By Dr. Nicole Sundene
Holistic Psychiatry & Hormone Specialist
While I am not a true MD Psychiatrist many of my patients refer to me as their "Natural Psychiatrist" because I am fulfilling the role of prescribing natural medicines, hormones, and nutrition as discussed below with my favorite anxiety herbs to treat my patient's mental health. However, I am not a true Psychiatrist, but simply practice "Holistic Psychiatry," which means together we will look at your anxiety not as a prescription, but as a process to first:
#1 Look for the Root Cause of the anxiety
#2 Test female hormones and balance hormones to optimize mental health
#4 Test nutrition aka vitamin and mineral deficiencies that may be contributing to lack of neurotransmitter production. Neurotransmitters such as serotonin and dopamine are needed to make us feel happy, and like everything is okay, and we can properly focus and get things done as procrastination caused anxiety which then makes anxiety worse.
#5 Work with you weeks in holistic counseling sessions or have you work with your counselor covered by your insurance plan to implement better coping skills and support the process of improving your nutrition, lifestyle, stress, exercise, and supplement routine.
So that is how I treat my Anxiety patients in my Holistic Psychiatry practice. Keep in mind if your mental health disorder is severe such as in bipolar, schizophrenia, or severe suicidal depression I will require you to have a board certified Psychiatrist MD working in conjunction with me, as well as a counselor.
Anxiety disorder in Women's Health is best managed by a Holistic Hormone Doctor that can work to evaluate the root cause of the anxiety. For women hormone imbalance such as PMS, PCOS, Perimenopause, Menopause, Adrenal Fatigue, Hypothyroidism, and Hashimoto's Thyroidtis are often the culprits behind what appears to be a generalized anxiety disorder. Especially when typical anti-depressants or anti-anxiety medications do not help.
While many of my patients are currently feeling anxious and can benefit from a natural anxiety treatment the real clue that the anxiety or depression is caused by hormone imbalance is when women experience fluctuating symptoms.
Anxiety that fluctuates monthly is absolutely hormonal. Women that suddenly develop anxiety later in life such as in their 40's or 50's that have never experienced anxiety before are most likely being triggered by peri-menopausal or menopausal hormone changes that can impact mood. Patients with a family history of thyroid disease that suddenly develop anxiety should also have their hormones checked by a female hormone expert.
While different herbs help patients with their anxiety the real issue with anxiety is that we work to discover the root cause. Some women are just more anxious than others but the real clue that there is an underlying hormone issue is when a woman that has never had anxiety before is suddenly feeling anxious, agitated, angry or impatient. Especially when nothing situational is actually going on to contribute to the anxiety.
As a Naturopathic Doctor I honestly don't really even care WHAT herb we use to treat your anxiety. That is pretty boring to me to just prescribe HERB X for SYMPTOM X. Dr. Google can do that for you....what my Detective brain always wants to know is what is the ROOT CAUSE? Until we understand the root cause the patient will just continue to perseverate with their symptoms and nothing will ever truly fix the problem or provide lasting results.
I have included a brief blurb so that you can get an idea of the herbs that I generally find safe for most women to try for their anxiety. Please always check with your Naturopathic Doctor before combining herbs with prescription drugs. Do not take sedative herbs during pregnancy or breastfeeding. More importantly treat yourself to a Naturopathic consultation to discover the root cause of your anxiety by popping over to my SCHEDULE page.
#1 Passionflower- The intricate purple flower pictured above was shown to be as effective as sedatives in the benzodiazepine (valium) family, the aerial parts of this herb are great for nervous tension and anxiety. In recent research, passion flower extract at 45 drops daily (tincture) was shown to be as effective as oxazepam (similar to valium). This nervine herb is also “antispasmodic” which makes it great for people with constant nervous twitching.
#2 Ashwaganda- This is probably one of my favorite herbs. Unlike most of the herbs on this list that are designed to be taken at night or at least late afternoon, both ashwaganda and schisandra (listed below) are terrific “adaptogenic” herbs that help us tolerate our stressful days that much better. You can make some tea, or grab some capsules of the organic root and take two capsules twice a day.
This herb is specifically intended for those that are exhausted and agitated or debilitated by stress. In ayurvedic medicine ashawganda is a renowned anti-aging and rejuvenating herb.
#3 Schisandra- Referred to as “Chinese Prozac” this herb is commonly unappreciated and underutilized in American herbal practice. Schisandra is a terrific day time adaptogen herb and should be taken as is recommended with Ashwaganda, two capsules with breakfast and lunch, or a cup of tea in the morning and afternoon. The berries can be made in to a nice aperitif for those with a low libido.
#4 California Poppy- The bright orange flowers of the California poppy, leaves and other aerial parts are sedative, anti-spasmodic, and mild pain relievers. This is also a gentle herb used for colic and agitation in children. Do not use this herb or any other sedative herbs in pregnancy.
#5 Hops- No I am not recommending that you drink more beer to calm down. However, the herb commonly used to make beer bitter also works as a sedative. It is extremely bitter though so is best given a small part in your herbal tea formula for insomnia or stress. Do not combine with prescription sleep aids due to an additive effect.
#6 Kava Kava- A well known Polynesian psychotropic sedative, this herb is sedative and “spasmolytic” and thus helpful for chronic pain conditions. Several conflicting studies debate the safety of using this herb with alcohol. Liver damage is thought to occur if used in large doses in conjunction with alcohol. This research however was used to scare many people away from using kava kava for whatever reason.
People need to simply remember that herbs are medicines and that an herb with actions similar to prescription sleep aids and analgesics will of course pack the same side effects. A strong herb demands respect. When used ceremoniously, or occasionally this herb does not run the risks it runs when it is heavily abused.
The best way to safely use kava kava is in an organic tea form. Look for a tea blend that includes kava, or make your own. This herb should not be used in large doses, and large doses should not be used over long term. Do not combine with alcohol, or use during pregnancy or nursing. Chronic abuse will result in a horrible scaly skin rash.
#7 Lavender- Try adding lavender to your favorite baked good recipe. Purple lavender flowers will offer a sophisticated herbal makeover to your favorite shortbread cookies, or white tea cakes.
Lavender is great in your herbal medicine blend, and can also be used to stuff pillows, or as an aromatherapy stress reliever throughout the day. Lavender should not be used in pregnancy due to it’s emmenagogue effect.
#8 Lemon Balm- Also known as “Melissa officinalis” this herbal sedative should not be used by those with hypothyroidism as it inhibits the thyroid and is used to treat hyperthyroidism, however for everyone else it is a common simple herb to grow in your garden and make in to your own calming sedative tincture each summer. Do not use this herb in pregnancy.
I grow lemon balm in my garden and harvest it, rinse it, let it dry and then pack it in a jar with enough room for it to swim around in some vodka. Shake the jar once a day for two weeks. The vodka will extract the constituents and after a few weeks you can strain out the plant part leftovers and put a half a teaspoon of this liquid “anxiety medicine” in a little bit of water when you need something to calm you down.
#9 St. John’s Wort- Although we think depression the second we hear about St. J’s Wort, we also need to address that depression and anxiety tend to walk hand in hand and this herb is not just an anti-depressant it is a mild sedative as well. St. John’s Wort has also been shown to have a lower risk of side effects than conventional anti-depressants and is worth trying for those that don’t quite have severe enough depression to mandate the use of a prescription pharmaceutical, but instead need something to take the edge off and boost the mood a bit.
If you are suffering from anxiety that has a form of depression associated with it, then this would be a great herb to consider in your herbal sedative blend pending that you are not on any anti-depressants or anti-psychotic medications. The condition “serotonin syndrome” may occur from combing this herb with those classes of medications or other herbs and supplements that boost neurotransmitter levels.
This herb should not be used by those on oral contraceptives, or any medications as it increases the cytochrome p450 enzyme system which results in a more rapid detoxification of drugs from the system. The drugs or birth control pills are then rendered useless. Standard dose of St. John’s Wort for those not on any other medications, is 300 mg three times daily of the 0.3% standardized extract.
#10 Red Clover- Not traditionally recognized as a sedative, but as a mineral source and blood thinner, this “cooling” herb calms the system and has a special affinity to the lungs, throat, and salivary glands.
This is a terrific balancing herb to include in your herbal sedative blend as the dried flower blossoms make for a beautiful addition to a glass teapot. Do not use in pregnancy, or if on blood thinning medications.
#11 Catnip- Not just for cats. Catnip is actually a gentle nervine herb for humans. No it won’t make you roll around on the carpet or chase after things (at least not to my current knowledge) but it is still a great mild sedative.
This herb should absolutely NOT be used during pregnancy, as most herbs should never be used during pregnancy without checking with your naturopathic midwife, however it can safely be used in children by making a very weak tea. Be sure to only give your children organic herbs and check with their pediatrician or naturopath prior to use.
#12 Valerian- Definitely one of the more potent herbal sedatives, valerian is also a great pain killer for those with chronic pain. Some people prefer not to use this herb because it can cause quite the herbal hangover the next morning and most complain that it makes them feel really groggy, or desire to sleep through the day.
Look for a tea formula that includes a bit of valerian to avoid the hangover, and if you have severe anxiety, chronic pain, or insomnia talk to your naturopathic doctor about using this at a more therapeutic dose. Always use organic root.
#13 Motherwort- The perfect herb for fried and frazzled mothers; it strengthens a weak heart and is great for nervous palpitations. Motherwort is best taken over a prolonged period of time, and because it is a uterine stimulant, it should not be used in pregnancy.
#14 Skullcap- A bitter, cooling sedative herb that is best used for nervous fear, restless sleep, and is also thought to lower blood pressure. This herb is great for people with the inability to pay attention—huh what was that? And has been used effectively to calm down children with ADHD. Some kids concentrate better when they are sped up, and some do better when they are calmed down.
#15 Chamomile- One of the most common kitchen herbs, chamomile is a great mild sedative and digestive bitter.
Be careful in using chamomile tea if you experience ragweed allergies, formally known as the “asteracea family” and previously recognized as “composite family.” If you have a history of seasonal allergies you should exercise caution.
If not, make your tea up strong, use a heaping tablespoon and not a teaspoon per 8 oz cup of water, and allow to steep 15 minutes covered. If you don’t cover your chamomile tea you will lose the calming essential oils to evaporation. Only elitist herbalists know to do that. Welcome to the club!
Traditional Herbal Sedative Use: Establishing a nighttime or daytime tea ritual is a great way to reduce stress, avoid binge eating, and help those that fight insomnia get to sleep at a decent hour.
Directions: For most of these herbs simply make a tea with about 1 tsp (milder herbs use a tablespoon) to 8 oz cup of boiling water. Allow to steep covered 15 minutes. Or if you aren’t a tea drinker just look for a pre-made organic herbal formula to take in tincture or capsule form, and follow the manufacturer’s recommendations.
Please check with your Naturopathic Doctor before combining any herbal medicines with prescription medications or making any changes to your health care routine or simply treat yourself to a Naturopathic consultation with me by popping over to my SCHEDULE page. I am able to help patients that are not in Arizona via Telemedicine with their anxiety, we can conduct hormone testing and implement naturopathic medicine by phone consult.
Dr. Nicole Sundene
Female Hormone Expert
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!
Dr. Nicole Sundene
Hormones actually picked me many years ago! Did you know I was serendipitously selected by life to become a Holistic Hormone Doctor 23 years ago? Be it God, kismet, fate or dumb Luck, my old neighbor in Issaquah, Washington chased me down one rainy morning when she saw I worked at our neighborhood medical clinic and offered me a job working for her Hormone Doctor. She said there was an immediate opening, better pay and it sounded much less stressful than the busy Family Medicine and Dermatology clinic I worked at for 20 Docs rooming 100 + patients per day. Of course I took the job!
Little did I know this would be the #1 experience that would shape my future career as a Women’s Health Doctor and I was put in very special training with a genius Female Hormone Specialist that was a Pharmacologist and Internist. Working for the Hormone Doctor every day was a wonderland of fun for me! I left the office giddy with joy every day! The biochemistry nerd in me really enjoyed the hormone and hormone lab lessons on her specialties of Menopause, Perimenopause, Osteoporosis and Chronic Pain. She also taught me everything I know about autoimmune testing and hormones.
The Female Hormone Specialist also taught me a lot about chronic pain testing for women with Fibromyalgia. It is difficult to find a doctor to take you seriously when you are in severe pain, or struggling with bizarre autoimmune disease symptoms… but she did this with tremendous compassion, kindness and brilliant detective work. Fibro patients need a multitude of proper tests conducted to determine the cause of the pain which requires multiple specialists working together or someone with enough knowledge in Rheumatology, Endocrinology, Neurology, Nutrition and Infectious Disease such as Dr. Panitch.
