stress

Understanding the Link Between Stress and Perimenopause

Stress - we’re all living with it.

And you don’t need me to tell you stress isn’t great for your health…

But for women in or near perimenopause, stress deserves special mention. Research has shown chronic stress actually worsens the hormonal symptoms of perimenopause, like hot flashes and PMS - as well as weight gain, decreased sex drive, and overall feelings of wellbeing.

But as we all know, “getting rid of” stress really isn’t an option. As a long-time health practitioner, my goal isn’t to help my clients eliminate stress, but rather teach them strategies to better manage stress. 

This is especially important during the perimenopause transition, when we are already in a hormonal shift and have less “wiggle room” to manage things like stress, blood sugar imbalances, and inflammation from hidden infections. 

But I’m not just talking about starting a meditation practice or saying no to that extra project at work. Targeted use of the right bioidentical hormones, herbs, and adrenal support supplements can help your body handle stress better, and help you transition through menopause seamlessly. 

Today, let’s explore what stress and menopause do to the body on a hormonal level - and what we can do to better support the body for more energy, less hormonal symptoms, and a better life. 

 

How Stress Impacts Your Hormones

When I say “hormones” I don’t just mean your sex hormones like testosterone, estrogen, and progesterone. I’m also talking about adrenal hormones like cortisol and DHEA, which play a role in controlling your sex hormones as well. 

During perimenopause, hormone levels fluctuate, and it's fluctuating hormones that can cause symptoms like hot flashes, mood swings, and weight gain. Research shows that stress only intensifies this. 

Stress triggers the release of cortisol. This is good, as cortisol is the “fight or flight” hormone that helps us respond to danger. But when stress is on-going, it can lead to an on-going state of elevated cortisol. Elevated cortisol in turn depletes the hormone DHEA, which is already in a natural state of decline as we age. 

Low DHEA is a problem for anyone, but especially for perimenopausal women because DHEA is a precursor to both testosterone and estrogen. Low levels of DHEA can therefore cause low levels of both testosterone and estrogen, intensifying the already changing hormone levels during this time. 

 

Low DHEA & The Pregnenolone Steal

So far, we’ve covered how stress can lead to elevated cortisol, which causes lower levels of DHEA. Because DHEA is a precursor for testosterone and estrogen, it can impact sex hormones.

But why does elevated cortisol deplete DHEA? That’s thanks to a process commonly called the “Pregnenolone Steal.” 

The basic premise of the pregnenolone steal is that pregnenolone  - a hormone produced by the adrenal gland - is a precursor for both cortisol and DHEA. When stress is high, the body reacts by producing more and more cortisol, “stealing” all the pregnenolone and leaving none for DHEA production.

That’s a bit of an oversimplification, though. There’s not just one pool of pregnenolone that gets depleted. In reality, pregnenolone is in the mitochondria of each of the cells. Rather than thinking about pregnenolone being stolen, it's more that the body prioritizes some pathways of hormone production that are about survival (cortisol), over reproductive hormones.

That being said, no matter “how” it happens, the decrease in sex hormone production this causes is particularly inopportune during the perimenopause years, when we are already hormonally in shift. It can make it seem like we are more sensitive to stress, or that it takes less stress to cause a noticeable change in how we look and feel. Coexisting issues like blood sugar imbalance or hidden infections - which are other common triggers for cortisol release - might suddenly become a bigger problem, too. 

 

Perimenopause and Low DHEA Symptoms

If you’re dealing with stress related hormone dysfunction on top of perimenopause symptoms, you might feel like you’ve got the worst perimenopause of anyone you know. It can cause an intensification of already-known symptoms like:

  • Hot flashes
  • Night sweats
  • Decreased sex drive (low libido)
  • Decreased sexual pleasure
  • Weight gain/ weight loss resistance
  • Poor sleep
  • Increased cravings
  • Mood disturbances (depression, anxiety, etc.)
  • Low energy
  • Overall lack of wellbeing

So that’s the “bad news.” Now let’s talk about the good news - all the things you can do to help rebalance hormones, support your body’s stress response, and get back to feeling like yourself. 

In fact, after 1-2 months on a customized plan based on your hormone test results, most of my clients see a 75% or more reduction in symptoms. 

