Hormone health is a tricky subject for anyone, whether you just want to ride stronger, you’re considering getting pregnant, you’re decidedly not trying to get pregnant, or you’re just having some weird feelings and want to know what’s going on. Lia Sonnenburg, a doctor of naturopathic medicine in Collingwood, Ontario, sat down with naturopath Lia Sonnenburg for an interview to talk about some of the most common issues and the natural and lifestyle-oriented ways that we can get our hormones back in balance.
Can’t listen right now? Read the highlights of Lia’s interview here:
What are some of the chief complaints that you hear from female athletes?
I find in general, athletes don’t like to complain. But the more I question, the more I find things are going on. The biggest complain is that something has changed and someone wants to know why it’s changed—they have a harder time getting out of bed, they feel moody, performance isn’t going as well, or they feel like they’re not coping as well as they used to. There are so many things going on in everyone’s life, and we have to figure out what’s causing what.
For female endurance athletes, what are some of the signs of overtraining that you’ve seen?
The big piece that people don’t discuss is that their immune system is getting warn down and they aren’t recovering, so they get things like that 100 day cough. And little stuff just knocks them out and they just can’t kick it.
There are also nuisance afflictions, like athlete’s foot or bacterial vaginosis or yeast infections or hangnails that aren’t healing, that are annoying but not causing huge issues. That’s stuff I ask about early on, because it’s a good sign of overtraining: your body doesn’t have the ability to deal with those little things.
In that same vein, what are some red flags for hormonal imbalance in active women?
I see a lot female athletes having amenorrhea, or not having regular cycles and they’re really inconsistent, and I find a lot of women don’t complain about not getting their cycle! That’s a huge red flag, though, because we know there’s some kind of imbalance that’s preventing things from going the way they should. Other red flags are UTIs and vaginal yeast infections with relative frequency. Personal care plays a piece in that, but there may be a hormonal piece perpetuating it.
If a woman suspects her hormones are imbalanced, what are the first things she should do?
The first thing I like to see in women who are still having a normal cycle is to have them track it: how many days are your cycles, how heavy, how’s your mood, how’s your cramping, how’s your flow… we spend a lot of time talking about the cycle to figure out what’s going on. If they want a more aggressive approach, based on their family history and personal health history, we’ll talk about intelligent testing—we can test hormones in the blood, but those aren’t very accurate because they’re fat soluble and often bound to other molecules, so it doesn’t give us a good overall picture of what’s going on in the body. Saliva and urine testing are better options and give us a lot more useful information. That gives us an idea of how well you’re balanced.
How do you know what’s low?
It’s hard to know. We’re looking for an optimal range, and we can hone in on that with urine or saliva, but the blood ranges are so broad that it’s impossible to tell how to work with them. When it’s women’s health and the intricate pathologies, we really want to see how much E1, E2, E3, how we’re metabolizing those… and we don’t get those from blood tests.
Which hormones tend to be most out of whack?
I’ve seen it go in a lot of ways, but for serious athletes, everything tends to just be really low. So then we work on fortifying the adrenal glands. There are a lot of botanicals I’ll use to help regulate the pituitary, and make sure my patients have enough good fats in the diet.
Is it ever wise for someone to try to supplement with botanicals on their own?
I think a lot of people end up in my office after they try to do this! You should absolutely get a professional opinion. You need to find the right fit, the right quality, something that’s going to do what it’s supposed to. Often the quality in the off-the-shelf stuff isn’t great, or on the flip side, we’re making really strong versions of these and they can really change your hormones so you have to be methodical.
Natural ways to restore hormonal balance?
You can get started on this part without a professional! We always need the bowels to be functioning perfectly: good fiber, lots of fruits and veggies, clean meat sources, and that will help give you proper fuel as an athlete and for everything else happening in the body. Cleaning up your diet is key. The liver metabolizes hormones and throws them into the gut, and then you’re going to eliminate them through a bowel movement. So if you’re not going at least once a day, you’re going to have difficultly eliminating those hormones and you’ll reabsorb them and they’ll still really effect your hormone levels. People always wonder why I want them to change their diet to work on hormones, but you have to—the gut and liver need to be working well.
What about training and activity?
You don’t have to stop training. We want to optimize the physiology within the training necessary for them, but it’s hard to find that balance for the person. Making sure their diet and lifestyle are going smoothly, and making sure what they’re running off of for fuel is good quality. Exercise is an oxidative process so you need those antioxidants! You also need sleep as an athlete. Quality sleep, so you can recover properly.
On that topic, is supplementing with hormones ever helpful?
If we step outside of athletes, yes, it can be helpful. I’ve seen women with horribly heavy menses and a couple months of birth control will get us to a playing field where we don’t have this bleeding and they’re not fainting at work. Drugs have their use here and there, and in acute care, they can help. But for a long-term strategy, I don’t think they work. It does get prescribed often because it’s easy to prescribe and it almost always does the trick in terms of regulating a cycle, and GPs don’t know about many other options. But there are other options out there!
Birth control and athletes: it messes with your hormones and constant training doesn’t help… But what can a woman who wants to make sure she stays not pregnant do to keep her hormones functioning properly?
Even with the birth control pill, I tell patients it’s best to have two methods. I see the extreme cases, I’ve seen a ton of women get pregnant on the Pill.
What about athletes hoping to get pregnant?
I’ll sound like a broken record, but track your cycle, make sure it’s regular. If you have been on birth control, it would be a great idea to wait a couple cycles until your hormones have come back to themselves. You’re having an artificial cycle on birth control, so give yourself some time to get used to it again. Minimum four cycles to clean out the pipes!
Do you ever deal with hormone issues in athletic men?
I don’t deal with it as often, but I have seen it. It usually comes with poor performance, poor recovery, being sick all the time… It’s similar to hormonal imbalance in women. It’s usually that testosterone is a bit low. We’d try to make sure everything you need to make testosterone is there: are you consuming enough selenium, enough zinc? And there are herbs that help supplement the production, but they’ll definitely increase levels so they do need to be monitored. Don’t try to do it on your own! It’s hard, as an athlete. You train and you know you’re capable of so much but things aren’t working.
If you had to sum up in just a couple sentences the best way an athlete can stay in-balance with overall health while still working towards her athletic goals, what would you say?
Big world picture is to be in tune with your body and your health. Don’t discredit your own knowledge of your body, and don’t turn a blind eye when those warning signs are going off. Just because something is common with athletes, or common with your friends, that doesn’t mean it’s right or normal. We can optimize your hormones and make them function the way that they should. Be proactive and be aware of when not to push yourself. You depend a lot on your body so you need to give yourself high performance fuel to get high performance for yourself. Avoid anything that’s going to knock you off your feet or tax your body.