Thankfully Dr. Panitch taught me a great deal about Menopause, Perimenopause and Osteoporosis, at the same time I also worked for 3 Dermatologists. While I loved helping them with their skin surgeries we would often see patients with chronic skin problems such as acne, psoriasis, eczema, dermatitis and MRSA struggle to get better. When I asked the Hormone Doctor about these patients she explained how a lot of chronic disease skin issues are actually hormone problems in disguise. Which makes a lot of sense when we see women get dry skin with menopause or thyroid disease, and oily skin with PCOS, Perimenopause and PMS. “Until we treat the cause of the Hormone Imbalance topical agents will continue to fail” is the take home message from my acne rant that prefaces the latest Natural Medicine research for Acne on my latest blog about “Hormonal Acne."
The #1 clue a symptom is related to hormone imbalance is fluctuation. Women who have fluctuating symptoms throughout the month or that begin with menopause, pregnancy or postpartum should be aware of how hormones can adversely impact their skin. There is way more to acne than just testosterone. Estrogen and progesterone are often to blame as well as many other hormones.
To properly balance hormones we need to use natural medicine to treat the root cause of the hormone imbalance. While we sometimes need bioidentical hormones or thyroid hormones, oftentimes from a Functional Medicine standpoint the cause of the hormone imbalance is something we address with herbs. Patients that like to drink tea, take herbal capsules, tinctures or supplements and improve their nutrition are perfect candidates for Naturopathy.
Patients that do not like those above things should stick with their MD's as it is difficult for me to help them as a Naturopath when they can't take herbs or make nutritional changes specific to what their body needs. Women are very unique as I discuss further in my Snowflake blog.
Today I wanted to share a picture of my favorite room, the "Herb Room" and remind you to drink more iced herbal tea to stay hydrated in the heat.
Teas are perfect for those of us in the Arizona heat that need to be taking in more water. I love to use ginger, mint and licorice which all contain powerful antioxidants and can help mask the flavor of herbs used for medicine. Patients can enjoy their herbal medicine tea iced for a refreshing change. Simply make your tea as normal, refrigerate and serve over ice!
If you need my help testing and balancing your hormones, or have not been feeling good and want to get to the "Root Cause," simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!
Dr. Nicole Sundene, NMD
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Specialist in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!
By Dr. Nicole Sundene
Scottsdale Naturopathic Doctor
Menopause is a common often frustrating Women's Health condition caused by a woman's permanent cessation of her menstrual period for more than 12 consecutive months. The sudden drop in estrogen, progesterone and testosterone levels from menopause result in hot flashes, night sweats, irritability, insomnia, weight gain, stomach aches, joint pain, hip pain, vaginal dryness, painful intercourse, bladder infections, anxiety, depression, anger, agitation and sadness.
While progesterone and testosterone begin to decline for women around age 35 as seen in Perimenopause, Menopause is primarily associated with the deficiency of the hormone estrogen. Menopause typically occurs between 40 and 50 years of age, with the average age of menopause being 52 years old. As women's estrogen levels drop they notice changes in their body temperature, hair, skin integrity, vision, vaginal dryness, sleep and concentration.
In the United States, studies reported that women at the age of 51 often experience menopause. Further, every year 1.3 million women report menopausal symptoms in the United States. Women with menopause have lost the ability to become pregnant naturally. Early menopause, also known as "Premature Ovarian Failure" occurs when women are in their early 40's or 10 years or more prior to the average age of menopause.
Medical studies report that hormonal disturbances are common in later stages of life. Depletion of estrogen level leads to the high concentration of follicle-stimulating hormone and luteinizing hormone in the body that significantly disrupt the hypothalamic-pituitary-ovarian axis. As a result, endometrial development failures disrupt the regular menstrual cycles and finally develop various menopausal symptoms. Moreover, different surgical procedures such as hysterectomy with bilateral oophorectomy may also cause surgical menopause. Other health conditions such as cancer, cancer treatments such as chemotherapy can cause early menopause and affect a woman's hormone and thyroid. Endometriosis medications such as antiestrogen medication can also lead to the development of premature menopause. [1, 2]
It is important for women not to confuse Perimenopause, Menopause, and Postmenopause. With so many different labels how can the patient even know which one applies to them? Knowing the correct diagnosis when working with your hormone doctor is important as different treatments, herbs and hormones are appropriate for these 3 different stages of a woman's normal life span. Perimenopause generally occurs 10 years prior to menopause or ages 41-51 if we were to predict based upon the average age of menopause and is characterized by irregular periods with heavier or lighter menstrual flow before menopause. Menopause is the complete absence of menstruation and often the most difficult time for women to get adjusted to as their body and brain adjust to their new low hormone levels. This is when women commonly need the most hormonal support as even tapering a patient slowly off BHRT is often more gentle than just the sudden cessation of estrogen. Some of my female patients need bioidentical hormones around menopause for a few years and then discontinue them when no longer needed and some patients will prefer to be on hormones at all times. Once a woman has gone through menopause she then becomes labeled with "Postmenopause."
Signs and Symptoms of Menopause
Menopausal symptoms are divided into the following three main categories. [1, 3]
Vasomotor Symptoms: Studies reported that 75% of menopausal women experience vasomotor symptoms. The vasomotor symptoms include:
Hot flashes are the prominent symptoms of menopause experienced by almost 85% of menopausal women. A menopausal hot flash episode often remains for at least three to four minutes. Moreover, different factors such as alcohol, emotional stress, and diet may aggravate hot flashes. Studies reported that the average age of menopausal hot flashes is around 5.2 years.
Note that the intensity and severity of migraine changes over time. Studies also reported that the migraine without aura commonly occurs during menopause. Remember that although migraine with aura is less common in menopausal women and is highly associated with the risk of stroke. [3, 4]
Urogenital Symptoms
Urogenital symptoms occur in approximately 60% of menopausal women. These symptoms include:
Vaginal dryness, pruritus, lichen sclerosis and dyspareunia (painful intercourse) results from vaginal atrophy. In contrast, urethral atrophy leads to urgency, frequent urination, dysuria, and stress incontinence. Women have more bladder infections, more kidney infections, more yeast and vaginal infections with menopause as the vaginal flora is impacted by pH changes and lack of hydration from diminished goblet cells producing mucous that can protect bacteria from adhering to the tissues. [3]
Psychological Symptoms
Around 45% of menopausal women report psychological symptoms. These symptoms include:
Studies also recommend checking and evaluating weight, blood pressure and overall health at a check up when women become menopausal or begin to notice changes. The Latin rood word for Uterus comes from "Hysteria" and that is how we ended up with the word hysterectomy. Most likely because a doctor made the observation that women go hysterical with menopause. As much as I hate this judgement label, I would agree it is true for some of my patients and have sadly seen many women struggle with menopause and their mood. My great grandmother was "accidentally given a hysterectomy after the birth of her last child" and she suddenly went in to severe depression and hot flashes. Back in 1911 the only cure her doctor was aware of for menopause was to "Drink beer." The church lady was told to illegally brew beer during Prohibition so she had medicine for her menopausal symptoms. She had to shutter her house once a month to make the beer she needed for her hot flashes. Thankfully we have much better treatments for menopause thanks to bioidentical hormones, nutrition and Naturopathy! I do not want any of my patients to feel like they have to break the law to treat their menopause. Brewing beer for menopausal symptoms illegally seems barbaric. I did learn in Naturopathic school at Bastyr University that Hops are a natural phytoestrogen that help with menopausal symptoms. Fortunately we have tinctures and capsules so women do not need to rely on drinking beer!
The key indicator that a woman's depression or anxiety is related to menopause or perimenopause is a sudden onset of anxiety or depression later in life when no previous mental health disorder occurred. Most women with anxiety will have a lifetime pattern that they describe to me as always feeling anxious since childhood, teens or 20's but when women that are 40-50 experience a sudden adverse shift in their mental health we should be extremely concerned about their hormone balance whether we are treating the menopause with hormones or herbs it is vital for it to be addressed and properly diagnosed or women can often feel they are going crazy, "I feel like I am suddenly going crazy!" has been a comment I have heard time and time again as a menopause doctor. I then ask whether they have experienced any mental health disorder previously in their life and when they tell me no, I counsel them that it is their hormones impacting their mental health and they are not crazy.
Nearly every single work day I get a new female patient that is depressed or anxious struggling with their mood and frustrated that they are not getting any results from their anti-depressants or anxiety medications. When we get their hormones properly fine tuned it can help stabilize the patient and oftentimes I have seen patients be able to discontinue the antidepressants whether I taper them off myself, their psychiatrist tapers them off or they just suddenly stop taking it because they tell me they no longer need it. Obviously I do not recommend women suddenly stop their antidepressants but instead gradually taper them down once their treatment is working effectively and they no longer need the anti-depressant or valium, Ritalin, Vyvance, etc. Hormones can impact mood, memory and concentration. It is possible for women to be taken off these common medications once their concentration, peace and sense of joy is restored by addressing the imbalanced endocrine system with Functional Medicine, Bioidentical Hormones and Naturopathy.
Did you know I once had a patient sent to me by a Psychiatrist that was on 5 mental health drugs? She is no longer taking any of those medications thanks to her decision to get her hormones checked and treated. Once we had all her levels adjusted properly she completely returned to normal. All of her symptoms started at 35 and she had never had anxiety or depression before until her hormones began to suddenly shift. The psychiatrist was of course shocked to see how much better she was with the hormones as we worked together to taper her down from everything. It was a very powerful mental health lesson for both of us.
While many Naturopathic Doctors are intimidated by complex patients, my background in prescription family medicine makes me a bit more fearless...especially since I know my treatments are generally harmless compared to the side effects of antidepressants, anti-psychotics and the addiction potential for patients at risk of becoming hooked on benzodiazepines like valium and xanax when really their hormones are just off and not compatible with feeling happy.
Perimenopause which begins as early as 30 for some women that will enter menopause early can be extremely hard on a woman's mental health as they battle estrogen dominance and progesterone deficiency or "Permanent PMS" as I like to call it as my mental health patient nods and says "That is exactly what is wrong with me. It does feel like permanent PMS because I am gaining weight, I am super bloated, I feel agitated, and I am constantly fighting with my husband and crying over nothing!"
Many marriages can be pushed to the brink of marriage counseling when women are struggling with their hormones. In order for men to have more empathy and understanding I would love to perform an experiment where I give someone's husband 6 x 1mg estradiol tablets with no progesterone to oppose it and see how bitchy and evil the husband becomes. So far I have not been able to find any men to participate in my "PMS Experiment" and I won't be holding my breath waiting for someone's husband to volunteer, although I would like to make a a video of a man crying and raging on imbalanced hormones. So that we can have more understanding and support with PMS and PMDD. I believe many marriages could be saved, families could stay together and not be broken with better understanding and more support for women. Many women bring their husbands in to the appointment so they can learn how to keep a period tracker app, know what window in the month is best to be kind, silent, keep things simple, or even better maybe just leave us alone and go on a fishing trip and return when it is all over.