 

Can Hormone Therapy Help Low DHEA and Perimenopause? 

For a deep dive into using bioidentical hormones safely during perimenopause, see my blog here. 

But in addition to sex hormone replacement therapy, supplementing with hormones like DHEA can be an option too. 

When used appropriately - and well monitored - DHEA is a safe way to help increase low testosterone in peri-and menopausal women. (It’s especially great for women with some types of hair loss, too!)

But, DHEA needs to be used carefully. Androgen dominance (too much testosterone) can be a main driver for the development or worsening of insulin resistance in perimenopause. 

That’s why I always recommend testing before starting DHEA (even if it is available over the counter where you live) and on-going monitoring. I recommend a comprehensive hormone panel like the DUTCH test. 

In the clinic, we also use pregnenolone supplementation when using DHEA. This helps with two main problems with DHEA supplementation. First, it can help offset the tendency of DHEA to lower cortisol levels, which can be a problem if someone is already dealing with low HPA output. 

Secondly, DHEA has a tendency to put weight on some people, or cause water retention. Adding pregnenolone can prevent this tendency. 

 

Active Stress Management and Supplements

Supplementing with hormones is just one part of the puzzle - just as, if not more, important are complementary lifestyle practices that help manage stress. 

I make a custom plan for each of my clients, but some of the techniques we use include:

  • Optimizing sleep hygiene (no blue light before bed, etc.)
  • Introducing movement (finding an exercise you actually enjoy– and prioritizing muscle building over cardio)
  • Circadian alignment (going to bed and rising with the sunset/sunrise)
  • Balancing blood sugar and increasing protein intake
  • Eliminating/reducing alcohol and processed sugar 

Active stress management - like qi gong, walks in nature, meditation in any form, making time for art, getting involved in your community, and spending time with friends and loved ones  - are also key. 

And then of course there are the issues that you can control - like your relationships, overall task burden, time management, ability to delegate and ask for support, and cutting out toxic people or activities. 

These steps can help you eliminate what stress you can and better tolerate the stress you have to live with. 

A final piece of the puzzle are adaptogenic herbs and herbs for supplement symptoms. As a long-time Traditional Chinese Medicine practitioner, I’ve seen the incredible power of herbs for transforming health. But, as with all powerful tools, they should only be used after adequate testing or practitioner diagnosis has identified the imbalances that exist. 

 

Look and Feel Your Best in Perimenopause

Perimenopause has a reputation as the worst time in a woman's life… but it doesn’t have to be that way!

With the right support, you can not just survive perimenopause - but actually enjoy the transition and step confidently into a new chapter in your life. 

You don’t have to accept weight gain, low sex drive and lack of pleasure, hot flashes, mood swings, cravings, irritability, and all the other common symptoms of perimenopause. 

My passion is guiding women through this change, helping to support their body’s unique needs, and watching them thrive in this phase of life!

If you’re interested in learning more, schedule a free 15 minute call by clicking here. We offer different programs for every need and budget, and would love to help you find the support that’s a perfect fit for you. 


Woman with depression sitting outside at sunset

How To Treat Depression & Anxiety Holistically - Part Two

In Part One of this series, I delved into the fact that depression and anxiety are not problems of JUST the brain or JUST the body. There is a definite mind-body connection, and the best treatments (and prevention) for depression and anxiety treat both. I also started going into the root causes – everything from childhood trauma to candida – and the solutions that might be able to help you. If you haven't read Part One yet, click here to go back and check it out!

 

Lots of people think “holistic” = “natural” or “alternative.”

But that’s not actually what holistic means!

A “holistic” approach looks at a person as a whole. Rather than seeing each part of the person - say their digestive system, or hormones, or mental health - as separate entities, holistic medicine views them all as interconnected.

(Sometimes, that does mean we use natural and alternative approaches to healing.)

But it always means that we’re looking at YOU as a whole person and not just a set of symptoms or a diagnosis.

I think that’s so important to make clear as I dive into the 2nd part of my series on treating depression and anxiety holistically.

Today, I’m going to explore how environmental exposure to toxins and hormone imbalances can play a role in depression and anxiety. It might seem crazy to think your detox pathways or PCOS could be related to depression or anxiety - but they can! Today I’ll explain exactly how and what you can do about it.

