Dr. Nicole Sundene
PCOS patients with imbalanced hormones should probably throw some pomegranate juice along with apples, aloe, ginger, curcumin, and cinnamon in their “PCOS Smoothie” recipe. The research is pretty consistent that pomegranate is beneficial for women with PCOS! As well as many of the other symptoms that impact women with Polycystic Ovarian Syndrome.
Recent research also demonstrates pomegranate is effective against Chronic Fatigue, Poor Memory, Poor Concentration, Weight Loss, High Cortisol Stress Hormone, High Blood Pressure, Inflammation, Aging Skin, Hyperpigmentation, Type 2 Diabetes, Insulin Resistance, Liver Disease, Fatty Liver: NAFLD, Heartburn, Bloating, High Cholesterol and Triglycerides which women with PCOS often struggle with. Pomegranate also protects against skin damage from UVB rays, helps with Stroke Recovery, and provided an anti-inflammatory benefit during hospitalization for a viral infection. [1-27]
PCOS, MENOPAUSE, HORMONES + POMEGRANATE
Pomegranate is not just for women with PCOS, but also for menopausal women. The researchers made me laugh out loud when they concluded pomegranate “significantly ameliorates the irritating symptoms of menopause.” I had to laugh at the description of "Irritating Symptoms" and had to wonder if the researchers were male or female. Because most women with menopause would describe their symptoms as far more disruptive than "irritating." Irritating symptoms are when we miss a few hours of sleep, or feel tired, sad or blah or blue for a few hours.
I listen to my menopause patients complain about symptoms that are far beyond irritating every day at work. They are severely fatigued from lack of sleep, they have brain fog and poor concentration, they are angry, irritable, over heated, on edge from feeling uncertain when the next hot flash will hit, or if they are going to be able to find a bathroom every thirty minutes because now they constantly have to pee all the time thanks to their new menopausal bladder.
Menopausal and perimenopausal women have Insomnia, and are waking up with night sweats because they are sweating and feel like they are internally boiling to death which then causes a horrible chronic Insomnia and they cannot sleep past 1-3am, and just start their day now at 2am! Or they cannot sleep at all and the insomnia is causing chronic fatigue and depression they never had before.
They are exhausted from lack of sleep, and the hormone shifts have now caused hypothyroidism or low thyroid function. Heavy bleeding in perimenopause prior to menopause also can leave many patients with severe anemia. Which is why women should have their iron levels and thyroid checked along with their female hormones.
Meanwhile the new hormone imbalance is causing Weight Gain, Anxiety, Depression, Bladder issues, Blood Pressure Issues, and Chronic Yeast Infections that they never had before. Most of my patients would actually describe their symptoms as "Moderately to severely disruptive to their quality of life."
Furthermore, I don't think women as a societal whole should tolerate having their menopausal symptoms minimized by researchers. Other doctors will then believe from reading conclusions of this type of research that menopausal symptoms are simply a little bit "irritating" or "annoying" when they actually can be life altering for many women and lead to divorce if not addressed properly. Losing your family to divorce, and splitting up children is beyond "irritating." Many menopausal women come to me in the midst of a divorce, separated, or just at wit's end with their partners. Menopausal hormone changes have caused both a lack of libido, and a lack of compassion from their partner as to what they are going through.
I have actually saved several marriages by sending a woman home with a set of horribly abnormal hormone labs I have scribbled all over and marked up with pen like an English teacher. The husband looks at the labs and sighs with relief that there is something wrong, that this situation is temporary, and his wife can be fixed. Then instead of fighting, the couple works as a team to help the wife get through this challenging time. Many husbands have learned to just quietly leave, go golfing, go to the gym, go on a walk and just give women time and space to deal with their hormone imbalance. Many women come back in tears and thank me for saving their marriage.
Women with menopausal hormone imbalance can end up divorced during this time in their lives because the symptoms are disruptive to their mental health, disrupting their sleep, causing them to feel fatigued and irritable, all while also causing low libido, which is now causing marital strain that never existed before... However, I will leave it up to the women to decide if their symptoms are life altering or simply irritating and am overall grateful to any researchers conducting research for women's health... So I will digress from my rant.... In another study pomegranate also improved women’s menopausal hot flashes, libido and quality of life. [12,15]
So pomegranate is officially the most perfect Herbal Medicine hormone food in my mind as it is providing fertility support to women of reproductive age, improves PCOS by lowering testosterone that can cause Hormonal Acne and infertility, and also is hormone modulating with estrogen and testosterone for women as they transition to perimenopause, and eventually menopause. Whether hormones are too high or too low pomegranate works to correct Hormone Imbalance!
So there you have it ladies, a pomegranate a day keeps the women’s health doctor away!
Basically pomegranate is a one stop shop women's health supplement that not only regulates female hormones but provides a myriad of other super food benefits. In my Instagram video, you can see how the groups of seeds somewhat look like eggs budding from our ovaries!
RED OR WHITE POMEGRANATE FOR HORMONES?