In conclusion, its a massive hormone red flag when women suddenly develop anxiety or depression later in life yet also cite no current stressors such as work stress, death, loss, finance, parenting or relational stress yet cannot figure out why they continue to remain unhappy, moody, agitated, on edge and constantly anxious or stressed. We all know when we are going through a tough time that we can expect not to feel fabulous. But if there is no actual trigger for a woman's mental health condition then I need to put on my Detective cap and look for possible hormone, vitamin and nutritional imbalances that can be the actual underlying cause of the moodiness. "Tolle Causam" means "Treat the Cause" and is my favorite Naturopathic Principle because unless we understand the cause we cannot treat the cause. Until we treat the actual cause whether it be with natural medicine or prescription medicine... the patient will fail to improve because we are not addressing the actual problem and simply trying to mask each symptom of hormone imbalance rather than treat it at its source.[3]
Causes of Hot Flashes during Menopause
Hot flashes are the first thing everyone thinks of when they hear the word menopause. But what actually is causing this hot flash? A hot flash is a feeling of sudden warmth in the upper body parts, experiencing high in the chest, face, and neck region. Sometimes it is accompanied by sweating, followed by chills. Medical research studies are still working to explore the exact mechanism of menopausal hot flashes. Multiple research studies attribute the hot flashes to hormonal changes during menopause. Such as the fluctuations in the estrogen or progesterone level, less estrogen production, and modulation of the thermoregulatory system that results in the development of hot flashes. With less estrogen the hypothalmus that is in charge of setting the body temperature is now telling the body to run hotter. The sudden drop in estrogen triggers the serotonin receptors in the brain to turn the temperature up via vasodilation. As a reflex the woman then becomes too cold and is having hot and cold flashes or hot flashes followed by sudden chills.[3, 5]
Research studies have found a connection between hot flashes estrogen and serotonin and have attributed the hot flashes to the estrogen withdrawal and imbalance between estradiol and follicle-stimulating hormone levels. Recent studies reported the association between hot flashes and a high concentration of serotonin that triggers changes in the set-point temperature. A low estrogen level modulates the activation of serotonin receptors in the hypothalamus that change the set-point temperature sensitivity and results in hot flashes. [3, 5, 6]
Complications of Menopause
Studies reported that women with menopause are at greater risk of developing certain medical conditions. These conditions include heart and blood vessel diseases, urinary incontinence, osteoporosis, sexual problems, and weight gain. [1, 2]
Menopause Diagnosis and Hormone Tests
The diagnosis of menopause involves the evaluation of clinical symptoms and lab tests. Generally, there is no need for lab tests to confirm menopause. However, there is never a more important time for a woman to get her check up and make sure her thyroid, cholesterol and blood chemistry are normal. While not all women require treatment for menopause having the full profile of hormones tested and balanced can help women to feel more optimal. [1, 2]
Menopause Treatment History
Menopausal treatments from opium to acupuncture were used for the management of menopausal symptoms till 1942. Then Wyeth pharmaceutical introduced Premarin containing synthetic estrogen obtained from "Pregnant-Mare urine" for the treatment of menopause. Despite the fact collecting urine from pregnant mares trapped in stalls all day is animal abuse, the sales of Premarin spiked until the 1970s. Reports linking synthetic estrogen with a high risk of breast cancer. During that time, the formulation was modified with the addition of progestin to ensure safety and efficacy. But the 1984 National Institutes of Health assertion backed that estrogen is an effective agent for hot flashes, bone loss prevention, night sweat, and other menopausal symptoms. [7]
Moreover, by the 1990s, the American Heart Association, the American College of Physicians, and the American College of Obstetricians and Gynecologists recommended estrogen for both heart conditions and bone loss. As a result, estrogen use soared up again among menopausal women until the Women’s Health Initiative (WHI) in July 2002. The Women’s Health Initiative (WHI) conducted a study on around 17,000 postmenopausal women. The study revealed that the combination of estrogen and progestin increased death rate in postmenopausal women due to increased risk of blood clotting, heart attack, stroke, breast cancer, and ovarian cancer. This report changed the whole scenario of hormone replacement therapy for more extended periods. Later, multiple research studies confirmed the WHI reports and found a high incidence of heart conditions and cancer with hormone therapy. The risk of these morbidities is prevalent in women older than 60 years. Moreover, women who abruptly stopped the hormone therapy intervention also showed a significant risk of death or comorbidities. Thus, the prescription of hormone therapy depends on the patient medical condition, duration of therapy and previous history. In 2002 we had to call 100's of women to take them off of their Premarin and Prempro without bioidentical hormones as widely available at the time, most patients were transitioned to soy and black cohosh although we have seen advancements in Women's Health since then and have much better natural treatment options for menopause. [7]
How Long Should Women take BHRT Hormones After Menopause?
Hormone experts generally prescribe BHRT hormone therapy for a 3-5 year window after menopause. Once a woman turns 55 her cancer risk is naturally going up which is when I generally taper the hormones down. An irresponsible hormone doctor leaves patients on the same dose, while a responsible hormone doctor will taper the dose down as is considered biologically normal for the woman's age group. Yes, hormones are effective drugs of choice in the treatment of menopausal symptoms, but treatment goals must be safe and realistic as the patient ages.
Do BHRT Hormones Cause Cancer?
It is important to work with an ethical hormone doctor to determine if BHRT is safe. The doctor should first evaluate the patient's entire family history of blood clots, heart disease, stroke, breast cancer, uterine cancer and ovarian cancer risk when considering any hormone use whether natural or synthetic. Women without a family history of reproductive cancer are excellent candidates for BHRT. A good menopause hormone doctor will provide alternative remedies to BHRT when family history of breast cancer exists. The hormone doctor should case by case weigh the benefit-risk ratio of hormone therapy and recommend a symptomatic approach to treat menopausal symptoms. For safety reasons women should not use hormones without a doctor continuously monitoring and checking hormone levels. Hormones should not be given to patients with cancer. After a reproductive cancer an Oncologist would need to approve if BHRT will be safe or harmful for the patient to use. While some cancers are hormone driven, patients that have had cancer will need to follow their Oncologist's instructions. Naturopathy and herbs can still be used even when hormones cannot be used. While BHRT hormones generally do not cause cancer a woman should always get their mammogram, pap smear and pelvic exam every year as a safety measure. Should a woman naturally develop cancer while taking BHRT these important cancer screenings will help Reproductive cancers are generally very slow to grow and thus the hormones would be removed immediately. [7]
Treatment of Menopause
Various treatment interventions help the management of menopausal symptoms and prevent the risk of severe medical conditions. These treatment options include:
Hormone Replacement Therapy
Hormone Replacement Therapy (HRT) encompasses both natural and synthetic hormone therapy for menopause and is considered the most effective approach to treat menopausal symptoms. It helps prevent both vasomotor symptoms, urogenital symptoms, improves lipoproteins level, and reduces the risk of osteoporosis. The hormonal agents include systemic estrogen, estrogen-progestin combination, progestin alone, estrogen-bazedoxifene combination, or progestin combined with oral contraceptives. Although many hormone formulations are currently available, I only prescribe BHRT from a compounding pharmacy or natural estrogen and progesterone from a regular pharmacy. Synthetic preparations are associated with worse side effects than a woman's own natural hormones or "bioidentical."[1-3]
Hormonal replacement therapy helps treat hot flashes, improves sleep disturbance, prevents bone loss, and helps urogenital atrophy. It is important to know that estrogen alone is not recommended in women with a uterus as it can cause uterine hyperplasia and cancer in such women. It is usually recommended for menopausal women with hysterectomy. The combination of estrogen and progesterone were mainly prescribed to menopausal women with an intact uterus. Now with the latest research we know women without a uterus still need progesterone for their mental health, sleep, vaginal lubrication, vision, weight and overall wellness. [1-3]
Whether natural or synthetic, hormones should be used for a short-term duration at their lowest therapeutic doses. Because the long-term use of hormone replacement therapy is associated with a high risk of coronary heart diseases, thromboembolism, breast cancer, stroke, and ovarian cancer. Side effects of hormones involve bleeding between periods, gastrointestinal symptoms, and breast tenderness. [1-3]
Alternative to Oral estrogen
Medical research studies reported the following alternative to oral estrogen formulations. [3, 7]
Localized Estrogen Therapy
Estrogen intended for vaginal administration helps urogenital symptoms, including vaginal dryness, vaginal atrophy, painful intercourse, and other urinary symptoms. Different dosage forms such as creams, rings, and suppositories deliver estrogen to the vaginal tissues. The localized estrogen therapy is associated with a bit of risk of venous thromboembolism. Alternative to vaginal estrogen, hormone-free remedies, including plant oils and lubricant, are also helpful in managing vaginal dryness. [1-3]
Non-Hormonal Treatment
Non-hormonal treatment involves using antidepressants, anti-seizure, and antihypertensive agents for a short duration, usually up to a few months. The antidepressant, including both serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in low doses, helps the management of both vasomotor (hot flashes) and psychological symptoms (poor mood). Paroxetine is the only FDA-approved SSRI for the treatment of hot flashes. Besides, Gabapentin, an anti-seizure agent, also helps reduction of menopausal hot flashes. Clonidine is an antihypertensive agent that might help both high blood pressure and hot flashes during menopause. [1-3]
Selective Estrogen Receptor Modulators (SERMs)
Selective estrogen receptor agents modulate the estrogen action without interfering with the endometrial growth. These agents include raloxifene, ospemifene, and bazedoxifene that help prevention of osteoporosis and improve lipoprotein level. Also, estrogen combined with these modulators significantly helps vasomotor symptoms and prevent hot flashes. Among these modulators, the ospemifene is highly effective in the management of vaginal dryness. [1-3]
Osteoporosis
Osteoporosis-specific treatment in menopausal women involves the intervention of the administration of denosumab, bisphosphonates, and supplementation of calcium and vitamin D. Both denosumab and bisphosphonates inhibit the activity of osteoclasts and resorption of bones that increase bone density and prevent the risk of fractures. The supplementation of Vit D and calcium strengthen the bones and improve bone mineralization. [1-3]
Nonprescription Remedies
Complementary and alternative treatments include phytoestrogens, vitamin E, and omega-3 fatty acids. Vitamin E and omega-3 fatty acids have been used to treat the vasomotor symptoms of menopause. They are generally safe; however, studies have shown that they are no better than placebo. [1-3]
Certain plants contain a high concentration of plant-based estrogen, known as a phytoestrogen. These plants include soybeans, whole grains, lentils, legumes, flaxseed, chickpeas, and various fruits and vegetables. They are rich sources of the main types of phytoestrogens, including Isoflavones and Lignans. [1-3]
Role of Bioidentical hormones in the management of menopausal symptoms
Bioidentical hormones are referred to the manmade hormones obtained from plant sources that share a similar chemical structure with the human testosterone, progesterone, and estrogen hormones. Examples of bioidentical hormones include 17 beta-estradiol, estrone, progesterone, and estriol. They are available in different dosage forms, including patches, oral pills, topical gels, vaginal capsules, and topical creams. Bioidentical hormones are either made by pharmaceutical companies or by pharmacies according to a physician's order. They help treat various menopausal symptoms, including hot flashes, mood disturbances, night sweats, sleep problems, low libido, and weight gain.The bioidentical hormones made in a pharmacy, known as compounded bioidentical hormones, are not approved by FDA. They are marketed as safe and effective bioidentical hormones, but they may possess serious health risks. The side effects of bioidentical hormones include fatigue, excessive facial hair growth, bloating, mood swings, and acne. It is important to mention that FDA recommends low doses of hormone replacement therapy for short-term use.
My hormone philosophy is to use the least amount of bioidentical hormones needed to keep women in a normal physiological range for their age group as some women will continue to make hormones from their adrenal glands and body fat while other women will have zero hormones in their tank and need a little bit of a hormone cream, troche or lozenge containing natural estrogen, progesterone and testosterone to restore skin integrity and aging, improve vaginal dryness, aid with mood, decrease hot flashes and improve sleep at night. It is important to work with a skilled hormone doctor that understands how to properly test bioidentical hormones via blood work (not saliva) and adjust them while also ensuring their safety. Women undergoing treatments for menopause, perimenopause and PMS will need to have their hormones checked and adjusted 1-2 times per year at minimum to ensure they are functioning optimally and that their hormones are at optimal levels. I have seen a lot of careless prescribing of hormones over the years and it is dangerous to not have these levels monitored and adjusted. Women should always be given progesterone with their estrogen regardless of if they have a uterurs because progesterone is also needed for vaginal hydration, mood, sleep and vision. Women will generally feel better on a low dose of combined hormones.
My practice style is to continuously test the hormone levels to ensure they are safe and being metabolized properly as genetics such as COMT mutation can cause estrogen pooling and increased risk of side effects and adverse outcome in women that are not having their hormones regularly checked.
The recommended schedule for hormone testing in menopausal patients is every 3 months the first year that bioidentical hormones are started and then every 6-12 months after that. Hormone testing is covered per the patient's insurance plan and it is imperative the patient goes to the correct lab either Labcorp or Sonora Quest whichever is contracted with the insurance plan is where the blood is drawn for testing. Whether a prescription product from the pharmacy is being used and states no testing is required or whether a compounded pharmacy is being used to make the BHRT the levels should tested as women metabolize hormones very uniquely and high levels of estrogen that women cannot eliminate can cause sudden weight gain.
Natural treatment of menopause
Medical research studies reported a significant positive impact of the following herb on menopausal symptoms.
Lifestyle modifications:
Various lifestyle interventions can also ease the menopausal signs and symptoms. [3] These include:
Need help with menopause symptoms? Simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!
Dr. Nicole Sundene
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!
References
Dr. Nicole Sundene, NMD
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!
Dr. Nicole Sundene, NMD
Menopause symptoms can be truly miserable between hot flashes, night sweats, insomnia, constipation, dry skin, and mood disturbances such as anxiety, depression, trouble concentrating, poor memory, ADHD, and generalized brain fog.
Many women experience hormonal anger from constantly feeling too hot.
Ladies, let food be thy medicine with this easy Menopause Milkshake recipe designed to help calm hot flashes and night sweats. This recipe is packed full of herbal medicines to help women stay cool.