If you haven’t read Part 1 of my series, go HERE and read it first! Then come back and dig into Part 2!

 

What Toxins Are (And Aren’t)

Toxins is one of those words that gets thrown around a lot. But what does it really mean?

A toxin is any chemical or compound that has noxious or harmful effects on living organisms.

Toxins can come from outside us (our environment) but they can also be generated internally. For example, our hormones can become toxins if they stick around too long. They must all be “detoxified” - broken down and cleared from the body in order to make room for new fresh hormones to be produced. We also produce toxins in the gut.

But, the major source of toxins is the outside environment.

We have THOUSANDS of toxin exposures every single day. Here are just some of the most common ones:

  • Smog in the air we breathe
  • Touching receipts coated with chemicals
  • Pesticide residue on food
  • Prescription medicine contamination in drinking water
  • Hair & beauty products made with dangerous chemicals

The EPA estimates that in 2014, 4 billion pounds of toxic chemical waste was released into the air, water or placed in some type of land disposal in the U.S.

(And they consider this an IMPROVEMENT over the 4.7 billion pounds released in 2002!)

It’s likely that at least 25% of the United States population is dealing with heavy metal poisoning, too.

And while our body is equipped to deal with toxins (that’s what our liver is for!) the amount of toxic exposure humans have today is overwhelming. That’s why so many people's detox systems are overburdened. We can’t detox at a rate fast enough to keep up with all the toxins coming in!

This leads to fatigue, allergies, skin reactions, accelerated aging, autoimmunity, brain fog, yeast and bacterial overgrowths, and… increased depression and anxiety.

 

How Toxins Mess With Our Brains

The brain is a powerful and vulnerable organ.

The brain is made of nearly 60% fat. And that’s a problem - because many chemicals and toxins are fat soluble (including the nefarious heavy metals!).

The brain is so susceptible to toxin damage that there’s a specific name for toxins that negatively impact the brain neurons’ function: neurotoxins.

Neurotoxin exposure is a direct cause of depression and anxiety because they cause neurotransmitter dysfunction and inflame the brain.

This creates problems with brain signaling.

Neurons work by secreting specific brain chemicals (primarily serotonin and dopamine) out of the end of one neuron (called vesicle) into the space between the neurons (called the synapse).

Ideally, these chemicals are taken up by the receptor sites on the next neuron meant to receive the message. When that happens, a response signal is stimulated, and it continues on down the line to next neuron. If too much of any one brain chemical is released, it should be reabsorbed into the storage vesicles. This is called reuptake.

It’s sort of like your neurons are all playing a game of telephone.

But when toxins get in the way, the game gets messed up. The next neuron can’t hear the message clearly and passes it on wrong - or maybe not at all.

The toxins (and the inflammation caused by them) block the receptor sites on the neurons from taking up the chemicals  - aka “hearing the message.” Your neurons don’t get the signal.

And that means you don’t feel the effects of serotonin or dopamine, because they aren’t able to do their job.

Then, the serotonin and dopamine that should have been taken up start building up in the synapse.

Your body goes into action: it knows it can’t let too much of these chemicals accumulate. It starts creating enzymes to break down the serotonin and dopamine that are stuck in synapse.

The end result? Your reserves of serotonin and dopamine are lowered.

Depression and anxiety are both a result of the receptor sites in your brain being “shut down” and the lowered serotonin and dopamine this ultimately causes.

 

Signs Your Detox System is Overburdened and Needs Help

If you’re dealing with symptoms of depression or anxiety, it’s a sign your detox systems could be overburdened - along with these other signs:

  • Memory, concentration, and focus problems
  • ADD or ADHD
  • Skin problems (acne, eczema, psoriasis, hives, rashes)
  • Fatigue
  • Overeating & food cravings
  • Autoimmune conditions
  • Feeling chronically flu-like
  • Yeast overgrowth (Candida)
  • Bacterial overgrowth (SIBO)
  • Food intolerances

But - all of these symptoms can be related to OTHER problems as well - which is why it’s so important to get accurate lab testing, and not just guess at a diagnosis based on symptoms.

