Is it time to get SASSY about your hormone balance?

We hear a lot about menopause and HRT in the media, this focus on menopausal women’s health is welcome and well overdue, but I wonder if it overlooks an opportunity to focus on hormonal health for all. Could we broaden the discussion to include people of all genders and ages; how can we all look after our hormonal health now and in the future? And can we discuss menopause in terms of more than just HRT? Can we take a holistic approach?

The Oxford English Dictionary definition of “sassy” (when used in a neutral or positive sense) is “self-assured, bold, or spirited;…vigorous, lively”. Could we all be self-assured and bold regarding our hormones? Perhaps we can if we pay attention to these SASSY factors:

S = Stress

A = Alcohol

S = Sleep

S = Sugar

Y = Yourself

In this article I’ll discuss each of these factors, how they affect your hormones (including around the time of the menopause but also at other stages) and give my top tips for simple changes in each of these areas which can have a positive impact on your hormonal health.

Stress

It is no co-incidence that I’ve put this first, in my clinic it the one factor that is affecting everyone who presents with some form of hormonal imbalance, and that is for good reason. Not all stress is bad, and the stress response evolved as a protective mechanism. In the acute phase this is the “fight, flight, or freeze” response where we release adrenaline and other hormones and neurotransmitters to allow us to fight that tiger or flee from it. More blood flows to your muscles, you have increased alertness, blood sugar rises, muscle tension increases, and a host of other adaptations that allow us to survive.

In modern life all too often the tiger is the constant pressure of work/family commitments/social isolation/life being too busy/past trauma and other stressors which are prolonged rather than temporary. This response becomes chronically activated and we go into chronic stress which is mediated by cortisol which is sometimes called “the stress hormone”. Again, this is the body’s attempt to help us survive and is adaptive e.g., at times of acute illness, but when this response is prolonged, it has a negative effect on the body, especially on your hormonal system.

Your body is just trying to help you survive – times of stress are not good times to procreate, and you need to hold onto weight because the stress might mean lack of food. So, sex hormones (oestrogen, progesterone, testosterone) reduce, and we may tend to gain weight around our abdomen. When we look at the hormonal pathways, we find nature has programmed this in – cortisol and the sex hormones produced through a common pathway. Simplistically put, if resources are directed into the stress pathway (to create cortisol which your body thinks you need to survive) then there is less available to put into making the other hormones.

Depending on your biological sex and life stage this will have different effects on your body such as:

worsen menopausal symptoms.
result in irregular or absent menstrual cycles in women of childbearing age.
contribute to endometriosis, heavy periods, PCOS, PMS or the more severe form PMDD.
cause reduced testosterone in men which can lead to erectile dysfunction, fatigue, and depression.

And for all it will result in a feeling of being tired and wired and can contribute to insomnia. Eventually if left unchecked we can burn out and get to the point of adrenal fatigue where we are tired all the time and can no longer mount the activating response.

This chronic stress response is at the root of a number of the other factors in the SASSY acronym so it’s important to address first, and I hope the above discussion has helped you to understand the foundational impact of this factor on your hormonal health. So, next question, what can we do to counteract this process and balance hormones?

The first and key step is to recognise if the chronic stress response is affecting you and give yourself permission to do something positive about it. One of the simplest ways to reduce the stress response is through breathing – start by taking just 5 minutes per day to sit and breathe, focusing in on your breath, breathing deep into your chest and abdomen, dropping your shoulders, feeling the air going deep into your lungs then gradually releasing that breath all the way out, feeling yourself relax and sink down more and more with each out breath. Or if a breath practice is not for you perhaps you find your relaxation response through yoga, laughing at a good comedy, a bath, listening to music... Whatever is your go to, spend time doing that, it is time well spent and your hormones will thank you!

Alcohol

At times of stress many of us may find our alcohol intake increasing but unfortunately alcohol consumption over time will increase cortisol levels, it contributes to the stress response detailed above. It also has direct effects via the brain, adrenals, signalling and detoxifying pathways which negatively impact our sex hormones, particularly progesterone and testosterone. This can lead to a situation of “oestrogen dominance” which is implicated in conditions such as endometriosis, PMS, PCOS, heavy menstrual bleeding, worsening of menopausal symptoms, poor response to HRT and reduced testosterone levels. Many people find in mid-life that their tolerance for alcohol declines or the hangovers get worse. This is the body being less able to metabolise the alcohol and more sensitive to its detrimental effects.