Whether the heat is bothering us in Arizona, or we are having a hot flashes or night sweats the cooling properties of spearmint, red clover, and nettles combine nicely with blueberries and pears to help cool women down. In Herbal Medicine, every food has a "temperature" and it is either heating, neutral or cooling. We need to avoid the hot foods, and heating herbs if too hot as I explain in my blog about how I gave myself a hot flash from mixing them all together!
Nettles were found to help menopausal hot flashes after 8 weeks at 450mg daily. Spearmint is cooling and refreshing.
Red clover is a phytoestrogen herb that also works for anxiety as a mild sedative to help women sleep better. I also love Red Clover for gentle ongoing detox support as a clogged liver often causes imbalanced hormones.
By combining multiple cooling foods and phytoestrogens this is how many of my menopause patients manage their menopause symptoms with Bioidentical Hormones!
Menopause Milkshake Recipe:
1-2 cups of chilled “Hot Flash Iced Tea”= Spearmint, Red Clover, and Nettles Herbal Tea
1 cup frozen Blueberries
½ frozen Pear
½ cup of Kefir
1-3 Tbl freshly ground Flaxseed
1-2 Packets of Stevia to taste (optional)
1 Scoop of Protein Powder or Collagen
Mint to Garnish
Instructions:
Add chilled herbal tea, fruit, flaxseeds, kefir, protein, and stevia to blender. Mix well and garnish with mint. Drink 1-3 shakes per day for hot flashes and night sweats.
To make your “Hot Flash Iced Tea,” combine 1 tsp each of nettles, red clover, and spearmint per 8 oz of water.
Tea should be made fresh every 1-2 days and discarded after 48 hours in the refrigerator.
To make 2 nights' worth of iced tea at once, you will need 3 cups of boiling water and 3 Tbl of each:
1) Nettles 2) Red Clover 3) Spearmint
Cover herbs with boiling water, stir, and let steep covered to preserve the mint essential oils for 15-45 minutes. Letting your tea steep a little longer helps absorb the minerals and phytoestrogens that mimic estrogen into your tea. Chill your tea before using it in my Menopause Milkshake.
Women should drink their menopause shake 1 hour before bedtime for optimal, cool sleep.
Dr. Nicole Sundene
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease.
She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!
Dr. Nicole Sundene, NMD
Female Hormone Specialist
"Why don't I lose weight since I turned forty? What is wrong with my hormones? I still have my period." Mindy, Scottsdale, AZ
Weight loss, especially for women, is a very complicated multifaceted hormonal and nutritional condition in my mind as a Naturopathic Hormone Doctor. Women in their forties and fifties dealing with perimenopausal and menopausal weight gain definitely need a skilled Naturopathic Hormone Doctor.
Battling weight gain, especially when you are doing everything right and the needle on the scale is not budging can be very stressful and stress ironically worsens weight gain.
Sadly, many of my hormone imbalance patients are basically starving themselves on very few calories to maintain their weight because their metabolism simply does not work correctly. Especially when they have a thyroid condition or an autoimmune disease such as Rheumatoid Arthritis and Hashimoto's. We correct the metabolism, and they can eat food again in reasonable amounts.
I am sure you would not be googling natural solutions to solve hormonal weight gain unless you were not getting lasting solutions to maintain your weight that actually worked as I describe in my story about “Why I Became a Naturopathic Doctor.”
To quickly summarize the story, I was having depression, anxiety, acne, and stomach aches while gaining weight at 205 pounds on a hamster wheel chasing all my different annoying symptoms with prescription drugs and specialty visits. None of the prescription drugs helped me at all, and actually made me gain more weight, until I met a Naturopathic Doctor that fixed me. This is when the trajectory of my career permanently changed because I realized I did not want to go to school to be a pill pushing MD doctor, I wanted to go to school to provide natural lasting solutions that actually solved women's health challenges!
So, I do understand the frustration of not getting lasting solutions that work for weight loss and having to pay a high amount of money in doctor visits, labs, specialty visits, and prescription drugs. Some patients against my advice are maintaining their weight with expensive semaglutide shots (that I do not recommend.) Let's talk about instead what is healthy for your aging body when dealing with weight loss.
First, I would like to take a minute to explain how I help women actually lose weight for good in my Women’s Health and Hormone practice. What we want to do is achieve lasting solutions so that they do not have to rely on prescription drugs.
Here is what I want to do as your Naturopathic Hormone Doctor to fix your weight:
#1 Why do you have weight gain in the first place?
#2 What is the "Root Cause” of your weight gain?
#3 Comprehensive Female Hormone Labs, Macronutrients, Cholesterol, Chem Panel, CBC, inflammatory markers, vitamins, minerals, macronutrients, etc
#4 Look at other health factors such as Diabetes, Insulin Resistance, Anemia, Hypothyroidism, Hashimotos, and other Hormone and Metabolic issues.
#5 Order Comprehensive Nutrition Testing to understand the right diet for your body specifically.
#6 Implement my 4 week Vegan or 4 Week Meat- Naturopathic Meal Plans I recommend set at 1500 calories per day to create a gradual calorie deficit over a long period of time. While tedious, especially over 40, the studies show slow and steady weight loss is lasting permanent weight loss. As my patients learn new healthy recipes they enjoy eating, they naturally begin to feel better. Proper nutrition means less expensive supplements and medications!
#7 Make sure you are working out with a trainer that is helping you enforce my plan, and/or a counselor or therapist that is helping with any emotional issues making proper nutrition choices. Some of my patients need weekly appointments. Most need monthly at first.
#8 Continue to fine tune nutrition, and use herbal medicine, vitamins and supplements as well as natural hormones or “BHRT” and Armour Thyroid to help you feel your very best and most energetic.
Without understanding #1 and #2 on my list, I sadly have seen many of my hormonal weight loss patients fail over the years, so I write these blogs so my potential new patients understand if they will be a good fit for my women’s health practice or not.
I want every single patient in my practice to be a success story. Please do treat yourself to a Naturopathic visit with me if you want want real answers, if you have an inquiring mind that wants to know, if you want the right nutrition for your body, want me to fix the underlying hormone imbalance that is most often causing your female hormonal weight gain then lets really do this!
While I love helping women with weigh loss, and am a proud “Mother Hen” watching them transform, I also have been doing this job for over seventeen years as a Naturopathic Doctor, and twenty five years total in family medicine and have seen women fail to lose weight because these hormone challenged were never properly tested for and treated.
If the same hormone imbalance or nutritional challenges made every woman fat then we would all have the same pill for that, however I see a variety of different types of female hormone imbalance, thyroid, adrenal, insulin, and inflammatory aka autoimmune weight gain that are all completely different from each other, and required different approaches, different hormones, and different herbs and supplements. That is what is so uniquely amazing about women's health! Just like in my "Female Hormones and Anxiety" blog I talk about how we are somewhat like snowflakes with our mental health. While weight gain symptoms all look the same, the Root cause is not always the same!
So if my investigative Women’s Health Naturopathic Hormone process sounds like exactly what you need to feel like the absolute best version of yourself…. then please visit my SCHEDULE page and let’s get working on your weight loss program now!
#1 question I am asked as a doctor is: "Why can't I lose weight?"
Weight loss programs that fail to address female hormones in women often fail women!
Oftentimes in Women's Health the "Root Cause" of weight gain is hormone imbalance. We need to first diagnose and treat the hormone imbalance as well as implement my basic Naturopathic hormone balancing weight loss program that is 100% free for women to start below.
One thing that always brings me joy as a Naturopathic Hormone Doctor is helping women identify the specific weaknesses in their hormones and metabolism so we can target the exact nutrition program, macros, and hormone balancing supplements to aid weight loss.
Getting to see women transform to their fittest most beautiful version of themselves is such an amazing reward for doing this job! I often receive new patient referrals from my weight loss success stories as their friends and family have always seen them challenged by being overweight and suddenly like magic change right before their eyes.
The truth though is that it is not magic... it is hormone balancing with a splash of hard work.
When we don't understand women's complex female hormones, thyroid, and adrenal profile, expecting weight loss to happen is somewhat like vacuuming in the dark. While vacuuming in the dark will be somewhat helpful, we are missing things, it is inefficient, time consuming, lacks results, and is frustrating. Vacuuming just like hormone balancing becomes a lot easier when we "flip the lights on" and know exactly the obstacles we are dealing with as well as the areas of greatest concern!
By running a full panel of Naturopathic Hormone Labs women can target their nutrition to their own metabolism and understand exactly what ratio of fats, protein, and carbs will works the best for their specific constitution.
This is when I see "the lights come on" for my hormone weight loss patients and everything becomes much easier and efficient. Hacking macros and hormones with labs makes everything so much easier and my women are no longer "bumbling around in the dark" lacking a clear direction of how to best target their efforts.
Bumbling around in the dark is oftentimes why women fail with their weight loss program because they are busy trying different fad diets, and not gathering the specific information that helps optimize their personal metabolic challenges.
Naturopathy can work very well for weight loss when we can take the time to analyze nutrition, metabolism, hormones, and vitamins that can impact weight.
Female hormones are complex and precisely why weight loss for women can be very tricky when complex hormone imbalance is present. To further confuse matters, women experience hormone imbalance and constantly fluctuating hormones every month with PMS. As well as in their forties and fifties with perimenopause and menopause. Therefore it is important we rule out hormonal causes of weight gain with women first and foremost as this is impacting women monthly, and also in midlife when perimenopausal weight gain begins around forty.
When women cannot lose weight with diet and exercise I recommend we conduct hormone and macronutrient testing to determine the correct macro profile of carbs, fats, protein, and fiber needed. Looking at a full set of female hormones, thyroid, and adrenal tests can diagnose the particular hormone imbalance or imbalances impeding the metabolism.
#2 Question I am asked as a Naturopathic Doctor: "Is my thyroid making me fat?"
As a thyroid specialist, I often see thyroid disease causing weight gain, and weight loss, but in women we MUST address all of the other hormones in the "hormone spider web" for a woman to feel properly balanced, healthy, and fit.
If we have a weakness in one part of the web it will impact the stability of the rest of the web.
The impact of estrogen deficiency that suddenly occurs in Menopause, can impact the rest of the hormone web and cause weakness in the thyroid, which is why it is imperative for women to have their thyroids checked when they are perimenopausal and menopausal in their forties and fifties. Some women will naturally start perimenopause earlier in their thirties.
The average age of menopause is 51, and perimenopause generally starts the ten years prior to menopause. Women that enter menopause at 45 will generally exhibit signs of hormone imbalance earlier, in their thirties. Premature Ovarian Failure occurs when women become menopausal sooner than age forty. POF is common in women with anorexia and low body fat as body fat levels directly increase estrogen levels whether too much body fat or not enough.
Menopause can also impact the adrenal glands in our spider web model. When the ovaries cease to produce estrogen, progesterone and testosterone, the adrenal glands become the sole source of hormone production. The hormones DHEA, and cortisol can begin to become deficient in menopause or sooner if there is "Chronic Stress."
Symptoms of adrenal fatigue can cause insomnia, joint pain, stiffness, moodiness, anxiety, depression, and a general blah unmotivated feeling where my patient has become flat and lost their zest for life.
The adrenals and the thyroid also interact with each other and when the adrenals become fatigued and cease to produce hormones that can impact the thyroid gland and tax it further. And vice versa. This is what is going on behind the scenes with many of my weight gain patient's labs.
It is not just always about the Thyroid! We must address our entire "Metabolic Web of Hormones" as I explain in my video about "Hormones and Metabolism" on my free class page.
Hypothyroidism, Hashimoto's, Insulin Resistance, and Adrenal Fatigue can also cause women to gain weight.
#3 Will testosterone help me lose weight?
Testosterone deficiency occurs for most women around the age of 35, this is why our metabolisms slow down when we lose our lean muscle mass with menopause. Each year our metabolism goes down further as we lose our female hormones. Transitioning through perimenopause and menopause also causes the body to become more inflamed and Insulin Resistant. Insulin is the "Weight Gain Hormone," that causes women to gain weight despite following the same diet and exercise regime in their 20's.
"I am doing everything the same, I am not cheating." I commonly hear women complain as they continue to gain weight and cannot figure out why. Most women that are over-weight have insulin resistance and need supplements to address and correct this blood sugar disorder that is common in women with PCOS.
Sluggish liver can also impact the metabolism, as can inflammation from Food Sensitivities and Food Allergies.
Chronic Fatigue and Chronic Pain can cause women to exercise less resulting in less calories burned on the same diet.
The good news is that by addressing female hormone imbalance, and implementing the following Naturopathic weight loss program I will review today, I do see many cases of stubborn hormonal weight gain finally release!