Here’s what I commonly see with my patients:

A patient with depression or anxiety will also have digestive tract infections or dysbiosis, yeast overgrowth, or food intolerances.

These promote inflammation in the gut, and the inflammatory cytokines circulate in the blood and travel into the brain across the blood brain barrier, impacting brain function.  

(What do I do to help? Glad you asked! After testing, I use specific amino acids like 5-HTP, tyrosine, and GABA, plus nutrient cofactors to deal with shut-down receptor sites and neurotransmitter deficiency. At the same time, I’m addressing  underlying root causes of the gut infections.)

 

How To Address Depression & Anxiety Related To Toxin Exposure

The solution to depression and anxiety caused by toxin exposure is to address the cause of the inflammation: those toxins!

That means limiting exposure as much as you can: get a water filter, air purifier, buy organic, switch to natural beauty products, etc.

From there, I start by enhancing detoxification pathways with nutrient protocols, hydration, herbs, saunas, skin brushing, and lymphatic system support so the toxins can be broken down and excreted from the body.

Next, I use lab testing to identify where in the detox pathway things are getting gummed up. Is your Phase 1 or Phase 2 liver detox malfunctioning? Proper testing can tell us!

I also use Organic Acids Testing and Heavy Metals testing to see exactly what toxins you’re dealing with.

I have to give a warning here: you MUST be careful when doing detox work. It can be dangerous to stimulate detox and have the body suddenly dump toxins from storage into circulation.

It’s never good to detox someone who still has a leaky gut or gut issues - and it can make your gut issues get worse.

You shouldn’t feel sick when detoxing - this usually indicates pulling toxins out of storage faster than your body can clear them.

An experienced practitioner can help you detox safely.

 

Depression, Anxiety & Hormones

I’ve saved the best (worst?) for last: hormones!

On some level, almost all depression & anxiety is related to hormone imbalances.

Neuroscientists at the National Institute of Mental Health have even stated that most depression in the United States is caused or contributed to by HPA-axis dysregulation (also called adrenal fatigue) and hormone imbalances.

The most important players for depression and anxiety are cortisol, DHEA, testosterone, estrogen, and progesterone. Together they can trigger a biochemically-induced depression.

 

Cortisol Dysfunction

Cortisol is a stress hormone that’s has to be just right. Too high or too low, and you can have lots of problems. But it’s tricky because your cortisol levels shouldn’t be steady throughout the day: they should follow a predictable arc of rising quickly in the morning when you’re exposed to light and slowly lowering throughout the day.

(That’s why cortisol problems can be easily overlooked! You can’t just look at one reading - you need to look at both levels throughout the day, and the rate at which they rise and fall to get the complete picture of cortisol health.)

Low cortisol levels are related to depression - and in particular, are linked to postpartum depression. Low CAR response (the rise of cortisol first thing in the morning) can also be related to depression.

But  - high cortisol (especially high at nighttime) is also related to depression - both high and low levels can cause similar symptoms. Again - that’s why you must have accurate testing!

What messes up cortisol levels?

The big triggers for cortisol imbalances are are sustained and chronic stress! It can be mental OR physical stress - anything from a stressful job, being a super-busy new mom, or over-exercising can wreak havoc on cortisol levels.

 

Sex Hormones Imbalances

Progesterone, estrogen, and testosterone are the primary sex hormones - but they can also have a huge impact on mental health and depression and anxiety in particular.

Here are just a few of the many ways sex hormones can directly impact mental health:

Progesterone helps balance blood sugar levels. Remember - the brain is dependent on adequate glucose to function. Low progesterone levels can lower the supply of glucose available to the brain. This decrease in "brain fuel" contributes to the most common psychological and emotional symptoms of PMS like:

  • Irritability
  • Rage
  • Depression
  • Tension
  • Anxiety
  • Confusion
  • Fatigue
  • Memory lapses and loss
  • Inability to concentrate
  • Decreased stress tolerance

Estrogen and progesterone also have a strong effect on the neurotransmitters involved in mood regulation:

  • Progesterone binds GABA receptors (which decreases anxiety and depression)
  • Progesterone raises serotonin hormone levels in brain
  • Estrogen increases dopamine activity in the brain

That means, any change in hormone levels (even subtle ones!) can contribute to psychological symptoms.