Being from Seattle, the first time I was walking down the street in Scottsdale and saw a pomegranate tree naturally growing I will admit, I actually stopped and freaked out as a Naturopathic Doctor and had to pick one and take a bunch of pictures!
So, if you live in Phoenix, you can grow your own pomegranates! If you do buy a pomegranate tree, buy a red pomegranate tree. As there are generally more flavonoids in deeply pigmented fruits than white ones.
I believe the red pomegranates are most likely more medicinal than the white ones, as it is the flavonoids that is the medicine here and those same flavonoids are much lower in white wine versus red wine. So it is safe to assume until proven otherwise we should eat the red pomegranates for the best benefits.
If research proves me wrong... I will let you know!
However, if we are intending to use pomegranate flavonoids for weight loss, and lipid metabolism, the red pomegranates were studied. Another study on pomegranates and fat metabolism concluded, “Short-term consumption of dietary doses of Pomegranate Juice exerts beneficial effects and affects lipid metabolism in overweight patients with dyslipidemia.” 
In another recent PCOS hormone study conducted in June 2023, they found testosterone levels were lowered for women with PCOS. Researchers concluded, “Serum testosterone levels were significantly decreased in overweight and obese women with PCOS who supplemented with concentrated pomegranate.” 
I found this very interesting as a Women’s Health Doctor because most of the research done on Pomegranate is for men's cardiovascular health, and "AMS" Aging Male Symptoms such as male erectile dysfunction. Interestingly my male patients with low tesosterone seem to find the most benefit from the Testosterone boosting formula “Testosterzone” by Progressive Labs in Fullscript, comprised of mainly pomegranate, along with ashwagandha, astaxanthin, and phosphitdyl serine.
Researchers found pomegranate beneficial for testosterone in men as it was modulating androgen production in prostate cancer patients, and was also helpful against AMS or “Aging Male Symptoms" when combined with chocolate! So my patients should be buying their husband’s some chocolate covered pomegranate seeds for Valentine’s Day! 
Another hormone study with pomegranate looked at cortisol, thyroid, and blood sugar levels in patients with Type 2 Diabetes and concluded that pomegranate improved blood sugar, lowered the stress hormone, cortisol in both men and women, but did not impact thyroid levels. This is good news for my diabetic patients that have been told to never ever ever drink juice…the exception to the rule is pomegranate juice! 
Okay back to Women’s Health….
My experience using pomegranate to boost testosterone in men leads me to hypothesize that pomegranate does not always raise testosterone, nor does it lower testosterone, it is likely more of a hormone “modulator” to the male and female reproductive system as was concluded in the prostate study. So whether testosterone is too low or too high, eating pomegranates, taking a pomegranate supplement or drinking pomegranate juice will likely help even things out.
IS POMEGRANATE JUICE SAFE?
Pomegranate juice is the only time I allow my patients to have fruit juice! I am a big enough person to admit when I am wrong and there is a research study combined chokeberry, cranberry, and pomegranate juice versus placebo, and concluded:
"Beneficial effects on lipid metabolism by reduced energy intake, modulation of biomarkers such as Phosphodiesterase activity and improved DNA integrity associated with Pomegranate consumption.” 
So in layman’s terms that means that pomegranate is anti-aging, anti-inflammatory, improves immune function, cholesterol metabolism, relaxes arteries, helping to open them up and increase blood flow, which is the primary mechanism as to why it helps lower high blood pressure and has been touted as a treatment for male erectile dysfunction for years.
BUT... every rule was made to be broken? Right? 😉
Pomegranate juice for Women’s Health and Hormones is pretty much the ONLY TIME you will ever see me prescribing juice to my patients. Pure blueberry, blackberry, and cranberry are also the exceptions. As I generally think we should be eating the whole fruit or whole pomegranate seeds to get the fiber along with the sugar.
But I know many of you love to drink juice or add it to your smoothies and recipes, so as long as it is a pure form of Pomegranate juice then it can be used. Only 4-8 oz of juice is needed to receive medicinal properties which is nice to know for hormone patients as it can be one of the most expensive juices out there, just as Saffron is the world’s most expensive spice!
But because Pomegranate is such a tremendous anti-inflammatory, hormone balancing agent I wanted to share some of the exciting Dermatology studies I stumbled upon. Women should not only drink pomegranate juice for their hormones, but also for glowing skin, perfect hormones, and decreased weight and inflammation.
POMEGRANATE FOR DERMATOLOGY: ANTI-AGING, DARK PIGMENTATION + COLLAGEN
In an eight week Dermatology research study on skin aging and pomegranate, researchers concluded that pomegranate, “improved the moisture, brightness, elasticity, and collagen density of the skin of most subjects,” and improved the “moisture, brightness, elasticity, spots, UV spots, and collagen density of skin.” 
So this is great news because when I tell my patients that something I need to have them take for their hormone imbalance is actually anti-aging and will plump their collagen, smooth their wrinkles, and help fight dark spots…they suddenly become a million times more compliant with following their treatment plan!
Also for my patients that frequently sunburn or have history of skin cancer, we can increase Pomegranate in their diet to add an extra layer of protection against UVB rays (of course in Arizona and most areas you will still need to use a nontoxic sunscreen, like the Alba 50 SPF spray is my favorite since it gives your skin an added shine, goes on clear, smells like coconuts and is coral reef safe.)