Usually I treat the hormone imbalance with herbs and supplements. Herbal medicine takes time to work, most women only can lose one pound per week and need to be patient. If you have fifty pounds to lose as a woman, that is a year of hard work you need to mentally commit to doing for long term success to keep the weight off.
With menopause, generally Bioidentical Hormones are needed to reduce the inflammation spike causing weight gain. Women under fifty generally do not need hormones and instead have weight gain issues from excessive amounts of hormones as I discuss more in my "Estrogen Dominance" blog. Much of what I do for women and weight loss does involve making dietary changes and taking supplements.
In order to lose weight, one must follow the basic laws of physiology that you must consume fewer calories than you burn each day. This is especially important to follow if you have a thyroid condition, insulin resistance, or estrogen dominance! Expecting your twenty year old metabolism to burn a ton of calories is not realistic without first fine tuning your hormones and then creating a calorie deficit every day.
You must burn more calories from exercise than you consume. If you are inactive and not exercising this is why it is impossible to lose weight especially when lack of exercise is compounded by hormone imbalance.
Addressing the underlying causes behind poor eating and lifestyle habits with regular weekly counseling is the ONLY way to ensure a healthy and long-term approach to weight loss. Food should be fuel and not a treat. The treat is feeling and looking good from perfect fueling!
I know this very well based on how I used to look and feel before I went to Naturopathic school and how I look and feel now. Many people say I look better today than I did in college! That is because I am on the right fuel for my metabolism and hormones!
Eating wrong and not properly fueling your body is the hard way after living both options!
The best approach to weight loss emphasizes lifestyle changes that incorporate whole foods and activity. Many simple sustainable Naturopathic changes in diet and activity can lead to maintainable, long-term weight loss success.
Physical activity guidelines are recommended to complement the nutrition counseling and make this process easier and more productive.
If you are struggling with Seasonal Depression, or post holiday exhaustion it is imperative you get outside for an hour to get 10,000 lux of natural light every day to ensure your energy, metabolism and mood are optimal for weight loss. Especially for women that crave carbs! Lack of light puts us in a fatigued dormant state that is not conducive to fat burning.
Many of my weight loss patients have underlying mental health issues such as depression, anxiety, and PTSD and are using food for comfort instead of fuel. This can create a vicious mental health loop when choices for emotional reasons are worsening physical health, appearance, and self confidence which then drives more unhealthy food choices as "rewards."
Patients constantly seek instant gratification for emotional reasons to treat their poor mood. These poor fuel choices then cause them to feel more fatigued, lethargic, hopeless and depressed.
Depression, sadness, hopelessness and anger trigger more unhealthy food reward behavior and the vicious cycle continues as a woman continues to gain more and more weight.
By using Naturopathy and hormone balancing we can also treat these underlying mental health issues naturally and work to use new rewards such as jewelry, makeup, concerts, events, and fun trips rather than cookies, cake, and candy.
The interesting thing about women's health is that each woman generally has different hormonal metabolic challenges to address. It is not a one sized fit all program, although I generally need my patients following the basics below.
Please do not sign up for hormone balancing work with me if you are not willing to make at least some baby step changes with your diet. Occasionally I get new patients that seem to think all their problems will be fixed with popping a hormone or applying a cream. This is not realistic and we are working to balance the hormones so your metabolism is running optimally and you are receiving benefits from your efforts with diet and exercise.
Hormone testing is important in women's health since many women with hormone imbalance are starving themselves to death to compensate for their sluggish metabolism. Sadly, I see this happening often, and is why I am writing this blog so women know there is a better way than living on 800 calories a day in starvation!
Once I diagnose the metabolic problem and fine tune their hormones they are then able to eat a normal amount of food each day without gaining weight.
While each woman's metabolism is unique like a snowflake and will require labs to develop a custom tailored dietary macro program, I would like to share the basics for hormone balancing that generally work for most women with hormone imbalance.
#4 What is the best diet to support imbalanced female hormones in weight loss?
The best diet for balanced hormones and weight loss is:
• HIGH in fiber-dense carbohydrates found in whole grains, beans, fresh fruits, and vegetables. Also, it is important to drink plenty of water= 60-80oz daily + 8 oz per "vice" of alcohol or caffeine and more water if you are exercising.
• MODERATE in fish and organic lean meats such as chicken and turkey.
• LOW in red meat, animal fats, hydrogenated oils, full-fat dairy products, pre-packaged, processed, and refined foods, sugar, alcohol, and caffeine.
General Tips
• Set a realistic weight loss goal, usually 1 to 2 pounds per week is recommended.
• Balance food intake with activity. The most successful weight loss programs combine increased activity with decreased caloric intake.
Tips to Increase the Amount of Physical Activity in a Day:
• Try some group activity classes at the local gym, fitness center, or swimming pool.
• Work out with family, friends, or neighbors. Motivation is increased with partners.
• Take a walk at lunchtime.
• Use a bike to run local errands and go for pleasure rides.
• Use the stairs instead of the elevator.
• Walk to the bus stop or work
• Park the car a few blocks away and walk.
• Dance to some favorite music at home or sign-up for a series of classes.
Tips to Reduce the Quantity of Food Eaten:
• Plan and prepare meals ahead of time.
• Identify foods that are often over consumed and set limits, or avoid.
• Identify and limit problem foods.
• Eat small, frequent meals and healthful snacks.
• Eat slowly and savor each mouthful. Allow 20-30 minutes for each meal, rest, set the fork down, and/or converse between bites. Chew the food well.
• Wait 10-15 minutes before taking a second helping.
• Serve food on a smaller plate.
• Drink two glasses of water or a cup of hot tea 30 minutes before meals to reduce appetite.
• Postpone a desired snack for at least 10 minutes. It may be helpful to take a walk, get some fresh air, drink a cup of water or tea, or take a short nap during this time.
• At restaurants eat half of the portion and take the rest home. Prepackage the food to go before starting the meal.
• Nurture with nonfood related activities, such as a hot bubble bath or a massage, developing a hobby, relaxing with a good book, or listening to some music.
WHAT DO I DO IF MY PROBLEM WITH WEIGHT LOSS IS BINGE EATING?
Tips to Eliminate Eating Cues that Promote Overeating:
• Designate a specific place in the home to eat, preferably the kitchen or dining room. Eat snacks and meals only when sitting down at this place.
• Avoid watching TV, talking on the phone, reading, or driving while eating. This will help increase the awareness of fullness.
• Do the grocery shopping on a full stomach to decrease impulse buys.
• Create a schedule for eating. Plan meals and snacks at regular intervals, including the types of food to be eaten.
• Carry food to work or when going out, to eliminate long periods without eating.
• To prevent visual food distractions, keep all food stored in the kitchen cupboards or refrigerator, rather than out on the counter.
• Read or listen to motivational books, join a support group, or consider seeing a therapist to help with any emotional issues involving food, eating, and/or weight loss.
Diet, activity, and emotional work can provide feelings of health and wellness, which establish new patterns that support and nurture the body. Food should be eaten for fuel and not just for fun.
When we are on the best fuel we have the best energy and mental health.
Think well! Eat well! Be well! Let's get to work ladies!
If you need my help diagnosing and treating your personal hormone imbalance to determine your personalized weight loss plan, I would be happy to help!
Simply visit my SCHEDULE page to treat yourself to a Naturopathic hormone visit in my Scottsdale clinic or by telemedicine!
Dr. Nicole Sundene
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease.
She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!
By Dr. Nicole Sundene
"My hair is thinning. Is this from hormones? What vitamins should I take for hair loss?"
Nancy M, Scottsdale, AZ
Female hair loss is much different than male pattern balding. Rarely do I NOT find a hormone imbalance when my female patient's hair is falling out. While I will discuss which vitamins hair needs to grow today it is important we always address and Treat the Root Cause of hair loss. We cannot just gloss over it with some vitamins.
Ladies your hair is your "Fifth Vital Sign." Hair loss is the #1 Women's Health alert your body sends when something is seriously wrong! I actually cannot think of a single time in over fifteen years that a patient did not have a mild to moderate level of hormone imbalance with their hair loss.
While nutritional deficiencies such as B vitamins, biotin, zinc, pantothenic acid, iodine, selenium, iron, and so forth can cause hair loss it is often multifactorial and there is a number of different physical issues I find on blood chemistry causing my patients to lose their luscious hair. If you are in your 20's enjoy your amazing hair and try to use some of my tips for prevention!
Women often have a hormone imbalance and nutritional deficiencies causing hair loss especially with Postpartum changes, PCOS, Hashimotos, Hypothyroidism, Adrenal Fatigue, and Menopause.
First and foremost let's analyze hair loss from a somewhat bizarre-sounding Chinese Medicine standpoint.... Chinese Medicine considers hair the ”glory of the kidneys." What that crazy talk means is that your hair is an excess of your total well-being it is your glory. If your "glory" is burnt out or burnt up so then so shall your hair be from an energetic standpoint.
“Kidney chi” is our “energetic bank” in Chinese Medicine, and if our energetic bank is all dried up, then there is not much left over for such frivolities as hair! Think about it. The healthiest women in my practice that eat super healthy all naturally have long healthy hair. In Chinese Medicine when they are referring to the kidneys they actually are talking about the Adrenal Glands. Too much constant stress taps the Kidney Chi Bank and can contribute to female hair loss.
Second and most importantly, I would like to just say FLAXSEEDS, FLAXSEEDS, FLAXSEEDS! If you get nothing from this discussion with me as a Female Hormone Specialist and Naturopathic Doctor on hair loss and how to grow your hair faster, please add 1-3 tablespoons of freshly ground flaxseeds to your daily routine. You can do up to three tablespoons twice daily if you are a flax seed fanatic like me, It's basically a functional food full of omega-3's, proteins, and phytoestrogens that help balance imbalanced hormones. So unless you have a Food Sensitivity to them they are the PERFECT women's health food to stir in your oatmeal, add to applesauce, and mix in to your smoothies.
I am pretty sure on my death bed I will still be mumbling about the importance of flaxseeds.
On the advice of my vet, since fish oil gives my dog the runs, I now give my Golden Retriever freshly ground flaxseeds and in just a week his coat became shiny, less itchy, and the bare patches filled in (normally this time of year he pulls his hair out like a mad man from Seasonal Allergies.
Thirdly we want to have PROTEIN. Flaxseeds are a great source of omega 3 oils and protein, but I would also drink a protein smoothie a day; you can add your flaxseeds to a smoothie with collagen and protein powder. You need to be taking either collagen, bone broth, or hyaluronic acid also in somewhat high doses until your hair is growing in again. You can get organic high quality brands through your account with Fullscript.
Omega Up! If you are doing the flaxseeds hardcore, you are getting enough omega 3’s to ensure shiny strong hair, if not, then try a tablespoon of fish or flax oil daily (no cod liver oil for pregnant women because the vitamin A is a teratogen.) Flaxseed can be used as a salad dressing, go in your smoothies, oatmeal, or drizzle on roasted or steamed veggies.
Multivitamin: B-vitamins and iron are crucial to hair growth as nearly the whole B family plays a role in hair growth. While it is nice to pretend like you are getting all your nutrients from your food the reality is a simple multivitamin can prevent a lot of different women's health issues I see with anemia, depression, and hair loss being the top three. If you are menopausal and no longer bleeding you should not supplement with iron without having your Ferritin stores tested. Your Ferritin stores should be above 75 at minimum for female hair loss. while too much iron is toxic not enough is the #1 cause of female hair loss that I almost always find. So please check your iron levels!
Multimineral: A mineral-rich diet is important for healthy hair growth. Deficiencies in calcium and iron are very common unnecessary causes of women's hair loss!
Biotin: Your multivitamin may not contain that much biotin so check the label and see if you are getting the RDA. I usually recommend 10,000 mcg of biotin daily for hair loss patients. Be sure to stop taking your biotin 2 weeks prior to any thyroid or hormone testing as it can cause abnormal results.
Skip the Sodium Lauryl Sulfate! A known carcinogen and skin irritant, look for SLS-free shampoos.
Skip the daily shampooing! You can still rinse your hair every day and condition it, but daily shampooing is stripping your scalp of essential oils. If you have a dry scalp, seborrheic dermatitis, or dandruff this is especially important. This saves not just your hair, but your water and shampoo bill. See? You can afford that more expensive SLS free shampoo after all now….No excuses, organic isn’t really that much more expensive when you look at it as a whole because now you are washing your hair every 2-3 days and using less shampoo.
SLS= Poison for your scalp!
Don’t forget to get a bit trimmed off your ends every 12 weeks or so. If you are growing your hair out it is okay to skip a few hair cuts but try not to skip them completely.
Try some handstands! If you aren’t a gymnast, you can still hang your head off the edge of the bed to increase blood flow to the scalp periodically throughout the day, or you can do some extra downward dogs if you are a yoga fiend like me. We recently bought a Yoga Trapeze stand which makes inversion therapy fun and easy!