Unfortunately, the treatment given to many women who do experience mood symptoms with their monthly cycle is the hormonal birth control pill.

This drives me crazy as it only compounds the problem!

Birth control pills deplete the body of essential vitamins and minerals like folate, b vitamins, and magnesium - all of which are involved in the synthesis of chemicals for brain health (among other things!).

This can result in intensified depression, anxiety and PMS! A number of studies have linked depression with the use of oral contraception.

Studies have also indicated that using the Pill for extended periods of time can alter the gut microbiome, especially predisposing users to candida overgrowth and other bacterial and fungal issues.

The nutrient deficiencies that are induced by the Pill are largely due to the influence on the gut microbes, where many of these nutrients are synthesized. (So again, many of these issues point back to the gut - make sure you read Part 1 of this series!)

But that’s not all…

Thyroid Problems

Every cell in your body has receptors for thyroid hormone - including the brain!

(That should give you a clue to how essential a healthy thyroid is for overall well-being!)

Thyroid hormone makes progesterone receptors more sensitive. This means that low thyroid hormone can mimic the symptoms of low progesterone. (Remember the fun PMS stuff we talked about in the previous section??)

Low thyroid hormone can also directly impact neurotransmitter levels. It can cause low dopamine levels - which translates to lack of motivation, drive, and willpower.

Taking Control Of Anxiety & Depression

No matter what root cause (or causes) of depression and anxiety you’re dealing with, there are certain steps you take with your diet and lifestyle to help alleviate symptoms.

For some of my clients, just making lifestyle and diet changes is enough to completely alleviate symptoms of depression and anxiety! Here are some things to try in all the major categories:

Eat:

  • Eat plenty of healthy fats (like avocado, coconut, and olive oil)
  • Avoid processed foods and excessive sugar
  • Some people can benefit from removing dairy & gluten
  • Choose organic foods (especially the Dirty Dozen)
  • Aim for 10 servings of fruits & veggies per day
  • Focus on eating for balanced blood sugar (avoiding processed carbs!)

Move:

  • Exercise has been shown to be as effective in most cases as antidepressant drugs for alleviating depression
  • Find what works for you and what you ENJOY doing
  • If you haven’t been exercising regularly, just start with 20-30 minute walks daily

Sleep:

  • Turn off screens 1 hour before bedtime
  • Schedule enough time for enough hours (8 hours or more)
  • Sleep in a dark room, with the temperature slightly cooler

Stress:

  • Active stress management is something I recommend for ALL my clients (no matter what health concern they have)
  • Meditation, yoga, tai chi or qi gong, making art, dance, journaling are some of my favorite options for managing stress
  • Making a conscious decision to “switch” from fight-or-flight mode to rest-and-digest mode
  • Consider working with a counselor or therapist - especially if unresolved emotional issues are a factor for you

 

Next Steps For Treating Anxiety & Depression

After reading Part 1 and Part 2 of this series, you might be feeling a little overwhelmed.

It seems like you could have hormone issues, toxin exposure, gut issues, and maybe yeast overgrowth, too! (Plus there’s definitely some past trauma lurking that needs to be dealt with….)

As one of my mentors in Chinese medical school used to say: “You are entitled to more than one problem at the same time!”

The truth is that while some people have one primary cause, the majority of depression or anxiety cases is due to a “perfect storm” of factors.

Everything we’ve discussed in this series can be interrelated:

  • Having dysregulated cortisol levels can not only contribute to changes in the brain and brain chemistry, but can alter the way the immune system operates, leaving us more prone to inflammation and more vulnerable to infections in the gut
  • Having a leaky gut from food intolerances or infections will affect the brain directly, but will also be a major contributor to detox system overwhelm
  • Having low thyroid function can cause symptoms of low progesterone

The complex way all these systems interacts means one thing: you don’t want to go this alone!

I really believe everyone should have a trusted practitioner by their side, guiding them through the process of healing.

The right practitioner (trained in a holistic approach like Functional Medicine) can untangle the strings of depression and anxiety and get back to feeling like yourself!

 

If this resonates with you, I’d be honored to have you book a 20-minute consult with my team. These consults are totally free and a chance for us to share how we are trained to help you!

→ Learn more and book a free consult with my team here.