “save” and turn in for the night. The stress and motivation you felt only hours before dwindle, as the neurotransmitters responsible for these responses are swept out of your synaptic clefts and recycled.

When our brains have had enough stimulation of dopamine (mood, reward, pleasure, but also aggression, irritability, impulsivity and psychosis) and norepinephrine (stress and anxiety, “Fight or Flight”, but also alertness and energy), both get recycled through COMT, which pulls them out of circulation, breaks them down into their chemical parts, and reassembles them for later use.

We all have variability in how fast our COMT enzyme works, based on the expression of the COMT genes in our DNA. Some of us have slower COMT genes, meaning that our brain levels of dopamine and norepinephrine tend to be higher than other people’s, as our ability to clean up and recycle these hormones is slowed. This might result in an individual (depending on other genetic and lifestyle factors) who is at a higher risk of mental health conditions like psychosis or bipolar disorder, or someone who is more irritable, prone to aggression, or stress intolerant.

Others have more COMT gene expression, resulting in a faster enzyme that clears dopamine and norepinephrine more quickly, resulting in lower brain levels of these neurotransmitters. If other factors are present, these individuals may be more at risk for mental health conditions such as depression, low mood, lack of motivation, or susceptible to addictions.

Beyond genetics, there are several environmental and biological factors that may affect the speed of the COMT enzyme. One of these factors is estrogen. Estrogen slows the COMT enzyme down by as much as 30%. This means that when estrogen levels are high (seen in many women around ovulation or premenstrually, or in women with generally high estrogen levels, termed “Estrogen Dominance”, COMT performs more slowly and dopamine and norepinephrine levels remain elevated.

Depending on the extent of the problem, women with high estrogen often experience anxiety and irritability and a low tolerance for stress. On the more severe end of the spectrum, some women experience conditions such as PMDD (Premenstrual Dysphoria Disorder) or PMS-induced psychosis, resulting from abnormally high brain levels of dopamine and norepinephrine due to high estrogen. These conditions probably result from a combination of high estrogen, slowed COMT and other genetic and lifestyle factors. Xenoestrogens from environmental toxins, or birth control pills may also slow COMT and further exacerbate some of the symptoms of estrogen dominance.

Conversely, women with lowered levels of estrogen, such as those with amenorrhea (missed menstrual cycles) from various causes—PCOS is one, so is the birth control pill, especially progestin-only pills, or hormonal IUDs—or women who are peri-menopausal or menopausal, will have a faster COMT enzyme. This means that dopamine and norepinephrine will be cleared from the brain more quickly. Low levels of these neurotransmitters may result in depression: low mood, low energy and lack of motivation. On the extreme end, low levels of dopamine in the brain may result in conditions like Parkinson’s. Currently, research is being done on estrogen-replacement therapy as a treatment for Parkinson’s because of its ability to increase brain dopamine levels through slowing COMT.

When it comes to birth control pills, which are combination of synthetic estrogen and synthetic progesterone (“progestins”), or just straight progestin, either in pill-form or in a hormonal IUD, effects can be unpredictable. There is evidence that oral contraceptive use, especially progestin-only contraception, can exacerbate anxiety and depression, especially in teens. The pill acts by suppressing ovulation and suppressing natural hormone production, which may result in low levels of naturally-occurring progesterone and estrogen, which can slow COMT. However, the synthetic estrogens from the pill may interact with COMT, speeding it up in some women. Therefore the effects of specific forms of birth control on individual women is hard to predict; if functional medicine and genetic research tells us anything, it’s that there is no one-size-fits-all when it comes to striking the right hormonal balance.

Estrogen also has effects on another enzyme, called MAO-A, that recycles serotonin, the “Happy Hormone”, often implicated in depression and anxiety. Like COMT, estrogen slows down MAO, reducing the speed at which the body breaks down serotonin, resulting in higher brain serotonin levels. Drops in estrogen around and before a woman’s period, or low estrogen levels, may result in feelings of depression. Many women report feeling depressed and craving carbs and sugar around their periods. This is often related to a drop in serotonin as estrogen levels fall right before menses. Drops in serotonin levels due to drops in estrogen levels after childbirth may explain postpartum depression, according to some researchers.

The link between estrogen and its effects on COMT and MAO hint at the complexities of the body and brain’s hormonal milieu and its implications for hormonal regulation and mental health. Mental wellness is a complex state involving a variety of factors: hormones, enzymes and neurochemical pathways that are affected by our environment, our genetics and our hormonal predispositions. This is why I believe in taking a functional approach to mental health, seeing our mental health symptoms for what they are: symptoms, and making efforts to uncover underlying causes rooted in lifestyle, genetics and our environment. I believe the way to address symptoms is to trace them back to their source.

For many women, treating depression, anxiety and stress-intolerance may involve balancing estrogen levels and healing the menstrual cycle. For others it may involve supporting genetic susceptibilities with lifestyle changes, finding a birth control method that balances (or coming off entirely), and reducing exposure to xenoestrogens, supporting estrogen detoxification pathways, and addressing women’s health conditions such as irregular menses, and conditions like PMS, fibroids, endometriosis and PCOS.

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