Women can safely use Pomegranate juice to help balance female hormones. Everyone knows I ban juice as a mom and am very anti juice because of the high fructose corn syrup. I believe children should be fed fruit and not fruit juice, as the juice is generally missing the fiber.
But pomegranate juice, blackberry juice, and blueberry juice are exceptions to that rule because they contain one of the most powerful antioxidants on the planet, “proanthocyanidins” that help reduce inflammation, reduce chronic pain, reduce blood pressure, protect the skin from UVB radiation, and are generally anti-aging.
So there is the vanity...er... Dermatology motivation to stay consistent with pomegranate as medicine! 😉
In Herbal Medicine, pomegranate is a key reproductive herb that aids hormone balance, detoxification, reduces inflammation which then reduces insulin resistance and estrogen dominance. Estrogen dominance is the enemy of women because it is the very hormone imbalance we experience every month with PMS or Premenstrual Syndrome.
So when I tell women in perimenopause that it is basically now "Permanent PMS," unless we use herbal medicine to reduce the estrogen dominance, speed up liver detox pathways to eliminate this estrogen, address constipation that also causes estrogen dominance, and add a light progesterone cream or pill in a Bioidentical Hormone or BHRT form....women will feel much better!
Estrogen Dominance causes women to feel bloated, angry, agitated, annoyed, depressed, anxious, can be responsible for panic attacks, headaches, migraines, fibroids, high blood pressure, blood clots, endometriosis, crying, and severe chronic fatigue when estrogen is elevated. PCOS is oftentimes the culprit of estrogen dominance.
Did you know women have three forms of estrogen? Estradiol, the one your doctor frequently tests for is not the only estrogen and can cause the hormone test to be erroneously wrong. This is the medical equivalent of mammogramming one breast to assume the other breast is just fine.
Estradiol, estrone, and Total Estrogen should be tracked for women with symptoms of hormone imbalance. If the amount of estradiol and estrone do not closely mimic the Total Estrogen, then this is a common sign the woman is suffering from excess of Xenoestrogens from beauty products.
This is where shampoos, makeup, creams, and lotions with pthalates and parabens can actually screw up hormones and help to cause hormonal acne, and other disease of estrogen dominance.
Pomegranate juice and seeds primarily work via potent antioxidants to reduce inflammation. Inflammation is shown in multiple research studies to increase estrogen dominance and is therefore the "Elephant in the Room," many times causing women to have PCOS, Insulin Resistance, Rheumatoid Arthritis, Autoimmunity, Perimenopause, and the infamous PMS.
We need to work on both cleaning up the diet, AND cleaning up beauty products. If the beauty product is allowed per European guidelines, that is one of the easiest ways to know that it is clean. Or if it is made with certified organic ingredients. You have to be careful though, because just one of the ingredients can be organic and above that seal it says "With Organic Lavender," and the lavender is the only organic ingredient.
POMEGRANATE FOR BLOOD PRESSURE, HEART + CARDIOVASCULAR HEALTH
The pomegranate, when transformed into juice, does some amazing things for the body, and in particular, the cardiovascular system.
First and foremost it has been shown to lower blood pressure, and inhibit the formation of plaque along artery walls (aka atherosclerosis). Not only has it been shown to inhibit new plaque formation, but it also can reverse the atherosclerosis that has already occurred!
This last result is pretty amazing. Patients drank pomegranate juice daily, and then a Doppler ultrasound of the carotid artery showed up to a 30% decrease in the thickness of the artery. Patients who did not take the pomegranate juice showed a 9% increase in the thickness of their carotid arteries. 
Pomegranate has also been shown to help diabetic patients lower their LDL and total cholesterol, while having no significant effect on their blood glucose levels. Yep, you read that right, a juice that does not significantly increase blood glucose levels, but actually works to improve them!
You can find the juice at most supermarkets and health food stores. However, make sure it is 100% pomegranate juice with no added sweeteners or other types of juice as they will only add calories and reduce the positive effects you have just been reading about!
My favorite is of course the Pomwonderful brand. I have been a fan of Pomwonderful ever since it came out many years ago when they mailed me a case of it and I started reading pomegranate research.
I love that the juice is 100% pure pomegranate with no added sweeteners. Some of my patients find the flavor a bit too tart so I recommend they mix it with half of the PomBlueberry juice, or add stevia and dilute it with water. To make my fun non-alcoholic "Happy Hour Pom Pom" just add 1-2 packets of stevia to your pomegranate juice and then top off with lime or plain club soda (not tonic water as that is poison for PCOS.) If you add the club soda first you can float the pomegranate juice on top for a pretty effect.
So please enjoy the only juice I allow women to drink as a hormone doctor! 😉
If you need my help with hormone imbalance, PCOS, perimenopause, menopause, or other Women’s Health matters simply give us a call or visit my SCHEDULE page to treat yourself to a Naturopathic visit! I would be happy to help.
Dr. Nicole Sundene