Rosemary and Mint! The invigorating herbs of the Laminacea family bring more circulation to your scalp as I just talked about in the above handstand blurb. Rosemary has been associated with improving hair growth for quite some time. It is also anti-aging and good for memory and ADHD.
Buy organic rosemary essential oil and add a few drops to your favorite shampoo and conditioner. Start with 1-2 drops and then work up to about 5-10 drops of the pure essential oil (remember never apply any essential oil straight to the skin unless it is lavender.)
Horsetails and Nettles: have long been touted as hair-growing herbs because of their high silica and mineral content; unfortunately, as our soil becomes more toxic, I don’t feel comfortable using them unless they are certified organic. The reason for this is that they suck up minerals like silica from the soil along with toxic heavy metals such as cadmium and arsenic. So when I make nettle and horsetail tea I use organic herbs. I generally buy my organic herbs from Mountain Rose Herbs and Starwest Botanicals as my trusted suppliers. Please do your research and be sure you are buying good organic products for your herbal medicines!
While I am happy to share my basic Naturopathic strategy for female hair loss, please ensure you are working with a skilled hormone doctor that knows how to test you to determine the cause of your hair loss. If we do not identify and treat the cause of female hair loss it will just continue to get worse. So ladies please pay attention to this important "5th Vital Sign" ...Your Hair!
Treat yourself to a Naturopathic visit with me if you need my help. Simply pop over to my SCHEDULE page. Most decent insurance plans cover the labs I would need to order for hair loss (not Medicaid but Medicare is fine.) So if you are dealing with this I would be happy to run some screening tests so we know what is going on with your hormones, vitamins, and nutrition. It is important not to ignore female hair loss, while usually, I find hormone imbalance, sometimes more severe diseases such as Autoimmunity are actually to blame. Therefore we should never ignore hair loss! While hair is important to many of us women for vanity reasons it is also a clear indicator of my patient's overall health and well being.
Thank you for the great women's health questions. Please continue to send them to me on a postcard to my address below. Remember if your Naturopathic question can't fit on a postcard then you need to BOOK A VISIT!
Dr. Nicole Sundene, NMD
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!
Dr. Nicole Sundene, NMD
Scottsdale Naturopathic Doctor
As a Naturopathic Doctor, my primary goal is always to “Find the Cause”.
I follow seven principles, but in my mind finding the cause is the most important and trumps things like “Docere: Doctor as Teacher”, “Prevention”, “Treat the Whole Person”, and “Remove the Obstacles to Cure."
When you really think about it, without treating the cause, the rest of those principles are basically useless.
Now of course the hippocratic oath tells us to “First do no harm”, but I have to argue with that a bit. If you don’t have a proper diagnosis established, if you don’t know what is CAUSING a certain symptom set then there is no way you can actually “do no harm”. The wrong diagnosis inevitably leads to harm. We have to find the cause to avoid harming the patient with the wrong medication or treatment that will always have the potential for side effects.
I have an enquiring mind that always want to know what is causing the patient's symptoms and am not a good fit as a doctor for patients that want to just mask their symptoms with medications or herbs. While I know how to do this, I am going to explain today why this is totally ineffective and sometimes dangerous.
What happens when you can’t find the cause?
You keep looking…
Recently I came home and something smelled REALLY bad in my house.
REALLY BAD!!!
Now, I looked everywhere and could not find the cause. I have a child and four pets so the possibilities of where the smell could come from were seemingly endless in my mind.
Eventually, I realized that the smell was coming from the garbage can in the kitchen. It was a hot day, and earlier I had made some fresh cabbage and pear juice and the remnants were left in the trash to heat up and stink up my entire place.
No amount of incense, air freshener, oils, or candles can combat the smell of rotting cabbage!
Trust me! I tried.
And even after I “treated the cause” there was still a residual stench.
Occasionally the body sends us really stinky signals like acne, eczema, psoriasis, and skin rashes that will just NOT clear up. The typical medical “air fresheners” aka drugs, herbs, supplements and natural medicines are just suppressing the symptoms or “smells” and not treating the actual cause of the problem. The fact is we simply need to “take out the trash," or remove whatever is causing or triggering the symptoms as I commonly see in Chronic Bladder Pain and Chronic Yeast Infections in women.
A good doctor will always put on their medical detective cap and find the cause of the problem.
The REAL cause of the problem with acid reflux for instance, is NOT that your stomach is making too much aberrant acid at the wrong time of the day and so you need to be on some sort of proton pump inhibitor to decrease the levels of HCL produced.
The real problems I actually find are Food Sensitivities and stress.
Stress and diet is then what we need to treat while we also do something to soothe the acid reflux, and allow the ulcers on the stomach lining to heal.
If we don’t treat the real cause the body will just continue to over-ride the medications.
In most cases if you are on a medicine and the dose has to be increased, or a new med needs to be added on board to further manage new symptoms, then chances are you are ”spraying too many air fresheners” and not actually “taking out the trash”.
I say if you can’t find the cause, you always just have to keep looking. Maybe you have to do what I did with the stench in my home and spray air fresheners WHILE searching for the cause. Maybe you still need to “spray some air fresheners” AFTER treating the cause. Obviously there are diseases that have a strong genetic component that will not respond to diet and lifestyle. But, by all means, find and treat the causes that you can. I have yet to see a Chronic Disease in women that did not somewhat improve from my Naturopathic methods.
Most causes of disease boil down to poor diet, stress, and lack of exercise. When we bring someone’s health in to balance diseases and symptoms just naturally start to fall off. A balanced diet and lifestyle creates a balanced and healthy person.
However, I always tell all people with chronic disease to never give up.
I know the limitations of the kind of care I provide patients, and if I can no longer be of help, then I am busy looking for the person that can.
I don’t care who it is, I don’t care what they do. You have to never ever give up when it comes to certain medical mysteries. I refuse to be so arrogant as to think that I can facilitate the healing process perfectly in every single person I encounter. Also, not all patients are willing to do the kind of work I prescribe as I explain in my blog about "Why I Became a Naturopathic Doctor."
If you want to watch a very inspiring movie about two parents determined to save their chronically ill little boy, I would highly recommend the movie “Lorenzo’s Oil."
Oftentimes when I am not successful with adequately helping someone as a Naturopathic Doctor, it is because the patient is not willing to treat the underlying cause. Perhaps they are in denial about the cause, or perhaps they are suffering from depression, or lack of motivation, but regardless, I think it is tough for people to REALLY get better unless we are always working to address the cause.
Just my experience after 23 years working in Women's Health. Women that show up with a notepad and take notes during our visits always get better. I have learned this is a key sign that my patient is perfect for Naturopathy because they are committed to the process of finding the best things for their personal constitution, and want to actively learn how to avoid triggers that make them worse.
In Latin, Tolle Causum means “Find the Cause."
If you need my help finding your Root Cause, simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!
Dr. Nicole Sundene
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!
Why did you become a Naturopathic Doctor? Who will be successful with Naturopathic Medicine and who will not be successful with Naturopathic Medicine? Jen Phoenix, AZ
"Naturopathic Doctor" was a term I had never heard of growing up. I always wanted to be a doctor as a child and was working to get a Pre-Med degree so I could become an OBgyn. As I started a Pre-Med program in college, I experienced a cluster of symptoms that all started up at once. I was having terrible headaches, stomach aches, and acne. I constantly went to the Campus Doctor who eventually sent me to an Internist who then sent me to a variety of specialists: Dermatologist, Pain Management Doctor, Migraine Specialist, Psychiatrist, Gastroenterologist, Neurologist, and many more. It went on for a year and I continued to get worse. I gained weight from the side effects of the different medications and I became depressed and began to lose hope. On top of my symptoms that did not improve, the antidepressants caused my weight to balloon to 200 pounds! I was suddenly trapped in a fat suit, on a bunch of medications that were not working, and did not feel like myself. I was not getting any benefits from the anti-depressants and just getting the side effects of weight gain.
Each doctor I was sent to gave me a different medicine and then referred me to a different specialist for my other symptoms. I continued to down spiral with my health and depression until a friend recommended I visit her Naturopathic Doctor. Within a few weeks, I gradually began to feel better with herbal medicine. When my “Food Sensitivity Test” came in I rapidly became better as I was now able to exactly pinpoint the foods causing my stomach aches, headaches, and acne.
My spirits lifted and I was no longer depressed as I began to feel better and regained hope I did not have to live like that anymore. The ND also took the time to get to know me and acknowledge my stress levels from moving 90 minutes away from my family and sudden reliance on flavorless unhealthy dorm food that we often avoided and instead went out for even worse Fast Food. My Naturopathic Doctor encouraged me to return to my normal healthy diet, stop the Fast Food, exercise for my anxiety and depression and my depressed mood returned to normal. He kept track of the big picture and pointed out how my change in diet was the Root Cause of my sudden issues.
As I returned to a perfect state of health thanks to Naturopathy, the experience made me stop and think about what I was planning on doing with my life as a doctor. I was struggling with severe disappointment in the medical system and realized how ineffective it could be for chronic disease management. I realized my own personal hero in this challenge was the Naturopathic Doctor and not all of the MD's that spent no more than 5 minutes with me and just gave me ineffective prescriptions that caused side effects. I then decided if I really wanted to be an effective doctor with the time to get to know my patients, I was going to have to become a Naturopathic Doctor and study Functional Medicine, Naturopathy, Nutrition, and Herbal Medicine.
I wanted to be a doctor that took the time to listen and put the whole story together and not just treat each symptom with medication. Part of what my Naturopathic Doctor did that was so helpful was to take the time to understand what had changed with my dietary habits, dorm food, lack of sleep from studying all the time, and increased stress being away from my parents for the first time. The dorm cafeteria food was unhealthy, high in calories, and full of triggers from my Food Sensitivity Test.
At the same time in 1994, a lady in my Microbiology class changed my life forever when she recruited me to work at her Health Food Store. She was impressed with my quick ability to memorize everything and wanted me to help run her health food store. As a Biochemistry major, I was in absolute heaven getting to learn about all of the vitamins, herbs, and supplements! I couldn't believe it was actually my job to read about the products in the health food store when I was not cleaning, stocking, or helping customers! Amidst all the books in the health food store, I found several books by Naturopathic Doctors that went to Bastyr University, and the light bulb went off! I then felt inspired to attend Bastyr University for my medical degree instead of the University of Washington as I had first planned.
After I graduated from college in 1999 I began working for a Hormone Doctor, which is when my love of Women's Health and Hormones began which you can read more about in my Hormone Doctor blog. Which is why I love answering your Women's Health and Hormone questions on my blog! Please drop me a postcard with your questions. Remember if it can't fit on a postcard then you need to SCHEDULE an appointment with me.
Here are a few more Naturopathic questions I received this week from patients. Everyone always should know how Naturopathy works so they don't invest their time or money in something they cannot follow through on. I want every patient I see to be a success story. The following is more information on how Naturopathic Medicine works, the type of timeline to expect, as well as what kind of patients should not sign up for Naturopathic Medicine that I cannot help as well as the patients that I can most easily help.
Remember that Naturopathy is a process you go through, and I don't actually have a magic wand to wave. I know it appears that way at times when you see a patient of mine. But I can promise they did some level or work. Instead, I am teaching you about what diet and lifestyle your particular body needs and using herbs and vitamins to heal your system and provide temporary relief of symptoms while we are working to address the symptoms at their Root Cause.
#1 Question I receive as Naturopathic Doctor: Can you help me?
The #1 question I constantly receive every day blowing up my phone is "Can Naturopathic Medicine help me?" I can never answer that question until I can review with the patient what Naturopathic Medicine entails they do as I list below. In my mind as someone that has served patients for 15 years as a Naturopathic Doctor is not if what I do will be effective. I know it works. My concern is whether or not the patient is going to do it. Patients that do not follow the instructions as I have listed below simply don't get better. So please know I would not waste my time practicing ineffective herbal medicine as an Integrated Doctor that also knows how to prescribe medications. When it comes down to the decision I want to do what is the most effective, with the least side effects. So really when patients want me to prescribe their medications it is pretty boring for me. I feel like anyone can sit and write you a book of prescriptions and that my talents are being wasted. This is why I prefer patients read the information listed below carefully to ensure they will be successful with Naturopathy. Practicing prescription Family Medicine is truly boring to me and their are millions of other places you can go for that. I want to help women transform into their ultimate healthy best most beautiful anti-aging version of themself and that is what truly brings joy to my heart as a doctor!
Who are the most successful Naturopathic Patients?
