Dr. Doni, author of The Stress Remedy, explains how changes in estrogen and progesterone levels can affect your sleep, and what you can do about it.
The hormones that orchestrate the benefits of sleep can be disrupted by hormonal changes in the body, such as peri-menopause and menopause—which is why insomnia is common amongst menopausal or peri-menopausal women. Estrogen and progesterone are the hormones produced by the ovaries, creating a menstrual cycle in women from ages twelve to fifty-one (typically).
Estrogen signals to the uterus to grow a lining in preparation for a possible pregnancy. Progesterone, which is produced after ovulation (when the ovaries release an egg) each month, prevents the uterine lining from shedding before it may be needed (for pregnancy). If a pregnancy is not present, progesterone levels drop, allowing the uterine lining to be shed, forming what is referred to as menses or “a period.” This cycle optimally lasts 28 days.
But that’s not the only effect of estrogen and progesterone in a woman’s body. These hormones actually influence many other areas of the body including the nervous system, immune system, digestion, and other hormones (thyroid, insulin, and cortisol, for example).
Optimally, estrogen and progesterone should be in balance with one other; when they are out of balance or simply fluctuating—as they do in pregnancy, during the menstrual cycle, and as the ovaries decrease in function with age—women can feel the effects throughout their bodies.
Common symptoms of hormonal changes:
- Mood – Irritability, low mood, anxiety, and libido changes
- Digestion – Change in bowel movements and ability to digest, bloating
- Skin – Acne and other skin issues
- Joints – Aches and pains
- Blood vessels – Hot flashes, night sweats, and migraines
- Metabolism – Decreased insulin function and increased weight gain (around your middle)
- Breasts – Tenderness, cysts, pain
- Vaginal – Dryness, susceptibility to infection, discharge changes
- Urinary – Frequent urination, discomfort, susceptibility to infection
- Sleep – Can’t get to sleep, frequent waking, can’t get back to sleep
Symptoms of peri-menopause can begin as early as ten years before the menstruation cycle ceases altogether (menopause is marked by one full year without a period).
What happens to hormone levels during peri-menopause and menopause?
Most commonly, progesterone levels begin to decrease first, especially when women are stressed, because both age and stress decrease the amount of progesterone produced by the ovaries. This creates an imbalance between progesterone and estrogen.
When estrogen is higher than progesterone for any reason (including peri-menopause), the menstrual cycle becomes irregular—either shorter or longer than 28 days. Symptoms known as premenstrual syndrome (PMS)—which include mood changes, bloating, breast tenderness, and water retention—become more likely. Menstrual cramping, fibroids, polyps, and heavy bleeding are also more likely when estrogen is higher than progesterone (also known as estrogen dominance).
We often talk about estrogen as a single hormone, but there are actually three forms: estrone (the strongest form), estradiol (the most prevalent form in menstruating women), and estriol (more prevalent in menopause and the weakest of the three). All forms of estrogen are metabolized by the liver and leave the body in the form of bile that travels from the gall bladder out through the bowels.
Each of us has a unique ability to metabolize (or detoxify) estrogen in the liver in two phases, including a process called methylation. The efficiency with which we do this is determined by our genetics. If your body is not as able to detoxify estrogen, it is going to stay in your body longer and in more toxic forms, increasing the risk of PMS and fibroids, as well as breast cancer and other estrogen-related health issues.
Eventually, as peri-menopause progresses, the ovaries also start to make less estrogen, so both progesterone and estrogen levels begin to gradually decrease. Estrogen often decreases in a turbulent manner, sometimes fluctuating from high to low within minutes. Every time estrogen levels shift, it sends a signal through your body that triggers many of the symptoms we associate with peri-menopause or menopause—insomnia, night sweats, hot flashes, migraines, and mood changes.
When ovulation finally stops altogether, estrogen and progesterone levels stop cycling from low to high, and instead remain low. At this point, women are likely to experience vaginal dryness, urinary infections, joint pain, and weight gain—all of which can also disrupt sleep.
Is there a test that can tell me what’s going on?
Estrogen and progesterone levels can be measured in the blood, urine, and saliva. Each test is used for different purposes and of course, the timing of the test (based on ovulation) directly influences what the levels will be.
Blood tests show the level of estrogen (or more specifically of estrone, estradiol and estriol) and progesterone at the time the blood is drawn and can help to identify levels that are very high or way too low.
Salivary tests can be helpful, especially when levels are measured in a series, over several days or a whole month so we can identify patterns. However, I use saliva levels much less often now, and instead prefer a urine panel.
Urine samples can be collected over 24 hours, but I find the most useful information from urine samples collected throughout a day and evening. This type of test can show hormone levels, as well as how well estrogen, progesterone, and testosterone are being metabolized. A practitioner with training in the use of these tests will be able to tell you if testing is right for you and, if so, which test will be most helpful. Click here to make an appointment with me.
A genetic panel, such as the one I discussed in an article about MTHFR mutations, can tell you whether you have genetic mutations that may affect your ability to detoxify estrogen and process it out of your body. If you do have these mutations, we can support your body with nutrients, herbs and other supplements to help progress be more efficient and decrease your risk of developing health problems.