Some people find an app helpful to monitor and reduce their drinking (such as the free “Drink free days” app https://www.nhs.uk/better-health/drink-less/ ). For others it is important to work out why they are drinking (to relax, because they are hungry, to overcome shyness etc) and then find a more helpful way to fulfil that need. For example, a cup of herbal tea after work, enjoyed mindfully, and possibly combined with the breathing practice above can work wonders for de-stressing from the day. Or having an early evening meal rather than reaching for a glass of wine when feeling tired/hungry in the evening means you nourish your body with what it needs and the urge to have a drink passes.

Sleep

This is another really important factor, linked with the effects of cortisol/stress response discussed above. Stress and high cortisol levels contribute to insomnia, and insomnia worsens high cortisol levels. Better sleep results in more balanced hormone levels, but hormonal imbalance (such as low progesterone levels or the night sweats of menopause) negatively affects sleep. Two very tricky chicken and egg situations! The good news is that there are many approaches that can improve your sleep and once you start to make changes the benefits are cumulative.

Early morning natural light, or at this time of year using a “SAD lamp” can help to re-set circadian rhythms and encourage the release of melatonin (which initiates sleep) approximately 12-14 hrs after light exposure. So, watch your light exposure later in the day too – dim down indoor lighting and switch off screens at least an hour before bed otherwise you will delay that all important melatonin release.

Stress and alcohol are sleep stealers – avoiding both before bedtime and having an evening practice of offloading anything that’s been worrying you and then spending some time relaxing can be helpful. You could try writing things down to “empty your mind” then a breathing or meditation practice before bed.

Exercise can also promote sleep, taking regular physical activity during the day has more evidence of long-term benefit for sleep problems than any medication. So perhaps try putting on those trainers for a walk or taking the washing off the off the exercise bike and using it for a workout instead may be a key change for you.

Sugar

Blood sugar is important in the stress response – blood sugar spikes will increase cortisol levels, and stress/high cortisol will increase blood sugar. When your blood sugar goes up your insulin will increase, this also affects your sex hormones. High insulin causes the ovaries to produce more testosterone which may contribute to PCOS, acne and facial hair. Via its effects on hormone binding in the blood it is another factor which can lead to “oestrogen dominance” (see above). So, it’s not just diabetics who need to pay attention to their blood sugar, anyone suffering hormonal imbalance will benefit from a lifestyle approach to normalise blood sugar and insulin levels.

Eating a diet high in fibre, with good sources of plant based or lean animal protein and enough healthy fats will help to balance blood sugar and hormone levels. It’s not just sugary foods that can spike your blood sugar, anything containing carbohydrate is broken down into sugar and often quite rapidly. For a great pictorial representation of what impact foods have on sugar levels see this link https://phcuk.org/sugar/. Did you know that a 30g bowl of cornflakes is the equivalent of eating 8.4 teaspoons of sugar for breakfast?!?

Having said that carbohydrates are not the enemy and you do not have to go “low carb” if that’s not your thing. Ensuring each meal is a balance of protein, healthy fats, plenty of veg/salad and keeping your carbohydrates “complex” (e.g. wholegrain rather than white versions, whole fruits rather than fruit juice) will help to keep things in balance.

It is also important to have a reasonable overnight fast of at least 12 hours and consolidate daytime eating into balanced meals. Aim to avoid snacks unless there is a medical need to eat between meals. This will result in your blood sugar spiking less during the day and allow your gut to rest overnight which can improve sleep quality and bowel function.

Yourself

This word in the acronym is there to remind you to take care of yourself, that you are worth it and that it is essential to put on your own metaphorical oxygen mask before helping others. Many of the people I see who are suffering the effects of hormonal imbalance are racing around looking after or worrying about others, and often don’t take time for themselves. Or they are caught up in the busy-ness of modern life and don’t take time to get off the hamster wheel and look at what this constant activity and stress is doing to their bodies and hormone levels. Or they have past stress/trauma which they may have repressed. They need reminding that they are worth the time and care for themselves.

So, congratulations on making it to the end of this article and please now take a moment to check in with yourself…. Just for 2 minutes (you can set a timer if you feel the need!)

What in this article resonated for you?

What one change might you make after reading it (something listed here or even better your own idea for what may help YOU)?

Who, or what, can help make that change happen?

When will you start?

I would love to hear your answers, please do share via email to enquiries@thenaturalpractice.com or on our Facebook page.

If this article has got you thinking and you feel you would benefit from the personalised, holistic approach to health that we offer here at The Natural Practice please speak to reception about booking an appointment.

And for those women who would like to understand more about how a busy and stressful life can impact their hormones I can also recommend the book