My most successful Naturopathic patients understand that healing is a process and not a prescription. They trust me, my methods, and my expertise. They don't Google everything I prescribe and call to argue about potential side effects...instead they just follow their treatment plan and let me know when they have an adverse reaction to something I have prescribed so I can provide a substitute. They let go of any pre-conceived notions as to what diet they should be on and trust their body will tell them through the Naturopathic process of testing their Food Sensitivities, hormones, vitamins, cholesterol, and blood sugar what diet they should be on.
They are committed and highly capable of following my instructions and are eager to learn about what helps their bodies function the best. They love to use metrics such as hormone and nutrition labs to understand their body and thrive from the detailed information. They know we will need to work closely together monthly until their symptoms have improved and budget this in accordingly so they can be successful with the Naturopathic process they start. They understand they are investing in a new system of living that is a learning process in order to find long-term solutions to avoid the use of medications. They know all of that will require more than one appointment.
Who can you not help with Naturopathic Medicine?
What is the #1 factor that determines if a patient will be successful with Naturopathic Medicine?
Trust is the #1 factor that determines if my patient will be successful with Naturopathic Medicine. I always have better outcomes with patients who trust Naturopathy and trust me as their Naturopathic Doctor. I always find it easier to help patients that are referred by another patient. Especially for weight loss. They have seen with their own eyes how my hormone fine-tuning and herbs work and they are eager to do everything I say to do. They have already seen the magic of Naturopathy with their own eyes! They know it works.
I will be honest and admit that I have trust issues myself, and sometimes want to be skeptical. But my skeptical patients rarely improve. They are too busy researching everything I say to do to determine if it is "right" and figuring out why it is wrong and then go to another doctor to see if they have a different plan and cannot commit to any one particular doctor's plan. The issue with this is that when we have 10 Naturopaths in the room we have 12 different ideas is the joke in my profession because we all do things differently. There is a huge abundance of effective herbal medicines to potentially try.
Every doctor has their "style" of practicing medicine and you will never go to two Naturopathic Doctors that are exactly the same. I offer a completely different skill set with my background in Women's Health and Family Medicine. I know how to prescribe many medications from working 8 years in regular Family Medicine, and therefore practice very complex Women's Health care. This can save women from going from many doctors as I explain was my experience before I found a Naturopathic Doctor of my own to see.
I understand it is scary for women with trust issues to trust me or any doctor, but I also completely cannot help you if you cannot decide upfront that you can trust me and my 15 years as a Naturopathic Doctor and 23 years of experience in Women's Health and Family Medicine 28 years of experience as an Herbalist. Keep in mind I have been essentially prescribing herbs for people since 1994! That is what I have done every day with my life as an adult is to try to help people with their health issues.
But I cannot help everyone and most commonly it is because the patient is too busy being a skeptic and not actually rolling up their sleeves and doing the work. Health is technically a four-letter word and it is called WORK. I need patients committed to doing the work with me. It doesn't work if you don't help me do the things I need you to do things on your end. Successful patients show up with a pen and paper and take notes.
Naturopathy is a process and you have to be able to trust the process. People that know me well, know my personality is "No Nonsense. " I not going to waste your time when I personally know how it feels to be sick and scared, so I will always tell you the truth if I cannot help you. If we are working together regularly that means I expect you can get better, and I have seen other patients with similar symptoms improve. If I cannot help you I will refer you to a doctor that can help you. Otherwise, I always need patients following their exact plan as prescribed and following up monthly for adjustments to their Chronic Disease plan until improved. That is how we become successful together as a team. That is how I work my way of out a job after 2-3 months the majority of my patient cases are solved and they don't need to return. We may need to continue doing Hormone Checkups every 6-12 months but their problems are resolved and managed with natural medicine. I have many doctors and nurses as my patients who trust me wholeheartedly and they know that avoiding medications is our mutual goal and trust my Naturopathic healing process and expertise. They also know it is a process to even find the right drug for a patient which is the same in Naturopathic Medicine.
My Naturopathic patients that simply follow my exact instructions almost always improve by taking herbs, supplements, and a proper nutrition plan! How can I say that? Because my assistant is always calling to remind people to follow up and she tells me they are better and don't need to follow up again. Or even better I get a text message from you that says "Hey, my XYZ problem is totally fixed and I just wanted to say thank you for how much better I am feeling!"
My favorite though is when women text me to tell me they are pregnant after finally getting their hormones balanced. While I don't specialize in fertility my process of treating PCOS, endometriosis and complex hormone issues has resulted in a lot of surprise babies that nobody was planning on, and did not think they could have. So I do get to see the magic of Naturopathy happen before my eyes every day and that is my favorite part of my job. But that magic does not happen unless you are willing to make dietary changes, take herbs in the form of capsules, teas, or tinctures and take some vitamin supplements. So is it actually magic or is it just what happens when we listen to the body and give it what it needs?
Please plan to budget in monthly appointments if you decide to give Naturopathic Medicine a try so that you can be my next success story! There is an element of trust involved on the patient's end and it is imperative you choose a Naturopathic Doctor with a proven track record of success. A good Naturopathic Doctor will not require you to follow up constantly for the rest of your life. You should get better and only need to come in 1-2 times per year once your issues are resolved for an annual check-up. Once your plan is in place and you have learned your new system you will generally not need to constantly be returning to your Naturopathic Doctor.
If you think you will be a good fit for Naturopathy, please book your visit on my SCHEDULE page.
Dr. Nicole Sundene, NMD
(480) 837-0900
Dr. Nicole Sundene
Hypothyroidism and thyroid disease are the #1 conditions I treat in my Holistic Women’s Health and Hormone practice. Before I answer a lot of the questions I am commonly asked about hypothyroidism and discuss the best natural and prescription treatments, let me first take a minute to explain the process of how I help my patients with hypothyroidism achieve lasting solutions with natural thyroid hormones, herbs, nutrition and supplements.
I wish treating hypothyroidism was as simple as the current medical model that constantly fails women. Women with hypothyroidism are oftentimes frustrated because they are stuck in an antiquated hormone treatment system of:
Take X Thyroid Drug for X Symptoms
Oftentimes my thyroid patients are still complaining of common thyroid symptoms such as weight gain, chronic fatigue, depression, anxiety, cold intolerance, hair loss, heart palpitations, high cholesterol, insomnia, poor libido, dry skin, eczema, psoriasis, acne, and abnormal female hormones. All while their Family Doctor or Endocrinologist is saying the dose is fine. Half the time the dose is not properly tested and that is why it is not correct.
In Naturopathic and Functional Medicine, the body will continue to scream about its thyroid symptoms until we get the dose adjusted properly, changed to natural thyroid hormone and off the synthetic garbage.
After all, the thyroid is the “Mother of the endocrine system,” so we all know that when “Mommy” is not happy that none of the “Children” relying on her in female hormone and adrenal land will be happy! 😉
Here is the exact Holistic Thyroid detective process I perform as a Holistic Thyroid Doctor to fix hypothyroid symptoms:
#1 Why do you have hypothyroidism in the first place?
#2 What is the “Root Cause” of your hypothyroidism? Hint: It is different for each thyroid patient!
#3 Are vitamins, minerals, and nutrients the thyroid needs to make T4 and T3 hormones deficient?
#4 Assess adrenal function for women with chronic fatigue, anxiety and insomnia.
#5 Teach women my healthy hormone balancing Naturopathic meal plans and recipes my nutritionist designed to specifically help my overweight thyroid patients lose weight and balance female hormones.
#6 Addressing the gut inflammation is oftentimes why my patients have hormone imbalance in the first place, looking at the right nutrition for the individual patient, eliminating food triggers, testing the microbiome, and ruling out dysbiosis is critical for many of my thyroid patients.
#7 Continue to monitor the thyroid with FREE THYROID LEVELS AND NOT JUST USELESS TSH via blood hormone labs to confirm your thyroid function is OPTIMAL and that you are not running on an “Empty tank of gas” or at the bottom of the “hormonal normal range” which is not optimal, yet many doctors that do not specialize in hormones will decide it is totally fine despite being low and the patient frustrated by multiple annoying symptoms such as weight gain, hair loss, and chronic fatigue.
My TSH RANT: Please be advised if the doctor or Endocrinologist monitoring your thyroid is just checking TSH, or is checking total thyroid hormones and not free levels then they are not educated enough on this topic to be managing your hormones in my opinion. This is the #1 reason why my poor thyroid patients is suffering so badly. Checking TSH is 90's medicine and it is time for a better, modern, educated thyroid doctor!
If I treated my menopause patients this way, people would think I was insane to just check their FSH and not actual female hormones. Let's imagine if I stopped checking estrogen, progesterone, and testosterone levels to adjust menopausal women's bioidentical hormones and instead just adjusted hormones off of FSH or the message the brain is sending to the ovaries to make more hormones. Just as TSH is the message the brain is sending to the thyroid that it needs to make more hormones. Managing thyroid this way is a grave disservice to women everywhere.
We have much more sophisticated better ways to manage hypothyroidism now, thankfully! The only way we can stop this madness is to properly educate women and make sure they know what to expect on their labs tests so they can immediately fire their doctor if there is less than three thyroid tests being monitored.
I digress from my TSH rants, and want to move on to my "Root Cause" rant, because I want to take the time to investigate and understand #1 and #2 on my list, I sadly have seen many of my thyroid patients fail to improve over my seventeen years of experience working as a Naturopathic Hormone Doctor. Sadly then Natural Medicine also fails, and I don’t get to receive the “Joy of Fixing you” because I don't understand why the symptoms are here in the first place.
The real reason why most women don't feel good on synthetic synthroid and levothyroxine is because...
#1 Levothyroxine is a factory made synthetic compound.
#2 Levothyroxine is the dreadful "T4 monotherapy" that makes most of my thyroid patients fat because it needs to be converted to T3 to actually be useful. The T3 from the thyroid tells every cell in our body to work...somewhat like flipping on a light switch on or off.
#3 Lack of T3 means less collagen production, hair growth, and joint repair. Thyroid hormones set the pace for collagen production, along with metabolism. Therefore it is imperative that the thyroid levels for my chronic pain, autoimmune, Hashimotos, Rheumatoid Arthritis , and Lupus patients are in the optimal range and not just “normal.” Many of my unhappy thyroid patients are "Poor Converters" that are unable to convert the store hormone, T4 (Levothyroxine, Synthroid) to the active hormone that burns fat and gives energy=T3. This is why I firmly believe in natural thyroid hormone for women, and the majority of the women in my hormone practice ~95% are on natural thyroid hormone.
While many women are totally fine with their hypothyroidism utilizing the standard synthetic hormones synthroid and levothyroxine, many women specifically seek me out to fix their hypothyroidism related issues because they have been given these synthetic thyroid hormone replacements, yet still have symptoms and just don’t quite feel right.
I want every woman in my practice to be a success story. So please do treat yourself to a Naturopathic visit with me if you also want real answers, want the right nutrition for your body, want natural hormones, like to use herbal medicine, and want me to fix the underlying digestive and adrenal issues that are most often causing low thyroid function.
If that sounds like what you need to finally solve the mystery of your frustrating thyroid symptoms then please pop over to my SCHEDULE page and treat yourself to a Naturopathic visit! I would be happy to help! As a thyroid patients myself, this is of course one of my favorite hormone subjects! Now let me answer the most common questions I am asked about hypothyroidism.
WHAT IS HYPOTHYROIDISM?
Hypothyroidism is a medical condition characterized by low thyroid hormones in the body affecting vital physiological functions. Thyroid hormones, including T3 and T4, are secreted by a small, butterfly-shaped Thyroid Gland located in the front of the neck. Different factors impair the function of the thyroid gland that results in underactive thyroid or insufficient production of the hormone to meet the daily body requirements. [1, 2]
Remember that a low thyroid hormone level or hypothyroidism negatively affects lung function, metabolism, neurological function, body mass index, heart rate, and gastrointestinal health. It is estimated that about 4.6 percent of the US population, or approximately 10 million Americans have hypothyroidism.
LOW THYROID: WHAT ARE HYPOTHYROID SYMPTOMS?
The hypothyroidism symptoms vary among individuals. However, it involves the following signs and symptoms. [1, 2, 3]
WHAT ARE THE RISK FACTORS FOR HYPOTHYROIDISM?
Hypothyroidism can occur in any individual, but certain risk factors increase the chances of its development. These risk factors include:
Also, the presence of certain medical conditions increases the risk of hypothyroidism. These conditions include pernicious anemia, Sjogren's syndrome, lupus, diabetes, Turner syndrome, and rheumatoid arthritis. [1, 2, 3]
WHAT CAUSES HYPOTHYROIDISM?