It can also be helpful to measure cortisol and neurotransmitter levels when addressing estrogen and progesterone because we know that they affect each other—and balancing one will benefit the other. Read more about cortisol and sleep here, and about neurotransmitters and sleep here.
What can I do if hormonal changes are affecting my sleep?
When it comes to helping you get back to sleep even while your hormones are changing (whether as a result of your menstrual cycle, peri-menopause or post-menopause), there are many nutrients, herbs and supplements* for us to choose from that can help. I’ve separated them into three categories: Liver Detoxification of Estrogen Support, Estrogen Support and Progesterone Support.
Liver Detoxification of Estrogen Support
- B vitamins: B6 (P5P), folate (5MTHF), and B12
B vitamins, and especially B6, B12 and folate, are needed by the liver to detoxify estrogens.
- Methylation support: choline
Methylation is an important step in the detoxification of estrogens. Choline provides methyl groups for that process.
- Estrogen detoxification: Diindolmethionine (DIM) and sulfurophane
Substances that come from broccoli, including indole-3 carbinol, diindolmethionine, and sulfurophane are all known to assist in the detoxification of estrogens, ensuring they exit the body instead of being converted to toxic estrogens that can cause health issues.
- Estrogen elimination: Calcium D-glucarate
Once estrogen is metabolized by the liver, it needs to exit through the digestive tract. Calcium D-glucarate helps with that process.
- Turmeric (Curcumin)
Shown in research to support the detoxification of many substances, including estrogen.
- Milk Thistle (Silymarin)
Milk Thistle is generally supportive of liver detoxification and is known to assist with ridding the body of excess estrogens.
- Green Tea Extract
Studies show that green tea extract (also known as EGCG) can help detoxify toxins and estrogens from the body, and decrease the negative effects of excess estrogen.
Estrogen Support (when levels are too low)
- Black Cohosh (Cimicifuga)
This is one of the most studied and clinically effect herbs to assist with hot flashes, night sweats, and other peri-menopausal symptoms. Black cohosh used to be considered a “phyto-estrogen” (a naturally occurring nutrient that mimics the effects of estrogen) but is now believed to be more of an estrogen blocker, by taking up space in the estrogen receptors. It has been shown to be safe for patients who have, or who have had, breast cancer.
- Dong Quai
A traditional herb used for peri-menopausal and menopausal symptoms, Dong Quai supports the function of estrogen, which can be helpful when levels are too low.
Extremely popular recently, Maca has been well researched and is considered safe and effective for PMS, peri-menopausal, and post-menopausal symptoms. It helps to balance hormones, and in particular, supports estrogen levels that are too low.
- Chaste tree berry (Vitex)
One of my “go to” herbs whenever we need to support the ovaries to ovulate and produce hormones on their own, Chaste Tree Berry assists with the communication from the brain to the ovaries, resulting in increased progesterone production by the ovaries.
- Wild Yam (Dioscorea)
Wild yam, both in oral and topical forms, acts as a mild progesterone-like substance in the body. Most all plants make hormone-like substances, which can then be turned into “natural” or “bio-identical” progesterone that looks and acts the same as the progesterone our bodies make.
- Progesterone cream
Derived from plant sources, and then modified in a lab to form “natural” or “bio-identical” progesterone (meaning it looks and behaves the same as the progesterone our bodies make) progesterone cream can be applied topically as a way to support low progesterone levels.
- Adrenal support, which supports healthy ovarian function
When the adrenal glands are under-functioning, the ovaries may also produce too little estrogen and progesterone. In those cases, assessing and addressing adrenal function can greatly improve peri-menopausal and post-menopausal symptoms. Here is an example product.
Please note: It is important to work with a practitioner to help you determine which of these products is best for you, and in what dose.
We know from research that supporting our bodies when we are under stress helps with all three categories and with overall hormone balance. My e-book, Stress Remedies, is all about stress and the stress response. It also includes activities you can choose on a daily basis to help your body reduce stress and boost your health.
If any of this sounds like you, and you are having trouble sleeping, you might want to check out my Sleep Solutions Package. It includes consultations with me, the testing discussed in this article, as well as support to help you make the changes needed to get your hormones back in balance and you sleeping through the night. At the same time you’ll be preventing health issues associated with both hormone imbalance and insomnia. Two things at once! (I love it when it works that way).
In the next article in this sleep series, I will be exploring how low melatonin can affect your sleep. Don’t forget to subscribe to my Weekly Wellness Newsletter if you want to receive future articles direct to your inbox.
12th February 2015
Dr. Doni’s Natural Sleep Solutions Package
This rigorous program will help you identify the underlying cause of your sleep issues, construct a natural remedy plan that will reduce or eliminate your symptoms, and design a long-term health regime to help you get restful sleep and restore your quality of life.
For more info, please see: https://doctordoni.com/sleep-solutions.
*Please keep in mind that any and all supplements—nutrients, herbs, enzymes, or other—should be used with caution. My recommendation is that you seek the care of a naturopathic doctor (with a doctorate degree from a federally-accredited program) and that you have a primary care physician or practitioner whom you can contact to help you with individual dosing and protocols. If you ever experience negative symptoms after taking a product, stop taking it immediately and contact your doctor right away.