Different factors significantly impact the function of the thyroid gland and lead to the development of hypothyroidism. [1, 2, 3] These include:
Hashimoto's Thyroiditis is the most common cause of hypothyroidism. It is an autoimmune disease where the body's immune system attacks the thyroid gland. That results in the development of thyroid inflammation and leads to an impaired thyroid hormone level. Hashimoto's disease is the most common thyroid disorder in America, affecting around 14 million people. It is seven times more prevalent in women than men. Individuals with Hashimoto's disease are also at high risk of other autoimmune diseases. [7]
TYPES OF HYPOTHYROIDISM
Hypothyroidism is divided into three main types based on the etiology of low thyroid hormone in the body. These include:
Moreover, a rare type of hypothyroidism caused by an abnormal expression of the deiodinase three enzyme in tumor tissues is termed Peripheral or Consumptive hypothyroidism. The elevated concentration of the deiodinase three enzyme inactivates thyroid hormone.
WHAT IS SUBCLINICAL HYPOTHYROIDISM
Subclinical hypothyroidism is an early hypothyroidism form characterized by an abnormal thyroid-stimulating hormone and a normal thyroxine level with minimal or no symptoms. It occurs in about 15% and 8% of women and men respectively over the age of 60 years. Remember that subclinical hypothyroidism shares the same causes, similar symptoms, and treatment options to other hypothyroidism types. [6]
It is important to mention that levothyroxine is indicated during pregnancy or in women who want to conceive. It helps prevention of harmful effects of hypothyroidism both on pregnant women and fetal development.
MEDICAL COMPLICATIONS OF HYPOTHYROIDISM?
Untreated hypothyroidism increases the risk of following medical conditions or aggravates their symptoms. [3]
HOW DO WE DIAGNOSE HYPOTHYROIDISM?
Sometimes the diagnosis of hypothyroidism is difficult due to the number of symptoms confused with other medical conditions. Medical history, family history, physical examination (enlarged thyroid, dry skin, puffy eyes, etc.), medical symptoms, and different blood tests are performed to diagnose hypothyroidism. The blood tests such as thyroid-stimulating hormone tests and evaluating the level of thyroxin level are highly recommended for hypothyroidism diagnosis. Plus, the physician may order a blood test for Hashimoto's disease to confirm the presence of hypothyroidism. Note that high thyroid-stimulating hormone levels and low levels of thyroxine indicate an underactive thyroid or hypothyroidism. [2, 3]
WHAT ARE THE BEST TREATMENTS FOR HYPOTHYROIDISM?
Hypothyroidism treatment involves the restoration of normal thyroid hormone levels in the body. Moreover, the treatment aims must include complete control over the hypothyroid symptoms, normalization of thyroid-stimulating and thyroxine hormone level, avoidance of overtreatment, and prevention of medical complications associated with hypothyroidism. It is important to know that hormone replacement such as armour thyroid or levothyroxine, and cytomel are the primary prescriptions used for hypothyroidism management. [4, 8]
WHAT IS NATURAL THYROID HORMONE REPLACEMENT THERAPY?
In MD hormone replacement therapy, synthetic thyroid hormone levothyroxine is prescribed to restore normal thyroid hormone levels in the body. The administration of levothyroxine (T4) maintains an optimal level of thyroxine and thyroid-stimulating hormones that prevent or manage hypothyroidism symptoms. Moreover, it regulates the high cholesterol level, metabolic dysfunctions and also helps the management of weight gain. Primarily, hormone replacement therapy is indicated for a lifetime, but the dose may vary with the patient's condition. Sometimes, Liothyronine (T3) combined with Levothyroxine (T4) is given to the patients when they do not feel better with single hormone therapy. At the beginning of therapy, a levothyroxine dose of 50-75 µg/day is indicated to treat mild to moderate hypothyroidism. However, the initial dose of levothyroxine depends on the patient's weight, age, pregnancy status in women, lean body mass, hypothyroidism type, TSH level, and other medical comorbidities. [4, 8]
Note that all hypothyroid patients respond well to hormone replacement therapy. However, in severe myxedema (life-threatening hypothyroidism), the treatment approaches involve the parenteral administration of levothyroxine (T4), antibiotics, steroids, and optimal oxygen supply. [4, 8]
It is important to know that always consult and take great care about the dosage of thyroid hormone, as a low dose can't benefit the hypothyroidism symptoms. In comparison, the high doses will result in the development of hyperthyroidism. Thus, it is advised to regularly check the thyroid-stimulating hormone and levothyroxine level for the first 6-8 weeks during hormone replacement therapy; after getting stable, check the levels at an interval of 6 months or can be extended up to 12 months. [4, 8]
The clinical benefits of hormone replacement therapy appear within 3-5 days, but the complete restoration takes 4-6 weeks. Moreover, the normal TSH reference level regulation may take several months due to the modulation of the hypothalamic-pituitary axis. Plus, it is recommended not to switches between different brands or generic formulations of levothyroxine to avoid dose fluctuation. [4, 8]
Different thyroids hormone formulations are available in the market for the management of hypothyroidism. The most popular formulation include Armour Thyroid, Nature Thyroid Tablet, NP Thyroid, Synthroid, and Cytomel. These medications are natural thyroids hormone formulation obtained from animal thyroid glands (usually a pig's) intended for hypothyroidism treatment. Side effects involve temporary hair loss due to the drug-body adjustment. Note that regularly confirm the normal thyroid level to avoid the hyperthyroidism symptoms. [4, 8]
The American thyroid association recommended the evaluation of certain situations or conditions that may alter the thyroxine level. Such as examine the patients for gastrointestinal disorders who need a higher dose of levothyroxine. Plus, always talk with a qualified physician about the initiation or discontinuation of other hormone replacement therapies such as androgen and estrogen hormone during TSH level assessment or levothyroxine therapy. Moreover, other medications such as tyrosine kinase inhibitors, phenobarbital, sertraline, phenytoin, carbamazepine, and rifampin may also alter the Thyroxine level. Also, the concomitant use of proton pump inhibitors, sucralfate, and supplements such as calcium, magnesium, etc., interfere with the levothyroxine absorption. Furthermore, consume the levothyroxine before 35-45 min before breakfast or at least 3 hours post-meal at bedtime for optimal absorption.
Remember that if the hypothyroidism symptoms do not ease with hormone replacement therapy, one must consider and check for other medical causes instead of increasing the levothyroxine dosage. [4, 8]
Surgery
Hypothyroidism is rarely treated with surgical procedures. Surgery has opted in case of large goiters that negatively impact the function of trachea-esophageal tracts. [4, 8]
Treatment Concerns:
Medical studies reported that thyroid replacement therapy exacerbates the co-existing adrenal insufficiency condition. So, remember that treat or evaluate the adrenal insufficiently condition before initiation of thyroid replacement treatment. Moreover, it is important to know that adrenal insufficiency can also occur with subclinical hypothyroidism. Plus, always treat or confirm the adrenal insufficiency during severe hypothyroidism (such as during myxedema coma) for rational treatment options. Furthermore, in heart conditions such as coronary artery disease, ischemic heart disease, etc., medical studies suggested that always start with the lower dose of hormones.
Then gradually increase the dosage over time for adjustment with heart conditions. At normal doses, levothyroxine does not cause any severe side effects. But overconsumption of overdosage of thyroid hormone increases the risk of poor muscle coordination, fatigue, insomnia, anxiety, excitability, tremors, feeling hotter than normal, osteoporosis, breathing difficulty, muscle weakness, atrial fibrillation, arrhythmias, heart palpitation, and increased appetite. [4, 5]
Natural remedies for hypothyroidism
Different natural interventions are also used to help the hypothyroidism symptoms. These include diet changes and administration of Supplements. Studies reported that selenium levels decrease during Hashimoto's disease and impair thyroxine levels. Selenium Supplementation helps regulate normal T4 levels and improve hypothyroidism symptoms. Moreover, a sugar-free diet also helps prevent aggravation of hypothyroidism symptoms. Studies showed that sugar consumption increases the risk of inflammation that impairs the conversion of T4 to T3 and thus may aggravate or favor the progression of hypothyroidism.
Further, the supplementation of Vitamin B12 improves certain hypothyroidism symptoms, including tiredness and healthy metabolism. Also, the consumption of probiotics restores healthy gut microbiota and improves gastrointestinal symptoms associated with hypothyroidism. Additionally, the supplementation of Zinc, Iron, Iodine, Vit D3 and Tyrosine combined with Iodine help regulate both the stimulating tissue hormone and thyroxine levels. [9]
Dr. Nicole Sundene, NMD
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!
References:
“Should thyroid patients take iodine?” Melinda Cave Creek, AZ
Thyroid treatment is complicated. Taking hormones, iodine, and seaweed at the same time are not always a good holistic thyroid mix, so that is a great question, for me to answer today for women with hypothyroidism.
Oftentimes my Naturopathic patients are either ingesting zero iodine and have low levels as they cook with sea salt that is not iodized, or they are overdosing on iodine for their thyroid, and taking way too much of it to the point they are hyperthyroid, sweaty, angry, and having diarrhea and other abnormal movements from their nervous system.
I will admit over the years, I have had to manage what I call a "Thyroid Hormone Train Wreck" from patients starting iodine at the same time as their Armour thyroid without telling me. While it is good to read about your new thyroid condition, combining thyroid herbs and nutrients that have a synergistic effect with your thyroid hormone without first telling your hormone doctor at an appointment that you plan to do this is likely more dangerous than helpful.
I describe this to my patients that are not low in iodine as the hormonal equivalent of throwing a match on a pool of gasoline. As a women’s health doctor I have seen many women go into a dangerous hyperthyroid storm from doing this, so please be careful with iodine if you take thyroid hormone!
Nonetheless, the thyroid does need iodine to function. This is why women should look for iodized sea salt and buy that, and not just use pink Himalayan salt, or regular sea salt as it will lack adequate iodine. Generally using iodized sea salt is all my low iodine patients need to do to.
While I understand some patients do not want to take any hormone at all, and that is why they seek me out. That is also not always realistic for every patient, thyroid "medicine" is not a drug, it is a hormone that is natural and the body is failing to make it which is causing a myriad of symptoms. All of these symptoms generally result in my patients being on MULTIPLE DRUGS without proper thyroid hormones. I often see women on high blood pressure pills, cholesterol statins, diuretics, laxatives, hair loss drugs, and psychiatric drugs for depression, anxiety, and ADHD. Taking a bunch of drugs and anti-depressants is a much higher price to pay in my opinion than simply having thyroid hormones properly adjusted.
Therefore when I see mild thyroid deficiency symptoms I think “Let’s use natural supplements to correct this.” But when I see more severe deficiency combined with a myriad of annoying thyroid symptoms, perimenopause, or menopause I begin to think of just giving some thyroid hormone gland or NDT “Natural Dessicated Thyroid,” rather than waste time trying to replete nutrients. high
While iodine, zinc, tyrosine and b-vitamins are needed to make thyroid hormone, I do not recommend ever adding these things in without first checking with your holistic hormone doctor as it will generally result in symptoms of hyperthyroidism, and cause the dose of the thyroid hormone your doctor has prescribed to become too high. This can be seen with anxiety, nervousness, sweating, jitteriness, palpitations, chest pain, high blood pressure, rage, and agitation.
The better thing to do is to either start with these nutrients in mild thyroid deficiency symptoms and labs, or to look at adding them in after thyroid hormone has been properly adjusted and then further test and adjust it after that.
While women in Scottsdale often beg me to crank their thyroid hormone up to the “fat burning max” too much thyroid hormone feels worse than taking too little. Depressed, forgetful and tired is far better than angry and wired.
Keep in mind for patients with a history of hyperthyroidism or "high thyroid" from Grave's Disease and Hashimoto's that have had their thyroid radiated or removed taking these nutrients generally is not very beneficial, other than to insure they are not deficient in them, and that other systems that convert thyroid from stores to active hormones such as in the liver are supported with the nutrients needed for this conversion process from T4 to T3. Light in the form of 10,000 lux daily from the outdoors and physical exercise are also needed for this conversion.
If you do choose to try iodine for your thyroid, I recommend eating organic seaweed as the best source. The seaweed my puppy is trying to eat at the beach in my Instagram video, was before the San Diego oil spill, so please consider the health of the water where your seaweed grows when harvesting seaweed in the wild, and ensure you are leaving enough for the wild life that requires it to live!
Most commercially sold organic seaweed is grown in controlled tanks and ponds due to the amount of plastic, heavy metals and toxins in our ocean water. So that is what I look for when I buy seaweed, certified organic only!
Need help with testing or treating your thyroid? Simply visit my SCHEDULE page to treat yourself to a Naturopathic Hormone visit! I would be happy to help!
Dr. Nicole Sundene
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Specialist in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!
